Tare da zurfafa fahimtar mutane game da thrombus, an yi amfani da D-dimer a matsayin gwajin da aka fi amfani da shi don cire thrombus a cikin dakunan gwaje-gwaje na asibiti na coagulation. Duk da haka, wannan babban fassarar D-Dimer ne kawai. Yanzu masana da yawa sun ba D-Dimer ma'ana mai zurfi a cikin binciken kan D-Dimer da alaƙarsa da cututtuka. Abubuwan da ke cikin wannan batu za su sa ku fahimci sabon alkiblar amfani da shi.
Tushen amfani da D-dimer na asibiti
01. Ƙaruwar D-Dimer yana wakiltar kunna tsarin coagulation da tsarin fibrinolysis a cikin jiki, kuma wannan tsari yana nuna yanayin canji mai girma. Ana iya amfani da D-Dimer mara kyau don cire thrombus (mafi mahimmancin ƙimar asibiti); yayin da D-Dimer mai kyau ba zai iya tabbatar da samuwar thromboembolism ba. Ko an samar da thromboembolism ko a'a ya dogara da daidaiton waɗannan tsarin guda biyu.
02. Rabin rayuwar D-Dimer yana ɗaukar awanni 7-8, kuma ana iya gano shi bayan awanni 2 bayan thrombosis. Wannan fasalin za a iya daidaita shi da aikin asibiti, kuma ba zai yi wahala a sa ido ba saboda rabin rayuwar ya yi gajere, kuma ba zai rasa mahimmancin sa ido ba saboda rabin rayuwar ya yi tsayi sosai.
03. D-Dimer zai iya zama mai karko a cikin samfuran jini bayan in vitro na akalla awanni 24-48, don haka abubuwan da ke cikin D-Dimer da aka gano a cikin vitro zasu iya nuna matakin D-Dimer daidai a cikin vivo.
04. Hanyar D-Dimer duk ta dogara ne akan amsawar antigen-antibody, amma takamaiman hanyar tana da yawa amma ba iri ɗaya ba. Kwayoyin rigakafi da ke cikin reagent ɗin sun bambanta, kuma gutsuttsuran antigen da aka gano ba su da daidaito. Lokacin zabar wani alama a dakin gwaje-gwaje, yana buƙatar a tantance shi.
Amfani da maganin hana jini na gargajiya na D-dimer a asibiti
1. Ganewar rashin VTE:
Gwajin D-Dimer tare da kayan aikin tantance haɗarin asibiti za a iya amfani da shi yadda ya kamata don kawar da thrombosis na jijiyoyin jini mai zurfi (DVT) da embolism na huhu (PE).
Idan aka yi amfani da shi don cire thrombus, akwai wasu buƙatu don maganin D-Dimer da hanyar aiki. Dangane da ƙa'idar masana'antar D-Dimer, haɗakar yuwuwar kafin gwajin yana buƙatar ƙimar hasashen mara kyau na ≥97% da kuma ƙarfin amsawa na ≥95%.
2. Gano ƙarin bayani game da yadda coagulation ke yaɗuwa a cikin jijiyoyin jini (DIC):
Babban abin da ke nuna alamun DIC shine tsarin hyperfibrinolysis, kuma ganowar da ke nuna hyperfibrinolysis tana taka muhimmiyar rawa a tsarin maki na DIC. An nuna a asibiti cewa D-Dimer zai ƙaru sosai (fiye da sau 10) a cikin marasa lafiya na DIC. A cikin jagororin ganewar DIC na cikin gida da na ƙasashen waje ko yarjejeniya, ana amfani da D-Dimer a matsayin ɗaya daga cikin alamun dakin gwaje-gwaje don gano DIC, kuma ana ba da shawarar a gudanar da FDP tare. Inganta ingancin ganewar DIC yadda ya kamata. Ba za a iya yin ganewar DIC kawai ta hanyar dogaro da ma'aunin dakin gwaje-gwaje guda ɗaya da sakamakon gwaji ɗaya ba. Yana buƙatar a yi nazari sosai kuma a sa ido sosai tare da haɗuwa da bayyanar asibiti na majiyyaci da sauran alamun dakin gwaje-gwaje.
Sabbin amfani na asibiti na D-Dimer
1. Amfani da D-Dimer ga marasa lafiya da ke dauke da COVID-19: A wata ma'ana, COVID-19 cuta ce ta thrombosis da ke tasowa sakamakon cututtukan garkuwar jiki, tare da yaduwar kumburi da kuma ƙananan ƙwayoyin cuta a cikin huhu. An ruwaito cewa sama da kashi 20% na marasa lafiya da ke dauke da VTE a asibiti suna dauke da COVID-19.
• Matakan D-Dimer da aka ɗauka a asibiti sun yi hasashen mace-mace a asibiti daban-daban, sannan kuma sun tantance marasa lafiya da ke cikin haɗarin kamuwa da cutar. A halin yanzu, D-dimer ya zama ɗaya daga cikin muhimman abubuwan da ake tantancewa ga marasa lafiya da ke ɗauke da COVID-19 lokacin da aka kwantar da su a asibiti.
• Ana iya amfani da D-Dimer don jagorantar ko za a fara maganin hana zubar jini na heparin ga marasa lafiya da ke dauke da COVID-19. An ruwaito cewa a cikin marasa lafiya da ke dauke da D-Dimer ≥ sau 6-7 a sama da iyakar da aka kayyade, fara maganin hana zubar jini na heparin zai iya inganta sakamakon marasa lafiya sosai.
• Ana iya amfani da sa ido mai ƙarfi na D-Dimer don tantance faruwar VTE a cikin marasa lafiya da ke ɗauke da COVID-19.
• Sa ido kan D-Dimer, wanda za a iya amfani da shi don tantance sakamakon COVID-19.
• Kula da D-Dimer, idan aka fuskanci shawara kan maganin cutar, shin D-Dimer zai iya bayar da wasu bayanai na asali? Akwai gwaje-gwaje da yawa na asibiti da ake yi a ƙasashen waje.
2. Sa ido kan yanayin aiki na D-Dimer yana annabta samuwar VTE:
Kamar yadda aka ambata a sama, rabin rayuwar D-Dimer shine awanni 7-8. Daidai saboda wannan fasalin ne D-Dimer zai iya sa ido da kuma hasashen samuwar VTE. Don yanayin da jini ke iya tsayawa ko kuma ƙananan jijiyoyin jini, D-Dimer zai ƙaru kaɗan sannan ya ragu da sauri. Idan akwai sabbin ƙwayoyin jini a jiki, D-Dimer a cikin jiki zai ci gaba da tashi, yana nuna lanƙwasa mai kama da kololuwa. Ga mutanen da ke da yawan kamuwa da cututtukan thrombosis, kamar su matsi da tsanani, marasa lafiya bayan tiyata, da sauransu, idan matakin D-Dimer ya ƙaru da sauri, ku yi taka tsantsan game da yiwuwar kamuwa da cututtukan thrombosis. A cikin "Ƙungiyar Ƙwararru kan Dubawa da Maganin Ciwon Jijiyoyin Jijiyoyi Masu Zurfi a cikin Marasa Lafiyar Kashi Mai Rauni", ana ba da shawarar cewa marasa lafiya da ke da matsakaicin haɗari bayan tiyatar kashin baya su lura da canje-canjen D-Dimer a kowane sa'o'i 48. Ya kamata a yi gwajin hoto a kan lokaci don duba DVT.
3. D-Dimer a matsayin alamar hasashen cututtuka daban-daban:
Saboda kusancin da ke tsakanin tsarin coagulation da kumburi, raunin endothelial, da sauransu, ana kuma ganin ƙaruwar D-Dimer a wasu cututtukan da ba su da thrombosis kamar kamuwa da cuta, tiyata ko rauni, gazawar zuciya, da kuma ciwon daji. Bincike ya gano cewa mafi yawan rashin hasashen waɗannan cututtuka shine thrombosis, DIC, da sauransu. Yawancin waɗannan rikice-rikicen sune cututtuka ko yanayin da suka fi yawa waɗanda ke haifar da hauhawar D-Dimer. Saboda haka, ana iya amfani da D-Dimer a matsayin ma'aunin kimantawa mai faɗi da mahimmanci ga cututtuka.
• Ga masu fama da ciwon daji, bincike da dama sun gano cewa adadin masu fama da ciwon daji masu girman D-Dimer na tsawon shekaru 1-3 yana da ƙasa sosai fiye da na marasa lafiya na yau da kullun na D-Dimer. Ana iya amfani da D-Dimer a matsayin alamar kimanta hasashen masu fama da ciwon daji masu girman D-Dimer.
• Ga marasa lafiya na VTE, bincike da yawa sun tabbatar da cewa marasa lafiya da ke da D-Dimer-positive tare da VTE suna da haɗarin sake dawowar thrombus a lokacin hana zubar jini fiye da marasa lafiya marasa lafiya. Wani bincike na meta wanda ya haɗa da bincike 7 tare da jimillar mutane 1818 ya nuna cewa, Abnormal D-Dimer yana ɗaya daga cikin manyan abubuwan da ke hasashen sake dawowar thrombus a cikin marasa lafiya na VTE, kuma an haɗa D-Dimer a cikin samfuran hasashen haɗarin sake dawowar VTE da yawa.
• Ga marasa lafiya da ke maye gurbin bawul ɗin injiniya (MHVR), wani bincike na dogon lokaci da aka yi kan mutane 618 ya nuna cewa haɗarin abubuwan da ba su dace ba a cikin marasa lafiya da matakan D-Dimer marasa kyau yayin warfarin bayan MHVR ya ninka kusan sau 5 na marasa lafiya na yau da kullun. Binciken hulɗar Multivariate ya tabbatar da cewa matakin D-Dimer mai zaman kansa yana hasashen abubuwan da ke faruwa a cikin thrombosis ko cututtukan zuciya yayin hana zubar jini.
• Ga marasa lafiya da ke fama da matsalar toshewar jijiyoyin jini (AF), D-Dimer na iya hasashen abubuwan da ke faruwa na thrombosis da kuma abubuwan da ke faruwa a zuciya a lokacin da ake hana toshewar jijiyoyin jini ta baki. Wani bincike da aka yi kan marasa lafiya 269 da ke fama da matsalar toshewar jijiyoyin jini ta atrial na tsawon shekaru 2 ya nuna cewa a lokacin da ake hana toshewar jijiyoyin jini ta baki, kusan kashi 23% na marasa lafiya da ke fama da matsalar toshewar jijiyoyin jini ta INR sun nuna matakan D-Dimer marasa kyau, yayin da marasa lafiya da ke fama da matsalar toshewar jijiyoyin jini ta D-Dimer suka samu matsala. Haɗarin abubuwan da ke faruwa na toshewar jijiyoyin jini da kuma abubuwan da ke faruwa a zuciya da jijiyoyin jini sun kai sau 15.8 da 7.64, bi da bi, na marasa lafiya da ke fama da matakan D-Dimer na yau da kullun.
• Ga waɗannan takamaiman cututtuka ko takamaiman marasa lafiya, D-Dimer mai ƙarfi ko mai ci gaba da kasancewa mai kyau sau da yawa yana nuna rashin kyakkyawan hasashen cutar ko kuma ta'azzara ta.
4. Amfani da D-Dimer a cikin maganin hana zubar jini ta baki:
• D-Dimer yana ƙayyade tsawon lokacin da za a yi amfani da maganin hana zubar jini ta baki: Tsawon lokacin da za a yi amfani da maganin hana zubar jini ga marasa lafiya da ke fama da VTE ko wasu thrombus har yanzu ba a kammala shi ba. Ko NOAC ne ko VKA, jagororin ƙasashen duniya masu dacewa sun ba da shawarar cewa ya kamata a yanke shawara kan tsawon lokacin da za a yi amfani da maganin hana zubar jini bisa ga haɗarin zubar jini a cikin wata na uku na maganin hana zubar jini, kuma D-Dimer zai iya ba da bayanai na musamman don wannan.
• D-Dimer yana jagorantar daidaita ƙarfin maganin hana zubar jini ta baki: Warfarin da sabbin magungunan hana zubar jini ta baki sune magungunan hana zubar jini ta baki da aka fi amfani da su a aikin asibiti, waɗanda duka suna iya rage matakin D-Dimer. da kunna tsarin fibrinolytic, ta haka ne ke rage matakin D-Dimer a kaikaice. Sakamakon gwaji ya nuna cewa maganin hana zubar jini ta hanyar D-Dimer a cikin marasa lafiya yana rage yawan faruwar abubuwan da ba su dace ba yadda ya kamata.
A ƙarshe, gwajin D-Dimer ba ya iyakance ga aikace-aikacen gargajiya kamar gano VTE da gano DIC ba. D-Dimer yana taka muhimmiyar rawa a hasashen cututtuka, hasashen cututtuka, amfani da magungunan hana ɗaukar ciki na baki, da COVID-19. Tare da ci gaba da zurfafa bincike, amfani da D-Dimer zai ƙara faɗaɗa.
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