{"id":134234,"date":"2025-08-22T15:23:14","date_gmt":"2025-08-22T08:23:14","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=134234"},"modified":"2025-08-22T15:24:36","modified_gmt":"2025-08-22T08:24:36","slug":"dieu-bac-si-hoi-suc-cap-cuu-can-biet-ve-cmv-o-benh-nhan-suy-giam-mien-dich-tai-icu","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/dieu-bac-si-hoi-suc-cap-cuu-can-biet-ve-cmv-o-benh-nhan-suy-giam-mien-dich-tai-icu\/","title":{"rendered":"\u0110i\u1ec1u b\u00e1c s\u0129 h\u1ed3i s\u1ee9c c\u1ea5p c\u1ee9u c\u1ea7n bi\u1ebft v\u1ec1 CMV \u1edf b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch t\u1ea1i ICU"},"content":{"rendered":"

L\u01b0\u1ee3t d\u1ecbch: NT \u0397\u039d<\/strong><\/p>\n

T\u1ea3i PDF t\u1ea1i \u0111\u00e2y<\/a><\/strong><\/p>\n

Trong nh\u1eefng th\u1eadp k\u1ef7 g\u1ea7n \u0111\u00e2y, s\u1ed1 l\u01b0\u1ee3ng ng\u01b0\u1eddi b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch \u0111\u00e3 gia t\u0103ng do nh\u1eefng ti\u1ebfn b\u1ed9 trong \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch cho b\u1ec7nh ung th\u01b0 v\u00e0 b\u1ec7nh t\u1ef1 mi\u1ec5n, s\u1ef1 gia t\u0103ng s\u1ed1 ca gh\u00e9p t\u1ea1ng \u0111\u1eb7c, c\u0169ng nh\u01b0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u00e1c t\u00ednh. C\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng c\u01a1 h\u1ed9i l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y b\u1ec7nh t\u1eadt v\u00e0 t\u1eed vong \u1edf nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng n\u00e0y. Trong s\u1ed1 \u0111\u00f3, virus CMV l\u00e0 m\u1ed9t trong nh\u1eefng virus th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf b\u1ec7nh nh\u00e2n b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch qua trung gian t\u1ebf b\u00e0o, v\u00e0 khi lan r\u1ed9ng, virus n\u00e0y c\u00f3 th\u1ec3 g\u00e2y r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 quan v\u00e0 g\u00e2y t\u1eed vong.<\/p>\n

Ng\u00e0y c\u00e0ng c\u00f3 nhi\u1ec1u b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch nguy c\u01a1 cao \u0111\u01b0\u1ee3c nh\u1eadp v\u00e0o c\u00e1c \u0111\u01a1n v\u1ecb \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c (ICU), v\u00e0 vi\u1ec7c qu\u1ea3n l\u00fd CMV \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u1eb7t ra nhi\u1ec1u th\u00e1ch th\u1ee9c m\u00e0 b\u00e1c s\u0129 h\u1ed3i s\u1ee9c c\u1ea7n nh\u1eadn bi\u1ebft. T\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 quan li\u00ean quan \u0111\u1ebfn CMV c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n l\u00e0m cho b\u1ec7nh nh\u00e2n nh\u1eadp ICU ho\u1eb7c ti\u1ebfn tri\u1ec3n trong qu\u00e1 tr\u00ecnh n\u1eb1m vi\u1ec7n t\u1ea1i ICU, v\u00e0 th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn t\u1ef7 l\u1ec7 t\u1eed vong cao. H\u01a1n n\u1eefa, CMV kh\u00f4ng ch\u1ec9 g\u00e2y t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp l\u00ean t\u1ebf b\u00e0o, m\u00e0 c\u00f2n c\u00f3 t\u00e1c \u0111\u1ed9ng gi\u00e1n ti\u1ebfp l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t do c\u00e1c m\u1ea7m b\u1ec7nh kh\u00e1c v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n \u0111e d\u1ecda t\u00ednh m\u1ea1ng kh\u00e1c nh\u01b0 b\u1ec7nh huy\u1ebft kh\u1ed1i vi m\u1ea1ch. Vi\u1ec7c hi\u1ec3u r\u00f5 c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a nhi\u1ec5m CMV \u1edf b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch \u0111ang trong t\u00ecnh tr\u1ea1ng nguy k\u1ecbch l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 l\u1ef1a ch\u1ecdn x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n ph\u00f9 h\u1ee3p v\u00e0 b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. C\u00e1c bi\u1ec3u hi\u1ec7n n\u00e0y kh\u00e1c nhau t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch n\u1ec1n. Tuy nhi\u00ean, b\u1ec7nh nh\u00e2n nguy k\u1ecbch th\u01b0\u1eddng c\u00f3 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd ph\u1ee9c t\u1ea1p, khi\u1ebfn vi\u1ec7c x\u00e1c \u0111\u1ecbnh c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u l\u00e0 do nhi\u1ec5m CMV hay do nguy\u00ean nh\u00e2n kh\u00e1c tr\u1edf n\u00ean kh\u00f3 kh\u0103n. Th\u00eam v\u00e0o \u0111\u00f3, m\u1eb7c d\u00f9 x\u00e9t nghi\u1ec7m PCR d\u1ecbch c\u01a1 th\u1ec3 c\u00f3 th\u1ec3 cho k\u1ebft qu\u1ea3 nhanh ch\u00f3ng v\u00e0 ch\u00ednh x\u00e1c, nh\u01b0ng l\u1ea1i kh\u00f4ng ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c r\u00f5 r\u00e0ng gi\u1eefa nhi\u1ec5m CMV v\u00e0 b\u1ec7nh CMV (s\u1ef1 x\u00e2m l\u1ea5n virus \u0111ang sao ch\u00e9p v\u00e0o m\u00f4).<\/p>\n

Nhi\u1ec5m CMV \u1edf b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch trong t\u00ecnh tr\u1ea1ng nguy k\u1ecbch v\u00ec v\u1eady \u0111\u1eb7t ra th\u00e1ch th\u1ee9c l\u1edbn \u0111\u1ed1i v\u1edbi b\u00e1c s\u0129 h\u1ed3i s\u1ee9c.<\/p>\n

Sinh l\u00fd b\u1ec7nh c\u1ee7a nhi\u1ec5m CMV<\/h2>\n
CMV l\u00e0 m\u1ed9t lo\u1ea1i virus DNA s\u1ee3i k\u00e9p thu\u1ed9c h\u1ecd beta-herpesvirus \u1edf ng\u01b0\u1eddi (HHV-5) v\u00e0 c\u00f3 t\u00ednh \u0111\u1eb7c hi\u1ec7u lo\u00e0i r\u1ea5t cao. Virus n\u00e0y l\u00e2y truy\u1ec1n qua n\u01b0\u1edbc b\u1ecdt, quan h\u1ec7 t\u00ecnh d\u1ee5c, truy\u1ec1n qua nhau thai, cho con b\u00fa, truy\u1ec1n m\u00e1u, gh\u00e9p t\u1ea1ng, gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c t\u1ea1o m\u00e1u. CMV ch\u1ee7 y\u1ebfu nhi\u1ec5m v\u00e0o t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 c\u00e1c tuy\u1ebfn v\u00e0 ni\u00eam m\u1ea1c, v\u00e0 virus c\u00f3 th\u1ec3 v\u1eabn \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n trong d\u1ecbch ti\u1ebft m\u1ed9t th\u1eddi gian sau khi nhi\u1ec5m. Ngo\u00e0i ra, CMV c\u0169ng c\u00f3 th\u1ec3 nhi\u1ec5m v\u00e0o c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4, nguy\u00ean b\u00e0o s\u1ee3i v\u00e0 c\u00e1c t\u1ebf b\u00e0o chuy\u00ean bi\u1ec7t kh\u00e1c, d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 quan. C\u00e1c b\u1ea1ch c\u1ea7u mang virus v\u00e0 t\u1ebf b\u00e0o n\u1ed9i m\u00f4 l\u01b0u h\u00e0nh trong m\u00e1u gi\u00fap CMV lan r\u1ed9ng \u0111\u1ebfn nhi\u1ec1u c\u01a1 quan \u0111\u00edch.<\/p>\n
Nhi\u1ec5m CMV nguy\u00ean ph\u00e1t k\u00edch ho\u1ea1t nhi\u1ec1u ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch, t\u1eeb \u0111\u00f3 thi\u1ebft l\u1eadp kh\u1ea3 n\u0103ng mi\u1ec5n d\u1ecbch l\u00e2u d\u00e0i. M\u1ed9t \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch s\u1edbm, m\u1ea1nh m\u1ebd v\u00e0 \u0111\u1eb7c hi\u1ec7u v\u1edbi CMV c\u1ee7a t\u1ebf b\u00e0o T l\u00e0 y\u1ebfu t\u1ed1 then ch\u1ed1t \u0111\u1ec3 ki\u1ec3m so\u00e1t s\u1ef1 sao ch\u00e9p c\u1ee7a virus v\u00e0 ng\u0103n ng\u1eeba b\u1ec7nh CMV. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p suy gi\u1ea3m mi\u1ec5n d\u1ecbch t\u1ebf b\u00e0o nghi\u00eam tr\u1ecdng, CMV c\u00f3 th\u1ec3 t\u00e1i ho\u1ea1t \u0111\u1ed9ng v\u00e0 g\u00e2y b\u1ec7nh CMV n\u1eb7ng.<\/p>\n
C\u00e1c \u0111\u1ecbnh ngh\u0129a v\u1ec1 nhi\u1ec5m CMV v\u00e0 b\u1ec7nh CMV<\/h2>\n
Nhi\u1ec5m CMV: Ph\u00e2n l\u1eadp virus qua c\u1ea5y ho\u1eb7c ph\u00e1t hi\u1ec7n protein virus ho\u1eb7c acid nucleic trong b\u1ea5t k\u1ef3 d\u1ecbch c\u01a1 th\u1ec3 ho\u1eb7c m\u1eabu m\u00f4 n\u00e0o, b\u1ea5t k\u1ec3 c\u00f3 tri\u1ec7u ch\u1ee9ng hay kh\u00f4ng.<\/p>\n
Nhi\u1ec5m CMV nguy\u00ean ph\u00e1t: L\u1ea7n \u0111\u1ea7u ph\u00e1t hi\u1ec7n nhi\u1ec5m CMV \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng ph\u01a1i nhi\u1ec5m CMV tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n
Nhi\u1ec5m CMV t\u00e1i ph\u00e1t: Nhi\u1ec5m CMV m\u1edbi \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 b\u1eb1ng ch\u1ee9ng nhi\u1ec5m CMV tr\u01b0\u1edbc \u0111\u00f3 nh\u01b0ng kh\u00f4ng ph\u00e1t hi\u1ec7n virus trong \u00edt nh\u1ea5t 4 tu\u1ea7n li\u00ean ti\u1ebfp trong qu\u00e1 tr\u00ecnh theo d\u00f5i ch\u1ee7 \u0111\u1ed9ng.<\/p>\n
CMV t\u00e1i ho\u1ea1t \u0111\u1ed9ng: Nhi\u1ec5m CMV do c\u00f9ng ch\u1ee7ng virus \u0111\u00e3 g\u00e2y ra nhi\u1ec5m tr\u00f9ng ban \u0111\u1ea7u \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 huy\u1ebft thanh d\u01b0\u01a1ng t\u00ednh tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n
T\u00e1i nhi\u1ec5m CMV: Ph\u00e1t hi\u1ec7n m\u1ed9t ch\u1ee7ng CMV m\u1edbi kh\u00e1c bi\u1ec7t v\u1edbi ch\u1ee7ng \u0111\u00e3 g\u00e2y ra nhi\u1ec5m tr\u00f9ng ban \u0111\u1ea7u.<\/p>\n
Nhi\u1ec5m CMV dai d\u1eb3ng: S\u1ef1 t\u1ed3n t\u1ea1i ho\u1eb7c t\u0103ng h\u01a1n 1 log10 trong n\u1ed3ng \u0111\u1ed9 DNA CMV trong m\u00e1u (t\u1eeb t\u1ea3i l\u01b0\u1ee3ng virus \u0111\u1ec9nh trong tu\u1ea7n \u0111\u1ea7u ti\u00ean \u0111\u1ebfn t\u1ea3i l\u01b0\u1ee3ng virus \u0111\u1ec9nh sau \u2265 2 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng virus v\u1edbi li\u1ec1u th\u00edch h\u1ee3p).<\/p>\n
Nhi\u1ec5m CMV kh\u00e1ng tr\u1ecb: S\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a bi\u1ebfn \u0111\u1ed5i di truy\u1ec1n \u1edf virus l\u00e0m gi\u1ea3m \u0111\u1ed9 nh\u1ea1y \u0111\u1ed1i v\u1edbi m\u1ed9t ho\u1eb7c nhi\u1ec1u lo\u1ea1i thu\u1ed1c kh\u00e1ng virus.<\/p>\n
B\u1ec7nh CMV:<\/p>\n
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H\u1ed9i ch\u1ee9ng CMV: Ph\u00e1t hi\u1ec7n CMV trong m\u00e1u b\u1eb1ng c\u00e1ch ph\u00e2n l\u1eadp virus, nu\u00f4i c\u1ea5y nhanh, x\u00e9t nghi\u1ec7m kh\u00e1ng nguy\u00ean ho\u1eb7c acid nucleic + \u00edt nh\u1ea5t 2 trong c\u00e1c y\u1ebfu t\u1ed1 sau:\n
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S\u1ed1t \u2265 38\u00b0C \u00edt nh\u1ea5t 2 ng\u00e0y<\/li>\n
M\u1ec7t m\u1ecfi ho\u1eb7c u\u1ec3 o\u1ea3i m\u1edbi xu\u1ea5t hi\u1ec7n ho\u1eb7c t\u0103ng l\u00ean<\/li>\n
Gi\u1ea3m b\u1ea1ch c\u1ea7u ho\u1eb7c gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t trong 2 m\u1eabu x\u00e9t nghi\u1ec7m ri\u00eang bi\u1ec7t, c\u00e1ch nhau \u00edt nh\u1ea5t 24 gi\u1edd<\/li>\n
\u22655% lympho b\u1ea5t th\u01b0\u1eddng<\/li>\n
Gi\u1ea3m ti\u1ec3u c\u1ea7u<\/li>\n
T\u0103ng men AST ho\u1eb7c ALT l\u00ean g\u1ea5p \u0111\u00f4i gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng<\/li>\n<\/ol>\n<\/li>\n
CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch: Nhi\u1ec5m CMV x\u00e2m l\u1ea5n m\u00f4 g\u00e2y t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan tr\u1ef1c ti\u1ebfp \u0111\u01b0\u1ee3c ch\u1ee9ng minh b\u1eb1ng s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u1eb7c hi\u1ec7u c\u1ee7a c\u01a1 quan b\u1ecb t\u1ed5n th\u01b0\u01a1ng c\u00f9ng v\u1edbi vi\u1ec7c ph\u00e1t hi\u1ec7n CMV trong m\u00f4 qua c\u00e1c k\u1ef9 thu\u1eadt m\u00f4 b\u1ec7nh h\u1ecdc, mi\u1ec5n d\u1ecbch h\u00f3a m\u00f4 b\u1ec7nh h\u1ecdc, k\u1ef9 thu\u1eadt lai DNA, ph\u00e2n l\u1eadp virus ho\u1eb7c nu\u00f4i c\u1ea5y nhanh.<\/li>\n
B\u1ec7nh CMV dai d\u1eb3ng: Kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u c\u1ea3i thi\u1ec7n, t\u00ecnh tr\u1ea1ng c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng tr\u1edf n\u00ean n\u1eb7ng h\u01a1n ho\u1eb7c ti\u1ebfn tri\u1ec3n th\u00e0nh b\u1ec7nh l\u00fd c\u01a1 quan \u0111\u00edch sau \u00edt nh\u1ea5t 2 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng virus v\u1edbi li\u1ec1u th\u00edch h\u1ee3p.<\/li>\n<\/ul>\n
CMV t\u00e1i ho\u1ea1t h\u00f3a \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u1eb7ng kh\u00f4ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch<\/h2>\n
Nhi\u1ec1u nghi\u00ean c\u1ee9u trong nh\u1eefng th\u1eadp k\u1ef7 g\u1ea7n \u0111\u00e2y \u0111\u00e3 \u0111\u00e1nh gi\u00e1 s\u1ef1 t\u00e1i ho\u1ea1t \u0111\u1ed9ng c\u1ee7a CMV \u1edf b\u1ec7nh nh\u00e2n ICU, \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00ean \u0111\u1ebfn 30% nh\u1eefng ng\u01b0\u1eddi c\u00f3 huy\u1ebft thanh d\u01b0\u01a1ng t\u00ednh v\u1edbi CMV tr\u01b0\u1edbc \u0111\u00f3. Ph\u1ea7n l\u1edbn c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y ch\u1ec9 t\u1eadp trung v\u00e0o b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc \u0111\u00f3 c\u00f3 mi\u1ec5n d\u1ecbch b\u00ecnh th\u01b0\u1eddng, ng\u01b0\u1eddi ta cho r\u1eb1ng t\u00ecnh tr\u1ea1ng b\u1ec7nh n\u1eb7ng t\u1ea1o ra m\u1ed9t tr\u1ea1ng th\u00e1i thu\u1eadn l\u1ee3i c\u00f9ng v\u1edbi suy gi\u1ea3m mi\u1ec5n d\u1ecbch t\u1ebf b\u00e0o m\u1eafc ph\u1ea3i t\u1ea1i ICU, l\u00e0m t\u0103ng nguy c\u01a1 t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV. Nhi\u1ec5m tr\u00f9ng huy\u1ebft, h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh v\u00e0 Covid-19 n\u1eb7ng \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1. D\u1eef li\u1ec7u g\u1ea7n \u0111\u00e2y cho th\u1ea5y t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV trong m\u00e1u x\u1ea3y ra \u1edf 20% b\u1ec7nh nh\u00e2n Covid-19 nguy k\u1ecbch, t\u0103ng l\u00ean \u0111\u1ebfn 41.7% \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 vi\u00eam ph\u1ed5i do Aspergillus li\u00ean quan \u0111\u1ebfn Covid-19, trong \u0111\u00f3 suy gi\u1ea3m mi\u1ec5n d\u1ecbch t\u1eeb tr\u01b0\u1edbc khi nhi\u1ec5m Covid-19 l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 ch\u00ednh. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u kh\u00e1c ch\u1ec9 b\u00e1o c\u00e1o t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV ph\u1ed5i c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng \u1edf 6% b\u1ec7nh nh\u00e2n Covid-19 \u0111\u01b0\u1ee3c th\u1edf m\u00e1y. Hi\u1ec7n v\u1eabn ch\u01b0a hi\u1ec3u r\u00f5 li\u1ec7u t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y l\u00e0 do tr\u1ef1c ti\u1ebfp t\u00e1c \u0111\u1ed9ng c\u1ee7a virus Covid, c\u00e1c li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng hay do th\u1eddi gian th\u1edf m\u00e1y k\u00e9o d\u00e0i.<\/p>\n
C\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t, ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p \u0111\u00e3 li\u00ean k\u1ebft t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV v\u1edbi k\u1ebft c\u1ee5c x\u1ea5u h\u01a1n \u1edf b\u1ec7nh nh\u00e2n nguy k\u1ecbch, bao g\u1ed3m th\u1eddi gian th\u1edf m\u00e1y k\u00e9o d\u00e0i, th\u1eddi gian n\u1eb1m ICU l\u00e2u h\u01a1n v\u00e0 t\u1ef7 l\u1ec7 t\u1eeb vong cao h\u01a1n. C\u00e1c c\u01a1 ch\u1ebf \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t bao g\u1ed3m t\u00e1c \u0111\u1ed9ng g\u00e2y t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan c\u1ee7a CMV trong ph\u1ed5i, r\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a mi\u1ec5n d\u1ecbch do ph\u1ea3n \u1ee9ng CMV qu\u00e1 m\u1ee9c, v\u00e0 s\u1ef1 bi\u1ebfn \u0111\u1ed5i mi\u1ec5n d\u1ecbch do s\u1ef1 sao ch\u00e9p c\u1ee7a virus, l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t \u1edf b\u1ec7nh nh\u00e2n. Tuy nhi\u00ean, vai tr\u00f2 g\u00e2y b\u1ec7nh c\u1ee7a CMV trong nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y v\u1eabn c\u00f2n ch\u01b0a r\u00f5 r\u00e0ng; ba th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u00e3 kh\u00f4ng cho th\u1ea5y l\u1ee3i \u00edch l\u00e2m s\u00e0ng t\u1eeb vi\u1ec7c \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus d\u1ef1 ph\u00f2ng ho\u1eb7c can thi\u1ec7p s\u1edbm m\u1eb7c d\u00f9 c\u00f3 gi\u1ea3m t\u1ef7 l\u1ec7 t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y. H\u01a1n n\u1eefa, t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV c\u00f3 th\u1ec3 t\u1ef1 kh\u1ecfi trong v\u00f2ng 2-3 tu\u1ea7n, v\u1edbi b\u1eb1ng ch\u1ee9ng h\u1ea1n ch\u1ebf v\u1ec1 b\u1ec7nh CMV x\u00e2m l\u1ea5n c\u01a1 quan \u0111\u00edch trong c\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y.<\/p>\n
$\"B\u1ec7nh$
B\u1ec7nh sinh c\u1ee7a nhi\u1ec5m v\u00e0 t\u1ea3i ho\u1ea1t \u0111\u1ed9ng CMV. C\u00e1c t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 ni\u00eam m\u1ea1c v\u00e0 tuy\u1ec3n l\u00e0 \u0111\u00edch ch\u00ednh c\u1ee7a CMV. C\u00e1c b\u1ea1ch c\u1ea7u \u0111\u01b0\u1ee3c huy \u0111\u1ed9ng t\u1ea1i v\u1ecb tr\u00ed nhi\u1ec5m tr\u00f9ng ban \u0111\u1ea7u gi\u00fap CMV lan truy\u1ec1n qua \u0111\u01b0\u1eddng m\u00e1u \u0111\u1ebfn c\u00e1c c\u01a1 quan \u0111\u00edch. Ngo\u00e0i ra, c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 l\u01b0u h\u00e0nh trong m\u00e1u c\u0169ng \u0111\u00f3ng vai tr\u00f2 l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n v\u1eadn chuy\u1ec3n virus. Nhi\u1ec5m CMV nguy\u00ean ph\u00e1t k\u00edch ho\u1ea1t c\u00e1c ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch b\u1ea9m sinh v\u00e0 th\u00edch nghi \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 h\u1ec7 mi\u1ec5n d\u1ecbch b\u00ecnh th\u01b0\u1eddng. S\u1ef1 k\u00edch th\u00edch th\u1ee5 th\u1ec3 TLR b\u1edfi CMV k\u00edch ho\u1ea1t c\u00e1c con \u0111\u01b0\u1eddng truy\u1ec1n t\u00edn hi\u1ec7u g\u00e2y gi\u1ea3i ph\u00f3ng cytokine (vd, TNF-a, IFN-a\/\u1e9e) t\u1eeb c\u00e1c t\u1ebf b\u00e0o \u0111u\u00f4i gai v\u00e0 \u0111\u1ea1i th\u1ef1c b\u00e0o, qua \u0111\u00f3 k\u00edch ho\u1ea1t c\u00e1c t\u1ebf b\u00e0o NK cell \u0111\u1ec3 ti\u00eau di\u1ec7t t\u1ebf b\u00e0o nhi\u1ec5m virus. T\u1ebf b\u00e0o TCD4+ \u0111\u01b0\u1ee3c k\u00edch ho\u1ea1t qua ph\u1ee9c h\u1ee3p MHC class II, k\u00edch th\u00edch t\u1ebf b\u00e0o B s\u1ea3n xu\u1ea5t kh\u00e1ng th\u1ec3 \u0111\u1eb7c hi\u1ec7u v\u1edbi CMV, trong khi t\u1ebf b\u00e0o TCD8+ c\u00f3 t\u00e1c d\u1ee5ng ti\u00eau di\u1ec7t t\u1ebf b\u00e0o nhi\u1ec5m virus th\u00f4ng qua s\u1ef1 k\u00edch ho\u1ea1t c\u1ee7a MHC class I. Sau nhi\u1ec5m tr\u00f9ng ban \u0111\u1ea7u, CMV t\u1ed3n t\u1ea1i \u1edf tr\u1ea1ng th\u00e1i ti\u1ec1m \u1ea9n trong c\u00e1c t\u1ebf b\u00e0o ti\u1ec1n th\u00e2n t\u1ea1o m\u00e1u CD34+ v\u00e0 c\u00e1c t\u1ebf b\u00e0o mono CD14+, tr\u00e1nh \u0111\u01b0\u1ee3c s\u1ef1 nh\u1eadn di\u1ec7n c\u1ee7a h\u1ec7 mi\u1ec5n d\u1ecbch. S\u1ef1 bi\u1ec7t h\u00f3a c\u1ee7a c\u00e1c t\u1ebf b\u00e0o ti\u1ec1n th\u00e2n t\u1ea1o myeloid CD34+ th\u00e0nh t\u1ebf b\u00e0o \u0111u\u00f4i gai ho\u1eb7c \u0111\u1ea1i th\u1ef1c b\u00e0o d\u01b0\u1edbi t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c t\u00edn hi\u1ec7u cytokine vi\u00eam nh\u01b0 TNF-a ho\u1eb7c IFN-gama cho ph\u00e9p CMV t\u1ea3i pho\u1ea1t \u0111\u1ed9ng. \u1ede b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch v\u1edbi s\u1ef1 thi\u1ebfu h\u1ee5t mi\u1ec5n d\u1ecbch t\u1ebf b\u00e0o, m\u1ea5t c\u00e1c \u0111\u00e1p \u1ee9ng \u0111\u1eb7c hi\u1ec7u c\u1ee7a t\u1ebf b\u00e0o T d\u1eabn \u0111\u1ebfn s\u1ef1 sao ch\u00e9p CMV kh\u00f4ng ki\u1ec3m so\u00e1t qua s\u1ef1 t\u00e1i ho\u1ea1t \u0111\u1ed9ng ho\u1eb7c nhi\u1ec5m m\u1edbi, g\u00e2y lan truy\u1ec1n qua \u0111\u01b0\u1eddng m\u00e1u v\u00e0 ph\u00e1t tri\u1ec3n th\u00e0nh b\u1ec7nh l\u00fd tr\u00ean l\u00e2m s\u00e0ng.<\/figcaption><\/figure>\n
Nhi\u1ec5m CMV v\u00e0 b\u1ec7nh CMV \u1edf b\u1ec7nh nh\u00e2n nguy k\u1ecbch b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch<\/h2>\n
T\u1ef7 l\u1ec7<\/h3>\n
T\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV th\u01b0\u1eddng g\u1eb7p h\u01a1n v\u00e0 g\u00e2y h\u1ea1i nhi\u1ec1u h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch t\u1eeb tr\u01b0\u1edbc, nh\u1eefng ng\u01b0\u1eddi th\u01b0\u1eddng g\u1eb7p ph\u1ea3i t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan v\u00e0 b\u1ec7nh CMV x\u00e2m l\u1ea5n c\u01a1 quan \u0111\u00edch, c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n l\u00e0m cho b\u1ec7nh nh\u00e2n nh\u1eadp ICU ho\u1eb7c ph\u00e1t sinh trong qu\u00e1 tr\u00ecnh n\u1eb1m ICU. Tuy nhi\u00ean, d\u1eef li\u1ec7u c\u1ee5 th\u1ec3 v\u1ec1 b\u1ec7nh nh\u00e2n nh\u1eadp ICU v\u1edbi nhi\u1ec5m CMV v\u00e0 b\u1ec7nh CMV c\u00f2n h\u1ea1n ch\u1ebf, ph\u1ea7n l\u1edbn d\u1eef li\u1ec7u l\u00e2m s\u00e0ng v\u00e0 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb hi\u1ec7n nay \u0111\u1ec1u l\u1ea5y t\u1eeb m\u00f4i tr\u01b0\u1eddng ngo\u00e0i ICU.<\/p>\n
M\u1ed9t nghi\u00ean c\u1ee9u h\u1ed3i s\u1ee9c t\u1ea1i m\u1ed9t trung t\u00e2m tr\u00ean 178 b\u1ec7nh nh\u00e2n nguy k\u1ecbch m\u1eafc b\u1ec7nh \u00e1c t\u00ednh huy\u1ebft h\u1ecdc v\u00e0 c\u00f3 k\u1ebft qu\u1ea3 PCR CMV d\u01b0\u01a1ng t\u00ednh trong m\u00e1u v\u00e0\/ho\u1eb7c c\u00e1c d\u1ecbch c\u01a1 th\u1ec3 kh\u00e1c nhau trong th\u1eddi gian n\u1eb1m ICU cho th\u1ea5y 44 b\u1ec7nh nh\u00e2n (24.7%) ph\u00e1t tri\u1ec3n b\u1ec7nh CMV, trong \u0111\u00f3 m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p li\u00ean quan \u0111\u1ebfn nhi\u1ec1u c\u01a1 quan. B\u1ec7nh CMV c\u00f3 m\u1ed1i li\u00ean h\u1ec7 \u0111\u00e1ng k\u1ec3 v\u1edbi t\u1ea3i l\u01b0\u1ee3ng virus, gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c t\u1ea1o m\u00e1u v\u00e0 th\u1edf m\u00e1y, trong khi c\u1ea3 t\u1ea3i l\u01b0\u1ee3ng virus CMV v\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u1ec1u c\u00f3 li\u00ean quan \u0111\u1ed9c l\u1eadp \u0111\u1ebfn t\u1ef7 l\u1ec7 t\u1eed vong t\u1ea1i b\u1ec7nh vi\u1ec7n. Trong m\u1ed9t nghi\u00ean c\u1ee9u h\u1ed3i s\u1ee9c t\u01b0\u01a1ng t\u1ef1 bao g\u1ed3m 364 b\u1ec7nh nh\u00e2n huy\u1ebft h\u1ecdc n\u1eb1m ICU, 10.4% tr\u1ea3i qua t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV, v\u1edbi h\u01a1n m\u1ed9t n\u1eeda bi\u1ec3u hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan. M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c b\u00e1o c\u00e1o r\u1eb1ng t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV trong c\u00e1c m\u1eabu d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n ICU b\u1ecb vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng n\u1eb7ng v\u00e0 c\u00f3 suy gi\u1ea3m mi\u1ec5n d\u1ecbch tr\u01b0\u1edbc \u0111\u00f3 so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 mi\u1ec5n d\u1ecbch b\u00ecnh th\u01b0\u1eddng. H\u01a1n n\u1eefa, b\u1ec7nh \u00e1c t\u00ednh huy\u1ebft h\u1ecdc ho\u1eb7c gh\u00e9p t\u1ea1ng \u0111\u1eb7c tr\u01b0\u1edbc \u0111\u00f3 c\u00f3 li\u00ean quan \u0111\u1ed9c l\u1eadp \u0111\u1ebfn t\u00e1i ho\u1ea1t \u0111\u1ed9ng herpesvirus \u1edf b\u1ec7nh nh\u00e2n ICU n\u1eb7ng do covid-19. Nhi\u1ec5m CMV c\u00f3 tri\u1ec7u ch\u1ee9ng c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf 39.4% b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn trong th\u1eddi gian n\u1eb1m ICU.<\/p>\n
M\u1ed9t nghi\u00ean c\u1ee9u \u0111a trung t\u00e2m g\u1ea7n \u0111\u00e2y \u0111\u00e3 x\u00e1c \u0111\u1ecbnh vi\u00eam ph\u1ed5i do CMV l\u00e0 m\u1ed9t d\u1ea1ng b\u1ec7nh CMV x\u00e2m l\u1ea5n c\u01a1 quan \u0111\u00edch, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf b\u1ec7nh nh\u00e2n ICU suy gi\u1ea3m mi\u1ec5n d\u1ecbch (62%), ti\u1ebfp theo l\u00e0 b\u1ec7nh l\u00fd \u0111\u01b0\u1eddng ti\u00eau h\u00f3a (34.6%), v\u1edbi g\u1ea7n 10% b\u1ec7nh nh\u00e2n b\u1ecb t\u1ed5n th\u01b0\u01a1ng \u0111a c\u01a1 quan. Hai ph\u1ea7n ba s\u1ed1 b\u1ec7nh nh\u00e2n n\u00e0y c\u1ea7n s\u1eed d\u1ee5ng thu\u1ed1c v\u1eadn m\u1ea1ch v\u00e0 th\u1edf m\u00e1y x\u00e2m nh\u1eadp, v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong l\u00ean \u0111\u1ebfn 60%, thay \u0111\u1ed5i t\u00f9y theo nguy\u00ean nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch v\u00e0 c\u01a1 quan b\u1ecb \u1ea3nh h\u01b0\u1edfng. M\u1eb7c d\u00f9 vi\u1ec7c x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c t\u00e1c \u0111\u1ed9ng c\u1ee7a CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch l\u00ean k\u1ebft qu\u1ea3 l\u00e2m s\u00e0ng l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9 do th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi c\u00e1c t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd kh\u00e1c, CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch th\u01b0\u1eddng ph\u1ea3n \u00e1nh s\u1ef1 thi\u1ebfu t\u1ee5t t\u1ebf b\u00e0o T ti\u1ec1m \u1ea9n, g\u00f3p ph\u1ea7n l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong trong nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n
B\u1ec7nh l\u00fd \u00e1c t\u00ednh huy\u1ebft h\u1ecdc<\/h3>\n
Gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c t\u1ea1o m\u00e1u (allogenic HSCT) v\u1eabn l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 ch\u00ednh \u0111\u1ed1i v\u1edbi nhi\u1ec5m CMV. M\u1ee9c \u0111\u1ed9 nguy c\u01a1 thay \u0111\u1ed5i t\u00f9y theo c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c nhau, ch\u1eb3ng h\u1ea1n nh\u01b0 t\u00ecnh tr\u1ea1ng huy\u1ebft thanh h\u1ecdc, v\u1edbi nguy c\u01a1 th\u1ea5p nh\u1ea5t \u1edf c\u00e1c c\u1eb7p ng\u01b0\u1eddi hi\u1ebfn v\u00e0 ng\u01b0\u1eddi nh\u1eadn \u0111\u1ec1u \u00e2m t\u00ednh, v\u00e0 nguy c\u01a1 cao nh\u1ea5t l\u00e0 \u1edf ng\u01b0\u1eddi nh\u1eadn d\u01b0\u01a1ng t\u00ednh, v\u1edbi t\u1ef7 l\u1ec7 nhi\u1ec5m v\u00e0 m\u1eafc b\u1ec7nh CMV l\u1ea7n l\u01b0\u1ee3t t\u1edbi 35% v\u00e0 5%. Gh\u00e9p m\u00e1u cu\u1ed1ng r\u1ed1n l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m CMV so v\u1edbi c\u00e1c ngu\u1ed3n t\u1ebf b\u00e0o g\u1ed1c kh\u00e1c, trong khi t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh CMV l\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng gi\u1eefa ng\u01b0\u1eddi hi\u1ebfn t\u1ea1ng haploidentical v\u00e0 ng\u01b0\u1eddi hi\u1ebfn ph\u00f9 h\u1ee3p HLA, c\u0169ng nh\u01b0 kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ti\u1ec1n gh\u00e9p t\u1ee7y c\u00f3 ho\u1eb7c kh\u00f4ng tri\u1ec7t ti\u00eau t\u1ee7y. Vi\u1ec7c s\u1eed d\u1ee5ng corticosteroid \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng sau HSCT c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 nhi\u1ec5m CMV cao nh\u1ea5t.<\/p>\n
C\u00e1c li\u1ec7u ph\u00e1p d\u1ef1 ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm \u0111\u00e3 l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh CMV t\u1eeb 20% – 30% xu\u1ed1ng c\u00f2n d\u01b0\u1edbi 5% – 10% trong v\u00f2ng 100 ng\u00e0y \u0111\u1ea7u sau gh\u00e9p. Tuy nhi\u00ean, b\u1ec7nh CMV kh\u1edfi ph\u00e1t mu\u1ed9n \u0111ang ng\u00e0y c\u00e0ng tr\u1edf n\u00ean th\u01b0\u1eddng g\u1eb7p h\u01a1n. B\u1ec7nh l\u00fd \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u1eabn th\u01b0\u1eddng g\u1eb7p \u1edf giai \u0111o\u1ea1n s\u1edbm, trong khi vi\u00eam ph\u1ed5i chi\u1ebfm \u01b0u th\u1ebf trong c\u00e1c bi\u1ec3u hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u1edf giai \u0111o\u1ea1n mu\u1ed9n. C\u00e1c nghi\u00ean c\u1ee9u t\u1ea1i ICU b\u00e1o c\u00e1o t\u1ef7 l\u1ec7 t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV \u1edf 7-15% b\u1ec7nh nh\u00e2n gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c t\u1ea1o m\u00e1u d\u1ecb gen (HSCT), v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong cao h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV so v\u1edbi nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng t\u00e1i ho\u1ea1t \u0111\u1ed9ng. Ngo\u00e0i ra, HSCT \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9c l\u1eadp \u0111\u1ed1i v\u1edbi CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong cao \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nguy k\u1ecbch m\u1eafc c\u00e1c b\u1ec7nh \u00e1c t\u00ednh huy\u1ebft h\u1ecdc.<\/p>\n
\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c t\u1ef1 th\u00e2n, t\u1ef7 l\u1ec7 nhi\u1ec5m CMV t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi nh\u1eefng ng\u01b0\u1eddi gh\u00e9p d\u1ecb gen (30-50% \u1edf b\u1ec7nh nh\u00e2n d\u01b0\u01a1ng t\u00ednh huy\u1ebft thanh), m\u1eb7c d\u00f9 b\u1ec7nh CMV v\u1eabn hi\u1ebfm g\u1eb7p (< 1%). M\u1ed9t s\u1ed1 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb v\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng t\u1ebf b\u00e0o g\u1ed1c CD34+ \u0111\u01b0\u1ee3c ch\u1ecdn l\u1ecdc \u0111\u00e3 c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 cao h\u01a1n c\u1ee7a t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/p>\n
B\u1ec7nh nh\u00e2n m\u1eafc c\u00e1c b\u1ec7nh \u00e1c t\u00ednh huy\u1ebft h\u1ecdc nh\u01b0ng kh\u00f4ng gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c c\u0169ng c\u00f3 nguy c\u01a1 cao nhi\u1ec5m v\u00e0 m\u1eafc b\u1ec7nh CMV, do t\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch g\u00e2y ra b\u1edfi ch\u00ednh kh\u1ed1i u \u00e1c t\u00ednh ho\u1eb7c b\u1edfi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb. Thu\u1ed1c alemtuzumab v\u00e0 c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf PI3K nh\u01b0 idelalisib c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 cao nhi\u1ec5m CMV \u1edf b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh b\u1ea1ch c\u1ea7u lympho m\u1ea1n t\u00ednh, v\u1edbi t\u1ef7 l\u1ec7 nhi\u1ec5m l\u1ea7n l\u01b0\u1ee3t l\u00e0 4-29% v\u00e0 6%. Nhi\u1ec5m CMV c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng rituximab, m\u1eb7c d\u00f9 th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c l\u00e0m suy gi\u1ea3m t\u1ebf b\u00e0o T kh\u00e1c. B\u1ec7nh CMV c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p CAR-T cell.<\/p>\n
\u1ede b\u1ec7nh nh\u00e2n nguy k\u1ecbch m\u1eafc b\u1ec7nh \u00e1c t\u00ednh huy\u1ebft h\u1ecdc, t\u1ef7 l\u1ec7 t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV dao \u0111\u1ed9ng t\u1eeb 9-13%, nguy nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y vi\u00eam ph\u1ed5i CMV v\u00e0 b\u1ec7nh CMV lan t\u1ecfa, \u0111\u1ed3ng th\u1eddi l\u00e0 nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong cao nh\u1ea5t.<\/p>\n
B\u1ec7nh l\u00fd \u00e1c t\u00ednh<\/h3>\n
H\u00f3a tr\u1ecb \u1ee9c ch\u1ebf t\u1ebf b\u00e0o th\u01b0\u1eddng g\u00e2y suy gi\u1ea3m t\u1ebf b\u00e0o lympho v\u00e0 t\u1ebf b\u00e0o NK cell, trong khi m\u00f4i tr\u01b0\u1eddng vi m\u00f4 c\u1ee7a kh\u1ed1i u mang t\u00ednh \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch c\u00e0ng l\u00e0m suy gi\u1ea3m th\u00eam ch\u1ee9c n\u0103ng c\u1ee7a mi\u1ec5n d\u1ecbch t\u1ebf b\u00e0o. M\u1eb7c d\u00f9 c\u00f3 nh\u1eefng y\u1ebfu t\u1ed1 n\u00e0y, b\u1ec7nh CMV v\u1eabn hi\u1ebfm g\u1eb7p \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y, chi\u1ebfm d\u01b0\u1edbi 10% s\u1ed1 b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch nh\u1eadp ICU v\u1edbi b\u1ec7nh CMV x\u00e2m l\u1ea5n c\u01a1 quan \u0111\u00edch. Tuy nhi\u00ean, s\u1ef1 gia t\u0103ng t\u1ef7 l\u1ec7 m\u1eafc ung th\u01b0 c\u00f9ng v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch v\u00e0 c\u00e1c li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u00edch c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m v\u00e0 m\u1eafc b\u1ec7nh CMV trong nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng n\u00e0y.<\/p>\n
B\u1ec7nh nh\u00e2n gh\u00e9p t\u1ea1ng \u0111\u1eb7c<\/h3>\n
CMV l\u00e0 m\u1ed9t nguy c\u01a1 \u0111\u00e1ng k\u1ec3 sau gh\u00e9p t\u1ea1ng \u0111\u1eb7c, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng ng\u01b0\u1eddi nh\u1eadn \u00e2m t\u00ednh huy\u1ebft thanh t\u1eeb ng\u01b0\u1eddi hi\u1ebfn d\u01b0\u01a1ng t\u00ednh, trong khi ng\u01b0\u1eddi nh\u1eadn d\u01b0\u01a1ng t\u00ednh c\u00f3 nguy c\u01a1 trung b\u00ecnh v\u00e0 c\u00e1c c\u1eb7p ng\u01b0\u1eddi hi\u1ebfn-nh\u1eadn \u0111\u1ec1u \u00e2m t\u00ednh c\u00f3 nguy c\u01a1 th\u1ea5p nh\u1ea5t. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb ti\u1ec1n tri\u1ec7u ch\u1ee9ng \u0111\u00e3 l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh CMV xu\u1ed1ng c\u00f2n 10-30% \u1edf nh\u00f3m nguy c\u01a1 cao v\u00e0 5-15% \u1edf nh\u00f3m nguy c\u01a1 trung b\u00ecnh, v\u1edbi s\u1ef1 thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 t\u00f9y theo lo\u1ea1i c\u01a1 quan \u0111\u01b0\u1ee3c gh\u00e9p. Tuy nhi\u00ean, b\u1ec7nh CMV kh\u1edfi ph\u00e1t mu\u1ed9n ng\u00e0y c\u00e0ng th\u01b0\u1eddng g\u1eb7p h\u01a1n, th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n 3-6 th\u00e1ng sau khi k\u1ebft th\u00fac giai \u0111o\u1ea1n d\u1ef1 ph\u00f2ng.<\/p>\n
C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 ch\u00ednh \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p t\u1ea1ng \u0111\u1eb7c bao g\u1ed3m th\u1ea3i gh\u00e9p, \u0111i\u1ec1u tr\u1ecb l\u00e0m suy gi\u1ea3m t\u1ebf b\u00e0o lympho nh\u01b0 alemtuzumab, ho\u1eb7c s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch li\u1ec1u cao k\u00e9o d\u00e0i, trong khi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mTQR l\u1ea1i c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 nhi\u1ec5m CMV th\u1ea5p h\u01a1n.<\/p>\n
\u1ede b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn nh\u1eadp ICU, t\u1ef7 l\u1ec7 nhi\u1ec5m CMV c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00ean \u0111\u1ebfn 39.4% v\u1edbi vi\u1ec7c s\u1eedd\u1ee5ng thymoglobulin v\u00e0 th\u1eddi \u0111i\u1ec3m xu\u1ea5t hi\u1ec7n trong v\u00f2ng 6 th\u00e1ng \u0111\u1ea7u sau gh\u00e9p l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 ch\u00ednh ph\u00e1t tri\u1ec3n b\u1ec7nh CMV.<\/p>\n
Khi b\u1ec7nh CMV x\u00e2m l\u1ea5n c\u01a1 quan \u0111\u00edch, m\u1eb7c d\u00f9 t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng ti\u00eau l\u00e0 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, nh\u01b0ng gh\u00e9p t\u1ea1ng \u0111\u1eb7c l\u00e0 nguy\u00ean nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch th\u01b0\u1eddng g\u1eb7p th\u1ee9 hai \u1edf b\u1ec7nh nh\u00e2n nguy k\u1ecbch m\u1eafc vi\u00eam ph\u1ed5i CMV, v\u00e0 \u0111\u00e3 c\u00f3 t\u1ef7 l\u1ec7 b\u00e1o c\u00e1o cao (55%) v\u1ec1 ph\u00e2n l\u1eadp CMV t\u1eeb m\u1eabu d\u1ecbch h\u00f4 h\u1ea5p \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn trong ICU c\u00f3 bi\u1ebfn ch\u1ee9ng nhi\u1ec5m tr\u00f9ng.<\/p>\n
Nhi\u1ec5m HIV<\/h3>\n
B\u1ec7nh do CMV li\u00ean quan \u0111\u1ebfn nhi\u1ec5m HIV x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch n\u1eb7ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o T CD4+ \u2264 50\/mm\u00b3. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, t\u00e1i ho\u1ea1t \u0111\u1ed9ng c\u1ee7a virus l\u00e0 c\u01a1 ch\u1ebf ch\u00ednh. T\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh do CMV c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u1edf ng\u01b0\u1eddi s\u1ed1ng chung v\u1edbi HIV \u0111\u00e3 gi\u1ea3m t\u1eeb 20% xu\u1ed1ng c\u00f2n 3-5% sau khi \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng virus v\u00e0 hi\u1ec7n nay b\u1ec7nh n\u00e0y r\u1ea5t hi\u1ebfm g\u1eb7p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c s\u1ef1 nh\u00e2n l\u00ean c\u1ee7a HIV. Tuy nhi\u00ean, t\u1ea1i nh\u1eefng khu v\u1ef1c c\u00f3 kh\u1ea3 n\u0103ng ti\u1ebfp c\u1eadn ART h\u1ea1n ch\u1ebf, CMV v\u1eabn l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y b\u1ec7nh t\u1eadt v\u00e0 t\u1eed vong. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng corticosteroid, ch\u1eb3ng h\u1ea1n trong vi\u00eam ph\u1ed5i do Pneumocystic, l\u00e0m t\u0103ng nguy c\u01a1 t\u00e1i ho\u1ea1t \u0111\u1ed9ng c\u1ee7a CMV.<\/p>\n
Kho\u1ea3ng 30-35% ng\u01b0\u1eddi s\u1ed1ng chung v\u1edbi HIV c\u00f3 s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o TCD4 < 100\/mm\u00b3 c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c DNA CMV trong m\u00e1u. C\u00e1c nghi\u00ean c\u1ee9u t\u1ea1i khoa ICU \u0111\u00e3 b\u00e1o c\u00e1o t\u1ef7 l\u1ec7 th\u1eadm ch\u00ed c\u00f2n cao h\u01a1n v\u00e0 x\u00e1c \u0111\u1ecbnh nhi\u1ec5m CMV l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9c l\u1eadp \u0111\u1ed1i v\u1edbi t\u1eed vong trong b\u1ec7nh vi\u1ec7n \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y. Tuy nhi\u00ean, kh\u00f4ng khuy\u1ebfn c\u00e1o d\u1ef1 ph\u00f2ng th\u01b0\u1eddng quy v\u00ec s\u1ef1 h\u1ed3i ph\u1ee5c mi\u1ec5n d\u1ecbch do ART gi\u00fap ki\u1ec3m so\u00e1t t\u00ecnh tr\u1ea1ng c\u00f3 DNA CMV trong m\u00e1u. Vi\u00eam v\u00f5ng m\u1ea1c l\u00e0 b\u1ec7nh CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch th\u01b0\u1eddng g\u1eb7p nh\u1ea5t (chi\u1ebfm 85% c\u00e1c tr\u01b0\u1eddng h\u1ee3p), ti\u1ebfp theo l\u00e0 c\u00e1c b\u1ec7nh l\u00fd \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Vi\u00eam ph\u1ed5i do CMV hi\u1ebfm g\u1eb7p, m\u1eb7c d\u00f9 virus n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n trong c\u00e1c m\u1eabu d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n \u2013 ph\u1ebf nang (BAL), th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi c\u00e1c vi sinh v\u1eadt c\u01a1 h\u1ed9i kh\u00e1c \u2013 nh\u1eefng t\u00e1c nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng cao h\u01a1n g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p. Tuy nhi\u00ean, xu\u1ea5t huy\u1ebft ph\u1ebf nang li\u00ean quan \u0111\u1ebfn CMV \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o TCD4+ < 50\/mm\u00b3.<\/p>\n
C\u00f3 t\u1edbi m\u1ed9t ph\u1ea7n ba ng\u01b0\u1eddi s\u1ed1ng chung v\u1edbi HIV b\u1ecb nhi\u1ec5m CMV c\u00f3 tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 c\u1ea7n nh\u1eadp khoa ICU ch\u1ee7 y\u1ebfu do c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p ho\u1eb7c th\u1ea7n kinh li\u00ean quan \u0111\u1ebfn CMV. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, t\u1ef7 l\u1ec7 t\u1eed vong c\u00f3 th\u1ec3 l\u00ean t\u1edbi 47%, v\u00e0 vi\u1ec7c ph\u1ea3i th\u1edf m\u00e1y l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9c l\u1eadp \u0111\u1ed1i v\u1edbi t\u1eed vong trong v\u00f2ng 30 ng\u00e0y.<\/p>\n
Thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch<\/h3>\n
\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc c\u00e1c b\u1ec7nh l\u00fd h\u1ec7 th\u1ed1ng, t\u1ef7 l\u1ec7 nhi\u1ec5m CMV th\u1ea5p (2%), nh\u01b0ng t\u0103ng m\u1ea1nh (l\u00ean \u0111\u1ebfn 40%) \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb t\u1ea5n c\u00f4ng (v\u1edbi corticosteroid li\u1ec1u cao ho\u1eb7c k\u00e9o d\u00e0i [> 0.5 mg\/kg\/ng\u00e0y], bao g\u1ed3m c\u1ea3 methylprednisolone truy\u1ec1n t\u0129nh m\u1ea1ch li\u1ec1u cao, v\u00e0\/ho\u1eb7c c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch nh\u01b0 cyclophosphamide, mycophenolate v\u00e0\/ho\u1eb7c azathioprine. Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng l\u00e0 b\u1ec7nh n\u1ec1n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, ti\u1ebfp theo l\u00e0 vi\u00eam da c\u01a1 v\u00e0 vi\u00eam m\u1ea1ch. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u t\u1ea1i khoa ICU \u0111\u00e3 b\u00e1o c\u00e1o v\u1ec1 vi\u1ec7c ph\u00e1t hi\u1ec7n CMV trong \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p \u1edf 23% b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh l\u00fd th\u1ea5p \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng corticosteroid v\u00e0 b\u1ecb suy h\u00f4 h\u1ea5p c\u1ea5p; tuy nhi\u00ean, s\u1ef1 hi\u1ec7n di\u1ec7n th\u01b0\u1eddng g\u1eb7p c\u1ee7a P. jirovecii trong m\u1eabu b\u1ec7nh ph\u1ea9m \u0111\u00f3 khi\u1ebfn vi\u1ec7c x\u00e1c \u0111\u1ecbnh vai tr\u00f2 g\u00e2y b\u1ec7nh c\u1ee7a CMV g\u1eb7p nhi\u1ec1u kh\u00f3 kh\u0103n.<\/p>\n
B\u1ec7nh ru\u1ed9t vi\u00eam (IBD), \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ng\u01b0\u1eddi \u0111i\u1ec1u tr\u1ecb vi\u00eam lo\u00e9t \u0111\u1ea1i tr\u00e0ng kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi corticosteroid, c\u00f3 t\u1ef7 l\u1ec7 t\u00e1i ho\u1ea1t CMV \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a l\u00ean \u0111\u1ebfn 35%. Vi\u1ec7c ph\u00e2n bi\u1ec7t gi\u1eefa m\u1ed9t \u0111\u1ee3t b\u00f9ng ph\u00e1t c\u1ea5p t\u00ednh c\u1ee7a IBD v\u00e0 vi\u00eam \u0111\u1ea1i tr\u00e0ng do CMV c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c. Nh\u1eefng b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc \u0111\u00f3 c\u00f3 h\u1ec7 mi\u1ec5n d\u1ecbch b\u00ecnh th\u01b0\u1eddng, nh\u01b0ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng corticosteroid (li\u1ec1u cao ho\u1eb7c truy\u1ec1n t\u0129nh m\u1ea1ch) ho\u1eb7c c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c trong th\u1eddi gian d\u00e0i c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n t\u00ecnh tr\u1ea1ng t\u00e1i ho\u1ea1t CMV trong th\u1eddi gian n\u1eb1m ICU. Tuy nhi\u00ean, t\u1ef7 l\u1ec7 m\u1eafc CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 th\u1ec3 th\u1ea5p v\u00e0 ti\u00ean l\u01b0\u1ee3ng th\u01b0\u1eddng t\u1ed1t h\u01a1n so v\u1edbi nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh \u00e1c t\u00ednh ho\u1eb7c \u0111\u00e3 gh\u00e9p t\u1ea1ng.<\/p>\n
Suy gi\u1ea3m mi\u1ec5n d\u1ecbch nguy\u00ean ph\u00e1t<\/h3>\n
B\u1ec7nh do CMV \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc c\u00e1c d\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch ti\u00ean ph\u00e1t li\u00ean quan \u0111\u1ebfn t\u1ebf b\u00e0o T, c\u00f3 th\u1ec3 k\u00e8m theo ho\u1eb7c kh\u00f4ng k\u00e8m theo khi\u1ebfm khuy\u1ebft t\u1ebf b\u00e0o NK, bao g\u1ed3m nhi\u1ec1u d\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch k\u1ebft h\u1ee3p. M\u1eb7c d\u00f9 h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p x\u1ea3y ra \u1edf tr\u1ebb em, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u1edfi ph\u00e1t \u1edf ng\u01b0\u1eddi l\u1edbn v\u1edbi bi\u1ec3u hi\u1ec7n \u0111\u1ea7u ti\u00ean l\u00e0 do b\u1ec7nh CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o. Do \u0111\u00f3, nh\u1eefng ng\u01b0\u1eddi l\u1edbn b\u1ecb b\u1ec7nh CMV n\u1eb7ng m\u00e0 kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n, suy gi\u1ea3m mi\u1ec5n d\u1ecbch n\u00ean \u0111\u01b0\u1ee3c kh\u1ea3o s\u00e1t \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch ti\u00ean ph\u00e1t. D\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch ti\u00ean ph\u00e1t th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf ng\u01b0\u1eddi l\u1edbn l\u00e0 CVID, \u0111\u1eb7c tr\u01b0ng v\u1edbi s\u1ef1 suy gi\u1ea3m s\u1ea3n xu\u1ea5t globulin mi\u1ec5n d\u1ecbch. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n CVID c\u0169ng c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n m\u1ee9c \u0111\u1ed9 n\u00e0o \u0111\u00f3 c\u1ee7a suy gi\u1ea3m mi\u1ec5n d\u1ecbch t\u1ebf b\u00e0o, v\u1edbi t\u1ef7 l\u1ec7 m\u1eafc h\u1ed9i ch\u1ee9ng CMV ho\u1eb7c CMV c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch l\u00e0 7.6%. Ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n CVID c\u0169ng m\u1eafc c\u00e1c r\u1ed1i lo\u1ea1n vi\u00eam ho\u1eb7c t\u1ef1 mi\u1ec5n, c\u1ea7n \u0111i\u1ec1u tr\u1ecb thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m ho\u1eb7c m\u1eafc b\u1ec7nh do CMV.<\/p>\n
Bi\u1ec3u hi\u1ec7n b\u1ec7nh CMV<\/h2>\n
Vi\u00eam ph\u1ed5i CMV<\/h3>\n
Vi\u00eam ph\u1ed5i CMV, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 vi\u00eam ph\u1ed5i do CMV, l\u00e0 d\u1ea1ng nghi\u00eam tr\u1ecdng nh\u1ea5t c\u1ee7a CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch, ch\u1ee7 y\u1ebfu \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn b\u1ec7nh nh\u00e2n gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c t\u1ea1o m\u00e1u v\u00e0 ng\u01b0\u1eddi nh\u1eadn gh\u00e9p ph\u1ed5i. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng th\u01b0\u1eddng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, c\u00e1c bi\u1ec3u hi\u1ec7n h\u00ecnh \u1ea3nh h\u1ecdc th\u01b0\u1eddng g\u1eb7p bao g\u1ed3m c\u00e1c v\u00f9ng k\u00ednh m\u1edd v\u00e0 c\u00e1c n\u1ed1t nh\u1ecf. Kho\u1ea3ng 50% c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ea7n ph\u1ea3i nh\u1eadp khoa ICU, v\u00e0 \u0111\u00e2y v\u1eabn l\u00e0 d\u1ea1ng CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch th\u01b0\u1eddng g\u1eb7p v\u00e0 nguy hi\u1ec3m nh\u1ea5t trong m\u00f4i tr\u01b0\u1eddng ICU. Kho\u1ea3ng m\u1ed9t ph\u1ea7n ba s\u1ed1 b\u1ec7nh nh\u00e2n n\u00e0y c\u1ea7n th\u1edf m\u00e1y x\u00e2m nh\u1eadp khi ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u n\u00e0y l\u00e0m t\u0103ng nguy c\u01a1 t\u1eed vong m\u1ed9t c\u00e1ch \u0111\u1ed9c l\u1eadp, v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong l\u00ean \u0111\u1ebfn 60% m\u1eb7c d\u00f9 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng virus.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o x\u00e9t nghi\u1ec7m qPCR, v\u00ec CMV th\u01b0\u1eddng nhi\u1ec5m v\u00e0o t\u1ebf b\u00e0o ph\u1ebf nang trong vi\u00eam ph\u1ed5i CMV \u0111i\u1ec3n h\u00ecnh v\u00e0 c\u0169ng c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u1ebf b\u00e0o m\u00f4 \u0111\u1ec7m ho\u1eb7c \u0111\u1ea1i th\u1ef1c b\u00e0o c\u01b0 tr\u00fa. Tuy nhi\u00ean, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i CMV r\u1ea5t ph\u1ee9c t\u1ea1p, v\u00ec t\u1ea3i l\u01b0\u1ee3ng virus CMV d\u01b0\u01a1ng t\u00ednh trong d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n (BAL) c\u00f3 th\u1ec3 ph\u1ea3n \u00e1nh nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p m\u00e0 ch\u01b0a ch\u1eafc \u0111\u00e3 c\u00f3 s\u1ef1 x\u00e2m l\u1ea5n m\u00f4. Vi\u1ec7c t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV \u1edf ph\u1ed5i \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf 45% b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch m\u1eafc vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng n\u1eb7ng nh\u1eadp ICU. \u1ede b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh l\u00fd \u00e1c t\u00ednh huy\u1ebft h\u1ecdc c\u1ea7n th\u1edf m\u00e1y do vi\u00eam ph\u1ed5i, t\u00e1i ho\u1ea1t \u0111\u1ed9ng CMV \u1edf ph\u1ed5i x\u1ea3y ra \u1edf kho\u1ea3ng 11% v\u00e0 c\u00f3 li\u00ean quan \u0111\u1ed9c l\u1eadp \u0111\u1ebfn t\u1eed vong t\u1ea1i ICU n\u1ebfu \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u1edbm sau khi \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n, m\u1eb7c d\u00f9 ch\u1ec9 c\u00f3 r\u1ea5t \u00edt tr\u01b0\u1eddng h\u1ee3p \u0111\u00e1p \u1ee9ng ti\u00eau chu\u1ea9n cho vi\u00eam ph\u1ed5i CMV c\u00f3 kh\u1ea3 n\u0103ng x\u1ea3y ra. T\u1ea3i l\u01b0\u1ee3ng DNA CMV cao h\u01a1n trong m\u1eabu BAL t\u01b0\u01a1ng quan v\u1edbi kh\u1ea3 n\u0103ng cao h\u01a1n c\u1ee7a vi\u00eam ph\u1ed5i CMV, m\u1eb7c d\u00f9 ch\u01b0a c\u00f3 ng\u01b0\u1ee1ng ch\u00ednh x\u00e1c n\u00e0o \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp. \u1ede ng\u01b0\u1eddi nh\u1eadn gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c t\u1ea1o m\u00e1u, t\u1ea3i l\u01b0\u1ee3ng DNA CMV trong m\u1eabu BAL kh\u00f4ng li\u00ean quan \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng \u0111\u1ed3ng th\u1eddi. Do \u0111\u00f3, vi\u1ec7c \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n bao g\u1ed3m x\u00e1c su\u1ea5t tr\u01b0\u1edbc khi x\u00e9t nghi\u1ec7m, c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng t\u01b0\u01a1ng \u1ee9ng, v\u00e0 t\u1ea3i l\u01b0\u1ee3ng DNA CMV trong BAL l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n. Vi\u1ec7c x\u00e1c \u0111\u1ecbnh c\u00e1c th\u1ec3 virus trong t\u1ebf b\u00e0o BAL c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n, nh\u01b0ng x\u00e9t nghi\u1ec7m n\u00e0y c\u00f3 \u0111\u1ed9 nh\u1ea1y th\u1ea5p v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u01b0\u1eddng quy t\u1ea1i nhi\u1ec1u trung t\u00e2m do h\u1ea1n ch\u1ebf v\u1ec1 chuy\u00ean m\u00f4n.<\/p>\n
\u0110i\u1ec1u quan tr\u1ecdng l\u00e0 CMV \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam ph\u1ed5i li\u00ean quan \u0111\u1ebfn th\u1edf m\u00e1y \u1edf b\u1ec7nh nh\u00e2n ICU c\u00f3 mi\u1ec5n d\u1ecbch b\u00ecnh th\u01b0\u1eddng khi ph\u1ea3i th\u1edf m\u00e1y k\u00e9o d\u00e0i, \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng b\u1eb1ng ch\u1ee9ng m\u00f4 b\u1ec7nh h\u1ecdc. Ch\u1ea9n \u0111o\u00e1n n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 suy gi\u1ea3m mi\u1ec5n d\u1ecbch m\u1eafc ph\u1ea3i t\u1ea1i ICU, ch\u1eb3ng h\u1ea1n nh\u01b0 do s\u1eed d\u1ee5ng corticosteroid li\u1ec1u cao ho\u1eb7c k\u00e9o d\u00e0i ho\u1eb7c c\u00e1c li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, nh\u1eefng ng\u01b0\u1eddi c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ph\u00f9 h\u1ee3p v\u00e0 t\u1ea3i l\u01b0\u1ee3ng virus CMV cao trong m\u1eabu d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n (BAL).<\/p>\n
B\u1ec7nh l\u00fd th\u1ea7n kinh trung \u01b0\u01a1ng do CMV<\/h3>\n
S\u1ef1 x\u00e2m nh\u1eadp c\u1ee7a CMV v\u00e0o h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng hi\u1ebfm g\u1eb7p, ch\u1ee7 y\u1ebfu \u1edf ng\u01b0\u1eddi nhi\u1ec5m HIV, v\u1edbi kho\u1ea3ng m\u1ed9t n\u1eeda s\u1ed1 tr\u01b0\u1eddng h\u1ee3p ph\u1ea3i nh\u1eadp ICU. Th\u1ec9nh tho\u1ea3ng, vi\u00eam n\u00e3o do CMV x\u1ea3y ra \u1edf b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch kh\u00f4ng ph\u1ea3i AIDS trong ICU. Tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 vi\u00eam n\u00e3o lan t\u1ecfa, \u0111\u00f4i khi xu\u1ea5t hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng vi\u00eam n\u00e3o th\u1ea5t. \u1ede ng\u01b0\u1eddi nh\u1eadn gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c t\u1ea1o m\u00e1u, b\u1ec7nh l\u00fd CNS do CMV th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n mu\u1ed9n sau gh\u00e9p, \u0111i\u1ec3n h\u00ecnh \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 t\u00e1i ph\u00e1t CMV trong m\u00e1u nhi\u1ec1u l\u1ea7n v\u00e0 tr\u1ea3i qua nhi\u1ec1u \u0111\u1ee3t \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng, d\u1eabn \u0111\u1ebfn b\u1ec7nh CMV kh\u00e1ng tr\u1ecb. S\u1ef1 x\u00e2m nh\u1eadp c\u1ee7a CMV v\u00e0o t\u1ee7y s\u1ed1ng, bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng vi\u00eam t\u1ee7y c\u1eaft ngang ho\u1eb7c b\u1ec7nh l\u00fd \u0111a r\u1ec5 d\u00e2y th\u1ea7n kinh c\u0169ng \u0111\u01b0\u1ee3c ghi nh\u1eadn.<\/p>\n
H\u00ecnh \u1ea3nh h\u1ecdc ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3 cho th\u1ea5y t\u1ed5n th\u01b0\u01a1ng t\u0103ng t\u00edn hi\u1ec7u lan t\u1ecfa tr\u00ean MRI chu\u1ed7i T2, trong khi c\u00e1c k\u1ebft qu\u1ea3 d\u1ecbch n\u00e3o t\u1ee7y (CSF) th\u01b0\u1eddng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u. qPCR \u0111\u1ec3 ph\u00e1t hi\u1ec7n DNA c\u1ee7a CMV trong d\u1ecbch n\u00e3o t\u1ee7y c\u00f3 \u0111\u1ed9 nh\u1ea1y cao, nh\u01b0ng c\u00f3 th\u1ec3 x\u1ea3y ra d\u01b0\u01a1ng t\u00ednh gi\u1ea3, v\u1edbi gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n d\u01b0\u01a1ng t\u00ednh \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o th\u1ea5p \u0111\u1ebfn 50%. K\u1ebft qu\u1ea3 c\u1ea7n \u0111\u01b0\u1ee3c di\u1ec5n gi\u1ea3i c\u1ea9n th\u1eadn, \u0111\u1eb7c bi\u1ec7t n\u1ebfu m\u1eabu d\u1ecbch n\u00e3o t\u00f9y b\u1ecb nhi\u1ec5m m\u00e1u \u1edf b\u1ec7nh nh\u00e2n c\u00f3 CMV DNA trong m\u00e1u, ho\u1eb7c n\u1ebfu c\u00f3 kh\u1ea3 n\u0103ng c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y b\u1ec7nh l\u00fd th\u1ea7n kinh trung \u01b0\u01a1ng. T\u1ef7 l\u1ec7 t\u1eed vong trong b\u1ec7nh l\u00fd th\u1ea7n kinh trung \u01b0\u01a1ng do CMV v\u1eabn cao, dao \u0111\u1ed9ng t\u1eeb 40% \u0111\u1ebfn 90%.<\/p>\n
B\u1ec7nh \u0111\u01b0\u1eddng ti\u00eau h\u00f3a do CMV<\/h3>\n
T\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a l\u00e0 th\u1ec3 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a b\u1ec7nh do CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch \u1edf b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch kh\u00f4ng do gh\u00e9p ph\u1ed5i v\u00e0 kh\u00f4ng nhi\u1ec5m HIV, v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p th\u1ee9 hai c\u1ee7a CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch t\u1ea1i khoa ICU. Kho\u1ea3ng m\u1ed9t ph\u1ea7n ba b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh CMV \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng, v\u1edbi bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng r\u1ea5t \u0111a d\u1ea1ng. Vi\u00eam th\u1ef1c qu\u1ea3n l\u00e0 d\u1ea1ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a b\u1ec7nh l\u00fd \u0111\u01b0\u1eddng ti\u00eau h\u00f3a tr\u00ean, c\u00f3 th\u1ec3 dao \u0111\u1ed9ng t\u1eeb vi\u00eam nh\u1eb9 \u0111\u1ebfn lo\u00e9t n\u1eb7ng v\u00e0 n\u00f4n ra m\u00e1u, trong khi vi\u00eam \u0111\u1ea1i tr\u00e0ng \u2013 d\u1ea1ng ch\u00ednh c\u1ee7a b\u1ec7nh l\u00fd \u0111\u01b0\u1eddng ti\u00eau h\u00f3a d\u01b0\u1edbi th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n b\u1eb1ng ti\u00eau ch\u1ea3y. Vi\u00eam ru\u1ed9t c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0 xu\u1ea5t huy\u1ebft, ho\u1eb7c hi\u1ebfm g\u1eb7p h\u01a1n l\u00e0 th\u1ee7ng ru\u1ed9t.<\/p>\n
C\u00e1c ph\u00e1t hi\u1ec7n qua n\u1ed9i soi kh\u00f4ng \u0111\u1eb7c hi\u1ec7u v\u00e0 c\u00f3 th\u1ec3 gi\u1ed1ng ho\u1eb7c li\u00ean quan \u0111\u1ebfn c\u00e1c t\u00ecnh tr\u1ea1ng kh\u00e1c nh\u01b0 b\u1ec7nh th\u1ea3i gh\u00e9p, nhi\u1ec5m adenovirus ho\u1eb7c nhi\u1ec5m Clostridioides difficile. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o c\u00e1c thay \u0111\u1ed5i m\u00f4 b\u1ec7nh h\u1ecdc \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh qua sinh thi\u1ebft, m\u1eb7c d\u00f9 c\u00e1c bao v\u00f9i CMV c\u00f3 th\u1ec3 kh\u00f4ng xu\u1ea5t hi\u1ec7n l\u00ean \u0111\u1ebfn 20% c\u00e1c tr\u01b0\u1eddng h\u1ee3p. H\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch ho\u1eb7c lai t\u1ea1i ch\u1ed7 tr\u00ean m\u1eabu sinh thi\u1ebft gi\u00fap c\u1ea3i thi\u1ec7n \u0111\u1ed9 nh\u1ea1y ch\u1ea9n \u0111o\u00e1n v\u00e0 hi\u1ec7n \u0111\u01b0\u1ee3c xem l\u00e0 ti\u00eau chu\u1ea9n. M\u1eb7c d\u00f9 x\u00e9t nghi\u1ec7m qPCR tr\u00ean m\u1eabu sinh thi\u1ebft \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u00f3 th\u1ec3 cho k\u1ebft qu\u1ea3 d\u01b0\u01a1ng t\u00ednh gi\u1ea3, nh\u01b0ng t\u1ea3i l\u01b0\u1ee3ng DNA cao l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng m\u1eafc b\u1ec7nh CMV \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. \u0110\u00e1ng ch\u00fa \u00fd, c\u00f3 t\u1edbi m\u1ed9t ph\u1ea7n ba b\u1ec7nh nh\u00e2n b\u1ecb CMV \u0111\u01b0\u1eddng ti\u00eau h\u00f3a kh\u00f4ng c\u00f3 CMV DNA trong m\u00e1u, ngay c\u1ea3 trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng.<\/p>\n
Vi\u00eam gan do CMV<\/h3>\n
Vi\u00eam gan do CMV ch\u1ee7 y\u1ebfu x\u1ea3y ra \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p gan, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kho\u1ea3ng 2-5% c\u00e1c tr\u01b0\u1eddng h\u1ee3p, th\u01b0\u1eddng l\u00e0 b\u1ec7nh l\u00fd khu tr\u00fa t\u1ea1i gan. \u1ede c\u00e1c b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch kh\u00e1c, t\u1ed5n th\u01b0\u01a1ng gan th\u01b0\u1eddng l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a b\u1ec7nh CMV lan t\u1ecfa. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng dao \u0111\u1ed9ng t\u1eeb t\u0103ng nh\u1eb9 bilirubin v\u00e0\/ho\u1eb7c men gan cho \u0111\u1ebfn nh\u1eefng tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm g\u1eb7p kh\u00e1c nh\u01b0 suy gan t\u1ed1i c\u1ea5p; vi\u00eam gan \u1ee9 m\u1eadt l\u00e0 b\u1ec7nh c\u1ea3nh th\u01b0\u1eddng g\u1eb7p nh\u1ea5t.<\/p>\n
Vi\u00eam v\u00f5ng m\u1ea1c CMV<\/h3>\n
Vi\u00eam v\u00f5ng m\u1ea1c CMV l\u00e0 th\u1ec3 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a b\u1ec7nh CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HIV giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n gh\u00e9p t\u1ea1ng, vi\u00eam v\u00f5ng m\u1ea1c do CMV hi\u1ebfm g\u1eb7p v\u00e0 x\u1ea3y ra \u0111\u1ed3ng th\u1eddi v\u1edbi t\u1ed5n th\u01b0\u01a1ng CMV \u1edf c\u00e1c c\u01a1 quan kh\u00e1c trong kho\u1ea3ng 40% c\u00e1c tr\u01b0\u1eddng h\u1ee3p. G\u1ea7n m\u1ed9t n\u1eeda s\u1ed1 ca b\u1ec7nh kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, vi\u00eam v\u00f5ng m\u1ea1c do CMV \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n ICU b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch. Do \u0111\u00f3, c\u1ea7n ti\u1ebfn h\u00e0nh kh\u00e1m m\u1eaft \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n ICU c\u00f3 nguy c\u01a1 cao b\u1ecb nhi\u1ec5m CMV huy\u1ebft ho\u1eb7c CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch, \u0111\u1eb7c bi\u1ec7t khi c\u00f3 tri\u1ec7u ch\u1ee9ng v\u1ec1 th\u1ecb gi\u00e1c ho\u1eb7c \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng t\u1ec9nh t\u00e1o.<\/p>\n
\u1ee8c ch\u1ebf t\u1ee7y do CMV<\/h3>\n
CMV c\u00f3 li\u00ean quan \u0111\u1ebfn hi\u1ec7n t\u01b0\u1ee3ng suy t\u1ee7y th\u00f4ng qua vi\u1ec7c nhi\u1ec5m v\u00e0o c\u00e1c t\u1ebf b\u00e0o t\u1ea1o m\u00e1u v\u00e0 t\u1ebf b\u00e0o m\u00f4 \u0111\u1ec7m, c\u0169ng nh\u01b0 qua c\u00e1c c\u01a1 ch\u1ebf trung gian mi\u1ec5n d\u1ecbch. T\u00ecnh tr\u1ea1ng gi\u1ea3m t\u1ebf b\u00e0o m\u00e1u do CMV \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o \u00e1o \u1edf c\u00e1c b\u1ec7nh nh\u00e2n nguy k\u1ecbch m\u1eafc b\u1ec7nh l\u00fd huy\u1ebft h\u1ecdc \u00e1c t\u00ednh v\u00e0 c\u00f3 t\u00e1i ho\u1ea1t CMV. Tuy nhi\u00ean, vi\u1ec7c x\u00e1c \u0111\u1ecbnh b\u1eb1ng m\u00f4 b\u1ec7nh h\u1ecdc v\u1ec1 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a CMV trong t\u1ee7y x\u01b0\u01a1ng l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c, v\u00e0 c\u1ea7n xem x\u00e9t c\u00e1c nguy\u00ean nh\u00e2n ti\u1ec1m \u1ea9n kh\u00e1c g\u00e2y suy t\u1ee7y \u2013 ch\u1eb3ng h\u1ea1n nh\u01b0 \u0111\u1ed9c t\u00ednh do thu\u1ed1c, nhi\u1ec5m tr\u00f9ng huy\u1ebft, th\u1ea3i gh\u00e9p, ho\u1eb7c t\u00e1i ph\u00e1t b\u1ec7nh l\u00fd huy\u1ebft h\u1ecdc \u00e1c t\u00ednh.<\/p>\n
H\u1ed9i ch\u1ee9ng CMV<\/h3>\n
H\u1ed9i ch\u1ee9ng CMV (B\u1ea3ng 1) l\u00e0 bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a b\u1ec7nh do CMV \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p t\u1ea1ng \u0111\u1eb7c, chi\u1ebfm \u0111\u1ebfn 40-60% c\u00e1c tr\u01b0\u1eddng h\u1ee3p. Tuy nhi\u00ean, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n \u1edf c\u00e1c b\u1ec7nh nh\u00e2n nguy k\u1ecbch g\u1eb7p nhi\u1ec1u kh\u00f3 kh\u0103n, do kh\u00f4ng th\u1ec3 lo\u1ea1i tr\u1eeb ho\u00e0n to\u00e0n c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y ra c\u00e1c tri\u00eau ch\u1ee9ng l\u00e2m s\u00e0ng \u0111i k\u00e8m v\u1edbi nhi\u1ec5m CMV, ch\u1eb3ng h\u1ea1n nh\u01b0 nhi\u1ec5m tr\u00f9ng huy\u1ebft ho\u1eb7c \u0111\u1ed9c t\u00ednh do thu\u1ed1c.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m\/b\u1ec7nh CMV<\/h2>\n
C\u00f3 nhi\u1ec1u c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n hi\u1ec7n c\u00f3 \u0111\u1ec3 ph\u00e1t hi\u1ec7n nhi\u1ec5m v\u00e0 b\u1ec7nh do CMV. M\u1eb7c d\u00f9 x\u00e9t nghi\u1ec7m chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh t\u1eebng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i, nh\u01b0ng gi\u00e1 tr\u1ecb l\u00e2m s\u00e0ng c\u1ee7a n\u00f3 hi\u1ec7n v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng, \u0111\u1eb7c bi\u1ec7t \u1edf c\u00e1c b\u1ec7nh nh\u00e2n nguy k\u1ecbch. Ph\u01b0\u01a1ng ph\u00e1p qPCR gi\u00fap ph\u00e1t hi\u1ec7n DNA c\u1ee7a CMV trong m\u00e1u ho\u1eb7c c\u00e1c d\u1ecbch c\u01a1 th\u1ec3 kh\u00e1c, \u0111\u00e3 tr\u1edf th\u00e0nh ph\u01b0\u01a1ng ph\u00e1p \u01b0u ti\u00ean nh\u1edd t\u1ed1c \u0111\u1ed9 v\u00e0 \u0111\u1ed9 nh\u1ea1y cao. Tuy nhi\u00ean, vi\u1ec7c x\u00e1c \u0111\u1ecbnh ng\u01b0\u1ee1ng t\u1ea3i l\u01b0\u1ee3ng virus \u0111\u1ec3 cho th\u1ea5y nhi\u1ec5m tr\u00f9ng \u0111ang ho\u1ea1t \u0111\u1ed9ng v\u00e0 c\u1ea7n \u0111i\u1ec1u tr\u1ecb l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c. M\u1ed9t k\u1ebft qu\u1ea3 PCR d\u01b0\u01a1ng t\u00ednh \u0111\u01a1n l\u1ebb kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 kh\u1eb3ng \u0111\u1ecbnh nhi\u1ec5m tr\u00f9ng \u0111ang ho\u1ea1t \u0111\u1ed9ng, do \u0111\u00f3 vi\u1ec7c l\u00e0m qPCR nhi\u1ec1u l\u1ea7n \u2013 theo d\u00f5i s\u1ef1 thay \u0111\u1ed5i t\u00e0i l\u01b0\u1ee3ng virus theo th\u1eddi gian l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p c\u00f3 gi\u00e1 tr\u1ecb.<\/p>\n
Ngo\u00e0i ra, kh\u1ea3 n\u0103ng m\u1eafc b\u1ec7nh CMV t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch tr\u01b0\u1edbc khi x\u00e9t nghi\u1ec7m v\u00e0 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c d\u1ea5u hi\u1ec7u ho\u1eb7c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng g\u1ee3i \u00fd c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t khi quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng virus, v\u00ec \u0111i\u1ec1u tr\u1ecb qu\u00e1 m\u1ee9c c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9c t\u00ednh ho\u1eb7c kh\u00e1ng thu\u1ed1c.<\/p>\n
Nu\u00f4i c\u1ea5y virus hi\u1ec7n nay hi\u1ebfm khi \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n.<\/p>\n
$\"Ch\u1ea9n$
Ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m\/b\u1ec7nh CMV<\/figcaption><\/figure>\n
\u0110i\u1ec1u tr\u1ecb v\u00e0 ph\u00f2ng ng\u1eeba nhi\u1ec5m b\u1ec7nh do CMV \u1edf b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch t\u1ea1i ICU<\/h2>\n
\u0110i\u1ec1u tr\u1ecb<\/h3>\n
Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m CMV \u1edf c\u00e1c b\u1ec7nh nh\u00e2n nguy k\u1ecbch b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch c\u00f3 th\u1ec3 g\u1eb7p nhi\u1ec1u kh\u00f3 kh\u0103n do \u0111\u1ed9c t\u00ednh ti\u1ec1m \u1ea9n c\u1ee7a thu\u1ed1c v\u00e0 c\u00e1c b\u1ec7nh l\u00fd \u0111i k\u00e8m. Ganciclovir ti\u00eam t\u0129nh m\u1ea1ch l\u00e0 thu\u1ed1c kh\u00e1ng virus h\u00e0ng \u0111\u1ea7u \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh CMV n\u1eb7ng, trong khi foscarnet v\u00e0 cidofovir l\u00e0 c\u00e1c l\u1ef1a ch\u1ecdn h\u00e0ng th\u1ee9 hai do nguy c\u01a1 g\u00e2y \u0111\u1ed9c th\u1eadn. Tuy nhi\u00ean, foscarnet c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb h\u00e0ng \u0111\u1ea7u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb gi\u1ea3m t\u1ebf b\u00e0o m\u00e1u nghi\u00eam tr\u1ecdng. \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh CMV kh\u00e1ng tr\u1ecb, c\u1ea7n \u0111\u00e1nh gi\u00e1 c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 t\u00ecnh tr\u1ea1ng \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch qu\u00e1 m\u1ee9c, n\u1ed3ng \u0111\u1ed9 thu\u1ed1c kh\u00e1ng virus d\u01b0\u1edbi ng\u01b0\u1ee1ng \u0111i\u1ec1u tr\u1ecb, ho\u1eb7c t\u00ecnh tr\u1ea1ng kh\u00e1ng ganciclovir.<\/p>\n
$\"C\u00e1c$
C\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m CMV<\/figcaption><\/figure>\n
Theo c\u00e1c h\u01b0\u1edbng d\u1eabn hi\u1ec7n h\u00e0nh, foscarnet v\u1eabn l\u00e0 l\u1ef1a ch\u1ecdn \u01b0u ti\u00ean cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m CMV kh\u00e1ng thu\u1ed1c, m\u1eb7c d\u00f9 maribavir \u0111\u00e3 cho th\u1ea5y k\u1ebft qu\u1ea3 \u0111\u1ea7y h\u1ee9a h\u1eb9n, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy th\u1eadn. Trong m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng pha 3 g\u1ea7n \u0111\u00e2y, maribavir \u0111\u00e3 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 t\u1ed1t h\u01a1n trong vi\u1ec7c l\u00e0m s\u1ea1ch virus CMV v\u00e0 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng trong 8 tu\u1ea7n, so v\u1edbi valganciclovir\/ganciclovir, foscarnet ho\u1eb7c cidofovir, v\u1edbi \u00edt t\u00e1c d\u1ee5ng ph\u1ee5 h\u01a1n nh\u01b0 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p v\u00e0 gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t. Tuy nhi\u00ean, maribavir kh\u00f4ng ph\u00f9 h\u1ee3p \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam v\u00f5ng m\u1ea1c ho\u1eb7c vi\u00eam n\u00e3o do kh\u1ea3 n\u0103ng ng\u1ea5m k\u00e9m v\u00e0o h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng.<\/p>\n
M\u1eb7c d\u00f9 kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ch\u00ednh, letermovir \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n gh\u00e9p t\u1ea1ng \u0111\u1eb7c v\u00e0 gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c t\u1ea1o m\u00e1u kh\u00f4ng dung n\u1ea1p ho\u1eb7c kh\u00e1ng v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1ng virus kh\u00e1c, v\u1edbi k\u1ebft qu\u1ea3 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t. Trong m\u1ed9t nghi\u00ean c\u1ee9u quan s\u00e1t \u0111a trung t\u00e2m tr\u00ean b\u1ec7nh nh\u00e2n gh\u00e9p t\u1ea1ng, letermovir ch\u1ec9 cho k\u1ebft qu\u1ea3 thu\u1eadn l\u1ee3i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 CMV DNA d\u01b0\u1edbi 1000 IU\/mL. Do r\u00e0o c\u1ea3n kh\u00e1ng thu\u1ed1c th\u1ea5p v\u00e0 hi\u1ec7u qu\u1ea3 h\u1ea1n ch\u1ebf \u1edf t\u1ea3i l\u01b0\u1ee3ng virus cao, letermovir c\u00f3 v\u1ebb ph\u00f9 h\u1ee3p h\u01a1n cho d\u1ef1 ph\u00f2ng sau \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m CMV kh\u00e1ng tr\u1ecb, h\u01a1n l\u00e0 s\u1eed d\u1ee5ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb ch\u00ednh.<\/p>\n
Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c c\u00e1 th\u1ec3 h\u00f3a d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u00e0 m\u1ee9c t\u1ea3i l\u01b0\u1ee3ng virus, th\u01b0\u1eddng k\u00e9o d\u00e0i cho \u0111\u1ebfn khi CMV DNA trong m\u00e1u kh\u00f4ng c\u00f2n ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c ho\u1eb7c gi\u1ea3m xu\u1ed1ng d\u01b0\u1edbi m\u1ed9t ng\u01b0\u1ee1ng x\u00e1c \u0111\u1ecbnh tr\u01b0\u1edbc, v\u1edbi th\u1eddi gian t\u1ed1i thi\u1ec3u l\u00e0 2 tu\u1ea7n. N\u00ean x\u00e9t nghi\u1ec7m CMV DNA h\u00e0ng tu\u1ea7n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng.<\/p>\n
\u0110\u1ed1i v\u1edbi c\u00e1c t\u00ecnh tr\u1ea1ng nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng nh\u01b0 vi\u00eam ph\u1ed5i do CMV ho\u1eb7c b\u1ec7nh nh\u00e2n thi\u1ebfu gammaglobumin m\u00e1u, c\u00f3 th\u1ec3 c\u1ea7n li\u1ec7u ph\u00e1p h\u1ed7 tr\u1ee3 b\u1eb1ng immunoglobulin ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c globulin mi\u1ec5n d\u1ecbch \u0111\u1eb7c hi\u1ec7u v\u1edbi CMV.<\/p>\n
Sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng virus, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m DNA CMV h\u00e0ng tu\u1ea7n \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u00e1i ph\u00e1t, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n v\u1eabn c\u00f2n c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 nh\u01b0 gi\u1ea3m b\u1ea1ch c\u1ea7u lympho, \u0111ang d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch li\u1ec1u cao ho\u1eb7c ph\u1ee5c h\u1ed3i t\u1ebf b\u00e0o T ch\u1eadm. Vi\u1ec7c theo d\u00f5i \u0111\u00e1p \u1ee9ng c\u1ee7a t\u1ebf b\u00e0o T \u0111\u1eb7c hi\u1ec7u v\u1edbi CMV c\u0169ng c\u00f3 th\u1ec3 gi\u00fap \u0111\u00e1nh gi\u00e1 nguy c\u01a1 t\u00e1i ph\u00e1t.<\/p>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
Fern\u00e1ndez S, Castro P, Azoulay E. What intensivists need to know about cytomegalovirus infection in immunocompromised ICU patients. Intensive Care Med. 2025 Jan;51(1):39-61. doi: 10.1007\/s00134-024-07737-5. Epub 2025 Jan 7. PMID: 39774866.<\/p>\n","protected":false},"excerpt":{"rendered":"
L\u01b0\u1ee3t d\u1ecbch: NT \u0397\u039d T\u1ea3i PDF t\u1ea1i \u0111\u00e2y Trong nh\u1eefng th\u1eadp k\u1ef7 g\u1ea7n \u0111\u00e2y, s\u1ed1 l\u01b0\u1ee3ng ng\u01b0\u1eddi b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch \u0111\u00e3 gia t\u0103ng do nh\u1eefng ti\u1ebfn b\u1ed9 trong \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch cho b\u1ec7nh ung th\u01b0 v\u00e0 b\u1ec7nh t\u1ef1 mi\u1ec5n, s\u1ef1 gia t\u0103ng s\u1ed1 ca gh\u00e9p t\u1ea1ng \u0111\u1eb7c, c\u0169ng nh\u01b0 k\u00e9o […]\n","protected":false},"author":1,"featured_media":134277,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-134234","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134234","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=134234"}],"version-history":[{"count":2,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134234\/revisions"}],"predecessor-version":[{"id":134280,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134234\/revisions\/134280"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/134277"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=134234"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=134234"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=134234"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}