Hoʻohana pinepine ʻia ka D-dimer ma ke ʻano he hoʻokahi o nā hōʻailona koʻikoʻi i manaʻo ʻia o ka PTE a me DVT i ka hana lapaʻau. Pehea i hiki mai ai?

ʻO ka Plasma D-dimer kahi huahana hoʻohaʻahaʻa kikoʻī i hana ʻia e ka plasmin hydrolysis ma hope o ka hoʻopili ʻia ʻana o ka fibrin monomer e ka mea hoʻoulu XIII. He hōʻailona kikoʻī ia o ke kaʻina hana fibrinolysis. Loaʻa nā D-dimers mai nā clots fibrin i hoʻopili ʻia e ka plasmin. Inā he thrombosis ikaika a me ka hana fibrinolytic i loko o nā kīʻaha koko o ke kino, e hoʻonui ʻia ka D-dimer. ʻO ka myocardial infarction, cerebral infarction, pulmonary embolism, venous thrombosis, ʻoki kino, tumor, disseminated intravascular coagulation, maʻi a me ka necrosis kiko e alakaʻi i ka D-dimer kiʻekiʻe. ʻOi aku hoʻi no nā poʻe ʻelemakule a me nā poʻe maʻi ma ka haukapila, ma muli o ka bacteremia a me nā maʻi ʻē aʻe, he maʻalahi ke hana i ka coagulation koko kūpono ʻole a alakaʻi i ka hoʻonui ʻia o ka D-dimer.

Hōʻike nui ka D-dimer i ka hana fibrinolytic. Hoʻonui ʻia a maikaʻi paha i ʻike ʻia i ka hyperfibrinolysis lua, e like me ke kūlana hypercoagulable, disseminated intravascular coagulation, maʻi renal, hōʻole ʻana o ka hoʻoili ʻana o nā kino, thrombolytic therapy, a pēlā aku. ʻO ka hoʻoholo ʻana i nā kumu nui o ka ʻōnaehana fibrinolytic he mea nui loa ia no ka ʻike ʻana a me ka mālama ʻana i nā maʻi o ka ʻōnaehana fibrinolytic (e like me DIC, nā thrombus like ʻole) a me nā maʻi e pili ana i ka ʻōnaehana fibrinolytic (e like me nā tumors, pregnancy syndrome), a me ka nānā ʻana i ka thrombolytic therapy.

ʻO nā pae kiʻekiʻe o ka D-dimer, kahi huahana hoʻohaʻahaʻa fibrin, e hōʻike ana i ka hoʻohaʻahaʻa pinepine ʻana o ka fibrin i loko o ke kino. No laila, ʻo ka fibrous D-dimer kahi hōʻailona koʻikoʻi o ka deep vein thrombosis (DVT), pulmonary embolism (PE), disseminated intravascular coagulation (DIC).

Hoʻoulu nā maʻi he nui i ka hoʻoulu ʻana o ka ʻōnaehana coagulation a/a i ʻole ka ʻōnaehana fibrinolytic i loko o ke kino, e hopena ana i ka piʻi ʻana o ka pae o D-dimer, a pili loa kēia hoʻoulu ʻana i ke kahua, ke koʻikoʻi a me ka mālama ʻana i ka maʻi, no laila i loko o kēia mau maʻi hiki ke hoʻohana ʻia ka ʻike ʻana i ka pae o D-dimer ma ke ʻano he māka loiloi no ke kahua o ka maʻi, ka prognosis a me ke alakaʻi mālama ʻana.

Ka hoʻohana ʻana o D-dimer i ka thrombosis vein hohonu

Mai ka wā i hoʻopili mua ai ʻo Wilson et al. i nā huahana hoʻohaʻahaʻa fibrin no ka ʻike ʻana i ka embolism pulmonary i ka makahiki 1971, ua hoʻokani nui ka ʻike ʻana o D-dimer i ka ʻike ʻana i ka embolism pulmonary. Me kekahi mau ʻano ʻike koʻikoʻi loa, loaʻa i ka waiwai kino D-dimer maikaʻi ʻole kahi hopena wānana maikaʻi ʻole no ka embolism pulmonary, a ʻo kona waiwai he 0.99. Hiki i kahi hopena maikaʻi ʻole ke kāpae i ka embolism pulmonary, no laila e hōʻemi ana i nā hoʻokolohua invasive, e like me ka ventilation perfusion scanning a me ka angiography pulmonary; e pale i ka lāʻau anticoagulation makapō.D - Pili ka nui o ka dimer i kahi o ka thrombus, me nā nui kiʻekiʻe ma nā lālā nui o ka pulmonary trunk a me nā nui haʻahaʻa ma nā lālā liʻiliʻi.

ʻAʻole hiki i nā D-dimers plasma maikaʻi ʻole ke hōʻole i ka hiki ke loaʻa ʻo DVT. Ua hōʻoia ka angiography he 100% maikaʻi ka DVT no ka D-dimer. Hiki ke hoʻohana ʻia no ka lāʻau thrombolytic a me ke alakaʻi ʻana i ka lāʻau heparin anticoagulation a me ka nānā ʻana i ka pono.

Hiki i ka D-dimer ke hōʻike i nā loli i ka nui o ka thrombus. Inā piʻi hou ka ʻike, hōʻike ia i ka hoʻi hou ʻana o ka thrombus; i ka wā mālama, hoʻomau ia i ke kiʻekiʻe, a ʻaʻole e loli ka nui o ka thrombus, e hōʻike ana ʻaʻole pono ka mālama ʻana.