{"id":30169,"date":"2023-05-04T17:19:41","date_gmt":"2023-05-04T10:19:41","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30169"},"modified":"2023-05-15T14:12:27","modified_gmt":"2023-05-15T07:12:27","slug":"toi-cap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/toi-cap\/","title":{"rendered":"Th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p v\u00e0 th\u1ea3i gh\u00e9p t\u1ebf b\u00e0o trong gh\u00e9p th\u1eadn"},"content":{"rendered":"

Th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p v\u00e0 th\u1ea3i gh\u00e9p t\u1ebf b\u00e0o \u0111\u1ec1u l\u00e0 nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p th\u1ea3i gh\u00e9p trong gh\u00e9p th\u1eadn. Th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u1ea3i gh\u00e9p nhanh ch\u00f3ng v\u00e0 hi\u1ec7u qu\u1ea3 b\u1eb1ng c\u00e1ch lo\u1ea1i b\u1ecf to\u00e0n b\u1ed9 ho\u1eb7c m\u1ed9t ph\u1ea7n t\u1ea1m th\u1eddi c\u1ee7a h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch c\u1ee7a b\u1ec7nh nh\u00e2n. Trong khi \u0111\u00f3, th\u1ea3i gh\u00e9p t\u1ebf b\u00e0o l\u00e0 qu\u00e1 tr\u00ecnh lo\u1ea1i b\u1ecf t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch t\u1eeb ng\u01b0\u1eddi cho gh\u00e9p v\u00e0o ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ec3 tr\u00e1nh s\u1ef1 ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch. C\u1ea3 hai ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u0111\u1ec1u \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 ph\u1ea3n \u1ee9ng t\u1ee9c th\u1eddi v\u00e0 t\u0103ng kh\u1ea3 n\u0103ng th\u00edch nghi c\u1ee7a c\u01a1 th\u1ec3 v\u1edbi t\u1ebf b\u00e0o gh\u00e9p.<\/strong><\/p>\n

1. Th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p (hyperacute rejection)<\/strong><\/h1>\n

1.1 Nguy\u00ean nh\u00e2n<\/strong><\/h3>\n

– Do hi\u1ec7n di\u1ec7n kh\u00e1ng th\u1ec3 \u0111\u1ed9c t\u1ebf b\u00e0o v\u1edbi n\u1ed3ng \u0111\u1ed9 cao trong huy\u1ebft thanh c\u1ee7a ng\u01b0\u1eddi nh\u1eadn, ch\u1ed1ng l\u1ea1i c\u00e1c kh\u00e1ng nguy\u00ean c\u1ee7a ng\u01b0\u1eddi cho (quan tr\u1ecdng nh\u1ea5t l\u00e0 c\u00e1c kh\u00e1ng nguy\u00ean HLA) th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n tr\u00ean t\u1ebf b\u00e0o n\u1ed9i m\u00f4 m\u1ea1ch m\u00e1u th\u1eadn gh\u00e9p.<\/p>\n

– Th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p v\u1ec1 b\u1ea3n ch\u1ea5t l\u00e0 th\u1ea3i gh\u00e9p th\u1ec3 d\u1ecbch n\u1eb7ng v\u00e0 t\u1ee9c th\u00ec, x\u1ea3y ra do hi\u1ec7n di\u1ec7n:<\/p>\n

+ Kh\u00e1ng th\u1ec3 kh\u00e1ng HLA \u1edf ng\u01b0\u1eddi nh\u1eadn, xu\u1ea5t hi\u1ec7n sau nh\u1eefng l\u1ea7n truy\u1ec1n m\u00e1u, c\u00f3 thai, ho\u1eb7c gh\u00e9p t\u1ea1ng tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n

+ Kh\u00e1ng th\u1ec3 kh\u00e1ng ABO khi gh\u00e9p b\u1ea5t t\u01b0\u01a1ng h\u1ee3p nh\u00f3m m\u00e1u.<\/p>\n

+ Kh\u00e1ng th\u1ec3 kh\u00e1ng c\u00e1c kh\u00e1ng nguy\u00ean kh\u00f4ng ph\u1ea3i HLA, ch\u1eb3ng h\u1ea1n MICA hay c\u00e1c kh\u00e1ng nguy\u00ean kh\u00e1c, hi\u1ec7n di\u1ec7n tr\u00ean t\u1ebf b\u00e0o n\u1ed9i m\u00f4.<\/p>\n

1.2 Ch\u1ea9n \u0111o\u00e1n <\/strong>th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p<\/strong><\/h3>\n

1.2.1. L\u00e2m s\u00e0ng<\/strong>: X\u1ea3y ra t\u1ee9c th\u00ec trong nh\u1eefng ph\u00fat hay gi\u1edd \u0111\u1ea7u ti\u00ean sau t\u00e1i t\u01b0\u1edbi m\u00e1u th\u1eadn. Bi\u1ec3u hi\u1ec7n: th\u1eadn m\u1ea5t ch\u1ee9c n\u0103ng nguy\u00ean ph\u00e1t hay ng\u01b0ng \u0111\u1ed9t ng\u1ed9t n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

1.2.2. C\u1eadn l\u00e2m s\u00e0ng<\/strong>:<\/p>\n

– Si\u00eau \u00e2m Doppler th\u1eadn gh\u00e9p t\u1ea1i ph\u00f2ng m\u1ed5 ho\u1eb7c sau m\u1ed5 \u0111\u00e1nh gi\u00e1 t\u01b0\u1edbi m\u00e1u nhu m\u00f4 th\u1eadn v\u00e0 lo\u1ea1i tr\u1eeb huy\u1ebft kh\u1ed1i \u0111\u1ed9ng ho\u1eb7c t\u0129nh m\u1ea1ch th\u1eadn.<\/p>\n

– Gi\u1ea3i ph\u1eabu b\u1ec7nh h\u1ecdc th\u1eadn gh\u00e9p: \u0110\u1ea1i th\u1ec3 th\u1eadn t\u00edm, ph\u00f9 n\u1ec1 v\u00e0 xu\u1ea5t huy\u1ebft. Vi th\u1ec3: t\u1ebf b\u00e0o n\u1ed9i m\u00f4 ho\u1ea1i t\u1eed, bong kh\u1ecfi l\u1edbp m\u00e0ng \u0111\u00e1y k\u00e8m ho\u1ea1t h\u00f3a h\u1ec7 th\u1ed1ng \u0111\u00f4ng m\u00e1u c\u00f3 th\u1ec3 d\u1eabn t\u1edbi \u0111\u00f4ng m\u00e1u th\u1ee9 ph\u00e1t. N\u1ebfu m\u00f4 th\u1eadn ch\u01b0a ho\u1ea1i t\u1eed ho\u00e0n to\u00e0n, c\u00f3 th\u1ec3 th\u1ea5y C4d d\u01b0\u01a1ng t\u00ednh \u1edf mao m\u1ea1ch v\u00e0 \u0111\u1ed9ng m\u1ea1ch, x\u00e1c nh\u1eadn ngu\u1ed3n g\u1ed1c th\u1ec3 d\u1ecbch c\u1ee7a th\u1ea3i gh\u00e9p (do ho\u1ea1t h\u00f3a b\u1ed5 th\u1ec3 theo con \u0111\u01b0\u1eddng c\u1ed5 \u0111i\u1ec3n b\u1edfi kh\u00e1ng th\u1ec3 kh\u00e1ng ng\u01b0\u1eddi cho) v\u00e0 gi\u00fap ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi huy\u1ebft kh\u1ed1i \u0111\u1ed9ng ho\u1eb7c t\u0129nh m\u1ea1ch th\u1eadn nguy\u00ean ph\u00e1t.<\/p>\n

\"\"
Vi\u1ec7c sinh thi\u1ebft gh\u00e9p s\u1edbm sau gh\u00e9p th\u1eadn cho th\u1ea5y m\u1ed9t c\u1ea7u th\u1eadn v\u1edbi s\u1ef1 x\u00e2m nh\u1eadp qu\u00e1 m\u1ee9c c\u1ee7a b\u1ea1ch c\u1ea7u. M\u1ed9t v\u00e0i b\u1ea1ch c\u1ea7u c\u0169ng \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y trong kho\u1ea3ng gian n\u1ed9i m\u00f4. Nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a s\u1ef1 th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p, nh\u01b0ng th\u01b0\u1eddng l\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u.<\/strong> Ngu\u1ed3n<\/strong>: UPMC<\/em><\/figcaption><\/figure>\n

1.2.3. Ti\u00ean l\u01b0\u1ee3ng<\/strong>: \u00a0x\u1ea5u v\u00ec th\u01b0\u1eddng ph\u1ea3i c\u1eaft b\u1ecf th\u1eadn gh\u00e9p.<\/p>\n

1.3 \u0110i\u1ec1u tr\u1ecb th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p<\/strong><\/h3>\n

– Gi\u1ea3i ph\u00e1p duy nh\u1ea5t l\u00e0 c\u1eaft b\u1ecf th\u1eadn gh\u00e9p v\u00ec nguy c\u01a1 ho\u1ea1t h\u00f3a \u0111\u00f4ng m\u00e1u th\u1ee9 ph\u00e1t d\u1eabn t\u1edbi \u0111\u00f4ng m\u00e1u n\u1ed9i m\u1ea1ch lan t\u1ecfa, c\u01a1 \u0111\u1ecba ch\u1ea3y m\u00e1u v\u00e0 v\u1ee1 th\u1eadn gh\u00e9p.<\/p>\n

1.4 D\u1ef1 ph\u00f2ng <\/strong>th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p<\/strong><\/h3>\n

– Th\u1ef1c hi\u1ec7n th\u01b0\u1eddng qui ph\u1ea3n \u1ee9ng ch\u00e9o tr\u01b0\u1edbc gh\u00e9p gi\u1eefa huy\u1ebft thanh ng\u01b0\u1eddi nh\u1eadn v\u00e0 lympho T v\u00e0 B c\u1ee7a ng\u01b0\u1eddi cho (b\u1eb1ng k\u1ef9 thu\u1eadt \u0111\u1ed9c t\u1ebf b\u00e0o l\u1ec7 thu\u1ed9c b\u1ed5 th\u1ec3 v\u00e0 ho\u1eb7c flow cytometry).<\/p>\n

– C\u00e1c k\u1ef9 thu\u1eadt t\u1ea7m so\u00e1t kh\u00e1ng th\u1ec3 m\u1edbi (Luminex) gi\u00fap th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p r\u1ea5t hi\u1ebfm x\u1ea3y ra. Tuy nhi\u00ean, gh\u00e9p th\u1eadn v\u1edbi nguy c\u01a1 mi\u1ec5n d\u1ecbch cao nh\u01b0: gh\u00e9p th\u1eadn l\u1ea1i, gh\u00e9p th\u1eadn v\u1edbi ph\u1ea3n \u1ee9ng ch\u00e9o d\u01b0\u01a1ng t\u00ednh, gh\u00e9p th\u1eadn b\u1ea5t t\u01b0\u01a1ng h\u1ee3p nh\u00f3m m\u00e1u ABO\u2026 th\u00ec t\u1ef7 l\u1ec7 th\u1ea3i gh\u00e9p c\u1ea5p th\u1ec3 d\u1ecbch n\u1eb7ng, k\u1ec3 c\u1ea3 th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p, t\u0103ng l\u00ean \u0111\u00e1ng k\u1ec3 sau gh\u00e9p, d\u00f9 \u0111\u00e3 th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p d\u1ef1 ph\u00f2ng chuy\u00ean bi\u1ec7t nh\u01b0 h\u1ea5p ph\u1ee5 mi\u1ec5n d\u1ecbch, IV Ig, rituximab ho\u1eb7c c\u1eaft l\u00e1ch.<\/p>\n

2. Th\u1ea3i gh\u00e9p c\u1ea5p t\u1ebf b\u00e0o (acute T-cell mediated rejection)<\/strong><\/h2>\n

2.1 Ch\u1ea9n \u0111o\u00e1n<\/strong><\/h3>\n

2.1.1. L\u00e2m s\u00e0ng<\/strong>: \u0110\u00e2y l\u00e0 h\u00ecnh th\u1ee9c th\u1ea3i gh\u00e9p th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, th\u01b0\u1eddng x\u1ea3y ra gi\u1eefa ng\u00e0y th\u1ee9 10 v\u00e0 th\u00e1ng th\u1ee9 3 sau gh\u00e9p.<\/p>\n

+ Tri\u1ec7u ch\u1ee9ng m\u1ec7t m\u1ecfi to\u00e0n th\u00e2n, s\u1ed1t, \u0111au th\u1eadn gh\u00e9p (do ph\u1ea3n \u1ee9ng vi\u00eam c\u1ee7a ph\u00fac m\u1ea1c quanh th\u1eadn gh\u00e9p), t\u0103ng huy\u1ebft \u00e1p, c\u00f3 ho\u1eb7c kh\u00f4ng thi\u1ec3u ni\u1ec7u.<\/p>\n

+ \u1ede giai \u0111o\u1ea1n s\u1edbm sau gh\u00e9p, c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n: ng\u01b0ng tr\u1ec7 tr\u1ecb s\u1ed1 creatinine huy\u1ebft thanh \u1edf m\u1ee9c t\u01b0\u01a1ng \u0111\u1ed1i cao, d\u00f9 tr\u01b0\u1edbc \u0111\u00f3 ch\u1ee9c n\u0103ng th\u1eadn \u0111ang c\u1ea3i thi\u1ec7n.<\/p>\n

2.1.2. C\u1eadn l\u00e2m s\u00e0ng<\/strong>:<\/p>\n

+ Creatinine huy\u1ebft thanh t\u0103ng >20% tr\u1ecb s\u1ed1 c\u01a1 b\u1ea3n tr\u01b0\u1edbc \u0111\u00f3)<\/p>\n

+ Natri ni\u1ec7u c\u00f3 th\u1ec3 gi\u1ea3m ho\u1eb7c kh\u00f4ng.<\/p>\n

+ C\u00e1c x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh h\u1ecdc (si\u00eau \u00e2m Doppler th\u1eadn gh\u00e9p, x\u1ea1 h\u00ecnh th\u1eadn, ch\u1ee5p c\u1eaft l\u1edbp \u1ed5 b\u1ee5ng) gi\u00fap lo\u1ea1i tr\u1eeb c\u00e1c bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u hay \u0111\u01b0\u1eddng ni\u1ec7u l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n

2.1.3. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh <\/strong><\/p>\n

+ Sinh thi\u1ebft \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi \u0111\u00e3 lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c.<\/p>\n

+ V\u1ec1 ph\u01b0\u01a1ng di\u1ec7n gi\u1ea3i ph\u1eabu b\u1ec7nh h\u1ecdc, th\u1ea3i gh\u00e9p c\u1ea5p t\u1ebf b\u00e0o g\u1ed3m 2 th\u00e0nh ph\u1ea7n, \u1ed1ng th\u1eadn-m\u00f4 k\u1ebd (vi\u00eam \u1ed1ng th\u1eadn v\u00e0 th\u00e2m nhi\u1ec5m vi\u00eam m\u00f4 k\u1ebd) v\u00e0 ho\u1eb7c m\u1ea1ch m\u00e1u (vi\u00eam n\u1ed9i m\u00f4 m\u1ea1ch m\u00e1u). H\u00ecnh th\u1ee9c v\u00e0 \u0111\u1ed9 n\u1eb7ng c\u1ee7a c\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u00f4 h\u1ecdc theo ph\u00e2n lo\u1ea1i Banff n\u0103m 2009 quy\u1ebft \u0111\u1ecbnh \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb v\u00e0 ti\u00ean l\u01b0\u1ee3ng.<\/p>\n

\"\"
Ngu\u1ed3n: Anita S. Chong & David L. Perkins, \u201cMolecular phenotyping of T-cell-mediated rejection\u201d,<\/strong> Nature Reviews Nephrology volume 10, p678\u2013680 (2014)<\/em><\/figcaption><\/figure>\n

2.1.4. Ti\u00ean l\u01b0\u1ee3ng<\/strong>: Th\u1ea3i gh\u00e9p c\u1ea5p l\u00e0m suy gi\u1ea3m kh\u1ea3 n\u0103ng s\u1ed1ng c\u00f2n c\u1ee7a th\u1eadn gh\u00e9p trung h\u1ea1n v\u00e0 d\u00e0i h\u1ea1n, \u0111\u1eb7c bi\u1ec7t khi th\u1ea3i gh\u00e9p c\u1ea5p mu\u1ed9n v\u00e0 creatinine huy\u1ebft thanh kh\u00f4ng h\u1ed3i ph\u1ee5c v\u1ec1 tr\u1ecb s\u1ed1 c\u01a1 b\u1ea3n ban \u0111\u1ea7u.<\/p>\n

2.1.5. M\u1ed9t s\u1ed1 h\u00ecnh th\u1ee9c th\u1ea3i gh\u00e9p c\u1ea5p \u0111\u1eb7c bi\u1ec7t<\/strong><\/p>\n

+ Th\u1ea3i gh\u00e9p c\u1ea5p t\u1ebf b\u00e0o gia t\u1ed1c (accelerated acute T-cell mediated rejection):<\/strong> x\u1ea3y ra \u1edf tu\u1ea7n \u0111\u1ea7u sau gh\u00e9p, ngh\u0129a l\u00e0 tr\u01b0\u1edbc th\u1eddi \u0111i\u1ec3m th\u00f4ng th\u01b0\u1eddng c\u1ee7a th\u1ea3i gh\u00e9p c\u1ea5p t\u1ebf b\u00e0o, th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c m\u1eabn c\u1ea3m tr\u01b0\u1edbc \u0111\u00f3 v\u1edbi c\u00e1c kh\u00e1ng nguy\u00ean c\u1ee7a th\u1eadn gh\u00e9p, v\u00ec th\u1ebf ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch nh\u1edb l\u1ea1i, huy \u0111\u1ed9ng c\u00e1c lympho T v\u00e0 B nh\u1edb. C\u01a1 ch\u1ebf sinh b\u1ec7nh h\u1ecdc: th\u00f4ng th\u01b0\u1eddng l\u00e0 th\u1ea3i gh\u00e9p c\u1ea5p h\u1ed7n h\u1ee3p v\u1edbi th\u00e0nh ph\u1ea7n t\u1ebf b\u00e0o v\u00e0 th\u1ec3 d\u1ecbch c\u00f9ng t\u1ed3n t\u1ea1i; nh\u01b0ng 1 s\u1ed1 th\u1ea3i gh\u00e9p c\u1ea5p gia t\u1ed1c thu\u1ea7n t\u00fay ch\u1ec9 g\u1ed3m th\u00e0nh ph\u1ea7n t\u1ebf b\u00e0o, kh\u00f4ng c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a kh\u00e1ng th\u1ec3 kh\u00e1ng ng\u01b0\u1eddi cho, do \u0111\u00f3 C4d \u00e2m t\u00ednh tr\u00ean c\u00e1c m\u1eabu sinh thi\u1ebft. Do \u0111\u00f3 b\u00ean c\u1ea1nh vi\u1ec7c \u0111\u00e1nh gi\u00e1 mi\u1ec5n d\u1ecbch th\u1ec3 d\u1ecbch tr\u01b0\u1edbc gh\u00e9p, c\u1ea7n \u0111\u00e1nh gi\u00e1 mi\u1ec5n d\u1ecbch t\u1ebf b\u00e0o c\u1ee7a ng\u01b0\u1eddi nh\u1eadn ch\u1ed1ng l\u1ea1i ng\u01b0\u1eddi cho b\u1eb1ng k\u1ef9 thu\u1eadt ELIPOT \u0111\u1ec3 gi\u00fap h\u01b0\u1edbng d\u1eabn c\u00e1ch th\u1ee9c \u0111i\u1ec1u tr\u1ecb d\u1eabn nh\u1eadp. C\u00e1c lympho nh\u1edb ch\u1ecbu tr\u00e1ch nhi\u1ec7m trong h\u00ecnh th\u1ee9c th\u1ea3i gh\u00e9p n\u00e0y \u00edt nh\u1ea1y c\u1ea3m v\u1edbi c\u00e1c thu\u1ed1c UCMD, do \u0111\u00f3 d\u1ef1 ph\u00f2ng th\u1ea3i gh\u00e9p c\u1ea5p gia t\u1ed1c l\u00e0 bi\u1ec7n ph\u00e1p h\u1eefu hi\u1ec7u nh\u1ea5t.<\/p>\n

+ Th\u1ea3i gh\u00e9p d\u01b0\u1edbi m\u1ee9c l\u00e2m s\u00e0ng (subclinical rejection): <\/strong>Ph\u00e1t hi\u1ec7n khi sinh thi\u1ebft th\u1eadn th\u01b0\u1eddng qui v\u1edbi ch\u1ee9c n\u0103ng th\u1eadn b\u00ecnh th\u01b0\u1eddng ho\u1eb7c \u1ed5n \u0111\u1ecbnh. T\u1ea7n su\u1ea5t v\u00e0 \u00fd ngh\u0129a l\u00e2m s\u00e0ng c\u1ee7a c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y t\u00f9y thu\u1ed9c ph\u00e1c \u0111\u1ed3 UCMD (cyclosporin hay tacrolimus), c\u00e1ch th\u1ee9c \u0111i\u1ec1u tr\u1ecb d\u1eabn nh\u1eadp (kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng hay \u0111a d\u00f2ng) v\u00e0 nguy c\u01a1 mi\u1ec5n d\u1ecbch tr\u01b0\u1edbc gh\u00e9p (s\u1ed1 b\u1ea5t t\u01b0\u01a1ng h\u1ee3p HLA, t\u00ecnh tr\u1ea1ng m\u1eabn c\u1ea3m tr\u01b0\u1edbc gh\u00e9p v\u00e0 b\u1ec7nh s\u1eed th\u1ea3i gh\u00e9p c\u1ea5p tr\u01b0\u1edbc \u0111\u00f3).<\/p>\n

+ Th\u1ea3i gh\u00e9p c\u1ea5p v\u00e0 cytomegalovirus (CMV):<\/strong> Do ph\u1ea3n \u1ee9ng ch\u00e9o gi\u1eefa kh\u00e1ng nguy\u00ean virus v\u00e0 kh\u00e1ng nguy\u00ean HLA c\u1ee7a th\u1eadn gh\u00e9p \u0111\u01b0\u1ee3c nh\u1eadn di\u1ec7n b\u1edfi c\u00e1c lympho T \u0111\u1eb7c hi\u1ec7u, m\u1ed1i li\u00ean h\u1ec7 n\u00e0y di\u1ec5n ra theo 2 chi\u1ec1u: m\u1ed9t m\u1eb7t, \u0111i\u1ec1u tr\u1ecb th\u1ea3i gh\u00e9p c\u1ea5p, nh\u1ea5t l\u00e0 khi s\u1eed d\u1ee5ng kh\u00e1ng th\u1ec3 \u0111a d\u00f2ng hay \u0111\u01a1n d\u00f2ng \u0111\u1ed9c lympho b\u00e0o, c\u00f3 th\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n xu\u1ea5t hi\u1ec7n nhi\u1ec5m tr\u00f9ng CMV (s\u01a1 nhi\u1ec5m t\u1eeb ng\u01b0\u1eddi cho ho\u1eb7c t\u00e1i ho\u1ea1t virus); m\u1eb7t kh\u00e1c, nhi\u1ec5m tr\u00f9ng CMV v\u1edbi c\u00e1c \u0111\u1eb7c t\u00ednh \u0111i\u1ec1u h\u00f2a mi\u1ec5n d\u1ecbch c\u0169ng c\u00f3 th\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n xu\u1ea5t hi\u1ec7n th\u1ea3i gh\u00e9p c\u1ea5p. D\u1ef1 ph\u00f2ng h\u1eefu hi\u1ec7u CMV v\u1edbi valganciclovir \u0111\u01b0\u1eddng u\u1ed1ng t\u1eeb 3 \u0111\u1ebfn 6 th\u00e1ng, ngo\u00e0i t\u00e1c d\u1ee5ng kh\u00e1ng CMV, c\u00f2n gi\u00fap ng\u0103n ng\u1eeba th\u1ea3i gh\u00e9p c\u1ea5p, c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n c\u1ea3i thi\u1ec7n s\u1ed1ng c\u00f2n l\u00e2u d\u00e0i c\u1ee7a th\u1eadn gh\u00e9p v\u00e0 b\u1ec7nh nh\u00e2n.<\/p>\n

2.2 \u0110i\u1ec1u tr\u1ecb<\/strong><\/h3>\n

– K\u1ebft h\u1ee3p c\u00e1c thu\u1ed1c UCMD l\u00e0 nguy\u00ean t\u1eafc c\u0103n b\u1ea3n trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn. Nguy c\u01a1 th\u1ea3i gh\u00e9p c\u1ea5p thay \u0111\u1ed5i theo c\u00e1c ph\u00e1c \u0111\u1ed3 UCMD, trong \u0111\u00f3 k\u1ebft h\u1ee3p tacrolimus, mycophenolate mofetil v\u00e0 corticosteroid c\u00f3 t\u1ef7 l\u1ec7 th\u1ea3i gh\u00e9p c\u1ea5p th\u1ea5p nh\u1ea5t (10-15%).<\/p>\n

– Khi th\u1ea3i gh\u00e9p c\u1ea5p v\u1eabn x\u1ea3y ra c\u1ea7n t\u0103ng c\u01b0\u1eddng UCMD ngay. Khi b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng r\u00f5 r\u00e0ng, ngh\u0129a l\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n n\u00e0o kh\u00e1c gi\u1ea3i th\u00edch r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn, ho\u1eb7c c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh sinh thi\u1ebft th\u1eadn, b\u1eaft \u0111\u1ea7u ngay corticosteroid li\u1ec1u t\u1ea5n c\u00f4ng (methylprednisolone 250-500 mg\/ng\u00e0y, 3 ng\u00e0y li\u00ean ti\u1ebfp). N\u1ebfu di\u1ec5n ti\u1ebfn l\u00e2m s\u00e0ng kh\u00f4ng thu\u1eadn l\u1ee3i sau \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u n\u00e0y, c\u1ea7n thi\u1ebft sinh thi\u1ebft th\u1eadn \u0111\u1ec3 c\u00f3 ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u00e0 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ti\u1ebfp theo.<\/p>\n

– N\u1ebfu sinh thi\u1ebft th\u1eadn \u0111\u01b0\u1ee3c, \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng th\u1ea3i gh\u00e9p c\u00f3 th\u1ec3 d\u1ef1a tr\u00ean ph\u00e2n lo\u1ea1i Banff. \u0110a s\u1ed1 th\u1ea3i gh\u00e9p \u1ed1ng th\u1eadn-m\u00f4 k\u1ebd (Banff \u0111\u1ed91) nh\u1ea1y c\u1ea3m v\u1edbi corticosteroid, do \u0111\u00f3, \u0111i\u1ec1u tr\u1ecb b\u01b0\u1edbc \u0111\u1ea7u l\u00e0 corticosteroid t\u0129nh m\u1ea1ch, li\u1ec1u t\u1ea5n c\u00f4ng m\u1ed7i ng\u00e0y, 3-5 ng\u00e0y. Ng\u01b0\u1ee3c l\u1ea1i, th\u1ea3i gh\u00e9p v\u1edbi th\u00e0nh ph\u1ea7n m\u1ea1ch m\u00e1u (Banff \u0111\u1ed9 2 v\u00e0 3) c\u00f3 th\u1ec3 kh\u00e1ng corticosteroid, c\u1ea7n \u0111i\u1ec1u tr\u1ecb v\u1edbi kh\u00e1ng th\u1ec3 \u0111\u1ed9c lympho b\u00e0o, nh\u01b0 thymoglobulin, ATG (antithymocyte globulin), ho\u1eb7c OKT3. \u0110\u00f4i khi, c\u00e1c \u0111i\u1ec1u tr\u1ecb n\u00e0y \u0111\u01b0\u1ee3c d\u00f9ng ngay t\u1eeb \u0111\u1ea7u. Vd: ATG (Thymogam):10-15mg\/kg\/ng\u00e0y (t\u1ed1i \u0111a 700mg\/ng\u00e0y) trong 14 ng\u00e0y, sau \u0111\u00f3 c\u00e1ch ng\u00e0y th\u00eam 14 ng\u00e0y n\u1eefa , t\u1ed5ng li\u1ec1u 21 m\u0169i trong 28 ng\u00e0y.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 b\u1ec7nh th\u1eadn \u2013 ti\u1ebft ni\u1ec7u c\u1ee7a B\u1ed9 Y t\u1ebf 2015<\/p>\n","protected":false},"excerpt":{"rendered":"

Th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p v\u00e0 th\u1ea3i gh\u00e9p t\u1ebf b\u00e0o \u0111\u1ec1u l\u00e0 nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p th\u1ea3i gh\u00e9p trong gh\u00e9p th\u1eadn. Th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u1ea3i gh\u00e9p nhanh ch\u00f3ng v\u00e0 hi\u1ec7u qu\u1ea3 b\u1eb1ng c\u00e1ch lo\u1ea1i b\u1ecf to\u00e0n b\u1ed9 ho\u1eb7c m\u1ed9t ph\u1ea7n t\u1ea1m th\u1eddi c\u1ee7a h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch c\u1ee7a b\u1ec7nh nh\u00e2n. Trong khi \u0111\u00f3, […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[73,33],"tags":[],"yoast_head":"\nTh\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p v\u00e0 th\u1ea3i gh\u00e9p t\u1ebf b\u00e0o trong gh\u00e9p th\u1eadn - Vinmec<\/title>\n<meta name=\"description\" content=\"Th\u1ea3i gh\u00e9p t\u1ed1i c\u1ea5p v\u00e0 th\u1ea3i gh\u00e9p t\u1ebf b\u00e0o \u0111\u1ec1u l\u00e0 nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p th\u1ea3i gh\u00e9p trong gh\u00e9p th\u1eadn. 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