- HCV: ton thudng dUdng mat, nang lympho trong khoang cUa, te bao gan thoai hoa md.
4. Dieu trj viem gan virus B man tinh
Cac dang benh nhan nhiem viem gan B
- Ngiidi mang man ti'nh khong co trieu chiing: HBsAg + Transam inase binh thiidng khi kiem tra nhieu lan lien tiep, khong co virus nhan len [khong co HBVADN, HBeAg(-)] mo benh hoc binh thiidng.
- Viem gan man tinh hoat dong yeu 30%.
- Viem gan man ti'nh hoat dong 30% chi nen dieu tri viem gan bang cac thuoc diet virus vao giai doan nay: cac marker virus viem gan thiidng diidng ti'nh: HBVADN, HBsAg, HBeAg, IGMHBc.
•K ,
- 0 mot so BN co virus nhan len (HBVADN+) khong co HBeAg (-) tinh trang huyet thanh nay diidc goi la virus dot bien. Dieu tri thiidng kho doi vdi the benh dot bien.
M uc tieu: cat dilt hien ttfdng virus nhan len va dilng viem gan hoat dong nham ngan can qua trinh tien trien den xd gan.
Chi dinh dieu tri: lam sang co the co trieu chiing HBsAg (+) keo dai > 6 thang
HBVADN > 100000 copies / ml ALAT > 2 lan binh thiidng
M6 benh hoc: viem hoai til > 4 diem Knodell
Cac thuoc dieu tri: In terferon:
L/u diem: khong tao dong virus dot bien, co kha nang lam mat HBsAg (ma khong co doi vdi cac thuoc khac), thdi gian dieu tri ngan hdn
Nhiidc diem: nhieu tac dung phu, phai lila chen benh nhan phu hdp vdi chi dinh
- Interferon a (3 - 6 trieu UI 31an / tuan) trong 6 thang, trong triidng hdp viem gan B +D lieu con tang hdn. - Interferon Pegyle (Pegasys): 180pg tiem dildi da 1 lan /
tuan it tac dung phu co hieu qua cao
Lam ivudin diicfc ch i dinh thii 2 lOOmg / ngay.
Dap ilng 30% ty le tai phat cao, it tac dung phu
A d efovir: lieu dung lOmg/ngay. Uu diem khong co khang thuoc cheo giila cac nhom thuoc co hoat chat nucleoside. Sil dung ddn gian co the dung keo dai.
Ghep gan chi danh cho cac benh nhan co benh gan nang khong co virus nhan len trildc phau thuat.
Diing riidu bat buoc.
Tieu chuan danh gia khoi benh hoan toan:
H BVA DN < 4000 copies / ml H BsAg (-), GPT < 40UI/ml
Thdi gian keo dai > 6 thang sau dieu tri