NGHIEN CUtJ KHOA HOC
NHAN XET DAC OI^M B^NH MAY DAY VA K^T QUA DI^U TRI TAI KHOA DA LI§U B^NH VI^N DA KHOA TINH THAI BINH
\ u Dinh Tham*, Nguyen Thj Van*
TOM
TATNghien cdu 154 benh nhdn (BN) mdy day, chiem 9,33%o trong 1651 BN duge dieu tri tgi khoa Da lieu, Benh vien Da khoa tinh Thdi Binh td thdng 1/2005 den 12/2006.
Kit qua: BN nd chiem 53,25%) vd nam chiem 46,75%); phdn Idn BN tuoi tre (0-19 tuoi chiem 7 l,43%o).
Tneu ehUng Idm sdng Id sdn phu vd ngUa (100%), trieu ehUng khde Id sot 39,61 %, dau bung 35,71 %o, kho thd 13,64% vd phu dudi da 9,74%o. C6 110BN (71,43%o) cap tinh, 44 BN (28,57%o) man tinh. Gom 2 nhom BN dugc dieu tri: nhdm 1 sddung khdng histamin ket hgp vdi corticoid, nhom 2 sddung khdng histamin dan thudn; nhom 1 co ket qud tot han: trieu chdng Idm sdng gidm nhanh vd thai gian ndm vien ngdn hon so vdi nhom 2.
Tdkhda: may day, khang histamin, corticoid.
I.DATVANDE
Benh may day (Urticaria) la benh da thadng gap va gap d mpi Ida tudi. Benh xay ra cap tinh hoac man tinh lien quan den nhieu yeu t d ben ngoai hoac ben trong cO the, trong dd co dja cua BN ddng vai trd rat quan trpng.
Bieu hien dac trung ca ban eua benh may day la san phu tren da, cd khi don thuan ed khi ket hpp vdi trieu chdng d nhieu eP quan. Chan doan lam sang benh may day thPdng de, song viec tim can nguyen va quan ly dieu tri benh edn gap nhieu khd khan.Tai khoa Da lieu Benh vien Da khoa tinh Thai Binh BN may day vao nhap vien chiem ti le cao so vdi cac benh da khae; Chinh vi the chung tdi tien hanh nghien edu de tai nay vdi mue tieu:
' /id III on /J(i /li •!! Tl -Irdng Dai /ipc • 1' T/idi Biii/i
1. Nhdn xet dde diem cua benh mdy day.
2. Ddnh gid ket gud dieu tri benh mdy day, tUdd de ro bien phdp gudn ly vd phong benh.
II. DOI TLTONG VA P H L T O N G P H A P NGHIEN CU'U 1. Doi tUOng
Gdm 154 BN may day dieu tri ndi tru tai khoa Da lieu, Benh vien Da khoa tinh Thai Binh trong 2 nam: t d thang 1 nam 2005 den thang
12 nam 2006.
2. PhUcfng phap nghien cufu
2.7. Thiit ki nghiin cdu: md ta lam sang 2.2. Chdn dodn xdc dinh binh
- Dpa vao trieu chdng lam sang: san phu tren da xuat hien nhanh va mat di nhanh, ngda nhieu. Trieu chdng kem theo cd the ed: sdt, khd t l ; % dau bung hoac rdi loan tieu hda.
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- Theo ddi lam sang: ve tien sd, benh sd, yeu td lien quan de'n sp phat benh, yeu cau xet nghiem, chi dinh va ket qua dieu tri.Theo ddi BN de'n dieu tri theo mua.
- Can lam sang: nhdng xet nghiem co ban thpc hien dPpe d benh vien tinh.
2.3. Phuang phdp dieu tri Chia 2 nhdm BN:
-I- Nhdm 1: dung corticoid ket hpp vdi khang histamin HI (the he 1 & 2): tiem tinh mach hoac udng. Lieu corticoid bat dau t d 1 de'n 1,5mg/kg can nang/ngay va giam dan.
-I- Nhdm 2: dung khang histamin don thuan, bao gdm ca BN ed chdng chi djnh dung corticoid.
2.4. Ddnh gid kit qua dieu tri
- Dpa vao lam sang theo 2 mde dp:
-I-Tdt: BN het tat ea cac trieu chdng sau khi
cat corticoid va khang histamin.
-I- Trung binh: trieu chdng giam cham va keo dai tdi khi xuat vien.
- Dpa theo sd ngay dieu trj: chia theo nhdm.
- Xd ly sd lieu theo phaong phap toan thdng ke trong y hpc.
III. KET QUA NGHIEN CU'U 1. Dac diem eua benh may day
7.7. Ti li BN may day dieu trj tgi khoa Da liiu trong 2 ndm
154 BN may day trong tdng sd 1651 BN bj benh ngoai da dapc dieu tri trong 2 nam 2005 &
2006, chiem 9,33%.
7.2. Gidi BN may day
Irong 154 BN ed 82 la nd chiem 53,25% va 72 la nam chiem 46,75%. Sd BN nd chiem ti le cao hon so vdi nam gidi.
1.3. Tuoi
Bang 1. BN may day phan bdtheo tuoi Do tuoi
SdBN Ti le %
0 - 9 81 52,60
1 0 - 1 9 29 18,83
2 0 - 2 9 9 5,84
3 0 - 3 9 12 7,80
40-49
8 5,19
5 0 - 5 9 9 5,84
60-69 6 3,90
Tong 154 100 Qua bang 1 chung tdi thay dp tudi td 0 - 9 chiem ti le cao nhat (52,60%) va neu tinh nhdm tudi td 0-19 thi ti le la 71,43%, cao hon nhieu so vdi cae dp tudi > 20, khdng cd BN tren 70 tudi.
1.4. Dgc diem lam sang binh may day
Bang 2. Bieu hiin lam sang d154BN Bieu hien
SoBN SdBN Ti le %
San phu
154 100
Ngura
154 100
Sot
61 39,61
Bieu hien dda day, ruot
55 35,71
Bieu hien cl phoi
21 13,64
Bieu hien khac
15 9,74 Bang 2 eho thay san phu va ngda chiem 100% sd trPdng hpp. Sdt va dau bung chiem ti le tdong ddPng nhau (39,61% & 35,71%), bieu hien d phdi cd 21 BN chiem 13,64%,15 trPdng hpp (chiem 9,74%) cd trieu chdng khac d da la phu to chdc dddi da hoac chdng da ve ndi.
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7.5. Phan nhom BN theo solan phdt binh
Bang 3. Solan phdt binh cua BN Solan phat
SdBN Ti le %
Lan dau (1 lan)
no
71,43
Tir 2 lan trd len 44
Tong so 154
28,57 100 Qua bang 3 cho thay sd BN phat benh lan dau la ehu yeu (110 BN chiem 71,43%), sd BN bi benh
t d 2 lan trd len ed 44 (chiem 28,57%).
1.6. Mpt sdyiu td thuan lai cho sUphdt binh
Bang 4. Phan boBN theo mua va yeu tdkhdc Mua va yeu to
khac SdBN Ti le %
Mua nong ( T h 4 - T h 9 )
100 64,94
Mua lanh ( T h 1 0 - T h 3 )
54 35,06
Do thuTc an (BN 62 mua)
19 12,34
Do thuoc ( B N d c a 2 m u a )
15 9,74
Chung tdi chia thdi tiet trong nam thanh 2 mua: mua ndng chung tdi gap nhieu BN hon mua lanh (64,94% va 35,06%). Trong tdng sd 154 BN ed 19 BN (12,34%) phat benh sau khi an thdc an; 15 BN (9,74%) sau khi dung thudc dieu tri benh khac.
7.7. Can lam sang
Bang 5. Kit qua mpt sdxet nghiim dBN may day (n = 154) Loai XN
SdBN Ti le %
Bach cautang
> 1 1 , 0 x 1 0 ' "
53 34,42
Ti le BCai toan
> 1 0 % 42 27,27
Ti le BCai kiem 0 0
KST dudng ruot
(+)
55/128 42,97 Ket qua bang 5 eho thay 34,42% sd BN cd tang sd iPpng bach cau trong cdng thdc mau va 42 BN (27,27%) ed ti le bach eau ai toan tang t d 10% t r d len trong cdng thdc bach cau. 128 BN dPpe xet nghiem phan tim ky sinh trung dPdng rudt, ed 55 BN (42,97%) ed ky sinh trung dPdng rudt ma ehu yeu la giun dua.
2. Ket qua dieu trj
Bang 6. Kit qua dieu tri theo triiu chdng lam sang d2 nhom
Ket qua dieu trj cua 2 nhom
SdBN Tl le %
Khang histamin va corticoid (107 BN) T6t(1)
91 85,05
Trung binh (2)
16 14,95
Khang histamin don thuan (47) Tot(3)
6 12,77
Trung binh (4) 41 87,23
P
(1),(3)<0,05 (2), (4) < 0,05
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Qua bang 6 cho thay n h d m 1 dung Khang histamin va Corticoid cho ket qua t d t 85,05%, nhdm 2 d u n g Khang histamine don thuan (12,77%), so sanh gida 2 n h d m thi sd khae nhau cd y nghla - nhdm 1 ed ket qua t d t hon nhdm 2 vdi p < 0,05; ket qua t r u n g binh d 2 n h d m : n h d m 1 thap hon nhdm 2 (14,95% va 87,23%) vdi p < 0,05.
Bang 7. Kit qua dieu tri 2 nhom theo so ngay dieu tri
^ \ ^ ^ NhomBN
Ngay dieu t r r \ . .
4 - 67 - 9 1 0 - 1 2 1 3 - 1 5
> 16
Khang histamin va corticoid (107 BN)N1)
BN 53 36 12 4 2
Ti le % 49,53 33,64 11,21 3,74 1,87
Khang histamin dtfn thuan (47 BN) (N2)
BN 0 6 22 14 5
Ti le % 0 12,77 46,81 29,79 10,64
P
P < 0,05 P < 0,05 P < 0,05 P < 0,05 P < 0,05
Theo bang 7 d nhdm 1 vdi 4 - 6 va 7 - 9 ngay dieu tri (chiem 49,53% va 33,64%) ma nhdm 2 ti le thap (0% va 12,77%). NhPng vdi thdi gian 10 - 1 2 ngay va 13 - 1 5 thi nhdm 1 ed ti le thap hon nhdm 2. Sp khae nhau ve sd ngay dieu tri gida 2 nhdm khae nhau ed y nghia vdi p < 0,05.
IV. BAN LUAN
1 . Mot so dac diem benh may day
- Sd BN may day nhap vien dieu trj trong 2 nam chiem ti le nay tPPng ddi cao so vdi cac benh dj dng khac, ddng hang t h a 3 sau viem da CO dia va viem da di ang.
- Tudi va gidi bi benh: chu yeu d dp tudi tre (<19 tudi), ti le n d cao hon nam khdng nhieu.
Theo nhan djnh cua eae tae gia [2] thi may day man tinh thPdng g a p d n g P d i Idn va n d g i d i , ket qua cua chung tdi khdng phu hpp vdi cac tac gia cd le do chung tdi khdng phan loai the cap tinh va man tinh theo tudi va gidi; hPn nda tudi tre ddpc quan tam nhieu hpn va t h a d n g bi the cap tinh nen BN dapc nhap vien dieu tri.
- Ve dae diem lam sang: 100% sd BN cd san phu vdi hinh thai dien hinh la ndi cao tren da mau hdng do hinh trdn, bau due sap xep rieng re hoac lien ket t d n g dam, trieu chdng co nang ed ngda; san phu va ngda la dae trPng cua benh va la tieu chuan de chan doan benh.Trieu chdng sdt, dau bung, khd t h d chiem t i le thap hon va t h a d n g gap d the cap t i n h . Trieu chdng khac n h a phu mach (angioederma) t h a d n g xay ra d t d chdc da Idng leo, da phd dd t d n g vung ranh gidi khdng rd. Chdng da ve ndi (dermographism) xay ra khi BN gai, tam va khi kham benh dung ngdn tay vach tren da BN xuat hien nhdng vet ndi cao theo d a d n g vach. N h a vay ngoai trieu chang d da edn cd cac trieu chdng d nhieu co quan, day la sp ket hpp t h a d n g gap d BN may day n h a nhieu tac gia da de cap [1 ], [2].
- Bang 3, qua tien sd BN chung tdi thay 71,43% sd BN bj benh lan dau vdi bieu hien cap tinh va 28,57% sd BN da bj tai phat, thudc the man tinh. Theo nhieu tac gia [1 ], [2], [6] da neu the man tinh chiem 25% sd t r a d n g hpp thi ket
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qua cua chdng tdi (28,57%) t a o n g daong. Tuy nhien, ket qua eua chung tdi chi the hien d thdi diem BN den nhap vien trong 2 nam vl trong sd 110 BN (71,43%) tren khi nao benh tai phat chung tdi khdng xac djnh dapc.
-Ve phan loai BN theo mua, chdng tdi gap mua ndng nhieu BN ban mua lanh (64,94% va 35,06%), cd the coi la dieu kien thuan Ipi cho sp phat benh ma may day do yeu t d vat ly d d n g vai trd quan trpng [1], [2]. Nguyen nhan do thdc an (12,34%) ed the do protid eua thdc an hoac do chat bao quan cung n h a nhan djnh eua GS Greaves [4],[9]: mdt ti le nhd BN may day man tinh phan dng vdi chat phu gia thpc pham, dae biet la chat bao quan; Do thudc (9,74%) la mdt the cua nhiem dde da do thudc ma chung tdi thadng gap d khoa Da lieu. Do vay, trong dieu tri cung can quan tam khai thac ti mi tdi nhdng nguyen nhan thdc an va thudc gay ra may day de loai t r d va dieu trj se cd ket qua tdt ddi vdi nhdng BN nay.
Bang 5 cho thay cd 27,27% sd BN tang bach cau ai toan > 10%, ed the do dac diem cua benh dj dng hoac do BN bj nhiem KST d a d n g rudt vi cd 42,97% (55/128) nhiem KST dPdng rudt.
Theo cac tac gia fVly [2] thi bach eau ai toan cung ehi tang nhat thdi d may day do thdc an va do KST d a d n g rudt. GS Greaves [4],[9]
nghien cdu d An Dp cung nhan xet: nhiem ky sinh trung tPPng ddi phd bien d An Op va ed the gay ra may day, va day la mdt ITnh vpc t h i i vi can cd nhieu nghien edu hPn nda.
2. Ket qua dieu trj theo nhom BN
- Tat ea BN d 2 n h d m ddpc dieu trj bang khang histamin. Theo hau bet cac tac gia khuyen cao thi bade dau tien lam giam trieu
chdng bang each d u n g thudc khang histamin H I , eho du may day do bat ky nguyen nhan gi gay nen, va nen bat dau vdi thude it gay ngu [9], song chdng tdi s d d u n g thude khang histamin HI the he 1 cho tat ea eae BN d ca 2 nhdm (Dimedrol 0,01 g x 1-2 dng tiem bap), trieu chdng ngda giam nhanh. BN nhdm 1 (69,48%) dPpe dieu trj ket hpp vdi corticoid, chdng tdi nhan thay trieu chdng lam sang cua BN giam nhanh, khdi nhanh ban so vdi BN n h d m 2 (ve ket qua so sanh ti le d bang 6), nhieu BN dn dinh lau dai, dae biet la nhdng trPdng hpp cap tinh hoac rd nguyen nhan. Sd ngay dieu trj eua BN nhdm 1 cung ngan hon n h d m 2 (ket qua so sanh ti le d bang 6).
Qua ket qua va phan tich tren chung tdi nhan xet:
- Khang histamin HI la thudc ehinh trong dieu trj may day, ed the ket hpp: the he 1 nen eho vao budi tdi va the be 2 nen eho vao ban ngay de han che tac dung phu cua thude.
- Corticoid nen dPpe ap dung trong dieu trj may day, dac biet la the cap tinh, vdi thdi gian ngan: vdi lieu cao va giam dan, t d 5 den 12 ngay tuy theo t d n g tradng hpp, tuy nhien khdng nen lam dung corticoid cho mpi trPdng hpp.
- Phat hien can nguyen gay benh de loai trd.
V. KET LUAN
1. Dac diem eua benh may day d 154 BN 1.1. TileBN may day so vdi tdng sdBN trong 2 nam 2005,2006:9,33% (154/1651)
7.2. Gidi cua BN may day: nd 53,25%; nam 46,75%
1.3. Dp tuoi cua BN mdy day
Gap d mpi Ida tudi, tudi tre gap nhieu hon:
Op tudi 0 - 9: 52,60%; 10 - 19: 18,83%; cae dp tudi > 20 chiem ti le thap hon.
S6 03 (Thang 01 / 2011) D A L l E U H O C 5 1
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1.4. Dgc diem lam sang cua BN may day Bieu hien: san phu va ngda: 100%; sdt: 39,61%;
dau bung: 35,71 %; khd thd: 13,64%; bieu hien khac (phu da, dddi da, chdng da ve ndi): 9,7%
7.5. Sd Idn phdt binh: lan dau bi benh (cap tinh): 71,43%; > 2 lan (man tinh): 28,57%
7.6. Miia va yiu tdliin quan
-H Mua ndng 64,94%; mua lanh: 35,06%
-H Thdc an: 12,34%; thude: 9,74% (trong t d n g sdBN).
7.7. Can Idm sang
-H Sd Ippng bach eau > 1 lOOO/mm^: 34,42%
-HTi le bach cau ai toan > 10%: 27,2%
+ KST dadng rudt {+): 42,97% (55/128)
2. Danh gia ket qua dieu trj
- Theo lam sang d nhdm 1 (Khang histamin va corticoid) tdt hpn so vdi nhdm 2 (Khang histamin don thuan):
- ^ N h d m 1: t d t 85,05%; t r u n g binh 14,95%
-h Nhdm 2: t d t 12,77%; t r u n g binh 87,23%
- Theo sd ngay dieu trj n h d m 1 ed thdi gian dn djnh nhanh hon so vdi n h d m 2:
-F On dinh d 4 - 6 ngay (nhdm 1: 49,53%, n h d m 2: 0%) va 7 - 9 ngay (nhdm 1: 33,64%, n h d m 2: 12,77%).
+ On djnh d 10 - 12 ngay (nhdm 1: 11,21%, n h d m 2:46,810%) va 13 - 1 5 ngay (nhdm 1: 3,74
%, n h d m 2: 29,79%).
TAI LIEU THAM KHAO
1. Nguyen Cdnh Cdu, Nguyen Khdc Vien vd cae tdc gid.
Gido tnnh benh da vd hoa lieu (sau dgi hgc) - Bg mon Da lieu Hgc vien Qudn y. Nhd xudt bdn Qudn dgi nhdn ddn- Hd ngi 2001, tr 225
2. Thomas B. Fitzpatrck, M.D. Richard Allen Johnson, M.D. Klaus Wolff, M.D. Dick Suurmond M.D.
Color Atlas and Synopsis of Clinical Dermatology-Common and serious diseases.
McGraw - Hill Medical Publishing Division, Fourth edition-2001,tr 338-345.
3. Thompson,-A-K; Finn,-A-F; Sehoenwetter,-W-F Effect of 60 mg twice-daily fexofenadine HCI on quality of life, work and classroom productivity, and regular activity in patients with chronic idiopathic urticaria. J-Am-Acad-Dermatol 2000 Jul; 43(1 Ptl): 24-30.
4. Greaves,-M: Chronic urticaria. J-Allergy-Clln- Immunol 2000 Apr; 105(4): 664-72
5. Wedi,-B; Novacovic,-V; Koerner,-M; Kapp,-A.
Chronic urticaria serum induces histamine release, leukotriene production, and basophil CD63 surface expression-inhibitory effects of anti- inflammatory drugs.
J-Allergy-Clin-lmmunol. 2000 Mar; 105(3):
552-60
6. Charlesworth,-E-N: Chronic urticaria: back- ground, evaluation, and treatment.
Curr-Allergy-Asthmo-Rep. 2001 Jul 1(4): 342-7 7. Liutu,-M; Kallmo,-K; Uksila,-J; Savolainen,-J T.
Extraction of IgE-binding components of Helicobacter pylori by immunoblotting analysis in chronic urticaria patients. Int-Areh-Allergy-lmmunol.
2001 Nov; 126(3): 213-7
8. Blaek,-A-K: Unusual urticarias. J-Dermatol.
2001 Nov; 28(11): 632-4
9. Malcolm W. Greaves, Gido sU chuyen khoa Da lieuVien Da lieu St. John's London: Hgi chdng mdy day mgn tinh - nhdng trien vgng hien nay TTKH Vien Da lieu 2005.
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SUMMARY
STUDY OF CLINICAL MANIFESTATIONS ANDTREATMENT EFFECTIVENESS OF URTICARIA ATTHETHAIBINHGENERALHOSPITALFROM 1/2005 TO 12/2006
Result: 53.25%o were a females and 46.75%) were males with age ranging from 0 - 69, almost age of patients was young (0 - 19 years old: 71.43%o); There were 110 (71.43%o) acute cases and 44 (28.57%)) chronic cases. Clinical symptoms: oedematous papules and pruritic (100%o) and other symptoms: fever 39.61%, abdominant paint 35.71%o, dyspnea 13.64%o and oedema of subcutaneous tissue 9.74%o. Two group of patients: the first group was treated with antihistamin and corticoid, the second group was used only antihistamln. Result of group 1 was better than group 2: about clinical symptoms and the time of patients in the hospital were short.
