Ma monomers a Fibrin m'magazi amalumikizidwa ndi activated factor X III, kenako amathiridwa ndi hydrolyzed ndi activated plasmin kuti apange chinthu china chowonongeka chotchedwa "fibrin degradation product (FDP)." D-Dimer ndiye FDP yosavuta kwambiri, ndipo kuwonjezeka kwa kuchuluka kwake kumasonyeza momwe hypercoagulable state ndi secondary hyperfibrinolysis in vivo. Chifukwa chake, kuchuluka kwa D-Dimer ndikofunikira kwambiri pakupeza matenda, kuwunika momwe magazi amayendera komanso kuweruza matenda a thrombotic.
Kuyambira pamene COVID-19 yafalikira, chifukwa cha kukulirakulira kwa zizindikiro zachipatala komanso kumvetsetsa bwino za matendawa komanso kuchuluka kwa chidziwitso cha matenda ndi chithandizo, odwala omwe ali ndi matenda a mtima omwe ali ndi matenda atsopano a mtima amatha kukhala ndi vuto la kupuma mofulumira. Zizindikiro, septic shock, refractory metabolic acidosis, coagulation dysfunction, komanso multiple organ failure. D-dimer imakwera mwa odwala omwe ali ndi chibayo chachikulu.
Odwala omwe akudwala kwambiri ayenera kusamala kwambiri za chiopsezo cha venous thromboembolism (VTE) chifukwa chogona nthawi yayitali pabedi komanso kusagwira bwino ntchito kwa magazi.
Pa nthawi ya chithandizo, ndikofunikira kuyang'anira zizindikiro zoyenera malinga ndi vutoli, kuphatikizapo zizindikiro za myocardial, ntchito yotsekeka kwa magazi, ndi zina zotero. Odwala ena akhoza kukhala ndi myoglobin yowonjezereka, ena omwe ali ndi vuto lalikulu angaone kuwonjezeka kwa troponin, ndipo pa milandu yoopsa, D-dimer (D-Dimer) ingawonjezeke.
Zikuoneka kuti D-Dimer ili ndi kufunika koyang'anira mavuto okhudzana ndi kupita patsogolo kwa COVID-19, ndiye kodi imagwira ntchito bwanji pa matenda ena?
1. Kutsekeka kwa mitsempha ya m'magazi
D-Dimer yagwiritsidwa ntchito kwambiri pa matenda okhudzana ndi venous thromboembolism (VTE), monga deep vein thrombosis (DVT) ndi pulmonary embolism (PE). Kuyesa kwa D-Dimer kopanda D kungathe kuchotsa DVT, ndipo kuchuluka kwa D-Dimer kungagwiritsidwenso ntchito kulosera kuchuluka kwa VTE. Kafukufukuyu adapeza kuti chiŵerengero cha zoopsa cha kubwereranso kwa VTE mwa anthu omwe ali ndi kuchuluka kwakukulu chinali nthawi 4.1 kuposa cha anthu omwe ali ndi kuchuluka kwabwinobwino.
D-Dimer ndi chimodzi mwa zizindikiro zodziwira matenda a PE. Kufunika kwake kodziwira matenda ndi kwakukulu kwambiri, ndipo kufunika kwake ndikuchotsa matenda a pulmonary embolism, makamaka kwa odwala omwe ali ndi kukayikira kochepa. Chifukwa chake, kwa odwala omwe akuganiziridwa kuti ali ndi matenda a pulmonary embolism, ultrasound ya mitsempha yakuya ya miyendo ndi D-Dimer iyenera kugwirizanitsidwa.
2. Kugawanika kwa magazi m'mitsempha yamagazi
Kugawanika kwa magazi m'mitsempha yamagazi (DIC) ndi matenda omwe amadziwika ndi kutuluka magazi m'magazi komanso kulephera kwa magazi kuyenda bwino chifukwa cha matenda ambiri. Njira yopangira matendawa imaphatikizapo machitidwe osiyanasiyana monga kugawanika kwa magazi, kuletsa kugawanika kwa magazi, ndi fibrinolysis. D-Dimer inawonjezeka kumayambiriro kwa kupanga DIC, ndipo kuchuluka kwake kunapitirira kuwonjezeka nthawi zoposa 10 pamene matendawa ankapitirira. Chifukwa chake, D-Dimer ingagwiritsidwe ntchito ngati chimodzi mwa zizindikiro zazikulu zodziwira matenda a DIC koyambirira komanso kuyang'anira momwe zinthu zilili.
3. Kuduladula kwa mtsempha wamagazi
"Katswiri wa ku China wogwirizana pa matenda ndi chithandizo cha kudulidwa kwa mtsempha wamagazi" adanenanso kuti D-Dimer, monga mayeso a labotale ochiritsira kudulidwa kwa mtsempha wamagazi (AD), ndi wofunikira kwambiri pakupeza matenda ndi kuzindikira kusiyanasiyana kwa kudulidwa kwa mtsempha. D-Dimer ya wodwalayo ikakwera mofulumira, mwayi wopezeka ndi AD umawonjezeka. Mkati mwa maola 24 kuyambira pomwe D-Dimer idayamba, pamene ifika pamtengo wofunikira wa 500 µg/L, kukhudzidwa kwake pozindikira AD yoopsa ndi 100%, ndipo kudziwika kwake ndi 67%, kotero ingagwiritsidwe ntchito ngati chizindikiro chochotsera matenda a AD yoopsa.
4. Matenda a mtima ndi mitsempha yamagazi otchedwa atherosclerotic
Matenda a mtima otchedwa atherosclerotic cardiovascular disease ndi matenda a mtima omwe amayamba chifukwa cha arteriosclerotic plaque, kuphatikizapo ST-segment elevation acute myocardial infarction, non-ST-segment elevation acute myocardial infarction, ndi angina yosakhazikika. Pambuyo pa plaque break, necrotic core material mu plaque imatuluka, zomwe zimapangitsa kuti magazi aziyenda bwino, kuyambitsa coagulation system, komanso kuchuluka kwa D-Dimer. Odwala matenda a mtima omwe ali ndi D-Dimer yokwera amatha kulosera chiopsezo chachikulu cha AMI ndipo angagwiritsidwe ntchito ngati chizindikiro chowonera momwe ACS ilili.
5. Chithandizo cha Thrombolytic
Kafukufuku wa Lawter adapeza kuti mankhwala osiyanasiyana ochepetsa thrombolytic amatha kuwonjezera D-Dimer, ndipo kusintha kwa kuchuluka kwake kusanachitike komanso pambuyo pa thrombolysis kungagwiritsidwe ntchito ngati chizindikiro chowunikira chithandizo cha thrombolytic. Kuchuluka kwake kunakwera mofulumira kufika pamlingo wapamwamba kwambiri pambuyo pa thrombolysis, ndipo kunabwerera m'mbuyo kwakanthawi kochepa ndi kusintha kwakukulu kwa zizindikiro zachipatala, zomwe zikusonyeza kuti chithandizocho chinali chothandiza.
- Mlingo wa D-Dimer unakwera kwambiri ola limodzi mpaka maola 6 pambuyo pa kutsekeka kwa magazi chifukwa cha kutsekeka kwa mtima ndi kutsekeka kwa ubongo.
- Pa nthawi ya DVT thrombolysis, nthawi zambiri D-Dimer peak imachitika maola 24 kapena kupitirira apo.
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