Kodi D-dimer ndi chiyani?

D-dimer ndi chinthu chosavuta kwambiri chomwe chimapangitsa kuti fibrin iwonongeke, ndipo kuchuluka kwake kokwezeka kumatha kuwonetsa momwe magazi amathira magazi komanso kuchuluka kwa magazi m'thupi. D-dimer ingagwiritsidwe ntchito ngati chizindikiro cha kuchuluka kwa magazi m'thupi komanso kuchuluka kwa magazi m'thupi, ndipo kuwonjezeka kwake kumasonyeza kuti ikugwirizana ndi matenda a thrombotic omwe amayamba chifukwa cha zifukwa zosiyanasiyana m'thupi, komanso kumasonyeza kuwonjezeka kwa ntchito ya fibrinolytic.

Kodi kuchuluka kwa D-dimer kumawonjezeka pazifukwa ziti?

Matenda a venous thromboembolism (VTE) ndi matenda a non-venous thromboembolic angayambitse kuchuluka kwa D-dimer.

VTE imaphatikizapo acute pulmonary embolism, deep vein thrombosis (DVT) ndi cerebral venous (sinus) thrombosis (CVST).

Matenda a non-venous thromboembolic thrombosis ndi monga acute aortic dissection (AAD), ruptured aneurysm, stroke (CVA), disseminated intravascular coagulation (DIC), sepsis, acute coronary syndrome (ACS), ndi chronic obstructive Pulmonary disease (COPD), ndi zina zotero. Kuphatikiza apo, milingo ya D-dimer imakweranso m'mikhalidwe monga ukalamba, opaleshoni/zoopsa zaposachedwa, ndi thrombolysis.

D-dimer ingagwiritsidwe ntchito poyesa kuchuluka kwa matenda a pulmonary embolism

D-dimer imaneneratu za imfa mwa odwala omwe ali ndi pulmonary embolism. Mwa odwala omwe ali ndi acute pulmonary embolism, kuchuluka kwa D-dimer ​​kumagwirizana ndi kuchuluka kwa PESI scores (Pulmonary Embolism Severity Index Score) komanso kuwonjezeka kwa imfa. Kafukufuku wasonyeza kuti D-dimer <1500 μg/L ili ndi phindu labwino kwambiri lodziwira imfa ya miyezi itatu ya pulmonary embolism: Imfa ya miyezi itatu ndi 0% pamene D-dimer <1500 μg/L. Ngati D-dimer ili yoposa 1500 μg/L, muyenera kusamala kwambiri.

Kuphatikiza apo, kafukufuku wina wasonyeza kuti kwa odwala khansa ya m'mapapo, D-dimer <1500 μg/L nthawi zambiri ndi ntchito yowonjezera ya fibrinolytic yomwe imayamba chifukwa cha zotupa; D-dimer >1500 μg/L nthawi zambiri imasonyeza kuti odwala khansa ya m'mapapo ali ndi deep vein thrombosis (DVT) ndi pulmonary embolism.

D-dimer ikuneneratu kuti VTE ibwereranso

D-dimer ikuwonetsa kuti VTE idzabwereranso. Odwala omwe alibe D-dimer anali ndi chiŵerengero cha kubwereranso kwa 0 kwa miyezi itatu. Ngati D-dimer idzakweranso panthawi yotsatiridwa, chiopsezo cha kubwereranso kwa VTE chikhoza kuwonjezeka kwambiri.

D-dimer imathandiza kuzindikira kusweka kwa mtsempha wamagazi

D-dimer ili ndi phindu labwino lodziwira matenda mwa odwala omwe ali ndi acute aortic dissection, ndipo D-dimer negativity ingathe kuchotsa acute aortic dissection. D-dimer imakwera mwa odwala omwe ali ndi acute aortic dissection ndipo siikwera kwambiri mwa odwala omwe ali ndi acute aortic dissection.

D-dimer imasinthasintha mobwerezabwereza kapena imakwera mwadzidzidzi, zomwe zikusonyeza kuti pali chiopsezo chachikulu cha kusweka kwa ziwalo. Ngati mulingo wa D-dimer wa wodwalayo ndi wokhazikika komanso wotsika (<1000 μg/L), chiopsezo cha kusweka kwa ziwalo ndi chochepa. Chifukwa chake, mulingo wa D-dimer ukhoza kutsogolera chithandizo chabwino kwa odwalawo.

D-dimer ndi matenda

Matenda ndi chimodzi mwa zifukwa zomwe zimayambitsa VTE. Pakuchotsa mano, mabakiteriya amatha kuchitika, zomwe zingayambitse matenda a thrombosis. Panthawiyi, kuchuluka kwa D-dimer kuyenera kuyang'aniridwa mosamala, ndipo mankhwala oletsa magazi kuundana ayenera kukulitsidwa pamene kuchuluka kwa D-dimer kwakwera.

Kuphatikiza apo, matenda opatsirana m'mapapo ndi kuwonongeka kwa khungu ndi zinthu zomwe zimayambitsa matenda a deep vein thrombosis.

Chithandizo cha D-dimer choletsa magazi kuundana

Zotsatira za kafukufuku wa POLONG multicenter, womwe unachitika koyamba (miyezi 18 yotsatira) komanso nthawi yayitali (miyezi 30 yotsatira) zinasonyeza kuti poyerekeza ndi odwala omwe sanalandire chithandizo cha matenda a mtima, odwala omwe ali ndi D-dimer anapitirizabe pambuyo pa mwezi umodzi atasiya kulandira chithandizo cha mankhwala a anticoagulant, mankhwala a anticoagulant anachepetsa kwambiri chiopsezo cha VTE kubwereranso, koma panalibe kusiyana kwakukulu pakati pa odwala omwe alibe D-dimer.

Mu ndemanga yofalitsidwa ndi Blood, Pulofesa Kearon adanenanso kuti mankhwala oletsa magazi kuundana amatha kutsogozedwa malinga ndi mulingo wa D-dimer wa wodwala. Kwa odwala omwe ali ndi DVT yosakhudzidwa kapena pulmonary embolism, mankhwala oletsa magazi kuundana amatha kutsogozedwa ndi kuzindikira D-dimer; ngati D-dimer sigwiritsidwa ntchito, njira yoletsa magazi kuundana imatha kudziwika malinga ndi chiopsezo cha kutuluka magazi komanso zomwe wodwalayo akufuna.

Kuphatikiza apo, D-dimer ingathandize pa chithandizo cha thrombolytic.