CHNG 7.

PHNG PHP PHNG X NG DNG TRONG X TR

Ngy nay trn th gii phng php phng x ang c s dng trong nhiu ngnh khoa hc k thut
v kinh t. N c s dng rt rng ri trong y sinh hc. Trong y hc ngoi vic dng phng x tiu
dit cc yu t gy bnh v t bo bnh, ng dng k thut nh du bng ng v phng x (vpx) vo
cc chuyn khoa khc nhau, bn thn n cn to ra mt chuyn khoa mi l y hc ht nhn (yhhn). Bng
cc phng tin khc nhau, cc kt qu ghi o hot phng x c th hin bng nhiu hnh thc: s
xung, th, hnh nh. T cc thy thuc c th nh gi cu trc chc nng v chn on bnh.
Di y gii thiu nhng k thut v ni dung chnh ca phng php s dng v vpx vo y sinh hc.
BI 1. PHNG PHP PHNG X NH DU
1. C s ca phng php nguyn t nh du phng x.
Cho n nay vic ng dng ng v phng x vo chn on bnh v iu tr kh pht trin, bao gm
nhiu k thut, trong rng ri nht vn l k thut nh du phng x. K thut ny da vo nhng
c im sau y:
ng v phng x v ng v bn chu mi qu trnh sinh l v sinh ho nh nhau trong t chc sng. Ni
mt cch khc l t chc sng t mc phn t n ton c th hay c qun th nhiu vi sinh vt cng
khng phn bit c ng v bn v vpx trong hot ng sinh hc ca mnh trong lc li c th d
ghi o chng qua cc phng x pht ra.
Khi lng cc cht nh du thng rt nh v khng gy nn mt s nh hng no n hot ng
ca t chc sng. Cc k thut p dng trong y hc ht nhn thng l khng gy thng tn (Non invasive) bi v cao nht cng ch l th thut tim tnh mch.
Cht nh du (Tracer) l tng nht cn c cc c im sau y:
- C tnh cht hon ton ging nh i tng cn kho st.
- Cht nh du c hp th hon ton, nhanh chng v ch ring ngay ti c quan, m cn kho st
(Target Organ).
- Nng ca n t thay i ti ch trong sut qu trnh kho st.
- Sau khi kho st xong, n nhanh chng v hon ton c o thi ra khi c th.
- Phng x pht ra t cht nh du d dng ghi o c bng cc phng tin sn c (Loi tia, nng
lng tia).
- To ra liu hp th nht.
2. Cc ng dng ca phng php nh du.
- Thm d chc nng cc t bo, m, c quan hay h thng trong c th sng
Nghim php ny bao gm:
+ Chc nng hp th, chuyn ho, o thi
+ ng hc ca cc qu trnh nh ca h tun hon, tit niu.

+ Hm lng v nng ca cc yu t thnh phn hoc nng ca cc hp cht sinh hc trong mt

i tng kho st no nh hm lng cc cht in gii, th tch cc dch trong c th, th tch mu,
khi lng hng cu nng cc enzym, cc hormon trong mu, trong m
T cc gi tr v nng ta c th nh gi c cc chc nng c bn ca t chc sng hay c
quan.
Cc gi tr thu c c th l cc th, biu , s xung hoc gi tr tuyt i ca hm lng.
thu c cc nng c th o tng mu tng thi im khc nhau, m xung hoc o hot
tnh tng cng; c th o mu ri (invitro) hoc o ngay trn c th bnh nhn (invivo); c th bng
nhng php so snh i chiu hoc xc nh gi tr tuyt i t cc mu o.
- nh lng bng k thut min dch phng x RIA v IRMA (Radio Immuno Assay v Immuno Radio
Metric Assay).
Thc ra k thut ny cng l nh gi v thm d chc nng ca cc tuyn ni tit, m hay ph tng.
Tuy vy do c s khoa hc ca k thut v kh nng ng dng rng ri ca n trong chn on v
nghin cu, ngi ta tch ring thnh mt ni dung ca y hc ht nhn. Ngy nay nhiu c s y hc v
khoa hc c th ch xy dng ring Labo RIA v IRMA phc v cho cng vic ca mnh. Nm 1960 k
thut nh lng min dch phng x (RIA) c khi u bng Yellow v Berson vi insulin. Do pht
minh ny m h c gii Nobel y hc.
K thut ny cho php nh lng n c nanogram (10-9g) v picogram (10-12g) v tnh c hiu rt
cao ca phn ng min dch. Ngoi ra n cn cho php t ng ho o mu xt nghim hng lot.

Ab

+ Nguyn l ca phng php.

Khng nguyn d nh du phng x hay khng s kt hp vi khng th c hiu to ra phn ng min
dch v c phc hp mi. C s ca k thut RIA l hin tng cnh tranh gia khng nguyn nh du
Ag* v khng nh du Ag khi kt hp vi khng th Ab. Nu cho mt lng hn ch Ab th khng
nguyn khng nh du Ag (cht mun nh lng) trong mu tng, phc hp Ag*Ab nh du s gim.
Gi phn gn Ag* Ab l phc hp gn (Bound = B) v phn Ag* khng gn l t do (free = F), khi B gim
xung th phn F s tng ln v ngc li. Do t l B/F c gi tr trong tnh ton v nh lng.
Xc nh kt qu bng cch so snh vi th chun m trc tung l t l ca B/F mu v trc honh l
nng cht cn xc nh. Cng c th tnh ton theo tng quan B/T hoc B/Bo thay cho t l B/F v
nng . Trong T l tng hot tnh mu (B+F) v Bo l phn gn (bound fraction) im 0 ca th
(nng = 0).V sau k thut ny c ci tin thnh phng php min dch phng x khng cnh
tranh: Immunioradiometric assay (IRMA) do Miller v Hales xng nm 1968 nhng mi n nm
1980 mi c ng dng rng ri trong lm sng. Nguyn l ca n l cht cn nh lng (hormon
chng hn) vn ng vai tr Ag nhng lc ny khng cho vo mu Ag* v Ab thng kt hp nh
trong RIA na m cho Ab* nh du. Lng Ab* cho tht d tha th hot tnh px ca phn gn (B) Ag*
Ab s t l thun vi nng cht cn nh lng Ag.

K thut ny cho php ng dng cc Ab n dng (monoclonal) nn cho cc kt qu vi c hiu v

chnh xc cao hn RIA.
- thc hin c k thut RIA hoc IRMA cn c
+ Cht nh du phng x Ag* hoc Ab*
+ Cht gn c hiu: khng th (Ab)
+ H thng tch ring phn B v F
+ Cht cn nh lng lp th chun.
Nh vy 2 khu quan trng m mt labo ring phi t lm c l to ra Ab* hoc Ag* v Ab c hiu
(Antiserum cha Ab c hiu i vi Ag nht nh no ).
Hin nay k thut ny c p dng rng ri trong lm sng v phng th nghim.
3. Phng php tm dit t bo nhim HIV bng khng th nh du phng x
Theo Harris Goldstein, ngi ng u nhm nghin cu ti trng i hc Duc Albert Einstein,
phng thc mi ny c th tiu dit cc t bo nhim HIV ngay khi virus mi bt u xm nhim c
th, iu ny ngn chn kh nng virus to nn mt tn thng lu di trong c th. Cch ny c th s
dng kt hp vi liu php HART (liu php s dng cht chng virus cc mnh) ang thnh hnh. Tuy
nhin, phng php ny cng c th thch hp vi nhng ngi nhim virus mt thi gian bng cch
kt hp vi nhng thuc cha tr m hin gi vn ang trong giai on th nghim khc. Cc liu php
ny s g b lp o tng hnh ca virus HIV, bt gi v to iu kin h min dch c th loi b hon
ton HIV ra khi c th

BI 2. NG DNG PHNG PHP CHIU X TRONG Y HC V NNG SINH HC.

1. ng dng chiu x trong chn on
Vi s chiu tia to ra cc phn ng ht nhn thch hp cng c th coi k thut nh lng kch hot
bng Neutron (Neutron Activization Analysis) l mt k thut y hc ht nhn bi v bng k thut
chng ta c th nh lng cc yu t vi, a lng trong cc mu sinh hc (mu, da, tc) chn on
bnh.
Nguyn l ca k thut ny l c th bin mt ng v bn thnh ng v phng x bng cch bn cc
Neutron thch hp vo ht nhn ca ng v bn. Ngi ta xc nh hm lng ng v bn bng cch
o m phng x pht ra t ng v phng x mi c to ra sau khi chiu Neutron. V d: 55Mn
(n,)56Mn hay 16O (n, P)16N trong : 55Mn, 16O l nhng ng v bn (ng v m), 56Mn v 16N l
nhng ng v phng x (ng v con).
Tt nhin hot tnh phng x thu c ph thuc nhiu yu t nh:
- Nng ca ng v m c trong mu
- Thng lng v c im ca chm Neutron.
- Tit din ca hiu ng.
- Thi gian chiu.
Khi chiu neutron vo mu c th xy ra nhiu loi phn ng v c nhiu ng v phng x con c to
ra. V vy cn phi phn tch, tinh sch bng cc k thut ha hc v vt l khc nhau. Tuy vy n cho
php xc nh rt chnh xc nhng yu t vi lng trong c th nh: Fe, Sc, Zn, Rb, Cr, Co, Cu, Cs, K,

Th, Au, Mg, Na, Br, As, I hoc nhng yu t a lng nh C, O, N, Ca trong c th. T c th
chn on c nhiu bnh khc nhau v ri lon chuyn ho, hp thu, tim mch, tiu ha, tm thn
2. ng dng chiu x trong iu tr.
Mt ng dng na trong y hc ht nhn l tc dng sinh hc ca tia phng x khi c hp th vo t
chc sinh hc. Ngay t u ngi ta thy r tc dng dit t bo ca phng x v s dng n
trong nhiu phn ngnh khc nhau ca sinh hc v y hc (dit khun v dit t bo bnh). Vi nhng
hiu bit ngy cng su sc v c ch truyn nng lng, c ch dit bo, cc c im vt l ca
phng x, cc yu t nh hng ca mi trng (nhit , nng oxy..) cc phng x ion ho ln cc
mm bnh, t bo bnh. N cng to ra nhng li ch thit thc v lun lun i mi trong y hc. Chng
bao gm:
- iu tr chiu ngoi (Teletherapy).
Bao gm c li dao gamma (Gamma knife), cc ngun kn (kim, ht..) v ngun h (Applicator) s
dng cc ng v phng x pht ra beta cng hoc gamma mm. N bao gm c k thut n gin
iu tr bnh ngoi da hoc k thut phc tp nh a c ngun 90Y vo khi u tuyn yn hay kt hp
vi phu thut a cc ngun x kn vo tn cc hc t nhin.
K thut iu tr p st c ci tin rt nhiu lm xut hin cc phng php mi nh iu tr np
ngun sau (After Loading Therapy), lp k hoch iu tr theo kch thc khi u (Dimentional Treatment
Planing) hoc dng thit b t tin (Gamma Knife) cha cc bnh v mch mu trong hp s.
Ngoi cc ng v phng x c in nh 222Ra, 60Co, 90Y ngy nay ngi ta cn dng nhiu ng v
phng x mi trong iu tr p st nh Palludium - 107, Samarium - 145, Americum - 241, Yterbrium 169.
- iu tr bng cc ngun h (Curietherapy)
y thc s l mt bc tin di v lm thay i v bn cht k thut x tr. Da vo cc hot tnh
chuyn ho bnh thng (t bo tuyn gip hp th iode) hoc thay i bnh l (khi ung th hp th
nhng phn t hu c c hiu) ngi ta choc cc ngun h phng x vo n cc t chc ch (Target
Tissue) b bnh iu tr. Cc ng v phng x cn c a vo cc t chc ch nh vo qu trnh
c hc nh a vo kh ph qun v phi nh s thng kh (Ventilation), vo d dy (nh ng tc
nut), vo cc t bo mu (nh tun hon mu)
Bng cc ngun phng x h thch hp ngy nay chng ta c th iu tr c mt s bnh tuyn gip,
bnh mu, c xng khp, tc mch vnh v nhiu bnh ung th cng di cn ca n.
3. ng dng chiu x trong nng - sinh hc
Vic p dng cc ngun chiu x trong ngnh sinh hc c th t mt trong cc mc ch sau y:
- Tiu dit cc nm, mc, vi sinh vt gy hi:
Lng thc, thc phm c th b h hng, km phm cht trong thi gian ct gi, nht l vng nhit
i. Nhn chung, s hao ht do bo qun thng l 5% v c khi ln dn 60%. Khng phi lc no chng
ta cng x l c bng nhit vi khi lng ln. Dng ho cht c khi khng c kt qu v c th gy
tc dng xu cho ngi s dng cc lng thc, thc phm . Chiu x l mc tiu dit nm, mc,
vi sinh vt, su b gy h hng lng thc, thc phm. Mun vy phi dng nhng liu rt ln. Cc
nghin cu cho thy liu 5.000 15.000 R c th hn ch s sinh trng ca su b, liu 20.000 R c
th git cht c trng su. Liu lng dng trc ht ph thuc vo loi vi khun v mi trng chiu
x. Vi nhng liu ln nh vy ngi ta cn phi quan tm n hu qu xy ra sau chiu x trong lng

thc thc phm. Liu c s phn hu v lm gim cht lng dinh dng hoc lm xut hin nhng
cht c hi mi do chiu x khng? Qua nhiu ln th nghim, ngi ta thy vi liu 7.000 10.000R c
th bo qun khoai ty lu ngy khng ny mm v cng khng gy hi cho sc kho ngi s dng.
Khoai ty ny mm l do qu trnh tng hp acid nhn nhng im sinh trng. Vic chiu xc c th
lm chm qu tnh tng hp ny li.
i vi cn trng gy hi, ngoi vic tiu dit bn thn cn trng bng tia x, ngi ta cn mun to ra
nhng thuc tnh di truyn bt li nh gy v sinh cho cho cn trng c ri tung chng vo mi trng
chng sinh sng. K thut ny c nhiu li ch v vi liu khong 8.000 R c th lm con c mt kh
nng sinh sn, to ra nhng trng ung v do sau mt thi gian, c tp hp cn trung b dit vong.
T trc ti nay, thng khi kh trng dng c y t, ch khu, thuc, vaccin bng ho cht (thuc st
trng, ty ra, cn) v nhit nng (luc, hp, sy, t). Cc cch x l khng phi lc no cng
p dng c v c th lm h hng mt phn hoc ton b sn phm. T sau i chin th gii ln th
hai, ngi ta p dng rng ri vic dng phng x ion ho tiu dit cc vi sinh vt cc sn phm y t
nu trn. Ngy nay, nhiu loi thuc, gng tay phu thut, dng c tim truyn, dng c phu thut
c xut xng sau khi p dng vic kh trng bng phng x ion ho.
Thc ra vic xc nh ci cht ca vi sinh vt y rt kh. Thng thng, ch c th kim tra s "v
trng" ca sn phm m thi. Ly nhng mu vt ca sn phm, trong nhit thun li cho s pht
trin ca vi khun (300C, 370C v 550C). Nui cy tip vo nhng mi trng thch hp. Nu khng thy
vi khun pht trin (mc thnh cc khun lc hoc lm thay i mi trng nui cy vi khun) th c
coi l "v trng".
- Kch thch cy trng, ht ging v gy t bin gen c li to ging mi:
Kt qu nghin cu cho thy, vi mt liu nht nh c th tng thu hoch v thc y s pht trin ca
cy. C th iu khin s sinh trng v pht trin ca cy trng bng cch la chn liu chiu x vo
nhng thi k pht trin nht nh ca cy. S d nh vy l v phng x tc ng ln s phn chia t
bo cy. Chiu nhng liu nh vo ht ging trc khi gieo trng c th kch thch sinh trng nhanh,
chng gy bnh v rt ngn thi gian thu hoch.
Cc ngun ln bng 50Co v 137Cs thng c dng vo cc mc ch ny.
- Phng x ion ho c th gy nn nhng bin i cc cht liu di truyn l AND v RNA, to ra cc t
bin:
Nhng t bin thu c bng chiu x mt s cy trng.
Cy trng Chng
t bin a im v thi gian to t bin u im mi xut hin
Ci u h Regina Thu in, 1953 Nng sut cao
La mch ma ng Jutta c, 1953 Chu rt, nng sut cao
Yn mch Florad Florida, 1960 Khng bnh tn li
La mch ma xun Mari Thu in, 1960 Chn sm
La m NP 836 n , 1960 Dai cung, chu hn, nng sut cao