Fibrin monomers nyob rau hauv cov ntshav yog cross-linked los ntawm activated factor X III, thiab ces hydrolyzed los ntawm activated plasmin los tsim ib tug tshwj xeeb degradation khoom hu ua "fibrin degradation product (FDP).D-Dimer yog qhov yooj yim tshaj plaws FDP, thiab qhov nce hauv nws cov concentration ntau qhia txog lub xeev hypercoagulable thiab theem nrab hyperfibrinolysis hauv vivo.Yog li ntawd, qhov concentration ntawm D-Dimer yog qhov tseem ceeb heev rau kev kuaj mob, kev ntsuas kev ua tau zoo thiab kev txiav txim siab ntawm cov kab mob thrombotic.
Txij li thaum muaj kev sib kis ntawm COVID-19, nrog rau qhov tob zuj zus ntawm cov kev kho mob thiab kev nkag siab ntawm tus kab mob thiab kev sib sau ntawm kev kuaj mob thiab kev kho mob, cov neeg mob hnyav nrog mob ntsws tshiab tuaj yeem ua rau mob ua pa nyuaj.Cov tsos mob, septic shock, refractory metabolic acidosis, coagulation dysfunction, thiab ntau lub cev tsis ua hauj lwm.D-dimer tau nce siab hauv cov neeg mob uas muaj mob ntsws hnyav.
Cov neeg mob hnyav yuav tsum tau them sai sai rau qhov kev pheej hmoo ntawm venous thromboembolism (VTE) vim yog lub txaj ntev ntev thiab kev ua haujlwm tsis zoo ntawm coagulation.
Thaum cov txheej txheem kho mob, nws yog ib qho tsim nyog los saib xyuas cov ntsuas ntsuas raws li tus mob, suav nrog cov cim myocardial, coagulation muaj nuj nqi, thiab lwm yam. Qee cov neeg mob yuav muaj myoglobin nce ntxiv, qee qhov mob hnyav tuaj yeem pom muaj zog troponin, thiab mob hnyav, D-dimer ( D-Dimer) tuaj yeem nce ntxiv.
Nws tuaj yeem pom tias D-Dimer muaj teeb meem cuam tshuam txog kev saib xyuas qhov tseem ceeb hauv kev nce qib ntawm COVID-19, yog li nws ua haujlwm li cas rau lwm yam kab mob?
1. Venous thromboembolism
D-Dimer tau siv dav hauv venous thromboembolism (VTE) cov kab mob ntsig txog, xws li cov hlab ntsha sib sib zog nqus (DVT) thiab pulmonary embolism (PE).Qhov kev ntsuam xyuas tsis zoo D-Dimer tuaj yeem txiav txim siab tawm DVT, thiab D-Dimer concentration kuj tuaj yeem siv los kwv yees qhov rov tshwm sim ntawm VTE.Txoj kev tshawb nrhiav pom tias qhov kev phom sij ntawm VTE rov tshwm sim hauv cov pej xeem uas muaj siab dua yog 4.1 npaug ntawm cov pejxeem uas muaj qhov qub.
D-Dimer kuj yog ib qho ntawm cov ntsuas ntsuas ntawm PE.Nws qhov kev kwv yees tsis zoo yog qhov siab heev, thiab nws qhov tseem ceeb yog txhawm rau tshem tawm cov mob ntsws pulmonary embolism, tshwj xeeb tshaj yog nyob rau hauv cov neeg mob uas tsis tshua muaj kev poob siab.Yog li ntawd, rau cov neeg mob uas xav tias mob ntsws embolism, ultrasound ntawm cov hlab ntsha sib sib zog nqus ntawm cov leeg qis thiab D-Dimer kev ntsuam xyuas yuav tsum ua ke.
2. Disseminated intravascular coagulation
Disseminated intravascular coagulation (DIC) yog ib qho kev kho mob uas tshwm sim los ntawm hemorrhage thiab microcirculatory tsis ua hauj lwm ntawm ntau yam kab mob.Txoj kev loj hlob muaj ntau lub tshuab xws li coagulation, anticoagulation, thiab fibrinolysis.D-Dimer tau nce nyob rau theem pib ntawm kev tsim DIC, thiab nws cov concentration txuas ntxiv nce ntau dua 10-fold raws li tus kab mob tau nce.Yog li, D-Dimer tuaj yeem siv los ua ib qho ntawm cov cim tseem ceeb rau kev kuaj mob ntxov thiab kev saib xyuas ntawm DIC.
3. Aortic dissection
"Cov kws tshaj lij Suav pom zoo rau kev kuaj mob thiab kev kho mob ntawm aortic dissection" tau taw qhia tias D-Dimer, raws li kev kuaj mob niaj hnub rau aortic dissection (AD), tseem ceeb heev rau kev kuaj mob thiab kev kuaj mob sib txawv ntawm kev txiav tawm.Thaum tus neeg mob D-Dimer nce nrawm, qhov muaj peev xwm ntawm kev kuaj mob raws li AD nce.Hauv 24 teev ntawm qhov pib, thaum D-Dimer ncav cuag tus nqi tseem ceeb ntawm 500 µg / L, nws qhov rhiab heev rau kev kuaj mob AD yog 100%, thiab nws qhov tshwj xeeb yog 67%, yog li nws tuaj yeem siv los ua qhov ntsuas tsis suav rau kev kuaj mob. mob AD.
4. Atherosclerotic Cardiovascular Disease
Atherosclerotic cardiovascular kab mob yog kab mob plawv los ntawm arteriosclerotic plaque, nrog rau ST-segment elevation mob myocardial infarction, non-ST-segment elevation mob myocardial infarction, thiab tsis ruaj khov angina.Tom qab cov quav hniav rupture, cov khoom siv necrotic hauv cov quav hniav ntws tawm, ua rau cov ntshav ntws tsis zoo, ua kom lub cev coagulation, thiab nce D-Dimer concentration.Cov neeg mob plawv mob plawv uas muaj D-Dimer siab tuaj yeem kwv yees qhov kev pheej hmoo siab ntawm AMI thiab tuaj yeem siv los ua qhov taw qhia los saib xyuas cov xwm txheej ntawm ACS.
5. Kev kho mob thrombolytic
Lawter txoj kev tshawb fawb pom tias ntau yam tshuaj thrombolytic tuaj yeem nce D-Dimer, thiab nws cov kev hloov pauv ua ntej thiab tom qab thrombolysis tuaj yeem siv los ua qhov ntsuas rau kev txiav txim siab thrombolytic kho.Nws cov ntsiab lus tau nce mus rau qhov siab tshaj plaws tom qab thrombolysis, thiab poob rov qab hauv lub sijhawm luv luv nrog kev txhim kho tseem ceeb hauv cov tsos mob, qhia tias kev kho mob tau zoo.
- Cov theem ntawm D-Dimer tau nce ntau 1 teev mus rau 6 teev tom qab thrombolysis rau mob myocardial infarction thiab cerebral infarction
- Thaum lub sij hawm DVT thrombolysis, D-Dimer ncov feem ntau tshwm sim 24 teev lossis tom qab ntawd
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