(T\u00e1c gi\u1ea3: Jiacai Cho, Sze Chin Jong, Siok Bian Ng. \u0110\u0103ng t\u1ea3i ng\u00e0y 26\/6\/2018 tr\u00ean JAMA)<\/p>\n
B\u1ec7nh nh\u00e2n n\u1eef, 38 tu\u1ed5i, ti\u1ec1n s\u1eed ch\u01b0a ph\u00e1t hi\u1ec7n g\u00ec \u0111\u1eb7c bi\u1ec7t, b\u1ec7nh di\u1ec5n bi\u1ebfn 10 ng\u00e0y v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng s\u1ed1t, ph\u00f9 chi d\u01b0\u1edbi v\u00e0 quanh h\u1ed1c m\u1eaft. Kh\u00f4ng ho, kh\u00f4ng kh\u00f3 th\u1edf, kh\u00f4ng c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ec1 ti\u00eau ho\u00e1 hay ti\u1ebft ni\u1ec7u. B\u1ec7nh nh\u00e2n tr\u01b0\u1edbc \u0111\u00f3 kh\u00f4ng \u0111i du l\u1ecbch v\u00e0 kh\u00f4ng ti\u1ebfp x\u00fac v\u1edbi ng\u01b0\u1eddi \u1ed1m. Ti\u1ec1n s\u1eed s\u1ea3n ph\u1ee5 khoa v\u00e0 gia \u0111\u00ecnh kh\u00f4ng c\u00f3 g\u00ec \u0111\u1eb7c bi\u1ec7t. Th\u00e2n nhi\u1ec7t \u0111o \u0111\u01b0\u1ee3c l\u00e0 40 \u0111\u1ed9 C; nh\u1ecbp tim 100 l\u1ea7n\/ ph\u00fat; huy\u1ebft \u00e1p 130\/ 80 mmHg. H\u1ea1ch to v\u00f9ng c\u1ed5 2 b\u00ean, kh\u00f4ng c\u1ee9ng, ph\u00f9 chi d\u01b0\u1edbi \u1ea5n l\u00f5m 1+. Kh\u00e1m c\u00e1c c\u01a1 quan b\u1ed9 ph\u1eadn kh\u00e1c kh\u00f4ng c\u00f3 g\u00ec \u0111\u1eb7c bi\u1ec7t.<\/p>\n
C\u00f4ng th\u1ee9c m\u00e1u: b\u1ea1ch c\u1ea7u 1,040 G\/L (b\u1ea1ch c\u1ea7u trung t\u00ednh 0,540 G\/L; b\u1ea1ch c\u1ea7u lympho 0,39 G\/L), hemoglobin 9,6 g\/dL (\u0111\u1eb3ng s\u1eafc, h\u1ed3ng c\u1ea7u b\u00ecnh th\u01b0\u1eddng), ti\u1ec3u c\u1ea7u 228 G\/L. H\u1ed3ng c\u1ea7u l\u01b0\u1edbi 8,1 G\/L (gi\u1edbi h\u1ea1n tham chi\u1ebfu 38,3 – 110,5 G\/L). ALT 322 U\/L, AST 161 U\/L, LDH 2183 U\/L. Ch\u1ee9c n\u0103ng th\u1eadn, n\u1ed3ng \u0111\u1ed9 phosphatase ki\u1ec1m v\u00e0 bilirubin b\u00ecnh th\u01b0\u1eddng. Ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u: 4 b\u1ea1ch c\u1ea7u\/ vi tr\u01b0\u1eddng (HPF), 16 h\u1ed3ng c\u1ea7u\/ HPF, 1 t\u1ebf b\u00e0o bi\u1ec3u m\u00f4\/ HPF v\u00e0 kh\u00f4ng c\u00f3 tr\u1ee5 ni\u1ec7u. C\u1ea5y m\u00e1u v\u00e0 c\u1ea5y n\u01b0\u1edbc ti\u1ec3u \u00e2m t\u00ednh. Protein ni\u1ec7u to\u00e0n ph\u1ea7n 0,7 g\/dL. Ferritin 4779 ng\/mL (gi\u1edbi h\u1ea1n tham chi\u1ebfu 10-120 ng\/mL). Fibrinogen 45,2 mg\/dL, D-dimer 1,8 mg\/L. X\u00e9t nghi\u1ec7m virus vi\u00eam gan, HIV, lao, parvovirus B19 et EBV \u00e2m t\u00ednh. IgM kh\u00e1ng CMV d\u01b0\u01a1ng t\u00ednh nh\u01b0ng CMV DNA \u00e2m t\u00ednh. Kh\u00e1ng th\u1ec3 kh\u00e1ng nh\u00e2n hi\u1ec7u gi\u00e1 1\/640. C3 (b\u1ed5 th\u1ec3) 72 mg\/dL (gi\u1edbi h\u1ea1n tham chi\u1ebfu 85-185), C4 b\u00ecnh th\u01b0\u1eddng. Anti-dsDNA d\u01b0\u01a1ng t\u00ednh v\u1edbi n\u1ed3ng \u0111\u1ed9 188 IU\/mL (gi\u1edbi h\u1ea1n tham chi\u1ebfu <100). Si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c cho th\u1ea5y ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i b\u00ecnh th\u01b0\u1eddng. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh th\u1ea5y h\u00ecnh \u1ea3nh h\u1ea1ch c\u1ed5 v\u00e0 h\u1ea1ch n\u00e1ch to nh\u01b0ng kh\u00f4ng th\u1ea5y l\u00e1ch to. Sinh thi\u1ebft h\u1ea1ch lympho v\u00f9ng c\u1ed5 th\u1ea5y h\u00ecnh \u1ea3nh vi\u00eam m\u00f4 t\u1ebf b\u00e0o ho\u1ea1i t\u1eed. \u0110o d\u00f2ng t\u1ebf b\u00e0o th\u1ea5y ki\u1ec3u h\u00ecnh t\u1ebf b\u00e0o B v\u00e0 T kh\u00f4ng theo d\u00f2ng. B\u1ec7nh nh\u00e2n c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c sinh thi\u1ebft tu\u1ef7 (xem h\u00ecnh).<\/p>\n
L\u00e0m g\u00ec ti\u1ebfp theo cho b\u1ec7nh nh\u00e2n?<\/p>\n
A. \u0110i\u1ec1u tr\u1ecb nhi\u1ec5m CMV b\u1eb1ng ganciclovir.
\nB. B\u1eaft \u0111\u1ea7u d\u00f9ng corticoid li\u1ec1u cao.
\nC. Ch\u1ee5p c\u1eaft l\u1edbp ph\u00e1t x\u1ea1 positron.
\nD. Ti\u1ebfn h\u00e0nh sinh thi\u1ebft l\u00e1ch.
\n———————————————————-
\n\u0110\u00e1p \u00e1n: B. B\u1eaft \u0111\u1ea7u d\u00f9ng corticoid li\u1ec1u cao.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n: Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng (SLE) k\u00e8m h\u1ed9i ch\u1ee9ng ho\u1ea1t ho\u00e1 \u0111\u1ea1i th\u1ef1c b\u00e0o (MAS)<\/p>\n
Ch\u1ea9n \u0111o\u00e1n \u0111\u00fang h\u1ed9i ch\u1ee9ng ho\u1ea1t ho\u00e1 \u0111\u1ea1i th\u1ef1c b\u00e0o (MAS) \u0111\u01b0\u1ee3c x\u00e1c th\u1ef1c b\u1eb1ng hi\u1ec7n t\u01b0\u1ee3ng th\u1ef1c b\u00e0o c\u00e1c t\u1ebf b\u00e0o sinh m\u00e1u khi sinh thi\u1ebft tu\u1ef7 x\u01b0\u01a1ng, c\u00f9ng v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng gi\u1ea3m c\u00e1c d\u00f2ng t\u1ebf b\u00e0o m\u00e1u, t\u0103ng enzym gan v\u00e0 t\u0103ng ferritin m\u00e1u. C\u00e1c tri\u1ec7u ch\u1ee9ng s\u1ed1t, h\u1ea1ch to v\u00e0 th\u1ef1c b\u00e0o t\u1ebf b\u00e0o m\u00e1u c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a MAS, c\u00f3 th\u1ec3 nh\u1ea5t l\u00e0 do lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng (SLE), \u0111\u01b0\u1ee3c \u1ee7ng h\u1ed9 b\u1edfi x\u00e9t nghi\u1ec7m ANA v\u00e0 anti-dsDNA c\u00f9ng v\u1edbi bilan nhi\u1ec5m tr\u00f9ng \u00e2m t\u00ednh v\u00e0 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 b\u1ec7nh l\u00fd t\u0103ng sinh lympho b\u00e0o. Hi\u1ec7n t\u01b0\u1ee3ng ph\u00f9 quanh h\u1ed1c m\u1eaft v\u00e0 ph\u00f9 \u1ea5n l\u00f5m c\u00f3 th\u1ec3 l\u00e0 do tho\u00e1t protein qua \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u trong SLE, hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y c\u00f3 th\u1ec3 n\u1eb7ng n\u1ec1 h\u01a1n trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a b\u1ec7nh. \u00cdt c\u00e2n nh\u1eafc h\u01a1n \u0111\u1ebfn kh\u1ea3 n\u0103ng vi\u00eam h\u1ea1ch lympho Kikuchi (b\u1ec7nh vi\u00eam h\u1ea1ch ho\u1ea1i t\u1eed m\u00f4 t\u1ebf b\u00e0o bi\u1ec3u hi\u1ec7n b\u1eb1ng s\u1ed1t, h\u1ea1ch to v\u00e0 gi\u1ea3m b\u1ea1ch c\u1ea7u), v\u00ec ANA v\u00e0 anti-dsDNA d\u01b0\u01a1ng t\u00ednh m\u1ea1nh. \u0110i\u1ec1u tr\u1ecb ganciclovir (ph\u01b0\u01a1ng \u00e1n A) l\u00e0 kh\u00f4ng h\u1ee3p l\u00ed ngay c\u1ea3 khi IgM CMV d\u01b0\u01a1ng t\u00ednh v\u00ec kh\u00f4ng th\u1ea5y virus trong m\u00e1u v\u00e0 x\u00e9t nghi\u1ec7m tu\u1ef7 x\u01b0\u01a1ng kh\u00f4ng th\u1ea5y virus. \u0110\u00e3 ghi nh\u1eadn nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p x\u00e9t nghi\u1ec7m mi\u1ec5n d\u1ecbch d\u01b0\u01a1ng t\u00ednh gi\u1ea3, \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u1edbi CMV tr\u00ean b\u1ec7nh nh\u00e2n SLE v\u00e0 \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch b\u1eb1ng s\u1ef1 g\u1eafn ch\u00e9o c\u1ee7a c\u00e1c kh\u00e1ng th\u1ec3 \u0111a ph\u1ea3n \u1ee9ng khi ho\u1ea1t ho\u00e1 nhi\u1ec1u d\u00f2ng t\u1ebf b\u00e0o lympho B [1,2]. Ch\u1ee5p c\u1eaft l\u1edbp ph\u00e1t x\u1ea1 positron (ph\u01b0\u01a1ng \u00e1n C) kh\u00f4ng th\u1ec3 gi\u00fap \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n \u0111\u1eb7c hi\u1ec7u. Sinh thi\u1ebft l\u00e1ch (ph\u01b0\u01a1ng \u00e1n D) kh\u00f4ng th\u1ec3 gi\u00fap cung c\u1ea5p th\u00eam th\u00f4ng tin v\u00ec \u0111\u00e3 l\u00e0m sinh thi\u1ebft h\u1ea1ch lympho v\u00e0 tu\u1ef7 x\u01b0\u01a1ng.<\/p>\n
MAS l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00ed \u0111\u1eb7c tr\u01b0ng b\u1edfi ph\u1ea3n \u1ee9ng vi\u00eam qu\u00e1 m\u1ee9c, khi \u0111\u00f3 b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n s\u1ed1t, h\u1ea1ch to, gi\u1ea3m t\u1ebf b\u00e0o m\u00e1u, gan l\u00e1ch to, t\u0103ng ferritin huy\u1ebft thanh, gi\u1ea3m fibrinogen m\u00e1u v\u00e0 t\u0103ng triglycerid m\u00e1u [3,4]. MAS l\u00e0 m\u1ed9t d\u01b0\u1edbi nh\u00f3m c\u1ee7a b\u1ec7nh l\u00ed m\u00f4 t\u1ebf b\u00e0o lympho c\u00f3 th\u1ef1c b\u00e0o t\u1ebf b\u00e0o m\u00e1u (HLH) kh\u1edfi ph\u00e1t do c\u00e1c b\u1ec7nh l\u00ed kh\u1edbp nh\u01b0 vi\u00eam kh\u1edbp v\u00f4 c\u0103n \u1edf tu\u1ed5i thi\u1ebfu ni\u00ean, SLE v\u00e0 b\u1ec7nh Still kh\u1edfi ph\u00e1t \u1edf tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh [5]. C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c c\u1ee7a HLH bao g\u1ed3m b\u1ec7nh l\u00ed t\u0103ng sinh lympho b\u00e0o v\u00e0 nhi\u1ec5m virus (nh\u01b0 c\u00fam, herpes simplex v\u00e0 EBV) [4]. M\u1eb7c d\u00f9 \u0111\u00e3 x\u00e2y d\u1ef1ng ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n cho HLH, ch\u00fang kh\u00f4ng \u00e1p d\u1ee5ng \u0111\u01b0\u1ee3c cho MAS v\u00ec c\u00f3 m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 nh\u01b0 s\u1ed1t v\u00e0 gi\u1ea3m t\u1ebf b\u00e0o m\u00e1u th\u01b0\u1eddng g\u1eb7p trong b\u1ec7nh kh\u1edbp b\u1ea5t k\u1ec3 c\u00f3 xu\u1ea5t hi\u1ec7n MAS hay kh\u00f4ng [4].<\/p>\n
MAS c\u00f3 t\u1ec9 l\u1ec7 m\u1eafc cao t\u1eeb 8% \u0111\u1ebfn 60% [3,5,6]. C\u01a1 ch\u1ebf b\u1ec7nh sinh bao g\u1ed3m (1) gi\u1ea3m ch\u1ee9c n\u0103ng li gi\u1ea3i t\u1ebf b\u00e0o c\u1ee7a t\u1ebf b\u00e0o di\u1ec7t t\u1ef1 nhi\u00ean do gi\u1ea3m bi\u1ec3u hi\u1ec7n gen perforin (PRF1) [7,8]; t\u0103ng c\u01b0\u1eddng c\u00e1c t\u1ebf b\u00e0o lympho T g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o s\u1ea3n xu\u1ea5t cytokine ho\u1ea1t ho\u00e1 \u0111\u1ea1i th\u1ef1c b\u00e0o, trong \u0111\u00f3 c\u00f3 IFN gamma [7,8]; (3) bi\u1ec7t ho\u00e1 \u0111\u1ea1i th\u1ef1c b\u00e0o theo \u0111\u01b0\u1eddng kh\u00e1c [8]; v\u00e0 (4) n\u1ed3ng \u0111\u1ed9 interleukin (IL)-18 t\u0103ng cao [4]. \u1ede b\u1ec7nh nh\u00e2n m\u1eafc SLE va c\u00e1c b\u1ec7nh t\u1ef1 mi\u1ec5n kh\u00e1c, MAS c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n do t\u0103ng cytokine m\u00e1u khi b\u1ec7nh kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t. Th\u00e2m nhi\u1ec5m c\u00e1c lympho b\u00e0o ho\u1ea1t ho\u00e1 v\u00e0o gan v\u00e0 l\u00e1ch bi\u1ec3u hi\u1ec7n th\u00e0nh gan l\u00e1ch to v\u00e0 t\u0103ng enzyme gan.<\/p>\n
MAS g\u00e2y bi\u1ebfn ch\u1ee9ng \u1edf 0,9% \u0111\u1ebfn 4,6% c\u00e1c tr\u01b0\u1eddng h\u1ee3p SLE v\u00e0 c\u00f3 th\u1ec3 l\u00e0 \u0111\u1eb7c \u0111i\u1ec3m bi\u1ec3u hi\u1ec7n b\u1ec7nh [9]. Ch\u1ea9n \u0111o\u00e1n MAS \u1edf SLE r\u1ea5t kh\u00f3 kh\u0103n. \u0110\u1ea7u ti\u00ean, gi\u1ea3m c\u00e1c d\u00f2ng t\u1ebf b\u00e0o m\u00e1u hay g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n SLE v\u00e0 n\u1eb1m trong ti\u00eau chu\u1ea9n ph\u00e2n lo\u1ea1i SLICC (Systemic Lupus International Collaborating Clinics) [10]. Tuy nhi\u00ean, ph\u1ea3i ngh\u0129 t\u1edbi MAS khi xu\u1ea5t hi\u1ec7n s\u1ed1t cao, h\u1ea1ch to, t\u0103ng enzyme gan, t\u0103ng ferritin m\u00e1u ho\u1eb7c t\u0103ng LDH [6,8]. Hai l\u00e0, c\u1ea7n lo\u1ea1i tr\u1eeb nhi\u1ec5m tr\u00f9ng, \u0111i\u1ec1u c\u0169ng c\u00f3 th\u1ec3 g\u00e2y MAS trong SLE [5,6]. Ba l\u00e0, b\u1ea3n ch\u1ea5t kh\u00e1ng th\u1ec3 \u0111a ph\u1ea3n \u1ee9ng bi\u1ec3u hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n SLE c\u00f3 th\u1ec3 g\u00e2y d\u01b0\u01a1ng t\u00ednh gi\u1ea3 x\u00e9t nghi\u1ec7m huy\u1ebft thanh h\u1ecdc virus, l\u00e0m sai l\u1ec7ch ch\u1ea9n \u0111o\u00e1n [1,2]. M\u1eb7c d\u00f9 b\u1ec7nh nh\u00e2n n\u00e0y kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u hay tri\u1ec7u ch\u1ee9ng ban \u0111\u1ecf b\u00ean ngo\u00e0i (ANA v\u00e0 ds-DNA c\u00f3 t\u00ednh g\u1ee3i \u00fd nh\u01b0ng kh\u00f4ng \u0111\u1ea1t gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n), b\u1ec7nh nh\u00e2n sau \u0111\u00f3 \u0111\u00e3 xu\u1ea5t hi\u1ec7n ban vi\u00eam m\u1ea1ch \u1edf chi d\u01b0\u1edbi gi\u00fap ngh\u0129 nhi\u1ec1u h\u01a1n t\u1edbi SLE.<\/p>\n
Hi\u1ec7n ch\u01b0a th\u1ed1ng nh\u1ea5t v\u1ec1 x\u1eed tr\u00ed MAS trong SLE. H\u1ea7u h\u1ebft b\u00e1c s\u0129 l\u00e2m s\u00e0ng \u0111\u1ec1u s\u1eed d\u1ee5ng li\u1ec1u cao corticosteroid, cyclosporine, cyclophosphamide, immunoglobulin t\u0129nh m\u1ea1ch, ho\u1eb7c protocol HLH 2004 bao g\u1ed3m cyclosporine, dexamethasone, v\u00e0 etoposide [7]. Rituximab c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u00e0nh c\u00f4ng trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u00e1ng tr\u1ecb [6].<\/p>\n
K\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb: B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c cho li\u1ec1u pulse methylprednisolone sau \u0111\u00f3 l\u00e0 prednisolone (1 mg\/kg). B\u1ec7nh nh\u00e2n nhanh ch\u00f3ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb, bi\u1ec3u hi\u1ec7n b\u1eb1ng h\u1ebft s\u1ed1t, c\u00f4ng th\u1ee9c m\u00e1u v\u00e0 enzym gan tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u00eam hydroxychloroquine v\u00e0 cyclosporine. Sau \u0111\u00f3 gi\u1ea3m d\u1ea7n li\u1ec1u prednisolone v\u00e0 v\u1eabn \u0111\u1ea1t lui b\u1ec7nh.
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\nT\u00e0i li\u1ec7u tham kh\u1ea3o<\/p>\n
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2. Santosa A, Poh Z, Teng GG. Delayed diagnosis of systemic lupus erythematosus due to misinterpretation of dengue serology. Scand J Rheumatol. 2012;41(1):77-79.<\/p>\n
3. Ravelli A, Minoia F, Dav\u00ec S, et al. 2016 classification criteria for macrophage activation syndrome complicating systemic juvenile idiopathic arthritis. Ann Rheum Dis. 2016;75(3):481-489.<\/p>\n
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<\/p>\n
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(T\u00e1c gi\u1ea3: Jiacai Cho, Sze Chin Jong, Siok Bian Ng. \u0110\u0103ng t\u1ea3i ng\u00e0y 26\/6\/2018 tr\u00ean JAMA) B\u1ec7nh nh\u00e2n n\u1eef, 38 tu\u1ed5i, ti\u1ec1n s\u1eed ch\u01b0a ph\u00e1t hi\u1ec7n g\u00ec \u0111\u1eb7c bi\u1ec7t, b\u1ec7nh di\u1ec5n bi\u1ebfn 10 ng\u00e0y v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng s\u1ed1t, ph\u00f9 chi d\u01b0\u1edbi v\u00e0 quanh h\u1ed1c m\u1eaft. Kh\u00f4ng ho, kh\u00f4ng kh\u00f3 th\u1edf, kh\u00f4ng c\u00f3 c\u00e1c tri\u1ec7u […]\n","protected":false},"author":1,"featured_media":4105,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-4104","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\/4104","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=4104"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/4104\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/4105"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=4104"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=4104"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=4104"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}