{"id":27047,"date":"2023-04-23T00:34:24","date_gmt":"2023-04-22T17:34:24","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27047"},"modified":"2023-04-23T00:34:24","modified_gmt":"2023-04-22T17:34:24","slug":"phan-loai-phan-ung-qua-man-thuoc","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/phan-loai-phan-ung-qua-man-thuoc\/","title":{"rendered":"Ph\u00e2n lo\u1ea1i ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn"},"content":{"rendered":"

Nh\u1eefng ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn thu\u1ed1c c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a nhi\u1ec1u b\u1ec7nh kh\u00e1c nhau. \u0110\u1ec3 d\u1ec5 d\u00e0ng \u0111\u00e1nh gi\u00e1 s\u1ef1 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t n\u00e0y v\u00e0 gi\u1ea3i th\u00edch c\u00e1c h\u00ecnh \u1ea3nh l\u00e2m s\u00e0ng kh\u00e1c nhau, Gell v\u00e0 Coombs \u0111\u00e3 ph\u00e2n lo\u1ea1i ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn thu\u1ed1c c\u0169ng nh\u01b0 nh\u1eefng ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch kh\u00e1c t\u1eeb lo\u1ea1i I \u0111\u1ebfn lo\u1ea1i IV. S\u1ef1 ph\u00e2n lo\u1ea1i n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eeda \u0111\u1ed5i d\u1ef1a tr\u00ean s\u1ef1 ph\u00e1t hi\u1ec7n ra c\u00e1c vai tr\u00f2 kh\u00e1c nhau c\u1ee7a t\u1ebf b\u00e0o T v\u00e0 s\u1ef1 t\u00e1c \u0111\u1ed9ng qua l\u1ea1i gi\u1eefa c\u00e1c ph\u1ea3n \u1ee9ng n\u00e0y, v\u00ed d\u1ee5: d\u1ecb \u1ee9ng thu\u1ed1c c\u1ee7a nh\u1eefng t\u1ebf b\u00e0o B ti\u1ebft ra IgE ho\u1eb7c IgG ph\u1ee5 thu\u1ed9c v\u00e0o t\u1ebf b\u00e0o T tr\u1ee3 gi\u00fap. Do \u0111\u00f3, ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i I v\u00e0 lo\u1ea1i IVb, th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u0111\u1ed3ng th\u1eddi, c\u0169ng nh\u01b0 ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i II, lo\u1ea1i III v\u1edbi lo\u1ea1i IVa v\u00e0 h\u00ecnh \u1ea3nh l\u00e2m s\u00e0ng ch\u1eafc ch\u1eafn s\u1ebd b\u1ecb chi ph\u1ed1i b\u1edfi m\u1ed9t ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch chi\u1ebfm \u01b0u th\u1ebf.<\/p>\n

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T\u1ed5ng quan v\u1ec1 4 lo\u1ea1i ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn<\/figcaption><\/figure>\n

1. Ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i I (Ph\u1ea3n \u1ee9ng qua trung gian IgE)<\/h2>\n

C\u00e1c kh\u00e1ng th\u1ec3 IgE \u0111\u01b0\u1ee3c t\u1ea1o ra do ph\u1ea3n \u1ee9ng c\u1ee7a h\u1ec7 mi\u1ec5n d\u1ecbch v\u1edbi m\u1ed9t l\u01b0\u1ee3ng r\u1ea5t nh\u1ecf kh\u00e1ng nguy\u00ean, s\u1ef1 ph\u1ea3n \u1ee9ng m\u1ea1nh m\u1ebd n\u00e0y l\u00e0 do th\u00f4ng qua c\u00e1c th\u1ee5 th\u1ec3 Fc\u03b5 c\u00f3 \u00e1i l\u1ef1c cao (Fc\u03b5-RI) g\u1eafn tr\u00ean c\u00e1c d\u01b0\u1ee1ng b\u00e0o (mastocyt), n\u01a1i m\u00e0 d\u1ecb nguy\u00ean ho\u1eb7c thu\u1ed1c-kh\u00e1ng th\u1ec3 IgE \u0111\u1eb7c hi\u1ec7u \u0111\u01b0\u1ee3c g\u1eafn v\u00e0o. M\u1ed9t l\u01b0\u1ee3ng nh\u1ecf thu\u1ed1c d\u01b0\u1eddng nh\u01b0 \u0111\u1ee7 \u0111\u1ec3 t\u01b0\u01a1ng t\u00e1c v\u00e0 k\u00edch th\u00edch nh\u1eefng th\u1ee5 th\u1ec3 g\u1eafn tr\u00ean ph\u00e2n t\u1eed IgE, do \u0111\u00f3 \u0111\u00f4i khi ngay c\u1ea3 nh\u1eefng x\u00e9t nghi\u1ec7m v\u1edbi thu\u1ed1c \u1edf tr\u00ean da c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng ph\u1ea3n \u1ee9ng to\u00e0n th\u00e2n. Nh\u1edd v\u00e0o li\u00ean k\u1ebft ch\u00e9o c\u1ee7a Fc\u03b5RI, nh\u1eefng ch\u1ea5t trung gian h\u00f3a h\u1ecdc histamin, tryptase, leukotrien, prostaglandin, y\u1ebfu t\u1ed1 ho\u1ea1i t\u1eed u \u03b1 (TNF-\u03b1) \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a c\u00e1c tri\u1ec7u ch\u1ee9ng d\u1ecb \u1ee9ng tr\u00ean l\u00e2m s\u00e0ng. Giai \u0111o\u1ea1n m\u1eabn c\u1ea3m kh\u00f4ng xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u00e0 n\u00f3 c\u00f3 th\u1ec3 \u0111\u00e3 x\u1ea3y ra trong l\u1ea7n d\u00f9ng thu\u1ed1c tr\u01b0\u1edbc \u0111\u00f3. S\u1ef1 ti\u1ebfp x\u00fac l\u1ea1i v\u1edbi thu\u1ed1c l\u1ea7n ti\u1ebfp theo, ph\u1ee9c h\u1ee3p g\u1eafn hapten \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh l\u1ea1i, sau \u0111\u00f3 ph\u1ee9c h\u1ee3p n\u00e0y li\u00ean k\u1ebft ch\u00e9o v\u1edbi kh\u00e1ng th\u1ec3 IgE \u0111\u1eb7c hi\u1ec7u v\u1edbi thu\u1ed1c tr\u00ean nh\u1eefng d\u01b0\u1ee1ng b\u00e0o. Thu\u1ed1c th\u01b0\u1eddng c\u00f3 tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed qu\u00e1 nh\u1ecf \u0111\u1ec3 qua li\u00ean k\u1ebft hai ph\u00e2n t\u1eed k\u1ebf c\u1eadn IgE do \u0111\u00f3 c\u1ea7n ph\u1ee9c h\u1ee3p mang hapten, v\u00ec v\u1eady m\u1ed9t l\u01b0\u1ee3ng nh\u1ecf thu\u1ed1c c\u0169ng g\u00e2y n\u00ean nh\u1eefng ph\u1ea3n \u1ee9ng nghi\u00eam tr\u1ecdng.<\/p>\n

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C\u01a1 ch\u1ebf c\u1ee7a ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn type 1<\/figcaption><\/figure>\n

Tuy nhi\u00ean trong qu\u00e1 tr\u00ecnh gi\u1ea3m m\u1eabn c\u1ea3m v\u1edbi thu\u1ed1c \u0111\u00e3 ch\u1ee9ng minh t\u00ednh m\u1eabn c\u1ea3m c\u00f2n ph\u1ee5 thu\u1ed9c li\u1ec1u m\u1ed9t c\u00e1ch r\u00f5 r\u00e0ng. Ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i I tr\u00ean ng\u01b0\u1eddi b\u1ec7nh c\u00f3 c\u01a1 \u0111\u1ecba nh\u1ea1y c\u1ea3m c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n m\u1ed9t v\u00e0i gi\u00e2y sau khi ti\u00eam thu\u1ed1c v\u00e0 m\u1ed9t v\u00e0i ph\u00fat sau khi u\u1ed1ng thu\u1ed1c. S\u1ed1c ph\u1ea3n v\u1ec7 c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong v\u00f2ng 15 ph\u00fat, ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 ng\u1ea1t th\u1edf do ph\u00f9 n\u1ec1 thanh qu\u1ea3n trong kho\u1ea3ng 15 \u0111\u1ebfn 60 ph\u00fat. C\u00e1c tri\u1ec7u ch\u1ee9ng ban \u0111\u1ea7u c\u00f3 th\u1ec3 l\u00e0 ng\u1ee9a \u1edf gan b\u00e0n tay, ch\u00e2n, b\u1ed9 ph\u1eadn sinh d\u1ee5c, ho\u1eb7c n\u00e1ch, c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t nh\u01b0 d\u1ea5u hi\u1ec7u b\u00e1o tr\u01b0\u1edbc c\u1ee7a s\u1ed1c. Ban \u0111\u1ecf da th\u01b0\u1eddng l\u00e0 d\u1ea5u hi\u1ec7u \u0111\u1ea7u ti\u00ean xu\u1ea5t hi\u1ec7n \u1edf th\u00e2n, sau \u0111\u00f3 lan ra to\u00e0n b\u1ed9 c\u01a1 th\u1ec3 trong kho\u1ea3ng t\u1eeb 30 \u0111\u1ebfn 60 ph\u00fat, m\u00e0y \u0111ay c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n, k\u00e8m theo ph\u00f9 v\u00f9ng quanh h\u1ed1c m\u1eaft, xung quanh mi\u1ec7ng, \u0111\u00f4i khi \u1edf b\u1ed9 ph\u1eadn sinh d\u1ee5c. S\u1ed1c ph\u1ea3n v\u1ec7 c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong chi\u1ebfm kho\u1ea3ng 1% c\u00e1c tr\u01b0\u1eddng h\u1ee3p. Nh\u1eefng y\u1ebfu t\u1ed1 l\u00e0m cho c\u00e1c ph\u1ea3n \u1ee9ng thu\u1ed1c n\u1eb7ng h\u01a1n nh\u01b0 hen ph\u1ebf qu\u1ea3n, tu\u1ed5i gi\u00e0, nh\u1ed3i m\u00e1u c\u01a1 tim ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o n\u00e3o…<\/p>\n

2. Ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i II (\u0110\u1ed9c t\u1ebf b\u00e0o – ph\u1ea3n \u1ee9ng qua trung gian IgG)<\/h2>\n

Trong nh\u1eefng ph\u1ea3n \u1ee9ng lo\u1ea1i II, ho\u1eb7c l\u00e0 kh\u00e1ng th\u1ec3 \u0111\u01b0\u1ee3c g\u1eafn tr\u1ef1c ti\u1ebfp tr\u00ean m\u00e0ng t\u1ebf b\u00e0o (hi\u1ebfm g\u1eb7p) ho\u1eb7c ho\u1ea1t h\u00f3a ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch ph\u1ea3n \u1ee9ng x\u1ea3y ra tr\u00ean b\u1ec1 m\u1eb7t t\u1ebf b\u00e0o. C\u1ea3 hai hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y \u0111\u1ec1u c\u00f3 th\u1ec3 d\u1eabn t\u1edbi ph\u00e1 h\u1ee7y ho\u1eb7c c\u00f4 l\u1eadp t\u1ebf b\u00e0o. C\u00e1c t\u1ebf b\u00e0o \u0111\u00edch b\u1ecb t\u00e1c \u0111\u1ed9ng bao g\u1ed3m h\u1ed3ng c\u1ea7u, b\u1ea1ch c\u1ea7u, ti\u1ec3u c\u1ea7u v\u00e0 c\u00e1c t\u1ebf b\u00e0o non sinh m\u00e1u trong t\u1ee7y x\u01b0\u01a1ng. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng r\u00f5 nh\u1ea5t \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 do quinin, quinidin, ho\u1eb7c sulfonamid. Nh\u1eefng t\u1ebf b\u00e0o \u0111\u01b0\u1ee3c g\u1eafn kh\u00e1ng th\u1ec3 s\u1ebd b\u1ecb gi\u1eef l\u1ea1i t\u1ea1i h\u1ec7 th\u1ed1ng l\u01b0\u1edbi n\u1ed9i m\u00f4 t\u1ea1i gan v\u00e0 l\u00e1ch do g\u1eafn v\u1edbi th\u1ee5 th\u1ec3 Fc ho\u1eb7c th\u1ee5 th\u1ec3 b\u1ed5 th\u1ec3. S\u1ef1 ph\u00e1 h\u1ee7y n\u1ed9i m\u1ea1ch c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n do ly gi\u1ea3i qua trung gian b\u1ed5 th\u1ec3 nh\u01b0ng hi\u1ebfm g\u1eb7p h\u01a1n. Thi\u1ebfu m\u00e1u huy\u1ebft t\u00e1n \u0111\u00e3 \u0111\u01b0\u1ee3c cho l\u00e0 do penicilin v\u00e0 c\u00e1c d\u1eabn xu\u1ea5t c\u1ee7a ch\u00fang, cephalosporin, levodopa, methyldopa, quinidin, m\u1ed9t s\u1ed1 thu\u1ed1c ch\u1ed1ng vi\u00eam. Gi\u1ea3m ti\u1ec3u c\u1ea7u l\u00e0 m\u1ed9t tai bi\u1ebfn d\u1ecb \u1ee9ng t\u01b0\u01a1ng \u0111\u1ed1i ph\u1ed5 bi\u1ebfn do thu\u1ed1c.<\/p>\n

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C\u01a1 ch\u1ebf c\u1ee7a ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn type II<\/figcaption><\/figure>\n

\u0110\u00f4i khi gi\u1ea3m ti\u1ec3u c\u1ea7u c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 \u0111e d\u1ecda t\u1edbi t\u00ednh m\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1eeba nh\u1eadn do \u0111i\u1ec1u tr\u1ecb b\u1eb1ng quinin, c\u00e1c kh\u00e1ng sinh nh\u00f3m sulfonamid v\u00e0 m\u1ed9t v\u00e0i lo\u1ea1i thu\u1ed1c kh\u00e1c. Gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch do thu\u1ed1c th\u01b0\u1eddng ti\u1ebfn tri\u1ec3n sau 5 \u0111\u1ebfn 8 ng\u00e0y sau khi ti\u1ebfp x\u00fac v\u1edbi nh\u1eefng thu\u1ed1c nh\u1ea1y c\u1ea3m ho\u1eb7c sau khi ti\u1ebfp x\u00fac v\u1edbi c\u00f9ng m\u1ed9t lo\u1ea1i thu\u1ed1c l\u1ea7n th\u1ee9 hai. Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 tri\u1ec7u ch\u1ee9ng xu\u1ea5t huy\u1ebft lan r\u1ed9ng d\u01b0\u1edbi da v\u00e0 ni\u00eam m\u1ea1c mi\u1ec7ng, \u0111\u00f4i khi k\u00e8m theo xu\u1ea5t huy\u1ebft \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u v\u00e0 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, xu\u1ea5t huy\u1ebft n\u00e3o hi\u1ebfm g\u1eb7p. Sau khi ng\u1eebng thu\u1ed1c, ti\u1ec3u c\u1ea7u th\u01b0\u1eddng tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng trong v\u00f2ng 3 t\u1edbi 5 ng\u00e0y. \u0110\u1eb7c bi\u1ec7t c\u00f3 m\u1ed9t h\u00ecnh th\u1ee9c trung gian gi\u1eefa ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i II v\u00e0 lo\u1ea1i III l\u00e0 gi\u1ea3m ti\u1ec3u c\u1ea7u do heparin: Nh\u1eefng ti\u1ec3u c\u1ea7u c\u00f3 \u00e1i l\u1ef1c y\u1ebfu v\u1edbi c\u00e1c th\u1ee5 th\u1ec3 Fc (Fc\u03b3-RIIa) c\u00f3 th\u1ec3 g\u1eafn v\u1edbi ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch v\u00e0 k\u00edch ho\u1ea1t c\u00e1c ti\u1ec3u c\u1ea7u.<\/p>\n

3. Ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i III (l\u1eafng \u0111\u1ecdng ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch – Ph\u1ea3n \u1ee9ng qua trung gian IgG)<\/h2>\n

Ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh trong qu\u00e1 tr\u00ecnh d\u00f9ng thu\u1ed1c ho\u1eb7c thu\u1ed1c h\u00ecnh th\u00e0nh m\u1ed9t ph\u1ee9c h\u1ee3p mang hapten, do \u0111\u00f3 l\u00e0m t\u0103ng m\u1ed9t \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch ho\u1eb7c n\u1ebfu thu\u1ed1c l\u00e0 m\u1ed9t protein l\u1ea1 th\u00ec ch\u00ednh n\u00f3 c\u00f3 th\u1ec3 g\u00e2y ra \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch. Kh\u00e1ng th\u1ec3 th\u01b0\u1eddng \u0111\u01b0\u1ee3c t\u1ea1o ra trong v\u00f2ng 4 ng\u00e0y \u0111\u1ebfn 10 ng\u00e0y, sau khi ti\u1ebfp x\u00fac v\u1edbi d\u1ecb nguy\u00ean, t\u1ea1o th\u00e0nh ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch h\u00f2a tan l\u01b0u h\u00e0nh. C\u00e1c m\u1ea1ch m\u00e1u nh\u1ecf b\u1ecb ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch ch\u1ee9a b\u1ed5 th\u1ec3 (C1q) l\u1eafng \u0111\u1ecdng v\u00e0 thu h\u00fat c\u00e1c b\u1ea1ch c\u1ea7u b\u1eb1ng c\u00e1ch t\u01b0\u01a1ng t\u00e1c v\u1edbi th\u1ee5 th\u1ec3 Fc\u03b3-RIII, sau \u0111\u00f3 gi\u1ea3i ph\u00f3ng c\u00e1c enzym ph\u00e2n h\u1ee7y protein g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u00e0nh m\u1ea1ch.<\/p>\n

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C\u01a1 ch\u1ebf c\u1ee7a ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn type III<\/figcaption><\/figure>\n

Ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i III \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n qua t\u1ed5n th\u01b0\u01a1ng vi\u00eam c\u00e1c m\u1ea1ch nh\u1ecf ho\u1eb7c b\u1ec7nh huy\u1ebft thanh d\u1ecb lo\u00e0i ho\u1eb7c huy\u1ebft thanh \u0111\u1ed3ng lo\u00e0i. G\u1ea7n \u0111\u00e2y b\u1ec7nh huy\u1ebft thanh ch\u1ee7 y\u1ebfu do c\u00e1c thu\u1ed1c g\u00e2y ra. Vi\u00eam m\u1ea1ch d\u1ecb \u1ee9ng th\u01b0\u1eddng do cefaclor, trimethoprim-sulfamethoxazol, cephalexin, amoxicilin, thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid (NSAID<\/a>) v\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u. C\u00e1c tri\u1ec7u ch\u1ee9ng ch\u00ednh c\u1ee7a b\u1ec7nh ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch l\u00e0 \u0111au kh\u1edbp, \u0111au c\u01a1, s\u1ed1t v\u00e0 vi\u00eam m\u1ea1ch. C\u00e1c bi\u1ec3u hi\u1ec7n ch\u1ee7 y\u1ebfu tr\u00ean da d\u01b0\u1edbi d\u1ea1ng ban xu\u1ea5t huy\u1ebft, c\u00e1c n\u1ed1t t\u00edm, \u0111\u1ecf th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf ch\u00e2n. \u1ede tr\u1ebb em th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 ban xu\u1ea5t huy\u1ebft Henoch-Sch\u00f6nlein, th\u01b0\u1eddng k\u00e8m theo vi\u00eam kh\u1edbp. Nh\u1eefng t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 li\u00ean k\u1ebft l\u1ea1i \u0111\u1ec3 t\u1ea1o th\u00e0nh m\u1ea3ng v\u00e0 \u0111\u00f4i khi b\u1ecb lo\u00e9t. C\u00e1c c\u01a1 quan n\u1ed9i t\u1ea1ng th\u01b0\u1eddng \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u nh\u1ea5t l\u00e0 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, th\u1eadn v\u00e0 kh\u1edbp. Ti\u00ean l\u01b0\u1ee3ng t\u1ed1t n\u1ebfu kh\u00f4ng k\u00e8m theo t\u1ed5n th\u01b0\u01a1ng c\u00e1c c\u01a1 quan n\u1ed9i t\u1ea1ng. M\u00f4 b\u1ec7nh h\u1ecdc c\u00f3 th\u1ec3 th\u1ea5y ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch ch\u1ee9a IgA v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u00f4 b\u1ec7nh h\u1ecdc c\u1ee7a t\u1ed5n th\u01b0\u01a1ng th\u1eadn trong th\u1ef1c t\u1ebf gi\u1ed1ng v\u1edbi b\u1ec7nh th\u1eadn IgA.<\/p>\n

4. Ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i IV (trung gian t\u1ebf b\u00e0o T)<\/h2>\n

Ph\u00e2n lo\u1ea1i ban \u0111\u1ea7u c\u1ee7a Gell v\u00e0 Coombs v\u1ec1 c\u00e1c ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng thu\u1ed1c \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 tr\u01b0\u1edbc khi th\u1ebf gi\u1edbi c\u00f3 b\u1ea3n ph\u00e2n t\u00edch chi ti\u1ebft v\u1ec1 c\u00e1c ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c lo\u1ea1i t\u1ebf b\u00e0o lympho T kh\u00e1c nhau sau n\u00e0y. G\u1ea7n \u0111\u00e2y nhi\u1ec1u t\u00e1c gi\u1ea3 \u0111\u00e3 \u0111\u01b0a ra ba lo\u1ea1i ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng ph\u1ee5 thu\u1ed9c kh\u00e1ng th\u1ec3 \u0111\u00f2i h\u1ecfi s\u1ef1 tham gia c\u1ee7a c\u00e1c t\u1ebf b\u00e0o T tr\u1ee3 gi\u00fap, nh\u1eefng t\u1ebf b\u00e0o T c\u00f3 vai tr\u00f2 \u0111i\u1ec1u khi\u1ec3n c\u00e1c h\u00ecnh th\u1ee9c kh\u00e1c nhau c\u1ee7a qu\u00e1 tr\u00ecnh vi\u00eam. Do \u0111\u00f3 nh\u1eefng ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i IV qua trung gian t\u1ebf b\u00e0o T \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i nh\u1ecf h\u01a1n n\u1eefa, t\u1eeb IVa \u0111\u1ebfn IVd.<\/p>\n

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C\u01a1 ch\u1ebf c\u1ee7a ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn type IV<\/figcaption><\/figure>\n
    \n
  • Ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i IVa: T\u01b0\u01a1ng \u1ee9ng v\u1edbi nh\u1eefng \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch lo\u1ea1i Th1: Nh\u1eefng t\u1ebf b\u00e0o Th1 k\u00edch th\u00edch c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o b\u1eb1ng c\u00e1ch ti\u1ebft ra s\u1ed1 l\u01b0\u1ee3ng l\u1edbn interferon-\u03b3 (IFN-\u03b3), \u0111i\u1ec1u ti\u1ebft vi\u1ec7c s\u1ea3n xu\u1ea5t c\u00e1c nh\u00f3m kh\u00e1ng th\u1ec3 c\u1ed1 \u0111\u1ecbnh b\u1ed5 th\u1ec3 trong nh\u1eefng ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i II v\u00e0 III (IgG 1, IgG 3), l\u00e0 \u0111\u1ed3ng y\u1ebfu t\u1ed1 cho nh\u1eefng \u0111\u00e1p \u1ee9ng ti\u1ec1n vi\u00eam (TNF, IL-12) v\u00e0 nh\u1eefng \u0111\u00e1p \u1ee9ng c\u1ee7a t\u1ebf b\u00e0o T CD8. C\u00e1c t\u1ebf b\u00e0o T th\u00fac \u0111\u1ea9y nh\u1eefng ph\u1ea3n \u1ee9ng n\u00e0y b\u1eb1ng c\u00e1ch ti\u1ebft IFN-\u03b3 v\u00e0 c\u00f3 th\u1ec3 l\u00e0 c\u00e1c cytokin kh\u00e1c (TNF-\u03b1, IL-18).<\/li>\n
  • Ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i IVb: T\u01b0\u01a1ng \u1ee9ng v\u1edbi nh\u1eefng \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch lo\u1ea1i Th2. Nh\u1eefng t\u1ebf b\u00e0o Th2 ti\u1ebft ra c\u00e1c cytokin IL-4, IL13 v\u00e0 IL-5, c\u00e1c cytokin n\u00e0y th\u00fac \u0111\u1ea9y t\u1ebf b\u00e0o B s\u1ea3n xu\u1ea5t IgE v\u00e0 IgG4, \u0111i\u1ec1u h\u00f2a ho\u1ea1t \u0111\u1ed9ng c\u1ee7a \u0111\u1ea1i th\u1ef1c b\u00e0o, d\u01b0\u1ee1ng b\u00e0o v\u00e0 b\u1ea1ch c\u1ea7u \u00e1i toan. Vi\u1ec7c t\u0103ng ti\u1ebft c\u00e1c cytokin IL-5 c\u1ee7a t\u1ebf b\u00e0o Th2 d\u1eabn \u0111\u1ebfn t\u0103ng ph\u1ea3n \u1ee9ng vi\u00eam do b\u1ea1ch c\u1ea7u \u00e1i toan, \u0111\u00e2y lo\u1ea1i t\u1ebf b\u00e0o vi\u00eam \u0111\u1eb7c tr\u01b0ng trong nhi\u1ec1u ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn thu\u1ed1c. Ngo\u00e0i ra, c\u00f3 m\u1ed9t m\u1ed1i li\u00ean k\u1ebft v\u1edbi ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i I, do nh\u1eefng t\u1ebf b\u00e0o Th2 h\u1ed7 tr\u1ee3 s\u1ea3n xu\u1ea5t IgE th\u00f4ng qua ti\u1ebft IL-4 ho\u1eb7c IL-13.<\/li>\n
  • Ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i IVc: Nh\u1eefng ph\u1ea3n \u1ee9ng n\u00e0y x\u1ea3y ra \u1edf h\u1ea7u h\u1ebft c\u00e1c ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn thu\u1ed1c ch\u1eadm, ch\u1ee7 y\u1ebfu k\u1ebft h\u1ee3p c\u00f9ng v\u1edbi c\u00e1c ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i IV kh\u00e1c (b\u1ea1ch c\u1ea7u mono, \u00e1i toan, ho\u1eb7c thu h\u00fat v\u00e0 k\u00edch ho\u1ea1t c\u00e1c b\u1ea1ch c\u1ea7u h\u1ea1t \u0111a nh\u00e2n). C\u00e1c t\u1ebf b\u00e0o lympho T \u0111\u1ed9c do \u0111\u00f3 \u0111\u00f3ng vai tr\u00f2 trong c\u00e1c b\u1ec7nh ban s\u1ea9n ho\u1eb7c nh\u1eefng b\u1ec7nh da b\u1ecdng n\u01b0\u1edbc nh\u01b0 vi\u00eam da do b\u1ea1ch c\u1ea7u trung t\u00ednh, AGEP, vi\u00eam da ti\u1ebfp x\u00fac. Ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i IVc \u0111\u00f3ng vai tr\u00f2 ch\u1ee7 y\u1ebfu trong c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a c\u00e1c b\u1ec7nh da b\u1ecdng n\u01b0\u1edbc nh\u01b0 h\u1ed9i ch\u1ee9ng SJS v\u00e0 TEN, n\u00f3 c\u0169ng c\u00f3 th\u1ec3 chi\u1ebfm \u01b0u th\u1ebf trong vi\u00eam gan ho\u1eb7c vi\u00eam th\u1eadn do thu\u1ed1c.<\/li>\n
  • Ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn lo\u1ea1i IVd: Trong ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn n\u00e0y c\u00e1c t\u1ebf b\u00e0o T c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p v\u1edbi b\u1ea1ch c\u1ea7u trung t\u00ednh g\u00e2y vi\u00eam v\u00f4 khu\u1ea9n. M\u1ed9t v\u00ed d\u1ee5 \u0111i\u1ec3n h\u00ecnh l\u00e0 AGEP. Trong b\u1ec7nh n\u00e0y CXCL8 v\u00e0 y\u1ebfu t\u1ed1 k\u00edch th\u00edch \u0111\u01a1n d\u00f2ng \u0111\u1ea1i th\u1ef1c b\u00e0o – b\u1ea1ch c\u1ea7u h\u1ea1t (GM – CSF) \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t t\u1eeb c\u00e1c t\u1ebf b\u00e0o lympho T, \u0111\u00e3 thu h\u00fat c\u00e1c b\u1ea1ch c\u1ea7u trung t\u00ednh th\u00f4ng qua vi\u1ec7c gi\u1ea3i ph\u00f3ng CXCL 8 v\u00e0 ng\u0103n ng\u1eeba qu\u00e1 tr\u00ecnh ch\u1ebft theo ch\u01b0\u01a1ng tr\u00ecnh c\u1ee7a ch\u00fang th\u00f4ng qua vi\u1ec7c gi\u1ea3i ph\u00f3ng GM – CSF. Ngo\u00e0i b\u1ec7nh AGEP, nh\u1eefng ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng do t\u1ebf b\u00e0o T c\u0169ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u1edf ng\u01b0\u1eddi b\u1ec7nh b\u1ecb b\u1ec7nh v\u1ea9y n\u1ebfn v\u00e0 b\u1ec7nh Beh\u00e7et.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

    Nh\u1eefng ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn thu\u1ed1c c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a nhi\u1ec1u b\u1ec7nh kh\u00e1c nhau. \u0110\u1ec3 d\u1ec5 d\u00e0ng \u0111\u00e1nh gi\u00e1 s\u1ef1 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t n\u00e0y v\u00e0 gi\u1ea3i th\u00edch c\u00e1c h\u00ecnh \u1ea3nh l\u00e2m s\u00e0ng kh\u00e1c nhau, Gell v\u00e0 Coombs \u0111\u00e3 ph\u00e2n lo\u1ea1i ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn thu\u1ed1c c\u0169ng nh\u01b0 nh\u1eefng ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch kh\u00e1c […]<\/p>\n","protected":false},"author":30,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[73,12,33],"tags":[],"yoast_head":"\nPh\u00e2n lo\u1ea1i ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110\u1ec3 d\u1ec5 d\u00e0ng \u0111\u00e1nh gi\u00e1 v\u00e0 gi\u1ea3i th\u00edch c\u00e1c h\u00ecnh \u1ea3nh l\u00e2m s\u00e0ng kh\u00e1c nhau, Gell v\u00e0 Coombs \u0111\u00e3 ph\u00e2n lo\u1ea1i ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn thu\u1ed1c t\u1eeb lo\u1ea1i I \u0111\u1ebfn lo\u1ea1i IV.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ph\u00e2n lo\u1ea1i ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn - 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