Y HỌC CÁ THỂ HÓA TRONG ĐIỀU TRỊ BỆNH GOUT

Nguyễn Thu Hiền; Hoàng Thị Thu Yến; Đỗ Hà Thanh

doi:10.34238/tnu-jst.10372

Y HỌC CÁ THỂ HÓA TRONG ĐIỀU TRỊ BỆNH GOUT

Thông tin bài báo

Ngày nhận bài: 13/05/24 Ngày hoàn thiện: 17/06/24 Ngày đăng: 17/06/24

Các tác giả

1. Nguyễn Thu Hiền , Trường Đại học Y Dược - ĐH Thái Nguyên
2. Hoàng Thị Thu Yến, Trường Đại học Khoa học - ĐH Thái Nguyên
3. Đỗ Hà Thanh, Bệnh viện Trung ương Thái Nguyên

Tóm tắt

Trong điều trị gout, celecoxib được sử dụng để điều trị viêm, sốt và đau, còn allopurinol, lesinurad và pegloticase được kê đơn để làm giảm nồng độ uric acid máu. Biến thể CYP2C9*2 và CYP2C9*3 gene CYP2C9, HLA-B*58:01 gene HLA-B và một số biến thể gene gây nên thiếu G6PD (Viangchan, Canton, …) liên quan đến các phản ứng có hại khi điều trị gout sử dụng các thuốc trên. Trong nghiên cứu này, chúng tôi phân tích đặc điểm bệnh lý, phương pháp điều trị gout, sự phân bố của CYP2C9*2, CYP2C9*3, HLA-B*58:01, Viangchan và mối liên quan với các phản ứng có hại trong điều trị gout. Kết quả phân tích cho thấy, celecoxib và lesinurad được chuyển hóa chủ yếu bởi CYP2C9. CYP2C9*2 và CYP2C9*3 gây giảm hoạt tính CYP2C9 dẫn đến nguy cơ biến cố tim mạch và đường tiêu hóa khi sử dụng thuốc celecoxib, trong khi lesinurad gây nên các vấn đề về thận và tim mạch. Bệnh nhân mang HLA-B*58:01 hoặc thiếu G6PD được khuyến cáo không sử dụng allopuriol hoặc pegloticase do gây nên phản ứng có hại nghiêm trọng ở da, tan máu và methemoglobin huyết có thể dẫn đến tử vong. CYP2C9*3, HLA-B*58:01, Viangchan chiếm tỷ lệ không nhỏ ở người Việt Nam và các nước châu Á. Kết quả phân tích này là cơ sở để nghiên cứu xây dựng liệu pháp điều trị y học cá thể hóa nhằm tối ưu hóa hiệu quả điều trị và nâng cao chất lượng cuộc sống cho bệnh nhân gout.

Từ khóa

Bệnh gout; CYP2C9; CYP2C9*3; HLA-B; HLA-B*58:01; Thiếu G6PD; Biến thể Viangchan; Y học cá thể hóa

Toàn văn:

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Tài liệu tham khảo

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DOI: https://doi.org/10.34238/tnu-jst.10372

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