I-Fibrin monomers egazini i-cross-linked by activated factor X III, kwaye emva koko i-hydrolyzed nge-plasmin esebenzayo ukuvelisa imveliso ethile yokuthotywa ebizwa ngokuba yi "fibrin degradation product (FDP)."I-D-Dimer iyona FDP elula, kwaye ukwanda kobuninzi bayo kubonakalisa i-hypercoagulable state kunye ne-hyperfibrinolysis yesibini kwi-vivo.Ke ngoko, uxinaniso lwe-D-Dimer lubaluleke kakhulu ekuxilongeni, ukuvavanya ukusebenza kakuhle kunye nokugwetywa kwezifo ze-thrombotic.
Ukusukela oko kwaqhambuka i-COVID-19, ngokunzulu kokubonakaliswa kweklinikhi kunye nokuqonda ngezifo zesi sifo kunye nokuqokelelwa koxilongo kunye namava onyango, izigulana eziqatha ezinenyumoniya entsha ye-coronary inokukhula ngokukhawuleza i-acute restress distress syndrome.Iimpawu, ukothuka kwe-septic, i-refractory metabolic acidosis, ukungasebenzi kakuhle kwe-coagulation, kunye nokusilela kwamalungu amaninzi.I-D-dimer iphakanyisiwe kwizigulane ezine-pneumonia enzima.
Izigulana ezigula kakhulu kufuneka zinike ingqwalasela kumngcipheko we-venous thromboembolism (VTE) ngenxa yokuphumla ixesha elide ebhedini kunye nokusebenza okungaqhelekanga kokuqina.
Ngethuba lenkqubo yokonyango, kuyimfuneko ukubeka iliso kwizikhombisi ezifanelekileyo ngokwemeko, kubandakanywa iimpawu ze-myocardial, umsebenzi we-coagulation, njl njl. Ezinye izigulane zinokunyuka kwe-myoglobin, ezinye iimeko ezinzima zinokubona ukwanda kwe-troponin, kwaye kwiimeko ezinzima, i-D-dimer (i-D-dimer) D-Dimer) inokunyuswa.
Inokubonwa ukuba i-D-Dimer inokubaluleka kokubeka iliso okunxulumene nobunzima ekuqhubekeni kwe-COVID-19, ke idlala indima njani kwezinye izifo?
1. I-venous thromboembolism
I-D-Dimer isetyenziswe ngokubanzi kwizifo ezinxulumene ne-venous thromboembolism (VTE), ezifana ne-deep vein thrombosis (DVT) kunye ne-pulmonary embolism (PE).Uvavanyo olubi lwe-D-Dimer lunokulawula i-DVT, kwaye i-concentration ye-D-Dimer ingasetyenziselwa ukuqikelela izinga lokuphindaphinda kwe-VTE.Uphononongo lufumene ukuba umlinganiselo wengozi yokuphindaphinda kwe-VTE kuluntu olunogxininiso oluphezulu lwaluyi-4.1 ngamaxesha anabantu abanoxinzelelo oluqhelekileyo.
I-D-Dimer iphinde ibe enye yezibonakaliso zokufumanisa i-PE.Ixabiso layo elibi lokuxela kwangaphambili liphezulu kakhulu, kwaye ukubaluleka kwayo kukungabandakanyi i-acute pulmonary embolism, ngakumbi kwizigulane ezinokukrokra okuphantsi.Ngoko ke, kwizigulane ezirhanelwa nge-acute pulmonary embolism, i-ultrasonography ye-veins enzulu ye-low ends kunye noviwo lwe-D-Dimer kufuneka ludibaniswe.
2. Ukusasazwa kwe-intravascular coagulation
I-Disseminated intravascular coagulation (DIC) yi-syndrome yeklinikhi ebonakaliswe ngokuphuma kwegazi kunye nokungaphumeleli kwe-microcirculatory ngesiseko sezifo ezininzi.Inkqubo yophuhliso ibandakanya iinkqubo ezininzi ezifana ne-coagulation, i-anticoagulation, kunye ne-fibrinolysis.I-D-Dimer yanda kwinqanaba lokuqala lokubunjwa kwe-DIC, kwaye ukugxininiswa kwayo kwaqhubeka nokwandisa ngaphezu kwe-10-fold njengoko isifo siqhubela phambili.Ngoko ke, i-D-Dimer ingasetyenziselwa njengenye yezibonakaliso eziphambili zokuxilongwa kwangaphambili kunye nokubeka iliso kwimeko ye-DIC.
3. I-aortic dissection
"Imvumelwano yeengcali zaseTshayina malunga nokuxilongwa kunye nokunyangwa kwe-aorta dissection" yabonisa ukuba i-D-Dimer, njengovavanyo lwebhubhoratri yesiqhelo ye-aortic dissection (AD), ibaluleke kakhulu ekuxilongweni kunye nokuxilongwa kwe-dissection.Xa iD-Dimer yesigulana inyuka ngokukhawuleza, amathuba okuba afunyanwe njengeAD ayanda.Kwiiyure ezingama-24 zokuqala, xa i-D-Dimer ifikelela kwixabiso elibalulekileyo le-500 µg/L, ubuntununtunu bayo bokuxilonga i-AD ebukhali yi-100%, kwaye ingcaciso yayo yi-67%, ngoko inokusetyenziswa njengesalathiso sokungabandakanyi ukuxilongwa kwe-AD. acute AD.
4. I-Atherosclerotic Cardiovascular Disease
I-Atherosclerotic cardiovascular disease sisifo sentliziyo esibangelwa yi-arteriosclerotic plaque, kuquka i-ST-segment elevation acute myocardial infarction, i-non-ST-segment elevation acute myocardial infarction, kunye ne-angina engazinzanga.Emva kokuqhekeka kwe-plaque, i-necrotic core material kwi-plaque iphuma, ibangele amacandelo angaqhelekanga okuhamba kwegazi, ukusebenza kwenkqubo yokudibanisa, kunye nokunyuka kwe-D-Dimer concentration.Izigulane ze-Coronary heart disease ezine-D-Dimer ephakamileyo zinokuthi ziqikelele ingozi ephezulu ye-AMI kwaye ingasetyenziselwa njengesalathisi sokuqwalasela imeko ye-ACS.
5. Unyango lwe-Thrombolytic
Uphononongo lukaLawter lwafumanisa ukuba amayeza ahlukeneyo e-thrombolytic anokunyusa i-D-Dimer, kwaye utshintsho lwalo ngaphambi nangemva kwe-thrombolysis lunokusetyenziswa njengesalathisi sokugweba unyango lwe-thrombolytic.Umxholo wayo wanda ngokukhawuleza kwixabiso eliphezulu emva kwe-thrombolysis, kwaye wabuyela emva kwexesha elifutshane kunye nokuphucula okubonakalayo kwiimpawu zeklinikhi, ebonisa ukuba unyango lusebenza kakuhle.
Inqanaba le-D-Dimer linyuke kakhulu kwiyure eli-1 ukuya kwiiyure ze-6 emva kwe-thrombolysis ye-acute myocardial infarction kunye ne-cerebral infarction.
Ngexesha le-DVT thrombolysis, i-D-Dimer peak ngokuqhelekileyo ivela kwiiyure ezingama-24 okanye kamva
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