{"id":3940,"date":"2019-03-05T00:33:41","date_gmt":"2019-03-04T17:33:41","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=3940"},"modified":"2019-03-05T00:35:14","modified_gmt":"2019-03-04T17:35:14","slug":"ton-thuong-gan-do-thuoc-drug-induced-liver-injury-diliby","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/ton-thuong-gan-do-thuoc-drug-induced-liver-injury-diliby\/","title":{"rendered":"T\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c (Drug-induced liver injury \u2013 DILI)By"},"content":{"rendered":"<p><em>SV. Nguy\u1ec5n Thanh Huy\u1ec1n, TS.DS. V\u00f5 Th\u1ecb H\u00e0 &#8211; Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Y khoa Ph\u1ea1m Ng\u1ecdc Th\u1ea1ch.<\/em><\/p>\n<h2>GI\u1edaI THI\u1ec6U<\/h2>\n<p>Gan l\u00e0 c\u01a1 quan \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh chuy\u1ec3n ho\u00e1 thu\u1ed1c. Ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i c\u1ee7a thu\u1ed1c l\u00e0 nguy\u00ean nh\u00e2n quan tr\u1ecdng d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng gan.\u00a0T\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c (DILI)\u00a0l\u00e0 v\u1ea5n \u0111\u1ec1 ph\u1ed5 bi\u1ebfn v\u00e0 g\u1ea7n nh\u01b0 t\u1ea5t c\u1ea3 c\u00e1c nh\u00f3m thu\u1ed1c \u0111\u1ec1u c\u00f3<br \/>\nth\u1ec3 g\u00e2y ra b\u1ec7nh gan. \u0110\u00e2y c\u0169ng l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a b\u1ec7nhsuy gan c\u1ea5p t\u00ednh \u1edf Hoa K\u1ef3. H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p<br \/>\nDILI l\u00e0 l\u00e0nh t\u00ednh v\u00e0 c\u1ea3i thi\u1ec7n sau khi ng\u1eebng thu\u1ed1c. Trong s\u1ed1 c\u00e1c thu\u1ed1c g\u00e2y \u0111\u1ed9c cho gan,\u00a0paracetamol \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u nhi\u1ec1u nh\u1ea5t. Tuy nhi\u00ean, m\u1ed9t lo\u1ea1t c\u00e1c t\u00e1c nh\u00e2n d\u01b0\u1ee3c l\u00fd kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng gan, bao g\u1ed3m\u00a0thu\u1ed1c g\u00e2y m\u00ea, thu\u1ed1c tr\u1ecb ung th\u01b0, thu\u1ed1c kh\u00e1ng sinh, thu\u1ed1c tr\u1ecb lao, thu\u1ed1c kh\u00e1ng virus v\u00e0 thu\u1ed1c tr\u1ee3 tim.\u00a0Ngo\u00e0i ra, nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb truy\u1ec1n th\u1ed1ng v\u00e0 thu\u1ed1c th\u1ea3o d\u01b0\u1ee3c c\u0169ng c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9c cho gan.<sup>[1]<\/sup><\/p>\n<h2>KH\u00c1I NI\u1ec6M<\/h2>\n<p>T\u1ed5n th\u01b0\u01a1ng gan do<br \/>\nthu\u1ed1c (Drug-induced liver injury \u2013 DILI)\u00a0d\u00f9ng \u0111\u1ec3 ch\u1ec9 c\u00e1c t\u1ed5n th\u01b0\u01a1ng gan m\u00e0 thu\u1ed1c l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ra<br \/>\nt\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd. B\u00ean c\u1ea1nh \u0111\u00f3 c\u00f2n c\u00f3 kh\u00e1i ni\u1ec7m\u00a0T\u1ed5n th\u01b0\u01a1ng gan do th\u1ea3o d\u01b0\u1ee3c (Herb-induced liver injury \u2013 HILI)\u00a0d\u00f9ng<br \/>\n\u0111\u1ec3 ch\u1ec9 c\u00e1c t\u1ed5n th\u01b0\u01a1ng gan m\u00e0 th\u1ea3o d\u01b0\u1ee3c l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ra b\u1ec7nh l\u00fd.<sup>[4]<\/sup><\/p>\n<h2>PH\u00c2N LO\u1ea0I<\/h2>\n<p>T\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c (DILI)\u00a0c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo nhi\u1ec1u c\u00e1ch (B\u1ea3ng 1), bao g\u1ed3m:<sup>[2]<\/sup><\/p>\n<p>B\u1ea3ng 1.<br \/>\nPh\u00e2n lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng gan<\/p>\n<table class=\"m_1526039367295241923wp-block-table\">\n<tbody>\n<tr>\n<td>Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng<\/td>\n<td>C\u01a1 ch\u1ebf g\u00e2y \u0111\u1ed9c cho gan<\/td>\n<td>K\u1ebft qu\u1ea3 m\u00f4 h\u1ecdc<\/td>\n<\/tr>\n<tr>\n<td>\u2022 T\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan (g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o)\u2022 T\u1ed5n th\u01b0\u01a1ng m\u1eadt\u2022 T\u1ed5n th\u01b0\u01a1ng gan h\u1ed7n h\u1ee3p (t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan v\u00e0 \u00a0m\u1eadt)<\/td>\n<td>\u2022 N\u1ed9i t\u1ea1i\u2022 \u0110\u1eb7c \u1ee9ng<\/td>\n<td>\u2022 Vi\u00eam gan\u2022 \u1ee8 m\u1eadt\u2022 Gan nhi\u1ec5m m\u1ee1<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li>DILI<br \/>\nn\u1ed9i t\u1ea1i:\u00a0l\u00e0<br \/>\n\u0111\u1ed9c t\u00ednh tr\u00ean gan do thu\u1ed1c c\u00f3 th\u1ec3 d\u1ef1 \u0111o\u00e1n tr\u01b0\u1edbc v\u00e0 li\u00ean quan \u0111\u1ebfn li\u1ec1u (v\u00ed d\u1ee5:\u00a0paracetamol).<em>DILI<br \/>\n\u0111\u1eb7c \u1ee9ng\u00a0(d\u1ecb<br \/>\n\u1ee9ng \u0111\u1eb7c bi\u1ec7t \u1edf t\u1eebng b\u1ec7nh nh\u00e2n): \u00edt<br \/>\nx\u1ea3y ra h\u01a1n, \u00edt li\u00ean quan \u0111\u1ebfn li\u1ec1u v\u00e0 c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n \u0111a d\u1ea1ng h\u01a1n.<\/em><\/li>\n<\/ul>\n<h2>D\u1ecaCH T\u1ec4<\/h2>\n<p>T\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c (DILI)\u00a0c\u00f3 t\u1ef7 l\u1ec7 m\u1eafc h\u00e0ng n\u0103m \u01b0\u1edbc<br \/>\nt\u00ednh t\u1eeb 10-15\/10.000-100.000 ng\u01b0\u1eddi d\u00f9ng thu\u1ed1c k\u00ea \u0111\u01a1n. DILI chi\u1ebfm kho\u1ea3ng 10% c\u00e1c<br \/>\ntr\u01b0\u1eddng h\u1ee3p vi\u00eam gan c\u1ea5p t\u00ednh v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a b\u1ec7nh suy gan c\u1ea5p t\u00ednh \u1edf Hoa K\u1ef3. DILI<br \/>\nc\u0169ng l\u00e0 l\u00fd do th\u01b0\u1eddng xuy\u00ean nh\u1ea5t khi\u1ebfn thu\u1ed1c b\u1ecb r\u00fat kh\u1ecfi th\u1ecb tr\u01b0\u1eddng. DILI c\u00f3 th\u1ec3 kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n tr\u01b0\u1edbc khi ph\u00ea duy\u1ec7t thu\u1ed1c,<br \/>\nv\u00ec h\u1ea7u h\u1ebft c\u00e1c lo\u1ea1i thu\u1ed1c m\u1edbi \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m \u1edf \u00edt h\u01a1n 3.000 ng\u01b0\u1eddi. Do \u0111\u00f3, c\u00e1c tr\u01b0\u1eddng h\u1ee3p DILI v\u1edbi t\u1ef7 l\u1ec7 m\u1eafc<br \/>\n1\/10.000 c\u00f3 th\u1ec3 b\u1ecb b\u1ecf s\u00f3t.\u00a0<sup>[2]<\/sup><\/p>\n<h2>Y\u1ebeU T\u1ed0 NGUY C\u01a0<\/h2>\n<p>C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u00f3 th\u1ec3 l\u00e0 ch\u1ee7 quan, do m\u00f4i<br \/>\ntr\u01b0\u1eddng ho\u1eb7c li\u00ean quan \u0111\u1ebfn thu\u1ed1c (B\u1ea3ng 2).<\/p>\n<p>B\u1ea3ng 2. Y\u1ebfu t\u1ed1 nguy c\u01a1 c\u00f3 th\u1ec3 g\u00e2y DILI.\u00a0<sup>[5]<\/sup><\/p>\n<table class=\"m_1526039367295241923wp-block-table\">\n<tbody>\n<tr>\n<td>Y\u1ebfu t\u1ed1 ch\u1ee7 quan<\/td>\n<td>Y\u1ebfu t\u1ed1 m\u00f4i tr\u01b0\u1eddng<\/td>\n<td>Y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn<br \/>\nthu\u1ed1c<\/td>\n<\/tr>\n<tr>\n<td>Tu\u1ed5i<br \/>\nGi\u1edbi t\u00ednh<br \/>\nMang thai<br \/>\nSuy dinh<br \/>\nd\u01b0\u1ee1ng<br \/>\nB\u00e9o ph\u00ec<br \/>\n\u0110\u00e1i th\u00e1o<br \/>\n\u0111\u01b0\u1eddng<br \/>\n\u0110\u1ed3ng m\u1eafc b\u1ec7nh<br \/>\nbao g\u1ed3m c\u1ea3 b\u1ec7nh\u00a0<a>gan<br \/>\nt\u00ecm \u1ea9n<\/a>[V1]\nCh\u1ec9 \u0111\u1ecbnh<br \/>\n\u0111i\u1ec1u tr\u1ecb<br \/>\nDILI, t\u1ed5n<br \/>\nth\u01b0\u01a1ng gan do thu\u1ed1c<\/td>\n<td>H\u00fat thu\u1ed1c<br \/>\nL\u1ea1m d\u1ee5ng<br \/>\nr\u01b0\u1ee3u<br \/>\nNhi\u1ec5m<br \/>\ntr\u00f9ng v\u00e0 vi\u00eam<\/td>\n<td>Li\u1ec1u d\u00f9ng<br \/>\nh\u1eb1ng ng\u00e0y<br \/>\nChuy\u1ec3n ho\u00e1<br \/>\nthu\u1ed1c<br \/>\nT\u00e1c d\u1ee5ng<br \/>\nthu\u1ed1c theo nh\u00f3m v\u00e0 nh\u1ea1y c\u1ea3m ch\u00e9o<br \/>\nT\u01b0\u01a1ng t\u00e1c<br \/>\nthu\u1ed1c v\u00e0 d\u00f9ng qu\u00e1 nhi\u1ec1u thu\u1ed1c<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>C\u01a0 CH\u1ebe<\/h2>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">DILI c\u00f3 th\u1ec3 g\u00e2y ra b\u1edfi \u0111\u1ed9c t\u00ednh c\u1ee7a thu\u1ed1c ho\u1eb7c c\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a trung gian, \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh beta-oxy ho\u00e1 acid b\u00e9o \u1edf ty th\u1ec3 v\u00e0 c\u00f2n c\u00f3 th\u1ec3 do c\u00e1c c\u01a1 ch\u1ebf qua trung gian mi\u1ec5n d\u1ecbch. M\u1eb7c d\u00f9 c\u00e1c c\u01a1 ch\u1ebf n\u00e0y l\u00e0 kh\u00e1c bi\u1ec7t, ch\u00fang c\u0169ng c\u00f3 th\u1ec3 li\u00ean quan v\u1edbi nhau (v\u00ed d\u1ee5: s\u1ef1 ph\u00e1 h\u1ee7y t\u1ebf b\u00e0o gan ban \u0111\u1ea7u do \u0111\u1ed9c t\u00ednh thu\u1ed1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u0103ng c\u01b0\u1eddng h\u01a1n n\u1eefa b\u1edfi c\u00e1c ph\u1ea3n \u1ee9ng vi\u00eam ti\u1ebfp theo). <em>Nh\u01b0 v\u1eady, thu\u1ed1c u\u1ed1ng chuy\u1ec3n h\u00f3a <\/em><em>\u0111\u00e1ng k\u1ec3 <\/em><em>\u1edf gan c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng d\u1eabn \u0111\u1ebfn DILI.<\/em><em><sup>[1]<\/sup><\/em><\/pre>\n<h2 class=\"m_1526039367295241923wp-block-preformatted\">CH\u1ea8N \u0110O\u00c1N<\/h2>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u x\u1ea3y ra sau khi s\u1eed d\u1ee5ng thu\u1ed1c (nh\u01b0 bu\u1ed3n n\u00f4n, ch\u00e1n \u0103n, kh\u00f3 ch\u1ecbu, m\u1ec7t m\u1ecfi, \u0111au h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, ho\u1eb7c ng\u1ee9a) c\u00f3 th\u1ec3 ch\u1ec9 ra \u0111\u1ed9c t\u00ednh c\u1ee7a thu\u1ed1c v\u00e0 c\u1ea7n nh\u1eafc nh\u1edf \u0111\u00e1nh gi\u00e1 DILI.<sup>[2]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">T\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1ee3c ph\u1ea3n \u00e1nh qua s\u1ef1 b\u1ea5t th\u01b0\u1eddng v\u1ec1 x\u00e9t nghi\u1ec7m gan (B\u1ea3ng 3). <sup>[2]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">B\u1ea3ng 3. B\u1ea5t th\u01b0\u1eddng v\u1ec1 x\u00e9t nghi\u1ec7m gan<\/pre>\n<table class=\"m_1526039367295241923wp-block-table\">\n<tbody>\n<tr>\n<td>T\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan<\/td>\n<td>T\u1ed5n th\u01b0\u01a1ng do \u1ee9 m\u1eadt<\/td>\n<\/tr>\n<tr>\n<td>\u2022T\u0103ng kh\u00f4ng c\u00e2n x\u1ee9ng trong aminotransferase huy\u1ebft thanh so v\u1edbi<br \/>\nphosphatase ki\u1ec1m.<\/td>\n<td>\u2022 T\u0103ng kh\u00f4ng c\u00e2n x\u1ee9ng trong phosphatase ki\u1ec1m so v\u1edbi aminotransferase<br \/>\nhuy\u1ebft thanh.<\/td>\n<\/tr>\n<tr>\n<td>\u2022 C\u00f3 th\u1ec3 t\u0103ng n\u1ed3ng \u0111\u1ed9 bilirubin trong huy\u1ebft thanh.<br \/>\n\u2022 C\u00e1c x\u00e9t nghi\u1ec7m v\u1ec1 ch\u1ee9c n\u0103ng t\u1ed5ng h\u1ee3p c\u00f3 th\u1ec3 b\u1ea5t th\u01b0\u1eddng.<sup>[2]<\/sup><\/td>\n<\/tr>\n<tr>\n<td>DILI c\u1ea5p t\u00ednh<\/td>\n<td>DILI m\u1ea1n t\u00ednh<\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 x\u00e9t nghi\u1ec7m gan kh\u00f4ng tri\u1ec7u ch\u1ee9ng, \u1ee9 m\u1eadt v\u00e0 ng\u1ee9a, b\u1ec7nh c\u1ea5p t\u00ednh v\u1edbi v\u00e0ng da gi\u1ed1ng vi\u00eam gan do virut v\u00e0 suy gan c\u1ea5p.<\/td>\n<td>C\u00f3 th\u1ec3 gi\u1ed1ng v\u1edbi c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c c\u1ee7a b\u1ec7nh gan m\u1ea1n t\u00ednh nh\u01b0 vi\u00eam gan t\u1ef1 mi\u1ec5n, x\u01a1 gan m\u1eadt nguy\u00ean ph\u00e1t, vi\u00eam \u0111\u01b0\u1eddng m\u1eadt x\u01a1 c\u1ee9ng ho\u1eb7c b\u1ec7nh gan do r\u01b0\u1ee3u.<\/td>\n<\/tr>\n<tr>\n<td>\u00a0DILI \u0111\u01b0\u1ee3c coi l\u00e0\u00a0<em>c\u1ea5p t\u00ednh<\/em>n\u1ebfu c\u00e1c x\u00e9t nghi\u1ec7m gan kh\u00f4ng b\u00ecnh th\u01b0\u1eddng &lt; 3 th\u00e1ng v\u00e0\u00a0<em>m\u1ea1n t\u00ednh<\/em>\u00a0n\u1ebfu c\u00e1c x\u00e9t nghi\u1ec7m gan b\u1ea5t th\u01b0\u1eddng &gt; 3 th\u00e1ng.<sup>[2]<\/sup><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">Ch\u1ea9n \u0111o\u00e1n DILI th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch thi\u1ebft l\u1eadp <em>m\u1ed1i quan h\u1ec7 t\u1ea1m th\u1eddi gi\u1eefa ph\u01a1i nhi\u1ec5m thu\u1ed1c v\u00e0 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh gan.<\/em><sup>[1]<\/sup> Ch\u1ea9n \u0111o\u00e1n DILI c\u00f3 th\u1ec3 kh\u00f3 kh\u0103n. N\u00f3 ph\u1ee5 thu\u1ed9c v\u00e0o vi\u1ec7c c\u00f3 \u0111\u01b0\u1ee3c m\u1ed9t ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c tin c\u1eady v\u00e0 lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n ti\u1ec1m \u1ea9n kh\u00e1c c\u1ee7a t\u1ed5n th\u01b0\u01a1ng gan. Kh\u00f4ng c\u00f3 d\u1ea5u \u1ea5n sinh h\u1ecdc huy\u1ebft thanh c\u1ee5 th\u1ec3 ho\u1eb7c c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m m\u00f4 h\u1ecdc \u0111\u1eb7c tr\u01b0ng \u0111\u00e1ng tin c\u1eady \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ed9t lo\u1ea1i thu\u1ed1c l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng gan.<sup>[2]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">M\u1ed9t bi\u1ec3u hi\u1ec7n quan tr\u1ecdng kh\u00e1c gi\u00fap x\u00e1c nh\u1eadn DILI l\u00e0 <em>s\u1ef1 <\/em><em>c\u1ea3i thi\u1ec7n sau khi ng\u1eebng thu\u1ed1c<\/em>. M\u1ed9t th\u1eed th\u00e1ch d\u00f9ng l\u1ea1i thu\u1ed1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n. Tuy nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng l\u1ea1i thu\u1ed1c kh\u00f4ng th\u1ef1c t\u1ebf trong th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng do nh\u1eefng lo ng\u1ea1i v\u1ec1 an to\u00e0n v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. <sup>[1]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">M\u1ed9t y\u1ebfu t\u1ed1 kh\u00e1c h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n DILI l\u00e0 t\u1ed5n th\u01b0\u01a1ng gan x\u1ea3y ra khi s\u1eed d\u1ee5ng <em>thu\u1ed1c c\u00f3 ti\u1ec1n s\u1eed g\u00e2y DILI<\/em> \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00e1c.<sup>[2]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<p><em>C\u00e1c<br \/>\nti\u00eau chu\u1ea9n h\u00f3a sinh l\u00e2m s\u00e0ng<\/em>\u00a0\u0111\u1ec3 x\u00e1c \u0111\u1ecbnh s\u1ef1 xu\u1ea5t hi\u1ec7n DILI bao g\u1ed3m \u00edt<br \/>\nnh\u1ea5t m\u1ed9t trong c\u00e1c ti\u00eau ch\u00ed sau (B\u1ea3ng 4):\u00a0<sup>[4]<\/sup><\/p>\n<p>B\u1ea3ng 4. C\u00e1c ti\u00eau chu\u1ea9n ho\u00e1 sinh l\u00e2m s\u00e0ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh DILI.<\/p>\n<table class=\"m_1526039367295241923wp-block-table\">\n<tbody>\n<tr>\n<td>Lo\u1ea1i 1<\/td>\n<td>Lo\u1ea1i 2<\/td>\n<td>Lo\u1ea1i 3<\/td>\n<\/tr>\n<tr>\n<td>T\u1ed5n<br \/>\nth\u01b0\u01a1ng t\u1ebf b\u00e0o gan<\/td>\n<td>T\u1ed5n<br \/>\nth\u01b0\u01a1ng m\u1eadt<\/td>\n<td>T\u1ed5n<br \/>\nth\u01b0\u01a1ng h\u1ed7n h\u1ee3p<\/td>\n<\/tr>\n<tr>\n<td>Ch\u1ec9<br \/>\nc\u00f3 ALT &gt; 2 ULN<br \/>\nho\u1eb7c<br \/>\nR \u2265 5.<\/td>\n<td>Ch\u1ec9<br \/>\nc\u00f3 ALT &gt; 2 ULN<br \/>\nho\u1eb7c<br \/>\nR \u2264 2<\/td>\n<td>ALT<br \/>\n&gt; 2 ULN v\u00e0 ALP t\u0103ng,<br \/>\nv\u1edbi<br \/>\n2 &lt; R &lt; 5<\/td>\n<\/tr>\n<tr>\n<td><em>*<\/em><em>\u00a0ALT = alanine aminotransferase;\u00a0<\/em><em>ALP =\u00a0<\/em><em>phosphatase ki\u1ec1m<\/em><em>;\u00a0<\/em><em>ULN = gi\u1edbi h\u1ea1n<\/em><em>tr\u00ean\u00a0<\/em><em>b\u00ecnh th\u01b0\u1eddng.<\/em><br \/>\n<em>* R = (ALT)\/(ALP)<\/em><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>C\u1ea7n l\u01b0u \u00fd, lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng v\u00e0 c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u00f3<br \/>\nth\u1ec3 thay \u0111\u1ed5i \u0111\u1ed1i v\u1edbi c\u00f9ng m\u1ed9t thu\u1ed1c.<\/p>\n<h2>THANG \u0110O L\u00c2M S\u00c0NG<\/h2>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">V\u00ec th\u00e1ch th\u1ee9c ch\u00ednh l\u00e0 thi\u1ebft l\u1eadp m\u1ed1i quan h\u1ec7 nh\u00e2n qu\u1ea3 gi\u1eefa m\u1ed9t lo\u1ea1i thu\u1ed1c nh\u1ea5t \u0111\u1ecbnh v\u00e0 t\u1ed5n th\u01b0\u01a1ng gan, m\u1ed9t s\u1ed1 <em>thang \u0111o l\u00e2m s\u00e0ng<\/em> \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n. C\u00e1c ti\u00eau ch\u00ed ch\u1ea5m \u0111i\u1ec3m d\u1ef1a tr\u00ean m\u1ed1i quan h\u1ec7 theo th\u1eddi gian gi\u1eefa vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c\/ng\u01b0ng thu\u1ed1c v\u00e0 hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng, qu\u00e1 tr\u00ecnh ph\u1ea3n \u1ee9ng l\u00e2m s\u00e0ng, lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n ti\u1ec1m n\u0103ng kh\u00e1c v\u00e0 th\u1eed th\u00e1ch d\u00f9ng l\u1ea1i thu\u1ed1c. <sup>[1]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">Ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 nguy\u00ean nh\u00e2n Rousse Uclaf c\u1ee7a H\u1ed9i \u0111\u1ed3ng khoa h\u1ecdc y t\u1ebf qu\u1ed1c t\u1ebf (RUCAM\/CIOMS) l\u00e0 ti\u00eau ch\u00ed \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng <em>th\u01b0\u1eddng xuy\u00ean nh\u1ea5t<\/em> \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n DILI. Ngo\u00e0i c\u00e1c ti\u00eau ch\u00ed \u0111\u00e3 n\u00f3i \u1edf tr\u00ean, <em>thang \u0111o RUCAM\/CIOMS<\/em> c\u00f2n ghi nh\u1eadn \u0111\u01b0\u1ee3c m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 r\u1ee7i ro <em>(tu\u1ed5i, u\u1ed1ng r\u01b0\u1ee3u v\u00e0 mang thai) <\/em>v\u00e0 t\u00e1ch DILI th\u00e0nh ba lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u1edf tr\u00ean: t\u1ebf b\u00e0o gan, \u1ee9 m\u1eadt v\u00e0 h\u1ed7n h\u1ee3p. <sup>[1]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><em>H\u1ec7 th\u1ed1ng ch\u1ea5m \u0111i\u1ec3m Maria v\u00e0 Victorino (M&amp;V)<\/em> \u0111\u01a1n gi\u1ea3n h\u00f3a c\u00e1ch ti\u1ebfp c\u1eadn b\u1eb1ng c\u00e1ch ch\u1ec9 s\u1eed d\u1ee5ng n\u0103m trong s\u1ed1 b\u1ea3y ti\u00eau ch\u00ed c\u1ee7a thang RUCAM\/CIOMS, nh\u01b0ng c\u0169ng xem x\u00e9t s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c bi\u1ec3u hi\u1ec7n ngo\u00e0i gan nh\u01b0 s\u1ed1t, ph\u00e1t ban, \u0111au kh\u1edbp, t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan. M\u1ed9t nh\u01b0\u1ee3c \u0111i\u1ec3m ch\u00ednh c\u1ee7a thang \u0111i\u1ec3m M&amp;V l\u00e0 s\u1ef1 thi\u1ebfu s\u00f3t trong m\u00f4 h\u00ecnh t\u1ed5n th\u01b0\u01a1ng gan. Ngo\u00e0i ra, thang \u0111o M&amp;V kh\u00f4ng nh\u1ea1y trong ch\u1ea9n \u0111o\u00e1n c\u00e1c d\u1ea1ng DILI m\u1ea1n t\u00ednh v\u00e0 vi\u00eam gan do thu\u1ed1c t\u1ed1i c\u1ea5p n\u00ean kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u nh\u01b0 thang \u0111o RUCAM\/CIOMS.<sup>[1]<\/sup><\/pre>\n<h2 class=\"m_1526039367295241923wp-block-preformatted\">\u0110I\u1ec0U TR\u1eca<\/h2>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u0110i\u1ec1u tr\u1ecb ch\u00ednh cho t\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c (DILI) l\u00e0 <em>ng\u1eebng thu\u1ed1c nghi ng\u1edd<\/em>. Nh\u1eadn bi\u1ebft s\u1edbm \u0111\u1ed9c t\u00ednh c\u1ee7a thu\u1ed1c l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 cho ph\u00e9p \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng v\u00e0 theo d\u00f5i b\u1ec7nh suy gan c\u1ea5p t\u00ednh. <sup>[1]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">B\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i b\u1eb1ng c\u00e1c x\u00e9t nghi\u1ec7m li\u00ean ti\u1ebfp cho \u0111\u1ebfn khi x\u00e9t nghi\u1ec7m gan tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng. H\u1ed9i ch\u1ea9n v\u1ec1 gan n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t n\u1ebfu c\u00f3 lo ng\u1ea1i r\u1eb1ng b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 b\u1ecb suy gan c\u1ea5p t\u00ednh (v\u00ed d\u1ee5, n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u b\u1ec7nh n\u00e3o gan ho\u1eb7c r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u), c\u00f3 d\u1ea5u hi\u1ec7u b\u1ec7nh gan m\u1ea1n t\u00ednh, ho\u1eb7c khi kh\u00f4ng ch\u1eafc ch\u1eafn ch\u1ea9n \u0111o\u00e1n sau \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u. Ngo\u00e0i ra, b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n suy gan c\u1ea5p t\u00ednh n\u00ean \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ebfn trung t\u00e2m gh\u00e9p gan s\u1edbm. <sup>[1]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">M\u1ed9t s\u1ed1 h\u1ec7 th\u1ed1ng t\u00ednh \u0111i\u1ec3m kh\u00e1c nhau \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c \u1ee9ng c\u1eed vi\u00ean cho vi\u1ec7c gh\u00e9p gan. <em>Ti\u00eau chu\u1ea9n c\u1ee7a \u0110\u1ea1i h\u1ecdc King<\/em> v\u1ec1 b\u1ec7nh suy gan c\u1ea5p t\u00ednh chia b\u1ec7nh nh\u00e2n th\u00e0nh hai nh\u00f3m, t\u00f9y thu\u1ed9c v\u00e0o nguy\u00ean nh\u00e2n (B\u1ea3ng 5) v\u00e0 r\u1ea5t h\u1eefu \u00edch \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n b\u1ec7nh nh\u00e2n n\u00e0o s\u1ebd s\u1ed1ng s\u00f3t v\u00e0 b\u1ec7nh nh\u00e2n n\u00e0o s\u1ebd c\u1ea7n gh\u00e9p gan.<sup>[1]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">B\u1ea3ng 5. Ti\u00eau ch\u00ed c\u1ee7a \u0110\u1ea1i h\u1ecdc King \u0111\u1ed1i v\u1edbi vi\u1ec7c gh\u00e9p gan<\/pre>\n<table class=\"m_1526039367295241923wp-block-table\">\n<tbody>\n<tr>\n<td>N\u1ebfu do paracetamol<\/td>\n<td>N\u1ebfu kh\u00f4ng ph\u1ea3i do paracetamol<\/td>\n<\/tr>\n<tr>\n<td>pH&lt;7.3<\/td>\n<td>INR &gt; 6,5 \/ PT&gt; 100 gi\u00e2y ho\u1eb7c b\u1ea5t k\u1ef3 ba trong s\u1ed1 nh\u1eefng k\u1ebft qu\u1ea3 sau \u0111\u00e2y:<\/td>\n<\/tr>\n<tr>\n<td>Axit lactic &gt; 3,5mM sau 8 gi\u1edd<\/td>\n<td>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 INR &gt; 3,4 \/ PT&gt; 50 gi\u00e2y<\/td>\n<\/tr>\n<tr>\n<td>Axit lactic &gt; 3.0mM sau 12 gi\u1edd<\/td>\n<td>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bilirubin &gt; 17,5mg \/ dl<\/td>\n<\/tr>\n<tr>\n<td>Creatinine&gt; \u00a03,4mg \/ dl<\/td>\n<td>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 V\u00e0ng da trong &gt; 7 ng\u00e0y<\/td>\n<\/tr>\n<tr>\n<td>INR &gt; 6,5 \/ PT &gt; 100 gi\u00e2y<\/td>\n<td>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tu\u1ed5i t\u1eeb 10 \u0111\u1ebfn 40<\/td>\n<\/tr>\n<tr>\n<td>B\u1ec7nh n\u00e3o c\u1ea5p \u0111\u1ed9 3 ho\u1eb7c 4<\/td>\n<td>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 C\u0103n nguy\u00ean: ph\u1ea3n \u1ee9ng thu\u1ed1c ho\u1eb7c kh\u00f4ng r\u00f5<\/td>\n<\/tr>\n<tr>\n<td><em>* X\u00e9t nghi\u1ec7m INR \/ PT (International Normalized Ratio \/ Prothrombin Time) l\u00e0 x\u00e9t nghi\u1ec7m m\u00e1u gi\u00fap \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 ho\u1eb7c th\u1eddi gian h\u00ecnh th\u00e0nh c\u00e1c c\u1ee5c m\u00e1u \u0111\u00f4ng.<\/em><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><em>\u00a0<\/em><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">TI\u00caN L\u01af\u1ee2NG B\u1ec6NH<\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 T\u1ed5n th\u01b0\u01a1ng gan c\u1ea5p t\u00ednh<\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">Ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n b\u1ecb DILI s\u1ebd ph\u1ee5c h\u1ed3i ho\u00e0n to\u00e0n sau khi <em>ng\u1eebng thu\u1ed1c nghi ng\u1edd.<\/em> Trong tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng \u1ee9 m\u1eadt, tri\u1ec7u ch\u1ee9ng v\u00e0ng da c\u00f3 th\u1ec3 m\u1ea5t v\u00e0i tu\u1ea7n \u0111\u1ebfn v\u00e0i th\u00e1ng \u0111\u1ec3 ph\u1ee5c h\u1ed3i. <sup>[2]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><em>C\u00e1c y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng k\u00e9m h\u01a1n \u1edf b\u1ec7nh nh\u00e2n b\u1ecb t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan bao g\u1ed3m:<\/em><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><em>\u00a0<\/em><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00a7\u00a0 S\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a v\u00e0ng da: bilirubin &gt;2 l\u1ea7n ULN trong tr\u01b0\u1eddng h\u1ee3p ALT &gt;3 l\u1ea7n ULN, (\"\u0110\u1ecbnh lu\u1eadt Hy\"*). T\u1ef7 l\u1ec7 t\u1eed vong trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u00f3 th\u1ec3 l\u00ean t\u1edbi 14% (80% n\u1ebfu suy gan c\u1ea5p t\u00ednh ph\u00e1t tri\u1ec3n v\u00e0 b\u1ec7nh nh\u00e2n kh\u00f4ng tr\u1ea3i qua gh\u00e9p gan).Tuy nhi\u00ean, nh\u1eefng b\u1ec7nh nh\u00e2n h\u1ed3i ph\u1ee5c sau DILI c\u1ea5p t\u00ednh v\u1edbi v\u00e0ng da th\u01b0\u1eddng c\u00f3 ti\u00ean l\u01b0\u1ee3ng thu\u1eadn l\u1ee3i, m\u1eb7c d\u00f9 m\u1ed9t s\u1ed1 ng\u01b0\u1eddi ti\u1ebfp t\u1ee5c ti\u1ebfn tri\u1ec3n l\u00ean b\u1ec7nh gan m\u1ea1n t\u00ednh.<\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u25cf Suy gan c\u1ea5p do thu\u1ed1c tr\u1ecb \u0111\u1ed9ng kinh \u1edf tr\u1ebb em.<\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u25cf Suy gan c\u1ea5p do paracetamol c\u1ea7n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o.<\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u25cf Creatinine huy\u1ebft thanh t\u0103ng.<\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u25cf S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a b\u1ec7nh gan t\u1eeb tr\u01b0\u1edbc.<\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><em>* \u0110\u1ecbnh lu\u1eadt Hy: quan s\u00e1t \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi Hyman Zimmerman cho th\u1ea5y nguy c\u01a1 t\u1eed vong do DILI l\u00e0 1\/10 n\u1ebfu \u0111\u00e1p \u1ee9ng ba ti\u00eau ch\u00ed sau:<\/em><\/pre>\n<ol>\n<li><em>ALT huy\u1ebft thanh &gt; 3 \u00d7 ULN<\/em><em>.<\/em><\/li>\n<li><em>Bilirubin huy\u1ebft thanh t\u0103ng<\/em><em>\u00a0<\/em><em>&gt; 2 \u00d7 ULN, kh\u00f4ng c\u00f3 ph\u00e1t hi\u1ec7n ban \u0111\u1ea7u v\u1ec1 \u1ee9 m\u1eadt.<\/em><\/li>\n<li><em>Kh\u00f4ng c\u00f3 l\u00fd do n\u00e0o kh\u00e1c \u0111\u1ec3 gi\u1ea3i th\u00edch s\u1ef1 t\u0103ng\u00a0<\/em><em>l\u00ean c\u1ee7a c\u1ea3\u00a0<\/em><em>ALT v\u00e0<br \/>\nbilirubin,\u00a0<\/em><em>(<\/em><em>ch\u1eb3ng h\u1ea1n<br \/>\nnh\u01b0 vi\u00eam gan si\u00eau vi A, B, C, b\u1ec7nh gan t\u1eeb tr\u01b0\u1edbc ho\u1eb7c b\u1ec7nh c\u1ea5p t\u00ednh kh\u00e1c<\/em><em>).\u00a0<sup>[5]<\/sup><\/em><\/li>\n<\/ol>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00a7\u00a0 Ti\u00ean l\u01b0\u1ee3ng t\u1ed5ng th\u1ec3 cho t\u1ed5n th\u01b0\u01a1ng \u1ee9 m\u1eadt ho\u00e0n to\u00e0n t\u1ed1t h\u01a1n so v\u1edbi t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan, m\u1eb7c d\u00f9 c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1eed vong \u0111\u00e3 t\u1eebng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o.<\/pre>\n<ul>\n<li>Gan nhi\u1ec5m m\u1ee1 c\u1ea5p t\u00ednh do thu\u1ed1c (tho\u00e1i h\u00f3a m\u1ee1)\u00a0l\u00e0 kh\u00f4ng ph\u1ed5 bi\u1ebfn v\u00e0 \u00edt x\u1ea3y ra h\u01a1n so v\u1edbi nhi\u1ec5m m\u1ee1 m\u1ea1n t\u00ednh.<br \/>\nV\u00e0ng da th\u01b0\u1eddng nh\u1eb9 v\u00e0 aminotransferase huy\u1ebft thanh th\u1ea5p h\u01a1n so v\u1edbi t\u1ed5n th\u01b0\u01a1ng g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o.\u00a0<sup>[2]<\/sup><\/li>\n<\/ul>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 T\u1ed5n th\u01b0\u01a1ng gan m\u1ea1n t\u00ednh<\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">T\u1ed5n th\u01b0\u01a1ng m\u1ea1n t\u00ednh th\u01b0\u1eddng \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft khi ng\u1eebng s\u1eed d\u1ee5ng thu\u1ed1c nghi ng\u1edd, nh\u01b0ng s\u1ef1 t\u1ed5n th\u01b0\u01a1ng gan n\u00e0y c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n th\u00e0nh x\u01a1 gan v\u00e0 suy gan. \u1ee8 m\u1eadt c\u00f3 th\u1ec3 k\u00e9o d\u00e0i, c\u1ea7n v\u00e0i th\u00e1ng (&gt; 3 th\u00e1ng) \u0111\u1ec3 tr\u1ecb kh\u1ecfi. S\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh m\u1ea1n t\u00ednh \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o x\u1ea3y ra trong kho\u1ea3ng 5-10% c\u00e1c ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i c\u1ee7a thu\u1ed1c v\u00e0 ph\u1ed5 bi\u1ebfn h\u01a1n trong c\u00e1c lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng \u1ee9 m\u1eadt\/h\u1ed7n h\u1ee3p. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n b\u1ecb \u1ee9 m\u1eadt m\u1ea1n t\u00ednh ph\u00e1t tri\u1ec3n th\u00e0nh h\u1ed9i ch\u1ee9ng \u1ed1ng m\u1eadt bi\u1ebfn m\u1ea5t (vanishing bile duct syndrome \u2013 VBDS). Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, b\u1ec7nh k\u00e9o d\u00e0i d\u1eabn \u0111\u1ebfn m\u1ea5t \u1ed1ng d\u1eabn m\u1eadt v\u00e0 gi\u1ea3m \u1ed1ng d\u1eabn tr\u1ee9ng. Trong m\u1ed9t s\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p, ti\u1ebfn tri\u1ec3n th\u00e0nh x\u01a1 gan v\u00e0 cu\u1ed1i c\u00f9ng l\u00e0 suy gan. <sup>[2]<\/sup><\/pre>\n<h2 class=\"m_1526039367295241923wp-block-preformatted\">C\u00c1C THU\u1ed0C TH\u01af\u1edcNG G\u00c2Y T\u1ed4N TH\u01af\u01a0NG GAN<\/h2>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">H\u01b0\u1edbng d\u1eabn th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng c\u1ee7a Tr\u01b0\u1eddng Ti\u00eau ho\u00e1 Hoa K\u1ef3 n\u0103m 2014 c\u0169ng \u0111\u00e3 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c nh\u00f3m thu\u1ed1c th\u01b0\u1eddng g\u00e2y DILI v\u00e0 th\u1eddi gian t\u1eeb khi d\u00f9ng thu\u1ed1c \u0111\u1ebfn khi c\u00f3 DILI (th\u1eddi gian ti\u1ec1m t\u00e0ng) \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong B\u1ea3ng 6.<\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">B\u1ea3ng 6. C\u00e1c thu\u1ed1c th\u01b0\u1eddng g\u00e2y t\u1ed5n th\u01b0\u01a1ng gan <sup>[5]<\/sup><\/pre>\n<table class=\"m_1526039367295241923wp-block-table\">\n<tbody>\n<tr>\n<td>Nh\u00f3m thu\u1ed1c<\/td>\n<td>Thu\u1ed1c<\/td>\n<td>Th\u1eddi gian ti\u1ec1m t\u00e0ng<\/td>\n<td>Lo\u1ea1i DILI<\/td>\n<\/tr>\n<tr>\n<td>Kh\u00e1ng<br \/>\nsinh<\/td>\n<td>Amoxicilin\/clavulanat<\/td>\n<td>Ng\u1eafn \u0111\u1ebfn trung b\u00ecnh<\/td>\n<td>TTM, c\u00f3 th\u1ec3 l\u00e0<br \/>\nTTTBG<\/td>\n<\/tr>\n<tr>\n<td>Isoniazid<\/td>\n<td>Trung b\u00ecnh \u0111\u1ebfn d\u00e0i<\/td>\n<td>TTTBG c\u1ea5p t\u00ednh<\/td>\n<\/tr>\n<tr>\n<td>Trimethoprim\/<br \/>\nsulfamethoxazol<\/td>\n<td>Ng\u1eafn \u0111\u1ebfn trung b\u00ecnh<\/td>\n<td>TTM, c\u00f3 th\u1ec3 l\u00e0<br \/>\nTTTBG<\/td>\n<\/tr>\n<tr>\n<td>Fluoroquinolon<\/td>\n<td>Ng\u1eafn<\/td>\n<td>TTTBG, TTM ho\u1eb7c<br \/>\nTTHH<\/td>\n<\/tr>\n<tr>\n<td>Macrolid<\/td>\n<td>Ng\u1eafn<\/td>\n<td>TTTBG, c\u00f3 th\u1ec3 l\u00e0<br \/>\nTTM<\/td>\n<\/tr>\n<tr>\n<td>Thu\u1ed1c<br \/>\n\u0111i\u1ec1u<br \/>\ntr\u1ecb nhi\u1ec5m<br \/>\ntr\u00f9ng \u0111\u01b0\u1eddng<br \/>\nti\u1ec3u<\/td>\n<td>C\u1ea5p<br \/>\nT\u00ednh<\/td>\n<td>Ng\u1eafn<\/td>\n<td>TTTBG<\/td>\n<\/tr>\n<tr>\n<td>M\u1ea1n t\u00ednh<\/td>\n<td>Trung b\u00ecnh \u0111\u1ebfn d\u00e0i<\/td>\n<td>TTTBG<\/td>\n<\/tr>\n<tr>\n<td>Minocyclin<\/td>\n<td>Trung b\u00ecnh \u0111\u1ebfn d\u00e0i<\/td>\n<td>TTTBG<\/td>\n<\/tr>\n<tr>\n<td>Thu\u1ed1c<br \/>\nch\u1ed1ng<br \/>\n\u0111\u1ed9ng<br \/>\nkinh<\/td>\n<td>Phenytoin<\/td>\n<td>Ng\u1eafn \u0111\u1ebfn trung b\u00ecnh<\/td>\n<td>TTTBG, TTM ho\u1eb7c<br \/>\nTTHH<\/td>\n<\/tr>\n<tr>\n<td>Carbamazepin<\/td>\n<td>Trung b\u00ecnh<\/td>\n<td>TTTBG, TTM ho\u1eb7c<br \/>\nTTHH<\/td>\n<\/tr>\n<tr>\n<td>Lamotrigin<\/td>\n<td>Trung b\u00ecnh<\/td>\n<td>TTTBG<\/td>\n<\/tr>\n<tr>\n<td>Valproat<\/td>\n<td>Trung b\u00ecnh \u0111\u1ebfn d\u00e0i<\/td>\n<td>TTTBG<\/td>\n<\/tr>\n<tr>\n<td>Thu\u1ed1c gi\u1ea3m \u0111au<\/td>\n<td>NSAIDs<\/td>\n<td>Trung b\u00ecnh \u0111\u1ebfn d\u00e0i<\/td>\n<td>TTTBG<\/td>\n<\/tr>\n<tr>\n<td>\u00a0Thu\u1ed1c \u0111i\u1ec1u bi\u1ebfn mi\u1ec5n d\u1ecbch<\/td>\n<td>Interferon-\u03b2<\/td>\n<td>Trung b\u00ecnh \u0111\u1ebfn d\u00e0i<\/td>\n<td>TTTBG<\/td>\n<\/tr>\n<tr>\n<td>Interferon-\u03b1<\/td>\n<td>Trung b\u00ecnh<\/td>\n<td>TTTBG<\/td>\n<\/tr>\n<tr>\n<td>Thu\u1ed1c kh\u00e1ng TNF<\/td>\n<td>Trung b\u00ecnh \u0111\u1ebfn d\u00e0i<\/td>\n<td>TTTBG<\/td>\n<\/tr>\n<tr>\n<td>Azathioprin<\/td>\n<td>Trung b\u00ecnh \u0111\u1ebfn d\u00e0i<\/td>\n<td>TTTBG, TTM<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Thu\u1ed1c kh\u00e1c<\/td>\n<td>Methotrexat (u\u1ed1ng)<\/td>\n<td>D\u00e0i<\/td>\n<td>Gan nhi\u1ec5m m\u1ee1 ho\u1eb7c<br \/>\nx\u01a1 h\u00f3a<\/td>\n<\/tr>\n<tr>\n<td>Allopurinol<\/td>\n<td>Ng\u1eafn \u0111\u1ebfn trung b\u00ecnh<\/td>\n<td>TTTBG ho\u1eb7c TTHH<\/td>\n<\/tr>\n<tr>\n<td>Androgen ch\u1ee9a<br \/>\nkhung<br \/>\nsteroid<\/td>\n<td>Ng\u1eafn \u0111\u1ebfn trung b\u00ecnh<\/td>\n<td>TTTBG ho\u1eb7c TTHH<\/td>\n<\/tr>\n<tr>\n<td>Amiodaron<br \/>\n(u\u1ed1ng)<\/td>\n<td>Trung b\u00ecnh \u0111\u1ebfn d\u00e0i<\/td>\n<td>TTTBG, TTM ho\u1eb7c<br \/>\nTTHH<\/td>\n<\/tr>\n<tr>\n<td>Thu\u1ed1c m\u00ea d\u1ea1ng h\u00edt<\/td>\n<td>Ng\u1eafn<\/td>\n<td>TTTBG<\/td>\n<\/tr>\n<tr>\n<td>Sulfasalazin<\/td>\n<td>Ng\u1eafn \u0111\u1ebfn trung b\u00ecnh<\/td>\n<td>TTHH, TTTBG, TTM<\/td>\n<\/tr>\n<tr>\n<td>\u1ee8c ch\u1ebf b\u01a1m proton<\/td>\n<td>Ng\u1eafn<\/td>\n<td>TTTBG<\/td>\n<\/tr>\n<tr>\n<td>Th\u1ea3o<br \/>\nd\u01b0\u1ee3c<\/td>\n<td><\/td>\n<td>Ng\u1eafn,<br \/>\ntrung b\u00ecnh \u0111\u1ebfn<br \/>\nd\u00e0i<\/td>\n<td>TTHH, ho\u1eb7c TTTBG,<br \/>\nho\u1eb7c TTM<\/td>\n<\/tr>\n<tr>\n<td><em>*Th\u1eddi gian ti\u1ec1m t\u00e0ng (th\u1eddi gian t\u1eeb<br \/>\nkhi d\u00f9ng thu\u1ed1c \u0111\u1ebfn khi ghi nh\u1eadn bi\u1ebfn c\u1ed1):<\/em><br \/>\n<em>ng\u1eafn = 3 &#8211; 30 ng\u00e0y, trung b\u00ecnh =<br \/>\n30 &#8211; 90 ng\u00e0y, d\u00e0i &gt; 90 ng\u00e0y.<\/em><br \/>\n<em>*Ch\u1eef vi\u1ebft t\u1eaft: TTM: t\u1ed5n th\u01b0\u01a1ng m\u1eadt, TTTBG: t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan, TTHH: t\u1ed5n th\u01b0\u01a1ng gan h\u1ed7n h\u1ee3p<\/em><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">C\u00e1c thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng gan \u1edf c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y kh\u00e1 chi ti\u1ebft trong c\u01a1 s\u1edf d\u1eef li\u1ec7u h\u1ed3i c\u1ee9u c\u1ee7a WHO v\u00e0 tr\u00ean trang web LiverTox. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y cho th\u1ea5y m\u1ed9t s\u1ed1 thu\u1ed1c nh\u01b0 paracetamol, troglitazon, valproat, stavudin v\u00e0 amoxcilin\/clavulanat \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u00e0 c\u00f3 t\u1ef7 l\u1ec7 g\u00e2y t\u1ed5n th\u01b0\u01a1ng gan cao nh\u1ea5t. Nh\u00f3m thu\u1ed1c th\u01b0\u1eddng g\u00e2y t\u1ed5n th\u01b0\u01a1ng gan bao g\u1ed3m thu\u1ed1c kh\u00e1ng sinh, thu\u1ed1c tr\u1ecb lao, thu\u1ed1c tr\u1ecb \u0111\u1ed9ng kinh, thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, thu\u1ed1c tr\u1ecb ung th\u01b0,...<sup>[4]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Paracetamol: l\u00e0 v\u00ed d\u1ee5 kinh \u0111i\u1ec3n c\u1ee7a DILI c\u1ea5p t\u00ednh, \u0111\u1ed9c t\u00ednh ph\u1ee5 thu\u1ed9c li\u1ec1u v\u00e0 chi\u1ebfm s\u1ed1 l\u01b0\u1ee3ng l\u1edbn nh\u1ea5t trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p g\u00e2y t\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c. C\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u bao g\u1ed3m l\u00e0m r\u1ed7ng d\u1ea1 d\u00e0y b\u1eb1ng c\u00e1ch th\u1ee5t r\u1eeda d\u1ea1 d\u00e0y ho\u1eb7c d\u00f9ng si-r\u00f4 ipeca v\u00e0 u\u1ed1ng than ho\u1ea1t t\u00ednh trong v\u00f2ng b\u1ed1n gi\u1edd \u0111\u1ea7u. <em>N-acetyl-cysteine<\/em> \u200b\u200bl\u00e0 thu\u1ed1c gi\u1ea3i \u0111\u1ed9c \u0111\u1eb7c hi\u1ec7u c\u00f3 th\u1ec3 d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch. B\u1ec7nh nh\u00e2n h\u1ed3i ph\u1ee5c sau nhi\u1ec5m \u0111\u1ed9c paracetamol kh\u00f4ng c\u00f3 di ch\u1ee9ng gan l\u00e2u d\u00e0i. C\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m \u0111\u1ed9c paracetamol nghi\u00eam tr\u1ecdng c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n th\u00e0nh suy gan c\u1ea5p t\u00ednh, v\u00e0 nhu c\u1ea7u gh\u00e9p gan \u0111\u01b0\u1ee3c d\u1ef1 \u0111o\u00e1n theo Ti\u00eau ch\u00ed c\u1ee7a \u0110\u1ea1i h\u1ecdc King.<sup>[1]<\/sup> (B\u1ea3ng 2)<\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Thu\u1ed1c g\u00e2y m\u00ea: DILI do Halothane g\u00e2y ra th\u01b0\u1eddng x\u1ea3y ra sau nhi\u1ec1u l\u1ea7n ph\u01a1i nhi\u1ec5m v\u00e0 \u0111\u01b0\u1ee3c cho l\u00e0 do c\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 l\u00e0 s\u1ed1t v\u00e0 v\u00e0ng da sau khi d\u00f9ng thu\u1ed1c. S\u1ef1 ph\u00e1 h\u1ee7y t\u1ebf b\u00e0o gan \u0111\u01b0\u1ee3c ph\u1ea3n \u00e1nh b\u1edfi transaminase huy\u1ebft thanh t\u0103ng cao v\u00e0 s\u1ef1 gia t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan cho th\u1ea5y ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch. K\u1ebft qu\u1ea3 sinh thi\u1ebft c\u00f3 th\u1ec3 bao g\u1ed3m t\u1eeb th\u00e2m nhi\u1ec5m b\u1ea1ch c\u1ea7u \u0111\u1ebfn ho\u1ea1i t\u1eed gan l\u1edbn. H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec1u nh\u1eb9, nh\u01b0ng suy gan c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 x\u1ea3y ra, c\u00f3 kh\u1ea3 n\u0103ng ph\u1ea3i gh\u00e9p gan.<sup>[1]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Thu\u1ed1c tr\u1ecb vi\u00eam kh\u00f4ng steroid <em>(<\/em><em>Nonsteroidal anti-inflammatory drugs<\/em><em>\u00a0- NSAIDs)<\/em>: Do s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i, NSAID c\u0169ng l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n quan tr\u1ecdng g\u00e2y nhi\u1ec5m \u0111\u1ed9c gan. Diclofenac, \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u nhi\u1ec1u nh\u1ea5t trong nh\u00f3m n\u00e0y. S\u1eed d\u1ee5ng diclofenac l\u00e2u d\u00e0i c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 ALT t\u0103ng trong b\u1ed1n th\u00e1ng \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u1ed9c t\u00ednh nghi\u00eam tr\u1ecdng c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o. B\u00ean c\u1ea1nh diclofenac, bromfenac, nimesulide v\u00e0 sulindac l\u00e0 nh\u1eefng ch\u1ea5t NSAID th\u01b0\u1eddng g\u1eb7p nh\u1ea5t g\u00e2y nhi\u1ec5m \u0111\u1ed9c gan d\u1eabn \u0111\u1ebfn suy gan c\u1ea5p t\u00ednh. Sulindac v\u00e0 ibuprofen c\u00f3 li\u00ean quan \u0111\u1ebfn DILI \u1ee9 m\u1eadt, c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c sau khi ng\u1eebng thu\u1ed1c, m\u1eb7c d\u00f9 c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1eed vong c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o.<sup>[1]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kh\u00e1ng sinh kh\u00e1c: nh\u00f3m Beta-lactam, nh\u01b0 nh\u00f3m penicillin v\u00e0 nh\u00f3m cephalosporin, th\u01b0\u1eddng li\u00ean quan t\u1edbi DILI. S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf beta-lactamase <em>(axit clavulanic)<\/em> l\u00e0m t\u0103ng \u0111\u00e1ng k\u1ec3 t\u1ea7n su\u1ea5t c\u1ee7a c\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i d\u1eabn \u0111\u1ebfn \u1ee9 m\u1eadt ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng gan h\u1ed7n h\u1ee3p. DILI g\u00e2y ra b\u1edfi c\u00e1c h\u1ee3p ch\u1ea5t <em>acid clavulanic<\/em> th\u01b0\u1eddng \u0111\u01b0\u1ee3c bi\u1ec3u hi\u1ec7n qua v\u00e0ng da c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c \u0111\u01b0\u1ee3c, th\u1eadm ch\u00ed c\u00e1c tr\u01b0\u1eddng h\u1ee3p nghi\u00eam tr\u1ecdng c\u1ea7n gh\u00e9p gan ho\u1eb7c d\u1eabn \u0111\u1ebfn t\u1eed vong c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o.<sup>[1]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Thu\u1ed1c tr\u1ecb n\u1ea5m: Ketoconazole v\u00e0 c\u00e1c azole kh\u00e1c c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 nhi\u1ec5m \u0111\u1ed9c gan. B\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c tr\u1ecb n\u1ea5m c\u1ea7n theo d\u00f5i c\u1ea9n th\u1eadn v\u00e0 n\u00ean ng\u1eebng thu\u1ed1c ngay n\u1ebfu men gan t\u0103ng cao \u0111\u1ed9t ng\u1ed9t. N\u1ebfu kh\u00f4ng x\u1eed l\u00fd ngay c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng gan nghi\u00eam tr\u1ecdng v\u00e0 t\u1eed vong.<sup>[1]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0110i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat HIV: C\u00f3 t\u1edbi 18% b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p kh\u00e1ng retrovirus ho\u1ea1t t\u00ednh cao <em>(<\/em>highly active antiretroviral therapy <em>- <\/em><em>HAART)<\/em> d\u1eabn \u0111\u1ebfn DILI. Nguy c\u01a1 t\u0103ng l\u00ean khi u\u1ed1ng r\u01b0\u1ee3u, tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng cao tu\u1ed5i hay n\u1eef gi\u1edbi. Ngo\u00e0i ra, \u0111\u1ed3ng nhi\u1ec5m HBV v\u00e0 HCV l\u00e0m t\u0103ng c\u1ea3 t\u1ea7n su\u1ea5t v\u00e0 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng gan. Trong s\u1ed1 c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y, ritonavir l\u00e0 li\u00ean quan th\u01b0\u1eddng xuy\u00ean nh\u1ea5t v\u1edbi nhi\u1ec5m \u0111\u1ed9c gan.<sup>[1]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<ul>\n<li>Th\u1ea3o<br \/>\nd\u01b0\u1ee3c ho\u1eb7c ph\u01b0\u01a1ng thu\u1ed1c truy\u1ec1n th\u1ed1ng:\u00a0C\u00e1c th\u1ea3o d\u01b0\u1ee3c \u0111ang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i v\u00e0 bi\u1ec3u hi\u1ec7n v\u1ec1 g\u00e2y \u0111\u1ed9c cho gan \u0111\u01b0\u1ee3c ghi nh\u1eadn ng\u00e0y c\u00e0ng nhi\u1ec1u. Kh\u00e1c<br \/>\nv\u1edbi c\u00e1c thu\u1ed1c k\u00ea \u0111\u01a1n v\u00e0 kh\u00f4ng k\u00ea \u0111\u01a1n ch\u1ee9a c\u00e1c th\u00e0nh ph\u1ea7n c\u00f3 ho\u1ea1t t\u00ednh v\u00e0 kh\u00f4ng<br \/>\nho\u1ea1t t\u00ednh \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i r\u00f5 r\u00e0ng, th\u00e0nh ph\u1ea7n c\u1ee7a c\u00e1c\u00a0ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3c\u00a0th\u01b0\u1eddng r\u1ea5t thay<br \/>\n\u0111\u1ed5i\u00a0<em>(kh\u00e1c nhau v\u1ec1 hi\u1ec7u l\u1ef1c c\u1ee7a th\u00e0nh ph\u1ea7n<br \/>\nc\u00f3 ho\u1ea1t t\u00ednh c\u0169ng nh\u01b0 t\u1ea1p ch\u1ea5t)<\/em>. C\u00e1c s\u1ea3n ph\u1ea9m n\u00e0y c\u0169ng thi\u1ebfu s\u1ef1 gi\u00e1m s\u00e1t,<br \/>\nqu\u1ea3n l\u00fd, g\u00e2y kh\u00f3 kh\u0103n trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 DILI. M\u1ed9t s\u1ed1 ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n<br \/>\nph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3c li\u00ean quan \u0111\u1ebfn DILI v\u00e0 ph\u1ea3n \u1ee9ng l\u1eb7p l\u1ea1i sau khi t\u00e1i<br \/>\ns\u1eed d\u1ee5ng s\u1ea3n ph\u1ea9m bao g\u1ed3m s\u1ea3n ph\u1ea9m chi\u1ebft xu\u1ea5t t\u1eeb tr\u00e0 xanh, c\u00e1c glycosid t\u1eeb phan<br \/>\nt\u1ea3 di\u1ec7p, rau m\u00e1\u00a0<em>(Centella asiatica),<\/em>\u00a0c\u00e2y Ho\u00e0ng li\u00ean l\u1edbn, v\u1ecf<br \/>\nh\u1ea1t m\u00e3 \u0111\u1ec1 (isabgol) v\u00e0 Venencapsan.<sup>[3]<\/sup><\/li>\n<\/ul>\n<pre class=\"m_1526039367295241923wp-block-preformatted\"><\/pre>\n<h2 class=\"m_1526039367295241923wp-block-preformatted\">C\u00c1C NGU\u1ed2N TH\u00d4NG TIN TRA C\u1ee8U DILI<\/h2>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">M\u1ed9t s\u1ed1 trang web, \u1ee9ng d\u1ee5ng \u0111\u00e1ng tin c\u1eady c\u00f3 th\u1ec3 d\u00f9ng \u0111\u1ec3 tra c\u1ee9u, \u0111\u00e1nh gi\u00e1 DILI (B\u1ea3ng 7).<\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">B\u1ea3ng 7. Ngu\u1ed3n tra c\u1ee9u DILI<\/pre>\n<table class=\"m_1526039367295241923wp-block-table\">\n<tbody>\n<tr>\n<td>Web, \u1ee8ng d\u1ee5ng<\/td>\n<td>Gi\u1edbi thi\u1ec7u<\/td>\n<\/tr>\n<tr>\n<td>C\u01a1 s\u1edf h\u1ed3i c\u1ee9u d\u1eef li\u1ec7u c\u1ee7a WHO<\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>LiverTox<\/td>\n<td>Th\u00f4ng tin c\u1eadp nh\u1eadt v\u00e0 to\u00e0n di\u1ec7n v\u1ec1 t\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c c\u1ee7a Th\u01b0 vi\u1ec7n Qu\u1ed1c gia Y khoa Hoa K\u1ef3.<\/td>\n<\/tr>\n<tr>\n<td>Micromedex<\/td>\n<td>\u1ee8ng d\u1ee5ng cung c\u1ea5p th\u00f4ng tin thu\u1ed1c.<\/td>\n<\/tr>\n<tr>\n<td>DILIrank<\/td>\n<td>Th\u00f4ng tin v\u1ec1 1036 thu\u1ed1c \u0111\u01b0\u1ee3c FDA ph\u00ea duy\u1ec7t v\u00e0 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo nguy c\u01a1 DILI ti\u1ec1m t\u00e0ng.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">PH\u00d2NG NG\u1eeaA<\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <em>Giai \u0111o\u1ea1n ti\u1ec1n l\u00e2m s\u00e0ng v\u00e0 l\u00e2m s\u00e0ng<\/em><em>:<\/em> ph\u00e1t hi\u1ec7n \u0111\u1ed9c t\u00ednh tr\u00ean \u0111\u1ed9ng v\u1eadt ho\u1eb7c m\u00f4 h\u00ecnh t\u1ebf b\u00e0o, ph\u00e2n t\u00edch \u0111\u1ed9c t\u00ednh tr\u00ean ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kho\u1ebb m\u1ea1nh. <sup>[4]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <em>Giai \u0111o\u1ea1n sau khi thu\u1ed1c \u0111\u01b0\u1ee3c \u0111\u01b0a ra th\u1ecb tr\u01b0\u1eddng:<\/em> tr\u00e1nh t\u00e1i s\u1eed d\u1ee5ng thu\u1ed1c nghi ng\u1edd, kh\u00f4ng d\u00f9ng \u0111\u1ed3ng th\u1eddi nhi\u1ec1u lo\u1ea1i thu\u1ed1c, ch\u00fa \u00fd \u0111\u1ebfn b\u1ec7nh nh\u00e2n cao tu\u1ed5i v\u00e0 b\u1ec7nh nh\u00e2n nhi\u1ec5m HIV. B\u00ean c\u1ea1nh \u0111\u00f3, ch\u00fa \u00fd theo d\u00f5i x\u00e9t nghi\u1ec7m ALT, AST (Aspartat amino transferase)\u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng gan s\u1edbm v\u00e0 c\u00f3 bi\u1ec7n ph\u00e1p x\u1eed l\u00ed k\u1ecbp th\u1eddi. <sup>[4]<\/sup><\/pre>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <em>Th\u00f4ng tin cho<\/em><em> b\u1ec7nh nh\u00e2n<\/em> khi d\u00f9ng thu\u1ed1c g\u00e2y \u0111\u1ed9c t\u1edbi gan (v\u00ed d\u1ee5, paracetamol) v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng an to\u00e0n, bao g\u1ed3m c\u1ea3 li\u1ec1u l\u01b0\u1ee3ng th\u00edch h\u1ee3p v\u00e0 kh\u1ea3 n\u0103ng t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c ho\u1eb7c r\u01b0\u1ee3u. B\u1ec7nh nh\u00e2n c\u0169ng n\u00ean \u0111\u01b0\u1ee3c c\u1ea3nh b\u00e1o v\u1ec1 c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng gan. <sup>[2]<\/sup><\/pre>\n<h2 class=\"m_1526039367295241923wp-block-preformatted\">K\u1ebeT LU\u1eacN<\/h2>\n<pre class=\"m_1526039367295241923wp-block-preformatted\">T\u1ed5n th\u01b0\u01a1ng gan c\u00f3 th\u1ec3 x\u1ea3y ra sau khi s\u1eed d\u1ee5ng nhi\u1ec1u lo\u1ea1i thu\u1ed1c. C\u00f3 nhi\u1ec1u c\u01a1 s\u1edf d\u1eef li\u1ec7u t\u00ecm ki\u1ebfm v\u1ec1 thu\u1ed1c, thu\u1ed1c th\u1ea3o d\u01b0\u1ee3c v\u00e0 ch\u1ebf ph\u1ea9m b\u1ed5 sung li\u00ean quan \u0111\u1ebfn DILI. <sup>[2]<\/sup> \u0110i\u1ec1u tr\u1ecb ch\u00ednh cho DILI l\u00e0 <em>ng\u1eebng thu\u1ed1c nghi ng\u1edd<\/em> v\u00e0 theo d\u00f5i \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o c\u00e1c x\u00e9t nghi\u1ec7m gan l\u00e0 b\u00ecnh th\u01b0\u1eddng. <sup>[2]<\/sup> Ph\u1ee5c h\u1ed3i s\u1ebd x\u1ea3y ra \u1edf ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n m\u1eafc DILI sau khi <em>ng\u1eebng thu\u1ed1c nghi ng\u1edd<\/em>. <sup>[2]<\/sup> H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p DILI l\u00e0 l\u00e0nh t\u00ednh, v\u00e0 c\u1ea3i thi\u1ec7n sau khi ng\u1eebng thu\u1ed1c. D\u01b0\u1ee3c s\u0129 \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c ng\u0103n ng\u1eeba DILI v\u00e0 x\u00e1c \u0111\u1ecbnh c\u00e1c thu\u1ed1c nghi ng\u1edd g\u00e2y DILI \u0111\u1ec3 g\u00f3p ph\u1ea7n gi\u00fap b\u1ec7nh nh\u00e2n k\u1ecbp th\u1eddi ng\u1eebng s\u1eed d\u1ee5ng m\u1ed9t c\u00e1ch s\u1edbm nh\u1ea5t.<sup>[1]<\/sup><\/pre>\n<h2 class=\"m_1526039367295241923wp-block-preformatted\">T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/h2>\n<p>1.\u00a0\u00a0\u00a0\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=David%20S%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=21874146\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term%3DDavid%2520S%255BAuthor%255D%26cauthor%3Dtrue%26cauthor_uid%3D21874146&amp;source=gmail&amp;ust=1551804501765000&amp;usg=AFQjCNFodS0VK8NpnEi9Tp9ptSo_59qzqw\">Stefan David<\/a>and\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Hamilton%20JP%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=21874146\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term%3DHamilton%2520JP%255BAuthor%255D%26cauthor%3Dtrue%26cauthor_uid%3D21874146&amp;source=gmail&amp;ust=1551804501765000&amp;usg=AFQjCNGCqRE6Inhm8kYNUZECX2tNIpONcg\">James P Hamilton<\/a>(2010). Drug-induced Liver Injury.<\/p>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3160634\/\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3160634\/&amp;source=gmail&amp;ust=1551804501765000&amp;usg=AFQjCNHQX_rGycRhBmpPwh_PyniyVqgo1g\">https:\/\/www.ncbi.nlm.nih.gov\/<wbr \/>pmc\/articles\/PMC3160634\/<\/a><\/p>\n<p>2.\u00a0\u00a0\u00a0\u00a0<a href=\"https:\/\/www.uptodate.com\/contents\/drug-induced-liver-injury\/contributors\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/www.uptodate.com\/contents\/drug-induced-liver-injury\/contributors&amp;source=gmail&amp;ust=1551804501765000&amp;usg=AFQjCNEN43H3A8ggkLB-8H7VkZAzL8IpmA\">Anne M Larson<\/a><br \/>\n(2017).\u00a0 Drug-induced Liver Injury.<\/p>\n<p><a href=\"https:\/\/www.uptodate.com\/contents\/drug-induced-liver-injury\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/www.uptodate.com\/contents\/drug-induced-liver-injury&amp;source=gmail&amp;ust=1551804501765000&amp;usg=AFQjCNHyRIRUSa_dH8XmSJc9xohZwMzTiQ\">https:\/\/www.uptodate.com\/<wbr \/>contents\/drug-induced-liver-<wbr \/>injury<\/a><\/p>\n<ul>\n<li>\u0110\u00e0m Th\u1ecb Thanh H\u01b0\u01a1ng, L\u01b0\u01a1ng Anh T\u00f9ng (2010). T\u1ed5ng<br \/>\nquan v\u1ec1 t\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c.<\/li>\n<\/ul>\n<figure class=\"m_1526039367295241923wp-block-embed\">\n<div class=\"m_1526039367295241923wp-block-embed__wrapper\"><a href=\"http:\/\/magazine.canhgiacduoc.org.vn\/Magazine\/Details\/181\" target=\"_blank\" rel=\"nofollow noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=http:\/\/magazine.canhgiacduoc.org.vn\/Magazine\/Details\/181&amp;source=gmail&amp;ust=1551804501765000&amp;usg=AFQjCNGJ9MsuI-apglfzOBVcp4tRJYh-dQ\">http:\/\/magazine.canhgiacduoc.<wbr \/>org.vn\/Magazine\/Details\/181<\/a><\/div>\n<\/figure>\n<ul>\n<li>Tr\u1ea7n Th\u1ecb Ng\u1ecdc<br \/>\n(2016). T\u1ea7m so\u00e1t t\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c th\u00f4ng qua k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m<br \/>\ns\u00e0ng t\u1ea1i b\u1ec7nh vi\u1ec7n H\u1eefu Ngh\u1ecb.<\/li>\n<\/ul>\n<figure class=\"m_1526039367295241923wp-block-embed\">\n<div class=\"m_1526039367295241923wp-block-embed__wrapper\"><a href=\"http:\/\/canhgiacduoc.org.vn\/SiteData\/3\/UserFiles\/KLTN%202016%20Tran%20Thi%20Ngoc.pdf\" target=\"_blank\" rel=\"nofollow noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=http:\/\/canhgiacduoc.org.vn\/SiteData\/3\/UserFiles\/KLTN%25202016%2520Tran%2520Thi%2520Ngoc.pdf&amp;source=gmail&amp;ust=1551804501766000&amp;usg=AFQjCNFRF8EeAH2rfd-pu5OqpeBMTp57OQ\">http:\/\/canhgiacduoc.org.vn\/<wbr \/>SiteData\/3\/UserFiles\/KLTN%<wbr \/>202016%20Tran%20Thi%20Ngoc.pdf<\/a><\/div>\n<\/figure>\n<p>5.\u00a0\u00a0Naga P. Chalasani, et al. Fontana MD6 on behalf of the Practice Parameters Committee of the American College of<br \/>\nGastroenterology (2014). Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury.<\/p>\n<figure class=\"m_1526039367295241923wp-block-embed-wordpress m_1526039367295241923wp-block-embed m_1526039367295241923is-type-wp-embed m_1526039367295241923is-provider-american-college-of-gastroenterology\">\n<p class=\"m_1526039367295241923wp-block-embed__wrapper\"><a href=\"https:\/\/gi.org\/guideline\/diagnosis-and-management-of-idiosyncratic-drug-induced-liver-injury\/\" target=\"_blank\" rel=\"nofollow noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/gi.org\/guideline\/diagnosis-and-management-of-idiosyncratic-drug-induced-liver-injury\/&amp;source=gmail&amp;ust=1551804501766000&amp;usg=AFQjCNHgKQtXvtDfMcxbnjM3yTfB9KTeMA\">https:\/\/gi.org\/guideline\/<wbr \/>diagnosis-and-management-of-<wbr \/>idiosyncratic-drug-induced-<wbr \/>liver-injury\/<\/a><\/p>\n<\/figure>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>SV. Nguy\u1ec5n Thanh Huy\u1ec1n, TS.DS. V\u00f5 Th\u1ecb H\u00e0 &#8211; Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Y khoa Ph\u1ea1m Ng\u1ecdc Th\u1ea1ch. GI\u1edaI THI\u1ec6U Gan l\u00e0 c\u01a1 quan \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh chuy\u1ec3n ho\u00e1 thu\u1ed1c. Ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i c\u1ee7a thu\u1ed1c l\u00e0 nguy\u00ean nh\u00e2n quan tr\u1ecdng d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng gan.\u00a0T\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c (DILI)\u00a0l\u00e0 [&#8230;]\n","protected":false},"author":1,"featured_media":3942,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3940","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\/3940","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=3940"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/3940\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/3942"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=3940"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=3940"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=3940"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}