Ama-enzyme enhliziyo (igama elidala), noma ama-biomarker enhliziyo (igama elisha), kukhona ukuhlolwa kwegazi okusetshenziselwa ukubona ukulimala kwamangqamuzana e-muscle yenhliziyo. Ama-biomarker we-cardiac amaprotheni avela emangqamuzanini e-muscle ye-heart aphumile egazini ngemuva kokulimala komzimba we-cardiac. Uma amazinga wegazi lala ma-biomarker ephakanyisiwe, kusho ukuthi kungenzeka ukuthi kube nomonakalo kumisipha yenhliziyo.
Lezi zivivinyo ziwusizo kakhulu ekuhloleni ukuhlukunyezwa kwe-myocardial (ukuhlaselwa kwenhliziyo) , kodwa manje sekusetshenziselwa ukubona ukulimala kwamangqamuzana enhliziyo kwezinye izimbangela, kanye - njengokungathi ukulimala kabuhlungu noma i- myocarditis .
I-creatine kinase ne-troponin yizi-proteine ezimbili okwamanje ezilinganisiwe ekuhlolweni kwe-biomarker.
Yeka ukuthi "Ukuhlolwa kwe-Cardiac Enzyme" kwaba kanjani "Ukuhlolwa kwe-Cardiac Biomarker"
I-creatine kinase yiyiprotheni yokuqala yomzimba esetshenziswa kakhulu odokotela ukusiza ukuxilonga ukuhlaselwa kwenhliziyo, futhi i-creatine kinase iyi-enzyme - iphrotheni esiza ukuletha ukusabela okuthile okuphilayo. Ngenxa yalesi sizathu, ukuhlolwa kwegazi ekuhloleni ukuhlaselwa kwenhliziyo kwakubizwa ngokuthi ekuqaleni kwe-enzyme test test.
Kodwa-ke, i-troponin iye yaba yi-protein yegazi ebaluleke kakhulu esetshenziselwa ukuthola umonakalo we-cell cell, kanti i-troponin akuyona i-enzyme. Kunalokho, i-troponin iyinkimbinkimbi yamaprotheni alawulayo okubalulekile ekuphambeni kwemisipha yomzimba.
Lapho i-troponin ithola igazi, kuyisibonakaliso esinokwethenjelwa sokuthi umonakalo wamangqamuzana enhliziyo kwenzekile. Ngenxa yokuthi i-troponin ayilona i-enzyme, odokotela abaningi manje babhekisela "ekuhlolweni kwe-biomarker" esikhundleni se "ukuhlolwa kwe-enzyme."
Izivivinyo ze-Biomarker zisetshenziswa kanjani?
Ukulinganisa ama-biomarker ngokuvamile kuyisinyathelo esibalulekile sokuqala ekuhloleni ukuhlaselwa kwenhliziyo.
Namuhla, i-troponin yi-biomarker ekhethiwe esetshenziselwa le njongo, ngoba iyimakethi ecacile kakhulu (futhi futhi nomaka ozwelayo) wengozi ye-muscle yenhliziyo kune-creatine kinase. Odokotela abaningi bazoqhubeka bekala kokubili amazinga we-troponin nama-creatine kinase uma kuhlaselwa isifo senhliziyo - kodwa noma isilinganiso se-creatine kinase sinezela kakhulu ekunakekelweni kwemitholampilo kuyinto engabaza.
Lapho kuhlasela isifo senhliziyo, ukukhululwa kwamaprotheni e-cell cell egazini ngokuvamile kulandela iphethini evamile esikhathini esingamahora. Ngakho-ke, ukuqinisekisa ukuthi ukuhlasela kwenhliziyo kwenzekile kuvame ukudinga ukuhlolwa kwegazi eziningana esikhathini esithile, kubonisa ukukhuphuka nokuwa kwamazinga we-biomarker.
I-Creatine kinase ikhiphelwa egazini elingama-4 kuya ku-6 amahora ngemva kokulimala kwamangqamuzana enhliziyo, futhi amazinga wegazi we-creatine kinase abonakala emva kwamahora angu-24. Amazinga aphezulu e-creatine kinase ngokuvamile, kepha hhayi ngaso sonke isikhathi, akhombisa ukulimala kwenhliziyo. Amazinga e-Creatine kinase ngezinye izikhathi anganyuka ngomonakalo kwezinye izinhlobo zamaseli, ngoba nawo akhona kuma-cell muscle angenayo inhliziyo.
I-Troponin idedelwa egazini lika-2 kuya ku-6 amahora ngemuva kokulimala kwamangqamuzana enhliziyo, futhi amazinga egazi aphezulu emahoreni angu-12 kuya kwangu-26.
Amazinga aphezulu we-troponin abhekwa njengesibonakaliso esinokwethenjelwa senhliziyo yomonakalo wemisipha kunamazinga aphezulu e-creatine kinase.
Ngenxa yokuthi i-troponin iyimpawu zokulimala kwamangqamuzana ekhanda kune-creatine kinase, futhi ngenxa yokuthi inembile kakhulu ekuboniseni umonakalo wamangqamuzana ekhanda kune-creatine kinase, i-troponin iyimakethi ekhethiwe namuhla yokuthola ukuhlaselwa kwenhliziyo.
Ngabe Ama-Biomarkers Awusizo Kakhulu?
Uma isiguli sinomkhuhlane we-myocardial we-myocardial nge-ST-ingxenye ekukhuphukeni kwe- ECG ( "STEMI" ), iphethini le-ECG ngokwayo, kanye nezimpawu zomtholampilo, ngokuvamile kuvame ukwenza ukuxilongwa okulungile.
Ngakho nge-STEMI ngokuvamile akudingekile ukuba udokotela alinde imiphumela yesilingo se-biomarker ngaphambi kokuqala ukwelashwa.
Ama-biomarkers ayasiza kakhulu kubantu abanokuhlasela kwehliziyo okunamandla abangenayo i-STEMI evamile, okungukuthi, kubantu abano "NSTEMI" . Nge-NSTEMI izinguquko ze-ECG zivame ukungabi yizici, ngakho-ke kunzima kakhulu ukwenza ukuxilongwa okulungile okusekelwe ku-ECG nezimpawu zodwa. Lapha, ukuvivinywa kwe-biomarker kuvame ukugxila ekunqumeni ukuthi ngabe kuyadingeka yini ukwelashwa okunamandla ukuhlaselwa kwenhliziyo.
Kubantu abanesifo se-NSTEMI, ukuhlolwa kwegazi lokuqala kwe-biomarker kungase kube "ebangeni" elingenamkhawulo. Kulokhu, ukuhlolwa kwegazi okwesibili amahora ambalwa kamuva kuzokuveza ukuthi amazinga we-troponin (noma amazinga e-kinase) aveza indlela ejwayelekile yokukhuphuka nokuwa ebonakala ngokuhlaselwa kwenhliziyo.
Eminyakeni yamuva, ukuhlaziywa kwe-troponin ephakeme kakhulu yenzelwe ukuthi, kubantu abaningi abane-NSTEMI, ivumela ukuxilongwa ukuthi kwenziwe isifo esisodwa segazi, ngaleyo ndlela kuvumela ukuthi ukwelashwa kuqale ngaphambi kwalokho kungase kuphakanyiswe.
Yini Ebangelwa "Amanga" Ukuphakama kwama-Biomarkers?
Akuzona zonke iziphakamiso ezinhlobonhlobo zezinhliziyo ezibonisa ukuhlasela kwenhliziyo.
Amazinga e-Creatine kinase angakhuphuka kakhulu nanoma yikuphi ukulimala kwemisipha, noma umonakalo ebuchosheni noma emaphaphu, noma ngesifo sebindi noma isifo.
Ukuphakama kwezinga legazi le-troponin kuqondile ngempela ekulimazeni kwamangqamuzana e-cardiac, ngakho-ke, akukho into enjengokuphakama "okungamanga" kwe-troponin. Kodwa-ke, ukulimala kwamangqamuzana enhliziyo kungenziwa ngezizathu ngaphandle kokuhlaselwa kwenhliziyo. Lezi zimo zingase zihlanganise ukwehluleka kwenhliziyo , i-myocarditis, ukufiphaza kwe-atrial ngokushesha, i- sepsis , i- coronary artery spasm , i- dissection ye-aortic , ukucindezeleka kokugulisa umzimba , noma i- pulmonary severe embolus .
Yingakho ukuxilongwa kwesifo senhliziyo akuxhomeki ekuhloleni kwegazi elilodwa, kodwa futhi kuzimpawu zomtholampilo, ukuguqulwa kwe-ECG, futhi (kaningi) ngephethini lokuphakama kwe-biomarker okuphakamisa ukulimala kakhudlwana kwekhanda lenhliziyo.
Izwi elivela
Ama-biomarker we-cardiac amaprotheni angena egazini uma kudala ukulimala kwenhliziyo, njengokuhlasela kwenhliziyo. Ukuhlolwa kwe-Biomarker kuvame ukusiza ekwenzeni ukuhlolisiswa okusheshayo kokuhlasela kwenhliziyo, ngakho-ke ukwelashwa kokuqala kungaqala.
> Imithombo:
> Mills NL, Churchhouse AM, Lee KK, et al. Ukusetjenziswa kwe-Troponin I-Assay ne-Risk ye-Myocardial Infarction eFuthiweko nokuPhelelwa kwabaPhezulu abane-Suspected Acute Coronary Syndrome. I-JAMA 2011; 305: 1210.
> Thygesen K, Mair J, Katus H, et al. Izincomo Zokusetshenziswa Kwe-Cardiac Troponin Measurement In Care Acute Cardiac. I-Eur Heart J 2010; 31: 2197.