{"id":23838,"date":"2023-04-18T01:44:05","date_gmt":"2023-04-17T18:44:05","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=23838"},"modified":"2023-04-18T10:56:56","modified_gmt":"2023-04-18T03:56:56","slug":"cac-tieu-chuan-chan-doan-benh-da-u-tuy-xuong-kahler","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/cac-tieu-chuan-chan-doan-benh-da-u-tuy-xuong-kahler\/","title":{"rendered":"C\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n b\u1ec7nh \u0111a u t\u1ee7y x\u01b0\u01a1ng (Kahler)"},"content":{"rendered":"

B\u1ec7nh \u0111a u t\u1ee7y x\u01b0\u01a1ng l\u00e0 m\u1ed9t b\u1ec7nh ung th\u01b0 m\u00e1u ph\u1ed5 bi\u1ebfn v\u00e0 nguy hi\u1ec3m, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u1ec7 th\u1ed1ng t\u1ee7y x\u01b0\u01a1ng v\u00e0 g\u00e2y ra nhi\u1ec1u bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng kh\u00e1c nhau. \u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh c\u1ea7n k\u1ebft h\u1ee3p nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c nhau. Ti\u1ebfn tri\u1ec3n v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1.<\/strong><\/p>\n

1. \u0110\u1ecbnh ngh\u0129a b\u1ec7nh \u0111a u t\u1ee7y x\u01b0\u01a1ng<\/h2>\n

\u0110a u t\u1ee7y x\u01b0\u01a1ng l\u00e0 m\u1ed9t lo\u1ea1i ung th\u01b0 nguy hi\u1ec3m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u1ee7y x\u01b0\u01a1ng – n\u01a1i s\u1ea3n xu\u1ea5t c\u00e1c t\u1ebf b\u00e0o m\u00e1u. B\u1ec7nh n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 “\u0111a u” v\u00ec n\u00f3 g\u00e2y ra s\u1ef1 ph\u00e1t tri\u1ec3n b\u1ea5t th\u01b0\u1eddng c\u1ee7a nhi\u1ec1u u kh\u00e1c nhau trong t\u1ee7y x\u01b0\u01a1ng. \u0110\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 m\u00e1u ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn s\u1ee9c kh\u1ecfe v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

\"hinh-anh-benh-da-u-tuy-xuong\"
H\u00ecnh \u1ea3nh b\u1ec7nh \u0111a u t\u1ee7y x\u01b0\u01a1ng<\/figcaption><\/figure>\n

2. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh b\u1ec7nh \u0111a u t\u1ee7y x\u01b0\u01a1ng<\/h2>\n

2.1. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n theo IMWG 2014<\/h3>\n

Hi\u1ec7n nay b\u1ec7nh \u0111a u t\u1ee7y x\u01b0\u01a1ng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng theo Hi\u1ec7p h\u1ed9i Nghi\u00ean c\u1ee9u \u0110a u t\u1ee7y x\u01b0\u01a1ng qu\u1ed1c t\u1ebf – IMWG 2014.<\/p>\n

Ti\u00eau chu\u1ea9n n\u00e0y g\u1ed3m c\u00f3<\/p>\n

a) T\u1ef7 l\u1ec7 t\u1ebf b\u00e0o t\u01b0\u01a1ng b\u00e0o trong t\u1ee7y x\u01b0\u01a1ng \u2265 10% ho\u1eb7c tr\u00ean m\u1ea3nh sinh thi\u1ebft m\u00f4 b\u1ec7nh h\u1ecdc ch\u1ea9n \u0111o\u00e1n u t\u01b0\u01a1ng b\u00e0o v\u00e0<\/p>\n

b) T\u1ed5n th\u01b0\u01a1ng c\u00e1c c\u01a1 quan kh\u00e1c trong c\u01a1 th\u1ec3 (\u22651 c\u01a1 quan)(CRAB):<\/p>\n

[C] : T\u0103ng canxi m\u00e1u (Calci >11 mg\/L ho\u1eb7c >2,75mmol\/L).<\/p>\n

[R] : Suy th\u1eadn (creatinine >2 mg\/100ml ho\u1eb7c >177 \u00b5mol\/L).<\/p>\n

[A] : Thi\u1ebfu m\u00e1u (Hb <100 g\/L ho\u1eb7c >< gi\u1edbi h\u1ea1n th\u1ea5p 2g\/L).<\/p>\n

[B] : T\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng ho\u1eb7c lo\u00e3ng x\u01b0\u01a1ng \u1edf 1 ho\u1eb7c nhi\u1ec1u v\u1ecb tr\u00ed \u2265 5 mm v\u1ec1 k\u00edch th\u01b0\u1edbc tr\u00ean ch\u1ee5p X.Quang, MRI, CT, ho\u1eb7c PET \/ CT.<\/p>\n

c) Ho\u1eb7c c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a \u00edt nh\u1ea5t m\u1ed9t biomarker li\u00ean quan \u0111\u1ebfn s\u1ef1 ti\u1ebfn tri\u1ec3n kh\u00f4ng th\u1ec3 tr\u00e1nh kh\u1ecfi \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch:<\/p>\n

– \u2265 60% t\u1ebf b\u00e0o t\u01b0\u01a1ng b\u00e0o trong t\u1ee7y x\u01b0\u01a1ng.<\/p>\n

– T\u1ef7 l\u1ec7 th\u00e0nh ph\u1ea7n chu\u1ed7i nh\u1eb9 \u2265 100 ho\u1eb7c \u2264 0,01.<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng tr\u00ean phim ch\u1ee5p MRI c\u00f3 nhi\u1ec1u h\u01a1n m\u1ed9t t\u1ed5n th\u01b0\u01a1ng tr\u1ecdng t\u00e2m (bao g\u1ed3m x\u01b0\u01a1ng ho\u1eb7c t\u1ee7y x\u01b0\u01a1ng).<\/p>\n

– C\u00e1c bi\u1ec3u hi\u1ec7n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan kh\u00f4ng ph\u1ea3i l\u00e0 CRAB (v\u00ed d\u1ee5, t\u0103ng t\u00ednh l\u01b0u th\u00f4ng, nhi\u1ec5m khu\u1ea9n t\u00e1i ph\u00e1t, b\u1ec7nh amyloidosis, b\u1ec7nh l\u00fd th\u1ea7n kinh ngo\u1ea1i bi\u00ean\u2026) kh\u00f4ng \u0111\u1eb7c hi\u1ec7u v\u00e0 kh\u00f4ng d\u00f9ng l\u00e0m ti\u00eau ch\u1ea9n ch\u1ea9n \u0111o\u00e1n \u0110UTX.<\/p>\n

2.2.Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n c\u1ee7a Bart-Barlogie 1995<\/h3>\n

2.2.1. Ti\u00eau chu\u1ea9n ch\u00ednh<\/h4>\n

\u2013 C\u00f3 u t\u01b0\u01a1ng b\u00e0o tr\u00ean sinh thi\u1ebft tu\u1ef7 ho\u1eb7c \u1edf m\u1ed9t t\u1ed5 ch\u1ee9c.<\/p>\n

\u2013 C\u00e1c t\u1ebf b\u00e0o thu\u1ed9c d\u00f2ng t\u01b0\u01a1ng b\u00e0o > 30% trong tu\u1ef7.<\/p>\n

\u2013 Protein M t\u0103ng trong m\u00e1u ho\u1eb7c n\u01b0\u1edbc ti\u1ec3u<\/p>\n

+ IgG > 3,5g\/dl ho\u1eb7c<\/p>\n

+ IgA > 2 g\/dl ho\u1eb7c<\/p>\n

+ chu\u1ed7i nh\u1eb9 > 1g\/ 24h trong n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

2.2.2. Ti\u00eau chu\u1ea9n ph\u1ee5<\/h4>\n

\u2013 C\u00e1c t\u1ebf b\u00e0o thu\u1ed9c d\u00f2ng t\u01b0\u01a1ng b\u00e0o 10- 30% trong tu\u1ef7<\/p>\n

\u2013 Protein M t\u0103ng d\u01b0\u1edbi m\u1ee9c tr\u00ean<\/p>\n

\u2013 T\u1ed5n th\u01b0\u01a1ng ti\u00eau x\u01b0\u01a1ng tr\u00ean phim Xquang<\/p>\n

\u2013 Gi\u1ea3m Ig b\u00ecnh th\u01b0\u1eddng trong m\u00e1u: IgM < 0,05g\/dl ho\u1eb7c IgA < 0,1g\/dl ho\u1eb7c IgG < 0,6g\/dl<\/p>\n

Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh khi c\u00f3 \u00edt nh\u1ea5t 1 ti\u00eau chu\u1ea9n ch\u00ednh + 1 ti\u00eau chu\u1ea9n ph\u1ee5 ho\u1eb7c c\u00f3 \u00edt nh\u1ea5t 3 ti\u00eau chu\u1ea9n ph\u1ee5 (ph\u1ea3i c\u00f3 2 ti\u00eau chu\u1ea9n ph\u1ee5 \u0111\u1ea7u ti\u00ean).<\/p>\n

3. Ch\u1ea9n \u0111o\u00e1n giai \u0111o\u1ea1n b\u1ec7nh \u0111a u t\u1ee7y x\u01b0\u01a1ng<\/a><\/h2>\n

3.1. Theo ti\u00eau chu\u1ea9n Durie-Salmon<\/h3>\n

3.1.1. Giai \u0111o\u1ea1n I: g\u1ed3m c\u00e1c ti\u00eau chu\u1ea9n sau \u0111\u00e2y:<\/h4>\n
    \n
  1. Hemoglobin > 10g\/dl<\/li>\n
  2. H\u00e0m l\u01b0\u1ee3ng Calci huy\u1ebft b\u00ecnh th\u01b0\u1eddng ho\u1eb7c \u2264 12mg%<\/li>\n
  3. H\u00ecnh \u1ea3nh X-quang x\u01b0\u01a1ng b\u00ecnh th\u01b0\u1eddng ho\u1eb7c c\u00f3 u t\u01b0\u01a1ng b\u00e0o \u0111\u01a1n \u0111\u1ed9c.<\/li>\n
  4. T\u1ef7 l\u1ec7 protein M th\u1ea5p: IgG < 5g\/dl, IgA < 3g\/dl, th\u00e0nh ph\u1ea7n chu\u1ed7i nh\u1eb9 protein M (Protein Bence-Jones) ni\u1ec7u < 4g\/24gi\u1edd<\/li>\n<\/ol>\n

    3.1.2. Giai \u0111o\u1ea1n II: c\u00f3 \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c ti\u00eau chu\u1ea9n sau \u0111\u00e2y:<\/h4>\n
      \n
    1. Hemoglobin 8.5 – 10g\/dl<\/li>\n
    2. H\u00e0m l\u01b0\u1ee3ng Calci huy\u1ebft b\u00ecnh th\u01b0\u1eddng ho\u1eb7c < 12mg%<\/li>\n
    3. M\u1ed9t t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng.<\/li>\n
    4. T\u1ef7 l\u1ec7 protein M cao: IgG 5-7 g\/dl, IgA 3-5 g\/dl, th\u00e0nh ph\u1ea7n chu\u1ed7i nh\u1eb9 protein M (Protein Bence-Jones) ni\u1ec7u 4-12 g\/24gi\u1edd<\/li>\n<\/ol>\n

      3.1.3. Giai \u0111o\u1ea1n III: c\u00f3 \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c ti\u00eau chu\u1ea9n sau \u0111\u00e2y:<\/h4>\n
        \n
      1. Hemoglobin d\u01b0\u1edbi 8,5g\/dl<\/li>\n
      2. H\u00e0m l\u01b0\u1ee3ng Calci huy\u1ebft t\u0103ng >12mg\/dl<\/li>\n
      3. X-quang x\u01b0\u01a1ng c\u00f3 nhi\u1ec1u \u1ed5 ti\u00eau x\u01b0\u01a1ng.<\/li>\n
      4. T\u1ef7 l\u1ec7 protein M cao: IgG > 7g\/dl, IgA tr> 5g\/dl, th\u00e0nh ph\u1ea7n chu\u1ed7i nh\u1eb9 protein M (Protein Bence-Jones) ni\u1ec7u > 12g\/24gi\u1edd.<\/li>\n<\/ol>\n

        Hai nh\u00f3m ph\u1ee5 cho t\u1ea5t c\u1ea3 giai \u0111o\u1ea1n:<\/p>\n

          \n
        1. Creatinin huy\u1ebft < 2,0 mg\/dl<\/li>\n
        2. Creatinin huy\u1ebft \u2265 2,0 mg\/dl<\/li>\n<\/ol>\n

          3.2. Theo h\u1ec7 th\u1ed1ng ph\u00e2n lo\u1ea1i qu\u1ed1c t\u1ebf ISS (International Staging System)<\/h3>\n

          3.2.1. Giai \u0111o\u1ea1n I:<\/h4>\n

          \u03b22 micoglobulin < 3,5 mG\/L<\/p>\n

          Albumin \u2265 3,5 g\/dl<\/p>\n

          3.2.2. Giai \u0111o\u1ea1n II:<\/h4>\n

          \u03b22 micoglobulin < 3,5 mG\/L v\u00e0 Albumin < 3,5 g\/dl, ho\u1eb7c:<\/p>\n

          \u03b22 micoglobulin 3,5 – 5,5 mG\/L v\u00e0 n\u1ed3ng \u0111\u1ed9 Albumin b\u1ea5t k\u1ef3.<\/p>\n

          3.2.3. Giai \u0111o\u1ea1n III:<\/h4>\n

          \u03b22 micoglobulin \u2265 5,5 mG\/L<\/p>\n

          4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t b\u1ec7nh \u0111a u t\u1ee7y x\u01b0\u01a1ng v\u1edbi b\u1ec7nh kh\u00e1c<\/h2>\n

          Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t b\u1ec7nh \u0111a u t\u1ee7y x\u01b0\u01a1ng l\u00e0 qu\u00e1 tr\u00ecnh quan tr\u1ecdng \u0111\u1ec3 \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u00e0 \u0111\u00fang \u0111\u1eafn. C\u00e1c b\u1ec7nh l\u00fd kh\u00e1c c\u00f3 tri\u1ec7u ch\u1ee9ng t\u01b0\u01a1ng t\u1ef1 v\u1edbi \u0111a u t\u1ee7y x\u01b0\u01a1ng, bao g\u1ed3m b\u1ec7nh Waldenstrom macroglobulinemia, b\u1ec7nh amyloidosis, b\u1ec7nh Castleman, v\u00e0 b\u1ec7nh Paget.<\/p>\n

          \u0110\u1ec3 ph\u00e2n bi\u1ec7t \u0111a u t\u1ee7y x\u01b0\u01a1ng v\u1edbi c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c, c\u00e1c b\u00e1c s\u0129 c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c nhau, bao g\u1ed3m c\u00e1c x\u00e9t nghi\u1ec7m huy\u1ebft thanh v\u00e0 x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh.<\/p>\n

          X\u00e9t nghi\u1ec7m huy\u1ebft thanh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n bi\u1ec7t \u0111a u t\u1ee7y x\u01b0\u01a1ng v\u1edbi b\u1ec7nh Waldenstrom macroglobulinemia. Khi b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh Waldenstrom macroglobulinemia, huy\u1ebft thanh s\u1ebd c\u00f3 s\u1ef1 t\u0103ng c\u1ee7a protein M, trong khi \u0111\u00f3, \u0111a u t\u1ee7y x\u01b0\u01a1ng th\u01b0\u1eddng kh\u00f4ng c\u00f3 s\u1ef1 t\u0103ng \u0111\u00e1ng k\u1ec3 c\u1ee7a protein M trong huy\u1ebft thanh.<\/p>\n

          X\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh, bao g\u1ed3m ch\u1ee5p X-quang, si\u00eau \u00e2m, CT scan, v\u00e0 MRI, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n bi\u1ec7t \u0111a u t\u1ee7y x\u01b0\u01a1ng v\u1edbi b\u1ec7nh amyloidosis, b\u1ec7nh Castleman, v\u00e0 b\u1ec7nh Paget. M\u1ed7i b\u1ec7nh l\u00fd c\u00f3 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh ri\u00eang bi\u1ec7t, t\u1eeb \u0111\u00f3 gi\u00fap b\u00e1c s\u0129 ph\u00e2n bi\u1ec7t ch\u00fang v\u1edbi \u0111a u t\u1ee7y x\u01b0\u01a1ng.<\/p>\n

          Ngo\u00e0i ra, kh\u1ea3o s\u00e1t t\u1ee7y x\u01b0\u01a1ng l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p quan tr\u1ecdng \u0111\u1ec3 ph\u00e2n bi\u1ec7t \u0111a u t\u1ee7y x\u01b0\u01a1ng v\u1edbi c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c. Vi\u1ec7c x\u00e1c \u0111\u1ecbnh s\u1ef1 t\u0103ng s\u1ea3n xu\u1ea5t t\u1ebf b\u00e0o u trong t\u1ee7y x\u01b0\u01a1ng c\u00f3 th\u1ec3 gi\u00fap ph\u00e2n bi\u1ec7t \u0111a u t\u1ee7y x\u01b0\u01a1ng v\u1edbi b\u1ec7nh Waldenstrom macroglobulinemia v\u00e0 b\u1ec7nh Castleman.<\/p>\n","protected":false},"excerpt":{"rendered":"

          B\u1ec7nh \u0111a u t\u1ee7y x\u01b0\u01a1ng l\u00e0 m\u1ed9t b\u1ec7nh ung th\u01b0 m\u00e1u ph\u1ed5 bi\u1ebfn v\u00e0 nguy hi\u1ec3m, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u1ec7 th\u1ed1ng t\u1ee7y x\u01b0\u01a1ng v\u00e0 g\u00e2y ra nhi\u1ec1u bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng kh\u00e1c nhau. \u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh c\u1ea7n k\u1ebft h\u1ee3p nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c nhau. Ti\u1ebfn tri\u1ec3n v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh […]<\/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":"\nC\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n b\u1ec7nh \u0111a u t\u1ee7y x\u01b0\u01a1ng (Kahler)<\/title>\n<meta name=\"description\" content=\"Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t \u0111a u t\u1ee7y x\u01b0\u01a1ng l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh ph\u1ee9c t\u1ea1p v\u00e0 ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1 v\u00e0 ti\u00eau chu\u1ea9n kh\u00e1c nhau\" \/>\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=\"C\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n 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