Kodi D-dimer ndi chiyani?

D-dimer ndiye chinthu chosavuta chowononga cha fibrin, ndipo mulingo wake wokwezeka ukhoza kuwonetsa hypercoagulable state ndi hyperfibrinolysis yachiwiri mu vivo.D-dimer ikhoza kugwiritsidwa ntchito ngati chizindikiro cha hypercoagulability ndi hyperfibrinolysis mu vivo, ndipo kuwonjezeka kwake kumasonyeza kuti kumakhudzana ndi matenda a thrombotic omwe amayamba chifukwa cha zifukwa zosiyanasiyana mu vivo, komanso amasonyezanso kupititsa patsogolo ntchito ya fibrinolytic.

Ndi zinthu ziti zomwe D-dimer imakwezedwa?

Matenda a venous thromboembolism (VTE) komanso matenda omwe si a venous thromboembolic amatha kuyambitsa kuchuluka kwa D-dimer.

VTE imaphatikizapo acute pulmonary embolism, deep vein thrombosis (DVT) ndi cerebral venous (sinus) thrombosis (CVST).

Non-venous thromboembolic matenda akuphatikizapo acute aortic dissection (AAD), ruptured aneurysm, sitiroko (CVA), disseinated intravascular coagulation (DIC), sepsis, acute coronary syndrome (ACS), ndi matenda osokoneza bongo a m'mapapo (COPD), ndi zina zotero. , Miyezo ya D-dimer imakwezedwanso mumikhalidwe monga ukalamba, opaleshoni yaposachedwa / kuvulala, ndi thrombolysis.

D-dimer angagwiritsidwe ntchito kuyesa pulmonary embolism prognosis

D-dimer amalosera za kufa kwa odwala omwe ali ndi pulmonary embolism.Odwala omwe ali ndi vuto lalikulu la pulmonary embolism, ma D-dimer apamwamba adalumikizidwa ndi ma PESI apamwamba (Pulmonary Embolism Severity Index Score) komanso kuchuluka kwaimfa.Kafukufuku wasonyeza kuti D-dimer <1500 μg/L ili ndi mtengo wolosera bwino wa miyezi itatu ya pulmonary embolism kufa: kufa kwa miyezi itatu ndi 0% pomwe D-dimer <1500 μg/L.D-dimer ikaposa 1500 μg/L, kusamala kwambiri kuyenera kugwiritsidwa ntchito.

Kuonjezera apo, kafukufuku wina wasonyeza kuti kwa odwala khansa ya m'mapapo, D-dimer <1500 μg / L nthawi zambiri imakhala ntchito yowonjezera ya fibrinolytic chifukwa cha zotupa;D-dimer> 1500 μg/L nthawi zambiri imasonyeza kuti odwala khansa ya m'mapapo amakhala ndi thrombosis yakuya (DVT) ndi pulmonary embolism.

D-dimer amalosera kubwereza kwa VTE

D-dimer ndi kulosera za VTE yobwereza.Odwala D-dimer-negative anali ndi miyezi ya 3 yobwerezabwereza ya 0. Ngati D-dimer ikukwera kachiwiri panthawi yotsatila, chiopsezo cha kubwereza kwa VTE chikhoza kuwonjezeka kwambiri.

D-dimer imathandizira kuzindikira kwa aortic dissection

D-dimer ali ndi zabwino zolosera zamtengo wapatali kwa odwala omwe ali ndi vuto la aortic dissection, ndipo D-dimer negativity imatha kutulutsa kung'ambika kwa aortic.D-dimer imakwezedwa kwa odwala omwe ali ndi vuto lalikulu la aortic dissection komanso osakwezeka kwambiri kwa odwala omwe ali ndi vuto la aortic dissection.

D-dimer imasinthasintha mobwerezabwereza kapena ikukwera mwadzidzidzi, kusonyeza chiopsezo chachikulu cha kupasuka kwa dissection.Ngati mlingo wa D-dimer wa wodwalayo uli wosasunthika komanso wochepa (<1000 μg/L), chiopsezo cha kupasuka kwa dissection ndi kochepa.Chifukwa chake, mulingo wa D-dimer utha kuwongolera chithandizo chamankhwala chaodwalawo.

D-dimer ndi matenda

Kutenga kachilomboka ndi chimodzi mwazomwe zimayambitsa VTE.Pakuchotsa dzino, bacteremia imatha kuchitika, yomwe ingayambitse thrombosis.Panthawiyi, mlingo wa D-dimer uyenera kuyang'aniridwa mosamala, ndipo chithandizo cha anticoagulation chiyenera kulimbikitsidwa pamene milingo ya D-dimer yakwera.

Kuphatikiza apo, matenda opumira komanso kuwonongeka kwa khungu ndizomwe zimayambitsa chiopsezo cha thrombosis ya mitsempha yakuya.

D-dimer amawongolera anticoagulation therapy

Zotsatira za PROLONG multicenter, kafukufuku woyembekezeredwa koyambirira (kutsata kwa miyezi 18) ndikuwonjezera (kutsata kwa miyezi 30) adawonetsa kuti poyerekeza ndi odwala omwe alibe anticoagulated, odwala D-dimer-positive adapitilira pambuyo pa 1. mwezi wa kusokonezeka kwa mankhwala Anticoagulation kwambiri kuchepetsa chiopsezo cha VTE kubwereza, koma panalibe kusiyana kwakukulu D-dimer-negative odwala.

Mu ndemanga yofalitsidwa ndi Magazi, Pulofesa Kearon adanenanso kuti chithandizo cha anticoagulation chikhoza kutsogoleredwa ndi mlingo wa D-dimer wa wodwala.Odwala omwe ali ndi DVT yosavomerezeka kapena pulmonary embolism, chithandizo cha anticoagulation chikhoza kutsogoleredwa ndi D-dimer kuzindikira;ngati D-dimer sagwiritsidwa ntchito, njira ya anticoagulation imatha kutsimikiziridwa malinga ndi kuopsa kwa magazi ndi zofuna za wodwalayo.

Kuphatikiza apo, D-dimer imatha kutsogolera chithandizo cha thrombolytic.