Báo cáo trường hợp bệnh gan nhiễm mỡ liên quan đến chuyển hóa trên bệnh nhân vảy nến

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Tác giả: Văn Trở Châu, Việt Thanh Phúc Nguyễn, Thị Khánh Tường Trần

Ngôn ngữ: vie

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Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2024

Mô tả vật lý: tr.195

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ID: 286523

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Đặt vấn đề: Đến nay, bệnh vảy nến đã được chứng minh là bệnh hệ thống, ngoài biểu hiện ngoài da, bệnh vảy nến còn ảnh hưởng đến các hệ cơ quan khác trong cơ thể, đặc biệt là hệ tim mạch và rối loạn chuyển hóa. Một vài nghiên cứu trên thế giới đã chứng minh bệnh nhân vảy nến có nguy cơ mắc bệnh gan nhiễm mỡ liên quan đến chuyển hóa (Metabolic Associated Fatty Liver Disease - MAFLD) cao hơn so với dân số nói chung và bệnh vảy nến có liên quan đến sự tiến triển nặng của MAFLD. MAFLD là một thuật ngữ mới xuất hiện từ năm 2021 nhằm thay thế thuật ngữ bệnh gan nhiễm mỡ không do rượu (NAFLD), đã được Hiệp hội nghiên cứu về gan Châu Á - Thái Bình Dương đưa vào hướng dẫn chẩn đoán và điều trị. Báo cáo trường hợp: 03 trường hợp bệnh nhân được chẩn đoán vảy nến mảng, mức độ trung bình - nặng theo chỉ số diện tích cơ thể (Body Surface Area - BSA) và chỉ số độ nặng của vảy nến theo vùng (Psoriasis Area and Severity Index - PASI), hiện đang điều trị vảy nến tại Bệnh viện Da Liễu Thành phố Hồ Chí Minh bằng thuốc thoa, chưa điều trị bằng các thuốc ức chế miễn dịch đường toàn thân, bệnh nhân chưa được chẩn đoán các bệnh nội khoa, như tăng huyết áp, đái tháo đường, tăng lipid máu, các bệnh lý về gan. Trước khi điều trị bằng thuốc ức chế miễn dịch đường toàn thân, bệnh nhân được xét nghiệm máu tổng quát và đánh giá tình trạng gan bằng siêu âm đàn hồi thoáng qua (Fibroscan®). Cả 03 bệnh nhân đều thỏa tiêu chuẩn chẩn đoán MAFLD: Béo phì độ I, xơ hóa gan nhẹ ở mức độ F0 - F1, gan nhiễm mỡ nhiều ở mức độ S3 bằng siêu âm đàn hồi thoáng qua (Fibroscan®) kèm các rối loạn chuyển hóa như tăng chu vi vòng eo (≥ 90cm: nam, ≥ 80cm: nữ), tăng triglyceride huyết thanh (≥ 150 mg/dl), tăng đường huyết đói (100 - 125 mg/dl), tăng huyết áp (≥ 130/85 mmHg). Kết luận: Cả 3 bệnh nhân vảy nến đều có gan nhiễm mỡ liên quan đến chuyển hóa (MAFLD). Vì vậy, cần có những nghiên cứu lớn hơn về vấn đề này để xác định tỉ lệ mắc MAFLD và các yếu tố liên quan, mối liên quan giữa MAFLD và vảy nến. Abstract Background: Nowadays, psoriasis has been proven to be a systemic disease. In addition to skin manifestations, psoriasis also affects other organ systems in the body, especially the cardiovascular system and metabolic disorders. Several studies around the world demonstrate that psoriasis patients are at higher risk of metabolic associated fatty liver disease (MAFLD) than the general population, and psoriasis is associated with the progression of MAFLD. MAFLD is a new term that emerged in 2021 to replace the term non-alcoholic fatty liver disease (NAFLD), which has been included in the diagnostic and treatment guidelines by the Asia-Pacific Liver Association. Case report: 03 cases of patients with moderate-severe plaque psoriasis according to Body Surface Area (BSA) and Psoriasis Area and Severity Index (PASI), currently being treated for psoriasis at Ho Chi Minh City Dermatology Hospital with topical medications, not yet treated with systemic immunosuppressants, patients have not been diagnosed with internal diseases, such as hypertension, diabetes, hyperlipidemia, liver diseases. Before treatment with systemic immunosuppressants, patients had a general blood test and liver status was assessed by transient elastography (Fibroscan®). All met the diagnostic criteria for MAFLD: Obesity grade I, mild liver fibrosis at F0 - F1 level, severe fatty liver at S3 level by transient elastography (Fibroscan®) with metabolic disorders such as increased waist circumference (≥ 90cm: men, ≥ 80cm: women), hypertriglyceridemia (≥ 150 mg/dl), hyperglycemia (100 - 125 mg/dl), hypertension (≥ 130/85 mmHg). Conclusion: All three psoriasis patients had metabolic fatty liver disease (MAFLD). Therefore, more researches are needed on this issue to determine the prevalence of MAFLD and related factors, the relationship between MAFLD and psoriasis. DOI: 10.59715/pntjmp.3.4.24

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