????????(disseminated or diffuse intravascular coagulation, DIC):???????????,???????????,????????,????????????,?????????????,?????????????,??????????????????????????

1
??? ????????

• ??
• ????????(disseminated or diffuse
  intravascular coagulation, DIC)???????????,????
  ???????,????????,????????????,?????????????,??????
  ???????,??????????????????????????

2
?????????????

• ????????
• ??????????????
• (?)???????
• ????(tissue factor,TF)????47KD??????,?
  263????????????????????CD142??????????????????????
  ??????????a????????,?????a??????

3
?????
??????TF,????????????ET IL-1?TNF????????TF,???
????
?????TF , ????
4

• ????????(?????????????)????????,???????
  ?????-?????(?-Carboxyglutamate,GLa),??GLa?Ca2????
  ?,???????Ca2??TF?????,??????????a,???a-TF????

??????????a ,?a, ?a (???)? ?????????a,?????
?????
5

• ?a-TF??????????,??????????????????????,????
  ??????????,?????????
• ?a-TF?????????,????a,?a??Ca2????????????
  ????,???????????,??????????
• ??,?????,????TF??,?a?TF?????,?????,?????
  ?????????,???????,??????????????,???????

6
(No Transcript)
7
(?)???????
1???????
8

• 2????????a?????????????a,?a,?a???GLa?Ca2??,??
  ???????????????????,????????,????????a?
• 3???????????
• ????a.?a??GLa??Ca2????????????????,?
  ??????????????????????????????????????

9
(No Transcript)
10

• ?????????? ????????????,???????????
• ???????????,????????,???????A??B?,????
  ?????

????????????????,????????????????????????,?
?a?Ca2??????????????????????????????,??????
11

• ??????????
• ? ???????

???????????????????????????(?)????
12
(?)???????

• 1???????????(t-PA)???????,?????,???,???
  ,???????????????????????,t-PA???????
• 2????????????(u-PA)?????????,??u-PA?t
  -PA??????C(APC)?????????????????????,u-PA????????
• 3????????????????

13
?????????????????????? ??????????????????
14
(?)??????
??????,????????(Fbg)?????( Fbn)
?????????????????????????????
15
??? DIC????????

• ?????????
• ??????????????(????,????,????)??????????
  ???????,?????????????????????,???????Ca2?????????
  ??????????????a??a-TF??????????,???????????????,??
  ?????,???????????????,?????????

16
????????

• ????????????????????????????????????,???
  ????,?????????? ???????,???,??????????,??????????,
  ???? a??,??????????????,??????,?????????????,?????
  ????????
• ???????????????????????????,??X???,????
  ??????,??DIC? ?? a???f????????????????,?????DIC???
  ?

17

• ????????,???????
• (?)??????
• ? ??????????
• ?????????????????,????????????????(gluc
  oprotein,GP), ????????????GP?b??b??a??b??????GP??
  ????????????????????GP????

????GP ?b ?b ?a ?b ?
????GP? ? ? ? ?
18

• ? ?????b(GP?b)????????
• ??(vWF)???,?????????????
• ??vWF?????,?????????,???
• ?????????????????????vWF
• ????????????,??????GPIb??,
• ??????????????
• ??vWF GPIb
  

??????b?a???(GP?b/?a)? ?????
??????b(GPIVb)????
????V(GPV)??????
19
????????DIC???

• 1???????????????????,??????,???????GP
  Ib???????????(vWF)?????,???????
• 2??????????ADP??????TXA2?PAF?????????
  ??????????????,???????
• 3????????????????,????????ADP?5-HT???
  ???,???????,???????????,?????????????????(DG)?????
  C??,?????????,???????????,???A2???,???????????????
  ?,?????TXA2?TXA2??????????????

20

• 4??????????????????,????????GP?b/?a??
  ???????GP?b/?a??????????????,????????????????????G
  P?b/?a???,??????,???????
• 5??????????????????????????????,?????
  ???X?????????-?????(GIa)?Ca2??,????????????????,?
  ????????????????????,???????????????????,???????,?
  ????

21
(?)?????

• 1??????????????
• 2??????
• 3???????
• ????????
• 1?????????

2??? ??????????
22
??? ??DIC???????

• ??????????????
• ????????(mononuclear phagocyte
  system,MPS)??????????????,
• ????????????,????????FDP??????
• ?????????
• (generalized shwartzman reaction,GSR)
• rabbit
• ??? iV ??24h ??? iV
• ET ET
  ??DIC

23
???????????

• ??????????????????C?
• ????????????????????-?
• (AT-?)?????????????????
• 1?????????
• (1)??C(PC)??C?????????
• ??,????????????????????
• ???????,?????C(APC)???????????a??a????????????

PC?????????????????t-PA?u-PA???
24
(No Transcript)
25

• (2)??S(PS)?????????????????-????????????S??
  ????APC????? APC??,??APC???a??a????? PS
  ???APC????????

(3)??????(TM)??????????????,??????,???a-TM????,??
?????,????????? ????C??????,TM????????????????????
???????
26
2????????????

• (1)????-?(AT-?)??????????,???????????????????
  ????????a????a??a??a?????????????,AT-???????????
• (2)?????????(TFPI)?????
• ????????,???????????????a??a?
• ?????????????????????
• ??????????,????????????,
• ?????DIC?

27

• ?????????
• ????????
• 1????
• 2????
• 3??????(antiphospholipid
  antibody,APA),
• APA?????????????????????????
  APA??????????????APA????????????,???????????????,
  ??????????????,????????C??????????C????????S?????
  ,????????????,???????
• ??????? 1. 2. 3.
• ?????????????-6-????

28
??? DIC??????

• ????
• 1????
• 2???????
• 3?????????
• ????
• (?)?DIC??????
• 1????
• 2?????
• 3????

29
(?)?DIC???????

• ????????????????????????DIC????
• ????????
• 1???? ???? ??DIC
• 2????? ??gt?? ???DIC
• 3?????? ??lt?? ???DIC
• 
  DIC???
• ???DIC???????????????

30
??? DIC????????????

• ????
• DIC???????
• (?)??????????
• ?DIC???????,?????????????,???????????,?
  ??????????????
• (?)??????
• 1???????????a???,????????,???????,???????
  ?????????

31

• 2???????????????,??????????,?????????????,
  ???????,?????,?????t-PA,???????
• 3????,SAMS??,???????????????????????????
• 4???????????????,?????????(t-PA,u-PA)??,?
  ???????,????????
• ??????????(?)???,?????????????a??a?,??????
  ?

32
(?)FDP???

• ????(?)??????????FDP,????????????????
• 1?X?Y?D??????????????
• 2?Y?E??????????
• 3?????????????,???????
• ????,?????????????????
• ?????

33
??? ?

• ??DIC????????DIC???????
• 1??????????????,??????????
• 2????????????
• 3?????,????????
• 4??DIC?????,????????,???????,???????,???
  ???????
• ? C3a?C5a??????????????????

34
????????????????,?????,???????,???????
? FDP?????(A?B?C??)?????? ?????,???????????????? ?
???,??????????? ??DIC?????,?????????? DIC???
,??????,???????
35
????????

• ?????????????,????,?????,?????????????????
  ????
• 1??????????????????
• 2??????,???,?????
• 3????,?????
• 4??????????,??????

36

• 5??????????????,???????????,??????,???,
  ??-????
• (Waterhouse-Frderichsen syndrome)?
• 6?????,??????,??,???????,??????(Sheehan
  syndrome).
• 7????????????,?????,??
• ?,?????,???????,??,??,??????

37
????
??????????(microangiopathic hemolytic
anemia,MHA )??????? ???????????,????????? ??????
???????,??????? ??????,?????????,???? ??
DIC???????? ???? ? ?
????????
38
??? ???

• ????,????
• 1?????????
• 2???????????
• ?????
• 1??????????DIC???????
• 2????????????????,????,??????????????DIC?
  ???
• ???
• 3???????????DIC???????

39

• 4????????DIC???????
• 5???????????????,??????????????????????
  ??
• 6?????????????????DIC???????
• 7?DIC???????????
• 8?DIC???????????
• 9?DIC?????????????(DIC???
  ?????????????)????