Đánh giá xơ gan

Vao nam 1997, toi di xet nghiem sieu vi B, ket qua duong tinh. Toi khong dieu tri thuoc gi cho den nam 2006 di xet nghiem lai va ket qua la: HBS AB: Pos S/co: 4446, den nam 2007: HBSAG: Pos index => 1000.0; SGOT. (AST): 22 ; SGPT (ALT): 34; HBeAg: Pos S/co = 18.182.

Sau do toi bat dau dieu tri bang cac loai thuoc: Victron 100mg, Ozinaolin 80mg, philoRPA-S, Silitrol 100, Thymolan, Lavimodine. Hien toi dang dieu tri thuoc Baraclude ngay 2 vien. Khi xet nghiem dinh luong HBV-DNA co ket qua nhu sau 521x10^0 copies/mL huyet tuong; HBeAg: Pos S/co: 15.315; SGOT (AST): 19.5;SGPT (ALT): 26.4; A.F.P: 3.04; fibroscan: 7.2 KPa.

Xin hoi nhu vay tinh hinh cua toi nang hay nhe? Co the chua cach khac khong?

(Ngo Van Sinh)

- Tra loi cua phong mach online:

O cac nam 2006 va 2007 xet nghiem mau cua ban cho ket qua HBsAg (chu khong phai HBsAB nhu ban ghi o ket qua nam 2006) duong tinh, cho thay ban da nhiem virus viem gan B (HBV) man tinh. Ban con co HBeAg duong tinh chung to virus nay trong co the ban co muc do sinh san cao ca vao nam 2007 cho den ket qua gan day, mac du xet nghiem dinh luong DNA cua HBV cho thay ket qua khong cao.

Cac men gan (ALT, AST) la chi so danh gia tinh trang viem xay ra tai gan; trong truong hop cua ban cac lan do men gan deu ra ket qua trong gioi han binh thuong cho thay hien tai cac te bao gan khong bi huy hoai. Tuy nhien, co le vi ban co HBeAg duong tinh nen ban duoc chi dinh cac thuoc ben tren, trong do co mot so thuoc diet virus (Victron, Lamivudine, Baraclude).

Ket qua do do dan hoi cua gan Fibroscan nham danh gia tinh trang xo hoa gan cho thay gan ban bi xo hoa muc do trung binh. Do co the la hau qua cua viem gan man dien ra trong hon 10 nam nay. Ket qua cua men gan va Fibroscan cho thay gan ban co le van con kha nang lam viec bu tru tot.

Tom lai, tinh trang cua ban hien nay la HBeAg duong tinh, luong DNA cua HBV o muc thap, men gan nam trong gioi han binh thuong, gan con kha nang bu tru nen chi can theo doi tai kham moi 3 - 6 thang, lam cac xet nghiem lai de danh gia dien tien benh. Thuoc chong virus thuong duoc chi dinh khi luong DNA cua virus tren 105 copies/mL, men gan tang, gan mat kha nang bu tru.

Nhieu thuoc chua cac benh khac co tac dung tren gan nen khi su dung ban nen luu y den cac tac dung nay. Ngung bia ruou cung lam cham dien tien xo gan. Giu ve sinh an uong de phong tranh nhiem virus viem gan A vi neu bi viem gan A kem se lam tang ap luc len gan da bi ton thuong san.

Vi ban co HBeAg duong tinh nen chu y phong tranh lay benh cho nguoi khac: di kham benh va chich ngua viem gan B cho nhung thanh vien chua mac trong gia dinh, dung rieng do ca nhan nhu ban chai rang, dao cao rau, do cat mong tay... ap dung bien phap an toan tinh duc. Ban cung nen xet nghiem kiem tra tinh trang nhiem virus viem gan C cua minh.

* Toi da xet nghiem viem gan sieu vi B: PCR dinh luong Hepetitis B virus DNA, co ket luan: 512 x 100 copies/mL huyet tuong (nguong phat hien >= 250 copies/ mL huyet tuong). Toi muon hoi ket qua nhu vay la cao hay thap

(Mercury Stellar)

Luong DNA cua virus viem gan B (HBV) trong mau cua ban nhu vay la thap. Tuy nhien ban van nen thuc hien cac xet nghiem theo doi tinh trang nhiem virus viem gan B moi 6 - 12 thang.

Rieng ve theo doi DNA cua virus viem gan B trong huyet thanh, day la cong cu quan trong xac dinh tinh trang sao chep (sinh san) cua virus, theo doi dap ung voi dieu tri va tien luong benh co kha nang dieu tri thanh cong hay khong. So voi HBsAg, dinh luong DNA cua virus viem gan B co do nhay cao hon trong viec phat hien tinh trang nhiem virus viem gan B. Nguoi ta co the van tim ra DNA cua virus trong mau o nhung truong hop HBsAg chuyen tu duong tinh sang am tinh nhu sau dieu tri voi thuoc khang virus, virus an trong mo gan va khong tiet ra HBsAg, dot bien lam virus giam hoac ngung san xuat HBsAg.

Thong thuong nong do DNA virus de co chi dinh dung thuoc khang virus la ≥105 copies/mL, tuy nhien con phu thuoc tinh trang men gan (cho biet muc do viem xay ra tai gan), cac xet nghiem khac ve nhiem HBV (cho biet giai doan benh, do hoat dong, lay truyen cua virus), tinh trang chuc nang gan (cho biet muc do anh huong cua benh len hoat dong cua gan), benh gan di kem (nhung ton thuong khac cua gan co the lam nang them dien tien benh)...

Gan la bo phan co nhieu chuc nang rat quan trong cho co the nhu chuyen chat co hai thanh chat khong con tac hai va thai ra ngoai, tong hop cac nguyen lieu can thiet cho hoat dong song con cua co the, chuyen hoa chat beo… Ban da nhiem virus viem gan B nen cang can quan tam bao ve la gan thong qua che do sinh hoat, an uong… Ngu du giac, tranh lam viec qua suc, ngung bia ruou, can than khi dung bat cu thuoc nao trong dieu tri cac benh, nen lam cuoc song tinh than vui ve… la nhung bien phap mang lai loi ich thiet thuc cho la gan cua ban.

BS LE THUY TUOI