Cov fibrin monomers hauv cov ntshav raug sib txuas los ntawm activated factor X III, thiab tom qab ntawd hydrolyzed los ntawm activated plasmin los tsim cov khoom degradation tshwj xeeb hu ua "fibrin degradation product (FDP)." D-Dimer yog FDP yooj yim tshaj plaws, thiab qhov nce ntawm nws qhov hnyav concentration qhia txog lub xeev hypercoagulable thiab secondary hyperfibrinolysis hauv vivo. Yog li ntawd, qhov concentration ntawm D-Dimer yog qhov tseem ceeb heev rau kev kuaj mob, kev ntsuam xyuas qhov ua tau zoo thiab kev txiav txim siab txog kev kwv yees ntawm cov kab mob thrombotic.
Txij li thaum muaj kev sib kis ntawm COVID-19, nrog rau kev nkag siab tob txog cov tsos mob thiab kev nkag siab txog tus kab mob thiab kev sib sau ua ke ntawm kev kuaj mob thiab kev kho mob, cov neeg mob hnyav uas muaj mob ntsws tshiab tuaj yeem tsim cov mob ntsws ua pa nyuaj sai sai. Cov tsos mob, septic shock, refractory metabolic acidosis, coagulation dysfunction, thiab ntau lub cev tsis ua haujlwm. D-dimer nce siab rau cov neeg mob uas muaj mob ntsws hnyav.
Cov neeg mob uas mob hnyav heev yuav tsum tau them sai sai rau qhov kev pheej hmoo ntawm kev mob venous thromboembolism (VTE) vim yog pw tsaug zog ntev thiab kev ua haujlwm ntawm cov ntshav tsis zoo.
Thaum lub sijhawm kho mob, nws yog ib qho tsim nyog los saib xyuas cov cim qhia tseem ceeb raws li tus mob, suav nrog cov cim myocardial, kev ua haujlwm coagulation, thiab lwm yam. Qee tus neeg mob yuav muaj myoglobin ntau ntxiv, qee qhov mob hnyav yuav pom troponin ntau ntxiv, thiab hauv cov mob hnyav, D-dimer (D-Dimer) yuav raug nce ntxiv.
Pom tau tias D-Dimer muaj qhov tseem ceeb ntawm kev saib xyuas cov teeb meem hauv kev nce qib ntawm COVID-19, yog li nws ua lub luag haujlwm li cas hauv lwm yam kab mob?
1. Kev mob ntshav hauv cov hlab ntsha
D-Dimer tau siv dav hauv cov kab mob ntsig txog venous thromboembolism (VTE), xws li deep vein thrombosis (DVT) thiab pulmonary embolism (PE). Kev kuaj D-Dimer tsis zoo tuaj yeem tshem tawm DVT, thiab D-Dimer concentration kuj tseem siv tau los kwv yees qhov rov tshwm sim ntawm VTE. Kev tshawb fawb pom tias qhov piv txwv ntawm kev pheej hmoo ntawm VTE rov tshwm sim hauv cov pej xeem uas muaj ntau dua yog 4.1 npaug ntawm cov pej xeem uas muaj ntau dua.
D-Dimer kuj yog ib qho ntawm cov cim qhia txog PE. Nws tus nqi kwv yees tsis zoo yog siab heev, thiab nws qhov tseem ceeb yog kom tsis txhob muaj cov kab mob ntsws loj heev, tshwj xeeb tshaj yog rau cov neeg mob uas tsis muaj kev xav tsis thoob. Yog li ntawd, rau cov neeg mob uas xav tias muaj cov kab mob ntsws loj heev, kev kuaj mob ultrasound ntawm cov leeg ntshav tob ntawm qhov qis qis thiab kev kuaj D-Dimer yuav tsum tau ua ke.
2. Kev sib kis ntawm cov ntshav hauv cov hlab ntsha
Kev mob ntshav txhaws hauv cov hlab ntsha (DIC) yog ib qho mob uas muaj tus yam ntxwv los ntawm kev los ntshav thiab kev ua tsis tiav ntawm cov ntshav hauv lub cev vim muaj ntau yam kab mob. Cov txheej txheem kev loj hlob suav nrog ntau lub tshuab xws li kev coagulation, anticoagulation, thiab fibrinolysis. D-Dimer nce ntxiv thaum ntxov ntawm kev tsim DIC, thiab nws qhov kev sib sau ua ke txuas ntxiv nce ntau dua 10 npaug thaum tus kab mob loj hlob. Yog li ntawd, D-Dimer tuaj yeem siv ua ib qho ntawm cov cim qhia tseem ceeb rau kev kuaj mob thaum ntxov thiab kev saib xyuas tus mob ntawm DIC.
3. Kev phais plawv
"Cov kws tshaj lij Suav pom zoo txog kev kuaj mob thiab kev kho mob ntawm aortic dissection" tau taw qhia tias D-Dimer, ua kev kuaj mob hauv chaw kuaj mob rau aortic dissection (AD), yog qhov tseem ceeb heev rau kev kuaj mob thiab kev kuaj mob sib txawv ntawm kev txiav. Thaum tus neeg mob D-Dimer nce sai, qhov ua tau tias yuav kuaj mob AD nce ntxiv. Hauv 24 teev tom qab pib mob, thaum D-Dimer nce mus txog qhov tseem ceeb ntawm 500 µg / L, nws qhov kev nkag siab rau kev kuaj mob AD mob hnyav yog 100%, thiab nws qhov tshwj xeeb yog 67%, yog li nws tuaj yeem siv ua tus ntsuas kev zam rau kev kuaj mob AD mob hnyav.
4. Kab mob plawv Atherosclerotic
Kab mob plawv Atherosclerotic yog ib yam kab mob plawv uas tshwm sim los ntawm cov hlab ntsha arteriosclerotic, suav nrog ST-segment elevation acute myocardial infarction, non-ST-segment elevation acute myocardial infarction, thiab unstable angina. Tom qab cov hlab ntsha tawg, cov khoom necrotic core hauv cov hlab ntsha ntws tawm, ua rau cov ntshav ntws tsis zoo, ua rau lub cev coagulation system ua haujlwm, thiab nce D-Dimer concentration. Cov neeg mob uas muaj kab mob plawv coronary uas muaj D-Dimer siab yuav kwv yees tau tias muaj kev pheej hmoo siab dua ntawm AMI thiab siv tau ua qhov qhia tau los saib xyuas qhov mob ntawm ACS.
5. Kev kho mob ntshav txhaws
Lawter txoj kev tshawb fawb pom tau tias ntau yam tshuaj thrombolytic tuaj yeem ua rau D-Dimer nce ntxiv, thiab nws qhov kev hloov pauv ua ntej thiab tom qab thrombolysis tuaj yeem siv ua qhov qhia txog kev txiav txim siab txog kev kho mob thrombolytic. Nws cov ntsiab lus nce sai sai mus rau qhov siab tshaj plaws tom qab thrombolysis, thiab poob qis hauv lub sijhawm luv luv nrog kev txhim kho tseem ceeb hauv cov tsos mob hauv tsev kho mob, qhia tias kev kho mob tau zoo.
- Qib D-Dimer nce ntxiv ntau heev 1 teev txog 6 teev tom qab thrombolysis rau mob myocardial infarction thiab cerebral infarction.
- Thaum lub sijhawm DVT thrombolysis, qhov siab tshaj plaws ntawm D-Dimer feem ntau tshwm sim 24 teev lossis tom qab ntawd.
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