{"id":33690,"date":"2023-05-13T21:03:20","date_gmt":"2023-05-13T14:03:20","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=33690"},"modified":"2023-05-13T21:03:20","modified_gmt":"2023-05-13T14:03:20","slug":"viem-mang-nao-mu-tre-em-tong-quan-tac-nhan-co-che-benh-sinh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/13\/viem-mang-nao-mu-tre-em-tong-quan-tac-nhan-co-che-benh-sinh\/","title":{"rendered":"Vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 tr\u1ebb em: T\u1ed5ng quan, t\u00e1c nh\u00e2n, c\u01a1 ch\u1ebf b\u1ec7nh sinh"},"content":{"rendered":"
Vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 l\u00e0 m\u1ed9t b\u1ec7nh nhi\u1ec5m tr\u00f9ng nghi\u00eam tr\u1ecdng c\u1ee7a h\u1ec7 th\u1ea7n kinh. B\u1ec7nh n\u00e0y th\u01b0\u1eddng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn tr\u1ebb em d\u01b0\u1edbi 5 tu\u1ed5i v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra t\u00ecnh tr\u1ea1ng li\u1ec7t n\u1eeda th\u00e2n ho\u1eb7c li\u1ec7t to\u00e0n th\u00e2n, v\u00e0 trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong.<\/strong><\/div>\n

1. T\u1ed5ng quan Vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 tr\u1ebb em<\/strong><\/h2>\n

1.1 C\u1ea5u t\u1ea1o m\u00e0ng n\u00e3o<\/strong><\/h3>\n
G\u1ed3m 3 m\u00e0ng:\u00a0 <\/strong><\/div>\n
+ M\u00e0ng c\u1ee9ng: <\/strong><\/div>\n
– Dai, kh\u00f4ng \u0111\u00e0n h\u1ed3i, d\u00e0y 0,3-1 mm<\/div>\n
– S\u00e1t th\u00e0nh x\u01b0\u01a1ng, kh\u00f4ng c\u00f3 khoang ngo\u00e0i m\u00e0ng c\u1ee9ng<\/div>\n
– T\u1ea1o n\u00ean c\u00e1c xoang t\u0129nh m\u1ea1ch m\u00e0ng c\u1ee9ng.<\/div>\n
<\/div>\n
+ M\u00e0ng nh\u1ec7n:\u00a0<\/strong><\/div>\n
– M\u1ecfng, trong su\u1ed1t<\/div>\n
– Gi\u1eefa m\u00e0ng nh\u1ec7n v\u00e0 m\u00e0ng nu\u00f4i l\u00e0 khoang d\u01b0\u1edbi nh\u1ec7n ch\u1ee9a DNT<\/div>\n
– Li\u00ean k\u1ebft v\u1edbi xoang t\u0129nh m\u1ea1ch m\u00e0ng c\u1ee9ng b\u1edfi c\u00e1c h\u1ea1t m\u00e0ng nh\u1ec7n\u2192 ti\u00eau tho\u00e1t DNT<\/div>\n
<\/div>\n
+ M\u00e0ng nu\u00f4i: <\/strong><\/div>\n
– M\u00f4 li\u00ean k\u1ebft l\u1ecfng l\u1ebdo, ch\u1ee9a nhi\u1ec1u vi m\u1ea1ch \u0111\u1ec3 nu\u00f4i n\u00e3o b\u1ed9<\/div>\n
-T\u1ea1o m\u00e0ng nu\u00f4i – \u0111\u1ec7m (c\u01a1 s\u1edf c\u1ee7a h\u00e0ng r\u00e0o m\u00e1u , d\u1ecbch n\u00e3o t\u1ee7y ), h\u00ecnh th\u00e0nh kho\u1ea3ng quanh m\u1ea1ch m\u00e1u c\u1ee7a c\u00e1c\u00a0 ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch, ti\u1ec3u t\u0129nh m\u1ea1ch.<\/div>\n
<\/div>\n
\n
\"Ngu\u1ed3n:
Ngu\u1ed3n: Slide CLB N\u1ed9i khoa \u0110H Y Hu\u1ebf 2018<\/figcaption><\/figure>\n<\/div>\n

1.2 C\u1ea5u t\u1ea1o v\u00e0 sinh l\u00fd d\u1ecbch n\u00e3o t\u1ee7y<\/strong><\/h3>\n
– Ngu\u1ed3n g\u1ed1c:<\/strong> ti\u1ebft ra ch\u1ee7 y\u1ebfu t\u1eeb c\u00e1c \u0111\u00e1m r\u1ed1i m\u00e0ng m\u1ea1ch trong c\u00e1c n\u00e3o th\u1ea5t, ngo\u00e0i ra c\u00f2n c\u00f3 huy\u1ebft t\u01b0\u01a1ng t\u1eeb c\u00e1c m\u1ea1ch m\u00e1u trong khoang d\u01b0\u1edbi nh\u1ec7n t\u1ea1o ra d\u1ecbch n\u00e3o t\u1ee7y qua c\u00e1c kho\u1ea3ng quanh m\u1ea1ch m\u00e1u.<\/div>\n
– S\u1ef1 l\u01b0u th\u00f4ng b\u00e0i ti\u1ebft DNT:<\/strong><\/div>\n
\n
\"Ngu\u1ed3n:
Ngu\u1ed3n: AtLas Gi\u1ea3i ph\u1eabu h\u1ecdc 7<\/figcaption><\/figure>\n<\/div>\n
<\/div>\n
*Ch\u1ee9c n\u0103ng:\u00a0<\/strong><\/div>\n
+ Dinh d\u01b0\u1ee1ng, \u0111\u00e0o th\u1ea3i : D\u1ecbch n\u00e3o t\u1ee7y<\/a> trao \u0111\u1ed5i v\u1eadt ch\u1ea5t 2 chi\u1ec1u v\u1edbi t\u1ed5 ch\u1ee9c th\u1ea7n kinh trung \u01b0\u01a1ng b\u1eb1ng c\u00e1ch cung c\u1ea5p c\u00e1c ch\u1ea5t dinh d\u01b0\u1ee1ng, l\u1ea5y \u0111i c\u00e1c ch\u1ea5t th\u1ea3i sinh ra trong qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a.<\/div>\n
+ B\u1ea3o v\u1ec7: Ng\u0103n c\u1ea3n kh\u00f4ng cho ch\u1ea5t \u0111\u1ed9c l\u1ecdt v\u00e0o t\u1ed5 ch\u1ee9c th\u1ea7n kinh<\/div>\n
\u0110\u00f3ng vai tr\u00f2 nh\u01b0 m\u1ed9t h\u1ec7 th\u1ed1ng \u0111\u1ec3 b\u1ea3o v\u1ec7 n\u00e3o v\u00e0 t\u1ee7y kh\u1ecfi b\u1ecb t\u1ed5n th\u01b0\u01a1ng m\u1ed7i khi b\u1ecb ch\u1ea5n th\u01b0\u01a1ng.<\/div>\n

1.3 H\u00e0ng r\u00e0o m\u00e1u n\u00e3o<\/strong><\/h3>\n
\u2756 C\u1ea5u t\u1ea1o:\u00a0<\/strong><\/div>\n
\u2713 C\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 (endothelial cell) c\u00f3 s\u1ed1 l\u01b0\u1ee3ng v\u00e0 th\u1ec3 t\u00edch ty th\u1ec3 l\u1edbn l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng th\u1ea5m ph\u00e2n t\u1eed ch\u1ecdn l\u1ecdc c\u1ee7a h\u00e0ng r\u00e0o m\u00e1u n\u00e3o.<\/div>\n
\u2713 M\u00e0ng \u0111\u00e1y d\u00e0y 30 \u0111\u1ebfn 40 nm c\u00f3 c\u00e1c protein xuy\u00ean m\u00e0ng t\u1ea1o l\u1eadp c\u00e1c m\u1ed1i n\u1ed1i ch\u1eb7t ch\u1ebd gi\u1eefa c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 l\u00e2n c\u1eadn nhau h\u1ea1n ch\u1ebf s\u1ef1 khu\u1ebfch t\u00e1n c\u1ee7a c\u00e1c ch\u1ea5t tan ph\u00e2n c\u1ef1c th\u00f4ng qua khe h\u1edf t\u1ebf b\u00e0o<\/div>\n
\u2713 T\u1ebf b\u00e0o ngo\u1ea1i m\u1ea1ch (pericyte) ki\u1ec3m so\u00e1t l\u01b0u l\u01b0\u1ee3ng m\u00e1u n\u00e3o do \u0111i\u1ec1u ch\u1ec9nh \u0111\u01b0\u1eddng k\u00ednh mao m\u1ea1ch th\u00f4ng qua s\u1ee3i actin<\/div>\n
\u2713 T\u1ebf b\u00e0o h\u00ecnh sao (astrocyte) c\u00f3 c\u00e1c ch\u00e2n g\u1eafn ch\u1eb7t v\u00e0o m\u00e0ng \u0111\u00e1y<\/div>\n
\u2713 \u0110\u1ea1i th\u1ef1c b\u00e0o ngo\u1ea1i m\u1ea1ch<\/div>\n
<\/div>\n
\u2756 Ch\u1ee9c n\u0103ng:<\/strong><\/div>\n
H\u00e0ng r\u00e0o n\u00e0y c\u00f3 th\u1ec3 cho O2 v\u00e0 CO2 v\u00e0 c\u00e1c ph\u00e2n t\u1eed kh\u00ed kh\u00e1c nh\u01b0 helium, xenon, N2 v\u00e0 nhi\u1ec1u ch\u1ea5t g\u00e2y m\u00ea kh\u00ed th\u1ea5m qua. C\u00e1c ch\u1ea5t tan trong lipid c\u00f3 th\u1ec3 v\u01b0\u1ee3t qua h\u00e0ng r\u00e0o b\u1eb1ng c\u00e1ch khu\u1ebfch t\u00e1n. Glucose \u0111\u01b0\u1ee3c v\u1eadn chuy\u1ec3n nh\u1edd ch\u1ea5t v\u1eadn chuy\u1ec3n GLUT1 (Glucose transpoter 1). HRMN ph\u1ea7n l\u1edbn kh\u00f4ng cho aspartate v\u00e0 glutamate th\u1ea5m qua (c\u01a1 ch\u1ebf b\u1ea3o v\u1ec7 n\u00e3o).C\u00e1c protein v\u00e0 peptit, c\u00e1c ion \u0111\u01b0\u1ee3c v\u1eadn chuy\u1ec3n qua HRMN qua c\u00e1c k\u00eanh ion, n\u1ed3ng \u0111\u1ed9 kali trong d\u1ecbch n\u00e3o t\u1ee7y v\u00e0 d\u1ecbch n\u00e3o k\u1ebd \u0111\u01b0\u1ee3c duy tr\u00ec \u1edf\u00a0 kho\u1ea3ng 2,5\u20132,9 mmol\/l.<\/div>\n
\u21e8 H\u00e0ng r\u00e0o m\u00e1u n\u00e3o c\u00f3 2 ch\u1ee9c n\u0103ng:<\/strong><\/div>\n
\u2713 Dinh d\u01b0\u1ee1ng: cho ph\u00e9p v\u1eadn chuy\u1ec3n qua HRMN c\u00e1c ch\u1ea5t sinh h\u1ecdc c\u1ea7n cho s\u1ef1 chuy\u1ec3n h\u00f3a t\u1ebf b\u00e0o n\u00e3o<\/div>\n
\u2713 B\u1ea3o v\u1ec7: ng\u0103n ng\u1eeba c\u00e1c ch\u1ea5t \u0111\u1ed9c h\u1ea1i v\u00e0o t\u1ebf b\u00e0o n\u00e3o<\/div>\n

2. T\u00e1c nh\u00e2n g\u00e2y Vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 tr\u1ebb em<\/strong><\/h2>\n
D\u1ecbch t\u1ec5 h\u1ecdc c\u1ee7a b\u1ec7nh vi\u00eam m\u00e0ng n\u00e3o do vi khu\u1ea9n m\u1eafc ph\u1ea3i tr\u00ean to\u00e0n th\u1ebf gi\u1edbi \u0111\u00e3 thay \u0111\u1ed5i trong nh\u1eefng th\u1eadp ni\u00ean v\u1eeba qua do k\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1 ra \u0111\u1eddi c\u00e1c vacxin li\u00ean h\u1ee3p v\u1edbi H.influenza lo\u1ea1i B, N. meningitidis huy\u1ebft thanh C v\u00e0 c\u00e1c lo\u1ea1i vacxin li\u00ean h\u1ee3p ph\u1ebf c\u1ea7u khu\u1ea9n 7, 10, 13.<\/div>\n
o Tr\u1ebb s\u01a1 sinh:\u00a0<\/strong><\/div>\n
\n\n\n\n\n\n\n\n\n
T\u00e1c nh\u00e2n<\/strong><\/td>\nT\u1ef7 l\u1ec7<\/strong><\/td>\n<\/tr>\n
Streptococcus agalactiae<\/td>\n58%<\/td>\n<\/tr>\n
Escherichia coli<\/td>\n21%<\/td>\n<\/tr>\n
Streptococcus pneumoniae<\/td>\n4%<\/td>\n<\/tr>\n
Listeria monocytogenes<\/td>\n2%<\/td>\n<\/tr>\n
Other<\/td>\n16%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
<\/div>\n
o Tr\u1ebb ngo\u00e0i s\u01a1 sinh:\u00a0<\/strong><\/div>\n
\n\n\n\n\n\n\n\n
T\u00e1c nh\u00e2n<\/strong><\/td>\nT\u1ef7 l\u1ec7<\/strong><\/td>\n<\/tr>\n
Neisseria meningitidis<\/td>\n50%<\/td>\n<\/tr>\n
Streptococcus pneumoniae<\/td>\n37%<\/td>\n<\/tr>\n
Haemophilus influenzae<\/td>\n5%<\/td>\n<\/tr>\n
Other<\/td>\n8%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

3. C\u01a1 ch\u1ebf b\u1ec7nh sinh g\u00e2y Vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 tr\u1ebb em:<\/strong><\/h2>\n

3.1 C\u01a1 ch\u1ebf x\u00e2m nh\u1eadp c\u1ee7a vi khu\u1ea9n:<\/strong><\/h3>\n
\u2666\u00a0\u0110\u01b0\u1eddng v\u00e0o: \u0110\u01b0\u1eddng h\u00f4 h\u1ea5p; c\u00e1c \u1ed5 nhi\u1ec5m tr\u00f9ng l\u00e2n c\u1eadn:<\/div>\n
o Vi\u00eam xoang s\u00e0ng, xoang tr\u00e1n, xoang b\u01b0\u1edbm<\/div>\n
o Vi\u00eam tai gi\u1eefa, vi\u00eam tai x\u01b0\u01a1ng ch\u0169m<\/div>\n
o Vi\u00eam x\u01b0\u01a1ng t\u1ee7y x\u01b0\u01a1ng s\u1ecd, c\u1ed9t s\u1ed1ng, ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o h\u1edf, u m\u00e0ng n\u00e3o t\u1ee7y.<\/div>\n
<\/div>\n
\u2713 Vi\u00eam m\u00e0ng n\u00e3o do vi khu\u1ea9n ph\u00e1t tri\u1ec3n khi c\u00e1c y\u1ebfu t\u1ed1 \u0111\u1ed9c l\u1ef1c c\u1ee7a t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh v\u01b0\u1ee3t qua c\u00e1c c\u01a1 ch\u1ebf b\u1ea3o v\u1ec7 v\u1eadt ch\u1ee7.<\/a> S\u1ef1 x\u00e2m l\u1ea5n m\u00e0ng n\u00e3o li\u00ean quan \u0111\u1ebfn m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 \u0111\u1ed9c l\u1ef1c cho ph\u00e9p vi khu\u1ea9n x\u00e2m chi\u1ebfm bi\u1ec3u m\u00f4 ni\u00eam m\u1ea1c, x\u00e2m nh\u1eadp v\u00e0 t\u1ed3n t\u1ea1i trong m\u00e1u, v\u01b0\u1ee3t qua h\u00e0ng r\u00e0o m\u00e1u – n\u00e3o v\u00e0 nh\u00e2n l\u00ean trong d\u1ecbch n\u00e3o t\u1ee7y.<\/div>\n
<\/div>\n
\u2713 S\u1ef1 x\u00e2m chi\u1ebfm v\u00e0 lan tr\u00e0n:<\/div>\n
o C\u00e1c th\u00e0nh ph\u1ea7n b\u1ec1 m\u1eb7t, ch\u1eb3ng h\u1ea1n<\/div>\n
o nh\u01b0 fimbriae ho\u1eb7c pili, b\u00e1m ch\u1eb7t v\u00e0o c\u00e1c th\u1ee5 th\u1ec3 kh\u00e1c nhau bao g\u1ed3m PAFR, th\u1ee5 th\u1ec3 \u03b22 adrenergic v\u00e0 CD147 => l\u00e0m t\u0103ng s\u1ef1 b\u00e1m d\u00ednh v\u00e0o t\u1ebf b\u00e0o ni\u00eam m\u1ea1c v\u1eadt ch\u1ee7.<\/div>\n
o S\u1ef1 x\u00e2m chi\u1ebfm v\u00e0o bi\u1ec3u m\u00f4 ni\u00eam m\u1ea1c v\u1eadt ch\u1ee7 c\u0169ng \u0111\u01b0\u1ee3c t\u1ea1o \u0111i\u1ec1u ki\u1ec7n qua s\u1ef1 b\u00e0i ti\u1ebft IgA protease l\u00e0m cho vi khu\u1ea9n tr\u1ed1n tr\u00e1nh globulin mi\u1ec5n d\u1ecbch IgA ti\u1ebft c\u1ee7a ni\u00eam m\u1ea1c. IgA protease kh\u1eed ho\u1ea1t t\u00ednh kh\u00e1ng th\u1ec3 ni\u00eam m\u1ea1c v\u00e0 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n g\u1eafn k\u1ebft vi khu\u1ea9n v\u1edbi c\u00e1c t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 v\u1eadt ch\u1ee7. Sau khi x\u00e2m chi\u1ebfm th\u00e0nh c\u00f4ng, vi khu\u1ea9n s\u1ebd v\u00e0o m\u00e1u v\u00e0 l\u01b0u th\u00f4ng theo d\u00f2ng m\u00e1u.<\/div>\n
o S\u1ef1 t\u1ed3n t\u1ea1i trong l\u00f2ng m\u1ea1ch: Sau khi x\u00e2m nh\u1eadp v\u00e0o d\u00f2ng m\u00e1u, vi khu\u1ea9n t\u1ed3n t\u1ea1i th\u00f4ng qua s\u1ef1 tr\u1ed1n tr\u00e1nh h\u1ec7 th\u1ed1ng b\u1ed5 th\u1ec3, \u0111\u1eb7c bi\u1ec7t l\u00e0 con \u0111\u01b0\u1eddng b\u1ed5 th\u1ec3 thay th\u1ebf. Polysaccharide bao ngo\u00e0i vi khu\u1ea9n l\u00e0 c\u01a1 ch\u1ebf ch\u00ednh cho s\u1ef1 tr\u1ed1n tr\u00e1nh b\u1ed5 th\u1ec3 thay th\u1ebf.<\/div>\n
V\u00ed d\u1ee5:<\/strong><\/div>\n
\u25aa Axit sialic bao ngo\u00e0i c\u1ee7a N. meningitidis ng\u0103n c\u1ea3n s\u1ef1 g\u1eafn c\u1ee7a y\u1ebfu t\u1ed1 B v\u1edbi C3b v\u00e0 k\u00edch ho\u1ea1t ti\u1ebfp theo c\u1ee7a con \u0111\u01b0\u1eddng thay th\u1ebf.<\/div>\n
\u25aa \u0110\u1ed1i v\u1edbi S. pneumoniae, C3b li\u00ean k\u1ebft kh\u00f4ng hi\u1ec7u qu\u1ea3 v\u1edbi y\u1ebfu t\u1ed1 B tr\u00ean b\u1ec1 m\u1eb7t bao ngo\u00e0i .<\/div>\n
Trong c\u1ea3 hai tr\u01b0\u1eddng h\u1ee3p, c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh tr\u00e1nh ho\u1ea1t \u0111\u1ed9ng di\u1ec7t khu\u1ea9n c\u1ee7a b\u1ed5 th\u1ec3, t\u1ed3n t\u1ea1i trong m\u00e1u v\u00e0 v\u01b0\u1ee3t qua h\u00e0ng r\u00e0o m\u00e1u n\u00e3o v\u00e0o d\u1ecbch n\u00e3o t\u1ee7y.<\/div>\n
<\/div>\n
\u2713 S\u1ef1 x\u00e2m nh\u1eadp m\u00e0ng n\u00e3o: V\u1ecb tr\u00ed ch\u00ednh x\u00e1c \u0111\u1ec3 vi khu\u1ea9n \u0111i v\u00e0o d\u1ecbch n\u00e3o t\u1ee7y th\u00ec kh\u00f4ng r\u00f5 r\u00e0ng v\u00e0 c\u00f3 th\u1ec3 kh\u00e1c bi\u1ec7t \u0111\u1ed1i v\u1edbi c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh kh\u00e1c nhau.<\/div>\n
o \u0110\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh nh\u01b0 Escherichia coli, b\u1eb1ng ch\u1ee9ng th\u1ef1c nghi\u1ec7m cho th\u1ea5y r\u1eb1ng s\u1ef1 x\u00e2m nh\u1eadp v\u00e0o d\u1ecbch n\u00e3o t\u1ee7y x\u1ea3y ra \u0111\u1ea7u ti\u00ean \u1edf \u0111\u00e1m r\u1ed1i m\u00e0ng m\u1ea1ch.<\/div>\n
o Ph\u00e2n t\u1eed phosphorylcholine c\u1ee7a acid lipoteichoic th\u00e0nh t\u1ebf b\u00e0o ph\u1ebf c\u1ea7u s\u1eed d\u1ee5ng c\u00e1c th\u1ee5 th\u1ec3 n\u1ed9i sinh cho y\u1ebfu t\u1ed1 k\u00edch ho\u1ea1t ti\u1ec3u c\u1ea7u (PAF) \u0111\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho s\u1ef1 g\u1eafn k\u1ebft v\u00e0 di chuy\u1ec3n qua t\u1ebf b\u00e0o n\u1ed9i m\u00f4.<\/div>\n
Tuy nhi\u00ean, c\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh c\u00f3 th\u1ec3 v\u01b0\u1ee3t qua h\u00e0ng r\u00e0o m\u00e1u – n\u00e3o th\u00f4ng qua s\u1ef1 m\u1ea5t t\u00ednh to\u00e0n v\u1eb9n c\u1ee7a h\u00e0ng r\u00e0o m\u00e1u n\u00e3o.<\/div>\n
<\/div>\n
\u2713 Sau khi x\u00e2m nh\u1eadp d\u1ecbch n\u00e3o t\u1ee7y th\u00e0nh c\u00f4ng, vi khu\u1ea9n c\u00f3 th\u1ec3 nh\u00e2n l\u00ean n\u1ed3ng \u0111\u1ed9 cao v\u00ec kh\u00f4ng \u0111\u1ee7 mi\u1ec5n d\u1ecbch d\u1ecbch th\u1ec3 trong d\u1ecbch n\u00e3o t\u1ee7y. C\u1ee5 th\u1ec3, n\u1ed3ng \u0111\u1ed9 globulin mi\u1ec5n d\u1ecbch v\u00e0 b\u1ed5 th\u1ec3 th\u1ea5p trong d\u1ecbch n\u00e3o t\u1ee7y d\u1eabn \u0111\u1ebfn ho\u1ea1t \u0111\u1ed9ng k\u00e9m ph\u00e1t tri\u1ec3n, nh\u00e2n b\u1ea3n th\u00e0nh c\u00f4ng c\u1ee7a vi khu\u1ea9n v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n vi\u00eam ti\u1ebfp theo.<\/div>\n

3.2 C\u01a1 ch\u1ebf b\u1ec7nh sinh g\u00e2y Vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 tr\u1ebb em:<\/strong><\/h3>\n
\u2713 Khi h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch nh\u1eadn di\u1ec7n c\u00e1c th\u00e0nh ph\u1ea7n vi khu\u1ea9n, ngay l\u1eadp t\u1ee9c s\u1ebd k\u00edch th\u00edch ph\u1ea3n \u1ee9ng vi\u00eam m\u1ea1nh d\u1eabn \u0111\u1ebfn suy gi\u1ea3m h\u00e0ng r\u00e0o m\u00e1u n\u00e3o do t\u1eadp trung b\u1ea1ch c\u1ea7u, \u0111i\u1ec1u ti\u1ebft m\u1ea1ch m\u00e1u, vi\u00eam m\u1ea1ch v\u00e0 t\u1eafc m\u1ea1ch, g\u00e2y t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd.<\/div>\n
<\/div>\n
\u2713 \u0110\u1ea7u ti\u00ean t\u1ea1o ra c\u00e1c cytokine g\u00e2y vi\u00eam: n\u1ed3ng \u0111\u1ed9 c\u1ee7a c\u00e1c cytokine ti\u1ec1n vi\u00eam (IL-1, IL-6, y\u1ebfu t\u1ed1 ho\u1ea1i t\u1eed kh\u1ed1i u, IFN-\u0264\u03b3, IL-2 v\u00e0 IL-12) v\u00e0 c\u00e1c chemokine (IL-8, protein-1a g\u00e2y vi\u00eam \u0111\u1ea1i th\u1ef1c b\u00e0o, v\u00e0 protein-1 h\u00f3a tr\u1ecb li\u1ec7u b\u1ea1ch c\u1ea7u mono) trong d\u1ecbch n\u00e3o t\u1ee7y cao. C\u00e1c cytokine n\u00e0y ho\u1ea1t \u0111\u1ed9ng c\u00f9ng v\u1edbi c\u00e1c th\u00e0nh ph\u1ea7n b\u1ec1 m\u1eb7t vi khu\u1ea9n, nh\u01b0 lipopolysaccharide, \u0111\u1ec3 t\u1ed5ng h\u1ee3p c\u00e1c glycoprotein d\u00ednh tr\u00ean b\u1ec1 m\u1eb7t c\u1ee7a n\u1ed9i m\u00f4 n\u00e3o, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho s\u1ef1 b\u00e1m d\u00ednh c\u1ee5c b\u1ed9 v\u00e0 s\u1ef1 ph\u00e2n gi\u1ea3i c\u1ee7a b\u1ea1ch c\u1ea7u trung t\u00ednh v\u00e0o DNT.<\/div>\n
<\/div>\n
\u2713 Khi vi\u00eam \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u, m\u1ed9t lo\u1ea1t c\u00e1c t\u1ed5n th\u01b0\u01a1ng x\u1ea3y ra v\u1edbi n\u1ed9i m\u00f4 c\u1ee7a h\u00e0ng r\u00e0o m\u00e1u – n\u00e3o d\u1eabn \u0111\u1ebfn ph\u00f9 n\u00e3o gi\u00e3n m\u1ea1ch, m\u1ea5t t\u1ef1 \u0111\u1ed9ng m\u1ea1ch m\u00e1u n\u00e3o v\u00e0 t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd. \u0110i\u1ec1u n\u00e0y d\u1eabn \u0111\u1ebfn c\u00e1c khu v\u1ef1c n\u00e3o b\u1ecb thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, t\u1ed5n th\u01b0\u01a1ng do \u0111\u1ed9c t\u1ebf b\u00e0o, v\u00e0 apoptosis th\u1ea7n kinh.<\/div>\n
<\/div>\n
\u2713 C\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a c\u01a1 ch\u1ebf sinh b\u1ec7nh n\u00e0y l\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh c\u1ee7a vi\u00eam m\u00e0ng n\u00e3o bao g\u1ed3m h\u00f4n m\u00ea, co gi\u1eadt, \u0111i\u1ebfc v\u00e0 r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng, c\u1ea3m gi\u00e1c, thi\u1ebfu h\u1ee5t nh\u1eadn th\u1ee9c.<\/div>\n
<\/div>\n
\u2713 Ph\u00f9 n\u00e3o, t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd trong vi\u00eam m\u00e0ng n\u00e3o m\u1ee7 l\u00e0 do:<\/div>\n
<\/div>\n
o Ch\u1ebft t\u1ebf b\u00e0o (ph\u00f9 n\u00e3o do g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o).<\/div>\n
o T\u0103ng t\u00ednh th\u1ea5m mao m\u1ea1ch do ch\u1ea5t cytokine (ph\u00f9 n\u00e3o do ngu\u1ed3n g\u1ed1c m\u1ea1ch m\u00e1u).<\/div>\n
o Gia t\u0103ng \u00e1p l\u1ef1c th\u1ee7y t\u0129nh (ph\u00f9 n\u00e3o k\u1ebd), do t\u1eafc ngh\u1ebdn, t\u00e1i h\u1ea5p thu d\u1ecbch n\u00e3o t\u1ee7y.<\/div>\n
o T\u0103ng ti\u1ebft ADH b\u1ea5t th\u01b0\u1eddng v\u00e0 g\u00e2y \u1ee9 n\u01b0\u1edbc qu\u00e1 m\u1ee9c.<\/div>\n
\n
\"Ngu\u1ed3n:
Ngu\u1ed3n: Slide thuy\u1ebft tr\u00ecnh CLB \u0110H Hu\u1ebf 2018<\/figcaption><\/figure>\n

 <\/p>\n<\/div>\n

Ngu\u1ed3n tham kh\u1ea3o<\/strong><\/div>\n
    \n
  • CLB Nhi khoa \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c Hu\u1ebf<\/li>\n<\/ul>\n
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