Hoʻopili ʻia nā monomers Fibrin i loko o ke koko e ka factor X III i hoʻāla ʻia, a laila hydrolyzed ʻia e ka plasmin i hoʻāla ʻia e hana i kahi huahana degradation kikoʻī i kapa ʻia ʻo "fibrin degradation product (FDP)." ʻO D-Dimer ka FDP maʻalahi loa, a ʻo ka hoʻonui ʻia o kona nui o ka nui e hōʻike ana i ke kūlana hypercoagulable a me ka hyperfibrinolysis lua i vivo. No laila, he mea nui ka nui o ka D-Dimer no ka ʻike ʻana, ka loiloi pono a me ka hoʻoholo ʻana i ka wānana o nā maʻi thrombotic.
Mai ka hoʻomaka ʻana o COVID-19, me ka hohonu o nā hōʻike lapaʻau a me ka hoʻomaopopo ʻana i ka maʻi pathological o ka maʻi a me ka hōʻiliʻili ʻana o ka ʻike hōʻoia a me ka mālama ʻana, hiki i nā maʻi koʻikoʻi me ka pneumonia coronary hou ke hoʻomohala koke i ka maʻi hanu ʻeha. Nā hōʻailona, septic shock, refractory metabolic acidosis, coagulation dysfunction, a me ka hāʻule ʻana o nā ʻano he nui. Hoʻokiʻekiʻe ʻia ka D-dimer i nā maʻi me ka pneumonia koʻikoʻi.
Pono nā poʻe maʻi maʻi nui e makaʻala i ka pilikia o ka venous thromboembolism (VTE) ma muli o ka hoʻomaha lōʻihi ma kahi moe a me ka hana coagulation kūpono ʻole.
I ka wā o ke kaʻina hana lapaʻau, pono e nānā i nā ʻōkuhi pili e like me ke kūlana, me nā māka myocardial, ka hana coagulation, a pēlā aku. Hiki i kekahi mau maʻi ke hoʻonui i ka myoglobin, hiki i kekahi mau hihia koʻikoʻi ke ʻike i ka hoʻonui ʻia o ka troponin, a i nā hihia koʻikoʻi, hiki ke hoʻonui ʻia ka D-dimer (D-Dimer).
Hiki ke ʻike ʻia he koʻikoʻi ka nānā ʻana i nā pilikia e pili ana i ka D-Dimer i ka holomua o COVID-19, no laila pehea kona kuleana i nā maʻi ʻē aʻe?
1. Ka thromboembolism venous
Ua hoʻohana nui ʻia ʻo D-Dimer i nā maʻi e pili ana i ka venous thromboembolism (VTE), e like me ka deep vein thrombosis (DVT) a me ka pulmonary embolism (PE). Hiki i kahi hoʻāʻo D-Dimer maikaʻi ʻole ke kāpae i ka DVT, a hiki ke hoʻohana ʻia ka nui o ka D-Dimer e wānana i ka helu hoʻi hou ʻana o VTE. Ua ʻike ʻia ke aʻo ʻana ʻo ka lakio pōpilikia o ka hoʻi hou ʻana o VTE i ka heluna kanaka me ka nui kiʻekiʻe he 4.1 mau manawa o ka heluna kanaka me ka nui maʻamau.
ʻO D-Dimer kekahi o nā hōʻailona ʻike o PE. He kiʻekiʻe loa kona waiwai wānana maikaʻi ʻole, a ʻo kona koʻikoʻi ka hoʻokaʻawale ʻana i ka embolism pulmonary acute, ʻoi aku hoʻi i nā poʻe maʻi me ka kānalua haʻahaʻa. No laila, no nā poʻe maʻi i manaʻo ʻia he embolism pulmonary acute, pono e hui pū ʻia ka ultrasonography o nā aʻa hohonu o nā ʻaoʻao haʻahaʻa a me ka hoʻokolokolo ʻana o D-Dimer.
2. Hoʻolaha ʻia ke coagulation intravascular
ʻO ka disseminated intravascular coagulation (DIC) kahi maʻi lapaʻau i hōʻike ʻia e ke kahe koko a me ka hāʻule ʻana o ka microcirculatory ma ke kumu o nā maʻi he nui. Pili ke kaʻina hana hoʻomohala i nā ʻōnaehana he nui e like me ke coagulation, anticoagulation, a me ka fibrinolysis. Ua piʻi aʻe ʻo D-Dimer i ka wā mua o ka hoʻokumu ʻia ʻana o DIC, a ua hoʻomau ka piʻi ʻana o kona nui ma mua o 10-fold i ka holomua ʻana o ka maʻi. No laila, hiki ke hoʻohana ʻia ʻo D-Dimer ma ke ʻano he hoʻokahi o nā hōʻailona nui no ka ʻike mua ʻana a me ka nānā ʻana i ke kūlana o DIC.
3. Ka ʻoki ʻana o ke aorta
Ua kuhikuhi ka "ʻaelike loea Kina ma ka hōʻailona a me ka mālama ʻana i ka dissection aortic" ʻo D-Dimer, ma ke ʻano he hoʻāʻo hoʻokolohua maʻamau no ka dissection aortic (AD), he mea nui loa ia no ka hōʻailona a me ka ʻike ʻokoʻa o ka dissection. Ke piʻi koke ka D-Dimer o ka mea maʻi, piʻi ka hiki ke ʻike ʻia he AD. I loko o 24 mau hola o ka hoʻomaka ʻana, i ka wā e hiki ai i ka D-Dimer ke hōʻea i ka waiwai koʻikoʻi o 500 µg/L, ʻo kona ʻike no ka hōʻailona ʻana i ka AD acute he 100%, a ʻo kona kikoʻī he 67%, no laila hiki ke hoʻohana ʻia ma ke ʻano he helu hoʻokoe no ka hōʻailona ʻana i ka AD acute.
4. Maʻi Pūnaehana o ka ʻAtherosclerotic
ʻO ka maʻi cardiovascular Atherosclerotic kahi maʻi puʻuwai i hoʻokumu ʻia e ka plaque arteriosclerotic, me ka ST-segment elevation acute myocardial infarction, non-ST-segment elevation acute myocardial infarction, a me ka angina paʻa ʻole. Ma hope o ka haki ʻana o ka plaque, kahe ka mea necrotic core i loko o ka plaque, e hana ana i nā ʻāpana kahe koko maʻamau, ka hoʻāla ʻana o ka ʻōnaehana coagulation, a me ka hoʻonui ʻia ʻana o ka D-Dimer. Hiki i nā maʻi maʻi puʻuwai coronary me ka D-Dimer kiʻekiʻe ke wānana i kahi pilikia kiʻekiʻe o ka AMI a hiki ke hoʻohana ʻia ma ke ʻano he hōʻailona e nānā i ke kūlana o ACS.
5. Ka lāʻau lapaʻau thrombolytic
Ua ʻike ʻia ma ke aʻo ʻana a Lawter e hiki i nā lāʻau thrombolytic like ʻole ke hoʻonui i ka D-Dimer, a hiki ke hoʻohana ʻia kona ʻano ma mua a ma hope o ka thrombolysis ma ke ʻano he hōʻailona no ka hoʻoholo ʻana i ka lāʻau thrombolytic. Ua piʻi koke kona ʻike i kahi waiwai kiʻekiʻe ma hope o ka thrombolysis, a ua hāʻule i hope i ka manawa pōkole me ka hoʻomaikaʻi nui ʻana i nā hōʻailona lapaʻau, e hōʻike ana ua pono ka lāʻau.
- Ua piʻi nui ka pae o D-Dimer i 1 hola a 6 mau hola ma hope o ka thrombolysis no ka myocardial infarction acute a me ka cerebral infarction
- I ka wā o ka thrombolysis DVT, ʻo ka piko D-Dimer e kū pinepine ma hope o 24 mau hola a ma hope paha
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