Nghien cmi Y hpc Y Hoc TP. Ho Chi Minh * Tap 20 • So 1 * 2016
KHAO SAT YEU TO NGUY CO TREN THAI PHU TIEN SAN GIAT TAI KHOA SAN BENH VIEN DA KHOA KIEN GIANG
Bang Thj Thuy Phuang*, Hnynh Nguyen Khdtih Trmg^
TOMTAT
Tieh sdn giat - San giat (TSG-SG) la mot trong nhieng nguyen nhdn gay tit vong cho thai phu va thai jite"
nhieu nhai tren thi'gi&i. Phat hien sam deed kehoach quan ly va can thiep kip thdi se gi^p gidm henh su& va tie suat cho thai phu.
Phuang phdp: Nghien dm hehh diieng khong hat cap ooi ty le 1:2 tren 408 sdn phu dan thai khdm thai tai henh vien Da khoa Kien giang chia 2 nhom: nhom henh la 136 thai phu hi tien sdn giat vd nhom chiing Id 272 thai phu khong hi tieh sdn giat trong Miodng ihai gian tii thdng 11/2014 den thdng 4/2015.
KB qua: Mot soy&l toldm tang nguy ca TSG: (i) BMI tru&c sarih 18,5 - 24,9 co OR - 7,2; KTC 95% 12,7 -19,8], BMI tru&c sanh > 25 CO OR=22,9; KTG 95% [6,8 - 77,9]; (ii) tuSS me>35cdOR=3,1; KTC 95% [1,2 - 7,7J, (in) CStiSncanUTSGcoOR- 7,3; MIC 95% [1,4 - 36,71), (iv) Co tieh can say co OR-4,5 KTC 95%
13,1 - 9,6], (v) tdng can > 10 kg trong thai Sy co OR - 2,4 KTC 95% [1,4 - 3,9]. YHi tffco anh hudng lam giim nguy CO TSG: (i) khdm thai > 4 lah trong thai kycoOR- 0,45 KTC 95% [0,2 - 0,8]; lao dmg chdn tayc60R = 0,4 KTC 95% [0,2-0,91
Kei luan: Tieh sdn giat co the cdn duac quan tdm nhieii han deed the phdt hien s&m, tiedoco kehoach qudn ly degidm nguy co cho thai phu vd thai nhi.
Titkhoa: Tieh sdn giat, sdn giat, nghien cieu benh chieng.
ABSTRACT
RISK FACTORS IN PREGNANT WOMEN VWIH PREECLAMPSIA IN OBSTETRIC DEPARTEMENT OF GENER/U, KIEN GIANG HOSPTTAL
Dang Thi I h u y Phuong, Huynh Nguyen Khanh Trang
*Y Hoc TP. Ho Chi Minh • VoL 20 - No 1 - 2016:310 - 315 Preeclampsia - Echmtpsia is one of the most causes (^ death of pregnant women and their unborn hiMes in the world. Early detection in order to make plan for management and timely intervention will he helpful to redua maternal morbidity and mortality.
Methods: Unpaired 1:2 Case-control studies was conducted in 408 women with singleton pregnandes vks were followed up at the antenatal clinics in general Kien Giang Hospital. They were divided into 2 groups: studu group of 136 pre-eclampsia pregnant patients and the control group of 272 non pre-eclampsia pregnant women.
Data was collected during the period from November 2014 to April 2015.
Results: Several factors increase the risks of preeclampsia: (i) antenatal BMI from 185 to 24.9 with 0R=
7.2; 95% CI (2.7 to 19.8], antenatal BMI > 25 increases the risk of pre-eclampsia with OR -22.9; 95% Q (6.S * 77.91; (ii) maternal age > 35 ivith OR-3.1; 95% CI fl.2 to 7.7J, (Hi) History of preeclampsia has OR - 7.3; 95%
CI n.4 to 36.7ft (iv) History of miscarriage with OR - 4.5, 95% CI f3.1 to 9.6], (v) Gain the weight more Itor 10 kg during wegnanai increase the risk ofpre-eckmpsia with OR -2.4,95% CI [1.4 to 3.9]. Factors that redaa
* Khoa San, b?nh vi?n b ^ vien Da khoa Kien Giang
*• Bo mon Phv San DHYD Tp HCM, Khoa San b&lh, BV Hung Vmjng.
Tk gia tien lac. PGS.TS. Huynh Nguyin Klianh Trang DT: 09(B882ra5. EmaUi pgsJiuynhnguyenlchanhtrangjBgiiiaiLaim.
310 Q , „ y g „ D l Siic Khoe Sinh S a n - B a Me Tre Em
Y Hpc TP. H o Chi Minh * Tap 20 * So 1 * 2016 N g h i e n cmi Y hoc the risks of preeclampsia are: (i) the antenatal follow-up at the clinics > 4 times during pregnancy with OR = 0.45 95% CI [0.2 to 0.8]; manual labor with OR = 0.4, 95% CI [0.2 to 0.9].
Conclusion: Preeclampsia may need more attention to detect early, since management plans help to reduce the risks for both mothers and their fetus.
Keywords: Preeclampsia, eclampsia, case-control study.
D A T V A N D E
Ti&i san gi$t (TSG) la mgt trong ba nguyen nhan hang dau gay hx vong cho me hien nay dmg voi bang huyet sau sanh va nhiem trung tren the'gioi va tai Viet Nam. Sua't do xay ra TSG khoang 2-8% thai ky<i^'. Tren the' gioi, uac tinh cac roi loan THA trong thai ky gay ra khoang 50.000 ca hr vong me trong nam va phan Ion 6 nhimg ntroc co thu nhap thap hoac trung binhP). Them vao do, no thuang ket hop voi tinh trang thai cham tang tnrong trong tiJ cung, nhau bong non, buoc phai cham dut thai ky som dem dm ke't cue xau cho ca me va thai nhif^- ^\
To chih; y te' the gioi (TCYTTG) ghi nhan nam 2014, tir 276.388 thai phu a cac nuoc co nen kinh te thap - trung binh, ghi nhan co 10.754 (chion 4%) la bi TSG - SG®. 6 Viet Nam, ty le TSG cung CO nhieu thay doi tiiy theo tac gia.
Trong mot nghien a h i doan he cua Nguyen Thi Tir Van (2003)^ thuc hien tren dan so con so tai quan 8 - TPHCM cho ke't qua ty le moi mic ciia tang huyel ap trong fliai ky la 4,3%; a Benh Vien Tir Du -TP.HCM (2005), ty le cao huyet ap trong thai ky la 2,5%. Theo nghien cihi 6 huyen Co Do- Can Tho (2008) ciia Duong My Linh ghi nhan ty Ienayla8,l%i8>.
Nhieu nghien cuu tren the gioi va trong nuoc cho thay co su lien quan giira cac yeii to' nguy CO ciia me truoc khi mang thai (tuoi me, da thai, tien can THA, beo phi, dai thao duong, kinh t e t h u n h | p thap ...) voi su xua't hien a i a hpi chung TSGI^-^-*'. Cung co nhieu ihu nghiem lam sang de tien doan va du phong TSG hay SG hrong thai ky nhu bo sung canxi, vitamin C va vitamin E, sir dung aspirin lieu tha'p a tiioi thai < 16 tuan...">. Nhung van chua CO bang chihig ro rang vi vay van con dang ti-anh luan va can nghien a h i fliem.
Chiing toi da tieh hanh nghien cuu de tai:
"Khao sat ye'u to nguy co tien thai phu TSG tai khoa san Benh Vien Da Khoa Kien Giang", de tao CO so cho ke hoach cham soc va quan ly thai nghen duoc hieu qua hon tai dia phuong.
Muc tieu nghien cuu
Xac dinh moi lien quan giira TSG voi dac diem thai ky hien tai: BMI, tang can thai ky, da thai, so lah kham thai.
Xac dinh moi lien quan giua TSG voi dac tinh n&i, tien can benh ly va san khoa cua thai phu.
DOI Tl/ONG VA PHl/ONG PHAP Nghien cuu benh chihig khong bat cap voi ty le 1:2.
Chon m l u
San phu co thai tu 20 tuah deh kham thai va sanh tai benh vien Da khoa Kien Giang tiong thoi gian tu thang 11/2014 dan thang 4/2015.
Nhombenh
San phu co tang huyel ap (HA): HA tam thu
^ 140 mmHg va hoac tam truong > 90 mmHg (tiong 2 lah do each nhau it nha't 4 gio. Hay HA tam thu > 160 mmHg hoac tam truong a 110 mmHg (xac nhan trong vong 15 phiit). Va protein nieu: > 300 mg/24 gio hoac que thir nuoc tieu > +1. Neil protein nieu am tinh: nhung co THA moi khoi phat kem theo ba't ky cac da'u hieu (giam heu. cau < lOO.OOO/mm^; suy than:
creatinine>l,l mg/dl hoac tang nong do gap doi;
men gan tang ga'p doi; phii phoi; mo mat; phii nao; dau dau) thi van ch&i doan TSG. Dong y tham gia nghien cihi.
Nhdm chiing
Thai phu 00 HA tam ftiu < l^)nimHg va HA tam tmong < 90 nrurfi^. Protein nieu (<30C)mg^4 gio
San Phv K h o a 311
Nghien cihi Y hpc Y Hpc TP. Ho Chi Minh * Tap 20 * So 1 * 2016 hoac am tinh tren que thu nuoc tieu hay tien
nuoc tieu 10 thong so). Dong y fliam gia nghien aiu.
Tieu chudn loai trie
Benh nhan bj roi logn tam than khong hieu va khong tra loi chinh xac cau hoi. Ho so benh an khong day dii nhung thong tin cSh thu thap va san phu khong dong y tiqj tuc tham gia nghien cihi. Co mSu nghien a i u dupe uoc lugng Iheo cong thiic:
Pl= ORP2/[OR.P2 + (1 - P2)l
Voi: Pi la xac suat yeii to nguy co tiong nhom benh tien san giat. Pa: la xac suat ve yeii to nguy CO tiong nhom chiing (khong bi benh). Dp tin c|y 90%, nang luc mau la 80%;
nghien cuu benh chiing ty le 1 benh : 2 chiing, tmh CO mau theo phan mem epi.7 nhu sau:
Theo nghien cuu Kashanian (2011)'"), ty le thai phu CO ti&i can TSG tiong nhom chting la P2 = 0,6%; nguy co TSG voi OR = 9,4 co y nghia fliong ke. So ca benh = 136 ca, so ca chiing = 272 ca. MSu chung = 408 ca.
Nhimg thai phu sau khi nhap vao khoa san, se dirpc do HA bang may do HA lay, neu Imyet ap > 140/90 mmHg, benh nhan se dupic nam nghi tai gjuong benh trong phong flieo doi, 30 phiit sau se tiCTi hanh do lai HA lan nua nmi huye't ap S: 140/90 mmHg Ihi cho nhap khoa san va dupe kiSn tia lai HA l m 2 sau khi nhap vien 4 gio.
Nhirng thai phu sau khi nhap vien vao khoa san - BVDK Kien Giang, thoa tieu chuan chan doan TSG theo Willam 2014, se dupe nhan vao nhom benh nghien ciiu.
Thu thap tix benh an
E)ia chi, tuoi, trinh dp van hoa, nghe nghiep, chieu cao, can nang truoc mang thai, hen thai, khoang each giua cac lah sanh, don thai hay da thai trong l&i sinh nay, ve tien su cao h u y ^ ap gia a n h (me, chj em gai), hen six thai phu (THA, dai thao ducmg truoc khi mang thai hoac xua^
hien trong khi co thai) kei qua dupe ghi nhan
vao phieu thu fhap so lieu va cac chi so huyei ap, can nang hien tai, cac xet nghiem co san trong ho so benh an. (Lim y: benh nhan se dupe do huyei ap sau khi da nghi ngoi it nhai 30 phiit, bang quang tiong; khong uong ca phe, nrpu, hiit thuo'c la va dimg cac thuo'c gian mach tnroc do).
Nhdmbenh
Chpn tai ca cac thai phu du tieu diuah dian doan TSG (dua tren tieu chuan chpn nhom bpih) dieu tri tai Khoa San, Benh Vien Da Khoa Kien Giang, cho toi du 136 ca benh TSG. Sau khi chon dupe 1 ca nhom benh, chiing toi se tieh hanh chpn 2 ca lien tiep sau do khong hi TSG vao nhom chiing nhung nhap vi&i vao khoa san berth vien cung liic voi thoi diem chpn nhom benh. Va cimg tieh hanh thu th|p thong tin nhu nhom benh. Nhung thai phu dupe chpn vao nhom chiing nghien ciiu, dJng dupe tu van, giai fliich tuang hr nhu nhiing thai phu dirpc chpn vao nhom benh TSG.
Kei qua dupe xu ly voi phan m&i thong ke SPSS 10.0
KET QUA
Bang 1. Bac dian dan so nghim cdu D|c dilm
s 20 tuoi 21-34
2 35 Noi 0: ngosi o
Thdnh thi
<cap2
>Cap2 S6 con: 19
so DSn tQC Kinh
Khac Tien cSn say
C6 Kh6ng Tifen can cao HA
C6 KhSng TlSn can TSG-SG
C6 KhSng
Nhom b|nh N = 136
11 86 39 133 33 IDS 28 53 60 17 109 27 30 106
5 131
8 128
Nhom chfrng N = 272
54 181 37 204 1
68 i 211
61 142 ) 101 J
17 217 55 15 ' 257
1 271
2 270
312 Chuyen D e Siic Khde Sinh San - Ba Me Tre Em
Y Hoc TP. Ho Chi Minh * T | p 20 * So 1 * : Nghien cmi Y hgc
Biic dilm Me/Chj/Em cao HA
Co Khong Lao dong ch§n tay
Lao dong tri 6c Kham thai £ 4 tan
>4 lan Tang can thai ky
>10l<g
£10l<g BMltnfaccothai
<18.5 18,5-24,9
2 25
Nhdm benh N = 136
3 133 118 18 33 103 86 50 5 103 28
Nhdm chipng N = 272
3 269 254 18 42 230 110 162 74 186 12 Sau khi phan tich don bim de danh gia ban dau ve miic dp anh hudng d m ke't cue, cac yeu
^lien quan dupe can nhac dua vao mo hinh hoi quy logistic da bi&i. Tieu ehi chpn lua la nhiing bi&i so CO kha nang hen quan d m kei cue, cu the CO nguong P < 0,25, hoac nhiing bim so da dupe ghi nhan eo hen quan deh tien san giat tiong y van. Kei qua OR hieu chinh (OR*) sau khi phan tich da bim sir dung hoi quy logistic dupe trinh bay va so sanh voi OR tho ve ye'u to' nguy ca ciia tioi san giat.
Bang 2. Phdn tich hoi guy da bien Y l u t d
BMI tnfoc cd thai 18,5-24,9
2 25 Tuoi me > 35 C6 tien can TSG -
SG C6 tiln can say rang > 10 l(g trong
thai l(y Kham thai >4 lan Lao ddng chdn tay
OR 8,1 34,5 5,1 8,4 4,8 2.5 0,6 0,5
OR*
7,2 22,9 3,1 7.3 4,6 2,4 0,45 0,4
KTC 95%
2 , 7 - i g , 8 6,8-77,9 1,2-7,7 1,4-36,7 2,1-9,6 1,4-3,9 0.2-0,8 0.2-0,9
P
<0,001
<0,001 0,015 0,015
<0,001 0,01 0,01 0,03 GM chu: OR'^ OR hieu chinh
BANLUAN
Trong mpt nghien cihi ve cac yeu to nguy co TSG tai Anh (2005) ghi nhan kei qua:'^) Co tim sir TSG tiong lan mang tiiai tnxac (RR = 7,19; KTC 95% [5 85-8 83]); Ci nhirng tiiai phu co khang the khang pho^phoUpid (RR = 9,72; KTC 95% [4,34 -
21,75]); CO tieh sir tieu duong (RR = 3,56; KTC 95% [2,54 - 4,99]); Da fliai (RR = 2,93; KTC 95%
[2,04 - 4,21]); Con so (RR = 2,91; KTC 95% [1,28 - 6,61]); Tim sii gia dinh (RR = 2,9; KTC 95% [1,70 - 4,93]); THA a thai diem dang ky kham thai voi HA tam truong > 80 mmHg (RR = 1,38; KTC 95%
[1,01 - 1,87]); tang chi so khoi eo flie truoc khi mang thai voi BMI > 30 kg/m^ (RR = 2,47; KTC 95% [1,66 - 3,67]) hole liic dang ky kham fliai (RR = 1,55; KTC 95% [1,28 - 1,88]); Tuoi me a 40 tiioi (RR = 1,96; KTC 95% [1,34 - 2,87]) so vol nhimg phu nir tre tuoi.
Theo TCYTTG (2014) doi voi 276.388 san phu 6* cac nuoc co thu nhap thap va tnmg binh thi ty le TSG la 4%, thuang gap 6 ba me > 30 tuoi va co trinh dp hpc van tha'p. Trong do, nhirng ba me CO BMI cao va con so ihi nguy co bi TSG tang 2,04 l&i; CO THA man nguy co tang 7,75 lan;
benh DTD thai ky tang nguy ca 2 lah; benh than/
tim thi tang hap 2,38 Ian va thieu mau nang nguy eo eao gap 2,98 lah so voi nhimg thai phu binh thuang. Trong khi do, nghien ciiu ciing cho thay cham soc tim san > 8 lan co kha nang bao ve hon 0,9 Irui so voi viec khong cham soc tim san^'.
Mpt nghien a i u hoi ciiu Ion ve cac yeu to' nguy eo TSG aia nhung phu nir My Latin va Caribean hi 1985 - 1997, vai dan so la 878.680 thai phu 6 700 benh vim khac nhau, voi ty le TSG la 4% va SG la 0,2%. Kei qua cho thay eae yeu to'lam tang nguy co TSG co y nghia thong ke la: con so, da tiiai, tim sir THA man, DTD thai ky, me > 35 tuoi, di tat thai, me khong song chung voi eha aia tre, san phu co BMI tnroc khi CO tiiai la fliua can, beo phi (BMI > 26 kg/m^)P).
Trong khi can nang truoc khi mang thai va chieu eao giiip chiing ta uac tinh chi so' BMI truoe khi mang thai, co y nghia quan tipng tiong viec theo doi va tien lupng thai ky nguy CO cao. Thi qua timh tang can tiong thai ky cung dupe ghi nhan tiong qua trinh kham thai dinh ky, nhung hau hei deu it dupe ehii y deh, ngoai hen quan toi tang trucmg cua thai nhi thi con CO nhieu lien quan toi tang nguy co DTD thai ky va tiong nghien a h i nay la nguy
San P h v Khoa 313
Nghien ciiu Y hoc Y H p c TP. Ho Chi M i n h * T^p 20 * So 1 * 2016 CO TSG, dang la vah de noi trpi trong viec
cham soc siic khoe sinh san.
Bodar LM va epng su (2007) nghien a i u ti^
1.179 phu nii con so ve su tucmg quan giira chi so khoi eo the vdi nguy co tien san giat nam 2005, cho ftiay: so vdi phu nu eo BMI = 21 kg/m^
(sau khi da dieu chinh ve tinh t r ^ g hiit ttiuoc la va chung toe) thi nguy co tien san giat tang gap doi 6 phu nir CO BMI # 26 kg/m^ va gap 3 lan 6 chi so BMI ^ 30 kg/m^. Tuy nhien voi BMI < 17 kg/m^ till giam 57% nguy CO TSG, chi so'BMI < 19 kg/m^ till giam 33% nguy co<*i.
Kei qua bang 2 ghi nhan: nhiing thai phu kham fliai > 4 lam lam giam nguy co mac benh TSG CO y nghia thong ke so vdi nhom kham thai
< 4 lan voi OR = 0,45; KTC 95% (0,2 - 0,8). Tuong tu, trong nghien ciiu ciia tac gia Dang Thi Ngpc Ha (2010) 6 tinh Draig Thap, cho rang kham thai
< 3 lan la y m to Iam tang nguy co xuai hien TSG nang gap 2,6 lah (KTC 95%: 1,45 - 4^78) so vdi thai binh thuongP'.
Trong nghien ohi benh chung ciia Guerrier (2013), khao sat tren 419 ca TSG nang/ sari-giat a Nigeria, cho rling so lan kham thai < 4 lan tlu tang nguy co mac b | n h len 1,6 lah (iCTC 95%: 1,1 - 2,4; p=0,02) CO y nghiaoa.
Theo tac gia BOano (2014), khao sat cat ngang tren 276.388 thai phu, ghi nhan kham ttiai > 8 IMI la yeu to bao ve thai phu giam nguy co mac TSG 0,9 lan (KTC 95%: 0,83 - 0,98; p < 0,05)PI.
Ve nghe nghiep, chiing toi chia thanh 2 nhom ehinh: lao dpng chan tay (cong nhan, nong dan lam rupng, lam thue, buon ban tieu thuong, ngi trp) va lao dpng tri 6c (lam quan ly, hanh chanh cong nhan vien van phong...). Trong ca nhom benh va nhom chung ttu ty le lao dpng chan tay, song a ngoai 6 thanh pho va co trinh dp hpc van tir cap 2 tro xuong la chii yeu. Trong bang 2 phan tich da bim, ghi nhan nhimg fliai phu lao dpng chan tay lai giam 60% nguy co mac TSG so vdi nhom lao dpng tri 6c.
Nghien cihi aia chiing toi, tucmg tu tac gja Haelterman va cong su khao sat tren 4281 tiiai
phu lam viec suoi thai ky tiong nam 2007, cho rang tinh tiang eang thang cong viec va lam viec keo dai trong suoi fliai ky se tang nguy eo TSG len 3,0 lah (KTC 95%: 1,0 - 9,5)"^. Trong khao sat cua Guerrier (2013) tai Nigeria, nhirng thai phu Iam npi trp c6 so chenh mac TSG nang/ san giat len 2,0 IMI (KTC 95%: 1,2 - 3A p =004)t").
Theo kei qua nghien cihi ciia tac gja Duong My Linh ttiai phu la cong nhan vim, lao dpng tri 6c cang thang stress nhieu thi ty le THA thai ky cao hon, nhung su khac biet nay cung diira co y nghia tiicoig ke. Cd su khac biet tren, co le do khac nhau ve noi 6, dia Iy, khi hau va tmh chS cong viec ciia moi vimg mim voi miic dp cang tf^g khac nhau. Do do can c6 nhimg nghim ciiu sau han ve van de nay.
Han che
Do Ia nghien cihi benh chting, co the co mot so gioi han: Sai lech hoi tuong: do ftiong tin thu tiiap dua tien sir nho lai cua nguoi dupe phdng vah. De han che sai lech nay, chung ^ i dion nhom benh va nhom chiing 6 cung mot thoi diem. Sai lech thong tin: do nguoi phdng vm biei muc tieu nghien eihi. De han che chiing tti h u m hiyen nguoi thu dir lieu khong biei muc tieu nghien ciiu de phong van doi tupng tham gja dua tren bang cau hoi phong vah Sai ledi dipn lira: de han che^ chpn lua dc3 tupng vao nh6m ehiing dua theo phuong phap ngau nhiffl lien tiep. Sai lech do yeu to gay nhieu: de ban die, cac yeu to nguy co dirpc dua vao phuong trinh hoi quy da b i m de phan tich KETLUAN
Qua nghien cuu benh chiing voi 136 thai phu bj TSG va 272 thai phu khong bi TSG tai khoa San benh vien Da khoa Kien Giang, chiing toi nit ra mpt so kei luan sau:
Thai phu CO BMI trung Wnh tnrdc khi co ttiai tang nguy co TSG len 7,2 lah so voi nh6m co BMI < 18,5. Nhom ttiai phu thira can va beo phi (BMI ^ 25) tang nguy CO TSG len 22,8 IEHI SO voi nhom tiiai phu gay.
Chuyen D e Siic Khoe Sinh San - Ba Me Tri Em
Y H p c TP. H o C h i M i n h * Tap 20 * So 1 * 2016 Nghidn Clin Y hpc Thai phu > 35 tuoi tang nguy co TSG len 3,1
lah so vdi nhdm thai phu < 20 tuoi c6 nghia fhohg ke.
Thai phu c6 tien can TSG hay SG 6- nhimg thai ky truoc lam tang nguy co TSG voi OR
= 7,3; KTC 95%[1,4 - 36,7]; p = 0,01.
Thai phu c6 tim can say thai lam &ig nguy co TSGvdiOR=4^;KTC95%[2,l-9,61,p<0,001.
Thai phu eo tang can nang > 10kg tiong suo't fliai ky lam tang nguy co TSG voi OR = 2,3;
KTC 95% [1,4 - 3,7]; p = 0,001.
Kham thai > 4 lan, giiip giam nguy eo TSG 0,55 lan voi p = 0,01.
Lao dpng chan tay giiip giam nguy co TSG 0,6 lah so voi lao dpng tri dc voi p = 0,03.
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Ngay nhdn bai bdo: 20/11/2015 Ngay phdn biin nhSn xet bUt bao: 25/11/2015 Ngay bai bdo duac dang 20/01/2016
