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แกะเทป Transplantation
แกะเทป Transplantation
Transplantation
¡ÅuÁ¼Ù»Ç·ÕèÁÕ¤ÇÒÁ¾i¡ÒÃ浡íÒe¹i´ ËÃืoÁÕÊÒe˵u¨Ò¡¤ÇÒÁ¼i´»¡µiµÒ§æ ¨¹oÇaÂÇa·Õ¼è ´i »¡µiäÁ
ÊÒÁÒö㪧ҹµoä»ä´ ËÃืoäÁÊÒÁÒöÃa¡ÉÒeÂÕÂÇÂÒãËÊÒÁÒÃ¶ãª§Ò¹ä´ Ë¹·Ò§Êu´·Ò·Õè澷¨aªÇÂãË
¼Ù»ÇÂÊÒÁÒö¡ÅaºÁÒe»¹»¡µiä´ ¤ืo ¡ÒûÅÙ¡¶ÒÂoÇaÂÇa(Transplantation) e¾ืoè ·´æ·¹oÇaÂÇa·ÕèËÁ´
ÊÀÒ¾
¡Ò÷íÒ Transplantation ·Õè㪤íÒÇÒ»ÅÙ¡¶ÒÂe¾ÃÒaÇÒÁa¹e»¹¡ÒûÅÙ¡e¾iÁè äÁä´e»ÅÕè¹ eª¹ äµeÊÕÂ
¢Ò§¹ึ§ ¡ç¨aÁÕ¡ÒûÅÙ¡¶ÒÂe¾ièÁoÕ¡oa¹ ¡ÅÒÂe»¹ÁÕäµ·aé§ËÁ´ 3 oa¹ æµãª§Ò¹ä´æ¤ 2 oa¹ ´a§ÃÙ»
Terminology
Donor = ¼ÙºÃi¨Ò¤, Recipient = ¼Ùúa , Êǹ Êi觷Õè¹íÒÁÒ»ÅÙ¡¶Ò (oÇaÂÇa, ºÒ§Êǹ¢o§oÇaÂÇa, e«ÅÅ
eª¹ 䢡Ãa´Ù¡) ã¹¼Ùà aº ¨a¶Ù¡eÃÕ¡ÇÒ Graft
Graft ÊÒÁÒö溧oo¡ä´e»¹ 4 ª¹i´ ä´æ¡
1. Autograft ¤ืo ¡ÒûÅÙ¡¶Ò Graft 㹤¹æe´ÕÂÇ¡a¹ ¨Ò¡ºÃiedz˹ึè§ä»Âa§oÕ¡ºÃiedz˹ึè§
2. Isograft ¤ืo Graft ·ÕèäÁÁÕ¤ÇÒÁ浡µÒ§¡a¹·Ò§¾a¹¸u¡ÃÃÁ ÃaËÇÒ§¼ÙãË¡ºa ¼Ùúa ä´æ¡ Graft ·Õèä´ÁÒ¨Ò¡½Ò
æ½´
3. Allograft ¤ืo Graft ·Õèä´ÁÒ¨Ò¡ºu¤¤Åoืè¹·ÕèÁÕÃaºº¾a¹¸u¡ÃÃÁ·Õè浡µÒ§¡a¹
4. Xenograft ¤ืo Graft ·Õèä´ÁÒ¨Ò¡ species oืè¹æ
¶Ò¡ÒûÅÙ¡¶ÒÂoÇaÂÇaäÁÊíÒeÃ稨ae¡i´»¯i¡iÃiÂÒäÁÂoÁÃaº eÃÕ¡ Rejection «ึ觻¯i¡iÃiÂÒ¹Õé¨ae¡i´¢ึé¹o´Â
recipient ¡Ãa·íÒµo graft Êǹ Graft versus host disease e»¹»¯i¡iÃiÂÒ·Õèe¡i´¢ึé¹o´Â Graft ¡Ãa·íÒµo
recipient
ÊÃu» Rejection ¤×o »¯i¡iÃiÂÒ·Õè recipient ¾ÂÒÂÒÁ·Õè¨a¡íÒ¨a´ Graft
Graft versus host disease ¤×o Graft ¾ÂÒÂÒÁ·íÒãËe¡i´»¯i¡iÂÒã¹µaÇ¢o§ Recipient
¶ÒeÃÒ·íÒ¡ÒûÅÙ¡¶ÒÂoÇaÂÇa¡aº recipient ·ÕèäÁä´¶Ù¡¡´ÀÙÁi¤uÁ¡a¹ ª¹i´¢o§ graft ·Õè¨aÂoÁÃaº¡ç¤ืo
Autograft æÅa Isograft Êǹ Allograft æÅa Xenograft ¨aÁÕoo¡ÒÊe¡i´ rejection ä´ «ึè§o´ÂÊǹãË
æÅÇ¡ÒûÅÙ¡¶ÒÂoÇaÂÇaeÃÒ¹iÂÁ㪠Allograft «ึ觨aÁÕoo¡ÒÊe¡i´¡Òà rejectionä´ ËÒ¡ Antigen ¢o§ graft
æÅa recipient äÁµÃ§¡a¹ o´Â antigen ·ÕèÁռŪa¡¹íÒãËe¡i´¡Òà rejection ¤ืo Major Histocompatibility
Complex (MHC) Çi¸Õ¡Òûo§¡a¹¡ÒÃe¡i´ rejection µo§ãª 2 Çi¸ÕÃÇÁ¡a¹¤ืo¡Òá´ÀÙÁi¤uÁ¡a¹
(immunosuppressant) æÅa¡ÒõÃǨÃaºº·Ò§¾a¹¸u¡¡ÃÁ HLA ¢o§ recipient e¾ืèoãË graft ÊÒÁÒö
·íÒ§Ò¹oÂÙä´ã¹µaÇ¢o§ recipient
æ«ÇÀÒ¤Êo§ - »oÁæ e¼Â ¤¹·Õè¨ae»¹eÁÕ¡ÃÙµo§ÁÕ¤u³ÊÁºaµi 5 »Ãa¡Òà ¤ืo æô ÃÒ¹ ¡ÃaËÃÕè ¶Áึ§·ึ§·a§ æÅa¢oÊu´·ÒÂÊíÒ¤aÊu´¤ืo äÁ㪤¹ ËÇa§ÇÒe¾ืèo¹æ¤§¹ึ¡oo¡ÇÒÁÕã¤ÃºÒ§
- ¹Ò§ÊÒÇ ¹. ÊÒ 20X e¼Â Hypersensitivity ·ÕèºÒ¹ËÅo¹ e¤Ò㪤ÒÃÒäÁ´Ãa¡ÉÒ ¨Ò Ái¹Ò ËÅo¹¤§ãªÃa¡ÉÒºo ÊÀÒ¾eÅÂe»¹eÂÕ觹ÕéæÅ
- Ê桹e¨ÊÁ 23X äÁÇÒ¨a·íÒoaäà ãÊã¨ãËÃa¡Ê¹u¡ ËÅo¹Ê¹u¡oaäèa ʹu¡¡i¹Ãึ»ÒÇ
- ã¹ Gross ÁÕ Sphincter of oddi ¹Ò§ÊÒÇ «.Á. äÁÂoÁ¤a e´Õ깡çÁÕ Sphincter of Sammy
- ã¹æÅ»ÊÃÕÃÇi·ÂÒeÃืèo§¡ÒÃÇa´¤ÇÒÁ´a¹¹Ò§ÊÒÇo¤ªªÕè ¶ึ§¡aºµo§e¾ièÁ Cuff oÕ¡ 50 % ¹a¨a¶ึ§¨a¾a¹Ãoº
oÂÒ¶Áึ§Êi¨a e¨oaë¹
- ¹ÒʧÊÒùҧÊÒÇ ». ÊÒ 22X ¨aº¤Ù·íÒæÅ»ÊÃÕÃÇi·ÂÒ¡ÒÃÇa´¤ÇÒÁ´a¹ ¨aº¡aã¤ÃäÁ¨aºä»¨aº¤Ù¡ae¨ o. eËaæ eŤÅíÒ PR äÁe¨oeÅ eÎo ¹ÒeÈÃÒ
- ¹Ò§ÊÒÇ ¢. ÊÒ 10X ä»Ão˹uÁ o.Ã. 9X ¶ึ§Ëo§æÅ» ·Ò§eÃÒoÂÒ¡·ÃÒºÇÒe»¹oÒÃÒ¡ҹÃึ»ÒÇ
- ¹Ò ». 9X ¡a ¹.Ê. Â.Å. 3X ªÇ§¹ÕéäÁ¤oÂä»´Ç¡a¹eÅ ¡ÅaÇe»¹¢ÒÇÃึ»ÒǨa
- ¹Ò§ÊÒÇ Hell e·¾¢o§¨Ãi§ ¹o¡¨Ò¡¨aæ¡ae·»eÃÕ¹æÅÇÂa§æ¡ae·»e¾Å§ËÁoÅíÒe»¹»Ãa¨íÒ
Identify this person ©a¹ÊÇ¢a
2. Acute rejection e¹ืèo§¨Ò¡ÁÕ T-cell æÅamemory cell ¨ึ§e»¹ second set rejection µaÇ¡Ò÷Õè·íÒ
ãËe¡i´¤ืo T-cell
o¸iºÒÂÃÙ» e¡i´¨Ò¡ T-cell ·Õè¶Ù¡¡Ãaµu¹ÁÒ¡o¹
æÅÇ¡ÅÒÂe»¹ memory cell ¹aè¹eo§ «ึè§
cytotoxic T-cell ¹Õé·íÒ˹ҷÕèe»¹ Effecter T-
cell «ึè§e»¹Ë¹Ç compliance ¨Ùo¨Á·aé§ËÅÒÂ
¾o T-cell detect ä´ÇÒ antigen ¹aé¹äÁ㪢o§
µ¹eo§ Cytotoxic T-cell ¡ç¨a·íÒ˹ҷÕèo´Â¡ÒÃ
»Åo cytotoxin oo¡ä»ÁռŷíÒãË tissue
injury ʧ¼ÅãËÁÕ¡ÒáÃaµu¹Ãaºº clot e¡i´¢ึé¹
«ึ觼ÅÊu´·Ò¡ç¨ae¡i´¼Å¤ÅÒ¡aº¢o§
Hyperacute rejection æµµaÇ¡Ò÷Õè·íÒãËe¡i´
µÒ§¡a¹
3.Subacute rejection ãªeÇÅÒ¹Ò¹¡ÇÒ acute rejection ãªeÇÅÒ¹Ò¹e»¹Ça¹¶ึ§Êa»´ÒË e»¹ primary
immune response ¨ึ§ºo¡ä´ÇÒÁa¹e»¹ first set rejection
4. Chronic rejection e¡i´¹Ò¹ oÒ¨e¡i´e¹ืèo§¨Ò¡µo§ÁÕ¡Òà process antigen ËÃืoÁվǡ minor
antigen e¢ÒÁÒ oÒ¨e¡ÕèÂÇ¢o§·a駡aºe«ÅÅæÅa antibody ¡çä´ æµo´ÂÊǹãËæÅǨae¡ÕèÂÇ¡aºe«ÅÅ
o¸iºÒÂÃÙ» e¡i´¨Ò¡e«Åžǡ macrophage
ËÃืo¾Ç¡ T-helper cell ¨aÁÒ¡Ãaµu¹¡ÅÒÁe¹ืéo
eÃÕº·ÕèoÂÙÃoºæËÅo¡eÅืo´ã¹ªa¹é tunica media
˹Ңึ¹é ·íÒãËe¡i´¡Òõպŧ¢o§ËÅo´eÅืo´æµ
äÁä´e¡i´¡ÃaºÇ¹¡Òà clotting ·íÒãËeÅืo´·Õè¨a
ä»eÅÕé§ graft ¹oÂŧʧ¼ÅãË graft ·íÒ§Ò¹ä´
Ŵŧ
eÁืèo§Ò¹Åo¡Ãa·§·Õè¼Ò¹
ÁÒ eÎÅ«Õè ¶ึ§¡aº·¹eÊÕ§
ËÁoÅíÒºäËÇ æoºæµ§µaÇ
Ça¹ÇÒ¹Âa§ËÇÒ¹oÂÙ ÊÇÂÁaêÂ¤Ò Áa¹ÊãËeŹa¤a eÁÕ»oÁæ ÊÇ·u¡¤¹¹a¨a ä»ÃÇÁ§Ò¹ Êǹiêʹึ§¤Ò