Site na nghọta miri emi nke ndị mmadụ banyere thrombus, ejiri D-dimer mee ihe dị ka ihe nnwale a na-ejikarị maka mwepu thrombus na ụlọ nyocha ụlọ ọgwụ coagulation.Agbanyeghị, nke a bụ naanị nkọwa nke D-Dimer.Ugbu a ọtụtụ ndị ọkà mmụta enyela D-Dimer nkọwa bara ụba na nyocha nke D-Dimer n'onwe ya na mmekọrịta ya na ọrịa.Ọdịnaya nke mbipụta a ga-eduga gị ịghọta ntụzịaka ngwa ọhụrụ ya.
Ndabere nke ngwa ụlọ ọgwụ nke D-dimer
01. Mmụba nke D-Dimer na-anọchite anya mmalite nke usoro coagulation na usoro fibrinolysis n'ime ahụ, usoro a na-egosikwa ọnọdụ mgbanwe dị elu.Enwere ike iji D-Dimer na-adịghị mma maka mwepu thrombus (uru ụlọ ọgwụ kachasị isi);ebe D-Dimer ziri ezi enweghị ike igosipụta nguzobe nke thromboembolism.Ma a na-emepụta thromboembolism ma ọ bụ na-adabere na nguzozi nke usoro abụọ a.
02. Ọkara ndụ nke D-Dimer bụ 7-8h, a pụkwara ịchọta ya 2h mgbe thrombosis gasịrị.Njirimara a nwere ike jikọta nke ọma na omume ụlọ ọgwụ, ọ gaghị esiri ike nyochaa n'ihi na ọkara ndụ dị mkpụmkpụ, ọ gaghịkwa efunahụ mkpa nlekota n'ihi na ọkara ndụ dị ogologo.
03. D-Dimer nwere ike kwụsie ike na nlele ọbara mgbe in vitro ma ọ dịkarịa ala awa 24-48, nke mere na ọdịnaya D-Dimer achọpụtara na vitro nwere ike gosipụta nke ọma ọkwa D-Dimer na vivo.
04. Usoro nke D-Dimer niile dabere na mmeghachi omume antigen-antibody, mana usoro a kapịrị ọnụ dị ọtụtụ ma ọ bụghị otu.Ihe mgbochi nje ndị dị na reagent dị iche iche, na iberibe antigen achọpụtara adabaghị.Mgbe ị na-ahọrọ ika na ụlọ nyocha, ọ dị mkpa ka enyocha ya.
Ngwa ọgwụgwọ coagulation ọdịnala nke D-dimer
1. Nchọpụta mwepu VTE:
Enwere ike iji ule D-Dimer jikọtara ya na ngwaọrụ nyocha ihe ize ndụ nke ụlọ ọgwụ na-arụ ọrụ nke ọma iji wepụ thrombosis miri emi (DVT) na pulmonary embolism (PE).
Mgbe ejiri ya maka mwepu thrombus, enwere ụfọdụ ihe achọrọ maka D-Dimer reagent na usoro.Dị ka ọkọlọtọ ụlọ ọrụ D-Dimer si kwuo, ihe puru omume tupu ule ejikọta ọnụ chọrọ ọnụego amụma na-adịghị mma nke ≥97% na nghọta nke ≥95%.
2. Nchọpụta inyeaka nke coagulation intravaskụla na-ekesa (DIC):
Ihe ngosi nke DIC bụ usoro hyperfibrinolysis, na nchọpụta nke nwere ike igosi hyperfibrinolysis na-arụ ọrụ dị mkpa na usoro akara akara DIC.E gosipụtara na ụlọ ọgwụ na D-Dimer ga-abawanye nke ukwuu (karịa ugboro 10) na ndị ọrịa DIC.N'ime ntuziaka ma ọ bụ nkwenye DIC nke ụlọ na nke mba ofesi, a na-eji D-Dimer dị ka otu n'ime ihe ngosi ụlọ nyocha maka ịchọpụta DIC, a na-atụ aro ka ịmekọrịta FDP.Meziwanye arụmọrụ nke nyocha DIC nke ọma.Enweghị ike ịme nchọpụta nke DIC naanị site na ịdabere na otu nyocha ụlọ nyocha na nsonaazụ nke otu nyocha.Ọ dị mkpa ka enyocha ya nke ọma ma nyochaa ya nke ọma yana nhụta ụlọ ọgwụ nke onye ọrịa na ihe ngosi ụlọ nyocha ndị ọzọ.
Ngwa ụlọ ọgwụ ọhụrụ nke D-Dimer
1. Ngwa nke D-Dimer n'ime ndị ọrịa nwere COVID-19: N'echiche, COVID-19 bụ ọrịa thrombotic na-ebute site na nsogbu mgbochi ọrịa, yana nzaghachi mkpali na-agbasa na microthrombosis na ngụgụ.A na-akọ na ihe karịrị 20% nke ndị ọrịa nwere VTE n'ụlọ ọgwụ COVID-19.
• Ọkwa D-Dimer na nnabata n'onwe ya buru amụma banyere ọnwụ n'ụlọ ọgwụ wee nyochaa ndị ọrịa nwere nnukwu ihe ize ndụ.Ugbu a, D-dimer abụrụla otu n'ime isi ihe nyocha maka ndị ọrịa nwere COVID-19 mgbe a na-anabata ha n'ụlọ ọgwụ.
Enwere ike iji D-Dimer duzie ma ọ ga-amalite ọgwụ mgbochi heparin na ndị ọrịa nwere COVID-19.A kọwo na n'ime ndị ọrịa nwere D-Dimer ≥ 6-7 ugboro nke elu nke oke ntụaka, mmalite nke heparin anticoagulation nwere ike ime ka nsonaazụ ndị ọrịa dịkwuo mma.
Enwere ike iji nlebanya dị egwu nke D-Dimer iji chọpụta ihe omume VTE na ndị ọrịa nwere COVID-19.
• D-Dimer onyunyo, nke enwere ike iji chọpụta nsonaazụ COVID-19.
• Nleba anya D-Dimer, mgbe ọgwụgwọ ọrịa chere mkpebi ihu, D-Dimer nwere ike ịnye ụfọdụ ozi ntụaka?A na-ahụ ọtụtụ ule ụlọ ọgwụ na mba ofesi.
2. D-Dimer nleba anya ike na-ebu amụma guzobe VTE:
Dị ka e kwuru n'elu, ọkara ndụ nke D-Dimer bụ 7-8h.Ọ bụ kpọmkwem n'ihi njirimara a ka D-Dimer nwere ike nyochaa ma buru amụma nhazi nke VTE.Maka ọnọdụ hypercoagulable na-adịru nwa oge ma ọ bụ microthrombosis, D-Dimer ga-abawanye ntakịrị wee belata ngwa ngwa.Mgbe enwere usoro thrombus ọhụrụ na-adịgide adịgide n'ime ahụ, D-Dimer n'ime ahụ ga-aga n'ihu na-ebili, na-egosi usoro nrịgo elu dị ka elu.Maka ndị nwere nnukwu nsogbu nke thrombosis, dị ka nnukwu na ikpe siri ike, ndị ọrịa na-arụ ọrụ, wdg, ọ bụrụ na ọkwa D-Dimer na-abawanye ngwa ngwa, kpachara anya maka ohere nke thrombosis.Na "Nkwenye ndị ọkachamara na nyocha na ọgwụgwọ nke thrombosis miri emi na ndị na-arịa ọrịa ọkpụkpụ trauma", a na-atụ aro ka ndị ọrịa nwere nnukwu ihe ize ndụ mgbe ịwa ahụ ọkpụkpụ kwesịrị ịhụ mgbanwe nke D-Dimer kwa awa 48 ọ bụla.Ekwesịrị ime nyocha onyonyo n'oge iji lelee DVT.
3. D-Dimer dị ka prognostic egosi maka ọrịa dị iche iche:
N'ihi mmekọrịta chiri anya n'etiti usoro coagulation na mbufụt, mmerụ ahụ endothelial, wdg, a na-ahụkarị elu D-Dimer na ụfọdụ ọrịa ndị na-abụghị thrombotic dị ka ọrịa, ịwa ahụ ma ọ bụ trauma, obi mgbawa, na ụbụrụ ọjọọ.Nnyocha achọpụtala na ihe na-adịghị mma na-emekarị maka ọrịa ndị a bụ thrombosis, DIC, wdg. Ọtụtụ n'ime nsogbu ndị a bụ ọrịa kachasị emetụta ma ọ bụ steeti ndị na-ebute elu D-Dimer.Ya mere, enwere ike iji D-Dimer mee ihe dị ka nyocha nyocha sara mbara ma dị nro maka ọrịa.
• Maka ndị ọrịa tumor, ọtụtụ nchọpụta achọpụtala na afọ 1-3 nke ndụ ndụ nke ndị ọrịa na-arịa ọrịa ụbụrụ na-arịa ọrịa ụbụrụ nwere elu D-Dimer dị elu dị ala karịa nke ndị ọrịa D-Dimer nkịtị.Enwere ike iji D-Dimer mee ihe dị ka ihe nleba anya maka nleba anya n'ọhụụ nke ndị ọrịa akpụ akpụ.
• Maka ndị ọrịa VTE, ọtụtụ nchọpụta ekwenyela na ndị ọrịa D-Dimer-positive na VTE nwere 2-3 ugboro ihe ize ndụ dị elu nke nlọghachite thrombus na-esote n'oge anticoagulation karịa ndị ọrịa na-adịghị mma.Meta-analysis ọzọ gụnyere 7 ọmụmụ na ngụkọta nke 1818 isiokwu gosiri na, Abnormal D-Dimer bụ otu n'ime ndị bụ isi amụma nke thrombus nlọghachite na VTE ọrịa, na D-Dimer abanyela na otutu VTE ihe ize ndụ amụma amụma amụma.
• Maka ndị ọrịa na-agbanwe valvụ igwe (MHVR), nyocha nyocha ogologo oge nke isiokwu 618 gosipụtara na ihe ize ndụ nke ihe ọjọọ na ndị ọrịa nwere ọkwa D-Dimer na-adịghị mma n'oge warfarin mgbe MHVR dị ihe dị ka ugboro 5 nke ndị ọrịa nkịtị.Ntụle mmekọrịta dị iche iche gosipụtara na ọkwa D-Dimer bụ onye amụma nọọrọ onwe ya maka ihe omume thrombotic ma ọ bụ nke obi n'oge mgbochi mgbochi.
• Maka ndị ọrịa nwere fibrillation atrial (AF), D-Dimer nwere ike ịkọ ihe omume thrombotic na ihe omume obi na akwara na mgbochi ọnụ.Nnyocha a tụrụ anya nke ndị ọrịa 269 nwere fibrillation atrial sochiri ihe dị ka afọ 2 gosiri na n'oge ọgwụ mgbochi ọnụ, ihe dị ka 23% nke ndị ọrịa nwere INR ruru ebumnuche gosipụtara ọkwa D-Dimer na-adịghị mma, ebe ndị ọrịa nwere ọkwa D-Dimer na-adịghị mma mepụtara ihe ize ndụ nke thrombotic. ihe omume na comorbid ọrịa obi bụ 15.8 na 7.64 ugboro, n'otu n'otu, nke ndị ọrịa nwere ọkwa D-Dimer nkịtị.
• Maka ọrịa ndị a akọwapụtara ma ọ bụ ndị ọrịa a kapịrị ọnụ, D-Dimer dị elu ma ọ bụ na-adịgide adịgide na-egosikarị amụma na-adịghị mma ma ọ bụ na-akawanye njọ nke ọrịa ahụ.
4. Ngwa nke D-Dimer na ọgwụgwọ mgbochi ọrịa ọnụ:
• D-Dimer na-ekpebi oge ọgwụ mgbochi ọnụ: Ogologo oge kachasị mma nke ọgwụ mgbochi maka ndị ọrịa nwere VTE ma ọ bụ thrombus ndị ọzọ ka na-enweghị isi.N'agbanyeghị ma ọ bụ NOAC ma ọ bụ VKA, ụkpụrụ nduzi mba ụwa dị mkpa na-atụ aro na a ga-ekpebi ọgwụ mgbochi ogologo oge dịka ihe ize ndụ ọbara ọgbụgba n'ime ọnwa nke atọ nke ọgwụgwọ mgbochi ọrịa, na D-Dimer nwere ike ịnye ozi nkeonwe maka nke a.
• D-Dimer na-eduzi ngbanwe nke ọgwụ mgbochi ọnụ: Warfarin na ọgwụ mgbochi ọhụrụ bụ ihe a na-ejikarị na-eme ihe na-agwọ ọrịa, nke abụọ nwere ike ibelata ọkwa D-Dimer.na ịgbalite usoro fibrinolytic, si otú a na-ebelata ọkwa D-Dimer n'ụzọ na-edoghị anya.Nsonaazụ nnwale na-egosi na mgbochi mgbochi nke D-Dimer na-eduzi na ndị ọrịa na-ebelata nke ọma ihe omume ọjọọ.
N'ikpeazụ, ule D-Dimer abụghịzi naanị na ngwa ọdịnala dịka nchọpụta mwepu VTE na nchọpụta DIC.D-Dimer na-arụ ọrụ dị mkpa na amụma ọrịa, prognosis, iji ọgwụ mgbochi ọnụ, yana COVID-19.Site na nyocha nyocha na-aga n'ihu, ntinye nke D-Dimer ga-abawanye ụba.
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