内科学 出血性疾病(英文).ppt

Antithrombin III (AT): This is an inhibitor of serine protease enzymes synthesized by liver and endothelial cells which binds and directly inactivates thrombin and the other serine proteases (Factors IXa, Xa., and XIa).The activity of AT3 is dramatically enhanced by the presence of heparan. Protein C : Proteins C and S are both Vitamin K dependent glycoprotein. thrombomodulin is the endothelial cell membrane surface protein and regarded as receptor of thrombin. Thrombin binds to thrombomodulin and form a complex. It activates circulating protein C. The APC then inactivate Factors Va and VIIIa. Protein S acts as a cofactor for APC,can markedly enhances the activity of protein C. TFPI: endothelial cell is the major site of its production. Anticoagulation mechanism:1. Anti factor 10 directly;2. Anti TF/7a complex, in the presence of calcium. Heparin:a kind of sulfate mucopolysaccharide.is synthesized by mast cells. Its anticoagulation mechanism is closely concerned with AT3. First, heparin binds to AT3, cause the change of configuration of AT3, then the active center exposed, binds and directly inactivates thrombin and the other serine proteases (Factors IXa, Xa., and XIa). 抗凝血酶Ⅲ:是人体内最重要的抗凝物质，生成于肝及血管内皮细胞，主要功能是灭活FⅩa和凝血酶，对Ⅱа、Ⅸа、Ⅹа、Ⅺа，Ⅻа有灭活作用。 蛋白C（PC）抗凝系统 由PC、蛋白S（PS）、血栓调节素（TM）及蛋白C抑制物（PCI）所组成； PC和PS属于维生素K依赖性蛋白质。 凝血酶+TM→激活PC→APC，与PS、Ca++形成复合物→灭活Ⅴa、Ⅷa；激活纤溶酶原。 组织因子途径抑制因子（TFPI）→先与Xa结合，再与TF/Ⅶa复合物相结合→抑制外源性凝血的起始反应。 Plasminogen;纤溶酶原；Tissue-type plasminogen activator(t-PA)：组织型纤溶酶原活化剂；Urokinase- type plasminogen activator(u-PA)：尿激酶型纤溶酶原活化剂；Inhibitors:α2-plasmin inhibitor(α2-PI)：纤溶酶抑制剂, plasminogen activator inhibitor-1(PAI-1)： Fibrinolysis system is activated through 2 pathway: in and extrinsic pathway. In-p: this pathway is closely concerned with the in-p of blood coagulation. When factor 12 is activated, it can convert prekallekrein to kallekrein, the latter one activate the plasminogen to plasmin, then fibriolysis system is initiated. Ex-p:when vascular endothelial cell surf