Đánh giá kết quả điều trị của peginterferon alpha-2b kết hợp ribavirin ở bệnh nhân viêm gan virus C mạn tính và giá trị của Fibroscan trong chẩn đoán xơ hóa gan
Luận án Đánh giá kết quả điều trị của peginterferon alpha-2b kết hợp ribavirin ở bệnh nhân viêm gan virus C mạn tính và giá trị của Fibroscan trong chẩn đoán xơ hóa gan. Bệnh viêm gan virus C (VGVRC) đã được xác định trong hơn 3 thập kỷ qua, nhưng cho đến nay VGVRC vẫn đang là một trong những nguyên nhân hàng đầu gây viêm gan mạn tính, xơ gan và ung thư tế bào gan [1],[2]. Theo thông báo của Tổ chức Y tế Thế giới (TCYTTG), trên toàn cầu có khoảng 130 – 170 triệu người nhiễm virus viêm gan C (HCV) và theo ước tính khoảng 80% các trường hợp nhiễm HCV sẽ tiến triển thành viêm gan mạn tính
[3] . Trong quá trình tiến triển của bệnh viêm gan virus C mạn tính (VGVRCMT) có sự tích tụ quá mức các chất cơ bản giàu protein và collagen ở khoảng gian bào, gây rối loạn cấu trúc nhu mô gan, xơ gan, bệnh gan mất bù
[4] ,[5]. Vì vậy, các y văn đều nhận định việc xác định tình trạng xơ hóa gan là một trong những yếu tố quan trọng để tiên lượng sự tiến triển của bệnh. Cho đến nay sinh thiết gan vẫn được coi là tiêu chuẩn vàng để đánh giá tình trạng xơ hóa gan [6],[7]. Tuy nhiên, đây là một thủ thuật xâm lấn nên có một số hạn chế như gây đau, có một số tai biến như chảy máu,… ngoài ra còn được ghi nhận là có thể có sai số [8]. Để khắc phục các hạn chế của kỹ thuật sinh thiết gan, một số phương pháp không xâm nhập đã được khuyến cáo nghiên cứu áp dụng vào thực hành điều trị bệnh. Năm 2014, TCYTTG đã khuyến cáo sử dụng các phương pháp không xâm nhập như Fibroscan và APRI để theo dõi tiến triển của xơ hóa gan trên bệnh nhân VGVRCMT thay thế cho các giải pháp xâm nhập [9].
Về điều trị, hiện tại các Hiệp hội gan mật quốc tế và TCYTTG đang khuyến cáo nghiên cứu các giải pháp điều trị VGVRCMT bằng thuốc kháng virus phù hợp với sự phân bố của các kiểu gen HCV ở mỗi khu vực [9],[10],[11]. Mục tiêu được đề ra cho điều trị là đạt được tiêu chuẩn đáp ứng virus bền vững (ĐƯVRBV) [9],[12]. Tiêu chuẩn này được xem là tiêu chuẩn khỏi bệnh, giúp giữ vững hoặc cải thiện mức độ xơ hóa tổ chức nhu mô gan, cải thiện tiên lượng bệnh [13],[14]. Tại Việt Nam từ năm 2015 trở về trước, phác đồ peginterferon alfa-2b phối hợp ribavirin (pegIFN alfa-2b + RBV) vẫn đang là phác đồ cơ bản cho hiệu quả điều trị cao. Hiện đã có một số nghiên cứu đánh giá hiệu quả của phác đồ trên dựa trên các chỉ số sinh hóa, virus học [15],[16].
Tuy nhiên, cho đến thời điểm hiện tại các nghiên cứu vẫn chưa có bằng chứng về hiệu quả của phác đồ pegIFN alfa-2b + RBV cũng như giá trị của kỹ thuật Fibroscan dựa trên bằng chứng về thay đổi mô bệnh học ở bệnh nhân VGVRCMT tại Việt Nam.
Cho đến nay nhiều phác đồ mới điều trị cho bệnh nhân VGVRCMT đang được nghiên cứu tuy nhiên việc đánh giá kết quả điều trị của từng phác đồ bằng các phương pháp nghiên cứu chặt chẽ, các minh chứng khoa học cũng như áp dụng các kỹ thuật mới trong thực hành chẩn đoán và điều trị sẽ có ý nghĩa to lớn trong thực hành lâm sàng cũng như có giá trị khoa học.
Xuất phát từ thực tế trên, chúng tôi tiến hành nghiên cứu đề tài: “Đánh giá kết quả điều trị của peginterferon alpha-2b kết hợp ribavirin ở bệnh nhân viêm gan virus C mạn tính và giá trị của Fibroscan trong chẩn đoán xơ hóa gan” với các mục tiêu sau:
1. Đánh giá kết quả điều trị bệnh viêm gan virus C mạn tính bao gồm cả xơ gan còn bù bằng phác đồ peginterferon alpha-2b kết hợp ribavirin
2. Đánh giá giá trị của Fibroscan so sánh với bằng chứng mô bệnh học trong xác định mức độ xơ hóa gan ở bệnh nhân viêm gan virus C mạn tính.
DANH MỤC CÁC CÔNG TRÌNH Đánh giá kết quả điều trị của peginterferon alpha-2b kết hợp ribavirin ở bệnh nhân viêm gan virus C mạn tính và giá trị của Fibroscan trong chẩn đoán xơ hóa gan
NGHIÊN CỨU KHOA HỌC LIÊN QUAN ĐẾN LUẬN ÁN
1. Ngô Anh Thế, Nguyễn Ngọc Phúc, Trịnh Thị Ngọc, Bùi Vũ Huy, Nguyễn Văn Kính (2015). Đánh giá kết quả điều trị bệnh nhân viêm gan virus C mạn tính bằng phác đồ peginterferon alfa-2b kết hợp ribavirin. Truyền nhiễm Việt Nam, ĐB1: 14-18.
2. Ngô Anh Thế, Nguyễn Ngọc Phúc, Bùi Vũ Huy, Trịnh Thị Ngọc, Nguyễn Văn Kính (2015). Đánh giá hiệu quả điều trị viêm gan virus C mạn tính bằng peginterferon phối hợp ribavirin tại Việt Nam. Y học Việt Nam tháng 11, 2015. Số đặc biệt: 503 – 509.
3. Ngô Anh Thế, Vũ Thị Nhung, Nguyễn Văn Hưng, Bùi Vũ Huy (2015). Đánh giá sự thay đổi mô bệnh học ở bệnh nhân viêm gan virus C mạn tính được điều trị bằng peginterferon phối hợp ribavirin. Y học Việt Nam tháng 11, 2015. Số đặc biệt: 510 – 515.
4. Ngô Anh Thế, Nguyễn Ngọc Phúc, Bùi Vũ Huy, Nguyễn Văn Kính (2015), Giá trị của Fibroscan trong đánh giá mức độ xơ hóa gan trên bệnh nhân viêm gan virus C mạn tính. Tạp chí Truyền nhiễm Việt Nam, số 1 – 2015, 35- 38.
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