Cu 1: trnh by ngnhn v biu hin ca nhim toan chuyn ho.

Cho vd -nhim acid: l tnh trng cc acid thm nhp vo huyt tng (t tb hoc t ngoi mi) hoc tnh trng huyt tng b mt cc mui kim, lm cho pH c xu hng jm xung -nhim acid chuyn ho l s tch lu (.) mu cc acid hoc s mt nhiu mui kim -nguyn nhn: do nhim acid ni sinh hoc t ngoi mi (thuc, truyn dch) hoc do ko o thi c acid hoc mt nhiu mui kim +nhim acid chuyn ho sinh l: ., (.) lng nng: do c 1 fn glucid chuyn ho ym kh -> acid lactic tm thi tng (.) mu ., (.) cn i s huy ng m c th lm gan a vo mu 40g acid thuc th cetonic +nhim acid chuyn ho bnh l: .,gp (.) cc bnh c chuyn ho ym kh: bnh tim mch, bnh h hp lm c th thiu O2 .,tiu ng do tu: m b chuyn ho mnh nhng ko vo c vng Krebs m bin thnh th cetonic gy nhim acid nng .,cc bnh lm mt kim: l d tu, l d mt,suy thn trng din, c bit mt nhiu kim (.) tiu chy cp v fn ln cc dch tiu ho cha mui kim ., bnh thn: vim cu thn cp, vim ng thn cp, suy thn lm c th ko o thi c acid .,c th nhim toan do a acid vo c th (thuc, dch cha bnh) vd dch truyn c nhiu acid citric -biu hin: +th nhanh, kh th +bun nn, nn ma (p thi acid) +dch v tng tit, tng toan +ri lon chuyn ho +nhim c thn kinh, hn m Cu 2: trnh by ngnhn v biu hin ca nhim toan h hp.vd -nhim toan h hp: acid cacbonic ng lm t s 1/20 ca h m bicacbonat c xu hng tng ln -ngnhn: +nhim acid h hp sinh l: ., (.) gic ng: trung tm h hp km nhy cm vi CO2 -> b tch li v hi tng (.) mu ., (.) lng nng: CO2 to ra vt qu kh nng o thi +nhim acid hi bnh l: ., (.) gy m su, ng c thuc m, thuc ng: trung tm h hp b c ch ., cc bnh tun hon: lm km vn chuyn mu n fi vd: suy tim ton b, suy tim fi ., cc bnh gy tng kh cn ca fi : do cn tr s khuch tn ca CO2 t mu ra vd: x fi, lao x, suy tim tri, hen ., cc bnh ca g dn kh: lm cn tr s lu thng ca ko kh th: vim f qun, d vt, ph thanh qun, hen suyn, ngt (f fi cp, bch hu) ., vim fi thu: ng bnh c im au ko dm th mnh, vim xut tit lm thu fi ng c, p vim l vng xquanh f n km thng kh .,vim f qun tr em: vim ri rc fi v cc f qun, hn ch s trao i kh, p vim lan c sang vng lnh gy xut tit, co tht f qun v km n hi f nang, p st to nhiu CO2 -biu hin: +kh th +trung tm h hp b kthch +tm ti Cu 6: Nu v ptch quy lut vtr ca p tnh (.) bnh sinh -Tnh p ca c th l tp hp cc 2 p ca c th trc cc kthch ni chung v trc bnh nguyn ni ring. Tnh p # nhau c th lm qtrnh bnh sinh mi c th v mi nhm khng jng nhau a li cc kqu # nhau (tt, xu, nng, nh) -Trc tng ca 1 kthch no (gy bnh hoc ko gy bnh) c th p ng li = 1 hay nhiu p: +S p ng c th = loi p chung cho nhiu loi: ng t co li khi nh sng cng chiu vo vng mc, tng glucose mu khi au n +Loi p ring cho cc c th (.) 1 loi, ring cho tng c th: ng khi b stress th tng nhp tim, c ng tng mnh -> hi hp lo lng, c ng th tng rt t +Nu c th c chung 1 p trc kthch ng ta xp h thnh nhm v thnh ku p: nhm ng j, nhm ng tr +a s p mang m du vt di truyn v tnh bm sinh nhng cng c nhiu p hthnh (.) i sng f thuc vo ti, ji, yu t tkinh - ni tit, mi trg, thi tit Cu 3: nu cc t/c c bn trong kn K/hc v bnh, vd -Bnh c t/c 1 cn bng mi km bn vng: +S hng nh ni mi l kqu ca 1 cn bng sinh l ja 2 qtrnh: qtrnh tn to v qtrnh tiu hu. Vd: glucoza huyt l kqu ca s cn bng ja tiu v to glucoza

+Khi 1 yu t v bnh xm nhp vo trong c th, c th c nhng p bo v, p ny to ra trng thi cn bng mi, cn bng ny k ko di v thng bin i theo hng hoc hi fc trong trng thi cn bng ban u (khi bnh ) hoc cn bng tin trin theo hng bt li cho c th vt qu knng bo v ca cth -> t vong. Vd: bnh i tho ng -Bnh hn ch knng thch nghi ca c th +Cth lun tm cch thch nghi vi ngoi cnh bng nhiu c ch nhm duy tr s hng nh ni mi. Khi yu t ngoi mi thay i mnh m n mc lm thay i ni mi th c th vn cn knng thch nghi song b hn ch. +Vd: khi st knng iu ho thn nhit vn cn, ng bnh ra lnh vn c p tng to nhit vo nng vn thi nhit nhng p k mnh m nh khi khe. knng iu ho ng huyt ca ng b x gan hn ch -Bnh hn ch knng lng: +Bnh gy s tn thng, lch lc ri lon ctrc, cnng t mc pt, tb, m, c quan, ton c th -> jm knng lng thm ch nhiu bnh li di chng lm mt knng lng +Vd: khi st bnhn mt mi -> jm hot ng Bnh bi lit lm mt knng lng v vy thc hin fng chm fng bnh l chnh v trong iu tr fi ch n bo tn nht l nhng c quan chc nng c lquan n lng Cu 4:Trby cc kn Khc v bnh nguyn. Vd -Kn K/hc v bnh nguyn l quan nim c da trn duy vt bin chng, t c mqh ng n ja ngnhn v kin gy bnh v p dng c quy lut nhn qu. bnh nguyn gm nguyn nhn v kin -Mqh ngnhn k: ngnhn l quyt nh, l yu t khch quan: +Bnh k t sinh ra m fi do ngnhn no c th c tm ra hoc cha c tm ra +Ngnhn khi tng ln c th trong k nht nh s gy bnh v quyt nh tnh c hiu ca bnh. Trong hu ht trng hp bnh ny biu hin k jng bnh # do chng c nhng ngnhn khc nhau. Vd: bnh lao do trc khun lao cn bnh a chy do vk t +Ngnhn ch ft huy c tdng ca n trong nhng k nht nh ca c th v mi trng. vd lao phi do trc khun lao gy ra song thng xy ra ngi suy yu sc chng jm, hon cnh sinh hot kh khn. +k h tr v to thun li cho ngnhn nhng k ko th gy bnh nu thiu ngnhn. Vd 1 ng d n ung thiu thn, lng nng nhc cng k th mc bnh nu ko nhim vk lao +C ngnhn i hi nhiu k mi ft huy tdng nhng c nhng ngnhn i hi t k. thm ch c ngnhn dng nh k cn k j gy bnh, vd da tht tip xc vi nhit rt cao hu nh gy bnh bng -S hon i: +Ngnhn trong trng hp ny c th l k trong trng hp khc: n ung thiu thn l ngnhn ca suy dinh dng nhng trong nhiu trng hp l k ca bnh lao +k trong trng hp ny c th l ngnhn trong trng hp khc: lnh l k cho virus ng mi hng gy cm cm, lnh li gy ra nhim lnh -Ngnhn - hu qu: +Mi hu qu u fi c ngnhn no vd bnh bi lit l do virus +C ngnhn cha hn c hu qu do thiu k hoc do th tng v s p tt ca c th. Vd c th c mdch hoc thch nghi +1 ngnhn c th gy nhiu hu qu tu thuc vo k. Vd: vk lao c th gy nhng bnh khc nhau: rut, fi, ct sng, mng no +Cc ngnhn khc nhau c th gy cng 1 hu qu. Vd: bnh l c th do 2 ngnhn hon ton khc nhau gy ra do amip v do vk Shigella -P ca cth: +Cng 1 ngnhn mi c th khc nhau gy hu qu khc nhau. Vd: d ng +Tnh p c th tng t nhau c cng ng thm ch c dn tc. vd: F n Chu Fi him khi b bnh long xng. Ng Chu Phi him khi b su rng +C nhng p c bit r, vd tnh trng MD ca c th: ng mc hoc tim chng 1 bnh nhim khun s k mc bnh na +Tnh p trc 1 yu t gy bnh nu t nhiu c tnh h thng v tnh di truyn th c gi l tng, vd : tng d ng, tng d xut huyt nim mc +Da vo cht lng v mu sc hcu: thng da vo ch s lng Hb trung bnh hcu (MCH): .,Thiu mu nhc sc: MCH< 27 pg .,Thiu mu u sc: MCH> 35 pg .,Thiu mu ng sc: MCH = 27-35 pg Vd: thiu mu nhc sc do thiu Fe, thiu mu u sc do thiu VTM B12 v acid folic +Da vo ngnhn v c ch bnh sinh: .,Thiu mu do chy mu ( cp v mn tnh): thng nhc sc. vd: chn thng v tng .,Thiu mu do tan mu (ngnhn ti hcu hay huyt tng): thng ng sc. vd st rt .,Thiu mu do jm sinh mu (do thiu nguyn liu, do cnng tu km) vd: suy tu, thiu Fe, suy dinh dng

Cu 7: Th no l p thc ngo (.) y hc, cho vd -P2 thc ngo l p2 bt chc nh tht, chun m hnh thc t vo thc ngo. l p2 xut ft t s qst cc htng bnh l sau dng nhng hiu bit c cminh t trc ct ngha chng, cui cng dng 1 hoc nhiu thc ngo cminh s ng sai ca j thuyt -P2 thc ngo c 3 bc: qst htng bnh l, c ch bnh sinh, thc ngo cminh r rng -vd: gy m hnh sc = cch to ra chn thng ch +dng v p mnh ltc vo mt (.) i sau ca ch n khi HA jm 60mmHg qst ton trng: ., con ch: sc c 2 g: -sc cng: HA tng -sc nhc: HA jm ., mch: nhanh, nh, h hp nhanh, nng Cc ch tiu c xu hng thay i, ko u +Chn thng gy dp nt ti ch -> sinh ra cht c. ., chn thng gy RL tkinh, gy au n qu mc ., Cht c sinh ra t t chc ko fi l ngnhn ch yu gy ra sc m n ch 1 fn gy ra sc hoc g no +Sc chn thng do RL tkinh v au n qu mc

Cu 5: (c s cui) Trby knim v bnh sinh v vng xon bnh l (.) bnh sinh. Vd c th -Bnh sinh l qtrnh din bin ca 1 bnh t khi bt u n khi kt thc. Vd: bnh vim cu thn cp: xhin sau 1 nhim trng do nhng lin cu dung huyt nhm A typ 12. ., fc hp KN-KT t nhim trng tin ft n lng ng cu thn vi s kt hp ca b th gy 1 lot cc p lm tn thng t chc ti ch thn. fc hp ny gn vi cc ctrc ca cu thn to fc hp c tnh KN kthch c th sinh KT chng li chnh t chc ca mnh ., mt # s lng ng fc hp MD trn ni mc cu thn gy p thm nhim bi cc Bcu t mu hoc tb ca t chc lkt -> tn thng tng sinh .,Hqu: thay i cu thn lm jm cnng lc ca cu thn ko theo nhng thay i cnng ca ng thn -> thu niu, v niu. Vim cu thn cp c th: +suy thn cp vi ur huyt cao -> t vong +vim cu thn mn +khi bnh -vng xon bnh l: (.) qtrnh bnh sinh nhng ngnhn ban u c th gy ra nhng hu qu nht nh, nhng thay i ny li l nhng ngnhn ca nhiu ri lon mi v nhng ri lon mi c th gy nhng hu qu # nhau. kqu l bnh ko ngng tin trin v ngy 1 nng. bit nhng khu sau li tng tr li khu trc hthnh vng xon bnh l Vd (s Cu19: nu cc t.cht c bn ca s lo ha v yu t chi phi tui th +t/c c bn ca s lo ha - l quy lut tt yu v ng vi tt c cc loi -thay i c bn ca c th gi so vi tr(ngoi hnh, chc nng, kha nng mc bnh)c tnh quy lut cho mun loi -T/K khng ng th v khng ng tc trong s lo ha:khc nhau cp d loi, chng, c th v c quan -qu trnh lo ha khc gia cc loi v khc nhau v tui th ti a tc tng t l t vong theo tg, khc nhau gia cc loi c tnh quy lut *cc yu t chi phi tui th: +tui th lin quan n gen -quan st thng k cho thy tui th khc nhau gia cc loi, chng, dng h, gia nh=>do gen chi phi -qua lai 2 dng sc vt c tui th cao v thp=>dng tui th TB +tui th lin quan n mi trng, k sng: quan st loi ng c tui th TB tng theo LS pht trin XH

Cu 12: trby 1 s hiu bit c bn v cc hot cht trung jan (.) vim -Cc hot cht trung jan xut ft t tn thng tin ft v th ft -Bn cht l cht chuyn ho trung jan glucid, lipid, protein c hot tnh sinh hc cao -Gm: +Cc acid amin hot mch

+Cc dn xut acid bo, leucotrien gy au v hp dn BC +Cc men ca lysosom gy hu hoi t chc: collagen +Cc kinin, bradykinin +Cc lymphokin: TL-1: hot ho tb, TL-2: tng sinh tb, TL-3: tng tu xng

Cu 11: nu v s thc bo (.) vim: -Thc bo l htng BC bt j v tiu ho cc i tng thc bo (VK, mnh tb b fn hu) -cc tp tham ja: TB, lympho bo, tb ni m -Cc gon: +Ho hng ng -> thu ht BC ti vim: ti vim BC c hot ho lm cho knng thc bo tng ln r rt. v hnh thi chng ln hn cc thc bo bthng cha nhiu ty th, lp th, lysosome, giu li golgi, ribosome, v sinh ho chng cha nhiu protein, ATP, glycogen +BC bm dnh v xuyn mch: BC tip cn i tng thc bo, bao quanh chng, sau lysosome tin ti ho mng gphng cc cht fn hu i tng thc bo +Thc bo: khi b thc bo cth xy ra 5 knng: .,N b tiu dit nh vtr ca lysosom .,N k b tiu dit m tn ti lu (.) tb nh bi than (.) tb fi, cht hemosiderin gan (.) bnh x gan nhim st .,N k b tiu hu v c th theo thc bo i ni # gy vim mi .,N c th b nh ra m TB k cht .,N lm cht thc bo: lao, lin cu khun +tr ng nhn gy vim hn l tr triu chng vim

Cu 15: Trby bn cht, nggc ca cc cht gy st v c ch gy st -Bn cht. ngun gc: +Cht gy st ngoi sinh: loi a t ngoi vo c th: vk, virus, nm, kst +Loi ni sinh: do sfm hu hoi m ca c th: xut huyt ni, hoi t t chc + Mui: tim mui vo di da hay bp tht u gy st +Thuc: 1 s thuc c tdng kthch sinh nhit: thyroxin -C ch: cht gy st ngoi sinh t ngoi vo c th thng c nggc vk, kthch i thc bo sinh ra cht gy st ni sinh, cht gy st ni sinh tng ln vng di i thng qua Prostaglandin E2 tng ln th th ca n lm thay i im t iu ho nhit cao hn bthng, ngha l trung tm p vi nhit 370c l b nhim lnh v iu chnh nhit c th theo hng tng sn nhit, jm thi nhit

Cu 16: nu cc hu qu v RLCH trong st -Chuyn ho nlng: do nhu cu tng thn nhit nn CH nlng tng kh r. nhit tng 10c -> CH tng 3-5%

-Chuyn ho glucid: l nlng ch yu sdng gon u ca st. nlng d tr trong gan: glycogen -> glucose -> glucid jm -> cn kit. c th tng to glucid t protid -> khi st cn truyn ng glucose -Chuyn ho lipid: lun b huy ng trong st, nht l khi lng glucid bt u cn kit, lm lipid mu tng cao, xhin th xeton -Chuyn ho protid: do nhim c, nhim trng, i n. Tng to KT, b th, BC lm cho huy ng protid d tr tng ln -Nhu cu sinh t: do tng CH nn nhu cu sinh t B1, C tng rt mnh -CH mui nc v thng bng kim toan:CH mui nc thay i theo din bin ca st: +G u: CH mui nc hi tng +G 2: aldosterol, ADH tng -> j nc v mui thn v tuyn m hi -> da kh, lng nc tiu jm -> thy kht +G 3: ADH, aldosterol c gphng khi tuyn m hi -> v m hi, lng nc tiu tng ln -> thn nhit tr v bt

Cu 18: cho bit ngha ca p st v thi x tr khi gp trg hp bn st -Thi x tr: +Duy tr p bo v t nhin ca c th, k h nhit v nguyn nu st k t ra nguy him v gy hu qu ln i vi din bin v tin lng bnh +Jp c th chu ng c cc hu qu xu ca st v khc fc hu qu hn l ct cn: b nc, tr tim, b sung VTM +Can thip h st nu c hu qu ln, qu sc chu ng ca c th +Tm ngnhn x tr ng Cu20: nu s thay i c bn trong qu trnh lo ha *thay i mc ton thn -ngoi hnh: dng dp, c ch -th lc: gim st, km chu ng, km thch nghi trc han cnh khng thun li -d mc bnh, t vong *thay i mc c quan. +thn kinh:gim s lng TB TK, tch t sc t Lypofuchsin-cht c trng ca qu trnh lo ha, gim sm xut cht dn truyn trung gian=>tng ngungx v gim tc phn x do km dn truyn -gim sm xut Catecholamin=> gim kh nng hng phn -s thay i chc nng vng di i din ra chm +h ni tit:thay i nng nhiu hooc mn trong mu v gim mc nhy cm ca c quan ch=> gim kh nng iu ha nhit -gim hot ng ca tuyn sinh dc -tuyn thng thn gim mc cm ng vi s kch thch ca vng di i v c tuyn yn -suy gim chc nng tuyn gip=>nh hng ti thn nhit -di lon hot ng ca tuyn ty -tuyn c lien tc gim kch thc v chc nng +h MD -KT trong mu: gim hiu gi KT t nhin, gim p ng to KT vi KN ngoi lai, tng sm xut t KT -p ng MD TB gim phn ng da, gim phn bo(blast ha), gim sm xut IL-2, gim hot tnh v s lng TH trong h tr sm xut KT, gim SXIL-3, gim sm xut TH1, gim s lng v ch nng TCD4 +M khi gim cc glycoprotein, proteoglycan cu trc nn cc si n hi, tng Collagen -xng cng b x, gim lng ng canxi +cc c quan khc: -tun hon:HA tng, tim v mch x ha, gim mt mao mch, km p ng vnhy cm vi s iu ha ni tit TKT v TV -phi:pht trin m x, nhu m km n hi -thn:c c nc tiu km, s lng gim, gim t trng -to mu gim -tiu ha:gim tit dch Cu21:trnh by s thay i mc phn t trong qu trnh lo ha.-qu trnh lo ha s ko theo s tch ly cc phn t ch gp o tui tr trong tnh trng bnh l: lipofusin trong nhiu loi TB hoc hemosiderin trong TB h lien vng hoc dng tinh bt hu ht ng gi trn 80 tui, b ba c quan nhim dng tinh bt (amyloit): no, tim, o ty, -cc pt collagen tr nn tr ,km ha tan,d b co do nhit, o ln cu trc v gn glycosyl -tch ly nhiu enzyme mt c hiu,k cn h, nhng ng ch nht l bin i trong AND &ARN +AND gn cht hn vi histon v KL,d b phn on, nhu NST c cto sai lc +cc enzyme chu trch nhim phc hi cc tn thng ca AND cng gim hot tnh

CU 22nu nhng thng c v bnh ng gi -gi lm gim cnng cc c quan->hn ch knng thch ng v phc hi, d a n ri lon cn bng ni mi,tin cho bnh tt xhin -bnh ng gi c th l bnh nh t tui tr nay ptrin mnh c th gi -c th coi bnh ng gi l bnh pht sinh do tui, bt ngun t s thay i Tb, cquan, h thng trong qtrnh lo ha a n tnh trng km bo v=>t l t vong tng -din bin bnh khng in hnh, d bt ng -bnh c trng chon ng gi thng gp:ung th, tim mch, HA, tiu g, long xng -qu trnh lo ha c vai tr ca ngoi cnh v di truyn Cu 30:T.by n, n.nhn, hu qu ca tc rut n: Tc rut l tnh trng 1 on rut mt lu thng khin fa trn b cng jn do t.n & cht dch tr. N.nhn: C hc: tht rut, xon rut,lng rut, tc do bi giun, thot v bn. Chc fn: lit rut, cng f giao cm. Hu qu: khc nhau tu tng v tr tc cao hay thp. Tc cao: mt nc do nn c bit l khi tc mn v gy nn nhiu, mt acid --> nhim kim. Tc t trng: nn ra dch rut, mt kim--> nhim acid. Tc thp: tnh trng nhim c nng hn mt nc. Cu 31: P.tch n.nhn & c ch ri lon hp thu ti rut & ngoi rut: Hp thu l c.nng quan trng ca rut cng l ca ton b h tiu ho --> kh nng hp thu ni l c.nng chung ca rut & hi chng km hp thu c coi l tnh trng thiu nng tiu ho. N.nhn & c ch: Ti rut: + Nhim khun gy vim rut mn tnh, k c RL VK ch & s c mt ca KST. + Nhim c tiu ho: cht c trc tip ln NM ng tiu ho: ru, cc thuc ty, thuc cha lao... + Gim tit enzym tiu ho: cc cht c ni trn lm teo NM tiu ho, c ch tit enzym tiu ho. + Gim din hp thu: ct 1 on rut, RL tun hon ti rut. Ngoi rut: +Bnh d dy: vim,lot,v toan,ung th... tc ng trc tip hay gin tip .hng xu n co bp & tit dch rut. + Suy gan: gy thiu mui mt hp thu lipid. + Suy ty: thiu 1 ngun enzym quan trng. + 1 s bnh ni tit: suy cn gip, suy thng thn a n gim canxi huyt gy tng co bp rut. Cu 33:Nu n.nhn,c ch bnh sinh, biu hin sinh hc ca vim ng thn cp N.nhn: do nhim c. + Cc cht c ho hc & thuc: thu ngn,ch,asen,bismut. + Cht c bt ngun t hu t chc & TB nh do fu thut, chn thng,bng,truyn mu nhm loi... + Cc cht c bt ngun t VK. C ch bnh sinh: l 1 q.trnh c ch cc men chuyn ha ca TB thn gy ra nhng h hi v sinh ho. 1s cht c td ln nhng men ca thn c th to thnh nhng kt hp bn vng lm cho nhng men ny mt hot tnh a n RL c.nng & tn thng thc th thn. + Thn c c im d tn thng hn cc t chc # l v n l t chc c n` mu qua nht. Biu hin: thiu niu hoc v niu. + Nhng triu chng cp tnh ch xut hin nhng ngy u. + Sau dn n hn m km theo s tng ur & cc gc nit # (.) huyt tng. + S nhim toan & nhim c kali l n.nhn ch yu lm bnh nng & dn n t vong nu k c iu tr thch hp. Cu 34:T.by c ch bnh sinh & cc biu hin ca hi chng thn h. C ch bnh sinh: s jn rng cc l lc cu thn khin protein thot ra --> hin tng mt protein,nng cht ny (.) huyt tng gim xung m ch n & s sx ca gan k b p c --> tn thng cu thn. + Lng dch lc t cu thn sang ng thn b.thg do vy k c s ng cht o thi (.) c th, k f do tng p lc thm thu m f do p lc keo (.) mu -->c.nng ng thn b.thg. + Lng ng thn x.hin tr m. + Kh nng ti hp thu m gim. + C tn thng mng lc cu thn. Biu hin: protein niu cao, protein mu gim, f ton thn, RL chuyn ho m.

. Cu 39:Nu k.nim v suy thn cp,g.thch c ch nhng thay ic bn (.) mu do suy thn cp. Suy thn cp: l hu qu ca n` bnh thn # nhau (.) thn k thc hin c y c.nng ca n: trc ht l o thi biu hin = s ng (.) c th cc cht cn b & cht tha #. Lm jm nhanh chng c.nng thn y bnh nhn vo tnh trng nguy him. C ch nhng thay i c bn (.) mudo suy thn cp. + Tb` fng to, lm tc ng thn. + Tb` hoi t bong ra lm lp ng thn,n' tiu chy trc tip vo mu em theo cht o thi. + S tr cp din n` sn fm c:H+,hp cht nit( hi chng ure huyt cp din) + cc cht c hot tnh ca vim gp' vo mu. Cu 40:T.by c ch bnh sinh ca hn m thn. Nu cc biu hin chnh ca suy thn mn. Hn m thn l g.on cui cng ca bnh thn. S tng ure (.) mu chng t c n` sn fm c (.) c th k c o thi. + cc sn fm c:indol,phenol,amoniac... thm vo mu. Nhng cht ny b.thg vo mu s c gan thi c & thi qua fn. Nhng (.) bnh thn do cc cht c k c x l, loi thi,tch li & gy c. + n' tiu vi tp`:acid citric,acid oxalic...k c o thi li lm tng tnh trng nhim c c th. . No b chn p bi f n cng vi tnh trng f n chung: nhc u, co jt,ng g. . c ch TK do TK b nhim c: l m, l ln,kh th. . Jm ion Ca2+ mu do kt hp vi photphat k c o thi: co jt,nn,a lng. Cc biu hin chnh ca suy thn mn: + RL n' tiu: thiu niu,(.) n' tiu c protein,tb.tr niu. + RL mu: ure huyt tng & nhim acid. + Ph: xy ra trn ton thn. + HA cao. Cu 38:T.by c ch nhng biu hin ton thn ca bnh thn ( f,tng HA) Nhng biu hin ton thn: -Ph: + vim cu thn cp: s ng mui Natri ko theo j n' li c th. N.nhn j natri: . Tn thng cu thn--> Na+ tc lc (.) khi ng thn ti hp thu b.thng. . Tng tit aldosterol th ft. + Hi chng thn h: do mt protein qua n' tiu--> jm protein mu--> jm p lc keo-->f. Tng HA: tn thng cu thn,ng thn u lm jm dng muqua thn( thiu mu cc b)--> TB` cnh cu thn tng tit renin--> tng HA. P.bit f do vim cu thn cp & hi chng thn h v bn cht. Vim cu thn cp: jm c.nng lc ca cu thn. Thn h: c.nng j protein ca cu thn b suy jm + hin tng nhim m tb`ng thn.

Cu 43:T.by cc b.hin ca RLCH glucid, RLCH mui n' khi gan b bnh. Biu hin ca RL chuyn ho Glucid: + Gim k.nng chuyn ho g` mi hp thu t ng tiu ho,g` tha thnh glycogen d tr. + Jm k.nng d tr glycogen nn bnh nhn d b h g` mu xa ba n. + Tng cc sn fm chuyn ho trung jan ca glucid: lactic,acid pyruvic. V gan thiu nng nn k s dng c vitamin B1 hnh thnh coenzym photpho ho a nhng sn fm trn vo vng Krebs. RL chuyn ho mui-n':

+ Gan sx fn ln protein huyt tng,protein huyt tng c td j n' (.) lng mch. Protein huyt tng jm,n' s thot ra ngoi mch mu--> trng thi f thng. + Trng hp x gan c tng p lc TM ca lm cho p lc thu tnh tng--> n' b y ra ngoi lng mch--> f n` hn. + Gan l c quan duy nht f hu ADH, (.) suy gan ADH b j li lm jm lng n' tiu-->f nng thm. Aldosterol cng b j li-->j mui-->j n'.Mc d gan ng vai tr "th yu" (.) chuyn ho mui-n' nhng n` khi suy gan nng cng s hnh thnh bng n' cn thy thiu niu, kht,h HA. Cu 44: Cc hnh thc kh c ca gan & cc b.hin khi RL chc fn chng c. Cc hnh thc kh c ca gan: + C.nng chng c ca gan c thc hin = 2 fng thc: c nh & thi tr. + Do tb` nhu m gan & tb` ca t chc lin vng m nhim, cc p.ng ho hc ch do cc tb` nhu m gan m nhim. Biu hin khi RL chc fn chng c: +Gim fn hu 1 s hormon: . Kch t sinh dc: suy gan c cc triu chng: teo tinh hon,jn mch,mt kch dc tnh. . Kch t v thng thn: mui, n'-->thiu niu--> f & bng n'. . ADH hormon chng li niu ca tuyn yn k b f hu--> thiu niu,f bg n'c + GIm k.nng c nh cht mu: cht mu lu hnh (.) mu n` (.) 1 t.gian nht nh,gan cn jm k.nng c nh VK khi b suy( sinh KT trung ho c t & chng li VK). + Gim k.nng chuyn cht c thnh cht k c hoc km c = p.ng ho hc: . Oxy ho: phenylbutazon, hexobarbbital. . Kh oxy: chloramphenicol. . thu fn: fethidin . Acetyl ho: sunphonamit. . lin hp: bilirubin t do,amoniac,acid benzoic. Cu 45:T.by n vng da.Nu n.nhn & c im ca vng da do n.nhn trc gan & sau gan. n vng da: l tnh trng bnh l xy ra khi sc t mt (.) mu cao hn b.thg` & ngm vo da & nim mc. Vng da trc gan: l vng da do tng dung huyt nn Hb c chuyn thnh bilirubin t do qua n`. + N.nhn: nhim khun (lin cu khun dung huyt,xon khun),KST(st rt),nhim c(phenyl hydrazin,sulfamit dinitro phenol...) & do truyn nhm nhm mu. + c im: . bilirubin t do tng cao (.) mu.nhng k c (.) n' tiu v bilirubin t do k tan (.) n'. . Gan b.thg` nn tng cng k.nng kt hp--> bilirubin kt hp tng,urobilinogen & stercobilinogen tng,fn sm mu. Vng da sau gan( vng da do tc mt): mt k xung rut c & vo mu gy vng da,fn trng,n' tiu vng.Cc tp` # ca mt:cholesterol, acid mt tng do mt. +N.nhn: do c hc(si ng mt,giun chui ng mt,u u tu,hch to chn p g` dn mt),vim so,dy chng,RL TKTV gy co tht c oddi. + c im: vng da m,fn trng,n' tiu vng; cholesterol,acid mt & bilirubin kt hp tng.

Cu 46:T.by cc biu hin v xt No ca suy gan trng din.

Cu 47:T.by n.nhn & cc biu hin xt No ca suy gan cp. N.nhn: + Nhim c: tt c cc n.nhn lm gan b nhim c nng: phospho,thuc m... + Nhim khun nng,vim gan do virus. Biu hin: + Lm sng: Bnh nhn c nhng du hiu nng ngay t u,hnh thnh rt y & nhanh tu theo mc ca x gan: nn,du hiu TK (mt l, ng g, mt ng,ni ln,hnh vi k b.thg`, co jt,hn m),xut huyt di da,d dy rut, ri st tng ln. + Xt No mu:gluce jm,cholesterol este ho jm n`,amoniac tng cao. Gii fu bnh :nhu m gan b hoi t ton b hoc kiu mi gm,hoi t c cu ni nht l hoi t vng trung tm tiu thu. + tin trin ca bnh: bnh nhn cht ngay sau 5-6 ngy nu suy gan th ti cp vi RL (.) c th nh ct gan thc nghim trn sc vt. Nhng thc th ng` bnh cnh fc tp hn n`,tu thuc vo tc nhn tn thng gan mc no m .hng n cc c quan #: thn,tiu ho lm cho din bin & tin lng bnh # nhau. Cu 48:T.by biu hin & c ch bnh sinh ca hn m gan. Biu hin hn m gan do suy gan bt u t nhng RLTK: chn tay run ry,p.x tng, thc jm st,m mng,ni lp bp,co jt cui cng l hn m. C ch: + Tng NH3 (.) mu: NH3 c s.xut 7-8g/24h t 2 ngun:ni sinh(kh nhm amin) & ngoi sinh(VK g` rut) bthg` NH3 (.) mu rt thp(0,02-0,18mg/100ml)nh gan-c quan duy nht chuyn n thnh ure k c: NH3 + NH3 + CO2--> (NH2)2CO + H2O. (.) bnh l x gan NH3 tng ln 0,3mg/100nl & (.) hn m gan 0,54mg/100ml & c bit tng cao bnh nhn c RL tiu ho do VK g` rut lm tng NH3 ngoi sinh. + Tng cc cht dn truyn TK gi: cc cht dn truyn TK gi l cc dn xut bt thg` ca cc cht dn truyn TK do qu trnh B-hydroxyl ho bi 1 enzym k c hiu ti t chc TK. . Nu s tch lu cc cht dn truyn TK j no--> hi chng tm thn kinh: mt thc,chn tay run ly by. . Nu s tch ngoi vi--> jm trng lc c tiu M,hnh thnh mch tc ngoi vi,jm mu ni tng--> hi chng gan thn. + Glucose mu jm,f t chc no,cc sn fm c t ng tiu ho k c gan c nh & thi tr,tnh trng suy sp c th. Cu 49: nu v pitch cc c ch ph. mi loi cho 1 vd -tng p lc thu tnh: nc b y ra khi lng mch nhiu hn lng nc tr v do p lc thm thu keo ca protein. C ny c vtr qtrng: ph do tim fi (ph ton than, vng thp), suy tim tri (ph phi), chn p tnh mch (vim tc, c thai), ph y mt (cao HA) -gim p lc thm thu keo huyt tng (80% do albumin chi fi): nc c ko ra lng mch nhiu hn nc tr v. thng gp: suy dinh dng, suy gan, x gan, thn h nhim m -tng tnh thm mch: protein thot qua vch mao mch ra jan bo lm p lc thm thu keo 2 bn t trit tiu ln nhau do p lc thu tnh t do y nc ra. thng gp: ph do d ng: xhin cc cht gy tng thm thnh mch, cn trng t, (.) vim, (.) f phi -ph do tc bch huyt: tng tnh thm mch gy ph chm chp. thng gp: ph do jun ch, vim bch mch ko di, tc ng bch huyt -ph do tng p lc thm thu: do cc ion quyt nh, c quan ch yu o thi in ji l thn vi s tham ja ca aldosterol. thng gp ph do vim thn -mt ca m: lm cho ph xhin sm hay mun, r rt hay ko.vd: ph phi: t chc phi l t chc lng lo, li mao mch dy c, thnh mch mng

Cu 57: k ra 1 s ngnhn gy bnh v nu 3 ri lon c trng ca bnh bcu, hu qu -Ngnhn: do virus, tia x, ho cht ( nhm gy ankin ho), di truyn (yu t tng trng ni sinh hoc ngoi lai) -2:+Qu sn: sinh sn mt iu ho, vi s lng ln v k b cc tc nhn iu chnh lm cho ji hn li, tb c tnh xm ln vo tu xng vo hch ngoi vi, vo lch +Lon sn: t chc sinh bch cu da, gan, lch, s k bit ho ca bcu. Nhn to, bt mu kim, dng gon cn non +D sn: tb tng gon cui cng nhng k in hnh v c trng cho m sinh ra n m mang nhng nt ca 1 m # -Hu qu:+Bcu b tung vo mu ngoi vi nhng fn ln l bcu non cha hon chnh lm d b nhim trng +Huyt cu jm sinh gy thiu mu +Jm tiu cu gy xut huyt

Cu 54: Nu v jthch c ch 1 s chung thng c (.) thiu mu do tan mu (S ) -Thng kh: a khng kh t mi trng vo n (.) f nang v ngc li +Ri lon thng kh khi c s thay i p lc, t l ja cc cht (.) lng f nang cng nh th tch kh th qua mi ln h hp +Cc yu t chi fi: .,Do ko kh th bn ngoi .,B my h hp: ng dn kh trn, di .,Lng ngc: g vo ct sng, gy xng sn .,Tkinh- c: vim c h hp, lit c +Kqu: th nhanh, kh th, nhp th di ra, tm ti nu suy h hp Cu 60: K tn cc ngnhn gy ri lon thng kh do thay i ko kh th v c ch, -Bnh ln cao: khi c s thay i p lc ko kh bn ngoi: +C ch: p sut ko kh cng ln cao cng thp, p sut ring fn O2 v CO2 u jm dn (% cc kh k i), jm p sut ring fn O2 v O2 (.) f nang +2: c O2 v CO2 (.) mu u jm, bnh cng nng khi cng ln cao, nu c vn ng th lc i km lm ri lon chuyn ho (nhim toan) do sfm chuyn ho ym kh tng ji phng acid lactic -Ngt: do thay i t l % cc cht kh (.) tfn kh th hoc do b ngt, tc b my h hp +C ch: p sut O2 v CO2 qu cao (.) mu gy i O2 +: th nhanh, su cho ti khi trung tm h hp b nng cao CO2 lm cho t lit -i O2 do CO: thay i t l % cc cht kh (.) thnh fn kh th +C ch cnh tranh ca CO v O2 chim Hb lm ko vn chuyn O2 -Bnh chung ln: l t su di nc a ln mt nc qu nhanh lm p lc (.) chung jm t ngt lm N ho tan (.) huyt tng s tr li dng kh lm tc mch trn lan (.) ton thn Cu 63 Trnh by k/n v suy h hp. Nu ng.nhn, biu hin, cch xc nh _Suy h hp l tnh trng chc nng ca h h hp ngoi ko m bo dc yu cu cung cp O2 v o thi CO2 =cho c th _Ng.nhn +H hp chu k: l kiu th bt thng, lp i lp li c chu k. VD:kiu th cheyne stoles ko di40-60s: th su, th nng, ngng tp thi ri lp li .,tjan mu ln no tng i chm lm trung tm h hp ko phn ng tc thi vi s thay i p sut CO2 v O2 mu m chm chp lch pha ., Do s iu ho ngc m tnh tng ln vng kim sot nhp th ngha l s thay di nh CO2, O2 mu lm thay i ln hn v thng kh so vi ngi bnh thng +Tm ti: l tnh trng Hb kh tnh mch(30%) lm da, nim mc, vng ju mao mch da c mu tm nh mu tnh mch. Tm ti l do tr kh CO2 m ko phi do thiu O2. xut hin trog trng hp i O2 hoc bnh a HC, tr tun hon a phng

+kh th: do tc nghn g h hp( hen, nghn) hoc cm jc c vt nng ngc ln _Biu hin: th gng sc, c s co rt cc c h hp...VCjm, FEV1 jm, RV tng, Tiffeneau jm _Cch xc nh: tin hnh nghim php thm d h hp: o th tch kh lu thng. Dung tch sng =V kh lu thng+ V dung tch ht vo+ V dung tch th ra

Cu64:trnh by cc g RLTK ca chn thng s no Trong chn thng s no c 4gd: -g 1:sau chn thng c ch lan rng ton v no v di v,ty chn thng m mc v thi gian c ch khc nhau -g 2: qtrnh c ch chung gim i v hng phn 1 s b phn biu hin bi p 1 s kthch tng, ri lon tng quan gia v no v di v c RLTKTV: tit m hi -g 3: nu chn thng k nng cc ri lon mt dn v phc hi h TK theo trnh t ngc li:mt trc thi phc hi sau.vd:px c k t nhin phc hi sm hn px c k nhn to -g 4: ti ni tn thng ln so kthch vo ni tn thng c th l ngun gc ca cc cn ng kinh sau ny CU 65:k tn cc ng/nhn gy RLTK.vai tr ca cc yt TK nh hng ti bnh l TK *cc ng/nhn gy RLTK +ng/nhn bn ngoi: -cc yt vt l:nhit ,phng x,dng in -yt c hc: -yt ha hc:nghin ru,thuc ng,thuc m, -vi sinh vt:nhim khun,lao,bch hu,un vn -virus: bi lit,di -tinh thn:chn thng tm l cp v mn:lo lng,bun phin +ng/nhn bn trong: -thiu oxi no -RL tun hon cc b ti no:x cng mch no,tc mch,u no -RL ni tit v chuyn ha -di truyn: AO -bnh l MD:bnh t min *vai tr ca cc yt TK nh hng ti bnh l TK ch yu l nhng chn thng tm l cp v mn +lo lng, bun phin tc ng ln h thng tn hiu th nht +px c k: xy dng cm gic nhn thc tc ng ln h thng tn hiu th 2 +2 h ny c qh mt thit,qua li vi nhau -h 1:tnh cm t pht lun kim sot h 2 l l tr

-h 2 km hm h 1 mt cch ng mc +khi 1 trong 2 h km=>RLTm thn -h 1:mnh =>hay xhin bnh histeri -h 2:mnh=>mt mi, n o sngh nhiu nhng xa ri thc t

CU66:tby qlut tng mn cm khi mt TK -c vn v dy TK vn ng ti c vn hnh thnh 1 v vn ng m qtrng l 1 tm vn ng -khi 1day Tk vn ng ti 1cquan b ct =>rt nhy cm vi acetylcholine v s tng mn cm cng thy c trn mc d k ging c vn -c trn teo khi mt TK nhng p ng cng tng vi acetylcholine v adrenalin -tb cng nh cc si TKc th b cc yt gy bnh lm tn thng=> tb thoi ha v ra v thc bo tiu i,t chc so hnh thnh v c th ph hy tb v t chc TK khc *qtrnh ph hy ty theo nron: -nron ngoi vi:vn ng=>lit c;cm gic=>mt cgic; tit dch=>ngng; vn mch=>mch k co +nron trung tm:do c lquan vi nhiu nron khc to thnh h thng tng tc ln nhau:c 1cnng chnh nhng c th h hip ng or i khng vi nhiu cnng khc -tn thng nron trung tm c 2RL: +RL cnng chnh m Tk ph trch b mt i +RL biu hin gii c chd nhng cnng m trc y b phn tn thng km hm CU67:pitch qlut tng tnh t ng c bn ca cc nron Tk khi tn thng 1noron trung ng c 2 hin tng: +mt cnng do noron chu trch nhim +gii km hm cc cnng di -trong qtrnh tin ha ca sinh vt,TK ptr t thp ti cao,ctrc tng di hnh thnh trc,ctrc tng trn hthnh sau.mi ctrc nh vy c th h t ng v ng gp vo h chungca cp thp phi chu s iu ha h ca cp cao.\

Cu 68: N cm gic au, p.tich 1 s n.nhn gy au au: l 1 triu chng c bn ca qu trnh bn l ni ln ri lon chc nng v tn thg t chc. Nu au thg l hu qu th bn than n cng hay l ng.nhn ca nhiu ri lon khc nhau l thn kinh N.nhn gy au: Cm gic au path sinh do nhng tc nhn phi hoi mnh kch thch ln mt on tkinh (cc th quan), gy mt lung xung ng dn truyn qua tu ln no, qua i th ti v no gy nn cm gic kh chu y. Cm gic au c dn truyn bi 2 loi tkinh: + loi c g knh to, c v myelin (loi A), c tc dn truyn nhanh (cm gic au tc th) + loi c g knh nh ko c myelin (loi C) vi tc chm -> cm gic au m nhiu ng.nhn # nhau gy au nh tip xc, nhit . cm gic au ti vim l cc cht ho hc # nhau tc ng ln mt on tkinh cm hic # nhau l Histamin bradykinin , prostaglandin chng gy au vi nhng liu rt nh nh 10-6 10-8 mg. 1931 Van Enlle v Gaddum pht hin ra cht P (Pain) l mt cht dn truyn cm gic au t da n c quan tkinh T. C s cn bng iu ho ca cht P vi cht endorphin ca h thg vin, h khu no, no gia Cu70:tby c ch bnh sinh ca x va M: -x va m l tnh trng vch mch dy ln do lng ng cholesterol v lp o trong gy tn thng thoi ha lon dng=>lng ng Ca2+=>vim lot,si,huyt khi v hp long mch,gim tnh n hi thnh mch -c ch;ch yu do RL chuyn ha lipoprotein m trong Lp c cholesterol ton phn,cholesterol este ha,photpholipit,triglicerid +da vo trng lng phn t:VLDL,IDL,LDL, HDL +trong LDL:gy x va mch HDL:tng chuyn ha cholesterol LDL:tng ln do 2 c ch: khu phn n tha cht ny, n mc vt nhu cu ti a ca cc tb v s o thi theo g mt khng xu (2)cc tb thiu th th tip nhn cholesterol thng do di truyn +ngoi ra cn c nhiu yu t thun li cho s xhin v tng x va M:thiu VTM C, thiu Thyrosin, gim hot tnh h enzyme heparin-lipase, cc stress,tng tit adrenalin v gim ng huyt ko di, bnh HA cao

Cu 69: Phn loi v phn tch cc th au bnh l: Cc th au bnh l chia thnh cc loi: au su, au c, tng cm gic au, au ni tng au su: s # bit gia au bn ngoi v au su kh khu tr, thg kt hp vi m hi, nn v thay i HA thc nghim gy au su = cch tim nc mui u trg vo di ct mc hay dy chng. Khi au th gy co tht phn x cc c xung quanh mu km nui dng gy au trong c au li gy co tht mnh hn vng xon bnh l b) au c: Cc c thiu mu nh co ko di thg gy au, khi lu lng mu cung cp tr li th cm gic au cng ht Ng ta cho rng khi thiu mu th cc cht Kinin c hnh thnh v gy au Lewis cho yu t P hnh thnh khi c co v c mu o thi i, ch khi no mu ko lu thg th mi tch li gy au c) tng cm gic au: Mt s trg hp bnh l, tnh nhy cm vi au thay i, l tng cm gic au. + C th l tin pht nh thy vng xung huyt ng mch xung quanh vim, ch cn kh s vo khu vc cng thy au d di. Do vng xung huyt c yu t kho hc c tnh cht tiu m v phng thch cc Kinin gy au + th pht sau mt chn thg, ti y ngng au tng v lan c ra 1 vng xung quanh d) au ni tng: Ni tng bnh thg ko gy cm gic au hoc ch cho mt vi cm gic m h nh tc, kh chu do mt s ni tng rng b cng ra (d dy, bang quang) Trong ni tng c rt nhiu cm th quan i vi p lc, ho cht, nhng rt t i vi nhit , vi au. D t nhng vn c nhng th quan vi au trong ni tng khi lm cng cc tng rng

N.nhn gy au ni tng gin: cng tng rng, co ko cc mc treo, tn thg thanh mc (mng phi, mng bng)

Cu 73: Nu cch phn loi suy tim: V lm sang: c th chia ra: + theo mc suy *) 1: tim vn p ng c mi nhu cu cp mu tr nhu cu ti a mc trc suy; II, III v cui cng l IV nu tim ko cp c lg mu ti thiu theo nhu cu c th + theo din bin. *) suy cp: t ngt v din bin nhanh, tim ko kp hon thnh cc bin php thch nghi. *) suy mn: dn dn v ko di. tim c thi gian hnh thnh y cc c ch thch nghi -V b tr: +) tim tri: lc cn ln i tun hon, qu ti th tch do mu hoc tht tri qu nhiu +) tim pahi: suy do lc cn phi, do qu ti th tch, do l thng i-tiu tun hon -V chuyn ho: + Suy tim do gim sn xut nng lg: do thiu oxy trong tbo c tim + Suy tim do km d tr nng lg do ri lon cn bng K+, Na+ trong tbo c tim v ton thn, nhim acid ti tim do chuyn ho ym kh + Suy tim do ko s dng c nng lg, do bin i cu trc actin-myosin v ATP-A trong c tim V c ch SLB: + Suy tim do qu ti: do lg mu v tim nhiu hay lc cn qu ln + Suy tim do bnh l bn thn tim v mch +Suy tim do bnh l ngoi tim mch. *) Suy tim do qu ti th tch, lg mu v tim qu ln. *) Suy tim do qu ti p lc: lc cn tng Cu 74: Nhng thay i ch tiu hot g ca tim khi tm suy Gim cung lg v lu lg: do sc co bp ca tim gim tng th tch mu: *) Tim suy-> tim co bp yu -> ko y mu ra khi tim ht -> li TM -> mu qua thn t -> c/nng lc thn gim -> nc v in gii -> th tch maus tng. *) do thiu mu -> kch thc tu xg -> sx Erythropoietin Gim tc chy mu do tim co b yu thay i HA: suy tim -> HA gim v lu lg mu gim, sc co mbp gim, sc cn ngoi vi cng gim, do gin mch v thiu O2 -> HA M gim nhng HA TM tng do tim bp yu mu chy chm -> mu TM Cng v hiu sut cu tim gim: do cng sut tim gim lm cho tim phi p nhanh hn, tiu th o2 nhiu lm hiu sut ca tim gim. Bn cnh bin php tng nhp v s dng O2 ghn ch nn tim d suy Cu 75: Cc yu t nguy c gy x va M cc yu t nguy c: Thiu Vit C, thyroxin lm chm thoi ho cholesterol + Gim hot tnh h enzyme hepin lipase tui gi v do di ruyn

+ Stress lm tng huy g m, tg m huyt ko di. + tg tit Adrenalin v gim g huyt ko di u lm tg m huyt + Bnh cao HA. + tn thg vch mch + Ni c tc ngc ca HA cao: Cung M ch, ch ng ba m, thnh sau M chc, v tr t di dg ca M + tg g huyt v T + bo ph bnh l + t vn g th lc + n nhiu m, c bit l m g vt, cc thc n nhiu cholesterol 2) Hu qu: + Mch km bn, + Lng g mch hp li + hnh thnh huyt khi ti ni x va + mch khng Cu 77:Nu cc bin chng v gii thch c ch hu qu ca vic tng huyt p +bin chng ca HA: -suy tim -x va M -cc bin chng tim no khc -gim th lc +gii thch: -bin chng tim:tht tri s dn dn ph i do phi thng p lc cao ca ca h M suy tim tri vi cc hu qu ca n( h van M ch c nng, lon nhp tim, thiu mu no,thiu mu mch vnh, suy tim phi, ph phi suy tim ton b -cao HA to diu kin cho x va pht trin Mv mch, gy xut huyt nhi mu v cc tai bn cp tnh khc -gim th lc do ph n v xut huyt vng mc Cu 78:nu nh ngha v cc ri lon trong sc: +N:sc l hi chng suy mach cp tinh do nhiu nguyn nhn khc nhau, l tnh trng ri lon su sc v huyt dng hc v chuyn ho, c trng bng suy xp chc nng tun hon khin cc c quan sinh tn ko c cp mu nui dng +c ri lon xy ra trong sc: -huyt g hc: mt nc nhiu, mt mu h HA -chuyn ho: ng c ,sc phn v -sc do tim: bnh l tim: vim c tim,bnh van tim ; ngoi mng mch -gim khi lng tun hon: mt mu, mt nc,gim sc co bp ca tim -thiu oxy t chc tim p nhanh, kh th -t.kinh: hn m, au n Cu 76: Phn loi tng HA, n.nhn, c ch ca tng HA HA bnh thg: + HA tm thu: 100-139; 140-150: tg HA ti hn; >150: tg HA th s + HA tm trg: 60-89; 90-94: tg HA ti hn; >95: tg HA thc s Phn loi: Cao HA c chia lm 2 loi + Nguyn pht: cha r n.nhn, v cn: 90-95% + Th pht: xc nh c n.nhn. 5% Ng.nhn, c ch ca tng HA + Cao HA th pht(5-10%) */X cng M hay x va M:lm gim kh nng n hi ca thnh mch v lm tng sc cn ngoi vi */thiu mu thn: thiu ovy tc ng ln b my cn cu thn tit vo mu rennin tc dng vo angiotensinogen angiotensin I angiotensin II gy tng HA = cch lm co mch ng thi kch thch thng thn tit aldosterol gi NA+ gi nc tng HA */Ni tit -u tu thng thn,u ca m a crom: nng catecholamine tng cao trong mu -hi chngconn: thng do u lm tng tit aldosteron nguyn pht Na+ trong c th v nhim kim chuyn ho -hi chng cushing;tng tit glucocorticoid v mineralocorticoidgi Na+ +/cao HA nguyn pht(90-95%)

.-tng cung lng tim:lng Na+ da vo c th cao hn lng thi ra. h thng rennin-angiotensin,vai tr ca stress i vi giao cm lm tng catecholamine tng sc co bp ca tim -tng sc cn ca mch ngoi vi: h thng reninangiotnin v h thn kiunh giao cm,thay i mng ngoi t bo,ph i thnh mch,tc nhn t ni mi,tnh khng insulin v nng insulin huyt

Cu 79: phn bit sc, ngt, tru mach v nguyn nhn, biu hin, c ch 1/Sc: */nguyn nhn: -chn thng -mt mu, mt nc -phn v -bng -nhim khun *) biu hin -ri lon vi tun hon: xut huyt, ng mu ni mch lan to -thiu oxy c bit tim v no -RLCH: nhim c, nhim toan, cht t bo *)c ch: sc gin mch mu nhiu mao mch gim khi lng tun hon gy h huyt p, thiu oxy t chc chuyn ho ym kh nhim toan, nhim c , cht t bo. 2) Ngt: tnh trng bnh l do mt tri gic t ngt trong thi gian ngn *) Ng.nhn: hng phn dy 10, ri lon dn truyn nh tht, lon nhp nhanh *) Biu hin: +) mt tri gic trong thi gian ngn, phn ln t hi phc +) chong vng, xy xm mt my, v m hi, au ngc. + Bun nn, mt ti nht, ng t gin, th chm *) C ch: do mu ln no t, lm thiu O2 t ngt, mt tri gic. 3) Tru mch: *) n.nhn: + trung tam vn mch b c ch do nhim c, nhim khun v do cc sn phm chuyn ho ym kh + thay i t th t ngt + chc tho bng qu nhanh, nhiu *) biu hin: h HA t ngt, c th xung 0 + tim co bp rng du hiu thiu O2 nghim trng: xy xm mt my, ti mt *) C ch: gin t ngt h tiu m, c bit h tnh mch khi c ch b tr chua kp c tc dng

Cu 80: trnh by k/n v u nng ni tit v hu qu ca n mt tuyn ni tit u nng l khi tuyn tng cng hot ng v tit ra 1 lng ni tit t ln hn bnh thng m c th ko iu chnh c nguyn nhn: ti tuyn v ngoi tuyn -hu qu: + vi chnh bn than tuyn: t chc tuyn ph i tng sinh to thnh cc u bu,chuyn ho ca t chc rt mnh. V d: u nng tuyn gip + vi c quan ch: tng hormone tng hot ng. v d: u nng tuyn tu tng tit insulingim ng huyt ; u nng tuyn giptng tit thyroxin tng chuyn ho c bn + vi tuyn ln cn c nh hng nu lien quan. V d: u nng tuyn v thng thn tng tit catecholaminetun yn gim tit ACTH gim hot ng ca tuyn yn tuyn thng thn bn lnh b teo Cu 81:phn bit u nng ti tuyn hay ngoi tuyn cho v d c th v 1 tuyn chn on u nng ngoi cc triu chng lm sang cn da vo cc nghim php thm d, trong nghim php ng c p dng phn bit u nng ti tuyn hay ngoi tuyn nguyn l chung: dung 1 tc ng km hm tuyn nh thm d v quan st phn ng ca chng + u nng ti tuyn:hot ng ca nhu m ko chu s iu ho bnh thng na th nghim (-) cho bit lng hormon ko thay i,duy tr mc cao + u nng ngoi tuyn: nghim php ng (+) ngha l gim hot ng nu km hm li V d: trc 1 bnh nhn u nng tuyn thng thn phn bit u nng ngoi tuyn hay ti tuyn ta lm nh sau: tm cch ct t s kch thch t tuyn yn bng cch u vo c th 1 lng ln hormone thng thn (loi tng hp) ri theo di : + nu thng thn vn tit hormone loi t nhinu nng ti tuyn + nu gim tit u nng ngoi tuyn tc u nng tuyn yn Cu 82:trnh by v thiu nng ni tit v hu qu ca n thiu nng ni tit l khi tuyn ko tit hoc tit ko lng hormon cn thit cho c th hot ng bnh thng hu qu: + tuyn ko hot ng th teo i, t chc x pht trin. v d:thiu nng tuyn thng thn + c quan dch: gy thay i nht nh c hiu ca bnh cnh lm sang */nu c quan ch l 1 tuyn th tuyn s teo i. V d: gim kch dc t tuyn sinh dc thiu nng b phn sinh dc km pht trin

*/nu c quan ch l 1 cht c lng nht nh trong c th mt cn bng cht . V d: glucose huyt tng nu thiu insulin, canxi huyt tng nu thiu nng tuyn cn gip Cu 88: T.by 2 c bn v cu trc & c.nng ca tb` BC trung tinh,BC i kim,BC i toan,tiu cu (.) MD: Tb` B.cu trung tnh: + Cu trc: trn b mt tb`c cc th th vi cc Ig(KT),b th--> c vai tr l.kt KN li thc hin c.nng tiu thc bo. + C.nng: . Tiu thc bo c bit cc vim. . Tit ra 1 s yu t ho tan c td iu ho hot ng ca 1 s tb` # ti vim ni KN xm nhp. Tb` B.cu i kim: + Cu trc: b mt c cc th th dnh cho KT IgE, khi c sn xut ra IgE c gn ngay trn b mt tb` ny,lm bin i tb` hoc f v tb`,to ra cc cht c hot tnh sinh hc (.) tb`:histamin--> gy fn v,d ng. + C.nng: . C vai tr quan trng (.) fn v & d ng. . Tit ra 1 s yu t ho ng ng Bcu i toan--> iu ho tc ng MD. Tb` Bcu i toan: + Cu trc: tng bo c cc ht c hiu a acid cha cc enzym: histaminaza,arylsulfataza. + C.nng: . iu ho hot ng ca Bcu i kim. . C kh nng thc bo & gy c i vi u trng ca 1 s KST. Tiu cu: + Cu trc: l nhng khi bo tng nh. + C.nng: c n` KT & b th nn n tham ja vo q.trnh ng mu & MD: . Gn b th. . Gn KT (.) q.trnh MD. Cu 105: tr.by cc k/nim v: MD bnh l,qu mn,suy gim MD & bnh t MD? -MD bnh l l nhng tnh trng bnh l do hu qu ca tn thg cu trc & rlon c ch hot ng ca h MD MD bnh l nghin cu nhng kha cnh khng bnh thng ca h thng MD -Suy gm MD: tn thng cu trc hay ri lon c ch hot ng ca 1 hay nhiu cu thnh no trong h thng MD;do vy p ng yu ko t yu cu gy hu qu bnh l -Qa mn: L tnh trng bnh l do tng mn cm c hiu ca c th vi cc KN # nhau " l nhng tn thng,rlon c/nng cc c quan do P ca p ng MD c hiu hnh thnh trog c th vi KN" -Bnh t MD: l nhng tnh trang bnh l do p ng MD chng li cc thnh phn bn thn (t KN), gy ra cc tn thng t chc,ri lon c/nng c quan Cu 92: Trnh by c ch chng KST v cc bin fp n trnh MD ca chng -c ch: +bo v ko c hiu:KST sau khi xm nhp vo c th theo g da, nim mc, g mu: jun ch, st rt chng s gp fi: ., b th hot ho: cc KN KST xut hin l tc nhn hot ho b th theo con g cnh tranh -> li ji KST nh fc hp tn cng mng ., thc bo: TB c th n cc KST nhng c ch ny l rt yu +c ch bo v c hiu: ., p ng MD dch th: tng sx IgE c hiu v tng bch cu i toan, 1 s Ig # c kh nng hot ho b th opsorin ho KST tng thc bo, TB khi c hot ho cng c kh nng trc tip nut v tiu dit KST, mt s KST gy cc u ht, ptrin cc t chc x ., MD t bo: TCD4 v cc xitokin ng gp vo vic y li bnh nhng cng c th lm bnh trm trng them. TCD8 c vai tr bo v (.) st rt -s n trnh cc c ch MD ca KST: +1 s KST tm ch lp ngay bn (.) tb: plasmodium, Toxoplasma, +KST n mnh (.) 1 v bc: amp, jun xon +KST ngu trang bi 1 lp v bc protein ca c th ch +thay i KN b mt: thay i KN tng gon, thay i lien tc +KST lm jm MD Cu 94: k tn v cc hng ro MD t nhin,ptch c dim cu to & c ch bv hng ro vt l +Cc hng ro MD t nhin:

-Hng ro vt l: da,nim mc -Hng ro ho hc: cc ho cht c mt da,nim mc,huyt thanh,dch tit -Hng ro t bo -Hng ro th cht -Vim ko c hiu +c im cu to ca hng ro vt l: _Da: gm rt nhiu lp tbo.trog lp tbo cng sng ho,lun lun c bong ra & i mi Nim mc: tuy ch c 1 lp tbo,ngoi tnh n hi nh da,n cn c ph bi 1lp cht nhy do nhng tuyn di nim mc tit ra +C ch bv: -Da: do c im cto ca mnh m da to ra 1 hng ro vl ht sc vng chc vi s xm nhp ca VK.Nhng khi da b tn thng rt d c nhim trng .iu chng t vai tr qtrng ca hng ro ny -Nim mc: do cc tbo tuyn di nim mc tit ra c cht nhy,to nn 1 hng ro bv lm cho vt l & cc VK ko bm thng vo c tbo,m s bm ny l kin tin quyt cho chg xnhp su hn. +1 s nim mc(mt,ming,ng tit niu) thng xuyn c ra sch bi tit long(nc mt,nc bt,nc tiu) +1s nim mc # bit l nim mc g h hp,li c cc vi nhung mao lun rung ng,c tdng cn li bi mang theo VK & cc vt l,ko cho chng vo f nang & y dn chng ra khi f qun cng px ho & ht hi Vi c im cto & vtr camnh,hng ro vl c coi l tuyn fng ng u tin

Cu 95: Nu tphn tja,cto & c ch bv ca hng ro ho hc +Thnh fn: Trn da nh c cc cht tit nh acid lactic,acid bo ca m hi & tuyn m di da m cc VK ko tn ti c lu -Ti nim mc cht nhy che ch b mt tbo khi b enzym neuramindase caVRt tc ng -Cht nhy ca cc tuyn nh nc mt,nc bt,nc mi,sa...c nhiu lyosom,1loi enym muranidase c tdng trn v ca 1 s VK.nhng tphn # ca huyt thanh nh b th,protein,fn ng CA,inteferon +Cu to: -Da % nim mc l hng ro u tin ngn cch c th vi mi trng ngoi,c tdng cn tr c hc.Ngoi ra,cc hng ro ny cn c tng cng yt ho hc.2 hng ro ny fi hp vi nhau to ra 1 tuyn fng ng vng chc u tin -Nhng 1 khi KN vt qua c hng ro da & nim mc th s gp fi hng ro ho hc ngay bn trong c th, l huyt thanh +C ch bv: c ch s ft trin,lan trn & tiu dit VSV -Ngn cn s tc ng ca cc d vt & VSV ln da & nim mc +vtr: qtrng tu theo VSV Cu 96: Nu tphn tham ja & cc c im c/nng chung cahng ro tbo +tphn tja: fong f,a dng,loi trc tip tja tiu dit & cc tbo hiu ng -Trc tip: N.E,M,K,NK... dit ngoi tbo & thc bo bn trong -Hiu ng: ni m,tiu cu B,mt,si,biu b,tkinh,mch mu +c im c/nng chung: -C c/nng tiu dit VSV gy bnh,vi tu loi c cch tiu dit # nhau:thc bo,dit ngoi,tbo hiu ng -Thc bo vi 3 gon: g gn,g nut,g tiu ho ca cc tbo thc bo +i thc bo: bt ngun t tu xng,fn ho thnh mono bo mu & di tn ti cc m thnh h thng vng ni m +Tiu thc bo: l cc BCu a nhn trung tnh ca mu -Dit ngooi: vi cc tbo nhim khun.Tbo NK l bin th ca lympho bo,nhng ko c k/nng tiu dit cht c (perorin) hu tbo

-Tbo hiu ng: tng sinh tbo,tng gi bcu ti vim,lm hot ho vim v iu ho,sa cha tn thng. _Kt lun:Nh hng ro tbo bv c th khi nhng tc nhn VSV,tbo u,tbo cha VR,tham ja P vim,bv hu hiu hn

Cu 97: phn loi cc c ch ca hng ro tbo tu tng loi tbo m c nhng cch bv c th theo nhng c ch ring _thc bo: l c ch qtrng nht +vi cc tbo thc bo: bao gm tiu thc bo v i thc bo +qtrnh thc bo bao gm cc gon sau: -gon gn: .cc VSV khi gp tbo thc bo s dnh vo mng tbo nh cc receptor b mt # nhau.cc receptor ny c th l nhng pt trc tip ca thc bo nh cht MBP hay cc adhesin hoc thng qua nhng tphn ca b th nh C3,C5 bi cc C3R,C5R sau khi nhng cht ny bm trc ln i tng thc bo (VK).S kin i tng thc bo gn vo receptor s khi ng s chuyn thng tin vo bn trong gy nn qtrnh nut v tiu -goan nut: mng tbo b lm vo,cht nguyn sinh s to cc chn gi bao ly VSV,ri ng kn li to thnh hc "thc bo" (phagosom) -gon tiu: cc ht lysosom tin n gn cc hc thc bo (phagosom),xy ra htng ho mng,mng lysosom nhp vo cng mng phagosom (gi l phagolysosom).cc cht c trog lysosom s vo trog hc tbo tiu dit i tng thc bo.trog cc phagolysosom,VSV s b tiu dit nh 1 lot cc phng tin nh: pH acid,enzym thu phn,polypeptit dit khun,superoxyt (sn fm ca s bng n xy ho ni tbo _Dit ngoi: i vi tbo NK +tbo NK l 1 bin th ca lysosom bo,nhng c k/nng tiu dit ko c hiu vi cc tbo u,tbo c VR, bng cch p st,tit cht c (peroxyt) hu tbo _tbo hiu ng: lm hot ho vim,tng sinh tbo,tng gi bch cu ti vim,iu ho,sa cha tn thng Kt lun: Nh vy hng ro tbo ng vtr rt qtrng MD t nhin Cu 98: ptch mi qh ca cc yt bo v trog MD t nhin: hng ro ho hc,tbo,th cht trog bo v c th -Cc cht ho trong c th c trog da (acid lactic,acid bo ca tuyn m hi & tuyn m di da);ti nim mc (cht nhy,dch tit);trog huyt thanh (b th,interferon); c tdng c ch s pht trin,lan trn & tiu dit VK -Ngoi ra,cc cht ho hc cn c trog 1s tbo,cht ho hc trog lysosome,perforin trog tbo NK;cc cht c trog hc thc bo,histamin,inteleukin-1,interferon ca i thc bo +Cc cht trog lysosome c tdng tiu ho i tng thc bo +perforin c tit bi tbo NK c tdng dit ko c hiu tbo u,tbo c VR +Ngoi ra,1 s cht trog phagolysosom khi gii fng khi tbo c th lm tng p vim cp,tng tnh thm thnh mch,tng gi bch cu ti vim -Bch cu cn gii fng cht st ni sinh lm tng thc bo,gii fng histamin c tdng hot ho b th,kthch chuyn ho mng tbo -i thc bo tit interleukin-1 v interferon l nhng cytokin c tdng khuych i p ti ch & ton thn -Nh vy,cc cht ho hc v tbo ca hng ro ho hc & hng ro tbo cng hp tc vi nhau;cc cht ho hc lm tng qtrnh vim,tng tbo u,tbo c VR.gup bv c th qua MD t nhin -Hng ro th cht l tng hp tt c cc c im hnh thi & c/nng ca c th trc yt xm nhp;lm cho c th ny,loi ny nhy cm hoc t,nhiu khng vi s xm nhp ca 1 loi VSV no .trog ,hng ro ho hc & hng ro tbo cng ng gp 1 fn trong hng ro th cht. -S kt hp ca 3 hng ro trn c tdng bv c th tt hn.Ngoi ra,qtrnh MD t nhin cn khi ng MD thu c Cu 99: ptch mi qh ca cc yt bv t nhin (thc bo,b th) vi bv c hiu -Tbo thc bo c c/nng trnh din KN cho cc tbo min dch #.nu hin tng thc bo

l 1 fn ca MD ko c hiu th ng thi n cng l bc khi u ca MD c hiu.trog MD c hiu,i thc bo c c/nng nhn din bng x l & trnh din KN.V nhng thng tin v KN s c truyn cho cc lympho bo c tr ti nhng hch gn khu vc KN xm nhp;cc sn phm ging ho sau thc bo ca KN li c da ra ngoi mng kt hp gia phn t MCH 2 trnh din sphm vi cc tbo c thm quyn min dch #.Nhng lympho bo tham gia MD ln u;nhng lympho c mn cm( c tip xc vi KN) s sn xut ra KTh chng li KN ;c th l KT dch th hoc KT tbo +Khj P vim c hiu xy ra,khi KN-KT u di dng ho tan th s hnh thnh fc hp MD.fc hp ny s c cc i thc bo(TB) n qua tng tc gi KT & b th vi cc receptor dc hiu trn b mt TB.TB cn dn nhng t chc & tbo cht +1 s lymphokin c tdng tp trung & hot ho cc TB,thu ht bch cu n nhn & a nhn,tng cng ti vim -Khi P KN-KT xy ra,s hot ho b th,lm tan Tbo KN (VK,KST,nm,Tbo ghp...);tng cng kt dnh,tng qtrnh thc bo,tng p vim;C3a,C5a c tdng gy co c trn thnh mch,c tdng tng tnh thm thnh mch;C5a cn hp dn & tp trung bch cu a nhn,trung tnh ti vim +C3b cn bm trn 1 s nhm lympho T & B,hot ho chng Ngoi ra,s hot ho cn c th xy ra theo con ng cnh;KN c th t hot ho b th -S hot ho b th gip cho mu nhanh chng thi fc hp MD.theo con dng c in ngn cn fc hp MD ln ln v kch thc.theo con ng th 2 gip fc hp MD d ho tan,kh lng ng nn t gy hqu bnh l Cu 103: k tn cc yt b th,th t tham gia hot ho ca chng 2 con ng c in *Cc yt b th: -tphn:+ theo con ng c in: C1q,C1r,C1s,C2,C3,C4,C5,C6,C7,C8,C9. +theo con ng thay fin: B,D,P, cc yt iu ho -Nng cc cht trog huyt tng 0,025-1,4mg/ml *Th t tham gia hot h ca chng: -Con ng c in: +Xy ra sau khi KN kt hp vi KT IgM,IgG1,IgG2,IgG3 +Vi m hnh thc nghim u tin nghin cu hot ho b th ng c in: gm KN l HC cu- vit tt E: Erythrocyte KT chng HC cu vt tt A: anti body Khi kt hp vi KN;fn Fc ca KT IgM & IgG thay i cu hnh,lm bc l 1 v tr m C1q c th gn vo;m mn cho qtrnh hot ho +Sau l s hot ho C1 C1 gm 3 tphn: C1q,C1r,C1s -C1q gm 6 tiu n v,c cu hnh # nh 1 b hoa sen 6 chic m cung l 6 chui peptid xon nhau 3 chui mt,tn cng C, ni gn vo Fc.Khi gn vo KT,chng c th kt hp t nht 2 pt Ig l iu kin P tip tc,nu cc pt Ig qu xa nhau th hot ho CA ko xy ra.Vi IgM lun xy ra s hot ho b th.Tip ,C1r,C1s s gn vo C1q. 2 PT C1r & 2 pt C1s s lin kt vi nhau thnh nhm,gn vo cung ca C1q thnh phc hp C1qrs,vi s c mt ca Can xi EA + C1q EAC1q EAC1q + C1rC1s EAC1qrs ( vit tt EAC1s) -Tip theo l s hot ho C4 & C2: EAC1s + C4 EAC1,4b Cu 106: Tr.by c ch bnh sinh ca qu mn tp 1,K tn & m t biu hin bnh l lm sng tiu biu cho qu mn tp 1? -Qa mn tp 1: tn gi phn v trn sc vt,bnh d ng c c a di truyn( ngi) -C ch bnh sinh: .Giai on mn cm: KN( bt k, t nhin) mn cm,kch thch c th sinh KT IgE lm hot ho Mast, BC i kim do c IgE-Receptor .Gon phn v : KN +KT(IgE) hot ho Mast,Basophil hot cht trung gian (histamin,serotonin,leucotrien,NAF,EAF,PAF) tc ng ln Receptors (mch mu,c trn,no) triu chng: co c trn, gin mch;tng tnh thm mch,tng tit) .G.on gii mn cm: sau phn v xy ra,a KN c hiu vo ko xy ra phn v na KN trc kt hp ht vi IgE c nh -Cc biu hin lm sng:

.Ton thn: Sc phn v ( do thuc,huyt thanh,sa): tt HA nhanh,co tht c trn ( kh th,a vi,nga ton thn,ht hong,au u e do t vong nu ko cu cha kp thi,ng cch .Biu hin khu tr cc c quan: +Hen ph qun +Vim mi d ng +Vim da d ng (eczema) +My ay +Ph Quincke +Vim kt mc mi Cu 109: M t biu hin c trng,c ch & nu 1 s vd lm sng ca qu mn tp 4? Qa mn tp 4: qu mn chm.xut hin sau 12h k t khi KN vo c th ln 2 1.Biu hin lm sng: -P Mantoux: da,sn cng,phng,c th lot -P bong mnh ght -Vim da do tip xc -H/C Lyell-Stevenson -P to u ht trog bnh fong,lao -Vim da do tip xc( eczema): da ,dy,nga,c mn li ti,phng d v 2.c ch: _giai on mm cm: KN vo da, phi lympho T mm cm( hot ho) _giai an qu mm: KN vo ln 2 phn ng vi T mm cmtit lymphokines( MIF,MAF,IFN...) vim c hiu kiu mun, u ht do thm nhim t.bo n nhn, tn thng t chc khu tr 3. v d: _qu mm kiu Tubeculin: to nn nhng nt sn cng, sng , c th lot _qu mm do txc: c th mm cm vi 1 KN, sau c dp tip xc vi KN qua da, th ti ni tip xc s xut hin nt chm, da dy ln rt nga, b mt c nhng mn phng nh li ti, d v, to c hi cho nhim khun th pht, KN gy bnh Cu 107: Tr.by c ch bnh sinh ca qu mn tp 2. -Qa mn tp 2:bnh l c tbo ph thuc KT -C ch bnh sinh: .G.on mn cm: KN tbo mu,hapten(thuc)KT(IgG,IgM) .G.on qu mn: KN + KTCA(c in) tan tbo KN nh HC,BC,tiu cu C3a,C5a tng tnh thm mch,hot ho kinin,gin mch HA h,sc,vim,thc bo. -Biu hin lm sng: +tai bin do truyn nhm nhm mu h: ABO: cn tan mu cp,c th sc,v niu -Vng da tan mu tr s sinh do # bit Rh gia m & con (m Rh-,con Rh+) -Thiu mu tan mu,gim BC do thuc;do t min dch -Bong mnh ghp ti cp,bnh nhc c,bnh thn c t KT chng mng c bn -Thc nghim in hnh l th nghim truyn mu # loi: Sc xut hin y khi c truen 20-30ml mu # loi(th,ln,ngi ) cho ch.Huyt tng d sm,hematocrit gim do tan hng cu.C thot huyt tng,gim bch cu c bit l BC trung tnh & i toan,mu tr nn kh ng, hot tnh b th gim r Cu 108: Tr.by c ch bnh sinh ca qu mn tp 3.? -QM tp 3: bnh do fc hp MD(PHMD) -C ch bnh sinh: .G.on mn cm: hinh thnh KT (IgG,IgM,IgA vn t) .G.on QM: KN + KT = PHMD lu hnh lng ng cc c quan hot ho CA ti ch vim dc hiu thc bo tng tinh thm mch,ten thng ni mc & c quan -Biu hin lm sng: +Bnh huyt thanh: st,ni hch,au khp,protein niu:sau tim huyt thanh iu tr 1vi tun +Vim cu thn,thp tim sau nhim trng +Vim mch mu d ng +Vim thn,mch mu do thuc

+Tn thng da trog bnh phong +Vim khp dng thp,lupus ban _ v d: +Bnh huyt thanh: c triu trng st, pht ban, vim cc khp, protein niu, sau khi tim huyt thanh iu tr 1 n vi tun. do khi huyt thanh vo c th ln th 2 lm b th v khng th tt thp phc hp min dch tng ln, s li ko b th, bch cu, tiu cu gy vim +vim cu thn, vim tim sau nhim trng: khi vim thn: st, au lng, nc tiu c protein, bch cu, tr, dn dn ph do i t. nu din bin cp thn to, cng, sng, xut huyt, vi th thy KN lin cu, KT' chng lin cu Cu 110: nu 1 s bnh l tiu biu i km vi suy jm MD bm sinh, nu c im c trng v MD hc ca chng _Thiu nng MD dng T: bnh l tiu biu l hi chng Di George +Hi chng Di George hay jm sn tuyn c lm cho dng lympho T ko th trng thnh v bit ho c nn lm jm s lng v chc nng lympho T mu ngoi vi, hch bch huyt v lch.Nhng s lng lympho B,globulin MD b mt mu ngoi vi li tng cao v vy tr b jm MD t bo, d b vsv k sinh ni bo: nm candida albicans... +Ngoi ra cn hi chng thiu IL-12R, hi chng tng IgM cng dn n suy jm MD t bo do cc vi rt, nm, vi khun k sinh ni bo _Thiu nng MD dng B: d b nhim cc vi khun sinh m( ph cu, lin cu...) xy ra b my h hp, ti cc xoang mng no, nhim 1 s vi rt( bi lit) KST ng rut( Giardia) +Tiu biu l bnh Bruton: bnh di truyn theo th ln nhim sc th X do vy ch xut hin con trai. Do ko bit ho c lympho B nn jm lympho B trong mu, hch, c th ko pht hin c, jm nng Ig huyt thanh, MD dch th, d nhim VK ngoi bo c bit h thng h hp, cc hch bch huyt ko c tng bo v trung tm mng +ngoi ra cn b thiu nng Isotyp globulin MD chn lc. Thiu nng IgA, IgM, IgG u ko bit ho c lympho B _Thiu nng MD phc hp: c B v T +Dn n bnh SGMD phi hp nng, c trng bi cc ri lon qu trnh cc lympho B, T. nng n lympho bo, SGMD +Hi chng Wiskott-Aldrich: c im lm sng ni bt l eczema, hay chy mu, jm tiu cu, thng t vong trc 10 tui +Hi chng Ataxia telangiectasia: Tht iu gin mch , c trng bi dng i bt bnh thng, d dng mch mu _Thiu nng MD ko c hiu:jm b th gy cc bnh Lupus ban , vim cu thn, nhim VK sinh m +Jm kh nng thc bo: u ht mn tnh +jm kt dnh bch cu: thng biu hin= tng t nhim khun 1 nm ti i ti li +Hi chng Job Cu 111: Trnh by k/n v suy jm MD (SGMD) mc phi v nu cc ng.nhn 1.Khi nim: thiu nng MD mc phi hay th pht, rt phc tp l hu qu ca nhiu qu trnh bnh l nh suy dinh dng...nhim khun, K, sau iu tr thuc c ch MD... ng ch l cc bnh thiu nng MD do cc t bo c thm quyn MD b nhim khun, c bit l cc vi rt gy SGMD ngi 2.Cc ng.nhn SGMD mc phi: _Do nhim vi rt HIV: VR HIV l ARN virus c men sao chp ngc, k sinh trong t bo lympho T h tr, i thc bo( nhng t bo c CD4 trn mng t bo l th th HIV xm nhp) +sau khi xm nhp t bo ch, n nhn ln ri chui ra khi t bo, ph hu t bo TCD4 +Do jm st nng s lng v chc nng ca CD4, tin trin trong nhiu nm( 8 n 10 nm). V Th l trung tm iu ho h tr cc MD t bo v MD dch th, sau l chuyn sang giai on AIDS v cht _Do suy dinh dng: +ng.nhn: do thiu n c v cht lng v s lng, do bnh l ng tiu ho, nhim khun, jm kh nng tng hp, tng tiu th bnh gan, thn, st, K, bnh mn tnh hoc mt ra ngoi qua l d +c im: thiu cht dinh dng lm cho cc c quan, m, t bo chu trch nhm v MD s b suy jm v s lng, cht lng +tuyn c v hch bch huyt b suy thoi, teo nh +jm r s lng v chc nng lympho bo T, jm MD, jm phn ng qu mn chm +s lng lympho jm mu ngoi vi, i thc bo v bch cu ht jm kh nng thc bo +hm lng b th ton phn jm r rt, cc thnh phn bo tng cng jm, nhiu nht l C3 +MD dch th t nh hng, s lng lympho B+ hm lng cc globulin MD t thay i 3. Cc nguyn nhn #: do tn thng h MD bi ho cht, thuc, tia x. c tnh ho h lympho.Nhim khun KST,nm, n bo,vi rt( si,HIV) _do thiu nguyn liu tn to,thiu n, suy dinh dng, bng _do thuc c ch MD: thiopurin, corticoid, huyt thanh chng lympho bo Cu 112: Phn tch nhng c trng ca suy gim MD(SGMD) do nhim HIV-AIDS?

Do tnh fc tp v sinh hc ca HIV nn cc biu hin lm sng ca nhim khun rt thay i.Sau khi nhim HIV,ngi b nhim ko thy triu chng g hoc ch c 1 s tr/chng: st, au c, au hng,ni ban ,kiu nhim Influenzal. giai on ny VR sao chp mnh,nhanh trog mu, dch no tu, -Tip theo giai on ny, VR ngoi tbo bin mt,chng thm nhp gy nhim m cc tbo TCD4+,i thc bo,cc tbo Microglial ca h thn kinh trung ng.Cc KTh ca huyt thanh chng li HIV xut hin t tun th 3 sau VR -Thi gian bnh lu m t 2-10 nm hoc lu hn -S lng & c/nng ca TCD4 gim mnh l nt dc trng nht ca SGMD tbo -Cc tbo TCD4, i thc bo,NK,B chua gim trog nhim HIV nhng gim r rt trog gon AIDS gon AIDS ngi thng xuyn b cc bnh nhim khun c hi,u c tnh, 1 s bnh ca no -Tbo TCD4 suy gim do cc c ch + do tdng c tbo trc tip bi HIV,do s sinh sn ca VRsn fm ADN ko c ho nhp gen ca Tbo b nhim cc sn fm ca gen + do hp bo tbo nhim VR kt hp vi tbo bnh thng s gy c cho c tbaog cha nhim qua tphn GP 120 ca VR (GP120 gn CD4 ca tbo cha nhim) + HIV fong b qu trnh chn ca cc tbo TCD4+ thng qua cc cytokin ca cc tbo b nhim +S cht tbo theo chng trnh Cu 113: Tby gi thit v c ch pht sinh p ng t MD C ch a n bnh t MD c th # nhau 1)phi c s kick thick ca t KN: Ng.nhn u tin c th ngh n l s xhin mt t KN m r thi k bo thai KN ko c mt trong mu. Th nghim tim tnh trng bn than con vt cho chnh con vt gy dc KT l 1 minh chng Bnh t min ko xy ra, c th do s lg KN qu thp, cha kick thick h MD (qua s trnh din nh MHC) 2) 1 s KN ngoi sinh c nhng epitop ging nh KN ni sinh mt s Kn ngoi sinh c nhng epitop ging nh KN ni sinh, do vy KT ca n c kh nng p cho vi KN ni sinh tm thy nhng tg ng gia KN ca lin cu khun vi KN c tim, do vy c th ct ngha nhng thg tn c tim theo co tim theo c ch t min trong nhiu trg hp nhim lin cu khun tr em v ng ln 3) cc tc nhn vt l (lnh, nng, x), ho hc (thuc, ho cht) v sinh hc (vr, vk) cc tc nhn vt l, ho hc, sinh hc c th lm KN c th thay i tnh cht,c u hnh, t kick thick sinh KT chng li cc tbo, m, c quan mang KN . c ch t min do bt chc KN: Cc kh ng c th gp khi Kn tip xc vi h MD: nu l KN l c 2 epitop, chng b c tbo B v T nhn ra, hnh thnh p ng chng li Nu l t KN, n ko b chng li v dng tbo T ko chng li (do b loi, b v cm, b c ch) ch cn tbo B nhn ra. Do vy ko c chng li bn than KN ni sinh c them 1 epitop b tbo T nhn ra, t xhin p MD chng t KN 4) S biu hin sai lc ca MHC: cng c xem l n.nhn v c ch ca t min. bnh thg KN ngoi lai c i thc bo v tbo tua trnh din = MHC lp II cn KN bn thn c trnh din = MHC lp I. C nhiu tc nhn lm tng s biu hin ca MHC lp II v lm n xhin cc tbo khc ngoi i thc bo t KN ni sinh b h MD chng li 5) s bin d thn (soma) ca cc t bo MD. lm mt can bng s iu ho v kim sot. Cu 114: Gii thch cc c ch gy ra cc tn thng trog bnh t MD? Ch khi t KTh ( hoc Tbo T t P ) gy ra nhng ri lon bnh l, & khi loi tr chng th mt hoc gim cc ri lon ,ngi ta mi coi l bnh l t MD C ch tn thng tbo,m,hoc c quan trog bnh t MD v c bn cng ging nh c ch tn thng trog qu mn.Tuy nhin, ngi ta cha gp bnh t min do IgE.C l IgE ch chng KN ngoi lai.Kth trog t min a s trng hp la IgM. 1.C ch th nht: C ch u tin l KTh trc tip tn cng cc tbo mang t KN c hiu,chng hn trog bnh t min tan hu hng cu,bch cu,tiu cu. y c vai tr quan trng ca b th.Cc trng hp tng t nh hi chng Goodpasture c KTh chng mng c bn ca fi,thn, bnh vim gip trng Hashimoto, nhim c gip ( KTh chng th th TSH ), thiu mu c tnh t min ( KTh chng yt ni )..... 2.C ch h 2: C ch th 2 l s lng ng ca fc hp MD, cng nh trong bnh lupus ban . ng lu l 1 khi m b tn thng do fc hp MD th cng to iu kin fc hp MD tip tc lng ng thm 3.C ch do tbo T:

Tbo T chng li cc t KN cng gp nhiu bnh t min.Chng hot ng ring r hoc kt hp vi KTh.C th k ra 1 s vd sau : Vim teo d dy (a n thiu m do thiu vtamin B12 ) Vim gan mn t min. Vim tuyn gip Hashimoto. Vim no t min thc nghm, v tinh trng thc nghim ..... 4.C ch khuych i: S khuyn i cc tn thng trog bnh t min cng tng t nh trog qu mn.Tn thng nguyn ft do KTh, fc hp MD hay tbo T t P c th c m rng bng vai t b th,cc enzym hu hoi ca bch cu a nhn,cc lymphokin.Ngi ta thy IL-1,IL-6 v TNF c tdng gy tn thng rt mnh trog vim a khp dng thp Cu 115: Trnh by cu trc & c/nng ca phn t TCR trog p ng mn dch tbo (MD TB )? Cu trc: TCR- T cell receptor l phn t c c/nng nhn bit KN 1 cch c hiu trn b mt cc tbo T Cu trc l phn t glycoprotein c 2 chui polypeptid & hoc & Trng lng phn t 40 000 - 50 000D , gn vi CD3 thnh fc hp Cu trc kiu tng t cc chui ca vng Ig : vng C & vng V +phn hng nh C c u tn l - COOH, + phn thay i V c u tn cng l -NH2.Vng V lin quan n tnh c hiu ca TCR khi gn vi KN, chia lm 3 fn CDR1,CDR2,CDR3 ( complement determinant region ) C vng xuyn mng ngn 2.Chc nng: Nhn bit KN trn b mt tbo trnh din KN, lin quan n tnh c hiu ca TCR & KN , & trn tbo ch giai on loi tr KN T ng ng lien kt to ra tn hiu hot ho tbo, iu ho c/nng MD Cu 116: M t cc c im cu to v chc nng ca mt s loi t bo lympho T tham ja vo MD t bo Di nhm cc t bo trc tip thc hin chc nng MD t bo _TDTH : l phn nhnh ca T cng c CD4 trong cu trc +TDTH vi CD4 cng c kh nng nhn bit KN ngoi lai,do MCH(II) gii thiu +TDTH c hot ho sn xut ra cc lymphokin ring,c tdng ch yu l thu ht i thc bo (TB) ti.Chnh TB l tbo hiu ng trc tip loi tr KN. -Cc lymphokine ch yu ca TDTH l: +MIF: yu t c ch TB.do TB tp trung dy c ti vim +MAF: yu r hot ho TB lm TB hot ho mnh -Do vy vm c TTDH to ra xy ra chm,tin trin mn tnh,tp trung dy c lympho bo, TB,rt t Bcu a nhn.Cch to vim ny c hiu qu loi tr cc VK ni bo -TDTH c k/nng gy qu mn chm khi vim ti hch _Tc ( lympho gy c tbo) c phn t CD8 +C k/nng nhn bit KN ni sinh do c pt CD8 c th gn kt c hiu vi phn t MHC(I),do vy Tc c iu kin tip cn vi mnh KN do MHC I trnh ra b mt tbo +Chng li cc tbo c mang KN ni sinh tc l hnh thnh t trog ni bo.Tbo nhim VR,1s VK, n bo c KN gia nhp ni bo hoc chng li cc tbo b K ho.Ngoi ra, n cng chng c cc tbo ghp d gen 2.Di nhm iu ho MD _Th c CD4 trog cu trc c c/nng iu ho & chi fi MD + Nhn bit KN ngoi sinh do c phn t CD4 c th gn c hiu vi phn t MHC II.Do vy T h c iu kin tip cn vi mnh KN do MHC II ra b mt tbo (TB) +T h chi fi ton b cc hot ng hiu ng, tc l hot ng ca cc tbo MD k c chc nng trc tip loi tr KN vd nh s sn xut KTh ( ca tbo B),vai tr gy c ca Tc & vtr gy vim ca TDHT..Do nh Th c th tit ra cc interleukin thch hp cho s sn sinh mc ca cc tbo hiu ng,gip cho chng hot ho mc loi tr KN +S hot ho Th s c kim sot nh chnh cc sn phm & hu qu tbo hiu ng _Ts c CD8 trog tuyt i i s trng hp c c/nng kim sot MD + c ch loi tr KN khi P ny t ra qu mnh +Ngoi ra,n cn km hm sut i nhng qun th(dng) Th "t P" tc l nhng Th c k/nng chng li KN ca chnh c th ch.Nh vy c th ko mc nhiu bnh t min -Th c : CD4,CD2,CD3.CD5.CD7 -Tc c: CD8,CD2,CD3,CD5.CD7 Cu 117:k tn,nu bn cht & c/nng ca 1 s phn t lymphokin? _k tn: lymphokin bao gm cc interleukin( IL) v MTF(yu t c ch di tn i thc bo) , MAF(yu t hot ho i thc bo), MF( yu t gay cc dng lympho bo, NIF( yu t c ch di tn bch cu ht trung tnh), CSF( yu t kch thch t bo gc thnh dng v n bo), TNF,( yu t hoi t), IFN(c ch tc dng ca virus), v 1 s

interleukin(IL) nh IL-1,; IL-2,3,4,5,...c tc dng hot ha & pht trin nhiu qun th t bo _bn cht: lymphokin l nhng cht tit ra t T hot ho c bn cht l cc peptid trng lng phn t thp, hot nng cao, tc dng hp, ngn hn +c ch thng qua receptor, thay i C' ho ni bo _chc nng: kch thch bit ho tng sinh t bo MD: IL-1, IL-2, IL-4, GF +gy vim, ho hng ng thc bo: IL-1, MIF, NIF, MAF, IFN, CF +gy t bo: TNF, lymphotoxin, +tham ja iu ho MD: IF, RF Cu 119: Lit k cc yu t tham ja kim sot v iu ho MD v phn tch vai tr iu ho MD ca KN tham ja iu ho v kim sot MD c cc yu t nh KN, KT, t bo(Th, Ts), mng li idiodyp-khng idiodyp, cc cytokin. Bn cch yu t di truyn, TK- ni tit cng ng gp 1 phn vo qu trnh iu ho v kim sot MD Phn tch vai tr iu ho MD ca KN _Cc KN l l cc tn hiu u tin gy hot ho t bo lympho. Bn cht KN c nh hng n loi MD v n cng ca p ng xy ra _cc KN # nhau v cu trc ho hc kch thch cc loi p ng khc nhau +cc KN polysarcarid v lypit ko gy c MD t bo +cc KN protein gy c MD dch th v t bo _Liu lng KN tip xc c nh hng n cng p ng vi KN . Cc liu rt ln hay khi tim nhc li cc liu KN nh thng gy c ch _MD i vi 1 KN nht nh thay i tu ng vo ca KN . Khi a theo ng di da thng l sinh MD, khi a theo ng tim & ng ung thng ko p ng l do dung th ca t bo T, B hay do kch thch cc Ts c hiu _Cng sn xut cc KT jm khi nng KN jm. Khi mn cm, cc t bo c hiu KN tng, cc t bo MD hay cc KT s loi b KN sau p ng jm dn v tt c khi cc KN b loi b hon ton sn sng phn ng vi cc nhim khun mi. Nu mt c ch ny c th s trn ngp cc clon t bo MD c hiu hay sn phm ca chng Cu122: MD ch ng bng vaccine & MD th ng: cc loi,phm vi, sng dng? 1.MD ch ng: Gm: vaccine cht,vaccine sng gim c lc,vaccine di v,vaccine ti t hp DNA -Phm vi ng dng: p dung cho mi i tng c nguy c mc 1 bnh no m cha c MD chng li bnh 1.MD th ng: -Gm: +Huyt thanh # loi.vd: khng huyt thanh chng c rn + Huyt thanh cng loi: n gi hoc a gi.vd: -globulin MD + Kth n dng -Phm vi ng dng: +suy gim MD bm sinh + Nhim khun nng : bch hu,un vn + nhim vi rt: vim gan,vim no, cm + ng th + bnh t MD Cu 120: Trnh by c ch v vai tr iu ho MD ca yu t KT v tb 1.yu t KT _vai tr: cc KT c sn xut khi c kch thch KN c kh nng c ch cc p ng sinh KT tip theo vi cng KN _C ch : + Thanh lc KN: hin tng thc bo cc phc hp MD, KT trung ho KN, nn loi b c kch thch khi ng cho MD +KT phong b cc epitop KN, ko cho cc epitop tip cc vi sIg trn t bo B, ko hot ho c t bo B +cc KT khi gn vi th th Fc trn t bo B s c ch trc tip s hot ho ca t bo B +cc KT c th cm ng 1 mng li idiotip-antiidiotip trong iu ho MD 2.Mng li idiotip-antiidiotip trong iu ho MD _ chng 1KN c th sinh ra KT( 1) (idiotip). Nhng KT( 1) li c vng cc k thay i, l vi c th. Do n b KT( 2) chng li, KT( 2) l KT antiidiotip. Vai tr KT antiidiotip c th hoc tng cng hoc c ch MD _c ch: do antiidiotip c th gn c hiu vi cc idiotip trn t bo MD. Khi nng anti idiotip tng cao th s c tc dng c ch MD, dp tt MD

Ts( T c ch) c ch qu trnh MD khi MD y . Ngoi ra Ts cn c ch MD vi cc t KN ko c s tip cc vi cc t bo lympho non trong qu trnh bit ho _c ch: do t bo cm ng c ch khi g s hot ho ca Ts. Do ThCD4+. Ts ko c cm ng khi tip xc vi cc liu KN ln hay cc hapten a vo ko c ph cht hay bng ng tnh mch + Ts c CD8+ c th gn vi KN dng nguyn u khi thiu APC v thiu MHC. Do n c th c ch MD ngay c khi MD xy ra cha y ( c th cha xy ra) +tc dng c ch thng qua ncht tit ca n( yu t c ch). Yu t c ch ko c tnh c hiu KN, l cc TCR hot ho, tranh ginh phc hp KN- phn t MHC trn cc APC ca cc t bo T # Th c vai tr cm ng c ch (Ts), h tr MD chi phi ton b cc hot ng hiu ng ( tc hot ng t bo MD) _c ch: Th c th tit ra cc interleukin thch hp, trc ht l IL2, IL4,IL6, gip cho s sinh sn nh mc ca t bo hiu ng, gip chng hot ho mc loi tr KN. Th s c kim sot( km hm hoc tng cng) nh chnh cc sn phm v hu qu ca t bo hiu ng: KT, TNF Cu121: Khi nim tr liu MD cc phng thc chnh ca tr liu MD & mc ch ca cc phng thc 1.K/nim: Tr liu MD l cc bin fp can thip ca y t hc da trn hiu bit ca MD hc p dng vo thc tin phng & cha bnh cho ngi, vt nui. 2.Cc phng thc: 4 phng thc: -MD ch ng: a KN ko gy bnh vo c th t trc gy ra trog c th sng 1 ch ng ca h thng MD nhm ch ng ngn chn,tiu dit VSV gy bnh xm nhp sau -MD th ng: a vo c th ngi mc bnh nhim trng nng hoc suy gim MD m cha c MD chng bnh no 1 loi ch phm huyt thanh t ngi hoc ng vt cha KTh dc hiu a gi hoc n gi c hiu qu bo v tc khc khi cn cha khi hay mang li s thuyn gim 1 bnh ang ptrin (vim gan cp,bch hu cp) hoc phng 1 bnh ang chuyn thnh dch ( cm,vim no) Kch thch, iu ha MD: b sung cc yu t sinh hc,t nhin, nhn to, tham gia trong chui iu ha DMD ( cht iu bin MD) lm tng hoc gim ng thi tng cng cc hot ng chung ca h MD VD: BCG, cht cm ng NF, cytokine -c ch MD: km hm s hinh thnh MD iu ha ca c th bng cch tdng hn ch yu t tham gia MD Vd: corticoid c ch trc tip cc tbo lumpho, ngn cn thoai ha interleukin 2 l cht tng cng hot ng ca NK & lympho Tc.Gim bch cu toan tnh,,tng bch cu trung tnh,gim mt ht cc tbo kim & gim b th trog mu Cu 123: Cc phng thc tr liu MD bng cht KTH MD : ngun gc, bn cht.tdng,phm vi, ng dng ngun gc: +t VK: vd: Biostin t klebsiella, BCG, ni c t ca VK nh LPS +T tuyn c: vd: hocmn tuyn c,thymopentin + Cht ti t hp do cng ngh gen: vd cc chtcm ng interferon, cytokin ti t hp Ngoi ra chng c th c chit sut t nm,tho mc ,ngun gc ni sinh -Bn cht: peptid,protein,polysacharid -Tc dng: +Tng sc khng MD ko iu ha +Tng hiu qu bv ca vaccine + Kth MD: tng tng tc gia lumpho & i thc bo, Kth sn xut IL-1,TNF, tng tng hp interferon,hot nng ca NK ,tng tng hp Kth c/nng i thc bo -Phm vi ng dng: +bnh nhim trng mn tnh dai dng + bnh t MD,bnh c suy gim MD ( nh VR, suy dinh dng ) +ng th Cu 124: Cc bin php c ch MD: ngun gc,bn cht,phm vi ng dung,tdng -ngun gc: phong ph, c tng hp trog hay ngoi c th vd:+ tuyn v thng thn > cortisol + thuc c ch MD : aziathioprrin,methotrat -Bn cht: l cc cht ha hc,sinh hc,tia x,chit xut t thc vt -Tdung:+ gim c/nng ca i thc bo,gim sxut IL-1,TNF +c ch cc lympho,ngn cn tng hp interleukin-2 cht lm tng hot ng ca NK & lympho Tc + gim bch cu toan tinh,gim b th + c ch phn bo phm vi ng dng:+ chng vim: vd: thuc seroid = bnh tc min + ghp tng + ng th Cu 125: khi nim ghp v cc P thi ghp:

1, K/N: ghp m v c quan l 1 can thip sinh hc, nhn to, iu tr tm thi or lu di cho cc trn hp bnh nhn b mt chc nng ca m, c quan no 2, phn loai: 4 loi: -ghp cng gen:mnh ghp c trao i gia 2 c th ging nhau hon ton vdi truyn.vd: 2anh em sinh i cng trng or cc c th v cng dng thun khit. -ghp khc gen cung loi:n ghp c trao i, gia 2 c th cng lao nhng khc nhau v di truyn -ghp khc lao:m ghp c trao i gia 2 c th thuc 2 loi khc nhau -ghp t thn m ghp t v tr ny ghp ln v tr khc trong cng 1 c th vd: ly da ni lnh ghp vo ni bng. 3,cc P thai ghp:c 3 lao P thi ghp tnh theo tg t lc ghp n lc c bh thi b -P ti cp: xut hin sau vi pht dn vi ngy sau ghp do c th c sn KT chng li KN ca c th cho. vd: ghp tim, thn ca ng nh mu AB chon g nhm mu O. Trong P ti cp , cc TB ni mac mch mu m ghp b cc KT v b th ph hy gy tn thng sm, nghim trng, lan rng, tc mch lan rng trong mnh ghp -P cp xut hin cui tun th 1 sau ghp nhng ko ko di n vi tun ngay c bnh nhn c dng thuc c ch MD mnh,tn thng ch yu l TB ni mc mch mu do c 2 c ch dch th v TB. vd MD qua trung gian TB gy t thng thn ghp biu hin bngP st, i t,suy thn,c th suy yu. -P mn tnh: xut hin sau nhiu thng,thng kt hp vi s gim dn c/nng ca m ghp.Vd: ghp thn biu hin chnh ca P mn tnh l protein niu,cao huyt p, xt nghim m hc thy ni mc mch mu tng sinh,hp cc ng mch nh. Cu 126: Nu bng chng v vai tr ca cc PMD trong thi b m gp? Tin hnh ghp da trn chut bnh thng thy bong mnh ghp ra sm hn nhng ln ghp sau.cho thy cu c th ngy cng mnh hn Tnh iu ha ca m ghp quyt nh hin tng bong mnh ghp sm: chut A -> chut B ( 1) -> 7 ngy chut A-> chut B -> < 7 ngy Truyn th ng k/nng bong mnh ghp sm bng cch truyn huyt thanh ( hoc lympho) ca c th c ghp nhiu ln cho c th mi cng dng thun chng th vn xy ra hin tng thi b m ghp. _ vic thi b m ghp do tbo lympho thc hin nn hin tng bong mnh ghp c c ch MD c hiu -KN c trog mnh ghp quyt nh thi gian thi b m ghp c gi l KN ghp - ngi h thng KN l HLA ( k/nng ha hp t chc) thuc KN ha hp m MHC. Cc KN trog h thng HLA chia thnh 2 lp I & II +lp I : c mt trn hu ht cc tbo c nhn hot ng nh 1 v nhn dng, quyt nh tnh c hiu trog vic tn cng bi cc Tc gy c tbo nhim VR, tbo ng th, tbo alen # loi +Lp II: ch c cc tbo MD: lympho B, tbo tuyn c, tbo ni mc & lympho T hot ha -> khi ng qu trnh m ghp chng tc ch, kch thch tng sinh cc lympho T # gen cng loi Cu 127: C ch MD trog thi b m ghp? P thi b m ghp xy ra bi h MD ca c th nhn,xy ra sm hay mun ph thuc: + Mc ko ph hp KN HLA ca c th cho & c th nhn + C th ngi nhn c mn cm trc vi KN ph hp t chc ca c th cho hay ko + Mc MD ca c th nhn Vi c/nng l tbo MD, tbo ni mc m ghp tp trung cc tbo MD ca ngi nhn vo mnh ghp & trinh din KN cho chng nhn din. Trn tbo ni mc c cc protein dnh c hiu trc ht l nhm selectin c k/nng bm dnh cc bch cu lm cho chng di chuyn chm li, tng thi gian tip xc gia cc bch cu ca c th nhn vi tbo nim mc ca m ghp.Tip theo l cc protein dnh thuc gia nh Ig,tng cng bm dnh gia cc tbo nim mc & bch cu lm cho tbo MD dnh vo tbo nim mc bn vng. Mt # cc cytokine ( IL-1,IL-2,IL-8,TNF,.) lm tng tnh thm gip tbo MD d dng di chuyn qua thnh mch vo lp di ni m _ tbo i thc bo, tbo dendrritic, tbo ni mc ca mnh ghp c k/nng gii thiu KN cho lympho T ca ngi nhn lm tng sinh lympho T. kt qu: gy nn MD ca coe th nhn m hu qu l cc tbo Tc & KT mn cm vi KN ca m ghp n tc ng vo tbo ni mc nh 1 tbo ch gy ra s tn thng mch mu trong qu trnh thi ghp ti cp, cp , mn Cu 128: Nu 1 s bin php nhm hn ch,ngn cn thi b m ghp; KN: +Mc ch: tm m ghp ph hp hn + KN ABO gia ngi cho 7 ngi nhn l bc c bn ngn cn P thi ghp ti cp + KN HLA: s ph hp KN HAL-B c ngha quan trng trog vic ghp thnh cng. nh tp m: dung huyt thanh ca ngi c truyn mu nhiu ln hoc ph n c thai nhiu ln nhn dng cc KN ghp ngi v trog huyt thanh ca nhng ngi ny c nhiu KT chng li cc KN ghp # nhau.Hin nay, sn xut c cc KT n clon, c tiu chun ha , dung nh tp m Pht hin tnh trng mn cm sn: pht hin KT chng KN ghp c sn trong c th ngi nhn bng cch ly huyt thanh ca ngi nhn cho P vi lympho bo ca 1 panel bch cu c y KN ph hp m.Xc nh hiu gi

KT & xc nh KN c hiu vi KT. ng thi cho huyt thanh ca ngi nhn P vi lympho bo ca c th cho d tuyn. -Truyn mu ton b: truyn mu trc khi ghp ci thin c tnh trng sng ca m ghp. Dng thuc c ch MD hu nh ton b ngi nhn ghp c dung thuc c ch MD trc khi ghp:azathiopril, cyclosporine A,steroid,methotrexat ngoi bin chng gy c ch MD lan ta cc thuc c ch phn bo ny cn rt c vi ty xng, rut non, nn s dng ht sc cn thn. -P m ghp chng vt ch. Khi c th nhn b suy gim MD th cc tbo MD mnh ghp s mn cm vi KN ph hp t chc lp II ca c th nhn sinh MD chng c th nhn vd: ghp ty xng ngi bnh thng vo c th suy gim MD ( do phng x, dung thuc c ch MD..).Mc d Kth trc khi ghp ko pht hin s ko ph hp tip xc gia c th cho & c th nhn. -> vic nh gi mc do P ghp chng tc ch c tm quan trng trong tin lng & chn phng php iu tr thch hp Cu 129:trnh by bng chng v MD chng ung th. -th nghim1: ghp U chut. mn cm chut = nhng mnh SarcomaA nh ly t chut b Sarcoma cho 1 con chut khc trong dng thun chng sau khi khi U ptrin 1 thi gian ng ta loi b khi U v ghp li mnh SarcomaA vo chut -> thi loi mnh ghp. Thay SarcomaA bng Sarcoma B-> khng c hin tng thi loi. nh vy chut c MD vi loi TB U no th ko mc loi U na. Th nghim 2: Tim cho chut TB K b bt hot bi ha cht or tia x sau tim TB K cng loi th K ko pht trin c. nu tim TB K cho chut ko c gy MD th K ko ptrin c-> c th tc ch c MD c hiu chng K. KN K khc KN khc. nu thay mn cm chut vi cc Sarcoma nh, TB K b bt hot = t chc BThng th chut ko co kh nng ngn cn K ptrin -TN 3: K do ha cht. Gy MD cho 3 nhm chut = TB K bt hot do ha cht MC1 .sau : + nhm 1 c ghp li tbo K cng loi -. K ko ptrin + nhm 2 c ghp li tbo K do MC2 -.> K ptrin + nhm 3 ghp li tbo K do VR -> K ptrin Mi K gy bi ha cht c KN c hiu ring TN4: K do VR: 3 nhm chut c gy MD vi SV 40 bt hot sau nhm 1,2 c ghp li K do SV40 -> K ko ptrin,nhm 3 c ghp li K do MuLV -> K ptrin _Vy chut c gy MD vi SV40 c k/nng chng li K do SV40 nhng li b K do MuLV Mt # c nhiu im lin quan gia K & MD ngi Mt s K t thoi lui: chorio epithelioma, melanoma, & neuroloma -Ko c globulin -> lymphoma ptrin -lymphosacoma thng xut hin trog thiu mu dung huyt t min Ko th gy K thc nghim ngi bng VR song c mi lien h gia nhm VR Herpes vi 1 s K ngi - Pht hin c 1 s KN K ngi nh KN K phi thai;AEP c trog K gan,CEA trog K i trng,KN trog K no & KN trog melanoma -TN nui cy tbo hn hp xc nh KN trog iu kin ng gen & d gen Cu 130;Nu KN K: tn gi, TN chng minh -KN K bn cht l cc protein c rt t hoc ko c tbo bnh thng m do t bin gen mt k/nng iu ha tng hp protein & ptrin tbo.VD: protein P53 c 3 loi KN KN ghp c hiu ung th TSTAs c pht hin bng cch ghp cc mnh K gm cc protein ca cc tbo K c x l & trnh din KN trong phn t MCH.Phc hp TSTAs-MHC l ch th th ca tbo lympho T & Kth tip cn.Tnh ieeuf ha ca KN ph thuc vo t chc m K ptrin ch ko ph thuc vo loi ha cht gy K -KN c hiu t chc TSAs c mt trn tbo bnh thng & c dc tnh ring cho tng loi t chc K xut hin t chc no thng biu hin KN dc hiu ca t chc -TSAs l 1 thnh phn ca tbo bnh thng ko kch thch MD chng K trog lm sang c s dng nh `1 ci ch cho MD tr liu lm du n tm ngun gc xut pht ca t chc K KN K phi thai c sn xut 1 cch bnh thng ca tbo phi thai m ko c sn xut hoc ch c sn xut vi 1 lng rt t nn c th kh c th pht hin c.KN ny ti xut hin do mt k/nng kim ch cc gen chu trch nhim sn xut KN phi thai cc tbo c tnh ca c th trng thnh -KN phi thai ko chng tc ch CEA, AFP +AFP c sn xut bnh thng trc tin ti non hong sau l ni b & gan phi thai. ngi ln protein -> bin i thnh albulin & ch cn 1 lng rt nh AFP tng cao bnh nhn K gan, K tbo mm,K ty

-CEA l prtein ca mng b g lycozyl ha cao.CEA b ly giaq dch ngoi tbaog & tng cao trog vim ty,gt,vim ty 3 thng u & gia thai k trog dich nhy ca vim trang ca ngi ln,sa m CEA tng rt cao trog huyt thanh,bnh nhn K trc trng Cu 131: cc loi MD chng K: bn cht,vai tr? C 2 loi MD trog K l MD c hiu & ko dc hiu 1.MD ko dc hiu : +bn cht l qu trnh ly gii tbo K 1 cch t nhin m ko cn mn cm trc. ny ko cn c KT & KN dc hiu + vtr: tbo NK: c k/nng loi b tbo K ghp,loi b ghp ty & ngn cn di cn.ngoi ra cn c s dng trong MD K vay mn -i thc bo :hot ha & ly gii mnh cc tbo bnh thng & cc tbo K bch cu i toan trog K:thc bo & tiu dit cc tbao K theo c ch c tdng ca b th & ph thuc vo KN.& gy tn thng t chc K UMD c hiu: -MD dch th: t c vtr trog iu tr K MD tbo: ph thuc ch yu vo lympho T & cc KN glycoprotein b mt ca cc tbo #.tbo Th sn xut cc lymphokin rt cn cho vic b sung & hot ha i thc bo,tbo NK. Vtr ca Tc: Tc mu ngoi vi ngi b carcinoma & melanoma c k/nng ly gii tbo K MHC : cc protein MHC hin din trn b mt tbo K. l mc tiu tbo lympho T nhn bit KN & dit cc tbo K Cu 132: Cc bin php n trnh ca t chc K thot khi s kim sot ca h thng MD? -1 s K c tnh sinh MD yu,chng ko biu l cc MHC cn thit cho vic gn & trnh din KN c tbo K x l -> h thng MD ca c th ko nhn bit c & ko MD gim iu ha ca MHC trn tbo K nn ko hnh thnh c phc hp KN-KT kch thch MD tc ch dung np 1 s KN K.Lc mi hoc tbo K trinh din cc KN dng dung np c cho h thng MD Hin tng ln qua vi 1 lng KN qu t n ni m c th ko nhn din c ko kthch MD.Khi h thng MD ca c th pht hin c th khi u ptrin qu ln 1 s tbo K t bin ko biu hin cc protein c k/nng sinh MD c bit l cc protein tr nn c tnh lm mt KN m cc clon Lympho Tc c th nhn bit c -> K ptrin & di cn cc phn t KTh gn vi KN trn b mt tbo K ta thnh kin kt lm bt ng protein mng,KN s tp trung li 1 cc tbo chm vo trong mng tbo.Kth ca lien kt ny mt k/nng hot ha b th-> tbo K s ko b ly gii KN di khi khi u n kt hp vi KTh to phc hp KN-KT phong b lm mt c/nng iu ha ca tbo Th vi KN c hiu K KN b mt ca tbo K c th ln trnh h thng MD do cc phn t glycocalyx gm acid sialic cha mucplysacarid to nn mng che KN Cc sn phm ca K hoc cc tc nhn vt l,ha hc nhim trng gy chuyn dng c tnh tbo -> suy gim h thng MD Cu 133: trnh by yu t c bn tham gia kim sot v iu ho MD 1/vai tr ca dung th trong kim sot MD -c ch: khi liu lng KN qu ln tiu dit c c cc t bo lympho B,T v c cc t bo khc c ch ko p ng na m chp nhn n v chung sng vi n KN gy ra s tr ko cn cm ng ca dng t bo cc KN bn thn cng gy ra dung th MD do cc clon Tc v Th t phn ng vi KN bn thn 2/vai tr ca KN: - ph thuc bn cht ca KN ; -ph thuc liu lng ca KN -ph thuc vo ng vo ca KN; -ph thuc vo cng sx KT 3/vai tr ca t bo; -Ts: c ch qu trnh p ng MD khi MD y -Th:tham gia vo qu trnh iu ho hot ho cc TB MD ( Tc, TTDH, v lympho ba B ) c bit l qu trnh iu ho hot ho lympho B 4/vai tr ca KT iu ho (-) tnh nguc ca KT: KT khi sx ra c kh nng c ch sinh KT tip theo i vi chnh KN y c ch: + thanh lc KN = hin tng thc bo + KT phong b cc epitop ca KN +KT khi gn vi th th Fc trn t bo B s c ch trc tip hot ho ca tb B +mi KT sinh ra c th sinh ra KT chng li KT y ( c ch ) 5/vai tr ca cytokine: c th tng cng hay c ch MD 6/vai tr ca yu t TK,di truyn, ni tit -yu t di truyn:1 vi gen a/h n chung thong qua chc nng ca TB do chng c nh hng n kh nng s l v trnh din KN ca TBa/h n qu trnh p ng MD -cc hormon ni tit v cc yu t TK cng nh hng n qu trnh MD

+ 1 s hormon c tc dng c ch MD: androgen, estrogen, progesterol, glucocorticoid + 1 s hormon c tc dng tng cng p ng MD: GH,thyroxin v insulin + cc c quan MD c cc TK t ng v cm gic nn hot ng ca tk a/h n qu trnh sinh MD Cu 134: trnh by c ch kim sot v iu ho MD bi cc lympho T h tr 1/c ch hot ho lympho T h tr: -CD4 v TCR (ca Th ) tip xc vi phn t MHC ( II) v KN (ca TB ) l tn hiu th nht, cn TB tit ra IL-1 tc ng ln Th l tn hiu th 2 cn v Th tr thnh hot ho 2/c ch kim sot v iu ho MD -S hot ho Th th hin hin tng kick thick ca cht tit IL-2, IL-4 hay IL-6 tc ng ln lot t bo khc m trc ht l tc ng ln bn thn Th ri Tc,TDTH,B + Th mi c hot ho tit IL-2 tc ng li ln chnh n, t hot ho v chuyn t vai tr nhn bit KN sang vai tr iu ho chi phi MD + Th hot ho h gii phng IL-2 t/ ln Tc. TDTH l diu kin chng hon thnh chc nng nhn bit chuyn sang c/n hiu ng t bo hot ho h tr lympho B bng cch tit ra IL-4 gip cho 1 qun th B s sinh KT chng li KN m Th nhn bit. cc tm im mn ca nang lympho xut hin, m mn cho giai on tng sinh.tip Th sx IL-6 h tr qun th B ny bit ho Cu 135: trnh by c ch kim sot v iu ho MD bi cc lympho T c ch ( Ts) -cc t bo khi ng s hot ho ca Ts gi l Tb cm ng c ch. l cc t bo c phenotip ca t bo Th vi CD4+ -Ts thng c cm ng khi p ng vi cc liu KN ln hay vi cc hapten a vo ko c ph cht hay bng ng tnh mch. Ts thng nhn bit cc KN khi thiu cc phn t MHC ca ATC -S tng sinh v bit ho ca Ts ph thuc vo cc Th CD4+ -tc dng c ch ca Ts thong qua cht tit ca n gi l cc yu t c ch yu t c ch ko c tnh c hiu KN nhng c th c cng Kn idiotip vi bn thn tb T, cho nn c tc gi cho rng,yu t c ch l cc TCR hot ho ( bi tit ra dng ho tan) tranh ginh phc hp KN-pt MHC trn cc APC ca cc TB T khc -Ts c nhiu nhm nh c phenotip v chc nng khc nhau Ts CD8+W- : ch cc Ts ko bm dnh vo lectin W Ts CD8+W+ :ch cc Ts bm dnh vo lectin W Ts CD8+ W-:c kh nng c ch cc t bo B mnh TsCD8+W+:ko c ch c p ng to KT ca t bo B m chng li tc dng c ch Ts CD8+ WNh vy tong nhm Ts ngoi cc tb c chc nng c ch cn c cc tb chn li s c ch to s cn bng Ni chung, s diu ho v kim sot DMd ca Ts thong qua qu trnh c ch MD, c ch phn ng loi tr KN ( do Th pht ng) nu p ny t ra qu mnh ng thi n cn km hm sut i nhng Th t phn ng tc Th c tim nng chng li cc KN ca chnh c th ch Cu 136:trnh by mt s th nghim rt ra nhn nh v vai tr kim sot v iu ho MD ca KN -th nghim 1: + cc VK c v bc thng c cc KN polisaccarid v p ng MD chng VK ny c i sng ngn + cc KN protein gy c MD dch th v t bo gp trong 1 s vi khun v a s virut.chng cn gy c MD nh ko di. Do 1 s c th c tim vacxin ch ng chng nhng virut vn cn khng trong nhiu nm v thng l c i Nh vy cc KN khc nhau v cu trc ho hc kch thch cc p ng khc nhau -th nghim 2: + khi tim liu rt ln hay tim nhc li cc liu KN nh thng gy c ch +cc liu lng ln KN polysaccarid hay protein c cc nhm quyt nh ging nhau c xu hng gy dung th cc TB B c hiu KN, c ch s sx KT Nh vy liu lng KN c nh hng n cng p ng ca KN -th nghim 3: + tim KN vo c th = ng di da thng l sinh MD,KN a = ng tim hay ng ung thng ko p ng do c s cm ng s dung th ca tb B hay T.hay do kch thch cc TS c hiu Nh vy MD i vi 1 KN nht nh thay i tu ng vo ca KN -th nghim 4: + khi mn cm, cc t bo c hiu KN pht trin, cc t bo MD hay cc KT s loi b KN v sau p ng gim dn v tt i khi Kn b loi b hon ton sn sang i ph vi cc Kn mi Nh vy cng sn xut KT gim khi [ KN] gim -th nghim khc: thanh lc KN = tim 1 lng KT tha trong thi gian c p ng MD s lm gim vic tng hp KT v gim s lng cc t bo tit KT Cu 137: Th nghim rt ra nhn nh v vai tr kim sotv iu ho MD ca KT Th nghim v iu ho ngc m tnh ca KT

Nu tim cho sc vt 1 lg KT c hiu ngay trc khi mn cm vi KN hay trog thoi gian xy ra p ng c hiu th s sn xut KT b gim. l hin tg iu ho ngc m tnhca KT, KT c th iu ho c MD dich th v TB *)c ch: + thanh lc KN = htg thc bo cc phc hp MD: KT trung ho KN, loi tr KN, nn loi n c kthch khi g cho md + KT fong b cc epitop KN, ko cho cc epitop tip cn vi sIg trn tbo B, ko hot ha c tbo B + Cc KT khi gn vi th th Fc/TB B s c ch trc tip s hot ho ca tb B + Cc KT c th cm ng 1 mng li idiotip antidiotip trong iu ho MD 2) cc Kt c th cm ng 1 mng li idiotip antidioptip iu ho md dch th v tbo Th nghim: KN c mn cm cho sc vt th nht c KT chng li KN : ng ta em tinh khit KT ny v nh s l KT1 (tc idiotip 1). Sau ng ta em tim Id1 cho sc vt T2 c KT2 (tc idiotip 2). Ng ta em tinh khit Id2 mn cm cho sc vt T3 v c tip tc nh th. Kt qu thy rng Kt2 (tc idiotip 2) chnh l Antin Id1: n nhn bit Id1 c mt trn KT 1 nhng ng thi cng nhn bit c Id1 c mt trn KT3 (chnh l Anti id2 tc Id3). KT4 c t/c ging KT2 nhng ch c 1 phn nh ca KT3 (Antin Id2) l kt hp vi KN u tin. N th 1 Id c nhiu p/ cho vi nhiu nhm quyt nh # nhau ca KN c th khi ng cc tbo B c hiu # nhau, nn thg c 1 mng li idiotip chung hay idiotip gy p/ cho /ho MD cho n khi nng KN hay KT gim dn ri tr v nh lc cha mn cm. ngha l dp tt md. Sau khi KN b loi tr mng li idiotip c th cho php md chy ko trong 1 thi gian duy tr qun th tbo nh. Cc tbo Th mn cm trc tip vi cc Id chung trn cc Tbo nh # nhau & c hiu vi KN nht nh tng cng md th ft. Cu 138 - 141: Nu cc chng c v vai tr /ho md ca hthng Tk - ni tit T/dng ca hormone trn tbo MD cc tbmd c receptor vi nhiu loi hormon. Do hormon c th tc dng i vi md: + cc glucocorticoid, androgen, oesterogen, progesterol c ch md. + GH, thyroxin v insulin c tc dng tng cng md Khi ct b tuyn thg thn ca con vt hay b stress u lien quan n s bin i cc tbo tit KT. Cc bnh t min c nhiu # bit trog cc gii # nhau. Cc c quan md c cc dy tkinh t ng v cm gic. Khi ct tkinh giao cm ca tr s sinh bng 6 hydroxydopamin hoc ct b tkinh lch ca tr - a tr s tng cng md. Dng bo c lien quan vi tk v gii phu. cc yu t tng trng tkinh gy mt ht dng bo. Cc cht P, somatosstatin, VIP h tiu ho c ch s tng sinh lympho mng Payer, c ch prolactin s c ch hot tnh tbo T. Cyclosporin A c ch chn lc c tbo Th, c Receptor chung vi prolactin trn tbo t 2) tc ng ca h md trn h tk nt Sau thch thc vi KN, khi KT t nh cao, nng glucococticoid cao s c ch md. IL-1 kick thch s tnghp cc glucococticoid thong qua trc tuyn yn - thng thn. Trong vng lnh vt thg c tg tc gia cc tbo, vim v cc yu t tng trg tkinh, IL-1 cng gy tng yu t tng trng tkinh on tkinh hng to. Il-1 v cc N gy st thong qua cc trung tm iu nhit. Cc tg tc gia h md v tk nt di theo cc mch knh + mch 1: lquan n s tng hp c glucococticoid di a/hg ca IL-1, glucococticoid l c ch ngc tr li IL-1 v IL-2 mch 2: lquan n hcmon, receptor vi hocmon (ccoi nh idiotip); vi anti hocmon v vi anti idiotip (anti receptor). mch ny c th lquan n c ch bn sinh ca bn t min v chng trc tip cc Receptor vi hocmon (chng receptor vi axetylcholine trong bn nhc c l 1 vd) Cu 142: cc cch phn loi KN Phn loi theo mi tng quan di truyn gia KN v c th nhn KN KN khc loi (xenoantigen): KN ng loi nhng d gen (alloantigen): T KN (autoantigen): Ngoi ra, sinh hc pt cn phn them vo nhm ny mt loi KN na: l KN idiotyp. VD: KN ng loi nhng d gen: in hnh cho loi KN ny l: h thng cc KN bch cu (HLA: Human Leucocyte Antigen) b) phn loi theo bn cht ho hc: Kn l Glucid: vd: tnh c hiu KN ca c vk: t cu, ph cu, lin cu, KN ca cc nhm mu do cc nhm g quyt nh KN l Lipid: vd: cht cardiolipin ly t tim b c dung lm KN pht hin Kt chng giang mai KN l acid nucleic: vd: trong cc bnh t min nh bnh lupus ban h thng, vim a khp dng thp, c xhin KT khng nhn (khng DNA) trog mu Kn l Protein: l loi KN ph bin nht trong t nhin v v c tnh Kn cao. Vd: cht vasopressin Kn tng hp, ti t hp, siu KN. Vd: pt enterotoxin, pro A G ca lin cu c) phn loi theo p ng MD (theo ngun gc)

Kn ph thuc tuyn c: hu ht cc Kn l pro u thuc loi ny KN ko ph thuc tuyn c: vd: Flagellin l 1 pro nhng trong pt c cc nhm quyt nh Kn lp i lp li nn cng l KN ko ph thuc tuyn c. Cu 143: Cu trc MHC lp I (v hnh) L cc glycoprotein Tt c c pt lp I u gm c 2 loi chui a peptid: + chui alpha (. hay chui nng) xp x 40kD ng, cha 1 oligosacarit gn vi u N, ca chui c u tn amin hng v ngoi bo, do gen MHC m ho. 1 on ngn k nc xuyn mng v nhm tn cacboxyl qung 30 acid anin nm trog bo tg + Chui : ko do gen MHC m ho, gn ko ng ho tr vi phn ngoi bo ca chui v ko gn trc tip vi tbo Phn b: thg thy cc tbo c nhn v chng u l nhng tbo trnh din KN i vi cc pro l, pro ni sinh cho TCD8+ Phn t MHCI c chia thnh 4 vng rieng bit + 1 vng c u tn amin ngoi bo gn peptid + 1vng ngoi bo ging pt Ig + 1 vng xuyn mng +1 vng trog bo tg *) vng gn peptid: +vng gn peptid ny ca chui alpha gn khong 180aa, chia thnh 2 on ging nhau (khong 90 aa) gi l alpha1 v alpha2. alpha1 v alpha 2 tg tc to thnh 1 sn c 8 chui ca l beta cc cnh alpha1 v alpha2, to thnh 1 rnh gn peptid di t 10 20 aa ca c KN ging ho mt phn. + phc hp peptid v MHC lp I c biu l trn b mt cc APC trnh din cho tbo TCD8+. + tnh a hnh ca cc alen MHC lp I, mt mt l to nn cc bin i cu trc ho hc ca rnh gn c vi cc peptid # nhau, mt khc l tip xc vi cc TCR c hiu khc nhau. + MHC trn tbo APC ging vi pt MHC lp I ca chnh tbo *) Vng ging Ig: gm c chui alpha3 ca chui nng alpha, c khong 90 aa ngoi bo, nm gia nhm tn cng cacboxyl1 ca alpha2 v vng cm trong bo tg. + ngoi ra cn c chui beta do 1 gen ngoi MHC m, tuyt i ko thay i gia cc pt lp I v n c gi l Beta2microglobulin c tnh di truyn trog in rtn, kick thc nh v c tnh ho tan + beta2 v alpha3 u gp li to cu trc ging ng vng hng nh ca Ig v nh th cc phn t MHC lp I c th thuc gia nh cc pt Ig. Hai domain ny tg tc vi nhau v beta2 microglobulin cng tip xc vi l nn ca rnh gn peptid to nn s tip xc gia vng ging Ig vi cc aa ca 2 chui alpha1, alpha2 *) Vng xuyn mng: l chui a peptid chy t cui ca alpha3 n mt vng k nc c khong 25 aa, i qua cng k nc ca mng plasma. *) Vng bo tg: l vng tn cng ca cc chui alpha ca lp I di khong 30 aa cm vo trog bo tg Cu 144: Cu trc MHC lp II (v hnh) Gm 2 chui a peptid alpha v beta kt hp ko ng ho tr vi nhau. Chui alpha ln hn chui beta mt t do glycosyl ho nhiu hn. c 2 chui u c u tn amin ngoi bo v u tn cacboxyl ni bo. Hn 2/3 mi chui l phn ngoi bo. c 2 chui u do gen MHC a hnh m ho. Cc pt lp II cng c chia lm 4 vng nh lp I *) Vng gn peptid: gm 2 phn alpha1 v beta1 gp li to thnh nn l l beta c 8 lp, 2 cnh alpha1 v beta1 to nn rnh gn peptid, alpha1 ca cc pt lp II ko c cu ni di-sunfua, trog lc beta1 c + tnh a hnh ca gen MHC lp II tp trung trog cu trc ca alpha1 v beta1 ca rnh gn peptid, to nn c b mt c cu trc ho hc c hiu ca rnh, quyt nh tnh c hiu v i tnh gn peptid ca rnh. + tnh a hnh ca gen MHC cn quyt nh s nhn bit c hiu ca TCR vi pt MHC *) Vng ging Ig: gm 2 on alpha2 v beta2 ca lp II c cc cu ni di-sunfua bn trong chui. v c bn ko a hnh nhng # bit nhng khc bit nhau trong cc cm gen # nhau + cc pt CD4+ ca Th gn vng ko a hnh l vng ging Ig ca cc pt lp II v n ch p ng c hiu trong gii hn ca cc pt MHC lp II *) Vng xuyn mng: gm khang 25 aa k nc. tip ni ca 2 chui alpha2, beta2. tn cng ca vng xuyn mng ca 2 chu l cc aa kim *) vng bo tg: l 1 ui i nc ngn trog bo tg to thnh u cacboxyl tn ca mi chui a peptid Cu 145: phn tch dd c trng ca SGMD do suy dinh dng -thiu cc cht dinh dng protein,glucid, lipid, Vit, cc cht vi lng cc t bo thiu nng lng v nguyn liu trng thnh,pht trin v hot ng. do vy cc c quan, cc m, cc tb chu trch nhim v MD s b suy gim v s lng v cht lng. dc bit l suy gim v MD qua trung gian t bo -tuyn c v cc hch bch huyt b teo nh: tuyn c ch cn li 1 vin nh, m nht, ko c hay rt t lympho bo, tiu th hassal b thay th bi t chc x, hch bch huyt cng t t bo lympho -s lng lympho bo : gim mu ngoi vi,v cc m bch huyt, c nhng lympho bo ko in hnh.k/n thc bo ca cc TB v bch cu ht gim

lympho bo T gim r rt v s lng v cht lng, gim p ng MD qua trung gian t bo, gim cc phn ng qu mn chm vi candida, PPD k/n tit lymphokin ca cc lympho bo gim. thi gian thi loi mnh ghp d gen di hn so vi bnh thng -s lng lympho bo B, hm lung cc globulin MD. t thay i. gim k/n sx KT ca cc lympho bo khi c mn cm a s cc trng hp suy dinh dng c s lng lympho bo B bnh thng, Ig bnh thng hay tng. Cc trng hp ny c nhim khun km theo hm lng b th ton phn gim r rt, cc thnh phn b th u gim ( tr C4) gim nhiu nht l C3 vi vacxin: khi dc tim chng vacxin phng bnh, cc tr suy dinh dng phn ng rt khc nhau v c khi li nguy him cho tr. k/n to KT cng nh hiu gi KT ca tr suy dinh dng thp hn nhiu so vi tr bnh thng cng la tui Cu 71: nh ngha suy tim, ri lon chuyn ho tbo c tim khi suy tim: N: Suy tim l tnh trng qu tim ko m bo c nhu cu cp mu cho c th (qua cc ch s v lu lng). hu qu ca suy tim sm mun cng lan ti mch, dn ti suy tun hon chung. Ri lon chuyn ho: cc n.nhn suy tim cui cng dn n RLCH trong t bo c tim + thiu oxy tim khin qu trnh oxy ho to nng lg b thu hp. tim ko ng lg co bp + thiu oxy v 1 s ng.nhn khc dn n Ca++ ko vo c tbo c tim ng khi g h enzym ATPase do thiu ng lg co c. + gim tc chy mu + thay i HA: Suy tim -> HA gim, lu lg mu gim, sc co bp gim, sc cn ngoi vi cng gim. do gin mch v thiu oxy -> HA M gim nhng HA TM tng do tim bp yu mu chy chm -> mu TM + Cng v hi sut ca tim gim Cu 72: cc nguyn nhn gy suy tim hay gp: C 2 nhm ln: do mch vnh v khng do mch vnh Khng do mch vnh: Tim b qu ti ko di, qu ti v th tch (bnh van tim, st cao); qu ti v p lc (cao HA, hp van M ch) u a n thiu oxy Bnh l ca tim: c tim b vim, nhim khun, nhim c, ng c K+, Ca++, 1 s thuc c i vi tim, vi khun, t vi khun, (cm, thg hn..) thiu vit B1 Do mch (gim khi lng tun hon chung, chy mu, tru mch) Ng.nhn ngoi tim: bnh l ca gan, thn, ni tit 2) Do mch vnh: hp, tc, co tht:, nhi mu c tim. Tt c cc ng.nhn lm ri lon chuyn ho trong tbo c tim. Tbo c tim thiu nng lg hot ng u dn n suy ti