CHAO Mirwo HOI MGHI KHOA HOC T H l t d N G NIEN HOI H 6 H^P V I S T K A M
VAN D E s i r D U N G C O R T I C O S T E R O I D T R E N LAM S A N G cr B E N H NHI NHlfiM V I R U S H O T B A O HO H A P
Vo Minh Hien*, Pham Enga*, Lay Mynint Yoshida**
T 6 M TAT
Oat van d e : Sir nhiem trung vi rut, dac biet la RSV 6 tre em du'di 5 tuoi co tlie dan den suy ho hap, kho khe hoac hen. Hieu qua cua steroid trong thiTc lianh lam sang d benh nhi nhiem RSV chu^ du'dc ro rang.
Muc dich cua nghien citu:
1. Khao sat ty le benh va dac diem iam sang cua nhiSm khuan ho hap cap tfnh tre em d benh vien da khoa Khanh hloa.
2. Khao sat moi lien quan g i u ^ trieu chirng lam sang va viec chi djnh steroid d tre nhap vien vi ARIs.
3. Danh gia hieu qua cua viec dieu trj steroid len thdi gian nam vien.
Boi tifOng va phirong p h i p nghien ciifu:
Tat ca nhiing benh nhi < 5 tuoi vdi trieu chiing ho ho3c kho thd nhap vien khoa Nhi - Benh vien Khanh Hoa trong thdi gian 2009 den 2011. Viec chi djnh dieu trj steroid du'dc thu'c hien bdi cac bac sy khong lien quan den ket qua xet nghiem vl rut. PCR diing de xac djnh 13 loai vi rut ho hap (Influenza A,B; HMPV; PIVl-4, Rhinovirus, Human Corona vius; 229E, 0 C t 3 , Adenovirus, Human Bocavuirus, RSV) tir benh pham djch mui hpng. Trieu chimg lam sang, thdi gian nam v i | n , ket qua xet nghiem vi rut du'dc so sanh giii^a nhom steroid va khong steroid.
Ket qua: 1810 ARIs dUdc chon vao nghien cirti va 1769 tri/dng hdp du'dc xet nghiem PCR., 59,3% dirdng tinh vdi 1 trong 13 loai vi rut.
* Bfnh vifn Da khoa Khdnh Hoa
* • Trudng Dgi hpc Nagasaki Nhgt Bdn Chju trach nhi?m chinh; V6 Minh Hien Email: [email protected] Ngay nhjn bai: 22/9/2015 Ngay phan bi?n khoa hoc: 16/10/2015 Ngay duyft bai: 22/10/2015
Rhino (31.38%), RSV (22%) chiem ty \i cao.
RSV pho bien 6 tre em dudi 2 tuoi (80%). Chung toi ghi nhan 45,64% benh nhan ARI du'dc dieu trj vdl steroid, kho khe va trieu chirtig lam sang nSng lien quan den viec chi djnh dieu tri steroid trong nhom RSV dtfdng tinh (p<0.05). Tuy nhien, hieu qua lam sang cua viec sir dijng steroid tren viec rut ngan thdi gian nam vien d benh nhan ARIs du'dc so sanh giii^ 3 nhom RSV ( + ) , cac vi rut khac ( + ) va vi rut ( + ) thi khong co sir khac biet co y nghTa thong ke (p>0.05). Ket l u | n : RSV la tac nhan gay benh ho hap thu'dng gap nhat d tre < 2 tuoi va vao miia he. Khong co sd khac biet co y nghia giifa 2 nhdm steroid va khong steroid tren thdi gian nam vien d binh nhan nhiem RSV.
SUMMARY
THE USE OF CORTICOSTEROID ON CLINICAL CONDITIONS IIV CHILDREN WITH RESPIRATORY SYNCYTIAL VIRUS INFECTION Background: , Viral pathogens were considered as etiology for most of ARIs In children less than 5 years of age. Children Infected with respiratory syncytial virus (RSV), may lead t d respiratory distress, wheezing, asthma during and after infection. The beneficial effects of corticosteroid dn clinical practices are still unclear. The aim of our study is to: 1. To determine clinical characteristic cf hospitalized pediatric ARI cases in KHGH, central Vietnam. 2.
To investigate the association between clinical symptoms and corticosteroid usage among hospitalized ARIs cases. 3. To determine the effect of corticosteroid use on duration of hospital stay among hospitalized ARI children
86
YHOC VIET NAM THANG 11 - SO CHUYtN DE - 2015
With RSV. Methods: All ARIs cases admitted to KHGH from our target population presenting with cough or difficulty of breathing between 2009 January to 2011 December were studied.
Enrolled cases were allocated to steroid and non- steroid therapy by the physicians regardless of viral testing results. Multiplex PCR assays were performed to detect 13 respiratory viruses {influenza A and B, HMPV, P I V l - 4, rhinovirus, human corona viruses: 229E, OC43, adenovirus and human bocavirus, RSV) from nasopharyngeal samples. Clinical characteristics, duration of hospitalization were analyzed based on their steroid treatment In relation with RSV.
Results: During tiie study period, 1810 ARIs cases were enrolled and 1769 cases were tested for 13 viral pathogens. At least one virus were detected in 59.3% (1049/1769). Rhino (31.38%), RSV (22%) were the leading cause of ARIs. RSV was most common in children ^ 2 years old with typical summer seasonality (19%), 45.64% {826/1810) of cases were treated with corticosteroid in our study. Patients who presented with wheeze and severe respiratory symptoms were associated with steroid use in group with RSV positive (p<Q.05). However, there was no diff
I . D i i l T V A N O l
Nhiem khuin ho hSp d p tinh la mot trong nhQng b?nh co ty If mic benh va ty le tu vong cao dSc bi?t la a eke nuac dang phat triin (Hall va CS., 2009; Nair va CS., 2010).
Theo th6ng ke cua t6 chuc y t^ the gioi (WHO, 2013), nhiem khudn ho h§p cip tinh van la mot trong nhihig nguyen nhan hang dSu dan d^n tu vong a tre em duoi 5 tuoi ngoai di?n so sinh. theo sau la nhom nguyen nhan tieu chay, sdt ret. viem mang nao, chdn thuang va cac b?nh ly bdm sinh. Trong so tac nhan gay nhiem khuan ho hap cap tinh.
70% tnrong hop duac ghi nhan boi virus va 20% trong so do la do virus hpp bao ho hap {Hall va cs., 2009; Simoes, 2010; Suzuki va cs., 2012; Lay Myint, 2013).
Viec su dung corticosteroid 6 benh nhan bi nhiem khuan ho hap cap tinh, dac biet la virus hop bao ho hap (RSV) dugc cho rang CO tac dung cai thien trieu chung ho hap va nit ngan thai gian nam vien (Bentur va CS., 2005; Kajosaari va cs., 2000; Johani and Akhter. 2013). Tuy nhien, hi?u qua ciia corticosteroid trong thuc hanh lam sang o benh nhan nhiem RSV van con nhieu tranh cai. Do do, nghien cuu ciia chiing toi nhSm muc dich:
/. Md td dich te hgc, ddc tinh ldm sdng eua hinh nh) nhiem khudn hd hdp cdp dugc nhdp vien vdo khoa Nhi - benh vien da khoa Khdnh Had.
2. Khao .sdt moi lien quan giUa tri$u chimg ldm .sdng vd viec su dt^ng cortico.steroid trong so tre nhgp vi$n vi nhiem khudn ho hdp cdp tinh.
3. Xde dinh hieu qud cua vi^c .su dgng corticosteroid tren thdi gian ndm vi^n trong sd tre hi nhiem khudn ho hdp cdp tinh.
II. OOI TUQNG VA PHl/CrNG PHAP NGHIEN CUTJ
2.1. Thiet ke nghien cihi: nghien cuu hoi cuu
2.2. PhiroTig phap va doi tvcmg nghien cuu:
Tat ca tre trong dp tuoi tir 1 thang - 60 thang thupc 16 xk phucmg o Nha Trang nhap vien vao khoa Nhi - Benh vien da khoa tinh Khanh Hoa bat ddu tir thang 1/2009 din thang 12/2011 voi trieu chung ho vk/hokc kho tha duac chpn vao trong nghien cuu.
Viec thu thap thong tin ve dich te hoc. dac tinh lam sang va chi dinh corticosteroid bcri bac sT Nhi khoa tai thai diem nhap vi?n khi
CHAO MLTNS HOI MGH| KHOA HOC T H U 6 N G N I S N HQI HO HAP V I | T NAM
chua CO kSt qua vims hoc. Dich mfli hpng duoc thu thap ngay sau tham kham Iam sang va dupe gui di phan tfch PCR ik phat hien 1 trong 13 tac nhan virus: Influenza A-B, RSV, hMPV, PIVl-4, rhinovirus, corona: 229E- OC43, adenovirus va bocavirus (Yoshida va cs, 2010). tai phong thi nghiem true thugc vi$n nghien cuu benh nhiet doi a dai hoc Nagasaki, Nhat Ban.
Cach kham ik phat hien tri?u chfag, phan loji bjnh d\ta theo huong din cua to chile ytethS gioi (WHO. 2005).
DO li$u dugc phan tich dua vao phin mem STATA software version 12.0
III. KET QUA
Trong giai doan nghien ciiu tir thang 1 nam 2009 dSn thang 12 nam 2011, 1810
trucmg du tieu chuin ik chpn vao nghiffi eijru, trong do 1769 truong hgp dugc liy dich mui hgng de lam xet nghiem phan tich 1 trong 13 loai virus bang phucmg phap PCR va 41 truang hgp bi loai vi mau benh phim khong dat yeu cau.
3.1. Ty le nhiem virus du-oug ho hip fr b^nh nhi nhiem triing ho hip cap tinh
Trong s6 1769 mau berih phim dugc phan tich, 1049 (59,30%) tniong hgp duong tinh v6i it nhit mgt trong 13 logi vims.
Trong sd do, 847 trucmg hgp (66,22%) la nhi^m mfit loai virus, con lgi la boi nhiem tu 2 loai virus tra len.
Rhino (31,78%), RSV (22%), van la nguyen nhan hang diu gay nhiim khuin ho hap cap tinh 6 tre em nhap vien duoi 5 tuii, theo sau la Influenza typ A (13,16%), Adeno (10,71%). (Bangl)
Bing 1: Kkt qua xet nghiem virus hpc
Tong cong Bffn nhiim Ba nhiSm Rhinovirus 422(31.38%) Respiratory syncytial virus 296 (22%)
Influenza A Adenovirus Influenza B
Parainfluenza virus type 3 Parainfluenza virus type 1 Human bocavirus Human metapneumovirus Parainfluenza virus type 2 Human coronavirus Parainfluenza virus tvpe 4
177(13.16%) 144(10.71%
55 (4.09%) 48 (3.57%) 41 (3.05%) 39 (2.89%) 33 (2.45%) 11(0.82%) 10(0.74%) 3 fO.22%1
288 08.25%) 219(73.99%) 138(77.97%) 47 (32.64%) 44 (80%) 31 (64.58%) 28 (68.29%) 17(43.59%) 25 (75.76%) 8 (72.73%) 0 (0%) 2 (66.67%)
134(31.75%) 77(26.01%) 39 (22.03%) 97 (67.36%) 11 (20.00%) 17(35.42%) 13(31.74%) 22(56.41%) 8 (24.24%) 3 (27.27%) 10(100%) 1 (33.33%)
Tong cong 1279 847 (66.22%) 432 (33.78%)
3.2. Sir phan bi vi rut theo mua
Rhino virus phan b6 quanh nam khong co miia r8 rang. Rieng d6i voi RSV, dinh diem vko ckc thang miia he bit diu tir thang 5 din thang 10. Ngoai ra, d6i vai virus cum A mac dil phan b6 rai rae quanh nam, nhung tit thang 12 nSm 2009 dSn thang 6 nam 2010 khdng ghi nhjn tructng hgp mic nao (Hinh 1)
Y H O C VIET NAM THANG 11 - SO CHUYEN BE - 2015
ninh 1: Su phan bo virus theo cac thang trong nam
RBquency 90
/ •* / -^^ ^^ / /* / ^^ ^^ </ / / «*' ^^ ^' ^^
l R S V ( n ^ 9 6 ) 3 Other iriruses positive
3lnfa(n=177) - ARI cases (n=1769)
D Rhino (n=422)
- P o s i t i v e cases monthfy(n=1049)
3.3. D3c diim lam sang cua vi^c sir di^ng corticosteroid & nhom benh nhi vol kit qua RSV (+), virus khac (+) vk virus (-)(Bang2)
Trong t6ng so 1049 truong hgp duong tinh voi ) trong 13 loai virus dugc djnh danh, trong do 219 truong hgp nhiem chi mpt lo^ RSV, 628 truong hgp ducmg tinh voi mgt trong 12 loai virus con lai.
CJ nhdm RSV(+): Trong s6 219 trucmg hgp, 100 ca dugc chi dinh corticosteroid va 119 ca khong chi dinh corticosteroid. Chiing toi ghi nhan rang viec su dung corticosteroid thuong a tre trai hon gai (68% so vai 32%.
p<0,05). Mac khac. 6 nhung benh nhan co bilu hi?n lam sang tho nhanh, nit 16m 16ng nguc, kho khe. nhjp tim nhanh. nhiem triing
ho hap cap tinh nang dugc chi dinh corticosteroid hon so voi benh nhan khong CO bieu hien nhihig trieu chung nay (p<0.05).
CJ nhom virus khac (+): Trong so 628 ca duang tinh voi 1 trong 12 loai virus con lai.
297 ca dugc chi dinh corticosteroid va 331 ca khong dugc chi djnh cortocosteoroid. Ket qua cung tuang tu voi nhom chi voi RSV (+), chung toi ghi nhan riing tre trai thuong dugc chi djnh corticosteroid hon so voi tre gai (61.9% so vol 38.05%) va nhihig benh nhan co bieu hien lam sang tho nhanh, nit lom nguc. kho khe. nhip tim nhanh. nhiem trimg ho hap cap tinh nang thi thirong dugc chi dinh corticosteroid hem so voi tre khong CO bieu hien lam sang nay (p<0,05).
C H A D MLTNG HOI NGHI KHOA HOC THlfCtNG NigN H 6 | H 6 HKP VIET HAM
Bang 2: DSc tinh lam
Gioi Nam Nil Nhom tuoi
HUr%
6-l2lliaiig U.24ll<iiig 24-60 diang
Tlnnhanli RtillSmngvc Kho l d i Ran no Tiis6tholnjngbinhllOR) Nhjplimtruigbi^(IQR) B^ thuong Iren Xquang Khang sinh tnroc nhap vi^n Qinhatre U^uphapo)^
Nhiem Irung ho hap d w i Nhiemtrunehohapn^
Corticoid (+
n=llt
61(61%) ]!{]2%)
29 (2W) 2S(2S%) 32 (]2"/.) I4(I4%|
22(22%)
11(11%) 43(«%) 1(1%)
!S(10) 110(20) I4(I4,2«) 29(29%) I I (31%)
Hm
19(19%) -12(12%)
sang ciia
I I S V ( * ) I F 2 1 9
Corticold(-) n=119
64(5371%) Si(46J2%)
21(22.69%) 24(20.17%) 37(3I.0W) 3l(26.0i%) 13(10.92%)
4(I.36'«) 30(23.21%) 10(1.4%) 35(10) l(»(ll) 14(11.16%) 26(2US%) 41(34.45%) 0 19(15.97%) 4(3J6'/.)
benh nhi nhjp vien vi nhiem ho hko cim tinh
B*
o.e2
0.153
0.026 0.026 0.OOS 0.699 0.72311
<0.001l O.SI 0J12 O.SII 0.057 OSSS UIU
Vitus khac (+)n=62
Corticoid (+)
•=297
114(61,9%) 113(31.05%)
26(I.JS%) 64(21,55%) 93(31J1%) I I 4 ( 3 I J I % ) 44(14,11%)
22(7,41%) 100(33,61%) I2(4,04%0 12(1) 100(121 42(14,41%) 75(2525%) 153(51,52%) 7(2,36%) 69(23,23%) 2719,09%)
Corticoid (-) D=331
200(6042%) )3I (39.51%)
39(11,71%) 56(16,92%) l l l ( 3 5 J 5 % ) 119(35,95%
25(7,55%)
9(172%) 44(13,29%) 12(3,63%) 32(7) 100(111 61(11,77%) 11(23,26%) 151 (45,62%) 2(0,6%) 37(11,11%) I2l3,ij%l
f
0.695
ms
0,004 0.007
<0,I01
0,717 0,069«
0,2621 0,234 0.529 0,3)2 0,065
<0.00l
<t.mi
Corticoid (+
n-310
170(54,14%) 140(4516%)
4404,19%) 61(2194%) 96(30,97%) 102(32.9%) 46(14,14%) 23(7,42%) 120(31,71%) 19(6,13%) 33(10) 107,5112) 46(15,11%) 75(24,19%) 119(31.39%) 9 ( 2 . « ) 65(20.97%) 30(9,61%)
(iru!(.)>-72l) Corticoid (.
0-410
235(5722%) 175(4261%)
52(12,61%) 71(19,02%) 126(30.73%) 154(37,56%) 41(11,71%) ll(4J9%) 71(I7J2%|
11(4,19%) 32(10) 102(11) 7201%) 16(20,91%) )77(43.)7%) 7(1,71%) 69(16,13%) 19(4,63%)
fi»
OJ07 '
0,541
0217 0,012 0,011 0,295 0,5251 0,0I7«
0,603 OJI 0,1%
0,211 0,151 l,029S
3.4. So s^nh hieu qua ciia viec sir dung corticosteroid tren thM gian nam vien o*
bfnh nhi nhiim RSV (+), virus khac (+), virus (-) (Bang 3).
Nhin chung, khong co su khac bi?t co y nghta gi&a nhom dugc chi djnh dung corticosteroid va khong dimg corticosteroid tren thoi gian truoc khi nhap vien, thoi gian nim vi?n o nhom benh nhi RSV (+), virus khac (+), virus (-).
Phan tich dua theo trieu chiing kho khe:
su khac biet khong co y nghia gitJa nhom dugc chi dinh sir dung corticosteroid va khong corticosteroid tren thai gian nam vien (p>0,05). Tuy nhien, chiing toi ghi nhan rang
thoi gian khoi benh o nhom dugc chi djnh sii dung corticosteroid dai hon o nhom khong dugc chi dinh corticosteroid 6 nhom b^nh nhan RSV (+) (3 voi 2. p=0,022)
Phan tich dua theo tri?u chimg riil 15m long ngirc, gioi. nhom tuoi: thoi gian b?nh cr tre gai vai RSV (+) dugc chi dinh diing corticosteroid dai hon so vai kh6ng diing corticosteroid (8,5 so vdi 7, p=0,045). Cac tinh trang khac kh6ng ghi nhan co sii khdc biet giii'a nhom dugc chi djnh su d\ing corticosteroid va nhom khong dugc chi djnh diing corticosteroid tren thoi gian khoi b?nh va thoi gian nam vien (p>0,05).
YHOC Vlfr NAM THANG 11 - SO CHUYEN BE - 2015 Ban;? J ; Hieu qua cna
1 tim gian irung binh cua benh (IQR) Thai gian Hung binh nam vijn (IQR) Tbtii gian iruoc nhap vi^n |IQR) Kh6 khf (+)
TliiJi gian mmg binh cua benh (IQR) Thni gian tnmg binh nam vien (IQR) Thin gian DTKFC nh|p vi?n (IQR) MHmngvt T1»i gian tmng bjnfi cua benh (IQR) Then gian tning binh nim vien (IQR) Then gian tmdc nh^p vien (IQR) Trai
Tiiin gian Imng binh cua bfnh (IQR) TMn gian trung binh nam vien (IQR) Thin gian tmac nh^p vi^n (IQR) Gii
Thin ^an Irung binh cua benh (IQR) Thai giantrung binh nilm vien (IQR) Thiri ^anlruiic nhjp vien (IQR) 0-6 thdng Iu6i Thm gian tnii% hlnh cua benh (IQR) Thm giantriE^ hudi nim vien< IQRl l i m gian Dime nhjp vi;n | IQR) 6-12 thing (iifii Thin gian tning binh cua bfnh (IQR) Thai gian tnn^ binh nam vien (iQR) Riin gian ]miK nhpp vien (IQR) 12-24 thing liiAl Thiri gian trung binh cua b^nh I IQR) 'lliiri gian irung binh nam vi^n (IQIi) Thin gian tnrdc nhjip vi^n (IQK) 24-60 thing tu6i Thm gian (rung binh CUB benh (IQR) Thin gian lrui% binh nam vi^n (IQR) Thai gianiruijc nhap vien IICjR)
corticosteroid tren thoi
RSV(+)n=:i9
Corticoid {+) Corticoid (-) ^ n=100
8(4) 5(3 5) 3(2) n=43 8(3) 5(4) 3(2) n=U 9(6) 7 (J) 3(3) n=68 7 5(5) 4(3) 3(2,5) n=140 8.5(4 5) 5(4.5) 3(3) n=29 8(41 f.(4|
3(3) n=2S 9(4) 512) 3(3) n=32 l!(4) 5(2.5) 3(3) n=l4 7 5(6) 4(3) 2.5(2)
n=li9 7(4) 5(3) 3(3) n=30 7(3) 45(3) 2(2) n=4 10(25) 6.5 (4) 3 i ( 3 5) n=64 75(3.5) 5(3) 2.5(3) 1FI75 7(5) 4(31 3(2) n=27 7(4) Mi) 2(2) iF24 75(5) 4(3) 2 5(2) n=37 814) 5(2) 3(2) n=51 7(3) 5(3) 2(3)
0273 0,73S 0329
0067 0 82 0.022
0895 0895 0597
0867 0277 0,583
0.045 0094 02)4
03W 0907 0342
0267 0369 0343
0903 0638 0797
0 785 0S71 0.663
gian nam vien
Vina k h k (-i-) n ^ 2 8 Corticoid (+) Corticoid (- n=197 6(5) 4(3) 1(3) n=IOO 7(5) 5(3) 2(3 5) n=22 65(5) 5(4) 1(1) n=lK4 7(5) 5(4) 2(3) n=ll3 614) 4(2) 1(3) n=26 65(4) 5H) 1(3) n=64 8(4) 6(31 2(2 51 n=93 7|4|
5(31 2(4) n=ll4 5(4) 4(3) 1(3)
n=331 6(5) 4(31 2(2]
n=44 8(6) 5(35) 3(4) n=9 7(5) 3(2) 2(4) n=20fl 6,5(5) 4(3) 2(2) n=13l 6(5) 4|4) 2|2) rpi<t 7(41 5(41 2(2l 5fi 7(6) 4 5 | ! 5 ) 2(2 5) n=ll7 6(51 4 { ! | 10) n=ll9 6(4) 4(3) Ml)
pi
0734 0366 0123
0138 0429 0098
0743 0252 0086
032 02113 0494
0442 095K 0113
0962 0782 0238
0 153 0067 0 793
08114 084 0327
039 0921 0215
, thdi gian benh
\1nis(-) =720 Corticoid (+) Corticoid (-) ^^
n=310 6(4]
4(3) 2(2) n=l20 8 5(6) 4(4) 3(3) n=23 8(5) 6(4) 2(3) IF 170 65(4) 4(3) 2(2) n=32 614 5) 4(3) 2(2) n=44 7(6) 4^(15) 2|4) n=68 6(4) 4(2) 2(2.5) n ^ 6 6(4) 4(31 2(2]
n-102 5(6) 4(4) 2(2)
n^lO 6(4) 4(3) 2(2) n=7l 7(5) 5(4) 2(2) n=18 8(5) 5(3) 2.5(1) n=235 6(5) 4(3) 2(2) n=55 7(4) 4(3) 2(2) n=52 7(45]
4(35) 2(2) n=78 6(5) 4(3) 2(21 n=l2h 7(4) 4(3) 2(2) n=l.54 7,5(5) 413) 2(2)
0.66 0,609 0,579
0607 0669 0,627
0.499 0661 0.123
0 224 0417 0 703
0.441 0837 0211
0134 0 386 0266
0499 087 0594
0.391 0 794 0.114
0938 0972 0 616
IV. BAN IUAN
4.1. Die tinh cua nhiim virus iirimg ho bip trong so tre nh^p vifn tif thang 1 nSm 2009 den thang 12 nam 2011
Trong giai doan 3 nam nghien cilu.
chung toi ghi nhjin rang virus la nguyen nhan chii yiu cua nhiem trimg ho hdp a tre em nhap vien a khoa Nhi - Benh vien Khanh Hoa. Trong s6 1769 mau benh phdm dich mui hong dupe xet nghi?m dinh danh virus hpc b k g kf thu^t PCR. 59.3% duong tinh voi it nhat 1 trong 13 lo^ii virus tren. Ka qua nay cung tuong tif voi nhttng kat qua khac tit
My (49.8%), Philippine (61,2%) (Huang va CS., 2013; Suzuki va CS., 2012). Ngoai ra chung toi nhan thdy Rhino (31,38%), RSV (22%), Influenza typ A (13,16%) la tac nhan gay b?nh hang dau dugc nhan dien, chiem khoang 2/3 tac nhan virus dugc tim thay a tre mdc nhiim khuan ho hap cap tinh. Dieu dac biet luu y la 82,09% truong hgp ket qua duong tinh voi RSV xay ra 6 Ire duoi 6 thang tuoi, ket qua nay cung phii hgp voi ket qua nghien ciru ciia cac tac gia khac (Broor va CS.. 2007; Garcia et al., 2010; Suzuki va CS., 2012). Tuy nhien, ty le luu hanh cua
CHAO MiTNG HQI NGH! KHOA HOC THUdNG NieHHOi HO HAP V i e r NAM
virus gay benh tren khong co miia ro rang, ngoai n-ir RSV luu hanh chu yeu vao cac thang mua he thu (bat ddu vao thang 5 keo dai cho dfa thang 10), diSu nay dac biet khac voi cac nghien cilu cua cac tac gia truoc da chi ra ring dinh dilm luu hanh ciia virus dac Met la RSV chii ylu vao cac thing lanh (CDC, 2013; Hall va CS., 2009; Huang va CS., 2013; Kaneko va CS.; 2002). Chung toi nhan thdy so di co sir khac nhau la do dac dilm dia ly hoc va thW tilt, a nhihig vimg khi hau nhi?t doi va can nhiet doi su gia tang b$nh nhiem triing ho hdp chii ylu vao cac thang nong miia he), mac khac cac yeu to lien quan nhu su gia tang dan so, mat do dan so cao cung nhu 6 nhiem khong khi, kiln thirc ciia ngucri dan cung anh huong den sir luu hanh benh dac biet vao miia he o cac nuoc nhiet doi,
4.2. D^c diem lam sang lien quan den vifc chi djnh dung corticosteroid ff benh nhi nhiem triing ho hap cap tinh
Mot vai nghien ciiu cua cac tac gia da bao cao rang nhihig tre kho khe lien thuong lien quan den nhiem triing virus hon la vi khuan a tat ca nhom tuoi tre nhi bi nhiem khudn ho hdp cap tinh (Gem va Busse, 2002;
McNamara and Smyth, 2002; Tsukagoshi va CS.. 2013). Trong nghien cim ciia chiing toi da chi ra rdng 33% trucmg hgp nhiim RSV CO bieu hiln kho khe va 23% trucmg hgp nhiem 1 trong 12 loai virus con lai co bilu hiln kho khe, dilu nay ciing dugc ghi nhan trong nghien cuu cua tac gia Garcia (2010) da cho ring 7 1 % (444/626) tac nhan virus dugc tim thdy 6 tre nhap vien co bilu hien kho khe cdp tinh. trong do 24% la do RSV (Garcia va CS, 2010). Nhiing nghien cira khac cOng co kit qua tuong tu khi ghi nhan rdng RSV dugc tim thdy khoang 40,9%> cr tre duoi 2 tuli nhap vien vi kho khe cdp tinh.
Lgi ich cua viec sir dung corticosteroid lien quan din giam tinh trang phu n l duong ho hap va lam giam tinh trang tang tilt dich, giam CO that phe quan do tang dap ilng viSm khi bi nhiem virus dac biet la RSV. Mot s6 tac gia tin rSng viec sir dung corticosteroid CO the cai thien dugc cac chi s6 lam sang nang a benh nhan bi nhiim RSV (Kajosaari va CS., 2000; McBride, 2002; Schuh va CS., 2002; Van Woensel va CS., 2001). Kit qui nghien cuu ciia chiing toi ghi nhan o benh nhi CO bilu hien kho khe va cac trieu chiing ho hap nang nhu thcr nhanh, nit lom ngirc co chi dinh diing corticosteroid roi vao nhom RSV (+) va virus khac (+), riing voi trucmg hgp kit qua virus (-) thi chi dinh corticosteroid khi benh nhan co bilu hi?n kho khe. Su khac nhau gitta 2 nhom virus (+) va virus (-) co thi la mgt khi bi nhiem vims thucrng thuc day phan ung vilm gay tang dap ung phi quan va tiiu phe quan dan den co that, phil ne, tac nghen ducmg tho ducfi thuong gap o virus (Ermers va CS., 2009;
Ogra, 2004 Ruuskanen va CS., 2011;
Tsukagoshi va CS., 2013), trong khi do tac nhan vi khuan thucmg lien quan den ton thuong phe nang va tang tiet dich o phe quan Ion la chu ylu (Garcia va CS„ 2010; Gern va Busse, 2002)
4.3. Hieu qua ciia corticosteroid len thM gian n h a p nam vifn
Lgi ich ciia viec chi dinh corticosteroid trong thuc hanh lam sang a bfnh nhan nhiem khudn ho hdp cho thay thdy oo hifu qua nit ngdn thoi gian nam vien a mot vai nghiin cilu truoc day (Kajosaari va CS., 2h000;
Plint va CS.. 2009; Schuh va CS.. 2002). Tuy nhien. kit qua nghien eiru cua chiing toi cho thdy thoi gian ndm vifn giua hai nhdm dugc chi dinh corticosteroid va khong chi djnh corticosteroid khong co su khac bift co j
Y HOC V l ^ NAM THANG 11 - SO CHUYEN DE - 2015
nghia, dac bift khi khi phan tich dua theo cac cac trieu chirng lam sang nhu kho khe, rut lom nguc, gicri tinh, nhom tuli a nhom benh nhan RSV (+), Virus khac (+), Virus (-). Kit qua chiing toi cOng gilng voi cac nghien ciiu ciia nghien cim cua cac tac gia khac da dua ghi nh$n viec sir dung corticosteroid khong nit ngSn then gian nam vifn 6 bfnh nhan nhiem virus ho hdp (Berger va CS., 1998;
Comeli va CS., 2007; Ducharme and ktajinovic, 2011; Lee et at., 2011; Zhang va CS., 2003). MJc dil nghiin ciiu cua chiing toi ghi nhan khong co sir khac bift tren then gian nita vifn gitta 2 nhom co su dung corticosteroid va khong su dung corticosteroid, nhung chiing toi nhan thdy 6 nhom bfnh nhan dugc chi dinh corticosteroid c6 thoi gian truoc khoi bfnh truoc khi nhap vifn dai hon, trifu chiing lam sang tai thoi dilm nhap vifn nang hem, dieu do co the tin rdng vifc corticosteroid co hifu qua cai thifn hifu chUng lam sang niing o bfnh nhan nhiem virus ho hdp, dac bift la RSV.
Nghien cilu cua chiing toi ciing co mot so han chl. Thii nhdt. thong tin vi loai corticosteroid va phucmg thirc sir dving khong dugc thu th^p ma thong tin nay co thi htru ich cho vifc nghiin ciiu di img dung trong thuc hanh lam sang. Thii 2. thong tin vi mat trifu chiing lam sang di danh gia hifu qua sau khi dimg corticosteroid dcm dgc hay ket hgp voi mot loai thuic gian phi quan de tSng hifu qua diiu tri ma mot s6 nghifn cira da nhdc din (Hartling va cs., 2011; Kuyucu va cs., 2004; Van Woensel va Kimpen, 2000) tai cic thfri dilm nhdt dinh sau khi diing thuoc. Thir 3, nghien cilu cua chiing toi chi CO thi ghi nhan thai gian ndm vifn, khong danh gia dugc hifu qua ciia vifc su d\mg corticosteroid trong ngSn ngira hen 6 nhttng bfnh nhan nhiem RSV.
V. KET LUAN
Trong nghien cilu nay, chiing toi nhan thdy virus la tac nhan chinh cua nhiem tning ho hdp cap tinh o tre em nhap vien. Sir nhiem trimg ho hap do RSV chii yeu 6 tre em dudi 2 tuoi vao cac thang miia he. O bfnh nhan co bieu hien kho khe va trifu chung lam sang nang thucmg lien quan den viec chi dinh corticosteroid. Mac dii nghiin ciiu ciia chiing toi khong ghi nhan vifc chi dinh corticosteroid khong nit ngan thai gian nam vifn 6 bfnh nhi nhiem khuan ho hap cap tinh, tuy nhien hieu qua cua vifc su dung corticosteroid o bfnh nhan nhiem virus ho hap CO bilu hifn trifu chiing kho khe va lam sang nang.
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