I te hohonu haere o te māramatanga o te tangata ki te thrombus, kua whakamahia te D-dimer hei whakamātautau e whakamahia whānuitia ana mō te tango i te thrombus i roto i ngā taiwhanga haumanu toto toto. Heoi, he whakamārama tuatahi noa iho tēnei mō te D-Dimer. Inaianei kua hoatu e te tini o ngā tohunga he tikanga nui ake ki te D-Dimer i roto i ngā rangahau mō te D-Dimer tonu me tōna whanaungatanga ki ngā mate. Mā ngā kōrero o tēnei take koe e ārahi ki te mārama ki tōna huarahi tono hou.
Ko te pūtake o te whakamahinga haumanu o te D-dimer
01. Ko te pikinga o te D-Dimer e tohu ana i te whakahohenga o te pūnaha toto toto me te pūnaha fibrinolysis i roto i te tinana, ā, e whakaatu ana tēnei tukanga i te āhua whakawhiti teitei. Ka taea te whakamahi i te D-Dimer kino hei whakakore i ngā thrombus (te uara haumanu matua); engari kāore e taea e te D-Dimer pai te whakaatu i te hanganga o te thromboembolism. Ko te hanganga o te thromboembolism, kāore rānei, e whakawhirinaki ana ki te taurite o ēnei pūnaha e rua.
02. Ko te haurua-ora o te D-Dimer he 7-8 hāora, ā, ka taea te kite i muri i te 2 hāora i muri i te totohu toto. Ka taea te whakataurite i tēnei āhuatanga ki ngā mahi haumanu, ā, kāore e uaua ki te aroturuki nā te mea he poto rawa te haurua-ora, ā, e kore e ngaro te hiranga o te aroturuki nā te mea he roa rawa te haurua-ora.
03. Ka taea e te D-Dimer te noho pumau i roto i ngā tauira toto i muri i te whakatōnga in vitro mō te 24-48 hāora pea, kia taea ai e te ihirangi D-Dimer i kitea i roto i te vitro te whakaata tika i te taumata D-Dimer i roto i te tinana ora.
04. Ko te tikanga o te D-Dimer e hangai ana ki te tauhohenga antigen-antibody, engari he maha ngā tikanga motuhake engari kāore i te ōrite. He kanorau ngā antibodies i roto i te reagent, ā, he rerekē ngā kongakonga antigen kua kitea. I te wā e whiriwhiri ana i tētahi waitohu i roto i te taiwhanga, me tirotirohia.
Te whakamahinga haumanu tuku iho o te D-dimer mō te toto toto
1. Te tātaritanga ārai VTE:
Ka taea te whakamahi whai hua i te whakamātautau D-Dimer me ngā taputapu aromatawai mōrearea haumanu hei tirotiro i te thrombosis uaua hōhonu (DVT) me te embolism pūkahukahu (PE).
Ina whakamahia mō te tango i ngā toto totoka, me whai i ētahi whakaritenga mō te matū me te tikanga whakamahi o te D-Dimer. E ai ki te paerewa ahumahi D-Dimer, ko te tūponotanga o mua i te whakamātautau e hiahiatia ana he reiti matapae kino o te ≥97% me te tairongo o te ≥95%.
2. Tātaritanga āwhina mō te toto totoka horapa (DIC):
Ko te whakaaturanga matua o te DIC ko te pūnaha hyperfibrinolysis, ā, ko te kitenga ka taea te whakaata i te hyperfibrinolysis he mea nui ki te pūnaha whakatauranga DIC. Kua whakaaturia i roto i ngā whakamātautau haumanu ka nui ake te pikinga o te D-Dimer (neke atu i te 10 ngā wā) i roto i ngā tūroro DIC. I roto i ngā aratohu tātaritanga DIC ā-rohe me tāwāhi, ka whakamahia te D-Dimer hei tētahi o ngā tohu taiwhanga mō te tātaritanga DIC, ā, e taunakihia ana kia whakahaerehia ngātahi te FDP. Ka whakapai ake i te whai huatanga o te tātaritanga DIC. Kāore e taea te whakatau i te DIC mā te whakawhirinaki noa ki tētahi tohu taiwhanga kotahi me ngā hua o tētahi whakamātautau kotahi. Me tātari whānuitia, me aroturukihia hoki me ngā tohu taiwhanga.
Ngā tono haumanu hou o te D-Dimer
1. Te whakamahinga o te D-Dimer i roto i ngā tūroro COVID-19: I tētahi tikanga, ko te COVID-19 he mate toto toto i puta mai i ngā mate ārai mate, me te urupare mumura horapa me te microthrombosis i roto i ngā pukahukahu. E ai ki ngā pūrongo neke atu i te 20% o ngā tūroro VTE i roto i ngā keehi COVID-19 i te hōhipera.
• I te whakaurunga ki te hōhipera, i matapae motuhaketia e ngā taumata D-Dimer te mate i roto i te hōhipera, ā, i tirotirohia ngā tūroro mōrearea pea. I tēnei wā, kua noho ko te D-dimer tētahi o ngā tūemi tirotiro matua mō ngā tūroro COVID-19 ina whakaurua rātou ki te hōhipera.
• Ka taea te whakamahi i te D-Dimer hei ārahi i te tīmatanga o te heparin anticoagulation i roto i ngā tūroro COVID-19. Kua pūrongohia mō ngā tūroro he D-Dimer ≥ 6-7 ngā wā i te rohe o runga o te awhe tohutoro, mā te tīmatanga o te heparin anticoagulation ka taea te whakapai ake i ngā putanga o te tūroro.
• Ka taea te whakamahi i te aroturukitanga hihiri o te D-Dimer hei aromatawai i te putanga mai o te VTE i roto i ngā tūroro e pangia ana e te COVID-19.
• Te tirotiro i te D-Dimer, ka taea te whakamahi hei aromatawai i te putanga o te COVID-19.
• Te aroturuki i te D-Dimer, ina whakaritea he whakatau mō te maimoatanga o te mate, ka taea e te D-Dimer te whakarato i ētahi mōhiohio tohutoro? He maha ngā whakamātautau haumanu kei tāwāhi e tirohia ana.
2. Mā te aroturukitanga hihiri o te D-Dimer ka matapaetia te hanganga o te VTE:
E ai ki te kōrero i runga ake nei, ko te haurua-ora o te D-Dimer he 7-8 hāora. Nā tēnei āhuatanga tonu ka taea e te D-Dimer te aroturuki me te matapae i te hanganga o te VTE. Mō te āhua toto totoka tere, te microthrombosis rānei, ka paku piki ake te D-Dimer, kātahi ka tere heke. Ina he hanganga toto hou tonu i roto i te tinana, ka piki tonu te D-Dimer i roto i te tinana, ka whakaatu i te pihi piki rite ki te tihi. Mō te hunga he nui te mate toto toto, pērā i ngā take whakapeka me te kino, ngā tūroro i muri i te pokanga, me ētahi atu, ki te tere piki te taumata o te D-Dimer, kia tūpato ki te tūponotanga o te toto toto. I roto i te "Whakaaetanga Tohunga mō te Tirotiro me te Maimoatanga o te Thrombosis Utauta Hōhonu i roto i ngā Tūroro Orthopedic Whara", e taunakihia ana kia aroturukihia e ngā tūroro he mōrearea waenga me te nui i muri i te pokanga orthopedic ngā huringa o te D-Dimer i ia 48 hāora. Me whakahaere ngā whakamātautau whakaahua i te wā tika hei tirotiro mō te DVT.
3. Ko te D-Dimer hei tohu matapae mō ngā mate maha:
Nā te hononga tata i waenga i te pūnaha toto totoka me te mumura, te whara endothelial, me ētahi atu, ka kitea te pikinga o te D-Dimer i roto i ētahi mate kore-totoka pērā i te mate pāwera, te pokanga, te whara rānei, te ngoikore o te ngākau, me ngā pukupuku kino. Kua kitea e ngā rangahau ko te tino kino o te matapae o ēnei mate ko te toto totoka, te DIC, me ētahi atu. Ko te nuinga o ēnei raruraru ko ngā mate e pā ana ki te pikinga o te D-Dimer. Nō reira, ka taea te whakamahi i te D-Dimer hei taupū aromatawai whānui me te tairongo mō ngā mate.
• Mō ngā tūroro pukupuku, kua kitea e ētahi rangahau he iti iho te ora o ngā tūroro pukupuku kino me te D-Dimer teitei i roto i te 1-3 tau i tērā o ngā tūroro D-Dimer noa. Ka taea te whakamahi i te D-Dimer hei tohu mō te aromatawai i te matapae o ngā tūroro pukupuku kino.
• Mō ngā tūroro VTE, he maha ngā rangahau kua whakaū he 2-3 ngā wā teitei ake te mōrearea o te hokinga mai o te thrombus i muri mai i ngā tūroro VTE he pai te D-Dimer i te wā e ārai ana i te toto toto i ngā tūroro kāore i te pai te toto toto. I whakaatuhia e tētahi atu tātaritanga-maha tae atu ki ngā rangahau e 7 me te katoa o ngā kaupapa 1818, ko te D-Dimer rerekē tētahi o ngā tohu matua o te hokinga mai o te thrombus i roto i ngā tūroro VTE, ā, kua whakaurua te D-Dimer ki roto i ngā tauira matapae mōrearea hokinga mai o te VTE maha.
• Mō ngā tūroro whakakapinga takirere ā-mīhini (MHVR), i whakaatuhia e tētahi rangahau whai muri mō te wā roa o te 618 tāngata ko te mōrearea o ngā pānga kino i roto i ngā tūroro he taumata D-Dimer rerekē i te wā o te warfarin i muri i te MHVR he tata ki te 5 ngā wā i ērā o ngā tūroro noa. I whakaūhia e te tātaritanga hononga maha-taurangi ko te taumata D-Dimer he tohu motuhake mō ngā pānga toto toto, ngā pānga ngakau rānei i te wā o te anticoagulation.
• Mō ngā tūroro e pāngia ana e te fibrillation atrial (AF), ka taea e te D-Dimer te matapae i ngā huihuinga toto toto me ngā huihuinga ngakau i roto i te anticoagulation ā-waha. I whakaatuhia i roto i tētahi rangahau tirohanga whakamua o ngā tūroro 269 e pāngia ana e te fibrillation atrial mō te 2 tau pea, i te wā o te anticoagulation ā-waha, tata ki te 23% o ngā tūroro me te INR i eke ki te ūnga i whakaatu i ngā taumata D-Dimer rerekē, i te mea i whanake ngā tūroro me ngā taumata D-Dimer rerekē. Ko ngā mōrearea o ngā huihuinga toto toto me ngā huihuinga ngakau tāpiri he 15.8 me te 7.64 ngā wā, ia, o ngā tūroro me ngā taumata D-Dimer noa.
• Mō ēnei mate motuhake, mō ngā tūroro motuhake rānei, ko te pikinga o te D-Dimer, te roanga rānei o te pai, he tohu pinepine tēnei i te kino o te oranga, i te kino haere rānei o te mate.
4. Te whakamahinga o te D-Dimer i roto i te rongoā ā-waha mō te ārai toto toto:
• Mā te D-Dimer e whakatau te roa o te wā e whakamahia ana te rongoā ārai toto ā-waha: Kāore anō kia whakatauhia te roanga pai o te rongoā ārai toto mō ngā tūroro e pāngia ana e te VTE, e ētahi atu toto toto rānei. Ahakoa he NOAC, he VKA rānei, e taunaki ana ngā aratohu ā-ao kia roa te wā e whakamahia ana te rongoā ārai toto kia rite ki te mōrearea o te toto i te toru o ngā marama o te rongoā ārai toto, ā, ka taea e te D-Dimer te whakarato i ngā mōhiohio takitahi mō tēnei.
• Mā te D-Dimer e ārahi te whakatikatika i te kaha o te whakaheke toto ā-waha: Ko te Warfarin me ngā rongoā whakaheke toto ā-waha hou ngā rongoā whakaheke toto ā-waha e whakamahia whānuitia ana i roto i te mahi haumanu, ā, ka taea e ēnei te whakaiti i te taumata o te D-Dimer me te whakahohe i te pūnaha fibrinolytic, ā, ka whakaiti ā-kore i te taumata o te D-Dimer. E whakaatu ana ngā hua whakamātautau he whai hua te whakaheke toto ā-ringa a te D-Dimer i roto i ngā tūroro ki te whakaiti i te maha o ngā pānga kino.
Hei whakamutunga, kāore te whakamātautau D-Dimer e herea noa ki ngā tono tuku iho pēnei i te tātaritanga aukati VTE me te kimi DIC. He mea nui te mahi a te D-Dimer ki te matapae i te mate, te matapae i te mate, te whakamahinga o ngā rongoā ārai toto ā-waha, me te COVID-19. Mā te hohonu haere tonu o te rangahau, ka whānui haere te whakamahinga o te D-Dimer.
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