Me ka hoʻomaopopo hohonu ʻana o ka poʻe i ka thrombus, ua hoʻohana ʻia ʻo D-dimer ma ke ʻano he mea hoʻāʻo maʻamau no ka hoʻokaʻawale ʻana i ka thrombus i nā keʻena hoʻokolohua coagulation. Eia naʻe, he wehewehe mua wale nō kēia o D-Dimer. I kēia manawa, ua hāʻawi ka nui o nā kānaka akamai iā D-Dimer i kahi manaʻo momona i ka noiʻi ʻana ma D-Dimer ponoʻī a me kona pilina me nā maʻi. ʻO ka ʻike o kēia puke e alakaʻi iā ʻoe e mahalo i kāna kuhikuhi noi hou.
ʻO ke kumu o ka hoʻopili lapaʻau o D-dimer
01. ʻO ka hoʻonui ʻia ʻana o D-Dimer e hōʻike ana i ka hoʻoulu ʻana o ka ʻōnaehana coagulation a me ka ʻōnaehana fibrinolysis i loko o ke kino, a hōʻike kēia kaʻina hana i kahi kūlana hoʻololi kiʻekiʻe. Hiki ke hoʻohana ʻia ʻo D-Dimer maikaʻi ʻole no ka hoʻokaʻawale ʻana i nā thrombus (ka waiwai lapaʻau koʻikoʻi loa); ʻoiai ʻaʻole hiki i ka D-Dimer maikaʻi ke hōʻoia i ka hoʻokumu ʻia ʻana o ka thromboembolism. ʻO ka hoʻokumu ʻia ʻana o ka thromboembolism a i ʻole ma muli o ke kaulike o kēia mau ʻōnaehana ʻelua.
02. ʻO ka hapalua ola o D-Dimer he 7-8 hola, a hiki ke ʻike ʻia he 2 hola ma hope o ka thrombosis. Hiki ke hoʻohālikelike maikaʻi ʻia kēia hiʻohiʻona me ka hana lapaʻau, a ʻaʻole ia he mea paʻakikī ke nānā ʻia no ka mea he pōkole loa ka hapalua ola, a ʻaʻole ia e nalowale ke koʻikoʻi o ka nānā ʻana no ka mea he lōʻihi loa ka hapalua ola.
03. Hiki ke paʻa ka D-Dimer i loko o nā hāpana koko ma hope o ka in vitro no 24-48 mau hola ma ka liʻiliʻi, i hiki ai i ka ʻike D-Dimer i ʻike ʻia ma vitro ke hōʻike pololei i ka pae D-Dimer ma vivo.
04. Hoʻokumu ʻia ke ʻano hana o D-Dimer ma ka hopena antigen-antibody, akā he nui ke ʻano hana kikoʻī akā ʻaʻole like. He ʻokoʻa nā antibodies i loko o ka reagent, a ʻaʻole kūlike nā ʻāpana antigen i ʻike ʻia. I ke koho ʻana i kahi brand i loko o ka hale hana, pono e nānā ʻia.
Ka hoʻohana kuʻuna ʻana o ka D-dimer i ka coagulation lapaʻau
1. Ka hōʻoia ʻana o ka hoʻokaʻawale ʻana o VTE:
Hiki ke hoʻohana pono ʻia ka hoʻāʻo D-Dimer i hui pū ʻia me nā mea hana loiloi pilikia lapaʻau e kāpae i ka deep vein thrombosis (DVT) a me ka pulmonary embolism (PE).
I ka wā e hoʻohana ʻia ai no ka hoʻokaʻawale ʻana i nā thrombus, aia kekahi mau koi no ka reagent D-Dimer a me ke ʻano hana. Wahi a ke kūlana ʻoihana D-Dimer, ʻo ka hiki ke hoʻāʻo mua i hui pū ʻia e koi ana i kahi helu wānana maikaʻi ʻole o ≥97% a me kahi ʻike o ≥95%.
2. Ka hōʻoia kōkua o ka coagulation intravascular disseminated (DIC):
ʻO ka hōʻike maʻamau o DIC ka ʻōnaehana hyperfibrinolysis, a ʻo ka ʻike ʻana e hiki ke hōʻike i ka hyperfibrinolysis he kuleana koʻikoʻi ia i ka ʻōnaehana helu DIC. Ua hōʻike ʻia ma ke ʻano lapaʻau e hoʻonui nui ʻia ka D-Dimer (ʻoi aku ma mua o 10 mau manawa) i nā poʻe maʻi DIC. Ma nā alakaʻi diagnostic DIC kūloko a me nā haole a i ʻole ka ʻaelike, hoʻohana ʻia ʻo D-Dimer ma ke ʻano he hoʻokahi o nā ʻōkuhi keʻena no ka ʻike ʻana i ka DIC, a ua ʻōlelo ʻia e hoʻokō pū i ka FDP. Hoʻomaikaʻi maikaʻi i ka pono o ka ʻike ʻana i ka DIC. ʻAʻole hiki ke hana ʻia ka ʻike ʻana o DIC ma ka hilinaʻi wale ʻana i kahi helu kuhikuhi keʻena hoʻokolohua hoʻokahi a me nā hopena o kahi hoʻokolohua hoʻokahi. Pono e kālailai piha ʻia a nānā pono ʻia me ka hui pū ʻana me nā hōʻike lapaʻau o ka mea maʻi a me nā ʻōkuhi keʻena hoʻokolohua ʻē aʻe.
Nā noi lapaʻau hou o D-Dimer
1. Ka hoʻopili ʻana o D-Dimer i nā poʻe maʻi me COVID-19: Ma kekahi ʻano, ʻo COVID-19 kahi maʻi thrombotic i hoʻokumu ʻia e nā maʻi pale, me ka pane mumū diffuse a me ka microthrombosis i loko o nā māmā. Ua hōʻike ʻia ma mua o 20% o nā poʻe maʻi me VTE i nā hihia haukapila o COVID-19.
• Ua wānana kūʻokoʻa nā pae D-Dimer i ka wā i komo ai i ka haukapila i ka make ʻana a ua nānā i nā poʻe maʻi me ka pilikia kiʻekiʻe. I kēia manawa, ua lilo ʻo D-dimer i hoʻokahi o nā mea nānā koʻikoʻi no nā poʻe maʻi me COVID-19 i ka wā e komo ai lākou i ka haukapila.
• Hiki ke hoʻohana ʻia ka D-Dimer e alakaʻi i ka hoʻomaka ʻana i ka heparin anticoagulation i nā poʻe maʻi me COVID-19. Ua hōʻike ʻia i nā poʻe maʻi me D-Dimer ≥ 6-7 mau manawa o ka palena kiʻekiʻe o ka pae kuhikuhi, hiki i ka hoʻomaka ʻana o ka heparin anticoagulation ke hoʻomaikaʻi nui i nā hopena o ka poʻe maʻi.
• Hiki ke hoʻohana ʻia ka nānā ʻana i ka D-Dimer e loiloi i ka hanana o VTE i nā poʻe maʻi me COVID-19.
• Ka nānā ʻana iā D-Dimer, hiki ke hoʻohana ʻia e loiloi i ka hopena o COVID-19.
• Ka nānā ʻana iā D-Dimer, i ka wā e kū ai ka lāʻau lapaʻau i kahi hoʻoholo, hiki iā D-Dimer ke hāʻawi i kekahi ʻike kuhikuhi? Nui nā hoʻokolohua lapaʻau ma nā ʻāina ʻē e nānā ʻia nei.
2. Ua wānana ka nānā ʻana o D-Dimer i ka hoʻokumu ʻana o VTE:
E like me ka mea i ʻōlelo ʻia ma luna, ʻo ka hapalua ola o D-Dimer he 7-8h. Ma muli o kēia hiʻohiʻona hiki i ka D-Dimer ke nānā a wānana i ka hoʻokumu ʻia ʻana o VTE. No ke kūlana hypercoagulable transient a i ʻole microthrombosis, e piʻi iki ka D-Dimer a laila e emi koke. Ke loaʻa ka hoʻokumu ʻana o ka thrombus hou i loko o ke kino, e hoʻomau ka piʻi ʻana o ka D-Dimer i loko o ke kino, e hōʻike ana i kahi piʻo piʻi e like me ka piko. No ka poʻe me ka nui o ka thrombosis, e like me nā hihia koʻikoʻi a koʻikoʻi, nā maʻi postoperative, a pēlā aku, inā piʻi koke ka pae D-Dimer, e makaʻala i ka hiki ke loaʻa ka thrombosis. Ma ka "Expert Consensus on the Screening and Treatment of Deep Vein Thrombosis in Trauma Orthopedic Patients", ua ʻōlelo ʻia e nānā pono nā maʻi me ka pilikia waena a kiʻekiʻe ma hope o ke ʻoki kino orthopedic i nā loli o D-Dimer i kēlā me kēia 48 hola. Pono e hana ʻia nā hoʻokolohua kiʻi i ka manawa kūpono e nānā no DVT.
3. ʻO D-Dimer ma ke ʻano he hōʻailona wānana no nā maʻi like ʻole:
Ma muli o ka pilina pili loa ma waena o ka ʻōnaehana coagulation a me ka mumū, ka ʻeha endothelial, a me nā mea ʻē aʻe, ʻike pinepine ʻia ka piʻi ʻana o D-Dimer i kekahi mau maʻi non-thrombotic e like me ka maʻi, ke ʻoki kino a i ʻole ka trauma, ka hāʻule ʻana o ka puʻuwai, a me nā puʻupuʻu malignant. Ua ʻike ʻia nā noiʻi ʻo ka prognosis maikaʻi ʻole o kēia mau maʻi ʻo ia ka thrombosis, DIC, a me nā mea ʻē aʻe. ʻO ka hapa nui o kēia mau pilikia nā maʻi pili maʻamau a i ʻole nā kūlana e hoʻoulu ai i ka piʻi ʻana o D-Dimer. No laila, hiki ke hoʻohana ʻia ʻo D-Dimer ma ke ʻano he helu loiloi ākea a koʻikoʻi no nā maʻi.
• No nā poʻe maʻi puʻupuʻu, ua ʻike ʻia kekahi mau noiʻi he haʻahaʻa loa ka nui o ke ola ʻana o nā poʻe maʻi puʻupuʻu ʻino no 1-3 mau makahiki me ka D-Dimer kiʻekiʻe ma mua o nā poʻe maʻi D-Dimer maʻamau. Hiki ke hoʻohana ʻia ka D-Dimer ma ke ʻano he hōʻailona no ka loiloi ʻana i ka wānana o nā poʻe maʻi puʻupuʻu ʻino.
• No nā poʻe maʻi VTE, ua hōʻoia nā haʻawina he nui he 2-3 mau manawa kiʻekiʻe aʻe ka pilikia o ka hoʻi hou ʻana o ka thrombus i nā poʻe maʻi D-Dimer me VTE i ka wā o ka anticoagulation ma mua o nā poʻe maʻi maikaʻi ʻole. Ua hōʻike ʻia kekahi meta-analysis ʻē aʻe me 7 mau haʻawina me ka huina o 1818 mau kumuhana, ʻo Abnormal D-Dimer kekahi o nā mea wānana nui o ka hoʻi hou ʻana o ka thrombus i nā poʻe maʻi VTE, a ua hoʻokomo ʻia ʻo D-Dimer i loko o nā hiʻohiʻona wānana pilikia VTE he nui.
• No nā poʻe maʻi pani valve mechanical (MHVR), ua hōʻike ʻia kahi noiʻi hahai lōʻihi o 618 mau kumuhana ʻo ka pilikia o nā hanana maikaʻi ʻole i nā poʻe maʻi me nā pae D-Dimer maʻamau ʻole i ka wā warfarin ma hope o MHVR ma kahi o 5 mau manawa ma mua o nā poʻe maʻi maʻamau. Ua hōʻoia ka loiloi correlation multivariate he mea wānana kūʻokoʻa ka pae D-Dimer o nā hanana thrombotic a i ʻole cardiovascular i ka wā anticoagulation.
• No nā poʻe maʻi me ka atrial fibrillation (AF), hiki i ka D-Dimer ke wānana i nā hanana thrombotic a me nā hanana cardiovascular i ka anticoagulation waha. Ua hōʻike ʻia kahi noiʻi e pili ana i 269 mau maʻi me ka atrial fibrillation i ukali ʻia no kahi o 2 mau makahiki i ka wā o ka anticoagulation waha, ma kahi o 23% o nā maʻi me INR i hōʻea i ka pahuhopu i hōʻike i nā pae D-Dimer maʻamau ʻole, ʻoiai nā maʻi me nā pae D-Dimer maʻamau i ulu. ʻO nā pilikia o nā hanana thrombotic a me nā hanana cardiovascular comorbid he 15.8 a me 7.64 mau manawa, kēlā me kēia, o nā maʻi me nā pae D-Dimer maʻamau.
• No kēia mau maʻi kikoʻī a i ʻole nā maʻi kikoʻī, ʻo ka D-Dimer kiʻekiʻe a mau loa paha e hōʻike pinepine ana i ka prognosis maikaʻi ʻole a i ʻole ka ʻoi ʻana o ka maʻi.
4. Ka hoʻohana ʻana o D-Dimer i ka lāʻau lapaʻau anticoagulation waha:
• Hoʻoholo ka D-Dimer i ka lōʻihi o ka anticoagulation waha: ʻAʻole i maopopo ka lōʻihi kūpono o ka anticoagulation no nā maʻi me VTE a i ʻole nā thrombus ʻē aʻe. Me ka nānā ʻole inā he NOAC a VKA paha, ʻōlelo nā alakaʻi honua pili e hoʻoholo ʻia ka anticoagulation lōʻihi e like me ka pilikia o ke kahe koko i ke kolu o ka mahina o ka lāʻau anticoagulation, a hiki i ka D-Dimer ke hāʻawi i ka ʻike pilikino no kēia.
• Alakaʻi ʻo D-Dimer i ka hoʻoponopono ʻana i ka ikaika o ka anticoagulant waha: ʻO Warfarin a me nā anticoagulants waha hou nā anticoagulants waha i hoʻohana pinepine ʻia i ka hana lapaʻau, hiki i nā mea ʻelua ke hōʻemi i ka pae o D-Dimer. a me ka hoʻoulu ʻana o ka ʻōnaehana fibrinolytic, no laila e hōʻemi pololei ʻole ana i ka pae o D-Dimer. Hōʻike nā hopena hoʻokolohua e hōʻemi pono ana ka anticoagulation i alakaʻi ʻia e D-Dimer i nā maʻi i ka nui o nā hanana maikaʻi ʻole.
I ka hopena, ʻaʻole i kaupalena ʻia ka hoʻāʻo D-Dimer i nā noi kuʻuna e like me ka VTE exclusion diagnosis a me ka ʻike ʻana iā DIC. He kuleana koʻikoʻi ko D-Dimer i ka wānana ʻana i nā maʻi, ka wānana ʻana, ka hoʻohana ʻana i nā anticoagulants waha, a me COVID-19. Me ka hoʻomau ʻana o ka noiʻi, e lilo ka hoʻohana ʻana o D-Dimer i mea ākea aʻe.
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