Y HOC VlgT NAM THANG 3 - SO 1/2013 Phan tich ket qua trong 400 ngffdi mac tien
DTD, cd 98 ngu'di chi cd IFG chiem 24.5%, 128 ngffdi chi cd IGT chiem 3 2 % , 174 ngffdi cd ca IFG va IGT chlem 43.5%.
PhSn tich ket qua lam nghiem phap dung nap glucose d 316 ngu'di cd roi loan dffdng mau doi (30%), chung tdi thay: cd 5 5 . 1 % la tien DTO, 13.9% la OTD, 31 % cho ket qua binh thffdng.
Theo ket qua nghien cffu cua DffOng Bich Thuy, Trffdng Da Uyen va CS nghien cffu tren 247 trffdng hdp cd rdi loan dffdng mau luc ddi sau khl tien hanh nghiem phap tang dffdng mau thi thay cd 38.9% cd rdi loan dung nap glucose mau, 22.7% dffdc xac djnh la dai thao dffdng typ 2va 38.4% dung nap glucose binh thffdng [1].
Theo Tran Thi Doan nghien cffu 160 ngffdi tien DTD, ty le chi cd IFG la 2 3 . 1 % , chi cd IGT la 28.1%, vffa cd IFG vffa cd IGT la 48.8%. Ket qua ciia chung tdi cung tffOng dffOng vdi ket qua nay.
Theo Kham Phoong Phu Vdng nghien cffu tren 358 benh nhan tien DTO, ty le chi mac IFG la 22.4%, chi mac IGT la 25.7%, ty le mac ca IFG va IGT la 46.6%.
Theo Tran Quang Trung va Hoang Thj Thu Hffdng nghien cffu tren 50 ngffdi cd rdi loan dffdng mau ddi, tudl tff 30 den 65, phat hien 16.36% bl OTO va 52.73% bl RLDNG. Theo nghien cffu ciia Ta Van Binh (200i3) tai 4 tinh Phu Tho, Sdn La, Thanh Hoa va Nam Oinh Iffa tudi 30 - 6 4 thi tyle nay la 8.8%.
Theo tac gia Dffdng Bfch Thuy va CS nghien
cffu tai Benh vien Hoan My, Thanh phd Ho Chi Minh, tren nhffng ddi tffdng cd glucose mau luc ddi > 6 , 1 - 6.9 mmol/l thay cd 42.3% so ddi tffdng bi rdi loan dung nap glucose mau va 30.9% so ddi tffdng dffdc chan doan dai thao dffdng typ 2.
V. KET LUAN
Qua nghien cffu 1054 ddi tffdng tudl tff 30 den 69 dl kham sffc khde djnh ky tai Khoa Kham chffa benh theo yeu cau - Benh vien Bach Mai tudl chimg tdi nhan xet sau:
- Ty le tien dai thao dffdng la 38%.
- Ty le benh dai thao dffdng la 9%.
TAI LIEU THAM K H A O
1. Du'cfng Bich Thuy, Tru'dng Da Uyen, Nguyen Hu'u Han Chau (2006), 'Ty le roi loan dung nap glucose tren cac doi tu'dng co roi loan du'dng huyet luc doi", Yhoc thwc hinh, so 14, 15 2. ywGenuth S; Alberti KG; Bennett P et al
(2003), "Follow-up report on the diagnosis of diabetes mellitus", Diabetes Care, 26, pp. 3160.
3. ZyJayawardena R, Ranasinghe P, Byrne NM, et al. (2012), "Prevalence and trends of the diabetes epidemic in South Asia: a systematic review and meta-anaiysis", BMC Public Health, 12 (1), pp. 380.
^. ZyLee JE,Jung SCaa (2003), "Prevalence of Diabetes Mellitus and Prediabetes in Dalseong- gun, Daegu City, Korea", Diabetes i^etab J, 35 (3), pp. 255-63.
NGHIEN CllfU TiNH HJNH BENH DA VA BENH PHONG TAI MOT SO XA CO TY LE LUU HANH BENH PHONG CAO NAM 2011
Nguyen Duy H U n g * , N g u y i n Thj Thanh H u y e n * , Bao Hu'u G h i * , Oinh Hu'u N g h j * , Ha Tuan M i n h * , Nguyen Tien T h a n h *
TOM T^T Myc tieu:
- Khao sat tinh hinh benh phong tal mgt so xa co ty le lu\j hanh benh phong cao d 7 tinh tien hanh dieu tra dich te benh phong.
- Danh gla md hinh benh ngoai da tai mot so xa CO t/ le \\iu hanh benh phong cao d 7 tinh tien hanh aieu tra djch t l .
Phu'ang phap; Nghien cutj m6 ta cat ngang va cd
* Benh vien Da lieu TW
Phan bien khoa hpc: PGS.TS. Nguyin HO'u Sau
mau toan bg dan cu' song tren dia ban 17 xa dUOC lua chgn cua 7 tinh tien hanh kham dieu tri benh da phat hien benh phong: Yen Bai, Quang Nam, Kon Tum, Gia Lai, Binh Phu'dc, Kien Giang, Ca Mau.
Ket qua: Chiing toi da phat hien 5 benh nhan (BN) phong d Gia Lai (1 BN), Kon Tum (2 BN), Binh Phu'dc (2 BN). Tat ca cac BN phong deu la the nhieu vi tmng (MB).
Ty le phat hien (TLPH) benh nhan phong mdi la 4,69/100.000 la cao hdn nhieu so vdi mot trong 4 tieu chi loai trif benh phong d cap tinh. Ty le mac benh da chung
Y HQC VIET NAM T H A N G 3 • s 6 1/2013
cho cac tinh tuHng ddi cao (10,68%). Tnang dd, viem da dj iiTig chiem ty le cao nhat, dao ddng tff 26,14% - 58,89%.
Ty I? m k benh nam da la kha cao (8,5% -27,12%).
Tir khoa: benh phong, benh da, 7 tinh.
SUMMARY
SITUATION OF SKIN DESASES AND LEPROSY I N 17 COMMUNES OF 7 PROVINCES: YEN BAI, QUANG NAM, KON TUM, GIA LAI, BINH PHUOC,
KIEN GIANG, CA MAU I N 2011 Objective: To evaluate the skin diseases and leprosy in 17 communes of 7 provinces: Yen Bai, Quang Nam, Kon Tum, Gia Lai, Bmh Phuoc, Kien Giang, Ca Mau.
Methodology: Cross-sectional study, Results: The results showed that: Detecting 5 leprosy patients in Gia Lai (1 patient), Kon Tum (2 pabents), Binh Phuoc (2 patients). All leprosy patients were Multibacillar/.TTie detecting rate was 4,69/100.000, that was higher than one in 4 criterias of leprosy elimination at province level. The prevalence of skin disases was relatively high (10,68%) in which allergic dennatitis was highest (26,14% - 58,89%), following demiatophytoses were (8,5%-27,12%).
Keywords, leprosy, skin diseases, 7 provinces.
I.
OAT VANo f
Cho den cuoi nam 2011 cd 46/63 tinh/thanh phd du'dc cdng nhan dat 4 tieu chuan loai trff benh phong cua Viet Nam, Tuy nhien, mpt sd tinh da dffdc cong nhan loai trff benh phong cd xu hu'dng ldi long, Mpt sd tinh mac du da cd nhieu cd gang trong cdng tac chong phong nhffng ty le lull hanh va ty le phat hien van cdn cao, sd BN phong mdi phat hien hang nam cdn nhieu.
Chinh vi ly do dd, chiing tdl da tien hanh kham
dieu tri benh da de phat hien benh phong cho mot sd xa trong 3 nSm lien tiep cd BN phong mdi cua 7 tinh. Dong thdl tap huan cho can bo dja phffdng kien thffc ve benh phong va cac benh da thdng thudhg, kham phat hi?n va dieu tri cac benh da thdng thudng cho nhan dan tai dja phffdng.
Ten de t a i : "Nghien cthj tinh hlnh benh da va benh phong nim 2011 tal mot sdxa co ty le luV hanh benh phong cao".
Muc t i e u nghien cu'u:
- Khao sat tinh hinh benh phong tai mot so xa cd ty le Iffu hanh benh phong cao d 7 tinh tien hanh dieu tra djch te.
- Oanh gla md hinh benh ngoai da tai mot so xa cd ty le Iffu hanh benh phong cao d 7 tinh tien hanh dieu tra djch te.
II. o 6 l TUONG VA PHUONG P H A P NGHIEN COU 2 . I . D 0 I tu'dng nghien ciijru
Tieu chuan chon: Dan cff sdng tren dja ban 17 xa cd BN phong mdi dMdc l u ^ chon cua 7 tinh tien hanh dieu tra dich te benh da nSm 2011:
Yen Bai, Quang Nam, Kon T u m , Gia Lai, Binh Phffdc, Kien Giang, Ca Mau.
2 . 2 . Phu'dng p h a p n g h i e n cuTu 2.2.1. Thiet l<e nghien cuV: Nghien cffu md ta c3t ngang.
2.2.2. Cd mau: Toan bo dan cff sdng tren dja ban xa dffdc Iffa chon cua 7 tinh tien hanh kham dieu tn benh da phat hien benh phong;
Yen Bai, Quang Nam, Kon T u m , Gia Lai, Binh Phffdc, Kien Giang, Ca Mau.
2 . 3 . T h d i gian nghien cuTu: Tff thang 1/2011 den thang 11/2011.
III. KET QUA NGHIEN COU
Bang 1 : So ngffdi dffdc kham va ty le m§c benh Da lieu STT
1.
2.
3.
4.
5.
6.
7,
Tinh
Yen Bai Quang Nam
Kon Tum Gia Lai Binh phu'dc Kien Giang Ca Mau
Tonq
So dan ciia cac xa dfeu tra
12480 13331 12441 18371 13565 10159 26276
106623So ngu'di kham n
11234 12266 11324 17265 13303 9562 24189
9914390.02 %
92.01 91.02 93.98 98.07 94.12 92.06
93S& ngu'di mSc benh da n
1792 1707 720 2417 1110 919 1925
1059015.96 %
13.91 6.45 14.01
8.34
9.61
8.99
10,68 Nhan xet: Bang 1 cho thay so ngu'di duHc l<ham dieu tra tmng binh (Sat 9 3 % dan so. Ty le mac benh da cao nhat la d Yen Bai (15,96%), Bep den la Gia L.ai (14,01%), thap nhat d Kon Tum 6,45%.Y HQC VlgT NAM THANG 3 - SO 1/2013 Bang 2 : Tinh hinh
STT 1.
2.
3.
4.
5.
6.
7.
Tinh Yen Bai Ouanq Nam
Kon tum Gia lai Binh phu'dc
Kien Giang Ca l^au
Tong
mac benh phonq theo tCrnq tinh So ngu'di
kham 11234 12266 11324 17265 13303 9562 24189 99143
So ngu'di mac b^nh phong mdi phat hien n
0 0 2 1 2 0 0 5
/100.000
16,08 5,44 14,74
MB n 0 0 2 1 2 0 0
%
100 100 100
Nhanxet: Bang 2 cho thay tai 17 xa CLia 7 tinh tien hanh dieu tra djch te nam 2011 phat hien dlTdc 5 BN phong m6i/106.623 dan so cac xa dieu tra =>TLPH 4,69/100.000. Trong do Kon Tum 2 BNi Binh Phu'dc 2 BN va Gia Lai 1 BN. 100% so benh nhan phong mdi la the MB.
Bang 3: J<i le
srr
1.
2.
3.
4.
5.
6.
7.
r
Tlnh
Yen Bai Quang Nam
Kbntum Gia^i Binh phirifc Kien Giang Ca Mau than xet: B
cac benh da cua 7 tinh B#nh
da dj uiig
»/o 39.12 40.89 58.89 54.05 26.13 35.26 48.05 ang 3 che
Benh viem da mil
4.19
%
8.26 6.67 9.91 10.00 17.41 13.77 thay be
Benh do da bong vav
»/o 1.51 6.68 - 1.67 4.59 3.24 4 35 4.94 nh da di
Benh nam da 8.15
%
14.65 14.58 18.02 27.12 21.22 22.60 /ng chie
B^nh da do KST
"A 3.24 5.62 7.92 1.80 13.60
6.31 2.60 m ty le
Benh da bong nu'dc 0.28
%
0.29 2.08 0.18 0.45 0.22 0.1 cao nhat
B^nh d a t u mien
»/o 0.28 0.18 2.36 0.09 0.45 0.11 0.05
B^nh phong mdi phat
hien 0 00
%
0.00 0.28 0.09 0.18 0.00 0.00
Benh da khac
•/o 43.23 23.43 5.55 11.27 18 83 15.12
7.89 (26.13%-58.89%), benh da bong nffdc va benh da tff mien chiem ty le rat thap.
_XIB$nh_viem-da_di_u'ng _
aB
Bleu do 1 : Tinh hinh mac benh da dj ffng theo tffng tinh
Nhan x e t : Bleu do 1 cho thay ty le mac benh da'dj ffng cao nhat d Ca Mau (6.21%), xep Z thff 2 la kien Giang (3.82%), thap nhat Gia Lai
(2.18%).
Y6n Bdi Qudng Kon tum Gla lai Binh Kiln CS Mau Nam ?\\\xiK. Giang
Bang 4 : Tinh hinh mac benh nam da theo tC/nq tinh
sn
1.
2.
3.
4.
5.
6.
7.
Tinh Yen Bai Quang Nam
Kon tum Gia lai Binh phu'dc
Kien Giang Ca Mau
Tong
Sd ngudi kham 11234 12266 11324 17265 13303 9562 24189 11234
So ngu'di mac benh nam da n
146 250 105 200 301 195 150 1347
•A 1.30 2.04 0.93 1.16 2.26 2.04 0.62
Y Hpc VlgT NAM THANG 3 • S6' 1J2013
Nhan xet: Bang 4 cho thay ty le mSc benh nam da cao nhat 6 Binh Phu'dc (2.26%), thap nhat la Ca Mau (0.62%).
OB^nhd ae^nhr ne^nhd
a d> irng j m d a a t l ^ m l i n
• B^nhul^mdamu
• B^nhdadoKST OB^nhphong
DB^nh d6 da bong vdy ae^nh da b^ng nxtin
• B^nhdakhAc
B l e u rf6 2 : Tinh hinh mic benh da 7 tinh
Nhan xSt: Bleu do 2 cho thay trong sd cac benh da thi benh da di ffng (43.19%) va benh nam da( 18.04%) chiem ty le cao, benh da tff mien chiem ty le rat thap.
(V. BAN L U A N
4 . 1 . T i n h h i n h b e n h P h o n g
Phat hien dffdc 5 BN phong mdi tai cac diem dieu tra dich te tren, trong dd Kon Tum: 2 BN, Binh Phffdc: 2 BN va Gia Lai: 1 BN. Tat ca 5 BN phong mdi deu the MB.
Oieu dang ban d day la mac du so lffdng BN phong phat hien dffdc tai 3 tinh tren la khdng nhieu nhffng tfnh ty le phat hien (TLPH) va ty le Iffu hanh (TLLH) deu rat cao.
Phat hien dffdc 5 BN phong mdl/106.623 dan sd cac xa dieu tra)=>TLPH 4,69/100.000.
Tinh Kon Tum
Gia Lai Binh Phudc
So dan kham dfeu tra
12.441 18.371 13.565
Sd BN phong mdi 2 1 2
TLPH ( / 1 0 0 . 0 0 0 dan)
16,08 5.44 14,74 Oay la TLPH cao so vdl TLPH ciia 4 tieu
chua'n toai trff benh phong ciia Viet Nam (Tieu chua'n 2: Tal thdl diem kiem tra, ty le phat hien ngu'di benh phong mdi du'di 1/100.000 dan). 5 BN phat hien dffdc d 3 tinh Kon T u m , Gla Lai, Binh Phu'dc - day cung la cac tinh chffa dat dffdc tieu chuan Loai trff benh phong ciia Viet Nam va cac xa ciia 3 tinh nay hang nam deu cd BN phong mdi. Do vay can phai t d chffc kham nhdm, kham cum dan cu" thu'dng xuyen d cac xa 3 nam cd benh nhan phong mdi. Tang cffdng giao due y te va dong thdi can cd nhieu ddt giam sat, tap huan cho can bd chuyen trach ve cdng tac phdng chdng phong d cac tinh cd TLLH va TLPH cao de sdm phat hien sd lffdng BN phong cdn lan khuat trong cdng dong, de dieu tri sdm va giam ty le tan tat.
4 xa cua 2 tinh Yen Bai va Quang Nam da loai trff benh phong (Yen Bai nam 2004 va Quang Nam nam 2000) deu khdng phat hien BN phong mdi. Dieu nay cho thay cdng tac phdng chdng benh phong trong thdi glan qua dat ket qua tdt va sff ben vu'ng trong cdng tac phdng chong benh phong sau khi loal trff. Mac dii 17
xa/7 tinh kham dieu t n benh da de phat hien benh phong phan bo d 4 viing mien: Phia Bac (Yen Bai), Trung Bd (Quang Nam), Tay Nguyen (Kon t u m , Gia Lai), Phia Nam (Binh Phffdc, Kien Giang, Ca Mau) nhung chung tdi nhan thay can dieu tra nhleu tinh hdn nffa mdi du cd sd khoa hoc de so sanh.
Do chu'a cd dieu kien kham tren dien rpng, mac du Gla Lai va Kon tum TLLH va TLPH trong nhij'ng nam qua cdn cao nhffng d d t dieu tra nay chi phat hien dffdc 3 trffdng hdp/B xa (hang nam moi tinh deu phat hien dffdc hang chuc BN phong mdi). Chimg toi cang thay can phai tiep tuc dieu tra tren dien rpng tai cac tinh nay de cd cd sd khoa hoc so sanh va cd nhffng tham mffu diing dan cho cac cd quan chffc nang lien quan nham tang cffdng cac hoat ddng phong chong phong de sdm cd the dat dffdc cac muc tieu cua chffdng trinh la: 63/63 tinh/thanh pho dat dffdc 4 tieu chuan loai trff benh phong theo tieu chuan cua Viet Nam vao nSm 2015 va tien tdi loai trff benh phong d cap quan/huyen.
Y HQC VlgT NAM THANG 3 - SO 1/2013 4.2. T i n h h i n h b e n h da
-Trong thdi glan kham dieu tra tal 17 xa tal 7 tinh {Yen Bai, Quang Nam, Kon Tum, Gla Lai, Binh Phffdc, Kien Giang, Ca Mau) tien hanh kham dieu tri benh da de phat hien benh phong nam 2011, chung toi da Wiam dudc 99.143 ngu'di tren dan sd cua 17 xa/7 tinh la 106623. Sd ngffdi dffdc kham dieu tra diiem ty le cao (trung binh 93% dan sd), tff dd thay dutfc vlec tap huan dffdc chua'n bj tdt, cong tac kham dieu tra ciia cac can bo y te cd sd cd hieu qua cao, sff tuyen tnjyien va hdp tac kham chiia benh ciia ngudl dan cac tinh rat tdt. Ty le kham dieu tra chiem ty le cao de han che kha nang bd sdt benh da va benh phong. Trong dd ty le mac benh da la 10.68
% k^t qua nay tutfng dffdng cac nghien ciru ciia Nguyen Thj Thanh Huyen va CS [3] ty le mSc benh da la 11,01 % ; Nguyen Duy Hung va CS [2] t^ le mac benh da la 9,25 % . Qua cac nghien cirli tru'dc ve ty 1^ mac benh da tai Viet Nam dao dpng trong khoang 9.25% - 1 1 . 0 1 % . Tuy nhien, so Iffdng m l u chua dil ldn de khai quat benh da tren 63 tinh thanh tren ca nudc. Can them nhleu nghien ciHi khac vdi so luWng nghien ciru vcfi cd mau ldn hdn de cd mdt ty le mac benh da chinh xac tai Viet Nam.
- Ty le mac benh da cao nhat la d Yen Bai (15,96%) tiep den la Gia Lai (14.01%). Oong bao dan toe tai Yen Bai chii yeu dimg nffdc sudi, phong tuc tap quan sinh hoat cdn lac hau (gia sue, sue vat nudi d ngay dffdi san). Oieu nay cd the la ly do khien ty le benh da d Yen Bai cd ty le cao. Oong bao cac dan tdc d day dieu kien sdng con gap nhieu khd khan, chffa cd dieu kien de quan tam nhleu den sffc khoe ndi chung va cac benh da lieu ndi rieng.
- Trong so cac benh da thi benh da d| img va benh vtem da mu chiem ty le cao nhat, benh da bong nudc va benh da tff mien chlem ty le rat thap {0.05% - 3.36%).
B$nh viem da di iTng cao nhat d Yen Bai (6,21%), thap nhat d Binh Phffdc (2,18%). Benh viem da mii cao d Quang Nam, Kien Giang, Ca Mau. Mpt trong nhung yeu t d lam tang benh da oia cac tinh tren la: yeu t d dia dff, dieu kien dia hlnh Kmg nui, am thap, nhieu cdn triing, ky sinh biing gay benh hoat ddng nen lam cho ty le benh da dj lihg cao d Yen Bai.
Benh da do ky sinh tnJng va con triing ty le cao cfYen Bai va Quang Nam do dia hinh nhleu riihg niil.
- Cac benh nam da cd ty le cao d Quang Nam (2,04%), Binh Phffdc (2,26%), Kien Giang (2.04%) va thap nhat la d tinh Yen Bai. Cd the giai thi'ch do khi hau ndng ra nhieu mo hdi, mol trffdng lam viec tiep xiic am thap...la dieu kien thuan ldi cho cac loai nam gay benh phat trien.
- Cac benh da tu' mien phat hien du'dc tai ca 7 tinh trong cac dpt dieu tra deu chiem ty le thap nhat trong sd cac benh ngoai da. Cac BN cd dau hieu nghi ngd bi mac benh he thdng deu dffdc sang lpc va phat hien, chan doan xac dinh lai tal cac cd sd y te chuyen khoa, giup dieu tri sdm, hieu qua cac benh tren.
V. KET LUAN
- Trong ddt kham dieu tra phat hien 5 BN phong d Gia Lai (1 BN), Kon Tum (2 BN), Binh Phffdc (2 BN). Tat ca cac BN phong deu la the nhieu vi triing (MB). Ty le phat hien BN phong mdi la 4,69/100.000 la cao hdn nhieu so vdi mpt trong 4 tieu chi ioai trff benh phong d cap tinh.
- Ty le mac benh da chung cho cac tinh tu'dng ddi cao (10,68%). Ty le mac benh da cao nhat la d Yen Bai (15,96%) tiep den la Gla Lai (14.01%). Trong do, viem da di ffng chlem ty le cao nhat, dao ddng tff 26,14% - 58,89. Cac benh nam da cd ty le cao d Quang Nam (2,04%), Binh Phffdc (2,26%), Kien Giang (2.04%) va thap nhat la d tinh Yen Bai.
TAI UEU T H A M KHAO
1. Le Kinh Due (1989): Nhu'ng kien thffc hien dai ve benh phong. Nha xuat ban Y hgc.
2. N g u y i n Duy Hu'ng, Oao Hu'u Ghi, Vu Huy Ha: Tinh hinh benh .da lieu tai 3 xa Ngpc Hoa, Long Thanh, Hoa Dien thuoc huyen Rong Rieng va Kien Lu'ong tinh Kien Giang nam 2009,Tap chi Da lilu so 3 nam 2011, tr. 12-16.
3 Nguyen Thi Thanh Huyen va CS: Nghien cffu tinh hinh benh da tai 1 so xa thuoc huyen Mai Chau tinh Hoa Binh nam 2010. Oe tai cap cO sd Benh vien Da lieu Tnjng Udng nam 2010, tr. 32-33.
4 Pham Van Hien (2009), Da lieu hoc benh phong. Nha xuat ban Y hpc nam 2009, tr. 106 5. Tran Hau Khang (2009): Hi/dng dan quoc gia
thUc hien chu'dng trinh phong chong benh phong. Nha xuat ban Y hoc nam 2009 6. Tran Hau Khang (2003): Djch te benh phong 6
Viet Nani. Y hoc tin/c hanh 11/2003, tr. 43 - 46.
