{"id":3672,"date":"2020-03-19T16:59:10","date_gmt":"2020-03-19T09:59:10","guid":{"rendered":"http:\/\/new.vientebaogoc.edu.vn\/?post_type=blog_post&p=1164"},"modified":"2024-11-24T07:58:41","modified_gmt":"2024-11-24T00:58:41","slug":"ghep-te-bao-goc-tu-day-ron-dieu-tri-benh-phoi-tac-nghen-man-tinh","status":"publish","type":"post","link":"https:\/\/sci.edu.vn\/home\/blog\/2020\/03\/19\/ghep-te-bao-goc-tu-day-ron-dieu-tri-benh-phoi-tac-nghen-man-tinh\/","title":{"rendered":"Gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c t\u1eeb d\u00e2y r\u1ed1n: \u0110i\u1ec1u tr\u1ecb b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u00e3n t\u00ednh"},"content":{"rendered":"\n

T\u1ebf b\u00e0o g\u1ed1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u1ebf b\u00e0o g\u1ed1c trung m\u00f4 c\u00f3 nh\u1eefng \u01b0u \u0111i\u1ec3m v\u01b0\u1ee3t tr\u1ed9i trong \u0111i\u1ec1u tr\u1ecb c\u0103n b\u1ec7nh \u0111ang l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong th\u1ee9 t\u01b0 \u1edf Vi\u1ec7t Nam n\u00e0y. Quy tr\u00ecnh nghi\u00ean c\u1ee9u v\u00e0 \u0111i\u1ec1u tr\u1ecb ho\u00e0n to\u00e0n \u1edf Vi\u1ec7t Nam.<\/em><\/strong><\/p>\n\n\n\n

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Ngu\u1ed3n \u1ea3nh: B\u1ec7nh vi\u1ec7n V\u1ea1n H\u1ea1nh<\/figcaption><\/figure>\n\n\n\n

Quy tr\u00ecnh nghi\u00ean c\u1ee9u \u201cmade in Vietnam\u201d<\/strong><\/p>\n\n\n\n


B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u00e3n t\u00ednh (COPD) l\u00e0 m\u1ed9t d\u1ea1ng b\u1ec7nh li\u00ean quan \u0111\u1ebfn ph\u1ea3n \u1ee9ng vi\u00eam b\u1ea5t th\u01b0\u1eddng c\u1ee7a \u0111\u01b0\u1eddng th\u1edf v\u00e0 nhu m\u00f4 ph\u1ed5i b\u1edfi c\u00e1c ph\u1ea7n t\u1eeb v\u00e0 kh\u00ed \u0111\u1ed9c h\u1ea1i, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111\u01b0\u1eddng th\u1edf c\u1ee7a h\u1ec7 h\u00f4 h\u1ea5p. COPD \u0111ang t\u0103ng tr\u01b0\u1edfng nhanh ch\u00f3ng trong th\u1eddi gian g\u1ea7n \u0111\u00e2y v\u00e0 tr\u1edf th\u00e0nh nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong x\u1ebfp th\u1ee9 4 \u1edf Vi\u1ec7t Nam v\u00e0 tr\u00ean to\u00e0n th\u1ebf gi\u1edbi (theo kh\u1ea3o s\u00e1t n\u0103m 2018 c\u1ee7a Vi\u1ec7n \u0110o l\u01b0\u1eddng v\u00e0 \u0111\u00e1nh gi\u00e1 s\u1ee9c kh\u1ecfe – IMHE thu\u1ed9c \u0110\u1ea1i h\u1ecdc Washington \u1edf Seattle, M\u1ef9). Nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c nhau \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u01b0 d\u00f9ng thu\u1ed1c, th\u1ed1ng kh\u00ed h\u1ed7 tr\u1ee3, ph\u1eabu thu\u1eadt gi\u1ea3m th\u1ec3 t\u00edch ph\u1ed5i, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng kh\u00e1c. Tuy nhi\u00ean c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00e0y v\u1eabn kh\u00f4ng th\u1ec3 l\u00e0m gi\u1ea3m s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh.<\/p>\n\n\n\n


T\u1ebf b\u00e0o g\u1ed1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u1ebf b\u00e0o g\u1ed1c trung m\u00f4 c\u00f3 nh\u1eefng \u01b0u \u0111i\u1ec3m \u0111\u1ed9c quy\u1ec1n m\u00e0 cho \u0111\u1ebfn nay nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra c\u00f3 th\u1ec3 l\u00e0 l\u1ef1a ch\u1ecdn m\u1edbi trong \u0111i\u1ec1u tr\u1ecb c\u0103n b\u1ec7nh n\u00e0y. Trong \u0111\u00f3, t\u1ebf b\u00e0o g\u1ed1c trung m\u00f4 (MSC) t\u1eeb d\u00e2y r\u1ed1n l\u00e0 m\u1ed9t trong nh\u1eefng ngu\u1ed3n \u0111ang thu h\u00fat \u0111\u01b0\u1ee3c nhi\u1ec1u nh\u00e0 nghi\u00ean c\u1ee9u t\u1eadp trung khai th\u00e1c. Ch\u00fang c\u00f3 th\u1ec3 bi\u1ec7t ho\u00e1 th\u00e0nh nhi\u1ec1u d\u00f2ng t\u1ebf b\u00e0o ch\u1ee9c n\u0103ng kh\u00e1c nhau v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng ti\u1ebft c\u00e1c y\u1ebfu t\u1ed1 c\u1eadn ti\u1ebft \u0111\u00f3ng vai tr\u00f2 trong \u0111i\u1ec1u bi\u1ebfn h\u1ec7 mi\u1ec5n d\u1ecbch. Nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng, t\u1ebf b\u00e0o g\u1ed1c trung m\u00f4 c\u00f3 th\u1ec3 \u0111i\u1ec1u bi\u1ebfn \u0111\u01b0\u1ee3c h\u1ec7 mi\u1ec5n d\u1ecbch th\u00edch nghi v\u00e0 h\u1ec7 mi\u1ec5n d\u1ecbch b\u1ea9m sinh b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf s\u1ef1 t\u0103ng sinh c\u1ee7a t\u1ebf b\u00e0o T v\u00e0 t\u1ebf b\u00e0o B; \u1ee9c ch\u1ebf s\u1ef1 tr\u01b0\u1edfng th\u00e0nh c\u1ee7a c\u00e1c t\u1ebf b\u00e0o tua (DC), \u1ee9c ch\u1ebf s\u1ef1 t\u0103ng sinh v\u00e0 t\u00e1c \u0111\u1ed9ng g\u00e2y \u0111\u1ed9c c\u1ee7a t\u1ebf b\u00e0o gi\u1ebft t\u1ef1 nhi\u00ean (NK); th\u00fac \u0111\u1ea9y s\u1ef1 t\u00e1i t\u1ea1o c\u1ee7a t\u1ebf b\u00e0o Treg th\u00f4ng qua c\u00e1c y\u1ebfu t\u1ed1 h\u00f2a tan nh\u01b0 transforming growth factor-\u03b21 (TGF-\u03b21), prostaglandin E2 (PGE2), hepatocyte growth factor (HGF), indoleamine-pyrrole 2,3-dioxygenase (IDO), nitric oxide (NO) and interleukin-10 (IL-10), v\u00e0 c\u01a1 ch\u1ebf t\u01b0\u01a1ng t\u00e1c gi\u1eefa t\u1ebf b\u00e0o v\u1edbi t\u1ebf b\u00e0o. V\u1edbi \u0111\u1eb7c t\u00ednh \u0111i\u1ec1u bi\u1ebfn mi\u1ec5n d\u1ecbch, ch\u00fang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng m\u1ed9t c\u00e1ch c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh li\u00ean quan \u0111\u1ebfn h\u1ec7 mi\u1ec5n d\u1ecbch.<\/p>\n\n\n\n


Trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd COPD, m\u1ed9t b\u00e1o c\u00e1o ph\u00e2n t\u00edch tr\u00ean 20 th\u1eed nghi\u1ec7m ti\u1ec1n l\u00e2m s\u00e0ng c\u1ea5y gh\u00e9p MSC cho th\u1ea5y MSC \u0111\u00e3 k\u00edch th\u00edch qu\u00e1 tr\u00ecnh s\u1eeda ch\u1eefa m\u00f4 ph\u1ed5i v\u00e0 c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 ch\u1ee9c n\u0103ng c\u1ee7a ph\u1ed5i. C\u01a1 ch\u1ebf \u0111i\u1ec1u tr\u1ecb ch\u00ednh c\u1ee7a lo\u1ea1i t\u1ebf b\u00e0o n\u00e0y l\u00e0 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng vi\u00eam c\u1ee7a \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p.<\/p>\n\n\n\n


Trong nghi\u00ean c\u1ee9u do nh\u00f3m b\u00e1c s\u0129 \u0111\u1ebfn t\u1eeb B\u1ec7nh vi\u1ec7n \u0110a khoa V\u1ea1n H\u1ea1nh th\u1ef1c hi\u1ec7n, lo\u1ea1i t\u1ebf b\u00e0o \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn l\u00e0 t\u1ebf b\u00e0o g\u1ed1c t\u1eeb d\u00e2y r\u1ed1n ng\u01b0\u1eddi. T\u1ebf b\u00e0o n\u00e0y \u0111\u01b0\u1ee3c thu nh\u1eadn, ph\u00e2n l\u1eadp v\u00e0 x\u1eed l\u00fd theo quy tr\u00ecnh c\u00f4ng ngh\u1ec7 c\u1ee7a nh\u00f3m nghi\u00ean c\u1ee9u \u0111\u1ebfn t\u1eeb Vi\u1ec7n T\u1ebf b\u00e0o g\u1ed1c, tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Khoa h\u1ecdc T\u1ef1 nhi\u00ean, \u0110HQG TP.HCM, \u0111\u1ee9ng \u0111\u1ea7u l\u00e0 PGS.TS. Ph\u1ea1m V\u0103n Ph\u00fac th\u1ef1c hi\u1ec7n. Lo\u1ea1i t\u1ebf b\u00e0o n\u00e0y \u0111\u01b0\u1ee3c x\u1eed l\u00fd \u0111\u1eb7c bi\u1ec7t v\u00e0 \u0111\u01b0\u1ee3c \u0111\u1eb7t t\u00ean l\u00e0 ModultistTM. T\u1ebf b\u00e0o sau khi ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c \u0111\u00f4ng l\u1ea1nh cho \u0111\u1ebfn khi b\u1ec7nh nh\u00e2n c\u00f3 nhu c\u1ea7u c\u1ea5y gh\u00e9p. Tr\u01b0\u1edbc khi gh\u00e9p, t\u1ebf b\u00e0o \u0111\u00f4ng l\u1ea1nh \u0111\u01b0\u1ee3c ho\u1ea1t ho\u00e1 b\u1eb1ng c\u00e1ch r\u00e3 \u0111\u00f4ng v\u00e0 nu\u00f4i c\u1ea5y qua \u0111\u00eam \u0111\u1ec3 lo\u1ea1i b\u1ecf c\u00e1c t\u1ebf b\u00e0o ch\u1ebft (c\u00e1c t\u1ebf s\u1ed1ng s\u1ebd b\u00e1m tr\u00ean b\u1ec1 m\u1eb7t d\u1ee5ng c\u1ee5 nu\u00f4i c\u1ea5y, t\u1ebf b\u00e0o s\u1ed1ng kh\u00f4ng b\u00e1m \u0111\u01b0\u1ee3c s\u1ebd b\u1ecb lo\u1ea1i b\u1ecf khi thay m\u00f4i tr\u01b0\u1eddng). Qua ng\u00e0y h\u00f4m sau, t\u1ebf b\u00e0o s\u1ed1ng \u0111\u01b0\u1ee3c thu nh\u1eadn v\u00e0 s\u1eed d\u1ee5ng cho c\u1ea5y gh\u00e9p.<\/p>\n\n\n\n


Nhi\u1ec1u \u01b0u \u0111i\u1ec3m so v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1eefa tr\u1ecb kh\u00e1c<\/strong>
<\/p>\n\n\n\n

B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n COPD \u1edf giai \u0111o\u1ea1n 4 d\u1ef1a tr\u00ean x\u00e9t nghi\u1ec7m \u0111o th\u1ec3 t\u00edch th\u1edf g\u1eafng s\u1ee9c trong gi\u00e2y \u0111\u1ea7u (FEV1) s\u1ebd \u0111\u01b0\u1ee3c gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c. Sau khi gh\u00e9p t\u1ebf b\u00e0o, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c theo d\u00f5i v\u00e0 \u0111\u00e1nh gi\u00e1 l\u1ea1i tri\u1ec7u ch\u1ee9ng s\u1eed d\u1ee5ng thang \u0111i\u1ec3m CAT (COPD Assessment Test) v\u00e0 mMRC (modified Medical Research Council) \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng s\u1ee9c kho\u1ebb.<\/p>\n\n\n\n


B\u1ec7nh nh\u00e2n \u0111\u1ea7u ti\u00ean tham gia nghi\u00ean c\u1ee9u l\u00e0 m\u1ed9t ng\u01b0\u1eddi \u0111\u00e0n \u00f4ng sinh n\u0103m 1959. Tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb, FEV1 c\u1ee7a \u00f4ng \u1edf m\u1ee9c th\u1ea5p (20,8%) trong khi thang CAT v\u00e0 mMRC cao (l\u1ea7n l\u01b0\u1ee3t l\u00e0 28 v\u00e0 2). Ng\u01b0\u1eddi b\u1ec7nh n\u00e0y \u0111\u01b0\u1ee3c gh\u00e9p s\u1ea3n ph\u1ea9m ModultistTM v\u1edbi li\u1ec1u 1 tri\u1ec7u t\u1ebf b\u00e0o\/1kg th\u1ec3 tr\u1ecdng b\u1ec7nh nh\u00e2n b\u1eb1ng c\u00e1ch truy\u1ec1n t\u0129nh m\u1ea1ch tay. T\u1ebf b\u00e0o \u0111\u01b0\u1ee3c h\u00f2a trong 250 mL dung d\u1ecbch n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd NaCl 0,9%. T\u1ed1c \u0111\u1ed9 truy\u1ec1n 30-45 ph\u00fat. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c theo d\u00f5i t\u1ea1i b\u1ec7nh vi\u1ec7n trong v\u00f2ng 1 tu\u1ea7n sau khi gh\u00e9p \u0111\u1ec3 theo d\u00f5i b\u1ea5t c\u1ee9 ph\u1ea3n \u1ee9ng ph\u1ee5 c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 vi\u00eam nhi\u1ec5m. Sau khi xu\u1ea5t vi\u1ec7n, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c theo d\u00f5i ngo\u1ea1i tr\u00fa trong 5 th\u00e1ng. Thang CAT v\u00e0 mMRC \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 sau 1, 3 v\u00e0 5 th\u00e1ng. T\u1ea5t c\u1ea3 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p truy\u1ec1n th\u1ed1ng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng v\u00e0 duy tr\u00ec trong su\u1ed1t th\u1eddi gian n\u00e0y. K\u1ebft qu\u1ea3 cho th\u1ea5y thang CAT gi\u1ea3m \u0111\u00e1ng k\u1ec3 t\u1eeb 28 tr\u01b0\u1edbc khi gh\u00e9p xu\u1ed1ng c\u00f2n 9,7 v\u00e0 8 \u1edf th\u1eddi \u0111i\u1ec3m 1, 3 v\u00e0 5 th\u00e1ng. Tuy nhi\u00ean, m\u1ee9c mMRC v\u1eabn duy tr\u00ec \u1edf m\u1ee9c 2 k\u1ec3 c\u1ea3 tr\u01b0\u1edbc v\u00e0 sau khi gh\u00e9p. Trong khi \u0111\u00f3, FEV1 t\u0103ng nh\u1eb9 sau khi gh\u00e9p, \u0111\u1ea1t m\u1ee9c 22,8% sau 3 th\u00e1ng v\u00e0 tang l\u00ean 23,1% sau 5 th\u00e1ng gh\u00e9p. B\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y s\u1ee9c kho\u1ebb t\u1ed1t h\u01a1n v\u00e0 gi\u1ea3m \u0111\u00e1ng k\u1ec3 c\u00e1c \u0111\u1ee3t c\u1ea5p COPD.<\/p>\n\n\n\n


\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n th\u1ee9 2 l\u00e0 m\u1ed9t ph\u1ee5 n\u1eef sinh n\u0103m 1938, tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb, FEV1 \u1edf m\u1ee9c th\u1ea5p (59,6%) trong khi thang CAT v\u00e0 mMRC cao (l\u1ea7n l\u01b0\u1ee3t l\u00e0 18 v\u00e0 4). Sau khi \u0111i\u1ec1u tr\u1ecb, ch\u1ec9 s\u1ed1 CAT gi\u1ea3m xu\u1ed1ng c\u00f2n 5, FEV1 t\u0103ng \u1edf m\u1ee9c 72,4% t\u1eeb th\u00e1ng th\u1ee9 3 v\u00e0 ch\u1ec9 s\u1ed1 mMRC gi\u1ea3m xu\u1ed1ng c\u00f2n 2 sau 1 th\u00e1ng. Kh\u00f4ng c\u00f3 b\u1ea5t c\u1ee9 t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0o xu\u1ea5t hi\u1ec7n sau khi gh\u00e9p. \u0110\u1eb7c bi\u1ec7t, s\u1ed1 \u0111\u1ee3t t\u00e1i ph\u00e1t c\u1ea5p COPD gi\u1ea3m \u0111\u00e1ng k\u1ec3, t\u1eeb 13 l\u1ea7n m\u1ed7i n\u0103m gi\u1ea3m xu\u1ed1ng c\u00f2n 0 trong su\u1ed1t 5 th\u00e1ng theo d\u00f5i.<\/p>\n\n\n\n


T\u1eeb k\u1ebft qu\u1ea3 th\u1eed nghi\u1ec7m \u0111i\u1ec1u tr\u1ecb tr\u00ean \u0111\u00e2y, cho th\u1ea5y \u0111\u00e2y l\u00e0 li\u1ec7u ph\u00e1p \u0111\u1ea7y h\u1ee9a h\u1eb9n cho \u0111i\u1ec1u tr\u1ecb b\u1ec7nh COPD. T\u1ebf b\u00e0o g\u1ed1c t\u1eeb d\u00e2y r\u1ed1n \u0111\u01b0\u1ee3c x\u1eed l\u00fd theo c\u00f4ng ngh\u1ec7 c\u1ee7a Vi\u1ec7n t\u1ebf b\u00e0o g\u1ed1c \u0111\u00e3 cho th\u1ea5y hi\u1ec7u qu\u1ea3 t\u00edch c\u1ef1c \u0111\u1ed1i v\u1edbi vi\u1ec7c c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng b\u1ec7nh c\u1ee7a c\u00e1c b\u1ec7nh nh\u00e2n COPD. Hi\u1ec7n nay, b\u1ec7nh vi\u1ec7n \u0111ang ti\u1ebfp t\u1ee5c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n l\u1edbn h\u01a1n.<\/p>\n\n\n\n

V\u1edbi \u0111\u1eb7c t\u00ednh \u0111i\u1ec1u bi\u1ebfn mi\u1ec5n d\u1ecbch, ch\u00fang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng m\u1ed9t c\u00e1ch c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh li\u00ean quan \u0111\u1ebfn h\u1ec7 mi\u1ec5n d\u1ecbch.
Trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd COPD, m\u1ed9t b\u00e1o c\u00e1o ph\u00e2n t\u00edch tr\u00ean 20 th\u1eed nghi\u1ec7m ti\u1ec1n l\u00e2m s\u00e0ng c\u1ea5y gh\u00e9p MSC cho th\u1ea5y MSC \u0111\u00e3 k\u00edch th\u00edch qu\u00e1 tr\u00ecnh s\u1eeda ch\u1eefa m\u00f4 ph\u1ed5i v\u00e0 c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 ch\u1ee9c n\u0103ng c\u1ee7a ph\u1ed5i. C\u01a1 ch\u1ebf \u0111i\u1ec1u tr\u1ecb ch\u00ednh c\u1ee7a lo\u1ea1i t\u1ebf b\u00e0o n\u00e0y l\u00e0 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng vi\u00eam c\u1ee7a \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p.<\/p>\n\n\n\n


Trong nghi\u00ean c\u1ee9u do nh\u00f3m b\u00e1c s\u0129 \u0111\u1ebfn t\u1eeb B\u1ec7nh vi\u1ec7n \u0110a khoa V\u1ea1n H\u1ea1nh th\u1ef1c hi\u1ec7n, lo\u1ea1i t\u1ebf b\u00e0o \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn l\u00e0 t\u1ebf b\u00e0o g\u1ed1c t\u1eeb d\u00e2y r\u1ed1n ng\u01b0\u1eddi. T\u1ebf b\u00e0o n\u00e0y \u0111\u01b0\u1ee3c thu nh\u1eadn, ph\u00e2n l\u1eadp v\u00e0 x\u1eed l\u00fd theo quy tr\u00ecnh c\u00f4ng ngh\u1ec7 c\u1ee7a nh\u00f3m nghi\u00ean c\u1ee9u \u0111\u1ebfn t\u1eeb Vi\u1ec7n T\u1ebf b\u00e0o g\u1ed1c, tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Khoa h\u1ecdc T\u1ef1 nhi\u00ean, \u0110HQG TP.HCM, \u0111\u1ee9ng \u0111\u1ea7u l\u00e0 PGS.TS. Ph\u1ea1m V\u0103n Ph\u00fac th\u1ef1c hi\u1ec7n. Lo\u1ea1i t\u1ebf b\u00e0o n\u00e0y \u0111\u01b0\u1ee3c x\u1eed l\u00fd \u0111\u1eb7c bi\u1ec7t v\u00e0 \u0111\u01b0\u1ee3c \u0111\u1eb7t t\u00ean l\u00e0 ModultistTM. T\u1ebf b\u00e0o sau khi ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c \u0111\u00f4ng l\u1ea1nh cho \u0111\u1ebfn khi b\u1ec7nh nh\u00e2n c\u00f3 nhu c\u1ea7u c\u1ea5y gh\u00e9p. Tr\u01b0\u1edbc khi gh\u00e9p, t\u1ebf b\u00e0o \u0111\u00f4ng l\u1ea1nh \u0111\u01b0\u1ee3c ho\u1ea1t ho\u00e1 b\u1eb1ng c\u00e1ch r\u00e3 \u0111\u00f4ng v\u00e0 nu\u00f4i c\u1ea5y qua \u0111\u00eam \u0111\u1ec3 lo\u1ea1i b\u1ecf c\u00e1c t\u1ebf b\u00e0o ch\u1ebft (c\u00e1c t\u1ebf s\u1ed1ng s\u1ebd b\u00e1m tr\u00ean b\u1ec1 m\u1eb7t d\u1ee5ng c\u1ee5 nu\u00f4i c\u1ea5y, t\u1ebf b\u00e0o s\u1ed1ng kh\u00f4ng b\u00e1m \u0111\u01b0\u1ee3c s\u1ebd b\u1ecb lo\u1ea1i b\u1ecf khi thay m\u00f4i tr\u01b0\u1eddng). Qua ng\u00e0y h\u00f4m sau, t\u1ebf b\u00e0o s\u1ed1ng \u0111\u01b0\u1ee3c thu nh\u1eadn v\u00e0 s\u1eed d\u1ee5ng cho c\u1ea5y gh\u00e9p.<\/p>\n\n\n\n


Nhi\u1ec1u \u01b0u \u0111i\u1ec3m so v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1eefa tr\u1ecb kh\u00e1c<\/strong><\/p>\n\n\n\n


B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n COPD \u1edf giai \u0111o\u1ea1n 4 d\u1ef1a tr\u00ean x\u00e9t nghi\u1ec7m \u0111o th\u1ec3 t\u00edch th\u1edf g\u1eafng s\u1ee9c trong gi\u00e2y \u0111\u1ea7u (FEV1) s\u1ebd \u0111\u01b0\u1ee3c gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c. Sau khi gh\u00e9p t\u1ebf b\u00e0o, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c theo d\u00f5i v\u00e0 \u0111\u00e1nh gi\u00e1 l\u1ea1i tri\u1ec7u ch\u1ee9ng s\u1eed d\u1ee5ng thang \u0111i\u1ec3m CAT (COPD Assessment Test) v\u00e0 mMRC (modified Medical Research Council) \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng s\u1ee9c kho\u1ebb.<\/p>\n\n\n\n


B\u1ec7nh nh\u00e2n \u0111\u1ea7u ti\u00ean tham gia nghi\u00ean c\u1ee9u l\u00e0 m\u1ed9t ng\u01b0\u1eddi \u0111\u00e0n \u00f4ng sinh n\u0103m 1959. Tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb, FEV1 c\u1ee7a \u00f4ng \u1edf m\u1ee9c th\u1ea5p (20,8%) trong khi thang CAT v\u00e0 mMRC cao (l\u1ea7n l\u01b0\u1ee3t l\u00e0 28 v\u00e0 2). Ng\u01b0\u1eddi b\u1ec7nh n\u00e0y \u0111\u01b0\u1ee3c gh\u00e9p s\u1ea3n ph\u1ea9m ModultistTM v\u1edbi li\u1ec1u 1 tri\u1ec7u t\u1ebf b\u00e0o\/1kg th\u1ec3 tr\u1ecdng b\u1ec7nh nh\u00e2n b\u1eb1ng c\u00e1ch truy\u1ec1n t\u0129nh m\u1ea1ch tay. T\u1ebf b\u00e0o \u0111\u01b0\u1ee3c h\u00f2a trong 250 mL dung d\u1ecbch n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd NaCl 0,9%. T\u1ed1c \u0111\u1ed9 truy\u1ec1n 30-45 ph\u00fat. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c theo d\u00f5i t\u1ea1i b\u1ec7nh vi\u1ec7n trong v\u00f2ng 1 tu\u1ea7n sau khi gh\u00e9p \u0111\u1ec3 theo d\u00f5i b\u1ea5t c\u1ee9 ph\u1ea3n \u1ee9ng ph\u1ee5 c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 vi\u00eam nhi\u1ec5m. Sau khi xu\u1ea5t vi\u1ec7n, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c theo d\u00f5i ngo\u1ea1i tr\u00fa trong 5 th\u00e1ng. Thang CAT v\u00e0 mMRC \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 sau 1, 3 v\u00e0 5 th\u00e1ng. T\u1ea5t c\u1ea3 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p truy\u1ec1n th\u1ed1ng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng v\u00e0 duy tr\u00ec trong su\u1ed1t th\u1eddi gian n\u00e0y. K\u1ebft qu\u1ea3 cho th\u1ea5y thang CAT gi\u1ea3m \u0111\u00e1ng k\u1ec3 t\u1eeb 28 tr\u01b0\u1edbc khi gh\u00e9p xu\u1ed1ng c\u00f2n 9,7 v\u00e0 8 \u1edf th\u1eddi \u0111i\u1ec3m 1, 3 v\u00e0 5 th\u00e1ng. Tuy nhi\u00ean, m\u1ee9c mMRC v\u1eabn duy tr\u00ec \u1edf m\u1ee9c 2 k\u1ec3 c\u1ea3 tr\u01b0\u1edbc v\u00e0 sau khi gh\u00e9p. Trong khi \u0111\u00f3, FEV1 t\u0103ng nh\u1eb9 sau khi gh\u00e9p, \u0111\u1ea1t m\u1ee9c 22,8% sau 3 th\u00e1ng v\u00e0 tang l\u00ean 23,1% sau 5 th\u00e1ng gh\u00e9p. B\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y s\u1ee9c kho\u1ebb t\u1ed1t h\u01a1n v\u00e0 gi\u1ea3m \u0111\u00e1ng k\u1ec3 c\u00e1c \u0111\u1ee3t c\u1ea5p COPD.<\/p>\n\n\n\n


\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n th\u1ee9 2 l\u00e0 m\u1ed9t ph\u1ee5 n\u1eef sinh n\u0103m 1938, tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb, FEV1 \u1edf m\u1ee9c th\u1ea5p (59,6%) trong khi thang CAT v\u00e0 mMRC cao (l\u1ea7n l\u01b0\u1ee3t l\u00e0 18 v\u00e0 4). Sau khi \u0111i\u1ec1u tr\u1ecb, ch\u1ec9 s\u1ed1 CAT gi\u1ea3m xu\u1ed1ng c\u00f2n 5, FEV1 t\u0103ng \u1edf m\u1ee9c 72,4% t\u1eeb th\u00e1ng th\u1ee9 3 v\u00e0 ch\u1ec9 s\u1ed1 mMRC gi\u1ea3m xu\u1ed1ng c\u00f2n 2 sau 1 th\u00e1ng. Kh\u00f4ng c\u00f3 b\u1ea5t c\u1ee9 t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0o xu\u1ea5t hi\u1ec7n sau khi gh\u00e9p. \u0110\u1eb7c bi\u1ec7t, s\u1ed1 \u0111\u1ee3t t\u00e1i ph\u00e1t c\u1ea5p COPD gi\u1ea3m \u0111\u00e1ng k\u1ec3, t\u1eeb 13 l\u1ea7n m\u1ed7i n\u0103m gi\u1ea3m xu\u1ed1ng c\u00f2n 0 trong su\u1ed1t 5 th\u00e1ng theo d\u00f5i.<\/p>\n\n\n\n


T\u1eeb k\u1ebft qu\u1ea3 th\u1eed nghi\u1ec7m \u0111i\u1ec1u tr\u1ecb tr\u00ean \u0111\u00e2y, cho th\u1ea5y \u0111\u00e2y l\u00e0 li\u1ec7u ph\u00e1p \u0111\u1ea7y h\u1ee9a h\u1eb9n cho \u0111i\u1ec1u tr\u1ecb b\u1ec7nh COPD. T\u1ebf b\u00e0o g\u1ed1c t\u1eeb d\u00e2y r\u1ed1n \u0111\u01b0\u1ee3c x\u1eed l\u00fd theo c\u00f4ng ngh\u1ec7 c\u1ee7a Vi\u1ec7n t\u1ebf b\u00e0o g\u1ed1c \u0111\u00e3 cho th\u1ea5y hi\u1ec7u qu\u1ea3 t\u00edch c\u1ef1c \u0111\u1ed1i v\u1edbi vi\u1ec7c c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng b\u1ec7nh c\u1ee7a c\u00e1c b\u1ec7nh nh\u00e2n COPD. Hi\u1ec7n nay, b\u1ec7nh vi\u1ec7n \u0111ang ti\u1ebfp t\u1ee5c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n l\u1edbn h\u01a1n.<\/p>\n\n\n\n


<\/a>Ch\u00fa th\u00edch:
ModulatistTM l\u00e0 t\u1ebf b\u00e0o \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t t\u1eeb m\u00f4 d\u00e2y r\u1ed1n, c\u00f3 x\u1eed l\u00fd trong qu\u00e1 tr\u00ecnh nu\u00f4i c\u1ea5y, bi\u1ec3u hi\u1ec7n kh\u1ea3 n\u0103ng \u0111i\u1ec1u bi\u1ebfn mi\u1ec5n d\u1ecbch m\u1ea1nh h\u01a1n so v\u1edbi t\u1ebf b\u00e0o g\u1ed1c t\u1eeb m\u00f4 m\u1ee1 v\u00e0 t\u1ee7y x\u01b0\u01a1ng. Ch\u00fang c\u00f3 th\u1ec3 \u1ee9c ch\u1ebf t\u1ebf b\u00e0o T, B v\u00e0 NK th\u00f4ng qua nhi\u1ec1u c\u01a1 ch\u1ebf kh\u00e1c nhau. ModulatistTM c\u00f3 th\u1ec3 ki\u1ec3m so\u00e1t vi\u00eam c\u0169ng nh\u01b0 c\u00e1c ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch b\u00ean trong b\u1ec7nh nh\u00e2n.
Vi\u00eam \u0111\u01b0\u1ee3c cho l\u00e0 qu\u00e1 tr\u00ecnh ch\u00ednh g\u00f3p ph\u1ea7n v\u00e0o COPD, n\u00ean kh\u1ea3 n\u0103ng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o g\u1ed1c c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb d\u00e2y r\u1ed1n (Modulatist \u2122) trong \u0111i\u1ec1u ch\u1ec9nh c\u00e1c tri\u1ec7u ch\u1ee9ng vi\u00eam l\u00e0 r\u1ea5t kh\u1ea3 thi.<\/a><\/em><\/p>\n\n\n\n

TS. V\u0169 B\u00edch Ng\u1ecdc<\/strong><\/p>\n\n\n\n

Ngu\u1ed3n: http:\/\/khoahocphattrien.vn\/suc-khoe\/ghep-te-bao-goc-tu-day-ron-dieu-tri-benh-phoi-tac-nghen-man-tinh\/2019022210342860p1c784.htm<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

T\u1ebf b\u00e0o g\u1ed1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u1ebf b\u00e0o g\u1ed1c trung m\u00f4 c\u00f3 nh\u1eefng \u01b0u \u0111i\u1ec3m v\u01b0\u1ee3t tr\u1ed9i trong \u0111i\u1ec1u tr\u1ecb c\u0103n b\u1ec7nh \u0111ang l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong th\u1ee9 t\u01b0 \u1edf Vi\u1ec7t Nam n\u00e0y. Quy tr\u00ecnh nghi\u00ean c\u1ee9u v\u00e0 \u0111i\u1ec1u tr\u1ecb ho\u00e0n to\u00e0n \u1edf Vi\u1ec7t Nam. Quy tr\u00ecnh nghi\u00ean c\u1ee9u \u201cmade in Vietnam\u201d B\u1ec7nh […]<\/p>\n","protected":false},"author":293,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[161],"tags":[],"class_list":["post-3672","post","type-post","status-publish","format-standard","hentry","category-ban-tin"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/sci.edu.vn\/home\/wp-json\/wp\/v2\/posts\/3672","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sci.edu.vn\/home\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sci.edu.vn\/home\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sci.edu.vn\/home\/wp-json\/wp\/v2\/users\/293"}],"replies":[{"embeddable":true,"href":"https:\/\/sci.edu.vn\/home\/wp-json\/wp\/v2\/comments?post=3672"}],"version-history":[{"count":1,"href":"https:\/\/sci.edu.vn\/home\/wp-json\/wp\/v2\/posts\/3672\/revisions"}],"predecessor-version":[{"id":4483,"href":"https:\/\/sci.edu.vn\/home\/wp-json\/wp\/v2\/posts\/3672\/revisions\/4483"}],"wp:attachment":[{"href":"https:\/\/sci.edu.vn\/home\/wp-json\/wp\/v2\/media?parent=3672"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sci.edu.vn\/home\/wp-json\/wp\/v2\/categories?post=3672"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sci.edu.vn\/home\/wp-json\/wp\/v2\/tags?post=3672"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}