Ngu\u1ed3n: S\u00e1ch \u0110\u1ea1i c\u01b0\u01a1ng s\u1ee9c kh\u1ecfe t\u00ecnh d\u1ee5c – Ch\u01b0\u01a1ng 3: R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c nam\u00a0<\/span><\/p>\n \u0110\u1ea1i c\u01b0\u01a1ng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c nam<\/span><\/p>\n Nh\u00e0 xu\u1ea5t b\u1ea3n Y h\u1ecdc<\/span><\/p>\n Ch\u1ee7 bi\u00ean: PGS.TS.BS. L\u00ea Minh T\u00e2m<\/span><\/p>\n Bi\u00ean so\u1ea1n<\/span><\/p>\n PGS.TS.BS. T\u00f4n N\u1eef V\u00e2n Anh<\/span><\/p>\n ThS.BS. H\u1ed3 Tr\u1ea7n Tu\u1ea5n H\u00f9ng<\/span><\/p>\n ThS.BS. Nguy\u1ec5n \u0110\u1eafc Nguy\u00ean<\/span><\/p>\n ThS.BS. Tr\u1ea7n Th\u1ecb Nh\u01b0 Qu\u1ef3nh<\/span><\/p>\n T\u1ef7 l\u1ec7 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c nam t\u0103ng theo tu\u1ed5i v\u00e0 t\u01b0\u01a1ng \u0111\u1ed1i cao v\u1edbi h\u01a1n 50% nam gi\u1edbi t\u1eeb 40 \u0111\u1ebfn 70 tu\u1ed5i b\u1ecb r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng \u1edf c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau. C\u00e1c y\u1ebfu t6 nguy c\u01a1 \u0111\u1ed1i v\u1edbi r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c nam bao g\u1ed3m tu\u1ed5i t\u00e1c, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (Diabetes Mellitus – DM), ung th\u01b0, \u0111\u1ed9t qu\u1ef5, t\u0103ng huy\u1ebft \u00e1p, h\u1ed9i ch\u1ee9ng truy\u1ec1n ho\u00e1, ch\u1ea5n th\u01b0\u01a1ng d\u01b0\u01a1ng v\u1eadt, tr\u1ea7m c\u1ea3m, lo l\u1eafng v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n th\u1ea7n kinh th\u00f4ng qua serotonin trung \u01b0\u01a1ng v\u00e0 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a th\u1ee5 th\u1ebf sau synap 5-HT.<\/span><\/p>\n C\u00e1c nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p bao g\u1ed3m c\u00e1c b\u1ec7nh l\u00fd b\u1ea5t th\u01b0\u1eddng di truy\u1ec1n, b\u1ec7nh tinh ho\u00e0n lac cho, s\u1eed d\u1ee5ng thu\u1ed1c, c\u00e1c b\u1ec7nh l\u00fd th\u1ea7n kinh nh\u01b0 Parkinson va da x\u01a1 c\u1ee9ng, t\u00ecnh tr\u1ea1ng ch\u1ea5n th\u01b0\u01a1ng c\u1ed9t s\u1ed1ng v\u00e0 vi\u00eam c\u1ed9t s\u1ed1ng c\u1eaft ngang.<\/span><\/p>\n C\u00e1c nguy\u00ean nh\u00e2n nguy\u00ean ph\u00e1t g\u00e2y suy sinh d\u1ee5c th\u01b0\u1eddng g\u1eb7p bao g\u1ed3m: h\u1ed9i ch\u1ee9ng Kallmann, c\u00e1c kh\u1ed1i u t\u1ea1i tuy\u1ebfn y\u00ean g\u00e2y t\u0103ng prolactin m\u00e1u. C\u00e1c t\u00e1c \u0111\u1ed9ng l\u00ean v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i – tuy\u1ebfn y\u00ean g\u00e2y \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng ti\u1ebft xung c\u00e1c hormon h\u01b0\u1edbng sinh duc nh\u01b0: GnRH, LH, FSH g\u00e2y \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a tr\u1ee5c d\u01b0\u1edbi \u0111\u1ed3i – tuy\u1ebfn y\u00ean – t\u1ec9nh ho\u00e0n. M\u1ed9t s\u1ed1 h\u1ec7 qu\u1ea3 bao g\u1ed3m: ho\u1ea1t \u0111\u1ed9ng n\u1ed9i ti\u1ebft b\u1ecb \u1ee9c ch\u1ebf, t\u1ebf b\u00e0o Sertoli b\u1ecb \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p tinh tr\u00f9ng, t\u1ebf b\u00e0o Leydig b\u1ecb \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p testosterone.<\/span><\/p>\n C\u00e1c nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t t\u1ea1i tinh ho\u00e0n bao g\u1ed3m: t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng t\u1ea1i ch\u1ed7 nh\u01b0 quai b\u1ecb bi\u1ebfn ch\u1ee9ng vi\u00eam tinh ho\u00e0n, s\u1ef1 xo\u1eafn tinh ho\u00e0n, s\u1ef1 tr\u1ea3i qua qu\u00e1 tr\u00ecnh ho\u00e1 x\u1ea1 tr\u1ecb,… M\u1eb7c d\u00f9 \u0111\u01b0\u1ee3c k\u00edch th\u00edch m\u1ed9t c\u00e1ch \u0111\u1ea7y \u0111\u1ee7 t\u1eeb h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, nh\u01b0ng c\u00e1c t\u1ebf b\u00e0o sinh d\u1ee5c t\u1ea1i tinh ho\u00e0n kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng \u0111\u1ea7y \u0111\u1ee7 v\u1edbi c\u00e1c hormone n\u1ed9i ti\u1ebft h\u01b0\u1edbng sinh d\u1ee5c.<\/span><\/p>\n T\u00ecnh tr\u1ea1ng suy sinh duc c\u00f3 th\u1ec3 x\u1ea3y ra tr\u01b0\u1edbc sinh. S\u1ef1 thi\u1ebfu h\u1ee5t testosterone tr\u01b0\u1edbc sinh s\u1ebd l\u00e0m thay \u0111\u1ed5i s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a b\u1ed9 ph\u1eadn sinh d\u1ee5c, g\u00e2y ra c\u00e1c r\u1ed1i lo\u1ea1n trong qu\u00e1 tr\u00ecnh h\u00ecnh th\u00e0nh b\u1ed9 ph\u1eadn sinh d\u1ee5c ngo\u00e0i nh\u01b0 l\u1ed7 ti\u1ec3u th\u1ea5p, t\u1ec9nh ho\u00e0n l\u1ea1c ch\u1ed7, v\u00e0 b\u1ed9 ph\u1eadn sinh d\u1ee5c ngo\u00e0i n\u1eef ho\u00e1. Nh\u1eefng thay \u0111\u1ed5i v\u1ec1 m\u1eb7t gi\u1ea3i ph\u1eabu n\u00e0y s\u1ebd l\u00e0m suy gi\u1ea3m ch\u1ee9c n\u0103ng sinh d\u1ee5c trong t\u01b0\u01a1ng lai. C\u00e1c v\u1ea5n \u0111\u1ec1 ch\u00ednh trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p l\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c nh\u1eadn bi\u1ebft v\u00e0 ch\u1ea9n \u0111o\u00e1n khi m\u1edbi sinh v\u00e0 r\u1ea5t kh\u00f3 \u0111i\u1ec1u tr\u1ecb sau 2 tu\u1ed5i do vai tr\u00f2 gi\u1edbi v\u00e0 xu h\u01b0\u1edbng t\u00ednh d\u1ee5c \u0111\u00e3 \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp.<\/span><\/p>\n Trong tr\u01b0\u1eddng h\u1ee3p r\u1ed1i lo\u1ea1n tr\u01b0\u1edbc tu\u1ed5i d\u1eady th\u00ec, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 m\u1eafc t\u00ecnh tr\u1ea1ng d\u1eady th\u00ec mu\u1ed9n, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a \u1edf tr\u1ebb trai l\u00e0 kh\u00f4ng c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m sinh d\u1ee5c th\u1ee9 c\u1ea5p (t\u0103ng k\u00edch th\u01b0\u1edbc tinh ho\u00e0n) tr\u01b0\u1edbc 14 tu\u1ed5i Nh\u1eefng c\u1eadu b\u00e9 n\u00e0y kh\u00f4ng th\u1ec3 hi\u1ec7n h\u1ee9ng th\u00fa t\u00ecnh d\u1ee5c, gi\u1ea3m xu h\u01b0\u1edbng t\u1ef1 k\u00edch th\u00edch. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n s\u1ebd c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n kh\u00e1c nh\u01b0 kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng c\u01b0\u01a1ng d\u01b0\u01a1ng, thay \u0111\u1ed5i h\u00e0nh vi t\u00ecnh d\u1ee5c. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi s\u1ebd kh\u00f4ng c\u00f3 s\u1ef1 ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng v\u1ec1 \u0111\u1eb7c t\u00ednh t\u00ecnh d\u1ee5c nam gi\u1edbi tr\u01b0\u1edfng th\u00e0nh, t\u1eeb \u0111\u00f3 \u0111\u1eddi s\u1ed1ng t\u00ecnh d\u1ee5c s\u1ebd b\u1ecb suy gi\u1ea3m nghi\u00eam tr\u1ecdng.<\/span><\/p>\n Thi\u1ebfu h\u1ee5t testosterone \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh s\u1ebd g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c so v\u1edbi c\u00e1c d\u1ea1ng suy sinh d\u1ee5c \u0111\u00e3 \u0111\u1ec1 c\u1eadp tr\u01b0\u1edbc \u0111\u00f3. C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ed9 ph\u1eadn sinh d\u1ee5c ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng, c\u00e1c \u0111\u1eb7c t\u00ednh sinh d\u1ee5c ph\u1ee5 ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng ch\u1ee9c n\u0103ng v\u00e0 h\u00e0nh vi t\u00ecnh d\u1ee5c b\u00ecnh th\u01b0\u1eddng cho \u0111\u1ebfn khi b\u1eaft \u0111\u1ea7u suy sinh \u0111\u1ee5c. C\u00e1c tri\u1ec7u ch\u1ee9ng t\u00ecnh d\u1ee5c bao g\u1ed3m m\u1ea5t ham mu\u1ed1n t\u00ecnh d\u1ee5c, r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng, gi\u1ea3m ham mu\u1ed1n t\u00ecnh d\u1ee5c, r\u1ee5ng l\u00f4ng tr\u00ean c\u01a1 th\u1ebf v\u00e0 b\u1ed1c h\u1ecfa. C\u00e1c bi\u1ebfn ch\u1ee9ng chuy\u1ec3n h\u00f3a l\u00e0 m\u1ea5t kh\u1ed1i l\u01b0\u1ee3ng x\u01b0\u01a1ng. thi\u1ec3u c\u01a1, t\u0103ng c\u00e2n, t\u0103ng m\u1ee1 c\u01a1 th\u1ebf v\u00e0 t\u0103ng nguy c\u01a1 c\u00e1c b\u1ec7nh l\u00fd tim m\u00e1u.<\/span><\/p>\n Suy gi\u1ea3m kh\u1ea3 n\u0103ng sinh t\u1ed5ng h\u1ee3p tinh tr\u00f9ng do s\u1ef1 suy tinh ho\u00e0n nguy\u00ean ph\u00e1t c\u00f3 nhi\u1ec1u m\u1ee9c \u0111\u1ed9 n\u1eb7ng n\u00e9 kh\u00e1c nhau: t\u1eeb v\u00f4 tinh (kh\u00f4ng c\u00f3 tinh tr\u00f9ng trong m\u1eabu tinh dich) cho \u0111\u1ebfn thi\u1ebfu tinh (< 39 tri\u1ec7u tinh tr\u00f9ng\/m\u1eabu tinh d\u1ecbch). V\u00f2 t\u1ec9nh \u0111\u01b0\u1ee3c chia th\u00e0nh nhi\u1ec1u nh\u00f3m nguy\u00ean nh\u00e2n kh\u00e1c nhau ph\u1ee5 thu\u1ed9c v\u00e0o k\u1ebft qu\u1ea3 sinh thi\u1ebft m\u00f4 tinh ho\u00e0n bao g\u1ed3m: H\u1ed9i ch\u1ee9ng t\u1ebf b\u00e0o Sertoli (Sertoli cell only syndrome – PCOS); H\u1ed9i ch\u1ee9ng \u1ee9c ch\u1ebf tr\u01b0\u1edfng th\u00e0nh tinh tr\u00f9ng \u1edf c\u00e1c giai \u0111o\u1ea1n kh\u00e1c nhau (tinh nguy\u00ean b\u00e0o, tinh b\u00e0o, tinh tr\u00f9ng); ng\u01b0ng sinh tinh. T\u01b0\u01a1ng t\u1ef1 v\u1edbi k\u1ebft qu\u1ea3 gi\u1ea3i ph\u1eabu b\u1ec7nh, k\u1ebft qu\u1ea3 c\u1ee7a FSH, LH, th\u1ec3 t\u00edch tinh tr\u00f9ng v\u00e0 androgen c\u00f3 s\u1ef1 dao \u0111\u1ed9ng kh\u00e1c nhau ph\u1ee5 thu\u1ed9c v\u00e0o kh\u1ea3 n\u0103ng sinh t\u1ec9nh c\u1ee7a b\u1ec7nh nh\u00e2n. S\u1ef1 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t gi\u1eefa c\u00e1c h\u00ecnh th\u00e1i b\u1ec7nh l\u00fd kh\u00e1c nhau v\u1ec1 suy gi\u1ea3m sinh t\u00ednh \u1edf nam gi\u1edbi g\u1ee3i \u00fd kh\u1ea3 n\u0103ng \u0111\u00f3ng g\u00f3p v\u00e0o <\/span>c\u01a1 ch\u1ebf g\u00e2y b\u1ec7nh c\u00e1c y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn di truy\u1ec1n ho\u1eb7c b\u1ea7m sinh. Nhi\u1ec1u lo\u1ea1i \u0111\u1ed9t bi\u1ebfn gen v\u00e0 b\u1ea5t th\u01b0\u1eddng nhi\u1ec5m s\u1eafc th\u1ec3 \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y.<\/span><\/p>\n C\u00e1c b\u1ec7nh l\u00fd di truy\u1ec1n th\u01b0\u1eddng g\u1eb7p bao g\u1ed3m: c\u00e1c b\u1ea5t th\u01b0\u1eddng c\u1ea5u tr\u00fac NST, cdu tr\u00fac c\u1ee7a \u0111o\u00e0n h\u1ec7 gen,\u00a0 r\u1ed1i lo\u1ea1n trong bi\u1ec3u hi\u1ec7n ch\u1ee9c n\u0103ng c\u1ee7a gen. H\u1ed9i ch\u1ee9ng Klinefelter l\u00e0 m\u1ed9t trong nh\u1eefng r\u1ed1i lo\u1ea1n di truy\u1ec1n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t d\u1eabn \u0111\u1ebfn v\u00f4 sinh \u1edf nam gi\u1edbi. T\u00ecnh tr\u1ea1ng b\u1ed9 nhi\u1ec5m s\u1eafc th\u1ec3 47,XXY l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y n\u00ean b\u1ec7nh l\u00fd n\u00e0y. 80% c\u00e1c tr\u01b0\u1eddng h\u1ee3p Klinefelter c\u00f3 b\u1ed9 NST to\u00e0n b\u1ed9 l\u00e0 47,XXY, 20% c\u01b0ng h\u1ee3p c\u00f2n l\u1ea1i l\u00e0 th\u1ec3 d\u1ecb b\u1ed9i, th\u1ec3 kh\u1ea3m 46,XY\/47, XXY,ho\u1eb7c b\u1ea5t th\u01b0\u1eddng c\u1ea5u tr\u00fac nhi\u1ec5m s\u1eafc th\u1ec3 X- C\u00e1c tr\u01b0\u1eddng h\u1ee3p th\u1ec3 kh\u1ea3m \u0111\u01b0\u1ee3c nh\u1eadn th\u1ea5y \u00edt b\u1ecb \u1ea3nh h\u01b0\u1edfng nghi\u00eam tr\u1ecdng h\u01a1n. S\u1ef1 hi\u1ec7n di\u1ec7n hai NST X tr\u00ean b\u1ed9 NST \u1edf nam gi\u1edbi s\u1ebd d\u1eabn \u0111\u1ebfn s\u1ef1 r\u1ed1i lo\u1ea1n sinh t\u1ed5ng h\u1ee3p tinh tr\u00f9ng v\u00e0 th\u1ea5t b\u1ea1i trong qu\u00e1 tr\u00ecnh gi\u1ea3m ph\u00e2n sinh tinh tr\u00f9ng. Trong h\u1ed9i ch\u1ee9ng Klinefelter, s\u1ef1 tho\u00e1i ho\u00e1 cic \u1ed1ng sinh tinh b\u1eaft \u0111\u1ea7u xu\u1ea5t hi\u1ec7n ngay t\u1eeb tr\u01b0\u1edbc tudi d\u1eady th\u00ec, va d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng hyalin h\u00f3a ho\u00e0n to\u00e0n c\u00e1c \u1ed1ng \u1edf tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh. Ngo\u00e0i ra, nam gi\u1edbi Klinefelter c\u00f2n \u0111\u01b0\u1ee3c ch\u1ee9ng minh m\u1eafc ph\u1ea3i nh\u1eefng r\u1ed1i lo\u1ea1n n\u1eb7ng n\u1ec1 \u1edf ho\u1ea1t \u0111\u1ed9ng tinh d\u1ee5c nh\u01b0 gi\u1ea3m ham mu\u1ed1n, r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng n\u1eb7ng n\u1ec1, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p m\u1eafc ph\u1ea3i nh\u1eefng r\u1ed1i lo\u1ea1n v\u1ec1 h\u00e0nh vi v\u00e0 nh\u1eadn th\u1ee9c, t\u1eeb \u0111\u00f3 g\u1eb7p nh\u1eefng tr\u1edf ng\u1ea1i l\u1edbn trong qu\u00e1 tr\u00ecnh quan h\u1ec7 t\u00ecnh d\u1ee5c.<\/span><\/p>\n <\/p>\n M\u1ed9t s\u1ed1 b\u1ea5t th\u01b0\u1eddng di truy\u1ec1n kh\u00e1c nh\u01b0 h\u1ed9i ch\u1ee9ng NST 47,XYY; h\u1ed9i ch\u1ee9ng NST 46, XX. Nh\u1eefng h\u1ed9i ch\u1ee9ng n\u00e0y th\u01b0\u1eddng din \u0111\u1ebfn r\u1ed3i lo\u1ea1n ch\u1ea5t l\u01b0\u1ee3ng tinh tr\u00f9ng m\u1ee9c \u0111\u1ed9 nh\u1eb9 cho \u0111\u1ebfn t\u00ecnh tr\u1ea1ng v\u00f4 tinh. C\u00e1c r\u1ed1i lo\u1ea1n v\u1ec1 ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh \u1edf b\u1ec7nh nh\u00e2n m\u1eafc c\u00e1c h\u1ed9i ch\u1ee9ng n\u00e0y. \u0110\u1eb7c bi\u1ec7t, l\u01b0u \u00fd nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 nguy c\u01a1 cao d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng t\u1ebf b\u00e0o Sertoli \u0111\u01a1n thu\u1ea7n, t\u1eeb \u0111\u00f3 g\u00e2y r\u1ed1i lo\u1ea1n n\u1eb7ng n\u1ec1 kh\u1ea3 n\u0103ng sinh tinh.<\/span><\/p>\n H\u1ed9i ch\u1ee9ng 46,XX \u1edf nam gi\u1edbi (hay c\u00f2n g\u1ecdi l\u00e0 h\u1ed9i ch\u1ee9ng Chapelle) c\u00f3 t\u1ef7 l\u1ec7 1\/20.000 tr\u1ebb em m\u1edbi sinh ra. H\u00ecnh th\u00e1i c\u1ee7a h\u1ed9i ch\u1ee9ng kh\u00e1c so v\u1edbi h\u1ed9i ch\u1ee9ng Klinefelter v\u1edbi ki\u1ec3u h\u00ecnh nam gi\u1edbi c\u00f3 t\u1ea7m v\u00f3c ng\u01b0\u1eddi th\u01b0\u1eddng nh\u1ecf h\u01a1n, v\u1edbi t\u1ef7 l\u1ec7 l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 c\u1ea5u tr\u00fac v\u00fa t\u01b0\u01a1ng t\u1ef1 n\u1eef gi\u1edbi, k\u00e8m theo t\u00ecnh tr\u1ea1ng v\u00f4 tinh.<\/span><\/p>\n H\u01a1n n\u1eefa, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 h\u00ecnh th\u00e1i b\u1ed9 ph\u1eadn sinh d\u1ee5c kh\u00f4ng r\u00f5 r\u00e0ng. S\u1ef1 chuy\u1ec3n \u0111o\u1ea1n c\u1ee7a SUY (y\u1ebfu t\u1ed1 quan tr\u1ecdng \u0111\u1ea3m b\u1ea3o s\u1ef1 bi\u1ec7t ho\u00e1 r\u00f5 r\u00e0ng c\u01a1 quan sinh d\u1ee5c th\u00e0nh tinh ho\u00e0n \u1edf th\u1eddi k\u1ef3 ph\u00f4i b\u00e0o) tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 X ch\u1ecbu tr\u00e1ch nhi\u1ec7m ch\u00ednh cho 80-90% tr\u01b0\u1eddng h\u1ee3p m\u1eafc h\u1ed9i ch\u1ee9ng n\u00e0y. Tr\u00ecnh t\u1ef1 gen t\u1ea1i v\u00f9ng gi\u1ea3 nguy\u00ean t\u1eed (pseudoautosomal region – PAR) tr\u00ean c\u00e1nh ng\u1eafn c\u1ee7a NST Y, v\u00e0 s\u1ef1 t\u00e1i c\u1ea5u tr\u00fac tr\u00ecnh t\u1ef1 gen c\u00f3 th\u1ebf m\u1eafc l\u1ed7i trong qu\u00e1 tr\u00ecnh ti\u1ebfp h\u1ee3p hai NST gi\u1edbi t\u00ednh t\u1ea1i v\u00f9ng PAR. Ph\u01b0\u01a1ng ph\u00e1p TESE kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o ch\u1ec9 \u0111\u1ecbnh tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y (kh\u00e1c v\u1edbi nam gi\u1edbi h\u1ed9i ch\u1ee9ng Klinefelter) b\u1edfi v\u00ec s\u1ef1 thi\u1ebfu h\u1ee5t y\u1ebfu t\u1ed1 AZF, \u0111\u00f3ng ngh\u0129a v\u1edbi s\u1ef1 sinh tinh c\u1ee5c b\u1ed9 t\u1ea1i ch\u1ed7 l\u00e0 kh\u00f4ng th\u1ec3 x\u1ea3y ra. Nam gi\u1edbi m\u1eafc h\u1ed9i<\/span><\/p>\n ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 c\u00f3 thi\u1ec3u n\u0103ng n\u1ed9i ti\u1ebft sinh d\u1ee5c, v\u00ec v\u1eady vi\u1ec7c \u0111\u00e1nh gi\u00e1 n\u1ed9i ti\u1ebft (bao g\u1ed3m FSH, LH, n\u1ed3ng \u0111\u1ed9 testosterone) l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft.<\/span><\/p>\n Vi\u1ec7c m\u1ea5t \u0111o\u1ea1n m\u1edbi tr\u00ean nh\u00e1nh d\u00e0i c\u1ee7a nhi\u1ec5m s\u1eafc th\u1ec3 Y (Yq) \u1edf nam gi\u1edbi vo tinh \u0111\u00e3 th\u00fac diy<\/span><\/p>\n vi\u1ec7c nghi\u00ean c\u1ee9u nh\u1eb1m l\u00e0m r\u00f5 y\u1ebfu t\u1ed1 AZF \u1edf tinh tr\u00f9ng.<\/span><\/p>\n Kaletsky v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 x\u00e1c \u0111\u1ecbnh c\u00e1c v\u00f9ng AZF \u1edf c\u1ea5p \u0111\u1ed9 ph\u00e2n t\u1eed v\u00e0 x\u00e1c \u0111\u1ecbnh h\u00e0m l\u01b0\u1ee3ng gen c\u1ee7a c\u00e1c v\u00f9ng n\u00e0y. T\u1ea7n su\u1ea5t \u0111\u1ed9t bi\u1ebfn m\u1ea5t \u0111o\u1ea1n AZF trong d\u00e2n s\u1ed1 n\u00f3i chung l\u00e0 kh\u00e1 hi\u1ebfm (1\/4.000), nh\u01b0ng t\u1ef7 l\u1ec7 n\u00e0y t\u0103ng cao v\u1edbi 10% \u1edf b\u1ec7nh nh\u00e2n v\u00f4 sinh kh\u00f4ng t\u1eafc ngh\u1ebdn, v\u00e0 \u1edf 5% nam gi\u1edbi b\u1ecb thi\u1ec3u tinh tr\u00f9ng n\u1eb7ng (nh\u1eefng ng\u01b0\u1eddi c\u00f3 < 2 tri\u1ec7u tinh tr\u00f9ng\/ml khi xu\u1ea5t tinh). M\u1ea5t \u0111o\u1ea1n AZF l\u00e0 nguy\u00ean nh\u00e2n di truy\u1ec1n ph\u1ea7n t\u1eed th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a t\u00ecnh tr\u1ea1ng kh\u00f4ng c\u00f3 tinh tr\u00f9ng v\u00e0 thi\u1ec3u tinh tr\u00f9ng nghi\u00eam tr\u1ecdng. Vi\u1ec7c s\u00e0ng l\u1ecdc nh\u1eefng mit \u0111o\u1ea1n n\u00e0y \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf nam gi\u1edbi c\u00f3 mau tinh d\u1ecbch < 5 tri\u1ec7u tinh tr\u00f9ng\/ml.<\/span><\/p>\n Trong qua trinh kich thich tinh dyc, hoat \u0111\u1ed9ng \u0111\u1ed1i giao c\u1ea3m t\u1eeb t\u1ee7y s\u1ed1ng b\u1eaft \u0111\u1ea7u m\u1ed9t lo\u1ea1t c\u00e1c s\u1ef1 ki\u1ec7n gi\u1ea3i ph\u00f3ng oxit nitric (NO) v\u00e0 l\u00e0m ting guanosine monophosphate tu\u1ea7n ho\u00e0n n\u1ed9i b\u00e0o (cGMP). Tang cGMP din \u0111\u1ebfn gi\u00e3n c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u v\u00e0 t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u v\u00e0o th\u1ec3 hang. D\u00f2ng m\u00e1u ch\u1ea3y v\u00e0o nhanh ch\u00f3ng n\u00e0y din \u0111\u1ebfn ch\u00e8n \u00e9p m\u1ea1ng l\u01b0\u1edbi t\u0129nh m\u1ea1ch, l\u00e0m gi\u1ea3m d\u00f2ng ch\u1ea3y ra c\u1ee7a t\u0129nh m\u1ea1ch, do \u0111\u00f3 l\u00e0m t\u0103ng \u00e1p l\u1ef1c trong th\u1ec3 hang v\u00e0 g\u00e2y c\u01b0\u01a1ng c\u1ee9ng.<\/span><\/p>\n C\u00e1c b\u1ea5t th\u01b0\u1eddng th\u1ea7n kinh li\u00ean quan \u0111\u1ebfn ho\u1ea1t \u0111\u1ed9ng ch\u1ee9c n\u0103ng sinh l\u00fd k\u1ec3 tr\u00ean c\u00f3 th\u1ebf g\u00e2y n\u00ean nh\u1eefng t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c l\u00ean ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c \u1edf nam gi\u1edbi. M\u1ed9t s\u1ed1 c\u00e1c r\u1ed1i lo\u1ea1n th\u01b0\u1eddng g\u1eb7p nh\u01b0: c\u00e1c b\u1ec7nh l\u00e0m suy y\u1ebfu h\u1ec7 th\u1ea7n kinh, ch\u1eb3ng h\u1ea1n nh\u01b0 b\u1ec7nh da x\u01a1 c\u1ee9ng v\u00e0 b\u1ec7nh Parkinson, c\u00f3 th\u1ebf l\u00e0m gi\u00e1n \u0111o\u1ea1n c\u00e1c con \u0111\u01b0\u1eddng th\u1ea7n\u00a0 kinh g\u00e2y c\u01b0\u01a1ng c\u1ee9ng, g\u00e2y ra r\u1ed3i loan c\u01b0\u01a1ng d\u01b0\u01a1ng. H\u01a1n n\u1eefa, ch\u0103n th\u01b0\u01a1ng t\u1ee7y s\u1ed1ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0m gi\u00e1n \u0111o\u1ea1n c\u00e1c \u0111\u01b0\u1eddng di truy\u1ec1n th\u1ea7n kinh n\u00e0y v\u00e0 g\u00e2y ra r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng \u1edf nam gi\u1edbi. C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 ch\u1ee9c n\u0103ng v\u00e0 gi\u1ea3i ph\u1eabu th\u1ea7n kinh cho th\u1ea5y c\u00f3 m\u1ed1i quan h\u1ec7 gi\u1eefa m\u1ee9c \u0111\u1ed9 ch\u1ea5n th\u01b0\u01a1ng v\u00e0 ch\u1ee9c n\u0103ng<\/span><\/p>\n c\u01b0\u01a1ng d\u01b0\u01a1ng c\u1ee7a nam gi\u1edbi do suy gi\u1ea3m c\u00e1c con \u0111\u01b0\u1eddng \u0111i xu\u1ed1ng, k\u00edch th\u00edch v\u00e0 \u1ee9c ch\u1ebf c\u00f3 trong t\u1ee7y s\u1ed1ng.<\/span><\/p>\n Kho\u1ea3ng 20% nam gi\u1edbi s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta (thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 beta) \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p b\u1ecb r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng. Thu\u1ed1c ch\u1ee7 v\u1eadn alpha t\u00e1c d\u1ee5ng trung \u01b0\u01a1ng (v\u00ed d\u1ee5 clonidin) v\u00e0 thu\u1ed1c l\u1ee3i ti\u1ec3u c\u0169ng c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c l\u00e0m suy gi\u1ea3m ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c. Thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 aldosterone spironolactone c\u00f3 kh\u1ea3 n\u0103ng ng\u0103n ch\u1eb7n th\u1ee5 th\u1ec3 androgen v\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01b0\u01a1ng d\u01b0\u01a1ng v\u00e0 ch\u1ee9ng v\u00fa to \u1edf nam gi\u1edbi.<\/span><\/p>\n Nhi\u1ec1u thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m g\u00e2y kh\u00f3 kh\u0103n trong t\u00ecnh d\u1ee5c. Thu\u1ed1c \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu serotonin c\u00f3 ch\u1ecdn l\u1ecdc v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu serotonin – noradrenaline g\u00e2y \u1ee9c ch\u1ebf ham mu\u1ed1n, g\u00e2y r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng, Ch\u00fang c\u0169ng l\u00e0m gi\u1ea3m c\u1ef1c kho\u00e1i \u1edf S-7 1% b\u1ec7nh nh\u00e2n. T\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 tr\u00ec ho\u00e3n xu\u1ea5t tinh s\u1edbm.<\/span><\/p>\n Thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m ba v\u00f2ng \u1ee9c ch\u1ebf ham mu\u1ed1n t\u00ecnh d\u1ee5c v\u00e0 c\u1ef1c kho\u00e1i. T\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c lo\u1ea1i thu\u1ed1c c\u1ee5 th\u1ec3 kh\u00e1c nhau t\u00f9y thu\u1ed9c v\u00e0o c\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a ch\u00fang. V\u00ed d\u1ee5, clomipramine g\u00e2y kh\u00f3 \u0111\u1ea1t c\u1ef1c kho\u00e1i \u1edf 90% b\u1ec7nh nh\u00e2n, trong khi nortriptyline g\u00e2y r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng nhi\u1ec1u h\u01a1n nh\u01b0ng \u00edt \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u1ef1c kho\u00e1i h\u01a1n.<\/span><\/p>\n \u0110\u00e0n \u00f4ng d\u00f9ng thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n c\u00f3 th\u1ebf xu\u1ea5t hi\u1ec7n r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng, gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng c\u1ef1c kho\u00e1i v\u1edbi xu\u1ea5t tinh chim, b\u1ecb \u1ee9c ch\u1ebf ho\u1eb7c xu\u1ea5t t\u1ec9nh ng\u01b0\u1ee3c d\u00f2ng v\u00e0 gi\u1ea3m h\u1ee9ng th\u00fa v\u1edbi t\u00ecnh d\u1ee5c. Ph\u1ea7n l\u1edbn c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n g\u00e2y ra r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c b\u1eb1ng c\u00e1ch phong t\u1ecfa th\u1ee5 th\u1ebf dopamine. \u0110i\u1ec1u n\u00e0y g\u00e2y ra ch\u1ee9ng ting prolactinaemia v\u1edbi s\u1ef1 \u1ee9c ch\u1ebf sau \u0111\u00f3 c\u1ee7a tr\u1ee5c h\u1ea1 \u0111\u1ed3i – tuy\u1ebfn y\u00ean – tuy\u1ebfn sinh d\u1ee5c v\u00e0 thi\u1ec3u n\u0103ng sinh d\u1ee5c \u1edf c\u1ea3 hai gi\u1edbi. \u0110i\u1ec1u n\u00e0y l\u00e0m gi\u1ea3m ham mu\u1ed1n t\u00ecnh d\u1ee5c v\u00e0 l\u00e0m gi\u1ea3m h\u01b0ng ph\u1ea5n v\u00e0 c\u1ef1c kho\u00e1i.<\/span><\/p>\n Tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u d\u00f9ng thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 dopamin, \u0111i\u1ec1u c\u1ea7n thi\u1ebft l\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 <\/span>prolactin c\u01a1 b\u1ea3n, v\u00ec s\u1ef1 gia t\u0103ng sau \u0111\u00f3 c\u00f3 th\u00e9 l\u00e0 do thu\u1ed1c. C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y t\u0103ng prolactin m\u00e1u kh\u00f4ng do thu\u1ed1c nh\u01b0 kh\u1ed1i u tuy\u1ebfn y\u00ean n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 dopamin.<\/span><\/p>\n R\u1ed1i lo\u1ea1n c\u01b0\u01a1ng c\u00f3 m\u1ed1i t\u01b0\u01a1ng quan thu\u1eadn v\u1edbi tu\u1ed5i t\u00e1c: 52% nam gi\u1edbi t\u1eeb 40 \u0111\u1ebfn 70 tu\u1ed5i th\u01b0\u1eddng g\u1eb7p t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng \u1edf c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau. M\u1ed9t nghi\u00ean c\u1ee9u c\u1eaft ngang cho th\u1ea5y t\u1ef7 l\u1ec7 m\u1eafc r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng \u1edf nam gi\u1edbi \u1edf \u0111\u1ed9 tu\u1ed5i 70 t\u0103ng g\u1ea5p b\u1ed1n l\u1ea7n so v\u1edbi nam gi\u1edbi \u1edf \u0111\u1ed9 tu\u1ed5i 20.<\/span><\/p>\n M\u1ee9c \u0111\u1ed9 ph\u1ed5 bi\u1ebfn c\u1ee7a t\u00ecnh tr\u1ea1ng gi\u1ea3m h\u1ee9ng th\u00fa ho\u1eb7c ham mu\u1ed1n \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong nghi\u00ean c\u1ee9u v\u1edbi t\u1ef7 l\u1ec7 t\u1eeb 15% \u0111\u1ebfn 25% \u0111\u1ed1i v\u1edbi c\u00e1c \u0111\u1ed9 tudi v\u00e0 v\u1ecb tr\u00ed \u0111\u1ecba l\u00fd kh\u00e1c nhau. M\u1ee9c \u0111\u1ed9 quan t\u00e2m t\u00ecnh d\u1ee5c \u00e9n \u0111\u1ecbnh t\u1eeb cu\u1ed1i tu\u1ed5i thi\u1ebfu ni\u00ean \u0111\u1ebfn kho\u1ea3ng 60, tuy v\u1eady, sau \u0111\u1ed9 tu\u1ed5i n\u00e0y t\u1ef7 l\u1ec7 n\u00e0y suy gi\u1ea3m \u0111\u00e1ng k\u1ec3.<\/span><\/p>\n H\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u b\u00e1o c\u00e1o t\u1ef7 l\u1ec7 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u1ef1c kho\u00e1i ph\u1ed5 bi\u1ebfn trong kho\u1ea3ng 1 1,8% \u0111\u1ebfn 19,4%. B\u00e1o c\u00e1o to\u00e0n c\u1ea7u v\u1ec1 r\u1ed1i lo\u1ea1n kh\u1ea3 n\u0103ng c\u1ef1c kho\u00e1i c\u1ee7a Nicolosi v\u00e0 c\u1ed9ng s\u1ef1 cho th\u1ea5y t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh t\u1eeb S% \u0111\u1ebfn 8% \u0111\u1ed1i v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c khu v\u1ef1c tr\u00ean th\u1ebf gi\u1edbi ngo\u1ea1i tr\u1eeb \u0110\u00f4ng v\u00e0 \u0110\u00f4ng Nam A, n\u01a1i c\u00f3 t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh l\u00e0 10% \u0111\u1ebfn 15%. T\u1ef7 l\u1ec7 n\u00e0y t\u0103ng l\u00ean g\u1ea5p 1,5 l\u1ea7n \u0111\u1ed1i v\u1edbi nam gi\u1edbi tr\u00ean 40 tu\u1ed5i.<\/span><\/p>\n M\u1ed9t ph\u00e1t hi\u1ec7n c\u1ee7a m\u1ed9t nghi\u00ean c\u1ee9u tong hop gin day l\u00e0 s\u1ef1 kh\u00e1c bi\u1ec7t g\u00e1p 10 l\u1ea7n v\u1ec1 nguy c\u01a1 m\u1eafc r\u1ed1i lo\u1ea1n t\u00ecnh d\u1ee5c li\u00ean quan \u0111\u1ebfn ng\u01b0\u1eddi l\u1edbn tu\u1ed5i, b\u00e1t k\u1ebf t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe hay ch\u1ee9c n\u0103ng c\u01b0\u01a1ng d\u01b0\u01a1ng tr\u01b0\u1edbc \u0111\u00f3.<\/span><\/p>\n <\/p>\n Tinh ho\u00e0n ho\u1ea1t \u0111\u1ed9ng t\u1ed1i \u01b0u \u1edf nhi\u1ec7t \u0111\u1ed9 35-36\u00b0C. T\u0103ng nhi\u1ec7t \u0111\u1ed9 v\u00f9ng b\u00ecu \u0111\u01b0\u1ee3c nh\u1eadn th\u1ea5y g\u00e2y n\u00ean t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c \u0111\u1ebfn t\u00ednh \u1ed5n \u0111\u1ecbnh c\u1ee7a m\u00e0ng t\u1ebf b\u00e0o tinh tr\u00f9ng v\u00e0 l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng th\u1ee5 t\u1ec9nh t\u1ec9nh tr\u00f9ng, Ngo\u00e0i ra ho\u1ea1t \u0111\u1ed9ng t\u1ed5ng h\u1ee3p testosterone suy gi\u1ea3m r\u00f5 r\u1ec7t, t\u1eeb \u0111\u00f3 g\u00e2y n\u00ean c\u00e1c r\u1ed1i lo\u1ea1n v\u1ec1 ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c nam gi\u1edbi. M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y t\u0103ng nhi\u1ec7t \u0111\u1ed9 v\u00f9ng b\u00ecu nh\u01b0: t\u00ecnh tr\u1ea1ng gi\u00e3n t\u0129nh m\u1ea1ch thong tinh, h\u1ed9i ch\u1ee9ng truy\u1ec1n ho\u00e1, s\u1ef1 ph\u01a1i nhi\u1ec5m v\u1edbi nhi\u1ec7t \u0111\u1ed9 ngo\u1ea1i c\u1ea3nh cao k\u00e9o d\u00e0i nh\u01b0 th\u00f3i quen t\u1eafm n\u01b0\u1edbc n\u00f3ng…<\/span><\/p>\n C\u00e1c b\u1eb1ng ch\u1ee9ng hi\u1ec7n nay \u0111\u1ec1u cho th\u1ea5y \u0111\u01b0\u1ee3c s\u1ef1 c\u1ea3i thi\u1ec7n v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng tinh tr\u00f9ng \u1edf nam gi\u1edbi khi ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c y\u1ebfu t\u1ed1 b\u00e9o ph\u00ec th\u00f4ng qua qu\u00e1 tr\u00ecnh t\u1eadp luy\u1ec7n ho\u1eb7c thay \u0111\u1ed5i ch\u1ebf do \u0103n. M\u1eb7c d\u00f9 c\u00f3 th\u1ebf ch\u1ec9 s\u1ed1 BMI kh\u00f4ng thay \u0111\u1ed5i r\u00f5 r\u1ec7t nh\u01b0ng c\u00e1c ch\u1ec9 s\u1ed1 tinh tr\u00f9ng nh\u01b0 m\u1eadt do, t\u1ef7 l\u1ec7 di dong h\u00ecnh th\u00e1i b\u00ecnh th\u01b0\u1eddng v\u00e0 \u0111\u1ed9 \u0111\u1ee9t g\u00e3y ADN \u0111\u1ec1u c\u00f3 s\u1ef1 c\u1ea3i thi\u1ec7n t\u1ed1t. C\u00e1c nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt nh\u1eadn th\u1ea5y r\u1eb1ng vi\u1ec7c gi\u1ea3m c\u00e2n mang l\u1ea1i c\u00e1c l\u1ee3i \u00edch nh\u01b0 ting chit l\u01b0\u1ee3ng ph\u00f4i, t\u0103ng ph\u00e1t tri\u1ec3n v\u00e0 trao \u0111\u1ed5i ch\u1ea5t \u1edf th\u1ebf h\u1ec7 sau c\u00f3 bo b\u1ecb b\u00e9o ph\u00ec. H\u01a1n n\u1eefa, ch\u1ebf \u0111\u1ed9 \u0103n c\u0169ng c\u00f3 nh\u1eefng m\u1ed1i li\u00ean quan v\u1edbi ch\u1ea5t l\u01b0\u1ee3ng tinh tr\u00f9ng c\u1ee5 th\u1ec3 h\u01a1n: ch\u1ebf \u0111\u1ed9 an<\/span><\/p>\n nhi\u1ec1u tr\u00e1i c\u00e2y, rau c\u1ee7, ch\u1ea5t x\u01a1, h\u1ea3i s\u1ea3n, h\u1ea1t, d\u1ea7u th\u1ef1c v\u1eadt v\u00e0 c\u00e1c th\u1ef1c ph\u1ea9m ch\u1ee9a nhi\u1ec1u ch\u1ea5t ch\u1ed1ng oxy h\u00f3a. BG sung c\u00e1c vi ch\u1ea5t nh\u01b0 carotenes, acid ascorbic, tocopherols, selenium, co-enzyme Q10 c\u0169ng c\u00f3 nh\u1eefng c\u1ea3i thi\u1ec7n r\u00f5 r\u1ec7t. T\u1eadp luy\u1ec7n th\u1ec3 d\u1ee5c m\u1ee9c \u0111\u1ed9 v\u1eeba ph\u1ea3i c\u00f3 th\u1ec3 thay \u0111\u1ed5i c\u00e1c ch\u1ec9 s\u1ed1 tinh d\u1ecbch, gi\u1ea3m stress oxy h\u00f3a v\u00e0 s\u1ef1 \u0111\u1ee9t g\u00e3y ADN tinh tr\u00f9ng. Tuy nhi\u00ean, vi\u1ec7c v\u1eadn \u0111\u1ed9ng hay ho\u1ea1t \u0111\u1ed9ng th\u1ebf l\u1ef1c qu\u00e1 s\u1ee9c n\u00ean h\u1ea1n ch\u1ebf b\u1edfi v\u00ec nh\u1eefng t\u00e1c d\u1ee5ng ng\u01b0\u1ee3c l\u1ea1i.<\/span><\/p>\n Gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng tinh<\/b><\/p>\n Gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng tinh l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y n\u00ean v\u00f4 sinh \u1edf nam gi\u1edbi, v\u1edbi t\u1ef7 l\u1ec7 15% \u1edf qu\u00e1n th\u00e9 nam gi\u1edbi n\u00f3i chung v\u00e0 40% \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p v\u00f4 sinh. Stress oxy h\u00f3a l\u00e0 c\u01a1 ch\u1ebf \u1ea3nh h\u01b0\u1edfng ch\u00ednh c\u1ee7a b\u1ec7nh l\u00fd n\u00e0y. S\u1ef1 t\u0103ng ROS v\u00e0 suy gi\u1ea3m n\u1ed3ng \u0111\u1ed9 c\u00e1c ch\u1ea5t ch\u1ed1ng oxy h\u00f3a th\u01b0\u1eddng hi\u1ec7n di\u1ec7n \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng tinh. \u1ede Nam gi\u1edbi gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng t\u1ec9nh, ROS \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t t\u1eeb 3 lo\u1ea1i t\u1ebf b\u00e0o d\u01b0\u1edbi \u0111i\u1ec1u ki\u1ec7n c\u1ee7a nhi\u1ec7t \u0111\u1ed9 cao v\u00e0 thi\u1ebfu oxy. C\u00e1c t\u1ebf b\u00e0o n\u00e0y bao g\u1ed3m t\u1ebf b\u00e0o m\u00e0o tinh, t\u1ebf b\u00e0o n\u1ed9i m\u00f4 \u1edf c\u00e1c \u0111\u00e1m r\u1ed1i gi\u00e3n t\u0129nh m\u1ea1ch, v\u00e0 t\u1ebf b\u00e0o tinh ho\u00e0n nh\u01b0 t\u1ebf b\u00e0o m\u1ea7m, t\u1ebf b\u00e0o Leydig, \u0111\u1ea1i th\u1ef1c b\u00e0o, v\u00e0 t\u1ebf b\u00e0o bi\u1ec3u m\u00f4. \u1ede ty th\u1ec3, stress do nhi\u1ec7t \u0111\u1ed9 cao v\u00e0 thi\u1ebfu oxy c\u00f3 th\u1ec3 k\u00edch ho\u1ea1t tr\u1ef1c ti\u1ebfp l\u00e9n k\u00eanh v\u1eadn chuy\u1ec3n \u0111i\u1ec7n t\u1eed v\u00e0 g\u00e2y t\u0103ng s\u1ea3n xu\u1ea5t ROS. Mic kh\u00e1c, N\u00f3 \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t t\u1eeb tinh ho\u00e0n v\u00e0 c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 tinh ho\u00e0n c\u00f3 gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng tinh c\u00f3 th\u1ec3 k\u00edch ho\u1ea1t ph\u1ee9c h\u1ee3p Iva IV, v\u00e0 sau \u0111\u00f3 ph\u1ee9c h\u1ee3p Ill nh\u1eb1m th\u00fac \u0111\u1ea9y s\u1ea3n xu\u1ea5t ROS. Stress oxy h\u00f3a c\u00f2n \u0111\u00f3ng vai tr\u00f2 ch\u00ednh g\u00e2y t\u1ed5n th\u01b0\u01a1ng m\u00f4 tinh ho\u00e0n. Nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u1eb1m do m\u1ee9c \u0111\u1ed9 stress oxy h\u00f3a trong tinh d\u1ecbch c\u1ee7a nam gi\u1edbi v\u00f4 sinh c\u00f3 gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng tinh v\u00e0 so v\u1edbi nh\u1eefng nam gi\u1edbi vo sinh ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n. K\u1ebft qu\u1ea3 l\u00e0 \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 gi\u00e3n t\u0129nh m\u1ea1ch thing t\u00ednh th\u00ec k\u1ebft qu\u1ea3 n\u1ed3ng \u0111\u1ed9 c\u00e1c g\u1ed1c oxy h\u00f3a cao h\u01a1n r\u00f5 r\u1ec7t nh\u01b0 NO, H;O;, nitric oxide synthase, va MDA.<\/span><\/p>\n C\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4i c\u0169ng c\u00f3 th\u1ec3 s\u1ea3n xu\u1ea5t l\u01b0\u1ee3ng l\u1edbn c\u00e1c g\u1ed1c oxy h\u00f3a. N\u1ed3ng \u0111\u1ed9 NO v\u00e0 eOS trong huy\u1ebft t\u01b0\u01a1ng \u1edf t\u0129nh m\u1ea1ch th\u1eebng tinh c\u1ee7a nh\u1eefng nam gi\u1edbi gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng t\u00ednh cao h\u01a1n h\u1eafn so v\u1edbi nh\u1eefng t\u0129nh m\u1ea1ch kh\u00e1c. C\u00e1c ch\u1ea5t ch\u1ed1ng oxy h\u00f3a enzyme v\u00e0 kh\u1ed5ng ph\u1ea3i enzyme \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111o l\u01b0\u1eddng nh\u1eb1m nghi\u00ean c\u1ee9u t\u00e1c \u0111\u1ed9ng c\u1ee7a stress oxy h\u00f3a \u1edf nam gi\u1edbi v\u00f4 sinh c\u00f3 gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng tinh.<\/span><\/p>\n K\u1ebft qu\u1ea3 nh\u1eadn th\u1ea5y r\u1eb1ng t\u1ed5ng n\u1ed3ng \u0111\u1ed9 c\u00e1c ch\u1ea5t ch\u1ed1ng oxy h\u00f3a th\u1ea5p h\u01a1n \u1edf b\u1ec7nh nh\u00e2n nam v\u00f4 sinh c\u00f3 gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng tinh so v\u1edbi nh\u00f3m nam gi\u1edbi kh\u1ecfe m\u1ea1nh… \u0110i\u1ec1u n\u00e0y ch\u1ee9ng t\u1ecf gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng tinh s\u1ebd s\u1ea3n xu\u1ea5t ROS v\u00e0 din \u0111\u1ebfn c\u00e1c t\u1ed5n th\u01b0\u01a1ng do stress oxy h\u00f3a g\u00e2y n\u00ean. M\u1ee9c \u0111\u1ed9 gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng t\u1ec9nh c\u0169ng li\u00ean quan v\u1edbi m\u1ee9c \u0111\u1ed9 stress oxy h\u00f3a: gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng m\u1ee9c \u0111\u1ed9 c\u00e0ng n\u1eb7ng th\u00ec s\u1ef1 r\u1ed1i lo\u1ea1n oxy h\u00f3a c\u00e0ng cao.<\/span><\/p>\n H\u1ed9i ch\u1ee9ng chuy\u1ec3n h\u00f3a<\/b><\/p>\n H\u1ed9i ch\u1ee9ng r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a bao g\u1ed3m: t\u0103ng huy\u1ebft \u00e1p, t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, b\u00e9o ph\u00ec trung t\u00e2m, t\u0103ng triglyceride m\u00e1u, gi\u1ea3m HDL-cholesterol.<\/span><\/p>\n Ti\u00eau chu\u1ea9n c\u1ee7a IDF AHA\/NHLBI nh\u1eadn th\u1ea5y t\u1ef7 l\u1ec7 h\u1ed9i ch\u1ee9ng chuy\u1ec3n ho\u00e1 \u1edf nam gi\u1edbi v\u00f4 sinh v\u00e0 kh\u1ecfng vo sinh l\u1ea7n l\u01b0\u1ee3t l\u00e0 17,9% so v\u1edbi 6,1%.<\/span><\/p>\n Nhi\u1ec1u c\u01a1 ch\u1ebf \u0111\u00e3 \u0111\u01b0\u1ee3c t\u00ecm hi\u1ec3u nh\u1eb1m l\u00e0m r\u00f5 m\u1ed3i \u1ea3nh h\u01b0\u1edfng gi\u1eefa r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a v\u00e0 ch\u1ee9c n\u0103ng sinh s\u1ea3n \u1edf nam gi\u1edbi nh\u01b0: s\u1ef1 r\u1ed1i lo\u1ea1n v\u1ec1 ho\u1ea1t \u0111\u1ed9ng n\u1ed9i ti\u1ebft, t\u0103ng c\u00e1c ch\u1ec9 \u0111i\u1ec1u ho\u00e0 ph\u1ea3n \u1ee9ng vi\u00eam, t\u0103ng n\u1ed3ng \u0111\u1ed9 c\u00e1c g\u00f3c oxy ho\u00e1, v\u00e0 t\u0103ng nhi\u1ec7t \u0111\u1ed9 \u1edf v\u00f9ng b\u00ecu.<\/span><\/p>\n B\u1ec7nh nh\u00e2n r\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1 c\u00f3 s\u1ef1 suy gi\u1ea3m v\u1ec1 m\u1eadt \u0111\u1ed9 tinh tr\u00f9ng, t\u0103ng s\u1ed1 l\u01b0\u1ee3ng tinh tr\u00f9ng, t\u1ef7 l\u1ec7 tinh tr\u00f9ng di \u0111\u1ed9ng ti\u1ebfn t\u1edbi, h\u00ecnh th\u00e1i b\u00ecnh th\u01b0\u1eddng, t\u1ef7 l\u1ec7 sinh s\u00f3ng, \u0111\u1ed9 b\u1ec1n v\u1eefng DNA tinh tr\u00f9ng, v\u00e0 b\u1ea5t th\u01b0\u1eddng t\u00ednh \u1ed5n \u0111\u1ecbnh m\u00e0ng b\u00e0o t\u01b0\u01a1ng ty th\u1ec3. H\u01a1n n\u1eefa, h\u1ed9i ch\u1ee9ng chuy\u1ec3n ho\u00e1 c\u00f2n g\u00e2y n\u00ean suy gi\u1ea3m testosterone, FSH v\u00e0 inhibin B. Ch\u00ednh s\u1ef1 s\u1ee5t gi\u1ea3m n\u00f3ng do n\u1ed9i ti\u1ebft sinh d\u1ee5c nam gi\u1edbi g\u00e2y n\u00ean c\u00e1c r\u1ed1i lo\u1ea1n v\u00e9 ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c th\u1ebf hi\u1ec7n \u1edf: s\u1ef1 r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng, t\u00ecnh tr\u1ea1ng xu\u1ea5t tinh s\u1edbm, gi\u1ea3m ham mu\u1ed1n d\u00e1ng k\u1ebf.<\/span><\/p>\n Ph\u1ea3n \u1ee9ng vi\u00eam<\/b><\/p>\n Ph\u1ea3n \u1ee9ng vi\u00eam l\u00e0 t\u00ecnh tr\u1ea1ng ph\u1ea3n \u1ee9ng t\u1ef1 nhi\u00ean c\u1ee7a c\u01a1 th\u1ec3 v\u1edbi s\u1ef1 t\u1ea5n c\u00f4ng c\u1ee7a vi sinh v\u1eadt ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng m\u00f4 v\u00e0 cu\u1ed1i c\u00f9ng din \u0111\u1ebfn t\u00e1i t\u1ea1o h\u1ec7 \u0111\u1ed9ng m\u1ea1ch v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng c\u1ee7a n\u00f3. Sau khi ph\u1ea3n \u1ee9ng vi\u00eam x\u1ea3y ra, m\u1eb7c d\u00f9 c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong ph\u1ea3n \u1ee9ng vi\u00eam, nh\u01b0ng b\u1ea1ch c\u1ea7u trung t\u00ednh ch\u00ednh l\u00e0 h\u00e0ng r\u00e0o mi\u1ec5n d\u1ecbch \u0111\u1ea7u ti\u00ean xu\u1ea5t hi\u1ec7n t\u1ea1i v\u00f9ng ph\u1ea3n \u1ee9ng vi\u00eam. C\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o v\u00e0 c\u00e1c t\u1ebf b\u00e0o th\u00fac \u0111\u1ea9y ph\u1ea3n \u1ee9ng vi\u00eam kh\u00e1c ti\u1ebft ra m\u1ed9t l\u01b0\u1ee3ng l\u1edbn prostaglandin E2 (PGE2), cytokine v\u00e0 NO. Tuy nhi\u00ean, ph\u1ea3n \u1ee9ng vi\u00eam c\u1ee7ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 t\u1ed5ng h\u1ee3p c\u00e1c steroids v\u00e0 qu\u00e1 tr\u00ecnh sinh tinh. Nhi\u1ec5m tr\u00f9ng c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m r\u00f5 r\u1ec7t n\u00f3ng \u0111\u1ed9 testosterone v\u00e0 LH trong m\u00e1u.<\/span><\/p>\n C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e1nh gi\u00e1 s\u1ef1 nhi\u1ec5m virus MERS-CoV 2 l\u00ean ch\u1ea5t l\u01b0\u1ee3ng tinh d\u1ecbch v\u00e0 ch\u1ee9c n\u0103ng sinh s\u1ea3n nam gi\u1edbi \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111i\u1ec1u cho th\u1ea5y c\u00e1c t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c c\u1ee7a t\u00ecnh tr\u1ea1ng nhi\u1ec5m virus l\u00ean ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c c\u1ee7a nam gi\u1edbi.<\/span><\/p>\n T\u00f3m l\u1ea1i, c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh g\u00e2y n\u00ean nh\u1eefng r\u1ed1i lo\u1ea1n v\u1ec1 ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c \u1edf nam gi\u1edbi bao g\u1ed3m: \u0111\u1ed9 tudi; c\u00e1c y\u1ebfu t\u1ed1 l\u1ed1i s\u1ed1ng nh\u01b0 s\u1ef1 h\u00fat thu\u1ed1c l\u00e1, r\u01b0\u1ee3u bia, s\u1ef1 b\u1ee9c x\u1ea1… ; v\u00e0 m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd li\u00ean quan nh\u01b0 t\u00ecnh tr\u1ea1ng gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng tinh, h\u1ed9i ch\u1ee9ng r\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1, c\u00e1c b\u1ec7nh l\u00fd nhi\u1ec5m tr\u00f9ng t\u1ea1i chd v\u00e0 to\u00e0n th\u00e2n. C\u00e1c nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y n\u00ean r\u1ed1i lo\u1ea1n ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c nh\u01b0 s\u1ef1 suy sinh b\u1ec7nh l\u00fd di truy\u1ec1n, c\u00e1c t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh v\u00e0 s\u1eed d\u1ee5ng m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c trong \u0111i\u1ec1u tr\u1ecb t\u00e2m th\u1ea7n, huy\u1ebft \u00e1p.<\/span><\/p>\n C\u00e2u 1. Khi ph\u00e2n t\u00edch m\u1eabu tinh d\u1ecbch, ti\u1ec3u tinh \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi:<\/i><\/b><\/p>\n C\u00e2u 2. D\u1eady th\u00ec mu\u1ed9n \u1edf nam \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a kh\u00ed tr\u1ebb kh\u00f4ng t\u0103ng k\u00edch th\u01b0\u1edbc tinh ho\u00e0n tr\u01b0\u1edbc<\/i><\/b><\/p>\n C\u00e2u 3. Nguy\u00ean nh\u00e2n n\u00e0o d\u01b0\u1edbi \u0111\u00e2y kh\u00f4ng ph\u1ea3i l\u00e0 nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t g\u00e2y suy sinh duc:<\/i><\/b><\/p>\n C\u00e2u 4. Nguy\u00ean nh\u00e2n n\u00e0o d\u01b0\u1edbi \u0111\u00e2y kh\u00f4ng ph\u1ea3i l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng:<\/i><\/b><\/p>\n C\u00e2u 5. Thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p n\u00e0o d\u01b0\u1edbi \u0111\u00e2y \u00edt c\u00f3 nguy c\u01a1 g\u00e2y r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng:<\/i><\/b><\/p>\n R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c nam l\u00e0 m\u1ed9t lo\u1ea1t c\u00e1c t\u00ecnh tr\u1ea1ng, \u0111\u00e1ng ch\u00fa \u00fd nh\u1ea5t bao g\u1ed3m r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng, b\u1ec7nh Peyronie v\u00e0 xu\u1ea5t t\u00ednh s\u1edbm (Premature Ejaculation – PE); m\u1ed9t s\u1ed1 th\u1ebf r\u1ed1i lo\u1ea1n kh\u00e1c bao g\u1ed3m: ch\u1eadm \u0111\u1ea1t c\u1ef1c kho\u00e1i, gi\u1ea3m ham mu\u1ed1n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi ch\u1ee9c n\u0103ng t\u00ecnh […]\n","protected":false},"author":1,"featured_media":52707,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[150],"tags":[],"class_list":["post-52569","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sinh-ly-nam-nu"],"acf":[],"_links":{"self":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/52569","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\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/comments?post=52569"}],"version-history":[{"count":1,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/52569\/revisions"}],"predecessor-version":[{"id":72468,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/52569\/revisions\/72468"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/media\/52707"}],"wp:attachment":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/media?parent=52569"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/categories?post=52569"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/tags?post=52569"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}T\u1ed4NG QUAN<\/span><\/h2>\n
NGUY\u00caN NH\u00c2N C\u1ee6A R\u1ed0I LO\u1ea0N CH\u1ee8C N\u0102NG T\u00ccNH D\u1ee4C NAM<\/span><\/h2>\n
Suy sinh d\u1ee5c<\/span><\/h3>\n
![\"H\u00ecnh](\"https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2023\/10\/13.1.jpg\" "\\"\\"")
<\/a>C\u00e1c b\u1ec7nh l\u00fd di truy\u1ec1n<\/span><\/h3>\n
![\"H\u00ecnh](\"https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2023\/10\/13.2.jpg\" "\\"\\"")
<\/a>![\"H\u00ecnh](\"https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2023\/10\/13.3.jpg\" "\\"\\"")
<\/a>![\"H\u00ecnh](\"https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2023\/10\/13.4.jpg\" "\\"\\"")
<\/a>C\u00e1c b\u1ec7nh l\u00fd th\u1ea7n kinh<\/span><\/h3>\n
![\"H\u00ecnh](\"https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2023\/10\/13.5.jpg\" "\\"\\"")
<\/a>S\u1eed d\u1ee5ng thu\u1ed1c<\/span><\/h3>\n
C\u00c1C Y\u1ebeU T\u1ed4 NGUY C\u01a0 CUA ROI LO\u1ea0N CH\u1ee8C N\u0102NG T\u00ccNH D\u1ee4C NAM<\/span><\/h2>\n
\u0110\u1ed9 tu\u1ed5i<\/span><\/h3>\n
![\"H\u00ecnh](\"https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2023\/10\/hinh13-6-ty-le-mac-roi-loan-cuong-duong-theo-do-tuoi-o-nam-gioi.jpg\" "\\"\\"")
<\/a>Y\u1ebfu t\u1ed1 l\u1ed1i s\u1ed1ng<\/span><\/h3>\n
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![\"H\u00ecnh](\"https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2023\/10\/hinh13.7.jpg\" "\\"\\"")
<\/a>M\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd li\u00ean quan<\/span><\/h3>\n
![\"H\u00ecnh](\"https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2023\/10\/13.8.jpg\" "\\"\\"")
<\/a>![\"\"](\"https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2023\/10\/hinh13.9.jpg\" "\\"\\"")
<\/a><\/p>\n![\"H\u00ecnh](\"https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2023\/10\/hinh13.10.jpg\" "\\"\\"")
<\/a>![\"H\u00ecnh](\"https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2023\/10\/hinh13.11.jpg\" "\\"\\"")
<\/a>T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/span><\/h2>\n
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C\u00c2U H\u1eceI L\u01af\u1ee2NG GI\u00c1<\/span><\/h2>\n
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