Lao hhi
rat nquu hiem
DC
-e-BS. QUYNH VIEN
L
ao khdng thudc la khi vi trimg lao trong ed the chdng lai vdi mdt hay nhieu loai thulc lao. Cd 2 nhdm thud'c tri benh lao, thudng gpi la "thud'c khang lao hdng 1" va "thud'c khdng lao hang 2": Khang lao hfing 1 la cac thuoe dugc lua chon dau tien d l dieu tri cho b&nh nhan lao, gom cd 5 thuoe:rifampicin (vie't tat la RIF hay R), isoniazid (USTH hay H), pyrazinamid (PZA hay Z), ethambutol (EMB hay E), vd streptomycin (SM hay S).
Khdng lao hang 2 gim: kanamycin, capreomycin, amikacin, ethionamid, PAS, c y c l o s e r i n , elofazimin, ciprofloxacin, ofloxacin, levofloxacin...
Id ede thud'c dugc dCing khi bdnh nhan bi khang vdi thudc lao hang 1, thudng cd nhilu tac dung phu hon vd vi^c SLf dung thud'c cdng phdc tap hdn thudc khang lao hang 1.
B^nh lao khdng thuoc dUpc phan log,i nhi£ sau:
- Khdng thud'c tien phdt: la sii khdng thudc xay ra d benh nhan chua dugc dung thud'c khang lao Ian ndo. Nguyen nhan la do vi khuan lao khang thud'c Ian truyen td benh nhan khac sang,
- Khang thud'c mac phai hay cdn gpi Id khang thud'c thd phat Id sU khang thudc sau khi dung cdc thud'c chd'ng lao it nhat mot thang.
Nguyen nhan do dung thud'c khong dung lilu lugng va phdi hgp thudc khdng dung gay ra cac chung vi khuan khang thud'c.
Ngodi ra, cdn cii vdo miic do nguy hiem, cd 2 loai:
• Khdng da thudc (Multi drug Resistant TB): La khdng thud'c d ngudi b^nh cd vi khuan lao khdng vdi ca 2 loai INH va rifampicin.
• Sieu khdng thudc (Extensively drug Resistant TB): Ld nhiTng trUdng hgp lao khdng da thudc cd
Vl khuan lao qua kinh hien vi
khang them vdi bait cu" thud'c nao trong nhdm quinolon vd khdng vdi it nhat mpt Ipai thud'c khdng lao hdng 2 dang tiem (amikacin, capreomycin hpfic kanamycin).
Co ba nguyen nhdn ddn den lao khdng da thuoc la bdnh nhan, thay thud'c va dot biln vi trung lao.
> Do benh nh^n khdng tuan thu dieu tri: ud'ng thudc khdng diing chi ddn, dilu tri khdng du thdi gian quy dinh.
> Do thay thuoe dung thud'c chd'ng lao khdng tuan thu theo phac do: Khdng phoi hgp cac thud'c dieu tri lao, lilu lugng thudc khdng du,..
> Do vi khuan lao dpt biln gen cd kha nang de khdng lai vdi thud'c khdng lao, ldm vi khuan khdng bi chit trong mdi trudng cd thud'c khdng lao. Khi benh lao dugc phdt hien mudn, SP lugng vi khuan lao sinh san den mpt so' lugng nhd't dinh se ed mdt so vi khuan dpt bien khang lai thud'c chd'ng lap, vi du tai p t i n thUdng lap d phoi khi sd' lugng vi khuan lap din 10 trieu eon vi khuan se cd 1 cpn khdng
Ngudi benh lao dang dieu In lai phong cap cuu benh vien Pham Ngoc Thach
lai thud'c rifampicin, 100.000 con vi khuan se cd mdt con vi khuan ddt bien khdng lai streptpmyein vd isoniazid.
Phdt hifn lao khdng thu&c: Khi benh nhan dang dieu tri lao nhuiig cdc tri^u chufng sd't, ho, khac ddm khdng thuydn giam hofic thuyen giam mpt thdi gian roi lai xudt hidn trd lai nfing hon thi cdn ngM den lao khdng thud'c, ngUdi b^nh cdn bdo cho thdy thudc bilt dl ldm cdc x^t nghiem can lam sdng: X quang phoi cd hinh dnh ton thuong tren phim khdng thay doi hofic xuat hien thdm ton thUdng mdi. Xdt nghi?m ddm thay AFB dUdng tinh lien tuc hoac dm tinh mpt thdi gian r6i duong tinh trd lai hofic dm tinh - dUdng tinh xen ke. Cdn chdn dodn xac dinh b^nh lao khdng thuSc bdng each nudi cay tim vi khufo lao, khdng sinh do vdi cdc thulc chong lao hdng 1 vd hdng 2.
PhUdng phdp sinh hoc phdn td:
Cd the chan dodn nhanh bdng cdch xdc dinh cdc doan gen khdng thudc.
Hg.u qua cua b^nh lao khdng thuoc: B0nh nhdn dilu tri khdng THUOC & S0C KHOE sd 497 (1.4.2014)
tiJim tn benh lao khang tliudc
te bao gdc
iftg
T
irong tUOng lai, nhiSag bdnh nhdn mac b?nh lao khdng thulc nguy hiem cd the dUgc dilu tri bdng t l bao gdc lay td tuy xUdng cua chinh minh. Dd Id k i t qud cua cdng trinh nghidn cdu do nhdm nhd khoa hpc Anh vd Thuy Diln tiln hanh tren 30 b$nh nhdn & dp tuli 21 - 65, mac lao da khdng thulc vd lap sidu khdng thulc. Nhiftig b$nh nhan ndy dugc dilu tri thulc khdng lao tidu chuan, dong thdi dugc truyin khodng 10 trieu te bfio goc cua chinh hp.Cdc t l bdo glc dugc IS^y ttf tuy xUdng eua b?nh nhdn vd dugc nudi phdt triln thfinh s i lUOng Idn trong phdng thi nghidm trUdc khi truyin trd lai vfio cd the b$nh nhfin dd. Ke't qud cho thd^y hdn 50% trong s i b§nh nhfin dugc dilu tri theo phuong phfip kit hgp trgn d i khdi b$nh sau 6 thdng so vdi nhdm chdng chi dimg thulc khdng lao c6 13% khdi b$nh.
Vl mfit CO ehl, vi khu^n lao gfiy ra phdn dng vidm trong cdc t l bdo miln dich vfi cfic md xung quanh phii, cd t h i gfiy ra rli loan chdc nfing miln dich vd phd huy md trong cO thi.
Trong khi dd, cdc t l bdo glc tuy xUOng di chuyin tdi nhffng vung phii bi vidm, tin thuong vd chfla tri cdc md hi phd huy, phuc hdi phdn Ctng mien dich cua CO t h i vfi thuc diy sU loai bd vi khuan lao.
Trong thdi gian thd nghipm, cdc nhd khoa hoe nhdn tha'y phUOng phdp dilu tri tren Id an tofin vfi dung nap t i t dii vdi b§nh nhdn. Dfic biet, khdng
1^.
Nudi tg bdo gdc dd phdt triSn s6 lifpng ed tdc dung phu nghiem trong ndo xdy ra ngodi nhfling tde dung phu pho bien nhU mdc cholesterol cao, buon ndn, lUOng bach' cau thd^p vd tidu chdy.Chuyen gia vl lao phoi Alimuddin Zumla thu^c Dai hoc College London - ding tfie gia nghidn cflu - neu rd kd't qua nghidn cihi eho thiy nhflng thfich thflc vd khd khfin hidn thdi ciia vi$c dilu tri lao da khfing thulc hay lao sieu khfing thulc khdng phai Id khdng t h i vugt qua vfi nghien cflu mdi mang lai hy vong cho hang trfim nghin bpnh nhfin lao khfing thulc tren toan cau.
-» BS. C X M T I ^ N theo The Lancet. 9.1.2014
khdi se td vong. NhCfng b?nh nhfin hi lao phoi khdng thud'c Ifi nguon Idy Ian vi khuin lao khang thud'c cho nhflng ngUdi khde.
DiSu tri vd phong b0nh lao khdng thuoc
- Eilu tri b§nh lao khfing thud'c hi$n nay rd't khd khfin, dfic bigt benh nhfin lao khdng da thud'c vd sidu khdng thulc. B^nh lao khdng thud'c phdi dilu tri thdi gian kdo dfii lidn tuc tiT 18 din 20 thdng (phdc dl dilu tri lao khdng khdng thud'c Id 8 thdng), dimg nhilu loai
T H U d c & SLfC KHOE •.1497 (1.4.:()14)
thud'c phii hgp, rfi't dat tiln vd nhilu tai biln khi diing thuoc.
- Phong benh lao khang thud'c khong con bien phdp nao khac Id:
Phat hien sdm vd dieu tri kip thdi cho benh nhan mdc lao. Qudn ly dieu tri chat che b^nh nhfin lao dam bdo benh nhdn dung thud'c theo diing phfic do, dung nguyen tdc dieu tri.
NgUdi nha benh nhan khi cd bieu hi^n nhd: dau ngUc, sd't ve chilu, ra mo hdi dem, ho khac ddm kdo ddi tren 2 tuan, dung thud'c thdng thudng (khfing sinh, giam
hp) khdng thiy dd, ho ra mdu, sut can... nen din b^nh vi^n kiem tra xem cd mde lao hay khdng, nen khdm lao dinh ky 6 thdng m§t Ian de ddm bao sflc khde vfi phdt hi^n benh dilu tri kip thdi.
Vdi tre em, khi tre ho s i t kdo ddi 2 tuan khdng rd nguydn nhdn, quay khde, cham Idn... cha me phai dua be din b^nh vi^n d l dUOc xdt nghidm ddm vd chup X quang phoi phdt hi§n sdm b^nh lao, dfic bi^t Id khi trong nhd dfi cd ngUdi mdc lao.
B?nh lao cd the chfla khdi dUOc hodn todn nlu phdt hi?n sdm. 5p
