{"id":19176,"date":"2023-04-14T00:18:11","date_gmt":"2023-04-13T17:18:11","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19176"},"modified":"2023-04-17T16:21:38","modified_gmt":"2023-04-17T09:21:38","slug":"tang-ap-phoi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/tang-ap-phoi\/","title":{"rendered":"T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i: \u0110\u1ecbnh ngh\u0129a, ph\u00e2n lo\u1ea1i v\u00e0 sinh l\u00fd b\u1ec7nh"},"content":{"rendered":"<p><strong>T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (Pulmonary Artery Hypertension) l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh hi\u1ebfm g\u1eb7p, nh\u01b0ng c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng cho s\u1ee9c kh\u1ecfe c\u1ee7a con ng\u01b0\u1eddi. B\u1ec7nh l\u00fd n\u00e0y \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u0103ng \u00e1p su\u1ea5t trong c\u00e1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, d\u1eabn \u0111\u1ebfn s\u1ef1 suy gi\u1ea3m ch\u1ee9c n\u0103ng c\u1ee7a tim v\u00e0 ph\u1ed5i.\u00a0Trong b\u00e0i n\u00e0y\u00a0 s\u1ebd tr\u00ecnh b\u00e0i m\u1ed9t c\u00e1ch t\u1ed5ng quan v\u1ec1 t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, t\u1eeb \u0111\u1ecbnh ngh\u0129a, ph\u00e2n lo\u1ea1i v\u00e0 sinh l\u00fd b\u1ec7nh.<\/strong><\/p>\n<h1><strong>1. T\u1ed5ng qu\u00e1t v\u1ec1 t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i\u00a0<\/strong><\/h1>\n<p><strong>1.1. \u0110\u1ecbnh ngh\u0129a<\/strong><\/p>\n<p>Theo nh\u01b0 \u0111\u1ecbnh ngh\u0129a tr\u01b0\u1edbc kia, t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i ( Pulmonary Hypertension \u2013 PH) l\u00e0 khi \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trung b\u00ecnh (mean pulmonary artery pressure \u2013mPAP) \u2265 25 mmHg khi ngh\u1ec9 ng\u01a1i.<\/p>\n<p>Hi\u1ec7n nay, theo ESC\/ERS 2022 th\u00ec t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trung b\u00ecnh &gt;20 mmHg khi ngh\u1ec9 ng\u01a1i. \u0110\u1ecbnh ngh\u0129a v\u1ec1 t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (PAH) c\u0169ng bao h\u00e0m s\u1ee9c c\u1ea3n m\u1ea1ch m\u00e1u ph\u1ed5i (PVR) &gt;2 \u0111\u01a1n v\u1ecb Wood v\u00e0 \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u00edt \u2264 15 mmHg.<\/p>\n<p><strong>1.2. Ph\u00e2n lo\u1ea1i<\/strong><\/p>\n<p>T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) v\u00e0 Hi\u1ec7p h\u1ed9i tim m\u1ea1ch New York (NYHA) ph\u00e2n lo\u1ea1i b\u1ec7nh t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i th\u00e0nh 5 nh\u00f3m d\u1ef1a tr\u00ean c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m chung v\u1ec1 c\u01a1 ch\u1ebf b\u1ec7nh v\u00e0 g\u1ed3m c\u00e1c nh\u00f3m sau \u0111\u00e2y<\/p>\n<p><strong>1.2.1. T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (Pulmonary Hypertension)<\/strong><\/p>\n<p>Nh\u00f3m n\u00e0y t\u1eadp trung v\u00e0o c\u00e1c b\u1ec7nh \u1ea3nh h\u01b0\u1edfng tr\u1ef1c ti\u1ebfp \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, d\u1eabn \u0111\u1ebfn c\u00e1c thay \u0111\u1ed5i c\u1ea5u tr\u00fac, t\u0103ng sinh c\u01a1 tr\u01a1n v\u00e0 ch\u1ee9c n\u0103ng b\u1ea5t th\u01b0\u1eddng c\u1ee7a t\u1ebf b\u00e0o n\u1ed9i m\u1ea1c.<\/p>\n<p>T\u0103ng huy\u1ebft \u00e1p ph\u1ed5i \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a trong th\u1ee7 thu\u1eadt m\u1ea1ch m\u00e1u tim khi \u1edf tr\u1ea1ng th\u00e1i ngh\u1ec9, \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trung b\u00ecnh \u2265 20 mmHg, \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u00edt \u00a0\u2264 15 mmHg v\u00e0 kh\u00e1ng tr\u1edf \u00a0\u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u2265 3 \u0111\u01a1n v\u1ecb Wood.<\/p>\n<figure id=\"attachment_20961\" aria-describedby=\"caption-attachment-20961\" style=\"width: 635px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-20961 size-full\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/2-13.jpg\" alt=\"\" width=\"635\" height=\"445\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/2-13.jpg 635w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/2-13-300x210.jpg 300w\" sizes=\"(max-width: 635px) 100vw, 635px\" \/><figcaption id=\"caption-attachment-20961\" class=\"wp-caption-text\"><strong>M\u00f4 t\u1ea3 sinh l\u00fd b\u1ec7nh t\u0103ng \u00e1p ph\u1ed5i.\u00a0<\/strong> <strong>Ngu\u1ed3n:<\/strong> <em>Centers for Disease Control and Prevention<\/em><\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p><strong>1.2.2. T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i do b\u1ec7nh tim Tr\u00e1i (Pulmonary venous hypertension due to left heart disease).<\/strong><\/p>\n<p>Nh\u00f3m n\u00e0y bao g\u1ed3m ch\u1ee9c n\u0103ng b\u1ea5t th\u01b0\u1eddng c\u1ee7a th\u1ea5t tr\u00e1i ho\u1eb7c b\u1ec7nh l\u00fd van tim.<\/p>\n<figure id=\"attachment_20969\" aria-describedby=\"caption-attachment-20969\" style=\"width: 806px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-20969 size-full\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/3-12.jpg\" alt=\"\" width=\"806\" height=\"529\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/3-12.jpg 806w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/3-12-300x197.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/3-12-768x504.jpg 768w\" sizes=\"(max-width: 806px) 100vw, 806px\" \/><figcaption id=\"caption-attachment-20969\" class=\"wp-caption-text\"><strong>T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u1edf b\u1ec7nh nh\u00e2n suy tim.<\/strong> <strong>Ngu\u1ed3n:<\/strong> <em>International Journal of Heart Failure<\/em><\/figcaption><\/figure>\n<p><strong>1.2.3. T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i do c\u00e1c b\u1ec7nh ph\u1ed5i v\u00e0\/ho\u1eb7c thi\u1ebfu Oxy (Pulmonary hypertension due to lung disease or hypoxemia).<\/strong><\/p>\n<p>Nh\u00f3m n\u00e0y do b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh, gi\u1ea3m th\u00f4ng kh\u00ed ph\u1ed5i, v\u00e0 c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y ra t\u00ecnh tr\u1ea1ng thi\u1ebfu Oxy m\u00e1u m\u1ea1n.<\/p>\n<figure id=\"attachment_20972\" aria-describedby=\"caption-attachment-20972\" style=\"width: 591px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-20972 size-full\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/4-6.png\" alt=\"\" width=\"591\" height=\"334\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/4-6.png 591w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/4-6-300x170.png 300w\" sizes=\"(max-width: 591px) 100vw, 591px\" \/><figcaption id=\"caption-attachment-20972\" class=\"wp-caption-text\"><strong>M\u00f4 t\u1ea3 sinh l\u00fd b\u1ec7nh c\u1ee7a t\u0103ng \u00e1p ph\u1ed5i trong tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu Oxy<\/strong>. <strong>Ngu\u1ed3n<\/strong>: <em>Hypoxia and Human Disease by Jing Zheng and Chi Zhou<\/em><\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p><strong>1.2.4. T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i do huy\u1ebft kh\u1ed1i m\u1ea1n t\u00ednh (pulmonary hypertension due to pulmonary obstruction)<\/strong><\/p>\n<p>Nh\u00f3m n\u00e0y ch\u1ee7 y\u1ebfu bao g\u1ed3m t\u0103ng huy\u1ebft \u00e1p ph\u1ed5i do t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 c\u0169ng bao g\u1ed3m c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c c\u1ee7a t\u1eafc ngh\u1ebdn \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, ch\u1eb3ng h\u1ea1n nh\u01b0 sarcoma, ung th\u01b0 di c\u0103n, v\u00e0 h\u1eb9p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1ea9m sinh.<\/p>\n<figure id=\"attachment_20974\" aria-describedby=\"caption-attachment-20974\" style=\"width: 800px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-20974 size-full\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/5.jpeg\" alt=\"\" width=\"800\" height=\"545\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/5.jpeg 800w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/5-300x204.jpeg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/5-768x523.jpeg 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption id=\"caption-attachment-20974\" class=\"wp-caption-text\"><strong>M\u00f4 t\u1ea3 sinh l\u00fd b\u1ec7nh c\u1ee7a t\u0103ng \u00e1p ph\u1ed5i trong b\u1ec7nh l\u00fd t\u1eafc ngh\u1ebdn<\/strong>. <strong>Ngu\u1ed3n<\/strong>: <em>Treating Hypertension in Chronic Obstructive Pulmonary Disease by Shannon W. Finks, Pharm.D., Mark J. Rumbak, M.D., and Timothy H. Self, Pharm.D.<\/em><\/figcaption><\/figure>\n<p><strong>1.2.5. T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u1edbi c\u00e1c c\u01a1 ch\u1ebf \u0111a y\u1ebfu t\u1ed1 kh\u00f4ng r\u00f5 r\u00e0ng (pulmonary hypertension secondary to unclear or multifactorial mechanisms)<\/strong><\/p>\n<p>M\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a t\u0103ng huy\u1ebft \u00e1p ph\u1ed5i \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo h\u1ec7 th\u1ed1ng ph\u00e2n lo\u1ea1i NYHA, \u0111\u01b0\u1ee3c ban \u0111\u1ea7u ph\u00e1t tri\u1ec3n cho suy tim nh\u01b0ng sau \u0111\u00f3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh b\u1edfi WHO; n\u00f3 ch\u1ee7 y\u1ebfu d\u1ef1a tr\u00ean c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 tr\u1ea1ng th\u00e1i ch\u1ee9c n\u0103ng:<\/p>\n<ul>\n<li>Nh\u00f3m I: Kh\u00f4ng gi\u1edbi h\u1ea1n ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t; kh\u00f4ng c\u00f3 kh\u00f3 th\u1edf, m\u1ec7t m\u1ecfi, \u0111au ng\u1ef1c ho\u1eb7c \u00a0g\u1ea7n nh\u01b0 kh\u00f4ng xu\u1ea5t hi\u1ec7n khi v\u1eadn \u0111\u1ed9ng.<\/li>\n<li>Nh\u00f3m II: H\u1ea1n ch\u1ebf nh\u1eb9 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t; kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng \u1edf tr\u1ea1ng th\u00e1i ngh\u1ec9 ng\u01a1i, nh\u01b0ng kh\u00f3 th\u1edf, m\u1ec7t m\u1ecfi, \u0111au ng\u1ef1c ho\u1eb7c suy nh\u01b0\u1ee3c xu\u1ea5t hi\u1ec7n khi v\u1eadn \u0111\u1ed9ng ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t b\u00ecnh th\u01b0\u1eddng.<\/li>\n<li>Nh\u00f3m III: H\u1ea1n ch\u1ebf \u0111\u00e1ng k\u1ec3 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t; kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng \u1edf tr\u1ea1ng th\u00e1i ngh\u1ec9 ng\u01a1i, nh\u01b0ng kh\u00f3 th\u1edf, m\u1ec7t m\u1ecfi, \u0111au ng\u1ef1c ho\u1eb7c suy nh\u01b0\u1ee3c xu\u1ea5t hi\u1ec7n khi v\u1eadn \u0111\u1ed9ng ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t \u00edt h\u01a1n b\u00ecnh th\u01b0\u1eddng.<\/li>\n<li>Nh\u00f3m IV: Kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n b\u1ea5t k\u1ef3 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t n\u00e0o m\u00e0 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng; kh\u00f3 th\u1edf v\u00e0 m\u1ec7t m\u1ecfi xu\u1ea5t hi\u1ec7n ngay c\u1ea3 khi ngh\u1ec9 ng\u01a1i v\u00e0 tri\u1ec7u ch\u1ee9ng tr\u1edf n\u00ean n\u1eb7ng h\u01a1n khi v\u1eadn \u0111\u1ed9ng.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2><strong>2. C\u01a1 ch\u1ebf sinh l\u00fd b\u1ec7nh trong t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/strong><\/h2>\n<p><strong>2.1. T\u1ed5n th\u01b0\u01a1ng n\u1ed9i m\u00f4<\/strong><\/p>\n<p>\u0110\u1ed9t bi\u1ebfn gen \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn bao g\u1ed3m th\u1ee5 th\u1ec3 Protein t\u1ea1o h\u00ecnh th\u00e1i x\u01b0\u01a1ng 2 b\u00ecnh th\u01b0\u1eddng c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf t\u0103ng sinh c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u (Bone morphogenetic protein receptor &#8211; BMPR2). 70% t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 t\u00ednh ch\u1ea5t gia \u0111\u00ecnh v\u00e0 10 \u2013 40% c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u01a1n l\u1ebb ho\u1eb7c nh\u1eefng tr\u01b0\u1eddng h\u1ee3p li\u00ean quan \u0111\u1ebfn ch\u1ea5t g\u00e2y ch\u00e1n \u0103n \u0111\u1ec3 gi\u1ea3m c\u00e2n \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y c\u00f3 \u0111\u1ed9t bi\u1ebfn BMPR 2.<\/p>\n<p>VEGF, Endothelin-1 v\u00e0 Survivin l\u00e0 m\u1ed9t trong nh\u1eefng y\u1ebfu t\u1ed1 c\u00f3 trong c\u00e1c t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng \u0111\u00e1m r\u1ed1i c\u00f3 th\u1ec3 t\u0103ng c\u01b0\u1eddng t\u1ebf b\u00e0o n\u1ed9i m\u00f4 v\u00e0 t\u0103ng sinh t\u1ebf b\u00e0o c\u01a1 tr\u01a1n ho\u1eb7c gi\u1ea3m qu\u00e1 tr\u00ecnh ch\u1ebft theo ch\u01b0\u01a1ng tr\u00ecnh c\u1ee7a t\u1ebf b\u00e0o m\u1ea1ch m\u00e1u. Nh\u1eefng t\u1ed5n th\u01b0\u01a1ng n\u00e0y \u0111\u00e3 l\u00e0m gi\u1ea3m bi\u1ec3u hi\u1ec7n c\u1ee7a c\u00e1c ch\u1ea5t trung gian ch\u1ed1ng t\u00e1i t\u1ea1o nh\u01b0 Nitric oxide synthase v\u00e0 Prostacyclin synthase, v\u00e0 c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf kh\u1ed1i u, ch\u1eb3ng h\u1ea1n nh\u01b0 Caveolin-1.<\/p>\n<p>T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i li\u00ean quan \u0111\u1ebfn t\u01b0\u01a1ng t\u00e1c ph\u1ee9c h\u1ee3p c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 d\u1eabn \u0111\u1ebfn t\u00e1i t\u1ea1o m\u1ea1ch m\u00e1u ti\u1ebfn tri\u1ec3n v\u1edbi t\u1ebf b\u00e0o n\u1ed9i m\u00f4 v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n c\u01a1 tr\u01a1n, co m\u1ea1ch c\u0169ng nh\u01b0 huy\u1ebft kh\u1ed1i ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u1ed9i m\u00f4 m\u1ea1ch m\u00e1u ph\u1ed5i d\u1eabn \u0111\u1ebfn t\u0103ng nh\u00f3m co m\u1ea1ch (v\u00ed d\u1ee5 endothelin) v\u00e0 gi\u1ea3m nh\u00f3m gi\u00e3n m\u1ea1ch (v\u00ed d\u1ee5 NO v\u00e0 prostacyclin). H\u1eadu qu\u1ea3 thay \u0111\u1ed5i t\u00ednh ch\u1ea5t l\u00f2ng m\u1ea1ch v\u00e0 h\u1eb9p l\u00f2ng m\u1ea1ch, d\u00f2ng ch\u1ea3y c\u1ee7a m\u00e1u b\u1ecb h\u1ea1n ch\u1ebf v\u00e0 t\u1ea1o ra \u00e1p su\u1ea5t cao v\u00e0 kh\u00e1ng l\u1ef1c m\u1ea1ch m\u00e1u ph\u1ed5i cao (Pulmonary Vascular Resistance \u2013 PVR).<\/p>\n<p>C\u00e1c b\u1eb1ng ch\u1ee9ng m\u1edbi cho th\u1ea5y c\u00e1c y\u1ebfu t\u1ed1 virus c\u00f3 th\u1ec3 \u0111\u00f3ng m\u1ed9t vai tr\u00f2 trong c\u00e1c t\u1ed5n th\u01b0\u01a1ng t\u0103ng sinh t\u1ebf b\u00e0o n\u1ed9i m\u00f4 \u1edf t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i n\u1eb7ng.<\/p>\n<p>Apoptosis t\u1ebf b\u00e0o n\u1ed9i m\u00f4 ban \u0111\u1ea7u c\u00f3 th\u1ec3 t\u1ea1o thu\u1eadn l\u1ee3i cho s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 kh\u00e1ng apoptosis, c\u00f3 kh\u1ea3 n\u0103ng t\u0103ng sinh kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c.<\/p>\n<p><strong>2.2. Q\u00faa tr\u00ecnh t\u00e1i t\u1ea1o c\u00e1c m\u1ea1ch m\u00e1u trung gian.<\/strong><\/p>\n<p>T\u0103ng s\u1ea3n t\u1ebf b\u00e0o c\u01a1 tr\u01a1n c\u00f3 th\u1ec3 \u0111\u00f3ng m\u1ed9t vai tr\u00f2 nh\u1ecf trong s\u1ef1 d\u00e0y l\u00ean c\u1ee7a l\u1edbp trung gian so v\u1edbi ph\u00ec \u0111\u1ea1i t\u1ebf b\u00e0o ho\u1eb7c l\u1eafng \u0111\u1ecdng \u1edf ngo\u1ea1i b\u00e0o.<\/p>\n<p>C\u00e1c b\u1eb1ng ch\u1ee9ng v\u1ec1 s\u1ef1 gi\u1ea3m bi\u1ec3u hi\u1ec7n c\u1ee7a BMPR2 \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong v\u00e1ch ng\u0103n ph\u1ebf nang v\u00e0 vi\u1ec7c nh\u1eadn th\u1ea5y s\u1ef1 gi\u1ea3m c\u1ee7a c\u00e1c d\u1ea1ng ho\u1ea1t h\u00f3a c\u1ee7a SMAD 1 (Signaling marker for BMPR2) trong c\u00e1c t\u1ebf b\u00e0o c\u01a1 tr\u01a1n c\u1ee7a c\u00e1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u00a0v\u1eabn ch\u01b0a r\u00f5 l\u00e0m th\u1ebf n\u00e0o \u0111\u1ed9t bi\u1ebfn BMPR2 c\u00f3 th\u1ec3 g\u00e2y ra ho\u1eb7c k\u00edch ho\u1ea1t b\u1ec7nh.<\/p>\n<p>Vai tr\u00f2 c\u1ee7a serotonin (5-hydroxytryptamine) trong vi\u1ec7c k\u00edch th\u00edch t\u0103ng tr\u01b0\u1edfng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o c\u01a1 tr\u01a1n \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u chuy\u00ean s\u00e2u nh\u01b0 m\u1ed9t c\u01a1 ch\u1ebf t\u00e1i t\u1ea1o trung gian trong t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 m\u1ed9t gen \u0111i\u1ec1u ch\u1ec9nh ti\u1ec1m n\u0103ng cho t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i t\u00ednh ch\u1ea5t gia \u0111\u00ecnh.<\/p>\n<p>M\u1eb7c d\u00f9 c\u00f3 b\u1eb1ng ch\u1ee9ng \u1ee7ng h\u1ed9 vi\u1ec7c m\u1ea5t ch\u1ee9c n\u0103ng TGF-\u03b2, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 c\u1ee7a t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i t\u00ednh ch\u1ea5t gia \u0111\u00ecnh, TGF-\u03b2 c\u00f3 th\u1ec3 t\u1ea1o ra nh\u1eefng thay \u0111\u1ed5i v\u1ec1 ch\u1ee9c n\u0103ng l\u00e0m c\u01a1 s\u1edf cho s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a t\u1ebf b\u00e0o c\u01a1 tr\u01a1n v\u00e0 k\u00edch ho\u1ea1t nguy\u00ean b\u00e0o s\u1ee3i ngo\u1ea1i lai.<\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y v\u1ec1 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a k\u00eanh K + \u0111\u00e3 cung c\u1ea5p m\u1ed9t c\u00e1i nh\u00ecn s\u00e2u s\u1eafc m\u1edbi v\u1ec1 vi\u1ec7c thi\u1ebfu t\u00edn hi\u1ec7u Proapoptotic trong c\u00e1c t\u1ebf b\u00e0o c\u01a1 tr\u01a1n.<\/p>\n<p>M\u1ed9t nghi\u00ean c\u1ee9u th\u00fa v\u1ecb d\u1ef1a tr\u00ean s\u1ef1 t\u01b0\u01a1ng t\u00e1c gi\u1eefa c\u00e1c k\u00eanh K+ v\u00e0 qu\u00e1 tr\u00ecnh ch\u1ebft theo ch\u01b0\u01a1ng tr\u00ecnh trong c\u00e1c t\u1ebf b\u00e0o c\u01a1 tr\u01a1n \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u00e3 ch\u1ee9ng minh vi\u1ec7c k\u00edch ho\u1ea1t c\u00e1c k\u00eanh K+ g\u00e2y ra s\u1ef1 gi\u1ea3i ph\u00f3ng cytochrom C t\u1eeb ty th\u1ec3. Ng\u01b0\u1ee3c l\u1ea1i, \u1ee9c ch\u1ebf k\u00eanh K+ g\u00e2y kh\u1eed c\u1ef1c t\u1ebf b\u00e0o, t\u0103ng kh\u1ea3 n\u0103ng co b\u00f3p v\u00e0 gi\u1ea3m qu\u00e1 tr\u00ecnh ch\u1ebft theo ch\u01b0\u01a1ng tr\u00ecnh c\u1ee7a t\u1ebf b\u00e0o c\u01a1 tr\u01a1n \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n<p>M\u1ed9t c\u01a1 ch\u1ebf ti\u1ec1m n\u0103ng th\u1ec3 hi\u1ec7n s\u1ef1 li\u00ean k\u1ebft v\u1edbi \u0111\u1ed9t bi\u1ebfn BMPR2 \u0111\u00e3 ph\u00e1t hi\u1ec7n ra r\u1eb1ng k\u00edch ho\u1ea1t BMPR2 \u0111i\u1ec1u ch\u1ec9nh t\u0103ng k\u00eanh K+ v\u00e0 g\u00e2y ra qu\u00e1 tr\u00ecnh ch\u1ebft theo ch\u01b0\u01a1ng tr\u00ecnh c\u1ee7a c\u00e1c t\u1ebf b\u00e0o c\u01a1 tr\u01a1n \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u00ecnh th\u01b0\u1eddng, ch\u1ee9 kh\u00f4ng ph\u1ea3i t\u1ebf b\u00e0o c\u1ee7a b\u1ec7nh nh\u00e2n m\u1eafc t\u0103ng\u00a0 \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i t\u00ednh ch\u1ea5t gia \u0111\u00ecnh.<\/p>\n<p>Survivin thi\u1ebfu h\u1ee5t m\u1ed9t c\u00e1ch ng\u1eabu nhi\u00ean trong qu\u00e1 tr\u00ecnh t\u00e1i t\u1ea1o m\u1ea1ch m\u00e1u \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Monocrotaline v\u00e0 khi \u0111\u01b0\u1ee3c d\u00f9ng sau khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Monocrotaline, n\u00f3 s\u1ebd ti\u00eau di\u1ec7t qu\u00e1 tr\u00ecnh ch\u1ebft theo ch\u01b0\u01a1ng tr\u00ecnh c\u1ee7a c\u00e1c t\u1ebf b\u00e0o c\u01a1 tr\u01a1n \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n<p><strong>2.3. Q\u00faa tr\u00ecnh t\u00e1i t\u1ea1o ng\u1eabu nhi\u00ean<\/strong><\/p>\n<p>C\u00e1c nguy\u00ean b\u00e0o s\u1ee3i tr\u1ea3i qua m\u1ed9t s\u1ef1 gia t\u0103ng r\u00f5 r\u1ec7t v\u1ec1 s\u1ef1 t\u0103ng sinh t\u1ebf b\u00e0o \u0111\u1ea1t m\u1ee9c t\u0103ng g\u1ea5p 11 l\u1ea7n \u1edf c\u00e1c m\u1ea1ch m\u00e1u r\u1ed1n ph\u1ed5i, v\u00e0o ng\u00e0y th\u1ee9 3 c\u1ee7a t\u00ecnh tr\u1ea1ng thi\u1ebfu oxy m\u00e3n t\u00ednh.<\/p>\n<p>C\u00e1c nguy\u00ean b\u00e0o s\u1ee3i \u00a0c\u00f3 th\u1ec3<\/p>\n<ul>\n<li>Bi\u1ec7t h\u00f3a th\u00e0nh c\u00e1c t\u1ebf b\u00e0o c\u01a1 tr\u01a1n v\u00e0 di chuy\u1ec3n v\u00e0o m\u00f4i tr\u01b0\u1eddng \u0111\u00e3 \u0111\u01b0\u1ee3c tu s\u1eeda ho\u1eb7c;<\/li>\n<li>K\u00edch ho\u1ea1t s\u1ef1 t\u0103ng sinh t\u1ebf b\u00e0o c\u01a1 tr\u01a1n b\u1eb1ng c\u00e1ch ti\u1ebft ra c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng;<\/li>\n<li>Cho ph\u00e9p s\u1eed d\u1ee5ng c\u00e1c t\u1ebf b\u00e0o ti\u1ec1n th\u00e2n vi\u00eam v\u00e0 t\u1ee7y x\u01b0\u01a1ng;<\/li>\n<li>T\u1ea1o ra m\u1ed9t ng\u00e1ch &#8216;t\u1ea1o m\u1ea1ch v\u00e0 t\u1ea1o m\u1ea1ch&#8217; \u0111\u1ec3 t\u0103ng c\u00e1c m\u1ea1ch m\u1edbi h\u00ecnh th\u00e0nh (vasa vasorum).<\/li>\n<\/ul>\n<p>C\u00e1c nguy\u00ean b\u00e0o s\u1ee3i c\u1ea3m nh\u1eadn \u0111\u01b0\u1ee3c s\u1ef1 thay \u0111\u1ed5i trong tr\u1ea1ng th\u00e1i oxy h\u00f3a kh\u1eed, d\u1eabn t\u1edbi \u00a0k\u00edch ho\u1ea1t c\u1ee7a s\u1ef1 t\u0103ng sinh t\u1ebf b\u00e0o, gi\u1ea3i ph\u00f3ng cytokine v\u00e0 t\u1ea1o ra c\u00e1c ch\u1ea5t oxy h\u00f3a th\u00f4ng qua k\u00edch ho\u1ea1t NADPH oxyase.<\/p>\n<p><strong>2.4. T\u00e1c \u0111\u1ed9ng c\u1ee7a t\u0129nh m\u1ea1ch<\/strong>.<\/p>\n<p>Ng\u01b0\u1eddi ta bi\u1ebft r\u1ea5t \u00edt v\u1ec1 s\u1ef1 thay \u0111\u1ed5i ch\u1ee9c n\u0103ng c\u1ee7a n\u1ed9i m\u00f4, c\u01a1 tr\u01a1n v\u00e0 nguy\u00ean b\u00e0o s\u1ee3i trong t\u0103ng \u00e1p t\u0129nh m\u1ea1ch ph\u1ed5i. C\u00e1c t\u0129nh m\u1ea1ch ph\u1ed5i r\u1ea5t kh\u00f3 x\u00e1c \u0111\u1ecbnh trong c\u00e1c ph\u1ea7n ph\u1ed5i, do th\u1ef1c t\u1ebf l\u00e0 ch\u00fang n\u1eb1m \u1edf gi\u1eefa c\u00e1c m\u00f4 c\u00f3 ph\u1ebf nang. Ch\u1ec9 c\u00e1c \u0111o\u1ea1n t\u0129nh m\u1ea1ch hi\u1ec7n di\u1ec7n trong v\u00e1ch ng\u0103n gian ti\u1ec3u thu\u1ef3 m\u1edbi c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng nh\u1eadn ra h\u01a1n. S\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 \u0111\u1ed1i v\u1edbi c\u00e1c t\u0129nh m\u1ea1ch ph\u1ed5i s\u1ebd gi\u00fap \u0111\u00e1nh gi\u00e1 \u0111\u00fang s\u1ef1 t\u00e1c \u0111\u1ed9ng c\u1ee7a r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u1ebf b\u00e0o n\u1ed9i m\u00f4 trong t\u0103ng huy\u1ebft \u00e1p ph\u1ed5i t\u0129nh m\u1ea1ch.<\/p>\n<p><strong>2.5. Vi\u00eam, s\u1ef1 l\u01b0u th\u00f4ng c\u00e1c t\u1ebf b\u00e0o ti\u1ec1n th\u00e2n v\u00e0 c\u00e1c t\u00e1c nh\u00e2n virus.<\/strong><\/p>\n<p>M\u1eb7c d\u00f9 vi\u00eam quanh m\u1ea1ch m\u00e1u c\u00f3 gi\u00e1 tr\u1ecb h\u1ea1n ch\u1ebf trong qu\u00e1 tr\u00ecnh gi\u1ea3i quy\u1ebft b\u1ec7nh l\u00fd c\u1ee7a c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i , nh\u01b0ng hi\u1ec7n t\u1ea1i \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng l\u0129nh v\u1ef1c h\u1ee9a h\u1eb9n nh\u1ea5t v\u1ec1 b\u1ec7nh. C\u00e1c t\u1ebf b\u00e0o vi\u00eam c\u00f3 th\u1ec3 t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 virus, \u0111\u00e3 n\u1ed5i l\u00ean nh\u01b0 l\u00e0 t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh\/c\u0103n nguy\u00ean ti\u1ec1m \u1ea9n trong t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u ch\u1ee9ng minh r\u1eb1ng s\u1ef1 c\u1ea1n ki\u1ec7t c\u1ee7a c\u00e1c t\u1ebf b\u00e0o monocytic trong tu\u1ea7n ho\u00e0n l\u00e0m gi\u1ea3m b\u1edbt s\u1ef1 t\u00e1i t\u1ea1o m\u1ea1ch m\u00e1u ph\u1ed5i do t\u00ecnh tr\u1ea1ng thi\u1ebfu oxy m\u00e3n t\u00ednh.<\/p>\n<p>Nhi\u1ec5m virus c\u00f3 th\u1ec3 l\u00e0m gi\u00e1n \u0111o\u1ea1n qu\u00e1 tr\u00ecnh \u0111i\u1ec1u h\u00f2a mi\u1ec5n d\u1ecbch v\u00e0 c\u00e2n b\u1eb1ng n\u1ed9i m\u00f4i b\u00ecnh th\u01b0\u1eddng c\u1ee7a t\u1ebf b\u00e0o, d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o n\u1ed9i m\u00f4 ho\u1eb7c t\u1ebf b\u00e0o c\u01a1 tr\u01a1n v\u00e0 k\u00edch ho\u1ea1t ph\u1ea3n \u1ee9ng vi\u00eam. Vai tr\u00f2 quan tr\u1ecdng c\u1ee7a t\u00ecnh tr\u1ea1ng vi\u00eam \u0111\u01b0\u1ee3c nh\u1ea5n m\u1ea1nh h\u01a1n n\u1eefa trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p PH c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n do virus.<\/p>\n<p>\u0110\u1ed9t bi\u1ebfn BMPR2 kh\u00f4ng b\u1eaft bu\u1ed9c \u0111\u1ed1i v\u1edbi t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i nghi\u00eam tr\u1ecdng x\u1ea3y ra \u1edf b\u1ec7nh nh\u00e2n nhi\u1ec5m HIV, tuy nhi\u00ean c\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u \u1edf ph\u1ed5i t\u1eeb b\u1ec7nh nh\u00e2n nhi\u1ec5m HIV \u00a0gi\u1ed1ng h\u1ec7t v\u1edbi nh\u1eefng ng\u01b0\u1eddi m\u1eafc t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i t\u00ednh ch\u1ea5t gia \u0111\u00ecnh v\u1edbi \u0111\u1ed9t bi\u1ebfn BMPR2.<\/p>\n<p><strong>Ngu\u1ed3n tham kh\u1ea3o:<\/strong><\/p>\n<p><strong>Refenrence<\/strong><\/p>\n<p>Maxine A. Papadakis, Stephen J.McPhee, Michael W.Rabow: <em>CURRENT Medical Diagnosis &amp; Treatment<\/em>, 2023, p301.<\/p>\n<p>Hemant Godara, Angela Hirbe, Michael Nassif, Hannah Otepka, Aron Rosenstock: <em>The Washington Manual of Medical Therapeutics 34<sup>th<\/sup> Edition<\/em>, 2014, p405.<\/p>\n<p>Humbert M, Kovacs G, Hoeper MM, et al.,: <em>Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension: Developed by the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), 2022.<\/em><\/p>\n<p>Rubin M. Tuder, M.D.,a,b John C. Marecki, Ph.D.,c Amy Richter, B.S.,d Iwona Fijalkowska, Ph.D.,d,e and Sonia Flores, Ph.D: <em>Pathology of Pulmonary Hypertension<\/em>, 2007.<\/p>\n<p>Tao Le, Matthew Sochat, Connie Qiu, Panagiotis Kaparaliotis, Kimberly Kallianos, Vikas Bhushan, Caroline Coleman, Anup Chalise, Stephanie Jones: <em>FIST AID FOR THE USMLE STEP 1<\/em>, 2022, p704.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (Pulmonary Artery Hypertension) l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh hi\u1ebfm g\u1eb7p, nh\u01b0ng c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng cho s\u1ee9c kh\u1ecfe c\u1ee7a con ng\u01b0\u1eddi. B\u1ec7nh l\u00fd n\u00e0y \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u0103ng \u00e1p su\u1ea5t trong c\u00e1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, d\u1eabn \u0111\u1ebfn s\u1ef1 suy gi\u1ea3m ch\u1ee9c n\u0103ng c\u1ee7a tim v\u00e0 ph\u1ed5i.\u00a0Trong [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i: \u0110\u1ecbnh ngh\u0129a, ph\u00e2n lo\u1ea1i v\u00e0 sinh l\u00fd b\u1ec7nh<\/title>\n<meta name=\"description\" content=\"theo ESC\/ERS 2022 th\u00ec t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trung b\u00ecnh &gt;20 mm Hg khi ngh\u1ec9 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