01. Ukuxilongwa kwe-deep vein thrombosis kunye ne-pulmonary embolism

I-Deep vein thrombosis (D-VT) ithambekele kwi-pulmonary embolism (PE), eyaziwa ngokuba yi-venous thromboembolism (VTE). Amanqanaba e-Plasma D-dimer aphakanyiswa kakhulu kwizigulana ze-VTE.

Izifundo ezinxulumene noko zibonise ukuba uxinaniso lwe-D-dimer kwi-plasma kwizigulane ezine-PE kunye ne-D-VT lungaphezulu kwe-1 000 μg/L.

Nangona kunjalo, ngenxa yezifo ezininzi okanye ezinye izinto ezibangela izifo (utyando, iithumba, izifo zentliziyo, njl.njl.) zinempembelelo ethile kwi-hemostasis, nto leyo ebangela ukwanda kwe-D-dimer. Ke ngoko, nangona i-D-dimer inovakalelo oluphezulu, ukuchaneka kwayo yi-50% ukuya kwi-70% kuphela, kwaye i-D-dimer yodwa ayinakuxilonga i-VTE. Ke ngoko, ukwanda okukhulu kwe-D-dimer akunakusetyenziswa njengesalathisi esithile se-VTE. Intsingiselo esebenzayo yovavanyo lwe-D-dimer kukuba isiphumo esibi sithintela ukuxilongwa kwe-VTE.

 

02 Ukusasazwa kwe-intravascular coagulation

I-Disseminated intravascular coagulation (DIC) sisifo se-microthrombosis enkulu kwimithambo emincinci emzimbeni wonke kunye ne-hyperfibrinolysis yesibini phantsi kwesenzo sezinto ezithile ezibangela izifo, ezinokuhamba ne-fibrinolysis yesibini okanye i-fibrinolysis ethintelweyo.

Umthamo ophezulu we-D-dimer kwi-plasma unexabiso eliphezulu lereferensi yeklinikhi ekuxilongweni kwangoko kwe-DIC. Nangona kunjalo, kufuneka kuqatshelwe ukuba ukunyuka kwe-D-dimer akulona uvavanyo oluthile lwe-DIC, kodwa izifo ezininzi ezihamba ne-microthrombosis zinokukhokelela ekwandeni kwe-D-dimer. Xa i-fibrinolysis ilandela ukuqina kwemithambo yegazi ngaphandle kwegazi, i-D-dimer nayo iya kwanda.

Izifundo zibonise ukuba i-D-dimer iqala ukunyuka kwiintsuku ngaphambi kwe-DIC kwaye iphezulu kakhulu kunesiqhelo.

 

03 Ukufuthaniseka kweentsana ezisandula ukuzalwa

Kukho amanqanaba ahlukeneyo e-hypoxia kunye ne-acidosis kwi-infant asphyxia, kwaye i-hypoxia kunye ne-acidosis zinokubangela umonakalo omkhulu we-endothelial yemithambo yegazi, okubangela ukukhululwa kwezinto ezininzi ezibangela ukujiya kwegazi, ngaloo ndlela kwandisa imveliso ye-fibrinogen.

Izifundo ezifanelekileyo zibonise ukuba ixabiso le-D-dimer legazi lentambo kwiqela le-asphyxia liphezulu kakhulu kunelo leqela eliqhelekileyo lolawulo, kwaye xa lithelekiswa nexabiso le-D-dimer kwigazi elingaphandle, likwaphezulu kakhulu.

 

04 I-Systemic lupus erythematosus (SLE)

Inkqubo yokujiya-i-fibrinolysis ayiqhelekanga kwizigulane ze-SLE, kwaye ukujiya kwenkqubo yokujiya-i-fibrinolysis kubonakala ngakumbi kwinqanaba elisebenzayo lesi sifo, kwaye utyekelo lwe-thrombosis luyabonakala ngakumbi; xa isifo siphelile, inkqubo yokujiya-i-fibrinolysis idla ngokuba yeqhelekileyo.

Ngoko ke, amanqanaba e-D-dimer kwizigulana ezine-systemic lupus erythematosus kwizigaba ezisebenzayo nezingasebenziyo aza kunyuka kakhulu, kwaye amanqanaba e-D-dimer kwi-plasma kwizigulana ezikwisigaba esisebenzayo aphezulu kakhulu kunalawo akwisigaba esingasebenziyo.

05 Isifo sesibindi kunye nomhlaza wesibindi

I-D-dimer yenye yeempawu ezibonisa ubukhali besifo sesibindi. Okukhona isifo sesibindi sinzima, kokukhona umthamo we-D-dimer kwiplasma uphezulu.

Izifundo ezifanelekileyo zibonise ukuba amaxabiso e-D-dimer e-Child-Pugh A, B, kunye ne-C kwizigulane ezine-cirrhosis yesibindi yayiyi-(2.218 ± 0.54) μg/mL, (6.03 ± 0.76) μg/mL, kunye ne-(10.536 ± 0.664) μg/mL, ngokwahlukeneyo.

Ukongeza, i-D-dimer yayinyuswe kakhulu kwizigulane ezinomhlaza wesibindi eziqhubela phambili ngokukhawuleza kwaye zinesifo esinganyangekiyo.

06 Umhlaza wesisu

Emva kokususwa kwakhona kwezigulane ezinomhlaza, i-thromboembolism yenzeka kwisiqingatha sezigulane, kwaye i-D-dimer iyanda kakhulu kwi-90% yezigulane.

Ukongeza, kukho udidi lwezinto ezineswekile eninzi kwiiseli zethumba ezinesakhiwo kunye ne-tissue factor ezifanayo kakhulu. Ukuthatha inxaxheba kwimisebenzi ye-metabolic yomntu kunokukhuthaza umsebenzi wenkqubo yomzimba yokujiya kunye nokwandisa umngcipheko we-thrombosis, kwaye inqanaba le-D-dimer liyanda kakhulu. Kwaye inqanaba le-D-dimer kwizigulana ezinomhlaza wesisu ezinesigaba se-III-IV laliphezulu kakhulu kunelo kwizigulana ezinomhlaza wesisu ezinesigaba se-I-II.

 

07 I-Mycoplasma pneumonia (MMP)

I-MPP enzima idla ngokuhamba namanqanaba aphezulu e-D-dimer, kwaye amanqanaba e-D-dimer aphezulu kakhulu kwizigulane ezine-MPP enzima kunakwiimeko ezincinci.

Xa i-MPP igula kakhulu, i-hypoxia, ischemia kunye ne-acidosis ziya kwenzeka ngaphakathi, kunye nokuhlasela ngokuthe ngqo kwezifo ezibangelwa zizifo, okuya konakalisa iiseli ze-vascular endothelial, kuveze i-collagen, kusebenze inkqubo yokujiya, kwenze imeko yokujiya kakhulu, kwaye kwenze i-microthrombi. Iinkqubo ze-fibrinolytic zangaphakathi, i-kinin kunye ne-complement nazo ziyavuselelwa ngokulandelelana, nto leyo ekhokelela ekwandeni kwamanqanaba e-D-dimer.

 

08 Isifo seswekile, isifo seswekile i-nephropathy

Amanqanaba e-D-dimer anyuswe kakhulu kwizigulane ezinesifo seswekile kunye ne-diabetes nephropathy.

Ukongeza, ii-D-dimer kunye ne-fibrinogen indexes zezigulane ezine-diabetes nephropathy zaziphezulu kakhulu kunezo zezigulane zesifo seswekile sohlobo lwesibini. Ke ngoko, kunyango lwezonyango, i-D-dimer ingasetyenziswa njenge-index yovavanyo lokufumanisa ubunzima besifo seswekile kunye nesifo sezintso kwizigulane.

09 I-Allergic Purpura (AP)

Kwisigaba esibukhali se-AP, kukho amanqanaba ahlukeneyo okuxinana kwegazi kunye nokusebenza kakuhle kweeplatelet, okukhokelela kwi-vasospasm, ukuhlanganiswa kweeplatelet kunye ne-thrombosis.

I-D-dimer ephezulu kubantwana abane-AP ixhaphakile emva kweeveki ezi-2 zokuqala kwaye iyahluka phakathi kwamanqanaba eklinikhi, ibonisa ubungakanani kunye nobungakanani bokuvuvukala kwemithambo yegazi.

Ukongeza, ikwasisibonakaliso sokuxela kwangaphambili, ngenxa yamanqanaba aphezulu e-D-dimer, esi sifo sihlala siqhubeka ixesha elide kwaye sinomngcipheko wokonakala kwezintso.

 

10 Ukukhulelwa

Izifundo ezinxulumene noko zibonise ukuba malunga ne-10% yabasetyhini abakhulelweyo banamanqanaba aphezulu e-D-dimer, nto leyo ebonisa umngcipheko wokuqhekeka kwegazi.

I-Preeclampsia yingxaki eqhelekileyo yokukhulelwa. Utshintsho oluphambili lwe-preeclampsia kunye ne-eclampsia kukusebenza kwe-coagulation kunye nokuphucula i-fibrinolysis, okubangela ukwanda kwe-microvascular thrombosis kunye ne-D-dimer.

I-D-dimer yehla ngokukhawuleza emva kokubeletha kubafazi abaqhelekileyo, kodwa yanda kubafazi abane-preeclampsia, kwaye ayizange ibuyele kwisiqhelo de kwadlula iiveki ezi-4 ukuya kwezi-6.

11 I-Acute Coronary Syndrome kunye ne-Dissecting Aneurysm

Izigulane ezine-acute coronary syndromes zinezinga eliqhelekileyo okanye eliphantsi kancinci le-D-dimer, ngelixa i-aortic dissecting aneurysms iphezulu kakhulu.

Oku kunxulumene nomahluko omkhulu kumthwalo we-thrombus kwimithambo yegazi yemithambo yegazi yale mibini. I-coronary lumen incinci kwaye i-thrombus kwimithambo yegazi yentliziyo incinci. Emva kokuba i-aortic intima breaks, igazi elininzi lemithambo yegazi lingena eludongeni lwemithambo yegazi ukuze lenze i-dissecting aneurysm. Inani elikhulu le-thrombi lenziwa phantsi kwesenzo se-coagulation mechanism.

12 Isifo sobuchopho esibukhali

Kwi-acute cerebral infarction, i-spontaneous thrombolysis kunye nomsebenzi we-secondary fibrinolytic ziyanda, zibonakala njengokwanda kwamanqanaba e-plasma D-dimer. Inqanaba le-D-dimer landa kakhulu kwinqanaba lokuqala le-acute cerebral infarction.

Amanqanaba e-Plasma D-dimer kwizigulane ezine-acute ischemic stroke anyuswe kancinci kwiveki yokuqala emva kokuqala, anyuswe kakhulu kwiiveki ezi-2 ukuya kwezi-4, kwaye ayengahlukanga kumanqanaba aqhelekileyo ngexesha lokuchacha (>iinyanga ezi-3).