I-D-dimer ivame ukusetshenziswa njengenye yezinkomba ezibalulekile ezisolwayo ze-PTE kanye ne-DVT emtholampilo. Kwenzeka kanjani?

I-Plasma D-dimer iwumkhiqizo othize wokuwohloka okhiqizwa yi-plasmin hydrolysis ngemuva kokuthi i-fibrin monomer ixhunywe yi-activating factor XIII. Iwuphawu oluthile lwenqubo ye-fibrinolysis. Ama-D-dimers atholakala kuma-clots e-fibrin axhunywe yi-plasmin. Uma nje kukhona i-thrombosis esebenzayo kanye nomsebenzi we-fibrinolytic emithanjeni yegazi yomzimba, i-D-dimer izokhula. I-Myocardial infarction, i-cerebral infarction, i-pulmonary embolism, i-venous thrombosis, ukuhlinzwa, isimila, i-disseminated intravascular coagulation, ukutheleleka kanye ne-tissue necrosis kungaholela ku-D-dimer ephezulu. Ikakhulukazi ezigulini ezindala nezisesibhedlela, ngenxa ye-bacteremia nezinye izifo, kulula ukubangela ukujiya kwegazi okungavamile futhi kuholele ekwandeni kwe-D-dimer.

I-D-dimer ikhombisa kakhulu umsebenzi we-fibrinolytic. Ukwanda noma okuhle kubonakala ku-hyperfibrinolysis yesibili, njengesimo se-hypercoagulable, ukujiya kwemithambo yegazi okusabalele, isifo sezinso, ukwenqatshwa kokufakelwa kwezitho, ukwelashwa nge-thrombolytic, njll. Ukunqunywa kwezici eziyinhloko zesistimu ye-fibrinolytic kubaluleke kakhulu ekuxilongweni nasekwelapheni izifo zesistimu ye-fibrinolytic (njenge-DIC, i-thrombus ehlukahlukene) kanye nezifo ezihlobene nesistimu ye-fibrinolytic (njengezimila, isifo sokukhulelwa), kanye nokuqapha ukwelashwa nge-thrombolytic.

Amazinga aphezulu e-D-dimer, umkhiqizo wokonakala kwe-fibrin, abonisa ukonakala kwe-fibrin njalo emzimbeni. Ngakho-ke, i-D-dimer ene-fibrous iyisibonakaliso esibalulekile se-deep vein thrombosis (DVT), i-pulmonary embolism (PE), kanye ne-dissembled intravascular coagulation (DIC).

Izifo eziningi zibangela ukusebenza kwesistimu yokujiya kanye/noma uhlelo lwe-fibrinolytic emzimbeni, okuholela ekwandeni kwezinga le-D-dimer, futhi lokhu kusebenza kuhlobene eduze nesigaba, ubukhali kanye nokwelashwa kwesifo, ngakho-ke kulezi zifo Ukutholwa kwezinga le-D-dimer kungasetshenziswa njengophawu lokuhlola isigaba sesifo, ukubikezela kanye nesiqondiso sokwelashwa.

Ukusetshenziswa kwe-D-dimer ekushayweni kwemithambo ejulile

Kusukela uWilson nabanye baqala ukusebenzisa imikhiqizo yokuwohloka kwe-fibrin ekuxilongweni kwe-pulmonary embolism ngo-1971, ukutholwa kwe-D-dimer kudlale indima enkulu ekuxilongweni kwe-pulmonary embolism. Ngezindlela ezithile zokuthola ezibucayi kakhulu, i-negative D-dimer Inani lomzimba linomphumela omuhle wokubikezela i-pulmonary embolism, futhi inani lalo lingu-0.99. Umphumela omubi ungasusa ngokuyisisekelo i-pulmonary embolism, ngaleyo ndlela kuncishiswe ukuhlolwa okuhlaselayo, njengokuskena kwe-ventilation perfusion kanye ne-pulmonary angiography; gwema ukwelashwa okungabonakali kwe-anticoagulation.D - Ukuhlushwa kwe-dimer kuhlobene nendawo ye-thrombus, kanye nokuhlushwa okuphezulu emagatsheni amakhulu esiqu se-pulmonary kanye nokuhlushwa okuphansi emagatsheni amancane.

I-D-dimers ye-plasma engemihle isusa amathuba okuba ne-DVT. I-Angiography iqinisekisile ukuthi i-DVT yayine-100% enhle ku-D-dimer. Ingasetshenziswa ekwelapheni i-thrombolytic kanye nesiqondiso semithi ye-heparin anticoagulation kanye nokubheka ukusebenza kahle kwayo.

I-D-dimer ingabonisa izinguquko kusayizi we-thrombus. Uma okuqukethwe kukhuphuka futhi, kubonisa ukuphinda kwe-thrombus; phakathi nesikhathi sokwelashwa, kuyaqhubeka nokuba phezulu, futhi usayizi we-thrombus awushintshi, okubonisa ukuthi ukwelashwa akusebenzi.