Ii-monomers ze-Fibrin egazini zidityaniswa yi-activated factor X III, emva koko zifakwe i-hydrolyzed yi-activated plasmin ukuvelisa imveliso ethile yokubola ebizwa ngokuba yi-"fibrin degradation product (FDP)." I-D-Dimer yeyona FDP ilula, kwaye ukwanda koxinzelelo lwayo olukhulu kubonisa imeko yokubola kwe-hypercoagulable kunye ne-secondary hyperfibrinolysis in vivo. Ke ngoko, uxinzelelo lwe-D-Dimer lubaluleke kakhulu ekuxilongweni, kuvavanyo olusebenzayo kunye nokugweba kwangaphambili kwezifo ze-thrombotic.
Ukusukela oko kwaqhambuka i-COVID-19, ngokukhula kweempawu zeklinikhi kunye nokuqonda okunzulu kwesi sifo kunye nokuqokelelana kwamava okuxilonga kunye nonyango, izigulana eziqatha ezine-coronary pneumonia entsha zinokukhawuleza zibe ne-acute respiratory distress syndrome. Iimpawu, i-septic shock, i-refractory metabolic acidosis, ukungasebenzi kakuhle kwe-coagulation, kunye nokusilela kwamalungu amaninzi. I-D-dimer iphakanyisiwe kwizigulana ezine-pneumonia enzima.
Izigulana ezigula kakhulu kufuneka ziqwalasele umngcipheko we-venous thromboembolism (VTE) ngenxa yokuphumla ebhedini ixesha elide kunye nokusebenza okungaqhelekanga kokubopha kwegazi.
Ngexesha lenkqubo yonyango, kuyimfuneko ukujonga izalathisi ezifanelekileyo ngokwemeko, kubandakanya iimpawu zentliziyo, umsebenzi wokujiya kwegazi, njl. Ezinye izigulana zisenokuba ne-myoglobin eyonyukileyo, ezinye iimeko ezinzima zinokubona ukwanda kwe-troponin, kwaye kwiimeko ezinzima, i-D-dimer (D-Dimer) inokunyuka.
Kuyabonakala ukuba i-D-Dimer ibaluleke kakhulu ekubekweni esweni okunxulumene neengxaki ekuqhubekeni kwe-COVID-19, ngoko ke idlala indima njani kwezinye izifo?
1. Ukuvaleka kwemithambo yegazi
I-D-Dimer isetyenziswa kakhulu kwizifo ezinxulumene ne-venous thromboembolism (VTE), ezifana ne-deep vein thrombosis (DVT) kunye ne-pulmonary embolism (PE). Uvavanyo lwe-D-Dimer olune-negative lunokuthintela i-DVT, kwaye i-D-Dimer concentration ingasetyenziselwa ukuqikelela izinga lokuphinda kwe-VTE. Olu phononongo lufumanise ukuba umlinganiselo wengozi yokuphinda kwe-VTE kubantu abanoxinzelelo oluphezulu wawuphindwe kayi-4.1 kunowoluntu olunoxinzelelo oluqhelekileyo.
I-D-Dimer ikwayenye yeempawu zokufumanisa i-PE. Ixabiso layo elibi lokuqikelela liphezulu kakhulu, kwaye ukubaluleka kwayo kukukhupha i-acute pulmonary embolism, ingakumbi kwizigulane ezirhaneleka kancinci. Ke ngoko, kwizigulane ezirhaneleka ukuba zine-acute pulmonary embolism, kufuneka kudityaniswe i-ultrasonography yemithambo enzulu yemilenze esezantsi kunye novavanyo lwe-D-Dimer.
2. Ukusasazwa kwe-intravascular coagulation
I-Disseminated intravascular coagulation (DIC) sisifo seklinikhi esibonakaliswa kukuphuma kwegazi kunye nokungaphumeleli kwe-microcirculatory ngenxa yezifo ezininzi. Inkqubo yophuhliso ibandakanya iinkqubo ezininzi ezifana ne-coagulation, i-anticoagulation, kunye ne-fibrinolysis. I-D-Dimer yanda kwinqanaba lokuqala lokwakheka kwe-DIC, kwaye uxinzelelo lwayo lwaqhubeka nokwanda ngaphezu kwe-10-izihlandlo njengoko isifo siqhubeka. Ke ngoko, i-D-Dimer ingasetyenziswa njengenye yeempawu eziphambili zokuxilongwa kwangoko kunye nokujonga imeko ye-DIC.
3. Ukuqhaqhwa kwe-Aorta
"Imvumelwano yeengcali zaseTshayina malunga nokuxilongwa kunye nonyango lwe-aortic dissection" ibonise ukuba i-D-Dimer, njengovavanyo oluqhelekileyo lwelabhoratri lwe-aortic dissection (AD), ibaluleke kakhulu ekuxilongweni nasekuxilongweni ngokwahlukileyo kwe-dissection. Xa i-D-Dimer yesigulane inyuka ngokukhawuleza, amathuba okuxilongwa njengoko i-AD ikhula. Kwiiyure ezingama-24 zokuqala, xa i-D-Dimer ifikelela kwixabiso elibalulekileyo le-500 µg/L, uvakalelo lwayo lokufumanisa i-AD ebukhali yi-100%, kwaye ukuchaneka kwayo yi-67%, ngoko ke ingasetyenziswa njengesalathiso sokukhupha ekuxilongweni kwe-AD ebukhali.
4. Isifo sentliziyo esine-atherosclerotic
Isifo sentliziyo esibangelwa yi-atherosclerotic cardiovascular disease sisifo sentliziyo esibangelwa yi-arteriosclerotic plaque, kuquka i-ST-segment elevation acute myocardial infarction, i-non-ST-segment elevation acute myocardial infarction, kunye ne-angina engazinzile. Emva kokuqhekeka kwe-plaque, izinto ezingundoqo ze-necrotic kwi-plaque ziyaphuma, nto leyo ebangela ukuba kubekho ukuhamba kwegazi okungaqhelekanga, ukusebenza kwenkqubo yokujiya kwegazi, kunye nokwanda koxinzelelo lwe-D-Dimer. Izigulane zesifo sentliziyo esine-D-Dimer ephezulu zinokuqikelela umngcipheko ophezulu we-AMI kwaye zingasetyenziswa njengesalathisi sokujonga imeko ye-ACS.
5. Unyango lweThrombolytic
Uphononongo lukaLawter lufumanise ukuba amayeza ahlukeneyo e-thrombolytic anokunyusa i-D-Dimer, kwaye utshintsho loxinzelelo lwayo ngaphambi nasemva kwe-thrombolysis lungasetyenziswa njengesalathisi sokugweba unyango lwe-thrombolytic. Umxholo wayo wanda ngokukhawuleza ukuya kwixabiso eliphezulu emva kwe-thrombolysis, kwaye wabuyela umva ngexesha elifutshane kunye nophuculo olukhulu kwiimpawu zeklinikhi, nto leyo ebonisa ukuba unyango lusebenza kakuhle.
- Inqanaba le-D-Dimer lenyuke kakhulu emva kweyure e-1 ukuya kwiiyure ezi-6 emva kokuhlinzwa kwemithambo yegazi ngenxa ye-acute myocardial infarction kunye ne-cerebral infarction.
- Ngexesha le-DVT thrombolysis, i-D-Dimer peak idla ngokuvela kwiiyure ezingama-24 okanye kamva
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