{"id":9531,"date":"2019-05-15T19:50:54","date_gmt":"2019-05-15T12:50:54","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=9531"},"modified":"2019-10-02T12:42:56","modified_gmt":"2019-10-02T05:42:56","slug":"viem-gan-b-2","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/viem-gan-b-2\/","title":{"rendered":"Vi\u00eam gan B"},"content":{"rendered":"

N\u1ed9i dung ch\u00ednh<\/h2>\n
\n
Vi\u00eam gan B<\/strong><\/a> l\u00e0 b\u1ec7nh truy\u1ec1n nhi\u1ec5m do virus t\u1ea5n c\u00f4ng gan v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra b\u1ec7nh m\u00e3n t\u00ednh v\u00e0 c\u1ea5p t\u00ednh.<\/li>\n
Virus \u0111\u01b0\u1ee3c truy\u1ec1n qua vi\u1ec7c ti\u1ebfp x\u00fac v\u1edbi m\u00e1u v\u00e0 c\u00e1c d\u1ecbch c\u01a1 th\u1ec3 kh\u00e1c c\u1ee7a ng\u01b0\u1eddi b\u1ecb nhi\u1ec5m.<\/li>\n
Theo \u01b0\u1edbc t\u00ednh c\u00f3 kho\u1ea3ng 257 tri\u1ec7u ng\u01b0\u1eddi \u0111ang b\u1ecb nhi\u1ec5m virus vi\u00eam gan B ( \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 d\u01b0\u01a1ng t\u00ednh v\u1edbi kh\u00e1ng nguy\u00ean b\u1ec1 m\u1eb7t vi\u00eam gan B)<\/li>\n
N\u0103m 2015, b\u1ec7nh vi\u00eam gan B \u0111\u00e3 g\u00e2y ra 887000 ca t\u1eed vong, h\u1ea7u h\u1ebft \u0111\u1ec1u do bi\u1ebfn ch\u1ee9ng (Bao g\u1ed3m s\u01a1 gan v\u00e0 ung th\u01b0 t\u1ebf b\u00e0o gan)<\/li>\n
Vi\u00eam gan B l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c l\u1edbn \u0111\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi l\u00e0m y t\u1ebf.<\/li>\n
Tuy nhi\u00ean, c\u00f3 th\u1ec3 ng\u0103n ch\u1eb7n vi\u00eam gan B b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i vaccine hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n hi\u1ec7n c\u00f3.<\/li>\n<\/ul>\n
Vi\u00eam gan B l\u00e0 g\u00ec?<\/h2>\n
Vi\u00eam Gan B l\u00e0 m\u1ed9t b\u1ec7nh nhi\u1ec5m tr\u00f9ng gan c\u00f3 kh\u1ea3 n\u0103ng \u0111e d\u1ecda t\u00ednh m\u1ea1ng con ng\u01b0\u1eddi g\u00e2y ra b\u1edfi virus vi\u00eam gan B (HBV). \u0110\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe to\u00e0n c\u1ea7u. N\u00f3 c\u00f3 th\u1ec3 g\u00e2y ra b\u1ec7nh nhi\u1ec5m tr\u00f9ng m\u00e3n t\u00ednh v\u00e0 \u0111\u1ea9y con ng\u01b0\u1eddi t\u1edbi nguy c\u01a1 t\u1eed vong r\u1ea5t cao do b\u1ecb x\u01a1 gan v\u00e0 ung th\u01b0 gan.<\/p>\n
$\"$
H\u00ecnh \u1ea3nh: c\u1ea5u t\u1ea1o c\u1ee7a virus vi\u00eam gan b<\/figcaption><\/figure>\n
M\u1ed9t lo\u1ea1i vaccin ch\u1ed1ng l\u1ea1i Vi\u00eam gan B \u0111\u01b0\u1ee3c ph\u00e1t h\u00e0nh v\u00e0o n\u0103m 1982. Hi\u1ec7u qu\u1ea3 c\u1ee7a lo\u1ea1i vaccin n\u00e0y trong vi\u1ec7c ng\u0103n ch\u1eb7n truy\u1ec1n nhi\u1ec5m, ph\u00e1t tri\u1ec3n th\u00e0nh b\u1ec7nh m\u00e3n t\u00ednh v\u00e0 ung th\u01b0 do virus vi\u00eam gan B g\u00e2y ra l\u00ean t\u1edbi 95%.<\/p>\n
$\"vaccin$
H\u00ecnh \u1ea3nh: vaccin ch\u1ed1ng l\u1ea1i Vi\u00eam gan B<\/figcaption><\/figure>\n
Ph\u00e2n b\u1ed1 \u0111\u1ecba l\u00fd c\u1ee7a b\u1ec7nh vi\u00eam gan si\u00eau vi B<\/h2>\n
Tr\u00ean th\u1ebf gi\u1edbi<\/h3>\n
T\u1ef7 l\u1ec7 ph\u1ed5 bi\u1ebfn c\u1ee7a b\u1ec7nh vi\u00eam gan B cao nh\u1ea5t theo WHO l\u00e0 \u1edf v\u00f9ng ph\u00eda t\u00e2y th\u00e1i b\u00ecnh d\u01b0\u01a1ng v\u00e0 ch\u00e2u phi, n\u01a1i m\u00e0 s\u1ed1 ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh nhi\u1ec5m l\u00ean \u0111\u1ebfn 6.2% v\u00e0 6.1 %. Theo WHO khu v\u1ef1c \u0110\u00f4ng \u0110\u1ecba Trung H\u1ea3i, WHO \u0110\u00f4ng Nam \u00c1 v\u00e0 WHO khu v\u1ef1c ch\u00e2u \u00c2y, \u01b0\u1edbc t\u00ednh t\u01b0\u01a1ng \u1ee9ng c\u00f3 kho\u1ea3ng 3.2%, 2.0% v\u00e0 1.6% d\u00e2n s\u1ed1 trung b\u00ecnh b\u1ecb nhi\u1ec5m. 0.7% d\u00e2n s\u1ed1 c\u1ee7a WHO ch\u00e2u M\u1ef9 b\u1ecb nhi\u1ec5m.<\/p>\n
Tr\u00ean th\u1ebf gi\u1edbi c\u00f3 kho\u1ea3ng 2 t\u1ec9 ng\u01b0\u1eddi \u0111\u00e3 v\u00e0 \u0111ang b\u1ecb vi\u00eam gan B m\u1ed7i n\u0103m, trong \u0111\u00f3 c\u00f3 kho\u1ea3ng 780 000 ng\u01b0\u1eddi ch\u1ebft m\u1ed7i n\u0103m do bi\u1ebfn ch\u1ee9ng c\u1ee7a vi\u00eam gan B, bao g\u1ed3m c\u1ea3 x\u01a1 gan v\u00e0 ung th\u01b0 gan. (Ngu\u1ed3n\u00a0 https:\/\/vietnamnet.vn\/vn\/suc-khoe\/nguoi-trang-hoa-de-mac-viem-gan-b-290978.html )<\/a><\/p>\n
T\u00ecnh h\u00ecnh vi\u00eam gan B \u1edf Vi\u1ec7t Nam<\/h3>\n
T\u1ea1i Vi\u1ec7t Nam, theo th\u1ed1ng k\u00ea d\u1eef li\u1ec7u n\u0103m 2017 c\u00f3 kho\u1ea3ng 8 tri\u1ec7u ng\u01b0\u1eddi nhi\u1ec5m vi\u00eam gan B m\u1ea1n t\u00ednh trong \u0111\u00f3 c\u00f3 h\u01a1n 51.000 b\u1ec7nh nh\u00e2n \u0111\u00e3 b\u1ecb x\u01a1 gan, h\u01a1n 14.000 b\u1ec7nh nh\u00e2n ung th\u01b0 t\u1ebf b\u00e0o gan v\u00e0 h\u01a1n 32.000 ng\u01b0\u1eddi t\u1eed vong.<\/p>\n
$\"vi\u00eam$
H\u00ecnh \u1ea3nh: vi\u00eam gan b \u1edf vi\u1ec7t nam<\/figcaption><\/figure>\n
Vi\u00eam gan B l\u00e2y qua \u0111\u01b0\u1eddng n\u00e0o?<\/h2>\n
Virus vi\u00eam gan B c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i b\u00ean ngo\u00e0i \u00edt nh\u1ea5t trong 7 ng\u00e0y. Trong su\u1ed1t th\u1eddi gian \u0111\u00f3, virus v\u1eabn c\u00f3 th\u1ec3 l\u00e2y nhi\u1ec5m n\u1ebfu n\u00f3 \u0111i v\u00e0o c\u01a1 th\u1ec3 c\u1ee7a m\u1ed9t ng\u01b0\u1eddi kh\u00f4ng \u0111\u01b0\u1ee3c b\u1ea3o v\u1ec7 b\u1edfi vaccin. Th\u1eddi gian \u1ee7 b\u1ec7nh c\u1ee7a virus trung b\u00ecnh l\u00e0 75 ng\u00e0y, nh\u01b0ng c\u00f3 th\u1ec3 dao \u0111\u1ed9ng t\u1eeb 30 \u0111\u1ebfn 180 ng\u00e0y. Virus c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u00a0trong v\u00f2ng 30 t\u1edbi 60 ng\u00e0y sau khi l\u00e2y nhi\u1ec5m v\u00e0 c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i v\u00e0 ph\u00e1t tri\u1ec3n th\u00e0nh vi\u00eam gan B m\u00e3n t\u00ednh. \u1ede nh\u1eefng v\u00f9ng \u0111\u1eb7c h\u1eefu, vi\u00eam gan B h\u1ea7u h\u1ebft s\u1ebd \u0111\u01b0\u1ee3c l\u00e2y truy\u1ec1n t\u1eeb m\u1eb9 sang con l\u00fac m\u1edbi sinh (l\u00e2y truy\u1ec1n chu sinh), ho\u1eb7c th\u00f4ng qua s\u1ef1 l\u00e2y truy\u1ec1n ngang h\u00e0ng (ti\u1ebfp x\u00fac v\u1edbi m\u00e1u b\u1ecb nhi\u1ec5m), \u0111\u1eb7c bi\u1ec7t t\u1eeb nh\u1eefng \u0111\u1ee9a tr\u1ebb b\u1ecb nhi\u1ec5m b\u1ec7nh \u0111\u1ebfn m\u1ed9t \u0111\u1ee9a tr\u1ebb kh\u00f4ng b\u1ecb nhi\u1ec5m b\u1ec7nh trong 5 n\u0103m \u0111\u1ea7u \u0111\u1eddi. S\u1ef1 ph\u00e1t tri\u1ec3n th\u00e0nh b\u1ec7nh m\u00e3n t\u00ednh \u0111\u1ed1i v\u1edbi nh\u1eefng em b\u00e9 m\u1edbi sinh m\u00e0 b\u1ecb l\u00e2y truy\u1ec1n t\u1eeb m\u1eb9 ho\u1eb7c nh\u1eefng \u0111\u1ee9a tr\u1ebb d\u01b0\u1edbi 5 tu\u1ed5i r\u1ea5t ph\u1ed5 bi\u1ebfn.<\/p>\n
$\"\u0110\u01b0\u1eddng$
H\u00ecnh \u1ea3nh minh h\u1ecda: \u0110\u01b0\u1eddng l\u00e2y truy\u1ec1n c\u1ee7a vi\u00eam gan B<\/figcaption><\/figure>\n
Vi\u00eam gan B c\u0169ng b\u1ecb l\u00e2y lan b\u1edfi vi\u1ec7c ti\u1ebfp x\u00fac qua da ho\u1eb7c ni\u00eam m\u1ea1c v\u1edbi m\u00e1u b\u1ecb nhi\u1ec5m v\u00e0 c\u00e1c ch\u1ea5t d\u1ecbch kh\u00e1c nhau c\u1ee7a c\u01a1 th\u1ec3 nh\u01b0 n\u01b0\u1edbc b\u1ecdt, kinh nguy\u1ec7t, \u00e2m \u0111\u1ea1o ho\u1eb7c tinh d\u1ecbch. Vi\u1ec7c l\u00e2y lan qua \u0111\u01b0\u1eddng t\u00ecnh d\u1ee5c c\u00f3 th\u1ec3 x\u1ea3y ra, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ed1i v\u1edbi nam gi\u1edbi ch\u01b0a \u0111\u01b0\u1ee3c ti\u00eam vaccine m\u00e0 quan h\u1ec7 v\u1edbi ng\u01b0\u1eddi \u0111\u1ed3ng gi\u1edbi v\u00e0 nh\u1eefng ng\u01b0\u1eddi d\u1ecb t\u00ednh, quan h\u1ec7 v\u1edbi nhi\u1ec1u b\u1ea1n t\u00ecnh ho\u1eb7c quan h\u1ec7 v\u1edbi g\u00e1i m\u1ea1i d\u00e2m. Vi\u1ec7c l\u00e2y nhi\u1ec5m \u1edf tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh m\u00e0 d\u1eabn t\u1edbi b\u1ec7nh m\u00e3n t\u00ednh \u00edt h\u01a1n 5% trong s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p. S\u1ef1 l\u00e2y truy\u1ec1n virus c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra do vi\u1ec7c t\u00e1i s\u1eed d\u1ee5ng c\u00e1c kim v\u00e0 \u1ed1ng ti\u00eam, ho\u1eb7c c\u01a1 s\u1edf ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe hay gi\u1eefa nh\u1eefng ng\u01b0\u1eddi ti\u00eam ch\u00edch ma t\u00fay. Th\u00eam n\u1eefa, b\u1ec7nh truy\u1ec1n nhi\u1ec5m c\u00f3 th\u1ec3 x\u1ea3y ra trong c\u00e1c qu\u00e1 tr\u00ecnh y t\u1ebf, ph\u1eabu thu\u1eadt v\u00e0 nha khoa, x\u0103m m\u00ecnh. Ho\u1eb7c th\u00f4ng qua vi\u1ec7c s\u1eed d\u1ee5ng dao c\u1ea1o d\u00e2u v\u00e0 nh\u1eefng v\u1eadt c\u00f3 li\u00ean quan m\u00e0 d\u00ednh m\u00e1u b\u1ecb l\u00e2y nhi\u1ec5m.<\/p>\n
$\"\u0110\u01b0\u1eddng$
H\u00ecnh \u1ea3nh minh h\u1ecda: \u0110\u01b0\u1eddng l\u00e2y truy\u1ec1n c\u1ee7a vi\u00eam gan B<\/figcaption><\/figure>\n
Tri\u1ec7u ch\u1ee9ng vi\u00eam gan B<\/h2>\n
H\u1ea7u h\u1ebft m\u1ecdi ng\u01b0\u1eddi kh\u00f4ng nh\u1eadn th\u1ea5y b\u1ea5t k\u1ef3 tri\u1ec7u ch\u1ee9ng n\u00e0o trong su\u1ed1t giai \u0111o\u1ea1n l\u00e2y nhi\u1ec5m c\u1ea5p t\u00ednh. Tuy nhi\u00ean, v\u1eabn c\u00f3 v\u00e0i ng\u01b0\u1eddi g\u1eb7p ph\u1ea3i m\u1ed9t s\u1ed1 tri\u1ec7u ch\u1ee9ng k\u00e9o d\u00e0i \u0111\u1ebfn v\u00e0i tu\u1ea7n, nh\u01b0 v\u00e0ng da, v\u00e0ng m\u1eaft, n\u01b0\u1edbc ti\u1ec3u c\u00f3 m\u00e0u \u0111\u1eadm, m\u1ec7t m\u1ecfi c\u1ef1c \u0111\u1ed9, bu\u1ed3n n\u00f4n, n\u00f4n v\u00e0 \u0111au b\u1ee5ng. C\u00f3 m\u1ed9t nh\u00f3m nh\u1ecf nh\u1eefng ng\u01b0\u1eddi b\u1ecb vi\u00eam gan c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 h\u00ecnh th\u00e0nh suy gan th\u1ea5p, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn t\u1edbi t\u1eed vong. V\u1edbi m\u1ed9t v\u00e0i ng\u01b0\u1eddi, virus vi\u00eam gan B c\u0169ng c\u00f3 th\u1ec3 d\u1eabn t\u1edbi vi\u00eam gan m\u00e3n t\u00ednh v\u00e0 sau \u0111\u00f3 ph\u00e1t tri\u1ec3n th\u00e0nh x\u01a1 gan (g\u00e2y s\u1eb9o tr\u00ean gan) ho\u1eb7c ung th\u01b0 gan.<\/p>\n
$\"vi\u00eam$
H\u00ecnh \u1ea3nh minh h\u1ecda: tri\u1ec7u ch\u1ee9ng v\u00e0ng da v\u00e0ng m\u1eaft \u1edf b\u1ec7nh nh\u00e2n vi\u00eam gan B<\/figcaption><\/figure>\n
Ng\u01b0\u1eddi c\u00f3 nguy c\u01a1 m\u1eb7c b\u1ec7nh vi\u00eam gan si\u00eau vi B m\u00e3n t\u00ednh<\/h2>\n
Kh\u1ea3 n\u0103ng \u0111\u1ec3 b\u1ec7nh tr\u1edf th\u00e0nh m\u00e3n t\u00ednh ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u1ed9 tu\u1ed5i c\u1ee7a ng\u01b0\u1eddi m\u1eafc b\u1ec7nh. Tr\u1ebb em d\u01b0\u1edbi 6 tu\u1ed5i m\u00e0 b\u1ecb nhi\u1ec5m b\u1ec7nh th\u00ec kh\u1ea3 n\u0103ng cao s\u1ebd ph\u00e1t tri\u1ec3n th\u00e0nh b\u1ec7nh m\u00e3n t\u00ednh.<\/p>\n
\u0110\u1ed1i v\u1edbi tr\u1ebb s\u01a1 sinh ho\u1eb7c tr\u1ebb nh\u1ecf:<\/p>\n
\n
80 \u0111\u1ebfn 90% tr\u1ebb m\u1edbi sinh c\u00f3 th\u1ec3 b\u1ecb l\u00e2y nhi\u1ec5m trong su\u1ed1t n\u0103m \u0111\u1ea7u \u0111\u1eddi, b\u1ec7nh c\u00f3 th\u1ec3 tr\u1edf th\u00e0nh m\u00e3n t\u00ednh;<\/li>\n
30-50% tr\u1ebb em d\u01b0\u1edbi 6 tu\u1ed5i c\u00f3 kh\u1ea3 n\u0103ng ph\u00e1t tri\u1ec3n th\u00e0nh m\u00e3n t\u00ednh.<\/li>\n<\/ul>\n
V\u1edbi ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh:<\/p>\n
\n
Kho\u1ea3ng d\u01b0\u1edbi 5% s\u1ed1 ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh kh\u1ecfe m\u1ea1nh m\u00e0 b\u1ecb nhi\u1ec5m, b\u1ec7nh s\u1ebd ph\u00e1t tri\u1ec3n th\u00e0nh m\u00e3n t\u00ednh.<\/li>\n
20 \u0111\u1ebfn 30% ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh m\u00e0 b\u1ec7nh \u0111\u00e3 th\u00e0nh m\u00e3n t\u00ednh th\u00ec s\u1ebd ph\u00e1t tri\u1ec3n th\u00e0nh s\u01a1 gan ho\u1eb7c ung th\u01b0 gan.<\/li>\n<\/ul>\n
\u0110\u1ed3ng nhi\u1ec5m c\u1ea3 HIV v\u00e0 HBV<\/h2>\n
C\u00f3 kho\u1ea3ng 1% s\u1ed1 ng\u01b0\u1eddi b\u1ecb b\u1ec7nh vi\u00eam gan si\u00eau vi B – HBV\u00a0 (2.7 tri\u1ec7u ng\u01b0\u1eddi) c\u0169ng b\u1ecb nhi\u1ec5m HIV. Ng\u01b0\u1ee3c l\u1ea1i, t\u1ef7 l\u1ec7 nhi\u1ec5m HBV \u1edf ng\u01b0\u1eddi nhi\u1ec5m HIV tr\u00ean to\u00e0n c\u1ea7u l\u00e0 7,4%. T\u1eeb n\u0103m 2015, WHO \u0111\u00e3 \u0111\u1ec1 ngh\u1ecb \u0111i\u1ec1u tr\u1ecb \u0111\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi b\u1ecb chu\u1ea9n \u0111o\u00e1n nhi\u1ec5m HIV \u1edf b\u1ea5t k\u00ec giai \u0111o\u1ea1n n\u00e0o c\u1ee7a b\u1ec7nh. Tenofovir l\u00e0 m\u1ed9t lo\u1ea1i thu\u1ed1c c\u00f3 m\u1eb7t trong ph\u00e1c \u0111\u1ed3 ph\u1ed1i h\u1ee3p ch\u1eefa tr\u1ecb \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t \u0111\u1ea7u ti\u00ean ch\u1ed1ng l\u1ea1i b\u1ec7nh HIV, c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng ch\u1ed1ng l\u1ea1i HBV.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m b\u1ec7nh vi\u00eam gan B<\/h2>\n
Theo c\u0103n c\u1ee9 l\u00e2m s\u00e0ng th\u00ec kh\u00f3 c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t s\u1ef1 kh\u00e1c nhau gi\u1eefa vi\u00eam gan B v\u1edbi c\u00e1c lo\u1ea1i vi\u00eam gan m\u00e0 b\u1ecb g\u00e2y ra b\u1edfi nh\u1eefng t\u00e1c nh\u00e2n virus kh\u00e1c, v\u00ec th\u1ebf, s\u1ef1 x\u00e1c nh\u1eadn c\u1ee7a ph\u00f2ng th\u00ed nghi\u1ec7m trong vi\u1ec7c chu\u1ea9n \u0111o\u00e1n l\u00e0 c\u1ea7n thi\u1ebft.<\/p>\n
X\u00e9t nghi\u1ec7m vi\u00eam gan B<\/h3>\n
M\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m m\u00e1u c\u00f3 s\u1eb5n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 theo d\u00f5i nh\u1eefng ng\u01b0\u1eddi b\u1ecb vi\u00eam gan B. Ch\u00fang c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n bi\u1ec7t l\u00e2y nhi\u1ec5m c\u1ea5p t\u00ednh v\u00e0 m\u00e3n t\u00ednh.<\/p>\n
$\"Vi\u00eam$ <\/p>\n
Vi\u1ec7c chu\u1ea9n \u0111o\u00e1n c\u1ee7a ph\u00f2ng th\u00ed nghi\u1ec7m li\u00ean quan \u0111\u1ebfn b\u1ec7nh vi\u00eam gan B t\u1eadp trung v\u00e0o vi\u1ec7c ph\u00e1t hi\u1ec7n c\u00e1c kh\u00e1ng nguy\u00ean b\u1ec1 m\u1eb7t vi\u00eam gan B HbsAg.<\/p>\n
WHO khuy\u1ebfn c\u00e1o r\u1eb1ng t\u1ea5t c\u1ea3 m\u00e1u hi\u1ebfn t\u1eb7ng \u0111\u1ec1u \u0111\u01b0\u1ee3c ki\u1ec3m tra vi\u00eam gan B \u0111\u1ec3 ch\u1eafc r\u1eb1ng l\u01b0\u1ee3ng m\u00e1u \u0111\u00f3 l\u00e0 an to\u00e0n v\u00e0 tr\u00e1nh \u0111\u01b0\u1ee3c nh\u1eefng r\u1ee7i ro trong vi\u1ec7c truy\u1ec1n m\u00e1u cho ng\u01b0\u1eddi kh\u00e1c.<\/p>\n
\n
HBV c\u1ea5p t\u00ednh \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng \u00a0b\u1edfi s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a kh\u00e1ng th\u1ec3 HbsAg v\u00e0 immunoglobulin M (IgM) t\u1edbi kh\u00e1ng nguy\u00ean l\u00f5i HbcAg. Trong su\u1ed1t giai \u0111o\u1ea1n truy\u1ec1n nhi\u1ec5m ban \u0111\u1ea7u, c\u00e1c b\u1ec7nh nh\u00e2n c\u0169ng c\u00f3 huy\u1ebft thanh d\u01b0\u01a1ng t\u00ednh \u0111\u1ed1i v\u1edbi kh\u00e1ng nguy\u00ean vi\u00eam gan B e (HbeAg). HbeAg lu\u00f4n lu\u00f4n \u0111\u00e1nh d\u1ea5u m\u1ee9c \u0111\u1ed9 nh\u00e2n l\u00ean cao c\u1ee7a virus. S\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a HbeAg ch\u1ec9 ra r\u1eb1ng m\u00e1u v\u00e0 c\u00e1c ch\u1ea5t d\u1ecbch c\u01a1 th\u1ec3 t\u1eeb c\u00e1 nh\u00e2n b\u1ecb l\u00e2y nhi\u1ec5m c\u0169ng c\u00f3 kh\u1ea3 n\u0103ng truy\u1ec1n nhi\u1ec5m cao.<\/li>\n
Nhi\u1ec5m tr\u00f9ng m\u00e3n t\u00ednh \u0111\u01b0\u1ee3c \u0111\u1eb7c h\u00f3a b\u1edfi s\u1ef1 t\u1ed3n t\u1ea1i c\u1ee7a HbsAg \u00edt nh\u1ea5t kho\u1ea3ng 6 th\u00e1ng (c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 HBeAg \u0111\u1ed3ng th\u1eddi). S\u1ef1 t\u1ed3n t\u1ea1i c\u1ee7a HbsAg l\u00e0 d\u1ea5u hi\u1ec7u ch\u00ednh v\u1ec1 nguy c\u01a1 ph\u00e1t tri\u1ec3n th\u00e0nh b\u1ec7nh gan m\u00e3n t\u00ednh v\u00e0 ung th\u01b0 gan (ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan) trong qu\u00e3ng \u0111\u1eddi sau n\u00e0y.<\/li>\n<\/ul>\n
\u0110i\u1ec1u tr\u1ecb vi\u00eam gan B<\/h2>\n
Hi\u1ec7n nay, v\u1eabn ch\u01b0a c\u00f3 ph\u01b0\u01a1ng th\u1ee9c \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c bi\u1ec7t n\u00e0o \u0111\u1ed1i v\u1edbi b\u1ec7nh vi\u00eam gan B c\u1ea5p t\u00ednh. Do v\u1eady, s\u1ef1 ch\u0103m s\u00f3c \u0111\u01b0\u1ee3c nh\u1eafm \u0111\u1ebfn duy tr\u00ec s\u1ef1 tho\u1ea3i m\u00e1i v\u00e0 c\u00e2n b\u1eb1ng dinh d\u01b0\u1ee1ng \u0111\u1ea7y \u0111\u1ee7, bao g\u1ed3m s\u1ef1 thay th\u1ebf c\u00e1c ch\u1ea5t d\u1ecbch \u0111\u00e3 b\u1ecb m\u1ea5t khi n\u00f4n m\u1eeda v\u00e0 ti\u00eau ch\u1ea3y.<\/p>\n
$\"thu\u1ed1c$ <\/p>\n
Nhi\u1ec5m vi\u00eam gan B m\u00e3n t\u00ednh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1eefa tr\u1ecb b\u1eb1ng c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1ng virus. C\u00e1ch ch\u1eefa tr\u1ecb n\u00e0y s\u1ebd gi\u00fap l\u00e0m ch\u1eadm qu\u00e1 tr\u00ecnh s\u01a1 gan, gi\u1ea3m thi\u1ec3u c\u00e1c tr\u01b0\u1eddng h\u1ee3p d\u1eabn \u0111\u1ebfn ung th\u01b0 gan v\u00e0 k\u00e9o d\u00e0i s\u1ef1 s\u1ed1ng.<\/p>\n
Ai n\u00ean ho\u1eb7c kh\u00f4ng n\u00ean \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B m\u00e3n t\u00ednh?<\/h3>\n
Nh\u1eefng ng\u01b0\u1eddi c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B m\u00e3n t\u00ednh:<\/h4>\n
\u01afu ti\u00ean:\u00a0\u00a0\u0110i\u1ec1u tr\u1ecb cho nh\u1eefng ng\u01b0\u1eddi \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i b\u1ecb nhi\u1ec5m vi\u00eam gan B m\u00e3n t\u00ednh v\u00e0 c\u00f3 b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng v\u1ec1 x\u01a1 gan c\u00f2n b\u00f9 \/ m\u1ea5t b\u00f9 (ho\u1eb7c x\u01a1 gan d\u1ef1a tr\u00ean \u0111i\u1ec3m APRI> 2 \u1edf ng\u01b0\u1eddi l\u1edbn), b\u1ea5t k\u1ec3 m\u1ee9c \u0111\u1ed9 c\u1ee7a alanine transaminase (ALT) hay t\u1ea3i l\u01b0\u1ee3ng virus vi\u00eam gan B (HBV) DNA, ho\u1eb7c t\u00ecnh tr\u1ea1ng kh\u00e1ng HBeAg Khuy\u1ebfn c\u00e1o: \u0110i\u1ec1u tr\u1ecb cho ng\u01b0\u1eddi l\u1edbn b\u1ecb nhi\u1ec5m vi\u00eam gan B m\u00e3n t\u00ednh m\u00e0 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng v\u1ec1 b\u1ec7nh x\u01a1 gan (ho\u1eb7c d\u1ef1a tr\u00ean \u0111i\u1ec3m APRI \u22642 \u1edf ng\u01b0\u1eddi l\u1edbn), nh\u01b0ng\u00a0c\u00f3 t\u1ea5t c\u1ea3 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m sau\u00a0v\u00e0 b\u1ea5t k\u1ec3 t\u00ecnh tr\u1ea1ng HBeAg :\u00b7<\/p>\n
\n
L\u1edbn h\u01a1n 30 tu\u1ed5i.<\/li>\n
C\u00f3 m\u1ee9c ALT b\u1ea5t th\u01b0\u1eddng k\u00e9o d\u00e0i.<\/li>\n
C\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 s\u1ef1 sao ch\u00e9p HBV \u1edf m\u1ee9c \u0111\u1ed9 cao (HBV DNA> 20.000 IU \/ mL).\u00a0(N\u1ebfu x\u00e9t nghi\u1ec7m HBV DNA kh\u00f4ng c\u00f3 s\u1eb5n, h\u00e3y xem x\u00e9t \u0111i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean m\u1ee9c ALT b\u00ecnh th\u01b0\u1eddng li\u00ean t\u1ee5c, b\u1ea5t k\u1ec3 t\u00ecnh tr\u1ea1ng HbeAg).<\/li>\n<\/ul>\n
\u1ede nh\u1eefng ng\u01b0\u1eddi b\u1ecb \u0111\u1ed3ng nhi\u1ec5m virus suy gi\u1ea3m mi\u1ec5n d\u1ecbch tr\u00ean ng\u01b0\u1eddi ( HIV) v\u00e0 HBV , b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat (ART) \u1edf t\u1ea5t c\u1ea3 nh\u1eefng ng\u01b0\u1eddi c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 b\u1ec7nh gan m\u00e3n t\u00ednh nghi\u00eam tr\u1ecdng, b\u1ea5t k\u1ec3 s\u1ed1 l\u01b0\u1ee3ng CD4, c\u0169ng nh\u01b0 \u00a0nh\u1eefng ng\u01b0\u1eddi c\u00f3 s\u1ed1 l\u01b0\u1ee3ng CD4 l\u00e0 500 t\u1ebf b\u00e0o \/ mm\u00a0^{3<\/sup>\u00a0\u00a0tr\u1edf xu\u1ed1ng, b\u1ea5t k\u1ec3 giai \u0111o\u1ea1n b\u1ec7nh gan c\u1ee7a h\u1ecd.<\/p>\n}
$\"Vi\u00eam$ <\/p>\n
Nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng n\u00ean \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B nh\u01b0ng c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i<\/h4>\n
\u0110i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat\u00a0kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u00a0v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ho\u00e3n l\u1ea1i \u1edf\u00a0nh\u1eefng ng\u01b0\u1eddi c\u00f3 t\u1ea5t c\u1ea3 nh\u1eefng \u0111i\u1ec1u sau \u0111\u00e2y\u00a0, b\u1ea5t k\u1ec3 tu\u1ed5i hay t\u00ecnh tr\u1ea1ng c\u1ee7a HBeAg.<\/p>\n
\n
Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng v\u1ec1 b\u1ec7nh x\u01a1 gan (ho\u1eb7c d\u1ef1a tr\u00ean \u0111i\u1ec3m APRI \u22642 \u1edf ng\u01b0\u1eddi l\u1edbn).<\/li>\n
M\u1ee9c ALT b\u00ecnh th\u01b0\u1eddng k\u00e9o d\u00e0i.<\/li>\n
M\u1ee9c \u0111\u1ed9 sao ch\u00e9p DNA HBV th\u1ea5p (HBV DNA <2.000 IU \/ mL).\u00a0(N\u1ebfu x\u00e9t nghi\u1ec7m HBV DNA kh\u00f4ng c\u00f3 s\u1eb5n, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ho\u00e3n l\u1ea1i \u1edf nh\u1eefng ng\u01b0\u1eddi d\u01b0\u01a1ng t\u00ednh v\u1edbi HBeAg t\u1eeb 30 tu\u1ed5i tr\u1edf xu\u1ed1ng, nh\u1eefng ng\u01b0\u1eddi c\u00f3 m\u1ee9c ALT b\u1ea5t th\u01b0\u1eddng k\u00e9o d\u00e0i).<\/li>\n<\/ul>\n
T\u1ea5t c\u1ea3 nh\u1eefng ng\u01b0\u1eddi b\u1ecb vi\u00eam gan B m\u00e3n t\u00ednh, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau ch\u00ed \u0111i\u1ec1u tr\u1ecb \/ kh\u00f4ng \u0111i\u1ec1u tr\u1ecb tr\u00ean tr\u00ean \u0111\u00f2i h\u1ecfi ph\u1ea3i ti\u1ebfp t\u1ee5c theo d\u00f5i \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh xem li\u1ec7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong t\u01b0\u01a1ng lai \u0111\u1ec3 ng\u0103n ng\u1eeba ti\u1ebfn tri\u1ec3n b\u1ec7nh gan.\u00a0Nh\u1eefng ng\u01b0\u1eddi nh\u01b0 v\u1eady bao g\u1ed3m nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng m\u1eafc b\u1ec7nh m\u00e3n t\u00ednh, t\u1eeb 30 tu\u1ed5i tr\u1edf xu\u1ed1ng:<\/p>\n
\n
V\u1edbi m\u1ee9c \u0111\u1ed9 HBV DNA tr\u00ean 20.000 IU \/ mL\u00a0\u00a0nh\u01b0ng\u00a0\u00a0m\u1ee9c ALT b\u00ecnh th\u01b0\u1eddng k\u00e9o d\u00e0i.<\/li>\n
HBeAg \u00e2m t\u00ednh, v\u1edbi m\u1ee9c \u0111\u1ed9 HBV DNA dao \u0111\u1ed9ng trong kho\u1ea3ng 2.000 \u0111\u1ebfn 20.000 IU \/ mL\u00a0ho\u1eb7c\u00a0v\u1edbi m\u1ee9c ALT b\u1ea5t th\u01b0\u1eddng kh\u00f4ng li\u00ean t\u1ee5c (N\u1ebfu x\u00e9t nghi\u1ec7m DNA HBV kh\u00f4ng c\u00f3 s\u1eb5n, h\u00e3y ti\u1ebfp t\u1ee5c theo d\u00f5i nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng m\u1eafc b\u1ec7nh t\u1eeb 30 tu\u1ed5i tr\u1edf xu\u1ed1ng, nh\u1eefng ng\u01b0\u1eddi c\u00f3 m\u1ee9c ALT b\u1ea5t th\u01b0\u1eddng k\u00e9o d\u00e0i, b\u1ea5t k\u1ec3 t\u00ecnh tr\u1ea1ng HBeAg c\u1ee7a h\u1ecd).<\/li>\n<\/ul>\n
\u0110i\u1ec1u tr\u1ecb vi\u00eam gan B b\u1eb1ng thu\u1ed1c kh\u00e1ng virus<\/h3>\n
WHO khuy\u1ebfn c\u00e1o vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng th\u1ee9c ch\u1eefa tr\u1ecb \u0111\u01b0\u1eddng u\u1ed1ng tenofovir ho\u1eb7c entecavir, v\u00ec \u0111\u00e2y l\u00e0 c\u00e1c lo\u1ea1i thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng cao trong vi\u1ec7c \u0111\u1ea9y l\u00f9i virus vi\u00eam gan B. Ch\u00fang hi\u1ebfm khi d\u1eabn \u0111\u1ebfn vi\u1ec7c kh\u00e1ng thu\u1ed1c h\u01a1n so v\u1edbi c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c, d\u1ec5 u\u1ed1ng (1 vi\u00ean 1 ng\u00e0y), v\u00e0 c\u00f3 \u00edt t\u00e1c d\u1ee5ng ph\u1ee5 n\u00ean ch\u1ec9 c\u1ea7n theo d\u00f5i h\u1ea1n ch\u1ebf.<\/p>\n
$\"Tenofovir\"$
H\u00ecnh \u1ea3nh: C\u00f4ng th\u1ee9c c\u1ea5u t\u1ea1o c\u1ee7a Tenofovir<\/figcaption><\/figure>\n
M\u1ed9t s\u1ed1 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B ph\u1ed5 bi\u1ebfn tr\u00ean th\u1ebf gi\u1edbi v\u00e0 \u1edf n\u01b0\u1edbc ta:<\/p>\n
\n
Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B c\u00f3 th\u00e0nh ph\u1ea7n l\u00e0 Tenofovir: Thu\u1ed1c Hepbest<\/a>, Tenofovir Stada<\/a>, Savi Tenofovir<\/a>,…<\/li>\n
Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B c\u00f3 th\u00e0nh ph\u1ea7n l\u00e0 Entecavir:<\/li>\n<\/ul>\n
Thu\u1ed1c Entecavir kh\u00f4ng c\u00f3 b\u1eb1ng s\u00e1ng ch\u1ebf nh\u01b0ng c\u00f3 s\u1eb5n v\u00e0 gi\u00e1 c\u1ea3 r\u1ea5t \u0111a d\u1ea1ng. Tenofovir \u0111\u01b0\u1ee3c b\u1ea3o h\u1ed9 b\u1edfi 1 b\u1eb1ng s\u00e1ng ch\u1ebf, cho t\u1edbi t\u1eadn n\u0103m 2018 \u1edf c\u00e1c qu\u1ed1c gia c\u00f3 thu nh\u1eadp trung b\u00ecnh v\u00e0 cao, n\u01a1i m\u00e0 gi\u00e1 c\u1ea3 cho vi\u1ec7c ch\u1eefa tr\u1ecb h\u00e0ng n\u0103m dao \u0111\u1ed9ng t\u1eeb 400$ \u0111\u1ebfn 1500$ v\u00e0o T2\/2017. Trong khi m\u1ed9t v\u00e0i n\u01b0\u1edbc thu nh\u1eadp trung b\u00ecnh (nh\u01b0 Trung Qu\u1ed1c v\u00e0 Li\u00ean bang Nga) v\u1eabn ph\u1ea3i \u0111\u1ed1i m\u1eb7t v\u1edbi d\u00e0o c\u1ea3n v\u1ec1 b\u1eb1ng s\u00e1ng ch\u1ebf li\u00ean quan \u0111\u1ebfn thu\u1ed1c Tenofovir, th\u00ec v\u1edbi h\u1ea7u h\u1ebft c\u00e1c n\u01b0\u1edbc kh\u00e1c \u0111\u00e3 c\u00f3 th\u1ec3 ti\u1ebfp c\u1eadn \u0111\u01b0\u1ee3c v\u1edbi lo\u1ea1i thu\u1ed1c n\u00e0y. Global Price Reporting Mechanism (GPRM) ch\u1ec9 ra r\u1eb1ng gi\u00e1 c\u1ea3 \u0111i\u1ec1u tr\u1ecb m\u1ed9t n\u0103m dao \u0111\u1ed9ng t\u1eeb 48 \u0111\u1ebfn 50 \u0111\u00f4 la trong th\u00e1ng 2\/2017.<\/p>\n
\u0110i\u1ec1u tr\u1ecb kh\u00e1ng virus h\u00e0ng \u0111\u1ea7u<\/h4>\n
T\u1ea5t c\u1ea3 c\u00e1c c\u00e1 nh\u00e2n t\u1eeb 12 tu\u1ed5i tr\u1edf l\u00ean \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111i\u1ec1u tr\u1ecb b\u1eb1ng tenofovir ho\u1eb7c entecavir, c\u00e1c ch\u1ea5t t\u01b0\u01a1ng t\u1ef1 nucleos(t)ide (NAs) c\u00f3 kh\u1ea3 n\u0103ng kh\u00e1ng thu\u1ed1c cao.\u00a0Entecavir \u0111\u01b0\u1ee3c khuy\u00ean d\u00f9ng \u1edf tr\u1ebb em t\u1eeb 2-11 tu\u1ed5i.C\u00e1c NA c\u00f3 r\u00e0o c\u1ea3n th\u1ea5p \u0111\u1ed1i v\u1edbi kh\u00e1ng thu\u1ed1c (lamivudine, adefovir ho\u1eb7c telbivudine) kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o do kh\u1ea3 n\u0103ng kh\u00e1ng thu\u1ed1c c\u1ee7a ch\u00fang.\u1ede nh\u1eefng ng\u01b0\u1eddi \u0111\u1ed3ng nhi\u1ec5m HBV \/ HIV t\u1eeb 3 tu\u1ed5i tr\u1edf l\u00ean, ph\u1ed1i h\u1ee3p tenofovir \/ lamivudine (ho\u1eb7c emtricitabine) \/ efavirenz v\u1edbi li\u1ec1u c\u1ed1 \u0111\u1ecbnh l\u00e0 l\u1ef1a ch\u1ecdn \u01b0u ti\u00ean \u0111\u1ec3 b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb ART.<\/p>\n
\u0110i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat th\u1ee9 hai \u0111\u1ec3 qu\u1ea3n l\u00fd th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb<\/h4>\n
\u0110\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi b\u1ecb kh\u00e1ng virut \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn ho\u1eb7c nghi ng\u1edd (v\u00ed d\u1ee5, ti\u1ec1n s\u1eed ph\u01a1i nhi\u1ec5m tr\u01b0\u1edbc \u0111\u00f3 ho\u1eb7c kh\u00f4ng \u0111\u00e1p \u1ee9ng ch\u00ednh) v\u1edbi lamivudine, entecavir, adefovir ho\u1eb7c telbivudine, WHO khuy\u1ebfn c\u00e1o n\u00ean chuy\u1ec3n sang tenofovir.<\/p>\n
Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb, ng\u1eebng thu\u1ed1c v\u00e0 t\u00e1i s\u1eed d\u1ee5ng<\/h3>\n
Li\u1ec7u ph\u00e1p NA su\u1ed1t \u0111\u1eddi<\/p>\n
T\u1ea5t c\u1ea3 c\u00e1c c\u00e1 nh\u00e2n\u00a0b\u1ecb x\u01a1 gan\u00a0d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng (ho\u1eb7c \u0111i\u1ec3m APRI> 2 \u1edf ng\u01b0\u1eddi l\u1edbn) c\u1ea7n \u0111i\u1ec1u tr\u1ecb NA su\u1ed1t \u0111\u1eddi.\u00a0Kh\u00f4ng n\u00ean ng\u1eebng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat \u1edf nh\u1eefng ng\u01b0\u1eddi n\u00e0y do kh\u1ea3 n\u0103ng t\u00e1i ho\u1ea1t \u0111\u1ed9ng c\u1ee7a HBV.<\/p>\n
Ng\u1eebng\u00a0\u00a0\u0111i\u1ec1u tr\u1ecb NA\u00a0C\u00e1c c\u00e1 nh\u00e2n kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng v\u1ec1 b\u1ec7nh x\u01a1 gan (ho\u1eb7c d\u1ef1a tr\u00ean \u0111i\u1ec3m APRI \u22642 \u1edf ng\u01b0\u1eddi l\u1edbn)\u00a0c\u00f3 t\u1ea5t c\u1ea3 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m sau \u0111\u00e2y c\u00f3\u00a0th\u1ec3 \u0111\u01b0\u1ee3c coi l\u00e0 c\u00e1 bi\u1ec7t khi ng\u1eebng NA:<\/p>\n
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C\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd \u0111\u1ec3 s\u1eed d\u1ee5ng l\u1ea1i trong th\u1eddi gian d\u00e0i.<\/li>\n
C\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 vi\u1ec7c m\u1ea5t HBeAg v\u00e0 chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh th\u00e0nh kh\u00e1ng HBe (\u1edf nh\u1eefng ng\u01b0\u1eddi ban \u0111\u1ea7u c\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh), c\u0169ng nh\u01b0 sau khi ho\u00e0n th\u00e0nh \u00edt nh\u1ea5t m\u1ed9t n\u0103m \u0111i\u1ec1u tr\u1ecb.<\/li>\n
C\u00f3 m\u1ee9c ALT b\u00ecnh th\u01b0\u1eddng li\u00ean t\u1ee5c\u00a0v\u00e0\u00a0n\u1ed3ng \u0111\u1ed9\u00a0HBV DNA li\u00ean t\u1ee5c kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c (n\u01a1i c\u00f3 s\u1eb5n x\u00e9t nghi\u1ec7m DNA HBV).\u00a0(N\u1ebfu kh\u00f4ng c\u00f3 x\u00e9t nghi\u1ec7m HBV DNA, h\u00e3y c\u00e2n nh\u1eafc ng\u1eebng \u0111i\u1ec1u tr\u1ecb NA \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 kh\u00e1ng nguy\u00ean b\u1ec1 m\u1eb7t vi\u00eam gan B dai d\u1eb3ng [HBsAg] v\u00e0 sau khi ho\u00e0n th\u00e0nh \u00edt nh\u1ea5t m\u1ed9t n\u0103m \u0111i\u1ec1u tr\u1ecb, b\u1ea5t k\u1ec3 t\u00ecnh tr\u1ea1ng HBeAg tr\u01b0\u1edbc \u0111\u00f3 c\u1ee7a h\u1ecd).<\/li>\n<\/ul>\n
T\u00e1i \u0111i\u1ec1u tr\u1ecb<\/h3>\n
Do nguy c\u01a1 t\u00e1i ph\u00e1t sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb NA, WHO khuy\u1ebfn c\u00e1o n\u00ean t\u00e1i \u0111i\u1ec1u tr\u1ecb khi c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u t\u00e1i ho\u1ea1t \u0111\u1ed9ng quay l\u1ea1i (HBsAg ho\u1eb7c HBeAg d\u01b0\u01a1ng t\u00ednh, t\u0103ng m\u1ee9c ALT ho\u1eb7c DNA HBV c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n l\u1ea1i) (n\u01a1i c\u00f3 s\u1eb5n x\u00e9t nghi\u1ec7m DNA HBV).<\/p>\n
Gi\u00e1m s\u00e1t<\/h3>\n
Theo d\u00f5i ti\u1ebfn tri\u1ec3n b\u1ec7nh v\u00e0 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc, trong v\u00e0 sau \u0111i\u1ec1u tr\u1ecbWHO khuy\u1ebfn ngh\u1ecb theo d\u00f5i h\u00e0ng n\u0103m \u1edf m\u1ee9c t\u1ed1i thi\u1ec3u sau \u0111\u00e2y:<\/p>\n
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M\u1ee9c ALT (v\u00e0 m\u1ee9c AST cho APRI), HBsAg, HBeAg v\u00e0 HBV DNA (n\u01a1i c\u00f3 s\u1eb5n x\u00e9t nghi\u1ec7m DNA HBV).<\/li>\n
X\u01a1 gan, \u1edf nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng b\u1ecb x\u01a1 gan c\u01a1 b\u1ea3n, s\u1eed d\u1ee5ng c\u00e1c nghi\u00ean c\u1ee9u kh\u00f4ng x\u00e2m l\u1ea5n nh\u01b0 \u0111i\u1ec3m s\u1ed1 APRI ho\u1eb7c FibroScan.<\/li>\n
Tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb trong khi \u0111i\u1ec1u tr\u1ecb, \u0111\u1ec1u \u0111\u1eb7n kho\u1ea3ng th\u1eddi gian v\u00e0 m\u1ed7i l\u1ea7n kh\u00e1m.<\/li>\n<\/ul>\n
Gi\u00e1m s\u00e1t th\u01b0\u1eddng xuy\u00ean h\u01a1n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf m\u1ed9t s\u1ed1 c\u00e1 nh\u00e2n.<\/h4>\n
Nh\u1eefng ng\u01b0\u1eddi ch\u01b0a \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau ch\u00ed cho \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat.\u00a0\u00a0Nh\u1eefng ng\u01b0\u1eddi nh\u01b0 v\u1eady l\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 n\u1ed3ng \u0111\u1ed9 ALT b\u1ea5t th\u01b0\u1eddng ho\u1eb7c m\u1ee9c HBV DNA dao \u0111\u1ed9ng trong kho\u1ea3ng 2.000 IU \/ mL \u0111\u1ebfn 20.000 IU \/ mL (n\u01a1i c\u00f3 s\u1eb5n x\u00e9t nghi\u1ec7m DNA HBV), c\u0169ng nh\u01b0 ng\u01b0\u1eddi nhi\u1ec5m HBV \/ HIV.<\/p>\n
Nh\u1eefng ng\u01b0\u1eddi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ho\u1eb7c sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb: Gi\u00e1m s\u00e1t \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u00edt nh\u1ea5t 3 th\u00e1ng m\u1ed9t l\u1ea7n trong n\u0103m \u0111\u1ea7u ti\u00ean cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p sau:<\/p>\n
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C\u00e1c c\u00e1 nh\u00e2n m\u1eafc b\u1ec7nh ti\u1ebfn tri\u1ec3n h\u01a1n (x\u01a1 gan b\u00f9 \/ m\u1ea5t b\u00f9).<\/li>\n
C\u00e1c c\u00e1 nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m v\u1edbi HBV \/ HIV.<\/li>\n
Trong n\u0103m \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb (\u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb v\u00e0 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb)<\/li>\n
Khi tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1.<\/li>\n
C\u00e1 nh\u00e2n sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb.<\/li>\n<\/ul>\n
Theo d\u00f5i \u0111\u1ed9c t\u00ednh tenofovir v\u00e0 entecavir<\/h3>\n
Tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat, h\u00e3y xem x\u00e9t \u0111o ch\u1ee9c n\u0103ng th\u1eadn c\u01a1 b\u1ea3n c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c c\u00e1 nh\u00e2n c\u0169ng nh\u01b0 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn c\u1ee7a h\u1ecd.<\/p>\n
Theo d\u00f5i ch\u1ee9c n\u0103ng th\u1eadn h\u00e0ng n\u0103m \u1edf nh\u1eefng ng\u01b0\u1eddi s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p tenofovir ho\u1eb7c entecavir d\u00e0i h\u1ea1n;\u00a0theo d\u00f5i c\u1ea9n th\u1eadn s\u1ef1 t\u0103ng tr\u01b0\u1edfng \u1edf tr\u1ebb em.<\/p>\n
Theo d\u00f5i ung th\u01b0 t\u1ebf b\u00e0o gan (HCC)<\/h3>\n
Th\u01b0\u1eddng xuy\u00ean \u00a0si\u00eau \u00e2m b\u1ee5ng v\u00e0 ki\u1ec3m tra m\u1ee9c \u0111\u1ed9 alpha-fetoprotein (AFP) m\u1ed7i 6 th\u00e1ng cho nh\u1eefng ng\u01b0\u1eddi:<\/p>\n
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B\u1ec7nh x\u01a1 gan, b\u1ea5t k\u1ec3 tu\u1ed5i t\u00e1c hay s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c.<\/li>\n
C\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh b\u1ecb HCC.<\/li>\n
L\u1edbn h\u01a1n 40 tu\u1ed5i (tu\u1ed5i tr\u1ebb h\u01a1n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh d\u1ef1a tr\u00ean t\u1ef7 l\u1ec7 m\u1eafc HCC khu v\u1ef1c), kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng v\u1ec1 b\u1ec7nh x\u01a1 gan (ho\u1eb7c d\u1ef1a tr\u00ean \u0111i\u1ec3m APRI \u22642) v\u00e0 c\u00f3 m\u1ee9c DNA HBV tr\u00ean 2.000 IU \/ mL X\u00e9t nghi\u1ec7m DNA c\u00f3 s\u1eb5n).<\/li>\n<\/ul>\n
$\"ung$
H\u00ecnh \u1ea3nh: ung th\u01b0 gan<\/figcaption><\/figure>\n
Tuy nhi\u00ean, \u0111\u1ed1i v\u1edbi h\u1ea7u h\u1ebft m\u1ecdi ng\u01b0\u1eddi, vi\u1ec7c ch\u1eefa tr\u1ecb kh\u00f4ng ch\u1eefa d\u1ee9t \u0111i\u1ec3m \u0111\u01b0\u1ee3c s\u1ef1 l\u00e2y nhi\u1ec5m c\u1ee7a vi\u00eam gan B m\u00e0 ch\u1ec9 ng\u0103n ch\u1eb7n \u0111\u01b0\u1ee3c s\u1ef1 nh\u00e2n l\u00ean c\u1ee7a virus. Do \u0111\u00f3 v\u1edbi h\u1ea7u h\u1ebft nh\u1eefng ng\u01b0\u1eddi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B th\u00ec ph\u1ea3i ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb c\u1ea3 \u0111\u1eddi.Nhi\u1ec1u c\u01a1 s\u1edf v\u1eabn c\u00f2n h\u1ea1n ch\u1ebf trong vi\u1ec7c ti\u1ebfp c\u1eadn, chu\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam gan B. Trong n\u0103m 2015, trong s\u1ed1 257 tri\u1ec7u ng\u01b0\u1eddi nhi\u1ec5m HBV, ch\u1ec9 c\u00f3 9% (kho\u1ea3ng 22 tri\u1ec7u ng\u01b0\u1eddi) bi\u1ebft chu\u1ea9n \u0111o\u00e1n c\u1ee7a h\u1ecd. Trong s\u1ed1 ng\u01b0\u1eddi \u0111\u01b0\u1ee3c chu\u1ea9n \u0111o\u00e1n th\u00ec ph\u1ea1m vi \u0111i\u1ec1u tr\u1ecb to\u00e0n c\u1ea7u ch\u1ec9 c\u00f3 kho\u1ea3ng 8% (1.7 tri\u1ec7u ng\u01b0\u1eddi). R\u1ea5t nhi\u1ec1u ng\u01b0\u1eddi \u0111\u01b0\u1ee3c chu\u1ea9n \u0111o\u00e1n ch\u1ec9 khi b\u1ec7nh gan c\u1ee7a h\u1ecd ph\u00e1t tri\u1ec3n.Trong s\u1ed1 c\u00e1c bi\u1ebfn ch\u1ee9ng l\u00e2u d\u00e0i c\u1ee7a b\u1ec7nh HBV, x\u01a1 gan v\u00e0 ung th\u01b0 t\u1ebf b\u00e0o gan g\u00e2y ra g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt r\u1ea5t l\u1edbn. Ung th\u01b0 gan ti\u1ebfn tri\u1ec3n nhanh, v\u00e0 v\u00ec c\u00e1c l\u1ef1a ch\u1ecdn ch\u1eefa b\u1ec7nh c\u00f2n h\u1ea1n ch\u1ebf, k\u1ebft qu\u1ea3 nh\u00ecn chung c\u00f2n k\u00e9m. T\u1ea1i nh\u1eefng n\u01b0\u1edbc thu nh\u1eadp th\u1ea5p, h\u1ea7u h\u1ebft m\u1ecdi ng\u01b0\u1eddi b\u1ecb ung th\u01b0 gan c\u00f3 th\u1ec3 ch\u1ebft trong v\u00f2ng v\u00e0i th\u00e1ng k\u1ec3 t\u1eeb sau khi \u0111\u01b0\u1ee3c chu\u1ea9n \u0111o\u00e1n. V\u1edbi c\u00e1c n\u01b0\u1edbc thu nh\u1eadp cao, ph\u1eabu thu\u1eadt v\u00e0 h\u00f3a tr\u1ecb c\u00f3 th\u1ec3 k\u00e9o d\u00e0i s\u1ef1 s\u1ed1ng th\u00eam v\u00e0i n\u0103m n\u1eefa. Vi\u1ec7c thay th\u1ebf gan thi tho\u1ea3ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u1edbi nh\u1eefng ng\u01b0\u1eddi x\u01a1 gan trong c\u00e1c n\u01b0\u1edbc thu nh\u1eadp cao, v\u1edbi t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng kh\u00e1c nhau.<\/p>\n
Ti\u00eam ph\u00f2ng vi\u00eam gan B<\/h2>\n
Vaccin vi\u00eam gan B<\/h3>\n
Vaccine vi\u00eam gan B l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u00ednh trong vi\u1ec7c ng\u0103n ch\u1eb7n vi\u00eam gan B. WHO khuy\u1ebfn c\u00e1o r\u1eb1ng t\u1ea5t c\u1ea3 nh\u1eefng tr\u1ebb em m\u1edbi sinh n\u00ean \u0111\u01b0\u1ee3c ti\u00eam vaccin ngay sau khi sinh, t\u1ed1t nh\u1ea5t l\u00e0 trong v\u00f2ng 24 gi\u1edd. T\u1ef7 l\u1ec7 nhi\u1ec5m HBV m\u1ea1n t\u00ednh th\u1ea5p \u1edf tr\u1ebb em d\u01b0\u1edbi 5 tu\u1ed5i hi\u1ec7n nay c\u00f3 th\u1ec3 l\u00e0 do s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i vaccin vi\u00eam gan B. Tr\u00ean th\u1ebf gi\u1edbi, v\u00e0o n\u0103m 2015, theo \u01b0\u1edbc t\u00ednh t\u1ec9 l\u1ec7 ng\u01b0\u1eddi nhi\u1ec5m HBV trong nh\u00f3m tu\u1ed5i n\u00e0y l\u00e0 kho\u1ea3ng 1,3% so v\u1edbi kho\u1ea3ng 4,7% tr\u01b0\u1edbc khi c\u00f3 vaccin.<\/p>\n
$\"vi\u00eam$
H\u00ecnh \u1ea3nh: ti\u00eam ph\u00f2ng vi\u00eam gan b \u1edf tr\u1ebb em<\/figcaption><\/figure>\n
$\"vi\u00eam$ <\/p>\n
$\"Ti\u00eam$
Ti\u00eam ch\u1ee7ng to\u00e0n c\u1ea7u 1989-2017 li\u1ec1u th\u1ee9 3 vi\u00eam gan B bao ph\u1ee7 \u1edf tr\u1ebb s\u01a1 sinh, bao ph\u1ee7 to\u00e0n c\u1ea7u t\u1ef7 l\u1ec7 84% n\u0103m 2017<\/figcaption><\/figure>\n
Ngu\u1ed3n d\u1eef li\u1ec7u tham kh\u1ea3o t\u1ea1i WHO.int: Link \u1edf \u0111\u00e2y<\/a><\/p>\n
Ti\u00eam ngay sau khi sinh n\u00ean \u0111\u01b0\u1ee3c chia th\u00e0nh 2 ho\u1eb7c 3 li\u1ec1u. Trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, c\u00f3 2 l\u1ef1a ch\u1ecdn nh\u01b0 sau \u0111\u01b0\u1ee3c xem l\u00e0 ph\u00f9 h\u1ee3p:<\/p>\n
\n
Li\u1ec7u tr\u00ecnh 3 li\u1ec1u, li\u1ec1u \u0111\u1ea7u ti\u00ean (\u0111\u01a1n tr\u1ecb) \u0111\u01b0\u1ee3c ti\u00eam sau khi sinh, li\u1ec1u th\u1ee9 2 v\u00e0 th\u1ee9 3(vaccin \u0111\u01a1n tr\u1ecb ho\u1eb7c k\u1ebft h\u1ee3p) \u0111\u01b0\u1ee3c ti\u00eam c\u00f9ng th\u1eddi \u0111i\u1ec3m v\u1edbi li\u1ec1u th\u1ee9 nh\u1ea5t v\u00e0 th\u1ee9 ba c\u1ee7a b\u1ec7nh b\u1ea1ch h\u1ea7u, ho g\u00e0 (ho g\u00e0) v\u00e0 u\u1ed1n v\u00e1n – (DTP); ho\u1eb7c l\u00e0<\/li>\n
Li\u1ec7u tr\u00ecnh 4 li\u1ec1u, li\u1ec1u \u0111\u01a1n tr\u1ecb khi sinh sau \u0111\u00f3 l\u00e0 3 li\u1ec1u \u0111\u01a1n tr\u1ecb ho\u1eb7c c\u00e1c li\u1ec1u vaccin k\u1ebft h\u1ee3p, th\u01b0\u1eddng \u0111\u01b0\u1ee3c ti\u00eam c\u00f9ng c\u00e1c lo\u1ea1i vaccin cho tr\u1ebb s\u01a1 sinh kh\u00e1c.<\/li>\n<\/ul>\n
$\"ti\u00eam$ <\/p>\n
Lo\u1ea1t vaccin ho\u00e0n ch\u1ec9nh t\u1ea1o ra m\u1ee9c kh\u00e1ng th\u1ec3 b\u1ea3o v\u1ec7 \u1edf h\u01a1n 95% tr\u1ebb s\u01a1 sinh, tr\u1ebb em v\u00e0 thanh ni\u00ean. Vi\u1ec7c b\u1ea3o v\u1ec7 k\u00e9o d\u00e0i \u00edt nh\u1ea5t 20 n\u0103m v\u00e0 c\u00f3 khi c\u1ea3 cu\u1ed9c \u0111\u1eddi. Do v\u1eady, WHO kh\u00f4ng khuy\u1ebfn c\u00e1o ti\u00eam ch\u1ee7ng cho ng\u01b0\u1eddi \u0111\u00e3 ho\u00e0n th\u00e0nh li\u1ec7u tr\u00ecnh 3 li\u1ec1u ti\u00eam ch\u1ee7ng.<\/p>\n
T\u1ea5t c\u1ea3 tr\u1ebb em v\u00e0 c\u00e1c thanh thi\u1ebfu ni\u00ean d\u01b0\u1edbi 18 tu\u1ed5i v\u00e0 ch\u01b0a \u0111\u01b0\u1ee3c ti\u00eam ph\u00f2ng tr\u01b0\u1edbc \u0111\u00f3 n\u00ean \u0111\u01b0\u1ee3c ti\u00eam ngay n\u1ebfu h\u1ecd s\u1ed1ng \u1edf c\u00e1c n\u01b0\u1edbc n\u01a1i m\u00e0 c\u00f3 t\u1ec9 l\u1ec7 l\u01b0u h\u00e0nh b\u1ec7nh th\u1ea5p ho\u1eb7c trung b\u00ecnh. Trong s\u1ed1 c\u00e1c n\u01b0\u1edbc n\u00e0y, c\u00f3 nhi\u1ec1u ng\u01b0\u1eddi trong nh\u00f3m c\u00f3 nguy c\u01a1 m\u1eafc b\u1ec7nh cao c\u00f3 th\u1ec3 b\u1ecb l\u00e2y nhi\u1ec5m, v\u00ec th\u1ebf h\u1ecd n\u00ean \u0111\u01b0\u1ee3c ti\u1ec3m ch\u1ee7ng. S\u1ed1 n\u00e0y bao g\u1ed3m:<\/p>\n
\n
Ng\u01b0\u1eddi th\u01b0\u1eddng xuy\u00ean c\u1ea7n cung c\u1ea5p m\u00e1u, b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, ng\u01b0\u1eddi nh\u1eadn gh\u00e9p t\u1ea1ng;<\/li>\n
Ng\u01b0\u1eddi b\u1ecb giam trong c\u00e1c nh\u00e0 t\u00f9;<\/li>\n
Ng\u01b0\u1eddi ti\u00eam ch\u00edch ma t\u00fay;<\/li>\n
C\u00f3 quan h\u1ec7 gia \u0111\u00ecnh ho\u1eb7c quan h\u1ec7 t\u00ecnh d\u1ee5c v\u1edbi nh\u1eefng ng\u01b0\u1eddi nhi\u1ec5m HBV m\u00e3n t\u00ednh;<\/li>\n
Nh\u1eefng ng\u01b0\u1eddi ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe v\u00e0 nh\u1eefng ng\u01b0\u1eddi ti\u1ebfp x\u00fac v\u1edbi m\u00e1u hay c\u00e1c s\u1ea3n ph\u1ea9m t\u1eeb m\u00e1u do \u0111\u1eb7c th\u00f9 c\u00f4ng vi\u1ec7c c\u1ee7a h\u1ecd;<\/li>\n
Kh\u00e1ch du l\u1ecbch ch\u01b0a ho\u00e0n th\u00e0nh lo\u1ea1t vaccin vi\u00eam gan B c\u1ee7a h\u1ecd, nh\u1eefng ng\u01b0\u1eddi n\u00ean \u0111\u01b0\u1ee3c cung c\u1ea5p vaccin tr\u01b0\u1edbc khi \u0111i \u0111\u1ebfn c\u00e1c khu v\u1ef1c l\u01b0u h\u00e0nh.<\/li>\n<\/ul>\n
V\u1eafc xin \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn v\u1ec1 \u0111\u1ed9 an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3. T\u1eeb n\u0103m 1982. Tr\u00ean 1 t\u1ef7 li\u1ec1u v\u1eafc xin vi\u00eam gan B \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u00ean kh\u1eafp th\u1ebf gi\u1edbi. Trong nhi\u1ec1u n\u01b0\u1edbc n\u01a1i m\u00e0 kho\u1ea3ng 8-15% s\u1ed1 tr\u1ebb \u0111\u00e3 t\u1eebng b\u1ecb nhi\u1ec5m virus vi\u00eam gan B m\u00e3n t\u00ednh, th\u00ec ti\u00eam ch\u1ee7ng \u0111\u00e3 gi\u1ea3m \u0111\u01b0\u1ee3c t\u1ec9 l\u1ec7 nhi\u1ec5m m\u00e3n t\u00ednh xu\u1ed1ng \u0111\u1ebfn ch\u1ec9 d\u01b0\u1edbi 1% Trong n\u0103m 2015, t\u1ef7 l\u1ec7 ti\u00eam li\u1ec1u vaccin vi\u00eam gan B th\u1ee9 ba \u0111\u1ea1t 84%, v\u00e0 ti\u00eam vaccin vi\u00eam gan B khi m\u1edbi sinh l\u00e0 39% tr\u00ean to\u00e0n c\u1ea7u. WHO Region of the Americas and WHO Western Pacific Region l\u00e0 nh\u1eefng v\u00f9ng duy nh\u1ea5t c\u00f3 s\u1ef1 bao ph\u1ee7 r\u1ed9ng r\u00e3i. Th\u00eam n\u1eefa, vi\u1ec7c th\u1ef1c hi\u1ec7n chi\u1ebfn l\u01b0\u1ee3c an to\u00e0n m\u00e1u, bao g\u1ed3m s\u00e0ng l\u1ecdc \u0111\u1ea3m b\u1ea3o ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c th\u00e0nh ph\u1ea7n m\u00e1u v\u00e0 m\u00e1u \u0111\u01b0\u1ee3c hi\u1ebfn t\u1eb7ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho truy\u1ec1n m\u00e1u, c\u00f3 th\u1ec3 ng\u0103n c\u1ea3n s\u1ef1 l\u00e2y truy\u1ec1n c\u1ee7a HBV. Tr\u00ean th\u1ebf gi\u1edbi v\u00e0o n\u0103m 2013, 97% l\u01b0\u1ee3ng m\u00e1u \u0111\u01b0\u1ee3c hi\u1ebfn \u0111\u00e3 \u0111\u01b0\u1ee3c s\u00e0ng l\u1ecdc v\u00e0 \u0111\u1ea3m b\u1ea3o ch\u1ea5t l\u01b0\u1ee3ng, nh\u01b0ng m\u1ed9t v\u00e0i d\u00e0o c\u1ea3n v\u1eabn t\u1ed3n t\u1ea1i. Th\u1ef1c h\u00e0nh ti\u00eam an to\u00e0n, lo\u1ea1i b\u1ecf ti\u00eam kh\u00f4ng c\u1ea7n thi\u1ebft v\u00e0 kh\u00f4ng an to\u00e0n c\u00f3 th\u1ec3 l\u00e0 nh\u1eefng chi\u1ebfn d\u1ecbch hi\u1ec7u qu\u1ea3 \u0111\u1ec3 b\u1ea3o v\u1ec7 kh\u1ecfi s\u1ef1 lan truy\u1ec1n c\u1ee7a HBV. Ti\u00eam kh\u00f4ng an to\u00e0n \u0111\u00e3 gi\u1ea3m t\u1eeb 39% n\u0103m 2000 xu\u1ed1ng 5% n\u0103m 2010 tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. H\u01a1n n\u1eefa, vi\u1ec7c th\u1ef1c hi\u1ec7n quan h\u1ec7 an to\u00e0n, bao g\u1ed3m gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng b\u1ea1n t\u00ecnh v\u00e0 s\u1eed d\u1ee5ng bao cao su, c\u0169ng l\u00e0 c\u00e1ch b\u1ea3o v\u1ec7 ch\u1ed1ng l\u1ea1i s\u1ef1 l\u00e2y truy\u1ec1n.<\/p>\n
$\"vaccin$ <\/p>\n
D\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n HBV t\u1eeb m\u1eb9 sang con b\u1eb1ng li\u1ec7u ph\u00e1p kh\u00e1ng vi-r\u00fat\u00a0Ph\u1ee5 n\u1eef mang thai \u0111\u01a1n nhi\u1ec5m HBV n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat theo ch\u1ec9 \u0111\u1ecbnh cho nh\u1eefng ng\u01b0\u1eddi l\u1edbn kh\u00e1c, v\u1edbi tenofovir l\u00e0 NA \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb.\u00a0Hi\u1ec7n t\u1ea1i, WHO kh\u00f4ng \u0111\u01b0a ra khuy\u1ebfn ngh\u1ecb n\u00e0o v\u1ec1 li\u1ec7u ph\u00e1p kh\u00e1ng vi-r\u00fat th\u00f4ng th\u01b0\u1eddng \u0111\u1ec3 d\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n HBV t\u1eeb m\u1eb9 sang con.<\/p>\n
\u0110\u1ed1i v\u1edbi ph\u1ee5 n\u1eef mang thai v\u00e0 cho con b\u00fa b\u1ecb nhi\u1ec5m HIV (bao g\u1ed3m c\u1ea3 nh\u1eefng ph\u1ee5 n\u1eef trong ba th\u00e1ng \u0111\u1ea7u c\u1ee7a thai k\u1ef3 v\u00e0 ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i sinh \u0111\u1ebb), \u0111i\u1ec1u tr\u1ecb ARV \u0111\u1ea7u tay \u00a0\u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb l\u00e0 k\u1ebft h\u1ee3p tenofovir \/ lamivudine li\u1ec1u d\u00f9ng m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y \u00e1p d\u1ee5ng cho \u0111i\u1ec1u tr\u1ecb su\u1ed1t \u0111\u1eddi c\u0169ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb ARV kh\u1edfi \u0111\u1ea7u \u0111\u1ec3 d\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n HBV t\u1eeb m\u1eb9 sang con v\u00e0 sau \u0111\u00f3 d\u1eebng l\u1ea1i.<\/p>\n
\u0110\u1ed9ng th\u00e1i c\u1ee7a WHO<\/h2>\n
Trong th\u00e1ng 3 n\u0103m 2015, WHO \u0111\u00e3 kh\u1edfi \u0111\u1ed9ng chi\u1ebfn d\u1ecbch \u201cGuidelines for the prevention, care and treatment of persons living with chronic hepatitis B infection\u201d ( h\u01b0\u1edbng d\u1eabn ng\u0103n ch\u1eb7n, ch\u0103m s\u00f3c v\u00e0 ch\u1eefa tr\u1ecb cho ng\u01b0\u1eddi nhi\u1ec5m vi\u00eam gan B m\u00e3n t\u00ednh).<\/p>\n
$\"vi\u00eam$ <\/p>\n
C\u1ee5 th\u1ec3:<\/p>\n
\n
Th\u00fac \u0111\u1ea9y s\u1eed d\u1ee5ng c\u00e1c x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n \u0111\u01a1n gi\u1ea3n, kh\u00f4ng x\u00e2m l\u1ea5n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 giai \u0111o\u1ea1n b\u1ec7nh gan v\u00e0 \u0111i\u1ec1u ki\u1ec7n \u0111i\u1ec1u tr\u1ecb;<\/li>\n
\u01afu ti\u00ean \u0111i\u1ec1u tr\u1ecb cho nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh gan ti\u1ebfn tri\u1ec3n nh\u1ea5t v\u00e0 c\u00f3 nguy c\u01a1 t\u1eed vong cao nh\u1ea5t;<\/li>\n
Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t t\u01b0\u01a1ng t\u1ef1 nucleos(t)ide ng\u0103n ch\u1eb7n \u0111\u01b0\u1ee3c vi\u1ec7c kh\u00e1ng thu\u1ed1c (tenofovir v\u00e0 entecavir, v\u00e0 entecavir cho tr\u1ebb c\u00f3 \u0111\u1ed9 tu\u1ed5i t\u1eeb 2 \u2013 11 tu\u1ed5i) \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tuy\u1ebfn 1 ho\u1eb7c tuy\u1ebfn 2.<\/li>\n<\/ul>\n
Nh\u1eefng h\u01b0\u1edbng d\u1eabn n\u00e0y c\u0169ng khuy\u00ean nh\u1eefng ng\u01b0\u1eddi b\u1ecb x\u01a1 gan n\u00ean \u0111i\u1ec1u tr\u1ecb su\u1ed1t \u0111\u1eddi v\u00e0 ki\u1ec3m so\u00e1t th\u01b0\u1eddng xuy\u00ean \u0111\u1ed1i v\u1edbi ti\u1ebfn tr\u00ecnh c\u1ee7a b\u1ec7nh, ch\u1ea5t \u0111\u1ed9c c\u1ee7a c\u00e1c lo\u1ea1i thu\u1ed1c v\u00e0 s\u1edbm ph\u00e1t hi\u1ec7n ung th\u01b0 gan.<\/p>\n
V\u00e0o th\u00e1ng 5\/2016, t\u1ed5 ch\u1ee9c y t\u1ebf th\u1ebf gi\u1edbi \u0111\u00e3 th\u00f4ng qua chi\u1ebfn d\u1ecbch \u0111\u1ea7u ti\u00ean mang t\u00ean “Global Health Sector Strategy on Viral Hepatitis, 2016-2020”. Chi\u1ebfn d\u1ecbch n\u00e0y \u0111\u00e1nh d\u1ea5u vai tr\u00f2 quan tr\u1ecdng c\u1ee7a Universal Health Coverage (B\u1ea3o hi\u1ec3m y t\u1ebf to\u00e0n c\u1ea7u) v\u00e0 m\u1ee5c ti\u00eau c\u1ee7a n\u00f3 nh\u1eb1m l\u00e0m cho ph\u00f9 h\u1ee3p v\u1edbi nh\u1eefng m\u1ee5c ti\u00eau c\u1ee7a Sustainable Development Goals (M\u1ee5c ti\u00eau ph\u00e1t tri\u1ec3n b\u1ec1n v\u1eefng). T\u1ea7m nh\u00ecn c\u1ee7a chi\u1ebfn d\u1ecbch n\u00e0y l\u00e0 lo\u1ea1i tr\u1eeb virus vi\u00eam gan B do \u0111\u00e2y v\u1ea5n \u0111\u1ec1 li\u00ean quan t\u1edbi s\u1ee9c kh\u1ecfe c\u1ed9ng \u0111\u1ed3ng v\u00e0 \u0111i\u1ec1u n\u00e0y \u0111\u01b0\u1ee3c g\u00f3i g\u1ecdn trong m\u1ee5c ti\u00eau to\u00e0n c\u1ea7u nh\u1eb1m gi\u1ea3m thi\u1ec3u vi\u1ec7c l\u00e2y nhi\u1ec5m vi\u00eam gan do virus g\u00e2y ra \u0111\u1ebfn 90% v\u00e0 l\u00e0m gi\u1ea3m c\u00e1c ca t\u1eed vong do virus vi\u00eam gan g\u00e2y ra \u0111\u1ebfn 65% v\u00e0o n\u0103m 2030. M\u1ed9t s\u1ed1 qu\u1ed1c gia v\u00e0 Ban th\u01b0 k\u00fd WHO \u0111\u00e3 ti\u1ebfn h\u00e0nh b\u1eaft tay v\u00e0o h\u00e0nh \u0111\u1ed9ng \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c nh\u1eefng m\u1ee5c ti\u00eau \u0111\u1ec1 ra.\u0110\u1ec3 h\u1ed7 tr\u1ee3 c\u00e1c qu\u1ed1c gia \u0111ang ti\u1ebfn t\u1edbi \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau to\u00e0n c\u1ea7u theo Sustainable Development Agenda v\u00e0o n\u0103m 2030, WHO \u0111ang l\u00e0m vi\u1ec7c theo nh\u1eefng l\u0129nh v\u1ef1c sau:<\/p>\n
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N\u00e2ng cao nh\u1eadn th\u1ee9c, th\u00fac \u0111\u1ea9y quan h\u1ec7 \u0111\u1ed1i t\u00e1c v\u00e0 th\u00fac \u0111\u1ea9y ngu\u1ed3n l\u1ef1c;<\/li>\n
X\u00e2y d\u1ef1ng ch\u00ednh s\u00e1ch d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng v\u00e0 d\u1eef li\u1ec7u cho h\u00e0nh \u0111\u1ed9ng;<\/li>\n
Ng\u0103n ch\u1eb7n vi\u1ec7c truy\u1ec1n nhi\u1ec5m; v\u00e0 nh\u00e2n r\u1ed9ng c\u00e1c d\u1ecbch v\u1ee5 s\u00e0ng l\u1ecdc, ch\u0103m s\u00f3c v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/li>\n<\/ul>\n
WHO c\u0169ng t\u1ed5 ch\u1ee9c Ng\u00e0y h\u1ed9i vi\u00eam gan th\u1ebf gi\u1edbi (World Hepatitis Day) v\u00e0o ng\u00e0y 28\/7 h\u00e0ng n\u0103m \u0111\u1ec3 n\u00e2ng cao hi\u1ec3u bi\u1ebft v\u00e0 nh\u1eadn th\u1ee9c v\u1ec1 virus vi\u00eam gan.<\/p>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
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Hepatitis B Guidelines: https:\/\/emedicine.medscape.com\/article\/177632-guidelines<\/a><\/li>\n
Hepatitis B: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hepatitis-b<\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"
N\u1ed9i dung ch\u00ednh Vi\u00eam gan B l\u00e0 b\u1ec7nh truy\u1ec1n nhi\u1ec5m do virus t\u1ea5n c\u00f4ng gan v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra b\u1ec7nh m\u00e3n t\u00ednh v\u00e0 c\u1ea5p t\u00ednh. Virus \u0111\u01b0\u1ee3c truy\u1ec1n qua vi\u1ec7c ti\u1ebfp x\u00fac v\u1edbi m\u00e1u v\u00e0 c\u00e1c d\u1ecbch c\u01a1 th\u1ec3 kh\u00e1c c\u1ee7a ng\u01b0\u1eddi b\u1ecb nhi\u1ec5m. Theo \u01b0\u1edbc t\u00ednh c\u00f3 kho\u1ea3ng 257 tri\u1ec7u ng\u01b0\u1eddi \u0111ang b\u1ecb […]\n","protected":false},"author":1,"featured_media":9538,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9531","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\/9531","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=9531"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/9531\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/9538"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=9531"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=9531"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=9531"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}