Y HOC VIET NAM THANG 10 - SO OAC BIET/2011
NGHIEN CLfU DAC OIEM LAM SANG, CAN LAM SANG VA
^MAT DO XaONG 6 CAC BENH NHAN LOANG Xl/ONG DIEU TRI
• • • •
TAI KHOA NOI 2 - BENH VIEN VIET TIEP HAI PHONG
Le Thi Dieu Hien*, Do Thi Van^
TOM TAT
Nghien ciiu tien hanh tren 83 benh nhan trong thdi gian mot nam tai khoa npi 2 benh vien Viet Tiep Hal Phdng t i i thang 2/2009 2/2010.
Ket qua nhU sau; ty le ntif (66,3%) nhieu hon nam (33,7%) chung cho cac nhdm tuoi vdi p < 0,01;
trieu chu'ng moi lu'ng, dau iUng, dau xu'dng dai;
trieu chiing gCi veo cot sdng va vj tri cac diem dau cot song gap deu d cac nhdm tuoi va nhu'ng nhdm > 70 tuoi gap nhieu nhat. Ty le loang xu'dng nang la 7,3% gap toan bo d nhdm > 70 tuo'i. Hinh anh Xquang quy Udc nhdm > 70 tuoi gap nhieu hOn. Trong cac nhdm tuoi, chi so Meunieur d cac do deu gap nhU nhau, nhUng nhum > 70 tudi gap vdi ti le cao htfn chii yeu d do IV, V. Cd siT lien quan giu'a trieu chiing cd nang vdi chi so Meunieur d cac do va hinh anh Xquang cot song quy u'dc. Cd sii lien quan giu'a trieu chiing cd nang va trieu chu'ng gii veo cot sdng vdi mat do xu'dng
SUMMARY:
THE OVERVIEW OSTEOPOROSIS IN DEPARTMENT OF INTERNAL MEDICINE2,
VIET TIEP - HAI PHONG HOSPITAL
The study carried out on 83 patients with osteoporpsis in the department of Intrenal medicine 2 of Viet Tiep hospital from February of 2009 to February of 2010 shows the following results: women are more than men (66,3% compared to 35,8%) and most of patient live in rural area (33,7% in rural area compared to 26,4% in urban area), the age of 60 to 69 is major (40,8%). The symptom of bone pain often occurs on the patient aged more than 70 years, which presents mostly with long bone pain. The result of
spine X- ray on patients of more than 70 years old shows that the major images are X-ray absorptionmetry (33,5%) and "weeper border"
(35,3%), The "brief images" is less than that (31%).
The Meunier's level III, IV and V are determined regularly especially at the age of more than 70. The level I and II are found at the age of 50- 59. The result of bone mineral density measurement: The highest rate is osteoporosis (42,7%), severe osteoporosis was found at low rate (9,6%), the low bone mass occupies 40,8%.
I. OAT V A N OE
Loang xuong la benh ly roi loan chuyen hda cua he thdng xuoTig do suy giam mat do khoang cua xucmg va hu hai cau true vi the cua xuomg, giam chat lugng xucmg lam cho xucmg yhu di dan tai tang nguy ca gay xuong. Ci Phap, theo udc tinh cd khoang 4,6 trieu phu nil va 1,4 trieu nam gidi bi loang xuong; khoang 70.000 trudng hgp gay xuong mdi moi nam voi do loang xuong 10% hi tan phh va 3-5.000 trudmg hgp gay cd xuong dui, hang nam gay phi tdn nam vien len tod 1,5 ty francs [4]. Theo sd lieu cua Vien dinh duoTig Viet Nam, benh loang xuong anh hudmg toi 1/3 phu nil va 1/8 dan dng tren 50 tudi, hien nay cd khoang 6 trieu nguoi tren 60 tudi bi loang xuong nghia la tuong duong khoang 1 trieu ngudi cao tudi cd nguy co gay xuong.
C) Hai Phdng, cd mgt sd tac gia da de cap toi vin dh nay nhung cac nghien cuu cdn nhd le, dh gdp phSn phat hien sdm va phdng benh loang xuong tren dia ban thanh phd, chung
tdi tien hanh ngliien cim na> nham hai muc ticu:
/. Md td trieu chirng lam sdng vd can lam sdng cua benh nhdn loang .xuong dieu trj tai khoa Ngi 2 - benh vien \ let Tiep Hdi Phdng.
2. Ddnh gid moi lien quan giira trieu chirng lam sdng vdi mat dg xuong vd Xquang cgt sdng quy udc a cdc ddi tugng tren.
II. o6l TUPNG VA PHUONG PHAP NGHIEN CCfU 2.1. Dja diem vii thirl gian nghien cuu:
khoa Ngi 2 Benh \'icn Vict Tiep Hai Phdng tir thang 1/2010- den thang 8/2010
2.2. Ddi tugng nghien ciiu: gom ca benh nhiin dugc chan doan la benh loan xuong dieu tri tai khoa Ngi 2 - Benh via:
Vict Tiep Hai PhcMig [7|, [21. Ti^u chu^n chli doan bdnh loang xuong WHO 1994 mat di xuong theo chi so I- Score [6]: Loan]
xmrng: T Score < -2,5
2.3. Phirang phap nghien curu: Thiet i(i ngiiicn cii'u Md td cdl nf^an^.
2.4. PhUdfng phap xu ly sd lieu thee phan mdm SPSS 15.0. Tfnh /.' Test T vStudent va tinh hc sd tuong quan r, OR [6].
,x.
I. KET QUA NGHIEN CCfU
3.L Trieu chung lam sang va can lam sang ciia doi tuong nghien ciiu Bang 3.1. Phan bd theo tuoi, gidi
^ ^ ^ v , ^ Gidi Tuoi ^^^^^
5 0 - 5 9 6 0 - 6 9
> 7 0 Tong
Nam N
0 0 28 28
Ty le % 0,0 0,0 33,7 33,7
Nu' n
16 11 28 55
Ty le % 19,3 13,3 33,7 66,3
Chung N
16 11 56 83
Ty le % 19,3 13,3 67,4 100
P
< 0 , 0 1
0,01
Nhdn xet: Ty le nir (66,3%) nhi^u hgn nam (33,79() chung cho cac nhdm luoi vdi p Bang 3.2. Tri6u chihig co nSng theo tudi
\ s . ^ Tuoi T r i ? u ^ \ ^
chu'ng ^^.^
c6 nang \ . j Moi IUng
Oaulung Oau xu'dng dai Co ca 3 trieu chiTng tren 1 benh nhan
Tong (n= 83) n
73 71 65 60
Ty le % 87,9 85,5 78,3 72,2
5 0 - 5 9 (n= 16) n
12 13 11 9
Ty le % 75,0 81,2 68,75 56,25
6 0 - 6 9 (n= 13) n
10 10 11 10
Ty le % 94,4 88,8 79,6 76,9
> 70 ( n = 54) n
51 48 43 41
Ty le % 77,0 77,0 84,6 75,9
P
<0,01_
<0,05_
<0,05_
<0,05
Nhdn xet: Cac trieu chung mdi lung, dau lung, dau xuong dai gap deu o nhdm > 70 tuo cao hon cac nhdm tuoi khac sir khac biet cd y nghia thdng ke voi p < 0,05
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
Bang 3.3. Trieu chung thuc th6 theo tudi
^\.^^ Tuoi neu ^^^^
:hu'ng ^ \ ^
ihUc the ^ \
3U
teo cot song
(hong CO ca gii va veo :pt song tren 1 bn :6 ca gu va veo cot song ren 1 benh nhan
Tong ( n = 83) n
12 7 58
6
Ty le % 14,5
8,4 68,9
7,2
5 0 - 5 9 (n= 16)
n 3 3 10
0
Ty le % 18,8 18,8 62,4
0,0
6 0 - 6 9 (n= 13)
n 0 0 11
2
Ty le % 0,0 0,0 84,6
15,4
> 70 (n= 54) n
9 4 37
4
Ty le % 16,6
7,4 68,6
7,4
P
< 0,05
<0,05
<0,05
Nhdn xet: Nhdm 60- 69 tudi khdng cd benh nhan nao bi gii vii veo cot sdng Bang 3.4. Hinh anh Xquang cot sdng quy uoc theo tudi
\ v ^ Tuoi X q u a n ^ ^
cot song ^ v
quy u'dc ^ \ Tang thau quang
Cai rang lUdc Vien khan tang
Tong (n= 83) n
74 55 68
TylO
89,1 66,2 81,9
5 0 - 5 9 (n= 16)
n 12
7 11
TylO
% 75,0 43,7 68,7
6 0 - 6 9 (n= 13)
n 12
9 12
TylO
92,3 69,2 92,3
> 70 (n= 54) n
50 39 45
TylO
o/o
92,6 72,2 83,3
P
<0,05
< 0,05
<0,05
Nhdn xet: Trong cac nhdm tudi hinh anh Xquang quy uoc deu gap trong cac nhdm tudi, nhung 6 nhdm > 70 tudi so voi cac nhdm tudi khac gap nhieu hon
Bang 3.5. Chi sd Meunieur theo tudi
^ \ Tuoi
Meunieur ^ \ 06II
06 III 06 IV 06 V
Tong (n= 83) n
28 29 23 3
Ty l6 o/o 33,7 34,9 27,7 3,7
5 0 - 5 9 (n= 16) n
8 6 2 0
Ty 10 o/o 50,0 37,5 12,5 0,0
n 5 4 4 0
6 0 - 6 9 (n= 13)
Ty 10 o/o 38,6 30,7 30,7 0,0
(I
n 15 19 17 3
> 70 1 = 5 4 )
Ty 10 o/o 27,3 35,2 31,5 5,0
P
<0,05
<0,05
<0,05
Nhdn xet: Trong cac nhdm tudi, chi sd Meunieur 6 cac do deu gap nhu nhau, nhung nhdm
> 70 tudi so voi cac nhdm tudi khac gap vdi ti le cao hon.
^~~~~~—-—^,.^__^ Tuoi M|it dp xUtfng ~-—_
T - Score < -2,5
T - Score<.-2,5 va co gay 1 ho3c nhieuxUdnq
Biing 3.6. Ket quii 5 0 - 5 9 ( n = 16)
n 16
0
Ty leVo 100 0,0
mat d d x u o n g theo 6 0 - 6 9 ( n = 13)
n 13
0
Ty le % 100 0,0
t u d i
> 70 ( n = 54) n
48 6
Ty le % 88,8 11,2
P
<0,05
A/;<//; vc'/. Da so ddi tugng nghicMi ciru bi h)ang xuong chi cd 7,3% la loang xuong nang Loang xuong gap o cac nhdm tudi nhung nhieu nhiit a nhdm ::: 70 tudi (88,8%). Loang xuong nang chi gap a nhdm > 70 tudi (11.2%)
3.2 Moi lien quan giua tri^u chung lam siing voi mat dg \uoTig va Xquang cot song quy uoc ciia doi tugng nghien ciiu
Bang 3.7. Mdi lien quan giira trieu chirng co n^ng voi chi sd Meunieur
^~~~--~T>i^u chu'ng Cd nang
Chi so Meunieur ^^~~~-^
D o l l 06 III 06 IV 06 V
R P
C
n 10 15 19 27
>au IUng
[n=71)
TO 10 o/o 14,0 21,1 26,7 38,0 r=0,52 p=0,01
Moi IUng (n= 73) n
9 12 17 35
Tu 10 o/o 12,3 16,4 23,2 47,9 r=0,7 p = 0 , 0 1
Dau xu'dng dai (n= 65) n
6 9 13 37
Tu 10 o/o 9,2 13,8 20,0 56,9 r=0,39 p<0,01
Nhdn xet: Cd mdi lien quan giu-a trieu chirng mdi lung, dau limg \ a dau xuong dai vdi chi so Meunieur 6 cac do 11, do 111, do IV, do V (r= 0.52; i - 0,7; r=0.45: r- 0.39).
Bang 3.8. Mdi lien quan giira triyni chimg co ni\ng \ oi mat do xucrng (n=^ 83) Tri?u chuTng
cd ndng M$t 6g xUdng
Dau IUng (,"= 73)
Ty le %
Moi IUng (n= 71)
Ty le %
Dau xUdng dai (n= 65)
Ty le % T - Score < -2,5 (Loang xUOng) 67 91,7 68 95,7 60 92,3
T - Score£-2,5 va co gay 1 ho3c nhieu
xUOng 8,3 4,3 7,7
r P
r=0,7 p<0,01
r= 0,56 p<0,01
r= 0,49 p<0,01
Nhdn xet: Cd su lien quan giiia trieu chimg dau lung, mdi lung va dau xuong dai vdd miic do loang xuong (r= 0,7; r= 0,56; r= 0,49)
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
Bang 3.9. Mdi lien quan giii'a trieu chimg thuc the voi mat do xuong (n=19)
~—~-_____^ Trieu chu'ng thUc the Mat do xUdng ' —^__^
r - Score <. -2,5
r - Score:<-2,5 va co qay 1 lioac nliieuxUdng r
P
Gil CQt song (n= 12) n
11 1
Ty le % 91,6
8,4 r= 0,31 p<0,05
Veo cot song ( n = 7 ) n
6 1
Ty le % 85,7 14,3 r= 0,38 p<0,01
Nhdn xet: Cd mdi lien quan giira trieu chiing gii \ ii \ co cot sdng voi mire do loang xuong ( r - 0 , 3 1 var=0.38).
Bang3.10. Mdi lien quan giija \i tri diCMii dau cot sdng voi mat do xuong
^""^"^-.^^ Vj tri diem dau
^^""•-^^.^CQt song
Mat dp xUdng ^ ^ ^ - - ~ ^ T - Score <. -2,5
T - Score<.-2,5 va co gay 1 hoac nhieu xu'dng
r P
Cot song ngUc (n= 76) n
75 1
Tu l6 o/o 98,6
1,4 r=0,25 p>0,05
Cot song IUng (n= 33) n
32 1
TO 10 o/o 96,9
3,1 r=0,35 p<0,05
Cot song that IUng Cn= 49) n
43 6
Tu Id o/o 87,7 12,3 r=0,45 p<0,01
Nhdn xet: Khdng cd lien lien quan giiia vj tri diem dau cot sdng nguc voi muc do loang xuong (r= 0,25)
IV. BAN LUAN
4.1. Trieu chung lam sang va can lam sang cua doi tvong nghien ciru
Bang 1: or ca 3 nhdm tudi thi ty le nir (66,3%) cao hon nam la (33,7%) cd y nhia thong ke voi p < 0,001. Ket qua nay phii hgp vdd nghien cuu cua tac gia Nguyin Thai Thanh (voi p > 0,05) ty le nir (89,1%) cao hon nam (10,9%) [6]. Bang 3.2 nhdm 50- 59 tudi mdi lung 12 ca (75,0%); dau lung 13 ca (81,2%); dau xuong dai 11 ca (68,75) phu hgp voi nghien cuu ciia tac gia Tran Thi Td Chau (p > 0,05) trieu chung dau lung 6 nhdm 50-59 tu6i(16 benh nhan), nhdm 60- 69 tudi [178 benh nhan) va nhdm > 70 tudi (197
benh nhan) [3]. Bang 3.3: nhdm > 70 tudi gii 9 benh nhan, phii hgp vdi nghien cuu cua tac gia Via Thi Thanh Thuy (p > 0,05) gay liin cot sdng do loang xuong sau man kinh la nhdm > 70 tudi cd tdn thuong gii veo cot sdng nhieu nhat voi [7]. Theo bang 3.4 nhdm
> 70 tudi cd do 11 38,6%, do III 30,7%, do IV 30,7 % va dp V khdng cd benh nhan. Ket qua ciia bang 3.5 cho thay ket qua mat do xuong theo tudi ciia ddi tugng nghien cuu la ket qua la 100% ddi tugng nghien cuu bi loang xuong va trong dd cd loang xuong nang 7,3%, su khac biet nay cd y nghia. Ket qua nay khdng phu hgp vol nghien cuu cua Bac sy Nguyen Van Cdng va cs (voi p < 0,05) ty
Ic loang xuong hi 56'/o, binii Ihuirng hi 44'/(i [10]p<0,()5.
4.2. Moi lien quan giua liicu chiing lam siing vdi mat do xuong
Bang 3.7: dau lirng cr do II hi 10 ix'iih nhiin. dd III la \^ benh nhan, tlo IV cd 19 benh nhan \a do V cd 27 benh nhiin, iricu chimg dau lung \a chi so Meunieur cd mdi lien quan la cd y nghia \(Vi r= 0.52 \a p 0.01. Biing 3.8: do ty ic loang xuong nang gap cd 1,}%, trieu chirng niu cd nidi lien quan \(Vi loang xuong \'a loang xuong nang (r 0,7). ("iic trieu chirng co nilng cdn lai (mdi lung vii dau xuong dai) ciing cd mdi HCMI quan id \di ciic do ciia loang xuong (r= 0,56 \a r= 0,49) .Bang 3.9: trieu chirng gii cot sdng cd 11 benh nhan bi loang xuong va 1 benh nhan loang xuong nang. Ca hai trieu chirng gii \ co cot sdng deu cd mdi lien quan voi cac do ciia loang xuong (r= 0,31 vii r= 0, 38. Bang 3.10 cho thay ket qua \e mdi lien quan ciia dau cot sdng nguc, \i tri diem dau cot sdng lung, vi tri diem dau cot sdng that lung vdi cac do ciia loang xuong. Diem dau cot sdng nguc khdng cd mdi lien quan voi cac do ciia loang xuong (r= 0,25). Cd nghTa khi benh nhan cd dau a cot sdng lung va cot sdng that lung cang nhieu cang bi loang xuong.
V. KET LUAN
Trieu chirng lam sang vii can lam sang cua doi tugng nghien ciiu
Ty le nir (66,3%) nhieu hon nam (33,7%) chung cho cac nhdm tudi voi p <
0,01
Trieu chimg mdi lung, dau lung, dau xuong dai; trieu chung gii \ co cot sdng vii vi tri cac diem dau cot sdng gSp deu 6 cac nhdm tudi va nhung nhdm > 70 tuoi gSp nhi^u nhat. Ty le loang xuong nang la 1,3% gap toan bg 6 nhdm > 70 tuoi. Hinh anh Xquang
quy uoc nhdm > 70 tudi gSp nhieu hon. 0 sir lien quan giira trieu chimg co nang vdi ch so Meunieur a ciic do vii hinh anh Xquanj cdi sdng quy irirc. Cd sir lien quan giira triei chirng co niing \a trieu chirng gii veo coi sdng \(Vi milt do xuong. Khdng cd mdi Her quan giira vi tri dic-m dau cgt sdng nguc voi miit dd xuong, nhirng cd lien quan giira vi tri diem dau cgt sdnu lung \a cgt sdng that lung vdi mat do xuong.
TAI LIEU THAAA KHAO
1. Le The Bieu (1998). "Mot so dac diem dau col sdng thai lung cua nhung ngudi linh va cong nhan Vicl N'am" Bdo cdo tai hoi thao thd'p khdp hgc Pluip- \ iel.
2. Nguyen Thj Hoiii Chau (2003). "Khao sat mat do xuong \a tim hieu nhung \eu to lien quan den benh loang xuong cua phu nir 6 thanh pho Ho Chi Minh \a mot sd tinh mien Tay Nam Bd", Tap chi Sinh ly hgc, ".(2). 1-5.
3. Iran Thj To Chau (2002), .\ghien cim mgt so hieu hien Idm sdng ve ca- xucnig- khdp va do mat do .xiroii!^ \^di hang sieu dm tren phu nir mdn kinh lid Ngi. LuStn van Thac si Y hoc, Trudng Dai hgc ^' Ha N6i.
4. Nguyen Viin Cong, Phan Thanh Hai (2004),"Viii sd lieu budc dau \L^ t\ I? khoang xuong cua ngudi \ i^t Nam do bang phuang phap Ostcograin" Trung tam Y khoa Ml-DlC.
5. D;)ng Hong Hoa (2008), "Nghien curu mat dd xiroiig viing cd xuong diii cua ngudi binh thudng bang phuong phap do hap thu tia X nang lugng kep', Lugn dn TS- Hgc vien Qudn y
6. Nguyen Thai Thanh (2007)," Khao sat mat 6Q xuong d ngudi Viet Nam qua phuong phap sieu am gdt chan", Thdng tin Y duoc,
11,34-36.
7. Vu Thj Thanh Thuy (1996), Nghien cU mot so yeu to' nguy co ddi v&i gay lun cot
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011 sdng do loang xuong sau mdn kinh, Trudng
dai hoc Y Ha Noi.
Wien Med Wochenschr (2007), "Use of imaging procedures in the diagnostics of osteoporosis interpretation of X-ia)s and bone density measurements", PubMed,
157(23-24), 593-605.
Worls Health Organisation Study, (1994), Assessment of fracture ri.sk and its application to screening for po.st-menopausal
o.steoporosi.s, WHO Technical Report Series, 843.
10. WHO study group (1998), ''A.sses.sment of fracture ri.sk and its application to screening for posmenopausal o.steoporosi.s", World
health organi/alion, pp 1 129.
11. WHO, Bulletin of World Health ()ii:anization (i999), 77(5). 416- 426
MO TA TRIEU
C H Q N GLAM SANG, XET NGHIEM, NOI SOI PHE QUAN
C O A B E N HNHAN MAC UNG THL/ PHOI DIEU TRj
TAI KHOA NOI II BENH VIEN VIET TIEP TLf 1/2010 - 6/2011
Dinh Thi Phuoiig Lan*, Luong Dinh Ha*
TOM TAT
Hien nay, ung thU phoi la benh co ty le nnac hang dau va tii" vong cao d nam gidi. Oe'dieu tri co hieu qua benh can phai dUdc chan doan giai ^oan con co the can thiep dUdc. Muc tieu: Nghien cii'u lam sang, xquang, noi soi va ket qua mo benh hpc ciia ung thU phoi va hieu qua ciia phUdng phap npi soi. Doi tU^ng nghien cuTu: 45 benh nhan dUdc chan doan xac dinh ung thU phoi tai khoa Npi 2 Benh vien Viet tiep tir thangl/2010 den 6/2011. PhUdng phap nghien curu: mo ta cat ngang. Ket qua: trieu chu'ng hay gap:
dau ngUc (75,56%), ho keo dai (57,78%), kho thd (53,33%), hoi chu'ng 3 giam (933,33%), co hach thu'dng don (22,22%), hoi chu'ng can u (28,89%). Npi soi phe quan, ton thu'dng dang tham nhiem hay gap (64,44%), chit hep phu ne (57,78%). Chan doan xac djnh chii yeu sinh thiet phe quan (97,72%). Mo benh hpc ghi nhan 48,89% ung thU bieu mo tuyen, 37,78%
ung thu bieu mo vay. Ket luan: 3 trieu chu'ng thu'dng gap la dau ngUc, ho keo dai, kho thd. Npi soi phe quan
thiet phe quan qua npi soi cho hieu qua chan doan cao.
Tit khoa: ung thU phoi, npi soi phe quan.
SUMMARY
OVERVIEW OF LUNG CANCER DIANOSIS IN RESPIRATORY DEPARTEMENT, VIET TIEP
HOSPITAL FROM 1/2010 TO 6 / 2 0 1 1 Nowadays, lung cancer stands at the first place in the area of the incidence and mortality rate in men.
Early diagnostic plays one of the most important roles in saving patients' lives. Objective: Determining the clinical symptoms and sign of lung cancer patients and evaluating results of diagnostic tests. Subjects: 45 lung-cancer patients in Respiratory Departement of Viet Tiep from January 2010 to June 2011. Method:
Etude restrospective sectionale. Results: chest pain (75,56%), cough (57,78%), dyspnea (53,33%), pleural effusion (33,33%), lymph nodes (22,22%).
Almost all patients referred to hospital in pre-terminal
