{"id":31042,"date":"2023-05-06T21:42:50","date_gmt":"2023-05-06T14:42:50","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31042"},"modified":"2023-05-06T21:42:50","modified_gmt":"2023-05-06T14:42:50","slug":"tong-quan-benh-teo-da-he-thong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tong-quan-benh-teo-da-he-thong\/","title":{"rendered":"T\u1ed5ng quan b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng"},"content":{"rendered":"

Teo \u0111a h\u1ec7 th\u1ed1ng (MSA) l\u00e0 m\u1ed9t b\u1ec7nh tho\u00e1i h\u00f3a th\u1ea7n kinh ti\u1ebfn tri\u1ec3n t\u0103ng d\u1ea7n, th\u01b0\u1eddng g\u1eb7p th\u1ee9 hai trong h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh. B\u1ec7nh bi\u1ec3u hi\u1ec7n v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ed9i ch\u1ee9ng Parkinson, th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o, r\u1ed1i lo\u1ea1n th\u1ea7n kinh th\u1ef1c v\u1eadt v\u00e0 h\u1ed9i ch\u1ee9ng th\u00e1p.<\/p>\n

Ba\u0300i vi\u00ea\u0301t “T\u1ed5ng quan b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng” tri\u0301ch ngu\u00f4\u0300n t\u01b0\u0300 H\u00f4\u0323i Th\u00e2\u0300n Kinh ho\u0323c Vi\u00ea\u0323t Nam.<\/strong><\/em><\/p>\n

Ta\u0301c gia\u0309: L\u00ea Th\u1ecb Ng\u1ecdc1, Nguy\u1ec5n Thanh B\u00ecnh2<\/em>
\nB\u1ec7nh vi\u1ec7n L\u00e3o khoa Trung \u01b0\u01a1ng1<\/em>
\n\u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i2<\/em><\/p>\n

1. L\u1ecbch s\u1eed<\/strong><\/h2>\n

N\u0103m 1900, Dejerine v\u00e0 Thomas l\u1ea7n \u0111\u1ea7u ti\u00ean m\u00f4 t\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng v\u1ec1 b\u1ec7nh teo tr\u00e1m c\u1ea7u ti\u1ec3u n\u00e3o. Sau n\u00e0y, \u0111\u00e2y \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t th\u1ec3 c\u1ee7a teo \u0111a h\u1ec7 th\u1ed1ng.
\nN\u0103m 1969, thu\u1eadt ng\u1eef \u201cteo \u0111a h\u1ec7 th\u1ed1ng\u201d \u0111\u01b0\u1ee3c \u0111\u01b0a ra bao g\u1ed3m c\u1ea3 ba h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng l\u00e0 tho\u00e1i h\u00f3a th\u1ec3 v\u00e2n ch\u1ea5t \u0111en, teo tr\u00e1m c\u1ea7u ti\u1ec3u n\u00e3o v\u00e0 h\u1ed9i ch\u1ee9ng Shy-Drager. N\u0103m 1999, thu\u1eadt ng\u1eef teo \u0111a h\u1ec7 th\u1ed1ng th\u1ec3 Parkinson v\u1edbi tri\u1ec7u ch\u1ee9ng Parkinson chi\u1ebfm \u01b0u th\u1ebf (MSA-P) \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng thay th\u1ebf cho tho\u00e1i h\u00f3a th\u1ec3 v\u00e2n ch\u1ea5t \u0111en, teo \u0111a h\u1ec7 th\u1ed1ng th\u1ec3 ti\u1ec3u n\u00e3o v\u1edbi tri\u1ec7u ch\u1ee9ng ti\u1ec3u n\u00e3o chi\u1ebfm \u01b0u th\u1ebf (MSA-C) thay th\u1ebf teo tr\u00e1m c\u1ea7u ti\u1ec3u n\u00e3o. H\u1ed9i ch\u1ee9ng Shy-Drager \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng khi b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh th\u1ef1c v\u1eadt chi\u1ebfm \u01b0u th\u1ebf.<\/p>\n

2. D\u1ecbch t\u1ec5<\/strong><\/h2>\n

T\u1ef7 l\u1ec7 m\u1eafc trung b\u00ecnh h\u00e0ng n\u0103m \u01b0\u1edbc t\u00ednh l\u00e0 0,6 \u0111\u1ebfn 0,7 tr\u00ean 100.000 ng\u01b0\u1eddi. T\u1ef7 l\u1ec7 hi\u1ec7n m\u1eafc \u01b0\u1edbc t\u00ednh l\u00e0 3,4 \u0111\u1ebfn 4,9 tr\u01b0\u1eddng h\u1ee3p tr\u00ean 100.000 d\u00e2n s\u1ed1, t\u0103ng l\u00ean 7,8 tr\u00ean 100.000 \u1edf ng\u01b0\u1eddi tr\u00ean 40 tu\u1ed5i [1]. B\u1ec7nh \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u1ea3 2 gi\u1edbi v\u00e0 kh\u1edfi ph\u00e1t \u1edf kho\u1ea3ng 55 tu\u1ed5i. \u1ede h\u1ea7u h\u1ebft c\u00e1c qu\u1ed1c gia, teo \u0111a h\u1ec7 th\u1ed1ng th\u1ec3 Parkinson nhi\u1ec1u h\u01a1n th\u1ec3 ti\u1ec3u n\u00e3o tuy nhi\u00ean \u1edf Nh\u1eadt B\u1ea3n th\u1ec3 ti\u1ec3u n\u00e3o l\u1ea1i th\u01b0\u1eddng g\u1eb7p h\u01a1n.
\nNguy\u00ean nh\u00e2n c\u1ee7a teo \u0111a h\u1ec7 th\u1ed1ng v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng, ch\u01b0a c\u00f3 y\u1ebfu t\u1ed1 m\u00f4i tr\u01b0\u1eddng n\u00e0o \u0111\u01b0\u1ee3c coi l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a b\u1ec7nh. M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn m\u00f4i tr\u01b0\u1eddng ngh\u1ec1 nghi\u1ec7p nh\u01b0 ti\u1ebfp x\u00fac v\u1edbi kim lo\u1ea1i, nh\u1ef1a, dung m\u00f4i h\u1eefu c\u01a1 v\u00e0 thu\u1ed1c tr\u1eeb s\u00e2u \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 tr\u00ean b\u1ec7nh nh\u00e2n teo \u0111a h\u1ec7 th\u1ed1ng, tuy nhi\u00ean ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y m\u1ed1i li\u00ean quan gi\u1eefa c\u00e1c y\u1ebfu t\u1ed1 n\u00e0y v\u00e0 b\u1ec7nh.
\nTrong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 di truy\u1ec1n tr\u00ean b\u1ec7nh nh\u00e2n teo \u0111a h\u1ec7 th\u1ed1ng cho th\u1ea5y s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a di truy\u1ec1n tr\u1ed9i ho\u1eb7c l\u1eb7n tr\u00ean NST th\u01b0\u1eddng. C\u00e1c \u0111\u1ed9t bi\u1ebfn trong gen coenzyme Q2 (gen c\u1ea7n thi\u1ebft cho qu\u00e1 tr\u00ecnh sinh t\u1ed5ng h\u1ee3p coenzyme Q10) \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n MSA. Ngo\u00e0i ra, ng\u01b0\u1eddi ta c\u0169ng nh\u1eadn th\u1ea5y m\u1ed1i li\u00ean quan c\u1ee7a c\u00e1c bi\u1ebfn th\u1ec3 gen SNCA, MATP v\u00e0 t\u0103ng nguy c\u01a1 m\u1eafc b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng. Gen LRRK2 v\u00e0 gen GBA li\u00ean quan \u0111\u1ebfn b\u1ec7nh Parkinson c\u0169ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n teo \u0111a h\u1ec7 th\u1ed1ng [2].<\/p>\n

3. Gi\u1ea3i ph\u1eabu b\u1ec7nh<\/strong><\/h2>\n

Gi\u1ea3i ph\u1eabu b\u1ec7nh l\u00fd \u0111\u1eb7c tr\u01b0ng c\u1ee7a teo \u0111a h\u1ec7 th\u1ed1ng l\u00e0 m\u1ea5t t\u1ebf b\u00e0o th\u1ea7n kinh v\u00e0 th\u1ea7n kinh \u0111\u1ec7m trong th\u1ec3 v\u00e2n, ch\u1ea5t \u0111en, nh\u00e2n xanh, nh\u00e2n c\u1ea7u n\u00e3o, cu\u1ed1ng ti\u1ec3u n\u00e3o gi\u1eefa, t\u1ebf b\u00e0o Purkinje ti\u1ec3u n\u00e3o, nh\u00e2n olive d\u01b0\u1edbi; c\u1ed9t trung gian, nh\u00e2n Onuf c\u1ee7a t\u1ee7y s\u1ed1ng.
\nNg\u01b0\u1eddi ta nh\u1eadn th\u1ea5y c\u00f3 s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a \u03b1 -synuclein trong t\u1ebf b\u00e0o ch\u1ea5t c\u1ee7a t\u1ebf b\u00e0o th\u1ea7n kinh \u0111\u1ec7m oligodendrocytes (hay c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 c\u00e1c th\u1ec3 v\u00f9i) ph\u00e2n b\u1ed1 \u0111i\u1ec3n h\u00ecnh \u1edf ti\u1ec3u n\u00e3o, c\u1ea7u n\u00e3o v\u00e0 h\u1ea1ch n\u1ec1n. Teo \u0111a h\u1ec7 th\u1ed1ng c\u00f9ng v\u1edbi b\u1ec7nh Parkinson v\u00e0 sa s\u00fat tr\u00ed tu\u1ec7 th\u1ec3 Lewy \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 chung b\u1ea3n ch\u1ea5t l\u00e0 r\u1ed1i lo\u1ea1n c\u1ee7a \u03b1 -synuclein, v\u00e0 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 b\u1ec7nh \u03b1 -synuclein.<\/p>\n

4. L\u00e2m s\u00e0ng<\/strong><\/h2>\n

C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7a teo \u0111a h\u1ec7 th\u1ed1ng bao g\u1ed3m c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng v\u00e0 ngo\u00e0i v\u1eadn \u0111\u1ed9ng \u1edf nhi\u1ec1u d\u1ea1ng ph\u1ed1i h\u1ee3p, kh\u00e1c nhau \u1edf t\u1eebng giai \u0111o\u1ea1n v\u00e0 t\u1eebng th\u1ec3 b\u1ec7nh.
\nGi\u1ed1ng nh\u01b0 b\u1ec7nh Parkinson, teo \u0111a h\u1ec7 th\u1ed1ng c\u00f3 giai \u0111o\u1ea1n ti\u1ec1n v\u1eadn \u0111\u1ed9ng g\u1eb7p trong 20 \u2013 75% tr\u01b0\u1eddng h\u1ee3p, bao g\u1ed3m r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c, ti\u1ec3u kh\u00f4ng t\u1ef1 ch\u1ee7 ho\u1eb7c b\u00ed ti\u1ec3u, h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf, th\u1edf r\u00edt v\u00e0 r\u1ed1i lo\u1ea1n h\u00e0nh vi trong gi\u1ea5c ng\u1ee7 giai \u0111o\u1ea1n \u0111\u1ed9ng m\u1eaft nhanh (REM) xu\u1ea5t hi\u1ec7n t\u1eeb v\u00e0i th\u00e1ng \u0111\u1ebfn nhi\u1ec1u n\u0103m tr\u01b0\u1edbc khi c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng \u0111\u1ea7u ti\u00ean xu\u1ea5t hi\u1ec7n.<\/p>\n

4.1. C\u00e1c tri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng<\/strong><\/h3>\n

4.1.1. Teo \u0111a h\u1ec7 th\u1ed1ng v\u1edbi h\u1ed9i ch\u1ee9ng Parkinson chi\u1ebfm \u01b0u th\u1ebf<\/strong><\/em><\/h4>\n

MSA-P bi\u1ec3u hi\u1ec7n h\u1ed9i ch\u1ee9ng Parkinson v\u1edbi nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m nh\u01b0 gi\u1ea3m \u0111\u1ed9ng, c\u1ee9ng, m\u1ea5t \u1ed5n \u0111\u1ecbnh t\u01b0 th\u1ebf v\u00e0\/ho\u1eb7c run. Run khi ngh\u1ec9 x\u1ea3y ra \u1edf 1\/3 b\u1ec7nh nh\u00e2n MSA-P v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ec1 v\u1eadn \u0111\u1ed9ng th\u01b0\u1eddng \u0111\u1ed1i x\u1ee9ng. C\u00e1c d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o kh\u00e1c c\u1ee7a teo \u0111a h\u1ec7 th\u1ed1ng bao g\u1ed3m m\u1ea5t \u1ed5n \u0111\u1ecbnh t\u01b0 th\u1ebf v\u00e0 t\u00e9 ng\u00e3 (th\u01b0\u1eddng trong v\u00f2ng ba n\u0103m sau khi b\u1eaft \u0111\u1ea7u c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng), c\u00e1c d\u1ea5u hi\u1ec7u th\u00e1p (d\u1ea5u hi\u1ec7u Babinski) v\u00e0 ti\u1ebfn tri\u1ec3n nhanh d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb dopaminergic [3]. \u0110\u00e1p \u1ee9ng k\u00e9m v\u1edbi levodopa l\u00e0 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n b\u1eaft bu\u1ed9c \u0111\u1ed1i v\u1edbi b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng. C\u00f3 40% b\u1ec7nh nh\u00e2n teo \u0111a h\u1ec7 th\u1ed1ng \u0111\u00e1p \u1ee9ng tho\u00e1ng qua v\u1edbi levodopa trong giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a b\u1ec7nh. C\u00e1c r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng kh\u00e1c c\u00f3 th\u1ec3 g\u1eb7p nh\u01b0 gi\u1eadt c\u01a1, m\u00faa vung n\u1eeda ng\u01b0\u1eddi, m\u00faa gi\u1eadt, lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1. M\u1ed9t s\u1ed1 ki\u1ec3u lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 nh\u01b0 lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 v\u00f9ng mi\u1ec7ng m\u1eb7t gi\u1ed1ng nh\u01b0 \u201cc\u01b0\u1eddi co th\u1eaft\u201d (co th\u1eaft c\u01a1 m\u1eb7t g\u00e2y bi\u1ec3u hi\u1ec7n c\u01b0\u1eddi m\u00e9o m\u00f3) v\u00e0 h\u1ed9i ch\u1ee9ng Pisa (lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 b\u00e1n c\u1ea5p v\u1edbi s\u1ef1 u\u1ed1n cong n\u1eb7ng c\u1ee7a th\u00e2n, \u0111\u1ea7u v\u00e0 c\u1ed5 sang b\u00ean). Ngo\u00e0i ra, lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 tr\u1ee5c th\u00e2n \u2013 Camptocormia (c\u1ed9t s\u1ed1ng g\u1eadp v\u1ec1 ph\u00eda tr\u01b0\u1edbc nghi\u00eam tr\u1ecdng) v\u00e0 lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 c\u1ed5 g\u1eadp tr\u01b0\u1edbc l\u00e0 nh\u1eefng b\u1ea5t th\u01b0\u1eddng t\u01b0 th\u1ebf th\u01b0\u1eddng g\u1eb7p.<\/p>\n

\"\"<\/a><\/p>\n

H\u00ecnh 1. H\u1ed9i ch\u1ee9ng Pisa<\/p>\n

\"\"<\/a><\/p>\n

H\u00ecnh 2. Lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 tr\u1ee5c th\u00e2n \u2013 Camptocormia<\/p>\n

4.1.2 Teo \u0111a h\u1ec7 th\u1ed1ng v\u1edbi tri\u1ec7u ch\u1ee9ng ti\u1ec3u n\u00e3o chi\u1ebfm \u01b0u th\u1ebf<\/strong><\/em><\/h4>\n

MSA-C ch\u1ee7 y\u1ebfu bi\u1ec3u hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 th\u1ea5t \u0111i\u1ec1u d\u00e1ng \u0111i, th\u1ea5t \u0111i\u1ec1u chi, r\u1ed1i lo\u1ea1n v\u1eadn ng\u00f4n v\u00e0 r\u1ed1i lo\u1ea1n chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a m\u1eaft. C\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 m\u1eaft c\u00f3 th\u1ec3 bao g\u1ed3m rung gi\u1eadt nh\u00e3n c\u1ea7u, suy gi\u1ea3m kh\u1ea3 n\u0103ng theo \u0111u\u1ed5i nh\u1ecbp nh\u00e0ng, gi\u1ea3m ph\u1ea3n x\u1ea1 ti\u1ec1n \u0111\u00ecnh m\u1eaft.
\n\u1ede giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh th\u01b0\u1eddng g\u1eb7p t\u00ecnh tr\u1ea1ng ng\u00e3 t\u00e1i ph\u00e1t, kh\u00f3 ph\u00e1t \u00e2m (thay \u0111\u1ed5i t\u00f4ng gi\u1ecdng), kh\u00f3 n\u00f3i (kh\u00f3 n\u00f3i th\u00e0nh l\u1eddi), ch\u1ea3y n\u01b0\u1edbc d\u00e3i v\u00e0 kh\u00f3 nu\u1ed1t.
\n4.2 C\u00e1c tri\u1ec7u ch\u1ee9ng ngo\u00e0i v\u1eadn \u0111\u1ed9ng
\nR\u1ed1i lo\u1ea1n th\u1ea7n kinh t\u1ef1 ch\u1ee7
\nR\u1ed1i lo\u1ea1n th\u1ea7n kinh th\u1ef1c v\u1eadt s\u1edbm v\u00e0 n\u1eb7ng l\u00e0 \u0111\u1eb7c \u0111i\u1ec3m ch\u00ednh c\u1ee7a teo \u0111a h\u1ec7 th\u1ed1ng. Trong \u0111\u00f3 tri\u1ec7u ch\u1ee9ng ti\u1ebft ni\u1ec7u sinh d\u1ee5c v\u00e0 tim m\u1ea1ch b\u1ecb \u1ea3nh h\u01b0\u1edfng th\u01b0\u1eddng xuy\u00ean nh\u1ea5t.
\nNam gi\u1edbi b\u1ecb teo \u0111a h\u1ec7 th\u1ed1ng th\u01b0\u1eddng b\u1ecb r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng s\u1edbm. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng ti\u1ec3u ti\u1ec7n bao g\u1ed3m ti\u1ec3u kh\u00f3, ti\u1ec3u \u0111\u00eam, ti\u1ec3u g\u1ea5p, ti\u1ec3u d\u1ea7m tuy nhi\u00ean \u00edt khi g\u1eb7p b\u00ed ti\u1ec3u. C\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n s\u1edbm h\u01a1n v\u00e0 n\u1eb7ng h\u01a1n trong teo \u0111a h\u1ec7 th\u1ed1ng, trong khi b\u1ec7nh Parkinson th\u01b0\u1eddng g\u1eb7p \u1edf giai \u0111o\u1ea1n mu\u1ed9n.
\nTrong tri\u1ec7u ch\u1ee9ng v\u1ec1 tim m\u1ea1ch, ha huy\u1ebft \u00e1p t\u01b0 th\u1ebf l\u00e0 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t. Ngo\u00e0i ra, teo \u0111a h\u1ec7 th\u1ed1ng c\u00f2n c\u00f3 th\u1ec3 c\u00f3 h\u1ea1 huy\u1ebft \u00e1p sau b\u1eefa \u0103n v\u00e0 h\u1ea1 huy\u1ebft \u00e1p v\u1ec1 \u0111\u00eam. Hi\u1ec7n t\u01b0\u1ee3ng Raynaud (ph\u1ea3n \u1ee9ng m\u1ea1ch m\u00e1u qu\u00e1 m\u1ee9c v\u1edbi nhi\u1ec7t \u0111\u1ed9 l\u1ea1nh ho\u1eb7c c\u0103ng th\u1eb3ng v\u1ec1 c\u1ea3m x\u00fac) ho\u1eb7c \u0111\u1ea7u chi l\u1ea1nh c\u0169ng c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n teo \u0111a h\u1ec7 th\u1ed1ng.
\nR\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p
\n50% b\u1ec7nh nh\u00e2n teo \u0111a h\u1ec7 th\u1ed1ng c\u00f3 tri\u1ec7u ch\u1ee9ng th\u1edf r\u00edt ban ng\u00e0y ho\u1eb7c ban \u0111\u00eam v\u00e0 xu\u1ea5t hi\u1ec7n th\u01b0\u1eddng xuy\u00ean h\u01a1n \u1edf giai \u0111o\u1ea1n b\u1ec7nh n\u1eb7ng. Ngo\u00e0i ra, b\u1ec7nh nh\u00e2n teo \u0111a h\u1ec7 th\u1ed1ng c\u00f2n xu\u1ea5t hi\u1ec7n ng\u1eebng th\u1edf khi ng\u1ee7 do t\u1eafc ngh\u1ebdn (15% \u0111\u1ebfn 37% tr\u01b0\u1eddng h\u1ee3p), ng\u01b0ng th\u1edf khi ng\u1ee7 trung \u01b0\u01a1ng, gi\u1ea3m th\u00f4ng kh\u00ed khi ng\u1ee7 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh v\u00e0 \u0111\u1ed9t t\u1eed [4].
\nR\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7
\nR\u1ed1i lo\u1ea1n h\u00e0nh vi trong gi\u1ea5c ng\u1ee7 giai \u0111o\u1ea1n \u0111\u1ed9ng m\u1eaft nhanh (RBD) g\u1eb7p \u1edf \u00edt nh\u1ea5t 2\/3 b\u1ec7nh nh\u00e2n teo \u0111a h\u1ec7 th\u1ed1ng. B\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 nh\u1eefng gi\u1ea5c m\u01a1 s\u1ed1ng \u0111\u1ed9ng, b\u1ea1o l\u1ef1c ho\u1eb7c \u0111\u00e1ng s\u1ee3. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 n\u00f3i ho\u1eb7c la h\u00e9t trong khi ng\u1ee7 v\u00e0 c\u00f3 th\u1ec3 t\u1ea5n c\u00f4ng ng\u01b0\u1eddi ng\u1ee7 c\u00f9ng. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p RBD c\u00f3 th\u1ec3 x\u1ea3y ra tr\u01b0\u1edbc c\u00e1c bi\u1ec3u hi\u1ec7n v\u1eadn \u0111\u1ed9ng c\u1ee7a teo \u0111a h\u1ec7 th\u1ed1ng v\u00e0i n\u0103m ho\u1eb7c th\u1eadm ch\u00ed h\u00e0ng ch\u1ee5c n\u0103m. Bu\u1ed3n ng\u1ee7 ban ng\u00e0y qu\u00e1 m\u1ee9c v\u00e0 h\u1ed9i ch\u1ee9ng ch\u00e2n kh\u00f4ng y\u00ean xu\u1ea5t hi\u1ec7n \u1edf g\u1ea7n 30% b\u1ec7nh nh\u00e2n teo \u0111a h\u1ec7 th\u1ed1ng, t\u1ef7 l\u1ec7 t\u01b0\u01a1ng t\u1ef1 ho\u1eb7c cao h\u01a1n \u1edf b\u1ec7nh Parkinson [5].
\nCh\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c
\nCh\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c trong teo \u0111a h\u1ec7 th\u1ed1ng c\u00f3 xu h\u01b0\u1edbng \u0111\u01b0\u1ee3c b\u1ea3o t\u1ed3n t\u01b0\u01a1ng \u0111\u1ed1i t\u1ed1t so v\u1edbi b\u1ec7nh Parkinson v\u00e0 c\u00e1c h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh kh\u00e1c. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u00f9y tr\u00e1n k\u00e8m theo m\u1ea5t kh\u1ea3 n\u0103ng ch\u00fa \u00fd \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong m\u1ed9t ph\u1ea7n ba s\u1ed1 tr\u01b0\u1eddng h\u1ee3p teo \u0111a h\u1ec7 th\u1ed1ng. Kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c c\u1ea3m x\u00fac hay h\u1ed9i ch\u1ee9ng gi\u1ea3 h\u00e0nh t\u1ee7y (c\u01b0\u1eddi ho\u1eb7c kh\u00f3c kh\u00f4ng th\u00edch h\u1ee3p khi kh\u00f4ng c\u00f3 b\u1ed1i c\u1ea3nh c\u1ea3m x\u00fac ph\u00f9 h\u1ee3p) c\u0169ng nh\u01b0 c\u00e1c thay \u0111\u1ed5i h\u00e0nh vi, bao g\u1ed3m c\u1ea3 tr\u1ea7m c\u1ea3m, lo l\u1eafng, c\u01a1n ho\u1ea3ng s\u1ee3 v\u00e0 \u00fd \u0111\u1ecbnh t\u1ef1 t\u1eed c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra [6].<\/p>\n

5. C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/h2>\n

5.1. C\u00e1c x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh h\u1ecdc<\/strong><\/h3>\n

V\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu c\u1ee7a teo \u0111a h\u1ec7 th\u1ed1ng l\u00e0 v\u00f9ng h\u1ea1ch n\u1ec1n, th\u00e2n n\u00e3o v\u00e0 ti\u1ec3u n\u00e3o v\u00ec v\u1eady c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) lu\u00f4n l\u00e0 x\u00e9t nghi\u1ec7m \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng. C\u1eaft l\u1edbp vi t\u00ednh s\u1ecd n\u00e3o \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi MRI n\u00e3o, gi\u00fap lo\u1ea1i tr\u1eeb c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e3o \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng v\u1edbi c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c.
\n\u2013 MRI n\u00e3o
\nMRI l\u00e0 m\u1ed9t x\u00e9t nghi\u1ec7m \u0111\u00e1ng tin c\u1eady v\u00e0 d\u1ec5 ti\u1ebfp c\u1eadn \u0111\u1ec3 ph\u00e2n bi\u1ec7t teo \u0111a h\u1ec7 th\u1ed1ng v\u1edbi b\u1ec7nh Parkinson, sa s\u00fat tr\u00ed tu\u1ec7 th\u1ec3 Lewy v\u00e0 li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n. C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a teo \u0111a h\u1ec7 th\u1ed1ng c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y tr\u00ean MRI 1,5 Tesla th\u01b0\u1eddng quy g\u1ed3m c\u00f3: t\u0103ng t\u00edn hi\u1ec7u vi\u1ec1n ngo\u00e0i c\u1ee7a b\u00e8o s\u1eabm (d\u1ea5u hi\u1ec7u vi\u1ec1n b\u00e8o s\u1eabm), teo b\u00e8o s\u1eabm, gi\u1ea3m t\u00edn hi\u1ec7u b\u00e8o s\u1eabm ph\u00eda sau tr\u00ean T2W; d\u1ea5u ch\u1eef th\u1eadp \u1edf c\u1ea7u n\u00e3o, teo c\u1ea7u v\u00e0 ti\u1ec3u n\u00e3o, t\u0103ng t\u00edn hi\u1ec7u cu\u1ed1ng ti\u1ec3u n\u00e3o gi\u1eefa.
\nD\u1ea5u hi\u1ec7u \u201chot cross-bun\u201d (d\u1ea5u hi\u1ec7u ch\u1eef th\u1eadp) \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn nhi\u1ec1u nh\u1ea5t v\u00e0 \u0111\u1ea1i di\u1ec7n cho s\u1ef1 tho\u00e1i h\u00f3a c\u1ee7a c\u1ea7u n\u00e3o v\u00e0 b\u00f3 c\u1ea7u ti\u1ec3u n\u00e3o v\u1edbi s\u1ef1 b\u1ea3o t\u1ed3n c\u1ee7a \u1ed1ng t\u1ee7y. Tr\u00ean T2 axial xu\u1ea5t hi\u1ec7n t\u0103ng t\u00edn hi\u1ec7u d\u1ea1ng ch\u1eef ch\u1eef th\u1eadp \u1edf c\u1ea7u n\u00e3o. M\u1eb7c d\u00f9 \u0111\u00e2y l\u00e0 d\u1ea5u hi\u1ec7u nh\u1eadn bi\u1ebft MSA-C v\u1edbi \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao (97%), nh\u01b0ng \u0111\u1ed9 nh\u1ea1y c\u1ee7a n\u00f3 ch\u1ec9 l\u00e0 50% [7].
\nD\u1ea5u hi\u1ec7u \u201cvi\u1ec1n b\u00e8o s\u1eabm\u201d \u2013 T\u0103ng t\u00edn hi\u1ec7u vi\u1ec1n ngo\u00e0i b\u00e8o s\u1eabm tr\u00ean h\u00ecnh \u1ea3nh T2 * \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong MSA-P v\u00e0 c\u00f3 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao nh\u1ea5t (90%), \u0111\u1ed9 nh\u1ea1y 72%. Ngo\u00e0i ra, MRI MSA-P c\u00f2n th\u1ea5y teo b\u00e8o s\u1eabm tr\u00ean xung T1 (\u0111\u1ed9 nh\u1ea1y 83%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 87%), v\u00e0 gi\u1ea3m t\u00edn hi\u1ec7u b\u00e8o s\u1eabm (\u0111\u1ed9 nh\u1ea1y 89%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 70%) .
\nMSA-C c\u00f3 nh\u1eefng thay \u0111\u1ed5i nh\u01b0 t\u0103ng t\u00edn hi\u1ec7u c\u1ee7a cu\u1ed1ng ti\u1ec3u n\u00e3o gi\u1eefa (MCP) v\u00e0 teo ti\u1ec3u n\u00e3o v\u00e0 th\u00e2n n\u00e3o (\u0111\u1eb7c bi\u1ec7t l\u00e0 c\u1ea7u n\u00e3o) (\u0111\u1ed9 nh\u1ea1y 100%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 82 %) [9].<\/p>\n

\"\"<\/a><\/p>\n

H\u00ecnh 3. H\u00ecnh \u1ea3nh c\u1ed9ng h\u01b0\u1edfng t\u1eeb b\u1ec7nh nh\u00e2n teo \u0111a h\u1ec7 th\u1ed1ng:
\nA: Gi\u1ea3m t\u00edn hi\u1ec7u b\u00e8o s\u1eabm, B: teo cu\u1ed1ng ti\u1ec3u n\u00e3o gi\u1eefa, C: d\u1ea5u hi\u1ec7u \u201cvi\u1ec1n b\u00e8o s\u1eabm\u201d, D: teo c\u1ea7u n\u00e3o v\u00e0 nh\u1ed9ng ti\u1ec3u n\u00e3o, E: d\u1ea5u hi\u1ec7u ch\u1eef th\u1eadp tr\u00ean T2 PD W, F: d\u1ea5u hi\u1ec7u ch\u1eef th\u1eadp tr\u00ean T2*, G: d\u1ea5u hi\u1ec7u ch\u1eef th\u1eadp v\u00e0 t\u0103ng t\u00edn hi\u1ec7u cu\u1ed1ng ti\u1ec3u n\u00e3o gi\u1eefa tr\u00ean T2, H: d\u1ea5u hi\u1ec7u ch\u1eef th\u1eadp tr\u00ean T2 FLAIR<\/p>\n

C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111\u1ecbnh l\u01b0\u1ee3ng \u0111\u01a1n gi\u1ea3n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u1ea3i thi\u1ec7n \u0111\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a ch\u1ea9n \u0111o\u00e1n. Trong teo \u0111a h\u1ec7 th\u1ed1ng teo c\u1ea7u n\u00e3o \u01b0u th\u1ebf h\u01a1n so v\u1edbi teo n\u00e3o gi\u1eefa, do v\u1eady ng\u01b0\u1eddi ta s\u1eed d\u1ee5ng c\u00e1c ph\u00e9p \u0111o \u0111\u01a1n gi\u1ea3n \u0111\u01b0\u1eddng k\u00ednh tr\u01b0\u1edbc sau n\u00e3o gi\u1eefa, c\u1ea7u n\u00e3o hay t\u1ef7 l\u1ec7 n\u00e3o gi\u1eefa\/c\u1ea7u n\u00e3o \u0111\u01b0\u1ee3c \u0111o tr\u00ean sagittal qua \u0111\u01b0\u1eddng gi\u1eefa \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng, b\u1ec7nh Parkinson v\u00e0 li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n. T\u1ef7 l\u1ec7 di\u1ec7n t\u00edch n\u00e3o gi\u1eefa\/c\u1ea7u n\u00e3o \u1edf b\u1ec7nh nh\u00e2n MSA-P l\u1edbn h\u01a1n \u1edf b\u1ec7nh nh\u00e2n li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n. S\u1eed d\u1ee5ng c\u00e1ch \u0111o \u0111\u01b0\u1eddng k\u00ednh tr\u1ee5c ng\u1eafn, teo \u0111a h\u1ec7 th\u1ed1ng c\u00f3 t\u1ef7 l\u1ec7 n\u00e3o gi\u1eefa\/c\u1ea7u n\u00e3o > 0.52 [10].
\nNgo\u00e0i ra, \u0111\u1eb7c \u0111i\u1ec3m teo cu\u1ed1ng ti\u1ec3u n\u00e3o gi\u1eefa (chi\u1ec1u r\u1ed9ng cu\u1ed1ng ti\u1ec3u n\u00e3o gi\u1eefa < 8mm \u1edf m\u1eb7t c\u1eaft sagittal) c\u1ee7a teo \u0111a h\u1ec7 th\u1ed1ng c\u0169ng gi\u00fap ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi b\u1ec7nh Parkinson c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 100%. T\u1ef7 l\u1ec7 cu\u1ed1ng ti\u1ec3u n\u00e3o gi\u1eefa \/cu\u1ed1ng ti\u1ec3u n\u00e3o c\u0169ng th\u1ea5p h\u01a1n \u1edf b\u1ec7nh nh\u00e2n teo \u0111a h\u1ec7 th\u1ed1ng.
\nCh\u1ec9 s\u1ed1 Parkinson c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRPI) [= di\u1ec7n t\u00edch c\u1ea7u n\u00e3o \/n\u00e3o gi\u1eefa) * (chi\u1ec1u r\u1ed9ng cu\u1ed1ng ti\u1ec3u n\u00e3o gi\u1eefa\/cu\u1ed1ng ti\u1ec3u n\u00e3o tr\u00ean)] \u0111ang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y c\u00f3 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao h\u01a1n nh\u01b0ng \u0111\u1ed9 nh\u1ea1y th\u1ea5p h\u01a1n so v\u1edbi t\u1ef7 s\u1ed1 n\u00e3o gi\u1eefa\/c\u1ea7u n\u00e3o trong vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t teo \u0111a h\u1ec7 th\u1ed1ng v\u00e0 li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n.<\/p>\n

\"\"<\/a><\/p>\n

H\u00ecnh 4. \u0110o k\u00edch th\u01b0\u1edbc tr\u01b0\u1edbc sau c\u1ea7u n\u00e3o \u0111o \u1edf kho\u1ea3ng c\u00e1ch l\u1edbn nh\u1ea5t vu\u00f4ng g\u00f3c v\u1edbi s\u00e0n c\u1ee7a n\u00e3o th\u1ea5t t\u01b0 (A, B), \u0111o k\u00edch th\u01b0\u1edbc trung n\u00e3o (C, D) [11]<\/p>\n

\u2013 Ch\u1ee5p c\u1eaft l\u1edbp ph\u00e1t x\u1ea1 Positron s\u1eed d\u1ee5ng fluorodeoxyglucose 18-F (FDG-PET) \u1edf b\u1ec7nh nh\u00e2n MSA c\u00f3 th\u1ec3 th\u1ea5y t\u00ecnh tr\u1ea1ng gi\u1ea3m chuy\u1ec3n h\u00f3a glucose khu v\u1ef1c trong th\u1ec3 v\u00e2n, th\u00e2n n\u00e3o v\u00e0 ti\u1ec3u n\u00e3o v\u00e0 m\u00f4 h\u00ecnh chuy\u1ec3n h\u00f3a c\u1ee5 th\u1ec3 li\u00ean quan \u0111\u1ebfn teo \u0111a h\u1ec7 th\u1ed1ng, nh\u01b0ng \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u th\u1ef1c s\u1ef1 c\u1ee7a nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y \u0111\u1ec3 ph\u00e2n bi\u1ec7t teo \u0111a h\u1ec7 th\u1ed1ng v\u00e0 b\u1ec7nh Parkinson v\u1eabn ch\u01b0a ch\u1eafc ch\u1eafn.
\n\u2013 SPECT: Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ph\u00e1t x\u1ea1 \u0111\u01a1n photon s\u1eed d\u1ee5ng 99m Tc-ECD l\u00e0m ch\u1ea5t \u0111\u00e1nh d\u1ea5u cho th\u1ea5y h\u00ecnh \u1ea3nh gi\u1ea3m t\u01b0\u1edbi m\u00e1u \u1edf th\u1ec3 v\u00e2n, th\u00e2n n\u00e3o v\u00e0 ti\u1ec3u n\u00e3o gi\u00fap ph\u00e2n bi\u1ec7t teo \u0111a h\u1ec7 th\u1ed1ng v\u1edbi b\u1ec7nh Parkinson (\u0111\u1ed9 nh\u1ea1y 73,3%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 84%).<\/p>\n

5.2. C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c<\/strong><\/h3>\n

\u2013 C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 r\u1ed1i lo\u1ea1n th\u1ea7n kinh th\u1ef1c v\u1eadt: holter \u0111i\u1ec7n tim v\u00e0 huy\u1ebft \u00e1p 24 gi\u1edd gi\u00fap \u0111\u00e1nh gi\u00e1 nguy c\u01a1 h\u1ea1 huy\u1ebft \u00e1p th\u1ebf \u0111\u1ee9ng.
\n\u2013 Ghi \u0111i\u1ec7n c\u01a1 co th\u1eaft b\u00e0ng quang
\n\u2013 Si\u00eau \u00e2m \u0111\u00e1nh gi\u00e1 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u t\u1ed3n d\u01b0
\n\u2013 Ghi \u0111a k\u00fd gi\u1ea5c ng\u1ee7: ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng ng\u1eebng th\u1edf khi ng\u1ee7, h\u1ed9i ch\u1ee9ng ch\u00e2n kh\u00f4ng y\u00ean ho\u1eb7c c\u00e1c r\u1ed1i lo\u1ea1n h\u00e0nh vi ban \u0111\u00eam.<\/p>\n

6. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n<\/strong><\/h2>\n

Ch\u1ea9n \u0111o\u00e1n ch\u1eafc ch\u1eafn b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng ch\u1ec9 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c qua gi\u1ea3i ph\u1eabu b\u1ec7nh. N\u1ebfu ch\u1ec9 d\u1ef1a tr\u00ean l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc, ch\u1ec9 c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n teo \u0111a h\u1ec7 th\u1ed1ng \u1edf m\u1ee9c \u0111\u1ed9 \u201cc\u00f3 th\u1ec3\u201d v\u00e0 \u201cc\u00f3 kh\u1ea3 n\u0103ng\u201d.
\nN\u0103m 2008, c\u00e1c chuy\u00ean gia v\u1ec1 teo \u0111a h\u1ec7 th\u1ed1ng (MSA) bao g\u1ed3m c\u00e1c nh\u00e0 l\u00e2m s\u00e0ng, b\u1ec7nh l\u00fd h\u1ecdc, v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc \u0111\u00e3 th\u1ed1ng nh\u1ea5t b\u1ea3n \u0111\u1ed3ng thu\u1eadn v\u1ec1 c\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n teo \u0111a h\u1ec7 th\u1ed1ng c\u1ee7a H\u1ed9i Th\u1ea7n kinh Hoa K\u1ef3 v\u00e0 H\u1ed9i Th\u1ea7n kinh Th\u1ef1c v\u1eadt Hoa K\u1ef3 [12], bao g\u1ed3m c\u00e1c b\u1ea3ng sau:
\nB\u1ea3ng 1: Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n \u201cc\u00f3 th\u1ec3 l\u00e0 MSA\u201d (probable MSA):
\nB\u1ec7nh kh\u1edfi ph\u00e1t \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh tr\u00ean 30 tu\u1ed5i, ti\u1ebfn tri\u1ec3n d\u1ea7n, xu\u1ea5t hi\u1ec7n r\u1ea3i r\u00e1c, v\u1edbi c\u00e1c \u0111\u1eb7c tr\u01b0ng: R\u1ed1i lo\u1ea1n th\u1ea7n kinh th\u1ef1c v\u1eadt c\u00f3 li\u00ean quan \u0111\u1ebfn ti\u1ec3u kh\u00f4ng t\u1ef1 ch\u1ee7 (kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng ki\u1ec3m so\u00e1t b\u00e0i ti\u1ebft n\u01b0\u1edbc ti\u1ec3u t\u1eeb b\u00e0ng quang, nam gi\u1edbi th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n c\u00f9ng r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng) ho\u1eb7c t\u1ee5t huy\u1ebft \u00e1p t\u01b0 th\u1ebf trong v\u00f2ng 3 ph\u00fat khi \u0111\u1ee9ng, v\u1edbi huy\u1ebft \u00e1p t\u00e2m thu gi\u1ea3m \u00edt nh\u1ea5t 30mmHg, ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng gi\u1ea3m \u00edt nh\u1ea5t 15mmHg, V\u00c0 m\u1ed9t trong nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m sau:
\n\u2022 H\u1ed9i ch\u1ee9ng Parkinson (gi\u1ea3m \u0111\u1ed9ng v\u1edbi c\u1ee9ng, run, m\u1ea5t th\u0103ng b\u1eb1ng t\u01b0 th\u1ebf) \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi Levodopa (d\u01b0\u1edbi nh\u00f3m Parkinson [MSA-P])
\n\u2022 H\u1ed9i ch\u1ee9ng ti\u1ec3u n\u00e3o (th\u1ea5t \u0111i\u1ec1u d\u00e1ng \u0111i, lo\u1ea1n v\u1eadn ng\u00f4n do ti\u1ec3u n\u00e3o \u2013 cerebellar dysarthria, th\u1ea5t \u0111i\u1ec1u chi, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng v\u1eadn nh\u00e3n do ti\u1ec3u n\u00e3o) (d\u01b0\u1edbi nh\u00f3m ti\u1ec3u n\u00e3o [MSA-C])
\nB\u1ea3ng 2: Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n \u201cc\u00f3 kh\u1ea3 n\u0103ng l\u00e0 MSA\u201d (possible MSA):
\nB\u1ec7nh kh\u1edfi ph\u00e1t \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh tr\u00ean 30 tu\u1ed5i, ti\u1ebfn tri\u1ec3n d\u1ea7n, xu\u1ea5t hi\u1ec7n r\u1ea3i r\u00e1c, v\u1edbi \u0111\u1eb7c \u0111i\u1ec3m sau:
\n\u2022 H\u1ed9i ch\u1ee9ng Parkinson (gi\u1ea3m \u0111\u1ed9ng v\u1edbi c\u1ee9ng, run, m\u1ea5t th\u0103ng b\u1eb1ng t\u01b0 th\u1ebf) HO\u1eb6C h\u1ed9i ch\u1ee9ng ti\u1ec3u n\u00e3o (th\u1ea5t \u0111i\u1ec1u d\u00e1ng \u0111i, lo\u1ea1n v\u1eadn ng\u00f4n do ti\u1ec3u n\u00e3o, th\u1ea5t \u0111i\u1ec1u chi, ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng v\u1eadn nh\u00e3n do ti\u1ec3u n\u00e3o) V\u00c0
\n\u2022 \u00cdt nh\u1ea5t 1 \u0111\u1eb7c \u0111i\u1ec3m g\u1ee3i \u00fd c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ef1c v\u1eadt (ch\u1ee9ng ti\u1ec3u g\u1ea5p m\u00e0 kh\u00f4ng gi\u1ea3i th\u00edch b\u1eb1ng l\u00fd do kh\u00e1c, ph\u1ea3i ti\u1ec3u th\u01b0\u1eddng xuy\u00ean ho\u1eb7c ti\u1ec3u kh\u00f4ng h\u1ebft b\u00e3i, r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng \u1edf nam, ho\u1eb7c h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf r\u00f5 r\u1ec7t nh\u01b0ng kh\u00f4ng th\u1ecfa m\u00e3n ti\u00eau ch\u00ed \u201cc\u00f3 th\u1ec3 l\u00e0 MSA\u201d) V\u00c0
\n\u2022 \u00cdt nh\u1ea5t c\u00f3 1 d\u1ea5u hi\u1ec7u b\u1ed5 sung, \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea trong b\u1ea3ng 3
\nB\u1ea3ng 3: C\u00e1c d\u1ea5u hi\u1ec7u b\u1ed5 sung c\u1ee7a \u201cc\u00f3 kh\u1ea3 n\u0103ng l\u00e0 MSA\u201d:
\nC\u00f3 kh\u1ea3 n\u0103ng MSA-P ho\u1eb7c MSA-C
\n\u2022 D\u1ea5u hi\u1ec7u Babinski k\u00e8m t\u0103ng ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng.
\n\u2022 Th\u1edf r\u00edt (stridor).
\nC\u00f3 kh\u1ea3 n\u0103ng MSA-P
\n\u2022 H\u1ed9i ch\u1ee9ng Parkinson ti\u1ebfn tri\u1ec3n nhanh.
\n\u2022 \u0110\u00e1p \u1ee9ng k\u00e9m v\u1edbi levodopa.
\n\u2022 M\u1ea5t \u1ed5n \u0111\u1ecbnh t\u01b0 th\u1ebf trong v\u00f2ng 3 n\u0103m k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng.
\n\u2022 Th\u1ea5t \u0111i\u1ec1u d\u00e1ng \u0111i, lo\u1ea1n v\u1eadn ng\u00f4n do ti\u1ec3u n\u00e3o, th\u1ea5t \u0111i\u1ec1u chi, ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng v\u1eadn nh\u00e3n do ti\u1ec3u n\u00e3o.
\n\u2022 Kh\u00f3 nu\u1ed1t trong v\u00f2ng 5 n\u0103m k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng.
\n\u2022 H\u00ecnh \u1ea3nh teo c\u00e1c v\u00f9ng nh\u00e2n b\u00e8o s\u1eabm, cu\u1ed1ng ti\u1ec3u n\u00e3o gi\u1eefa, c\u1ea7u n\u00e3o ho\u1eb7c ti\u1ec3u n\u00e3o tr\u00ean phim c\u1ed9ng h\u01b0\u1edfng t\u1eeb.
\n\u2022 Gi\u1ea3m chuy\u1ec3n h\u00f3a tr\u00ean phim FDG-PET c\u1ee7a b\u00e8o s\u1eabm, th\u00e2n n\u00e3o ho\u1eb7c ti\u1ec3u n\u00e3o.
\nC\u00f3 kh\u1ea3 n\u0103ng MSA-C
\n\u2022 H\u1ed9i ch\u1ee9ng Parkinson (gi\u1ea3m \u0111\u1ed9ng v\u00e0 c\u1ee9ng)
\n\u2022 MRI v\u1edbi h\u00ecnh \u1ea3nh teo b\u00e8o s\u1eabm, cu\u1ed1ng ti\u1ec3u n\u00e3o gi\u1eefa, c\u1ea7u n\u00e3o
\n\u2022 Gi\u1ea3m chuy\u1ec3n h\u00f3a tr\u00ean FDG-PET \u1edf b\u00e8o s\u1eabm
\n\u2022 M\u1ea5t ph\u00e2n b\u1ed1 ch\u1ea5t d\u1eabn truy\u1ec1n dopamin tr\u01b0\u1edbc synap t\u1ea1i ch\u1ea5t \u0111en \u2013 th\u1ec3 v\u00e2n tr\u00ean SPECT ho\u1eb7c PET
\nB\u1ea3ng 4: C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m h\u1ed7 tr\u1ee3 (d\u1ea5u hi\u1ec7u c\u1edd \u0111\u1ecf) v\u00e0 kh\u00f4ng h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n MSA
\n* \u0110\u1eb7c \u0111i\u1ec3m h\u1ed7 tr\u1ee3:
\n\u2022 Lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 mi\u1ec7ng m\u1eb7t
\n\u2022 Lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 c\u1ed5 g\u1eadp tr\u01b0\u1edbc kh\u00f4ng c\u00e2n x\u1ee9ng
\n\u2022 Camptocormia (c\u1ed9t s\u1ed1ng g\u1eadp v\u1ec1 ph\u00eda tr\u01b0\u1edbc nghi\u00eam tr\u1ecdng) v\u00e0\/ho\u1eb7c h\u1ed9i ch\u1ee9ng Pisa (c\u1ed9t s\u1ed1ng cong v\u1ec1 m\u1ed9t b\u00ean nghi\u00eam tr\u1ecdng)
\n\u2022 Co c\u1ee9ng c\u01a1 b\u00e0n tay ho\u1eb7c b\u00e0n ch\u00e2n
\n\u2022 Th\u1edf kh\u00f2 kh\u00e8
\n\u2022 R\u1ed1i lo\u1ea1n ph\u00e1t \u00e2m n\u1eb7ng
\n\u2022 Kh\u00f3 n\u00f3i n\u1eb7ng
\n\u2022 Ng\u00e1y m\u1edbi ho\u1eb7c gia t\u0103ng
\n\u2022 Tay v\u00e0 ch\u00e2n l\u1ea1nh
\n\u2022 Kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c c\u1ea3m x\u00fac (c\u01b0\u1eddi ho\u1eb7c kh\u00f3c b\u1ec7nh l\u00fd)
\n\u2022 Run gi\u1eadt b\u1ea5t th\u01b0\u1eddng ho\u1eb7c run t\u01b0 th\u1ebf ho\u1eb7c run khi v\u1eadn \u0111\u1ed9ng
\n* \u0110\u1eb7c \u0111i\u1ec3m kh\u00f4ng h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n MSA
\n\u2022 Run khi ngh\u1ec9 ki\u1ec3u \u201cv\u00ea thu\u1ed1c\u201d \u0111i\u1ec3n h\u00ecnh
\n\u2022 B\u1ec7nh l\u00fd th\u1ea7n kinh ngo\u1ea1i bi\u00ean r\u00f5 r\u1ec7t tr\u00ean l\u00e2m s\u00e0ng
\n\u2022 \u1ea2o gi\u00e1c kh\u00f4ng do thu\u1ed1c.
\n\u2022 Kh\u1edfi ph\u00e1t sau 75 tu\u1ed5i.
\n\u2022 Ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 bi\u1ec3u hi\u1ec7n th\u1ea5t \u0111i\u1ec1u ho\u1eb7c h\u1ed9i ch\u1ee9ng Parkinson.
\n\u2022 Sa s\u00fat tr\u00ed tu\u1ec7 (ph\u00f9 h\u1ee3p v\u1edbi ti\u00eau chu\u1ea9n DSM-IV).
\n\u2022 T\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng g\u1ee3i \u00fd b\u1ec7nh x\u01a1 c\u1ee9ng r\u1ea3i r\u00e1c.<\/p>\n

7. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/strong><\/h2>\n

Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t quan tr\u1ecdng c\u1ee7a MSA-P l\u00e0 v\u1edbi b\u1ec7nh Parkinson v\u00e0 v\u1edbi c\u00e1c h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh kh\u00e1c, ch\u1ee7 y\u1ebfu l\u00e0 li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n v\u00e0 tho\u00e1i h\u00f3a v\u1ecf h\u1ea1ch n\u1ec1n.
\n\u2013 B\u1ec7nh Parkinson:
\nTrong giai \u0111o\u1ea1n \u0111\u1ea7u, kh\u00f3 ph\u00e2n bi\u1ec7t MSA-P v\u1edbi b\u1ec7nh Parkinson v\u00f4 c\u0103n. Teo \u0111a h\u1ec7 th\u1ed1ng th\u01b0\u1eddng \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi levodopa, ti\u1ebfn tri\u1ec3n \u0111\u1ebfn t\u00e0n t\u1eadt nhanh ch\u00f3ng v\u00e0 xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 r\u1ed1i lo\u1ea1n th\u1ea7n kinh t\u1ef1 ch\u1ee7 r\u00f5, c\u1ee9ng v\u00e0 ch\u1eadm v\u1eadn \u0111\u1ed9ng kh\u00f4ng t\u01b0\u01a1ng x\u1ee9ng v\u1edbi run, n\u00f3i kh\u00f3 nghi\u00eam tr\u1ecdng, th\u1edf r\u00edt, ng\u00e3 s\u1edbm.
\n\u2013 Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebft tri\u1ec3n: B\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 li\u1ec7t li\u1ebfc d\u1ecdc, ng\u00e3 xu\u1ea5t hi\u1ec7n s\u1edbm h\u01a1n teo \u0111a h\u1ec7 th\u1ed1ng v\u00e0 kh\u00f4ng c\u00f3 h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf.
\n\u2013 Tho\u00e1i h\u00f3a v\u1ecf h\u1ea1ch n\u1ec1n: B\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 m\u1ea5t th\u1ef1c d\u1ee5ng \u0111\u1ed9ng t\u00e1c, lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1, gi\u1eadt c\u01a1, h\u1ed9i ch\u1ee9ng b\u00e0n tay ng\u01b0\u1eddi ngo\u00e0i h\u00e0nh tinh, m\u1ea5t c\u1ea3m gi\u00e1c v\u1ecf n\u00e3o.
\nMSA-C c\u00f3 th\u1ec3 b\u1ecb ch\u1ea9n \u0111o\u00e1n nh\u1ea7m v\u1edbi:
\n\u2013 Th\u1ea5t \u0111i\u1ec1u t\u1ee7y ti\u1ec3u n\u00e3o.
\n\u2013 Th\u1ea5t \u0111i\u1ec1u Friendreich kh\u1edfi ph\u00e1t mu\u1ed9n
\n\u2013 FXTAS: h\u1ed9i ch\u1ee9ng run\/th\u1ea5t \u0111i\u1ec1u c\u00f3 li\u00ean quan \u0111\u1ebfn nhi\u1ec5m s\u1eafc th\u1ec3 X d\u1ec5 g\u00e3y<\/p>\n

8. \u0110i\u1ec1u tr\u1ecb<\/strong><\/h2>\n

Hi\u1ec7n nay ch\u01b0a c\u00f3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u n\u00e0o cho teo \u0111a h\u1ec7 th\u1ed1ng, ch\u1ee7 y\u1ebfu l\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng, ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng v\u00e0 ch\u0103m s\u00f3c h\u1ed7 tr\u1ee3.
\nTri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng
\n\u2013 Levodopa: C\u00e1c tri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng c\u1ee7a b\u1ec7nh nh\u00e2n teo \u0111a h\u1ec7 th\u1ed1ng th\u01b0\u1eddng \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi thu\u1ed1c. N\u00ean t\u0103ng li\u1ec1u levodopa m\u1ed9t c\u00e1ch t\u1eeb t\u1eeb \u0111\u1ec3 gi\u1ea3m thi\u1ec3u \u0111\u1ee3t c\u1ea5p c\u1ee7a h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf \u0111\u1ee9ng, ph\u00f9 v\u00e0 bu\u1ed3n n\u00f4n. Vi\u1ec7c ng\u1eebng s\u1eed d\u1ee5ng Levodopa \u0111\u1ed9t ng\u1ed9t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 \u0111\u00e1p \u1ee9ng r\u00f5 r\u00e0ng \u0111\u00f4i khi l\u00e0m n\u1eb7ng h\u01a1n c\u00e1c v\u1eadn \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng v\u00e0 kh\u00f4ng th\u1ec3 h\u1ed3i ph\u1ee5c.
\n\u2013 Thu\u1ed1c \u0111\u1ed3ng v\u1eadn dopamine \u00edt c\u00f3 hi\u1ec7u qu\u1ea3 c\u1ea3i thi\u1ec7n v\u1eadn \u0111\u1ed9ng v\u00e0 th\u01b0\u1eddng l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam t\u00ecnh tr\u1ea1ng h\u1ea1 huy\u1ebft \u00e1p th\u1ebf \u0111\u1ee9ng, c\u00e1c tri\u1ec7u ch\u1ee9ng ti\u00eau h\u00f3a v\u00e0 r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7 trong b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng.
\n\u2013 B\u1eb1ng ch\u1ee9ng v\u1ec1 hi\u1ec7u qu\u1ea3 c\u1ee7a amantadine (ch\u1ea5t \u0111\u1ed1i kh\u00e1ng ch\u1ecdn l\u1ecdc c\u00e1c th\u1ee5 th\u1ec3 NMDA) c\u00f2n \u0111ang tranh c\u00e3i.
\n\u2013 Ti\u00eam \u0111\u1ed9c t\u1ed1 botulinum c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 \u1edf chi ho\u1eb7c lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 tr\u1ee5c th\u00e2n.
\n\u2013 Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng v\u00e0 ng\u00f4n ng\u1eef gi\u00fap cho b\u1ec7nh nh\u00e2n gi\u1ea3m t\u00e9 ng\u00e3 v\u00e0 t\u0103ng c\u01b0\u1eddng kh\u1ea3 n\u0103ng giao ti\u1ebfp.
\nC\u00e1c tri\u1ec7u ch\u1ee9ng ngo\u00e0i v\u1eadn \u0111\u1ed9ng
\nH\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf
\nC\u00f3 th\u1ec3 s\u1eed d\u1ee5ng fludrocortisone acetate l\u00e0 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay \u0111\u1ec3 t\u0103ng th\u1ec3 t\u00edch l\u00f2ng m\u1ea1ch. Ngo\u00e0i ra c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng midodrine (thu\u1ed1c ch\u1ee7 v\u1eadn alpha-1 adrenergic) v\u00e0 droxidopa (ti\u1ec1n ch\u1ea5t norepinephrine). C\u00e1c bi\u1ec7n ph\u00e1p kh\u00f4ng d\u00f9ng thu\u1ed1c bao g\u1ed3m u\u1ed1ng nhi\u1ec1u n\u01b0\u1edbc v\u00e0 mu\u1ed1i, \u0111i t\u1ea5t \u00e1p l\u1ef1c, thay \u0111\u1ed5i t\u01b0 th\u1ebf t\u1eeb t\u1eeb v\u00e0 n\u00e2ng cao \u0111\u1ea7u gi\u01b0\u1eddng 10-20 \u0111\u1ed9.
\nTrong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n c\u00f3 h\u1ea1 huy\u1ebft \u00e1p sau \u0103n c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng octreotide ti\u00eam d\u01b0\u1edbi da 30 ph\u00fat tr\u01b0\u1edbc m\u1ed7i b\u1eefa \u0103n. Ngo\u00e0i ra, b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n \u0103n nhi\u1ec1u b\u1eefa nh\u1ecf, c\u00e1c b\u1eefa \u0103n \u00edt carbohydrate, tr\u00e1nh h\u1ea1n ch\u1ebf mu\u1ed1i, tr\u00e1nh \u0111\u1ee9ng d\u1eady \u0111\u1ed9t ng\u1ed9t ho\u1eb7c \u0111\u1ee9ng y\u00ean sau b\u1eefa \u0103n, \u0111i b\u1ed9 gi\u1eefa c\u00e1c b\u1eefa \u0103n; n\u1ebfu \u0111i b\u1ed9 kh\u00f4ng \u0111\u01b0\u1ee3c, n\u1eb1m v\u1edbi \u0111\u1ea7u gi\u01b0\u1eddng 45 \u0111\u1ed9 trong 90 ph\u00fat sau b\u1eefa \u0103n.
\nTi\u1ebft ni\u1ec7u, sinh d\u1ee5c
\nB\u00e0ng quang t\u0103ng ho\u1ea1t g\u00e2y ti\u1ec3u kh\u00f4ng ki\u1ec3m so\u00e1t c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c kh\u00e1ng h\u1ec7 muscarinic oxybutynin ho\u1eb7c tolterodine. \u0110\u1ed1i v\u1edbi b\u00e0ng quang m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c, s\u1eed d\u1ee5ng \u0111\u1eb7t \u1ed1ng th\u00f4ng ng\u1eaft qu\u00e3ng khi th\u1ec3 t\u00edch n\u01b0\u1edbc ti\u1ec3u t\u1ed3n d\u01b0 >100ml.
\nR\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng: C\u00e1c thu\u1ed1c nh\u01b0 sildenafil 50 mg ho\u1eb7c tadalafil 2,5 \u0111\u1ebfn 5 mg m\u1ed9t l\u1ea7n\/ng\u00e0y v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p v\u1eadt l\u00fd tr\u1ecb li\u1ec7u kh\u00e1c.
\nTh\u1edf r\u00edt
\nTh\u1edf \u00e1p l\u1ef1c d\u01b0\u01a1ng li\u00ean t\u1ee5c v\u1ec1 \u0111\u00eam l\u00e0 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb cho h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n. M\u1edf kh\u00ed qu\u1ea3n trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng.
\nT\u00e1o b\u00f3n
\nC\u00f3 th\u1ec3 s\u1eed d\u1ee5ng ch\u1ebf \u0111\u1ed9 \u0103n nhi\u1ec1u ch\u1ea5t x\u01a1 v\u00e0 ch\u1ea5t l\u00e0m m\u1ec1m ph\u00e2n; \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u00e1p \u1ee9ng k\u00e9m c\u00f3 th\u1ec3 c\u1ea7n th\u1ee5t th\u00e1o.<\/p>\n

9. Ti\u1ebfn tri\u1ec3n v\u00e0 ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh<\/strong><\/h2>\n

Teo \u0111a h\u1ec7 th\u1ed1ng \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 ti\u1ebfn tri\u1ec3n x\u1ea5u \u0111i kh\u00f4ng ng\u1eebng c\u1ee7a c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng v\u00e0 kh\u00f4ng v\u1eadn \u0111\u1ed9ng trong kho\u1ea3ng th\u1eddi gian trung b\u00ecnh l\u00e0 10 n\u0103m. Kho\u1ea3ng 50% b\u1ec7nh nh\u00e2n c\u1ea7n h\u1ed7 tr\u1ee3 \u0111i l\u1ea1i trong v\u00f2ng 3 n\u0103m sau khi b\u1eaft \u0111\u1ea7u c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng, 60% ph\u1ea3i ng\u1ed3i xe l\u0103n sau 5 n\u0103m, v\u00e0 th\u1eddi gian trung b\u00ecnh tr\u01b0\u1edbc khi b\u1ec7nh nh\u00e2n n\u1eb1m li\u1ec7t gi\u01b0\u1eddng l\u00e0 6 \u0111\u1ebfn 8 n\u0103m. Nguy\u00ean nh\u00e2n t\u1eed vong trong b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng th\u01b0\u1eddng bao g\u1ed3m vi\u00eam ph\u1ebf qu\u1ea3n ph\u1ed5i, nhi\u1ec5m tr\u00f9ng ti\u1ebft ni\u1ec7u, ho\u1eb7c \u0111\u1ed9t t\u1eed. \u0110\u1ed9t t\u1eed th\u01b0\u1eddng x\u1ea3y ra v\u00e0o ban \u0111\u00eam v\u00e0 \u0111\u01b0\u1ee3c cho l\u00e0 do r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p trung \u01b0\u01a1ng, ng\u1ea1t th\u1edf do \u0111\u1eddm v\u00e0 th\u1ee9c \u0103n, r\u1ed1i lo\u1ea1n th\u1ea7n kinh t\u1ef1 ch\u1ee7 c\u1ee7a tim ho\u1eb7c s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 n\u00e0y.<\/p>\n

T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/h2>\n

1. Bower J.H., Maraganore D.M., McDonnell S.K. and et al. (1997). Incidence of progressive supranuclear palsy and multiple system atrophy in Olmsted County, Minnesota, 1976 to 1990. Neurology, 49(5), 1284\u20131288.
\n2. Sailer A., Scholz S.W., Nalls M.A. and et al. (2016). A genome-wide association study in multiple system atrophy. Neurology, 87(15), 1591\u20131598.
\n3. Wenning G.K., Colosimo C., Geser F. and et al. (2004). Multiple system atrophy. The Lancet Neurology, 3(2), 93\u2013103.
\n4. K\u00f6llensperger M., Geser F., Seppi K. and et al. (2008). Red flags for multiple system atrophy. Movement disorders: official journal of the Movement Disorder Society, 23(8), 1093\u20131099.
\n5. Moreno-L\u00f3pez C., Santamar\u00eda J., Salamero M. and et al. (2011). Excessive daytime sleepiness in multiple system atrophy (SLEEMSA study). Archives of neurology, 68(2), 223\u2013230.
\n6. Stankovic I., Krismer F., Jesic A. and et al. (2014). Cognitive impairment in multiple system atrophy: a position statement by the Neuropsychology Task Force of the MDS Multiple System Atrophy (MODIMSA) study group. Movement Disorders, 29(7), 857\u2013867.
\n7. Schrag A., Good C.D., Miszkiel K. and et al. (2000). Differentiation of atypical Parkinsonian syndromes with routine MRI. Neurology, 54(3), 697\u2013697.
\n8. Lee E.A., Cho H.I., Kim S.S. and et al. (2004). Comparison of magnetic resonance imaging in subtypes of multiple system atrophy. Parkinsonism Relat Disord, 10(6), 363\u2013368.
\n9. Fanciulli A. v\u00e0 Wenning G.K. (2015). Multiple-system atrophy. New England Journal of Medicine, 372(3), 249\u2013263.
\n10. Massey L.A., J\u00e4ger H.R., Paviour D.C. and et al. (2013). The midbrain to pons ratio: a simple and specific MRI sign of progressive supranuclear palsy. Neurology, 80(20), 1856\u20131861.
\n11. Warmuth-Metz M., Naumann M., Csoti I. and et al. (2001). Measurement of the Midbrain Diameter on Routine Magnetic Resonance Imaging: A Simple and Accurate Method of Differentiating Between Parkinson Disease and Progressive Supranuclear Palsy. Archives of Neurology, 58(7), 1076\u20131079.
\n12. Gilman S., Wenning G.K., Low Pa. al and et al. (2008). Second consensus statement on the diagnosis of multiple system atrophy. Neurology, 71(9), 670\u2013676.<\/p>\n

1. Bower J.H., Maraganore D.M., McDonnell S.K. and et al. (1997). Incidence of progressive supranuclear palsy and multiple system atrophy in Olmsted County, Minnesota, 1976 to 1990. Neurology, 49(5), 1284\u20131288.
\n2. Sailer A., Scholz S.W., Nalls M.A. and et al. (2016). A genome-wide association study in multiple system atrophy. Neurology, 87(15), 1591\u20131598.
\n3. Wenning G.K., Colosimo C., Geser F. and et al. (2004). Multiple system atrophy. The Lancet Neurology, 3(2), 93\u2013103.
\n4. K\u00f6llensperger M., Geser F., Seppi K. and et al. (2008). Red flags for multiple system atrophy. Movement disorders: official journal of the Movement Disorder Society, 23(8), 1093\u20131099.
\n5. Moreno-L\u00f3pez C., Santamar\u00eda J., Salamero M. and et al. (2011). Excessive daytime sleepiness in multiple system atrophy (SLEEMSA study). Archives of neurology, 68(2), 223\u2013230.
\n6. Stankovic I., Krismer F., Jesic A. and et al. (2014). Cognitive impairment in multiple system atrophy: a position statement by the Neuropsychology Task Force of the MDS Multiple System Atrophy (MODIMSA) study group. Movement Disorders, 29(7), 857\u2013867.
\n7. Schrag A., Good C.D., Miszkiel K. and et al. (2000). Differentiation of atypical Parkinsonian syndromes with routine MRI. Neurology, 54(3), 697\u2013697.
\n8. Lee E.A., Cho H.I., Kim S.S. and et al. (2004). Comparison of magnetic resonance imaging in subtypes of multiple system atrophy. Parkinsonism Relat Disord, 10(6), 363\u2013368.
\n9. Fanciulli A. v\u00e0 Wenning G.K. (2015). Multiple-system atrophy. New England Journal of Medicine, 372(3), 249\u2013263.
\n10. Massey L.A., J\u00e4ger H.R., Paviour D.C. and et al. (2013). The midbrain to pons ratio: a simple and specific MRI sign of progressive supranuclear palsy. Neurology, 80(20), 1856\u20131861.
\n11. Warmuth-Metz M., Naumann M., Csoti I. and et al. (2001). Measurement of the Midbrain Diameter on Routine Magnetic Resonance Imaging: A Simple and Accurate Method of Differentiating Between Parkinson Disease and Progressive Supranuclear Palsy. Archives of Neurology, 58(7), 1076\u20131079.
\n12. Gilman S., Wenning G.K., Low Pa. al and et al. (2008). Second consensus statement on the diagnosis of multiple system atrophy. Neurology, 71(9), 670\u2013676.<\/p>\n","protected":false},"excerpt":{"rendered":"

Teo \u0111a h\u1ec7 th\u1ed1ng (MSA) l\u00e0 m\u1ed9t b\u1ec7nh tho\u00e1i h\u00f3a th\u1ea7n kinh ti\u1ebfn tri\u1ec3n t\u0103ng d\u1ea7n, th\u01b0\u1eddng g\u1eb7p th\u1ee9 hai trong h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh. B\u1ec7nh bi\u1ec3u hi\u1ec7n v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ed9i ch\u1ee9ng Parkinson, th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o, r\u1ed1i lo\u1ea1n th\u1ea7n kinh th\u1ef1c v\u1eadt v\u00e0 h\u1ed9i ch\u1ee9ng th\u00e1p. Ba\u0300i vi\u00ea\u0301t “T\u1ed5ng […]<\/p>\n","protected":false},"author":42,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"\nT\u1ed5ng quan b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng - Vinmec<\/title>\n<meta name=\"description\" content=\"Teo \u0111a h\u1ec7 th\u1ed1ng (MSA) l\u00e0 m\u1ed9t b\u1ec7nh tho\u00e1i h\u00f3a th\u1ea7n kinh ti\u1ebfn tri\u1ec3n t\u0103ng d\u1ea7n, th\u01b0\u1eddng g\u1eb7p th\u1ee9 hai trong h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.\" \/>\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=\"T\u1ed5ng quan b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Teo \u0111a h\u1ec7 th\u1ed1ng (MSA) l\u00e0 m\u1ed9t b\u1ec7nh tho\u00e1i h\u00f3a th\u1ea7n kinh ti\u1ebfn tri\u1ec3n t\u0103ng d\u1ea7n, th\u01b0\u1eddng g\u1eb7p th\u1ee9 hai trong h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tong-quan-benh-teo-da-he-thong\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-05-06T14:42:50+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/hoithankinhhocvietnam.com.vn\/wp-content\/uploads\/2022\/04\/17-509x1024.jpg\" \/>\n<meta name=\"author\" content=\"Minh Nguyen Phuong Hong\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Minh Nguyen Phuong Hong\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"23 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\/06\/tong-quan-benh-teo-da-he-thong\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tong-quan-benh-teo-da-he-thong\/\",\"name\":\"T\u1ed5ng quan b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng - Vinmec\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-05-06T14:42:50+00:00\",\"dateModified\":\"2023-05-06T14:42:50+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/03b2d0bc3d50ddac2db2720cc5f983e5\"},\"description\":\"Teo \u0111a h\u1ec7 th\u1ed1ng (MSA) l\u00e0 m\u1ed9t b\u1ec7nh tho\u00e1i h\u00f3a th\u1ea7n kinh ti\u1ebfn tri\u1ec3n t\u0103ng d\u1ea7n, th\u01b0\u1eddng g\u1eb7p th\u1ee9 hai trong h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tong-quan-benh-teo-da-he-thong\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tong-quan-benh-teo-da-he-thong\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tong-quan-benh-teo-da-he-thong\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"T\u1ed5ng quan b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/03b2d0bc3d50ddac2db2720cc5f983e5\",\"name\":\"Minh Nguyen Phuong Hong\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/0.gravatar.com\/avatar\/6abe0451bc535a2494837653d4fdba14?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/0.gravatar.com\/avatar\/6abe0451bc535a2494837653d4fdba14?s=96&d=mm&r=g\",\"caption\":\"Minh Nguyen Phuong Hong\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/helennguyen24062002gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"T\u1ed5ng quan b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng - Vinmec","description":"Teo \u0111a h\u1ec7 th\u1ed1ng (MSA) l\u00e0 m\u1ed9t b\u1ec7nh tho\u00e1i h\u00f3a th\u1ea7n kinh ti\u1ebfn tri\u1ec3n t\u0103ng d\u1ea7n, th\u01b0\u1eddng g\u1eb7p th\u1ee9 hai trong h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"T\u1ed5ng quan b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng - Vinmec","og_description":"Teo \u0111a h\u1ec7 th\u1ed1ng (MSA) l\u00e0 m\u1ed9t b\u1ec7nh tho\u00e1i h\u00f3a th\u1ea7n kinh ti\u1ebfn tri\u1ec3n t\u0103ng d\u1ea7n, th\u01b0\u1eddng g\u1eb7p th\u1ee9 hai trong h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tong-quan-benh-teo-da-he-thong\/","og_site_name":"Vinmec","article_published_time":"2023-05-06T14:42:50+00:00","og_image":[{"url":"http:\/\/hoithankinhhocvietnam.com.vn\/wp-content\/uploads\/2022\/04\/17-509x1024.jpg"}],"author":"Minh Nguyen Phuong Hong","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Minh Nguyen Phuong Hong","Est. reading time":"23 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tong-quan-benh-teo-da-he-thong\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tong-quan-benh-teo-da-he-thong\/","name":"T\u1ed5ng quan b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng - Vinmec","isPartOf":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-05-06T14:42:50+00:00","dateModified":"2023-05-06T14:42:50+00:00","author":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/03b2d0bc3d50ddac2db2720cc5f983e5"},"description":"Teo \u0111a h\u1ec7 th\u1ed1ng (MSA) l\u00e0 m\u1ed9t b\u1ec7nh tho\u00e1i h\u00f3a th\u1ea7n kinh ti\u1ebfn tri\u1ec3n t\u0103ng d\u1ea7n, th\u01b0\u1eddng g\u1eb7p th\u1ee9 hai trong h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tong-quan-benh-teo-da-he-thong\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tong-quan-benh-teo-da-he-thong\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tong-quan-benh-teo-da-he-thong\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"T\u1ed5ng quan b\u1ec7nh teo \u0111a h\u1ec7 th\u1ed1ng"}]},{"@type":"WebSite","@id":"http:\/\/noithathoaphat.in\/ctv\/#website","url":"http:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/03b2d0bc3d50ddac2db2720cc5f983e5","name":"Minh Nguyen Phuong Hong","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/0.gravatar.com\/avatar\/6abe0451bc535a2494837653d4fdba14?s=96&d=mm&r=g","contentUrl":"http:\/\/0.gravatar.com\/avatar\/6abe0451bc535a2494837653d4fdba14?s=96&d=mm&r=g","caption":"Minh Nguyen Phuong Hong"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/helennguyen24062002gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/31042"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/42"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=31042"}],"version-history":[{"count":1,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/31042\/revisions"}],"predecessor-version":[{"id":31045,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/31042\/revisions\/31045"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=31042"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=31042"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=31042"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}