D-dimer nthawi zambiri imagwiritsidwa ntchito ngati chimodzi mwa zizindikiro zofunika kwambiri za PTE ndi DVT m'machitidwe azachipatala. Kodi zinayamba bwanji?

Plasma D-dimer ndi chinthu chowonongeka chomwe chimapangidwa ndi plasmin hydrolysis pambuyo poti fibrin monomer yalumikizidwa ndi activating factor XIII. Ndi chizindikiro chapadera cha njira ya fibrinolysis. D-dimers imachokera ku ma fibrin clots olumikizidwa ndi cross-linked omwe amachotsedwa ndi plasmin. Bola ngati pali active thrombosis ndi fibrinolytic activity m'mitsempha yamagazi ya thupi, D-dimer idzawonjezeka. Myocardial infarction, cerebral infarction, pulmonary embolism, venous thrombosis, opaleshoni, chotupa, disseminated intravascular coagulation, matenda ndi necrosis ya minofu zingayambitse kuchuluka kwa D-dimer. Makamaka kwa okalamba ndi odwala omwe ali m'chipatala, chifukwa cha bacteremia ndi matenda ena, n'zosavuta kuyambitsa magazi osakhazikika ndikupangitsa kuti D-dimer ichuluke.

D-dimer imasonyeza kwambiri ntchito ya fibrinolytic. Kuwonjezeka kapena kukhala ndi zotsatira zabwino kumawoneka mu hyperfibrinolysis yachiwiri, monga momwe magazi amathira magazi, kutsekeka kwa magazi m'mitsempha, matenda a impso, kukana kusamutsa ziwalo, chithandizo cha thrombolytic, ndi zina zotero. Kudziwa zinthu zazikulu za dongosolo la fibrinolytic ndikofunikira kwambiri pakupeza ndi kuchiza matenda a dongosolo la fibrinolytic (monga DIC, thrombus zosiyanasiyana) ndi matenda okhudzana ndi dongosolo la fibrinolytic (monga zotupa, matenda a mimba), ndi kuyang'anira chithandizo cha thrombolytic.

Kuchuluka kwa D-dimer, chinthu chomwe chimawononga fibrin, kumasonyeza kuwonongeka kwa fibrin pafupipafupi m'thupi. Chifukwa chake, D-dimer yokhala ndi ulusi ndi chizindikiro chachikulu cha thrombosis ya mitsempha yakuya (DVT), pulmonary embolism (PE), ndi kugawanika kwa magazi m'mitsempha (DIC).

Matenda ambiri amachititsa kuti magazi azigwira ntchito bwino komanso/kapena kuti maselo a fibrinolytic m'thupi, zomwe zimapangitsa kuti D-dimer ichuluke, ndipo izi zimagwirizana kwambiri ndi gawo, kuopsa kwake komanso chithandizo cha matendawa, kotero m'matendawa, kuzindikira kuchuluka kwa D-dimer kungagwiritsidwe ntchito ngati chizindikiro chowunikira momwe matendawo akuyendera, nthawi yodziwira matenda komanso chitsogozo cha chithandizo.

Kugwiritsa ntchito D-dimer mu thrombosis ya mitsempha yozama

Kuyambira pamene Wilson ndi anzake anayamba kugwiritsa ntchito mankhwala owononga fibrin pozindikira matenda a pulmonary embolism mu 1971, kuzindikira D-dimer kwakhala ndi gawo lalikulu pakupeza matenda a pulmonary embolism. Pogwiritsa ntchito njira zina zodziwira matenda, D-dimer yoipa imakhala ndi zotsatira zabwino kwambiri pa matenda a pulmonary embolism, ndipo mtengo wake ndi 0.99. Zotsatira zoyipa zimatha kuchotsa pulmonary embolism, motero kuchepetsa mayeso olowa m'magazi, monga kusanthula mpweya wotuluka m'magazi ndi angiography ya pulmonary; kupewa chithandizo cha anticoagulation chopanda khungu. D - Kuchuluka kwa dimer kumakhudzana ndi komwe thrombus ili, ndi kuchuluka kwakukulu m'nthambi zazikulu za thunthu la pulmonary ndi kuchuluka kochepa m'nthambi zazing'ono.

Ma D-dimers a plasma olakwika amaletsa kuthekera kwa DVT. Angiography yatsimikizira kuti DVT inali ndi 100% yabwino kwa D-dimer. Ingagwiritsidwe ntchito pochiza thrombolytic ndi mankhwala a heparin oletsa magazi kuundana komanso kuyang'anira bwino momwe magazi amagwirira ntchito.

D-dimer ikhoza kuwonetsa kusintha kwa kukula kwa thrombus. Ngati kuchuluka kwa thrombus kukuwonjezekanso, zimasonyeza kubwereranso kwa thrombus; panthawi ya chithandizo, imapitirira kukhala yayikulu, ndipo kukula kwa thrombus sikusintha, zomwe zikusonyeza kuti chithandizocho sichikugwira ntchito.