Ma Fibrin monomers m'magazi amalumikizidwa ndi activated factor X III, kenako amalowetsedwa ndi plasmin kuti apange chinthu china choyipa chotchedwa "fibrin degradation product (FDP)."D-Dimer ndi FDP yosavuta kwambiri, ndipo kuwonjezeka kwa misala yake kumasonyeza hypercoagulable state ndi hyperfibrinolysis yachiwiri mu vivo.Chifukwa chake, kuchuluka kwa D-Dimer ndikofunikira kwambiri pakuzindikiritsa, kuwunika kogwira mtima komanso kuzindikira kwa matenda a thrombotic.
Chiyambireni kufalikira kwa COVID-19, ndikuzama kwamawonetseredwe azachipatala komanso kumvetsetsa bwino kwa matendawa komanso kudzikundikira kwa chidziwitso ndi chithandizo chamankhwala, odwala omwe ali ndi chibayo chatsopano cha coronary amatha kukhala ndi matenda opumira kwambiri.Zizindikiro, septic shock, refractory metabolic acidosis, coagulation dysfunction, ndi kulephera kwa ziwalo zingapo.D-dimer imakwezedwa mwa odwala omwe ali ndi chibayo chachikulu.
Odwala kwambiri ayenera kusamala za chiopsezo cha venous thromboembolism (VTE) chifukwa cha kupumula kwa bedi kwanthawi yayitali komanso kukomoka.
Panthawi ya chithandizo, ndikofunikira kuyang'anira zizindikiro zoyenera malinga ndi momwe zilili, kuphatikizapo zizindikiro za myocardial, coagulation function, etc. Odwala ena akhoza kukhala ndi kuchuluka kwa myoglobin, ena ovuta kwambiri amatha kuwona kuwonjezeka kwa troponin, ndipo nthawi zambiri, D-dimer (D-dimer) D-Dimer) ikhoza kuwonjezeredwa.
Zitha kuwoneka kuti D-Dimer ili ndi kuwunikira kokhudzana ndi zovuta pakukula kwa COVID-19, ndiye imagwira nawo bwanji matenda ena?
1. Venus thromboembolism
D-Dimer yagwiritsidwa ntchito kwambiri pa matenda okhudzana ndi venous thromboembolism (VTE), monga deep vein thrombosis (DVT) ndi pulmonary embolism (PE).Kuyesa koyipa kwa D-Dimer kumatha kutulutsa DVT, ndipo ndende ya D-Dimer ingagwiritsidwenso ntchito kulosera kuchuluka kwa VTE.Kafukufukuyu adapeza kuti chiŵerengero chowopsa cha kubwereza kwa VTE mwa anthu omwe ali ndi chiwerengero chachikulu chinali 4.1 nthawi ya chiwerengero cha anthu omwe ali ndi chiwerengero chokhazikika.
D-Dimer ndi chimodzi mwazowonetsa za PE.Mtengo wake wolosera woyipa ndiwokwera kwambiri, ndipo tanthauzo lake ndikuchotsa pachimake pulmonary embolism, makamaka kwa odwala omwe amakayikira pang'ono.Chifukwa chake, kwa odwala omwe akuganiziridwa kuti ali ndi vuto la pulmonary embolism, ultrasound ya mitsempha yakuya ya m'munsi ndi D-Dimer iyenera kuphatikizidwa.
2. Kufalitsa intravascular coagulation
Disseminated intravascular coagulation (DIC) ndi matenda omwe amadziwika ndi kutuluka kwa magazi ndi microcirculatory kulephera chifukwa cha matenda ambiri.Njira yachitukuko imaphatikizapo machitidwe angapo monga coagulation, anticoagulation, ndi fibrinolysis.D-Dimer inakula kumayambiriro kwa mapangidwe a DIC, ndipo ndende yake inapitirizabe kuwonjezeka kuposa 10 pamene matendawa akupita patsogolo.Chifukwa chake, D-Dimer itha kugwiritsidwa ntchito ngati chimodzi mwazizindikiro zazikulu zakuzindikira koyambirira komanso kuwunika kwa DIC.
3. Kung'ambika kwa mng'oma
"Chigwirizano cha akatswiri a ku China pa matenda ndi chithandizo cha kung'ambika kwa mng'oma" adanena kuti D-Dimer, monga kuyesa kwa labotale ya kung'ambika kwa mng'oma (AD), ndiyofunikira kwambiri pa matenda ndi kusiyanitsa kwa dissection.Pamene D-Dimer ya wodwalayo ikukwera mofulumira, mwayi wopezeka ngati AD ukuwonjezeka.Mkati mwa maola 24 chiyambireni, pamene D-Dimer ifika pamtengo wofunikira wa 500 µg/L, kukhudzika kwake pozindikira AD pachimake ndi 100%, ndipo kutsimikizika kwake ndi 67%, kotero ingagwiritsidwe ntchito ngati index yopatula pachimake AD.
4. Atherosclerotic Cardiovascular Disease
Atherosclerotic cardiovascular disease ndi matenda amtima omwe amayamba chifukwa cha zolembera za arteriosclerotic, kuphatikiza ST-segment elevation acute myocardial infarction, non-segment elevation acute myocardial infarction, komanso angina wosakhazikika.Pambuyo pakuphulika kwa zolengeza, zinthu za necrotic pachimake zimatuluka, zomwe zimapangitsa kuti magazi aziyenda mosadziwika bwino, kuyambitsa kwa coagulation system, komanso kuchuluka kwa D-Dimer.Odwala matenda a mtima omwe ali ndi D-Dimer yokwezeka akhoza kuneneratu za chiopsezo chachikulu cha AMI ndipo angagwiritsidwe ntchito ngati chizindikiro chowonera chikhalidwe cha ACS.
5. Thrombolytic therapy
Kafukufuku wa Lawter adapeza kuti mankhwala osiyanasiyana a thrombolytic amatha kuonjezera D-Dimer, ndipo kusintha kwake kumasintha kusanachitike komanso pambuyo pa thrombolysis kungagwiritsidwe ntchito ngati chizindikiro choweruza chithandizo cha thrombolytic.Zomwe zili mkati mwake zinawonjezeka mofulumira kufika pamtengo wapatali pambuyo pa thrombolysis, ndipo zinabwereranso m'kanthawi kochepa ndi kusintha kwakukulu kwa zizindikiro zachipatala, kusonyeza kuti mankhwalawa anali othandiza.
- Mlingo wa D-Dimer unakula kwambiri pa ola limodzi mpaka 6 pambuyo pa thrombolysis ya pachimake myocardial infarction ndi cerebral infarction.
- Pa DVT thrombolysis, nsonga ya D-Dimer nthawi zambiri imapezeka maola 24 kapena mtsogolo
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