{"id":11391,"date":"2019-06-03T21:28:37","date_gmt":"2019-06-03T14:28:37","guid":{"rendered":"https:\/\/pharmog.com\/wp\/?p=11391"},"modified":"2025-01-08T23:23:47","modified_gmt":"2025-01-08T16:23:47","slug":"tong-quan-ve-ton-thuong-gan-do-thuoc","status":"publish","type":"post","link":"https:\/\/pharmog.com\/wp\/tong-quan-ve-ton-thuong-gan-do-thuoc\/","title":{"rendered":"T\u1ed5ng quan v\u1ec1 t\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c"},"content":{"rendered":"

Theo Canhgiacduoc<\/em><\/strong><\/p>\n

T\u1ed4NG QUAN V\u1ec0 T\u1ed4N TH\u01af\u01a0NG GAN DO THU\u1ed0C<\/strong><\/p>\n

\u00a0\u0110\u00e0m Th\u1ecb Thanh H\u01b0\u01a1ng, L\u01b0\u01a1ng Anh T\u00f9ng<\/em><\/p>\n

T\u00f3m t\u1eaft<\/strong><\/p>\n

T\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c (drug-induced liver injury – DILI) l\u00e0 b\u1ec7nh l\u00fd kh\u00f4ng ph\u1ed5 bi\u1ebfn, nh\u01b0ng c\u00f3 nguy c\u01a1 g\u00e2y t\u1eed vong, nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn c\u00e1c thu\u1ed1c k\u00ea \u0111\u01a1n, c\u00e1c thu\u1ed1c kh\u00f4ng k\u00ea \u0111\u01a1n, c\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3c. DILI \u0111\u01b0\u1ee3c chia th\u00e0nh 2 lo\u1ea1i: n\u1ed9i t\u1ea1i v\u00e0 \u0111\u1eb7c \u1ee9ng. C\u00e1c y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn b\u1ec7nh nh\u00e2n, m\u00f4i tr\u01b0\u1eddng v\u00e0 thu\u1ed1c c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n g\u00e2y DILI. T\u1ea1i M\u1ef9, kh\u00e1ng sinh v\u00e0 thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh l\u00e0 c\u00e1c nh\u00f3m thu\u1ed1c li\u00ean quan \u0111\u1ebfn DILI ph\u1ed5 bi\u1ebfn nh\u1ea5t, nh\u01b0ng s\u1ed1 ca DILI do c\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3cc\u00f3 xu h\u01b0\u1edbng gia t\u0103ng. \u0110i\u1ec1u tr\u1ecb DILI bao g\u1ed3m lo\u1ea1i b\u1ecf t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh v\u00e0 s\u1eed d\u1ee5ng N-acetylcystein trong tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng gan do paracetamol. K\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb ph\u1ee5 thu\u1ed9c v\u00e0o lo\u1ea1i thu\u1ed1c s\u1eed d\u1ee5ng v\u00e0 lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng gan. D\u01b0\u1ee3c s\u0129 c\u00f3 th\u1ec3 \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 DILI, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng nhi\u1ec1u thu\u1ed1c v\u00e0 ch\u1ebf ph\u1ea9m b\u1ed5 sung.<\/p>\n

\"\"<\/p>\n

N\u1ed9i dung b\u00e0i<\/strong><\/p>\n

T\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c (DILI; c\u00f2n g\u1ecdi l\u00e0 \u0111\u1ed9c t\u00ednh tr\u00ean gan do thu\u1ed1c – drug-induced hepatotoxicity)\u0111\u01b0\u1ee3c g\u00e2y ra do thu\u1ed1c (thu\u1ed1c k\u00ea \u0111\u01a1n ho\u1eb7c OTC), c\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3c, ho\u1eb7c c\u00e1c ch\u1ea5t ngo\u1ea1i lai kh\u00e1c (xenobiotic) d\u1eabn t\u1edbi b\u1ea5t th\u01b0\u1eddng trong x\u00e9t nghi\u1ec7m v\u1ec1 gan ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c. C\u00f3 2 lo\u1ea1i DILI: n\u1ed9i t\u1ea1i v\u00e0 \u0111\u1eb7c \u1ee9ng. DILIn\u1ed9i t\u1ea1i<\/em>\u00a0l\u00e0 \u0111\u1ed9c t\u00ednh tr\u00ean gan do thu\u1ed1c c\u00f3 th\u1ec3 d\u1ef1 \u0111o\u00e1n tr\u01b0\u1edbc v\u00e0 li\u00ean quan \u0111\u1ebfn li\u1ec1u (v\u00ed d\u1ee5:paracetamol); DILI\u0111\u1eb7c \u1ee9ng<\/em>\u00a0\u00edt x\u1ea3y ra h\u01a1n, \u00edt li\u00ean quan \u0111\u1ebfn li\u1ec1u v\u00e0 c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n \u0111a d\u1ea1ng h\u01a1n.<\/p>\n

Kh\u00f3 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c t\u1ef7 l\u1ec7 m\u1eafc DILI do c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u01b0\u1edbc khi thu\u1ed1c \u0111\u01b0\u1ee3c l\u01b0u h\u00e0nh tr\u00ean th\u1ecb th\u01b0\u1eddng kh\u00f4ng \u0111\u1ee7 hi\u1ec7u l\u1ef1c \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c DILI \u0111\u1eb7c \u1ee9ng. T\u1ef7 l\u1ec7 m\u1eafc DILI h\u00e0ng n\u0103m \u0111\u01b0\u1ee3c \u01b0\u1edbc t\u00ednh kho\u1ea3ng 10 \u0111\u1ebfn 15 trong 10.000\u0111\u1ebfn 100.000 ng\u01b0\u1eddi s\u1eed d\u1ee5ng thu\u1ed1c k\u00ea \u0111\u01a1n. Theo \u0111\u00f3, m\u1ed7i n\u0103m c\u00f3 kho\u1ea3ng 44.000 ng\u01b0\u1eddi M\u1ef9 m\u1eafc DILI,g\u00e2y t\u1ed5n h\u1ea1i v\u1ec1 s\u1ee9c kh\u1ecfe ng\u01b0\u1eddi b\u1ec7nh v\u00e0 gia t\u0103ng chi ph\u00ed y t\u1ebf.T\u1ef7 l\u1ec7 n\u00e0y \u0111\u01b0\u1ee3c d\u1ef1 \u0111o\u00e1n s\u1ebd gia t\u0103ng do vi\u1ec7c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3ic\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3c. Trong 2000 tr\u01b0\u1eddng h\u1ee3p suy gan c\u1ea5p (acute liver failure – ALF) \u1edf M\u1ef9 m\u1ed7i n\u0103m, s\u1ed1 ca li\u00ean quan \u0111\u1ebfn thu\u1ed1c chi\u1ebfm >50%, v\u1edbi 37% s\u1ed1 ca li\u00ean quan \u0111\u1ebfn paracetamol v\u00e0 13%s\u1ed1 ca do c\u00e1c ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i \u0111\u1eb7c \u1ee9ng c\u1ee7a thu\u1ed1c.<\/p>\n

C\u01a1 ch\u1ebf c\u1ee7a DILI<\/strong><\/p>\n

DILI \u0111\u01b0\u1ee3c cho r\u1eb1ng c\u00f3 th\u1ec3 x\u1ea3y ra theo m\u1ed9t s\u1ed1 c\u01a1 ch\u1ebf kh\u00e1c nhau.Trong \u0111\u00f3 c\u00f3suy gi\u1ea3m tr\u1ef1c ti\u1ebfp v\u1ec1 c\u1ea5u tr\u00fac (v\u00ed d\u1ee5 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng ty th\u1ec3) v\u00e0 ch\u1ee9c n\u0103ng to\u00e0n v\u1eb9n c\u1ee7a gan;h\u00ecnh th\u00e0nh ch\u1ea5t chuy\u1ec3n h\u00f3a l\u00e0m thay \u0111\u1ed5i c\u1ea5u tr\u00fac v\u00e0 ch\u1ee9c n\u0103ng t\u1ebf b\u00e0o gan;h\u00ecnh th\u00e0nh ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 ho\u1ea1t t\u00ednh li\u00ean k\u1ebft v\u1edbi protein \u1edf gan,h\u00ecnh th\u00e0nh s\u1ea3n ph\u1ea9m thu\u1ed1c-protein c\u00f3 t\u00ednh kh\u00e1ng nguy\u00ean l\u00e0 m\u1ee5c ti\u00eau t\u1ea5n c\u00f4ng c\u1ee7a h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch c\u1ee7ac\u01a1 th\u1ec3 (gi\u1ea3 thuy\u1ebft b\u00e1n kh\u00e1ng nguy\u00ean); v\u00e0 s\u1ef1 kh\u1edfi \u0111\u1ea7u \u0111\u00e1p \u1ee9ng qu\u00e1 m\u1eabn to\u00e0n th\u00e2n (v\u00ed d\u1ee5: d\u1ecb \u1ee9ng thu\u1ed1c) g\u00e2y t\u1ed5n th\u01b0\u01a1ng gan.<\/p>\n

C\u00e1c thu\u1ed1c li\u00ean quan \u0111\u1ebfn DILI<\/strong><\/p>\n

Tr\u00ean 60% tr\u01b0\u1eddng h\u1ee3p DILI li\u00ean quan \u0111\u1ebfn kh\u00e1ng sinh v\u00e0 thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh. C\u00e1c h\u01b0\u1edbng d\u1eabn l\u00e2m s\u00e0ng v\u1ec1 DILI \u0111\u1eb7c \u1ee9ng c\u1ee7a Tr\u01b0\u1eddng m\u00f4n Ti\u00eau h\u00f3a Hoa K\u1ef3 (American College of Gastroenterology-ACG)\u0111\u00e3 x\u00e1c \u0111\u1ecbnh c\u00e1c thu\u1ed1c ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 chi ti\u1ebft li\u00ean quan \u0111\u1ebfn DILI c\u0169ng nh\u01b0 lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng gan\u00a0(b\u1ea3ng 1).<\/em><\/p>\n

\u00a0B\u1ea3ng 1: C\u00e1c thu\u1ed1c v\u00e0 nh\u00f3m thu\u1ed1c li\u00ean quan \u0111\u1ebfn DILI v\u00e0 lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng gan<\/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
Thu\u1ed1c\/nh\u00f3m thu\u1ed1c<\/strong><\/td>\nLo\u1ea1i t\u1ed5n th\u01b0\u01a1ng gan<\/strong><\/td>\n<\/tr>\n
Alopurinol<\/td>\nT\u1ebf b\u00e0o gan ho\u1eb7c h\u1ed7n h\u1ee3p (k\u1ebft h\u1ee3p c\u1ee7a vi\u00eam gan ho\u1ea1i t\u1eed t\u1ebf b\u00e0o v\u00e0 vi\u00eam gan \u1ee9 m\u1eadt), th\u01b0\u1eddng k\u00e8m c\u00e1c bi\u1ec3u hi\u1ec7n d\u1ecb \u1ee9ng – mi\u1ec5n d\u1ecbcha<\/sup><\/td>\n<\/tr>\n
Amiodaron<\/td>\nT\u1ebf b\u00e0o gan, h\u1ed7n h\u1ee3p, ho\u1eb7c \u1ee9 m\u1eadt<\/td>\n<\/tr>\n
Amoxicilin-clavulanat<\/td>\n\u1ee8 m\u1eadt; c\u00f3 th\u1ec3 t\u1ebf b\u00e0o gan<\/td>\n<\/tr>\n
C\u00e1c steroid t\u0103ng \u0111\u1ed3ng h\u00f3a<\/td>\n\u1ee8 m\u1eadt; c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn c\u00e1c t\u1ea1p ch\u1ea5t c\u00f3 m\u1eb7t trong c\u00e1c s\u1ea3n ph\u1ea9m thu\u1ed1c k\u00edch th\u00edch<\/td>\n<\/tr>\n
C\u00e1c androgen ch\u1ee9a khung steroid<\/td>\n\u1ee8 m\u1eadt; c\u00f3 th\u1ec3 c\u00f3 c\u00e1c nang m\u00e1u trong gan, t\u0103ng s\u1ea3n n\u1ed1t t\u00e1i t\u1ea1o, ho\u1eb7c ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan<\/td>\n<\/tr>\n
Thu\u1ed1c kh\u00e1ng y\u1ebfu t\u1ed1 ho\u1ea1i t\u1eed kh\u1ed1i u (TNF)<\/td>\nT\u1ebf b\u00e0o gan; c\u00f3 th\u1ec3 gi\u1ed1ng vi\u00eam gan t\u1ef1 mi\u1ec5n<\/td>\n<\/tr>\n
Azathioprin<\/td>\n\u1ee8 m\u1eadt ho\u1eb7c t\u1ebf b\u00e0o gan; c\u00f3 th\u1ec3 k\u00e8m t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda<\/td>\n<\/tr>\n
Carbamazepin<\/td>\nT\u1ebf b\u00e0o gan, h\u1ed7n h\u1ee3p, ho\u1eb7c \u1ee9 m\u1eadt, th\u01b0\u1eddng k\u00e8m c\u00e1c bi\u1ec3u hi\u1ec7n d\u1ecb \u1ee9ng – mi\u1ec5n d\u1ecbch (h\u1ed9i ch\u1ee9ng qu\u00e1 m\u1eabn do thu\u1ed1c ch\u1ed1ng co gi\u1eadt)a<\/sup><\/td>\n<\/tr>\n
Flavocoxid<\/td>\nH\u1ed7nh\u1ee3p, t\u1ebf b\u00e0o gan, ho\u1eb7c \u1ee9 m\u1eadt<\/td>\n<\/tr>\n
C\u00e1c fluoroquinolon<\/td>\n\u1ee8 m\u1eadt, t\u1ebf b\u00e0o gan, ho\u1eb7c h\u1ed7n h\u1ee3p<\/td>\n<\/tr>\n
Chi\u1ebft xu\u1ea5t tr\u00e0 xanh<\/td>\nT\u1ebf b\u00e0o gan<\/td>\n<\/tr>\n
Thu\u1ed1c g\u00e2y m\u00ea d\u1ea1ng h\u00edt<\/td>\nT\u1ebf b\u00e0o gan; c\u00f3 th\u1ec3 c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n d\u1ecb \u1ee9ng – mi\u1ec5n d\u1ecbcha<\/sup><\/td>\n<\/tr>\n
Interferon-alpha<\/td>\nT\u1ebf b\u00e0o gan; gi\u1ed1ng vi\u00eam gan t\u1ef1 mi\u1ec5n<\/td>\n<\/tr>\n
Interferon-beta<\/td>\nT\u1ebf b\u00e0o gan<\/td>\n<\/tr>\n
Isonizid<\/td>\nT\u1ebf b\u00e0o gan c\u1ea5p t\u00ednh; gi\u1ed1ng vi\u00eam gan virus c\u1ea5p<\/td>\n<\/tr>\n
Lamotrigin<\/td>\nT\u1ebf b\u00e0o gan, th\u01b0\u1eddng k\u00e8m c\u00e1c bi\u1ec3u hi\u1ec7n d\u1ecb \u1ee9ng – mi\u1ec5n d\u1ecbch (h\u1ed9i ch\u1ee9ng qu\u00e1 m\u1eabn do thu\u1ed1c ch\u1ed1ng co gi\u1eadt)a<\/sup><\/td>\n<\/tr>\n
C\u00e1c macrolid<\/td>\nT\u1ebf b\u00e0o gan; c\u00f3 th\u1ec3 \u1ee9 m\u1eadt<\/td>\n<\/tr>\n
Methotrexat \u0111\u01b0\u1eddng u\u1ed1ng<\/td>\nGan nhi\u1ec5m m\u1ee1, x\u01a1 gan<\/td>\n<\/tr>\n
Minocyclin<\/td>\nT\u1ebf b\u00e0o gan; c\u00f3 th\u1ec3 gi\u1ed1ng vi\u00eam gan t\u1ef1 mi\u1ec5n<\/td>\n<\/tr>\n
Nitrofurantoin<\/td>\nC\u1ea5p t\u00ednh: t\u1ebf b\u00e0o gan; m\u1ea1n t\u00ednh: h\u1ea7u h\u1ebft t\u1ebf b\u00e0o gan, nh\u01b0ng c\u00f3 th\u1ec3 gi\u1ed1ng vi\u00eam gan t\u1ef1 mi\u1ec5n<\/td>\n<\/tr>\n
C\u00e1c thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid (NSAID)<\/td>\nT\u1ebf b\u00e0o gan<\/td>\n<\/tr>\n
Phenytoin<\/td>\nT\u1ebf b\u00e0o gan, h\u1ed7n h\u1ee3p, ho\u1eb7c \u1ee9 m\u1eadt, th\u01b0\u1eddng k\u00e8m c\u00e1c bi\u1ec3u hi\u1ec7n d\u1ecb \u1ee9ng – mi\u1ec5n d\u1ecbch (h\u1ed9i ch\u1ee9ng qu\u00e1 m\u1eabn do thu\u1ed1c ch\u1ed1ng co gi\u1eadt)a<\/sup><\/td>\n<\/tr>\n
C\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf b\u01a1m proton (PPI)<\/td>\nT\u1ebf b\u00e0o gan, nh\u01b0ng hi\u1ebfm g\u1eb7p<\/td>\n<\/tr>\n
C\u00e1c alkaloid pyrrolizidin<\/td>\nH\u1ed9i ch\u1ee9ng t\u1eafc m\u1ea1ch xoang\/t\u1eafc t\u0129nh m\u1ea1ch<\/td>\n<\/tr>\n
Sulfasalazin<\/td>\nH\u1ed7nh\u1ee3p, t\u1ebf b\u00e0o gan, ho\u1eb7c \u1ee9 m\u1eadt; c\u00f3 th\u1ec3 c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n d\u1ecb \u1ee9ng – mi\u1ec5n d\u1ecbcha<\/sup><\/td>\n<\/tr>\n
Sulfamethoxazol – trimethoprim (cotrimoxazol)<\/td>\n\u1ee8 m\u1eadt; c\u00f3 th\u1ec3 t\u1ebf b\u00e0o gan, v\u00e0\/ho\u1eb7c c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c bi\u1ec3u hi\u1ec7n d\u1ecb \u1ee9ng – mi\u1ec5n d\u1ecbcha<\/sup><\/td>\n<\/tr>\n
Acid valproic<\/td>\nT\u0103ng ammoniac m\u00e1u, t\u1ebf b\u00e0o gan, h\u1ed9i ch\u1ee9ng t\u01b0\u01a1ng t\u1ef1 h\u1ed9i ch\u1ee9ngReye<\/td>\n<\/tr>\n
Ghi ch\u00fa:\u00a0a<\/sup>C\u00e1c bi\u1ec3u hi\u1ec7n c\u1ee7a d\u1ecb \u1ee9ng – mi\u1ec5n d\u1ecbch bao g\u1ed3m s\u1ed1t, n\u1ed5i m\u1ea9n v\u00e0 t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

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LiverTox (https:\/\/livertox.nih.gov) l\u00e0 c\u01a1 s\u1edf d\u1eef li\u1ec7u v\u1ec1 l\u00e2m s\u00e0ng v\u00e0 nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n b\u1edfi nh\u00f3m nghi\u00ean c\u1ee9u h\u1ed7n h\u1ee3p thu\u1ed9c Vi\u1ec7n c\u00e1c b\u1ec7nh \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng, Ti\u00eau h\u00f3a v\u00e0 Th\u1eadn Hoa K\u1ef3, Th\u01b0 vi\u1ec7n Y khoa Hoa K\u1ef3 v\u00e0 M\u1ea1ng l\u01b0\u1edbi nghi\u00ean c\u1ee9u t\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c (DILIN) nh\u1eb1m cung c\u1ea5p nh\u1eefng th\u00f4ng tin l\u00e2m s\u00e0ng c\u1eadp nh\u1eadt, to\u00e0n di\u1ec7n v\u1ec1 DILI. LiverTox ch\u1ee9a th\u00f4ng tin t\u1ed5ng quan v\u1ec1 c\u00e1c thu\u1ed1c (t\u00ednh ch\u1ea5t h\u00f3a h\u1ecdc, ch\u1ec9 \u0111\u1ecbnh, li\u1ec1u khuy\u1ebfn c\u00e1o, v\u00e0 t\u1ea7n su\u1ea5t s\u1eed d\u1ee5ng), m\u00f4 t\u1ea3 v\u1ec1 lo\u1ea1i v\u00e0 di\u1ec5n bi\u1ebfn qu\u00e1 tr\u00ecnh t\u1ed5n th\u01b0\u01a1ng gan, ti\u1ec1n s\u1eed ca b\u1ec7nh k\u00e8m k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m v\u00e0 c\u00e1c t\u00e0i li\u1ec7u tham kh\u1ea3o. D\u01b0\u1ee3c s\u0129 n\u00ean th\u01b0\u1eddng xuy\u00ean tham kh\u1ea3o LiverTox \u0111\u1ec3 c\u1eadp nh\u1eadt nh\u1eefng th\u00f4ng tin m\u1edbi nh\u1ea5t v\u1ec1 DILI do c\u00f3 nhi\u1ec1u thay \u0111\u1ed5i v\u1ec1 t\u00f3m t\u1eaft \u0111\u1eb7c t\u00ednh c\u1ee7a c\u00e1c thu\u1ed1c v\u00e0 c\u00e1c b\u00e1o c\u00e1o \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 li\u00ean quan \u0111\u1ebfn \u0111\u1ed9c t\u00ednh ti\u1ec1m t\u00e0ng tr\u00ean gan c\u1ee7a c\u00e1c thu\u1ed1c. M\u1ed9t danh s\u00e1ch tham kh\u1ea3o kh\u00e1c v\u1ec1 thu\u1ed1c l\u00e0 DILIrank, bao g\u1ed3m th\u00f4ng tin v\u1ec1 1036 thu\u1ed1c \u0111\u01b0\u1ee3c FDA ph\u00ea duy\u1ec7t v\u00e0 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo nguy c\u01a1 DILI ti\u1ec1m t\u00e0ng. Ngo\u00e0i ra, FDA \u0111\u00e3 x\u00e2y d\u1ef1ng ph\u1ea7n m\u1ec1m eDISH (\u0111\u00e1nh gi\u00e1 \u0111\u1ed9c t\u00ednh tr\u00ean gan nghi\u00eam tr\u1ecdng do thu\u1ed1c) \u0111\u1ec3 r\u00e0 so\u00e1t s\u1ed1 l\u01b0\u1ee3ng l\u1edbn c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng tham gia c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u1ec1 nh\u1eefng d\u1ea5u hi\u1ec7u c\u1ee7a DILI (v\u00ed d\u1ee5: t\u0103ng ALT trong huy\u1ebft thanh ho\u1eb7c bilirubin to\u00e0n ph\u1ea7n).<\/p>\n

T\u1ed5n th\u01b0\u01a1ng gan do c\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3c<\/strong><\/p>\n

S\u1ed1 tr\u01b0\u1eddng h\u1ee3p DILI do c\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3cc\u00f3 s\u1ef1 gia t\u0103ng \u0111\u00e1ng k\u1ec3. D\u1eef li\u1ec7u t\u1eeb nghi\u00ean c\u1ee9u DILIN cho th\u1ea5ym\u1ee9c t\u0103ng t\u1eeb 7% \u0111\u1ebfn 20% t\u1eeb n\u0103m 2004 \u0111\u1ebfn n\u0103m 2013. C\u00e1c c\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3c ph\u1ed5 bi\u1ebfn nh\u1ea5t li\u00ean quan \u0111\u1ebfn DILI t\u1ea1i M\u1ef9 l\u00e0 c\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung trongt\u1eadp luy\u1ec7n th\u1ec3 h\u00ecnh v\u00e0 gi\u1ea3m c\u00e2n. C\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3c trong t\u1eadp luy\u1ec7n th\u1ec3 h\u00ecnh g\u00e2y v\u00e0ng da k\u00e9o d\u00e0i, nh\u01b0ng kh\u00f4ng g\u00e2y t\u1eed vong, tr\u00ean nam gi\u1edbi kh\u1ecfe m\u1ea1nh. C\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3cngo\u00e0i t\u1eadp luy\u1ec7n th\u1ec3 h\u00ecnh g\u00e2y DILI t\u1ebf b\u00e0o gan ch\u1ee7 y\u1ebfu \u1edf nh\u1eefng ph\u1ee5 n\u1eef trung ni\u00ean v\u00e0 nhi\u1ec1u kh\u1ea3 n\u0103ng h\u01a1n d\u1eabn t\u1edbi t\u1eed vong (trong 13%) ho\u1eb7c c\u1ea7n c\u00f3 ch\u1ec9 \u0111\u1ecbnh gh\u00e9p gan. Kh\u00e1c v\u1edbi c\u00e1c thu\u1ed1c k\u00ea \u0111\u01a1n v\u00e0 kh\u00f4ng k\u00ea \u0111\u01a1n ch\u1ee9a c\u00e1c th\u00e0nh ph\u1ea7n c\u00f3 ho\u1ea1t t\u00ednh v\u00e0 kh\u00f4ng ho\u1ea1t t\u00ednh \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i r\u00f5 r\u00e0ng, th\u00e0nh ph\u1ea7n c\u1ee7a c\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3c th\u01b0\u1eddng r\u1ea5t dao \u0111\u1ed9ng (kh\u00e1c nhau v\u1ec1 hi\u1ec7u l\u1ef1c c\u1ee7a th\u00e0nh ph\u1ea7n c\u00f3 ho\u1ea1t t\u00ednh, t\u1ea1p ch\u1ea5t). C\u00e1c s\u1ea3n ph\u1ea9m n\u00e0y c\u0169ng thi\u1ebfu s\u1ef1 gi\u00e1m s\u00e1t, qu\u1ea3n l\u00fd, g\u00e2y kh\u00f3 kh\u0103n trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 DILI. M\u1ed9t s\u1ed1 ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3cli\u00ean quan \u0111\u1ebfn DILI v\u00e0 ph\u1ea3n \u1ee9ng l\u1eb7p l\u1ea1i sau khi t\u00e1i s\u1eed d\u1ee5ng s\u1ea3n ph\u1ea9m bao g\u1ed3m s\u1ea3n ph\u1ea9m chi\u1ebft xu\u1ea5t t\u1eeb tr\u00e0 xanh, c\u00e1c glycosid t\u1eeb phan t\u1ea3 di\u1ec7p, rau m\u00e1\u00a0(Centella asiatica),<\/em>\u00a0c\u00e2y Ho\u00e0ng li\u00ean l\u1edbn, v\u1ecf h\u1ea1t m\u00e3 \u0111\u1ec1 (isabgol) v\u00e0 Venencapsan.<\/p>\n

Y\u1ebfu t\u1ed1 nguy c\u01a1<\/strong><\/p>\n

Tuy hi\u1ebfm g\u1eb7p nh\u01b0ng m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 xu\u1ea5t hi\u1ec7nDILItr\u00ean b\u1ec7nh nh\u00e2n. C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 thu\u1ed9c v\u1ec1 ng\u01b0\u1eddi b\u1ec7nh bao g\u1ed3m di truy\u1ec1n, tu\u1ed5i (cao tu\u1ed5i ho\u1eb7c tr\u1ebb tu\u1ed5i), gi\u1edbi t\u00ednh (n\u1eef), ch\u1ee7ng t\u1ed9c, ph\u1ee5 n\u1eef c\u00f3 thai, dinh d\u01b0\u1ee1ng k\u00e9m, h\u1ec7 vi sinh v\u1eadt \u0111\u01b0\u1eddng ru\u1ed9t, t\u00ecnh tr\u1ea1ng hormon, b\u00e9o ph\u00ec, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, c\u00e1c b\u1ec7nh m\u1eafc k\u00e8m bao g\u1ed3m b\u1ec7nh gan ho\u1eb7c HIV, v\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb (v\u00ed d\u1ee5: vi\u00eam gan virus C). C\u00e1c y\u1ebfu t\u1ed1 thu\u1ed9c v\u1ec1 m\u00f4i tr\u01b0\u1eddng c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 DILI bao g\u1ed3m h\u00fat thu\u1ed1c, s\u1eed d\u1ee5ng \u0111\u1ed3 u\u1ed1ng c\u00f3 c\u1ed3n, c\u00f3 c\u00e1c \u0111\u1ee3t vi\u00eam ho\u1eb7c nhi\u1ec5m khu\u1ea9n.<\/p>\n

C\u00e1c y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn thu\u1ed1c c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n g\u00e2y ti\u1ebfn tri\u1ec3n DILI bao g\u1ed3m li\u1ec1u d\u00f9ng h\u00e0ng ng\u00e0y (v\u00ed d\u1ee5 >50 mg\/ng\u00e0y), \u0111\u1eb7c t\u00ednh chuy\u1ec3n h\u00f3a thu\u1ed1c (thu\u1ed1c \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a c\u00e0ng m\u1ea1nh th\u00ec nguy c\u01a1 c\u00e0ng cao), t\u00e1c d\u1ee5ng chung c\u1ee7a nh\u00f3m thu\u1ed1c v\u00e0 t\u00ecnh tr\u1ea1ng m\u1eabn c\u1ea3m ch\u00e9o (\u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn v\u1edbi c\u00e1c thu\u1ed1c ch\u1ed1ng co gi\u1eadt), t\u01b0\u01a1ng t\u00e1c thu\u1ed1c ho\u1eb7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi nhi\u1ec1u thu\u1ed1c. Li\u1ec1u h\u00e0ng ng\u00e0y >50-100 mg c\u1ee7a c\u00e1c thu\u1ed1c c\u00f3 t\u00ednh th\u00e2n d\u1ea7u cao (v\u00ed d\u1ee5 h\u1ec7 s\u1ed1 ph\u00e2n t\u00e1n octanol-n\u01b0\u1edbc \u22653) t\u1ecf ra c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y DILI cao h\u01a1n so v\u1edbi li\u1ec1u d\u00f9ng <50 mg\/ng\u00e0y c\u1ee7a c\u00e1c thu\u1ed1c \u00edt th\u00e2n d\u1ea7u. Li\u1ec1u cao c\u00f3 th\u1ec3 d\u1eabn t\u1edbi gia t\u0103ng n\u1ed3ng \u0111\u1ed9 c\u1ee7a thu\u1ed1c ho\u1eb7c d\u1eabn ch\u1ea5t chuy\u1ec3n h\u00f3a t\u1ea1i gan, c\u00e1c thu\u1ed1c c\u00f3 t\u00ednh th\u00e2n d\u1ea7u cao c\u00f3 th\u1ec3 chuy\u1ec3n h\u00f3a nhi\u1ec1u h\u01a1n, \u0111i\u1ec1u n\u00e0y d\u1eabn t\u1edbi h\u00ecnh th\u00e0nh li\u00ean k\u1ebft \u0111\u1ed3ng h\u00f3a tr\u1ecb v\u1edbi c\u00e1c b\u00e1n kh\u00e1ng nguy\u00ean t\u1ea1o ra \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch b\u1ea5t l\u1ee3i tr\u00ean c\u00e1c c\u00e1 th\u1ec3 nh\u1ea1y c\u1ea3m. Vi\u00eam gan t\u1ef1 mi\u1ec5n do thu\u1ed1c x\u1ea3y ra ph\u1ed5 bi\u1ebfn h\u01a1n v\u1edbi c\u00e1c thu\u1ed1c chuy\u1ec3n h\u00f3a m\u1ea1nh qua gan. 90% s\u1ed1 tr\u01b0\u1eddng h\u1ee3p suy gan c\u1ea5p x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c v\u1edbi li\u1ec1u \u226550 mg\/ng\u00e0y. H\u01a1n n\u1eefa, c\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a qua CYP2C9 ho\u1eb7c CYP2C19 t\u1ecf ra c\u00f3 li\u00ean quan \u0111\u1ebfn gia t\u0103ng nguy c\u01a1 DILI h\u01a1n c\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a qua CYP3A ho\u1eb7c CYP2D6.<\/p>\n

\u0110\u00e1nh gi\u00e1 nguy\u00ean nh\u00e2n<\/strong><\/p>\n

DILI \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n theo ph\u01b0\u01a1ng ph\u00e1p lo\u1ea1i tr\u1eeb d\u1ef1a tr\u00ean thu th\u1eadp \u0111\u1ea7y \u0111\u1ee7 th\u00f4ng tin v\u1ec1 b\u1ec7nh s\u1eed, bao g\u1ed3m c\u00e1c thu\u1ed1c k\u00ea \u0111\u01a1n, thu\u1ed1c kh\u00f4ng k\u00ea \u0111\u01a1n v\u00e0c\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3c \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, k\u1ebft qu\u1ea3 c\u00e1c x\u00e9t nghi\u1ec7m, ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh th\u0103m d\u00f2 ch\u1ee9c n\u0103ng gan\/\u0111\u01b0\u1eddng m\u1eadt v\u00e0 sinh thi\u1ebft gan khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh. T\u0103ng ALT kh\u00f4ng k\u00e8m theo d\u1ea5u hi\u1ec7u r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan kh\u00f4ng \u0111\u01b0\u1ee3c coi l\u00e0 nghi\u00eam tr\u1ecdng do gan th\u01b0\u1eddng xuy\u00ean th\u00edch nghi v\u00e0 tr\u1edf n\u00ean dung n\u1ea1p v\u1edbi thu\u1ed1c. \u0110\u1ec3 th\u00edch nghi, vi\u1ec7c li\u00ean t\u1ee5c ph\u01a1i nhi\u1ec5m v\u1edbi thu\u1ed1c (v\u00ed d\u1ee5 khi s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c h\u1ea1 lipid m\u00e1u nh\u00f3m statin) d\u1eabn \u0111\u1ebfn b\u00ecnh th\u01b0\u1eddng h\u00f3a ho\u1eb7c \u1ed5n \u0111\u1ecbnh c\u00e1c enzym gan. Khi ti\u1ebfn h\u00e0nh \u0111\u00e1nh gi\u00e1 c\u00e1c thu\u1ed1c b\u1ec7nh nh\u00e2n \u0111\u00e3 s\u1eed d\u1ee5ng, c\u1ea7nx\u00e2y d\u1ef1ng m\u1ed9t khung th\u1eddi gian ch\u00ednh x\u00e1c li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c v\u00e0 th\u1eddi gian kh\u1edfi ph\u00e1t c\u0169ng nh\u01b0 di\u1ec5n bi\u1ebfn c\u1ee7a c\u00e1cb\u1ea5t th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn c\u00e1c ch\u1ec9 s\u1ed1 x\u00e9t nghi\u1ec7mch\u1ee9c n\u0103ng gan. M\u1eb7c d\u00f9 th\u1eddi gian kh\u1edfi ph\u00e1t c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a DILI c\u00f3 th\u1ec3 dao \u0111\u1ed9ng, \u0111a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec1u x\u1ea3y ra trong 6 th\u00e1ng \u0111\u1ea7u sau khi ph\u01a1i nhi\u1ec5m v\u1edbi thu\u1ed1c.<\/p>\n

C\u00e1c t\u00ecnh tr\u1ea1ng b\u1ec7nh kh\u00e1c c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111\u1ec3 lo\u1ea1i tr\u1eeb bao g\u1ed3m vi\u00eam gan virus (vi\u00eam gan virus A, B, C v\u00e0 c\u00f3 th\u1ec3 c\u1ea3 vi\u00eam gan virus E) v\u00e0 c\u00e1c t\u00ecnh tr\u1ea1ng nhi\u1ec5m virus kh\u00e1c (cytomegalovirus, Epstein-Barr ho\u1eb7c Herpessimplex), vi\u00eam gan t\u1ef1 mi\u1ec5n, t\u1ed5n th\u01b0\u01a1ng gan do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, h\u1ed9i ch\u1ee9ng Budd-Chiari (t\u1eafc ngh\u1ebdn c\u00f3 ho\u1eb7c kh\u00f4ng h\u00ecnh th\u00e0nh huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch ra kh\u1ecfigan), b\u1ec7nh Wilson (b\u1ec7nh di truy\u1ec1n l\u1eb7n tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 th\u01b0\u1eddng g\u00e2y r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a \u0111\u1ed3ng). Th\u00f4ng th\u01b0\u1eddng, sinh thi\u1ebft gan l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft v\u00ec vi\u1ec7c n\u00e0y th\u01b0\u1eddng kh\u00f4ng h\u01b0\u1edbng \u0111\u1ebfn ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh DILI. DILI t\u1eafc m\u1eadt c\u1ea7n th\u1eddi gianh\u1ed3i ph\u1ee5c d\u00e0i h\u01a1n so v\u1edbi DILI t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan. ALT c\u00f3 th\u1ec3 gi\u1ea3m r\u00f5 r\u1ec7t trong v\u00f2ng 30-60 ng\u00e0y sau khi ng\u1eebng thu\u1ed1c nghi ng\u1edd trong tr\u01b0\u1eddng h\u1ee3p DILI t\u1ed5n th\u01b0\u01a1ng ho\u1ea1i t\u1eed t\u1ebf b\u00e0o gan, trong khi \u1edf DILI lo\u1ea1i t\u1eafc m\u1eadt, alkalin phosphatase (ALP) v\u00e0 bilirubin huy\u1ebft thanh c\u00f3 th\u1ec3 gi\u1ea3m \u0111\u00e1ng k\u1ec3 trong kho\u1ea3ng th\u1eddi gian l\u00ean t\u1edbi 180 ng\u00e0y.<\/p>\n

C\u00e1c ti\u00eau chu\u1ea9n h\u00f3a sinh l\u00e2m s\u00e0ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh s\u1ef1 xu\u1ea5t hi\u1ec7n DILI bao g\u1ed3m \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c ti\u00eau ch\u00ed sau: ALT t\u0103ng \u22655 l\u1ea7n ULN (gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng tr\u00ean); ALP t\u0103ng \u22652 l\u1ea7n ULN; v\u00e0 ALT t\u0103ng \u22653 l\u1ea7n ULN k\u00e8m theobilirubin t\u0103ng >2 l\u1ea7n ULN. Gi\u00e1 tr\u1ecb R \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng gan:R=(ALT\/ULN)\/(ALP\/ULN). R\u22655 ph\u1ea3n \u00e1nh t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan; R <2 t\u01b0\u01a1ng \u1ee9ng v\u1edbi t\u1ed5n th\u01b0\u01a1ng t\u1eafc m\u1eadt;trong khi 2< R <5 th\u1ec3 hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan v\u00e0 t\u1eafc m\u1eadt h\u1ed7n h\u1ee3p. C\u1ea7n l\u01b0u \u00fd, lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng v\u00e0 c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 thay \u0111\u1ed5i\u0111\u1ed1i v\u1edbi c\u00f9ng m\u1ed9t thu\u1ed1c.<\/p>\n

M\u1eb7c d\u00f9 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n DILI \u0111\u1eb7c \u1ee9ng hi\u1ec7n ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o s\u1ef1 \u0111\u1ed3ng thu\u1eadn \u00fd ki\u1ebfn c\u1ee7a c\u00e1c chuy\u00ean gia, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng m\u1ed9t s\u1ed1 c\u00f4ng c\u1ee5 h\u1ed7 tr\u1ee3 trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 nh\u01b0 thang RUCAM (Roussel Uclaf Causality Assesment Method), \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n b\u1edfi H\u1ed9i \u0111\u1ed3ng c\u00e1c t\u1ed5 ch\u1ee9c qu\u1ed1c t\u1ebf v\u1ec1 khoa h\u1ecdc y h\u1ecdc (CIOMS) ho\u1eb7c thang \u0111\u00e1nh gi\u00e1 M&V (Maria and Victorino). D\u1ef1a tr\u00ean s\u1ed1 \u0111i\u1ec3m \u0111\u01b0\u1ee3c t\u00ednh theo thang RUCAM, kh\u1ea3 n\u0103ng bi\u1ebfn c\u1ed1 g\u00e2y ra do thu\u1ed1c \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i nh\u01b0 sau: <0,lo\u1ea1i tr\u1eeb nguy\u00ean nh\u00e2n do thu\u1ed1c; 1-2, \u00edt c\u00f3 kh\u1ea3 n\u0103ng; 3-5, c\u00f3 th\u1ec3; 6-8, c\u00f3 kh\u1ea3 n\u0103ng; v\u00e0 >8, c\u00f3 kh\u1ea3 n\u0103ng cao. Thang RUCAM \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i b\u1edfi c\u00e1c nh\u00e0 l\u00e2m s\u00e0ng, C\u00f4ng ty D\u01b0\u1ee3c v\u00e0 c\u00e1c c\u01a1 quan qu\u1ea3n l\u00fd \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 DILI. Thang M&V (c\u00f2n \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn l\u00e0 Thang Ch\u1ea9n \u0111o\u00e1n L\u00e2m s\u00e0ng – Clinical Diagnostic Scale) l\u00e0 m\u1ed9t phi\u00ean b\u1ea3n bi\u1ebfn \u0111\u1ed5i c\u1ee7a thang CIOMS\/RUCAM, c\u00f3 m\u1ed9t s\u1ed1 h\u1ea1n ch\u1ebf nh\u01b0 t\u1eadp trung v\u00e0o c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m qu\u00e1 m\u1eabn c\u1ee7a DILI,ph\u1ee5 thu\u1ed9c \u00fd ki\u1ebfn c\u1ee7a m\u1ed9t s\u1ed1 \u00edt chuy\u00ean gia, \u00edt ch\u00ednh x\u00e1c trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111i\u1ec3n h\u00ecnh ho\u1eb7c c\u00f3 th\u1eddi gian ti\u1ec1m t\u00e0ng k\u00e9o d\u00e0i, v\u00e0\u00edtc\u00f3 m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng \u0111\u1ed3ngv\u1edbi thang CIOMS\/RUCAM. B\u1ea3n \u0111i\u1ec7n t\u1eed c\u1ee7a c\u00e1c c\u00f4ng c\u1ee5 \u0111\u00e1nh gi\u00e1 n\u00e0y hi\u1ec7n c\u00f3 tr\u00ean trang webLiverTox. C\u00e1c h\u01b0\u1edbng d\u1eabn th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng v\u1ec1 DILI cho r\u1eb1ng \u00fd ki\u1ebfn \u0111\u1ed3ng thu\u1eadn gi\u1eefa c\u00e1c chuy\u00ean gia (d\u1ef1a tr\u00ean \u0111\u00e1nh gi\u00e1 to\u00e0n di\u1ec7n v\u1ec1 c\u00e1c nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9c t\u00ednh tr\u00ean gan) l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ed1i quan h\u1ec7 nh\u00e2n qu\u1ea3, nh\u01b0ng v\u1ec1 kh\u00eda c\u1ea1nh th\u1ef1c h\u00e0nh, ph\u01b0\u01a1ng ph\u00e1p n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i v\u00e0 ch\u01b0a\u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. Do \u0111\u00f3, ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ed1i quan h\u1ec7 nh\u00e2n qu\u1ea3 trong tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd DILI l\u00e0 thang CIOMS\/RUCAM.<\/p>\n

\u0110i\u1ec1u tr\u1ecb<\/strong><\/p>\n

\u0110i\u1ec3m quan tr\u1ecdng nh\u1ea5t \u0111\u1ec3ki\u1ec3m so\u00e1t DILI l\u00e0 lo\u1ea1i b\u1ecf t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh s\u1edbm nh\u1ea5t c\u00f3 th\u1ec3. M\u1eb7c d\u00f9 ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh, s\u1ef1 ng\u1eebng thu\u1ed1c nhanh ch\u00f3ng \u0111\u01b0\u1ee3c cho r\u1eb1ng c\u00f3 th\u1ec3 gi\u1ea3m thi\u1ec3u ti\u1ebfn tri\u1ec3n th\u00e0nhsuy gan c\u1ea5p. Corticoisteroid c\u00f3 hi\u1ec7u qu\u1ea3 trongtr\u01b0\u1eddng h\u1ee3p vi\u00eam gan do r\u01b0\u1ee3u v\u00e0 vi\u00eam gan t\u1ef1 mi\u1ec5n, tuy nhi\u00ean ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u0111\u1ea7y \u0111\u1ee7 \u0111\u1ed1i v\u1edbi DILI. Tuy v\u1eady, c\u00e1c thu\u1ed1c n\u00e0y v\u1eabn \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong x\u1eed tr\u00ed vi\u00eam gant\u01b0\u01a1ng t\u1ef1 c\u01a1 ch\u1ebft\u1ef1 mi\u1ec5n do thu\u1ed1cbao g\u1ed3mng\u1eebng thu\u1ed1c v\u00e0 s\u1eed d\u1ee5ng corticoisteroid. Li\u1ec7u ph\u00e1p corticosteroid c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc n\u1ebfu c\u00e1c k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m b\u1ea5t th\u01b0\u1eddng kh\u00f4ng h\u1ed3i ph\u1ee5c sau 6-8 tu\u1ea7n, \u0111\u1eb7c bi\u1ec7t n\u1ebfu thu\u1ed1c nghi ng\u1edd c\u00f3 li\u00ean quan \u0111\u1ebfn c\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch c\u1ee7a DILI.<\/p>\n

N-acetylcystein (NAC) \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9c t\u00ednh do paracetamol, nh\u01b0ng vai tr\u00f2 c\u1ee7a n\u00f3 \u0111\u00e3 \u0111\u01b0\u1ee3c m\u1edf r\u1ed9ng c\u1ea3 trong tr\u01b0\u1eddng h\u1ee3p DILI do nguy\u00ean nh\u00e2n ngo\u00e0iparacetamol. Theo c\u00e1c h\u01b0\u1edbng d\u1eabn th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng c\u1ee7a ACG, NAC c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc tr\u00ean b\u1ec7nh nh\u00e2n ng\u01b0\u1eddi l\u1edbn c\u00f3 suy gan c\u1ea5p giai \u0111o\u1ea1n s\u1edbm, nh\u01b0ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean tr\u1ebb em c\u00f3 DILI n\u1eb7ng do t\u1ef7 l\u1ec7 s\u1ed1ng th\u1ea5p h\u01a1n \u1edf b\u1ec7nh nh\u00e2n suy gan c\u1ea5p do nguy\u00ean nh\u00e2n ngo\u00e0i paracetamol. T\u1ed5ng quan d\u1ef1a tr\u00ean d\u1eef li\u1ec7u \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 t\u1eeb n\u0103m 2003 \u0111\u1ebfn 2012 cho th\u1ea5y NAC c\u00f3 hi\u1ec7u qu\u1ea3 cho b\u1ec7nh nh\u00e2n suy gan c\u1ea5p do nguy\u00ean nh\u00e2n ngo\u00e0iparacetamolc\u00f3 h\u00f4n m\u00ea \u0111\u1ed9 Iv\u00e0\u0111\u1ed9 II, \u0111\u1ed3ng th\u1eddi kh\u00f4ng khuy\u1ebfn c\u00e1o vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y th\u01b0\u1eddng quy. M\u1ed9t t\u1ed5ng quan h\u1ec7 th\u1ed1ng v\u1ec1 s\u1eed d\u1ee5ng NACtrong DILI do nguy\u00ean nh\u00e2n ngo\u00e0iparacetamol hi\u1ec7n \u0111ang \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n. NAC kh\u00f4ng \u0111\u01b0\u1ee3c FDA ph\u00ea duy\u1ec7t cho ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb suy gan c\u1ea5p do nguy\u00ean nh\u00e2n ngo\u00e0iparacetamol.<\/p>\n

Acid ursodeoxycholic \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u1eed tr\u00ed DILI c\u00f3 t\u1eafc m\u1eadt; tuy nhi\u00ean, d\u1eef li\u1ec7u h\u1ed7 tr\u1ee3 cho vi\u1ec7c s\u1eed d\u1ee5ng n\u00e0y c\u00f2n h\u1ea1n ch\u1ebf. Carnitin \u0111\u01b0\u1ee3c d\u00f9ng trong t\u1ed5n th\u01b0\u01a1ng gan do valproat. C\u00e1c s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c t\u1ef1 nhi\u00ean nh\u01b0 silymarin, resveratrol, curcumin v\u00e0 ginkgo \u0111ang \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 v\u1ec1 hi\u1ec7u qu\u1ea3 b\u1ea3o v\u1ec7 gan, m\u1eb7c d\u00f9 d\u1eef li\u1ec7u ch\u1ec9 \u1edf m\u1ee9c s\u01a1 b\u1ed9 ban \u0111\u1ea7u. Li\u1ec7u ph\u00e1p thay th\u1ebf huy\u1ebft t\u01b0\u01a1ng, t\u00e1i tu\u1ea7n ho\u00e0n s\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t h\u1ea5p ph\u1ee5 ph\u00e2n t\u1eed, t\u00e1ch huy\u1ebft t\u01b0\u01a1ng ph\u00e2n \u0111o\u1ea1n v\u00e0 h\u1ea5p ph\u1ee5 hi\u1ec7n \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb suy gan c\u1ea5p.<\/p>\n

Ti\u00ean l\u01b0\u1ee3ng<\/strong><\/p>\n

Lu\u1eadt Hy (Hy\u2019s law)\u00a0<\/em>\u0111\u1ec1 c\u1eadp t\u1edbi kh\u1ea3 n\u0103ng suy gan c\u1ea5p do ph\u01a1i nhi\u1ec5m v\u1edbi m\u1ed9t thu\u1ed1c c\u00f3 \u0111\u1ed9c t\u00ednh tr\u00ean gan. Theo \u0111\u00f3, c\u1ee9 10 b\u1ec7nh nh\u00e2n c\u00f3 v\u00e0ng da th\u1ee9 ph\u00e1t ti\u1ebfn tri\u1ec3n sau t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan trong m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng,m\u1ed9t b\u1ec7nh nh\u00e2n s\u1ebd c\u00f3 suy gan c\u1ea5pk\u00e8m theo r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u ho\u1eb7cb\u1ec7nh n\u00e3o gan. H\u01a1n n\u1eefa, Temple\u2019s Corollary cho r\u1eb1ng c\u1ee9 10 tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u0103ng ALT >10 l\u1ea7n ULN trong m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng, s\u1ebd c\u00f3 1 tr\u01b0\u1eddng h\u1ee3p tu\u00e2n theo lu\u1eadt Hy. FDA \u0111\u00e3 \u0111\u01b0a ra \u0111\u1ecbnh ngh\u0129a v\u1ec1 nguy c\u01a1 ti\u1ebfn tri\u1ec3n DILI n\u1eb7ng d\u1ef1a tr\u00ean lu\u1eadt Hy trong H\u01b0\u1edbng d\u1eabn cho C\u00f4ng ty D\u01b0\u1ee3cnghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng tr\u01b0\u1edbc khi thu\u1ed1c \u0111\u01b0\u1ee3c l\u01b0u h\u00e0nh tr\u00ean th\u1ecb tr\u01b0\u1eddng v\u1ec1 t\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c.<\/p>\n

DILI, l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u d\u1eabn t\u1edbi suy gan c\u1ea5p t\u1ea1i Hoa K\u1ef3, nhi\u1ec1u h\u01a1n c\u1ea3 vi\u00eam gan virus. Lo\u1ea1i DILI c\u00f3 \u1ea3nh h\u01b0\u1edfng t\u1edbi k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. T\u1ed5n th\u01b0\u01a1ng gan doparacetamol c\u00f3 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t h\u01a1n v\u00e0 kho\u1ea3ng th\u1eddi gian t\u1ed5n th\u01b0\u01a1ng t\u1ef1 h\u1ed3i ph\u1ee5c nhanh h\u01a1n do kh\u1ea3 n\u0103ng t\u00e1i t\u1ea1o t\u1ebf b\u00e0o gan nhanh h\u01a1n so v\u1edbi DILI \u0111\u1eb7c \u1ee9ng t\u01b0\u01a1ng \u1ee9ng v\u1edbi t\u1ef7 l\u1ec7 gh\u00e9p gan l\u00e0 9%, v\u1edbi t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t ng\u1eafn h\u1ea1n sau t\u1ed5n th\u01b0\u01a1ng gan l\u00e0 70%.DILIc\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u1ea5p t\u00ednh t\u1ebf b\u00e0o gan l\u00e0 d\u1ea1ng ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a DILI \u0111\u1eb7c \u1ee9ng, chi\u1ebfm kho\u1ea3ng 90% t\u1ed5ng s\u1ed1 ca, v\u00e0 chi\u1ebfm t\u1edbi 10-50% s\u1ed1 ca t\u1eed vong. T\u1ef7 l\u1ec7 t\u1eed vong l\u00ean t\u1edbi 60-80% trongsuy gan c\u1ea5p th\u1ee9 ph\u00e1t do DILI \u0111\u1eb7c \u1ee9ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c gh\u00e9p gan.<\/p>\n

T\u1ef7 l\u1ec7 ti\u1ebfn tri\u1ec3n th\u00e0nh DILI m\u1ea1n t\u00ednh c\u00f3 xu h\u01b0\u1edbng ng\u00e0y c\u00e0ng t\u0103ng v\u00e0 cao h\u01a1n so v\u1edbi nh\u1eadn \u0111\u1ecbnh tr\u01b0\u1edbc \u0111\u00e2y, l\u00ean t\u1edbi 15-20% trong s\u1ed1 b\u1ec7nh nh\u00e2n DILI c\u1ea5p t\u00ednh. Kh\u00e1ng sinh (amoxicilin-clavulanat, trimethoprim-sulfamethoxazol, azithromycin) l\u00e0 nh\u00f3m thu\u1ed1c ph\u1ed5 bi\u1ebfn nh\u1ea5t li\u00ean quan \u0111\u1ebfnti\u1ebfn tri\u1ec3n DILI m\u1ea1n t\u00ednh. C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00f3p ph\u1ea7n ti\u1ebfn tri\u1ec3n DILI m\u1ea1n t\u00ednh bao g\u1ed3m DILI ki\u1ec3u \u1ee9 m\u1eadt, tu\u1ed5i \u226465, v\u00e0 th\u1eddi gian ti\u1ec1m t\u00e0ng>365 ng\u00e0y k\u1ec3 t\u1eeb l\u1ea7n ph\u01a1i nhi\u1ec5m cu\u1ed1i c\u00f9ng v\u1edbi thu\u1ed1c.<\/p>\n

H\u1ec7 th\u1ed1ng ghi nh\u1eadn \u0111\u1ed9c t\u00ednh tr\u00ean gan \u1edfmi\u1ec1n Nam T\u00e2y Ban Nha cho th\u1ea5y 5,7% s\u1ed1 ca DILI \u0111\u1eb7c \u1ee9ng ti\u1ebfn tri\u1ec3n th\u00e0nh \u0111\u1ed9c t\u00ednh tr\u00ean gan m\u1ea1n t\u00ednh, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u00ecnh tr\u1ea1ng c\u00e1c ch\u1ec9 s\u1ed1 sinh h\u00f3a \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o gan duy tr\u00ec \u1edf m\u1ee9c \u0111\u1ed9 b\u1ea5t th\u01b0\u1eddng k\u00e9o d\u00e0i>3 th\u00e1ng sau khi ng\u1eebng thu\u1ed1c ho\u1eb7c >6 th\u00e1ng sau khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u1ee9 m\u1eadt ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng ph\u1ed1i h\u1ee3p. C\u00e1c thu\u1ed1c tim m\u1ea1ch v\u00e0 thu\u1ed1c t\u00e1c \u0111\u1ed9ng l\u00ean th\u1ea7n kinh trung \u01b0\u01a1ng l\u1ea7n l\u01b0\u1ee3t chi\u1ebfm kho\u1ea3ng 9,8% v\u00e0 13% t\u1ed5ng s\u1ed1 c\u00e1c ca m\u1eafc DILI, c\u00e1c nh\u00f3m thu\u1ed1c n\u00e0y c\u0169ngli\u00ean quan \u0111\u1ebfn \u0111\u1ed9c t\u00ednh tr\u00ean gan m\u1ea1n t\u00ednh t\u01b0\u01a1ng \u1ee9ng v\u1edbi t\u1ef7 l\u1ec7 28,5% v\u00e0 25%.<\/p>\n

Kh\u00f4ng n\u00ean d\u00f9ng l\u1ea1i c\u00e1c thu\u1ed1c nghi ng\u1edd g\u00e2y \u0111\u1ed9c t\u00ednh tr\u00ean gan, tr\u1eeb khi kh\u00f4ng c\u00f3 l\u1ef1a ch\u1ecdn kh\u00e1cph\u00f9 h\u1ee3p trong tr\u01b0\u1eddng h\u1ee3p \u0111e d\u1ecda t\u00ednh m\u1ea1ng. Ph\u1ea3n \u1ee9ng s\u1ebd x\u1ea3y ra nhanh, n\u1eb7ng h\u01a1n v\u00e0 c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong khi ph\u01a1i nhi\u1ec5m l\u1ea1i v\u1edbi thu\u1ed1c, \u0111\u1eb7c bi\u1ec7t n\u1ebfu c\u00e1ck\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan ban \u0111\u1ea7u >5 l\u1ea7n ULN v\u00e0 tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau chu\u1ea9n c\u1ee7a lu\u1eadt Hy hay c\u00f3 v\u00e0ng da.<\/p>\n

K\u1ebft lu\u1eadn<\/strong><\/p>\n

S\u1ed1 tr\u01b0\u1eddng h\u1ee3p DILI \u0111\u01b0\u1ee3c d\u1ef1 \u0111o\u00e1n s\u1ebd gia t\u0103ng do t\u0103ng t\u00ednh s\u1eb5n c\u00f3 c\u1ee7a c\u00e1c thu\u1ed1c k\u00ea \u0111\u01a1n t\u1eeb thay \u0111\u1ed5i trong ch\u00ednh s\u00e1ch b\u1ea3o hi\u1ec3m y t\u1ebf v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a th\u1ecb tr\u01b0\u1eddng c\u00e1c ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 s\u1ea3n ph\u1ea9m c\u00f3 ngu\u1ed3n g\u1ed1c th\u1ea3o d\u01b0\u1ee3c. D\u01b0\u1ee3c s\u0129 \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong g\u00f3p ph\u1ea7n ng\u0103n ng\u1eeba DILI v\u00e0 x\u00e1c \u0111\u1ecbnhnguy\u00ean nh\u00e2n thu\u1ed1c nghi ng\u1edd g\u00e2y DILI \u0111\u1ec3 k\u1ecbp th\u1eddi ng\u1eebng s\u1eed d\u1ee5ng s\u1edbm nh\u1ea5t t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh. \u0110\u1ec3 b\u1ea3o v\u1ec7 ng\u01b0\u1eddi b\u1ec7nht\u1ed1t nh\u1ea5t, d\u01b0\u1ee3c s\u0129 c\u1ea7n c\u00f3 ki\u1ebfn th\u1ee9c v\u1ec1 c\u00e1c thu\u1ed1c li\u00ean quan c\u0169ng nh\u01b0 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 di\u1ec5n bi\u1ebfn b\u1ec7nh. C\u1ea7n khai th\u00e1c k\u1ef9 ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd m\u1eafc DILI. Khi DILI \u0111\u01b0\u1ee3c kh\u1eb3ng \u0111\u1ecbnh, b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i trong \u00edt nh\u1ea5t 6 th\u00e1ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 ti\u1ebfn tri\u1ec3n t\u1ed5n th\u01b0\u01a1ng m\u1ea1n t\u00ednh. Gi\u00e1m s\u00e1t k\u00ea \u0111\u01a1n l\u00e0 c\u00e1ch ti\u1ebfp c\u1eadnc\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc ho\u1eb7c c\u00f3 nguy c\u01a1 m\u1eafc DILI.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Theo Canhgiacduoc T\u1ed4NG QUAN V\u1ec0 T\u1ed4N TH\u01af\u01a0NG GAN DO THU\u1ed0C \u00a0\u0110\u00e0m Th\u1ecb Thanh H\u01b0\u01a1ng, L\u01b0\u01a1ng Anh T\u00f9ng T\u00f3m t\u1eaft T\u1ed5n th\u01b0\u01a1ng gan do thu\u1ed1c (drug-induced liver injury – DILI) l\u00e0 b\u1ec7nh l\u00fd kh\u00f4ng ph\u1ed5 bi\u1ebfn, nh\u01b0ng c\u00f3 nguy c\u01a1 g\u00e2y t\u1eed vong, nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn c\u00e1c thu\u1ed1c k\u00ea \u0111\u01a1n, c\u00e1c thu\u1ed1c […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[373],"tags":[],"class_list":["post-11391","post","type-post","status-publish","format-standard","hentry","category-duoc-lam-sang"],"_links":{"self":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/11391","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/comments?post=11391"}],"version-history":[{"count":1,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/11391\/revisions"}],"predecessor-version":[{"id":11393,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/11391\/revisions\/11393"}],"wp:attachment":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media?parent=11391"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/categories?post=11391"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/tags?post=11391"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}