Ndi mapeputisayidi natriuretic chiyani?

Monga tanena kale posachedwapa, kuwonjezera zoonekeratu ntchito mtima amachita udindo wa endocrine limba. Ndi chidwi osati mwa theorists wa mankhwala, komanso pakati kutsatilidwa. Natriuretic mapeputisayidi (NUP) amalembedwa osati myocardium, komanso chiwerengero cha ziwalo zina za m'kati, poyamba lilibe ntchito endocrine. Chinapangidwa chisankho limodzi ntchito kachulukidwe zizindikiro NFA magazi kwa ulosi wa pathologies mtima, monga njira imeneyi anali wamng'ono olanda mosavuta wodwalayo.

Kupezeka kwa endocrine ntchito ya mtima

mapeputisayidi Natriuretic akhala anapeza mu Mipingo ya atumwi wotsiriza, asayansi adaona kugwirizana pakati pa mavuto a zipinda za mtima ndi mphamvu ya katulutsidwe wa mkodzo. chotulukira poyamba kuti anali chodabwitsa reflex ndi kuupereka kutanthauza.

Kenako, pamene phunziro la funso limeneli anachokera pathologists ndi histology, iwo anapeza kuti maselo a minofu, gawo la atrium, pali inclusions munali zedi okha. Zakhala experimentally anatsimikizira kuti Tingafinye ku atria makoswe umabala wamphamvu diuretic kwenikweni. Ndiye anakwanitsa kusakonda ndi peputayidi ndi ndondomeko ya zatsalira kwa amino asidi zomwe zimapanga izo.

Patapita nthawi, biochemists apeza mapuloteni mu zigawo zitatu (Alpha, beta ndi Popanga madzi a gamma), osiyanasiyana osati dongosolo mankhwala, koma ali ndi zotsatira za Alpha kuposa ena awiri. Panopa wolemekezeka:

- matenda NUP (mtundu A);
- NUP oziziritsa (mtundu B);
- urodilatin (mtundu C).

Sayansi natriuretic peputayidi

mapeputisayidi onse natriuretic ofanana mu dongosolo ndipo amasiyana kokha pa mapeto ankafuna kusintha zinthu mopitirira nitrogenous kapena makonzedwe a maatomu mpweya. Lero, chisamaliro lolunjika pa akatswiri NUP mtundu B, monga umakhala wolimba mu madzi a m'magazi, komanso zimathandiza kuti zotsatira zina nkhani. Matenda NFA atenge mbali ya munthu wa correctors wa madzi ndi electrolyte bwino thupi. Chifukwa amapangidwa mu myocardium mu yachibadwa ndi zoopsa aakulu mtima.

Iwo imatsimikizirika kuti n'zofanana ndi ubongo NUP tichipeza zatsalira 108 kwa amino asidi ndi apanga ndi maselo a ventricle kumanzere. Pamene molekyulu otshnurovyvaetsya ku cytoplasm, ndi puloteni furin kuchita pa izo, zomwe zimapangitsa mapuloteni izi mu maonekedwe ake yogwira (32 kwa amino zidulo ya 108). NUP ubongo uli mwazi wa mphindi 40, ndiye linakwiriridwa. Kuwonjezeka mapuloteni kaphatikizidwe kugwirizana ndi mwai mavuto yamitsempha yamagazi khoma ischemia mtima.

Excretion UNYP kuchokera m'madzi imagwiridwa mu njira ziwiri zikuluzikulu:

- pogawanikana pamawere wa michere lysosomal;
- proteolysis.

A otsogolera ndi kudzipatula mphamvu pa ndale endopeptidase molekyulu, koma njira zonse zimathandiza kuti Kupha mapeputisayidi natriuretic.

dongosolo cholandilira

mavuto onse a mapeputisayidi natriuretic zimagwiridwa chifukwa mogwirizana ndi maselo awo inali ku ubongo, mitsempha ya magazi, minofu, mafupa ndi minofu adipose. Chofanana kwa mitundu itatu NFA ndipo pali mitundu itatu ya maselo - A, B ndi C. Komabe, kufalitsa "ntchito" sangaone:

- zolandilira mtundu A kucheza ndi matenda ndi ubongo NUP;
- mtundu The amachitira okha urodilatin;
- maselo akhoza kumumanga kwa mitundu itatu mamolekyulu.

Zolandilira mwapadera Chrixitu. Mitundu A ndi B yadaikidwa kuti litsatira zotsatira okhudza maselo ambiri a maselo natriuretic peputayidi ndi mtundu C zifunika kwa biodegradation wa zedi. Pali nkhambakamwa kuti padzuwa la UNYP oziziritsa ikuchitika osati ndi mtundu A cholandilira, komanso ndi mbali zina cholinga omwe amatsatira kuchuluka kwa ozungulira guanosine monophosphate.

Chiwerengero chachikulu cha mtundu C zolandilira opezeka minofu ubongo, zopangitsa adrenal, impso, ndi zotengera. Pamene UNYP molekyulu chimamanga kwa lilime la mtundu C, ndi chosakanikirana ndi foni ndipo lamamatira ndi lilime ufulu amagwanso Kakhungu lapansi.

Maphunziro Akakhalidwe Kazolengedwa natriuretic peputayidi

Ubongo ndi matenda mapeputisayidi natriuretic kusonyeza zotsatira zawo kudzera dongosolo mayankho zovuta zokhudza thupi. Koma iwo onse kudzabadwira cholinga chomwecho - kuchepetsa preload pa mtima. NUP amakhudza mtima, endocrine, excretory ndi chapakati mantha dongosolo.

Popeza mamolekyulu awa ndi kuyandikana kwa maselo osiyanasiyana, yapadera, zotsatira za mitundu ina ya NFA pa dongosolo makamaka, n'zovuta. Komanso, peputayidi zotsatira zimatengera osati mtundu wake, koma pa malo cholinga cholandilira.

Matenda natriuretic peputayidi amatanthauza mapeputisayidi vasoactive, i.e. zotsatira mwachindunji awiri mtima. Koma kupatula kuti akhoza kupangidwa kwa okusayidi nitric amenenso amalimbikitsa vasodilation. NUP A ndi B ndi yofanana ndi njira mphamvu kanthu pa mitundu yonse ya ziwiya, P-mtundu kwakukulukulu zambiri mitsempha yekha.

Posachedwapa ena amanena kuti NFA ayenera anazindikira osati monga vasodilator, koma makamaka ngati antagonist wa vasoconstrictor. Komanso, pali maphunziro amene akusonyeza kuti mapeputisayidi natriuretic zimakhudza kufalitsa madzimadzi mkati ndi kunja kwa maukonde capillary.

Zotsatira aimpso wa peputayidi natriuretic

Za peputayidi natriuretic tinganene kuti ndi stimulant diuresis. Makamaka NUP mtundu A kumawonjezera aimpso magazi ndi kumawonjezera kuthamanga ziwiya glomeruli lapansi. Zimenezi, kumaonjezera kusefera glomerular. Pa wofanana nthawi NUP C kumawonjezera excretion wa ayoni sodium, ndipo zimenezi zimapangitsa kuti imfa zina za madzi.

Ndi zonse za kusintha kwambiri dongosolo kuthamanga si anati, ngakhale mlingo peputayidi kuchuluka kangapo. Akatswiri onse amavomereza kuti zotsatira za kuti mapeputisayidi natriuretic khama pa impso, ndi koyenera kuti awongolera madzi ndi electrolyte bwino mu pathologies aakulu a dongosolo mtima.

Zotsatira pa CNS

Brain natriuretic peputayidi monga matenda, sangalowerere magazi ndi ubongo chotchinga. Choncho, bwanji mantha dongosolo nyumba ili kunja. Koma pamene ena mwa NFA ndi tochoka ndi nembanemba ubongo ndi malo ena.

Zotsatira chapakati mapeputisayidi natriuretic pa choona kuti ya limbitse alipo kusintha zotumphukira. Choncho, mwachitsanzo, pamodzi ndi kuchepetsa mtima preload thupi amachepetsa kufunika kwake kwa madzi ndi mchere salt, ndi chimasintha kamvekedwe ka mantha dongosolo autonomic ku mbali ya gawo parasympathetic.

zolembera zasayansi

Ganizo kutenga natriuretic peputayidi kusanthula pa matenda a dongosolo mtima unachokera mu oyambirira 90 ntchentche Mu zaka zapitazo. Pambuyo pa zaka khumi, mabuku oyamba ndi zotsatira za kafukufuku mderali. Zinamveka kuti B-mtundu NPU nkhani pamene akuona mwamphamvu chifukwa chakuti mtima ndi akuneneratu kupitilira matenda.

Mapuloteni zomwe anatsimikiza magazi venous lonse, wothira EDTA, kapena pogwiritsa ntchito kusanthula immunochemical. Bwinobwino UNYP mlingo sayenera upambana 100 ng / ml. Komanso, n'zotheka kudziwa mlingo wa kalambulabwalo NFA kudzera njira electrochemiluminescent. mankhwala zoweta, wopanda zosiyanasiyana zimenezi ntchito zogwirizana immunosorbent zofufuza ngati njira chilengedwe cha kudziwa kuchuluka kwa zinthu mu seramu magazi.

Khama la kukanika mtima

Natriuretic peputayidi (ponseponse - mpaka 100 ng / ml) panopa otchuka kwambiri ndi zambiri zamakono chikhomo chifukwa kudziŵa mtima minofu kukanika. The maphunziro loyamba mapeputisayidi anali kumayambitsa mavuto zosiyanasiyana cha matenda kulephera magazi ndi aakulu obstructive matenda m'mapapo mwanga. Popeza zizindikiro matenda zinali zofanana, mayeso kumathandiza kupeza chifukwa cha matenda ndi kulosera za pofuna kukwaniritsa matenda.

The kudwala lachiwiri, limene kakusintha kuphunzira mmene izi, anali ischemic matenda a mtima. Olemba maphunziro amavomereza kuti tanthauzo la mlingo NFA amathandiza kukhazikitsa Akuti imfa kapena zisadzachitikenso wodwalayo. Komanso, mphamvu kutsatira NFA msinkhu ndi chikhomo cha efficacy chithandizo.

Panopa, mlingo wa NFA anatsimikiza odwala ndi cardiomyopathy, matenda oopsa, stenosis ziwiya zazikulu ndi matenda ena magazi.

Ntchito opaleshoni ya mtima

Empirically kwavumbulutsidwa kuti mlingo wa matenda natriuretic peputayidi magazi angathe kuonedwa monga chizindikiro cha zovuta chikhalidwe ndi ntchito ya ventricle kumanzere odwala pamaso ndipo pambuyo opaleshoni ya mtima.

Kuphunzira zodabwitsazi inayamba mu 1993, koma anafika zambiri mu 2000s ndi. Anapeza kuti kufooka lakuthwa chiwerengero cha NUP m'magazi zotumphukira, ngati pamaso mlingo wake wakhala mosalekeza akweza, zikusonyeza kuti ntchito ya myocardium ndi yafupika ndi opareshoni wopambana. Ngati kuchepetsa NFA sizinkachitika, wodwalayo anafa ndi 100% Mwina. Kubverana msinkhu, kugonana ndi mlingo wa peputayidi akhala kuzindikiridwa Choncho, chithunzi ichi ndi chilengedwe cha magulu onse odwala.

Kulosera tsogolo la matenda pambuyo opaleshoni

Asanachite opareshoni mtima natriuretic peputayidi kuchuluka. Ndipotu, ngati mutero, ndiye chithandizo kulibe. The mkulu mlingo wa odwala NFA pamaso chithandizo ndi chinthu akumane kwakukulu umachititsa kuti madokotala ananena zawo pambuyo opaleshoni.

Popeza gulu osankhidwa kuphunzira ndinali wamng'ono, zotsatira zinaphatikizana. Pa dzanja limodzi, kudziwa mlingo wa NFA pamaso ndipo pambuyo opaleshoni imathandiza madokotala kulosera omwe mankhwala ndi chithandizo chida zidzafunika kumaliza ayambe mtima ntchito zake. Komanso anazindikira kuti kochulukira kuchuluka kwa NUP mtundu B ndi kalambulabwalo wa fibrillation matenda mu nyengo postoperative.