Y HOC VigT NAM THANG 9 - SO 2/2014 gan. Hdn nuS, FibroTest la diem danh dau Ichong
xam lan duy nhat du'dc chutig minh la co gia trj tien lu'dng tot hdn so vdi sinh thiet [ 6 ] , [7]
Vdi su" tien bp cua y hpc gan day, d nu'dc ta phu'dng phap t3m soat x d gan banc/ may Fibroscan - do dp dan hoi gan da du'dc trien khai.
Day la bu'dc tien dang miitig giup ngu'di benh tam soat xd gan mpt each nhe nhang va khong anh hu'dng den sii'c khoe. Tu' cuoi nam 2013, da d u ^ vao sir dung may t i m soat xd gan Fibroscan.
Ndi ve u\i diem cua phu'dng phap tren. Nguyen ly cua may Fibroscan la dung song sieu am de do dp ciing ciia gan. Sau do gan dtfdc danh gia theo tijtig cap dp va dda vao do, se biet du'dc mii'c dp ton thu'dng cua gan de du!a ra quyet djnh dieu trj phii hdp.
V . K i t LUie^N
- FibroTest va Fibroscan co the du'dc thu'c hidn vdi so sanh chan doan chinh xac cho khong xam lan cua xd gan. Kiem tra huyet thanh la thong tin trong mpt ty le cao benh nhan hdn Fibroscan.
- FibroTest va Fibroscan c6 the du'dc thu'c hien vdi so sanh chein doan chfnh xac cho gan xd. Khong CO su* khac bi§t giu^ Fibroscan va Fibrotest la 0,76 (0,92), va 0,67 (0,91) vdi p = 0,66.
TAI L l | U T H A M KHAO
1 . Tran Ngpc anh; Nguyen Thj Mai HiWnfl (2012).Gia tri ciia chi so (Model For and Stage Liver Diseasej Meld trong tien lu'dng benh nhan xtf gan. Nghien ai\j Y hoc. no. 3C. tr. 128-134.
<,. Tran Ngoc anh;' Dang H i i Mai HiTtfng (2012).So "sanh chi so Maddrey (Disctiminant Function) va Meld (Model for End Stage liver Disease) trong tien lu'dng benh xd gan. Nghien cu'u Y hoc.no. 3D. tr. 46-51.
3. Dao Nguyen Khdi; TrSn NgfC dnh (2011).
Fibroscan - Ky ttiuat miS trong chan doan xd gan va c^c bien chirtig. Tap dif Nghien cCfu Y hoc. no.
4. tr. 40-46.
4. Le Thanh Hd; Ph^m W&n T r i n ; Trinh Qu6c D^t (2012). NghiSn cull nong d$ Apolipoprotein A l va Alpha 2- Macroglobylin trong huyet tu'dng 6 binh nhan xd gan co nhiem Virus viem gan B. Y hocVietNam.no. 2. tr. 77-81.
Berends M.A., Snoek ] . , de Jong E.M., Van Krielcen J.H., de Knegt R.3., van Oijen M.G., and al ( 2 0 0 7 ) . Biochemical and biophysical assessment of MTX-induced liver fibrosis in psoriasis patients: Fibrotest predicts the presence and Fibroscan predicts the absence of significant liver fibrosis i/Ve/-7/7/; 27:639-645.
De Ledinghen V., Le Bail B., Rebouissoux L., F o u m i e r C , Foucher J., MietteV., and al (2009). Liver stiffness measurement in children using FibroScan; feasibility study and comparison with Fibrotest, aspartate transaminase to platelets ratio index, and liver biopsy J Pediat Gastroen^rolNutr, 45 : 443-450.
5.
TINH TRANG COI XlTaNG, HAM LirgNG VITAMIN D TRONG SfrA ME vA MOT SO YEU TO NGUY CO 6* TRfi 1- 6 THANG
TAI N 6 I T H A N H H A N O I NAM 2 0 1 1
T 6 M TAT
Nghien cOftj c3t ngang dudc den hanh tai quan Oong Da, Ha Noi nam 2011 nliam xac dhh t^ le coi xuWng, ham lu'dng Vitamin D trong su'a me va mpt so yeu la tien quan d tre 1-6 thang tuoi. Tong so 186 tre Ms 1-6 thang dang duWc bu me, va cac ba me cua be da du'dc chpn ngau nhien vao nghien oTu. Chan doan coi xu'dng d i ^ vao fri^u chutig lam s^ng va xet nghi?m m^u. SEb me du'dc thu thap de phan tich ham lu^ng vitamin D3 bSng phuWng phap s5c k^ long cao ip (HfH.C). C^c thong tin ve tuoi cua me va con, tinh
* Vien Dinh Du'Qng
Chju trach nhiem chfnh: V u T h i T h u H i S n Email: hienvuthithugivahoo.com Ot: 0983.640.470 Phan bien khoa hpc: PGS.TS Oao Ngpc Dien Ngay nh$n bai: 22.7.2014
V0 Thi Thu Hien*, Lg Danh TuySn*
trang tiep xiic vdi anh nSng cua tre v i mpt so thong tin lien quan du'dc thu thap bSng phutJng phap ph6ng van ba me. Ket qua cho theiy: Ty le coi xu'dng d txk la 38,2%, tSng dan theo nhom thang tuoi, thap nhat b tre 1-2 thang (17,4%), cao nhat d tre 5-6 thang (56,7%). Ham lu'dng vitamin D trung binh trong su^ m?
la 44 IU/ 100ml, ty le b^ me cd ham ludng wtamin D su^ me thap la 60,4%. Cac yeu to nguy cd lien quan den tinh tr?ng coi xu'dng cua tre IS: Me Sn Ideng torn, cua, ca b-ong 3 thang sau sinh (0R= 5,74, p<0,001), me khong u5ng bo sung Canxi/ vitamin 0 khi mang thai (0R= 4,25, p<0,001), hSm lu'dng Vitamin D trong sift me thap (0R= 2,04, p<0,05), tre khong dUpc tam nSng dung each fOR= 2,38, p<0,05). Cong tac truyen th6ng giao due dinh du9ng cho c6ng dong a n dUdc diu trpng hdn n i b trong nhijTig nSm tdi de cac ba me nuoi mn \»s CO du kien thiit du phong cdi xu'dng cho trk.
T£tich6a:Oi\ xUdng, tre 1-6 th^ng, sQ^ m?
106
Y HOC VI$T HAM THAHG 9 - SO 2^014
SUMMARY
RICKETS, BREASTMILK VITAMIN D CONCENTRATION AND RELATED FACTORS I N INFANTS AGED 1-6 MONTHS I N URBAN
AREA OF HANOI, 2 0 1 1 A cross-sectional study was done in Dong Da district, Hanoi capital in 2011 to determine the prevalence of Rickets, breastmilk Vitamin D concentration and related factors in infants aged 1-6 months. A total of 186 infants aged 1- 6 months and who were breast fed, and their mothers were randomly selected and invited to participate. Dianogsis of ridc^ based on clinic symptoms and bkxxl analysis.
Mother's breastmilk was collected for analysis vitamin D3 concentration by High-performance liquid chromatography (HPLC) method. Age, sun exposure of Infants and related Informations was evaluated by Interviewing mothers. Results showed that, the prevalence of rickets of infants was 38,2%, increasing with age, lowest in infants aged 1-2 months (17,4%), highest In infants aged 5-6 months (56,7%). Mean of breastmilk Vitamin D concentration was 44 IU/ 100ml, prevalence of mothers with low breastmilk Vitamin D concentration was 60,4%. Factors associated with rickets were mothers on diet (0R= 5,74, p<0,001), mothers did not take Vitamin D/calcium supplements during pregnance (0R= 4,25, p<0,001), low breastmilk Vitamin D concentration (0R= 2,04, p<0,05), and lack of sun exposure (0R= 2,38, p<0,05). Our findings suggest that, nutrition education should be paid more attention in coming years to give enough knowledge to lactating mothers to control rickets for children.
Keywords: Rickets, infants aged 1-6 months, breastmilk
I.Oi^iTV^NOl
Benh cof xu'dng la benh loan du'dng do thieu vitamin D hay roi loan chuyen hoa vitamin D. Coi xu'dng do thieu vitamin D goi la cdi xu'dng dinh du9ng [1]. Tre em bi coi xu'dng se de bj suy dinh du0ng va han che pliat trien chieu cao [2]. Tre bi roi xudng luc con nho se co khoi lu'dng xu'dng dinh luc budng thanh thap va co nguy cd bi loang xudng luc cao tuoi [3], gay nhutig hau qua anh hu'dng den ganh nang chi phi cho nganh y ^ c u n g nhu" ton that ve kinh te- xa hoi. Viet nam la mpt nu'dc nhiet ddi nhutig ty le coi xu'dng cung kha cao so vdi cac nu'dc xung quanh. Nghien cuU cua Nguyen Van Sdn va CS tren cd mau 1263 tre 1-36 th^ng tai cac tinh mien nui phia Bac nam 1994- 1996 cho thay: ty le tre coi xu'dng la 14,4 % [4].
Thieu vitamin D la nguyen nhan quan trong gay benh coi xu'dng. Ty le thieu Vitamin D d Viet nam kha cao so vdi cac nu'dc xung quanh, chiem 55,3% 6 phg nu' tuoi sinh de 15- 49 tuoi [5], 58% d tre < 5 tuoi [6], 23,6% % d tre 1-6 thang
tuoi tai nong thon [7]. Tuy nhien, cho den nay, chu^ CO nghien cirtj cap nhat va mo ta ve ttii/c trang coi xu'dng d tre em, dac biet tre < 6 thang la giai doan xu'dng phat trien rat nhanh nen de bi coi xu'dng. Trong khi chung ta khuyen cao ba me nuoi con bang su^ me hoan toan trong 6 thang dau thi viec tim hieu liam lu'dng vitamin D trong svia me va moi lien quan vdi coi xu'dng cung vdi nhii'ng yeu to nguy cd khac la rat can thiet. Vdi nhij'ng luan glai do, chung toi da trien khai nghien cu\j de tim hieu ve thyc trang coi xu'dng, ham lu'dng Vitamin D trong sula me va mot so yeu to nguy cd d tre em 1- 6 thang tu6i tai mot dja ban thanh pho, do la quan Dong Da, Ha N6l.
II. €)6l TU'PNG VA PHU'CrNG PHAP NGHIEN CCOI 2 . 1 . Thiet ke nghien cu'u: cat ngang mo ta 2.2. Oia diem: quan Dong Da- Ha Noi 2.3. Thdi gian nghien cu'u: tii thang 7- 12/ 2011
2.4. Dol tu'dng v^ cd mau:
2.4.1. Doi tu'dng: cap me- con 1- 6 thang, tre dang du'dc nuoi du'dng bang siJa me, chUa uong vit D sau khi sinh, dong y tham gia nghien cu'u, khong mac benh cap tinh, me khong mac benh anh hu'dng den tiet sUa (sot cao...) va khong bi cac khuyet tat nhu' tam than, diec
2.4.2. Cdmau:
- De xac dinh ty le col xu'dng, ap dung cong thu'c:
z^.^2.p.(l-p)
Trong do; n la c8 mau, Z i-^ji = 1/96, p la ty le cdi xu'dng (u'dc tinh la 14%)[4]
d= 0,05. Tu' do tinh du'dc cd mau la 186.
- De xac djnh moi lien quan giife coi xu'dng va ham lu'dng vitamin D trong su^ me: Ap dung cong thut:
(1 + r)^ C r(lnORJ^p(l-p)
Trong dd : n la cd mau, ty suat chenh (OR) u'dc tinh la 3,0; p la ty le ba me co ham lu'dng vitamin D trong siJa me thap (u'dc tmh p= 0,3), tn so C=7.85 tu'dng u'ng vdi ly'c mau la 80%, r la ty so c5 mau giiJa nhom benh va nhom chutig, u'dc ti'nh r=0,25 tu'dng utig vdi 1 benh/2 chutig.
Tir do tinh du'dc n= 13?
Nhu' vay, de dam bao ca 2 tieu chi la xac
dmh ty le col xu'dng va tim moi tu'dng quan vdi
ham lu'dng vitamin D trong sij^ me, c3 mau can
cho nghien cutj la 186 (cap me- con).
Y HOC Vl|T NAM THANG 9 - SO 2Bt014
2.5. Phu'dng phap thu thap so lieu va k9
thuStapdyng:
- Phong van ba me: tuoi, trinh dp van hoa, nghe nghiep cua me, each tam nang clio con.,, va mot so yeu to lien quan. Tam nang dung each du'dc xac djnh khi tre du'dc tiep xuc vdi anh nang trong khoang thdi gian tii 6-8 gid sang, phan da ta^va chan cua tre du'dc tiep xuc tru'c tiep vdi anh nang m3t trdi.
- So do nhan trac cua con: can nang va chieu dai cua tre du'dc xac djnh bang bp can thu'dc d§c biet dung clio tre sd sinh va tre nhd.
- kham lam sang de phat hien cac trieu chu'ng coi xu'dng
- Xet nghiem mau tre: Dinh lu'dng vitamin D tono so (25(OH)D) trong mau^bang phu'dng phap mien djch, tren may mien dich tu" dpng
ARCHITECr. Dinh lu'dng phosphatase kiem trong mau bang do quang.
- Ch^n doan xac dinh coi xu'dng khi [1]:
- Thu thap mau sQ^ me de dinh lu'dng Vitamin D: LUdng su'a me can de phan tich vitamin D la 15ml/jnau siJa. Djnh tu'dng Vitamin D trong slJa me bang phu'dng phap sac ky Idng cao ap (HPLC). Ham lu'dng vitamin D trong siJa me dudc danh gia la thSp khi < 53,3 IU/100 ml (tu'dng utig 400 Ul trong 750 ml) [10].
2.6. Phan tich so lieu: Ket qua du'dc phan tich bang phan mem SPSS" 15.0
2.7. Dao du'c nghien cu'u: Nghien ciru da du'dc Hpi d&ng dao du'c Vien Dinh Du'dng thdng qua. Tat ca cac d5\ tu'dng (^u ky cam ket dong y tham gia tru'dc khi nghien cu'u.
III. Kij QUA NGHIEN CU'U
Bang 1. Dac diem chung cua ba me va tre (n=186) Cac bien so
D^c diem cua me
e$c diem cua con
Trinli do itoc van Het cap 2 Het cap 3 Oai hoc va sau dai tioc Nglie ngliiep Cong nhan Buon ban, noi trd Can bo, vien chiic Can nang (kg) Chieu dai (cm)
Ty le tre co can nang sd sinii < 2500 g Ty le tre du'dc sinh < 36 tuan Ham lu'dnq vit D (nmol/L) Ham lu'dnq phosphatase kiem (UI/L)
T* lg C%) 10,7 59,1 29,5 23,1 43,5 33,3
5,6 14,0
TB ± S D
5,9 ± 1,3 60,7 ± 9,5
85,8 ± 53,1 289,2 ± 86,1 Ket qua 6 Bang 1 cho thay: Phan ldn ba me deu co trinh do van hoa het cap 3(59,1%). Ti le co trinh do d?i hoc va cao hdn la 29,5%. Nghe nghiep chi'nh chO yeu la buon ban/npi trd (43,5%). Ty le tre oi can nang sd sinh thap chiem 5,6%. Co 14% tre sd sinh thieu thang.
Hinh 1. Ty l i col xu'dng cua tre
I'"
v°
1- 20 3S 2
*
1 7 441.2
fe
Ty le coi xu'dng chung aia doi tudng nghien cuti li 38,2%, Ty le ting dan theo cic nhdm tiling tiiS,
tri cang Idn thi tile col xudng dng cao, cao nhat d nhdm tre 5-6 thing (56,7%) (Hinh 1)
Y HOC V I | T HAM THANG 9 - SO 2/2014
Bang 2. Ham lu'dng vitamin D trong s&a me theo thang tuoi con Thang tuoi cua con
1-2 thang 3-4 thang 5-6 thanq Chung
Ham lu'dng vitamin D su'a me ' (lU/lOOmI)
52 ± 40,8
45,2 ± 30
37,6 ± 36,4 44 ± 36,8400 Ul/ngay
Ham ludng vitamin D trung binh trong siTa cua cac ba me la 4f IU/ lOOmi (Bang 2). Ham Iwcfng na) giam dan theo thang tudi cua con.
Hinh 2. Ty le ba me co ham lu'dng vit D trong sUa thap
57 4
61 5
tr^ 5-6
M2.^ cho thay: ty le ba me co ham ludng vitamin D trong su'a thap chiem tdi 60,4%. Tre cang Idn thi tylebame cd ham lu'dng vitamin D trong sij'a thap cang cao.
Bing 3. Moi lien quan qiiis coi xu'dng vdi cac yeu to Me kieng torn cua, ca trong 3 thang sau sinh
Co Khong
M$ uong bo sung canxl/vltD khi mang thai Khong
Co
Ham lu'dng vitamin D trong su'a me Thap
Binh thu'dnq
Tre du'dc tam nang dung each Khoiig
Co
nquy cd OR 5,74 0 4,25
0 2,04
0 2,38
0
9 5 % CI 2,72-12,0 2,23-8,11 1,11-3,78 1,12-5,08
P p<0,001 p<0,001 p<0,05 p < 0,05 Phin tich hoi quy ddn bien, lien quan co YNTKkhlp< 0,05 Ket qui d Bing 3 cho thay: nhiing yeu td nguy cd lien quan den tinh trang col xu'dng ciia tre la: Me an kieng tdm, cua, d trong 3 thing sau sinh (0R= 5,74), me khong uong bp sung Canxi/ vitamin D khi mang thai (0R= 4,25), ham IWdng Vitamin D trong sua me thap (0R= 2,04), tre khong du'dc tam ning dung dch (0R= 2,38)
IV. BAN LU^N
Nghien ciJu da cho ket qua ty le coi xu'dng 4 tre 1-6 thang du'dc bii me la 38,2% (Hinh 1), Ty le nay cao hdn rat nhieu so vdi nghien cu'u trirdc day cua tac gia Nguyen Van Sdn [4], cao hdn tre ciing do tuoi d khu vi/c nong thon Ha Npi (27,6%) [7]. Bleu nay chirng to coi xUOng d tre
em la van de rat dang quan tam 6 Viet Nam trong thdi diem hien nay. Trong nghien ciiu nay, mac dil tre du'dc bii me nhu'ng ty ie coi xu'dng van rat cao, day la 1 diem rat dang chu y.
Ty le coi xu'dng tang dan theo thang tuoi ciia
tre. Oieu nay co the giai thich 1 phan la do ham
lUdng vitamin D trong su'a me giam dan theo
Y HQC VIET HAM THANG 9 - SO 2/2014 thang tuoi cua con (Bang 2), va ty le ba me co
ham iu'dng vitamin D thap trong sula me cung tang dan theo thang tuoi ciia tre (Hinh 2). Tuy nhien, han che cua nghien cu'u la chu'a phan tich du'dc ham lu'dng canxi va phospho trong sij'a me.
Neu phan tfch du'dc thi se ly giai du'dc sang to hdn cho dau ra nay.
Ket qua phan tich vitamin D trong siJa me cho thay: Mac du ham lu'dng vitamin D trung binh trong su'a me d nghien cutJ cua chung toi (44 I U / 100ml) cao hdn nhieu so vdi nghien cu'u tru'dc d nong thon (9,8 I U / 100ml) [7], nhutig van chu^ dap litig du so vdi nhu cau khuyen nghj vitamin D cho tre. Vdi ham lu'dng Vitamin D trong su'a thap nhu" vay, neu tre du'dc bu du lu'dng su^
me theo nhu cau hang ngay (750 m l / ngay) thi tdng lu'dng vitamin D cung cap cho tre qua s i i ^ me cung chu^ dii dap utig nhu c^u vitamin D cua tre la 400 lU/ngay.
Ty le ba me co ham lu'dng vitamin D trong su'a thap chiem tdi 60,4%. Chiing toi da tim thay moi lien quan giu^ ham lu'dng vitamin D trong siJa me va tJnh trang col xu'dng d tre (Ba me co ham lu'dng vitamin D trong s u ^ thap < 53,3 I U / 100 ml thi con CO nguy cd bj coi xu'dng cao gap 2,04 lan so vdi ba me co ham lutJng vitamin D cao > 53,3 IU/100 ml). Ket qua nay cung phu hdp vdi nghien ciiu cua Ghai d tre em An Dp.
Cung nhu' nghien cuU tru'dc 6 tre em nong thon, nghien cutJ nay da khang djnh: tre khong du'dc tam nang dung each la yeu to nguy cd cua coi xu'dng va thieu Vitamin D [7]. Nhu'ng khac vdi ba me va tre em nong thon, d day chiing toi da tim thay moi lien quan giu'a tinh trang coi xu'dng cua tre va cac thyc hanh ciia ba me: me an kieng tom, cua, ca trong 3 thang dau sau sinh thi con cd nguy cd bi coi xu'dng cao gap 5,74 lan so vdi ba me khong an kieng (p<a,001). Ba me khong uong bo sung Canxi/vitamin D khi mang thai thi con CO nguy cd bj coi xu'dng cao gap 4,25 lan so vdi ba me co uong (p<0,001).
V. K I T LUAN
1. Ty le coi xu'dng d tre 1-6 thang la 38,2%, tang dan theo nhom thang tuoi, thap nhat d tre 1-2
thang (17,4%), cao nhat d tre 5-6 thang (56,7%).
2. Ham luUng vitamin D trung binh bong sife me d dia diem nghien ciftj la 44 I U / 100ml, ty le ba me cd ham lu'dng vitamin D sife me thap la 60,4%.
3. Cac yeu to nguy cd lien quan den tinh trang cdi xu'dng ciia tre la: Me an kieng tom, cua, ca trong 3 thang sau sinh ( 0 R = 5,74, p<0,001), me khong uong bo sung Canxi/ vitamin D khi mang thai ( 0 R = 4,25, p<0,001), ham lu'dng Vitamin D trong su'a me thap ( 0 R = 2,04, p<0,05), tre khong du'dc tam nang dung each { 0 R = 2,38, p<D,D5).
V I . KHUYEN N G H j
Cong tac truyen thong giao due dinh duQng cho cpng dong can du'dc chu trong hdn nfe trong nhutig nam tdi de cac ba me nuoi con bu CO du kien thu'c dii phong coi xu'dng cho tre.
TAI U g U T H A M K H A O
1. Tru'dng Oai hpc Y H i Noi (2009). Bai giang niii khoa, tap I I . Nha xuat ban Y hoc.
2. Mou 35, LUG JY, Li YP, Shuai ZR, Uu XH (2009). Study on the nutritional status and determinants among rural stranded children in China. Zhonghua Uu Xing Bing Xue Za Zhi.
30(5):439-43.
3. Heaney RP (2002). The important of caldum intake for life long skeletal Health. Calcif Tissue Int; 70: 70- 73.
4. N g u y i n van Sdn, Dao Ngoc DiSn, Le Nam Tra (2006). Nhan xet ve ty le coi xudng 6 tre em tai mot so viing mien niii phfa BSC. Tgp chi Dinti DuSng va ThUc ph^m, 2 (2); 40- 44.
5. Vu Thj T h u H l e n , Nguyen Thj Lam, Lu'u Hong Anh, N g u y i n Thj Diep Anh (2010). Tinh trang thieu vitamin D va cac yeu to lien quan d phu nu' 15- 49 tuoi tai Ha Npi va Hai Dutfng. Dinh diiSng va Thyc pham, 6(so 3+4): 40- 47.
6. Laillou A, Wieringa F, Tran TN, et al (2013).
Hypovitaminosis D and mild hypocalcaemia are highly prevalent among young Vietnamese children and vi/omen and related to low dietary intake. PLoS One, 8(5): 13-19
7. Vu Thi Thu Hfen, Le Thi H0p, Le Bach Mai, Nguyen Thj Lam, Le Thi Hang (2012). Ty I?
thieu vitamin D va mpt so yeu to lien quan d tre em 1-6 thang tuoi tai Ha Noi. Tap chi Dinh Du'Sng va thu'c pham, 8(4): 8-16
