Iimvumi ze-cardiac (igama elidala), okanye i-cardiac biomarkers (igama elitsha), iimvavanyo zegazi ezisetyenziselwa ukufumana umonakalo kwiiseli zentliziyo. Iimpawu ze-cardiac biomarkers ziyi-protein ezisuka kwintsholongwane yeentliziyo eziye zangena kwigazi emva kokulimala kwesifo senhliziyo. Xa amanqanaba egazi lala ma-biomarker aphakanyisiwe, kuthetha ukuba kukho umonakalo kwi-heart muscle.
Ezi mvavanyo ziyiluncedo ekuhloleni iziphene ze-myocardial (ukuhlaselwa kwintliziyo) , kodwa ngoku sele zisetyenziselwa ukufumanisa umonakalo wentliziyo yezinye izizathu, ngokunjalo-ezifana nokulimala kabuhlungu okanye i- myocarditis .
I-kinine ye-creatase ne-troponin ziyi-proteins ezimbini ngoku zilinganiswe kwiimvavanyo ze-biomarker.
Indlela "Uvavanyo lwe-Enzyme yeCardiac" lwaba yi-"Cardiac Biomarker Test"
I-kinine ye-Creatine yayingumzekelo wokuqala weprotheni ye-cardiac esetyenziswa kakhulu oogqirha ukuze bancede bafumene ukuhlaselwa kweentliziyo, kwaye i-kinase idale i-enzyme-iprotheni eyanceda ukuzisa indlela ethile yokwenza i-biochemical reaction. Ngenxa yoko, ukuhlolwa kwegazi ukufumanisa ukuhlaselwa kwintliziyo kwakubizwa ngokuba yi-enzyme ye-cardiac.
Nangona kunjalo, i-troponin iye yaba yiprotheyini yegazi ebaluleke kakhulu ekusebenziseni ukufumanisa umonakalo wefestile yeentliziyo, kwaye i-troponin ayiyona inzyme. Kunoko, i-troponin iyinkimbinkimbi yeeprotheni ezilawulayo ezibalulekileyo ekuqhekekeni kwesifo senhliziyo.
Xa i-troponin efumene igazi, kuyisalathisi esithembekileyo sokuthi umonakalo wentliziyo yesimo senzeka. Ngenxa yokuba i-troponin ayilona i-enzyme, oogqirha abaninzi ngoku babhekisela "kwiimvavanyo ze-biomarker" esikhundleni se "iimvavanyo ze-enzyme."
Uvavanyo lwe-Biomarker lusetyenziswa njani?
Ukulinganisa ama-biomarkers ngokuqhelekileyo kubalulekile kwisinyathelo sokuqala ekufumaneni ukuhlaselwa kwentliziyo.
Namhlanje, i-troponin yi-biomarker ekhethiweyo esetyenzisiweyo kule njongo, kuba ngumakishi othe ngqo (kunye nommakethi othethekileyo) kwi-heart damage yomdaka kune-creatine kinase. Uninzi oogqirha baya kuqhubeka babalinganisa i-troponin kunye nokudala amanqanaba e-kinase xa kukhankanywa intliziyo ye-heart - kodwa ingaba umlinganiselo we-creatine kinase usongeza kakhulu kwiinkathalo zonyango ungathandabuzeki.
Xa kuhlaselwa intliziyo, ukukhululwa kweeprotheni zeentliziyo zegazi kwi-bloodstream ngokuqhelekileyo kulandela iphethini eqhelekileyo kwixesha leeyure. Ngoko, ukuqinisekisa ukuba ukuhlaselwa kwentliziyo kwenzekile kufuna ukuhlolwa kwegazi ezininzi kwixesha elide, kubonisa ukunyuka nokuhla kwamanqanaba e-biomarker.
I-creatine kinase ikhutshwa kwigazi emva kweeyure ezingama-4 ukuya kwe-6 emva kokuba umonakalo weeseli zentliziyo zenzeke, kwaye iqondo legazi le-creatine kinase libonakala emva kweeyure ezingama-24. Amanqanaba e-creatine ephakamileyo aphakanyisiwe ngokuqhelekileyo, kodwa akusoloko ebonisa, umonakalo wentliziyo yomonakalo. Amanqanaba e-kinase ngamanye amaxesha anganyuswa kunye nomonakalo kwezinye iindidi zeeseli ngokunjalo, kuba ikhona nakwii-cell ze-muscle zangasese.
I-Troponin ikhutshelwe kwigazi ukuya kwiiyure ezingama-6 emva kokulimala kweeseli zeentliziyo, kwaye amanqanaba egazi aphakame kwiiyure eziyi-12 ukuya kuma-26.
Amanqanaba aphakamileyo we-troponin abanjwe njengesalathisi esithembekileyo somonakalo wenthambo yenhliziyo kunamazinga aphezulu e-creatine kinase.
Ngenxa yokuba i-troponin "umonakalo" we-cell dialac umonakalo ongaphezu kwe-creatine kinase, kwaye ngenxa yokuba ichanekile ngakumbi ekubonakaliseni umonakalo we-cell cell kune-creatine kinase, i-troponin ngumxhasi okhethiweyo namhlanje ukufumanisa ukuhlaselwa kwentliziyo.
Ngaba Ziziphi Iimpawu Ezixhamlayo?
Xa isiguli sinesifo se-myocardial esiphakamileyo kunye nesigaba se- STG ( i-"STEMI" ), umzekelo we-ECG ngokwawo, kunye neempawu zekliniki, zihlala ziwanele ukwenzela ukuchongwa ngokuchanekileyo.
Ngoko nge-STEMI akukho mfuneko ukuba ugqirha alinde iziphumo zovavanyo lwe-biomarker ngaphambi kokuqalisa unyango.
I-Biomarkers iyanceda kakhulu kubantu abaneentliziyo ezihlaselekileyo ezingenayo i-STEMI eqhelekileyo, oko kukuthi, kubantu ababenayo "i-NSTEMI" . Nge-NSTEMI iinguqu ze-ECG zihlala zingabalulekanga, ngoko kunzima kakhulu ukwenza ukuxilongwa ngokuchanekileyo kusekelwe kwi-ECG kunye neempawu zodwa. Apha, uvavanyo lwe-biomarker luhlala lugxininise ekunqumeni ukuba ngaba unyango olunzima lokuhlaselwa kwentliziyo lufuneka.
Kubantu abanesiseko seNSTEMI, uvavanyo lokuqala lwegazi lwe-biomarker lungaba luhlu "olungagqibekanga". Kule meko, ukuhlolwa kwegazi lesibini emva kweeyure ezimbalwa kamva kuya kubonisa ukuba iinqanaba le-troponin (okanye ukudala amanqanaba e-kinase) zibonisa umzekelo wokunyuka nokuwa kwezinto ezibonakalayo ngokuhlaselwa kwentliziyo.
Kwiminyaka yakutshanje, i-troponin i-assay-high-senitivity test ephakanyisiwe ukuba, kubantu abaninzi abane-NSTEMI, ivumela ukuxilongwa ukuba kwenziwe uvavanyo olulodwa lwegazi, ngaloo ndlela vumela ukuba unyango luqale ngaphambi kokunye okunokulucebisa.
Ziyintoni Ebangelwa "Ubuxoki" Ukuphakama Kwezinto Eziphilayo?
Akukho konke ukuphakama kwimizimba yeentliziyo ezibonakalisa ukuhlaselwa kwentliziyo.
Amanqanaba e-kinase angakwazi ukuphakanyiswa naluphi na ukulimala kwemisipha, okanye umonakalo kwingqondo okanye kumaphaphu, okanye ngesibindi okanye isifo sesifo.
Ukuphakanyiswa kwinqanaba legazi le-troponin lichanekile ngokuchanekileyo kwimizimba yesifo senhliziyo, ngokuthe ngqongqo, akukho nto "into engamanga" yokuphakama kwe-troponin. Nangona kunjalo, umonakalo kwimizimba yesifo sinokuvela ngenxa yezizathu ngaphandle kokuhlaselwa kwentliziyo. Ezi meko zingabandakanya ukungaphumeleli kwintliziyo , i-myocarditis, i-fibrillation ye-atrial ephawulezileyo , i- sepsis , i- coronary artery spasm , i- aortic dissection , i- cardiomyopathy , okanye i- pulmonary .
Yingakho ukuxilongwa kwesifo senhliziyo akuxhomeki kuvavanyo olulodwa lwegazi, kodwa nakwiimpawu zeklinikhi, utshintsho lwe-ECG, kwaye (ngokuphindaphindiweyo) kwipatheni yokuphakanyiswa kwe-biomarker ebonisa ukulimala kwentsholongwane yenhliziyo.
ILizwi
Iimpawu ze-cardiac ziyi-protein ezangena kwigazi xa kukho umonakalo kwintliziyo yesisu, njengentlungu yesifo. Iimvavanyo ze-Biomarker zisoloko zi luncedo ekwenzeni ukuxilongwa ngokukhawuleza kokuhlaselwa kwentliziyo, ukwenzela ukuba unyango lokuqala luqaliswe.
> Imithombo:
> IMills NL, Churchhouse AM, Lee KK, et al. Ukuphunyezwa kwe-Troponin I-Assay ne-Risen ye-Myocardial Infarction ephindaphindayo kunye nokufa kwabagulane abane-Acon Coronary Syndrome. JAMA 2011; 305: 1210.
> Thygesen K, Mair J, uKatus H, et al. Iingcebiso zokusetyenziswa kweCardiac Troponin Measurement in Care Care Cardiac. I-Eur Heart J 2010; 31: 2197.