CUU KHOA HOC

NGHIEN CUU KHOA HOC

NGHIEN CUU KHANG NGUYEN NS1,

KHANG THE ANTI-DENGUE (IGM VA IGG) TRONG CHAN DOAN SOM SOT XUAT HUYET

N g u y i n Trung Kien', Trdn Thi Minh Di4m^

TOM TAT

Sdt SD/ SXHD la mdt trong nhiing benh truyen nhiem cd ti le mac va tii vong cao. Benh da va dang trd thanh van de y te nghiem trgng can dugc quan tam. Miic tieu nghien cim (l)Xac dmh ty ie ducmg tinh cua khang nguyen NSI, khang the anti-Dengue IgG vit IgM vdi test nhanh SD Dengue Duo (2)Khao sat su lien quan giiia cac ty le duong tinh cua NSI, anti-Dengue IgM, anti- Dengue IgG va mgt sd dac diem lam sitng vit te bao mau Phuang phap nghien ciiu: Thiet ke md ta cat ngang. Tir 4/

2012 din 4 / 2013 tai benh vien Binh Thanh. Mau 1000 benh nhan, dugc lam sang theo doi SXHD va dugc chi dmh lam xet nghiem cdng thicc mau, NSI vit anti-Dengue IgM va IgG. Chan doan huyet thanh Dengue duong tinh bao gdm duang tinh vdi it nhat mgt trong ba chi diem huyet thanh: khang nguyen NS 1, khang the anti- Dengue IgM, anti-Dengue IgG. Ket qua: Qua nghien cuu 1000 trudng hap dugc chan doan Iam sitng la SXHD tai Benh vien Quan Binh Thanh - Thitnh Phd Hd Chi Minh; nam:

50,2% va nii 49,8%. Benh nhan duong tinh vdi chan doan huyet thanh Dengue ty le 40,1%. trong do, nhdm

khang nguyen NS1(+) don thuan ty le cao (24,1%); sd Iuang bach cau trung binh Sa (4,1 ±2,1) x 109/L Nhdm cd NSl(-) cd sd lugng bach cau trung binh la 7,8 ± 4,2.

Su khac biet ciia hai nhdm tren cd y nghia thdng ke (p<

0,001). Sd lugng trung binh tiiu cau la (152,3 ±68,7) G/L trong nhdm NSl(+);thap hon nhieu so vdi nhdm cd NSI(-) la (244,9 ± 99,2) G/L. Su khac biet cd y nghia thdng ke. Ket luan: Ty le cao benh nhan duong tinh vdi chan doan huyet thanh Dengue; do do can tuyen truyen van dgng ngudi dan each phdng tranh SXHD. Sir dung thudng quy xet nghiem SD Bioline Dengue duo de xac dinh chan doan sdm SXHD. Ket hgp anti-Dengue IgM va anti - Dengue IgG de lam tang them gia tri chan doan.

RESEARCH NSlAg, ANTI - DENGUE (IgM AND IgG) IN EARLY DIAGNOSIS DENGUE

Nguyen Trung Kien - Binh Thanh District Hospital -HCMC

Tran Thi Mmh Diem - Pathophysiology Immune Department - Hue Medical University

1. Benh vien Quan Binh Thanh, TpHCM

2. Bg mdn Mien Djch, Sinh Ly Benh, Trirdng Dai hoc Y Duffc Hue

Ngay nhan bai: 10/11/2014 I Ngay phan bien: 13/11/2014 j >^ Ngay duyet dang: 15/11/2014

22

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CONG E)ONG 2014

ABSTRACT

Background: Dengue hemorrhagic fever ( DHF ) is an infectious disease caused by dengue virus . The disease occurs throughout the year , often increases during the rainy season and often found in children as well as adults . The kit NSI antigen detection , anti - Dengue antibodies ( IgM , IgG ) were present on the market and is being used in some hospitals contributed in the rapid diagnosis of dengue fever .

Methods: The study was conducted according to cross-sectional descriptive design. During the period from April 2012 to April 2013 in Binh Thanh District Hospital we have collected 1000 patient age and gender discrimination, the DHF clinical monitoring and testing specified CBC, and anti-Dengue NSI IgM and IgG. Results. The sample had equal proportions of men and women ( men : 50.2 % and 49.8 % female ) , average age was 19.9 ± 15.56 ; Patients tested positive for dengue serological diagnosis , accounting for 40.1 %; the NSI antigen ( + ) alone accounted for the highest percentage ( 24.1 % ). Patients diagnosed with NSI serum ( + , the average leukocyte count was (4.1

±2.1 ) X 109 / L in the group NSI ( - ) had an average neutrophil count is 7.8 ± 4 2 .

The difference of the above two groups was statistically significant (p<0.001). The average number of platelets is ( 152.3 ± 68.7 ) G / L in group NSI ( + ) in the group NSI ( - ) is ( 244.9 ± 99.2 ) G / , The difference between the two groups is statistically significant .Conclusion: High proportion of infection therefore have good coordination in the prevention locally. The routine use of SD Bioline Dengue Duo test to confirm a diagnosis of DHF soon. Combining anti-dengue IgM and anti - Dengue IgG to augment diagnostic value.

D^T VAN DE:

Sdt xuit huylt Dengue (SXHD) la benh truySn nhiem do vi-rut Dengue giiy nen va mudi Aedes aegypti la vec-ta trung gian truyen benh SXHD. Benh xay ra quanh nam, thudng gia tang vao miia mua va gap d tre em cung nhu ngudi Idn. Dac diem ciia sdt xuat huyet Dengue lit sdt, xuat huyet, thoat huyet tuang, cd the dan den sdc giam the tich tuan hoiin, rdt loan dong man, suy tang Neu khdng dugc chan doan sdm va xir tri kip thdi de dan den tir vong [3]. Tai Viet Nam, sdt SXHD lit mdt trong nhii'ng benh truyen nhiem cd ti le mac vit tir vong cao, benh da vii dang trd thanh van de y te nghiem trgng can dugc quan tam. Chan doan SXHD khdng nhiing dua tren nhirng trieu chting lam simg, ma cdn dua tren cac phuang tien chan doan can lam sitng cho ket qua nhanh chdng cd do nhay va do dac hieu cao. Bg kit phat hien khang nguyen NSI, khang the anti-Dengue (IgM, IgG) da cd mat tren thi trudng vit dang dugc sir dung tai mdt sd benh vien gdp phan trong cdng tac chan doan nhanh sdt xuat huyet. Chung tdi tien hanh nghien ciiu de titi nay nham muc tieu (l)Xac djnh ty le duang tinh ciia khang nguyen NSI, khang the anti-Dengue IgG va IgM vdi test nhanh SD Dengue Duo. (2)Khao sat su lien quan giiia cac ty le duang tinh ciia NSI, anti-Dengue IgM, anti-Dengue IgG vit mdt sd dac diem lam simg vit te biio mau. Xac dinh do phii hgp ciia test nhanh va tieu chuan chan doan sdt xuat huyet Dengue ciia Bd Y te trong vung dich.

DOI TUOfNG - PHUONG PHAP NGHIEN CUU:

Doi tugng nghien cu'u

Gdm tat ca benh nhan dugc lam sang theo ddi SXHD, kham va dieu tri tai Khoa Cap ciiu, Khoa Kham benh, Khoa Nhi tai Benh vien Binh Thanh, TP Hd Chi Minh.

Tit 4/2012 din 4 / 2 0 1 3

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NGHIEN CUU KHOA HOC

Thiet ke nghien ciru md tit cat ngang.

Cd mlu.. Man 1000 benh nhan. Chgn mau Tat ca cac benh nhan dugc chan doan lam sang theo ddi SXHD va dugc chi dinh lam xet nghiem cdng thiic mau, NSI va anti-Dengue IgM va IgG.

Vat lieu va ky thuat nghien ciiu . Su dung Bg xet nghiem chSn doan SD BIOLINE Dengue Duo cua Hang Biolin (Han qude) de phat hien NSI, anti-Dengue IgM va anti-Dengue IgG.

Xet nghiem cdng thirc mau. Xet nghiem cdng thirc

man duac thuc hien bdi may phan tich te bao Humacount plus ciia hang Human - Diic

Xu ly va phiin tich b^ng phin mem Excel 2010, SPSS 16.0

KET QUA NGHIEN ClTU

Dac diSm. Nam ty le 50,2 %. Nu ty le 49,8 %. Tudi trung binh lii 19,9 ± 15,6 (tudi nhd nhat la 1 tudi va tudi cao nhat la 91 tudi). Tre em dudi 15 tudi ty le 44,4%.

Ngudi Idn tren 15 tudi ty le 55,6 %.

Bdng 1. Ty le (+) eua NSI hogc anti-Dengue IgM hogc anti-Dengue IgG

Tong so Ty le %

NSI (+) hoac IgM (+) hoac IgG (+)

401 40,1

NSl(-),IgM(-),IgG(-) 599 59,9

Bdng 2. Lien quan giiia NSI vd so luong bgch cdu, BCTT, te bdo lympho, tieu cdu

Te bao mau Bach cau (xlO'/L) Bach cau trung tinh (xlO'/L)

Bach cau lympho

(xlO'/L)

Tieu cau (xlO'/L)

N S l A g Dirong tinh

X 4,1

2,6

1,12

152,3 n 341

341

341

341 SD 2,1

1,8

D,8

68,7

Am tinh X 7,8

5,1

2,10

244,9 n 659

659

659

659 SD 4,2

3,8

1,6

99,2

Chung X 6,5

4,3

1,8

213,3 n 1000

1000

1000

1000 SD 4,0

3,4

1,5

3,4 P

<0,0D1

<0,001

<0,001

<0,001

M ₂₄

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CONGDONG 2014

Bdng 3. Lien quan giira anti -

Te bao mau Bach cau (xlO^/L) Bach cau trung tinh (xlO^/L) Bach cau lympho (xlO^/L) Tieu cau (xlO''/L)

Dengue IgM vd so luOng BC, BCTT, te bdo lympho, tieu cdu Dengue IgM

Ducmg tinh X 3,7

1,8

L3

116,0 n 84

B4

84

84 SD 1,6

1,0

0.8

54,7

Am tinh X 5.8

4,5

1.8

222,2 n 516

316

916

316 SD 4,1

3,5

1,5

98,6

Chung X 6,5

4,3

1,8

213,3 n 1000

1000

1000

1000 SD 4,0

3,4

1,5

100,1 P

<0,00l

<0,001

K0,001

=0,001

Bang 4. Lien quan giOw mtilgG(+)va S luffng BC, BCTT, te liio lympho, tieu

T I bao mau

Bach cau ( X I 0 7 L ) Bach cau trung tinh

(xlO'/L) Te bao lympho (xlO'/L) Ticucau (xlO'/L)

DengueIgG Ducmg tinh

X 4,6

2,7

1,4

123,8 n 126

126

126

126 SD 3,2

2,5

1.2

57,0

Am tinh X 6,8

4,5

1,8

226,2 n 874

874

874

874 SD 4,1

3.5

1,5

97,5

Chung X 6,5

4,3

1,8

213.3 n 1000

1000

1000

1000 SD 4,0

3,4

1.5

100.1 cdu

P

<0,001

kO,OOI

<;o,ooi

<0,001

Bdng 3.16. Lien quan giira khdng

~^^--...„_^^ NSlAg Muc TC^^^--..^^^

< 5 0 x W/L 5 0 - < 100 X I 0 7 L

> 1 0 0 x 1 0 7 L Tong s6 P

Diiong tinh n

8 65 268 341

%

2,3 19,1 78,6 100.0

nguyen NSI vd mue dp tieu cdu Am tinh

n 9 21 629 659

%

1,3 3,2 95,5 100,0

Tdng so n

17 86 897 1000

%

!,7 8,6 89,7 100,0

<0,01

SO13-'rhangll/2014|

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NGHIEN CUU KHOA HOC

BAN LUAN

Mot so dac diem ciia nhom nghien ciru Nghien cuu ciia chiing toi ty le 50,2% la nam ya nu ty le 49,8%, phan b6 ve giai tuang duang nhau. Ket qua cua chiing toi phti hop voi nghien cuu cua tac gia Phan Van Be Bay tai khoa Nhiem Benh vien Dong Thap, ty le benh nhan nam la 52,04% va nu 47,96% [3]. Cac d6i tuang nghien ciiu c6 tuoi trung binh la 19,9 ± 15,56 (tuoi nho nhat la 1 tuoi va cao nhat la 91 tuoi). Tre em <

15 tu6i lit 444 tre ty le 44.4%) va nguoi lan > 15 tuoi la 556 nguai ty Ie 55,6 % (bang 3.2). Tac gia Hoang Lan Phuang, Peter J de Vries va cong su nghien cuu tai tinh Binh Thuan a 2096 benh nhan sot chua ro nguyen nhan duoc chan doan huyet thanh hpc cung co ket qua tuong tu' tre em 42,8% va nguoi lo'n 57,2% [5], [1].

Ty le chan doan huyet thanh NS 1, anti-Dengue IgM, anti-Dengue IgG

Ket qua benh nhan duong tinh voi chan doan huyet thanh Dengue ty le 40,1% va benh nhan am tinh voi chan doan huyet thanh Dengue ty le 59,9 %i. Ty le sa nhiem vi-rtit Dengue la 27,5%; ty Ie tai nhiem Dengue 8,5%.; va nhiem Dengue cu la 4,1%). C6 59,9%i benh nhan chua co dap ijng mien djch doi vai vi-riit Dengue . Chan doan huyet thanh Dengue duong tinh bao gom duong tinh voi it nhat mot trong ba chi diem huyet thanh: khang nguyen NSI, khang the anti- Dengue IgM, anti-Dengue IgG. Chan doan lam sang SXHD a giai doan sam thudng kho khan do cac trieu chiing va dau hieu lam sang khong dac hieu, nhat la khi can gian biet voi mot truang hgp nhiem vi -riit khac [2], [6],

Phan bo ty le cac nhom NSI, anti-Dengue IgM vit anti-Dengue IgG

Phat hien trong so 401 benh nhan co chan doan huyet thanh Dengue duong tinh, nhom khang nguyen NS1(+) don thuan ty le cao nhat (24,1%) tuong ting vai ty le cao ciia benh nhan den kham trong nhiing ngay dSu cua sot, ggi y tinh trang sa nhiem DENV .

Gia tri chan doan som ctia khang nguyen NSI, anti- Dengue IgM, anti-Dengue IgG: So lugng benh nhan chii yeu trong 5 ngay dau ciia sot ty Ie 93,9%o.

Ngay diiu ciia s6t NSI (+) ty le 26,4%, trong khi anti-Dengue IgM la 4%. Ket hgp NSI va IgM ch^n doan duang tinh tang 27%.

Ngay thii hai NS I (+) ty le 39,6% trong khi anti-Dengue IgM la 4,2%i. Ket hap NS 1 va IgM chan doan duong tinh tang 40%j

Ngay thii ba NSI (+) ty le 30,4% trong khi anti- Dengue IgM la 6,1%. Kgt hgp NSI va IgM chin doan duong tinh tang 3l,4%o.

Ngay thii tir NSI (+) ty Ie 40,1% trong khi anti- Dengue IgM la 15%o. K6t hgp NSI va IgM ch§n doan duang tinh tang 44,3%.

Ngay thir nam NSI (+) ty le 37,6% trong khi anti- Dengue IgM la 23,5%i. Ket hgp NSI va IgM chan doan duong tinh tang 45,9%i.

Dua vao tien tnen dpng hoc ciia nong do vi- rut va khang nguyen NSI thi vi- riit xuat hien som nhat ciing dong thai voi NSI o giai doan khoi phat benh, NSI keo dai dSn ngay thii 7. Trong khi do anti-Dengue IgM bat dku. tang ngay thir 4, nong dp IgM ton tai (rong mau 30 ngay trong trirang hgp sa nhiem. IgG xuat hien muon han khoang ngay thii 7. Nhung trong truang hgp tai nhiem IgG xuat hien dong thai vai IgM la ngay thir 4 [7].

Lien quan gifra NSI va so lirong cac te bao mau Ket qua the hien 341 ngudi co chan doan huyet thanh NSI(+) thi so lugng bach cau trung binh la (4,1 ±2,1) x 109/L trong khi nhom co NSl(-) co so lugng bach cau trung binh la (7,8 ±4,2) x 109/L (p < 0,001). Su lien quan giua NSI va so lugng bach cau giam a bang 3.25 cho thay co SIJ khac biet co y nghTa th6ng ke vS ty Ie giam bach cau giiia hai nhom NSI (+) va NSI (-) Ket qua nay phii hgp vdi ca che benh sinh ciia SXHD va tieu chuSn chSn doan ciia Bg Y Td 2/2011 [4].

KET LUAN

Ty le chan doan huyet thanh duong tinh (hoac NSI hoac anti-Dengue IgM hoac anti-Dengue IgG) ty le 40,1%), trong do, nhom khang nguyen NS1(+) dan thuan ty le cao (24,I%i); so lugng bach cau trung binh la (4,1

±2,1) X 109/L. Nhdm co NSI(-) c6 sd lugng bach cSu trung binhla 7,8 ± 4,2. Sir khac biet ciia hai nhdm tren co y nghTa thong ke (p< 0,00t). So lugng trung binh tigu cau la (152,3 ±68,7) G/L trong nhdm NSI(+);thap han nhiSu so vdi nhdm co NSI(-) ta (244,9 ± 99,2) G/L. Su khac biet CO y nghia thong ke. Gia tri chan doan sdm ciia khang nguyen NSI, anti-Dengue IgM, anti-Dengue IgG

Ket luan: Ty Ie cao benh nhan duong tinh vdi chan doan huyet thanh Dengue; do do can tuyen truyen van dong ngudi dan each phong tranh SXHD.

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TAI LIEU THAM KHAO

1. Tran Quang Binh, Hoang Lan Phuang " Chan doan sdm sot xuat huyet dengue bang phat hien khang nguyen khong ciiitriic NSI", Tap chi Y Hoc TRH6 Chi Minh, tap 14, phy ban s6 2, 2010, tr.7-10

2. Bg Y te (2011), Tai lieu huting dan chan doan vit dieu tri sot xuat huyet dengue, tr 2-33.

3. Bo Y te (2012), Titi lieu tap huan sdt xuat huyet 11.2012, Ban dieu hanh phdng chong SXH-D quoc gia.

4. Phan Van Be Bay, Hoang Tien My (2009), "Xet nghiem Elisa phat hien khang nguyen NSI trong chan doan sdt Dengue/sot xuat huyet dengue". Tap chi Y Hpc TP. Hd Chi Minh, tap 13, phu ban sd 1, tr. 249-255.

5. Hoang Lan Phuong, Peter J de Vries, Tran TT Nga, Phan T Giao, Le Q hung, Tran Q Binh, Nguyen V nam, Nico Nagelkerke, piet A kager (2006), " Dengue as a cause of acute undifferentiated fever in Vietnam", BMC infectious diseases, 6:123, pp 1471-2334

6. Wang S.M , Sekaran S.D. (2010), " Evaluation of a commercial SD dengue virus NSI antigen capture enzyme- linked immunosorbent assay kit for early diagnosis of dengue virus infection." J. Cim. Microbiol, pp I0I-I05 7. WHO (2012), "Dengue and severe dengue", http://www.who.int/ mediacentre/factsheets/fsll7/en/

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