医学课件止血凝血机制

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1、止血、凝血机制正常止血机制初期止血血管内皮细胞损伤，内皮下组织成分暴露（主要为胶原），血小板发生黏附、聚集和释放反应，形成血小板血栓二期止血凝血、抗凝和纤溶诸系统相互协调、有序完成的过程，血浆中一系列凝血因子经级联酶促反应依次被活化,最终形成纤维蛋白凝块Normalhemostasis（止血）VIIVIITF-VIIaXXaIIIIaFbgnFibrinsIXTFFibrinpVIIIVTFTF-VIIaIXaadhesion粘附aggregation聚集coagulationpathway凝血途径初期止血机制TXA2ADP纤维蛋白原凝血酶PF4-

2、TGPDGF纤维蛋白PGI2聚集白色血栓释放粘附vWFECSE++FibrinFibrinogenProthrombinThrombinFVaFXFXaFVIIIaFIXaTF/FVIIaGenerationofthrombinTF/FVIIaPlateletsadheretoVWFboundtosub-endotheliumcollagenTheplateletisactivatedandfibrinogenandotheradhesiveproteinsengagewithGpIIb/IIIaTissuefactorinitiatesthrom

3、bingeneration.ThrombinactivatesfactorsVandVIIIThrombinconvertsfibrinogentofibrinFibrinactsasacofactorforthrombin-dependentFXIIIactivation.++FVIIIFVProcoagulantFibrinFibrinogenProthrombinThrombinFVaFXFXaFVIIIaFIXaProcoagulantrolesforthrombinTF/FVIIaFXIIIFXIIIaCrosslinkedfibrin1

4、234TF/FVIIaThrombinbindstoGpIba,cleavesPARandGpV(notshown)andfurtheractivatesplateletsPlateletActivatedPlateletexposure/engagementGpIIb+GpIIIaGpIba+GpIb+GpIX+GpVGpIa+GpIIaProcoagulant++FibrinFibrinogenProthrombinThrombinFVaFXFXaFVIIIaFIXaTF/FVIIa5PARsactivatedProcoagulantroles

5、forthrombin6GpVcleavedTF/FVIIaThrombinboundtoGpIbaactivatesFXI,leadingtofurtherthrombingeneration++ProcoagulantFibrinFibrinogenProthrombinThrombinFVaFXFXaFVIIIaFIXaProcoagulantrolesforthrombinTF/FVIIaFXIIIFXIIIaCrosslinkedfibrinFXIa7TF/FVIIaThrombinproteolyticallyinactivatesAD

6、AMTS13,preventingdestabilisationoftheplateletplug++FibrinFibrinogenProthrombinThrombinFVaFXFXaFVIIIaFIXaPlatelet-plugenhancingroleofthrombinTF/FVIIaHighMWvWFmultimersLowerMWvWFmultimersADAMTS13X8TF/FVIIaThehaemostaticplugexpandsinanunregulatedmannerCofactorcompetitionbetweenTM

7、andfibrinabruptlyhaltsplugexpansion++ThrombomodulinFibrinFibrinogenProthrombinThrombinFVaFXFXaFVIIIaFIXaAnti-fibrinolyticroleofthrombinTF/FVIIaTAFITAFIaInhibitionoffibrinolysis9TF/FVIIa(VIIa)Xa,IXaCa2+VIIaIIaTM+IIaVIIaIIaCoagulationwaterfallPrecallicreinaXIIXIIaXIXIaIXIXaTFXXa

8、VIIIaVaIIIIaFibrinclotXIIIaXIIIChininogenProteinCAPCPSInhibit