<p class="MsoNormal" style="text-align: center;" align="center"><b><span style="font-size: 15pt; font-family: Tahoma; color: blue;">CÁC NGUYÊN LÝ VÀ PHƯƠNG PHÁP XÉT NGHIỆM HIV<o
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></span></b></p> <p class="MsoNormal" style="text-align: center; text-indent: 0.25in;" align="center"><b style=""><span style="font-size: 10pt;"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b style=""><span style="font-size: 10pt;">Nguyeãn Hoaøng AÂn<o
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> </o
></span></b></p> <p class="MsoNormal" style="text-align: center; text-indent: 0.25in;" align="center"><b style=""><span style="font-size: 10pt;"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.25in;"><b style=""><span style="font-size: 14pt;">1. </span></b><b style=""><span style="font-size: 14pt; font-family: "Times New Roman";">Đại cương:<o
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></span></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.1. Cấu trúc của virus HIV.<o
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></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-size: 10pt; font-family: "Times New Roman";"><o
> </o
></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b><span style="font-size: 13pt; font-family: "Times New Roman";">CẤU TRÚC CỦA VIRUS HIV<o
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></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b><span style="font-size: 10pt; font-family: "Times New Roman";"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><span style="font-size: 10pt;"><!--[if gte vml 1]><v:shapetype id="_x0000_t75" coordsize="21600,21600" o:spt="75" o
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></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-size: 10pt; font-family: "Times New Roman";"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">HIV có đặc điểm chung của họ retroviridae. Hạt virus hoàn chỉnh (virion) có cấu trúc gồm 3lớp.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.1.1. Lớp vỏ ngoài (vỏ peplon): lớp này là 1 màng lipid kép có kháng nguyên chéo với màng nguyên sinh chất tế bào. Gắn lên màng này là các nhú.</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt; font-family: "Times New Roman";">Đó là các phân tử Glycoprotein có trọng lượng phân tử 160 kilodalton (gp160). Nó gồm có 2 phần:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">+ Glycoprotein màng ngoài có trọng lượng phân t</span><span style="font-size: 14pt;">öû</span><span style="font-size: 14pt; font-family: "Times New Roman";"> là 120 kilodalton (gp120). GP120 là kháng nguyên d</span><span style="font-size: 14pt;">eã</span><span style="font-size: 14pt; font-family: "Times New Roman";"> biến đổi nhất, gây khó khăn cho phản ứng bảo vệ cơ thể và chế vaccin phòng bệnh.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">+ Glycoprotein: xuyên màng có trọng lượng phân t</span><span style="font-size: 14pt;">öû</span><span style="font-size: 14pt; font-family: "Times New Roman";"> 41 kilodalton.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.1.2. Vỏ trong (vỏ </span><span style="font-size: 14pt;">capsid</span><span style="font-size: 14pt; font-family: "Times New Roman";">): vỏ này gồm 2 lớp protein:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">+ Lớp ngoài hình cầu, cấu tạo bởi protein có trọng lượng phân </span><span style="font-size: 14pt;">töû</span><span style="font-size: 14pt; font-family: "Times New Roman";"> 18 kilodalton (p18).<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">+ Lớp trong hình trụ, cấu tạo bởi các phân </span><span style="font-size: 14pt;">töû</span><span style="font-size: 14pt; font-family: "Times New Roman";"> có trọng lượng phân tử là 24 kilodalton (p24).</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt; font-family: "Times New Roman";">Đây là kháng nguyên rất quan</span><span style="font-size: 14pt;">g</span><span style="font-size: 14pt; font-family: "Times New Roman";"> trọng để chẩn đoán nhiễm HIV/AIDS.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.1.3. Lõi:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">Là những thành phần bên trong của vỏ capsid, bao gồm:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">+ Hai phân tử ARN đơn,</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt; font-family: "Times New Roman";">đó là bộ gen di truyền HIV(genom).<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">Genom của HIV chứa 3 gen cấu trúc: Gag (group specific antigen) là cac gen mã hoá cho các kháng nguyên đặc hiệu của capsid </span><span style="font-size: 14pt;">cuûa vir</span><span style="font-size: 14pt; font-family: "Times New Roman";">us; Pol (polymerase) mã hoá cho các Enzym: reverve transcriptase (RT:Enzym sao mã ngược), protease và endonuclease (còn gọi kháng nguyên integrase); và EnV (envelop) mã hoá cho glycoprotein lớp vỏ peplon của HIV.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.2. Sự xâm nhập vào tế bào và nhân lên của virus HIV.</span><span style="font-size: 10pt; font-family: "Times New Roman";"><o
></o
></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><span style="font-size: 10pt; font-family: "Times New Roman";"><!--[if gte vml 1]><v:shape id="_x0000_i1032" type="#_x0000_t75" style='width:247.5pt;height:186pt'> <v:imagedata src="file:///C:\DOCUME~1\MrHais\LOCALS~1\Temp\msohtml1\01\clip_image006.emz" o:title=""/> </v:shape><![endif]--><!--[if !vml]--><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image007.gif" v="" height="248" width="330" /><!--[endif]--><o
></o
></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-size: 10pt; font-family: "Times New Roman";"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.2.1. Sự</span><span style="font-size: 14pt;"> </span><span style="font-size: 14pt; font-family: "Times New Roman";">hấp phụ lên bề <span style=""> </span>mặt tế bào.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">HIV bám vào bề<span style=""> </span>mặt tế bào cảm thụ nhờ sự phù hợp giữa Receptor tế bào với GP120 của nó. Trong đa số các trường hợp, các receptor này là các phân tử CD4 của lympho T hỗ trợ hoặc một s</span><span style="font-size: 14pt;">oá</span><span style="font-size: 14pt; font-family: "Times New Roman";"> tế bào khác như bạch cầu đơn nhân lớn, đại thực bào và 1 số tế bào d</span><span style="font-size: 14pt;">oøng</span><span style="font-size: 14pt; font-family: "Times New Roman";"> lympho.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.2.2. Sự xâm nhập vào tế bào:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Sau khi đã bám vào các receptor của tế bào vật chủ , phân tử gp41 của HIV cắm sâu vào màng tế bào. Nhờ đó genom của HIV chui vào bên trong của tế bào. Vì vậy giai đoạn này còn gọi là ‘cắm neo và hoà màng’.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.2.3. Sự nhân lên trong tế bào:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.2.3.1. Sao mã sớm: nhờ RT, ADN </span><span style="font-size: 14pt;">b</span><span style="font-size: 14pt; font-family: "Times New Roman";">ổ </span><span style="font-size: 14pt;">sung</span><span style="font-size: 14pt; font-family: "Times New Roman";"> của HIV đã được tạo thành (đã được tạo thành) từ khuôn mẫu ARN của nó. Lúc đầu là sản phẩm lai ARN_ADN, sau đó nhờ Enzym ARN_ase tách ARN khỏi ADN và sợi ADN bổ </span><span style="font-size: 14pt;">s</span><span style="font-size: 14pt; font-family: "Times New Roman";">ung mới được tổng hợp, tạo thành phân tử ADN chuỗi kép.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.2.3.2. Tích hợp.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Sau khi tổng hợp ADN kép tạo thành dạng vòng khép kín và chui vào nhân tế bào chủ. Sau đó nó tích hợp vào ADN nhờ integrase .<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Nhờ tích hợp, HIV đã tránh được sự bảo vệ cơ thể, tác dụng của thuốc và gây bệnh chậm.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Sau khi tích hợp, AND của<span style=""> </span>HIV có </span><span style="font-size: 14pt;">toàn</span><span style="font-size: 14pt; font-family: "Times New Roman";"> tại ở một trong 2 trạng thái:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Không hoạt động và nằm im như tiền virus. Trạng thái tiềm tàng này có thể trở thành hoạt động như những virus độc lực dưới các tác động của môi trường.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- ADN bổ sung của HIV được sao chép thành hạt virion mới.</span><span style="font-size: 14pt;"> Ñ</span><span style="font-size: 14pt; font-family: "Times New Roman";">ây là trạng thái nhân lên của HIV với các bước tiếp theo như sau:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.2.3.3. Sao mã muộn:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">ADN </span><span style="font-size: 14pt;">boå</span><span style="font-size: 14pt; font-family: "Times New Roman";"> sung của HIV được sao mã thành ARN genom và ARN </span><span style="font-size: 14pt;">thoâng</span><span style="font-size: 14pt; font-family: "Times New Roman";"> tin cho nó (mARN)<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.2.3.4. Dịch mã:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Nhờ mARN được tạo thành ở giai đoạn trên, các prrotein cần của HIV được </span><span style="font-size: 14pt;">toå</span><span style="font-size: 14pt; font-family: "Times New Roman";">ng hợp.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.2.3.5. Lắp ráp các hạt virion mới:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Từ các thành phần đã được </span><span style="font-size: 14pt;">toå</span><span style="font-size: 14pt; font-family: "Times New Roman";">ng hợp, các hạt HIV mới được lắp ráp ở bào tương tế bà</span><span style="font-size: 14pt;">o.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">1.2.3.6. Giải phóng các hạt HIV mới:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Từ các vị trí lắp ráp các hạt HIV gần màng nguyên sinh chất, các màng này nảy chồi và các hạt HIV được giải phóng. Chúng tiếp tục gây nhiễm cho tế bào mới, còn tế bào đã giúp chúng nhân lên thì bị diệt.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><b style=""><span style="font-size: 14pt; font-family: "Times New Roman";">2. </span></b><b><span style="font-size: 14pt;">Muïc tieâu xeùt nghieäm</span></b><b><span style="font-size: 14pt; font-family: "Times New Roman";"> HIV.<o
></o
></span></b></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">2.1. Giám sát HIV/AIDS. <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">2.2. An toàn truyền máu.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">2.3. Chẩn đoán nhiễm HIV/AIDS.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">2.4. Nghiên cứu khoa học.<span style=""> </span><o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><b><span style="font-size: 14pt; font-family: "Times New Roman";">3. Các phương cách xét nghiệm HIV.<o
></o
></span></b></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">3.1. <st2
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lace> (áp dụng cho công tác an toàn truyền máu):<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Mẫu huyết thanh được coi là dương tính với phương cách I khi mẫu đó dương tính với một trong các thử nghiệm như: ELISA, Serodia hay thử<span style=""> </span>nghiệm nhanh. <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Trong truyền máu, mẫu máu được xét nghiệm với phương cách I nếu dương tính hay nghi ngờ đều phải loại bỏ.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">3.2. Phương cách II: (áp dụng cho giám sát trọng điểm):<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Mẫu huyết thanh được coi là dương tính với phương cách II khi mẫu đó dương tính cả hai lần xét nghiệm bằng hai loại sinh phẩm với nguyên lý và chuẩn bị KN khác nhau.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">3.3. Phương cách III: (chẩn đoán nhiễm HIV).<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Mẫu huyết thanh được coi là dương tính với phương cách III khi mẫu đó dương tính cả ba lần xét nghiệm bằng ba loại sinh phẩm với nguyên lý và chuẩn bị KN khác nhau.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><b><span style="font-size: 14pt; font-family: "Times New Roman";">4. Các nguyên lý và phương pháp xét nghiệm HIV.<o
></o
></span></b></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.1. Phương pháp gián tiếp:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Phát hiện kháng thể kháng HIV trong máu, dịch tiết.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Áp dụng: <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Giám sát dịch tễ.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Chẩn đoán nhiễm HIV<span style=""> </span>trên 18 tháng tuổi.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Các kỹ thuật tìm kháng thể được chia thành 2 loại:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* Các xét nghiệm phát hiện sàng lọc: cần có độ nhạy cao.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* Các xét nghiệm khẳng định: cần độ đặc hiệu cao. <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.1.1. Xét nghiệm phát hiện sàng lọc.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Các kỹ thuật: ELISA, các thử nghiệm nhanh có độ nhạy và độ đặc hiệu khác nhau. Phối hợp các kỹ thuật khác nhau trong các phương cách xét nghiệm phải tuân theo nguyên tắc: <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* Thử nghiệm đầu tiên có độ nhạy cao.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* Các thử nghiệm tiếp theo có nguyên lý hoặc cách chuẩn bị KN khác nhau và cần có độ đặc hiệu cao. <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.1.1.1. Thử nghiệm miễn dịch gắn men – Elisa (Enzyme Linked Immuno Sorbent Assay)<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* Nguyên lý chung: <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">-<span style=""> </span>Kháng nguyên (Ag) virus cố định trên phiến nhựa. <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Kháng thể (Ab) kháng HIV của bệnh nhân kết hợp đặc hiệu với Ag. <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Phức hợp Ag-Ab được phát hiện bởi hệ thống cộng hợp gắn enzyme và cho phản ứng hiện<span style=""> </span>màu với cơ chất tương ứng.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.1.1.1.1. ELISA<b> </b>gin tiếp: Độ nhạy cao huyết thanh cần thử ủ với bản nhựa đã gắn kháng nguyên, sau khi rửa để loại kháng thể thừa, không đặc hiệu, lại tiếp tục ủ với kháng thể kháng globulinngười gắn Enzym. Hoạt tính Enzym sẽ biến cơ chất không màu thành một sản phẩm có màu. Phản ứng màu được nhận định sơ bộ bằng mắt thường và đọc chính xác bằng quang kế.<o
></o
></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.25in;"><span style="font-size: 10pt;"><o
> </o
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> </o
></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b><span style="font-size: 13pt; font-family: "Times New Roman"; color: black;" lang="PT-BR">Phản ứng màu tỷ lệ thuận với nồng độ kháng thể<o
></o
></span></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.25in;"><span style="font-size: 10pt;" lang="PT-BR"><o
> </o
></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR">4.1.1.1.2. ELISA sandwich: <i>độ đặc hiệu và độ nhạy cao.<o
></o
></i></span></p> <p class="MsoNormal" style="margin-top: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR">Cũng tương tự<span style=""> </span>kỷ thuật ELISA gián tiếp chỉ khác là kháng nguyên virus có gắn Enzym được thay kháng thể globlin người gắn enzym. Như<span style=""> </span>vậy hình thành 1 Sandwich của phức hợp KN_KT_KN_Enzym. Sự thay đổi này làm tăng độ nhạy và đô đặc hiệu của phản ứng, nó cũng cho cho phép phát hiện tất cả các lớp kháng thể vì không dùng Anti IgG người gắn Enzym.<o
></o
></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-size: 10pt;" lang="PT-BR"><o
> </o
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></o
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></o
></span></b></p> </div> <![if !mso]></td> </tr> </table> <![endif]></v:textbox> </v:rect><w:wrap type="none"/> <w:anchorlock/> </v:group><![endif]--><!--[if !vml]--><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image010.gif" v="" _x0000_s1059="" _x0000_s1060="" _x0000_s1061="" _x0000_s1062="" _x0000_s1063="" _x0000_s1064="" _x0000_s1065="" _x0000_s1066="" _x0000_s1067="" _x0000_s1068="" _x0000_s1069="" _x0000_s1070="" _x0000_s1071="" _x0000_s1072="" _x0000_s1073="" _x0000_s1074="" _x0000_s1075="" _x0000_s1076="" _x0000_s1077="" _x0000_s1078="" _x0000_s1079="" _x0000_s1080="" _x0000_s1081="" _x0000_s1082="" _x0000_s1083="" _x0000_s1084="" _x0000_s1085="" _x0000_s1086="" _x0000_s1087="" _x0000_s1088="" height="277" width="578" /><!--[endif]--></span><!--[if mso & !supportInlineShapes & supportFields]><span lang=PT-BR style='font-size:10.0pt;mso-ansi-language
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></o
></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b><span style="font-size: 11pt;" lang="PT-BR">Phaûn öùng maøu tyû leä thuaän vôùi noàng ñoä khaùng theå<o
></o
></span></b></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-size: 10pt;" lang="PT-BR"><span style=""> </span></span><span style="font-size: 14pt;" lang="PT-BR">Ví duï:</span><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR"> </span><span style="font-size: 10pt;"><o
></o
></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: center;" align="center"><span style="font-size: 10pt;"><!--[if gte vml 1]><v:shape id="_x0000_i1033" type="#_x0000_t75" style='width:225.75pt;height:169.5pt'> <v:imagedata src="file:///C:\DOCUME~1\MrHais\LOCALS~1\Temp\msohtml1\01\clip_image011.emz" o:title=""/> </v:shape><![endif]--><!--[if !vml]--><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image012.gif" v="" height="226" width="301" /><!--[endif]--></span><span style="font-size: 10pt;" lang="PT-BR"><o
></o
></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: center;" align="center"><span style="font-size: 10pt;" lang="PT-BR"><o
> </o
></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: center;" align="center"><span style="font-size: 10pt;"><!--[if gte vml 1]><v:shape id="_x0000_i1034" type="#_x0000_t75" style='width:227.25pt;height:171.75pt'> <v:imagedata src="file:///C:\DOCUME~1\MrHais\LOCALS~1\Temp\msohtml1\01\clip_image013.emz" o:title=""/> </v:shape><![endif]--><!--[if !vml]--><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image014.gif" v="" height="229" width="303" /><!--[endif]--></span><span style="font-size: 10pt;" lang="PT-BR"><o
></o
></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.25in;"><span style="font-size: 10pt;" lang="PT-BR"><o
> </o
></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR">4.1.1.1.3. ELISA cạnh tranh:<i> Độ nhạy cao.</i><o
></o
></span></p> <p class="MsoNormal" style="margin-top: 6pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR">Nguyên lý phản ứng tương tự như hai loại trên song chỉ khác là huyết thanh của mẫu thử có KT kháng HIV ủ cùng với kháng thể kháng HIV có gắn Enzym. Như vậy có sự tranh chấp giữa hai loại kháng thể trong phản ứng kết hợp với KN-KT đã gắn vào pha rắn, Đậm độ KT trong mẫu thử càng cao thì KT càng ít được cố định vào KN . Cơ chất sẽ cho 1 phản ứng màu tỉ lệ nghịch<span style=""> </span>với đâm đô KT của màu phải thử.<o
></o
></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-size: 10pt;" lang="PT-BR"><o
> </o
></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><span style="font-size: 10pt;"><!--[if gte vml 1]><v:shape id="_x0000_i1035" type="#_x0000_t75" style='width:234.75pt;height:176.25pt' filled="t" fillcolor="#9cf"> <v:imagedata src="file:///C:\DOCUME~1\MrHais\LOCALS~1\Temp\msohtml1\01\clip_image015.emz" o:title=""/> </v:shape><![endif]--><!--[if !vml]--><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image016.gif" v="" height="235" width="313" /><!--[endif]--></span><span style="font-size: 10pt;" lang="PT-BR"><o
></o
></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.25in;"><b><i><span style="font-size: 13pt; font-family: "Times New Roman";" lang="PT-BR">ƯU VÀ NHƯỢC ĐIỂM THỬ NGHIỆM MIỄN DỊCH GẮN MEN – ELISA.<o
></o
></span></i></b></p> <p class="MsoNormal" style="margin: 6pt 0in 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR">* Ưu điểm:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR">- Thực hiện đồng thời được nhiều mẫu.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR">- Đọc kết quả bằng máy không phụ thuộc vào chủ quan của con người.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR">- Có thể lưu kết quả, thuận lợi cho kiểm tra đánh giá chất lượng xét nghiệm.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR">- Giá thành tương đối rẻ.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR">* Hạn chế:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR">- Phải đầu tư trang thiết bị ban đầu và bảo dưỡng máy.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR">- Sinh phẩm phải bảo quản lạnh.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="PT-BR">- Nhân viên xét nghiệm phải được đào tạo.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Thời gian thực hiện: 3 – 4 giờ.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Nếu số lượng mẫu ít thì tốn kém vì phải làm nhiều chứng. <o
></o
></span></p> <p class="MsoNormal" style="margin: 6pt 0in 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.1.1.2. Các thử nghiệm nhanh.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.1.1.2.1. Thử nghiệm ngưng kết hạt Serodia:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Nguyên lý: <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Những hạt gelatin được gắn với các thành phần KN của virus HIV sẽ tạo ngưng kết khi trong huyết thanh (hoặc huyết tương) bệnh nhân có KT kháng HIV.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Kháng nguyên được gắn trên hạt gelatin:<o
></o
></span></p> <p class="MsoNormal" style="margin: 0in 0in 4pt 81pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-size: 14pt; font-family: Symbol;"><span style=""><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image002.gif" alt="*" height="16" width="16" /><span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 14pt; font-family: "Times New Roman";"><span style=""> </span>HIV 1 gp41 protein tái tổ hợp.<o
></o
></span></p> <p class="MsoNormal" style="margin: 0in 0in 4pt 81pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-size: 14pt; font-family: Symbol;"><span style=""><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image002.gif" alt="*" height="16" width="16" /><span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 14pt; font-family: "Times New Roman";"><span style=""> </span>HIV 1 p24 protein tái tổ hợp.<o
></o
></span></p> <p class="MsoNormal" style="margin: 0in 0in 4pt 81pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-size: 14pt; font-family: Symbol;"><span style=""><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image002.gif" alt="*" height="16" width="16" /><span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 14pt; font-family: "Times New Roman";"><span style=""> </span>HIV2<span style=""> </span>gp36 protein tái tổ hợp.<b><o
></o
></b></span></p> <p class="MsoNormal" style="text-align: justify;"><b><span style="font-size: 10pt;"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: justify;"><!--[if mso & !supportInlineShapes & supportFields]><span style='font-size:10.0pt'><span style="'mso-element:field-begin;mso-field-lock: yes'"></span><span style="'mso-spacerun:yes'"> </span>SHAPE<span style='mso-spacerun:yes'> </span>\* MERGEFORMAT <span style="'mso-element:field-separator'"></span></span><![endif]--><span style="font-size: 10pt;"><!--[if gte vml 1]><v:group id="_x0000_s1089" editas="canvas" style='width:6in;height:174.45pt; mso-position-horizontal-relative:char;mso-position-vertical-relative:line' coordorigin="1701,3906" coordsize="8640,3489"> <o:lock v:ext="edit" aspectratio="t"/> <v:shape id="_x0000_s1090" type="#_x0000_t75" style='position:absolute;left:1701; top:3906;width:8640;height:3489' o
referrelative="f"> <v:fill o
etectmouseclick="t"/> <v
ath o:extrusionok="t" o:connecttype="none"/> <o:lock v:ext="edit" text="t"/> </v:shape><v:group id="_x0000_s1091" style='position:absolute;left:7352;top:5210; width:392;height:580' coordorigin="3380,2839" coordsize="211,312"> <v:line id="_x0000_s1092" style='position:absolute;flip:y;v-text-anchor:middle' from="3387,2976" to="3442,3151" strokecolor="red" strokeweight="4pt"> <v:shadow color="navy"/> </v:line><v:line id="_x0000_s1093" style='position:absolute;flip:y; v-text-anchor:middle' from="3474,2972" to="3591,3008" strokecolor="red" strokeweight="4pt"> <v:shadow color="navy"/> </v:line><v:line id="_x0000_s1094" style='position:absolute;flip
y; v-text-anchor:middle' from="3380,2839" to="3474,3008" strokecolor="red" strokeweight="4pt"> <v:shadow color="navy"/> </v:line></v:group><v:group id="_x0000_s1095" style='position:absolute; left:8314;top:4524;width:429;height:425' coordorigin="3898,2469" coordsize="231,229"> <v:line id="_x0000_s1096" style='position:absolute;v-text-anchor:middle' from="3898,2469" to="3985,2550" strokecolor="red" strokeweight="4pt"> <v:shadow color="navy"/> </v:line><v:line id="_x0000_s1097" style='position:absolute;flip
; v-text-anchor:middle' from="3962,2582" to="4017,2698" strokecolor="red" strokeweight="4pt"> <v:shadow color="navy"/> </v:line><v:line id="_x0000_s1098" style='position:absolute;flip:y; v-text-anchor:middle' from="4017,2515" to="4129,2582" strokecolor="red" strokeweight="4pt"> <v:shadow color="navy"/> </v:line></v:group><v:rect id="_x0000_s1099" style='position:absolute;left:1701; top:5376;width:2909;height:510' filled="f" fillcolor="#36f" stroked="f" strokecolor="white" strokeweight="1pt"> <v:fill color2="#009"/> <v:shadow color="navy"/> <v:textbox inset="1.86003mm,2.59pt,1.86003mm,2.59pt"> <![if !mso]> <table cellpadding="0" cellspacing="0" width="100%"> <tr> <td><![endif]> <div> <p class="MsoNormal" align="right" style="'text-align:right;mso-layout-grid-align: none;text-autospace:none'"><b><span style="'mso-bidi-font-size:16.0pt; mso-bidi-font-family:VNI-Times;color:black;text-shadow:auto'">Khaùng theå khaùng HIV 1/2<o
></o
></span></b></p> </div> <![if !mso]></td> </tr> </table> <![endif]></v:textbox> </v:rect><v:rect id="_x0000_s1100" style='position:absolute;left:3229;top:4663; width:1388;height:390' filled="f" fillcolor="#36f" stroked="f" strokecolor="white" strokeweight="1pt"> <v:fill color2="#009"/> <v:shadow color="navy"/> <v:textbox inset="1.86003mm,2.59pt,1.86003mm,2.59pt"> <![if !mso]> <table cellpadding="0" cellspacing="0" width="100%"> <tr> <td><![endif]> <div> <p class="MsoNormal" align="right" style="'text-align:right;mso-layout-grid-align: none;text-autospace:none'"><b><span style="'mso-bidi-font-size:16.0pt; mso-bidi-font-family:VNI-Times;color:black;text-shadow:auto'">Haït gelatin<o
></o
></span></b></p> </div> <![if !mso]></td> </tr> </table> <![endif]></v:textbox> </v:rect><v:rect id="_x0000_s1101" style='position:absolute;left:2055;top:6356; width:2560;height:430' filled="f" fillcolor="#36f" stroked="f" strokecolor="white" strokeweight="1pt"> <v:fill color2="#009"/> <v:shadow color="navy"/> <v:textbox inset="1.86003mm,2.59pt,1.86003mm,2.59pt"> <![if !mso]> <table cellpadding="0" cellspacing="0" width="100%"> <tr> <td><![endif]> <div> <p class="MsoNormal" align="right" style="'text-align:right;mso-layout-grid-align: none;text-autospace:none'"><b><span style="'mso-bidi-font-size:16.0pt; mso-bidi-font-family:VNI-Times;color:black;text-shadow:auto'">Khaùng nguyeân HIV 1/2<o
></o
></span></b></p> </div> <![if !mso]></td> </tr> </table> <![endif]></v:textbox> </v:rect><v:line id="_x0000_s1102" style='position:absolute;v-text-anchor:middle' from="4713,4841" to="6288,4842" strokecolor="#f6bf69" strokeweight="2pt"> <v:stroke endarrow="block"/> <v:shadow color="navy"/> </v:line><v:line id="_x0000_s1103" style='position:absolute;v-text-anchor:middle' from="4746,5554" to="6052,5554" strokecolor="#f6bf69" strokeweight="2pt"> <v:stroke endarrow="block"/> <v:shadow color="navy"/> </v:line><v:line id="_x0000_s1104" style='position:absolute;v-text-anchor:middle' from="5013,6534" to="6230,6534" strokecolor="#f6bf69" strokeweight="2pt"> <v:stroke endarrow="block"/> <v:shadow color="navy"/> </v:line><v:group id="_x0000_s1105" style='position:absolute;left:9052;top:5009; width:573;height:516' coordorigin="4296,2730" coordsize="308,278"> <v:line id="_x0000_s1106" style='position:absolute;flip
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y; v-text-anchor:middle' from="4253,3159" to="4391,3294" strokecolor="red" strokeweight="4pt"> <v:shadow color="navy"/> </v:line><v:line id="_x0000_s1124" style='position:absolute;flip
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></span></b></p> </div> <![if !mso]></td> </tr> </table> <![endif]></v:textbox> </v:rect><v:rect id="_x0000_s1190" style='position:absolute;left:7558;top:5085; width:793;height:793;v-text-anchor:middle' fillcolor="#c0fef9" stroked="f" strokecolor="white" strokeweight="1pt"> <v:fill color2="fill darken(76)" method="linear sigma" type="gradient"/> <v:shadow color="navy"/> </v:rect><v:oval id="_x0000_s1191" style='position:absolute;left:7368;top:4299; width:1075;height:976;v-text-anchor:middle' fillcolor="#fde3ba" strokecolor="white" strokeweight="1pt"> <v:fill color2="fill darken(204)" focusposition=".5,.5" focussize="" method="linear sigma" focus="100%" type="gradientRadial"/> <v:shadow color="navy"/> </v:oval><v:oval id="_x0000_s1192" style='position:absolute;left:7459;top:4391; width:892;height:793;v-text-anchor:middle' fillcolor="#f39fd1" stroked="f" strokecolor="white" strokeweight="1pt"> <v:fill color2="fill darken(229)" focusposition=".5,.5" focussize="" method="linear sigma" focus="100%" type="gradientRadial"/> <v:shadow color="navy"/> </v:oval><v:rect id="_x0000_s1193" style='position:absolute;left:7537;top:5144; width:551;height:755;v-text-anchor:middle' filled="f" fillcolor="#36f" stroked="f" strokecolor="white" strokeweight="1pt"> <v:fill color2="#009"/> <v:shadow color="navy"/> </v:rect><v:rect id="_x0000_s1194" style='position:absolute;left:7539;top:5246; width:839;height:750' filled="f" fillcolor="#36f" stroked="f" strokecolor="white" strokeweight="1pt"> <v:fill color2="#009"/> <v:shadow color="navy"/> <v:textbox inset="2.08625mm,1.0248mm,2.08625mm,1.0248mm"> <![if !mso]> <table cellpadding="0" cellspacing="0" width="100%"> <tr> <td><![endif]> <div> <p class="MsoNormal" style="'mso-layout-grid-align:none;text-autospace:none'"><b><span style='font-size:26.5pt;mso-bidi-font-size:32.0pt;color:#081D58'>++<o
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></span></b></p> </div> <![if !mso]></td> </tr> </table> <![endif]></v:textbox> </v:rect><v:rect id="_x0000_s1195" style='position:absolute;left:1588;top:3362; width:286;height:353' filled="f" fillcolor="#36f" stroked="f" strokecolor="white" strokeweight="1pt"> <v:fill color2="#009"/> <v:shadow color="navy"/> <v:textbox inset="2.08625mm,1.0248mm,2.08625mm,1.0248mm"> <![if !mso]> <table cellpadding="0" cellspacing="0" width="100%"> <tr> <td><![endif]> <div> <p class="MsoNormal" style="'mso-layout-grid-align:none;text-autospace:none'"><b><span style='font-size:10.0pt;mso-bidi-font-size:12.0pt;color:#3366FF; text-shadow:auto'><span style="'mso-spacerun:yes'"> </span><o
></o
></span></b></p> </div> <![if !mso]></td> </tr> </table> <![endif]></v:textbox> </v:rect><v:rect id="_x0000_s1196" style='position:absolute;left:7341;top:3362; width:236;height:590' filled="f" fillcolor="#36f" stroked="f" strokecolor="white" strokeweight="1pt"> <v:fill color2="#009"/> <v:shadow color="navy"/> <v:textbox inset="2.08625mm,1.0248mm,2.08625mm,1.0248mm"> <![if !mso]> <table cellpadding="0" cellspacing="0" width="100%"> <tr> <td><![endif]> <div> <p class="MsoNormal" style="'mso-layout-grid-align:none;text-autospace:none'"><b><span style='font-size:10.0pt;mso-bidi-font-size:12.0pt;color:white;text-shadow: auto'><o
> </o
></span></b></p> <p class="MsoNormal" style="'mso-layout-grid-align:none;text-autospace:none'"><b><span style='font-size:10.0pt;mso-bidi-font-size:12.0pt;color:white;text-shadow: auto'><o
> </o
></span></b></p> </div> <![if !mso]></td> </tr> </table> <![endif]></v:textbox> </v:rect><v:rect id="_x0000_s1197" style='position:absolute;left:1786;top:5742; width:236;height:353' filled="f" fillcolor="#36f" stroked="f" strokecolor="white" strokeweight="1pt"> <v:fill color2="#009"/> <v:shadow color="navy"/> <v:textbox inset="2.08625mm,1.0248mm,2.08625mm,1.0248mm"> <![if !mso]> <table cellpadding="0" cellspacing="0" width="100%"> <tr> <td><![endif]> <div> <p class="MsoNormal" style="'mso-layout-grid-align:none;text-autospace:none'"><b><span style='font-size:10.0pt;mso-bidi-font-size:12.0pt;color:#86D1EC; text-shadow:auto'><o
> </o
></span></b></p> </div> <![if !mso]></td> </tr> </table> <![endif]></v:textbox> </v:rect><w:wrap type="none"/> <w:anchorlock/> </v:group><![endif]--><!--[if !vml]--><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image019.gif" v="" _x0000_s1156="" _x0000_s1157="" _x0000_s1158="" _x0000_s1159="" _x0000_s1160="" _x0000_s1161="" _x0000_s1162="" _x0000_s1163="" _x0000_s1164="" _x0000_s1165="" _x0000_s1166="" _x0000_s1167="" _x0000_s1168="" _x0000_s1169="" _x0000_s1170="" _x0000_s1171="" _x0000_s1172="" _x0000_s1173="" _x0000_s1174="" _x0000_s1175="" _x0000_s1176="" _x0000_s1177="" _x0000_s1178="" _x0000_s1179="" _x0000_s1180="" _x0000_s1181="" _x0000_s1182="" _x0000_s1183="" _x0000_s1184="" _x0000_s1185="" _x0000_s1186="" _x0000_s1187="" _x0000_s1188="" _x0000_s1189="" _x0000_s1190="" _x0000_s1191="" _x0000_s1192="" _x0000_s1194="" _x0000_s1195="" _x0000_s1196="" _x0000_s1197="" height="281" width="579" /><!--[endif]--></span><!--[if mso & !supportInlineShapes & supportFields]><span style='font-size:10.0pt'><v:shape id="_x0000_i1029" type="#_x0000_t75" style='width:6in; height:208.8pt'> <v:imagedata croptop="-65520f" cropbottom="65520f"/> </v:shape><span style="'mso-element:field-end'"></span></span><![endif]--><span style="font-size: 10pt;"><o
></o
></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-size: 10pt;"><o
> </o
></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-size: 14pt; font-family: "Times New Roman";"><o
> </o
></span></p> <p class="MsoNormal" style="margin: 0in 0in 6pt 0.25in; text-align: justify;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.1.1.2.2. Các thử nghiệm nhanh: <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Kit Determine HIV1/2: dựa trên nguyên lý miễn dịch sắc ký. (Thường sử dụng để kiểm tra HIV gấp và luôn phải được kiểm chứng bằng kỹ thuật khác) <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Kit Multispot HIV1/2: là phương pháp miễn dịch trên màng lọc, dựa trên nguyên lý ELISA (Phân biệt được HIV1 và HIV2).<o
></o
></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";"><o
> </o
></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><b><span style="font-size: 10pt;"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><span style="font-size: 10pt;"><!--[if gte vml 1]><v:shape id="_x0000_i1036" type="#_x0000_t75" style='width:451.5pt;height:3in'> <v:imagedata src="file:///C:\DOCUME~1\MrHais\LOCALS~1\Temp\msohtml1\01\clip_image020.emz" o:title=""/> </v:shape><![endif]--><!--[if !vml]--><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image021.gif" v="" height="288" width="602" /><!--[endif]--><o
></o
></span></p> <p class="MsoNormal" style="text-align: justify;"><b><span style="font-size: 10pt;"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: justify;"><b><span style="font-size: 10pt;"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: justify;"><b><span style="font-size: 10pt;"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: justify;"><b><span style="font-size: 10pt;"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: justify;"><b><span style="font-size: 10pt; font-family: "Times New Roman";"><o
> </o
></span></b></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* Ưu điểm:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Xét nghiệm với số lượng mẫu nhỏ.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Dễ thực hiện, cho kết quả nhanh. <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Không đòi hỏi thiết bị đặc biệt, sinh phẩm dễ bảo quản.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Có thể thực hiện ở các tuyến cơ sở.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Xét nghiệm viên có thể được đào tạo nhanh.<o
></o
></span></p> <p class="MsoNormal" style="margin: 6pt 0in 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">* Nhược điểm:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Giá thành cao.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Không thuận lợi khi xét nghiệm số mẫu lớn.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Không lưu được dữ liệu<span style=""> </span>kỹ thuật. <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Một số test nhanh có độ nhạy kém hơn so với ELISA.<o
></o
></span></p> <p class="MsoNormal" style="margin: 6pt 0in 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.1.2. Xét nghiệm khẳng định.<o
></o
></span></p> <p class="MsoNormal" style="margin: 0in 0in 4pt 0.5in; text-align: justify;"><span style="font-size: 14pt; font-family: "Times New Roman";">Western blot (Kit New Lab blot I ):<o
></o
></span></p> <p class="MsoNormal" style="margin: 6pt 0in 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.1.2.1. Nguyên lý:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Protein Virus HIV được<span style=""> </span>tách theo PM bằng điện di trên gel polyacrylamid.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Chuyển sang giấy nitrocellulose, các protein định vị theo PM. <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- KT kháng HIV trong mẫu thử kết hợp đặc hiệu với KN tương ứng.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Phát hiện phức hợp KN-KT bằng cộng hợp KT kháng IgG gắn men, cho phản ứng màu với cơ chất tại các vị trí có KT đặc hiệu với KN tương ứng. Western blot có độ nhạy và độ đặc hiệu cao; song giá thành cao và đòi hỏi người xét nghiệm phải có trình độ và kinh nghiệm.<o
></o
></span></p> <p class="MsoNormal" style="text-align: justify;"><b><span style="font-size: 10pt;"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b><span style="font-size: 10pt;"><!--[if gte vml 1]><v:shape id="_x0000_i1037" type="#_x0000_t75" style='width:244.5pt;height:183pt'> <v:imagedata src="file:///C:\DOCUME~1\MrHais\LOCALS~1\Temp\msohtml1\01\clip_image022.emz" o:title=""/> </v:shape><![endif]--><!--[if !vml]--><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image023.gif" v="" height="244" width="326" /><!--[endif]--><o
></o
></span></b></p> <p class="MsoNormal" style="text-align: justify;"><b><span style="font-size: 10pt;"><o
> </o
></span></b></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.1.2.2. Biện luận kết quả.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* WB âm tính: không có băng nào<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* WB dương tính: có ít nhất 2 băng tương ứng với proteine vỏ:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify;"><span style="font-size: 14pt; font-family: "Times New Roman";"><span style=""> </span>HIV 1:<span style=""> </span>gp 160, gp 120, gp 41<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify;"><span style="font-size: 14pt; font-family: "Times New Roman";"><span style=""> </span>HIV 2:<span style=""> </span>gp 140, gp 125, gp 36 ngoài ra có các băng tương ứng với sản phẩm của gen gag/pol.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* WB chưa xác định : có băng ở vị trí khác tiêu chuẩn WB dương tính.<o
></o
></span></p> <p class="MsoNormal" style="margin: 6pt 0in 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.2. Phương pháp trực tiếp:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Phát hiện trực tiếp: KN virus, axit nucleic hoặcVirus.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Áp dụng:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Phát hiện nhiễm HIV ở trẻ sơ sinh được sinh ra từ mẹ nhiễm HIV.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Phát hiện sớm giai đoạn mới nhiễm HIV (giai đoạn cửa sổ) hoặc khi kết quả phát hiện KT không rõ ràng.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Theo dõi diễn tiến bệnh, đánh giá hiệu quả điều trị thuốc kháng virút và trong các mục đích nghiên cứu khác.<span style=""> </span><o
></o
></span></p> <p class="MsoNormal" style="margin: 6pt 0in 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.2.1. Phân lập virus bằng nuôi cấy tế bào.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Nguyên lý:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Tách tế bào đơn nhân trong máu bệnh nhân và nuôi cấy chung với tế bào đơn nhân của người lành đã được hoạt hóa trong môi trường nuôi cấy PHA (phytohemagglutinin) thích hợp.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Xác định sự nhân lên của virus bằng kỹ thuật:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* ELISA phát hiện KN p24 trong nước nổi môi trường nuôi cấy tế bào.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* Dùng đồng vị phóng xạ phát hiện enzyme sao chép ngược của virus (RT).<span style=""> </span><o
></o
></span></p> <p class="MsoNormal" style="margin: 6pt 0in 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.2.2. Phát hiện các axit nucleic (RNA) của virus hoặc DNA (provirut) trong tế bào nhiễm.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* RNA của virus HIV bằng kỹ thuật RT-PCR:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: Symbol;"><span style="">·</span></span><span style="font-size: 14pt; font-family: "Times New Roman";"> RNA enzyme sao chép ngược và mồi cDNA<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: Symbol;"><span style="">·</span></span><span style="font-size: 14pt; font-family: "Times New Roman";"> Quá trình PCR là chuỗi nhiều chu kỳ kế tiếp nhau.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">Mỗi chu kỳ gồm 3 bước:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Bước 1: biến tính tách rời 2 chuỗi của phân tử DNA đích ở nhiệt độ 94<sup>0</sup> – 95<sup>0</sup>.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Bước 2: bắt cặp, các cặp mồi đặc hiệu cho một trình tự DNA xác định bắt cặp với sợi DNA đích ở nhiệt độ 40<sup>0</sup> -70<sup>0</sup>. <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Bước 3: tổng hợp, kéo dài. Ở nhiệt độ 72<sup>0</sup>, Taq polymerase hoạt động tổng hợp sợi DNA có trình tự bổ sung cho sợi khuôn. <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Trong chẩn đoán nhiễm HIV ở trẻ sơ sinh, ngoài RT- PCR còn dùng PCR phát hiện các DNA provirút trong tế bào nhiễm.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- PCR được thực hiện trên 3 vùng gen: env, gag và pol.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Kết quả được trả lời dương tính khi có PCR dương tính ít nhất là trên hai trong ba gen và được thực hiện trên hai mẫu máu ở thời điểm khác nhau. <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* Ưu điểm: có độ nhạy cao, cho kết quả nhanh chóng.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><span style="font-size: 14pt; font-family: "Times New Roman";">* Hạn chế: phải có cơ sở phòng thí nghiệm đủ tiêu chuẩn và trang thiết bị đắt tiền. Cán bộ cần đào tạo tốt.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 0.25in;"><b><span style="font-size: 14pt; font-family: "Times New Roman";"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b><span style="font-size: 10pt;"><!--[if gte vml 1]><v:shape id="_x0000_i1038" type="#_x0000_t75" style='width:231pt;height:173.25pt'> <v:imagedata src="file:///C:\DOCUME~1\MrHais\LOCALS~1\Temp\msohtml1\01\clip_image024.emz" o:title=""/> </v:shape><![endif]--><!--[if !vml]--><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image025.gif" v="" height="231" width="308" /><!--[endif]--><o
></o
></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b><span style="font-size: 10pt;"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b><span style="font-size: 10pt;"><!--[if gte vml 1]><v:shape id="_x0000_i1039" type="#_x0000_t75" style='width:228.75pt;height:172.5pt'> <v:imagedata src="file:///C:\DOCUME~1\MrHais\LOCALS~1\Temp\msohtml1\01\clip_image026.emz" o:title=""/> </v:shape><![endif]--><!--[if !vml]--><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image027.gif" v="" height="230" width="305" /><!--[endif]--><o
></o
></span></b></p> <p class="MsoNormal" style="text-align: justify;"><b><span style="font-size: 10pt;" lang="DE"><o
> </o
></span></b></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">4.2.3. Phát hiện KN p24 của virus trong mu.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">- p24 l một chỉ số trực tiếp phản ánh sự nhân lên của virut<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Được phát hiện sớm trong giai đoạn mới nhiễm.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Giảm khi có KT kháng p24.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">- Gia tăng khi chuyển sang giai đoạn AIDS <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">Kit phát hiện p24: ELISA sandwich.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">* Nguyên lý: <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">KT đơn dòng kháng với KN p24 được gắn sẵn trong các giếng, nếu mẫu thử có KN p24 sẽ gắn với KT này và được phát hiện bằng cộng hợp (KT đa dòng kháng HIV) gắn men cho phản ứng màu với cơ chất.<span style=""> </span><o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">4.3. Lựa chọn kỹ thuật xét nghiệm HIV.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">4.3.1. Sự biến động của các thông số sinh học trên bệnh nhân nhiễm HIV chưa điều trị.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Kháng nguyên HIV đặc hiệu KNp24 xuất hiện sớm, một thời gian ngắn sau nhiễm HIV và duy trì trong suốt thời gian cấp (sớm) của nhiễm HIV. Sau đó KNp24 giảm dần đồng thời có sự xuất hiện KTp24. Điều này báo hiệu giai đoạn không triệu chứng của nhiễm HIV.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Vài tháng tới vài năm sau nhiễm trùng, KTp24 mất đi v KNp24 tái xuất hiện, báo giai đoạn triệu chứng của bệnh. Sự nhân lên của HIV tương ứng với sự có mặt của KNp24.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Kháng thể HIV: Trước tiên kháng thể HIV lớp IgM xuất hiện, sau đó giảm dần và thay vào đó là KT lớp IgG. IgG khng p24 xuất hiện và giảm dần cùng với sự mất đi và xuất hiện lại KN HIV. Trong khi đó IgG kháng KN vỏ của HIV tồn tại lâu dài trong suốt thời gian bị nhiễm.<o
></o
></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><b><span style="font-size: 10pt;" lang="DE"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b><span style="font-size: 10pt;"><!--[if gte vml 1]><v:shape id="_x0000_i1040" type="#_x0000_t75" style='width:300pt;height:225pt'> <v:imagedata src="file:///C:\DOCUME~1\MrHais\LOCALS~1\Temp\msohtml1\01\clip_image028.emz" o:title=""/> </v:shape><![endif]--><!--[if !vml]--><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image029.gif" v="" height="300" width="400" /><!--[endif]--></span></b><b><span style="font-size: 10pt;" lang="DE"><o
></o
></span></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.25in;"><b><span style="font-size: 10pt;" lang="DE"><o
> </o
></span></b></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">4.3.2. Lựa chọn kỹ thuật xét nghiệm HIV<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">4.3.2.1. Nguyên tắc chung.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Mục đích xét nghiệm.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Thời điểm phơi nhiễm.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Đối tượng xét nghiệm.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Tỷ lệ nhiễm trong quần thể.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Thời gian cần trả lời kết quả.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Điều kiện cụ thể của phòng thí nghiệm.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Tư vấn trước xét nghiệm.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">4.3.2.2. Lựa chọn cụ thể<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">4.3.2.2.1. Giai đoạn ủ bệnh: 6-8 tuần kể từ khi virus HIV xâm nhập vào trong cơ thể các phương pháp phát hiện kháng thể đặc hiệu HIV thông thường (Serodia, ELISA, Test nhanh, WB) chưa thể giúp ích gì cho chẩn đoán giai đoạn này gọi<span style=""> </span>là “giai đoạn cửa sổ sinh học’’. Giai đoạn này từ khi nhiễm HIV 1 tuần lễ: một số kỹ thuật có thể giúp ích chẩn đoán như:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Phân lập virus.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- PCR.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Phát hiện kháng nguyên p24.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Phát hiện kháng thể Ig (kỹ thuật ELISA sandwich)<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">4.3.2.2.2. Giai đoạn có kháng thể<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">Kỹ thuật:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Serodia.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- ELISA.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Test nhanh.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Western blot.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">4.3.3. Nhận định kết quả.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">4.3.3.1. Các phương pháp trực tiếp:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Dương tính: kết luận dương tính.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Âm tính: kết luận âm tính. <o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">4.3.3.2. Các phương pháp xét nghiệm gián tiếp:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Mẫu thử nghiệm âm tính lần đầu: kết luận âm tính.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE">- Để khẳng định mẫu HIV dương tính: Mẫu huyết thanh được coi là dương tính với khi mẫu đó dương tính cả ba lần xét nghiệm bằng ba loại sinh phẩm với nguyên lý và chuẩn bị KN khác nhau.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><b><span style="font-size: 14pt; font-family: "Times New Roman";" lang="DE"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.25in;"><b><span style="font-size: 10pt;" lang="DE"><o
> </o
></span></b></p> <p class="MsoNormal" style="text-align: center;" align="center"><b><span style="font-size: 9pt; font-family: "Times New Roman";" lang="DE">QUI TRÌNH XÉT NGHIỆM TẠI PHÒNG HIV BỆNH VIỆN PHONG - DA LIỄU TRUNG ƯƠNG QUY HOÀ</span></b><span style="font-size: 10pt; font-family: "Times New Roman";" lang="DE"><o
></o
></span></p> <p class="MsoNormal" style="text-align: center;" align="center"><b><span style="font-size: 10pt;"><!--[if gte vml 1]><v:shape id="_x0000_i1031" type="#_x0000_t75" style='width:447pt;height:321.75pt'> <v:imagedata src="file:///C:\DOCUME~1\MrHais\LOCALS~1\Temp\msohtml1\01\clip_image030.jpg" o:title="bsan hiv-1"/> </v:shape><![endif]--><!--[if !vml]--><img src="file:///C:/DOCUME%7E1/MrHais/LOCALS%7E1/Temp/msohtml1/01/clip_image031.jpg" v="" height="429" width="596" /><!--[endif]--><o
></o
></span></b></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 10pt;"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 10pt;"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 10pt;"><o
> </o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><b><span style="font-size: 14pt; font-family: "Times New Roman";">5. Kết luận:</span></b><span style="font-size: 14pt; font-family: "Times New Roman";"><span style=""> </span>Để kết luận tình trạng mẫu thử là dương tính khi:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">5.1. Tính hợp lệ của thử nghiệm:<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">Theo đúng hướng dẫn của nhà sản xuất sinh phẩm.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">5.2. Chỉ thực hiện tại các phòng thí nghiệm HIV được phép khẳng định HIV dương tính.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">5.3. Theo đúng hướng dẫn sử dụng sinh phẩm và đúng phương cách xét nghiệm.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><span style="font-size: 14pt; font-family: "Times New Roman";">5.4. Nếu kết quả giữa các thử nghiệm không phù hợp, hẹn 3 tháng sau lấy mẫu xét nghiệm lại.<o
></o
></span></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><i><span style="font-size: 14pt; font-family: "Times New Roman";"><o
> </o
></span></i></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><b style=""><i><span style="font-family: "Times New Roman";">Tài liệu tham khảo<o
></o
></span></i></b></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><i><span style="font-family: "Times New Roman";">1. Phạm nhật An và cs (1995), Nhiễm HIV/AIDS y học cơ sở, lâm sàng và phòng chống, NXBY học, Hà nội, 26-51.<o
></o
></span></i></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><i><span style="font-family: "Times New Roman";">2. Trần chí Liêm và CS (11-2001), xét nghiệm chẩn đoán HIV, Hà nội, 4-28.<o
></o
></span></i></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><i><span style="font-family: "Times New Roman";">3. Trương xuân Liên, tài liệu tập huấn tại viên Pasteur TPHCM.<o
></o
></span></i></p> <p class="MsoNormal" style="margin-bottom: 4pt; text-align: justify; text-indent: 17.85pt;"><o
> </o
></p>
