{"id":29314,"date":"2023-04-29T18:21:51","date_gmt":"2023-04-29T11:21:51","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29314"},"modified":"2023-04-29T18:21:51","modified_gmt":"2023-04-29T11:21:51","slug":"tiep-can-chan-doan-va-chien-luoc-dieu-tri-roi-loan-lipid-mau","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/tiep-can-chan-doan-va-chien-luoc-dieu-tri-roi-loan-lipid-mau\/","title":{"rendered":"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n v\u00e0 chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u"},"content":{"rendered":"

R\u1ed1i lo\u1ea1n lipid m\u00e1u<\/a> (Dyslipidemia) l\u00e0 m\u1ed9t trong c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 h\u00e0ng \u0111\u1ea7u g\u00e2y b\u1ec7nh tim m\u1ea1ch \u0111\u1ed3ng th\u1eddi l\u00e0m gia t\u0103ng c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c. C\u00f3 m\u1ed9t m\u1ed1i li\u00ean quan li\u00ean t\u1ee5c, b\u1ec1n v\u1eefng, \u0111\u1ed9c l\u1eadp gi\u1eefa n\u1ed3ng \u0111\u1ed9 cholesterol to\u00e0n ph\u1ea7n (TC) ho\u1eb7c cholesterol tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p (LDL-C) v\u1edbi c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch do x\u01a1 v\u1eefa.<\/strong><\/p>\n

1.\u0110\u1ea1i c\u01b0\u01a1ng<\/strong><\/h2>\n

R\u1ed1i lo\u1ea1n lipid m\u00e1u (Dyslipidemia) l\u00e0 m\u1ed9t trong c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 h\u00e0ng \u0111\u1ea7u g\u00e2y b\u1ec7nh tim m\u1ea1ch \u0111\u1ed3ng th\u1eddi l\u00e0m gia t\u0103ng c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c. C\u00f3 m\u1ed9t m\u1ed1i li\u00ean quan li\u00ean t\u1ee5c, b\u1ec1n v\u1eefng, \u0111\u1ed9c l\u1eadp gi\u1eefa n\u1ed3ng \u0111\u1ed9 cholesterol to\u00e0n ph\u1ea7n (TC) ho\u1eb7c cholesterol tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p (LDL-C) v\u1edbi c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch do x\u01a1 v\u1eefa.<\/p>\n

2.Nguy\u00ean nh\u00e2n r\u1ed1i lo\u1ea1n lipid m\u00e1u<\/h2>\n

2.1 T\u0103ng cholesterol m\u00e1u<\/strong><\/h3>\n
    \n
  • Ch\u1ebf \u0111\u1ed9 \u0103n\/sinh ho\u1ea1t.<\/li>\n
  • Di truy\u1ec1n (c\u00f3 t\u00ednh ch\u1ea5t gia \u0111\u00ecnh).<\/li>\n
  • Th\u1ee9 ph\u00e1t: H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, suy gi\u00e1p, liormon…<\/li>\n<\/ul>\n

    2.2 T\u0103ng triglyceride<\/h3>\n
      \n
    • Thi\u1ebfu h\u1ee5t gen lipase ti\u00eau hu\u1ef7 lipoprotein ho\u1eb7c apolipoprotein C-II.<\/li>\n
    • T\u0103ng Triglyceride c\u00f3 t\u00ednh ch\u1ea5t gia \u0111\u00ecnh.<\/li>\n
    • B\u00e9o ph\u00ec.<\/li>\n
    • U\u1ed1ng qu\u00e1 nhi\u1ec1u r\u01b0\u1ee3u. \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/li>\n
    • D\u00f9ng thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m k\u00e9o d\u00e0i.<\/li>\n<\/ul>\n

      2.3 Gi\u1ea3m HDL-C<\/h3>\n
        \n
      • H\u00fat thu\u1ed1c l\u00e1, b\u00e9o ph\u00ec, l\u01b0\u1eddi v\u1eadn \u0111\u1ed9ng th\u1ec3 l\u1ef1c.<\/li>\n
      • \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng kh\u00f4ng ph\u1ee5 thu\u1ed9c insulin.<\/li>\n
      • T\u0103ng Triglyceride m\u00e1u.<\/li>\n
      • D\u00f9ng thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m k\u00e9o d\u00e0i. R\u1ed1i lo\u1ea1n gen chuy\u1ec3n h\u00f3a HDL-C.<\/li>\n<\/ul>\n

        3.\u0110\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng b\u1ec7nh nh\u00e2n r\u1ed1i lo\u1ea1n lipid m\u00e1u<\/h2>\n

        3.1 Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a r\u1ed1i lo\u1ea1n lipid m\u00e1u th\u01b0\u1eddng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/strong><\/h3>\n
          \n
        • C\u00f3 th\u1ec3 th\u1ea5y m\u1ea3ng u v\u00e0ng \u1edf mi m\u1eaft (m\u1ea3ng xanthelasma) (trong b\u1ec7nh r\u1ed1i lo\u1ea1n m\u1ee1 m\u00e1u mang t\u00ednh gia \u0111\u00ecnh).<\/li>\n
        • C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a c\u00e1c YTNC (THA; \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng.).<\/li>\n
        • C\u00e1c tri\u1ec7u ch\u1ee9ng khi \u0111\u00e3 c\u00f3 bi\u1ebfn ch\u1ee9ng do b\u1ec7nh do XV\u0110M: B\u1ec7nh l\u00fd \u0110M v\u00e0nh, b\u1ec7nh l\u00fd \u0110M n\u00e3o, m\u1ea1ch ngo\u1ea1i vi<\/li>\n<\/ul>\n

          3.2 X\u00e9t nghi\u1ec7m c\u00e1c th\u00e0nh ph\u1ea7n lipid m\u00e1u c\u01a1 b\u1ea3n<\/h3>\n

          C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 r\u1ed1i lo\u1ea1n lipid m\u00e1u c\u01a1 b\u1ea3n:<\/p>\n

            \n
          • Cholesterol to\u00e0n ph\u1ea7n (TC) LDL-Cholesterol (LDL-C) HDL-Cholesterol (HDL-C) Triglyceride (TG)<\/li>\n<\/ul>\n

            M\u1ed9t s\u1ed1 th\u00f4ng s\u1ed1 kh\u00e1c :<\/p>\n

              \n
            • Non – HDL cholesterol c\u00f3 th\u1ec3 t\u00ednh to\u00e1n d\u1ec5 d\u00e0ng qua c\u00f4ng th\u1ee9c: Non – HDL cholesterol = Cholesterol to\u00e0n ph\u1ea7n – HDL = LDL + VLDL Apo B<\/li>\n<\/ul>\n

              3.3 R\u1ed1i lo\u1ea1n lipid m\u00e1u khi c\u00f3 m\u1ed9t ho\u1eb7c nhi\u1ec1u c\u00e1c r\u1ed1i lo\u1ea1n sau<\/h3>\n
                \n
              • T\u0103ng Cholesterol: > 200 mg\/dL (5,2 mmol\/L). T\u0103ng LDL-C: > 130 mg\/dL (3,4 mmol\/L).<\/li>\n
              • Gi\u1ea3m HDL-C: < 40 mg\/dL (1,0 mmol\/L).<\/li>\n
              • T\u0103ng Triglyceride: > 200 mg\/dL (2,3 mmol\/L).<\/li>\n<\/ul>\n

                R\u1ed1i lo\u1ea1n ki\u1ec3u h\u1ed7n h\u1ee3p: <\/strong>Khi t\u0103ng cholesterol k\u1ebft h\u1ee3p v\u1edbi t\u0103ng triglyceride.<\/p>\n

                Khuy\u1ebfn c\u00e1o hi\u1ec7n t\u1ea1i v\u1ec1 th\u1eddi \u0111i\u1ec3m x\u00e9t nghi\u1ec7m: <\/strong>> 20 tu\u1ed5i, x\u00e9t nghi\u1ec7m lipid m\u00e1u khi \u0111\u00f3i: Cholesterol to\u00e0n ph\u1ea7n, LDL-C, HDL-C v\u00e0 Triglyceride; x\u00e9t nghi\u1ec7m l\u1ea1i m\u1ed7i 5 n\u0103m n\u1ebfu k\u1ebft qu\u1ea3 l\u1ea7n x\u00e9t nghi\u1ec7m tr\u01b0\u1edbc trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng v\u00e0 kh\u00f4ng c\u00f3 bi\u1ebfn c\u1ed1 tim m\u1ea1ch. N\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch ho\u1eb7c ph\u00e2n t\u1ea7ng nguy c\u01a1 cao th\u00ec c\u1ea7n ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb ngay.<\/p>\n

                \"Bi\u1ebfn<\/p>\n

                Bi\u1ebfn ch\u1ee9ng trong r\u1ed1i lo\u1ea1n lipid m\u00e1u<\/strong><\/p>\n

                4.Ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u<\/h2>\n

                4.1 Ph\u00e2n t\u1ea7ng nguy c\u01a1 b\u1ec7nh nh\u00e2n<\/strong><\/h3>\n

                4.1.1 Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u<\/h4>\n
                  \n
                • Ph\u1ea3i lu\u00f4n lo\u1ea1i tr\u1eeb nh\u1eefng nguy\u00ean nh\u00e2n t\u0103ng lipid m\u00e1u (t\u0103ng lipid th\u1ee9 ph\u00e1t).<\/li>\n
                • Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng l\u00e0 v\u1ea5n \u0111\u1ec1 c\u01a1 b\u1ea3n v\u00e0 c\u1ed1t l\u00f5i trong \u0111i\u1ec1u tr\u1ecb: Ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng ph\u00f9 h\u1ee3p; ch\u1ebf \u0111\u1ed9 luy\u1ec7n t\u1eadp th\u1ec3 d\u1ee5c \u0111\u1ec1u \u0111\u1eb7n.<\/li>\n
                • C\u00e2n nh\u1eafc l\u1ee3i \u00edch\/nguy c\u01a1 khi \u0111i\u1ec1u tr\u1ecb thu\u1ed1c.<\/li>\n
                • V\u1eadn d\u1ee5ng c\u00e1c b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 t\u1ed1i \u01b0u: Vai tr\u00f2 c\u1ee7a statin v\u00e0 statin li\u1ec1u cao v\u0201n l\u00e0 c\u1ed1t l\u00f5i \u0111i\u1ec1u tr\u1ecb gi\u1ea3m bi\u1ebfn c\u1ed1 (ASCVD).<\/li>\n
                • Theo d\u00f5i l\u00e2u d\u00e0i khi \u0111i\u1ec1u tr\u1ecb, tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb l\u00e0 y\u1ebfu t\u1ed1 quan tr\u1ecdng.<\/li>\n<\/ul>\n

                  4.1.2 X\u00e1c \u0111\u1ecbnh \u0111\u00edch \u0111i\u1ec1u tr\u1ecb (theo ESC 2019)<\/h4>\n

                  \u0110\u00edch \u0111i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean ph\u00e2n t\u1ea7ng nguy c\u01a1 v\u00e0 x\u00e9t nghi\u1ec7m c\u00e1c th\u00e0nh ph\u1ea7n lipid m\u00e1u. T\u00f9y theo t\u1ea7ng nguy c\u01a1 m\u00e0 c\u00f3 m\u1ed9t \u0111\u00edch \u0111i\u1ec1u tr\u1ecb kh\u00e1c nhau. Nh\u1eefng th\u00e0nh ph\u1ea7n lipid m\u00e1u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 ch\u1ec9 s\u1ed1 x\u00e1c \u0111\u1ecbnh \u0111\u00edch \u0111i\u1ec1u tr\u1ecb nh\u01b0 sau:<\/p>\n

                    \n
                  • LDL-C l\u00e0 \u0111\u00edch \u0111i\u1ec1u tr\u1ecb ch\u00ednh.<\/li>\n
                  • Cholesterol to\u00e0n ph\u1ea7n (TC) c\u00f3 th\u1ec3 coi l\u00e0 \u0111\u00edch \u0111i\u1ec1u tr\u1ecb n\u1ebfu kh\u00f4ng c\u00f3 c\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c.<\/li>\n
                  • N\u00ean \u0111\u00e1nh gi\u00e1 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 c\u00f3 k\u1ebf ho\u1ea1ch can thi\u1ec7p khi b\u1ec7nh nh\u00e2n r\u1ed1i lo\u1ea1n lipid m\u00e1u c\u00f3 t\u0103ng Triglyceride nhi\u1ec1u.<\/li>\n
                  • Non-HDL-C ho\u1eb7c Apo B l\u00e0 \u0111\u00edch \u0111i\u1ec1u tr\u1ecb th\u1ee9 hai \u1edf BN r\u1ed1i lo\u1ea1n lipid m\u00e1u th\u1ec3 h\u1ed7n h\u1ee3p, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, h\u1ed9i ch\u1ee9ng chuy\u1ec3n h\u00f3a ho\u1eb7c b\u1ec7nh th\u1eadn m\u1ea1n.<\/li>\n
                  • T\u1ef7 l\u1ec7 apoB\/apoA1 v\u00e0 non-HDL-C\/HDL-C kh\u00f4ng c\u00f2n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 \u0111\u00edch \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng quy<\/li>\n<\/ul>\n

                    4.1.2.1 \u0110\u00edch \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t:<\/h4>\n
                      \n
                    • Nh\u00f3m nguy c\u01a1 r\u1ea5t cao: <\/strong>M\u1ee5c ti\u00eau gi\u1ea3m LDL-C > 50% so v\u1edbi m\u1ee9c n\u1ec1n (khi b\u1ec7nh nh\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng b\u1ea5t k\u1ef3 thu\u1ed1c h\u1ea1 lipid m\u00e1u n\u00e0o) v\u00e0 \u0111\u00edch LDL-C < 1,4 mmol\/L (< 55 mg\/dL).<\/li>\n
                    • Nh\u00f3m nguy c\u01a1 cao: <\/strong>m\u1ee5c ti\u00eau gi\u1ea3m LDL-C > 50% so v\u1edbi m\u1ee9c n\u1ec1n (khi b\u1ec7nh nh\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng b\u1ea5t k\u00ec thu\u1ed1c h\u1ea1 lipid m\u00e1u n\u00e0o) v\u00e0 \u0111\u00edch LDL-C d\u01b0\u1edbi 1,8 mmol\/L (< 100 mg\/dL).<\/li>\n
                    • Nh\u00f3m nguy c\u01a1 v\u1eeba: <\/strong>M\u1ee9c LDL-C t\u1ed1t nh\u1ea5t d\u01b0\u1edbi 2,6 mmol\/L (< 115 mg\/dL).<\/li>\n
                    • Nh\u00f3m nguy c\u01a1 th\u1ea5p: <\/strong>M\u1ee9c LDL-C t\u1ed1t nh\u1ea5t d\u01b0\u1edbi 3,0 mmol\/L (< 116 mg\/dL).<\/li>\n<\/ul>\n

                      M\u1ee5c ti\u00eau ph\u1ee5 bao g\u1ed3m: Non – HDL; apo-B. Trong \u0111\u00f3 m\u1ee5c ti\u00eau c\u1ee7a non-HDL t\u01b0\u01a1ng \u1ee9ng v\u1edbi m\u1ee5c ti\u00eau LDL-C + 0,8 mmol\/L cho t\u1eebng nh\u00f3m nguy c\u01a1 n\u00f3i tr\u00ean. M\u1ee5c ti\u00eau c\u1ee7a apo-B cho c\u00e1c nh\u00f3m b\u1ec7nh nh\u00e2n nguy c\u01a1 r\u1ea5t cao, cao v\u00e0 trung b\u00ecnh l\u1ea7n l\u01b0\u1ee3t l\u00e0 65, 80 v\u00e0 100 mg\/dL.<\/p>\n

                      4.1.2.2 \u0110\u00edch \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t:<\/strong><\/h4>\n
                        \n
                      • \u0110\u1ed1i v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n nguy c\u01a1 r\u1ea5t cao: <\/strong>M\u1ee5c ti\u00eau gi\u1ea3m LDL-C > 50% so v\u1edbi m\u1ee9c n\u1ec1n (khi b\u1ec7nh nh\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng b\u1ea5t k\u00ec thu\u1ed1c h\u1ea1 lipid m\u00e1u n\u00e0o) v\u00e0 \u0111\u00edch LDL-C < 1,4 mmol\/L (< 55 mg\/dL).<\/li>\n
                      • N\u1ebfu b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb li\u1ec1u statin t\u1ed1i \u0111a dung n\u1ea1p \u0111\u01b0\u1ee3c x\u1ea3y ra bi\u1ebfn c\u1ed1 tim m\u1ea1ch l\u1ea7n 2 (kh\u00f4ng nh\u1ea5t thi\u1ebft ph\u1ea3i c\u00f9ng m\u1ed9t lo\u1ea1i bi\u1ebfn c\u1ed1 tim m\u1ea1ch l\u1ea7n \u0111\u1ea7u) trong v\u00f2ng 2 n\u0103m, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc thay \u0111\u1ed5i m\u1ee5c ti\u00eau LDL-C th\u00e0nh 1,0 mmol\/L.<\/li>\n<\/ul>\n

                        4.1.3 X\u00e1c \u0111\u1ecbnh chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb<\/h3>\n

                        Vi\u1ec7c b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u00e0 chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u0169ng d\u1ef1a tr\u00ean ph\u00e2n t\u1ea7ng nguy c\u01a1 b\u1ec7nh nh\u00e2n v\u00e0 x\u00e9t nghi\u1ec7m LDL-C.<\/p>\n

                        5. C\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u<\/h2>\n

                        5.1 C\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00f4ng d\u00f9ng thu\u1ed1c (thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng)<\/strong><\/h3>\n
                          \n
                        • L\u00e0 bi\u1ec7n ph\u00e1p quan tr\u1ecdng, b\u1eaft bu\u1ed9c cho m\u1ecdi b\u1ec7nh nh\u00e2n <\/strong>d\u00f9 \u0111\u00e3 c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c hay ch\u01b0a.<\/li>\n
                        • Bao g\u1ed3m: Ch\u1ebf \u0111\u1ed9 \u0103n, gi\u1ea3m c\u00e2n, t\u1eadp th\u1ec3 d\u1ee5c v\u00e0 b\u1ecf thu\u1ed1c l\u00e1, \u0111i\u1ec1u tr\u1ecb t\u1ed1t c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c \u0111i k\u00e8m (n\u1ebfu c\u00f3).<\/li>\n
                        • \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3: T\u01b0\u01a1ng t\u1ef1 trong t\u0103ng huy\u1ebft \u00e1p.<\/li>\n<\/ul>\n

                          5.2 C\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb d\u00f9ng thu\u1ed1c<\/strong><\/h3>\n

                          C\u00e1c nh\u00f3m thu\u1ed1c nh\u01b0 Statin,C\u00e1c lo\u1ea1i resin g\u1eafn acid m\u1eadt: Cholestyramine (Questran), colestipol (Colestid)…. c\u00f3 vai tr\u00f2 quan tr\u1ecdng.<\/p>\n

                           <\/p>\n

                          \u00a0<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

                          R\u1ed1i lo\u1ea1n lipid m\u00e1u (Dyslipidemia) l\u00e0 m\u1ed9t trong c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 h\u00e0ng \u0111\u1ea7u g\u00e2y b\u1ec7nh tim m\u1ea1ch \u0111\u1ed3ng th\u1eddi l\u00e0m gia t\u0103ng c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c. 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