{"id":1181,"date":"2020-03-22T22:04:42","date_gmt":"2020-03-22T15:04:42","guid":{"rendered":"http:\/\/vinathuoc.com\/?p=1181"},"modified":"2020-03-22T22:05:20","modified_gmt":"2020-03-22T15:05:20","slug":"huong-dan-chan-doan-va-dieu-tri-benh-viem-gan-vi-rut-b","status":"publish","type":"post","link":"https:\/\/vinathuoc.com\/huong-dan-chan-doan-va-dieu-tri-benh-viem-gan-vi-rut-b\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn ch\u1ea5n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam gan vi r\u00fat B"},"content":{"rendered":"

\u00a0H\u01af\u1edaNG D\u1eaaN<\/h1>\n

Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam gan vi r\u00fat B<\/h1>\n

(Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1: 5448\/Q\u0110-BYT ng\u00e0y 30 th\u00e1ng 12 n\u0103m 2014 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf)<\/h4>\n

 <\/p>\n

I. \u0110\u1ea0I C\u01af\u01a0NG<\/h2>\n

– Vi\u00eam gan vi r\u00fat B l\u00e0 m\u1ed9t b\u1ec7nh ph\u1ed5 bi\u1ebfn to\u00e0n c\u1ea7u, do vi r\u00fat vi\u00eam gan B (HBV) g\u00e2y ra. B\u1ec7nh c\u00f3 th\u1ec3 l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng m\u00e1u, \u0111\u01b0\u1eddng t\u00ecnh d\u1ee5c, t\u1eeb m\u1eb9 truy\u1ec1n sang con. N\u1ebfu m\u1eb9 nhi\u1ec5m HBV v\u00e0 c\u00f3 HBeAg (+) th\u00ec kh\u1ea3 n\u0103ng l\u00e2y cho con l\u00e0 h\u01a1n 80% v\u00e0 kho\u1ea3ng 90% tr\u1ebb sinh ra s\u1ebd mang HBV m\u1ea1n t\u00ednh.<\/p>\n

– Vi\u00eam gan vi r\u00fat B c\u00f3 th\u1ec3 di\u1ec5n bi\u1ebfn c\u1ea5p t\u00ednh, trong \u0111\u00f3 h\u01a1n 90% s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u1ecfi ho\u00e0n to\u00e0n, g\u1ea7n 10% chuy\u1ec3n sang vi\u00eam gan m\u1ea1n t\u00ednh v\u00e0 h\u1eadu qu\u1ea3 cu\u1ed1i c\u00f9ng l\u00e0 x\u01a1 gan ho\u1eb7c ung th\u01b0 gan.<\/p>\n

– Hi\u1ec7n nay \u0111\u00e3 c\u00f3 v\u1eafc xin d\u1ef1 ph\u00f2ng n\u00ean l\u00e0m gi\u1ea3m r\u00f5 r\u1ec7t s\u1ed1 ng\u01b0\u1eddi nhi\u1ec5m m\u1edbi HBV.<\/p>\n

II. CH\u1ea8N \u0110O\u00c1N V\u00c0 \u0110I\u1ec0U TR\u1eca VI\u00caM GAN VI R\u00daT B C\u1ea4P<\/strong><\/h2>\n

1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/h3>\n

a) Th\u1ec3 v\u00e0ng da \u0111i\u1ec3n h\u00ecnh:<\/strong><\/h4>\n

– C\u00f3 ti\u1ec1n s\u1eed truy\u1ec1n m\u00e1u hay c\u00e1c ch\u1ebf ph\u1ea9m c\u1ee7a m\u00e1u, ti\u00eam ch\u00edch, quan h\u1ec7 t\u00ecnh d\u1ee5c kh\u00f4ng an to\u00e0n trong kho\u1ea3ng t\u1eeb 4 tu\u1ea7n \u0111\u1ebfn 6 th\u00e1ng.<\/p>\n

– L\u00e2m s\u00e0ng: c\u00f3 th\u1ec3 c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng ch\u00e1n \u0103n, m\u1ec7t m\u1ecfi, v\u00e0ng da, ti\u1ec3u \u00edt s\u1eabm m\u00e0u, \u0111au t\u1ee9c v\u00f9ng gan, n\u00f4n, bu\u1ed3n n\u00f4n, ph\u00e2n b\u1ea1c m\u00e0u…<\/p>\n

– C\u1eadn l\u00e2m s\u00e0ng:<\/p>\n

+ AST, ALT t\u0103ng cao (th\u01b0\u1eddng t\u0103ng tr\u00ean 5 l\u1ea7n so v\u1edbi gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng).<\/p>\n

+ Bilirubin t\u0103ng cao, ch\u1ee7 y\u1ebfu l\u00e0 Bilirubin tr\u1ef1c ti\u1ebfp.<\/p>\n

+ HBsAg (+) ho\u1eb7c (-) v\u00e0 anti-HBc IgM (+)<\/p>\n

b) M\u1ed9t s\u1ed1 th\u1ec3 l\u00e2m s\u00e0ng kh\u00e1c:<\/strong><\/p>\n

– Th\u1ec3 kh\u00f4ng v\u00e0ng da: + L\u00e2m s\u00e0ng: c\u00f3 th\u1ec3 c\u00f3 m\u1ec7t m\u1ecfi, ch\u00e1n \u0103n, \u0111au c\u01a1.<\/p>\n

+ X\u00e9t nghi\u1ec7m: AST, ALT t\u0103ng cao, anti-HBc IgM (+) v\u00e0 HBsAg (+\/-). – Th\u1ec3 v\u00e0ng da k\u00e9o d\u00e0i:<\/p>\n

+ L\u00e2m s\u00e0ng: C\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng gi\u1ed1ng nh\u01b0 th\u1ec3 \u0111i\u1ec3n h\u00ecnh, k\u00e8m theo c\u00f3 ng\u1ee9a. T\u00ecnh tr\u1ea1ng v\u00e0ng da th\u01b0\u1eddng k\u00e9o d\u00e0i tr\u00ean 6 tu\u1ea7n, c\u00f3 khi 3-4 th\u00e1ng.<\/p>\n

+ X\u00e9t nghi\u1ec7m:<\/strong> AST, ALT t\u0103ng cao, Bilirubin t\u0103ng cao, ch\u1ee7 y\u1ebfu l\u00e0 Bilirubin tr\u1ef1c ti\u1ebfp, HBsAg (+) ho\u1eb7c (-) v\u00e0 anti-HBc IgM (+).<\/p>\n

– Th\u1ec3 vi\u00eam gan t\u1ed1i c\u1ea5p:<\/p>\n

+ L\u00e2m s\u00e0ng: Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 bi\u1ec3u hi\u1ec7n suy gan c\u1ea5p k\u00e8m theo c\u00e1c bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh l\u00fd n\u00e3o gan.<\/p>\n

+ X\u00e9t nghi\u1ec7m: AST, ALT t\u0103ng cao, Bilirubin t\u0103ng cao, ch\u1ee7 y\u1ebfu l\u00e0 Bilirubin tr\u1ef1c ti\u1ebfp, HBsAg (+) ho\u1eb7c (-) v\u00e0 anti-HBc IgM (+), th\u1eddi gian \u0111\u00f4ng m\u00e1u k\u00e9o d\u00e0i, gi\u1ea3m ti\u00eau c\u1ea7u.<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/h4>\n

– C\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c lo\u1ea1i vi\u00eam gan kh\u00e1c nh\u01b0: vi\u00eam gan nhi\u1ec5m \u0111\u1ed9c, vi\u00eam gan do virut kh\u00e1c (vi\u00eam gan vi r\u00fat A, vi\u00eam gan vi r\u00fat E, vi\u00eam gan vi r\u00fat C), vi\u00eam gan t\u1ef1 mi\u1ec5n, vi\u00eam gan do r\u01b0\u1ee3u\u2026<\/p>\n

– C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y v\u00e0ng da kh\u00e1c:<\/p>\n

+ V\u00e0ng da trong m\u1ed9t s\u1ed1 b\u1ec7nh nhi\u1ec5m khu\u1ea9n: B\u1ec7nh do Leptospira, s\u1ed1t r\u00e9t, s\u1ed1t xu\u1ea5t huy\u1ebft…<\/p>\n

+ V\u00e0ng da do t\u1eafc m\u1eadt c\u01a1 h\u1ecdc: u \u0111\u1ea7u t\u1ee5y, u \u0111\u01b0\u1eddng m\u1eadt, s\u1ecfi \u0111\u01b0\u1eddng m\u1eadt,\u2026 3. \u0110i\u1ec1u tr\u1ecb: Ch\u1ee7 y\u1ebfu l\u00e0 h\u1ed7 tr\u1ee3<\/p>\n

– Ngh\u1ec9 ng\u01a1i tuy\u1ec7t \u0111\u1ed1i trong th\u1eddi k\u1ef3 c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n

– H\u1ea1n ch\u1ebf \u0103n ch\u1ea5t b\u00e9o, ki\u00eang r\u01b0\u1ee3u bia, tr\u00e1nh s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c chuy\u1ec3n h\u00f3a qua gan.<\/p>\n

– Xem x\u00e9t nu\u00f4i d\u01b0\u1ee1ng b\u1eb1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch n\u1ebfu c\u1ea7n thi\u1ebft. – C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c b\u1ed5 tr\u1ee3 gan.<\/p>\n

Ri\u00eang \u0111\u1ed1i v\u1edbi th\u1ec3 vi\u00eam gan t\u1ed1i c\u1ea5p: C\u1ea7n \u0111i\u1ec1u tr\u1ecb h\u1ed3i s\u1ee9c n\u1ed9i khoa t\u00edch c\u1ef1c. C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng vi r\u00fat \u0111\u01b0\u1eddng u\u1ed1ng.<\/p>\n

III. CH\u1ea8N \u0110O\u00c1N V\u00c0 \u0110I\u1ec0U TR\u1eca VI\u00caM GAN VI R\u00daT B M\u1ea0N<\/strong><\/h2>\n

1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/h3>\n

– HBsAg (+) > 6 th\u00e1ng ho\u1eb7c HBsAg (+) v\u00e0 Anti HBc IgG (+).<\/p>\n

– AST, ALT t\u0103ng t\u1eebng \u0111\u1ee3t ho\u1eb7c li\u00ean t\u1ee5c tr\u00ean 6 th\u00e1ng.<\/p>\n

– C\u00f3 b\u1eb1ng ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng m\u00f4 b\u1ec7nh h\u1ecdc ti\u1ebfn tri\u1ec3n, x\u01a1 gan (\u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng sinh thi\u1ebft gan ho\u1eb7c \u0111o \u0111\u1ed9 \u0111\u00e0n h\u1ed3i gan ho\u1eb7c Fibrotest ho\u1eb7c ch\u1ec9 s\u1ed1 APRI) m\u00e0 kh\u00f4ng do c\u0103n nguy\u00ean kh\u00e1c (Ph\u1ee5 l\u1ee5c 1).<\/p>\n

2. \u0110i\u1ec1u tr\u1ecb:<\/h3>\n

a) Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb khi:<\/strong><\/h4>\n

– ALT t\u0103ng tr\u00ean 2 l\u1ea7n gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng ho\u1eb7c c\u00f3 b\u1eb1ng ch\u1ee9ng x\u00e1c nh\u1eadn c\u00f3 x\u01a1 h\u00f3a gan ti\u1ebfn tri\u1ec3n\/x\u01a1 gan b\u1ea5t k\u1ec3 ALT \u1edf m\u1ee9c n\u00e0o.<\/p>\n

\u00a0v\u00e0<\/p>\n

– HBV-DNA \u2265 105 copies\/ml (20.000 IU\/ml) n\u1ebfu HBeAg (+) ho\u1eb7c HBV- DNA \u2265 104 copies\/ml (2.000 IU\/ml) n\u1ebfu HBeAg (-).<\/p>\n

b) \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3:<\/strong><\/h4>\n

– Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb:<\/p>\n

+ Tenofovir (300mg\/ng\u00e0y) ho\u1eb7c entecavir (0,5 mg\/ng\u00e0y).<\/p>\n

+ Lamivudine (100mg\/ng\u00e0y) s\u1eed d\u1ee5ng cho ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan m\u1ea5t b\u00f9, ph\u1ee5 n\u1eef mang thai.<\/p>\n

+ Adefovir d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi lamivudine khi c\u00f3 kh\u00e1ng thu\u1ed1c.<\/p>\n

+ Peg\u2013IFN\u03b1, IFN\u03b1<\/span> (Peg-IFN\u03b1-2a li\u1ec1u 180mcg\/tu\u1ea7n; Peg-IFN\u03b1-2b li\u1ec1u 1,5mcg\/kg\/tu\u1ea7n; IFN\u03b1 li\u1ec1u 5 tri\u1ec7u IU\/ng\u00e0y ho\u1eb7c 10 tri\u1ec7u IU\/l\u1ea7n -3 l\u1ea7n\/tu\u1ea7n, ti\u00eam d\u01b0\u1edbi da t\u1eeb 6-12 th\u00e1ng. C\u1ea7n theo d\u00f5i t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a thu\u1ed1c \u0111\u1ec3 x\u1eed tr\u00ed k\u1ecbp th\u1eddi) \u01b0u ti\u00ean s\u1eed d\u1ee5ng<\/span> trong tr\u01b0\u1eddng h\u1ee3p ph\u1ee5 n\u1eef mu\u1ed1n sinh con, \u0111\u1ed3ng nhi\u1ec5m vi\u00eam gan vi r\u00fat D, kh\u00f4ng dung n\u1ea1p ho\u1eb7c th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf sao ch\u00e9p HBV \u0111\u01b0\u1eddng u\u1ed1ng.<\/p>\n

– Xem x\u00e9t ng\u1eebng thu\u1ed1c \u1ee9c ch\u1ebf sao ch\u00e9p HBV u\u1ed1ng khi:<\/p>\n

+ Tr\u01b0\u1eddng h\u1ee3p HBeAg (+): sau 6-12 th\u00e1ng c\u00f3 chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh HBeAg v\u00e0 HBV-DNA d\u01b0\u1edbi ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n.<\/p>\n

+ Tr\u01b0\u1eddng h\u1ee3p HBeAg (-): HBV-DNA d\u01b0\u1edbi ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n trong 3 l\u1ea7n x\u00e9t nghi\u1ec7m li\u00ean ti\u1ebfp c\u00e1ch nhau m\u1ed7i 6 th\u00e1ng.<\/p>\n

– Ch\u00fa \u00fd: C\u1ea7n theo d\u00f5i t\u00e1i ph\u00e1t sau khi ng\u1eebng thu\u1ed1c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb l\u1ea1i. c) \u0110i\u1ec1u tr\u1ecb cho m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t:<\/p>\n

* \u0110\u1ed3ng nhi\u1ec5m HBV\/HIV:<\/p>\n

+ Ti\u00eau chu\u1ea9n \u0111i\u1ec1u tr\u1ecb gi\u1ed1ng nh\u01b0 \u0111\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p vi\u00eam gan vi r\u00fat B \u0111\u01a1n thu\u1ea7n nh\u01b0ng ng\u01b0\u1ee1ng HBV-DNA > 104 copies\/ml (2.000 IU\/mL).<\/p>\n

+ D\u00f9ng ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb 3 thu\u1ed1c kh\u00e1ng HIV (HAART) c\u00f3 ch\u1ee9a TDF v\u00e0 LAM c\u00f3 t\u00e1c d\u1ee5ng v\u1edbi vi r\u00fat vi\u00eam gan B, kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ed1 l\u01b0\u1ee3ng TCD4 v\u00e0 giai \u0111o\u1ea1n l\u00e2m s\u00e0ng c\u1ee7a HIV.<\/p>\n

* \u0110\u1ed3ng nhi\u1ec5m HBV\/HCV: \u0110i\u1ec1u tr\u1ecb nh\u01b0 ph\u00e1c \u0111\u1ed3 chu\u1ea9n cho vi\u00eam gan vi r\u00fat C.<\/p>\n

* Vi\u00eam gan vi r\u00fat B m\u1ea1n t\u00ednh \u1edf tr\u1ebb em: xem x\u00e9t th\u1ef1c hi\u1ec7n theo l\u01b0u \u0111\u1ed3:<\/p>\n

\"\"<\/p>\n

(*): Tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng sinh thi\u1ebft \u0111\u01b0\u1ee3c gan c\u1ea7n h\u1ed9i ch\u1ea9n chuy\u00ean gia \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh.<\/p>\n

L\u01b0u \u00fd khi ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c \u0111i\u1ec1u tr\u1ecb cho tr\u1ebb em:<\/p>\n

– ETV cho tr\u1ebb \u2265 2 tu\u1ed5i v\u00e0 \u226510kg v\u1edbi li\u1ec1u nh\u01b0 sau:<\/p>\n\n\n\n\n\n\n\n\n\n\n
C\u00e2n n\u1eb7ng (kg)<\/strong><\/td>\nLi\u1ec1u d\u00f9ng (mg)<\/strong><\/td>\n<\/tr>\n
10-11 kg<\/td>\n0.15 mg<\/td>\n<\/tr>\n
>11-14 kg<\/td>\n0.2 mg<\/td>\n<\/tr>\n
>14-17 kg<\/td>\n0.25 mg<\/td>\n<\/tr>\n
>17-20 kg<\/td>\n0.3 mg<\/td>\n<\/tr>\n
>20-23 kg<\/td>\n0.35 mg<\/td>\n<\/tr>\n
>23-26 kg<\/td>\n0.4 mg<\/td>\n<\/tr>\n
>26-30 kg<\/td>\n0.45 mg<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Trong tr\u01b0\u1eddng h\u1ee3p kh\u00e1ng LAM th\u00ec t\u0103ng li\u1ec1u ETV g\u1ea5p \u0111\u00f4i.<\/p>\n

– LAM: 3mg\/kg x 1 l\u1ea7n\/ng\u00e0y (t\u1ed1i \u0111a 100mg).<\/p>\n

– ADV \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho tr\u1ebb \u226512 tu\u1ed5i: 10mg x 1 l\u1ea7n\/ng\u00e0y.<\/p>\n

– TDF \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho tr\u1ebb \u226512 tu\u1ed5i v\u00e0 \u2265 35 kg: 300mg x 1 l\u1ea7n\/ng\u00e0y. C\u00f3 th\u1ec3 xem x\u00e9t d\u00f9ng TDF cho tr\u1ebb \u2265 2 tu\u1ed5i 8mg\/kg x 1 l\u1ea7n\/ng\u00e0y.<\/p>\n

– IFN\u03b1 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho tr\u1ebb tr\u00ean 12 th\u00e1ng tu\u1ed5i.<\/p>\n

* Ph\u1ee5 n\u1eef mang thai:<\/strong><\/p>\n

– \u0110\u1ed1i v\u1edbi ph\u1ee5 n\u1eef \u0111ang mang thai ph\u00e1t hi\u1ec7n m\u1eafc vi\u00eam gan vi r\u00fat B m\u1ea1n.<\/p>\n

+ N\u1ebfu c\u00f3 th\u1ec3 tr\u00ec ho\u00e3n \u0111i\u1ec1u tr\u1ecb th\u00ec tr\u00ec ho\u00e3n v\u00e0 theo d\u00f5i s\u00e1t tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m.<\/p>\n

+ N\u1ebfu ph\u1ea3i \u0111i\u1ec1u tr\u1ecb: d\u00f9ng thu\u1ed1c TDF, trong 3 th\u00e1ng cu\u1ed1i thai k\u1ef3 c\u00f3 th\u1ec3 d\u00f9ng thu\u1ed1c TDF ho\u1eb7c LAM.<\/p>\n

– \u0110\u1ed1i v\u1edbi ph\u1ee5 n\u1eef \u0111ang \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat B m\u1ea1n t\u00ednh mu\u1ed1n c\u00f3 thai: N\u1ebfu \u0111ang d\u00f9ng thu\u1ed1c ETV th\u00ec ng\u1eebng thu\u1ed1c ETV tr\u01b0\u1edbc khi c\u00f3 thai 2 th\u00e1ng v\u00e0 chuy\u1ec3n sang d\u00f9ng thu\u1ed1c TDF.<\/p>\n

– \u0110\u1ed1i v\u1edbi ph\u1ee5 n\u1eef \u0111ang \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat B m\u1ea1n t\u00ednh th\u00ec mang thai: d\u00f9ng thu\u1ed1c TDF, trong 3 th\u00e1ng cu\u1ed1i thai k\u1ef3 c\u00f3 th\u1ec3 d\u00f9ng thu\u1ed1c TDF ho\u1eb7c LAM.<\/p>\n

* Tr\u01b0\u1eddng h\u1ee3p vi\u00eam gan vi r\u00fat B m\u1ea1n t\u00ednh c\u00f3 b\u1ec7nh l\u00fd gan m\u1ea5t b\u00f9:<\/strong><\/p>\n

+ Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng interferon.<\/p>\n

+ B\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t.<\/p>\n

+ L\u1ef1a ch\u1ecdn d\u00f9ng ETV ho\u1eb7c TDF.<\/p>\n

+ Theo d\u00f5i ch\u1ee9c n\u0103ng th\u1eadn, acid lactic m\u00e1u.<\/p>\n

* Tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 gan c\u00f3 HBsAg (+): Xem x\u00e9t \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ETV <\/span>ho\u1eb7c TDF l\u00e2u d\u00e0i tr\u01b0\u1edbc, trong v\u00e0 sau khi \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC).<\/span><\/p>\n

* Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m HBV (HBsAg d\u01b0\u01a1ng t\u00ednh ho\u1eb7c anti-HBc d\u01b0\u01a1ng t\u00ednh) \u0111\u01b0\u1ee3c gh\u00e9p t\u1ea1ng, d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, h\u00f3a tr\u1ecb li\u1ec7u:<\/p>\n

+ N\u00ean x\u00e9t nghi\u1ec7m HBV DNA \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng nhi\u1ec5m HBV.<\/p>\n

+ Xem x\u00e9t \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng vi\u00eam gan vi r\u00fat B m\u1ea1n b\u00f9ng ph\u00e1t b\u1eb1ng thu\u1ed1c ETV, TDF ho\u1eb7c LAM. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc, trong v\u00e0 ti\u1ebfp t\u1ee5c \u00edt nh\u1ea5t 12 th\u00e1ng sau khi ng\u01b0ng tr\u1ecb li\u1ec7u thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, h\u00f3a tr\u1ecb li\u1ec7u.<\/p>\n

* B\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u00e3n t\u00ednh v\u00e0 ti\u1ec1n s\u1eed gia \u0111\u00ecnh li\u00ean quan \u0111\u1ebfn ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC): \u01b0u ti\u00ean \u0111\u1eb7c bi\u1ec7t c\u00e1c tr\u01b0\u1eddng h\u1ee3p gi\u00e1 tr\u1ecb c\u1ee7a ALT trong kho\u1ea3ng 1-2 l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean b\u00ecnh th\u01b0\u1eddng (ULN), n\u1ed3ng \u0111\u1ed9 HBV-DNA cao (> 106 copies\/ml ho\u1eb7c 200.000 IU\/ml), th\u00ec c\u1ea7n xem x\u00e9t sinh thi\u1ebft gan ho\u1eb7c \u0111o \u0111\u1ed9 \u0111\u00e0n h\u1ed3i gan ho\u1eb7c c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 x\u01a1 h\u00f3a \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng vi r\u00fat.<\/p>\n

3. Theo d\u00f5i \u0111i\u1ec1u tr\u1ecb:<\/strong><\/h3>\n

– Tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb: c\u1ea7n t\u01b0 v\u1ea5n cho b\u1ec7nh nh\u00e2n v\u1ec1 l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb (ph\u01b0\u01a1ng ti\u1ec7n nh\u1eafc u\u1ed1ng thu\u1ed1c).<\/p>\n

– Th\u00e1ng \u0111\u1ea7u ti\u00ean sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb: theo d\u00f5i AST, ALT, creatinine m\u00e1u.<\/p>\n

– Sau m\u1ed7i 3-6 th\u00e1ng trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb: theo d\u00f5i AST, ALT, creatinine m\u00e1u, HBeAg, Anti-HBe, HBV-DNA, c\u00f3 th\u1ec3 \u0111\u1ecbnh l\u01b0\u1ee3ng HBsAg.<\/p>\n

– N\u1ebfu \u0111i\u1ec1u tr\u1ecb IFN ho\u1eb7c Peg IFN: theo d\u00f5i c\u00f4ng th\u1ee9c m\u00e1u, glucose m\u00e1u, ure m\u00e1u, creatinin m\u00e1u, ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a thu\u1ed1c.<\/p>\n

– Sau khi ng\u01b0ng \u0111i\u1ec1u tr\u1ecb: + Theo d\u00f5i c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng. + X\u00e9t nghi\u1ec7m sau m\u1ed7i 3 – 6 th\u00e1ng: AST, ALT, HBsAg, HBeAg, anti-HBe, HBV DNA \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00e1i ph\u00e1t.<\/p>\n

4. Th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb:\u00a0<\/strong><\/h4>\n

* Ti\u00eau chu\u1ea9n th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb:<\/p>\n

+ ALT c\u00f3 th\u1ec3 t\u0103ng cao tr\u1edf l\u1ea1i.<\/p>\n

+ HBV DNA t\u0103ng tr\u1edf l\u1ea1i > 1ln10 so v\u1edbi tr\u1ecb s\u1ed1 th\u1ea5p nh\u1ea5t ho\u1eb7c gi\u1ea3m < 1ln10 sau 12 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb ho\u1eb7c gi\u1ea3m < 2ln10 sau 24 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb.<\/p>\n

* L\u01b0u \u00fd:<\/strong><\/p>\n

– C\u1ea7n \u0111\u00e1nh gi\u00e1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u1ed9 tin c\u1eady c\u1ee7a x\u00e9t nghi\u1ec7m HBV DNA tr\u01b0\u1edbc khi k\u1ebft lu\u1eadn th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb. (Trong tr\u01b0\u1eddng h\u1ee3p ch\u01b0a l\u00e0m \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m HBV DNA n\u1ebfu th\u1ea5y ALT kh\u00f4ng gi\u1ea3m ho\u1eb7c t\u0103ng l\u00ean c\u1ea7n \u0111\u00e1nh gi\u00e1 v\u1ea5n \u0111\u1ec1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb n\u1ebfu b\u1ec7nh nh\u00e2n tu\u00e2n th\u1ee7 t\u1ed1t c\u1ea7n chuy\u1ec3n b\u1ec7nh nh\u00e2n l\u00ean tuy\u1ebfn tr\u00ean \u0111\u1ec3 x\u00e9t nghi\u1ec7m HBV DNA).<\/p>\n

– N\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n n\u00ean x\u00e1c \u0111\u1ecbnh vi r\u00fat \u0111\u1ed9t bi\u1ebfn kh\u00e1ng thu\u1ed1c b\u1eb1ng gi\u1ea3i tr\u00ecnh t\u1ef1 gen \u0111\u1ec3 c\u00f3 h\u01b0\u1edbng x\u1eed tr\u00ed ti\u1ebfp theo.<\/p>\n

* Thay \u0111\u1ed5i thu\u1ed1c \u0111i\u1ec1u tr\u1ecb:<\/strong><\/p>\n

+ Kh\u00e1ng LAM: chuy\u1ec3n sang d\u00f9ng TDF ho\u1eb7c ph\u1ed1i h\u1ee3p TDF ho\u1eb7c c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p LAM v\u1edbi ADV.<\/p>\n

+ Kh\u00e1ng ADV: chuy\u1ec3n sang d\u00f9ng TDF ho\u1eb7c ETV ho\u1eb7c ph\u1ed1i h\u1ee3p ADV v\u1edbi LAM ho\u1eb7c ETV.<\/p>\n

+ Kh\u00e1ng ETV: chuy\u1ec3n sang d\u00f9ng TDF ho\u1eb7c ph\u1ed1i h\u1ee3p ETV v\u1edbi TDF.<\/p>\n

+ \u0110\u00e1p \u1ee9ng m\u1ed9t ph\u1ea7n v\u1edbi TDF: ph\u1ed1i h\u1ee3p TDF v\u1edbi LAM ho\u1eb7c v\u1edbi ETV. ho\u1eb7c chuy\u1ec3n sang d\u00f9ng ETV.<\/p>\n

+ Kh\u00e1ng TDF v\u00e0 ETV: c\u00f3 th\u1ec3 chuy\u1ec3n sang d\u00f9ng IFN ho\u1eb7c PEG-IFN.<\/p>\n

IV. PH\u00d2NG B\u1ec6NH:<\/h2>\n

1. Ph\u00f2ng ch\u1ee7 \u0111\u1ed9ng: <\/strong><\/h3>\n

– Ti\u00eam v\u1eafc xin vi\u00eam gan vi r\u00fat B cho t\u1ea5t c\u1ea3 tr\u1ebb em trong v\u00f2ng 24h sau sinh v\u00e0 c\u00e1c m\u0169i ti\u1ebfp theo l\u00fac 2, 3 v\u00e0 4 th\u00e1ng tu\u1ed5i theo ch\u01b0\u01a1ng tr\u00ecnh ti\u00eam ch\u1ee7ng m\u1edf r\u1ed9ng.<\/p>\n

– Ti\u00eam v\u1eafc xin vi\u00eam gan vi r\u00fat B cho c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng ch\u01b0a b\u1ecb nhi\u1ec5m HBV. C\u1ea7n x\u00e9t nghi\u1ec7m HBsAg v\u00e0 anti-HBs tr\u01b0\u1edbc khi ti\u00eam ph\u00f2ng v\u1eafc xin.<\/p>\n

– Ti\u00eam v\u1eafc xin vi\u00eam gan vi r\u00fat B cho nh\u00e2n vi\u00ean y t\u1ebf.<\/p>\n

2. Ph\u00f2ng l\u00e2y truy\u1ec1n t\u1eeb m\u1eb9 sang con:<\/h3>\n

– N\u1ebfu m\u1eb9 mang thai c\u00f3 HBsAg (+): Ti\u00eam v\u1eafc xin vi\u00eam gan vi r\u00fat B li\u1ec1u sau sinh cho tr\u1ebb theo ch\u01b0\u01a1ng tr\u00ecnh ti\u00eam ch\u1ee7ng m\u1edf r\u1ed9ng v\u00e0 ph\u1ed1i h\u1ee3p v\u1edbi ti\u00eam kh\u00e1ng th\u1ec3 kh\u00e1ng HBV cho tr\u1ebb. N\u00ean ti\u00eam c\u00f9ng th\u1eddi \u0111i\u1ec3m nh\u01b0ng \u1edf hai v\u1ecb tr\u00ed kh\u00e1c nhau. Sau \u0111\u00f3 ti\u00eam \u0111\u1ea7y \u0111\u1ee7 c\u00e1c li\u1ec1u v\u1eafc xin vi\u00eam gan vi r\u00fat B cho tr\u1ebb theo quy \u0111\u1ecbnh c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh ti\u00eam ch\u1ee7ng m\u1edf r\u1ed9ng.<\/span><\/p>\n

– N\u1ebfu m\u1eb9 mang thai c\u00f3 HBV-DNA > 106 copies\/ml (200.000 IU\/mL): D\u00f9ng thu\u1ed1c kh\u00e1ng vi r\u00fat (lamivudine ho\u1eb7c tenofovir) t\u1eeb 3 th\u00e1ng cu\u1ed1i c\u1ee7a thai k\u1ef3. X\u00e9t nghi\u1ec7m l\u1ea1i HBV DNA sau sinh 3 th\u00e1ng \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh ng\u1eebng thu\u1ed1c ho\u1eb7c ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb n\u1ebfu m\u1eb9 \u0111\u1ee7 ti\u00eau chu\u1ea9n \u0111i\u1ec1u tr\u1ecb. Theo d\u00f5i s\u00e1t ng\u01b0\u1eddi m\u1eb9 \u0111\u1ec3 ph\u00e1t hi\u1ec7n vi\u00eam gan b\u00f9ng ph\u00e1t.<\/p>\n

3. Ph\u00f2ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u:<\/h3>\n

– S\u00e0ng l\u1ecdc m\u00e1u v\u00e0 ch\u1ebf ph\u1ea9m m\u00e1u.<\/p>\n

– Kh\u00f4ng d\u00f9ng chung kim ti\u00eam v\u00e0 c\u00e1c d\u1ee5ng c\u1ee5 xuy\u00ean ch\u00edch qua da kh\u00e1c.<\/p>\n

– T\u00ecnh d\u1ee5c an to\u00e0n.<\/p>\n

– Tr\u00e1nh ti\u1ebfp x\u00fac v\u1edbi m\u00e1u v\u00e0 c\u00e1c d\u1ecbch ti\u1ebft c\u1ee7a b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV.<\/p>\n

– Th\u1ef1c hi\u1ec7n ph\u00f2ng ng\u1eeba chu\u1ea9n gi\u1ed1ng c\u00e1c b\u1ec7nh l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng m\u00e1u.<\/p>\n

Vina Thu\u1ed1c<\/p>\n","protected":false},"excerpt":{"rendered":"

\u00a0H\u01af\u1edaNG D\u1eaaN Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam gan vi r\u00fat B (Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1: 5448\/Q\u0110-BYT ng\u00e0y 30 th\u00e1ng 12 n\u0103m 2014 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf)   I. \u0110\u1ea0I C\u01af\u01a0NG – Vi\u00eam gan vi r\u00fat B l\u00e0 m\u1ed9t b\u1ec7nh ph\u1ed5 bi\u1ebfn to\u00e0n c\u1ea7u, do vi r\u00fat vi\u00eam gan […]\n","protected":false},"author":1,"featured_media":1184,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[31],"tags":[32],"acf":{"ten_phong_kham":"","logo_phong_kham":null,"dia_chi_phong_kham":"","website_phong_kham":null,"dien_thoai_phong_kham":"","th\u1eddi_gian_lam_vi\u1ec7c":null,"phu_trach_chuyen_mon":"","cac_ch\u1ee9ng_nh\u1eadn":"","mo_t\u1ea3_don_vi_y_te":""},"yoast_head":"\nH\u01b0\u1edbng d\u1eabn ch\u1ea5n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam gan vi r\u00fat B - 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