He aha ka D-dimer?

ʻO D-dimer ka huahana hoʻohaʻahaʻa maʻalahi loa o ka fibrin, a hiki i kona pae kiʻekiʻe ke hōʻike i ke kūlana hypercoagulable a me ka hyperfibrinolysis lua i vivo. Hiki ke hoʻohana ʻia ʻo D-dimer ma ke ʻano he hōʻailona o ka hypercoagulability a me ka hyperfibrinolysis i vivo, a ʻo kona hoʻonui ʻana e hōʻike ana e pili ana ia i nā maʻi thrombotic i hoʻokumu ʻia e nā kumu like ʻole i vivo, a hōʻike pū i ka hoʻonui ʻana o ka hana fibrinolytic.

Ma lalo o nā kūlana hea e hoʻokiʻekiʻe ʻia ai ka nui o D-dimer?

Hiki i nā maʻi venous thromboembolism (VTE) a me nā maʻi thromboembolic non-venous ke hoʻonui i nā pae D-dimer.

ʻO ka VTE e komo pū ana me ka acute pulmonary embolism, deep vein thrombosis (DVT) a me ka cerebral venous (sinus) thrombosis (CVST).

ʻO nā maʻi thromboembolic non-venous e komo pū me ka acute aortic dissection (AAD), ruptured aneurysm, stroke (CVA), disseminated intravascular coagulation (DIC), sepsis, acute coronary syndrome (ACS), a me ka maʻi obstructive Pulmonary chronic (COPD), a pēlā aku. Eia kekahi, hoʻokiʻekiʻe ʻia nā pae D-dimer i nā kūlana e like me ka ʻelemakule, ke ʻoki kino/trauma hou, a me ka thrombolysis.

Hiki ke hoʻohana ʻia ka D-dimer e loiloi i ka prognosis o ka embolism pulmonary

Wānana ʻo D-dimer i ka make ʻana o nā maʻi me ka embolism pulmonary. I nā maʻi me ka embolism pulmonary koʻikoʻi, ua pili nā waiwai D-dimer kiʻekiʻe me nā helu PESI kiʻekiʻe (Pulmonary Embolism Severity Index Score) a me ka piʻi ʻana o ka make. Ua hōʻike ʻia nā haʻawina he waiwai wānana maikaʻi ʻole ʻo D-dimer <1500 μg/L no ka make ʻana o ka embolism pulmonary 3 mahina: ʻo ka make ʻana o 3 mahina he 0% ke D-dimer <1500 μg/L. Ke ʻoi aku ka nui o D-dimer ma mua o 1500 μg/L, pono e hoʻohana ʻia ka makaʻala kiʻekiʻe.

Eia kekahi, ua hōʻike kekahi mau noiʻi no nā poʻe maʻi me ka maʻi kanesa o ka māmā, ʻo ka D-dimer <1500 μg/L he hana fibrinolytic i hoʻonui ʻia e nā ʻōpū; Hōʻike pinepine ka D-dimer >1500 μg/L i ka loaʻa ʻana o ka thrombosis vein hohonu (DVT) a me ka embolism pulmonary i nā poʻe maʻi me ka maʻi kanesa o ka māmā.

Ua wānana ʻo D-dimer i ka hoʻi hou ʻana o VTE

He wānana ka D-dimer i ka VTE hou. ʻO ka nui o ka hoʻi hou ʻana o 3 mahina i nā poʻe maʻi me ka ʻole o ka D-dimer he 0. Inā piʻi hou ka D-dimer i ka wā o ka nānā ʻana, hiki ke hoʻonui nui ʻia ka pilikia o ka hoʻi hou ʻana o VTE.

Kōkua ʻo D-dimer i ka ʻike ʻana i ka dissection aortic

He waiwai wānana maikaʻi ʻole ko D-dimer i nā maʻi me ka dissection aortic acute, a hiki i ka D-dimer negativity ke kāpae i ka dissection aortic acute. Hoʻokiʻekiʻe ʻia ka D-dimer i nā maʻi me ka dissection aortic acute a ʻaʻole i hoʻokiʻekiʻe nui ʻia i nā maʻi me ka dissection aortic mau loa.

Hoʻololi pinepine ʻia ka D-dimer a piʻi koke paha, e hōʻike ana i kahi pilikia nui o ka haki ʻana o ka dissection. Inā paʻa a haʻahaʻa ka pae D-dimer o ka mea maʻi (<1000 μg/L), liʻiliʻi ka pilikia o ka haki ʻana o ka dissection. No laila, hiki i ka pae D-dimer ke alakaʻi i ka mālama ʻana i kēlā mau maʻi.

D-dimer a me ka maʻi

ʻO ka maʻi kekahi o nā kumu o VTE. I ka wā o ka unuhi ʻana i ka niho, hiki ke loaʻa ka bacteremia, kahi e alakaʻi ai i nā hanana thrombotic. I kēia manawa, pono e nānā pono ʻia nā pae D-dimer, a pono e hoʻoikaika ʻia ka lāʻau anticoagulation ke kiʻekiʻe nā pae D-dimer.

Eia kekahi, ʻo nā maʻi hanu a me ka hōʻino ʻana o ka ʻili he mau mea pilikia no ka thrombosis vein hohonu.

Ke alakaʻi nei ʻo D-dimer i ka lāʻau anticoagulation

Ua hōʻike ʻia nā hopena o ka noiʻi PROLONG multicenter, prospective ma nā pae mua (18 mahina follow-up) a me nā pae i hoʻolōʻihi ʻia (30 mahina follow-up) i ka hoʻohālikelike ʻana me nā poʻe maʻi i hoʻopaʻa ʻole ʻia, ua hoʻomau nā poʻe maʻi D-dimer-positive ma hope o 1 mahina o ka hoʻōki ʻana i ka lāʻau. Ua hōʻemi nui ka Anticoagulation i ka pilikia o ka hoʻi hou ʻana o VTE, akā ʻaʻohe ʻokoʻa koʻikoʻi i nā poʻe maʻi D-dimer-negative.

Ma kahi loiloi i paʻi ʻia e Blood, ua kuhikuhi pū ʻo Polofesa Kearon e hiki ke alakaʻi ʻia ka lāʻau anticoagulation e like me ka pae D-dimer o ka mea maʻi. I nā poʻe maʻi me ka DVT proximal i hoʻonāukiuki ʻole ʻia a i ʻole ka embolism pulmonary, hiki ke alakaʻi ʻia ka lāʻau anticoagulation e ka ʻike ʻana o D-dimer; inā ʻaʻole hoʻohana ʻia ka D-dimer, hiki ke hoʻoholo ʻia ke kaʻina hana anticoagulation e like me ka pilikia o ke kahe koko a me nā makemake o ka mea maʻi.

Eia kekahi, hiki i ka D-dimer ke alakaʻi i ka lāʻau thrombolytic.