{"id":33493,"date":"2023-05-13T21:21:19","date_gmt":"2023-05-13T14:21:19","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=33493"},"modified":"2023-05-13T21:21:19","modified_gmt":"2023-05-13T14:21:19","slug":"viem-cau-than-tre-em-nguyen-nhan-va-co-che-benh-sinh-2","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/13\/viem-cau-than-tre-em-nguyen-nhan-va-co-che-benh-sinh-2\/","title":{"rendered":"Vi\u00eam c\u1ea7u th\u1eadn tr\u1ebb em: Nguy\u00ean nh\u00e2n v\u00e0 c\u01a1 ch\u1ebf b\u1ec7nh sinh"},"content":{"rendered":"

Vi\u00eam c\u1ea7u th\u1eadn tr\u1ebb em l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng tr\u1ebb em t\u1eeb 2-6 tu\u1ed5i. B\u1ec7nh x\u1ea3y ra khi h\u1ec7 mi\u1ec5n d\u1ecbch c\u1ee7a c\u01a1 th\u1ec3 t\u1ea5n c\u00f4ng nh\u1ea7m c\u00e1c m\u00f4 t\u1ebf b\u00e0o trong th\u1eadn, g\u00e2y ra s\u1ef1 vi\u00eam nhi\u1ec5m v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u00e1c c\u1ea7u th\u1eadn. Trong b\u00e0i vi\u1ebft n\u00e0y, ch\u00fang ta s\u1ebd t\u00ecm hi\u1ec3u s\u00e2u h\u01a1n v\u1ec1 nguy\u00ean nh\u00e2n v\u00e0 c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a vi\u00eam c\u1ea7u th\u1eadn tr\u1ebb em, \u0111\u1ec3 gi\u00fap c\u00e1c chuy\u00ean gia y t\u1ebf hi\u1ec3u r\u00f5 h\u01a1n v\u1ec1 b\u1ec7nh l\u00fd n\u00e0y v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0a ra c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 cho c\u00e1c b\u1ec7nh nh\u00e2n.<\/strong><\/p>\n

\"Vi\u00eam
Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p \u1edf tr\u1ebb em | Vinmec<\/figcaption><\/figure>\n

1. T\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn \u1edf tr\u1ebb em:<\/strong><\/h2>\n

C\u00f3 hai c\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch c\u1ee7a t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn: vi\u00eam v\u00e0 kh\u00f4ng vi\u00eam<\/p>\n

T\u1ed5n th\u01b0\u01a1ng vi\u00eam (vi\u00eam c\u1ea7u th\u1eadn)<\/strong> \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 t\u0103ng sinh t\u1ebf b\u00e0o c\u1ea7u th\u1eadn, k\u1ebft qu\u1ea3 t\u1eeb vi\u1ec7c x\u00e2m nh\u1eadp c\u1ee7a c\u00e1c t\u1ebf b\u00e0o m\u00e1u (ch\u1eb3ng h\u1ea1n nh\u01b0 b\u1ea1ch c\u1ea7u trung t\u00ednh v\u00e0 \u0111\u1ea1i th\u1ef1c b\u00e0o) v\u00e0 \/ ho\u1eb7c ph\u00e1t tri\u1ec3n c\u00e1c t\u1ebf b\u00e0o c\u1ea7u th\u1eadn. Nh\u1eefng t\u1ebf b\u00e0o t\u00e1c \u0111\u1ed9ng n\u00e0y g\u00e2y ra c\u00e1c b\u1ea5t th\u01b0\u1eddng kh\u00e1c, ch\u1eb3ng h\u1ea1n nh\u01b0 huy\u1ebft kh\u1ed1i, ho\u1ea1i t\u1eed, v\u00e0 h\u00ecnh th\u00e0nh d\u1ea1ng h\u00ecnh li\u1ec1m, d\u1ea1ng m\u00e0 n\u1ebfu lan r\u1ed9ng, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u00eam c\u1ea7u th\u1eadn ti\u1ebfn tri\u1ec3n nhanh.<\/p>\n

C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng ch\u00ednh c\u1ee7a b\u1ec7nh vi\u00eam c\u1ea7u th\u1eadn l\u00e0 ti\u1ec3u m\u00e1u v\u00e0 th\u1ec9nh tho\u1ea3ng c\u00f3 b\u1ea1ch c\u1ea7u ni\u1ec7u, th\u01b0\u1eddng v\u1edbi m\u1ed9t s\u1ed1 h\u1ed3ng c\u1ea7u bi\u1ebfn d\u1ea1ng (d\u1ecb d\u1ea1ng hay kh\u00f4ng b\u00ecnh th\u01b0\u1eddng v\u1ec1 h\u00ecnh d\u1ea1ng hay c\u1ea5u tr\u00fac) , c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 tr\u1ee5 h\u1ed3ng c\u1ea7u ; c\u00e1c m\u1ee9c \u0111\u1ed9 protein ni\u1ec7u kh\u00e1c nhau, t\u1eeb nh\u1eb9 \u0111\u1ebfn ph\u1ea1m vi c\u1ee7a h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0; v\u00e0 t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a b\u1ec7nh, m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u1ea3m. C\u00e1c nguy\u00ean nh\u00e2n th\u00f4ng th\u01b0\u1eddng c\u1ee7a vi\u00eam c\u1ea7u th\u1eadn qua trung gian mi\u1ec5n d\u1ecbch g\u1ed3m c\u00f3 b\u1ec7nh th\u1eadn IgA, vi\u00eam th\u1eadn lupus, v\u00e0 vi\u00eam c\u1ea7u th\u1eadn c\u00f3 li\u00ean quan \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng hay h\u1eadu nhi\u1ec5m tr\u00f9ng.<\/p>\n

C\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng vi\u00eam<\/strong> do mi\u1ec5n d\u1ecbch th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn t\u1ebf b\u00e0o c\u00f3 ch\u00e2n v\u00e0 k\u1ebft h\u1ee3p v\u1edbi s\u1ef1 thay \u0111\u1ed5i ch\u1ee9c n\u0103ng ch\u00ednh c\u1ee7a c\u1ea7u th\u1eadn d\u1eabn \u0111\u1ebfn s\u1ef1 gia t\u0103ng t\u00ednh th\u1ea5m c\u1ea7u th\u1eadn v\u1edbi albumin v\u00e0 c\u00e1c protein kh\u00e1c.<\/p>\n

C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng ch\u00ednh c\u1ee7a t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn kh\u00f4ng vi\u00eam l\u00e0 protein ni\u1ec7u v\u00e0 h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 ti\u1ec3u m\u00e1u v\u00e0 kh\u00f4ng c\u00f3 tr\u1ee5 h\u1ed3ng c\u1ea7u. Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p c\u1ee7a h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 qua trung gian mi\u1ec5n d\u1ecbch kh\u00f4ng vi\u00eam l\u00e0 b\u1ec7nh c\u1ea7u th\u1eadn sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u (MCD), x\u01a1 chai c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng v\u00f9ng (FSGS), v\u00e0 vi\u00eam c\u1ea7u th\u1eadn m\u00e0ng (MN).<\/p>\n\n\n\n\n\n\n
<\/td>\nT\u1ed5n th\u01b0\u01a1ng vi\u00eam <\/strong><\/td>\nT\u1ed5n th\u01b0\u01a1ng kh\u00f4ng vi\u00eam <\/strong><\/td>\n<\/tr>\n
\u0110\u1eb7c \u0111i\u1ec3m<\/td>\nt\u0103ng sinh t\u1ebf b\u00e0o c\u1ea7u th\u1eadn<\/td>\nli\u00ean quan \u0111\u1ebfn t\u1ebf b\u00e0o c\u00f3 ch\u00e2n v\u00e0 k\u1ebft h\u1ee3p v\u1edbi s\u1ef1 thay \u0111\u1ed5i ch\u1ee9c n\u0103ng ch\u00ednh c\u1ee7a c\u1ea7u th\u1eadn d\u1eabn \u0111\u1ebfn s\u1ef1 gia t\u0103ng t\u00ednh th\u1ea5m c\u1ea7u th\u1eadn v\u1edbi albumin v\u00e0 c\u00e1c protein kh\u00e1c.<\/td>\n<\/tr>\n
L\u00e2m s\u00e0ng<\/td>\n– ti\u1ec3u m\u00e1u v\u00e0 th\u1ec9nh tho\u1ea3ng c\u00f3 b\u1ea1ch c\u1ea7u ni\u1ec7u<\/p>\n

-c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 tr\u1ee5 h\u1ed3ng c\u1ea7u\u00a0 -c\u00e1c m\u1ee9c \u0111\u1ed9 protein ni\u1ec7u kh\u00e1c nhau, t\u1eeb nh\u1eb9 \u0111\u1ebfn ph\u1ea1m -m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u1ea3m.<\/td>\n

– protein ni\u1ec7u v\u00e0 h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 – \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 ti\u1ec3u m\u00e1u v\u00e0 kh\u00f4ng c\u00f3 tr\u1ee5 h\u1ed3ng c\u1ea7u<\/td>\n<\/tr>\n
C\u00e1c b\u1ec7nh<\/p>\n

Th\u01b0\u1eddng g\u1eb7p<\/td>\n

b\u1ec7nh th\u1eadn IgA, vi\u00eam th\u1eadn lupus, v\u00e0 vi\u00eam c\u1ea7u th\u1eadn c\u00f3 li\u00ean quan \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng hay h\u1eadu nhi\u1ec5m tr\u00f9ng.<\/td>\nb\u1ec7nh c\u1ea7u th\u1eadn sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u (MCD), x\u01a1 chai c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng v\u00f9ng (FSGS), v\u00e0 vi\u00eam c\u1ea7u th\u1eadn m\u00e0ng (MN).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

2. C\u01a1 ch\u1ebf vi\u00eam trong t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn \u1edf tr\u1ebb em:<\/strong><\/h2>\n

2.1. T\u1ea5n c\u00f4ng mi\u1ec5n d\u1ecbch: <\/strong><\/h3>\n

\u0110\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch d\u1ecbch th\u1ec3 (qua t\u1ebf b\u00e0o Th2) v\u1edbi nhi\u1ec1u t\u00e1c nh\u00e2n k\u00edch ho\u1ea1t d\u1eabn \u0111\u1ebfn s\u1ef1 l\u1eafng \u0111\u1ecdng globulin mi\u1ec5n d\u1ecbch v\u00e0 k\u00edch ho\u1ea1t b\u1ed5 th\u1ec3 trong c\u00e1c c\u1ea7u th\u1eadn.<\/p>\n

Trong h\u1ea7u h\u1ebft c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e0y, s\u1ef1 l\u1eafng \u0111\u1ecdng ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh ho\u1ea1t \u0111\u1ed9ng g\u00e2y ra b\u1edfi vi\u1ec7c k\u1ebft h\u1ee3p kh\u00e1ng th\u1ec3 v\u1edbi kh\u00e1ng nguy\u00ean t\u1ea1i ch\u1ed7 khu tr\u00fa trong c\u1ea7u th\u1eadn.<\/p>\n

C\u00e1c kh\u00e1ng nguy\u00ean c\u00f3 th\u1ec3 l\u00e0 th\u00e0nh ph\u1ea7n c\u1ea5u t\u1ea1o c\u1ea7u th\u1eadn, ch\u1eb3ng h\u1ea1n nh\u01b0 kh\u00e1ng nguy\u00ean Goodpasture trong v\u00f9ng kh\u00f4ng collagen c\u1ee7a chu\u1ed7i alpha-3 c\u1ee7a collagen typ IV \u1edf m\u00e0ng \u0111\u00e1y c\u1ea7u th\u1eadn (GBM)<\/p>\n

Ngo\u00e0i ra, c\u00e1c kh\u00e1ng nguy\u00ean c\u00f3 th\u1ec3 b\u1ecb m\u1eafc k\u1eb9t ho\u1eb7c l\u1eafng \u0111\u1ecdng trong c\u1ea7u th\u1eadn, bao g\u1ed3m c\u00e1c t\u1ef1 kh\u00e1ng nguy\u00ean nh\u01b0 DNA trong c\u00e1c d\u1ea1ng nucleosome trong vi\u00eam th\u1eadn lupus, ho\u1eb7c c\u00e1c kh\u00e1ng nguy\u00ean b\u00ean ngo\u00e0i do c\u00e1c t\u00e1c nh\u00e2n g\u00e2y nhi\u1ec5m tr\u00f9ng nh\u01b0 vi khu\u1ea9n (Streptococcus, Staphylococcus), virus (vi\u00eam gan B) , ho\u1eb7c kh\u00e1ng nguy\u00ean kh\u1ed1i u. C\u00e1c ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch h\u00ecnh th\u00e0nh t\u1ea1i ch\u1ed7 n\u00e0y c\u00f3 th\u1ec3 khu\u1ebfch \u0111\u1ea1i l\u00ean n\u1ebfu c\u00f3 \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch xa h\u01a1n bao g\u1ed3m k\u00edch ho\u1ea1t t\u1ebf b\u00e0o B \u0111a h\u00ecnh, g\u00e2y ra s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c kh\u00e1ng th\u1ec3 kh\u00e1c nhau. Ch\u00fang bao g\u1ed3m c\u00e1c y\u1ebfu t\u1ed1 th\u1ea5p IgM, Anti- IgG, ho\u1eb7c c\u00e1c kh\u00e1ng th\u1ec3 anti- idiotypic li\u00ean k\u1ebft v\u1edbi c\u00e1c ph\u1ee9c h\u1ee3p n\u00e0y.<\/p>\n

M\u1ed9t c\u01a1 ch\u1ebf kh\u00e1c c\u00f3 th\u1ec3 cho s\u1ef1 l\u1eafng \u0111\u1ecdng ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch l\u00e0 qu\u00e1 tr\u00ecnh th\u1ee5 \u0111\u1ed9ng c\u1ee7a b\u1eaby c\u00e1c ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch l\u01b0u th\u00f4ng trong c\u1ea7u th\u1eadn. M\u1eb7c d\u00f9 qu\u00e1 tr\u00ecnh n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u tr\u00ean c\u00e1c m\u00f4 h\u00ecnh \u0111\u1ed9ng v\u1eadt (b\u1ec7nh huy\u1ebft thanh), d\u01b0\u1eddng nh\u01b0 \u00edt th\u1ea5y \u1edf vi\u00eam c\u1ea7u th\u1eadn \u1edf ng\u01b0\u1eddi h\u01a1n so v\u1edbi h\u00ecnh th\u00e0nh ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch t\u1ea1i ch\u1ed7.<\/p>\n

Vi\u00eam c\u1ea7u th\u1eadn<\/a> do s\u1ef1 h\u00ecnh th\u00e0nh kh\u00e1ng th\u1ec3 \u0111\u00f2i h\u1ecfi s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a lympho T.. Tuy nhi\u00ean, lympho T c\u00f3 th\u1ec3 g\u00e2y vi\u00eam c\u1ea7u th\u1eadn m\u00e0 kh\u00f4ng c\u00f3 kh\u00e1ng th\u1ec3. M\u1eb7c d\u00f9 c\u01a1 ch\u1ebf \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch qua trung gian t\u1ebf b\u00e0o n\u00e0y \u00edt \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5 r\u00e0ng \u1edf ng\u01b0\u1eddi, nh\u01b0ng d\u01b0\u1eddng nh\u01b0 n\u00f3 ho\u1ea1t h\u00f3a c\u1ea3 lympho T v\u00e0 \u0111\u1ea1i th\u1ef1c b\u00e0o, \u0111\u1eb7c bi\u1ec7t trong vi\u00eam c\u1ea7u th\u1eadn ti\u1ebfn tri\u1ec3n nhanh.. C\u00e1c t\u1ebf b\u00e0o n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 c\u00e1c t\u1ebf b\u00e0o Th17 v\u00ec t\u1ea1o ra nh\u1eefng th\u00e0nh ph\u1ea7n c\u1ee7a h\u1ecd cytokine interleukin (IL) -17. S\u1ef1 gia t\u0103ng c\u00e1c t\u1ebf b\u00e0o Th17 \u0111\u01b0\u1ee3c \u0111i\u1ec1u khi\u1ec3n b\u1edfi IL-23, v\u00e0 IL-23 \/ Th17 r\u1ea5t quan tr\u1ecdng trong c\u00e1c ki\u1ec3u h\u00ecnh kh\u00e1c nhau c\u1ee7a vi\u00eam c\u1ea7u th\u1eadn th\u1ef1c nghi\u1ec7m.<\/p>\n

C\u00e1c t\u1ebf b\u00e0o Th17 c\u0169ng th\u00fac \u0111\u1ea9y vi\u00eam th\u1eadn c\u1ea7u th\u1eadn t\u1ef1 mi\u1ec5n qua trung gian kh\u00e1ng MPO th\u00f4ng qua s\u1ef1 b\u00e0i ti\u1ebft IL-17a.<\/p>\n

C\u00e1c epodope t\u1ebf b\u00e0o T MPO mi\u1ec5n d\u1ecbch \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. C\u00e1c b\u1ea1ch c\u1ea7u trung t\u00ednh k\u00edch ho\u1ea1t ANCA g\u00e2y ra t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn v\u00e0 c\u0169ng gi\u1eef MPO trong c\u1ea7u th\u1eadn, cho ph\u00e9p c\u00e1c t\u1ebf b\u00e0o CD4 d\u01b0\u01a1ng t\u00ednh kh\u00e1ng MPO t\u1ef1 ho\u1ea1t h\u00f3a g\u00e2y ra vi\u00eam c\u1ea7u th\u1eadn ti\u1ebfn tri\u1ec3n nhanh t\u01b0\u01a1ng t\u1ef1 ki\u1ec3u qu\u00e1 m\u1eabn mu\u1ed9n.<\/p>\n

Ng\u01b0\u1ee3c l\u1ea1i, trong m\u1ed9t m\u00f4 h\u00ecnh chu\u1ed9t kh\u00e1c c\u1ee7a vi\u00eam c\u1ea7u th\u1eadn qua trung gian kh\u00e1ng MPO, k\u00edch th\u00edch s\u1ef1 thi\u1ebfu h\u1ee5t IL-17a l\u00e0m gi\u1ea3m c\u1ea3 s\u1ef1 t\u00edch t\u1ee5 c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o th\u1eadn v\u00e0 s\u1ef1 bi\u1ec3u hi\u1ec7n c\u1ee7a mRNA \u1edf th\u1eadn cho chemokine CCL5 thu h\u00fat monocyte.<\/p>\n

2.2. C\u00e1c qu\u00e1 tr\u00ecnh th\u1ee9 ph\u00e1t:<\/strong><\/h3>\n

Qu\u00e1 tr\u00ecnh mi\u1ec5n d\u1ecbch b\u1ec7nh h\u1ecdc nguy\u00ean ph\u00e1t ho\u1ea1t h\u00f3a c\u00e1c h\u1ec7 th\u1ed1ng sau tham gia v\u00e0o \u0111\u00e1p \u1ee9ng vi\u00eam v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn:<\/p>\n

\u00a0H\u1ec7 th\u1ed1ng b\u1ed5 th\u1ec3:<\/em><\/strong> \u0110\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch d\u1ecbch th\u1ec3 ho\u1ea1t h\u00f3a con \u0111\u01b0\u1eddng c\u1ed5 \u0111i\u1ec3n. \u1ede m\u1ed9t s\u1ed1 b\u1ec7nh l\u00ed th\u1eadn (v\u00ed d\u1ee5 vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng typ II v\u00e0 vi\u00eam c\u1ea7u th\u1eadn sau nhi\u1ec5m li\u00ean c\u1ea7u) con \u0111\u01b0\u1eddng t\u1eaft \u0111\u01b0\u1ee3c ho\u1ea1t h\u00f3a. Ho\u1ea1t h\u00f3a b\u1ed5 th\u1ec3 d\u1eabn \u0111\u1ebfn gi\u1ea3i ph\u00f3ng ch\u1ea5t h\u00f3a h\u01b0\u1edbng \u0111\u1ed9ng v\u00e0 ch\u1ea5t trung gian h\u00f3a h\u1ecdc (C3a, C5a, C3b) l\u00f4i cu\u1ed1n b\u1ea1ch c\u1ea7u \u0111\u1ebfn v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng v\u00e0 h\u00ecnh th\u00e0nh ph\u1ee9c h\u1ee3p t\u1ea5n c\u00f4ng m\u00e0ng (C5b-C9) c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp t\u1ebf b\u00e0o c\u1ea7u th\u1eadn v\u00e0 gi\u1ea3i ph\u00f3ng cytokine, c\u00e1c g\u1ed1c oxy h\u00f3a, prostaglandin v\u00e0 ch\u1ebft t\u1ebf b\u00e0o theo ch\u01b0\u01a1ng tr\u00ecnh.<\/p>\n

T\u1ea7m quan tr\u1ecdng c\u1ee7a ho\u1ea1t h\u00f3a b\u1ed5 th\u1ec3, c\u00e1c protein \u0111i\u1ec1u h\u00f2a b\u1ed5 th\u1ec3 v\u00e0 c\u00e1c ch\u1ea5t trung gian kh\u00e1c nh\u01b0 y\u1ebfu t\u1ed1 \u1ee9c ch\u1ebf \u0111\u1ea1i th\u1ef1c b\u00e0o (MIF), chemokines v\u00e0 cytokine c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c minh h\u1ecda b\u1eb1ng c\u00e1c quan s\u00e1t d\u01b0\u1edbi \u0111\u00e2y:<\/p>\n

– T\u1ea1o ra y\u1ebfu t\u1ed1 h\u00f3a h\u01b0\u1edbng \u0111\u1ed9ng C5a, m\u1ed9t \u0111o\u1ea1n protein \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng kh\u1ecfi th\u00e0nh ph\u1ea7n b\u1ed5 th\u1ec3 C5, \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng trong vi\u00eam c\u1ea7u th\u1eadn g\u00e2y ra do kh\u00e1ng th\u1ec3 C5a c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c thu h\u00fat c\u00e1c t\u1ebf b\u00e0o vi\u00eam, nh\u01b0 b\u1ea1ch c\u1ea7u trung t\u00ednh, b\u1ea1ch c\u1ea7u eosin, c\u00e1c monocytes, v\u00e0 t\u1ebf b\u00e0o lympho T, v\u00e0 k\u00edch ho\u1ea1t c\u00e1c t\u1ebf b\u00e0o th\u1ef1c b\u00e0o, ph\u00f3ng th\u00edch c\u00e1c enzymes tr\u00ean b\u1ea1ch c\u1ea7u \u01b0a base, v\u00e0 t\u1ea1o ra c\u00e1c ch\u1ea5t oxy h\u00f3a, t\u1ea5t c\u1ea3 ch\u00fang c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n g\u00e2y t\u1ed5n th\u01b0\u01a1ng m\u00f4<\/p>\n

Trong vi\u00eam th\u1eadn c\u1ea7u th\u1eadn g\u00e2y ra b\u1edfi ANCA, nh\u01b0 l\u00e0 u h\u1ea1t c\u00f3 vi\u00eam nhi\u1ec1u m\u1ea1ch ho\u1eb7c vi\u00eam \u0111a vi m\u1ea1ch, s\u1ef1 ho\u1ea1t h\u00f3a b\u1ea1ch c\u1ea7u trung t\u00ednh v\u00e0 vi\u00eam c\u1ea7u th\u1eadn \u0111\u01b0\u1ee3c trung gian b\u1edfi th\u1ee5 th\u1ec3 C5a, v\u00e0 receptor C5a (CD88) b\u1ea3o v\u1ec7 ch\u1ed1ng l\u1ea1i myeloperoxidase (MPO)- ANCA (m\u1ed9t glycoprotein \u0111\u01b0\u1ee3c ti\u1ebft ra t\u1eeb c\u00e1c b\u1ea1ch c\u1ea7u trung t\u00ednh \u0111a nh\u00e2n b\u1ecb k\u00edch ho\u1ea1t) trong vi\u00eam c\u1ea7u th\u1eadn.<\/p>\n

– M\u1eb7c d\u00f9 c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 vai tr\u00f2 c\u1ee7a C5b-9 trong b\u1ec7nh c\u1ea7u th\u1eadn t\u1eadp trung ch\u1ee7 y\u1ebfu v\u00e0o t\u1ebf b\u00e0o c\u00f3 ch\u00e2n v\u00e0 MN ( b\u1ec7nh th\u1eadn m\u00e0ng membranous nephropathy), nh\u1eefng qu\u00e1 tr\u00ecnh t\u01b0\u01a1ng t\u1ef1 nh\u01b0 trung gian qua C5b-9 c\u0169ng g\u00e2y ra t\u1ed5n th\u01b0\u01a1ng mi\u1ec5n d\u1ecbch \u0111\u1ed1i v\u1edbi c\u00e1c t\u1ebf b\u00e0o mesangial (v\u00ed d\u1ee5 nh\u01b0 \u1edf b\u1ec7nh th\u1eadn th\u1eadn IgA v\u00e0 lupus) v\u00e0 t\u1ebf b\u00e0o n\u1ed9i m\u1ea1c (v\u00ed d\u1ee5 nh\u01b0 \u1edf b\u1ec7nh th\u1eadn lupus v\u00e0 b\u1ec7nh th\u1eadn c\u1ea7u th\u1eadn C3)<\/p>\n

– Ngo\u00e0i vai tr\u00f2 c\u1ee7a C5b-9, r\u1ed1i lo\u1ea1n ho\u1ea1t h\u00f3a con \u0111\u01b0\u1eddng b\u1ed5 th\u1ec3 thay th\u1ebf c\u00f3 li\u00ean quan \u0111\u1ebfn b\u1ec7nh th\u1eadn c\u1ea7u th\u1eadn. Thu\u1eadt ng\u1eef C glomerulopathy \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t cho nh\u00f3m r\u1ed1i lo\u1ea1n c\u1ea7u th\u1eadn n\u00e0y, ch\u1ee7 y\u1ebfu l\u00e0 do \u0111\u1ed9t bi\u1ebfn ho\u1eb7c t\u1ef1 kh\u00e1ng kh\u00e1ng protein \u0111i\u1ec1u h\u00e0o b\u1ed5 th\u1ec3 (CFH, CFI) ho\u1eb7c kh\u00e1ng enzyme C3 convertase, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 y\u1ebfu t\u1ed1 vi\u00eam th\u1eadn C3.<\/p>\n

– C\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 di truy\u1ec1n v\u00e0 mi\u1ec5n d\u1ecbch c\u1ee7a con \u0111\u01b0\u1eddng b\u1ed5 th\u1ec3 thay th\u1ebf c\u0169ng c\u00f3 li\u00ean quan \u0111\u1ebfn “vi\u00eam th\u1eadn c\u1ea7u th\u1eadn sau nhi\u1ec5m khu\u1ea9n” v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng k\u00e9o d\u00e0i v\u00e0 ti\u1ebfn tri\u1ec3n \u0111\u1ebfn b\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i (ESRD); nh\u1eefng b\u1ec7nh nh\u00e2n nh\u01b0 v\u1eady c\u00f3 th\u1ec3 c\u00f3 b\u1ec7nh th\u1eadn c\u1ea7u th\u1eadn C3.<\/p>\n

– Vi\u00eam c\u1ea7u th\u1eadn qua trung gian ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch v\u00e0 s\u1ef1 li\u00ean quan \u0111\u1ebfn th\u00e2m nhi\u1ec5m c\u1ee7a t\u1ebf b\u00e0o vi\u00eam, \u1edf m\u1ed9t s\u1ed1 thi\u1ebft l\u1eadp, gi\u1ea3m \u0111\u00e1ng k\u1ec3 khi d\u00f9ng m\u1ed9t kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i MIF, m\u1ed9t cytokine g\u00e2y vi\u00eam<\/p>\n

– S\u1ef1 thi\u1ebfu h\u1ee5t ho\u1eb7c \u0111\u1ed1i kh\u00e1ng c\u1ee7a c\u00e1c chemokine (nh\u01b0 protein h\u00f3a h\u01b0\u1edbng \u0111\u1ed9ng monocyte MCP-1 v\u00e0 \u0111i\u1ec1u h\u00f2atr\u00ean s\u1ef1 ho\u1ea1t h\u00f3a binh th\u01b0\u1eddng t\u1ebf b\u00e0o T bi\u1ec3u hi\u1ec7n v\u00e0 ch\u1ebf ti\u1ebft [RANTES]) v\u00e0 \/ ho\u1eb7c c\u00e1c th\u1ee5 th\u1ec3 chemokine (bao g\u1ed3m CCR2 v\u00e0 CCR5) gi\u00fap ng\u0103n ng\u1eeba b\u1ec7nh th\u1eadn c\u1ea7u th\u1eadn \u1edf m\u00f4 h\u00ecnh \u0111\u1ed9ng v\u1eadt. Ngo\u00e0i ra, bi\u1ec3u hi\u1ec7n c\u1ee7a chemokine CXCR1 c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c thu h\u00fat b\u1ea1ch c\u1ea7u trung t\u00ednh v\u00e0o c\u1ea7u th\u1eadn trong b\u1ec7nh vi\u00eam c\u1ea7u th\u1eadn c\u1ea7u th\u1eadn \u1edf ng\u01b0\u1eddi .<\/p>\n

H\u1ec7 th\u1ed1ng \u0111\u00f4ng m\u00e1u:<\/em><\/strong> \u1ede b\u1ec7nh nh\u00e2n vi\u00eam c\u1ea7u th\u1eadn ti\u1ebfn tri\u1ec3n nhanh, t\u1ed5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp t\u1ebf b\u00e0o n\u1ed9i m\u1ea1c ho\u1ea1t h\u00f3a th\u00e1c \u0111\u00f4ng m\u00e1u. \u0110i\u1ec1u n\u00e0y d\u1eabn \u0111\u1ebfn h\u00ecnh th\u00e0nh c\u1ee5 m\u00e1u \u0111\u00f4ng v\u00e0 l\u1eafng \u0111\u1ed9ng fibrin l\u00e0 th\u00e0nh ph\u1ea7n quan tr\u1ecdng h\u00ecnh th\u00e0nh c\u00e1c th\u1ec3 h\u00ecnh li\u1ec1m<\/p>\n

Ti\u1ec3u c\u1ea7u n\u1ed5i b\u1eadt \u1edf m\u1ed9t s\u1ed1 t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn, ch\u1ee7 y\u1ebfu l\u00e0 nh\u1eefng b\u1ec7nh li\u00ean quan \u0111\u1ebfn huy\u1ebft kh\u1ed1i trong c\u1ea7u th\u1eadn nh\u01b0 trong h\u1ed9i ch\u1ee9ng kh\u00e1ng th\u1ec3 kh\u00e1ng phospholipid v\u00e0 c\u00e1c b\u1ec7nh l\u00fd huy\u1ebft kh\u1ed1i vi m\u1ea1ch.<\/p>\n

B\u00ean c\u1ea1nh vai tr\u00f2 c\u1ee7a ch\u00fang trong c\u00e1c qu\u00e1 tr\u00ecnh t\u1ea1o huy\u1ebft kh\u1ed1i li\u00ean quan \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o n\u1ed9i m\u1ea1c, ti\u1ec3u c\u1ea7u c\u0169ng ti\u1ebft ra m\u1ed9t s\u1ed1 s\u1ea3n ph\u1ea9m tham gia v\u00e0o v\u00e0 l\u00e0m gia t\u0103ng t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn bao g\u1ed3m nh\u1eefng ch\u1ea5t h\u00f3a h\u1ecdc, g\u00e2y ph\u00e2n b\u00e0o v\u00e0 ho\u1ea1t h\u00f3a m\u1ea1ch. Sau \u0111\u00e2y l\u00e0 m\u1ed9t s\u1ed1 m\u1ed1i li\u00ean h\u1ec7 \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o:<\/p>\n

– C\u00e1c y\u1ebfu t\u1ed1 ngu\u1ed3n g\u1ed1c ti\u1ec3u c\u1ea7u nh\u01b0 y\u1ebfu t\u1ed1 k\u00edch ho\u1ea1t ti\u1ec3u c\u1ea7u v\u00e0 y\u1ebfu t\u1ed1 ti\u1ec3u c\u1ea7u 4 t\u0103ng t\u00ednh th\u1ea5m c\u1ea7u th\u1eadn cho protein v\u00e0 s\u1ef1 l\u1eafng \u0111\u1ecdng ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch<\/p>\n

– Y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng ngu\u1ed3n g\u1ed1c t\u1eeb ti\u1ec3u c\u1ea7u (PDGF) g\u00f3p ph\u1ea7n t\u0103ng sinh t\u1ebf b\u00e0o mesangial, v\u00e0 s\u1ef1 bi\u1ebfn \u0111\u1ed5i y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng beta (TGF-beta) g\u00f3p ph\u1ea7n l\u00e0m x\u01a1 c\u1ee9ng t\u1ebf b\u00e0o mesangial<\/p>\n

– Ti\u1ec3u c\u1ea7u g\u00f3p ph\u1ea7n v\u00e0o vi\u1ec7c thu h\u00fat b\u1ea1ch c\u1ea7u v\u00e0 t\u1ef1 thu h\u00fat v\u00e0o c\u1ea7u th\u1eadn b\u1ecb vi\u00eam th\u00f4ng qua m\u1ed9t \u0111\u01b0\u1eddng d\u1eabn ph\u1ee5 thu\u1ed9c th\u1ee5 th\u1ec3 collagen alpha-IIb beta-3 \/ GPVI<\/p>\n

– Ti\u1ec3u c\u1ea7u \u0111\u00f3ng g\u00f3p v\u00e0o t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn qua trung gian b\u1ea1ch c\u1ea7u trung t\u00ednh th\u00f4ng qua c\u01a1 ch\u1ebf kh\u00f4ng qua ch\u1ea5t h\u00f3a h\u1ecdc.<\/p>\n

Huy \u0111\u1ed9ng b\u1ea1ch c\u1ea7u:<\/em><\/strong><\/p>\n

M\u1ed9t \u0111\u1eb7c \u0111i\u1ec3m h\u1eb1ng \u0111\u1ecbnh c\u1ee7a vi\u00eam c\u1ea7u th\u1eadn l\u00e0 th\u00e2m nhi\u1ec5m b\u1ea1ch c\u1ea7u \u1edf c\u1ea7u th\u1eadn ( \u0111a nh\u00e2n trung t\u00ednh, monocyte v\u00e0 \u0111\u1ea1i th\u1ef1c b\u00e0o) \u0111\u01b0\u1ee3c huy \u0111\u1ed9ng theo tu\u1ea7n t\u1ef1 t\u1edbi c\u1ea7u th\u1eadn b\u1edfi s\u1ef1 ph\u00f3ng th\u00edch c\u00e1c ch\u1ea5t h\u00f3a h\u01b0\u1edbng \u0111\u1ed9ng (v\u00ed d\u1ee5: C3a, C5a v\u00e0 CXC chemokine). Khi ho\u1ea1t h\u00f3a c\u00e1c t\u1ebf b\u00e0o n\u00e0y gi\u1ea3i ph\u00f3ng c\u00e1c g\u1ed1c oxy h\u00f3a (ROS v\u00ed d\u1ee5 H2O2) v\u00e0 enzyme lysosome (l\u00e0m t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o n\u1ed9i m\u1ea1c, m\u00e0ng \u0111\u00e1y, v\u00e0 gian m\u1ea1ch), y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng (l\u00e0m l\u1eafng \u0111\u1ed9ng fibrin, t\u0103ng sinh t\u1ebf b\u00e0o v\u00e0 h\u00ecnh th\u00e0nh c\u00e1c th\u1ec3 h\u00ecnh li\u1ec1m). Nh\u01b0 \u1edf b\u1ec7nh nh\u00e2n u h\u1ea1t v\u1edbi vi\u00eam \u0111a kh\u1edbp (tr\u01b0\u1edbc \u0111\u00e2y l\u00e0 u h\u1ea1t Wegener) c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn th\u1eadn, sinh b\u1ec7nh h\u1ecdc do tham gia c\u1ee7a t\u1ebf b\u00e0o n\u1ed9i m\u1ea1c th\u1eadn, gi\u1ea3i ph\u00f3ng protease, ROS v\u00e0 cytokine vi\u00eam d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn<\/p>\n

– C\u00f3 ba lo\u1ea1i t\u1ebf b\u00e0o c\u1ea7u th\u1eadn kh\u00e1c nhau: t\u1ebf b\u00e0o n\u1ed9i m\u00f4, t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 (t\u1ebf b\u00e0o c\u00f3 ch\u00e2n v\u00e0 t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 th\u00e0nh) v\u00e0 t\u1ebf b\u00e0o mesangial.<\/p>\n

Kh\u00f4ng gi\u1ed1ng nh\u01b0 c\u00e1c quy tr\u00ecnh kh\u00f4ng vi\u00eam c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c b\u1ec7nh m\u00e0 \u0111\u00edch l\u00e0 c\u00e1c t\u1ebf b\u00e0o c\u00f3 ch\u00e2n, c\u00e1c r\u1ed1i lo\u1ea1n li\u00ean quan ch\u1ee7 y\u1ebfu \u0111\u1ebfn c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 v\u00e0 \/ ho\u1eb7c t\u1ebf b\u00e0o mesangial c\u00f3 bi\u1ec3u hi\u1ec7n \u0111\u00e1p \u1ee9ng m\u1ea1nh h\u01a1n \u0111\u1ed1i v\u1edbi th\u01b0\u01a1ng t\u1ed5n mi\u1ec5n d\u1ecbch. Ph\u1ea3n \u1ee9ng n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi sinh thi\u1ebft th\u1eadn b\u1eb1ng t\u0103ng sinh t\u1ebf b\u00e0o, thay \u0111\u1ed5i ki\u1ec3u h\u00ecnh v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u1ea5u tr\u00fac c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y \u0111\u01b0\u1ee3c.<\/p>\n

+ T\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o n\u1ed9i m\u00f4 c\u1ea7u th\u1eadn<\/p>\n

C\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 c\u1ea7u th\u1eadn d\u01b0\u1eddng nh\u01b0 l\u00e0 \u0111\u00edch t\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh, nh\u01b0 h\u1ed9i ch\u1ee9ng ti\u1ec3u m\u00e1u, nhi\u1ec5m \u0111\u1ed9c thai ngh\u00e9n ti\u1ec1n s\u1ea3n gi\u1eadt, v\u00e0 m\u1ed9t s\u1ed1 d\u1ea1ng vi\u00eam m\u1ea1ch.<\/p>\n

T\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o n\u1ed9i m\u00f4 c\u1ea7u th\u1eadn c\u00f3 th\u1ec3 l\u00e0m t\u0103ng sinh, thay \u0111\u1ed5i ki\u1ec3u h\u00ecnh (bi\u1ec3u hi\u1ec7n c\u1ee7a c\u00e1c ph\u00e2n t\u1eed b\u00e1m d\u00ednh) , gi\u1ea3i ph\u00f3ng c\u00e1c ch\u1ea5t ph\u00f3ng ho\u1ea1t m\u1ea1ch (endothelin, oxit nitric) v\u00e0 chuy\u1ec3n \u0111\u1ed5i tr\u1ea1ng th\u00e1i huy\u1ebft kh\u1ed1i. Nh\u1eefng thay \u0111\u1ed5i n\u00e0y d\u1eabn \u0111\u1ebfn s\u1ef1 t\u0103ng sinh t\u1ebf b\u00e0o, apoptosis, s\u1ef1 t\u00e1ch r\u1eddi t\u1ebf b\u00e0o, v\u00e0 quan tr\u1ecdng nh\u1ea5t, huy\u1ebft kh\u1ed1i.<\/p>\n

+ T\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o mesangial c\u1ea7u th\u1eadn<\/p>\n

T\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o mesangial c\u1ea7u th\u1eadn \u0111\u01b0\u1ee3c th\u1ea5y trong c\u00e1c b\u1ec7nh li\u00ean quan \u0111\u1ebfn mesangium (m\u00e0ng n\u00e2ng cu\u1ed9n mao m\u1ea1ch). \u0110i\u1ec1u n\u00e0y th\u01b0\u1eddng g\u1eb7p nh\u1ea5t khi c\u00f3 c\u00e1c ph\u00e2n t\u1eed mi\u1ec5n d\u1ecbch trong mesangium, quan s\u00e1t \u0111\u01b0\u1ee3c \u1edf b\u1ec7nh th\u1eadn IgA, vi\u00eam th\u1eadn lupus, Henoch-Sch\u00f6nleinpurpura (c\u00f2n g\u1ecdi l\u00e0 vi\u00eam m\u1ea1ch do IgA) v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n kh\u00e1c.<\/p>\n

3. Nguy\u00ean nh\u00e2n<\/strong><\/h2>\n

Vi\u00eam c\u1ea7u th\u1eadn c\u00f3 th\u1ec3 ch\u1ec9 t\u1ed5n th\u01b0\u01a1ng t\u1ea1i th\u1eadn (vi\u00eam c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t) ho\u1eb7c l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a b\u1ec7nh l\u00ed h\u1ec7 th\u1ed1ng ( vi\u00eam c\u1ea7u th\u1eadn th\u1ee9 ph\u00e1t)<\/p>\n\n\n\n
Vi\u00eam c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t <\/strong><\/p>\n

– Vi\u00eam c\u1ea7u th\u1eadn m\u00e0ng<\/p>\n

– Vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng typ I<\/p>\n

– Vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng typ II<\/p>\n

– B\u1ec7nh th\u1eadn IgA<\/p>\n

– Vi\u00eam c\u1ea7u th\u1eadn do kh\u00e1ng th\u1ec3 kh\u00e1ng m\u00e0ng n\u1ec1n<\/p>\n

– Vi\u00eam c\u1ea7u th\u1eadn t\u1ebf b\u00e0o h\u00ecnh li\u1ec1m ti\u00ean ph\u00e1t<\/td>\n

Vi\u00eam c\u1ea7u th\u1eadn th\u1ee9 ph\u00e1t <\/strong><\/p>\n

–\u00a0 Vi\u00eam c\u1ea7u th\u1eadn sau nhi\u1ec5m li\u00ean c\u1ea7u<\/p>\n

–\u00a0 Vi\u00eam c\u1ea7u th\u1eadn sau nhi\u1ec5m tr\u00f9ng kh\u00e1c<\/p>\n

–\u00a0 Scholein Henoch<\/p>\n

–\u00a0 Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng<\/p>\n

–\u00a0 Vi\u00eam \u0111a kh\u1edbp vi th\u1ec3<\/p>\n

–\u00a0 U h\u1ea1t Wegener<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

    \n
  • Ph\u00e2n lo\u1ea1i nguy\u00ean nh\u00e2n<\/strong><\/li>\n<\/ul>\n

    \u2666 Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng<\/p>\n

    \u2666 M\u00f4 b\u1ec7nh h\u1ecdc<\/p>\n

    C\u00e1ch ti\u1ebfp c\u1eadn l\u00e0 s\u1eed d\u1ee5ng gi\u1ea3n \u0111\u1ed3 l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c \u01b0a th\u00edch h\u01a1n v\u00ec ph\u01b0\u01a1ng ph\u00e1p m\u00f4 b\u1ec7nh h\u1ecdc \u0111\u00f2i h\u1ecfi m\u1ed9t m\u1eabu sinh thi\u1ebft.<\/p>\n

      \n
    • Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng:<\/strong> C\u00e1c th\u1ec3 l\u00e2m s\u00e0ng kh\u00e1c nhau bao g\u1ed3m:<\/li>\n<\/ul>\n

      \u2666 Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p<\/p>\n

      \u2666 Vi\u00eam c\u1ea7u th\u1eadn ti\u1ebfn tri\u1ec3n nhanh<\/p>\n

      \u2666 \u0110\u00e1i m\u00e1u \u0111\u1ea1i th\u1ec3 h\u1ed3i quy<\/p>\n

      \u2666 Vi\u00eam c\u1ea7u th\u1eadn m\u1ea1n<\/p>\n

      M\u1ed7i th\u1ec3 l\u00e2m s\u00e0ng bao g\u1ed3m m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd th\u1eadn kh\u00e1c nhau. M\u1ed9t ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng gi\u1ea3 \u0111\u1ecbnh \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n d\u1ef1a tr\u00ean bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c bi\u1ec3u hi\u1ec7n ngo\u00e0i th\u1eadn, ti\u1ec1n s\u1eed gia \u0111\u00ecnh v\u00e0 x\u00e9t nghi\u1ec7m, bao g\u1ed3m x\u00e9t nghi\u1ec7m n\u01b0\u1edbc ti\u1ec3u. M\u00f4 b\u1ec7nh h\u1ecdc x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng sinh thi\u1ebft th\u1eadn.<\/p>\n

      Vi\u00ean c\u1ea7u th\u1eadn c\u1ea5p- Bi\u1ec3u hi\u1ec7n \u0111\u1eb7c tr\u01b0ng c\u1ee7a vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p l\u00e0 \u0111\u00e1i m\u00e1u kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t (\u0111\u1ea1i th\u1ec3 ho\u1eb7c vi th\u1ec3) k\u00e8m v\u1edbi protein ni\u1ec7u, gi\u1ea3m m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn, v\u00e0 \u1ee9 \u0111\u1ed9ng mu\u1ed1i v\u00e0 n\u01b0\u1edbc th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn t\u0103ng huy\u1ebft \u00e1p v\u00e0 ph\u00f9<\/p>\n

      \u1ede tr\u1ebb em, Nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p l\u00e0 sau nhi\u1ec5m li\u00ean c\u1ea7u. Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p c\u0169ng li\u00ean quan \u0111\u1ebfn m\u1ed9t s\u1ed1 t\u00e1c nh\u00e2n nhi\u1ec5m tr\u00f9ng kh\u00e1c. C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p bao g\u1ed3m vi\u00eam c\u1ea7u th\u1eadn th\u1ee9 ph\u00e1t (V\u00ed d\u1ee5 Vi\u00eam m\u1ea1ch IgA, Henoch- Sch\u00f6nlein, vi\u00eam th\u1eadn li\u00ean quan v\u1edbi vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c b\u00e1n c\u1ea5p nhi\u1ec5m khu\u1ea9n, vi\u00eam th\u1eadn shunt)<\/p>\n

      B\u00ean c\u1ea1nh \u0111\u00f3, m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam c\u1ea7u th\u1eadn m\u1ea1n c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n nh\u01b0 h\u1ed9i ch\u1ee9ng th\u1eadn vi\u00eam c\u1ea5p v\u00e0 c\u00f3 th\u1ec3 ban \u0111\u1ea7u kh\u00f4ng th\u1ec3 ph\u00e2n bi\u1ec7t l\u00e2m s\u00e0ng v\u1edbi vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p. C\u00e1c t\u00ecnh tr\u1ea1ng m\u1ea1n t\u00ednh bao g\u1ed3m vi\u00eam c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t (V\u00ed d\u1ee5 b\u1ec7nh th\u1eadn IgA, vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng v\u00e0 vi\u00eam c\u1ea7u th\u1eadn th\u1ee9 ph\u00e1t nh\u01b0 vi\u00eam th\u1eadn lupus)<\/p>\n

      Vi\u00eam c\u1ea7u th\u1eadn ti\u1ebfn tri\u1ec3n nhanh- Vi\u00eam c\u1ea7u th\u1eadn ti\u1ebfn tri\u1ec3n nhanh l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng bi\u1ec3u hi\u1ec7n c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p v\u00e0 m\u1ea5t ch\u1ee9c n\u0103ng th\u1eadn ti\u1ebfn tri\u1ec3n trong m\u1ed9t kho\u1ea3ng th\u1eddi gian t\u01b0\u01a1ng \u0111\u1ed1i ng\u1eafn (v\u00e0i ng\u00e0y, v\u00e0i tu\u1ea7n ho\u1eb7c v\u00e0i th\u00e1ng). N\u00f3 c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m m\u00f4 b\u1ec7nh h\u1ecdc \u0111\u1eb7c tr\u01b0ng l\u00e0 t\u1ebf b\u00e0o h\u00ecnh li\u1ec1m lan t\u1ecfa<\/p>\n

      Vi\u00eam c\u1ea7u th\u1eadn ti\u1ebfn tri\u1ec3n nhanh hi\u1ebfm x\u1ea3y ra \u1edf tr\u1ebb em. Nguy\u00ean nh\u00e2n vi\u00eam c\u1ea7u th\u1eadn ti\u1ebfn tri\u1ec3n nhanh \u1edf tr\u1ebb em bao g\u1ed3m:<\/p>\n

      \u2666 Vi\u00eam c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t: B\u1ec7nh th\u1eadn IgA, Vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng v\u00e0 b\u1ec7nh c\u1ea7u th\u1eadn do kh\u00e1ng th\u1ebf ch\u1ed1ng m\u00e0ng n\u1ec1n (HC Goodpasture)<\/p>\n

      \u2666 Vi\u00eam c\u1ea7u th\u1eadn th\u1ee9 ph\u00e1t: u h\u1ea1t v\u1edbi vi\u00eam \u0111a kh\u1edbp, vi\u00eam c\u1ea7u th\u1eadn sau nhi\u1ec5m li\u00ean c\u1ea7u, vi\u00eam m\u1ea1ch IgA, vi\u00eam \u0111a kh\u1edbp vi th\u1ec3<\/p>\n

      Ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u1edbi sinh thi\u1ebft th\u1eadn v\u00e0 huy\u1ebft thanh h\u1ecdc v\u00e0 b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p s\u1edbm l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 gi\u1ea3m thi\u1ec3u m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng th\u1eadn kh\u00f4ng h\u1ed3i ph\u1ee5c.<\/p>\n

      \u0110\u00e1i m\u00e1u \u0111\u1ea1i th\u1ec3 h\u1ed3i quy: \u1edf tr\u1ebb em, bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p c\u1ee7a b\u1ec7nh th\u1eadn IgA l\u00e0 \u0111\u00e1i m\u00e1u \u0111\u1ea1i th\u1ec3 tho\u00e1ng qua t\u1eebng \u0111\u1ee3t. N\u00f3 x\u1ea3y ra m\u1ed9t ho\u1eb7c 2 ng\u00e0y sau nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p tr\u00ean. \u0110\u00e1i m\u00e1u \u0111\u1ea1i th\u1ec3 h\u1ed3i quy c\u00f3 th\u1ec3 g\u1eb7p \u1edf tr\u1ebb m\u1eafc h\u1ed9i ch\u1ee9ng Alport<\/p>\n

      Vi\u00eam c\u1ea7u th\u1eadn m\u1ea1n: B\u1ec7nh nh\u00e2n vi\u00eam c\u1ea7u th\u1eadn m\u1ea1n c\u00f3 th\u1ec3 c\u00f3 m\u1ed9t v\u00e0i bi\u1ec3u hi\u1ec7n r\u00f5 r\u00e0ng, \u0111\u00e1i m\u00e1u kh\u00f4ng tri\u1ec7u ch\u1ee9ng ph\u00e1t hi\u1ec7n b\u1eb1ng x\u00e9t nghi\u1ec7m n\u01b0\u1edbc ti\u1ec3u th\u01b0\u1eddng quy. B\u00ean c\u1ea1nh \u0111\u00f3, nguy\u00ean nh\u00e2n c\u1ee7a vi\u00eam c\u1ea7u th\u1eadn m\u1ea1n c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n h\u1ed9i ch\u1ee9ng th\u1eadn vi\u00eam c\u1ea5p v\u00e0 ban \u0111\u1ea7u kh\u00f4ng th\u1ec3 ph\u00e2n bi\u1ec7t l\u00e2m s\u00e0ng v\u1edbi vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p.<\/p>\n

      \u1ede m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u1edf giai \u0111o\u1ea1n cu\u1ed1i c\u1ee7a b\u1ec7nh v\u00e0 bi\u1ec3u hi\u1ec7n v\u1edbi t\u0103ng huy\u1ebft \u00e1p, suy th\u1eadn, v\u00e0 protein ni\u1ec7u k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m \u0111\u00e1i m\u00e1u. Sinh thi\u1ebft th\u1eadn \u1edf giai \u0111o\u1ea1n n\u00e0y ch\u1ec9 c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u kh\u00f4ng \u0111\u1eb7c hi\u1ec7u v\u00e0 kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n ch\u1ea9n \u0111o\u00e1n v\u1ec1 x\u01a1 h\u00f3a, x\u01a1 c\u1ee9ng c\u1ea7u th\u1eadn v\u00e0 teo \u1ed1ng th\u1eadn tr\u00ean k\u00ednh hi\u1ec3n vi quang h\u1ecdc. K\u0129 thu\u1eadt mi\u1ec5n d\u1ecbch hu\u1ef3nh quang h\u1eefu \u00edch h\u01a1n trong x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n.<\/p>\n

      Vi\u00eam c\u1ea7u th\u1eadn m\u1ea1n \u1edf tr\u1ebb em bao g\u1ed3m c\u1ea3 vi\u00eam c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t v\u00e0 Vi\u00eam c\u1ea7u th\u1eadn th\u1ee9 ph\u00e1t (vi\u00eam th\u1eadn lupus, u h\u1ea1t v\u1edbi vi\u00eam \u0111a kh\u1edbp).<\/p>\n

      Ngu\u1ed3n tham kh\u1ea3o:<\/p>\n

        \n
      • B\u00e0i gi\u1ea3ng n\u1ed9i khoa \u0110H Y Hu\u1ebf 2018<\/li>\n
      • \n

        Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p \u1edf tr\u1ebb em: Nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft | Vinmec<\/p>\n<\/li>\n<\/ul>\n

        usechatgpt init success<\/div>\n","protected":false},"excerpt":{"rendered":"

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