NHiiN XET MOT SO DAC DIEM LAM SANG,
CAN L A M SANG VA KET QUA D l I u TRj BENH SAN LA GAN LdN TAI BENH VIEN DA KHOA TJNH THANH HOA
Do Xuan Tien'.
Muc tieu: Nhan xet mpt so dac diem dich lam sang, can lam sang va danh gia kdt qua dieu tri san la gan lan tai Khoa Truyen nhiem, Benh vien da khoa tinh Thanh Hoa. Doi tuang vd phirong phdp: Nghien cihi mo ta hoi ciiu ket hgp tien ciiu 95 benh nhan nhiem san la gan Ion dieu tri tai IChoa Truyen nhiem, Benh vien da khoa tinh Thanh Hoa. Ket qud vd kit ludn: trieu chimg lam sang thucmg gap nhat la met moi, chan an (91,6%), sut can (9%), dau die ha suon phai (85,3%), dau thuoTig vi (76,8%) va dSy bung cham tieu (76,8%). Cac trieu chiing can tam sdng thucmg gap ia tang bach cau ai toan trong mau ngoai vi va hinh anh ton thuonng giam am hoac am hon hgp tren sieu am hoac CT scanner 6 bung. Tai thai diem 1 thang sau Axhx trj dac hieu bSng tri- clabendazole, phan Ion cac trieu chiing lam sang thuyen giam trong khi cac ton thucmg gan tren sieu am va CT c6 the keo dai tai 3 thang sau dieu tri.
Tu- khoa: san la gan Ion, triclabendazole.
OAT VAN DE
Benh san la gan Idn d ngu'di do hai loai ky sinh triing la Fasciola hepatica ho^c Fasciola giganbea gay nen. Benh hien lull hanh tren 70 qudc gia tren the gidi trong dd cd Viet Nam. Mae dii du'dc xep vao eac benh bj lang quen nhutig trong thdi gian gan day benh nay trd thanh mot van de y te edng cgng quan trgng va cd xu hu'dng dang gia tang trd iai^l Ky sinh triing Fasiola chii yeu gay benh cho gia sue (ciiU, trau, bd, lac da, de) nhuTig ngu'di cd the trd thanh vat chii tinh cd do an phai au triing nam trong thiTc vat thuy sinh, uong nu'dc khong dun sdi cd au tiling hoac an gan dgng vat bj nhiem chu'a du'dc nau chin.
6 Viet Nam, benh san la gan Idn lutj hanh d it nhat 52/64 tinh, thanh pho trong ca nUdd^l Da sd benh nhan nhiem san la gan Idn thudng cd cac trieu chiing lam sang khong dac hieu nhu* dau ha su'dn phai, dau viing thu'dng VI, sdt, sut can, met mdi, san ngu^, rdi loan tieu hda, buon
'''Khoa Truyen nhiem. Benh vien da khoa tinh Thanh Hoa Ngaj nhSii b i i : 29/6/2015.
Nga> phan b i f n \ong: 12/7/2015.
Ngai du>fi ding: Sli7/2015.
Ngiriri ch|u trich nhi|m nfi) dung khaa h^c: Do Xudn Tien. Khoa Truven nhicm. Benh vien da khaa tinh Thanh Hoa
Dii-n Ihoifi 0912602462. E-mail tienbvih@gmail com
ndn... va rat de nham vdi mdt sd benh ly du'dng tieu hda, he gan mat hoac ngiic bung'^'i'^it'i, gay chan doan va dieu tri mupn, khien tdn thu'dng lan rgng. Tai Thanh Hda, benh san la gan Idn cdn It du'dc nghien ciru. De gdp phan bd sung ho trd cac bac sT lam sang chan doan, phat hien sdm va dieu tn kip thdi benh san la gan Idn, chiing toi tien hanh nghien ciTu de tai nay nham muc tieu: Nhan xet mgt so dac diem dich lam sang, can lam sang va danh gia ket qua dieu tri san la gan Idn tai Khoa Truyen nhiem, Benh vien da khoa tinh Thanh Hoa.
e o i TUONG VA P H U O I ^ G P H A P
Odi tu'dng nghien cu'u: Benh nhan du'dc chan doan xae dmh nhiem san la gan ldn nhap vien va dieu tri tai khoa Truyen nhiem, Benh vien Da khoa tinh Thanh Hda tir tiiang 8/2011 den thang 7/2013.
Tieu chuan chgn benh nhan: Benh nhan co tren 2 trieu chiitig lam sang eiia benh san la gan Idn bao gom; met mdi chan an, dau tiic ha su'dn phai hoac thu'dng vi, sut can, buon non, non, sdt, san ngiia, di ngoai phan long, gan to. Benh nhan cd xet nghiem mien djch gan enzyme (ELiSA) du'dng tfnh vdi san la gan ldn.
Phu'dng phap nghien ciiu: Nghien ciili md ta hdi ciiu ket hdp tien a i u .
TRUYeNNHliMVieTNAM*s6 3M11 201F ^ ^
Xet nghiem EUSA de chan doan san la gan ldn sir dung khang nguyen F. gigantica. Cac xet nghiem can lam sang du'dc tiiiic hien tai khoa xet nghiem, Benh vien da khoa tinh Thanh Hda. Benh nhan du'dc tiieo doi tai khoa Truyen nhiem trong it nhat 03 ngay sau Idii bat dau dieu bi bing triclabendazole va du'dc kham lai sau 1 thang, 3 ttrang va 6 thang dieu bi. Ket qua du'dc xir ly ttieo phu'dng phap tiidng ke y hpc bang phan mem SPSS 16.0.
KET QUA
Oac diem chung cua doi tu'dng nghien cu'u
Tdng sd 95 benh nhan du'dc chan doan nhiem san la gan Idn da dUdc tiiu tuyen, sd benh nhan Nam gidi la 51 (53,7%) va sd benh nhan NO- gidi la 44 (46,3%). Tuoi bung binh eua cac benh nhan trong nghien cihj la 49 tuoi, benh nhan nhd nhSt la 8 tudi va Idn nhat la 82 tuoi, ti-ong do nhdm tudi 31 - 60 chiem 73,7%.
OSc diem lam sang va can lam sang d benh nhan nhiem san la gan ldn
Bang 1 : Mot so trieu chutig can lam sang ctia benh san la gan ldn
Bin ^ k c^* I Ilk
\'mt AL IBS (ta I tut
*Bieu hien lac i:ho: gom 01 binh nhin c6 ton thi/Ong dang san d lach va 01 benh nhin c6 fdn tfii/Bhg san d thanh bung.
Bieu do 1. Trieu chiing lam sang cua benh san la gan Idn
Ket qua bieu do 1 cho thay cac ti-ieu chutig thu'dng gap nhat d b§nh nhan nhiem san la gan Idn bao gom Chan an, met mdi (91,6%), dau ha si/dn phai (85,3%), day bung, Cham tieu (76,8%) va dau thupng vi (76,8%).
Xet n g h i i m
S6 lu'dng bach cau trong mau ngoai vr > 10 G/L.
Tl le b ^ tau ai toan trong mau ngoai vi > 10%, ASTt3ng(>37UI/L).
ALTtang(>37UI/L).
Bilirubin toan phan > 17mmol/l.
S o b ^ n h nhan (n = 95)
50 71 38 37 13
T i l § %
52,6 74,7 40,0 39 13,7
Ket qua bang 1 cho thay c6 tdi 74,7% so benh nhan ed tang ti le bach cau ai toan trong mau ngoai vi.
Bang 2: Dac diem hinh anh ton thu'dng tren sieu am v a C T scanner
Hinh anh t o n thUflng S6 khoi ton thirOng giam am hoac hon hdp 3m
Vj tri ton thu'dng llchoi
> 2 k h a Gan phai Gan trai Ton thi/dng gan hai ben TT bao gan ddn thu3n Tran djCh mang phoi hoac mang bung
S S b | n h nhan { n = 95)
56 39 53 25 16 1 10
T i l | % 59,0 41,1 55,8 25,3 16,8 1,1 10,5 Bang 2 cho thay phan Idn benh nhan nhiem san \i gan ldn co ton thu'dng 1 khdi giam am hoac hon hdp am (59%) va vi tri ton thu'dng thu'dng gap nhat la gan phai (55,8%).
Ket qua dieu tri benh nhan nhiem san la gan ldn Bang 3: Nhan xet ket qua diieu t n d thang 1 va thang 3 sau diieu trj nhiem san la gan Idn bang
Triclabendazole
Tneu chiJUg lam sang Bach du ai toan trong mau ngoai vi Hinh anh sieu am va c r scanner
< 1 bieu chuhg lam sang.
> 1 trieu chiitig lam sang.
Binh thUtJng (< 10%).
Tang (> 10%).
Thuyen giam, Khong thay iloi.
S a u l tiiang
80(84,2%) 15 (15,8%) 78 (82,1%) 17(17,9%) 02 (2,1%) 93(97,9%)
Sau 3 thang n(%) 93(97,9%)
2(2,1%) 93(97,9%)
2(2,1%) 29(30,5%) 66(«,5%)
4 4 TRUYfelNHliMVlfriMAM*s63(11)-2015
Ket qua bang 3 cho thay ti le benh nhan cdn > 1 hieu chuhg lam sang 6 tiiang t h i i 1 va thang tiiu' 3 lan lUdt la 15,8% va 2 , 1 % . Ti le benh nhan cdn tang bach cau ai toan trong mau ngoai vi d thang thii' 3 la 2 , 1 % va cd t ^ 69,5% so benh nhan van cdn ti-ieu chiing tdn thu'dng tren sieu am va CT scanner d Oiang thii* 3 sau dieu h i . BAN LUAN
Trong nghien ciiu cua chiing toi, ti le benh nhan Nam gidi la 53,7%, vdi tuoi tnjng binh la 49 bjoi. Trong nghien eiili 37 tru'dng hdp nhiem san la gan ldn ciia Cosme va cong sii tai Tay Ban Nha, tac gia nhan thay Nam gidi chiem ti le ldn (23/37) va tuoi cua benh nhan dao dpng b i 19 - 71 tijoi, ti-ong sd do cd 27 tii/dng hdp cd tien sir co 3n cac rau thiiy sinh khong nau chH^\ Tai Viet Nam, dieu kien t i i nhien du'dc cho rang liiuan Idi eho sii phat trien eiia san la gan vdi dp am khong khi cao va ty ie nhiem trong cpng dong phu thupe nhieu vao tap quan an song rau thiiy sinh nhu' rau ngo, rau muong niidc, rau cai xoong.
Trong nghien ciru cua chung tdi, b-ieu chutig lam sang ciia benh san la gan Idn thu'dng khdng dae hieu, trong do cae trieu chutig thu'dng gap la met mdi, chan an (91,6%), sut can (9%), dau hie ha su'dn phai (85,3%), dau thu'dng vj (76,8%) va day bung cham tieu (76,8%). Ti le benh nhan co sdt ehi chiem 32,6%. Trieu chutig can lam sang dang chu y la tang bach eau ai toan trong mau ngoai vi (74,7%) va ton thu'dng giam am hoac am hon hdp trong gan. Trong nghien ciili ciia Cosme, dac diem can lam sang thu'dng gap nhat la tang bach cau ai toan (91,8%), suy nhu'de va sut can (75,6%), tang phosphatase kiem (74,2%) va dau bung (72,9%). Trong nghien cuXi cua Huynh Hong Quang va cpng sii tai khu viic Mien Trung - Tay Nguyen, Viet Nam trong giai doan 2006 - 2008, eac tae gia da ghi nhan eae trieu chiitig lam sang va can lam sang tu'dng t i i nhU nghien ciitj ciia chiing toi^. Ngoai ra, du^ tren hinh anh sieu am, cae ton thu'dng gan mat dUdc tac gia chia lam 2 giai doan cap va man tinh. Trong giai doan cap b'nh, tiieo cac tac gia san thu'dng gay ton thu'dng Irong nhu mo con giai doan man ti'nh thu'dng gay ton thu'dng di/dng mat. Ton tfiiidng giai doan cap gom co 3 loai chinh: Hinh anh nhu md khdng dong nhat (87,87%);
Cac khoang trong nhu' khoang gidng dudng ham va eac 6
ton thu'dng sat bao gan. Ton thu'dng tren hinh anh SA giai doan man la da o nhd li ti ca trong nhu mo va du'dng mat cd kem gian, day du'dng mat hoac thanh tiji matt^J.
Ve ket qua dieu trj, hau het benh nhan het cac trieu chutig lam sang va cd ti lebach cau ai toan trong mau ngoai vi trd ve binh thu'dng trong vdng 1 thang sau dieu hi (tiidng utig la 84,21% va 82,11%) va ti le nay d thdi diem 3 thang sau dieu tri tu'dng iitig la 97,9%. Tuy nhien, mac dii cae trieu chiitig lam sang va chi sd bach cau ai toan trong mau ngoai vi cd xu hu'dng hoi phuc trong vdng 3 tiiang nhuhg cac hinh anh ton thu'dng tren sieu am va CT scanner lai bien doi va mat cham, ehi cd 2 , 1 % mat hinh anh tdn thu'dng sau 1 thang va 30,5% mat hinh anh tdn thu'dng sau 3 thang. Hien tai d Viet Nam, thuoe duUc Ilia chpn de dieu tri dac hieu benh san la gan la Tn- dabendazole 250mg vdi liieu la lOmg/kg can nang, udng lieu duy nhati^i. Trong nghien ciili ciia minh, chung to\ ghi nhan mot ti le cao benh nhan van cdn ton thu'dng tren hinh anh tai thdi diem 3 thang sau dieu tn vdi lieu tri- clabendazole khuyen cao. Tuy nhien, do han che cua thiet ke nghien cuti, chung tdi chuia the khang djnh ve hieu qua eiia phac do hien dang sd dung cung nhu" tinh can thiet eiia viee dieu trj lap lai lieu thii 2 cho benh nhan cd dap ijttg kem.
KET LUAN
Nghien ciiu d 95 tru'dng hdp nhiem san la gan Idn ehung toi nhan thay:
Cac bieu hien lam sang khong dac hieu, vdi cac trieu chutig lam sang thu'dng gap nhat la met moi, chan an (91,6%), sut can (9%), dau lu'c ha su'dn phai (85,3%), dau thu'dng vi (76,8%) va day bung cham tieu (76,8%).
Cac trieu chiing can lam sang thu'dng gap la tang bach cau ai toan trong mau ngoai vi va hinh anh ton thu'dng giam am hoac am hon hdp tren sieu am hoac CT scanners bung.
Tai thdi diem 1 thang sau dieu trj dac hieu bang tri- clabendazole, phan Idn eac trieu chiitig lam sang thuyen giam trong khi cae ton thu'dng gan tren sieu am va CT co the keo dai tdi 3 thang sau dieu tri.
TRUYiRINHI&UIVl|TNAM*s63(11) - 2015 - 4 S
TAI LIEU THAM KHAO
1. Nguyen Van De, Le Thanh Hoa (2005), "Nghiin alu san ia, san day gay benh d ngifdi Viet Nam", Tap chf Y hgc thirc hanh, so 509, tr. 20 - 26.
2. Hoi ngh! khoa hgc Kinh ts - Y te Viet nam (2010),
"Hieu qua phong, chong benh san la gan idn Idiu vi/c Mien Trung - Tay Nguyen (2006 - 2009)", http://www.im- peqn.org.vn.
3. Nguyen Van Be (2006), "San ia gan idn - Benh cu, quan niem mdi". Tap chi Ttiong tin Y DuBc, so 1, tr. 12 -14.
4. Nguyen Van Be (2005), "San la gan vdi ung thii gan mat", Tap chi Y hoc Viet Nam, tap 310, thang 5, tr. 35 -52.
5. Nguyen Van Kha (2007), "Hinh anh sieu am ton thudng gan do san la gan ldn",\3\ iieu tap huan chan doan va dieu tri benh san la gan Idn.Vien Sot ret - Ky sinh trijng - Con triing Quy Nhdn.
6. Huynh Hong Quang va Nguyen Van V5n (2011)
"San ia gan idn lac cho d ngwdi: bao cao loat ca benii vi tong hdp y van thegidl & Viet Nam 2000-2011"; Tap dii Y hgc thiTc hanh so 781 - 2011, tr 118.
7. Huynh Hong Quang, Nguyen Nggc Vinh, Nguyen Duy Sdn va CS (2008), "Nghien cihj dac diem Imi sang » can iam sang trin binh nhin nhiem san la gan idn fss- oiae spp. Tai iihu viJc mien Tmng - Tay Nguyin, Wet Nam, 2006 ••2008", Tap chi Y hgc thanh pho Ho Chi Minli, voi.l2. SO4-2008, tr 1 1 - 1 8 .
8. Bo Y te (2006), "HUdng dan chan doin va dieu tii binh san ia gan Idn d ngwdl" Qf> so 3420/QB-BYT ngay 13 thang 9 nam 2006.
THE CLINICAL MANIFESTATION, LABORATORIER AND TREATMENT OUTCOME OF HUMAN ACQUIRED FASCIOLIASIS
Summary
Objective: to describe the dinicai manifestations, lab- oratories and treatment outcomes of human acquired fas- cioiiasis. Subjects and Method: retrospective and prospective study of 95 patients with fascioliasis admitted at Department of Infectious Diseases, Thanh Hoa Provin- ciai Hospital during 8/2011 - 7/2013. Results and conclu- sion: the most common clinical manifestations were
fatigue, anorexia (91.6%), weight ioss (9%), right-upper- quadrant pain (85.3%), epigastric pain (76.8%) and dys- pepsia (76.8%). Peripheral biood eosinophilia and hyperechogenic lesions on abdominal ultrasound or CT scanner were also common. At 3 months after treatment, clinical symptoms can resolved completely or partly while the lesions on ultrasound or CT still can be remained.
Key words; Fasiola hepatica, triclabendazole.
4 6 TRUY^NNHieMVIETNOM^Rn.^dll-
