01. Te tātaritanga o te thrombosis uaua hohonu me te embolism pūkahukahu

He ngāwari te pāngia e te pulmonary embolism (PE) i te deep vein thrombosis (D-VT), e mōhiotia whānuitia ana ko te venous thromboembolism (VTE). Ka tino piki ake ngā taumata plasma D-dimer i roto i ngā tūroro VTE.

Kua whakaatuhia e ngā rangahau e pā ana ko te kukū D-dimer i roto i te toto i roto i ngā tūroro me te PE me te D-VT he nui ake i te 1 000 μg/L.

Heoi, nā te maha o ngā mate, nā ētahi āhuatanga mate rānei (te pokanga, ngā pukupuku, ngā mate pūnaha toto, me ētahi atu) he pānga motuhake ki te hemostasis, ka hua ake te pikinga o te D-dimer. Nō reira, ahakoa he nui te aro o te D-dimer, ko tōna motuhaketanga he 50% ki te 70% noa iho, ā, kāore e taea e te D-dimer anake te tautuhi i te VTE. Nō reira, kāore e taea te whakamahi i te pikinga nui o te D-dimer hei tohu motuhake mō te VTE. Ko te hiranga o te whakamātautau D-dimer ko te korenga o te tautuhi i te VTE mēnā he hua kino.

 

02 Te toto totoka horapa i roto i te toto

Ko te toto toto totoro kua horapa (DIC) he mate e pā ana ki te microthrombosis whānui i roto i ngā oko toto iti puta noa i te tinana me te hyperfibrinolysis tuarua i raro i te mahi a ētahi āhuatanga mate, ka haere tahi pea me te fibrinolysis tuarua, te aukati rānei i te fibrinolysis.

He nui te uara tohutoro haumanu o te nui o te D-dimer i roto i te toto hei tautuhi wawe i te DIC. Heoi, me mōhio ko te pikinga o te D-dimer ehara i te whakamātautau motuhake mō te DIC, engari he maha ngā mate e haere tahi ana me te microthrombosis ka arahi pea ki te pikinga o te D-dimer. Ina he tuarua te fibrinolysis i te coagulation extravascular, ka piki ake hoki te D-dimer.

Kua whakaatuhia e ngā rangahau ka tīmata te piki o te D-dimer i ētahi rā i mua i te DIC, ā, he tino teitei ake i te tikanga.

 

03 Te mate pēpi hou

He rerekē ngā taumata o te hypoxia me te acidosis i roto i te pēpi hou e mate ana i te manawa, ā, ka taea e te hypoxia me te acidosis te whakararu nui i te endothelial vascular, ka tukuna te nui o ngā matū toto totoka, ā, ka piki ake te hanga o te fibrinogen.

Kua whakaatuhia e ngā rangahau e tika ana he nui ake te uara D-dimer o te toto taura i roto i te rōpū mate manawa i tērā o te rōpū whakahaere noa, ā, ki te whakaritea ki te uara D-dimer i roto i te toto ā-taha, he nui ake anō hoki.

 

04 Te mate lupus erythematosus pūnaha (SLE)

He rerekē te pūnaha toto toto-fibrinolysis i roto i ngā tūroro SLE, ā, ka kitea nuitia te rerekētanga o te pūnaha toto toto-fibrinolysis i te wāhanga hohe o te mate, ā, ka kitea nuitia te ia o te thrombosis; ina ora te mate, ka noho noa te pūnaha toto toto-fibrinolysis.

Nō reira, ka tino piki ake ngā taumata D-dimer o ngā tūroro e pangia ana e te systemic lupus erythematosus i ngā wāhanga hohe me ngā wāhanga kore mahi, ā, ka tino teitei ake ngā taumata D-dimer plasma o ngā tūroro i te wāhanga hohe i ērā i te wāhanga kore mahi.

05 Te mate ate cirrhosis me te mate pukupuku ate

Ko te D-dimer tētahi o ngā tohu e whakaatu ana i te kaha o te mate ate. Ka nui ake te kaha o te mate ate, ka nui ake te ihirangi D-dimer i roto i te toto.

I whakaatuhia e ngā rangahau e tika ana ko ngā uara D-dimer o ngā tohu Child-Pugh A, B, me C i roto i ngā tūroro e pangia ana e te cirrhosis ate ko (2.218 ± 0.54) μg/mL, (6.03 ± 0.76) μg/mL, me (10.536 ± 0.664) μg/mL, ia.

Hei tāpiritanga, i tino piki ake te D-dimer i roto i ngā tūroro he mate pukupuku ate tere te whanaketanga, ā, he kino te matapae.

06 Matepukupuku puku

Whai muri i te tango i ngā tūroro matepukupuku, ka puta te thromboembolism i roto i te haurua o ngā tūroro, ā, ka tino piki ake te D-dimer i roto i te 90% o ngā tūroro.

Hei tāpiritanga, kei roto i ngā pūtau pukupuku tētahi momo matū huka nui, he tino ōrite te hanganga me te tauwehenga kiko. Mā te whai wāhi atu ki ngā mahi pākia o te tangata ka taea te whakatairanga i te mahi a te pūnaha toto toto o te tinana, me te whakanui ake i te mōrearea o te thrombosis, ā, ka tino piki ake te taumata o te D-dimer. Ā, ko te taumata o te D-dimer i roto i ngā tūroro matepukupuku puku me te wāhanga III-IV he nui ake i tērā i roto i ngā tūroro matepukupuku puku me te wāhanga I-II.

 

07 Te niumōnia mycoplasma (MMP)

He maha ngā wā ka haere tahi te MPP nui me ngā taumata D-dimer teitei, ā, he teitei ake ngā taumata D-dimer i ngā tūroro he MPP kino tō rātou i ngā take ngawari.

Ina tino pāngia te MPP e te mate nui, ka puta te hypoxia, te ischemia me te acidosis i te rohe, me te whakaekenga tika mai o ngā pathogens, ka kino ai ngā pūtau endothelial vascular, ka whakaatuhia te collagen, ka whakahohe i te pūnaha toto toto, ka hanga he āhua toto totoka nui, ka hanga hoki i te microthrombi. Ka whakahohehia hoki ngā pūnaha fibrinolytic ā-roto, kinin me te complement, ka hua ake te pikinga o ngā taumata D-dimer.

 

08 Mate huka, mate pūkahukahu mate huka

I tino piki ake ngā taumata D-dimer i roto i ngā tūroro mate huka me te mate huka nephropathy.

Hei tāpiritanga, he nui ake te D-dimer me te fibrinogen i ngā tūroro he mate huka nephropathy i ērā o ngā tūroro mate huka momo 2. Nō reira, i roto i te mahi haumanu, ka taea te whakamahi i te D-dimer hei whakamātautau mō te tautuhi i te kaha o te mate huka me te mate tākihi i roto i ngā tūroro.

09 Te Purpura Mate Pāwera (AP)

I te wāhanga whakapeka o te AP, he rerekē ngā taumata o te toto totoka nui me te mahi pereti toto ka pai ake, ka arahi ki te vasospasm, te whakakotahitanga pereti toto me te thrombosis.

He mea noa te pikinga o te D-dimer i roto i ngā tamariki whai AP i muri i ngā wiki e rua o te tīmatanga, ā, ka rerekē i waenga i ngā wāhanga haumanu, e whakaata ana i te whānuitanga me te nui o te mumura o ngā oko toto pūnaha.

Hei tāpiritanga, he tohu matapae anō hoki, nā te mea he tiketike tonu ngā taumata o te D-dimer, ka roa te mate, ā, ka ngāwari te pakaru o te whatukuhu.

 

10 Te Hapūtanga

Kua whakaatuhia e ngā rangahau e pā ana he tino teitei ngā taumata D-dimer o te 10% o ngā wāhine hapū, e tohu ana i te mōrearea o te toto totoka.

He raruraru noa te preeclampsia i te wā e hapu ana. Ko ngā huringa matua o te mate o te preeclampsia me te eclampsia ko te whakahohenga o te toto toto me te whakanui ake i te fibrinolysis, ka hua ake te pikinga o te thrombosis microvascular me te D-dimer.

I tere te heke o te D-dimer i muri i te whānautanga o ngā wāhine noa, engari i piki ake i roto i ngā wāhine e pāngia ana e te preeclampsia, ā, kāore i hoki ki te āhua noa tae noa ki te 4 ki te 6 wiki.

11 Te Mate Koronari Whakapeka me te Aneurysm Wetewete

He noa, he paku teitei rānei ngā taumata D-dimer o ngā tūroro e pāngia ana e ngā mate pūkahukahu whakapeka, engari he tino teitei ngā taumata o ngā aneurysms wehewehe aorta.

E pā ana tēnei ki te rerekētanga nui o te kawenga thrombus i roto i ngā oko toto o te rua. He angiangi ake te lumen coronary, ā, he iti iho te thrombus i roto i te uaua coronary. I muri i te pakaru o te intima aortic, ka uru te nui o te toto arterial ki te pakitara o te oko toto hei hanga i te aneurysm dissecting. He nui ngā thrombi ka hangaia i raro i te mahi a te tikanga coagulation.

12 Te mate puku roro whakapeka

I roto i te mate urutā roro whakapeka, ka piki ake te thrombolysis tūpono me te mahi fibrinolytic tuarua, ka kitea hei pikinga o ngā taumata D-dimer plasma. I tino piki ake te taumata D-dimer i te wā tōmua o te mate urutā roro whakapeka.

I paku piki ake ngā taumata D-dimer i roto i te toto i ngā tūroro e pāngia ana e te whiu ischemic acute i te wiki tuatahi i muri i te tīmatanga, ā, i tino piki ake i roto i ngā wiki e 2 ki te 4, ā, kāore i rerekē i ngā taumata noa i te wā whakaora (>3 marama).