{"id":32705,"date":"2022-05-20T09:18:16","date_gmt":"2022-05-20T02:18:16","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=32705"},"modified":"2022-05-20T09:47:50","modified_gmt":"2022-05-20T02:47:50","slug":"hoi-chung-khang-phospholipid-antiphospholipid-syndrome","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/hoi-chung-khang-phospholipid-antiphospholipid-syndrome\/","title":{"rendered":"H\u1ed9i ch\u1ee9ng kh\u00e1ng Phospholipid (Antiphospholipid syndrome)"},"content":{"rendered":"<p style=\"text-align: right;\"><strong><a href=\"https:\/\/www.vnras.com\/drug\/\">Nh\u00e0 thu\u1ed1c L\u01b0u V\u0103n Ho\u00e0ng<\/a> &#8211; Ch\u1ee7 \u0111\u1ec1: <a href=\"https:\/\/www.vnras.com\/drug\/2022\/05\/hoi-chung-khang-phospholipid-antiphospholipid-syndrome.html\">H\u1ed9i ch\u1ee9ng kh\u00e1ng Phospholipid <em>(Antiphospholipid syndrome)<\/em><\/a><\/strong><\/p>\n<p style=\"text-align: right;\"><strong>T\u1ea3i b\u1ea3n PDF \u0111\u1ea7y \u0111\u1ee7 <a href=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2022\/05\/Hoi-chung-khang-Phospholipid.pdf\">t\u1ea1i \u0111\u00e2y<\/a><\/strong><\/p>\n<h2>T\u00ecm hi\u1ec3u chung v\u1ec1 h\u1ed9i ch\u1ee9ng Anti Phospholipid<\/h2>\n<ul>\n<li>Antiphospholipid syndrome (APS) l\u00e0 m\u1ed9t b\u1ec7nh t\u1ef1 mi\u1ec5n, l\u00e0m t\u0103ng nguy c\u01a1 huy\u1ebft kh\u1ed1i, nguy\u00ean nh\u00e2n t\u1eeb c\u00e1c kh\u00e1ng th\u1ec3 g\u00e2y r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u.<\/li>\n<li>Nguy\u00ean nh\u00e2n l\u00e0 v\u00f4 c\u0103n ho\u1eb7c th\u1ee9 ph\u00e1t nh\u01b0 Lupus ban \u0111\u1ecf. C\u00e1c kh\u00e1ng th\u1ec3 l\u01b0u h\u00e0nh trong m\u00e1u, k\u00edch ho\u1ea1t c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u v\u00e0 ti\u1ec3u c\u1ea7u.<\/li>\n<li>Catastrophic APS (CAPS): Catastrophic ngh\u0129a l\u00e0 th\u1ea3m kh\u1ed1c. Bi\u1ec3u hi\u1ec7n t\u1eafc m\u1ea1ch, huy\u1ebft kh\u1ed1i \u0111\u1ebfn \u00edt nh\u1ea5t 3 c\u01a1 quan, nguy hi\u1ec3m t\u00ednh m\u1ea1ng.<\/li>\n<li>C\u00e1c nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t c\u00f3 th\u1ec3 l\u00e0\n<ul>\n<li>Lupus ban \u0111\u1ecf (th\u01b0\u1eddng g\u1eb7p nh\u1ea5t)<\/li>\n<li>Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p<\/li>\n<li>T\u00e2n sinh (kh\u1ed1i U)<\/li>\n<li>HIV, virus vi\u00eam gan A,B,C<\/li>\n<li>M\u1ed9t s\u1ed1 lo\u1ea1i vi khu\u1ea9n (hi\u1ebfm g\u1eb7p)<\/li>\n<\/ul>\n<\/li>\n<li>C\u01a1 ch\u1ebf sinh b\u1ec7nh:\n<ul>\n<li>Kh\u00e1ng th\u1ec3 k\u00edch ho\u1ea1t ti\u1ec3u c\u1ea7u v\u00e0 y\u1ebfu t\u1ed1 n\u1ed9i m\u1ea1c.<\/li>\n<li>Kh\u00e1ng th\u1ec3 \u1ee9c ch\u1ebf protein C, protein S v\u00e0 antithrombin III: V\u00ec protein S v\u00e0 C gi\u00fap b\u1ea5t ho\u1ea1t y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u V v\u00e0 VIII (gi\u00fap gi\u1ea3m \u0111\u00f4ng m\u00e1u).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<figure id=\"attachment_32706\" aria-describedby=\"caption-attachment-32706\" style=\"width: 950px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-32706\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2022\/05\/hinh-anh-te-bao.jpg\" alt=\"H\u00ecnh 1: Protein C v\u00e0 S \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 V v\u00e0 VIII tr\u1edf th\u00e0nh d\u1ea1ng ho\u1ea1t \u0111\u1ed9ng (Osmosis)\" width=\"950\" height=\"633\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/05\/hinh-anh-te-bao.jpg 950w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/05\/hinh-anh-te-bao-600x400.jpg 600w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/05\/hinh-anh-te-bao-768x512.jpg 768w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/05\/hinh-anh-te-bao-350x233.jpg 350w\" sizes=\"auto, (max-width: 950px) 100vw, 950px\" \/><figcaption id=\"caption-attachment-32706\" class=\"wp-caption-text\">H\u00ecnh 1: Protein C v\u00e0 S \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 V v\u00e0 VIII tr\u1edf th\u00e0nh d\u1ea1ng ho\u1ea1t \u0111\u1ed9ng (Osmosis)<\/figcaption><\/figure>\n<h2>Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/h2>\n<p>Ti\u1ec1n s\u1eed nhi\u1ec1u \u0111\u1ee3t huy\u1ebft kh\u1ed1i t\u00e1i \u0111i t\u00e1i l\u1ea1i \u1edf nhi\u1ec1u c\u01a1 quan<\/p>\n<h3>\u1ede T\u0129nh m\u1ea1ch<\/h3>\n<p>Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u (DVT)<\/p>\n<p>Thuy\u00ean t\u1eafc ph\u1ed5i (PE)<\/p>\n<p>M\u1ea1ng m\u1ea1ch xanh t\u00edm (<a href=\"https:\/\/empendium.com\/mcmtextbook-sae\/chapter\/B78.II.2.35.3.?rfmcm\" rel=\"noopener\">Livedo reticularis<\/a>)<\/p>\n<p>Livedo reticularis c\u00f2n c\u00f3 trong c\u00e1c b\u1ec7nh sau<\/p>\n<ul>\n<li>X\u01a1 v\u1eefa m\u1ea1ch m\u00e1u<\/li>\n<li>N\u1ed1t vi\u00eam \u0111a \u0111\u1ed9ng m\u1ea1ch (polyarteritis nodosa)<\/li>\n<li>Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng<\/li>\n<li>Ch\u1ee9ng Cryoglobulin m\u00e1u<\/li>\n<\/ul>\n<p>Lo\u00e9t da: Do t\u1eafc \u0111\u1ed9ng m\u1ea1ch \u1edf chi, g\u00e2y lo\u00e9t da chi d\u01b0\u1edbi.<\/p>\n<h3>\u0110\u1ed9ng m\u1ea1ch<\/h3>\n<ul>\n<li>\u0110\u1ed9t qu\u1ef5, TIA<\/li>\n<li>T\u1eafc \u0111\u1ed9ng m\u1ea1ch \u1edf c\u00e1c c\u01a1 quan<\/li>\n<li>T\u1eafc \u0111\u1ed9ng m\u1ea1ch chi (\u0111o\u1ea1n xa)<\/li>\n<\/ul>\n<h3>Mao m\u1ea1ch<\/h3>\n<ul>\n<li>Xu\u1ea5t huy\u1ebft d\u01b0\u1edbi m\u00f3ng (splinter hemorrhages)<\/li>\n<\/ul>\n<figure id=\"attachment_32707\" aria-describedby=\"caption-attachment-32707\" style=\"width: 950px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-32707\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2022\/05\/hinh2-splinter.jpg\" alt=\"H\u00ecnh 2: Splinter hemorrhages\" width=\"950\" height=\"633\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/05\/hinh2-splinter.jpg 950w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/05\/hinh2-splinter-600x400.jpg 600w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/05\/hinh2-splinter-768x512.jpg 768w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/05\/hinh2-splinter-350x233.jpg 350w\" sizes=\"auto, (max-width: 950px) 100vw, 950px\" \/><figcaption id=\"caption-attachment-32707\" class=\"wp-caption-text\">H\u00ecnh 2: Splinter hemorrhages<\/figcaption><\/figure>\n<h2>Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch<\/h2>\n<p>Huy\u1ebft kh\u1ed1i s\u00e2u t\u0129nh m\u1ea1ch chi d\u01b0\u1edbi \u0111i l\u00ean c\u00f3 th\u1ec3 g\u00e2y thuy\u00ean t\u1eafc ph\u1ed5i (PE)<\/p>\n<p>Huy\u1ebft kh\u1ed1i \u1edf t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi g\u00e2y h\u1ed9i ch\u1ee9ng Budd-Chiari<\/p>\n<p>Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch n\u00e3o g\u00e2y t\u0103ng \u00e1p n\u1ed9i s\u1ecdi v\u00e0 t\u1eafc t\u0129nh m\u1ea1ch v\u00f5ng m\u1ea1c.<\/p>\n<p>C\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh kh\u00e1c nh\u01b0 \u0111au \u0111\u1ea7u<\/p>\n<p>\u1ede x\u01b0\u01a1ng: Ho\u1ea1i t\u1eed x\u01b0\u01a1ng v\u00f4 m\u1ea1ch (thi\u1ebfu m\u00e1u t\u1edbi x\u01b0\u01a1ng n\u1ebfu t\u1eafc \u0111\u1ed9ng m\u1ea1ch)<\/p>\n<p>Ch\u1ea9n \u0111o\u00e1n d\u1ef1a tr\u00ean c\u00e1c y\u1ebfu t\u1ed1 sau: Ti\u1ec1n s\u1eed c\u00f3 huy\u1ebft kh\u1ed1i ho\u1eb7c huy\u1ebft kh\u1ed1i \u1edf th\u1eddi \u0111i\u1ec3m hi\u1ec7n t\u1ea1i ho\u1eb7c c\u00f3 bi\u1ebfn ch\u1ee9ng s\u1ea3n khoa \u0111\u1eb7c tr\u01b0ng cho b\u1ec7nh (s\u1ea9y thai, thai l\u01b0u) v\u1edbi \u00edt nh\u1ea5t 1 trong c\u00e1c ti\u00eau chu\u1ea9n c\u1eadn l\u00e2m s\u00e0ng sau:<\/p>\n<ul>\n<li>Anticardiolipin antibodies<\/li>\n<li>Anti\u2013\u03b2-2 glycoprotein-I<\/li>\n<li>Lupus anticoagulant<\/li>\n<\/ul>\n<p>C\u00e1c kh\u00e1ng th\u1ec3 n\u00e0y c\u1ea7n c\u00f3 \u00edt nh\u1ea5t 2 k\u1ebft qu\u1ea3 c\u00e1ch nhau \u00edt nh\u1ea5t 12 tu\u1ea7n T\u0102NG.<\/p>\n<p>N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 l\u00e2m s\u00e0ng r\u1ea5t g\u1ee3i \u00fd APS, nh\u01b0ng x\u00e9t nghi\u1ec7m huy\u1ebft thanh \u00e2m t\u00ednh. Th\u00ec \u0111\u00e2y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 th\u1ec3 seronegative APS (APS huy\u1ebft thanh \u00e2m t\u00ednh). L\u00fac n\u00e0y x\u00e9t nghi\u1ec7m t\u00ecm Antiphosphatidylserine\/Prothrombin Antibodies c\u00f3 \u00edch.<\/p>\n<p>Ch\u00fa \u00fd<\/p>\n<ul>\n<li>Ph\u1ee5 n\u1eef c\u00f3 b\u1ec7nh m\u1ea1ch m\u00e1u n\u00e3o \u1edf tu\u1ed5i &lt; 55 th\u00ec ta n\u00ean nghi ng\u1edd<\/li>\n<li>Ti\u1ec1n s\u1eed s\u1ea9y thai hay thai l\u01b0u nhi\u1ec1u l\u1ea7n kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n, n\u00ean nghi ng\u1edd.<\/li>\n<li>S\u1ea9y thai ho\u1eb7c thai l\u01b0u sau 12 tu\u1ea7n c\u0169ng l\u00e0 m\u1ed9t g\u1ee3i \u00fd<\/li>\n<li>Thai ph\u1ee5 tr\u1ebb; ti\u1ec1n s\u1ea3n gi\u1eadt c\u00f3 d\u1ea5u hi\u1ec7u n\u1eb7ng<\/li>\n<\/ul>\n<h2>C\u1eadn l\u00e2m s\u00e0ng<\/h2>\n<p>Test h\u1ed7n h\u1ee3p (Mixing studies): H\u1ed7n h\u1ee3p huy\u1ebft t\u01b0\u01a1ng ng\u01b0\u1eddi b\u1ec7nh v\u1edbi ng\u01b0\u1eddi l\u00e0nh. N\u1ebfu aPTT v\u1ec1 b\u00ecnh th\u01b0\u1eddng, ch\u1ee9ng t\u1ecf ng\u01b0\u1eddi b\u1ec7nh thi\u1ebfu y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u (b\u1ec7nh hemophilia) v\u00ec huy\u1ebft t\u01b0\u01a1ng ng\u01b0\u1eddi l\u00e0nh gi\u00fap b\u00f9 tr\u1eeb. N\u1ebfu aPTT v\u1eabn k\u00e9o d\u00e0i (ngh\u0129a l\u00e0 t\u0103ng \u0111\u00f4ng), c\u00f3 ngh\u0129a l\u00e0 huy\u1ebft t\u01b0\u01a1ng b\u1ec7nh nh\u00e2n c\u00f3 Lupus anticoagulant, v\u00ec kh\u00e1ng th\u1ec3 n\u00e0y ti\u1ebfp t\u1ee5c \u1ee9c ch\u1ebf protein C v\u00e0 S \u1edf huy\u1ebft t\u01b0\u01a1ng ng\u01b0\u1eddi l\u00e0nh (kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng).<\/p>\n<p>Anticardiolipin antibodies (IgG v\u00e0 IgM): IgG ho\u1eb7c IgM t\u0103ng l\u00ean \u0111\u1ec1u c\u00f3 \u00fd ngh\u0129a. L\u01b0u \u00fd r\u1eb1ng, trong Giang Mai, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 d\u01b0\u01a1ng t\u00ednh v\u1edbi Anticardiolipin antibodies. V\u00e0 ng\u01b0\u1ee3c l\u1ea1i, b\u1ec7nh nh\u00e2n APS (h\u1ed9i ch\u1ee9ng kh\u00e1ng phospholipid) c\u0169ng c\u00f3 th\u1ec3 d\u01b0\u01a1ng t\u00ednh v\u1edbi VDRL v\u00e0 RPR (kh\u00e1ng th\u1ec3 trong b\u1ec7nh Giang Mai)<\/p>\n<p>C\u00f4ng th\u1ee9c m\u00e1u: Gi\u1ea3m 3 d\u00f2ng m\u00e1u (ti\u1ec3u c\u1ea7u, h\u1ed3ng c\u1ea7u, b\u1ea1ch c\u1ea7u). Kh\u00e1ng th\u1ec3 ph\u00e1 h\u1ee7y t\u1ebf b\u00e0o m\u00e1u.<\/p>\n<h3>Ti\u00ean l\u01b0\u1ee3ng:<\/h3>\n<p>Ph\u1ee5 thu\u1ed9c v\u00e0o: S\u1ed1 l\u01b0\u1ee3ng kh\u00e1ng th\u1ec3 t\u0103ng, m\u1ee9c \u0111\u1ed9 t\u0103ng v\u00e0 kh\u00e1ng th\u1ec3 kh\u00e1ng phospholipid t\u1ed3n t\u1ea1i bao l\u00e2u.<\/p>\n<h3>\u0110i\u1ec1u tr\u1ecb<\/h3>\n<p>C\u1ea5p t\u00ednh<\/p>\n<ul>\n<li>LMWH (Heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p) ho\u1eb7c UFH (Heparin kh\u00f4ng ph\u00e2n m\u1ea3nh)<\/li>\n<li>Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng nh\u01b0 trong CAPS: Glucocorticoid li\u1ec1u cao, l\u1ecdc huy\u1ebft t\u01b0\u01a1ng (\u0111\u1ec3 lo\u1ea1i b\u1ecf kh\u00e1ng th\u1ec3). C\u00f3 th\u1ec3 th\u00eam IVIG (immunoglobulin)<\/li>\n<\/ul>\n<p>D\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t:<\/p>\n<p>Nguy c\u01a1 th\u1ea5p: Aspirin<\/p>\n<p>Nguy c\u01a1 cao v\u00e0 kh\u00f4ng mu\u1ed1n mang thai: Warfarin \u0111\u01b0\u1eddng u\u1ed1ng<\/p>\n<p>Warfarin c\u00f3 nguy c\u01a1 bi\u1ebfn d\u1ea1ng x\u01b0\u01a1ng cho thai<\/p>\n<p>Mu\u1ed1n c\u00f3 con: LMWH + Aspirin (\u0111\u1ec3 tr\u00e1nh s\u1ea9y thai)<\/p>\n<p>xem th\u00eam: [JAMA] <a href=\"https:\/\/www.vnras.com\/drug\/2019\/03\/jama-lien-quan-giua-luong-cholesterol-trong-che-do-an-va-luong-trung-tieu-thu-voi-bien-co-tim-mach-va-tu-vong.html\">Li\u00ean quan gi\u1eefa l\u01b0\u1ee3ng cholesterol trong ch\u1ebf \u0111\u1ed9 \u0103n<\/a> v\u00e0 l\u01b0\u1ee3ng tr\u1ee9ng ti\u00eau th\u1ee5 v\u1edbi bi\u1ebfn c\u1ed1 tim m\u1ea1ch v\u00e0 t\u1eed vong<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<p>Thromb Haemost, <span class=\"cit\">2020 Apr;120(4):592-598.<\/span><span class=\"secondary-date\">\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32185783\/\" rel=\"noopener\">Antiphosphatidylserine<\/a> <span class=\"citation-doi\">doi: 10.1055\/s-0040-1705115.<\/span> Epub 2020 Mar 17<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Nh\u00e0 thu\u1ed1c L\u01b0u V\u0103n Ho\u00e0ng &#8211; Ch\u1ee7 \u0111\u1ec1: H\u1ed9i ch\u1ee9ng kh\u00e1ng Phospholipid (Antiphospholipid syndrome) T\u1ea3i b\u1ea3n PDF \u0111\u1ea7y \u0111\u1ee7 t\u1ea1i \u0111\u00e2y T\u00ecm hi\u1ec3u chung v\u1ec1 h\u1ed9i ch\u1ee9ng Anti Phospholipid Antiphospholipid syndrome (APS) l\u00e0 m\u1ed9t b\u1ec7nh t\u1ef1 mi\u1ec5n, l\u00e0m t\u0103ng nguy c\u01a1 huy\u1ebft kh\u1ed1i, nguy\u00ean nh\u00e2n t\u1eeb c\u00e1c kh\u00e1ng th\u1ec3 g\u00e2y r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u. Nguy\u00ean [&#8230;]\n","protected":false},"author":1,"featured_media":32708,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-32705","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\/32705","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=32705"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/32705\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/32708"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=32705"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=32705"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=32705"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}