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TONG QUAN VAI TRO CUA LOC MAU TRONG BONG
Lyac djch: Nguyln Nhu> Ldm Vidn Bdng QuSc Gia
Linden K, Stewart IJ, Kreyer SFX et aL (2014), "Extracorporeal blood purification in burns: A review", Burns, pp. 1071 -1078
T6M TAT
Tinh tr^ng gia ting cip tinh vi kdo dii cic mediator tiin vidm vi khing vidm thu-dng g§p 6 bdnh nhin bdng ning. Cic kp thudt Igc miu bao gdm trao dii huyit tu-ong, IQC miu lidn ti^c tinh m^ch tinh mach vi cic ming hip phu c6 vai trd tiim ning trong diiu hda dip O-ng niy, cii thidn kit qui diiu tn. Bii bio niy dd dp din cic khia canh ca chi bdnh sinh vi tic di,rng cOa IQC miu cho bdnh nhin bdng vi di xuit mdt si lidu phip tiim ning.
LBATVANDE
0ieu hda midn djch qua phyang phdp IQC mdu ngodi ca the dd dyp-c nghidn cCcu vd dypc coi Id lidu phdp tlem ndng dieu trj cdc trgng thdi vidm clp tinh nhy nhiem khuin, vidm tyy clp, sau ngCfng tim. Cdc ky thudt ndy dypc cho Id cd tdc dyng d bdnh nhdn bdng trong trydng hp-p suy tgng hpdc soc bdng khdng hIi phyc. bdi bdo ndy di sdu phdn tich ca che bgnh sinh cung nhy kha ndng dp dyng cdc lidu phdp Ipc mdu cho bdnh nhdn bong.
2. LQC IVIAU NGOAI CO T H £
Cd nhieu bdng chung cho thay trang thdi vidm di cCing vdi tinh trgng nhilm khuan trdn Idm sdng. Trgng thdi ndy cung xuat hidn d bdnh nhdn bdng do cd nhO-ng sy tyang dong trong ddp t>ng vidm. Nhiem khuin cd moi lidn quan tdi hdi chd-ng ddp d-ng vidm hd thong (SIRS) do tdng giai phdng cdc mediator tien vidm vd khdng vidm. Trong giai dogn sdm cua SIRS chu ylu thiy gia tdng cdc cytokine tiln vidm, sau dd Id cdc cytokine khdng vidm, cd thi cd bieu hidn cua hdi chu-ng khdng vidm bO tri> (compensatory anti - inflammatory response syndrome - CARS) dan din suy
giam mien djch. Cd gia thuylt cho ring "con bdo cytokine" ndy sd gdy ra hdi chi>ng suy da tang vd Idm tdng ty Id tu- vong. Mdt khdc, hidn tu-p-ng suy giam hodc r6i logn san xult cdc cytokine cung gdp d bdnh nhdn nhiem khuin vdi ty Id tu- vong cao. Nhy vdy bdnh nhdn nhidm khuin mudn sdng sdt can thilt phai cd sy can bdng v l n6ng dp cdc cytokine. Trdn ca sd dd cdc thy nghidm dd dydc tiln hdnh trdn mpt so cdc cytokine ddc bidu nhy khdng thy the lL-1, khdng bradykinin, khdng the khdng TNF, khdng thy cam the hogt hda tilu clu nhyng khdng cd tdc nhdn ndo cd hidu qua tren thu- nghidm giai doan HI. Chl cd duy nhlt protein C ngydi tdi t6 hp-p dyp-c dya thdnh san phim thyang mgi tuy nhidn dd bj rOt lui sau dd do It cd hidu qua thuylt phyc trdn nhO-ng nghidn cu-u ve sau.
Trong khi nhO-ng lidu phdp dilu trj dich ndu trdn chya chd-ng minh dygc hidu qua, lidu phdp Ipc mdu ngodi ca the dydc coi Id mdt lya chpn tiim ndng d l gdp phan dilu chinh cdc rli logn lidn quan din cdc cytokine. Hidn nay cd 3 gia thuylt v l dieu hda mu-c cytokine. Thu- nhat Id gia thuylt v l
"nong dO dinh" (Peak concentration) cho ring bing cdch giSm nong dd todn bO cdc
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cytokine trong giai dogn sdm tien vidm cd thi dy phdng dyp-c suy cdc tang vd tO- vong.
Gia thuylt thu- hai cd tdn Id ngydng dieu hda midn djch (Threshold immunomodulation) cd cdch nhin ddng han ve cac khia cgnh khdc nhau. Bdng cdch loai bd khdng chpn IQC cdc cytokine trong mdu, cdc cytokine tO- khoang ke vd to chd-c se giam theo theo sy thay doi v l gradient nong do cho den khi dat cdn bdng mdi Tgi thdi diem dd, cdc ddng thdc vidm qud mu-c se di>ng lai, cdc mediator cd ning dd cdng cao se dydc logi bo nhilu nhat vd tinh trgng suy tgng cd t h i trdnh dyQC. Gia thuylt thu- ba; sy- phdn phoi cdc mediator (Delivery mediator) cho ring vide tdng cydng ddng chay d mu-c cao se thuc dly Idm tdng ddng lyu thdng hd bach huylt qua dd Idm tdng qud trinh phdn b l cdc cytokine tdi cdc khoang md ky thudt ipc mdu cd thi logi bd dyp-c chdng. Ky thudt Ipc mdu khdng chpn IQC khdng nhlm vdo dich cytokine d^c hidu ndo nhyng Idm giam nong dd cdc cytokine trong mdu, theo dd cdc cytokine dy thii-a se dyp'c logi bd vd Idp lai can bdng cytokine cho ca the.
3. SINH Lt BENH B 6 N G LIEN QUAN D£N AP DVNG KY THlJAT LOG MAU
Cdc cytokine tdng cao sdm sau bdng khdng kdm theo dau hidu nhidm khuan. Finnerty vd cdng sy nghidn cu-u thay cdc cytokine 1L6, IL8, IL10, IL17, GM-CF, interferol gamma tdng cao d bdnh nhdn bdng ngydi Idn so vdi d tre em, ding thdi nong dd IL6, IL8, IL10.
IL18 vd 1L1J3 tdng cao nhat trong vdng 1 tuIn diu sau bdng. Nong dd cao cua cdc cytokine vidm cdn gdy cdc roi loan chuyen hda cd vai trd dnh hydng den diln bien vd td vong sau bdng. Ddp u-ng vidm vd tdng chuyin hda xult hidn sdm trong 24h dau vd tdng nhanh chdng trong 5 ngdy dau sau bdng di kdm vdi sy gia tdng ddng k l sy giai phdng cdc cytokin tiln vidm vd cdc cytokine khdng vidm. Qud trinh thay dli ndy dydc gpi Id "bdo cytokine" bieu hidn bing sy rli logn sy cdn bdng cytokine ndi sinh. Cdc qud trinh bdnh 1;^ ldm thdc dly
qud trinh vidm Idn din dinh dilm diu cd hdu qud ti> vong Vat cao, vl dy nhy nhidm khuin, phlu thudt Idn, suy da tgng.
Tinh trgng tidu ca vdn din din ton thyang thdn clp vd ty Id tu- vong cao thydng gdp d bdnh nhdn bdng ndng. Myoglobin Id sdc t6 ca giai phdng td- ca van tin thyang ddng vai trd quan trpng gdy ton thyang thdn clp do Idm tdng san xuat cdc goc oxy ty do vd Idm Idng dpng cdc protein Tamm - Horsfall d ong thdn. Loai bo sdm myoglobin bdng lidu phdp Ipc mdu cd t h i cai thidn didn biln vd ty Id to vong d bdnh nhan bong ndng.
4. CAC K? THUAT LQC M A U A P Dl^NG CHO BENH NHAN B^HG
4.1. Trao d6i huylt tu<ang (Plasma exchange) Trao dli huylt tyang hodc thanh Ipc huylt tyang (Plasmapheresis) dd dyp-c nghidn cO'u d-ng dgng cd-u song bdnh nhdn bdng khdng ddp u-ng vdi hoi su-c djch the trong thdi ky sic bong. Mdc du cd it bing chCi-ng nhyng mdt so trung tdm bong dd dya vdo quy trinh dilu trj s6c bdng rlt n^ng ho$c sic bdng khdng hoi phyc. Mdt so nghidn ci>u nho dd chd-ng minh lidu phdp ndy cd tdc dyng tdm giam s6 lyQng dich truyen, tdng huyet dp ddng mgch trung binh, tdng bdi nidu, giam ning dd lactat mdu, hIi phyc chu-c ndng cua cdc lympho bdovd giam cdc phan u-ng hIn hp'p cua hd lympho. Cdc nghidn cu-u ndy cQng thdng bdo chya cd cdc bien chu-ng hay tdc dyng phy ndo dyp-c ghi nhdn. Cho tdi nay chya cd nghidn cd-u ndo v l bien dli nong dd cdc cytokine trong khi thyc hidn kj thudt trao dli huyet tyang d bdnh nhdn bdng. Lidu phdp dilu trj ndy cQng dd dyp-c tiln hdnh trong ITnh vyc nhiem khuin vd cung giong nhy trong bdng, thay cai thidn huyet ddng nhyng khdng cd tdc ddng trdn ty Id tu- vong. Cdc hgn chl CLJa cua ky thudt ndy cOng d n phai chCi y Khi trao dli huylt tyang, todn bd t h i tich huylt tyang dyp'c logi bd vd thay thi, dan din logi bd khdng chi cdc yeu to bdnh ly (cytokine) md cdn ca cdc ylu t l cd Ip-i nhy cdc ylu t l ddnn mdu, cdc khdng thi, vd cdc pnDtein khdc ciJa
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59 huylt tyang. Do vdy se gdy dnh hydng dincdc ddp yng sinh ly dly du cua ca thi. Ngodi ra cung khdng the dilu hda dyp'c s6 lyp-ng cdc chat dd bj logi bd do vdy khd xdc djnh Id cd [p-i hay cd hgi. Thdm vdo dd, ky thudt ndy ddi hoi phai cd huylt tyang tyai ddng Ignh vd/hodc albumin. Vide truyin cdc che pham mdu Idm tdng nguy ca nhiem trCing, s6c phan vd vd hdi chO-ng ton thyang phli do truyen mdu. Tdm Igi, trao doi huylt tyang dyp-c coi Id mdt lidu phdp dieu trj tiim ndng cho sic bdng khdng hoi phyc mdc dii chya cd bing chu-ng cai ttiidn ty Id cdu sing, chLing ta cIn cd nhO-ng nghidn cdu tilp theo d l khing djnh 4.2. LQC lien tyc tinh m^ch -tinh m^ch (CWH)
CWH (Continuous venovenous hemofiltration) Id ky thudt dd dydc chip nhdn trong dieu trj tin thyo-ng thdn clp. Trong khi cdc lidu phdp thay thi thdn truyin thing nhy thim tdch mdu (thdn nhdn tgo) dgt khd ndng thanh thai nhd pha lodng cdc chit qua mdng bdn thim, CWH hogt ddng theo nguydn ly doi lyu (hodc Idi kdo cdc chit) vdi tdc dyng chinh Id Idm tdng kha ndng ddo thai cdc chit hda tan trong nydc cd trpng lyQng phdn tu- trung binh (5-50kDa) bao gim cd cdc cytokine. Cdc nghidn cu-u trdn bdnh nhdn nhiem khuan ve vai trd cua CWH cho cdc kit qua cdn khdc nhau. Heenng vd cdng sy thdng bdo cd sy cai thidn huylt ddng, nhyng khdng Idm giam ning dd TNFo trong djch Ipc vd trong huylt thanh. Nghidn cO-u da trung tdm v l vai trd cOa CWH dli vdi nhilm khuin so sdnh vdi phyang phdp dilu trj truyin thing cho thay ty Id ty vong cao han , mdc dd ndng cua suy tgng trong khi ning dd cdc cytokine khdng giam.
Cdc nghidn cdu tilp theo thyc hidn CWH vdi ddng cao (High Volume hemofiltration - HVHF) vdi gia thuylt ddng cao sd Idm tdng qud trinh dli lyu cua cdc chit cln lo^i bd.
Thi> nghidm da trung tdm IVOIRE trdn bdnh nhdn sic nhidm khuin vd tin thyang thdn cap chia ngdu nhidn ldm hai nhdm HVHF vdi t l dd ddng 70ml/kg/h vd CWH vdi tic dd
35ml/kg/h kit qua cho thiy khdng cd sy khdc bidt ve ty Id td vong sau 28 ngdy cQng nhy cdc chi tidu huylt ddng cQng nhy chd-c ndng cdc tgng d hai nhdm. Cdc tdc g\i kit ludn rdng HVHF khdng ndn chl djnh cho soc nhidm khuan cd ton thyang thdn clp vd nghidn cdu bj dCfng tniOc khi kit thuc theo k l hogch. Ket qua tir mdt nghidn cdu thu- nghidm khdc dya ra khuyin cdo dli vdi cdc trydng hQp cd tin thyang thdn clp chi ndn Ipc d mdc ddng 25ml/kg/h. Cho tdi nay, cd rlt It cdc nghidn cdu thu- nghidm trdn bdnh nhdn bdng. Nghidn cdu hIi cdu ciJa chung tdi ve vai trd cua CWH sdm trdn 29 bdnh nhdn bdng > 40%
didn tich ca t h i kdm theo tin thyang thdn cap (chan dodn theo thang dilm AKI Network
> 2) vdi tic dd ddng 30-120 ml/kg/h so sdnh vdi nhdm khdng thyc hidn CWH thiy nhdm dp dyng sdm CWH cd ty Id td vong sau 28 ngdy thIp han, ty s l P/F dyp'c cdi thidn d bdnh nhdn ARDS, s l bdnh nhdn dOng thulc vdn mgch 24 - 48h cOng It han so vdi nhdm chdng.
Cdc ket qua td cdc nghidn cdu thu dydc khdc nhau cd Wil do quy md, mdc dd bdnh ly, vd logi tgng suy khdc nhau, tuy nhidn kit qud td thy nghidm da trung tdm chi ra ring chya cd bdng chdng thuylt phyc cho lidu phdp dp dyng ddng cao vd cdc kit qud cua cdc thd nghidm chi cd tdc dyng tit trdn mdt s6 tidu chl nhlt djnh It cd y nghTa trdn Idm sdng (vl dy nhy F1O2 a bdnh nhdn ARDS). Hidn nay HFVF dang dyp-c tiln hdnh thd nghidm trdn bdnh nhdn bdng cd ton thyang thdn clp vd den nay chya kit thiic.
5. cAc K^ THUAT LpC MAU DANG NGHIDN COu 5.1. Cot IQC vd mdng hip phg
Ky thudt ndy dya trdn nguydn ly hip phy cdc phdn td (mediator, cytokine, khdng sinh, vd protein) vdo mdng hodc cdt IQC cd d$c tfnh hip phy theo tinh chit mang ion ho$c theo kich thydc. Cdc logi mdng vd cdt IQC hip phy ndy dd dyQC sd dyng trong vide logi bd cdc cytokine d bdnh nhdn cd hdi chdng SIRS vd
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nhidm khuan. Mdt vdi ky thudt trinh bdy dydi ddy dd dyp-c sd dung Idm cdc mdng trong lidu phdp thay the thgn. Cdc cdt Ipc ndy cd thi dCing kit hp-p vdi lidu phdp thay the th|n (trong trydng hprp CWH hodc tham tdch mdu truyin thong) hodc sd dyng ddc Idp. Cdc phyang phdp dilu trj ndy nhdm myc tidu logi bd cdc cyokine khdng ddc hidu, cd the cd tdc dyng tit trdn bdnh nhdn bdng.
5.1.1. Cic cgtigc cd Poiymicin B Cdc cdt Ipc du'p'c phu khdng sinh poiymicin B cd kha ndng kit hp-p vdi ndi ddc t i . Trong nghien cdu sd dung sdm cdt Ipc cd poiymicin B dieu trj nhilm khuan cd nguIn glc td 6 byng thay cai thidn huylt ddng, giam suy cdc tgng vd giam ty Id td vong sau 28 ngdy dilu trj so vdi nhdm chdng, Nghien cdu tdc dyng cua cdt Ipc chda poiymicin B trong sic nhiem khuin vd nhilm ndi ddc t l mdu (endotoxemia) se dyp-c nghidn cdu vdi vide ddnh gid ngodi ty Id td vong sau 28 ngdy cdn ddnh gid thdm sau 90 ngdy, 6 thdng vd 12 thdng. Vi khuan gram dm Id tdc nhdn chinh gdy nhilm tnjng d bdnh nhdn bong do vdy cdt Ipc poiymicin B cd the cd hidu qua trdn bdnh nhdn bdng cd dau hidu nhidm ndi ddc t l mdu.
Peng vd cdng sy nghidn cdu tdc dyng cua Ipc thim tdch tidn tyc tTnh mgch finh mgch (CWHD) vdi cdc sQ-i cd chda poiymicin d bdnh nhdn bdng a 50% didn tich ca thi cd nhidm khuin thay nong dd trong huyet thanh cua ndi ddc to, IL-lp, IL-6, IL-8 vd TNFa giam ddng ke tuy nhidn kit qua dieu trj khdng thi ddnh gid do so lyQng bdnh nhdn qud It.
5.1.2. Ming Polymethylmethacrylate - PMMA PMMA cd kha ndng loai bd ddng k l cdc cytokine, trdn Idm sdng cd hidu qua cdi thidn huylt ddng. Trdn bdnh nhdn bdng, Nakae vd cdng sy nghidn cdu 3 tnj-dng hQp trang > 30%
didn tich ca thi dyp'c IQC mdu CWH bdng mdng PMMA thiy giam ning dd lL-6 trdn ca 3 bdnh nhdn. Matsuda vd cdng sy so sdnh sidu Ipc thim tdch bdng PMMA vd thdn nhdn tao d
bdnh nhdn ARDS cd suy thdn thiy cai thidn ty Id sing sdt sau 28 ngdy ddng thdi giam ddng k l ning dd IL-6.
5.1.3. Cic c0f hap phy cytokine Cdc vdt lidu ndy thilt k l theo hydng hap phg logi bd cdc cytokine khdng ddc hidu.
Trong clu trOc cOa cdc cdt ndy cd cdc chuli hgt ddc bidt cd tdc dyng bit vd hip phg cdc cytokine. Cdc chit cd trQng lu-Q-ng phdn td
< 10 kDa di chuyin qua du-p-c cdc l6 cOa cdc hgt ndy, trong khi dd cdc chit vd cdc t l bdo cd trpng lyQng phan td > 50 kDa se di chuyin xung quanh cdc hgt. Cdc vdt lidu ndy dd dyQc thy nghidm trdn ddng vdt cd tdc dyng ldm gidm ning dd cytokine vd ty Id td vong. Cdt Cytosorb dd dyp-c thd nghidm nghdu nhidn, da trung tdm trdn 43 bdnh nhdn nhilm khuin cd ton thyang phoi cd tdc dgng giam IL-6, MCP-1, IL-Ira vd IL-8 trong khi dd lL-10 vd ndi ddc t l dydng nhy It bj anh hydng, dong thdi ty Id td vong cung khdng thay doi ddng kl. Cytosorb cQng dd dyp-c chdng minh cd tdc dyng Idm gidm nong dd Myoglobin trdn in vitro vd cd the cd tdc dyng didu tri bdnh nhdn bdng cd tidu ca van do cdc tdc nhdn khdc.
Gid thuylt ndy dang trong qud trinh nghidn cdu de khdng dinh.
5.2. Mang co dilm cdt cao (High cutoff-HCO) Cdc mdng HCO cd diem cdt trdn in - vivo dli vdi cdc chit cd trQng lytyng phdn td 50-60 kDa. PhIn Idn cdc nhd san xult khuyin cdo sd dyng cdc loai mdng ndy cho thim tdch mdu vdi hy vpng logi bo cdc cytokine bing phyang phdp khuylch tdn.
Nghidn cdu trdn bdnh nhdn nhilm khuin cd tin thyang thdn clp (mdc dd F theo phdn logi RIFLE) dd chdng minh dilu ndy, adng thdi lidu phdp ndy cdn cd tdc dyng logi bd cdc chat cd trpng lypng phdn td trung binh nhu p2 - microglobulin vd cystatin C tuy nhidn tdc dgng trdn ty id td vong, nhu cau sd dgnq thulc vdn mgch, thdi gian dieu trj hIi sdc thi chya rd rdng khi so sdnh vdi sidu Ipc i h | tdch tTnh mgch tinh mgch. Khi sd dyng mdn
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61ndy trong chl dd sidu Ipc (hemofiltration) cd the gdy mat cd albumin. Mpt so tdc gid sd dung logi mdng ndy khi can loai bd cytokine theo phyang phdp thanh thai doi lyu thay cd tdc dgng idm tdng mdc thanh thai IL-6. Mdt nghidn cdu khdc trdn 76 bdnh nhdn soc nhidm khuan cd tin thyang thgn clp dd dyQC tien hanh nhyng chya thdng bdo kit qua.
5.3. Hdp phy IQC huylt tu-ang ddi (Coupled plasma filtration adsorption - CPFA)
Trong phyang phdp ndy, huyet tyang dypc tdch ridng sau dd IQC qua mdng IQC mdi sau dd dyp'c dya trd Igi tuan hodn chung tilp dd todn bd mdu dyp-c Ipc tiep thee phyang phdp sidu Ipc hodc tham tdch. Vide tdch huyet tyang rli Ipc cd thi Idm giam nguy ca bj kit tdp vd vdn tilu clu Idm tdng thdi gian tilp xuc bdng ddng thIp. Nghidn cdu trdn bdnh nhdn nhiem khuin, sd dyng phyang phdp CPFA vdi thim tdch mdu thay cai thidn huyet ddng so vdi CWHDF tuy nhidn khdng thiy thay dli nong dd cdc cytokine. Mdt nghidn cdu trdn 350 bdnh nhdn sic nhidm khuan dang dyQC tien hdnh vd chya cd kit qua cuoi cung.
6. CAC THlfeT B| CHQN LQC TREN T^ BAO (Selective Cytopheretic Device - SCO)
SCD Id thiet bj hoat ddng dya trdn nguydn ly dilu hda midn djch de Idm giam cdc rli logn Id hdu qua cua ddp dng vidm qud mdc vdi myc tidu chinh Id tdc ddng trdn cdc bgch cau dd bj hogt hda Id tdc nhdn cd vai trd chinh trong ddp dng vidm Idm tdng san xult cdc mediator vidm vd tdc dgng thyc bdo. SCD cd cdc sp-i polysulfone, mdu di qua cdc Sdi ndy vdi toe dd chdm vd bp ddy Ipc mdu dyp-c thiet ke theo dgng chia Iyc de ddm bao tic dd chdm cua ddng mdu. Chat chong ddng cho ky thudt ndy Id citrate de tgo ra mdi trydng calci ion hda thIp cd tdc dgng bit hogt hogt tinh cua cdc bgch clu dyp-c che Id tdc nhdn chinh gdy hdi chdng ddp dng vidm hd thong (SIRS), cdc bgch clu se bj ket dlnh vdo be m$t. Cd
hai nghien cdu thd nghidm ky thudt ndy d bdnh nhan ton thyang thdn cap sau hogi td cap Ing thgn, SCD dyp-c kit noi thdm vdo hd thong ddy Ipc mdu cOg mdy IQC mdu. Kit qud nghidn cdu thd nhlt trdn 9 bgnh nhdn cho thdy ty id td vong Id 22,9% so vdi 77,8% d nhdm doi chdng hIi cdu theo phyang phdp so sdnh so lidu tdng cdp. Nghidn cdu thd hai trdn 35 bdnh nhdn cho kit qud td vong 31,4%, cd su- hIi phgc chdc ndng thdn d tit ca bdnh nhdn song sdt vdo ngdy thd 60 so vdi nhdm chdng hIi cdu (ty Id td vong 50%) trong nhdm bdnh nhdn cd ton thyang thdn cap cd chi djnh lidu phdp thay thi thdn tgi khoa hoi sdc clp cdu. Mdt nghien cdu Idn han trdn 344 bdnh nhdn vdi ton thyang thdn clp sd dyng thilt bj ndy dang trong qud trinh thd nghidm.
7. KfeT LUAN
LpC mdu cho bdnh nhdn bong vdi myc tidu loai bd khdng chpn IQC cdc mediator vidm dydng nhy cd hidu qua khi tien hdnh trong giai dogn dau sau bdng, Theo nhy hilu bilt hidn nay, IQC mdu cd the cai thidn didn biln vd kha ndng cdu sing cho bdnh nhdn nhilm khuin vd cdc bdnh nhdn cd cdc roi logn dilu hda ddp dng vidm. Cdc mdng, cdt Ipc hip phy nhy PMMA dyp'c cho Id cd tiim ndng hda hen cho giai dogn dau sau bdng chya cd tin thyang thdn clp, trong dd cdc mdng Ipc cd poiymicin B cd the logi bd npi ddc t l trong nhidm khuan do vi khuan gram dm. SCD hidn nay dyp-c sd dyng cho cdc trydng hp-p cd tin thyang thdn clp, trong tyang lai cd thi phCi hp'p chp bdnh nhdn bdng vdi myc tidu dilu hda midn djch.
Chung ta tin tudng rdng, lidu phdp Ipc mdu cd thi Id mdt cudc cdch mang tiem ndng cho nhieu loai bdnh ly n|ng bao gom cd bdnh nhdn bong, tuy nhidn cln cd nhdng nghidn cdu thy nghidm sdu han, so lyp-ng bdnh nhdn idn han Qi ddnh gid vai trd cua lidu phdp ndy.
