NGHIEN CUU KHOA HOC
TiNH HINH, D A C OIEM LAM SANG, C A N LAM S A N G BENH VAY NEN d TRE EM DIEU TT?I NOI TRU TAI BENH VIEN DA UEU TRUNG UONG
Le Thj Trang*, Pham D a n g Bang*
TOMTAT
Muc tiiu: Nghiin cdu dugc tien hdnh nhdm khdo sat tinh hmh, ddc diem Idm sang va can lam sang benh vdy nen 6 tre em dieu tri ngi tru tgi Benh vien Da liiu Trung uang.
Doi tMng vd pbiftttig phdp ngbien cdu: Doi tugng Id tdt cd cdc ho sa binh dn cija cdc binh nhdn vdy nen dudi 15 tuoi do ro vien td thdng 1/2007 den het thdng 12/2012. Phi/ang phap nghiin cdu md ta cdt ngang, nghien cdu hoi cdu.
Ket qud: CO 70 ho sa benh dn cua 48 benh nhan vay nen dudi 15 tuoi dieu tri npi tru trong thdi gian tren.
Co 87,5% trudng hgp khdi phat binh trudc 10 tuoi. Tyle nam, nd mac benh Id nhu nhau. The binh Idm sdng thudng gap nhdt la vdy nen the mu, chiem 56,3%. Co 60,4% trudng hap dugc lam smh thiet da chdn dodn xdc dinh binh.
Ket lugn: Benh vay nen chiem ty li thdp d tre em. Ty le tre trai vd tre gdi mdc benh la nhu nhau.
Tit khda: vay nen, tre em.
I.DATVAND£
Benh vay n^n tUong ddi it gap d tre em.
Thuong t o n cd ban la nhdng dat d d cd vay trang n h u nen. Trong mpt so trUdng h p p benh cdn bieu hien t h u o n g t o n d m d n g , khdp, niem mac.
Mac d i l da dupc nghien cUu tU lau, tuy nhien cho den nay can sinh benh hpc cua benh v l n cdn nhieu dieu chda ddpc sang t d . Oa so tac gia cho rSng vSy nen la benh roi loan mien djch cd yeu t d di truyen.
B^nh v^y nen 1^ benh da man t i n h , tai phat nhieu deft. Khdi phat benh cang sdm t h d i gian
'DgihQcYHdNpi
Phdn bi$n khoa hoc: PGS.TS Nguyin Hdu Sdu
chju anh hudng cua benh cang dai. Benh khdng anh hudng den sdc lao dpng nhung anh hudng rat nhieu den chat lUpng cupc song, dac biet la tam If d tre em. Cho den nay, da co rat nhieu cdng trinh nghien cdu benh vay nen d nudc ngoai va Viet Nam, tuy nhien cac nghien cdu benh vay nen d t r e em cdn rat ft. 6 V i e t Nam chda cd t h o n g keday du ve benh vay nen d tre em.
Vi vay, chung tdi thuc hien de tai nay nham hai muc tieu:
- Khdo sat tinh hinh, ddc diem Idm sang benh vdy nen dtre em.
- Khao sdt dac diem cdn Idm sang benh vay nen dtre em.
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2. DOI TUONG VA PHUONG P H A P NGHIEN CLTU Nghien cUu dupc tien hanh tai Benh vien Da li^u t r u n g UOng. Q6\ tUOng la 70 ho so benh an cua benh nhan vay nen dudi 15 t u o i dupc chan doan vay nen tai Benh vien Da li^u Trung dong, da ra vien t d 1/1/2007 den 31/12/2012. Thdc hien nghien cdu hoi cdu, mo ta cat ngang. Cac t h o n g tin t h u thap t h o n g nhat theo m l u bao g o m cac
t h d n g t i n hanh chinh (ten, t u o i , gidi), dac diem lam sang (ngda, t o n t h u o n g da, m d n g , khdp, niem mac) va cac dac d i e m can lam sang (sinh thiet da, cac bien doi t r o n g cdng t h d c mau, sinh hda mau).
Cac sd lieu t h u t h a p d u p c nhap va x d ly tren phin m e m SPSS 16.0, cac bien d j n h t i n h dUpc mo t^
d u d i dang %, cac bien d i n h Idpng d u p c mdtadi/S dang t r u n g binh ± dp lech.
3. K^T QUA
3 . 1 . T m h hinh, dac cTiem lam sang benh vay nen d t r e e m 3.1.1. Tuoi khdi phdt
Bdng 3.1. Pbdn bo theo tuoi khdi pbdt Idn ddu (n=48)
Tuoi khdi phat So ii/ong
Ty le %
< 1 t u o i 11 22,9%
1 - 5 15 33,3%
6 - 1 0 15 31,2%
11-15 6 12,5%
Tong 48 100%
Nhan xet:Tudi khdi phat benh cao nhat d n h d m t u d i 1-5 t u d i (33,3%).
3.1.2. Gidi
Bdng 3.2. Phdn bo tbeo gidi tinb Gidi tinh
Nam NO Tong
Sd benh nhan 24 24 48
T y i e % 50%
50%
100%
Nhan xet: Tyle nam gidf va n d g i d i mac benh la n h d nhau.
3.1.3. Ty le benb vdy nen dtre em
Bdng 3.3. Ty le benh vdy nen d tre em So lUtft BN vay nen tre e m so vdi
Tong so luot BN vay nen Tong so luot BN da lieu Tong so lifot benh da lieu d t r e em
So lucrt BN/tong so luot BN 70/2161 70/9977 70/1666
Ty le % 3,24%
0,70%
4,2%
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NGHIEN CUU KHOA HOC
3.1.4. Pbdn the ldm sdng
Bdng 3.4. Phdn the Idm sdng (n=48) The benh vay nen
The gipt The d o n g tien The mang The m u n mu toan than The do da toan than
n 1/48 2/48 14/48 27/48 4/48
T y l e % 2 , 1 % 4,2%
29,2%
56,3%
8,3%
Nhan xet: vay nen t h e mun mu toan than chiem t y le cao.
3.1.5. Thuang ton trong benb vdy nen
Bdng 3.5. Tbuang ton trong benb vdy nen Trieu chuTng lam sang
NgCfa Thuong ton d d a T h u o n g t o n m o n g Thuong ton khap Thuong ton niem mac
So benh nhan 33 48 12 2 3
Ty le % 68,8%
100%
25%
4,2%
6,2%
Nhan xet:ThdOng ton da g a p d t a t c a cac benh nhan vay nen.
Bang 3.6. Dac diem thUOng ton da (n=48) ThUtfng ton da
So luot benh nhan Ty le %
Dat do 48 100%
Co vay 48 100%
IVIun mij 27 56,2%
Nhan xet: 100% benh nhan cd bieu hien t h u o n g t o n dat do d d a . Bdng 3.7. Vi tri thUang ton da xudt hien ddu tien (n=48)
V| tri
n
%
D a y
13 27,1
IVIat
4 8,3
Co
1 2,1
Ngiic, bung 2 4,2
LUng, mong 1 2,1
Tay
3 6,2
Chan
3 6,2
Toan than 9 18,8
Khong ro 12 25,0
Tong
48 100 Nhan xet:ThUong tdn da xuat hien lan dau tien gap nhieu nhat d d a dau.
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Bang 3.8. Dac diem thUdng t o n d m o n g (n=12) STT
1 2 3 4 5 6 7 B 9
Dac diem t o n t h u o n g mong Day m o n g
Nga mau vang Cham 16m mat m o n g De m u n
Loan d u d n g m d n g Mat m d n g Mat t r o n g
D u d n g ke t h e o chieu dpc Bong m d n g b d t u d o
So lucrt benh nhan 8 5 3 2 1 1 0 0 0
T y l e % 67,7%
41,7%
25%
16,7%
8,3%
8,3%
0%
0%
0%
- ThUdng ton khdp: cd 2/48 benh nhan bieu hien dau khdp, n h d n g khdng cd t r d d n g h o p nao bieu hien sung, nong, do, bien dang khdp.
- Niem m a c : c d 3/48 benh nhan bieu hien thUOng t d n niem mac: sung huyet ket mac, mieng cogiS mac, ludi c d d a m rop trang, niem mac sinh due t r p t va tiet djch.
3.2. Dac diem can lam sang
Bdng 3.9. Tyle benh nbdn dugcsinh tbiet da cban dodn vdy nen (n=48)
Sinh thiet da Cd Khong
Tong
So benh nhan 29 19 48
Ty le % 60,4%
39,6%
100%
4. BAN LUAN
- Tuoi khdi phat: Ket qua nghien cdu cua chung toi cho thay t u o i khdi phat benh lan dau tien t r o n g khoang 10 ngay t u o i den 12 t u o i , t r o n g do chiem t y le cao nhat la 1-5 t u o i (33,3%), cd tdi 87,5% t r u d n g hop khdf phat benh trUdc 10 t u o i . Op t u o i khdi phat t r u n g binh la 4,64 ± 4,01 t u d i .
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- Gidt: Ket qua n g h i e n c d u t h a y d tre em ty le bi b e n h vay nen t h e o gidi la n h u nhau, c6 24 benh nhan nam va 24 b e n h nhan nd, t y le nam/
n d = 1/1. Ket qua cua c h u n g t d i p h i i hdp vdi cac tai lieu da ghi nhan ve t y le b e n h vay nen d nam gidi va n d gidi la n h u n h a u . Tuy nhien, ket qua n g h i e n cUu cua c h u n g t d i cd sd khac biet so vdi m p t sd b a o c a o t r u d c . Stefanaki (2011) thay nam gidi mac b e n h nhieu h o n nda g i d i , t y le nam/niil la 1,4/1 [1], Sheyhan {2006} lai t h a y rang benh vay nen gap d tre gai nhieu h o n , t y !e nam/nQ la 1/1,65 [2],
- Ty le benh vay nen or t r e e m : Trong thdi gian c h u n g t d i t h d c hien de tai cd 9977 Iddt benh nhan dieu t r i npi t r u tai Benh vien Da lieu t r u n g UOng d tat ca cac Ida t u d i , bao g d m tat c5 cac benh ve da. Trong so nay cd 2161 Idpt benh nhan vay nen. Cd 70 Idot b e n h n h a n vay nen dUdi
NGHIEN CUU KHOA HOC
15 t u d i ( g d m tat ca cac the), chiem 0,7% t o n g sd Idpt benh nhan da li^u, chiem 3,24% t o n g so Idpt benh nhan vay nen dieu t r i ndi t r u d v i e n . Ket qua nay cua chung tdi tUOng dUOng vdi ket qua cua Parisi (2013), t y le benh vay nen tre em dao d p n g t d 0% (Dai Loan) den 2 , 1 % (Y) [3]. Neu chi tfnh neng d tre dUdi 15 t u d i t h i cd 1666 lUpt benh nhan (bao g d m tat ca cac benh da), t r o n g do cd 70 lupt benh nhan vay nen, chiem 4,2% t o n g so cac benh da d tre em d u d i 15 t u o i . Cd t h e thay rang benh vay nen kha t h u d n g gap d t r e em dudi 15 t u o i .
- Phan t h e lam sang: Co 48 benh nhan vay nen dddi 15 t u o i dieu tri ndi tru t r o n g v o n g 6 nam (2007-2012). Phan t h e benh vay nen theo t i n h chat va dac diem lam sang, chiing t o i thay: Vay nen t h e m u n m i l toan than (56,3%) la t h e benh chiem ty le cao nhat t r o n g cac t h e benh vay nen d tre e m , tiep den la vay nen t h e mang 29,2%, the do da toan t h a n 8,3%, t h e d o n g tien 4,2%, t h e giot 2 , 1 % , khong cd trUdng hop nao duoc ghi nhan d t h e vay nen t h e khdp, vay nen the dao nguoc So vdi cac nghien cdu trUdc day ve benh vay nen d tre e m , ket qua ciia c h i i n g toi co sU khac biet. Trong nghien cdu ciia Sheyhan (2006) 83,6% vay nen the t h d n g thUdng, 13,1% t h e m u n m i l va 3,3% t h e do da toan than do vay nen [2].
Nghien cdu ciia Fan (2007) co 68,6% vay nen t h e mang, 28,9% vay nen t h e giot, 1,1% t h e m u n m i l va 1,4% the d d da toan than [4]. Nghien cdu cua Kwon (2012) cho thay t h e benh chii yeu la vay nen t h e m i n g (67,3%) [5], nghien cdu ciia Kaur (2008) cung cho ket qua the benh t h e mang la chii yeu (70,8%) [6]. Sd khac biet nay cd t h e la do benh nhan vay nen d nudc ngoai da phan nhap vien dieu tri, t r o n g khi d Viet Nam da phan dieu tri ngoai tru hoac dieu t n d tuyen dUdi, nhdng trUdng h p p dieu t n npi t r u tai benh vien Da lieu
t r u n g u o n g - mdt benh vien dau nganh da li^u, chu yeu la n h d n g benh nhan nang, nhat la vay nen t h e m u n m i i toan than la mot t h e benh nang.
- Thuang t d n trong benh vay nen: Thuong t o n d da la thUOng t d n co ban t r o n g benh vay nen, vdi dac diem dat do cd vay trang phfa tren, kem theo m u n mu trong mdt sd trUdng hpp.
Trieu chdng dat do, cd vay phfa tren gap d 100%
benh nhan. Day la trieu chdng kha dac trUng de chan doan benh tren lam sang. Vi trf t h u o n g t o n da t r o n g nghien cdu cua chiing tdi phan bd khap c o t h e . V i trf t h u o n g ton da xuat hien lan dau tien t r o n g nghien cdu ciia chiing toi cao nhat la d da dau gap d 13/48 benh nhan (27,1%). Ket qua ciia chiing toi phu hpp vdi cac nghien cdu trUdc cho rang vj trf thUOng tdn xuat hien dau tien t h u d n g gap nhat ia da dau. Nhu vay, da dau la vi trf xuat hien thUOng ton da dau tien thUdng gap t r o n g benh vay nen.
T h u o n g ton m o n g t r o n g benh vay nen co t h e gap m o n g nga mau vang, be mat m d n g cd cac cham 16 ro tren be mat, m d n g day va de m i i n , CO t h e gap b o n g m d n g b d tU do, loan d u d n g mong. Trong nghien cdu cua c h i i n g t o i , t h u o n g t o n m d n g gap d 12/48 iupt benh nhan, chiem 25% Ty le nay t h a p hon so vdi cac tai lieu trUdc day la 30-40% [7], 3 0 , 1 % d Malay den 47,25% d Trung Quoc t r o n g nghien cdu ve benh vay nen tre em chau A ciia Chandran (2012) [8]. Thuang ton m d n g la bieu hien lam sang duy nhat giup phat hien cac benh nhan vay nen cd nguy co bi viem khdp t r o n g tdOng lai [9]. Vi vay, can kiem soat va dieu tri t o t cho nhdng tre bi vay nen co ton t h u o n g m d n g nham han che nguy cO viem k h d p t r o n g tdOng lai.
Thuong ton khdp gap d 2/48 benh nhan (4,2%), bieu hien dau khdp d benh nhan vay nen the mil va the do da toan than la nhdng the benh
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nang.Tuy nhien, khdng cd trUdng h p p nao cd bieu hien t o n t h u o n g k h d p t h U c s d v a k h d n g cd t r u d n g h p p nao dupc chan doan vay nen t h e khdp.
T h u o n g t o n niem mac t r o n g nghien cdu cua chung tdi g a p d 3 benh nhan, chiem 6,3%, n h d n g khac vdi cac t h u p n g t d n da dUpc mo ta t r o n g cac tai lieu trudc. T h u o n g t d n d u p c g h i nhan bao g o m sung huyet ket mac mat, mieng cd gia mac, ludi cd dam rdp trang, niem mac sinh dye t r p t va tiet dich
- Mo benh hoc: Hinh anh mo benh hoc dac trUng t r o n g benh vay nen la ldp sUng day co hien t u o n g a sdng, ldp hot bien mat, ldp gai m d n g , mam lien nhu dai ra, va cd vi apxe fVlunro t r o n g ldp gai. Hinh anh m d benh hpc la tieu chuan chan doan xac dfnh benh vay nen, giiip khang dinh benh vay nen t r o n g m d t so t r u d n g hpp t h u o n g ton da khdng dien hinh, hay chan doan phan biet benh vay nen vdi cac benh da khac. Ket qua nghien cdu cua chiing toi cd 29 benh nhan t r o n g t d n g sd
48 benh nhan d d p c lam sinh t h i e t da khang dmh benh vay nen, chiem 60,4%. D d la n h d n g trudng h p p benh nhan den vien dieu tri lan dau.Ty le nay t h a p la do dac d i e m lam sang ciia benh vay nen kha dien hinh d i i de chan doan. Tuy nhien, chan doan m d benh hpc van la tieu chuan quan trpng de chan doan xac dinh b e n h , dac biet t r o n g nhflng t r u d n g hdp khd.
5. KET LUAN
- Benh vay nen chiem t y le 4,2% cac benh da d t r e e m , t r o n g do vay nen t h e m u n m i l toan than chiem t y le cao nhat. Ty le tre trai va tre gai mac benh vay nen la nhU nhau.
- T h u o n g t d n CO ban la dat do, b o n g vay da, Cac bieu hien t h u o n g t o n d m d n g , khdp va mem mac chi chiem t y le thap.
-Ty le benh nhan dUOc lam slnh t h i e t da chan doan xac dinh vay nen chiem 60.4%.
TAI LIEU T H A M KHAO
1. Stefanaki, C, et dl., Psoriasis in children:
LA retrospective analysis. J Eur Acad Dermatol Venereol, 2011. 25(4): p. 417-21.
2. Seyhan, M., et al.. Psoriasis in childhood and adolescence: evaluation of demographic and clinical features. Pediatrics international, 2006. 48(6): p.
525-30.
3. Parisi, R., et al., Global epidemiology of psoriasis:
a systematic review of incidence and prevalence. J Invest Dermatol, 2013.133(2): p. 377-85.
4. Fan, X., et al.. Childhood psoriasis: a study of 277 patients from China. J Eur Acad Dermatol Venereol, 2007.21 {6}: p. 762-5.
5 Kwon, H.H., et al., Epidemiology and clinical features of pediatnc psoriasis in tertiary referral
psoriasis clinic. The Journal of dermatology, 2012.
39(3): p. 260-264.
6. Kaur, 1., et, al.. Systemic methotrexate treatment in childhood psoriasis: further experience in 24 childrer\
from India. Pediatr Dermatol, 2008.25(2): p. 184-8.
7. Pham Van Hien, Benh vdy nen, in Da lieu hoc 2011, Nha xuat ban Giao due Viet Nam: Vinh Phuc.
p. 57 - 62.
8. Chandran, N.S., et al.. Clinical characteristics of childhood psonasis in a multi-ethnic Asian population. J Dermatol, 2012. 39(3): p. 278-9.
9. Nguy§nThi Ngpc Lan, Viem khdp vay nen,\ri Benh hoc caxuang khdp noi khoo (Dung cho bac si vd hgc vien sau dgi hgc). 2012, Nha xuat ban Giao due Viet Nam. p. 408.
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N G H I ^ c d u KHOA HOC
SUMMARY
THE SITUATION, CLINICAL A N D PARACLINICAL CHARACTERISTICS OF PSORIASIS IN CHILDREN ATTHE NATIONAL HOSPITAL OF DERMATOLOGY ANDVENEREOLOGY
Objective: The study WAS carried out to survey the situation, clinical and paraclinical characteristics of psoriasis in children who have resident treatment at the National Hospital of Dermatology and Venereology.
Subjects and Method: Subjects ore all medical records of patients under the age of 15 left hospitai from 1/2007 to the end of 12/2012. Methods ore cross-sectional descriptive study and retrospective study.
Results: There are 70 medical records of 48 psonasis patients under the age of 15 in the period of above tim. There are 87.5 % of case onset before the age of 10. Proportions of disease of male and female are the same. The most common clinical psoriasis is pustular psoriasis with 56.3 %. There were 60.4% cases of biopsy confirmed diagnosis of skin disease.
Conclusion: proportion of childhood psoriasis Is low. Percentage of disease of boys and girls are the same.
Keywords: psoriasis, children.
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