Me yasa za a iya amfani da bututun jini don gano abun ciki na D-dimer? Za a sami samuwar gudan jini na fibrin a cikin bututun jini, shin ba za a lalata shi zuwa D-dimer ba? Idan bai lalace ba, me yasa ake samun ƙaruwa sosai a cikin D-dimer lokacin da aka samar da gudan jini a cikin bututun hana zubar jini saboda ƙarancin samfurin jini don gwajin zubar jini?
Da farko dai, rashin isasshen tattara jini na iya haifar da lalacewar jijiyoyin jini, da kuma sakin sinadarin subendothelial tissue factor da plasminogen activator (tPA) cikin jini. A gefe guda, sinadarin nama yana kunna hanyar hada jini ta waje don samar da toshewar fibrin. Wannan tsari yana da sauri sosai. Kawai ka kalli lokacin prothrombin (PT) don sanin, wanda yawanci yake kusan daƙiƙa 10. A gefe guda kuma, bayan an samar da fibrin, yana aiki a matsayin cofactor don ƙara yawan aikin tPA sau 100, kuma bayan an haɗa tPA zuwa saman fibrin, ba zai sake hana shi cikin sauƙi ta hanyar plasminogen activation inhibitor-1 (PAI-1) ba. Saboda haka, ana iya canza plasminogen cikin sauri da ci gaba zuwa plasmin, sannan fibrin zai iya lalacewa, kuma ana iya samar da adadi mai yawa na FDP da D-Dimer. Wannan shine dalilin da yasa samuwar kwayoyin halittar jini a cikin vitro da fibrin ke ƙaruwa sosai saboda ƙarancin samfurin jini.
To, me yasa tarin bututun jini na yau da kullun (ba tare da ƙari ba ko tare da coagulant) samfuran kuma suka samar da ƙwayoyin fibrin a cikin vitro, amma ba su lalace ba don samar da adadi mai yawa na FDP da D-dimer? Wannan ya dogara da bututun jini. Me ya faru bayan an tattara samfurin: Na farko, babu babban adadin tPA da ke shiga cikin jini; na biyu, ko da ƙaramin adadin tPA ya shiga cikin jini, tPA kyauta za ta ɗaure ta da PAI-1 kuma ta rasa aikinta cikin kimanin mintuna 5 kafin ta manne da fibrin. A wannan lokacin, sau da yawa babu samuwar fibrin a cikin bututun jini ba tare da ƙari ko tare da coagulant ba. Yana ɗaukar fiye da mintuna goma don jini ba tare da ƙari ya taru ta halitta, yayin da jini tare da coagulant (yawanci foda silicon) yana farawa a ciki. Hakanan yana ɗaukar fiye da mintuna 5 don samar da fibrin daga hanyar coagulant jini. Bugu da ƙari, aikin fibrinolytic a zafin jiki na ɗaki a cikin vitro shima zai shafi.
Bari mu sake magana game da thromboelastogram a kan wannan batu: za ku iya fahimtar cewa gudan jini a cikin bututun jini ba shi da sauƙi, kuma za ku iya fahimtar dalilin da yasa gwajin thromboelastogram (TEG) ba shi da sauƙin nuna hyperfibrinolysis - duka yanayi biyun. Haka ne, ba shakka, zafin jiki a lokacin gwajin TEG za a iya kiyaye shi a digiri 37. Idan TEG ya fi saurin nuna yanayin fibrinolysis, hanya ɗaya ita ce ƙara tPA a cikin gwajin TEG a cikin vitro, amma har yanzu akwai matsalolin daidaitawa kuma babu aikace-aikacen gama gari; ƙari, ana iya auna shi a gefen gado nan da nan bayan an ɗauki samfur, amma ainihin tasirin shi ma yana da iyaka sosai. Gwaji na gargajiya kuma mafi inganci don kimanta aikin fibrinolytic shine lokacin narkewar euglobulin. Dalilin rashin lafiyarsa ya fi na TEG girma. A cikin gwajin, ana cire anti-plasmin ta hanyar daidaita ƙimar pH da centrifugation, amma gwajin yana cinyewa Yana ɗaukar lokaci mai tsawo kuma yana da ɗan tauri, kuma ba kasafai ake yin sa a dakunan gwaje-gwaje ba.
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