Ngokuqonda kwabantu ngakumbi nge-thrombus, i-D-dimer iye yasetyenziswa njengeyona nto isetyenziswa kakhulu ekuvavanyweni kwe-thrombus kwiilabhoratri zeklinikhi zokuxinana kwegazi. Nangona kunjalo, le yindlela eyintloko yokutolika i-D-Dimer. Ngoku uninzi lwabaphengululi lunike i-D-Dimer intsingiselo engakumbi kuphando malunga ne-D-Dimer ngokwayo kunye nolwalamano lwayo nezifo. Umxholo wale ngxaki uza kukukhokelela ekubeni uyixabise indlela entsha yokusebenzisa.
Isiseko sokusetyenziswa kweklinikhi kwe-D-dimer
01. Ukwanda kwe-D-Dimer kubonisa ukusebenza kwenkqubo yokujiya kunye nenkqubo ye-fibrinolysis emzimbeni, kwaye le nkqubo ibonisa imeko yotshintsho ephezulu. I-D-Dimer engalunganga ingasetyenziselwa ukukhutshwa kwe-thrombus (eyona xabiso liphambili leklinikhi); ngelixa i-D-Dimer ene-positive ayinakungqina ukwakheka kwe-thromboembolism. Ukuba i-thromboembolism yenziwe okanye ayidalwanga kuxhomekeke kwibhalansi yezi nkqubo zimbini.
02. Isiqingatha sobomi be-D-Dimer ziiyure ezisi-7-8, kwaye sinokufunyanwa emva kweeyure ezi-2 emva kwe-thrombosis. Olu phawu lunokuhambelana kakuhle noqheliselo lweklinikhi, kwaye akuyi kuba nzima ukulujonga kuba isiqingatha sobomi sifutshane kakhulu, kwaye aluyi kulahlekelwa kukubaluleka kokujonga kuba isiqingatha sobomi side kakhulu.
03. I-D-Dimer ingazinza kwiisampuli zegazi emva kwe-in vitro ubuncinane iiyure ezingama-24-48, ukuze umxholo we-D-Dimer ofunyenwe kwi-vitro ukwazi ukubonisa ngokuchanekileyo inqanaba le-D-Dimer kwi-vivo.
04. Indlela yokusebenza ye-D-Dimer isekelwe kwi-antigen-antibody reaction, kodwa indlela ethile ininzi kodwa ayifani. Ii-antibodies ezikwi-reagent zahlukahlukene, kwaye iziqwenga ze-antigen ezifunyenweyo azingqinelani. Xa ukhetha uphawu kwilebhu, kufuneka luhlolwe.
Ukusetyenziswa kweklinikhi yendabuko ye-D-dimer ekujiyeni igazi
1. Ukuxilongwa kokungabikho kwe-VTE:
Uvavanyo lwe-D-Dimer oludityaniswe nezixhobo zovavanyo lomngcipheko weklinikhi lungasetyenziswa ngokufanelekileyo ukususa i-deep vein thrombosis (DVT) kunye ne-pulmonary embolism (PE).
Xa isetyenziselwa ukukhupha i-thrombus, kukho iimfuno ezithile ze-D-Dimer reagent kunye nendlela yokusebenza. Ngokomgangatho weshishini le-D-Dimer, amathuba adibeneyo ovavanyo lwangaphambi kovavanyo afuna izinga elibi lokuqikelela eliyi-≥97% kunye novakalelo oluyi-≥95%.
2. Ukuxilongwa okuncediswayo kwe-disseminated intravascular coagulation (DIC):
Ukubonakaliswa okuqhelekileyo kwe-DIC yinkqubo ye-hyperfibrinolysis, kwaye ukufunyanwa okunokubonakalisa i-hyperfibrinolysis kudlala indima ebalulekileyo kwinkqubo yokufumana amanqaku e-DIC. Kuye kwaboniswa ngokwezonyango ukuba i-D-Dimer iya kwanda kakhulu (ngaphezulu kwezihlandlo ezili-10) kwizigulane ze-DIC. Kwizikhokelo zokuxilonga ze-DIC zasekhaya nezangaphandle okanye ukuvumelana, i-D-Dimer isetyenziswa njengenye yezalathisi zelebhu zokuxilonga i-DIC, kwaye kuyacetyiswa ukuba kwenziwe i-FDP kunye. Ukuphucula ngokufanelekileyo ukusebenza kokuxilongwa kwe-DIC. Ukuxilongwa kwe-DIC akunakwenziwa kuphela ngokuxhomekeka kwisalathiso selabhoratri enye kunye neziphumo zovavanyo olunye. Kufuneka ihlalutywe ngokupheleleyo kwaye ijongwe ngokudibeneyo kunye neempawu zeklinikhi zesigulana kunye nezinye izalathisi zelebhu.
Usetyenziso olutsha lweklinikhi lwe-D-Dimer
1. Ukusetyenziswa kwe-D-Dimer kwizigulana ezine-COVID-19: Ngandlela thile, i-COVID-19 sisifo esibangela ukuxinana kwegazi esibangelwa ziingxaki zomzimba, esinokusabela ngokusasazeka kokudumba kunye ne-microthrombosis emiphungeni. Kubikwa ukuba ngaphezulu kwama-20% ezigulana ezine-VTE kwiimeko ze-COVID-19 ezibhedlele.
• Amanqanaba e-D-Dimer xa engeniswa esibhedlele aqikelela ngokuzimeleyo ukufa esibhedlele kwaye ahlola izigulane ezinokuba semngciphekweni omkhulu. Okwangoku, i-D-dimer iye yaba yenye yezinto ezibalulekileyo zokuhlola izigulane ezine-COVID-19 xa zingeniswa esibhedlele.
• I-D-Dimer ingasetyenziselwa ukukhokela ukuba iqalise na i-heparin anticoagulation kwizigulane ezine-COVID-19. Kuye kwaxelwa ukuba kwizigulane ezine-D-Dimer ≥ amaxesha ama-6-7 kunomda ophezulu woluhlu olubhekiselweyo, ukuqaliswa kwe-heparin anticoagulation kunokuphucula kakhulu iziphumo zezigulane.
• Ukubeka esweni i-D-Dimer ngendlela eguqukayo kungasetyenziselwa ukuvavanya ukuvela kwe-VTE kwizigulane ezine-COVID-19.
• Ukuhlolwa kwe-D-Dimer, okunokusetyenziswa ukuvavanya iziphumo ze-COVID-19.
• Ukubeka iliso kwi-D-Dimer, xa unyango lwesifo lujongene nesigqibo, ngaba i-D-Dimer inganika ulwazi oluthile oluchazayo? Kukho iimvavanyo ezininzi zeklinikhi ezijongwayo kwamanye amazwe.
2. Ukubeka esweni okunamandla kwe-D-Dimer kuqikelela ukwakheka kwe-VTE:
Njengoko kukhankanyiwe apha ngasentla, isiqingatha sobomi be-D-Dimer ziiyure ezisi-7-8. Kungenxa yolu phawu kanye ukuba i-D-Dimer ikwazi ukujonga ngokuguquguqukayo kwaye iqikelele ukwakheka kwe-VTE. Kwimeko ye-hypercoagulable okanye i-microthrombosis, i-D-Dimer iya kwanda kancinci ize yehle ngokukhawuleza. Xa kukho ukwakheka kwe-thrombus entsha eqhubekayo emzimbeni, i-D-Dimer emzimbeni iya kuqhubeka inyuka, ibonise i-peak-like ringing curve. Kubantu abane-thrombosis ephezulu, njengeemeko ezibukhali nezinzima, izigulane emva kotyando, njl.njl., ukuba inqanaba le-D-Dimer liyanda ngokukhawuleza, qaphela amathuba e-thrombosis. Kwi-"Expert Consensus on the Screening and Treatment of Deep Vein Thrombosis in Trauma Orthopedic Patients", kucetyiswa ukuba izigulane ezine-medium and high risk emva kotyando lwe-orthopedic zifanele zijonge ngokuguquguqukayo utshintsho lwe-D-Dimer rhoqo emva kweeyure ezingama-48. Uvavanyo lwe-imaging kufuneka lwenziwe ngexesha elifanelekileyo ukujonga i-DVT.
3. I-D-Dimer njengesalathisi sokuxela kwangaphambili izifo ezahlukeneyo:
Ngenxa yobudlelwane obusondeleyo phakathi kwenkqubo yokujiya kwegazi kunye nokuvuvukala, ukwenzakala kwe-endothelial, njl.njl., ukuphakama kwe-D-Dimer kuhlala kubonwa kwezinye izifo ezingezizo ezibangela i-thrombosis ezifana nosulelo, utyando okanye ukwenzakala, ukusilela kwentliziyo, kunye neethumba ezinobungozi. Izifundo zifumanise ukuba eyona nto ixhaphakileyo yokuxela kwangaphambili kwezi zifo yi-thrombosis, i-DIC, njl.njl. Uninzi lwezi ngxaki zezona zifo zixhaphakileyo okanye iimeko ezibangela ukunyuka kwe-D-Dimer. Ke ngoko, i-D-Dimer ingasetyenziswa njengesalathiso sovavanyo esibanzi nesinobuthathaka kwizifo.
• Kwizigulane ezinethumba, izifundo ezininzi zifumanise ukuba izinga lokusinda leminyaka eli-1-3 kwizigulane ezinethumba elibi ezine-D-Dimer ephezulu liphantsi kakhulu kunelo lezigulane eziqhelekileyo ezine-D-Dimer. I-D-Dimer ingasetyenziswa njengesalathisi sokuvavanya ukubikezela kwangaphambili kwezigulane ezinethumba elibi.
• Kwizigulane ze-VTE, izifundo ezininzi ziqinisekisile ukuba izigulane ezine-D-Dimer ezine-VTE zinomngcipheko ophezulu ngokuphindwe ka-2-3 wokuphinda kuvele i-thrombus ngexesha lokuthintela ukujiya kwegazi kunezigulane ezingezizo. Olunye uhlalutyo lwe-meta oluquka izifundo ezi-7 kunye nabantu abayi-1818 lubonise ukuba, i-D-Dimer engaqhelekanga yenye yezona zinto ziphambili ezixela ukuphinda kuvele i-thrombus kwizigulane ze-VTE, kwaye i-D-Dimer ifakiwe kwiimodeli ezininzi zokuqikelela ukuphinda kuvele i-VTE.
• Kwizigulane ezitshintsha ivalvu yoomatshini (MHVR), uphando olulandelelanayo oluqhubeke ixesha elide lwabantu abangama-618 lubonise ukuba umngcipheko weziganeko ezimbi kwizigulane ezinezinga elingaqhelekanga le-D-Dimer ngexesha le-warfarin emva kwe-MHVR wawumalunga nezihlandlo ezi-5 kunezigulane eziqhelekileyo. Uhlalutyo lwe-Multivariate correlation luqinisekisile ukuba izinga le-D-Dimer lalisisichazi esizimeleyo seziganeko ze-thrombotic okanye ze-cardiovascular ngexesha lokuthintela ukugabha kwegazi.
• Kwizigulane ezine-atrial fibrillation (AF), i-D-Dimer inokuqikelela iziganeko ze-thrombotic kunye neziganeko zentliziyo kwi-oral anticoagulation. Uphononongo olucwangcisiweyo lwezigulane ezingama-269 ezine-atrial fibrillation olulandelwe malunga neminyaka emi-2 lubonise ukuba ngexesha le-oral anticoagulation, malunga ne-23% yezigulane ezine-INR ezifikelele kujoliso zibonise amanqanaba e-D-Dimer angaqhelekanga, ngelixa izigulane ezine-D-Dimer angaqhelekanga ziphuhlisiwe. Ingozi yeziganeko ze-thrombotic kunye neziganeko zentliziyo ezihambelanayo yayizizihlandlo ezili-15.8 kunye nezi-7.64, ngokulandelelana, zezigulane ezine-D-Dimer amanqanaba aqhelekileyo.
• Kwezi zifo okanye izigulane ezithile, i-D-Dimer ephezulu okanye ehlala ikho idla ngokubonisa ukuba isifo asikabi nazinjongo okanye ukuba mandundu kwaso.
4. Ukusetyenziswa kwe-D-Dimer kunyango lokuthintela ukujiya kwegazi ngomlomo:
• I-D-Dimer imisela ixesha lokuthintela ukujiya kwegazi ngomlomo: Ixesha elifanelekileyo lokuthintela ukujiya kwegazi kwizigulane ezine-VTE okanye ezinye ii-thrombus alikacaci. Nokuba yi-NOAC okanye i-VKA, izikhokelo zamazwe ngamazwe ezifanelekileyo zicebisa ukuba ukuthintela ukujiya kwegazi ixesha elide kufuneka kugqitywe ngokwengozi yokopha kwinyanga yesithathu yonyango lokuthintela ukujiya kwegazi, kwaye i-D-Dimer inokubonelela ngolwazi lomntu ngamnye malunga noku.
• I-D-Dimer ikhokela uhlengahlengiso lobukhali be-anticoagulant yomlomo: I-Warfarin kunye ne-anticoagulants entsha yomlomo zezona zi-anticoagulants zomlomo ezisetyenziswa kakhulu kunyango, zombini ezinokuthi zinciphise inqanaba le-D-Dimer. kunye nokusebenza kwenkqubo ye-fibrinolytic, ngaloo ndlela zinciphise ngokungathanga ngqo inqanaba le-D-Dimer. Iziphumo zovavanyo zibonisa ukuba i-anticoagulation ekhokelwa yi-D-Dimer kwizigulana inciphisa ngokufanelekileyo ukwenzeka kweziganeko ezimbi.
Ukuqukumbela, uvavanyo lwe-D-Dimer alusekho kuphela kwizicelo zemveli ezifana nokuxilongwa kwe-VTE ngaphandle kunye nokufunyanwa kwe-DIC. I-D-Dimer idlala indima ebalulekileyo ekuxeleni kwangaphambili kwesifo, ukuqikelela kwangaphambili, ukusetyenziswa kwe-anticoagulants yomlomo, kunye ne-COVID-19. Ngokuqhubeka kophando, ukusetyenziswa kwe-D-Dimer kuya kuba kubanzi ngakumbi nangakumbi.
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