TCNCYH Phu trwang 80 (3A) - 2012
TY LE NHIEM SAN LA GAN LON TREN NHOM BENH NHAN DU'P'C CHAN DOAN U GAN
Nguyin Van De', Phan Thj Hunyng Lien\ Pham Nggc Minh^ va Do Tuan Anh^
'Trwdng Dai hoc Y Ha Noi, ^Benh vien Viet Dire. Ha Noi Tai cac bdnh vien Hd Ndi nam 2010 - 2011. theo ddi trdn 339 bdnh nhdn duac chin dodn khi nhdp vien Id u gan tidn hanh xet nghidm xdc dmh nhidm sdn Id gan Idn. Kit qua cho thiy, cd 111 bdnh nhdn nhidm sdn Id gan Idn (32.7%). Tren nhdm benh nhan sdn la gan Idn, nam chidm 59.5%. nw chiim 40.5%, cdc tndu chdng lam sang chu yiu gdm sdt 71.2%, sut can 73.0%. dau ha suon phat 73,0%, dm ach khd tidu 64,9%,. dau thuong vi 61.3%. rdi loan tieu hod 25.2%,. sin ngwa 21 6%, vdng da, vdng mdt 9.0%
Tneu chirng can Idm sang chu ydu d nhdm san la gan Idn gdm ELISA(+) 100%, (cd hidu gid khdng thd tir 1/3200 - 1/12800), tin thwong gan dang u 100%. tang BCAT 92,8%. tim thdy trung sdn trong phdn cd 6.3%. Trong nhdm u gan chi cd tndu chwng sut can la cao nhdt (53 5%>) thw din Id dau ha swdn phat (42.1 %,) cdn cac tneu chwng khdc rit thdp
Tiy khoa: U gan, san fa gan Idn, Fascioia I. DAT V A N Bt
U gan la mot dang u thudng gap, do nhilu nguyen nhan tao nen, trong dd ed ky sinh trung, dae biet la san la gan ldn tao khli u trong gan khd phan biet vdi cac khoi u nhat la ung thu Do dd, ma cac thly thuic d l ehln doan nhdm vdi ung thu gan va xir ly nhu mdt ung thu (phlu thugt cat bd, tlem/truyln hoa chat, chay tia .,) d i n den hau qua khdng tit cho benh nhan, trong liic dd dilu tn san la gan ldn ehi can uong thule
Benh san la gan ldn (Fasciollasis) do loai san Fascioia hepatlca hoae Fasciolia glganti- ca gay nen. Ca 2 loai nay phan b l d Trung QuIe, Dai Loan, Viet Nam, Lao, Campu- chia...[10] Benh san la gan ldn anh hudng Idn d i n sire khoe cdng ddng va gay t i n thuang nang ne gan mat, ed t h i d i n d i n eac biln chirng nguy hilm nhu tac mat, xa hoa dudng mat va cd lien quan d i n ung thu gan mat. Cac bilu hien lam sang ciia benh khdng dae hieu nhu sot, dau bung vung ha sudn phai hoae thuang vi, siit can, met moi. , Sieu am cd t h i thly t i n thuang dac hieu cita
SLGL, Song, tieu ehuin vang d l ehan doan benh la tim thly trirng trong phan, nhung ty le tim thay trirng trong phan thdp, phln Idn cae trudng hap khdng tim thly, Huylt thanh miln dich hoe dac hieu rdt cd gia tn trong chan doan xac djnh, song phuang tien nay chua duac trang bi rdng rai ma chf dugc trang bi d cac tuyln chuyen sau. Oac biet, mil quan tam d i n benh, eac hilu bilt v l lam sang, can lam sang, dilu tri va phdng ngira benh cdn it do vay ma ehan doan -thudng mudn, ty le bd sdt nguyen nhan ky smh triing cdn cao hay chin doan nhim d l lai nhilu hau qua nghiem trong dang tile, lam giam, tham chl mdt kha nang lao ddng, lam anh hudng tu tudng, nilm tin, sue khoe cita ngudl benh, cQng nhu gia dtnh va xa hpi.
Trong lue dd, san la gan ldn luu hanh it nhlt d 52 tinh vdi tren 20.000 benh nhan ( s l lieu chua edng bl), cd nai ty le nhilm 11,1% nhu d Khanh Hoa [1]. Mdt nghien cuu nam 2006 cho thly tai khoa Gan mat benh vien Viet D(yc Ha Ndi cd 11% nhilm san la gan ldn trong s l benh nhan chin doan bi benh gan dugc vao vien [2] va tu nam 2006 - 2010
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TCNCYH Phu trwang 80 (3A) - 2012 cung da xac djnh cd 34,6% nhilm san la gan'
Idn tren nhdm benh nhan dugc chin doan "u gan" [3], Viec xac dinh nguyen nhan sinh u do san lan gan Idn hay do nguyen nhan khae rdt quan trpng ca v l xir ly va tien lugng benh. Do vay chiing tdi tien hanh d l tai ty le nhilm san la gan ldn tren nhdm benh nhan dugc chan doan u gan tai benh vien Ha Ndi nam 2010-2011 vdi muc tieu.
Xac dinh ty le nhiim san la gan Idn tren nhom benh nhan dwac chin doan la "u gan"
Mo ta mot so hinh anh lam sang va can lam sang chu yeu a doi twang theo dot.
II. 0 6 l TU'gNG VA PHU'aNG PHAP 1. Ddi tu'O'ng
Bao g i m 339 benh nhan duac chan doan la u gan tir cae benh vien Viet Qdrc, benh vien Quan Y 108, benh vien Bach Mai, benh vien Nhi Trung uang, benh vien Oai hoc Y Ha Npi trong nam 2010 - 2011.
1.1. Tieu chuan chon benh nhan Tat ca benh nhan khong phan biet tuli, gidi, nghl nghiep, dan tpc, vj tri dia ly d i u duge ehpn vao m l u nghien ciru thoa man cac chl so sau:
Benh nhan dwoc chin doan la u gan cd hinh anh sieu am, CT gan hay MRI va ding y tham gia theo doi nghien ciru
Benh nhan nhilm san la gan Idn khi ed phan irng huylt thanh miln djch hoc bang phuang phap ELISA vdt khang nguyen F.
gigantica cd k i t qua duang tinh tir 1/3200 trd len (ngudng am tinh la 1/800) hay benh nhan CO trirng san la gan ldn trong phan
1.2 Tieu chuan ioai trip
- Benh nhan khong chip thuan tham gia nghien eiru
Benh nhan eo ELISA tir 1/1.600 trd
xuing d l loai trir nhtrng trudng hap trong vung djch te cd tilp xiic mim benh, ed khang t h i trong mau nhung khdng bi benh san la gan Idn.
2. PhU'O'ng phap nghien ciru: Nghien ciru theo phuang phap md ta
Xay dung benh an nghien ciru cho toan bd cae benh nhan la ddi tuang nghien ciru.
Kham lam sang de ghi nhan cac tneu chirng; ghi nhan cac hinh anh sieu am gan mat, CT/MRI; lam phan irng ELISA; xet nghiem phan tim trirng san la gan ldn.
3. PhU'O'ng phap thu thap va xu' ly so lieu
Thu thap cac s l lieu theo cac biln so nghien ciru cac thdng tin can thiet theo mau benh an
Xu' ly cae s l lieu thu duac theo phuang phap thing ke y hoc, sir dung phan mim Excel, SPSS 15 0
III. K ^ T Q U A
1. Ty le n h i l m san la gan Idn tren nhom benh nhan duac c h i n doan la u gan
Trong nhdm benh nhan duac ehln doan u gan tai eac benh vien Ha Ndi, chung tdi theo ddi 339 benh nhan, cd 111 benh nhan nhiem san la gan ldn, chilm 32,7%,
Bang 1. Mot so dau hieu can lam sang chil yeu tren 98 benh nhan san la gan
Idn
Gidi tinh
%
Nam
Nu' 45 40,5
Trong s l benh nhan san la gan ldn, nam gidl ehilm 59,5% (66/111) va nir gidi chilm 40,5% (45/111)
TCNCYH Phu trwang 80 (3A) - 2012
Ten tinh HaNpi Nghe An Thanh Hoa Quang Ninh Hal Phong VTnh Phuc Bac Giang Hai Duong Ha TTnh Nam Dmh B^c Ninh Nmh Binh Phu Tho
Bang 2. Phan bfl benh nhan san la gan
n % Ten tinh 19 17,1 Hung Yen 12 10,8 Lao Cai
9 8,1 Hoa Binh 8 7,2 Thai Binh 6 5,4 Thai Nguyen 6 5,4 Tuyen Quang 6 5,4 Quang Binh 5 4,5 Quang Tn 4 3,6 Son La 4 3,6 Yen Bai 4 3,6 Ha Nam 3 2,7 Oac Lac 3 2,7 Kon Tum
Id'n theo tinh
n 3 3 2 2 2 2 2 1 1 1 1 1 1
%
2,7 2,7 1,8 1,8 1,6 1,8 1,8 0,9 0,9 0,9 0,9 0,9 0,9 Trong bang 2, benh nhan d i n tir 26 tfnh, ehu yeu d mien Bae, trong dd Ha Ndi la dia phuang nhilu benh nhan nhlt (ehilm 17,1% trong tong so benh nhan), tiep d i n la Nghe An (10,8%)
2. Cac bieu hien lam sang chu yeu
Bang 3. Cac b i l u hien lam sang thu'dng gap Trieu chirng n = 339 Nhdm SLGL/%(n = 111)
Sut can Dau ha suo'n phai Sot
81 (73,0%) 81 (73,0%) 79(71,2%)
Nhom u gan/ % (n = 228) 122 (53,5%)
96(42,1%) 16 (7,0%) Am ach l<hfl tieu
Dau thuong vi Rfli loan tieu hoa S^n ngua
72 (64,9%) 68(61,3%) 28 (25,2%) 24(21,6%)
10(4,4%) 5 (2,2%) 3 (1,3%) 1 (0,4%)
Vang da, vang mat 10(9,0%) 2 (0,8%)
Bang 3 cho thSy o nhom benh nhan san la gan Ion, sut can va dau ha suo'n phai la tneu chifng thuong gap nh§t, thif dfln la sflt. am ach khfl tieu va dau thuong vi con mot sfl tneu chifng khac nhu roi loan tieu hoa, sSn ngifa, vang da, vang mat co ty le thap hon Trong khi dfl
TCNCYH PhiJ trwang 80 (3A) - 2012 nhdm u gan chf cd trieu ehirng sut can la cao nhlt thir d i n ia dau ha sudn phai cdn cac tneu chirng khac rdt thdp
3. Cac b i l u hieu can lam sang chu yeu
Bang 4. Mot s6 d^u hieu can lam sang chu y l u tren 98 benh nhan san la gan Idn Bach cau ai toan
> 8% (%)
Trirng san la gan Idn trong phan (%) 103(92,8%) 7 (6,3%) Tat ca cac benh nhan san la gan ldn d i u CO ELISA (+) vdl khang nguyen Fascioia spp tir 1/3200-1/12800 va d i u cd ton thuang gan tren hinh anh sieu am Hdu hit ed bach cau ai toan tang eao va cht cd 6,3% phat hien trirng trong phan.
IV. BAN LUAN
Trong nhdm 339 benh nhan dugc chan doan u gan tai cac benh vien Ha Ndi, cd 111 benh nhan nhiem san la gan ldn, ehilm 32,7%, trong so benh nhan san la gan Idn, nam gidi chilm 59,5% (66/111) va nQ- gidi chilm 40,5%. (45/111). So vdi k i t qua cua Nguyin Van O l va cdng su (2006) s l benh nhan dilu tri tai khoa gan mat benh vien Viet Oirc cd 11% bi nhilm san la gan ldn. kit qua trong nghien ciru nay cao han, nhung so vdi kit qua nam 2006 - 2010 thi tuang tu (32,7%
so vdi 34,6%.) [3] V l gidi tinh, k i t qua nay cung tuang t u vdi kit qua cua Nguyen Van Be va cgng su (2006) la nam chilm 54,9%..
nu- chilm 45,1% va nam 2006 - 2010 la nam 52% va nir 48% Theo Rafael "va edng su (1995) ty le 14 nam/6 nu'; theo Robert (2005): nam 60% va nu 40% [10] Mdt s l tae gia khac ty le nhilm san la gan ldn d nCr cao han nam nhu Trln Vmh Hiln (2004) [5]- nQ' 69% va nam 3 1 % , Vd Hung (2002): nam 28,8% va nir 71,2% [6]
Trong nghien cuu nay t i t ca eae benh
ELISA 1/3200- 1/12800 (%) 111 (100%)
Tdn thuang gan tren sieu am (%) 111 (100%) nhan vao benh vien duae chin doan la u gan vdl cae tneu chirng eua u gan.
Sau khl tiln hanh chin doan phan biet eho thay, d nhdm benh nhan nhilm san la gan ldn, eac tneu chirng lam sang chu ylu gdm sut can va dau ha sudn phai la trieu chirng thudng gap nhlt (73,0%), thir d i n la s i t (71,2%), am ach kho tieu 64,9%, dau thuang vi 61,3%, roi loan tieu hoa 25,2%, sin ngira 21,6%, vang da, vang mat 9,0%.
Kit qua cua trieu ehirng s i t phii hgp vdi kit qua cua Nguyin Van De 60 - 68,6% [2]; Vo Hung 56,3% [6], Trln Vinh Hiln 57% [5], Pham Thi Kim Ngan 55,2% [8]; Rafael Arjona 60%[9] Trieu ehirng sut can so vdi tac gia Nguyen Van O l sut can chilm 57,1 - 52,9%
va 74,5% [2, 3], Vd Hung 59,2% [6] Tneu chu'ng san trong kit qua eiia cac tae gta khac nhu Nguyin Van D l 31,4%, 19,4% [2, 3].
Trong lite dd nhdm u gan chf cd trieu ehirng sut can la cao nhat (53,5%.) thir d i n la dau ha sudn phai (43,1%.) cdn cae tneu chiPng khac rat thdp, cu t h i s i t (7,0%), am ach khd tieu 4,4%, dau thuang vi 2,2%, r l i loan tieu hoa 1,3%, s i n ngira 0,4%, vang da, vang mdt 0,8%). Kit qua nay hoan toan phu hgp vdi kit qua ciia Nguyen Van O l va es, 2011 131
Bilu hien can lam sang chit y l u bao gdm tdt ca eac benh nhan san la gan ldn d i u cd ELISA (+) tu 1/3200-1/12800 va deu ed t i n
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TCNCYH Phu tnmng 80 (3A) - 2012 thuong gan tren hinh anh sieu am (100%).
Hau hflt CO bach c§u ai toan tang cao (92.8%) va chf CO 6,3% phat hien trirng trong phan,
Theo cac tac gia Nguyfln Van De 16,9- 25,7% benh nhan san la gan Ion cfl trirng trong phan[4] Mflt sfl tac gia khac ty lfl tim thay trirng san trong phan rSt thSp nhu Tr§n Vinh Hien la 5% [5]; Vo Hung chi co 1/191 b?nh nhan (0,5%) [6]; Nguyin Van Kha 1,71% [7]. Trong liic 36 nhom benh nhan u gan chf tuong tu nhflm san la gan \iyn la cfl ton thuang dang u 100%, khflng co truo'ng h(?p nao CO bach cilu ai toan cao tren 7% va dac biflt khflng co truo'ng hgp nao ELISA (+) tren 1/1600. Vo'i kflt qua nay tuong tu kk qua ciia Nguyin Van D§ va cflng su, 2011 [3].
V. K^T LUAN
Trong nhom benh nhan dugc chin doan
"u gan" tai cac benh vien Ha Nfli, chung tfli theo dfli 339 benh nhan, cfl 111 benh nhan nhiem san la gan \dn, chilm 32,7%, Trong sfl nhiflm san la gan \cm. nam giO'i chiflm 59,5%, nu giO'i chiflm 40,5%.
Tren nhom benh nhan san la gan id'n, cac trieu chifng lam sang chii yflu gflm sut can 73%, dau ha suo'n phai 73%, sflt (71,2%),
$m ach kho tieu 64,9%, dau thugng vi 61,3%, rfli loan tieu hoa 25,2%, san ngu'a 21,6%, vang da, vang mit 9% Trieu chirng can lam sang chu yflu o nhflm san la gan Ifl'n gom ELISA(+) 100% (cfl hieu gia khang thfl tir 1/3200 - 1/12800), tfln thuong gan dang u 100%, tang bach c§u ai toan 92,8%, tim thly trirng san trong phan chf cfl 6,3%.
Tren nhom benh nhan u gan, chf c6 trieu chu'ng sut can la cao nhlt (53,5%) thif dfln la dau ha suo'n phai (42,1%), sflt (7%), am ach khfl tieu 4,4%, dau thugng vi 2,2%, rfli loan
tieu hoa 1,3%, s i n ngifa 0,4%, vang da, vang mat 0,8%. Trieu chifng c?n lam sang trong nhom benh nhan u gan chi cfl ton thuong gan dang u 100%, khong cfl truo'ng hgp nao ELISA (+) tir 1/3200 trfl' len va dac biet khflng co truo'ng hgp nao tang bach cau ai toan.
TAI LIEU THAIVI KHAO 1. Nguyin Van 06, Le Thj Xuan, Le Van Chau va cong sip (2003). Kfltqua buoc dau dilu tra benh san la gan Ion 6' Khanh Hoa.
Tap chl Y hgc thuc hanh so 3 : 77 - 80, 2. Nguyin Van D l , Doan Thanh Tiing, D6 T u i n Anh, Nguyin Khanh Tr?ch(2006).
Bilu hien benh ly ciia benh san la gan Ifl'n Fasciolasis g Viet Nam Tap chi Y hoc Viflt Nam (8): 2 9 - 3 5 .
3. Nguyin Van D l , Dfl Tuin Anh (2011).
Nhilm san la gan Ifl'n tren nhom nguoi dugc chan doan la U gan tai benh vien Viet DifC nam 2006 - 2010. Tap chi Y hoc thifo hanh, (8) 169-172
4. Nguyin Van Dfl (2005). San la gan vo'i ung thu gan mat. Tap chi Y hoc Viet Nam (310): 3 5 - 5 2
5. Trln Vinh Hiln, Trln Thj Kim Dung (2004). Benh san la gan o Viet Nam. Tap chi thong tin Y Dugc. Sfl chuyen de gan mat;
142-149
6. Vo Hu'ng, H6 Viet My, Le Quang Hung va cong sir (2002). Nhan xet dac dilm lam sang va xet nghiem benh san la gan Ign tai Binh Dmh. Tap chi nghien ciru y hpc, (4) 154-159.
7. Nguyin Van Kha (2005). Nghien ciru thuc trang nhilm san la gan Ifl'n va mpt so ylu ta nguy eg g mflt s6 dilm ciia 2 tinh PhiJ Yen va Khanh Hoa Luan van thac sT y hgc - Bfl Y te, Trugng Oai hpc Y Ha Nfli
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TCNCYH Phu trwang 80 (3A) - 2012 8. Pham Thj Kim Ngan (2006). Oac dilm man liver flukes A review Res Rev Parasitol hinh anh ciia ton thugng gan do san la gan 57; 145 - 218
lon tren sieu am va chup oat lgp vi tinh Luan ,,„ ^ . ^ ^ ^ ^ 1 ^ . , ^^.^^ ^^^^^^ ^ ^ 1 ^ ^ ^ ^ ^ . ^ , van thac sT y hgc - Truong Oai hoc Y Ha Nfli z„^„^^^, Intemational IWedical Foundation
9. Mas-Coma S, Bargues MD (1997). Hu- of Japan. Tokyo-1991: 60 - 80.
Summary
FASCIOLIASIS INFECTION IN TUMOUR LIVER PATIENTS GROUP DIAGNOSED AT HANOI HOSPITALS DURING 2010-2011
Case study on 339 patients, who diagnosed tumour liver, examined for fasciollasis for all of them in Hanoi hospitals during 2010-2011. The results showed that, there were 111 fasioliasis patients (32.7%,). In fasciollasis patients group, male 59.5% and female 40.5%,. The mam clini- cal symptoms on these patients were found as loosed weight of 73%, pain of liver of 73%,, fever of 71.2%, plodding of 64.9%,, abdominal pain of 61.3%,, digestive disorder of 25.2%,. allergy of 21.6%, and jaundice of 9%. The main para-clinical symptoms in fasciollasis patients showed that positive ELISA test by Fascioia gigantica antigen of 100%, with titer of 1/3200 to 1/12800;
clearly prejudice in liver by ultrasound of 100%,; eoslnophillia of 92.8%,; positive stool examina- tion with Fascioia egg of 6.3%. The first clinical symptoms in tumour patients group was loosed weight (53.5%o) and the second was pain of liver (42.1 %j and other symptoms were low.
Keywords: tumour liver, fascioliasi^
CAP NHAT BENH KY SINH TRUNG O VIET NAM
Nguyin Van De Trwdng Dai hoc Y Ha Nol Vi$t Nam Id nwdc nhidt ddi. ve smh mdi trwdng, ldi sdng, tdp qudn dn udng, canh tac cua ngwdi dan Id diiu kidn thudn loi cho cac benh ky sinh trimg phdt tnin vd phd biin trong todn qudc Benh ky sinh trung Id gdnh ndng benh tdt cOa cdng ding. Nhidm giun dwdng rudt phd biin tren toan qudc. cd nai a miin Bdc ty Id nhidm giun dua, giun tdc Id 80-90%,, nhiim giun mdc/md cd noi 70 - 85%. Sdn Id gan nhd phdn bd d it nhit 32 tinh, cd dia phwong ty Id nhidm trdn 30%,. Sdn la gan Idn phan bd a it nhit tren 52 tinh vdi sd Iwang trdn 20.000 benh nhan, cd noi ty Id nhidm 11.1%, Sdn Id rudt Idn Iwu hdnh d It nhit 16 tinh, cd noi ty Id nhidm 3.8%> San Id phdi Iwu hdnh d It nhit 10 tinh, cd nai ty Id nhidm 15%. Sdn Id rudt nhd dd xdc dmh Iwu hdnh d it nhit 18 tinh vdi 5 lodi. cd noi ty Id nhiem tdi 52,4%, Sdn ddy/iu trung san Ion Iw-u hdnh d It nhit 50 tinh. cd nai ty Id nhiim sdn day 12%, vd nhidm iu trung sdn lon 7.2%,. Bdnh giun xoin trichi- nelliasis da gdy ra 5 vu dich vdi tren 100 bdnh nhdn vd tw vong 8 ngwdi Da cd hdng tram benh nhdn nhiim giun Gnathostoma spinigerum, nhiiu chuc tre em viem mang ndo tdng bach ciu di toan do nhiim giun Iwan Angiostrongylus. Giun Dirofilana repens va Thelazia callipaeda ky smh d mdt ngwdi dd dwac phdt hidn Cf Viet Nam cd 43,4 tndu ngwdi sdng trong viing sit ret trong dd cd 15 tndu ngwdi sdng trong vung sdt rdt ndng.
Tiy khoa: Ky sinh triing, benh ky sinh trung, Viet Nam
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