Ngokujula kokuqonda kwabantu nge-thrombus, i-D-dimer isetshenziswe njengento evame ukusetshenziswa kakhulu yokuhlola ukukhishwa kwe-thrombus kumalabhorethri we-coagulation Clinic.Kodwa-ke, lokhu kuyincazelo eyinhloko ye-D-Dimer.Manje izazi eziningi zinikeze i-D-Dimer incazelo ecebile ocwaningweni lwe-D-Dimer ngokwayo kanye nobudlelwano bayo nezifo.Okuqukethwe kwalolu daba kuzokuholela ekutheni uthokozele isiqondiso sayo esisha sohlelo lokusebenza.
Isisekelo sokusetshenziswa komtholampilo kwe-D-dimer
01. Ukwanda kwe-D-Dimer kumelela ukusebenza kwesistimu ye-coagulation kanye nesistimu ye-fibrinolysis emzimbeni, futhi le nqubo ibonisa isimo esiphezulu sokuguqulwa.I-D-Dimer engeyiyo ingasetshenziselwa ukukhishwa kwe-thrombus (inani lomtholampilo eliwumgogodla);kuyilapho i-D-Dimer positive ayikwazi ukufakazela ukwakheka kwe-thromboembolism.Ukuthi i-thromboembolism yakheka noma cha kuncike ebhalansini yalezi zinhlelo ezimbili.
02. I-half-life ye-D-Dimer ingu-7-8h, futhi ingatholwa 2h ngemva kwe-thrombosis.Lesi sici singahambisana kahle nokusebenza komtholampilo, futhi ngeke kube nzima ukuqapha ngoba isigamu sempilo sifushane kakhulu, futhi ngeke silahlekelwe ukubaluleka kokuqapha ngoba isigamu sempilo side kakhulu.
03. I-D-Dimer ingakwazi ukuzinza kumasampula egazi ngemva kwe-invitro okungenani amahora angu-24-48, ukuze okuqukethwe kwe-D-Dimer okutholwe ku-vitro kubonise ngokunembile izinga le-D-Dimer ku-vivo.
04. Indlela yokusebenza ye-D-Dimer yonke isekelwe ekuphenduleni kwe-antigen-antibody, kodwa indlela yokusebenza ethile miningi kodwa ayifani.Amasosha omzimba aku-reagent ahlukene, futhi izingcezu ze-antigen ezitholiwe azihambisani.Lapho ukhetha umkhiqizo elabhorethri, kufanele uhlolwe.
Traditional coagulation emtholampilo isicelo D-dimer
1. Ukuxilongwa kokukhishwa kwe-VTE:
Ukuhlolwa kwe-D-Dimer okuhlanganiswe namathuluzi okuhlola ubungozi basemtholampilo kungasetshenziswa kahle ukuze kungafaki i-deep vein thrombosis (DVT) kanye ne-pulmonary embolism (PE).
Uma kusetshenziselwa ukukhishwa kwe-thrombus, kunezidingo ezithile ze-D-Dimer reagent kanye nendlela yokusebenza.Ngokwezinga lemboni ye-D-Dimer, amathuba okuhlolwa ahlanganisiwe adinga izinga lokuqagela elibi lika-≥97% kanye nokuzwela okungu-≥95%.
2. Ukuxilongwa kwe-axiliary kwe-dissemination intravascular coagulation (DIC):
Ukubonakaliswa okuvamile kwe-DIC uhlelo lwe-hyperfibrinolysis, futhi ukutholwa okungabonisa i-hyperfibrinolysis kudlala indima ebalulekile kusistimu yokufaka amaphuzu ye-DIC.Kuye kwaboniswa emtholampilo ukuthi i-D-Dimer izokwenyuka kakhulu (ngaphezu kwezikhathi ze-10) ezigulini ze-DIC.Eziqondisweni zokuxilonga ze-DIC zasekhaya nezangaphandle noma ukuvumelana, i-D-Dimer isetshenziswa njengenye yezinkomba zaselabhorethri zokuxilonga i-DIC, futhi kuyanconywa ukwenza i-FDP ngokuhlanganyela.Thuthukisa ngempumelelo ukuxilongwa kwe-DIC.Ukuxilongwa kwe-DIC akukwazi ukwenziwa kuphela ngokuthembela kunkomba eyodwa yaselabhorethri kanye nemiphumela yokuhlolwa okukodwa.Kudingeka ukuthi ihlaziywe ngokuphelele futhi iqashwe ngamandla kuhlanganiswe nokubonakaliswa komtholampilo kwesiguli nezinye izinkomba zaselabhorethri.
Izicelo ezintsha zomtholampilo ze-D-Dimer
1. Ukusetshenziswa kwe-D-Dimer ezigulini ezine-COVID-19: Ngomqondo othile, i-COVID-19 iyisifo esibangelwa yizifo ezibangelwa amasosha omzimba, esinempendulo yokuvuvukala esakazekile kanye ne-microthrombosis emaphashini.Kubikwa ukuthi ngaphezu kwama-20% eziguli ezine-VTE ezisemacaleni alaliswe esibhedlela e-COVID-19.
• Amazinga e-D-Dimer ekungenisweni abikezele ngokuzimele ukufa kwabantu esibhedlela futhi ahlola iziguli ezingaba sengozini enkulu.Njengamanje, i-D-dimer isiphenduke enye yezinto ezibalulekile zokuhlola iziguli ezine-COVID-19 lapho zingeniswa esibhedlela.
• I-D-Dimer ingasetshenziselwa ukuqondisa ukuthi kufanele kuqalwe yini i-heparin anticoagulation ezigulini ezine-COVID-19.Kuye kwabikwa ukuthi ezigulini ezine-D-Dimer ≥ izikhathi ezingu-6-7 umkhawulo ophezulu webanga lokubhekisela, ukuqaliswa kwe-heparin anticoagulation kungathuthukisa kakhulu imiphumela yesiguli.
• Ukuqapha okunamandla kwe-D-Dimer kungasetshenziswa ukuhlola ukwenzeka kwe-VTE ezigulini ezine-COVID-19.
• Ukubhekwa kwe-D-Dimer, okungasetshenziswa ukuhlola umphumela we-COVID-19.
• Ukuqapha kwe-D-Dimer, lapho ukwelashwa kwesifo kubhekene nesinqumo, ingabe i-D-Dimer inganikeza ulwazi oluthile lwereferensi?Ziningi izinhlolo zokwelashwa ezibhekwa phesheya.
2. Ukuqapha okunamandla kwe-D-Dimer kubikezela ukwakheka kwe-VTE:
Njengoba kushiwo ngenhla, isigamu-ukuphila D-Dimer kuyinto 7-8h.Kungenxa yalesi sici ukuthi i-D-Dimer ingakwazi ukuqapha ngamandla futhi ibikezele ukwakheka kwe-VTE.Esimeni se-hypercoagulable yesikhashana noma i-microthrombosis, i-D-Dimer izokhuphuka kancane bese yehla ngokushesha.Uma kunokwakheka kwe-thrombus okusha okuqhubekayo emzimbeni, i-D-Dimer emzimbeni izoqhubeka nokukhuphuka, ikhombisa ijika elikhuphukayo elifana nenani eliphakeme.Kubantu abanezinga eliphezulu le-thrombosis, njengezimo ezinzima nezinzima, iziguli zangemva kokuhlinzwa, njll., uma izinga le-D-Dimer likhula ngokushesha, qaphela ukuthi kungenzeka yini i-thrombosis.Ku-"Expert Consensus on the Screening and Treatment of Deep Vein Thrombosis in Trauma Orthopedic Patients", kunconywa ukuthi iziguli ezisengozini emaphakathi nephezulu ngemva kokuhlinzwa kwamathambo kufanele ziqaphele izinguquko ze-D-Dimer njalo emahoreni angu-48.Ukuhlolwa kwezithombe kufanele kwenziwe ngesikhathi ukuze kuhlolwe i-DVT.
3. I-D-Dimer njengenkomba yokubikezela izifo ezihlukahlukene:
Ngenxa yobudlelwane obuseduze phakathi kwesistimu ye-coagulation kanye nokuvuvukala, ukulimala kwe-endothelial, njll., ukuphakama kwe-D-Dimer nakho kuvame ukubonwa kwezinye izifo ezingezona ze-thrombotic ezifana nokutheleleka, ukuhlinzwa noma ukuhlukumezeka, ukuhluleka kwenhliziyo, kanye nezimila ezimbi.Ucwaningo luye lwathola ukuthi ukubikezela okubi okuvame kakhulu kwalezi zifo i-thrombosis, i-DIC, njll. Iningi lalezi zinkinga yizifo ezihlobene kakhulu noma izifunda ezibangela ukuphakama kwe-D-Dimer.Ngakho-ke, i-D-Dimer ingasetshenziswa njengenkomba yokuhlola ebanzi futhi ebucayi yezifo.
• Ezigulini zesimila, izifundo eziningana zithole ukuthi izinga lokusinda leminyaka engu-1-3 yeziguli ezinobungozi ezine-D-Dimer ephakeme liphansi kakhulu kuneziguli ezivamile ze-D-Dimer.I-D-Dimer ingasetshenziswa njengenkomba yokuhlola ukubikezelwa kweziguli ezibulalayo zesimila.
• Ezigulini ze-VTE, ucwaningo oluningi luye lwaqinisekisa ukuthi iziguli ezine-D-Dimer-positive ezine-VTE zinengozi ephakeme izikhathi ezingu-2-3 zokuphindaphinda kwe-thrombus elandelayo ngesikhathi se-anticoagulation kuneziguli ezingezinhle.Okunye ukuhlaziywa kwe-meta okuhlanganisa izifundo ezingu-7 ezinengqikithi yezifundo ze-1818 zibonise ukuthi, i-D-Dimer engavamile ingenye yezibikezelo eziyinhloko zokuphindaphinda kwe-thrombus ezigulini ze-VTE, futhi i-D-Dimer ifakwe kumamodeli amaningi okubikezela ingozi yokuphindaphinda kwe-VTE.
• Ezigulini zokushintsha ama-valve emishini (MHVR), ucwaningo olulandela isikhathi eside lwezifundo ezingama-618 lubonise ukuthi ingozi yezenzakalo ezimbi ezigulini ezinamazinga angavamile e-D-Dimer phakathi ne-warfarin ngemva kwe-MHVR yayicishe ibe izikhathi ezi-5 kuneziguli ezivamile.Ukuhlaziywa kwe-multivariate correlation kuqinisekisile ukuthi izinga le-D-Dimer laliyisibikezelo esizimele sezenzakalo ze-thrombotic noma zenhliziyo phakathi ne-anticoagulation.
• Ezigulini ezine-atrial fibrillation (AF), i-D-Dimer ingabikezela izehlakalo ze-thrombotic kanye nezenzakalo zenhliziyo nemithambo yegazi ku-anticoagulation yomlomo.Ucwaningo olulindelekile lweziguli ezingama-269 ezine-atrial fibrillation olwalandelwa cishe iminyaka emi-2 lubonise ukuthi ngesikhathi sokunqanda ukuqunjelwa ngomlomo, cishe ama-23% eziguli ezine-INR zafinyelela lapho okwakuhloswe khona zabonisa amazinga e-D-Dimer angejwayelekile, kuyilapho iziguli ezinezinga le-D-Dimer elingavamile zakhula Izingozi ze-thrombotic. imicimbi kanye nemicimbi ye-comorbid ye-cardiovascular yayingu-15.8 kanye nezikhathi ze-7.64, ngokulandelana, zeziguli ezinamazinga ajwayelekile e-D-Dimer.
• Kulezi zifo ezithile noma iziguli ezithile, i-D-Dimer ephakeme noma eqhubekayo ivame ukukhombisa ukubikezela okungekuhle noma ukwanda kwesifo.
4. Ukusetshenziswa kwe-D-Dimer ekwelashweni kwe-oral anticoagulation:
• I-D-Dimer inquma ubude besikhathi se-anticoagulation yomlomo: Isikhathi esiphezulu se-anticoagulation ezigulini ezine-VTE noma enye i-thrombus ihlala ingacacile.Kungakhathaliseki ukuthi i-NOAC noma i-VKA, iziqondiso ezifanele zamazwe ngamazwe zincoma ukuthi i-anticoagulation ehlala isikhathi eside kufanele inqunywe ngokuvumelana nengozi yokopha enyangeni yesithathu yokwelashwa kwe-anticoagulation, futhi i-D-Dimer ingahlinzeka ngolwazi lomuntu ngamunye ngalokhu.
• I-D-Dimer iqondisa ukulungiswa kwe-oral anticoagulant intensity: I-Warfarin kanye nama-anticoagulant omlomo amasha ama-anticoagulant omlomo asetshenziswa kakhulu ekusebenzeni komtholampilo, kokubili okunganciphisa izinga le-D-Dimer.kanye nokusebenza kohlelo lwe-fibrinolytic, ngaleyo ndlela kwehlisa izinga le-D-Dimer ngokungaqondile.Imiphumela yokuhlola ibonisa ukuthi i-D-Dimer-guided anticoagulation ezigulini inciphisa ngempumelelo izehlakalo zezenzakalo ezimbi.
Sengiphetha, ukuhlolwa kwe-D-Dimer akusakhawulelwe ezinhlelweni ezivamile ezifana nokuxilongwa kwe-VTE nokutholwa kwe-DIC.I-D-Dimer idlala indima ebalulekile ekubikezelweni kwezifo, ekubikezelweni, ekusetshenzisweni kwama-anticoagulant omlomo, kanye ne-COVID-19.Ngokujula okuqhubekayo kocwaningo, ukusetshenziswa kwe-D-Dimer kuzokwanda kakhulu.
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