He aha hoki ka taea ai te whakamahi i ngā ngongo toto hei kimi i te nui o te D-dimer? Ka puta he toto totoka fibrin i roto i te ngongo toto, kāore ianei e pakaru hei D-dimer? Ki te kore e pakaru, he aha i nui ai te pikinga o te D-dimer ina puta he toto totoka i roto i te ngongo ārai totoka nā te koretake o te tauira toto mō ngā whakamātautau totoka?
Tuatahi, ko te korenga o te kohi toto ka arahi ki te kino o te endothelial vascular, me te tukunga o te subendothelial tissue factor me te tissue-type plasminogen activator (tPA) ki roto i te toto. I tetahi taha, ka whakahohehia e te tissue factor te ara toto toto exogenous hei whakaputa i ngā toto totoka fibrin. He tino tere tēnei tukanga. Tirohia te wā prothrombin (PT) kia mōhio ai koe, ko te tikanga he 10 hēkona pea. I tetahi atu taha, i muri i te hanganga o te fibrin, ka mahi ia hei cofactor hei whakanui ake i te mahi a te tPA mā te 100 ngā wā, ā, i muri i te piri o te tPA ki te mata o te fibrin, kāore e taea te aukati ngāwari e te plasminogen activation inhibitor-1 (PAI-1). Nō reira, ka taea te huri tere me te haere tonu o te plasminogen ki te plasmin, kātahi ka taea te wawahi i te fibrin, ā, ka taea te whakaputa i te nui o te FDP me te D-Dimer. Koinei te take e tino piki ake ai te hanganga toto totoka in vitro me ngā hua pakaru fibrin nā te korenga o te tauira toto.
Nā, he aha i hanga ai ngā pūtu fibrin i roto i te vitro i te kohinga noa o ngā tauira ngongo toto (kāore he tāpiringa, he mea whakakōkī rānei), engari kāore i pakaru hei whakaputa i te nui o te FDP me te D-dimer? Kei te ngongo toto tēnei. He aha i tupu i muri i te kohikohinga o te tauira: Tuatahi, kāore he nui o te tPA e uru ana ki te toto; tuarua, ahakoa he iti noa te tPA e uru ana ki te toto, ka herea te tPA kore utu e te PAI-1 ka ngaro tana mahi i roto i te 5 meneti pea i mua i te piri ki te fibrin. I tēnei wā, he maha ngā wā kāore he hanganga fibrin i roto i te ngongo toto me te kore he tāpiringa, he mea whakakōkī rānei. Neke atu i te tekau meneti te roa o te toto me te kore he tāpiringa ki te whakakōkī māori, ko te toto me te mea whakakōkī (te nuinga o te paura silicon) ka tīmata i roto. Neke atu i te 5 meneti hoki te roa o te hanga fibrin mai i te ara whakakōkī toto. Hei tāpiri, ka pāngia hoki te mahi fibrinolytic i te pāmahana rūma i roto i te vitro.
Me kōrero anō tātou mō te thromboelastogram i runga i tēnei kaupapa: ka taea e koe te mārama he uaua te pakaru o te toto totoka i roto i te ngongo serum, ā, ka taea e koe te mārama he aha te whakamātautau thromboelastogram (TEG) kāore e aro ki te whakaata i te hyperfibrinolysis - e rua ngā āhuatanga. He rite tonu, ko te tikanga, ka taea te pupuri i te pāmahana i te wā o te whakamātautau TEG i te 37 nekehanga. Mena he aro ake te TEG ki te whakaata i te mana fibrinolysis, ko tētahi huarahi ko te tāpiri i te tPA i roto i te whakamātautau TEG in vitro, engari kei te mau tonu ngā raruraru paerewa, ā, kāore he tono whānui; hei tāpiri, ka taea te ine i te taha o te moenga i muri tonu i te tauira, engari he iti rawa hoki te pānga tuturu. Ko tētahi whakamātautau tuku iho me te whai hua ake mō te aromatawai i te mahi fibrinolytic ko te wā whakarewa o te euglobulin. Ko te take o tōna aro he teitei ake i te TEG. I roto i te whakamātautau, ka tangohia te anti-plasmin mā te whakarerekē i te uara pH me te centrifugation, engari ka pau te whakamātautau. He roa te wā, ā, he āhua taratara, ā, he onge te mahi i roto i ngā taiwhanga.
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