Nh\u00e0 thu\u1ed1c L\u01b0u V\u0103n Ho\u00e0ng<\/a> – V\u00ec sao ph\u1ea3i ch\u1ee7ng ng\u1eeba v\u1eafc xin 3 lo\u1ea1i vi khu\u1ea9n (S. pneumonia, N. meningitidis, v\u00e0 H. influenza) \u1edf tr\u1ebb s\u01a1 sinh\/ ng\u01b0\u1eddi c\u1eaft l\u00e1ch?<\/a><\/strong><\/p>\n

T\u00e1c gi\u1ea3: Bs. Phan Tr\u00fac<\/b><\/p>\n

\u0110\u1ec3 tr\u1ea3 l\u1eddi c\u00e2u h\u1ecfi n\u00e0y, c\u1ea7n chia ra m\u1ed9t s\u1ed1 \u00fd nh\u1ecf:<\/div>\n
1. 3 t\u00e1c nh\u00e2n n\u00e0y c\u00f3 g\u00ec \u0111\u1eb7c bi\u1ec7t?
\n2. Tr\u1ebb s\u01a1 sinh\/ L\u00e1ch c\u00f3 v\u1ea5n \u0111\u1ec1 g\u00ec v\u1edbi 3 con n\u00e0y?
\n3. Vacxin l\u00e0m c\u00e1ch n\u00e0o v\u01b0\u1ee3t qua nh\u1eefng tr\u1edf ng\u1ea1i n\u00e0y?<\/div>\n
Mu\u1ed1n v\u1eady, c\u1ea7n trang b\u1ecb m\u1ed9t s\u1ed1 ki\u1ebfn th\u1ee9c v\u1ec1 mi\u1ec5n d\u1ecbch (xem h\u00ecnh \u0111\u1ec3 hi\u1ec3u th\u00eam)
\n1. C\u00f3 2 lo\u1ea1i t\u1ebf b\u00e0o lympho B, g\u1ed3m B1 v\u00e0 B2<\/b>. Th\u00f4ng th\u01b0\u1eddng lympho B ch\u1ec9 s\u1ea3n xu\u1ea5t ra \u0111\u01b0\u1ee3c kh\u00e1ng th\u1ec3 \u0111\u1eb7c hi\u1ec7u v\u1edbi kh\u00e1ng nguy\u00ean khi \u0111\u1ee7 2 \u0111i\u1ec1u ki\u1ec7n:
\na. KN \u0111\u01b0\u1ee3c b\u1eaft gi\u1eef b\u1edfi t\u1ebf b\u00e0o tr\u00ecnh di\u1ec7n KN, v\u00e0 tr\u00ecnh di\u1ec7n KN cho lympho T
\nb. Lympho T s\u1ebd k\u1ebft n\u1ed1i v\u1edbi B v\u00e0 \u0111i\u1ec1u khi\u1ec3n t\u1ebf b\u00e0o B s\u1ea3n xu\u1ea5t KT c\u0169ng nh\u01b0 t\u1ea1o ra t\u1ebf b\u00e0o B nh\u1edb trong trung t\u00e2m m\u1ea7m (Germinal center<\/b>) c\u1ee7a h\u1ea1ch b\u1ea1ch huy\u1ebft (\u2026)
\n2. C\u00e1ch s\u1ea3n xu\u1ea5t KT \u0111\u00f3 l\u00e0 c\u00e1ch x\u1eed s\u1ef1 c\u1ee7a B2, tuy nhi\u00ean kh\u00f4ng ph\u1ea3i KN n\u00e0o c\u0169ng k\u00edch ho\u1ea1t B2 theo c\u00e1ch \u0111\u00f3. B\u1edfi v\u00ec n\u1ebfu KN \u0111\u00f3 kh\u00f4ng th\u1ec3 tr\u00ecnh di\u1ec7n, th\u00ec c\u01a1 ch\u1ebf kh\u00e1c ph\u1ea3i ho\u1ea1t \u0111\u1ed9ng, l\u00fac n\u00e0y c\u00e1c lympho B1 s\u1ebd b\u1eaft gi\u1eef, v\u00e0 B1 tr\u1ef1c ti\u1ebfp ho\u1ea1t ho\u00e1 (kh\u00f4ng c\u1ea7n lympho T n\u1eefa), s\u1ea3n xu\u1ea5t c\u00e1c KT tuy kh\u00f4ng c\u00f3 t\u00ednh \u0111\u1eb7c hi\u1ec7u cao nh\u01b0ng \u0111\u1ee7 \u0111\u1ec3 d\u1eb9p nh\u1eefng anh ch\u00e0ng KN lo\u1ea1i n\u00e0y (t\u1ea5t nhi\u00ean kh\u00f4ng c\u00f3 lympho nh\u1edb t\u1ea1o th\u00e0nh – \u1edf \u0111\u00e2y xin kh\u00f4ng \u0111i s\u00e2u v\u00e0o B1a v\u00e0 B1b). R\u1ed3i, c\u00f9ng v\u00e0o b\u00e0i nh\u00e9, vi\u1ebft t\u00f3m t\u1eaft th\u00f4i, mu\u1ed1n b\u00ecnh lu\u1eadn g\u00ec th\u00ec comment nhe:<\/div>\n
Kh\u00e1ng nguy\u00ean (KN) x\u00e2m nh\u1eadp c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia l\u00e0m 2 lo\u1ea1i:<\/strong><\/h2>\n1. Ph\u1ee5 thu\u1ed9c tuy\u1ebfn \u1ee9c (Thymus-dependent \u2013 TD)<\/b><\/div>\n
2. \u0110\u1ed9c l\u1eadp v\u1edbi tuy\u1ebfn \u1ee9c (Thymus independent \u2013 TI).<\/b><\/div>\nKh\u00e1ng nguy\u00ean TD g\u1ed3m nh\u1eefng protein ho\u1eb7c peptide ho\u00e0 tan g\u1eafn v\u1edbi ph\u1ee9c h\u1ee3p ho\u00e0 h\u1ee3p t\u1ed5 ch\u1ee9c (MHC) tr\u00ean m\u00e0ng t\u1ebf b\u00e0o tr\u00ecnh di\u1ec7n KN (APC), v\u00ec v\u1eady cho ph\u00e9p APC t\u01b0\u01a1ng t\u00e1c v\u1edbi T CD4+ => li\u00ean h\u1ec7 v\u1edbi B2 nh\u00e9!<\/div>\n
Ng\u01b0\u1ee3c l\u1ea1i, kh\u00e1ng nguy\u00ean TI kh\u00f4ng c\u1ea7n \u0111\u1ebfn s\u1ef1 h\u1ed7 tr\u1ee3 c\u1ee7a T-cell \u0111\u1ec3 t\u1ea1o \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch. C\u0169ng ch\u00ednh v\u00ec th\u1ebf, kh\u00e1ng nguy\u00ean TI kh\u00f4ng\/ ho\u1eb7c k\u00e9m t\u1ea1o ra mi\u1ec5n d\u1ecbch nh\u1edb [Ph\u1ea3i nh\u1edb l\u00e0 mu\u1ed1n c\u00f3 mi\u1ec5n d\u1ecbch nh\u1edb, t\u1ebf b\u00e0o B ph\u1ea3i tr\u1ea3i qua s\u1ef1 hu\u1ea5n luy\u1ec7n t\u1ea1i trung t\u00e2m m\u1ea7m d\u01b0\u1edbi s\u1ef1 gi\u00fap \u0111\u1ee1 c\u1ee7a T-cell]. Kh\u00e1ng th\u1ec3 (KT) \u0111\u01b0\u1ee3c t\u1ea1o ra ch\u1ee7 y\u1ebfu l\u00e0 IgM => Li\u00ean h\u1ec7 B1 nh\u00e9!<\/div>\n
Kh\u00e1ng nguy\u00ean TI ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c chia l\u00e0m type 1 (TI-1) v\u00e0 type 2 (TI-2)<\/b>. TI-1 k\u00edch th\u00edch s\u1ef1 t\u0103ng sinh v\u00e0 bi\u1ec7t ho\u00e1 c\u1ee7a lymphocyte B t\u1ea1o n\u00ean \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch \u1edf c\u1ea3 ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em. Tr\u00e1i l\u1ea1i, TI-2 ch\u1ec9 t\u1ea1o ra m\u1ed9t \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch h\u1ea1n ch\u1ebf \u1edf tr\u1ebb d\u01b0\u1edbi 2 tu\u1ed5i, nh\u01b0ng t\u1ea1o ra \u0111\u00e1p \u1ee9ng \u0111\u1ea7y \u0111\u1ee7 \u1edf ng\u01b0\u1eddi l\u1edbn. KN TI-1 bao g\u1ed3m lipopolysaccharides (m\u1ed9t ph\u1ea7n c\u1ee7a th\u00e0nh vi khu\u1ea9n Gram \u00e2m). V\u00ec v\u1eady, mi\u1ec5n d\u1ecbch v\u1edbi vi khu\u1ea9n Gram \u00e2m t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ea7y \u0111\u1ee7 \u1edf tr\u1ebb em m\u1eb7c d\u00f9 v\u1eabn y\u1ebfu h\u01a1n so v\u1edbi ng\u01b0\u1eddi l\u1edbn. KN TI-2 l\u00e0 polysaccharides (t\u1eeb vi khu\u1ea9n c\u00f3 v\u1ecf – encapsulated bacteria) ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 S. pneumonia, N. meningitidis, v\u00e0 H. influenza. Nhi\u1ec5m tr\u00f9ng nh\u1eefng t\u00e1c nh\u00e2n n\u00e0y \u0111\u01b0a \u0111\u1ebfn m\u1ed9t \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch k\u00e9m hi\u1ec7u qu\u1ea3 \u1edf tr\u1ebb s\u01a1 sinh, v\u00ec v\u1eady nguy c\u01a1 cao \u1edf \u0111\u1ed1i t\u01b0\u1ee3ng n\u00e0y<\/div>\n
T\u1ebf b\u00e0o B \u1edf v\u00f9ng r\u00eca (Marginal zone B cell \u2013 MZ B cell): Trung t\u00e2m c\u1ee7a c\u00e2u chuy\u1ec7n<\/b><\/h2>\n
KN polysaccharide \u0111\u1ecbnh v\u1ecb \u01b0a th\u00edch \u1edf t\u1ebf b\u00e0o B v\u00f9ng marginal zone (MZ), t\u00ecm th\u1ea5y ch\u1ee7 y\u1ebfu \u1edf l\u00e1ch [Vui l\u00f2ng xem l\u1ea1i m\u00f4 h\u1ecdc c\u1ee7a m\u00f4 lympho nh\u01b0 h\u1ea1ch, l\u00e1ch,..]<\/i>. Th\u1eadt ra l\u00e0 b\u1edfi v\u00ec, KN n\u00e0y tr\u00e1nh \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch t\u1ea1i ch\u1ed7, do v\u1ecf bao c\u1ee7a n\u00f3 \u0111\u1ec1 kh\u00e1ng v\u1edbi th\u1ef1c b\u00e0o, ng\u0103n c\u1ea3n vi\u1ec7c opsonin ho\u00e1, che khu\u1ea5t c\u00e1c kh\u00e1ng nguy\u00ean b\u00ean trong vi khu\u1ea9n<\/a>, v\u00ec v\u1eady n\u00f3 s\u1ebd v\u01b0\u1ee3t qua h\u00e0ng r\u00e0o t\u1ea1i ch\u1ed7, \u0111i v\u00e0o m\u00e1u, \u0111\u1ebfn l\u00e1ch.
\nNh\u1eefng t\u1ebf b\u00e0o B n\u00e0y hi\u1ec7n di\u1ec7n s\u1ed1 l\u01b0\u1ee3ng th\u1ea5p l\u00fac sinh, v\u00e0 ch\u01b0a tr\u01b0\u1edfng th\u00e0nh \u1edf th\u1eddi s\u01a1 sinh. MZ B cells tr\u01b0\u1edfng th\u00e0nh sau 2 tu\u1ed5i, l\u00fac n\u00e0y c\u00f3 kh\u1ea3 n\u0103ng t\u1ea1o \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch hi\u1ec7u qu\u1ea3 v\u1edbi polysaccharides. V\u00ec v\u1eady, s\u1ef1 s\u1ea3n xu\u1ea5t kh\u00e1ng th\u1ec3 k\u00e9m hi\u1ec7u qu\u1ea3: Tr\u1ebb em d\u01b0\u1edbi 2 tu\u1ed5i c\u00f3 s\u1ed1 l\u01b0\u1ee3ng th\u1ea5p IgG2 v\u00e0 IgG4, m\u00e3i \u0111\u1ebfn 5-10 tu\u1ed5i m\u1edbi \u0111\u1ea1t m\u1ee9c c\u1ee7a ng\u01b0\u1eddi l\u1edbn. Trong khi \u0111\u00f3 IgG2 l\u00e0 Ig hi\u1ec7u qu\u1ea3 nh\u1ea5t ch\u1ed1ng l\u1ea1i m\u1ed9t s\u1ed1 polysaccharides. Ch\u00ednh v\u00ec nh\u1eefng l\u00fd do n\u00e0y, tr\u1ebb em v\u00e0 nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng suy gi\u1ea3m ch\u1ee9c n\u0103ng l\u00e1ch (ng\u01b0\u1eddi gi\u00e0, d\u00f9ng thu\u1ed1c) ho\u1eb7c c\u1eaft l\u00e1ch r\u1ea5t nh\u1ea1y c\u1ea3m v\u1edbi c\u00e1c vi khu\u1ea9n c\u00f3 v\u1ecf, v\u00e0 vi\u1ec7c d\u00f9ng kh\u00e1ng sinh d\u1ef1 ph\u00f2ng\/ vacxin l\u00e0 c\u1ea7n thi\u1ebft.<\/div>\n
CD21 v\u00e0 b\u1ed5 th\u1ec3<\/b><\/h3>\n\u0110\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch v\u1edbi polysaccharides \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ed9ng khi polysaccharides ho\u1ea1t ho\u00e1 th\u00e0nh ph\u1ea7n b\u1ed5 th\u1ec3 C3d qua con \u0111\u01b0\u1eddng thay th\u1ec3 (Alternative pathway, xin xem l\u1ea1i c\u00e1c con \u0111\u01b0\u1eddng b\u1ed5 th\u1ec3 t\u1ea1i b\u00e0i vi\u1ebft: )<\/a><\/i>. Ph\u1ee9c h\u1ee3p polysaccharide-C3d sau \u0111\u00f3 s\u1ebd \u0111\u01b0\u1ee3c b\u1eaft gi\u1eef nh\u1edd CD21 (complement receptor 2) tr\u00ean MZ B cells. S\u1ef1 bi\u1ec3u hi\u1ec7n th\u1ea5p CD21 tr\u00ean B cell \u1edf tr\u1ebb s\u01a1 sinh gi\u1ea3i th\u00edch \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch kh\u00f4ng hi\u1ec7u qu\u1ea3 c\u1ee7a tr\u1ebb v\u1edbi polysaccharides. H\u01a1n n\u1eefa, h\u1ec7 th\u1ed1ng b\u1ed5 th\u1ec3 c\u00f2n y\u1ebfu \u1edf tr\u1ebb, l\u00e0m CD21 kh\u00f4ng g\u1eafn hi\u1ec7u qu\u1ea3 v\u1edbi ph\u1ee9c h\u1ee3p polysaccharide-C3d, v\u00e0 nh\u01b0 th\u1ebf KT kh\u00f4ng t\u1ea1o ra \u0111\u01b0\u1ee3c. Vi\u1ec7c d\u00f9ng vacxin li\u00ean h\u1ee3p (Conjugate vaccines) s\u1ebd kh\u00f4ng c\u1ea7n t\u1edbi b\u1ed5 th\u1ec3, v\u00e0 nh\u1edd \u0111\u00f3 t\u1ea1o ra \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch.<\/div>\n
Vacxin gi\u00fap g\u00ec?<\/b><\/h3>\n
Vacxin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ed1ng l\u1ea1i nh\u1eefng t\u00e1c nh\u00e2n n\u00e0y l\u00e0 c\u00e1c vacxin li\u00ean h\u1ee3p (Conjugate vaccines) ngh\u0129a l\u00e0 ch\u00fang g\u1eafn polysaccharide v\u1edbi m\u1ed9t ch\u1ea5t mang (protein carrier). H\u00e3y nh\u1edb l\u1ea1i tr\u01b0\u1eddng h\u1ee3p c\u1ee7a hapten, n\u00f3 v\u1eabn l\u00e0 m\u1ed9t kh\u00e1ng nguy\u00ean, nh\u01b0ng kh\u00f4ng t\u1ea1o ra \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch, v\u00e0 khi g\u1eafn v\u1edbi protein th\u00edch h\u1ee3p, n\u00f3 s\u1ebd l\u00e0m \u0111\u01b0\u1ee3c! [Nh\u01b0 v\u1eady t\u00ednh \u201ckh\u00e1ng nguy\u00ean\u201d v\u00e0 t\u00ednh \u201csinh mi\u1ec5n d\u1ecbch\u201d l\u00e0 kh\u00f4ng gi\u1ed1ng nhau nh\u00e9]. V\u1ecf \u0111\u01b0\u1ee3c t\u1ea1o b\u1edfi polysaccharide r\u1ea5t k\u00e9m sinh mi\u1ec5n d\u1ecbch v\u00ec nhi\u1ec1u do, \u0111\u01a1n gi\u1ea3n nh\u1ea5t n\u00f3 l\u00e0 m\u1ed9t \u201cv\u1ecf b\u1ecdc b\u1ec1n v\u1eefng\u201d, \u0111\u1ec1 kh\u00e1ng v\u1edbi th\u1ef1c b\u00e0o, kh\u00f4ng cho c\u00e1c th\u00e0nh ph\u1ea7n \u201cb\u1ed5 th\u1ec3\u201d g\u1eafn l\u00ean, v\u00e0 che khu\u1ea5t c\u00e1c kh\u00e1ng nguy\u00ean b\u00ean trong vi khu\u1ea9n, l\u00e0m cho mi\u1ec5n d\u1ecbch ch\u1ec9 c\u00f3 th\u1ec3 theo h\u01b0\u1edbng TI-2. Vi\u1ec7c d\u00f9ng vacxin li\u00ean h\u1ee3p s\u1ebd chuy\u1ec3n KN t\u1eeb loa\u1ecb TI-2 th\u00e0nh TD, v\u00e0 nh\u01b0 v\u1eady l\u00e0 mi\u1ec5n d\u1ecbch nh\u1edb \u0111\u00e3 c\u00f3 th\u1ec3 h\u1ecdat \u0111\u1ed9ng! (Xem h\u00ecnh)
\nM\u1eb7c d\u00f9 c\u00f2n nh\u1eefng c\u01a1 ch\u1ebf kh\u00e1c g\u00f3p ph\u1ea7n v\u00e0o s\u1ef1 suy y\u1ebfu \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch ch\u1ed1ng c\u00e1c KN ki\u1ec3u n\u00e0y \u1edf tr\u1ebb, tuy nhi\u00ean \u0111\u00e2y l\u00e0 nh\u1eefng \u0111i\u1ec3m quan tr\u1ecdng nh\u1ea5t. V\u00ec tr\u00e1nh b\u00e0i vi\u1ebft qu\u00e1 d\u00e0i, m\u00ecnh xin kh\u00f4ng \u0111i qu\u00e1 s\u00e2u v\u00e0o mi\u1ec5n d\u1ecbch. Hy v\u1ecdng s\u1ebd gi\u00fap \u00edch cho qu\u00fd anh ch\u1ecb em.<\/div>\n
\n
$\"S\u01a1$
S\u01a1 \u0111\u1ed3 bi\u1ec3u di\u1ec5n<\/figcaption><\/figure>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
Nh\u00e0 thu\u1ed1c L\u01b0u V\u0103n Ho\u00e0ng – V\u00ec sao ph\u1ea3i ch\u1ee7ng ng\u1eeba v\u1eafc xin 3 lo\u1ea1i vi khu\u1ea9n (S. pneumonia, N. meningitidis, v\u00e0 H. influenza) \u1edf tr\u1ebb s\u01a1 sinh\/ ng\u01b0\u1eddi c\u1eaft l\u00e1ch? T\u00e1c gi\u1ea3: Bs. Phan Tr\u00fac \u0110\u1ec3 tr\u1ea3 l\u1eddi c\u00e2u h\u1ecfi n\u00e0y, c\u1ea7n chia ra m\u1ed9t s\u1ed1 \u00fd nh\u1ecf: 1. 3 t\u00e1c nh\u00e2n n\u00e0y c\u00f3 […]\n","protected":false},"author":1,"featured_media":32464,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-32463","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\/32463","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=32463"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/32463\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/32464"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=32463"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=32463"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=32463"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}