{"id":10153,"date":"2020-04-23T03:58:08","date_gmt":"2020-04-23T00:58:08","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/complement-hemolitic-total-ch100\/"},"modified":"2025-02-05T16:07:28","modified_gmt":"2025-02-05T14:07:28","slug":"complement-hemolitic-total-ch100","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/complement-hemolitic-total-ch100\/","title":{"rendered":"\u041e\u0431\u0449\u0438\u0439 \u0433\u0435\u043c\u043e\u043b\u0438\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0439 \u043a\u043e\u043c\u043f\u043b\u0435\u043c\u0435\u043d\u0442 (CH100)"},"content":{"rendered":"

Sinonime <\/em><\/strong>\u2013 CH100, CH50, complement seric total6<\/sup><\/p>\n

\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f <\/em><\/strong><\/p>\n

Complementul este un sistem de aproximativ 20 de proteine \u015fi glicoproteine plasmatice (10% din totalul globulinelor serice), ce produce un r\u0103spuns rapid \u015fi mult amplificat la un stimul declan\u015fator, prin activarea \u00een cascad\u0103 a componentelor sale. In urma clivajului proteolitic se produc multiplii mediatori ai inflama\u0163iei cu rol \u00een reglarea sistemului imun. Componentele complementului se activeaz\u0103 prin 3 c\u0103i: calea clasic\u0103, calea altern\u0103 \u015fi calea lectinelor ce folose\u015fte o protein\u0103 seric\u0103 denumit\u0103 mannose-binding lectin (MBL).<\/p>\n

Calea clasic\u0103 a complementului este compus\u0103 dintr-o serie de proteine care sunt activate ca r\u0103spuns la prezen\u0163a de complexe imune ce con\u0163in IgM, IgG1, IgG2 sau IgG3. O serie de molecule, cum ar fi: proteina C reactiv\u0103, \u03b2 amiloidul, heparina, unele bacterii gram negative, virusuri, mycoplasme, protozoare, componente celulare (ADN, membrana mitocondrial\u0103, filamente de citoschelet) au de asemenea capacitatea de a activa complementul pe calea clasic\u0103 prin interac\u0163iunea direct\u0103 cu componenta C1q.<\/p>\n

Componenta C1 este un complex proteic format din 3 molecule: C1q, C1r \u015fi C1s asociate necovalent \u00eempreun\u0103 cu ioni de Ca2+<\/sup>. C1q este o protein\u0103 de 400 kD format\u0103 din 18 catene polipeptidice, cu regiuni \u00een triplu helix\u00a0\u015fi regiuni globulare, la nivelul c\u0103rora se g\u0103sesc situsurile de legare cu imunoglobulinele. C1q interac\u0163ioneaz\u0103 prin domeniul s\u0103u globular cu domenii specifice ale IgG\u00a0\u015fi IgM numai dac\u0103 acestea formeaz\u0103 complexe imune. C1q nu are activitate proteazic\u0103 \u015fi se asociaz\u0103 cu 2 molecule C1r \u015fi 2 C1s, \u00een prezen\u0163a Ca2+<\/sup>. In mod normal, activarea spontan\u0103 a complexului C1s \u2013 C1r este stopat\u0103 de un factor inhibitor \u2013 C1 inh (inhibitor de serin proteaz\u0103). In urma ata\u015f\u0103rii complexului antigen \u2013 anticorp, C1q sufer\u0103 o modificare conforma\u0163ional\u0103 care duce la eliberarea C1\u00a0inh \u015fi la activarea autocatalitic\u0103 a unei molecule de C1r.<\/p>\n

Fragmentul C1r are activitate serin-proteazic\u0103 \u015fi activeaz\u0103 C1s. Acesta are activitate esterazic\u0103 \u015fi cliveaz\u0103 componenta C4 \u00een dou\u0103 fragmente: unul mic, C4a (o anafilatoxin\u0103 eliberat\u0103 \u00een ser),\u00a0 \u015fi unul mare, C4b, ce r\u0103m\u00e2ne ata\u015fat de activatorul s\u0103u. In prezen\u0163a ionilor de Mg2+<\/sup>, C4b leag\u0103 C2 care este clivat, la r\u00e2ndul s\u0103u,\u00a0\u00a0\u00een dou\u0103 fragmente: cel mare, C2a, r\u0103m\u00e2ne legat pe C4b \u015fi constituie complexul C4b2a, denumit convertaza\u00a0C3, iar cel mic, C2b, este eliberat \u00een plasm\u0103.<\/p>\n

Clivarea lui C3 este evenimentul central al fix\u0103rii complementului, pe calea clasic\u0103 sau altern\u0103. C4b2a (convertaza lui C3), prin componenta sa enzimatic\u0103 C2a, formeaz\u0103 dou\u0103 peptide: C3a, anafilatoxina, \u015fi C3b, principala opsonin\u0103 a serului. Fiecare unitate C1qrs4b2a (convertaza C3) poate ata\u015fa \u015fi cliva sute de molecule C3, deoarece C3 are o concentra\u0163ie plasmatic\u0103 crescut\u0103. Majoritatea moleculelor de C3b r\u0103m\u00e2n \u00een plasm\u0103 \u015fi au rol opsonizant. Restul se leag\u0103 la complexul C4b2a \u015fi formeaz\u0103 urm\u0103toarea unitate catalitic\u0103, C4b2a3b, convertaza C5. Aceast\u0103 enzim\u0103 cliveaz\u0103 substratul \u00een dou\u0103 subunit\u0103\u0163i: C5a \u015fi C5b. Fragmentul mare C5b se fixeaz\u0103 pe membrana celular\u0103, ata\u015feaz\u0103 C6 \u015fi ini\u0163iaz\u0103 formarea complexului de atac membranar.<\/em> In prezen\u0163a lui C7 se formeaz\u0103 complexul C5b67, cu propriet\u0103\u0163i amfifile, care se leag\u0103 de fosfolipidele membranare. La acesta se adaug\u0103 compomentele C8 \u015fi C9 constituindu-se astfel un complex macromolecular C5b6789, asem\u0103n\u0103tor unui canal, cu suprafa\u0163a extern\u0103 hidrofob\u0103 \u015fi un ax central hidrofil. Rezultatul final al cascadei de activare este formarea unui complex de liz\u0103 membranar\u0103 (MAC), care permite intrarea rapid\u0103 a cationilor (Ca2+<\/sup>, Na+<\/sup>) \u015fi a apei, distrugerea celular\u0103 cu eliberarea de histamin\u0103 prin degranularea mastocitelor \u015fi plachetelor, cre\u015fterea permeabilit\u0103\u0163ii vasculare, contrac\u0163ia mu\u015fchilor netezi \u015fi liza unor virusuri.<\/p>\n

Complexele imune nu sunt capabile s\u0103 activeze cascada complementului \u00een absen\u0163a unor componente ale complementului cum ar fi C1, C2, C3, C4. Pacien\u0163ii cu deficien\u0163e de C5, C6, C7, C8 \u015fi C9 nu pot forma MAC \u015fi au o sensibilitate crescut\u0103 la infec\u0163iile bacteriene.<\/p>\n

Determinarea CH100 este un test screening pentru bolile asociate cu hipocomplementemie; evalueaz\u0103 \u00een principal calea clasic\u0103 a complementului \u015fi cuantific\u0103 complementul seric func\u0163ional total<\/span>1;2;4;5;6<\/sup>.<\/p>\n

Recomand\u0103ri pentru determinarea CH100<\/em><\/strong> \u2013 primul test screening pentru evaluarea deficien\u0163elor congenitale ale componentelor complementului; evaluarea \u015fi monitorizarea LES (lupus eritematos sistemic); evaluarea activit\u0103\u0163ii complementului \u00een cazul bolilor cu complexe imune: vasculite generalizate, glomerulonefrite, artrita reumatoid\u0103, crioglobulinemie4;5,6<\/sup>.<\/p>\n

Preg\u0103tire pacient<\/em><\/strong> \u2013 \u00e0 jeun (pe nem\u00e2ncate)3<\/sup><\/p>\n

Specimen recoltat<\/em><\/strong> \u2013 s\u00e2nge venos3<\/sup><\/p>\n

Recipient de recoltare <\/em><\/strong>-<\/em> vacutainer f\u0103r\u0103 anticoagulant cu\/f\u0103r\u0103 gel separator3<\/sup><\/p>\n

Prelucrare necesar\u0103 dup\u0103 recoltare<\/em><\/strong> - <\/em>se separ\u0103 serul prin centrifugare3<\/sup><\/p>\n

Cantitate recoltat\u0103 <\/em><\/strong>\u2013 1 mL3<\/sup><\/p>\n

Cauze\u00a0 de respingere a probei<\/em><\/strong> - <\/em>specimen intens hemolizat\/lipemic\/contaminat bacterian3<\/sup><\/p>\n

Stabilitate prob\u0103 <\/em><\/strong>\u2013 complementul se deterioreaz\u0103 la temperatura camerei; dac\u0103 proba nu se poate lucra imediat (2h),\u00a0serul\u00a0se p\u0103streaz\u0103 \u00een tuburi \u00eenchise ermetic, congelate la\u00a0\u00a0-70\u00baC p\u00e2n\u0103 se efectueaz\u0103 testul3<\/sup><\/p>\n

Metoda<\/em><\/strong> - EIA<\/span>3<\/sup><\/p>\n

Valori de referin\u0163\u0103 <\/em><\/strong>\u2013 40 \u2013 200 U\/ml 3<\/sup>.\u00a0<\/em><\/strong><\/p>\n

Interpretarea rezultatelor<\/em><\/strong><\/p>\n

Un nivel normal de CH100 indic\u0103 faptul c\u0103 toate componentele de la C1 la C9 sunt prezente, dar, cu toate acestea, chiar \u015fi \u00een prezen\u0163a unei concentra\u0163ii normale, valorile absolute ale unor componente (de exemplu, C3 \u015fi C4) pot fi semnificativ (50 \u2013 80%) mai mici dec\u00e2t nivelele de referin\u0163\u0103, f\u0103r\u0103 a afecta \u00eens\u0103 activitatea complementului. Acest lucru se datoreaz\u0103 faptului c\u0103, \u00een mod normal, \u00een ser exist\u0103 concentra\u0163ii \u00een exces de C3 \u015fi C4.<\/p>\n

Nivele nedetectabile se g\u0103sesc la pacien\u0163ii cu diferite deficien\u0163e ale componentelor complementului. Ace\u015ftia nu pot genera peptide chemotactice \u015fi prezint\u0103 risc crescut de infec\u0163ii bacteriene recurente cu microorganisme \u00eencapsulate. De asemenea pot prezenta simptome care sugereaz\u0103 o boal\u0103 autoimun\u0103.<\/p>\n

Concentra\u0163ii sc\u0103zute se \u00eent\u00e2lnesc \u00een boli infec\u0163ioase \u015fi autoimune datorit\u0103 consumului complementului ca urmare a procesului de fixare. Astfel, persoanele cu afec\u0163iuni reumatismale, \u00een special cele cu forme active \u015fi complexe imune circulante prezente, au concentra\u0163ii plasmatice reduse de complement. Nivelul sc\u0103zut \u00een ser al complementului hemolitic total, dar \u015fi al frac\u0163iunilor C1q, C3 \u015fi C4 sunt semnalate la o parte semnificativ\u0103 a bolnavilor cu LES \u00een puseu \u015fi atunci c\u00e2nd exist\u0103 o afectare renal\u0103. Hipocomplementemia sever\u0103 este considerat\u0103 un indicator precoce al unui puseu de LES.<\/p>\n

Proteinele complementului pot cre\u015fte tranzitoriu ca urmare a r\u0103spunsului de faz\u0103 acut\u0103 la inflama\u0163ie sau infec\u0163ie, valorile revenind la normal dup\u0103 \u00eencetarea procesului patologic1,4,6<\/sup>.<\/p>\n

Limite \u015fi interferen\u0163e<\/em><\/strong><\/p>\n

CH100 poate fi utilizat pentru evaluarea integrit\u0103\u0163ii c\u0103ii clasice (prezen\u0163a componentele C1-C9), dar pentru monitorizarea specific\u0103 a modific\u0103rilor concentra\u0163iilor componentelor complementului sunt necesare determin\u0103ri suplimentare de C3 \u015fi C4.<\/div>\n
Factorii c\u0103ii alternative nu pot fi detecta\u0163i \u015fi din acest motiv este necesar\u0103 efectuarea unor teste specifice de determinare a nivelelor individuale de componente ale complementului.<\/div>\n
Deoarece acesta este un test func\u0163ional, rezultatele sunt dependente de modul de transport \u015fi depozitare a probei4;6<\/sup>.<\/div>\n

\u00a0<\/span><\/p>\n

\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/strong><\/span><\/p>\n

1. Frances Fischbach, Total hemolytic complement (CH50). In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams & Wilkins, USA, 7 Ed., 2009, 617-621.<\/span><\/div>\n
2. H. Davis Massey, Richard A. McPherson. Mediators of Inflammation: Complement, Cytokines, and Adhesion Molecules. In Henry\u2019s Clinical Diagnosis and Management by Laboratory Methods, Saunders-Elsevier, 21st Edition, 849-852.<\/span><\/div>\n
3. Laborator Synevo. Referin\u0163e specifice tehnologiei de lucru utilizate 2010. Ref Type: Catalog.<\/span><\/div>\n
4. Laboratory Corporation of America. Directory of Services and Interpretive Guide. Complement, Total, Serum Profile. www.labcorp.com 2010. Ref Type: Internet Communication.<\/span><\/div>\n
5. Lothar Thomas. The complement system. In Clinical Laboratory Diagnostics-Use and Assessment of Clinical Laboratory Results. TH-Books Verlagsgesellschaft mbH, Frankfurt \/Main, Germany, 1 Ed., 1998, 794-805.<\/span><\/div>\n
6. Mayo Clinic\/Mayo Medical LaboratoriesTest Catalogs and Guides. Test Catalog. Complement, Total, Serum. www.mayomedicallaboratories.com. Ref Type: Internet Communication<\/span><\/div>","protected":false},"excerpt":{"rendered":"

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\u041a\u0430\u043a \u043f\u0440\u0430\u0432\u0438\u043b\u044c\u043d\u043e \u043f\u043e\u0434\u0433\u043e\u0442\u043e\u0432\u0438\u0442\u044c\u0441\u044f \u043a \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044e?<\/strong><\/p>\n

    \n
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