TAP CHI Y HOC VIET NAM TAP 459 - THANG 10 - SO 1 - 2017 reconstnjction of continuity defects of the
mandible and the maxilla with fibular free flaps: A retrospective study" British Journal of Oral and Maxillofacial Surgery 5 1 ; 965-967.
. Micha Peled, e t a l (2005) "The Use of Free Fibular Flap for Functional Mandibular ReconstructJon" Journal American Association of Oral and Maxillofacial Surgeons. Vol 126 : 220-224.
. Lei Li, etal (2007) "Long-Term Evaluation After Mandibular Reconstruction With Fibular Grafts Versus Microsurgical Fibular Flaps" J Oral Maxillofac Surg 65:281-286.
, Zhang Chenping, et al (2012) "Dental Implant Disb-actor Combined Witti Free Fibular Flap: A New Design for Simultaneous FuncHonal Mandibular Reconstnjction" J Oral Maxillofec Surg 70:2687-2700.
DANH GIA THAY DOI MOT SO CHI SO CAN LAM SANG VA MOT SO CHi SO MIEN DICH O BENH NHAN LUPUS BAN D 6 HE THONG TIEN TRIEN NANG DlJaC DIEU TRI BANG METHYLPREDNISOLONE XUNG
Huynh Van Khoa*, Le Anh Thu-*, Le Thu Ha*
T O M TAT
Methylprednisolone lieu cao truyen tmh mach (MP xung) cho thay cd hieu qua d benh nhan lupus ban dd he thong (systemic lupus erythematosus^- SLE) tien trien nSng. Muc tieu: danh gia su" thay ddi mot so chi so can lam sang va mot so chi so mien dich (bao gom cytokine TNFA, IL6, IL10)^d 80 benh nhan SLE tien tnen nang dUOc dieu tri bang MP xung. Ket qua: cai thien cac chi so huyet hoc va mot so chi so sinh hda thong thu'dng thay ro sau 1 tuan sau dieu tn MP xung, tot nhat la sau 4 tuan dieu tri. Cai thien chdc nang than, protid, albumin mau sau 4 tuan dieu tri va sau 12 tuan dieu tri. MP xung cai thien cac chi sd ve protein nieu, HC sau 1 tuSn, sau 4 tuan dieu tri. MP xung cd the lam giam di tinh trang roi loan ligid mau d benh nhan SLE sau 4 tuan va sau 12 tuan dieu tri. MP xung lam giam ti' le anti-dsDNA (+) trUdc ya sau dieu tn. MP xung lam cai thien nong do cac bo the C3, C4 va lam giam mot so Ig MD so vdi trUdc dieu tri. Nong dp trung binh TNFA, IL6, ILIO cd giam sau dieu tri MP xung, tuy nhien ehi ed TNFA giam cd y nghia thdng ke. i<et luan: cac chi so huyet hpc, sinh hda, cho thay CO sU cai thien. Nong dp anti-dsDNA giam, tang C3, C4, giam mot sd Ig I^D sau khi dieu tn MP xung. Nong do TNFA, IL6, ILIO CO giam sau khi dieu tri I^P xung, tuy nhien chi co TNFA giam co y nghTa thong ke. ^ Td khoa: Thay ddi can lam sang, chi sd mien dich, methylprednisolone lieu cao truyen tinh mach, lupus ban dd he thong nSng.
SUMMARY
EVALUATION OF CHANGES I N SUBCUNICAL AND IMMUNITY INDEX I N SEVERE LUPUS SYSTEMIC ERYTHEMATOSUS TREATED W H H
PULSE METHYLPREDNISOLONE THERAPY High dose intravenous methylprednisolone (MP) has been shown to be effective m severe systemic
*Benh vien Chd Pay
**B3nh vien Trung ddng Quan dgl 108 Chju trach nhiem chinh: Huynh Van Khoa Email: [email protected] Ngay nhan bai: 18/8/2017 Ngay phan bien khoa hpc; 13/9/2017 Ngay duyet bai: 21/9/2017
lupus erythematosus (SLE). Objectives: To evaluate changes in subclinical and immunity Index (including TNFA, IL6, ILIO cytokines) in 80 severe SLE patients treated with pulse MP. Results: Improved hematological indices and some of the normal biochemical parameters were observed 1 week after pluse MP therapy, the best after 4 weeks of treatment.
Improved kidney function, protid, and serum albumin after 4 weeks of treatment and after 12 weeks of treatment. The improvement of the proteinuria index, urirary erythrocyte morphology after 1 week, after 4 weeks of treatment. Pulse MP can reduce dyslipidemia in SLE patients after 4 weeks and after 12 weeks of treatment. Pulse MP reduces the rate of anti-dsDNA (+) before and after treatment. Pulse MP improves C3, C4 levels and reduces some IgM antibodies to previous treatments. Mean concentrations of TNFA, IL6, ILIO decreased after pulse pulse therapy, but only TNFA decreased significantly. Conclusions: Hematologic, biochemical, showed improvement after pulse I^P therapy. Anti-ds DNA levels decrease, increase C3, C4, decrease some immunoglobulin index after MP therapy.
TNFA, IL6, ILIO decreased after pulse MP therapy, but only TNFA deaeased significantiy.
Key words: Subclinical changes, immunity index, pulse methylprednisolone therapy, systemic lupus erythematosus
I. OAT VAN OE
Trong ed che benh sinh ciia lupus ban dd he thong (systemic lupus erythematosus - SLE) thi SLf roi loan dap u'ng mien djch ed lien quan den cae te bao mien djch nhu lympho T, lympho B, cae ty" khang the. Immunoglobulin miln dich, cac cytokine ddng vai trd rat quan trong [7]. MP xung cd tac dung ire che qua trinh viem, iTc che eac te bao mien dich va cae yeu to tham gia vao qua trinh dap iTng viem. Viee diing methylprednisolone lieu cao truyen tmh mach (xung tri lieu - pulse therapy) dieu trj cho SLE tien trien nang de doa ti'nh mang va nhieu nghien eiru cho thay ed hieu qua [ 5 ] . Chung tdi tien hanh nghien ciTu nay vdi muc tieu: danh gia
VIETNAM MEDICAL JOURNAL N°1 - OCTOBER - 2017 SLT thay doi mdt sd chi so can lam sang va mdt
so chi sd mien dich (bao gom cytokine TNFA, IL6, ILIO) d benh nhan SLE tien trien nang du'dc dieu tri bang MP xung.
II. 001 TUpNG VA PHUONG PHAP NGHIEN COU 2.1 Doi tu'dng nghien cu'u
- Nghien cuTu du'dc thu'c hien tai khoa ndi Cd Xu'dng Khdp, benh vien Chd Ray TP HCM tir thang 5/2011 den thang 12/2015 tren 80 benh nhan SLE du'dc chan doan du^ vao tieu chuan ACR ciia Hoa Ky nam 1997 va ed bieu hien ddt tien trien nang (ed thang diem SLEDAI > 12 diem va cd ft nhat cd mot trong cae ton thu'dng ndi tang nang) [6], du'dc dieu tri bang lieu phap MP xung (methylprednisolone Ig/ngay truyen TM trong 3 ngay lien tiep) va theo doi dinh ky cac ehi sd ve lam sang, can lam sang, cytokine tru'dc va sau dieu tri
- Bieu hien ton thu'dng ndi tang nang: viem than lupus cd hdi chirng than hd, ton thu'dng than kinh trung u'dng, thieu mau tan huyet nang, xuat huyet phdi, viem cd tim.
- Danh gia hieu su" thay doi cac ehi so huyet hoc, sinh hda mau, nu'de tieu tru'dc va sau MP xung d cae thdi diem sau 1 tuan, 4 tuan va sau 12 tuan. Oanh gia sd thay doi anti-dsDNA, C3, C4, cae Ig MD (A, E, G, M) tru'dc va sau dieu tri MP xung d eae thdi diem sau 1 tuan, 4 tuan va 12 tuan. Danh gia sd thay ddi ndng dd TNFA, IL6, ILIO d cae thdi diem tru'dc va sau dieu trj MP xung 1 tuan va 4 tuan.
2.2. Phu'dng phap nghien cu'u: ThiT nghiem lam sang, so sanh tru'dc va sau dieu tri.
III. KET QUA
3.1. Thay doi cac chi so huydt hoc
Bang 3.1.
Chi s d HH Giam BCTB Giam HbTB Giam TCTB Tang VS
l l i T B
Dac diem Trirdc e x
( n = 8 0 ) n % 12 (15.0) 8.59 ± 5 . 1 1
61 (76.3) 93.78±22.77 22 (27.5) 181.86il02.99
68 (85.0) 5238 ±37.22
thay ddi cac chi sd huyet hoc S a u diieu tr 1 t u a n
( n = 8 0 ) no/o 31 (38.8) 10.92 ± 5.33
63 (78.8) 94.26± 21.34
10 (12.5) 220.08± 92.73
67 (83.8) 35.40 ± 31.76
4 t u a n ( n = S O ) n">/o 33 (41.3) 10.83 ± 4.98
38 (47.5) 105.6gt25.28
3 (3.8) 276.40±116.53
67 (83.8) 39.80 ±31.38
1 2 t u a n ( n = 7 9 )
no/o 27 (34.2) 9.99± 4.03
20 (25.3) 119.84±21.26
1 (1.3) 268.24± 74.77
68 (86.1) 38.39 ± 32.01
Gia tri p Po-i 0.089 0.001
< 0 . 0 0 1 0.818 0.014 0.001 0.641
< 0 . 0 0 1 PO-2 0.504 0,003
<0.001
<0.001
<0.001
<0.001 0.373 0.016
Po-3 0.467 0.037
<0.001
<0.001
<0.001
<0.001 0.259 0.007 Nhan xet: cac chi so ve BC, TC, VS sau 1 gid cai thien ro clii sau 1 tuan dieu tri
3 . 2 . Thay doi chi s o sinh h o a
Bang 3.2. 0ac diem thay doi cac eh/sd sinh hda
C h i s o S H Tang GlucoseTB
, Giam ProteinTB
Giam AibuminTB
Tang CRP TB TSng BUN
TB Tang CreatininTB
eGER<60) Tang GPT
TB
Trirdc e r { n = 8 0 )
n»/o 2(2.5) 9 2 . « ± 1 9 5 1
55(68.8) 526 ±1.03
64(80.0) Z54±0.72
38(47.5) 15.65 ±27.13
47(58B) 28.01 ±15.42
13(163) 1.03 ±0.49
22(275) 18(22.5) 36,58 ±30.63
S a u d i e u tri 1 t u a n
( n = 8 0 ) n»/o 2(25) 85.91 ± 19.49
58(725) 532 ±1.04
59(73.8) 290 ±0.61 27(33.8) 9.59 ± 1 8 3 5
46(57.5) 27.89 ±16.21
11(B.8) 1.01 ±0.59
19P3.8) 36.89 ±23.07
4 t u a n ( n = 8 0 ) n ° / o 1(13) 84.79 ±20.14
55(683) 550 ±0.90
50(625) 3.20 ± 0 5 9
14(17.5) 5.77 ±12.05
39(48.8) 23.19 ±12.18
4(5.0) 0.96 ±0.52
11(133) 13(16.3) 40.08 ±44.51
1 2 t u a n ( n = 7 9 )
n % 1(13) 84.1S± 12.56
35(44.3) 5 « ± 0 3 5 27(31.2) 3.57 ±0.65
44(55.7) 3.62 ±6.77
26(32.9) 1916 ±8.03
4(5.1) 0.89 ± 0 3 4
6(7£) 6(7.6) 29.21 ± 1 5 3 0
Gia tri p Po-i 0.0«
0.048 0.441 0.441
<0,001
<0.001 0.058 0.058 0.935 0.935 0.611 0.611 0.259 0.922 0.922
Po-2 0.014 0.014 0fll5 0.015
<Ofl)l
<0.001 0.001 0.001 0.011 0.011 0.250 0.250 0.007 0.562 0.562
Po.3
<om
<0.001
<0.001
<Ofl)l
<Ofl)l
<OX101
<0.001
<0.001
<0.001
<0.001 0.001 0.001
<0.001 0.061 0.061
TAP CHl Y HOC VIET NAM TAP 459 - T H A N G 10 - S 6 1 - 2017
Tang GOT TB
33(413) 7236 ±85.92
15(183) 42.18 ± 2 3 3 9
8(105) 3524±26.40
0(0) 2631 ± 9 5 4
0.001 0.001
<0.001
<0.001
<0.001
<0.001 Nhan xet: Sau 1 tuan: ti le giam al bumin mau va ndng do albumin mau cd cai thien sau, ti le tang GOT va ehi sd GOT trung binh giam. Sau 4 tuan; hau het cac ehi sd sinh hda cai thien rd.
3.3. "Hiay doi chi so nu'de tieu
Bang 3.3. Dac diem thay ddi cac chi sd nu'de tieu C h i s o S H
Protein nieu ( + ) HC(+) BC(+) RDtonnEu/24qKl
TBProtein nieu/24qid
T r U d c B T (n=80)n %
74 (92.5) 67 (83.8) 11(13.8) 65 (81.3) 7.40±14.07
Sau dieu tri 1 tuan
(n=80)n%
63 (78.8) 53(66.2) 15(18.7) 60(75.0) 5.49±4.67
4 tuan (n=80)n%
69(86.3) 52(65.0) 10(12.5) 58(72.5) 3.12±1.77
12 tuan (n=79)n%
63(78.7) 58(60.0) 11(13.7) 56(70.0) 1.82±1.16
Gia tri p Po-1
<0.001
<0.001 0.107 0.024
<0.001 Po-2
<0.001
<0.001 0,540 0,007
<0.001 Po-3
<0.001
<0.001 0.533 0.006
<0.001 Nhan xet: Ty le dam nieu ( + ) cai thien sau 1 tuan va sau 12 tuan dieu tri. 0am nieu trung binli/24 gid cai ttiien sau 1 tuan va sau 12 tuan dteu t n .
3.4. Bien doi nong do Ichang the ti^ mien Bang 3.4. Bac diem thay doi ndng do Anti-dsDNA
Chi so Anti-ds DNA
Tru'dc OT ( n = 8 0 )
n°/o
(n=BO) n°/o
( n = 8 0 ) n %
Cn=79) n % 23 (29.1)
Gia tri p
Tang > 50 UI 63 (78.8) 43 (53.e 31 (38.8
Trung binh 1S3.91±9Z67 82.90 ±75.61 54.22 ±50.06 3538 ±27.68 <0.001 <0.001 <0.001 (min -max) (4.9-2.40) (3.29-Z40) 2.40) I (0.79-BTS)^
Nhan xet: ti le Anti-ds DNA ( + ) va nong do trung binh anti-dsDNA deu giam sau dieu tri 1 tuan, 4 tuan va 12 tuan
3.5. Dac diem thay doi nong d& C3, C4 va I g MD
Bang 3.5. Dac diem thay ddi ndng do C3^ C4 va Ig MD (tinh gia tri TB) Chi
s o C3 C4 IqA IqE IqG Igl>1
TrUdc B T ( n = 8 0 ) 41.67 ±25.27
10.95 ± 7 3 6 246.24 ±103.30
545.17 ±587.51 1170.72 ±611.70 13Z16± 10127
S a u d i e u tri 1 t u a n
( n = 8 0 ) 55.40 ± 2 2 1 9
1353 ±7.48 20632 ±33.60 353.92 ±468.08 94336 ±526.55 104.75 ±59.87
4 t u a n ( n = 8 0 ) 79.54 ±23.32
18.84 ±9.02 207.82 ±80.01 366.26 ±721.44 944.76 ±40217 115.78 ±61.79
1 2 t u a n ( n = 7 9 ) 90.23 ±20.27 20.75 ±10.10 225.18 ±83.19 188£1± 214.94 10O7.95±359S8 U9.52± 53.23
Gia tri p Po-1
< 0 . 0 0 1
< 0 . 0 Q 1
< 0 . 0 0 1 0 . 0 0 1
< 0 . 0 0 1 0 . 0 0 5
Po-2
< 0 . 0 0 1
< 0 . 0 Q 1 0 . 0 0 1
0.052
< 0 . 0 0 1 0.173
Po-3
< 0 . 0 D 1
< 0 . 0 0 1 0.091
< 0 . 0 0 1 0 . 0 2 3 0.786 3.6*. Bien doi non^ do mot so cytolcine
Bang 3.6. Bac diem thay tdi cytokine trudc va sau dBu tri
Gia trj p
Po-1 PO.2
Tang TNFA TB
28 (42.4) 31.52 ± 79.9
20 (32.8) 11.36 ± 13.12
9 (15.8) 7.56 ± 3.71 Tang IL6
TB
64 (97.0) 56.27 ± 180.704
58 (95.1) 15.76 ± 15.52
55 (96.5) 10.80 ± 12.91 TangILIO
TB
56 (84.8) 8.75±20.C'
54 (88.5) 7.34 ± 10,79
44 (77.2) 7.97 ± 14.87
Nhan xet: Ti e tang TNFA va nong do trung binh TNFA giam co y nghia thong ke sau 4 tuan. T ie tang' IL6, ILIO v^ nong dp trung binh cua IL6, ILIO co giam sau 1 tuan va sau 4 tuan tuy nhien chu'a thay co y nghTa thong ke.
TAP CHl Y HOC VI|T NAM TAP 459 - THANG 10 - SO 1 - 2017
IV. BAN LUAN
4.1. Thay doi cae chi sd huyet hoc: Theo ket qua (Bang 3.1) chung tdi nhan thay dap utig tren eac ehi sd huyet hpc cua lieu phap MP xung;
Hb va TC cai thien ed y nghTa clii sau 1 tuan dieu tri va on djnh sau 4 tuan, sau 12 tuan theo ddi.
Cae ehi so VS va BC thay khdng thay ddi ed y nghTa. Ket qua nghien edu nay cho thay ti le giam bach cau va tang VS khdng cd sd khac nhau tm'de va sau d tat ca thdi diem khao sat, tuy nhien Wii so sanh trj sd trung binh bach eau thi thay chi sd trung binh bach C3u tang va ehi sd VS giam ra y nghTa sau 1 tuan, 4 tuan va sau 12 tuan.
4.2. Dac diem thay ddi cac ehi so sinh hda: Theo ket qua (Bang 3.2) chung tdi nhan thay cae thay ddi ve cae ehi so sinh hda dang lu'u y tru'dc va sau dieu trj MP xung: khdng thay cd bieu hien tang du'dng huyet sau khi dieu trj MP xung. Ti le giam protid mau giam dang ke tru'dc va sau khi dieu trj xung nhat la thdi diem sau 4 tuan va sau 12 tuan dieu trj. Dieu nay phu hdp vdi tinh trang dap u'ng vdi dieu tri MP xung nhat la d nhdm lupus ed hoi chu'ng than hu'. Tu'dng tu"
tinh trang giam albumin mau giam cai thien sau khi dieu tri MP xung 1 tuan sau dieu tri. Chi sd viem giam ro sau 4 tuan dieu trj, cai thien chu'c nang than rd nhat sau 4 tuan va sau 12 tuan dieu tri. Nhu' vay cae ehi so sinh hda deu cd su' cai thien ro sau dieu trj MP xung 1 tuan va tot nhat sau 4 tuan. Ket qua nghien culi nay cung phij hdp vdi nghien eCru cua Pham Huy Thdng la cd su" cai thien mot sd chi so hda sau 1 thang va sau 3 thang dieu tri MP xung [2].
4.3. Dae diem thay ddi cae chi sd nu'de tieu: Chung tdi nhan thay cd sir cai thien cac chi so dam nieu, dam nieu/24 gid, HC nieu (theo bang 3.3) cho thay ed hieu qua chi sau 1 tuan dieu tri MP xung, ket qua nay cung duy tri tot sau 4 tuan va 12 tuan. Ket qua nay cua chung toi phii hdp vdi nghien CLTU cua Pham Huy Thong [1] la gia trj trung binh cua protein nieu/24 gld giam va HC nieu giam cd y nghia thdng ke sau 4 va 12 tuan. Gia trj trung binh cua BC nieu theo nghien edu cua chung tdi cd giam nhutig khong cd y nghTa thdng ke va ket qua nay cung phii hdp vdi nghien CIJ'U eua Pham Huy Thdng la gia tri trung binh ciia BC nieu cd giam sau 1 thang v^ sau 3 thang dieu tri nhutig khong cd y nghia thdng ke [1].
4.4. Bien ddi nong do khang the Anti- dsDNA: J\ le benh nhan cd nong do khang the anti-dsDNA t^ng > 50 UI giam so vdi tru'dc va sau dieu trj d eac thdi diem va giam dan theo
thdi gian va nong do trung binh ciia khang th^
anti-dsDNA cOng giam theo thdi gian (Bang 3.4).
Nhu' vay nong dp khang the anti-dsDNA giam dan theo mu'e dp nang ciia benh va cung phjj hdp vdi nghien nhieu nghien culi khac khi danh gia vai trd eua anti-ds DNA trong danh gia hoat ddng ciia benh va theo doi dieu tri [3]. Nong do anti-dsDNA giam sau dieu tri MP xung d cae thdi diem nghien ciTu 1 tuan, 4 tuan, 12 tuan. Nong dp anti-dsDNA giam phan iTng mu'e dp dap iitig eiia benh vdi lieu phap dieu t n .
4.5. Bien ddi nong do mot sd bd the, immunoglobulin mien djch: Sd thay doi nong dp C3, C4 theo ed y nghTa thdng ke sau 1 tuan, sau 4 tuan va sau 12 tuan dieu tri MP xung (bang 3.42). Danh gia ve sir thay ddi ndng do cae Ig MD nhu": Ig A, Ig E, i g G va Ig M chung tdi nhan thay rang cd SLT giam ndng do cac Ig MD cd y nghia thong ke sau 1 tuan dieu tri MP xung. Sau 4 tuan nong dp Ig A va Ig G trung binh giam cd y nghTa thdng k§ so vdi tru'dc khi dieu tri MP xung, nong dp Ig E sau 4 tuan co giam nhu'ng khdng ed y nghTa thdng ke, tuy vay sau 12 tuan ndng dd Ig E giam ed y nghTa thdng ke, rieng nong dd Ig M trung binh khdng thay giam ed y nghTa thdng ke sau 4 va 12 tuan. Theo ed che tac dung ciia lieu phap MP xung, methylprednisolone lieu eao ed tac dung iTc che te bao lympho B va se lam nong do eae Ig MD.
Iheo nghien ciTu cua Pham Huy Thdng khi theo doi ndng dp Ig G thay ed giam sau 1 thang dieu trj MP xung nhu'ng khdng ed y nghia thong ke [1], va eijng theo nghien culi nay thi ndng do Ig M thay ddi khdng ed y nghTa thong ke sau 1 thang va sau 3 thang dieu trj MP xung.
4.6. Bien ddi nong dp mdt sd cytokine:
Nghi nhan sy ti le tang TNFA, IL6, ILIO ed giam so vdi tru'dc MP xung d cac thdi diem nghien CU^J sau 1 tuan va sau 4 tuan, tuy nhien chi ed TNFA la giam cd y nghTa thong ke sau dieu tri MP xung 4 tuan, tu'dng tu" gia trj trung binh ciia cac cytokine trcing nghien culi cd giam nhutig ehi co gia tri trung binh nong dp TNFA la giam cd y nghTa thdng ke. Ket qua nay cung phii hdp vdi nghien cu'u ciia Bai thi nong dp ciia TNFA co giam sau khi dieu tri MP xung [4], Chiing toi hien chu'a tim thay tai lieu nao danh gia ve su" thay doi nong dp IL6, ILIO sau khi dieu trj MP xung.
V. KET LUAN
Cae chi so huyet hpc, sinh hda mau, nu'de tieu cho thay cai thien tot nhat sau 4 tuan dieu triJ4P xung. MP lam giam nong dp anti-ds DNA, tang
TAP CHi Y HOC VigT NAM TAP 459 • THANG 10 • SO 1 - 2017 nong dp C3, C4 va lam giam mdt so Ig MD. MP
xung lam giam nong dp TFNA, iL6, ILIO so vdi tru'dc dieu trj, tuy nhien ehi ed TNFA giam cd y nghTa thong ke.
TAI UEU T H A M KHAO
1. Ph^m Huy Thong, Phan Quang Doan (2012),
"Nghien cOli hieu qua dieu tri lupus ban do he thong cd deft cap ton thu'dng than bang methylprednisolon du'dng tTnh mach lieu cao". y Hgc Thue Hanh, 3 (813), pp. 83-85.
£. Pham Hu]^ Thong (2011), "Burdc dau nghien eiru sir thay doi mot sd yeu to mien dich dich the d b^nh nhan lupus ban do he tiiong cd ton thu'dng than trudc va sau dieu tri Methyl-prednisolone lieu cao truyen tinh mach". Y Hoc ThUc Hanh, 10 (788), pp. 80-82.
3. Alba P, Bento L, Cuadrado MJ, Karim Y, Tungekar MF, et al. (2003), "Anti-dsDNA, anti- Sm antibodies, and the lupus anticoagulant:
significant-factors associated with lupus nephritis".
Annals of the rheumatic diseases, 62 (6), pp.
556-560.
4. Bai LQ, Chen XM, Mao 3 (1994), "Effects of methylprednisolone pulse therapy on TNF alpha levels in chronic nephritis". Zhonghua nelke za zhi, 33 (12), pp. 827-829.
5. Barile-Fabris L, Ariza-Andraca R, Olguin- Ortega L, Jara U , Fraga-Mouret A, et al.
(2005), "Controlled dinical tnal of IV cyclophosphamide versus IV methylprednisolone in severe neurological manifestations in systemic lupus erythematosus". Annals of the Rheumatic Diseases, 64 (4), pp. 620-625.
6. Criteria American College of Rheumatology Ad Hoc Committee on Systemic Lupus Etythematosus Response (2004), 'The American College of Rheumatology response criteria for systemic lupus erythematosus clinical trials: measures of overall disease activity".
Arthritis and rheumatism, 50 (11), pp. 3418.
7. Grondal G, Gunnarsson I , Ronnelid J, Rogberg S, Klareskog L, et al. (2000), "Cytokine production, semm levels and disease activity in systemic lupus erythematosus". Qinical and experimental rheumatology, 18 (5), pp. 565-570.
KET QUA BAN DAU DIEU TRI KHOI DI DANG DONG TINH MACH NAO V&
BANG P H A U THUAT PHdl HgP VO^I NUT MACH TAI BENH VIEN BACH MAI
Nguyen H&u An*, Tran Anh Tuan*, Phaim Minh Thdng*
TOIVI TAT
Myc tieu: Nghien CLTU ve dac diem hinh anh va ket qua bUdc dau dieu tn di dang dpng tlnh mach nao vd (DDDTMN) bang phaii tliua't phoi hpp nut niach tai B&nh vien Bach Mai. Phu'dng phap: Nghien cifu tien cu^j theo doi doe theo thdi gian^khdng doi chdng 20 benh nhan DDDTMN v3 dUde phau thuat phdi hdp vdi niit mach tai benh vten Bach Mai td 8.2014 den 2.2017. Ket qua': Co 20 benh nhan co^DDDTMN v3 duWc dieu tri bang nut mach sau dd phau,thuat. Cac dac diem pho bien d cac d\ dang nay la 6 di dang d sau, tinh mach dan lulj sau va phinh dgng mach trong 6 di dang. Bien chu'ng chay mau sau niit mach gap d 2 b|nh nhan (10%). Ton thu'dng khuyet nhu,mo nao sau md phan Idn la nhd hdn kich thifdc ciia 6 dj dancj (85%). Ka qua tot vdi 100% cac di dang nho (Spetzler-Mart:in I H I I ) het di dang va co lam sang tot sau dieu trj, 80% cac d| dang Idn (Spetzler-Martin IV- V) het dl dang sau mo vdi 60% benh nhan cd ket qua l§m sang tot. C6 01 benh nhan td vong sau dieu tri.
Ket luSn: Phdi hdp phau thuat va niit mach la chi dinh phu hdp cho cac khdi DDDTMN vd Idn hoac co
*'Benh vien Bach Mai
ChjU trach nhiem chinh: Nguyen Wdu An Email: [email protected] Ngay nhan bai: 18.7.2017 Ngay phan bien khoa hpc: 5.9.2017 Ngay duyet bai: 14.9.2017
ddng mach nudi sau. Di dang d sau, tlnh mach dan luii sau, phinh dgng mach trong 6 dj dang la nhuYig yeu to nguy cd gay chay mau can dUdc can nhic de dieu tri vdi cac DDDTMN chUa v3.
SUMMARY
COMBINED ENDOVASCULAR EMBOLIZATION AND SURGERY I N TTIE MANAGEMENT OF RUPTURED CEREBRAL ARTERIOVENOUS MAlK)RMATION ATTHE BACH MAI HOSPITAL
Objective: To study the radiology features of ruptured cerebral artenovenous malformation and the results of combined endovascular and surgical management of ruptured cerebral AVM. Methods:
Uncontrolled follow-up study of 20 ruptured cerebral AVM underwent surgery combining with prior embolization in Bach Mai Hospital from 8.2014 to 2.2017. Results: Twenty patients were treated by combined endovascular and surgical management, These common imaging features were deep brain location, deep venous drainage and arterial aneurysms located in the AVI^ nidus. Complication of embolization includes bleeding in 10%. Postoperative parenchymal lesions were much smaller than the size of AVM in 85% cases. Radical resection was achieved in 80%
with good overall result 100% in small AVM and 60%
in large AVM. There was one patient died after treatment. Conclusions: The combination of endovascular embolization and surgery was an ideal indication for large AVM and deep feeder artenes.
