{"id":32595,"date":"2022-05-10T09:30:43","date_gmt":"2022-05-10T02:30:43","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=32595"},"modified":"2022-05-11T09:21:10","modified_gmt":"2022-05-11T02:21:10","slug":"thuoc-chong-dong-mau-khang-vitamin-k-ra-doi-nhu-the-nao","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/thuoc-chong-dong-mau-khang-vitamin-k-ra-doi-nhu-the-nao\/","title":{"rendered":"Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u kh\u00e1ng vitamin K ra \u0111\u1eddi nh\u01b0 th\u1ebf n\u00e0o?"},"content":{"rendered":"

Nh\u00e0 thu\u1ed1c L\u01b0u V\u0103n Ho\u00e0ng<\/a> \u2013 ch\u1ee7 \u0111\u1ec1: Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u kh\u00e1ng vitamin K ra \u0111\u1eddi nh\u01b0 th\u1ebf n\u00e0o?<\/a><\/strong><\/p>\n

Ngu\u1ed3n: Ngu\u1ed3n: Ngu\u1ed3n: B\u1ed9 m\u00f4n d\u01b0\u1ee3c li\u1ec7u \u2013 \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c TP HCM<\/strong><\/p>\n

L\u1ecbch s\u1eed h\u00ecnh th\u00e0nh thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u kh\u00e1ng vitamin K<\/h2>\n
Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u0111\u00e3 c\u00f3 m\u1ed9t qu\u00e1 tr\u00ecnh d\u00e0i ph\u00e1t tri\u1ec3n ph\u1ee9c t\u1ea1p, \u0111\u01b0\u1ee3c th\u1eeba h\u01b0\u1edfng c\u00e1c th\u00e0nh t\u1ef1u t\u1eeb sinh h\u00f3a, h\u00f3a h\u1ee3p ch\u1ea5t t\u1ef1 nhi\u00ean, c\u00f4ng ngh\u1ec7 sinh h\u1ecdc, gi\u00fap ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd cho con ng\u01b0\u1eddi ch\u00fang ta, b\u00ean c\u1ea1nh m\u1ed9t v\u00e0i c\u00f4ng d\u1ee5ng kh\u00e1c. Di\u1ec5n tr\u00ecnh l\u1ecbch s\u1eed \u0111\u00f3 \u0111\u00e3 \u0111\u1ec3 l\u1ea1i nh\u1eefng c\u00e2u chuy\u1ec7n th\u00fa v\u1ecb, nh\u1eefng b\u00e0i h\u1ecdc b\u1ed5 \u00edch, gi\u00fap ch\u00fang ta hi\u1ec3u h\u01a1n v\u1ec1 ho\u1ea1t \u0111\u1ed9ng nghi\u00ean c\u1ee9u khoa h\u1ecdc t\u1eeb tr\u01b0\u1edbc \u0111\u1ebfn nay. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 m\u1ed9t c\u00e2u chuy\u1ec7n nh\u01b0 v\u1eady.<\/p>\n
V\u00e0o \u0111\u1ea7u nh\u1eefng n\u0103m 1920, m\u1ed9t c\u0103n b\u1ec7nh gia s\u00fac xu\u1ea5t hi\u1ec7n \u1edf mi\u1ec1n B\u1eafc Hoa K\u1ef3 v\u00e0 Canada m\u00e0 tr\u01b0\u1edbc \u0111\u00f3 ch\u01b0a t\u1eebng ghi nh\u1eadn. Gia s\u00fac b\u1ecb xu\u1ea5t huy\u1ebft theo sau v\u00e0i tri\u1ec7u ch\u1ee9ng nh\u1ecf ho\u1eb7c \u0111\u00f4i khi t\u1ef1 ph\u00e1t m\u00e0 ch\u1eb3ng c\u00f3 d\u1ea5u hi\u1ec7u n\u00e0o. V\u00ed d\u1ee5, 21 trong s\u1ed1 22 con b\u00f2 ch\u1ebft sau khi l\u1ea5y s\u1eebng v\u00e0 12 trong s\u1ed1 25 con b\u00f2 \u0111\u1ef1c ch\u1ebft sau khi tri\u1ec7t s\u1ea3n. T\u1ea5t c\u1ea3 nh\u1eefng con v\u1eadt n\u00e0y \u0111\u00e3 ch\u1ea3y m\u00e1u \u0111\u1ebfn ch\u1ebft. T\u00ecnh h\u00ecnh n\u00e0y kh\u00e1 t\u1ed3i t\u1ec7 trong b\u1ed1i c\u1ea3nh \u0110\u1ea1i suy tho\u00e1i \u0111ang di\u1ec5n ra, n\u00f4ng d\u00e2n kh\u00f4ng \u0111\u1ee7 kh\u1ea3 n\u0103ng \u0111\u1ec3 l\u00e3ng ph\u00ed c\u1ecf kh\u00f4.<\/p>\n
N\u0103m 1921, Frank Schofield, m\u1ed9t nh\u00e0 nghi\u00ean c\u1ee9u b\u1ec7nh h\u1ecdc th\u00fa y \u1edf Canada, \u0111\u00e3 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n do gia s\u00fac \u0111\u00e3 \u0103n \u0111\u1ed3 \u1ee7 chua t\u1eeb c\u1ecf ba l\u00e1 ng\u1ecdt (Melilotus officinalis v\u00e0 c\u00f3 th\u1ec3 m\u1ed9t s\u1ed1 lo\u00e0i c\u00f9ng chi). \u00d4ng th\u1ea5y r\u1eb1ng ch\u1ec9 c\u00f3 c\u1ecf kh\u00f4 \u0111\u01b0\u1ee3c l\u00e0m t\u1eeb c\u1ecf ba l\u00e1 ng\u1ecdt tr\u1ed3ng \u1edf c\u00e1c bang ph\u00eda b\u1eafc Hoa K\u1ef3 v\u00e0 \u1edf Canada \u0111\u00e3 t\u1ea1o ra c\u0103n b\u1ec7nh n\u00e0y. Schofield t\u00e1ch th\u00e2n c\u00e2y c\u1ecf ba l\u00e1 b\u1ecb h\u1ecfng ra kh\u1ecfi, v\u00e0 cho m\u1ed9t ch\u00fa th\u1ecf kh\u00e1c \u0103n ch\u00fang. Con th\u1ecf \u0111\u00e3 \u0103n ph\u1ea3i th\u00e2n c\u00e2y t\u01b0\u01a1i v\u1eabn c\u00f2n kho\u1ebb, nh\u01b0ng con th\u1ecf \u0111\u00e3 \u0103n ph\u1ea3i c\u00e1c th\u00e2n c\u00e2y b\u1ecb h\u1ecfng ch\u1ebft v\u00ec b\u1ec7nh huy\u1ebft thanh. M\u1ed9t th\u00ed nghi\u1ec7m tr\u00f9ng l\u1eb7p v\u1edbi m\u1ed9t m\u1eabu c\u1ecf kh\u00e1c cho k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1. N\u0103m 1929, b\u00e1c s\u0129 th\u00fa y \u1edf B\u1eafc Dakota, L. M. Roderick \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng t\u00ecnh tr\u1ea1ng n\u00e0y l\u00e0 do thi\u1ebfu prothrombin ho\u1ea1t \u0111\u1ed9ng. Nh\u1eadn d\u1ea1ng ch\u1ea5t ch\u1ed1ng \u0111\u00f4ng trong c\u1ecf ba l\u00e1 ng\u1ecdt b\u1ecb h\u1ecfng v\u1eabn l\u00e0 m\u1ed9t b\u00ed \u1ea9n cho \u0111\u1ebfn n\u0103m 1940.<\/p>\n
Melilotus officinalis l\u00e0 m\u1ed9t lo\u1ea1i th\u1ef1c v\u1eadt h\u00e0ng n\u0103m ho\u1eb7c 2 n\u0103m thu\u1ed9c h\u1ecd \u0110\u1eadu (Fabaceae). Melilotus c\u1ea5u th\u00e0nh t\u1eeb 2 ph\u1ea7n Meli ngh\u0129a l\u00e0 m\u1eadt, lotus t\u1ee9c l\u00e0 hoa sen, officinalis: c\u00f3 t\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd. C\u1ea7n ph\u00e2n bi\u1ec7t chi Melilotus \u0111\u01b0\u1ee3c nh\u1eafc \u0111\u1ebfn trong b\u00e0i n\u00e0y v\u1edbi chi Trifolium (c\u0169ng c\u00f3 ngh\u0129a l\u00e0 3 l\u00e1). C\u00e1c l\u00e1 m\u1ecdc xen k\u1ebd tr\u00ean th\u00e2n v\u00e0 c\u00f3 ba l\u00e1 ch\u00e9t. Hoa m\u00e0u v\u00e0ng n\u1edf v\u00e0o m\u00f9a xu\u00e2n v\u00e0 m\u00f9a h\u00e8 t\u1ea1o qu\u1ea3, trong qu\u1ea3 th\u01b0\u1eddng ch\u1ee9a m\u1ed9t h\u1ea1t. H\u1ea1t gi\u1ed1ng c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i \u0111\u1ebfn 30 n\u0103m. Lo\u00e0i th\u1ef1c v\u1eadt n\u00e0y v\u1ed1n c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb \u00c1 \u00c2u v\u00e0 \u0111\u01b0\u1ee3c mang sang B\u1eafc M\u1ef9 \u0111\u1ec3 l\u00e0m th\u1ee9c \u0103n cho gia s\u00fac. M\u00f9a v\u1ee5 mang l\u1ea1i h\u01b0\u01a1ng v\u1ecb t\u1ed1t nh\u1ea5t c\u1ee7a c\u1ecf ba l\u00e1 ng\u1ecdt l\u00e0 xu\u00e2n \u0111\u1ebfn \u0111\u1ea7u h\u00e8. Do \u0111\u1eb7c t\u00ednh ch\u1ecbu h\u1ea1n v\u00e0 ch\u1ecbu l\u1ea1nh t\u1ed1t, l\u1ea1i c\u00f3 kh\u1ea3 n\u0103ng c\u1ed1 \u0111\u1ecbnh \u0111\u1ea1m m\u00e0 th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 c\u1ea3i t\u1ea1o \u0111\u1ea5t. C\u1ecf ba l\u00e1 ng\u1ecdt l\u00e0 ngu\u1ed3n cung c\u1ea5p m\u1eadt hoa ch\u00ednh cho ong m\u1eadt t\u1ea1i Hoa K\u1ef3.<\/p>\n
N\u0103m 1933, sau khi m\u1ed9t ng\u01b0\u1eddi n\u00f4ng d\u00e2n mang m\u1ed9t con b\u00f2 ch\u1ebft v\u00e0 m\u1ed9t lon s\u1eefa \u0111\u1ea7y m\u00e1u kh\u00f4ng \u0111\u00f4ng \u0111\u1ebfn m\u1ed9t tr\u1ea1m khuy\u1ebfn n\u00f4ng c\u1ee7a tr\u01b0\u1eddng, Karl Paul Link v\u00e0 ph\u00f2ng th\u00ed nghi\u1ec7m c\u1ee7a \u00f4ng c\u00f9ng c\u00e1c nh\u00e0 h\u00f3a h\u1ecdc l\u00e0m vi\u1ec7c t\u1ea1i \u0110\u1ea1i h\u1ecdc Wisconsin \u0111\u00e3 \u0111\u1ec1 ra c\u00e1ch ph\u00e2n l\u1eadp v\u00e0 nghi\u00ean c\u1ee9u ch\u1ea5t g\u00e2y xu\u1ea5t huy\u1ebft t\u1eeb c\u1ecf ba l\u00e1 kh\u00f4. Ph\u1ea3i m\u1ea5t n\u0103m n\u0103m \u0111\u1ec3 sinh vi\u00ean c\u1ee7a Link l\u00e0 Harold A. Campbell thu \u0111\u01b0\u1ee3c 6 mg ch\u1ea5t ch\u1ed1ng \u0111\u00f4ng k\u1ebft tinh. K\u1ebf ti\u1ebfp, m\u1ed9t sinh vi\u00ean kh\u00e1c c\u1ee7a Link, Mark A. Stahmann ti\u1ebfp qu\u1ea3n d\u1ef1 \u00e1n v\u00e0 b\u1eaft \u0111\u1ea7u vi\u1ec7c chi\u1ebft xu\u1ea5t quy m\u00f4 l\u1edbn, ph\u00e2n l\u1eadp 1,8 g ch\u1ea5t ch\u1ed1ng \u0111\u00f4ng k\u1ebft tinh trong v\u00f2ng 4 th\u00e1ng. Kh\u1ed1i l\u01b0\u1ee3ng n\u00e0y \u0111\u1ee7 cho Stahmann v\u00e0 Charles F. Huebner ki\u1ec3m tra k\u1ebft qu\u1ea3 c\u1ee7a h\u1ecd v\u00e0 m\u00f4 t\u1ea3 chi ti\u1ebft to\u00e0n b\u1ed9 h\u1ee3p ch\u1ea5t. Th\u00f4ng qua c\u00e1c th\u00ed nghi\u1ec7m tho\u00e1i gi\u00e1ng, h\u1ecd \u0111\u00e3 x\u00e1c \u0111\u1ecbnh ch\u1ea5t ch\u1ed1ng \u0111\u00f4ng l\u00e0 3,3′-methylenebis-(4-hydroxycoumarin), sau n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 dicoumarol. H\u1ecd \u0111\u00e3 x\u00e1c nh\u1eadn k\u1ebft qu\u1ea3 b\u1eb1ng c\u00e1ch t\u1ed5ng h\u1ee3p dicoumarol v\u00e0 ch\u1ee9ng minh v\u00e0o n\u0103m 1940 r\u1eb1ng s\u1ea3n ph\u1ea9m t\u1ed5ng h\u1ee3p gi\u1ed1ng h\u1ec7t v\u1edbi h\u1ee3p ch\u1ea5t c\u1ee7a t\u1ef1 nhi\u00ean.<\/p>\n
Dicoumarol<\/h2>\n
$\"Thu\u1ed1c$
Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u Dicoumarol<\/figcaption><\/figure>\n
Dicoumarol l\u00e0 m\u1ed9t d\u1eabn xu\u1ea5t dimer h\u00f3a c\u1ee7a h\u1ee3p ch\u1ea5t t\u1ef1 nhi\u00ean coumarin (kh\u00f4ng n\u00ean nh\u1ea7m l\u1eabn v\u1edbi Coumadin, t\u00ean th\u01b0\u01a1ng m\u1ea1i c\u1ee7a warfarin). Coumarin \u0111\u01b0\u1ee3c ph\u00e2n l\u1eadp v\u00e0o n\u0103m 1820 \u1edf Munich b\u1edfi A. Vogel t\u1eeb \u0111\u1eadu Tonka (Dipteryx odorata), ng\u01b0\u1eddi ban \u0111\u1ea7u nh\u1ea7m l\u1eabn h\u1ee3p ch\u1ea5t n\u00e0y v\u1edbi acid benzoic. Trong c\u00f9ng n\u0103m, Nicholas Jean Baptiste Gaston Guibourt \u0111\u1ebfn t\u1eeb Ph\u00e1p c\u0169ng \u0111\u1ed9c l\u1eadp t\u00ecm ra h\u1ee3p ch\u1ea5t n\u00e0y nh\u01b0ng ch\u1ee9ng minh n\u00f3 kh\u00f4ng ph\u1ea3i acid benzoic v\u00e0 sau \u0111\u00f3 \u0111\u1eb7t t\u00ean l\u00e0 coumarine, l\u1ea5y t\u1eeb coumarou, m\u1ed9t c\u00e1ch phi\u00ean \u00e2m ti\u1ebfng Ph\u00e1p t\u00ean g\u1ecdi \u0111\u1eadu Tonka c\u1ee7a ng\u01b0\u1eddi \u1ea4n \u0110\u1ed9. Sau \u0111\u00f3, coumarin \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong nhi\u1ec1u lo\u1ea1i th\u1ef1c v\u1eadt nh\u01b0 c\u1ecf ng\u1ecdt (Hierochloe odorata), woodruff (Galium odoratum, Rubiaceae), c\u1ecf vanilla (Anthoxanthum odoratum), c\u00e1c lo\u00e0i Qu\u1ebf, h\u00e0m l\u01b0\u1ee3ng th\u1ea5p h\u01a1n trong cam th\u1ea3o, o\u1ea3i h\u01b0\u01a1ng v\u00e0 m\u1ed9t s\u1ed1 lo\u1ea1i qu\u1ea3. Tr\u00ean th\u1ef1c t\u1ebf, coumarin t\u1ea1o n\u00ean t\u00ean g\u1ecdi chung \u201csweet clover\u201d (h\u01b0\u01a1ng th\u01a1m ng\u1ecdt ng\u00e0o) cho m\u1ed9t s\u1ed1 lo\u00e0i d\u1ef1a tr\u00ean m\u00f9i ng\u1ecdt ng\u00e0o n\u00ean \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong n\u01b0\u1edbc hoa t\u1eeb n\u0103m 1882, ch\u1ee9 kh\u00f4ng ph\u1ea3i v\u1ecb \u0111\u1eafng c\u1ee7a ch\u00ednh n\u00f3. V\u1ecb \u0111\u1eafng n\u00e0y khi\u1ebfn cho c\u00e1c v\u1eadt nu\u00f4i c\u1ea7n th\u1eddi gian \u0111\u1ec3 l\u00e0m quen. H\u00e0m l\u01b0\u1ee3ng coumarin trong d\u01b0\u1ee3c li\u1ec7u kh\u00f4 Melilotus officinalis kh\u00f4ng d\u01b0\u1edbi 0,3%, m\u1ed9t con s\u1ed1 kh\u00f4ng ph\u1ea3i l\u00e0 \u00edt. Coumarin \u0111\u01b0\u1ee3c l\u1ea5y t\u00ean chung cho nh\u00f3m h\u1ee3p ch\u1ea5t t\u1ef1 nhi\u00ean c\u00f3 khung c\u1ea5u tr\u00fac n\u00e0y.<\/p>\n
Tuy nhi\u00ean, coumarin kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 \u0111\u00f4ng m\u00e1u ho\u1eb7c t\u00e1c d\u1ee5ng gi\u1ed1ng warfarin. Tr\u01b0\u1edbc ti\u00ean, n\u00f3 ph\u1ea3i \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a b\u1eb1ng c\u00e1c lo\u1ea1i n\u1ea5m kh\u00e1c nhau th\u00e0nh c\u00e1c h\u1ee3p ch\u1ea5t nh\u01b0 4-hydroxycoumarin, sau \u0111\u00f3 ti\u1ebfp t\u1ee5c (v\u1edbi s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a formaldehyd t\u1ef1 nhi\u00ean) t\u1ea1o th\u00e0nh dicoumarol, \u0111\u1ec3 c\u00f3 t\u00ednh ch\u1ea5t ch\u1ed1ng \u0111\u00f4ng. S\u1ef1 t\u1ea5n c\u00f4ng c\u1ee7a n\u1ea5m g\u00e2y h\u1ea1i tr\u00ean c\u1ecf kh\u00f4 \u0111\u00e3 gi\u1ea3i th\u00edch s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a ch\u1ea5t ch\u1ed1ng \u0111\u00f4ng ch\u1ec9 c\u00f3 trong c\u1ecf \u1ee7 chua th\u1ed1i r\u1eefa. Do \u0111\u00f3, dicoumarol \u0111\u01b0\u1ee3c xem nh\u01b0 m\u1ed9t s\u1ea3n ph\u1ea9m l\u00ean men. C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y c\u00e1c d\u1eabn xu\u1ea5t coumarin kh\u00f4ng c\u00f3 nh\u00f3m OH tr\u00ean v\u1ecb tr\u00ed s\u1ed1 4 s\u1ebd kh\u00f4ng c\u00f3 \u0111\u1eb7c t\u00ednh kh\u00e1ng \u0111\u00f4ng.<\/p>\n
Thu\u1ed1c \u0111\u1ea7u ti\u00ean trong l\u1edbp \u0111\u01b0\u1ee3c th\u01b0\u01a1ng m\u1ea1i h\u00f3a v\u00e0 s\u1ea3n xu\u1ea5t r\u1ed9ng r\u00e3i l\u00e0 dicoumarol, \u0111\u01b0\u1ee3c c\u1ea5p b\u1eb1ng s\u00e1ng ch\u1ebf n\u0103m 1941 v\u00e0 sau \u0111\u00f3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0m d\u01b0\u1ee3c ph\u1ea9m. Karl Link ti\u1ebfp t\u1ee5c nghi\u00ean c\u1ee9u ph\u00e1t tri\u1ec3n thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u d\u1ef1a tr\u00ean coumarin \u0111\u1ec3 s\u1eed d\u1ee5ng l\u00e0m ch\u1ea5t \u0111\u1ed9c cho \u0111\u1ed9ng v\u1eadt g\u1eb7m nh\u1ea5m, d\u1eabn \u0111\u1ebfn s\u1ef1 ra \u0111\u1eddi c\u1ee7a warfarin v\u00e0o n\u0103m 1948. T\u00ean g\u1ecdi “warfarin” b\u1eaft ngu\u1ed3n t\u1eeb t\u1eeb vi\u1ebft t\u1eaft WARF, \u0111\u1ed1i v\u1edbi Qu\u1ef9 nghi\u00ean c\u1ee9u Alumni Wisconsin; k\u1ebft th\u00fac -arin ch\u1ec9 ra m\u1ed1i li\u00ean h\u1ec7 v\u1edbi coumarin. Warfarin l\u1ea7n \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c \u0111\u0103ng k\u00fd \u0111\u1ec3 s\u1eed d\u1ee5ng nh\u01b0 m\u1ed9t lo\u1ea1i thu\u1ed1c tr\u1eeb chu\u1ed9t \u1edf Hoa K\u1ef3 v\u00e0o n\u0103m 1948, v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u1ed5 bi\u1ebfn ngay l\u1eadp t\u1ee9c. M\u1eb7c d\u00f9 warfarin \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n b\u1edfi Link, T\u1ed5 ch\u1ee9c nghi\u00ean c\u1ee9u c\u1ef1u sinh vi\u00ean Wisconsin \u0111\u00e3 h\u1ed7 tr\u1ee3 t\u00e0i ch\u00ednh cho nghi\u00ean c\u1ee9u v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh b\u1eb1ng s\u00e1ng ch\u1ebf.<\/p>\n
Dicoumarol, warfarin c\u00f9ng m\u1ed9t s\u1ed1 h\u1ee3p ch\u1ea5t sau \u0111\u00f3 thu\u1ed9c v\u00e0o nh\u00f3m d\u1eabn xu\u1ea5t 4-hydroxycoumarin c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng Vitamin K.<\/p>\n
Gi\u1edbi thi\u1ec7u vitamin K<\/h2>\n
N\u1ebfu nh\u01b0 c\u00e2u chuy\u1ec7n v\u1ec1 nh\u00f3m h\u1ee3p ch\u1ea5t dicoumarol b\u1eaft \u0111\u1ea7u v\u1edbi \u0111\u00e0n gia s\u00fac b\u1ea5t h\u1ea1nh t\u1ea1i B\u1eafc M\u1ef9, th\u00ec c\u00e2u chuy\u1ec7n v\u1ec1 vitamin K l\u1ea1i b\u1eaft ngu\u1ed3n v\u1edbi…gia c\u1ea7m t\u1ea1i Ch\u00e2u \u00c2u.<\/p>\n
\u0110i\u1ec1u g\u00ec \u0111\u00e3 x\u1ea3y ra v\u1edbi \u0111\u00e0n gia c\u1ea7m?<\/h3>\n
N\u0103m 1929, nh\u00e0 khoa h\u1ecdc \u0110an M\u1ea1ch Henrik Dam trong khi \u0111ang nghi\u00ean c\u1ee9u v\u1ec1 vai tr\u00f2 c\u1ee7a cholesterol b\u1eb1ng c\u00e1ch cho \u0111\u00e0n g\u00e0 \u0103n th\u1ee9c \u0103n thi\u1ebfu nh\u00f3m ch\u1ea5t n\u00e0y \u0111\u00e3 ph\u00e1t hi\u1ec7n ra ch\u00fang b\u1ecb xu\u1ea5t huy\u1ebft. V\u1ea5n \u0111\u1ec1 n\u00e0y kh\u00f4ng gi\u1ea3i quy\u1ebft \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1ch b\u1ed5 sung cholesterol tinh ch\u1ebf. \u0110i\u1ec1u n\u00e0y c\u00f3 ngh\u0129a l\u00e0 g\u00ec? Ch\u1ebf \u0111\u1ed9 \u0103n c\u1ee7a \u0111\u00e0n g\u00e0 kia \u0111\u00e3 thi\u1ebfu \u0111i m\u1ed9t nh\u00e2n t\u1ed1 quan tr\u1ecdng g\u00e2y ra hi\u1ec7n t\u01b0\u1ee3ng xu\u1ea5t huy\u1ebft.<\/p>\n
Nh\u1eadn di\u1ec7n t\u00e1c nh\u00e2n<\/h3>\n
H\u1ee3p ch\u1ea5t quan tr\u1ecdng n\u00e0y sau \u0111\u00f3 \u0111\u01b0\u1ee3c ph\u00e2n l\u1eadp b\u1edfi Edward Adelbert Doisy v\u00e0 \u0111\u01b0\u1ee3c \u0111\u1eb7t t\u00ean l\u00e0 Vitamin K, h\u1eb3n l\u00e0 v\u00ec t\u1ea1p ch\u00ed c\u00f4ng b\u1ed1 c\u00f4ng tr\u00ecnh tr\u00ean ti\u1ebfng \u0110\u1ee9c r\u1ed3i (Koagulations vitamin). Henrik Dam v\u00e0 Edward Adelbert Doisy \u0111\u00e3 chia s\u1ebb gi\u1ea3i Nobel Y Sinh n\u0103m 1943 cho c\u00f4ng b\u1ed1 kh\u00e1m ph\u00e1 c\u1ee7a h\u1ecd v\u1ec1 vitamin K (K1 v\u00e0 K2) v\u00e0 vai tr\u00f2 c\u1ee7a n\u00f3 trong s\u1ef1 \u0111\u00f4ng m\u00e1u, xu\u1ea5t b\u1ea3n n\u0103m 1939. Adelbert Doisy \u0111\u00e3 c\u00f3 c\u00f4ng ph\u00e1t hi\u1ec7n vitamin K v\u00e0 Dam \u0111\u00e3 l\u00fd gi\u1ea3i \u0111\u01b0\u1ee3c quy tr\u00ecnh \u0111\u00f4ng m\u00e1u c\u1ea7n c\u00f3 vitamin K. \u00d4ng c\u00f2n ph\u00e1t hi\u1ec7n ra vitamin K c\u00f3 trong t\u1ea5t c\u1ea3 c\u00e1c lo\u1ea1i rau qu\u1ea3 v\u00e0 \u0111\u1eadu nh\u01b0 c\u00e0 chua, \u0111\u1eadu n\u00e0nh, c\u1ecf linh l\u0103ng v\u00e0 m\u1ed9t s\u1ed1 \u0111\u1ed9ng v\u1eadt. N\u0103m 1939, Doisy v\u00e0 c\u1ed9ng s\u1ef1 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c c\u1ea5u tr\u00fac c\u1ee7a vitamin K.<\/p>\n
C\u00e1c lo\u1ea1i Vitamin K<\/h3>\n
$\"Ngu\u1ed3n$
Ngu\u1ed3n g\u1ed1c Vitamin K t\u1eeb t\u1ef1 nhi\u00ean<\/figcaption><\/figure>\n
Vitamin K1 (phylloquinone) c\u00f3 nhi\u1ec1u trong c\u00e1c lo\u1ea1i rau xanh (c\u1ea3i, b\u00f4ng c\u1ea3i,\u2026), d\u1ea7u th\u1ef1c v\u1eadt (d\u1ea7u \u0111\u1eadu n\u00e0nh), tr\u00e1i c\u00e2y (b\u01a1, kiwi, nho,\u2026). Tuy nhi\u00ean, ch\u1ec9 5-10% l\u01b0\u1ee3ng vitamin K1 \u0111\u01b0\u1ee3c h\u1ea5p thu \u1edf \u0111\u01b0\u1eddng ti\u00eau ho\u00e1 t\u1eeb ngu\u1ed3n th\u1ef1c ph\u1ea9m. Vitamin K1 gi\u1eef vai tr\u00f2 ho\u1ea1t ho\u00e1 y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u \u1edf gan.<\/p>\n
Vitamin K2 (menaquinone) \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong c\u00e1c th\u1ef1c ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c \u0111\u1ed9ng v\u1eadt v\u00e0 c\u00e1c th\u1ef1c ph\u1ea9m l\u00ean men. Vitamin K2 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia th\u00e0nh nhi\u1ec1u lo\u1ea1i ph\u1ee5 kh\u00e1c nhau, tuy nhi\u00ean 2 lo\u1ea1i vitamin K2 quan tr\u1ecdng nh\u1ea5t th\u01b0\u1eddng \u0111\u01b0\u1ee3c nh\u1eafc \u0111\u1ebfn l\u00e0 MK-4 v\u00e0 MK-7. Vitamin K1 c\u00f3 th\u1ec3 chuy\u1ec3n h\u00f3a th\u00e0nh MK-4 t\u1ea1i tinh ho\u00e0n, tuy\u1ebfn t\u1ee5y v\u00e0 th\u00e0nh \u0111\u1ed9ng m\u1ea1ch.<\/p>\n
N\u1ebfu thi\u1ebfu m\u1ea5t chu\u1ed7i isoprenyl trong c\u1ea5u tr\u00fac s\u1ebd t\u1ea1o th\u00e0nh h\u1ee3p ch\u1ea5t \u0111\u01a1n gi\u1ea3n Menadione, g\u1ecdi l\u00e0 Vitamin K3, th\u01b0\u1eddng ch\u1ee7 y\u1ebfu s\u1eed d\u1ee5ng cho v\u1eadt nu\u00f4i.<\/p>\n
C\u01a1 duy\u00ean gi\u1eefa Vitamin K v\u00e0 warfarin<\/h2>\n
$\"C\u1ea5u$
C\u1ea5u tr\u00fac c\u1ee7a warfarin v\u00e0 vitamin K<\/figcaption><\/figure>\n
Sau m\u1ed9t tai n\u1ea1n x\u1ea3y ra v\u00e0o n\u0103m 1951, khi m\u1ed9t qu\u00e2n nh\u00e2n Hoa K\u1ef3 t\u1ef1 s\u00e1t b\u1eb1ng nhi\u1ec1u li\u1ec1u warfarin trong thu\u1ed1c di\u1ec7t chu\u1ed9t nh\u01b0ng h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n sau khi \u0111\u01b0a \u0111\u1ebfn b\u1ec7nh vi\u1ec7n v\u00e0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng vitamin K (sau n\u00e0y g\u1ecdi l\u00e0 thu\u1ed1c gi\u1ea3i \u0111\u1ed9c \u0111\u1eb7c hi\u1ec7u-antidote), c\u00e1c nghi\u00ean c\u1ee9u b\u1eaft \u0111\u1ea7u b\u1eb1ng vi\u1ec7c s\u1eed d\u1ee5ng warfarin nh\u01b0 thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u0111i\u1ec1u tr\u1ecb.<\/p>\n
Theo m\u1ed9t c\u00e2u chuy\u1ec7n \u0111\u01b0\u1ee3c Karl Link k\u1ec3 l\u1ea1i th\u00ec T\u1ed5ng th\u1ed1ng Hoa K\u1ef3 Dwight Eisenhower t\u1eebng \u0111\u01b0\u1ee3c tr\u1ecb li\u1ec7u b\u1eb1ng warfarin sau khi b\u1ecb \u0111au tim v\u00e0o n\u0103m 1955. M\u00e3i cho \u0111\u1ebfn 1978 th\u00ec hi\u1ec3u bi\u1ebft v\u1ec1 m\u1ed1i li\u00ean h\u1ec7 gi\u1eefa nh\u00f3m 4-hydroxycoumarin v\u00e0 vitamin K m\u1edbi c\u00f3 ti\u1ebfn tri\u1ec3n. R\u1eb1ng nh\u00f3m thu\u1ed1c n\u00e0y \u0111\u00e3 \u1ee9c ch\u1ebf m\u1ed9t enzym g\u1ecdi l\u00e0 vitamin K epoxide reductase.<\/p>\n
Warfarin \u0111\u00e3 l\u00e0m g\u00ec?<\/p>\n
T\u01b0\u1edfng t\u01b0\u1ee3ng r\u1eb1ng c\u01a1 th\u1ec3 ch\u00fang ta lu\u00f4n c\u00f3 nh\u1eefng c\u00f4ng t\u1eafc sinh h\u1ecdc, mu\u1ed1n b\u1eadt c\u00f4ng t\u1eafc n\u00e0y th\u00ec ph\u1ea3i \u0111\u1ee5ng \u0111\u1ebfn c\u00e1c enzym \u0111\u1eb7c hi\u1ec7u. Vitamin K epoxide reductase l\u00e0 m\u1ed9t enzym ki\u1ec3u v\u1eady, n\u00f3 g\u00f3p ph\u1ea7n tham gia v\u00e0o c\u00e1i g\u1ecdi l\u00e0 v\u00f2ng lu\u1ea9n qu\u1ea9n c\u1ee7a vitamin K. Nh\u01b0ng vitamin K kh\u00f4ng lu\u1ea9n qu\u1ea9n v\u00f4 \u00edch, trong l\u00fac bi\u1ebfn h\u00ecnh nh\u01b0 v\u1eady (gi\u1eefa d\u1ea1ng quinol ho\u1ea1t \u0111\u1ed9ng v\u00e0 d\u1ea1ng epoxide b\u1ea5t ho\u1ea1t), n\u00f3 \u0111\u1ed3ng th\u1eddi c\u0169ng b\u1eadt t\u1eaft nh\u00f3m c\u00f4ng t\u1eafc \u0111\u00f4ng m\u00e1u – ch\u1ea3y m\u00e1u trong c\u01a1 th\u1ec3.<\/p>\n
Kh\u00f4ng ph\u1ea3i t\u1ef1 d\u01b0ng m\u00e0 nh\u00e0 warfarin b\u1eadt t\u1eaft \u0111\u01b0\u1ee3c c\u00e1i c\u00f4ng t\u1eafc v\u1ed1n d\u0129 thu\u1ed9c nh\u00e0 Vitamin K, \u0111\u00f3 l\u00e0 do n\u00f3 chia s\u1ebb m\u1ed9t c\u1ea5u tr\u00fac t\u01b0\u01a1ng \u0111\u1ed1i t\u01b0\u01a1ng t\u1ef1. Kh\u00e1i ni\u1ec7m n\u00e0y g\u1ecdi l\u00e0 ch\u1ea5t ch\u1ee7 v\u1eadn (hay \u0111\u1ed3ng v\u1eadn) v\u00e0 ch\u1ea5t \u0111\u1ed1i v\u1eadn. Ch\u1ee7 v\u1eadn th\u00ec t\u00e1c d\u1ee5ng nh\u01b0 ch\u1ee7 nh\u00e0 (tr\u01b0\u1edbc sao gi\u1edd v\u1eady \u1ea5y \u1ea1), \u0111\u1ed1i v\u1eadn t\u1ee9c l\u00e0 g\u1eafn v\u00f4 nh\u01b0ng \u0111\u1ea3o ng\u01b0\u1ee3c qu\u00e1 tr\u00ecnh n\u00e0y (th\u01b0\u1eddng l\u00e0 kho\u00e1 n\u00f3 l\u1ea1i). Warfarin \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 1 ch\u1ea5t \u0111\u1ed1i v\u1eadn c\u1ee7a vitamin K.<\/p>\n
M\u1ed9t s\u1ed1 thu\u1ed1c kh\u00e1c \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n trong nh\u00f3m bao g\u1ed3m acenocoumarol (th\u1eddi gian b\u00e1n th\u1ea3i ng\u1eafn h\u01a1n) v\u00e0 phenprocoumon (d\u00e0i h\u01a1n),…<\/p>\n","protected":false},"excerpt":{"rendered":"
Nh\u00e0 thu\u1ed1c L\u01b0u V\u0103n Ho\u00e0ng \u2013 ch\u1ee7 \u0111\u1ec1: Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u kh\u00e1ng vitamin K ra \u0111\u1eddi nh\u01b0 th\u1ebf n\u00e0o? Ngu\u1ed3n: Ngu\u1ed3n: Ngu\u1ed3n: B\u1ed9 m\u00f4n d\u01b0\u1ee3c li\u1ec7u \u2013 \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c TP HCM L\u1ecbch s\u1eed h\u00ecnh th\u00e0nh thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u kh\u00e1ng vitamin K Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u0111\u00e3 c\u00f3 m\u1ed9t qu\u00e1 tr\u00ecnh d\u00e0i […]\n","protected":false},"author":1,"featured_media":32624,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-32595","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\/32595","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=32595"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/32595\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/32624"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=32595"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=32595"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=32595"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}