He aha ka D-dimer?

ʻO D-dimer ka huahana hoʻohaʻahaʻa maʻalahi loa o ka fibrin, a hiki i kona pae kiʻekiʻe ke hōʻike i ke kūlana hypercoagulable a me ka hyperfibrinolysis lua i loko o vivo.Hiki ke hoʻohana ʻia ʻo D-dimer ma ke ʻano he hōʻailona o ka hypercoagulability a me ka hyperfibrinolysis i loko o vivo, a ʻo kona hoʻonui e hōʻike ana e pili ana ia i nā maʻi thrombotic i hoʻokumu ʻia e nā kumu like ʻole i loko o vivo, a hōʻike pū i ka hoʻonui ʻana i ka hana fibrinolytic.

He aha nā kūlana i hoʻokiʻekiʻe ʻia nā pae D-dimer?

Hiki i nā maʻi thromboembolism venous ʻelua (VTE) a me nā maʻi thromboembolic non-venous ke hoʻonui i nā pae D-dimer.

Loaʻa i ka VTE ka embolism pulmonary acute, thrombosis vein hohonu (DVT) a me ka thrombosis cerebral venous (sinus) (CVST).

ʻO nā maʻi thromboembolic non-venous e pili ana i ka acute aortic dissection (AAD), ruptured aneurysm, stroke (CVA), disseminated intravascular coagulation (DIC), sepsis, acute coronary syndrome (ACS), a me ka maʻi obstructive Pulmonary maʻi (COPD), etc. , Hoʻokiʻekiʻe ʻia nā pae D-dimer i nā kūlana e like me ka makahiki ʻelemakule, ka ʻokiʻoki / trauma hou, a me ka thrombolysis.

Hiki ke hoʻohana ʻia ka D-dimer e loiloi i ka wānana pulmonary embolism

Hōʻike ka D-dimer i ka make i nā maʻi me ka pulmonary embolism.I nā poʻe maʻi me ka embolism pulmonary acute, ua pili nā koina D-dimer kiʻekiʻe me nā helu PESI kiʻekiʻe (Pulmonary Embolism Severity Index Score) a me ka nui o ka make.Ua hōʻike ʻia nā haʻawina ʻo D-dimer <1500 μg/L he ʻoi aku ka maikaʻi o ka wānana maikaʻi ʻole no ka 3-mahina pulmonary embolism make: 3-mahina make he 0% ke D-dimer <1500 μg/L.Ke ʻoi aku ka D-dimer ma mua o 1500 μg/L, pono e hoʻohana ʻia ka makaʻala kiʻekiʻe.

Eia kekahi, ua hōʻike kekahi mau haʻawina no nā poʻe maʻi me ka maʻi maʻi maʻi, D-dimer <1500 μg / L pinepine ka hana fibrinolytic i hoʻonui ʻia e nā maʻi koko;ʻO D-dimer>1500 μg/L e hōʻike pinepine ana i ka poʻe maʻi me ka maʻi kanesa o ka maʻi maʻi i loaʻa i ka thrombosis vein hohonu (DVT) a me ka embolism pulmonary.

Hōʻike ka D-dimer i ka hoʻi hou ʻana o VTE

ʻO D-dimer ka wānana o ka VTE hou.ʻO nā maʻi D-dimer-negative he 3 mau mahina o ka hoʻi hou ʻana o 0. Inā piʻi hou ka D-dimer i ka wā o ka hahai ʻana, hiki ke hoʻonui nui ʻia ka pilikia o ka hoʻi hou ʻana o VTE.

Kōkua ʻo D-dimer i ka hōʻoia ʻana o ka dissection aortic

Loaʻa i ka D-dimer ka waiwai wānana maikaʻi ʻole i nā poʻe maʻi me ka hoʻokaʻawale ʻana i ka aortic acute, a hiki i ka D-dimer negativity ke hoʻokuʻu i ka dissection acute acute.Hoʻokiʻekiʻe ʻia ka D-dimer i nā poʻe maʻi me ka dissection aortic acute a ʻaʻole i hoʻokiʻekiʻe nui ʻia i nā maʻi me ka dissection aortic mau loa.

Hiki ke piʻi pinepine a piʻi koke paha ka D-dimer, e hōʻike ana i ka nui o ka pilikia o ka haki ʻana.Inā paʻa a haʻahaʻa ka pae D-dimer o ka mea maʻi (<1000 μg/L), liʻiliʻi ka pilikia o ka hemo ʻana.No laila, hiki i ka pae D-dimer ke alakaʻi i ka mālama pono ʻana o kēlā mau maʻi.

D-dimer a me ka maʻi

ʻO ka maʻi maʻi kekahi o nā kumu o VTE.I ka wā o ka unuhi ʻana o nā niho, hiki mai ka bacteremia, a hiki ke alakaʻi i nā hanana thrombotic.I kēia manawa, pono ke nānā pono ʻia nā pae D-dimer, a pono e hoʻoikaika ʻia ka lāʻau anticoagulation ke hoʻokiʻekiʻe ʻia nā pae D-dimer.

Eia kekahi, ʻo nā maʻi hanu a me nā ʻili ʻili nā kumu pilikia no ka thrombosis vein hohonu.

Ke alakaʻi nei ʻo D-dimer i ka lāʻau anticoagulation

Ua hōʻike ʻia nā hopena o ka PROLONG multicenter, ka hoʻopaʻa ʻana i ka wā mua (18 mau mahina ma hope) a me ka hoʻonui ʻia (30 mau mahina ma hope) i ka hoʻohālikelike ʻia me nā maʻi non-anticoagulated, ua hoʻomau nā maʻi D-dimer-positive ma hope o 1 mahina o ke keakea ana o ka lapaau ana Anticoagulation nui hoemi i ka pilikia o VTE recurrence, aka, aole he nui okoa i D-dimer-negative maʻi.

Ma kahi loiloi i paʻi ʻia e ke koko, ua kuhikuhi pū ʻo Professor Kearon e hiki ke alakaʻi ʻia ka lāʻau anticoagulation e like me ka pae D-dimer o ka mea maʻi.I nā poʻe maʻi me ka DVT proximal unprovoked a i ʻole pulmonary embolism, hiki ke alakaʻi ʻia ka anticoagulation therapy e ka ʻike D-dimer;inā ʻaʻole hoʻohana ʻia ka D-dimer, hiki ke hoʻoholo ʻia ka papa anticoagulation e like me ka pilikia o ke koko a me ka makemake o ka mea maʻi.

Eia kekahi, hiki i ka D-dimer ke alakaʻi i ka thrombolytic therapy.