Gan nhiem mo do ruou va lam dung ruou – nhung dieu can biet truoc khi dieu tri

Nhiem mo gan la hau qua pho bien va som nhat cua viec uong ruou qua muc thuong xuyen. Duoc uoc tinh phat trien o hon 90% nguoi uong nhieu va trong nhieu nam co the la bieu hien duy nhat cua benh gan do ruou. Su co ve nhe nhan cua chan doan nay la mot trong nhung ly do khien ca benh nhan lan bac si dieu tri nghien ngap doi khi danh gia thap no ve mat lam sang. Tuy nhien steatosis do ruou la diem xuat phat cua nhung ton thuong nghiem trong hon, la tin hieu rang gan da bi qua tai, va – quan trong la – la tinh trang hoan toan hoi phuc duoc, co the thoai lui khong de lai dau vet sau khi cai ruou.

Co che tich luy mo trong te bao gan

Chuyen hoa ethanol boi alcohol dehydrogenase (ADH) tao ra luong NADH du thua. Ti le NADH/NAD+ cao uc che beta-oxy hoa axit beo va gluconeogenesis trong khi kich thich tong hop axit beo de novo. Ket qua la tich luy triglyceride. Ruou cung kich hoat cac yeu to phien ma SREBP-1c va ChREBP lam tang bieu hien gen lipogenesis. CYP2E1 duoc kich hoat boi ruou tao ra cac goc oxy phan ung lam tang cuong peroxy hoa lipit.

Bieu hien lam sang – tai sao nhiem mo thuong “im lang”

Nhiem mo gan don gian trong dai da so truong hop khong gay ra trieu chung dac hieu. Xet nghiem cho thay GGT tang cao chu yeu voi muc tang AST va ALT vua phai. Bilirubin albumin va INR thuong binh thuong. Sieu am tiet lo hinh anh dac trung cua “gan sang” tang am vang.

Luong ruou va nguy co nhiem mo

Nhiem mo va xo hoa – khi nao tro nen nghiem trong

Van de bat dau khi them thanh phan viem – viem gan nhiem mo do ruou (ASH). Voi viec tiep tuc uong ruou xo hoa co the tien trien den xo gan. Cai ruou dung qua trinh nay o bat ky giai doan nao.

Chan doan

Nhiem mo gan va dieu tri nghien ngap

Voi nhiem mo khong co xo hoa cac giao thuc cat co tieu chuan an toan ma khong can sua doi dang ke. Viec lua chon thuoc dieu tri phai tinh den tinh trang gan – disulfiram co doc tinh gan va chong chi dinh trong viem gan hoat dong. Cai ruou la lieu phap manh nhat cho nhiem mo gan do ruou.

Cau hoi thuong gap

Tai lieu tham khao

1. Gao B, Bataller R. Alcoholic liver disease: pathogenesis and new therapeutic targets. Gastroenterology. 2011;141(5):1572-1585.
2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Alcohol-related liver disease. J Hepatol. 2018;69(1):154-181.
3. Crabb DW, et al. Diagnosis and Treatment of Alcohol-Associated Liver Diseases: 2019 Practice Guidance. Hepatology. 2020;71(1):306-333.