{"id":21883,"date":"2023-04-16T00:16:33","date_gmt":"2023-04-15T17:16:33","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21883"},"modified":"2023-04-17T14:18:22","modified_gmt":"2023-04-17T07:18:22","slug":"da-hong-cau-nguyen-phat","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/da-hong-cau-nguyen-phat\/","title":{"rendered":"T\u1ed5ng quan v\u1ec1 b\u1ec7nh \u0111a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t"},"content":{"rendered":"

\u0110a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t (Polycythemia vera \u2013 PV) l\u00e0 m\u1ed9t r\u1ed1i lo\u1ea1n t\u0103ng sinh t\u1ee7y m\u1ea1n t\u00ednh. B\u1ec7nh \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 gia t\u0103ng qu\u00e1 m\u1ee9c s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u, th\u01b0\u1eddng k\u00e8m theo t\u0103ng s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u, ti\u1ec3u c\u1ea7u v\u00e0 l\u00e1ch to. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh bi\u1ec3u hi\u1ec7n \u0111a d\u1ea1ng v\u00e0 kh\u00f4ng \u0111\u1eb7c tr\u01b0ng.<\/strong><\/p>\n

1. \u0110\u1ecbnh ngh\u0129a<\/h2>\n

\u0110a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd mi\u1ec5n d\u1ecbch \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 s\u1ea3n xu\u1ea5t qu\u00e1 m\u1ee9c c\u00e1c t\u1ebf b\u00e0o m\u00e1u, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u. B\u1ec7nh th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ng\u01b0\u1eddi tr\u00ean 60 tu\u1ed5i, b\u1ec7nh c\u00f3 t\u1ef7 l\u1ec7 ph\u00e1t hi\u1ec7n \u1edf nam gi\u1edbi cao h\u01a1n so v\u1edbi n\u1eef gi\u1edbi.<\/p>\n

\"da-hong-cau-nguyen-phat-polycythemia-vera\"
\u0110a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t (Polycythemia vera)<\/a><\/figcaption><\/figure>\n

2. Nguy\u00ean nh\u00e2n c\u1ee7a b\u1ec7nh \u0111a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t<\/h2>\n

Nguy\u00ean nh\u00e2n g\u00e2y ra \u0111a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec3u r\u00f5.<\/p>\n

M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho th\u1ea5y r\u1eb1ng b\u1ec7nh c\u00f3 li\u00ean quan \u0111\u1ebfn m\u1ed9t s\u1ed1 \u0111\u1ed9t bi\u1ebfn gen di truy\u1ec1n. \u0110\u1ed9t bi\u1ebfn JAK2 V617F l\u00e0 m\u1ed9t trong nh\u1eefng \u0111\u1ed9t bi\u1ebfn \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y nhi\u1ec1u nh\u1ea5t \u1edf b\u1ec7nh nh\u00e2n PV, g\u00e2y ra s\u1ef1 k\u00edch ho\u1ea1t b\u1ea5t th\u01b0\u1eddng c\u1ee7a \u0111\u01b0\u1eddng t\u00edn hi\u1ec7u JAK-STAT, d\u1eabn \u0111\u1ebfn s\u1ef1 t\u0103ng s\u1ea3n xu\u1ea5t qu\u00e1 m\u1ee9c t\u1ebf b\u00e0o m\u00e1u, g\u1eb7p trong kho\u1ea3ng 99% c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh.<\/p>\n

Ngo\u00e0i ra, b\u1ea5t th\u01b0\u1eddng nhi\u1ec5m s\u1eafc th\u1ec3 s\u1ed1 8, nhi\u1ec5m s\u1eafc th\u1ec3 s\u1ed1 9, nhi\u1ec5m s\u1eafc th\u1ec3 Y c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p trong b\u1ec7nh \u0111a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t.<\/p>\n

B\u00ean c\u1ea1nh \u0111\u00f3, b\u1ec7nh nh\u00e2n PV c\u0169ng c\u00f3 li\u00ean quan \u0111\u1ebfn m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 m\u00f4i tr\u01b0\u1eddng nh\u01b0 h\u00fat thu\u1ed1c l\u00e1 v\u00e0 ti\u1ebfp x\u00fac v\u1edbi c\u00e1c ch\u1ea5t \u0111\u1ed9c h\u1ea1i nh\u01b0 benzen. C\u00e1c t\u00e1c nh\u00e2n n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra t\u1ed5n th\u01b0\u01a1ng cho t\u1ebf b\u00e0o t\u1ee7y x\u01b0\u01a1ng v\u00e0 k\u00edch th\u00edch s\u1ea3n xu\u1ea5t qu\u00e1 m\u1ee9c c\u00e1c t\u1ebf b\u00e0o m\u00e1u trong t\u1ee7y x\u01b0\u01a1ng.<\/p>\n

3. Tri\u1ec7u ch\u1ee9ng c\u1ee7a \u0111a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t<\/h2>\n

Tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a s\u1ef1 t\u0103ng s\u1ea3n xu\u1ea5t t\u1ebf b\u00e0o m\u00e1u, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u. T\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 t\u0103ng s\u1ea3n xu\u1ea5t t\u1ebf b\u00e0o m\u00e1u m\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n kh\u00e1c nhau. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a \u0111a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t r\u1ea5t \u0111a d\u1ea1ng v\u00e0 kh\u00f4ng \u0111\u1eb7c tr\u01b0ng, d\u1ec5 nh\u1ea7m l\u1eabn v\u1edbi c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c.<\/p>\n

B\u1ec7nh c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng v\u00e0 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n t\u00ecnh c\u1edd.<\/p>\n

3.1. Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng<\/h3>\n

M\u1ec7t m\u1ecfi v\u00e0 kh\u00f3 th\u1edf, \u0111au \u0111\u1ea7u v\u00e0 ch\u00f3ng m\u1eb7t, \u0111au ng\u1ef1c, ng\u1ee9a, r\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c, m\u1ea5t c\u1ea3m gi\u00e1c \u1edf tay v\u00e0 ch\u00e2n, \u0111au th\u01b0\u1ee3ng v\u1ecb v\u00e0 s\u1ee5t c\u00e2n,\u2026<\/p>\n

3.2. Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3<\/h3>\n

Da, ni\u00eam m\u1ea1c: da \u0111\u1ecf h\u1ed3ng ho\u1eb7c \u0111\u1ecf s\u1eabm, \u0111\u1ea7u ng\u00f3n c\u00f3 th\u1ec3 s\u01b0ng ph\u1ed3ng, h\u01a1i \u0111\u1ecf v\u00e0 \u0111au.<\/p>\n

Tim m\u1ea1ch: t\u0103ng huy\u1ebft \u00e1p l\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p. C\u00e1c b\u1ec7nh nh\u00e2n ch\u01b0a \u0111i\u1ec1u tr\u1ecb c\u00f3 nguy c\u01a1 cao b\u1ecb huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch, \u0111\u1ed9ng m\u1ea1ch v\u00e0 xu\u1ea5t huy\u1ebft. Huy\u1ebft kh\u1ed1i l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ra t\u1eed vong \u1edf 30-40% tr\u01b0\u1eddng h\u1ee3p v\u00e0 c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf c\u00e1c t\u0129nh m\u1ea1ch s\u00e2u chi d\u01b0\u1edbi, thuy\u00ean t\u1eafc ph\u1ed5i, t\u1eafc m\u1ea1ch ngo\u1ea1i vi,\u2026H\u01a1n 80% t\u1eed vong do huy\u1ebft kh\u1ed1i l\u00e0 t\u1eafc \u0111\u1ed9ng m\u1ea1ch.<\/p>\n

Ti\u00eau h\u00f3a: xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a ho\u1eb7c huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch m\u1ea1c treo, c\u00f3 th\u1ec3 g\u1eb7p lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng.<\/p>\n

Gan to th\u01b0\u1eddng g\u1eb7p.<\/p>\n

L\u00e1ch to g\u1eb7p trong 2\/3 tr\u01b0\u1eddng h\u1ee3p, m\u1eadt \u0111\u1ed9 c\u1ee9ng v\u00e0 tr\u01a1n l\u00e1ng.<\/p>\n

4. Ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n<\/h2>\n

Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n b\u1ec7nh \u0111\u00f2i h\u1ecfi s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a nhi\u1ec1u y\u1ebfu t\u1ed1 bao g\u1ed3m tri\u1ec7u ch\u1ee9ng b\u1ec7nh, k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m m\u00e1u, x\u00e9t nghi\u1ec7m di truy\u1ec1n,\u2026<\/p>\n

M\u1ed9t trong nh\u1eefng x\u00e9t nghi\u1ec7m m\u00e1u quan tr\u1ecdng nh\u1ea5t \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n \u00a0b\u1ec7nh l\u00e0 x\u00e9t nghi\u1ec7m \u0111o n\u1ed3ng \u0111\u1ed9 erythropoietin (EPO) trong m\u00e1u. EPO l\u00e0 m\u1ed9t hormone quan tr\u1ecdng \u0111\u1ec3 k\u00edch th\u00edch s\u1ea3n xu\u1ea5t t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u trong t\u1ee7y x\u01b0\u01a1ng. B\u1ec7nh nh\u00e2n PV th\u01b0\u1eddng c\u00f3 n\u1ed3ng \u0111\u1ed9 EPO th\u1ea5p ho\u1eb7c kh\u00f4ng c\u00f3 EPO trong m\u00e1u. K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m n\u00e0y c\u00f3 th\u1ec3 cho th\u1ea5y vi\u1ec7c t\u0103ng s\u1ea3n xu\u1ea5t t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 k\u00edch th\u00edch c\u1ee7a EPO.<\/p>\n

Ngo\u00e0i ra, x\u00e9t nghi\u1ec7m c\u00f4ng th\u1ee9c m\u00e1u m\u00e1u cho bi\u1ebft n\u1ed3ng \u0111\u1ed9 hemoglobin, hematocrit, v\u00e0 s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i vi.<\/p>\n

Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n \u0111a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t theo WHO n\u0103m 2008:<\/strong><\/p>\n

Ti\u00eau chu\u1ea9n ch\u00ednh:<\/p>\n

A1. Hb > 185 G\/L (nam) ho\u1eb7c Hb > 165 G\/L (n\u1eef)<\/p>\n

Ho\u1eb7c t\u0103ng th\u1ec3 t\u00edch kh\u1ed1i h\u1ed3ng c\u1ea7u to\u00e0n th\u1ec3 > 25% so v\u1edbi tr\u1ecb s\u1ed1 b\u00ecnh th\u01b0\u1eddng<\/p>\n

A2. C\u00f3 \u0111\u1ed9t bi\u1ebfn gen JAK2V617F<\/p>\n

Ti\u00eau chu\u1ea9n ph\u1ee5:<\/p>\n

B1. T\u0103ng sinh 3 d\u00f2ng t\u1ebf b\u00e0o t\u1ee7y<\/p>\n

B2. N\u1ed3ng \u0111\u1ed9 erythropoietin huy\u1ebft thanh gi\u1ea3m<\/p>\n

B3. T\u1ea1o c\u1ee5m EEC (endogenous erythroid colony) khi nu\u00f4i c\u1ea5y c\u1ee5m t\u1ebf b\u00e0o t\u1ee7y kh\u00f4ng d\u00f9ng ch\u1ea5t k\u00edch th\u00edch sinh h\u1ed3ng c\u1ea7u<\/p>\n

Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh \u0111a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t khi c\u00f3 c\u1ea3 2 ti\u00eau chu\u1ea9n ch\u00ednh (A1 v\u00e0 A2) v\u00e0 1 ti\u00eau chu\u1ea9n ph\u1ee5 ho\u1eb7c ti\u00eau chu\u1ea9n ch\u00ednh A1 v\u00e0 2 ti\u00eau chu\u1ea9n ph\u1ee5.<\/p>\n

5. \u0110i\u1ec1u tr\u1ecb \u0111a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t<\/h2>\n

\u0110i\u1ec1u tr\u1ecb b\u1ec7nh \u0111a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t nh\u1eb1m gi\u1ea3m thi\u1ec3u c\u00e1c tri\u1ec7u ch\u1ee9ng b\u1ec7nh v\u00e0 nguy c\u01a1 bi\u1ebfn ch\u1ee9ng li\u00ean quan \u0111\u1ebfn t\u0103ng s\u1ea3n xu\u1ea5t t\u1ebf b\u00e0o m\u00e1u. Vi\u1ec7c l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p ph\u1ee5 thu\u1ed9c v\u00e0o t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3 v\u00e0 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb bao g\u1ed3m:<\/p>\n

\u0110i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng: B\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao b\u1ecb huy\u1ebft kh\u1ed1i, do \u0111\u00f3 \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 n\u00e0y. C\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng nh\u01b0 Aspirin v\u00e0 Warfarin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 h\u00ecnh th\u00e0nh huy\u1ebft kh\u1ed1i.<\/p>\n

\u0110i\u1ec1u tr\u1ecb thu\u1ed1c: S\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u1ec3 gi\u1ea3m s\u1ea3n xu\u1ea5t t\u1ebf b\u00e0o m\u00e1u, bao g\u1ed3m Hydroxyurea v\u00e0 Interferon. Thu\u1ed1c Hydroxyurea \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t \u0111\u1ec3 gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o \u0111\u1ecf trong c\u01a1 th\u1ec3. Interferon c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m t\u0103ng s\u1ea3n xu\u1ea5t t\u1ebf b\u00e0o m\u00e1u v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng gi\u1ea3m nguy c\u01a1 bi\u1ebfn ch\u1ee9ng.<\/p>\n

Thay m\u00e1u: Thay th\u1ebf ph\u1ea7n n\u00e0o ho\u1eb7c to\u00e0n b\u1ed9 l\u01b0\u1ee3ng m\u00e1u b\u1ec7nh nh\u00e2n b\u1eb1ng m\u00e1u c\u1ee7a ng\u01b0\u1eddi kh\u00e1c \u0111\u1ec3 gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o m\u00e1u trong c\u01a1 th\u1ec3.<\/p>\n

6. K\u1ebft lu\u1eadn<\/h2>\n

B\u1ec7nh \u0111a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t Polycythemia vera (PV) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd hi\u1ebfm g\u1eb7p, \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u0103ng s\u1ea3n xu\u1ea5t t\u1ebf b\u00e0o m\u00e1u \u0111\u1ed3ng th\u1eddi v\u1edbi gi\u1ea3m ho\u1eb7c kh\u00f4ng c\u00f3 s\u1ef1 k\u00edch th\u00edch c\u1ee7a EPO. \u0110\u00e2y l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd c\u00f3 nguy c\u01a1 cao g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0 huy\u1ebft kh\u1ed1i, \u0111\u1ed9t qu\u1ef5 v\u00e0 ung th\u01b0.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u0110a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t (Polycythemia vera \u2013 PV) l\u00e0 m\u1ed9t r\u1ed1i lo\u1ea1n t\u0103ng sinh t\u1ee7y m\u1ea1n t\u00ednh. B\u1ec7nh \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 gia t\u0103ng qu\u00e1 m\u1ee9c s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u, th\u01b0\u1eddng k\u00e8m theo t\u0103ng s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u, ti\u1ec3u c\u1ea7u v\u00e0 l\u00e1ch to. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh bi\u1ec3u […]<\/p>\n","protected":false},"author":70,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[6,33],"tags":[3],"yoast_head":"\nT\u1ed5ng quan v\u1ec1 b\u1ec7nh \u0111a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd mi\u1ec5n d\u1ecbch \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 s\u1ea3n xu\u1ea5t qu\u00e1 m\u1ee9c c\u00e1c t\u1ebf b\u00e0o m\u00e1u, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"T\u1ed5ng quan v\u1ec1 b\u1ec7nh \u0111a h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t - 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