{"id":5307,"date":"2019-03-23T11:12:18","date_gmt":"2019-03-23T04:12:18","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=5307"},"modified":"2019-03-23T11:12:18","modified_gmt":"2019-03-23T04:12:18","slug":"them-bang-chung-cho-thay-tuyen-tuy-nhan-tao-an-toan-va-hieu-qua","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/them-bang-chung-cho-thay-tuyen-tuy-nhan-tao-an-toan-va-hieu-qua\/","title":{"rendered":"Th\u00eam b\u1eb1ng ch\u1ee9ng cho th\u1ea5y tuy\u1ebfn t\u1ee5y nh\u00e2n t\u1ea1o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3"},"content":{"rendered":"<h2 id=\"title\" class=\"content_title\">\u0110i\u1ec3m nghi\u00ean c\u1ee9u m\u1edbi c\u00f4ng b\u1ed1 (NEJM): Th\u00eam b\u1eb1ng ch\u1ee9ng cho th\u1ea5y tuy\u1ebfn t\u1ee5y nh\u00e2n t\u1ea1o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3<\/h2>\n<p>N\u0103m 2016, FDA \u0111\u00e3 ph\u00ea duy\u1ec7t h\u1ec7 th\u1ed1ng ph\u00e2n ph\u1ed1i insulin v\u00f2ng k\u00edn lai gh\u00e9p \u0111\u1ea7u ti\u00ean (t\u1ee5y nh\u00e2n t\u1ea1o) cho ng\u01b0\u1eddi l\u1edbn v\u00e0 thanh thi\u1ebfu ni\u00ean m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 1; n\u0103m 2018, gi\u1edbi h\u1ea1n \u0111\u1ed9 tu\u1ed5i s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c h\u1ea1 xu\u1ed1ng cho tr\u1ebb t\u1eeb 7 tu\u1ed5i. Thi\u1ebft b\u1ecb n\u00e0y bao g\u1ed3m m\u1ed9t m\u00e1y \u0111o n\u1ed3ng \u0111\u1ed9 glucose li\u00ean t\u1ee5c \u0111\u01b0\u1ee3c li\u00ean k\u1ebft v\u1edbi m\u1ed9t b\u01a1m insulin gi\u00fap cung c\u1ea5p li\u1ec1u insulin n\u1ec1n, t\u1ed1c \u0111\u1ed9 c\u1ee7a b\u01a1m n\u00e0y \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh li\u00ean t\u1ee5c v\u00e0 \u0111\u01b0\u1ee3c t\u1ed1i \u01b0u h\u00f3a b\u1eb1ng thu\u1eadt to\u00e1n; b\u1ec7nh nh\u00e2n v\u1eabn ph\u1ea3i t\u1ef1 ti\u00eam li\u1ec1u bolus sau \u0103n. C\u00e1c h\u1ec7 th\u1ed1ng v\u00f2ng k\u00edn \u0111\u00e3 gi\u00fap c\u1ea3i thi\u1ec7n ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 gi\u1ea3m nguy c\u01a1 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 1 n\u1ed9i tr\u00fa v\u00e0 ngo\u1ea1i tr\u00fa, nh\u01b0ng h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u tr\u01b0\u1edbc \u0111\u00e2y c\u00f3 quy m\u00f4 c\u00f2n nh\u1ecf v\u00e0 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong th\u1eddi gian ng\u1eafn. Trong n\u0103m 2018, m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u m\u1edbi \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 cho th\u1ea5y c\u00f4ng ngh\u1ec7 gh\u00e9p t\u1ee5y nh\u00e2n t\u1ea1o c\u00f3 th\u1ec3 mang l\u1ea1i l\u1ee3i \u00edch cho c\u1ea3 b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa v\u00e0 ngo\u1ea1i tr\u00fa.<\/p>\n<p>Trong \u1ea5n b\u1ea3n NEJM Journal Watch (General Meidicne) Year in Review 2018, c\u00e1c Editor c\u1ee7a t\u1ea1p ch\u00ed \u0111\u00e3 t\u1ed5ng h\u1ee3p k\u1ebft qu\u1ea3 t\u1eeb nh\u1eefng nghi\u00ean c\u1ee9u n\u1ed5i b\u1eadt trong n\u0103m 2018 v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng tuy\u1ebfn tuy nh\u00e2n t\u1ea1o v\u00e0 d\u1eef li\u1ec7u cho th\u1ea5y tuy\u1ebfn t\u1ee5y nh\u00e2n t\u1ea1o c\u00f3 th\u1ec3 \u0111\u00eam l\u1ea1i l\u1ee3i \u00edch cho b\u1ec7nh nh\u00e2n ti\u1ec3u \u0111\u01b0\u1eddng<\/p>\n<p>Trong m\u1ed9t nghi\u00ean c\u1ee9u ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean tr\u00ean b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa l\u1edbn nh\u1ea5t cho \u0111\u1ebfn nay v\u1ec1 k\u0129 thu\u1eadt v\u00f2ng k\u00edn th\u1ef1c hi\u1ec7n n\u0103m 2018, 86 b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa \u0110T\u0110 type 1 bao g\u1ed3m c\u1ea3 tr\u1ebb em v\u00e0 ng\u01b0\u1eddi l\u1edbn \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn ng\u1eabu nhi\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng k\u0129 thu\u1eadt v\u00f2ng k\u00edn ho\u1eb7c li\u1ec7u ph\u00e1p d\u00f9ng b\u01a1m \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 c\u1ea3m bi\u1ebfn (nh\u01b0ng v\u1eabn do ng\u01b0\u1eddi d\u00f9ng ki\u1ec3m so\u00e1t) trong 12 tu\u1ea7n. K\u1ebft qu\u1ea3, b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng h\u1ec7 th\u1ed1ng v\u00f2ng k\u00edn c\u00f3 n\u1ed3ng \u0111\u1ed9 glucose trong kho\u1ea3ng t\u1eeb 70 \u2013 180 mg\/dL trong th\u1eddi gian d\u00e0i h\u01a1n v\u00e0 n\u1ed3ng \u0111\u1ed9 HbA1c th\u1ea5p h\u01a1n so v\u1edbi nh\u00f3m \u0111\u1ed1i ch\u1ee9ng. T\u1ea7n xu\u1ea5t x\u1ea3y ra h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft l\u00e0 nh\u01b0 nhau \u1edf c\u1ea3 2 nh\u00f3m (NEJM JW Gen Med ng\u00e0y 1\/12 and Lancet ng\u00e0y 13\/10; 392:1321).<\/p>\n<p>C\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u c\u0169ng ti\u1ebfn h\u00e0nh m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p 40 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean h\u01a1n 1000 b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa \u0110T\u0110 type 1 \u0111\u01b0\u1ee3c ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean \u0111\u1ec3 s\u1eed d\u1ee5ng h\u1ec7 th\u1ed1ng v\u00f2ng k\u00edn ho\u1eb7c d\u00f9ng c\u00e1c ph\u01b0\u01a1ng th\u1ee9c ti\u00eam insulin kh\u00e1c. So v\u1edbi c\u00e1c nh\u00f3m \u0111\u1ed1i ch\u1ee9ng, b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng v\u00f2ng k\u00edn c\u00f3 c\u00f3 s\u1ed1 l\u1ea7n duy tr\u00ec \u0111\u01b0\u1eddng huy\u1ebft \u1edf m\u1ee9c g\u1ea7n b\u00ecnh th\u01b0\u1eddng (70 \u2013 180 mg\/dL) nhi\u1ec1u h\u01a1n v\u00e0 s\u1ed1 l\u1ea7n t\u0103ng th\u1eddi gian \u0111\u01b0\u1eddng huy\u1ebft \u1edf kho\u1ea3ng t\u0103ng\/ h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft \u00edt h\u01a1n; \u0111\u1ed3ng th\u1eddi c\u00f3 n\u1ed3ng \u0111\u1ed9 HbA1C th\u1ea5p h\u01a1n \u0111\u00e1ng k\u1ec3 (NEJM JW Gen Med ng\u00e0y 1\/7 and BMJ ng\u00e0y 18\/4; 361:1310).<\/p>\n<figure id=\"attachment_5309\" aria-describedby=\"caption-attachment-5309\" style=\"width: 450px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-5309\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/03\/thiet_bi_lai_ghep.jpg\" alt=\"Thi\u1ebft b\u1ecb lai gh\u00e9p\" width=\"450\" height=\"450\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/03\/thiet_bi_lai_ghep.jpg 450w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/03\/thiet_bi_lai_ghep-350x350.jpg 350w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/03\/thiet_bi_lai_ghep-150x150.jpg 150w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/03\/thiet_bi_lai_ghep-300x300.jpg 300w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/03\/thiet_bi_lai_ghep-100x100.jpg 100w\" sizes=\"auto, (max-width: 450px) 100vw, 450px\" \/><figcaption id=\"caption-attachment-5309\" class=\"wp-caption-text\">Thi\u1ebft b\u1ecb lai gh\u00e9p<\/figcaption><\/figure>\n<p>Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa, m\u1ed9t nghi\u00ean c\u1ee9u \u0111\u00e3 ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean 136 b\u1ec7nh nh\u00e2n c\u1ea7n s\u1eed d\u1ee5ng insulin ti\u00eam d\u01b0\u1edbi da, m\u1ed9t nh\u00f3m \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng h\u1ec7 th\u1ed1ng v\u00f2ng k\u00edn (kh\u00f4ng d\u00f9ng li\u1ec1u bolus), nh\u00f3m kia \u0111\u01b0\u1ee3c ti\u00eam insulin th\u00f4ng th\u01b0\u1eddng trong 15 ng\u00e0y. C\u0169ng nh\u01b0 c\u00e1c nghi\u00ean c\u1ee9u tr\u00ean, b\u1ec7nh nh\u00e2n d\u00f9ng h\u1ec7 th\u1ed1ng v\u00f2ng k\u00edn c\u00f3 t\u1ed5ng th\u1eddi gian \u0111\u1ea1t \u0111\u01b0\u1eddng huy\u1ebft m\u1ee5c ti\u00eau (100 \u2013 180 mg\/dL) l\u1edbn h\u01a1n v\u00e0 n\u1ed3ng \u0111\u1ed9 glucose trung b\u00ecnh th\u1ea5p h\u01a1n nh\u00f3m \u0111\u1ed1i ch\u1ee9ng; \u0111\u00e1ng l\u01b0u \u00fd r\u1eb1ng kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa 2 nh\u00f3m trong t\u1ed5ng li\u1ec1u insulin h\u00e0ng ng\u00e0y v\u00e0 t\u1ed5ng s\u1ed1 th\u1eddi gian h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft (NEJM JW Gen Med ng\u00e0y 1\/8 v\u00e0 N Engl J Med ng\u00e0y 9\/8; 379:547).<\/p>\n<p>C\u00f3 th\u1ec3 h\u01a1i qu\u00e1 l\u1eddi khi g\u1ecdi h\u1ec7 th\u1ed1ng v\u00f2ng k\u00edn l\u00e0 tuy\u1ebfn t\u1ee5y nh\u00e2n t\u1ea1o b\u1edfi b\u1ec7nh nh\u00e2n v\u1eabn ph\u1ea3i ti\u00eam li\u1ec1u bolus, v\u00e0 thi\u1ebft b\u1ecb n\u00e0y v\u1eabn c\u00f2n kh\u00e1 \u0111\u1eaft. Tuy nhi\u00ean, nh\u1eefng k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u tr\u00ean \u0111\u00e3 ch\u1ee9ng minh h\u1ec7 th\u1ed1ng v\u00f2ng k\u00edn s\u1ebd s\u1edbm c\u1ea3i thi\u1ec7n vi\u1ec7c ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 \u0111\u01a1n gi\u1ea3n h\u00f3a cu\u1ed9c s\u1ed1ng cho nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng.<\/p>\n<p>Ngu\u1ed3n:<a href=\"https:\/\/www.jwatch.org\/na48078\/2018\/12\/27\/nejm-journal-watch-general-medicine-year-review-2018\" rel=\"noopener\"> https:\/\/www.jwatch.org\/na48078\/2018\/12\/27\/nejm-journal-watch-general-medicine-year-review-2018<\/a><\/p>\n<p>Ng\u01b0\u1eddi t\u1ed5ng h\u1ee3p: Nguy\u1ec5n Th\u1ecb Thu H\u00e0 &#8211; \u0110o\u00e0n Ph\u01b0\u01a1ng Th\u1ea3o &#8211; Trung T\u00e2m C\u1ea3nh Gi\u00e1c D\u01b0\u1ee3c Qu\u1ed1c Gia.<\/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>\u0110i\u1ec3m nghi\u00ean c\u1ee9u m\u1edbi c\u00f4ng b\u1ed1 (NEJM): Th\u00eam b\u1eb1ng ch\u1ee9ng cho th\u1ea5y tuy\u1ebfn t\u1ee5y nh\u00e2n t\u1ea1o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 N\u0103m 2016, FDA \u0111\u00e3 ph\u00ea duy\u1ec7t h\u1ec7 th\u1ed1ng ph\u00e2n ph\u1ed1i insulin v\u00f2ng k\u00edn lai gh\u00e9p \u0111\u1ea7u ti\u00ean (t\u1ee5y nh\u00e2n t\u1ea1o) cho ng\u01b0\u1eddi l\u1edbn v\u00e0 thanh thi\u1ebfu ni\u00ean m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 1; n\u0103m [&#8230;]\n","protected":false},"author":1,"featured_media":5309,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5307","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\/5307","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=5307"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5307\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/5309"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=5307"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=5307"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=5307"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}