{"id":18969,"date":"2023-04-15T22:22:37","date_gmt":"2023-04-15T15:22:37","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=18969"},"modified":"2023-04-18T15:26:11","modified_gmt":"2023-04-18T08:26:11","slug":"gan-nhiem-mo-khong-do-ruou-tiep-can-dieu-tri-toan-dien","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/gan-nhiem-mo-khong-do-ruou-tiep-can-dieu-tri-toan-dien\/","title":{"rendered":"Gan nhi\u1ec5m m\u1ee1 kh\u00f4ng do r\u01b0\u1ee3u: ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb to\u00e0n di\u1ec7n"},"content":{"rendered":"<p><strong>B\u1ec7nh gan nhi\u1ec5m m\u1ee1 kh\u00f4ng do r\u01b0\u1ee3u (NAFLD) l\u00e0 m\u1ed9t thu\u1eadt ng\u1eef bao g\u1ed3m t\u1ea5t c\u00e1c b\u1ec7nh v\u00e0 c\u00e1c giai \u0111o\u1ea1n m\u00e0 c\u00f3 s\u1ef1 th\u00e2m nhi\u1ec5m \u22655% t\u1ebf b\u00e0o gan b\u1edfi c\u00e1c h\u1ea1t m\u1ee1 v\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y th\u00e2m nhi\u1ec5m m\u1ee1 (nh\u01b0 thu\u1ed1c, nh\u1ecbn \u0111\u00f3i, c\u00e1c r\u1ed1i lo\u1ea1n \u0111\u01a1n gen) \u1edf nh\u1eefng ng\u01b0\u1eddi u\u1ed1ng \u00edt ho\u1eb7c kh\u00f4ng u\u1ed1ng r\u01b0\u1ee3u bia (\u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 &lt;20g c\u1ed3n\/ng\u00e0y v\u1edbi n\u1eef v\u00e0 &lt;30g\/ng\u00e0y v\u1edbi nam). Ph\u1ed5 b\u1ec7nh n\u00e0y bao g\u1ed3m gan nhi\u1ec5m m\u1ee1 \u0111\u01a1n thu\u1ea7n (NAFL), nhi\u1ec5m m\u1ee1 kh\u00f4ng vi\u00eam v\u00e0 vi\u00eam gan nhi\u1ec5m m\u1ee1 kh\u00f4ng do r\u01b0\u1ee3u\u00a0 (NASH), th\u00e2m nhi\u1ec5m m\u1ee1 k\u00e8m theo vi\u00eam v\u00e0 t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan.<\/strong><\/p>\n<h2><strong>1. D\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 di\u1ec5n ti\u1ebfn t\u1ef1 nhi\u00ean c\u1ee7a b\u1ec7nh.<\/strong><\/h2>\n<p>T\u1ec9 l\u1ec7 hi\u1ec7n m\u1eafc c\u1ee7a NAFLD v\u00e0 NASH \u0111ang t\u0103ng tr\u00ean to\u00e0n c\u1ea7u theo \u0111\u00e0 t\u0103ng c\u1ee7a t\u1ec9 l\u1ec7 b\u00e9o ph\u00ec v\u00e0 c\u00e1c b\u1ec7nh chuy\u1ec3n h\u00f3a \u0111\u1ed3ng m\u1eafc (\u0111\u1ec1 kh\u00e1ng insulin, r\u1ed1i lo\u1ea1n lipid m\u00e1u, b\u00e9o ph\u00ec trung t\u00e2m, t\u0103ng huy\u1ebft \u00e1p). T\u1ec9 l\u1ec7 NAFLD \u0111\u01b0\u1ee3c t\u00ednh to\u00e1n 25 \u2013 30% d\u00e2n s\u1ed1 chung. T\u1ec9 l\u1ec7 NASH \u1edf b\u1ec7nh nh\u00e2n NAFLD t\u1eeb 10 \u2013 20%; trong \u0111\u00f3 c\u00f3 3 \u2013 5% b\u1ec7nh nh\u00e2n c\u00f3 x\u01a1 h\u00f3a F3-F4.<\/p>\n<p>Trong NAFLD, x\u01a1 h\u00f3a gan v\u00e0 NASH l\u00e0 2 y\u1ebfu t\u1ed1 ch\u00ednh ti\u00ean \u0111o\u00e1n ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh. \u1ede b\u1ec7nh nh\u00e2n c\u00f3 NASH k\u00e8m theo x\u01a1 h\u00f3a t\u1eeb F2 \u0111\u01b0\u1ee3c xem l\u00e0 NASH nguy c\u01a1, do t\u0103ng b\u1ec7nh su\u1ea5t v\u00e0 t\u1eed su\u1ea5t li\u00ean quan gan. X\u01a1 h\u00f3a gan c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi nhi\u1ec1u y\u1ebfu t\u1ed1 nh\u01b0 b\u1ec7nh \u0111\u1ed3ng m\u1eafc, ki\u1ec3u gen v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 m\u00f4i tr\u01b0\u1eddng.<\/p>\n<p>Nguy\u00ean nh\u00e2n t\u1eed vong th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf b\u1ec7nh nh\u00e2n NAFLD l\u00e0 b\u1ec7nh tim m\u1ea1ch v\u00e0 c\u00e1c b\u1ec7nh \u00e1c t\u00ednh ngo\u00e0i gan, sau \u0111\u00f3 m\u1edbi \u0111\u1ebfn b\u1ec7nh gan. T\u1eed vong do b\u1ec7nh gan ch\u1ee7 y\u1ebfu g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n c\u00f3 x\u01a1 h\u00f3a ti\u1ebfn tri\u1ec3n.<\/p>\n<figure id=\"attachment_19504\" aria-describedby=\"caption-attachment-19504\" style=\"width: 627px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-19504 \" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/jcth-8-215-g001-300x166.jpg\" alt=\"\" width=\"627\" height=\"347\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/jcth-8-215-g001-300x166.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/jcth-8-215-g001-1024x567.jpg 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/jcth-8-215-g001-768x425.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/jcth-8-215-g001.jpg 1500w\" sizes=\"(max-width: 627px) 100vw, 627px\" \/><figcaption id=\"caption-attachment-19504\" class=\"wp-caption-text\">Di\u1ec5n ti\u1ebfn t\u1ef1 nhi\u00ean c\u1ee7a b\u1ec7nh gan nhi\u1ec5m m\u1ee1 kh\u00f4ng do r\u01b0\u1ee3u. Ngu\u1ed3n: xiahepublishing .com<\/figcaption><\/figure>\n<h2><strong>2. Sinh b\u1ec7nh h\u1ecdc c\u1ee7a b\u1ec7nh gan nhi\u1ec5m m\u1ee1.<\/strong><\/h2>\n<p>NAFLD hi\u1ec7n di\u1ec7n nh\u1edd s\u1ef1 cung c\u1ea5p v\u00e0 l\u1eafng \u0111\u1ecdng c\u00e1c ch\u1ea5t t\u1ea1i gan: acid b\u00e9o, diacylglycerols, ceramides, cholesterol, phospholipids. \u0110\u1ec1 kh\u00e1ng insulin h\u1ea7u nh\u01b0 lu\u00f4n c\u00f3 \u1edf b\u1ec7nh nh\u00e2n NAFLD, th\u00fac \u0111\u1ea9y ti\u1ebfn tri\u1ec3n sang NASH. Y\u1ebfu t\u1ed1 quan tr\u1ecdng trong b\u1ec7nh sinh c\u1ee7a NASH l\u00e0 s\u1ef1 m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa dinh d\u01b0\u1ee1ng cung c\u1ea5p v\u00e0 s\u1eed d\u1ee5ng, tho\u00e1i gi\u00e1ng n\u0103ng l\u01b0\u1ee3ng k\u00e8m suy ch\u1ee9c n\u0103ng m\u00f4 m\u1ee1. Do \u0111\u00f3, y\u1ebfu t\u1ed1 v\u1ec1 c\u01b0\u1eddng \u0111\u1ed9 v\u00e0 t\u1ea7n su\u1ea5t v\u1eadn \u0111\u1ed9ng th\u1ec3 l\u1ef1c \u1ea3nh h\u01b0\u1edfng h\u00ecnh th\u00e0nh NASH.<\/p>\n<h2><strong>3. <a href=\"https:\/\/www.vinmec.com\/vi\/tieu-hoa-gan-mat\/thong-tin-suc-khoe\/bieu-hien-benh-gan-nhiem-mo-qua-tung-giai-doan\/\">Ch\u1ea9n \u0111o\u00e1n NAFLD<\/a>.<\/strong><\/h2>\n<h3><strong>3.1. X\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 nhi\u1ec5m m\u1ee1.<\/strong><\/h3>\n<ul>\n<li>Si\u00eau \u00e2m b\u1ee5ng t\u1ed5ng qu\u00e1t \u0111\u01b0\u1ee3c d\u00f9ng th\u01b0\u1eddng quy tr\u00ean l\u00e2m s\u00e0ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n gan nhi\u1ec5m m\u1ee1. Ph\u00e2n \u0111\u1ed9 theo ti\u00eau chu\u1ea9n Hagen-Ansert 1995.<\/li>\n<li>Si\u00eau \u00e2m \u0111\u00e0n h\u1ed3i gan cho \u0111\u00e1nh gi\u00e1 kh\u00e1ch quan v\u00e0 ch\u00ednh x\u00e1c h\u01a1n si\u00eau \u00e2m t\u1ed5ng qu\u00e1t.<\/li>\n<li>MRI t\u1ec9 tr\u1ecdng proton m\u1ee1 l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u00ednh x\u00e1c nh\u1ea5t \u0111\u1ec3 \u0111\u1ecbnh l\u01b0\u1ee3ng th\u00e2m nhi\u1ec5m m\u1ee1 v\u00e0 \u0111\u01b0\u1ee3c xem l\u00e0 chu\u1ea9n v\u00e0ng.<\/li>\n<\/ul>\n<h3><strong>3.2. Ch\u1ea9n \u0111o\u00e1n NASH.<\/strong><\/h3>\n<ul>\n<li>L\u00e2m s\u00e0ng: h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n NASH kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111\u1eb7c hi\u1ec7u. C\u00e1c bi\u1ec3u hi\u1ec7n c\u00f3 th\u1ec3 l\u00e0 m\u1ec7t m\u1ecfi, kh\u00f3 ch\u1ecbu \u1edf v\u00f9ng h\u1ea1 s\u01b0\u1eddn ph\u1ea3i hay gan to.<\/li>\n<li>T\u1ec9 s\u1ed1 ALT\/AST t\u0103ng. T\u1ec9 s\u1ed1 t\u0103ng, c\u00f3 nguy c\u01a1 cao NASH. Nh\u01b0ng t\u1ec9 s\u1ed1 b\u00ecnh th\u01b0\u1eddng c\u0169ng kh\u00f4ng lo\u1ea1i tr\u1eeb b\u1ec7nh.<\/li>\n<li>T\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n n\u00ean l\u00e0m x\u00e1c x\u00e9t nghi\u1ec7m:<\/li>\n<\/ul>\n<p>HbsAg, anti HBs, anti HBc; anti HCV.<\/p>\n<p>Fe, ferritin v\u00e0 TIBC.<\/p>\n<p>Gammaglobulin huy\u1ebft thanh, ANA, SMA ho\u1eb7c anti LKM1.<\/p>\n<p><em>Ch\u1ec9 \u0111i\u1ec3m sinh h\u1ecdc:<\/em><\/p>\n<p>Ferritin huy\u1ebft thanh t\u0103ng khi TIBC \u0111\u1ed9 b\u00e3o h\u00f2a transferin b\u00ecnh th\u01b0\u1eddng.<\/p>\n<p>Hi\u1ec7n kh\u00f4ng c\u00f3 biomarker c\u1ee7a NASH \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n<h3><strong>3.3. Ch\u1ea9n \u0111o\u00e1n x\u01a1 h\u00f3a gan.<\/strong><\/h3>\n<p>D\u1ef1a v\u00e0o h\u00ecnh \u1ea3nh h\u1ecdc: <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/chan-doan-xo-gan-bang-phuong-phap-fibroscan\/\">fibroscan.<\/a><\/p>\n<p>D\u1ef1a v\u00e0o c\u00e1c thang \u0111i\u1ec3m: APRI, NFS, FIB-4, ELF.<\/p>\n<h2><strong>4. \u0110i\u1ec1u tr\u1ecb NAFLD.<\/strong><\/h2>\n<h3><strong>4.1. T\u1ea7m so\u00e1t v\u00e0 \u0111i\u1ec1u tr\u1ecb y\u1ebfu t\u1ed1 nguy c\u01a1.<\/strong><\/h3>\n<ul>\n<li>B\u00e9o ph\u00ec (BMI &gt;30kg\/m2). M\u1ee5c ti\u00eau: gi\u1ea3m 7 \u2013 10% c\u00e2n n\u1eb7ng trong 48 \u2013 52 tu\u1ea7n.<\/li>\n<li>\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng. M\u1ee5c ti\u00eau: A1c &lt;7% c\u00f9ng thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.<\/li>\n<li>R\u1ed1i lo\u1ea1n lipid m\u00e1u. \u0110\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 x\u01a1 v\u1eefa 10 n\u0103m 7.5%; LDL 190mg\/dL; LDL 70 \u2013 189 k\u00e8m \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. M\u1ee5c ti\u00eau: \u0111i\u1ec1u tr\u1ecb statin li\u1ec1u trung b\u00ecnh \u2013 cao, gi\u1ea3m 50% LDL (n\u1ebfu d\u00f9ng c\u01b0\u1eddng \u0111\u1ed9 cao), gi\u1ea3m 30% n\u1ebfu c\u01b0\u1eddng \u0111\u1ed9 trung b\u00ecnh.<\/li>\n<li>T\u0103ng huy\u1ebft \u00e1p. M\u1ee5c ti\u00eau: HA t\u00e2m thu &lt; 150 ho\u1eb7c &lt;140 t\u00f9y tu\u1ed5i, c\u00f3 k\u00e8m \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0\/ho\u1eb7c b\u1ec7nh th\u1eadn m\u1ea1n hay kh\u00f4ng, HA t\u00e2m tr\u01b0\u01a1ng &lt;90 mmHg.<\/li>\n<li>Khuy\u1ebfn c\u00e1o NICE v\u1ec1 thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng: gi\u1ea3m 500 \u2013 1000kcal, th\u1ec3 d\u1ee5c nh\u1ecbp \u0111i\u1ec7u hay th\u1ec3 thao \u0111\u1ed1i kh\u00e1ng (150 \u2013 200 ph\u00fat\/tu\u1ea7n chia 3 \u2013 5 bu\u1ed5i); ch\u1ebf \u0111\u1ed9 ch\u1ea5t b\u00e9o t\u1eeb th\u1ea5p \u2013 trung b\u00ecnh, carbohydrate trung b\u00ecnh \u2013 cao; ch\u1ebf \u0111\u1ed9 \u0103n \u0110\u1ecba Trung H\u1ea3i. Gi\u1ea3m t\u1ed1i thi\u1ec3u 5 \u2013 7% trong 6 th\u00e1ng.<\/li>\n<\/ul>\n<h3><strong>4.2. \u0110i\u1ec1u tr\u1ecb d\u00f9ng thu\u1ed1c.<\/strong><\/h3>\n<ul>\n<li>Metformin: ch\u1ee9ng c\u1ee9 kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7\/kh\u00f4ng c\u00f3 l\u1ee3i.<\/li>\n<li>Vitamin E: xem x\u00e9t s\u1eed d\u1ee5ng d\u00f9 c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng hay kh\u00f4ng.<\/li>\n<li>\u0110\u1ed3ng v\u1eadn PPAR-gamma: xem x\u00e9t pioglitazone.<\/li>\n<li>PUFA: kh\u00f4ng ch\u1ee9ng c\u1ee9.<\/li>\n<li>Statin: an to\u00e0n, nh\u01b0ng kh\u00f4ng c\u00f3 l\u1ee3i.<\/li>\n<\/ul>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/p>\n<p>AASLD Practice Guidance on the Clinical Assessment and Management of Nonalcoholic Fatty Liver Disease.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>B\u1ec7nh gan nhi\u1ec5m m\u1ee1 kh\u00f4ng do r\u01b0\u1ee3u (NAFLD) l\u00e0 m\u1ed9t thu\u1eadt ng\u1eef bao g\u1ed3m t\u1ea5t c\u00e1c b\u1ec7nh v\u00e0 c\u00e1c giai \u0111o\u1ea1n m\u00e0 c\u00f3 s\u1ef1 th\u00e2m nhi\u1ec5m \u22655% t\u1ebf b\u00e0o gan b\u1edfi c\u00e1c h\u1ea1t m\u1ee1 v\u00e0 kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y th\u00e2m nhi\u1ec5m m\u1ee1 (nh\u01b0 thu\u1ed1c, nh\u1ecbn \u0111\u00f3i, c\u00e1c r\u1ed1i lo\u1ea1n \u0111\u01a1n gen) \u1edf nh\u1eefng [&hellip;]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - 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