DAC DIEM DjCH TE HOC L A M SANG, CAN LAM SANG BENH VIEM NAO NHAT BAN dTRE EM TAI BENH VIEN NHI TRUNG l/ONG
Bh Thien Hai', IVan Ba Dung'.
Viem nao Nhat ban (VNNB) la benh nhilm khudn cSp tinh he thin kinh do virus Viem nao Nhat ban gay nen. Bieu hien Iam sang rat nang ne, de lai di chiing vai ty le cao, tham chi tii vong. Muc tieu: xac dinh dac diem dich tl hpc, lam sang, can lam sang benh nhi mac \^em nao Nhat ban tai Benh vien Nhi Tnmg uong. Ddi tucmg: benh nhi duac chan doan \^em nao Nhat ban nhap vifn dilu tri trong thai gian 1/1/2013 dkn 20/7/2014. Phmmgphdp: nghien cuu hoi curu va ti^n cuu Ket qud vd ket lugn: Benh xay ra chii yeu a mua he ( thang 6 - 7); Ty le Nam/Nii: 1/1,4.
Tuoi gap nhieu a tre lan, chu yeu tir 3 - 15 tuoi. Tien su tiem vac xin chiem ty le thap. Trieu chung lam sang thuong gap nhat la sot, non, dau dau va hon me. Xet nghiem DNT chu yeu la tang nhe bach cau (duoi lOOTb/mm^) va protein tang nhe (chii yeu 0,4 - !g/l). Ty le khoi benh toi 70%, di chung 25%.
Til khoa: Viem nao Nhat ban.
DAT VAN OE
Viem nao Nhat ban la benh nhilm khuan cap ti'nh he than kinh do virus Viem nao Nhat ban gay nen. Bieu hien lam sang rat nang ne, de lai di chutig vdi ty le eao, tham chi tu" vong. Ke tir khi co vac xin d&i nay ty le mac benh da giam rd ret PI, ciing vdi ky thuat dieu bri co nhieu tien bg eung lam giam ty le tii' vong va di diiihgt'i. NhuYig den nay van con la can nguyen vinjs gay viem nao d tie em chiem ty le khong nho. Tai Benh vien Nhi Tmng udng, ty le benh nhi mac VNNB van chiem khoang 10%"-^'. Do vay, Chung toi tien hanh nghien culi nay nham muc tieu mo ta dac diem djch te, lam sang, can lam sang va dien bien ciia viem nao Nhat Ban tai khoa tmyai nhiem ti^ng cac nam 2013 - 2014.
D O I TU'ONG VA PHl/ONG PHAP
Doi tu'dng: Benh nhi dude ehan doan Viem nao Nhat Ban nhap vien dieu tri tirxig thdi gian 1/1/2013 dai 20/7/2014.
Tieu chuan chgn benh nhan: Benh nhi co it nhat 2 b-ong eac dau hieu gd\ y nhiem khuan than kinh nhu" sot cao, non nhi&j, CM giat, thdp phong, roi loan y thifc va tim thay khang the khang vi rut viem nao Nhat ban gay benh bxing djch nao hiy bang phi/dng phap ELISAt*^.
Thu thap so lieu: Cac thong tin dddc lay b-ong ho stJ benh nhi theo mau. Cac trieu chuhg lam sang dude lay khi CO xac nhan ciia bac sy Truyen nhiem Nhi, bac sy f ^ sut Nhi. Cac xet nghiem dddc thi/c hien tiiu'dng qui tai phong xet nghiem tai Benh vien Nhi Tmng ddng.
Phu'dng phap nghien c i h i : Hoi euU nSm 2013 va tien ciiu cac benh nhi nam 2014.
KET QUA Djch ^ hoc
Phan bo benh nhi theo tuoi
'"Khoa Tmyen nhiem. Bpth vifn .\7i; Tnmg uang Ngiy nhfo b i i : 01/4/2015
Ngiy p h i n blfn l o n g : 26/4/2015 Ngiy duyft d i a g : 27/4/2015
NgirM cbju Irscb nbifm ngi dung khoa h9c: B o Thifn Hdi. Khoa Truyen nhiem Bfnh vien Nhi Trung uang.
EHinthoQi 0902116119. [email protected]
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" S.7
1 n
Bieu do 1: Phan bo b|nh theo nhom tuoi
Nhan xet: \(ia tuoi tiiddng gap nhat la tiJ" 5 tuoi trd len (61,9%).Phan bo gidi tinh. Ty le tiem phong vie xin VNNB
Bieu do 2: Ty l | b#nh nhi theo gidi b'nh.
Tyle Nam/Nii'la: 1/1,4.
Bieu do 3: Tinh trang tiem phong cua tre Ty le benh nhi co tiem chung la 5,9%.
Phan bo benh nhi theo thdi gian trong nam.
1 1 3 4 S 6 7 8 9 10 11 I I
Bi^u do 4 : Phan bo benh nhi theo tiiang trong nam
Nhan xet: Benh geip nhieu vao thang 6, 7.TRUY6«rH&WVieTNAM*s6 2(10) - 2015 - 23
Trieu chuTng lam sang
Bang 1 : Trieu chutig lam sang cua benh
Trieu chihig
sa
Buon non, non khan Dau dau (tre ldn tren 3 tuoi) Co giat
Co giat khu tnj Uetkhutru Roi loan tri giac HCMN Ngiing thd Roi loan van mach
So tnrdng hdp (n = 172)
170 146 172
no
30 36 128 151 12 10
Ty 18 % 99,1 84,8 100 63,8 17,4 20,9 74,3 87,6 6,7 5,7
Nhan xet: Trieu chuhg thu'dng gap la: sot, non, dau d3u, roi loan y thiTe.
Can lam sang Cong tiiut mau
Bang 2: Cong thu'c mau Chi so SSca(n = 164) T y l e % BC(G/I}
< 5 5-12
>12
5 3,0 55 33,4 104 63,6 BC Mono Cii,}
<100 100 - 120
>120 21 85 58
12,9 51,5 35,6 Cia>(mg/l),n=14S
<=6
> 6 - 3 0
>30
25 76 44
17,2 S V 30,1 Nhan xet: Ty le tre co bach tau tang chiem t / le 63,6%; CRP tang > 6 chiem ti^n 80%.
D/c/i nao tuy
Bang 3: Protein, te bao trong dich nao tuy
Chi so Proteffi (g/0
<0.4 0.4-1
>1
Soca(n = 158)
23 119 16
Tyie%
IV 75,5 9,8 Tebao (TB/mn^)
<3081 30-100
>100-500
>500 0
51,5 58 19 0,0
36,6 11,9
TV J|7B Mono r%;
<=5 25
> 5 - 1 0
> 10 116
15,6 18 73,3
11,1
Nhan xet: hau het benh nhan cd Protein tiT)ng DNT tif 0,4 - 1 g/L (75,5%; te bao dddi 100 chiem ty le cao (tren 87%).
Bieu hien tren dian doan hinh anh CT, MRI sp nao Bang 4: Hinh thai ton thu'dng nhu mo nao
tren chan doan hinh anh CT, MRI 59 nao
vi tri, hinh thai ton thiAlng 001 till Ton OiifOng khu tru Uac
Phil nao lan toa Khong phat hi^n ton thuUng
a
(%);n = 18,29,1 13,6 59,1
:62 MR] [(%);n = 86 29,6 18,5 9,3 42,6 Nhan xet: ehup MRI so nao phat hien tren 50%
trudng hdp co ton thu'dng. Chup Cl so nao thay khoang 40% CO ton tiiu'dng cac hinh thai khac nhau.
Ket qua dieu tri
Bieu do 5: Icet qua diieu trj Nhan xet: t / le di chuhg chiem 25%.
24-THUY^NH&fl\nrrNAiW*s62{10)-2015
BAN LUAN
Trong thdi gian nghien ciili, ed 172 benh nhi dii tieu chuan.
S i c diem dich t i hoc
Tuoi va gidi: Tuoi: Dp hJoi thu'dng gap nhat la tren 3 tuoi (68,5%). Nghien ciru ciia Yuki Takamatsu va cong su" thi tiJoi tiung binh la 7, hau het la dddi 15'^. Gidi: Ty le tre trai gap nhieu hdn tre gai, ty le la; 1/1,4. Ket qua nghien cirij ciia Yuki Takamatsu va cs khi nghien ciiU 130 benh nhi thi ty le NO" la 1/1,71^]. Li do benh gap nhieu hdn d tre Nam van chu^ du'dc biet ro.
Ty le m$c benh theo thdi gian trong nam Theo ket qua nghien cud ciia chiing toi, viem nao co t / le mac eao nhat vao thang 6 - 7. Yuki Takamatsu va cs thay benh chii yeu gap d miia he (tir tiiang 5-7)i^]. Theo M. Jahangir Hossain 90% benh nhan gap ti-ong tiidi gian tiJ' thang 5 den tiiang 9^^\ Theo y van, viem nao do JEV cung nhd cac can nguyen khac thi chii yeu gap d miia he thu va troi nhat vao nhutig thang he.
Tien su" tiem vac xin viem nao Nhat Ban ghi nhan di/dc trong nghien cud nay cung thap (5,9%); 37,2% so tre mac VNNB khang dinh chiia tiem phong. Nghien ciftj ciia Yuki Takamatsu cijng ghi nhan ty le co tiem vac xin cung chi eo 12%[^]. Cac nghien ciru tru'dc day tai Viet nam cho thay, neu khong dddc tiem phdng tot thi ty le mac viem nao Nhat Ban co the len den tren 50% so ca nhap vien'"*].
Cac bieu hien tam sang: Cae bieu hien lam sang cua viem nao mang nao do JE kha phong phii, cac bieu hien hay gap nhat la sot (99,1%), non (84,8%), dau dau d tre ldn (100%); co giat (63,8%), roi loan tri giac cac mirc do khac nhau (74,3%). Yuki Takamatsu va cs nghien culi 60 ca viem nao Nhat Ban d mien Bac Viet Nam cho thay: eo giat ehiem 44%; roi loan y thu'c cae mu'c do khac nhau chiemm 97%; liet khu tru thay d 25% so ca^^l Tom Solomon va cs phan tich nhhieu nghien cud khac cung eho thay cac trieu chirng chii yeu la sot, non, co giat, roi loan y t h u f " . Alera MT va cs nghien cu\j tai Manila, Philip- pin cung cd cac bieu hien lam sang tu'dng t\f'*l M. Ja- hangir Hossain nghien ciru tai Bangladesh thay eo roi loan y tiidt den 55%'^. Cac bieu chiihg ciia benh cung co khac nhau tiiy timg nam, tiihg iiia tuoi va cd die khac nhau. Co mpt so benh nhi cd bieu hien ngimg thd chiem ty le thap (6,7%). Gay la bleu hien nang ciia benh va thu'dng gay
nen tinh trang dl chuhg, tir vong.
Bieu hien can lam sang - Cong th&c mau, CRP
Benh nhi dddc lam cong tiiite mau, co 63,6% tre co so lu'dng bach cau tang cao (> 12G/I). Ty le bach cau Mono tang tren 5% va 10% la 45,1% va 28,1%. Can cd them nghien cdu de li giai dieu nay.
CRP tang b'en 6mg/l va ti-en 30mg/l cung chiem ty le kha cao la: 52,7% va 30,1%. Benh nhi eo eac dau hieu viem nhd bach cau, CRP tang cao ngay ca khi Wiong cd cac bpi nhiem vl khuan.
' Dich nao tuy
Phan ti'ch sinh hda cho thay protein tang nhe thUdng du'di Ig/I (chiem 90,2%). Phan tich te bao eho thay bach eau DNT tang nhuhg ehii yeu dddi lOOBC/mm^ (tren 87%). Ty le bach cau Mono tang ti-en 5% cung chiem b^en 84%. Nghien culi ciia Yuki Takamatsu va cs thi trang DNT eiia benh nhi mac viem nao Nhat ban ed te bao trung binh la 18 (5 - 300); protein trung binh la 0,45 ^^\ Cac gia ti-i nay cd the khac nhau bJy thupe vao thdi diem lay benh pham.
- CT, MRI so nao
So IUdng benh nhi du'dc CT so nao cua ehung tdi thay CO bieu hien bat thudng d 41,9% so ca dUdc chup. Trong do ehu yeu la hinh anh ton thUdng doi thi (18,2%), phii nao (13,6%), ton thu'dng khu tru khac la 13,6%. Hinh anh chup MRI so nao cho thay t6n thUdng viing doi thi la 29,6%, ton thUdng khu trii khac la 18,5% va 42,6%
khong thay co bat thudng. Nghien ciifu cua Tom Solomon tai Thai lan cung thay cd 50% so ca cd ton HiUdng tren phim chup CT d cae vi tri khac nhau. Tren phim chup MRI thi cd tiie phat hien nhieu ton tiiUdng hdn ['•. Theo nhieu bao cao tien y van, ton thUdng tren CT, MRI so nao ciia viem nao Nhat ban chii yeu la cac hinh anh giam ton thu'dng viing doi thi, nhUng chiing toi cung thay cac ton thUdng khac nhU phii nao, viem viing thai dUdng, tran, nhuhg eac ton thUcfrig nay khong dac hieu va gap ti'ong rat nhieu benh li khac.
Tien trien: Ket qua nghien ciru ciia chiing toi cho tiiay ty le khdi hoan toan la 69,2%, di chuhg 25% va tir vong 5,8%. Cac tac gia khac cho ket qua khac nhau, Yuki Taka- matsu va cs nghien culi tai Viet nam trUdc day cho thay ty le khdi hoan toan la 78%, tir vong 12%!^]. Khi phan ti'ch
TRUYEN NHliM V I | T NAM * S 6 2(10) - 2015 - 2 5
mpt so nghien ciru khac ttii Tom Solomon va cs tiiay cd t / le tii' vong den 30%E'1, tiiam chi 3 2 % ^ . Ty le di chuHg cung khac nhau tiihg khu vUc, dao dong tit 25 - 71%^''^^-
Can CO them nhieu nghien cim de xac djnh cae yeu to tien IUdng.
ICET LUAN
Qua nghien culi 172 benh nhi viem nao Nhat Ban chung tdi rut ra cac ket luan sau:
Benh xay ra chii yeu d miia he (thang 6 - 7). Tien sir
tiem vac xin chiem ty le thap.
Tuoi gap nhieu 6 ti'e ldn, chii yeu tiJ* 3 -15 tuoi. Ty |g Nam mac nhieu hdn NQ".
Trieu chimg lam sang thu'dng gap nhat la sot, non, dau dau va hon me.
DNT d i i i yeu la tang nhe bach cau (dUdi lOOtb/mm') va protein (dUdi lg/1).
Ty le khoi benh tdi 70%, di chuhg 25%.
TAI LIEU THAM KHAO
1. Japanese encephalitis. Tom Solomon, Vo Thi Khanh.
J Neurol Neurosurg Psyrfwafry2000;68: 405 - 415.
2. An approach for differentiating echovirus 30 and Japanese encephalitis virus infections in acute meningi- tis/encephalitis: a retrospective study of 103 cases in Viet- nam.Takamatsu et al. Virology Joumal 2013, 10:280.
http://www/.virologyj.com/content/10/l/280.
3. Estimated global incidence of Japanese encephali- tis; a systematic review. Grant L Campbell. Bull World Health Organ 2011;89:766 774E 1 doi:10.2471/
BLT10.085233.
4. Hospital-based surveillance of Japanese encephalitis at a tertiary hospital in Manila. Alera MT', Velasco JMl.
Southeast Asian J Trop Med Public Healtii. 2013 Sep;44(5);
791 - 8.
5. Hospital-Based Surveillance for Japanese Encephali- tis at Four Sites in Bangladesh, 2003 - 2005. M. Jahangir Hossain, Am. J. Trop. Med. Hyg., 82(2), 2010, pp. 344 - 349. Doi:10.4269/ajtmh.2010.09 - 0125.
6. Japanese Encephalitis - A Patiiological and Clinical Perspective. PloS Negl Trop Dis. Sep 2009; 3(9): e437 Pub- lished online Sep 29, 2009. Doi: 10.1371/
journa!.pntd.0000437.PMCID:PMa745699.
7. HUdng dan ehan doan va xii tri viem nao cap d tre em. Bp y te. Quyet djnh so 2322/QD-BYT, ngay 3O/6/2006.
FIND OUT THE EPIDEMIOLOGY, CLINICAL FEATURE, UBORATOIUES OF CHILDREN W H H JAPANESE ENCEPHALITIS
AT NATIONAL HOSPHAL FOR PEDIATRICS( 1 / 2 0 1 3 - 7 / 2 0 1 4 )
Summary
Japanese Encephalitis (JE) is a cute central nervous system inflamatories caused by JE. It present with severe symtom, high sequale, death. This study airm to find out epidemiology, clinical feature, laboratories of children with JE in NHP. Results and condussions: Most of eases oc- curred in summer (Jun, July) and Age range in 3 -15 was
Key words: Japanese Encephalitis (JE).
the most frequency. Male - female: 1:1.4. The percentage of JEV vaccine was low. The most of patients complained of fever, vomitting, headache, lethargy. Result of CSF; leu- cocyte less than 100 ceil/mml protein levels 0.4 - lg/1- Discharge 70%, sequale: 25%.
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