Nekudzika kwekunzwisisa kwevanhu nezve thrombus, D-dimer yakashandiswa sechinhu chinowanzo shandiswa bvunzo yekusabatanidzwa kwethrombus mu coagulation kiriniki marabhoritari.Nekudaro, iyi ingori dudziro yekutanga yeD-Dimer.Iye zvino nyanzvi dzakawanda dzakapa D-Dimer chirevo chakapfuma mukutsvaga paD-Dimer pachayo uye hukama hwayo nezvirwere.Zviri mukati meiyi nyaya zvinokutungamirira iwe kukoshesa nzira yayo itsva yekushandisa.
Hwaro hwekiriniki yekushandisa yeD-dimer
01. Kuwedzera kweD-Dimer kunomiririra kushandiswa kweiyo coagulation system uye fibrinolysis system mumuviri, uye iyi nzira inoratidza kushanduka kwepamusoro.Negative D-Dimer inogona kushandiswa kubviswa kwethrombus (yakanyanya kukosha kukosha kwekiriniki);nepo D-Dimer yakanaka haigone kuratidza kuumbwa kwe thromboembolism.Kuti thromboembolism yakaumbwa here kana kuti kwete zvinoenderana nechiyero chemaitiro maviri aya.
02. Hafu yehupenyu hweD-Dimer ndeye 7-8h, uye inogona kuonekwa 2h mushure me thrombosis.Ichi chiitiko chinogona kunyatsoenderana nekiriniki yekudzidzira, uye hazvizove zvakaoma kutarisa nekuti hafu yehupenyu ipfupi, uye haizorasikirwe nekukosha kwekutarisa nekuti hafu yeupenyu yakarebesa.
03. D-Dimer inogona kugadzikana mumasampuli eropa mushure me in vitro kwemaawa angangoita 24-48, kuitira kuti zvinyorwa zveD-Dimer zvakaonekwa mu vitro zvinogona kunyatsoratidza D-Dimer level in vivo.
04. Nzira yeD-Dimer yose inobva pane antigen-antibody reaction, asi nzira chaiyo yakawanda asi kwete yunifomu.Masoja ekudzivirira chirwere ari mu reagent akasiyana-siyana, uye zvimedu zveantigen zvakaonekwa hazvienderane.Pakusarudza chiratidzo murabhoritari, inoda kuongororwa.
Traditional coagulation kiriniki yekushandisa yeD-dimer
1. VTE kusabatanidzwa kuongororwa:
Iyo D-Dimer bvunzo yakasanganiswa nekiriniki yekuongorora njodzi maturusi anogona kushandiswa zvine mutsindo kusabvisa deep vein thrombosis (DVT) uye pulmonary embolism (PE).
Kana ichishandiswa pakubvisa thrombus, pane zvimwe zvinodiwa zveD-Dimer reagent uye nzira.Zvinoenderana neiyo D-Dimer indasitiri chiyero, iyo yakasanganiswa pre-test mukana inoda yakashata yekufungidzira mwero we ≥97% uye kunzwa kwe ≥95%.
2. Kuongororwa kwekubatsira kwekuparadzira intravascular coagulation (DIC):
Iyo yakajairika kuratidzwa kweDIC ndeye hyperfibrinolysis system, uye iyo yekuona iyo inogona kuratidza hyperfibrinolysis inoita basa rakakosha muDIC scoring system.Zvave zvichiratidzwa nekliniki kuti D-Dimer ichawedzerwa zvakanyanya (kupfuura 10 nguva) muDIC varwere.MuDIC yemukati neyekunze nhungamiro yekuongorora kana kubvumirana, D-Dimer inoshandiswa seimwe yezviratidzo zverabhoritari yekuongorora DIC, uye inokurudzirwa kuita FDP pamwe chete.Kunyatsovandudza kushanda kweDIC kuongororwa.Kuongororwa kweDIC hakugone kuitwa chete nekutsamira pane imwechete laboratory index uye mhedzisiro yekuongororwa kumwe chete.Inoda kuongororwa zvakadzama uye kutariswa zvine simba pamwe chete nezviratidzo zvekiriniki zvemurwere uye zvimwe zviratidzo zverabhoritari.
Zvitsva zvekiriniki zvekushandisa zveD-Dimer
1. Kushandiswa kweD-Dimer muvarwere vane COVID-19: Neimwe nzira, COVID-19 chirwere chethrombotic chinokonzerwa nekusagadzikana kwemuviri, ine diffuse kuzvimba mhinduro uye microthrombosis mumapapu.Zvinonzi vanopfuura makumi maviri muzana evarwere vane VTE vari muchipatara nyaya dzeCCIDID-19.
• D-Dimer nhanho pakupinzwa yakazvimiririra kufanotaura muchipatara uye kuvhenekwa vangangove vari munjodzi huru.Parizvino, D-dimer yave chimwe chezvinhu zvakakosha zvekuongorora kune varwere vane COVID-19 kana vapinzwa muchipatara.
• D-Dimer inogona kushandiswa kutungamira kana kutanga heparin anticoagulation muvarwere vane COVID-19.Izvo zvakataurwa kuti kune varwere vane D-Dimer ≥ 6-7 nguva yepamusoro yemuganhu wekutsvaga, kutangwa kweheparin anticoagulation kunogona kuvandudza zvakanyanya migumisiro yevarwere.
• Dynamic monitoring yeD-Dimer inogona kushandiswa kuongorora kuitika kweVTE muvarwere vane COVID-19.
• D-Dimer surveillance, inogona kushandiswa kuongorora mhedzisiro yeCOVID-19.
• D-Dimer yekutarisa, apo chirwere chekurapa chinotarisana nechisarudzo, D-Dimer inogona kupa humwe ruzivo rwemashoko here?Kune miedzo yakawanda yekiriniki kunze kwenyika iri kucherechedzwa.
2. D-Dimer dynamic monitoring inofanotaura kuumbwa kweVTE:
Sezvambotaurwa pamusoro apa, hafu yeupenyu yeD-Dimer ndeye 7-8h.Izvo chaizvo nekuda kwechinhu ichi kuti D-Dimer inokwanisa kutarisa zvine simba uye kufanotaura kuumbwa kweVTE.Nezvenguva pfupi hypercoagulable state kana microthrombosis, D-Dimer ichawedzera zvishoma uye yobva yaderera nekukurumidza.Kana paine kuramba kuchiitika kutsva kwethrombus kuumbwa mumuviri, iyo D-Dimer mumuviri icharamba ichikwira, ichiratidza peak-yakafanana inosimuka curve.Kune vanhu vane chiitiko chepamusoro che thrombosis, zvakadai sematambudziko akaoma uye akaoma, varwere vepashure, nezvimwewo, kana chiyero cheD-Dimer chikakurumidza kuwedzera, chenjerera kune mukana we thrombosis.Mu "Nyanzvi Kubvumirana paKuongorora uye Kurapa kweDeep Vein Thrombosis muTrauma Orthopedic Patients", zvinokurudzirwa kuti varwere vane ngozi yepakati nepamusoro mushure mekuvhiyiwa kwemapfupa vanofanira kuona kuchinja kweD-Dimer kwemaawa makumi mana nemasere.Imaging bvunzo dzinofanirwa kuitwa nenguva yekutarisa DVT.
3. D-Dimer sechiratidzo chekufungidzira kwezvirwere zvakasiyana-siyana:
Nekuda kwehukama hwepedyo pakati peiyo coagulation system uye kuzvimba, endothelial kukuvara, zvichingodaro, kukwidziridzwa kweD-Dimer kunowanzoonekwawo mune dzimwe dzisiri-thrombotic zvirwere senge hutachiona, kuvhiyiwa kana kukuvadzwa, kutadza kwemoyo, uye mamota akashata.Zvidzidzo zvakawana kuti iyo inowanzozivikanwa yehurombo hurombo hwezvirwere izvi ndeye thrombosis, DIC, nezvimwewo. Zvizhinji zvezvipingamupinyi izvi ndizvo zvinowanzoenderana nezvirwere kana nyika dzinokonzera D-Dimer kukwirira.Naizvozvo, D-Dimer inogona kushandiswa seyakafara uye inonzwisisika yekuongorora index yezvirwere.
• Kune varwere vebundu, zvidzidzo zvakawanda zvakawana kuti 1-3-gore rekurarama kwechirwere chechirwere chechirwere chechirwere chepamusoro cheD-Dimer chakanyanya kuderera pane chenguva dzose D-Dimer varwere.D-Dimer inogona kushandiswa sechiratidzo chekuongorora fungidziro yevanorwara bundu varwere.
• Kune varwere veVTE, zvidzidzo zvakawanda zvakasimbisa kuti D-Dimer-positive varwere vane VTE vane 2-3 nguva yakawanda yengozi yekudzoka kwethrombus kunotevera panguva ye anticoagulation kupfuura varwere vasina kunaka.Imwe meta-analysis inosanganisira zvidzidzo zve 7 nehuwandu hwezvidzidzo zve1818 zvakaratidza kuti, Abnormal D-Dimer ndeimwe yezvinonyanya kufanotaura nezvekudzoka kwethrombus muVTE varwere, uye D-Dimer yakabatanidzwa mumhando dzakawanda dzeVTE dzekudzokorora njodzi.
• Kune varwere vane mechanical valve replacement (MHVR), kuongorora kwenguva refu kwezvidzidzo zve618 kwakaratidza kuti njodzi yezviitiko zvakashata kune varwere vane mazinga asina kunaka eD-Dimer panguva yewarfarin mushure meMHVR yaiva ye5 nguva yevarwere vemazuva ose.Multivariate correlation analysis yakasimbisa kuti D-Dimer nhanho yaive yakazvimiririra fungidziro yezviitiko zvethrombotic kana zvemoyo panguva yeanticoagulation.
• Kune varwere vane atrial fibrillation (AF), D-Dimer inogona kufanotaura zviitiko zvethrombotic uye zviitiko zvemwoyo mumuromo anticoagulation.Ongororo inotarisirwa yevarwere ve269 vane atrial fibrillation yakateverwa kweanenge makore maviri yakaratidza kuti panguva yemuromo anticoagulation, vangangoita 23% yevarwere vane INR vakasvika pachinangwa vakaratidza mazinga eD-Dimer asina kujairika, nepo varwere vane mazinga eD-Dimer asina kujairika akagadzirwa Njodzi dzethrombotic. zviitiko uye comorbid cardiovascular zviitiko zvaive 15.8 uye 7.64 nguva, zvichiteerana, yevarwere vane yakajairika D-Dimer mazinga.
• Nokuda kwezvirwere izvi zvakananga kana varwere chaivo, yakakwirira kana kuti inopfuurira yakanaka D-Dimer inowanzoratidza kushaya kufungidzira kana kuwedzera kwechirwere.
4. Kushandiswa kweD-Dimer mumuromo anticoagulation therapy:
• D-Dimer inosarudza nguva yemuromo anticoagulation: Nguva yakakwana yekudzivirira kwevarwere vane VTE kana imwe thrombus inoramba isinganzwisisiki.Pasinei nokuti NOAC kana VKA, nhungamiro dzepasi rose dzinokurudzira kuti anticoagulation yenguva refu inofanira kusarudzwa maererano nengozi yekubuda ropa mumwedzi wechitatu we anticoagulation therapy, uye D-Dimer inogona kupa ruzivo rwemunhu kune izvi.
• D-Dimer inotungamirira kugadziriswa kwemuromo anticoagulant intensity: Warfarin uye itsva oral anticoagulants ndiyo inonyanya kushandiswa nemuromo anticoagulants mumakiriniki maitiro, zvose zvinogona kuderedza chiyero cheD-Dimer.uye activation ye fibrinolytic system, nokudaro nenzira isina kunanga kuderedza chiyero cheD-Dimer.Migumisiro yekuedza inoratidza kuti D-Dimer-inotungamirirwa anticoagulation muvarwere inobudirira inoderedza kuitika kwezviitiko zvakashata.
Mukupedzisa, D-Dimer bvunzo haichaganhurirwe kune zvechinyakare zvikumbiro senge VTE kusabatanidzwa kuongororwa uye DIC kuonekwa.D-Dimer inoita basa rakakosha mukufanotaura kwechirwere, kufungidzira, kushandiswa kwemuromo anticoagulants, uye COVID-19.Nekuenderera mberi nekudzika kwekutsvagisa, kushandiswa kweD-Dimer kuchawedzera uye kwakawedzera.
Bhizinesi kadhi
Chinese WeChat
English WeChat