Ndikukula kwa kumvetsetsa kwa anthu za thrombus, D-dimer yakhala ikugwiritsidwa ntchito ngati chinthu choyezetsa chomwe chimagwiritsidwa ntchito kwambiri pochotsa thrombus m'ma laboratories azachipatala a coagulation.Komabe, uku ndikutanthauzira koyambirira kwa D-Dimer.Tsopano akatswiri ambiri apatsa D-Dimer tanthauzo lolemera mu kafukufuku wa D-Dimer palokha komanso ubale wake ndi matenda.Zomwe zili munkhaniyi zikuthandizani kuti muyamikire malangizo ake atsopano.
Maziko a matenda ntchito D-dimer
01. Kuwonjezeka kwa D-Dimer kumayimira kutsegula kwa coagulation system ndi fibrinolysis system mu thupi, ndipo ndondomekoyi ikuwonetsa kusintha kwakukulu.Negative D-Dimer ingagwiritsidwe ntchito pochotsa thrombus (chinthu chofunikira kwambiri chachipatala);pamene D-Dimer zabwino sangathe kutsimikizira mapangidwe thromboembolism.Kaya thromboembolism imapangidwa kapena ayi zimadalira kusinthasintha kwa machitidwe awiriwa.
02. Theka la moyo wa D-Dimer ndi 7-8h, ndipo imatha kudziwika 2h pambuyo pa thrombosis.Mbaliyi ikhoza kugwirizana bwino ndi machitidwe achipatala, ndipo sizidzakhala zovuta kuyang'anira chifukwa theka la moyo ndi lalifupi kwambiri, ndipo silidzataya kufunikira kwa kuyang'anitsitsa chifukwa theka la moyo ndi lalitali kwambiri.
03. D-Dimer ikhoza kukhala yokhazikika mu zitsanzo za magazi pambuyo pa mu vitro kwa maola osachepera 24-48, kotero kuti D-Dimer zomwe zapezeka mu vitro zikhoza kusonyeza molondola mlingo wa D-Dimer mu vivo.
04. Njira ya D-Dimer yonse imachokera ku antigen-antibody reaction, koma njira yeniyeni ndi yambiri koma osati yofanana.Ma antibodies mu reagent ndi osiyanasiyana, ndipo zidutswa za antigen zomwe zapezeka sizigwirizana.Posankha chizindikiro mu labotale, iyenera kuyang'aniridwa.
Traditional coagulation chipatala ntchito ya D-dimer
1. Kupezeka kwa VTE:
Mayeso a D-Dimer ophatikizidwa ndi zida zowunikira zoopsa zachipatala atha kugwiritsidwa ntchito bwino kuti asaphatikizepo deep vein thrombosis (DVT) ndi pulmonary embolism (PE).
Mukagwiritsidwa ntchito pochotsa thrombus, pali zofunikira zina za D-Dimer reagent ndi njira.Malinga ndi muyezo wamakampani a D-Dimer, kuthekera kophatikizana koyeserera kusanachitike kumafuna kuneneratu koyipa kwa ≥97% ndi kukhudzika kwa ≥95%.
2. Chithandizo chothandizira cha disseminated intravascular coagulation (DIC):
Mawonetseredwe a DIC ndi hyperfibrinolysis system, ndipo kuzindikira komwe kungawonetse hyperfibrinolysis kumakhala ndi gawo lofunikira mu dongosolo la DIC scoring system.Zakhala zikuwonetsedwa kuti D-Dimer idzawonjezeka kwambiri (kuposa nthawi za 10) mwa odwala DIC.M'mawu otsogolera a DIC akunja kapena akunja, D-Dimer imagwiritsidwa ntchito ngati chizindikiro cha labotale pozindikira DIC, ndipo tikulimbikitsidwa kuchita FDP limodzi.Kupititsa patsogolo bwino kwa matenda a DIC.Kuzindikira kwa DIC sikungapangidwe kokha podalira ndondomeko ya labotale imodzi ndi zotsatira za kufufuza kumodzi.Iyenera kufufuzidwa mozama ndikuyang'aniridwa mwamphamvu pamodzi ndi mawonetseredwe achipatala a wodwalayo ndi zizindikiro zina za labotale.
Ntchito zatsopano zachipatala za D-Dimer
1. Kugwiritsa ntchito D-Dimer mwa odwala omwe ali ndi COVID-19: M'njira ina, COVID-19 ndi matenda a thrombotic omwe amayamba chifukwa cha kusokonezeka kwa chitetezo chamthupi, kuyankha kotupa komanso microthrombosis m'mapapu.Akuti opitilira 20% a odwala omwe ali ndi VTE m'chipatala cha COVID-19.
• Miyezo ya D-Dimer pakuloledwa idaneneratu za kufa m'chipatala ndikuwunika odwala omwe ali pachiwopsezo chachikulu.Pakadali pano, D-dimer yakhala imodzi mwazinthu zofunika kwambiri zowunikira odwala omwe ali ndi COVID-19 akagonekedwa kuchipatala.
• D-Dimer ikhoza kugwiritsidwa ntchito kuwongolera ngati angayambitse heparin anticoagulation mwa odwala omwe ali ndi COVID-19.Zanenedwa kuti kwa odwala omwe ali ndi D-Dimer ≥ 6-7 nthawi zapamwamba zazomwe zimatchulidwa, kuyambitsa kwa heparin anticoagulation kumatha kusintha kwambiri zotsatira za odwala.
• Kuyang'anira kwamphamvu kwa D-Dimer kungagwiritsidwe ntchito kuyesa kupezeka kwa VTE mwa odwala omwe ali ndi COVID-19.
• Kuwunika kwa D-Dimer, komwe kungagwiritsidwe ntchito kuyesa zotsatira za COVID-19.
• Kuwunika kwa D-Dimer, pamene chithandizo cha matenda chikuyang'anizana ndi chisankho, kodi D-Dimer angakupatseni chidziwitso?Pali mayesero ambiri azachipatala kunja komwe akuwonedwa.
2. D-Dimer dynamic monitoring imaneneratu mapangidwe a VTE:
Monga tafotokozera pamwambapa, theka la moyo wa D-Dimer ndi 7-8h.Ndi chifukwa cha mbali imeneyi kuti D-Dimer akhoza dynamically kuwunika ndi kulosera mapangidwe VTE.Kwa hypercoagulable state yochepa kapena microthrombosis, D-Dimer idzawonjezeka pang'ono kenako imachepa mofulumira.Pakakhala kupangika kwatsopano kwa thrombus m'thupi, D-Dimer m'thupi imapitilira kukwera, kuwonetsa nsonga yokwera ngati yopingasa.Kwa anthu omwe ali ndi vuto lalikulu la thrombosis, monga milandu yoopsa komanso yoopsa, odwala pambuyo pa opaleshoni, ndi zina zotero, ngati mlingo wa D-Dimer ukuwonjezeka mofulumira, samalani ndi kuthekera kwa thrombosis.Mu "Kugwirizana Katswiri pa Kuwunika ndi Kuchiza kwa Deep Vein Thrombosis mu Trauma Orthopedic Odwala", tikulimbikitsidwa kuti odwala omwe ali ndi chiopsezo chapakati komanso chachikulu pambuyo pa opaleshoni ya mafupa ayenera kuwona kusintha kwa D-Dimer maola 48 aliwonse.Kuyesa kujambula kuyenera kuchitidwa munthawi yake kuti muwone ngati muli ndi DVT.
3. D-Dimer ngati chizindikiro cha matenda osiyanasiyana:
Chifukwa cha ubale wapamtima pakati pa coagulation system ndi kutupa, kuwonongeka kwa endothelial, etc., kukwera kwa D-Dimer kumawonedwanso nthawi zambiri m'matenda ena omwe si a thrombotic monga matenda, opaleshoni kapena kuvulala, kulephera kwa mtima, ndi zotupa zowopsa.Kafukufuku wapeza kuti ambiri osauka kulosera za matenda amenewa ndi thrombosis, DIC, etc. Ambiri mwa mavuto amenewa ndi matenda ofala kwambiri kapena mayiko amene amayambitsa D-Dimer kukwera.Chifukwa chake, D-Dimer itha kugwiritsidwa ntchito ngati cholozera chowunikira komanso chodziwika bwino cha matenda.
• Kwa odwala chotupa, maphunziro angapo apeza kuti kupulumuka kwa zaka 1-3 kwa odwala chotupa chotupa omwe ali ndi D-Dimer okwera ndi otsika kwambiri kuposa odwala omwe ali ndi D-Dimer.D-Dimer ingagwiritsidwe ntchito ngati chizindikiro chowunikira odwala omwe ali ndi chotupa choyipa.
• Kwa odwala a VTE, kafukufuku wambiri watsimikizira kuti odwala D-Dimer-positive omwe ali ndi VTE ali ndi chiopsezo cha 2-3 chotsatira chotsatira cha thrombus panthawi ya anticoagulation kusiyana ndi odwala oipa.Kufufuza kwina kwa meta kuphatikizapo maphunziro a 7 omwe ali ndi maphunziro a 1818 kunasonyeza kuti, D-Dimer yosadziwika bwino ndi imodzi mwazomwe zimapangidwira kuti thrombus ibwererenso kwa odwala a VTE, ndipo D-Dimer yaphatikizidwa mu zitsanzo zambiri zolosera za VTE.
• Kwa odwala mechanical valve replacement (MHVR), kufufuza kwa nthawi yaitali kwa maphunziro a 618 kunasonyeza kuti chiopsezo cha zochitika zovuta kwa odwala omwe ali ndi D-Dimer yachilendo pa nthawi ya warfarin pambuyo pa MHVR inali pafupi ndi 5 nthawi ya odwala abwinobwino.Kusanthula kwamalumikizidwe ambiri kunatsimikizira kuti mulingo wa D-Dimer unali wodziyimira pawokha wa zochitika zamtima kapena zamtima panthawi ya anticoagulation.
• Kwa odwala matenda a atrial fibrillation (AF), D-Dimer akhoza kuneneratu zochitika za thrombotic ndi zochitika za mtima mu anticoagulation oral.Kafukufuku woyembekezeredwa wa odwala 269 omwe adatsatiridwa kwa zaka pafupifupi 2 adawonetsa kuti panthawi ya anticoagulation yapakamwa, pafupifupi 23% ya odwala omwe ali ndi INR adafika pacholingacho adawonetsa milingo ya D-Dimer yachilendo, pomwe odwala omwe ali ndi milingo ya D-Dimer yosadziwika bwino idayamba Kuwopsa kwa thrombotic. zochitika ndi zochitika zapamtima za comorbid zinali 15.8 ndi 7.64 nthawi, motero, za odwala omwe ali ndi D-Dimer yachibadwa.
• Kwa matenda enieniwa kapena odwala enieni, D-Dimer yokwezeka kapena yosalekeza nthawi zambiri imasonyeza kusauka kapena kuwonjezereka kwa matendawa.
4. Kugwiritsa ntchito D-Dimer mu oral anticoagulation therapy:
• D-Dimer imatsimikizira nthawi ya anticoagulation oral: Nthawi yabwino ya anticoagulation kwa odwala omwe ali ndi VTE kapena thrombus ina imakhalabe yosadziwika.Mosasamala kanthu kuti ndi NOAC kapena VKA, malangizo apadziko lonse lapansi amalimbikitsa kuti anticoagulation yayitali iyenera kuganiziridwa molingana ndi chiwopsezo cha magazi m'mwezi wachitatu wa anticoagulation therapy, ndipo D-Dimer ikhoza kupereka chidziwitso payekhapayekha.
• D-Dimer amatsogolera kusintha kwa mphamvu ya oral anticoagulant: Warfarin ndi anticoagulants atsopano oral anticoagulants omwe amagwiritsidwa ntchito kwambiri pakamwa pachipatala, zomwe zingathe kuchepetsa mlingo wa D-Dimer.ndi kutsegula kwa fibrinolytic system, potero kuchepetsa mlingo wa D-Dimer.Zotsatira zoyeserera zikuwonetsa kuti D-Dimer-guided anticoagulation mwa odwala amachepetsa bwino zochitika zoyipa.
Pomaliza, kuyezetsa kwa D-Dimer sikulinso kumagwiritsidwe azikhalidwe monga kuzindikiridwa kwa VTE komanso kuzindikira kwa DIC.D-Dimer imatenga gawo lofunikira pakulosera matenda, kuneneratu, kugwiritsa ntchito ma anticoagulants amkamwa, ndi COVID-19.Ndikukula kosalekeza kwa kafukufuku, kugwiritsa ntchito D-Dimer kudzachulukirachulukira.
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