Những phương pháp mới trong điều trị viêm gan virus mạn tính

DIEN DAN Y HOC

Chuyen de trong thang

NHU'NG PHl/QNG PHAP MQI TRONG DIEU TRI

VIEM GAN VIRUS MAN TINH

Pham Thi Thu Ha*

TOM TA T

Trong Ihgp ky qua da cd rdt nhieu tien bg trong dieu tri viem gan virus B mgn tinh. Ngodi cdc thuoc

quen thuoc nhu: Interferon, Lamivudine. Adefovir EmtricUabine, Tenofovir... cdn xudt hien cdc hgp chdt tirong

tu nucleoside da md rgng cira cho cong tdc dieu tri viem gan B.

Cdc thuoc irc che toan dien virus hay gen tri lieu dd thuc su Id mdi quan tdm cua nhieu nhd nghien cim

vd Id niem hy vgng gdn dot vai viec dieu tri viem gan sieu vi B mgn.

I. M d DAU

Cae nha khoa hgc ude tinh cd trSn 2 ty

ngudi tren thS gidi nhiSm HBV, hon 350 trieu

ngudi mang HBV man, trong do 60 trieu chet vi

ung thu tS bao gan va 45 trieu chet vi xo' gan.

Ty IS ngudi mang HBsAg thay ddi khac

nhau trSn thS gidi tir 0,1%) dSn 0,2% d Anh My va

Scandinavia, den ban 3% d Hy Lap, d miSn nam

Italia cd the ISn den lO-l ]%. 0 chau Phi va Vien

Dong trong do cd Ddng Nam A ty IS nay cdn cao

hon nua. Cong dong ngudi sdng biet lap d Eskimo

Alaska va dan ban sir Australia mang ty IS HBsAg

rat cao. Blumberg da phat hien ra HBsAg d chinh

ngudi dan ban sir Australia dtrdi tSn la khang

nguySn Australia.

Tai Viet Nam, mirc dp nhiSm HBV tuong

doi cao, ty IS cd HBsAg trong cdng ddng ndi

ehung vao khoang 10-20% (Hoang Thiiy Nguyen,

NguySn Thu Van, 1992; Pham Song va CS,I996).

DiSu do cho thay Viet Nam II nudc cd djch HBV

dia phuang cao.

Trong nhung viing cd ty IS ngudi mang

HBsAg cao, nhiSm virus thudng theo each truySn

dgc tir me sang con, NhiSm virus thudng thdng qua

tTnh mach rdn ma chu ySu vao luc sinh vl trong cac

tiep xuc gan gui me con sau dd. Nguy ca truyen

nhiSm khi tiep xiic vdi benh nhan nhiem HBV cap

thudng cao hon d nhung benh nhan man tinh. Cd

mpt ty IS nghich giua nguy ca man tinh va tudi

nhiSm virus, nguy ca la 80-90% khi nhiSm virus

trudc I tuoi va20%o dSn 50%) khi nhiSm virus trSn

I tuoi. Ngup'c lai. ngudi Idn nhiem HBV chi vdi

mpt ty IS thap tir I % dSn 2%.

Hien nay chua cd tbudc dieu trj dac hieu

viem gan B. Tuy nhien, cac nha khoa hpc da kbdng

ngiing cai tiSn cac pble do diSu trj vdi cic thude

tong hgp mdi va da mang lai nhii'ng kSt qua khieh

IS trong diSu tri viSm gan man tinh.

II. CAC PHtTOfNG PHAP DIEU TRI VIEM

GAN MAN TINH

1. Ca che phan tur cua viem gan B man

I.I. He gen HBV

HBV thugc hg Hepadnaviridae - mdt hg

gay viSm gan cho nhiSu loai dgng vat. He gen HBV

khdng ben vung, da xac djnh dugc nhiSu biSn thS

va the dot biSn. Virus nay nhan len nhd enzyme

phien ma ngugc ban than, enzyme nay de sai sdt

hon hon enzyme polymerase nen hay gay dot bien

vl II mdt trong nhung nguyen nhan chuyen thanh

viSm gan man, dien bien kjch phat, khdng dip irng

thude dac hieu vl vaccine.

Dieu trj blng IFN- alpha II dot pha dau

*Khoa Mien dich- Benh vien Quan ddi 108

S647 (Thang 12/2009) Y HOC LAM SANGI 25