{"id":30139,"date":"2023-05-01T22:49:53","date_gmt":"2023-05-01T15:49:53","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30139"},"modified":"2023-05-01T22:49:53","modified_gmt":"2023-05-01T15:49:53","slug":"benh-fabry-chan-doan-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/benh-fabry-chan-doan-va-dieu-tri\/","title":{"rendered":"B\u1ec7nh Fabry ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

B\u1ec7nh Fabry<\/a> l\u00e0 b\u1ec7nh hi\u1ebfm g\u1eb7p, di truy\u1ec1n qua gen l\u1eb7n li\u00ean k\u1ebft nhi\u1ec5m s\u1eafc th\u1ec3 X, n\u00ean th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n \u1edf nam gi\u1edbi. B\u1ec7nh \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n t\u00edch tr\u1eef lysosome, do \u0111\u1ed9t bi\u1ebfn gen m\u00e3A h\u00f3a enzyme a-galactosidase A. S\u1ef1 thi\u1ebfu h\u1ee5t enzyme n\u00e0y d\u0201n \u0111\u1ebfn t\u0103ng t\u00edch t\u1ee5 ch\u1ea5t b\u00e9o globotriaosylceramide (GL-3) \u1edf m\u1ed9t s\u1ed1 c\u01a1 quan nh\u01b0 da, h\u1ec7 th\u1ea7n kinh, th\u1eadn, m\u1eaft, tim.<\/strong><\/p>\n

1. \u0110\u1ecbnh ngh\u0129a<\/h2>\n

B\u1ec7nh Fabry l\u00e0 b\u1ec7nh hi\u1ebfm g\u1eb7p, di truy\u1ec1n qua gen l\u1eb7n li\u00ean k\u1ebft nhi\u1ec5m s\u1eafc th\u1ec3 X<\/strong>, n\u00ean th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n \u1edf nam gi\u1edbi. B\u1ec7nh \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n t\u00edch tr\u1eef lysosome, do \u0111\u1ed9t bi\u1ebfn gen m\u00e3A h\u00f3a enzyme a-galactosidase A. S\u1ef1 thi\u1ebfu h\u1ee5t enzyme n\u00e0y d\u0201n \u0111\u1ebfn t\u0103ng t\u00edch t\u1ee5 ch\u1ea5t b\u00e9o globotriaosylceramide (GL-3) \u1edf m\u1ed9t s\u1ed1 c\u01a1 quan nh\u01b0 da, h\u1ec7 th\u1ea7n kinh, th\u1eadn, m\u1eaft, tim. T\u1ef7 l\u1ec7 b\u1ec7nh 1\/40.000. M\u1eb7c d\u00f9 di truy\u1ec1n qua gen l\u1eb7n tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 X nh\u01b0ng ph\u1ee5 n\u1eef c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p v\u00e0 b\u1ec7nh th\u01b0\u1eddng nh\u1eb9 h\u01a1n.<\/p>\n

2. Bi\u1ec3u hi\u1ec7n ngo\u00e0i tim<\/h2>\n

B\u1ec7nh g\u00e2y t\u1ed5n th\u01b0\u01a1ng nhi\u1ec1u c\u01a1 quan v\u00e0 ti\u1ebfn tri\u1ec3n th\u00e0nh t\u1eebng \u0111\u1ee3t tr\u00ean l\u00e2m s\u00e0ng. Bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng \u1edf \u0111\u1ed9 tu\u1ed5i l\u00ean 10, v\u1edbi tri\u1ec7u ch\u1ee9ng ch\u1ee7 y\u1ebfu l\u00e0 c\u00e1c n\u1ed1t \u0111\u1ecf m\u00e0u t\u00edm nh\u1ecf <\/strong>g\u1ecdi l\u00e0 u m\u1ea1ch d\u00e0y s\u1eebng \u1edf tr\u00ean da (c\u00f3 th\u1ec3 \u1edf h\u00f4ng, b\u1eb9n, v\u00f9ng quanh r\u1ed1n) v\u00e0 c\u1ea3m gi\u00e1c \u0111au b\u1ecfng r\u00e1t \u1edf tay v\u00e0 ch\u00e2n. C\u00f3 th\u1ec3 g\u1eb7p gi\u1ea3m ti\u1ebft m\u1ed3 h\u00f4i, k\u00e9m th\u00edch nghi v\u1edbi n\u00f3ng, r\u1ed1i lo\u1ea1n ti\u00eau ho\u00e1.<\/p>\n

T\u1eeb \u0111\u1ed9 tu\u1ed5i 20, b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n protein ni\u1ec7u, \u0111\u1ee5c gi\u00e1c m\u1ea1c, b\u1ec7nh l\u00fd v\u00f5ng m\u1ea1c, ch\u00f3ng m\u1eb7t v\u00e0 nghe k\u00e9m.<\/p>\n

T\u1eeb \u0111\u1ed9 tu\u1ed5i 30, b\u1ec7nh c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n suy th\u1eadn, b\u1ec7nh m\u1ea1ch n\u00e3o, b\u1ec7nh c\u01a1 tim l\u00e0m t\u0103ng nguy c\u01a1 t\u1eed vong c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

\"B\u1ec7nh<\/p>\n

Bi\u1ec3u hi\u1ec7n ngo\u00e0i tim c\u1ee7a B\u1ec7nh Fabry<\/strong><\/p>\n

3. Bi\u1ec3u hi\u1ec7n t\u1ea1i tim<\/h2>\n

C\u00e1c t\u1ed5n th\u01b0\u01a1ng t\u1ea1i tim trong b\u1ec7nh Fabry c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n qua hai h\u00ecnh th\u1ee9c: B\u1ec7nh tim k\u1ebft h\u1ee3p v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan kh\u00e1c v\u00e0 bi\u1ec3u hi\u1ec7n \u0111\u01a1n \u0111\u1ed9c t\u1ea1i tim.<\/p>\n

T\u0103ng huy\u1ebft \u00e1p, d\u00e0y th\u1ea5t tr\u00e1i, t\u1ed5n th\u01b0\u01a1ng d\u0201n truy\u1ec1n, b\u1ec7nh m\u1ea1ch v\u00e0nh, b\u1ec7nh van hai l\u00e1 v\u00e0 van \u0110M ch\u1ee7, gi\u00e3n g\u1ed1c \u0110M ch\u1ee7 \u0111\u1ec1u c\u00f3 th\u1ec3 x\u1ea3y ra. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111au ng\u1ef1c, kh\u00f3 th\u1edf, h\u1ed3i h\u1ed9p tr\u1ed1ng ng\u1ef1c, ng\u1ea5t.<\/p>\n

4. X\u00e9t nghi\u1ec7m<\/h2>\n
    \n
  • \u0110i\u1ec7n t\u00e2m \u0111\u1ed3: <\/strong>Ph\u1ea7n l\u1edbn l\u00e0 bi\u1ec3u hi\u1ec7n d\u00e0y th\u1ea5t tr\u00e1i<\/strong>, c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p PR ng\u1eafn, bi\u1ebfn \u0111\u1ed5i ST v\u00e0 s\u00f3ng Q gi\u1ed1ng trong thi\u1ebfu m\u00e1u c\u01a1 tim, c\u00e1c r\u1ed1i lo\u1ea1n d\u0201n truy\u1ec1n n\u00fat nh\u0129 th\u1ea5t, b\u00f3 His v\u00e0 c\u00e1c nh\u00e1nh Purkinje.<\/li>\n
  • C\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc: <\/strong>D\u1eef li\u1ec7u c\u00f2n h\u1ea1n ch\u1ebf, c\u00f3 th\u1ec3 t\u0103ng troponin v\u00e0 NT-proBNP.<\/li>\n
  • Si\u00eau \u00e2m doppler tim: <\/strong>C\u00e1c b\u1ea5t th\u01b0\u1eddng s\u1edbm v\u00e0 hay g\u1eb7p nh\u1ea5t l\u00e0 d\u00e0y th\u1ea5t tr\u00e1i. Gi\u00e3n t\u00e2m nh\u0129, gi\u00e3n g\u1ed1c \u0110M ch\u1ee7, v\u00e0 d\u00e0y c\u00e1c l\u00e1 van c\u1ee7a van hai l\u00e1 v\u00e0 van \u0110M ch\u1ee7 \u0111\u1ec1u c\u00f3 th\u1ec3 g\u1eb7p. Th\u1ea5t tr\u00e1i d\u00e0y l\u00e0 do s\u1ef1 l\u1eafng \u0111\u1ecdng c\u00e1c ch\u1ea5t b\u00e9o GL-3 trong t\u1ebf b\u00e0o c\u01a1 tim. S\u1ef1 d\u00e0y th\u00e0nh t\u00e2m th\u1ea5t n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i, nh\u01b0ng th\u01b0\u1eddng ph\u00ec \u0111\u1ea1i \u0111\u1ed3ng t\u00e2m th\u1ea5t tr\u00e1i. Ch\u1ee9c n\u0103ng t\u00e2m thu v\u00e0 t\u00e2m tr\u01b0\u01a1ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c b\u1ea3o t\u1ed3n.<\/li>\n
  • C\u1ed9ng h\u01b0\u1edfng t\u1eeb tim: <\/strong>C\u00f3 th\u1ec3 gi\u00fap \u00edch cho ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t c\u00e1c d\u1ea1ng kh\u00e1c nhau c\u1ee7a b\u1ec7nh c\u01a1 tim, \u0111\u1eb7c bi\u1ec7t khi d\u00e0y th\u1ea5t tr\u00e1i l\u00e0 d\u1ea5u hi\u1ec7u ch\u1ee7 y\u1ebfu tr\u00ean si\u00eau \u00e2m (\u0111\u00e1nh gi\u00e1 v\u00f9ng c\u01a1 tim ph\u00ec \u0111\u1ea1i, \u0111\u1ed9 r\u1ed9ng c\u1ee7a c\u01a1 nh\u00fa v\u00e0 c\u00e1c b\u00e8 c\u01a1, ph\u00ec \u0111\u1ea1i c\u1ee7a th\u1ea5t ph\u1ea3i, th\u00e0nh sau th\u1ea5t tr\u00e1i).<\/li>\n
  • Ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh: <\/strong>Th\u01b0\u1eddng ch\u1ec9 \u0111\u1ecbnh khi l\u00e2m s\u00e0ng c\u00f3 c\u01a1n \u0111au ng\u1ef1c v\u00e0 \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a thi\u1ebfu m\u00e1u c\u01a1 tim. Trong ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p, \u0110MV b\u00ecnh th\u01b0\u1eddng, c\u00f2n t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u l\u00e0 do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u1ed9i m\u1ea1c khi ch\u1ea5t b\u00e9o GL- 3 l\u1eafng \u0111\u1ecdng trong \u0110MV.<\/li>\n
  • Holter \u0111i\u1ec7n t\u00e2m \u0111\u1ed3: <\/strong>Hay g\u1eb7p nh\u1ea5t l\u00e0 rung nh\u0129, sau \u0111\u00f3 l\u00e0 nh\u1ecbp nhanh th\u1ea5t. Do s\u1ef1 l\u1eafng \u0111\u1ecdng lipid t\u1ea1i c\u00e1c m\u00f4 c\u1ee7a \u0111\u01b0\u1eddng d\u0201n truy\u1ec1n, b\u1ea5t k\u1ef3 d\u1ea1ng n\u00e0o block x\u1ea3y ra c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp.<\/li>\n
  • Sinh thi\u1ebft n\u1ed9i m\u1ea1c c\u01a1 tim: <\/strong>Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh d\u1ef1a v\u00e0o sinh thi\u1ebft n\u1ed9i m\u1ea1c c\u01a1 tim. Tr\u00ean k\u00ednh hi\u1ec3n vi c\u00f3 th\u1ec3 th\u1ea5y h\u00ecnh \u1ea3nh \u0111i\u1ec3n h\u00ecnh l\u00e0 c\u00e1c kh\u00f4ng b\u00e0o tr\u00ean c\u00e1c m\u00f4 nhu\u1ed9m haematoxylin v\u00e0 eosin.<\/li>\n<\/ul>\n

    5. \u0110i\u1ec1u tr\u1ecb<\/h2>\n

    Kh\u00f4ng \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 \u0111\u01b0\u1ee3c b\u1ec7nh Fabry, nh\u01b0ng li\u1ec7u ph\u00e1p enzyme <\/strong>thay th\u1ebf c\u00f3 th\u1ec3 gi\u00fap tim v\u00e0 th\u1eadn tr\u00e1nh \u0111\u01b0\u1ee3c ph\u1ea7n l\u1edbn s\u1ef1 l\u1eafng \u0111\u1ecdng GL-3 t\u1ea1i n\u1ed9i m\u1ea1c c\u1ee7a c\u00e1c vi m\u1ea1ch. Li\u1ec7u ph\u00e1p n\u00e0y c\u0169ng l\u00e0m gi\u1ea3m ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i, c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng tim. Do v\u1eady, c\u1ea7n ch\u00fa \u00fd l\u00e0m x\u00e9t nghi\u1ec7m s\u00e0ng l\u1ecdc b\u1ec7nh Fabry b\u1eb1ng vi\u1ec7c \u0111o n\u1ed3ng \u0111\u1ed9 a- gaiactoSidase A \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 d\u00e0y th\u1ea5t tr\u00e1i ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n. C\u1ea7n l\u00e0m x\u00e9t nghi\u1ec7m s\u00e0ng l\u1ecdc v\u1edbi nh\u1eefng ng\u01b0\u1eddi c\u00f3 quan h\u1ec7 h\u1ecd h\u00e0ng b\u1eadc 1 v\u1edbi b\u1ec7nh nh\u00e2n Fabry, v\u00e0 c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 d\u00e0y th\u1ea5t tr\u00e1i \u0111\u1ed3ng t\u00e2m m\u00e0 gia \u0111\u00ecnh kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed b\u1ecb b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i.<\/p>\n

    \u0110au th\u1eaft ng\u1ef1c<\/strong>: B\u1ec7nh nh\u00e2n Fabry th\u01b0\u1eddng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee7a \u0111au th\u1eaft ng\u1ef1c, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au ng\u1ef1c do nguy\u00ean nh\u00e2n m\u1ea1ch m\u00e1u nh\u1ecf. L\u00e0m nghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c ho\u1eb7c ch\u1ee5p \u0110MV khi nghi ng\u1edd c\u00f3 b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh k\u00e8m theo.<\/p>\n

    X\u1eed tr\u00ed c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp: <\/strong>Li\u1ec7u ph\u00e1p chu\u1ea9n nh\u01b0 trong \u0111i\u1ec1u tr\u1ecb c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp nh\u0129 v\u00e0 th\u1ea5t<\/p>\n

    M\u00e1y t\u1ea1o nh\u1ecbp v\u0129nh vi\u1ec5n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p nh\u1ecbp ch\u1eadm c\u00f3 tri\u1ec7u ch\u1ee9ng v\u00e0\/ho\u1eb7c block nh\u0129 th\u1ea5t \u0111\u1ed9 cao. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u1ea7n c\u1ea5y m\u00e1y ph\u00e1 rung t\u1ef1 \u0111\u1ed9ng \u0111\u1ec3 ng\u0103n ng\u1eeba \u0111\u1ed9t t\u1eed do tim.<\/p>\n

    X\u1eed tr\u00ed suy ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i kh\u00f4ng tri\u1ec7u ch\u1ee9ng: <\/strong>D\u00f9 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee7a gi\u1ea3m ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i nh\u01b0ng n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf h\u1ec7 angiotensin. Ch\u1eb9n beta giao c\u1ea3m c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc nh\u01b0ng c\u00e1c d\u1eef li\u1ec7u c\u00f2n h\u1ea1n ch\u1ebf.<\/p>\n

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

    B\u1ec7nh Fabry l\u00e0 b\u1ec7nh hi\u1ebfm g\u1eb7p, di truy\u1ec1n qua gen l\u1eb7n li\u00ean k\u1ebft nhi\u1ec5m s\u1eafc th\u1ec3 X, n\u00ean th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n \u1edf nam gi\u1edbi. B\u1ec7nh \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n t\u00edch tr\u1eef lysosome, do \u0111\u1ed9t bi\u1ebfn gen m\u00e3A h\u00f3a enzyme a-galactosidase A. S\u1ef1 thi\u1ebfu h\u1ee5t enzyme n\u00e0y d\u0201n \u0111\u1ebfn t\u0103ng t\u00edch t\u1ee5 ch\u1ea5t […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nB\u1ec7nh Fabry ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh Fabry l\u00e0 b\u1ec7nh hi\u1ebfm g\u1eb7p, di truy\u1ec1n qua gen l\u1eb7n li\u00ean k\u1ebft nhi\u1ec5m s\u1eafc th\u1ec3 X, n\u00ean th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n \u1edf nam gi\u1edbi.\" \/>\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=\"B\u1ec7nh Fabry ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec\" \/>\n<meta property=\"og:description\" content=\"B\u1ec7nh Fabry l\u00e0 b\u1ec7nh hi\u1ebfm g\u1eb7p, di truy\u1ec1n qua gen l\u1eb7n li\u00ean k\u1ebft nhi\u1ec5m s\u1eafc th\u1ec3 X, n\u00ean th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n \u1edf nam gi\u1edbi.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/benh-fabry-chan-doan-va-dieu-tri\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-05-01T15:49:53+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/20200204_111141_461461_dau-than-kinh-ngoai.max-1800x1800-1-300x203.png\" \/>\n<meta name=\"author\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/benh-fabry-chan-doan-va-dieu-tri\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/benh-fabry-chan-doan-va-dieu-tri\/\",\"name\":\"B\u1ec7nh Fabry ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - 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