01. ʻIke ʻia o ka thrombosis vein hohonu a me ka embolism pulmonary

He maʻalahi ka deep vein thrombosis (D-VT) i ka pulmonary embolism (PE), i ʻike ʻia ʻo venous thromboembolism (VTE). Kiʻekiʻe nui ʻia nā pae plasma D-dimer i nā poʻe maʻi VTE.

Ua hōʻike ʻia nā haʻawina pili e ʻoi aku ka nui o ka plasma D-dimer i nā maʻi me PE a me D-VT ma mua o 1 000 μg/L.

Eia nō naʻe, ma muli o nā maʻi he nui a i ʻole kekahi mau kumu pathological (ʻoki kino, nā ʻōpū, nā maʻi cardiovascular, a me nā mea ʻē aʻe) he hopena koʻikoʻi i ka hemostasis, e hopena ana i ka hoʻonui ʻia ʻana o ka D-dimer. No laila, ʻoiai he kiʻekiʻe ka ʻike o ka D-dimer, ʻo kona kikoʻī he 50% a 70% wale nō, a ʻaʻole hiki i ka D-dimer wale nō ke ʻike i ka VTE. No laila, ʻaʻole hiki ke hoʻohana ʻia ka piʻi nui ʻana o ka D-dimer ma ke ʻano he hōʻailona kikoʻī o VTE. ʻO ke koʻikoʻi kūpono o ka hoʻāʻo ʻana o D-dimer, ʻo ia ka hopena maikaʻi ʻole e pale i ka ʻike ʻana o VTE.

 

02 Hoʻolaha ʻia ke coagulation intravascular

ʻO ka disseminated intravascular coagulation (DIC) kahi maʻi o ka microthrombosis ākea i loko o nā kīʻaha koko liʻiliʻi ma ke kino a me ka hyperfibrinolysis lua ma lalo o ka hana a kekahi mau mea pathogenic, hiki ke hele pū me ka fibrinolysis lua a i ʻole ka fibrinolysis i kāohi ʻia.

ʻO ka nui o ka plasma o ka D-dimer he waiwai kuhikuhi lapaʻau kiʻekiʻe no ka ʻike mua ʻana o DIC. Eia nō naʻe, pono e hoʻomaopopo ʻia ʻaʻole ka hoʻonui ʻia o ka D-dimer he hoʻāʻo kikoʻī no DIC, akā he nui nā maʻi i hele pū ʻia me ka microthrombosis e alakaʻi i ka hoʻonui ʻia o ka D-dimer. Ke pili ka fibrinolysis i ka coagulation extravascular, e hoʻonui pū ʻia ka D-dimer.

Ua hōʻike ʻia nā haʻawina e hoʻomaka ana ka piʻi ʻana o ka D-dimer i nā lā ma mua o ka DIC a ʻoi aku ke kiʻekiʻe ma mua o ka maʻamau.

 

03 Ka hanu ʻole o ka pēpē hānau hou

Aia nā ʻano like ʻole o ka hypoxia a me ka acidosis i ka asphyxia neonatal, a hiki i ka hypoxia a me ka acidosis ke hōʻeha nui i ka endothelial vascular, e hopena ana i ka hoʻokuʻu ʻia ʻana o ka nui o nā mea coagulation, a laila e hoʻonui ai i ka hana ʻana o fibrinogen.

Ua hōʻike ʻia nā haʻawina pili i ke kiʻekiʻe loa o ka waiwai D-dimer o ke koko kaula i ka hui asphyxia ma mua o ka hui kaohi maʻamau, a i hoʻohālikelike ʻia me ka waiwai D-dimer i ke koko peripheral, ʻoi aku hoʻi ke kiʻekiʻe.

 

04 Lupus erythematosus ʻōnaehana (SLE)

He ʻano ʻē ka ʻōnaehana coagulation-fibrinolysis i nā poʻe maʻi SLE, a ʻoi aku ka ʻike ʻia o ka ʻano ʻē o ka ʻōnaehana coagulation-fibrinolysis i ke kahua hana o ka maʻi, a ʻoi aku ka maopopo o ke ʻano o ka thrombosis; ke hoʻomaha ʻia ka maʻi, e maʻamau ka ʻōnaehana coagulation-fibrinolysis.

No laila, e hoʻonui nui ʻia nā pae D-dimer o nā maʻi me ka systemic lupus erythematosus i nā pae hana a me nā pae hana ʻole, a ʻoi aku ke kiʻekiʻe o nā pae plasma D-dimer o nā maʻi i ke pae hana ma mua o ka poʻe i ke pae hana ʻole.

05 ʻO ka maʻi ʻaʻai ate a me ke kanesa ate

ʻO D-dimer kekahi o nā māka e hōʻike ana i ke koʻikoʻi o ka maʻi akepaʻa. ʻO ka ʻoi aku o ke koʻikoʻi o ka maʻi akepaʻa, ʻoi aku ke kiʻekiʻe o ka nui o ka plasma D-dimer.

Ua hōʻike ʻia nā haʻawina pili i nā waiwai D-dimer o nā papa Child-Pugh A, B, a me C i nā poʻe maʻi me ka cirrhosis akepaʻa he (2.218 ± 0.54) μg/mL, (6.03 ± 0.76) μg/mL, a me (10.536 ± 0.664) μg/mL, kēlā me kēia.

Eia kekahi, ua hoʻokiʻekiʻe nui ʻia ʻo D-dimer i nā poʻe maʻi me ka maʻi kanesa o ke akepaʻa me ka holomua wikiwiki a me ka prognosis maikaʻi ʻole.

06 Ka maʻi ʻōpū

Ma hope o ka ʻoki ʻana o nā maʻi kanesa, loaʻa ka thromboembolism ma kahi o ka hapalua o nā maʻi, a piʻi nui ka D-dimer ma 90% o nā maʻi.

Eia kekahi, aia kahi papa o nā mea kō kiʻekiʻe i loko o nā pūnaewele tumor nona ke ʻano a me ke kumu kiko e like loa. ʻO ke komo ʻana i nā hana metabolic kanaka hiki ke hoʻoulu i ka hana o ka ʻōnaehana coagulation o ke kino a hoʻonui i ka pilikia o ka thrombosis, a ua hoʻonui nui ʻia ke kiʻekiʻe o D-dimer. A ʻoi aku ka kiʻekiʻe o ka pae o D-dimer i nā maʻi kanesa ʻōpū me ke kahua III-IV ma mua o nā maʻi kanesa ʻōpū me ke kahua I-II.

 

07 Ka maʻi niumonia Mycoplasma (MMP)

Hoʻopili pinepine ʻia ka MPP koʻikoʻi me nā pae D-dimer kiʻekiʻe, a ʻoi aku ke kiʻekiʻe o nā pae D-dimer i nā poʻe maʻi me ka MPP koʻikoʻi ma mua o nā hihia akahai.

Ke maʻi nui ka MPP, e kū mai ka hypoxia, ischemia a me ka acidosis ma kahi kūloko, me ka hui pū ʻana me ka hoʻouka pololei ʻana o nā pathogens, ka mea e hōʻino ai i nā cell endothelial vascular, e hōʻike i ka collagen, e hoʻāla i ka ʻōnaehana coagulation, e hana i kahi kūlana hypercoagulable, a hana i ka microthrombi. Hoʻāla ʻia nā ʻōnaehana fibrinolytic kūloko, kinin a me ka complement i kēlā me kēia manawa, e hopena ana i ka hoʻonui ʻia ʻana o nā pae D-dimer.

 

08 Maʻi diabetes, maʻi diabetic nephropathy

Ua hoʻokiʻekiʻe nui ʻia nā pae D-dimer i nā poʻe maʻi me ka maʻi diabetes a me ka maʻi nephropathy diabetic.

Eia kekahi, ʻoi aku ka kiʻekiʻe o nā helu D-dimer a me fibrinogen o nā maʻi me ka diabetic nephropathy ma mua o nā maʻi diabetes type 2. No laila, i ka hana lapaʻau, hiki ke hoʻohana ʻia ka D-dimer ma ke ʻano he helu hoʻāʻo no ka ʻike ʻana i ke koʻikoʻi o ka maʻi diabetes a me nā maʻi puʻupaʻa i nā maʻi.

09 Allergic Purpura (AP)

I ke kahua koʻikoʻi o AP, aia nā ʻano like ʻole o ka hypercoagulability koko a me ka hoʻonui ʻia o ka hana platelet, e alakaʻi ana i ka vasospasm, platelet aggregation a me ka thrombosis.

ʻO ke kiʻekiʻe o ka D-dimer i nā keiki me ka AP he mea maʻamau ma hope o 2 mau pule o ka hoʻomaka ʻana a ʻokoʻa ma waena o nā pae lapaʻau, e hōʻike ana i ka nui a me ke kekelē o ka mumū o nā kīʻaha koko.

Eia kekahi, he hōʻailona prognostic nō hoʻi ia, me ke kiʻekiʻe mau o ka D-dimer, ua hoʻolōʻihi pinepine ʻia ka maʻi a hiki ke hōʻino ʻia ka renal.

 

10 Hāpai keiki

Ua hōʻike ʻia nā haʻawina pili e pili ana i ka 10% o nā wahine hāpai i hoʻokiʻekiʻe nui ʻia nā pae D-dimer, e hōʻike ana i kahi pilikia o nā ʻūpā koko.

He pilikia maʻamau ka preeclampsia o ka hāpai ʻana. ʻO nā loli pathological nui o ka preeclampsia a me ka eclampsia ʻo ia ka hoʻāla ʻana o ka coagulation a me ka hoʻonui ʻana o ka fibrinolysis, e hopena ana i ka hoʻonui ʻia ʻana o ka thrombosis microvascular a me ka D-dimer.

Ua emi koke ka D-dimer ma hope o ka hānau ʻana i nā wahine maʻamau, akā ua piʻi aʻe i nā wahine me ka preeclampsia, a ʻaʻole i hoʻi i ka maʻamau a hiki i 4 a 6 mau pule.

11 ʻO ka maʻi coronary koʻikoʻi a me ka dissecting aneurysm

ʻO nā maʻi me nā maʻi coronary acute he maʻamau a i ʻole kiʻekiʻe iki aʻe paha nā pae D-dimer, ʻoiai ua kiʻekiʻe nui nā aneurysms dissecting aortic.

Pili kēia i ka ʻokoʻa koʻikoʻi o ka ukana thrombus i loko o nā kīʻaha arterial o nā mea ʻelua. ʻOi aku ka lahilahi o ka lumen coronary a ʻoi aku ka liʻiliʻi o ka thrombus i loko o ke aʻa coronary. Ma hope o ka haki ʻana o ka aortic intima, nui ka nui o ke koko arterial e komo i loko o ka paia o ke kīʻaha e hana i kahi aneurysm dissecting. Hoʻokumu ʻia ka nui o nā thrombi ma lalo o ka hana o ke ʻano coagulation.

12 Ka infarction lolo koʻikoʻi

I ka infarction cerebral acute, hoʻonui ʻia ka thrombolysis spontaneous a me ka hana fibrinolytic lua, i hōʻike ʻia e like me ka hoʻonui ʻia ʻana o nā pae plasma D-dimer. Ua hoʻonui nui ʻia ka pae D-dimer i ka wā mua o ka infarction cerebral acute.

Ua hoʻonui iki ʻia nā pae plasma D-dimer i nā poʻe maʻi me ka hahau ischemic acute i ka pule mua ma hope o ka hoʻomaka ʻana, ua hoʻonui nui ʻia i loko o 2 a 4 mau pule, a ʻaʻole ʻokoʻa mai nā pae maʻamau i ka wā hoʻōla (>3 mau mahina).