{"id":18369,"date":"2023-04-11T19:32:29","date_gmt":"2023-04-11T12:32:29","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=18369"},"modified":"2023-04-14T15:21:27","modified_gmt":"2023-04-14T08:21:27","slug":"huong-dan-chan-doan-viem-gan-virus-c-cua-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/11\/huong-dan-chan-doan-viem-gan-virus-c-cua-bo-y-te\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n vi\u00eam gan virus C c\u1ee7a B\u1ed9 Y t\u1ebf"},"content":{"rendered":"

B\u1ec7nh vi\u00eam gan vi rus C l\u00e0 b\u1ec7nh truy\u1ec1n nhi\u1ec5m do vi rus vi\u00eam gan C (Hepatis C Virus: HCV) g\u00e2y ra. HCV ch\u1ee7 y\u1ebfu l\u00e2y qua \u0111\u01b0\u1eddng m\u00e1u, ngo\u00e0i ra c\u00f2n l\u00e2y qua \u0111\u01b0\u1eddng t\u00ecnh d\u1ee5c, m\u1eb9 truy\u1ec1n sang con. Hi\u1ec7n t\u1ea1i, ch\u01b0a c\u00f3 v\u1eafc xin ph\u00f2ng b\u1ec7nh vi\u00eam gan vi r\u00fat C. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n vi\u00eam gan virus C r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 gi\u1ea3m thi\u1ec3u t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng gan, c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng v\u00e0 tu\u1ed5i th\u1ecd c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/strong><\/p>\n

1. Tri\u1ec7u ch\u1ee9ng<\/strong><\/h2>\n

1.<\/em><\/strong>1<\/em><\/strong>. L\u00e2m s\u00e0ng<\/em><\/strong><\/h3>\n

– Ph\u1ea7n l\u1edbn ng\u01b0\u1eddi nhi\u1ec5m HCV kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng cho \u0111\u1ebfn khi c\u00f3 bi\u1ec3u hi\u1ec7n x\u01a1 gan. \u0110\u00f4i khi c\u00f3 m\u1ec7t m\u1ecfi, ch\u00e1n \u0103n, \u0111\u1ea7y b\u1ee5ng, \u0111au nh\u1eb9 h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a, \u0111au c\u01a1,…<\/p>\n

– C\u00f3 th\u1ec3 c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n ngo\u00e0i gan nh\u01b0: \u0111au kh\u1edbp, vi\u00eam kh\u1edbp, vi\u00eam da, t\u00f3c d\u1ec5 g\u00e3y r\u1ee5ng, cryoglobulinemia (globulin l\u1ea1nh trong m\u00e1u), \u0111au c\u01a1, b\u1ec7nh c\u01a1 tim, vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng, …<\/p>\n

1<\/em><\/strong>.2. C\u1eadn l\u00e2m s\u00e0ng<\/em><\/strong><\/h3>\n

– Anti-HCV l\u00e0 x\u00e9t nghi\u1ec7m ban \u0111\u1ea7u \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng nhi\u1ec5m HCV.<\/p>\n

+ Anti-HCV d\u01b0\u01a1ng t\u00ednh trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 ho\u1eb7c \u0111ang nhi\u1ec5m HCV.<\/p>\n

+ Trong tr\u01b0\u1eddng h\u1ee3p vi\u00eam gan vi r\u00fat C c\u1ea5p \u1edf giai \u0111o\u1ea1n s\u1edbm anti-HCV c\u00f3 th\u1ec3 \u00e2m t\u00ednh v\u00e0 HCV RNA d\u01b0\u01a1ng t\u00ednh.<\/p>\n

+ M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m HCV \u1edf ng\u01b0\u1eddi suy gi\u1ea3m mi\u1ec5n d\u1ecbch n\u1eb7ng nh\u01b0 ng\u01b0\u1eddi nhi\u1ec5m HIV, ng\u01b0\u1eddi ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, ng\u01b0\u1eddi \u0111i\u1ec1u tr\u1ecb c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch c\u00f3 th\u1ec3 c\u00f3 anti-HCV \u00e2m t\u00ednh v\u00ec th\u1ebf n\u00ean \u0111\u01b0\u1ee3c l\u00e0m x\u00e9t nghi\u1ec7m HCV RNA \u0111\u1ec3 kh\u1eb3ng \u0111\u1ecbnh nhi\u1ec5m HCV khi c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh gan (AST\/ALT t\u0103ng, \u2026).<\/p>\n

– HCV RNA \u0111\u1ecbnh t\u00ednh d\u01b0\u01a1ng t\u00ednh ho\u1eb7c \u0111\u1ecbnh l\u01b0\u1ee3ng HCV RNA tr\u00ean ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n: kh\u1eb3ng \u0111\u1ecbnh nhi\u1ec5m HCV.<\/p>\n

– Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng l\u00e0m \u0111\u01b0\u1ee3c HCV RNA, HCVcAg (HCV core Antigen) d\u01b0\u01a1ng t\u00ednh x\u00e1c \u0111\u1ecbnh nhi\u1ec5m HCV.<\/p>\n

– X\u01a1 h\u00f3a gan: T\u00ecnh tr\u1ea1ng x\u01a1 h\u00f3a gan \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng x\u00e2m l\u1ea5n nh\u01b0 ch\u1ec9 \u0111i\u1ec3m sinh ho\u00e1 (APRI, FIB4, FibroTest …) hay si\u00eau \u00e2m \u0111\u00e0n h\u1ed3i (FibroScan, ARFI…).\u00a0(Ph\u1ee5 l\u1ee5c 1).<\/em><\/p>\n

– X\u00e9t nghi\u1ec7m sinh h\u00f3a gan nh\u01b0 ALT, AST c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c t\u0103ng; s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u, th\u1eddi gian prothrombin, INR, albumin, bilirubin b\u00ecnh th\u01b0\u1eddng ho\u1eb7c b\u1ea5t th\u01b0\u1eddng ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng n\u1eb7ng c\u1ee7a vi\u00eam gan ho\u1eb7c x\u01a1 gan<\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p c\u00f3 bi\u1ebfn ch\u1ee9ng ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (Hepatocellular Carcinoma: HCC): AFP, AFP-L3, PIVKA-II c\u00f3 th\u1ec3 t\u0103ng; si\u00eau \u00e2m, ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh, c\u1ed9ng h\u01b0\u1edfng t\u1eeb v\u00f9ng b\u1ee5ng c\u00f3 h\u00ecnh \u1ea3nh kh\u1ed1i u gan.<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/strong><\/h2>\n

2.1. <\/em><\/strong>Ch\u1ea9n \u0111o\u00e1n v<\/strong>i\u00eam gan vi r\u00fat C c\u1ea5p<\/em><\/strong><\/h3>\n

– Th\u1eddi gian nhi\u1ec5m HCV d\u01b0\u1edbi 6 th\u00e1ng: c\u00f3 chuy\u1ec3n \u0111\u1ea3o huy\u1ebft thanh t\u1eeb anti-HCV \u00e2m t\u00ednh sang anti-HCV d\u01b0\u01a1ng t\u00ednh<\/p>\n

– C\u00f3 ti\u1ec1n s\u1eed ph\u01a1i nhi\u1ec5m v\u1edbi ngu\u1ed3n b\u1ec7nh<\/p>\n

– Kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ho\u1eb7c c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a vi\u00eam gan c\u1ea5p: m\u1ec7t, v\u00e0ng m\u1eaft, v\u00e0ng da,…<\/p>\n

– AST, ALT th\u01b0\u1eddng t\u0103ng.<\/p>\n

– HCV RNA: d\u01b0\u01a1ng t\u00ednh sau 2 tu\u1ea7n ph\u01a1i nhi\u1ec5m.<\/p>\n

– Anti-HCV c\u00f3 th\u1ec3 \u00e2m t\u00ednh trong v\u00e0i tu\u1ea7n \u0111\u1ea7u ho\u1eb7c d\u01b0\u01a1ng t\u00ednh sau 8-12 tu\u1ea7n ph\u01a1i nhi\u1ec5m.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m HCV c\u1ea5p khi (1) c\u00f3 chuy\u1ec3n \u0111\u1ea3o anti-HCV t\u1eeb \u00e2m t\u00ednh sang d\u01b0\u01a1ng t\u00ednh hay (2) anti-HCV \u00e2m t\u00ednh nh\u01b0ng HCV RNA d\u01b0\u01a1ng t\u00ednh \u1edf ng\u01b0\u1eddi c\u00f3 c\u01a1 \u0111\u1ecba mi\u1ec5n d\u1ecbch b\u00ecnh th\u01b0\u1eddng.<\/p>\n

\"X\u00e9t
X\u00e9t nghi\u1ec7 m\u00e1u gi\u00fap ch\u1ea9n \u0111o\u00e1n b\u1ec7nh vi\u00eam gan C<\/figcaption><\/figure>\n

2.2. <\/em><\/strong>Ch\u1ea9n \u0111o\u00e1n v<\/strong>i\u00eam gan vi r\u00fat C m\u1ea1n<\/em><\/strong><\/h3>\n

– Th\u1eddi gian nhi\u1ec5m HCV > 6 th\u00e1ng<\/p>\n

– C\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng.<\/p>\n

– Anti- HCV d\u01b0\u01a1ng t\u00ednh v\u00e0 HCV RNA d\u01b0\u01a1ng t\u00ednh ho\u1eb7c HCV core-Ag d\u01b0\u01a1ng t\u00ednh.<\/p>\n

– Kh\u00f4ng c\u00f3\/ho\u1eb7c c\u00f3 x\u01a1 h\u00f3a gan, x\u01a1 gan\u00a0(Ph\u1ee5 l\u1ee5c 1).<\/em><\/p>\n

Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n vi\u00eam gan vi r\u00fat C m\u1ea1n khi c\u00f3 anti-HCV d\u01b0\u01a1ng t\u00ednh v\u00e0 HCV RNA d\u01b0\u01a1ng t\u00ednh ho\u1eb7c t\u1ea3i l\u01b0\u1ee3ng HCV RNA tr\u00ean ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n ho\u1eb7c HCVcAg d\u01b0\u01a1ng t\u00ednh (h\u01b0\u1edbng d\u1eabn x\u00e9t nghi\u1ec7m vi r\u00fat vi\u00eam gan B, C ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 1868\/Q\u0110-BYT, ng\u00e0y 24\/4\/2020 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf).<\/p>\n

* C\u00e1c b\u01b0\u1edbc th\u1ef1c hi\u1ec7n ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m HCV:<\/p>\n

– Ti\u1ebfn h\u00e0nh x\u00e9t nghi\u1ec7m anti-HCV<\/p>\n

– N\u1ebfu anti-HCV \u00e2m t\u00ednh \u1edf ng\u01b0\u1eddi c\u00f3 c\u01a1 \u0111\u1ecba mi\u1ec5n d\u1ecbch b\u00ecnh th\u01b0\u1eddng ngh\u0129a l\u00e0 kh\u00f4ng nhi\u1ec5m HCV.<\/p>\n

– N\u1ebfu anti-HCV d\u01b0\u01a1ng t\u00ednh ngh\u0129a l\u00e0 \u0111\u00e3 t\u1eebng nhi\u1ec5m HCV ho\u1eb7c \u0111ang hi\u1ec7n nhi\u1ec5m HCV. Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 k\u1ebft qu\u1ea3 anti-HCV d\u01b0\u01a1ng t\u00ednh c\u1ea7n \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m kh\u1eb3ng \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng nhi\u1ec5m HCV b\u1eb1ng m\u1ed9t trong c\u00e1c x\u00e9t nghi\u1ec7m sau:<\/p>\n

+ X\u00e9t nghi\u1ec7m t\u1ea3i l\u01b0\u1ee3ng HCV RNA.<\/p>\n

+ X\u00e9t nghi\u1ec7m \u0111\u1ecbnh t\u00ednh HCV RNA.<\/p>\n

+ X\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean l\u00f5i HCVcAg.<\/p>\n

– Ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m HCV khi:<\/p>\n

+ K\u1ebft qu\u1ea3 t\u1ea3i l\u01b0\u1ee3ng HCV RNA tr\u00ean gi\u1edbi h\u1ea1n ph\u00e1t hi\u1ec7n, ho\u1eb7c<\/p>\n

+ \u0110\u1ecbnh t\u00ednh HCV RNA d\u01b0\u01a1ng t\u00ednh, ho\u1eb7c<\/p>\n

+ Kh\u00e1ng nguy\u00ean HCVcAg d\u01b0\u01a1ng t\u00ednh.<\/p>\n

\u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u1ecdc m\u00e1u ho\u1eb7c suy gi\u1ea3m mi\u1ec5n d\u1ecbch n\u1eb7ng c\u00f3 x\u00e9t nghi\u1ec7m anti-HCV \u00e2m t\u00ednh nh\u01b0ng c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh gan, n\u00ean x\u00e9t nghi\u1ec7m HCV-RNA ho\u1eb7c HCV coreAg \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n vi\u00eam gan C.<\/p>\n

2.3. Vi\u00eam gan vi r\u00fat C \u1edf tr\u1ebb em<\/em><\/strong><\/h3>\n

T\u1ea5t c\u1ea3 tr\u1ebb em sinh ra t\u1eeb m\u1eb9 b\u1ecb vi\u00eam gan vi r\u00fat C c\u1ea7n \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng nhi\u1ec5m HCV. X\u00e9t nghi\u1ec7m anti-HCV th\u1ef1c hi\u1ec7n khi tr\u1ebb t\u1eeb 18 th\u00e1ng tu\u1ed5i. Tr\u1ebb c\u00f3 anti-HCV d\u01b0\u01a1ng t\u00ednh c\u1ea7n \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m HCV RNA sau 3 tu\u1ed5i \u0111\u1ec3 kh\u1eb3ng \u0111\u1ecbnh nhi\u1ec5m HCV m\u1ea1n.<\/p>\n

Vi\u00eam gan virus C (HCV) l\u00e0 m\u1ed9t b\u1ec7nh nhi\u1ec5m tr\u00f9ng gan do virus HCV g\u00e2y ra. HCV l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y ra vi\u00eam gan m\u1ea1n t\u00ednh v\u00e0 x\u01a1 gan, d\u1eabn \u0111\u1ebfn c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u01b0 ung th\u01b0 gan. V\u00ec v\u1eady c\u1ea7n ch\u1ea9n \u0111o\u00e1n s\u1edbm b\u1ec7nh \u0111\u1ec3 c\u00f3 th\u1ec3 \u0111\u01b0a ra c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<\/p>\n

\u0110\u1ec3 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ea1i vi\u1ec7n, Qu\u00fd kh\u00e1ch vui l\u00f2ng b\u1ea5m s\u1ed1\u00a0HOTLINE<\/strong><\/a>\u00a0ho\u1eb7c \u0111\u1eb7t l\u1ecbch tr\u1ef1c ti\u1ebfp\u00a0T\u1ea0I \u0110\u00c2Y<\/strong><\/a>. T\u1ea3i v\u00e0 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ef1 \u0111\u1ed9ng tr\u00ean\u00a0\u1ee9ng d\u1ee5ng MyVinmec<\/a> \u0111\u1ec3 qu\u1ea3n l\u00fd, theo d\u00f5i l\u1ecbch v\u00e0 \u0111\u1eb7t h\u1eb9n m\u1ecdi l\u00fac m\u1ecdi n\u01a1i ngay tr\u00ean \u1ee9ng d\u1ee5ng.<\/p>\n