.1 DANH GIA KET QUA GHEP GAN DONG LOAI THUC NGHIEM TREN THO Tran Trung D i i n g \ Ngd Duy Thin^, Dao Xuan Tich' .f 3j mdn Ngoai, Trifiyng IXil Hgc Y Hi Ngi ^'BO mdn Md hgc Phdi thai
Trang 1.! (.1
DANH GIA KET QUA GHEP GAN DONG LOAI
THUC NGHIEM TREN THO
Tran Trung D i i n g \ Ngd Duy Thin^, Dao Xuan Tich'
.f )3(j mdn Ngoai, Trifiyng IXil Hgc Y Hi Ngi
^'BO mdn Md hgc Phdi thai hgc, IrUiing Dai I Ige Y I ia Ngi
Muc tieu: danh gia kcl qua ciia ghep gan dong loai ihuc nghiem Iren Ihd Doi tUgng vi phitang phap nghidn cdu: 10 can ihd dugc lien hanh ghep gan ddng loai via dudng ham xuang dui 2 hen, 2 can dugc ghep gim tu than dc lim nhdm chdng Kit qua: khdng tha'y cd sU tap trung ciia dc te bao viem (J thai
didm -1 tuan cd lhe quan sal tha'y sU tang sinh mach va xam nhip cae nguyen hao sgi via manh ghep U
thdi diem 8 luan tha'y sU xua't hien md xuang mdi quanh manh ghep Kit luan: khdng cd de da'u hieu
ciia nhiim triing va thai ghep Cd bleu hien Hen manh ghep dong loai trong dtfdng ham xtfang tifOng tU niitnh ghep lif than • - : • -\;
Tfl khoa: ghep gan, ddng loai, thuc nghiem, lien gan xfltfng : ,
L D A T V A N D E
Sfl (lung vat lieu ddng loai trong p h i u thuat
c h i n thflong chinh hinh cd xu the ngay ciing tang
C;6 hai loai vat lieu chinh thfldng difpc sfl dpng la
xifcjng ddng loai va gan ddng loai Trong dd, md
xu'dng (la dudc sfl dung tif lau va dem lai nhflng
k("M qua tdt Dd\ vdi mo gan, vice xfl ly va bao
quan ddi hdi nhflng y(5u cau chat che hon v i mat
thdi gian, khau vd trung, l i i u chicYu tia gamma va
each thflc bao quan Tai Labd B l o q u i n md, bd
mdn Mo hpc va Phdi thai hpc, trfldng Dai hpc Y
Ha Npi da hoan chinh quy trinh "Sing Ige, thu
nhan, xd ly va bao quin md gin sd dung cho
phau thuit" va bat dau thflc hien b l o q u i n md
gan de sfl dung cho phau thuat tfl cud'i nam 2007
Miic du quy trinh difdc xay dflng dfla theo nhflng
i\cu chuan ciia I licp h()i ngan hang md chau A
-Ih.ii Binh Dfldng (long ihdi cd tham khao cac ket
qua tr(5n lam sang cua viec sfl dung d c md ghep
dd cua cac nifdc tren the gidi, nhifng trong d i i u
kien thifc te Viet Nam, lieu quy trinh nay cd dam
b i d du'dc tinh an toan cua m i n h ghep de sfl dpng
cho phau Ihuat hay khdng thi c l n cd nhflng ket
qua chflng minh tren thflc nghiem, dac biet la yeu
td nhiem triing va thai loai manh gh(:p Do do chung tdi tien hanh de tai nghien cflu nay n h l m
muc tieu:
Danh gia kit qua ghep gan ddng loai thuc nghiem tren thd
II DOI TL/ONG VA PHI/ONG PHAP NGHIEN CL/U
1 Do'i tflpng nghien cflu
20 con thd dflc, khde manh, gi(')ng npi dja, khoing 3 thang tudi, can nang tfl 1 , 8 - 2 kg, ngudn gde tfl trung tam gidng de va thd Son l a y 8 con difdc dung de l i y gan nham muc dich ghep lai, 10 con dflpc sfl dung chd p h i u thual ghep gan ddng loai, 2 con dfldc ghep gan Ifl than de ddi chflng
2 Cac budc tie'n hanh
-I- L i y gan viing g'dt ihd, bao quan Ihco c|uy trinh "Thu nhan, xfl ly va bao quan md gan" cua Labd b l o q u i n md: 8 con thd dfloc giet b l n g each liem khdng khi vao mach mau, sau dd thifc hien phau thuat lay gan vung gdi cua thd va xfl ly gan theo quy trinh thu nhan, xfl ly va bao quan md
g i n d ngfldi, b l o quan lanh sau am 85"C cua
Trang 2Labd b i d quan md, bp mon Md hpc - Phdi thai
hoc, Trifdng Dai hpc Y Ha Npi
\ Phiu Ihuat trdng elieu kien vd trung: vc mat
p h i u thuat, chung tdi sfl dung md hinh Ihifc nghiem ghep gan tr(5n thd cua lac g i l Hideo
Kawakami cd d i i\en [6|
Hinh 1 Mo hinh thuc nghiem phau thuat tren tho theo Hideo Kawakami co cai tiini hinh ben phai) Ben
trai la mo hinh thUc nghiem nguyen mau cua Kawakami [6]
Vi tri khoan tao dfldng ham d dau dfldi xUOng diii thd
Vj tri l i y gan do xfl ly va bao quan
Hinh 2 Minh boa vi tri lay gin va vi tri khoan tao dUdng bam [4]
Trang 3Trdng md hinh thflc nghi(5m p h i u thuat cua
Kawakami, hai dfldng ham difdc lad ra d xifdng
dui va xifdng chay va m a n h gh(;p difdc c6 dmh
d ca hai difdng h a m Chung toi chi' c d dinh
manh ghep lrong dfldng ham xifdng dui cdn
|)han ngdai vi difdc khau vui trdng td chflc difdi
da cua Ihd
Thd difpc gay me tdan than bang ete, Rach da,
tach cd vao xfldng dui thd hai ben, xac djnh vj tri
lad difdng ham d vung dau difdi xifdng dui Khoan
tao difdng ham vung dau difdi xfldng dui sau 2 ben
cua thd, vdi dfldng kfnh 3,5inm, sau 6 m m M i n h
gan thd da difpc xfl ly, bao quan cd kich thfldc
3 x 1 0 mm, se dfldc dat vad difdng ham va c d
djnh lai vdi 1 vit kim loai, dfldng kinh 2,5mm dai
6mm Phan cdn lai cua manh ghi=p, dai khoang
4mm difdc khau c d djnh vad td chflc dfldi da cua
Ihd Ddng kin vet md
^^***
Hinh 3 Minh ghep gan tho dong loai sau khi dugc
bao quan, dang dugc xd ly di ghep lai vao xuang
dui tho
Nhfl vay, vdi 10 con thd, chung tdi tao difdc
20 vi tri ghc^p m i n h gh(3p
Hai Cdn thd cdn lai difpc tie'n lianh gh(Bp bang
m i n h gh(2p tfl than, l i y ifl chan sau ben trai gh(;p
sang chan sau ben phai vdi quy trinh phau thuat
nhif tren
+ Thcd ddi sail irid; sau md ihd dfloc nudi ri('Mig trong chudng dam bao vij sinh, chi?' d() an thdng
thifdng Difpc theo ddi tinh trang I d i n than, nliiel
dp, tai chd vet thifdng
+ l:)anh gia k(?'t qua sau 4 tuan va 8 t u a n : sau thdi gian gian lan Ifldt la 4 tuan va 8 tuan, n<5m con thd cua n h d m ghc>p ddng loai va 1 con thd cua n h d m gh<2p tfl than difpc gay chie't
b l n g each Uem khi vao tinh m a c h tai i h d
D a n h gia ve dai the tai vi trf m d , tfl ngoai vao trdng: md da, md dfldi da, cd, m a n g xifdng, khdp gd'i cua t h d Sau d d , phan dau dfldi xifdng d i l i dfldc c i t ra khdi cd t h e , difdc khfl Canxi xflong bang dung d j c h acid formic 3 0 % , due khd'i n(§'n va c i t lat tii^u ban m d n g 7 micromet vudng goc vdi true cua difdng h a m
M d i vi tri ghep lam 5 ti(5u ban nghic^n cflu
Cac deu ban dflpc nhupm HE va danh gia v(^
vi the dfldi kfnh h i i ' n vi quang hpc vat kfnh 10
va 40 [1]
III KETQUA
1 Danh gia ve dai the
Theo bang 1 ta t h i y , t i t ca 12 con thd (gdm
10 con gh«;p ddng loai va 2 con ghdp tfl than)
d i u sd'ng khde manh, chay n h l y td't Khdng cd con nao cd bieu hien n h i i m trung loan than cung nhfl tai chd Vet thifdng lien tdt va mpc Idng binh thfldng
D(2'n thdi d i d m danh gia ve md hpc, sau khi dflpc gay ch(5't, danh gia tai chd khu vflc quanh difdng ham cua tat c l cac con tho ghep ddng loai tha'y t d chflc da, dfldi da, md co, m i n g xifdng h d l n toan binh thifdng Khdp gdi binh thifdng, khong Iran d i c h , khdng cd bat thifdng cua mang hoat djch v l sun khdp, Cac bieu hien ve dai the tfldng tfl nhfl cua con thd gh(;p tfl than
Trang 4Hang 1 Kit qui nghien cdu '
Sl")' lu'dng thd nghien ci'fu
So lifdng vj Iri ghep
Sd lu'dng tii'^ii ban
l y Id thd sdng (lc"'n ihdi didm danh gia
NhifMn trung
Co nang gdi bi anh hifdng
1 licii lifong tang sinh mach d manh gh(5p thdi diem 4 tuan
Sfl x u i t hien d c nguyen ban sdi d vung ranh gidi
Tfl than Ddng loai Tfl than FJong loai Tfl than Ddng loai Tfl than Ddng loai Tfl than Ddng ldai Tfl than E)dng loai Tfl than Ddng loai Tfl than Ddng loai
Ke't qua
2
10
2
20
10
100
100
100
0
0
0
• ' ' 0
10/10 lieu ban 95/100 lieu ban 100/100 lieu ban 100/100 tieu b i n
Sfl x u i l hi(:n cua md xifong mdi va tap trung cua tao cd't bao
Tfl than 100/100 t i ( \ i ban Ddng loai 98/100 tii'-u ban
A •
V ' W r , ^ 0 ^ ^ ' ^ ^ • ^ « ' > • • ' ^ ^ ' , '••'•>'' ^
30 /
Hinh 4 Hinh anh dai the vi tri gbcp dui thd Td chdc dudi da binb thudng (A), B la vi tri dudng ham (dau kep chi vao vit) Chu thich: R - alio 8.6 / I con thd thd 6 tuan thd 8 nhdm ghep ddng loai
Trang 52 Danh gia ve vi the tion iH J , , « A , •••
Cung theo bang 1, tren d c tieu b i n sau 4 tuan, da x u i t hien c l e mach m l u tan tao cua m i n h ghep
va sfl x u l t hien day dac cua c l e nguyen b l o soi tap trung d vung giap danh {binh 5) Khdng t h i y sfl cd
mat cua d c te bao p h l n flng v i e m Sfl tap trung cua e l e nguyen b l o spi g i l m dan d thdi diem 8 tuan v l thay vao dd la cac sdi collagen Vao thdi diem 4 tuan ranh gidi md gan va xflong cdn tifong ddi rd r i n g tuy nhien vao thdi diem 8 t u i n , x u i t hien md xflong mdi p h l t trien va xen ke vao md gan, x u i t hien d c
te b l o dang sun C I c hinh I n h nay gap tren c l tieu b i n cua m i n h ghep ddng loai va m i n h ghep tfl
t h a n ' -^ '• - i : :
Xtrcme
Vungrjinb giOT
C a a ghep H:J:]J anil cac tao
cot bao rap tir.na o M1K2 laiil! aioi
Mo xircmg mdi xam nhap vao md gaii
Hiiili aiili mach miiu tang siiih trong mmih ghep
Hinh 5 Hinh anb mo gan ghep va viing ranh gidi (A) d thdi dUm 4 tuan (nhugm HE xlOO), hinb inh vung ranh gidi kbong con ro rang vdi so lugng nguyen bao sgi giam di, (B) binh tbanb cac sgi collagen va sU xam
nhap xen ke cua mo xuang mdi vao mo gan (nhugm HE x400)
•ifi^
Minlii)hi>[>
.<"scleb.Wdipg'iift
• / '
Hinh 6 Hinh anh mo xuang mdi moc lan vao mo gan d mknh ghep tU than (A) va mknh ghep ddng
toai (B)d thdi diem 8 tuan (nhuom HE XlOO)
Trang 6IV BAN LUAN
N h i i m trung la ndi e ngai dau lii?n khi sfl
dung manh gh(''p ddng loai, l i t ca cic con thd
deu sdng khde manh, lai c:li6 cung nhfl tdan than
khdng Cd bidu hicn n h i i ' m Iri'ing, Vdi ([uy trinh
Ihu nhan, xfl ly va bao (|uan mo gan ddng loai,
khdng chi Clia Labd bao quan md phdi thai hpc,
tnfdng Dai hpc Y Ha Npi ma cua d cac trung
lam bad quan md khac trong nfldc va tren the
gidi, hai khau quan lrong nhat cua quy trinh la
cay vi khuan thfldng quy va khu' khuan b l n g tia
gamma, \l\ec cay vi khuan thifdng C|uy nham
muc clich kicm tra va danh gia quy trinh de loai
1)0 nhrfiig manh ghc'^p co nguy cd, Tiet khuan
l:)lng tia Gamma lieu 25 kCrays dam b i d nguy
CO nhiem khuan nhd hdn 1/1000000 (1 phan 1
Irieu), Do dd nguy cd nhiem khuan dd manh
ghc'p gan nhfl khdng cd Khdng cd thdng bao
nao v('' bleu hicn nhic";m Irung manh ghep Iren
llu/c nghiem cua cac lac gia khac |6, 7, 8, 9,
1()|, lrong nghic^n cflu ciia chung tdi, chung tdi
chu dpng danh gia k i t qua Ifl 4 tuan trd di n h l m
muc dich bd qua giai doan phan flng viem sinh
ly cua qua trinh l i i n manh ghep de viec danh
gia sfl cd nicil hay khdng cua d c te bad viem
du'dc de dang hdn
Cac bieu hien v i md hpc tren lieu ban thdi
diif-m 4 tuan va 8 tuan deu khdng cd bieu hien
Clia thai gh('|), I heo Trinh Binh, c i u true ciia
manh ghc^|) gan ddng ldai chi bad gdm chu ydu la
cac Sdi collagen va m()t scY nguyen bad sdi ]2]
i hoo Vu Dfldng Quy va Pham Manh Hung, khang
nguydn hda hdp md chi cd tdn be mat cua cac te
bao cd nhan va te bao cua he thdng mien djch,
khdng cd Iron d c spi cdllagen [3], Khi difpc xfl ly
bang tia C]amma cac It"' bad nay bj tic^u diet hdan
loan (ldng ihdi c|iia Irinh bao quan lanh sau cung
lam giam linh khang nguyen cua manh gh(3p Cd
che""' lam giam tinh khang nguyen dfldc chd la do
d c te bao bi tieu diet, cac khang nguyen bam
tren b i mat cua te bao bj pha huy va h\in tinh
nen linh khang nguyen giam hoac nv'il hoan loan 16] , • , , ,
J j m i f l f t f t n O K n '•;• ':(-:• h\:.j i t i
Sfl l i i n Clia manh gh(=f) ddng ldai Irong dfldng ham xfldng lfldng ifl nhif l i i n m i n h ghc:p tfl than,
Cd 3 hicn tifdng cd the quan sal thay rd rang d
ca manh ghep ddng ldai va manh ghc'>p U.f Ihan la: sfl tang sinh mach man trong manh ghc^p, sfl tap trung nguyc';n bao spi va hinh lhanh sdi cdlla-gen, sfl phat trien cua md xfldng mdi vdi sfl xuat hien cua cac to bad dang sun, Thed Rodeo |9], qua trinh l i i n gan Irong difdng ham xfldng khdng don thuan nhif m()t qua trinh l i i n md gan hoac
mo xflong dien hinh ma nd la sfl phdi hdp ca hai
q u i trinh dd bao gdm: sfl tap trung te bao va tang sinh mach; sfl phat trien cua me xifdng mdi (bad gdm ca qua trinh huy xifong va tai lao xifdng) trdng dd sfl phat tridn cua md xifdng mdi ddng vai trd c|iian trong, dam bao sfl vflng chac Clia mcj'i lien kcl, Sfl xuat hicjn cua md xifdng mdi, (lac b i c i la sfl cd mat cua cac lc"' bad daiig spi la minh chflng chd qua Irinh lic^n manh ghc^p
Q u i trinh lien manh ghep nay, thed nghien cflu
cua Grassman [8] thi sfl x u i t hien cua md xifdng mdi tifdng tfl nhif hinh thanh can trong gay xfldng
dd dd cung tifdng do'i da dang v i hinh thai, Vdi sfl x u i t hien cua md xifdng m d i , sfl tap trung cac nguyen bad sdi va hinh thanh sdi Cdllagen tao nc"n md'i li(?n kdt gifla md gan va md xifdng gdm
4 vung tifdng dd'i rd rc5l: gan, md sun chifa khdang hda, md sun khdang hda va mo xifdng, Vai Ird quan trpng cua viec hinh lhanh mo xifdng mdi trdng viec lien manh ghep da clifdc chflng minh qua nhieu nghic'n cflu va cung la cai dich Clia n h i i u nghien cflu de thilc day qua Irinh lien manh ghc^p sau phau thuat nhif nghii?n ci'fu sfl dung te bad gcx: cua Michael Y I I Sddn |7] nghien cflu sfl dung chat flc che huy xifong cua
SA Rddeo 110] , ^^
Trang 7V K E T L U A N •• ' ''''- - "-•• — '•' •• '^'->- - '
CJu.i nghi("n cii'ii |lu,f( nghi(?m gh(''|.) gan (long
loai iKMi 10 con Ihd l)ang manh ghc^p dfldc ihu
nhan, xfl ly va Ijao c|uan iheo (.|iiy trinh cua Labd
B i d quan Md Phdi Ihai, Irifdng Dai hdc Y Ha Npi
thiy rang:
Khdng Cd bieu hicjn nhic^m trung manh ghc'^p
- Khdng cd bieu hien cua hien tifdng thai ldai
manh gh(?p Irc^n thflc nghicjm
Ci) bieu hien lien gan xifdng cua manh ghep
ddng loai lifong tfl nhif manh ght^^p tfl Ihan,
TAI L I E U T H A M KHAO
1 Bo mon Mo hoc - Phdi thai hoc (2001) "Ky
Ihual Md l l d c " , I ldi nghi md Phdi hdc loan qudc
lan I h f l 4 , tr 1 6,
2 Trjnh Binh (2007) "Md li(?n ket chinh
lhfl(:",Bai giang Md - Phdi Phan Md Hpc: Nha
xuit ban Y hpc, tr 39 - 52 > ':•.' « ' ' ' ' ' ' '
3 Vu DflOng Quy, Pham Manh Hung (2006)
"Mien djch ghc-p" Mi(?n djch hpc Nha x u i t ban
Y hpc, tr 277 - 290,
4 Boris A Zelle, Christian Lattermann, Anikar
Chhabra, Freddie H Tu and Johnny Huard
(2005) "Bidldgical Cdiisideratidns df Fenddii Graft
Incorporatidn VVilhin the Bdne Tunnel", Oper Tech
Orlhdp 15: 36 - 42 :,^,\,, ,,,,,„> , , / , , , , • ,_;
" ' 5 Hideo Kawakami, Konsei Shino, Masayuki
Hamada, Ken Nakata, Shigeto Nakagawa,
Norimasa Nakamura, Yukiyoshi Toritsuka, Hideki
Yoshikawa,Takahiro Ochi (2004) "Graft healing
in a bone liinne bone - attached graft with screw
, ' i n i Y'>' ' I I U I l l ! M!;'H i
fixationl versus bdiie tre(- grail w i l h (-xIra articular suture tixalidn" Knee Surg Spdrls
Fraumaldl Arlhrosc (2004) 1 2: [jp 384 590,
6 Konsei Shino, Takao Kawasaki, Hitoshi Hirose, Ippei Cotoh, Masahiro Inoue, Keiro Ono (1984) "Replacement of the anteridr cniciatc
ligament by an alldgeneic tenddn graft: An experimental study in the dog" J bdne Idint Surg
Br, Vdi 66 B, Nd 5, November, 672 682, ^
7 Michael Y H Soon, Afizah Hassan, James H
P Hui, James C H Goh and C H Lee (2007) "An
Analysis of Soft Tissue Allograft Anterior Cruciate Ligament Recdnstruclidn in a Rabbit Mddel: A Shdrl - form Study df the Use df Mesenchymal Stem Cells td I nhance li^nddn Osteointegration"
Am J Sports Med 2007; 35; 962 - 973
8 S.R.M Grassman, D.B McDonald, G.M Thornton, N.G Shrive, C B Frank (2002) "I arly
healing prcccsses df free tendnn grafts within bdne tunnels is bone - specific: a morphological study in
a rabbit model" The Knee 9 (2002): 21 - 26
9 SA Rodeo, SP Arnoczky, PA Torziili, C Hidaka and RF Warren (1993) "Fendon - Healing
in a Bone funnel: A bidmechanical and histdldgical study in ddg", J Bone Joint Surg Am,, 1993; 75: 1795 • 1803,
10 Scott A Rodeo, Sumito Kawamura, C Benjamin Ma, Xiang - hua Deng, Patrick S Sussman, Peyton Hays and Liang Ying (2007)
"The Effect df Osteoclastic Activity on FiMiddu - Id
- Bdne llealing: An experimental study in rabbits" ] Bene Jdint Surg A m ; 89: 2250 - 2259
' "• ' Summary EVALUATION OF EXPERIMENTAL ALLOGRAFT TENDON TRANSPLANTATION IN RABBITS
Objective: we evaluate the alldgraft irradiated deep frozen tendon td bdne healing in rabbits Methods:
we transplanted Ihe allograft tendon into the bdne tunnel of the femur for 10 rabbits, 2 rabbits were used
in conlrol group w i l h autdgraft Clinical and histological evaluatien were conducted at the time of 4 and 8
Trang 8weeks Results: lhi>re was no cdlleclidn of inflammatory cells at the lime of evaluation At 4 weeks, lhe
vasc:ulari/'ation and the invasion of fibroblasts were noted and at 8 weeks some new woven bone ardund
Ihe graft were fdiind Conclusion: there was no evidence of infection and rejection, fhe alldgraft lenddii lo
bone healing was recogni/cd with the same manner of autdgraft ;, , ,
Keywords: allograft, experimental, tendon graft, tendon to bone healing i i; > i
Ba6c DAU DANH GIA HIEU QUA DIEU TRj ENTECAVIR TREN
VA HBeAgAMTINH ,
Nguyen Cong Long, Dao Van Long, Biii Xuan Trfldng, Le Van Anh
Khoa Tieu hda - Benh vicn Bach Mai I la Ndi
Muc tieu: dinh gii tie dung, tinh an toin ciia Entecavir trong dieu trj vlSm gan virus B man tinh cd
HlieAg(+) va HBeAg(-) Doi tUgng va phuang phap nghien cdu: nghien cifu tie'n cdu 47 benh nhim dtfdc
chan doan viem gan virus B man linh (VGVRB) ehia hai nhdm ilBeAg(+) vi HBeAg(-) dtfgc dieu trj Hntecavir
i>,') mg/ngay trang thdi gian 12 tuan Kit qua: dac diem tudi nhdm ilBeAg(-) caa han nhdm HBeAg(+), tdn
thuang md henh hgc nhdm HBeAg(-) nang ban nhdm HBeAg(+) vdi chi so viem 10,1 ± 2,8 so vdi 9,6 ± 2,2,
chl sd xa 2,78 ± 1,8 so vdi 1,8 ± 1,3 diem mac dii nong do HBV DNA d nhdm HBeAg(+) eao ban nhdm
IIBeAg(~) 8,29 ± 0,87 sa vdi 6,23 ± 1,62 lagcaples/ntl Nong do HBV DNA giam > 2 logcopies/ml sau 12
luan dieu trj hntecavir 0,5mg/ngay la 95,7%, vdi nhdm HBeAg(-i-) la 94,1% va nhdm HBeAg(-) li 96,7%
Ndng do HBV DNA dat difdi ngifdng phit hien dat J6,2%, frung binh nong do HBV DNA giam 4,71 ± 1,8
logcoples/ml d nhdm VCVRB HBeAg(+) vi - 4,84 ± 1,7 logcaples/ml d nhdm VGVRB HBeAg(-) Ty le
chuyen dao huyet thanh d nhdm HBeAg(+) la 17,t)°/o, binh thifdng hai men gan ALT li 51,l"7o Cic tneu
chdng lam sing met mdi, chin an eai thien d 1U0%> benh nhan, lic dung phu ciia thudc it gap, thudng nhe,
hay gap nha't la dau dau va viem mui hgng Kit luan: lnlecavir li thud'c cd kha niing ifc che sU nhan len ciia
virus tdt d ca hai nhdm viem gan virus B man tinh cd HBeAg(+) vi HBeAgi-l, hinh thudng bail men gan va
ehuyen dao huyet lhanh l-IBeAg dat ly le kha cao, cai thien tneu chdng lam sang tdt It lac dung phu, nen
hfa chgn la thudc dau tay trong dieu trj viem gan virus R man tinh
Tii khoa: viem gan virus B, entecavir
I D A T V A N D E dflpc xdp vao vung dai djch nhiein LIBV vdi
Hien nay thc'^ gidi cd tren 350 trieu ngfldi phfldng thflc lay t r u y i n chu ye'u tfl me sang con,
nhiem HBV man tinh |9|, so' benh nhan n h i i m ddng thdi LIBV la nguyen nhan chinh gay vii^m
LIBV man tinh cd HBsAg dflong tinh tai Trung gan man, xo gan va ung thfl gan lOieu trj viem
Qucdc va khu vflc t3dng Nam chau A trong dd cd gan virus B cd n h i i u tien bp trong thap ky qua.,
Vii^t nam chiem khoang 5 0 % tdng sd benh n h i n Interferon - alpha dflpc xem la thud'c dau lien
tri§n tdan \hi gidi Tai Viet Nam, ty le n h i i m difpc cdng nhan trong dieu trj, nhifng thudc
HBV cd HBsAg difong tfnh cao tren 8% d i n sd nhdm cytokine nay chl cd hicMi qua k h o i n g 3 5 %