{"id":2052,"date":"2023-07-03T19:00:31","date_gmt":"2023-07-03T12:00:31","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=2052"},"modified":"2023-07-31T18:22:03","modified_gmt":"2023-07-31T11:22:03","slug":"u-hat-tophi-o-benh-nhan-gout","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/u-hat-tophi-o-benh-nhan-gout\/","title":{"rendered":"U h\u1ea1t tophi \u1edf b\u1ec7nh nh\u00e2n gout"},"content":{"rendered":"

1. GENERAL OBJECTIVES<\/strong><\/h2>\n

B\u1ec7nh gout l\u00e0 m\u1ed9t d\u1ea1ng arthritis<\/a> \u0111au \u0111\u1edbn x\u1ea3y khi c\u00f3 qu\u00e1 nhi\u1ec1u acid uric t\u00edch t\u1ee5 b\u00ean trong c\u01a1 th\u1ec3 do t\u00ecnh tr\u1ea1ng t\u0103ng acid uric m\u00e1u. Ph\u1ea7n l\u1edbn acid uric trong c\u01a1 th\u1ec3 \u0111\u01b0\u1ee3c t\u1ed5ng h\u1ee3p t\u1ef1 nhi\u00ean, c\u00f2n l\u1ea1i l\u00e0 s\u1ea3n ph\u1ea9m c\u1ee7a qu\u00e1 tr\u00ecnh ph\u00e2n gi\u1ea3i purin \u0111\u1ebfn t\u1eeb th\u1ef1c ph\u1ea9m gi\u00e0u \u0111\u1ea1m. Th\u1eadn \u0111\u00f3ng vai tr\u00f2 \u0111i\u1ec1u ch\u1ec9nh n\u1ed3ng \u0111\u1ed9 acid uric b\u1eb1ng c\u00e1ch l\u1ecdc th\u1ea3i h\u1ee3p ch\u1ea5t n\u00e0y ra kh\u1ecfi m\u00e1u, n\u1ebfu th\u1eadn kh\u00f4ng th\u1ec3 l\u1ecdc h\u1ebft ho\u1eb7c c\u01a1 th\u1ec3 s\u1ea3n sinh qu\u00e1 nhi\u1ec1u, t\u00ecnh tr\u1ea1ng t\u0103ng acid uric m\u00e1u s\u1ebd x\u1ea3y ra. Khi \u0111\u00f3, m\u1ed9t l\u01b0\u1ee3ng acid uric s\u1ebd r\u1eddi kh\u1ecfi m\u00e1u v\u00e0 b\u1eaft \u0111\u1ea7u l\u1eafng \u0111\u1ecdng \u1edf d\u1ea1ng mu\u1ed1i urat th\u00e0nh tinh th\u1ec3 s\u1eafc nh\u1ecdn \u1edf kh\u1edbp v\u00e0 m\u00f4 m\u1ec1m xung quanh, \u0111\u1ed3ng th\u1eddi g\u00e2y vi\u00eam t\u1ea1i \u0111\u00e2y. Trong nhi\u1ec1u n\u0103m, s\u1ed1 l\u01b0\u1ee3ng tinh th\u1ec3 ng\u00e0y c\u00e0ng t\u0103ng s\u1ebd h\u00ecnh th\u00e0nh n\u00ean c\u00e1c h\u1ea1t tophi. C\u00e1c h\u1ea1t tophi s\u1ebd xu\u1ea5t hi\u1ec7n v\u00e0 ph\u00e1t tri\u1ec3n v\u00e0o giai \u0111o\u1ea1n cu\u1ed1i c\u1ee7a gout.<\/p>\n

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H\u00ecnh 21.1. <\/strong>S\u1ef1 l\u1eafng \u0111\u1ecdng c\u1ee7a tinh th\u1ec3 urat h\u00ecnh th\u00e0nh h\u1ea1t tophi. Ngu\u1ed3n: BSCKII. Ch\u00e2u Tr\u1ea7n Ph\u01b0\u01a1ng Tuy\u1ebfn, C\u1eadp nh\u1eadt ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh gout, Ch\u01b0\u01a1ng tr\u00ecnh \u0111\u00e0o t\u1ea1o li\u00ean t\u1ee5c 2019 c\u1ee7a H\u1ed9i Th\u1ea5p kh\u1edbp h\u1ecdc TP. H\u1ed3 Ch\u00ed Minh<\/em><\/figcaption><\/figure>\n

2. \u0110\u1eb6C \u0110I\u1ec2M C\u1ee6A H\u1ea0T TOPHI<\/strong><\/h2>\n

H\u1ea1t tophi c\u00f3 th\u1ec3 h\u00ecnh th\u00e0nh t\u1ea1i m\u1ecdi kh\u1edbp, nh\u01b0ng th\u01b0\u1eddng g\u1eb7p \u1edf c\u00e1c kh\u1edbp b\u00e0n ch\u00e2n, kh\u1edbp b\u00e0n tay, c\u1ed5 tay, knee joint<\/a>. C\u1ee5 th\u1ec3 acid uric th\u01b0\u1eddng t\u00edch t\u1ee5 v\u00e0 h\u00ecnh th\u00e0nh h\u1ea1t tophi \u1edf c\u00e1c m\u00f4 g\u00e2n li\u00ean kh\u1edbp v\u00e0 c\u01a1, s\u1ee5n quanh kh\u1edbp, m\u00e0ng ho\u1ea1t d\u1ecbch, d\u00e2y ch\u1eb1ng, t\u00fai ho\u1ea1t d\u1ecbch.<\/p>\n

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H\u00ecnh 21.2.<\/strong> H\u1ea1t tophi \u1edf kh\u1edbp ng\u00f3n tay<\/a> (Ngu\u1ed3n: PGS.TS.BS. Nguy\u1ec5n \u0110\u00ecnh Khoa, C\u1eadp nh\u1eadt \u0111i\u1ec1u tr\u1ecb gout: khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb ACR 2020, H\u1ed9i ngh\u1ecb Khoa h\u1ecdc th\u01b0\u1eddng ni\u00ean n\u0103m 2020 c\u1ee7a H\u1ed9i Th\u1ea5p kh\u1edbp h\u1ecdc TP. HCM)<\/em><\/figcaption><\/figure>
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H\u00ecnh 21.3. <\/strong>H\u00ecnh \u1ea3nh c\u1eaft ngang u h\u1ea1t tophi \u1edf ng\u00f3n tay v\u1edbi c\u00e1c tinh th\u1ec3 tr\u1eafng ng\u00e0. Ngu\u1ed3n: Khoa Gi\u1ea3i ph\u1eabu b\u1ec7nh, B\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t TP. HCM<\/em><\/figcaption><\/figure><\/p>\n

H\u1ea1t tophi c\u00f3 th\u1ec3 s\u1edd th\u1ea5y d\u1ec5 d\u00e0ng d\u01b0\u1edbi da tr\u00ean c\u00e1c kh\u1edbp, h\u00ecnh d\u1ea1ng tr\u00f2n ho\u1eb7c oval, s\u1ed1 l\u01b0\u1ee3ng t\u1eeb m\u1ed9t \u0111\u1ebfn nhi\u1ec1u h\u1ea1t, k\u00edch th\u01b0\u1edbc c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n l\u1edbn \u0111\u1ebfn h\u01a1n 10 cm. B\u00ean trong th\u01b0\u1eddng ch\u1ee9a d\u1ecbch l\u1ecfng, s\u1ec7t, m\u00e0u tr\u1eafng ng\u00e0, c\u00f3 nhi\u1ec1u tinh th\u1ec3 r\u1eafn gi\u1ed1ng b\u00e3 \u0111\u1eadu.<\/p>\n

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H\u00ecnh 21.4.<\/strong> H\u1ea1t tophi s\u01b0ng \u0111\u1ecf trong c\u01a1n gout c\u1ea5p. Ngu\u1ed3n: PGS.TS.BS. Nguy\u1ec5n \u0110\u00ecnh Khoa, C\u1eadp nh\u1eadt \u0111i\u1ec1u tr\u1ecb gout: khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb ACR 2020, H\u1ed9i ngh\u1ecb Khoa h\u1ecdc th\u01b0\u1eddng ni\u00ean n\u0103m 2020 c\u1ee7a H\u1ed9i Th\u1ea5p kh\u1edbp h\u1ecdc TP. HCM<\/em><\/figcaption><\/figure>\n

H\u1ea1t tophi kh\u00f4ng ki\u1ec3m so\u00e1t t\u1ed1t c\u00f3 th\u1ec3 g\u00e2y nhi\u1ec5m tr\u00f9ng n\u1eb7ng, ch\u00e8n \u00e9p th\u1ea7n kinh g\u00e2y \u0111au, t\u00ea y\u1ebfu, g\u00e2y suy th\u1eadn do acid uric<\/a>, c\u00f3 th\u1ec3 g\u00e2y bi\u1ebfn d\u1ea1ng kh\u1edbp, ph\u00e1 h\u1ee7y s\u1ee5n kh\u1edbp.<\/p>\n

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H\u00ecnh\u00a0 21.5. <\/strong>H\u1ea1t tophi v\u1ee1 g\u00e2y nhi\u1ec5m tr\u00f9ng. Ngu\u1ed3n: Khoa Ngo\u1ea1i Ch\u1ea5n th\u01b0\u01a1ng Ch\u1ec9nh h\u00ecnh, B\u1ec7nh vi\u00ean Th\u1ed1ng Nh\u1ea5t TP. HCM<\/em><\/figcaption><\/figure>\n

3. CH\u1ea8N \u0110O\u00c1N M\u1ee8C \u0110\u1ed8 T\u1ed4N TH\u01af\u01a0NG KH\u1edaP DO U H\u1ea0T TOPHI<\/strong><\/h2>\n

C\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng ch\u1ea9n \u0111o\u00e1n h\u1ea1t tophi<\/a> qua kh\u00e1m l\u00e2m s\u00e0ng.<\/p>\n

X-ray<\/a> c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 s\u01a1 b\u1ed9 t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng kh\u1edbp c\u1ee7a h\u1ea1t tophi.<\/p>\n

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H\u00ecnh 21.6.<\/strong> H\u00ecnh \u1ea3nh h\u1ea1t tophi v\u1edbi \u0111\u1eadm \u0111\u1ed9 \u0111\u1ed3ng nh\u1ea5t, b\u1edd r\u00f5 r\u00e0ng tr\u00ean phim X-quang. Ngu\u1ed3n: Dr. Bahman Rasuli, \u201cGout-feet\u201d, https:\/\/radiopaedia.org\/cases\/gout-feet, tr\u00edch d\u1eabn 20\/10\/2022<\/em><\/figcaption><\/figure>
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H\u00ecnh 21.7. <\/strong>H\u00ecnh \u1ea3nh h\u1ee7y kh\u1edbp do u h\u1ea1t tophi. Ngu\u1ed3n: Fiona M McQueen, Anthony Doyle & Nicola Dalbeth, \u201cImaging in gout – What can we learn from MRI, CT, DECT and US?\u201d, https:\/\/arthritis-research.biomedcentral.com\/articles\/10.1186\/ar3489, tr\u00edch d\u1eabn 20\/10\/2022<\/em><\/figcaption><\/figure><\/p>\n

4. NGUY\u00caN T\u1eaeC \u0110I\u1ec0U TR\u1eca<\/strong><\/h2>\n

4.1 \u0110\u1ed1i v\u1edbi h\u1ea1t tophi nh\u1ecf<\/strong><\/h3>\n

S\u1eed d\u1ee5ng thu\u1ed1c nh\u00f3m \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p acid uric (allopurinol, febuxostat,\u2026) trong gout m\u1ea1n t\u00ednh. S\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c colchicin, gi\u1ea3m \u0111au NSAIDs, corticoid trong c\u01a1n gout c\u1ea5p gi\u00fap gi\u1ea3m nhanh tri\u1ec7u ch\u1ee9ng vi\u00eam, s\u01b0ng, n\u00f3ng, \u0111au.<\/p>\n

Thay \u0111\u1ed5i th\u00f3i quen sinh ho\u1ea1t: h\u1ea1n ch\u1ebf c\u00e1c th\u1ef1c ph\u1ea9m nhi\u1ec1u \u0111\u1ea1m, r\u01b0\u1ee3u bia, t\u1eadp th\u1ec3 d\u1ee5c, duy tr\u00ec tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 c\u00e2n \u0111\u1ed1i.<\/p>\n

4.2 \u0110\u1ed1i v\u1edbi c\u00e1c h\u1ea1t tophi l\u1edbn<\/strong><\/h3>\n

Ngo\u00e0i c\u00e1c ph\u01b0\u01a1ng ph\u00e1p<\/a> tr\u00ean, m\u1ed5 c\u1eaft h\u1ea1t tophi c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc. C\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 c\u1eaft h\u1ea1t tophi bao g\u1ed3m:<\/p>\n