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Thuoc dieu tri viem gan B man tinh

Muc dich chinh trong viec chua tri benh viem gan B man tinh la giam thieu su tang truong cua virut, ngan ngua su xam nhap cua virut viem gan B (HBV) vao te bao gan. Tuy nhien, muc tieu toi hau van la loai bo hoan toan HBV ra khoi co the, binh thuong hoa chuc nang cua gan, phuc hoi chat luong cuoc song, keo dai thoi gian song, loai bo cac bien chung suy gan, xo gan va ung thu gan.

Hinh anh virut viem gan B trong mau.

Hien nay, Co quan quan ly thuoc va thuc pham My  (FDA) tren co so cac hoi nghi thoa thuan cua Hoi gan mat the gioi va cac chau luc da chap thuan chinh thuc de dieu tri viem gan B man tinh cac thuoc sau day: thuoc tiem interferon va pegylated interferon, cac thuoc uong: lamivudin, adefovir dipivoxil va entecavir.

- Thuoc tiem interferon: interferon la mot chat hoa hoc quan trong trong he thong mien dich co the, giup cho he thong mien dich nhan dien cac virut hoac cac vi khuan co hai xam nhap vao co the de tan cong va tieu diet chung. Interferon la loai thuoc da duoc nghien cuu va ung dung lau nam nhat de dieu tri viem gan B man. Tren thi truong chinh thuc co 2 loai interferon: interferon alpha 2a (biet duoc roferol) va interferon 2b (biet duoc intron A). Thuoc tiem duoi da trong 6 - 12 thang. Trong nhung nam gan day nguoi ta bao che ra mot loai thuoc interferon moi, goi la pegylated interferon (biet duoc pegasys, pegintron), cong hieu tot hon interferon va chi can tiem 1 lan 1 tuan. Interferon va peginterferon co tac dung tot tren khoang 1/3 so benh nhan duoc dieu tri.

Thuoc nay co bat tien la phai tiem, gia thanh dat, lai co nhieu phan ung phu, co phan ung nhe, chiu duoc (nhu dau, sot nhe luc moi tiem, hien tuong met moi giong nhu cam cum); co loai nang hon (anh huong den mau, giam hong cau, bach cau, tieu cau, anh huong tuyen noi tiet). Thuoc cung khong dung duoc neu gan da bi xo, chuc nang kem. Vi vay, phuong phap interferon cung con nhieu han che, tuy van la mot phuong phap tot, co thoi gian su dung duoc xac dinh, co the ap dung, nhat la doi voi nguoi tre.

- Lamivudin (biet duoc epivir-HBV va zeffix) da duoc su dung khoang 10 nam nay. Thuoc co tac dung ban dau tot tren nhieu benh nhan nhung co nhuoc diem la ty le khang thuoc cao do bien doi gen YMDD (moi nam khoang 15-20%), doi khi xay ra con kich phat benh, do do lam tro ngai cho viec su dung lau dai. Khong nen dung thuoc khi co thai vi thuoc co the anh huong xau den su tang truong cua thai.

- Adefovir dipivoxil (biet duoc hepsera) co cong hieu ca trong cac chung HBV hoang dai cung nhu cac chung da khang lamivudin. Ty le khang adefovir thap hon khang lamivudin rat nhieu, tuy nhien, ty le nay cung den 28% sau 5 nam. Adefovir co the dung dieu tri lau dai co ket qua va an toan cao, tuy vay cung can theo doi chuc nang than bang xet nghiem creatinin.

- Entecavir (biet duoc baraclude) duoc chap nhan gan day nhat (dau nam 2005), ty le khang thuoc chua thay cong bo sau 2 nam dieu tri. Song, cung co mot so it truong hop khang thuoc duoc phat hien o nhung ca da khang lamivudin. Nhung tai lieu da duoc cong bo cho thay baraclude co cong hieu tot doi voi viem gan B man. Thuoc nen uong luc doi, khi dieu tri lau dai can theo doi chuc nang than bang xet nghiem creatinin.

 Doi voi ca 3 loai thuoc uong deu khong duoc ngung thuoc mot cach dot ngot neu khong duoc huong dan cua bac si vi co the gay ra nhung con bung no cua benh, gay ra nhung hau qua tai hai.

Ngoai cac thuoc duoc chinh thuc cong nhan o tren, con co mot so loai thuoc duoc su dung nhu:

Zadacin thymosin alpha 1 chua viem gan B bang cach tang cuong he thong mien dich cua co the. Thuoc co the tiem duoi da, 2 lan moi tuan, tiem rieng hoac tiem kem voi interferon hay thuoc uong lamivudin adefovir.

Cycloferon: thuoc uong cua Lien bang Nga, duoc Bo Y te Viet Nam cho phep nhap. Thuoc uong it tac dung phu, gia re, dung de kich thich co the tao ra interferon.

Cac thuoc y hoc co truyen duoc phep cua Bo Y te lam tu thao moc phyllantus amarus (nhu Liv 94, siro hebevera...), tu momordica cochinchinensis (nhu gacavit...).

Cac thuoc nay an toan, gia phai chang nhung chua co nhieu cong trinh nghien cuu khoa hoc quoc te xac nhan ket qua chinh thuc.

Tom lai, cac cach dieu tri viem gan B man tinh hien nay chi co kha nang giam thieu su tan pha cua virut HBV chu khong hoan toan loai bo virut ra khoi co the. Viec loai bo virut tuy co truong hop dat duoc nhung la han huu, khong bao dam duoc. Vi the, hon luc nao het, phong benh van hon chua benh. Hien nay nuoc ta da san xuat duoc vaccin phong viem gan B co hieu qua, giu ve sinh dung cach va tiem chung dung phuong phap co the ngan ngua duoc benh cho nhung nguoi chua bi benh viem gan B man tinh.     

GS.TS. Ha Van Mao (Chu tich Hoi gan mat Viet Nam)