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

I-deep vein thrombosis (D-VT) ivame ukuba ne-pulmonary embolism (PE), eyaziwa ngokuthi i-venous thromboembolism (VTE). Amazinga e-Plasma D-dimer aphakeme kakhulu ezigulini ze-VTE.

Izifundo ezihlobene zibonise ukuthi ukuhlushwa kwe-D-dimer egazini ezigulini ezine-PE kanye ne-D-VT kungaphezu kuka-1 000 μg/L.

Kodwa-ke, ngenxa yezifo eziningi noma ezinye izici ze-pathological (ukuhlinzwa, izimila, izifo zenhliziyo, njll.) zinomthelela othile ekuqhekekeni kwegazi, okuholela ekwandeni kwe-D-dimer. Ngakho-ke, yize i-D-dimer inokuzwela okuphezulu, ukucaciswa kwayo kungu-50% kuya ku-70% kuphela, kanti i-D-dimer yodwa ayikwazi ukuxilonga i-VTE. Ngakho-ke, ukwanda okukhulu kwe-D-dimer akukwazi ukusetshenziswa njengesibonakaliso esithile se-VTE. Ukubaluleka okusebenzayo kokuhlolwa kwe-D-dimer ukuthi umphumela ongemuhle uvimbela ukuxilongwa kwe-VTE.

 

02 Ukujiya kwemithambo yegazi okusabalalisiwe

Ukujiya kwemithambo yegazi okusabalalisiwe (DIC) kuyisifo se-microthrombosis enkulu emithanjeni emincane emzimbeni wonke kanye ne-hyperfibrinolysis yesibili ngaphansi kwesenzo sezinto ezithile ezibangela izifo, ezingase zihambisane ne-fibrinolysis yesibili noma i-fibrinolysis evinjelwe.

Okuqukethwe okuphezulu kwe-D-dimer egazini kunenani eliphezulu lokubhekisela emtholampilo lokuxilongwa kwangaphambi kwesikhathi kwe-DIC. Kodwa-ke, kufanele kuqashelwe ukuthi ukwanda kwe-D-dimer akuyona ukuhlolwa okuqondile kwe-DIC, kodwa izifo eziningi ezihambisana ne-microthrombosis zingaholela ekwandeni kwe-D-dimer. Uma i-fibrinolysis ilandela ukuqina kwemithambo yegazi, i-D-dimer nayo izokhula.

Izifundo zibonise ukuthi i-D-dimer iqala ukukhuphuka ezinsukwini ezimbalwa ngaphambi kwe-DIC futhi iphakeme kakhulu kunokujwayelekile.

 

03 Ukuphelelwa umoya kwezingane ezisanda kuzalwa

Kunezinhlobo ezahlukene ze-hypoxia kanye ne-acidosis ekuntulekeni komoya kosana olusanda kuzalwa, kanti i-hypoxia kanye ne-acidosis kungabangela umonakalo omkhulu we-endothelial yemithambo yegazi, okuholela ekukhishweni kwenani elikhulu lezinto ezibangela ukujiya kwegazi, ngaleyo ndlela kwandiswe ukukhiqizwa kwe-fibrinogen.

Izifundo ezifanele zibonise ukuthi inani le-D-dimer legazi lentambo eqenjini le-asphyxia liphakeme kakhulu kuneleqembu elijwayelekile lokulawula, futhi uma liqhathaniswa nenani le-D-dimer egazini elingaphandle, nalo liphakeme kakhulu.

 

04 I-systemic lupus erythematosus (SLE)

Uhlelo lwe-coagulation-fibrinolysis alujwayelekile ezigulini ze-SLE, futhi ukungajwayelekile kohlelo lwe-coagulation-fibrinolysis kusobala kakhulu esigabeni esisebenzayo salesi sifo, futhi ukuthambekela kwe-thrombosis kusobala kakhulu; lapho lesi sifo sesiphelile, uhlelo lwe-coagulation-fibrinolysis luvame ukuba olujwayelekile.

Ngakho-ke, amazinga e-D-dimer ezigulini ezine-systemic lupus erythematosus ezigabeni ezisebenzayo nezingasebenzi azokhushulwa kakhulu, kanti amazinga e-plasma D-dimer ezigulini ezisesigabeni ezisebenzayo aphezulu kakhulu kunalawo asesigabeni sokungasebenzi.

05 Isifo sokuqina kwesibindi kanye nomdlavuza wesibindi

I-D-dimer ingenye yezimpawu ezibonisa ubukhali besifo sesibindi. Uma isifo sesibindi siba sibi kakhulu, kulapho okuqukethwe yi-D-dimer egazini kuphakama khona.

Izifundo ezifanele zibonise ukuthi amanani e-D-dimer ebanga le-Child-Pugh A, B, kanye ne-C ezigulini ezine-cirrhosis yesibindi ayengu-(2.218 ± 0.54) μg/mL, (6.03 ± 0.76) μg/mL, kanye no-(10.536 ± 0.664) μg/mL, ngokulandelana.

Ngaphezu kwalokho, i-D-dimer yayiphakeme kakhulu ezigulini ezinomdlavuza wesibindi eziqhubeka ngokushesha kanye nokubikezela okubi.

06 Umdlavuza wesisu

Ngemva kokususwa kabusha kweziguli ezinomdlavuza, i-thromboembolism yenzeka cishe engxenyeni yeziguli, kanti i-D-dimer iyanda kakhulu ku-90% weziguli.

Ngaphezu kwalokho, kunezinhlobo zezinto ezinoshukela omningi kumaseli esimila anesakhiwo kanye nesici sezicubu ezifana kakhulu. Ukubamba iqhaza emisebenzini ye-metabolic yomuntu kungakhuthaza umsebenzi wohlelo lokugaya umzimba futhi kwandise ingozi ye-thrombosis, futhi izinga le-D-dimer likhuphuka kakhulu. Futhi izinga le-D-dimer ezigulini ezinomdlavuza wesisu ezinesigaba III-IV laliphezulu kakhulu kunelezigulini ezinomdlavuza wesisu ezinesigaba I-II.

 

07 I-Mycoplasma pneumonia (MMP)

I-MPP enamandla ivame ukuhambisana namazinga aphezulu e-D-dimer, kanti amazinga e-D-dimer aphezulu kakhulu ezigulini ezine-MPP enzima kunasezimweni ezincane.

Uma i-MPP igula kakhulu, i-hypoxia, ischemia kanye ne-acidosis kuzokwenzeka endaweni, kuhlanganiswe nokuhlasela okuqondile kwamagciwane, okuzolimaza amaseli e-endothelial emithambo yegazi, kudalulwe i-collagen, kusebenze uhlelo lokujiya, kwakhiwe isimo sokujiya okukhulu, futhi kwakhiwe i-microthrombi. Izinhlelo ze-fibrinolytic zangaphakathi, i-kinin kanye ne-complement nazo ziyavuselelwa ngokulandelana, okuholela ekwandeni kwamazinga e-D-dimer.

 

08 Isifo sikashukela, i-nephropathy yesifo sikashukela

Amazinga e-D-dimer akhushulwe kakhulu ezigulini ezinesifo sikashukela kanye ne-nephropathy yesifo sikashukela.

Ngaphezu kwalokho, izinkomba ze-D-dimer kanye ne-fibrinogen zeziguli ezine-nephropathy yesifo sikashukela zaziphakeme kakhulu kunezeziguli ezinesifo sikashukela sohlobo 2. Ngakho-ke, emtholampilo, i-D-dimer ingasetshenziswa njengenkomba yokuhlola ukuxilonga ubukhali besifo sikashukela kanye nesifo sezinso ezigulini.

09 I-Allergic Purpura (AP)

Esigabeni esiphuthumayo se-AP, kunezigaba ezahlukene zokujiya kwegazi kanye nokusebenza kahle kwama-platelet, okuholela ekuqhekekeni kwemithambo yegazi, ukuhlanganiswa kwama-platelet kanye ne-thrombosis.

I-D-dimer ephakanyisiwe ezinganeni ezine-AP ivame kakhulu ngemva kwamasonto amabili okuqala futhi iyahlukahluka phakathi kwezigaba zemitholampilo, okubonisa izinga kanye nezinga lokuvuvukala kwemithambo yegazi.

Ngaphezu kwalokho, futhi kuyisibonakaliso sokubikezela, njengoba amazinga aphezulu e-D-dimer eqhubeka, lesi sifo sivame ukuqhubeka isikhathi eside futhi sithambekele ekulimaleni kwezinso.

 

10 Ukukhulelwa

Izifundo ezihlobene zibonise ukuthi cishe u-10% wabesifazane abakhulelwe banezinga eliphezulu kakhulu le-D-dimer, okubonisa ingozi yokuqhekeka kwegazi.

I-Preeclampsia iyinkinga evamile yokukhulelwa. Izinguquko eziyinhloko ze-preeclampsia kanye ne-eclampsia ukuvuselelwa kwe-coagulation kanye nokuthuthukiswa kwe-fibrinolysis, okuholela ekwandeni kwe-microvascular thrombosis kanye ne-D-dimer.

I-D-dimer yehla ngokushesha ngemva kokubeletha kwabesifazane abavamile, kodwa yanda kwabesifazane abane-preeclampsia, futhi ayizange ibuyele esimweni sayo esivamile kwaze kwaba amasonto amane kuya kwayisithupha.

11 I-Acute Coronary Syndrome kanye ne-Dissecting Aneurysm

Iziguli ezine-acute coronary syndromes zinamazinga e-D-dimer ajwayelekile noma aphakeme kancane, kanti ama-aneurysms e-aorta dissecting akhuphuka kakhulu.

Lokhu kuhlobene nomehluko obalulekile emthwalweni we-thrombus emithanjeni yemithambo yemithambo yalezi ezimbili. I-lumen ye-coronary incane kanti i-thrombus emthanjeni we-coronary incane. Ngemva kokuqhuma kwe-aortic intima, inani elikhulu legazi lemithambo lingena odongeni lwemithambo ukuze kwakheke i-dissecting aneurysm. Inani elikhulu le-thrombi lakhiwa ngaphansi kwesenzo sendlela yokubopha igazi.

12 Ukuhlaselwa yisifo sobuchopho okunamandla

Ku-acute cerebral infarction, i-spontaneous thrombolysis kanye nomsebenzi wesibili we-fibrinolytic ziyanda, okubonakaliswa njengokwanda kwamazinga e-plasma D-dimer. Izinga le-D-dimer landa kakhulu esigabeni sokuqala se-acute cerebral infarction.

Amazinga e-Plasma D-dimer ezigulini ezine-acute ischemic stroke akhuphuke kancane ngesonto lokuqala ngemva kokuqala, akhuphuka kakhulu emavikini amabili kuya kwamane, futhi ayengafani namazinga ajwayelekile ngesikhathi sokululama (>izinyanga ezi-3).