Yintoni i-D-dimer?

I-D-dimer iyona mveliso elula yokuthotywa kwe-fibrin, kwaye inqanaba layo eliphakamileyo lingabonakalisa i-hypercoagulable state kunye ne-hyperfibrinolysis yesibini kwi-vivo.I-D-dimer ingasetyenziselwa njengophawu lwe-hypercoagulability kunye ne-hyperfibrinolysis kwi-vivo, kwaye ukunyuka kwayo kubonisa ukuba ihambelana nezifo ze-thrombotic ezibangelwa izizathu ezahlukeneyo kwi-vivo, kwaye ibonisa kwakhona ukuphuculwa komsebenzi we-fibrinolytic.

Ngaphantsi kwaziphi iimeko apho amanqanaba e-D-dimer aphakanyisiwe?

Zombini i-venous thromboembolism (VTE) kunye ne-non-venous thromboembolic ukuphazamiseka kunokubangela amanqanaba aphezulu e-D-dimer.

I-VTE ibandakanya i-acute pulmonary embolism, i-deep vein thrombosis (DVT) kunye ne-cerebral venous (sinus) thrombosis (CVST).

Iziphazamiso ze-thromboembolic ezingenayo i-venous ziquka i-acute aortic dissection (AAD), i-aneurysm ephukile, i-stroke (CVA), i-disseminated intravascular coagulation (DIC), i-sepsis, i-acute coronary syndrome (ACS), kunye nesifo esingapheliyo se-pulmonary (COPD), njl. , Amanqanaba e-D-dimer nawo aphakanyisiwe kwiimeko ezinjengobudala obudala, utyando lwangoku / ukwenzakala, kunye ne-thrombolysis.

I-D-dimer ingasetyenziselwa ukuvavanya i-pulmonary embolism prognosis

I-D-dimer iqikelela ukufa kwizigulane ezine-pulmonary embolism.Kwizigulana ezine-acute pulmonary embolism, amaxabiso aphezulu e-D-dimer anxulunyaniswa namanqaku aphezulu e-PESI (iPulmonary Embolism Severity Index Score) kunye nokunyuka kokusweleka.Uphononongo lubonise ukuba i-D-dimer <1500 μg / L inexabiso elingcono elibi lokuxela kwangaphambili kwi-3-inyanga yokufa kwe-pulmonary embolism: inyanga ye-3 yokufa yi-0% xa i-D-dimer <1500 μg/L.Xa i-D-dimer inkulu kune-1500 μg / L, kufuneka kusetyenziswe ukuqapha okuphezulu.

Ukongezelela, ezinye izifundo zibonise ukuba izigulane ezinomhlaza wemiphunga, i-D-dimer <1500 μg / L idla ngokuba ngumsebenzi ophuculweyo we-fibrinolytic obangelwa ngamathumba;I-D-dimer>1500 μg/L ihlala ibonisa ukuba izigulana ezinomhlaza wemiphunga zine-deep vein thrombosis (DVT) kunye ne-pulmonary embolism.

I-D-dimer iqikelela ukuphindaphinda kwe-VTE

I-D-dimer ingqikelelo ye-VTE eqhubekayo.Izigulane ze-D-dimer-negative zinezinga le-3 lokuphindaphinda kweenyanga ze-0. Ukuba i-D-dimer iphinda iphakame ngexesha lokulandelelana, umngcipheko wokuphindaphinda kwe-VTE unokunyuka kakhulu.

I-D-dimer inceda ekuxilongweni kwe-aortic dissection

I-D-dimer inexabiso elihle elibi lokuxela kwangaphambili kwizigulane ezine-aortic dissection, kunye ne-D-dimer negativity inokulawula i-aortic dissection.I-D-dimer iphakanyisiwe kwizigulane ezine-aortic dissection kwaye ayiphakamisi kakhulu kwizigulane ezine-aortic dissection engapheliyo.

I-D-dimer iguquguquka ngokuphindaphindiweyo okanye ngokukhawuleza iphakama, iphakamisa umngcipheko omkhulu wokuqhekeka kwe-dissection.Ukuba inqanaba le-D-dimer yesigulane lizinzile kwaye liphantsi (<1000 μg / L), umngcipheko wokuqhekeka kwe-dissection encinci.Ke ngoko, inqanaba le-D-dimer lingakhokela unyango olukhethekileyo lwezo zigulana.

D-dimer kunye nosulelo

Usulelo ngomnye woonobangela be-VTE.Ngethuba lokukhupha izinyo, i-bacterium ingenzeka, enokuthi ibangele iziganeko ze-thrombotic.Ngeli xesha, amanqanaba e-D-dimer kufuneka abekwe esweni ngokusondeleyo, kwaye unyango lwe-anticoagulation kufuneka luqiniswe xa amanqanaba e-D-dimer ephakanyisiwe.

Ukongezelela, izifo zokuphefumula kunye nokulimala kwesikhumba zizinto ezinobungozi kwi-vein thrombosis enzulu.

I-D-dimer ikhokela unyango lwe-anticoagulation

Iziphumo ze-PROLONG i-multicenter, isifundo esilindelekileyo zombini kwi-original (i-18-inyanga yokulandelelana) kunye nokwandiswa (i-30-inyanga yokulandelelana) izigaba zibonise ukuba xa kuthelekiswa nezigulane ezingenayo i-anticoagulated, izigulane ze-D-dimer-positive zaqhubeka emva kwe-1. inyanga yokuphazamiseka kwonyango I-Anticoagulation yanciphisa kakhulu umngcipheko wokuphindaphinda kwe-VTE, kodwa kwakungekho mmahluko obalulekileyo kwizigulane ze-D-dimer-negative.

Kuphononongo olupapashwe yiGazi, uNjingalwazi uKearon uphinde wachaza ukuba unyango lwe-anticoagulation lunokukhokelwa ngokwenqanaba le-D-dimer yesigulana.Kwizigulane ezine-DVT engavumelekanga okanye i-pulmonary embolism, unyango lwe-anticoagulation lunokukhokelwa ngu-D-dimer ukufumanisa;ukuba i-D-dimer ingasetyenziswanga, ikhosi ye-anticoagulation inokumiselwa ngokwengozi yokopha kunye neminqweno yesigulane.

Ukongeza, i-D-dimer inokukhokela unyango lwe-thrombolytic.