{"id":2088,"date":"2022-12-29T13:30:30","date_gmt":"2022-12-29T06:30:30","guid":{"rendered":"https:\/\/hienbacsi.com\/?p=2088"},"modified":"2022-12-29T13:30:33","modified_gmt":"2022-12-29T06:30:33","slug":"hoi-dap-chan-doan-va-dieu-tri-benh-viem-gan-b","status":"publish","type":"post","link":"https:\/\/hienbacsi.com\/index.php\/2022\/12\/29\/hoi-dap-chan-doan-va-dieu-tri-benh-viem-gan-b\/","title":{"rendered":"H\u1ecfi \u0111\u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam gan B"},"content":{"rendered":"\n

\u00a0Vi\u00eam gan B c\u00f3 t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh cao \u1edf ch\u00e2u \u00c1, \u0111\u1eb7c bi\u1ec7t \u1edf Vi\u1ec7t Nam ch\u00fang ta. B\u1ec7nh nguy hi\u1ec3m \u1edf ch\u1ed7 th\u1ea7m l\u1eb7ng \u00a0(c\u00f3 th\u1ec3 b\u1ea1n \u0111ang mang virus m\u00e0 b\u1ea1n c\u0169ng kh\u00f4ng bi\u1ebft n\u1ebfu kh\u00f4ng l\u00e0m x\u00e9t nghi\u1ec7m m\u00e1u!),\u00a0nh\u01b0ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong cao nh\u01b0 x\u01a1 gan v\u00e0 ung th\u01b0 gan. V\u00ec v\u1eady, ch\u00fang t\u00f4i bi\u00ean so\u1ea1n t\u00e0i li\u1ec7u n\u00e0y m\u1ee5c \u0111\u00edch \u0111\u1ec3 ph\u1ed5 bi\u1ebfn ki\u1ebfn th\u1ee9c v\u1ec1 vi\u00eam gan B m\u1ed9t c\u00e1ch r\u1ed9ng r\u00e3i v\u1edbi nh\u1eefng t\u00e0i li\u1ec7u \u0111\u00e1ng tin c\u1eady.\u00a0<\/strong><\/p>\n\n\n\n

ThS BS Tr\u1ea7n H\u1eefu Hi\u1ec1n<\/p>\n\n\n\n

T\u1ed1t nghi\u1ec7p b\u1eb1ng DIU \u0111\u1ea1i h\u1ecdc Corse CH Ph\u00e1p<\/p>\n\n\n\n

Th\u00e0nh vi\u00ean h\u1ed9i Nghi\u00ean C\u1ee9u Gan Ch\u00e2u \u00c2u<\/p>\n\n\n\n

Chuy\u00ean \u0111i\u1ec1u tr\u1ecb: x\u01a1 gan, ung th\u01b0 gan, vi\u00eam gan B, vi\u00eam gan C, gan nhi\u1ec5m m\u1ee1, b\u00e9o ph\u00ec, t\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, vi\u00eam d\u1ea1 d\u00e0y, nhi\u1ec5m Hp d\u1ea1 d\u00e0y, b\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c kh\u00e1ng tr\u1ecb, vi\u00eam ru\u1ed9t, h\u1ed9i ch\u1ee9ng ru\u1ed9t k\u00edch th\u00edch.<\/p>\n\n\n\n

\u0110\u1ecba ch\u1ec9: 399\/15 L\u00fd Th\u00e1i T\u1ed5, ph\u01b0\u1eddng 9, qu\u1eadn 10, Tp HCM<\/p>\n\n\n\n

phone 0987842200<\/p>\n\n\n\n

1. Vi\u00eam gan B l\u00e0 g\u00ec?<\/strong><\/p>\n\n\n\n

Vi\u00eam gan B l\u00e0 b\u1ec7nh g\u00e2y vi\u00eam gan do nhi\u1ec5m virus vi\u00eam gan B (hepatitis B virus \u2013 HBV), m\u1ed9t lo\u1ea1i virus thu\u1ed9c h\u1ecd Hepadnaviridae c\u00f3 8 type kh\u00e1ng nguy\u00ean.<\/p>\n\n\n\n

Khi virus nhi\u1ec5m x\u00e2m nh\u1eadp t\u1ebf b\u00e0o gan, t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch s\u1ebd nh\u1eadn di\u1ec7n v\u00e0 ti\u00eau di\u1ec7t t\u1ebf b\u00e0o b\u1ecb nhi\u1ec5m (v\u00ec v\u1eady m\u00e0 t\u0103ng men gan). N\u1ebfu di\u1ec7t h\u1ebft virus trong giai \u0111o\u1ea1n 6 th\u00e1ng \u0111\u1ea7u ti\u00ean b\u1ecb nhi\u1ec5m (giai \u0111o\u1ea1n c\u1ea5p) th\u00ec c\u01a1 th\u1ec3 s\u1ebd s\u1ea1ch virus v\u00e0 c\u00f3 th\u1ec3 c\u00f3 kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i virus. N\u1ebfu di\u1ec7t kh\u00f4ng h\u1ebft virus th\u00ec s\u1ebd d\u1eabn \u0111\u1ebfn vi\u00eam gan B m\u00e3n t\u00ednh (nhi\u1ec5m tr\u00ean 6 th\u00e1ng).<\/p>\n\n\n\n

<\/a><\/td><\/tr>
C\u1ea5u tr\u00fac c\u1ee7a virus vi\u00eam gan B (HBV)<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
\"\"\/<\/a><\/figure>\n\n\n\n

2. Vi\u00eam gan B c\u00f3 ph\u1ed5 bi\u1ebfn kh\u00f4ng?<\/strong><\/p>\n\n\n\n

Theo WHO, to\u00e0n th\u1ebf gi\u1edbi c\u00f3 kho\u1ea3ng 260 tri\u1ec7u ng\u01b0\u1eddi mang HBV m\u00e3n t\u00ednh, 2\/3 s\u1ed1 n\u00e0y \u1edf ch\u00e2u \u00c1.<\/p>\n\n\n\n

\u1ede Vi\u1ec7t Nam, trong m\u1ed9t nghi\u00ean c\u1ee9u (c\u1eaft ngang t\u1ea1i c\u1ed9ng \u0111\u1ed3ng v\u1edbi 1047 \u0111\u1ed1i t\u01b0\u1ee3ng) th\u00ec t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh l\u00e0 8,9%, trong m\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c ( c\u1eaft ngang, 1200 m\u1eabu m\u00e1u) l\u00e0 14%.<\/p>\n\n\n\n

3. HBV l\u00e2y qua \u0111\u01b0\u1eddng n\u00e0o v\u00e0 kh\u00f4ng l\u00e2y qua \u0111\u01b0\u1eddng n\u00e0o?<\/strong><\/p>\n\n\n\n

HBV th\u01b0\u1eddng l\u00e2y qua \u0111\u01b0\u1eddng m\u00e1u, tinh d\u1ecbch, d\u1ecbch ti\u1ebft c\u01a1 th\u1ec3 t\u1eeb ng\u01b0\u1eddi nhi\u1ec5m sang ng\u01b0\u1eddi l\u00e0nh. HBV c\u0169ng l\u00e2y qua \u0111\u01b0\u1eddng quan h\u1ec7 t\u00ecnh d\u1ee5c, s\u1eed d\u1ee5ng chung c\u00e1c d\u1ee5ng c\u1ee5 y t\u1ebf, v\u00e0 t\u1eeb ng\u01b0\u1eddi m\u1eb9 b\u1ecb nhi\u1ec5m sang con l\u00fac sinh.<\/p>\n\n\n\n

HBV kh\u00f4ng l\u00e2y khi d\u00f9ng chung \u0111\u1ed3 d\u00f9ng \u0103n u\u1ed1ng, \u00f4m, h\u00f4n, b\u1eaft tay, ho, h\u1eaft h\u01a1i. HBV kh\u00f4ng l\u00e2y qua th\u1ef1c ph\u1ea9m v\u00e0 n\u01b0\u1edbc \u00f4 nhi\u1ec5m nh\u01b0 m\u1ed9t s\u1ed1 virus vi\u00eam gan kh\u00e1c.<\/p>\n\n\n\n

\"\"\/<\/a><\/figure>\n\n\n\n

4. Khi b\u1ecb nhi\u1ec5m HBV c\u01a1 th\u1ec3 bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng g\u00ec?<\/strong><\/p>\n\n\n\n

Khi b\u1ecb vi\u00eam gan B c\u1ea5p t\u00ednh c\u01a1 th\u1ec3 s\u1ebd bi\u1ec3u hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng sau khi b\u1ecb nhi\u1ec5m v\u00e0i tu\u1ea7n ho\u1eb7c v\u00e0i th\u00e1ng:<\/p>\n\n\n\n

S\u1ed1t, m\u1ec7t<\/p>\n\n\n\n

Ch\u00e1n \u0103n<\/p>\n\n\n\n

N\u00f4n, bu\u1ed3n n\u00f4n<\/p>\n\n\n\n

V\u00e0ng da<\/p>\n\n\n\n

\u0110au b\u1ee5ng<\/p>\n\n\n\n

Ph\u00e2n b\u1ea1c m\u00e0u<\/p>\n\n\n\n

N\u01b0\u1edbc ti\u1ec3u \u0111\u1eadm m\u00e0u<\/p>\n\n\n\n

\u0110au kh\u1edbp<\/p>\n\n\n\n

Khi b\u1ecb vi\u00eam gan B m\u00e3n t\u00ednh c\u01a1 th\u1ec3 s\u1ebd kh\u00f4ng bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng g\u00ec, nh\u01b0ng v\u1eabn c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n virus trong m\u00e1u. Khi b\u1ecb nhi\u1ec5m kho\u1ea3ng 30 n\u0103m, tri\u1ec7u ch\u1ee9ng m\u1edbi ph\u00e1t hi\u1ec7n ra, gan b\u1ecb t\u1ed5n th\u01b0\u01a1ng dai d\u1eb3ng trong su\u1ed1t th\u1eddi gian n\u00e0y. Khi tri\u1ec7u ch\u1ee9ng xu\u1ea5t hi\u1ec7n th\u00ec t\u01b0\u01a1ng t\u1ef1 nh\u01b0 giai \u0111\u1ecdan c\u1ea5p t\u00ednh, l\u00fac n\u00e0y gan \u0111\u00e3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng.<\/p>\n\n\n\n

5. Vi\u00eam gan B c\u00f3 nguy hi\u1ec3m kh\u00f4ng?<\/strong><\/p>\n\n\n\n

C\u00f3. Nguy hi\u1ec3m b\u1edfi v\u00ec vi\u00eam gan B l\u00e0 m\u1ed9t b\u1ec7nh r\u1ea5t \u00e2m th\u1ea7m, ng\u01b0\u1eddi mang virus c\u0169ng nh\u01b0 ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng.<\/p>\n\n\n\n

Nhi\u1ec5m virus vi\u00eam gan B (HBV) c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c b\u1ec7nh v\u1ec1 gan nh\u01b0: suy gan, x\u01a1 gan, ung th\u01b0 gan. 80% c\u00e1c tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 gan l\u00e0 do nhi\u1ec5m HBV m\u00e3n t\u00ednh.<\/p>\n\n\n\n

M\u1ed7i n\u0103m  tr\u00ean th\u1ebf gi\u1edbi c\u00f3 780.000 ng\u01b0\u1eddi ch\u1ebft b\u1edfi c\u00e1c bi\u1ebfn ch\u1ee9ng do nhi\u1ec5m HBV m\u00e3n t\u00ednh, bao g\u1ed3m c\u1ea3 x\u01a1 gan v\u00e0 ung th\u01b0 gan.<\/p>\n\n\n\n

6. B\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam gan B c\u1ea5p t\u00ednh c\u00f3 \u0111i\u1ec1u tr\u1ecb kh\u00f4ng?<\/strong><\/p>\n\n\n\n

Kh\u00f4ng. Khi b\u1ec7nh nh\u00e2n vi\u00eam gan B c\u1ea5p t\u00ednh (HbsAG (+) v\u00e0 HbcAb-IgM (+)) th\u00ec b\u1ec7nh s\u1ebd t\u1ef1 gi\u1edbi h\u1ea1n \u1edf 95% ng\u01b0\u1eddi l\u1edbn v\u00e0 kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng virus. Thu\u1ed1c kh\u00e1ng virus ch\u1ec9 \u0111i\u1ec1u tr\u1ecb \u1edf c\u00e1c b\u1ec7nh nh\u00e2n vi\u00eam gan B m\u00e3n t\u00ednh.<\/p>\n\n\n\n

7. T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n vi\u00eam gan B m\u00e3n t\u00ednh \u0111\u1ec1u ph\u1ea3i tr\u1ecb kh\u00f4ng?<\/strong><\/p>\n\n\n\n

Kh\u00f4ng. Ch\u1ec9 \u0111i\u1ec1u tr\u1ecb nh\u1eefng b\u1ec7nh nh\u00e2n ph\u00e1t hi\u1ec7n virus \u0111ang ho\u1ea1t \u0111\u1ed9ng v\u00e0 t\u1ebf b\u00e0o gan \u0111ang b\u1ecb h\u1ee7y. C\u1ee5 th\u1ec3, ch\u1ec9 \u0111i\u1ec1u tr\u1ecb khi men gan ALT>2 l\u1ea7n gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng, HBeAg (+). Ho\u1eb7c khi HBeAg (-) th\u00ec l\u00e0m x\u00e9t nghi\u1ec7m n\u1ed3ng \u0111\u1ed9 HBV DNA b\u1eb1ng PCR, khi > 2000 IU\/ml.<\/p>\n\n\n\n

8. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B l\u00e0 g\u00ec?<\/strong><\/p>\n\n\n\n

Gi\u1ea3m sinh s\u1ea3n virus v\u00e0 ng\u0103n ng\u1eeba t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan, bi\u1ec3u hi\u1ec7n b\u1eb1ng s\u1ef1 chuy\u1ec3n huy\u1ebft thanh HBeAg (-), HBeAb (+)<\/p>\n\n\n\n

9. C\u00e1c thu\u1ed1c n\u00e0o c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B?<\/strong><\/p>\n\n\n\n

Hi\u1ec7n t\u1ea1i c\u00f3 7 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb, tuy nhi\u00ean c\u00f3 3 thu\u1ed1c \u01b0a d\u00f9ng: Pegylated Interferon alpha-2A, Tenofovir, Entecavir.<\/p>\n\n\n\n

<\/td>Pegylated Interferon alpha-2A<\/strong><\/td>Entecavir<\/strong><\/td>Tenofovir<\/strong><\/td><\/tr>
T\u00e1c d\u1ee5ng kh\u00e1ng virus<\/td>++<\/td>++++<\/td>++++<\/td><\/tr>
Th\u1eddi gian s\u1eed d\u1ee5ng<\/td>52 tu\u1ea7n<\/td>> 1 n\u0103m<\/td>> 1 n\u0103m<\/td><\/tr>
\u0110\u01b0\u1eddng d\u00f9ng<\/td>Ti\u00eam d\u01b0\u1edbi da<\/td>U\u1ed1ng<\/td>U\u1ed1ng<\/td><\/tr>
\u0110\u1ec1 kh\u00e1ng<\/td>Ch\u01b0a ghi nh\u1eadn \u0111\u1ec1 kh\u00e1ng<\/td>C\u00f3<\/td>Ch\u01b0a ghi nh\u1eadn \u0111\u1ec1 kh\u00e1ng<\/td><\/tr>
T\u00e1c d\u1ee5ng ph\u1ee5<\/td>Ph\u1ed5 bi\u1ebfn<\/td>\u00cdt ph\u1ed5 bi\u1ebfn<\/td>\u00cdt ph\u1ed5 bi\u1ebfn<\/td><\/tr>
Gi\u00e1 th\u00e0nh<\/td>\u0110\u1eaft<\/td>Th\u1ea5p h\u01a1n<\/td>Th\u1ea5p h\u01a1n<\/td><\/tr>
Chuy\u1ec3n huy\u1ebft thanh Antigen-e (1 n\u0103m)<\/td>30%<\/td>15-25%<\/td>15-25%<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

10. Theo d\u00f5i khi \u0111ang \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B nh\u01b0 th\u1ebf n\u00e0o?<\/strong><\/p>\n\n\n\n

Theo d\u00f5i \u0111\u1ecbnh l\u01b0\u1ee3ng HBV DNA v\u00e0 men gan ALT m\u1ed7i 3 th\u00e1ng. Ngo\u00e0i ra c\u1ea7n ki\u1ec3m tra ch\u1ee9c n\u0103ng th\u1eadn \u00edt nh\u1ea5t 1 l\u1ea7n\/n\u0103m khi d\u00f9ng thu\u1ed1c u\u1ed1ng (Entecavir v\u00e0 Tenofovir).<\/p>\n\n\n\n

11. \u0110i\u1ec1u tr\u1ecb vi\u00eam gan B c\u00f3 h\u1ed3i ph\u1ee5c \u0111\u01b0\u1ee3c ti\u1ec1n x\u01a1 gan (fibrosis) v\u00e0 x\u01a1 gan?<\/strong><\/p>\n\n\n\n

C\u00f3. 5 n\u0103m \u0111i\u1ec1u tr\u1ecb v\u1edbi tenofovir, 51% b\u1ec7nh nh\u00e2n h\u1ed3i ph\u1ee5c ti\u1ec1n x\u01a1 gan v\u00e0 74% kh\u00f4ng c\u00f2n x\u01a1 gan. K\u1ebft qu\u1ea3 c\u0169ng t\u01b0\u01a1ng t\u1ef1 v\u1edbi m\u1ed9t s\u1ed1 nh\u1ecf b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i v\u1edbi entecavir.<\/p>\n\n\n\n

\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n x\u01a1 gan ti\u1ebfn tri\u1ec3n v\u00e0 x\u01a1 gan m\u1ea5t b\u00f9 d\u00f9ng thu\u1ed1c u\u1ed1ng c\u0169ng c\u00f3 th\u1ec3 k\u00e9o d\u00e0i th\u1edbi gian s\u1ed1ng.<\/p>\n\n\n\n

12. Vi\u00eam gan B c\u00f3 th\u1ec3 d\u1ef1 ph\u00f2ng kh\u00f4ng?<\/strong><\/p>\n\n\n\n

C\u00f3. Vi\u00eam gan B c\u00f3 th\u1ec3 d\u1ef1 ph\u00f2ng b\u1eb1ng c\u00e1ch ti\u00eam vaccin.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u00a0Vi\u00eam gan B c\u00f3 t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh cao \u1edf ch\u00e2u \u00c1, \u0111\u1eb7c bi\u1ec7t \u1edf Vi\u1ec7t Nam ch\u00fang ta. B\u1ec7nh nguy hi\u1ec3m \u1edf ch\u1ed7 th\u1ea7m l\u1eb7ng \u00a0(c\u00f3 th\u1ec3 b\u1ea1n \u0111ang…<\/p>\n","protected":false},"author":1,"featured_media":2035,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[44],"tags":[52,53],"jetpack_featured_media_url":"https:\/\/hienbacsi.com\/wp-content\/uploads\/2022\/10\/img_7595-scaled.jpg","_links":{"self":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts\/2088"}],"collection":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/comments?post=2088"}],"version-history":[{"count":1,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts\/2088\/revisions"}],"predecessor-version":[{"id":2089,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/posts\/2088\/revisions\/2089"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/media\/2035"}],"wp:attachment":[{"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/media?parent=2088"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/categories?post=2088"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hienbacsi.com\/index.php\/wp-json\/wp\/v2\/tags?post=2088"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}