/
VIETWAM MEDICAL JOURNAL N'2 - MARCH - 201L
dung 02 ky thuat de tim cac dot dot bien tren cac benh nhan, trong khi tac gia Le Thj Hao chf siJ dung chi mot ky thuat ARI^S - PCR cho 8 kieu dot bien. Co 154/211 ( 7 3 % ) the p-Thal phoi hdp HbE chiem t i le cao nhat trong cac dang phoi hdp. Nghien cull cua Le Thj Hao, Nguyen Khac Han Hoan dang phoi hdp nay luon cf mu'c cao trSn 50% [ l j , [ 2 ] . Ket qua nay cung tir nhu' cac nghien ciJu khac d Bong Nam A, |3-thal/ HbE luon la the b$nh pho b i & nhat [3].
Kieu phoi hdp gen tao the dong hdp td chi tlm__thay d dot bjgn Cd 17 va Cd 41/42 la do sir pho bien cua dot. bien nay trong cong dong. Va sir pho bign nay qon the hien trong t h i di hdp tiJ kep, kieu phoi hdp Cd 17/Cd 41/42 chiSm'ti le cao nhat. Ngoai ra, trong dang phoi hdp vdi dot bien HbE thi sir xuat hien cua Cd41/42/HbE va Cdl7/HbE cung chiem t i le cao nhat i n lu'dt la 29,9%, 2 5 , 1 % . Chinh sir pho blen ciia 3 dot bien nay luon cao nen cd nhieu nghien ciJu trong nirdc xay diTng cac ky thuat chan doan nhanh vdi gia thanh thap nhat de cac benh nhan co the liet kiem nhat trong chan doan tru'dc sinh [ 3 ] . Oay la cd hoi cho cac gia dinh ngheo da co con mac benh p-Thal co the co cd hoi sinh cho minh mot be khoe manh.
V. KET LUiJN
Nghien cu'u xac djnh cac dot bien gen p- gtobin tren 211 benh nhan nhi khu viTc Dong bang Song Cu'u Long cho thay dot bien Cd 95+A pho blen hdn dot bien IVS1.5 G>C. Nhu' vay, ngoai 8 dot bien gay benh pho bien nen thSm dot bien Cd 95+A cho khu vi/c trong chan doan
xac dinh benh nhanh bang sinh hoc phan' chan doan tru'dc sinh benh p-Thal. Ben ca nghien cifu con chi ra p-Thal StripAssay trinh bi la nhiJng ky thuat hieu qua de xe dot blen 99,5%. Tuy nhien, can su'dung tt thuat khac ho t r d trong trirdng hdp char tru'dc sinh tS tranh bo sot cac d6t bien cum gen Beta, dij tan suat gap rat hiem. '
T A I L I E U T H A M K H A O , 1. Lg Thi Hao. Nghien ciOi l^ng dung ky tl
truyen phan tir phat hien dot biefi gen ga' beta-thajassemia tai Viet NaiTl. Bao cao khi 2001.^Tru'cfng Dai hoc Y du'tfc TP Ho Chl Mini
* . Nguyen Khac Han Hoan. Nghien cOU tam ; chan doan benh alpha va beta thalassemia;'. / tieh si, 2013. TnTcIng Dai hoc Y dutJc TP Ho Oil 3. Nguyen Thu T r a n g , Le Thi t h u Ha, Ni
Thuy Ngan, Trieu Tien Sang, Pham Anh Duong, Vo Thi Thuong Lan. Natural SE and Technology, Detection of CommdiS thalassemia Mutations by Reverse Dot Btot Ar
VNU Joumai of Science, 2016, 32,398-403.
4 . Antonio Cao and Renzo Galanello. p-thalas Genetics in Medidne, 2010,12, 61-76.
5. Bobnyawat B, Monsereenusom C, Tra C'MoTe^uiar analysis of beta-globin mutations ^mong Thai beta-thalassemla'chi results from a sirsgle center study. 1 0 researcii.lQU.T, 253-258.
6. D Filon, Ariella Oppenhelm, 3 Rachmilewitz, D. Ba True. Molecular AnalvsH Thalassemia in Vietnam. Artide in Hem^
2000, 24(2), 99-104. '%
7. Svasti S, Hieu TM, Munlcongdee T, V^nldii P, Van Be T, Van Binh T, Fucharoen S. Moi analysis of beta-thalassemia In South Vie American Joumai of Hematology, 2002, 71(2), 8
DAC DIEM DICH TE HOC B E \ H HEN PHE Q U A N TRE EM TU- 6 DEN 1 5 TUOI TAI D A O CAT HAI, HAI PHONG
Nguyen Thi Anh Hyong', Thai Lan Anh^ Nguyen Van K
benh HPQ tir do tim ra giai phap can t h i p l phu'dng phap dieu tra cat ngang, phong v a a j kham benh xac dinh ty le HPQ theo GINA 2 0 i W tren 6 tuoi va tien sir di uYig ciia tre. So'lieu OT tren phan mem SPSS 13.0, ket qua cho' t M HPQ la 8,1%, nam cao hOn nff 1,6 ^ n , n h o r i i a la_9,8%, nhom 10-15 tuoi la 6,2%. Ti 1§ H l ^ Ho gia dinh sir dung nhien li§u (cijl, thani tas) cap 4, nuoi cho meo, khoi thuoc la; tre cp^^ien ifnj ca nhan (di irng thftl tiet, viem mui xoang"!
dl Ung thuoc, d| irng thirc an, may day san ngil^' dmh cd tien sir di iihg.' bo (HPQ, dl irng thdi tleB mui dj utig, may day), me (dl utig thdi tiS), aj em (HPQ), ong ba (HPQ), ho hang (HPQ, di (itij an, dj Unp thdi tiet); tre co can thilp san khoaj Khi de, de non, can nang khi sinh thap; tre cosffl T 6 | V 1 TAT
Hen phe guan (HPg) ngay mpt gia tang theo gia tang phat tnen kinh te-xa hoi. Nghien cuU tien hanh tren toan bp 1663 tre tir 6 den 15 tuoi sinh song tai tat ca cac xa/thj tran, dao Cat Hal, Hai Phong va bS me tre vdi muc tieu khao sat dac diem dich tS hoc
^B$nh vien Ba khoa Cat Ba 'Tnidng Bai hoc Y Dtfdc Hal Phong Chiu trach nhiem chinh; Nguyen Van Khai Email: [email protected] Ngay nhan bai: 23.12.2016 Ngay phan blen khoa hoc: 3.2.2017 Ngay duyet bai: 14.2.2017
TAP CHi Y HOC VigT NAM TAP 452 - THANG 3 • S 6 2 - 2017 10 Wie, benh kem theo, vi§m phS quan phoi. Kien
jfiitTruyen th5ng dao dye sffc khoe ctio cac em hpc nh va jpia dinh biet berih HPQ la benh man dnh, j^ng dan each phong tranh dio tre cac yeu to nguy j^lam khdi phat benh nhu": thay doi thfii tiSt, nhiem luSn duffng ho hap, khoi thuoc la, khoi than....
u.TiO'idtda: hen phe quan,'tre 6-15 tuoi, djch te hpc
^ s a n g UMMARY
EPIDEMIOLOGY CHARACTERISnCS OF BRONCHIAL ASTHMA I N CHILDREN AGED 6 : 0 1 5 YEARS I N CAT H A I ISLAND, H A I PHONG
Asthma has been increasingly under increasing of conomical-social development. A study was onducted on total of 1663 children aged 6 to 15 ears old living in all communes/town of Cat Hai
;land, Hai Phong and their parents with the alme is to ivestigate the epidemiology characterisdcs of asthma onblbuting solutions to reduce asthma. By uang a iross-sectional method, questionnaires, cinilca scaminadon to determine the prevalanc^ of asthman lased on GINA guidline for .children over 6 years and heir hikory of allergy. Data analysis was done by i^ng SPSS progam 13.0, the results showed:
jpnchialasthma rats was 8.1%, school boys asthma vas^.6 times higher than school girls, age group 6- LO year old was 9.8%, age group 10-15 year old was
>.2%. Bronchial asthma was higher at groups of louseholds using fuel (ftrewocMJ, coal, gas), poor lousing condition, tobacgo smoke; children with MTSonal history of allergy taltergic weather, sinusitis allergy, drug allergy, ft)od allergy, urticaria, rash);
^milies with a history of allergies; father (asthma, iveather allergies, allergic rhinitis, urticaria), mother [allergic weattier), siblings (astiima), grandparents
;^^ma), cousins (asthma, food allergies, allergic iVeather); children of obstetric inten/ention, asphyxia sarturition, premature birth, low birth weight; children with a history of wheezing, concurrent diseases, Dneumonia. Recommendation: Health education for :hildren and ^miiies understand about bronchial asthma is chronic condition, guide the children how to wold risk factors such as tiie onset of Illness: changes n weather, respiratory infections, cigarette smoke, xal smoke...
Keywords: bronchial asthma, children 6-15 years 3f age, clinical epidemiology
I.DATVANOE
: Hen phe quan (HPQ) la benh kha pho bien lirong cac benh du'dng ho hap tren. Theo bao cao CLia To chu'e Y te The gidi, tren toan cau co hdn 300 trieu ngu'cfi mac benh HPQ, 6-8% ngu'cfi ldn, tre em duSi 15 tuoi chiem tren 10%, u'dc tinh Sen nam 2015 con so n^y tang len den 400 trieu ngu'di. Cu* 10 nam, dp idu hanh cua benh Iai tang 20-50%, tang nhanh nhat la 20 nam vi!r^
qua, tl ie mac HPQ khac nhau d cac quoc gia, lien quan nhieu den each song, moi tru'dng song ra yeu to di truyen. 6 khu vi/c Dong Nam A-Tay
TTiai Binh Du'dng, t i le tre mac HPQ trong 10 nam (1984-1994) tang len dang ke: Nhat Ban tu' 0,7-8%, Singapore tij* 5,0-20,0%, Indonesia tii 2,3-9,8%, Philipines tu* 6-18,8%. O Viet Nam tuy cfiu^ CO thong ke day d u , nhuYig mpt so nghien CIJXI cung cho thay t i 1$ HPQ d tre em du'di 15 tuoi gia tang nhanh chong tu* 2 , 7 % (nam 1998) tang 9,3% (nam 2002), den 8,74% (nam 2006) [2]. Tai dao Cat Hai, thanh pho Hai Phong chuci CO nghien cu'u nao nghien cdu ve djch te hpc benh HPQ d hpc sinh, do vay de tai nham muc tieu mo ta dac diem dich te hpc lam sang d tre em td 6 den 15 tuoi tai dao Cat Hai, Hai Phong.
II. DOI T l / p N G VA PHirONG PHAP NGHIEN COU 2 . 1 . D d i tiTtfng, dja d i e m , thdi gian nghien cuti: Toan bp 1663 tre em td 6 den 15 tuoi sinh song tai t a t ca cac x a / t h j t r a n , dao Cat Hai, Hai Phong
-Bo hoac me hoac ngu'cfi nuoi duSng tre (bo me) cua tre thuoc doi tu'dng neu tren. Thdi gian tu" 1/9 den 30/12 nam 2013
7/iu chuan iu^ chgn: dong y tham gia vao nghien cu'u, khong mac benh tam than.
2.2. Phu'dng phap nghien ci^u
2.2.1. Thiet ke nghien cdu: Nghien cud dt ngang mo ta
2.2.2. Cd mau nghien cud
n - 7 2 P(l-P) n - £. n-a/2 j T ^ + n: c9 mau toi thieu can chpn + d : sai so mong muon = 0,02 + 2^1= 1,96 vdi a = 0,05
+ p: T i le HPQ theo mot nghien ciJu tru'dc day
=0,095 [3]
k: he so tiiiet ke mau = 1,5
Vay n=1239, vdi 1 0 % tu' choi so mau nghien CUXJ la=1377 tre. Trong nghien cdu nay chung toi lay toan bo du'dc 1663 tre 6-15 tuoi cua toan bp dao Cat Hal.
2.2.3. PhuUng phap dion mau: Do dao Cat Hai CO khoang 1700 tre tir 6-15 tm\, do vay chung toi lay het toan bp tre 6-15 tuoi tham gia vao nghien ciJtj, tong so thu thap du'dc 1663 doi tu'dng.
2.4. Phu'dng phap va cong cu t h u t h a p so li$u: Tap huan cho dieu tra vien (can bp y t e xa, can bo dieu tra co nhieu kinh nghiem lam viec tai^cpng dong) ve each phong van. Dieu tra thu' de dieu ehinh bp eong eu phong van cho phu hdp vdi thdc te.
- Kham xac dmh benh HPQ va tien su' di iJ'ng do bac sy Nhi khoa cua bp mon Nhi dai hoc Y Du'dc Hai Phong va benh vien Tre em H^i Phong dam nhiem.
VIETNAM MEDICAL JOURNAL ^"2 - MARCH - 2017
2.5. Phu'dng phap xu* 1^ va phan tich sd ligu: So lieu du'dc nhap, phan tieh tren ehu'dng trinh SPSS 13.0
III. KET QUA NGHIEN CU'U VA BAN LUiSiN Tai dao Cat Hai cd khoang 1.700 tre tuoi ti^e- 15 tiioi, nghien cuti chung toi tien hanh tren 1663 tre em td 6-15 tuoi dat ti le 97,8%, dam bao b'nh tin cay va dai dien eho cong dong.
Trong nghien cdu nay vdi tSng so 1.663 tre em du'dc chia lam 2 do tuoi: nhdm 6-10 tuoi la 1088 em chiem 65,4%, con Iai 575 em la nhdm 1,1-15 tuoi ehiem 34,6%. Nhdm 10-15 tu6i ed ti ie thap dan la do tre d do tuoi nay thu'dng di lam va ganh vac cong viec gia dinh cho bo me tai dja phu'dng hoac di ndi khae de mdu sinh cuoc s5ng.
Trong nghien cu'u nay khoang mpt nu'a so ba me
va ong bo cd trinh dp hpc van thap (du'di trupg hpe pho thong). Ty le bo me lam nghe ty do chiem da so (57,8% ong bo; 70,2% ba fnl), nghe nghiep khong on djnh se anh hu'dng den qua trinh tif van cho bo me benh nhan.
Hen phe quan la benh viem man tfnh ddiin§
ho hap pho bien tren the gid^, hau qua cua m anh hu'dng ldn tdi chat lu'dng cuoc song ciia benh nhi, gia dinh va xa hpi. Cung vdi qua trinh do thi hda va cong nghiep hoa, benh co xu hu'dng nay eang gia tang, anh hu'dng den that lu'dng eupe song cua ngu'di benh, trd thanh ganh nang eho gia dinh va xa hpi. Ti le mae HPQ tf moi vijng va moi ida tuoi la khac nhau tuy theo hoan canh dja ly, khi hau, moi tru'dng.
Bang 3.1. Tile mac hen phS'guan theo nhdm tud'i vi gidi (n=1663) Nhom
tuoi 6 - < 10
10-15 Tong
Nam 1 Nu* 1 Chung SOI tre NC
572 319 891
So HPQ 1 So tre n(°/o] NC 65(11,4) 516
22 (6,9) 256 87(9,8)" 1 772
So HPQ 1 So tre n(%) NC 35(6,8) 1088 13(5,1) 575 48 (6,2)° 1 1663
So HPQ n(%) 100 (9,2)
35(6,1) 135 (8,1)
M Ti i§ (»/o)f< ' HPQtheoff nhom tuoi
74,1%
25,9%
100,0%
Khi nghien cult ve gidi tinh tren nhieu ngu'di mac hen, nhieu tac gia trong nu'dc va nu'dc ngoai da nhan thay rang d tre du'di 10 tuoi ty le nam/nff mac HPQ la 2/1 [4]. Drazen cho rang hen d tre em nam gap nhieu hdn d nd. Den tuoi day thi ty le hen d nam va nu' la ngang nhau, sau tuoi day thi nff bj hen nhieu hdn nam [6].
Ket qua nghien effu cua chung toi phili hdp vdi cac tac gia tren va nhan thay ty le tre em nam mac hen luon eao hdn tre em nff trong ea 2 dp
^ a^b< 0,0001; OR ^'° (95%a) = 1,6 (1,1-2,4}
tuoi ma ehung toi nghien euli: tff 6-<10 tuoi, va 10-15 tuoi. Su" khae nhau nay ed the liSn quan tdi dffdng ho hap hep hdn, tang trffdng lu'c dffdng thd va cd the lu'dng IgE tang cao hrfn 6 tre em nam dan den sff tang gidi han dffdngthcf trong dap ffng vdi sff da dang cua cac yeti to nguy cd. Den tuoi day thi sff thay doi kieh thu'dc hpng chi xay ra d nam, khong cd d nff, khiencho ty le hen giO^ hai gidi la tffdng dffdng [4].
Bing 3.2. Phin bo binh hen pheauin theo die diem ho aia dinh Ho gia dinh
Nguon dun nau
Kieu nha t
Nuoic
Rdm, ra Cui Than
Ga Dien Biet thu khepla'n'
Nha khep kirf Nha khonq khep kin
Nha cap 4'' Tren tau thuyen"
ho meo Kjioi thuoc la So ngu'di trong gia
dinh
1-4 S-6
>7
Tong so 5 424 1290 1255 513 2 375 332 948 6 1179 754 927 668 68
HPQ(
n 1 48 115 107 25 0 31 15 89 0 106
96 82 49 4
11=135) Ti le (»/o)
20,0 11,3 8,9 8,5 4,9 0,0 8,2 4,9 9,4 0,0 9,0 12,7 8,8 7,3 5,9
Cn=1663) OR (95»/oCI)
2,5 (1,1-7,8) 1,7 (1,2-2,5) 1,7 (1,0-2,9) 1,3 (0,8-2,0) 0,48 (0,3-0,8) 1,0 (0,7-1,6) 0,48 (0,3-0,9)
1,5 (1,0-2,2) 1,6 (1,0-2,4)
-
3,2 (2,1-4,9) 1,2 (0,8-1,8) 1,3(0,4-4,3)
1,0 P
>0,05
<0,Ota
< 0,011
>0,05!
<0,01
<0,0S
<0,0S:<
<0,0001
\
1
1 1
>0,05'il
TAP CHiYHQCVIETNAH TAP 452 -THANGJ -Sd'2-2017
Dien tfch nha cf (m2)
<30 31-60 71-100
>100
224 1010 230 199
23 67 24 21
10,3 6,6 10,4 10,6
1,0(0,5-1,9) 0,6 (0,4-1,1) 1,0 (0,5-1,9)
1,0
>0,05 Nguon nhien lieu dun nau: Mui nong (than,
ga, mui dun nau tliffe an, miJi nffde hoa manh...) cung la nguyen nhan lam xuat hien edn kiid thd dia tie. Ngiiien cutj eua chung toi thay nguyen lieu dun nau ehu yeu ciia cac gia dinh tai day la than va ga. Trong nghien cffu nay nguy cd mac HPQ d nhdm dun rdm ra la 2,5 lan, d nhdm dun cui va dun than la 1,7 Kn so vdi nhdm khong dun rdm, dun cui va dun than ed y nghTa thong kS vcfi p < 0,05 va p< 0,01. Khdi thuoc la yeu to kich thfch quan trpng nhat d trong nha doi vdi b$nh nhSn hen, phBn Idn gay ra triSu chffng hen
d ngu^ Idn va tre em. Tlieo nghien cffu nguy cd HPQ d nhom gia dinh nay eao gap 3,2 Ian (p<0,0001). Nhff vay, tre ed nguy oS cao tiep xue vdi khdi dun va Ididi thuoc. Nhdm tre song d nha cap 4 ed nguy cd HPQ eao gap 1,5 lan so viS nhdm tre d nha khep kin (p< 0,05), nhff vay dieu kien song am tliap la yeu to thuan Idi dan den HPQ. Nghien cffu ve nuoi chd meo, nguy cd mac HPQ cao gap 1,6 lan so vdi nhdm gia dinh khong nuoi chd meo (p< 0,05). Nghien cffu khong tim thay mcu lien quan giO& ti le HPQ v ^ nhan khau va dien tich nha d (p> 0,05).
Bing 3.3. Phin bo Oen su'dl vfna d nhin d nhdm doi tWdna nahlSn dfu (n- Tien silf dj ij^g ca nhan
Tien sir di utiq Di iJnq thdi tiet Viem miji xoanq di LTnq
Di LTnq thuoc Di uTiq thu'c an Viem l(et mac di LTng
May day, san nqlj^
Cham Di ij)iq Ithac
TSng so 306 162 85 11 49 6 22
1 6
HPQ (n= 135) n
66 59 24 3 8 2 13 0 0
Ti le (%) 21,6 32,7 28,2 23,7 16,3 33,3 59,1 0,0 0,0
OR (95°/oCI) 20,2 (13,1-31,3)
10,1 (6,7-15,2) 5,2(3,0-8,9) 4,2 (0,8-18,1)
2,3 (1,0-5,2) 5,7 (0,7-36,6) 18,0 (7,0-47,0)
- -
=1663) P
< 0,0001
< 0,0001
< 0,0001
=0,05
<0,05
>0,05
< 0,0001
>0,05
>0,05
"Tien sff d| ffng ciia tre ed ien quan ehat ehe vdi ty le HPQ dJa tre" ket luan nay la nhan djnh cOa mpt so tac gia. Qua khai thae tien sff dj ihig d nhOiig tre mac HPQ, chung toi thay nhieu tre trffdc khi bj HPQ da bj mpt so benh di ffng: Viem mui xoang dj utig, may day, eczema, dj ffng thuoc, di ffng thffc an, dj ffng thdi tiet, viem ket mac dj uYig... Tien sff may day san ngffa chiem ti l | cao nhat trong nhdm HPQ (59,1%), tre cd tien sff nay se cd nguy cd mac HPQ la 18 lan. \^h|
day la m6t trong nhij'ng bi^u hien lam sang cua b$nh di ffng. Nhdm dffhg thff hai lam tang nguy cd mac HPQ d tre la nhdm ed tien sff dj ffng thdi U€t, viem k§t mac dj utig, viem mui xoang dj utig, ti le HPQ d nhdm nay chiem khoang 30%.
Nguy ai m§e HPQ d nhdm may day san ngffa la 18 lan, sau den nhdm di ffng thdi tiet (10,1 lan).
viem mui xoang di utig va viem ket mae di utig (5,2-5,7 Ian) vdi p< 0,0001. Neu mot 'ngffdi ed viem mui dj ffng khi ket hdp vci tien sff gia dinh ro thi ed the eoi viem mui di ffhg ta tien trieu cua benh HPQ [7].
Ti le HPQ d nhdm di ffng thffc an la thap nhat (16,3%), gap 2,3 lan so vdi nhdm khong ed tien sff dj ffng thffc an cd y nghla thong ke vdi p <
0,05. Nghien euU eua Phan Quang {}oan tai b|nh vien Bach Mai, hay gap nhat la viem mui dj iJng ciiiem 48,0%, may day-phij quinke 27%, dj utig thuoc 17,0%, dj ffhg tiiffc an 15,0%, eczema 1%, tuy nhien tae gia khong de cap den tf le HPQ d cae nhdm dj ffng la bao nhieu. Qua eac k€t qua tren chung tdi nhan thay mS lien he ciiat che giD^
HPQ va cae benh dj ffhg, cd dja dj ffng.
Bang 3.4. Phin bo tien stfdi &ng gia dinh dnhdm ddi tu'dng nghiSn dfu Tien sH dj iJ'ng gia dinh
B6
Co hen HPQ Di O'nq there an
Di IJ)iq thuoc Di lirnq thdi tiet Viem mui di (friq
Tong so 14 10 5 30 18
HPQ(n=135) n
14 1 0 7 5
Ti le (»/o) 100,0
10,0 0,0 23,3 27,8
P
< 0,0001
>0,05
>0,05
<0,01
<0,05
VIETNAM MEDICAL JOURNAL N°2 • MARCH • 2017
Me
Anh chi em ruot
Ong ba noi ngoai
iHo hang
l^ay day Ctiam Co hen HPO Di utiq thu'c an Di u'nq thuoc Di Unq thc!i tiet Viem mui di u'nq
May day Cham Co hen HPO Di LTnq thii'c an Di uTnq thuoc Di u'nq thdi tiet Viem mui di u'nq
l^av day Cham Co hen HPO Di u'nq thu'c an Di u'nq thuoc Di u'nq thcJi tiet Viem mui di (inq
May day Cham Co hen HPQ Di Lfnq thu'c an Di iing thuoc Di crng thdi tiet Viem mui di ifnq
May day CInam
10 2 10 12 4 6,1 38 14 3 8 6 3 22 12 8 3 30 2 5 8 11
9 3 15
7 3 8 4 2 1
3 1 2 2 0 12
8 2 1 5 2 0 4 3 1 0 8 0 0 1 3 1 2 4 4 1 3 1 0 0
30,0 50,0 20,0 16,7 0,0 19,7 21,1 14,3 33,3 62,5 33,3 0,0 18,2 15,0 12,5 0,0 26,7 0,0 0,0 12,5 27,3 11,1 66,7 26,7 57,1 33,3 37,5 25,0 0,0 0,0
<0,05
>0,05
>0,05
>0,05
>0,05
<0,01
>0,05
>0,05
>0,05
< 0,0001
>0,05
>0,05
>0,05
=0,07
>0,05
>0,05 I
<0,01
>0,05
>0,05
>0,05
= 0,05
>0,05
<0,05
<0,05
< 0,001
>0,05
<0,05
>0,05
>0,05
>0,05 Tien sii gia dinh la mot yeu to gop phan quan
trong trong chan doan i-IPQ d tre em, co l<hoang 50-75% Isenh nhi HPQ trang gia dinh co ngui&i bj hen hoac bj cac benh dj uTng l(hac. Theo l<et qua nghien cihi ciia chung lioi, 100% tre mac hen co bo HPQ (p<0,0001) trong l<hi do S me chi chiem CO 20%. Trong cac nghien cuti tru'dc day cho thay Uen sii" ben me hinh nhu' co anh hu'dng Idn hdn tien siJ ben b5 den nguy cd xuat hien hen d
tre, nhu'ng trong nghien CLTU ciia chung toi hign chu'a thay dieu nay, ma ngu'dc Iai. Tuy nhien;
chu^ phan anh du'dc day dii nguy cd di truyen-' cd dja dj LTng trong gia dinh tre HPQ do trong;
nhom tre chiing toi nghien cuti co nhlBu tre la con mpt trong gia dinh, 6 ben ong ba noi ngoai?
cd tien sir hen, ti le hen d doi tu'dng nghien cuti' chiem 26,7% tu'dng du'dng ti le mac hen d nhom ho hang co tien sir HPQ.
Bang3.5. Tien sif sin khoa vdi benh hen phe quin cda doi tuVng nghien cifu TllSn sii san khoa Tong HPQ(n=135)
Ti 16 (%) OR (95°/oCI)
Co can thiep san khoa 24 24,0 4,1 (2,4-7,0)
Ngat khi de 34,3 6,4(2,9-13,8) <0,0001
Denon
Can nang khi sinh thap (<2500 gr) 10 23
31,3 39,7
5,5(2,4-12,5) 8,8 (4,8-15,9)
<0,0001
< 0,0001 Tre CO can nang liic sinh thap va tien siJ de
thieu thang cung la yeu to nguy cd ciia HPQ.
Nguy cd mac HPQ d nhom co can nang sd sinh thap gap 8,8 lan so vdi nhdm cd cin nang sd sinh binh thu'dng (p< 0,0001). Nuoi coii bang sSa me giOp cho tre tang them sire de khang trong nam dau ddi, giam nguy cd mac cac benh Viem nhiem du'dng ho hap la mpt trong nhiJng
yeu to lam khdi phat benh HPQ. Theo ket qu cua chung toi thay cd moi iien quan giu^ HPg vdi tien sir bu me. Tre bu me du'di 12 thang tuoi cd nguy cd bj HPQ gap 1,9 lan so vdi nhom tre bii me tren 12 thang tuoi (p< 0,05). Khong co moi lien quan giCt^ an sij^ ngoai vdi ti le mac HPQ (p> 0,05)
TAP CHi Y HOC VljT NAM TAP 4S2 - THANG 3 - so 2 • 2017
Bing 3.6. Tfen stf nuoi difdng, bSnh tit vdi iienh hen phe quin cda doi ttfdng nghien dfu Tien sii nuoi du'dng,
benh tSt Bu me du'di 12 thang
An su^ ngoai Tien sir kho khe
Benh kem theo Viem amidal
Viem honq Viem mui di utig Viem phe quan phoi
Benh tat khac
Tong so 177 614 142 200 18 49 37 61 35
HPQ (n=135) n
24 51 79 71 1 2 3 60
5
Ti \& (»/o) 7,9
OR(95°/oCI) 1,9 (1,1-3,0) 8,3 1 1,0(0,7-1,7) 55,2
35,5 5,6 4,1 8,1 98,4 14,3
32,9 (20,1-51,4) 12,0 (8,1-18,0) 0,7 (0,03-4,8) 0,5 (0,08-2,0) 1,0 (0,3-3,5) 1221 (179-24052)
1,9(0.6-5,3)
P
<0,05
>0,05
< 0,0001
< 0,0001
>0,05
>0,05
>0,05
< 0,0001
>0,05 Nguy cd mac HPQ 6 nhdm viem phe quan
phoi gap 1221 lan, d nhdm ed tien sff khdng khd khe gip 55,2 lan, cd benh kem theo gap 35,5 lan so v&i nhdm tre binh thffdng (p< 0,0001). Khdng c^npi lien quan giffa Ire cd tien sff viem hong - B ^ p l , viem mui d| ffng yh eac benh khac vdi
Demi HPQ (p> 0,05). Nhiem khuan ho hap cap
^ B c o i la nguyen nhSn d3u tiSn lam phat sinh
^ ^ dac biet d tre em. Tre nhd do dSc diem sinh ly, giSiphau chu^ hoan chinh nhff khau kinh (dffdng thdihep, mong manh ciia niem mae, sff biet hda t€ bao... cijng vdi he mien djch chu^
hoan chinh la dieu kien thu$n Idi cho virus hay vi khuan xam nhSp vao du&ng ho hap. Moi trffdng song khong dam bao (ehat ehpi, khong khi 6 nhiem), cham sde y te han che la y^u td thuan Idi lam tang nguy cd mac benh. Thay doi thdi tiet lam tang do d nhiem khong khi, tiiay doi nhiet dd, dp am tao dieu kien thuan I^ cho vi sinh vat gay benh ho hap phat trien, do vay lam nSng them b8nh HPQ va cac benh hd hap khae. Nhff v§y, cd moi quan h$ diat che glDS thay doi. thdi tiM, wem dffdng ho hap va benh HPQ, Vi v3y, viec phdng va dieu trj biet de benh dffdng hd hap ed y nghla quan tnpng trong ngan chan phat sinh HPQ.
IV.KfriU^N
- t l le HPQ la 8,1%, nam cao hdn nff 1,6 lan, nhdm 6-io tuoi la 9,8%, nhdm 10-15 tuoi la 6,2%.
- Tl le HPQ eao d: Hp gia dinh sff dung nhien li@u (cui, than, gas), nha cap 4, nudi chd meo, khdi thuoc la.
Tre cd tien sff dj ffng ca nhan (dj ffng thdi ti§t, viem mui xoang dj ffng, dj ffhg thudc, dj ffng thffc an, may day san ngffa).
Gia dinh cd tfen sff dj ffng: bo (HPQ, di ffhg tiidi tiet, viem miJi di uitig, may day), me (di ffng tiidi tiet), anh chi em (HPQ), ong ba (HPQ), ho
hang (HPQ, di ffng thffc an, dj utig thdi tiet).
tre cd can thiep san khoa, ngat Idii de, de non, can nang khi sinh thap.
Tre ed tien sff kho khe, benh kem theo, viem phe quan phoi
KIEN NGHj: Truyin thdng giao due sffe khde dio eac em hpc sinh va gia dinh biet trenh hen phe quan la benh man tinh, hffdng dan each phong tranh cho tre cac yeu to nguy cd Iam khdi phat benh nhff: thay doi thdi tiet, nhiem Idiuan dffdng ho hap, khdi thuoc la, khdi than....
TAI UEU THAM KHAO
1 . Bui D6'c Du'ctng (2005), "Tlnh hinh hen phe quan cua tre dUcti 5 tuoi tai Thai Binh, Quang Tri va Binh Du'dng nam 2002", Tap chi Y hoc tht/c hanh, so 1, tr. 44-46.
2. Phan Quang fiohn, Tdn Kim Long (2006), ^^
lull hanh ciia hen phe quan trong hpc sinh mot so tru'dng hoc d Ha Ngi va tinh hinh sff dung Seretide du" phong hen trong cac doi tuWng nay", Tap chi Y hoc thffc hanh, 6. tr.15-17.
3. Khonq Thi Nqoc Mai (2011), Nohien ahi ffiut bang hen phi auan d hoc sinh ti'i'u hoc - buna hoc af sd thanh pho Thai Nquyen va hieu qua kiem soat hen banq ICS + LABA. Luan an tien sy y hpc, Tru&ng Dai hpc Y Thai Nguyen.
4. Balzano G., Fuschiilo S., Melillo G., Bonini S (2002), "Epidemiological studies of the very high prevalence of asthma and related symptoms among school children in Costa Rica from 1989 to 1998", Pedrab-Allergy Immunol., 13(5);342-9.
5. Dan Norbadt, Erik Lampa, and Karin Engvali ( 2 0 1 1 ) , " Rhinitis phaiotypes conflate with different symptom presentation and risk factor patterns of asthma", Respir Med.,105(ll):pp. 1611-21.
6. Drazen J.M. (2012), "Asthma: tiie paiadox of heterogeneity", J Allergy Clin Immunol.,129{5): pp.
7. Eriksson J., Bjerg A., Lotvaii J., Wennergren G., Ronmaric E., Toren K., Lundback B. (2001),
"Asthma and sex homiones", Allergy, 56 (l);13-20.
