{"id":28118,"date":"2023-04-27T15:39:26","date_gmt":"2023-04-27T08:39:26","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28118"},"modified":"2023-04-27T15:39:26","modified_gmt":"2023-04-27T08:39:26","slug":"viem-than-lupus","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/viem-than-lupus\/","title":{"rendered":"Kh\u00e1i qu\u00e1t v\u1ec1 vi\u00eam th\u1eadn lupus: \u0110\u1ecbnh ngh\u0129a, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Vi\u00eam th\u1eadn l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng ph\u1ed5 bi\u1ebfn c\u1ee7a b\u1ec7nh lupus, m\u1ed9t b\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n d\u1ecbch g\u00e2y ra s\u1ef1 t\u1ea5n c\u00f4ng c\u1ee7a h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch v\u00e0o c\u00e1c m\u00f4 v\u00e0 c\u01a1 quan trong c\u01a1 th\u1ec3, bao g\u1ed3m c\u1ea3 th\u1eadn. Khi h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch t\u1ea5n c\u00f4ng c\u00e1c m\u00f4 v\u00e0 c\u01a1 quan trong th\u1eadn, n\u00f3 c\u00f3 th\u1ec3 g\u00e2y ra vi\u00eam nhi\u1ec5m v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u00e1c c\u1ea5u tr\u00fac c\u1ee7a th\u1eadn, l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng th\u1eadn ho\u1ea1t \u0111\u1ed9ng.<\/strong><\/p>\n

1. \u0110<\/strong>\u1ecbnh ngh\u0129a<\/strong><\/h1>\n

Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng l\u00e0 m\u1ed9t b\u1ec7nh t\u1ef1 mi\u1ec5n \u0111i\u1ec3n h\u00ecnh. Bi\u1ec3u hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng th\u1eadn r\u1ea5t th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng m\u00e0 t\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu l\u00e0 \u1edf c\u1ea7u th\u1eadn. Vi\u00eam th\u1eadn lupus \u0111\u00e3 \u0111\u01b0\u1ee3c nhi\u1ec1u t\u00e1c gi\u1ea3 coi l\u00e0 m\u1ed9t m\u1eabu h\u00ecnh b\u1ec7nh l\u00fd ki\u1ec3u \u201cph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch\u201d \u0111\u00f3 l\u00e0 \u0111\u00e1p \u1ee9ng qu\u00e1 m\u1eabn t\u00edp III. Theo nhi\u1ec1u t\u00e1c gi\u1ea3 th\u00ec t\u1ef7 l\u1ec7 bi\u1ec3u hi\u1ec7n then \u1edf b\u1ec7nh nh\u00f5n Lupus giao \u0111\u1ed9ng t\u1eeb 60-75%.<\/p>\n

\"\"
Ngu\u1ed3n<\/strong>: Lupus Nephritis <\/em><\/figcaption><\/figure>\n

Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh th\u1eadn lupus ph\u1ea3i kh\u1eb3ng \u0111\u1ecbnh \u0111\u01b0\u1ee3c 2 y\u1ebfu t\u1ed1 sau:<\/em><\/strong><\/p>\n

\u0110\u1ee7 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng theo ti\u00eau chu\u1ea9n qu\u1ed1c t\u1ebf. (Xem b\u00e0i Lupus)<\/p>\n

C\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u1eadn \u0111\u01b0\u1ee3c bi\u1ec3u hi\u1ec7n b\u1eb1ng c\u00f3 protein ni\u1ec7u th\u01b0\u1eddng xuy\u00ean v\u00e0 \/ho\u1eb7c h\u1ed3ng c\u1ea7u, tr\u1ee5 h\u1ea1t m\u00e0 ch\u1ee7 y\u1ebfu l\u00e0 tr\u1ee5 h\u1ed3ng c\u1ea7u.<\/p>\n

Qua kinh nghi\u1ec7m l\u00e2m s\u00e0ng v\u00e0 sinh thi\u1ebft th\u1eadn, khoa th\u1eadn b\u1ec7nh vi\u1ec7n B\u1ea1ch Mai \u0111\u00e3 \u0111\u01b0a ra nh\u1eefng kinh nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n vi\u00eam th\u1eadn lupus nh\u01b0 sau:<\/p>\n

C\u00f3 bi\u1ec3u hi\u1ec7n vi\u00eam kh\u00f4ng \u0111\u1eb7c hi\u1ec7u:<\/p>\n

– S\u1ed1t k\u00e9o d\u00e0i kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n nhi\u1ec5m khu\u1ea9n, \u0111\u1eb7c bi\u1ec7t l\u00e0 lao.<\/p>\n

– T\u1ed1c \u0111\u1ed9 m\u00e1u l\u1eafng t\u0103ng, Gamaglobulin m\u00e1u t\u0103ng<\/p>\n

C\u00f3 4\/11 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng trong \u0111\u00f3 c\u00f3 1 ti\u00eau chu\u1ea9n v\u1ec1 mi\u1ec5n d\u1ecbch h\u1ecdc [ho\u1eb7c kh\u00e1ng th\u1ec3 kh\u00e1ng nh\u00e2n (+), ho\u1eb7c kh\u00e1ng th\u1ec3 kh\u00e1ng DNA (+), ho\u1eb7c t\u1ebf b\u00e0o LE (+)].<\/p>\n

Bi\u1ec3u hi\u1ec7n th\u1eadn: ph\u1ea3i c\u00f3 protein ni\u1ec7u d\u01b0\u01a1ng t\u00ednh 1(+) tr\u1edf l\u00ean ( >0,2 g\/24 h), c\u00f3 th\u1ec3 c\u00f3 k\u00e8m theo h\u1ed3ng c\u1ea7u ni\u1ec7u, tr\u1ee5 ni\u1ec7u.<\/p>\n

2. \u0110<\/strong>i\u1ec1u tr\u1ecb<\/strong><\/h2>\n

2.<\/strong>1. Nguy\u00ean t\u1eafc<\/strong><\/h3>\n

– Ch\u01b0a c\u00f3 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u. C\u00e1c thu\u1ed1c s\u1eed d\u1ee5ng ch\u1ee7 y\u1ebfu l\u00e0 \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh vi\u00eam ho\u1eb7c can thi\u1ec7p v\u00e0o ch\u1ee9c n\u0103ng mi\u1ec5n d\u1ecbch.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb c\u00e1c \u0111\u1ee3t k\u1ecbch ph\u00e1t xen k\u1ebd c\u00e1c \u0111\u1ee3t b\u1ec7nh \u1ed5n \u0111\u1ecbnh.<\/p>\n

– C\u00e2n nh\u1eafc gi\u1eefa t\u00e1c d\u1ee5ng ch\u00ednh v\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c.<\/p>\n

– N\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n, \u0111i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean ph\u00e2n lo\u1ea1i m\u00f4 b\u1ec7nh h\u1ecdc l\u00e0 t\u1ed1t nh\u1ea5t<\/p>\n

– \u0110i\u1ec1u tr\u1ecb c\u00e1c bi\u1ec3u hi\u1ec7n ngo\u00e0i th\u1eadn c\u1ee7a b\u1ec7nh Lupus<\/p>\n

2.<\/strong>2. M\u1ee5c ti\u00eau c\u1ee7a \u0111i\u1ec1u tr\u1ecb l\u00e0<\/strong><\/h3>\n

– Nhanh ch\u00f3ng ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng th\u1eadn<\/p>\n

– Tr\u00e1nh g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u00eam cho th\u1eadn<\/p>\n

– H\u1ea1n ch\u1ebf ti\u1ebfn tri\u1ec3n \u0111\u1ebfn suy th\u1eadn m\u1ea1n t\u00ednh<\/p>\n

– \u0110\u1ea1t \u0111\u01b0\u1ee3c 3 m\u1ee5c ti\u00eau tr\u00ean b\u1eb1ng c\u00e1c li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch v\u1edbi \u00edt \u0111\u1ed9c t\u00ednh nh\u1ea5t<\/p>\n

2.<\/strong>3. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 vi\u00eam th\u1eadn lupus<\/strong><\/h3>\n

Ph\u1ee5 thu\u1ed9c r\u1ea5t nhi\u1ec1u v\u1edbi th\u1ec3 t\u1ed5n th\u01b0\u01a1ng m\u00f4 b\u1ec7nh h\u1ecdc.<\/p>\n

2.3.1<\/em><\/strong>. D\u1ef1a tr\u00ean t\u1ed5n th\u01b0\u01a1ng m\u00f4 b\u1ec7nh h\u1ecdc th\u1eadn th\u00ec \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 t\u00f3m t\u1eaft nh\u01b0 sau:<\/em><\/strong><\/h3>\n

Vi\u00eam th\u1eadn lupus class I: ch\u1ec9 \u0111i\u1ec1u tr\u1ecb nh\u1eefng bi\u1ec3u hi\u1ec7n ngo\u00e0i th\u1eadn.<\/p>\n

Vi\u00eam th\u1eadn lupus class II: \u0111i\u1ec1u tr\u1ecb nh\u1eefng bi\u1ec3u hi\u1ec7n ngo\u00e0i th\u1eadn. Khi c\u00f3 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng n\u1eb7ng n\u00ean c\u1ea7n sinh thi\u1ebft l\u1ea1i th\u1eadn. N\u1ebfu c\u00f3 thay \u0111\u1ed5i v\u1ec1 th\u1ec3 t\u1ed5n th\u01b0\u01a1ng m\u00f4 b\u1ec7nh h\u1ecdc th\u1eadn s\u1ebd \u0111i\u1ec1u tr\u1ecb nh\u01b0 th\u1ec3 t\u1ed5n th\u01b0\u01a1ng (class) m\u1edbi.<\/p>\n

Vi\u00eam th\u1eadn lupus class III: t\u1ed5n th\u01b0\u01a1ng nh\u1eb9 ch\u1ee7 y\u1ebfu \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p corticoids. N\u1ebfu t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng \u0111i\u1ec1u tr\u1ecb nh\u01b0 vi\u00eam c\u1ea7u th\u1eadn lupus type IV.<\/p>\n

Vi\u00eam th\u1eadn lupus class IV-V: l\u00e0 th\u1ec3 n\u1eb7ng nh\u1ea5t, c\u1ea7n \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c. C\u00f3 nhi\u1ec1u thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn t\u00f9y thu\u1ed9c v\u00e0o b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi nh\u00f3m n\u00e0o, th\u1ea7y thu\u1ed1c c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn m\u1ed9t trong nh\u1eefng ph\u00e1c \u0111\u1ed3 sau \u0111\u00e2y:<\/p>\n

– Prednisolon ( ho\u1eb7c c\u00f9ng nh\u00f3m t\u00ednh li\u1ec1u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng) 1mg\/kg\/24h ho\u1eb7c 2mg\/kg\/c\u00e1ch ng\u00e0y trong 3 – 6 th\u00e1ng, kh\u00f4ng qu\u00e1 80mg\/ng\u00e0y v\u00e0 kh\u00f4ng qu\u00e1 120mg c\u00e1ch ng\u00e0y.<\/p>\n

– Li\u1ec1u u\u1ed1ng cyclophosphamid (Endoxan) ho\u1eb7c azathioprin (Imurel) t\u1ea5n c\u00f4ng (3mg\/kg\/24h) trong 2 – 3 th\u00e1ng, li\u1ec1u cyclosporine A (3-4mg\/kg\/24h) 3 th\u00e1ng ho\u1eb7c h\u01a1n.<\/p>\n

– N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng, \u0111\u00e1p \u1ee9ng k\u00e9m ho\u1eb7c c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng n\u1eb7ng ngay t\u1eeb \u0111\u1ea7u c\u00f3 th\u1ec3 d\u00f9ng nh\u1eefng li\u1ec1u bolus (li\u1ec1u m\u1ea1nh) methylprednison ho\u1eb7c cyclophosphamid theo li\u1ec7u tr\u00ecnh nh\u01b0 sau:.<\/p>\n

– Methylprednison li\u1ec1u pulse: D\u00f9ng 1000mg pha trong dung dich glucose 5% truy\u1ec1n t\u0129nh m\u1ea1ch ch\u1eadm tr\u00ean m\u1ed9t gi\u1edd, 3 ng\u00e0y li\u00ean t\u1ee5c, sau \u0111\u00f3 ti\u1ebfp t\u1ee5c li\u1ec1u u\u1ed1ng 0,4 – 0,5mg\/kg\/24h, c\u00f3 th\u1ec3 nh\u1eafc l\u1ea1i m\u1ed7i th\u00e1ng 1 li\u1ec1u \u0111\u01a1n (1 ng\u00e0y) trong 6 th\u00e1ng. Ch\u00fa \u00fd nguy c\u01a1 t\u0103ng huy\u1ebft \u00e1p v\u00e0 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng<\/p>\n

– Cyclophosphamid: D\u00f9ng (0,7g – 1g\/m2<\/sup>\u00a0di\u1ec7n t\u00edch c\u01a1 th\u1ec3) pha truy\u1ec1n t\u0129nh m\u1ea1ch 1 th\u00e1ng 1 l\u1ea7n trong 6 th\u00e1ng, sau \u0111\u00f3 3 th\u00e1ng 1 l\u1ea7n c\u00f3 th\u1ec3 \u0111\u1ebfn 9 l\u1ea7n t\u00f9y theo \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n. Ch\u00fa \u00fd t\u00e1c d\u1ee5ng ph\u1ee5 gi\u1ea3m b\u1ea1ch c\u1ea7u v\u00e0 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng.<\/p>\n

2.3.2. <\/em><\/strong>Trong \u0111i\u1ec1u ki\u1ec7n \u1edf Vi\u1ec7t Nam ch\u01b0a sinh thi\u1ebft th\u1eadn \u0111\u01b0\u1ee3c cho t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n (BN) vi\u00eam th\u1eadn lupus, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 xem x\u00e9t nh\u01b0 sau:<\/em><\/strong><\/h3>\n

– BN kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, ch\u1ec9 c\u00f3 r\u1ed1i lo\u1ea1n nh\u1eb9 v\u1ec1 n\u01b0\u1edbc ti\u1ec3u: protein ni\u1ec7u d\u01b0\u1edbi 1g\/24g, kh\u00f4ng c\u00f3 h\u1ed3ng c\u1ea7u ni\u1ec7u ho\u1eb7c h\u1ed3ng c\u1ea7u ni\u1ec7u \u00edt: \u0111i\u1ec1u tr\u1ecb ch\u1ee7 y\u1ebfu l\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ec3u hi\u1ec7n ngo\u00e0i th\u1eadn.<\/p>\n

– B\u1ec7nh nh\u00f5n c\u00f3 h\u1ed9i ch\u1ee9ng c\u1ea7u th\u1eadn c\u1ea5p: C\u00f3 th\u1ec3 ch\u1ecdn 1 trong c\u00e1c ph\u00e1c \u0111\u1ed3 sau:<\/p>\n

Prednison u\u1ed1ng 1 – 1,5 mg\/kg\/24g h\u00e0ng ng\u00e0y ho\u1eb7c c\u00e1ch nh\u1eadt trung b\u00ecnh kho\u1ea3ng 1,5 – 2 th\u00e1ng, c\u0169ng c\u00f3 th\u1ec3 k\u00e9o d\u00e0i 3 th\u00e1ng ho\u1eb7c h\u01a1n, kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 6 th\u00e1ng. Li\u1ec1u h\u00e0ng ng\u00e0y kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 80mg. Li\u1ec1u c\u00e1ch ng\u00e0y t\u1ea5n c\u00f4ng kh\u00f4ng n\u00ean v\u01b0\u1ee3t qu\u00e1 120mg. Sau \u0111\u00f3 gi\u1ea3m li\u1ec1u d\u1ea7n xu\u1ed1ng li\u1ec1u c\u1ee7ng c\u1ed1 b\u1eb1ng n\u1eeda li\u1ec1u t\u1ea5n c\u00f4ng v\u00e0 duy tr\u00ec c\u00f3 th\u1ec3 h\u00e0ng n\u0103m v\u1edbi li\u1ec1u th\u1ea5p \u2264 20mg\/24h.<\/p>\n

Cyclophosphamid 2,5 – 3 mg\/kg\/24h kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 4mg\/kg\/24h. T\u1ea5n c\u00f4ng trong 1,5 – 2 th\u00e1ng, sau \u0111\u00f3 gi\u1ea3m li\u1ec1u c\u1ee7ng c\u1ed1 b\u1eb1ng n\u1eeda li\u1ec1u t\u1ea5n c\u00f4ng v\u00e0 duy tr\u00ec li\u1ec1u th\u1ea5p \u2248 50mg\/24h, th\u1eddi gian \u0111i\u1ec1u tr\u1ecb kh\u00f4ng n\u00ean qu\u00e1 1 n\u0103m.T\u00e1c d\u1ee5ng ph\u1ee5: gi\u1ea3m b\u1ea1ch c\u1ea7u, suy bu\u1ed3ng tr\u1ee9ng, v\u00f4 tinh tr\u00f9ng, vi\u00eam b\u00e0ng quang ch\u1ea3y m\u00e1u, ung th\u01b0 b\u00e0ng quang<\/p>\n

– Azathioprine (imurel) u\u1ed1ng li\u1ec1u 2,5 – 3mg\/kg\/24h t\u1eeb 1,5 – 2 th\u00e1ng, sau \u0111\u00f3 gi\u1ea3m li\u1ec1u c\u1ee7ng c\u1ed1 b\u1eb1ng n\u1eeda li\u1ec1u t\u1ea5n c\u00f4ng v\u00e0 duy tr\u00ec li\u1ec1u th\u1ea5p 50mg\/24h trong 1 n\u0103m ho\u1eb7c h\u01a1n n\u1ebfu b\u1ec7nh nh\u00e2n dung n\u1ea1p \u0111\u01b0\u1ee3c thu\u1ed1c.T\u00e1c d\u1ee5ng ph\u1ee5: g\u00e2y \u0111\u1ed9c cho t\u1ee7y x\u01b0\u01a1ng l\u00e0m gi\u1ea3m b\u1ea1ch c\u1ea7u, gi\u1ea3m ti\u1ec3u c\u1ea7u, thi\u1ebfu m\u00e1u, t\u0103ng nguy c\u01a1 g\u00e2y ung th\u01b0.<\/p>\n

– Cyclosporine A: 3 – 4mg\/kg\/24h t\u1eeb 1,5 – 3 th\u00e1ng ho\u1eb7c h\u01a1n, ph\u1ed1i h\u1ee3p v\u1edbi li\u1ec1u th\u1ea5p corticoids (\u224820mg\/24h) n\u1ebfu \u0111i\u1ec1u tr\u1ecb corticoids v\u00e0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c \u00edt t\u00e1c d\u1ee5ng. Sau \u0111\u00f3 gi\u1ea3m xu\u1ed1ng li\u1ec1u duy tr\u00ec kho\u1ea3ng 2mg\/kg\/24h c\u00f3 th\u1ec3 h\u00e0ng n\u0103m. Tuy nhi\u00ean b\u1ec7nh c\u0169ng hay t\u00e1i ph\u00e1t sau khi gi\u1ea3m li\u1ec1u ho\u1eb7c d\u1eebng thu\u1ed1c.T\u00e1c d\u1ee5ng ph\u1ee5: suy gan, suy th\u1eadn, t\u0103ng nguy c\u01a1 ung th\u01b0.<\/p>\n

– Mycophenolate Mofetil (CELLCEPT): \u0110\u01b0\u1ee3c d\u00f9ng r\u1ed9ng r\u00e3i trong ch\u1ed1ng \u0111\u00e0o th\u1ea3i t\u1ea1ng gh\u00e9p. G\u1ea7n \u0111\u00e2y MMF \u0111\u01b0a v\u00e0o \u0111i\u1ec1u tr\u1ecb vi\u00eam th\u1eadn lupus do: l\u00e0m gi\u1ea3m protein ni\u1ec7u v\u00e0 h\u1ed3ng c\u1ea7u ni\u1ec7u, \u0111\u01b0a n\u1ed3ng \u0111\u1ed9 b\u1ed5 th\u1ec3 v\u1ec1 m\u1ee9c b\u00ecnh th\u01b0\u1eddng, t\u0103ng n\u1ed3ng \u0111\u1ed9 albumin m\u00e1u, t\u1ef7 l\u1ec7 t\u00e1i ph\u00e1t th\u1ea5p v\u00e0 \u00edt t\u00e1c d\u1ee5ng ph\u1ee5. Li\u1ec1u d\u00f9ng ban \u0111\u1ea7u t\u1eeb 2-3g\/24h c\u00f3 th\u1ec3 d\u00f9ng k\u00e9o d\u00e0i t\u1edbi 12 th\u00e1ng.<\/p>\n

– C\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p corticoids v\u1edbi c\u00e1c thu\u1ed1c mi\u1ec5n d\u1ecbch kh\u00e1c v\u1edbi li\u1ec1u trung b\u00ecnh th\u01b0\u1eddng b\u1eb1ng n\u1eeda li\u1ec1u t\u1ea5n c\u00f4ng.<\/p>\n

– C\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb b\u1eb1ng truy\u1ec1n li\u1ec1u cao methylprednison ho\u1eb7c Cyclophosphamid (xem ph\u1ea7n tr\u00ean) ngay c\u1ea3 khi kh\u00f4ng c\u00fa m\u00f4 b\u1ec7nh h\u1ecdc trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng 1 trong c\u00e1c bi\u1ec7n ph\u00e1p n\u00eau tr\u00ean.<\/p>\n

– C\u00e1c ph\u01b0\u01a1ng ph\u00e1p m\u1edbi \u0111i\u1ec1u tr\u1ecb vi\u00eam th\u1eadn Lupus \u0111ang \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng<\/p>\n

Kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng (Rituximax): ti\u00eau di\u1ec7t t\u1ebf b\u00e0o Lympho B (\u0111\u01b0\u1ee3c cho l\u00e0 c\u00f3 vai tr\u00f2 trung t\u00e2m)<\/p>\n

L\u1ecdc huy\u1ebft t\u01b0\u01a1ng (plasmapheresis-plasma exchange):<\/p>\n

– Thay 3-4 lit huy\u1ebft t\u01b0\u01a1ng m\u1ed7i tu\u1ea7n b\u1eb1ng huy\u1ebft t\u01b0\u01a1ng hay s\u1ea3n ph\u1ea9m thay th\u1ebf. \u0110\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1eb7c bi\u1ec7t cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1eb1ng ch\u1ee9ng t\u0103ng r\u00f5 r\u1ec7t ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch l\u01b0u h\u00e0nh. \u0110\u1ed3ng th\u1eddi v\u1eabn ph\u1ea3i k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb t\u1ea5n c\u00f4ng b\u1eb1ng corticoids v\u00e0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch<\/p>\n

2<\/strong>.<\/strong>4.<\/strong> \u0110i\u1ec1u tr\u1ecb c\u00e1c bi\u1ec3u hi\u1ec7n ngo\u00e0i th\u1eadn v\u00e0 bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng.<\/strong><\/h3>\n

Nh\u1eefng bi\u1ec3u hi\u1ec7n ngo\u00e0i th\u1eadn n\u1eb7ng h\u01a1n bao g\u1ed3m vi\u00eam kh\u1edbp kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c kh\u00e1ng vi\u00eam gi\u1ea3m \u0111au kh\u00f4ng steroids, vi\u00eam tr\u00e0n d\u1ecbch m\u00e0ng tim, m\u00e0ng ph\u1ed5i; vi\u00eam c\u01a1 tim, bi\u1ec3u hi\u1ec7n n\u00e3o, vi\u00eam ph\u1ed5i do Lupus c\u1ea7n s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p corticoid v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 theo chuy\u00ean khoa, t\u00f9y theo t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

3<\/strong>. P<\/strong>h\u00f2ng b\u1ec7nh<\/strong><\/h2>\n

B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u1ebfn kh\u00e1m chuy\u00ean khoa th\u1eadn khi \u0111\u00e3 c\u00f3 bi\u1ec3u hi\u1ec7n vi\u00eam th\u1eadn do lupus, c\u1ea7n \u0111\u01b0\u1ee3c b\u00e1c s\u0129 chuy\u00ean khoa t\u01b0 v\u1ea5n, \u0111\u01b0a ra l\u1eddi khuy\u00ean v\u1ec1 ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb, ch\u1ebf \u0111\u1ed9 sinh ho\u1ea1t v\u00e0 theo d\u00f5i \u0111\u1ecbnh k\u1ef3.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 b\u1ec7nh v\u1ec1 th\u1eadn \u2013 ti\u1ebft ni\u1ec7u theo B\u1ed9 Y t\u1ebf 2015.<\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam th\u1eadn l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng ph\u1ed5 bi\u1ebfn c\u1ee7a b\u1ec7nh lupus, m\u1ed9t b\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n d\u1ecbch g\u00e2y ra s\u1ef1 t\u1ea5n c\u00f4ng c\u1ee7a h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch v\u00e0o c\u00e1c m\u00f4 v\u00e0 c\u01a1 quan trong c\u01a1 th\u1ec3, bao g\u1ed3m c\u1ea3 th\u1eadn. Khi h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch t\u1ea5n c\u00f4ng c\u00e1c m\u00f4 v\u00e0 c\u01a1 quan trong th\u1eadn, n\u00f3 […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[],"yoast_head":"\nKh\u00e1i qu\u00e1t v\u1ec1 vi\u00eam th\u1eadn lupus: \u0110\u1ecbnh ngh\u0129a, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/title>\n<meta name=\"description\" content=\"Vi\u00eam th\u1eadn l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng ph\u1ed5 bi\u1ebfn c\u1ee7a b\u1ec7nh lupus, m\u1ed9t b\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n d\u1ecbch g\u00e2y ra s\u1ef1 t\u1ea5n c\u00f4ng c\u1ee7a h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch v\u00e0o c\u00e1c m\u00f4\" \/>\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\" 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