{"id":24634,"date":"2023-04-21T11:56:48","date_gmt":"2023-04-21T04:56:48","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24634"},"modified":"2023-04-21T12:06:23","modified_gmt":"2023-04-21T05:06:23","slug":"ung-dung-diem-meld-trong-benh-ly-gan-man","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/ung-dung-diem-meld-trong-benh-ly-gan-man\/","title":{"rendered":"\u1ee8ng d\u1ee5ng c\u1ee7a \u0111i\u1ec3m MELD trong c\u00e1c b\u1ec7nh l\u00fd gan m\u1ea1n"},"content":{"rendered":"<p><strong>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 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 m\u1eafc b\u1ec7nh gan m\u1ea1n, gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb v\u00e0 ch\u0103m s\u00f3c ph\u00f9 h\u1ee3p. \u1ee8ng d\u1ee5ng \u0111i\u1ec3m MELD \u00a0ch\u1ee7 y\u1ebfu l\u00e0 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 c\u1ea7n thi\u1ebft c\u1ee7a gh\u00e9p gan v\u00e0 nguy c\u01a1 c\u1ee7a m\u1ed9t s\u1ed1 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb .<\/strong><\/p>\n<h2>1. C\u00e1ch t\u00ednh thang \u0111i\u1ec3m MELD<\/h2>\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 \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 c\u00f3 c\u00f4ng th\u1ee9c nh\u01b0 sau:<\/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*loge(bilirubin huy\u1ebft t\u01b0\u01a1ng [mg\/dL]) + 11.2*loge(INR) + 9.6*loge(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 \u0111\u1ed3ng m\u1eafc 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 ch\u1ecdn l\u00e0 4 mg\/dL.<\/p>\n<h2>2. \u1ee8ng d\u1ee5ng c\u1ee7a thang \u0111i\u1ec3m MELD<\/h2>\n<p>Vai tr\u00f2 ph\u1ed5 bi\u1ebfn c\u1ee7a thang \u0111i\u1ec3m MELD \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 \u01b0u ti\u00ean trong c\u00e1c b\u1ec7nh nh\u00e2n b\u1ec7nh gan m\u1ea1n ch\u1edd \u0111\u1ee3i gh\u00e9p gan, ch\u1ea5p thu\u1eadn b\u1edfi United Network for Organ Sharing (UNOS) &#8211; h\u1ec7 th\u1ed1ng duy nh\u1ea5t t\u1ea1i Hoa K\u1ef3 chuy\u00ean v\u1ec1 l\u0129nh vi\u1ec7c hi\u1ebfn t\u1eb7ng v\u00e0 nh\u1eadn t\u1ea1ng. Ngo\u00e0i ra, trong khu\u00f4n kh\u1ed5 c\u1ee7a b\u1ec7nh l\u00fd gan m\u1ea1n, \u0111i\u1ec3m MELD c\u0169ng gi\u00fap ti\u00ean l\u01b0\u1ee3ng t\u1eed su\u1ea5t c\u1ee7a b\u1ec7nh nh\u00e2n sau ph\u1eabu 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)\u00a0<\/i>v\u00e0 m\u1ed9t s\u1ed1 \u1ee9ng d\u1ee5ng kh\u00e1c.<\/p>\n<h3>2.1. \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 \u01b0u ti\u00ean trong gh\u00e9p t\u1ea1ng<\/h3>\n<p>Gh\u00e9p gan \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc trong c\u1ea3 c\u00e1c b\u1ec7nh l\u00fd gan c\u1ea5p n\u1eb7ng v\u00e0 c\u00e1c b\u1ec7nh l\u00fd gan m\u1ea1n giai \u0111o\u1ea1n mu\u1ed9n. Trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00e1nh gi\u00e1 th\u1ee9 t\u1ef1 \u01b0u ti\u00ean nh\u1eadn gan trong \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh gan m\u1ea1n, UNOS ch\u1ea5p thu\u1eadn \u1ee9ng d\u1ee5ng \u0111i\u1ec3m MELD \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 th\u1ee9 t\u1ef1 \u01b0u ti\u00ean trong gh\u00e9p gan t\u1eeb n\u0103m 2002. Thang \u0111i\u1ec3m MELD-Na c\u0169ng \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn s\u1eed d\u1ee5ng v\u1edbi m\u1ee5c \u0111\u00edch t\u01b0\u01a1ng t\u1ef1 t\u1eeb n\u0103m 2016.<\/p>\n<p>C\u00e1c b\u1ec7nh nh\u00e2n n\u1eb1m trong danh s\u00e1ch gh\u00e9p gan c\u1ee7a UNOS \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 theo thang \u0111i\u1ec3m MELD \u0111\u1ecbnh k\u1ef3. C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m MELD cao h\u01a1n &#8211; c\u00f3 m\u1ee9c \u0111\u1ed9 b\u1ec7nh n\u1eb7ng h\u01a1n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 \u0111\u1ecbnh k\u1ef3 th\u01b0\u1eddng xuy\u00ean h\u01a1n. C\u00e1c b\u1ec7nh nh\u00e2n MELD cao h\u01a1n 25 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 m\u1ed7i 7 ng\u00e0y. \u0110i\u1ec3m MELD c\u00f3 th\u1ec3 bi\u1ebfn \u0111\u1ed9ng \u0111\u00f4i ch\u00fat do di\u1ec5n bi\u1ebfn c\u1ee7a c\u00e1c b\u1ec7nh l\u00fd gan m\u1ea1n, \u0111\u1eb7c bi\u1ec7t l\u00e0 x\u01a1 gan. \u0110i\u1ec3m n\u00e0y s\u1ebd th\u1ec3 hi\u1ec7n t\u1eed su\u1ea5t trong v\u00f2ng 3 th\u00e1ng c\u00e1c b\u1ec7nh nh\u00e2n gan m\u1ea1n, cho th\u1ea5y kh\u1ea3 n\u0103ng gh\u00e9p gan s\u1ebd c\u00f3 l\u1ee3i \u00edch c\u1ea3i thi\u1ec7n t\u1eed su\u1ea5t so v\u1edbi ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c bi\u1ec7n ph\u00e1p kh\u00e1c. C\u00e1c nghi\u00ean c\u1ee9u khi x\u00e2y d\u1ef1ng thang \u0111i\u1ec3m MELD cho th\u1ea5y, \u0111i\u1ec3m MELD c\u00e0ng cao th\u00ec b\u1ec7nh nh\u00e2n c\u00e0ng c\u00f3 nhi\u1ec1u l\u1ee3i \u00edch v\u1ec1 c\u1ea3i thi\u1ec7n t\u1eed su\u1ea5t n\u1ebfu gh\u00e9p gan.<\/p>\n<p>L\u01b0u \u00fd m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p m\u00e0 b\u1ec7nh l\u00fd gan n\u1ec1n m\u1ea1n c\u00f3 th\u1ec3 \u0111e d\u1ecda \u0111\u1ebfn s\u1ed1ng c\u00f2n c\u1ee7a b\u1ec7nh nh\u00e2n b\u1eb1ng nh\u1eefng c\u01a1 ch\u1ebf b\u00ean c\u1ea1nh l\u00e0m gi\u1ea3m ch\u1ee9c n\u0103ng gan. Nh\u01b0 v\u1eady, thang \u0111i\u1ec3m MELD c\u1ed5 \u0111i\u1ec3n s\u1ebd kh\u00f4ng ph\u00f9 h\u1ee3p \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 t\u1eed vong c\u1ee7a b\u1ec7nh nh\u00e2n trong m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd. M\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd m\u00e0 thang \u0111i\u1ec3m MELD c\u00f3 th\u1ec3 kh\u00f4ng ti\u00ean l\u01b0\u1ee3ng \u0111\u1ea7y \u0111\u1ee7 nguy c\u01a1 t\u1eed vong c\u1ee7a b\u1ec7nh nh\u00e2n:<\/p>\n<ul>\n<li>Ung th\u01b0 t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 gan (Hepatocellular carcinoma &#8211; HCC)<\/li>\n<li>X\u01a1 nang<\/li>\n<li>T\u0103ng oxalat ni\u1ec7u nguy\u00ean ph\u00e1t<\/li>\n<li>H\u1ed9i ch\u1ee9ng gan ph\u1ed5i<\/li>\n<li>Ung th\u01b0 bi\u1ec3u m\u00f4 \u0111\u01b0\u1eddng m\u1eadt<\/li>\n<li>Huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch gan\n<p><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-s\u01b0-dung-nhieu-trong-chi-dinh-ghep-gan\" width=\"397\" height=\"265\" \/><figcaption class=\"wp-caption-text\">\u0110i\u1ec3m MELD c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong l\u1ef1a ch\u1ecdn gh\u00e9p gan<\/figcaption><\/figure><\/li>\n<\/ul>\n<h3>2.2. C\u00e2n nh\u1eafc th\u1ee7 thu\u1eadt TIPS<\/h3>\n<p>Thang \u0111i\u1ec3m MELD \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n ban \u0111\u1ea7u \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n t\u1ec9 l\u1ec7 s\u1ed1ng c\u00f2n c\u1ee7a b\u1ec7nh nh\u00e2n sau th\u1ee7 thu\u1eadt \u0111\u1eb7t TIPS. K\u1ebft c\u1ee5c sau th\u1ee7 thu\u1eadt \u0111\u1eb7t TIPS t\u1ed1t h\u01a1n khi th\u1ef1c hi\u1ec7n tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m MELD nh\u1ecf h\u01a1n 14. Nh\u00ecn chung, tr\u00e1nh th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt TIPS \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m MELD cao h\u01a1n 24. C\u1ea7n c\u00e2n nh\u1eafc k\u1ef9 c\u00e0ng khi quy\u1ebft \u0111\u1ecbnh th\u1ef1c hi\u1ec7n TIPS \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m MELD t\u1eeb 15 \u0111\u1ebfn 24. Khi \u0111i\u1ec3m MELD tr\u00ean 24, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn l\u00e0 c\u00f3 ch\u1ec9 \u0111\u1ecbnh gh\u00e9p gan, n\u1ebfu c\u00f3 th\u1ec3 th\u00ec s\u1ebd tr\u00ec ho\u00e3n TIPS \u0111\u1ec3 ch\u1edd \u0111\u1ee3i gh\u00e9p gan.<\/p>\n<h3>2.3. Ti\u00ean l\u01b0\u1ee3ng vi\u00eam gan do r\u01b0\u1ee3u<\/h3>\n<p>C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y c\u0169ng cho th\u1ea5y kh\u1ea3 n\u0103ng ti\u00ean l\u01b0\u1ee3ng t\u1eed \u00a0su\u1ea5t \u1edf c\u00e1c b\u1ec7nh nh\u00e2n vi\u00eam gan li\u00ean quan \u0111\u1ebfn r\u01b0\u1ee3u trong kho\u1ea3ng th\u1eddi gian 90 ng\u00e0y. Trong \u0111\u00f3, m\u1ed9t s\u1ed1 d\u1eef li\u1ec7u c\u0169ng cho th\u1ea5y, \u0111i\u1ec3m MELD c\u00f3 gi\u00e1 tr\u1ecb nh\u1ea5t trong ti\u00ean l\u01b0\u1ee3ng c\u00e1c b\u1ec7nh nh\u00e2n trong b\u1ec7nh c\u1ea3nh tr\u00ean. \u0110i\u1ec3m MELD tr\u00ean 20 \u0111\u01b0\u1ee3c nh\u1eadn \u0111\u1ecbnh l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam gan li\u00ean quan \u0111\u1ebfn r\u01b0\u1ee3u m\u1ee9c \u0111\u1ed9 n\u1eb7ng v\u00e0 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb b\u1eb1ng glucocorticoids.<\/p>\n<h3>2.4. H\u1ed9i ch\u1ee9ng gan th\u1eadn<\/h3>\n<p>\u1ede c\u00e1c b\u1ec7nh nh\u00e2n nghi ng\u1edd hay c\u00f3 bi\u1ec3u hi\u1ec7n r\u00f5 r\u00e0ng c\u1ee7a h\u1ed9i ch\u1ee9ng gan th\u1eadn, \u0111i\u1ec3m MELD t\u1eeb 20 tr\u1edf l\u00ean cho th\u1ea5y ti\u00ean l\u01b0\u1ee3ng th\u1eddi gian s\u1ed1ng khi kh\u00f4ng gh\u00e9p gan th\u1ea5p h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m MELD th\u1ea5p h\u01a1n.<\/p>\n<h3>2.5. Ch\u1ea3y m\u00e1u \u1edf c\u00e1c v\u1ecb tr\u00ed gi\u00e3n t\u0129nh m\u1ea1ch<\/h3>\n<p>Nhi\u1ec1u nghi\u00ean c\u1ee9u cho th\u1ea5y gi\u00e1 tr\u1ecb li\u00ean l\u01b0\u1ee3ng c\u1ee7a MELD \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ea3y m\u00e1u c\u1ea5p t\u1eeb c\u00e1c v\u1ecb tr\u00ed gi\u00e3n t\u0129nh m\u1ea1ch do t\u0103ng \u00e1p c\u1eeda. \u0110i\u1ec3m MELD c\u00e0ng l\u1edbn th\u00ec nguy c\u01a1 t\u1eed vong c\u00e0ng cao. V\u00ed d\u1ee5, \u0111i\u1ec3m MELD tr\u00ean 19 th\u00ec b\u1ec7nh nh\u00e2n c\u00f3 ti\u00ean l\u01b0\u1ee3ng t\u1eed vong trong 6 tu\u1ea7n l\u00e0 20%.<\/p>\n<h3><strong>2.6. \u0110\u00e1nh gi\u00e1 nguy c\u01a1 t\u1eed vong do ph\u1eabu thu\u1eadt<\/strong><\/h3>\n<p>C\u00e1c b\u1ec7nh nh\u00e2n x\u01a1 gan c\u00f3 t\u1ec9 l\u1ec7 t\u1eed vong cao h\u01a1n \u1edf giai \u0111o\u1ea1n chu ph\u1eabu. \u0110i\u1ec3m MELD \u0111\u01b0\u1ee3c gi\u00e1 \u0111\u1ec3 ti\u00ean l\u01b0\u1ee3ng nguy c\u01a1 t\u1eed vong c\u1ee7a b\u1ec7nh nh\u00e2n x\u01a1 gan giai \u0111o\u1ea1n chu ph\u1eabu c\u1ee7a c\u00e1c ph\u1eabu thu\u1eadt l\u1edbn nh\u01b0 ph\u1eabu thu\u1eadt \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, ch\u1ec9nh h\u00ecnh v\u00e0 tim m\u1ea1ch.<\/p>\n<p>Ngo\u00e0i ra c\u00f2n m\u1ed9t s\u1ed1 phi\u00ean b\u1ea3n kh\u00e1c nhau c\u1ee7a thang \u0111i\u1ec3m MELD \u00a0nh\u01b0 MELD ph\u1ed1i h\u1ee3p, MELD d\u00e0nh cho Nhi khoa. 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","protected":false},"excerpt":{"rendered":"<p>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. 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mu\u1ed9n v\u00e0 l\u1ee3i \u00edch c\u1ee7a m\u1ed9t s\u1ed1 \u0111i\u1ec1u tr\u1ecb kh\u00e1c\" \/>\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=\"\u1ee8ng d\u1ee5ng c\u1ee7a \u0111i\u1ec3m MELD trong c\u00e1c b\u1ec7nh l\u00fd gan m\u1ea1n -\" \/>\n<meta property=\"og:description\" content=\"\u1ee8ng d\u1ee5ng c\u1ee7a \u0111i\u1ec3m MELD l\u00e0 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 \u01b0u ti\u00ean trong gh\u00e9p gan c\u1ee7a b\u1ec7nh nh\u00e2n b\u1ec7nh gan giai \u0111o\u1ea1n mu\u1ed9n v\u00e0 l\u1ee3i \u00edch c\u1ee7a m\u1ed9t s\u1ed1 \u0111i\u1ec1u tr\u1ecb kh\u00e1c\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/ung-dung-diem-meld-trong-benh-ly-gan-man\/\" \/>\n<meta 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