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Nho ung dung cac ky thuat phan tich ADN cua virus viem gan B ma nguoi ta co the giai quyet duoc nhung han che cua ky thuat mien dich kinh dien. Ket qua phan tich ADN cua virus la co so danh gia benh trang, kha nang dien tien va theo doi dieu tri.
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| Xet nghiem mau de tim virus viem gan B. |
Theo bao cao cua To chuc Y te The gioi nam 2000, the gioi co khoang 2 ty nguoi da hoac dang nhiem virus viem gan B; va tren 350 trieu nguoi mang virus nay man tinh. Hang nam so nguoi nhiem virus tang them khoang 75.000 nguoi. Viem gan B duoc xep hang thu 9 trong nhung nguyen nhan gay tu vong. Viet Nam la mot trong nhung quoc gia co ty le nguoi nhiem sieu vi B cao (15 - 20%). Mac du chuong trinh tiem ngua virus viem gan B (HBV) da lam giam dang ke ty le benh viem gan do virus B nhung HBV van dang la nguy co lon nhat dan den xo gan, ung thu gan… Cac phuong phap chan doan va dieu tri moi da lan luot ra doi de giup dieu tri viem gan B man tinh hieu qua hon, giam ty le tu vong do xo gan, ung thu gan.
Viem gan B khong co trieu chung ro ret
Da so truong hop nhiem virus B man tinh ma benh nhan khong he biet vi thuong khong co bieu hien lam sang hoac neu co cung rat mo ho, lam cho nguoi benh lam tuong voi mot so truong hop roi loan tieu hoa. Chi co xet nghiem mau moi co the chan doan chinh xac duoc benh. Co nhieu loai xet nghiem khac nhau duoc su dung trong chan doan viem gan virus B, moi loai co mot y nghia khac nhau tuy vao tung giai doan cua benh ma bac si se lua chon xet nghiem thich hop.
Chan doan viem gan B
Nhung xet nghiem chan doan virus B hay duoc dung truoc day la HBsAg, AntiHBs, HBeAg, AntiHBe, AntiHBc, IgM va IgG. Cac xet nghiem nay la nhung xet nghiem co ban, dung phuong phap mien dich de phat hien, nhung van con mot so han che. Cho den khi ky thuat sinh hoc phan tu ra doi da mo ra mot ky nguyen moi ve chan doan gene giup chan doan duoc virus viem gan B o muc do phan tu. Nho ung dung cac ky thuat ve phan tich DNA cua HBV ma nguoi ta co the giai quyet duoc cac han che cua cac ky thuat mien dich kinh dien. Phan tich DNA virus giup cac nha chuyen mon co nhung co so danh gia tinh trang benh, kha nang dien tien cua benh, theo doi dieu tri benh va lua chon phuong thuoc dieu tri thich hop. Nho cac ky thuat sinh hoc phan tu, ngay nay cac nha chuyen mon co the danh gia va biet chi tiet, toan dien virus viem gan B o moi benh nhan de tu do dua ra phac do dieu tri toi uu. Tuy nhien, cuoc chien chong lai virus viem gan B van chua co hoi ket. HBV cung nhu moi virus noi chung luon luon bien doi cau truc di truyen cua no de tranh duoc tac dong cua cac thuoc dac tri.
Thuoc dieu tri viem gan B
Cho den nay, thuoc dieu tri HBV co the chia lam 2 nhom chinh, moi nhom co cac uu, nhuoc diem khac nhau cung nhu tac dung dieu tri, tac dung phu ma tuy vao moi truong hop cu the cua benh nhan, bac si se chon phuong phap dieu tri thich hop. Mot so thuoc hien dang duoc su dung pho bien tai Viet Nam nhu:
Nhom thuoc tiem: tieu bieu la Interferon co hieu qua dieu tri cao, khong co cac truong hop dot bien khang thuoc cua virus. Nho su no luc khong met moi cua cac nha khoa hoc ma cac the he moi cua Interferon duoc ra doi, tang hieu qua dieu tri cung nhu giam cac tac dung phu cua thuoc, thuan loi hon trong viec su dung thuoc cua benh nhan. Tuy nhien, nhuoc diem lon nhat cua loai thuoc nay la chi phi dieu tri rat cao, chua phu hop voi dieu kien kinh te cua cac nuoc dang phat trien nhu nuoc ta.
Nhom thuoc uong: co nhieu loai khac nhau, nhung uu diem noi bat cua nhom nay la re tien hon nhom thuoc tiem, khong co tac dung phu nao dang ke cung nhu rat thuan tien cho benh nhan su dung.
Thuoc uong dau tien duoc cong nhan dieu tri HBV la Lamivudine. Tuy nhien qua thoi gian su dung Lamivudine trong dieu tri HBV, nguoi ta phat hien co hien tuong dot bien khang thuoc cua virus.
Mot loai thuoc uong khac cung duoc cong nhan dieu tri benh viem gan B man HBeAg duong tinh hay am tinh nhung it bi de khang thuoc hon do la Adefovir Dipivoxil. O mot so truong hop, benh nhan co chuc nang gan xau, bac si thuong cho dieu tri ket hop giua Lamivudine va Adefovir de tranh tinh trang benh dien tien nang hon vi Adefovir co hieu qua uc che virus o benh nhan co tinh trang benh khong on dinh, xo gan mat bu, viem gan B tai phat sau ghep gan. Tuy nhien, vi Adefovir gay anh huong den than nen nguoi ta thuong giam lieu Adefovir cho benh nhan co benh ly than.
(Theo Suc Khoe & Doi Song)
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