Ngokuya nzulu kokuqonda kwabantu i-thrombus, i-D-dimer isetyenziswe njengeyona nto ixhaphakileyo yovavanyo lokukhutshwa kwe-thrombus kwiilebhu zeklinikhi ezidibeneyo.Nangona kunjalo, oku kukuphela kokutolika okuphambili kwe-D-Dimer.Ngoku abaphengululi abaninzi banike i-D-Dimer intsingiselo ecebileyo kuphando lwe-D-Dimer ngokwayo kunye nobudlelwane bayo nezifo.Umxholo walo mbandela uya kukukhokelela ekubeni uxabise isikhokelo sawo esitsha sesicelo.
Isiseko sokusetyenziswa kweklinikhi ye-D-dimer
01. Ukunyuka kwe-D-Dimer kubonisa ukusebenza kwenkqubo ye-coagulation kunye nenkqubo ye-fibrinolysis emzimbeni, kwaye le nkqubo ibonisa isimo esiphezulu sokuguqulwa.I-D-Dimer engalunganga ingasetyenziselwa ukukhutshwa kwe-thrombus (elona xabiso liphambili lekliniki);ngelixa i-D-Dimer positive ayinakungqina ukubunjwa kwe-thromboembolism.Ukuba ngaba i-thromboembolism yenziwe okanye ayiyiyo ixhomekeke kwibhalansi yezi nkqubo zimbini.
02. I-half-life ye-D-Dimer yi-7-8h, kwaye inokubonwa nge-2h emva kwe-thrombosis.Olu phawu lunokuhambelana kakuhle nokusebenza kweklinikhi, kwaye akuyi kuba nzima ukubeka iliso kuba isiqingatha sobomi sifutshane kakhulu, kwaye asiyi kulahlekelwa ukubaluleka kokubeka iliso kuba isiqingatha sobomi side kakhulu.
03. I-D-Dimer inokuzinza kwiisampuli zegazi emva kwe-in vitro ubuncinane iiyure ezingama-24-48, ukwenzela ukuba umxholo we-D-Dimer ofunyenwe kwi-vitro unokubonisa ngokuchanekileyo inqanaba le-D-Dimer kwi-vivo.
04. Indlela yokusebenza ye-D-Dimer yonke isekelwe kwi-antigen-antibody reaction, kodwa indlela ethile ininzi kodwa ayifani.Ama-antibodies kwi-reagent ahlukeneyo, kwaye amaqhekeza e-antigen afunyenweyo awahambelani.Xa ukhetha uphawu kwibhubhoratri, kufuneka ihlolwe.
I-Traditional coagulation isicelo seklinikhi ye-D-dimer
1. Ukuxilongwa kokungabandakanywa kwe-VTE:
Uvavanyo lwe-D-Dimer oludityaniswe nezixhobo zokuhlola umngcipheko weklinikhi lunokusetyenziswa ngokufanelekileyo ukungabandakanyi i-deep vein thrombosis (DVT) kunye ne-pulmonary embolism (PE).
Xa isetyenziselwa ukukhutshwa kwe-thrombus, kukho iimfuno ezithile ze-D-Dimer reagent kunye nendlela.Ngokomgangatho wemboniselo ye-D-Dimer, ithuba elidityanisiweyo lokuvavanya kwangaphambili lidinga izinga elibi lokuxela kwangaphambili ≥97% kunye novakalelo lwe-≥95%.
2. Ukuxilongwa kwe-Axiliary of disseminated intravascular coagulation (DIC):
Ukubonakaliswa okuqhelekileyo kwe-DIC yinkqubo ye-hyperfibrinolysis, kwaye ukufumanisa okungabonakalisa i-hyperfibrinolysis kudlala indima ebalulekileyo kwinkqubo yokufaka amanqaku e-DIC.Kuye kwaboniswa klinikhi ukuba i-D-Dimer iya kwandiswa kakhulu (ngaphezu kwamaxesha e-10) kwizigulane ze-DIC.Kwimigaqo yokuxilongwa kwe-DIC yasekhaya nakwamanye amazwe okanye ukuvumelana, i-D-Dimer isetyenziswe njengenye yezibonakaliso zebhubhoratri yokuxilongwa kwe-DIC, kwaye kucetyiswa ukuba iqhube i-FDP ngokubambisana.Ukuphucula ngokufanelekileyo ukuxilongwa kwe-DIC.Ukuxilongwa kwe-DIC akunakwenziwa kuphela ngokuxhomekeke kwisalathiso selabhoratri enye kunye neziphumo zoviwo olunye.Kufuneka ihlalutywe ngokubanzi kwaye ihlolwe ngamandla ngokudibanisa nokubonakaliswa kwekliniki yesigulane kunye nezinye izibonakaliso zebhubhoratri.
Izicelo ezintsha zeklinikhi ze-D-Dimer
1. Ukusetyenziswa kwe-D-Dimer kwizigulana ezine-COVID-19: Ngandlel’ ithile, i-COVID-19 sisifo se-thrombotic esibangelwa kukuphazamiseka kwe-immune, kunye nokusabela kokudumba okusasazeka kunye ne-microthrombosis emiphungeni.Kuxelwe ukuba ngaphezulu kwe-20% yezigulana ezine-VTE kwiimeko ezisesibhedlele ze-COVID-19.
• Amanqanaba e-D-Dimer ekungenisweni aqikelele ngokuzimeleyo ukubhubha kwabantu esibhedlele kwaye kwajongwa izigulane ezinokuthi zibe semngciphekweni omkhulu.Okwangoku, i-D-dimer iye yaba yenye yezinto eziphambili zokuhlola izigulana ezine-COVID-19 xa zithe zamkelwa esibhedlele.
• I-D-Dimer inokusetyenziselwa ukukhokela ukuba kuqaliswe i-heparin anticoagulation kwizigulana ezine-COVID-19.Kuye kwaxelwa ukuba kwizigulane ezine-D-Dimer ≥ amaxesha angama-6-7 umda ophezulu woluhlu lwereferensi, ukuqaliswa kwe-heparin anticoagulation kunokuphucula kakhulu iziphumo zesigulane.
• Ukujongwa okunamandla kwe-D-Dimer kunokusetyenziselwa ukuvavanya ukwenzeka kwe-VTE kwizigulana ezine-COVID-19.
• Ucupho lwe-D-Dimer, olunokuthi lusetyenziswe ukuvavanya isiphumo se-COVID-19.
• Ukujongwa kwe-D-Dimer, xa unyango lwesifo lujongene nesigqibo, ngaba i-D-Dimer ingabonelela ngolwazi oluthile lwereferensi?Maninzi amalingo onyango ajongwayo phesheya.
2. Ukujongwa okuguquguqukayo kwe-D-Dimer kuqikelela ukusekwa kwe-VTE:
Njengoko kukhankanyiwe ngasentla, i-half-life of D-Dimer yi-7-8h.Kungenxa yolu phawu ukuba i-D-Dimer inokubeka iliso ngamandla kwaye iqikelele ukusekwa kwe-VTE.Kwimeko ye-hypercoagulable yexesha elifutshane okanye i-microthrombosis, i-D-Dimer iya kwanda kancinci kwaye iyancipha ngokukhawuleza.Xa kukho ukwakheka kwe-thrombus eqhubekayo emzimbeni, i-D-Dimer emzimbeni iya kuqhubeka inyuka, ibonisa ijika elifana nephezulu.Kubantu abaneziganeko eziphezulu ze-thrombosis, ezifana neemeko ezinzima kunye nezinzima, izigulane ze-postoperative, njl., Ukuba izinga le-D-Dimer landa ngokukhawuleza, qaphela ukuba kunokwenzeka ukuba i-thrombosis.Kwi "Imvumelwano yeNgcali malunga nokuHlolwa kunye noNyango lwe-Deep Vein Thrombosis kwi-Trauma Orthopedic Patients", kucetyiswa ukuba izigulane ezinomngcipheko ophakathi kunye nomngcipheko ophezulu emva kokuhlinzwa kwamathambo kufuneka zibone ngokukhawuleza utshintsho lwe-D-Dimer rhoqo kwiiyure ze-48.Iimviwo zokucinga kufuneka zenziwe ngexesha elifanelekileyo ukujonga i-DVT.
3. I-D-Dimer njengesalathisi sezifo ezahlukeneyo:
Ngenxa yobudlelwane obusondeleyo phakathi kwenkqubo ye-coagulation kunye nokudumba, ukwenzakala kwe-endothelial, njl., ukuphakama kwe-D-Dimer kudla ngokubonwa kwezinye izifo ezingenayo i-thrombotic ezifana nosulelo, utyando okanye ukwenzakala, ukungaphumeleli kwentliziyo, kunye namathumba anobungozi.Uphononongo lufumanise ukuba eyona nto ixhaphakileyo yokuxilonga kwezi zifo yi-thrombosis, i-DIC, njl.Ke ngoko, i-D-Dimer ingasetyenziswa njengesalathiso sovavanyo esibanzi kwaye esibuthathaka kwizifo.
• Kwizigulane ze-tumor, izifundo ezininzi ziye zafumanisa ukuba izinga lokusinda le-1-3 yeminyaka yezigulane ezinobungozi ezine-D-Dimer ephakamileyo ziphantsi kakhulu kunezo zezigulane ze-D-Dimer eziqhelekileyo.I-D-Dimer ingasetyenziselwa njengesalathisi sokuvavanya ukuxilongwa kwezigulane ezinobungozi ezinobungozi.
• Kwizigulane ze-VTE, uphando oluninzi luye lwaqinisekisa ukuba i-D-Dimer-positive izigulane ezine-VTE zinomngcipheko we-2-3 wamaxesha aphezulu wokuphindaphinda kwe-thrombus ngexesha lokulwa ne-anticoagulation kunezigulane ezimbi.Olunye uhlalutyo lwe-meta olubandakanya izifundo ze-7 kunye nezifundo ze-1818 zizonke zibonise ukuba, i-D-Dimer engaqhelekanga yenye yezinto eziphambili zokuphindaphinda i-thrombus kwizigulane ze-VTE, kwaye i-D-Dimer ifakwe kwiimodeli ezininzi ze-VTE zokuphindaphinda ingozi.
• Kwizigulane ze-mechanical valve replacement (MHVR), uphononongo olulandelelanayo lwexesha elide lwezifundo ze-618 lubonise ukuba umngcipheko weziganeko ezimbi kwizigulane ezinezinga elingaqhelekanga le-D-Dimer ngexesha le-warfarin emva kwe-MHVR malunga namaxesha e-5 kwizigulane eziqhelekileyo.Uhlalutyo lwe-multivariate correlation luqinisekisile ukuba inqanaba le-D-Dimer liyi-predictor ezimeleyo yeziganeko ze-thrombotic okanye ze-cardiovascular ngexesha lokulwa ne-anticoagulation.
• Kwizigulane ezine-fibrillation ye-atrial (AF), i-D-Dimer inokuqikelela iziganeko ze-thrombotic kunye neziganeko ze-cardiovascular in anticoagulation yomlomo.Uphononongo olulindelekileyo lwezigulane ezingama-269 ezine-fibrillation ye-atrial elandelwayo malunga neminyaka eyi-2 lubonise ukuba ngexesha lokulwa nomlomo, malunga ne-23% yezigulane ezine-INR zifikelele kwithagethi zibonise amanqanaba e-D-Dimer angaqhelekanga, ngelixa izigulane ezinezinga elingaqhelekanga le-D-Dimer ziphuhlisiwe. iziganeko kunye neziganeko ze-cardiovascular 15.8 kunye ne-7.64 amaxesha, ngokulandelanayo, izigulane ezinezinga eliqhelekileyo le-D-Dimer.
• Kwezi zifo ezithile okanye izigulane ezithile, i-D-Dimer ephakamileyo okanye ethe gqolo ibonisa ukuba isifo sibi okanye sibi kakhulu.
4. Ukusetyenziswa kwe-D-Dimer kunyango lwe-anticoagulation yomlomo:
• I-D-Dimer inquma ubude be-anticoagulation yomlomo: Ixesha elifanelekileyo le-anticoagulation kwizigulane ezine-VTE okanye enye i-thrombus ihlala ingabonakali.Kungakhathaliseki ukuba i-NOAC okanye i-VKA, izikhokelo zamazwe ngamazwe ezifanelekileyo zincoma ukuba i-anticoagulation ixesha elide kufuneka igqitywe ngokwengozi yokuphuma kwegazi kwinyanga yesithathu yonyango lwe-anticoagulation, kwaye i-D-Dimer inokubonelela ngolwazi lomntu ngamnye kule nto.
• I-D-Dimer ikhokela ukulungiswa kwe-anticoagulant intensity yomlomo: I-Warfarin kunye ne-anticoagulants entsha yomlomo yinto esetyenziswa ngokuqhelekileyo kwi-anticoagulants yomlomo kwimisebenzi yeklinikhi, zombini inokunciphisa izinga le-D-Dimer.kunye nokusebenza kwenkqubo ye-fibrinolytic, ngaloo ndlela inciphisa ngokungathanga ngqo inqanaba le-D-Dimer.Iziphumo zovavanyo zibonisa ukuba i-D-Dimer-guided anticoagulation kwizigulane zinciphisa ngokufanelekileyo iziganeko zeziganeko ezimbi.
Ukuqukumbela, uvavanyo lwe-D-Dimer alusekho kuphela kwizicelo zemveli ezifana nokuxilongwa kwe-VTE kunye nokufunyanwa kwe-DIC.I-D-Dimer idlala indima ebalulekileyo kuqikelelo lwesifo, ukuxela kwangaphambili, ukusetyenziswa kwe-anticoagulants yomlomo, kunye ne-COVID-19.Ngokuqhubeka ngokunzulu kophando, ukusetyenziswa kwe-D-Dimer kuya kuba kubanzi ngakumbi.
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