Site n'ịghọtakwu thrombus nke ọma, ejirila D-dimer mee ihe dị ka ihe nnwale a na-ejikarị eme ihe maka mwepụ nke thrombus na ụlọ nyocha coagulation. Agbanyeghị, nke a bụ naanị nkọwa bụ isi nke D-Dimer. Ugbu a, ọtụtụ ndị ọkà mmụta enyela D-Dimer ihe ka mma na nyocha gbasara D-Dimer n'onwe ya na mmekọrịta ya na ọrịa. Ihe dị na mbipụta a ga-eme ka ị ghọta ntụziaka ọhụrụ e ji eme ya.
Ihe ndabere nke ojiji D-dimer n'ụlọ ọgwụ
01. Mmụba nke D-Dimer na-anọchite anya mkpali nke sistemụ coagulation na sistemụ fibrinolysis n'ahụ, usoro a na-egosikwa ọnọdụ mgbanwe dị elu. Enwere ike iji D-Dimer na-adịghị mma maka mwepụ nke thrombus (uru kachasị mkpa maka ahụike); ebe D-Dimer positive enweghị ike igosi mmalite nke thromboembolism. Ma thromboembolism e guzobere ma ọ bụ na ọ bụghị dabere na nguzozi nke sistemụ abụọ a.
02. Ọkara ndụ nke D-Dimer bụ awa 7-8, a pụkwara ịchọpụta ya awa 2 mgbe thrombosis gasịrị. Enwere ike ijikọ atụmatụ a na ọgwụgwọ ahụike, ọ gaghị esiri ike inyocha ya n'ihi na ọkara ndụ dị mkpụmkpụ, ọ gaghịkwa efunahụ mkpa nlekota anya n'ihi na ọkara ndụ dị ogologo.
03. D-Dimer nwere ike ịnọgide na-enwe ike n'ihe nlele ọbara mgbe in vitro gasịrị ruo ma ọ dịkarịa ala awa 24-48, ka ọdịnaya D-Dimer achọpụtara na in vitro wee nwee ike igosipụta ọkwa D-Dimer nke ọma na vivo.
04. Usoro D-Dimer niile dabere na mmeghachi omume antigen-antibody, mana usoro akọwapụtara dị ọtụtụ mana ọ bụghị otu. Mgbochi ndị dị na reagent dị iche iche, iberibe antigen achọpụtara adịghịkwa agbanwe agbanwe. Mgbe ị na-ahọrọ ụdị na ụlọ nyocha, ọ dị mkpa ka a nyochaa ya.
Ngwa D-dimer maka coagulation nke ọdịnala
1. Nchọpụta mwepu VTE:
Nnwale D-Dimer yana ngwaọrụ nyocha ihe egwu ahụike nwere ike iji nke ọma wezuga thrombosis akwara miri emi (DVT) na pulmonary embolism (PE).
Mgbe ejiri ya maka iwepụ thrombus, e nwere ihe ụfọdụ achọrọ maka reagent D-Dimer na usoro ya. Dịka ọkọlọtọ ụlọ ọrụ D-Dimer si dị, ihe gbasara ohere tupu ule ahụ jikọtara ọnụ chọrọ ọnụego amụma na-adịghị mma nke ≥97% na mmetụta nke ≥95%.
2. Nchọpụta enyemaka nke mgbasa nke coagulation intravascular (DIC):
Ihe na-egosikarị DIC bụ sistemụ hyperfibrinolysis, nchọpụta nke nwere ike igosipụta hyperfibrinolysis na-arụ ọrụ dị mkpa na sistemụ akara DIC. E gosila na D-Dimer ga-amụba nke ukwuu (ihe karịrị ugboro 10) n'ime ndị ọrịa DIC. N'ime ntuziaka ma ọ bụ nkwekọrịta nchọpụta DIC n'ime obodo na nke mba ọzọ, a na-eji D-Dimer eme ihe dị ka otu n'ime ihe ngosi ụlọ nyocha maka ịchọpụta DIC, a na-atụkwa aro ka e mee FDP ọnụ. Mee ka arụmọrụ nke nchọpụta DIC ka mma nke ọma. Agaghị eme nchọpụta DIC naanị site na ịdabere na otu ndeksi ụlọ nyocha na nsonaazụ nke otu ule. Ọ dị mkpa ka a nyochaa ya nke ọma ma nyochaa ya nke ọma yana ngosipụta ahụike nke onye ọrịa na ihe ngosi ụlọ nyocha ndị ọzọ.
Ngwa ọhụrụ nke D-Dimer maka ọgwụgwọ
1. Iji D-Dimer eme ihe n'ahụ ndị nwere COVID-19: N'otu aka ahụ, COVID-19 bụ ọrịa thrombosis nke nsogbu ahụ ji alụso ọrịa ọgụ na-akpata, yana nzaghachi mbufụt na obere thrombosis n'ime akpa ume. A kọrọ na ihe karịrị 20% nke ndị ọrịa nwere VTE nọ n'ụlọ ọgwụ nwere COVID-19.
• Ọkwa D-Dimer mgbe a na-anabata ndị ọrịa n'ụlọ ọgwụ n'adabereghị n'otu ihe gosiri na ndị nwere ike ịnwe nsogbu n'ụlọ ọgwụ ga-anwụ n'oge na-adịghị anya, ma chọpụtakwa ndị nwere ike ịnwe nsogbu n'oge ahụ. Ugbu a, D-dimer aghọọla otu n'ime ihe ndị dị mkpa a na-enyocha ndị ọrịa nwere COVID-19 mgbe a na-anabata ha n'ụlọ ọgwụ.
• Enwere ike iji D-Dimer duzie ma ọ bụrụ na a ga-amalite heparin anticoagulation n'ime ndị ọrịa nwere COVID-19. Akọpụtala na n'ime ndị ọrịa nwere D-Dimer ≥ ugboro 6-7 nke oke elu nke oke ntụnyere, ịmalite heparin anticoagulation nwere ike ime ka nsonaazụ ndị ọrịa ka mma nke ukwuu.
• Enwere ike iji nlekota D-Dimer nke ọma iji chọpụta ọnọdụ VTE n'ime ndị ọrịa nwere COVID-19.
• Nledo D-Dimer, nke enwere ike iji nyochaa ihe si na COVID-19 pụta.
• Nlekota D-Dimer, mgbe a na-eche mkpebi ihu maka ọgwụgwọ ọrịa ahụ, D-Dimer ò nwere ike inye ụfọdụ ozi ntụaka? E nwere ọtụtụ nnwale ahụike a na-ahụ na mba ofesi.
2. Nlekota D-Dimer na-ebu amụma nhazi VTE:
Dịka ekwuru n'elu, ọkara ndụ nke D-Dimer bụ awa 7-8. Ọ bụ kpọmkwem n'ihi njirimara a ka D-Dimer nwere ike inyocha ma buo amụma banyere mmepụta VTE. Maka ọnọdụ hypercoagulable ma ọ bụ microthrombosis nwa oge, D-Dimer ga-amụba ntakịrị wee belata ngwa ngwa. Mgbe e nwere nhazi thrombus ọhụrụ na-adịgide adịgide n'ahụ, D-Dimer dị n'ahụ ga-anọgide na-ebili, na-egosi usoro elu dị ka elu. Maka ndị nwere nnukwu nsogbu nke thrombosis, dị ka ikpe dị oke njọ na nke siri ike, ndị ọrịa mgbe a wachara ahụ, wdg, ọ bụrụ na ọkwa D-Dimer amụba ngwa ngwa, kpachara anya maka ohere nke thrombosis. Na "Nkwenye Ọkachamara na Nyocha na Ọgwụgwọ nke Thrombosis nke Mkpụrụ Obi Miri Emi na Ndị Ọrịa Ọkpụkpụ Trauma", a na-atụ aro ka ndị ọrịa nwere nnukwu ihe egwu mgbe a wachara ahụ ọkpụkpụ kwesịrị ileba anya na mgbanwe nke D-Dimer kwa awa 48. Ekwesịrị ime nyocha onyonyo n'oge iji lelee maka DVT.
3. D-Dimer dị ka ihe ngosi amụma maka ọrịa dị iche iche:
N'ihi mmekọrịta chiri anya dị n'etiti usoro coagulation na mbufụt, mmerụ ahụ endothelial, wdg, a na-ahụkarị mmụba nke D-Dimer na ụfọdụ ọrịa ndị na-abụghị thrombosis dịka ọrịa, ịwa ahụ ma ọ bụ mmerụ ahụ, nkụda obi, na etuto ọjọọ. Nnyocha achọpụtala na amụma adịghị mma nke ọrịa ndị a bụ thrombosis, DIC, wdg. Ọtụtụ n'ime nsogbu ndị a bụ ọrịa ma ọ bụ ọnọdụ ndị metụtara ya kachasị na-akpata mmụba nke D-Dimer. Ya mere, enwere ike iji D-Dimer dị ka ihe nrịbama nyocha sara mbara ma dị nro maka ọrịa.
• Maka ndị ọrịa kansa, ọtụtụ nnyocha achọpụtala na ọnụọgụ ndụ nke ndị ọrịa kansa kansa nwere D-Dimer dị elu ruo afọ 1-3 dị ala karịa nke ndị ọrịa D-Dimer nkịtị. Enwere ike iji D-Dimer mee ihe dị ka ihe ngosi maka ịtụle amụma nke ndị ọrịa kansa kansa.
• Maka ndị ọrịa VTE, ọtụtụ nnyocha egosila na ndị ọrịa D-Dimer nwere VTE nwere ohere dị elu okpukpu abụọ ruo atọ nke nlọghachi thrombus n'oge mgbochi coagulation karịa ndị ọrịa na-adịghị mma. Nyocha ọzọ gụnyere ọmụmụ ihe asaa nwere ngụkọta nke ndị ọrịa 1818 gosiri na, Abnormal D-Dimer bụ otu n'ime ndị na-ebu amụma nlọghachi thrombus na ndị ọrịa VTE, etinyekwala D-Dimer na ọtụtụ ụdị amụma nlọghachi VTE.
• Maka ndị ọrịa nwere mgbanwe valvụ mekanikal (MHVR), nnyocha ogologo oge nke ndị nwere 618 gosiri na ihe egwu nke ihe omume ọjọọ na ndị ọrịa nwere ọkwa D-Dimer na-adịghị mma n'oge warfarin mgbe MHVR gasịrị dị ihe dị ka ugboro ise karịa ndị ọrịa nkịtị. Nnyocha njikọ multivariate kwadoro na ọkwa D-Dimer bụ ihe na-ebu amụma onwe ya maka ihe omume thrombotic ma ọ bụ obi n'oge mgbochi coagulation.
• Maka ndị ọrịa nwere atrial fibrillation (AF), D-Dimer nwere ike ibu amụma ihe omume thrombotic na ihe omume obi na ọgwụ mgbochi coagulation ọnụ. Nnyocha e mere n'ime ndị ọrịa 269 nwere atrial fibrillation nke afọ 2013 gosiri na n'oge ọgwụ mgbochi coagulation ọnụ, ihe dị ka 23% nke ndị ọrịa nwere INR ruru ebe a chọrọ ya gosiri ọkwa D-Dimer na-adịghị mma, ebe ndị ọrịa nwere ọkwa D-Dimer na-adịghị mma mepụtara. Ihe ize ndụ nke ihe omume thrombotic na ihe omume obi na-adịghị mma bụ ugboro 15.8 na 7.64, n'otu n'otu, nke ndị ọrịa nwere ọkwa D-Dimer nkịtị.
• Maka ọrịa ndị a kpọmkwem ma ọ bụ ndị ọrịa kpọmkwem, D-Dimer dị elu ma ọ bụ nke na-adịgide adịgide na-egosikarị na ọrịa ahụ adịghị mma ma ọ bụ na-aka njọ.
4. Iji D-Dimer eme ihe n'ọgwụ mgbochi coagulation n'ọnụ:
• D-Dimer na-ekpebi oge ọgwụ mgbochi mkpọchi ọnụ: Ogologo oge kachasị mma maka ndị ọrịa nwere VTE ma ọ bụ thrombus ndị ọzọ ka bụ nke a na-apụghị ịkọwapụta. N'agbanyeghị ma ọ bụ NOAC ma ọ bụ VKA, ntuziaka mba ụwa dị mkpa na-atụ aro ka a kpebie ọgwụ mgbochi mkpọchi ogologo oge dabere na ihe egwu ọbara ọgbụgba n'ime ọnwa nke atọ nke ọgwụgwọ mgbochi mkpọchi ọbara, D-Dimer nwekwara ike inye ozi nkeonwe maka nke a.
• D-Dimer na-eduzi mgbanwe nke ike ọgwụ mgbochi afọ ime: Warfarin na ọgwụ mgbochi afọ ime ọhụrụ bụ ọgwụ mgbochi afọ ime a na-ejikarị eme ihe n'ọgwụgwọ, ha abụọ nwere ike ibelata ọkwa D-Dimer na ime ka sistemụ fibrinolytic rụọ ọrụ, si otú a na-ebelata ọkwa D-Dimer n'ụzọ na-apụtaghị ìhè. Nsonaazụ nnwale na-egosi na ọgwụ mgbochi ọbara nke D-Dimer duziri n'ime ndị ọrịa na-ebelata ohere nke ihe ndị na-adịghị mma.
Na mmechi, ule D-Dimer abụghịzi naanị maka ojiji ọdịnala dịka nchọpụta mwepụ VTE na nchọpụta DIC. D-Dimer na-arụ ọrụ dị mkpa na amụma ọrịa, amụma, ojiji nke ọgwụ mgbochi afọ, na COVID-19. Ka nnyocha na-aga n'ihu na-aga n'ihu, ojiji nke D-Dimer ga-abawanye ụba.
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