DANH GIA HIEU QUA DIEU TRI CUA MONTELUKAST KET HOP SERETIDE 6 BENH NHAN VIEM MUI DI tfNG CO HEN PHE QUAN
Trdn Hdi Yen", Phiing Chi Thiin"; Nguyen Thj Kim Huang'", Vd Minli Thuc, Pham Vdn Viuc"
TOMTAT
Dat van t&: Viem mui df ung (VMDlX) vd hen pht qudn (HPQ) Id benli duung ho hc^ thudng gap.
Montelukast cho hieu qud dieu tri vuat troi ^ vai hai loqi benh di dng ndy vd no seed hiiu qud lum rmi fcS hgp vai thud'c corticosteroid.
Muc tiiu: Ddnh gid hieu qud diSu tri cua Montelukast phm hap vai corticosteroid (SERETIDE) a benh ididn VMDU CO HPQ. Doi tuang vd phuang phdp nghiin cieu: gom 50 henh nlidn duac chdn dodn xdc dinh VMDU co HPQ, nghien ciiu tiin deu, mo td theo chUu dgc, tif doi diiing igi Benh vien DHY Hdi plidng.
Kei tpid: sau 12 thdng dieu iri, cdc trieu chiing ca ndng vd trieu chimg thuc the deu gidm; co su tiBi trien ddng kedoi vdi cdc trieu diiing vi hen phi'qudn vdo han ngdy vd ban dem. So benli nhdn len can hen gidm tit 34% tie ndm h-uac xud'ng 12% trong ndm dieu iri. so'binh nhdn plidi tliam klidm cap deu, nhdp men vd uohg thudc corticosteroid vi HPQ gidm tieang ting tie 20% xuong 6%, 6% xuong 0% vd tie 20% xud'ng 4%.
Kei ludn: Phdc do Montelukast plwi liap corticosteroid (SERETIDE) Id mot phieang phdp dieu tri hieu qud vd an todn dot vai benh nhdn VMDY co HPQ. Thuo'c dung nap toi khong co benh nhdn ndo xdy ra plidn iing phu.
THkhoa: Viim mdi di dng, hen phe'qudn, Montelukast, anticosieroid, SERETIDE ABSTRACT
THE EFFECTS OF COMBINATION OF MONTELUKAST AND SERETIDE ON ALLERGIC RHINmS AND ASTHMA PATIENTS
Tran Hai Yen, Phimg Chi Thien, Nguyen Thi Kim Huong, Vu Minh Thuc, Pham Van Thuc
* Y Hoc TP. Ho Chi Minh * Vol. 18 - Supplement of No 1 - 2014:33 - 38 Introduction: Allergic rhinitis (AR) and asthma is a popular respiratory disease. Montelukast is superior
^ective treatment fiyr them. And it's better combination Montelukast and corticosteroid (SERETIDE).
Objective: to examine the dianges in treatinent of wmbination Montelukast and corticosteroid (SERETIDE) at patients with allergic asthma. Paiienis and method: fifty patients with allergic asthma were enrolled in tlie auto controlled descriptive fallow-up stiidy ai Haiphong Medical University Hospital.
Results: After 12 months qf treaiiimit, functional symptoms and physical symptoms were decreased; the clinical symptoms were markedly improved there is significant progress far ihe symptoms of asthma at day and night. The proportwn of patients experiendng an asthma attack declines fiom 34% in the year before to 12%>
(p<0.001) the year after addition of Montelukast therapy. Proportions cf patients with an asthma-related emergency room visit, hospitalization, and oral corticosieroid use declined from 20% to 6%, from 6% io 0% and from 20% to 4% (pO.OV, respectively.
Conclusion: Combination Montelukast and cortiwsieroid (SERETIDE) is an ejfi^ctive and safe treatment fjr allergic asthma patients. All patients had ihe intention io continue using its. Tlie drugs are well tolerated.
• Benh vien Tai MQi Hpng TU" "Dai hoc Y Ha Noi ~D?i hpc Y Hai Phong Tdc gid lien lac. Bs. Tran Hai Yen DT: 0913 008 717 £wini7: [email protected]
Chuyen De Tai Miii Hpng 33
Nghien cuu Y hpc Y Hpc TP. Hb Chi Minh * Tap 18 * P h u b a n cua Sb 1 * 2014 Keywords: allergic rhinitis, asthma, Montelukast,
DATVANDE
Dieu tri viem miii di iing khong chi Iam giam tac nghen viem miii va xoang, ma con co the lam giam man cam duong ho hap duoi va trieu chiing aia benh HPQ">. Dieu tri viem miii di ling la mot diem quan trpng trong kiem soat HPQ. Khi CO sv tham gia ciia Leukotrienes cystein vao sinh ly b#nh hpc ciia benh hen va VMDU cho thay si; ngan ham thy the Leukotrienes cystein aia Montelukast co the mang lai lpi I'di trong dieu tri cho benh nhan VMDU CO HPQ. Montelukast la mpt loai chat doi khang thu the leukotriene anh huong mpt phan quan trpng den ducmg viem nhiem do di ling. Montelukast dm? sii dung nhu mpt phuang phap tri lieu don le hoac lieu phap bo sung (them vao logi hormone steroid do vo thuong t h ^ tong hpp dimg duoi dang hit (ICS) cho b?nh nhan hen va thuoc chong di iing antihistamine cho benh nhan VMDU)w. Muc dinh nghien cihi aia chung toi de danh gia tac dyng cai thi?n va kiem soat tri?u chiing Iam sang 6 benh nhan VMDU' c6 HPQ ciia Montelukast ket hpp LABA (Long Acting Beta 2 Agomst) noi chung va Seretide (salmeterol + fluhcason).
DOITU'ONG-iHLrONGHIAPNCMENCUlJ Dbi hrpng nghien cuu
Gom 50 benh nhan VMDU co HPQ dupc dieu tn Montelukast lieu lOmg/ngay phoi hpp voi SERETTOE 25/250 ^g dang hit (ngay 2 Ian dung hang ngay trong thoi gian 12 thang.
Thoi gian va dia diein nghien cuu Tli thang 9/2011 den 8/2013 tai khoa mien djch lam sang B ^ vien Dgi hpc Y Hai Phong.
Tieu chuu) chpn b^nh nhan
Dupc chah doan la VMDU co HPQ neu co:
Cac trieu chiing oia \MDU phai co tien sii til 2 nam tro len va cac trieu chiing cua HPQ phai CO tien sii tir 1 nam tro Ien.
corticosieroid, SERETIDE
Tien sii di iing va hen phe quan (ca nhan va gia dinh).
Co test lay da voi di nguyen (DN) cho ket qua duong tinh.
Lam sang
VMDU: Co cac trieu chiing ciia VMDU ban ngdy: ngh^t miii, chay nuoc miii, ngiia mui, hJt hoi. Cac trieu chiing nay xuat hien ttianh con, nhieu con trong mpt dpt Ban dim: Kho ngii, thiic giac ve dem, ngh^t miii khi thiic dgy. Co the xuat hien trieu chung o mit (mtt do)^'.
HPQ; Co tri?u chting lam sang chinh ciia HPQ: kho tho voi cac dgc di&n; Kho tho xuat hien thanh tung can, ngoai con nguoi bgnh binh thuang, con kho tho thudng xay ra ve dem, kho tho ra la chu yeu. Ke't hop vai kham thyc the 6 phoi. Do chiic nang ho hap: FEVI va FEVI % giam tren 20%.
Cac xet nghidm co ban trong gicd hgn binh thuong, cac xet nghiem sinh hoa ve chiic nang gan va than binh thuang.
Tuoi: tat ca cac b^nh nhan tir 15 tuoi tro len.
B#nh nhan tu nguyen tham gia.
Tieu chuaii Ioai trir
Se loai khoi nghien ciiu nay cac bpnh nhan:
Khong CO day dii cac trieu chiing ciia VMDU vaHPQ.
HPQ bac 4 theo phan loai ciia GINA.
Dang bi b^nh ly nhiem khuan cap 6 miii xoang: nhu viem miii mii, viem xoang mii, "cam dim"...
Dang bi benh ly nhiem khuah cap 6 duang ho hap dudi: viem phe quan, viem phoi...
Benh nhan mac cac benh toan than phoi hi^p:
benh tim mgch, viem gan, viem ttign, b$nh h?
thong...
Dang dieu tri trong viing 2 tuan truoc do bang cac thubc khang histamin, corticoid (tgi ch6 va toan than), ttiuoc lam ben vung mang te bao (cromoglycate...), ttiuoc kich ttiich beta2-
Chuyen D e Tai Mtii Hpng
Nghien ciiu Y hpc adrenergic (Salbutamol...); hoac cac bai tiiuoc
dong y chija di iing noi chung.
Phtromg p h a p nghien cuu Thiei ktng^tien ciiu
Nghien ciiu thii nghiem Iam sang, doi chiing truoc va sau dieu tri
QUI trinh dieu tri
Benh nhan duqrc dieu tri VMDU co HPQ vdi Montelukast lieu 10 mg/ngay vao buoi tai trudc khi di ngii phoi hpp vdi SERETIDE 25/250 \i:g dang hit (ngay 2 Kn) dimg hang ngay trong ttioi gjan 12 thang.
Quy trinh theo doi benh nhdn vd ddnh gid hieu qud dieu tri
Sau 3, 6,12 thang dieu tri benh nhan se duoc tham kham lam sang de so sanh va danh gja hieu qua dieu tri.
Ddnli gid hieu qud ve ldm sdng aia benh VMDU; dua vao miic dp tien trieh ciia cac trieu chiing Iam sang:
4 tneu chiing co nang: hat hoi, chay miii, ngat miji, ngiia miii.
2 trieu chiing thyc fhe: finh trgng niem mac miii, tinh trang cuon dudi.
Sy thay doi tneu chiing co nang dvra vao hoi benh true tiep, su ttiay doi trieu chiing thuc the qua tiiam kham bang npi soi. Tuy vao miic dp thay dol nhieu hay it ma chung toi cho diein va danh gia hieu qua la t6i, khd, trung binh hay kem.
Ddnli gid hiiu qud ve ldm sdng cua benli Hen Phf Qudn: Khd thd, ho, tiic nguc va ket hpp kham thuc the phoi. Tuy vao miic dp thay doi nhieu hay it ma chiing toi cho diem va danh gia hi?u qua dieu tri.
Quy trinh theo doi tdc dung phu va tinh an todn dm Montelukast phoi hap vdi SERETIDE
Benh nhan dupc theo doi trong subt qua trinh dieu tri ve cac tac dung phu co the gap khi dimg Montelukast va lam cac xet ngjuem ve chiic nang gan than khi ran ttiiet trong thdi gian
dieu tri va khi ket thiic gjai doan dieu tri de danh gia tinh an toan aia phac do Montelukast phra hpp vdi SERETIDE.
Xu ly sb lieu
Cac so lieu tren dupc xii ly tren may tinh vdi chucmg trinh phan mem SPSS 15.0.
Test Student khi so sanh 2 ty le va so sanh trung binh.
Cac ttiong sbco y nghia thbng ke khi p<0,05.
KET QUA NGHIEN CtfU
Thay dbi cac trieu chiing VMDU sau 12 fhang dieu tri.
Cd tdi 82,0% so benh nhan cd hieu qua tot va kha.
Thay dbi cac trieu chiing hen phe quan tnrac va sau dieu tii
Thay doi trieu chimg ca ndng
Sau 3 thang so benh nhan ho ve dem, khd thd, tlic nguc giam. Sau 6 thang ty le benh nhan khong cdn khd thd tang d s i 90% va sau 12 ttiang dieu tri cd 98% benh nhan khong con khd thd va chi con 6,0% b^nh nhan cam thay tiic nguc Tliay dd'i triiu chiing thuc the
Trudc dieu tri 30,0% benh rihan cd bieu hien CO nit co ho hap phu, 54% nghe phoi thay ri rao phe nang giam va cd ran d phoi. Sau dieu tri 3 thang, 6 thang va 12 thang cac trieu chiing thuc the iden dbi ro, cd tdi 98% benh nhan cd ^a\ so thd trd ve binh thudng, nghe phoi khong con ran, ri rao phe nang ro.
Thay doi ve nhu cau sudung tituoc cat can Trudc dieu tri 100% benh nhan cd nhu cau sii dung thubc cat con. Sau dieu bri so b^nh nhan a i nhu cau dyng thuoc cat con giam dan: con 58% sau 3 thang, 38% sau 6 thang va 12% sau 12 thang.
Tdc dung khong mang muon
Trong 12 thang theo ddi cac benh nhan hen dieu tri, chiing toi chi gap mpt ty le nhd cac b^nh nhan nhgy cam cd run chan tay nhe, hoi
C h u y e n D e Tai M u i H p n g
Nghien cmi Y hpc Y Hpc TP. Hb Chi Minh * Tap 18 * Phu b a n cua Sb 1 * 2014 hpp danh trong nguc, dau dau, ho ngay sau
hit thubc.
Ket qua cac chi tieu thong khi o phoi Su thay doi cdc the roi loan thong khi phoi
Trudc dieu hi chung toi ggp 76% RLTKTN, 10% RLTKHH. Sau dieu hi ty lp benh nhan bi RLTKTN giam hSn (tir 56% sau 3 tiiang xubng 30% sau 6 thing va chi cdn 10% sau 12 thang);
tuy nhien ti I? RLTKHH khong c6 su cai tiiien.
Su ffiay doi PEF sdng-chieu
Nghien ciiu ve dp dao dpng sang chieu ciia luu Iupng dinh chung toi ttiay rang: ti le benh nhan cd miic dao dpng <20% co xu hirdng tang dan tiieo ttidi gian dieu tri (tir 140% len 38,0%
sau 3 ttiang, dat 60,0% sau 6 tiiang va tdi 86,0%
sau 12 thang).
Si^ thay dbi bac hen phe quan
Tren 50 benh nhan VMDU cd HPQ bac 1, n. 111 ket qua sau dieu tri Montelukast + seretide cho thay: so benh nhan HPQ khong cdn trieu chiing ting dan tii 0% Ien 18,0% sau 3 thang, dgt 34,0% sau 6 thang va sau 12 thang cd tdi 62,0%. Chi cdn 5 benh nhan d hen bgc III sau 12 Uiang dieu tri (10,0%).
Qua phan tich sb lieu nghien cihi tien hanh tren 50 b^nh nhan, ty le benh nhan bi len con hen cap trong nam trudc can ttiiep la 34%, benh nhan cap ciiu do hen la 20%, cd 3% benh nhan nhgp vien, 20% benh nhan sir dung corticosteroid dudng uong va 52% b^nh nhan phai tham kham bac si bat chpt khong theo dinh ky. Sau dieu tri, cac chi so tren deu giam xuong, Ian Im?t la: 12%, 6%, 0%, 4% va 30%.
BAN LUAN
Tien trien aia cac trieu chung ve VMDU sau 12 thong dieu tri Montelukast phoi hpp seretide
Trieu chiing ca ndng
Ket qua nghien ciiu aia chung toi trudc dieu tn la 84,0% sb BN cd tir 3 tri^u chiing trd len, 20% cd tir 2 trieu chiing. Day la budc danh gia
i^u tien trudc khi kham benh. Ket qua ciia chiing toi phil hpp vdi tieu chuah chan doan ciia P.DemoIy va J.Bousquet. Sau dieu tri, Ket qua ban dau cho tiiay, cac trieu chiing chii quan d benh nhan da dupc cai tiiien ro ret. Tam chiing ngiia miii, hat hoi, chay miii va bieu hien ngat mui da giam rd ret ca ve ty le (p < 0,001) va cudng do ciia trieu chiing. Su tieh trieh nhanh chdng dupc nhan thay 6 sau dcrt dieu tri, sij khac biet trudc va sau dieu tri cd y nghia tiidng ke.
Trieu chiing thuc the
Ve kham thuc ttie, nghien aiu tham kham npi soi de danh gia tri|u chiing tiiyc tiie co ban trpng viem miii di ting la tinh trgng niem mgc miii. Sau dieu tri, chiing toi nhgn thay cd rat nhieu benh nhan da cd tiiay dbi ve hinh thai, mau sac niem mac miii. Su phii ne, li dpng djch nhay da giam manh (p > 0,05). Cac trieu chiing ttiuc the sau dieu tri diri^c ttiay rang cd su thay dbi ve mau sac niem mgc. Su phu ne va tang tiet djch da giam rat ro. Cac trudng hpp tot Ien nay deu la nhiing trudng hgrp trudc dieu tri chi qua phat nhe.
Thay dbi tri^u chting Iam sang ve HPQ 6 benh nhan VMDU co HPQ sau dieu tri Montelukast phbi hpp Seretide
Theo ddi si^ bi&i doi cac trieu chiing co nang va thuc the ciia HPQ khi dieu tri bang Montelukast phbi hpp Seretide tren cac bpnh nhan, chiing toi nhan thay trirdc dieu tri 48%
benh nhan cd khd thd cd cii, 68% ludn cam thay tlic nguc, 60% benh nhan cd ho ve dem; 50% cd tan so thd >22 Ian/phut; nghe phd'i d 54% b^nh nhan cd ri rao phe nang giam va cd ran trong do chil yeu gap ran rit (42%). Sau dieu bri 3 thang, sb benh nhan khdng con khd thd tang len den 68%;
cd 72% b?nh nhan cd fan so thd trong gidi hgn binh thudng va hren 70% berth nhan nghe phoi khdng cdn ran, ri rao phe nang rd. Theo ddi sau dieu tri 6 thang, chiing toi nhgn thay so b?nh nhan khong cdn kho thd tang Ien den 90%; co 86% benh nhan cd (an sb thd trd ve gidi hgn binh ttiuong, 92% benh nhan nghe phoi khdng con
36 Chuyen De Tai Mui Hpng
Nghien ciiu Y hpc ran. Sau 12 thang dieu tri 98% benh nhan khdng
cdn kho tiid, deu cd tan so ttid trd ve gidi hgn bmh thudng, nghe phbi khdng cdn ran va ri rao phe nang binh thirdng. Sb benh nhan cdn lai thinh thoang xuat hi^n con khd Ihd co a i nhung d miic dp nhe.
S u thay doi nhu cau sii dung thuoc d t con Theo ddi tren cac benh nhan nghien ciiu ve thay dbi nhu cau sii dung thuoc cat con, chiing tdi nhan thay trudc dieu bi 100% benh nhan deu cd nhu cau sii dumg ttiuoc cat con. Theo nghien Cliu AIRIAP 2, ti le benh nhan cd nhu cau sii dyng thuoc cSl con d Phap la 87%, d My 61% cdn tai Viet Nam la 62%. Cac ttiuoc benh nhan hay sir dung la cac thuoc gian phe quan tac dyng nhanh, benh nhan cd the sir dung mpt hoac nhieu tiiuoc gian phe quan cd ket hpp hogc khong vdi cac thuoc chong viem.
Tac dung khong mong muon
Khi tiieo ddi mpt so tac dyng khdng mong muon ciia ttiubc trong 12 ttiang dieu tri, chiing tdi gap mot so nhd cac tac dung khdng mong mudn la tac dung rieng cua Salmeterol va Flutic^^sone propionate (tac dyng khong mong muon oia Salmeterol la run tay, hoi hpp, dau dau, nhjp tim nhanh; tac dung khdng mong mudn oia fluticasone propionate la, nam Candidas mieng hpng). Nhung nhimg tac dung nay dupc giam da rat nhieu do lieu oia seretide chi cdn V^ (2 lan/ngay mdi Ian 1 nhat). Chung tdi khong gap bat ky mpt tac dyng phy nao mdi do su ket hpp cua Montelukast phoi hpp seretide.
Dieu nay ciing duoc Nicolas Detono nghien ciiu rat rd va nhan thay rang trong Seretide cd su ket hpp can dm cua hai thanh phan va dam bao khdng cd su hiong tac gay ra tac dung khdng mong mubn giiia chung. Nghien ciiu GOAL ding kMng dinh Montelukast phoi hop seretide la su phm hpp cd dp an toan cao, dat dupc va duy tri kiem soat benh VMDU cd hen ma khdng cd nhimg tac dyng phy hr viec dimg fliubc gay ra. Cac daii hieu tren chi xuat hien trong mpt vai
ngay dau dieu tri roi mai han, khdng gay khd chiu cho benh nhan.
Thay doi thong khi pho'i sau dieu tri Qua nghien ciiu chiing tdi thay gia tri cua cac chi tieu thdng khi phbi tang dan theo thdi gian dieu tri- Su thay dbi sau dieu tri so vdi trudc dieu tri la cii y nghia thong ke vai p<0,001. E)ieu nay da khang dinh hieu qua cua Montelukast phbi hpp seretide trong cai thien chiic nang hd hap ciia cac benh nhan hen. Viec n ^ e n ciiu sy thay doi chiic nang tiidng khi phm sau sii dyng thuoc cd su phoi hpp ciia Montelukast phbi hpp seretide (ICS + LABA) dd dupc nhieu tac gia trong va ngoai nudc danh gia khdng nhiing tren cac benh nhan HPQ, VMDU cd HPQ ma hren ca cac benh nhan Benh phbi t3c nghen man tinh (BPTNMT), nhu ket qua oia Harey S. ng^en ciiu sau sir dyng ttiuoc trong thdi gian 5 hian va ciia Don D. Sin ngjiien ciiu sau 3 ttiang deu khang dinh cd sy cai thien rd ret aia cac gia tri nay.
Thay dbi bac hen phe quan sau dieu tii Corticosteroids dang hit dupc khuyen cao nhu sir lua chpn dau tien cho hen dai dang- Thubc da chiing minh duac hieu qua trong hen, cai thien chiic nang phbi va Iam giam nhirng con hen cap va tram trong. Tuy nhien nhieu benh nhan HPQ sir dyng Corticosteroids dang hit van tiep tuc cd cac trieu chting aia hen, cd kha nang do corticosteroids khdng hoan toan ngan chan du<7c su tbng hpp va giai phdng cua cac cysteinyl leukotrienes d phbi. Cac cysteinyl leukotrienes LTC4> LTD4, LTE4 gay ra nhieu thay dbi sinh Iy benh d phdi aia benh nhan HPQ, bao gom tac nghen dudng thd, tang tiet didi nhay, giam van chuyai va lam sach he thong niem mgc tiet nhay, tang tap trung te bao viem. Cac thubc khang leukotrienes ngan ngira Montelukast, chat dbi khang thu the leukotrien typ 1 (CysLTl) dupc ghi nhan lam giam te bao ai toan dudng hd hap d benh nhan HPQ, cai thien trieu chiing hen, cai thien chiic nang phbi, giam sii dung p- agonist d benh nhan hen dai dang.
Chuyen D e Tai Mui Hpng
Nghien cuu Y hpc KETLUAN Cac tri?u chung V M D U
Benh nhan cd giam phii ne niem mac miii chiem ty le cao: 84,0%.
Hieu qua lam sang tbt \'a kha sau dieu tri chiem ty Ie cao: 74,0%.
Sy thay dbi cac bieii hien lam sang ciia cac benh nhan HPQ khi dieu tri Montelukast phbi hpp SERETIDE:
Trieu chiing co nang va thuc the aia hen phe quan cd sy ttiay dbi: 98% benh nhan khdng con khd ttid, tan sb tiid trd ve gjdi hgn binh ttiudng, nghe phbi khdng con ran sau 12 thang dieu tri.
So bpnh nhan cd con khd tiid hang ngay giam tii 48% trudc dieu tri xubng 32% sau 3 thang, cdn 10% sau 6 thang va sau 12 ttiang chi cdn 2%.
Sau 12 ttiang dieu tri: Ty Ie benh nhan hen bgc in giam tir 34% xubng cdn 10% va cd tdi 62%
khong cdn benh nhan cd trieu chiing HPQ (trudc dieu tri 0%).
Sy thay dbi ve thdng khi phoi aia cac benh nhan HPQ khi dieu trj Montelukast phoi hop SERETIDE:
Y Hpc TP. Hb Chi Minh * Tap 18 * Phu ban ciia Sb 1 * 2014 Cac chi tieu thong khi phoi dupc hbi phuc dan va trd ve binh thudng sau 12 thang lien tuc sir dyng thuoc.
Ty le benh nhan bi RLTKTN giam (tir 76%
trudc dieu tri xubng 56% sau 3 thang, 30% sau 6 thang va sau 12 tiiang chi cdn 10%);
Sau 12 thang lien tiep dimg ttiuoc cd 78%
benh nhan khdng cdn roi loan tiidng khi phoi;
tuy nhien ty Ie RLTKHH khdng cd su cai thien ro trong qua trinh dieu tri-
TAX LIEU THAM KHAO
1 Allergic Rhinitis And Asflima - Inlemational Recommendations For Patients And Health Professionals in 10 Languages Main Categoiy: Allergy Also Induded In.
Respiraloiy / Asthma, Ear, Nose and Throat Artide Date: 26 Oct 2007-2;O0PDT.
2 Alimed S, Atia N N (2010) SiinultmmJiL' drUrmimhcni of inmichikasl as spmiii^ therofni nitli some iiilvited cnrticosta-oids in tilfL-ma ofa.'thmatic pafintis ] H « n n Biomed AnaL 2013 FA 23;74:pp250-6.
3 Bp Y te (2007) Heii pheqiian va Dir plibng iien plil quan, Nha xuat ban Y hpc, tr 13-21
Ngdy tJidn lmi bdo:
Ngdy phdn bien nhdn xet bdi bdo:
Ngdy bai bao duvc ddng:
17/11/2013 16/12/2013 10/01/2014
Chuyen De Tai Mui Hpng
