Nekudzika kwekunzwisisa kwevanhu nezve thrombus, D-dimer yave kushandiswa sechinhu chinonyanya kushandiswa chekuyedza kubvisa thrombus mumarabhoritari ekiriniki ekuvharika. Zvisinei, iyi ingori dudziro huru yeD-Dimer. Iye zvino nyanzvi dzakawanda dzakapa D-Dimer zvinoreva zvakadzama mukutsvagisa paD-Dimer pachayo uye hukama hwayo nezvirwere. Zviri mumagazini iyi zvichaita kuti unzwisise nzira itsva yekushandisa kwayo.
Hwaro hwekushandiswa kweD-dimer mukiriniki
01. Kuwedzera kweD-Dimer kunomiririra kushanda kwesystem yekuvhara ropa uye system yefibrinolysis mumuviri, uye maitiro aya anoratidza mamiriro ekuchinja kwakanyanya. D-Dimer isina kunaka inogona kushandiswa kubvisa thrombus (chinhu chinonyanya kukosha pakurapa); nepo D-Dimer isina kunaka isingakwanise kuratidza kuumbwa kwethromboembolism. Kuti thromboembolism inoumbwa here kana kuti kwete zvinoenderana nekuenzana kwemasystem maviri aya.
02. Hafu yehupenyu hweD-Dimer maawa manomwe kusvika masere, uye inogona kuonekwa maawa maviri mushure methrombosis. Chinhu ichi chinogona kuenderana nemaitiro ekiriniki, uye hazvizove zvakaoma kutarisisa nekuti hafu yehupenyu ipfupi zvakanyanya, uye hazvizorasikirwi nekukosha kwekutarisa nekuti hafu yehupenyu yakareba zvakanyanya.
03. D-Dimer inogona kugara yakagadzikana muropa mushure mekuongororwa muropa remu ...
04. Maitiro eD-Dimer akavakirwa pakuita kweantigen-antibody, asi maitiro acho akawanda asi haana kufanana. Maantibodies ari mu reagent akasiyana-siyana, uye zvidimbu zveantigen zvakaonekwa hazvienderani. Pakusarudza rudzi murabhoritari, runofanira kuongororwa.
Kushandiswa kwekiriniki kweD-dimer pakuvhiya kweropa nenzira yechinyakare
1. Kuongororwa kweVTE kusabatanidzwa:
Kuongororwa kweD-Dimer pamwe chete nezvishandiso zvekuongorora njodzi zvinogona kushandiswa zvinobudirira kubvisa deep vein thrombosis (DVT) uye pulmonary embolism (PE).
Kana ikashandiswa pakubvisa thrombus, pane zvinodiwa zveD-Dimer reagent uye nzira. Zvichienderana nechiyero cheindasitiri cheD-Dimer, mukana wekubatanidza pre-test unoda mwero wekufanotaura we ≥97% uye kunzwisiswa kwe ≥95%.
2. Kuongororwa kwekubatsira kweropa rakapararira muropa (DIC):
Kuratidzwa kwakajairika kweDIC inzira ye hyperfibrinolysis, uye kuongororwa kunogona kuratidza hyperfibrinolysis kunoita basa rakakosha muhurongwa hwekuongorora DIC. Zvakaratidzwa mukiriniki kuti D-Dimer ichawedzera zvakanyanya (kanopfuura kagumi) muvarwere vane DIC. Mumitemo yekuongorora DIC yemuno neyekunze kana kuti kubvumirana, D-Dimer inoshandiswa seimwe yezviratidzo zverabhoritari yekuongorora DIC, uye zvinokurudzirwa kuita FDP pamwe chete. Kuvandudza kushanda kwekuongorora DIC zvinobudirira. Kuongororwa kweDIC hakugone kuitwa chete nekuvimba ne indekisi imwe chete yerabhoritari uye mhedzisiro yeongororo imwe chete. Inofanirwa kuongororwa zvakakwana uye kuongororwa zvine simba pamwe chete nezviratidzo zvekiriniki zvemurwere nezvimwe zviratidzo zverabhoritari.
Mashandisirwo matsva ekurapa eD-Dimer
1. Kushandiswa kweD-Dimer muvarwere vane COVID-19: Mupfungwa yakati, COVID-19 chirwere chinokonzerwa nekudzikira kweropa chinokonzerwa nezvirwere zvemuviri, chine kupararira kwekuzvimba uye microthrombosis mumapapu. Zvinonzi vanopfuura 20% yevarwere vane VTE muzvipatara vane COVID-19.
• Mazinga eD-Dimer pakubvumidzwa airatidza kufa kwevanhu vari muchipatara uye akaongorora varwere vangangove nenjodzi huru. Parizvino, D-dimer yave imwe yezvinhu zvakakosha zvekuongorora varwere vane COVID-19 pavanopinda muchipatara.
• D-Dimer inogona kushandiswa kutungamira kana ichifanira kutanga heparin anticoagulation muvarwere vane COVID-19. Zvakataurwa kuti muvarwere vane D-Dimer ≥ ka6-7 kupfuura muganho wepamusoro wereferensi, kutanga heparin anticoagulation kunogona kuvandudza zvakanyanya mhedzisiro yemurwere.
• Kuongororwa kweD-Dimer nenzira inochinja-chinja kunogona kushandiswa kuongorora kuitika kweVTE muvarwere vane COVID-19.
• Kuongororwa kweD-Dimer, uko kunogona kushandiswa kuongorora mhedzisiro yeCOVID-19.
• Kuongororwa kweD-Dimer, kana kurapwa kwechirwere kwatarisana nesarudzo, D-Dimer inogona here kupa rumwe ruzivo rwekutarisa? Kune miedzo yakawanda yekiriniki iri kucherechedzwa kunze kwenyika.
2. Kutarisa kweD-Dimer kunofanotaura kuumbwa kweVTE:
Sezvambotaurwa pamusoro apa, hafu yehupenyu hweD-Dimer i7-8h. Izvi ndizvo chaizvo zvinoita kuti D-Dimer ikwanise kutarisa nekufanotaura kuumbwa kweVTE. Kune transient hypercoagulable state kana microthrombosis, D-Dimer inowedzera zvishoma yozodzikira nekukurumidza. Kana paine thrombus itsva inoumbwa mumuviri, D-Dimer mumuviri icharamba ichikwira, ichiratidza peak-like rising curve. Kune vanhu vane thrombosis yakawanda, senge acute uye severage cases, postoperative patients, etc., kana D-Dimer level ikawedzera nekukurumidza, chenjerera mukana we thrombosis. Mu "Expert Consensus on the Screening and Treatment of Deep Vein Thrombosis in Trauma Orthopedic Patients", zvinokurudzirwa kuti varwere vane njodzi yepakati neyakakwira mushure mekuvhiyiwa kwemapfupa vanofanira kutarisa shanduko dzeD-Dimer maawa ese makumi mana nemasere. Kuongororwa kwemifananidzo kunofanirwa kuitwa nenguva kuti vaone kana DVT iripo.
3. D-Dimer sechiratidzo chekufanotaura zvirwere zvakasiyana-siyana:
Nekuda kwehukama hwepedyo huripo pakati pema "coagulation system" nekuzvimba, kukuvara kwe "endothelial", nezvimwewo, kukwira kweD-Dimer kunowanzoonekwawo mune zvimwe zvirwere zvisina thrombosis zvakaita sehutachiona, kuvhiyiwa kana kukuvara, kutadza kwemoyo, uye bundu rakaipa. Zvidzidzo zvakawana kuti fungidziro yakaipa yezvirwere izvi i "thrombosis", DIC, nezvimwewo. Mazhinji ematambudziko aya ndiwo anowanzo enderana nezvirwere kana mamiriro anokonzera kukwira kweD-Dimer. Nokudaro, D-Dimer inogona kushandiswa se "broad and sensitive evaluation index" yezvirwere.
• Kune varwere vane bundu, zvidzidzo zvakawanda zvakawana kuti huwandu hwekurarama kwemakore 1-3 hwevarwere vane bundu rine D-Dimer yakakwira hwakaderera zvakanyanya pane hwevarwere vane D-Dimer yakajairwa. D-Dimer inogona kushandiswa sechiratidzo chekuongorora kufambira mberi kwevarwere vane bundu rine bundu.
• Kune varwere vane VTE, zvidzidzo zvakawanda zvakasimbisa kuti varwere vane D-Dimer vane VTE vane njodzi yakapetwa kaviri kana katatu yekudzokororwa kweropa panguva yekudzivirira ropa kupwanya ropa kupfuura varwere vasina. Imwe ongororo inosanganisira zvidzidzo zvinomwe nevanhu vanosvika 1818 yakaratidza kuti, D-Dimer isina kujairika ndeimwe yezviratidzo zvikuru zvekudzokororwa kweropa muvarwere vane VTE, uye D-Dimer yakabatanidzwa mumamodheru akawanda ekufanotaura njodzi yekudzokororwa kweropa muVTE.
• Kune varwere vanotsiva mavharuvhu emakanika (MHVR), ongororo yekutevera kwenguva refu yevanhu 618 yakaratidza kuti njodzi yezviitiko zvakaipa muvarwere vane huwandu husina kujairika hweD-Dimer panguva yewarfarin mushure meMHVR yaive kanenge kashanu pane yevarwere vakajairwa. Kuongororwa kweMultivariate correlation kwakaratidza kuti huwandu hweD-Dimer hwaive chiratidzo chakazvimiririra chezviitiko zvethrombotic kana cardiovascular panguva yekudzivirira ropa kupwanya ropa.
• Kune varwere vane atrial fibrillation (AF), D-Dimer inogona kufanotaura zviitiko zvethrombotic uye zviitiko zvemwoyo mukurwisa ropa. Ongororo yakaitwa pavarwere 269 vane atrial fibrillation yakateverwa kwemakore angangoita maviri yakaratidza kuti panguva yekurwisa ropa mumuromo, vanenge 23% vevarwere vane INR vakasvika pachinangwa vakaratidza mazinga asina kujairika eD-Dimer, nepo varwere vane mazinga asina kujairika eD-Dimer vakabudirira. Njodzi dzezviitiko zvethrombotic uye zviitiko zvemwoyo zvakasangana zvaive ka15.8 uye ka7.64, zvichiteerana, yevarwere vane mazinga akajairwa eD-Dimer.
• Kune zvirwere izvi kana varwere chaivo, kuwedzera kana kuramba uine D-Dimer kunowanzo ratidza kusabudirira kana kuipa kwechirwere.
4. Kushandiswa kweD-Dimer mukurapa nemuromo kunoderedza ropa kunobva muropa:
• D-Dimer ndiyo inosarudza nguva yekurapa ropa rinodzima ropa: Nguva yakakwana yekurapa ropa rinodzima ropa kuvarwere vane VTE kana mamwe ma thrombus haisati yasvika pakuguma. Pasinei nekuti iNOAC kana VKA, nhungamiro dzepasi rose dzinokurudzira kuti kurapwa kwenguva refu kweropa kunoda kusarudzwa zvichienderana nenjodzi yekubuda ropa mumwedzi wechitatu wekurapa ropa rinodzima ropa, uye D-Dimer inogona kupa ruzivo rwakasiyana nezveizvi.
• D-Dimer inotungamira kugadziriswa kwesimba remushonga unorwisa ropa: Warfarin nemishonga mitsva inorwisa ropa ndiyo mishonga inonyanya kushandiswa mukurapa, iyo inogona kuderedza huwandu hweD-Dimer uye kushanda kwesystem yefibrinolytic, nokudaro ichideredza huwandu hweD-Dimer zvisina kunanga. Mhedzisiro yekuyedza inoratidza kuti mushonga unorwisa ropa unotungamirwa neD-Dimer unoderedza kuwanda kwezviitiko zvakaipa.
Mukupedzisa, bvunzo yeD-Dimer haichagumiri pakushandiswa kwechinyakare senge kuongororwa kweVTE kusabatwa uye kuongororwa kweDIC. D-Dimer ine basa rakakosha mukufanotaura chirwere, kufanotaura mafambiro echirwere, kushandiswa kwemishonga inorwisa ropa, uye COVID-19. Nekuwedzera kwekutsvaga, kushandiswa kweD-Dimer kuchawedzera kuwanda.
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