Y HQC Vt|T NAM THANG 3 - SO 1/2013
TiM HIEU MOl UEN QUAN GIUTA TINH TRANG TANG MAN CAM vcn CAC Dj NGUYEN HO HAP VA MlJnc DO NANG CUA HEN PHE QUAN TRE EM
Dao Thj Hong D i e n * Le Thj Minh Hu'dng *
TOJW T A T
Muc tieu: tim hieu moi lien quan giffa mffc dp ning cua benh hen va phan ffng ciia test lay da v6i 7 dl nguyen du'dng ho hap thirdng gSp trong nha. 150 binh nhan hen tuoi tff 2 den 15 tuoi dieu trj ngoai tru tal phong kham di irng benh vien Nhi Trung uong tff 2/2012 den 7/2012 dUpc xet nghiem test lay da v6i 7 di nguyen va danh gia mffc dp nang theo bac hen. Cac so lieu du'dc phan tich va danh gia mdi lien quan Ket qai: ty le test lay da du'dng b'nh vdi it nhat mot di nguyen la 60,7%, trong do vdi tffng di nguyen tUOng ling la: D.Pteronyssinus chiem 67%, D, Fannae- 65,9%, hon hpp bui nha- 59,3%, long cho • 15,4%, long meo- 9,9%, gian- 6,6%, hon hpp nam - 4,4%.
Nhom benh nhi cho ket qua test lay da du'dng tinh co bac hen nang hon so v6i nhom benh nhi c6 ket qua test lay da am tinh (OR=5,9). Nhom benh nhi co ket qua test du'dng b'nh vdi > 2 di nguyen thi ty le mac hen bac 2 va 3 cao hdn bac 1 (p<0,05). Cac benh nhi hen bac 2 va bac 3 00 ty le test lay da dUdng tinh cao vdi cac dl nguyen bp mat nha va bui nha. Ket luan: TTnh trang tang man cam ciia benh nhan hen vdi cac di nguyen ho hap trong nha, dac biet la cac loai bo mat nha la yeu to nguy ctJ lam tang mffc do nang cua benh hen.
Tu'khoa: di nguyen ho hap, hen phe quan, tre em SUMMARY
ASSOCIATION BETWEEN SKIN TEST REACTIVITY TO COMMON INDOOR ALLERGENS AND ASTHMA
SEVERITY IN CHILDREN WITH ASTHMA.
The purpose of Wiis study was to examine the assodation between asthma seventy and skin test reactivity to seven common indoor allergens. The charts of 150 asthmatic children, aged 2 to 15 years, seen in a allergy clinic of Nabonal Hospitai of Pediatncs from Febramry to July 2012 were reviewed to obtain the results of skin prick tests to common indoor allergens and asthma severity. Logistic regression for ordinal data was used to examine the assodation between skin test reactivity and asthma severity (mild, moderate or severe). Results: Children with minimum one positive skin prick test were 60,7%. The rate of allergen sensitivities were Dermatophagoides Pteronyssinus (67%), Dermatophagoides Fannae (65,9%), house dust or the acarine mite (59,3%), animal danders: dog (15,4%), cat (9,9%), coachroad (6,6%), Aspergilluss (4,4%). Children with positive ..skin test were more likely to have a higher asthma
*BSnh vien da khoa tlnh Cao bang, **Benh vien Nhi Trung Wdng Phan bien khoa hoc: PGS.TS. Nguyin Thj Quynh Hu'O'ng
severity rating than children with a negative skin test {OR=5,9), Children with positive skin test more > to allergens were been higher asthma severity grate 2 and 3 than 1 ( P < .05), Children with asthma severity of grate 2 and 3 have higher skin test to D.
Pteronyssinus, D. Fannae and dust mite allergens.
Conclusion: Our data also suggest that sensitization to indoor allergens, expectly dust mite is a nsk factor for more severe disease in these asthmatic children.
Key wordsiallergen, asthma, children
I.
DAT V A N OEChan doan hen phe quan (HPQ) d tre em la mot thach thffc do su' da dang ciia cac trieu chffng lam sang va sff kho khan trong danh gia tinh trang viem man tinh va han che dffdng thd.
Trong hu'dng dan cha'n doan hen d tre em viec xac dlnh tinh trang di ffng ciia benh nhan se gop phan quan trpng trong chan doan va tu' van dieu trj d l / phong hen [ 3 ] . Test lay da hoac dinh lu'dng IgE dac hieu vdi cac di nguyen nghi ngd CO the xac dmh dffdc tinh tang man cam ciia ngffdi benh. Test lay da du'dc cac trung tam di ffng tren The gidi danh gia la mot test an toan, nhanh chdng va gia thanh re hdn so vdi phffdng phap dinh Iffdng IgE dac hieu [ 7 ] . Cac nghien cffu tinh trang tang man cam ciia benh nhan hen ngu'di ldn da chi ra cac di nguyen hd hap la nguyen nhan thffdng gap cd the lam hen nang ne va khd kiem soat hdn [ 1 ] . Tuy nhien cac nghien cffu nay tren tre hen con han che tai Viet Nam. De tim hieu ty le hen di ffng d tre hen chung toi tien hanh nghien cffu de tai nay vdi muc tieu: Tim hieu va so sanh mdc dp nang cua tre hen phe quan td 2 den 15 tudl co kit qua test di nguyen du'dng ti'nh va am tinh vdl cac di nguyen ho hap trong nhi..
II. OOI Tl/ONG VA PHUONG PHAP NGHIEN COU 2 . 1 . Odi tu'dng nghien cu'u
Benh nhan hen phe quan chan doan theo tieu chuan GINA 2006 [ 4 ] , ngoai cdn hen cap, tuoi tff 2 den 15, khdng diing cac thuoc khang histamin, corticoid trong vdng 7 ngay, dieu tri
Y HQC VlgT NAM THANG 3 • S6' 1/2013
ngoai tru tal khoa Mien djch - Dj ffng B|nh vien
Nhi Trung LTdng tff 2/2012 den 7/2012. Gia dinh benh nhan dong y cho con tham gia vao nghien ciTu.
Tieu chuan loal trd: Benh nhan co cac b|nh
ly khac kem theo nhff: viem da, suy tim, suy gan, suy than,viem phoi, dj vat dffdng thd.
2.2. Phu'dng phap nghien cu'u: mo ta, cat ngang, c9 mau thuan tien
Cac chi sd nghien cuV : Tuoi, gidl, bac hen,
dffdc dff phong hay chffa ? neu dff phong roi, danh gia mffc dp kiem soat hen, ket qua test lay
da vdi cac di nguyen ho hap sau:
Dermatophagoides' ^ Pteronyssinus, Dermatophagoides Farinae, hon hdp bui nha, nam, long cho, long meo, gian. Nguon di nguyen do hang Stallergenes (Phap) cung cap da dffdc chuan hoa d nong do 166 IR/ml. Chffng am sff dung dung dich glycerol-salin (50% glycerol), chffng dffdng - histamin lOmg/ml. Test lay da dffdc thffc hien bdi dieu dffSng da dffdc dao tao theo quy trinh ciia khoa Mien djch- Dj iing.
2.3. Phan tich so li^u: phan mem SPSS16.0 va cac thuat toan thong ke y hoc.
III. KET QuA NGHIEN COU
150 benh nhan dii tieu chuan tham gia nghien cii^i vdi tuoi trung binh la 6,45 ± 3,12 tuoi, ty le nam/nff- 1.8/1. Trong so benh nhan cd chi dinh dieu trj dff phong (tff bac 2 trd len) co 79,8% binli nhan da diidc dieu trj dff pliong va miit do kiem scat hen dffdc danh gia nhff sau: khong kiem soat chlem 14,5% , kiem scat mot phan- 58,3%, kiem soat hoan toan-27,2%.
Ty le test lay da du'dng tinh vdl cac dj nguyen ho hap: 60,7% benh nhan hen co test lay da dffdng tinh vdl ft nhat mpt loai dj nguyen, trong do nhom benh nhan dffdi 5 tuoi co ty Ie test lay da dffdng tinh thap hdn (35,2%) so vdi tre tren 5 tuoi (64,8%).
Bang 3.1. Ty le test lay da dffdng tinh vdi tffng loai di nguyen
Test lay da du'dng tinh vdi cac dj nguyenBo nha Dermatophaqoides Pteronyssinus Dermatophagoides Farinae Bui nha
Lonq cho Long meo Gian
Hon hop nam Asperqiluss
So benh nhan n = 9 1
61 60 54 14 9 6 4
Ty le "A 67,0 65,9 59,3 15,4 9,9 6,6 4,4 Bang 3,2, So sanh bac
~~ ~—Testjay da
Bac hen • — — , _ B a d
Bac 2 Bac 3 Tong
n
%
n%
n%
n B%
HPO qiiJa 2 nhom co test lay da di/Onq va am ti'nh Difdng tinh
3 38,1
50 57,5
33 78,6
91 60,7
Am tinh 13 61,9 37 42,5
9 21,4
59 39,3
Tong 21 100 87 100 42 100 150 100 Pl2 = 0,11 ; 023 = 0,019 ; 0 l 3 = 0,002
OR ( 9 5 % C I )
2,20 (0,75-6,74)
5,96 (1,65 - 22,02)
Nhan xet: Nhdm benh nhi cho ket qua test lay da dffdng tinh co bac hen nang hdn so vdi nhdm benh nhi cd ket qua test lay da am tfnh.
Bang 3.3. Moi lien quan giffa so lffdng dl nguyen dffdng tinh vdi bac hen
Test + vdTso^——-di nguyen 1
Bac hen
n
%
B a d 12 66,7
B$c2 6 11,8
Bac 3 2 9,1
long 20 22,0
Y HOC VI|T NAM THANG 3 • SO 1/2013
> 2 Tong
n
%
nP
%
6 33,3
18 100
45 88,2
51 100
20 90,9
22 100
71 78,0
91 100 pl,2<0,001; p2,3=0,74 ; pl,3<0,001
NhanxSt: nhdm benh nhi co ket qua test dffdng tinh vdl > 2 di nguyen thi ty le mac hen bac 2 va 3 cao hdn bac 1.
Bang 3.4. Moi lien quan g i u ^ b^cHPQ vdi tffng loai t e s t d j nguyen dffdng ti'nh cua doi tu'dng NC
" ^ ^ - - . . e ^ n g u v e n Bac hen ^ ^ — ^
1 2 3 Tong
n
%
n%
n%
n%
D.
Pteronyssinus 10 16,4
36 59,0
15 24,6 61 100
D.
Farinae 9 15,0
37 61,7 14 23,3
60 100
Bui nha 6 11,1
30 55,6
18 33,3
54 100
Long cho 2 14,3
8 57,1
4 28,6
14 100
Long meo 3 33,3
6 66,7
0 0 9 100
Gian 4 66,7
2 33,3
0 0 6 100
Nam 2 50,0
2 50,0
0 0 4 100 Nhan
nguyen tro xet: benh mat nha va
nhi hen phe quan bac 2 va bac 3 cd ty le test lay da du'dng tinh cao vdi cac di bui nha.
IV. BAN LUAN
4 . 1 . Ty lg test lay da du'dng tinh vdi cac dj nguyen ho hap trong nha: Nhieu nghien cuff 6a chffng minh rang nhffng benh HPQ du'dng tinh vdi di nguyen ho hap, dac biet di nguyen mat nha cd nguy cd mac hen nang hdn so vdi nhffng benh nhan khac. Ket qua nghien cffu ciia chiing toi thu dffdc cho thay ty le test lay da dffdng tinh d benh nhan HPQ la 60,7%. Ket qua nghien ciru nay tffdng tff nhff cac nghien cffu trong va ngoai nu'dc nhff: Nghien cffu cua Le Thi Hong Hanh [1] cho thay ty le test lay da du'dng tinh d benh nhan HPQ la 62,25%, ket qua nghien cuff cua Nguyen Thi Dieu Thiiy [6] cho thay ty le qua man d nhdm benh nhi hen phe quan chiem 75,4%. Theo Nei W.Johnston va cpng sff [5] thay test lay da dffdng tinh chiem 53%, theo Hendrick D.J va cong sff [2] nghien cffu d 656 benh nhi hen phe quan ty le test lay da dffdng tfnh chiem 84%, theo nghien cffu ciia Wang y. va cpng sff cho thay 76,9% test lay da dffdng tfnh d benh nhi hen phe quan.
6 tre em co 4 the lam sang cua HPQ la hen khdi phat do virut, hen khdi phat do van dpng, hen do dj ffng va hen chffa ro nguyen nhan.
Nhom tre nhd da phan la the lam sang hen do virut, ngu'dc lai trong nhdm tre Idn the lam sang hen do cd che dj uYig nhieu hdn. Ket qua ciia chiing toi cho thay mhdm benh nhi tren 5 tuoi cd
test lay da dffdng tfnh cao gan gap 2 lan nhdm benh nhi du'di 5 tuoi. Tac gia Le Thi Hong Hanh [1] cung cho thay nhdm benh nhi tren 5 tud'i cd test lay da dffdng tfnh cao gap 2,1 lan so vdl nhdm benh nhi du'di 5 tuo'i.
Phan tfch cac tru'dng hdp cd test lay da dffdng tfnh cho thay test lay da dffdng tfnh vdl bp nha chiem b^ le cao nhat (D.Pteronyssinus chiem 67%, D. Farinae -65,9%), byi nha 59,3%, long chd- 15,4%, long meo- 9,9%, gian - 6,6%, hon hdp nam Aspergiluss- 4,4%. Ket qua nay phii hdp vdi cac nghien cffu trUdc ciia nhieu tac gia deu cho rang mat bp nha la yeu to nguy cd cao nhat trong so di nguyen trong nha.
Nghien cffu ciia Wang y. va cpng sir [7] cho thay test lay da dffdng tfnh vdi bo nha chiem b/ le cao nhat 72,4%, theo Hendrick D.J va cpng sff [2]
cho thay trong cac trffdng hdp test lay da dffdng tfnh thi bp nha chiem ty le cao nhat la 82%.Ket qua nghien cffu ciia Nguyen Thj Dieu Thiiy tai Uc [6] ty le qua man d benh nhi hen phe quan cao nhat vdi bp nha chiem 72,3%.
4.2. Moi lien quan giu'a mii'c do nang cua benh hen va ket qua test lay da vdi cac dj nguyen ho hap: Tim hieu moi lien quan giffa ket qua test lay da ciia doi tffdng nghien cffu va mffc dp nang ciia benh hen theo bac, chiing toi nhan thay nhdm benh nhan cho ket qua test lay da dffdng tinh cd mffc dp HPQ nang hdn so vdi
Y HQC VlgT NAM THANG 3 - SO 1/2013 nhdm cd ket qua test da am tinh, cu the hen bac
3 nhleu hdn bac 1 (p<0,05), bac 3 nhieu hdn bac 2 (p<0,05). Khong thay sff khac biet ve ty le test lay da dffdng tfnh ciia tre d 2 nhom hen bac 1 va bac 2 (p>0,05). Nhff chung ta da biet yeu to cd dja dj ffng la yeu to anh hffdng manh nhat trong hen phe quan. Nhffng tre cd cd dja di ffng cd kha nang mSc benh hen cao gap 10-20 lan so vdl ngffdi khong cd cd dja dj irtig. Ngffdi ta cho rSng 50-60%
cac tnjdng hdp hen la cd cd dja qua man.
Yeu to moi trffdng la mpt trong nhffng yeu td lam benh hen khdi phat d nhffng ngffdi cd cd dja hen, chiing cd tac dung thiic day cdn hen cap hoac lam trieu chffng nang len va keo dai. Yeu to moi trffdng bao gom cac yeu to di nguyen trong nha va ngoai nha. Theo mpt so tac gia cho rang 90% tre cd tinh trang man cam vdi cac di nguyen ho hap nhff phan hoa, long vat nudi trong nha, bui mat nha, nam moc [ 7 ] . Ket qua phan tich cac benh nhan cd test lay da dffdng tinh vdi mpt hoac nhieu loai dj nguyen cho thay benh nhan cd test lay da dffdng tfnh vdi nhieu di nguyen thi mffc dp nang ciia benh hen cang cao (bac 3 nhieu hdn bac 1). HPQ bac 2 va bac 3 hay gap d nhdm benh nhan du'dng tfnh vdi di nguyen mat bp nha con cac benh nhan hen bac 1 hay gap dffdng tfnh vdi dj nguyen vat nuoi va nam.
V. KET LUAN
Ty le tang man cam vdi ft nhat mpt dj nguyen hd hap ciia benh nhi hen phe quan la 60,7%. Nhdm tre tren 5 tuo'i cd test lay da dUdng tinh cao hdn nhdm tre dffdi 5 tuoi. Tinh
trang t3ng man cam ciia benh nhan hen vdi cac dj nguyen ho hap trong nha, dac biet la cac loal bp mat nha la yeu to nguy cd lam tSng mffc dp n3ng ciia benh hen.
T A I LIEU T H A M K H A O
1. L6 Thj Hong Hanh (2010), "Nghien ah/ die di&n lim sing cin lim sing ddt bung phit hen phi quan tri enl', Lu§n i n Tign sy Y hgc, Tru'dng D^i hpc Y H&
N$i, Tr 100 - 102.
I, Hendrick D J , Davies R J , D'Souza M.F and Pepys J. (1975), "An Analysis of skin pnck test reacbons in 656 asthmatic patients". Thorax Joumai, 30(2), pp.2-7.
3. GINA (2006), Global Strategy for Asthma management and prevention in children. Medical Communication Resources, Inc, ppl-16.
-t. Kjellman B, Gustafsson PM, Asthma from childhood to adulthood: asthma seventy, sensitization, living conditions, gender influence and social consequences, Respir Med 2000;94,pp. 454- 465
5. Neil W. Johnston, Sebastian L. Johnston, Joanne M. Duncan (2005),The September epidemic of asthma exacerbations m children: A search for etiology" American Academy of Allergy, Asthma and Immunology, 10(1016), pp.9-2S.
6. Thuy Nguven Thi Dieu (2007), Ainway Inflammation m school aged children with asthma, A thesis of Doctor of Philosophy, University of Newcasde, Australia.
7 Wang Y., Zhang X., Wang C. Et al (2009), Result of skin pnck test in 908 children with asthma, Zhongguo Dang Dai Er Ke 2a Zhi, 11(7), pp. 61-559.
