{"id":19705,"date":"2023-04-16T18:09:24","date_gmt":"2023-04-16T11:09:24","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19705"},"modified":"2023-04-17T14:09:56","modified_gmt":"2023-04-17T07:09:56","slug":"tong-quan-ve-benh-phoi-ke-o-nguoi-benh-lupus-ban-do-he-thong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/tong-quan-ve-benh-phoi-ke-o-nguoi-benh-lupus-ban-do-he-thong\/","title":{"rendered":"T\u1ed5ng quan v\u1ec1 b\u1ec7nh ph\u1ed5i k\u1ebd \u1edf ng\u01b0\u1eddi b\u1ec7nh Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng"},"content":{"rendered":"

B\u1ec7nh lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng (SLE<\/a>) l\u00e0 m\u1ed9t b\u1ec7nh l\u00ed kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t, b\u1ec7nh ch\u01b0a r\u00f5 c\u0103n nguy\u00ean. T\u1ed5n th\u01b0\u01a1ng b\u1ec7nh ph\u1ed5i k\u1ebd (Interstitial lung disease – ILD)\u00a0 l\u00e0 \u0111\u1eb7c tr\u01b0ng b\u1edfi vi\u1ec7c s\u1ea3n xu\u1ea5t c\u00e1c t\u1ef1 kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i c\u00e1c kh\u00e1ng nguy\u00ean v\u00e0 c\u00e1c ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch. Trong c\u00e1c h\u00ecnh th\u00e1i t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i \u1edf ng\u01b0\u1eddi b\u1ec7nh lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i k\u1ebd kh\u00f4ng th\u01b0\u1eddng g\u1eb7p nh\u01b0 vi\u00eam m\u00e0ng ph\u1ed5i.\u00a0<\/strong><\/p>\n

\"B\u1ec7nh
B\u1ec7nh ph\u1ed5i k\u1ebd \u1edf ng\u01b0\u1eddi b\u1ec7nh Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng<\/figcaption><\/figure>\n

1. D\u1ecbch t\u1ec5<\/h2>\n

T\u1ef7 l\u1ec7 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i trong b\u1ec7nh lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng t\u01b0\u01a1ng \u0111\u1ed1i cao, 24% \u0111\u1ebfn 70%, bao g\u1ed3m c\u00e1c t\u1ed5n th\u01b0\u01a1ng nh\u01b0 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, vi\u00eam m\u00e0ng ph\u1ed5i, b\u1ec7nh ph\u1ed5i k\u1ebd (ILD), t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, xu\u1ea5t huy\u1ebft ph\u1ebf nang lan t\u1ecfa, thuy\u00ean t\u1eafc ph\u1ed5i,\u2026<\/p>\n

2. Y\u1ebfu t\u1ed1 nguy c\u01a1<\/h2>\n

T\u1ed5n th\u01b0\u01a1ng ph\u1ed5i k\u1ebd ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb SLE l\u00e2u n\u0103m (> 10 n\u0103m), nh\u00f3m kh\u1edfi ph\u00e1t mu\u1ed9n (\u2265 50 tu\u1ed5i) c\u00f3 t\u1ef7 l\u1ec7 m\u1eafc t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i k\u1ebd cao h\u01a1n 2,56 l\u1ea7n so v\u1edbi nh\u00f3m kh\u1edfi ph\u00e1t s\u1edbm (<18 tu\u1ed5i)<\/p>\n

M\u1ee9c \u0111\u1ed9 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a SLE l\u00e0 c\u00f3 m\u1ed1i quan h\u1ec7 v\u1edbi d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i k\u1ebd khi kh\u1edfi \u0111\u1ea7u. \u0110i\u1ec3m SLEDAI-2K cao h\u01a1n \u0111\u00e1ng k\u1ec3 \u1edf nh\u1eefng NB b\u1ecb t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i k\u1ebd c\u1ea5p t\u00ednh ho\u1eb7c b\u00e1n c\u1ea5p so v\u1edbi nh\u1eefng ng\u01b0\u1eddi t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i k\u1ebd m\u00e3n t\u00ednh.<\/p>\n

N\u1ed3ng \u0111\u1ed9 protein ph\u1ea3n \u1ee9ng C cao, thi\u1ebfu m\u00e1u v\u00e0 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a cryoglobulin c\u0169ng c\u00f3 li\u00ean quan \u0111\u1ebfn ILD.<\/p>\n

3. Ch\u1ea9n \u0111o\u00e1n<\/h2>\n

3.1. L\u00e2m s\u00e0ng<\/h3>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh SLE-ILD l\u00e0 s\u1ed1t, ho, kh\u1ea1c \u0111\u1eddm, t\u1ee9c ng\u1ef1c, ho khan v\u00e0 kh\u00f3 th\u1edf. M\u1ed9t s\u1ed1 tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111i\u1ec3n nh\u01b0 s\u1ed1t, ho v\u00e0 \u0111\u1eddm h\u1ea7u h\u1ebft li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng l\u00e2u d\u00e0i glucocorticoid, thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch v\u00e0 c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c sau khi ch\u1ea9n \u0111o\u00e1n SLE, d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng mi\u1ec5n d\u1ecbch v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t.<\/p>\n

D\u1ea5u hi\u1ec7u nghe tim ph\u1ed5i b\u1ea5t th\u01b0\u1eddng ph\u1ed5 bi\u1ebfn nh\u1ea5t trong nh\u00f3m SLE-ILD l\u00e0 ran n\u1ed5 \u1edf ph\u1ed5i. Ran Velcro l\u00e0 ral \u0111i\u1ec3n h\u00ecnh c\u1ee7a vi\u00eam ph\u1ed5i k\u1ebd. Tuy nhi\u00ean, \u0111a s\u1ed1 ng\u01b0\u1eddi b\u1ec7nh vi\u00eam ph\u1ed5i k\u1ebd kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng t\u1ea1i ph\u1ed5i, trong nghi\u00ean c\u1ee9u t\u1ea1i Trung Qu\u1ed1c, c\u00f3 \u0111\u1ebfn 75,28 % nghe ph\u1ed5i kh\u00f4ng c\u00f3 b\u1ea5t th\u01b0\u1eddng.<\/p>\n

3.2. Ch\u1ee5p CT ph\u1ed5i \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao<\/b>\u00a0(HRCT)<\/h2>\n

Trong m\u1ed9t nghi\u00ean c\u1ee9u c\u1ee7a Lian v\u00e0 c\u1ed9ng s\u1ef1, b\u00e1o c\u00e1o r\u1eb1ng t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng k\u00ednh m\u1edd l\u00e0 thay \u0111\u1ed5i tr\u00ean HRCT ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf ng\u01b0\u1eddi b\u1ec7nh SLE-ILD, chi\u1ebfm kho\u1ea3ng 84,4% v\u00e0 c\u00e1c thay \u0111\u1ed5i h\u00ecnh \u1ea3nh c\u00f2n l\u1ea1i l\u00e0 m\u1edd d\u1ea1ng n\u1ed1t (21,1%), m\u1edd t\u1ed5 ong (15,6%) v\u00e0 gi\u00e3n ph\u1ebf qu\u1ea3n co k\u00e9o (12,8%). Trong nghi\u00ean c\u1ee9u n\u00e0y, c\u00e1c b\u1ea5t th\u01b0\u1eddng \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e0 k\u00ednh m\u1edd v\u00f9ng \u0111\u00e1y (46,07%) v\u00e0 d\u00e0y v\u00e1ch trong ti\u1ec3u th\u00f9y (17,98%). T\u1ed5n th\u01b0\u01a1ng c\u1ea3 hai ph\u1ed5i chi\u1ebfm 84,27%.<\/p>\n

Ngo\u00e0i ra c\u00f3 th\u1ec3 g\u1eb7p ch\u1ea3y m\u00e1u ph\u1ebf nang lan t\u1ecfa v\u1edbi h\u00ecnh \u1ea3nh k\u00ednh m\u1edd lan t\u1ecfa (DAD\/DAH)<\/p>\n

Theo d\u00f5i h\u00ecnh \u1ea3nh d\u00e0i h\u1ea1n cho th\u1ea5y h\u1ea7u h\u1ebft b\u1ec7nh c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh ti\u1ebfn tri\u1ec3n ch\u1eadm, v\u00e0 h\u1ea7u h\u1ebft c\u00e1c ch\u1ec9 s\u1ed1 ch\u1ee9c n\u0103ng ph\u1ed5i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c duy tr\u00ec.<\/p>\n

\"T\u1ed5n
T\u1ed5n th\u01b0\u01a1ng c\u1ee7a b\u1ec7nh ph\u1ed5i k\u1ebd \u1edf ng\u01b0\u1eddi b\u1ec7nh lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng tr\u00ean HRCT<\/figcaption><\/figure>\n

3.3. Gi\u1ea3i ph\u1eabu b\u1ec7nh<\/h3>\n

Sinh thi\u1ebft \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb n\u1ebfu ch\u1ea9n \u0111o\u00e1n kh\u00f4ng ch\u1eafc ch\u1eafn m\u1eb7c d\u00f9 \u0111\u00e3 l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m kh\u00f4ng x\u00e2m l\u1ea5n.<\/p>\n

NSIP<\/b>: lo\u1ea1i ph\u1ed5 bi\u1ebfn nh\u1ea5t. Th\u00e2m nhi\u1ec5m lymphocytic m\u00e3n t\u00ednh (t\u1ebf b\u00e0o lympho \/ t\u01b0\u01a1ng b\u00e0o), kh\u00f4ng c\u00f3 x\u01a1 h\u00f3a.<\/p>\n

UIP<\/b>: c\u00e1c m\u1ea3ng x\u01a1 h\u00f3a c\u00f3 t\u00e1i t\u1ea1o c\u1ea5u tr\u00fac ph\u1ed5i, vi\u00eam k\u1ebd m\u00e3n t\u00ednh m\u1ee9c \u0111\u1ed9 v\u1eeba.<\/p>\n

LIP<\/b>: th\u00e2m nhi\u1ec5m r\u00f5 m\u00f4 k\u1ebd lan t\u1ecfa b\u1edfi t\u1ebf b\u00e0o lympho, t\u01b0\u01a1ng b\u00e0o v\u00e0 m\u00f4 b\u00e0o.<\/p>\n

C\u00e1c b\u1ea5t th\u01b0\u1eddng gi\u1ea3i ph\u1eabu b\u1ec7nh c\u00f3 li\u00ean quan kh\u00e1c \u00edt ph\u1ed5 bi\u1ebfn h\u01a1n: tho\u00e1i h\u00f3a amyloidosis v\u00e0 vi\u00eam ph\u1ed5i t\u1ed5 ch\u1ee9c h\u00f3a kh\u00f4ng r\u00f5 c\u0103n nguy\u00ean c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o.<\/p>\n

4. \u0110i\u1ec1u tr\u1ecb<\/h2>\n

4.1. Ch\u0103m s\u00f3c<\/h3>\n

C\u0169ng nh\u01b0 \u0111\u1ed1i v\u1edbi vi\u1ec7c qu\u1ea3n l\u00fd t\u1ea5t c\u1ea3 c\u00e1c lo\u1ea1i b\u1ec7nh ph\u1ed5i, vi\u1ec7c cai thu\u1ed1c l\u00e1 l\u00e0 quan tr\u1ecdng. Li\u1ec7u ph\u00e1p oxy \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u0111\u1ed9 b\u00e3o h\u00f2a oxy khi ngh\u1ec9 ng\u01a1i ho\u1eb7c t\u1eadp th\u1ec3 d\u1ee5c <89 %. Ti\u00eam ph\u00f2ng c\u00fam v\u00e0 ph\u1ebf c\u1ea7u.<\/p>\n

4.2. \u0110i\u1ec1u tr\u1ecb thu\u1ed1c<\/h3>\n

B\u1ea3ng. C\u00e1c li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c trong b\u1ec7nh ph\u1ed5i k\u1ebd SLE<\/p>\n\n\n\n\n\n\n\n
\n

H\u00ecnh th\u00e1i t\u1ed5n<\/b>\u00a0th\u01b0\u01a1ng ph\u1ed5i<\/b><\/p>\n<\/td>\n

\n

\u0110i\u1ec1u tr\u1ecb corticoid<\/b><\/p>\n<\/td>\n

\n

Thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch<\/b><\/p>\n<\/td>\n<\/tr>\n

SLE-ILD ph\u1ed5 bi\u1ebfn nh\u1ea5t (v\u00ed d\u1ee5: NSIP, LIP)<\/i><\/b><\/td>\nGlucocorticoid to\u00e0n th\u00e2n, prednisone 0,5 \u0111\u1ebfn 1 mg \/ kg\/ng\u00e0y[149].<\/p>\n

\u0110i\u1ec1u tr\u1ecb n\u1ec1n, ph\u1ed1i h\u1ee3p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch.<\/td>\n

ILD nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh, mycophenolate ho\u1eb7c azathioprine l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean h\u1ee3p l\u00fd;<\/p>\n

T\u1ed5n th\u01b0\u01a1ng n\u1eb7ng h\u01a1n ho\u1eb7c ti\u1ebfn tri\u1ec3n nhanh \u01b0u ti\u00ean s\u1eed d\u1ee5ng cyclophosphamide ho\u1eb7c rituximab.<\/td>\n<\/tr>\n

ILD c\u1ea5p t\u00ednh (Flare – ILD)<\/i><\/b><\/p>\n

Flare- ILD ti\u1ebfn tri\u1ec3n v\u00e0 n\u1eb7ng (\u0111\u1eb7c tr\u01b0ng b\u1edfi gi\u1ea3m oxy m\u00e1u v\u00e0 gi\u1ea3m nghi\u00eam tr\u1ecdng ch\u1ee9c n\u0103ng ph\u1ed5i)<\/td>\n

Kh\u1edfi \u0111\u1ea7u b\u1eb1ng glucocorticoid li\u1ec1u cao (methylprednisolone t\u0129nh m\u1ea1ch 1 g m\u1ed7i ng\u00e0y trong ba ng\u00e0y, ho\u1eb7c prednisone 1 \u0111\u1ebfn 2 mg \/ kg \/ ng\u00e0y \u1edf nh\u1eefng NB \u00edt c\u1ea5p t\u00ednh h\u01a1n)<\/p>\n

Sau \u0111\u00f3 chuy\u1ec3n sang \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p c\u00f9ng \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch<\/td>\n

Cyclophosphamide \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch ho\u1eb7c rituximab \u0111i\u1ec1u tr\u1ecb trong 6 – 12 th\u00e1ng, sau \u0111\u00f3 chuy\u1ec3n sang azathioprine ho\u1eb7c mycophenolate mofetil.<\/p>\n

\u0110\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh \u00edt nghi\u00eam tr\u1ecdng ho\u1eb7c kh\u00f4ng dung n\u1ea1p t\u1ed1t cyclophosphamide, c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb v\u1edbi azathioprine ho\u1eb7c mycophenolate.<\/td>\n<\/tr>\n

Vi\u00eam ph\u1ed5i t\u1ed5 ch\u1ee9c h\u00f3a<\/i><\/b><\/td>\nPrednisone \u0111\u01b0\u1eddng u\u1ed1ng (1 mg\/kg m\u1ed7i ng\u00e0y trong m\u1ed9t th\u00e1ng sau \u0111\u00f3 gi\u1ea3m d\u1ea7n).<\/td>\n\u1ee8c ch\u1ebf mi\u1ec5n d\u1ecbch th\u01b0\u1eddng d\u00f9ng ph\u1ed1i h\u1ee3p \u0111\u1ec3 gi\u1ea3m li\u1ec1u prednisone<\/td>\n<\/tr>\n
ILD x\u01a1 h\u00f3a<\/i><\/b><\/td>\nVi\u00eam ph\u1ed5i k\u1ebd th\u00f4ng th\u01b0\u1eddng v\u00e0 NSIP x\u01a1 l\u00e0 nh\u1eefng ILD x\u01a1 l\u00e0m ph\u1ee9c t\u1ea1p b\u1ec7nh l\u00ed lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng.<\/p>\n

Kh\u00f4ng c\u00f3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 n\u00e0o cho b\u1ec7nh ph\u1ed5i x\u01a1 trong SLE. Tuy nhi\u00ean, m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u1ec1 ch\u1ea5t ch\u1ed1ng x\u01a1 h\u00f3a, nintedanib, \u1edf nh\u1eefng NB c\u00f3 ILD x\u01a1 h\u00f3a ti\u1ebfn tri\u1ec3n, bao g\u1ed3m c\u1ea3 b\u1ec7nh ILD li\u00ean quan \u0111\u1ebfn b\u1ec7nh t\u1ef1 mi\u1ec5n, cho th\u1ea5y l\u00e0m gi\u1ea3m t\u1ed1c \u0111\u1ed9 suy gi\u1ea3m ch\u1ee9c n\u0103ng ph\u1ed5i. Nintedanib \u0111\u00e3 \u0111\u01b0\u1ee3c FDA ch\u1ea5p thu\u1eadn \u0111\u1ec3 s\u1eed d\u1ee5ng trong b\u1ec7nh ph\u1ed5i k\u1ebd x\u01a1 h\u00f3a ti\u1ebfn tri\u1ec3n (Xem m\u1ee5c 5.7).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Ngo\u00e0i ra, gh\u00e9p ph\u1ed5i c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn cho nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh \u1edf giai \u0111o\u1ea1n n\u1eb7ng.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n