HIEU QUA DIEU TRj LAMIVUDINE TREN BENH NHI VIEM GAN VI RUT B MAN TAI BENH VIEN BENH NHIET Ddi TRUNG t/ONG
Nguyen Nguyen Huyen', Nguyen Van Kinh'.
Dgt vdn de: Dieu tri viem gan vi rut B man a tre em dang la thach thuc doi vai cac bac sT nhi khoa va bac sT truyen nhiem do it sir lira chpn thuoe khang vi nit va nguy ca khang thuoe lau dai. Nhieu nghien cim tren the gioi da chiing minh rang benh nhi viem gan vi nit B man khong dugc dieu tri se cham Ion va coi cgc hon, nguy co phat trien xa gan, ung thu gan cao hem so voi benh nhi dugc dieu tri. Trong nghien curu nay, chiing toi danh gia hieu qua dieu tri ciia lamivu- dine doi vai cac benh nhi viem gan vi nit B man. Muc tieu: mo ta dac diem lam sang, can lam sang cua cac benh nhi viem gan vi nit B man dieu tri tai benh vien Benh nhiet doi Trung uong, danh gia hieu qua dieu tri cua lamivudine tren cac benh nhi nay. Doi tuang: Lira chgn 39 benh nhi du tieu chuan, dieu tri lamivudine tren 1 nam voi lieu 3mg/kg/ngay. Phuang phdp: Nghien ciiu tien curu. Kit qud: Sau 12 thang dieu tri lamivudine, 39 benh nhi dat ket qua dieu tri nhu sau:
Ti le dap img sinh hoa la 100%; Dap umg vi nit la 56,4%; Chuyen dao huyet thanh HBeAg la 13,9%. Benh nhi co tai lugng HBV - DNA khai dau thap han 108 copies/ml co dap ung vi nit tot han gap 2 lan so vdi nhom con lai. Tac dung phu ciia lamivudine hiem va khong nghiem trgng. Ket lugn: Lamivudine to ra la thuoe c6 hieu luc, an toan trong dieu tri viem gan vi nit B man tinh a tre em.
Tu- khoa: Lamivudine, viem gan B man tinh, benh nhi.
DAT VAN DE
Oieu trj viem gan vi rut B man d tre em dang la thach thu'c doi vdi eae bac si nhi khoa va bac si truyen nhiem.
Viec quyet djnh dieu tri eho benh nhan, \Ua chon thdi gian dieu tri phii hdp, cijng nhu* su" lift chon thuoe khang vi nit la rat phuTc tap. Mac dii phan ldn benh nhi khong can phai dieu trj, nhuTig van can thiet theo doi djnh ky tien trien ciia benh de giup cho benh nhi khong bj bd 13 dieu trj khi can thiet. Hien nay, so lu'dng cae thuoe khang vi rut viem gan B ehi dmh dieu tri cho benh nhi la han ehe.
Viem gan vi riit B man la mot benh co ben trien am Hiam, eae trieu chimg lam sang thu'dng ngheo nan. Tuy
' Benh iifn Bfnh nhiet dm Trung ttang.
Nga) oh^n bii: 12/512015.
\^i\ phan bi^n \ o n g : 05/6/2015 Nfiiy duy?e ding: 25/6/2015
Ngiroi chju tricb nbifm npi dung kboa bfc: Nguyen Nguyen Huyen, Bt-iih vifn Bfnh nhiel dai Trung uang
Difn ihoai 098liO92036. E-mail- huyennguyen dr.nhld@gmail com
nhien cae trieu chuhg viem gan vi nit B man tren benh nhi thu'dng ft du'dc y van tren the gicfi de cap den. Oa eo nhijiig nghien ciiti chirTig minh rang benh nhi viem gan vi nit B man khong du'dc dieu trj se cham idn va co chieu cao thap hdn so vdi benh nhi dUdc dieu trj'*'. Vi vay, benh nhi vcfi ton thu'dng viem hoai tii gan d mii'c do vii^ va nang hoac ed xd gan thi can dUdc dieu tri.
Di/a vao hieu lUe eiia thuoe va nguy ed khang thudc, thu' ti/ uli tien cac thuoe dong phan nueleot(s)ide ly ti/dng du'dc chap nhan sii' dung cho benh nhi viem gan vi rut B man la entecavir, tenofovir, adefovir va cudi eiing la lamivudine. Tuy nhien, entecavir va tenofovir chi du'dc sir dung cho tre tii 15 tuoi trd len va adefovir eho benh nhi tren hoae bang 12 tuoi. Lamivudine du'dc chi djnh trong dieu trj HBV man d tre em til" 3 tuoi trd len vdi lieu 3mg/kg/ngay Mac dii doi vdi benh nhan viem gan vi nit B man ngu'di Idn, lamivudine khong phai thuoe chi dinh dau tay do hieu lu'c khang vi nit kem va nguy cd khang
T R U Y ^ I W ^ M V l l T N A M * SO OAC B I £ T NGAY VIEM GAN THE Gl6l - 2015 - 7
tiiuoc, nhutig dcfi vdi benh nhi, lamivudine van la thuoe chi dinh dau tay trong eac huidng dan dieu tri viem gan vi nit B man d tre em cua cac Hiep hdi Gan Mat - Dinh duSng - Tieu hda - Nhi khoa tren the gidi. Cho den nay tai Viet Nam, chiing ta ed rat it nghien cuU ve viem gan vi nit B man d tre em.
Vl vay, de tai nay du'dc tien hanh vdi muc deu: mo ta dae diem lam sang, can lam sang aia cac benh nhi viem gan vi riit B man d Viet Nam va danh gia hieu qua dieu trj ciia lamivudine tren cae benh nhi nay
D O I TUONG VA PHl/ONG PHAP Doi tu'dng nghien citu
Benh nhi du'dc chan doan viem gan vi nit B man tinh va cd ehi djnh dieu tri du'a theo tieu chuan ciia Hiep hpi Gan mat - Tieu hoa - Dinh duSng Nhi khoa chau Au va Bac My 2009 (European Society for Pediatrics Gastroen- terology, Hepatology and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition)'^' bao gom: HBsAg ton tai tren 6 thang, ALT lang dai dang gap 1,5 lan so vdi gia tii binh thuftng fren 6 thang, tai lu'dng HBV - DNA tren 20000 Ul/ml, eo bang chutig ton thu'dng gan hoai tir mire dp vift hoac nang, hoae khong eo bSng chiing nhutig tien su" gia dinh cd thanh vien bj ung thU gan, du'dc diing lamivudine vdi lieu 3mg/kg/ngay, ngay uong mpt ^ n trong vong it nhat 12 thang.
Chiing toi loai trii eac benh nhi ra khoi nghien ciiu neu CO dong nhiem HIV, viem gan vi nit C (HCV - Hepati- tis C virus), ton thu'dng gan do eac nguyen nhan khae nhu': thuoe, hda chat, benh gan t i i mien, benh Wilson, hoae dang mac cae benh ly khac: sot ret, leucemie, sot mo...
PhUtfng phap: Nghien eiiu tien ciiU.
Thuoe suf dung: Zeffix lOOmg (biet du'dc lamivudine eiia Glaso Smith Kline - GSK). Lieu lUdng 3mg/kg/ngay, uong 1 lan/ngay.
Cach thu'c tien hanh nghien cihi:
Cac b|nh nhi du'dc tiiam kham lam sang, lay mau xet nghiem va thu thap so lieu theo mau benh an nghien ciru tai cac thdi diem bu'dc dieu bi (MO), sau 3 thang (M3), 6 ttiang (M6) va 12 tiiang (M12). Oanh gia tae dung ciia thuoe lamivudine tiong qua binh dieu h i :
- Dap iitig sinh hda: cac chi so sinh hoa ALT, AST oia benh nhi ti-d ve binh tiiu'dng. (ALT < 40 U/I/37°C; AST <
37 U/I/37«C).
- Bap iitig vi nit: Tieu chuan la HBV - DNA trd ve am b'nh (du'di ngu'dng phat hien). Trong nghien eiili nay chiing toi djnh IUdng HBV - DNA theo phuUng phap Real- time PCR ngudng phat hien la > 20UI/ml. Ngoai ra cac ehi so dap utig sinh hoa ALT, AST trd ve binh thuftng. (ALT
< 40 U/I/37°C; AST < 37 U/l/37<<:).
- Oap iitig huyet Oianh (chuyen dao huyet thanh):
mat HBeAg d nhutig benh nhan ban dau co HBeAg dudng tinh va xuat hien anti - HBe.
- Dap iitig mgt phan: HBV - DNA giam tii" 2logl0 trd len. Cac chi so dap iitig sinh hoa ALT, AST trd ve binh thu'dng. (ALT < 40 U/l/37°C; AST < 37 U/l/37''C).
- Khong dap utig: Cae ehi so vl rut, dap iitig mien dieh, sinh hoa khong thay doi, hoae HBV - DNA co giam nhutig giam dUdi 2logl0.
Thu thap va xit ly so lieu: Theo phu'dng phap thong ke yhoc.
KET QUA
Qua thdi gian nghien ciiU tir tiiang 01/01/2009 den 30/10/2014 chiing toi cd 39 benh nhi dii tieu chuan chon vao nghien ciru vdi cae ket qua nhu* sau:
Dac diem chung cua nhom doi tu'dng nghien cihi tru'dc dieu trj
Bang 1 . Dac diem chung cua cac benh nhi viem gan vi nit B man
! n = 39 Tuoi {tuoi trung binh) Gia [Nam/NuO Tten su'me HBsAg {+}
HBeAg (+) ASr(U/l}
ALT(U/I) HBV-DNA(UI/mi)
11,46 ± 4,38 29/10 24/39 36/39 111 ± 107 154 ± 102 (4,07 ± 5,06) X I f f
t y le % hoSc min, max (min: 3 tuS; max: 16 tun) Nam' 74,4%; Nih 25,6%
61,5%
92,3%
mm:4,07xlO';ma)c:l,axl(P
Nhan xet: Tuoi trung binh ciia cac benh nhi la 11,46 tuoi. Ti le benh nhi Nam cao hOn benh nhi NiJ. Co 24 benh CO me mang HBsAg (+). Ty le benh nhi co HBeAg (+) nhi
cao: 92,3%.
8 - T R U Y t o l N H & I V e T N A M * s o DAC BIET NGAY VIEM GAN THE Glfll - 2015
Bang 2: Cac trieu chihig lam sang tn/olc dieu tri Cap u'ng diieu trj sau 12 tiiang uong lamivudine
Trieu c h u l i g An kem, dian an.
Cham len can, sut can Met moi Buon non, non Oay bung, t i i t ha su^n phai Ganix)
Vang mSt, vang da Lich to Saom^ch Xuat huyet
n = 39 49 35 10 8 8 1 0 0 0 0
%
94,2 67,3 19,2 15,4 15,4 1,9 0 0 0 0 Nhan xet: Cae trieu chiTng thu'dng thay d cae benh nhi la 3n kem, cham len can, met, buon non, titc ha sUdn phai.
Bieu do 1 : Ket qua diieu tri cua cac benh nhi sau 12 thang uong lamivudine Nhan xet: Sau 12 thang dieu trj 100% benh nhi ed ALT trd ve mii'c binh thu'dng. Ti le benh nhi dat dap utig vi rut la 56,4%. Ti le benh nhi ed chuyen dao HBeAg (+) thanh HBeAg (-) va co anti HBe (+) la 5/36 (13,9%).
Bang 3. Nong do ALT va tai IUdng HBV - DNA ciia cac benh nhi viem gan vi rut B man tru'dc dieu tri va sau 6 thang dieu trj bang lamivudin
Chi so
HBV-DNA (copies/mi)
M.T (U/l) AST(U/I)
TO Mean ± SD (4,07 ± 5,06) X 10'
max: 1,8 x ICP mm. 4,07 x 10' 154 ± 102 111 ±107
Median
8,74 X 10'
118,5 83
T6 Mean ± SD (1,01 ± 5,1) X 10^
max: 5,1 x 10^
minO 49 ± 7 6 33 ± 1 3
Median
863
Z4 30
P
< 0,0001
< 0,0001 0 001
Nhan xet: Sau 6 thang dieu tri bang lamivudine, eae benh nhi ed su* giam ro ret ve nong do ALT, AST va tai lu'dng HBV - DNA trong mau mot each co y nghia thong ke vdi p < 0,001.
Bang 4. Cac yeu to anh hu'dng den dap ufng vi rut ciia benh nhi diieu trj lamivudine
Y e u t S
TUCM
Gidi
M?
ALT t m * : OT
HBV • DNA t n r d c E>T
< 10 tuoi
> 10 tuoi Nam
CO HBsAg (+) CO HBsAg (-)
< 200 U/l
> 200 U/l
< 108 copies/ml
> 108 copies/ml
Tai luUng HBV - DNA sau 12 thang DT Tren nguSng
8/14 9/25 14/29 3/10 10/24 7/15 12/29 5/10 6/22 11/17
Du'di ngudng 6/14 16/5 15/29 7/10 14/24 8/15 17/29 5/10 16/22 6/17
n
14 25 29 10 24 15 29 10 22 17
P P = 0,201 OR = 1,374 P = 0,464 OR = 1,8 P = 0,759 OR = 1,0 P = 0,635 OR = 1,09 P = 0,019 OR = 2,06
THUYtolNHliMVflfTNAM* s o DAC BIET NGAY VIEM GAN THE GlOl - 2 0 1 5 - 9
Nhan xet: Cae yeu to tuoi, gidi, me cd HBsAg (+), nong do ALT tafdc dieu tri dudng nhu" Idiong anh hu'dng den dap uTig vi rut eiia benh nhi. Benh nhi ed tai lu'dng HBV - DNA ban dau < 108 copies/ml ed ti le dap iftig vi riit cao gap 2 lan so vdi nhdm cdn lai (p < 0,019).
Oau diu r^loantlfu phit ban AuUiAp UitngcAtic
Bieu do 2. Tac dung khong mong muon cua lamivudine theo doi du'dc Nhan xet: lamivudine to ra la ttiuoe kha an toan doi vdi cac benh nhi. Cac tae dung khong mong muon hiem g§p CO the thay la dau dau, dau khdp, roi loan nhe tieu hda, nhuTig cae trieu ehutig nay thoang qua va t i / het sau 3 thang udng lamivudine.
BAN LUAN
Oac diem lam sang cua cac benh nhi viem gan virus B man tru'dc dieu trj
Trong y van, hau het cae benh nhan viem gan vi riit B man d ngu'di Idn thu'dng khong co bieu hien benh, cac trieu chutig chii yeu la chan an, met moi khong dac hieu, mpt so it benh nhan ed trieu chiiTig roi loan tieu hoa, buon non, dau tufc ha sUdn phai. Tuy nhien mot sd it ngu'di benh lai co bieu hien nhu" mpt benh eanh viem gan vi nit B cap khien benh nhan phai nhap vien, eac trieu chutig lam sang ram rp va cap tinh nhU met moi, chan an, tieu vang, vang da vang mat tang dan, gan to. Nghien euU ciia chiing toi tren cac benh nhi viem gan vi njt B eung cho thay cae trieu chutig ghi nhan du'dc la khong dae hieu va khong ro rang: 94,2% eac tre ed trieu ehutig an kem va chan an, 100% cae tre d lu^ tuoi mau giao co trieu ehutig nay. Dii vay, trieu ehutig an kem va ehan an tren eae benh nhi nhd tuoi la rat md ho do tam ly ciia cac ba me Viet Nam. Ngay ca tren cae tre khde manh khong co benh ly gi, khi duWc hoi thi eae ba me eung deu cho ring con minh
an kem. Chung toi eho rSng trieu chutig nay la khong dang tin cay, do anh hu'dng ciia thdi quen, loi song, each ngh? cung nhu* truyen thong cua cae ba me Viet Nam.
Met moi la tneu ehutig kha dae hieu trong viem gan vi riit B man d ngu'di Idn: gap ty le 86,8% - 90% tiiy tiitig nghien euli. Trong nghien ciitj nay, trieu chutig met moi Chung toi ehi gap 19,2% va thudng khai thac duUe d life tuoi trung hpc va tieu hpe. Lil^ tuoi mau giao do eac diau eon nhd, nghich ngdm va hieu dpng nen rat kho quan sat ttiay cae trieu chutig nay tren lam sang.
Buon non, ndn, trd, tiTc ha su'dn phai ehiing toi deu quan sat thay vdi ty le 15,4%, thap hdn so vdi eae nghien ciru tren ngu*^ Idn viem gan vi rut B man (thu'dng gSp v&i ty le tren 60% tiiy tutig nghien ciili).
Cham len can va sut can la cae trieu chutig g3p ty le kha eao d cac benh nhi nghien eiflJ cua chung toi: 67,3%.
Thong thu'dng sau khoang 1 nam keo dai cae chau khong len can, hoac sut can, eoi cpc hdn cae ban cung \iia khien bd me benh nhi lo lang va du^ eae ehau den kham. Trong nghien culi ciia Gerner va cpng su" tren 135 tre nhilm HBV, tac gia chi ra rang, tinh trang nhiem HBV man tinh se anh hu'dng den s\X phat trien eiia tre, trong do yeu tfi thUe sy anh hu'dng den sU phat trien ciia tre la tinh trang tang nong dp ALT dai dang. Tac gia cting eho thay d cac tre nhiem HBV man ti'nh, cae tre du'dc dieu tri bang In- terferon hoac lamivudin deu co chieu eao cao hdn so vdi cae tre viem gan vi nit B man khong dUdc dieu tri(".
Chung toi gap 1 tru'dng hdp benh nhi gan to, khong gap tru'dng hdp nao eac chau eo bieu hien vang da, vang mat, lach to hay sao maeh. Nguyen nhan chii yeu do doi tu'dng nghien ciiU eiia chiing toi la cae benh nhi den kham va theo ddi tai khoa Kham benh. Cae tn/dng hdp nang co bieu hien xd gan hoac vang da deu cd ehi dinh nhap vien tai Khoa Nhi, Benh vien Benh nhiet ddi Trung u'dng, vi vay chiing toi khong quan sat thay eac bieu hien lam sang nay tren cae doi tu'dng nghien eiili eiia chiing toi.
Oap ihig dieu t n vdi lamivudine sau 12 thang Lamivudine la thuoe khang vi rut dang uong dau tien trong dieu tri viem gan vi rut B man. Hieu qua dieu tri ciia lamivudine d ngu'di Idn viem gan vi riit B man va tinh an toan ciia thudc da khien cho lamivudine du'dc ehi djnh cho benh nhi tren 3 tuoi.
Cac nghien cuU ve viem gan vi nit B man 6 tre em tren the gidi da cho thay 52 tuan dieu tri lamivudine cho
10 - TRUYiNNHieMVieTNAM*s6 DAC BIET NGAY VIEM GAN THE Gl(3l - 2015
ket qua tot vdi ty le dap uTig vi nit cao. Hdn nu^, dap utig vi njt hoan toan vdi chuyen dao HBsAg/anti - HBs va su*
binh thu'dng hda ALT da du'dc ghi nhan^^i. Nhieu dii' lieu khac cung khang dinh ti'nh hieu qua ciia lamivudine frong dap irng sinh hda va dap utig vi rut d eac benh nhi viem gan vi rut B man.
Nghien euli ciia ehung toi eho thay sau 6 thang dieu tri bang lamivudine, cae benh nhi eo si/ giam ro ret ve nong dp ALT, AST va tai lu'dng HBV - DNA trong mau mpt each CO y nghTa thong ke vdi p < 0,001. Ket qua nay ciia chiing toi hoan toan tu'dng dong vdi ket qua nghien cifu ve hieu qua eiia lamivudine trong dieu tri benh nhi viem gan vi nit B man eiia eac tac gia khae tren the gidit^i. Theo ddi dap utig sau 6 thang rat quan trong. Theo Keeffe E va eac chuyen gia hang dau the gidi vie vi§m gan vi rut thi nhutig benh nhan dat dap litig vi rut d thdi diem nay se CO kha nang dat dap utig hoan toan sau khi ket thiie thdi gian dieu tri (tai lu'dng vi riit dUdi ngudng, chuyen dao huyet thanh HBeAg, mat HBsAg). NgUdc lai nhijtig benh nhan khong ed dap iitig vi riit d thdi diem nay se it co kha nang dap utig hoan toan sau Wii ket thiie thdi gian dieu tri hoac ed kha nSng tai phat cao^^i.
Phan tich cac yeu to anh hu'dng den ket qua dap u'ng diieu trj vdi lamivudine ciia nhdm doi tu'dng nghien cufu
Chiing toi phSn chia 39 benh nhi udng lamivudine thanh 2 nhdm: 1 nhdm sau 12 thang eo dap litig vi rut, nghia la co tai lu'dng vi riit thap khong phat hien du'dc bang may Cobas; 1 nhdm sau 12 thang uong lamivudine tai lu'dng vi nit van tren ngu9ng phat hien (> 20 lU/ml).
Cac yeu to so sanh giti^ 2 nhdm la gidi, tuoi, tien su' me HBsAg, tuoi bat dau dieu tn, nong do ALT tru'dc dieu tri, tai lu'dng vi rut tru'dc dieu tri.
Gidi va tuoi
Nhutig benh nhi tren 10 tuoi cd kha nang dat dap utig vi nit cao hdn nhdm benh nhi nhd tuoi hdn (OR: 1,374; p
= 0,201). Ket qua nay eiia ehiing toi khae han vdi nghien cull eiia tae gia SuK Jin Hong. Trong nghien eiiU ciia tac gia nay, ty le chuyen dao huyet thanh d liJa tuoi mau giao (< 6 tuoi) Idn hdn ed y nghta so vdi \{ia tuoi trung hpe. Liia tuoi cap 3 dap iitig vdi lamivudine kem hdn. Tac gia nay d i o rSng tuoi cang nho thi dap utig vcfi lamivudine cang tot hdn^'i, Tu'dng ti/vay nghien euli ciia tac gia Choe BH da ehutig minh tre du'di 7 tuoi se co dap iitig vdi lamivu-
dine tot hdn la tre tren 7 tuoi^^l
NhOtig benh nhi NQ'eo kha nang dat dap iitig vi nit cao hdn nhdm benh nhi Nam (OR: 1,8; p = 0,464). Trong cac nghien cuU ve dieu trj viem gan B d ngu'di Idn tren the gidi, eac tae gia eung eho rang Nti' gidi co ty le dap litig ben viitig cao hdn so vdi Nam gidi.
Tai lu'dng HBV - DNA tru'dc dieu tr|
Nhiitig benh nhan eo tai lu'dng HBV - DNA tru'dc dieu trj < 108 lU/ml cd ty le dap uTig vi rut eao hdn nhdm co tai lu'dng vi riit >108 lU/ml (OR: 2,06, p = 0,019).
Ket qua nay ciia ehiing toi tu'dng t i / vdi nghien ciTu eiia tac gia Tran Xuan Chu'dng tren ngu'di Idn. Theo nghien eiiU nay thi yeu to lam tang kha nang dap iitig sdm la HBV - DNA < 107 copies/mlPi.
Trong nghien ciitJ eiia Anna Liberek, chuyen dao huyet thanh HBeAg d eac benh nhi dieu tri bSng lamivu- dine cd moi lien quan mat thiet vdi tai lu'dng HBV - DNA tru'dc dieu trj. Tai lu'dng HBV - DNA cang thap thi kha nang chuyen dao huyet thanh cang eaof'"].
Nong do ALT tru'dc dieu trj
Trong nghien ciiU nay, kha nang dat dap iitig vi riit sau 12 thang dieu tri Lamivudine eiia nhom benh nhi cd niong dp ALT ban dau > 200 U/l khong eao hdn so vdi nhdm benh nhi ed nong dp ALT < 200 U/l. Ket qua nay eiia ehiing toi tUdng dong vdi ket qua nghien ciTu ciia tae gia Anna Liberekt^"!. Tac gia Anna eung khong tim thay moi lien he nao giu^ nong dp ALT tru'dc dieu tri vdi ket qua dap ifng dieu trj sau 12 thang vdi lamivudine ciia eae benh nhi.
Trong khi dd, rat nhieu nghien ciili viem gan vi nit B man d ngu'di Idn lai chi ra rang nong do ALT cao tru'dc dieu tri la mpt trong nhutig yeu to tien lu'dng dap litig dieu tri viem gan vi rut B man bang thuoe khang vi n i t Ty le chuyen dao huyet thanh HBeAg
Cac tai lieu y van tren the gidi chi ra rang ty le chuyen dao huyet thanh tieh luy d tre em lan lu'dt la 34% va 68%
d nam thu' nhat va nam thir hai sau uong lamivudine!^]. Do vay, cae nha nghien ciilj cho rang dieu bi lamivudine keo dai d tre em ed hieu qua tot hdn trong viec lam tang ty le chuyen dao huyet thanh hdn d ngu'di Idn. Trong nghien cuU ciia chiing toi, 5/36 benh nhi dat dap litig ben vutig (nong do ALT trd ve binh thudng, chuyen dao HBeAg/anti - HBe, vi rut du'di nguSng phat hien ciia may Cobas) deu
T R U Y i N N H l i M V i r r N A M * s 6 DAC BIET NGAY VIEM GAN THE GlOl - 2015 - 11
ed thdi gian uong lamivudine tren 12 thang.
Tac dung phu cua lamivudine
Lamivudine da du'dc chiitig minh la thuoe ed dp an toan cao doi vdi benh nhi. Trong nghien aiU nay, tae dung phu ciia lamivudine quan sat du'dc la rat hiem, xay ra thoang qua va tif het sau 3 thang. Cac tac dung phu nghi ngd la ciia lamivudine bao gom: dau dau, dau khdp, roi loan tieu hoa nhe.
KET LUAN
- Gidi va tuoi: Tuoi trung binh ciia eae doi tu'dng nghien ciitJ 11,46 ± 4,38. Ti le mac benh d tre Nam eao hdn tre Nu'.
- Trung binh tai IUdng HBV - DNA eiia benh nhi tru'dc diieu tri la kha eao (4,07 ± 5,06) x 10^ eopies/ml. NhDtig benh nhan ed tai IUdng HBV - DNA tru'dc dieu trj <108 lU/ml CO ty le dap iitig vi riit cao hdn nhom co tai lu'dng viriit>10BIU/ml.
- Nong dp ALT tmng binh cua benh nhi tru'dc dieu tri:
154 ± 102 (U/l).
- Sau 12 thang dieu tri bang lamivudine, 100% benh nhi CO dap iitig sinh hda; 56,4% benh nhi co dap iitig vl rut va ty le chuyen dao huyet thanh HBeAg la 13,9%.
- Trong dieu tn viem gan vi rut B man 6 tre em lamivudine van la thuoe ed hieu lu'c va an toan.
KHUYEN NGHI
Tai Viet Nam, van de dieu tri viem gan vi riit B man d tre em chu^ du'dc quan tam nhieu. Qua nghien eiili nay chiing toi thay rang viee dieu tri viem gan vi nit B man cho tre la hoan toan ed ldi. Mac dii lamivudine khong c6 hieu qua cao trong dieu trj viem gan vl riit B man ngu'di Idn, nhutig trong dieu tri viem gan vi riit B man d tre em lamivudine van la thuoe ed hieu lUc va an toan. Chung te can cd them nhieu nghien culi sau hdn ve viem gan vi riit B man d tre em.
TAI LIEU THAM KHAO
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detecting, and managing viral resistance. Clin Gastroen- terol Hepatol, 2008. 6(3): p. 268 - 74.
7. Hong, S.J., et al.. Current role of Lamivudine re- garding therapeutic response and resistance in children with chronic hepatitis B. Pediatr Gastroenterol Hepatol Nutr, 2013. 16(2): p. 80 - 8.
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of lamivudine compared with interferon-alpha in children with chronic hepatitis B: the younger the better. J Pediatr Gastroenterol Nutr, 2007. 44(1): p. 92 - 8.
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1 2 • TRUYfeuNHliMVlgTNAM*SO DAC BIET NGAY VIEM GAN THE GlCl - 2015
EFFICACY OF LAMIVUDINE I N THE TREATMENT OF CHILDREN W H H CHRONIC HEPATITIS B I N NAHONAL HOSPHAL FOR TROPICAL DISEASES
Summary
Background: Chronic hepatitis B virus (HBV) infection in children presents a therapeutic challenge for the prac- titioner due to the limited number of antiviral drugs and high risk of development of drug resistance. Some re- searchs found that the average child with chronic hepati- tis B shows compromised growth. It is possible that treating HBV infected children with andviral dmgs may im- prove their gnawth in the long term. In this study, we eval- uated the efficacy and tolerability of lamivudine as a treatment for chronic infection with hepatitis B virus in children. Objective: The study descnbe the clinical and subclinical characteristic and evaluated the efficacy and tolerability of lamivudine as a treatment for chronic infec- tion with hepatitis B virus In children. Subjects: The study included thirty-nine pediatric patients with chronic hepa-
titis B, who received lamivudine treatment for at least 12 months. Methods: prospective study. Results: After re- ceived lamivudine treatment for 12 months, 39 of 39 (100%) pediatric patients had biochemical response (nor- malization of ALT); undetectable levels of HBV - DNA were obsen/ed in 22 of 39 children (56.4%); and the rate of se- roconversion from hepatitis B e antigen to hepatitis B e antibody was 13.9%. The rate of virologic response at week 48 was higher among children who have base line semm HBV DNA level < 10^ copies/ml than among those who have base line serum HBV DNA > 10^ copies/ml. The side effects of lamivudine are very rare and insignificant.
Condussions: Lamivudine is proven still be a effective and safe dnjg in the treatment of chronic hepatitis B in chil- dren.
Key words: Lamivudine, chronic hepatitis B, pediatne patients.
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