{"id":24449,"date":"2023-04-21T11:00:28","date_gmt":"2023-04-21T04:00:28","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24449"},"modified":"2023-04-21T12:35:39","modified_gmt":"2023-04-21T05:35:39","slug":"thang-diem-meld-va-cac-bien-the","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/thang-diem-meld-va-cac-bien-the\/","title":{"rendered":"\u0110i\u1ec3m MELD v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3 trong ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n x\u01a1 gan"},"content":{"rendered":"<p><strong>X\u01a1 gan l\u00e0 m\u1ed9t b\u1ec7nh gan m\u1ea1n t\u00ednh \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 ph\u00e1 h\u1ee7y ti\u1ebfn tri\u1ec3n c\u1ee7a t\u1ebf b\u00e0o gan v\u00e0 thay th\u1ebf ch\u00fang b\u1eb1ng m\u00f4 s\u1eb9o. Di\u1ec5n ti\u1ebfn c\u1ee7a b\u1ec7nh l\u00fd x\u01a1 gan r\u1ea5t \u0111a d\u1ea1ng, qua nhi\u1ec1u giai \u0111o\u1ea1n v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a m\u1ed7i giai \u0111o\u1ea1n c\u0169ng r\u1ea5t kh\u00e1c nhau. Thang \u0111i\u1ec3m MELD v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3 l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu \u00edch gi\u00fap l\u01b0\u1ee3ng gi\u00e1 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh nh\u00e2n x\u01a1 gan, gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb v\u00e0 ch\u0103m s\u00f3c ph\u00f9 h\u1ee3p.<\/strong><\/p>\n<h2>1. C\u00e1c giai \u0111o\u1ea1n c\u1ee7a x\u01a1 gan<\/h2>\n<p>X\u01a1 gan l\u00e0 k\u1ebft c\u1ee5c chung c\u1ee7a r\u1ea5t nhi\u1ec1u b\u1ec7nh gan m\u1ea1n t\u00ednh kh\u00e1c nhau, \u0111\u1eb7c tr\u01b0ng v\u1ec1 m\u00f4 b\u1ec7nh h\u1ecdc c\u1ee7a x\u01a1 gan l\u00e0 s\u1ef1 thay th\u1ebf c\u1ea5u tr\u00fac nhu m\u00f4 gan b\u00ecnh th\u01b0\u1eddng b\u1eb1ng m\u00f4 s\u1ee3i. S\u1ef1 h\u00f3a s\u1ee3i n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u00edch th\u00edch t\u1eeb nhi\u1ec1u y\u1ebfu t\u1ed1 kh\u00e1c nhau v\u00e0 c\u00f3 s\u1ef1 tham gia c\u1ee7a r\u1ea5t nhi\u1ec1u lo\u1ea1i t\u1ebf b\u00e0o \u1edf nhu m\u00f4 gan<\/p>\n<p>Di\u1ec5n ti\u1ebfn c\u1ee7a x\u01a1 gan th\u00f4ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c chia l\u00e0m hai giai \u0111o\u1ea1n ch\u00ednh l\u00e0 x\u01a1 gan c\u00f2n b\u00f9 v\u00e0 x\u01a1 gan m\u1ea5t b\u00f9. X\u01a1 gan \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 m\u1ea5t b\u00f9 khi c\u00f3 s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u00e1c bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u \u1edf c\u00e1c v\u1ecb tr\u00ed gi\u00e3n c\u1ee7a t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n, b\u00e1ng b\u1ee5ng, b\u1ec7nh n\u00e3o gan hay ung th\u01b0 t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 gan. V\u1ec1 ph\u01b0\u01a1ng di\u1ec7n l\u00e2m s\u00e0ng, c\u00f3 th\u1ec3 chia x\u01a1 gan th\u00e0nh 04 giai \u0111o\u1ea1n:<\/p>\n<ul>\n<li>Giai \u0111o\u1ea1n 1: x\u01a1 gan nh\u01b0ng ch\u01b0a c\u00f3 xu\u1ea5t hi\u1ec7n c\u1ee7a b\u00e1ng b\u1ee5ng v\u00e0 gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n.<\/li>\n<li>Giai \u0111o\u1ea1n 2: x\u01a1 gan v\u1edbi s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a c\u00e1c gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n nh\u01b0ng kh\u00f4ng ch\u1ea3y m\u00e1u, kh\u00f4ng c\u00f3 b\u00e1ng b\u1ee5ng<\/li>\n<li>Giai \u0111o\u1ea1n 3: x\u01a1 gan c\u00f3 b\u1ee5ng b\u00e1ng, c\u00f3 th\u1ec3 k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m theo c\u00e1c gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n.<\/li>\n<li>Giai \u0111o\u1ea1n 4: x\u01a1 gan c\u00f3 ch\u00e1y m\u00e1u t\u1ea1i c\u00e1c v\u1ecb tr\u00ed gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 b\u00e1ng b\u1ee5ng<\/li>\n<\/ul>\n<p>Theo h\u1ec7 th\u1ed1ng ph\u00e2n giai \u0111o\u1ea1n n\u00e0y, giai \u0111o\u1ea1n 1 v\u00e0 2 t\u01b0\u01a1ng \u1ee9ng v\u1edbi x\u01a1 gan c\u00f2n b\u00f9; giai \u0111o\u1ea1n 3 v\u00e0 4 t\u01b0\u01a1ng \u1ee9ng v\u1edbi x\u01a1 gan m\u1ea5t b\u00f9.<\/p>\n<figure style=\"width: 397px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"r48jcc pT0Scc iPVvYb\" src=\"https:\/\/cdn.memorial.com.tr\/files\/Uploads\/1\/37\/karacigernakliminjpg_8458.jpg\" alt=\"Thang-diem-MELD\" width=\"397\" height=\"265\" \/><figcaption class=\"wp-caption-text\">Thang \u0111i\u1ec3m MELD v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng nhi\u1ec1u trong gh\u00e9p gan<\/figcaption><\/figure>\n<h2>2. Ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n x\u01a1 gan<\/h2>\n<p>Nguy\u00ean nh\u00e2n g\u00e2y ch\u1ebft \u1edf c\u00e1c b\u1ec7nh nh\u00e2n x\u01a1 gan m\u1ea5t b\u00f9 th\u01b0\u1eddng ch\u00ednh l\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng n\u1eb7ng c\u1ee7a b\u1ec7nh l\u00fd x\u01a1 gan v\u00e0 suy c\u00e1c c\u01a1 quan kh\u00e1c ngo\u00e0i gan. C\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan \u0111\u1ebfn t\u0103ng \u00e1p l\u1ef1c h\u1ec7 t\u0129nh m\u1ea1ch c\u1eeda, ung th\u01b0 t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 gan (hepatocellular carcinoma &#8211; HCC) hay nhi\u1ec5m tr\u00f9ng l\u00e0 c\u00e1c nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u.<\/p>\n<p>Ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh nh\u00e2n x\u01a1 gan kh\u00f4ng ch\u1ec9 ph\u1ee5 th\u1ee5 thu\u1ed9c c\u00e1c giai \u0111o\u1ea1n c\u1ee7a b\u1ec7nh m\u00e0 c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc. M\u1ed9t s\u1ed1 thang \u0111i\u1ec3m d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n x\u01a1 gan nh\u01b0 Child-Turcotte-Pugh (hay th\u01b0\u1eddng g\u1ecdi l\u00e0 Child-Pugh), MELD, \u0111\u1ecbnh l\u01b0\u1ee3ng y\u1ebfu t\u1ed1 von Willebrand, \u0111o ch\u00eanh \u00e1p t\u0129nh m\u1ea1ch gan c\u0169ng c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng. \u0110i\u1ec3m MELD v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3 c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n x\u01a1 gan. Nh\u00ecn chung gi\u00e1 tr\u1ecb c\u1ee7a \u0111i\u1ec3m MELD v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3 kh\u00f4ng c\u00f3 nhi\u1ec1u kh\u00e1c bi\u1ec7t.<\/p>\n<h2>3. Thang \u0111i\u1ec3m MELD v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3<\/h2>\n<p>Thang \u0111i\u1ec3m M\u00f4 h\u00ecnh b\u1ec7nh gan giai \u0111o\u1ea1n cu\u1ed1i (Model for End-stage Liver Disease &#8211; MELD) \u00a0\u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 c\u1ee7a b\u1ec7nh gan m\u1ea1n t\u00ednh d\u1ef1a tr\u00ean c\u00e1c gi\u00e1 tr\u1ecb c\u1eadn l\u00e2m s\u00e0ng g\u1ed3m bilirubin, creatinine huy\u1ebft th\u01b0\u01a1ng v\u00e0 t\u1ef7 s\u1ed1 INR \u0111\u1ec3 \u0111o\u00e1n kh\u1ea3 n\u0103m s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n trong giai \u0111o\u1ea1n 3 th\u00e1ng sau th\u1ee7 thu\u1eadt t\u1ea1o \u0111\u01b0\u1eddng th\u00f4ng c\u1eeda ch\u1ee7 trong gian qua t\u0129nh m\u1ea1ch c\u1ea3nh trong (<i>Transjugular intrahepatic portosystemic shunt &#8211; TIPS). <\/i>\u0110i\u1ec3m MELD c\u00e0ng cao t\u01b0\u01a1ng \u1ee9ng v\u1edbi kh\u1ea3 n\u0103ng t\u1eed vong trong v\u00f2ng 3 th\u00e1ng c\u1ee7a b\u1ec7nh nh\u00e2n b\u1ec7nh gan m\u1ea1n c\u00e0ng cao. T\u1ea1i Hoa K\u1ef3, \u0111i\u1ec3m MELD \u0111\u01b0\u1ee3c t\u1ed5 ch\u1ee9c chuy\u00ean v\u1ec1 gh\u00e9p t\u1ea1ng duy nh\u1ea5t l\u00e0 Network for Organ Sharing (UNOS) s\u1eed d\u1ee5ng \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 \u01b0u ti\u00ean c\u1ee7a b\u1ec7nh nh\u00e2n ch\u1edd \u0111\u1ee3i gh\u00e9p gan<\/p>\n<p>Nh\u1eefng m\u00f4 h\u00ecnh \u0111\u1ea7u ti\u00ean c\u1ee7a MELD bao g\u1ed3m c\u1ea3 c\u00e1c nguy\u00ean nh\u00e2n c\u1ee7a b\u1ec7nh gan nh\u01b0 l\u00e0 t\u1eafc m\u1eadt, do r\u01b0\u1ee3u ho\u1eb7c kh\u00f4ng do r\u01b0\u1ee3u. Sau \u0111\u00f3, c\u00e1c y\u1ebfu t\u1ed1 nguy\u00ean nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u01b0a ra kh\u1ecfi m\u00f4 h\u00ecnh c\u1ee7a MELD \u0111\u1ec3 ph\u00e1t tri\u1ec3n th\u00e0nh c\u00f4ng c\u1ee5 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 c\u1ee7a c\u00e1c b\u1ec7nh gan m\u1ea1n n\u00f3i chung b\u1ea5t k\u1ec3 nguy\u00ean nh\u00e2n.<\/p>\n<h3>3.1. C\u00e1ch t\u00ednh thang \u0111i\u1ec3m MELD<\/h3>\n<p>C\u00f3 nhi\u1ec1u c\u00f4ng c\u1ee5 gi\u00fap t\u00ednh \u0111i\u1ec3m theo m\u00f4 h\u00ecnh MELD. C\u00e1ch t\u00ednh \u0111i\u1ec3m MELD nguy\u00ean b\u1ea3n \u0111\u01b0\u1ee3c h\u1ec7 th\u1ed1ng UNOS ch\u1ea5p thu\u1eadn v\u00e0o n\u0103m 2002 \u0111\u1ec3 s\u1eed d\u1ee5ng \u0111\u00e1nh g\u00eda m\u1ee9c \u0111\u1ed9 \u01b0u ti\u00ean c\u1ee7a b\u1ec7nh nh\u00e2n ch\u1edd gh\u00e9p gan:<\/p>\n<div class=\"page\" title=\"Page 2\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>MELD = 3.8*ln(bilirubin huy\u1ebft t\u01b0\u01a1ng [mg\/dL]) + 11.2*ln(INR) + 9.6*ln(creatinine huy\u1ebft t\u01b0\u01a1ng [mg\/dL]) + 6.4<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>Khi s\u1eed d\u1ee5ng c\u00f4ng th\u1ee9c n\u00e0y, h\u1ec7 th\u1ed1ng UNOS y\u00eau c\u1ea7u s\u1eed d\u1ee5ng gi\u00e1 tr\u1ecb l\u00e0 1 cho t\u1ea5t c\u1ea3 c\u00e1c gi\u00e1 tr\u1ecb d\u01b0\u1edbi 1 \u0111\u1ec3 tr\u00e1nh sai s\u1ed1. Khi c\u00e1c gi\u00e1 tr\u1ecb tr\u00ean \u0111\u1ec1u c\u00f3 gi\u00e1 tr\u1ecb &lt;1 th\u00ec \u0111i\u1ec3m MELD t\u1ed1i thi\u1ec3u l\u00e0 6. Ngo\u00e0i ra, UNOS ch\u1ecdn ng\u01b0\u1ee1ng tr\u00ean cho MELD l\u00e0 40 \u0111i\u1ec3m.<\/p>\n<p>\u0110\u1ec3 tr\u00e1nh s\u1ef1 kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u trong tr\u01b0\u1eddng h\u1ee3p c\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb suy th\u1eadn khi s\u1eed d\u1ee5ng MELD \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh gan m\u1ea1n, gi\u00e1 tr\u1ecb t\u1ed1i \u0111a c\u1ee7a MELD \u0111\u01b0\u1ee3c ch\u1ecdn l\u00e0 4mg\/dL. N\u1ebfu b\u1ec7nh nh\u00e2n \u0111ang \u0111\u01b0\u1ee3c l\u1ecdc th\u1eadn t\u1ed1i thi\u1ec3u 2 l\u1ea7n m\u1ed7i tu\u1ea7n ho\u1eb7c th\u1ea9m ph\u00e2n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c trong 24h trong tu\u1ea7n qua; gi\u00e1 tr\u1ecb creatinine \u0111\u01b0\u1ee3c d\u00f9ng l\u00e0 4 mg\/dL.<\/p>\n<h3>3.2. C\u00e1ch t\u00ednh thang \u0111i\u1ec3m MELD-Na<\/h3>\n<p>H\u1ea1 natri m\u00e1u c\u0169ng l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng hay g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n suy gan. Nhi\u1ec1u b\u1eb1ng ch\u1ee9ng cho th\u1ea5y m\u1ee9c \u0111\u1ed9 h\u1ea1 natri m\u00e1u c\u0169ng l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u th\u1ec3 hi\u1ec7n m\u1ee9c \u0111\u1ed9 c\u1ee7a b\u1ec7nh l\u00fd x\u01a1 gan. N\u0103m 2016, thang \u0111i\u1ec3m MELD \u0111\u01b0\u1ee3c b\u1ed5 sung th\u00eam gi\u00e1 tr\u1ecb natri m\u00e1u, bi\u1ebfn th\u1ec3 c\u1ee7a than MELD n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 thang \u0111i\u1ec3m MELD-Na. Thang \u0111i\u1ec3m MELD-Na c\u0169ng \u0111\u01b0\u1ee3c UNOS ch\u1ea5p thu\u1eadn \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 \u01b0u ti\u00ean c\u1ee7a b\u1ec7nh nh\u00e2n ch\u1edd gh\u00e9p gan. \u0110i\u1ec3m MELD-Na \u0111\u01b0\u1ee3c t\u00ednh nh\u01b0 sau:<\/p>\n<div class=\"page\" title=\"Page 3\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>MELD-Na = MELD + 1.32 * (137-Na) &#8211; [0.033*MELD * (137-Na)]<\/p>\n<p>Khi t\u00ednh to\u00e1n b\u1eb1ng thang MELD-Na, n\u1ed3ng \u0111\u1ed9 Na m\u00e1u d\u01b0\u1edbi 125mmol\/L th\u00ec ch\u1ecdn gi\u00e1 tr\u1ecb 125, c\u00f2n gi\u00e1 tr\u1ecb cao h\u01a1n 137 mmol\/L th\u00ec ch\u1ecdn 137. Thang \u0111i\u1ec3m MELD-Na gi\u00fap ti\u00ean l\u01b0\u1ee3ng ch\u00ednh x\u00e1c h\u01a1n \u1edf b\u1ec7nh nh\u00e2n c\u00f3 h\u1ea1 natri m\u00e1u. H\u1ea1n ch\u1ebf c\u1ee7a thang \u0111i\u1ec3m MELD-Na so v\u1edbi thang \u0111i\u1ec3m nguy\u00ean b\u1ea3n l\u00e0 n\u00f3 b\u1ecb \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u b\u1edfi c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 c\u00e1c lo\u1ea1i d\u1ecbch truy\u1ec1n t\u0129nh m\u1ea1ch.<\/p>\n<h3>3.3 Thang \u0111i\u1ec3m MELD 3.0<\/h3>\n<p>M\u1ed9t bi\u1ebfn th\u1ec3 c\u1ee7a thang \u0111i\u1ec3m MELD n\u1eefa l\u00e0 MELD 3.0 b\u1ed5 sung th\u00eam creatinine m\u00e1u, albumin va gi\u1edbi t\u00ednh c\u1ee7a b\u1ec7nh nh\u00e2n. MELD 3.0 \u0111\u01b0\u1ee3c t\u00ednh nh\u01b0 sau:<\/p>\n<p><strong>MELD 3.0\u00a0<\/strong>= 1.33*(Female) + 4.56*ln(Bilirubin) + 0.82*(137 &#8211; Na+) \u2013 0.24*(137 &#8211; Na+)*ln(Bilirubin) + 9.09*ln(INR) + 11.14*ln(Creatinine) + 1.85*(3.5 \u2013 Albumin) \u2013 1.83*(3.5 \u2013 Albumin)*ln(Creatinine) + 6<\/p>\n<p>Vai tr\u00f2 c\u1ee7a \u0111i\u1ec3m MELD v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3 nh\u00ecn chung l\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng.<\/p>\n<p>C\u00e1c b\u00e0i vi\u1ebft v\u1ec1 sinh b\u1ec7nh h\u1ecdc, c\u00e1c giai \u0111o\u1ea1n v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh l\u00fd x\u01a1 gan c\u00f3 tr\u00ean chuy\u00ean trang <a href=\"https:\/\/vinmecdr.com\">https:\/\/vinmecdr.com\/<\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>X\u01a1 gan l\u00e0 m\u1ed9t b\u1ec7nh gan m\u1ea1n t\u00ednh \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 ph\u00e1 h\u1ee7y ti\u1ebfn tri\u1ec3n c\u1ee7a t\u1ebf b\u00e0o gan v\u00e0 thay th\u1ebf ch\u00fang b\u1eb1ng m\u00f4 s\u1eb9o. Di\u1ec5n ti\u1ebfn c\u1ee7a b\u1ec7nh l\u00fd x\u01a1 gan r\u1ea5t \u0111a d\u1ea1ng, qua nhi\u1ec1u giai \u0111o\u1ea1n v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a m\u1ed7i giai \u0111o\u1ea1n c\u0169ng r\u1ea5t kh\u00e1c nhau. Thang \u0111i\u1ec3m [&hellip;]<\/p>\n","protected":false},"author":37,"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 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>\u0110i\u1ec3m MELD v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3 trong ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n x\u01a1 gan<\/title>\n<meta name=\"description\" content=\"Thang \u0111i\u1ec3m MELD v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3 l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu \u00edch gi\u00fap l\u01b0\u1ee3ng gi\u00e1 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh nh\u00e2n x\u01a1 gan, gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.\" \/>\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\" 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