{"id":12042,"date":"2018-03-28T04:04:55","date_gmt":"2018-03-27T21:04:55","guid":{"rendered":"https:\/\/yhoccongdong.org\/ung-thu\/diet-helicobacter-pylori-giup-ngan-ngua-tai-phat-phat-trien-them-ung-thu-da-day\/"},"modified":"2024-04-29T18:57:18","modified_gmt":"2024-04-29T11:57:18","slug":"diet-helicobacter-pylori-giup-ngan-ngua-tai-phat-phat-trien-them-ung-thu-da-day","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/ung-thu\/diet-helicobacter-pylori-giup-ngan-ngua-tai-phat-phat-trien-them-ung-thu-da-day\/","title":{"rendered":"Di\u1ec7t Helicobacter pylori gi\u00fap ng\u0103n ng\u1eeba t\u00e1i ph\u00e1t\/ph\u00e1t tri\u1ec3n th\u00eam ung th\u01b0 d\u1ea1 d\u00e0y"},"content":{"rendered":"

Ung th\u01b0 d\u1ea1 d\u00e0y \u0111\u00e3 tr\u1edf th\u00e0nh m\u1ed9t c\u0103n b\u1ec7nh c\u00f3 kh\u1ea3 n\u0103ng ph\u00f2ng ng\u1eeba \u0111\u01b0\u1ee3c th\u00f4ng qua vi\u1ec7c lo\u1ea1i tr\u1eeb vi khu\u1ea9n Helicobacter pylori<\/em>. Tuy nhi\u00ean, c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn chi\u1ebfn l\u01b0\u1ee3c “s\u00e0ng l\u1ecdc v\u00e0 \u0111i\u1ec1u tr\u1ecb”, v\u00ed d\u1ee5 nh\u01b0 hi\u1ec7u qu\u1ea3 th\u1ef1c t\u1ebf, c\u00e1ch l\u1ef1a ch\u1ecdn \u0111\u00fang \u0111\u1ed1i t\u01b0\u1ee3ng v\u00e0 c\u00e2n nh\u1eafc chi ph\u00ed-l\u1ee3i \u00edch,\u2026ti\u1ebfp t\u1ee5c \u1ea3nh h\u01b0\u1edfng t\u1edbi vi\u1ec7c \u00e1p d\u1ee5ng c\u00e1c k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u v\u00e0o th\u1ef1c ti\u1ec5n l\u00e2m s\u00e0ng.<\/p>\n

Hi\u1ec7n nay, ng\u01b0\u1eddi ta v\u1eabn ch\u01b0a ch\u1eafc ch\u1eafn v\u1ec1 th\u1eddi \u0111i\u1ec3m hi\u1ec7u qu\u1ea3 nh\u1ea5t \u0111\u1ec3 th\u1ef1c hi\u1ec7n ch\u01b0\u01a1ng tr\u00ecnh t\u1ea7m so\u00e1t v\u00e0 \u0111i\u1ec1u tr\u1ecb. M\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng trong \u0111\u00f3 l\u00e0 li\u1ec7u vi\u1ec7c\u00a0lo\u1ea1i tr\u1eeb\u00a0H. pylori<\/em>\u00a0c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c ng\u0103n ch\u1eb7n qu\u00e1 tr\u00ecnh g\u00e2y ung th\u01b0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam teo d\u1ea1 d\u00e0y m\u1ea1n t\u00ednh n\u1eb7ng<\/strong>, nh\u1eefng t\u1ed5n th\u01b0\u01a1ng ti\u1ec1n th\u00e2n c\u1ee7a ung th\u01b0 d\u1ea1 d\u00e0y hay kh\u00f4ng.<\/p>\n

Trong t\u1ea1p ch\u00ed NEJM ng\u00e0y 22 th\u00e1ng 3 n\u0103m nay, Choi v\u00e0 c\u1ed9ng s\u1ef1 b\u00e1o c\u00e1o k\u1ebft qu\u1ea3 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng th\u1ef1c hi\u1ec7n theo nguy\u00ean t\u1eafc ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean, so s\u00e1nh hi\u1ec7u qu\u1ea3 c\u1ee7a vi\u1ec7c lo\u1ea1i b\u1ecf\u00a0H. pylori<\/em> trong ng\u0103n ng\u1eeba ung th\u01b0 d\u1ea1 d\u00e0y t\u00e1i ph\u00e1t sau khi c\u1eaft b\u1ecf t\u1ed5n th\u01b0\u01a1ng ung th\u01b0 s\u1edbm b\u1eb1ng n\u1ed9i soi m\u1ec1m (endoscopic removal)<\/p>\n

V\u1edbi t\u1ed5ng c\u1ed9ng 396 b\u1ec7nh nh\u00e2n v\u00e0 th\u1eddi gian theo d\u00f5i trung b\u00ecnh l\u00e0 5.9 n\u0103m, nghi\u00ean c\u1ee9u cho th\u1ea5y vi\u1ec7c di\u1ec7t tr\u1eeb H. pylori<\/em> \u0111\u00e3 gi\u1ea3m b\u1edbt nguy c\u01a1 t\u00e1i ph\u00e1t 50% (hazard ratio 0.5), so v\u1edbi nh\u00f3m \u0111\u1ed1i ch\u1ee9ng l\u00e0 kh\u00f4ng \u0111i\u1ec1u tr\u1ecb g\u00ec. C\u1ee5 th\u1ec3 h\u01a1n, ung th\u01b0 \u0111\u00e3 t\u00e1i xu\u1ea5t hi\u1ec7n \u1edf 14 b\u1ec7nh nh\u00e2n (7.2%) trong nh\u00f3m \u0111i\u1ec1u tr\u1ecb, so v\u1edbi 27 b\u1ec7nh nh\u00e2n (13.4%) trong nh\u00f3m kh\u00f4ng \u0111i\u1ec1u tr\u1ecb (placebo\/gi\u1ea3 d\u01b0\u1ee3c).<\/p>\n

K\u1ebft qu\u1ea3 n\u00e0y \u0111\u00e3 g\u00f3p ph\u1ea7n ch\u1ee9ng minh r\u1eb1ng t\u00ecnh tr\u1ea1ng vi\u00eam teo c\u1ee7a ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng “b\u00e1o \u0111\u1ed9ng” c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n th\u00e0nh ung th\u01b0, v\u00e0 vi\u1ec7c tr\u1eeb vi khu\u1ea9n H. pylori<\/em> v\u1eabn c\u00f3 th\u1ec3 gi\u00fap \u00edch ngay c\u1ea3 \u1edf giai \u0111o\u1ea1n m\u00e0 tr\u01b0\u1edbc \u0111\u00e2y th\u01b0\u1eddng \u0111\u01b0\u1ee3c cho l\u00e0 \u201ckh\u00f4ng th\u1ec3 tr\u1edf v\u1ec1\u201d n\u00e0y.<\/p>\n

Tr\u00ean b\u00ecnh di\u1ec7n to\u00e0n c\u1ea7u, ung th\u01b0 d\u1ea1 d\u00e0y l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn th\u1ee9 ba g\u00e2y t\u1eed vong li\u00ean quan \u0111\u1ebfn ung th\u01b0, m\u1eb7c d\u00f9 t\u1ef7 l\u1ec7 n\u00e0y \u0111\u00e3 gi\u1ea3m \u0111\u00e1ng k\u1ec3 trong nh\u1eefng th\u1eadp k\u1ef7 qua. G\u00e1nh n\u1eb7ng kinh t\u1ebf l\u00ean h\u1ec7 th\u1ed1ng y t\u1ebf l\u00e0 cao, v\u00e0 c\u0103n b\u1ec7nh r\u1ea5t kh\u00f3 ch\u1eefa do b\u1ec7nh nh\u00e2n th\u01b0\u1eddng b\u1ecb ch\u1ea9n \u0111o\u00e1n \u1edf giai \u0111o\u1ea1n mu\u1ed9n. V\u00ec th\u1ebf c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u0169ng th\u01b0\u1eddng n\u1eb7ng v\u00e0 t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t trung b\u00ecnh trong 5 n\u0103m th\u01b0\u1eddng l\u00e0 d\u01b0\u1edbi 30% \u1edf c\u00e1c n\u01b0\u1edbc ph\u01b0\u01a1ng T\u00e2y. \u1ede c\u00e1c n\u01b0\u1edbc n\u00e0y c\u0169ng ch\u01b0a c\u00f3 ch\u01b0\u01a1ng tr\u00ecnh t\u1ea7m so\u00e1t ph\u00f2ng ng\u1eeba ung th\u01b0 d\u1ea1 d\u00e0y.<\/p>\n

Tuy nhi\u00ean, \u1edf c\u00e1c n\u01b0\u1edbc \u0110\u00f4ng \u00c1, n\u01a1i chi\u1ebfm kho\u1ea3ng 2\/3 s\u1ed1 ca ung th\u01b0 d\u1ea1 d\u00e0y ch\u1ea9n \u0111o\u00e1n tr\u00ean to\u00e0n th\u1ebf gi\u1edbi th\u00ec t\u00ecnh h\u00ecnh c\u00f3 kh\u00e1c. H\u00e0n Qu\u1ed1c v\u00e0 Nh\u1eadt B\u1ea3n \u0111\u00e3 c\u00f3 c\u00e1c chi\u1ebfn l\u01b0\u1ee3c s\u00e0ng l\u1ecdc nh\u1eb1m ph\u00e1t hi\u1ec7n ung th\u01b0 d\u1ea1 d\u00e0y \u1edf giai \u0111o\u1ea1n s\u1edbm, c\u00f3 th\u1ec3 ch\u1eefa kh\u1ecfi v\u00e0 vi\u1ec7c n\u00e0y \u0111\u00e3 l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 t\u1ec9 l\u1ec7 t\u1eed vong do c\u0103n b\u1ec7nh.<\/p>\n

M\u1ee5c ti\u00eau m\u1edbi nh\u1ea5t li\u00ean quan \u0111\u1ebfn vi\u1ec7c n\u00e0y l\u00e0 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m H. pylori<\/em> v\u00ec n\u00f3 l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 ch\u00ednh trong qu\u00e1 tr\u00ecnh g\u00e2y b\u1ec7nh. Kho\u1ea3ng 90% ung th\u01b0 d\u1ea1 d\u00e0y kh\u00f4ng n\u1eb1m t\u1ea1i t\u00e2m v\u1ecb (non-cardia) l\u00e0 do nhi\u1ec5m H. pylori<\/em>, v\u00e0 ph\u00e1c \u0111\u1ed3 di\u1ec7t tr\u1eeb \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c ph\u00f2ng ng\u1eeba ung th\u01b0 d\u1ea1 d\u00e0y nguy\u00ean ph\u00e1t trong m\u1ed9t s\u1ed1 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng. \u1ede nh\u1eefng c\u1ed9ng \u0111\u1ed3ng c\u00f3 t\u1ef7 l\u1ec7 ung th\u01b0 d\u1ea1 d\u00e0y cao, vi\u1ec7c di\u1ec7t tr\u1eeb \u0111\u1ea1i tr\u00e0 (mass eradication) H. pylori<\/em> \u0111\u00e3 l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 s\u1ef1 h\u00ecnh th\u00e0nh c\u0103n b\u1ec7nh. H\u01a1n n\u1eefa, t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh ung th\u01b0 d\u1ea1 d\u00e0y l\u00e0 th\u1ea5p h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ch\u1ecdn di\u1ec7t tr\u1eeb H. pylori<\/em> so v\u1edbi nh\u1eefng ng\u01b0\u1eddi \u0111\u01b0\u1ee3c b\u1ed5 sung ch\u1ea5t ch\u1ed1ng oxy ho\u00e1 trong 15 n\u0103m theo d\u00f5i, v\u00e0 m\u1ed9t k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 c\u0169ng \u0111\u01b0\u1ee3c ki\u1ec3m \u0111\u1ecbnh khi so s\u00e1nh vi\u1ec7c lo\u1ea1i tr\u1eeb H. pylori<\/em> v\u1edbi c\u00e1c ch\u1ea5t b\u1ed5 sung vitamin.<\/p>\n

K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u n\u00e0y c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng \u0111\u01b0\u1ee3c tr\u00ean ng\u01b0\u1eddi Vi\u1ec7t Nam kh\u00f4ng?<\/h2>\n

C\u1ea7n l\u01b0u \u00fd r\u1eb1ng theo s\u1ed1 li\u1ec7u t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m tr\u00ean, 125 ng\u01b0\u1eddi s\u1ebd c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 ng\u0103n ng\u1eeba 1 tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 d\u1ea1 d\u00e0y<\/em>, do \u0111\u00f3 chi\u1ebfn l\u01b0\u1ee3c nh\u01b0 v\u1eady ch\u1ec9 th\u1ef1c s\u1ef1 c\u00f3 s\u1ef1 c\u00e2n b\u1eb1ng gi\u1eefa hi\u1ec7u qu\u1ea3-chi ph\u00ed (cost-effective) \u1edf c\u00e1c n\u01b0\u1edbc c\u00f3 t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh cao. S\u1ed1 ng\u01b0\u1eddi c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb s\u1ebd cao h\u01a1n \u1edf nh\u1eefng n\u01b0\u1edbc c\u00f3 t\u1ef7 l\u1ec7 ph\u00e1t b\u1ec7nh th\u1ea5p ho\u1eb7c trung b\u00ecnh, v\u00e0 con s\u1ed1 n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 tranh lu\u1eadn v\u1edbi c\u00e1c chi\u1ebfn l\u01b0\u1ee3c gia v\u1ec1 ph\u00f2ng b\u1ec7nh.<\/p>\n

Nhi\u1ec1u b\u00e1c s\u0129 cho r\u1eb1ng t\u1ec9 l\u1ec7 nhi\u1ec5m H. Pylori <\/em>\u1edf Vi\u1ec7t Nam l\u00e0 kh\u00e1 cao, v\u00e0 b\u1ee9c tranh v\u1ec1 b\u1ec7nh ung th\u01b0 d\u1ea1 d\u00e0y c\u0169ng kh\u00e1 t\u01b0\u01a1ng \u0111\u1ed3ng v\u1edbi Nh\u1eadt B\u1ea3n, H\u00e0n Qu\u1ed1c. V\u00ec th\u1ebf, t\u00f9y theo kh\u1ea3 n\u0103ng t\u00e0i ch\u00ednh v\u00e0 ngu\u1ed3n l\u1ef1c y t\u1ebf t\u1ea1i \u0111\u1ecba ph\u01b0\u01a1ng, vi\u1ec7c t\u1ea7m so\u00e1t nhi\u1ec5m H. Pylori <\/em>b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u00edt x\u00e2m l\u1ea5n (nh\u01b0 test th\u1edf, \u0111o kh\u00e1ng th\u1ec3,\u2026) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ea7u ti\u00ean, \u0111i k\u00e8m v\u1edbi kh\u1ea3o s\u00e1t b\u1eb1ng N\u1ed9i soi d\u1ea1 d\u00e0y \u0111\u1ec3 ph\u00e2n \u0111\u1ecbnh nguy c\u01a1 v\u00e0 ti\u1ebfn h\u00e0nh di\u1ec7t tr\u1eeb H. Pylori. <\/em>Ti\u1ebfp \u0111\u00f3 l\u00e0 ch\u01b0\u01a1ng tr\u00ecnh theo d\u00f5i \u0111\u1ecbnh k\u1ef3 b\u1eb1ng n\u1ed9i soi \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 vi\u00eam teo n\u1eb7ng, k\u00e8m lo\u1ea1n s\u1ea3n ru\u1ed9t,\u2026\u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 d\u1ea1 d\u00e0y giai \u0111o\u1ea1n s\u1edbm.<\/p>\n

V\u00ec c\u00f3 nhi\u1ec1u l\u01b0u \u00fd khi ch\u1ecdn ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb H. Pylori <\/em>c\u0169ng nh\u01b0 ch\u1ecdn n\u01a1i th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt n\u1ed9i soi, h\u00e3y h\u1ecfi th\u00eam c\u00e1c b\u00e1c s\u0129 t\u1ea1i n\u01a1i b\u1ea1n s\u1ed1ng \u0111\u1ec3 c\u00f3 th\u00f4ng tin chi ti\u1ebft.<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
    \n
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  9. Mera RM, Bravo LE, Camargo MC, et al. Dynamics of Helicobacter pylori infection as a determinant of progression of gastric precancerous lesions: 16-year follow-up of an eradication trial. Gut 2017.<\/li>\n
  10. Ph\u00e1t hi\u1ec7n ung th\u01b0 d\u1ea1 d\u00e0y s\u1edbm: Nh\u1eefng tr\u1edf ng\u1ea1i c\u1ea7n v\u01b0\u1ee3t qua<\/a> t\u1ea1i Vi\u1ec7t Nam<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

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