{"id":27556,"date":"2023-04-25T00:59:26","date_gmt":"2023-04-24T17:59:26","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27556"},"modified":"2023-04-29T19:10:04","modified_gmt":"2023-04-29T12:10:04","slug":"benh-crohn-cac-loai-thuoc-dieu-tri-benh-crohn","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/25\/benh-crohn-cac-loai-thuoc-dieu-tri-benh-crohn\/","title":{"rendered":"B\u1ec7nh Crohn: C\u00e1c lo\u1ea1i thu\u1ed1c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Crohn"},"content":{"rendered":"<p><strong>B\u1ec7nh Crohn c\u00f3 kh\u1edfi ph\u00e1t l\u00e2m s\u00e0ng r\u1ea5t \u0111a d\u1ea1ng, c\u00f3 th\u1ec3 g\u00e2y tri\u1ec7u ch\u1ee9ng \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00e0 \u1edf c\u00e1c c\u01a1 quan n\u1eb1m ngo\u00e0i \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. T\u00f9y theo \u0111\u00e1nh gi\u00e1 c\u1ee7a nh\u00e0 l\u00e2m s\u00e0ng v\u1ec1 m\u1ee9c \u0111\u1ed9 v\u00e0 d\u1ea1ng kh\u1edfi ph\u00e1t c\u1ee7a b\u1ec7nh, c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn nhi\u1ec1u lo\u1ea1i thu\u1ed1c kh\u00e1c nhau \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Crohn.<\/strong><\/p>\n<h2>1. C\u00e1c y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Crohn<\/h2>\n<p>B\u1ec7nh Crohn (Crohn&#8217;s Disease &#8211; CD), c\u00f9ng v\u1edbi vi\u00eam lo\u00e9t \u0111\u1ea1i tr\u00e0ng (ulcerative colitis), l\u00e0 hai lo\u1ea1i ch\u00ednh c\u1ee7a nh\u00f3m b\u1ec7nh ru\u1ed9t vi\u00eam <span style=\"font-weight: 400;\">(inflammatory bowel disease \u2013 IBD). \u00a0IBD l\u00e0 nh\u00f3m b\u1ec7nh l\u00fd vi\u00eam m\u1ea1n t\u00ednh c\u1ee7a \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, c\u00f3 c\u01a1 ch\u1ebf b\u1ec7nh sinh r\u1ea5t ph\u1ee9c t\u1ea1p, nguy\u00ean nh\u00e2n v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh r\u00f5 r\u00e0ng.<\/span><\/p>\n<p>B\u1ec7nh Crohn c\u00f3 kh\u1edfi ph\u00e1t r\u1ea5t \u0111a d\u1ea1ng v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng ch\u1ee7 \u0111\u1ea1o th\u1ec3 hi\u1ec7n t\u00ecnh tr\u1ea1ng vi\u00eam v\u00e0 t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Ngo\u00e0i ra b\u1ec7nh Crohn c\u00f2n th\u1ec3 hi\u1ec7n tri\u1ec7u ch\u1ee9ng \u1edf \u00a0c\u00e1c c\u01a1 quan ngo\u00e0i h\u1ec7 ti\u00eau h\u00f3a. Tri\u1ec7u ch\u1ee9ng th\u1ec3 hi\u1ec7n t\u00ecnh tr\u1ea1ng vi\u00eam v\u00e0 t\u1ed5n th\u01b0\u01a1ng ru\u1ed9t nh\u01b0: ti\u00eau ph\u00e2n l\u1ecfng, ch\u00e1n \u0103n, s\u1ee5t c\u00e2n, s\u1ed1t nh\u1eb9, h\u00ecnh th\u00e0nh l\u1ed7 r\u00f2, vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y, \u00e1p t\u01a1 mi\u1ec7ng, ch\u00edt h\u1eb9p th\u1ef1c qu\u1ea3n. Tri\u1ec7u ch\u1ee9ng c\u1ee7a CD ngo\u00e0i h\u1ec7 ti\u00eau h\u00f3a c\u00f3 th\u1ec3 g\u1eb7p nh\u01b0: vi\u00eam kh\u1edbp\/\u0111au kh\u1edbp, vi\u00eam m\u00e0ng b\u1ed3 \u0111\u00e0o, thi\u1ebfu m\u00e1u, s\u1ecfi th\u1eadn, h\u1ed3ng ban da d\u1ea1ng n\u1ed1t, vi\u00eam da m\u1ee7 ho\u1ea1i t\u1eed.<\/p>\n<p>Ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 cho m\u1ed7i b\u1ec7nh nh\u00e2n ph\u1ee5 thu\u1ed9c ch\u1ee7 y\u1ebfu v\u00e0o m\u1ee9c \u0111\u1ed9 b\u1ec7nh, h\u00ecnh th\u00e1i b\u1ec7nh v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 d\u1ef1 b\u00e1o nguy c\u01a1 c\u00e1c k\u1ebft c\u1ee5c x\u1ea5u c\u1ee7a b\u1ec7nh nh\u00e2n. \u0110\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 b\u1ec7nh, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00f4ng c\u1ee5 Ch\u1ec9 s\u1ed1 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a b\u1ec7nh Crohn (Crohn&#8217;s Disease Activity Index &#8211; CDAI). \u0110\u00e2y c\u0169ng l\u00e0 c\u00f4ng c\u1ee5 \u0111\u01b0\u1ee3c d\u00f9ng ph\u1ed5 bi\u1ebfn tr\u00ean to\u00e0n th\u1ebf gi\u1edbi v\u00e0 \u0111\u01b0\u1ee3c Hi\u1ec7p h\u1ed9i Ti\u00eau H\u00f3a Hoa K\u1ef3 (ACG) s\u1eed d\u1ee5ng trong khuy\u1ebfn c\u00e1o v\u1ec1 \u0111i\u1ec1u tr\u1ecb CD. V\u1ec1 \u0111\u00e1nh gi\u00e1 h\u00ecnh th\u00e1i c\u1ee7a b\u1ec7nh, th\u01b0\u1eddng d\u00f9ng thang ph\u00e2n lo\u1ea1i Montreal cho CD \u0111\u1ec3 \u0111\u00e1nh gi\u00e1. Thang ph\u00e2n lo\u1ea1i n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong khuy\u1ebfn c\u00e1o c\u1ee7a ACG trong \u0111i\u1ec1u tr\u1ecb CD. Ngo\u00e0i ra, ACG c\u0169ng gi\u1edbi thi\u1ec7u trong khuy\u1ebfn c\u00e1o c\u00e1c d\u1ea5u hi\u1ec7u gi\u00fap \u0111\u00e1nh gi\u00e1 c\u00e1c bi\u1ebfn ch\u1ee9ng n\u1eb7ng c\u1ee7a b\u1ec7nh \u00edt c\u00f3 nguy c\u01a1 s\u1ea3y ra:<\/p>\n<ul>\n<li>N\u1ed3ng \u0111\u1ed9 b\u00ecnh ho\u1eb7c t\u0103ng nh\u1eb9 c\u1ee7a CRP trong m\u00e1u (ho\u1eb7c calprotectin trong ph\u00e2n).<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng kh\u00f4ng lan qu\u00e1 r\u1ed9ng, kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng lo\u00e9t s\u00e2u tr\u00ean n\u1ed9i soi.<\/li>\n<li>Kh\u00f4ng c\u00f3 c\u00e1c bi\u1ebfn ch\u1ee9ng quanh h\u1eadu m\u00f4n, ho\u1eb7c c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u1edf ti\u00eau h\u00f3a tr\u00ean.<\/li>\n<\/ul>\n<p>C\u00e1c ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb c\u0169ng kh\u00e1c bi\u1ec7t ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb \u1edf m\u1ed7i giai \u0111o\u1ea1n kh\u00e1c nhau. Nh\u00ecn chung, c\u00e1c m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb CD bao g\u1ed3m: \u0111\u1ea1t \u0111\u01b0\u1ee3c lui b\u1ec7nh, duy tr\u00ec lui b\u1ec7nh v\u00e0 qu\u1ea3n l\u00fd c\u00e1c \u0111\u1ee3t t\u00e1i ph\u00e1t. V\u1edbi m\u1ed7i m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb kh\u00e1c nhau, c\u00e1c lo\u1ea1i thu\u1ed1c s\u1ebd \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh v\u00e0 ph\u1ed1i h\u1ee3p \u0111\u1ec3 c\u00f3 th\u1ec3 s\u1edbm \u0111\u1ea1t m\u1ee5c ti\u00eau v\u00e0 h\u1ea1n ch\u1ebf nh\u1eefng bi\u1ebfn ch\u1ee9ng n\u1eb7ng.<\/p>\n<p>Ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb c\u0169ng c\u00f3 th\u1ec3 s\u1ebd kh\u00e1c bi\u1ec7t t\u00f9y thu\u1ed9c v\u00e0o chi\u1ebfn l\u01b0\u1ee3c ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb c\u1ee7a m\u1ed7i chuy\u00ean gia. Nh\u00ecn chung, c\u00f3 hai chi\u1ebfn l\u01b0\u1ee3c ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb CD g\u1ecdi l\u00e0 l\u00ean b\u1eadc (step-up) v\u00e0 xu\u1ed1ng b\u1eadc (top-down). Trong chi\u1ebfn l\u01b0\u1ee3c l\u00ean b\u1eadc, nh\u00e0 \u0111i\u1ec1u tr\u1ecb \u00a0s\u1ebd b\u1eaft \u0111\u1ea7u v\u1edbi c\u00e1c thu\u1ed1c c\u00f3 ho\u1ea1t t\u00ednh th\u1ea5p h\u01a1n nh\u01b0ng \u00edt t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n, n\u1ebfu kh\u00f4ng \u0111\u1ea1t m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb th\u00e0nh chuy\u1ec3n d\u1ea7n sang c\u00e1c thu\u1ed1c c\u00f3 ho\u1ea1t t\u00ednh cao h\u01a1n. Trong chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng b\u1eadc, c\u00e1c nh\u00e0 \u0111i\u1ec1u tr\u1ecb \u00a0kh\u1edfi \u0111\u1ea7u s\u1edbm c\u00e1c thu\u1ed1c c\u00f3 ho\u1ea1t t\u00ednh cao \u0111\u1ec3 nhanh ch\u00f3ng \u0111\u1ea1t \u0111\u01b0\u1ee3c lui b\u1ec7nh, sau \u0111\u00f3 \u0111i\u1ec1u ch\u1ec9nh \u0111\u1ec3 duy tr\u00ec lui b\u1ec7nh &#8211; chi\u1ebfn l\u01b0\u1ee3c n\u00e0y ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n m\u1ee9c \u0111\u1ed9 n\u1eb7ng, nhi\u1ec1u nguy c\u01a1.<\/p>\n<p>Ngo\u00e0i ra c\u00f2n m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n CD: gi\u00e1 c\u1ea3 \u0111i\u1ec1u tr\u1ecb, s\u1ef1 s\u1eb5n c\u00f3 c\u1ee7a c\u00e1c lo\u1ea1i thu\u1ed1c, ti\u1ec1n s\u1eed c\u1ee7a m\u1ed7i b\u1ec7nh nh\u00e2n&#8230;.<\/p>\n<p>B\u00e0i vi\u1ebft chi ti\u1ebft v\u1ec1 c\u00e1ch \u0111\u00e1nh gi\u00e1 CD theo CDAI v\u00e0 ph\u00e2n lo\u1ea1i Montreal \u0111\u00e3 c\u00f3 tr\u00ean chuy\u00ean trang <a href=\"http:\/\/vinmecdr.com\">VinmecDr<\/a>.<\/p>\n<figure style=\"width: 528px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"r48jcc pT0Scc iPVvYb\" src=\"https:\/\/drvitamin.vn\/wp-content\/uploads\/2022\/09\/thuoc-dieu-tri-benh-crohn-moi-nhat-hien-nay-0.jpg\" alt=\"Minh-hoa-thuoc-dieu-tri-benh-Crohn\" width=\"528\" height=\"396\" aria-hidden=\"false\" \/><figcaption class=\"wp-caption-text\">C\u00f3 nhi\u1ec1u lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c d\u00f9ng trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Crohn<\/figcaption><\/figure>\n<h2>2. C\u00e1c thu\u1ed1c d\u00f9ng \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Crohn<\/h2>\n<p>Nh\u01b0 \u0111\u00e3 \u0111\u1ec1 c\u1eadp \u1edf tr\u00ean, ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 b\u1ec7nh Crohn c\u00f3 th\u1ec3 thay \u0111\u1ed5i d\u1ef1a v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1. C\u00f3 nhi\u1ec1u thu\u1ed1c kh\u00e1c nhau \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Crohn &#8211; theo tham kh\u1ea3o c\u1ee7a khuy\u1ebfn c\u00e0o t\u1eeb ACG c\u00f4ng b\u1ed1 n\u0103m 2018:<\/p>\n<ul>\n<li><strong>Budesonide<\/strong>: d\u1ea1ng gi\u1ea3i ph\u00f3ng c\u00f3 ki\u1ec3m so\u00e1t c\u1ee7a budesonie \u0111\u01b0\u1ee3c d\u00f9ng qua \u0111\u01b0\u1eddng u\u1ed1ng l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay trong \u0111i\u1ec1u tr\u1ecb CD c\u00e1c m\u1ee9c \u0111\u1ed9, giai \u0111o\u1ea1n t\u1ea5n c\u00f4ng \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c lui b\u1ec7nh.<\/li>\n<li><strong>C\u00e1c lo\u1ea1i corticosteroids \u0111\u01b0\u1eddng to\u00e0n th\u00e2n:<\/strong> c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb UC \u0111\u1ed9 n\u1eb7ng, nhi\u1ec1u tri\u1ec7u ch\u1ee9ng, c\u00f3 th\u1ec3 d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch<\/li>\n<li><strong>Sulfasalazine<\/strong>: d\u01b0\u1ee3c ch\u1ea5t thu\u1ed9c nh\u00f3m (5-aminosalicylic acid &#8211; 5-ASA) c\u0169ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng CD m\u1ee9c \u0111\u1ed9 nh\u1eb9-trung b\u00ecnh.<\/li>\n<li><strong>Azathioprine:<\/strong> l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb CD m\u1ee9c \u0111\u1ed9 n\u1eb7ng trung b\u00ecnh, nguy c\u01a1 cao trong giai \u0111o\u1ea1n lui b\u1ec7nh<\/li>\n<li><strong>6-mercaptouprine:<\/strong> c\u0169ng \u0111\u01b0\u1ee3c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb CD m\u1ee9c \u0111\u1ed9 n\u1eb7ng trung b\u00ecnh, nguy c\u01a1 cao trong giai \u0111o\u1ea1n lui b\u1ec7nh<\/li>\n<li><strong>Methotrexate:<\/strong> c\u0169ng \u0111\u01b0\u1ee3c ph\u00e9p s\u1eed d\u1ee5ng \u0111i\u1ec1u t\u1ecb b\u1ec7nh CD m\u1ee9c \u0111\u1ed9 n\u1eb7ng-trung b\u00ecnh, nguy c\u01a1 cao \u0111\u1ec3 l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng b\u1ec7nh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ph\u1ee5 thu\u1ed9c corticosteroids v\u00e0 \u0111\u1ec3 duy tr\u00ec lui b\u1ec7nh.<\/li>\n<li><strong>C\u00e1c thu\u1ed1c c\u00f3 t\u00ednh \u0111\u1ed1i v\u1eadn y\u1ebfu t\u1ed1 ho\u1ea1i t\u1eed u (tumor necrosis factor &#8211; TNF) lo\u1ea1i alpha<\/strong>: (infliximab, adalimumab, certolizumab) \u00a0\u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb CD m\u1ee9c \u0111\u1ed9 n\u1eb7ng, kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi corticosteroids \u0111\u01b0\u1eddng u\u1ed1ng.<\/li>\n<li><strong>Kh\u00e1ng sinh:<\/strong> m\u1ed9t s\u1ed1 kh\u00e1ng sinh nh\u00f3m imidazoles c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan r\u00f2 quanh h\u1eadu m\u00f4n c\u1ee7a b\u1ec7nh CD. Tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ti\u00eau ch\u1ea3y do nhi\u1ec5m tr\u00f9ng, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng kh\u00e1ng sinh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb, th\u01b0\u1eddng d\u00f9ng metronidazole v\u00e0 ciprofloxacin.<\/li>\n<li><strong>C\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng ti\u00eau ch\u1ea3y:<\/strong> loperamide, cholestyramine c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 h\u1ea1n ch\u1ebf ti\u00eau ch\u1ea3y do UC.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>B\u1ec7nh Crohn c\u00f3 kh\u1edfi ph\u00e1t l\u00e2m s\u00e0ng r\u1ea5t \u0111a d\u1ea1ng, c\u00f3 th\u1ec3 g\u00e2y tri\u1ec7u ch\u1ee9ng \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00e0 \u1edf c\u00e1c c\u01a1 quan n\u1eb1m ngo\u00e0i \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. 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