Njengoba abantu beqonda ngokujula kwe-thrombus, i-D-dimer isetshenziswe njengento yokuhlola esetshenziswa kakhulu ekukhishweni kwe-thrombus emalabhorethri emitholampilo yokugoba. Kodwa-ke, lokhu kumane kuyincazelo eyinhloko ye-D-Dimer. Manje izazi eziningi zinikeze i-D-Dimer incazelo ecebile ocwaningweni lwe-D-Dimer uqobo kanye nobudlelwano bayo nezifo. Okuqukethwe kwalolu daba kuzokuholela ekwaziseni isiqondiso sayo esisha sokusebenza.
Isisekelo sokusetshenziswa kwezokwelapha kwe-D-dimer
01. Ukwanda kwe-D-Dimer kumele ukusebenza kohlelo lokujiya kanye nohlelo lwe-fibrinolysis emzimbeni, futhi le nqubo ikhombisa isimo sokuguquka okuphezulu. I-D-Dimer engemihle ingasetshenziswa ekukhishweni kwe-thrombus (inani eliyinhloko lomtholampilo); kuyilapho i-D-Dimer ene-positive ayikwazi ukufakazela ukwakheka kwe-thromboembolism. Ukuthi i-thromboembolism yakheka noma cha kuncike ekulinganisweni kwalezi zinhlelo ezimbili.
02. Isigamu sokuphila kwe-D-Dimer singamahora angu-7-8, futhi singatholakala emahoreni ama-2 ngemva kwe-thrombosis. Lesi sici singahambisana kahle nomkhuba wezokwelapha, futhi ngeke kube nzima ukusiqapha ngoba isigamu sokuphila sifushane kakhulu, futhi ngeke silahlekelwe ukubaluleka kokuqapha ngoba isigamu sokuphila side kakhulu.
03. I-D-Dimer ingahlala izinzile kumasampula egazi ngemva kokuhlolwa kwe-in vitro okungenani amahora angu-24-48, ukuze okuqukethwe kwe-D-Dimer okutholakale ku-in vitro kukwazi ukukhombisa ngokunembile izinga le-D-Dimer ku-in vivo.
04. Indlela yokusebenza ye-D-Dimer isekelwe ekusabeleni kwe-antigen-antibody, kodwa indlela ethile iningi kodwa ayifani. Ama-antibodies ku-reagent ayahlukahluka, futhi izingcezu ze-antigen ezitholakele azihambisani. Lapho ukhetha uhlobo elabhorethri, ludinga ukuhlolwa.
Ukusetshenziswa kwezokwelapha kwendabuko kwe-D-dimer ekuhlanganiseni kwegazi
1. Ukuxilongwa kokukhishwa kwe-VTE:
Ukuhlolwa kwe-D-Dimer kuhlanganiswe namathuluzi okuhlola ubungozi bomtholampilo kungasetshenziswa ngempumelelo ukususa i-deep vein thrombosis (DVT) kanye ne-pulmonary embolism (PE).
Uma kusetshenziselwa ukukhishwa kwe-thrombus, kunezidingo ezithile ze-D-Dimer reagent kanye nendlela yokusebenza. Ngokwezinga lomkhakha we-D-Dimer, amathuba ahlanganisiwe okuhlolwa kwangaphambi kokuhlolwa adinga izinga lokubikezela elibi elingu-≥97% kanye nokuzwela okungu-≥95%.
2. Ukuxilongwa okusizayo kwe-disseminated intravascular coagulation (DIC):
Ukubonakaliswa okuvamile kwe-DIC uhlelo lwe-hyperfibrinolysis, kanti ukutholwa okungabonisa i-hyperfibrinolysis kudlala indima ebalulekile ohlelweni lokuhlola i-DIC. Kuye kwaboniswa ngokwezokwelapha ukuthi i-D-Dimer izokwanda kakhulu (izikhathi ezingaphezu kweziyi-10) ezigulini ezine-DIC. Eziqondisweni zokuxilonga ze-DIC zasekhaya nezangaphandle noma ukuvumelana, i-D-Dimer isetshenziswa njengenye yezinkomba zelebhu zokuxilonga i-DIC, futhi kunconywa ukuthi kwenziwe i-FDP ngokubambisana. Thuthukisa ngempumelelo ukusebenza kahle kokuxilongwa kwe-DIC. Ukuxilongwa kwe-DIC akunakwenziwa kuphela ngokuthembela kunkomba eyodwa yelebhu kanye nemiphumela yokuhlolwa okukodwa. Kudingeka kuhlaziywe ngokuphelele futhi kuqashwe ngokuguquguqukayo kuhlanganiswe nokubonakaliswa kwemitholampilo kwesiguli kanye nezinye izinkomba zelebhu.
Ukusetshenziswa okusha kwezokwelapha kwe-D-Dimer
1. Ukusetshenziswa kwe-D-Dimer ezigulini ezine-COVID-19: Ngomqondo othile, i-COVID-19 iyisifo esibangela ukungasebenzi kahle kwemithambo yegazi esibangelwa izifo zokuzivikela komzimba, esinokusabela okusabalele kokuvuvukala kanye ne-microthrombosis emaphashini. Kubikwa ukuthi iziguli ezingaphezu kuka-20% ezine-VTE ezimweni ze-COVID-19 ezibhedlela.
• Amazinga e-D-Dimer lapho elaliswa esibhedlela abikezela ngokuzimela ukufa esibhedlela futhi ahlole iziguli ezingaba sengozini enkulu. Njengamanje, i-D-dimer isibe ngenye yezinto ezibalulekile zokuhlola iziguli ezine-COVID-19 lapho zingeniswa esibhedlela.
• I-D-Dimer ingasetshenziswa ukuqondisa ukuthi kufanele yini iqalise i-heparin anticoagulation ezigulini ezine-COVID-19. Kubikwe ukuthi ezigulini ezine-D-Dimer ≥ izikhathi ezingu-6-7 kunomkhawulo ophezulu webanga lokubhekisela, ukuqala kwe-heparin anticoagulation kungathuthukisa kakhulu imiphumela yeziguli.
• Ukuqapha okunamandla kwe-D-Dimer kungasetshenziswa ukuhlola ukuvela kwe-VTE ezigulini ezine-COVID-19.
• Ukuqapha kwe-D-Dimer, okungasetshenziswa ukuhlola umphumela we-COVID-19.
• Ukuqapha i-D-Dimer, lapho ukwelashwa kwesifo kubhekene nesinqumo, ingabe i-D-Dimer inganikeza ulwazi oluthile olubhekisela kukho? Kunezivivinyo eziningi zemitholampilo ezibhekwa kwamanye amazwe.
2. Ukuqapha okunamandla kwe-D-Dimer kubikezela ukwakheka kwe-VTE:
Njengoba kushiwo ngenhla, isigamu sokuphila kwe-D-Dimer singamahora angu-7-8. Kungenxa yalesi sici ukuthi i-D-Dimer ingakwazi ukuqapha ngokuguquguqukayo nokubikezela ukwakheka kwe-VTE. Esimweni esisheshayo sokuqhekeka kwegazi noma i-microthrombosis, i-D-Dimer izokhula kancane bese yehla ngokushesha. Uma kukhona ukwakheka kwe-thrombus okusha okuqhubekayo emzimbeni, i-D-Dimer emzimbeni izoqhubeka nokwenyuka, ikhombisa ukugoba okufana nokuphakama okuphezulu. Kubantu abane-thrombosis ephezulu, njengezimo ezibukhali nezinzima, iziguli ezilandela ukuhlinzwa, njll., uma izinga le-D-Dimer likhuphuka ngokushesha, qaphela amathuba e-thrombosis. Ku-"Expert Consensus on the Screening and Treatment of Deep Vein Thrombosis in Trauma Orthopedic Patients", kunconywa ukuthi iziguli ezinengozi ephakathi nephezulu ngemuva kokuhlinzwa kwamathambo kufanele ziqaphele ngokuqhubekayo izinguquko ze-D-Dimer njalo emahoreni angu-48. Ukuhlolwa kwezithombe kufanele kwenziwe ngesikhathi esifanele ukuze kuhlolwe i-DVT.
3. I-D-Dimer njengesibonakaliso sokubikezela izifo ezahlukahlukene:
Ngenxa yobudlelwano obuseduze phakathi kwesistimu yokujiya kanye nokuvuvukala, ukulimala kwe-endothelial, njll., ukuphakama kwe-D-Dimer kuvame ukubonwa nakwezinye izifo ezingezona eze-thrombotic ezifana nokutheleleka, ukuhlinzwa noma ukulimala, ukwehluleka kwenhliziyo, kanye nezimila ezinobungozi. Izifundo zithole ukuthi ukubikezela okubi okuvame kakhulu kwalezi zifo yi-thrombosis, i-DIC, njll. Iningi lalezi zinkinga yizifo ezihlobene kakhulu noma izimo ezibangela ukuphakama kwe-D-Dimer. Ngakho-ke, i-D-Dimer ingasetshenziswa njengenkomba yokuhlola ebanzi nebucayi yezifo.
• Kubantu abanesimila, izifundo eziningana zithole ukuthi izinga lokusinda leminyaka eyi-1-3 leziguli ezinesimila esibi ezine-D-Dimer ephezulu liphansi kakhulu kuneleziguli ezivamile ze-D-Dimer. I-D-Dimer ingasetshenziswa njengesibonakaliso sokuhlola ukubikezela kweziguli ezinesimila esibi.
• Ezigulini ze-VTE, izifundo eziningi ziqinisekisile ukuthi iziguli ezine-D-Dimer ezine-VTE zinengozi ephezulu ngokuphindwe ka-2-3 yokuphinda kuvele i-thrombus ngesikhathi sokuvimbela ukujiya kwegazi kuneziguli ezingezinhle. Okunye ukuhlaziywa kwe-meta okuhlanganisa izifundo ezi-7 nabantu abayi-1818 abaphelele kubonise ukuthi, i-D-Dimer engavamile ingenye yezibikezelo eziyinhloko zokuphinda kuvele i-thrombus ezigulini ze-VTE, futhi i-D-Dimer ifakiwe kumamodeli amaningi okubikezela ingozi yokuphinda kuvele i-VTE.
• Ezigulini ezishintsha ama-valve omshini (i-MHVR), ucwaningo lokulandelela lwesikhathi eside lwabantu abangu-618 lubonise ukuthi ingozi yezehlakalo ezimbi ezigulini ezinezinga le-D-Dimer elingajwayelekile ngesikhathi se-warfarin ngemuva kwe-MHVR yayicishe ibe izikhathi ezi-5 kuneziguli ezivamile. Ukuhlaziywa kokuxhumana kwe-Multivariate kuqinisekisile ukuthi izinga le-D-Dimer laliyisibikezelo esizimele sezehlakalo ze-thrombotic noma ze-cardiovascular ngesikhathi sokuvimbela ukujiya kwegazi.
• Ezigulini ezine-atrial fibrillation (AF), i-D-Dimer ingabikezela izehlakalo ze-thrombotic kanye nezehlakalo zenhliziyo ekuvimbeleni ukujiya kwegazi ngomlomo. Ucwaningo oluzayo lweziguli ezingu-269 ezine-atrial fibrillation olulandelwe iminyaka engaba ngu-2 lubonise ukuthi ngesikhathi sokuvimbela ukujiya kwegazi ngomlomo, cishe ama-23% eziguli ezine-INR afinyelele esiqondisweni abonise amazinga e-D-Dimer angajwayelekile, kuyilapho iziguli ezinezinga le-D-Dimer elingajwayelekile zithuthukile. Izingozi zezehlakalo ze-thrombotic kanye nezehlakalo zenhliziyo ezihambisanayo zaziyizikhathi ezingu-15.8 kanye nezingu-7.64, ngokulandelana, zeziguli ezinezinga le-D-Dimer elijwayelekile.
• Kulezi zifo ezithile noma iziguli ezithile, i-D-Dimer ephezulu noma ehlala ikhona ivame ukukhombisa ukubikezela okubi noma ukuba kubi kwesifo.
4. Ukusetshenziswa kwe-D-Dimer ekwelashweni komlomo okuvimbela ukujiya kwegazi:
• I-D-Dimer inquma isikhathi sokusetshenziswa komlomo kokuvimbela ukujiya kwegazi: Isikhathi esifanele sokusetshenziswa kokuvimbela ukujiya kwegazi ezigulini ezine-VTE noma enye i-thrombus asikacaci. Kungakhathaliseki ukuthi yi-NOAC noma i-VKA, iziqondiso zomhlaba wonke ezifanele zincoma ukuthi ukusetshenziswa kokuvimbela ukujiya kwegazi isikhathi eside kufanele kunqunywe ngokuya ngengozi yokopha enyangeni yesithathu yokwelashwa kokuvimbela ukujiya kwegazi, futhi i-D-Dimer inganikeza ulwazi lomuntu ngamunye ngalokhu.
• I-D-Dimer iqondisa ukulungiswa kokuqina kwe-anticoagulant yomlomo: I-Warfarin kanye ne-anticoagulant entsha yomlomo yizona ezisetshenziswa kakhulu ekusetshenzisweni kwezokwelapha, zombili ezinganciphisa izinga le-D-Dimer. kanye nokusebenza kohlelo lwe-fibrinolytic, ngaleyo ndlela zinciphise ngokungaqondile izinga le-D-Dimer. Imiphumela yokuhlola ikhombisa ukuthi i-anticoagulation eqondiswa yi-D-Dimer ezigulini inciphisa ngempumelelo izehlakalo ezimbi.
Ekuphetheni, ukuhlolwa kwe-D-Dimer akusagcini nje ngokusetshenziswa kwendabuko njengokuxilongwa kokukhishwa kwe-VTE kanye nokutholwa kwe-DIC. I-D-Dimer idlala indima ebalulekile ekubikezeleni isifo, ukubikezela, ukusetshenziswa kwemithi yomlomo yokuvimbela ukugabha kwegazi, kanye ne-COVID-19. Ngokuqhubeka kocwaningo, ukusetshenziswa kwe-D-Dimer kuzoba kubanzi kakhulu.
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