TiflkP CHl NGHIEN Cl>U Y HQC
D! LFNG BLOMIA TROPICAUS VA VIEM MUI D| LFNG O QUAN HOAN KIEM VA HUYEN BA Vi
Hoang Thj Lam, Nguyfln Van Tu>6>ng Truing Dai hqc Y Ha NQI Myc tieu cua nghiin cim la xac dinh mdi lien quan giu-a di ung Blomia tropicalis vi viim mui dj img d quan Hoan Kiem va huyin Ba Vi NghUn cuu dinyc tiin hanh tren 533 ddi tuvng. tir 23 - 72 tudi. Phdng vin bd cau hdi va test lay da voi Blomia tropicalis duac thuc hiin vdi tit ca cic ddi hrpng Di dng Blomia tropicalis xay ra chu yeu d nam gioi (27,7%; 18.7%) vi ngu&i tre < 45 tudi (27,3%; 19.1%). Khdng cd su khac biit vi di ung Blomia tmpicalis giua quan Hoan Kiim vi huyin Ba Vi. Tic ngat mOi (17.4%: 7.0%).
trieu Chung viem mui di Ong 12 thing qua (27,0%; 17.4%). tinh trang viem mui di ung (30.3%; 20.7%) vi viem mui di Ong ngit quang (11,5%; 5,4%) gap nhiiu hon o nhung ddi tuQ/ng di Ong Blomia tmpicalis so v&i nhOng ngu&i khdng di ung. Su khac biit cd y nghTa thong ki, p < 0,05. Tuoi tre < 45 tudi li yiu td nguy co cua di ung Blomia tropicalis. Kit luan: Dj irng Blomia tropicalis liin quan chat che v&i viem mui di ung & hai dia bin quin Hoan Kiem va huyin Ba Vi.
Tip khoa: Dj i>ng Blomia tropicalis, viem mui di img, bg kho chipa
I. DAT
V A N 0 &Viet Nam co khi hgu ndng am mu'a nhieu.
la di^u kien ly tu'ong cho bp nhS s6ng trong bui nha phSt trien.Trong s6 e^c di nguyen du'd'ng ho hap, Viet Nam chu yeu di tJng voi bo nhci va giSn.Theo Hoang Thj L^m va cpng sy, CO d6n 2 6 % ngu-o-i d^n di Crng vai it nhSt mot loai bo nha song trong bui nha [1], Mot nghi&n ciru khac du'ae tien hanh a thanh ph6 0S lgt vd'i doi tu'ong la ngu'cri dSn ti> 5 tuoi tro len cho t h i y , 50% benh nhan hen c6 k§t qua test lay da du-cng tinh vert di nguyen du'd'ng ho h^p, trong do di nguyen hay gSp n h i t la bui nhS va gian [2]. Cae nu'O'c Dong Nam A nhu' Thai Lan va Singapore eung g§p chu y^u la di nguydn bo n h ^ [3; 4]. Oac bi$t a Singapore, hon 9 6 % benh nhan hen va viSm
Bia ch! lien h$ Hoang Thi Lam, Bo mdn Di img - Mien dich lim sang, Tmong Bai hpc Y Hi noi
Email- [email protected] Ngiy nhan-20/12/2014
Ngay duoc chap thuin: 18/5/2015
mui di irng, di tjng vdi bp Blomia tropicalis [4]
Cac nhS khoa hpe d3 ehi4t xuat du'ae it nhat l^ 30 thcinh phan protein e6 tiem nang kieh thieh qua trinh sinh khang the ti> Blomia tropicalis.Jrong dd Bio t5 la di nguyen chinh, ehiem 90% c^c tru'O'ng hp'p du'ang tinh vdi Blomia tropicalis [5]. Ho^ng Thi Lam va e6ng s y eung da x^c dinh Blomia tropicalis la di nguygn chu yeu a nhu'ng ngu'ai e6 ket qua lest da du'ang tinh vai cae di nguyen du'ang ho h§p song a npi thanh va ngoai thanh Ha Noi [6]. M6t nghien ciru khac du'p'c tien hanh tren bgnh nhan hen phg quan a Venezuela vO\ x6t nghiem test lay da v6'i cac dj nguyfin du'ang ho hap cung cho biet: 92,2% benh nhan hen, v\€m mi3i di irng, c6 ket qua test lay da du'ang tinh vd'i hoac Blomia tropicalis hoac Dermatophagoides pteronyssinus [7]. Viem mui d! Crng la b6nh thu'O'ng gap Theo to chirc y t^ the giai vao nhiJng nam 2000 tl le mSc viSm mui dj irng tr&n toan cau la 400 trieu ngu'ai, con so u-ac tinh den nam 2025 se la
TCNCYH 93 (1) - 2015
TAP CHi NGHIEN CU'U Y H(?C • 500 trieu ngu-fri. Viem mui dj irng khdng gay nguy hiem den tinh mang nhu-ng anh hu-ang d i n sire khoe, kha nSng iam vi$e va c h i t Iu'O'ng cupc song cua ngu'ai b0nh r i t \(fr\.
Theo mot nghign cu-u du'p'c tien hanh nSm 2007 a Ha NOi, c6 s y eh6nh leeh r i t Id'n giOa viem mui dj Crng giu'a n6t thanh va ngoai thanh Ha NOi quSn HoSn Kiem, ti 1$ vi6m mui dj irng la 29,9% ebn a Ba VI la 10% [8]. ViOm mOt di irng hen quan chat che d i n cac y i u to mdi tru-d-ng cung nhu- thanh phan di nguySn c6 trong mdi tru'dng song do. Chinh vi v^y Chung tdi tien hanh de tai nay vd'i muc tieu xac dinh m i l hen quan giOa Blomia tropicalis va vidm mui dj irng a quan Hoan K i i m va huydn Ba Vi.
II. PHU'aNG PHAP NGHIEN CLPU
1. Ddituv^ng
Boi tu'ong nghidn eCru la nhO'ng ngu'di tuoi tir 23 den 72 tuoi, s i n g tgi qugn Hoan k i i m va huydn Ba vl, du'p'c lya chpn n g l u nhidn tir danh sach 5782 ngu'di da tham gta nghidn cCru d i i u tra theo bd edu hdi ve eac benh hd hap tCr nam 2007 d i n nam 2008 [8; 9).
2. Phu'O'ng phap
Day la nghien ciJu c i t ngang tgi thdi diem tCr thang 3 nSm 2009 den thang 4 ndm 2010
2.1. Cvmau va each chgn mau S6 lu'ong d i i tu'O'ng tham gia nghidn ci>u du'ae tinh toan b i n g cdng thirc u'dc lu'ong tl Id cho mdt quan t h i -
N = Z\a,2 P (1 - P)
Trong dd'
N: kich thu'de m i u ; Z: he so tin cdy d; sai so tuydt doi chap nhan d< 0,1; p- t? Id u'dc
luong sd ngu-di bi qud mdn trong q u i n th^
nghidn ciru trwde.
Theo tinh todn thi c d m i u cua chOng tdi la g i n 700 ngu'di, tuy nhidn de tang tinh tin cay eua nghien ciru, chung tdi tdng c d m i u 1 ^ g i p ddi, nhu" vdy c d m i u c i n t h i i t cua chitng tdi Id khoang 1500 ngu'di.
2.2. Cach tien hanh
c a c d i i tu'Q'ng nghidn a>u se du'pc mtn den cdc tram y t i dia phu-ang d i du'ae phong v i n theo bd cdu hoi vd t h y c hidn test lay da Bd edu hoi du'gc thiet k i d y a trdn bd cdu hoi eua ede nghidn ciru q u i c t i da du'ae thyc hiOn tgi eac nu'de chau Au. Test l i y da diroc t i i n hanh vdi di nguydn Blomia tropicalis, d nhCrng ngu'di du'di 60 tuoi. Xet nghidm se du'p'c cac bde sy va y td bo mdn Di irng - M i i n djeh lam sdng, trudng Dgi hpc Y Hd nOi thyc hidn. Test lay da du-crc coi Id du'ang tinh khi kich thu'de san phu so vdi ehirng am tinh
^ Smm, du'p'c do sau khi l i y da 15 phut 3. XtP ly s d lieu
So lieu du'gc xu" ly bdng p h i n mem PASW version 18.0 vdi cac thudt todn sir dung: ^ de so sanh cac ti Id, p < 0,05 du'p'c coi la cd y nghla thong kd
4. Dao d i r e n g h i e n cOu
Nghidn eiru khdng thu-c hidn b i t ky mdt thu thudt nao gdy ra cac tai bien ndng n i , gdy nguy h i i m cho tinh mang bdnh nhdn. Mac d£i vdy, ede doi tu'gng tham gia nghidn ei>u se du'ae giai thieh vd ky thudt cung nhu" tai bien cd t h i xay ra Bdnh nhdn toan q u y i n tCr choi tham gia nghidn cii-u md khdng c i n giai thich ly do Nhan vidn y te se tu- van day du v i hien tu'gng b$nh t$t cho ngu'di bgnh. n i u ed bat thu'dng ve k i t qua chirc ndng hd h i p . Trong qud trinh xu" \'if so lidu, hodc ddng bdo, cdc thdng tin v i ngu'di b^nh d u o c md hoa, ndn
4 T f P CHi NGHlfiN CU'U Y HQC khdng ai biet b i t cCr thdng tin nao ve ngu'di bdnh, ke ca nhdm nghidn cu-u.
III. K^T QUA
1. Mdi lien quan giu'a dj ii>ng Blomia tropicalis vdi cac y l u td nhan k h i u HQC Bang 1. Mdi lien quan giu'a dj ijng B/om/afroprca//s vdi gldi tinh, tuoi, vd djadu"
Nam NO' Hoan
Kidm B a V i < 4 5 tudi
Diirnga/rop/ca//s 27,7% 18,7% < 0,05 22,9% 22,9% > 0,05 27,3% 1 9 , 1 % 0,05
Cd 533 ddi tu'gng tham gia nghidn ciru, nam gidi dj dng vdi Blomia tropicalis n h i i u han h i n so vdi nO- gidl (27,7%; 18,7%; p < 0,05) va nhCrng ngu'di tre s 45 tuoi d| u'ng vdi Blomia tropicalis nhieu hgn so vdi nhu'ng ngu'di > 45 tuoi (27,3%; 19,1%, p < 0,05). Khong cd s y khae bidt v i di img Blomia tropicalis giCra qugn Hoan K i i m va huydn Ba VI.
2. Mdi lien quan giO>a di v n g Blomia tropicalis vdi cac tri^u chipng vidm mui dj u'ng
30.0%
25.0% •
20.0% - B
iihV h 1
ChSy Tac ngat NBiri Trieu m u i m u i kem ehirng vrvlDU 12 t h i n g
qua
• Di irng B. tropicalis
Hinh 1. Mdi lien quan giiPa dj u'ng B. tropicalis va viem mui dj u>ng Cac tneu ehirng cua vidm mui dj Crng nhu- ehay mOi (17,6%; 13,6%), t i c nggt mui (17,4%, 7,0%), ngiii kem (14,1%; 8,8%) vd trigu chCrng viem mQi dj irng 12 thang qua (27,0%; 17,4%) deu cao hon d nhu'ng ngu'di c6 test lay da duang tinh vdi Blomia tropicalis. Tuy nhidn s y khdc bidt ehi CO y nghta thong ke vdi trieu chCrng t i c nggt mut vd tridu ehirng vidm mui dj irng 12 thang qua, p < 0,05.
TCNCYH 93 (1) - 2015
TJ^P CHi NGHIEN c i r u Y HQC -
3. M6i lien quan giira cac t h e Idm sang cua vidm m u i d i i j n g t i n h t r a n g d j i>ng Blomia tropicalis
35.0-,.
30.0%
25 0"-;
20.0"-,.
15.0", 10 0 , 5.0"-, 0.0"-,.
P
WWB i^WSoB Viem nun
di UTij.'
< . • • •
im
Vicni piiui di irn?
n.ai
^
Viem nun diirn:- ddi danji
Diung B. tropitjli
• Khon^
Hinh 2. Mdi lien quan giOa cac thd lam s a n g cua v i e m m u i d | Ong va d j i m g B. tropicalis Vidm mui di Crng (30,3%; 20,7%) va viem mOi dj Crng n g i t qudng (11,5%, 5,4%) cao hon hdn 6 nhCrng ngu'di cd dj irng vdi Blomia tropicalis. Tuy nhidn khong cd s y khdc biet giira tinh trang d irng Blomia tropicalis hay khdng dt dng d nhirng ngu-di mdc vidm mui dj irng dai ddng.
4. Phan t i c h hoi quy da b i i n
Bang 2. Phan t i c h hdi quy da bidn
Gidl tinh Dja du' Hut t h u i c Id Tuoi
Bidn ddc lap
Nam gidi Hoan Kiem Bang hut thudc id s 45 tuoi
Bien phu OR 1.218 1.014 1.612 1,732
t h u d c dj Lpng B.tropicalis 95% Cl 0 , 6 7 1 - 2 . 2 1 0 0 , 6 5 6 - 1 , 5 6 7 0.875 - 2,972 1,140-2,632
Nhin vao bang 2 ta t h i y tuot tre £ 45 tuoi la y i u to nguy eo eho di irng Blomia tropk:alis, OR 1,732 95%CI (1,140 - 2,632).Gidi tinh nam, song d Hoan k i i m hay tinh trang hOt t h u i c ta deu khdng phat la y i u t6 nguy c o cho tinh trang di irng vdi Blomia tropicalis.
IV. BANLUAN
nghidn cdu tren gdn 10000 ngu'di bang each Theo nghien ciru ndy, nam gidi va nhdng thu-c hien test lay da vd phong v i n theo b6 ngu'di tre tuoi di irng vdi Blomia tropicalis cdu hoi. Trong nghidn eiru ndy, ti Id di dng vdi nhieu hon hdn so vdi nCr gidi vd nhO'ng ngu'di Blomia tropicalis id cao n h i t vd chij y i u gdp d
> 45 tuoi Dieu nay phu hap vdi cae nghidn ngu'di tre, nam gidi [10] Di dng Id tinh trang ciru khac [1;10]. Gabriel JS dd tidn hdnh co (Sa xay ra chu y i u d ngudi tre tuoi. Mdt s i
• TAP CHi NGHIEN CO'U Y HQC bgnh nhan khdng cdn dj dng khi ldn Idn, cho
du liic cdn nhd hp cd tinh trgng dj dng. Vi du, da phan tre dj dng vdi s&a bd se het di li'ng sda khi tre ldn 5 t u i i C o che cua tinh trang ndy hi0n nay chu'a rd, nhyng theo r i t nhieu nghidn c d u , di dng da phan xay ra d tuoi tre
ChCing toi khdng quan sdt thay s y khac bigt ve ti Id dj irng Blomia tmpicalis gida ndng thdn vd thanh thj, cu the Id gida qudn Hodn Kiem va huydn Ba Vi. N h i i u nghien c d u cho t h i y ti lg dj dng d ndng thdn thudng thap han so vdi thanh thi, ed the do tinh trang d n h i i m d ndng thdn t h i p han.B/om/a tropicalis Id mdt loai bg kho chda, mac dCi t i n tai trong nhd, trong phdng ngu, nhung mgt dp cua bp ndy cao hon d nhO'ng noi chda ngu c6c. Cd the d ndng thdn, h i u nhu gia dinh nao eung tich tru ngO e i e trong nha ndn mgt do bp Blomia tropicalis cao hon so vdi thdnh thj. Tir dd ddn den tinh trgng qua mdn vdi bp Blomia tropicalis cao d ndng thon.Tuy nhien dd cQng chi Id gia thuyet cua chung tdi. De xdc djnh dieu nay, cdn cdc nghien c u u sdu hon nua v i v i n de nay.
Cdc tneu ehirng cija vidm mui dj dng eung nhu cdc t h i lam sang cua vidm mOi dj dng d i u gap eao hon d nhdng n g u d i di irng vdi Blomia tropicalis. mac dii ed hogc khdng ed y nghTa t h i n g kd. Trieu chdng chay mui va ngui kdm khong cd s y khdc bidt cd y nghla t h i n g kd giO'a 2 nhdm c6 va khdng cd dj dng vdi Blomia tropicalis Cd le chay mdi Id tridu chdng rat hay g^p d midn B i c Viet Nam do t h d i tiet thay doi t h i t t h u d n g Ddc biOt dd am eao nen virus, vi k h u i n , n i m m i e dd phat trien vi the ede bdnh vidm mui do nguyen nhdn nhidm trung n h u cam lanh V v... cung xay ra vdi ti Id khd eao. Chlnh vl vgy ehay mOi khdng chi do nguydn nhdn di dng ndn chung tdi khdng quan sdt thay s u khac bidt cd y nghTa thong kd. T u o n g t u , ngCri
kdm cQng la tndu chung cua mdt tinh trgng vidm mui kdo ddi ho$c vidm xoang kdo ddi.
Md hai tinh trang ndy cung Id hdu qua eua nhieu bOnh ehd khdng phai ehi ed vidm mOi di dng. Dieu ndy cung phii hgp vdi k i t qua nghien cdu sau dd kht vidm mQi dj dng dai d i n g cOng khdng cd s y khdc bidt cd y nghTa thong kd gida nhdm dj Crng vd nhdm khdng di dng vdi Blomia tropicalis.
T i c nggt mui, tridu chdng vidm mOi di Crng 12 thdng qua va vidm mui di dng n g i t qudng ed ti Id cao han d nhdm di ung Blomia tropicalis so vdi nhdm khdng dj ung, s y khde bidt ndy cd ^ nghTa thong kd vdi p < 0,05. K i t qua ndy phCi hgp vdi k i t qua cua cac nghidn cdu khde d Singapore, Hong kdng [4; 5]. Mdt nghien cdu khac a dao Canary, Tdy ban nha cQng cho k i t qua tuang t y khi nhdng bdnh nhan cd tinh trang vidm mui d| ung k i t hop chat che vdi hidn t u o n g dj dng Blomia tropicalis khi ldm test l i y da [10]
T d k i t qua phan tich hoi quy da b i i n ta t h i y , tuoi tre £ 45 tuoi la ydu to nguy ca cho tinh trgng di dng vdi Blomia tropicalis sau khi loai bd cac yeu to nhidu. K i t qua ndy phu hgp vdi cde nghidn c d u trong vd ngodi nude [3; 6; 7]. Trong nghien c u u cua chung tdi, mac du nam gidi ed ti Id di ung vdi Blomia tropicalis eao hon h i n so vdi n d gidi, s y khac bidt nay cd y nghTa t h i n g ke nhung nam gidi khdng phai Id y i u to nguy eo cua dj dng Blomia tropicalis (theo k i t qua cua bang 2). Vidt Nam Id n u d c cd ti lg hut thuoc Id khd eao, tuy nhidn hut thuoc la cung khdng phai Id y i u to nguy co cua di ung Blomia tropi- calis Nghidn c d u eua ehung tdi thuc hidn nam 2010, ICie dd lenh cam hut thuoc Id d nhdng nai edng cdng chua ed hidu lue ndn t i t ca mpi ngudl d i u t i i p xCic vdi mdi trudng khdi t h u i e Id, vl vdy s y khdc bidt khdng cd y nghTa thdng kd gida nhCrng ngudi cd hCit
TCNCYH 93 (1) - 2015
TAP CHi NGHIEN CtPU Y HQC • thuoc Id vd nhdng ngudi khdng hut thuoc Id.
Chinh vi t h i ndn hCit thuoc Id khdng phai Id y i u td nguy c o cua dj dng Blomia tropicalis trong nghidn edu cua chiing tdi.
V. K£T LUAN
- Di dng Blomia tmpicalis xay ra chu y i u d nam gidi (27,7%; 19,1%) vd ngudi tre < 45 t u i i (27,3%; 19,1%).
- Cdc trigu Chung viem mui di ung nhu tdc nggt mOi (17,4%; 7,0%), tridu chdng viem mui dj ung 12 thdng qua (27,0%; 17,4%), tinh trang vidm mui di ung (30,3%; 20,7%) va vidm miii di dng n g i t quang (11,5%; 5,4%) gdp nhieu hon d nhdng ddi tugng di dng Blomia tropicalis so vdi nhdng ngudi khdng dj ung.
- Tuoi tre < 45 tuoi la yeu t i nguy eo cua di ung Blomia tropicalis.
Lo'i cam vn
Chung tdi xin cam o n cae y td vd bdc sy trong nhdm nghien cdu, nhdn vidn trgm y te huyen Ba VI, va qu§n Hodn K i i m d5 giup 6a tdc gia hodn thanh sd lieu Cam an ngudi ddn huydn Ba Vi vd quan Hoan k i i m da tham gia vdo nghien cdu.
TAI LIEU THAM KHAO
1 . Ldm HT, Ekerljung L, Berg A et al (2014). Sensitization to airbome allergens among adults and its impact on allergic symp- toms; a population survey in northern Vietnam Clin TransI Allergy. 4(1), 6.
2. Sy DQ, Thanh Binh MH, Quoc NT, Hung NV et al (2007). Prevalence of asthma and asthma-like symptoms in Dalat Highlands, Vietnam. Singapore Med J. 48(4), 294 - 303.
3. Prasamphanich T, SJndhurat S (2005).
Sensitization to common indoor allergens and Its association with allergic diseases in Tha female high-school students.Ped/atr Allergy Immunol, 16(5), 402 - 407.
4. Chew FT, Lim SH, Goh DY et al (1999).
Sensitization to local dust-mite fauna in Singa- pore. Allergy, 54, 1150 - 1 1 5 9 .
5. Sun BQ, W u A, Chan A et al (2004).
House dust mite allergen ( D e i p l and BlotS) levels in asthmatics' home in Hongkong. Chin M e d S c i J , 19(3), 1 8 5 - 1 8 8 .
6. Lam HT, Tuong NV, Lundback B, Ron- mark E (2011). Storage mites are the mam sensitizers among adults in northern Vietnam:
results from a population survey.Allergy, 2011 66(12), 1 6 2 0 - 1 6 2 1 .
7. Puccio FA, Lynch NR, Noga 0 et al (2004). Importance of including Blomia tropi- calis in the routine diagnosis of Venezuelan patients with persistent allergic symptoms.
Acta allergologica, 59(7), 753 - 757.
8. Lam HT, Ekerljung L, Tuong NV et al (2011). Allergic rhinitis in northem Vietnam increased risk of urtjan living according to a large population survey.Clin TransI Allergy.
1(1). 7.
9. Lam HT, Ronmark E, Tuong NV et al (2011). Increase in asthma and a high preva- lence of bronchitis: results from a population study among adults in urban and rural Viet- nam Respir Med. 105(2), 177 - 1 8 5 .
10. Gabriel JS, Pedro CN, Orlando AF et al (2012). Prevalence of sensitization to Blomia tropicalis among young adults in a temperate climate. J Asthma. 49(4), 49 - 54.
• TiBiP CHf NGHIEN CI>U Y HQC Summary
ALLERGIC SENSITIZATION TO BLOMIA TROPICALIS AND ALLERGIC RHINITIS IN HOAN KIEM AND BAVI DISTRICT The purpose of the study is to explore the relationship between allergic sensitization to Blomia
tmpicalis with allergic rhinitis in Hoankiem and Bavi district. The study was conducted with 533subjects between 23 - 72 years old. Structured interview, skin prick test with Blomia tropicalis were performed in all participants. Allergic sensitization to Blomia tropicalis was more common among male (27.7%; 18.7%) and young age < 45 years(27.3%; 19 1%). Stuffy nose (17.4%;
7 0%), 12 months allergic iliinitis (27%; 17.4%), allergic rhinitis (30.3%; 20.7%), intermittent aller- gic rhinitis (11.5%; 5.4%) were strongly associated with allergy to Blomia tropicalis with p < 0.05. Age under 45 years was a risk factor of allergic sensitization to Blomia tropicalis.
In conclusions Allergic sensitization to Blomia tropicalis was significantly associated with allergic rhinitis.
Keywords: Blomia tropicaiis sensitization, allergic rhinitis, storage mites
TCNCYH 93 (1) - 2015
