C H U Y S N Qg; H O I NOHI KHOA HQC HUYtit HQC - T R U Y I W M A U T O A N Q U 6 C 2012 xit nghi$m HBsAg duong tinh bing ELISA
thip nhit l i 0,88%
• Nhin viin thyc hifn xit nghiim:
Nhin viin c i c khoa khic ting cudng cho x i t nghiim cd t j l i x i t nghiim HBsAg duong tinh bing ELISA cao hon so vdi nhin viin c i a khoa Hiin miu & TP miu (1,44% v i 1,01%).
TAI U | U THAii K H A O
I. Nguyin Anh Tri v i cing s v (2004),'fidnA
gid hllu qui sir dung Ut nhanh HBsAg trong sdng loc trudc ngudi hiin mdu". Tap chi V hpc thyc hinh, 497, tt 1 7 5 - 7 .
Trin Ngpc Qui v i cfng tlf (2004), "Tinh hlnh sinh vlln cho mdu tgi Vlfn Huyet hoc- Truyin miu trong 5 nim (1998-2003) vi ty 14 nhiSm Hiy, HBV. HCV. Tap chi V hpc thyc hinh, 497, tt 191-2.
D l Tning Phin (2000) 'An loan truyen mdu". NXB Khoa hpc k; thuit B i Y t l (2007) Quy chi tniyin miu
KHAO SAT DAC DllflH BlNH BACH cAu MAN DONB LYMPHO TRONC 5 NAM 2006-2011
T r i n Thj Thien Kim ' , Hujinh Nghta ^ N g u y i n Trudng Sm'
T 6 M T A T
Nghiin a i u duipc thu'c hiin t r i n 62 binh nhin d u l ^ chan doin bach (Su mpn ddng lympho chua diiu b i tpl binh viin Truyin m i u huyet hpc thanh phd Ho Chi Minh Kr thing 6 n i m 2006 den thing 6 n i m 2011. K i t q u i cho thay tuii ttung binh 64,7, cao nhat 90 tudi, thip nhit 35 tuoi, ti l i nam/ nff la 1,5. Oa s5 binh nhin thudng dUpc chSn doin tinh cd khi khim site khde tdng quit. Cac triiu chiing thieu m i u , gan to, lich to i i tripu chiing thudng g i p . Huyit d i v i tuy dS cho thay sp x i m i l n tuypt doi cCia ddng bach &i lympho. Dau i n mien djch t i b i o phi hpp vdi chSn doan va sy hiin diin cua CD ' Benh Ylfn Truyen Mau Huyet Hoc, TP. HCM
' Khoa lam sang Nhl 2, Benh vien TruySn Mau Huyet Hgc, TP. HCM va Bg mdn Huyet hgc, Dal hgc Y DuUc TP.HCM
' Benh vien ait? Ray, TP.HCM Phin bifn khoa hpc: TS. Phan Thj Xinh 54
38, y i u to b i n lu^ng xau chlSn tdi 4 7 % . Tl ip sdng toin t h i sau n i m n i m la 7 6 % , trong do glal dopn muin cua bpnh lam g l i m thdi gian song cdn c i a binh nhan.
TU" khoi: Bach au man ddng lympho (BCMDL)
S U M M A R Y
A SURVEY OF CHARACTERISICS OF C H R O N I C L Y M P H O C Y T I C LEUKEMIA I N 5
YEARS: 2 0 0 6 - 2 0 1 1 The study deals v«ith 62 patients whom were diagnosed chronic lymphocyUc leukemia for die first time at the Hematology and Blood
Y HQC VlgT NAM T H A N Q « • 8 6 BAC BI6T/2012 Transfusion of Hochlminh city from June 2006 to
June 2011. The results shov^ed that: Median age was 64.7 ranged from 35-90. The male/female proportion was 1.5. Most patients were diagnosed by accident when they had a general examination. The symptoms; anemia, hepatomegaly and splenomegaly were the most usual. Peripheral blotxi count and myelogram indicated the absolute Invasion of the lymphoid cells. The immunopbenotypk: markets matched with the O i diagnosis and the presence of CD38, bad pnognostk: factor, accounted for 47%. The overall sun/Ivor time 5 yeais was 76%. Late stages of disease decreased survivor time of the paUenb
Keywonis: chnonk fyirvhocytk leukemia (OL)
I. OAT V&N OE
B$nh bpch ciu mpn ddng lympho (BCMDL) la mpt bpnh ly ic tinh thudng gip d ngudi cao tudi va cho din nay vin dupe xem la khdng chila dupe. Trin thi gidi, nhd sy thay ddi tiiu chuin chin doan cung nhu sy phat triin cia ky thuit ll bio ddng chiy xac djnh diu in te bio vi V.^ thuit sinh hpc phin td mi ngay cang cd nhieu bpnh nhan dupe chin doan sdm vi dinh gii tiin lupng kip thdi di lira chpn phic do thich hpp. Tuy nhiin d Viet Nam viic chin doin thudng dya vao cdng thiic miu vi hinh thii te bio. Hon nita vipc khim sue khde ting quit ngudi cao tuoi chua phii viec lim thudng quy nen bpnh BCMDL thudng bj bd sdt hoic chin doin d nhfhig giai doan mupn. Nhu viy dac diim bpnh nhin BCMDL d phia Nam Viet Nam nhu thi nao? Dl cd cii nhin khai quit chung tdi tiln hanh ngliiin ciiu nhim muc lieu:
Khao sdt dac diim lam sdng, can Idm sdng, yiu tS tiln lu(mg bfnh bach cdu mgn ddng lympho tai binh vifn Truyin mdu huyit
hgc thdnh phi Hi Chi Minh lit thdng 6/2006 din thdng 6/2011.
II. e t i l TUQN6 VA PHUONO P H A P N O H I E N C O U
2.1. Thilt kl nghiin ciru: Phin tich hing lopt ca.
2.2. DSn si nghiin cuu: Nhflng binh nhin chin doin bpch d u mpn ddng lympho tai binh viin Tniyin miu huyit hpc TP.HCM hi thing 6 nim 2006 din thing 6 nim 2011.
2.2.L Tiiu chuin chpn bfnh: Til ci nhOng binh nhin thda min tiiu chuin chin doin BCMDL theo hudng din chin doin binh BCMDL cia viin Ung thu Hoa Ky (NCI) nim 1996 bao gIm: [4]
• Ting tl bio lympho d miu ngopi vi, vdi gii tti biyit dii 5000 ll bio/pL, hmh thii ll bio trudng thinh. Nhihig te bio lympho , khdng diln hinh (tl bio prolympho) ti li khdng dupe vupl qui 55%. Sy ting ll bao lympho niy khdng giii thich dupe bing nguyin nhan khic.
• Cd it nhit 30% tl bio lympho trong tiy xuong ttin nin tiy binh thudng hoic ting sinh mat dp.
2.2.2. Tieu chuin lopi trii': nhihig binh nhin da dupe diiu tt)^ trudc dd.
'2.3. Phan tich si lifu: Sd dyng phin mem Stale 10 de phin tich thong ki.
III. KiT QuA
Nghiin cilu phan tich trin 62 binh nhan cho cic kit qua nhu sau:
3.1. D^c diim dich tl:
Ti le nam/ntt: 1.5 (60% so vdi 40%).
Tudi trung binh 64,7 ± 12.3, trong dd tali cao nhit: 90, tali thip nhit: 35. Nhdm tali 51-60 chiim li le cao nhat va nhdm tadi < 40 chiim ti le thip nhit (Bang 1).
55
CHUY6N BJ: H^\ NGH| KHOA HQC HUYe'l HQC • TRUYSN M A U T O A N Q U 6 C 2012
Bing 1: Tl Ij bjnh nhin phin bl theo nhdm tuii;
Nhdm tugl Tl It »/o
<40 41-50 51-60 «l-70
Ngoii ra, Phin bl theo 1^ do nhip viin; kiim tta siic khde 31%; thiiu miu 13%; gan lich to 3%; nhilm tting 13%; hpch lo 24%; xuil huyit; khim binh khic 13%.
3.2. Djic diim lim sing luc nh^p vifn:
Ti li cic triiu chdng thudng gip lin lu(?t li lich to (53%), thiiu miu (47%), hach to (40%), biiu chdng nhdm B ((im Ipnh, sit nh?, syl cin, do ml hdi dim) (31%), nhilm tting (13%), xuit huyit (5%). Trong si nhiing binh nhin khim thiy hpch lo cd 64% cd mil nhdm hpch to; 12% cd hai nhdm hpch vi 24% cd ba nhdm hpch trd lin.
3.3. D$c diem xit nghipm:
3.3.1. Huyit di:
Hb ttung binh; 106.6 ± 2.5g/L; thip nhit: 44g/L; cao nhit; 1 lOg/L. Cd 72.6% bpnh nhan thiiu miu nhung chi cd 15% binh nhin thiiu miu ning (<80g/L) (Bing 2).
Bang 2: Tl ip binh nhin phan bl Hemoglobin (g/L) Ti l i o/o
theo muc dp hemo
<80 15
80-110 37
Klobin;
110-120 21
> 1 2 0 27 50 lupng tieu ciu ttung bhih; 194,1 ± 112.7
thip nhit: 10.0 xlO'/L cao nhit; 583.0 xlO'/L.
Cd 19% bpnh nhan giim tiiu ciu duiii 100 x lO'/L, ttong dd cd 8% bpnh nhan cd so lupng liiu cau giim ning dutii 50x10'/L.
51 lupng bach ciu trung binh; 70.8 ± 72.2 X lO'/L; thip nhit: 11.6; cao nhit: 438, ttong dd cd 15% bpnh nhan ting bpch ciu tten 100 X lO'/L vi 11% bpnh nhan cd bpch ciu lympho ting ttin 100 x lO'/L.
3.3.2. Tuy do: Mat dp le bio Hiy ting trong 58% cic trudng hpp, khdng cd bpnh nhan nao cd mpt dp tl bio liy giam. Tuy
nhiin, mpl dp cac ddng hong cau, bach ciu hat vi lieu ciu giam riing le chiim 71%, 82%, va 63% tacmg iing. Ddng bpch ciu lympho ttudng thanh ting ttong 100% cic trudng hpp.
3.3.3. Dau in miln djch ti bao:
Khao sit diu an mien djch tl bio chung tdi nhin thiy ti Ip nhihing diu in die ttung cia le bao B ttvdng thinh CD 19, CD20, CD22 duong tinh 100%. Die biit ching toi ghi nhin ti Ip CD38 mpt yiu to lien lupng bpnh duong tinh 47% cac ttudng hgrp (Bieu dl 1).
Bieu do I: Ti li phin trim duong tinh va am tinh cac diu in mien djch li bao;
COS C019 COM C 0 2 C023 C025 COM s« CD791)
O l u i n m l i n a i c h t l M D
Y HQC VigT NAM T H A N O 8 • S 6 B A C B I $ T / 2 0 1 2
3.3.4. Phin nhim tiln lupng theo RAI:
Ti li phin ttim cic phin nhdm tiin lupng bfnh theo RAI lin Iupt li: giai dopn 0: 21%, giai dopn 1; 11%, giai dopn 2: 19%, giai dopn 3; 30%; giai dopn 4; 18%.
3.3.5. Thdi gian sing toin thi 5 nim cua nhim bfnh nhin nghiin ciru:
!(>'/<,
Bliu S 2: Dudng Kaplan-Meier biiu diln thdi gian sing toin thi 5 nim cia loin hi din sl.
Nhfn xit: ti li sing cdn sau 5 nim cia toin hi din sl nghiin cdu li 76%
L(5g-
\
-6d0-G<H-lOO%
•Gd2.a0%
Gd 3-74%
53T- 32%
rank test; x2=23.17, p=0.0000
chu thich: Gd: giai doan Biiu S 3: Dirdrng Kaplan-Meier bieu dien thdi gian s6ng con toan th^
S ndm theo cdc giai do^n RAI.
Nh^n xet: Ti 1? b?nh nh&i s6ng cdn sau 3 nam cua nh6m RAI giai do^n 4 thdp horn hAn ckc nhom khac. S\T khac biet c6 ^ nghia th6ng ke.
IV. B A N LUAN
S\r phan b6 gidi tinh cua b§nh (nam/n& = 1.5) va sy phan bo v^ nhom tudi khd gi6ng voi cdc vCing dich te tren th^ gi6i [1,2,5,7].
Tu6i trung binh ciia chiing toi 1^ 64,7 gan bang voi hai nghien cuu cua cdc tdc %\k Vi$t Nam (60 va 61,6 tu6i) [1,2] vd thdp hon so voi khao sat cua Hoa K^ ciia chau Au(70 vd 69 tuoi) [3,5,10]. Da so b$nh nhan dugic phdt hien benh khi khdm siic khde t6ng qudt (31%). Con so ndy cua tdc gid Shvidel Id 79.8% [10]. Su khdc biet ndy Id do vi^c khdm sue khoe t6ng qudt la vi?c lam thuong xuyen cf cdc nuoc phat trien.
Nghien cuu cua chiing tdi cho thdy nhftng tri?u chOmg thu6ng g$p nhdt thi^u mdu, hgch to, Idch to (>50%) vd cdc tri^u chung it g^p nhdt Id nhiem trung va xu4t huyet (13% va 5%). Can luu y nhiem trung Id mpt bien chumg cua b?nh BCMDL nen cung CO the g$p thudng xuyen 6 b$nh nhdn BCMDL. Sv tdng kin dao so lugfng lympho mdu ngo£ii vi c6 the bi che lap boi tinh tr^g nhilm trung tang bach cau hat.
Trong nhom b$nh nhdn c6 hgch to chiing toi n h ^ thay ti le mpt nhom hEich Id cao nhat 64% chu yeu la hach viing c6. Tii k8t qua nay chiing toi nhan thay cac bdc sT lam sdng co
57
C H U Y E N Bi: HQI N 0 H | KHOA HQC HUYtT HQC • TRUYJN M A U T O A N Q U 6 C 2012
thi bd qua cic nhdm hpch nich vi hpch bpn khi thim khim lim sing.
Khio sit huyit d l vi hiy dl, cd 72.6%
binh nhin cd thiiu miu tuong dng tl li giim sinh ddng hing ciu ttong biy (71%) ttvng dd cd 51.6% thiiu miu vCta vi ning (<lIOg/L) phi hpp vdi triiu chdng thiiu miu phit hif n dupe ttin lim sing (47%). Tl ii giim tiiu ciu < 50x10'/L li 8% cOng phi hpp vdi trifu chiing xuit huyit trin lim sing li S%. Tl li ting bpch ciu vi bpch ciu lympho >
lOOxIO'/L gin biong duong nhau (14.5% vi 11.3%) d miu ngopi vi vi sy ting lympho tayit dii trong biy phin inh tinh chit cia binh li sy ting sinh ic tinh cia ddng tl bio lympho trong tiy trin n g ^ ra miu ngopi vi.
Nhu viy cd mil sy phi hpp giiia die diim lim sing vi cin lim sing ciia din sl trong nghiin cihi.
Khi khio sit diu in mien djch tl bio, kit qui chiing tdi thu dupe hoin toin phi hpp vdi d$c trung ciia tl bio B trudng thinh vdi 100% CD19, CD20, CD22 duong, ti If CD5, CD23 duong tinh cao (84% vi 79%), globului mien djch bl mil chi biiu hipn hoic kappa hoic lamda (43%). Kit qui niy phi hpp vdi cic tic gii Kaushansky, Rai [7,8].
Trong vdng hai th§p ky gin diy, CD38, mjc du cdn tranh cii, dupe xem li mil yiu t l tiin lupng cia bpnh BCMDL. Ti Ip CD38 duong tinh lit khic nhau ttong nhiiu nghiin cdu(Shvidel 57%, Weinberg 27% [10,11] vi ching tdi 47%) cd thi vi cd mpt sl bpnh nhan chuyin dii biiu hif n CD38 td im thinh duong trong qui ttinh phil ttiln cia binh [6]. Tuy nhiin cd 11% cic ttxrdng hptp cd mdc biiu hifn CD38 ttin 30% gin Mang duong vdi tic gii Shvidel (19%) [10]. Nhiing trudng hpp niy theo nhiiu nghiin ciiu mdi inh hudng din lien lu(7ng binh.[9]
Ching tdi nhpn thiy ti le binh nhan d
giai dopn RAI 3-4 tiic l i nhdm nguy co cao theo RAI cii tiln chiim ti li cao hon rit nhiiu so viii hai tic gii Shvidel vi Weinberg (48% so vdi 7.5% vi 7%) [10,11]. Diiu dd cho thiy bfnh nhin cda chiing tdi din khim d nhihig giai dopn bfnh tiln ttiln hon binh nhin cic nude phit triln. Cd sy khic bifl niy li do cdng tic chim sdc sdc khde ban diu, f thdc vl siic khde vi hf thing bio hiim xi hii cia ngudi din lit hon d cic nude phit triln.
Dudng Kaplan Meier udc tinh ti If din sl sing cdn sau S nim li 76% gin taong duong vdi s l liiu thing ki cia Hoa K^ vi Israel [3,10].
Khi phin nhdm theo giai dopn RAI, d if binh nhin sing sau 3 nim cia nhdm RAI giai dopn 4 li thip nhit (32% v i 60%), giai dopn cing s(San thi thdi gian sing cdn cing dii vi sy khic bipt niy ii cd y nghia thing ke. Kit lupn niy phi hpp vdi y vin [7,10].
V. KIT LUi^lN
Qua nghiin cdu 62 trudng hpp bpnh BCMDL d bfnh vipn Truyin miu huyit hpc t i thing 6 nim 2006 din thing 6 nim 2011 ching tdi nhfn thiy binh BCMDL thudng gip d ngudi >40 tuii, nam nhiiu gap 1.5 lin nii. Diln tiln bfnh thudng im thim nin binh nhin thudng tinh cd dirpc chin doin khi khim sue khde ting quit. Cic trif u chiing thiiu miu, gan to, lich to l i nhctng trifu chung thudng gip nhung ciing l i ttif u chiing bio d$ng giai dopn tti cia bfnh. Diu in mien djch tl bio phi hpp vdi chin doin vi sy hipn difn cua CD 38, yiu t l bin lupng xiu chian tdi 47%. Ti if sing loin Ihl sau nim nim li 76%, ttong dd giai dopn mupn cia bpnh lam ting nguy co t i vong cia binh nhan.
58
Y HOC VlfeT NAM T H A N Q 8 - S 6 P A C BlgT/aOIZ
TAI U|U THAM KHAO
1. Biki Huy Tui^n, Ph^m Quang VInfa, (2008)
"M$t s6 d$c diim Ifim sdng vd huy^ hgc cda b^nh Lo xS mi kinh d6ng lympho d ngudi trudng thdnh". t<^p chiy h^c Vi$t Nam vol.
344(2), 472-478.
2. Ph^m Quang T$p,(2010) "Nh&n x^t d$c diim Xkm. sdng, huyit Ah, tOy d6 cOa b$nh nhdn b^h ciu lympho m^n". tgp chi y fiQC Viet Nam vol. 373(2), 42-46.
3. SEER Stat fiict sheets: Chronic lynphocytic leukemia NCFs SEER Cancer Statistics Review., USA, from http://se».canca'.gov/stat&cts/html/clyl.html
4. Cheson BD, Bennett JM, Grever M, et aL,il996) "National Cancer Institute- sponsored Working Group guidelines for chronic lymphocytic leukemia: revised guidelines for dif^osis and treatment."
Blood vol. 87,4990-4997.
5. Diehl Louis F. , Karnell Lucy Hynds , Menck Herman R.. et aL^(1999) "The national cancer data base report on Age, Gender, Treatment, and Outcomes of Patients with chronic lymphocytic leukemia." Cancer vol. 86,2684-2692.
6. Hamblin Terry J., Orchard JA, Ibbotson RE, et a/:,(2002) "CD38 expression and immunoglobulin variable region mutations are independent prognostic variables in chronic lymphocytic leukemia, but CD38
expression may vary during the course of the disease." Blood, vol. 99, 1023-1029.
7. Kaushansky K, Marshall A.Lichtman, Ernest Beutler, et aL(2010), Chronic lymphocytic leukemia and related disease.
In Kaushangsky K, Ernest Beutler, Seligsohn Uri, et al. (Eds.), Williams hematology 8th edition (pp 1761-1828). Mc Oraw Hill medical.
8. Rai Kanti R, Keating MD and Michael J(2000). Chronic lymphocytic leukemia. In Jr Bast RC. DW Kufe, RE Pollock (Eds.), Cancer Medicine (5th ed.). BC [)ecker 9. Salah Abbas, Bruce Cheson(200S). chronic
lymphocytic leukemia. In Griffin Rodgers, Neal Young (Eds.), Bethesda Handbook of clinical hematology (pp. 177-185).
Lippincott Williams & Wilkins Philadelphia USA.
10. Shvidel L, A Braester, O Bairey. el a/.,(2011) "Survival trends among 1325 patients with chronic lymphocytic leukemia seen over the past 40 years in Israel".
American Journal of Hematology.
11. Weinberg Brice, Volkbeimer Alicia, Chen Youwei, el al,(2007) "Clinical and molecular predictors of disease severity and survival in chronic lymphocytic leukemia".
American Journal of Hematology, vol. 82, 1063-1070.
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