Nrog rau kev nkag siab tob ntawm tib neeg kev nkag siab ntawm thrombus, D-dimer tau siv los ua cov khoom siv feem ntau siv rau kev tshem tawm thrombus hauv coagulation chaw kuaj mob.Txawm li cas los xij, qhov no tsuas yog kev txhais lus tseem ceeb ntawm D-Dimer.Tam sim no ntau tus kws tshawb fawb tau muab D-Dimer lub ntsiab lus ntau dua hauv kev tshawb fawb ntawm D-Dimer nws tus kheej thiab nws txoj kev sib raug zoo nrog cov kab mob.Cov ntsiab lus ntawm qhov teeb meem no yuav ua rau koj txaus siab rau nws cov kev taw qhia tshiab ntawm daim ntawv thov.
Lub hauv paus ntawm kev kho mob ntawm D-dimer
01. Qhov nce ntawm D-Dimer sawv cev rau kev ua kom cov coagulation system thiab fibrinolysis system nyob rau hauv lub cev, thiab cov txheej txheem no qhia tau hais tias ib tug high transformation xeev.Tsis zoo D-Dimer tuaj yeem siv rau kev tshem tawm thrombus (tus nqi tseem ceeb tshaj plaws hauv kev kho mob);thaum D-Dimer zoo tsis tuaj yeem ua pov thawj qhov tsim ntawm thromboembolism.Seb puas los yog tsis thromboembolism yog tsim nyob ntawm qhov sib npaug ntawm ob lub tshuab no.
02. Ib nrab-lub neej ntawm D-Dimer yog 7-8h, thiab nws tuaj yeem kuaj tau 2h tom qab thrombosis.Cov yam ntxwv no tuaj yeem ua tau zoo nrog kev kho mob, thiab nws yuav tsis yooj yim rau kev saib xyuas vim tias ib nrab lub neej luv luv, thiab nws yuav tsis poob qhov tseem ceeb ntawm kev saib xyuas vim tias ib nrab lub neej ntev dhau lawm.
03. D-Dimer tuaj yeem ruaj khov hauv cov ntshav kuaj tom qab hauv vitro tsawg kawg 24-48 teev, kom cov ntsiab lus D-Dimer kuaj pom hauv vitro tuaj yeem cuam tshuam txog qib D-Dimer hauv vivo.
04. Cov txheej txheem ntawm D-Dimer yog tag nrho raws li cov tshuaj tiv thaiv antigen-antibody, tab sis cov txheej txheem tshwj xeeb muaj ntau tab sis tsis sib xws.Cov tshuaj tiv thaiv kab mob hauv cov reagent muaj ntau haiv neeg, thiab cov tshuaj tiv thaiv antigen tsis sib haum.Thaum xaiv cov khoom lag luam hauv chav kuaj, nws yuav tsum tau kuaj xyuas.
Tsoos tshuaj coagulation kev kho mob ntawm D-dimer
1. Kev kuaj xyuas VTE tsis suav nrog:
Kev kuaj D-Dimer ua ke nrog cov cuab yeej tshuaj ntsuam xyuas kev pheej hmoo tuaj yeem siv tau zoo kom tsis suav nrog cov hlab ntsha sib sib zog nqus (DVT) thiab pulmonary embolism (PE).
Thaum siv rau kev tshem tawm thrombus, muaj qee yam yuav tsum tau ua rau D-Dimer reagent thiab cov txheej txheem.Raws li tus qauv kev lag luam D-Dimer, qhov sib xyaw ua ke ua ntej yuav tsum muaj qhov kev kwv yees tsis zoo ntawm ≥97% thiab qhov rhiab heev ntawm ≥95%.
2. Kev kuaj mob sib kis ntawm cov kab mob hauv cov hlab ntshav coagulation (DIC):
Qhov tshwm sim ntawm DIC yog hyperfibrinolysis system, thiab kev tshawb pom uas tuaj yeem cuam tshuam txog hyperfibrinolysis ua lub luag haujlwm tseem ceeb hauv DIC cov qhab nia.Nws tau raug kuaj pom tias D-Dimer yuav nce ntxiv (ntau dua 10 zaug) hauv cov neeg mob DIC.Hauv cov txheej txheem kev kuaj mob hauv tsev thiab txawv teb chaws DIC lossis kev pom zoo, D-Dimer yog siv los ua ib qho ntawm cov ntsuas ntsuas kev kuaj mob DIC, thiab nws raug pom zoo kom nqa tawm FDP ua ke.Txhim kho qhov ua tau zoo ntawm kev kuaj DIC.Kev kuaj mob ntawm DIC tsis tuaj yeem ua tau tsuas yog los ntawm kev cia siab rau ib qho kev ntsuas qhov ntsuas thiab cov txiaj ntsig ntawm ib qho kev ntsuam xyuas.Nws yuav tsum tau soj ntsuam tag nrho thiab dynamically soj ntsuam nyob rau hauv ua ke nrog nrog cov kev kho mob tshwm sim ntawm tus neeg mob thiab lwm yam kev ntsuas ntsuas.
Kev siv tshuaj kho tshiab ntawm D-Dimer
1. Daim ntawv thov ntawm D-Dimer rau cov neeg mob uas muaj tus kab mob COVID-19: Hauv kev txiav txim siab, COVID-19 yog ib qho kab mob thrombotic tshwm sim los ntawm kev tiv thaiv kab mob, nrog cov kab mob sib kis thiab microthrombosis hauv lub ntsws.Nws tau tshaj tawm tias ntau dua 20% ntawm cov neeg mob nrog VTE nyob hauv tsev kho mob ntawm COVID-19.
• D-Dimer theem ntawm kev nkag mus rau nws tus kheej tau kwv yees kev tuag hauv tsev kho mob thiab tshuaj xyuas cov neeg mob uas muaj kev pheej hmoo siab.Tam sim no, D-dimer tau dhau los ua ib qho ntawm cov tshuaj ntsuam xyuas tseem ceeb rau cov neeg mob COVID-19 thaum lawv mus rau hauv tsev kho mob.
• D-Dimer tuaj yeem siv los qhia seb puas yuav pib tshuaj heparin anticoagulation hauv cov neeg mob COVID-19.Nws tau raug tshaj tawm tias hauv cov neeg mob uas muaj D-Dimer ≥ 6-7 zaug ntawm qhov txwv sab saud ntawm cov ntaub ntawv siv, kev pib ntawm heparin anticoagulation tuaj yeem txhim kho cov txiaj ntsig ntawm tus neeg mob.
• Kev saib xyuas Dynamic ntawm D-Dimer tuaj yeem siv los ntsuas qhov tshwm sim ntawm VTE hauv cov neeg mob COVID-19.
• D-Dimer soj ntsuam, uas tuaj yeem siv los ntsuas qhov tshwm sim ntawm COVID-19.
• Kev saib xyuas D-Dimer, thaum kho tus kab mob raug txiav txim siab, D-Dimer puas tuaj yeem muab qee cov ntaub ntawv siv?Muaj ntau qhov kev sim tshuaj nyob txawv teb chaws tau pom.
2. D-Dimer dynamic saib xyuas kwv yees VTE tsim:
Raws li tau hais los saum no, ib nrab lub neej ntawm D-Dimer yog 7-8h.Nws yog qhov tseeb vim tias qhov tshwj xeeb no uas D-Dimer tuaj yeem saib xyuas thiab kwv yees qhov tsim ntawm VTE.Rau lub xeev hypercoagulable lossis microthrombosis, D-Dimer yuav nce me ntsis thiab tom qab ntawd txo qis.Thaum muaj cov thrombus tshiab nyob rau hauv lub cev tsis tu ncua, D-Dimer hauv lub cev yuav nce ntxiv, uas qhia txog lub ncov zoo li nce nkhaus.Rau cov neeg uas muaj qhov tshwm sim ntau ntawm thrombosis, xws li mob hnyav thiab mob hnyav, cov neeg mob tom qab phais, thiab lwm yam, yog tias qib D-Dimer nce sai, ceeb toom rau qhov muaj peev xwm ntawm thrombosis.Nyob rau hauv "Kev pom zoo ntawm tus kws kho mob thiab kev kho mob ntawm cov hlab ntsha sib sib zog nqus hauv cov neeg mob Orthopedic", nws tau pom zoo tias cov neeg mob uas muaj kev pheej hmoo siab nruab nrab thiab kev pheej hmoo siab tom qab phais orthopedic yuav tsum tau soj ntsuam cov kev hloov pauv ntawm D-Dimer txhua 48 teev.Kev ntsuam xyuas cov duab yuav tsum tau ua raws sijhawm los kuaj xyuas DVT.
3. D-Dimer raws li ib tug prognostic taw qhia rau ntau yam kab mob:
Vim muaj kev sib raug zoo ntawm coagulation system thiab o, kev raug mob endothelial, thiab lwm yam, qhov nce ntawm D-Dimer kuj tau pom nyob rau hauv qee cov kab mob uas tsis yog thrombotic xws li kev kis kab mob, phais lossis kev raug mob, lub plawv tsis ua hauj lwm, thiab cov qog nqaij hlav malignant.Cov kev tshawb fawb tau pom tias feem ntau cov kev mob tshwm sim tsis zoo ntawm cov kab mob no yog thrombosis, DIC, thiab lwm yam. Feem ntau ntawm cov teeb meem no yog cov kab mob feem ntau cuam tshuam los yog xeev uas ua rau D-Dimer nce.Yog li, D-Dimer tuaj yeem siv los ua qhov ntsuas dav dav thiab ntsuas ntsuas rau cov kab mob.
• Rau cov neeg mob qog nqaij hlav, ntau qhov kev tshawb fawb tau pom tias 1-3-xyoo txoj sia nyob ntawm cov neeg mob qog nqaij hlav uas muaj D-Dimer siab yog qis dua li cov neeg mob D-Dimer ib txwm muaj.D-Dimer tuaj yeem siv los ua qhov taw qhia rau kev ntsuas qhov kev cia siab ntawm cov neeg mob qog nqaij hlav.
• Rau cov neeg mob VTE, ntau qhov kev tshawb fawb tau lees paub tias cov neeg mob D-Dimer-zoo nrog VTE muaj 2-3 npaug ntawm kev pheej hmoo siab dua ntawm cov thrombus tom ntej thaum lub sij hawm anticoagulation dua li cov neeg mob tsis zoo.Lwm qhov kev tshuaj ntsuam xyuas nrog rau 7 cov kev tshawb fawb nrog tag nrho ntawm 1818 cov ntsiab lus tau pom tias, Qhov txawv txav D-Dimer yog ib qho ntawm cov kev kwv yees tseem ceeb ntawm thrombus rov tshwm sim hauv cov neeg mob VTE, thiab D-Dimer tau suav nrog ntau yam VTE rov ua dua kev kwv yees cov qauv.
• Rau cov neeg mob kho lub tshuab hloov pauv (MHVR), kev tshawb nrhiav mus sij hawm ntev ntawm 618 cov kev kawm tau pom tias qhov kev pheej hmoo ntawm cov xwm txheej tsis zoo hauv cov neeg mob uas muaj qhov txawv txav D-Dimer thaum lub sij hawm warfarin tom qab MHVR yog kwv yees li 5 npaug ntawm cov neeg mob ib txwm muaj.Multivariate correlation tsom xam tau lees paub tias qib D-Dimer yog ib qho kev kwv yees tus kheej ntawm thrombotic lossis plawv plawv thaum lub sij hawm anticoagulation.
• Rau cov neeg mob atrial fibrillation (AF), D-Dimer tuaj yeem kwv yees cov xwm txheej thrombotic thiab cov kab mob plawv hauv qhov ncauj anticoagulation.Kev tshawb fawb yav tom ntej ntawm 269 cov neeg mob uas muaj atrial fibrillation ua raws li 2 xyoos tau pom tias thaum lub sij hawm qhov ncauj anticoagulation, kwv yees li 23% ntawm cov neeg mob nrog INR mus txog lub hom phiaj pom qhov txawv txav D-Dimer, thaum cov neeg mob uas txawv txav D-Dimer theem tsim Cov kev pheej hmoo ntawm thrombotic. Cov xwm txheej thiab cov xwm txheej ntawm cov hlab plawv comorbid yog 15.8 thiab 7.64 zaug, feem, ntawm cov neeg mob uas muaj D-Dimer ib txwm muaj.
• Rau cov kab mob tshwj xeeb no lossis cov neeg mob tshwj xeeb, qhov siab siab lossis qhov zoo tsis tu ncua D-Dimer feem ntau qhia tias muaj kev mob tshwm sim tsis zoo lossis ua rau tus kab mob hnyav zuj zus.
4. Daim ntawv thov ntawm D-Dimer hauv qhov ncauj anticoagulation kho:
• D-Dimer txiav txim siab lub sij hawm ntawm qhov ncauj anticoagulation: Qhov zoo tshaj plaws lub sij hawm ntawm anticoagulation rau cov neeg mob nrog VTE los yog lwm yam thrombus tseem inconclusive.Txawm hais tias nws yog NOAC lossis VKA, cov lus qhia tseem ceeb thoob ntiaj teb pom zoo tias kev siv tshuaj tiv thaiv ntev ntev yuav tsum tau txiav txim siab raws li qhov kev pheej hmoo los ntshav hauv peb lub hlis ntawm kev kho anticoagulation, thiab D-Dimer tuaj yeem muab cov ntaub ntawv tus kheej rau qhov no.
• D-Dimer qhia txog kev hloov ntawm qhov ncauj anticoagulant siv: Warfarin thiab cov tshuaj tiv thaiv qhov ncauj tshiab yog cov tshuaj tiv thaiv qhov ncauj feem ntau siv hauv kev kho mob, ob qho tib si tuaj yeem txo qis D-Dimer.thiab ua kom cov kab mob fibrinolytic, yog li txo qis ntawm D-Dimer.Cov txiaj ntsig kev sim qhia tau hais tias D-Dimer-coagulation anticoagulation hauv cov neeg mob txo qis qhov tshwm sim tsis zoo.
Hauv kev xaus, kev xeem D-Dimer tsis txwv rau cov ntawv thov ib txwm muaj xws li VTE tsis suav nrog kev kuaj mob thiab kuaj DIC.D-Dimer ua lub luag haujlwm tseem ceeb hauv kev kwv yees kab mob, kev soj ntsuam, kev siv cov tshuaj tiv thaiv qhov ncauj, thiab COVID-19.Nrog rau kev tshawb fawb tob zuj zus, daim ntawv thov ntawm D-Dimer yuav dhau los ua ntau thiab ntau dua.
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