Iyini i-D-dimer?

I-D-dimer iwumkhiqizo olula wokuwohloka kwe-fibrin, futhi izinga layo eliphakeme lingabonisa isimo se-hypercoagulable kanye ne-hyperfibrinolysis yesibili ku-vivo.I-D-dimer ingasetshenziswa njengophawu lwe-hypercoagulability kanye ne-hyperfibrinolysis ku-vivo, futhi ukwanda kwayo kusikisela ukuthi ihlobene nezifo ze-thrombotic ezibangelwa izizathu ezihlukahlukene ku-vivo, futhi ikhombisa ukuthuthukiswa komsebenzi we-fibrinolytic.

Kungaphansi kwaziphi izimo lapho amazinga e-D-dimer ephakanyiswa?

Kokubili i-venous thromboembolism (VTE) kanye ne-non-venous thromboembolic disorders kungabangela amazinga aphezulu e-D-dimer.

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

Izinkinga ze-Non-venous thromboembolic zihlanganisa i-acute aortic dissection (AAD), i-aneurysm ephukile, i-stroke (i-CVA), i-disseminated intravascular coagulation (DIC), i-sepsis, i-acute coronary syndrome (ACS), nesifo se-chronic obstructive Pulmonary (COPD), njll. Ngaphezu kwalokho. , Amazinga e-D-dimer nawo aphakanyisiwe ezimeni ezifana nokukhula, ukuhlinzwa kwakamuva/ukuhlukumezeka, kanye ne-thrombolysis.

I-D-dimer ingasetshenziswa ukuhlola ukubikezelwa kwe-pulmonary embolism

I-D-dimer ibikezela ukufa kweziguli ezine-pulmonary embolism.Ezigulini ezine-acute pulmonary embolism, amanani aphezulu e-D-dimer ahlotshaniswa nezikolo eziphakeme ze-PESI (Pulmonary Embolism Severity Index Score) kanye nokunyuka kokufa.Ucwaningo luye lwabonisa ukuthi i-D-dimer <1500 μg/L inevelu elibikezela elibi elingcono lezinyanga ezi-3 zokufa kwe-pulmonary embolism: ukufa kwezinyanga ezi-3 kungu-0% lapho i-D-dimer <1500 μg/L.Uma i-D-dimer ingaphezu kuka-1500 μg/L, ukuqapha okuphezulu kufanele kusetshenziswe.

Ukwengeza, ezinye izifundo zibonise ukuthi ezigulini ezinomdlavuza wamaphaphu, i-D-dimer <1500 μg/L ivame ukuba umsebenzi othuthukisiwe we-fibrinolytic obangelwa izimila;I-D-dimer>1500 μg/L ivame ukukhombisa ukuthi iziguli ezinomdlavuza wamaphaphu zine-deep vein thrombosis (DVT) kanye ne-pulmonary embolism.

I-D-dimer ibikezela ukuphindeka kwe-VTE

I-D-dimer ibikezela i-VTE eqhubekayo.Iziguli ezine-D-dimer-negative zinezinga lokuphindaphinda lezinyanga ezingu-3 ze-0. Uma i-D-dimer iphakama futhi ngesikhathi sokulandelela, ingozi yokuphindaphinda kwe-VTE ingakhula kakhulu.

I-D-dimer isiza ekuxilongweni kwe-aortic dissection

I-D-dimer inenani elihle lokubikezela elibi ezigulini ezine-aortic dissection ebukhali, futhi ukunganaki kwe-D-dimer kungakhipha i-aortic dissection.I-D-dimer iphakanyisiwe ezigulini ezine-aortic dissection futhi ayiphakamisi kakhulu ezigulini ezine-aortic dissection engapheli.

I-D-dimer ishintshashintsha ngokuphindaphindiwe noma ikhuphuka ngokuzumayo, okuphakamisa ingozi enkulu yokuqhekeka kwe-dissection.Uma izinga le-D-dimer lesiguli lizinzile futhi liphansi (<1000 μg/L), ingozi yokuqhekeka kwe-disection incane.Ngakho-ke, izinga le-D-dimer lingaqondisa ukwelashwa okukhethekile kwalezo ziguli.

I-D-dimer kanye nokutheleleka

Ukutheleleka kungenye yezimbangela ze-VTE.Ngesikhathi sokukhishwa kwamazinyo, i-bacterium ingase ivele, engaholela ezenzakalweni ze-thrombotic.Ngalesi sikhathi, amazinga e-D-dimer kufanele aqashwe eduze, futhi ukwelashwa kwe-anticoagulation kufanele kuqiniswe lapho amazinga e-D-dimer ephakanyisiwe.

Ngaphezu kwalokho, izifo zokuphefumula kanye nokulimala kwesikhumba yizici eziyingozi ze-deep vein thrombosis.

I-D-dimer iqondisa ukwelashwa kwe-anticoagulation

Imiphumela ye-multicenter ye-PROLONG, ucwaningo olulindelekile kokubili ekuqaleni (ukulandelwa kwezinyanga ezingu-18) kanye nezigaba ezinwetshiwe (izinyanga ezingu-30 zokulandela) zibonise ukuthi uma kuqhathaniswa neziguli ezingezona i-anticoagulated, iziguli ezine-D-dimer-positive zaqhubeka ngemva kwe-1. inyanga yokuphazamiseka kokwelashwa I-Anticoagulation yanciphisa kakhulu ingozi yokuphindaphinda kwe-VTE, kodwa kwakungekho umehluko ophawulekayo ezigulini ezine-D-dimer-negative.

Ekubuyekezeni okushicilelwe yi-Blood, uProfesa Kearon wabuye waveza ukuthi ukwelashwa kwe-anticoagulation kungaqondiswa ngokwezinga le-D-dimer lesiguli.Ezigulini ezine-DVT eseduze engavunyelwe noma i-pulmonary embolism, ukwelashwa kwe-anticoagulation kungaqondiswa ukutholwa kwe-D-dimer;uma i-D-dimer ingasetshenziswa, inkambo ye-anticoagulation inganqunywa ngokuya ngengozi yokopha kanye nezifiso zesiguli.

Ngaphezu kwalokho, i-D-dimer ingaqondisa ukwelashwa kwe-thrombolytic.