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 Surg Br, Vdi. 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 Shdrl - 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, 10. 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 - Id - Bdne llealing: An experimental study in rabbits". ] 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 i i; > i Ba6c DAU DANH GIA HIEU QUA DIEU TRj ENTECAVIR TREN BENH NHAN VIEM GAN VIRUS B MAN TINH HBeAg DUONG TINH VA HBeAgAMTINH . , 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(-). Doi tUgng va phuang phap nghien cdu: nghien cifu tie'n cdu 47 benh nhim dtfdc chan doan viem gan virus B man linh (VGVRB) ehia hai nhdm ilBeAg(+) vi HBeAg(-) dtfgc dieu trj Hntecavir i>,') mg/ngay trang thdi gian 12 tuan. Kit qua: dac diem tudi nhdm ilBeAg(-) caa han nhdm HBeAg(+), tdn thuang md henh hgc nhdm HBeAg(-) nang ban nhdm HBeAg(+) vdi chi so viem 10,1 ± 2,8 so vdi 9,6 ± 2,2, chl sd xa 2,78 ± 1,8 so vdi 1,8 ± 1,3 diem mac dii nong do HBV DNA d nhdm HBeAg(+) eao ban nhdm IIBeAg(~) 8,29 ± 0,87 sa vdi 6,23 ± 1,62 lagcaples/ntl. Nong do HBV DNA giam > 2 logcopies/ml sau 12 luan dieu trj hntecavir 0,5mg/ngay la 95,7%, vdi nhdm HBeAg(-i-) la 94,1% va nhdm HBeAg(-) li 96,7%. Ndng do HBV DNA dat difdi ngifdng phit hien dat J6,2%, frung binh nong do HBV DNA giam 4,71 ± 1,8 logcoples/ml d nhdm VCVRB HBeAg(+) vi - 4,84 ± 1,7 logcaples/ml d nhdm VGVRB HBeAg(-). Ty le chuyen dao huyet thanh d nhdm HBeAg(+) la 17,t)°/o, binh thifdng hai men gan ALT li 51,l"7o. Cic tneu chdng lam sing met mdi, chin an eai thien d 1U0%> benh nhan, lic dung phu ciia thudc it gap, thudng nhe, hay gap nha't la dau dau va viem mui hgng. Kit luan: lnlecavir li thud'c cd kha niing ifc che sU nhan len ciia virus tdt d ca hai nhdm viem gan virus B man tinh cd HBeAg(+) vi HBeAgi-l, hinh thudng bail men gan va ehuyen dao huyet lhanh l-IBeAg dat ly le kha cao, cai thien tneu chdng lam sang tdt. It lac dung phu, nen hfa chgn la thudc dau tay trong dieu trj viem gan virus R man tinh. Tii khoa: viem gan virus B, entecavir I. DAT VAN DE dflpc xdp vao vung dai djch nhiein LIBV vdi Hien nay thc'^ gidi cd tren 350 trieu ngfldi phfldng thflc lay truyin chu ye'u tfl me sang con, 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%