Y HOC VIET NAM THANG 2 • SO 2/2013
THUC TRANG MAC U Q PHOI TRONG DAN SO 15 TUOI TROT LEN VA MOT SO YEU TO LIEN QUAN TAI TINH U I CHAU (2011 -2012)
Du'dng Oinh Ou'c^, ViTdng Van T h a n h ^ Le Dinh P h a n ^ Nguyen Cong H u a n ^ Dinh Ngoc Sy^
T 6 M TAT:
- Nghien cffu dUdc tien hanh tren 9800 ngudi tff 15 tuoi trd len tai 30 xa ciia tinh Lai Chau. Phat hien BN lao bSng phudng phap kham lam sang sang loc va xet nghiem ddm tru'c tiep theo quy trinh ciia ChUOng trinh chong lao quoc gia. Ket qua: Ty le mcic lao phot mdi AFB (+) la 0,9%; ty le nhiem HIV trong so BN lao la 33%. Tff ket qua xac dinh ngudi mSc lao tren so ngudi tham gia dieu tra, ffdc iuWng chi so mSc lao d ngffdi tff 15 tudi trd len la 102,7/100.000 dan (95%
a : 0-232 /100,000 dan).
- Phan tich so lieu thff cap doi vdi 264 trUdng hpp mSc lao phdi da dUdc xac dinh ciia tinh Lai Chau nam 2011-2012 cho thay: Ty I? mac lao phdi d nam (83,2%) cao hon d niy (74,3%), sff khac biet la khong CO y nghla thong ke (p >0,05). Ty le mac lao phoi cao nhSt d nhom tudi 35-44 (92,1%) va thap nhat 6 nhom tuoi 15-24 (60%), vdi p<0,001. Sff khac biet ve ty le mSc lao phoi gii?a cac nhdm dan tdc khac nhau va gffa cac nhom nghe nghiep khac nhau la co y nghTa thdng ke (p<0,01).
TO'khoa: Lai Chau, lao phoi, AFB (+).
SUMMARY:
SITUATION OF PULMONARY TUBERCULOSISIN THE POPULATION OVER 15 YEARS OLD AND SOME FACTORS
RELATED TO IN LAI CHAU (2011-2012) - The study was conducted on 9800 people aged 15 and older in the 30 communes of Lai Chau province. Tuberculosis patients detected by clinical examination and screening meUiods sputum directly under the National TuberculosisProgram. Results: The prevalence of new tuberculosis AFB (+) 0.9%; HIV prevalence among Tuberculosis patients is 33%. From the results identifed from the Tuberculosis survey participants, estimates the rate of Tuberculosis in people aged 15 years and older was 102.7 / 100,000 population (95% CI: 0-232 / 100 000 population).
- Secondary data analysis of 264 cases of tuberculosis were identified in Lai Chau province in 2011-2012 shows tiiat: Incidence of tuberculosis in men (83.2%) more than tiiat in women (74, 3%), Uie difference was not statistically significant (p> 0.05).
The highest incidence of tuberculosis in the age group 35-44 (92.1%) and lowest in the age group 15-24 (60%), with p <0.001. The study also showed that the difference in the incidence of tuberculosis among
ethnic groups and occupational groups is statistically significant (p <0.01).
Key words: Lai Chau, tuberculosis, AFB (+).
I. O A T V A N DE:
Ngay nay, benh lao v i n dang la van de sffc khoe cdng cdng ndi com ciia nhieu nffdc dang phat trien. Nam 1993, To chffc Y te the gidi (TCYTTG) da canh bao benh lao la mpt van de khan cap toan cau. Hang nam cd khoang 6,3- 11,1 trieu ngffdi mac lao mdi, trong dd lao phot AFB ( + ) ed sd mac tff 2,8-4,9 trieu. Hdn 95% so trffdng hdp mac lao la d cae nffde ed thu nhap thap. Theo bao cao ciia TCYTTG (2010), tinh hinh Iffu hanh benh lao tren the gidi nam 2009 van edn tram trong: Tren 200 trieu ngffdi nhiem lao, khoang 8,9-9,9 trieu ngffdi mac lao mdi hang nam, trong dd lao phdi AFB ( + ) la 3,9 trieu va sd ngffdi mac cac the lao tff 12-16 trieu.
Tinh hinh benh lao d nffdc ta edn rat nghiem trpng. Bao eao eiia TCYTTG (2010) eho biet, Viet Nam dffng hang thff 12 trong 22 nffde qudc gia ed ty le mac lao cao nhat the gidi. U'de tinh trong nam 2010, tong sd ngffdi hien mac lao khoang 290 nghin, trong do 180 nghin mac lao mdi, 69 nghin lao phdi AFB ( + ) va 29 nghin trffdng hdp ehet do lao. Chi sd hien mac lao ffdc ti'nh khoang 334/100.000 dan, trong dd chl sd mdi mac lao cac the la 199/100.000 dan.
Trong 5 nam (tff 2007-2011), trung binh moi nam Chffdng trinh chong lao Qudc gia Viet Nam phat hien khoang 50-55 nghin trffdng hdp lao phoi mdi AFB ( + ) va khoang 100 nghin lao eac the. Ty le phat hien lao phoi mdi AFB ( + ) khoang 60/100.000 dan va lao cac the khoang 114/100.000 dan [ 1 ] , [ 4 ] . Hoat dpng phat hien benh lao d nffdc ta cdn rat thap: Lao cac the dat khoang 5 6 % va lao phdi mdi AFB (+) khoang 62%, thap hdn muc tieu de ra ciia TCYTTG la phat hien tren 7 0 % sd ngffdi benh lao phdi mdi AFB (-I-), nhff vay, cdn mdt sd Iffdng ldn ngffdi benh lao (38%) van ton tai trong cdng ddng chffa dffdc phat hien [ 2 ] , [ 4 ] , [ 5 ] .
Tinh Lai Chau, hang nam ed khoang 450-550 ngffdi benh lao phdi cac loai, trong dd 345 ngffdi 51
Y HQC VI$T NAM THANG 2 . S6' 2/2013 laoAFB (+). Chffdng trinh phdng ehdng lao da
dffdc trien khai tff n3m 1993, tuy nhl^n, kha nang phat hien, quan ly va dieu trj benh lao hang nam so vdi toan qudc cdn thap, nhat la phat hien lao mdi AFB (+) dat rat thap khoang 30/100.000 dan (ehi bSng khoang 1/2 so vdi toan qudc).
Thffc trang nay khdng the eung cap so li|u chinh xac ve tinh hinh benh lao hi^n nay cung nhff dff bao xu hffdng dien tien ciia benh trong nhu'ng nam tiep theo.
Muc tieu cua nghien cu'u nay Id; Md ta thffc trang mSc lao phdi tren cae ddi tffdng dieu tra tff 15 tuoi trd len va mdt sd yeu td lien quan trong cac benh nhan lao ciia tinh Lai Chau nam 2011-2012. Lam ed sd de de xuat mdt sd hoat ddng can thiep nhim nang cao nSng Iffe cho can bo y te cd sd trong cdng tac phdng ehdng lao ciia tinh trong nhthig nam tiep theo.
II. D 6 | T U ^ N G VA PHUONG PHAP NGHIEN COU:
2.1. Odl tu'dng nghi§n CIJ'U
Cae edng dan tff 15 tudi trd len cd hp khau thffdng tru hoac tam trii tren 3 thang tai eac diem dffdc chpn dieu tra. Loai trff nhffng ngffdi dffdi 15 tud'i, benh nhan lao ngoai phdi va khdng hdp tae ra khdi danh sach dieu tra.
2.2. Dja diem va thdi gian nghien cu'u Nghien cillj tai tinh Lai Chau, tff thang 10/2011 den thang 3/2012.
2.3. Phu'dng phap nghien cu'u - Thiit ki'nghiin cutr. Md ta cat ngang dim ti-en 50 lieu dinh iffdng va phan ti'ch so lieu thff cap.
- Cd mau va chgn mau dot tddng tut 15 tuoi trd lin de nghlin cuV tien cud:
Ap dung edng thffc:
a-
Trong dd: p=0,00114 (lay chi sd mSc lao toan qudc eiia Chffdng trinh ehdng lao Qudc gia=114/100.000 dan); q = 1- p; Z vdi do tin cay 95% = 1,96; d (sai sd) = 0,0007 (70/100.000).
Thay sd vao edng thffc, tinh dffdc n=8923. Thffc teda dieu tra 9800 ngffdi (vffdt 10%).
Chon ngau nhien 30/108 xa, phffdng ciia tinh Lai Chau de nghien effu. Moi xa chpn ngau nhien 327 ngffdi cd dp tuoi tff 15 trd len de nghien cffu theo phffdng phap ngau nhien he thdng (9800/30=327 ngffdi).
- Cd mau de phan tfch thi/'c trang iao phoi tai tinh Lai Chau va mpt sd yeu td iien quan (phan tich so iieu thd cSp): Toan bp benh nhan (BN) lao phdi da dffdc xae dinh cua tinh Lai Chau nam 2011-2012 (264 BN lao).
• N^ldung va cdc chi sS nghien cdu:
+ Xac djnh ty le (%) ngffdi nghi lao va BN mac lao trong so doi tffdng dieu tra tff 15 tuoi trd len tai 30 xa nghien cffu theo gidi, tudi, dan tpc, nghe nghiep, cac trieu chuYig thffdng gap, benh khae ket hdp (nhiem HIV, dai thao dffdng). Tff ty le BN lao phoi AFB (-*-) mdi dffdc phat hien ffdc Iffdng ehi sd mac lao/100.000 d3n.
+ Xac djnh mpt sd yeu td lien quan d cac BN lao da dffdc xac dinh eiia tinh Lai Chau nam 2011-2012 nhff gidl, tudi, dan toe, dja gidi hanh chinh (huyen) va nhiem HIV ket hdp.
- Phu'dng phdp vii Ay' tiiuat thu th$p
thdng tin: Kham sang Ipc tat ca 9800 ngffditrong mau nghien ciTu de tim ra nhffng ngffdi nghi mic benh lao tren lam sang gom; Nhi?ng ngffdi cd mot trong nhiJtig trieu ehutig ho khac ddm tren 2 tuan; Ho ra mau; Dau tffc ngffc; Sdt + Ra mo hdi ban dem; Met mdi, G3y sut can va nhtitig ngffdi da hoac dang dieu trj lao tnDng vong 2 nam gan day:
Tien hanh xet nghierfi ddm trffc tiep ti'm vi khuan lao doi vdi tat ca doi tffdng nghi lao. Moi ngffdi dffdc lay 3 mau ddm xet nghiem (tai cho khi den kham, mau thff hai vao sang sdm mot ngay hen trffdc, vi dy ngay thff 4 hoac 5 va tai cho ngay thff 4 hoac 5 khi den kham lai). Hffdng dan BN lay ddm, kiem tra chat Iffdng va tien hanh gian tieu ban, nhupm soi tai cho. Sii" dung phffdng phap nhupm Ziehl-Neelsen, ket qua dffdc ghi trong "Phieu xet nghiem va ket qua xet nghiem ddm",
Tieu chuan xac dinh lao phdi AFB (+) phai co it nhat 2 tieu ban (+) tff 2 mau ddm khae nhau.
- Cdng cu, vatll^u nghiin cdtt: (1) Phieu dieu tra doi tffdng > 15 tudi dffdc chpn nghien cull va phieu khao sat hoi eiru benh nhan lao dffdc thiet ke s§n; (2) Dung cu xet nghiem^ddm nhff kinh hien vi, lam kinh, ede ddm, hda chat...
2.4. Xir ly va phan tich ^ lieu So lieu dffdc phan tich bang phan mem Stata vlOSE (Stata Corporation, College Station Tx, USA), phan tich cd hieu chinh theo sai so chuan eiia thiet ke mau va ty le tham gia cua cac diem dieu tra.
52
Y HQC V | £ T NAM THANG 2 - S6' 2/2013 III. KET QUA NGHIEN CljrU:
3 . 1 . Thu'c t r a n g t y le nghi lao va mac lao trong 9 8 0 0 ngu'di tir 1 5 tu6i t r d len t a i 30 xa nghien cufu
3.1.1. Thdc ti-^ng nghi lao
* Tyle ho ichac keo dai tren 2 tuan.Ty le ho khac keo dai tren 2 tuan trong sd ngffdi tham gia dieu tra la 884/9800 (9,0%). Ti le ho khac keo dai tren 2 tuan tang dan theo nhdm tudi, tff 5,6%^d nhdm 15-24 tud'i den 25,0% d nhdm tff 65 tuoi t r d len. Sff khae biet ve b/ le ho khac tren 2 tuan giffa cac nhdm tudi la cd y nghla thdng ke (P<0,001). Ty le ho khae tren 2 tuan rat eao d nhdm ngffdi 65 tuoi t r d len (25,0%), ed nghia la cff 4 ngffdi thi cd 1 ngffdi ho khac keo dai tren 2 tuan. Tuy nhien, sd ngffdi tff 65 tudi t r d len tham gja dieu tra rat thap (32 ngffdi, chiem 0,3% tren
^ n g sd ddi tffdng dieu tra). Ty le ho khac keo dai tren 2 tuan d nhdm cac dan tdc khac la 11,1%, cao hdn nhdm Thai (9,3%), H'mdng (8,4%), Kinh (4,2%). Ty le ho khac keo dai tren 2 tuan eao nhat d nhdm ddi tffdng la ndng dan (9,9%) va thap nhat d nhdm hpc sinh - sinh vien (3,3%). Nhdm buon ban va lam nghe tff do la 5,2% va nhdm cdng nhan - vien chffc la 7 , 1 % . Ty le ho khac keo dai tren 2 tuan cao d nhdm khdng dl hpe va tieu hoc ( 9 , 5 % va 10,1%), trong khi nhdm cd hpe van tff trung hpe ed sd t r d len (6,8%). Tat ca sff khae biet tren deu ed y nghTa thong ke (p<0,05). Ty le lio khac keo dai tren 2 tuan theo tuoi va gidi: nam cao hdn nff d cac nhdm tudi 15-54 va tff 65 tudi t r d len, tuy nhien d nhdm tuoi tff 55-64 thi nff (15,6%) lai cao hdn nam (14,2%) song sff khac biet khdng ed y nghla
thdng ke (p>0,05); dae biet la ty le ho khac rat cao d nam gidl tff 65 tudi t r d len (39,7%).
* Xac dinh ngu'di nghi iao bang phong van sang ioc du^ tren tieu chuan "Ho khac i<eo dai tren 2 tuan" hoac co mot trong cac trieu chu'ng nghi iao: Sd ngffdi cd trieu chffng nghi lao: ho khae keo dai tren 2 tuan; sdt ve chieu; gay sut can, an kem; ra mo hdi trpm; dau tffc ngffc; khd thd va ho ra mau. Trong tong sd 9800 ngffdi tham gia dieu tra, xae djnh dffdc 1182 ngffdi (12,1%) cd it nhat mdt trong cae trieu chffng nghi lao neu tren. Trong dd 4990 la nam va 4810 la nff, ty le cd it nhat mgt trieu chffng nghi lao d nam (13,4%) eao hdn niJ' (10^7%).
Trieu chffng nghi lao hay gap nhat la dau tffc ngffc (1017 ngffdi=10,4%); sau dd la khd thd (935=9,5%); ho khac keo dai tren 2 tuan (884=9,0%); ra md hdi trpm (769= 7,8%); sot ve chieu (693=7,1%); gay sut can, an kem (689=7,0%) ya cuoi ciing la ho ra mau (114=1,2%). 6 tat ca cae trieu chffng nghi lao neu tren, ty le cd trieu chffng nghi lao d nam cao hdn nff.
* Xac dinh ngu'di nghi lao di/a vao tien sd dieu trj: Trong tong sd 9.800 ngffdi tham gia dieu tra, cd 280 ngffdi (2,86%) ed tien sff dieu tn benh phd'i trffdc day (137 nam; 143 nff)va 13 ngffdi (0,13%) cd tien sff dieu tri lao trffdc day (7 nam va 6 nff), trong dd 10 ngffdi cd tien sff dieu tri lao trong vdng 2 nam gan day va 3 ngffdi da dieu trj lao tff trffdc day tren 2 nam.
3.1.2. Thdc trang mac lao
Trong sd 1.125 ngu'di dffdc lay ddm xet nghiem, tat ea 100% deu cd du 3 mau ddm.
Bang 1. T3n xuat cae trieu chffng thffdng 3hat hien tronq nghien effu
gap nhat ciia benh nhan lao phoi mdi AFB ( + ) du'dc
Trieu chi>ng Ho
Ho khac fldrn tren 2 tuan S6t v^ chieu Giy sut can, an k6m Ra mo hoi ban d§m Bau tLTC nqu'c Khe thff Ho ra mau
BN lao ph SL
7 6 6 7 5 6 7 1 10
6i AFB (+) 70,0 %
60,0
60,0
70,0
50,0
60,0
70,0
10,0
Y HQC VigT NAM THANG 2 - s6 2/2013 Ket qua xet nghiem soi trffc tiep: 10 trffdng
hdp (0,9%) cd It nhat 2 mau ddm dffdng tinh trd len. Nhff vay, dieu tra phat hien dffdc 10 BN lao phdi mdi AFB (+). Trong dd ea 10 BN deu khdng cd tien sff dieu trj lao trffdc day, 9 BN khdng cd tien sff benh phdi khac, va chi cd 1 BN la da tiTng dieu tri benh phoi trffdc day. Ty le xuat hien cac tri^u chffng ho; gay silt can, Sn kem; khd thd la 70%; cae trieu chffng ho khac ddm tren 2 tuan, sdt ve chieu, dau tffc ngffc la 60%; ra mo hdi ban dem la 50% va ed 1 BN ho ra mau (10%).
* Ti le hien mac lao phot AFB (+) d ngffdi >
15 tuoi
Dim ti^n ket qua xae djnh ngffdi mac lao tren so ngffdi tham gia dieu tra, ti le mac lao 6 ngffdi td 15 tud'i trd len dffdc [Sdc ti'nh la 102,7/100.000 dan (95% CI: 0-232 /100,000 dan).
Trong tong sd 4757 nam gidi tham gia dieu tra, phat hien dffdc 9 BN lao, ty le hien mac lao phdi mdi AFB (+) d nam tff 15 tuoi trd len (thd) la 189/100.000 dan va sau khi hieu chinh cho sai so do lay mau chiim va ty le ngffdi tham gia d
eac diem dieu tra la 188/100.000 dan (95% Q;
0-449/100.000 dan).
Trong tdng sd 4786 nu' gidi tham gia dieu tra, ehi phat hi?n dffdc 1 BN lao, ty le hien mac lao phdi mdi AFB (+) d nff tff 15 tudi trd len (tho) la 21,8/100.000 dan va sau khi hieu chinh cho sai sd do \Sy mau chum va ty le ngffdi tham gia c( |j e^c diS'm dieu tra la 21,8/100.000 dan (95% a;
0-66 100.000 dan).
Do han che ve nguon ly'c, nen ed mau diu tra chffa dii Idn de lam dai dien eho quan the II djnh danh trong cpng ddng dan cff cua ti'nh, do dd, khi phan BN theo cac nhdm tuoi thi so BN lao hien mac tai tffng nhdm tuoi rat it (ehi tff 0-3 BN). Tuy nhien, khi phan tieh ty le hien mSc lao theo cac nhdm tuoi (ngoai trir nhdm tudi tff 65 trd len khdng phat hien dffdc BN lao phoi AFB dffdng tinh), ty le hien mac lao thap nhat d nhom tudi 15-24 (29,4/100.000 dan (95% Q: 0- 89,4/100.000 dan) va cao nhat d nhdm tuffi 55- 64 (555 /lOO.OOO dan, 95% CI: 0-1359/100.000 dan). Sff khac biet ve ty le hien mac lao giO^ cac nhdm tudi la ed y nghla thdng ke (P<0,001).
Bang 2. Ty le hien mac 1 0 phoi Sd ngivoi di&u tra
TS Gidi
Nam NO' Nh6m tuoi
16-24 25-34 35-44 45-64 55-64 66+
DSn tOc Kinh ThSi H'mSnq Khac
n 9800 4990 4810 3451 2855 1822 1274 366 32 1340 3433 1849 3178
mcri AFE {+) theo tuoi, gicfi, dan tc AFB(+) SL
10 9 1 1 3 3 1 2 0 2 1 1 6
T y l i / 100.000
dan (tho) 102,4 180,4 20,1 29,0 105,1 164,7 78,5 546,6
0,0 149,3 29,1 54,1 188,8
Tyi?/
100.000 dSn (Hi^u
chinh) 102,7 187,9 21.8 29.4 107,5 167,6 79,6 555,4 0,0 154,5
30,4 55,1 192,9
X
95% CI
0 0 0 0 0 0 Q 0 0 0 0 0
231,6 448,7 66,3 89,4 267,0 417,7 244,4 1359,0 324,2 92,7 171,4 566,0
P
>0,06
<
0.001
<0,05 C Hieu chinh theo lay mau chum va ty te ngwdi tham gia d cac diem dieu tra) Ty le hien mac lao phoi AFB (-I-) d ngu'di > 15 trong nhom ngu'di dan toe thieu so khac (193/100.000 dan, 95% CI: 0-566/100.000 dan) cao hOn nhom ngu'di Kinh (155/100.000 dan, 95%
CI: 0-324/100.000 dan), ngu'di Thai (30/100.000 dan, 95% CI: 0-93/100.000 dan), ngu'di H'm6n9 (55/100.000 dan, 95% a : 0-171/100.000 dan).
54
Y H(?C VIET NAM THANG 2 - SO 2/2013
- Phan bo benh nhan lao phoi mdi AFB(-i-) theo dia phu'dng: Trong 10 BN lao phoi mdi AFB(-i-), tap trung chii yeu d huyen MuSng Te (6 BN), Tllj xa L^i Chau (2 BN), Sin Ho va Tan Uyen (moi huyen 1 BN).
Bang 3. So sanh ty le hien mac lao phoi mdi AFB (-t-) d ngi/di ldn > 15 tuoi trong nhdm cd trieu
Sd ngifo"! dieu tra
TS
n 9800 Ho khac trfen 2 tu^n
06 Khdng
884 8,916
SL 10 6 4
AFB(
Tyl#/100.000 diln (Tho)
102,4 678,7 44,9
*) Ty If /100.000 dan(HC)
102,7 674,7 45,4
95% CI 0 0
L L231,6 1600,5
100,6 P
<0,001
Ty le hien mac lao phoi mdi AFB ( + ) d ngffdiIdn > 15 tuoi rat cao trong nhdm cd ho khac tren 2 tuan: 675/100.000 ngffdi ( 9 5 % C I : 0- 1601/100.000 ngffdi) so vdi nhdm khdng ed trieu ehutig ho khae keo dai tren 2 tuan: 45,4 /lOO.OOO ngffdi ( 9 5 % C I : 0 101/100.000 ngffdi). Sff khac biet cd y nghTa thdng ke (p<0,001). Nhff vay, vdi viec bo sung cac trieu ehiftig nghi Iao Wiac nhff sdt ve chieu; gay sut can, an kem; ra mo hdi ban dem; dau tffc ngffc;
khd t h d ; ho ra mau; va tien sff dieu trj lao trong vdng 2 nam gan day da tang dffdc 4 0 % sd BN lao dffdc phat hien qua dieu tra (4/10 BN).Hay ndi each khac, 4 0 % sd BN lao phdi mdi AFB (-(-) dffdc phat hien qua dieu tra khdng cd trieu chffng ho khac keo dai Iren 2 tuan va chi dffdc phat hien thdng qua cae trieu chutig nghi lao khae hoac tien sff dieu trj lao trong vdng 2 nam gan day.
3.1,3. Ifdc tinh ti 1$ Men mac lao tai tinh Lai chau
Theo sd lieu cua Tdng eye Thdng ke, tong dieu tra dan sd va nha d nam 2009, ty le tre em<15 tudi la khoang 2 5 % . Vdi gia dinh eac trffdng hdp mac lao cd bang ehutig vi khuan (soi va cay) d tre em<15 tudi la rat hiem eoi nhff bang khdng (Thffc te van cd the ed cac trffdng hdp lao d tre em tim thay vi khuan lao trong ddm, djch da day nhffng vdi t i le rat thap).
Du^ tren sd mac lao phdi AFB ( + ) dddc phat hien trong nhdm ddi tffdng tff 15 tudi t r d len, ed the ffdc tinh ti le hien mac lao phoi AFB ( + ) tren dan sd toan tinh bao gom mpi Iffa tuoi la
77/100.000 dan ( 9 5 % CI: 0-174/100.000 dan).
Vdi dan sd hien nay ciia toan tinh khoang 391.059 dan, sd BN iao phdi AFB ( + ) hien mac ffdc khoang 301 BN (95% CI: 0-679).
U'de tinh tren chffa tinh ty le lao phdi AFB ( + ) dffdc phat hien thdng qua sang lpc bang X.Quang phdi (chup X.Quang phoi phat hien ngffdi ed hinh anh bat thffdng nghi lao ehiem khoang 4 , 1 % - Sd lieu dieu tra cua toan quoc) [3].
3.1.4. Tyli lao/HIV
Xet nghiem HIV trong so 10 BN lao phoi mdi AFB ( + ) dffdc phat hien, cd 3 BN cd ket qua HIV (-I-). Ca 3 BN lao/HIV deu la nam gidl, trong do cd 1 BN ngffdi Kinh (47 tudi), 1 BN H'mdng (32 tudi) va 1 BN ngffdi La Hii(31 tuoi). Ty le nhiem HIV trong sd BN lao la 3 3 % (95% CI: 10,8%- 60,3%) eao hdn ty le ciia toan qudc (8%) [4].
3.1.5. Lao va dai thao du'dng Tat ea cac BN lao dffdc phat hien deu dffdc xet nghiem dffdng huyet va thff test ehan doan dai thao dffdng nhffng khdng phat hien dffdc BN nao bj mac dai thao dffdng.
3.2. Phan tich m o t sd yeu t o lien quan trong sd 2 6 4 benh nhan lao cua tinh Lai Chau nam 2 0 1 1 - 2 0 1 2
Do SO lieu BN lao phdi mdi AFB (-I-) d\idc phat hien trong mau dieu tra la rat it (10 BN) khdng dii de phan tich. Chiing tdi da lay sd lieu BN mac lao phdi ciia toan tinh Lai Chau nam 2012-2013 de phan ti'eh mpt sd yeu t d lien quan nhffsau:
Bang 4. Tv le mac lao ohoitheo qidi, nhdm tuoi Sd nqifo'i dieu tra
Gidi
Nam n 264 190 74
Lao phoi SL 213 158 65
80,7 %*
83,2 74,3
95% CI 75,5 77,2
85 87,8 63,3 i 82,9
P
>0,05
Y Hpc VigT NAM THANG 2 • SO' 2/2013 S6 nqu'6'i diSu tra
Nhdm tudi 15-24 25-34 35-44 45-64 55-64 65+
45 49 63 51 24 32
Lao 27 38 63 42 20 28
ph6l 60 77,6 92,1 82,4 83,3 87,5
95% CI 45,5 64,1 82,7 69,7 64,1 71,9
73,0 87,0 96,6 90,4 93,3 95
P
<0,01
Trong so 264 tru'dng hdp mSc lao phoi da du'dc xac djnh trong toan tinh Lai Chau nam 2011- 2012, ty le mSc lao phoi d nam (83,2%) cao hdn d nU (74,3%), sir khac biet nay la khong co y nghla thong ke (p >0,05). Ty le mac lao phoi cao nhat d nhdm tuoi 35-44 (92,1%) va thap nhat d nhom tuoi 15-24 (60%), sir khac biet la cd y nghTa thong kS (p <0,01).
Bang 5. Ty le mic lao theo dan toe, huyen.
S6 ngyd-l di4u tra Tdnq sd
Dan t$c Kinh Thai H' mdng KhSc Huyfin
Thi xa Lai Chau Mu-dng T6 SirHd Phonq Thd Than Uyen Tan Uv6n Tam Oirdng
n 264
63 114 41 56 27 59 40 19 35 35 49
Lao SL 213 40 92 29 52 20 55 29 13 28 33 35
phdi 80,7 %•
75,5 80,7 70,7 92,9 74,1 93,2 72,5 68,4 80 94,3 71.4
95% CI 75,5 62,4 72,6 55,5 83 55,3 83,3 57,2 46 64,1 81,4 57,6
85 85,1 86,9 32,4 97,7 86,8 97,3 83,9 84,6 90,0 98,4 82,2
P
<0,05
<0,00 1
Ty le mac lao phdi eao nhat d nhdm dan tdc khac vdi ty le 92,9%, tiep theo dd lan Iffdt la Thai (80,7%), Kinh (75,5%) va H' mdng (70,7%). Sff khac biet cd y nghTa thdng ke (p<0,05). Ty le mac lao phdi eao nhat d huyen Tan Uyen (94,3%) va thap nhat d huyen Phong Tho (68,4%), sff khae biet cd y nghTa thong ke (p<0,001).
Bang 6. Ty le mac lao phdi theo nghe nghiep, trinh do hoe van S6 ngu^ai 6\ku tra
Tdnq sd Nqhe nqhi$p
cdnq nhan, vian chi>c Hoc sinh - sinh vidn Lam ruOnq Cdn nho Tir do Trinh (3d hoc van
Khdng di hoc Cd di hoc
n 264
9 7 230
3 15 138 126
Lao SL 213 8 5 187
0 13 117 96
ph6i 80,7 %*
83,9 71,4 81,3 0 86,7 84,8 76,2
95% CI 75,5 56,5 35,9 75,8 62,1 77,9 68,1
85 98 91,8 85,8 96,3 89,3 82,8
P
<0,01
>0,05
Ty le mac lao phoi cao nhat d nhdm ddi tffdng cd nghe nghiep la cdng nhan, vien chffc vdi ty le
88,9%, tiep theo la nhdm lam nghe nghiep ti/ do (86,7%), lam ruong (81,3%) va hpc sinh (71,4%)
vdi p<0,01); nhdm khong di hoc (84,8%) eao hdn so vdi nhdm ddi tffdng cd di hoc (76,2), sff khac
biet khdng ed y nghTa thdng ke (p>0,05).
Y HQC VigT NAM THANG 2 - SO 2/2013 Bang 7. Ty le mac lao phoi va HIV
Sd nqu'd'idieu tra T6nq sd
Lao ket hop HIV Cd nhiSm HIV Khdng nhiem HIV
n 264
7 257
Lao phdi SL 213 7 206
80,7 %*
100 80,2
95% CI 75,5 64,6 74,9
85 100 84,6
P
>0,05
Ty le mac lao phdi nhdm bi nhiem HIV (100%) eao hdn so vdi nhdm khdng nhiem HIV (80,2%), sff khae biet la khdng cd y nghia thdng ke (p>0,05).IV. KET LU^N:
1 . Thu'c t r a n g mac lao trong 9 8 0 0 ngu'di tiV 1 5 tuoi t r d len du'dc dieu t r a tai 3 0 x3 nghien ci^u
- Ty le mac lao phdi mdi AFB ( + ) la 0,9%
(10 ngffdi). Tff ket qua xae djnh ngffdi mac lao tren sd ngffdi tham gia dieu tra, ffdc Iffdng ehi sd mac lao d ngffdi tff 15 tuoi trd len la 102,7/100.000 dan ( 9 5 % C I : 0-232 /100,000 dan). Cd the suy ra lao phdi AFB (+) d eac luci tud'i la: 77/100.000 dan ( 9 5 % a : 0-174/100.000 dan).
- Trang so 10 BN lao phoi mdi AFB ( + ) , cd 3 BN nhiem HIV. Ty le nhiem HIV trong so BN lao la 33% ( 9 5 % a : 10^8% - 60,3%).
2. Mot so yeu t o lien quan trong 2 6 4 benh nhan lao phoi cua tinh Lai Chau ' ( 2 0 1 1 - 2 0 1 2 )
- Trang sd 264 trffdng hdp mac lao phoi da dffdc xac djnh trong toan tinh Lai Chau nam 2011-2012, ty le mac lao phdi d nam (83,2%) cao hdn d nff (74,3%), sff khae biet la khdng ed y nghia thong ke (p >0,65). Ty le mac lao phdi cao nhat d nhdm tud'i 35-44 (92,1%) va thap nhat d nhdm tuoi 15-24 ( 6 0 % ) , vdi p<0,001.
- Ty le mac lao phdi cao nhat d nhdm dan tdc khac (92,9%), Thai (80,7%), Kinh (75,5%) va H' mdng (70,7%), vdi p<0,05. Ty le mac lao phoi cao nhat d huyen Tan Uyen (94,3%) va thap nhat d huyen Phong Thd (68,4%), vdi p<0,001.
- Ty le mac lao phoi eao nhat d nhdm ddi tffdng la edng nhan, vien chffc(88,9%), nhdm lam nghe nghiep tff do (86,7%), lam rudng (81,3%) va hpc sinh (71,4%), vdi p <0,01.
- Khdng ed sff khae biet giffa ty le mac lao phoi d nhdm ddi tffdng khdng di hpc (84,8%) so vdi nhdm ddi tffdng cd di hpc (76,2); giffa nhdm bi nhiem HIV (100%) vdi nhdm khdng nhiem HIV (80,2%),vdi p>0,05.
TAI LIEU THAM KHAO:
1. Bo Y te - CTCLQG (2009), Dich te hgc benh lao thUc hanh - Hu'dng dan quan ly benh lao, Nha xuat ban Y hoc. Ha Noi, tr 48-53.
2. Bo Y te - CTCLQG (2009),DUdng loi ChUdng trinh chong lao Quoc gia Viet Nam - Hudng dan quan ly benh lao, Nha xuat ban Y hpc. Ha Npi, tr 33-42.
3. Bp Y te' - CTCLQG (2010), B^o cao tong ket hoat dong CTCLQG nam 2009 va danh gia giii^ ky 2007-20U.
4. Bo Y te - CLCLQG (2010), Bao cao sd ket hoat dgng 6 thang dau nam va trgng tam hoat dong 6 thang cuoi nam 2010, Ha Npi, tr 5-7.
5. Practical Approach to Lung Health (PAL) (2005), A primry health care strategy for integrated management of frspiratory conditiones, WHO, Geneva.
.. UfHO (2010), Global Tuberculilosis Control 2010, m\o repor 2010, Switzerianid 2010.
7. WHO and Centers for Disease Control and Prevention (2008), TB/HIV Clinical manual, WHO, Geneva.
