Kuyini i-D-dimer?

I-D-dimer iwumkhiqizo olula kakhulu wokuwohloka kwe-fibrin, futhi izinga layo eliphakeme lingabonisa isimo sokujiya kwegazi kanye ne-hyperfibrinolysis yesibili emzimbeni. I-D-dimer ingasetshenziswa njengophawu lwe-hypercoagulability kanye ne-hyperfibrinolysis emzimbeni, futhi ukwanda kwayo kusikisela ukuthi ihlobene nezifo ze-thrombotic ezibangelwa yizizathu ezahlukahlukene emzimbeni, futhi kubonisa nokuthuthukiswa komsebenzi we-fibrinolytic.

Kungaphansi kwaziphi izimo lapho amazinga e-D-dimer ekhuphuka khona?

Kokubili ukuphazamiseka kwe-venous thromboembolism (VTE) kanye nokuphazamiseka kwe-non-venous thromboembolic kungabangela amazinga aphezulu e-D-dimer.

I-VTE ihlanganisa i-acute pulmonary embolism, i-deep vein thrombosis (DVT) kanye ne-cerebral venous thrombosis (sinus) thrombosis (CVST).

Izifo ze-non-venous thromboembolic zifaka phakathi ukuhlukaniswa kwe-acute aortic (AAD), i-ruptured aneurysm, i-stroke (CVA), i-dissemed intravascular coagulation (DIC), i-sepsis, i-acute coronary syndrome (ACS), kanye nesifo se-chronic obstructive Pulmonary (COPD), njll. Ngaphezu kwalokho, amazinga e-D-dimer nawo akhuphukile ezimweni ezifana nokuguga, ukuhlinzwa/ukuhlukumezeka kwamuva, kanye ne-thrombolysis.

I-D-dimer ingasetshenziswa ukuhlola ukubikezela kwe-pulmonary embolism

I-D-dimer ibikezela ukufa ezigulini ezine-pulmonary embolism. Ezigulini ezine-acute pulmonary embolism, amanani aphezulu e-D-dimer ​​ahlotshaniswa namaphuzu aphezulu e-PESI (i-Pulmonary Embolism Severity Index Score) kanye nokwanda kokufa. Izifundo zibonise ukuthi i-D-dimer <1500 μg/L inenani elingcono lokubikezela elibi lokufa kwe-pulmonary embolism yezinyanga ezi-3: ukufa kwezinyanga ezi-3 kungu-0% uma i-D-dimer <1500 μg/L. Uma i-D-dimer ingaphezu kuka-1500 μg/L, kufanele kusetshenziswe ukuqapha okukhulu.

Ngaphezu kwalokho, ezinye izifundo zibonise ukuthi ezigulini ezinomdlavuza wamaphaphu, i-D-dimer <1500 μg/L ivame ukuba umsebenzi we-fibrinolytic othuthukisiwe obangelwa yizimila; i-D-dimer >1500 μg/L ivame ukukhombisa ukuthi iziguli ezinomdlavuza wamaphaphu zine-deep vein thrombosis (DVT) kanye ne-pulmonary embolism.

I-D-dimer ibikezela ukuphinda kwe-VTE

I-D-dimer ibikezela i-VTE ephindaphindayo. Iziguli ezingenayo i-D-dimer zazinezinga lokuphindeka kwe-0 ezinyangeni ezi-3. Uma i-D-dimer ikhuphuka futhi ngesikhathi sokulandelela, ingozi yokuphindeka kwe-VTE inganda kakhulu.

I-D-dimer isiza ekuxilongweni kokuqhekeka kwe-aorta

I-D-dimer inenani elihle lokubikezela elibi ezigulini ezine-acute aortic dissection, futhi ukungalungi kwe-D-dimer kungavimbela ukuhlukaniswa kwe-aortic okubukhali. I-D-dimer iphakeme ezigulini ezine-acute aortic dissection futhi ayiphakeme kakhulu ezigulini ezine-aortic dissection engapheli.

I-D-dimer iyashintshashintsha ngokuphindaphindiwe noma ngokuzumayo ikhuphuke, okuphakamisa ingozi enkulu yokuqhekeka kwezicubu. Uma izinga le-D-dimer lesiguli lizinzile futhi liphansi (<1000 μg/L), ingozi yokuqhekeka kwezicubu incane. Ngakho-ke, izinga le-D-dimer lingaqondisa ukwelashwa okukhethekile kwalezo ziguli.

I-D-dimer kanye nokutheleleka

Ukutheleleka kungenye yezimbangela ze-VTE. Ngesikhathi sokukhishwa kwamazinyo, kungase kube ne-bacteremia, okungase kuholele ezigamekweni ze-thrombotic. Ngalesi sikhathi, amazinga e-D-dimer kufanele aqashwe ngokucophelela, futhi ukwelashwa kokuvimbela ukujiya kwegazi kufanele kuqiniswe lapho amazinga e-D-dimer ephakanyisiwe.

Ngaphezu kwalokho, izifo zokuphefumula kanye nomonakalo wesikhumba kuyizinto eziyingozi zokuthuthukisa i-deep vein thrombosis.

Iziqondiso ze-D-dimer zokwelapha ngokuvimbela ukujiya kwegazi

Imiphumela yocwaningo lwe-PROLONG multicenter, oluzokwenzeka kokubili ezigabeni zokuqala (zokulandelela izinyanga ezingu-18) kanye nezigaba ezinde (zokulandelela izinyanga ezingu-30) ibonise ukuthi uma kuqhathaniswa neziguli ezingenayo i-anticoagulation, iziguli ezine-D-dimer zaqhubeka ngemva kwenyanga eyodwa yokumiswa kokwelashwa. I-anticoagulation inciphise kakhulu ingozi yokuphinda kwe-VTE, kodwa kwakungekho mehluko omkhulu ezigulini ezingenayo i-D-dimer.

Ekubuyekezweni okwanyatheliswa yi-Blood, uSolwazi Kearon uphinde waveza ukuthi ukwelashwa kokuvimbela ukujiya kwegazi kungaqondiswa ngokwezinga lesiguli le-D-dimer. Ezigulini ezine-proximal DVT noma i-pulmonary embolism engavuselelwanga, ukwelashwa kokuvimbela ukujiya kwegazi kungaqondiswa ngokutholwa kwe-D-dimer; uma i-D-dimer ingasetshenziswa, inkambo yokuvimbela ukujiya kwegazi inganqunywa ngokwengozi yokopha kanye nezifiso zesiguli.

Ngaphezu kwalokho, i-D-dimer ingaqondisa ukwelashwa kwe-thrombolytic.