N g h i e n ciiu Y hoc Y Hoc TP. H o Chi M i n h * Tap 16 * So 1 * 201g
scaffold matenals Bit'mflhTial~ 27 5658-5668
KHAO SAT sy" PHAT TRIEN THE CHAT O TRE EM SUY THAN MAN (2005 - 2008)
Trdn Thi Mgng Hiep TOM TAT
Muc tieu: highien cdu nhdm khdo sdt SH" phat trieh the'chat a tre bi suy than man (STM) nhap vien tai benh vien Nhi Ddng 2, Thdnh pho'HS Chi Minh (TP HCM),Viet Nam.
Doi tugng: Nghien dm dugc thuc hien tren 146 benh nhi STM nhap vien tai benh vien Nhi Dong 2 tir thiing 1/2005 den thdng 12/2008.
Phucmg phdp: Nghien cuu tien ciru mo ta.
Kei qud: Tuoi trung vi la 32 tuoi, 55% (80/146) la tre nam. Benh than goc bao gSm henh ly cau than (32%), benh ly bam sinh va di truyen (29%), 39% cdn lai khong khong dugc khdo sdt nguyen nhan.
Gid tri trung binh cua do lech chuan ctia chieii cao, cdn ndng vd chi so khoi co the (BMI) lan lugt la - 2,92±1,71, -1,96±1,03, -1,73±1,69. Ti le chant phdt trien chieii cao la 72% va thieu can la 57%. Tre mk benh than bam sinh vd di truyen bj cham phdt trim the chat nhieu hem tre bi benh than mac phdi.
Ke't luan: Phdt trien tlie chdi o tre STM nhap vien tai TP HCM bi dnh huong ttang Tie. Can theo ddi vd can thiep cho sic phdt trien thechSi ciia tre STM, dac biet cho nhom tre benh than bam sinh.
Tit khoa: Dg lech chuan;Cdn nang; Chieu cao; Chi so khoi ca the;Benh than bam sinh ABSTRACT
GROWTH SURVEY OF CHRONIC RENAL FAILURE IN CHILDREN (2005-2008) Iran Thi Mong Hiep * Y hoc TP. Ho Chi Minh * Vol, 16 - No.l - 2012:17 - 21 Objective: The aim of this study was to investigate the growth survey tn children with chronic renal failure (CRF) hospitalized in Hospital Nhi Dong 2, Vietnam.
* Bp Mon Nhi Tmong Dai Hoc Y Khoa Pham Ngpc Thach - Khoa Than - Noi Tiei BV Nhi Dong 2 Tic gti hen lac: TS.BS Tran Thj Mong Hi|p DT: 0908.198.104 Email: tranmonghicp8yahoo.fr
Patients and methods: We reviewed from January 2005 to December 2008 the records of 146 children with CRF hospitalized in in Hospital Nht Dong 2.
Results: The median age was 22 years, 55% (80/146; weie boys. Causes of CRF included glomerulonephritis (32%i congenital/hereditary anomalies (29%) but in 39%, of children, the etiology was unavailable. The mean and standard deviation of height, weight and BMI were -2,92 ± 1,71, -1,96 ± 1,03 and -1,73*1,69, respectively. Growth retardation was found in 72% and weight deficiency in 57%. Growth retardation was more frequent in patients with congenital and hereditary diseases than those with glomerular diseases.
Conclusion: Our data shows a severe growth failure in CRF children hospitalized in HoChiMinh City. Intervention on growth development is needed, especially for CRF children with congenital/hereditary diseases.
Y Hoc TP. Ho Chi M i n h * T a p 16 * So 3 * 2012 N g h i e n c u u Y h o c Keywords: Standard deviation; Height; Weight;
D A T V A N DE
Tien luong eho tre em mac benh suy than man (STM) thudng khdng kha quan do cd nhieu benh di kem va h le tir vong cdn eao, dac biet dd'i vdi tre em d eac nuoc dang phat trien. Benh di kem thudng gap nhat la nhdm berth tim mach, loan dudng xuong va cham phat trien the c h a f ' " ' ' . Cham phat trien the chat (CPTTC) la van de phd bieh va quan trpng d benh nhi STM. CPTTC con gay ra nhihig vah de sue khde, cae rdi loan tam ly cung n h u lam gia tang nguy co t u vong d tre STM<'2).
Nguyen nhan ctia CPTTC d tre em gdm nhieu yeu to: bat thudng ve su bai tiet hormone, suy dinh dudng, thie'u mau, toan chuyen hda va loan dudng xuong'^i. Do dd viee phat hi^n sdm va ap dung eae phuong phap dieu tri thich hop dd'i vdi cae bieh chung lien quan deh b | n h than m?n se giiip cai thien su tang trudng va phat trien eiia tre ddng thdi dam bao eho cae benh nhi cd mdt cude sd'ng tuong dd'i binh thudng.
Mae du cac phuong phap dieu tri va theo ddi benh nhi STM da ed nhieu tie'n bd nhung sir tang trudng ve the chat d tre em van ehua cd each giai quyet td'i uu. Theo y van, khoang 50% benh nhi STM ed bieu hien cham phat trieh the chat so vdi tre em d cimg dd tudi^''.
Ban bao cao nam 2007 d Bac My North American Pediatric Renal Transplant and Collaborative Studies (NAPRTCS) ghi nhan 36% trong td'ng so 6794 benh nhi STM cd bieu hien ch^m phat trien chieu eao vao thdi diem nhap viin'-'''. O Tunisia, ti le cham phat trien ve chieu eao d tre bi STM la 64%"-".
Tai Viet Nam hien nay cd rat it cdng trmh nghien cuu danh gia dac diem nhan trac hpe tren tre em STM. Vi vay, viec danh gia tinh trang phat trieh the chat d cac tre STM la can thiet.
PHU'ONG FHAP N G H I E N ClTU Nghien cuu dug'c thue hien theo phuong
59
29 15 Body mass indcx;Congemtal nephropathy.
phap hdi ciiu, md ta.
Tieu chuan chpn man
Tir thang 1 nam 2005 de'n thang 12 nam 2008, cd 146 berth nhan tu 1 - 15 tudi duoc ehan doan STM nhap vien tai BV Nhi Dong 2.
STM dupe phan loai theo dp lpc cau than va theo dinh nghia cua K/DOQl (the Kidney Disease Outeomes Quality Initiative)*^':
Giai doan 1: Dp lpc cau than > 90 ml/phut/l,73m2.
Giai doan 2: Dp lpc cau than tir 60 - 89 ml/phut/l,73m2.
Giai doan 3: Dp lpc cau than tir 30 ml/phut/l,73m2.
Giai doan 4: Dp lpc cau than tir 15 ml/phut/l,73m2.
Giai doan 5: Dp lpc eau than • ml/phut/l,73m2.
STM giai doan eud'i dupc dinh nghia khi GFR < 15 ml/min/l,73m^P>.
Dp lpc cau than (Glomerular Filtration Rate, GFR) ed the dupc tinh theo cdng thuc Schwartz va dupc dinh nghia nhu sau^*:
GFR (ml/min/l,73m^) = k x Height (cm)/
serum creatinine (mg/dl)
k = 0,45 cho tre tu 0 to 18 thang tudi 0,55 eho tre > 2 tuoi, va tre gai tudi day thi 0,70 tre trai tudi d?y thi
Ngoai tieu chuan dp lpc cau than, ehah doan STM dua vao cac dac diem lam sang, sieu am eho ket qua 2 than teo hoac tang ure/mau tren 3 thang.
Nghien cuu nay ehi khao sat nhimg trudng hpp n h | p vien lan dau hen.
Tat ca cae benh nhan deu dupc do can nang va chieu cao.
Cham phat trien chieu cao va can nang dupc dinh nghia khi tri sd' chieu eao va can namg theo ehuan dudi -2 dp lech ehuan. Do ehua cd chuan phat trien the chat cua tre em
N g h i e n cuu Y hoc
Viet Nam, chiing toi tam sii dung chuan cua treem\TiatBan""i.
Chl so khoi co the (BMI) duoc tinh theo cong thirc:
Can nang (kg) BMI (kg(m=) =
[Chieu cao (m))=
Cac tham so ve nhan khau hoc (noi sinh, tuo'i, gioi), tien su (can nang luc sinh, tien can benh ly), dac diem nhan trac hoc (can nang, chieu cao), dac diem lam sang (benh than nguyen phat, cac di dang bam sinh di kem), cac xet nghiem sinh hoc (mau va nuoc tieu) va cac chi dinh dieu tri duoc thu thap vao ho so benh an.
Xu ly thong ke
So' lieu lien tuc d u o c the hien b i n g tri so trung binh va d p I^ch chuan hoac bang trung vi.
Cac tham so nhan tr^c hgc (can nang, chieu cao, BMI) va nguyen nhan benh than goc duoc khao sat bang test Chi-square;
nguong y nghia thong ke duoc xac dmh khi P
< 0,05. Khao sat thong ke bang phan mem SPSS 15.0 for Windows (SPSS, Chicago, Illinois, USA) va NCSS 97 (NCSS, Kaysville, Utah, USA).
KETQUA
D|c diem nhan khau hoc
Trong khoang thoi gian Hr thang 1 nam 2005 den thang 12 nam 2008, co 146 benh nhi STM nhap vien tai BV Nhi Dong 2. Trong so do, 19% (n-28) sinh song tai TP HCM, 48% (n- 70) den tir mien Trung, 33% (n=48) tif mien Nam.
Lire nhap vien, 80% (117/146) benh nhi da mac STM giai doan cuoi. Tuoi hung binh va trung vj liic nhap vien lan luot la 11,2±3,8 Uioi va 12 tuoi va 55% (80/146) la tie trai.
Nguyen nhan benh than nguyen phat So' benh nhan khong duoc khao sat
Y Hgc TP. H o Chi M i n h * T i p
^s6im
nguyen nhan la 39% (57/346)- Phan coj benh cau than chiem 32% (47/146), n^
nhan bam sinh duac tim tha'y trong (34/146) va nguyen nhan di truyen hong (8/146).
Di dang dudng nieu la nguyen nhandi trong nhdm nguyen nhan benh than bSms (18/34; 53%). Trao ngupe bang quang [ quan dupc tim tha'y trong 2 trudng hpp.Tl san than dupc chan doan trong 47% (1^
eac trudng hpp benh th|in bam sinh. • Trong nhdm nguyen nhan do di truy&i 3 ca benh than da nang di truyen theo ti liet. Hdi ehung than h u khang Corticoid nguyen nhan thudng gap nhat va duoc chi doan trong 57% (27/47) cac trudng hpp co Ij thuong cau than.
Dac diem nhan t r i e hoc
Bo lech chuan chieu cao va can nang trm hinh
Gia tri trung binh cua DLC chieu cao vi DLC can nang cua tre STM rat thap. Chieu cjj ciia tre bi anh hudng n ^ g ne hon so vol cai nang (bang 1).
Bang 1: Trung hinh cua do lech chuan chieu cao vd can ngng
Tong Nam Nu
0 6 lech chuin (DLC) Chieu cao
-2,92 ±1,71 -2,98 ± 1,77 -2,82 ±1,61
Can nang -1,96 ±1,03 -1,83 ±1,07 -2,18 ±0,95
CM so khoi ca the (BMI)
Chi so BMI luc nhap vien o tre STM cunf ra't tha'p (bang 2) va ti le tre CO bach phan v ciia BMI < 5 la 35,6%.
Bdng 2: Trung binh BMI vd do lech chuan (DLC) BMI
BIMI (kg/m') CLC BMI T6ng 15,10 ±2,06
Nam 15,47 ±2,28 NU 14,66 ±1,69
-1,73 ±1,69 -1,44 ±1,85 -2,08 ±1,43
Ddc Aiem chieu cao
Ti Ie tre co bieu hien cham phat trieh chiei
Y Hoc TP. Ho Chi M i n h * Tap 16 * So I * 2012 N g h i e n cmi Y hoc eao <-2 DLC la 72% (105/146).
Khdng ghi nhan su khac biet ed y nghia thd'ng ke ve ti le cham phat trien chieu eao d 2 gidi.
Trong nhdm ed nguyen nhan, nhdm benh th|in bam sinh ed ton thuang chieu eao (83,3%) nang hon nhdm mac phai (57,4%) (bang 3).
Bdng 3. Khdo sdt chiSu cao va benh thdn gdc (Test Chi-square, p-value= 0,01)
Benh th#n gdc Bim sinh va di truyin
M i c phai
>-2 BLC n(%) 7(16,7) 20(42,6)
S-2 BLC n (%) 35(83,3) 27(57,4)
Tong 42 47 Dac diem cdn ndng
Ti le tre STM ed bieu hien thie'u can la 57%. Khdng cd su khac biet cd y nghla thd'ng ke ciia ti le tre thie'u can d 2 gidi.
Ti le thie'u can d nhdm benh than bam sinh (64%) cao hon nhdm mSe phai (36%) (Bang 4).
Bdng 4: Khdo sdt can ngng vd benh than goc
B#nh than g6c Bam sinh va di truyen
M i c phai
>-2 BLC n {%) 15(36) 30(64)
S-2 BLC n (%) 27(64) 17(36)
T6ng 42 47 (Test Chi-square, p-value= 0,01)
B A N LUAN
Cham phat trien chieu cao
Trung binh dp lech chuan (DLC) ehieu eao d tre STM trong nhdm nghien euu la 2,92+1,71. Ket qua nay eung tuong ty nghien euu d An Dp vdi trung binh DLC ehieu cao tre STM la -2,91^). Nam 2002, nghien cihi d Malaysia cho thay DLC ehieu cao rat thap tren nhiing benh nhi duoc tham phan phue mac: -2,71+1,37'"'. Trong khi dd d Hoa Ky, nhd vao chie'n lupe cham sde va quan ly, tre STM cd trung binh DLC chieu cao la 1,45±0,02(5).
Ti le tre ehgm phat trien chieu cao ciia Id nghien euu la 72%. Ket qua nay cung tuong hj tren nghien cuu d cae nude dang phat trien n h u d Tunisia ti le tre cham phat trien the chat
la 62%'^"**. O Malaysia ti 1? cham phat trien ve chieu eao la 62% dd'i vdi tre tham phan phiie mac'"'. Theo nghien euu eua NAPRTCS d BIc My nam 2007, ti le tre chgm phat trien ve chieu cao ciia tre STM la 35,6%'^'. Ti le cham phat trien the chat d b | n h nhi STM trong nghien cuu cua chung tdi kha cao do phan Idn tre nhap vien d giai doan tre khi da xay ra cae bie'n ehiing nhu toan ehuyen hda, loan dudng xuong lam anh hudng nang ne de'n chieu cao.
O cac nuoc phat trieh, nhd chie'n lupc phat hien sdm nhiing benh than man, chuong trinh quan ly benh nhi STM cung nhu viee sir dung sdm hormone tang trudng, da giiip eai thien chieu cao ciia tre STM'^*.
Ton thuong ehieu cao trong nghien c\m ciia chung tdi dac biet tram trpng d nhimg tre bi benh than bam sinh. Tre bi benh than bam sinh cd tdn thuong chieu eao la 83,3 % nhieu hon so vdi nhdm benh th^n mac phai (57,4%).
Nghien cuu eiia NAPRTCS nam 2007 eiing cho tha'y DLC chieu cao tha'p nhat d nhimg tre em bi benh than baim sinh dgc biet la loan san than va tac nghen dudng nieu*^'. Theo y van tre bi giam san than va loan san than ed tinh trang mat dien giai qua dudng nieu qua muc cd the la nguyen nhan dan de'n cham phat trien chieu cao. Viec dieu chinh tinh trang nude dien giai ed the lam cai thien sir phat trien chieu cao'^'.
Cham phat trien can nang
Ti le tre thieu can trong nghien euu la 58%. Trung binh DLC can nang trong Id nghien ciru eua chung tdi la -1,96±1,03. Ket qua nay tuong tu nghien euu d An Dd va Malaysia trong do trung binh DLC can nang lan lupt la -1,90 va -1,99'*'"'.
Mac dil khdng the so sanh vdi dan so' nghien cuu d Bac My vdi trung binh DLC can nang d tre STM la -0,89'^', ehiing tdi nhan tha'y tinh trang dinh duong eiia tre STM tai Viet Nam eiing nhu tai cac nude dang phat trien khae rat tha'p.
Viec danh gia tinh trang dinh dudng d tre
N g h i e n cmi Y hoc Y Hoc TP. H o C h i M i n h * T a p 16 * So 1 2012 STM ne'u chi dua tren can nang theo tuoi se
rat de bi sai lech do mdt sd' benh nhan cd the ed tii?u chung phii di kem. Do do, can danh gia them dua vao ehi sd' khoi eo the.
Chi so khoi ca the (BMI)
Chi so BMI o tre STM trong nghien cuu rat tha'p: 15,10±2,06. Ket qua nghien cuu nay eung tuong tu vdi nghien ctiu d Malaysia tren b^nh nhi tha'm phan phiic mgc vdi chi sd' BMI trung binh la 16,70+2,10<">. Dieu nay chiing td tinh trang dinh dudng ciia tre rat thieii. Do vay, can cd che' do an phii hpp cho tre suy than man, giup cho tre tang truang va phat trien td'i uu. Can cd su phd'i hpp chat che giira bae si lam sang va chuyen gia dinh dudng trong viec dieu tri va cham sde benh nhi suy than man.
KET LUAN
Su phat trien the chat ciia tre STM bi ton thuong ngng ne. Ngoai viec dieu tri benh, viec hd trp dinh dudng va dieu ehinh dien giai- toan hda mau cho benh nhan STM nham cai thi#n chieu cao, can nang la can thie't.
TAI LIEU THAM KHAO
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