Nghien clhi Y hpc Y Hoc TP. Ho Chi Minh * T^p 20 * So 2 * 2016
DANH GIA HIEU QUA CUA KEM AZELAIC ACID 20%
TRONG DIEU TRI RAM MA d PHU NU* CO THAI
Le Thdi Vdn Thanh, Trdn Lan Anh TOMTAT
Ma ddu vd muc tieu: Rdm md la Hnh Hang gia tdng sdc td'da giohg mat nq gap Hen phu nie mang thai.
Day Id tinh Hang rm loan sdc td'da mac phdi, thiecmg gap, mqn tinh. Tuy nhiin, hdu nhu Ididng co cdc nghien am can thiip di'tay rdm md b phu nu mang that Nghien aiu ndy nham ddnli gid hiiu qud dieu tri rdm md thai ky bdng phuang phdp bdi kem tdy ram azelaic acid 10% (Anzela®) so v&i mang khau Hang.
Doi tuang - Phuang phdp Nghiin cieu can thiip (bdi kem tay ndm Anzela®) co ddi chihig (mang khau Hang) kH hap theo doi dqc (Hen cuu) theo then gian duoc Hen hdnh Hin phu nie mang thai co hoqc Idiong bf rdm md Hong thai ky deh khdm iqi Benh vien Dqi Hoc Y Dugc TP.HCM - casd 4 (nay Id Binh viin Phu Sdn Me- kong TP.HCM), tie 02/2011- 03/2013.
Kei qud Cd 57 thai phu (41%) bdi kem AnzelafB) (nhdm AzA) vd 44 thai phu (Sl%) deo Idiau Hang (nhdm KT). Sau 5 ldn theo tioi, chi so'MASI vd L khdng thay dm trong nhom AzA. Rdm md nqng hem Hong nhdm KT (p<0,05). THeu ndy ducyc thehien qua gid tri L gidm tie lan theo doi thie hai vd chi so MASI tdng tie ldn Iheo dm thu ba (so vdi ldc dau). Cd su khde biit Hong gid trj L vd chi so MASI giiea hai nhom (p<0,001) bat dau tie sau 4 thdng can thiip. Trong nhdm AzA, tdc dung phu khdng con sau 3 thdng.
Ket ludn Ram md cdi thiin tdng dan Hong nhdm AzA, rd nhSi sau 3 thdng can thiip. Rdm md Hong nhom KT tdng nqng. So sdnh hiiu qua giiea hai nhom, rdm md Hong nhom AzA co cdi thiin nhieu hem so vdi nhdm KT.
Tdc dung phu thucmg nhe vd bim mai sau 4-5 thdng can thiip bang kem Anzela®.
Tit khoa: rdm md, thai ky, azelaic acid.
ABSTRACT
THE EFFECTIVENESS OF TOPICAL AZELAIC ACID 20% CKEAM TN TREATMENT OF MELASMA IN PREGNANT WOMEN
Le Thai Van Thanh, Tran Lan Anh * Y Hoc TP. Ho Chi Minh * Vol. 20 - No 2 - 2016:10 -18 Background and objectives Melasma is a phenomenon that increases melanin in the facial skm, is very common in women espedally during pregnancy. This is an acquired, common and chronic condiHon. However, almost no intervenHonal study has been done to Heat melasma during pregnancy. This study was to compare the effecHveness of melasma Heatment by topical azelaic acid 2{f/o cream and mask.
Method An interventional study zoith control group in combination with prospecHve observaHon was completed by 101 pregnant women at the University Medical Center - branch 4 (named Obstetric and Gynecological Hospital Mekong of HCM City at present), from February 2011 to March 2013.
Remits There were 57 pregnant women (41%) applied azelaic acid cream 20% (belong to AzA group) and 44 ones (31%}) wore mask (belong to Mask group) After 5 Hmes of Hacking, the index MASI and L virtually unchanged in AzA group. Melasma aggravated in Mask group (pO.05). This was presented by the value L decreased from the 2"'' Hme and the index MASI increased from the 3"^ Hme (compared to Hme 0). There was difference in the index MASI between AzA group and Mask group (pO.OOl) started to appear after 4 months cf
* Dai Hpc Y Duac TP.HCM.
Tdc gia lien lac: TS. L& Thai Van Thanh DT: 0903774310, Email: chamsocdadhyd(i"gmail
Y Hpc TP. H o Chi M i n h * Tap 20 * So 2 * 2016 Nghien cmi Y hpc
intervenHon (p=0.01). In AZA group, fi-om 3"* Hme there was no difference in the rate of side effects as compared to Hme 0.
Ccmclusicm AzA group had clinical improvement incrementally, the most obvious improvement could be seen after 3 months of the intervenHon. Melasma in Mask group aggravated. Comparing the effecHveness between the groups, Heating melasma in AzA group had much better improvement than in Mask group in pregnant women. Finally side effects were mild and disappeared after 4-5 months of the intervenHon by Anzela® cream
Keyword: melasma, pregnancy, azelaic add.
DATVANDE
Ram ma la tinh trang gia tang sac to da giong mat na ggp tren phu nir mang thai nen con goi la mat na thai ky. Day la tinh trang roi loan sac to da mac phai, thuong gap, man tinh. Ram ma xua't hien trong thoi gian mang thai co the thoai tri&i sau sanh mot each ty phat, trong do 70%
tniong hop bim mai hoan toan trong vong mot nam sau sinh''**. Tuy nhien 1/3 tnrdng hpp ram ma CO the keo dai trong nhieu nam sau do ma khong ro can nguyen^s), Cac phuong phap dieu tri doi hoi mang tinh hi|u qua, dong thoi dam bao an toan cho ba me va thai nhi. Vi vay cac phuang phap thuong dupe chon lua chti yeu la chraig nang co hoc (mang khau trang dung each), kem boi chong nang, thuoc boi azelaic acid, vitamin C, thao dupe
Tren the'gioi da co mpt so'nghien cihi ve dac di&n lam sang, cac yeu to khoi phat hoac nhiing yeu to lam nang linh trang ram ma a phu nu mang thai'^'^*'^*'. Tuy nhien, hau nhu khong c6 cac nghien cuu can thiep de tay ram ma 6 phu nu mang thai. O Viet Nam chua co nghien ciiu nao Ken quan d&i ram ma tren phu nii mang thai. Cling nhu cac bien phap can thiep ram ma tren doi tupng nay. Nghien cuu nay nham danh gja hieu qua di&i tri ram ma thai ky. bang phuang phap boi thuoc tay ram Anzela® so voi mang khau trang.
DOITl/ONG-PHLfCNGPHAPNGHIENajlJ Nghien ciiu can ftiiep co doi chiing ke't hpp theo doi dpc (Hen ciiu) theo thcri gian dupe tiai hanh tren phu nii mang thai co hoac khong bi ram ma trong thai ky deh kham tai Benh vien Dai Hoc Y Dupe TP.HCM - co so 4 (nay la Benh vien Phu San Me-kong TP.HCM), hr 02/2011-
03/2013. Tieu chl chem vdo n^ien dhi bao gom 1) thai phu 12 - 16 tuah thai 2) co ton thuong ram ma (dat mau nau sam hay den, kich thuoc thay doi, gidi han ro, bo khong deu, loin dom, khong do, khong bong vay, khong teo da, khong ngiia, rai rac hoac tap trung, doi xung hai ben go ma, miii, tran, cam, ham duoi) 3) dong y tham gia nghien ciiu 4) Khong co cac benh H gan, than, phoi nang, HTV/AIDS 5) Khong co chong chi dinh dimg thuoc boi. Tieu cht loai trit bao gom 1) da sii dung cac thud'c boi co chiia hydroquinone, tretinoin, steroids hoac cac thuoc uohg CO chiia draig van cua vitamin A (isotretinoin, adtretin), steroids trong vong 6 thang truoc nghien ciiu 2) Ti&i sii co dimg lot da bang hoa chat, vi bao da, laser tri Ueu trong vong 9 thang truoc nghien ciiu va 3) Di iing voi mot trong cac thanh phan ciia thuo'c boi dupe sii dung trong nghien ciiu.
Cong thiic ixac tinh ti le eai thien ram ma sau can thiep dua vao phep kiem Chi binh phuang McNemar eua David Machin et al (2009). Voi ti le cai thien ram ma trong thai ky khi khong co can thiep (0%^'); ti le cai thi$n ram ma sau can thiep (voi ky vpng ti le cai thien tinh trang ram ma la 38% dua vao nghien ciiu cua Lakhdar H va cs*^'); « = 0'05; P = 0'20 thi co miu ft nhat can thie't cho moi nhom can thiep trong nghien cvhi la 19. Thue te thu nhan dupe 57 thai phu thupe nhom AzA va 44 thai phu thupe nhom mang khau trang vao nghien ciiu.
Benh nhan duoc chia ngau nhien bang each bat tham thanh 2 nhom nhom boi thuoc tay ram Anzela® (Ig kem chiia AzA 200mg, methylparahydroxybenzoate 0,5mg, propylparahydroxybenzoate 0,5mg), nhom KT.
Nghien cihi Y hoc Y Hpc TP. Ho Chi Minh * T5p 20 * So 2 * 2016
Thai phu dupe tu van dimg cac bien phap can thiep dung each. Nhom boi thuoc tay ram: boi mpt lop mong deu tren ton thuong, masage nhe;
boi 1 lah moi ngay vao buoi toi, boi hen tuc it nhat 6 thang- ngimg boi ne'u sau 2 thang khong CO hieu qua. Nhom mang khau trang: deo khau trang moi khi ra nSng, nhat la thoi gian tir 9 gio sang dan 16 gio chieu. Hai nhom deu dupe tu van tranh cae yeu to' gay tang hae to' da nhu han che' tiep xiic anh nang nha't la tir 9-16 gio hang ngay, tranh nhiet, tranh kich thich cha xat da, tranh sir dung cac san pham gay nhay cam anh sang, ban che xa phong, cha't tay nia. Thai phu duac iheo doi 5 hoac 6 lan (lan 0, lan 1, lan 2, lah 3, lan 4/5) tuong img tai cac thai diem nhu sau:
liic nhan vao nghien ciiu can thiep (TO) va tai kham moi thang sau cho den khi sinh Tx (Tl, T2, T3,T4/5).
Dac di&n dich te hpc, thoi quen va hieu biet ve ram ma ding nhu cac dae diem lam sang dupe thu thap de danh gia miic dp tuang dong tren hai nhom can thiep. Miic do tang sac to'cua ton thucmg dupe danh gia dua vao chi so'MASI'^'
va dirpc tinh fheo cac miic dp nhe la <5,5, trung bmh la >5,5-<8,7, nang la >8,7-<13,l, rat nang la
>13,l-48. Danh gia fheo may Colorimeter de do dp sang toi cua thuong tont*) dua tren gia tri L thay doi theo miic dp sang/toi cua da, co the tii L am (den) deh L duong (trang). Da nguoi binh thuong CO gia tri L=45-65. L cang cao tuong iing da cang sang*^^'.
So lieu dupe kiem tra tinh hpp ly va day du thi duoc ma hoa va nhap vao may tmh bang phan mem EpiData 3.1 va dupe phan ti'ch bang phan mem Stata 12. Day la nghien cihi khong xam lah, thong tin dupe ma hoa va benh nhan co quyen tix choi khong tham gia nghien ciiu. Cac vat lieu dimg trong nghien ciiu khong co tac hai tren doi tupng tham gia nghien euu da dupe ghi nhan trong y van.
KET QUA NGHIEN CUtJ
Hai nhom can thiep tucmg dong nhau ve cac dac di&n dich te hpc, thoi quen va hieu bie't ve ram ma voi gja tri p > 0,05 (Bang 1).
Bang 1. So sdnh su tucmg dang vedac diem didi ti, tho Yiu tfi
Cjuen va hieu biei veram mda 2 nhom Nhom
AzA(N=57)n(%) 1 Kr(N=44)n'('!i,) P DAC DI^M DICH T £
Tuoi T[en SL^ thai san
So lan sinh
Tiln si> ram mA lan thai ln,6c Chu ky kinh nguy?t Dung thuoc ti^nh thai Tien si> gia dinh r^m ma
<30tu6i
£ 30 tuoi Cc Chu'a Chu'a Sinh 1 lan Smh a 2 lan
Co Khong
Deu KhSng diu
Co Khang
Co Khong
27 (47,4) 30 (52.6) 42 (T3,7) 15 (26,3) 23 (40,4) 30 (62,6) 4(7) 19 (33,3) 38 (S6,7) 46 (78,9) 12(21,1) 16(26.3) 42 (73.7) 21 (36,8) 36 (63,2)
19 (43,2) 25 (56,8) 33 (76) 11(26) 17(38,6) 23 (52.3) 4(9.1) 13(29,6) 31 (70,6) 32 (72,7) 12 (27,3) 7 (16,9) 37(84.1) 17 (38,6) 27(61,4)
0,675 0,881
0.965'
0.685 0,466 0,209 0864 rH6i OUEN vA Hieu Bier ve RAM MA
Tiip xuc ^nh nang mit trdi tu 9-16 gio'
Khong 15-30 phut
> 30 phut
10 (17,6) 26 (45,6) 21 (36,8)
4(9.1) 16 (34,1) 25 (56.8)
0,133'
Y Hpc TP. H 6 Chi M i n h * Tap 20 * Set 2 * 2016 Nghien citu Y hpc
Y l u 16 Thoi quen mang khau trang
Th6i quen thoa kem ch6ng nang Diing my pham
Biet ve nguyen nhan ram ma
Khong C6 (khong dung each)
C6 (dung c5ch) Kh6ng Co (khflng dung each)
Co (dung c^ch) Khong Thinh thoang C6 (thu'dng xuyen)
Co Khdng do ^nh nang mgt troi
do thai k;^
do bfnh gan do gen do dinh du'dng do thuoc ngira thai do gioi tinh ti^ai nhi do my ph^m do nguyen nhSn khSc
Nhom A2A(N=57)n(%)
3 (5.3) 48 (84,2)
6 (10.5) 41(71.9) 16 (28,1) 0 29 (50,9) 15(26,3) 13(22,8) 52 (91,2) 5 (8,8) 36 (63,2) 25 (43,9) 4(7) 9 (15,8)
3 (5,3) 1 (1.8) 0 10(17,5) 10(17,5)
KT(N=44)n(%) 6(13,6) 33(75) 5(11,4) 34(77.3) 10 (22,7) 0 13 (29,5) 16 (36,4) 15 (34,1) 37 (84,1) 7(15,9) 17 (38,6)
22(50) 0 3 (6,8) 3 (6,8) 0 0 5(11,4) 6 (13,6)
P 0.281*
0,543
0.097
0,272 0,014 0,540 0,130*
0,221*
0.999' 0.999*
KXO 0,386 0,594 'KiSn dinh chinh xdc Fisher
Hau het cac dac di&n hai nhom la nhu nhau (p Bdng 2: So sdnh su tucmg
ISm sang ram ma tren loan sac to sam da duong giiia bung va sam da
> 0,05) ngoai hii co roi quanh ron (p = 0,018) (Bang 2).
vidqc diim lam sdng b 2 nhom Y4ut6
Thdyi gian kho'i ph^t
The lam sang Loai ram ma
Tan nhang Sam da duo'ng giu'a bung
Sam da quanh ron Sam da quang vu Roi foan khac Tiin su benh noi hit Tiin SU' benh man tinh
Bit diu c6 thai
<12tuin 12-16 tuin Cdnh bm^m Tnjng t3m mat
Thucng bi Bl H5n hep
Nhom AzA(N=57)n(%)
26 (45,6) 26 (45,6) 5 (8,8)
0 57 (100) 6 (10,5) 7 (12,3) 44(77,2)
KT (N=44) n (%) 17 (38,6) 26 (69,1)
1 (2.3) 1 (2.3) 43 (97,7) 2(4,5) 1 (2,3) 41 (93,2)
P 0,265'
0,436'
0,083*
CAC R(il LOAN SAC TO TRONG THAI KY C6
Khdng Cd Khflng
Cd Khong
C6 Khong
C6 Khong
C6 Kh6ng
Co Khong
36(61,4) 22 (38,6) 26 (43,9) 32 (56,1) 27 (47,4) 30 (52,6) 48 (84,2) 9 (15,8) 12(21,1) 45 (78,9) 7 (12,3) 50 (87,7) 3 (5,3) 54(94,7)
23 (52,3) 21 (47,7) 11(25) 33(75) 12 (27.3) 32 (72.7) 39(88.6) 5(11.4) 8 (18,2) 36(81,8) 2(4,6) 42 (96,6)
0 44(100)
0.367 0.050 0.040 0.623 0.720 0.292' 0.265'
N g h i e n cmi Y h p c Y H p c T P . H o C h i M i n h * T^p 20 * Sfi 2 * 2016
Mi>c dq tang sic t i qua ddnh gia chij quan
Nhe Vua Nang
NhiSni AzA (N-57) n (%)
46 (80.7) 11(19.3) 0
Kr(N=44)n(%) 35 (79,5)
9 (20,5) 0
P
0,886 VILH: dfl tang sac t i qua chi s6 MASI
Tnjng binh ± dp lech chuin Nhe Tmng binh
Nang
3.2 (2.3) 60 (87,7) 3 (5,3)
4(7)
3,1 (1,9) 39 (88.6) 5(11.4) 0(00)
0,770 0,133' Vluc do tang sac to qua gia In L
Tmng binh ± dq lech chuan Cao Thip
66,0 (2,2) 27 (47,4) 30 (52.6)
66,9 (2,8) 24(54,5) 20(45,5)
0,066 0,474 'Ki&n dinh chinh xac Fisher
Ket qua cho tha'y co khac biet c6 y nghia thong ke ve danh gia chii quan tren cac nhom can thiep theo thoi gian, trong do sau 1 larv theo d5i ttu nhom AzA co ti le eai thien cao Bdng 3: Kit qud ddnh gid chit quan Hen 2 nhom
hon CO y nghta thong ke so voi nhom KT (p<0,05) (Bang 3).
Lani
Lan 2
Lan 3
Lin 4
Lan 5
Cai thi^n nhe Khflng thay do!
Nang hon Cai thien dang ke
Cai thien nhe Khflng thay del Nang hon Cai thifln dang k i
Cai thi$n nh?
Khflng thay dii Nang hem Cai thi^n dang k i
C:ai thifln nhe Khflng thay doi
Ning hon Cai thi^n ddng k i
Cai thifln nhe Khflng thay doi
Nang hmi
Nhom A2A(N=57)n(%)
4(7,0) 48 (84,2)
5 (8,8) 1 (1,8) 9(15,8) 38 (66,7) 9(15,8) 3 (5,3) 11 (19,3) 29 (50,9) 14 (24,6) 2 (3,8) 23 (44,2) 19(36,5) 8 (15,4) 2(4,2) 25(52,1) 17(36.4) 4(8.3)
KT (N=44) n (%) 1 (2.3) 43 (97.7) 0 0 0 38 (86.4)
6 (13.6) 0 2(4.6) 22(50) 20 (45,6)
0 0 31 (70,5) 13 (29,5) 0 0 29 (66.9) 16 (34.1)
P 0,071'
0,012'
0,017*
<0,001'
<0,001'
'KiSn dinh chinh xdc Fisher
So sanh chi so MASI trong hiii nhom qua cac lan can thiep cho thay gia trj MASI co khac biet CO y nghia thong ke so voi nhom su dung khau trang a lan theo doi lah 4 va 5 voi p lan luot la 0,010 va 0,002. Khi phan nhom chi so MASI thi cac phan nhom chi khac biet a lan theo doi thu 2 voi p =O,0*i4. Bieu do 1 cho thay
chi so MASI trong nhom mang khau trang bat dau tang vao thang thii 2 va tiep tuc tang dang ke trong nhimg lan theo doi sau, trong khi nhom six dung Anzela thi tang a lan Ihii 2 nhung sau do giii nguyen miic do MASI trong suo't qua trinh theo doi.
14
Y Hpc TP. H o Chi Minh * T | p 20 * S « 2 * 2016 N g h i e n CUTI Y hoc
Bdng 4; Ket qud ddnh gid chi so MASI tren 2 nhom
M A S I Lan 0[TB±DLci
Nh?
Tmng binh Nang Lan 1 [TB.oLci
Nh?
Tmng binh Nang Lan2rrB±£'Lci
Nh?
Tmng binh Nang Lan 3[reiDLci
Nh?
Tmng binh Nang Lan4[TB±DLci
Nh?
Tmng binh Nang Lan 6pB±t)Lcii
Nh?
Tmng binh Nang
N h o m A 2 A ( N = 5 7 ) n ( % )
3,2 (+2,3) 50 (87,7) 3 (6,3)
4 ( 7 ) 3,3 (+2,4)
49 (86) 4 ( 7 ) 4 ( 7 ) 3,4 (+2,6)
49 (86) 3 (5,3) 5 (8,8) 3,4 (+2,6)
49 (86) 2 ( 3 , 6 ) 6 (10,6) 3,3 (+2,6) 46 (86,5) 3 (5,8) 4 ( 7 , 7 ) 3,2 (±2,7) 4 1 (86,4) 4 ( 8 , 3 ) 3 (6,3)
K T { N = 4 4 ) n ( % ) 3,1 (+1.9) 39 (88.6) 5(11.4)
0 ( 0 0 ) 3.1 (+1.9) 39 (88,6) 5(11,4)
0 ( 0 0 ) 3,4 (+2,0) 38 (86,4) 6 (13,6) 0 ( 0 0 ) 3,9 (+2,2) 36(81,8) 6 (13,6) 2 ( 4 , 5 ) 4,6 (+2,0) 36 (79,6) 6 (13,6) 3 (6.8) 4.8 (+2,2) 35 (79,5) 3 (6,8) 6 (13,6)
P 0,770 0,133*
0,731 0,184*
0,984
0,044*
0,330 0,127*
0,010 0,463*
0,002 0,611*
nhom KT thi L giam dang ke co y nghia thong ke k e t u l a n t h i i Z
»—-f^^
[thibt] (aullliin{] (Swliliini} (iiuJIhint) {iw4tMn|| (HuSlMml
Anuli 04SS OJUi OfiU om 0.W KhautranE 0 ^ 0.004 <0JI01 4.001 <0.0D1
iKiem iinh chinh xdc Fisher
Bieu doi: Sit thay dS^ diim MASI qua cdc ldn theo doi a 2 nhom
So sanh gia trj L trong hai nhom cho thay khong khac biet co f nghia thong ke qua cac l&i theo doi (Bang 5). Trong nhom Anzela thi gia tri L khong thay doi trong qua trinh theo doi. Trong
(Bfadiu) tsulMnti (Saullhinf) (staSthintl |iM4thln|| [tiuStMni)
A f l i e b K h i u trang
0,595 0.697
1^521
< a . i » i 0,3E2
<0,001 0,467
<0,001 0,067
<0,DD1
Biai do 2: Su thay doi gid Hi L qua cdc lan theo doi Hen 2 rihdm
Khong xua't hien tac dung phu o nhom KT trong qua trinh theo doi. Nhom AzA co mot so tac dung phu nhu ngtia (n=18), do da (n=17), cham chich (n=10), kho da (n=10), troc vay (n=5).
N g h i e n c i ^ Y hpc Y Hpc TP. H o Chi M i n h * T a p 20 * So 2 * 2016
bong rat (n =4) chii yeu xuSt hien trong 3 lan theo doi dau va deu 6 miic do nhe.
Bdng 5: Kei qud ddnh gid gid tri L Hin 2 nhdm Gia triL
LanO[TB±eLci Cao Ttlip Lan 1 nB±flLCi
Cao Thip Lin2[rB±BLC]
Cao Thip Lin3[TB±£)LC|
Cao Thap Lan4[TB±flLCi
Cao Thap Lan 5 [TB±BLCI
Cao Thip
Nhdm AzA(N=57)n(%)
56,0 (+2,2) 27 (47,4) 30 (52,6) 56,1 (+2,2)
28 (49,1) 29(50,9) 66,1 (+2,2)
30 (52,6) 27 (47,4) 56,2 (+2.4) 28 (49.1) 29 (60,9) 56,3 (+2,6) 29 (65,8) 23 (44,2) 66.7 (+2.6) 31 (64,6) 17 (36,4)
Kr(N=44)n(%) 56,9 (+2.8)
24 (54.5) 20(45.5) 57 (+2.7) 24 (54.5) 20 (45.6) 66,6 (+2,7)
23 (62,3) 21 (47,7) 66,4 (±2,7)
21 (47,7) 23 (62,3) 56,2 (±2,7)
21 (47,7) 23 (52,3) 66 (±2,8) 20 (45,5) 24 (54,5)
P 0,066 0,474 0,066 0,689 0,303 0,971 0,664 0,889 0,938 0.432 0.206 0,066 'kimn dinh chinh xdc Fisher
B A N L U A N
Ket qua cho thay ti le cai thien ram ma tang dan trong qua trinh dieu tri bang AzA; 7% cai thien nhe tai thoi diem Tl; 48% co cai thien bao gom 3,8% eai thi|n dang ke t£ii ttioi diem T4;
56,3% CO cai thi^n bao g6m 4,2% cai thien dang ke tai thoi diem T5. Tuy nhien, ti le nang hon ciing tang dan sau moi thang deh toi da sau 3 thang can thiep. Co den 24,6% truong hgp ram ma tang nang tai thai diem T3 (tuong iing thai ky khoang 6-7 thang), sau do ti le thai phu bi ram ma niing hon giam dan cho deh khi Scinh (T5) con thap hon so voi tai thai diem 1 thang sau boi AzA (8,3%). Khi so sanh ket qua danh gia chii quan thi nhom boi AzA eho k ^ qua vugt trpi so voi nhom mang khau trang co y nghia thong ke (pO,05) tu sau can thiep 3 thang (T3). Trong nghien ciiu, AzA da giiip cai thien miic dp ram ma tang dan tu sau thoi di&n Tl. Tuy nhien ti le ram ma nang hon tang dan va dat cao nhat tai thcri diem T3 la phu hpp voi dien tieh ttr nhien ciia ram ma trong thai ky, sau do giam dan tai
thoi diem T4 va dat tha'p nha't tai thoi diem T5 la phii hpp vdi dien tieh ve tac dung eua AzA.
Diem MASI trong nhom AzA co khuynh huong khong thay doi trong suot tiioi gian nghien ciiu va khong khac biet co y nghia thong ke khi so sanh tai thai diem theo doi sau can thiep Tx so voi thai diem bat dau can ttiiep TO (p>0,05). Ti le phan nhom MASI trung binh dao dpng nhe va c6 khu5mh huang tang (tir 5,3% len 8,3%) sau qua trinh dieu tri. Nguoc Iai ti le phan nhom MASI nang tang dan tix 7% deh 10,5% t?i thai diem T3, nhung sau do giam dan con tha'p hon truac can thiep (6,3%) tai thtri dian T5. Mgc dil su thay doi nay khong khac biet co y nghia thong ke (p>0,05) nhung vin co gia tri trong nghien oiu nay. Thay vi diem MASI hoic phan nhom MASI nang se tang d&i theo thai gian mang thai cho drai khi cham dut thai ky la diin tien tu nhien ciia ram ma trong thai ky khi khong CO ean thiep. Ke^ qua nghien ciiu da cho thay ram ma trong nhom boi AzA da khong dien tieh nang hon ma con cai thien th^ hien qua giam ti le phan nhom MASI nang tu sau thai
Y Hpc TP. Ho Chi Minh * Tap 20 * So 2 * 2016 Nghien cuti Y hpc
dietn T3. Dien tiai nay kha phii hpp voi tac dung ciia AzA. Sau 5 thang theo dSi, ti le ram ma CO chi so MASI on dinh hoac cai thien (phan nhom MASI nhe va trung binh) la 93,7%. Co su khac biet diem MASI giiia nhom can thiep bang AzA va nhom mang KT tir sau 4 thang can thiep (p=0,010). Mpt so nghien a i u ve hieu qua cua AzA, cho (hay AzA don tri Ueu eo hieu qua eao trong dieu tri ram ma, vai ti le thanh cong gah 95% (37/39), ket qua ciia chiing toi ciing phii hpp voi nghien euu nay.
Tnmg bmh,gia tri L trong nhom AzA dao dpng va CO khuynh huong tang khi so sanh thoi diem bat dau va thai diem ke't thiic nghien ciiu can thiep. Ti Ie phan nhom L cao tang dang ke tai thai dietn T5. Mac dii su thay doi nay khong co khac biet co y nghia thong ke (p>0,05) nhung van CO gia tri trcmg nghien ciiu nay. Thay vi gia tri L hoac phan nhom L cao se giam dan theo tiioi gian mang thai cho d ^ khi chain diit thai ky la dien ti&i tu nhien ciia ram ma trong thai ky khi khong CO can thiep. Ket qua nghien cihi da cho thay da so ram ma trong nhom boi AzA da khong dien Hen nang hon va co cai thien, dang ke la vao cuoi thai icy (tir 52,6% thupe phan nhom L thap liic dau chi con 35,4% ihuoc phan nhom L thap liic sanh). Khong eo su khac biet ve gia tri L ciing nhu phan nhom gia tri L tren cac nhom can thiep (p > 0,05).
Trong nhom AzA, tae dung phu xuat Men trong thang dau tien dieu tri (29,8%), khac hiet co y nghia thong ke so vai nhom khau trang (p <
0,01), sau do giam han va khong con tac dung phu sau 5 thang theo d6i. Nhu vay AzA co tac dung phu nhieu hon va cac tae dung phu nay biCTi mat cham hon trong nhom AzA. Tuy nhien tac dung phu cua AzA chi la cac daii hieu nhe nhu ngiia da, do da, cham chich, troc vay va khong xuat hien rr^'t hac to hay nhay cam anh sang hay benh mo xam ngoai sinh nhu tac dung phu ciia HQ. Tac dung phu a ca hai nhom can thiep bang Ihuoe boi deu b i m mat hoan toan sau mot thai gian (5 ttiang doi voi AzA). Cac nghien a i u tren the gioi ve AzA dieu tri ram TTUI ciing
eho ket qua tuong tu ve tac dung phu. Tac dung phu oia AzA trong nghien cihi nay chi la nhe va ttioang qua, tuang tu voi ket qua trong cac nghien ciiu khac'^"'^^'^*'.
KETLUAN
Nhom boi AzA co cai thien lam sang tang dan, eai thien ro nha't la tir sau^ffttiang can thiep, tuy nhien su khac biet khong co y nghia tho'ng ke. So sanh hieu qua giua cac nhom: boi AzA CO tac dung tri ram vuot trpi han so vai nhom mang KT 6 phu nii mang t h ^ Tac dung phu ciia AzA deu nhe, khong dang ke va mat
di sau 4-5 thang. « TAI LIEU THAM KHAO
1 Guinot C, Cheffai S, Latredle J (2010). Aggravating feclors for melasma: a prospective study in 197 Tunisian patients.
JEADV, 24,1060-1069
2 Hann SK, Im S, Chung WS, Kim DY (2007). Pigmentary Disorders in the South East Dermatol Oin, 2 5 , 4 3 1 ^ 8 3 Hexsel D, Rodngues TC, DalTomo T, Zechmeister-Pradp D,
Lima M M (2009). Melasma and pregnanq^ in Southem Brazil.
JEADV, 23,317-368.
4. Hoang Van Minh, Le Thai Yan Thanh (2003). Khao sat d Ig bieu hi&n lam sang benh da va morscTyeu to van hoa-xa hpi- Gsn thai CO lien quan t^tig.^hai ky. Tap dii yhgctp.HS Chi
Mmh. 7 (1). '• " > , 5 Ingber A (2009) Obstetric Dermalology. S p n n g ^ - ^ l a g Berlin
Heidelberg • . ' ^ i * ^ « - 6 Lakhdar H , Z o u h a i r K , K h a d i r K , E s s a J d A , E i l S T a n i " ^ ^ t e S ,
Rougier A (2007) Evaluation of the effectivenefes. of a ^ i | ^ - spectrum sunscreen in the prevention of chloasma in pte^tsnV%$^
womea/EADV, 21,738-742. \ \ "
7 Mom A. laberv Z, FallahN (2006). Prevalence and awareness of melasma during pregnancy. International Joamd of Dermalology, 45,285-288
8 Muzaffar F, Hussain I, Haroon TS (1998). Physiologic skm changes duiing pregnancy, a study of 140 cases. Inlemational Joumai of Dermatology, 3 7 , 4 2 9 ^ 1 ,
9 Molmar VE, Taylor SC, Pandya AG (2014). What's new m objective assessment and treatment of faaal hyperpigmentahon? Dermalol Ctin, 32(2): p. 1 2 3 ^ . 10. Nikolaou V, Stratigos AJ, Katsambas AD (2006). Estabhshed
treatments of skm hypermelanoses, j Cosmet Dermatol, 5(4). p.
303-8.
i l . Ortone JP, Arellano I, Bemeburg M (2009). A global survey of the role of ultraviolet radiation and hormonal influences m the development of melasma. JEADV, 23,1254-1261 12. Pandya A, et al (2006). Guidelines for dinical trials m
melasma. Pigmentation Disorders Academy Br } Dermatol.
156 Suppl 1: p . 21-8.
13. Bendon M, et al (2006). Trealment of melasma. Joumai of the American Academy of Dermatology, 54(5)^p^72-S281.
14. Schmidt AN, et al (2006); Oestro^Tteceptor-beta e>;pre9sion in m e l a n o c ^ ^ i l ^ m s , Exp Dermalol, 15(12): p. 971-80.
',/' /
Nghien ciiu Y hoc Y Hpc TP. Ho Chi Minh * Tap 20 * So 2 * 2016
15. Sheth VM, Pandya AG (2011) Melasma, a comprehensive ]^g^ „ft^„ ft^- ( , ^ . 24/11/2015 update JAm Acad Dermatol, 65 (4)
16, Wong RC, Ellis CN (1989). Physiologic skin changes in Ngfly phdn bOn nhm xit bdi bdo: 30/11/2015 presnancy,7AmA«rfD^««H8:7.n. Ngdy hdibdodUOC Sdng: 20/02/2016
