Y HOC VI$T NAM THANG 3 - S6 2/2013
DAC DIEM CAN LAM SANG VA DIEU TRI MAY DAY CAP a TRE EM
TOM TAT
May day la benh ty gay nen bdi nhiiu nguyen nhan khac nhau, nhuhg trieu chutig lam sang thtfdng bieu hien kha giong nhau, va each thtfc dieu tri cung ttfdng ttf nhau. Oe tai dtfdc tien hanh vdi muc tieu nghien cu\j dSc diem can lam sang va each thtfc dieu tn may day cap tai benh vien Nhi Trung tfdng. Day la nghien ctfu mo ta c3t ngang tren 143 benh nhi m^y day cap dieu tn n$i trii tai benh vien Nhi Trung tfdng.
Ceic benh nhi dtfpc lam cac xet nghiem de danh gla tinh trang mciy day cap nhtf cong thtfc mau, IgE toan phan, IgE dSc hi^u, men gan. Cac thuoc dtfdc diing trcing dieu trj miiy day cap cung dtfdc xem xet. Ket qua nghien ctfu cho thay ty le may day lien quan den di img kha cao, vdi 54,2% benh nhi tang IgE toan phan, 48,5% tSng IgE dSc hJeu, 30,8% cd tang bach cau al toan. Co 90,2% benh nhi b| benh lan dau hen, vdi thdi gian dieu tn trung binh la 4,37 ± 1,81 ngay. Tat ca cac benh nhan deu dtfdc dieu tri bang khang Histamin the he 1, mgt so benh nhan co ket hdp diing khang Histamin the he 2 va/hoac Corticoid. Ket luan; Khoang 50% benh nhan may day cap co lien quan den yeu td dj tfng. Thuoc chii chot trong dieu tri may day cap la khang Histamin the he 1.
Tdkhda: May day cap, dieu tri.
SUMMARY
THE PARACLINICAL FEATURES AND TREATMENT OF URTICARIA I N CHILDREN Urticaria is caused by many different causes, but the clinical symptoms seem to tie similar, and the treatment are also similar. Ttiis study was conducted to evaluate the paraclinicai features and treatment of acute urticaria at the National Hospital of Pediatrics.
This was a cross-sectional and descriptive study on 143 children with urticaria who were inpatients at the National Hospital of Pediatrics. The children were peri'ormed the tests to assess the state of urticaria such as complete blood count, total IgE, specific IgE, and liver enzymes. The medication used for treatment of acute urt:icaria were also evaluated. The study results showed that the allergic uri:icaria was quite high, with 54.2% of children were increased total IgE, 48.57o of them had an increase in specific IgE , and 30.8% had high blood eosinophils. 90.2% of children were admitted to hospital for the first time, with the average duration of treatment was 4.37 ± 1.81 days. All children were treated with first generation antihistamines, and a number of children using a combination of second generation antihistamines
Pham N h a t A n * , Nguyen Thj Dieu Thuy*
and/or corticosteroids. Conclusions: Approximately 50%
of children with urticaria related to allergic factors. Key drug in the treatment of acute urticaria is first generation antihistamines.
Key words: urticaria, treatment I. DAT V A N o f
May day cap tuy khong phai la benh ly tram trpng nhtfng la benh gay anh htfdng rat nhieu den chat Itfdng cupc song. -DSc trtfng ciia benh may day la nhutig mang hoac not san ndi do tren da va rat ngu^. Ton thtfdng la nhtfng viing da stfng dd, cd quang bao quanh, co tfnh chat tam thdi. Cac nghien ctfu thtfdng gia djnh may day thupc nhdm benh dj utig, vi the thuoc dau tay de dieu trj may day cap thtfdng la nhdm khang Histamin. Cac cong trinh nghien ciru ve dac diem can lam sang va each thirc dieu tri may day d tre em Viet nam con chtfa nhieu. Chung ta\ tien hanh de tai nay vdi muc tieu nghien ciru dac diem can lam sang va each thtfc dieu tri may day cap tai benh vien Nhi Trung tfdng.
n. D 6 | TUONG VA PHUONG P H A P NGHIEN CCTU 2.1.D6i tu'dng nghien cdu: Benh nhi dtfdc chan doan may day cap va dtfdc dieu trj npi tru tai benh vien Nhi Trung tfdng ttf thang 2/2012 den thang 9/2012.
2.2. Thiet ke nghien cdu: Nghien ciru mo ta cat ngang
2.3. Phddng phap chgn mau. Chpn mau thuan tien: Tat ca nhtfng benh nhan dtfdc chan doan may day cap trong thdi gian nol tren deu dtfdc mdi tham gia nghien cu'u.
2.4. Cach thdc tien hanh
Benh nhan dtfdc thu thap mau lam xet nghiem cong thtfc mau, IgE toan phan, IgE dac hieu, men gan.
Cac xet nghiem can lam sang dtfdc thtfc hien tai khoa xet nghiem Benh vien Nhi Tmng utfng.
2.5. Ket qua:
* Bach cau tfa acid mau cao khi bach c^u u^ acid > 5%
* Djnh Itfdng IgE toan phan trong huyet thanh:
Ojnh luWng bang may mien djch ttf dpng ADVIA CEhfTAUR. Ket qua dtfdc tinh ra ddn vi Ul/ml.
* Dai hoc YHa Ngi
Phan bi^n Ithoa hgc: PGS.TS. Nguyin Thj Quj'nh Hu-cng
Y HQC VlgT NAM THANG 3 • s6 2/2013 + Gidi han binh thu'dng:
ScJsinh:'<1.5IU/nnl Ituoi: <15IU/ml 2-5 tuoi: <60 lU/ml 6-9 tuoi; <200IU/ml 10-15 tuol: <200 lU/nnI
* Dlnh lu'ong SGOT(AST), SGPT(ALT):
+ B§ng may hoa sinh tu' dong BECKMAN COULTER AU270a
AST binh thucing cl tre enn 15 - 60 U/l
• ALT binh thu'dng 6 tre em 13 - 45 U/l
* Lam test IgE dac hieu tim dj nguyen:
Panel 1, 2,3,4
Test xac djnh dj nguyen di/dc tien hanh de xac dlnh nhu'ng di nguyen ho hap va d| nguyen thu'c an nghi ngd gay khdi phat cdn hen cap.
XLT ly so lieu bSng chudng trinh SPSS 11.5.
III. KET OuA
Co 143 benh nhan may day cap dudi 15 tuoi du tieu chuan tham gia nghien ctru.
Bang 3.x. Ket qua conq thu'c bach tau ai toan va djnh lu'dng IgE toan phan, men qan Xdt nghidm
% Bach cau ai toan
Men gan AST
ALT IqE
Binh thu'dnq n 99 76 96 54
69,2
%
73,1 92,3 45,8
T i n g n 44 28 8 64
»/o 30,8 26,9 7,7 54,2
Tong n 143 104 104 118
100
%
100 100 100 Nhan xet: So benh nhi co % bach cau ai toan t3ng cao chiem ti l§ 30,8%
Ti le benh nhan co men gan tang la 26,9%
So tre CO ham Itfdng IgE toan phan cao chiem ty l | cao 54,2%
Bieu do 3.1. Ket qua Test IgE dac hieu xac djnh dj nguyen
Nhan xet: So tre co ket qua test xac dinh dj nguyen dtfdng tinh chiem ti le 48,5%, trong dd so tre cd ket qua test dtfdng tfnh vdi tii" 2 den 4 loai di nguyen chiem ti le cao nhat 32,4%
1 0 0 1 80 J 6 0 - 4 0 2 0 -
9 0 . 2 y-.
' \
^^^!
• 1 lan B >1ian
Bieu do 3.2. So lan mac benh may day trong nam
Nhan xet; Tre may day cap chu yeu bi benh lan dau tien, chiem 90,2% so benh nhan.
Y HQC VlgT NAM THANG 3 - SO 2/2013
Bieu do 3.3. Thdi gian dieu tri
Nhan xet: Thdi gian dieu tri trung binh: 4,37 ± 1,81 ngay. Nho nhat la 2 ngay, nhieu nhat la 10 ngay. So benh nhi phai dieu trj tii" 5 ngay trd len chiem ty le cao nhat 46,9%.
Bang 3.2. Phtfdng phap dieu tri Phi/tfng phap dfeu tri Khang Histamin the he 1
Khaog Histamin the he 1+ glucocorticoid
Khang Histamin the he 1+ khang Histamin the he 2+
glucocortacoid Tong
n 82 38 23 143
»/o 57,3 26,6 16,1 100°/o Nhan xet: Thuoc dieu tri chit yeu trong may day cap la khang Histamin the he 1, 100% benh nhan dtfdc dieu trj nhom thuoc nay. Ngoai ra cd the phoi hdp cac nhdm khac nhtf khang Histamin the he 2, Glucocorticoid.
IV. BAN LUiOkN ^
4.1.Dacdiem can lam sang
4.1.1. IgE toan phan trong huyet thanh IgE (cdn gpi la reagin) la khang the ai te bao, la mpt Wiang the gan lien vdi benh ly di tfng type 1, no ddng vai trd quan trpng nhat trong cd che dj ii'ng. 6 tre binh thtfdng, ham Itfdng IgE thay doi tuy theo lu^ tuoi, dao dpng rat ldn trong khoang 15 - < 200 lU/ml. Khi bj dj ifng, ham Itfdng cua no co the tang tdi hang chuc, tham chf hang tram lan. Viec dinh Itfdng IgE toan phan trong mau khong nhutig chi giup ich trong viec khang dinh chan doan benh dj tfng ndi chung va benh may day cap ndi rieng ma no con cd gia trj trong theo doi va tien Itfdng benh. Nghien ciru tren 437 tre mac cac benh dj iTng tai Trung Qudc cho thay 68,9% benh nhan co tang IgE huyet thanh, tuy nhien clii co 10% benh nhi may day cap CO tang IgE huyet thanh [8]. Trong nghien ctfu ciia chiing toi, chf co 57 benh nhi cd ket qua xet nghiem IgE toan phan trong mau, trong dd 57,9% benh nhi co nong dp IgE toan phan tang.
Holgate nhan thay d nhtfng benh nhan mac cac benh di irtig ham Itfdng IgE toan phan thtfdng tang cao hdn ngtfdi tiinh thtfdng khong mac cac benh di tfng [6]. Kessel va cpng stf nhan thay rang nong dp IgE ciia ngtfdi bj may day cao hdn
ro ret so vdi ngtfdi khong mac cac benh di uiig, va nong dp IgE cang cao, ngtfdi bi may day cang nang.
93% ngtfdi bi may day d mtfc do trung binh va nang cd tang nong do IgE huyet thanh [7].
4.1.2. Bach cau al toan trong mau ngoai bien
Tang bach cau al toan thtfdng thay tren cac benh ly viem da dj tfng va dtfdc cho la khdi phat may day [5]. Bach cau ai toan thtfdng tang trong benh may day cap va man. Stf thay do'i ve % bach cau ai toan cung gdp phan ho trd trong viec chan doan cd dia dj utig va dinh htfdng dieu tri.
Ket qua nghien cutf cua chiing toi cho thay 30,8% benh nhi cd tang bach cau ai toan. Ket qua nghien ciTu cung chi ra co nhom benh nhi may day cap khong tang bach cau ai toan va IgE huyet thanh. Dieu nay chutig to ngoai cac nguyen nhan di tfng thoija thtfdng con co cac nguyen nhan khac nhtf nhiem khuan, hay cac tac nhan vat ly, hoa hoc gay may day cap d tre em.
4.1.3. Men transaminase
GOT, GPT la 2 enzym c6 nguon goc chii yeu tif te bao gan. Cac enzyme nay cd tac dung xuc tac cho cac phan iing lien hdp, dam bao chii'c nang khir dpc ciia gan. Chiing gitf mpt vai trd quan trpng dac biet trong qua trinh chuyen hda thuoc d gan. Trong mot so benh ly cap tinh nhtf
Y HQC VlgT NAM THAHG 3 • 86 2/2013 viem gan cap, suy gan cap hoac mpt so nguyen
nhan dac biet khac, chtfc nang khir dpc ciia gan khong dam bao cung dan den bieu hien dj irng ngoai da va men gan tang. Chfnh vl vay, khi khai thac nguyen nhan dan den may day c^p, neu cd gdi y tien sir phat ban sau dung thudc, ho3c cac benh ly ve gan mat thi viec djnh Itfdng men GOT, GPT la can thiet giup gdi y clian doan. Neu nong dp men transaminase tSng trong mau chtfng to CO ton thtfdng te bao gan, nhtfng nong dp cac men nay phai tang gap nhieu lan thi mdi thtfc stf cd gla tri chan doan. Ket qua nghien ciru ciia Chung toi cho thay 26,9% benh nhi co tSng GOT va 7,7% cd tang GPT. Tuy nhien, phan Icfn cac benh nhi nay cd nong dp GOT, GPT tang d mu'c dp rat nhe. Nghien ciru ciia chiing toi cung ttfdng ttf vdi nghien ciru ciia Phan Quang Ooan, chi mpt so ft benh nhan may day co men gan tang nhe hdn gidi han binh thtfdng [1]. Trong nghien cutf nay, tren 16 benh nhan cd may day sau diing thudc thi 2 benh nhan co tang men gan, chiem ty le 12,5%.
4.1.4. Ket qua test xac dinh di nguyen (Dmh lu'dng IgE dac hieu)
Ket qua nghien cutf ciia chiing toi cho thay cd 48,5% benh nhi co ket qua dtfdng tfnh vdi cac dj nguyen dac hieu. Trong do, sd benh nhan cd dtfdng b'nh vdi ttf 2 di nguyen trd len chiem 35,3%.
Ti le tang IgE dac hieu trong nghien ciTu ciia chiing toi thap hdn nghien ciia Pham Thj Thu Ha la 79% [2], va so loai dj nguyen co ket qua (+) cung thap hdn. Nghien ciru ciia tac gia nay cho ket qua la benh nhan may day cd tang IgE dac hieu vdi hau het cac di nguyen da thiT (>10 dj nguyen). Stf khac biet nay cd the giai thfch do ddi ttfdng nghien ctfu ciia chiing toi la tre nho, hau het dtfdi 5 tuoi nen ty le mac may day thap hdn ngtfdi Idn. Hdn ntfa tuoi cang cao thi thdi gian man cam vdi cac dj nguyen moi trtfdng, nhat la cac di nguyen dtfdng ho hap cang nhieu, vi the ty le dtfdng tfnh vdl cac dj nguyen dac hieu se cao hdn.
4.2. Nhan xet ve thdi gian dieu trj va phu'dng phap dfeu trj
4.2.1. Thdi gian dieu tri
Nghien ciTu ciia chung toi, thdi gian dieu tn trung binh ciia tre: 4,4 ± 1,8 ngay. It nhat la 2 ngay, nhieu nhat la 10 ngay.
Thdl gian phai nam vien gap nhieu nhat la tir 3 tdi dtfdi 5 ngay chiem 46,9%, chi co so ft benh nhan (14,7%) nam vien dtfdi 3 ngay. Nhin chung thdi gian phai nam vien dieu tri ciia tre
mac may day cap la rat it ngay. Ket qua nay thi hi?n dSc trtfng ciia b?nh may day cap trong nghien ciru mac dii phan Idn tre phai nhap vi$n vi bi may day nang ho3c rat nang nhtfng benh mang tfnh chat cap ti'nh vcfi thdi gian bi benh dtfdi 6 tuan, trieu ehii'ng ciia benh bieu hien chii yeu d ngoai da vcfi cac not san phii va tinh trang ngii'a ngay, kho chiu, lo lang, mat ngii. NhQhg trieu chu'ng nay anh htfdng den chat Itfdng cuoc song la chfnh ma khong gay nguy hiem den tinh mang (trtf trtfdng hdp co soc phan ve - ma trong nghien ciru nay khong co tre nao). Khd khan nij^
cho viec dieu tri may day la tfnh de tai di tai lai nhieu ^ n . Trong nghien ciru cua chimg toi cd tdi 90,2% so tre mac may day cap lan dau, chi co rat it tre (9,8%) bj nhieu hdn mot lan mac may day cap trong nam. Nhtf vay tre nhap vien vi may day cap thtfdng mSc benh lan dau va benh thtfdng d mtfc do nSng, do la ly do tai sao tre phai di kham va nhap vien dieu tri.
4.2.2. Phu'dng phap diieu tri Trong pham vi ciia de tai chung toi khong cd y djnh danh gia hay so sanh hieu qua ciia cac phtfdng phap dieu tri may day cap tai vien Nhi trung tfdng. Muc tieu cua chung toi clii la mo ta cac phtfdng phap dieu trj dang dtfdc ap dung de dieu tri may day cap. Trong nghien ciTu nay 57,3% benh nhi dtfdc dieu tri chi bang mot loai thuoc khang Histamin the he 1, 16,1% t>enh nhi phai dieu tri bang phoi hdp ca 3 loai thuoc: ca khang Histamin the he 1 + khang Histamin the he 2 + Glucocori:icoid. Cung vdi thdi gian dieu tri trung binh ciia cac benh nhi la khong dai 4,4 ± 1,8 ngay, chiing toi nhan thay may day cap d tre em dap uVig tot vcfi cac thuoc dieu tri dj Omg cd ban. Khang Histamin la thuoc dau bang dtfdc khuyen cao trong dieu tri may day [3]. Nghien ciru ciia chiing toi cung phii hdp vdi ket qua nghien ciitJ ciia cac tac gia khac nhtf Carr, va Saltoun [4].
V. KET LUAN
Tre may day cap thtfdng tren nen tang co cd dja dj irng, the hien qua ty le tang IgE toan phan, IgE dac hieu va tang bach cau ai toan.
May day cap d tre em dap utig kha tot vdi thuoc khang Histamin the he 1.
TAI UEU THAM K H A O
1. Phan Quang Doan (2009), "Di uhg va mien djch lam sang", Nha xuat ban Y hoc, tr 65 -79.
74
Y HOC Vier NAM THANG 3 - SO 2/2013 Pham Thj Thu Ha, (2011) "Nghien ciru nguyen
nhan gay t>enh va iiieu qua dieu tri may day man tinh bang phoi hOp thuoc khang histamin H i + H2", Luan van thac sT Y hgc.
Amar SM, Dreskin SC (2008}. Urticaria. Prim Care. 35(l):141-57.
Carr TF, and Saltoun CA (2010}, Urticaria and angioedema. Allergy and Asthma Pre 33; 70-72.
Chang KL, Yang YH, Yu KH, Lee JH, Wang LC, Chiang BL (2012). Analysis of serum total
IgE, specific IgE and eosinophils in children with acute and chronic urticariaJ Microbiol Immunol Infect. [Epub ahead of pnnt].
Holgate ST (1999), Genetic and environmental interacbon in allergy and asthma, J.AIIergy Qin Immunol, 104(6), p. 1139-46.
Kessel A, Helou W, Bamberger E, Sabo E, Nusem D, Panassof 1, Toubi £.(2010). Elevated serum total IgE-a potential marker for severe chronic urticana. Int Arch Allergy Immunol. 153 (3):288-93.
NGHIEN Cl)U TiNH TRANG LECH LAC KHOTP CAN CUA MOT NHOM SINH VIEN TRirOTHG DAI HOC Y HAI PHONG NAM 2012
Nguyen Thj Thu Phu'dng * , Vo Tru'dng Nhtf Ngoc*
Dong Mai Hu'dng**
SUMMARY
STUDY REALITY OF MALOCCLUSION I N GROUP OF STUDENT STUDYING I N HAI PHONG
MEDICAL UNIVERSITY 2012 Sample and methodology: sample of study comprises 300 students, studying in Hai Phong Medical University. Method of study is cross sectioned description. 300 students were selected in accordant with study's criteria. All were examined and taken impressed to make study cast for describe occlusion's .charactensbcs. Goal of study Is to describe reality of malocclusion in group of the student to determine orthodontic treatment need and propose some preventive program. Result: According to Angle's dassification of malocclusion: Ratios of normal occlusion, class I , class I I and class III malocclusion are 25.3%, 24.7%, 25.3% and 24.7% respectively; ratio of malocdusion is 74.7%. Mild crowded upper teeth possesses 55% and mild crowded lower teeth does 60.7%.
Conduaon; High percentage of malocdusion was seen in the study aWiough the result is tower than result of other study. The difference of malocdusion distributon between male and female has no statisticaily significant. In both jaw, mildly insufficient space is most common and eccesslve space follows.
Keyword: Angle's classification of malocclusion, insufficient space, excessive space, malaligned teeth,,..
I. OAT V A N o f
Mpt ham rang lech lac anh htfdng nhieu den tham my, chu'c nang lam cho con ngtfdi thieu ttf
*Vi?nDTRang Ham Mit
* Khoa Rang Him Mat-Tn0}gDH YHii Phong Phin bifn lihoa hgc: PGS.TS. Tru'&ng Uyen Thai
tin trong cudc song va la dieu kien cho cac benh nha chu va sau rang phat trien. O Mia tuoi 18 he thong rang vTnh vien da moc hoan toan. Tim hieu tinh trang lech lac rang-ham gdp phan vao cong tac phong ngtfa va dieu tri benh rang mieng de cd 6\idc khuon mat can ddi, ham rang
khoe manh la can thiet. Dieu tra ve khdp can va nhu cau dieu tri CHRM da dtfdc tien hanh d nhieu ntfdc tren the gidi nhtf: Thuy dien, Nauy, Malaysia, Anh, Hoa Ky, Phan Lan, Hong Kong, Jordany-Tai Oai hpc Y Hai Phdng la ndi hpi tu cac em sinh vien den tir khap cac tlnh phia Bac va da so la cac tinh dong bang mien Duyen Hai.
Cd the noi sinh vien Dai hoc Y Hai Phdng dai dien cho mpt cpng dong ngtfdi trtfdng thanh ciia viing dong bang Bac bp tuy nhien he nay co rat ft de tai nghien ciru ve van de nay nen chiing toi tien hanh nghien ciru de tai nay vdi muc tieu:
Mo ta tinh trang lech lac khdp can cua sinh vien trddng Dai hgc Y Hal Phong.
I. TONG Q U A N TAI LIEU
Vao thap nien 1900 Edward H. Angle (1855- 1930) da dtfa ra phan loai khdp can. Day la mpt each phan loai dau tien va rat htfu dung quan trpng cho den ngay nay. Ong dtfa vao rang coi ldn vTnh vien thtf nhat (rang so 6) va stf xap xep ciia cac rang theo dtfdng chn de phan loai khdp can thanh 3 loai. (1) Lech lac khdp can loat I :
