{"id":31046,"date":"2023-05-06T21:42:29","date_gmt":"2023-05-06T14:42:29","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31046"},"modified":"2023-05-06T21:42:29","modified_gmt":"2023-05-06T14:42:29","slug":"nhan-xet-mot-so-dac-diem-lam-sang-can-lam-sang-va-yeu-to-lien-quan-tai-phat-cua-benh-nhan-viem-tuy-ngang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/nhan-xet-mot-so-dac-diem-lam-sang-can-lam-sang-va-yeu-to-lien-quan-tai-phat-cua-benh-nhan-viem-tuy-ngang\/","title":{"rendered":"Nh\u1eadn x\u00e9t m\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng v\u00e0 y\u1ebfu t\u1ed1 li\u00ean quan t\u00e1i ph\u00e1t c\u1ee7a b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee7y ngang"},"content":{"rendered":"

Vi\u00eam t\u1ee7y ngang (transerve myelitis) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd vi\u00eam mi\u1ec5n d\u1ecbch c\u1ea5p t\u00ednh ho\u1eb7c b\u00e1n c\u1ea5p \u1ea3nh h\u01b0\u1edfng t\u1edbi c\u00e1c ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng, c\u1ea3m gi\u00e1c v\u00e0 th\u1ea7n kinh t\u1ef1 \u0111\u1ed9ng c\u1ee7a t\u1ee7y s\u1ed1ng do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau, \u0111\u00e2y l\u00e0 nh\u00f3m b\u1ec7nh kh\u00f4ng th\u01b0\u1eddng g\u1eb7p. T\u1ea1i Vi\u1ec7t Nam ch\u00fang t\u00f4i ch\u01b0a th\u1ea5y c\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u v\u1ec1 vi\u00eam t\u1ee7y, \u0111\u1eb7c bi\u1ec7t l\u00e0 r\u1ea5t \u00edt c\u00e1c d\u1eef li\u1ec7u v\u1ec1 t\u00e1i ph\u00e1t c\u0169ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng. V\u00ec v\u1eady ch\u00fang t\u00f4i ti\u1ebfn h\u00e0nh nghi\u00ean c\u1ee9u n\u00e0y nh\u1eb1m b\u01b0\u1edbc \u0111\u1ea7u m\u00f4 t\u1ea3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng v\u00e0 m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng t\u00e1i ph\u00e1t c\u1ee7a b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee7y ngang.<\/strong><\/p>\n

\"Vi\u00eam
Vi\u00eam tu\u0309y ngang<\/figcaption><\/figure>\n

Ba\u0300i vi\u00ea\u0301t “Nh\u1eadn x\u00e9t m\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng v\u00e0 y\u1ebfu t\u1ed1 li\u00ean quan t\u00e1i ph\u00e1t c\u1ee7a b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee7y ngang” tri\u0301ch ngu\u00f4\u0300n t\u01b0\u0300 H\u00f4\u0323i Th\u00e2\u0300n Kinh ho\u0323c Vi\u00ea\u0323t Nam<\/strong><\/p>\n

Nguy\u1ec5n H\u1ed3ng Qu\u00e2n, Nguy\u1ec5n Cao Vinh, Ph\u1ea1m C\u1ea9m Di\u1ec7u Linh<\/strong>
\nNguy\u1ec5n T\u01b0\u1eddng Ng\u1ecdc Linh, Tr\u1ea7n Th\u1ecb Th\u00fay H\u1eb1ng<\/strong>
\nB\u1ec7nh vi\u1ec7n Trung \u01b0\u01a1ng Qu\u00e2n \u0111\u1ed9i 108<\/p>\n

T\u00d3M T\u1eaeT<\/strong><\/h2>\n

Ph\u01b0\u01a1ng ph\u00e1p nghi\u00ean c\u1ee9u: Nghi\u00ean c\u1ee9u m\u00f4 t\u1ea3, h\u1ed3i c\u1ee9u 25 b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb t\u1ea1i Khoa Th\u1ea7n kinh B\u1ec7nh vi\u1ec7n 108 t\u1eeb th\u00e1ng 1 n\u0103m 2014 \u0111\u1ebfn th\u00e1ng 5 n\u0103m 2019.
\nK\u1ebft qu\u1ea3: Tu\u1ed5i trung b\u00ecnh c\u1ee7a b\u1ec7nh nh\u00e2n nghi\u00ean c\u1ee9u l\u00e0 44,8 \u00b1 13,4 tu\u1ed5i, t\u1ef7 l\u1ec7 n\u1eef gi\u1edbi l\u00e0 52%, th\u1eddi gian ti\u1ebfn tri\u1ec3n d\u01b0\u1edbi 2 tu\u1ea7n l\u00e0 60%. T\u1ed5n th\u01b0\u01a1ng t\u1ee7y ng\u1ef1c 61,9%, t\u1ed5n th\u01b0\u01a1ng lan t\u1edbi h\u00e0nh t\u1ee7y 14,3%, t\u1ed5n th\u01b0\u01a1ng t\u1ee7y k\u00e9o d\u00e0i t\u1eeb 3 \u0111\u1ed1t s\u1ed1ng tr\u1edf l\u00ean chi\u1ebfm 90,5%. Bi\u1ebfn \u0111\u1ed5i d\u1ecbch n\u00e3o t\u1ee7y g\u1eb7p \u1edf 88% b\u1ec7nh nh\u00e2n, trong \u0111\u00f3 t\u0103ng t\u1ebf b\u00e0o 44%, t\u0103ng protein 56%, Pandy d\u01b0\u01a1ng t\u00ednh 68%. Trong th\u1eddi gian theo d\u00f5i trung b\u00ecnh 34 th\u00e1ng c\u00f3 59,1% b\u1ec7nh nh\u00e2n t\u00e1i ph\u00e1t. C\u00e1c y\u1ebfu t\u1ed1: t\u0103ng protein d\u1ecbch n\u00e3o t\u1ee7y, t\u1ed5n th\u01b0\u01a1ng t\u1ee7y k\u00e9o d\u00e0i t\u1eeb 3 \u0111\u1ed1t s\u1ed1ng tr\u1edf l\u00ean c\u00f3 nguy c\u01a1 t\u00e1i ph\u00e1t cao h\u01a1n. B\u1ec7nh nh\u00e2n t\u00e1i ph\u00e1t c\u00f3 t\u00ecnh tr\u1ea1ng ch\u1ee9c n\u0103ng x\u1ea5u h\u01a1n (mRs 3,0 \u00b1 1,9 so v\u1edbi 1,67 \u00b1 1,0 p < 0,01).
\nK\u1ebft lu\u1eadn: C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng t\u1ee7y k\u00e9o d\u00e0i t\u1eeb 3 \u0111\u1ed1t s\u1ed1ng tr\u1edf l\u00ean, t\u0103ng protein d\u1ecbch n\u00e3o t\u1ee7y c\u00f3 nguy c\u01a1 t\u00e1i ph\u00e1t cao. B\u1ec7nh nh\u00e2n t\u00e1i ph\u00e1t c\u00f3 h\u1eadu qu\u1ea3 ch\u1ee9c n\u0103ng x\u1ea5u h\u01a1n.
\nT\u1eeb kh\u00f3a: Vi\u00eam t\u1ee7y ngang, t\u00e1i ph\u00e1t.<\/p>\n

1. \u0110\u1eb6T V\u1ea4N \u0110\u1ec0<\/strong><\/h2>\n

Vi\u00eam t\u1ee7y ngang<\/a> (transerve myelitis) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd vi\u00eam mi\u1ec5n d\u1ecbch c\u1ea5p t\u00ednh ho\u1eb7c b\u00e1n c\u1ea5p c\u1ee7a t\u1ee7y s\u1ed1ng, \u1ea3nh h\u01b0\u1edfng t\u1edbi c\u00e1c ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng, c\u1ea3m gi\u00e1c v\u00e0 th\u1ea7n kinh t\u1ef1 \u0111\u1ed9ng c\u1ee7a t\u1ee7y s\u1ed1ng. C\u00e1c t\u00e0i li\u1ec7u g\u1ea7n \u0111\u00e2y cho th\u1ea5y vi\u00eam t\u1ee7y ngang l\u00e0 nh\u00f3m b\u1ec7nh l\u00fd c\u00f3 nguy c\u01a1 t\u00e1i ph\u00e1t cao. T\u1ef7 l\u1ec7 t\u00e1i ph\u00e1t t\u00f9y theo t\u1eebng nguy\u00ean nh\u00e2n, cao nh\u1ea5t l\u00e0 vi\u00eam t\u1ee7y th\u1ecb th\u1ea7n kinh (Neuromyelitis Optical: NMO) v\u00e0 B\u1ec7nh ph\u1ed5 vi\u00eam t\u1ee7y th\u1ecb th\u1ea7n kinh (Neuromyelitis Optical Spectrum disorder: NMOSD) c\u00f3 t\u1ef7 l\u1ec7 t\u00e1i ph\u00e1t t\u1edbi 90% sau 5 n\u0103m. T\u1ef7 l\u1ec7 t\u00e1i ph\u00e1t do c\u00e1c nguy\u00ean nh\u00e2n kh\u00f4ng ph\u1ea3i NMO v\u00e0 NMOSD dao \u0111\u1ed9ng kho\u1ea3ng 24,5-71%[1].
\nT\u1ea1i Vi\u1ec7t Nam ch\u00fang t\u00f4i ch\u01b0a th\u1ea5y c\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u v\u1ec1 vi\u00eam t\u1ee7y, \u0111\u1eb7c bi\u1ec7t l\u00e0 r\u1ea5t \u00edt c\u00e1c d\u1eef li\u1ec7u v\u1ec1 t\u00e1i ph\u00e1t c\u0169ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng. Trong \u0111i\u1ec1u ki\u1ec7n kh\u1ea3 n\u0103ng x\u00e9t nghi\u1ec7m \u0111\u1ec3 t\u1ea7m so\u00e1t nguy\u00ean nh\u00e2n r\u1ea5t h\u1ea1n ch\u1ebf th\u00ec vi\u1ec7c c\u00f3 th\u00eam nh\u1eefng d\u1eef li\u1ec7u s\u1eb5n c\u00f3 \u0111\u1ec3 l\u1ef1a ch\u1ecdn b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft. V\u00ec v\u1eady ch\u00fang t\u00f4i ti\u1ebfn h\u00e0nh nghi\u00ean c\u1ee9u n\u00e0y nh\u1eb1m: M\u00f4 t\u1ea3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng v\u00e0 m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 li\u00ean quan t\u00e1i ph\u00e1t c\u1ee7a b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee7y ngang.<\/p>\n

2. PH\u01af\u01a0NG PH\u00c1P<\/strong><\/h2>\n

Nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee7y nh\u1eadp vi\u1ec7n t\u1ea1i Khoa N\u1ed9i th\u1ea7n kinh \u2013 B\u1ec7nh vi\u1ec7n Trung \u01b0\u01a1ng Qu\u00e2n \u0111\u1ed9i 108 t\u1eeb n\u0103m 2014 t\u1edbi n\u0103m 2019. Thu th\u1eadp, \u0111\u00e1nh gi\u00e1 l\u1ea1i h\u1ed3 s\u01a1, phim c\u1ed9ng h\u01b0\u1edfng t\u1eeb v\u00e0 li\u00ean l\u1ea1c v\u1edbi b\u1ec7nh nh\u00e2n v\u00e0 gia \u0111\u00ecnh b\u1ec7nh nh\u00e2n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 l\u1ea1i ch\u1ea9n \u0111o\u00e1n v\u00e0 b\u01b0\u1edbc \u0111\u1ea7u \u0111\u00e1nh gi\u00e1 t\u00e1i ph\u00e1t, t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n t\u1ea1i th\u1eddi \u0111i\u1ec3m kh\u1ea3o s\u00e1t. Vi\u1ec7c \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh b\u1edfi \u00edt nh\u1ea5t 01 b\u00e1c s\u0129 n\u1ed9i th\u1ea7n kinh v\u00e0 01 b\u00e1c s\u0129 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh c\u00f3 kinh nghi\u1ec7m. Lo\u1ea1i kh\u1ecfi nghi\u00ean c\u1ee9u c\u00e1c b\u1ec7nh nh\u00e2n: t\u1ed5n th\u01b0\u01a1ng t\u1ee7y do b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u, u t\u1ee7y, ung th\u01b0, vi\u00eam t\u1ee7y do virut, t\u1ed5n th\u01b0\u01a1ng t\u1ee7y sau x\u1ea1 tr\u1ecb, t\u1ed5n th\u01b0\u01a1ng t\u1ee7y kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n, th\u1ea5t l\u1ea1c phim MRI.
\nCh\u00fang t\u00f4i xem x\u00e9t h\u1ed3 s\u01a1 t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n ch\u1ea9n \u0111o\u00e1n ban \u0111\u1ea7u l\u00e0 theo d\u00f5i vi\u00eam t\u1ee7y, nh\u1eadp Khoa N\u1ed9i Th\u1ea7n kinh \u2013 B\u1ec7nh vi\u1ec7n TWQ\u0110 108 t\u1eeb th\u00e1ng 1 n\u0103m 2014 \u0111\u1ebfn th\u00e1ng 05 n\u0103m 2019. C\u00f3 44 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ghi nh\u1eadn, sau khi thu th\u1eadp h\u1ed3 s\u01a1 \u0111\u00e1nh gi\u00e1 lo\u1ea1i tr\u1eeb c\u00f2n 25 b\u1ec7nh nh\u00e2n. C\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 \u0111\u1eb7c \u0111i\u1ec3m v\u1ec1 tu\u1ed5i, gi\u1edbi, t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh, \u0111\u1eb7c \u0111i\u1ec3m tr\u00ean phim MRI c\u1ed9t s\u1ed1ng, x\u00e9t nghi\u1ec7m d\u1ecbch n\u00e3o t\u1ee7y, c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb. T\u00e1i ph\u00e1t v\u00e0 t\u00ecnh tr\u1ea1ng ch\u1ee9c n\u0103ng t\u1ea1i th\u1eddi \u0111i\u1ec3m k\u1ebft th\u00fac \u0111\u00e1nh gi\u00e1 theo thang \u0111i\u1ec3m Rankin c\u1ea3i bi\u00ean (c\u00f3 22\/25 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u1ea1i). C\u00f3 4 b\u1ec7nh nh\u00e2n kh\u00f4ng r\u00f5 t\u1ed5n th\u01b0\u01a1ng tr\u00ean phim MRI tuy nhi\u00ean \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng, ti\u1ebfn tri\u1ec3n v\u00e0 theo d\u00f5i sau \u0111\u00f3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn l\u00e0 vi\u00eam t\u1ee7y ngang c\u1ea5p n\u00ean \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o s\u1ed1 li\u1ec7u \u0111\u1ec3 ph\u00e2n t\u00edch. Kh\u1eb3ng \u0111\u1ecbnh t\u00e1i ph\u00e1t d\u1ef1a tr\u00ean b\u1ec7nh nh\u00e2n kh\u00e1m l\u1ea1i ho\u1eb7c t\u00e1i nh\u1eadp vi\u1ec7n v\u00ec vi\u00eam t\u1ee7y t\u00e1i ph\u00e1t, v\u1edbi b\u1ec7nh nh\u00e2n nh\u1eadp vi\u00ean l\u1ea7n \u0111\u1ea7u nh\u01b0ng tr\u01b0\u1edbc \u0111\u00f3 \u0111\u00e3 c\u00f3 \u0111\u1ee3t vi\u00eam t\u1ee7y ngang \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh t\u1ea1i c\u00e1c chuy\u00ean khoa th\u1ea7n kinh c\u1ee7a b\u1ec7nh vi\u1ec7n tuy\u1ebfn trung \u01b0\u01a1ng th\u00ec t\u00ednh l\u00e0 \u0111\u1ee3t t\u00e1i ph\u00e1t.
\nC\u00e1c s\u1ed1 li\u1ec7u th\u1ed1ng k\u00ea \u0111\u01b0\u1ee3c t\u00ednh theo t\u1ef7 l\u1ec7 ph\u1ea7n tr\u0103m, so s\u00e1nh c\u00e1c t\u1ef7 l\u1ec7 v\u00e0 so s\u00e1nh 2 s\u1ed1 trung b\u00ecnh tr\u00ean ph\u1ea7n m\u1ec1m th\u1ed1ng k\u00ea SPSS.<\/p>\n

3. K\u1ebeT QU\u1ea2 NGHI\u00caN C\u1ee8U V\u00c0 B\u00c0N LU\u1eacN<\/strong><\/h2>\n

Tu\u1ed5i trung b\u00ecnh c\u1ee7a b\u1ec7nh nh\u00e2n nghi\u00ean c\u1ee9u l\u00e0 44,8 \u00b1 13,4 tu\u1ed5i, t\u1ef7 l\u1ec7 n\u1eef gi\u1edbi l\u00e0 52%. \u0110au khi kh\u1edfi ph\u00e1t 60%, li\u1ec7t chi 96%, r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c 96%, r\u1ed1i lo\u1ea1n c\u01a1 v\u00f2ng 84%. Th\u1eddi gian ti\u1ebfn tri\u1ec3n d\u01b0\u1edbi 7 ng\u00e0y 36%, t\u1eeb 7-14 ng\u00e0y 24%, tr\u00ean 14 ng\u00e0y 40%. S\u1ee9c c\u01a1 ch\u00e2n trung b\u00ecnh khi nh\u1eadp vi\u1ec7n l\u00e0 2,6 \u00b1 1,4 \u0111i\u1ec3m. Trong \u0111\u1ee3t ti\u1ebfn tri\u1ec3n c\u00f3 16\/25 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb methyprednisolon li\u1ec1u 80mg\/ng\u00e0y, 9\/25 BN \u0111i\u1ec1u tr\u1ecb li\u1ec1u bolus (500-1000mg methyprednisolon), 1\/25 b\u1ec7nh nh\u00e2n c\u00f3 l\u1ecdc huy\u1ebft t\u01b0\u01a1ng (b\u1ea3ng 1).<\/p>\n

B\u1ea3ng 1. \u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Tu\u1ed5i trung b\u00ecnh<\/strong><\/td>\n44.8 \u00b1 13.4<\/p>\n

(19-70 tu\u1ed5i)<\/td>\n<\/tr>\n

Gi\u1edbi: N\u1eef<\/strong><\/td>\n13\/25 (53%)<\/td>\n<\/tr>\n
Tri\u1ec7u ch\u1ee9ng<\/strong><\/td>\n<\/tr>\n
\u0110au<\/td>\n15\/25 (60%)<\/td>\n<\/tr>\n
R\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c<\/td>\n24\/25 (96%)<\/td>\n<\/tr>\n
Li\u1ec7t chi<\/td>\n24\/25 (96%)<\/td>\n<\/tr>\n
R\u1ed1i lo\u1ea1n c\u01a1 v\u00f2ng<\/td>\n21\/25 (84%)<\/td>\n<\/tr>\n
S\u1ee9c c\u01a1 ch\u00e2n (khi nh\u1eadp vi\u1ec7n)<\/td>\n2,6 \u00b1 1,4 (0-5)<\/td>\n<\/tr>\n
S\u1ee9c c\u01a1 ch\u00e2n (khi ra vi\u1ec7n)<\/td>\n3.2 \u00b1 1,15 (0-5)<\/td>\n<\/tr>\n
Th\u1eddi gian ti\u1ebfn tri\u1ec3n<\/strong><\/td>\n<\/tr>\n
D\u01b0\u1edbi 7 ng\u00e0y<\/td>\n9\/25 (36%)<\/td>\n<\/tr>\n
T\u1eeb 7-14 ng\u00e0y<\/td>\n6\/25 (24%)<\/td>\n<\/tr>\n
Tr\u00ean 14 ng\u00e0y<\/td>\n10\/25 (40%)<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb<\/strong><\/td>\n<\/tr>\n
Li\u1ec1u th\u00f4ng th\u01b0\u1eddng<\/td>\n16\/25 b\u1ec7nh nh\u00e2n<\/td>\n<\/tr>\n
Li\u1ec1u Bolus<\/td>\n9\/25 b\u1ec7nh nh\u00e2n<\/td>\n<\/tr>\n
L\u1ecdc huy\u1ebft t\u01b0\u01a1ng<\/td>\n1\/25 b\u1ec7nh nh\u00e2n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Tu\u1ed5i v\u00e0 gi\u1edbi c\u1ee7a b\u1ec7nh nh\u00e2n kh\u00e1c nhau trong c\u00e1c nghi\u00ean c\u1ee9u do khu v\u1ef1c \u0111\u1ecba l\u00fd v\u00e0 c\u00e1ch th\u1ee9c thu th\u1eadp b\u1ec7nh nh\u00e2n. Vi\u00eam t\u1ee7y ngang c\u00f3 nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau nh\u01b0 vi\u00eam t\u1ee7y ngang t\u1ef1 ph\u00e1t (idiopathic transverse myelitis), b\u1ec7nh ph\u1ed5 vi\u00eam t\u1ee7y th\u1ecb th\u1ea7n kinh, vi\u00eam t\u1ee7y c\u00f3 li\u00ean quan \u0111\u1ebfn kh\u00e1ng th\u1ec3 MOG, \u0111\u00f4i khi l\u00e0 c\u1ea3 x\u01a1 n\u00e3o t\u1ee7y r\u1ea3i r\u00e1c\u2026B\u1ec7nh c\u00f3 th\u1ec3 m\u1eafc \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i nh\u01b0ng nh\u00ecn chung c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 vi\u00eam t\u1ee7y ngang t\u1ef1 ph\u00e1t ho\u1eb7c vi\u00eam t\u1ee7y ngang n\u00f3i chung cho th\u1ea5y \u0111\u1ed9 tu\u1ed5i th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 35-45 tu\u1ed5i [2, 3]. C\u00e1c b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee7y ngang do kh\u00e1ng th\u1ec3 MOG, x\u01a1 n\u00e3o t\u1ee7y r\u1ea3i r\u00e1c c\u00f3 th\u1ec3 c\u00f3 \u0111\u1ed9 tu\u1ed5i trung b\u00ecnh th\u1ea5p h\u01a1n (d\u01b0\u1edbi 30 tu\u1ed5i)[4]. Kh\u00f4ng c\u00f3 kh\u00e1c bi\u1ec7t l\u1edbn v\u1ec1 t\u1ef7 l\u1ec7 n\u1eef\/nam trong c\u00e1c nghi\u00ean c\u1ee9u kh\u00f4ng ph\u00e2n lo\u1ea1i ho\u1eb7c trong vi\u00eam t\u1ee7y ngang t\u1ef1 ph\u00e1t [2, 5] nh\u01b0ng v\u1edbi c\u00e1c nguy\u00ean nh\u00e2n c\u1ee5 th\u1ec3 th\u00ec c\u00f3 s\u1ef1 ch\u00eanh l\u1ec7ch l\u1edbn, v\u1edbi vi\u00eam t\u1ee7y c\u00f3 kh\u00e1ng th\u1ec3 AQP4 d\u01b0\u01a1ng t\u00ednh t\u1ef7 l\u1ec7 n\u1eef\/nam kho\u1ea3ng 5-10\/1 [3, 6], Vi\u00eam t\u1ee7y c\u00f3 kh\u00e1ng th\u1ec3 MOG d\u01b0\u01a1ng t\u00ednh c\u00f3 t\u1ef7 l\u1ec7 n\u1eef ch\u1ec9 kho\u1ea3ng 37,5-44% [6, 7].
\nLi\u1ec7t chi, r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c, r\u1ed1i lo\u1ea1n c\u01a1 v\u00f2ng l\u00e0 nh\u1eefng tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, th\u1ef1c t\u1ebf th\u00ec \u0111\u00e2y l\u00e0 nh\u1eefng thi\u1ebfu s\u00f3t th\u1ea7n kinh ch\u1ee7 y\u1ebfu khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng t\u1ee7y theo kh\u00e1i ni\u1ec7m v\u1ec1 vi\u00eam t\u1ee7y, tuy nhi\u00ean kh\u00f4ng ph\u1ea3i m\u1ecdi b\u1ec7nh nh\u00e2n \u0111\u1ec1u c\u00f3 t\u1ea5t c\u1ea3 c\u00e1c d\u1ea5u hi\u1ec7u n\u00e0y [8]. \u0110au theo c\u00e1c r\u1ec5 th\u1ea7n kinh ch\u1ee7 y\u1ebfu \u1edf c\u00e1c r\u1ec5 xu\u1ea5t ph\u00e1t t\u1eeb \u0111o\u1ea1n t\u1ee7y b\u1ecb t\u1ed5n th\u01b0\u01a1ng th\u01b0\u01a1ng v\u00e0 n\u1eb7ng n\u1ec1 nh\u1ea5t khi kh\u1edfi ph\u00e1t b\u1ec7nh.
\nTi\u1ebfn tri\u1ec3n c\u1ee7a vi\u00eam t\u1ee7y ngang ch\u1ee7 y\u1ebfu l\u00e0 c\u1ea5p ho\u1eb7c b\u00e1n c\u1ea5p trong m\u1ed9t v\u00e0i tu\u1ea7n, m\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 c\u00f2n cho th\u1ea5y c\u00f3 th\u1ec3 di\u1ec5n ti\u1ebfn ki\u1ec3u m\u00e3n t\u00ednh trong nhi\u1ec1u th\u00e1ng. Trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i 60% b\u1ec7nh nh\u00e2n ti\u1ebfn tri\u1ec3n trong 2 tu\u1ea7n \u0111\u1ea7u, 40% b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ebfn tri\u1ec3n k\u00e9o d\u00e0i tr\u00ean 2 tu\u1ea7n, c\u00f3 m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n ti\u1ebfn tri\u1ec3n trong nhi\u1ec1u th\u00e1ng v\u00e0 qu\u00e1 tr\u00ecnh h\u1ed3i ph\u1ee5c ch\u1ec9 xu\u1ea5t hi\u1ec7n khi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb corticoid v\u00e0 \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch.
\nC\u00f3 21 b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng r\u00f5 tr\u00ean MRI c\u1ed9t s\u1ed1ng n\u00ean c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m v\u1ec1 h\u00ecnh \u1ea3nh MRI ch\u00fang t\u00f4i ch\u1ec9 \u0111\u00e1nh gi\u00e1 \u1edf c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y: T\u1ed5n th\u01b0\u01a1ng t\u1ea1i t\u1ee7y c\u1ed5 14,3%, t\u1ee7y ng\u1ef1c 61,9%, c\u1ea3 c\u1ed5 v\u00e0 ng\u1ef1c 23,8%, t\u1ed5n th\u01b0\u01a1ng lan r\u1ed9ng \u0111\u1ebfn h\u00e0nh t\u1ee7y 14,3%. T\u1ed5n th\u01b0\u01a1ng t\u1ee7y k\u00e9o d\u00e0i trung b\u00ecnh 5,1\u00b11,3 \u0111\u1ed1t s\u1ed1ng (1-9 \u0111\u1ed1t s\u1ed1ng), t\u1ed5n th\u01b0\u01a1ng t\u1ee7y k\u00e9o d\u00e0i t\u1eeb 3 \u0111\u1ed1t s\u1ed1ng tr\u1edf l\u00ean 90,5%, 6\/6 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ti\u00eam thu\u1ed1c \u0111\u1ed1i quang t\u1eeb \u0111\u1ec1u c\u00f3 h\u00ecnh \u1ea3nh ng\u1ea5m thu\u1ed1c, 80,95% c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u01b0u th\u1ebf \u1edf trung t\u00e2m t\u1ee7y. Bi\u1ebfn \u0111\u1ed5i d\u1ecbch n\u00e3o t\u1ee7y g\u1eb7p \u1edf 88% b\u1ec7nh nh\u00e2n, trong \u0111\u00f3 t\u0103ng t\u1ebf b\u00e0o 44%, t\u0103ng protein 56%, Pandy d\u01b0\u01a1ng t\u00ednh 68% (b\u1ea3ng 2).<\/p>\n

B\u1ea3ng 2. \u0110\u1eb7c \u0111i\u1ec3m c\u1eadn l\u00e2m s\u00e0ng<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
H\u00ecnh \u1ea3nh MRI<\/strong><\/td>\n<\/td>\n<\/tr>\n
V\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng<\/em><\/strong><\/td>\n<\/td>\n<\/tr>\n
T\u1ee7y c\u1ed5<\/td>\n3\/21 (14,3%)<\/td>\n<\/tr>\n
T\u1ee7y ng\u1ef1c<\/td>\n13\/21 (61,9%)<\/td>\n<\/tr>\n
T\u1ee7y c\u1ed5 v\u00e0 ng\u1ef1c<\/td>\n5\/21 (23,8%)<\/td>\n<\/tr>\n
Lan l\u00ean h\u00e0nh t\u1ee7y<\/td>\n3\/21 (14,3%)<\/td>\n<\/tr>\n
\u0110\u1ed9 d\u00e0i t\u1ed5n th\u01b0\u01a1ng<\/em><\/strong><\/td>\n<\/td>\n<\/tr>\n
D\u01b0\u1edbi 3 \u0111\u1ed1t s\u1ed1ng<\/td>\n2\/21 (9,5%)<\/td>\n<\/tr>\n
T\u1eeb 3 \u0111\u1ed1t s\u1ed1ng tr\u1edf l\u00ean<\/td>\n19\/21 (90,5%)<\/td>\n<\/tr>\n
S\u1ed1 \u0111\u1ed1t t\u1ed5n th\u01b0\u01a1ng trung b\u00ecnh<\/td>\n5,1\u00b1 1,3 (1-9)<\/td>\n<\/tr>\n
\u0110\u1eb7c \u0111i\u1ec3m t\u1ed5n th\u01b0\u01a1ng<\/em><\/strong><\/td>\n<\/td>\n<\/tr>\n
Ng\u1ea5m thu\u1ed1c \u0111\u1ed1i quang t\u1eeb<\/td>\n6\/6 (100%)<\/td>\n<\/tr>\n
T\u1ed5n th\u01b0\u01a1ng trung t\u00e2m t\u1ee7y chi\u1ebfm \u01b0u th\u1ebf<\/td>\n17\/21 (81%)<\/td>\n<\/tr>\n
X\u00e9t nghi\u1ec7m d\u1ecbch n\u00e3o t\u1ee7y<\/em><\/strong><\/td>\n<\/td>\n<\/tr>\n
T\u0103ng protein<\/td>\n56 %<\/td>\n<\/tr>\n
T\u0103ng t\u1ebf b\u00e0o<\/td>\n44 %<\/td>\n<\/tr>\n
Ph\u1ea3n \u1ee9ng Pandy d\u01b0\u01a1ng t\u00ednh<\/td>\n68 %<\/td>\n<\/tr>\n
C\u00f3 b\u1ea5t th\u01b0\u1eddng d\u1ecbch n\u00e3o t\u1ee7y<\/td>\n88 %<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

T\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee7y ngang c\u00f3 lan t\u1ecfa theo chi\u1ec1u d\u1ecdc (khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng t\u1ee7y k\u00e9o d\u00e0i t\u1eeb 3 \u0111\u1ed1t s\u1ed1ng tr\u1edf l\u00ean) (Longitudinally Extensive Transverse Myelitis: LETM) c\u00f3 kh\u00e1c bi\u1ec7t l\u1edbn \u1edf c\u00e1c nghi\u00ean c\u1ee9u. Trong nghi\u00ean c\u1ee9u t\u1ea1i b\u1ec7nh vi\u1ec7n Johns Hopkins (M\u1ef9) v\u00e0 t\u1ea1i Brasil t\u1ef7 l\u1ec7 LETM t\u1eeb 61- 67,6%[9, 10], c\u00f2n theo m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u kh\u00e1c t\u1ef7 l\u1ec7 n\u00e0y ch\u1ec9 8-10% [4, 11].
\nS\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1ef7 l\u1ec7 LETM c\u00f3 l\u1ebd c\u00f3 li\u00ean quan \u0111\u1ebfn nguy\u00ean nh\u00e2n c\u1ee7a vi\u00eam t\u1ee7y ngang. C\u00e1c nguy\u00ean nh\u00e2n nh\u01b0: do kh\u00e1ng th\u1ec3 kh\u00e1ng AQP4, do c\u00e1c b\u1ec7nh l\u00fd mi\u1ec5n d\u1ecbch kh\u00e1c (Sarcoidosis, Behcetl, h\u1ed9i ch\u1ee9ng Sjogren, Luput ban \u0111\u1ecf\u2026) ph\u1ea7n l\u1edbn l\u00e0 LETM [12, 13]. Tuy nhi\u00ean, t\u1ef7 l\u1ec7 LETM do vi\u00eam t\u1ee7y ngang t\u1ef1 ph\u00e1t hay x\u01a1 n\u00e3o t\u1ee7y r\u1ea3i r\u00e1c l\u00e0 kh\u00e1 th\u1ea5p [4, 13]. Trong khi \u0111\u00f3 t\u1ef7 l\u1ec7 c\u00e1c b\u1ec7nh l\u00fd n\u00e0y c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t theo v\u00f9ng \u0111\u1ecba l\u00fd v\u00e0 ch\u1ee7ng t\u1ed9c v\u00e0 c\u00e1ch th\u1ee9c thu th\u1eadp b\u1ec7nh nh\u00e2n\u2026 C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 LETM cho th\u1ea5y c\u00f3 35-60% b\u1ec7nh nh\u00e2n c\u00f3 kh\u00e1ng th\u1ec3 kh\u00e1ng AQP4 d\u01b0\u01a1ng t\u00ednh n\u00ean c\u00f3 th\u1ec3 n\u00f3i \u0111\u00e2y l\u00e0 nguy\u00ean nh\u00e2n ch\u1ee7 y\u1ebfu c\u1ee7a LETM [3, 10, 12]. Trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i t\u1ef7 l\u1ec7 LETM l\u00e0 90,5% (19\/21), t\u1ef7 l\u1ec7 n\u00e0y kh\u00e1 cao so v\u1edbi c\u00e1c t\u00e1c gi\u1ea3 kh\u00e1c. Li\u1ec7u t\u1ef7 l\u1ec7 LETM cao c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c nguy\u00ean nh\u00e2n nh\u01b0 c\u00f3 kh\u00e1ng th\u1ec3 kh\u00e1ng AQP4 hay MOG kh\u00f4ng? T\u1ea1i Vi\u1ec7t Nam ch\u00fang t\u00f4i ch\u01b0a th\u1ea5y c\u00f3 nghi\u00ean c\u1ee9u n\u00e0o v\u1ec1 kh\u00e1ng th\u1ec3 kh\u00e1ng AQP4 c\u0169ng nh\u01b0 c\u00e1c nguy\u00ean nh\u00e2n c\u1ee7a vi\u00eam t\u1ee7y ngang. Trong m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u v\u1ec1 kh\u00e1ng th\u1ec3 kh\u00e1ng AQP4 \u1edf ch\u00e2u \u00c1 cho th\u1ea5y d\u01b0\u1eddng nh\u01b0 t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n n\u00e0y cao h\u01a1n so v\u1edbi ch\u00e2u \u00c2u. Theo m\u1ed9t nghi\u00ean c\u1ee9u t\u1ea1i Malaysia t\u1ef7 l\u1ec7 c\u00f3 AQP4-ab d\u01b0\u01a1ng t\u00ednh l\u00ean t\u1edbi 76,2% [14].
\nPh\u1ea7n l\u1edbn c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ec1u c\u00f3 bi\u1ebfn \u0111\u1ed5i d\u1ecbch n\u00e3o t\u1ee7y nh\u01b0 t\u0103ng protein, t\u0103ng t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u tuy nhi\u00ean m\u1ee9c t\u0103ng kh\u00f4ng l\u1edbn, trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i cao nh\u1ea5t l\u00e0 25 t\u1ebf b\u00e0o\/dl. K\u1ebft qu\u1ea3 n\u00e0y nh\u00ecn chung l\u00e0 t\u01b0\u01a1ng \u0111\u1ed3ng v\u1edbi c\u00e1c t\u00e1c gi\u1ea3 kh\u00e1c [10].
\nC\u00f3 22 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c theo d\u00f5i \u0111\u1ebfn th\u1eddi \u0111i\u1ec3m th\u1ed1ng k\u00ea, trong \u0111\u00f3 c\u00f3 13 b\u1ec7nh nh\u00e2n c\u00f3 t\u00e1i ph\u00e1t chi\u1ebfm 59,1%. Kh\u1ea3o s\u00e1t m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn t\u00e1i ph\u00e1t cho th\u1ea5y: t\u0103ng protein d\u1ecbch n\u00e3o t\u1ee7y, t\u1ed5n th\u01b0\u01a1ng t\u1ee7y \u0111o\u1ea1n d\u00e0i (l\u1edbn h\u01a1n ho\u1eb7c b\u1eb1ng 3 \u0111\u1ed1t s\u1ed1ng) l\u00e0m t\u0103ng nguy c\u01a1 t\u00e1i ph\u00e1t, kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea v\u1edbi p <0,05. B\u1ec7nh nh\u00e2n t\u00e1i ph\u00e1t c\u00f3 \u0111i\u1ec3m mRs cao h\u01a1n, kh\u00e1c bi\u1ec7t v\u1edbi p<0,05, th\u1eddi gian theo d\u00f5i trung b\u00ecnh 34 \u00b1 10,5 th\u00e1ng, s\u1ed1 \u0111\u1ee3t t\u00e1i ph\u00e1t trung b\u00ecnh 2,7 \u00b1 1,5 \u0111\u1ee3t (b\u1ea3ng 3).<\/p>\n

B\u1ea3ng 3. M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn t\u00e1i ph\u00e1t<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\u0110\u1eb7c \u0111i\u1ec3m<\/strong><\/td>\nKh\u00f4ng t\u00e1i ph\u00e1t<\/strong><\/p>\n

n = 9 (%)<\/strong><\/td>\n

C\u00f3 t\u00e1i ph\u00e1t<\/strong><\/p>\n

n = 13 (%)<\/strong><\/td>\n

p<\/strong><\/td>\n<\/tr>\n
Tu\u1ed5i<\/td>\n43,8 \u00b1 14,5<\/td>\n46,6 \u00b1 12,6<\/td>\n0,60<\/td>\n<\/tr>\n
Gi\u1edbi: Nam<\/td>\n4 (44,4)<\/td>\n7 (53,8)<\/td>\n0,67<\/td>\n<\/tr>\n
Ti\u1ebfn tri\u1ec3n d\u01b0\u1edbi 1 tu\u1ea7n<\/td>\n2 (22,2)<\/td>\n6 (46,2)<\/td>\n0,25<\/td>\n<\/tr>\n
T\u1ed5n th\u01b0\u01a1ng \u2265 3 \u0111\u1ed1t s\u1ed1ng<\/strong><\/td>\n5\/7 (71,4)<\/strong><\/td>\n12\/12 (100%)<\/strong><\/td>\n0,05<\/strong><\/td>\n<\/tr>\n
\u0110\u1ed9 d\u00e0i t\u1ed5n th\u01b0\u01a1ng trung b\u00ecnh<\/td>\n4,1 \u00b1 2,1<\/td>\n5,6 \u00b1 1,8<\/td>\n0,14<\/td>\n<\/tr>\n
T\u0103ng protein DNT<\/strong><\/td>\n3 (33,3)<\/strong><\/td>\n10 (76,9)<\/strong><\/td>\n0,041<\/strong><\/td>\n<\/tr>\n
Pandy d\u01b0\u01a1ng t\u00ednh<\/td>\n5 (55,6)<\/td>\n11 (84,6)<\/td>\n0,13<\/td>\n<\/tr>\n
T\u0103ng t\u1ebf b\u00e0o DNT<\/td>\n4 (44,4)<\/td>\n5 (38,5)<\/td>\n0,77<\/td>\n<\/tr>\n
C\u00f3 b\u1ea5t th\u01b0\u1eddng DNT<\/td>\n9 (100%)<\/td>\n11 (84,6)<\/td>\n0,20<\/td>\n<\/tr>\n
mRS trung b\u00ecnh<\/strong><\/td>\n1,67 \u00b1 1,0<\/strong><\/td>\n3,0 \u00b1 1,9<\/strong><\/td>\n0,01<\/strong><\/td>\n<\/tr>\n
Th\u1eddi gian theo d\u00f5i (th\u00e1ng)<\/td>\n<\/td>\n34 \u00b1 10,5<\/td>\n<\/td>\n<\/tr>\n
S\u1ed1 \u0111\u1ee3t t\u00e1i ph\u00e1t trung b\u00ecnh<\/td>\n<\/td>\n2,7 \u00b1 1,5 (1-5)<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

C\u00e1c b\u00e1o c\u00e1o v\u1ec1 t\u00e1i ph\u00e1t c\u1ee7a b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee7y ngang t\u1ea1i Vi\u1ec7t Nam r\u1ea5t \u00edt. C\u00e1c quan \u0111i\u1ec3m v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng corticoid ho\u1eb7c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch k\u00e9o d\u00e0i \u0111\u1ec3 d\u1ef1 ph\u00f2ng t\u00e1i ph\u00e1t cho b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee7y ngang l\u1ea7n \u0111\u1ea7u hay kh\u00f4ng c\u0169ng c\u00f2n r\u1ea5t kh\u00e1c bi\u1ec7t. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u v\u1ec1 vi\u00eam t\u1ee7y ngang l\u1ea7n \u0111\u1ea7u cho th\u1ea5y t\u1ef7 l\u1ec7 t\u00e1i ph\u00e1t t\u1eeb 61- 66,7% [5, 9, 10].
\nC\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 t\u00e1i ph\u00e1t l\u00e0 t\u1ed5n th\u01b0\u01a1ng t\u1ee7y k\u00e9o d\u00e0i (t\u1eeb 3 \u0111\u1ed1t s\u1ed1ng tr\u1edf l\u00ean), n\u1eef gi\u1edbi, ch\u1ee7ng t\u1ed9c (ng\u01b0\u1eddi m\u1ef9 g\u1ed1c phi), c\u00f3 ph\u1ea3n \u1ee9ng vi\u00eam trong d\u1ecbch n\u00e3o t\u1ee7y, thi\u1ebfu vitamin D\u2026[9]. C\u00e1c nguy\u00ean nh\u00e2n nh\u01b0: do kh\u00e1ng th\u1ec3 kh\u00e1ng AQP4, x\u01a1 n\u00e3o t\u1ee7y r\u1ea3i r\u00e1c, do b\u1ec7nh l\u00fd vi\u00eam mi\u1ec5n d\u1ecbch kh\u00e1c (Sarcoidosis, Behcetl, h\u1ed9i ch\u1ee9ng Sjogren, Luput ban \u0111\u1ecf\u2026) c\u0169ng c\u00f3 nguy c\u01a1 t\u00e1i ph\u00e1t cao h\u01a1n [3, 4, 9, 11].
\nTrong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i ch\u01b0a c\u00f3 \u0111i\u1ec1u ki\u1ec7n \u0111\u1ec3 \u0111i s\u00e2u v\u00e0o ph\u00e2n t\u00edch c\u1ee5 th\u1ec3 c\u00e1c nguy\u00ean nh\u00e2n do s\u1ed1 li\u1ec7u ch\u01b0a nhi\u1ec1u, c\u00e1c x\u00e9t nghi\u1ec7m v\u1ec1 mi\u1ec5n d\u1ecbch kh\u00f4ng s\u1eb5n c\u00f3 nh\u01b0ng b\u01b0\u1edbc \u0111\u1ea7u c\u0169ng cho th\u1ea5y t\u1ef7 l\u1ec7 t\u00e1i ph\u00e1t l\u00e0 kh\u00e1 cao (59,1%), s\u1ed1 \u0111\u1ee3t t\u00e1i ph\u00e1t trung b\u00ecnh l\u00e0 2,7. B\u1ec7nh nh\u00e2n t\u00e1i ph\u00e1t c\u00f3 t\u00ecnh tr\u1ea1ng ch\u1ee9c n\u0103ng k\u00e9m h\u01a1n so v\u1edbi nh\u00f3m kh\u00f4ng t\u00e1i ph\u00e1t. T\u0103ng protein d\u1ecbch n\u00e3o t\u1ee7y, t\u1ed5n th\u01b0\u01a1ng t\u1ee7y \u0111o\u1ea1n d\u00e0i l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 c\u00f3 nguy c\u01a1 t\u00e1i ph\u00e1t cao (b\u1ea3ng 3). K\u1ebft qu\u1ea3 n\u00e0y c\u0169ng ph\u00f9 h\u1ee3p v\u1edbi nh\u1eadn \u0111\u1ecbnh c\u1ee7a nhi\u1ec1u t\u00e1c gi\u1ea3 [1, 3, 5, 7, 9-12, 15].
\nVi\u1ec7c l\u1ef1a ch\u1ecdn b\u1ec7nh nh\u00e2n c\u1ea7n thi\u1ebft ph\u1ea3i \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao, c\u1ea7n theo d\u00f5i k\u00e9o d\u00e0i \u0111\u1ec3 k\u1ecbp th\u1eddi ph\u00e1t hi\u1ec7n b\u1ec7nh nh\u00e2n c\u00f3 t\u00e1i ph\u00e1t c\u0169ng nh\u01b0 t\u0103ng c\u01b0\u1eddng c\u00e1c x\u00e9t nghi\u1ec7m t\u1ea7m so\u00e1t nguy\u00ean nh\u00e2n (kh\u00e1ng th\u1ec3 kh\u00e1ng MOG, AQP4, IgG index, Oligoclonal bands, SS-A Ab, SS-B Ab\u2026) [9]. Trong \u0111i\u1ec1u ki\u1ec7n c\u00e1c x\u00e9t nghi\u1ec7m mi\u1ec5n d\u1ecbch kh\u00f4ng s\u1eb5n c\u00f3 th\u00ec vi\u1ec7c c\u00f3 th\u00eam nh\u1eefng s\u1ed1 li\u1ec7u nghi\u00ean c\u1ee9u v\u1ec1 ti\u00ean l\u01b0\u1ee3ng t\u00e1i ph\u00e1t vi\u00eam t\u1ee7y ngang \u1edf Vi\u1ec7t Nam nh\u1eb1m l\u1ef1a ch\u1ecdn nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng t\u00e1i ph\u00e1t l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng.<\/p>\n

4. K\u1ebeT LU\u1eacN<\/strong><\/h2>\n

Kh\u1ea3o s\u00e1t 25 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u1ee7y ngang, v\u1edbi th\u1eddi gian theo d\u00f5i trung b\u00ecnh 34 th\u00e1ng ch\u00fang t\u00f4i nh\u1eadn th\u1ea5y:
\n\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng: Tu\u1ed5i trung b\u00ecnh c\u1ee7a b\u1ec7nh nh\u00e2n nghi\u00ean c\u1ee9u l\u00e0 44,8 \u00b1 13,4 tu\u1ed5i, t\u1ef7 l\u1ec7 n\u1eef gi\u1edbi l\u00e0 52%, th\u1eddi gian ti\u1ebfn tri\u1ec3n d\u01b0\u1edbi 2 tu\u1ea7n l\u00e0 60%. T\u1ed5n th\u01b0\u01a1ng t\u1ee7y ng\u1ef1c 61,9%, t\u1ed5n th\u01b0\u01a1ng lan t\u1edbi h\u00e0nh t\u1ee7y 14,3%, t\u1ed5n th\u01b0\u01a1ng t\u1eeb 3 \u0111o\u1ea1n t\u1ee7y tr\u1edf l\u00ean chi\u1ebfm 90,5%. Bi\u1ebfn \u0111\u1ed5i d\u1ecbch n\u00e3o t\u1ee7y g\u1eb7p \u1edf 88% b\u1ec7nh nh\u00e2n, trong \u0111\u00f3 t\u0103ng t\u1ebf b\u00e0o 44%, t\u0103ng protein 56%, Pandy d\u01b0\u01a1ng t\u00ednh 68%.
\nTrong th\u1eddi gian theo d\u00f5i trung b\u00ecnh 34 th\u00e1ng c\u00f3 59,1% b\u1ec7nh nh\u00e2n t\u00e1i ph\u00e1t. C\u00e1c y\u1ebfu t\u1ed1: t\u0103ng protein d\u1ecbch n\u00e3o t\u1ee7y, t\u1ed5n th\u01b0\u01a1ng t\u1ee7y k\u00e9o d\u00e0i t\u1eeb 3 \u0111\u1ed1t s\u1ed1ng tr\u1edf l\u00ean c\u00f3 nguy c\u01a1 t\u00e1i ph\u00e1t cao h\u01a1n, kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea v\u1edbi p <0,05. B\u1ec7nh nh\u00e2n t\u00e1i ph\u00e1t c\u00f3 t\u00ecnh tr\u1ea1ng ch\u1ee9c n\u0103ng x\u1ea5u h\u01a1n (mRs 3,0 \u00b1 1,9 so v\u1edbi 1,67 \u00b1 1,0 p < 0,01).<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/h2>\n

1. Maillart, E., et al., Outcome and risk of recurrence in a large cohort of idiopathic longitudinally extensive transverse myelitis without AQP4\/MOG antibodies. Journal of Neuroinflammation, 2020. 17(1): p. 128.
\n2. Zalewski, N.L., E.P. Flanagan, and B.M. Keegan, Evaluation of idiopathic transverse myelitis revealing specific myelopathy diagnoses. Neurology, 2018. 90(2): p. e96.
\n3. Kitley J, et al, Longitudinally Extensive Transverse Myelitis With and Without Aquaporin 4 Antibodies. JAMA Neurology, 2013. 70(11): p. 1375-1381.
\n4. S. Presas-Rodr\u00edguez, L.G.-L., J.V. Herv\u00e1s-Garc\u00edaa, A. Massuet-Vilamaj\u00f3, C. Ramo-Telloa, Myelitis: Differences between multiple sclerosis and other aetiologies. Neurolog\u00eda, 2016. 31: p. 71\u201475.
\n5. Aijaz Ali, S.B.B., Amir Riaz, at al, Assessment of Clinical Outcomes in Patients Presenting with Transverse Myelitis: A Tertiary Care Experience from a Developing Country. Cureus e4342, 2019. 11(3): p. e4342.
\n6. Sato, D.K., et al., Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders. 2014. 82(6): p. 474-481.
\n7. Dubey, D., et al., Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody. JAMA neurology, 2019. 76(3): p. 301-309.
\n8. Barnes, G., et al., Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology, 2002. 59: p. 499-505.
\n9. Kimbrough, D.J., et al., Predictors of recurrence following an initial episode of transverse myelitis. Neurol Neuroimmunol Neuroinflammation, 2014. 1(1): p. e4.
\n10. Alvarenga, M.P., et al., The clinical course of idiopathic acute transverse myelitis in patients from Rio de Janeiro. Journal of Neurology, 2010. 257(6): p. 992-998.
\n11. Gajofatto, A., et al., Assessment of Outcome Predictors in First-Episode Acute Myelitis: A Retrospective Study of 53 Cases. Archives of Neurology, 2010. 67(6): p. 724-730.
\n12. Tobin, W.O., B.G. Weinshenker, et al, Longitudinally extensive transverse myelitis. Current opinion in neurology, 2014. 27(3): p. 279-289.
\n13. Apostolos-Pereira, S., et al., Differential Diagnosis of Longitudinally Extensive Transverse Myelitis (P02.109). 2013. 80(7 Supplement): p. P02.109-P02.109.
\n14. Abdullah, S., W.F. Wong, and C. Tan, The Prevalence of Anti-Aquaporin 4 Antibody in Patients with Idiopathic Inflammatory Demyelinating Diseases Presented to a Tertiary Hospital in Malaysia: Presentation and Prognosis. Multiple Sclerosis International, 2017. 2017: p. 1-6.
\n15. Bulut, E., et al., MRI Predictors of Recurrence and Outcome after Acute Transverse Myelitis of Unidentified Etiology. 2019. 40(8): p. 1427-1432.<\/p>\n","protected":false},"excerpt":{"rendered":"

Vi\u00eam t\u1ee7y ngang (transerve myelitis) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd vi\u00eam mi\u1ec5n d\u1ecbch c\u1ea5p t\u00ednh ho\u1eb7c b\u00e1n c\u1ea5p \u1ea3nh h\u01b0\u1edfng t\u1edbi c\u00e1c ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng, c\u1ea3m gi\u00e1c v\u00e0 th\u1ea7n kinh t\u1ef1 \u0111\u1ed9ng c\u1ee7a t\u1ee7y s\u1ed1ng do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau, \u0111\u00e2y l\u00e0 nh\u00f3m b\u1ec7nh kh\u00f4ng th\u01b0\u1eddng g\u1eb7p. T\u1ea1i Vi\u1ec7t Nam ch\u00fang t\u00f4i ch\u01b0a th\u1ea5y […]<\/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":"\nNh\u1eadn x\u00e9t m\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng v\u00e0 y\u1ebfu t\u1ed1 li\u00ean quan t\u00e1i ph\u00e1t c\u1ee7a b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee7y ngang<\/title>\n<meta name=\"description\" content=\"Vi\u00eam t\u1ee7y ngang la\u0300 b\u1ec7nh l\u00fd vi\u00eam mi\u1ec5n d\u1ecbch c\u1ea5p t\u00ednh\/ b\u00e1n c\u1ea5p \u1ea3nh h\u01b0\u1edfng t\u1edbi c\u00e1c ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng, c\u1ea3m gi\u00e1c v\u00e0 th\u1ea7n kinh t\u1ef1 \u0111\u1ed9ng c\u1ee7a t\u1ee7y s\u1ed1ng.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta 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