{"id":25595,"date":"2023-04-20T19:40:12","date_gmt":"2023-04-20T12:40:12","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25595"},"modified":"2023-04-21T11:50:20","modified_gmt":"2023-04-21T04:50:20","slug":"viem-cau-than-hau-nhiem-lien-cau-trung","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/20\/viem-cau-than-hau-nhiem-lien-cau-trung\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam c\u1ea7u th\u1eadn h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u tr\u00f9ng"},"content":{"rendered":"

Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u tr\u00f9ng (VCTHNLCT) l\u00e0 do nhi\u1ec5m tr\u00f9ng tr\u01b0\u1edbc \u0111\u00f3 c\u00e1c ch\u1ee7ng h\u01b0\u1edbng th\u1eadn chuy\u00ean bi\u1ec7t c\u1ee7a li\u00ean c\u1ea7u tr\u00f9ng beta\u00a0 tan huy\u1ebft nh\u00f3m A<\/a>. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a VCTHNLCT thay \u0111\u1ed5i t\u1eeb ti\u1ec3u m\u00e1u vi th\u1ec3 kh\u00f4ng tri\u1ec7u ch\u1ee9ng t\u1edbi h\u1ed9i ch\u1ee9ng vi\u00eam th\u1eadn c\u1ea5p to\u00e0n ph\u00e1t, \u0111\u1eb7c tr\u01b0ng v\u1edbi ti\u1ec3u m\u00e0u n\u00e2u \u0111\u1ecf, ti\u1ec3u \u0111\u1ea1m (c\u00f3 th\u1ec3 \u0111\u1ea1t t\u1edbi ng\u01b0\u1ee1ng th\u1eadn h\u01b0), ph\u00f9, cao huy\u1ebft \u00e1p v\u00e0 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p.Ti\u00ean l\u01b0\u1ee3ng chung l\u00e0 t\u1ed1t, \u0111\u1eb7c bi\u1ec7t \u1edf tr\u1ebb em, nh\u01b0ng trong m\u1ed9t v\u00e0i tr\u01b0\u1eddng h\u1ee3p ti\u00ean l\u01b0\u1ee3ng l\u00e2u d\u00e0i kh\u00f4ng ph\u1ea3i l\u00e0nh t\u00ednh.<\/strong><\/p>\n

\"viem-cau-than-hau-nhiem-lien-cau-trung\"
Streptococcus pyogenes.<\/figcaption><\/figure>\n

1.B\u1ec7nh sinh vi\u00eam c\u1ea7u th\u1eadn h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u tr\u00f9ng:<\/strong><\/h2>\n

VCTHNLCT l\u00e0 b\u1ec7nh c\u1ea7u th\u1eadn do ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch \u0111\u01b0\u1ee3c g\u00e2y ra b\u1edfi ch\u1ee7ng h\u01b0\u1edbng th\u1eadn chuy\u00ean bi\u1ec7t c\u1ee7a li\u00ean c\u1ea7u beta tan huy\u1ebft nh\u00f3m A. C\u00e1c c\u01a1 ch\u1ebf \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb cho t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn mi\u1ec5n d\u1ecbch do nhi\u1ec5m li\u00ean c\u1ea7u nh\u00f3m A:<\/p>\n

-L\u1eafng \u0111\u1ecdng c\u00e1c ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch tu\u1ea7n ho\u00e0n v\u1edbi c\u00e1c th\u00e0nh ph\u1ea7n kh\u00e1ng nguy\u00ean li\u00ean c\u1ea7u.<\/p>\n

-S\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch t\u1ea1i ch\u1ed5 do s\u1ef1 l\u1eafng \u0111\u1ecdng c\u00e1c kh\u00e1ng nguy\u00ean li\u00ean c\u1ea7u b\u00ean trong m\u00e0ng \u0111\u00e1y c\u1ea7u th\u1eadn v\u00e0 s\u1ef1 g\u1eafn kh\u00e1ng th\u1ec3 sau \u0111\u00f3.<\/p>\n

-S\u1ef1 t\u1ea1o ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch c\u1ea7u th\u1eadn t\u1ea1i ch\u1ed5 \u0111\u01b0\u1ee3c th\u00fac \u0111\u1ea9y b\u1edfi c\u00e1c kh\u00e1ng th\u1ec3 \u0111\u1ed1i v\u1edbi kh\u00e1ng nguy\u00ean li\u00ean c\u1ea7u c\u00f3 ph\u1ea3n \u1ee9ng ch\u00e9o v\u1edbi c\u00e1c th\u00e0nh ph\u1ea7n c\u1ee7a c\u1ea7u th\u1eadn.<\/p>\n

-S\u1ef1 t\u00e1i ho\u1ea1t t\u1ef1 mi\u1ec5n<\/p>\n

C\u00e1c b\u1eb1ng ch\u1ee9ng c\u00f3 s\u1eb3n g\u1ee3i \u00fd c\u01a1 ch\u1ebf b\u1ec7nh sinh ch\u00ednh l\u00e0 s\u1ef1 t\u1ea1o ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch t\u1ea1i ch\u1ed5 do l\u1eafng \u0111\u1ecdng c\u00e1c kh\u00e1ng nguy\u00ean h\u01b0\u1edbng th\u1eadn c\u1ee7a li\u00ean c\u1ea7u.<\/p>\n

2. B\u1ec7nh h\u1ecdc:<\/strong><\/h2>\n

K\u00ednh hi\u1ec3n vi quang h\u1ecdc<\/em><\/strong>: vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh lan t\u1ecfa v\u1edbi t\u0103ng sinh \u01b0u th\u1ebf t\u1ebf b\u00e0o n\u1ed9i m\u1ea1ch v\u00e0 th\u1ea5m nh\u1eadp b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n. Nhu\u1ed9m trichrome c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c l\u1eafng \u0111\u1ecdng d\u1ea1ng b\u01b0\u1edbu nh\u1ecf d\u01b0\u1edbi t\u1ebf b\u00e0o th\u01b0\u1ee3ng b\u00ec. C\u00e1c sang th\u01b0\u01a1ng li\u1ec3m hi\u1ebfm g\u1eb7p v\u00e0 th\u01b0\u1eddng \u0111i k\u00e8m ti\u00ean l\u01b0\u1ee3ng x\u1ea5u. \u0110\u1ed9 n\u1eb7ng c\u1ee7a c\u00e1c t\u1ed5n th\u01b0\u01a1ng thay \u0111\u1ed5i v\u00e0 th\u01b0\u1eddng t\u01b0\u01a1ng quan v\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng.<\/p>\n

Mi\u1ec5n d\u1ecbch hu\u1ef3nh quang<\/em><\/strong>: d\u1ea1ng \u0111\u1eb7c tr\u01b0ng c\u1ee7a l\u1eafng \u0111\u1ecdng IgG v\u00e0 C3 ph\u00e2n b\u1ed1 d\u01b0\u1edbi d\u1ea1ng h\u1ea1t b\u00ean trong trung m\u00f4 v\u00e0 th\u00e0nh mao m\u1ea1ch c\u1ea7u th\u1eadn. C\u00e1c ch\u1ea5t ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch kh\u00e1c nh\u01b0 IgM, IgA, fibrin v\u00e0 c\u00e1c th\u00e0nh ph\u1ea7n b\u1ed5 th\u1ec3 kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n.<\/p>\n

K\u00ednh hi\u1ec3n vi \u0111i\u1ec7n t\u1eed<\/em><\/strong>: \u0111\u1eb7c t\u00ednh \u0111\u1eb7c tr\u01b0ng nh\u1ea5t \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n qua k\u00ednh hi\u1ec3n vi \u0111i\u1ec7n t\u1eed l\u00e0 l\u1eafng \u0111\u1ecdng \u0111\u1eb7c \u0111i\u1ec7n t\u1eed d\u01b0\u1edbi th\u01b0\u1ee3ng b\u00ec c\u00f3 d\u1ea1ng h\u00ecnh v\u00f2m. C\u00e1c l\u1eafng \u0111\u1ecdng n\u00e0y c\u00f9ng v\u1edbi c\u00e1c l\u1eafng \u0111\u1ecdng d\u01b0\u1edbi t\u1ebf b\u00e0o n\u1ed9i m\u1ea1ch l\u00e0 c\u00e1c ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch v\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi c\u00e1c l\u1eafng \u0111\u1ecdng c\u1ee7a IgG v\u00e0 C3 d\u01b0\u1edbi k\u00ednh hu\u1ef3nh quang.<\/p>\n

C\u00e1c l\u1eafng \u0111\u1ecdng mi\u1ec5n d\u1ecbch d\u01b0\u1edbi t\u1ebf b\u00e0o n\u1ed9i m\u1ea1ch v\u00e0 s\u1ef1 ho\u1ea1t h\u00f3a b\u1ed5 th\u1ec3 sau \u0111\u00f3 ch\u1ecbu tr\u00e1ch nhi\u1ec7m cho s\u1ef1 th\u1ea5m nh\u1eadp c\u00e1c t\u1ebf b\u00e0o vi\u00eam d\u1eabn \u0111\u1ebfn vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh,c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u ho\u1ea1t t\u00ednh v\u00e0 gi\u1ea3m \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn \u1edf c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau.<\/p>\n

C\u00e1c c\u1ee5c g\u00f9 d\u01b0\u1edbi th\u01b0\u1ee3ng b\u00ec ch\u1ecbu tr\u00e1ch nhi\u1ec7m cho t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o bi\u1ec3u b\u00ec v\u00e0 ti\u1ec3u \u0111\u1ea1m.<\/p>\n

Di\u1ec5n ti\u1ebfn l\u00e2m s\u00e0ng c\u1ee7a VCTHNLCT li\u00ean quan t\u1edbi t\u1ed1c \u0111\u1ed9 l\u00e0m s\u1ea1ch ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch kh\u00e1c nhau \u1edf 2 v\u1ecb tr\u00ed n\u00e0y.<\/p>\n

3. C\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng vi\u00eam c\u1ea7u th\u1eadn h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u tr\u00f9ng:<\/strong><\/h3>\n

3.1.Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng:<\/em><\/strong><\/p>\n

Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng thay \u0111\u1ed5i t\u1eeb ti\u1ec3u m\u00e1u vi th\u1ec3 kh\u00f4ng tri\u1ec7u ch\u1ee9ng t\u1edbi h\u1ed9i ch\u1ee9ng vi\u00eam th\u1eadn c\u1ea5p to\u00e0n ph\u00e1t, \u0111\u1eb7c tr\u01b0ng v\u1edbi ti\u1ec3u m\u00e0u n\u00e2u \u0111\u1ecf, ti\u1ec3u \u0111\u1ea1m (c\u00f3 th\u1ec3 \u0111\u1ea1t t\u1edbi ng\u01b0\u1ee1ng th\u1eadn h\u01b0), ph\u00f9, cao huy\u1ebft \u00e1p v\u00e0 t\u0103ng creatinin m\u00e1u. Ph\u1ea7n l\u1edbn tr\u1ebb kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, vi\u00eam c\u1ea7u th\u1eadn ti\u1ebfn tri\u1ec3n nhanh x\u1ea3y ra < 0,5% c\u00e1c tr\u01b0\u1eddng h\u1ee3p. Giai \u0111o\u1ea1n \u1ea9n gi\u1eeda nhi\u1ec5m li\u00ean c\u1ea7u v\u00e0 VCTHNLCT t\u00f9y thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed nhi\u1ec5m tr\u00f9ng:\u00a0 1 \u2013 3 tu\u1ea7n sau vi\u00eam h\u1ea7u h\u1ecdng v\u00e0 3 \u2013 6 tu\u1ea7n sau nhi\u1ec5m tr\u00f9ng da.<\/p>\n

Ph\u00f9: ph\u00f9 to\u00e0n th\u1ec3 hi\u1ec7n di\u1ec7n \u1ecf 2\/3 b\u1ec7nh nh\u00e2n do \u1ee9 mu\u1ed1i v\u00e0 n\u01b0\u1edbc. Qu\u00e1 t\u1ea3i d\u1ecbch c\u00f3 th\u1ec3 d\u1eabn t\u1edbi suy h\u00f4 h\u1ea5p do ph\u00f9 ph\u1ed5i.<\/p>\n

Ti\u1ec3u m\u00e1u \u0111\u1ea1i th\u1ec3: 30 \u2013 50% b\u1ec7nh nh\u00e2n. N\u01b0\u1edbc ti\u1ec3u m\u1edd, c\u00f3 m\u00e0u tr\u00e0 ho\u1eb7c coca.<\/p>\n

Cao huy\u1ebft \u00e1p: 50 \u2013 90% b\u1ec7nh nh\u00e2n v\u00e0 thay \u0111\u1ed5i t\u1eeb nh\u1eb9 \u0111\u1ebfn n\u1eb7ng. B\u00eanh n\u00e3o do cao huy\u1ebft \u00e1p l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng \u00edt g\u1eb7p nh\u01b0ng nghi\u00eam tr\u1ecdng.<\/p>\n

C\u00e1c tr\u01b0\u1eddng h\u1ee3p d\u01b0\u1edbi l\u00e2m s\u00e0ng ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi ti\u1ec3u m\u00e1u vi th\u1ec3.<\/p>\n

M\u1ed9t v\u00e0i b\u1ec7nh nh\u00e2n bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng li\u00ean quan t\u1edbi c\u01a1n cao huy\u1ebft \u00e1p ho\u1eb7c ph\u00f9 v\u1edbi c\u00e1c b\u1ea5t th\u01b0\u1eddng n\u01b0\u1edbc ti\u1ec3u nh\u1ecf.<\/p>\n

3.2.C\u00e1c d\u1ea5u hi\u1ec7n c\u1eadn l\u00e2m s\u00e0ng:<\/em><\/strong><\/p>\n

Ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u v\u00e0 ti\u1ebft \u0111\u1ea1m ni\u1ec7u: hi\u1ec7n di\u1ec7n h\u1ed3ng c\u1ea7u (m\u1ed9t v\u00e0i h\u1ed3ng c\u1ea7u b\u1ecb bi\u1ebfn d\u1ea1ng \u0111i\u1ec3n h\u00ecnh),tr\u1ee5 h\u1ed3ng c\u1ea7u, c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau c\u1ee7a \u0111\u1ea1m ni\u1ec7u v\u00e0 th\u01b0\u1eddng ti\u1ec3u b\u1ea1ch c\u1ea7u. Ti\u1ec3u \u0111\u1ea1m ng\u01b0\u1ee1ng th\u1eadn h\u01b0 (>1000mg\/m2\/ng\u00e0y ho\u1eb7c >40 mg\/m2\/gi\u1edd)l\u00e0 kh\u00f4ng th\u01b0\u1eddng g\u1eb7p, 5% c\u00e1c tr\u01b0\u1eddng h\u1ee3p v\u00e0o l\u00fac bi\u1ec3u hi\u1ec7n.<\/p>\n

Ch\u1ee9c n\u0103ng th\u1eadn: gi\u1ea3m \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1eb1ng t\u0103ng creatinin m\u00e1u. Suy th\u1eadn c\u1ea5p ph\u1ea3i l\u1ecdc th\u1eadn \u00edt x\u00e3y ra.<\/p>\n

B\u1ed5 th\u1ec3: 90% b\u1ec7nh nh\u00e2n c\u00f3 gi\u1ea3m C3 v\u00e0 CH50 trong 2 tu\u1ea7n \u0111\u1ea7u c\u1ee7a b\u1ec7nh v\u00e0 tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng sau 4 \u2013 8 tu\u1ea7n. C4 l\u00e0 b\u00ecnh th\u01b0\u1eddng v\u00e0 c\u00f3 th\u1ec3 th\u1ea5p \u1edf m\u1ed9t v\u00e0i b\u1ec7nh nh\u00e2n.<\/p>\n

B\u1eb1ng ch\u1ee9ng nhi\u1ec5m li\u00ean c\u1ea7u:<\/p>\n

C\u1ea5y ph\u1ebft h\u1ecdng ho\u1eb7c sang th\u01b0\u01a1ng da: ch\u1ec9 kho\u1ea3ng 25% b\u1ec7nh nh\u00e2n c\u1ea5y d\u01b0\u01a1ng t\u00ednh v\u00ec VCTHNLCT hi\u1ec7n di\u1ec7n v\u00e0i tu\u1ea7n sau nhi\u1ec5m li\u00ean c\u1ea7u nh\u00f3m A.<\/p>\n

Huy\u1ebft thanh h\u1ecdc: streptozyme (\u0111o 5 lo\u1ea1i kh\u00e1ng th\u1ec3 streptococcus kh\u00e1c nhau) d\u01b0\u01a1ng t\u00ednh > 95% c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam h\u1ea7u h\u1ecdng v\u00e0 80% c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng da. N\u1ebfu ch\u1ec9 d\u00f9ng ASO \u0111\u1ec3 t\u1ea7m so\u00e1t h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u, hi\u1ec7u gi\u00e1 kh\u00e1ng th\u1ec3 c\u00f3 th\u1ec3 th\u1ea5p ho\u1eb7c \u00e2m t\u00ednh gi\u1ea3 \u1edf c\u00e1c b\u1ec7nh nh\u00e2n nhi\u1ec5m tr\u00f9ng da. Ri\u00eang c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam h\u1ea7u h\u1ecdng do li\u00ean c\u1ea7u, ASO v\u1eabn l\u00e0 m\u1ed9t x\u00e9t nghi\u1ec7m h\u1eedu d\u1ee5ng.<\/p>\n

4. Ch\u1ea9n \u0111o\u00e1n vi\u00eam c\u1ea7u th\u1eadn h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u tr\u00f9ng:<\/strong><\/h2>\n

C\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng c\u1ee7a vi\u00eam th\u1eadn c\u1ea5p (ti\u1ec3u m\u00e1u \u00b1 tr\u1ee5 h\u1ed3ng c\u1ea7u, c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau c\u1ee7a ti\u1ec3u \u0111\u1ea1m, ph\u00f9, thi\u1ec3u ni\u1ec7u v\u00e0 cao huy\u1ebft \u00e1p) v\u00e0 b\u1eb1ng ch\u1ee9ng c\u1ee7a nhi\u1ec5m li\u00ean c\u1ea7u beta tan huy\u1ebft nh\u00f3m A g\u1ea7n \u0111\u00e2y ( c\u1ea5y ph\u1ebft h\u1ecdng \/da ho\u1eb7c c\u00e1c x\u00e9t nghi\u00eam huy\u1ebft thanh h\u1ecdc d\u01b0\u01a1ng t\u00ednh).<\/p>\n

M\u1eb7c d\u00f9 gi\u1ea3m C3 l\u00e0 ph\u00f9 h\u1ee3p v\u1edbi ch\u1ea9n \u0111o\u00e1n VCTHNLCT, gi\u1ea3m C3 c\u00f2n g\u1eb7p trong c\u00e1c b\u1ec7nh vi\u00eam c\u1ea7u th\u1eadn kh\u00e1c bao g\u1ed3m VCTTSM, vi\u00eam th\u1eadn do lupus.<\/p>\n

ST th\u1eadn kh\u00f4ng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n \u0111\u1ec3 kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n VCTHNLCT b\u1edfi v\u00ec b\u1ec7nh t\u1ef1 gi\u1ea3i quy\u1ebft trong v\u00f2ng 1 ho\u1eb7c 2 tu\u1ea7n t\u1eeb khi bi\u1ec3u hi\u1ec7n.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/em><\/strong><\/p>\n

Vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng: bi\u1ec3u hi\u1ec7n ban \u0111\u1ea7u c\u00f3 th\u1ec3 kh\u00f4ng ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c v\u1edbi VCTHNLCT. Tuy nhi\u00ean, b\u00eanh nh\u00e2n VCTTSM ti\u1ebfp t\u1ee5c c\u00f3 b\u1ea5t th\u01b0\u1eddng n\u01b0\u1edbc ti\u1ec3u k\u00e9o d\u00e0i v\u00e0 gi\u1ea3m b\u1ed5 th\u1ec3 sau 4 \u2013 6 tu\u1ea7n v\u00e0 c\u00f3 th\u1ec3 t\u0103ng th\u00eam creatinin m\u00e1u.<\/p>\n

B\u1ec7nh th\u1eadn IgA: c\u00e1c \u0111\u1eb7c t\u00ednh \u0111\u1ec3 ph\u00e2n bi\u1ec7t v\u1edbi VCTHNLCT g\u1ed3m kho\u1ea3ng th\u1eddi gian ng\u1eafn h\u1ee3n gi\u1eeda xu\u1ea5t hi\u1ec7n ti\u1ec3u m\u00e1u v\u00e0 nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p tr\u01b0\u1edbc \u0111\u00f3 (< 5 ng\u00e0y) v\u00e0 ti\u1ec1n s\u1eed ti\u1ec3u m\u00e1u \u0111\u1ea1i th\u1ec3 tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n

C\u00e1c nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t c\u1ee7a vi\u00eam c\u1ea7u th\u1eadn nh\u01b0 lupus, Henoch-schonlein, vi\u00eam c\u1ea7u th\u1eadn c\u00f3 li\u00ean quan t\u1edbi VGSV-B\u2026<\/p>\n

Vi\u00eam c\u1ea7u th\u1eadn h\u1eadu nhi\u1ec5m do c\u00e1c t\u00e1c nh\u00e2n vi sinh kh\u00e1c (si\u00eau vi v\u00e0 c\u00e1c vi tr\u00f9ng kh\u00e1c).<\/p>\n

5. \u0110i\u1ec1u tr\u1ecb trong giai \u0111o\u1ea1n c\u1ea5p:<\/strong><\/h2>\n

\u0110i\u1ec1u tr\u1ecb h\u1ed5 tr\u1ee3, t\u1eadp trung v\u00e0o \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh, c\u00e1c bi\u1ebfn ch\u1ee9ng do qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch: cao huy\u1ebft \u00e1p, ph\u00f9 ph\u1ed5i, b\u1ec7nh n\u00e3o do cao huy\u1ebft \u00e1p.<\/p>\n

H\u1ea1n ch\u1ebf mu\u1ed1i n\u01b0\u1edbc<\/p>\n

L\u1ee3i ti\u1ec3u quai: Furosemide TM, li\u1ec1u kh\u1edfi \u0111\u1ea7u 1 mg\/kg, c\u00f3 th\u1ec3 l\u1eadp l\u1ea1i 3 \u2013 4 l\u1ea7n\/ng\u00e0y.<\/p>\n

H\u1ea1 \u00e1p: l\u1ee3i ti\u1ec3u + \u1ee9c ch\u1ebf calci (Nifedipine, Nicardipine). \u1ee8c ch\u1ebf men chuy\u1ec3n n\u00ean s\u1eed d\u1ee5ng th\u1eadn tr\u1ecdng v\u00ec nguy c\u01a1 t\u0103ng Kali m\u00e1u.<\/p>\n

B\u1ec7nh nh\u00e2n suy th\u1eadn n\u1eb7ng c\u00f3 th\u1ec3 c\u1ea7n \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn c\u1ea5p. C\u1ea7n ST th\u1eadn th\u1eadn \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u1ec3 kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n VCTHNLCT. M\u1eb7c d\u00f9 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch t\u00edch c\u1ef1c c\u00f3 l\u1ee3i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ec7nh c\u1ea7u th\u1eadn li\u1ec1m ti\u1ebfn tri\u1ec3n nhanh, nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 > 30% sang th\u01b0\u01a1ng li\u1ec1m tr\u00ean ST th\u1eadn th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng methylprednisolon TM.<\/p>\n

B\u1ec7nh nh\u00e2n c\u00f3 b\u1eb1ng ch\u1ee9ng nhi\u1ec5m Streptococcus nh\u00f3m A t\u00e1i ph\u00e1t n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb 1 \u0111\u1ee3t kh\u00e1ng sinh.<\/p>\n

Di\u1ec5n ti\u1ebfn v\u00e0 theo d\u00f5i:<\/em><\/strong><\/p>\n

Gi\u1ea3i quy\u1ebft c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a VCTHNLCT t\u01b0\u01a1ng \u0111\u1ed1i nhanh: l\u1ee3i ti\u1ec3u b\u1eaft \u0111\u1ea7u trong 1 tu\u1ea7n v\u00e0 creatinine huy\u1ebft thanh quay tr\u1edf v\u1ec1 gi\u00e1 tr\u1ecb ban \u0111\u1ea7u trong 3- 4 tu\u1ea7n. Ti\u1ec3u m\u00e1u th\u01b0\u1eddng gi\u1ea3i quy\u1ebft trong 3- 6 th\u00e1ng. Ti\u1ec3u \u0111\u1ea1m c\u0169ng gi\u1ea3m trong giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c nh\u01b0ng v\u1edbi t\u1ed1c \u0111\u1ed9 ch\u1eadm h\u01a1n. T\u0103ng ti\u1ebft \u0111\u1ea1m nh\u1eb9 v\u1eabn c\u00f2n trong 15% v\u00e0o l\u00fac 3 n\u0103m, v\u00e0 2% v\u00e0o l\u00fac 7 \u2013 10 n\u0103m. Ti\u1ec3u \u0111\u1ea1m ng\u01b0\u1ee1ng th\u1eadn h\u01b0 (> 40mg\/m2\/gi\u1edd) c\u00f3 th\u1ec3 k\u00e9o d\u00e0i \u2265 6 th\u00e1ng, l\u00e2u h\u01a1n sau khi ti\u1ec3u m\u00e1u \u0111\u00e3 h\u1ebft. C\u00e1c giai \u0111o\u1ea1n t\u00e1i ph\u00e1t c\u1ee7a VCTHNLCT l\u00e0 hi\u1ebfm g\u1eb7p.<\/p>\n

Ch\u1ec9 \u0111\u1ecbnh sinh thi\u1ebft th\u1eadn: di\u1ec5n ti\u1ebfn c\u1ee7a b\u1ec7nh kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi di\u1ec5n ti\u1ebfn c\u1ee7a VCTHNLCT ho\u1eb7c kh\u00f4ng c\u00f3 b\u1ec7nh s\u1eed r\u1ecf r\u00e0ng c\u1ee7a nhi\u1ec5m streptococcus tr\u01b0\u1edbc \u0111\u00f3:<\/p>\n

Gi\u1ea3m C3 k\u00e9o d\u00e0i > 6 tu\u1ea7n<\/p>\n

C\u00e1c giai \u0111o\u1ea1n t\u00e1i ph\u00e1t c\u1ee7a ti\u1ec3u m\u00e1u<\/p>\n

T\u0103ng creatinin m\u00e1u k\u00e9o d\u00e0i ho\u1eb7c ti\u1ebfn tri\u1ec3n<\/p>\n

T\u01b0\u01a1ng quan v\u1edbi h\u1ed3i ph\u1ee5c v\u1ec1 m\u00f4 h\u1ecdc: Di\u1ec5n ti\u1ebfn m\u00f4 h\u1ecdc t\u01b0\u01a1ng quan v\u1edbi c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, gi\u1ea3m \u0111\u00e1ng k\u1ec3 s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o vi\u00eam trong c\u1ea7u th\u1eadn v\u00e0 s\u1ed1 l\u01b0\u1ee3ng l\u1eafng \u0111\u1ecdng mi\u1ec5n d\u1ecbch tr\u00ean k\u00ednh hi\u1ec3n vi \u0111i\u1ec7n t\u1eed khi c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng gi\u1ea3i quy\u1ebft. Gi\u1ea3i quy\u1ebft \u0111\u1ea1m ni\u1ec7u k\u00e9o d\u00e0i so v\u1edbi s\u1ef1 h\u1ed3i ph\u1ee5c nhanh h\u01a1n ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 ti\u1ec3u m\u00e1u c\u00f3 l\u1ebb ph\u1ea3n \u00e1nh t\u1ed1c \u0111\u1ed9 l\u00e0m s\u1ea1ch c\u00e1c ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch d\u01b0\u1edbi th\u01b0\u1ee3ng b\u00ec ch\u1eadm h\u1ee3n c\u00e1c ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch d\u01b0\u1edbi n\u1ed9i m\u00f4.<\/p>\n

6. Ti\u00ean l\u01b0\u1ee3ng:<\/em><\/strong><\/h2>\n

Ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n, \u0111\u1eb7c bi\u1ec7t tr\u1ebb em, c\u00f3 d\u1ef1 h\u1eadu t\u1ed1t, ngay c\u1ea3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n bi\u1ec3u hi\u1ec7n suy th\u1eadn c\u1ea5p v\u00e0 sang th\u01b0\u01a1ng li\u1ec1m tr\u00ean sinh thi\u1ebft th\u1eadn l\u00fac ban \u0111\u1ea7u. H\u1ed3i c\u1ee9u 229 tr\u1ebb VCTHNLCT ghi nh\u1eadn 20% c\u00f3 TPTNT b\u1ea5t th\u01b0\u1eddng (ti\u1ec3u \u0111\u1ea1m v\u00e0 \/ ho\u1eb7c ti\u1ec3u m\u00e1u) nh\u01b0ng h\u1ea7u nh\u01b0 t\u1ea5t c\u1ea3 (92 \u2013 99%) c\u00f3 ch\u1ee9c n\u0103ng th\u1eadn b\u00ecnh th\u01b0\u1eddng ho\u1eb7c ch\u1ec9 gi\u1ea3m nh\u1eb9 5 \u2013 18 n\u0103m sau bi\u1ec3u hi\u1ec7n. Tuy nhi\u00ean, ti\u00ean l\u01b0\u1ee3ng l\u00e2u d\u00e0i c\u1ee7a VCTHNLCT kh\u00f4ng ph\u1ea3i lu\u00f4n l\u00e0nh t\u00ednh. M\u1ed9t v\u00e0i b\u1ec7nh nh\u00e2n ph\u00e1t tri\u1ec3n cao huy\u1ebft \u00e1p, ti\u1ec3u \u0111\u1ea1m t\u00e1i ph\u00e1t (v\u1edbi c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u t\u01b0\u01a1ng \u0111\u1ed1i b\u00ecnh th\u01b0\u1eddng) v\u00e0 gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn 10 \u2013 40 n\u0103m sau bi\u1ec3u hi\u1ec7n b\u1ec7nh l\u00fac \u0111\u1ea7u. C\u00e1c bi\u1ebfn ch\u1ee9ng th\u1eadn tr\u1ec3 n\u00e0y \u0111i k\u00e8m v\u1edbi x\u01a1 h\u00f3a c\u1ea7u th\u1eadn tr\u00ean sinh thi\u1ebft th\u1eadn, \u0111\u01b0\u1ee3c ngh\u0129 l\u00e0 do huy\u1ebft \u0111\u1ed9ng (\u0111\u00e1p \u1ee9ng t\u0103ng l\u1ecdc b\u00f9 tr\u1eeb trong c\u00e1c c\u1ea7u th\u1eadn c\u00f2n l\u1ea1i l\u00e0m t\u0103ng \u00e1p l\u1ef1c v\u00e0 k\u00edch th\u01b0\u1edbc c\u1ea7u th\u1eadn g\u00f3p ph\u1ea7n v\u00e0o t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn kh\u00f4ng do mi\u1ec5n d\u1ecbch v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn ti\u1ebfn tri\u1ec3n).<\/p>\n

 <\/p>\n

Ngu\u1ed3n: ThsBS Nguy\u1ec5n \u0110\u1ee9c Quang<\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u tr\u00f9ng (VCTHNLCT) l\u00e0 do nhi\u1ec5m tr\u00f9ng tr\u01b0\u1edbc \u0111\u00f3 c\u00e1c ch\u1ee7ng h\u01b0\u1edbng th\u1eadn chuy\u00ean bi\u1ec7t c\u1ee7a li\u00ean c\u1ea7u tr\u00f9ng beta\u00a0 tan huy\u1ebft nh\u00f3m A. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a VCTHNLCT thay \u0111\u1ed5i t\u1eeb ti\u1ec3u m\u00e1u vi th\u1ec3 kh\u00f4ng tri\u1ec7u ch\u1ee9ng t\u1edbi h\u1ed9i ch\u1ee9ng vi\u00eam th\u1eadn c\u1ea5p to\u00e0n ph\u00e1t, […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15,33],"tags":[3],"yoast_head":"\nCh\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam c\u1ea7u th\u1eadn h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u tr\u00f9ng - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u tr\u00f9ng (VCTHNLCT) l\u00e0 do c\u00e1c ch\u1ee7ng h\u01b0\u1edbng th\u1eadn chuy\u00ean bi\u1ec7t c\u1ee7a li\u00ean c\u1ea7u tr\u00f9ng beta\u00a0 tan huy\u1ebft nh\u00f3m A.\" \/>\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=\"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam c\u1ea7u th\u1eadn h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u tr\u00f9ng - 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