JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol 7 - N°3/2012
Nghien ciru thuc trang b^nh glocom trong cOng dong t?i m^t s6 dia ban dan cu tinh Nam Djnh
Studying the Status of Glaucoma Disease in Some Pilots of Nam Dinh Province
» i o Thj Lam Hu-<Viig v4 c?ng sy Binh vign MSI Trung uang
T6m tat
Wire aich mS t4 thvc tr^ng t)*nh glOcSm trong cOng (Jing tai m«t s4 iJia b i n d i n o r cua tinh Nam Dinh.
Bii tuvng: 5.920 ngu'iri (Sin i 35 tu6i * 06 xa thu«c 02 huySn cua tinh Nam Dmh. Phuang phip. mS ti cit ngang. Kit qui: ty 1$ NB gl6c6m va nguy cc cao tjj gl6c6m trong cOng ddng dan cu nghifin ci>u la 2,2% va 10,8%. Hinh thai gi6c6m nguySn phat g6c d i n g chi4m da s4 (60,0%). 40,5% m i l da * giai doan t r i m trpng, g i n mil va mil. 28.5% NB gl6c6m chua tU^ng durprc chSn doSn va d i i u tri. 93,4% ngu<rl dan d« tu6i 235 va 77.9% NB gi6c6m I(h6ng nghe biit gl hoac r i t Iff mcr vi b^nh gl6c6m. 89,9% NB khfing ffi kham theo doi m j l dinh ky do di4u kifin kmh ti xa h«i cua ban than NB nhu' sue khde yiu (40.8%), nha xa (19,2%). kmh t4 kh6 khan (16,2%). Kit luin: Si dat du'O'c hiau qua phbng ch6ng mCi 16a do banh gl6c6m gay nSn c i n thi4t phai Siu tu nang cip kha nang c h i n doan, diAu trj, theo doi NB gl6c6m tai c i c tuy^n y ti ccr so va tang Du'd'ng cdng tac thong tin tuydn truyen Si nguiy't dan va NB glocom hidu bidt vd bdnh glOcdm.
Tir khda: sang loc. gidcdm. cdng ddng.
Summary
Purpose: To describe the status ol glaucoma disease in some localities ol Nam Dinh province. Material:
5.920 residents £ 35 years old in 6 communes of 2 districts in Nam Dlnh province. Method: Descfitie. cross study. Results The rate of glaucoma patients and high risk of glaucoma in studied community were 2.2%
and 10.8% respectively. Angle closure glaucoma took up 60.0%. Among them. 40.5% were in severe, nearly end and end stages. 28.5% of glaucoma patients had not received examination and treatment. 94.3%
of residents £ 35 years old and 77.9% of glaucoma patients didn't have any or just had a little knowledge ol glaucoma 89.9% of patients didn't have regular consultation, due to the patients' socio-economic conditions such as bad health (40.8%). long distance (19.2%) and poverty (16.2%). Conclusions: Jo prevent effectively the blindness due to glaucoma, we have to provide with necessary materials and to improve the capability of diagnosis, treatment and following up glaucoma patients at district and commune levels, as well as publication of wide knowledge of glaucoma.
Key words: Screening, Glaucoma, Community,
I . D a t v a n d d Attlantic nam 2007 cho thdy d' Vidt Nam hidn co Cho ddn nay bdnh glocom vdn la mOt trong ^'"°^"9 ^*-^°° "Butti mu 14 do gidcdm. chidm 6,5%
nhOng nguyen nhan hang ddu gay mil loa vinh vidn ' ° " 9 =° " 9 " ' * ' " > " • ' * " ^0 tuoi, dung hang thu' 2 sau khong hoi phuc tren the gi6i cQng nhu a Vi$t Nam, dye thd thuy tinh. Trong nhidu nam qua nghanh Niian Mat thl luc do glocom gay ra la m « tinh trang bdnh ly ''^"^ "^ "^V " " " 9 ^"'"^ '-"^^ '^^ '•^°"9 chSm soc mSt khong the chira d u w bdng bat cir thudc hay phdu '^^" " ^ ^ ' * " 9 khdp * nhieu tinh thanh trong ca n w c . thuat nao. Kdt qua didu tra lai 16 tinh thdnh cua bdnh °^ " ^ "^'''"a * i ^ " '""''^ P*'°"9 * * " 9 mil loa do vien Mdt trung uang vol sir phoi hgp ciia to chuc 9ldc6m trong cong dong tru'd'c tidn phai danh gia
Phan bien khoa hpc: TS. LE THI DONG PHUONC
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TAP CHl Y DUOC LAM S A N G 108 T$p 7 - S 6 3/2012
du'p'c tinh hinh b$nh gl6c6m trong dSn chOng. Vi v$y chung t6i ti^n heinh 6k tk\ nky vif\ myc ti§u "M6 ti tht^c tr^ng b$nh gidcdm trong c0ng d6ng t^i m^t so dia bin dan cw cOa tinh Nam Dfnh".
2. Ddi tiPQ'ng vd phipcxng p h d p n g h i d n c i K i 2.1. Doi tiFgmg nghiin ciru: \k nhOng ngu'di dSn tren 35 tu6i tJang song tgi 6\a bkn dSn cu" du'p'c lya chon vao nghien c u u .
Ti#u chuan logi triy: nhO'ng ngu'di quk gid y^u, khong phoi hp'p khdm, c h i n dodn, xdc djnh b§nh hodc til' ch6i tham gia nghifin ci^u.
2.2. Phipvng phip nghiin ciru: m6 td cdt ngang, khong doi chijng
C& m3u du'O'c tinh theo cong thCfc:
"-H)^
0.025x0,975 DE = (1,96)>< '•1,5 = 5500(0,005)
Chpn dia bdn ddn cu" nghien cCru theo phu'ang phdp chpn mdu tang: bdt thdm ngSu nhidn du'p'c 02 huyen Id My LOc va Tryc Ninh, or mSi huy$n bdt thdm du'O'c 3 xa: My Tan, My Thudn, My Thjnh (My L$c) vd Li§m Hai, Tryc Bgo, Tryc M? (Tryc Ninh).
Chpn ca the nghien cO-u theo phu'cng phdp n g l u nhien h6 thong, len danh sach toan b6 so dan ^ 35 tuoi cua xa, chon theo bang day so tu" nhien vdi khoang each mdu k, tinh theo cong thCrc k = N/ n (N- Quan the nghien c i / u ; n - C d m l u cdn nghien cCfu).
Chon so n g l u nhien dau tien < k .Tim so sau bdng so tru'de do + k. Can bg y te thon dOi len danh sach doi tu'ong du c d mau de du'a giay mdi den kham tgi trgm y te (TYT) xa theo lich hen.
Tai TYT xa cac doi tu'png nghien CLHU du'ac do thj lye (bang TL Landolt), do nhan ap (NA ke Maclakov, qua can lOg), khdm ban phan tru'de (sinh hien vi), soi goc t i l n phong {kinh Goldmann 1 mdt gu'ang) soi day mdt {kinhVolk hodc may soi day mdt). Moi chi tiet dupc dien vao "Phieu kham sang Ipc ngu'di benh glocom" thiet ke s i n . Doi tu'ong la ngu'di benh (NB) glocom va nguy ca cao bi glocom du'gc mdi di kham tiep tai khoa Glocom benh vien Mdt trung u'ang de danh gia mdc do ton thu'ang thi tru'dng va dTa thi giac bdng TT k6 Goldmann, may chup cdt Idp dTa thj - vong mac OCT.
Vdi nhdng NB glocom dong y tra Idi phong van, thong tin du'gc dien vao bg cau hoi ve mdc dp nghe biet ve glocom va cac phu'ang phap NB da du'ac dieu tri.
XLP ly so lieu: s d dung chu'ang trinh EpiData vd SPSS 19.0.
3. K6t qud vd bdn Iu$n
Chiing t6i dd ti6n hdnh khdm sdng lpc cho 5.920 ngu'di ddn £35 tu6i d 06 xa thudc 02 huy^n cOa tTnh Nam Djnh; 1685 nam, 4235 n d ; tu6i trung binh Id 57.7 ± 13.7, cao nhdt Id 98 tu6i, thdp nhdt Id 35 tudi.
109 ngu'di trong s6 NB gldcflm d6ng y trd Idi bO cdu h6i khdo sdt vfe mdc dO nghe bl^t vk b$nh gl6c6m vd cdc phu'ong phdp NB dd du'pc di6u trj.
Trong t6ng s6 5920 ngudi ddn tham gia khdm sdng Ipc gl6c6m chi co 391 ngudi (6,6%) da tdng nghe bi^t, 1221 ngudi (20,6%) bi^t la m a vd 4308 ngudi (72,8%) khfing nghe bi^t gi vh b0nh glocflm.
S y khde bi0l gida cdc nhom ve muc dO nghe biet gl6c6m c6 ^ nghTa t h i n g kd vdi p < 0,001.
Vdi difeu ki$n trang thiet bj mang theo v^ TYT xa Chung toi da phdt hi$n d u p c 108 NB gl6c6m (1,8%) vd 660 ngudi nghi ngd bj glScom (11,15%). Nhdng dfii tupng ndy d u p c mdi di khdm tgi chuyen khoa mdt tuy^n tinh hodc trung u a n g nhung thyc te chi c6 52 ngudi di khdm (6,8%), cdn Igi 716 ngudi da khong di (93,2%). S y khde bidt gida 2 nhom di, khong di co y nghTa thong ke vdi p < 0,0001.
Bang 1. Phan b d benh mdt cua cac ddi t u o n g diFp'C kham sang lpc
Phan loai
n
%
Benh glocom
130 2,2
Nguy CO bi glocom
NA
46 Goc TP 169
Lom dTa 230
T/s gia dlnh 193 638 10,8
Khac
5152 87,0
Tong
5920 100,0 Trong so 41 doi tuang nguy ca cao di kham lai benh vien Mdt trung u a n g chung toi da phat hien them 22 NB glocom, nang con so sang loc duac NB glocom tai cgng dong dan c u nghien cuu len la 130 ngudi, chiem ty le 2,2%, doi tuang nguy ca cao con lai la 638 ngudi vdi ty le cht6m 10,8%. Day vdn chua phai Id ket qua cuoi cung noi len thyc trang van de cua benh glocom hien nay vi con nhieu doi l u a n g nghl ngd chua di kham xac dinh benh. Kit qua cua chung toi cao han so vdi ket qua (1.6%) cua Nguy§n Trong Nhan va cdng s u [2]. Nguyen nhan la do tieu chuan de xac dinh benh glocom trudc day chi d u a vao chi so NA, nen da bo sot mot so Idn NB glocom khong co NA cao tai Ihdi diem kham sang loc. Ket qua cua chung toi thap han so vdi cac tac gia n u d c
99
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol 7 - N°3;2012
ngodi: ty Id mdc gidodm trong cdng ijAng nhtJng n g u ^ l 2 35 tudi * An B d Id 3.68%, t } Id gidcdm «•
vfmg ndng thdn cOa Myanmar la 4,9% d4n s i trSn 40 tu6i, 1} \i gl6c6m * ngifiri d4n t h i n h thl t?i ThSi lan la 3,8%, t j 1$ glftc6m 4 Singapore la 3,2% dan 86 trSn 40 t u i i [41,[5],[61. d cac nu'dc niy cac il4i t u v n g nguy Off cao gl6c6m du-crc k h i m xac djnh bOnh tai c6c c a s 4 ohuySn khoa m i t nSm g i n dia b i n dSn cu' sinh s i n g v * i d i y du trang t h i i t b| c h i n d o i n nSn da p h i t hi^n dui?c n h i i u NB g i f i c i m h e n .
Trong s i 638 d i i tucrng nghl n g i i c6 g l i c i m thl y i u t i nguy co tai mat c h i i m ty M 69.8% (445 nguiri).
y i u t i gia dlnh c h i i m 30,2% (193 ngi^iri).
VI nguy§n sinh b$nh chu'a rfl rang n6n khSng t h i phdng m i c bSnh gidcdm. Tuy nhi6n c i t h i phbng tranh mil loa do g l i o 6 m n i u banh dup'c p h i t hian 6 giai doan stmt trong c i c d i i tuffng nguy ca cao d i d i i u tri dir phdng va k i i m s o i t qua trinh t i i n t r i i n b$nh trSn nhO'ng NB da khdng may bi gidcdm. T i i n phdng ndng la y i u t i nguy c c gay g i d c i m gdc ddng.
B d s i u t i i n phdng trung binh cua ngudi Vi$t Nam la 2,69 mm - 2.94 mm (3). TrSn nhOng mat dd s4u t i i n phdng < 2,22mm d i x i y ra tinh trang ddng gdc |2],[81.
Mdt trong nhO'ng d i u hidu quan trpng nOa Si c h i n doan xac dinh va theo ddi t i i n t r i i n gidcdm la Idm teo dTa thl giac. Ton thu'o'ng t h i n kinh thi giac thudng x u i t hidn trudc cac t i n thu'ang thi trudng. Theo Quigley H.A va cdng su" (1982) Idp sai t h i n kmh cd the b| mat tdi 40% trong khi thi trudng v i n chua t h i y ton thu'Ong. Sir gidng nhau v i c i u true giai p h i u d nhO'ng ngudi rudt thit ciJa NB gidcdm la y i u t i thuan loi iam ty Id mac bdnh cao hon d cac d i i tuong nay.Ty ie ddng gdc tien phdng d nhOng ngu'di hg hang ddi thir n h i t cua NB gidcdm gdc ddng nguyen phat la 20%, cao g i p 4-5 t i n nhOng ngudi khdng cd tien s i i gia dlnh trong quan the nghien ciru [7]. O i l vdi gidcdm gdc m d nguyen phat cac nha khoa hoc da xac dinh duac gen gay bdnh [9]. VI v$y vide xac dmh bdnh d giai doan sdm va dieu tn kip thdi trong nhu-ng gia dlnh cd ngudi bl gidcdm nguyen phat la vide c i n lam n h i m ha bdt ty te mu loa do gidcdm gay ra trong cdng ddng.
Bang 2. Phan bd ngu'di bdnh theo hinh thai g i d c d m (n = 130 ngu'di)
Trong cdng d i n g dSn cu n g h i i n ci>u cOa chiing tdi gidcdm nguydn phSt c h i i m ty Id 65,4%. trong d i gidcdm gdc ddng c h i i m da s i 60,0% (78/130 NB), gidcdm gdc m i c h i i m 25,4%. T h v c t i trong odng d i n g I j l i g i d c i m gdc md cd t h i cao hon nhu'ng do b i i u hidn b i n h cOa hinh thai n i y thirdng khdng iS rang n i n NB chua quan t i m dl kh4m ph4t hidn »S d i i u tn b i n h . C i c c h u y i n gia cua W H O tiOc tinli tji khu vu'c Bdng Nam A t^ l i gidcdm Id 2,38% dSn s4 trdn 40 t u i i , trong dd gidcdm gdc ddng Id 50,4%, gidcdm gdc m d c h i i m 49,6%.
B i n g 3. P h a n b i m i t n g u ' d i b d n h t h e o glal doan
Hinh thai gidcdm
n
%
Nguyen phat
Gdc md 33 25.4
Gdc dong
78 60,0
Thir phdt
18 13,8
Khac
1 0,8
Ting
130 100
= « a .
n
%
Tiim tang 22 23,4
So phat 13 13,8
T i i n triin 21 22.3
'
Trim trong 32 34,1
Qin mil +
mil 6 6,4
.Jf Ting '5
94 100 Trong s6 94/260 m^l \km du(7C lh| trudng, giai doan t r i m trpng chiem ty 1$ cao n h i t 34,1%. C6 den 6,4% mat da if giai dogn cu6i cua b$nh. K6t qua nghi6n c u u cua chung tfli cOng tucrng t i / nhu cac tac g\k khde \k NB gidcdm t h u d n g khi da phdt hi§n ra b$nh d ^ di di^u Irj thi b$nh da d giai doan nSng [1].
Bdng 4. Phdn b 6 mdt g l o c o m t h e o mCpc nhan ap (n = 257 mat)
lytirc NA n (mat)
%
< 2 5 203 79.0
25-32 43 16.7
>32 11 4.3
257 100 Trong s6 257/260 mSt do dup'c NA ty l§ mat co NA khong difeu chinh chifem tdi 2 1 % (54 mat). Chirc nang th| gikc cua nhdng mat nay tiep tyc bj de doa ma NB da khdng t y nhan bi6t de di kham va di^u tn kip thdi.
Bang 5. Tinh t r ^ n g 6\iu t n mjjit cua n g u d i b^nh g l o c o m (n = 130 n g i f d i ) Tinh
trgng dieu tn mat n (ngu'di)
%
Da duoc diiu tri 1 mat
45 34,6
2 mat 48 36,9
Chua dieu tn
37 28,5
Ting
130 100 Trong nhdm NB glocom da d u a c dieu tn v i n c6n 45 ngudi (34.6%) mdi dieu tri mdt mat, mSt kia ctiifa d u g c quan tam dieu tri d u phong. 37 NB (28,5%) chua tdng d u a c ch^n doan va dieu tn gl6c6m. NhO'ng NB nay cung nhung n g u d i nghi ngd glocom la cac &o\
lug'ng c6 nguy c a mij liem an trong cong dong.
TAP CHi Y DUOC LAM S A N G 108 T i p 7 - S 6 3/2012
Trong so 109 NB gidcdm trS Idi phdng v6n chf cd 22,1% NB (24 ngudi) gidcdm bl^t minh bj gidcdm, han mOt nua s6 NB dup'c hoi (85 ngudi - 77,9%) khdng h\k ho$c rat la m a vi tinh trgng bSnh ciia minh. Cd tdi 35,2% NB (41 ngudi) khdng bi^t phuang phap minh da di^u tri va c i n t l i p tgc theo doi l i u dai. DJ^u dd ndi Idn sy giao ti^p cua nhan vien y t6 vdl NB cdn nhl6u hgn chi.Trong nhi^u trudng hp'p NB khdng dug'c bac sT tri,rc tiep giai thfch tien lug'ng cOa b$nh gidcdm, sif c^n thi6t dieu tri va theo doi lau dai trong quang ddi cdn lai. VI vay NB cho rang b$nh da dup'c chda khdi hokn tokn n6n da khong di kiem tra djnh ky mat.
Trong s6 68 NB bi^t v^ phuang phdp da dup'c difeu In thi cd tdi 91,7% (66 ngudi) da trSi qua can thi$p phSu thuat. Di^u tri bang thudc va laser chl^m ty 1$ riit nhd (2% va 3%). Bieu do la do trdn thi/c tk phuang ti$n laser dieu tn mdi chi cd d mdt s6 tnjng tam nhan khoa Idn nhu Ha Ndi va TP.H6 Chi Minh. Cac thu6c di^u trj h$
NA thudng v u g l qua kha nang chi tra cua NB, chua dup'c BHYT c h i p nh$n thanh toSn d ngay ca tuy^n tinh.
VI vay mac du theo quy trinh nhi^u NB cSn dieu trj bang thuoc van bj ep phai p h i u thuat hoac NB tij' bd di^u tri, ch^p nhan canh mij Ida.
De kiem scat, khdng de b$nh tiep tyc gay ton hgi th^n kinh thj giac NB gificdm c^n phai dup'c ki^m tra mat djnh ky suot quang ddi cdn lai. Ket qua khao sat 109 NB gidcdm cho Ihay dai da so NB gidcdm d cdng dong nghien cuu vdi ty le 89,9% (98 ngudi) da khdng di kham lai mat; 6,4% NB (7 ngudi) khdng di kham thudng xuyen. Ty le NB cd di kham dinh ky chi chiem 3,7% (4 ngudi). Vi vay ty le mat cd muc NA khdng dieu chinh trong nghien c u u cua chung tdi len tdi 2 1 % (Bang 4).
Ly do khdng di kham chu yeu la do dieu kidn kinh te xa hdi cua ban than NB nhu sue khde yeu (40,8%), nha xa (19,2%), kinh te khd khan (16,2%). Khdng chuyen duac BHYT len tuyen tren kham va dieu tri ciJng la mpt rao can NB di kiem tra Igi mat. Oieu dd cho thay nhu cau cua ngudi dan dup'c chSm sdc mat tai tuyen ca s d . Cac tuyen nay c i n dup'c quan lam dau t u nang cap vd trang thiet b|, nhan lye va n i n g luc, kien thuc de cd kha nang chu ddng Itch cue phong ngua cac benh gay mu cd the phong tranh duac trong do cd benh gidcdm tai cdng dong.
5. Kdt luan:
Ty le NB glocom va nguy ca cao bi gidcdm trong cong ddng dan c u nghien cuu la 2,2% va 10,8%. Hinh thai glocom nguyen phat gdc ddng chiem da so (60,0%). 40,5% mat da d giai doan tram trgng, gan mu va mu.28,5% NB glocom chua l u n g dup'c chan doan va dieu tri. 93,4% ngudi dan do luoi tren 35 va 77,9% NB gidcdm khdng nghe biet gi hoac rdt la m a ve benh gidcdm. 89,9% NB khdng di kham theo ddi
mk djnh ky dc difeu kt$n kinh t6 xa hdi cda bSn than NB nhu sdc khde y6u (40,8%), nha xa (19,2%), kinh
\k khd khan (16,2%). Dk dgt dup'c hi$u qua phdng ch6ng mCi Ida do b§nh gidcdm gay ndn eSn thi^t phSi d i u t u nang cdp khd nang chSn doan, di^u tri, theo ddi NB gidcdm tgi cac tuy^n y t^ ca s d va tang cudng cdng tac thdng tin tuySn truyen tdi ngudi dan ndi chung va NB gidcdm ndi ridng hi6u bifet dup'c tidn lug'ng bdnh 6h phdi hg'p 6\hu tri \ku dki su6t quang ddi cdn Igi.
l a i li$u t h a m khdo
1. Ha Trung Kidn va cdng sy (2011),"Nhan xdt mdt s6 dac diSm djch t$ hpc lam sang cda b$nh nhan gidcdm d i i u trj tgi khoa M^t bdnh vi$n da khoa tinh Thai Binh trong 3 nSm 2005-2007", Tgp chi NhSn khoa Vi$t Nam; 23:11 -18.
2. NguySn Trgng Nhdn (2006), "Tuyin tap cac cdng trinh nghidn cdu", Tap I, Nha xuit bdn Y hge Hk Ndi.
3. Nguyin Thi T u y i l (2001), " Nghien cuu sy tuang quan gida dd sau t i i n phdng, b i d i y t h i thuy tinh, chiiu dai trgc nhan c i u tren m i t gidcdm gdc ddng nguydn phat va m i l binh thudng d ngudi Vi$t Nam trudng thanh", Lu$n vin thac sT y hoc. Trudng Dai hpc Y khoa Ha Ndi.
4. Anand Palimkar, Rajiv Khandekar, Venkataraman V.
(2008), "Prevalence and distribution of glaucoma in central India", Indian J. Ophthalmol.; 56:57-62 5. Bourne R.R.A, Sukudom P, Foster P.J, Tantisevi V,
Jitapunkui S, Lee P.S, Johnson G.J, Rojanapomgpun P. (2003), "Prevalence of glaucoma in Thailand: a population based sun/ey in Rom Klao District, Bangkok.", Br. J. Ophthalmol.;
87: 1069-1074
6. Casson R.J, Newland H.S, Muecke J, McGovern S, Abrraham L, Shein W.K, Selva D, Aung T. (2007),
"Prevalence of glaucoma in rural l^^yanmar: the Meiktila Eye Study", Brt J Ophthalmol.; 91: 710-714 7. Congdon N, Tielsch J M (1992), " Issue in the
epidemiology and population - based screening of primary angle- closure glaucoma", Surv Ophthalmol, 36(6), pp. 411-423.
8. Joe G , Paul J.F et al (2000) , " Anterio Chamber Depth Measurement as a Screening Tool for Primary Angle - Closure Glaucoma in an East Asian Population", Arch Ophthalmol, 118; 257-263.
9. Stone E.M, Fingest J.H, ..CL al (1997), Identification of a gene that causes Primary Open Angle Glaucoma" Science, 275, pp. 668-670.
