Nghien ciJu - Ky thuat
v/Danh gia viec m dung thuoc trong dieu tri benti nhan lupus ban do he thong tai Benh vien Da lieu Trung vong
Nguyen Thi Kim Thu
Benh vien Da lieu Trung uomg E-mail: [email protected]Summary
Usage of drugs, therapeutic effects and adverse reactions in treatment of patients with systemic lupus erythematosus (SLE) was studied involving patients diagnosed with systemic lupus erythematosus monitored at the National Hospital of Dermatology and Venereology from November 2013 to May 2014 based on clinical and subclinical symptoms, adverse drug reactions on clinical symptoms and clinical laboratory markers of the liver function (GPT, GOT) and kidney function (urea, creatinine). All the patients at the National Hospital of Dermatology and Venereology used glucocorticoid separately or in combination with angiotensin-converiing-enzyme inhibitor, nonsteroidal anti-inflammatory drugs, antimalarial drugs. The average of both Red Blood Count and Peripheral blood Lymphocyte Count increased after 3 months of treatment. Significant reduction was observed in other indicators such as erythrocyte sedimentation rate, hematuria, proteinuna, ANA levels and anti dsDNA levels Some adverse drug reactions occurred in relation to certain drugs such as headache, dizziness, drowsiness, digestive disorders, gastrointestinal disorders including anorexia, bloating, affecting eyesight, infection status, increase in liver enzymes, hyperiipidemia and hyperglycemia. These findings would contribute to a better understanding of the usage of drugs in the treatment of SLE and help rationalize the use of drugs.
Keywords: Systemic lupus erythematosus, drugs, adverse drug reactions, therapeutic effects.
Dat van de nhien, Viet Nam chua co nhieu nghidn cuu v l s f i dyng thuoc trong d i l u tri lupus ban dd he t h i n g . Do do Chung tdi t i l n hanh d l tdi ndy vdi 2 myc tidu:
Bgnh lupus ban dd hg t h i n g (Systemic Lupus Erythematosus -SLE) Id mdi bdnh l g midn, khi hd thong midn djeh t i n cdng cac md va cdc ca quan
eCia CO t h i f^>^'. Nguyen nhan chinh xae cua benh - Khao sdt tinh hinh s u dyng t h u l c trong dieu lupus hien chua ro, nhung cdc nghidn cuu cho In bdnh lupus ban dd he t h i n g ,
thay CO s g tham gia eua cac t l bao m i l n djch, . ggnh gid higu qua vd an todn cua sfi dyng bao g i m l l bdo T t l bao B va t l bao dudi gal. ^^ulc trong d i l u tri bdnh nhan lupus ban do hd D i l u In SLE ehu yeu dga vao cac t h u l c uc c h l j^^^^g ^^j ^^^^ ^^^^ ^ a lilu Tmng uang.
mien djeh, vf dy nhu hydroxychloroquin va cac
corticosteroid i^i. Cac thulc dugc sfi dung trong Doi tu'O'ng va phu'O'ng phap nghien dieu In lupus ban do hd thong vdi muc dich uc CU'U
chl miln djch. Thuoc phdi dugc sfi dyng hang ngdy va keo dai de cd the kiem sodt linh trang
bdnh. Ngoai ra, cdc t h u l c trong d i l u trj lupus Cdc bdnh nhdn lupus ban do he t h i n g d u g c ban do he thong Ihudng cb nhilu dgc lfnh vd tdc theo ddi d i l u In ngogi tru tgi Bdnh vign Da l i l u dyng phy nghidm Irgng do do can phoi hgp vdi Trung uong, thdi gian t f i Ihdng 11/2013 d i n cac Ihuoc x(e tri lac dung khdng mong m u l n . Tuy thang 5/2014.
Doi tirgng
TAP CHi Diroc HQC - 10/2015 (SO 474 NAM 55)
Nghien CLPU -Kythuat
Tieu chuan lira chon
Theo lieu c h u i n c h i n dodn SLE ndm 1997 eua Hgi T h i p khdp hgc Hoa Ky (ACR) gdm 11 tieu chuan:
1/ Ban do hinh ednh b u d m d mgi 2/ Ban do dgng dTa.
3/ Nhgy cdm vdi anh sang 4/ Loet midng va mui hgng.
5/ Viem da khdp.
6/ Viem mdng lim, mdng phoi.
7/Ton thuang thdn: Protein nidu > 0,5 g/24 gid hogc nudc t i l u cd h l n g cau. Hemoglobin, try hat hoac ed hdi chfing thdn h u .
8/Ton thuang than kinh, lam t h i n (khdng co nguyen nhdn khac).
9/ Rdi loan v l mdu:
T h i l u mdu lan mdu cd tang hong cau iudi, hoac:
+ Gidm bgch cau dudi 4 G/l.
+ Giam lympho dudi 1,5 G/1.
+ Giam tieu cau dudi 100 G/l.
1 0 / R l i loan midn dich:
+ ANA, khang the khdng chudi kep DNA.
+ Td bao Margraves
+ Phdn fing giang mai duang linh gid keo dai trdn 6 thang, trong 6 thdng, Irong 6 Ihang do khdng cd b i l u hidn benh giang mai.
11/ Khang the khang nhan d hieu gid b i t thudng.
Bdnh nhan d u g c c h i n doan xac djnh la SLE khi CO t u 4 lieu chuan trd Idn trong t i l n s f i bdnh va tgi thdl d i l m tham kham.
Tieu chuan ioai trfi
- Cdc bdnh nhom collagen nhung khong phai la SLE nhu' vidm bi eo, xo cung bl, vidm nCit quanh dgng mgch, hgi chfing Overlab.
- Nhfing bdnh nhdn SLE sau kham phai nhap vidn d i l u tri. Benh nhdn bd d i l u trj, chuyln vien.
Npi dung nghien efi'u
Khdo sal s u dyng thudc Irong dieu tn bdnh SLE.
Ddnh gid hieu qua d i l u trj dga vao cac trieu chfing lam sang, can lam sang qua cac fan kham
bdnh nhan. T i l n hdnh do cdc chf so sinh hda mdu bao gom: Protein, albumin, men gan, ure, ereatinin, cholesterol, triglycerid, phat hidn tdng men gan, suy thgn. Do cdng thfic mau bao gim s l lugng hong c i u , bach cau, tieu cau; l i e dd mdu ldng; t i n g phdn lfch va l l bdo nude tilu de xae dinh cht s l protein nigu, hong c i u nigu, bach cau nidu. Xet nghiem m i l n djch ANA, anti ds-DNA.
Danh gid tdc dyng khong mong m u l n : Dya tren cae trigu chfing Idm sdng va dga tren cde chi sd xel nghigm lam sang v l chfic nang gan (GPT, GOT), chuc ndng than (ure, ereatinin).
Xfi ly so lieu nghien efi'u
Cac so lieu lhu Ihap d u g c luu tru va cac phdp todn t h i n g kd d u g c thgc hign vdi s u trg giup cua phan mem SPSS 16.0 for Windows. Cac s l lidu djnh tinh d u g c bieu hien d u d i dang ly Id %. Cdc s l lidu djnh lugng dugc b i l u hien dudi dang trung binh ± dp lech ehuan (TB ± SS).
Ket qua nghien cii'u
Khao sat S I J diing cdc nhom thuoc trong dieu tn bdnh SLE
Cac nhom thuoc trong dieu tri SLE t^i Benh vien Da liiu Trung uxmg
Ty lg cae nhom t h u l c d u g c tinh dga vao so lan gap cua nhom thudc do trong long s l bgnh nhdn didu tri. N l u Irong dgt d i l u In ma gap nhllu thuoc Irong mgt nhdm t h u l c thi van cht tinh Id mgt lan gap. K i t qua khao sat ve cdc nhdm thulc dung trong dieu trj SLE cu the nhu sau:
Bang 1 : Tyl$ cac thudc dung dieu tri Tnrac Sau 01 Sau 02 Sau 03 dieu In thing Sting tfiang Thuoc dieu tri chinh " = 125 n = 125 n = 110 n = 92
Glucocorticoid (GC) Thuoc ifcch^ mien didi (UCMD) Thuoc ch6ng sot ret tong hap(CSRTH) Thuoc chfing viem khfing steroiii (NSAiD) Thuoc khang smh
n % n
125 ICO 125
18 14,4 10
71 56,8 80
8 6,4 6 20 16,0 12
% n %
100 110 100
8,0 14 127
64,0 62 56,4
4,8 2 1,8 9,6 12 10,5 n 92 8 58 2 2
%
too
8,7 63,0
22 2,12
T,^P CHi D i r a c HOC-10/2015 (SO 474 NAM 55) ^
• Nghien ciJu - Ky thuat
Tium _ J - Seu tti Thuoc ho frp- n = t25
n %
Thuoc chong loet da day 102 81,6
l ^ ' " " ^ - 10 8,0 haipidmau
Thuoc ho tra tfiten^
gan. cac vitamin vamufii 125 100 khoang...
SauOt tfiang ii = )25 n % 95 76,0 5 4.0
125 100 Sau 02
thing n = «0 n % 90 81,8
15 13,6
110 100 Sail 03
tiiang 11 = 92 n % 74 80.4
5 5.4
92 100
Tdt ca cdc bdnh nhan ddu s f i dung GC trong dieu tri (100%), thuoc chong s i t ret long hgp cung d i f g c s f i dung t r v d c d i l u tri t f i 56,8% d i n 64,0%
sau dieu tri 1 thang, Ihuoc d i l u tri loet da day td trang cung d o o c s f i dung vdi ty Id ldn tru'dc dieu lri 81,6 % den 76% sau d i l u trj 1 thang, 100 % bgnh nhan d u g c dung thuoc hd trg dieu tri nhu vitamin, bo gan, chdng loang x u o n g , d i l u hoa midn dich. T h u l c fie c h l midn djch d u g c dung vdi ty le thap l f i 14,4% den 8,0%. Sau d i l u tri 02 thang va 03 thang, 100% bgnh nhan d u g c s f i dyng GC vd cdc t h u l c hd t r g khdc, ty Id bgnh nhan dung thuoc chdng sot ret long hgp t f i 56,4
% d i n 64%, t h u l c fie c ^ l midn djch t f i 8,0 % d i n 12,7%. Ty Id bdnh nhdn s u dung thudc c h i n g loel dg day khd cao t f i 76% d i n 81,8%.
Cac phac d6 gap trong miu nghien cOv dieu tri SLE
100% bdnh nhan s f i dung GC don dgc hoac phoi hgp cung vdi i h u l c UCMD, CSRTH, NSAID.
Cu the nhu sau:
Bang 2: Cac phac dd diiu tri Trvac Sau 01 Sau 02 Sau 03 dieu tri thing thing thing PhwtKyp n = 125 n = 12S n = 110 n = 92
thuoc
% n GC
G C . NSAID GC + CSRTH GC+UCMD
28 8 71 18
27.4 6,4 56,8 14.4
29 6 SO 10
23.2 4.8 64,0 8,0
22 2 62 14
20,0 1.8 56.3 12.7
24 2 58 8
26,1 2,1 63.0 8,7 Whan xet: S l benh nhdn s u dyng GC phdi hgp vdi CSRTH c h i l m ly le cao nhat t f i 56,3%
d i n 64,0%. So benh nhan s f i dung GC dan ddc c h i l m ty Id l f i 20,0% den 2 6 , 1 % , chi cd khoang 2,1 % den 6,4% s f i dung GC p h l i hgp vdi NSAID, t f i 8,0% d i n 14,4% s f i dung GC p h l i hgp vdi UCMD.
Ddnh gia h i ^ u qua va an t o a n cua s f i d u n g t h u o c t r o n g d i l u t n benh SLE
Sy chuyen biin benh theo cac xet nghiem can tarn sang
Cht so hdng cau
Bang 3: Cai thien chisd hdng ciu
Hong cau (TK)
<4.0
>4.0 T B I S S
Trum dieu Sau Sau Sau ln(Oj 01 Ihang (1) 02 thing (2) 03 thing (3) n = 125 n = 12S n = m n = 75
n % n % n % n %
6 4,8 2 1,6 2 1,8 0 0 119 95,2 123 98.4 111 98.2 75 100 4,54 ±0,51 4,7810,78 4,75 ±0,57 4.7210,42
P(3A1/0)<0.05
Nhan xet: S l lugng hong cau Imng binh tang (Xi y nghTa sau d i l u tri 01 thang, 02 Ihdng vd sau 03 thang so vdi trudc d i l u trj.
Chi sd lympho bao
Bang 4: Cai thien chi sd lympho bao
Lympitobio (G/l)
<1,5
>1,5 T B l S S
T n n c dieu Sau Of tfiang Sau02 tnIO) (1) thing (21 n = 12S n = « 5 11 = 1)3 n % n % n % 71 56,8 38 30,4 46 40 54 43,2 87 69,6 69 60 1,5110,90 1,9110,87 1.9010,92
Sau 03 thing (3) n = 80 n % 30 37,5 50 62,5 1,9411,14 P(3A1/0)<0.01
Nh$n xet: So lugng lympho bao Imng binh d mdu ngoai vi tang sau d i l u trj 01 thdng, 02 thdng vd tang cd y nghTa sau 03 thdng so vdi tm-dc d i l u trj.
Chisd tiiu ciu, chlsd mau ling Bang 5: Cai thien chisd tiiu ciu
Stt Thdigian dieu tj
c'hA„», So Ivong tieu cau t . So benh Z- u i m trung binh fj
UBtSS) 1 Truoc dieu tfi (0)
2 Saudieutril thang (1) 125 3 Sau dieu tn 2 thang (2) 114 4 Sau di6u tri 3 thang (3) 84 P(3,2,1/0}<0,05
Nh0n xet: S l lugng tieu cdu Irung binh tang sau dieu In 01 thang, 02 Ihdng, 03 thang so vdi tru'dc d i l u trj.
TAP CHi D i r o c HOC - 10/2015 (SO 474 NAM 55)
Nghien CLPU - Ky thuat
Bang 6: Cii thien chisd m^u ling
1 Tnnjca^utri 2 Sau dieu tri 3 thdng
P 125 92
T6cd9miulang(mm) (iBtSSI eialh(rt eicfthir2 33,36114,95 57,99120,83 16,84112,39 33.77119,05 P< 0,001 P< 0,001 Nhan xet: T i c do mdu lang gid thfi 1 va gid thfi 2 giam sau 3 thang d i l u trj so vdi trudc d i l u lri.
Cac chl sd nwac tiiu
Bang 7: Tj? lg % benh nhan cd protein nieu va hdng cau nl$u frudc va sau 03 thing diiu tn
Cfti so nuoc treu Hong cau nifiu (+) Protein nieu (+)
TniiK dieu tri Sau dreu trj 03 thing n = (25 11 = 90 n % 34 27,2 46 36,8
n % 10 11,1 P<0,01 12 13,3 P<0,01 Nhgn xit: Hong c i u nieu: trudc d i l u tri cd 34 benh nhdn (27,2%) giam edn 10 bdnh nhan (11,1%). Protein nieu: trude d i l u lri cd 46 benh nhdn (36,8%) giam edn 12 bgnh nhan (13,3%).
Chisd miin djch
Bang 8: Cai thiin chi sd ANA Gia tri ANA (OD) Tnmc dieu tii Sau 03 Oiang
P< 0.001
Nhan xet: Nong dp ANA giam ed y nghTa sau 3 Ihdng dieu trj
Bang 9: Cii thien chl sd anti ds-DNA Gii tri anti-ds DNA (Ul/mt) Trudc dieu trj Sau 03 thing
< 25: Am tinh 27 30
131,68±90.87 52,73±39,36 P< 0.001
Nhan xet: Nong dp Anli ds-DNA glam cd y nghTa sau 3 Ihang d i l u trj.
Cac tic dung khong mong muon Cic tic dung khdng mong mudn tren lim sang trong diiu tri
Bdng 10: 7y /g tac dicing khong mong mudn trin * lam sing trong diiu tri
stt Bieu hien 1 Loang xuong 2 Benh ly duong tifiu hoa 3 Bi^u hien than kmh (dau dki, chfing mat.
4 Mlt(loanthi,mcrmat,dgcthOytinhthe., 5 Tinh trang nhilm trfing 6 PhO 7 Hfii ruling Gushing
S6 benh nhfin 16 48 ) 45
19 18 9 2
W X
12,8 38,4 36,5 15,2 14,«ijL
Ti Nhin xet: Ty lg bdnh nhan ggp lac dyng
«
khdng mong m u l n c h i l m ty Id cao n h l t Id bieu hi^n bdnh ly dudng tidu hod (trdn 38%), b$nh than kinh (36,0%). Ty lg bdnh nhan g | p b0nh loang xuong 12,8%, b i l u hidn d mat 15,2%, tinh Irang nhiem trung 14,4%. Thap nhat la hgi chfing Gushing 1,6%.
Tac dung khdng mong mudn trin c$n lim sing
Bang 11: Ty /g tic dicing khdng mong mudn trin can lam sing
Tic dung Idiong mong muon Tang GPT Tang GOT Tang choiesterol Sinh hoa Tang tnglycerlcl
Tang LDL Tang glucose Giam h^ng cau Huyet hoc Giam bach cau hat
Giam t l i u cau
So Itenh nhan 18 10 9 20 9 4 0 0 0
TflfK
14,4 8,0 7,2 16,0 7,2 3,2 0 0 0 Nhin xet: Khdng cd benh nhan nao cd giSm ddng mdu ngogi vi, tinh Irgng tang men gan sau dieu trj gap 14,4% tang GPT va 8,0% tdng GOT Tang cholesterol ggp 7,2%, tang triglycerid gap 16%, tang LDL gap 7,2%, tang dudng huylt ggp d 3,2%.
Ban luan
Ve s f i dung thuoc trong dieu trj SLE tgi Bgnh vien Da lieu Trung u v n g
Cdc I h u l c d u g c sfi dung trong dieu trj SLE rat da dang t f i cdch Ihuc d i n so lugng cdc loai thuoc sfi dung ehfing td s u phfic tgp trong
T^P CHI D i r p c HQC -10/2015 (SO 474 NA
• Nghien CIFU - Ky thuat
d i l u trj benh. TJ Id benh nhan d u g c s f i dyng corticoid va cac thuoc hd trg d i l u In la 100%.
Corticoid la thuoc d u g c Iga chpn hang d i u Irong dieu lri SLE i"'. T i l ca cac bgnh nhan vao dieu tn tgi Bgnh vidn Da lidu Trung u a n g deu d u o c dung corticoid, thuoc h i Irg va cae t h u l c d i l u trj theo dung phdc d l . Corticoid d u g c chf djnh chu yeu la methylprednisolon dang u I n g vdi 2 biet d u g c Medrol 4 mg va Medrol 16 mg. Corticoid vdi tdc dung chdng viem vd uc c h l midn djch manh giup eai thign nhanh chdng hau h i t cac tridu chfing cua SLE. T u khi corticoid d u g c dua vao dieu tri lupus da giup cai thien r i t ldn lien lugng cua bdnh. Tuy nhien cd mpt v i n d l rat ldn dgt ra do Id vide s f i dung thuoc vdi lieu cao va keo dai mang lai r i l nhieu lac dung khdng mong muon tuc thdi cung nhu ve sau tren rat nhieu ca quan: Tim mgch, ndi l i l t , co xuong khdp, da/
mem mgc, tidu hda. Chinh vi vdy c i n cd nhung Ihuoc phoi hgp nhdm tang hidu qua d i l u lri cung nhu ha lieu nhanh va duy tri, kiem soat dgt bung phdt cua bdnh. Trong nghien cfiu nay GC d u g c p h l i hgp vdi t h u l c CSRTH vdi ty Id Idn t u 56,3%
den 64,0%. GC phoi hgp vdi thuoc UCMD vdi ty Ie l f i 8,0% d i n 14,4%.
Bgnh nhan SLE thudng phai sfi dyng corticoid Irong thdi gian dai, do dd nguy ca gay ra tdc dung khdng mong muon cua corticoid Id rat ldn. Cdc Ihuoc da ddy la trdng dung d l d i l u trj ede trieu chfing benh ly dudng lieu hoa va phdng ngua tac dyng khdng mong m u l n do dung corticoid vd cac thuoc uc che mien djch, c h i n g s l l rdt tong hgp. Thuoc da ddy td trang duge cht djnh n h i l u nhai Id omeprazol vdi cac bigl d u g c Lopioz 20 mg, omeprazol 20 mg, losec 20 mg. C o c h l cCia omeprazol la ij'c che dac hidu vd khdng h l i phuc bom proton cho lac dung nhanh va hidu qua han cac thuoc khac.
SLE la bgnh anh hudng d i n n h i l u eo quan, thdi gian d i l u trj keo dai ndn ngoai nhung thuoc ke Irdn benh nhan cdn d u g c dung nhieu loai t h u l c ho t r g khdc nhu: hd trg chfic nang gan, cdc vitamin vd m u l i khoang...
Cdc bgnh nhan cljng s u dung thuoc UClVlD tgi c h l . Cdc I h u l c UCMD dang bdi da d u g c dung la tacrolimus vdi cdc biel d u g c Imutac 0 , 1 % , Prolopic 0,03%), Talimus 0 , 1 % , tacrolimus la loai thuoc UCMD mdi tuy nhidn da dugc s u dung
cho benh nhan SLE tgl Benh vidn Da lieu Trung uong, dieu ndy cho thay mgt s g d l i mdi lfch cgc Irong danh muc I h u l c cua Bgnh vien ndi chung vd danh muc Ihuoc d i l u Irj benh nhan SLE cua Bgnh vien ndi ridng. IVlac dii nhung thdng tin cdn han c h l song nhieu nghidn cfiu da eho thay lac dyng ro ret cCia Tacrolimus Irong cac trudng hgp SLE khdng ddp fing vdi corticoid.
Ve hieu qua dieu trj bgnh t h o n g qua cac xet nghidm can lam sang
Trudc d i l u lri cd 6 bdnh nhan cd s l h l n g c i u giam < 4,0 T/l, s l lugng hong cau Imng binh la 4,54 ± 0,51; sau 3 thang d i l u In tdt ca eac bdnh nhdn d i u ed hong cau > 4,0 T/l vdi tmng binh la 4,72 ± 0,42. Trong mdt so nghien cfiu trodc '^^' k i t qua cua chung tdi cao hon, cd the do d l i tugng nghien cfiu eua cac lac gia Id nhung bgnh nhan nang cd nhieu thuong ton ngi tang ndng nhu viem tran djeh Ihanh mac, hdi chfing thgn h u , suy l h | n , Ihdi gian bj benh dai han, da dung qua r i l nhieu I h u l c dieu trj, do vdy dap ung kem han.
Theo bang 4, trudc dieu trj s l bdnh nhdn cd lympho bao < 1,5 G/l Id 71 vd sau 3 thang dieu trj giam con 30, so lympho bao trung binh tang cd y nghTa t f i 1,51 ± 0 , 9 0 len 1,94 ± 1,14.
S l lugng tieu cau trung binh (G/l) cua ca hai nhdm d i u tang cd y nghTa sau 3 Ihang so vdi trudc d i l u lri t f i 216,30 ± 69,9 tang ldn 237,74 + 51,98. Trong k i t qud nghien cuu nay chung tdi khdng phan lich s u thay doi cua s l lugng bach c l u ndi chung vi nd co the bj anh hudng bdi tinh trang nhiem triing eua bgnh nhan.
Chuc ndng than d u g c danh gid dua trdn nhung thay doi cua cac chf s l nudc t i l u , chiing tdi khong danh gia chf so ereatinin mau, ure mau hay mfic Ipc eau than bdi t i l ca bdnh nhdn cd cdc cht s l Irdn Irong gidi hgn blnh thudng. Theo bang 7 protein nieu duong tfnh (> 30 mg/dl) cd 46 benh nhan (36,8%) trudc dieu trj gidm cdn 12 benh nhdn (13,3%) sau 3 thdng dieu Irj. H l n g e i u nidu duang linh (£ 10/pl) cung eai thign i l l t u 34 benh nhan (27,2%) trudc d i l u lri cdn 10 bdnh nhan (11,1%) sau 3 Ihdng d i l u trj.
Vdi chi s l l i n g mau, mau l i n g gid thfi n h l t (mm) d i u gidm sau 3 thang d i l u trj so vdi Irudc d i l u In t u 33,36 ± 14,95 giam cdn 16,84 ± 12,39. T i c do mau l i n g gid thu hai cung giam t f i 57,99 ± 20,83 xuong edn 33,77 ± 19,05.
TAP CHI DirOC H p c -10/2015 (SO 474 NAM 55)
• Nghien ciru - Ky thuat
So sdnh vdi nghien cfiu eua Nguydn Cdng Chiln ^ mdu lang gid thfi n h i t giam t f i 64,60 ± 34,07 x u i n g 33,52 ± 29,57 sau 4 tuan dieu lri bdng methylprednisolon truyen tTnh mgch ngan ngay k i t hgp vdi prednisolon dudng u I n g trdn nhu'ng bgnh nhan cd ton thuong ndi tang ndng. K i t qua mdu l i n g Irung binh eao hon so vdi ehung ldi do doi l u g n g bgnh nhan chu yeu Irong dgt cap ngng, nhieu ton thuong co quan ndi tang nang, prolid va albumin mau giam lam giam dp lgc keo d i n den mau ldng cao khd Ird v l binh Ihudng, ngugc Igi trong nghien cuu eiia ehUng tdi ehu y l u benh la dgt d p nhg va trung binh, khdng CO bgnh nhdn ndo cd hien tugng glam protid hay albumin mau, Ihdi gian danh gid sau 3 thang dai han so vdi 4 t u i n . Mau l i n g eao khdng phai la b i l u hidn dac higu ciia SLE, nd cd the lang trong n h i l u benh va phu Ihudc vao nhieu y l u t l nhung mau lang lang Ihudng x u i t hidn sdm trong giai doan dau khdi bgnh vd trong dgt tai phat SLE ndn nhilu lac gid dCing xet nghigm nay d l theo ddi dgt tai phdi, d i l n b i l n eung nhu danh gia hieu qua d i l u trj benh.
Trong nghidn cfiu eua chung ldi 83,2% edc bgnh nhan cd ANA duang linh trudc d i l u trj vdi OD trung binh Id 3,80 ± 1,72, sau 3 thang d i l u lri OD giam Id 2,60 ± 1,18. Tuy nhien, t^ Id bdnh nhan cd ANA trd v l am linh Ihap (22/90 benh nhdn = 24,74%, xem bang 8 vd 9). Dieu nay phu hgp vdi k i t luan cua n h i l u nghien cfiu trudc day cung nhu h i l u bilt ve vai trd ciia ANA nhu Id marker chan dodn han la marker theo doi d i l u trj vd thudng duang tinh kdo dai '^l Khdng t h i khang dsDNA la y l u to quan trong trong c h i n dodn cung nhu tidn lugng, theo doi bdnh. Trong nghidn cfiu cOa chung ldi trudc d i l u In anti- dsDNA duong linh d 78,4% bgnh nhan vdi n i n g dp trung blnh 131,68 ± 90,87 Ul/ml vdt ngudng phdt hien > 25 U I/ml. Sau 3 thang d i l u trj ndng dp anti-dsDNAgidm la 52,73 ± 39,36.
Ve cac tdc dung khong mong muon gap trong d i l u tr|
Cdc fdc dung khdng mong m u l n eua cac thuoc d i l u lri SLE Iren lam sang hay ggp nhit la bieu hidn t h i n kinh nhu dau d i u , chdng mat, b u I n ngu, bgnh ly dudng tidu hda nhu chan an, day bung, r l i logn tidu hda, anh hudng den thi Ige,
linh Irang nhiem InJng. Cdc b i l u hign ndy hau hit Id do tac dyng khdng mong muon cua corticoid, thuoc UCMD vd I h u l c chdng s i t ret tong hgp.
Ddc tfnh Iren co quan tao mau: khdng ggp trudng hgp b$nh nhan nao ed dau hieu gidm dong mau ngogi vi. Tinh Irgng tdng men gan:
Cd 18 benh nhan tang GPT (14,4%) va 10 b^nh nhan tang GOT (8%i), ed 1 d i l u chu y la cd 6 bdnh nhan tang GOT va 10 bgnh nhdn lang GPT trudc d i l u Irj ( s l lidu khdng d u g c ghi trong bang k i t qua) day la nhfing trudng hgp d u g c xae djnh la b i l u hidn vidm gan cOa SLE (da dugc Ihyc hign cac xet nghigm loai Iru viem gan virus B vd C), sau d i l u trj men gan cCia i l l cd cac bgnh nhan nay d i u trd ve blnh thudng.
Hau h i t cdc tdc dung phu tren egn Idm sang x u i t hien Irong s u i t qua Irinh d i l u lri, cd nhii'ng bgnh nhan thi x u l l hign ngay sau Ihang d i l u trj d i u tidn, cd nhung benh nhan lgi x u i t hien d thdng l h u 2 va l h f i 3 trong qud trinh dieu lri.
Ket iuan
S u dung Ihuoc trong dieu trj bdnh lupus ban do he t h i n g thudng phdi keo dai, vd gay ra nhilu tdc dyng khdng mong m u l n . Trong nghien cuu nay ehung tdi da khao sat d u g c tJ Id sfi dyng thuoc trong dieu trj SLE tai Bdnh vign Da lilu Trung uong, cho t h i y 100% bdnh nhdn s u dyng GC dan dgc hogc p h l i hgp ciing vdi t h u l c UCMD, CSRTH, NSAID.
Qua ddnh gia eho thay cdc chf s l can lam sang nhu s l lugng h l n g c i u trung binh, s6 lugng lympho bao trung binh d mau ngoai vi deu tdng va cac chi so nhu l i e dg mdu lang, h l n g c l u nigu, protein nidu, n i n g dp ANA va nong do anti- dsDNA ddu gidm sau qud Irinh d i l u trj. Mdt so tdc dyng khdng mong muon xuat hidn Hdn quan den than kinh (36,0%), dudng tidu hda (28,8%), loang xuong (12,8%), m i l (15,2%), nhilm trting (14,4%), dau dg day (9,6%), t h i p n h i l la hpi chfing Gushing (1,6%). Kel qua ciia nghidn cfiu ndy gidp eho vi?c sfi dyng thulc dga trdn tidu chuin Igi fch/nguy ca trong d i l u tn bdnh lupus ban dd hg thong sd hgp ly, hidu qua han.
Tai lieu tham khao
1. Le Kinh Du§ (2003), "Bpnh lupus ban do", B^ch khoa thwbenh hpc, NXB Y hoc, f§p 3, trang 32 -39.
