王建中的D-dimer资料

D-dimerassaysMethodologyandApplication北京大学第一医院检验科王建中JianzhongWang,[e-mail]-dimerAmarkerofcoagulationandfibrinolysisactivationAmarkerofacutethrombosisfhbblidiiforthromboembolismdiagnosisJianzhongWang,[e-mail]ninthecirculationAcutethromboticeventsinthebloodcirculationCVTAcutethromboticeventsinthebloodcirculationVenousArterialMicrocirculationDeepvenousAcutecoronaryDisseminatedStrokePEDeepvenousthrombosis(DVT)Pulmonaryembolism(PE)Acutecoronarysyndromes(ACS)Disseminatedintravascularcoagulation(DIC);dtiACSe.g.duetosepsisCerebralvenousthrombosis(CVT)StrokeCross-linkedFibrinDegradationPdtProducts(D-dimer)DVTJianzhongWang,[e-mail]-dimerformationJianzhongWang,[e-mail]binFXIIIaDDEFibrinogenFibrinMonomerCross-linkedFibrinClotDDPlasminFragmentXEFragmentYFragmentDDDD-DimerFibrinolysisFragmentEDDDDDDDDDDEFDPJianzhongWang,[e-mail]3.53.5FPAFPAHalfHalf--life(min)ofcoagulationlife(min)ofcoagulation1515TATTATHalfHalflife(min)ofcoagulationlife(min)ofcoagulationActivationmarkersActivationmarkers1515IXactiv.peptideIXactiv.peptide90903030F1+2(II)F1+2(II)Xactiv.peptideXactiv.peptide1501509090VIIaVIIaF1+2(II)F1+2(II)480480DD--dimerdimer0100200300400500600JianzhongWang,[e-mail]ofD-dimerlevelfmJianzhongWang,[e-mail]-dimerAssayMethodologyimmunoassayprinciplesƒELISATwoanti-D-dimermonoclonalantibodies:catchingandenzyme-labelledtaggingƒManual(microplateimmunefiltration)ƒManual(microplate,immunefiltration)ƒAutomated(ELFA,enzyme-linkedfluorescenceassay;VIDAS®)ƒRedbloodcellagglutinationBi-specificmonoclonalantibody(redcellsandD-dimer)ƒManual,wholeblood(SimpliRED®)ƒLatexparticleagglutinationSingleanti-D-dimermonoclonalantibodyƒManual(slide)ƒAutomated(immunoturbidimetric;variousanalyzers)JianzhongWang,[e-mail]ƒAutomated(immunoturbidimetric;variousanalyzers)EifthDEifthDdilldillExpressionoftheDExpressionoftheD--dimerleveldimerlevelDDU:DDDU:D--dimerunit,dimerunit,µg/ml(orµg/ml(orngng/ml,mg/L)/ml,mg/L)FEU:FibrinogenEquivalentUnit.FEU:FibrinogenEquivalentUnit.µg/ml(orµg/ml(orngng/ml/ml,,mg/Lmg/L)),theDDUconcentrationisapproximatelyhalfof,theDDUconcentrationisapproximatelyhalfofmg/Lmg/L)),thDDconcntratonsappromatyhafof,thDDconcntratonsappromatyhafoftheFEUtheFEUhfhfTheuseofSIunitsTheuseofSIunitsJianzhongWang,[e-mail]-dimermeasurementDdiiidifliii•D-dimerisanindicatorofcoagulationactivation,cross-linkedfibrinformationandhyperfibrinolysisinvivoinvivo•MolecularweightofD-dimerisaround180kD•Monoclonalantibodiesweredeveloped,whichp,recongizeepitopesforD-dimer•ArapidsampleturnaroundtimeforD-dimertestissstilisessential•D-dimermeasurementshouldbereachedwithinminutesratherthanhoursminutesratherthanhoursJianzhongWang,[e-mail]2008,6:1059-1071JianzhongWang,[e-mail]2007,5:296-304JianzhongWang,[e-mail]ardizationoftheD-dimerassaystheDdimerassaysJianzhongWang,[e-mail]-dimerassays•ThecalibratorsforDDunitsWithithi•Withvarioustechniques•Differentcut-offs•SystemsofunitsOtilhtiti•Operationalcharacteristics•ClinicalvaliditynaayJianzhongWang,[e-mail]-dimerassays•Comprehensivereferencesystem:–referencemethod–Primarystandard–UseofSIunitsUseofSIunts•D-dimerisnotasingleentity•D-dimerisacomplexmixtureofdegradationDdimerisacomplexmixtureofdegradationproductsofdifferentsize•ResultsofD-dimerassayisamethod-specificyp•TomaketestresultscomparableJianzhongWang,[e-mail]yteD-dimerisnotasingleanalyteƒHeterogeneouscompositionoffibrindegradationproductsƒMultipleDdimerepitopesDDƒMultipleD-dimerepitopesƒQuantityandsizedistributionariesbeteenindiidalsandDDvariesbetweenindividualsandbetweendiseasestatesHihllihfDDƒHighmolecularweightfragmentsaremostabundantDDDDDDDDDDEJianzhongWang,[e-mail]-dimerasadiagnostictest•D-Dimerforrulingoutvenousthromboembolism•D-Dimerfordiagnosing(rulingin)venousthbblithromboembolism•UseofDDtestinginspecialpopulations–ElderlypatientsElderlypatients–Cancerpatients–PatientswithpreviousDVT/PE–Pregnantwomen–PatientswithasmallthrombusburdenPtitldtiltttt–Patientsalreadyonanticoagulanttreatment•D-dimerasaprognosticmarkerinpatientswithVTEJianzhongWang,[e-mail]terpretationoftheD--dimerleveldimerlevelInterpretationoftheDInterpretationoftheDdimerleveldimerlevelDD--dimer0.5mg/Ldimer0.5mg/LÎÎfurtherinvestigationsfurtherinvestigationsDVT/PE/ATEDVT/PE/ATE→→DVT/PE/ATEDVT/PE/ATE→→DICDIC→→CancerCancer→→CancerCancer→→SepsisSepsis→→Elderly,inflammation,postElderly,inflammation,post--surgery…surgery…ypypgygy→→OACefficacyOACefficacy0.5mg/L………………………….cutoffforVTEexclusion0.5mg/L………………………….cutoffforVTEexclusionJianzhongWang,[e-mail]--dimertests:clinicalperformancedimertests:clinicalperformanceatacutoffof0.5mg/Latacutoffof0.5mg/L