Đánh giá kết quả ghép gân đồng loại thực nghiệm trên thỏ

TCNCYH
66 (1) - 2010
.!
(.1
DANH GIA KET QUA GHEP GAN DONG LOAI
THUC NGHIEM TREN THO
Tran Trung
Diing\
Ngd Duy
Thin^,
Dao Xuan Tich'
.f )3(j
mdn Ngoai,
Trifiyng IXil
Hgc Y Hi Ngi
^'BO
mdn Md hgc Phdi thai hgc,
IrUiing
Dai I Ige Y I ia Ngi
Muc tieu: danh
gia
kcl qua
ciia
ghep gan dong loai
ihuc
nghiem Iren Ihd. Doi
tUgng
vi phitang phap
nghidn cdu:
10
can

ihd
dugc lien hanh ghep gan ddng loai via dudng ham xuang dui
2
hen, 2 can
dugc
ghep
gim tu than dc lim nhdm chdng. Kit qua: khdng tha'y cd sU tap trung
ciia
dc te bao
viem.
(J
thai
didm
-1
tuan cd lhe quan sal tha'y sU tang sinh mach va xam nhip cae nguyen hao sgi via manh ghep.
U
thdi diem 8 luan tha'y sU xua't hien md xuang mdi quanh manh ghep. Kit luan: khdng cd de da'u hieu
ciia
nhiim triing va thai ghep. Cd bleu hien Hen manh ghep dong
loai
trong dtfdng ham
xtfang
tifOng tU
niitnh
ghep
lif
than.
.• :.•. . .

-\;

Tfl khoa: ghep gan, ddng
loai,
thuc nghiem, lien gan
xfltfng : ,
LDATVANDE
Sfl (lung vat lieu ddng loai trong phiu thuat
chin thflong chinh hinh cd xu
the
ngay ciing tang.
C;6
hai loai vat lieu chinh thfldng difpc sfl dpng la
xifcjng
ddng loai va gan ddng
loai.
Trong dd, md
xu'dng (la dudc sfl dung tif lau va
dem
lai nhflng
k("M
qua tdt.
Dd\
vdi mo gan,
vice
xfl ly va bao
quan ddi hdi nhflng
y(5u
cau chat che hon vi mat
thdi
gian,
khau vd trung, liiu

chicYu
tia gamma va
each
thflc bao quan. Tai Labd Blo
quin
md, bd
mdn Mo hpc va Phdi thai hpc, trfldng Dai hpc Y
Ha Npi da hoan chinh quy trinh "Sing Ige, thu
nhan, xd ly va bao quin md gin sd dung cho
phau thuit" va bat dau thflc hien blo
quin
md
gan de sfl dung cho phau thuat tfl cud'i nam 2007.
Miic du quy trinh difdc xay dflng dfla theo nhflng
i\cu
chuan
ciia
I
licp
h()i ngan hang md chau A -
Ih.ii
Binh Dfldng (long
ihdi
cd tham khao cac ket
qua
tr(5n
lam sang cua viec sfl dung dc md ghep
dd cua cac nifdc tren the
gidi,
nhifng trong diiu

kien thifc te Viet Nam, lieu quy trinh nay cd dam
bid
du'dc tinh an toan cua
minh
ghep de sfl dpng
cho phau Ihuat hay khdng thi cln cd nhflng ket
qua chflng minh tren thflc nghiem, dac biet la yeu
td nhiem triing va thai loai manh
gh(:p.
Do do
chung tdi tien hanh de tai nghien cflu nay nhlm
muc
tieu:
Danh gia kit qua ghep gan ddng loai thuc
nghiem tren thd.
II.
DOI TL/ONG VA PHI/ONG PHAP
NGHIEN CL/U
1.
Do'i tflpng nghien cflu
20 con thd dflc, khde manh,
gi(')ng
npi dja,
khoing 3 thang
tudi,
can nang tfl 1,8-2 kg, ngudn
gde
tfl trung tam gidng de va thd Son lay. 8 con
difdc dung de liy gan nham muc dich ghep lai,
10

con dflpc sfl dung chd phiu thual ghep gan ddng
loai,
2 con dfldc ghep gan
Ifl
than de ddi chflng.
2.
Cac budc tie'n hanh
-I-
Liy gan
viing
g'dt
ihd,
bao quan
Ihco
c|uy
trinh "Thu nhan, xfl ly va bao quan md gan" cua
Labd blo
quin
md: 8 con thd dfloc giet blng
each
liem khdng khi vao mach mau, sau dd thifc hien
phau thuat lay gan vung
gdi
cua thd va xfl ly gan
theo quy trinh thu nhan, xfl ly va bao quan md
gin
d ngfldi, blo quan lanh sau am
85"C
cua
TCNCYH 66 (1) - 2010

Labd
bid
quan md, bp mon Md hpc
-
Phdi thai
hoc, Trifdng Dai hpc Y Ha Npi.
\ Phiu
Ihuat trdng
elieu kien
vd trung: vc mat
phiu
thuat, chung tdi sfl dung md hinh
Ihifc
nghiem ghep gan
tr(5n
thd cua lac gil Hideo
Kawakami cd di
i\en
[6|.
Hinh
1. Mo
hinh
thuc nghiem phau thuat tren tho theo Hideo Kawakami co cai
tiini
hinh ben phai) Ben
trai la mo hinh thUc
nghiem
nguyen mau cua Kawakami [6]
Vi tri khoan tao dfldng ham d
dau dfldi xUOng diii thd

Vj tri liy gan do xfl ly va bao quan
Hinh 2. Minh boa vi tri lay gin va vi tri khoan tao dUdng bam [4]
TCNCYH
66 (1) - 2010
Trdng md hinh thflc
nghi(5m
phiu thuat cua
Kawakami, hai dfldng ham difdc lad ra
d
xifdng
dui va xifdng chay va manh
gh(;p
difdc c6
dmh
d ca hai difdng ham. Chung toi chi' cd dinh
manh ghep lrong dfldng ham xifdng dui cdn
|)han ngdai
vi
difdc khau vui trdng td chflc difdi
da cua
Ihd.
Thd difpc gay me tdan than bang ete, Rach da,
tach cd vao xfldng dui thd hai ben, xac djnh vj tri
lad difdng ham d vung dau difdi xifdng dui. Khoan
tao difdng ham vung dau difdi xfldng dui sau 2 ben
cua thd, vdi dfldng kfnh
3,5inm,
sau 6mm.
Minh
gan thd da difpc xfl ly, bao quan cd

kich
thfldc
3x10
mm, se dfldc dat vad difdng ham va cd
djnh lai vdi
1
vit kim
loai,
dfldng kinh 2,5mm dai
6mm.
Phan cdn lai cua manh
ghi=p,
dai khoang
4mm difdc khau cd djnh vad td chflc dfldi da cua
Ihd.
Ddng kin vet md.
^^***
Hinh 3. Minh ghep gan tho dong loai sau khi dugc
bao quan, dang dugc xd ly di ghep lai vao xuang
dui
tho
Nhfl vay, vdi
10
con thd, chung tdi tao difdc
20 vi
tri ghc^p minh
gh(3p.
Hai Cdn thd cdn lai difpc tie'n
lianh gh(Bp
bang

minh gh(2p
tfl
than,
liy
ifl
chan sau ben trai
gh(;p
sang chan sau ben phai vdi quy trinh phau thuat
nhif
tren.
+ Thcd ddi
sail
irid;
sau
md
ihd
dfloc nudi
ri('Mig
trong chudng dam bao
vij
sinh,
chi?'
d()
an thdng
thifdng.
Difpc theo ddi tinh trang
Idin
than,
nliiel
dp,

tai chd vet thifdng.
+
l:)anh
gia
k(?'t
qua sau 4 tuan va 8
tuan:
sau thdi gian gian lan Ifldt la 4 tuan va 8
tuan,
n<5m
con thd cua nhdm
ghc>p
ddng loai va 1
con thd cua nhdm
gh<2p
tfl than difpc gay
chie't
blng
each Uem
khi vao
tinh
mach tai
ihd.
Danh gia ve
dai
the tai vi trf md, tfl ngoai vao
trdng:
md da, md dfldi da, cd, mang xifdng,
khdp gd'i cua thd. Sau dd, phan dau dfldi
xifdng

dili
dfldc
cit
ra khdi cd the, difdc khfl
Canxi xflong bang dung djch acid formic 30%,
due
khd'i
n(§'n
va cit lat
tii^u ban
mdng 7
micromet vudng goc vdi
true
cua difdng ham.
Mdi vi tri ghep lam 5
ti(5u
ban
nghic^n
cflu.
Cac deu ban dflpc nhupm HE va danh gia
v(^
vi the dfldi kfnh hii'n vi quang hpc vat kfnh
10
va 40
[1].
III.
KETQUA
1.
Danh gia ve dai the
Theo bang 1 ta thiy, tit ca 12 con thd (gdm

10 con
gh«;p
ddng loai va 2 con
ghdp
tfl
than)
diu sd'ng khde manh, chay nhly td't. Khdng cd
con nao cd bieu hien nhiim trung loan than
cung nhfl tai chd. Vet thifdng lien tdt va mpc
Idng binh thfldng.
D(2'n
thdi didm danh gia ve md hpc, sau khi
dflpc gay
ch(5't,
danh gia tai chd khu vflc quanh
difdng ham cua tat cl cac con tho ghep ddng
loai tha'y td chflc da, dfldi da, md co,
ming
xifdng
hdln
toan binh thifdng. Khdp gdi
binh
thifdng,
khong
Iran
dich,
khdng cd bat thifdng
cua mang hoat djch vl sun khdp, Cac bieu
hien ve dai the tfldng tfl nhfl cua con thd
gh(;p

tfl
than.
TCNCYH 66 (1) - 2010
Hang 1. Kit qui nghien cdu
'
Sl")'
lu'dng thd
nghien
ci'fu
So lifdng vj
Iri
ghep
Sd lu'dng
tii'^ii
ban
ly
Id
thd sdng
(lc"'n ihdi
didm danh gia
NhifMn trung
Co
nang
gdi
bi anh
hifdng
1 licii
lifong tang sinh mach d manh
gh(5p
thdi diem 4 tuan

Sfl xuit hien dc nguyen ban sdi d vung ranh gidi
Tfl than
Ddng loai
Tfl than
FJong
loai
Tfl than
Ddng loai
Tfl than
Ddng
loai
Tfl than
Ddng ldai
Tfl
than
E)dng loai
Tfl
than
Ddng loai
Tfl
than
Ddng loai
Ke't qua
2
10
2
20
10
100
100

100
0
0
0
•
'
'
0
10/10
lieu ban
95/100 lieu ban
100/100
lieu ban
100/100
tieu
bin
Sfl
xuil hi(:n
cua md xifong mdi va tap trung cua tao cd't bao
Tfl than
100/100 ti(\i
ban
Ddng loai
98/100 tii'-u
ban
A
.•
V'Wr,^
0^^'^^•^«'>••'^^',
'••'•>''

^
30
/
/^
"H£«2,ii>iaft
Hinh 4. Hinh anh dai the vi tri gbcp dui thd. Td chdc dudi da binb thudng (A), B la vi tri dudng ham
(dau kep chi vao
vit).
Chu thich:
R
-
alio
8.6
/I
con thd thd 6 tuan thd 8 nhdm ghep ddng loai
TCNCYH 66(1)-2010
2.
Danh
gia ve vi the
tion iH J , .,
.
«A
, •••
Cung theo bang
1,
tren
dc
tieu
bin
sau 4

tuan,
da
xuit hien
cle
mach
mlu tan tao cua
minh
ghep
va
sfl
xult hien
day dac cua cle
nguyen
blo soi tap
trung
d
vung giap danh {binh
5).
Khdng thiy
sfl cd
mat
cua dc te bao
phln flng viem.
Sfl tap
trung
cua ele
nguyen
blo spi
gilm
dan d

thdi diem
8
tuan
vl
thay
vao dd la cac sdi
collagen.
Vao
thdi diem
4
tuan ranh gidi
md gan va
xflong
cdn
tifong
ddi rd
ring
tuy nhien
vao
thdi diem
8
tuin,
xuit hien
md
xflong
mdi
phlt trien
va xen ke vao md
gan, xuit hien
dc

te
blo
dang
sun. CIc
hinh
Inh nay gap
tren
cl
tieu
bin
cua
minh
ghep ddng loai
va
minh
ghep
tfl
than.
' -^ '•

i:.
.:
Xtrcme
Vungrjinb giOT
Caa ghep
H:J:]J
anil
cac
tao
cot bao rap

tir.na o
M1K2
laiil!
aioi
Mo xircmg mdi xam
nhap vao md
gaii
Hiiili aiili
mach
miiu
tang
siiih
trong
mmih
ghep
Hinh
5.
Hinh
anb mo gan
ghep
va
viing ranh gidi
(A) d
thdi
dUm 4
tuan (nhugm
HE
xlOO),
hinb
inh

vung
ranh gidi kbong
con ro
rang
vdi
so lugng nguyen
bao sgi
giam
di, (B)
binh tbanb
cac sgi
collagen
va
sU xam
nhap
xen ke cua mo
xuang
mdi vao mo gan
(nhugm
HE
x400)
•ifi^
To (IiUT iiitrn'^nitii
iofbtrc strrrog 11)1^1
Minlii)hi>[>
.<"scleb.Wdipg'iift
•/'
Hinh
6.
Hinh

anh mo
xuang
mdi moc lan vao mo gan d
mknh
ghep
tU
than
(A) va
mknh
ghep ddng
toai (B)d thdi diem 8
tuan (nhuom
HE
XlOO)
TCNCYH
66 (1)
-
2010
IV. BAN LUAN
Nhiim trung la ndi
e
ngai dau
lii?n
khi sfl
dung
manh gh(''p ddng
loai,
lit
ca cic con thd
deu sdng khde manh, lai

c:li6
cung nhfl tdan than
khdng Cd bidu hicn
nhii'm
Iri'ing,
Vdi
([uy
trinh
Ihu nhan, xfl ly va bao (|uan mo gan ddng
loai,
khdng chi Clia Labd bao quan md phdi thai hpc,
tnfdng
Dai hpc Y Ha Npi ma cua d cac trung
lam bad quan md khac trong nfldc va tren the
gidi,
hai khau quan lrong nhat cua quy trinh la
cay vi khuan thfldng quy va
khu'
khuan blng tia
gamma,
\l\ec
cay vi khuan thifdng C|uy nham
muc
clich
kicm tra va danh gia quy trinh de loai
1)0
nhrfiig
manh
ghc'^p
co nguy cd, Tiet khuan

l:)lng
tia Gamma lieu 25
kCrays
dam
bid
nguy
CO nhiem khuan nhd hdn 1/1000000 (1 phan 1
Irieu),
Do dd nguy cd nhiem khuan dd manh
ghc'p
gan nhfl khdng cd. Khdng cd thdng bao
nao
v(''
bleu
hicn
nhic";m
Irung manh ghep
Iren
llu/c
nghiem cua cac lac gia khac |6, 7, 8,
9,
1()|,
lrong nghic^n
cflu
ciia
chung tdi, chung tdi
chu dpng danh gia kit qua
Ifl
4 tuan trd di nhlm
muc

dich
bd qua giai doan phan flng viem sinh
ly cua qua trinh liin manh ghep de viec danh
gia sfl cd
nicil
hay khdng cua dc te bad viem
du'dc de dang hdn.
Cac bieu hien vi md hpc tren lieu ban thdi
diif-m
4 tuan va 8 tuan deu khdng cd bieu hien
Clia thai
gh('|),
I heo Trinh Binh, ciu
true ciia
manh
ghc^|)
gan ddng ldai chi bad gdm chu ydu la
cac Sdi collagen va m()t
scY
nguyen bad sdi ]2].
i
hoo
Vu Dfldng Quy va Pham Manh Hung, khang
nguydn hda hdp md
chi
cd
tdn
be mat cua cac te
bao cd nhan va te bao cua he thdng mien
djch,

khdng cd Iron dc spi cdllagen
[3],
Khi difpc xfl ly
bang tia
C]amma
cac
It"'
bad nay bj
tic^u
diet hdan
loan (ldng
ihdi
c|iia
Irinh bao quan lanh sau cung
lam giam
linh
khang nguyen cua manh
gh(3p.
Cd
che""'
lam giam tinh khang nguyen dfldc chd la do
dc te bao bi tieu diet, cac khang nguyen bam
tren bi mat cua te bao bj pha huy va
h\in
tinh
nen
linh
khang nguyen giam hoac
nv'il
hoan

loan 16]. . , • , , . ,
Jjmi flftftn OKn '•;•
':(-:•
h\:.j
it i
Sfl liin Clia manh
gh(=f)
ddng ldai Irong dfldng
ham xfldng lfldng
ifl nhif
liin
minh ghc:p
tfl
than,
Cd 3 hicn tifdng cd the quan sal thay rd rang d
ca manh ghep ddng ldai va manh
ghc'>p
U.f Ihan
la:
sfl tang sinh mach man trong manh
ghc^p,
sfl
tap trung nguyc';n bao spi va hinh lhanh sdi cdlla-
gen,
sfl phat trien cua md xfldng mdi vdi sfl xuat
hien cua cac to bad dang sun, Thed
Rodeo
|9],
qua trinh liin gan Irong difdng ham xfldng khdng
don thuan

nhif m()t
qua trinh liin md gan hoac
mo xflong dien
hinh
ma nd la sfl phdi hdp ca hai
qui
trinh dd bao gdm: sfl tap trung te bao va
tang sinh mach; sfl phat trien cua me xifdng mdi
(bad gdm ca qua trinh huy xifong va tai lao
xifdng) trdng dd sfl phat tridn cua md xifdng mdi
ddng vai trd
c|iian
trong, dam bao sfl vflng chac
Clia
mcj'i
lien kcl, Sfl xuat
hicjn
cua md xifdng
mdi,
(lac
bici
la sfl cd mat cua
cac
lc"' bad
daiig
spi la minh chflng chd qua Irinh
lic^n
manh
ghc^p.
Qui

trinh lien manh ghep nay, thed nghien cflu
cua Grassman [8] thi sfl xuit hien cua md xifdng
mdi tifdng tfl
nhif hinh
thanh can trong gay xfldng
dd dd cung tifdng do'i da dang vi hinh
thai,
Vdi
sfl xuit hien cua md xifdng mdi, sfl tap trung cac
nguyen bad sdi va hinh thanh sdi Cdllagen tao
nc"n
md'i li(?n kdt gifla md gan va md xifdng gdm
4 vung tifdng dd'i rd
rc5l:
gan, md
sun
chifa
khdang hda, md sun khdang hda va mo xifdng,
Vai Ird quan trpng cua viec hinh lhanh mo xifdng
mdi trdng viec lien manh ghep da
clifdc
chflng
minh qua nhieu nghic'n cflu va cung la cai
dich
Clia nhiiu nghien cflu de
thilc
day qua Irinh lien
manh
ghc^p
sau phau thuat

nhif nghii?n
ci'fu sfl
dung te bad
gcx:
cua Michael
YII
Sddn |7]
nghien cflu sfl dung chat flc che huy xifong cua
SA Rddeo
110].
, ^^
TCNCYH 66 (1) - 2010
V.
KET
LUAN
••
' ''''- - "-•• — '•' ••
'^'->-
-'
CJu.i
nghi("n
cii'ii |lu,f( nghi(?m
gh(''|.) gan (long
loai
iKMi
10 con
Ihd
l)ang manh
ghc^p
dfldc

ihu
nhan,
xfl ly va
Ijao
c|uan
iheo
(.|iiy
trinh cua Labd
Bid
quan Md Phdi
Ihai,
Irifdng
Dai
hdc
Y Ha Npi
thiy
rang:
Khdng Cd bieu
hicjn nhic^m
trung manh
ghc'^p.
- Khdng cd bieu hien cua hien tifdng thai ldai
manh
gh(?p Irc^n
thflc
nghicjm.
Ci) bieu hien lien gan xifdng cua manh ghep
ddng loai lifong tfl
nhif
manh

ght^^p
tfl
Ihan,
TAI
LIEUTHAM
KHAO
1.
Bo mon Mo hoc - Phdi thai hoc (2001). "Ky
Ihual
Md
lldc",
I ldi nghi md Phdi
hdc
loan qudc
lan
Ihfl4,
tr
1
6,
2.
Trjnh Binh (2007). "Md
li(?n
ket chinh
lhfl(:",Bai giang Md - Phdi Phan Md Hpc:. Nha
xuit ban Y hpc, tr 39 - 52.
> ':•.'
«'''
' ' ' '
3. Vu DflOng Quy, Pham Manh Hung (2006).
"Mien djch

ghc-p".
Mi(?n
djch hpc. Nha xuit ban
Y hpc, tr 277 - 290,
4. Boris A. Zelle, Christian Lattermann, Anikar
Chhabra, Freddie H. Tu and Johnny Huard
(2005).
"Bidldgical
Cdiisideratidns
df
Fenddii
Graft
Incorporatidn
VVilhin the Bdne Tunnel", Oper
Tech
Orlhdp
15:
36 - 42.
:,^,\,, ,,,,,„>
.
,.,/,,., , • ,_;
" ' 5. Hideo Kawakami, Konsei Shino, Masayuki
Hamada,
Ken
Nakata, Shigeto Nakagawa,
Norimasa Nakamura, Yukiyoshi Toritsuka,
Hideki
Yoshikawa,Takahiro Ochi (2004). "Graft healing
in a bone
liinne

bone - attached graft with screw
,'ini
Y'>'
'IIUI
ll!
M!;'H
i
fixationl
versus
bdiie
tre(-
grail
wilh
(-xIra
articular suture
tixalidn".
Knee Surg Spdrls
Fraumaldl Arlhrosc
(2004)
1
2:
[jp
384
.590,
6. Konsei Shino, Takao Kawasaki, Hitoshi
Hirose, Ippei Cotoh, Masahiro
Inoue,
Keiro Ono
(1984).
"Replacement

of the anteridr
cniciatc
ligament by an alldgeneic tenddn graft: An
experimental study in the dog". J bdne
Idint
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66 B, Nd. 5, November, 672 682,
^
7. Michael Y. H. Soon, Afizah Hassan, James H.
P. Hui, James C. H. Goh and
C.
H. Lee (2007). "An
Analysis of Soft Tissue Allograft Anterior Cruciate
Ligament Recdnstruclidn in a Rabbit
Mddel:
A
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- form Study df the Use df Mesenchymal
Stem Cells td
I
nhance
li^nddn
Osteointegration".
Am.
J. Sports Med. 2007; 35; 962 - 973.
8. S.R.M. Grassman, D.B. McDonald, G.M.
Thornton,
N.G. Shrive, CB. Frank (2002). "I

arly
healing
prcccsses
df free tendnn grafts within bdne
tunnels is bone -
specific:
a morphological study in
a rabbit
model".
The Knee 9 (2002): 21
-
26.
9.
SA Rodeo, SP Arnoczky, PA Torziili, C
Hidaka and RF Warren (1993).
"Fendon
-
Healing
in a Bone funnel: A bidmechanical and
histdldgical study in ddg", J Bone Joint Surg Am,,
1993;
75:
1795
• 1803,
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Scott A. Rodeo, Sumito Kawamura, C.
Benjamin Ma, Xiang - hua Deng, Patrick S.
Sussman,
Peyton Hays and Liang Ying (2007).
"The Effect df Osteoclastic Activity on

FiMiddu
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- Bdne
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] Bene Jdint Surg Am; 89: 2250 - 2259.
' "•
' Summary
EVALUATION OF EXPERIMENTAL ALLOGRAFT TENDON TRANSPLANTATION IN RABBITS
Objective:
we evaluate the alldgraft irradiated deep frozen tendon td bdne healing in rabbits. Methods:
we transplanted Ihe allograft tendon into the bdne tunnel of the femur for
10
rabbits, 2 rabbits were used
in conlrol group wilh autdgraft. Clinical and histological
evaluatien
were conducted at the time of 4 and 8
TCNCYH
66 (1) - 2010
weeks.
Results:
lhi>re
was no
cdlleclidn
of inflammatory cells at the lime of evaluation. At 4 weeks, lhe
vasc:ulari/'ation
and the invasion of fibroblasts were noted and at 8 weeks some new woven bone ardund
Ihe graft
were
fdiind.

Conclusion: there was no evidence of infection and
rejection,
fhe alldgraft
lenddii
lo
bone healing was
recogni/cd
with the same
manner
of autdgraft. . ;, . ,,
Keywords: allograft, experimental, tendon graft, tendon to bone healing
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DAU DANH GIA HIEU QUA DIEU TRj ENTECAVIR TREN
BENH NHAN VIEM GAN VIRUS B MAN TINH HBeAg
DUONG
TINH
VA HBeAgAMTINH
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Nguyen Cong Long, Dao Van Long, Biii Xuan Trfldng, Le Van Anh
Khoa Tieu hda - Benh vicn Bach Mai I la Ndi
Muc tieu: dinh gii tie dung, tinh an toin ciia Entecavir trong dieu trj
vlSm
gan virus B man tinh cd
HlieAg(+) va
HBeAg(-).
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HBeAg(-)
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12
tuan. Kit qua: dac diem tudi nhdm ilBeAg(-) caa han nhdm HBeAg(+), tdn
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8,29 ± 0,87 sa vdi 6,23 ± 1,62
lagcaples/ntl.
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12
luan
dieu
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la
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va nhdm HBeAg(-) li 96,7%.
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viem mui
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ciia
virus tdt d ca hai nhdm viem gan virus B man tinh cd HBeAg(+) vi
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hinh thudng bail men gan va
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tdt.
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hfa chgn la thudc dau tay trong
dieu
trj viem gan virus
R
man tinh.
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I. DAT
VAN
DE dflpc xdp vao vung dai djch nhiein LIBV vdi
Hien nay
thc'^
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nhiem HBV man tinh |9|, so' benh nhan nhiim ddng thdi LIBV la nguyen nhan chinh gay
vii^m
LIBV man tinh cd HBsAg dflong tinh tai Trung gan man, xo gan va ung thfl gan.
lOieu
trj viem

Qucdc
va khu vflc
t3dng
Nam chau A trong dd cd gan virus B cd nhiiu tien bp trong thap ky qua.,
Vii^t
nam chiem khoang 50% tdng sd benh
nhin
Interferon - alpha dflpc xem la thud'c dau lien
tri§n
tdan
\hi
gidi.
Tai Viet Nam, ty le nhiim difpc cdng nhan trong dieu trj, nhifng thudc
HBV cd HBsAg
difong
tfnh cao tren 8%
din
sd nhdm cytokine nay chl cd
hicMi
qua khoing 35%