{"id":33854,"date":"2023-05-14T20:39:15","date_gmt":"2023-05-14T13:39:15","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=33854"},"modified":"2023-05-19T11:11:30","modified_gmt":"2023-05-19T04:11:30","slug":"sa-sut-tri-tue-alzheimer-co-che-benh-sinh-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/14\/sa-sut-tri-tue-alzheimer-co-che-benh-sinh-va-dieu-tri\/","title":{"rendered":"Sa s\u00fat tr\u00ed tu\u1ec7 (Alzheimer): c\u01a1 ch\u1ebf b\u1ec7nh sinh v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

B\u1ec7nh Alzheimer l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh l\u00e3o h\u00f3a th\u1ea7n kinh ph\u1ed5 bi\u1ebfn nh\u1ea5t tr\u00ean th\u1ebf gi\u1edbi, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u00e0ng tri\u1ec7u ng\u01b0\u1eddi m\u1ed7i n\u0103m. \u0110\u00e2y l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh kh\u00f3 ch\u1eefa v\u00e0 ti\u1ebfn tri\u1ec3n ch\u1eadm nh\u01b0ng ch\u1eafc ch\u1eafn g\u00e2y ra nh\u1eefng t\u00e1c \u0111\u1ed9ng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 ng\u01b0\u1eddi th\u00e2n. Trong b\u00e0i vi\u1ebft n\u00e0y, ch\u00fang ta s\u1ebd t\u00ecm hi\u1ec3u v\u1ec1c\u01a1 ch\u1ebf b\u1ec7nh sinh Alzheimer v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/strong><\/p>\n

\"tien-trien-cua-benh-Alzheimer\"
\u1ea2nh m\u00f4 t\u1ea3 s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh Alzheimer<\/figcaption><\/figure>\n

1. T\u1ed5ng quan b\u1ec7nh Alzheimer<\/strong><\/h2>\n

Alzheimer l\u00e0 b\u1ec7nh sa s\u00fat tr\u00ed tu\u1ec7 ti\u1ebfn tri\u1ec3n – do t\u1ebf b\u00e0o n\u00e3o tho\u00e1i ho\u00e1 ti\u1ebfn tri\u1ec3n<\/strong>. N\u00e3o b\u1ed9 l\u00e0 trung t\u00e2m ki\u1ec3m so\u00e1t to\u00e0n b\u1ed9 c\u01a1 th\u1ec3 v\u00e0 c\u00e1c v\u00f9ng kh\u00e1c nhau c\u1ee7a n\u00e3o b\u1ed9 ch\u1ecbu tr\u00e1ch nhi\u1ec7m cho c\u00e1c h\u00e0nh vi kh\u00e1c nhau. <\/span><\/p>\n

Hi\u1ec7n t\u01b0\u1ee3ng n\u00e3o b\u1ed9 tho\u00e1i h\u00f3a x\u1ea3y ra trong b\u1ec7nh Alzheimer \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn tr\u00ed nh\u1edb, k\u1ef9 n\u0103ng t\u01b0 duy, c\u1ea3m x\u00fac, h\u00e0nh vi v\u00e0 t\u00e2m tr\u1ea1ng. H\u1eadu qu\u1ea3 l\u00e0, kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n c\u00e1c ho\u1ea1t \u0111\u1ed9ng \u0111\u1eddi th\u01b0\u1eddng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh tr\u1edf n\u00ean khi\u1ebfm khuy\u1ebft. Khi b\u1ec7nh ti\u1ebfn tri\u1ec3n, c\u00e1c tri\u1ec7u ch\u1ee9ng tr\u1edf n\u1eb7ng h\u01a1n.<\/span><\/p>\n

2. Tri\u1ec7u ch\u1ee9ng Alzheimer<\/strong><\/h2>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u1ea7u ti\u00ean c\u1ee7a b\u1ec7nh Alzheimer kh\u00e1c nhau \u1edf m\u1ed7i ng\u01b0\u1eddi. C\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 tr\u00ed nh\u1edb th\u01b0\u1eddng l\u00e0 m\u1ed9t trong nh\u1eefng d\u1ea5u hi\u1ec7u \u0111\u1ea7u ti\u00ean c\u1ee7a s\u1ef1 suy gi\u1ea3m nh\u1eadn th\u1ee9c li\u00ean quan \u0111\u1ebfn b\u1ec7nh Alzheimer. Suy gi\u1ea3m nh\u1eadn th\u1ee9c,<\/a> ch\u1eb3ng h\u1ea1n nh\u01b0 kh\u1ea3 n\u0103ng t\u00ecm t\u1eeb, c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 th\u1ecb gi\u00e1c\/kh\u00f4ng gian v\u00e0 suy gi\u1ea3m kh\u1ea3 n\u0103ng suy lu\u1eadn ho\u1eb7c ph\u00e1n \u0111o\u00e1n, c\u0169ng c\u00f3 th\u1ec3 b\u00e1o hi\u1ec7u giai \u0111o\u1ea1n r\u1ea5t s\u1edbm c\u1ee7a b\u1ec7nh Alzheimer. <\/span><\/p>\n

M\u1ed9t s\u1ed1 ng\u01b0\u1eddi c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc ch\u1ee9ng suy gi\u1ea3m nh\u1eadn th\u1ee9c nh\u1eb9. Khi b\u1ec7nh ti\u1ebfn tri\u1ec3n, m\u1ecdi ng\u01b0\u1eddi b\u1ecb m\u1ea5t tr\u00ed nh\u1edb nhi\u1ec1u h\u01a1n v\u00e0 nh\u1eefng kh\u00f3 kh\u0103n v\u1ec1 nh\u1eadn th\u1ee9c kh\u00e1c.\u00a0<\/span>B\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng v\u00e0 tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 c\u1ee7a sa s\u00fat tr\u00ed tu\u1ec7.<\/span><\/p>\n

Bi\u1ec3u hi\u1ec7n ph\u1ed5 bi\u1ebfn \u1edf giai \u0111o\u1ea1n nh\u1eb9\u00a0<\/strong><\/p>\n

M\u1ea5t tr\u00ed nh\u1edb ng\u1eafn h\u1ea1n (v\u00ed d\u1ee5: h\u1ecfi l\u1eb7p \u0111i l\u1eb7p l\u1ea1i m\u1ed9t c\u00e2u, th\u01b0\u1eddng xuy\u00ean \u0111\u1eb7t sai \u0111\u1ed3 v\u1eadt ho\u1eb7c qu\u00ean c\u00e1c cu\u1ed9c h\u1eb9n)\u00a0<\/span><\/p>\n

Suy gi\u1ea3m kh\u1ea3 n\u0103ng l\u1eadp lu\u1eadn, kh\u00f3 kh\u0103n trong gi\u1ea3i quy\u1ebft c\u00e1c c\u00f4ng vi\u1ec7c ph\u1ee9c t\u1ea1p, v\u00e0 kh\u1ea3 n\u0103ng \u0111\u00e1nh gi\u00e1 k\u00e9m (v\u00ed d\u1ee5: kh\u00f4ng th\u1ec3 qu\u1ea3n l\u00fd t\u00e0i kho\u1ea3n ng\u00e2n h\u00e0ng, \u0111\u01b0a ra c\u00e1c quy\u1ebft \u0111\u1ecbnh kh\u00f4ng \u0111\u00fang v\u1ec1 t\u00e0i ch\u00ednh)\u00a0<\/span><\/p>\n

R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng ng\u00f4n ng\u1eef (v\u00ed d\u1ee5: kh\u00f3 kh\u0103n trong vi\u1ec7c suy ngh\u0129 v\u1ec1 nh\u1eefng t\u1eeb th\u00f4ng d\u1ee5ng, l\u1ed7i trong n\u00f3i v\u00e0\/ho\u1eb7c vi\u1ebft)<\/span><\/p>\n

\u00a0R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ecb gi\u00e1c kh\u00f4ng gian (v\u00ed d\u1ee5: kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng nh\u1eadn d\u1ea1ng khu\u00f4n m\u1eb7t ho\u1eb7c c\u00e1c \u0111\u1ed3 v\u1eadt th\u01b0\u1eddng g\u1eb7p)<\/span><\/p>\n

\u00a0Bi\u1ec3u hi\u1ec7n ph\u1ed5 bi\u1ebfn \u1edf giai \u0111o\u1ea1n trung b\u00ecnh\u00a0<\/strong><\/p>\n

B\u1ec7nh ti\u1ebfn tri\u1ec3n n\u1eb7ng d\u1ea7n, r\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c \u0111i k\u00e8m v\u1edbi c\u00e1c r\u1ed1i lo\u1ea1n h\u00e0nh vi:<\/span><\/p>\n

\u00a0+ Nhanh m\u1ea5t tr\u00ed nh\u1edb<\/a> v\u00e0 l\u00fa l\u1eabn<\/a> .<\/span><\/p>\n

+ Kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng h\u1ecdc nh\u1eefng \u0111i\u1ec1u m\u1edbi.<\/span><\/p>\n

+ Kh\u00f3 kh\u0103n v\u1edbi ng\u00f4n ng\u1eef v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111\u1ecdc, vi\u1ebft v\u00e0 l\u00e0m vi\u1ec7c v\u1edbi c\u00e1c con s\u1ed1.<\/span><\/p>\n

+ Kh\u00f3 t\u1ed5 ch\u1ee9c suy ngh\u0129 v\u00e0 suy ngh\u0129 m\u1ed9t c\u00e1ch logic.<\/span><\/p>\n

+ Kh\u00f3 th\u1ef1c hi\u1ec7n c\u00e1c nhi\u1ec7m v\u1ee5 nhi\u1ec1u b\u01b0\u1edbc, ch\u1eb3ng h\u1ea1n nh\u01b0 m\u1eb7c qu\u1ea7n \u00e1o.<\/span><\/p>\n

\u00a0+ Nh\u1eadn d\u1ea1ng gia \u0111\u00ecnh v\u00e0 b\u1ea1n b\u00e8 kh\u00f3 kh\u0103n.<\/span><\/p>\n

+ \u1ea2o gi\u00e1c<\/a>, \u1ea3o t\u01b0\u1edfng v\u00e0 hoang t\u01b0\u1edfng<\/a>.<\/span><\/p>\n

+ H\u00e0nh vi b\u1ed1c \u0111\u1ed3ng nh\u01b0 c\u1edfi qu\u1ea7n \u00e1o v\u00e0o <\/span>nh\u1eefng th\u1eddi \u0111i\u1ec3m ho\u1eb7c \u0111\u1ecba \u0111i\u1ec3m kh\u00f4ng th\u00edch <\/span>h\u1ee3p ho\u1eb7c s\u1eed d\u1ee5ng ng\u00f4n ng\u1eef th\u00f4 t\u1ee5c.<\/span><\/p>\n

+ T\u1ee9c gi\u1eadn b\u1ed9c ph\u00e1t.<\/span><\/p>\n

+ B\u1ed3n ch\u1ed3n, k\u00edch \u0111\u1ed9ng, lo l\u1eafng, ch\u1ea3y n\u01b0\u1edbc\u00a0<\/span>m\u1eaft, \u0111i lang thang \u2014 \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u00e0o bu\u1ed5i\u00a0<\/span>chi\u1ec1u mu\u1ed9n ho\u1eb7c bu\u1ed5i t\u1ed1i.<\/span><\/p>\n

+ C\u00e1c c\u00e2u n\u00f3i ho\u1eb7c c\u1eed \u0111\u1ed9ng l\u1eb7p \u0111i l\u1eb7p l\u1ea1i,\u00a0<\/span>th\u1ec9nh tho\u1ea3ng co gi\u1eadt c\u01a1.<\/span><\/p>\n

Bi\u1ec3u hi\u1ec7n ph\u1ed5 bi\u1ebfn \u1edf giai \u0111o\u1ea1n n\u1eb7ng<\/strong><\/p>\n

Kh\u00f4ng th\u1ec3 giao ti\u1ebfp v\u00e0 ho\u00e0n to\u00e0n ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 ch\u0103m s\u00f3c c\u1ee7a ng\u01b0\u1eddi kh\u00e1c. V\u00e0o giai \u0111o\u1ea1n n\u1eb7ng h\u01a1n, c\u01a1 th\u1ec3 c\u00f3 th\u1ec3 ng\u1eebng ho\u1ea1t \u0111\u1ed9ng, b\u1ec7nh nh\u00e2n n\u1eb1m li\u1ec7t gi\u01b0\u1eddng.<\/span><\/p>\n

+ Kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng giao ti\u1ebfp\u00a0<\/span><\/p>\n

+ S\u1ee5t c\u00e2n\u00a0<\/a><\/span><\/p>\n

+ Co gi\u1eadt\u00a0<\/a><\/span><\/p>\n

+ Nhi\u1ec5m tr\u00f9ng da<\/a>\u00a0<\/span><\/p>\n

+ Kh\u00f3 nu\u1ed1t<\/span><\/p>\n

\u00a0+ R\u00ean r\u1ec9 ho\u1eb7c c\u00e0u nh\u00e0u\u00a0<\/span><\/p>\n

+ Ng\u1ee7 nhi\u1ec1u<\/a><\/span><\/p>\n

+ M\u1ea5t ki\u1ec3m so\u00e1t ru\u1ed9t v\u00e0 b\u00e0ng quang\u00a0\u00a0<\/span><\/p>\n

3. C\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a Alzheimer<\/strong><\/h2>\n

APP\u00a0<\/strong><\/p>\n

APP l\u00e0 protein g\u1eafn tr\u00ean chu\u1ed7i nh\u1eb9 c\u1ee7a kinesin-1, l\u00e0m trung gian cho s\u1ef1 g\u1eafn k\u1ebft c\u00e1c ch\u1ea5t c\u1ea7n v\u1eadn chuy\u1ec3n v\u00e0o protein \u0111\u1ed9ng c\u01a1 kinesin-1, v\u00ed d\u1ee5 nh\u01b0 b\u00f3ng m\u00e0ng, c\u00e1c b\u00e0o quan, c\u00e1c protein v\u00e0 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i cho s\u1ef1 v\u1eadn chuy\u1ec3n c\u00e1c ch\u1ea5t tr\u00ean s\u1ee3i tr\u1ee5c t\u1ebf b\u00e0o th\u1ea7n kinh.<\/span><\/p>\n

\"cau-truc-APP\"<\/p>\n

V\u1ec1 m\u1eb7t c\u1ea5u tr\u00fac, APP l\u00e0 m\u1ed9t glycoprotein xuy\u00ean m\u00e0ng type I, ch\u1ee9a mi\u1ec1n n\u1ed9i b\u00e0o \u0111\u1ea7u C ng\u1eafn v\u00e0 mi\u1ec1n ngo\u1ea1i b\u00e0o l\u1edbn \u0111\u01b0\u1ee3c b\u1ea3o t\u1ed3n cao. APP thu\u1ed9c h\u1ecd protein APP, trong nh\u00f3m n\u00e0y c\u00f2n c\u00f3 APP-like protein 1 v\u00e0 2 (c\u1ea5u tr\u00fac t\u01b0\u01a1ng \u0111\u1ed3ng v\u1edbi APP nh\u01b0ng kh\u00f4ng c\u00f3 A\u03b2). Gene APP n\u1eb1m tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 s\u1ed1 21, n\u00f3 tr\u1ea3i qua qu\u00e1 tr\u00ecnh c\u1eaft n\u1ed1i thay th\u1ebf 18 exon \u0111\u1ec3 cu\u1ed1i c\u00f9ng t\u1ea1o ra ba protein \u0111\u1ed3ng d\u1ea1ng ch\u00ednh l\u00e0 APP 770, APP751 v\u00e0 APP695, trong \u0111\u00f3 APP 695 (d\u00e0i 695 amino acid) c\u00f3 nhi\u1ec1u nh\u1ea5t trong n\u00e3o.<\/span><\/p>\n

APP v\u00e0 c\u00e1c s\u1ea3n ph\u1ea9m ph\u00e2n c\u1eaft c\u1ee7a n\u00f3 r\u1ea5t c\u1ea7n thi\u1ebft cho s\u1ef1 ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng c\u1ee7a t\u1ebf b\u00e0o th\u1ea7n kinh. V\u00ed d\u1ee5, A\u03b2 v\u00e0 sAPP \u0111\u1ec1u \u0111\u00f3ng g\u00f3p v\u00e0o c\u00e1c ho\u1ea1t \u0111\u1ed9ng sinh l\u00fd kh\u00e1c nhau; mi\u1ec1n n\u1ed9i b\u00e0o c\u1ee7a APP (AICD) c\u00f3 th\u1ec3 ho\u1ea1t \u0111\u1ed9ng nh\u01b0 m\u1ed9t cofactor \u0111\u1ec3 k\u00edch ho\u1ea1t phi\u00ean m\u00e3 trong nh\u00e2n, v\u00e0 n\u00f3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t l\u00e0 ch\u1ea5t \u0111i\u1ec1u h\u00f2a ch\u00ednh trong s\u1ef1 h\u00ecnh th\u00e0nh, tr\u01b0\u1edfng th\u00e0nh v\u00e0 ho\u1ea1t \u0111\u1ed9ng ch\u1ee9c n\u0103ng c\u1ee7a synap th\u1ea7n kinh \u2013 c\u01a1.<\/span><\/p>\n

APP \u0111\u01b0\u1ee3c t\u1ed5ng h\u1ee3p trong l\u01b0\u1edbi n\u1ed9i ch\u1ea5t (ER) v\u00e0 sau \u0111\u00f3 \u0111\u01b0\u1ee3c v\u1eadn chuy\u1ec3n \u0111\u1ebfn ph\u1ee9c h\u1ee3p Golgi, n\u01a1i n\u00f3 ho\u00e0n th\u00e0nh qu\u00e1 tr\u00ecnh tr\u01b0\u1edfng th\u00e0nh v\u00e0 cu\u1ed1i c\u00f9ng \u0111\u01b0\u1ee3c v\u1eadn chuy\u1ec3n \u0111\u1ebfn m\u00e0ng sinh ch\u1ea5t.<\/span><\/p>\n

Ph\u00e2n c\u1eaft APP<\/strong><\/p>\n

APP tr\u01b0\u1edfng th\u00e0nh tr\u00ean m\u00e0ng sinh ch\u1ea5t tr\u1ea3i qua qu\u00e1 tr\u00ecnh ph\u00e2n c\u1eaft g\u1ed3m hai b\u01b0\u1edbc li\u00ean ti\u1ebfp. B\u01b0\u1edbc ph\u00e2n c\u1eaft \u0111\u1ea7u ti\u00ean ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi c\u00e1c alpha -secretase ho\u1eb7c beta -secretase.\u00a0<\/span><\/p>\n

\"phan-cat-APP\"
S\u1ef1 ph\u00e2n c\u1eaft APP b\u1edfi c\u00e1c secretase<\/figcaption><\/figure>\n

Trong con \u0111\u01b0\u1eddng alpha – secretase<\/strong> (con \u0111\u01b0\u1eddng non-amyloidogenic), n\u00f3 b\u1ecb ph\u00e2n c\u1eaft b\u1edfi m\u1ed9t metalloproteinase ADAM 10 (th\u01b0\u1eddng \u0111\u01b0\u1ee3c g\u1ecdi chung l\u00e0 -secretase) gi\u1eefa c\u00e1c g\u1ed1c K16 v\u00e0 L17 \u1edf v\u00f9ng ngo\u1ea1i b\u00e0o \u0111\u1ec3 t\u1ea1o ra C83\/CTF li\u00ean k\u1ebft m\u00e0ng v\u00e0 sAPP.\u00a0<\/span><\/p>\n

Trong con \u0111\u01b0\u1eddng beta – secretase (c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 con \u0111\u01b0\u1eddng amyloidogenic), APP \u0111\u01b0\u1ee3c ph\u00e2n c\u1eaft b\u1edfi beta-secretase t\u1ea1o th\u00e0nh C99\/CTF v\u00e0 sAPP.\u00a0<\/span><\/p>\n

C\u1ea3 CTF v\u00e0 CTF t\u1ea1o th\u00e0nh sau \u0111\u00f3 ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c x\u1eed l\u00fd b\u1edfi -secretase. -secretase l\u00e0 m\u1ed9t ph\u1ee9c h\u1ee3p enzyme bao g\u1ed3m 4 ti\u1ec3u \u0111\u01a1n v\u1ecb: presenilin 1 ho\u1eb7c 2, c\u00f3 ch\u1ee9c n\u0103ng nh\u01b0 l\u00f5i x\u00fac t\u00e1c c\u1ee7a ph\u1ee9c h\u1ee3p enzyme; presenilin enhancer 2, gi\u00fap \u1ed5n \u0111\u1ecbnh ph\u1ee9c h\u1ee3p enzyme tr\u01b0\u1edfng th\u00e0nh; anterior pharynx-defective 1, c\u00f3 ch\u1ee9c n\u0103ng l\u1eafp r\u00e1p ph\u1ee9c h\u1ee3p enzyme; v\u00e0 nicastrin, c\u00f3 ch\u1ee9c n\u0103ng nh\u1eadn d\u1ea1ng c\u01a1 ch\u1ea5t. S\u1ef1 m\u1ea5t \u0111i c\u1ee7a b\u1ea5t k\u1ef3 ti\u1ec3u \u0111\u01a1n v\u1ecb n\u00e0o s\u1ebd l\u00e0m m\u1ea5t ho\u1ea1t \u0111\u1ed9ng ph\u00e2n gi\u1ea3i protein c\u1ee7a n\u00f3. -secretase ph\u00e2n c\u1eaft trong mi\u1ec1n xuy\u00ean m\u00e0ng c\u1ee7a CTF \u0111\u1ec3 t\u1ea1o ra AICD c\u00f9ng v\u1edbi p3 (trong con \u0111\u01b0\u1eddng non-amyloidogenic) ho\u1eb7c c\u00e1c A\u03b2 c\u00f3 \u0111\u1ed9 d\u00e0i kh\u00e1c nhau (trong con \u0111\u01b0\u1eddng amyloidogenic).<\/span><\/p>\n

Beta amyloid (A\u03b2)<\/strong><\/p>\n

\u00a0Ch\u1ee9c n\u0103ng sinh h\u1ecdc <\/span><\/em><\/p>\n

A\u03b2 \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn nhi\u1ec1u nh\u1ea5t l\u00e0 peptide c\u00f3 li\u00ean quan \u0111\u1ebfn c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a b\u1ec7nh. Alzheimer. Tuy nhi\u00ean tai ti\u1ebfng n\u00e0y \u0111\u00e3 l\u00e0m lu m\u1edd th\u1ef1c t\u1ebf r\u1eb1ng A\u03b2 ph\u1ee5c v\u1ee5 cho m\u1ed9t s\u1ed1 ch\u1ee9c n\u0103ng sinh l\u00fd quan tr\u1ecdng trong c\u01a1 th\u1ec3. A\u03b2 \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong t\u1ea5t c\u1ea3 c\u00e1c \u0111\u1ed9ng v\u1eadt c\u00f3 x\u01b0\u01a1ng s\u1ed1ng \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u cho \u0111\u1ebfn nay, t\u1ed3n t\u1ea1i trong su\u1ed1t v\u00f2ng \u0111\u1eddi c\u1ee7a c\u00e1 th\u1ec3, v\u00e0 tr\u00ecnh t\u1ef1 ph\u00e2n t\u1eed c\u1ee7a n\u00f3 cho th\u1ea5y m\u1ee9c \u0111\u1ed9 b\u1ea3o t\u1ed3n cao. Nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m n\u00e0y ng\u1ee5 \u00fd n\u00f3 ph\u1ea3i mang \u0111\u1ebfn \u01b0u th\u1ebf ch\u1ecdn l\u1ecdc cho s\u1ef1 t\u1ed3n t\u1ea1i c\u1ee7a lo\u00e0i. Quan \u0111i\u1ec3m n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c c\u1ee7ng c\u1ed1 th\u00eam b\u1edfi b\u1eb1ng ch\u1ee9ng cho th\u1ea5y s\u1ef1 c\u1ea1n ki\u1ec7t A\u03b2 n\u1ed9i sinh g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 b\u1ea5t l\u1ee3i \u1edf nhi\u1ec1u lo\u00e0i \u0111\u1ed9ng v\u1eadt kh\u00e1c nhau.<\/span><\/p>\n

Cho \u0111\u1ebfn nay, nh\u1eefng vai tr\u00f2 \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn c\u1ee7a A\u03b2 bao g\u1ed3m:<\/span><\/p>\n

+ Ho\u1ea1t \u0111\u1ed9ng kh\u00e1ng khu\u1ea9n:<\/strong> A\u03b2 c\u00f3 \u0111\u1eb7c t\u00ednh kh\u00e1ng khu\u1ea9n, kh\u00e1ng n\u1ea5m v\u00e0 kh\u00e1ng virus. C\u00f3 hi\u1ec7u qu\u1ea3 ch\u1ed1ng l\u1ea1i \u00edt nh\u1ea5t 11 lo\u00e0i vi khu\u1ea9n.<\/span><\/p>\n

\"co-che-khang-khuan-cua-
H\u00ecnh 4. C\u01a1 ch\u1ebf kh\u00e1ng khu\u1ea9n c\u1ee7a AB<\/figcaption><\/figure>\n

+ \u1ee8c ch\u1ebf kh\u1ed1i u<\/strong><\/a>: A\u03b2 c\u00f3 th\u1ec3 ng\u0103n ch\u1eb7n virus g\u00e2y ung th\u01b0 v\u00e0 \u1ee9c ch\u1ebf s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a kh\u1ed1i u. <\/span><\/p>\n

+ Ng\u0103n ch\u1eb7n s\u1ef1 r\u00f2 r\u1ec9 trong h\u00e0ng r\u00e0o m\u00e1u n\u00e3o (BBB)<\/strong>: A\u03b2 li\u00ean k\u1ebft c\u00e1c ch\u1ea5t h\u00f2a tan trong m\u00e1u v\u1edbi nhau \u0111\u1ec3 t\u1ea1o th\u00e0nh m\u1ed9t ch\u1ed1t ch\u1eb7n s\u1ef1 khu\u1ebfch t\u00e1n c\u1ee7a c\u00e1c ch\u1ea5t \u0111\u1ed9c h\u1ea1i v\u00e0o n\u00e3o.<\/span><\/p>\n

\"AB-ngan-chan-su-ro-ri-qua-BBB\"<\/p>\n

+ Th\u00fac \u0111\u1ea9y ph\u1ee5c h\u1ed3i sau ch\u1ea5n th\u01b0\u01a1ng n\u00e3o: S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a A\u03b2 mang l\u1ea1i k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n \u1edf c\u00e1c \u0111\u1ed9ng v\u1eadt m\u00f4 h\u00ecnh v\u1ec1 t\u00e1c \u0111\u1ed9ng l\u00ean v\u1ecf n\u00e3o, t\u1ed5n th\u01b0\u01a1ng t\u1ee7y s\u1ed1ng<\/a>, thi\u1ebfu oxy v\u00e0\u00a0<\/span>c\u00e1c b\u1ec7nh t\u1ef1 mi\u1ec5n<\/a>.<\/span><\/p>\n

+ \u0110i\u1ec1u ch\u1ec9nh ch\u1ee9c n\u0103ng c\u1ee7a synap th\u1ea7n kinh: A\u03b2 \u0111i\u1ec1u ch\u1ec9nh kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng c\u1ee7a\u00a0<\/span>c\u00e1c synap th\u1ea7n kinh glutamatergic v\u00e0 cholinergic \u1edf h\u1ed3i h\u1ea3i m\u00e3, g\u00f3p ph\u1ea7n c\u1ee7ng c\u1ed1<\/span>tr\u00ed nh\u1edb.<\/span><\/p>\n

C\u00e1c d\u1ea1ng c\u1ea5u tr\u00fac c\u1ee7a peptide A\u03b2<\/span><\/em><\/p>\n

\u00a0A\u03b2 l\u00e0 t\u00ean g\u1ecdi chung c\u1ee7a m\u1ed9t nh\u00f3m peptide c\u00f3 k\u00edch th\u01b0\u1edbc t\u1eeb 37 \u0111\u1ebfn 49 amino acid. Isoform 42 amino acid c\u00f3 tr\u00ecnh t\u1ef1 \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n \u1edf h\u00ecnh b\u00ean d\u01b0\u1edbi. \u0110\u00e2y l\u00e0 d\u1ea1ng ph\u1ed5 bi\u1ebfn nh\u1ea5t li\u00ean quan \u0111\u1ebfn AD.<\/span><\/p>\n

\"trinh-tu-peptide-AB-va-cau-hinh-gap-dang-xoan\"<\/p>\n

A\u03b2 c\u00f3 th\u1ec3 h\u00f2a tan v\u00e0 ch\u1ee9a c\u00e1c v\u00f9ng ng\u1eafn c\u00f3 phi\u1ebfn\u00a0 v\u00e0 xo\u1eafn polyproline, tuy v\u1eady ch\u00fang v\u1eabn \u0111\u01b0\u1ee3c c\u1ea5u th\u00e0nh ph\u1ea7n l\u1edbn t\u1eeb c\u00e1c xo\u1eafn . Tuy nhi\u00ean, \u1edf n\u1ed3ng \u0111\u1ed9 \u0111\u1ee7 cao, c\u00e1c monomer A\u03b2 c\u00f2n t\u1eadp h\u1ee3p th\u00e0nh nhi\u1ec1u c\u1ea5u tr\u00fac kh\u00e1c nhau, bao g\u1ed3m c\u00e1c oligomer, protofibrils v\u00e0 s\u1ee3i amyloid. \u0110\u00e2y l\u00e0 c\u00e1c c\u1ea5u tr\u00fac b\u1eadc b\u1ed1n ch\u1ee9a nhi\u1ec1u phi\u1ebfn , g\u1ecdi l\u00e0 s\u1ee3i beta ch\u00e9o (cross-beta filament). C\u00e1c s\u1ee3i amyloid l\u1edbn h\u01a1n th\u01b0\u1eddng kh\u00f4ng h\u00f2a tan, v\u00e0 ch\u00fang c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c t\u1eadp h\u1ee3p th\u00e0nh c\u00e1c m\u1ea3ng amyloid, trong khi c\u00e1c oligomer amyloid c\u00f3 th\u1ec3 h\u00f2a tan v\u00e0 lan r\u1ed9ng trong n\u00e3o. Theo gi\u1ea3 thuy\u1ebft m\u1ea3ng amyloid, s\u1ef1 k\u1ebft t\u1eadp c\u00e1c monomer A\u03b2 \u0111\u01b0\u1ee3c cho l\u00e0 nguy\u00ean nh\u00e2n d\u1eabn \u0111\u1ebfn c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a b\u1ec7nh Alzheimer. Gi\u1ea3 thuy\u1ebft n\u00e0y \u0111\u01b0\u1ee3c \u0111\u01b0a ra khi ng\u01b0\u1eddi ta nh\u1eadn th\u1ea5y c\u00f3 s\u1ef1 h\u00ecnh th\u00e0nh m\u1ea3ng A\u03b2 trong n\u00e3o \u1edf c\u00e1c b\u1ec7nh nh\u00e2n qua \u0111\u1eddi v\u00ec Alzheimer.<\/span><\/p>\n

\u00a0C\u00e2n b\u1eb1ng AB<\/strong><\/p>\n

Vi\u1ec7c s\u1ea3n xu\u1ea5t A\u03b2 th\u01b0\u1eddng \u0111\u01b0\u1ee3c c\u00e2n b\u1eb1ng b\u1edfi m\u1ed9t s\u1ed1 qu\u00e1 tr\u00ecnh, bao g\u1ed3m ph\u00e2n h\u1ee7y protein, thanh th\u1ea3i qua trung gian t\u1ebf b\u00e0o (b\u1ea3n th\u00e2n n\u00f3 c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn s\u1ef1 ph\u00e2n h\u1ee7y protein), v\u1eadn chuy\u1ec3n t\u00edch c\u1ef1c ra kh\u1ecfi n\u00e3o v\u00e0 l\u1eafng \u0111\u1ecdng th\u00e0nh c\u00e1c t\u1eadp h\u1ee3p kh\u00f4ng h\u00f2a tan.<\/span><\/p>\n

A\u03b2 \u0111\u01b0\u1ee3c t\u1ea1o ra trong c\u00e1c m\u00f4 ngo\u1ea1i vi v\u00e0 h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, n\u01a1i n\u00f3 c\u00f3 th\u1ec3 k\u1ebft t\u1ee5 v\u00e0 t\u1ea1o th\u00e0nh c\u00e1c s\u1ee3i kh\u00f4ng h\u00f2a tan. A\u03b2 h\u00f2a tan c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c v\u1eadn chuy\u1ec3n qua BBB t\u1eeb m\u00e1u \u0111\u1ebfn n\u00e3o qua RAGE, v\u00e0 t\u1eeb n\u00e3o \u0111\u1ebfn m\u00e1u qua LRP. A\u03b2 c\u0169ng c\u00f3 th\u1ec3 li\u00ean k\u1ebft v\u1edbi c\u00e1c protein v\u1eadn chuy\u1ec3n, v\u00ed d\u1ee5, apoE, apoJ, \u03b12- macroglobulin (\u03b12M), c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 c\u00f4 l\u1eadp A\u03b2 c\u0169ng nh\u01b0 h\u00ecnh th\u1ee9c t\u00edch t\u1ee5 c\u1ee7a n\u00f3 trong n\u00e3o. A\u03b2 c\u00f3 th\u1ec3 b\u1ecb ph\u00e2n c\u1eaft b\u1edfi c\u00e1c protease Neprilysin (Nep), men chuy\u1ec3n endothelin (ECE), enzyme ph\u00e2n h\u1ee7y insulin (IDE), plasmin v\u00e0 c\u00e1c protease ph\u00e2n h\u1ee7y A\u03b2 kh\u00e1c (MMP, Cathepsin D), c\u0169ng nh\u01b0 b\u1edfi s\u1ef1 tho\u00e1i h\u00f3a qua trung gian microglia.\u00a0<\/span><\/p>\n

Ng\u00e0y c\u00e0ng c\u00f3 nhi\u1ec1u b\u1eb1ng ch\u1ee9ng cho th\u1ea5y r\u1eb1ng s\u1ef1 suy gi\u1ea3m qu\u00e1 tr\u00ecnh ph\u00e2n gi\u1ea3i protein l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi m\u1ee9c A\u03b2 trong n\u00e3o v\u00e0 n\u00f3i r\u1ed9ng ra l\u00e0 c\u1ee7a b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn A\u03b2.<\/span><\/p>\n

A\u03b2 trong b\u1ec7nh alzheimer\u00a0<\/strong><\/p>\n

C\u00e1c d\u1ea1ng A\u03b2 v\u00e0 t\u00e1c \u0111\u1ed9ng g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o c\u1ee7a ch\u00fang\u00a0<\/span><\/em><\/p>\n

Nh\u1eefng nghi\u00ean c\u1ee9u tr\u01b0\u1edbc \u0111\u00e2y cho r\u1eb1ng s\u1ee3i A\u03b2 l\u00e0 m\u1ed9t t\u00e1c nh\u00e2n g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o th\u1ea7n kinh, g\u00e2y ch\u1ebft t\u1ebf b\u00e0o, m\u1ea5t tr\u00ed nh\u1edb v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c c\u1ee7a AD. Tuy nhi\u00ean, trong h\u01a1n hai th\u1eadp k\u1ef7 g\u1ea7n \u0111\u00e2y, nh\u1eefng nghi\u00ean c\u1ee9u s\u00e2u h\u01a1n \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng th\u1ec3 oligomer c\u1ee7a peptide A\u03b2 l\u00e0 nguy\u00ean nh\u00e2n l\u1edbn nh\u1ea5t g\u00e2y h\u01b0 h\u1ea1i t\u1ebf b\u00e0o th\u1ea7n kinh.\u00a0<\/span><\/p>\n

T\u00e1c \u0111\u1ed9ng si\u00eau phosphoryl h\u00f3a Tau<\/strong><\/p>\n

\u00a0Tau l\u00e0 m\u1ed9t protein c\u00f3 vai tr\u00f2 \u1ed5n \u0111\u1ecbnh h\u1ec7 th\u1ed1ng khung x\u01b0\u01a1ng t\u1ebf b\u00e0o, l\u00e0m \u1ed5n \u0111\u1ecbnh s\u1ee3i tr\u1ee5c th\u1ea7n kinh. S\u1ef1 t\u1ef1 k\u1ebft t\u1eadp c\u00e1c A\u03b2 l\u00e0m cho protein Tau tr\u1edf n\u00ean si\u00eau phosphoryl h\u00f3a (hyperphosphorylated) do l\u00e0m thay \u0111\u1ed5i ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c kinase\/phosphatase d\u1eabn \u0111\u1ebfn s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c \u0111\u00e1m r\u1ed1i s\u1ee3i th\u1ea7n kinh (NTFs), l\u00e0m r\u1ed1i lo\u1ea1i ch\u1ee9c n\u0103ng t\u1ebf b\u00e0o th\u1ea7n kinh v\u00e0 sau \u0111\u00f3 l\u00e0 l\u00e0m m\u1ea5t ch\u1ee9c n\u0103ng synapse. Cu\u1ed1i c\u00f9ng l\u00e0 b\u1ec7nh Alzheimer.<\/span><\/p>\n

Thay \u0111\u1ed5i ho\u1ea1t \u0111\u1ed9ng c\u00e1c ch\u1ea5t v\u1eadn chuy\u1ec3n\u00a0qua m\u00e0ng<\/strong><\/p>\n

S\u1ef1 t\u1ef1 k\u1ebft t\u1eadp d\u1eabn \u0111\u1ebfn t\u1ea1o ra m\u1ed9t aldehyde \u0111\u1ed9c h\u1ea1i l\u00e0 4-hydroxynonenal v\u00e0 d\u1eabn \u0111\u1ebfn\u00a0<\/span>peroxy h\u00f3a lipid. C\u00f3 th\u1ec3 l\u00e0m h\u1ecfng ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c b\u01a1m ATPase, ch\u1ea5t mang\u00a0<\/span>glucose v\u00e0 protein v\u1eadn chuy\u1ec3n glutamate. Ngo\u00e0i ra, A\u03b2 c\u0169ng th\u00fac \u0111\u1ea9y kh\u1eed c\u1ef1c m\u00e0ng\u00a0<\/span>synapse, l\u00e0m t\u0103ng d\u00f2ng calci v\u00e0 g\u00e2y t\u1ed5n th\u01b0\u01a1ng ty th\u1ec3, gi\u00e1n \u0111o\u1ea1n ho\u1ea1t \u0111\u1ed9ng truy\u1ec1n\u00a0<\/span>tin qua synapse.<\/span><\/p>\n

S\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c ROS<\/strong><\/p>\n

S\u1ef1 k\u1ebft t\u1eadp c\u1ee7a A\u03b2 c\u0169ng c\u00f3 th\u1ec3 t\u1ea1o ra c\u00e1c g\u1ed1c t\u1ef1 do, g\u00e2y stress oxy h\u00f3a do ph\u1ea3n \u1ee9ng v\u1edbi protein ho\u1eb7c lipid. \u0110i\u1ec1u n\u00e0y d\u1eabn \u0111\u1ebfn l\u00e0m m\u1ea5t t\u00ednh to\u00e0n v\u1eb9n c\u1ee7a m\u00e0ng. Ngo\u00e0i ra th\u00ec stress oxy h\u00f3a<\/a> g\u00e2y ra b\u1edfi s\u1ef1 k\u1ebft t\u1eadp A\u03b2 c\u0169ng \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e0 g\u00e2y ra qu\u00e1 tr\u00ecnh oxy h\u00f3a DNA, d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng DNA.<\/span><\/p>\n

K\u00edch ho\u1ea1t c\u00e1c \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch\u00a0<\/strong><\/p>\n

M\u1ee9c A\u03b2 k\u1ebft t\u1eadp t\u0103ng li\u00ean t\u1ee5c c\u0169ng l\u00e0m th\u00fac \u0111\u1ea9y c\u00e1c ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch b\u1ea9m sinh b\u1eb1ng c\u00e1ch k\u00edch ho\u1ea1t microglia, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn m\u1ea5t t\u1ebf b\u00e0o th\u1ea7n kinh th\u00f4ng qua th\u1ef1c b\u00e0o tr\u1ef1c ti\u1ebfp. Ngo\u00e0i ra, s\u1ef1 t\u1eadp h\u1ee3p A\u03b2 c\u0169ng g\u00e2y ra c\u00e1c ph\u1ea3n \u1ee9ng vi\u00eam v\u00e0 gi\u1ea3i ph\u00f3ng c\u00e1c ch\u1ea5t trung gian c\u1ee7a qu\u00e1 tr\u00ecnh vi\u00eam, ch\u1eb3ng h\u1ea1n nh\u01b0 eicosanoids, chemokine, cytokine ti\u1ec1n vi\u00eam<\/a> v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 b\u1ed5 th\u1ec3, c\u00f3 th\u1ec3 l\u00e0m t\u0103ng qu\u00e1 tr\u00ecnh ch\u1ebft t\u1ebf b\u00e0o th\u1ea7n kinh, m\u1ea5t c\u00e1c synap th\u1ea7n kinh, d\u1eabn \u0111\u1ebfn gi\u1ea3m s\u1ef1 thanh th\u1ea3i A\u03b2 v\u00e0 c\u00e1c v\u1ee5n t\u1ebf b\u00e0o th\u1ea7n kinh qua trung gian microglia.\u00a0<\/span><\/p>\n

R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng ty th\u1ec3<\/strong><\/p>\n

Khi ti\u1ec1n ch\u1ea5t c\u1ee7a A\u03b2 l\u00e0 APP t\u00edch t\u1ee5 t\u1ea1i m\u00e0ng c\u1ee7a ty th\u1ec3, n\u00f3 ng\u0103n ch\u1eb7n s\u1ef1 chuy\u1ec3n v\u1ecb c\u1ee7a c\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a b\u00ean trong ty th\u1ec3 v\u00e0 chuy\u1ec3n v\u1ecb c\u00e1c protein, d\u1eabn \u0111\u1ebfn gi\u00e1n \u0111o\u1ea1n chu\u1ed7i v\u1eadn chuy\u1ec3n \u0111i\u1ec7n t\u1eed v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng ty th\u1ec3. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00e0m t\u0103ng th\u00eam qu\u00e1 tr\u00ecnh t\u1ea1o A\u03b2 v\u00e0 khi\u1ebfn cho t\u1ebf b\u00e0o r\u01a1i v\u00e0o v\u00f2ng xo\u00e1y c\u1ee7a vi\u1ec7c t\u0103ng s\u1ea3n xu\u1ea5t A\u03b2 v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng ti th\u1ec3.\u00a0<\/span><\/p>\n

T\u00e1c \u0111\u1ed9ng c\u1ee7a A\u03b2 \u1edf m\u1ee9c c\u01a1 quan<\/strong><\/p>\n

\u00a0S\u1ef1 l\u1eafng \u0111\u1ecdng c\u1ee7a peptit A\u03b2 t\u1ea1o th\u00e0nh m\u1ea3ng, trong khi s\u1ef1 t\u1eadp h\u1ee3p c\u1ee7a Tau si\u00eau phosphoryl h\u00f3a c\u00f3 th\u1ec3 t\u1ea1o th\u00e0nh \u0111\u00e1m r\u1ed1i s\u1ee3i th\u1ea7n kinh. M\u1eb7c d\u00f9 s\u1ef1 l\u1eafng \u0111\u1ecdng c\u00e1c m\u1ea3ng A\u03b2 c\u0169ng \u0111\u01b0\u1ee3c ghi nh\u1eadn t\u1ea1i nh\u1eefng v\u1ecb tr\u00ed kh\u00e1c trong c\u01a1 th\u1ec3, tuy nhi\u00ean ch\u00fang ch\u1ee7 y\u1ebfu t\u1eadp trung t\u1ea1i c\u00e1c v\u00f9ng c\u1ee7a n\u00e3o. Nh\u1eefng v\u00f9ng c\u1ee7a n\u00e3o c\u00f3 th\u1ec3 ghi nh\u1eadn th\u1ea5y s\u1ef1 t\u1eadp trung c\u1ee7a ch\u00fang bao g\u1ed3m h\u1ed3i h\u1ea3i m\u00e3, h\u1ea1ch h\u1ea1nh nh\u00e2n<\/a>, v\u1ecf n\u00e3o n\u1ed9i kh\u1ee9u (entorhinal cortex), n\u00e3o tr\u01b0\u1edbc. Do \u0111\u00f3 l\u00e0m \u1ea3nh h\u01b0\u1edfng t\u1edbi tr\u00ed nh\u1edb, h\u1ecdc t\u1eadp v\u00e0 c\u00e1c h\u00e0nh vi c\u1ea3m x\u00fac.<\/span><\/p>\n

C\u00e1c d\u1ea1ng c\u1ee7a b\u1ec7nh Alzheimer\u00a0<\/strong><\/p>\n

B\u1ec7nh Alzheimer c\u00f3 hai lo\u1ea1i:\u00a0<\/span><\/p>\n

B\u1ec7nh Alzheimer kh\u1edfi ph\u00e1t mu\u1ed9n (LOAD) <\/span><\/em><\/p>\n

D\u1ea1ng n\u00e0y c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 AD ng\u1eabu nhi\u00ean (sporadic type). Chi\u1ebfm h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p AD ghi nh\u1eadn \u0111\u01b0\u1ee3c, th\u01b0\u1eddng l\u00e0 kh\u1edfi ph\u00e1t mu\u1ed9n (\u2265 65 tu\u1ed5i) v\u1edbi c\u00e1c nguy\u00ean nh\u00e2n kh\u00f4ng r\u00f5 r\u00e0ng. \u0110\u1eb7c tr\u01b0ng b\u1edfi m\u1ed9t m\u00f4 h\u00ecnh y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111an xen gi\u1eefa c\u00e1c y\u1ebfu t\u1ed1 di truy\u1ec1n v\u00e0 kh\u00f4ng di truy\u1ec1n. M\u1ed7i gen y\u1ebfu t\u1ed1 nguy c\u01a1 n\u00e0y \u0111\u1ec1u \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ed9t ho\u1eb7c nhi\u1ec1u c\u01a1 ch\u1ebf g\u00e2y b\u1ec7nh \u0111\u00e3 bi\u1ebft: t\u0103ng s\u1ea3n xu\u1ea5t v\u00e0 t\u1eadp h\u1ee3p A\u03b2; gi\u1ea3m \u0111\u1ed9 thanh th\u1ea3i v\u00e0 tho\u00e1i h\u00f3a A\u03b2; t\u0103ng vi\u00eam; v\u00e0 kh\u00e1ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a \u03b3-secretase, v\u00e0 do \u0111\u00f3 d\u1eabn \u0111\u1ebfn tho\u00e1i h\u00f3a th\u1ea7n kinh \u1edf AD. Trong s\u1ed1 c\u00e1c gen nguy c\u01a1 n\u00e0y, \u0111\u1ed1i v\u1edbi APOE, c\u00e1c allele \u03b53 v\u00e0 \u03b54 \u0111\u00e3 cho th\u1ea5y c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c t\u0103ng nguy c\u01a1 AD. Bi\u1ebft r\u1eb1ng, APOE c\u00f3 vai tr\u00f2 ph\u00e1 h\u1ee7y c\u00e1c beta amyloid<\/span><\/p>\n

\u00a0B\u1ec7nh Alzheimer gia \u0111\u00ecnh kh\u1edfi ph\u00e1t s\u1edbm (EOFAD)<\/span><\/em><\/p>\n

Chi\u1ebfm kho\u1ea3ng 5 \u2013 15% c\u00e1c tr\u01b0\u1eddng h\u1ee3p, th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn c\u00e1c th\u1ec3 di truy\u1ec1n tr\u1ed9i v\u00e0 kh\u1edfi ph\u00e1t \u1edf \u0111\u1ed9 tu\u1ed5i s\u1edbm h\u01a1n. Type gia \u0111\u00ecnh c\u00f3 th\u1ec3 do nhi\u1ec1u \u0111\u1ed9t bi\u1ebfn gen g\u00e2y ra. Trong s\u1ed1 \u0111\u00f3 l\u00e0 \u0111\u1ed9t bi\u1ebfn \u1edf gene PSEN1 tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 14 ho\u1eb7c PSEN2 tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 1, m\u00e3 h\u00f3a presenilin 1 ho\u1eb7c 2 l\u00e0 th\u00e0nh ph\u1ea7n c\u1ee7a ph\u1ee9c h\u1ec7 protein gamma – secretase. C\u00e1c \u0111\u1ed9t bi\u1ebfn c\u00f3 th\u1ec3 l\u00e0m thay \u0111\u1ed5i v\u1ecb tr\u00ed c\u1eaft c\u1ee7a gamma -secretase tr\u00ean APP. C\u1ea3 hai d\u1ea1ng \u0111\u1ed9t bi\u1ebfn k\u1ec3 tr\u00ean \u0111\u1ec1u d\u1eabn \u0111\u1ebfn t\u0103ng t\u1ef7 l\u1ec7 A\u03b242\/A\u03b240. M\u1ed9t nguy\u00ean nh\u00e2n di truy\u1ec1n kh\u00e1c \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn \u1edf AD l\u00e0 trisomy 21 (\u1edf h\u1ed9i ch\u1ee9ng Down). Do l\u00e0m t\u0103ng s\u1ed1 b\u1ea3n sao c\u1ee7a APP, d\u1eabn \u0111\u1ebfn t\u1ea1o ra nhi\u1ec1u APP h\u01a1n.\u00a0<\/span><\/p>\n

\u00a04. D\u1ecbch t\u1ec5 h\u1ecdc<\/strong><\/h2>\n

N\u00f3i v\u1ec1 ch\u1ee9ng sa s\u00fat tr\u00ed tu\u1ec7 n\u00f3i chung, c\u1ee9 sau 3 gi\u00e2y th\u00ec tr\u00ean th\u1ebf gi\u1edbi l\u1ea1i c\u00f3 th\u00eam m\u1ed9t ng\u01b0\u1eddi m\u1eafc b\u1ec7nh<\/strong>. V\u00e0o n\u0103m 2020, c\u00f3 h\u01a1n 55 tri\u1ec7u ng\u01b0\u1eddi tr\u00ean to\u00e0n th\u1ebf gi\u1edbi \u0111ang s\u1ed1ng chung v\u1edbi ch\u1ee9ng sa s\u00fat tr\u00ed tu\u1ec7. Con s\u1ed1 n\u00e0y g\u1ea7n nh\u01b0 s\u1ebd t\u0103ng g\u1ea5p \u0111\u00f4i sau 20, \u0111\u1ea1t 78 tri\u1ec7u ng\u01b0\u1eddi v\u00e0o n\u0103m 2030 v\u00e0 139 tri\u1ec7u ng\u01b0\u1eddi v\u00e0o n\u0103m 2050. Ph\u1ea7n l\u1edbn s\u1ef1 gia t\u0103ng s\u1ebd l\u00e0 \u1edf c\u00e1c n\u01b0\u1edbc \u0111ang ph\u00e1t tri\u1ec3n. \u0110\u00e3 c\u00f3 60% ng\u01b0\u1eddi b\u1ecb sa s\u00fat tr\u00ed tu\u1ec7 s\u1ed1ng \u1edf c\u00e1c n\u01b0\u1edbc c\u00f3 thu nh\u1eadp th\u1ea5p v\u00e0 trung b\u00ecnh, nh\u01b0ng \u0111\u1ebfn n\u0103m 2050, con s\u1ed1 n\u00e0y s\u1ebd t\u0103ng l\u00ean 71%. T\u1ed1c \u0111\u1ed9 t\u0103ng d\u00e2n s\u1ed1 cao tu\u1ed5i nhanh nh\u1ea5t \u0111ang di\u1ec5n ra \u1edf Trung Qu\u1ed1c, \u1ea4n \u0110\u1ed9 v\u00e0 c\u00e1c n\u01b0\u1edbc xung quanh khu v\u1ef1c Nam \u00c1 v\u00e0 T\u00e2y Th\u00e1i B\u00ecnh D\u01b0\u01a1ng. <\/span><\/p>\n

V\u1ec1 b\u1ec7nh Alzheimer n\u00f3i ri\u00eang, \u0111\u00e2y l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y ra ch\u1ee9ng sa s\u00fat tr\u00ed tu\u1ec7<\/a> \u1edf ng\u01b0\u1eddi cao tu\u1ed5i, v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong \u0111\u1ee9ng h\u00e0ng th\u1ee9 5. B\u1ec7nh \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kho\u1ea3ng 44 tri\u1ec7u ng\u01b0\u1eddi tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. C\u00e1c nghi\u00ean c\u1ee9u d\u1ecbch t\u1ec5 h\u1ecdc g\u1ea7n \u0111\u00e2y cho th\u1ea5y t\u1ef7 l\u1ec7 m\u1eafc Alzheimer gi\u1ea3m, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch m\u1ed9t ph\u1ea7n l\u00e0 nh\u1edd s\u1ef1 ph\u00e1t tri\u1ec3n trong c\u00f4ng t\u00e1c ph\u00f2ng ng\u1eeba r\u1ee7i ro.<\/span><\/p>\n

5. Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/strong><\/h2>\n

5.1. Ch\u1ea9n \u0111o\u00e1n b\u1ec7nh Alzheimer<\/strong><\/h3>\n

C\u1ed9ng h\u01b0\u1edfng t\u1eeb (ch\u1ee5p MRI)<\/a> l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt t\u1ea1o h\u00ecnh c\u1eaft l\u1edbp s\u1eed d\u1ee5ng s\u00f3ng \u0111i\u1ec7n t\u1eeb tr\u01b0\u1eddng v\u00e0 s\u00f3ng radio. Khi c\u00e1c nguy\u00ean t\u1eed hydrogen trong c\u01a1 th\u1ec3 ng\u01b0\u1eddi d\u01b0\u1edbi t\u00e1c \u0111\u1ed9ng c\u1ee7a t\u1eeb tr\u01b0\u1eddng v\u00e0 s\u00f3ng radio, h\u1ea5p th\u1ee5 v\u00e0 ph\u00f3ng th\u00edch n\u0103ng l\u01b0\u1ee3ng RF (c\u00e1c m\u00f4 kh\u00e1c nhau s\u1ebd h\u1ea5p th\u1ee5 v\u00e0 ph\u00f3ng th\u00edch n\u0103ng l\u01b0\u1ee3ng kh\u00e1c nhau). Qu\u00e1 tr\u00ecnh ph\u00f3ng th\u00edch n\u0103ng l\u01b0\u1ee3ng \u0111\u01b0\u1ee3c m\u00e1y thu nh\u1eadn, x\u1eed l\u00fd v\u00e0 chuy\u1ec3n \u0111\u1ed1i th\u00e0nh c\u00e1c t\u00edn hi\u1ec7u h\u00ecnh \u1ea3nh.<\/span><\/p>\n

\u00a0H\u00ecnh \u1ea3nh c\u1ed9ng h\u01b0\u1edfng t\u1eeb MRI c\u00f3 \u0111\u1ed9 t\u01b0\u01a1ng ph\u1ea3n cao, s\u1eafc n\u00e9t v\u00e0 r\u00f5 r\u00e0ng, chi ti\u1ebft gi\u1ea3i ph\u1eabu t\u1ed1t v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng t\u00e1i t\u1ea1o 3D mang l\u1ea1i hi\u1ec7u qu\u1ea3 ch\u1ea9n \u0111o\u00e1n cho b\u00e1c s\u0129 \u0111\u1ed1i v\u1edbi b\u1ec7nh l\u00fd c\u1ee7a b\u1ec7nh nh\u00e2n.<\/span><\/p>\n

\u00a0MRI v\u1edbi \u01b0u th\u1ebf v\u1ec1 nhu m\u00f4 n\u00e3o v\u00e0 d\u1ecbch \u0111\u00e3 tr\u1edf th\u00e0nh ch\u1ec9 \u0111\u1ecbnh th\u01b0\u1eddng quy khi nghi ng\u1edd b\u1ec7nh Alzheimer. M\u1ee5c \u0111\u00edch MRI l\u00e0 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 teo n\u00e3o lan t\u1ecfa c\u1ee7a b\u1ec7nh Alzheimer, \u0111\u1eb7c bi\u1ec7t ph\u00e1t hi\u1ec7n teo th\u00f9y th\u00e1i d\u01b0\u01a1ng trong trong ch\u1ea9n \u0111o\u00e1n b\u1ec7nh giai \u0111o\u1ea1n s\u1edbm. C\u00e1c l\u00e1t c\u1eaft theo m\u1eb7t ph\u1eb3ng tr\u00e1n \u0111i qua h\u1ea3i m\u00e3 th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1.\u00a0<\/span><\/p>\n

\u1ede Vi\u1ec7t Nam, d\u1ef1 \u00e1n Brain Analytics \u0111\u00e3 ra \u0111\u1eddi v\u00e0o n\u0103m 2019. B\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng tr\u00ed tu\u1ec7 nh\u00e2n t\u1ea1o (AI), ph\u1ea7n m\u1ec1m c\u00f3 th\u1ec3 \u0111\u01b0a ra t\u1ef7 l\u1ec7 x\u00e1c su\u1ea5t m\u1eafc b\u1ec7nh, r\u00fat ng\u1eafn th\u1eddi gian ch\u1ea9n \u0111o\u00e1n b\u1ec7nh Alzheimer t\u1eeb 1 ti\u1ebfng ch\u1ec9 c\u00f2n kho\u1ea3ng 10 ph\u00fat.<\/span><\/p>\n

\u00a0D\u01b0\u1edbi \u0111\u00e2y l\u00e0 m\u1ed9t s\u1ed1 c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e3o c\u00f3 th\u1ec3 g\u1eb7p \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n Alzheimer:<\/span><\/p>\n

Teo v\u1ecf n\u00e3o<\/a>\u00a0<\/strong><\/p>\n

\u0110\u00e1nh gi\u00e1 teo v\u1ecf n\u00e3o to\u00e0n th\u1ec3 qua thang \u0111i\u1ec3m GCA<\/strong> (Global Cortical Atrophy scale hay Pasquier scale, \u0111\u1ed9 0-3). \u0110\u1ea1i \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n Alzheimer c\u00f3 teo v\u1ecf n\u00e3o to\u00e0n th\u1ec3 t\u1eeb m\u1ee9c \u0111\u1ed9 nh\u1eb9 \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 n\u1eb7ng (chi\u1ebfm 93.75%).<\/span><\/p>\n

Teo h\u1ed3i th\u00e1i d\u01b0\u01a1ng trong<\/strong><\/p>\n

\u00a0\u0110\u00e1nh gi\u00e1 b\u1eb1ng thang \u0111i\u1ec3m MTA<\/strong> (Medial Temporal Lobe Atrophy hay MTA scale, \u0111\u1ed9 0-4): Ph\u1ea7n l\u1edbn c\u00e1c b\u1ec7nh nh\u00e2n Alzheimer c\u00f3 t\u1ed5n th\u01b0\u01a1ng teo h\u1ed3i th\u00e1i d\u01b0\u01a1ng trong v\u1edbi nhi\u1ec1u m\u1ee9c \u0111\u1ed9, t\u1eeb m\u1edf r\u1ed9ng s\u1eebng th\u00e1i d\u01b0\u01a1ng v\u00e0 khe r\u00e3nh m\u1ea1ch m\u1ea1c \u0111\u1ebfn m\u1ea5t th\u1ec3 t\u00edch h\u1ea3i m\u00e3 m\u1ee9c \u0111\u1ed9 n\u1eb7ng (chi\u1ebfm t\u1edbi 87.5%).\u00a0<\/span><\/p>\n

T\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng\u00a0<\/strong><\/a><\/p>\n

\u0110\u00e1nh gi\u00e1 c\u00e1c t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng qua thang \u0111i\u1ec3m Fazekas (Fazekas scale, \u0111\u1ed9 0-3): Ch\u1ec9 c\u00f3 37.5% b\u1ec7nh nh\u00e2n Alzheimer c\u00f3 t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng b\u1ec7nh l\u00fd.<\/span><\/p>\n

Teo n\u00e3o v\u00f9ng \u0111\u1ec9nh<\/strong><\/p>\n

\u00a0\u0110\u00e1nh gi\u00e1 qua ch\u1ec9 s\u1ed1 Koedam (Koedam score, \u0111\u1ed9 0-3): \u0110a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n Alzheimer c\u00f3 teo n\u00e3o v\u00f9ng \u0111\u1ec9nh, chi\u1ebfm 81.25%.<\/span><\/p>\n

Hi\u1ec7n nay, c\u00f3 r\u1ea5t nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u1eb1m ph\u00e1t hi\u1ec7n nh\u1eefng bi\u1ebfn \u0111\u1ed5i b\u1ea5t th\u01b0\u1eddng trong c\u1ea5u tr\u00fac n\u00e3o c\u1ee7a b\u1ec7nh nh\u00e2n Alzheimer v\u1edbi m\u1ee5c \u0111\u00edch n\u00e2ng cao kh\u1ea3 n\u0103ng ch\u1ea9n \u0111o\u00e1n b\u1ec7nh.<\/span><\/p>\n

5.2. \u0110i\u1ec1u tr\u1ecb Alzheimer<\/strong><\/h3>\n

C\u00f3 th\u1ec3 k\u1ebft h\u1ee3p c\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p v\u00e0o m\u00f4i tr\u01b0\u1eddng v\u00e0 thu\u1ed1c:<\/span><\/p>\n