{"id":150581,"date":"2025-12-13T17:14:04","date_gmt":"2025-12-13T10:14:04","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=150581"},"modified":"2025-12-17T14:35:39","modified_gmt":"2025-12-17T07:35:39","slug":"huong-dan-thuc-hanh-lam-sang-quan-ly-viem-gan-b-man-cua-hiep-hoi-nghien-cuu-benh-gan-chau-au-easl-2025","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/huong-dan-thuc-hanh-lam-sang-quan-ly-viem-gan-b-man-cua-hiep-hoi-nghien-cuu-benh-gan-chau-au-easl-2025\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng Qu\u1ea3n l\u00fd Vi\u00eam gan B m\u1ea1n c\u1ee7a Hi\u1ec7p H\u1ed9i Nghi\u00ean C\u1ee9u B\u1ec7nh Gan Ch\u00e2u \u00c2u (EASL) 2025"},"content":{"rendered":"

Ngu\u1ed3n : Fanpage Filemed – T\u00e0i Li\u1ec7u Y D\u01b0\u1ee3c<\/p>\n

T\u1ed5ng quan<\/h2>\n

T\u1ed5ng quan nhi\u1ec5m vi\u00eam gan B<\/h3>\n
Vi\u00eam gan B l\u00e0 v\u1eabn l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c \u0111\u1ed1i v\u1edbi s\u1ee9c kh\u1ecfe to\u00e0n c\u1ea7u, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u00e0ng tri\u1ec7u ng\u01b0\u1eddi tr\u00ean th\u1ebf gi\u1edbi. Nhi\u1ec5m virus vi\u00eam gan B (HBV) m\u1ea1n t\u00ednh c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c b\u1ec7nh gan nghi\u00eam tr\u1ecdng bao g\u1ed3m x\u01a1 gan v\u00e0 ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC) c\u00f3 t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh v\u00e0 t\u1eedvong \u0111\u00e1ng k\u1ec3.<\/p>\n
N\u0103m 2022, \u01b0\u1edbc t\u00ednh c\u00f3 1.2 tri\u1ec7u ca nhi\u1ec5m HBV m\u1edbi tr\u00ean to\u00e0n c\u1ea7u, trong khi c\u00f3 254 tri\u1ec7u ng\u01b0\u1eddi \u0111ang s\u1ed1ng chung v\u1edbi t\u00ecnh tr\u1ea1ng nhi\u1ec5m HBV m\u1ea1n t\u00ednh. C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a vi\u00eam gan B bao g\u1ed3m x\u01a1 gan v\u00e0 HCC, g\u00e2y ra 1.08 tri\u1ec7u ca t\u1eed vong. T\u1ef7 l\u1ec7 nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 v\u1ec1 m\u1eb7t \u0111\u1ecba l\u00fd, v\u1edbi t\u1ef7 l\u1ec7 cao nh\u1ea5t \u1edf Ch\u00e2u Phi, \u0110\u00f4ng \u00c1 v\u00e0 c\u00e1c \u0111\u1ea3o Th\u00e1i B\u00ecnh D\u01b0\u01a1ng. \u1ede Ch\u00e2u \u00c2u, c\u00e1c qu\u1ed1c gia \u1edf \u0110\u00f4ng v\u00e0 \u0110\u00f4ng Nam \u00c2u b\u1ecb \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u nh\u1ea5t, v\u1edbi t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh trung b\u00ecnh. Tuy nhi\u00ean, t\u1ef7 l\u1ec7 m\u1eafc v\u00e0 t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh nhi\u1ec5m HBV Ch\u00e2u \u00c2u v\u1eabn ti\u1ebfp t\u1ee5c thay \u0111\u1ed5i do c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 to\u00e0n c\u1ea7u ho\u00e1, di c\u01b0 c\u1ee7a ng\u01b0\u1eddi t\u1ecb n\u1ea1n. \u1ede nh\u1eefng khu v\u1ef1c c\u00f3 t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh cao, l\u00e2y truy\u1ec1n d\u1ecdc t\u1eeb m\u1eb9 sang con trong khi sinh ho\u1eb7c th\u00f4ng qua ti\u1ebfp x\u00fac g\u1ea7n g\u00f3p ph\u1ea7n \u0111\u00e1ng k\u1ec3 v\u00e0o t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh nhi\u1ec5m HBV. HBV c\u00f3 th\u1ec3 l\u00e2y truy\u1ec1n qua nhi\u1ec1u con \u0111\u01b0\u1eddng kh\u00e1c nhau, bao g\u1ed3m t\u1eeb m\u1eb9 qua con, quan h\u1ec7 t\u00ecnh d\u1ee5c, d\u00f9ng chung kim ti\u00eam b\u1ecb nhi\u1ec5m b\u1ea9n ho\u1eb7c c\u00e1c d\u1ee5ng c\u1ee5 ti\u00eam ch\u00edch kh\u00e1c v\u00e0 ti\u1ebfp x\u00fac v\u1edbi m\u00e1u b\u1ecb nhi\u1ec5m b\u1ec7nh.<\/p>\n
Vi\u1ec7c tri\u1ec3n khai c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh ti\u00eam ch\u1ee7ng HBV ph\u1ed5 c\u1eadp \u0111\u00e3 t\u00e1c \u0111\u1ed9ng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn d\u1ecbch t\u1ec5 h\u1ecdc c\u1ee7a b\u1ec7nh n\u00e0y, \u0111\u1eb7c bi\u1ec7t \u1edf c\u00e1c qu\u1ed1c gia tri\u1ec3n khai ti\u00eam ch\u1ee7ng r\u1ed9ng r\u00e3i. Ti\u00eam ch\u1ee7ng khi m\u1edbi sinh v\u00e0 trong th\u1eddi th\u01a1 \u1ea5u \u0111\u00e3 ch\u1ee9ng minh \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 trong vi\u1ec7c gi\u1ea3m t\u1ef7 l\u1ec7 nhi\u1ec5m HBV m\u1ea1n t\u00ednh v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng.<\/p>\n

C\u00e1c giai \u0111o\u1ea1n nhi\u1ec5m virus vi\u00eam gan B<\/h3>\n
M\u1ed9t t\u1ef7 l\u1ec7 \u0111\u00e1ng k\u1ec3 nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh kh\u00f4ng th\u1ec3 d\u1ec5 d\u00e0ng \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh m\u1ed9t trong b\u1ed1n giai \u0111o\u1ea1n, nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t x\u1ebfp nh\u1eefng b\u1ec7nh nh\u00e2n \u1edf “v\u00f9ng x\u00e1m” ho\u1eb7c “giai \u0111o\u1ea1n trung gian”. \u0110\u1ec3 r\u00f5 r\u00e0ng v\u00e0 th\u1ed1ng nh\u1ea5t, n\u00ean tr\u00e1nh c\u00e1c thu\u1eadt ng\u1eef n\u00e0y v\u00e0 x\u00e1c \u0111\u1ecbnh ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean c\u00e1c giai \u0111o\u1ea1n hi\u1ec7n t\u1ea1i. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb \u0111\u01a1n gi\u1ea3n h\u00f3a kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng (HBeAg) (H\u00ecnh 1). M\u1eb7c d\u00f9 vi\u1ec7c ph\u00e2n lo\u1ea1i b\u1ec7nh nh\u00e2n th\u00e0nh c\u00e1c “giai \u0111o\u1ea1n b\u1ec7nh” c\u00f3 li\u00ean quan \u0111\u1ebfn m\u1ee5c \u0111\u00edch nghi\u00ean c\u1ee9u, ph\u00e2n t\u1ea7ng b\u1ec7nh nh\u00e2n cho c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u00e0 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus, nh\u01b0ng l\u1ea1i c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng th\u00e1ch th\u1ee9c trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. Do \u0111\u00f3, \u0111\u1ec3 \u0111\u01a1n gi\u1ea3n h\u00f3a c\u00e1c ph\u00e2n lo\u1ea1i n\u00e0y, khuy\u1ebfn c\u00e1o n\u00e0y \u0111\u01b0a ra c\u00e1c h\u01b0\u1edbng d\u1eabn r\u00f5 r\u00e0ng h\u01a1n \u0111\u1ec3 qu\u1ea3n l\u00fd hi\u1ec7u qu\u1ea3 t\u00ecnh tr\u1ea1ng nhi\u1ec5m HBV m\u1ea1n t\u00ednh nh\u1eb1m \u0111\u1ea3m b\u1ea3o ch\u0103m s\u00f3c t\u1ed1i \u01b0u v\u00e0 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n.<\/p>\n
B\u1ea3ng 1. Giai \u0111o\u1ea1n nhi\u1ec5m HPV<\/strong><\/p>\n\n\n\n\n\n\n\n\n
<\/td>\n Giai \u0111o\u1ea1n 1<\/strong><\/td>\n Giai \u0111o\u1ea1n 2<\/strong><\/td>\n Giai \u0111o\u1ea1n 3<\/strong><\/td>\n Giai \u0111o\u1ea1n 4<\/strong><\/td>\n<\/tr>\n
<\/td>\n Nhi\u1ec5m HBV m\u1ea1n HBeAg d\u01b0\u01a1ng t\u00ednh<\/td>\n Vi\u00eam gan m\u1ea1n HBeAg d\u01b0\u01a1ng t\u00ednh<\/td>\n Nhi\u1ec5m HBV m\u1ea1n HBeAg \u00e2m t\u00ednh<\/td>\n Vi\u00eam gan m\u1ea1n HBeAg \u00e2m t\u00ednh<\/td>\n<\/tr>\n
HBsAg<\/strong><\/td>\n Cao<\/td>\n Trung b\u00ecnh – Cao<\/td>\n Th\u1ea5p, th\u01b0\u1eddng <1.000 IU\/ml<\/td>\n Trung b\u00ecnh, th\u01b0\u1eddng >1.000 IU\/ml<\/td>\n<\/tr>\n
HBV DNA<\/strong><\/td>\n Cao, th\u01b0\u1eddng \u2265107 IU\/ml<\/td>\n Trung b\u00ecnh – Cao, th\u01b0\u1eddng 10^{4<\/sup>-10^{7<\/sup> IU\/ml<\/td>\n}} Th\u01b0\u1eddng <2.000 IU\/ml<\/td>\n Th\u01b0\u1eddng, >2.000 IU\/ml<\/td>\n<\/tr>\n
ALT<\/strong><\/td>\n B\u00ecnh th\u01b0\u1eddng<\/td>\n Cao<\/td>\n B\u00ecnh th\u01b0\u1eddng<\/td>\n Cao<\/td>\n<\/tr>\n
Ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh gan (n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb)<\/strong><\/td>\n Kh\u00f4ng\/Th\u1ea5p<\/td>\n Trung b\u00ecnh – N\u1eb7ng<\/td>\n Kh\u00f4ng c\u00f3<\/td>\n Nh\u1eb9 – N\u1eb7ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ch\u00fa th\u00edch: ALT: alanine aminotransferase; HBeAg: kh\u00e1ng nguy\u00ean e c\u1ee7a HBV; HBsAg: kh\u00e1ng nguy\u00ean b\u1ec1 m\u1eb7t HBV; HBV: virus vi\u00eam gan B.<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 1. Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m HBV m\u1ea1n<\/figcaption><\/figure>\n
^{1<\/sup> T\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi ISHAK F\u22654\/Metavir F\u22653 (\u01b0u ti\u00ean s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 kh\u00f4ng x\u00e2m l\u1ea5n, LSM > 8 kPa).<\/p>\n}
^{2<\/sup> X\u00e9t nghi\u1ec7m NAT nh\u1ea1y (gi\u1edbi h\u1ea1n d\u01b0\u1edbi <20 U\/L).<\/p>\n}
^{3<\/sup> T\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi ISHAK \u2265F3\/Metavir \u2265F2 (\u01b0u ti\u00ean s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 kh\u00f4ng x\u00e2m l\u1ea5n, LSM > 7 kPa).<\/p>\n}
^{4<\/sup> Gi\u00e1 tr\u1ecb ng\u01b0\u1ee1ng c\u1ee7a HBV DNA thay \u0111\u1ed5i t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c ho\u1ea1t \u0111\u1ed9ng v\u00e0 nguy c\u01a1 l\u00e2y truy\u1ec1n. Quan tr\u1ecdng: Tenofovir \u1edf ph\u1ee5 n\u1eef mang thai c\u00f3 HBV DNA \u2265200.000 IU\/ml.<\/p>\n}
^{5<\/sup> \u0110i\u1ec1u tr\u1ecb kh\u00e1ng HBV \u1edf b\u1ec7nh nh\u00e2n HCC, \u0111\u1ed3ng nhi\u1ec5m HIV, c\u00f3 bi\u1ec3u hi\u1ec7n ngo\u00e0i gan, s\u1eed d\u1ee5ng \u1ee9c thu\u1ed1c ch\u1ebf mi\u1ec5n d\u1ecbch.<\/p>\n}
^{6<\/sup> \u0110i\u1ec1u tr\u1ecb kh\u00e1ng HBV \u1edf b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch.<\/p>\n}
Ch\u00fa th\u00edch: HCC (hepatocellular carcinoma): ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan, HIV (human immunodeficiency virus): virus g\u00e2y suy gi\u1ea3m mi\u1ec5n d\u1ecbch \u1edf ng\u01b0\u1eddi, LSM (Liver stiffness measurement): \u0110o \u0111\u1ed9 c\u1ee9ng gan, ULN (upper limit of normal) gi\u1edbi h\u1ea1n tr\u00ean.<\/p>\n
S\u00e0ng l\u1ecdc v\u00e0 ch\u1ea9n \u0111o\u00e1n<\/h2>\n
\u0110\u1ed1i t\u01b0\u1ee3ng n\u00e0o c\u1ea7n \u0111\u01b0\u1ee3c s\u00e0ng l\u1ecdc nhi\u1ec5m HBV v\u00e0 s\u00e0ng l\u1ecdc nh\u01b0 th\u1ebf n\u00e0o?<\/h3>\n
Khuy\u1ebfn c\u00e1o<\/h4>\n
\u0110\u1ed1i v\u1edbi s\u00e0ng l\u1ecdc ban \u0111\u1ea7u nhi\u1ec5m HBV, c\u1ea7n s\u00e0ng l\u1ecdc b\u1eb1ng x\u00e9t nghi\u1ec7m HBsAg v\u00e0 anti-HBc (khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn).<\/p>\n
Ti\u1ebfn h\u00e0nh s\u00e0ng l\u1ecdc HBV \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n (khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh):<\/p>\n
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Men gan t\u0103ng cao v\u00e0\/ho\u1eb7c c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh gan<\/li>\n
X\u01a1 gan\/x\u01a1 ho\u00e1 gan<\/li>\n
Ung th\u01b0 gan (HCC ho\u1eb7c ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt)<\/li>\n
Bi\u1ec3u hi\u1ec7n ngo\u00e0i gan c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn HBV<\/li>\n
B\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i \u0111ang ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o<\/li>\n
Nhi\u1ec5m HIV<\/li>\n
Nhi\u1ec5m HCV<\/li>\n
\u0110ang \u0111\u01b0\u1ee3c xem x\u00e9t ho\u1eb7c \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch\/\u0111i\u1ec1u ho\u00e0 mi\u1ec5n d\u1ecbch ho\u1eb7c ho\u00e1 tr\u1ecb<\/li>\n
T\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch b\u1ea9m sinh<\/li>\n
Xem x\u00e9t c\u1ea5y t\u1ebf b\u00e0o g\u1ed1c\/t\u1ee7y x\u01b0\u01a1ng ho\u1eb7c gh\u00e9p t\u1ea1ng<\/li>\n
Nguy c\u01a1 l\u00e2y nhi\u1ec5m HBV cao<\/li>\n<\/ul>\n
Nh\u1eefng b\u1ec7nh nh\u00e2n t\u1eeb c\u00e1c khu v\u1ef1c c\u00f3 t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh HBsAg trung b\u00ecnh \u0111\u1ebfn cao<\/p>\n
Th\u00e0nh vi\u00ean gia \u0111\u00ecnh c\u1ee7a nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV<\/p>\n
B\u1ea1n t\u00ecnh c\u1ee7a nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV<\/p>\n
Nh\u1eefng ng\u01b0\u1eddi c\u00f3 nhi\u1ec1u b\u1ea1n t\u00ecnh<\/p>\n
Nh\u1eefng ng\u01b0\u1eddi ki\u1ec3m tra ho\u1eb7c \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00e2y qua \u0111\u01b0\u1eddng t\u00ecnh d\u1ee5c<\/p>\n
Nh\u1eefng ng\u01b0\u1eddi ti\u1ebfp x\u00fac v\u1edbi d\u1ecbch c\u01a1 th\u1ec3 b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ea3i v\u00ec m\u1ee5c \u0111\u00edch y t\u1ebf<\/p>\n
Nh\u1eefng ng\u01b0\u1eddi \u0111ang v\u00e0 \u0111\u00e3 ti\u00eam ma tu\u00fd<\/p>\n
S\u00e0ng l\u1ecdc HBV (HBsAg [kh\u00f4ng y\u00eau c\u1ea7u anti-HBc]) \u0111\u1ec3 d\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n (khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh):<\/p>\n
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Ng\u01b0\u1eddi hi\u1ebfn m\u00e1u, m\u00f4, tinh d\u1ecbch v\u00e0 t\u1ea1ng<\/li>\n
Nh\u00e2n vi\u00ean y t\u1ebf<\/li>\n
Ph\u1ee5 n\u1eef mang thai<\/li>\n<\/ul>\n
Tuy\u00ean b\u1ed1<\/h4>\n
Do t\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c ch\u1ea9n \u0111o\u00e1n s\u1edbm nhi\u1ec5m HBV (d\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n, c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3), EASL \u1ee7ng h\u1ed9 vi\u1ec7c s\u00e0ng l\u1ecdc d\u1ef1a tr\u00ean d\u00e2n s\u1ed1 ngo\u00e0i c\u00e1c nh\u00f3m nguy c\u01a1 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u01b0a r\u00f5, \u0111\u1eb7c bi\u1ec7t \u1edf c\u00e1c qu\u1ed1c gia c\u00f3 t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh trung b\u00ecnh \u0111\u1ebfn cao (\u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Nh\u1eefng x\u00e9t nghi\u1ec7m huy\u1ebft thanh v\u00e0 virus n\u00e0o \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho nh\u1eefng ng\u01b0\u1eddi c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u?<\/h3>\n
Khuy\u1ebfn c\u00e1o:<\/strong><\/p>\n
Nh\u1eefng ng\u01b0\u1eddi c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh, xem x\u00e9t th\u1ef1c hi\u1ec7n c\u00e1c x\u00e9t nghi\u1ec7m huy\u1ebft thanh v\u00e0 virus \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong b\u1ea3ng 2 (khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
B\u1ea3ng 2. X\u00e9t nghi\u1ec7m huy\u1ebft thanh v\u00e0 virus \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho nh\u1eefng ng\u01b0\u1eddi HBsAg d\u01b0\u01a1ng t\u00ednh\/anti-HBc d\u01b0\u01a1ng t\u00ednh<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
X\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n<\/strong><\/td>\n Khuy\u1ebfn c\u00e1o<\/strong><\/td>\n M\u1ee9c \u0111\u1ed9 khuy\u1ebfn c\u00e1o<\/strong><\/td>\n<\/tr>\n
\u0110\u1ecbnh l\u01b0\u1ee3ng HBV DNA<\/td>\n N\u00ean x\u00e9t nghi\u1ec7m HBV DNA v\u00ec \u0111\u00e2y l\u00e0 y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng quan tr\u1ecdng nh\u1ea5t v\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft cho ch\u1ec9 \u0111\u1ecbnh v\u00e0 theo d\u00f5i \u0111i\u1ec1u tr\u1ecb.<\/td>\n M\u1ea1nh<\/td>\n<\/tr>\n
\u0110\u1ecbnh l\u01b0\u1ee3ng HBsAg<\/td>\n N\u00ean x\u00e9t nghi\u1ec7m HBsAg \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh giai \u0111o\u1ea1n b\u1ec7nh, ti\u00ean l\u01b0\u1ee3ng v\u00e0 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb.<\/td>\n M\u1ea1nh<\/td>\n<\/tr>\n
Kh\u00e1ng th\u1ec3 anti-HBs<\/td>\n anti-HBs kh\u00f4ng c\u1ea7n thi\u1ebft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m HBV, h\u1eefu \u00edch \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng mi\u1ec5n d\u1ecbch n\u1ebfu HBsAg \u00e2m t\u00ednh v\u00e0 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh sau khi HBsAg \u00e2m t\u00ednh<\/td>\n Y\u1ebfu<\/td>\n<\/tr>\n
HBeAg<\/td>\n N\u00ean x\u00e9t nghi\u1ec7m HBeAg \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh giai doan b\u00eanh<\/td>\n M\u1ea1nh<\/td>\n<\/tr>\n
anti-HBe<\/td>\n C\u00f3 th\u1ec3 x\u00e9t nghi\u1ec7m anti-HBe \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh giai \u0111o\u1ea1n b\u1ec7nh (\u0111\u1eb7c bi\u1ec7t n\u1ebfu HBeAg \u00e2m t\u00ednh).<\/td>\n Y\u1ebfu<\/td>\n<\/tr>\n
anti-HBc IgM<\/td>\n N\u1ebfu nghi ng\u1edd vi\u00eam gan B c\u1ea5p t\u00ednh, c\u00f3 th\u1ec3 x\u00e9t nghi\u1ec7m anti-HBc IgM (l\u00fd t\u01b0\u1edfng nh\u1ea5t l\u00e0 x\u00e9t nghi\u1ec7m \u0111\u1ecbnh l\u01b0\u1ee3ng).<\/td>\n Y\u1ebfu<\/td>\n<\/tr>\n
Ki\u1ec3u gen HBV<\/td>\n C\u00f3 th\u1ec3 x\u00e9t nghi\u1ec7m ki\u1ec3u gene virus \u0111\u1ec3 t\u1ed1i \u01b0u ho\u00e1 ph\u00e2n t\u1ea7ng cho \u0111i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean interferon v\u00e0 \u01b0\u1edbc t\u00ednh nguy c\u01a1 HCC.<\/td>\n Y\u1ebfu<\/td>\n<\/tr>\n
S\u00e0ng l\u1ecdc HDV<\/td>\n N\u00ean x\u00e9t nghi\u1ec7m anti-HDV.<\/td>\n M\u1ea1nh<\/td>\n<\/tr>\n
S\u00e0ng l\u1ecdc HCV<\/td>\n N\u00ean x\u00e9t nghi\u1ec7m anti-HCV.<\/td>\n M\u1ea1nh<\/td>\n<\/tr>\n
HIV<\/td>\n N\u00ean x\u00e9t nghi\u1ec7m anti-HIV1\/2<\/td>\n M\u1ea1nh<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ch\u00fa th\u00edch: HBe: kh\u00e1ng nguy\u00ean e c\u1ee7a HBV; HBsAg: kh\u00e1ng nguy\u00ean b\u1ec1 m\u1eb7t HBV; HBV: virus vi\u00eam gan B; HCV: virus vi\u00eam gan C; HDV: virus vi\u00eam gan D; HEV: virus vi\u00eam gan E; HIV: virus g\u00e2y suy gi\u1ea3m mi\u1ec5n d\u1ecbch \u1edf ng\u01b0\u1eddi.<\/p>\n
Nh\u1eefng x\u00e9t nghi\u1ec7m b\u1ed5 sung n\u00e0o \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 b\u1ec7nh \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh?<\/h3>\n
Khuy\u1ebfn c\u00e1o:<\/strong><\/p>\n
Th\u1ef1c hi\u1ec7n \u0111\u00e1nh gi\u00e1 b\u1ec7nh ban \u0111\u1ea7u \u1edf t\u1ea5t c\u1ea3 nh\u1eefng ng\u01b0\u1eddi c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh (khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Si\u00eau \u00e2m b\u1ee5ng n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n khi ch\u1ea9n \u0111o\u00e1n \u1edf t\u1ea5t c\u1ea3 nh\u1eefng ng\u01b0\u1eddi c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh (khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
\u01afu ti\u00ean s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng x\u00e2m l\u1ea5n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng x\u01a1 gan v\u00e0 giai \u0111o\u1ea1n b\u1ec7nh \u1edf t\u1ea5t c\u1ea3 nh\u1eefng ng\u01b0\u1eddi c\u00f3 HBsAg d\u01b0\u01a1ng t\u1ec9nh (khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Sinh thi\u1ebft gan c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng ch\u1eafc ch\u1eafn ch\u1ea9n \u0111o\u00e1n, k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m kh\u00f4ng x\u00e2m l\u1ea5n kh\u00f4ng ph\u00f9 h\u1ee3p ho\u1eb7c c\u00f3 b\u1ec7nh gan \u0111\u1ed3ng m\u1eafc (khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
B\u1ec7nh nh\u00e2n vi\u00eam gan B m\u1ea1n n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus c\u1ea7n c\u00f3 l\u1ed9 tr\u00ecnh theo d\u00f5i nh\u01b0 th\u1ebf n\u00e0o?<\/h3>\n
Khuy\u1ebfn c\u00e1o:<\/strong><\/p>\n
\u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m HBV m\u1ea1n t\u00ednh, c\u1ea7n theo d\u00f5i ALT v\u00e0 HBV DNA 3-6 th\u00e1ng m\u1ed9t l\u1ea7n trong n\u0103m \u0111\u1ea7u ti\u00ean ho\u1eb7c cho \u0111\u1ebfn khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. Sau giai \u0111o\u1ea1n ban \u0111\u1ea7u n\u00e0y, t\u1ea7n su\u1ea5t theo d\u00f5i n\u00ean \u0111i\u1ec1u ch\u1ec9nh th\u00e0nh 6-12 th\u00e1ng m\u1ed9t l\u1ea7n, t\u00f9y thu\u1ed9c v\u00e0o giai \u0111o\u1ea1n b\u1ec7nh (khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
HBsAg n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra m\u1ed7i 12 th\u00e1ng. N\u1ebfu kh\u00f4ng th\u1ec3 x\u00e9t nghi\u1ec7m \u0111\u1ecbnh l\u01b0\u1ee3ng HBsAg, c\u00f3 th\u1ec3 x\u00e9t nghi\u1ec7m \u0111\u1ecbnh t\u00ednh HBsAg (khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
X\u00e9t nghi\u1ec7m HBeAg v\u00e0 anti-HBe \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh 12 th\u00e1ng m\u1ed9t l\u1ea7n ho\u1eb7c khi n\u1ed3ng \u0111\u1ed9 ALT ho\u1eb7c n\u1ed3ng \u0111\u1ed9 HBV DNA thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 (khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
S\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng x\u00e2m l\u1ea5n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ti\u1ebfn tri\u1ec3n x\u01a1 ho\u00e1 gan. T\u1ea7n su\u1ea5t v\u00e0 th\u1eddi gian n\u00ean \u0111\u01b0\u1ee3c c\u00e1 nh\u00e2n h\u00f3a d\u1ef1a tr\u00ean c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 giai \u0111o\u1ea1n b\u1ec7nh v\u00e0 b\u1ec7nh \u0111\u1ed3ng m\u1eafc (khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn).<\/p>\n
B\u1ea3ng 3. Ng\u01b0\u1ee1ng \u0111o \u0111\u1ed9 c\u1ee9ng gan (LSM) d\u1ef1a tr\u00ean \u0111o \u0111\u1ed9 \u0111\u00e0n h\u1ed3i tho\u00e1ng qua ki\u1ec3m so\u00e1t rung \u0111\u00f4ng (VICE)<\/p>\n\n\n\n\n\n\n
Giai \u0111o\u1ea1n x\u01a1 ho\u00e1<\/strong><\/td>\n Ng\u01b0\u1ee1ng<\/strong><\/td>\n<\/tr>\n
X\u01a1 ho\u00e1 \u0111\u00e1ng k\u1ec3 (F2 ho\u1eb7c F3 ho\u1eb7c F4 Metavir)<\/td>\n >7 kPa<\/td>\n<\/tr>\n
X\u01a1 ho\u00e1 ti\u1ebfn tri\u1ec3n (F3 ho\u1eb7c F4 Metavir)<\/td>\n >8 kPa<\/td>\n<\/tr>\n
X\u01a1 gan (F4 Metavir)<\/td>\n >11 kPa<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ch\u00fa th\u00edch: Gi\u00e1 tr\u1ecb \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cho ng\u01b0\u1ee1ng n\u00e0y n\u1eb1m trong kho\u1ea3ng 69-89%.<\/p>\n
B\u1ea3ng 4. Kho\u1ea3ng th\u1eddi gian theo d\u00f5i \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n HBsAg d\u01b0\u01a1ng t\u00ednh kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus<\/p>\n\n\n\n\n\n\n\n
\u0110\u1ed1i t\u01b0\u1ee3ng<\/strong><\/td>\n Theo d\u00f5i<\/strong><\/td>\n<\/tr>\n
Nhi\u1ec5m HBV HBeAg d\u01b0\u01a1ng t\u00ednh^{1<\/sup><\/td>\n} ALT m\u1ed7i 6 th\u00e1ng^{2<\/sup><\/p>\nHBV DNA m\u1ed7i 6 th\u00e1ng<\/p>\n
HBsAg \u0111\u1ecbnh l\u01b0\u1ee3ng m\u1ed7i 12 th\u00e1ng<\/p>\n
HBeAg\/anti-HBe m\u1ed7i 6-12 th\u00e1ng<\/p>\n
\u0110\u00e1nh gi\u00e1 x\u01a1 ho\u00e1 gan kh\u00f4ng x\u00e2m l\u1ea5n m\u1ed7i 12-24 th\u00e1ng d\u1ef1a tr\u00ean l\u00e2m s\u00e0ng<\/td>\n<\/tr>\n}
Nhi\u1ec5m HBV HBeAg \u00e2m t\u00ednh (HBV DNA <2.000 IU\/ml)^{1<\/sup><\/td>\n} ALT m\u1ed7i 12 th\u00e1ng^{3<\/sup><\/p>\nHBV DNA m\u1ed7i 12 th\u00e1ng^{4<\/sup><\/p>\n}
HBsAg \u0111\u1ecbnh l\u01b0\u1ee3ng m\u1ed7i 12 th\u00e1ng^{4<\/sup><\/p>\n}
\u0110\u00e1nh gi\u00e1 x\u01a1 h\u00f3a gan m\u1ed7i 2-3 n\u0103m<\/td>\n<\/tr>\n}
Nhi\u1ec5m HBV HBeAg \u00e2m t\u00ednh (HBV DNA \u22652.000-20.000 IU\/ml)^{1<\/sup><\/td>\n} ALT m\u1ed7i 6 th\u00e1ng<\/p>\n
HBV DNA m\u1ed7i 6 th\u00e1ng<\/p>\n
HBsAg \u0111\u1ecbnh l\u01b0\u1ee3ng m\u1ed7i 12 th\u00e1ng<\/p>\n
\u0110\u00e1nh gi\u00e1 x\u01a1 h\u00f3a gan m\u1ed7i 12-24 th\u00e1ng d\u1ef1a tr\u00ean l\u00e2m s\u00e0ng<\/p>\n
N\u1ebfu \u1ed5n \u0111\u1ecbnh trong 23 n\u0103m, kho\u1ea3ng th\u1eddi gian theo d\u00f5i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u00e9o d\u00e0i<\/td>\n<\/tr>\n
Nhi\u1ec5m HBV HBeAg \u00e2m t\u00ednh (b\u1ec7nh nh\u00e2n x\u01a1 gan c\u00f2n b\u00f9, HBV DNA kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c v\u00e0 ALT b\u00ecnh th\u01b0\u1eddng)^{1<\/sup><\/td>\n} ALT m\u1ed7i 6 th\u00e1ng<\/p>\n
HBV DNA m\u1ed7i 6 th\u00e1ng<\/p>\n
HBsAg \u0111\u1ecbnh l\u01b0\u1ee3ng m\u1ed7i 12 th\u00e1ng<\/p>\n
Theo d\u00f5i HCC m\u1ed7i 6 th\u00e1ng<\/p>\n
\u0110\u00e1nh gi\u00e1 x\u01a1 h\u00f3a gan kh\u00f4ng b\u1eaft bu\u1ed9c nh\u01b0ng LSM v\u00e0 s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng v\u00e0 nhu c\u1ea7u EGD.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ch\u00fa th\u00edch: ALT: alanine aminotransferase; EGD: n\u1ed9i soi th\u1ef1c qu\u1ea3n-d\u1ea1 d\u00e0y-t\u00e1 tr\u00e0ng; HBeAg: kh\u00e1ng nguy\u00ean e c\u1ee7a HBV; HBsAg: kh\u00e1ng nguy\u00ean b\u1ec1 m\u1eb7t HBV; HBV: virus vi\u00eam gan B; HCC: ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan.<\/p>\n
B\u1ec7nh nh\u00e2n c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb m\u1ea1nh (xem ph\u1ea7n m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb) kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u1edf \u0111\u00e2y. Kho\u1ea3ng th\u1eddi gian theo d\u00f5i c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi ch\u00ednh s\u00e1ch ch\u0103m s\u00f3c s\u1ee9c kho\u1ebb v\u00e0 ngu\u1ed3n l\u1ef1c s\u1eb5n c\u00f3 c\u1ee7a t\u1eebng qu\u1ed1c gia.<\/p>\n
^{1<\/sup> Sau khi ch\u1ea9n \u0111o\u00e1n ban \u0111\u1ea7u nhi\u1ec5m HBV m\u1ea1n t\u00ednh, c\u1ea7n theo d\u00f5i 3-6 th\u00e1ng m\u1ed9t l\u1ea7n trong n\u0103m \u0111\u1ea7u ti\u00ean sau khi ch\u1ea9n \u0111o\u00e1n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh giai \u0111o\u1ea1n nhi\u1ec5m.<\/p>\n}
^{2<\/sup> \u1ede nh\u1eefng ng\u01b0\u1eddi >30 tu\u1ed5i (n\u1ebfu ch\u01b0a \u0111i\u1ec1u tr\u1ecb), c\u00e2n nh\u1eafc theo d\u00f5i ch\u1eb7t ch\u1ebd h\u01a1n saum\u1ed7i 3-6 th\u00e1ng.<\/p>\n}
^{3<\/sup> Kho\u1ea3ng th\u1eddi gian theo d\u00f5i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh d\u1ef1a tr\u00ean c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a t\u1eebng c\u00e1 nh\u00e2n, khuy\u1ebfn c\u00e1o th\u1eddi gian ng\u1eafn h\u01a1n trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng ch\u1eafc ch\u1eafn, \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh.<\/p>\n}
^{4<\/sup> Kho\u1ea3ng th\u1eddi gian theo d\u00f5i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u00e9o d\u00e0i trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p giai \u0111o\u1ea1n nhi\u1ec5m HBV HBeAg \u00e2m t\u00ednh \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5 r\u00e0ng.<\/p>\n}
M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/h2>\n
M\u1ee5c ti\u00eau c\u1ee7a li\u1ec7u ph\u00e1p kh\u00e1ng virus \u0111\u1ed1i v\u1edbi nhi\u1ec5m HBV m\u1ea1n t\u00ednh nh\u01b0 th\u1ebf n\u00e0o?<\/h3>\n
Tuy\u00ean b\u1ed1:<\/strong><\/p>\n
M\u1ee5c ti\u00eau c\u1ee7a \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m HBV m\u1ea1n t\u00ednh l\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng (x\u01a1 gan, suy gan, HCC) v\u00e0 c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng s\u1ed1ng. V\u00ec c\u00e1c bi\u1ebfn ch\u1ee9ng l\u00e0 giai \u0111o\u1ea1n cu\u1ed1i c\u1ee7a b\u1ec7nh v\u00e0 c\u1ea7n th\u1eddi gian di\u1ec5n ti\u1ebfn b\u1ec7nh d\u00e0i h\u01a1n n\u00ean c\u00e1c d\u1ea5u hi\u1ec7u thay th\u1ebf \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng (\u0111\u1ed3ng thu\u1eadn m\u1ea1nh):<\/p>\n
\n
M\u1ee5c ti\u00eau ch\u00ednh c\u1ee7a li\u1ec7u ph\u00e1p kh\u00e1ng virus l\u00e0 \u1ee9c ch\u1ebf li\u00ean t\u1ee5c HBV DNA (t\u1ed1t nh\u1ea5t l\u00e0 kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c).<\/li>\n
M\u1ee5c ti\u00eau cu\u1ed1i c\u00f9ng c\u1ee7a li\u1ec7u ph\u00e1p kh\u00e1ng virus l\u00e0 HBsAg \u00e2m t\u00ednh.<\/li>\n
\u0110\u01b0a ALT v\u1ec1 gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng.<\/li>\n<\/ul>\n
C\u00e1c m\u1ee5c ti\u00eau b\u1ed5 sung c\u1ee7a li\u1ec7u ph\u00e1p kh\u00e1ng virus (\u0111\u1ed3ng thu\u1eadn m\u1ea1nh):<\/p>\n
\n
HBeAg \u00e2m t\u1ec9nh v\u00e0 \u0111\u1ea1t \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh th\u00e0nh anti-HBe.<\/li>\n
C\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng x\u01a1 gan.<\/li>\n
C\u1ea3i thi\u1ec7n c\u00e1c bi\u1ec3u hi\u1ec7n ngo\u00e0i gan li\u00ean quan HBV.<\/li>\n
C\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng li\u00ean quan \u0111\u1ebfn s\u1ee9c kho\u1ebb b\u1ec7nh nh\u00e2n.<\/li>\n
D\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n HBV.<\/li>\n
D\u1ef1 ph\u00f2ng t\u00e1i ho\u1ea1t \u0111\u1ed9ng HBV v\u00e0\/ho\u1eb7c vi\u00eam gan.<\/li>\n<\/ul>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb<\/h2>\n
Nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nh\u01b0 th\u1ebf n\u00e0o?<\/h3>\n
Tuy\u00ean b\u1ed1<\/h4>\n
T\u1ea5t c\u1ea3 nh\u1eefng b\u1ec7nh nh\u00e2n HBsAg d\u01b0\u01a1ng t\u00ednh v\u00e0 HBV DNA ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c \u0111\u1ec1u c\u00f3 ch\u1ec9 \u0111\u1ecbnh li\u1ec7u ph\u00e1p kh\u00e1ng virus. Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb ch\u1ee7 y\u1ebfu d\u1ef1a tr\u00ean m\u1ee9c HBV DNA v\u00e0 ALT, giai \u0111o\u1ea1n x\u01a1 h\u00f3a gan v\u00e0 nguy c\u01a1 ti\u1ebfn tri\u1ec3n b\u1ec7nh gan v\u00e0 HCC (\u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Khuy\u1ebfn c\u00e1o<\/h4>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb li\u1ec7u ph\u00e1p kh\u00e1ng virus cho b\u1ec7nh nh\u00e2n vi\u00eam gan B m\u1ea1n c\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh ho\u1eb7c HBeAg \u00e2m t\u00ednh, n\u1ed3ng \u0111\u1ed9 HBV DNA \u22652.000 IU\/ml v\u00e0 ALT t\u0103ng cao (>ULN) v\u00e0\/ho\u1eb7c x\u01a1 ho\u00e1 gan \u0111\u00e1ng k\u1ec3 (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb li\u1ec7u ph\u00e1p kh\u00e1ng virus cho b\u1ec7nh nh\u00e2n x\u01a1 gan n\u1ebfu ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c HBV DNA, b\u1ea5t k\u1ec3 n\u1ed3ng \u0111\u1ed9 virus trong m\u00e1u v\u00e0 ALT huy\u1ebft thanh (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb li\u1ec7u ph\u00e1p kh\u00e1ng virus cho b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh gan ti\u1ebfn tri\u1ec3n (t\u01b0\u01a1ng \u1ee9ng v\u1edbi \u0111\u1ed9 x\u01a1 h\u00f3a Metavir \u2265F3 tr\u00ean m\u00f4 h\u1ecdc gan ho\u1eb7c \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng LSM > 8 kPa) n\u1ebfu ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c HBV DNA, b\u1ea5t k\u1ec3 n\u1ed3ng \u0111\u1ed9 virus trong m\u00e1u v\u00e0 ALT huy\u1ebft thanh (m\u1ee9c b\u1eb1ng ch\u1ee9ng 5, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb li\u1ec7u ph\u00e1p kh\u00e1ng virus cho b\u1ec7nh nh\u00e2n c\u00f3 HBV DNA th\u1ea5p dai d\u1eb3ng (<2.000 IU\/ml) v\u00e0 ALT t\u0103ng cao dai d\u1eb3ng (>ULN). Tuy nhi\u00ean, c\u1ea7n c\u00e2n nh\u1eafc c\u00e1c b\u1ec7nh gan kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 g\u00e2y n\u00ean t\u00ecnh tr\u1ea1ng n\u00e0y (m\u1ee9c b\u1eb1ng ch\u1ee9ng 5, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn).<\/p>\n
B\u1ea3ng 5. C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 li\u00ean quan m\u1eafc HCC \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Y\u1ebfu t\u1ed1 nguy c\u01a1<\/strong><\/td>\n L\u01b0u \u00fd<\/strong><\/td>\n<\/tr>\n
Y\u1ebfu t\u1ed1 virus<\/td>\n<\/tr>\n
HBV DNA<\/td>\n Nguy c\u01a1 kh\u00f4ng tuy\u1ebfn t\u00ednh b\u1eaft \u0111\u1ea7u v\u1edbi >2.000 IU\/ml<\/p>\n
Nguy c\u01a1 cao nh\u1ea5t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh v\u1edbi 6-7 log10 IU\/ml (nguy c\u01a1 th\u1ea5p h\u01a1n n\u1ebfu HBV DNA \u22658 logio)<\/td>\n<\/tr>\n
HBsAg<\/td>\n HBsAg cao (\u22651.000 IU\/ml) \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 HBeAg \u00e2m t\u00ednh.<\/td>\n<\/tr>\n
HBeAg<\/td>\n Trong c\u00e1c ph\u00e2n t\u00edch t\u1ed5ng th\u1ec3, HBeAg d\u01b0\u01a1ng t\u00ednh (\u1edf nh\u1eefng ng\u01b0\u1eddi tr\u00ean 30 tu\u1ed5i) c\u00f3 li\u00ean quan \u0111\u1ebfn HCC.<\/td>\n<\/tr>\n
HBcrAg<\/td>\n D\u1ea5u hi\u1ec7u ti\u00ean l\u01b0\u1ee3ng cho s\u1ef1 xu\u1ea5t hi\u1ec7n v\u00e0 t\u00e1i ph\u00e1t, t\u1ea7m quan tr\u1ecdng c\u1ee7a HBcrAg trong nhi\u1ec5m virus HBeAg \u00e2m t\u00ednh.<\/td>\n<\/tr>\n
\u0110\u1ed9t bi\u1ebfn v\u00f9ng kh\u1edfi \u0111\u1ed9ng l\u00f5i<\/td>\n Hi\u1ec7n di\u1ec7n<\/td>\n<\/tr>\n
\u0110\u1ed3ng nhi\u1ec5m virus kh\u00e1c<\/td>\n HDV, HCV, HIV<\/td>\n<\/tr>\n
Y\u1ebfu t\u1ed1 v\u1eadt ch\u1ee7<\/td>\n<\/tr>\n
X\u01a1 gan<\/td>\n Y\u1ebfu t\u1ed1 nguy c\u01a1 m\u1ea1nh nh\u1ea5t \u0111\u1ed1i v\u1edbi HCC<\/p>\n
Nguy c\u01a1 HCC v\u1eabn c\u00f2n sau khi \u1ee9c ch\u1ebf virus<\/td>\n<\/tr>\n
Ti\u1ec3u c\u1ea7u th\u1ea5p<\/td>\n Ch\u1ec9 s\u1ed1 x\u01a1 gan<\/td>\n<\/tr>\n
Ti\u1ec1n s\u1eed gia \u0111\u00ecnh m\u1eafc HCC<\/td>\n Y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9c l\u1eadp trong t\u1ea5t c\u1ea3 c\u00e1c giai \u0111o\u1ea1n nhi\u1ec5m HBV m\u1ea1n t\u00ednh<\/td>\n<\/tr>\n
Tu\u1ed5i<\/td>\n Nguy c\u01a1 m\u1eafc HCC t\u0103ng theo tu\u1ed5i, h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u t\u1eadp trung v\u00e0o nh\u1eefng ng\u01b0\u1eddi tr\u00ean 30 tu\u1ed5i. B\u1eb1ng ch\u1ee9ng t\u0103ng l\u00ean theo \u0111\u1ed9 tu\u1ed5i \u226535, 240, \u226550.<\/p>\n
Nguy c\u01a1 m\u1eafc HCC kh\u00e1c nhau \u1edf c\u00e1c \u0111\u1ed9 tu\u1ed5i kh\u00e1c nhau \u0111\u1ed1i v\u1edbi nam v\u00e0 n\u1eef v\u00e0 c\u00e1c nh\u00f3m ch\u1ee7ng t\u1ed9c kh\u00e1c nhau.<\/td>\n<\/tr>\n
Gi\u1edbi<\/td>\n Nam gi\u1edbi c\u00f3 nguy c\u01a1 cao h\u01a1n<\/td>\n<\/tr>\n
ALT<\/td>\n T\u0103ng cao (ho\u1eb7c \u1edf m\u1ee9c b\u00ecnh th\u01b0\u1eddng cao)<\/td>\n<\/tr>\n
\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2<\/td>\n \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 c\u00f3 li\u00ean quan \u0111\u1ed9c l\u1eadp v\u1edbi HCC.<\/p>\n
\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o \u0111i\u1ec3m s\u1ed1 nguy c\u01a1 HCC.<\/p>\n
Tuy nhi\u00ean, 1 ph\u00e2n t\u00edch cho th\u1ea5y \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 kh\u00f4ng li\u00ean quan \u0111\u1ed9c l\u1eadp v\u1edbi HCC trong nhi\u1ec5m HBV m\u1ea1n.<\/td>\n<\/tr>\n
B\u1ec7nh gan nhi\u1ec5m m\u1ee1 (SLD)<\/td>\n D\u1eef li\u1ec7u m\u00e2u thu\u1eabn:<\/p>\n
– T\u0103ng nguy c\u01a1 m\u1eafc HCC v\u00e0 x\u01a1 gan<\/p>\n
– Gi\u1ea3m nguy c\u01a1 m\u1eafc HCC, x\u01a1 gan v\u00e0 t\u1eed vong<\/td>\n<\/tr>\n
Ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3 (BMI)<\/td>\n BMI cao \u226530, nguy c\u01a1 cao h\u01a1n \u1edf ph\u1ee5 n\u1eef<\/td>\n<\/tr>\n
H\u1ed9i ch\u1ee9ng chuy\u1ec3n h\u00f3a<\/td>\n Nhi\u1ec1u (23) y\u1ebfu t\u1ed1 nguy c\u01a1 chuy\u1ec3n h\u00f3a ho\u1eb7c g\u00e1nh n\u1eb7ng r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a ng\u00e0y c\u00e0ng t\u0103ng c\u00f3 li\u00ean quan \u0111\u1ebfn HCC.<\/td>\n<\/tr>\n
H\u00fat thu\u1ed1c l\u00e1<\/td>\n Hi\u1ec7n di\u1ec7n<\/td>\n<\/tr>\n
U\u1ed1ng r\u01b0\u1ee3u<\/td>\n U\u1ed1ng nhi\u1ec1u r\u01b0\u1ee3u \u226560g\/ng\u00e0y<\/td>\n<\/tr>\n
Ch\u1ee7ng t\u1ed9c<\/td>\n B\u1eb1ng ch\u1ee9ng th\u1ea5p ho\u1eb7c kh\u00f4ng c\u00f3:<\/p>\n
– Sinh ra \u1edf Ch\u00e2u Phi Ch\u00e2u \u0110\u1ea1i D\u01b0\u01a1ng: li\u00ean quan \u0111\u1ebfn HCC kh\u1edfi ph\u00e1t r\u1ea5t s\u1edbm.<\/p>\n
– Ng\u01b0\u1eddi d\u00e2n Ch\u00e2u Phi c\u1eadn Sahara m\u1eafc HBV \u1edf Ch\u00e2u \u00c2u: t\u1ef7 l\u1ec7 m\u1eafc HCC th\u1ea5p h\u01a1n, c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 t\u01b0\u01a1ng t\u1ef1 nh\u01b0 d\u00e2n s\u1ed1 n\u00f3i chung.<\/p>\n
– Nghi\u00ean c\u1ee9u ph\u01b0\u01a1ng T\u00e2y so v\u1edbi ph\u01b0\u01a1ng \u0110\u00f4ng: kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 n\u00e0o \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh theo \u0111\u1ed9 tu\u1ed5i trong t\u1ef7 l\u1ec7 m\u1eafc HCC.<\/td>\n<\/tr>\n
Y\u1ebfu t\u1ed1 m\u00f4i tr\u01b0\u1eddng<\/td>\n<\/tr>\n
\u0110\u1ed9c t\u1ed5 Aflatoxin B1 (AFB1)<\/td>\n \u1ede nh\u1eefng khu v\u1ef1c c\u00f3 nguy c\u01a1 ph\u01a1i nhi\u1ec5m cao, AFB1 v\u00e0 HBV c\u00f3 t\u00e1c d\u1ee5ng hi\u1ec7p \u0111\u1ed3ng l\u00e0m t\u0103ng nguy c\u01a1 m\u1eafc HCC.<\/p>\n
Vi\u1ec7c gi\u1ea3m ph\u01a1i nhi\u1ec5m Aflatoxin c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m 23% c\u00e1c tr\u01b0\u1eddng h\u1ee3p m\u1eafc HCC.<\/td>\n<\/tr>\n
\u00d4 nhi\u1ec5m kh\u00f4ng kh\u00ed<\/td>\n S\u1ef1 li\u00ean quan gi\u1eefa b\u1ee5i m\u1ecbn v\u00e0 HCC.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ch\u00fa th\u00edch: ALT: alanine aminotransferase; EGD: n\u1ed9i soi th\u1ef1c qu\u1ea3n-d\u1ea1 d\u00e0y-t\u00e1 tr\u00e0ng; HBcrAg: kh\u00e1ng nguy\u00ean li\u00ean quan \u0111\u1ebfn l\u00f5i HBV; HBeAg: kh\u00e1ng nguy\u00ean e HBV; HBsAg: kh\u00e1ng nguy\u00ean b\u1ebb m\u1eb7t HBV; HBV, virus vi\u00eam gan B; HCC: ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan; HIV: virus g\u00e2y suy gi\u1ea3m mi\u1ec5n d\u1ecbch \u1edf ng\u01b0\u1eddi.<\/p>\n
: Th\u00e0nh ph\u1ea7n c\u1ee7a thang \u0111i\u1ec3m REACH-B.<\/p>\n
C\u00f3 n\u00ean \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh kh\u00f4ng?<\/h3>\n
Tuy\u00ean b\u1ed1<\/h4>\n
\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i (<30 tu\u1ed5i) nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh, n\u1ed3ng \u0111\u1ed9 ALT b\u00ecnh th\u01b0\u1eddng li\u00ean t\u1ee5c, kh\u00f4ng x\u01a1 ho\u00e1 gan \u0111\u00e1ng k\u1ec3, kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh HCC v\u00e0 kh\u00f4ng c\u00f3 t\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch hay \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, kh\u00f4ng \u1ee7ng h\u1ed9 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus ngay. Tuy nhi\u00ean, nh\u1eefng l\u1ee3i \u00edch ti\u1ec1m n\u0103ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c c\u00e2n b\u1eb1ng v\u1edbi tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb trong th\u1eddi gian d\u00e0i v\u00e0 kh\u00f3 kh\u0103n trong vi\u1ec7c \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 \u1ee9c ch\u1ebf virus nhanh ch\u00f3ng v\u00e0 ho\u00e0n to\u00e0n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u1ea3i l\u01b0\u1ee3ng virus cao (\u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Khuy\u1ebfn c\u00e1o<\/h4>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh v\u00e0 c\u00f3 nguy c\u01a1 m\u1eafc HCC cao (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh v\u00e0 c\u00e1c bi\u1ec3u hi\u1ec7n ngo\u00e0i gan li\u00ean quan \u0111\u1ebfn HBV (m\u1ee9c b\u1eb1ng ch\u1ee9ng 4, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh \u0111ang \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch ho\u1eb7c nh\u1eefng b\u1ec7nh nh\u00e2n c\u01a1 \u0111\u1ecba suy gi\u1ea3m mi\u1ec5n d\u1ecbch (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, s\u1ef1 \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh \u0111\u1ec3 ng\u0103n ng\u1eeba l\u00e2y truy\u1ec1n HBV (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus \u1edf nh\u1eefng ph\u1ee5 n\u1eef mang thai c\u00f3 HBV DNA \u2265200.000 IU\/ml \u0111\u1ec3 d\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n t\u1eeb m\u1eb9 sang con (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
C\u00f3 n\u00ean \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg \u00e2m t\u00ednh kh\u00f4ng?<\/h3>\n
Tuy\u00ean b\u1ed1<\/h4>\n
B\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg \u00e2m t\u00ednh (HBV DNA li\u00ean t\u1ee5c <2.000 IU\/ml, ALT b\u00ecnh th\u01b0\u1eddng li\u00ean t\u1ee5c, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u x\u01a1 ho\u00e1 gan) c\u00f3 nguy c\u01a1 ti\u1ebfn tri\u1ec3n v\u00e0 l\u00e2y truy\u1ec1n b\u1ec7nh th\u1ea5p th\u01b0\u1eddng kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus ngay (\u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Khuy\u1ebfn c\u00e1o<\/h4>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg \u00e2m t\u00ednh v\u00e0 c\u00f3 nguy c\u01a1 m\u1eafc HCC cao (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg \u00e2m t\u00ednh v\u00e0 c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n ngo\u00e0i gan li\u00ean quan \u0111\u1ebfn HBV (m\u1ee9c b\u1eb1ng ch\u1ee9ng 4, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg \u00e2m t\u00ednh \u0111ang \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch ho\u1eb7c nh\u1eefng b\u1ec7nh nh\u00e2n c\u01a1 \u0111\u1ecba suy gi\u1ea3m mi\u1ec5n d\u1ecbch \u0111\u1ec3 ng\u0103n ng\u1eeba HBV t\u00e1i ho\u1ea1t \u0111\u1ed9ng\/vi\u00eam gan (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg \u00e2m t\u00ednh \u0111\u1ec3 ng\u0103n ng\u1eeba l\u00e2y truy\u1ec1n HBV (m\u1ee9c b\u1eb1ng ch\u1ee9ng 4, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn).<\/p>\n
\u0110i\u1ec1u tr\u1ecb<\/h2>\n
Nh\u1eefng l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb n\u00e0o \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh?<\/h3>\n
Tuy\u00ean b\u1ed1<\/h4>\n
Hai li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m HBV m\u1ea1n t\u00ednh l\u00e0 NA ho\u1eb7c PEG-IFNa (\u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Khuy\u1ebfn c\u00e1o<\/h4>\n
Khi l\u1ef1a ch\u1ecdn gi\u1eefa NA v\u00e0 PEG-IFNa l\u00e0m \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay, c\u1ea7n c\u00e2n nh\u1eafc to\u00e0n di\u1ec7n c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m ri\u00eang bi\u1ec7t c\u1ee7a t\u1eebng li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb (B\u1ea3ng 6) v\u00e0 s\u1edf th\u00edch c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
B\u1ea3ng 6. S\u1ef1 kh\u00e1c nhau gi\u1eefa li\u1ec7u ph\u00e1p PEG-IFNa v\u00e0 NA<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\u0110\u1eb7c \u0111i\u1ec3m<\/strong><\/td>\n ETV, Tenofovir (TDF, TAF)<\/strong><\/td>\n PEG-IFNa<\/strong><\/td>\n<\/tr>\n
M\u1ee5c ti\u00eau<\/td>\n Ng\u0103n ng\u1eeba b\u1ec7nh ti\u1ebfn tri\u1ec3n th\u00f4ng qua vi\u1ec7c \u1ee9c ch\u1ebf HBV li\u00ean t\u1ee5c<\/td>\n G\u00e2y \u0111\u00e1p \u1ee9ng c\u01a1 th\u1ec3 sau khi ng\u01b0ng \u0111i\u1ec1u tr\u1ecb ng\u1eafn h\u1ea1n b\u1eb1ng PEG-IFNa<\/td>\n<\/tr>\n
\u0110\u01b0\u1eddng d\u00f9ng<\/td>\n U\u1ed1ng, m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y<\/td>\n Ti\u00eam d\u01b0\u1edbi da, m\u1ed9t l\u1ea7n m\u1ed9t tu\u1ea7n<\/td>\n<\/tr>\n
Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb<\/td>\n D\u00e0i h\u1ea1n<\/td>\n C\u00f3 h\u1ea1n (48 tu\u1ea7n)<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb theo h\u01b0\u1edbng d\u1eabn<\/td>\n Ti\u00eau ch\u00ed d\u00f9ng \u0111i\u1ec1u tr\u1ecb d\u00e0i h\u1ea1n tr\u01b0\u1edbc khi HBsAg \u00e2m t\u00ednh (xem “Khi n\u00e0o c\u00f3 th\u1ec3 d\u1eebng li\u1ec7u ph\u00e1p kh\u00e1ng virus cho b\u1ec7nh vi\u00eam gan B b\u1eb1ng NA?”)<\/td>\n D\u1eebng sau 12-24 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb (xem “N\u00ean \u00e1p d\u1ee5ng li\u1ec7u ph\u00e1p PEG-IFNa nh\u01b0 th\u1ebf n\u00e0o \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb nhi\u1ec5m HBV m\u00e3n t\u1ec9nh?”)<\/td>\n<\/tr>\n
T\u00e1c d\u1ee5ng ph\u1ee5<\/td>\n R\u1ea5t th\u1ea5p<\/td>\n Trung b\u00ecnh \u0111\u1ebfn cao<\/td>\n<\/tr>\n
Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/td>\n R\u1ea5t \u00edt (v\u00ed d\u1ee5: ETV trong thai k\u00ec)<\/td>\n Nhi\u1ec1u<\/td>\n<\/tr>\n
M\u1ee9c \u0111\u1ed9 \u1ee9c ch\u1ebf virus<\/td>\n Cao<\/td>\n Th\u1ea5p \u0111\u1ebfn cao, tu\u1ef3 v\u00e0o t\u1eebng b\u1ec7nh nh\u00e2n<\/td>\n<\/tr>\n
T\u1ef7 l\u1ec7 chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh HBeAg\/anti-HBe<\/td>\n Ban \u0111\u1ea7u th\u1ea5p, trung b\u00ecnh trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb d\u00e0i h\u1ea1n<\/td>\n Th\u1ea5p \u0111\u1ebfn cao, tu\u1ef3 v\u00e0o t\u1eebng b\u1ec7nh nh\u00e2n<\/td>\n<\/tr>\n
HBsAg \u00e2m t\u00ednh<\/td>\n R\u1ea5t th\u1ea5p<\/td>\n Th\u1ea5p, cao h\u01a1n so v\u1edbi NA<\/td>\n<\/tr>\n
Nguy c\u01a1 kh\u00e1ng thu\u1ed1c virus<\/td>\n R\u1ea5t th\u1ea5p<\/td>\n Kh\u00f4ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ch\u00fa th\u00edch: ETV: entecavir; HBsAg: kh\u00e1ng nguy\u00ean b\u1ec1 m\u1eb7t HBV; HBV: virus vi\u00eam gan B; NA: ch\u1ea5t t\u01b0\u01a1ng t\u1ef1 nucleos(t)ide; PEG-IFNa: interferon-alpha pegylated.<\/p>\n
T\u1ef7 l\u1ec7 m\u1eaft HBsAg th\u1ea5p khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng NA \u0111\u01b0\u1ee3c cho l\u00e0 do t\u00e1c d\u1ee5ng h\u1ea1n ch\u1ebf c\u1ee7a NA \u0111\u1ed1i v\u1edbi khu\u00f4n m\u1eabu cccDNA v\u00e0 do s\u1ef1 gia t\u0103ng \u0111\u00e1ng k\u1ec3 c\u1ee7a qu\u00e1 tr\u00ecnh t\u00edch h\u1ee3p HBV v\u00e0o qu\u00e1 tr\u00ecnh t\u1ea1o ra HBsAg, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u00e2m t\u00ednh v\u1edbi HBeAg.<\/p>\n
Vi\u1ec7c \u1ee9c ch\u1ebf HBV DNA l\u00e2u d\u00e0i b\u1eb1ng li\u1ec7u ph\u00e1p NA c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m vi\u00eam gan v\u00e0 x\u01a1 gan, t\u1eeb \u0111\u00f3 gi\u00fap ng\u0103n ng\u1eeba b\u1ec7nh ti\u1ebfn tri\u1ec3n, ng\u0103n ng\u1eeba x\u01a1 gan v\u00e0 ung th\u01b0 gan, \u0111\u1ed3ng th\u1eddi c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 s\u1ed1ng.<\/p>\n
C\u1ea3i thi\u1ec7n m\u00f4 h\u1ecdc: \u0111i\u1ec1u tr\u1ecb NA k\u00e9o d\u00e0i (3-5 n\u0103m) c\u00f3 th\u1ec3 gi\u00fap c\u1ea3i thi\u1ec7n m\u00f4 h\u1ecdc gan, bao g\u1ed3m vi\u1ec7c gi\u1ea3m ti\u1ebfn tri\u1ec3n x\u01a1 gan.<\/p>\n
\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n x\u01a1 gan m\u1ea5t b\u00f9, \u0111i\u1ec1u tr\u1ecb NA c\u00f3 th\u1ec3 gi\u00fap b\u1ec7nh nh\u00e2n c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng: gi\u1ea3m nguy c\u01a1 HCC, gi\u1ea3m \u0111i\u1ec3m MELD v\u00e0 \u0111i\u1ec3m Child-Pugh, c\u00f9ng v\u1edbi c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n
\u0110i\u1ec1u tr\u1ecb NAs nh\u01b0 th\u1ebf n\u00e0o v\u00e0 c\u1ea7n l\u01b0u \u00fd nh\u1eefng g\u00ec trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb d\u00e0i h\u1ea1n?<\/h3>\n
Khuy\u1ebfn c\u00e1o<\/strong><\/p>\n
ETV, TDF ho\u1eb7c TAF \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 li\u1ec7u ph\u00e1p NA \u0111\u1ea7u tay. Khi l\u1ef1a ch\u1ecdn gi\u1eefa ETV, TDF v\u00e0 TAF, c\u1ea7n c\u00e2n nh\u1eafc \u0111\u1ebfn c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc (\u0111\u1eb7c bi\u1ec7t l\u00e0 suy th\u1eadn v\u00e0 gi\u1ea3m m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng) v\u00e0 c\u00e1c b\u1ed1i c\u1ea3nh kh\u00e1c \u0111i k\u00e8m (v\u00ed d\u1ee5 ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i sinh \u0111\u1ebb, mang thai, tu\u1ed5i t\u00e1c) c\u0169ng nh\u01b0 c\u00e1c thu\u1ed1c \u0111\u00e3 s\u1eed d\u1ee5ng tr\u01b0\u1edbc \u0111\u00f3 (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Vi\u1ec7c x\u00e1c \u0111\u1ecbnh n\u1ed3ng \u0111\u1ed9 HBV DNA v\u00e0 ALT n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n 3-6 th\u00e1ng m\u1ed9t l\u1ea7n cho \u0111\u1ebfn khi b\u1ec7nh nh\u00e2n \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng v\u1ec1 m\u1eb7t virus. Sau \u0111\u00f3, kho\u1ea3ng th\u1eddi gian theo d\u00f5i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u00e9o d\u00e0i \u0111\u1ebfn 6-12 th\u00e1ng \u0111\u1ed1i v\u1edbi li\u1ec7u ph\u00e1p ETV ho\u1eb7c tenofovir (TDF ho\u1eb7c TAF) (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).
\nHBsAg n\u00ean \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m m\u1ed7i 12 th\u00e1ng. L\u00fd t\u01b0\u1edfng nh\u1ea5t l\u00e0 n\u00ean th\u1ef1c hi\u1ec7n \u0111\u1ecbnh l\u01b0\u1ee3ng HBsAg (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
X\u00e9t nghi\u1ec7m HBeAg v\u00e0 anti-HBe \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh m\u1ed7i 12 th\u00e1ng (m\u1ee9c b\u1eb1ng ch\u1ee9ng, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn).<\/p>\n
Ch\u1ee9c n\u0103ng th\u1eadn c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i th\u01b0\u1eddng xuy\u00ean trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u NA (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
\u0110i\u1ec1u tr\u1ecb b\u1eb1ng TDF n\u00ean \u0111\u01b0\u1ee3c chuy\u1ec3n sang NA kh\u00e1c (ETV ho\u1eb7c TAF) n\u1ebfu m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn gi\u1ea3m, ho\u1eb7c x\u1ea3y ra b\u1ec7nh l\u00fd \u1ed1ng th\u1eadn v\u00e0 trong tr\u01b0\u1eddng h\u1ee3p h\u1ea1 phosphat m\u00e1u ho\u1eb7c lo\u00e3ng x\u01b0\u01a1ng. C\u00e1c thu\u1ed1c s\u1eed d\u1ee5ng tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 t\u00ecnh tr\u1ea1ng kh\u00e1ng thu\u1ed1c n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi l\u1ef1a ch\u1ecdn NA (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
\u0110\u00e1nh gi\u00e1 \u0111\u1ed9 x\u01a1 h\u00f3a kh\u00f4ng x\u00e2m l\u1ea5n n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n m\u1ed7i 12-24 th\u00e1ng (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn)<\/p>\n
X\u1eed tr\u00ed trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb m\u1ed9t ph\u1ea7n ho\u1eb7c kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi NAs ho\u1eb7c ti\u1ebfn tri\u1ec3n th\u00e0nh t\u00ecnh tr\u1ea1ng kh\u00e1ng thu\u1ed1c l\u00e0 g\u00ec?<\/h3>\n
Khuy\u1ebfn c\u00e1o<\/strong><\/p>\n
Trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00e1p \u1ee9ng v\u1ec1 m\u1eb7t virus m\u1ed9t ph\u1ea7n ho\u1eb7c kh\u00f4ng \u0111\u00e1p \u1ee9ng, c\u1ea7n \u0111\u00e1nh gi\u00e1 vi\u1ec7c tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n ngay t\u1eeb \u0111\u1ea7u (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
\n
\u0110\u00e1p \u1ee9ng v\u1ec1 m\u1eb7t virus ho\u00e0n to\u00e0n \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 HBV DNA kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c khi \u0111o b\u1eb1ng x\u00e9t nghi\u1ec7m c\u00f3 \u0111\u1ed9 nh\u1ea1y cao (<20 IU\/ml).<\/li>\n
\u0110\u00e1p \u1ee9ng v\u1ec1 m\u1eb7t virus m\u1ed9t ph\u1ea7n n\u1ebfu HBV DNA gi\u1ea3m nh\u01b0ng v\u1eabn >2.000 IU\/ml.<\/li>\n
Kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1ec1 m\u1eb7t virus \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng s\u1ef1 gi\u1ea3m <1 log 10 sau 6 th\u00e1ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng NA.<\/li>\n
Kh\u1ea3 n\u0103ng kh\u00e1ng virus \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh n\u1ebfu HBV DNA t\u0103ng l\u00ean \u2265 1 log 10 so v\u1edbi m\u1ee9c th\u1ea5p nh\u1ea5t. C\u00f3 th\u1ec3 x\u00e9t nghi\u1ec7m c\u00e1c bi\u1ebfn th\u1ec3 HBV li\u00ean quan \u0111\u1ebfn kh\u1ea3 n\u0103ng kh\u00e1ng NA n\u1ebfu x\u00e1c nh\u1eadn b\u1ec7nh nh\u00e2n c\u00f3 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/li>\n<\/ul>\n
Trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00e1p \u1ee9ng v\u1ec1 m\u1eb7t virus m\u1ed9t ph\u1ea7n, kh\u00f4ng \u0111\u00e1p \u1ee9ng ho\u1eb7c kh\u00e1ng virus, c\u00e1c thay \u0111\u1ed5i v\u1ec1 \u0111i\u1ec1u tr\u1ecb sau \u0111\u00e2y \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh):<\/p>\n
\n
Chuy\u1ec3n sang Tenofovir (TDF ho\u1eb7c TAF) n\u1ebfu tr\u01b0\u1edbc \u0111\u00f3 \u0111\u00e3 s\u1eed d\u1ee5ng ch\u1ea5t t\u01b0\u01a1ng t\u1ef1 nucleot(s)ide (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1).<\/li>\n
Chuy\u1ec3n sang ETV ho\u1eb7c Tenofovir (TDF ho\u1eb7c TAF) n\u1ebfu \u0111\u00e3 s\u1eed d\u1ee5ng Adefovir tr\u01b0\u1edbc \u0111\u00f3 (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1).<\/li>\n
Chuy\u1ec3n sang ho\u1eb7c b\u1ed5 sung ETV n\u1ebfu tr\u01b0\u1edbc \u0111\u00f3 \u0111\u00e3 s\u1eed d\u1ee5ng Tenofovir (TDF ho\u1eb7c TAF) (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2).<\/li>\n<\/ul>\n
Trong tr\u01b0\u1eddng h\u1ee3p HBV DNA \u1edf m\u1ee9c th\u1ea5p dai d\u1eb3ng (<2.000 IU\/ml) ho\u1eb7c d\u01b0\u1edbi ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Tenofovir (TDF ho\u1eb7c TAF) ho\u1eb7c ETV, kh\u00f4ng c\u1ea7n ph\u1ea3i thay \u0111\u1ed5i ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ngay l\u1eadp t\u1ee9c n\u1ebfu kh\u00f4ng c\u00f3 x\u01a1 gan ti\u1ebfn tri\u1ec3n v\u00e0 khi \u0111\u00e3 lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng kh\u00e1ng thu\u1ed1c (m\u1ee9c b\u1eb1ng ch\u1ee9ng 4, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh). C\u1ea7n xem x\u00e9t c\u00e1c v\u1ea5n \u0111\u1ec1 ti\u1ec1m \u1ea9n, ch\u1eb3ng h\u1ea1n nh\u01b0 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb k\u00e9m ho\u1eb7c gi\u1ea3m h\u1ea5p thu \u1edf ru\u1ed9t.<\/p>\n
\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n x\u01a1 gan, m\u1ee5c ti\u00eau l\u00e0 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee9c HBV DNA kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c, l\u00fd t\u01b0\u1edfng nh\u1ea5t l\u00e0 sau 12 th\u00e1ng \u0111i\u1ec1u tr\u1ecb. N\u1ebfu kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau n\u00e0y, c\u1ea7n xem x\u00e9t \u0111i\u1ec1u ch\u1ec9nh \u0111i\u1ec1u tr\u1ecb (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Khi n\u00e0o c\u00f3 th\u1ec3 ng\u1eebng \u0111i\u1ec1u tr\u1ecb NAs cho b\u1ec7nh nh\u00e2n vi\u00eam gan B?<\/h3>\n
Khuy\u1ebfn c\u00e1o<\/strong><\/p>\n
Ch\u1ec9 n\u00ean ng\u1eebng \u0111i\u1ec1u tr\u1ecb NA sau khi tham kh\u1ea3o \u00fd ki\u1ebfn b\u00e1c s\u0129 c\u00f3 kinh nghi\u1ec7m trong \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B v\u00e0 n\u1ebfu \u0111\u1ea3m b\u1ea3o c\u00f3 th\u1ec3 theo d\u00f5i ch\u1eb7t ch\u1ebd. C\u1ea7n \u0111\u00e1nh gi\u00e1 nhi\u1ec1u y\u1ebfu t\u1ed1 bao g\u1ed3m N\u1ed3ng \u0111\u1ed9 HBsAg, t\u00ecnh tr\u1ea1ng HBeAg, b\u1ec7nh \u0111\u1ed3ng m\u1eafc, th\u1eddi gian \u1ee9c ch\u1ebf HBV DNA, giai \u0111o\u1ea1n x\u01a1 gan, s\u1ef1 hi\u1ec3u bi\u1ebft v\u00e0 mong mu\u1ed1n c\u1ee7a b\u1ec7nh nh\u00e2n (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
\u0110i\u1ec1u tr\u1ecb kh\u00e1ng virus v\u1edbi NA n\u00ean \u0111\u01b0\u1ee3c d\u1eebng l\u1ea1i sau khi x\u00e1c nh\u1eadn m\u1ea5t HBsAg, v\u00e0 c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh anti-HBsAg khi kh\u00f4ng c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed3ng th\u1eddi (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 \u0111\u1ed3ng thu\u1eadn).<\/p>\n
N\u00ean s\u1eed d\u1ee5ng n\u1ed3ng \u0111\u1ed9 HBsAg \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e2n nh\u1eafc ng\u1eebng NA \u1edf b\u1ec7nh nh\u00e2n HBsAg d\u01b0\u01a1ng t\u00ednh (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh kh\u00f4ng m\u1eafc b\u1ec7nh gan ti\u1ebfn tri\u1ec3n, \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus v\u1edbi NA c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u1eebng l\u1ea1i sau 12 th\u00e1ng k\u1ec3 t\u1eeb khi x\u00e1c nh\u1eadn chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh HBeAg\/anti-HBe v\u00e0 HBV DNA kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c n\u1ebfu \u0111\u1ea3m b\u1ea3o theo d\u00f5i ch\u1eb7t ch\u1ebd sau khi k\u1ebft th\u00fac qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn).<\/p>\n
\u1ede m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 HBeAg \u00e2m t\u00ednh v\u00e0 kh\u00f4ng m\u1eafc b\u1ec7nh gan ti\u1ebfn tri\u1ec3n, c\u00f3 th\u1ec3 ng\u1eebng \u0111i\u1ec1u tr\u1ecb NA tr\u01b0\u1edbc khi m\u1eaft HBsAg n\u1ebfu HBV DNA kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c trong \u00edt nh\u1ea5t 3-4 n\u0103m, n\u1ed3ng \u0111\u1ed9 HBsAg th\u1ea5p (<1.000 IU\/ml) v\u00e0 \u0111\u1ea3m b\u1ea3o theo d\u00f5i ch\u1eb7t ch\u1ebd sau khi k\u1ebft th\u00fac qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1-2, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn).<\/p>\n
Ngo\u00e0i m\u1ee9c HBsAg, m\u1ee9c HBcrAg v\u00e0 HBV RNA c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n t\u1ea7ng b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn).<\/p>\n
H\u00ecnh 2.<\/p>\n
^{1<\/sup> HCC, x\u01a1 gan m\u1ea5t b\u00f9, HIV.<\/p>\n}
^{2<\/sup> M\u1ea5t HBsAg \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn trong hai l\u1ea7n c\u00e1ch nhau 6 th\u00e1ng.<\/p>\n}
^{3<\/sup> \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb x\u01a1 gan c\u00f2n b\u00f9, \u0111\u1ec1 xu\u1ea5t ng\u1eebng li\u1ec7u ph\u00e1p NA ch\u1ec9 sau khi chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn th\u00e0nh anti-HBs ho\u1eb7c sau khi m\u1ea5t HBsAg v\u1edbi \u00edt nh\u1ea5t 12 th\u00e1ng \u0111i\u1ec1u tr\u1ecb c\u1ee7ng c\u1ed1.<\/p>\n}
HBsAg <1.000 IU\/ml \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi da tr\u1eafng; <100 \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi ch\u00e2u \u00c1 (d\u1eef li\u1ec7u m\u1ea1nh h\u01a1n \u1edf ng\u01b0\u1eddi \u00e2m t\u00ednh v\u1edbi HBeAg); HBcrAg, HBV RNA c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n t\u00e1ng.<\/p>\n
* Theo d\u00f5i \u00edt nh\u1ea5t h\u00e0ng th\u00e1ng trong 6 th\u00e1ng \u0111\u1ea7u ti\u00ean, sau \u0111\u00f3 l\u00e0 3 th\u00e1ng m\u1ed9t l\u1ea7n trong 12-24 th\u00e1ng, xem x\u00e9t t\u00e1i ph\u00e1t s\u1edbm h\u01a1n khi \u0111i\u1ec1u tr\u1ecb tenofovir so v\u1edbi entecavir.
\nCh\u00fa th\u00edch: HbcrAg (hepatitis B core-related antigen): kh\u00e1ng nguy\u00ean l\u00f5i c\u1ee7a virus vi\u00eam gan B; LOD (limit of detection): ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n; NA (nucleos(t)ide analogue): ch\u1ea5t t\u01b0\u01a1ng t\u1ef1 nucleos(t)ide<\/p>\n
\u0110i\u1ec1u tr\u1ecb PEG-IFNa n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u01b0 th\u1ebf n\u00e0o \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh?<\/h3>\n
Khuy\u1ebfn c\u00e1o:<\/strong><\/p>\n
PEG-IFNa n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng v\u1edbi li\u1ec1u 180 \u00b5g m\u1ed9t l\u1ea7n m\u1ed7i tu\u1ea7n, trong 48 tu\u1ea7n (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).
\nVi\u1ec7c d\u1eebng thu\u1ed1c n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc d\u1ef1a tr\u00ean vi\u1ec7c \u0111\u1ecbnh l\u01b0\u1ee3ng HBV DNA v\u00e0 HBsAg t\u1ea1i tu\u1ea7n \u0111i\u1ec1u tr\u1ecb th\u1ee9 12 v\u00e0 24 (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
\u0110i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p PEG-IFNa v\u00e0 NA kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. PEG-IFNa l\u00e0 m\u1ed9t \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n HBeAg \u00e2m t\u00ednh \u0111ang \u0111i\u1ec1u tr\u1ecb v\u1edbi NA v\u1edbi m\u1ee9c HBsAg th\u1ea5p (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 \u0111\u1ed3ng thu\u1eadn).<\/p>\n
Trong v\u00e0 sau qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng PEG-IFNa, c\u1ea7n ti\u1ebfn h\u00e0nh x\u00e9t nghi\u1ec7m m\u00e1u th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 theo d\u00f5i c\u00e1c ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
H\u00ecnh 3. Nguy\u00ean t\u1eafc ng\u1eebng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng PEG-IFNa v\u00e0o tu\u1ea7n \u0111i\u1ec1u tr\u1ecb th\u1ee9 12 v\u00e0 24 \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n d\u01b0\u01a1ng t\u00ednh v\u00e0 \u00e2m t\u00ednh v\u1edbi HBeAg.<\/p>\n
Theo d\u00f5i HCC<\/h2>\n
Nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n n\u00e0o n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i HCC v\u00e0 vi\u1ec7c theo d\u00f5i n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u01b0 th\u1ebf n\u00e0o?<\/h3>\n
Khuy\u1ebfn c\u00e1o<\/strong><\/p>\n
Theo d\u00f5i HCC b\u1eb1ng si\u00eau \u00e2m b\u1ee5ng 6 th\u00e1ng m\u1ed9t l\u1ea7n (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Vi\u1ec7c theo d\u00f5i HCC n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 b\u1ea5t k\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus hi\u1ec7u qu\u1ea3 hay m\u1eaft HBsAg (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
N\u00ean s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh (CT-scan c\u00f3 ti\u00eam thu\u1ed1c c\u1ea3n quang, MRI) n\u1ebfu si\u00eau \u00e2m b\u1ee5ng kh\u00f4ng cung c\u1ea5p th\u00f4ng tin \u0111\u00e1ng tin c\u1eady (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
C\u00e1c marker sinh h\u1ecdc kh\u1ed1i u (v\u00ed d\u1ee5 alpha-fetoprotein (AFP)) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng b\u00ean c\u1ea1nh c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u0111\u1ec3 theo d\u00f5i HCC (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2 (\u0111\u1ed1i v\u1edbi AFP), khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn).<\/p>\n
B\u1ea3ng 7. Khuy\u1ebfn c\u00e1o theo d\u00f5i HCC \u1edf nh\u1eefng nh\u00e2n c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh<\/p>\n\n\n\n\n\n\n
B\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 m\u1eafc HCC<\/strong><\/td>\n Khuy\u1ebfn c\u00e1o<\/strong><\/td>\n M\u1ee9c b\u1eb1ng ch\u1ee9ng<\/strong><\/td>\n<\/tr>\n
B\u1ec7nh nh\u00e2n b\u1ecb x\u01a1 gan (Child-Pugh A, B v\u00e0 C. v\u00e0 l\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 kh\u1ea3 n\u0103ng gh\u00e9p gan)<\/td>\n Theo d\u00f5i HCC<\/td>\n 2<\/td>\n<\/tr>\n
B\u1ec7nh nh\u00e2n c\u00f3 HBsAg d\u01b0\u01a1ng t\u1ec9nh kh\u00f4ng b\u1ecb. x\u01a1 gan (\u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng NA) c\u00f3 nguy c\u01a1 m\u1eafc HCC trung b\u00ecnh ho\u1eb7c cao (v\u00ed d\u1ee5 PAGE-B \u226510, ti\u1ec1n s\u1eed gia \u0111\u00ecnh m\u1eafc HCC, vi\u00eam gan D m\u1ea1n t\u00ednh v\u00e0 x\u01a1 gan ti\u1ebfn tri\u1ec3n)<\/td>\n Theo d\u00f5i HCC<\/td>\n 3<\/td>\n<\/tr>\n
B\u1ec7nh nh\u00e2n c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh kh\u00f4ng b\u1ecb x\u01a1 gan c\u00f3 nguy c\u01a1 m\u1eafc HCC th\u1ea5p<\/td>\n Theo d\u00f5i HCC kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o nh\u01b0ng n\u00ean \u0111\u00e1nh gi\u00e1 l\u1ea1i th\u01b0\u1eddng xuy\u00ean c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a HCC<\/td>\n 2<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
B\u1ea3ng 8. \u0110\u00e1nh gi\u00e1 nguy c\u01a1 ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC) b\u1eb1ng thang \u0111i\u1ec3m PAGE-B v\u00e0 mPAGE-B<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
PAGE-B: Nguy c\u01a1 th\u1ea5p: 0-9 \u0111i\u1ec3m; Nguy c\u01a1 trung b\u00ecnh: 10-17 \u0111i\u1ec3m; Nguy c\u01a1 cao: \u226518 \u0111i\u1ec3m<\/strong><\/td>\n<\/tr>\n
Tu\u1ed5i (n\u0103m)<\/strong><\/td>\n \u0110i\u1ec3m<\/strong><\/td>\n Gi\u1edbi t\u00ednh<\/strong><\/td>\n \u0110i\u1ec3m<\/strong><\/td>\n Ti\u1ec3u c\u1ea7u (umol\/L)<\/strong><\/td>\n \u0110i\u1ec3m<\/strong><\/td>\n <\/td>\n<\/tr>\n
16-29<\/td>\n 0<\/td>\n N\u1eef<\/td>\n 0<\/td>\n >200<\/td>\n 0<\/td>\n<\/tr>\n
30-39<\/td>\n 2<\/td>\n Nam<\/td>\n 6<\/td>\n 100-199<\/td>\n 6<\/td>\n<\/tr>\n
40-49<\/td>\n 4<\/td>\n <\/td>\n <\/td>\n <100<\/td>\n 9<\/td>\n<\/tr>\n
50-59<\/td>\n 6<\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n
60-69<\/td>\n 8<\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n
\u226570<\/td>\n 10<\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n
mPAGE-B: Nguy c\u01a1 th\u1ea5p: 0-8 \u0111i\u1ec3m; Nguy c\u01a1 trung b\u00ecnh: 9-12 \u0111i\u1ec3m; Nguy c\u01a1 cao: \u226513<\/strong><\/td>\n<\/tr>\n
Tu\u1ed5i (n\u0103m)<\/strong><\/td>\n \u0110i\u1ec3m<\/strong><\/td>\n Gi\u1edbi t\u00ednh<\/strong><\/td>\n \u0110i\u1ec3m<\/strong><\/td>\n Ti\u1ec3u c\u1ea7u (umol\/L)<\/strong><\/td>\n \u0110i\u1ec3m<\/strong><\/td>\n Albumin (g\/dL)<\/strong><\/td>\n \u0110i\u1ec3m<\/strong><\/td>\n<\/tr>\n
16-29<\/td>\n \u00a00<\/td>\n N\u1eef<\/td>\n \u00a00<\/td>\n \u00a0>250<\/td>\n \u00a00<\/td>\n \u22654.0<\/td>\n 0<\/td>\n<\/tr>\n
30-39<\/td>\n \u00a03<\/td>\n Nam<\/td>\n \u00a02<\/td>\n \u00a0200-250<\/td>\n \u00a02<\/td>\n 3.5-4.0<\/td>\n 1<\/td>\n<\/tr>\n
40-49<\/td>\n \u00a05<\/td>\n <\/td>\n <\/td>\n 150-250<\/td>\n \u00a03<\/td>\n 3.0-3.5<\/td>\n 2<\/td>\n<\/tr>\n
50-59<\/td>\n \u00a07<\/td>\n <\/td>\n <\/td>\n \u00a0100-150<\/td>\n \u00a04<\/td>\n <3.0<\/td>\n 3<\/td>\n<\/tr>\n
60-69<\/td>\n \u00a09<\/td>\n <\/td>\n <\/td>\n <100<\/td>\n \u00a05<\/td>\n <\/td>\n <\/td>\n<\/tr>\n
\u226570<\/td>\n \u00a011<\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
\u0110i\u1ec1u tr\u1ecb \u1edf nh\u1eefng nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u1eb7c bi\u1ec7t<\/h2>\n
B\u1ec7nh nh\u00e2n nhi\u1ec5m HBV c\u1ea5p c\u00f3 n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus kh\u00f4ng?<\/h3>\n
Tuy\u00ean b\u1ed1<\/h4>\n
Do t\u1ef7 l\u1ec7 thanh th\u1ea3i t\u1ef1 nhi\u00ean HBsAg cao trong qu\u00e1 tr\u00ecnh nhi\u1ec5m HBV c\u1ea5p \u1edf ng\u01b0\u1eddi l\u1edbn n\u00ean kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y n\u1ebfu ch\u1ee9c n\u0103ng gan kh\u00f4ng b\u1ecb suy gi\u1ea3m (\u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Khuy\u1ebfn c\u00e1o<\/h4>\n
B\u1ec7nh nh\u00e2n vi\u00eam gan B c\u1ea5p v\u00e0 c\u00f3 suy gi\u1ea3m ch\u1ee9c n\u0103ng gan n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng NA v\u00e0 n\u00ean \u0111\u01b0\u1ee3c qu\u1ea3n l\u00fd ph\u1ed1i h\u1ee3p v\u1edbi trung t\u00e2m gh\u00e9p t\u1ea1ng (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb cho ph\u1ee5 n\u1eef mang thai c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh l\u00e0 g\u00ec?<\/h3>\n
\u1ede ph\u1ee5 n\u1eef mang thai \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus, n\u00ean ti\u1ebfp t\u1ee5c d\u00f9ng Tenofovir (TDF, TAF), chuy\u1ec3n ETV ho\u1eb7c Adefovir sang Tenofovir (TDF, TAF). N\u00ean ng\u1eebng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng PEG-IFNa v\u00e0 chuy\u1ec3n sang Tenofovir (TDF, TAF) (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Ph\u1ee5 n\u1eef mang thai ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus trong th\u1eddi k\u1ef3 mang thai trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p sau (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, s\u1ef1 \u0111\u1ed3ng thu\u1eadn m\u1ea1nh):<\/p>\n
\n
Vi\u00eam gan m\u1ea1n, theo khuy\u1ebfn c\u00e1o d\u00e0nh cho ph\u1ee5 n\u1eef kh\u00f4ng mang thai.<\/li>\n
N\u1ed3ng \u0111\u1ed9 HBV DNA \u2265200.000 IU\/ml, \u0111\u1ec3 d\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n HBV t\u1eeb m\u1eb9 sang con.<\/li>\n
HBeAg d\u01b0\u01a1ng t\u00ednh b\u1ea5t k\u1ec3 m\u1ee9c \u0111\u1ed9 HBV DNA \u0111\u1ec3 d\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n t\u1eeb m\u1eb9 sang con.<\/li>\n<\/ul>\n
\u0110i\u1ec1u tr\u1ecb \u0111\u1ec3 d\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n t\u1eeb m\u1eb9 sang con l\u00fd t\u01b0\u1edfng nh\u1ea5t n\u00ean \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u tr\u01b0\u1edbc tam c\u00e1 nguy\u1ec7t cu\u1ed1i c\u1ee7a thai k\u1ef3. Tenofovir (TDF, TAF) n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong th\u1eddi k\u1ef3 mang thai (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
C\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c d\u1ef1 ph\u00f2ng b\u1eb1ng thu\u1ed1c kh\u00e1ng virus Tenofovir cho m\u1eb9 trong th\u1eddi gian d\u00e0i sau khi sinh \u0111\u1ec3 duy tr\u00ec kh\u1ea3 n\u0103ng \u1ee9c ch\u1ebf virus (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
B\u00e0 m\u1eb9 v\u1eabn c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c cho con b\u00fa khi \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Tenofovir (m\u1ee9c b\u1eb1ng ch\u1ee9ng 4, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
B\u1ec7nh nh\u00e2n nhi\u1ec5m HBV v\u00e0 x\u01a1 gan m\u1ea5t b\u00f9 ho\u1eb7c suy gan c\u1ea5p tr\u00ean n\u1ec1n m\u1ea1n n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nh\u01b0 th\u1ebf n\u00e0o?<\/h3>\n
B\u1ec7nh nh\u00e2n HBsAg d\u01b0\u01a1ng t\u00ednh c\u00f3 x\u01a1 gan m\u1ea5t b\u00f9 ho\u1eb7c suy gan c\u1ea5p tr\u00ean m\u1ea1n n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ETV ho\u1eb7c Tenofovir (TDF, TAF), b\u1ea5t k\u1ec3 n\u1ed3ng \u0111\u1ed9 HBV DNA.<\/p>\n
Kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng PEG-IFNa \u1edf b\u1ec7nh nh\u00e2n x\u01a1 gan m\u1ea5t b\u00f9 ho\u1eb7c suy gan c\u1ea5p tr\u00ean n\u1ec1n m\u1ea1n (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
B\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh v\u00e0 HCC c\u00f3 n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus kh\u00f4ng v\u00e0 n\u1ebfu c\u00f3 th\u00ec \u0111i\u1ec1u tr\u1ecb nh\u01b0 th\u1ebf n\u00e0o?<\/h3>\n
Khuy\u1ebfn c\u00e1o:<\/strong><\/p>\n
B\u1ec7nh nh\u00e2n HCC c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng NA, b\u1ea5t k\u1ec3 n\u1ed3ng \u0111\u1ed9 HBV DNA (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
C\u1ea7n l\u01b0u \u00fd nh\u1eefng g\u00ec khi \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HBV\/HIV?<\/h3>\n
Nh\u1eefng b\u1ec7nh nh\u00e2n HIV c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng HBV b\u1ea5t k\u1ec3 m\u1ee9c ALT ho\u1eb7c HBV DNA (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 HBsAg d\u01b0\u01a1ng t\u1ec9nh \u0111\u1ed3ng m\u1eafc HIV, \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng virus n\u00ean c\u00f3 tenofovir (TDF ho\u1eb7c TAF) (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Vi\u1ec7c theo d\u00f5i v\u00e0 thay \u0111\u1ed5i \u0111i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n theo c\u00e1c khuy\u1ebfn c\u00e1o d\u00e0nh cho b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV \u0111\u01a1n \u0111\u1ed9c, v\u00e0 c\u1ea7n c\u00e2n nh\u1eafc \u0111\u1ebfn t\u00ecnh tr\u1ea1ng \u0111\u1ed3ng nhi\u1ec5m HIV (m\u1ee9c b\u1eb1ng ch\u1ee9ng 5, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh)<\/p>\n
Kh\u00f4ng n\u00ean ng\u1eebng \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus HBV trong tr\u01b0\u1eddng h\u1ee3p \u0111\u1ed3ng nhi\u1ec5m HBV\/HIV do nguy c\u01a1 t\u00e1i ph\u00e1t v\u1ec1 m\u1eb7t virus v\u00e0 m\u1eb7t sinh h\u00f3a (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
C\u1ea7n c\u00e2n nh\u1eafc nh\u1eefng g\u00ec khi \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HBV\/HDV?<\/h3>\n
Khuy\u1ebfn c\u00e1o:<\/strong><\/p>\n
Khuy\u1ebfn c\u00e1o ch\u00ednh v\u1ec1 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan D m\u1ea1n t\u00ednh \u0111\u01b0\u1ee3c l\u1ea5y t\u1eeb h\u01b0\u1edbng d\u1eabn th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng c\u1ee7a EASL v\u1ec1 vi\u00eam gan D<\/em><\/p>\n
T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HBV\/HDV m\u1ea1n t\u1ec9nh n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng HDV (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u00e1o m\u1ea1nh)<\/p>\n
B\u1ec7nh nh\u00e2n b\u1ecb x\u01a1 gan m\u1ea5t b\u00f9 n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 \u0111\u1ec3 gh\u00e9p gan (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u1ea3o m\u1ea1nh)<\/p>\n
T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HBV\/HDV m\u1ea1n t\u00ednh v\u00e0 b\u1ec7nh gan c\u00f2n b\u00f9, b\u1ea5t k\u1ec3 c\u00f3 x\u01a1 gan hay kh\u00f4ng, \u0111\u1ec1u n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb b\u1eb1ng PEG-IFNa ho\u1eb7c bulevirtide (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2 \u0111\u1ed1i v\u1edbi PEG-IFNa v\u00e0 m\u1ee9c b\u1eb1ng ch\u1ee9ng 3 \u0111\u1ed1i v\u1edbi bulevirtide, khuy\u1ebfn c\u00e1o m\u1ea1nh)<\/p>\n
S\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a PEG-IFNa v\u00e0 bulevirtide c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng kh\u00f4ng dung n\u1ea1p ho\u1eb7c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi PEG-IFNa (m\u1ee9c b\u1eb1ng ch\u1ee9ng 5, khuy\u1ebfn c\u00e1o y\u1ebfu)<\/p>\n
NA n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng cho nh\u1eefng b\u1ec7nh nh\u00e2n x\u01a1 gan c\u00f2n b\u00f9 ho\u1eb7c m\u1ea5t b\u00f9 (m\u1ee9c b\u1eb1ng ch\u1ee9ng 5, khuy\u1ebfn c\u00e1o m\u1ea1nh)<\/p>\n
NA n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng cho nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng b\u1ecb x\u01a1 gan n\u1ebfu n\u1ed3ng \u0111\u1ed9 HBV DNA \u22652.000 IU\/ml (m\u1ee9c b\u1eb1ng ch\u1ee9ng 5, khuy\u1ebfn c\u00e1o m\u1ea1nh).<\/p>\n
B\u1ec7nh nh\u00e2n b\u1ec7nh gan m\u1ea5t b\u00f9 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p \u0111\u01a1n tr\u1ecb bulevirtide t\u00f9y thu\u1ed9c v\u00e0o vi\u1ec7c \u0111\u00e1nh gi\u00e1 l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 c\u1ee7a t\u1eebng c\u00e1 nh\u00e2n. B\u1ec7nh nh\u00e2n \u0111ang \u0111\u01a1n tr\u1ecb v\u1edbi Bulevirtide n\u1ebfu x\u1ea3y ra m\u1ea5t b\u00f9 v\u1eabn c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c d\u00f9ng thu\u1ed1c (m\u1ee9c b\u1eb1ng ch\u1ee9ng 4, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh)<\/p>\n
C\u1ea7n c\u00e2n nh\u1eafc \u0111i\u1ec1u g\u00ec khi \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HBV\/HCV c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh?<\/h3>\n
Tuy\u00ean b\u1ed1<\/h4>\n
Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb HBV gi\u1ed1ng v\u1edbi ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m HBV m\u1ea1n t\u00ednh \u0111\u01a1n thu\u1ea7n. Tuy nhi\u00ean, trong b\u1ed1i c\u1ea3nh \u0111i\u1ec1u tr\u1ecb HCV, c\u00f3 nh\u1eefng y\u1ebfu t\u1ed1 b\u1ed5 sung c\u1ea7n xem x\u00e9t (\u0111\u1ed3ng thu\u1eadn m\u1ea1nh m\u1ebd).<\/p>\n
Khuy\u1ebfn c\u00e1o<\/h4>\n
B\u1ec7nh nh\u00e2n nhi\u1ec5m HCV m\u1ea1n t\u00ednh c\u00f3 HBsAg d\u01b0\u01a1ng t\u1ec9nh n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp \u0111\u1eb7c hi\u1ec7u v\u1edbi HCV (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n x\u01a1 gan c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh (k\u1ec3 c\u1ea3 khi kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c HBV DNA) n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng NA trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp ch\u1ed1ng HCV \u0111\u1ec3 ng\u0103n ng\u1eeba HBV t\u00e1i ho\u1ea1t \u0111\u1ed9ng (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
C\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb NA d\u1ef1 ph\u00f2ng \u0111\u1ec3 ng\u0103n ng\u1eeba t\u00e1i ho\u1ea1t trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp ch\u1ed1ng HCV cho nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m HBV m\u1ea1n t\u00ednh \u0111\u01a1n \u0111\u1ed9c (v\u00ed d\u1ee5 : HBV DNA <2.000 IU\/ml, ALT b\u00ecnh th\u01b0\u1eddng v\u00e0 kh\u00f4ng c\u00f3 x\u01a1 gan\/x\u01a1 gan ti\u1ebfn tri\u1ec3n) (m\u1ee9c b\u1eb1ng 2, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
D\u1ef1 ph\u00f2ng t\u00e1i ho\u1ea1t HBV<\/h2>\n
Nh\u1eefng ng\u01b0\u1eddi c\u00f3 nguy c\u01a1 t\u00e1i ph\u00e1t HBV n\u00ean \u0111\u01b0\u1ee3c ch\u0103m s\u00f3c nh\u01b0 th\u1ebf n\u00e0o?<\/h3>\n
Khuy\u1ebfn c\u00e1o<\/strong><\/p>\n
\u0110\u00e1nh gi\u00e1 nguy c\u01a1 t\u00e1i ho\u1ea1t HBV v\u00e0 ch\u1ec9 \u0111\u1ecbnh d\u1ef1 ph\u00f2ng d\u1ef1a tr\u00ean c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a HBV (HBsAg, anti-HBc v\u00e0 HBV DNA), k\u1ebf ho\u1ea1ch s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch v\u00e0 b\u1ec7nh l\u00fd n\u1ec1n c\u1ea7n s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch (B\u1ea3ng 9). Do \u0111\u00f3, HBsAg v\u00e0 anti-HBc n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch. Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng v\u1edbi nh\u1eefng khuy\u1ebfn c\u00e1o \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec3 xu\u1ea5t d\u00e0nh cho t\u1ea5t c\u1ea3 nh\u1eefng ng\u01b0\u1eddi c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh. Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 HBsAg \u00e2m t\u00ednh v\u00e0 anti-HBc d\u01b0\u01a1ng t\u00ednh n\u00ean \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m HBV DNA tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
\u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh nh\u01b0ng kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb v\u1edbi c\u00e1c li\u1ec7u ph\u00e1p kh\u00e1ng virus kh\u00e1c:<\/p>\n
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Nh\u1eefng b\u1ec7nh nh\u00e2n HBsAg d\u01b0\u01a1ng t\u00ednh c\u00f3 nguy c\u01a1 virus t\u00e1i ho\u1ea1t \u0111\u1ed9ng cao v\u00e0 trung b\u00ecnh n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng b\u1eb1ng thu\u1ed1c kh\u00e1ng virus NA (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/li>\n
Nh\u1eefng b\u1ec7nh nh\u00e2n HBsAg d\u01b0\u01a1ng t\u00ednh c\u00f3 nguy c\u01a1 virus t\u1ea3i ho\u1ea1t th\u1ea5p kh\u00f4ng c\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb n\u1ebfu c\u00f3 th\u1ec3 theo d\u00f5i HBV DNA \u00edt nh\u1ea5t 3 th\u00e1ng m\u1ed9t l\u1ea7n. N\u1ebfu b\u00e1c s\u0129 c\u1ea3m th\u1ea5y lo ng\u1ea1i v\u1ec1 kh\u1ea3 n\u0103ng theo d\u00f5i HBV DNA c\u1ee7a b\u1ec7nh nh\u00e2n th\u00ec n\u00ean b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng v\u1edbi NA (m\u1ee9c b\u1eb1ng ch\u1ee9ng 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/li>\n<\/ul>\n
\u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n HBsAg \u00e2m t\u00ednh\/anti-HBc d\u01b0\u01a1ng t\u00ednh:<\/p>\n
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Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 HBsAg \u00e2m t\u00ednh, anti-HBc d\u01b0\u01a1ng t\u00ednh v\u00e0 HBV DNA d\u01b0\u01a1ng t\u00ednh n\u00ean \u0111\u01b0\u1ee3c qu\u1ea3n l\u00fd gi\u1ed1ng nh\u01b0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 HBsAg d\u01b0\u01a1ng t\u1ec9nh (m\u1ee9c b\u1eb1ng ch\u1ee9ng, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/li>\n
Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 HBsAg \u00e2m t\u00ednh, anti-HBc d\u01b0\u01a1ng t\u00ednh, HBV DNA \u00e2m t\u00ednh n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng b\u1eb1ng NA n\u1ebfu c\u00f3 k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, v\u00ec nguy c\u01a1 t\u00e1i ho\u1ea1t HBV cao (m\u1ee9c b\u1eb1ng ch\u1ee9ng, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).
\nNh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 HBsAg \u00e2m t\u00ednh, anti-HBc d\u01b0\u01a1ng t\u00ednh, HBV DNA \u00e2m t\u00ednh s\u1ebd \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u00e1c \u0111\u1ed3 \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, v\u1edbi nguy c\u01a1 t\u00e1i ho\u1ea1t \u0111\u1ed9ng virus \u1edf m\u1ee9c trung b\u00ecnh ho\u1eb7c th\u1ea5p kh\u00f4ng c\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd (HBsAg v\u00e0\/ho\u1eb7c HBV DNA 3 th\u00e1ng m\u1ed9t l\u1ea7n). N\u1ebfu b\u00e1c s\u0129 c\u1ea3m th\u1ea5y lo ng\u1ea1i v\u1ec1 kh\u1ea3 n\u0103ng theo d\u00f5i HBV DNA c\u1ee7a b\u1ec7nh nh\u00e2n th\u00ec n\u00ean b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng v\u1edbi NA (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn).<\/li>\n<\/ul>\n
Nh\u1eefng b\u1ec7nh nh\u00e2n c\u1ea7n \u0111i\u1ec1u tr\u1ecb NA d\u1ef1 ph\u00f2ng:<\/p>\n
\n
ETV ho\u1eb7c Tenofovir (TAF ho\u1eb7c TDF) n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 d\u1ef1 ph\u00f2ng t\u1ea3i ho\u1ea1t HBV. Th\u1eddi gian d\u1ef1 ph\u00f2ng NA ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5. \u0110i\u1ec1u tr\u1ecb v\u1edbi NA n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng trong \u00edt nh\u1ea5t 6-12 th\u00e1ng sau khi ho\u00e0n th\u00e0nh \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p nguy c\u01a1 cao, ch\u1eb3ng h\u1ea1n nh\u01b0 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c l\u00e0m suy gi\u1ea3m ch\u1ee9c n\u0103ng t\u1ebf b\u00e0o B, n\u00ean ti\u1ebfp t\u1ee5c NA trong \u00edt nh\u1ea5t 18 th\u00e1ng sau khi ho\u00e0n th\u00e0nh \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch. L\u00fd t\u01b0\u1edfng nh\u1ea5t l\u00e0 vi\u1ec7c ng\u1eebng NA n\u00ean tu\u00e2n theo c\u00e1c ti\u00eau ch\u00ed \u0111\u00e3 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 ng\u1eebng NA, \u0111\u1eb7c bi\u1ec7t n\u1ebfu HBV DNA d\u01b0\u01a1ng t\u00ednh tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb NA (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/li>\n<\/ul>\n
B\u1ea3ng 9. Nguy c\u01a1 t\u1ea3i ho\u1ea1t HBV \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch<\/p>\n\n\n\n\n\n\n
Nguy c\u01a1 t\u00e1i ho\u1ea1t<\/strong><\/td>\n HBsAg d\u01b0\u01a1ng t\u1ec9nh ho\u1eb7c HBsAg \u00e2m t\u00ednh\/anti-HBc d\u01b0\u01a1ng t\u00ednh nh\u01b0ng HBV DNA d\u01b0\u01a1ng t\u00ednh<\/strong><\/td>\n HBsAg \u00e2m t\u00ednh\/anti-HBc d\u01b0\u01a1ng t\u00ednh (HBV DNA \u00e2m t\u00ednh)<\/strong><\/td>\n<\/tr>\n
Nguy c\u01a1 cao (>10%)<\/td>\n \u1ee8c ch\u1ebf mi\u1ec5n d\u1ecbch trong gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c<\/p>\n
H\u00f3a tr\u1ecb li\u1ec1u cao ph\u1ed1i h\u1ee3p (v\u00ed d\u1ee5: R-CHOP)<\/p>\n
\u0110i\u1ec1u tr\u1ecb l\u00e0m suy gi\u1ea3m t\u1ebf b\u00e0o B<\/p>\n
\u0110i\u1ec1u tr\u1ecb HCC (TACE, x\u1ea1 tr\u1ecb, ph\u1ea7u thu\u1eadt c\u1eaft b\u1ecf, h\u00f3a tr\u1ecb to\u00e0n th\u00e2n)<\/p>\n
Anthracyclines<\/p>\n
Li\u1ec7u ph\u00e1p t\u1ebf b\u00e0o CAR-T nh\u1eafm v\u00e0o t\u1ebf b\u00e0o B (BCMA, CD19)<\/p>\n
Thu\u1ed1c kh\u00e1ng TNF<\/p>\n
Corticoid (>4 tu\u1ea7n, li\u1ec1u >20 mg\/ng\u00e0y)<\/p>\n
Cyclophosphamide<\/p>\n
Thu\u1ed1c \u1ee9c ch\u1ebf JAK<\/p>\n
Ch\u1ea5t \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 IL-6<\/p>\n
Kh\u00e1ng IL-17<\/p>\n
Thu\u1ed1c \u1ee9c ch\u1ebf tyrosine kinase<\/td>\n
\u1ee8c ch\u1ebf mi\u1ec5n d\u1ecbch trong gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c<\/p>\n
H\u00f3a tr\u1ecb li\u1ec1u cao ph\u1ed1i h\u1ee3p (v\u00edd\u1ee5: R-CHOP)<\/p>\n
Li\u1ec7u ph\u00e1p l\u00e0m suy gi\u1ea3m t\u1ebf b\u00e0o B<\/p>\n
\u0110i\u1ec1u tr\u1ecb HCC (TACE, x\u1ea1 tr\u1ecb, ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf, h\u00f3a tr\u1ecb to\u00e0n th\u00e2n)<\/p>\n
Anthracyclines<\/p>\n
\u0110i\u1ec1u tr\u1ecb l\u00e0m suy gi\u1ea3m t\u1ebf b\u00e0o T b\u1eb1ng belatacept – t\u00e1i ho\u1ea1t t\u1edbi 17% trong gh\u00e9p t\u1ea1ng<\/td>\n<\/tr>\n
Nguy c\u01a1 trung b\u00ecnh (1-10%)<\/td>\n Thu\u1ed1c kh\u00e1ng IL-12\/23 (VD: ustekinumab)<\/p>\n
Thu\u1ed1c \u1ee9c ch\u1ebf ho\u1ea1t h\u00f3a t\u1ebf b\u00e0o T (abatacept, belatacept)<\/p>\n
Thu\u1ed1c \u1ee9c ch\u1ebf mTOR<\/td>\n
Li\u1ec7u ph\u00e1p l\u00e0m suy gi\u1ea3m t\u1ebf b\u00e0o T (v\u00ed d\u1ee5: abatacept)<\/p>\n
Li\u1ec7u ph\u00e1p t\u1ebf b\u00e0o CAR-T<\/p>\n
Corticosteroids (>40 mg)<\/p>\n
Thu\u1ed1c kh\u00e1ng TNF<\/p>\n
Kh\u00e1ng IL-12\/23<\/p>\n
Kh\u00e1ng IL-17<\/p>\n
Thu\u1ed1c \u1ee9c ch\u1ebf JAK<\/p>\n
Thu\u1ed1c \u1ee9c ch\u1ebf tyrosine kinase (v\u00ed d\u1ee5: ibrutinib)<\/p>\n
Cyclophosphamide<\/td>\n<\/tr>\n
Nguy c\u01a1 th\u1ea5p (<1%)<\/td>\n Azathioprine<\/p>\n
Methotrexate<\/p>\n
Mycophenolate mofetil<\/p>\n
Corticoid li\u1ec1u th\u1ea5p (<10 mg\/ng\u00e0y)<\/p>\n
Thu\u1ed1c \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch (immune checkpoint inhibitors)<\/td>\n
Azathioprine<\/p>\n
Methotrexate<\/p>\n
Mycophenolate mofetil<\/p>\n
Thu\u1ed1c \u1ee9c ch\u1ebf mTOR<\/p>\n
Corticosteroids (<40 mg\/ng\u00e0y trong t\u1ed1i \u0111a 1 tu\u1ea7n)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
HBV v\u00e0 gh\u00e9p t\u1ea1ng<\/h2>\n
B\u1ea3ng 10. Qu\u1ea3n l\u00fd ng\u01b0\u1eddi nh\u1eadn t\u1ea1ng hi\u1ebfn t\u1eb7ng c\u00f3 HBsAq \u00e2m t\u00ednh\/anti-HBc d\u01b0\u01a1ng t\u00ednh<\/p>\n\n\n\n\n\n\n\n\n\n
<\/td>\n T\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi nh\u1eadn<\/strong><\/td>\n <\/td>\n<\/tr>\n
C\u01a1 quan<\/strong><\/td>\n Anti-HBs<\/strong><\/td>\n Anti-HBc<\/strong><\/td>\n Khuy\u1ebfn c\u00e1o<\/strong><\/td>\n<\/tr>\n
Gan<\/td>\n (-)<\/td>\n (-)<\/td>\n D\u1ef1 ph\u00f2ng b\u1eb1ng NA d\u00e0i h\u1ea1n<\/p>\n
Kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p HBIG\/NA<\/td>\n<\/tr>\n
(+)<\/td>\n (-)<\/td>\n Nguy c\u01a1 t\u1ea3i ho\u1ea1t HBV th\u1ea5p h\u01a1n<\/p>\n
Khuy\u1ebfn c\u00e1o d\u1ef1 ph\u00f2ng b\u1eb1ng NA<\/td>\n<\/tr>\n
(-)<\/td>\n (+)<\/td>\n<\/tr>\n
(+)<\/td>\n (+)<\/td>\n Nguy c\u01a1 t\u00e1i ho\u1ea1t HBV r\u1ea5t th\u1ea5p<\/p>\n
Kh\u00f4ng b\u1eaft bu\u1ed9c d\u1ef1 ph\u00f2ng b\u1eb1ng NA nh\u01b0ng c\u1ea7n theo d\u00f5i ch\u1eb7t ch\u1ebd HBV DNA v\u00e0 HBsAg<\/p>\n
N\u1ebfu kh\u00f4ng th\u1ec3 theo d\u00f5i, h\u00e3y b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb NA<\/p>\n
L\u1ef1a ch\u1ecdn thay th\u1ebf: d\u1ef1 ph\u00f2ng NA trong 6-12 th\u00e1ng<\/td>\n<\/tr>\n
C\u01a1 quan kh\u00e1c<\/td>\n +\/-<\/td>\n +\/-<\/td>\n Kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng d\u1ef1 ph\u00f2ng HBIG\/NA do nguy c\u01a1 HBV th\u1eafp<\/p>\n
C\u1ea7n th\u1ef1c hi\u1ec7n theo d\u00f5i HBV DNA v\u00e0 HBsAg \u0111\u1ecbnh k\u1ef3<\/p>\n
B\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb NA n\u1ebfu HBV DNA ho\u1eb7c HBsAg chuy\u1ec3n d\u01b0\u01a1ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ch\u00fa th\u00edch: HBIG (hepatitis B immunoglobulin): globulin mi\u1ec5n d\u1ecbch vi\u00eam gan B.<\/p>\n
D\u1ef1 ph\u00f2ng nhi\u1ec5m HBV<\/h2>\n
Ai n\u00ean ti\u00eam vaccine ph\u00f2ng vi\u00eam gan B v\u00e0 ai n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i ph\u1ea3n \u1ee9ng sau ti\u00eam vaccine?<\/h3>\n
Khuy\u1ebfn c\u00e1o<\/h4>\n
Khuy\u1ebfn c\u00e1o ti\u00eam vaccine ph\u00f2ng vi\u00eam gan B cho t\u1ea5t c\u1ea3 tr\u1ebb s\u01a1 sinh, tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t, t\u1ed1tnh\u1ea5t l\u00e0 tr\u01b0\u1edbc khi d\u1eady th\u00ec (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Tr\u1ebb s\u01a1 sinh c\u1ee7a nh\u1eefng b\u00e0 m\u1eb9 c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh ho\u1eb7c nh\u1eefng b\u00e0 m\u1eb9 kh\u00f4ng r\u00f5 t\u00ecnh tr\u1ea1ng HBsAg n\u00ean \u0111\u01b0\u1ee3c ti\u00eam vaccine vi\u00eam gan B c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t sau khi sinh, l\u00fd t\u01b0\u1edfng nh\u1ea5t l\u00e0 trong v\u00f2ng 12 gi\u1edd, k\u1ebft h\u1ee3p v\u1edbi mi\u1ec5n d\u1ecbch th\u1ee5 \u0111\u1ed9ng b\u1eb1ng globulin mi\u1ec5n d\u1ecbch vi\u00eam gan B \u0111\u1ec3 t\u1ed1i \u0111a h\u00f3a kh\u1ea3 n\u0103ng b\u1ea3o v\u1ec7 ch\u1ed1ng l\u1ea1i s\u1ef1 l\u00e2y truy\u1ec1n HBV (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn).<\/p>\n
C\u00e1c nh\u00f3m nguy c\u01a1 sau \u0111\u00e2y n\u00ean \u0111\u01b0\u1ee3c ti\u00eam vaccine ph\u00f2ng ng\u1eeba nhi\u1ec5m HBV (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh):<\/p>\n
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Nh\u1eefng c\u00e1 nh\u00e2n c\u00f3 nguy c\u01a1 m\u1eafc vi\u00eam gan B n\u1eb7ng do t\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch, s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch ho\u1eb7c \u0111ang m\u1eafc c\u00e1c b\u1ec7nh m\u1ea1n t\u00ednh nh\u01b0 b\u1ec7nh gan ho\u1eb7c th\u1eadn m\u1ea1n t\u00ednh.<\/li>\n
Nh\u1eefng c\u00e1 nh\u00e2n c\u00f3 nguy c\u01a1 ph\u01a1i nhi\u1ec5m kh\u00f4ng do ngh\u1ec1 nghi\u1ec7p, v\u00ed d\u1ee5 nh\u01b0 ti\u1ebfp x\u00fac v\u1edbi ng\u01b0\u1eddi c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh (b\u1ea1n t\u00ecnh v\u00e0 th\u00e0nh vi\u00ean gia \u0111\u00ecnh c\u1ee7a nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh vi\u00eam gan m\u1ea1n t\u00ednh), h\u00e0nh vi t\u00ecnh d\u1ee5c c\u00f3 nguy c\u01a1 cao, nh\u1eefng ng\u01b0\u1eddi th\u0103m kh\u00e1m \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng t\u00ecnh d\u1ee5c, nh\u1eefng ng\u01b0\u1eddi ti\u00eam ch\u00edch ma t\u00fay, t\u00f9 nh\u00e2n v\u00e0 b\u1ec7nh nh\u00e2n trong c\u00e1c c\u01a1 s\u1edf \u0111i\u1ec1u tr\u1ecb t\u00e2m th\u1ea7n.<\/li>\n
Nh\u1eefng c\u00e1 nh\u00e2n c\u00f3 nguy c\u01a1 ph\u01a1i nhi\u1ec5m ngh\u1ec1 nghi\u1ec7p cao, bao g\u1ed3m nh\u00e2n vi\u00ean ch\u0103m s\u00f3c y t\u1ebf, th\u1ef1c t\u1eadp sinh, sinh vi\u00ean, t\u00ecnh nguy\u1ec7n vi\u00ean, nh\u00e2n vi\u00ean ph\u00f2ng th\u00ed nghi\u1ec7m v\u00e0 v\u1ec7 sinh t\u1ea1i c\u00e1c c\u01a1 s\u1edf ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe, nh\u00e2n vi\u00ean y t\u1ebf, ng\u01b0\u1eddi \u1ee9ng ph\u00f3 kh\u1ea9n c\u1ea5p, c\u1ea3nh s\u00e1t, l\u00ednh c\u1ee9u h\u1ecfa, binh l\u00ednh v\u00e0 nh\u00e2n vi\u00ean t\u1ea1i c\u00e1c c\u01a1 s\u1edf c\u00f3 t\u1ef7 l\u1ec7 nhi\u1ec5m HBV m\u1ea1n t\u00ednh cao<\/li>\n<\/ul>\n
Ngo\u00e0i ra, ti\u00eam vaccine vi\u00eam gan B \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t cho (m\u1ee9c b\u1eb1ng ch\u1ee9ng 4, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh): t\u1ea5t c\u1ea3 nh\u1eefng c\u00e1 nh\u00e2n mu\u1ed1n \u0111\u01b0\u1ee3c b\u1ea3o v\u1ec7 c\u01a1 th\u1ec3, tr\u00e1nh nhi\u1ec5m HBV, b\u1ea5t k\u1ec3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 n\u00e0o.<\/p>\n
Tuy\u00ean b\u1ed1<\/h4>\n
\u0110\u1ed1i v\u1edbi nh\u1eefng c\u00e1 nh\u00e2n kh\u00f4ng thu\u1ed9c nh\u00f3m nguy c\u01a1 c\u1ee5 th\u1ec3, kh\u1ecfe m\u1ea1nh v\u00e0 d\u01b0\u1edbi 40 tu\u1ed5i, kh\u00f4ng c\u1ea7n \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 sau ti\u00eam ch\u1ee7ng (anti-HBs) (\u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
N\u00ean ti\u00eam vaccine nh\u01b0 th\u1ebf n\u00e0o cho nh\u1eefng ng\u01b0\u1eddi c\u00f3 h\u1ec7 mi\u1ec5n d\u1ecbch suy gi\u1ea3m?<\/h3>\n
\u0110\u1ed1i v\u1edbi nh\u1eefng c\u00e1 nh\u00e2n b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch, bao g\u1ed3m b\u1ec7nh nh\u00e2n b\u1ecb x\u01a1 gan ho\u1eb7c nh\u1eefng ng\u01b0\u1eddi \u0111ang ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, n\u00ean t\u0103ng li\u1ec1u vaccine ti\u00eau chu\u1ea9n (ho\u1eb7c th\u1ebf h\u1ec7 th\u1ee9 hai) (li\u1ec1u g\u1ea5p \u0111\u00f4i ho\u1eb7c li\u1ec1u \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh cho b\u1ec7nh nh\u00e2n \u0111ang ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o) ho\u1eb7c vaccine th\u1ebf h\u1ec7 th\u1ee9 ba (m\u1ee9c khuy\u1ebfn c\u00e1o 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
N\u00ean l\u00e0m g\u00ec n\u1ebfu \u0111\u00e1p \u1ee9ng c\u1ee7a c\u01a1 th\u1ec3 kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 v\u1edbi li\u1ec7u tr\u00ecnh ti\u00eam vaccine \u0111\u1ea7u ti\u00ean?<\/h3>\n
Tuy\u00ean b\u1ed1<\/h4>\n
Anti-HBs \u226510 IU\/L cho th\u1ea5y c\u00f3 kh\u1ea3 n\u0103ng b\u1ea3o v\u1ec7. Tuy nhi\u00ean, \u0111\u1ed1i v\u1edbi c\u00e1c nh\u00f3m c\u00f3 nguy c\u01a1 cao h\u01a1n v\u1ec1 c\u00e1c k\u1ebft c\u1ee5c nghi\u00eam tr\u1ecdng, ch\u1eb3ng h\u1ea1n nh\u01b0 nh\u1eefng ng\u01b0\u1eddi b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch, n\u1ed3ng \u0111\u1ed9 anti-HBs \u0111\u01b0\u1ee3c coi l\u00e0 t\u1ed1i \u01b0u n\u1ebfu m\u1ee9c anti-HBs \u2265100 IU\/L 1-2 th\u00e1ng sau l\u1ea7n ti\u00eam ch\u1ee7ng cu\u1ed1i c\u00f9ng. Ch\u1ec9 s\u1ed1 n\u00e0y cho th\u1ea5y kh\u1ea3 n\u0103ng b\u1ea3o v\u1ec7 l\u00e2u d\u00e0i, c\u00f3 th\u1ec3 l\u00e0 su\u1ed1t \u0111\u1eddi ch\u1ed1ng l\u1ea1i vi\u00eam gan B (\u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Khuy\u1ebfn c\u00e1o<\/h4>\n
Nh\u1eefng c\u00e1 nh\u00e2n c\u00f3 n\u1ed3ng \u0111\u1ed9 anti-HBs \u2265100 IU\/L 1-2 th\u00e1ng sau khi ho\u00e0n th\u00e0nh lo\u1ea1t ti\u00eam ch\u1ee7ng kh\u00f4ng c\u1ea7n theo d\u00f5i th\u00eam v\u00e0 ti\u00eam nh\u1eafc l\u1ea1i. C\u00e1c tr\u01b0\u1eddng h\u1ee3p ngo\u1ea1i l\u1ec7 bao g\u1ed3m nh\u1eefng c\u00e1 nh\u00e2n b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch, nh\u1eefng ng\u01b0\u1eddi n\u00e0y c\u1ea7n ph\u1ea3i l\u00e0m x\u00e9t nghi\u1ec7m theo d\u00f5i anti-HBs (v\u00e0 ti\u00eam nh\u1eafc l\u1ea1i n\u1ebfu anti-HBs <100 IU\/L). Kho\u1ea3ng c\u00e1ch gi\u1eefa c\u00e1c l\u1ea7n x\u00e9t nghi\u1ec7m anti-HBs dao \u0111\u1ed9ng t\u1eeb h\u00e0ng n\u0103m \u0111\u1ebfn 10 n\u0103m m\u1ed9t l\u1ea7n, t\u00f9y thu\u1ed9c v\u00e0o nguy c\u01a1 (m\u1ee9c khuy\u1ebfn c\u00e1o 2, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
\u0110\u1ed1i v\u1edbi nh\u00f3m nguy c\u01a1 c\u00f3 n\u1ed3ng \u0111\u1ed9 anti-HBs t\u1eeb 10 \u0111\u1ebfn 100 IU\/L 1-2 th\u00e1ng sau khi ho\u00e0n th\u00e0nh li\u1ec7u tr\u00ecnh ti\u00eam ch\u1ee7ng, n\u00ean ti\u00eam th\u00eam m\u1ed9t li\u1ec1u nh\u1eafc l\u1ea1i, sau \u0111\u00f3 \u0111\u00e1nh gi\u00e1 l\u1ea1i n\u1ed3ng \u0111\u1ed9 anti-HBs sau 1-2 th\u00e1ng (m\u1ee9c b\u1eb1ng ch\u1ee9ng 3, khuy\u1ebfn c\u00e1o y\u1ebfu, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
Nh\u1eefng c\u00e1 nh\u00e2n c\u00f3 n\u1ed3ng \u0111\u1ed9 anti-HBs <10 IU\/L 1-2 th\u00e1ng sau khi ho\u00e0n th\u00e0nh lo\u1ea1t ti\u00eam ch\u1ee7ng n\u00ean \u0111\u01b0\u1ee3c ti\u00eam l\u1ea1i v\u1edbi m\u1ed9t li\u1ec7u tr\u00ecnh ti\u00eam ch\u1ee7ng \u0111\u1ea7y \u0111\u1ee7 (c\u00f3 th\u1ec3 v\u1edbi l\u1ecbch ti\u00eam ch\u1ee7ng \u0111\u01b0\u1ee3c t\u1ed1i \u01b0u h\u00f3a) v\u00e0 n\u1ed3ng \u0111\u1ed9 anti-HBs n\u00ean \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u1ea1i sau 1-2 th\u00e1ng. C\u1ea7n c\u00e2n nh\u1eafc lo\u1ea1i tr\u1eeb t\u00ecnh tr\u1ea1ng nhi\u1ec5m HBV \u0111ang ho\u1ea1t \u0111\u1ed9ng (HBsAg, anti-HBc) tr\u01b0\u1edbc khi ti\u00eam l\u1ea1i vaccine cho nh\u1eefng c\u00e1 nh\u00e2n n\u00e0y (m\u1ee9c b\u1eb1ng ch\u1ee9ng 1, khuy\u1ebfn c\u00e1o m\u1ea1nh, \u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n
PH\u1ee4 L\u1ee4C: Ph\u00e2n lo\u1ea1i nhi\u1ec5m HBV m\u1ea1n t\u00ednh v\u00e0 vi\u00eam gan B m\u1ea1n t\u00ednh d\u1ef1a tr\u00ean c\u00e1c d\u1ea5u \u1ea5n virus, ho\u1ea1t \u0111\u1ed9ng vi\u00eam, giai \u0111o\u1ea1n b\u1ec7nh v\u00e0 nguy c\u01a1 ti\u1ebfn tri\u1ec3n b\u1ec7nh<\/p>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o: EASL 2025 Clinical Practice Guidelines on the management of hepatitis B virus infection.<\/p>\n","protected":false},"excerpt":{"rendered":"
Ngu\u1ed3n : Fanpage Filemed – T\u00e0i Li\u1ec7u Y D\u01b0\u1ee3c T\u1ed5ng quan T\u1ed5ng quan nhi\u1ec5m vi\u00eam gan B Vi\u00eam gan B l\u00e0 v\u1eabn l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c \u0111\u1ed1i v\u1edbi s\u1ee9c kh\u1ecfe to\u00e0n c\u1ea7u, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u00e0ng tri\u1ec7u ng\u01b0\u1eddi tr\u00ean th\u1ebf gi\u1edbi. Nhi\u1ec5m virus vi\u00eam gan B (HBV) m\u1ea1n t\u00ednh c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c b\u1ec7nh […]\n","protected":false},"author":1,"featured_media":150582,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-150581","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/150581","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=150581"}],"version-history":[{"count":8,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/150581\/revisions"}],"predecessor-version":[{"id":150836,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/150581\/revisions\/150836"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/150582"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=150581"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=150581"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=150581"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

T\u1ed5ng quan<\/h2>\n

S\u00e0ng l\u1ecdc v\u00e0 ch\u1ea9n \u0111o\u00e1n<\/h2>\n

\u0110\u1ed1i t\u01b0\u1ee3ng n\u00e0o c\u1ea7n \u0111\u01b0\u1ee3c s\u00e0ng l\u1ecdc nhi\u1ec5m HBV v\u00e0 s\u00e0ng l\u1ecdc nh\u01b0 th\u1ebf n\u00e0o?<\/h3>\n

M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/h2>\n

Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb<\/h2>\n

Nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nh\u01b0 th\u1ebf n\u00e0o?<\/h3>\n

C\u00f3 n\u00ean \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh kh\u00f4ng?<\/h3>\n

C\u00f3 n\u00ean \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh c\u00f3 HBeAg \u00e2m t\u00ednh kh\u00f4ng?<\/h3>\n

\u0110i\u1ec1u tr\u1ecb<\/h2>\n

Nh\u1eefng l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb n\u00e0o \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n nhi\u1ec5m HBV m\u1ea1n t\u00ednh?<\/h3>\n

Tuy\u00ean b\u1ed1<\/h4>\nHai li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m HBV m\u1ea1n t\u00ednh l\u00e0 NA ho\u1eb7c PEG-IFNa (\u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n

\u0110i\u1ec1u tr\u1ecb \u1edf nh\u1eefng nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u1eb7c bi\u1ec7t<\/h2>\n

B\u1ec7nh nh\u00e2n nhi\u1ec5m HBV c\u1ea5p c\u00f3 n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus kh\u00f4ng?<\/h3>\n

D\u1ef1 ph\u00f2ng t\u00e1i ho\u1ea1t HBV<\/h2>\n

D\u1ef1 ph\u00f2ng nhi\u1ec5m HBV<\/h2>\n

Ai n\u00ean ti\u00eam vaccine ph\u00f2ng vi\u00eam gan B v\u00e0 ai n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i ph\u1ea3n \u1ee9ng sau ti\u00eam vaccine?<\/h3>\n

N\u00ean l\u00e0m g\u00ec n\u1ebfu \u0111\u00e1p \u1ee9ng c\u1ee7a c\u01a1 th\u1ec3 kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 v\u1edbi li\u1ec7u tr\u00ecnh ti\u00eam vaccine \u0111\u1ea7u ti\u00ean?<\/h3>\n

Tuy\u00ean b\u1ed1<\/h4>\n
Hai li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m HBV m\u1ea1n t\u00ednh l\u00e0 NA ho\u1eb7c PEG-IFNa (\u0111\u1ed3ng thu\u1eadn m\u1ea1nh).<\/p>\n