Ama-monomer e-Fibrin egazini axhunyaniswa yi-activated factor X III, bese e-hydrolyzed yi-activated plasmin ukuze akhiqize umkhiqizo othize wokuwohloka obizwa ngokuthi "umkhiqizo wokuwohloka kwe-fibrin (FDP)." I-D-Dimer iyi-FDP elula kakhulu, futhi ukwanda kokuhlushwa kwayo okukhulu kubonisa isimo se-hypercoagulable kanye ne-hyperfibrinolysis yesibili emzimbeni. Ngakho-ke, ukuhlushwa kwe-D-Dimer kubaluleke kakhulu ekuxilongweni, ekuhlolweni kokusebenza kahle kanye nokwahlulela kusengaphambili kwezifo ze-thrombotic.
Kusukela kwaqubuka i-COVID-19, ngokujula kwezibonakaliso zemitholampilo kanye nokuqonda kwezifo ngalesi sifo kanye nokuqongelela ulwazi lokuxilongwa kanye nokwelashwa, iziguli ezibucayi ezine-pneumonia entsha yenhliziyo zingaba ne-acute respiratory distress syndrome ngokushesha. Izimpawu, ukushaqeka kwe-septic, i-refractory metabolic acidosis, ukungasebenzi kahle kwe-coagulation, kanye nokwehluleka kwezitho eziningi. I-D-dimer iphakeme ezigulini ezine-pneumonia enzima.
Iziguli ezigula kakhulu zidinga ukunaka ingozi ye-venous thromboembolism (VTE) ngenxa yokuphumula isikhathi eside embhedeni kanye nokusebenza okungajwayelekile kokujiya kwegazi.
Ngesikhathi senqubo yokwelashwa, kuyadingeka ukuqapha izinkomba ezifanele ngokwesimo, okuhlanganisa izimpawu ze-myocardial, umsebenzi wokuqina kwemithambo yegazi, njll. Ezinye iziguli kungenzeka ukuthi zikhuphukile i-myoglobin, ezinye izimo ezinzima zingase zibone ukwanda kwe-troponin, kanti ezimweni ezimbi kakhulu, i-D-dimer (D-Dimer) ingakhushulwa.
Kungabonakala ukuthi i-D-Dimer inokubaluleka kokuqapha okuhlobene nezinkinga ekuqhubekeni kwe-COVID-19, ngakho-ke idlala kanjani indima kwezinye izifo?
1. Ukuvaleka kwemithambo yegazi
I-D-Dimer isetshenziswe kabanzi ezifweni ezihlobene ne-venous thromboembolism (VTE), njenge-deep vein thrombosis (DVT) kanye ne-pulmonary embolism (PE). Ukuhlolwa kwe-D-Dimer okungekuhle kungaqeda i-DVT, kanti ukuhlushwa kwe-D-Dimer nakho kungasetshenziswa ukubikezela izinga lokuphindeka kwe-VTE. Ucwaningo luthole ukuthi isilinganiso sengozi sokuphindeka kwe-VTE kubantu abane-concentration ephezulu sasiphindwe izikhathi ezingu-4.1 kunesabantu abane-concentration evamile.
I-D-Dimer ingenye yezinkomba zokutholakala kwe-PE. Inani layo elibi lokubikezela liphezulu kakhulu, futhi ukubaluleka kwayo ukukhipha i-acute pulmonary embolism, ikakhulukazi ezigulini ezisolakala ukuthi zine-acute pulmonary embolism, kufanele kuhlanganiswe i-ultrasonography yemithambo ejulile yemilenze engezansi kanye nokuhlolwa kwe-D-Dimer.
2. Ukujiya kwemithambo yegazi okusabalalisiwe
Ukuvaleka kwemithambo yegazi okusabalalisiwe (i-DIC) kuyisifo esibonakala ngokuphuma kwegazi kanye nokwehluleka kwe-microcirculatory ngenxa yezifo eziningi. Inqubo yokukhula ihilela izinhlelo eziningi ezifana nokuvaleka kwemithambo yegazi, ukuvimbela ukuvaleka kwemithambo yegazi, kanye ne-fibrinolysis. I-D-Dimer yanda esigabeni sokuqala sokwakheka kwe-DIC, futhi ukuhlushwa kwayo kwaqhubeka nokwanda ngokuphindwe kayishumi njengoba isifo siqhubeka. Ngakho-ke, i-D-Dimer ingasetshenziswa njengenye yezinkomba eziyinhloko zokuxilongwa kwasekuqaleni kanye nokuqapha isimo se-DIC.
3. Ukusikwa kwe-Aorta
"Ukuvumelana kochwepheshe baseShayina mayelana nokuxilongwa nokwelashwa kokuqhekeka komthambo i-aorta" kuveze ukuthi i-D-Dimer, njengokuhlolwa okuvamile kwelabhorethri kokuqhekeka komthambo i-aorta (AD), ibaluleke kakhulu ekuxilongweni nasekuxilongweni okuhlukile kokuqhekeka komthambo. Lapho i-D-Dimer yesiguli ikhuphuka ngokushesha, amathuba okuxilongwa njengoba i-AD ikhula. Phakathi namahora angama-24 okuqala, lapho i-D-Dimer ifinyelela inani elibalulekile lika-500 µg/L, ukuzwela kwayo ekuxilongweni kwe-AD ebukhali kungu-100%, kanti ukucaciswa kwayo kungu-67%, ngakho-ke ingasetshenziswa njengenkomba yokukhipha ekuxilongweni kwe-AD ebukhali.
4. Isifo Senhliziyo Nemithambo Yegazi Esibangelwa Yi-Atherosclerotic
Isifo senhliziyo esibangelwa yi-atherosclerotic cardiovascular disease yisifo senhliziyo esibangelwa yi-arteriosclerotic plaque, okuhlanganisa i-ST-segment elevation acute myocardial infarction, i-non-ST-segment elevation acute myocardial infarction, kanye ne-angina engazinzile. Ngemva kokuqhuma kwe-plaque, izinto eziyinhloko ze-necrotic ku-plaque ziyaphuma, okubangela izingxenye zokugeleza kwegazi okungajwayelekile, ukusebenza kwesistimu yokujiya, kanye nokwanda kokuhlushwa kwe-D-Dimer. Iziguli zesifo senhliziyo esine-D-Dimer ephezulu zingabikezela ingozi ephezulu ye-AMI futhi zingasetshenziswa njengesibonakaliso sokubona isimo se-ACS.
5. Ukwelashwa nge-Thrombolytic
Ucwaningo lukaLawter luthole ukuthi imithi ehlukahlukene ye-thrombolytic ingandisa i-D-Dimer, futhi ukuhlushwa kwayo kuyashintsha ngaphambi nangemva kwe-thrombolysis kungasetshenziswa njengesibonakaliso sokwahlulela ukwelashwa kwe-thrombolytic. Okuqukethwe kwayo kwanda ngokushesha kwaba inani eliphakeme ngemva kwe-thrombolysis, futhi kwabuyela emuva ngesikhathi esifushane ngokuthuthuka okukhulu kwezimpawu zomtholampilo, okubonisa ukuthi ukwelashwa kwakuphumelele.
- Izinga le-D-Dimer lenyuke kakhulu ngemva kwehora eli-1 kuya emahoreni ayi-6 ngemuva kokuhlinzwa kwe-thrombolysis ngenxa yokuhlaselwa yinhliziyo okubukhali kanye nokuhlaselwa yisifo sobuchopho.
- Ngesikhathi sokuhlolwa kwe-DVT thrombolysis, i-D-Dimer peak ivame ukwenzeka emahoreni angama-24 noma kamuva.
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