Y HQC VigT NAM T H A N G 12 - s 6 1/2012 gidi phau va c h u t ndng sau khi dieu trj. Khi lap
kS hoach dlBu tri van de tham my ludn dUde ddt ra, tCr dd se cd thai do xii t r i dung mufc, ky thudt phu hdp. Khi danii gia tren tidu tri: sU hai long ciia benh nhdn, cdn doi eua khudn mat va hai mdt. Nghien cu'u cho thay sd b f n h hoan'toan hai Idng, sU cdn ddi eiia khudn mdt vd 2 mdt t r d lai binh thudng ed 79 (54,1%), trung binh: 47 (32,2%), xau: 20 (13,7%) benh nhan.
Vdi thi lyc khi benh nhdn xuat vien, so sdnh trong nhdm benh nhan do dui?c thj lUc trUdc khi dieu trj vdi thj lyc sau khi ra vien cd 77,9% dat
>3/10, cai thien ro ret, s y khac biet cd y nghTa thdng ke. Nhutig benh nhan tdn thudng tai nhan cau va than kinh thj gidc, khd nSng phue hoi thj lUc kem. Benh nhan giam thj I u t do phu ne mi, mau tu hoc mdt, phii ne giac mac, k€t mac, sau khi dieu trj thu'dng tien trien tdt
V. K l T LU&N:
- Benh nhdn nam chiem ty le 7 8 , 1 % . Dp tudi hj'16 den 45 cd 7 8 , 1 % , trung tiinh la 32,6 ± 11,2 tudi. Cd 86,3% benh nhan du'dc nhdp vien trong tinh trang cap c i i l i . Bieu hien lam sdng:
xutig ne, chay mdu, dau tai cho. Ldi nhan <^u, tu mdu hoc mat, song thj, thut nhan cau. Ton thudng loai B theo phdn loai ciia Ellis gdp 83,6%.
- Nguyen nhan thudng gap Id do tai nan.
Trong d d tai nan giao thdng chiem ty le cao nhat: 72,6%.
- Benh nhdn dUdc x y tri bu'dc 72 gid trong nghien culi chiem 86,3%, trong dd cd 24,3% chi can thiep phan mem ciia mi. Can thiep xUdng gd ma cd 56,3%. Bfnh nhdn CMC xii tri mupn;13,7%.
K S qudphuc hoi tot ve giai phau, chii'c ndng vd tham my sau dieu tri: Tdt 79 (54,1%), trung binh:
47 (32,2%), xau: 20 (13,7%) benh nhan.
TAI UEU T H A M KHAO:
1. L£ Minh Thdng vd C9ng sy, "Nghien citu diiu tn gay skn hoc mSt ket hop Idt ch3 gay bSng ch§
pham san h5 ISy tu" vung bien Viet Nam", YHoc TPHCM., (2008), H$i nghi KHKT thii 25 chuyen (Je mat-TMH,t|p 12 s6 1 Trll9-126.
2. Abiose BO., "Maxillofacial Skeleton injuries in the western states of Nigeria", Br. J. OralMaxiilofac Surg. (1986),24, pp. 31-39
3. Arun Kumar Singh, "Spectrum of pnmary bone grafting in cranio maxillofacial trauma at a tertiary care centre in India", Indian J Plast Surg. (2011) Jan-Apr; 44(1), pp 29-35
-r. Criden MR, Ellis FJ.,"Unear nondisplaced orbital fractures with muscle entrapment". J AAPOS.
(2007), Apr,ll(2), pp:142-147.
5. Evans GR, Daniels M, Newell L.,An evidence- based approach to zygomatic fractures. Plast Reconstr Surg., (2011), Feb. 127(2), pp: 891- 897 6 Fini G., "Fronto-Orbito-Zygomatic Trauma with
Eyelid involvement". The Joumal of Craniofacial Surgery, (2011), Vol 22, No 4, pp: 1287-1293 7. Hwang.K, and.Kim D.H, "analysis of zygomatic
fracture " the journal of surgery,(2011), 22(4), pp:
1416-1421
NGHllN Cllu DAC DIEM LAM SANG VA CAN LAM SANG CUA BENH VIEM MAO MACH Dj l)NG
T 6 M TAT:
Mvc t i e u : khao Scit tinh hinh d|c diem lam sang va cdn lam sang ciia bdnh viem mao mach di utig tai Benh vien Da lieu Trung Udng. Phu'dng phdp: hoi ciili, md ta cat ngang 44 b|nh nhan dudc chan doan la viem mao mgch dj utig tii thang 1/2007 ^ i thang 5/2012. Ket qua: ty le b|nh viem mao mach dj uYig
• B0nh vi$n Da li§u Tnjng uong
Phan bi#n khoa hgc: PGS.TS. Nguyin HOu SSu
T r a n V a n T i ^ n * , T r a n T h j H u y e n * dieu b-j npi bii la 0,6%, tuoi tu" 15-30 chiem 34,1%, niy gap 2 idn nam, da so benh nhan d nong thon (70,5%).
Vi tri thUdng ton hay gdp la 6 chi: mu chdn (68,2%), cSng ch§n (81,8%); chi tren (11,4%). ThUdng ton xuat hien ban dau hay gdp la ban xuat huyet (45,5%), dat do (40,9%); it gap hdn la mun nUdc, san do (13,6%). Phan Idn thu'dng ^ n la loet ho?i tii (77,3%)
Y H g c VigT NAM T H A N G 12 - s 6 1/2012 vd ban xudt huyet (63,6%), ngodi ra cdn t^Sy dit
thdm (27,3%) vk myn mil (22,7). TSng b?ch c l u trong miu ngo?i vl chiem 43,2% trUdng hdP, trong dd tSng b?ch cau da nh§n trung tfnh 1^ 75%, khdng cd b§nh nhSn ndo tiing bach cdu dl toan. Mdt sd trUdng hdp duVc xdt nghilm p-ANCA vd c-ANCA d§u dm tinh. Md b$nh hpc hdu het ddu c6 thSm nhiSm vigm, hoqil tir thinh m?ch 68,8%, xuSt huySt quanh mgch 56,3%.
Kdt lu$n: vi€m mao m^ch dj img l i b^nh it g$p, d^c dilm iSm sing da d^ng, cd th£ nhdm vdi cic b$nh da khic ngn b^nh nhin cdn dUpc lim cdc xdt nghl$m d^
chdn doin xic djnh, giiip tidn iuyng vd diiu trj- Td'khda: viim mao mpch di dhg, viim m^ch.
SUMMARY:
STUDY ON CLINICAL AND LABORATORY FEATURES OF HYPERSENSITIVE VASCULITIS (HV) Objective: to Investigate situation, clinical characteristics and laboratory tests of HV at the National Hospital of Demiato-Venereology (NHDV).
Method: this is a retrospective, cross-secdonal descriptive study on 44 medical records with diagnoses as HV at NHDV from Jan, 2007 to May, 2012.
Results: among in patients b^eated at NHDV, HV cases were 0.6%, patients aged 15-30 were 34.1%;
female/male ratio was 2 : 1 ; 70.5% patients were from roral areas. Common sites had lesions ofHV: the back of feet (68.2%), lower legs (81.1%), upper extremities (11.4%). Manifestations initially appearing included purpara (45.5%), erythematous macule (40.9%), veside and erythematous papule were less common with 13.6%. Many patients had unceration (77.3%)and purpara (63.3%), in addition, uncommon lesions were macule of hyperpigmentation (27.3%) and pusbJie (22.7%). Patients with hyperieukocytoemia were 43.2%, and with increasing neutrophil were 75%, no one with increasing eosinophil in peripheral blood. Some patients were tested with p-ANCA and c-ANCA, all resuits were negative. Histological lesions included inflammation (appearing in all pabents), necrotic of the blood vessel walls (68.8%), and extravasated erythrocytes (56.3%). Conclusion: HV is a uncommon disease with variously dinicai characteristics and it isnt easy to diagnose exactiy. Tests should be fully done to diagnose, predict and treat HV.
Keywords: hyper^nslOve vasdiitis, angiitis.
I. O A T V X N DE:
Vidm mach la nhdm benh phyc tap, ed ddc (Kem OiUdng tdn md benh hpc la hoai t y va viem thdnh mach lien quan den cd che mien djch.
NgUdi ta chia ra cac the lam sdng khae nhau duci vao kieh ed mach mau bj ton thUdng, nhutig cd
quan bj b^nh, s y thay ddi v8 sinh hda vd mfin d|ch. Viem mao mach dj utig (hypersensitive vasculitis) thupc loai vidm mach nhd khdng d ANCA (antlneutrophil cytoplasme antibodies), oS thg t h y phdt hodc t y sinh r i ] [ 2 ] .
Tgl B|nh v [ | n Da lieu Trung uWig, trong thyc hdnh ISm sdng, chiing tdl gdp nhieu truSng hpp dupe chdn dodn Id vidm mao mach dj fitig ho$c vidm mao m^ch hoal t y vdl ddc i ^ ^ Idm sdng khd da dang, n h i i u khi chan dodn nham, tidn lupng vd d i i u trj nhutig chUa phii hpp. vi v^y, chdng tdl tidn hdnh d i tdl nhdm khao sdt tinh hinh vd nghidn ciiu ddc d i & n Idm sang va cdn lam sdng $nh vidm mao mach dj yng d l i u bl t^l B^nh vi#n Da l l l u Trung Udng t y thang 1/2007 tdl thdng 5/2012.
II. D 6 I TUpNG VA PHUONG P H A P NGHIEN COU:
2 . 1 . D d i tu'dng nghidn c i h i
Tong so 44 b^nh nhdn dUpC chan doan xdc djnh Id viem mao mach d! iitig t y thang 1/2007 ddn thdng 5/2012.
Tieu chuan chSn doan chu yeu d u ^ vao thUdng ton Idm sang, vdi eae d$e diem nhU ban xuat huyet, lodt hoal t y , ddt thdm, seo cu, dau nhyc tai thUdng t d n , tdc mach...
2.2. Phutfng ph^p nghien dtu - Tht3: ke nghien cCiXi: md ta cdt ngang, hoi cuU.
- Cac budc tien hanh:
TTiu thap thdng tin t y benh an cua cac benh nhan (BN).
Khao sat mdt sd yeu to lien quan re tuoi, gidi, n^he nghiep, ndi d , tudi bdt dau b| b^nh, d^c diem lam sang vd can Idm sdng.
2.3. Xur ly s 5 l l | u : theo phdn m&n SPSS 16.0.
III. K i T Q u A N G H l l N COU:
3 . 1 . Tinh hlnh b f n h v i i m m^ch dj Omg T y thang 1/2007 den 5/2012, tai Benh vi?n Da lieu Trung Udng cd 44 tru&ng hdp dUdc chan dodn xdc djnh Id vidm mao m^ch di utig vao dieu trj npi tru (chiem 0,6%), phdn bd theo tudi, gidl vd nghe nghiep nhUsau:
^ Tuoi bi benh: <15 tudi chi€m 18,2%, 15-30 tudi chiem 3 4 , 1 % , thap nhat la 4 tudi vd cao nhat Id 79 tudi.
Nam chiem 3 4 , 1 % , nu* chi€m 65,9%, binh nhdn sdng d ndng thdn chiem 70,5%, ttianh thj chiem 29,5%.
60
Y HQC VigT NAM THANG 12 - S 6 K2012
Hpc sinh-sinh vien chiem 38,6%, nong dSn chiem 11,4%, cong nhan chiem 2,3%, vSn phong chiem 6,8%, nhihig nghe khac chiem 10,9%.
3.2. D i e diem lam siing
L 4 5 , 5 %
Bliu dd 3.1. Cac thuang ton xuat hien dau tien
Nhin xit: Cac thuBng ton thu'dng xuat hien Siu tien ia ban xuat huyet (chiem 45,5%), dat do (40,9%), cac thuUng ton l<hac (mun nu'dc, san d6...) chiem 13,6%.
g3.1. Cac loai hinh thu'c Thuvng t6n ca b i n Lo6t hoai tij Bgng nirdc IVIO B a n xuSt h u Y ^ t Phil DSt tham Seocu Tac mach
nq ton thu'dnq qap n 34 6 10 28 8 12 15 2
77,3
%
13,6 22,7 63,6 18,2 27,3 34,1 4.5
Nhan xet: Cac loai hinh thUdng tdn hay gap trong viem mao mach dj yng la loet hoai ty (77,3%), ban xuat huyet (63,6%), seo eu (34,1%), dat thdm (27,3%), tac mach it gap (chiem 4,5%).
g 3.2. Vi t n thu'dnq ton V i t r i i\^u chdn C i n q chdn
Nqodi chan (tav, bunq ..)
n 30 36 5
68,2
%
81,8 11,4
Nhan xet: Vj tri hay g3p nhat ciia benh viem mach di utig ia d cang chan (chiem 81, chan (68,2%). Cac vj tri i<hac nhu'tay, diii, bung chiem 11,4%.
3.3. Die diem can ISm sang Bing 3.3. Cong thifc bach cau
p§c di4m Tang bach ciu tronq mdu nqoai vi
Tanq bach ciu da nhan trunq tinh trong miu nqoai vi Tanq bach cau da nhan ai toan tronq mdu nqoai vi
43.2
Nhan xetixnVi nhan tang so lu'dng bach cau trong mau ngoai vi chiem 43,2%, tang ty le bach clu da lihSn trung t'nh chiSm 75%. Kliong co benh nhan nao tSng ty ie bach cau da nhan ai toan.
Trong so 44 binh nhan, co 5 benh nhan du'Oc xet nghiem p-ANCA(perinuder-ANCA) va c-ANCA (cytoplasmic-ANCA), ket qua deu am tmh.
Bina 3.4. Ket qua xet nqhiem mo benh hoc Hinh i n h mo binh hoc xam nhap viem
Hoai to thdnh mach Xuat huv4t quanh mach
DuHyng ttnh 16 11
Nh$n x^fHau het cac tru'dng hdp co xam nhap viem ciia bach cSu da nhan trung tinh (100%),
hoai tu'thanh mach chiem 68,8%, hinh anh xuat huyet quanh mach chiem 56,3%.
Y Hpc VigT NAM THANS 12 - S 6 1/2012 IV.
BAN L U ^ N :4.1. Tinh hlnh b$nh viem m^ch dj u'ng Trong khoang thdi gian 5 nSm (tii' thdng 1/2007 tdi thang 5/2012), t?i B|nh vl?n Da iieu Trung u'dng da tiep nhan dieu trj 44 b|nh nhSn viem mao mach dj iitig, chiem khoang 0,6%
benh nhan noi trii. Cic tri$u chihig ISm sing ciia benh viem mao mach dj utig da dang. Vl$c chSn doan xac dinh chu y^u di/a via 13m sing vi m6 b^nh hoc. Trong dd cd 2 b?nh nhSn du'cJc chSn dodn liic vdo vi|n ia b?nh chdm vl khuan vd viem da mil.
Cdc b#nh nhan bi viem mao mgch dj img trong nghlin cutj ciia chung toi cd d$c diem: nff chiim 65,9%, g5n gap doi so vdi nam (34,1%).
Ttieo kit qua ciia mpt s6 cong nghiin cilu thi ty l | b! benh d nam vd ni? la tu'dng du'dng nhau t3][4]. Mpt s5 nghien cuti khde d Tay Ban Nha cung cho thay ty II b| b|nh d nam cao hdn nif [3]. Tuoi mSc b|nh <15 tuoi chlem 18,2%, tir 15-30 tuoi chlim 34,1%. Ooi tu'png Id hpc sinh- sinh viln chiem 38,6%, trong khi do nong dan chi chiem 11,4%, cong nhan chlim 2,3% vd ngu'di Idm van phong chlim 6,8%. Chung toi cung chuS co cd sd d l ly gidi tai sao benh viem mao mach dj utig Iai gap nhieu 6 hpc sinh vd sinh viln. Co the do viec phdn phoi benh theo nghe nghiep thi doi tu'dng la hpc sinh- sinh viln co^nhieu ngu'di triing lap trong nhdm ngu'di tre tuoi. Nhu'vay, ket qua ciia chiing toi phu hdp vdi y vdn Id benh viim mao mach d^ irng hay gdp d tre em vd thanh thilu nien [4]. O dp tuoi di hpc cd the dang 6 giai doan phat triln, cdc chii'c ndng dang du'dc hoan thien, ddc bi|t la hp thong mien dich bdo ve cd t h i nin co t h i de mdc mpt so benh nhiem tnjng, dj utig mlln djch. Tuy nhien, benh co the gdp d bat ky tuoi ndo [3].
Trong nghiin cuti ciia chiing toi, benh nhan tre nhat la 4 tuoi vd gid nhat Id 79 tu5i. Co 70,5%
benh nhan song d nong thon, cao hdn nhieu so vdl bpnh nhan song 6 thdnh thj Id 29,5%. Co the do d nong thon do dieu kiln sinh ho^t, dn d vd Iao dpng khong tot bdng d thdnh thj nin de mdc benh hdn. Mdt khac, cung co the d nong thon diiu kiln du'dc tilp can chdm soc y t l khong thuan ldi bdng d thdnh thj nen ngu'di ddn thu'dng di khdm, chiia benh mupn. Thu'dng khi benh nang anh hu'dng den sinh hoat vd Iao dpng thi ngu'di dan d nong thon mdi di chua trj. Vi vay, benh nhan mdi phdi vao dieu trj npi tru d b|nh viln thupc tuyen trung u'dng.
62
4.2. e^c a\im \im sing
Kit qud d bdng 3.2 cho thSy cdc vj tri hay bj tdn tht/dng ciia benh viem mao mach dj utig Id mu chdn chiim 68,2%, cSng chdn chiim 81,8%, d cdc v| tri khde nhu' chi trin, bung chlim 11,4%.
6 ddy chiing tdi chia ra d mu chdn vd cdng chdn mdc dil hdu hit benh nhdn deu gdp thu'dng ton d chl du'di. Kit qud cua chiing toi cung phii hdp vdl so ii|u cua W. Sterry, R. Paus, W. Burgdorf cho thiy vl tri thu'dng ton vllm mao mach dl litig hay gdp Id chi du'di (100%), it gdp hdn Id d chl trin (15%), niem m?c (15%) va tai ngodi (10%) [4], Kit qud nghiin ciiti cua chiing toi khong thiy bpnh nhdn ndo cd thu'dng ton d niem m?c vd tal ngodi. Theo co chl b|nh sinh, thu'dng ton ciia b|nh viem mao mach d| irtig duWc hinh thdnh Id do cdc phiic hpp miin djch sinh ra vd luti hdnh trong mdu ngoai vi, khi gdp cdc dieu ki|n thuan loi nhu' toe dp mdu cham d cdc madi xa trung tdm, gdp cdc vdt can nhU chS re dpi aia cdc map mach, vj tri t?nh mach sau mao mach, khi thdnh mach bj ton thu'dng...thi chung ling dpng d thdnh macli. Cac phifc hdp mien djch nay tu'dng tac vdi t l bap npi mo gay ra hang Ioat cdc phdn iitig Idm ton thu'dng mach mau. Cd die b|nh sinh ndy ly giai tai sao thuong ton oia benh viim mao mach dj litig chii yeu gdp d chi dudi vd mpt phan d chi tren [5].
Kit qua d bleu do 3.1 cho thay cac bleu hiln sdm ciia benh viem mao mach hay gdp Id ban xuat hjiylt chiem 45,5%, ddt do chiaii 40,9%, cdc bleu hiln khac (mun n u ^ , san do...) ft gdp hdn, chlem 13,6%. Cdc bleu hl|n nay cd the gdp trong nhieu benh da khac nhau. Cho nin, d giai doan dau, khi b|nh mdi phat triSn cd t h i bj chan doan nham vdi cac b|nh da khac hodc din giai dojin mupn khi benh cd cac Wpu chiitig lam sang dien hinh nhu' Ipet hoai tir, dau nhut mdi du«c chan dodn xac djnh.
Loai hinh thutJng ton ciia b?nh vHm mach d{
litig rat da d?ng, mite dp vableu hl|n khac nhau
tiiy theo timg b|nh nhan, tiiy thupc vap giai
doan cua benh va mii'c dp boi nhlem. Kit qua
nghien ciitj d bang 3.2 thay tri|u chutig Idm sang
d nhffng b|nh nhan b| viim mach di iitig dieu tn
nol_tru tai B|nh viln hay gdp nhat Id kjet hoal ti
chiem 77,3%, dip theo la ban xuat huyet cliian
63,6%, seo cu chlim 34,1%; ft g^p hdn Id dat
tham (27,3%), mun mil (22,7%) phii chdn
(18,2%), bpng nude (13,6%). NguBc lai theo lai
lieu thi trieu chiitig hay gap nhat Id ban xu3t
huyit Id 99%, ddt 40%, loet 30%, mun mil 20%,
Y HQC VigT NAM T H A N G 12 - s 6 1/2012 san phu 1 0 % , ndt dUdi da 10% [ 4 ] . Oe giai thieh
sy khae nhau nay, chung tdi cho rang B^nh vien Da lieu Trung Udng la bdnh vien chuyen khoa tuyen cudi nen khi benh nhan di/dc chuyen den kham va dieu trj thu'dng benh dd d giai doan mupn hodc nhii'ng trUdng lidp benh n^ng mdi dudc chuyen den. Mdt khac, ddi tUdng nghien cyu cua Chung tdi la nhffng b^nh nhan dieu trj noi tru nen ed t h ^ nhu'ng trudng hdp viem mach dj utig nhe da dUde sang Ipe dieu trj ngoai tru tai khoa kham benh. Qua thdm kham va phdng van benh nhdn ehung tdi nhdn thay ty le benh nhdn cd loet hoai t y , boi nhiem cao cdn do b f n h nhan chda dude t u van ki ve cac bien phap phdng ngya va chdm sdc thut^ng tdn tai eho, ehuci cd bien phdp bao hd khi tham gia Iao ddng chdn tay.
4 . 3 . C d c d i e m c $ n I a m sidng
Xet nghiem huyet hoe, ket qua bang 3.3 ttiay 43,2% trUdng hdp cd tdng bach cau trong mau ngoai vi, 7 5 % trUdng hdp tdng bach cau da nhdn trung tinh. Ket qua nay cd the phan nao phan anh s y dap ijtig cua cd the vdi tinh trang nhiem biing trong benh viem mao mach dj yng.
Khi cay dich mu tai thu'dng ton d mdt sd benh nhdn cd t u cau vang. Nhiem trung lam cho thudng tdn toet hoai t y eua benh viem mao mach dj yng ndng len. Vi vay, khi dieu trj ran phdi phoi hdp cac thuoc chong viem vd khang sinh chdng nhiem t m n g , ddc biet la phai chdm sdc tai cho tot. Benh viem mach cd len quan tdi cd d i e dj utig tien phat hode t h y phat, nhUng thyc te ket qua nghien cyu cua chung tdi thay ty le bach <Su da nhan ai toan trong mau ngoai vi cua cac benh nhan deu khdng tang.
Trong sd 44 benh nhan nghien cull hoi euU, chung tdi chi thay cd 5 biTdng hdp dudC xet nghiem p-ANCA va c-ANCA, ket qua deu am b'nh. Dieu nay frfiij h ^ vdi chan doan vi viem mao madi dj litig la mpt b i n h viem madi nhd khdng ANCA [1][2].
K€t qua xet nghiem md b?nh hpc (bang 3.4) thyc hi$n d 16 benh nhan thay 100% cd sU xam nhap eua eae te bao viem nhU bach cau da nhdn
trung tinh, 68,8% ed hinh anh hoai t y thanh m?eh va 56,3% cd hien tUdng xuat huyet quanh mach. Ket qua md benh hpc kha tUdng xyng vdi cae thUdng tdn tren lam sang.
V. KET LUAN:
Ty ie benh viem mao mach dj yng didu trj ndi tru tal benh vien Da lieu Trung Udng la 0,6%, tudi t y 15-30 chi^m 3 4 , 1 % , nff gap 2 lan nam, da so benh nhan d ndng thdn (70,5%).
Vi trf thu'dng tdn hay gdp la d chi: mu chan (68,2%), cdng chan (81,8%); chi tren (11,4%).
Thudng tdn xuat hien ban dau hay gdp la ban xuat huyet (45^5%)," dat do (40,9%); it gdp hdn la mun nUdc, san dd (13,6%).
Phan Idn thudng tdn la loet hoai t y (77,3%) va ban xuat huyet (63,6%), ngoai ra cdn thay dat tham (27,3%) va mun mu (22,7).
Tang bach cau trong mau ngoai vi chiem 43,2% trUdng hdp, trong do tang bach cau da nhdn trung tinh la 75%, khdng cd benh nhdn ndo tdng bach cau al toan.
Mpt sd trudng hdp dUdc xet nghiem p-ANCA vd c-ANCA deu am tinh. Md benh hpc hau het deu ed tham nhiem viem, hoai t y tfianh mach 68,8%, xuat huyet quanh mach 56,3%.
TAI UEU T H A M KHAO:
1. Benh da mien dich-dj u l i g (2012), Dai hpc Y diidc Thai Nguyen, giao trinh giang day sau dai hoc, tr. 36-40.
2. Fitzpatrick's Dermatology in general medicine (2008), Cutaneous Necrotizing Venulitis, p. 1600-1606.
3. Jeffrey P Callen (2012), Leukocytoclastic vasculitis.
4. W. Sterry, R. Paus, W. Burgdorf (2006), Dermatology, p. 245-261.
5. B. Crickx, S.Belaich, Purpuras et vasculites, Dermatologie et maladies sexuellement transmissibles, Masson, pp: 657- 660.
