{"id":158936,"date":"2026-06-19T12:44:41","date_gmt":"2026-06-19T05:44:41","guid":{"rendered":"https:\/\/hmm88i.com\/drug\/?p=158936"},"modified":"2026-06-19T12:44:41","modified_gmt":"2026-06-19T05:44:41","slug":"quyet-dinh-so-1740-qd-byt-ve-viec-ban-hanh-tai-lieu-chuyen-mon-huong-dan-chan-doan-dieu-tri-viem-gan-vi-rut-b","status":"publish","type":"post","link":"https:\/\/hmm88i.com\/drug\/quyet-dinh-so-1740-qd-byt-ve-viec-ban-hanh-tai-lieu-chuyen-mon-huong-dan-chan-doan-dieu-tri-viem-gan-vi-rut-b\/","title":{"rendered":"Quy\u1ebft \u0111\u1ecbnh s\u1ed1 1740\/Q\u0110-BYT V\u1ec1 vi\u1ec7c ban h\u00e0nh t\u00e0i li\u1ec7u chuy\u00ean m\u00f4n “H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat B\u201d"},"content":{"rendered":"\n\n\n
B\u1ed8 Y T\u1ebe<\/strong><\/p>\n

S\u1ed1: 1740\/Q\u0110-BYT<\/strong><\/td>\n

C\u1ed8NG H\u00d2A X\u00c3 H\u1ed8I CH\u1ee6 NGH\u0128A VI\u1ec6T NAM<\/strong><\/p>\n

\u0110\u1ed9c l\u1eadp – T\u1ef1 do – H\u1ea1nh ph\u00fac<\/strong><\/p>\n

H\u00e0 N\u1ed9i, ng\u00e0y 16 th\u00e1ng 06 n\u0103m 2026<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

QUY\u1ebeT \u0110\u1ecaNH<\/strong><\/p>\n

V\u1ec0 VI\u1ec6C BAN H\u00c0NH T\u00c0I LI\u1ec6U CHUY\u00caN M\u00d4N \u201cH\u01af\u1edaNG D\u1eaaN CH\u1ea8N \u0110O\u00c1N, \u0110I\u1ec0U TR\u1eca VI\u00caM GAN VI R\u00daT B\u201d<\/p>\n

B\u1ed8 TR\u01af\u1edeNG B\u1ed8 Y T\u1ebe <\/b><\/p>\n

C\u0103n c\u1ee9 Lu\u1eadt Kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh n\u0103m 2023;<\/em><\/p>\n

C\u0103n c\u1ee9 Ngh\u1ecb \u0111\u1ecbnh s\u1ed1 42\/2025\/N\u0110-CP ng\u00e0y 27 th\u00e1ng 2 n\u0103m 2025 c\u1ee7a Ch\u00ednh ph\u1ee7 quy \u0111\u1ecbnh ch\u1ee9c n\u0103ng, nhi\u1ec7m v\u1ee5, quy\u1ec1n h\u1ea1n v\u00e0 c\u01a1 c\u1ea5u t\u1ed5 ch\u1ee9c c\u1ee7a B\u1ed9 Y t\u1ebf;<\/em><\/p>\n

Theo \u0111\u1ec1 ngh\u1ecb c\u1ee7a C\u1ee5c tr\u01b0\u1edfng C\u1ee5c Qu\u1ea3n l\u00fd Kh\u00e1m, ch\u1eefa b\u1ec7nh.<\/em><\/p>\n

QUY\u1ebeT \u0110\u1ecaNH: <\/b><\/p>\n

\u0110i\u1ec1u 1.<\/strong> Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh n\u00e0y \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat B\u201d.<\/p>\n

\u0110i\u1ec1u 2.<\/strong> H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat B \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng t\u1ea1i c\u00e1c c\u01a1 s\u1edf kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh trong c\u1ea3 n\u01b0\u1edbc.<\/p>\n

\u0110i\u1ec1u 3.<\/strong> Quy\u1ebft \u0111\u1ecbnh n\u00e0y c\u00f3 hi\u1ec7u l\u1ef1c k\u1ec3 t\u1eeb ng\u00e0y k\u00fd, ban h\u00e0nh. Quy\u1ebft \u0111\u1ecbnh n\u00e0y thay th\u1ebf Quy\u1ebft \u0111\u1ecbnh s\u1ed1 3310\/Q\u0110-BYT ng\u00e0y 29\/7\/2019 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf v\u1ec1 vi\u1ec7c ban h\u00e0nh H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat B.<\/p>\n

\u0110i\u1ec1u 4.<\/strong> C\u00e1c \u00f4ng, b\u00e0: Ch\u00e1nh V\u0103n ph\u00f2ng B\u1ed9, C\u1ee5c tr\u01b0\u1edfng C\u1ee5c Qu\u1ea3n l\u00fd Kh\u00e1m, ch\u1eefa b\u1ec7nh, V\u1ee5 tr\u01b0\u1edfng, C\u1ee5c tr\u01b0\u1edfng c\u00e1c V\u1ee5\/C\u1ee5c thu\u1ed9c B\u1ed9 Y t\u1ebf; Gi\u00e1m \u0111\u1ed1c c\u00e1c c\u01a1 s\u1edf kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh tr\u1ef1c thu\u1ed9c B\u1ed9 Y t\u1ebf; Gi\u00e1m \u0111\u1ed1c S\u1edf Y t\u1ebf c\u00e1c t\u1ec9nh, th\u00e0nh ph\u1ed1; Th\u1ee7 tr\u01b0\u1edfng Y t\u1ebf c\u00e1c B\u1ed9, ng\u00e0nh; Th\u1ee7 tr\u01b0\u1edfng c\u00e1c \u0111\u01a1n v\u1ecb c\u00f3 li\u00ean quan ch\u1ecbu tr\u00e1ch nhi\u1ec7m thi h\u00e0nh Quy\u1ebft \u0111\u1ecbnh n\u00e0y.\/.<\/p>\n\n\n\n
N\u01a1i nh\u1eadn:<\/em><\/strong><\/p>\n

– Nh\u01b0 \u0110i\u1ec1u 4;
\n– B\u1ed9 tr\u01b0\u1edfng (\u0111\u1ec3 b\/c);
\n– C\u00e1c Th\u1ee9 tr\u01b0\u1edfng (\u0111\u1ec3 ph\/h ch\/\u0111);
\n– L\u01b0u: VT, KCB.<\/td>\n

\n

KT. B\u1ed8 TR\u01af\u1edeNG<\/strong>
\nTH\u1ee8 TR\u01af\u1edeNG<\/strong><\/p>\n

Tr\u1ea7n V\u0103n Thu\u1ea5n<\/strong><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

\n

H\u01af\u01a0\u0301NG D\u00c2\u0303N CH\u1ea8N \u0110O\u00c1N, \u0110I\u1ec0U TR\u1eca VI\u00caM GAN VI R\u00daT B<\/strong><\/p>\n

(Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 1740\/Q\u0110-BYT, ng\u00e0y 16 th\u00e1ng 06 n\u0103m 2026 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf)<\/i><\/p>\n

DANH S\u00c1CH BAN BI\u00caN SO\u1ea0N<\/strong><\/p>\n

\u201cH\u01af\u01a0\u0301NG D\u00c2\u0303N CH\u1ea8N \u0110O\u00c1N, \u0110I\u1ec0U TR\u1eca VI\u00caM GAN VI R\u00daT B\u201d<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Ch\u1ec9 \u0111\u1ea1o bi\u00ean so\u1ea1n:<\/strong><\/td>\n<\/tr>\n
GS.TS. Tr\u1ea7n V\u0103n Thu\u1ea5n<\/td>\nTh\u1ee9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf, Ch\u1ee7 t\u1ecbch H\u1ed9i \u0111\u1ed3ng Y khoa Qu\u1ed1c gia;<\/td>\n<\/tr>\n
TS. H\u00e0 Anh \u0110\u1ee9c<\/td>\nC\u1ee5c tr\u01b0\u1edfng C\u1ee5c Qu\u1ea3n l\u00fd Kh\u00e1m, ch\u1eefa b\u1ec7nh.<\/td>\n<\/tr>\n
Ch\u1ee7 bi\u00ean:<\/strong><\/td>\n<\/tr>\n
TS. Ph\u1ea1m Ng\u1ecdc Th\u1ea1ch<\/td>\nGi\u00e1m \u0111\u1ed1c B\u1ec7nh vi\u1ec7n B\u1ec7nh Nhi\u1ec7t \u0111\u1edbi Trung \u01b0\u01a1ng, Ch\u1ee7 t\u1ecbch H\u1ed9i Truy\u1ec1n nhi\u1ec5m Vi\u1ec7t Nam;<\/td>\n<\/tr>\n
TS. Nguy\u1ec5n Tr\u1ecdng Khoa<\/td>\nPh\u00f3 C\u1ee5c tr\u01b0\u1edfng C\u1ee5c Qu\u1ea3n l\u00fd Kh\u00e1m, ch\u1eefa b\u1ec7nh;<\/td>\n<\/tr>\n
GS.TS. Nguy\u1ec5n V\u0103n K\u00ednh<\/td>\nPh\u00f3 Ch\u1ee7 t\u1ecbch th\u01b0\u1eddng tr\u1ef1c T\u1ed5ng h\u1ed9i Y h\u1ecdc Vi\u1ec7t Nam, nguy\u00ean Gi\u00e1m \u0111\u1ed1c B\u1ec7nh vi\u1ec7n B\u1ec7nh Nhi\u1ec7t \u0111\u1edbi Trung \u01b0\u01a1ng.<\/td>\n<\/tr>\n
Tham gia bi\u00ean so\u1ea1n:<\/strong><\/td>\n<\/tr>\n
PGS. TS. Tr\u1ecbnh Th\u1ecb Ng\u1ecdc<\/td>\nPh\u00f3 Ch\u1ee7 t\u1ecbch H\u1ed9i Gan m\u1eadt Vi\u1ec7t Nam;<\/td>\n<\/tr>\n
PGS.TS. B\u00f9i H\u1eefu Ho\u00e0ng<\/td>\nCh\u1ee7 t\u1ecbch H\u1ed9i Gan m\u1eadt Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh, Ban Chuy\u00ean gia B\u1ec7nh vi\u1ec7n \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh;<\/td>\n<\/tr>\n
PGS.TS. Ph\u1ea1m Th\u1ecb Thu Th\u1ee7y<\/td>\nPh\u00f3 Ch\u1ee7 t\u1ecbch H\u1ed9i Gan m\u1eadt Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh, Tr\u01b0\u1edfng khoa Gan, Trung t\u00e2m Ch\u1ea9n \u0111o\u00e1n Y khoa Medic Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh;<\/td>\n<\/tr>\n
PGS.TS. \u0110\u1ed7 Duy C\u01b0\u1eddng<\/td>\nCh\u1ee7 t\u1ecbch H\u1ed9i \u0111\u1ed3ng chuy\u00ean ng\u00e0nh B\u1ec7nh nhi\u1ec7t \u0111\u1edbi H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec, ki\u00eam Gi\u00e1m \u0111\u1ed1c Trung t\u00e2m B\u1ec7nh nhi\u1ec7t \u0111\u1edbi Vinmec Times City;<\/td>\n<\/tr>\n
PGS.TS. Tr\u1ea7n V\u0103n Giang<\/td>\nVi\u1ec7n tr\u01b0\u1edfng Vi\u1ec7n \u0110\u00e0o t\u1ea1o v\u00e0 Nghi\u00ean c\u1ee9u B\u1ec7nh Nhi\u1ec7t \u0111\u1edbi, B\u1ec7nh vi\u1ec7n B\u1ec7nh Nhi\u1ec7t \u0111\u1edbi Trung \u01b0\u01a1ng;<\/td>\n<\/tr>\n
PGS.TS. T\u1ea1 Th\u1ecb Di\u1ec7u Ng\u00e2n<\/td>\nTr\u01b0\u1edfng khoa B\u1ec7nh nhi\u1ec7t \u0111\u1edbi v\u00e0 Can thi\u1ec7p gi\u1ea3m h\u1ea1i, B\u1ec7nh vi\u1ec7n \u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i;<\/td>\n<\/tr>\n
PGS.TS. Ph\u1ea1m Th\u1ecb Th\u00fay V\u00e2n<\/td>\nGi\u1ea3ng vi\u00ean cao c\u1ea5p, Tr\u01b0\u1edfng khoa D\u01b0\u1ee3c l\u00fd – D\u01b0\u1ee3c l\u00e2m s\u00e0ng, Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc D\u01b0\u1ee3c H\u00e0 N\u1ed9i;<\/td>\n<\/tr>\n
PGS.TS. Nguy\u1ec5n Th\u1ecb C\u1ea9m H\u01b0\u1eddng<\/td>\nTr\u01b0\u1edfng ph\u00f2ng Khoa h\u1ecdc – \u0110\u00e0o t\u1ea1o – \u0110\u1ed1i ngo\u1ea1i ki\u00eam nhi\u1ec7m Ph\u00f3 tr\u01b0\u1edfng B\u1ed9 m\u00f4n Nhi\u1ec5m, Tr\u01b0\u1eddng Y, \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh;<\/td>\n<\/tr>\n
PGS.TS. Tr\u1ea7n Th\u1ecb Kh\u00e1nh T\u01b0\u1eddng<\/td>\nTr\u01b0\u1edfng khoa Y, Tr\u01b0\u1edfng B\u1ed9 m\u00f4n N\u1ed9i T\u1ed5ng qu\u00e1t, Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Y khoa Ph\u1ea1m Ng\u1ecdc Th\u1ea1ch;<\/td>\n<\/tr>\n
BSCKII. Nguy\u1ec5n Nguy\u00ean Huy\u1ec1n<\/td>\nGi\u00e1m \u0111\u1ed1c Trung t\u00e2m Ph\u00f2ng ch\u1ed1ng d\u1ecbch, B\u1ec7nh vi\u1ec7n B\u1ec7nh nhi\u1ec7t \u0111\u1edbi Trung \u01b0\u01a1ng;<\/td>\n<\/tr>\n
ThS. Tr\u01b0\u01a1ng L\u00ea V\u00e2n Ng\u1ecdc<\/td>\nTr\u01b0\u1edfng ph\u00f2ng Nghi\u1ec7p v\u1ee5, C\u1ee5c Qu\u1ea3n l\u00fd Kh\u00e1m, ch\u1eefa b\u1ec7nh;<\/td>\n<\/tr>\n
BSCKII. Ho\u00e0ng Th\u1ecb Th\u01b0<\/td>\nTr\u01b0\u1edfng ph\u00f2ng T\u1ed5 ch\u1ee9c c\u00e1n b\u1ed9, Tr\u01b0\u1edfng khoa B\u1ec7nh nhi\u1ec7t \u0111\u1edbi, B\u1ec7nh vi\u1ec7n \u0110a khoa Trung \u01b0\u01a1ng Th\u00e1i Nguy\u00ean;<\/td>\n<\/tr>\n
BSCKII. \u0110\u00e0o B\u00e1ch Khoa<\/td>\nTr\u01b0\u1edfng khoa Nhi\u1ec5m A, B\u1ec7nh vi\u1ec7n B\u1ec7nh Nhi\u1ec7t \u0111\u1edbi Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh;<\/td>\n<\/tr>\n
ThS. Tr\u1ea7n Th\u1ecb H\u1ea1nh Ch\u00e2n<\/td>\nTr\u01b0\u1edfng khoa Nhi Ti\u00eau h\u00f3a – Ti\u1ebft ni\u1ec7u – B\u1ec7nh nhi\u1ec7t \u0111\u1edbi, B\u1ec7nh vi\u1ec7n Trung \u01b0\u01a1ng Hu\u1ebf;<\/td>\n<\/tr>\n
TS. \u0110o\u00e0n Th\u1ecb Th\u00f9y Linh<\/td>\nPh\u00f3 Tr\u01b0\u1edfng ph\u00f2ng Ki\u1ec3m so\u00e1t HIV v\u00e0 b\u1ec7nh truy\u1ec1n nhi\u1ec5m m\u1ea1n t\u00ednh, C\u1ee5c Ph\u00f2ng b\u1ec7nh;<\/td>\n<\/tr>\n
BSCKII. B\u00f9i Ho\u00e0ng Ch\u01b0\u01a1ng<\/td>\nPh\u00f3 Tr\u01b0\u1edfng ph\u00f2ng K\u1ebf ho\u1ea1ch t\u1ed5ng h\u1ee3p, B\u1ec7nh vi\u1ec7n B\u1ec7nh Nhi\u1ec7t \u0111\u1edbi Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh;<\/td>\n<\/tr>\n
TS. Cao Th\u1ecb Thanh Th\u1ee7y<\/td>\nKhoa Truy\u1ec1n nhi\u1ec5m, B\u1ec7nh vi\u1ec7n \u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i;<\/td>\n<\/tr>\n
TS. Nguy\u1ec5n Th\u1ecb Th\u00fay V\u00e2n<\/td>\nChuy\u00ean gia c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi t\u1ea1i Vi\u1ec7t Nam;<\/td>\n<\/tr>\n
BSCKII. Hu\u1ef3nh Th\u1ecb Kim Y\u1ebfn<\/td>\nGi\u1ea3ng vi\u00ean B\u1ed9 m\u00f4n Lao – Truy\u1ec1n nhi\u1ec5m, Khoa Y, Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c C\u1ea7n Th\u01a1;<\/td>\n<\/tr>\n
BS. \u0110\u1ed7 Minh H\u00f9ng<\/td>\nChuy\u00ean vi\u00ean ch\u00ednh, Ph\u00f2ng \u0110\u0103ng k\u00fd thu\u1ed1c, C\u1ee5c Qu\u1ea3n l\u00fd D\u01b0\u1ee3c;<\/td>\n<\/tr>\n
ThS. Ph\u1ea1m H\u00f9ng Ti\u1ebfn<\/td>\nChuy\u00ean vi\u00ean Ph\u00f2ng Nghi\u1ec7p v\u1ee5, C\u1ee5c Qu\u1ea3n l\u00fd Kh\u00e1m, ch\u1eefa b\u1ec7nh;<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

M\u1ee4C L\u1ee4C<\/b><\/p>\n

C\u00c1C T\u1eea VI\u1ebeT T\u1eaeT<\/b><\/p>\n

C\u00c1C THU\u1eacT NG\u1eee<\/b><\/p>\n

I. \u0110\u1ea0I C\u01af\u01a0NG<\/b><\/p>\n

II. X\u00c9T NGHI\u1ec6M CH\u1ea8N \u0110O\u00c1N NG\u01af\u1edcI NHI\u1ec4M HBV<\/b><\/p>\n

III. CH\u1ea8N \u0110O\u00c1N V\u00c0 \u0110I\u1ec0U TR\u1eca VI\u00caM GAN B C\u1ea4P<\/b><\/p>\n

3.1. Ch\u1ea9n \u0111o\u00e1n vi\u00eam gan B c\u1ea5p<\/p>\n

3.2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/p>\n

3.3. \u0110i\u1ec1u tr\u1ecb<\/p>\n

3.3.1. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng<\/p>\n

3.3.2. \u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u:<\/p>\n

3.4. Theo d\u00f5i<\/p>\n

3.4.1. L\u00e2m s\u00e0ng<\/p>\n

3.4.2. C\u1eadn l\u00e2m s\u00e0ng<\/p>\n

3.4.3. X\u00e1c \u0111\u1ecbnh h\u1ed3i ph\u1ee5c ho\u1eb7c chuy\u1ec3n m\u1ea1n<\/p>\n

IV. CH\u1ea8N \u0110O\u00c1N V\u00c0 \u0110I\u1ec0U TR\u1eca VI\u00caM GAN B M\u1ea0N<\/b><\/p>\n

4.1. Ch\u1ea9n \u0111o\u00e1n<\/p>\n

4.1.1. Ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m HBV m\u1ea1n<\/p>\n

4.1.2. \u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng vi\u00eam gan B m\u1ea1n<\/p>\n

4.2. \u0110i\u1ec1u tr\u1ecb<\/p>\n

4.2.1. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/p>\n

4.2.2. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/p>\n

4.2.3. \u0110i\u1ec1u tr\u1ecb<\/p>\n

4.2.4. Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb<\/p>\n

4.2.5. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u00e0 ti\u00eau chu\u1ea9n ng\u1eebng \u0111i\u1ec1u tr\u1ecb<\/p>\n

4.2.6. \u0110i\u1ec1u tr\u1ecb c\u00e1c qu\u1ea7n th\u1ec3 \u0111\u1eb7c bi\u1ec7t<\/p>\n

4.3. Theo d\u00f5i \u0111i\u1ec1u tr\u1ecb<\/p>\n

4.3.1. Tr\u01b0\u1eddng h\u1ee3p ch\u01b0a c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng vi r\u00fat<\/p>\n

4.3.2. Tr\u01b0\u1eddng h\u1ee3p \u0111ang \u0111i\u1ec1u tr\u1ecb ho\u1eb7c \u0111\u00e3 ng\u1eebng \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng vi r\u00fat<\/p>\n

4.4. C\u00e1c tr\u01b0\u1eddng h\u1ee3p th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c kh\u00e1ng vi r\u00fat<\/p>\n

4.4.1. Ti\u00eau chu\u1ea9n th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb<\/p>\n

4.4.2. X\u1eed tr\u00ed<\/p>\n

4.5. T\u0103ng c\u01b0\u1eddng tri\u1ec3n khai ch\u0103m s\u00f3c v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B t\u1ea1i c\u00e1c c\u01a1 s\u1edf y t\u1ebf<\/p>\n

V. PH\u00d2NG B\u1ec6NH<\/b><\/p>\n

5.1. Ph\u00f2ng b\u1ec7nh ch\u1ee7 \u0111\u1ed9ng<\/p>\n

5.2. Ph\u00f2ng l\u00e2y truy\u1ec1n HBV t\u1eeb m\u1eb9 sang con<\/p>\n

5.3. D\u1ef1 ph\u00f2ng sau ph\u01a1i nhi\u1ec5m HBV6,7<\/sup><\/p>\n

5.4. Ph\u00f2ng b\u1ec7nh kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/p>\n

PH\u1ee4 L\u1ee4C 1. CH\u1ea8N \u0110O\u00c1N C\u00c1C GIAI \u0110O\u1ea0N C\u1ee6A NHI\u1ec4M HBV M\u1ea0N1<\/sup><\/b><\/b><\/p>\n

PH\u1ee4 L\u1ee4C 2. \u0110\u00c1NH GI\u00c1 C\u00c1C GIAI \u0110O\u1ea0N \u0110\u1ed8 X\u01a0 H\u00d3A GAN V\u00c0 X\u01a0 GAN3<\/sup><\/b><\/p>\n

PH\u1ee4 L\u1ee4C 3. \u0110I\u1ec0U TR\u1eca D\u1ef0 PH\u00d2NG VI\u00caM GAN B B\u00d9NG PH\u00c1T KHI \u0110I\u1ec0U TR\u1eca C\u00c1C THU\u1ed0C \u1ee8C CH\u1ebe MI\u1ec4N D\u1ecaCH HAY H\u00d3A TR\u1eca LI\u1ec6U12<\/sup><\/b><\/b><\/p>\n

PH\u1ee4 L\u1ee4C 4. CHUY\u1ec2N THU\u1ed0C HO\u1eb6C \u0110I\u1ec0U CH\u1ec8NH LI\u1ec0U THU\u1ed0C KH\u00c1NG VI R\u00daT TR\u00caN NG\u01af\u1edcI SUY TH\u1eacN THEO M\u1ee8C L\u1eccC C\u1ea6U TH\u1eacN3<\/sup><\/b><\/b><\/p>\n

PH\u1ee4 L\u1ee4C 5. \u0110I\u1ec0U TR\u1eca VI\u00caM GAN B M\u1ea0N \u1ede NG\u01af\u1edcI \u2265 12 TU\u1ed4I1<\/sup><\/b><\/p>\n

PH\u1ee4 L\u1ee4C 6. X\u00c9T NGHI\u1ec6M V\u00c0 \u0110I\u1ec0U TR\u1eca NG\u0102N NG\u1eeaA L\u00c2Y TRUY\u1ec0N HBV11<\/sup><\/b><\/p>\n

T\u1eea NG\u1eee VI\u1ebeT T\u1eaeT<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
AFP<\/td>\nAlpha-fetoprotein<\/td>\n<\/tr>\n
ALT<\/td>\nAlanine Aminotransferase<\/td>\n<\/tr>\n
Anti-HBc<\/td>\nAntibody against Hepatitis B core antigen – Kh\u00e1ng th\u1ec3 kh\u00e1ng kh\u00e1ng nguy\u00ean l\u00f5i vi r\u00fat vi\u00eam gan B<\/td>\n<\/tr>\n
Anti-HBe<\/td>\nAntibody against Hepatitis B e antigen – Kh\u00e1ng th\u1ec3 kh\u00e1ng kh\u00e1ng nguy\u00ean e vi r\u00fat vi\u00eam gan B<\/td>\n<\/tr>\n
Anti-HBs<\/td>\nAntibody against Hepatitis B surface antigen – Kh\u00e1ng th\u1ec3 kh\u00e1ng kh\u00e1ng nguy\u00ean b\u1ec1 m\u1eb7t vi r\u00fat vi\u00eam gan B<\/td>\n<\/tr>\n
APRI<\/td>\nAST to Platelet Ratio Index – Ch\u1ec9 s\u1ed1 t\u1ef7 s\u1ed1 AST tr\u00ean ti\u1ec3u c\u1ea7u<\/td>\n<\/tr>\n
ARFI<\/td>\nAcoustic Radiation Force Impulse<\/td>\n<\/tr>\n
AST<\/td>\nAspartate aminotransferase<\/td>\n<\/tr>\n
ARV<\/td>\nAntiretrovirals – Thu\u1ed1c kh\u00e1ng retrovirus<\/td>\n<\/tr>\n
CMV<\/td>\nCytomegalovirus<\/td>\n<\/tr>\n
CrCl<\/td>\nCreatinin clearance – \u0110\u1ed9 thanh th\u1ea3i Creatinin<\/td>\n<\/tr>\n
DAAs<\/td>\nDirect-acting antiviral agents – C\u00e1c thu\u1ed1c kh\u00e1ng vi r\u00fat t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp<\/td>\n<\/tr>\n
EBV<\/td>\nEpstein- Barr virus<\/td>\n<\/tr>\n
ETV<\/td>\nEntecavir<\/td>\n<\/tr>\n
HBcAg<\/td>\nHepatitis B core antigen – Kh\u00e1ng nguy\u00ean l\u00f5i vi r\u00fat vi\u00eam gan B<\/td>\n<\/tr>\n
HBeAg<\/td>\nHepatitis B e antigen – Kh\u00e1ng nguy\u00ean e vi r\u00fat vi\u00eam gan B<\/td>\n<\/tr>\n
HBsAg<\/td>\nHepatitis B surface antigen – Kh\u00e1ng nguy\u00ean b\u1ec1 m\u1eb7t vi r\u00fat vi\u00eam gan B<\/td>\n<\/tr>\n
HBV<\/td>\nHepatitis B virus – Vi r\u00fat vi\u00eam gan B<\/td>\n<\/tr>\n
HCC<\/td>\nHepatocellular carcinoma – Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan<\/td>\n<\/tr>\n
HCV<\/td>\nHepatitis C virus – Vi r\u00fat vi\u00eam gan C<\/td>\n<\/tr>\n
HDV<\/td>\nHepatitis D virus – Vi r\u00fat vi\u00eam gan D<\/td>\n<\/tr>\n
HEV<\/td>\nHepatitis E virus – Vi r\u00fat vi\u00eam gan E<\/td>\n<\/tr>\n
HIV<\/td>\nHuman immunodeficiency virus – Vi r\u00fat g\u00e2y suy gi\u1ea3m mi\u1ec5n d\u1ecbch \u1edf ng\u01b0\u1eddi<\/td>\n<\/tr>\n
IFN<\/td>\nInterferon<\/td>\n<\/tr>\n
IL-6<\/td>\nInterleukin 6<\/td>\n<\/tr>\n
CAR-T<\/td>\nChimeric antigen receptor T-cell therapy<\/td>\n<\/tr>\n
TKI<\/td>\nTyrosine Kinase Inhibitor<\/td>\n<\/tr>\n
TACE<\/td>\nTranscatheter arterial chemoembolization – Thuy\u00ean t\u1eafc h\u00f3a ch\u1ea5t xuy\u00ean \u0111\u1ed9ng m\u1ea1ch hay c\u00f2n g\u1ecdi l\u00e0 n\u00fat m\u1ea1ch<\/td>\n<\/tr>\n
JK<\/td>\nJanus Kinase<\/td>\n<\/tr>\n
INR<\/td>\nInternational normalized ratio – T\u1ef7 s\u1ed1 chu\u1ea9n h\u00f3a qu\u1ed1c t\u1ebf<\/td>\n<\/tr>\n
LAM<\/td>\nLamivudine<\/td>\n<\/tr>\n
MRE<\/td>\nMagnetic Resonance Elastography – C\u1ed9ng h\u01b0\u1edfng t\u1eeb \u0111\u00e0n h\u1ed3i<\/td>\n<\/tr>\n
NAs<\/td>\nNucleot(s)ide analogue – Thu\u1ed1c t\u01b0\u01a1ng t\u1ef1 nucleot(s)ide<\/td>\n<\/tr>\n
Peg-IFN<\/td>\nPegylated- interferon<\/td>\n<\/tr>\n
qHBsAg<\/td>\nHepatitis B surface antigen quantitative – \u0111\u1ecbnh l\u01b0\u1ee3ng HbsAg<\/td>\n<\/tr>\n
RNA<\/td>\nRibonucleic acid – Chu\u1ed7i th\u00f4ng tin di truy\u1ec1n ax\u00edt nh\u00e2n ribo<\/td>\n<\/tr>\n
DNA<\/td>\nAxit deoxyribonucleic<\/td>\n<\/tr>\n
TAF<\/td>\nTenofovir alafenamide<\/td>\n<\/tr>\n
TDF<\/td>\nTenofovir disoproxil fumarate<\/td>\n<\/tr>\n
ULN<\/td>\nUpper Limit of Normal – Gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a m\u1ee9c b\u00ecnh th\u01b0\u1eddng<\/td>\n<\/tr>\n
M2BPGI<\/td>\nMac-2 Binding Protein Glycosylation<\/td>\n<\/tr>\n
HBcrAg<\/td>\nHepatitis B core-related antigen – Kh\u00e1ng nguy\u00ean li\u00ean quan \u0111\u1ebfn l\u00f5i c\u1ee7a HBV<\/td>\n<\/tr>\n
PIVKA II<\/td>\nProthrombin induced by vitamin K absence-II: Prothrombin \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh do thi\u1ebfu h\u1ee5t vitamin K – tu\u00fdp II<\/td>\n<\/tr>\n
TNF<\/td>\nTumor Necrosis Factors: Y\u1ebfu t\u1ed1 ho\u1ea1i t\u1eed u<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

C\u00c1C THU\u1eacT NG\u1eee<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
DI\u1ec4N BI\u1ebeN T\u1ef0 NHI\u00caN C\u1ee6A NHI\u1ec4M VI R\u00daT VI\u00caM GAN B (HBV)<\/strong><\/td>\n<\/tr>\n
Vi\u00eam gan B<\/td>\nTrong h\u01b0\u1edbng d\u1eabn n\u00e0y, th\u1ed1ng nh\u1ea5t s\u1eed d\u1ee5ng t\u1eeb \u2018vi\u00eam gan B\u2019 thay cho t\u1eeb \u2018vi\u00eam gan vi r\u00fat B\u2019.<\/td>\n<\/tr>\n
Nhi\u1ec5m HBV c\u1ea5p<\/td>\nT\u00ecnh tr\u1ea1ng nhi\u1ec5m m\u1edbi HBV, c\u00f3 th\u1ec3 c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, th\u01b0\u1eddng k\u00e9o d\u00e0i d\u01b0\u1edbi 6 th\u00e1ng v\u00e0 c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n \u1edf ph\u1ea7n l\u1edbn ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh (m\u1ea5t HBsAg).<\/td>\n<\/tr>\n
Nhi\u1ec5m HBV m\u1ea1n<\/td>\nT\u00ecnh tr\u1ea1ng HBsAg t\u1ed3n t\u1ea1i duy tr\u00ec t\u1eeb 6 th\u00e1ng tr\u1edf l\u00ean sau nhi\u1ec5m c\u1ea5p HBV. Tr\u00ean l\u00e2m s\u00e0ng, nhi\u1ec5m HBV m\u1ea1n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh \u1edf ng\u01b0\u1eddi l\u1edbn v\u00e0 HBsAg t\u1ed3n t\u1ea1i k\u00e9o d\u00e0i 6 th\u00e1ng tr\u1edf l\u00ean \u1edf v\u1ecb th\u00e0nh ni\u00ean v\u00e0 tr\u1ebb em1.<\/td>\n<\/tr>\n
Nhi\u1ec5m HBV m\u1ea1n HBeAg d\u01b0\u01a1ng t\u00ednh (Giai \u0111o\u1ea1n dung n\u1ea1p mi\u1ec5n d\u1ecbch)<\/td>\nGiai \u0111o\u1ea1n s\u1edbm c\u1ee7a nhi\u1ec5m HBV m\u1ea1n, x\u1ea3y ra \u1edf ng\u01b0\u1eddi nhi\u1ec5m HBV l\u00fac m\u1edbi sinh ho\u1eb7c trong th\u1eddi th\u01a1 \u1ea5u, \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 nh\u00e2n l\u00ean HBV cao m\u00e0 kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng gan \u0111\u00e1ng k\u1ec3.<\/td>\n<\/tr>\n
Vi\u00eam gan B m\u1ea1n HBeAg d\u01b0\u01a1ng t\u00ednh<\/td>\nGiai \u0111o\u1ea1n c\u00f3 HBeAg d\u01b0\u01a1ng, AST v\u00e0 ALT dao \u0111\u1ed9ng n\u1ed3ng \u0111\u1ed9 HBV DNA cao; c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh sang anti-HBe.<\/td>\n<\/tr>\n
Nhi\u1ec5m HBV HBeAg \u00e2m t\u00ednh (Giai \u0111o\u1ea1n kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng)<\/td>\nGiai \u0111o\u1ea1n HBV nh\u00e2n l\u00ean th\u1ea5p, \u0111\u1eb7c tr\u01b0ng b\u1edfi HBeAg \u00e2m t\u00ednh, anti HBe d\u01b0\u01a1ng t\u00ednh, ALT b\u00ecnh th\u01b0\u1eddng v\u00e0 t\u1ea3i l\u01b0\u1ee3ng HBV DNA < 2000 IU\/mL.<\/td>\n<\/tr>\n
Vi\u00eam gan B m\u1ea1n HBeAg \u00e2m t\u00ednh (Giai \u0111o\u1ea1n t\u00e1i ho\u1ea1t \u0111\u1ed9ng)<\/td>\nGiai \u0111o\u1ea1n \u0111\u1eb7c tr\u01b0ng b\u1edfi m\u1ea5t HBeAg (th\u01b0\u1eddng \u0111i k\u00e8m s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a anti-HBe) nh\u01b0ng HBV v\u1eabn ho\u1ea1t \u0111\u1ed9ng nh\u00e2n l\u00ean (sao ch\u00e9p) v\u1edbi c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau g\u00e2y ra t\u00ecnh tr\u1ea1ng vi\u00eam v\u00e0 ho\u1ea1i t\u1eed gan c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau.<\/td>\n<\/tr>\n
V\u00f9ng x\u00e1m<\/td>\nT\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 bi\u1ec3u hi\u1ec7n x\u00e9t nghi\u1ec7m kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, kh\u00f4ng thu\u1ed9c c\u00e1c giai \u0111o\u1ea1n ti\u00eau chu\u1ea9n. \u0110i\u1ec1u n\u00e0y g\u00e2y kh\u00f3 kh\u0103n cho vi\u1ec7c ph\u00e2n lo\u1ea1i b\u1ec7nh v\u00e0 t\u1ea1o ra s\u1ef1 kh\u00f4ng ch\u1eafc ch\u1eafn v\u1ec1 quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng vi r\u00fat.<\/td>\n<\/tr>\n
Vi\u00eam gan B th\u1ec3 \u1ea9n<\/td>\nT\u00ecnh tr\u1ea1ng nhi\u1ec5m HBV kh\u00f4ng c\u00f2n HBsAg (HBsAg \u00e2m t\u00ednh nh\u01b0ng HBV DNA tr\u00ean ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n, th\u01b0\u1eddng \u1edf n\u1ed3ng \u0111\u1ed9 th\u1ea5p (<200 IU\/mL), anti-HBc to\u00e0n ph\u1ea7n h\u1ea7u h\u1ebft d\u01b0\u01a1ng t\u00ednh.<\/td>\n<\/tr>\n
X\u01a1 gan<\/td>\nGiai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh l\u00fd gan, \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi c\u00f3 x\u01a1 h\u00f3a lan r\u1ed9ng, nhu m\u00f4 gan c\u00f3 n\u1ed1t t\u00e1i sinh v\u00e0 r\u1ed1i lo\u1ea1n nghi\u00eam tr\u1ecdng v\u1ec1 c\u1ea5u tr\u00fac v\u00e0 tu\u1ea7n ho\u00e0n c\u1ee7a gan. Ch\u1ea9n \u0111o\u00e1n x\u01a1 gan khi x\u01a1 h\u00f3a gan \u1edf m\u1ee9c F4 b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 kh\u00f4ng x\u00e2m l\u1ea5n ho\u1eb7c x\u00e2m l\u1ea5n.<\/td>\n<\/tr>\n
X\u01a1 gan m\u1ea5t b\u00f9<\/td>\nGiai \u0111o\u1ea1n cu\u1ed1i c\u1ee7a b\u1ec7nh gan m\u1ea1n t\u00ednh v\u1edbi ch\u1ee9c n\u0103ng gan suy gi\u1ea3m n\u1eb7ng, kh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng b\u00f9 tr\u1eeb. X\u00e1c \u0111\u1ecbnh x\u01a1 gan m\u1ea5t b\u00f9 khi ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u2265 1 bi\u1ebfn c\u1ed1 m\u1ea5t b\u00f9: v\u1ee1, gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n, c\u1ed5 ch\u01b0\u1edbng, b\u1ec7nh n\u00e3o gan, v\u00e0ng da; v\u00e0\/ho\u1eb7c khi \u0111i\u1ec3m Child Pugh \u2265 7.<\/td>\n<\/tr>\n
Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC)<\/td>\nKh\u1ed1i u \u00e1c t\u00ednh ph\u00e1t sinh t\u1eeb c\u00e1c t\u1ebf b\u00e0o gan.<\/td>\n<\/tr>\n
Vi\u00eam gan B th\u1ec3 t\u1ed1i c\u1ea5p<\/td>\nT\u00ecnh tr\u1ea1ng suy gan c\u1ea5p x\u1ea3y ra trong v\u00f2ng v\u00e0i tu\u1ea7n k\u1ec3 t\u1eeb khi xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u00e0ng da v\u1edbi 3 \u0111\u1eb7c \u0111i\u1ec3m ch\u00ednh: suy ch\u1ee9c n\u0103ng gan nghi\u00eam tr\u1ecdng, b\u1ec7nh n\u00e3o gan v\u00e0 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u n\u1eb7ng. Vi\u00eam gan B th\u1ec3 t\u1ed1i c\u1ea5p c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong r\u1ea5t cao (th\u01b0\u1eddng > 70%) n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi1.<\/td>\n<\/tr>\n
Vi\u00eam gan B t\u00e1i ho\u1ea1t<\/td>\nT\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd gan nghi\u00eam tr\u1ecdng, x\u1ea3y ra khi HBV \u0111ang kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng ho\u1eb7c th\u1ec3 \u1ea9n, \u0111\u1ed9t ng\u1ed9t nh\u00e2n l\u00ean nhanh ch\u00f3ng, d\u1eabn \u0111\u1ebfn vi\u00eam v\u00e0 ho\u1ea1i t\u1eed t\u1ebf b\u00e0o gan c\u1ea5p t\u00ednh, g\u00e2y ra c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng t\u1eeb nh\u1eb9 \u0111\u1ebfn n\u1eb7ng, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u00eam gan B th\u1ec3 t\u1ed1i c\u1ea5p v\u00e0 t\u1eed vong.<\/td>\n<\/tr>\n
Chuy\u1ec3n \u0111\u1ea3o huy\u1ebft thanh HBeAg<\/td>\nT\u00ecnh tr\u1ea1ng m\u1ea5t HBeAg (HBeAg \u00e2m t\u00ednh) v\u00e0 xu\u1ea5t hi\u1ec7n anti-HBe (anti-HBe d\u01b0\u01a1ng t\u00ednh).<\/td>\n<\/tr>\n
Chuy\u1ec3n \u0111\u1ea3o huy\u1ebft thanh HBsAg<\/td>\nT\u00ecnh tr\u1ea1ng m\u1ea5t HBsAg (HBsAg \u00e2m t\u00ednh) v\u00e0 xu\u1ea5t hi\u1ec7n anti HBs (anti-HBs d\u01b0\u01a1ng t\u00ednh).<\/td>\n<\/tr>\n
C\u00c1C THU\u1eacT NG\u1eee KH\u00c1C<\/strong><\/td>\n<\/tr>\n
X\u00e9t nghi\u1ec7m t\u1ea1i \u0111i\u1ec3m ch\u0103m s\u00f3c (Point of<\/i> Care)<\/i><\/td>\nX\u00e9t nghi\u1ec7m s\u1eed d\u1ee5ng c\u00e1c thi\u1ebft b\u1ecb \u0111\u01a1n gi\u1ea3n c\u00f3 kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n t\u1ea1i c\u00e1c c\u01a1 s\u1edf kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh c\u1ea5p ban \u0111\u1ea7u v\u00e0 cho k\u1ebft qu\u1ea3 nhanh.<\/td>\n<\/tr>\n
X\u00e9t nghi\u1ec7m t\u1ea1i ph\u00f2ng x\u00e9t nghi\u1ec7m (Laboratory – based assays)<\/i><\/td>\nX\u00e9t nghi\u1ec7m th\u1ef1c hi\u1ec7n t\u1ea1i ph\u00f2ng x\u00e9t nghi\u1ec7m tr\u00ean c\u00e1c h\u1ec7 th\u1ed1ng t\u1ef1 \u0111\u1ed9ng (automatic), b\u00e1n t\u1ef1 \u0111\u1ed9ng (semi- automatic).<\/td>\n<\/tr>\n
L\u1ea5y m\u1eabu x\u00e9t nghi\u1ec7m HBV DNA t\u1ea1i th\u1eddi \u0111i\u1ec3m ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m HBV (Re\ufb02ex HBV DNA testing)<\/i><\/td>\nVi\u1ec7c thu th\u1eadp m\u1eabu x\u00e9t nghi\u1ec7m HBV DNA ngay sau khi m\u1ed9t ng\u01b0\u1eddi \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m HBsAg d\u01b0\u01a1ng t\u00ednh th\u00f4ng qua vi\u1ec7c s\u1eed d\u1ee5ng m\u1eabu m\u00e1u \u0111\u00e3 c\u00f3 ho\u1eb7c l\u1ea5y m\u1eabu m\u00e1u ngay sau khi c\u00f3 k\u1ebft qu\u1ea3 HBsAg.<\/td>\n<\/tr>\n
Tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb<\/td>\nM\u1ee9c \u0111\u1ed9 h\u00e0nh vi c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh (bao g\u1ed3m vi\u1ec7c u\u1ed1ng thu\u1ed1c duy tr\u00ec \u0111\u1ec1u \u0111\u1eb7n \u0111\u00fang gi\u1edd h\u00e0ng ng\u00e0y, t\u00e1i kh\u00e1m \u0111\u00fang h\u1eb9n, x\u00e9t nghi\u1ec7m \u0111\u1ecbnh k\u1ef3, th\u1ef1c hi\u1ec7n ch\u1ebf \u0111\u1ed9 \u0103n ki\u00eang v\u00e0\/ho\u1eb7c thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng) ph\u00f9 h\u1ee3p v\u1edbi k\u1ebf ho\u1ea1ch ch\u0103m s\u00f3c v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ed1ng nh\u1ea5t gi\u1eefa nh\u00e2n vi\u00ean y t\u1ebf v\u00e0 ng\u01b0\u1eddi \u0111ang s\u1ed1ng chung v\u1edbi HBV.<\/td>\n<\/tr>\n
\u0110\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B ban \u0111\u1ea7u<\/td>\nT\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u v\u1edbi t\u1ea3i l\u01b0\u1ee3ng HBV DNA gi\u1ea3m > 1log10 IU\/mL trong v\u00f2ng ba th\u00e1ng k\u1ec3 t\u1eeb khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb kh\u00e1ng vi r\u00fat.<\/td>\n<\/tr>\n
\u0110\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B<\/td>\nHBV DNA kh\u00f4ng ph\u00e1t hi\u1ec7n trong m\u00e1u\/huy\u1ebft thanh t\u1ea1i m\u1ed9t th\u1eddi \u0111i\u1ec3m x\u00e1c \u0111\u1ecbnh sau khi ho\u00e0n th\u00e0nh \u0111i\u1ec1u tr\u1ecb.<\/td>\n<\/tr>\n
Th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u<\/td>\nT\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u v\u1edbi t\u1ea3i l\u01b0\u1ee3ng HBV DNA gi\u1ea3m < 1log10 IU\/mL trong v\u00f2ng ba th\u00e1ng k\u1ec3 t\u1eeb khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb kh\u00e1ng vi r\u00fat.<\/td>\n<\/tr>\n
Th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb th\u1ee9 c\u1ea5p (th\u01b0\u1eddng l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a kh\u00e1ng thu\u1ed1c n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb)<\/i><\/td>\nT\u00ecnh tr\u1ea1ng m\u1ea5t hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb sau khi ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 c\u00f3 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B ban \u0111\u1ea7u, x\u00e1c \u0111\u1ecbnh khi n\u1ed3ng \u0111\u1ed9 HBV DNA t\u0103ng > 1log10 IU\/mL so v\u1edbi m\u1ee9c th\u1ea5p nh\u1ea5t \u0111\u00e3 \u0111\u1ea1t \u0111\u01b0\u1ee3c trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/td>\n<\/tr>\n
\u0110\u00e1p \u1ee9ng vi r\u00fat ho\u00e0n to\u00e0n<\/td>\nHBV DNA kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c b\u1eb1ng x\u00e9t nghi\u1ec7m c\u00f3 \u0111\u1ed9 nh\u1ea1y cao (ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n th\u01b0\u1eddng <20 IU\/mL).<\/td>\n<\/tr>\n
Kh\u00f4ng \u0111\u00e1p \u1ee9ng vi r\u00fat<\/td>\nHBV DNA gi\u1ea3m <1 log10 IU\/mL sau 6 th\u00e1ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi r\u00fat nucleot(s)ide.<\/td>\n<\/tr>\n
\u0110\u1ed3ng nhi\u1ec5m<\/td>\nT\u00ecnh tr\u1ea1ng m\u1ed9t ng\u01b0\u1eddi m\u1eafc \u0111\u1ed3ng th\u1eddi hai ho\u1eb7c nhi\u1ec1u b\u1ec7nh truy\u1ec1n nhi\u1ec5m kh\u00e1c nhau.<\/td>\n<\/tr>\n
\u0110\u1ed3ng m\u1eafc<\/td>\nT\u00ecnh tr\u1ea1ng m\u1ed9t ng\u01b0\u1eddi m\u1eafc hai hay nhi\u1ec1u b\u1ec7nh l\u00fd kh\u00e1c nhau. C\u00e1c b\u1ec7nh l\u00fd n\u00e0y xu\u1ea5t hi\u1ec7n \u0111\u1ed3ng th\u1eddi ho\u1eb7c k\u1ebf ti\u1ebfp nhau, kh\u00f4ng c\u00f9ng chung nguy\u00ean nh\u00e2n.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

H\u01af\u01a0\u0301NG D\u00c2\u0303N CH\u1ea8N \u0110O\u00c1N, \u0110I\u1ec0U TR\u1eca VI\u00caM GAN VI R\u00daT B<\/strong><\/p>\n

(Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 1740\/Q\u0110-BYT, ng\u00e0y 16 th\u00e1ng 06 n\u0103m 2026 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf)<\/i><\/p>\n

I. \u0110\u1ea0I C\u01af\u01a0NG<\/b><\/p>\n

Vi\u00eam gan vi r\u00fat B (Vi\u00eam gan B) l\u00e0 b\u1ec7nh truy\u1ec1n nhi\u1ec5m ph\u1ed5 bi\u1ebfn tr\u00ean to\u00e0n c\u1ea7u, do vi r\u00fat vi\u00eam gan B (HBV) g\u00e2y ra. Theo b\u00e1o c\u00e1o c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi, \u01b0\u1edbc t\u00ednh n\u0103m 2022 c\u00f3 kho\u1ea3ng 254 tri\u1ec7u ng\u01b0\u1eddi nhi\u1ec5m HBV m\u1ea1n tr\u00ean to\u00e0n c\u1ea7u; 1,2 tri\u1ec7u ng\u01b0\u1eddi nhi\u1ec5m HBV m\u1edbi h\u00e0ng n\u0103m; 1,1 tri\u1ec7u tr\u01b0\u1eddng h\u1ee3p t\u1eed vong, ch\u1ee7 y\u1ebfu l\u00e0 do x\u01a1 gan v\u00e0 ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (HCC)1,2<\/sup>. HBV l\u00e2y nhi\u1ec5m qua \u0111\u01b0\u1eddng m\u00e1u, quan h\u1ec7 t\u00ecnh d\u1ee5c v\u00e0 t\u1eeb m\u1eb9 sang con. T\u1ea1i Vi\u1ec7t Nam, \u0111\u01b0\u1eddng l\u00e2y ch\u1ee7 y\u1ebfu l\u00e0 t\u1eeb m\u1eb9 truy\u1ec1n sang con. T\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh HBsAg trong c\u1ed9ng \u0111\u1ed3ng d\u00e2n c\u01b0 \u226518 tu\u1ed5i l\u00e0 9,4%2<\/sup>. Hi\u1ec7n nay, t\u1ec9 l\u1ec7 ng\u01b0\u1eddi nhi\u1ec5m HBV \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00f2n th\u1ea5p, s\u1ed1 t\u1eed vong li\u00ean quan \u0111\u1ebfn vi\u00eam gan B c\u00f2n cao.<\/p>\n

HBV thu\u1ed9c h\u1ecd Hepadnaviridae, <\/i>c\u00f3 c\u1ea5u tr\u00fac di truy\u1ec1n DNA, \u0111\u01b0\u1ee3c chia th\u00e0nh 10 ki\u1ec3u gen k\u00fd hi\u1ec7u t\u1eeb A \u0111\u1ebfn J. HBV c\u00f3 3 lo\u1ea1i kh\u00e1ng nguy\u00ean ch\u00ednh: HBsAg, HBeAg v\u00e0 HBcAg, t\u01b0\u01a1ng \u1ee9ng v\u1edbi 3 lo\u1ea1i kh\u00e1ng th\u1ec3 l\u00e0: Anti-HBs, Anti-HBe v\u00e0 Anti-HBc. X\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n c\u00e1c kh\u00e1ng nguy\u00ean, kh\u00e1ng th\u1ec3 n\u00e0y c\u00f3 \u00fd ngh\u0129a quan tr\u1ecdng trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh b\u1ec7nh, th\u1ec3 b\u1ec7nh c\u0169ng nh\u01b0 di\u1ec5n bi\u1ebfn b\u1ec7nh.<\/p>\n

HBV c\u00f3 th\u1ec3 g\u00e2y vi\u00eam gan c\u1ea5p, vi\u00eam gan t\u1ed1i c\u1ea5p nh\u01b0ng ch\u1ee7 y\u1ebfu l\u00e0 vi\u00eam gan m\u1ea1n v\u00e0 c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n th\u00e0nh x\u01a1 gan, HCC. Vi\u00eam gan B l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y b\u1ec7nh x\u01a1 gan v\u00e0 HCC t\u1ea1i Vi\u1ec7t Nam. Ti\u00eam v\u1eafc xin vi\u00eam gan B v\u00e0 ph\u00f2ng ng\u1eeba l\u00e2y truy\u1ec1n HBV t\u1eeb m\u1eb9 sang con l\u00e0 ph\u01b0\u01a1ng ph\u00e1p d\u1ef1 ph\u00f2ng ch\u00ednh, hi\u1ec7u qu\u1ea3.<\/p>\n

II. X\u00c9T NGHI\u1ec6M CH\u1ea8N \u0110O\u00c1N NG\u01af\u1edcI NHI\u1ec4M HBV<\/b><\/p>\n

M\u1ecdi ng\u01b0\u1eddi d\u00e2n \u0111ang sinh s\u1ed1ng t\u1ea1i Vi\u1ec7t Nam n\u00ean x\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n s\u1edbm nhi\u1ec5m HBV, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng sau3-5<\/sup><\/i>:<\/p>\n

+ Ng\u01b0\u1eddi sinh tr\u01b0\u1edbc n\u0103m 2003 – n\u0103m tri\u1ec3n khai ch\u01b0\u01a1ng tr\u00ecnh v\u1eafc xin vi\u00eam gan B cho tr\u1ebb d\u01b0\u1edbi m\u1ed9t tu\u1ed5i tr\u00ean to\u00e0n qu\u1ed1c.<\/p>\n

+ Ng\u01b0\u1eddi \u0111\u1ebfn t\u01b0 v\u1ea5n, x\u00e9t nghi\u1ec7m t\u1ea1i c\u00e1c ph\u00f2ng kh\u00e1m t\u01b0 v\u1ea5n x\u00e9t nghi\u1ec7m HIV, lao.<\/p>\n

+ Ph\u1ee5 n\u1eef mang thai.<\/p>\n

+ Ng\u01b0\u1eddi c\u00f3 h\u00e0nh vi nguy c\u01a1 l\u00e2y nhi\u1ec5m HBV: ng\u01b0\u1eddi nhi\u1ec5m HIV, ng\u01b0\u1eddi ti\u00eam ch\u00edch ma tu\u00fd, nam quan h\u1ec7 t\u00ecnh d\u1ee5c \u0111\u1ed3ng gi\u1edbi, ph\u1ee5 n\u1eef m\u1ea1i d\u00e2m, ph\u1ea1m nh\u00e2n, ng\u01b0\u1eddi c\u00f3 quan h\u1ec7 t\u00ecnh d\u1ee5c kh\u00f4ng an to\u00e0n.<\/p>\n

+ Ng\u01b0\u1eddi c\u00f3 bi\u1ec3u hi\u1ec7n nghi ng\u1edd m\u1eafc vi\u00eam gan: c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a vi\u00eam gan v\u00e0\/ho\u1eb7c x\u00e9t nghi\u1ec7m men gan t\u0103ng. Ng\u01b0\u1eddi c\u00f3 bi\u1ec3u hi\u1ec7n x\u01a1 h\u00f3a gan v\u00e0 x\u01a1 gan.<\/p>\n

+ Ng\u01b0\u1eddi b\u1ec7nh ph\u1ea3i ch\u1ea1y th\u1eadn chu k\u1ef3, l\u1ecdc m\u00e1u, truy\u1ec1n m\u00e1u v\u00e0 ch\u1ebf ph\u1ea9m m\u00e1u.<\/p>\n

+ Ng\u01b0\u1eddi b\u1ec7nh tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, ho\u00e1 tr\u1ecb li\u1ec7u. Ng\u01b0\u1eddi m\u1eafc c\u00e1c b\u1ec7nh l\u00fd kh\u1ed1i u v\u00e0 ung th\u01b0.<\/p>\n

+ Nh\u00e2n vi\u00ean y t\u1ebf ch\u01b0a \u0111\u01b0\u1ee3c ti\u00eam v\u1eafc xin vi\u00eam gan B.<\/p>\n

+ Ng\u01b0\u1eddi hi\u1ebfn m\u00e1u, ng\u01b0\u1eddi hi\u1ebfn t\u1ea1ng, ng\u01b0\u1eddi cho tr\u1ee9ng, tinh tr\u00f9ng.<\/p>\n

+ B\u1ea1n t\u00ecnh, th\u00e0nh vi\u00ean gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi nhi\u1ec5m HBV.<\/p>\n

+ Ng\u01b0\u1eddi c\u00f3 ti\u1ec1n s\u1eed ti\u00eam, l\u00e0m th\u1ee7 thu\u1eadt kh\u00f4ng an to\u00e0n. Ng\u01b0\u1eddi c\u1ea7n d\u1ef1 ph\u00f2ng sau ph\u01a1i nhi\u1ec5m HBV.<\/p>\n

+ C\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng kh\u00e1c theo y\u00eau c\u1ea7u.<\/p>\n

C\u00e1c x\u00e9t nghi\u1ec7m c\u1ea7n l\u00e0m: HBsAg, anti-HBs, anti-HBc (n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n<\/i>)6<\/sup>; t\u1ed1i thi\u1ec3u ph\u1ea3i th\u1ef1c hi\u1ec7n HbsAg<\/b>5<\/sup>.<\/p>\n

B\u1ea3ng 1. Phi\u00ean gi\u1ea3i c\u00e1c k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m HBV5,6<\/sup><\/b><\/p>\n\n\n\n\n\n\n\n\n\n
C\u00e1c x\u00e9t nghi\u1ec7m<\/b><\/td>\n\n

Phi\u00ean gi\u1ea3i<\/b><\/p>\n<\/td>\n

\n

Qu\u1ea3n l\u00fd<\/b><\/p>\n<\/td>\n

\n

Ti\u00eam v\u1eafc xin vi\u00eam gan B<\/b><\/p>\n<\/td>\n<\/tr>\n

\n

HBsAg<\/b><\/p>\n<\/td>\n

\n

anti- HBc<\/b><\/p>\n<\/td>\n

\n

anti-HBs<\/b><\/p>\n<\/td>\n<\/tr>\n

\n

D\u01b0\u01a1ng T\u00ednh<\/p>\n<\/td>\n

\n

D\u01b0\u01a1ng T\u00ednh<\/p>\n<\/td>\n

\n

B\u1ea5t k\u1ef3<\/p>\n<\/td>\n

Vi\u00eam gan B m\u1ea1n<\/td>\nK\u1ebft n\u1ed1i c\u01a1 s\u1edf \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 qu\u1ea3n l\u00fd theo h\u01b0\u1edbng d\u1eabn<\/td>\n\n

Kh\u00f4ng<\/p>\n<\/td>\n<\/tr>\n

\n

\u00c2m t\u00ednh<\/p>\n<\/td>\n

\n

D\u01b0\u01a1ng t\u00ednh<\/p>\n<\/td>\n

\n

\u2265 10 IU\/L<\/p>\n<\/td>\n

H\u1ed3i ph\u1ee5c sau nhi\u1ec5m HBV trong qu\u00e1 kh\u1ee9<\/td>\nKh\u00f4ng c\u1ea7n qu\u1ea3n l\u00fd v\u1ec1 vi\u00eam gan B tr\u1eeb khi suy gi\u1ea3m mi\u1ec5n d\u1ecbch ho\u1eb7c \u0111ang h\u00f3a tr\u1ecb ho\u1eb7c \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch<\/td>\n\n

Kh\u00f4ng<\/p>\n<\/td>\n<\/tr>\n

\n

\u00c2m t\u00ednh<\/p>\n<\/td>\n

\n

D\u01b0\u01a1ng t\u00ednh<\/p>\n<\/td>\n

\n

< 10 IU\/L<\/p>\n<\/td>\n

H\u1ed3i ph\u1ee5c sau nhi\u1ec5m HBV trong qu\u00e1 kh\u1ee9 ho\u1eb7c d\u01b0\u01a1ng t\u00ednh gi\u1ea3<\/td>\nX\u00e9t nghi\u1ec7m HBV DNA n\u1ebfu suy gi\u1ea3m mi\u1ec5n d\u1ecbch ho\u1eb7c nghi ng\u1edd vi\u00eam gan B th\u1ec3 \u1ea9n<\/td>\n\n

Kh\u00f4ng<\/p>\n<\/td>\n<\/tr>\n

\n

\u00c2m t\u00ednh<\/p>\n<\/td>\n

\n

\u00c2m t\u00ednh<\/p>\n<\/td>\n

\n

\u2265 10 IU\/L<\/p>\n<\/td>\n

Kh\u00f4ng nhi\u1ec5m HBV, c\u00f3 mi\u1ec5n d\u1ecbch b\u1ea3o v\u1ec7 do ti\u00eam ph\u00f2ng<\/td>\nKh\u00f4ng c\u1ea7n x\u00e9t nghi\u1ec7m th\u00eam<\/td>\n\n

Kh\u00f4ng<\/p>\n

(ti\u1ebfp t\u1ee5c b\u1ed5 sung c\u00e1c m\u0169i ti\u00eam theo l\u1ecbch n\u1ebfu ch\u01b0a ho\u00e0n th\u00e0nh)<\/i><\/p>\n<\/td>\n<\/tr>\n

\n

\u00c2m t\u00ednh<\/p>\n<\/td>\n

\n

\u00c2m t\u00ednh<\/p>\n<\/td>\n

\n

< 10 IU\/L<\/p>\n<\/td>\n

Kh\u00f4ng nhi\u1ec5m HBV, ch\u01b0a c\u00f3 mi\u1ec5n d\u1ecbch b\u1ea3o v\u1ec7<\/td>\nX\u00e9t nghi\u1ec7m anti-HBs sau 1- 2 th\u00e1ng k\u1ec3 t\u1eeb khi ho\u00e0n th\u00e0nh li\u1ec7u tr\u00ecnh ti\u00eam v\u1eafc xin vi\u00eam gan B n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n<\/td>\n\n

C\u00f3<\/p>\n

(ti\u00eam \u0111\u1ea7y \u0111\u1ee7 c\u00e1c m\u0169i theo li\u1ec7u tr\u00ecnh ho\u1eb7c theo ph\u00e1c \u0111\u1ed3 t\u0103ng<\/i> c\u01b0\u1eddng v\u1edbi c\u00e1c nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u1eb7c bi\u1ec7t)<\/i><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

L\u01b0u \u00fd<\/i><\/b>:<\/p>\n

– V\u1edbi ng\u01b0\u1eddi c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh: c\u1ea7n t\u01b0 v\u1ea5n v\u00e0 k\u1ebft n\u1ed1i ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ebfn c\u01a1 s\u1edf qu\u1ea3n l\u00fd v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh;<\/p>\n

– V\u1edbi ng\u01b0\u1eddi c\u00f3 HBsAg \u00e2m t\u00ednh: n\u00ean l\u00e0m x\u00e9t nghi\u1ec7m anti-HBc v\u00e0 anti-HBs (n\u1ebfu tr\u01b0\u1edbc \u0111\u00f3 ch\u01b0a l\u00e0m) \u0111\u1ec3 t\u01b0 v\u1ea5n c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng b\u1ec7nh.<\/p>\n

III. CH\u1ea8N \u0110O\u00c1N V\u00c0 \u0110I\u1ec0U TR\u1eca VI\u00caM GAN B C\u1ea4P<\/b><\/p>\n

3.1. Ch\u1ea9n \u0111o\u00e1n vi\u00eam gan B c\u1ea5p<\/b><\/p>\n

– Ti\u1ec1n s\u1eed: ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u1ec1n s\u1eed nguy c\u01a1 ti\u1ebfp x\u00fac\/ph\u01a1i nhi\u1ec5m v\u1edbi HBV (truy\u1ec1n m\u00e1u hay c\u00e1c ch\u1ebf ph\u1ea9m c\u1ee7a m\u00e1u, ti\u00eam ch\u00edch ma t\u00fay, quan h\u1ec7 t\u00ecnh d\u1ee5c kh\u00f4ng an to\u00e0n, x\u0103m tr\u1ed5, tr\u1ea3i qua th\u1ee7 thu\u1eadt y t\u1ebf v\u1edbi c\u00e1c d\u1ee5ng c\u1ee5 ch\u01b0a \u0111\u01b0\u1ee3c kh\u1eed khu\u1ea9n t\u1ed1t) trong kho\u1ea3ng 4 – 24 tu\u1ea7n (th\u1eddi gian \u1ee7 b\u1ec7nh) tr\u01b0\u1edbc khi kh\u1edfi ph\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng.<\/p>\n

– L\u00e2m s\u00e0ng:<\/p>\n

+ Th\u1ec3 \u0111i\u1ec3n h\u00ecnh:<\/p>\n

\u25aa Giai \u0111o\u1ea1n ti\u1ec1n v\u00e0ng da: C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u nh\u01b0 m\u1ec7t m\u1ecfi, ch\u00e1n \u0103n, bu\u1ed3n n\u00f4n, n\u00f4n, s\u1ed1t nh\u1eb9 (th\u01b0\u1eddng x\u1ea3y ra tr\u01b0\u1edbc khi v\u00e0ng da), \u0111au t\u1ee9c nh\u1eb9 v\u00f9ng h\u1ea1 s\u01b0\u1eddn ph\u1ea3i.<\/p>\n

\u25aa Giai \u0111o\u1ea1n v\u00e0ng da: sau khi h\u1ebft s\u1ed1t, ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n ng\u1ee9a, v\u00e0ng da, v\u00e0ng m\u1eaft, ti\u1ec3u s\u1eadm m\u00e0u (nh\u01b0 n\u01b0\u1edbc ch\u00e8 \u0111\u1eb7c), ph\u00e2n b\u1ea1c m\u00e0u (\u00edt g\u1eb7p h\u01a1n).<\/p>\n

\u25aa Giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c: tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ea3i thi\u1ec7n v\u00e0 lui d\u1ea7n. Ng\u01b0\u1eddi b\u1ec7nh t\u1eeb t\u1eeb h\u1ed3i ph\u1ee5c.<\/p>\n

+ C\u00e1c th\u1ec3 l\u00e2m s\u00e0ng kh\u00e1c:<\/p>\n

\u25aa Th\u1ec3 kh\u00f4ng tri\u1ec7u ch\u1ee9ng: \u0110a s\u1ed1 ng\u01b0\u1eddi b\u1ec7nh (\u0111\u1eb7c bi\u1ec7t l\u00e0 ng\u01b0\u1eddi l\u1edbn) kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng r\u00f5 r\u00e0ng ho\u1eb7c ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng m\u01a1 h\u1ed3.<\/p>\n

\u25aa Th\u1ec3 t\u1ed1i c\u1ea5p (\u00edt g\u1eb7p v\u1edbi t\u1ef7 l\u1ec7 < 1% \u1edf ng\u01b0\u1eddi l\u1edbn): Vi\u00eam gan B c\u1ea5p c\u00f3 th\u1ec3 di\u1ec5n ti\u1ebfn n\u1eb7ng sang th\u1ec3 t\u1ed1i c\u1ea5p v\u1edbi b\u1ec7nh c\u1ea3nh suy gan c\u1ea5p d\u1eabn \u0111\u1ebfn b\u1ec7nh n\u00e3o gan, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u nghi\u00eam tr\u1ecdng. Vi\u00eam gan B th\u1ec3 t\u1ed1i c\u1ea5p c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong r\u1ea5t cao (th\u01b0\u1eddng > 70%) n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi1,7<\/sup>.<\/p>\n

– C\u1eadn l\u00e2m s\u00e0ng:<\/p>\n

+ AST, ALT t\u0103ng, th\u01b0\u1eddng tr\u00ean 5 l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a m\u1ee9c b\u00ecnh th\u01b0\u1eddng (ULN, ULN \u0111\u1ed1i v\u1edbi ALT: 30 U\/L \u0111\u1ed1i v\u1edbi nam, 19 U\/L \u0111\u1ed1i v\u1edbi n\u1eef).<\/p>\n

+ Anti-HBc IgM d\u01b0\u01a1ng t\u00ednh, HBsAg d\u01b0\u01a1ng t\u00ednh (ho\u1eb7c \u00e2m t\u00ednh trong giai \u0111o\u1ea1n c\u1eeda s\u1ed5).<\/p>\n

+ C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c c\u00f3 th\u1ec3 thay \u0111\u1ed5i t\u00f9y th\u1ec3 l\u00e2m s\u00e0ng.<\/p>\n

3.2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/b><\/p>\n

– Vi\u00eam gan c\u1ea5p do vi r\u00fat kh\u00e1c (HAV, HCV, HDV, HEV,…).<\/p>\n

– \u0110\u1ee3t c\u1ea5p c\u1ee7a vi\u00eam gan B m\u1ea1n.<\/p>\n

– Vi\u00eam gan do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c t\u00f9y theo b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng.<\/p>\n

3.3. \u0110i\u1ec1u tr\u1ecb<\/b><\/p>\n

\u0110i\u1ec1u tr\u1ecb vi\u00eam gan B c\u1ea5p ch\u1ee7 y\u1ebfu l\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng.<\/p>\n

3.3.1. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng<\/b><\/p>\n

– Ngh\u1ec9 ng\u01a1i, tr\u00e1nh l\u00e0m vi\u1ec7c n\u1eb7ng ho\u1eb7c g\u1eafng s\u1ee9c trong th\u1eddi k\u1ef3 c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n

– Ch\u1ebf \u0111\u1ed9 dinh d\u01b0\u1ee1ng: gi\u1ea3m b\u1edbt ch\u1ea5t b\u00e9o, ki\u00eang r\u01b0\u1ee3u bia. Ch\u1ec9 nu\u00f4i d\u01b0\u1ee1ng t\u1ea1m th\u1eddi b\u1eb1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch khi b\u1ecb n\u00f4n nhi\u1ec1u ho\u1eb7c kh\u00f4ng \u0103n u\u1ed1ng \u0111\u01b0\u1ee3c.<\/p>\n

– Tr\u00e1nh s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c chuy\u1ec3n h\u00f3a qua gan.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb h\u1ed3i s\u1ee9c n\u1ed9i khoa t\u00edch c\u1ef1c c\u00e1c tr\u01b0\u1eddng h\u1ee3p di\u1ec5n ti\u1ebfn n\u1eb7ng.<\/p>\n

3.3.2. \u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u:<\/b><\/p>\n

– Ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c kh\u00e1ng vi r\u00fat: D\u00f9ng tenofovir disoproxil fumarate (TDF) ho\u1eb7c entecavir (ETV) ho\u1eb7c tenofovir alafenamid (TAF) cho \u0111\u1ebfn khi m\u1ea5t HBsAg sau 3 th\u00e1ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p sau8<\/sup>:<\/p>\n

+ Vi\u00eam gan B c\u1ea5p di\u1ec5n bi\u1ebfn n\u1eb7ng, x\u00e1c \u0111\u1ecbnh khi c\u00f3 \u00edt nh\u1ea5t 2 ti\u00eau ch\u00ed sau:<\/p>\n

\u25aa B\u1ec7nh n\u00e3o gan.<\/p>\n

\u25aa Bilirubin to\u00e0n ph\u1ea7n huy\u1ebft thanh > 3 mg\/dL hay > 51 \u00b5mol\/L (ho\u1eb7c bilirubin tr\u1ef1c ti\u1ebfp > 1,5 mg\/dL hay > 25 \u00b5mol\/L).<\/p>\n

\u25aa INR > 1,5<\/p>\n

+ B\u1ec7nh k\u00e9o d\u00e0i > 4 tu\u1ea7n v\u1edbi bilirubin c\u00f3 xu h\u01b0\u1edbng t\u0103ng.<\/p>\n

+ Ng\u01b0\u1eddi b\u1ec7nh suy gi\u1ea3m mi\u1ec5n d\u1ecbch ho\u1eb7c c\u00f3 b\u1ec7nh \u0111\u1ed3ng m\u1eafc nghi\u00eam tr\u1ecdng.<\/p>\n

– V\u1edbi vi\u00eam gan B th\u1ec3 t\u1ed1i c\u1ea5p c\u1ea7n h\u1ed9i ch\u1ea9n chuy\u00ean khoa \u0111\u1ec3 x\u00e9t ch\u1ec9 \u0111\u1ecbnh gh\u00e9p gan n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u0111i\u1ec1u ki\u1ec7n.<\/p>\n

3.4. Theo d\u00f5i<\/b><\/p>\n

3.4.1. L\u00e2m s\u00e0ng<\/b><\/p>\n

Theo d\u00f5i c\u00e1c tri\u1ec7u ch\u1ee9ng: v\u00e0ng da, v\u00e0ng m\u1eaft, r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a, xu\u1ea5t huy\u1ebft, ph\u00f9, c\u1ed5 tr\u01b0\u1edbng, r\u1ed1i lo\u1ea1n tri gi\u00e1c,\u2026<\/p>\n

3.4.2. C\u1eadn l\u00e2m s\u00e0ng<\/b><\/p>\n

B\u1ea3ng 2. X\u00e9t nghi\u1ec7m theo d\u00f5i ng\u01b0\u1eddi b\u1ec7nh vi\u00eam gan B c\u1ea5p3<\/sup><\/b><\/p>\n\n\n\n\n\n\n\n
\n

X\u00e9t nghi\u1ec7m<\/b><\/p>\n<\/td>\n

\n

T\u1ea7n su\u1ea5t<\/b><\/p>\n<\/td>\n

\n

M\u1ee5c \u0111\u00edch<\/b><\/p>\n<\/td>\n<\/tr>\n

\n

AST\/ALT<\/p>\n<\/td>\n

1\u22122 tu\u1ea7n\/l\u1ea7n cho \u0111\u1ebfn khi m\u1ee9c ALT gi\u1ea3m v\u1ec1 m\u1ee9c b\u00ecnh th\u01b0\u1eddng. Sau \u0111\u00f3, \u0111\u1ecbnh k\u1ef3 4\u221212 tu\u1ea7n\/l\u1ea7n trong v\u00f2ng \u00edt nh\u1ea5t 6 th\u00e1ng (ho\u1eb7c \u0111\u1ebfn khi HBsAg \u00e2m t\u00ednh).<\/td>\n\u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng v\u00e0 h\u1ed3i ph\u1ee5c c\u1ee7a t\u1ebf b\u00e0o gan.<\/td>\n<\/tr>\n
\n

INR (T\u1ec9 l\u1ec7 chu\u1ea9n h\u00f3a qu\u1ed1c t\u1ebf)\/ ho\u1eb7c t\u1ec9 l\u1ec7 PT v\u00e0 bilirubin (to\u00e0n ph\u1ea7n v\u00e0 tr\u1ef1c ti\u1ebfp)<\/p>\n<\/td>\n

1\u22122 tu\u1ea7n\/l\u1ea7n cho \u0111\u1ebfn khi c\u00e1c ch\u1ec9 s\u1ed1 tr\u1edf v\u1ec1 tr\u1ecb s\u1ed1 b\u00ecnh th\u01b0\u1eddng.<\/td>\n\u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng \u0111\u00f4ng m\u00e1u v\u00e0 ch\u1ee9c n\u0103ng th\u1ea3i bilirubin c\u1ee7a gan, \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng \u0111\u1ec3 lo\u1ea1i tr\u1eeb suy gan c\u1ea5p.<\/td>\n<\/tr>\n
\n

HBsAg v\u00e0 Anti-HBs<\/p>\n<\/td>\n

X\u00e9t nghi\u1ec7m t\u1ea1i th\u1eddi \u0111i\u1ec3m tu\u1ea7n th\u1ee9 12 v\u00e0 tu\u1ea7n th\u1ee9 24 (ho\u1eb7c 3 v\u00e0 6 th\u00e1ng sau kh\u1edfi ph\u00e1t b\u1ec7nh).<\/td>\nX\u00e1c \u0111\u1ecbnh qu\u00e1 tr\u00ecnh thanh th\u1ea3i vi r\u00fat v\u00e0 \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch.<\/td>\n<\/tr>\n
\n

T\u1ea3i l\u01b0\u1ee3ng HBV DNA<\/p>\n<\/td>\n

C\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u1ecbnh k\u1ef3 24 tu\u1ea7n\/l\u1ea7n n\u1ebfu nghi ng\u1edd ti\u1ebfn tri\u1ec3n th\u00e0nh m\u1ea1n.<\/td>\n\u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 nh\u00e2n l\u00ean c\u1ee7a vi r\u00fat.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

3.4.3. X\u00e1c \u0111\u1ecbnh h\u1ed3i ph\u1ee5c ho\u1eb7c chuy\u1ec3n m\u1ea1n<\/b><\/p>\n

– H\u1ed3i ph\u1ee5c: <\/i><\/b>x\u00e1c \u0111\u1ecbnh khi m\u1ea5t HBsAg (HBsAg \u00e2m t\u00ednh), c\u00f3 ho\u1eb7c kh\u00f4ng xu\u1ea5t hi\u1ec7n anti-HBs sau 6 th\u00e1ng k\u1ec3 t\u1eeb l\u00fac kh\u1edfi ph\u00e1t b\u1ec7nh. Sau h\u1ed3i ph\u1ee5c, ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n ki\u1ec3m tra sinh h\u00f3a gan h\u00e0ng n\u0103m. Tr\u01b0\u1eddng h\u1ee3p b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch ho\u1eb7c s\u1eed d\u1ee5ng h\u00f3a tr\u1ecb li\u1ec7u ung th\u01b0 ho\u1eb7c c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch c\u1ea7n x\u00e9t nghi\u1ec7m HBsAg, HBV DNA \u0111\u1ec3 theo d\u00f5i s\u1ef1 t\u00e1i ho\u1ea1t (xem th\u00eam b\u1ea3ng 1).<\/i><\/p>\n

– Chuy\u1ec3n m\u1ea1n<\/i><\/b>: khi HBsAg d\u01b0\u01a1ng t\u00ednh sau 6 th\u00e1ng k\u1ec3 t\u1eeb l\u00fac kh\u1edfi ph\u00e1t b\u1ec7nh (ho\u1eb7c t\u1eeb khi ch\u1ea9n \u0111o\u00e1n vi\u00eam gan B c\u1ea5p). Ng\u01b0\u1eddi b\u1ec7nh trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i v\u00e0 qu\u1ea3n l\u00fd nh\u01b0 ng\u01b0\u1eddi b\u1ec7nh vi\u00eam gan B m\u1ea1n (<\/i><\/b>xem ph\u1ea7n IV).<\/b><\/i><\/p>\n

IV. CH\u1ea8N \u0110O\u00c1N V\u00c0 \u0110I\u1ec0U TR\u1eca VI\u00caM GAN B M\u1ea0N<\/b><\/p>\n

4.1. Ch\u1ea9n \u0111o\u00e1n<\/b><\/p>\n

4.1.1. Ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m HBV m\u1ea1n<\/b><\/p>\n

Tr\u00ean l\u00e2m s\u00e0ng, nhi\u1ec5m HBV m\u1ea1n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh \u1edf ng\u01b0\u1eddi l\u1edbn, v\u00e0 HBsAg t\u1ed3n t\u1ea1i k\u00e9o d\u00e0i 6 th\u00e1ng tr\u1edf l\u00ean \u1edf v\u1ecb th\u00e0nh ni\u00ean v\u00e0 tr\u1ebb em1<\/sup>.<\/p>\n

4.1.2. \u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng vi\u00eam gan B m\u1ea1n<\/b><\/p>\n

T\u1ea5t c\u1ea3 ng\u01b0\u1eddi nhi\u1ec5m HBV m\u1ea1n c\u1ea7n \u0111\u01b0\u1ee3c k\u1ebft n\u1ed1i v\u1edbi c\u01a1 s\u1edf \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 \u0111\u01b0\u1ee3c qu\u1ea3n l\u00fd l\u00e2u d\u00e0i v\u00e0 \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng vi r\u00fat theo ch\u1ec9 \u0111\u1ecbnh c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t \u0111\u1ec3 ng\u0103n ng\u1eeba ti\u1ebfn tri\u1ec3n \u0111\u1ebfn c\u00e1c b\u1ec7nh l\u00fd gan giai \u0111o\u1ea1n cu\u1ed1i.<\/p>\n

Ng\u01b0\u1eddi nhi\u1ec5m HBV m\u1ea1n c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 v\u1ec1 l\u00e2m s\u00e0ng, th\u1ef1c hi\u1ec7n c\u00e1c x\u00e9t nghi\u1ec7m v\u00e0 th\u0103m d\u00f2 \u0111\u00e1nh gi\u00e1 giai \u0111o\u1ea1n b\u1ec7nh gan v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng (x\u01a1 gan, HCC), \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng nh\u00e2n l\u00ean c\u1ee7a vi r\u00fat \u0111\u1ec3 x\u00e9t ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng vi r\u00fat v\u00e0 theo d\u00f5i ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh c\u0169ng nh\u01b0 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb.<\/p>\n

a. L\u00e2m s\u00e0ng<\/i><\/b><\/p>\n

– Ph\u1ea7n l\u1edbn ng\u01b0\u1eddi nhi\u1ec5m HBV kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng cho \u0111\u1ebfn khi c\u00f3 bi\u1ec3u hi\u1ec7n b\u1ec7nh gan ti\u1ebfn tri\u1ec3n bao g\u1ed3m x\u01a1 gan ho\u1eb7c HCC.<\/p>\n

+ C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng kh\u00e1c c\u1ee7a b\u1ec7nh gan ti\u1ebfn tri\u1ec3n v\u00e0 x\u01a1 gan c\u00f3 th\u1ec3 bao g\u1ed3m: gan to, l\u00e1ch to, ng\u1ee9a, m\u1ec7t m\u1ecfi, \u0111au kh\u1edbp, ban \u0111\u1ecf l\u00f2ng b\u00e0n tay, sao m\u1ea1ch v\u00e0 ph\u00f9 n\u1ec1…<\/p>\n

+ C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7a x\u01a1 gan m\u1ea5t b\u00f9: t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda (c\u1ed5 tr\u01b0\u1edbng, xu\u1ea5t huy\u1ebft do v\u1ee1 gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n), b\u1ec7nh n\u00e3o gan, v\u00e0ng da.<\/p>\n

– C\u00f3 th\u1ec3 c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n ngo\u00e0i gan nh\u01b0: vi\u00eam c\u1ea7u th\u1eadn, vi\u00eam \u0111a kh\u1edbp, cryoglobulin m\u00e1u ho\u1eb7c vi\u00eam m\u1ea1ch.<\/p>\n

b. C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 giai \u0111o\u1ea1n b\u1ec7nh<\/i><\/b><\/p>\n

Bao g\u1ed3m c\u00e1c x\u00e9t nghi\u1ec7m sinh h\u00f3a gan, c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng vi r\u00fat, c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng x\u01a1 h\u00f3a gan v\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n s\u1edbm bi\u1ebfn ch\u1ee9ng<\/p>\n

– C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng gan v\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam gan<\/i>:<\/p>\n

+ X\u00e9t nghi\u1ec7m huy\u1ebft h\u1ecdc: c\u00f4ng th\u1ee9c m\u00e1u (s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u), th\u1eddi gian prothrombin, INR (thay \u0111\u1ed5i khi ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan)<\/p>\n

+ X\u00e9t nghi\u1ec7m sinh h\u00f3a gan:<\/p>\n

\u25aa ALT, AST c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c t\u0103ng (Gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a m\u1ee9c b\u00ecnh th\u01b0\u1eddng \u0111\u1ed1i v\u1edbi ALT \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 30 U\/L \u0111\u1ed1i v\u1edbi nam v\u00e0 19 U\/L \u0111\u1ed1i v\u1edbi n\u1eef);<\/p>\n

\u25aa Bilirubin to\u00e0n ph\u1ea7n v\u00e0 tr\u1ef1c ti\u1ebfp;<\/p>\n

\u25aa Albumin m\u00e1u.<\/p>\n

– C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng vi r\u00fat (xem th\u00eam ph\u1ee5 l\u1ee5c 1):<\/i><\/p>\n

+ X\u00e9t nghi\u1ec7m \u0111o t\u1ea3i l\u01b0\u1ee3ng HBV DNA t\u1ea1i ph\u00f2ng x\u00e9t nghi\u1ec7m (laboratory-based) ho\u1eb7c tr\u00ean h\u1ec7 th\u1ed1ng x\u00e9t nghi\u1ec7m t\u1ea1i \u0111i\u1ec3m ch\u0103m s\u00f3c (point-of-care).<\/p>\n

+ XN huy\u1ebft thanh h\u1ecdc:<\/p>\n

\u25aa HBeAg\/anti HBe: gi\u00fap \u0111\u00e1nh gi\u00e1 giai \u0111o\u1ea1n b\u1ec7nh;<\/p>\n

\u25aa Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 \u0111i\u1ec1u ki\u1ec7n c\u00f3 th\u1ec3 x\u00e9t nghi\u1ec7m qHBsAg, HBcrAg: gi\u00fap ph\u00e2n t\u1ea7ng nguy c\u01a1 \u0111\u1ec3 theo d\u00f5i v\u00e0 ti\u00ean l\u01b0\u1ee3ng \u0111i\u1ec1u tr\u1ecb.<\/p>\n

– C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng x\u01a1 h\u00f3a gan, x\u01a1 gan<\/i>: (xem Ph\u1ee5 l\u1ee5c 2)<\/i>.<\/p>\n

+ \u0110\u00e1nh gi\u00e1 b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng x\u00e2m l\u1ea5n nh\u01b0 \u00e1p d\u1ee5ng c\u00e1c ch\u1ec9 s\u1ed1 APRI, M2BPGi, FIB-4, FibroTest \u2026 hay si\u00eau \u00e2m \u0111\u1ed9 \u0111\u00e0n h\u1ed3i gan (\u0111o \u0111\u1ed9 \u0111\u00e0n h\u1ed3i gan tho\u00e1ng qua, si\u00eau \u00e2m \u0111\u00e0n h\u1ed3i \u0111i\u1ec3m, si\u00eau \u00e2m \u0111\u00e0n h\u1ed3i 2D hay MRE\u2026).<\/p>\n

\u25aa B\u1eb1ng ch\u1ee9ng x\u01a1 h\u00f3a gan \u0111\u00e1ng k\u1ec3 (\u2265 F2): v\u00ed d\u1ee5 APRI > 0,5 ho\u1eb7c FibroScan >7 kPa.<\/p>\n

\u25aa Ch\u1ea9n \u0111o\u00e1n x\u01a1 gan d\u1ef1a v\u00e0o tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0\/ho\u1eb7c k\u1ebft qu\u1ea3 \u0111\u00e1nh gi\u00e1 x\u01a1 h\u00f3a gan l\u00e0 F4: v\u00ed d\u1ee5 APRI > 1 ho\u1eb7c FibroScan >12,5 kPa.<\/p>\n

+ \u0110\u00e1nh gi\u00e1 x\u01a1 gan c\u00f2n b\u00f9 ho\u1eb7c m\u1ea5t b\u00f9 d\u1ef1a v\u00e0o ph\u00e2n lo\u1ea1i Child-Pugh: Child-Pugh A l\u00e0 x\u01a1 gan c\u00f2n b\u00f9; Child-Pugh B, C l\u00e0 x\u01a1 gan m\u1ea5t b\u00f9.<\/p>\n

– C\u00e1c x\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n s\u1edbm bi\u1ebfn ch\u1ee9ng:<\/i><\/p>\n

+ Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan: X\u00e9t nghi\u1ec7m c\u00e1c ch\u1ec9 d\u1ea5u ung th\u01b0 gan nh\u01b0 AFP, PIVKA II, AFP-L3 v\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh nh\u01b0 si\u00eau \u00e2m \u1ed5 b\u1ee5ng, ch\u1ee5p c\u1eaft l\u1edbp gan m\u1eadt v\u00e0 c\u1ed9ng h\u01b0\u1edfng t\u1eeb gan m\u1eadt. Tr\u01b0\u1eddng h\u1ee3p c\u00f3 ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan: c\u00e1c ch\u1ec9 d\u1ea5u ung th\u01b0 gan c\u00f3 th\u1ec3 t\u0103ng; si\u00eau \u00e2m, ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh, c\u1ed9ng h\u01b0\u1edfng t\u1eeb v\u00f9ng b\u1ee5ng c\u00f3 h\u00ecnh \u1ea3nh kh\u1ed1i u gan.<\/p>\n

+ X\u01a1 gan: n\u1ed9i soi th\u1ef1c qu\u1ea3n-d\u1ea1 d\u00e0y \u0111\u1ec3 ph\u00e1t hi\u1ec7n gi\u00e3n t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n.<\/p>\n

c. C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc:<\/i><\/b><\/p>\n

– C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 b\u1ec7nh th\u1eadn, b\u1ec7nh \u0111\u1ed3ng nhi\u1ec5m (HIV, HCV, HDV, HEV), b\u1ec7nh \u0111\u1ed3ng m\u1eafc (b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, b\u1ec7nh gan nhi\u1ec5m m\u1ee1 li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a\u2026).<\/p>\n

– C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c theo ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng.<\/p>\n

4.2. \u0110i\u1ec1u tr\u1ecb<\/b><\/p>\n

4.2.1. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n

– \u1ee8c ch\u1ebf l\u00e2u d\u00e0i s\u1ef1 sao ch\u00e9p c\u1ee7a HBV.<\/p>\n

– C\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng, ng\u0103n ng\u1eeba di\u1ec5n ti\u1ebfn x\u01a1 gan, HCC.<\/p>\n

– D\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n HBV cho c\u1ed9ng \u0111\u1ed3ng bao g\u1ed3m d\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n m\u1eb9 con.<\/p>\n

– D\u1ef1 ph\u00f2ng \u0111\u1ee3t b\u00f9ng ph\u00e1t vi\u00eam gan B v\u00e0 vi\u00eam gan B t\u00e1i ho\u1ea1t.<\/p>\n

4.2.2. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n

– L\u1ef1a ch\u1ecdn ban \u0111\u1ea7u l\u00e0 c\u00e1c thu\u1ed1c u\u1ed1ng nucleot(s)ide analogues (NAs) \u0111\u01a1n tr\u1ecb li\u1ec7u (xem b\u1ea3ng 3<\/i>). Ch\u1ec9 n\u00ean d\u00f9ng c\u00e1c ph\u00e1c \u0111\u1ed3 c\u00f3 Peg-IFN \u0111\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb vi\u00eam gan B m\u1ea1n v\u1edbi NAs l\u00e0 \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i, c\u00f3 th\u1ec3 k\u00e9o d\u00e0i su\u1ed1t \u0111\u1eddi.<\/p>\n

– Tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 quy tr\u00ecnh t\u00e1i kh\u00e1m.<\/p>\n

4.2.3. \u0110i\u1ec1u tr\u1ecb<\/b><\/p>\n

a. Ti\u00eau chu\u1ea9n \u0111i\u1ec1u tr\u1ecb<\/i><\/b><\/p>\n

\u0110\u00e1nh gi\u00e1 ti\u00eau chu\u1ea9n \u0111i\u1ec1u tr\u1ecb d\u1ef1a v\u00e0o m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh gan qua \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 x\u01a1 h\u00f3a gan (APRI ho\u1eb7c \u0111\u1ed9 \u0111\u00e0n h\u1ed3i gan), t\u00ecnh tr\u1ea1ng x\u01a1 gan m\u1ea5t b\u00f9 (thang \u0111i\u1ec3m Child-Pugh), \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng, x\u00e9t nghi\u1ec7m AST\/ALT, t\u1ea3i l\u01b0\u1ee3ng HBV DNA, c\u00f4ng th\u1ee9c m\u00e1u (ti\u1ec3u c\u1ea7u) v\u00e0 ti\u1ec1n s\u1eed c\u00f3 b\u1ec7nh \u0111\u1ed3ng nhi\u1ec5m, b\u1ec7nh \u0111\u1ed3ng m\u1eafc, suy gi\u1ea3m mi\u1ec5n d\u1ecbch, bi\u1ec3u hi\u1ec7n ngo\u00e0i gan ho\u1eb7c ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi ung th\u01b0 gan ho\u1eb7c x\u01a1 gan.<\/p>\n\n\n\n\n
Ti\u00eau chu\u1ea9n \u0111i\u1ec1u tr\u1ecb cho ng\u01b0\u1eddi l\u1edbn, v\u1ecb th\u00e0nh ni\u00ean v\u00e0 tr\u1ebb \u2265 12 tu\u1ed5i<\/strong><\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho t\u1ea5t c\u1ea3 ng\u01b0\u1eddi l\u1edbn v\u00e0 thanh thi\u1ebfu ni\u00ean (\u226512 tu\u1ed5i) nhi\u1ec5m HBV m\u1ea1n v\u00e0 c\u00f3:<\/p>\n

– X\u01a1 h\u00f3a gan \u0111\u00e1ng k\u1ec3 (\u2265F2: v\u00ed d\u1ee5 APRI > 0,5, FibroScan > 7 kPa) ho\u1eb7c x\u01a1 gan (tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng x\u01a1 gan v\u00e0\/ho\u1eb7c x\u01a1 h\u00f3a F4: v\u00ed d\u1ee5 APRI > 1, FibroScan >12,5 kPa) (kh\u00f4ng ph\u1ee5 thu\u1ed9c t\u1ea3i l\u01b0\u1ee3ng HBV DNA ho\u1eb7c n\u1ed3ng \u0111\u1ed9 ALT).<\/p>\n

Ho\u1eb7c<\/i><\/b><\/p>\n

– T\u1ea3i l\u01b0\u1ee3ng HBV DNA > 2000 IU\/mL v\u00e0 ALT > gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a m\u1ee9c b\u00ecnh th\u01b0\u1eddng. \u0110\u1ed1i v\u1edbi v\u1ecb th\u00e0nh ni\u00ean ALT > gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a m\u1ee9c b\u00ecnh th\u01b0\u1eddng \u00edt nh\u1ea5t 2 l\u1ea7n trong 6-12 th\u00e1ng.<\/p>\n

Ho\u1eb7c<\/i><\/b><\/p>\n

– C\u00f3 b\u1ea5t k\u1ef3 y\u1ebfu t\u1ed1 n\u00e0o d\u01b0\u1edbi \u0111\u00e2y k\u00e8m t\u1ea3i l\u01b0\u1ee3ng HBV DNA tr\u00ean ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n (kh\u00f4ng ph\u1ee5 thu\u1ed9c m\u1ee9c ALT v\u00e0 \u0111\u1ed9 x\u01a1 h\u00f3a gan):<\/i><\/p>\n

+ B\u1ec7nh \u0111\u1ed3ng nhi\u1ec5m (HIV, HDV, HCV);<\/p>\n

+ B\u1ec7nh \u0111\u1ed3ng m\u1eafc (\u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, b\u1ec7nh gan nhi\u1ec5m m\u1ee1 li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a);<\/p>\n

+ Suy gi\u1ea3m mi\u1ec5n d\u1ecbch (\u0111i\u1ec1u tr\u1ecb steroid k\u00e9o d\u00e0i, gh\u00e9p t\u1ea1ng);<\/p>\n

+ Bi\u1ec3u hi\u1ec7n ngo\u00e0i gan (vi\u00eam c\u1ea7u th\u1eadn, vi\u00eam \u0111a kh\u1edbp ho\u1eb7c vi\u00eam m\u1ea1ch);<\/p>\n

+ Ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi ung th\u01b0 gan ho\u1eb7c x\u01a1 gan;<\/p>\n

+ T\u00e1i ph\u00e1t sau khi ng\u01b0ng \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng HBV.<\/p>\n

Ho\u1eb7c<\/i><\/b><\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c t\u1ea3i l\u01b0\u1ee3ng HBV DNA:<\/b><\/p>\n

Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb khi ALT > gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a m\u1ee9c b\u00ecnh th\u01b0\u1eddng k\u00e9o d\u00e0i trong 6- 12 th\u00e1ng, kh\u00f4ng ph\u1ee5 thu\u1ed9c \u0111\u1ed9 x\u01a1 h\u00f3a gan.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

b. Chu\u1ea9n b\u1ecb \u0111i\u1ec1u tr\u1ecb, cung c\u1ea5p th\u00f4ng tin v\u00e0 t\u01b0 v\u1ea5n h\u1ed7 tr\u1ee3<\/i><\/b><\/p>\n

– Chu\u1ea9n b\u1ecb \u0111i\u1ec1u tr\u1ecb<\/i><\/b><\/p>\n

+ Khai th\u00e1c th\u00f4ng tin v\u1ec1 th\u1eddi gian ph\u00e1t hi\u1ec7n nhi\u1ec5m HBV c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh, ti\u1ec1n s\u1eed \u0111\u00e3 t\u1eebng\/ch\u01b0a t\u1eebng \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng vi r\u00fat, ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi m\u1eafc x\u01a1 gan v\u00e0\/ho\u1eb7c ung th\u01b0 gan;<\/p>\n

+ \u0110\u00e1nh gi\u00e1 c\u00e1c bi\u1ec3u hi\u1ec7n ngo\u00e0i gan nh\u01b0 vi\u00eam m\u1ea1ch, vi\u00eam tuy\u1ebfn gi\u00e1p, vi\u00eam kh\u1edbp, vi\u00eam c\u1ea7u th\u1eadn;<\/p>\n

+ \u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn: X\u00e9t nghi\u1ec7m creatinine, \u0111\u00e1nh gi\u00e1 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 cao g\u00e2y r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c g\u00e2y \u0111\u1ed9c v\u1edbi th\u1eadn, tu\u1ed5i cao, nh\u1eb9 c\u00e2n (<50 kg), \u2026\u0111\u1ec3 l\u1ef1a ch\u1ecdn thu\u1ed1c \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i \u0111i\u1ec1u tr\u1ecb;<\/p>\n

+ \u0110\u00e1nh gi\u00e1 c\u00e1c b\u1ec7nh \u0111i k\u00e8m (HCV, HIV, HDV, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, b\u1ec7nh gan nhi\u1ec5m m\u1ee1 li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a\u2026) v\u00e0 c\u00e1c thu\u1ed1c \u0111ang s\u1eed d\u1ee5ng (c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch ho\u1eb7c h\u00f3a tr\u1ecb li\u1ec7u ung th\u01b0..).<\/p>\n

– Cung c\u1ea5p th\u00f4ng tin v\u00e0 t\u01b0 v\u1ea5n h\u1ed7 tr\u1ee3<\/i><\/b><\/p>\n

Vi\u1ec7c cung c\u1ea5p th\u00f4ng tin v\u00e0 t\u01b0 v\u1ea5n h\u1ed7 tr\u1ee3 cho ng\u01b0\u1eddi nhi\u1ec5m HBV c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ngay sau khi c\u00f3 ch\u1ea9n \u0111o\u00e1n, tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, v\u00e0 trong su\u1ed1t qu\u00e1 tr\u00ecnh qu\u1ea3n l\u00fd, \u0111i\u1ec1u tr\u1ecb b\u1ec7nh. N\u1ed9i dung cung c\u1ea5p th\u00f4ng tin, t\u01b0 v\u1ea5n c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh ph\u00f9 h\u1ee3p v\u1edbi t\u00ecnh tr\u1ea1ng b\u1ec7nh, m\u1ee9c \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb v\u00e0 m\u1ee9c \u0111\u1ed9 tu\u00e2n th\u1ee7 c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

+ Cung c\u1ea5p th\u00f4ng tin v\u1ec1 b\u1ec7nh v\u00e0 ti\u00ean l\u01b0\u1ee3ng:<\/i><\/p>\n

\u25cf Th\u00f4ng tin v\u1ec1 b\u1ec7nh v\u00e0 ti\u00ean l\u01b0\u1ee3ng.<\/p>\n

\u25cf Gi\u1ea3i th\u00edch r\u00f5 t\u00ecnh tr\u1ea1ng nhi\u1ec5m HBV hi\u1ec7n t\u1ea1i v\u00e0 di\u1ec5n ti\u1ebfn t\u1ef1 nhi\u00ean c\u1ee7a b\u1ec7nh.<\/p>\n

\u25cf Th\u00f4ng tin v\u1ec1 nguy c\u01a1 ti\u1ebfn tri\u1ec3n c\u1ee7a vi\u00eam gan B m\u1ea1n, bao g\u1ed3m x\u01a1 gan v\u00e0 ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan, k\u1ec3 c\u1ea3 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb (\u0111\u1eb7c bi\u1ec7t \u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 x\u01a1 h\u00f3a gan m\u1ee9c \u0111\u1ed9 F \u2265 3).<\/p>\n

\u25cf Tr\u00ecnh b\u00e0y k\u1ebf ho\u1ea1ch qu\u1ea3n l\u00fd v\u00e0 \u0111i\u1ec1u tr\u1ecb d\u00e0i h\u1ea1n.<\/p>\n

+ Cung c\u1ea5p th\u00f4ng tin v\u1ec1 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng vi r\u00fat v\u00e0 t\u01b0 v\u1ea5n v\u1ec1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb:<\/i><\/p>\n

\u25cf Gi\u1ea3i th\u00edch m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb, hi\u1ec7u qu\u1ea3 mong \u0111\u1ee3i v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb.<\/p>\n

\u25cf Cung c\u1ea5p th\u00f4ng tin v\u1ec1 thu\u1ed1c: lo\u1ea1i thu\u1ed1c, li\u1ec1u d\u00f9ng, c\u00e1ch s\u1eed d\u1ee5ng, c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n v\u00e0 c\u00e1ch x\u1eed tr\u00ed.<\/p>\n

\u25cf Nh\u1ea5n m\u1ea1nh t\u1ea7m quan tr\u1ecdng c\u1ee7a tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb; t\u01b0 v\u1ea5n c\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 tu\u00e2n th\u1ee7.<\/p>\n

\u25cf H\u01b0\u1edbng d\u1eabn l\u1ecbch t\u00e1i kh\u00e1m, x\u00e9t nghi\u1ec7m \u0111\u1ecbnh k\u1ef3 v\u00e0 theo d\u00f5i l\u00e2u d\u00e0i.<\/p>\n

+T\u01b0 v\u1ea5n s\u1ed1ng kh\u1ecfe m\u1ea1nh:<\/i><\/p>\n

\u25cf Duy tr\u00ec ch\u1ebf \u0111\u1ed9 dinh d\u01b0\u1ee1ng h\u1ee3p l\u00fd v\u00e0 c\u00e2n n\u1eb7ng ph\u00f9 h\u1ee3p.<\/p>\n

\u25cf Tr\u00e1nh ho\u1eb7c h\u1ea1n ch\u1ebf t\u1ed1i \u0111a s\u1eed d\u1ee5ng r\u01b0\u1ee3u, bia.<\/p>\n

\u25cf Th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c c\u00f3 nguy c\u01a1 g\u00e2y \u0111\u1ed9c cho gan (v\u00ed d\u1ee5: m\u1ed9t s\u1ed1 thu\u1ed1c gi\u1ea3m \u0111au\/h\u1ea1 s\u1ed1t nh\u01b0 Acetaminophen, thu\u1ed1c ch\u1ed1ng lao, thu\u1ed1c ch\u1ed1ng co gi\u1eadt, thu\u1ed1c th\u1ea3o d\u01b0\u1ee3c ho\u1eb7c th\u1ef1c ph\u1ea9m ch\u1ee9c n\u0103ng kh\u00f4ng r\u00f5 ngu\u1ed3n g\u1ed1c).<\/p>\n

\u25cf Th\u00f4ng b\u00e1o cho nh\u00e2n vi\u00ean y t\u1ebf v\u1ec1 t\u00ecnh tr\u1ea1ng nhi\u1ec5m HBV khi \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c, \u0111\u1eb7c bi\u1ec7t trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ea7n \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch ho\u1eb7c h\u00f3a tr\u1ecb li\u1ec7u.<\/p>\n

+ T\u01b0 v\u1ea5n v\u1ec1 ph\u00f2ng ng\u1eeba l\u00e2y nhi\u1ec5m:<\/i><\/p>\n

\u25cf Th\u00f4ng tin v\u1ec1 nguy c\u01a1 l\u00e2y truy\u1ec1n HBV cho ng\u01b0\u1eddi th\u00e2n v\u00e0 ng\u01b0\u1eddi ti\u1ebfp x\u00fac g\u1ea7n (bao g\u1ed3m b\u1ea1n t\u00ecnh v\u00e0 ng\u01b0\u1eddi s\u1eed d\u1ee5ng chung d\u1ee5ng c\u1ee5 ti\u00eam ch\u00edch).<\/p>\n

\u25cf Khuy\u1ebfn ngh\u1ecb x\u00e9t nghi\u1ec7m s\u00e0ng l\u1ecdc HBV cho c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 nguy c\u01a1.<\/p>\n

\u25cf H\u01b0\u1edbng d\u1eabn c\u00e1c bi\u1ec7n ph\u00e1p d\u1ef1 ph\u00f2ng l\u00e2y nhi\u1ec5m, bao g\u1ed3m s\u1eed d\u1ee5ng bao cao su, kh\u00f4ng d\u00f9ng chung v\u1eadt d\u1ee5ng c\u00e1 nh\u00e2n c\u00f3 nguy c\u01a1 ti\u1ebfp x\u00fac m\u00e1u (dao c\u1ea1o, b\u00e0n ch\u1ea3i \u0111\u00e1nh r\u0103ng), v\u00e0 ti\u00eam v\u1eafc xin ph\u00f2ng HBV cho ng\u01b0\u1eddi ch\u01b0a nhi\u1ec5m.<\/p>\n

4.2.4. Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n

B\u1ea3ng 3. C\u00e1c thu\u1ed1c kh\u00e1ng vi r\u00fat vi\u00eam gan B cho ng\u01b0\u1eddi \u2265 12 tu\u1ed5i1<\/sup><\/b><\/p>\n\n\n\n\n\n\n\n\n
\n

T\u00ean thu\u1ed1c<\/b><\/p>\n<\/td>\n

\n

Li\u1ec1u ng\u01b0\u1eddi l\u1edbn v\u00e0 l\u01b0u \u00fd<\/b><\/p>\n<\/td>\n

\n

T\u00e1c d\u1ee5ng ph\u1ee5<\/b><\/p>\n<\/td>\n<\/tr>\n

Tenofovir disoproxil fumarate 300 mg<\/p>\n

(TDF)<\/td>\n

– 300 mg\/ng\u00e0y<\/p>\n

– \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi c\u00f3 suy th\u1eadn: \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u theo m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn (Ph\u1ee5 l\u1ee5c 4)<\/i><\/td>\n

– B\u1ec7nh th\u1eadn, h\u1ed9i ch\u1ee9ng Fanconi, h\u1ed9i ch\u1ee9ng lo\u00e3ng x\u01b0\u01a1ng, nhi\u1ec5m toan lactic<\/p>\n

– Tr\u00e1nh d\u00f9ng cho ng\u01b0\u1eddi b\u1ec7nh c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn <50 ml\/ph\u00fat; ho\u1eb7c \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh lo\u00e3ng x\u01b0\u01a1ng; ho\u1eb7c ng\u01b0\u1eddi c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 cao g\u00e2y r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c g\u00e2y \u0111\u1ed9c v\u1edbi th\u1eadn, tu\u1ed5i cao, nh\u1eb9 c\u00e2n (<50 kg).<\/td>\n<\/tr>\n

Entecavir 0,5 mg, 1 mg<\/p>\n

(ETV)<\/td>\n

– 0,5 mg\/ng\u00e0y<\/p>\n

(1 mg\/ng\u00e0y n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh t\u1eebng s\u1eed d\u1ee5ng lamivudine ho\u1eb7c c\u00f3 x\u01a1 gan m\u1ea5t b\u00f9)<\/p>\n

– \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi c\u00f3 suy th\u1eadn: \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u theo m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn (Ph\u1ee5 l\u1ee5c 4)<\/i><\/td>\n

– Nhi\u1ec5m toan lactic.<\/p>\n

– Kh\u00f4ng d\u00f9ng cho ph\u1ee5 n\u1eef mang thai.<\/td>\n<\/tr>\n

Tenofovir alafenamide 25 mg<\/p>\n

(TAF)<\/td>\n

– 25 mg\/ng\u00e0y<\/p>\n

– Kh\u00f4ng c\u1ea7n gi\u1ea3m li\u1ec1u \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p suy th\u1eadn nh\u1eb9, v\u1eeba v\u00e0 n\u1eb7ng, ho\u1eb7c ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o.<\/td>\n

– C\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh cho ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan m\u1ea5t b\u00f9.<\/p>\n

– C\u00f3 th\u1ec3 g\u00e2y t\u0103ng c\u00e2n, t\u0103ng cholesterol, nhi\u1ec5m toan lactic.<\/p>\n

– Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh cho ng\u01b0\u1eddi b\u1ec7nh suy th\u1eadn c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn <15 ml\/ph\u00fat m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c l\u1ecdc m\u00e1u\/ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o.<\/td>\n<\/tr>\n

Thu\u1ed1c ph\u1ed1i h\u1ee3p:<\/p>\n

Tenofovir disoproxil fumarate 300 mg\/lamivudine 100 mg (TDF\/3TC)<\/p>\n

ho\u1eb7c<\/i><\/b><\/p>\n

Tenofovir disoproxil fumarate 300 mg\/ emtricitabine 200 mg (TDF\/FTC)<\/td>\n

– 1 vi\u00ean ph\u1ed1i h\u1ee3p\/ng\u00e0y<\/p>\n

– Ch\u1ec9 s\u1eed d\u1ee5ng khi kh\u00f4ng s\u1eb5n c\u00f3 TDF \u0111\u01a1n<\/td>\n

– B\u1ec7nh th\u1eadn, h\u1ed9i ch\u1ee9ng Fanconi, h\u1ed9i ch\u1ee9ng lo\u00e3ng x\u01b0\u01a1ng, nhi\u1ec5m toan lactic<\/td>\n<\/tr>\n
Peg-IFN-\u03b1-2a<\/td>\n– 180 \u00b5g\/tu\u1ea7n<\/p>\n

– C\u00f3 th\u1ec3 xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh cho ng\u01b0\u1eddi b\u1ec7nh mu\u1ed1n \u0111i\u1ec1u tr\u1ecb trong th\u1eddi gian ng\u1eafn h\u1ea1n; ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ed3ng nhi\u1ec5m HDV; ho\u1eb7c ng\u01b0\u1eddi b\u1ec7nh c\u00f3 t\u1ea3i l\u01b0\u1ee3ng vi r\u00fat th\u1ea5p v\u00e0 ALT t\u0103ng cao, kh\u00f4ng mu\u1ed1n \u0111i\u1ec1u tr\u1ecb d\u00e0i h\u1ea1n b\u1eb1ng NAs.<\/p>\n

– L\u01b0u \u00fd: c\u1ea7n t\u01b0 v\u1ea5n k\u1ef9 v\u1ec1 hi\u1ec7u qu\u1ea3 v\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 khi ch\u1ec9 \u0111\u1ecbnh ph\u00e1c \u0111\u1ed3 n\u00e0y<\/td>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng gi\u1ea3 c\u00fam, m\u1ec7t m\u1ecfi, r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n, gi\u1ea3m b\u1ea1ch c\u1ea7u, r\u1ed1i lo\u1ea1n mi\u1ec5n d\u1ecbch, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p, ch\u00e1n \u0103n v\u00e0 s\u1ee5t c\u00e2n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

4.2.5. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u00e0 ti\u00eau chu\u1ea9n ng\u1eebng \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n

a. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb<\/i><\/b><\/p>\n

– V\u1edbi thu\u1ed1c NAs<\/i><\/p>\n

+ Ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan, HCC: ph\u1ea3i \u0111i\u1ec1u tr\u1ecb su\u1ed1t \u0111\u1eddi.<\/p>\n

+ Ng\u01b0\u1eddi b\u1ec7nh ch\u01b0a x\u01a1 gan: \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i, c\u00f3 th\u1ec3 su\u1ed1t \u0111\u1eddi. Vi\u1ec7c ng\u01b0ng thu\u1ed1c kh\u00e1ng vi r\u00fat \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc khi ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ea1t c\u00e1c ti\u00eau chu\u1ea9n ng\u1eebng \u0111i\u1ec1u tr\u1ecb.<\/p>\n

– V\u1edbi thu\u1ed1c Peg-IFN<\/i><\/p>\n

+ Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb l\u00e0 48 tu\u1ea7n.<\/p>\n

b. Ti\u00eau chu\u1ea9n ng\u1eebng \u0111i\u1ec1u tr\u1ecb<\/i><\/b><\/p>\n

C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc ng\u1eebng \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng vi r\u00fat NAs n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ea1t c\u00e1c ti\u00eau chu\u1ea9n sau (c\u1ea7n gi\u1ea3i th\u00edch v\u00e0 t\u01b0 v\u1ea5n cho ng\u01b0\u1eddi b\u1ec7nh nguy c\u01a1 b\u00f9ng ph\u00e1t vi\u00eam gan B, b\u1ec7nh gan m\u1ea5t b\u00f9 v\u00e0 ung th\u01b0 gan sau khi ng\u01b0ng \u0111i\u1ec1u tr\u1ecb<\/i>):<\/p>\n

– Kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh gan ti\u1ebfn tri\u1ec3n (b\u1eb1ng ch\u1ee9ng tr\u00ean l\u00e2m s\u00e0ng, \u0111\u00e1nh gi\u00e1 kh\u00f4ng c\u00f3 x\u01a1 h\u00f3a gan ti\u1ebfn tri\u1ec3n (F3) ho\u1eb7c x\u01a1 gan (F4) v\u00e0:<\/p>\n

– C\u00f3 \u0111i\u1ec1u ki\u1ec7n theo d\u00f5i \u0111\u1ecbnh k\u1ef3 trong th\u1eddi gian d\u00e0i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng t\u00e1i ho\u1ea1t HBV sau khi ng\u01b0ng thu\u1ed1c.<\/p>\n

V\u00c0 c\u00f3 m\u1ed9t trong c\u00e1c ti\u00eau chu\u1ea9n d\u01b0\u1edbi \u0111\u00e2y:<\/b><\/p>\n

– T\u1ea3i l\u01b0\u1ee3ng HBV DNA d\u01b0\u1edbi ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n v\u00e0 m\u1ea5t HBsAg (c\u00f3 ho\u1eb7c kh\u00f4ng xu\u1ea5t hi\u1ec7n anti-HBs) t\u1ea1i 2 th\u1eddi \u0111i\u1ec3m c\u00e1ch nhau 6 th\u00e1ng;<\/p>\n

– Ng\u01b0\u1eddi vi\u00eam gan B m\u1ea1n HBeAg d\u01b0\u01a1ng t\u00ednh: c\u00f3 th\u1ec3 ng\u01b0ng \u0111i\u1ec1u tr\u1ecb sau khi \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb th\u00eam 12 th\u00e1ng k\u1ec3 t\u1eeb khi c\u00f3 chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh HBeAg (HBeAg \u00e2m t\u00ednh, anti-HBe d\u01b0\u01a1ng t\u00ednh v\u00e0 t\u1ea3i l\u01b0\u1ee3ng HBV DNA d\u01b0\u1edbi ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n);<\/p>\n

– Ng\u01b0\u1eddi vi\u00eam gan B m\u1ea1n HBeAg \u00e2m t\u00ednh: c\u00f3 th\u1ec3 ng\u01b0ng \u0111i\u1ec1u tr\u1ecb khi t\u1ea3i l\u01b0\u1ee3ng HBV DNA d\u01b0\u1edbi ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n \u00edt nh\u1ea5t 3- 4 n\u0103m v\u00e0 m\u1ee9c HBsAg \u0111\u1ecbnh l\u01b0\u1ee3ng th\u1ea5p (<100 IU\/ml);<\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng th\u1ec3 \u0111o t\u1ea3i l\u01b0\u1ee3ng HBV DNA, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc ng\u01b0ng thu\u1ed1c kh\u00e1ng vi r\u00fat khi m\u1ea5t HBsAg k\u00e9o d\u00e0i \u00edt nh\u1ea5t t\u1ea1i 2 th\u1eddi \u0111i\u1ec3m c\u00e1ch nhau 6 th\u00e1ng tr\u01b0\u1edbc khi ng\u01b0ng \u0111i\u1ec1u tr\u1ecb (kh\u00f4ng ph\u1ee5 thu\u1ed9c t\u00ecnh tr\u1ea1ng HBeAg);<\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p c\u00f3 \u0111i\u1ec1u ki\u1ec7n x\u00e9t nghi\u1ec7m \u0111\u01b0\u1ee3c HBcrAg: ng\u1eebng \u0111i\u1ec1u tr\u1ecb n\u1ebfu HBcrAg < 2 logU\/mL v\u00e0 t\u1ea3i l\u01b0\u1ee3ng HBV DNA d\u01b0\u1edbi ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n.<\/p>\n

Tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi b\u1ec7nh suy gi\u1ea3m mi\u1ec5n d\u1ecbch ho\u1eb7c \u0111i\u1ec1u tr\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch kh\u00f4ng khuy\u1ebfn c\u00e1o ng\u1eebng thu\u1ed1c kh\u00e1ng vi r\u00fat do c\u00f3 nguy c\u01a1 cao b\u1ecb vi\u00eam gan B t\u00e1i ho\u1ea1t, vi\u1ec7c ng\u1eebng thu\u1ed1c ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1edfi b\u00e1c s\u0129 chuy\u00ean khoa.<\/p>\n

Theo d\u00f5i ng\u01b0\u1eddi b\u1ec7nh h\u00e0ng th\u00e1ng sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb trong 6 th\u00e1ng \u0111\u1ea7u, v\u00e0 sau \u0111\u00f3 12 tu\u1ea7n\/l\u1ea7n trong 1- 2 n\u0103m ti\u1ebfp theo b\u1eb1ng x\u00e9t nghi\u1ec7m ALT v\u00e0 t\u1ea3i l\u01b0\u1ee3ng HBV DNA. T\u00e1i ho\u1ea1t vi r\u00fat khi t\u1ea3i l\u01b0\u1ee3ng HBV DNA \u2265 2000 IU\/ml. \u0110i\u1ec1u tr\u1ecb l\u1ea1i khi t\u1ea3i l\u01b0\u1ee3ng HBV DNA > 10.000 IU\/ml kh\u00f4ng ph\u1ee5 thu\u1ed9c m\u1ee9c ALT. (Xem <\/a>ph\u1ea7n 4.4)<\/i><\/p>\n

4.2.6. \u0110i\u1ec1u tr\u1ecb c\u00e1c qu\u1ea7n th\u1ec3 \u0111\u1eb7c bi\u1ec7t<\/b><\/p>\n

a. \u0110\u1ed3ng nhi\u1ec5m HBV\/HCV9<\/sup><\/i><\/b><\/p>\n

X\u00e9t nghi\u1ec7m anti-HCV cho t\u1ea5t c\u1ea3 ng\u01b0\u1eddi nhi\u1ec5m HBV. N\u1ebfu anti-HCV d\u01b0\u01a1ng t\u00ednh, ti\u1ebfn h\u00e0nh x\u00e9t nghi\u1ec7m t\u1ea3i l\u01b0\u1ee3ng HCV RNA ho\u1eb7c kh\u00e1ng nguy\u00ean HCVcAg \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n vi\u00eam gan C.<\/p>\n

Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb vi\u00eam gan C khi ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n vi\u00eam gan C m\u1ea1n.<\/p>\n

C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ed3ng nhi\u1ec5m HBV\/HCV c\u1ea7n ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B b\u1eb1ng thu\u1ed1c kh\u00e1ng vi r\u00fat NAs, kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c t\u1ea3i l\u01b0\u1ee3ng HBV DNA, ALT v\u00e0 \u0111\u1ed9 x\u01a1 h\u00f3a gan (xem <\/a>ph\u1ea7n 4.2.3).<\/i><\/p>\n

Nguy c\u01a1 t\u00e1i ho\u1ea1t HBV \u1edf ng\u01b0\u1eddi b\u1ecb vi\u00eam gan C c\u00f3 HBsAg \u00e2m t\u00ednh, anti-HBs \u00e2m t\u00ednh nh\u01b0ng anti-HBc d\u01b0\u01a1ng t\u00ednh r\u1ea5t th\u1ea5p trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb thu\u1ed1c DAA. Nh\u1eefng ng\u01b0\u1eddi n\u00e0y kh\u00f4ng \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng b\u1eb1ng NAs, nh\u01b0ng c\u1ea7n theo d\u00f5i ALT, AST \u0111\u1ecbnh k\u1ef3 4 – 8 tu\u1ea7n\/l\u1ea7n trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb thu\u1ed1c DAA v\u00e0 trong 12 tu\u1ea7n sau khi ho\u00e0n th\u00e0nh \u0111i\u1ec1u tr\u1ecb DAA. N\u1ebfu ALT\/AST t\u0103ng, ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m HBsAg v\u00e0 t\u1ea3i l\u01b0\u1ee3ng HBV DNA \u0111\u1ec3 ph\u00e1t hi\u1ec7n vi\u00eam gan B t\u00e1i ho\u1ea1t. \u0110i\u1ec1u tr\u1ecb NAs n\u1ebfu c\u00f3 b\u1eb1ng ch\u1ee9ng vi\u00eam gan B t\u00e1i ho\u1ea1t (HBsAg d\u01b0\u01a1ng t\u00ednh v\u00e0\/ho\u1eb7c HBV DNA ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c).<\/p>\n

b. \u0110\u1ed3ng nhi\u1ec5m HBV\/HIV1<\/sup><\/i><\/b><\/p>\n

C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ed3ng nhi\u1ec5m HBV\/HIV n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng HIV (ARV) v\u1edbi ph\u00e1c \u0111\u1ed3 c\u00f3 TDF ho\u1eb7c TAF1<\/sup>.<\/p>\n

N\u1ebfu ph\u1ea3i chuy\u1ec3n ph\u00e1c \u0111\u1ed3 c\u00f3 TDF ho\u1eb7c TAF sang ph\u00e1c \u0111\u1ed3 kh\u00e1c do kh\u00e1ng thu\u1ed1c th\u00ec khi chuy\u1ec3n ph\u00e1c \u0111\u1ed3 v\u1eabn ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng TDF ho\u1eb7c TAF.<\/p>\n

N\u1ebfu kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c TDF do ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh (suy ch\u1ee9c n\u0103ng th\u1eadn ho\u1eb7c c\u00f3 lo\u00e3ng x\u01b0\u01a1ng): thay th\u1ebf TDF b\u1eb1ng TAF \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u1ed3ng th\u1eddi c\u1ea3 vi\u00eam gan B v\u00e0 HIV ho\u1eb7c ch\u1ec9 \u0111\u1ecbnh d\u00f9ng ETV \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B.<\/p>\n

c. \u0110\u1ed3ng nhi\u1ec5m HBV\/HDV<\/i><\/b><\/p>\n

Ch\u1ea9n \u0111o\u00e1n vi\u00eam gan D: X\u00e9t nghi\u1ec7m anti-HDV total cho t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh (n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n). N\u1ebfu c\u00f3 anti-HDV d\u01b0\u01a1ng t\u00ednh, x\u00e9t nghi\u1ec7m t\u1ea3i l\u01b0\u1ee3ng HDV RNA. N\u1ebfu HDV RNA d\u01b0\u01a1ng t\u00ednh ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m HDV ho\u1ea1t \u0111\u1ed9ng.<\/p>\n

\u0110i\u1ec1u tr\u1ecb vi\u00eam gan D (khi t\u1ea3i l\u01b0\u1ee3ng HDV RNA cao v\u00e0 n\u1ed3ng \u0111\u1ed9 ALT t\u0103ng): \u0111i\u1ec1u tr\u1ecb Peg-IFN\u03b1180 \u00b5g\/tu\u1ea7n x 48 tu\u1ea7n (ho\u1eb7c c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb thay th\u1ebf \u0111\u01b0\u1ee3c B\u1ed9 Y t\u1ebf c\u1ea5p ph\u00e9p). X\u00e9t nghi\u1ec7m HDV RNA sau \u0111i\u1ec1u tr\u1ecb n\u1ebfu ALT t\u0103ng \u0111\u1ec3 theo d\u00f5i s\u1ef1 t\u00e1i ph\u00e1t HDV.<\/p>\n

\u0110i\u1ec1u tr\u1ecb vi\u00eam gan B: Ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ed3ng nhi\u1ec5m HBV\/HDV c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb kh\u00e1ng vi r\u00fat vi\u00eam gan B m\u00e0 kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c t\u1ea3i l\u01b0\u1ee3ng HBV DNA, ALT v\u00e0 \u0111\u1ed9 x\u01a1 h\u00f3a gan (xem <\/a>ph\u1ea7n 4.2.3).<\/i><\/p>\n

d. Ph\u1ee5 n\u1eef mang thai 11<\/sup><\/i><\/b><\/p>\n

– \u0110\u1ed1i v\u1edbi ph\u1ee5 n\u1eef mang thai c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh v\u00e0 ch\u01b0a \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng vi r\u00fat, c\u1ea7n \u0111\u00e1nh gi\u00e1 c\u00e1c ti\u00eau chu\u1ea9n \u0111i\u1ec1u tr\u1ecb (xem ph\u1ea7n ph\u1ee5 l\u1ee5c 6):<\/i><\/p>\n

+ N\u1ebfu \u0111\u1ee7 ti\u00eau chu\u1ea9n: \u0111i\u1ec1u tr\u1ecb b\u1eb1ng TDF ho\u1eb7c TAF;<\/p>\n

+ N\u1ebfu ch\u01b0a \u0111\u1ee7 ti\u00eau chu\u1ea9n: \u0110i\u1ec1u tr\u1ecb TDF ho\u1eb7c TAF \u0111\u1ec3 d\u1ef1 ph\u00f2ng l\u00e2y nhi\u1ec5m HBV t\u1eeb m\u1eb9 sang con. (Xem Quy\u1ebft \u0111\u1ecbnh s\u1ed1 678\/Q\u0110-BYT ng\u00e0y 26\/02\/2025 c\u1ee7a B\u1ed9 Y t\u1ebf v\u1ec1 vi\u1ec7c ban h\u00e0nh H\u01b0\u1edbng d\u1eabn k\u1ef9 thu\u1eadt c\u00e1c can thi\u1ec7p d\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n HIV, vi\u00eam gan B v\u00e0 giang mai t\u1eeb m\u1eb9 sang con.<\/i><\/p>\n

– \u0110\u1ed1i v\u1edbi ph\u1ee5 n\u1eef \u0111ang \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B m\u1ea1n v\u00e0 mu\u1ed1n c\u00f3 thai, ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng TDF ho\u1eb7c TAF. N\u1ebfu \u0111ang \u0111i\u1ec1u tr\u1ecb ETV, chuy\u1ec3n sang TDF ho\u1eb7c TAF tr\u01b0\u1edbc khi d\u1ef1 ki\u1ebfn c\u00f3 thai \u00edt nh\u1ea5t 2 th\u00e1ng.<\/p>\n

– \u0110\u1ed1i v\u1edbi ph\u1ee5 n\u1eef m\u1edbi ph\u00e1t hi\u1ec7n c\u00f3 thai trong khi \u0111ang \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng vi r\u00fat, ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb TDF ho\u1eb7c TAF, ho\u1eb7c chuy\u1ec3n sang TDF ho\u1eb7c TAF n\u1ebfu \u0111ang \u0111i\u1ec1u tr\u1ecb ETV.<\/p>\n

e. Tr\u1ebb em 2-11 tu\u1ed5i<\/i><\/b><\/p>\n

Ti\u00eau chu\u1ea9n \u0111i\u1ec1u tr\u1ecb cho tr\u1ebb 2-11 tu\u1ed5i1<\/sup><\/b>:<\/p>\n

Hi\u1ec7n ch\u01b0a c\u00f3 \u0111\u1ea7y \u0111\u1ee7 b\u1eb1ng ch\u1ee9ng \u0111\u1ec3 \u00e1p d\u1ee5ng ti\u00eau chu\u1ea9n \u0111i\u1ec1u tr\u1ecb c\u1ee7a ng\u01b0\u1eddi l\u1edbn v\u00e0 v\u1ecb th\u00e0nh ni\u00ean cho tr\u1ebb em d\u01b0\u1edbi 12 tu\u1ed5i. V\u00ec th\u1ebf ch\u1ec9 \u0111i\u1ec1u tr\u1ecb cho tr\u1ebb 2-11 tu\u1ed5i khi c\u00f3 m\u1ed9t trong c\u00e1c bi\u1ec3u hi\u1ec7n sau \u0111\u00e2y:<\/p>\n

– C\u00f3 b\u00f9ng ph\u00e1t vi\u00eam gan dai d\u1eb3ng (\u00edt nh\u1ea5t 2 l\u1ea7n \u0111\u00e1nh gi\u00e1 trong v\u00f2ng 6 th\u00e1ng) v\u00e0 c\u00f3 HBV DNA >2000 IU\/mL;<\/p>\n

– X\u01a1 gan ho\u1eb7c x\u01a1 h\u00f3a gan ti\u1ebfn tri\u1ec3n (\u2265F2);<\/p>\n

– C\u00e1c b\u1ec7nh \u0111\u1ed3ng nhi\u1ec5m, \u0111\u1ed3ng m\u1eafc c\u00f3 nguy c\u01a1 l\u00e0m t\u0103ng ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh gan;<\/p>\n

– C\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch ho\u1eb7c h\u00f3a tr\u1ecb li\u1ec7u.<\/p>\n

Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B m\u1ea1n \u1edf tr\u1ebb em c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t c\u1ea9n th\u1eadn v\u00e0 lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y t\u1ed5n th\u01b0\u01a1ng gan, bao g\u1ed3m c\u00e1c b\u1ec7nh gan di truy\u1ec1n (v\u00ed d\u1ee5 b\u1ec7nh Wilson…).<\/p>\n

Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb \u1edf tr\u1ebb < 2 tu\u1ed5i.<\/p>\n

B\u1ea3ng 4. C\u00e1c thu\u1ed1c kh\u00e1ng vi r\u00fat vi\u00eam gan B cho tr\u1ebb 2-11 tu\u1ed5i1<\/sup><\/b><\/p>\n\n\n\n\n\n\n\n
\n

T\u00ean thu\u1ed1c<\/strong><\/p>\n<\/td>\n

\n

Li\u1ec1u tr\u1ebb em<\/strong><\/p>\n<\/td>\n

\n

T\u00e1c d\u1ee5ng ph\u1ee5<\/strong><\/p>\n<\/td>\n<\/tr>\n

Entecavir 0,5 mg, 1 mg<\/p>\n

(ETV)<\/td>\n

Tr\u1ebb \u2265 2 tu\u1ed5i: t\u00ednh li\u1ec1u theo c\u00e2n n\u1eb7ng: 0,015 mg\/kg m\u1ed7i ng\u00e0y (cao nh\u1ea5t 0,5 mg\/ng\u00e0y)<\/td>\nNhi\u1ec5m toan lactic.<\/td>\n<\/tr>\n
Tenofovir disoproxil fumarate 300 mg<\/p>\n

(TDF)<\/td>\n

TDF g\u00f3i: 8mg\/kg\/ng\u00e0y (t\u1ed1i \u0111a 300 mg\/ng\u00e0y) cho tr\u1ebb \u2265 2 tu\u1ed5i1<\/sup><\/td>\nB\u1ec7nh th\u1eadn, h\u1ed9i ch\u1ee9ng Fanconi, h\u1ed9i ch\u1ee9ng lo\u00e3ng x\u01b0\u01a1ng, nhi\u1ec5m toan lactic.<\/p>\n

Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh cho tr\u1ebb c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn <50 ml\/ph\u00fat; ho\u1eb7c \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh lo\u00e3ng x\u01b0\u01a1ng.<\/td>\n<\/tr>\n

Tenofovir alafenamide 25 mg<\/p>\n

(TAF)<\/td>\n

d\u00f9ng 25 mg\/ng\u00e0y v\u1edbi tr\u1ebb \u2265 6 tu\u1ed5i v\u00e0 c\u00f3 c\u00e2n n\u1eb7ng \u2265 25kg;1<\/sup><\/td>\nT\u0103ng c\u00e2n, t\u0103ng cholesterol, nhi\u1ec5m toan lactic.<\/p>\n

Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh cho tr\u1ebb suy th\u1eadn c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn <15 ml\/ph\u00fat m\u00e0 kh\u00f4ng l\u1ecdc m\u00e1u\/ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o.<\/td>\n<\/tr>\n

IFN-\u03b1-2b<\/td>\nTr\u1ebb \u2265 2 tu\u1ed5i: 6 tri\u1ec7u \u0111\u01a1n v\u1ecb\/m2<\/sup> x 3 l\u1ea7n\/tu\u1ea7n<\/td>\nC\u00e1c tri\u1ec7u ch\u1ee9ng gi\u1ea3 c\u00fam, m\u1ec7t m\u1ecfi, r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n, gi\u1ea3m b\u1ea1ch c\u1ea7u, ch\u00e1n \u0103n v\u00e0 s\u1ee5t c\u00e2n.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

g. Ng\u01b0\u1eddi b\u1ec7nh b\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan<\/i><\/b><\/p>\n

\u0110i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i b\u1eb1ng ETV ho\u1eb7c TDF ho\u1eb7c TAF ngay tr\u01b0\u1edbc, trong v\u00e0 sau khi \u0111i\u1ec1u tr\u1ecb HCC.<\/p>\n

h. Ng\u01b0\u1eddi b\u1ec7nh d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, h\u00f3a tr\u1ecb li\u1ec7u ung th\u01b0, gh\u00e9p t\u1ea1ng12<\/sup><\/i><\/b><\/p>\n

– C\u00e1c tr\u01b0\u1eddng h\u1ee3p chu\u1ea9n b\u1ecb gh\u00e9p t\u1ea1ng, d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, h\u00f3a tr\u1ecb li\u1ec7u ung th\u01b0 ph\u1ea3i l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n nhi\u1ec5m HBV g\u1ed3m HBsAg, anti- HBc, t\u1ea3i l\u01b0\u1ee3ng HBV DNA. (ph\u1ee5 l\u1ee5c 3).<\/i><\/p>\n

– C\u00e1c tr\u01b0\u1eddng h\u1ee3p d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, h\u00f3a tr\u1ecb li\u1ec7u ung th\u01b0: \u0110i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng b\u1eb1ng thu\u1ed1c kh\u00e1ng vi r\u00fat kh\u1edfi \u0111\u1ea7u c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t, tr\u01b0\u1edbc 2 tu\u1ea7n ho\u1eb7c mu\u1ed9n nh\u1ea5t l\u00e0 c\u00f9ng l\u00fac v\u1edbi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch hay h\u00f3a tr\u1ecb li\u1ec7u ung th\u01b0, ti\u1ebfp t\u1ee5c duy tr\u00ec 6 – 12 th\u00e1ng (t\u00f9y tr\u01b0\u1eddng h\u1ee3p) sau khi ng\u01b0ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch v\u00e0 h\u00f3a tr\u1ecb li\u1ec7u (ph\u1ee5 l\u1ee5c 3). <\/i>Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng t\u00e1i ho\u1ea1t HBV g\u1ed3m TDF ho\u1eb7c TAF ho\u1eb7c ETV.<\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p gh\u00e9p t\u1ea1ng: d\u1ef1 ph\u00f2ng theo ch\u1ec9 \u0111\u1ecbnh gh\u00e9p t\u1ea1ng.<\/p>\n

i. \u0110\u1ee3t b\u00f9ng ph\u00e1t c\u1ee7a vi\u00eam gan B m\u1ea1n12<\/sup><\/i><\/b><\/p>\n

– Ch\u1ea9n \u0111o\u00e1n \u0111\u1ee3t b\u00f9ng ph\u00e1t vi\u00eam gan B m\u1ea1n khi \u0111\u1ed9t ng\u1ed9t t\u0103ng ALT > 3 l\u1ea7n m\u1ee9c t\u0103ng ban \u0111\u1ea7u ho\u1eb7c > 5 l\u1ea7n ULN kh\u00f4ng do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c nh\u01b0 r\u01b0\u1ee3u, thu\u1ed1c\u2026\u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh. L\u01b0u \u00fd t\u1ea3i l\u01b0\u1ee3ng HBV DNA c\u00f3 th\u1ec3 kh\u00f4ng t\u0103ng th\u1eadm ch\u00ed c\u00f3 th\u1ec3 gi\u1ea3m so v\u1edbi tr\u01b0\u1edbc.<\/p>\n

– Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a \u0111\u1ee3t b\u00f9ng ph\u00e1t vi\u00eam gan B m\u1ea1n r\u1ea5t \u0111a d\u1ea1ng, c\u00f3 th\u1ec3 t\u1eeb kh\u00f4ng tri\u1ec7u ch\u1ee9ng cho \u0111\u1ebfn c\u00f3 tri\u1ec7u ch\u1ee9ng t\u01b0\u01a1ng t\u1ef1 vi\u00eam gan c\u1ea5p.<\/p>\n

– \u0110\u1ee3t b\u00f9ng ph\u00e1t vi\u00eam gan B m\u1ea1n c\u00f3 th\u1ec3 x\u1ea3y ra t\u1ef1 ph\u00e1t ho\u1eb7c khi c\u00f3 y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i:<\/p>\n

+ \u0110i\u1ec1u tr\u1ecb v\u1edbi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch hay h\u00f3a tr\u1ecb li\u1ec7u;<\/p>\n

+ Ng\u01b0ng thu\u1ed1c kh\u00e1ng HBV;<\/p>\n

+ C\u00f3 b\u1ec7nh \u0111i k\u00e8m g\u00e2y t\u1ed5n th\u01b0\u01a1ng gan v\u00e0 suy y\u1ebfu h\u1ec7 mi\u1ec5n d\u1ecbch.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng vi r\u00fat ngay \u0111\u1ed1i v\u1edbi \u0111\u1ee3t b\u00f9ng ph\u00e1t vi\u00eam gan B m\u1ea1n \u0111\u1ec3 tr\u00e1nh nguy c\u01a1 d\u1eabn \u0111\u1ebfn b\u1ec7nh gan m\u1ea5t b\u00f9 v\u00e0 t\u1eed vong. T\u01b0 v\u1ea5n cho ng\u01b0\u1eddi b\u1ec7nh gh\u00e9p gan n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

k. C\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u01b0a \u0111\u1ec1 c\u1eadp trong H\u01b0\u1edbng d\u1eabn<\/i><\/b><\/p>\n

C\u1ea7n h\u1ed9i ch\u1ea9n chuy\u00ean khoa \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n

4.3. Theo d\u00f5i \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n

4.3.1. Tr\u01b0\u1eddng h\u1ee3p ch\u01b0a c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng vi r\u00fat<\/b><\/p>\n

– T\u01b0 v\u1ea5n v\u1ec1 theo d\u00f5i t\u00ecnh tr\u1ea1ng nhi\u1ec5m HBV<\/i><\/p>\n

+ Gi\u1ea3i th\u00edch l\u00fd do ch\u01b0a c\u00f3 ch\u1ec9 \u0111inh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng vi r\u00fat;<\/p>\n

+ H\u01b0\u1edbng d\u1eabn l\u1ecbch t\u00e1i kh\u00e1m v\u00e0 x\u00e9t nghi\u1ec7m \u0111\u1ecbnh k\u1ef3 \u0111\u1ec3 theo d\u00f5i t\u00ecnh tr\u1ea1ng b\u1ec7nh;<\/p>\n

+ Nh\u1ea5n m\u1ea1nh s\u1ef1 c\u1ea7n thi\u1ebft c\u1ee7a vi\u1ec7c duy tr\u00ec theo d\u00f5i l\u00e2u d\u00e0i, nguy c\u01a1 x\u01a1 gan v\u00e0 HCC n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c theo d\u00f5i \u0111\u1ecbnh k\u1ef3 v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh;<\/p>\n

+ Ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n th\u00f4ng b\u00e1o cho b\u00e1c s\u0129 v\u1ec1 t\u00ecnh tr\u1ea1ng nhi\u1ec5m HBV v\u00e0 b\u1ec7nh gan khi \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c (nh\u01b0 l\u00e0 \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, h\u00f3a tr\u1ecb li\u1ec7u ung th\u01b0).<\/p>\n

– Ch\u1ec9 s\u1ed1 theo d\u00f5i<\/i><\/p>\n

Kh\u00e1m l\u00e2m s\u00e0ng, l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m sinh h\u00f3a gan, c\u00f4ng th\u1ee9c m\u00e1u\/ti\u1ec3u c\u1ea7u, x\u00e9t nghi\u1ec7m t\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u (\u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng vi\u00eam c\u1ea7u th\u1eadn) 3- 6 th\u00e1ng m\u1ed9t l\u1ea7n.<\/p>\n

Khai th\u00e1c ti\u1ec1n s\u1eed gia \u0111\u00ecnh x\u01a1 gan\/HCC v\u00e0 t\u00ecm c\u00e1c bi\u1ec3u hi\u1ec7n ngo\u00e0i gan m\u1ed7i l\u1ea7n th\u0103m kh\u00e1m \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/p>\n

Th\u1ef1c hi\u1ec7n c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng vi r\u00fat (HBeAg\/anti HBe, t\u1ea3i l\u01b0\u1ee3ng HBV DNA \u0111\u1ecbnh k\u1ef3 24- 48 tu\u1ea7n\/l\u1ea7n v\u00e0 qHBsAg ho\u1eb7c HBcrAg n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n.<\/p>\n

Th\u1ef1c hi\u1ec7n c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng x\u01a1 h\u00f3a gan 24- 48 tu\u1ea7n\/l\u1ea7n.<\/p>\n

Th\u1ef1c hi\u1ec7n c\u00e1c x\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n s\u1edbm ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan nh\u01b0 si\u00eau \u00e2m v\u00e0 c\u00e1c ch\u1ec9 d\u1ea5u ph\u00e1t hi\u1ec7n s\u1edbm HCC 24- 48 tu\u1ea7n\/l\u1ea7n t\u00f9y theo m\u1ee9c \u0111\u1ed9 nguy c\u01a1 c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

4.3.2. Tr\u01b0\u1eddng h\u1ee3p \u0111ang \u0111i\u1ec1u tr\u1ecb ho\u1eb7c \u0111\u00e3 ng\u1eebng \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng vi r\u00fat<\/b><\/p>\n

a. \u0110ang \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng vi r\u00fat<\/i><\/b><\/p>\n

B\u1ea3ng 5: C\u00e1c ch\u1ec9 s\u1ed1 theo d\u00f5i \u0111i\u1ec1u tr\u1ecb ng\u01b0\u1eddi b\u1ec7nh vi\u00eam gan B<\/b><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Ch\u1ec9 s\u1ed1 theo d\u00f5i<\/b><\/td>\nT\u1ea7n su\u1ea5t<\/b><\/td>\n<\/tr>\n
L\u1ecbch t\u00e1i kh\u00e1m<\/td>\n– T\u00e1i kh\u00e1m v\u00e0 c\u1ea5p thu\u1ed1c 12 tu\u1ea7n (ho\u1eb7c 3 th\u00e1ng)\/l\u1ea7n v\u1edbi nh\u00f3m c\u00f3 nguy c\u01a1 ti\u1ebfn tri\u1ec3n nh\u01b0: ng\u01b0\u1eddi b\u1ecb x\u01a1 gan, ng\u01b0\u1eddi \u0111i\u1ec1u tr\u1ecb n\u0103m \u0111\u1ea7u ti\u00ean, ng\u01b0\u1eddi tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb kh\u00f4ng t\u1ed1t.<\/p>\n

– T\u00e1i kh\u00e1m v\u00e0 c\u1ea5p thu\u1ed1c 12- 24 tu\u1ea7n (ho\u1eb7c 3- 6 th\u00e1ng)\/l\u1ea7n v\u1edbi nh\u00f3m \u0111i\u1ec1u tr\u1ecb \u1ed5n \u0111\u1ecbnh \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi: \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb > 1 n\u0103m, kh\u00f4ng c\u00f3 x\u01a1 gan, tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb t\u1ed1t, v\u00e0 c\u00f3 \u0111\u00e1p \u1ee9ng vi r\u00fat (t\u1ea3i l\u01b0\u1ee3ng HBV DNA d\u01b0\u1edbi ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n).<\/p>\n

– L\u1ecbch t\u00e1i kh\u00e1m c\u00f3 th\u1ec3 \u0111i\u1ec1u ch\u1ec9nh t\u00f9y theo t\u00ecnh tr\u1ea1ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh<\/td>\n<\/tr>\n

\u0110\u00e1nh gi\u00e1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb<\/td>\n– Th\u1ef1c hi\u1ec7n trong t\u1ea5t c\u1ea3 c\u00e1c l\u1ea7n t\u00e1i kh\u00e1m.<\/p>\n

– C\u1ea7n khai th\u00e1c k\u1ef9 vi\u1ec7c u\u1ed1ng thu\u1ed1c \u0111\u1ec1u \u0111\u1eb7n h\u00e0ng ng\u00e0y, \u0111\u00fang gi\u1edd, \u0111\u00fang li\u1ec1u l\u01b0\u1ee3ng v\u00e0 h\u1ed7 tr\u1ee3 ng\u01b0\u1eddi b\u1ec7nh tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb n\u1ebfu c\u1ea7n.<\/td>\n<\/tr>\n

C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng gan v\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam gan<\/b><\/td>\n<\/tr>\n
– C\u00f4ng th\u1ee9c m\u00e1u<\/p>\n

– AST\/ALT<\/td>\n

Th\u1ef1c hi\u1ec7n 12- 24 tu\u1ea7n\/l\u1ea7n v\u1edbi ph\u00e1c \u0111\u1ed3 d\u00f9ng NAs, 12 tu\u1ea7n\/l\u1ea7n n\u1ebfu ph\u00e1c \u0111\u1ed3 d\u00f9ng Peg-IFN\/IFN.<\/td>\n<\/tr>\n
– Bilirubin, INR\/PT, Albumin<\/td>\nTh\u1ef1c hi\u1ec7n 12- 24 tu\u1ea7n\/l\u1ea7n \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan ho\u1eb7c khi nghi ng\u1edd ng\u01b0\u1eddi b\u1ec7nh x\u01a1 gan.<\/td>\n<\/tr>\n
X\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb v\u00e0 ng\u01b0ng thu\u1ed1c<\/b><\/td>\n<\/tr>\n
– T\u1ea3i l\u01b0\u1ee3ng HBV DNA<\/td>\nTh\u1ef1c hi\u1ec7n \u1edf tu\u1ea7n \u0111i\u1ec1u tr\u1ecb th\u1ee9 12, 24 v\u00e0 48; sau \u0111\u00f3 th\u1ef1c hi\u1ec7n 24- 48 tu\u1ea7n\/l\u1ea7n; ho\u1eb7c khi ALT t\u0103ng kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n.<\/td>\n<\/tr>\n
– HBeAg\/anti-HBe<\/td>\nTh\u1ef1c hi\u1ec7n HBeAg 48 tu\u1ea7n\/l\u1ea7n; anti-HBe 48 tu\u1ea7n\/l\u1ea7n n\u1ebfu HBeAg \u00e2m t\u00ednh.<\/td>\n<\/tr>\n
– qHBsAg\/ HBsAg<\/p>\n

– HBcrAg<\/td>\n

– Th\u1ef1c hi\u1ec7n HBsAg, qHBsAg 48 tu\u1ea7n\/l\u1ea7n, sau khi t\u1ea3i l\u01b0\u1ee3ng HBV DNA d\u01b0\u1edbi ng\u01b0\u1ee1ng, n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n.<\/p>\n

– Th\u1ef1c hi\u1ec7n HBcrAg 48 tu\u1ea7n\/l\u1ea7n \u0111\u1ec3 theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb v\u00e0 quy\u1ebft \u0111\u1ecbnh ng\u01b0ng thu\u1ed1c n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n.<\/td>\n<\/tr>\n

\u0110\u00e1nh gi\u00e1 x\u01a1 h\u00f3a gan b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng x\u00e2m l\u1ea5n<\/b><\/td>\n<\/tr>\n
– APRI<\/p>\n

– FIB-4<\/p>\n

– FibroScan<\/p>\n

– M2BPGi13,14<\/sup> (n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n)<\/td>\n

24- 48 tu\u1ea7n\/l\u1ea7n (c\u00f3 th\u1ec3 l\u00e0m 1- 2 ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 t\u00f9y theo \u0111i\u1ec1u ki\u1ec7n c\u1ee7a c\u01a1 s\u1edf y t\u1ebf).<\/i><\/p>\n

\u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 x\u01a1 h\u00f3a gan ch\u1ec9 n\u00ean th\u1ef1c hi\u1ec7n khi b\u1ec7nh nh\u00e2n kh\u00f4ng trong giai \u0111o\u1ea1n vi\u00eam gan c\u1ea5p ho\u1eb7c \u0111\u1ee3t b\u00f9ng ph\u00e1t. (ALT < 5 ULN).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

b. \u0110\u00e3 ng\u1eebng \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng vi r\u00fat<\/i><\/b><\/p>\n

– Kh\u00e1m \u0111\u1ecbnh k\u1ef3 \u0111\u1ec3 theo d\u00f5i c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u00e1c ch\u1ec9 s\u1ed1 x\u00e9t nghi\u1ec7m.<\/p>\n

– N\u0103m \u0111\u1ea7u ti\u00ean sau ng\u01b0ng thu\u1ed1c: x\u00e9t nghi\u1ec7m c\u00f4ng th\u1ee9c m\u00e1u, AST\/ALT, bilirubin 4-12 tu\u1ea7n\/l\u1ea7n; si\u00eau \u00e2m b\u1ee5ng, t\u1ea3i l\u01b0\u1ee3ng HBV DNA 12-24 tu\u1ea7n\/l\u1ea7n.<\/p>\n

– C\u00e1c n\u0103m ti\u1ebfp theo: x\u00e9t nghi\u1ec7m AST, ALT 12-24 tu\u1ea7n\/l\u1ea7n v\u00e0 t\u1ea3i l\u01b0\u1ee3ng HBV DNA 24- 48 tu\u1ea7n\/l\u1ea7n. X\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n s\u1edbm bi\u1ebfn ch\u1ee9ng HCC 12-24 tu\u1ea7n\/l\u1ea7n b\u1eb1ng si\u00eau \u00e2m b\u1ee5ng v\u00e0 c\u00e1c ch\u1ec9 d\u1ea5u ung th\u01b0 gan.<\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb Peg-IFN: theo d\u00f5i \u0111\u00e1p \u1ee9ng vi r\u00fat mu\u1ed9n b\u1eb1ng HBeAg n\u1ebfu tr\u01b0\u1edbc \u0111\u00f3 HBeAg d\u01b0\u01a1ng t\u00ednh, \u0111\u1ecbnh l\u01b0\u1ee3ng (ho\u1eb7c \u0111\u1ecbnh t\u00ednh) HBsAg v\u00e0 t\u1ea3i l\u01b0\u1ee3ng HBV DNA 12 tu\u1ea7n\/l\u1ea7n trong th\u1eddi gian \u00edt nh\u1ea5t 1 n\u0103m sau khi ng\u01b0ng thu\u1ed1c, sau \u0111\u00f3 12- 24 tu\u1ea7n\/l\u1ea7n trong 5 n\u0103m ti\u1ebfp theo.<\/p>\n

– L\u01b0u \u00fd m\u1ecdi tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m HBV d\u00f9 ch\u01b0a \u0111i\u1ec1u tr\u1ecb, \u0111ang \u0111i\u1ec1u tr\u1ecb hay \u0111\u00e3 ng\u01b0ng \u0111i\u1ec1u tr\u1ecb \u0111\u1ec1u c\u1ea7n ph\u1ea3i x\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n s\u1edbm HCC 12-24 tu\u1ea7n\/l\u1ea7n <\/b>b\u1eb1ng si\u00eau \u00e2m \u1ed5 b\u1ee5ng v\u00e0 c\u00e1c ch\u1ec9 d\u1ea5u ung th\u01b0 gan (AFP v\u00e0\/ho\u1eb7c AFP-L3 v\u00e0\/ho\u1eb7c PIVKA II)15<\/sup>. N\u1ebfu nghi ng\u1edd u gan tr\u00ean si\u00eau \u00e2m ho\u1eb7c b\u1ea5t th\u01b0\u1eddng v\u1ec1 c\u00e1c ch\u1ec9 d\u1ea5u ung th\u01b0 gan th\u00ec ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh b\u1ee5ng c\u00f3 ch\u1ea5t c\u1ea3n quang ho\u1eb7c c\u1ed9ng h\u01b0\u1edfng t\u1eeb b\u1ee5ng c\u00f3 ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n t\u1eeb.<\/p>\n

4.4. C\u00e1c tr\u01b0\u1eddng h\u1ee3p th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c kh\u00e1ng vi r\u00fat<\/b><\/p>\n

4.4.1. Ti\u00eau chu\u1ea9n th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n

D\u1ef1 ph\u00f2ng th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb, tr\u00e1nh kh\u00e1ng thu\u1ed1c, ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb khi chu\u1ea9n b\u1ecb \u0111i\u1ec1u tr\u1ecb, \u0111\u00e1nh gi\u00e1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb trong t\u1ea5t c\u1ea3 c\u00e1c l\u1ea7n t\u00e1i kh\u00e1m v\u00e0 t\u0103ng c\u01b0\u1eddng h\u1ed7 tr\u1ee3 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb cho t\u1ea5t c\u1ea3 ng\u01b0\u1eddi b\u1ec7nh tu\u00e2n th\u1ee7 kh\u00f4ng t\u1ed1t v\u00e0 nghi ng\u1edd th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb:<\/b><\/p>\n

Tr\u01b0\u1eddng h\u1ee3p l\u00e0m \u0111\u01b0\u1ee3c t\u1ea3i l\u01b0\u1ee3ng HBV DNA1,10,16<\/sup><\/i><\/b><\/p>\n

Th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u: khi t\u1ea3i l\u01b0\u1ee3ng HBV DNA gi\u1ea3m <1 log10 IU\/mL trong v\u00f2ng ba th\u00e1ng k\u1ec3 t\u1eeb khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb kh\u00e1ng vi r\u00fat.<\/p>\n

Th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb th\u1ee9 c\u1ea5p: t\u1ea3i l\u01b0\u1ee3ng HBV DNA t\u0103ng > 1log10 IU\/mL so v\u1edbi m\u1ee9c th\u1ea5p nh\u1ea5t \u0111\u00e3 \u0111\u1ea1t \u0111\u01b0\u1ee3c trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb sau khi ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 c\u00f3 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B ban \u0111\u1ea7u.<\/p>\n

* L\u01b0u \u00fd:<\/i><\/p>\n

– C\u1ea7n \u0111\u00e1nh gi\u00e1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, t\u0103ng c\u01b0\u1eddng h\u1ed7 tr\u1ee3 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 xem x\u00e9t c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111o t\u1ea3i l\u01b0\u1ee3ng HBV DNA \u0111\u1ec3 ki\u1ec3m tra l\u1ea1i tr\u01b0\u1edbc khi k\u1ebft lu\u1eadn th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb.<\/p>\n

– Vi\u1ec7c \u0111\u00e1nh gi\u00e1 th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 thay \u0111\u1ed5i ho\u1eb7c ph\u1ed1i h\u1ee3p thu\u1ed1c kh\u00f4ng n\u00ean k\u00e9o d\u00e0i qu\u00e1 4 tu\u1ea7n.<\/p>\n

– N\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n n\u00ean x\u00e1c \u0111\u1ecbnh \u0111\u1ed9t bi\u1ebfn kh\u00e1ng thu\u1ed1c b\u1eb1ng gi\u1ea3i tr\u00ecnh t\u1ef1 gen \u0111\u1ec3 c\u00f3 h\u01b0\u1edbng x\u1eed tr\u00ed ph\u00f9 h\u1ee3p.<\/p>\n

Tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng l\u00e0m \u0111\u01b0\u1ee3c t\u1ea3i l\u01b0\u1ee3ng HBV DNA:<\/i><\/b><\/p>\n

Nghi ng\u1edd th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb v\u00e0 kh\u00e1ng thu\u1ed1c c\u00f3 th\u1ec3 d\u1ef1a tr\u00ean c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m sau: \u0111ang d\u00f9ng thu\u1ed1c kh\u00e1ng vi r\u00fat c\u00f3 h\u00e0ng r\u00e0o kh\u00e1ng thu\u1ed1c th\u1ea5p, \u0111\u01b0\u1ee3c ghi nh\u1eadn ho\u1eb7c nghi ng\u1edd tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb k\u00e9m k\u00e8m theo t\u0103ng ALT v\u00e0\/ho\u1eb7c c\u00f3 b\u1eb1ng ch\u1ee9ng b\u1ec7nh gan ti\u1ebfn tri\u1ec3n.<\/p>\n

4.4.2. X\u1eed tr\u00ed<\/b><\/p>\n

– Ch\u1ec9 thay \u0111\u1ed5i thu\u1ed1c kh\u00e1ng vi r\u00fat sau khi \u0111\u00e3 t\u0103ng c\u01b0\u1eddng h\u1ed7 tr\u1ee3 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 x\u00e1c \u0111\u1ecbnh c\u00f3 th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb. \u00c1p d\u1ee5ng cho t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb NAs kh\u00f4ng \u0111\u00e1p \u1ee9ng ban \u0111\u1ea7u ho\u1eb7c b\u00f9ng ph\u00e1t vi r\u00fat.<\/p>\n

– \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi b\u1ec7nh \u0111ang \u0111i\u1ec1u tr\u1ecb v\u1edbi TDF (ho\u1eb7c TAF) ho\u1eb7c ETV m\u00e0 t\u1ea3i l\u01b0\u1ee3ng HBV DNA th\u1ea5p (< 2.000 IU\/mL) th\u00ec t\u00f9y tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3, c\u00f3 th\u1ec3 \u0111\u1ed5i thu\u1ed1c ngay ho\u1eb7c ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i \u0111\u1ebfn khi t\u1ea3i l\u01b0\u1ee3ng HBV DNA t\u0103ng cao h\u01a1n m\u1edbi thay \u0111\u1ed5i thu\u1ed1c.<\/p>\n

– Nguy\u00ean t\u1eafc thay \u0111\u1ed5i thu\u1ed1c: chuy\u1ec3n sang thu\u1ed1c c\u00f3 hi\u1ec7u l\u1ef1c kh\u00e1ng vi r\u00fat m\u1ea1nh, h\u00e0ng r\u00e0o kh\u00e1ng cao, v\u00e0 kh\u00f4ng c\u00f3 kh\u00e1ng ch\u00e9o v\u1edbi ph\u00e1c \u0111\u1ed3 tr\u01b0\u1edbc \u0111\u00f3. C\u00e1c thu\u1ed1c \u01b0u ti\u00ean bao g\u1ed3m tenofovir disoproxil fumarate ho\u1eb7c tenofovir alafenamide ho\u1eb7c entecavir. Ph\u1ed1i h\u1ee3p c\u00e1c thu\u1ed1c nucleos(t)ide kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o th\u01b0\u1eddng quy v\u00e0 ch\u1ec9 \u0111\u01b0\u1ee3c xem x\u00e9t trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00e1ng thu\u1ed1c ph\u1ee9c t\u1ea1p10<\/sup>.<\/p>\n

B\u1ea3ng 6. L\u1ef1a ch\u1ecdn thu\u1ed1c khi th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb1,8,10<\/sup><\/b><\/p>\n\n\n\n\n\n\n\n
\n

Th\u1ea5t b\u1ea1i<\/b> \u0111i\u1ec1u tr\u1ecb v\u1edbi c\u00e1c thu\u1ed1c \u0111ang s\u1eed d\u1ee5ng<\/b><\/p>\n<\/td>\n

\n

C\u00e1ch th\u1ee9c<\/b><\/p>\n<\/td>\n<\/tr>\n

\n

\u0110\u1ed5i thu\u1ed1c<\/b><\/p>\n<\/td>\n

\n

Ph\u1ed1i h\u1ee3p thu\u1ed1c<\/b><\/p>\n<\/td>\n<\/tr>\n

\n

Entecavir<\/p>\n<\/td>\n

\n

Tenofovir (TDF ho\u1eb7c TAF)<\/p>\n<\/td>\n

\n

Entecavir + Tenofovir (TDF ho\u1eb7c TAF) ho\u1eb7c TDF +FTC<\/p>\n<\/td>\n<\/tr>\n

\n

TDF<\/p>\n<\/td>\n

\n

Entecavir ho\u1eb7c TAF<\/p>\n<\/td>\n

\n

Tenofovir (TDF ho\u1eb7c TAF) + Entecavir<\/p>\n<\/td>\n<\/tr>\n

\n

\u0110a kh\u00e1ng<\/p>\n<\/td>\n

\n

Tenofovir (TDF ho\u1eb7c TAF)<\/p>\n<\/td>\n

\n

Tenofovir (TDF ho\u1eb7c TAF) + Entecavir<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

4.5. T\u0103ng c\u01b0\u1eddng tri\u1ec3n khai ch\u0103m s\u00f3c v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B t\u1ea1i c\u00e1c c\u01a1 s\u1edf y t\u1ebf<\/b><\/p>\n

– Ph\u00e2n c\u1ea5p v\u00e0 m\u1edf r\u1ed9ng d\u1ecbch v\u1ee5:<\/b><\/p>\n

+ Ph\u00e2n c\u1ea5p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B \u0111\u1ebfn c\u01a1 s\u1edf kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh c\u1ea5p ban \u0111\u1ea7u v\u00e0 c\u1ea5p c\u01a1 b\u1ea3n theo ph\u1ea1m vi chuy\u00ean m\u00f4n \u0111\u01b0\u1ee3c b\u1ea3o hi\u1ec3m y t\u1ebf chi tr\u1ea3.<\/p>\n

+ Thi\u1ebft l\u1eadp v\u00e0 duy tr\u00ec d\u1ecbch v\u1ee5 ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p v\u1edbi ch\u1ee9c n\u0103ng c\u1ee7a t\u1eebng c\u1ea5p chuy\u00ean m\u00f4n, k\u1ef9 thu\u1eadt.<\/p>\n

+ B\u1ea3o \u0111\u1ea3m kh\u1ea3 n\u0103ng ti\u1ebfp c\u1eadn x\u00e9t nghi\u1ec7m, bao g\u1ed3m th\u1ef1c hi\u1ec7n t\u1ea1i ch\u1ed7 ho\u1eb7c chuy\u1ec3n m\u1eabu theo quy \u0111\u1ecbnh.<\/p>\n

– T\u0103ng c\u01b0\u1eddng n\u0103ng l\u1ef1c h\u1ec7 th\u1ed1ng y t\u1ebf<\/b><\/p>\n

+ \u0110\u00e0o t\u1ea1o v\u00e0 c\u1eadp nh\u1eadt ki\u1ebfn th\u1ee9c cho nh\u00e2n vi\u00ean y t\u1ebf v\u1ec1 ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb v\u00e0 qu\u1ea3n l\u00fd vi\u00eam gan B.<\/p>\n

+ Chu\u1ea9n h\u00f3a quy tr\u00ecnh chuy\u00ean m\u00f4n nh\u1eb1m b\u1ea3o \u0111\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng d\u1ecbch v\u1ee5 t\u1ea1i c\u00e1c c\u1ea5p chuy\u00ean m\u00f4n, k\u1ef9 thu\u1eadt.<\/p>\n

– M\u1edf r\u1ed9ng s\u00e0ng l\u1ecdc v\u00e0 ch\u1ea9n \u0111o\u00e1n s\u1edbm<\/b><\/p>\n

+ L\u1ed3ng gh\u00e9p x\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n HBV v\u00e0o ho\u1ea1t \u0111\u1ed9ng kh\u00e1m ch\u1eefa b\u1ec7nh th\u01b0\u1eddng quy.<\/p>\n

+ M\u1edf r\u1ed9ng s\u00e0ng l\u1ecdc t\u1ea1i c\u1ed9ng \u0111\u1ed3ng, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u00f3m nguy c\u01a1 cao.<\/p>\n

+ S\u1eed d\u1ee5ng x\u00e9t nghi\u1ec7m nhanh HBsAg khi ph\u00f9 h\u1ee3p.<\/p>\n

+ Th\u1ef1c hi\u1ec7n x\u00e9t nghi\u1ec7m HBV DNA s\u1edbm sau khi ph\u00e1t hi\u1ec7n HBsAg d\u01b0\u01a1ng t\u00ednh nh\u1eb1m r\u00fat ng\u1eafn th\u1eddi gian \u0111i\u1ec1u tr\u1ecb.<\/p>\n

– T\u0103ng c\u01b0\u1eddng qu\u1ea3n l\u00fd ng\u01b0\u1eddi b\u1ec7nh<\/b><\/p>\n

+ Thi\u1ebft l\u1eadp h\u1ec7 th\u1ed1ng qu\u1ea3n l\u00fd d\u1eef li\u1ec7u \u0111\u1ed3ng b\u1ed9 \u0111\u1ec3 theo d\u00f5i ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

+ Theo d\u00f5i tu\u00e2n th\u1ee7 t\u00e1i kh\u00e1m, x\u00e9t nghi\u1ec7m v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

+ Tri\u1ec3n khai c\u01a1 ch\u1ebf nh\u1eafc l\u1ecbch v\u00e0 can thi\u1ec7p s\u1edbm \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi b\u1ec7nh tu\u00e2n th\u1ee7 k\u00e9m.<\/p>\n

– T\u0103ng c\u01b0\u1eddng ph\u1ed1i h\u1ee3p li\u00ean c\u1ea5p chuy\u00ean m\u00f4n, k\u1ef9 thu\u1eadt<\/b><\/p>\n

+ Thi\u1ebft l\u1eadp c\u01a1 ch\u1ebf ph\u1ed1i h\u1ee3p r\u00f5 r\u00e0ng gi\u1eefa c\u01a1 s\u1edf kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh c\u1ea5p ban \u0111\u1ea7u, c\u01a1 b\u1ea3n v\u00e0 chuy\u00ean s\u00e2u: C\u1ea5p ban \u0111\u1ea7u v\u00e0 c\u1ea5p c\u01a1 b\u1ea3n qu\u1ea3n l\u00fd v\u00e0 \u0111i\u1ec1u tr\u1ecb cho ng\u01b0\u1eddi b\u1ec7nh vi\u00eam gan B giai \u0111o\u1ea1n \u1ed5n \u0111\u1ecbnh (ch\u01b0a x\u01a1 gan ho\u1eb7c x\u01a1 gan c\u00f2n b\u00f9); c\u1ea7n chuy\u1ec3n c\u1ea5p chuy\u00ean s\u00e2u v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p x\u01a1 gan m\u1ea5t b\u00f9 (Child-Pugh B, C), nghi ng\u1edd th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb (kh\u00e1ng thu\u1ed1c).<\/p>\n

+ Qu\u1ea3n l\u00fd ng\u01b0\u1eddi b\u1ec7nh \u1ed5n \u0111\u1ecbnh t\u1ea1i c\u1ea5p ban \u0111\u1ea7u, c\u1ea5p c\u01a1 b\u1ea3n; chuy\u1ec3n c\u1ea5p chuy\u00ean s\u00e2u c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng ho\u1eb7c ph\u1ee9c t\u1ea1p.<\/p>\n

+ X\u00e2y d\u1ef1ng ti\u00eau ch\u00ed chuy\u1ec3n c\u1ea5p chuy\u00ean m\u00f4n, k\u1ef9 thu\u1eadt hai chi\u1ec1u minh b\u1ea1ch v\u00e0 hi\u1ec7u qu\u1ea3.<\/p>\n

– T\u00edch h\u1ee3p d\u1ecbch v\u1ee5<\/b><\/p>\n

+ T\u00edch h\u1ee3p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan B v\u00e0o c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh hi\u1ec7n c\u00f3 nh\u01b0: ch\u0103m s\u00f3c HIV, s\u1ee9c kh\u1ecfe sinh s\u1ea3n, c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh gi\u1ea3m t\u00e1c h\u1ea1i.<\/p>\n

+ T\u0103ng c\u01b0\u1eddng ti\u1ebfp c\u1eadn c\u00e1c nh\u00f3m d\u00e2n s\u1ed1 c\u00f3 nguy c\u01a1 cao.<\/p>\n

V. PH\u00d2NG B\u1ec6NH<\/b><\/p>\n

5.1. Ph\u00f2ng b\u1ec7nh ch\u1ee7 \u0111\u1ed9ng<\/b><\/p>\n

Ph\u00f2ng b\u1ec7nh ch\u1ee7 \u0111\u1ed9ng b\u1eb1ng v\u1eafc xin vi\u00eam gan B, th\u1ef1c hi\u1ec7n theo quy \u0111\u1ecbnh hi\u1ec7n h\u00e0nh.<\/p>\n

5.2. Ph\u00f2ng l\u00e2y truy\u1ec1n HBV t\u1eeb m\u1eb9 sang con<\/b><\/p>\n

Xem Ph\u1ee5 l\u1ee5c 6 v\u00e0 chi ti\u1ebft t\u1ea1i Quy\u1ebft \u0111\u1ecbnh 678\/Q\u0110-BYT ng\u00e0y 26 th\u00e1ng 2 n\u0103m 2025 c\u1ee7a B\u1ed9 Y t\u1ebf v\u1ec1 vi\u1ec7c ban h\u00e0nh H\u01b0\u1edbng d\u1eabn k\u1ef9 thu\u1eadt c\u00e1c can thi\u1ec7p d\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n HIV, vi\u00eam gan B v\u00e0 giang mai t\u1eeb m\u1eb9 sang con11<\/sup>.<\/p>\n

5.3. D\u1ef1 ph\u00f2ng sau ph\u01a1i nhi\u1ec5m HBV6,7<\/sup><\/b><\/p>\n

\u0110i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng sau ph\u01a1i nhi\u1ec5m v\u1edbi vi r\u00fat vi\u00eam gan B c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ngay sau ph\u01a1i nhi\u1ec5m (trong v\u00f2ng 24 gi\u1edd). Th\u1ef1c hi\u1ec7n c\u00e1c b\u01b0\u1edbc sau \u0111\u00e2y:<\/p>\n

B\u01b0\u1edbc 1: R\u1eeda v\u1ebft th\u01b0\u01a1ng\/n\u01a1i ti\u1ebfp x\u00fac d\u01b0\u1edbi v\u00f2i n\u01b0\u1edbc ch\u1ea3y b\u1eb1ng x\u00e0 ph\u00f2ng. Tr\u01b0\u1eddng h\u1ee3p l\u00e0 ni\u00eam m\u1ea1c m\u1eaft th\u00ec r\u1eeda b\u1eb1ng n\u01b0\u1edbc nh\u1ecf m\u1eaft NaCl 0,9%;<\/p>\n

B\u01b0\u1edbc 2: X\u00e9t nghi\u1ec7m HBsAg, anti-HBs, anti-HBc cho ng\u01b0\u1eddi ph\u01a1i nhi\u1ec5m;<\/p>\n

B\u01b0\u1edbc 3: Th\u1ef1c hi\u1ec7n bi\u1ec7n ph\u00e1p d\u1ef1 ph\u00f2ng khi ng\u01b0\u1eddi ph\u01a1i nhi\u1ec5m c\u00f3 HBsAg \u00e2m t\u00ednh, anti-HBs < 10 IU\/ml, anti-HBc \u00e2m t\u00ednh. (c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00e1c kh\u00f4ng c\u1ea7n can thi\u1ec7p).<\/i><\/p>\n

D\u1ef1 ph\u00f2ng b\u1eb1ng:<\/p>\n

– Hepatitis B immune globulin, li\u1ec1u 0,06mL\/kg ti\u00eam b\u1eafp;<\/p>\n

– Ti\u00eam \u0111\u1ee7 3 m\u0169i v\u1eafc xin vi\u00eam gan B;<\/p>\n

– X\u00e9t nghi\u1ec7m l\u1ea1i HBsAg, anti-HBs sau 1-2 th\u00e1ng sau khi ho\u00e0n th\u00e0nh m\u0169i ti\u00eam v\u1eafc-xin vi\u00eam gan B cu\u1ed1i c\u00f9ng.<\/p>\n

5.4. Ph\u00f2ng b\u1ec7nh kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/b><\/p>\n

– \u0110\u1ea3m b\u1ea3o an to\u00e0n truy\u1ec1n m\u00e1u v\u00e0 c\u00e1c ch\u1ebf ph\u1ea9m c\u1ee7a m\u00e1u. T\u1ea5t c\u1ea3 c\u00e1c m\u1eabu m\u00e1u to\u00e0n ph\u1ea7n v\u00e0 m\u00e1u t\u00e1ch huy\u1ebft t\u01b0\u01a1ng c\u1ea7n \u0111\u01b0\u1ee3c s\u00e0ng l\u1ecdc \u0111\u1ec3 ph\u00e1t hi\u1ec7n vi\u00eam gan B tr\u01b0\u1edbc khi \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o s\u1eed d\u1ee5ng trong l\u00e2m s\u00e0ng ho\u1eb7c s\u1ea3n xu\u1ea5t. T\u01b0 v\u1ea5n v\u00e0 chuy\u1ec3n g\u1eedi ng\u01b0\u1eddi cho m\u00e1u c\u00f3 HBsAg d\u01b0\u01a1ng t\u00ednh sang c\u00e1c c\u01a1 s\u1edf y t\u1ebf cung c\u1ea5p d\u1ecbch v\u1ee5 \u0111i\u1ec1u tr\u1ecb vi\u00eam gan vi r\u00fat \u0111\u1ec3 \u0111\u01b0\u1ee3c theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i.<\/p>\n

– Kh\u00f4ng d\u00f9ng chung kim ti\u00eam v\u00e0 c\u00e1c d\u1ee5ng c\u1ee5 xuy\u00ean da.<\/p>\n

– Th\u1ef1c hi\u1ec7n an to\u00e0n t\u00ecnh d\u1ee5c.<\/p>\n

– Tr\u00e1nh ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp v\u1edbi m\u00e1u v\u00e0 c\u00e1c d\u1ecbch ti\u1ebft c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh nhi\u1ec5m HBV.<\/p>\n

– C\u00e1c c\u01a1 s\u1edf y t\u1ebf c\u1ea7n th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba chu\u1ea9n, d\u1ef1 ph\u00f2ng c\u00e1c b\u1ec7nh l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng m\u00e1u.<\/p>\n

PH\u1ee4 L\u1ee4C 1. CH\u1ea8N \u0110O\u00c1N C\u00c1C GIAI \u0110O\u1ea0N C\u1ee6A NHI\u1ec4M HBV M\u1ea0N<\/b>1<\/sup><\/b><\/p>\n

(Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 1740\/Q\u0110-BYT ng\u00e0y 16 th\u00e1ng 06 n\u0103m 2026 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf)<\/i><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Thu\u1eadt ng\u1eef<\/b><\/td>\nNhi\u1ec5m HBV HBeAg d\u01b0\u01a1ng<\/b><\/td>\nVi\u00eam gan B HBeAg d\u01b0\u01a1ng<\/b><\/td>\nNhi\u1ec5m HBV HBeAg \u00e2m<\/b><\/td>\nVi\u00eam gan B HBeAg \u00e2m<\/b><\/td>\nV\u00f9ng x\u00e1m<\/b><\/td>\nVi\u00eam gan B th\u1ec3 \u1ea9n<\/b><\/td>\n<\/tr>\n
C\u00e1ch g\u1ecdi kh\u00e1c<\/td>\nDung n\u1ea1p mi\u1ec5n d\u1ecbch<\/td>\nTh\u1ec3 ho\u1ea1t \u0111\u1ed9ng<\/td>\nTh\u1ec3 kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng<\/td>\nTh\u1ec3 t\u00e1i ho\u1ea1t \u0111\u1ed9ng<\/td>\nKh\u00f4ng x\u00e1c \u0111\u1ecbnh<\/td>\nKh\u00f4ng x\u00e1c \u0111\u1ecbnh<\/td>\n<\/tr>\n
Huy\u1ebft thanh<\/td>\nHBsAg<\/td>\nD\u01b0\u01a1ng<\/td>\nD\u01b0\u01a1ng<\/td>\nD\u01b0\u01a1ng<\/td>\nD\u01b0\u01a1ng<\/td>\nD\u01b0\u01a1ng<\/td>\n\u00c2m<\/td>\n<\/tr>\n
(IU\/mL)<\/td>\nqHBsAg<\/td>\n3.5-4.5 log10<\/td>\n3.5-4.5 log10<\/td>\n2.5-3.5 log10<\/td>\n2-3 log10<\/td>\n2-3 log10<\/td>\n\u00c2m<\/td>\n<\/tr>\n
Huy\u1ebft thanh<\/td>\nHBeAg<\/td>\nD\u01b0\u01a1ng<\/td>\nD\u01b0\u01a1ng<\/td>\n\u00c2m<\/td>\n\u00c2m<\/td>\n\u00c2m<\/td>\n\u00c2m<\/td>\n<\/tr>\n
Huy\u1ebft thanh<\/td>\nAnti-HBe<\/td>\n\u00c2m<\/td>\n\u00c2m<\/td>\nD\u01b0\u01a1ng<\/td>\nD\u01b0\u01a1ng<\/td>\nD\u01b0\u01a1ng<\/td>\nC\u00f3 th\u1ec3 D\u01b0\u01a1ng<\/td>\n<\/tr>\n
IU\/mL<\/td>\nHBV DNA<\/td>\nTh\u01b0\u1eddng 7 >10<\/td>\nTh\u01b0\u1eddng 5 7 >10 -10<\/td>\n3 <10<\/td>\nTh\u01b0\u1eddng 3 5 10 -10<\/td>\n2000 – 20000<\/td>\nTh\u1ea5p \u1edf gi\u1edbi h\u1ea1n ph\u00e1t hi\u1ec7n<\/td>\n<\/tr>\n
Sinh h\u00f3a<\/td>\nALT<\/td>\nB\u00ecnh th\u01b0\u1eddng<\/td>\nT\u0103ng<\/td>\nB\u00ecnh th\u01b0\u1eddng<\/td>\nT\u0103ng<\/td>\nDao \u0111\u1ed9ng<\/td>\nB\u00ecnh th\u01b0\u1eddng<\/td>\n<\/tr>\n
M\u00f4 h\u1ecdc<\/td>\nSinh thi\u1ebft<\/td>\nVi\u00eam ho\u1ea1i t\u1eed t\u1ed1i thi\u1ec3u ho\u1eb7c x\u01a1 h\u00f3a<\/td>\nVi\u00eam ho\u1ea1i t\u1eed trung b\u00ecnh ho\u1eb7c n\u1eb7ng v\u00e0 c\u00e1c m\u1ee9c \u0111\u1ed9 x\u01a1 h\u00f3a<\/td>\nVi\u00eam ho\u1ea1i t\u1eed t\u1ed1i thi\u1ec3u v\u00e0 x\u01a1 h\u00f3a<\/td>\nVi\u00eam ho\u1ea1i t\u1eed trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng ho\u1eb7c x\u01a1 h\u00f3a<\/td>\nVi\u00eam ho\u1ea1i t\u1eed t\u1ed1i thi\u1ec3u ho\u1eb7c th\u1ea5p<\/td>\nVi\u00eam ho\u1ea1i t\u1eed t\u1ed1i thi\u1ec3u ho\u1eb7c th\u1ea5p C\u00f3 th\u1ec3 x\u01a1 h\u00f3a<\/td>\n<\/tr>\n
HBcrAg<\/td>\n\u0110o l\u01b0\u1eddng<\/td>\nM\u1ee9c cao<\/td>\nM\u1ee9c cao<\/td>\nTh\u1ea5p ho\u1eb7c kh\u00f4ng ph\u00e1t hi\u1ec7n<\/td>\nTh\u1ea5p<\/td>\nC\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n<\/td>\nKh\u00f4ng \u0111\u1ee7 d\u1eef li\u1ec7u<\/td>\n<\/tr>\n
HBV RNA<\/td>\n\u0110o l\u01b0\u1eddng<\/td>\nM\u1ee9c cao<\/td>\nM\u1ee9c cao<\/td>\nTh\u1ea5p ho\u1eb7c kh\u00f4ng ph\u00e1t hi\u1ec7n<\/td>\nTh\u1ea5p<\/td>\nC\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n<\/td>\nKh\u00f4ng \u0111\u1ee7 d\u1eef li\u1ec7u<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

PH\u1ee4 L\u1ee4C 2. \u0110\u00c1NH GI\u00c1 C\u00c1C GIAI \u0110O\u1ea0N \u0110\u1ed8 X\u01a0 H\u00d3A GAN V\u00c0 X\u01a0 GAN<\/b>3<\/sup><\/b><\/p>\n

(Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 1740\/Q\u0110-BYT ng\u00e0y 16 th\u00e1ng 6 n\u0103m 2026 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf)<\/i><\/p>\n

X\u01a1 h\u00f3a gan g\u1ed3m 4 giai \u0111o\u1ea1n (F0\u21924) theo ph\u00e2n lo\u1ea1i Metavir tr\u00ean m\u00f4 h\u1ecdc<\/p>\n

C\u00e1c m\u1ee9c \u0111\u1ed9 x\u01a1 h\u00f3a gan g\u1ed3m<\/p>\n

– Kh\u00f4ng x\u01a1 h\u00f3a gan ho\u1eb7c x\u01a1 h\u00f3a r\u1ea5t nh\u1eb9: F0-F1<\/p>\n

– X\u01a1 h\u00f3a \u0111\u00e1ng k\u1ec3 (significant fibrosis): F \u2265 2<\/p>\n

– X\u01a1 h\u00f3a ti\u1ebfn tri\u1ec3n (advanced fibrosis): F \u2265 3<\/p>\n

– X\u01a1 gan (cirrhosis): F4<\/p>\n

1. \u0110o \u0111\u1ed9 \u0111\u00e0n h\u1ed3i gan <\/b>(v\u00ed d\u1ee5 FibroScan)<\/p>\n

F0-1: \u2264 7,0 Kpa F3 : > 9,5 v\u00e0 \u2264 12,5KPa<\/p>\n

F2: >7,0 v\u00e0 \u2264 9,5 Kpa F4 : > 12,5 Kpa<\/p>\n

2. Ch\u1ec9 s\u1ed1 APRI<\/b><\/p>\n

\"c\u00f4ng<\/p>\n

F0-1: < 0,79 C.O.I F3 : 1.14 – < 1,3 C.O.I<\/p>\n

F2: 0,79 – < 1,14 C.O.I F4 : \u2265 1,3 C.O.I<\/p>\n

F4 : >1<\/p>\n

3. Ch\u1ec9 s\u1ed1 M2BPGi13,14<\/sup><\/b><\/p>\n

4. B\u1ea3ng \u0111i\u1ec3m Child-Turcotte-Pug<\/b><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
Ti\u00eau chu\u1ea9n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1<\/b><\/td>\n1 \u0111i\u1ec3m<\/b><\/td>\n2 \u0111i\u1ec3m<\/b><\/td>\n3 \u0111i\u1ec3m<\/b><\/td>\n<\/tr>\n
B\u1ec7nh n\u00e3o gan<\/td>\nKh\u00f4ng<\/td>\nGiai \u0111o\u1ea1n 1-2<\/td>\nGiai \u0111o\u1ea1n 3-4<\/td>\n<\/tr>\n
C\u1ed5 tr\u01b0\u1edbng<\/td>\nKh\u00f4ng<\/td>\n\u00cdt<\/td>\nNhi\u1ec1u<\/td>\n<\/tr>\n
Bilirubin huy\u1ebft thanh (mg\/dl)<\/td>\n< 2<\/td>\n2-3<\/td>\n> 3<\/td>\n<\/tr>\n
(\u00b5mol\/L)<\/td>\n< 35<\/td>\n35-50<\/td>\n> 50<\/td>\n<\/tr>\n
Albumin huy\u1ebft thanh (g\/dL)<\/td>\n> 3,5<\/td>\n2,8-3,5<\/td>\n< 2,8<\/td>\n<\/tr>\n
(g\/L)<\/td>\n> 35<\/td>\n28 – 35<\/td>\n< 28<\/td>\n<\/tr>\n
T\u1ef7 l\u1ec7 Prothrombin (%) hay INR<\/td>\n> 64<\/td>\n44-64<\/td>\n< 44<\/td>\n<\/tr>\n
< 1,7<\/td>\n1,7-2,3<\/td>\n> 2,3<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

– Child A: 5-6 \u0111i\u1ec3m x\u01a1 gan c\u00f2n b\u00f9<\/p>\n

– Child B: 7-9 \u0111i\u1ec3m x\u01a1 gan m\u1ea5t b\u00f9<\/p>\n

– Child C: \u2265 10 \u0111i\u1ec3m x\u01a1 gan m\u1ea5t b\u00f9<\/p>\n

PH\u1ee4 L\u1ee4C 3. \u0110I\u1ec0U TR\u1eca D\u1ef0 PH\u00d2NG VI\u00caM GAN B B\u00d9NG PH\u00c1T KHI \u0110I\u1ec0U TR\u1eca C\u00c1C THU\u1ed0C \u1ee8C CH\u1ebe MI\u1ec4N D\u1ecaCH HAY H\u00d3A TR\u1eca LI\u1ec6U<\/b>12<\/sup><\/b><\/p>\n

(Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 1740\/Q\u0110-BYT ng\u00e0y 16 th\u00e1ng 6 n\u0103m 2026 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf)<\/i><\/p>\n

\"Hinh<\/p>\n

PH\u1ee4 L\u1ee4C 4. CHUY\u1ec2N THU\u1ed0C HO\u1eb6C \u0110I\u1ec0U CH\u1ec8NH LI\u1ec0U THU\u1ed0C KH\u00c1NG VI R\u00daT TR\u00caN NG\u01af\u1edcI SUY TH\u1eacN THEO M\u1ee8C L\u1eccC C\u1ea6U TH\u1eacN<\/b>3<\/sup><\/b><\/p>\n

(Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 1740\/Q\u0110-BYT ng\u00e0y 16 th\u00e1ng 6 n\u0103m 2026 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf)<\/i><\/p>\n\n\n\n\n\n\n
\n

Thu\u1ed1c kh\u00e1ng vi r\u00fat<\/b><\/p>\n<\/td>\n

\n

M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn<\/b><\/p>\n<\/td>\n

\n

\u0110i\u1ec1u ch\u1ec9nh li\u1ec1u<\/b><\/p>\n<\/td>\n<\/tr>\n

1. Tenofovir disoproxil fumarate (TDF)<\/td>\n+ CrCl \u2265 50 mL\/ph\u00fat<\/p>\n

CrCl < 50 mL\/ph\u00fat<\/p>\n

+ CrCl 30-49 mL\/ph\u00fat<\/p>\n

+ CrCl 10-29 mL\/ph\u00fat<\/p>\n

+ CrCl <10 mL\/ph\u00fat<\/p>\n

+ Ch\u1ea1y th\u1eadn<\/td>\n

+ Kh\u00f4ng c\u1ea7n gi\u1ea3m li\u1ec1u<\/p>\n

Chuy\u1ec3n thu\u1ed1c ETV ho\u1eb7c TAF ho\u1eb7c<\/p>\n

+ TDF 300mg m\u1ed7i 48 gi\u1edd<\/p>\n

+ TDF 300mg m\u1ed7i 72 – 96 gi\u1edd<\/p>\n

+ TDF Kh\u00f4ng d\u00f9ng<\/p>\n

+ TDF 300mg m\u1ed7i 7 ng\u00e0y ho\u1eb7c u\u1ed1ng sau 12 gi\u1edd m\u1ed7i l\u1ea7n ch\u1ea1y th\u1eadn<\/td>\n<\/tr>\n

2. Entecavir (ETV)<\/td>\n+ CrCl: \u2265 50 mL\/ph\u00fat<\/p>\n

CrCl < 50 mL\/ph\u00fat<\/p>\n

+ CrCl: 30-49 mL\/ph\u00fat<\/p>\n

+ CrCl: 10-29 mL\/ph\u00fat<\/p>\n

+ CrCl <10 mL\/ph\u00fat, ch\u1ea1y th\u1eadn<\/td>\n

+ Kh\u00f4ng c\u1ea7n gi\u1ea3m li\u1ec1u.<\/p>\n

Chuy\u1ec3n thu\u1ed1c TAF ho\u1eb7c<\/p>\n

+ ETV 0,25 mg\/ng\u00e0y ho\u1eb7c 0,5 mg m\u1ed7i 48 gi\u1edd.<\/p>\n

+ ETV 0,15 mg\/ng\u00e0y ho\u1eb7c 0,5 mg m\u1ed7i 72 gi\u1edd.<\/p>\n

+ ETV 0,5 mg m\u1ed7i 7 ng\u00e0y<\/td>\n<\/tr>\n

3. Tenofovir alafenamide (TAF)<\/td>\n<\/td>\nKh\u00f4ng c\u1ea7n gi\u1ea3m li\u1ec1u \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p suy th\u1eadn nh\u1eb9, v\u1eeba v\u00e0 n\u1eb7ng, ho\u1eb7c ch\u1ea1y th\u1eadn. Ch\u01b0a c\u00f3 d\u1eef li\u1ec7u tr\u00ean ng\u01b0\u1eddi suy th\u1eadn c\u00f3 CrCl < 15 ml\/ph\u00fat nh\u01b0ng ch\u01b0a ch\u1ea1y th\u1eadn<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

PH\u1ee4 L\u1ee4C 5. \u0110I\u1ec0U TR\u1eca VI\u00caM GAN B M\u1ea0N \u1ede NG\u01af\u1edcI \u2265 12 TU\u1ed4I<\/b>1<\/sup><\/b><\/p>\n

\"Hinh<\/p>\n

PH\u1ee4 L\u1ee4C 6. X\u00c9T NGHI\u1ec6M V\u00c0 \u0110I\u1ec0U TR\u1eca NG\u0102N NG\u1eeaA L\u00c2Y TRUY\u1ec0N VI\u00caM GAN B T\u1eea M\u1eb8 SANG CON<\/b>11<\/sup><\/b><\/p>\n

\"Hinh<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/b><\/p>\n

1. WHO. Organization WH, ed. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection<\/i>. 2024.<\/p>\n

2. WHO. Viral hepatitis situation and response in Vietnam 2018;<\/p>\n

3. Quy\u1ebft \u0111\u1ecbnh 3310\/Q\u0110-BYT H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam gan vi r\u00fat B (2019).<\/p>\n

4. Quy\u1ebft \u0111\u1ecbnh 1868 \/Q\u0110- BYT H\u01b0\u1edbng d\u1eabn x\u00e9t nghi\u1ec7m vi r\u00fat vi\u00eam gan B, C (2020).<\/p>\n

5. WHO. Organization WH, ed. Consolidated guidance on hepatitis B and C prevention, testing, treatment, service delivery and monitoring: an implementation handbook for a public health approach<\/i>. 2026.<\/p>\n

6. Conners EE PL, Hofmeister MG, Spradling PR, Hagan LM, Harris AM, Rogers-Brown JS, Wester C, Nelson NP; Contributors. Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations – United States, 2023. MMWR Recomm Rep<\/i>. 2023;1(72)doi:10.15585\/mmwr.rr7201a1.<\/p>\n

7. Wedemeyer M, Berg, Keitel, Rockstroh, Sarrazin. Hepatology – A clinical textbook<\/i>. 2024.<\/p>\n

8. Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology<\/i>. Apr 2018;67(4):1560-1599. doi:10.1002\/hep.29800<\/p>\n

9. Quy\u1ebft \u0111\u1ecbnh 2855\/Q\u0110-BYT H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam gan vi r\u00fat C (2024).<\/p>\n

10. European Association for the Study of the L. EASL Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol<\/i>. Aug 2025;83(2):502-583. doi:10.1016\/j.jhep.2025.03.018.<\/p>\n

11. Quy\u1ebft \u0111\u1ecbnh 678\/Q\u0110-BYT H\u01b0\u1edbng d\u1eabn k\u1ef9 thu\u1eadt c\u00e1c can thi\u1ec7p d\u1ef1 ph\u00f2ng l\u00e2y truy\u1ec1n HIV, HBV v\u00e0 giang mai t\u1eeb m\u1eb9 sang con (2025).<\/p>\n

12. Ali FS, Nguyen MH, Hernaez R, et al. AGA Clinical Practice Guideline on the Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals. Gastroenterology<\/i>. Feb 2025;168(2):267-284. doi:10.1053\/j.gastro.2024.11.008.<\/p>\n

13. Pham TTT, Ho DT, Phan HT, Nguyen TB, Nguyen KM. Assessing the role of Mac-2 binding protein glycosylation isomer in the management of patients with chronic hepatitis B. World J Hepatol<\/i>. May 27 2025;17(5):106916. doi:10.4254\/wjh.v17.i5.106916.<\/p>\n

14. Feng S, Wang Z, Zhao Y, Tao C. Wisteria floribunda agglutinin-positive Mac-2-binding protein as a diagnostic biomarker in liver cirrhosis: an updated meta-analysis. Sci Rep<\/i>. Jun 29 2020;10(1):10582. doi:10.1038\/s41598-020-67471-y.<\/p>\n

15. Quy\u1ebft \u0111\u1ecbnh 3129\/Q\u0110-BYT H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (2020).<\/p>\n

16. Sarin SK, Kumar M, Lau GK, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatology International<\/i>. 2015;10(1):1-98. doi:10.1007\/s12072-015-9675-4.<\/p>\n","protected":false},"excerpt":{"rendered":"

B\u1ed8 Y T\u1ebe S\u1ed1: 1740\/Q\u0110-BYT C\u1ed8NG H\u00d2A X\u00c3 H\u1ed8I CH\u1ee6 NGH\u0128A VI\u1ec6T NAM \u0110\u1ed9c l\u1eadp – T\u1ef1 do – H\u1ea1nh ph\u00fac H\u00e0 N\u1ed9i, ng\u00e0y 16 th\u00e1ng 06 n\u0103m 2026 QUY\u1ebeT \u0110\u1ecaNH V\u1ec0 VI\u1ec6C BAN H\u00c0NH T\u00c0I LI\u1ec6U CHUY\u00caN M\u00d4N \u201cH\u01af\u1edaNG D\u1eaaN CH\u1ea8N \u0110O\u00c1N, \u0110I\u1ec0U TR\u1eca VI\u00caM GAN VI R\u00daT B\u201d B\u1ed8 TR\u01af\u1edeNG B\u1ed8 Y T\u1ebe […]\n","protected":false},"author":878,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-158936","post","type-post","status-publish","format-standard","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/158936","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/users\/878"}],"replies":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/comments?post=158936"}],"version-history":[{"count":1,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/158936\/revisions"}],"predecessor-version":[{"id":158942,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/158936\/revisions\/158942"}],"wp:attachment":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/media?parent=158936"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/categories?post=158936"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/tags?post=158936"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}