Nghien ciru Y hoc Y Hoc TP. H6 Chi M i n h * Tap 20 * So 1 * 2016
DAC DIEM DICH TE, LAM SANG, C^N LAM SANG VA DIEN TIEN CUA TRE EM BENH TAY CHAN MIENG TAI PHONG KHAM NGOAI TRU
BENH VIEN BENH NHIET D 6 I
Ph^m Lan Chi*, Dong Thi Hoai T&m**, HodngMitdi Td Van***, Nguyen TdAnh*, LeNguyen TrucNhu*, Nfftyen Hodng Phuang Nghi*, Nguyen Thi TlmHong*, Tran Tan Thdiih*,
Lam Anh Nguyet*, Nguyen TM Han Ny *, Vu TM Ty Hang Hang*, Tran Thuy Ngan*, Nfftyhi Trdc Trang*, li Van Tan***, H. Rogier van Doom***, Nguyen Vdn Wnft Cfeaa*
TOMTAT
Md dau: Benh canh Tay Otdn Mieng (TCM), do enteramrus thuoc nhdm A gdy ra, co nhieu mite do tir nhe deh ndng. Via: phdn lap xdrus hay xd nghiem PCR tim virus Ididng ducjc dat ra a cdc benh nhdn khdm ngod tru.
Dim ndy gdy hm cheve thdng tin vesu lieu hdrih cua cdc dong drus tm ^g dorig him cheve nam ^^
cua berih tie nhimg ngdy ddu, han dieviec phdt trim nhieng chim luge dm pho vai djch benh hoac dam luge chich ngiea. E>e tdi dugc tieh hanh de tim him vdn de ndy, hy vong gdp phm vdo viec tien lugng dien tiai ciia benh ngay tie nhieng ngdy ddu.
Phuang phdp nghien cdu: Mo td tim cuu cat ngang.
Muc tieu: Mo ta cdc dac diem lam sdng, can lam sdng vd dim bim binh a cdc tre em dual 5 tudi dugc thm dodn 1dm sdng Id TCM trong 3 ngdy dau cua benh, Ididm td phdng khdm ngoai trd BV Binh Nhiet Dai tie thdng 11/2013 dm thdng 3/2015.
Kei qua: Qua 255 trudng hgp dua vdo nghien cieu, ty li phdt hien dugc enterovirus diegc xdc dinh bang PCR Id 88,9%, trong do coxsackievirus A6 (CV-A6) chiHn ty li cao nhdi (27,8%), tiep deh Id mterodrus ATI (EV-A71) (25,1%). EV-A71 him diin nhieii vdo cdc thdng cuoi nam vd daii nam. Da so cac tre nam trong Ida tudi tie 12-36 thdng. Ty li nam cao han nd (1.39:1). Chi cd 20,4% tre c6 tiep xuc binh nhdn T(2M. SSi chi hiin dien a 65,9% cdc tre, trim chdng tieu hoa (tieu chdy) khong nhim bang trim chieng ho hqj idiu ho (42%), sovm (40,8%). Sang thucmg da chu ym dang hBn hap (68,8%), a> 2 vitri (82,3%) vd 86,7% tre co sang thuang da Hm lod mieng. Gida 2 nhom hirih nhdn nhiem EV-A71 vd CV-A6, khong co su Ididc biet mgidi tinh, nd ca ngu, tinh trang dinh dmng, vd bim hiin sang thucmg da Tuy nhien nhiem CV~A6 gap nhieii han a tre < 24 thdng, dtrecosSivd nhiec ddu. Chi c62ca nhap vien (4,9%), klwng co ca ndo tu vong. Cdc ym toliin quan den rihap vien: tre < 12 thdng (OR = 1,3) vd giat minh (OR = 10,8).
K^ ludn: Trong thdi gian cuoi nam 2013 deh ddu 2015, khdng co betdi cdnh TCM nang cr nhom binh nhan ngoai trd dm thdm khdm tai Binh vien Benh Nhiet Dai, du EV-A71 vd CV-A6 lieu hanh dong didi. Lda tuoi, di hgc, thdi gian trong nam, cdc trim chieng: soi, nhuc dm giup phan biet tdc nhdn gdy bmh vd tiin lugng binh.
Tvrkhod: Tay Chdn Mieng CV-A6, EV-A7t
* B|nh vien Benh Nhiet Doi ** Bp mon Nhilm DHYD TPHCM
*** Don vi nghi&n ciiu lam sang DH Oxford
Tdc gid lien lac: BS Pham Lan Chi DT:0984336160 Email: [email protected]
Y Hpc TP. H o Chi Minh * Tap 20 * So 1 * 2016 Nghien cuu Y hpc
ABSTRACT
EPIDEMIOLOGY, CLINICAL AND AETIOLOGY OF OUTPATIENTS WTTH HAND FOOT MOUTH DISEASE PRESENTING TO THE OUTPATIENT CLINIC OF THE HOSPTTAL FOR TROPICAL
DISEASES
Pham Lan Chi, Dong Thi Hoai Tam, Hoang Minh Tu Van, Nguyen To Anh, Le Nguyen Tnic Nhu, Nguyen Hoang Phuong Nghi, Nguyen Thi Thu Hong, Tran Tan Thanh, Lam Anh Nguyet, Nguyen Thi Han Ny, Vu Thi Ty Hang Hang, Tran Thuy Ngan, Nguyen Tmc Trang, Le Van Tan, H. Rogier van Doom, Nguyen Van Vinh Chau: * Y Hoc TP. Ho Chi Minh * VoL 20 - No 1 - 2016:158 -165
Backgrcnmd Hand, foot and mouth disease (HFMD) is caused hy enteromrus A (including enterovirus A71 (EV-A71), and coxsackieviruses A (CV-A) as CV-A6, CV-AIO and CV-A16). The infection can result in diverse clinical features ranging from selflimiting to fatality. PCR diagnositics or mrus isolation is not indicated for outpatients as pari cf routine care. As a consequence, knowledge about epidemiology, clinical and causes of HFMD among outpatient group is incomplete, while such knowledge is essential for clinical management, in particular prediction of disease progression at early time point cf the illness, and development of intervention strategies including cmtbreak response and vacdne.
Objedive: The present study was conducted to describe the epidemiology, clinicd and aetiology of outpatients with HFMD presenting to the Outpatient Clinic of the Hospital for Tropical Diseases from November 2013 to March 2015.
Material and methods: A prospective, descriptive study was conducted. Any child less than 5 years of age with clinically diagnosed HFMD and an illness day of 3 days or less was eligible. Viral lietedion was attempted by i^ing a combination cf multiplex red time RT-PCR and nested RT-PCR.
Results: Of 255 mrolled patimts, dral detection by PCR was achieved in 88.9%. CV-A6 was the most common virus deteded f27.S%), followed by EV-A71 (25.1%>). The detection rate of EV-A71 fluctuated throughout the study period. Themajority of the patients (68.3%) were between 12 - 36 months of age. Boys/girls ratio was 1.39:1. Only 20.4% cf cases had known contacts with HFMD patimts prior to illness. Fever was present in 65.9%i of ihe children. Gastrdntestinal symptoms (including diarrhoea) were less commonly observed than respiratory symptoms, sudi as cough (42%) or runny nose (40.8%,). Mamlovesimlar erythema were observed in 68.8°/o cf231 patimts who had skin lesion, of whom 82.3%o had lesion at 2 or more sites. A total of 86.7% patimts had both skin lesions and mouth ulcers. There were no di^mces in terms of gender, residence, nutritional status and features of erythema betwem E^/-A71 and CV-A6 patimts. However, CV-A6 infection was significantly more common in childrm younger than 2 years of age, and in childrm who had fever or headache.
Twelve patimts (4.9%o) were subsequmtly hospitalized, cf whom none had grade 2b or above. No death was recorded. Risk factors for disease progression which resulted in hospitd admisdon were: < 12 months (OR = 1.3 (1.1 -13.2)) and myoclonus (OR = 10.8 (25 - 56.8)).
CotKlusions: During the study period, there was no HFMD outpatimt progressing to clinical severity. EV- A71 and CV-A6 were the two most common viruses detected. Age (< 12 months) and myoclonous were thefadors assodated vnth severe disease progression.
Key words: hand, foot and mouth disease, CV-A6, EV-A71.
Nhi Khoa
Nghien cuu Y hpc Y Hpc TP. Ho Chi Minh * Tap 20 * So 1 * 2016
MO DAU
Tif khi duoc mo ta lan dau tien nam 1957 boi Robinson d « i nay, benh Tay Chan Mieng (TCM) da gay ra nhieu tran dich, dac biet la tai cac quoc gia Chau A<^'. Tai phia Nam Viet Nam nam 2011, benh duoc ghi nhan la co su gia tang ba't thuong so voi giai do?n 2008 - 2010, vol so ca mac gap 6 lan va so ca tu vong gap 6 - 2 4 lanf^. Tac nhan gay benh duoc xac dinh la virus nhom Enterovirus, voi cac chiing sieu vi gay benh thay doi theo thoi gian. Trong nghien cuu tai Guangzhou tir nam 2010 d&i 2012, EV-A71 va CV-A16 cung luu hanh voi ti le cao (35% va 30,7%)"^. Tir sau 2012, cac c h ^ g nay bj thay the boi chung CV-A16'"'.
Nghien ciHi cua Phan Van Tii nam 2007 tai Viet Nam cung cho tha'y CV-A16 va EV-A71 cimg chiem im the (52,1% va 42,1%), tuy nhien CV-A16 uu the tii ttiang 3 den thang 5, con giai doan thang 10 - thang 11 lai do EV-A71<^.
Cho d m nay, hau het cac nghien a h i diroc Ihirc hien tren cac benh nhan noi tru. Viec phan lap sieu vi cung khong duoc dat ra tren cac benh nhan ngoai tru. Chung toi tiai hanh nghien ctiu nay de ca ihong tin toan dien hon ve dac di&n dich ti va dien hen lam sang ngay tir dau ciia benh, ding nhu cac thong tin vi sinh hpc cua cac dong Enterovinis dang luu hanh.
DdlTU'ONG-PHU'aNGPHAPNGHIENCUlJ Thiet ke ng^hien cihi
Mo ta tien ciiu cat ngang.
Doi hrang nghien cuu
Tieu chuan chon benh: benh nhi < 5 tuoi duofc chah doan lam sang benh TCM trong vong 3 ngay dau cua benh don kham tai phong kham ngoai tni benh vien Benh Nhiet Doi.
Tieu ehuah loai trCr: cac benh ly khac khong phai benh TCM (thuy dau, di iing da, nhiem trimg do vi trimg....).
Cac bu6c thu th^p so li^u
Ngay dau vao nghien cuu: ghi nhan cac
dac diem dan so hoc (tuoi, gioi, noi cu tni), dich te hoc (tien can tiep xuc tai gia dinh va truang hoc), dac diem lam sang (ngay benh, cac trieu chiing co nang va dau hieu ttiuc the, sang thuong da va loet mieng,...) va phan do benh, thuc hien cac xet nghiem thuong quy bao gom cong thiic mau, duong huye't, CRP.
Mau phet hong va phe't true trang tim Enterovirus voi phuong phap RT-PCR tim Enterovirus va xac dinh EV-A71. Sau do, ky thuat Nested RT- PCR va giii trinh ti^ duoc sii dung de xac dinh cac Enterovirus khong phai EV-A71P-6).
Nhiing ngay sau, benh nhan duoc lien lac qua dien thoai vao cac ngay 2-4-6 cua nghien ciiu de thu thap tinh trang cai ihien benh, tai kham va nhap vien neu co. Doi voi benh nhan nhap vien: kham moi ngay cho deh ngay 8 cua n ^ e n ciiu de danh gia phan do va dien hiki cua benh Xu ly va phan tich so lieu
Sit dung vdi phan m a n SE'SS 20.0. Phan tich da bioi logistic duoc dimg de xac dinh cac yea ^ hen quan doi tinh trang nhap vien. Q a trip < 0,05 duoc xem la co y nghia thong ke.
V M I de Y dlic
E)e tai la mot phan cua chuang ttinh 'Nghien cihi quan sat ve dich te va vims hoc cua Enterovirus 71 va benh tay chan mieng tai cac benh vien tuy&i cum 6 thanh pho Ho Qu Minh, Viet Nam do Don vi ngJiien ciiu lam sang Dai Hoc Oxford ihuc hien, thong qua HDYD BV BND theo quyet dinh so 150/BVBND - KH.
KET QUA
Dac diem dich tl, lam sang
Trong ihoi gian nghien aiu, chiing toi da thu dung duoc 255 ca benh. Cho deh ngay 6 cua nghien ciiu, co 32 ca mat theo doi. Co 4 ca nhap vien va da xuat vien truoc ngay 8 ciia benh Khong CO ca nao tii vong. Ti le Enterovirus dupe xac dinh bSng PCR la 88,9% (227 ca/255 benh nhan). Ket qua cho Ihay CV-A6 chi&i iy le cao nhat (27,8%), tiep den la EV-A71(25,1%) (Bang 1).
Y H p c TP. H 6 Chf M i n h * T^p 20 * S ^ 1 * 2016 N g h i e n cthi Y hpc EV-A71 t m the vao thang 11 va 12 nam 2013,
giam dot ngot tir thang 1-2014 d&i 8-2014 va u u the tro lai tii thing 11-2014 d&i thang 3-2015. Tir thang 1 deh thang 9-2014, CV-A6 u u the; thii hai la CV-A16. Hai chung sieu vi nay luu hanh vcd ti le kha thap (10%-20%) vao cac thang con lai trong nam (Bieu do 1).
Bing 1: Ty le cic loai Enterovirus phan lap dugc tii mau phe't hong va true trang bang ca 2 phuong phap PCR va giii trinh tu
Lo^i Enterovirus (n = 227) EV-A71 CVA6 CVA15 CVA10 Enterovirus ithSc
Tlnsd(%) 57 (26,1) 63 (27,8) 39 (17.2) 19(8,3) 49(21,6)
100% 1 90% - S0% - 70% - 60% - 50% - 40% - 30% - 20% - 10% -
^
i
s.''
<
/*
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# y y
•Eiita oviniskhac
• CV-AI6
• CV.A6
• EV-A71
Bim do 1: Tan sual xucd hiin cac Enteromrus theo then pan
\: Dac dian ddn sffhgc vd ym totiqj xdc cua ddn sd nghiin cim, so sdnh giiia nhom nhiim EV-A71 vd
D l c d i l m
Ddn s6 h9C
Yeu t6 tiep xOc
GirJi nam Cif nguo'TPHCIW
5 24 thdng tuoi Trung vj ttidng BiVII trong gidi han binh thu'b'ng
C6 di hoc C6 tiep xOc tai nhd ( ^ ban cCing tn/frng mSc b^nh
C6 tiep xiic v6i b$nh ntian
DSn sd ngliien ci>u (N = 255)n(%)
146 (57,3) 190(74,5) 165 (84,7) 20 (14-29) 190(74,5) 60 (23,5) 14(5,5)
3(6) 52 (20,4)
NliiimEVA71 (n = 57)n(%)
30 (52,6) 44(77,2) 28 (49,1) 26 (17,5-37,5)
38 (67,9) 24(42,1) 4(7) 2(18,2) 15(31,2)
NlliimCVA6 (n = 63) n (%)
38 (60,3) 47(74,6) 48 (76,2) 18 (14-24) 47(77) 9 (14,3)
3(4,8) 0 15(27,3)
f NS NS
<0,05 NS
<0,05 NS NS NS
*p: khde hiit giQa nhom EV-A71 Vd CV-A6 Tr^ 12 - 36 thing chiein 68,3%, tre £ 4 tuoi chi CO 3,1%. Tre nam nhieii hon tre nii (ti le la 13:1). 75% CU ngu 6 thanh ph6K6 Chi Minh.
Co 24% tr^ bj thiia cin-beo phi, 2% tre nhe can.
52 tre co tiep xiic voi benh nhan TCM (20,4%), nhung chi co 14 truong hcrp tiep xiic trong gia
^ n h va 3 ca t i ^ xiic tai truong hoc. 64,7%
khong c6 tien can hep xiic (Bing 2).
Giua 2 nhom b&ih nhan nhiem EV-A71 va CV-A6, khong co s^t khac biet ve gidi tinh, noi cu ngu va tinh trgng dinh duong. Tre > 24 ihang tuoi nhilm EV-A71 nhi& hon CV-A6, con tre < 24 thing nhiem CV-A6 nhieu hon (p < 0,05). Ti le tre CO di hpc trong nhom tre nhiem EV-A71 cao hon so voi CV-A6 (42,1% so voi 1^3%) v6i p < 0,05.
Cic y ^ to khac nhu tiep xuc voi benh nhan TCM khong khic biet ^ a n g 2).
Nhi Khoa
Nghien ctiu Y hgc Y Hpc TP. H o Chi Minh * T?p 20 * So 1 * 2016
Sot chi gap trong 65,9% cac truong hop. Bieu hien tieu hoa: tieu chay it gap hon (4,3%), so voi trieu chiing ho ha'p; ho, so miii (40% - 42%). Bieii hien than kinh nhu nhu lir dii, giat minh, ngu ga,.... gap voi ti le tii 0,8%-3,5% (Bieu do 2). Ti le sot cao hon a nhom nhiem CV-A6 (79,4%) so voi
EV-A71 (45,6%). Nhiic dau gap nhieu hon d nhom nhiem CV-A6 (16,7%), khong co ca nhiic dau trong nhom EV-A71. Cac dau hieu sinh ton liic vao nghien ciiu giua 2 nhom hau h^: daj trong gioi han binh thuong.
Mi iiio hoi Nliuc dm Tiai chay Ngiiga Kich tliich Lit dii Nciii Ho So imlt Giat niiiili
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r
• NliieiuE\"-A7l DNliiliii C\'-A6 B Dai) so nsjiiai cihi
JJJJI.JJIIIJIJIJI.JI.IIJJI.IIIII.I.JIJI..I ^....
Bim do 2: Trieu chung ca ndng cua ddn songhUn cieu, cua nhom nhiim EV-A71 vd nhiim CV-A6 Bang 3: Tinh ch^ sang thuang da cua ddn so'nghien cuu, cua nhdm nhiem EV-A71 vd nhiim CV~A6
Trnti c t ) ^ sang ttiuxmg da C6 kin\ lo6t mreng Loai sang thumig
S6vi tri c6 sang thi«mg
C6 Kh6ng Bongniiuc
H&ngt)an H6nh(?p 1 vjtn 2vilri Svjtrl
[3an so nghien ciAi (N = 231)n(%)
221 (95,7) 10(4.3) 5(2,2) 67 (29,0) 159(68.8) 41 (17,7) 62(26,8) 128 (55,5)
Nhiem EVJI71 (n=56)n(%)
51 (91.1) 5(8,9) 2(3,6) 16 (28,6) 38 (67,9) 10(17,9) 11 (19,6) 36 (62,5)
Nhiim CV.A6 (n = 59)n(%) 59(100)
0 1(1,7) 11 (18,6) 47(79,7)
4(6,8) 17(28,8) 38 (64,4)
P
<0,05 NS
NS Chi CO 231 tre (90,6%) co bieu hien sang
thuong da gpi y TCM. 86,7% sang thuong da kem loet mieng. Chi co 24 benh nhan loet m i s i g khong kem sang thuong da (9,4%). 68,8% la sang ftiuong da dang hon hop (hong ban-bong nuoc). Ve vi tri, 55,5% ca co sang thuong phan b o o ca 3 vi tri: ban tay-ban chan, goi-khuyu lay va mong). Neu chi co mpt vi trt sang thuong tap trung nhieu 6 ban tay-ban chan (25/41 ca, 61%).
Neu la 2 vi tri, sang thuang 6 ban tay-ban chan va gcTi-khuyu chiem 53,2% (33/62 ca).
1MI suat xuat bieii hioi sang thuong da khraig khic biet giira 2 nhom nhiim CV-A6 (93,7%) va EV-A71 (98,2%). Tat ca cac benh nhan nhiem CV- A6 CO sang ftiuong da deu co kem ftieo loet mieng, cao hon so voi nhom EV-A71 (p < 0,05) (Bang 3).
Xet nghiem can iam sang
Bach cau m i u tang nhe voi trung vi la 12.00D/mm3 (IQR: 9.800- 14.600). Co 19,6% so ca CO so' lupng bach cau > 16.000/mm^ nhung thanh ph&i da nhan trung tinh khong cao voi trung vi la 46,8% (IQR: 37- 58). Co 13,7%
truong hop co tieu cau > 400.000/mm3. CRP va
Y Hpc TP. H o Chi Minh * Tap 20 * So 1 * 2016 Nghien cuu Y hpc
duong huyet hau het trong gioi han binh thuong.
Dien tien benh
Chi CO 12 tntcmg hap nhap vien trong so 244 benh nhan con theo d5i duoc cho d a i ngay nghien ciiu thii 6 (ty le nhap vien: 4,9%). Ngiy b$nh liic nhgip vien: trung binh la 2,5 ± 1,3 ngay.
Cac yeu to lifin quan d « i nhap v i ^
Bdng 4: Phdn tich dem biih vd da bieh cdc yeu toliin quan den nhap viin
9/12 ca nh$p vien vao ngay 2 va 3. Khong co ca nao chuy&i ftiarih dp 2b, do 3 hay dp 4. So' ngay nam vien: trung vj la 5,5 ngay (IQR: 4,2 - 6,7).
Thoi gian nam vien ngan nhat la 4 ngay va dai nM't la 12 ngay. Tat ci cac truong hpp hoi phuc hoan toan.
Yiuti
£12 Ihang tu6i Cd gi^t minh
LCpdff Ngugd
Phan t'ch don biin P
<0,05
<0,05
<0,05 0,092
OR 4,8(1.5-15,6) 15,1(3,1-73,3) 7,9(1,4-44,2)
Phan tich da biin P
0,036 0,005 0,7 0,6
OR 3,8(1,1-13a 10,8(2,5-66,8)
Cac yeii to ngii ga, lir dir, gw.t uunh va tuOT 512 ftiar^ duoc dua vao phan tich da b i a i sau khi phan tich don bien co p < 0,1. Qua p h i n tich da biai, chi con thing tuoi va giat minh la cac yeii to d6c lap lien quan deh tinh trang nhap vien. Co 6 tre < 12 ftiang nhap vien (50%), nhom khdng nhap vien la 41 tre (16,9%).
Nguy CO nhap vien 6 tre < 12 thing cao ga'p 3,8 ian (1,1-13,2).
Trong 12 ca nhap vien, co 5 ca nhiem EV- A71 (41,7%), va 2 ca nhiim CV-A6 (16,6%). Tuy nhien, sv khic biet khong co y nghfe de xic dinh moi lien quan giiia tic nhan gay benh va nh^p vien (p > 0,05).
BANLUAN
Daic diem dan so hpc va dich te cua dan so nghien c ^
Hau het (68,3%) tre 6 liia tuoi tif 12-36 thing. Ti 1? mac benh thap 6 tre < 12 thing tuoi va > 36 thing tuoi. Dieu nay co the dugc giii thich bing su d i p iing miln dich. Tr^ tir 12-36 thing tuoi co ti le mac benh cao nhi't do khang the tut me truy&i cho da giam. Sau 36 ftiing tuoi, nong dp khang the tang dan sau khi tre mac benh. Do do, ti le mac benh giam dan a liia tuoi > 36 thing tuoi*^''''. Ve phai tinh, chung toi chua tim thay duoc ly do tai sao tr6 nam lai mac benh nhieu hon tre nii, mac dii kei
qua nay phii hpp vol cic nghien ciiu khic tgi Viet Nam va Trung Qaoci^^.
Voi 20,4% tre co tiep xiic voi benh nhan TCM, chi CO 5% (3 ca) tiep xiic tai truong hpc va 5,5% (14 ca) tiep xuc tai nha. Cac ca con lai co the da tiep xiic voi cac tre benh song 6 xung quanh nha khi choi cimg. Nhu vay, lay nhiem trong gia dinh va nha truong khong phii la ducmg lay quan trpng trong dot benh nay. Lay nhiem tu tre benh tai dia phuong da duoc tic gii Ruan F.
chifeig minh la ducmg lay quan trpng'''.
D^c diem lam sang va c ^ Iam sang luc vao nghien cuu
Nghien cniu cho thay rang chi co 65,9% co sot, tucmg duong voi ket q u i nghien ciiu cua tic gia Truang Thi Chiei Ngu (ti le tre co so't 6 b§nh nhan TCM dp 1 va dp 2 la 60% va 65,6%)'^^'. So voi cac nghien ciiu thuc hien tren benh nhan npi tiii nang va co bieh chiing, ti le sot cao hon (90%-100%)(5). Mpt so nghien a i u da chiing minh rang benh TCM ngng c6 bieh chiing co ti le s6^t cao hon benh khong bieh chiing(*'. Chiing toi cung ghi n h | n rang tan sua't cua cic bieii hien tieu h o i thuong thap"-^"'. Mac du day la mpt benh lay qua duong tieu hoi, trong khi cac tri|u chiing ho hap tren nhu ho, so mui lai xiiat hien nhieu hon. Cac bieu hien nhiic dau, lir dir.
Nhi Khoa 163
Nghien cuu Y hpc Y Hpc TP. Ho Chi M i n h * T^p 20 * So 1 * 2016
giat minh dupe ghi nhan voi ti le ftia'p. Chung toi cho rang ket qua nay phii hop vi hem 95%
ca benh la do 1, khong co bien chiing. Ciing can phii nhan manh rang benh nhan co sang thucmg da dac hi?u TCM kem voi loet mipng chi xua't hien 6 86,7% cic truong hpp, sang thucmg nay thuang 6 dang hon hop (hong ban va bong nuoc: 68,8%) va xua't hien 6 nhieu vi tri (> 2 vi tri) vdi so lupng nhieu.
Nhu vay, so' luong sang thuong duang nhu khong song hanh vai dp nang ciia benh. Ve loet mieng, vom hpng la vi tri thuong gap nhat, CO the co hoac khong kem loet cic vj tri khac nhu niem mac m i , moi,... So sanh vcn cac nghien ciiu khic, ti le loet mieng dem thuan ftiay dSi tii 3,3%-31,3%ti^">. Tan suat xuat hien sang thucmg da va loet mieng co su thay doi giiia cac tian dich qua cic nam.
N ^ xem xet ket qua can lam sang de noi ve tiin lupng benh, chi co 19,6% truong hpp tang b^ch cau mau > 16.000/mm3. Voi duong huyel va CRP trong gioi han binh thuong, chung toi cho rang voi benh nhan TCM kham ngpai tni, CO le chiing ta khdng can 2 xet nghiem nay khi trieu chiing Iam sang khong nang.
Tac nhan g ^ benh va su khac biet ^ u a EV- A71vaCV-A6
PCR tim enterovirus khong duoc ftiuc hien thuong quy 6 benh nhan ngoai tni (dp 1 hoac 2a). Cong trinh nay da cho biet cic tac nhan dang luu hanh that su trong cong dong, dii la benh nhin 6 miic dp benh nhe. Neu truoc day chi CO EV-A71 va CV-A16 dugc ghi nhan la cic sieu vi luu hanh tgi Viet Nam, thi d o i nam 2011, EV-A71 tipi hon (11). Nghien ciiu nay lai cho ftiay la CV-A6 va EV-A71 cimg chion uu fiie tirong thoi gian nay (27,8% va 25,1%). Nhu vay, CO su thay doi loai sieu vi luu hanh so vdi cic tian dich truoc day. CV-A16 v i n phan lap dugc nhung ti le ftiap hon so voi CV-A6 va EV-A71.
Thoi gian nghien cuu cho phep tha'y rang EV-A71 uu the vao cac thing cuoi nam (ftiang 11 va 12 nam 2013) va dau nam (thing 11 - 2014
deh thing 3-2015). Su phan bo theo fticri gian ciia EV-A71 phii hpp voi nghien ciiu ciia tac gia P.V. Tii nam 2005"^. Con CV-A6 va CV-A16 lai u u the vao nhung ttiing giiia nam.
Cac yeu to li£n quan den nhap vien Trong so 9 tre co giSt minh, chi 3 tie nhgp vien. Phan dp liic xua't vien ciia cac truong hgp nay la 2a. Ket qua nay phii hgp vai ket lugn ciia tic gia T.T.C. Ngu. Giat minh don thuan chua dii de ket luan benh co him chiing than kinh, nhung la dau hieu nhay de phat hien som bieh chiing*^^'.
Tre < 12 thing co nguy co nhap vien cao hon 3,8 lah so voi tre > 12 thing. Ket cjua nghien ciiu ciia tic gji Wang Y. ciing cho thay tre < 12 thing tuoi CM ti le benh nang cao nha't, va thoi gjan tu liic khoi phat benh cho den hie co chan doan cheim nhat so voi cic liia turn khac<'fl. Do do, tre <
12 thing tuoi c&i dugc chii y chah doin som \k ftieo doi sit d^ phat hien kip thoi bi&i chiing.
KETLUAN
Trong thoi gian hx cuoi nam 2013 deh 2015, tinh hinh benh TCM khong co nhieu benh cinh nang 6 nhom benh nhan ngoai tni, du vay, tre £ 12 thing tuoi nen dugc chii f chah doan som va theo doi phit hien kip thoi biai chiing. Hai chung sieu vi EV-A71 va CV-A6 cimg hm hanh nhung CO mot so diem khic nhau. Tr^ TCM tren 24 thang tuoi, co di hoc, loet mieng va then diem cuffl nam thuong nhiem EV-A71 hon. Nguoc lai, 6 tre co sot, nhiic dau vao 3 ngay dau cua benh, loet vom hpng va ftioi diem gjiia nam, co kha nang nhiem CV-A6 nhieu hon Tuy nhien cac nghien ciiu giim sit tir 2-5 nam tren dia ban rpng CO the can dugc thuc hien de nam dugc si?
thay doi cua enterovirus trong cong dong.
TAI LIEU THAM KHAO
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Ngdy nhan bdi bdo: 27/11/2015 Ngayphdnbien nhan xet bdi bdo: 30/11/2015 Ngdy bdi bdo dieoc dang: 20/01/2016
Nhi Khoa
