{"id":31596,"date":"2023-05-07T15:30:26","date_gmt":"2023-05-07T08:30:26","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31596"},"modified":"2023-05-07T15:30:26","modified_gmt":"2023-05-07T08:30:26","slug":"gioi-thieu-ve-viem-gan-b-va-thai-nghen","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/gioi-thieu-ve-viem-gan-b-va-thai-nghen\/","title":{"rendered":"Gi\u1edbi thi\u1ec7u v\u1ec1 vi\u00eam gan B v\u00e0 thai ngh\u00e9n"},"content":{"rendered":"

Vi\u00eam gan virus l\u00e0 b\u1ec7nh truy\u1ec1n nhi\u1ec5m th\u01b0\u1eddng g\u1eb7p. Tr\u01b0\u1edbc \u0111\u00e2y ph\u00e2n l\u00e0m 2 lo\u1ea1i vi\u00eam gan do virus vi\u00eam gan A v\u00e0 B. Ng\u00e0y nay \u0111\u00e3 t\u00ecm ra 5 lo\u1ea1i vi\u00eam gan l\u00e0 A, B, C, D, E. Vi\u00eam gan do virus B, C, D th\u01b0\u1eddng g\u00e2y n\u00ean vi\u00eam gan m\u1ea1n t\u00ednh v\u00e0 x\u01a1 gan.<\/strong><\/p>\n

1. Gi\u1edbi thi\u1ec7u v\u1ec1 vi\u00eam gan B v\u00e0 thai ngh\u00e9n<\/h2>\n

1.1 Nhi\u1ec5m vi\u00eam gan B c\u1ea5p t\u00ednh<\/strong><\/p>\n

Vi\u00eam gan<\/a> si\u00eau vi c\u1ea5p t\u00ednh l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y v\u00e0ng da trong thai k\u1ef3. C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c bao g\u1ed3m c\u00e1c b\u1ec7nh v\u1ec1 gan li\u00ean quan \u0111\u1ebfn thai k\u1ef3, ch\u1eb3ng h\u1ea1n nh\u01b0 gan nhi\u1ec5m m\u1ee1 c\u1ea5p t\u00ednh khi mang thai, tan m\u00e1u, t\u0103ng men gan, h\u1ed9i ch\u1ee9ng s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u th\u1ea5p (HELLP) v\u00e0 \u1ee9 m\u1eadt trong gan khi mang thai.<\/p>\n

Nhi\u1ec5m vi r\u00fat vi\u00eam gan B (HBV) c\u1ea5p t\u00ednh trong th\u1eddi k\u1ef3 mang thai th\u01b0\u1eddng nh\u1eb9 v\u00e0 kh\u00f4ng li\u00ean quan \u0111\u1ebfn t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong ho\u1eb7c qu\u00e1i thai. Nhi\u1ec5m HBV c\u1ea5p t\u00ednh x\u1ea3y ra s\u1edbm trong thai k\u1ef3 c\u00f3 li\u00ean quan \u0111\u1ebfn t\u1ef7 l\u1ec7 l\u00e2y truy\u1ec1n chu sinh l\u00e0 10%. T\u1ef7 l\u1ec7 l\u00e2y truy\u1ec1n t\u0103ng \u0111\u00e1ng k\u1ec3 n\u1ebfu nhi\u1ec5m tr\u00f9ng c\u1ea5p t\u00ednh x\u1ea3y ra v\u00e0o ho\u1eb7c g\u1ea7n th\u1eddi \u0111i\u1ec3m sinh n\u1edf, kho\u1ea3ng 60%.<\/p>\n

\u0110i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng c\u1ea5p t\u00ednh ch\u1ee7 y\u1ebfu l\u00e0 h\u1ed7 tr\u1ee3.\u00a0C\u1ea7n theo d\u00f5i c\u00e1c x\u00e9t nghi\u1ec7m sinh h\u00f3a gan v\u00e0 th\u1eddi gian prothrombin.\u00a0\u0110i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat th\u01b0\u1eddng kh\u00f4ng c\u1ea7n thi\u1ebft, ngo\u1ea1i tr\u1eeb \u1edf nh\u1eefng ph\u1ee5 n\u1eef b\u1ecb suy gan c\u1ea5p t\u00ednh ho\u1eb7c vi\u00eam gan n\u1eb7ng k\u00e9o d\u00e0i. \u0110\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi b\u1ecb nhi\u1ec5m HBV c\u1ea5p t\u00ednh c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat, vi\u1ec7c l\u1ef1a ch\u1ecdn s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0o n\u00ean d\u1ef1a tr\u00ean th\u1eddi gian \u0111i\u1ec1u tr\u1ecb d\u1ef1 \u0111o\u00e1n v\u00e0 kh\u1ea3 n\u0103ng ti\u1ebfp c\u1eadn c\u0169ng nh\u01b0 chi ph\u00ed cho b\u1ec7nh nh\u00e2n.\u00a0Tenofovir disoproxil fumarate\u00a0(TDF) (300 mg m\u1ed7i ng\u00e0y) ho\u1eb7c\u00a0lamivudine (100 mg m\u1ed7i ng\u00e0y) \u0111\u1ec1u l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn ph\u00f9 h\u1ee3p trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y v\u00ec c\u1ea3 hai \u0111\u1ec1u \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng an to\u00e0n trong thai k\u1ef3 v\u00e0 nguy c\u01a1 kh\u00e1ng thu\u1ed1c th\u1ea5p do th\u1eddi gian \u0111i\u1ec1u tr\u1ecb d\u1ef1 ki\u1ebfn \u200b\u200bs\u1ebd k\u00e9o d\u00e0i<\/p>\n

\"Vi\u00eam
Vi\u00eam gan B<\/figcaption><\/figure>\n

1.2 Nhi\u1ec5m vi\u00eam gan B m\u00e3n t\u00ednh<\/strong><\/p>\n

T\u00e1c \u0111\u1ed9ng c\u1ee7a vi\u1ec7c mang thai \u0111\u1ed1i v\u1edbi ti\u1ec1n s\u1eed c\u1ee7a b\u1ec7nh vi\u00eam gan B m\u00e3n t\u00ednh:<\/span>\u00a0Mang thai th\u01b0\u1eddng \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t \u1edf nh\u1eefng ph\u1ee5 n\u1eef b\u1ecb nhi\u1ec5m vi-r\u00fat vi\u00eam gan B (HBV) m\u00e3n t\u00ednh kh\u00f4ng m\u1eafc b\u1ec7nh gan ti\u1ebfn tri\u1ec3n.\u00a0Tuy nhi\u00ean, mang thai \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t tr\u1ea1ng th\u00e1i dung n\u1ea1p mi\u1ec5n d\u1ecbch v\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 cao c\u1ee7a corticosteroid tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn c\u00f3 th\u1ec3 \u0111i\u1ec1u ch\u1ec9nh ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch.\u00a0V\u00ec v\u1eady, c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng sau \u0111\u00e2y c\u00f3 th\u1ec3 th\u1ea5y \u1edf ph\u1ee5 n\u1eef mang thai b\u1ecb nhi\u1ec5m HBV m\u1ea1n t\u00ednh:<\/p>\n

    \n
  • C\u00e1c c\u01a1n b\u00f9ng ph\u00e1t \u1edf gan: Nh\u1eefng thay \u0111\u1ed5i v\u1ec1 mi\u1ec5n d\u1ecbch trong th\u1eddi k\u1ef3 mang thai v\u00e0 th\u1eddi k\u1ef3 h\u1eadu s\u1ea3n c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c \u0111\u1ee3t b\u00f9ng ph\u00e1t vi\u00eam gan (bao g\u1ed3m c\u1ea3 gan m\u1ea5t b\u00f9);\u00a0tuy nhi\u00ean, c\u00e1c \u0111\u1ee3t b\u00f9ng ph\u00e1t v\u1edbi di ch\u1ee9ng l\u00e2m s\u00e0ng nghi\u00eam tr\u1ecdng d\u01b0\u1eddng nh\u01b0 kh\u00f4ng ph\u1ed5 bi\u1ebfn. M\u1ed9t \u0111\u1ee3t b\u00f9ng ph\u00e1t nhi\u1ec5m HBV th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 gia t\u0103ng alanine aminotransferase (ALT) l\u1edbn h\u01a1n hai \u0111\u1ebfn ba l\u1ea7n, cao h\u01a1n \u00edt nh\u1ea5t ba \u0111\u1ebfn n\u0103m l\u1ea7n so v\u1edbi ph\u1ea1m vi tham chi\u1ebfu.\u00a0Trong th\u1eddi k\u1ef3 h\u1eadu s\u1ea3n, c\u00e1c \u0111\u1ee3t b\u00f9ng ph\u00e1t c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn s\u1ef1 ph\u1ee5c h\u1ed3i mi\u1ec5n d\u1ecbch, m\u1ed9t t\u00ecnh hu\u1ed1ng t\u01b0\u01a1ng t\u1ef1 v\u1ec1 m\u1eb7t mi\u1ec5n d\u1ecbch v\u1edbi c\u00e1c \u0111\u1ee3t b\u00f9ng ph\u00e1t \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 sau khi ng\u1eebng s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng mang thai m\u1eafc HBV m\u1ea1n t\u00ednh<\/li>\n
  • \n

    S\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh gan: Nh\u1eefng thay \u0111\u1ed5i v\u1ec1 mi\u1ec5n d\u1ecbch, trao \u0111\u1ed5i ch\u1ea5t v\u00e0 huy\u1ebft \u0111\u1ed9ng h\u1ecdc x\u1ea3y ra trong thai k\u1ef3 c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam ho\u1eb7c l\u00e0m l\u1ed9 ra b\u1ec7nh gan ti\u1ec1m \u1ea9n.\u00a0M\u1eb7c d\u00f9 ti\u1ebfn tri\u1ec3n th\u00e0nh x\u01a1 gan c\u00f3 th\u1ec3 kh\u00f4ng \u0111\u01b0\u1ee3c bi\u1ec3u hi\u1ec7n trong m\u1ed9t th\u1eddi gian ng\u1eafn, nh\u01b0ng t\u00ecnh tr\u1ea1ng m\u1ea5t b\u00f9 c\u00f3 th\u1ec3 x\u1ea3y ra trong b\u1ed1i c\u1ea3nh b\u00f9ng ph\u00e1t nghi\u00eam tr\u1ecdng.<\/p>\n

    Tuy nhi\u00ean, c\u00f3 th\u1ec3 kh\u00f3 \u0111\u00e1nh gi\u00e1 s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh gan trong th\u1eddi k\u1ef3 mang thai v\u00ec nh\u1eefng thay \u0111\u1ed5i sinh l\u00fd b\u00ecnh th\u01b0\u1eddng c\u00f3 th\u1ec3 b\u1eaft ch\u01b0\u1edbc c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh gan m\u00e3n t\u00ednh.\u00a0\u0110\u1eb7c bi\u1ec7t, albumin huy\u1ebft thanh v\u00e0 hematocrit th\u01b0\u1eddng gi\u1ea3m, trong khi phosphatase ki\u1ec1m v\u00e0 alpha fetoprotein t\u0103ng. C\u00f3 th\u1ec3 cho th\u1ea5y nh\u1eefng d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh gan m\u00e3n t\u00ednh nh\u01b0 ban \u0111\u1ecf l\u00f2ng b\u00e0n tay, ph\u00f9 chi d\u01b0\u1edbi v\u00e0 u m\u1ea1ch d\u1ea1ng nh\u1ec7n.<\/p>\n<\/li>\n

  • HBV DNA. Nh\u1eefng thay \u0111\u1ed5i mi\u1ec5n d\u1ecbch li\u00ean quan \u0111\u1ebfn thai k\u1ef3 c\u0169ng c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m t\u0103ng l\u01b0\u1ee3ng virus HBV trong m\u00e1u;\u00a0tuy nhi\u00ean, h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ph\u00e1t hi\u1ec7n ra r\u1eb1ng n\u1ed3ng \u0111\u1ed9 HBV DNA v\u1eabn \u1ed5n \u0111\u1ecbnh trong thai k\u1ef3.<\/li>\n<\/ul>\n

    2. \u1ea2nh h\u01b0\u1edfng c\u1ee7a HBV m\u00e3n t\u00ednh \u0111\u1ed1i v\u1edbi k\u1ebft qu\u1ea3 thai k\u1ef3<\/h2>\n

    Ph\u1ee5 n\u1eef b\u1ecb x\u01a1 gan c\u00f3 nguy c\u01a1 cao b\u1ecb bi\u1ebfn ch\u1ee9ng chu sinh v\u00e0 k\u1ebft qu\u1ea3 x\u1ea5u cho m\u1eb9 v\u00e0 thai nhi, bao g\u1ed3m h\u1ea1n ch\u1ebf t\u0103ng tr\u01b0\u1edfng trong t\u1eed cung, nhi\u1ec5m tr\u00f9ng trong t\u1eed cung, sinh non v\u00e0 thai ch\u1ebft trong t\u1eed cung.\u00a0C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a m\u1eb9 bao g\u1ed3m t\u0103ng huy\u1ebft \u00e1p thai k\u1ef3, nhau bong non v\u00e0 xu\u1ea5t huy\u1ebft chu sinh t\u0103ng l\u00ean \u1edf nh\u00f3m b\u1ecb x\u01a1 gan.\u00a0Ngo\u00e0i ra, 15% b\u00e0 m\u1eb9 b\u1ecb x\u01a1 gan b\u1ecb suy gan. Tr\u1ebb s\u01a1 sinh c\u00f3 m\u1eb9 b\u1ecb x\u01a1 gan c\u0169ng c\u00f3 t\u1ef7 l\u1ec7 sinh non v\u00e0 h\u1ea1n ch\u1ebf t\u0103ng tr\u01b0\u1edfng cao h\u01a1n v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong thai nhi cao h\u01a1n \u0111\u00e1ng k\u1ec3 (5,2 so v\u1edbi 2,1%).\u00a0C\u00e1c b\u00e1o c\u00e1o kh\u00e1c \u0111\u00e3 m\u00f4 t\u1ea3 t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft do gi\u00e3n t\u0129nh m\u1ea1ch, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong tam c\u00e1 nguy\u1ec7t th\u1ee9 ba v\u00e0 trong qu\u00e1 tr\u00ecnh chuy\u1ec3n d\u1ea1 do t\u0103ng \u00e1p l\u1ef1c trong \u1ed5 b\u1ee5ng v\u00e0 t\u0103ng th\u1ec3 t\u00edch huy\u1ebft t\u01b0\u01a1ng.<\/p>\n

    B\u1ec7nh nh\u00e2n c\u00f3 thai trong khi \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat: C\u1ea7n ph\u1ea3i xem x\u00e9t \u0111\u1ec3 ng\u1eebng \u0111i\u1ec1u tr\u1ecb ti\u1ebfp t\u00fac ho\u1eb7c chuy\u1ec3n sang m\u1ed9t lo\u1ea1i ch\u1ebf ph\u1ea9m kh\u00e1c \u0111\u1ec3 kh\u00f4ng g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c kho\u1ebb m\u1eb9 v\u00e0 thai nhi.<\/p>\n

    Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi-r\u00fat:\u00a0Quy\u1ebft \u0111\u1ecbnh b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb trong khi mang thai ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 hi\u1ec7n di\u1ec7n hay v\u1eafng m\u1eb7t c\u1ee7a b\u1ec7nh x\u01a1 gan, HBeAg v\u00e0 kh\u00e1ng th\u1ec3 e vi\u00eam gan B (anti-HBe), c\u0169ng nh\u01b0 m\u1ee9c \u0111\u1ed9 HBV DNA v\u00e0 aminotransferase<\/p>\n","protected":false},"excerpt":{"rendered":"

    Vi\u00eam gan virus l\u00e0 b\u1ec7nh truy\u1ec1n nhi\u1ec5m th\u01b0\u1eddng g\u1eb7p. Tr\u01b0\u1edbc \u0111\u00e2y ph\u00e2n l\u00e0m 2 lo\u1ea1i vi\u00eam gan do virus vi\u00eam gan A v\u00e0 B. Ng\u00e0y nay \u0111\u00e3 t\u00ecm ra 5 lo\u1ea1i vi\u00eam gan l\u00e0 A, B, C, D, E. Vi\u00eam gan do virus B, C, D th\u01b0\u1eddng g\u00e2y n\u00ean vi\u00eam gan m\u1ea1n t\u00ednh v\u00e0 x\u01a1 […]<\/p>\n","protected":false},"author":49,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[13,33],"tags":[],"yoast_head":"\nGi\u1edbi thi\u1ec7u v\u1ec1 vi\u00eam gan B v\u00e0 thai ngh\u00e9n - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam gan virus l\u00e0 b\u1ec7nh truy\u1ec1n nhi\u1ec5m th\u01b0\u1eddng g\u1eb7p. 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