Các tiến bộ mới trong chẩn đoán và quản lý bệnh nhân viêm gan virus B=New advancements in diagnosis and management of patients with viral hepatitis B

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Tác giả: Thị Thu Thủy Phạm

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.88-96

Bộ sưu tập: Báo, Tạp chí

ID: 243678

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According to the latest announcement of the World Health Organization (WHO) in 2024, hepatitis B virus (HBV) is still a global burden due to high mortality rates of cirrhosis and hepatocellular carcinoma (HCC). Although there is currently no cure for the hepatitis B, there are many achievements in the field of testing that contribute to early and accurate diagnosis of HBV, assessment of disease severity, monitoring of treatment effectiveness as well as early HCC prediction, which help to manage HBV effectively. Those markers include: (a) Quantitative HBsAg: It is used for early disease diagnosis, monitoring/predicting responses to treatments, risks of HCC and risks of HBV transmission
(b) HBcrAg: This is a new marker widely used to manage Hepatitis B as well as HCC. HBcrAg can be used to predict the risk of HBV reactivation, occult HBV infection, the risk of HCC recurrence, the decision to stop HBV treatment, and the reinfection after liver transplantation
(c) M2BPGi: This new marker helps assess liver fibrosis, diagnose and monitor treatments. It is also used to predict HCC
(d) PIVKA-II: This marker can help diagnose HCC early in order to provide effective treatment
(e) HBV RNA: Serum HBV RNA concentration correlates with liver pgRNA, liver histopathology, and cccDNA concentration and activity. Thanks to these new milestones, many patients will be saved, their quality of life improves and HBV will be eliminated in the near future.Theo công bố mới nhất 2024 của Tổ chức Y tế Thế giới (WHO) viêm gan virus B (HBV) vẫn còn là một gánh nặng toàn cầu do tỉ lệ tử vong cao vì các biến chứng xơ gan và ung thư tế biểu mô tế bào gan (HCC). Mặc dù chưa có một thuốc điều trị triệt để HBV nhưng có nhiều thành tựu trong lĩnh vực xét nghiệm góp phần trong chẩn đoán HBV sớm, chính xác, đánh giá mức độ bệnh, theo dõi hiệu quả điều trị cũng như tiên đoán sớm biến chứng HCC đã giúp cho việc quản lý HBV hiệu quả. Đó là các dấu ấn: (a) HBsAg định lượng: chẩn đoán bệnh sớm, theo dõi/dự đoán đáp ứng với điều trị, nguy cơ ung thư tế bào gan và nguy cơ lây truyền HBV
(b) HBcrAg: dấu ấn mới dùng rất nhiều trong quản lý viêm gan B cũng như HCC. HBcrAg có thể được sử dụng để dự đoán nguy cơ tái hoạt động của HBV, nhiễm HBV tiềm ẩn, nguy cơ tái phát HCC, quyết định ngừng điều trị HBV, tái nhiễm sau ghép gan…
(c) M2BPGi: một dấu ấn mới giúp đánh giá độ xơ hóa gan giúp chẩn đoán và theo dõi điều trị, còn là dấu ấn tiên đoán HCC
(d) PIVKA-II: có thể giúp chẩn đoán các trường hợp HCC sớm từ đó điều trị sẽ hiệu quả
(e) HBV RNA: nồng độ HBV RNA trong huyết thanh tương quan với pgRNA trong gan, mô bệnh học ở gan, nồng độ và hoạt động của cccDNA. Nhờ những dấu ấn mới này sẽ có nhiều bệnh nhân được cứu sống, nâng cao chất lượng cuộc sống và thải trừ HBV trong tương lai không xa.

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