止血障碍-血栓形成课件.ppt

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止血障碍-血栓形成课件.ppt

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止血障碍：血栓形成DisordersofHemostasis:Thrombosis

止血障碍：血栓形成

止血障碍：血栓形成HypercoagulabilityDefinition:Alterationinthehemostaticbalancebetweenbloodfluidityandclotformation.Thisisduetogeneticandacquireddisorderswhichshiftthisbalancetowardexcessiveorinappropriateplateletaggregationandfibrinformationandpredisposetothrombosis.

止血障碍：血栓形成PrethromboticStates10-inheritedabnormalitiesresultingfrommutationsaffectingthefunctionofcoagulantproteinsandnaturalinhibitors20-acquireddefectsthateitheraffecttheendothelium,fluidfloworbloodcomponents.Thesedefectsareoftensuperimposedon10defects

止血障碍：血栓形成Hypercoagulability:

PrethromboticStatesVirchow(1856)AbnormalitiesofbloodvesselsAbnormalitiesoffluidflowAbnormalitiesofbloodcomponents

止血障碍：血栓形成BloodVesselAbnormalitiesEndothelialcellantithromboticproperties-PGI2,NO2,TFPI,PAI-1,heparans,thrombomodulinGeneticpredispositionandacquireddefectsinthesefunctionsincreasetheriskofarterialandvenousthrombosisRoleofdietaryexcesses,hypertension,diabetesmellitus,obesity,smoking,lipidabnormalitiesinatherosclerosis

止血障碍：血栓形成AtherosclerosisEndothelialinjuryanddysfunctionLDLcholesterol–oxidizedLDL---foamcellsDiabetesmellitus–glycatedLDLcholesterolSmoking–freeradicalproductionHypertension–smoothmuscleproliferationGeneticalterations–MTHFRmutations

止血障碍：血栓形成R.Ross.Atherosclerosis.NEJM340:115-126,1999

止血障碍：血栓形成AtherosclerosisSitespecific:BifurcationsBranchingvesselsCurvaturesDecreasedshearstressandincreasedturbulencePlaqueformationandrupture

止血障碍：血栓形成Unstableplaque.R.RossNEJM340:115-126,1999.

止血障碍：血栓形成BloodFlowAbnormalitiesStasisistheunderlyingmechanismasthecauseofvenousorarterialthrombosisConditions-immobilization,surgery,congestiveheartfailure,pregnancy,obesity.IncreasedbloodviscosityRBCs-polycythemias,sicklecellsWBCs–myeloproliferativedisordersespeciallyCMLPlatelet