hon so vdi ba tinh cbn lai. Ket qua nghien cifu nfy cung cho tha'y ty If cO sd y te bj thiet hai do bao sd 9 ndm 2011 vd lu lut sau bao nf y If cao nhf't trong bfl'n tinh: 90,9% co sd y te tuydn tinh; 92.9% co sd y t l tuyen huyen va 41,8% tram y te xa [4], Thift hai do lut chiem ty If cao nhf't: 46,7% tdng sd Ifn ihift hai.
Ofc biet cd 9,9% tram y te xa vd 4,3% co sd y td tuydn tinh vd huyfn ti/ng bj bj thift hai tdi 5 Idn trong 5 ndm qua. Ty If tram y tf' xa bj thiet hai nhieu ldn cao hdn ty If ndy cua cO sd y td tinh vf huyfn cho thay tram y te xa 6h bi tdn thUdng bdi bao lut hdn so vdi cac cd sd y td tuydn tinh vf huyfn. Phat hien ndy cho thay tram y te xa cdn dupc dau tu, chuln bi sin sang tdt hdn de tdng cudng kha ndng i/ng phd vdi bao lut nham giam tdi da thiet hai cd the gay ra.
Ode diem ve kdt cf'u cua cd sd y td; trong sd 244 CO sd y td dupc danh gia, cd 63,9% cd sd y td cd mai tdn; 19,7% cd mai ngdi vd 7% cd mai bang xi mdng.
Ty If CO sd y te tuydn tinh cd mai bang xi mdng cdt thep cao hon ty If ndy ddi vdi tram y td xa: 12,7% so vdi 5,6%. Cd 21,3% tram y td xa vf 12,8% cd sd y td tuye'n tinh va huyen cd tudng gach vf mai ngdi. Thuc td tai Viet Nam cho thf'y co sd y te tuydn tinh vf huyfn thudng nhan dupc nhidu ddu tu hdn tram y td xa, do db cd sd y td tinh va huyen thudng dupc xay kien cd hdn tram y td xa. Nha kien cd mai be tdng cdt thep thudng dupc lam them mai tfln cd tac dung bao ve mai bang va lam ha nhiet dp ngfli nha trong miia he. Tuy nhien, vific cd them mai tfln ddi khi cung lam tang tfnh dfi bj tdn thuong cua cdng trinh ddi vdi gid bao ne'u nhu mai khong dupc thie't kd phii hpp va gan chat vao khung thep va vao mai nha. Dieu nay giai thich cho viec rat thudng thay la mai tdn cua cac tda nha bi gid bao lat tung. Ket qua danh gia thift hai cd sd y td do bao Xangsane va bao Kammuri da cung cap bang chifng cu t h l ve tdn thuong cua rnhufng mai tdn trong cac tba nha cua benh vien la hien hufu va can dupc chu y [2, 3].
Trong nhCfng nam gan day, nhidu co sd y td trong ca nudc da dupc nang cap, cai tao vf xay mdi. Kdt qua danh gia nay cho thay 56.1% sd cO sd y td dupc danh gia dupc xay dUhg va dUa vfo sif dung dudi 10 ndm (tfnh den thdi diem danh gia (bang 5). Tuy nhien, do mpt sd nguyen nhan, trong dd chii ydu la han che vd kinh phi nen cd tdi 9,0% sd co sd y td da cd thdi gian Slf dung tren 20 ndm va da xudng cdp. NhOng cO sd y
td nfy ddu cd nhOfng hang muc cdn dupc sifa ch&a, nf ng cf'p dd If m giam tfnh tdn thuong trudc bao lut va bao dfm cung cf'p djch vu y td, dap ifng nhu cdu cOa ngudi ddn trong didu kifn blnh thudng cung nhu trong tinh hudng tham hpa. Nhu cdu sifa chura cd sd y t i dupc hdu hfi't can bfl quan ly y td dupc phdng vdn trong nghifin cifu nfy dd cfp tdi. IVIflt can bfl Sd y te nbi:
"Trong 5 nSm qua, hiu hit cSc ca sd y ii tuyin huydn ciia chung tdi dS dugc stfa chtfa, ning cip, Cd mdt si dugc xdy mdi. Tuy nhidn gin 10% tram y ti xS trong ttnh dS dugc stf dung trdn 20 nSm. da xuing dp ndn cin duac tu bi. sCia chi/a nhiiu, thSm chi can xay mdl di cd thi ching lai bSo, tut".
KfeT L U A N V A KHUYD'N NGH!
50,5% CO sd y td dUpc danh gia nam d khu vifc thdp hofc gdn sdng, sudi cd nguy cd bj ngfp lut 18,0% d vj tri cd nguy co sat Id ddt. Trong 5 ndm (2004-2008). trung binh mfli cd sd y td tuyen tinh, huyfn da bj ^nh hudng bdi bao. lut mflt lan, Sd lan bj anh hudng trung blnh d Quang Ngai cao nhdt: 1.2 Idn, thdp nhdt d Kon Tum: 0,25 lan. Sd Idn cd sd y td bi anh hudng bdi lut chidm 46.7% tdng sd ldn anh hudng tich luy trong 5 ndm. 4,3% CSYT tuydn tinh vf huyfn timg bj anh hudng 5 Idn, Tram y td xa bj einh hudng bdi bao, lut cao hon CSYT tuydn tinh vf huyen: 9,9% so vdi 4,3%. Danh gif tfnh df bj tdn thUdng cua cd sd y te can duoc thuc hien thudng xuyfin nham phat hifn tfnh dfi bj ton thuong, tren cO sd dd thUc hien nhOng bifin phap lam giam tfnh de bj tdn thuong, tSng mifc do an toan cua CSYT trong tinh hudng cd thien tai. Qua trinh danh gia tfnh de bj tdn thUOng cua CSYT cung gbp phdn lam tdng nhan thi/c cua can bp y td ve phbng chd'ng va giam nhe tac dpng cua thien tai ddi vdi cd sd ytd,
TAI LI&U THAM KHAO
1. Ban chl dao PCLBTa (2009), Tong hdp thifit hai do bao Ketsana de'n 15 thang 10 ndm 2009. Truy cap ngay 20 thdng 10 ndm 2009 ti/www.ccfsc.org.vn
2. Ha VN, Le VT (2006). Report on rapid assessment on damage caused by Xangsane typhoon
3. Ha VN. Vu QH (2008). Report on RapW Health Assessment Yen Bai province
4. Worid health organization (2010). Report on assessment of damage to the health facilities caused by Ketsana typhoon in Viet Nam.
OAC DIEM L A M SANG, XQUANG
CUA BENH NHAN LAO PHOI TAI P H A T C 6 VI KHU JN K H A N G T H U O C
NGUY§N THU
HA, T R A N V A N S A N G ,OINH NGOC SY TOM
T A TTinh hinh khang thuoc cOa vi khuin iao d nudc ta d quan din binh lao phii tai phSt khang thuic. Phuong mtfc cap so vdi cac quoc gia khac trong khu vuc va phap: Phin ttch, md ta, tiin ctfu 106 binh nhan lao tren the gidi. Muc tieu: 1. So sanh dSc diim lam sang, phoi tai phat (duac chin doan xac dinh theo tiiu chuan.
Xquang cCia 3 nhdm benh nhan lao phii tai phSt cd vt cOa WHO 2007) chia lam 3 nhdm theo mtfc dd nh$y khuan nhay cam, khang da thuoc va khang thuic cam thuic: nhay cam (33 binh nhan), khang ia thm (khdng khang da thuoc). 2. Phan tich cac yiu to lien (34 benh nhan), khSng thuic (39 bdnh nhSn) 6i0
18 Y HOC THl/C HANH (782) - S6 9/2011
kham lam sang, chup xuang phot va nudi cay tim vi khuan lao trong mdt trudng Loweinstein - Jensen lam khang stnh do. Kit qua va kit luan: Tp le xuat hien cac trieu chUng lam sang ra m6 hdt dem, sui can. ran im d phoi cd xu hudng cao d 2 nhdm khang da thuoc va nhdm khang thuoc han nhdm nhay cam. Su khac biet cd y nghia vdt p < 0,05. Hinh anh tin thuang not trSn Xquang g$p nhieu d b&nh nljan nhdm khang thuic
(84,6%) han nhdm khang da (76,5%) va nhay (54.5%) vdt p < 0,05. Ton thuang tren Xquang mUc dd hai cd su khac biet giCta 3 nhdm khang da (64,7%), khang thuic (64,1%) va nhdm nhay cam (39,4%) vdip < 0,05. Cd 3 yeu toed lien quan chat che vdi khang thud'c (p <0,01) la: trieu chUng sut can (OR = 3,15 ) , tin thuang dang not (OR = 3.51) va mUc dd tin thuang tr&n Xquang (OR = 4,19).
TCf khoa: Lao phot tat phat. khang da thuoc. khdng thud'c.
SUMMARY
The situation of drug resistance of Mycobacterium tuberculosis tn our country constitute a high level compared with other countries in the region and the worid. Objectives: 1. Comparison of clinical features.
X-ray of the three groups of patients with recurrent pulmonary tuben:ulosts with sensitive, multi-drugs resistant and drug resistance bacteria. 2. Analysis of factors related to relapse pulmonry tuberculosis have drug resistance bacteria. Method : To analyse, descript, advanced study 106 patients with relapse pulmonary tuberculosis (diagnosed according to criteria defined by WHO 2007), divided into three groups based on drug sensitivity: sensitive group (33 patients), multi-drugs resistance (34 patients), drug resistance (39 patients.). Clinical examination and paraclinical tests: X Ray , cultures on Loweinstein Jensen media and drug sensitive test Results and conclusions: The rate of appearance of clinical symptoms night sweats, weight loss, moisture tn the lungs, which ran high in the two groups tend to have multl drugs resistant and drug resistant group than the sensitive group. Significant difference with p <0.05.
Images on X-ray damage score in patients having drug resistant group (84.6%) than multl drugs resistant (76.5%) and sensitivity (54.5%) with p <0.05. X-ray damage on level two ts the difference between the three groups most resistant (64.7%), drug resistance (64.1%) and sensitive group (39.4%) with p <0.05.
There are three factors closely associated with drug resistance (p <0.01) are: symptoms of weight loss (OR
= 3.15), lesions form nodules (OR = 3.51) and extent of lesions on X-ray (OR = 4.19).
Keywords: Recurrent pulmonary tuberculosis, sentive, multi-drugs resistance, drug resistance
DAT VAN DE
Viet Nam la mot trong 36 quoc gia nam trong "Dir an giam sat khang thuoc toan cau". dieu nay cho thay tinh hinh khang thuoc cCia vi khuan lao cf ni/dc ta cl mLTc cao so v6i cac quoc gia khac trong khu vi/c va tren the gidi. M6i nam nirdc ta co khoang 3 den 4 nghin ngi/di mac lao khang thuoc. Day thiic sir la con so dang lo ngai. NhijTng benh nhan dieu tri lai, trong do c6 lao phdi tai phat la nguon lay chinh phat tan nhumg chdng vi khuan lao khang thudc nay. Theo sd lieu thdng ke cCia
CTCLQG n§m 2009, sd benh nhan lao hang n§m cua nu'dc ta vao khoang hon 100 nghin ngu'di, trong d6 sd benh nhan dieu trj lai c6 ty le khdng nho (8,3%) [1], sd lUdng nay t3ng 1 % so vdi n§m 2008 (7,3%). Bdi vay hieu biet day du ve benh lao va ngudn lay benh lao khang thudc ddng mot vai trd khdng nho vao cudc chien chdng lai benh lao d ni/dc ta ndi rieng va tren toan cau ndi chung.
Chfnh vl the chung tdi da tien hanh nghien cifu nay nham muc tieu: 1. So sanh dSc diem lam sang, Xquang cua 3 nhdm benh nhan lao phdi tai phat cd vi khuan nh§y cam, khang da thudc vS khang thudc. 2.
Phan tfch cac yeu td lien quan den benh lao phdi tai phat khang thudc.
001 TaONG VA PHaONG
PHAP 1. Ddi turdng nghien curu.Nghien cCru 106 benh nhan tren 15 tudi, da di/dc chan doan xac djnh mac benh lao phdi tai phat cd vi khuan khang thud'c theo tieu chuln cCia WHO 2007 [6]
dieu trj tai Benh vien Phdi trung Udng tCr thang 3/2007 den 4/2010 dupc kham lam sang, chup X quang p^hdi va nudi cay vi khuan lao lam khang sinh dd de khang djnh chan doan.
2. PhUdng phap nghien curu.
Nghien ciru phan tfch. md ta. tien cClu.
Tieu chuan chon benh nhan: Tat ca cac benh nhan dUdc dieu trj lao phdi du thdi gian va da dUdc thay thudc xac djnh la khdi benh, nay mac benh trd lai va xet nghiem ddm AFB (+) bang soi tare tiep hoac nudi cay ddm BK (+).
ThCr nghiem tfnh nhay cam vdi bdn thudc dieu tri lao (S, H, R, E): Benh pham ddm cua nhdm nghien cuu dUdc dem nudi cay tim vi khuan lao tai benh vien phdi Trung Udng bang phUdng phap Petrof tren mdi tardng Loweinstein - Jensen, doc, phan tfch ket qua sau 2, 4, 6, 8 tuan sau dd chia lam 3 nhdm:
+ Nhdm nhay cam (Nhdm I): Gdm nhung benh nhan cd vi khuan khdng khang vdi 4 thud'c chdng lao hang mdt la streptomycin, isoniazid, rifampicin va pyrazynamid.
+ Nhdm khang da thudc (nhdm II): Gdm nhCrng benh nhan khang cung luc vdi nhieu loai thud'c chdng lad trong dd ft nha't cd cung khang vdi isoniazid va rifampicin.
+ Nhdm khang thudc (nhdm III): Bao gdm tat ca cac benh nhan cd khang vdi mdt hoac nhieu thudc lao nhung khdng cung luc khang vdi isoniazid va rifampicin.
Sd lieu thu thap dUdc xCr ly tren phan mem Epidata
KET QUA
Tdng sd 106 benh nhan (gdm 33 benh nhan cd vi khuan nhay cam, 34 benh nhan cd vi khuan khang da thudc va 39 benh nhan cd vi khuan khang thudc) dUdc chan doan xac dinh bj benh lao phdi tai phat, cd do tudi trung binh 45.38 ±12,93; nhd nha't la 16, Idn nhat la 75. Trong dd nam chiem 81,1%, nU chiem 18,9%.
Tudi tmng binh cCia nam la 44,15 ± 12,62; tudi trung binh cOanurla 50,65 ±13,26.
HHHHHHHHHHHANH (782) - SO 9/2011 19
Bang 1: So sanh trieu chCmg lam s^ng giijra 3 nhdm benh nhan tai phat
Trifiu iam sang Ra m6 hfli dfim
Sut can Ran am
Nhflm I (N = 33) 10 14
30,3 42,4 18 54,5
Nhflm II (N = 34) N 20 23 18
58,8 67,6
Nhflm III (N = 39) 13 28
52,9 30 76,9 33,3 71,8 <0,05 Nhan xet: Ty Id xuS't hidn cac tridu chifng ra md hdi dem, sut c§n v^ ran S'm khac nhau d 3 nhdm. SU kh^c biet n^y 1^ cd y nghTa p < 0,05
Bang 2: So s^nh loai tdn thUdng trdn Xquang giiJfa 3 nhdm bdnh nhan tai ph^t
\ . ^ Nhflm LoaiWft thaong ^ \
Nfit Tham nhiSm
Xo Hang
Nhflm 1 (N = 33) n 18 32 12 14
% 54,5
97 36,4
19
Nhflm II (N = 34) N 26 29 19 21
% 76,5 87,9 55,9 13
Nhflm III (N = 39) n
33 34 15 22
% 84,6 87,2 38,5 17
P
<0,05
>0,05 Nh$n xet: Hinh anh ndt v^ th§m nhiem hay gSp trdn Xquang d ca 3 nhdm hdn hinh anh xd v^ hang. Cd s u khac biet v ^ hinh anh ndt giua 3 nhdm bdnh nh§n vdi p < 0.05.
Bang 3: So sanh mute dp tdn thUOng trdn Xquang iua 3 nhdm benh nhan tai phat
\ ^ Nhflm MOcSA tfin thaong
1 II III
Nhflm 1 (N = 33) n 9 13 11
% 27,3 39,4 33,3
Nhflm II (N = 34) N 4 22
8
% 11,8 64,7 23,5
Nhflm III (N = 39) n
2 25 12
% 5,1 64,1 30,8
P
>0,05
<0,05
>0,05 N h i n xet: Mufc do II tren Xquang hay gSp hdn cac mtfc do khac d ca 3 nhdm. Cd sU khac biet d 3 nhdm ve mCfedd II vdi p < 0,05
Bang 4: Phan tfch cac yeu t d lien quan den benh ao phoi tai
Yeu tfi Sul can Hinh 4nh
nfit trgn Xquang Ofi tfin thaong X quang
phat khang thudc Chl sfi
Co Khflng
Co Khflng II va III
1
Khang thufic
51 22 59 14 67 6
Nhay c^m
14 19 18 15 24 9
OR (95%CI) 3,15(1,24
-8,08) 3,51 (1,31
-9,54) 4,19(1,19
-5,08)
P
<0,01
Nhan xet: Trieu chCmg sut can, hinh anh nd't v i mirc do tdn thUdng tren Xquang cd lien quan chat che vdi hien tUdng khang thudc cua vi khuan lao.
BAN LUAN
So sanh d&c diem lam sang, Xquang cdia 3 nhdm benh nhan lao phdi tai phat
Trong nghien cCru cua chung tdi ve trieu chCmg lam sang giua 3 nhdm cua benh nhan lao phoi tai phat cho thay chl cd 3 trieu chCmg ra md hdi dem, sut can, ran am d phdi la cd sU khac biet cd y nghia thdng ke (p <
0,05). Ca 3 trieu chifng nay deu cd xu hUdng gSp cao hdn d nhumg benh nhan thudc 2 nhdm khang da thudc (ra md hdi dem la 58,8%; sut can la 67,6% va ran am
la 52,9%) vi nhdm khang thud'c thudc (ra md hdi dem la 33,3%; sut can l i 71,8% v i ran I m \i 76,9%) hon nhdm nhSy clim thudc (ra md hdi dem la 30,3%; sut can la 42,4% va ran am la 54,5%). Ket qua nay cOa chiing tdi phu hdp vdi kdt qua nghien cifU cOa tac gia Ld Thj Kim Hoa (2000) [51. Didu nay phai chSng la do nhCfng bdnh nhdn lao phoi tdi phat cd vi khuan khang thudc thudng cd tdn thUdng nang, phai dieu trj lau dai ndn ^nh hudng nhi^u ddn tinh trang sire khoe ciia bdnh nhdn hdn nhiimg bdnh nhan cd vi khuan nhay clim.
Kdt qua vd loai tdn thUdng tren Xquang cOa chiing tdi chl ra rSng cdc loai tdn thUdng dang tham nhilm (nhdy cam 97%; khdng da 87,9%; khdng khang da 87,2%) vd ndt (khdng khdng da 84.6%; khang da 76,5%; nhdy 54,5%) gap nhieu hdn xd (khang da 55,9%; khdng khdng da 38,7%; nhay 36,4%) va hang (nhdy 19%; khdng khang da 17%; khang da 13%) va cQng cd xu hudng gdp cao hdn d nhOmg benh nhan c6 khdng thudc. Trong cac loai tdn thUdng thi chi cd hinh anh tdn thUdng ndt tren Xquang Id cd sU khac bidt vdi p < 0,05 giOfa 3 nhdm bdnh lao phdi tai phat. Ket qua ndy cOa chung tdi khdng gidng vdi nghien ciru cua tac gid Ld Thj Kim Hoa, cd the do hai loai ddi tUdng nghien ciru Id khdng gidng nhau. [5]
Nghidn ciru ve mifc dp tdn thUdng tren Xquang cOa 3 nhdm bdnh nhan lao phdi tai phat chiing tdi nhan thdy mirc do hai cd ty Id gdp cao hdn ca. cao nhat la nhdm khang da (64.7%), tid'p den la nhdm khang thudc (64,1%) va cudi ciing la nhdm nhay cam (39,4%). Sif khdc bidt ndy cd ^ nghTa vdi p < 0,05. Nghien ciiU nay ciia chiing tdi gidng vdi ket qua nghidn cua cac tac gia khac nhu Ld Ngoc Hung (2007). Hodng Ha (2009). Le Thj Kim Hoa (2009). LUU Thj Lien (2009) [2.3.4,5]
Lien quan gitra ldm sang. Xquang vdi benh lao phdi tai phat khdng thudc
Phdn tich cac yeu td lien quan den benh lao phdi tai phdt cd vi khuan khdng thudc da chi ra rang chi c6 3 yd'u td la tridu chimg sut can. tdn thUdng dang ndt va mifc do tdn thUdng tren Xquang la cd lien quan chat che vdi khang thudc (p < 0.01) Id: sut can (OR = 3.15), tdn thUdng dang not (OR = 3.51) va mdc do tdn thiiOng tren Xquang (OR = 4.19). Nhan xet nay cua chung toi cung gidng vdi nghien cifU cua Hodng Ha (2009). [3]
Ke'TLUAN
Ty Id xud't hien cac tridu chimg ldm sang ra mo hoi dem, sut can, ran im d phdi cd xu hudng cao ci 2 nhdm khang da thudc va nhdm khang thudc hdn nhom nhay cam. Su khdc bidt cd y nghTa vdi p < 0,05.
Hinh anh tdn thUdng nd't tren Xquang gap nhieu ci bdnh nhan nhdm khang thud'c (84,6%) hdn nhom khang da (76,5%) va nhay (54,5%) vdi p < 0.05.
Ton thUdng tren Xquang mirc do hai cd sU khac bidt giira 3 nhdm khang da (64.7%), khdng thuoc (64,1%) va nhdm nhdy cam (39.4%) vdi p < 0,05.
Cd 3 yeu td cd lien quan chat che vdi khang thuoc (p < 0,01) la: trieu chifng sut can (OR = 3,15 ), ton thUdng dang ndt (OR = 3,51) va mifc do tdn thifdng tren Xquang (OR = 4,19).
20 Y HOC THirC HANH (782) - SO 9/2011
TAI LIEU THAM KHAO
1. CTCLQG (2009), "Bao cao tdng ket ChUdng trinh Chdng lao Qudc gia nSm 2009 va phUdng hUdng hoat dong nSm 2010". Ha N611/2008. Tr. 5,6.
^ 2. Le Ngoc Hung va cong sU (2007), "Nghien cUu dSc diem lam sang, can lam sang va tinh hinh khang thudc cua lao phdi tai phat". Tap chl thdng tin y duac si dSc bt$t chao mCtng hot nght khoa hoc b&nh phii todn quic iin thU 2, Ha ndi 10/2007. Tr 148-153
3. Hoang Ha (2009), "Nghien cilU mot sd dSc diem iam sang, can lam sang, sinh hoc ciia vi khuln d bdnh nhan lao phdi dieu tri lai". Lu$n an tten spy hoc.
4. Luu Thi Lien, Nguyin Thj PhUdng Thao va cong sU (2009), " Dac diem lam sang, xquang phdi, tfnh khang thudc cLia vi khuan lao blng ky thuat MGIT d benh nhan lao phdi tai phat tai benh vien lao va benh phdi Ha Noi".
KJ? yiu hdt nghi khoa hoc b&nh phii todn qud'c tin thit III, Hd Not 11/2009. Tr 300 - 305
5. Le Thj Kim Hoa (2009), "Nghien ciru dSc diem lam sang, cdn Idm sdng cua lao phdi c6 vi khuan khang da thudc". Ludn vdn chuydn khoa II.
6. WHO (2007), "Global TB control: surveillance, planning, financing", WHO report, Geneva 1-4
BAO CAO M O B E N H HOC 2 TBIANG HOP BENH CBOHN (CD)
NGUY§N VAN HUNG, T R A N NGOC MINH, N G U Y I N T H O Y HUONG Trudng D?i hpc Y Hi N^i
TOM TAT
Benh Crohn (CD) duac coi la bdnh tu miin dtch.
trong dd he thong miin dich cOa ca thi tin cdng dudng tieu hda gay viem. Muc tieu: Xac dinh ddc diim md benh hoc benh Crohn dua theo tidu chuin md hoc Nottingham 2000 vi bdnh rudt vidm (IBD). Phuong phap nghien ciiu: Cac benh phim ngoai khoa cCia 2 benh nhan benh Crohn duac nghidn cUu vi md hoc.
Kit qua: Cdc manh cit dai trang cho thd'y vi dai thi hinh anh Idt da cOa niem mac, vdch rudt ddy. tin thuang nhay cdc: ve vi thi. ciu true khe tuyin khdng deu tUng o, viem man tinh xuyen thanh tCfng i, u hat dang bieu md, nUt niem mac, mit chit nhay d day khe tuyin. Kit luan: Cdc tidu chuan htnh thdt hgc Nottingham (2000) ve benh rudt viem cd thi cho phep phan bidt dugc bdnh Crohn (CD).
TCr khda: benh rudt viem (IBD), benh Crohn (CD), viem dai trdng.
SUMMARY
Crohn's disease is thought to be an autoimmune disease, in which the body's immune system attacks the gastrointestinal tract, causing inflammation.
Objective: To determine the histopathological features of Crohn's disease (CD) based on the Nottingham 2000 histological criteria for inflammatory bowel disease (IBD). Methods: Surgical resection samples of two patients with Crohn's disease are researched histologically. Results: surgical samples of colon have indicated macroscopically the cobblestone appearance, thick intestinal wall, skip lesions, and microscopically, focal crypt architectural irregularity, focal transmural chronic Inflammation, epithelioid granuloma, mucosal fissures, mucin depletion tn crypt bottom. Conclusions: Nottingham 2000 morphological criteria for inflammatory bowel disease (IBD) is possible to distinguish Crohn's disease (CD).
Keywords: inflammatory bowel disease (IBD), Crohn's disease (CD), colitis.
DAT VAN OE
Bdnh Crohn (CD) dUdc coi la benh tu midn djch, trong dd he thdng midn djch ciia cd the tan cdng dudng tieu hda gay viem. Bdnh cd nhOmg bieu hidn he thdng vdi tdn thUdng chfnh d dudng tieu hda gdm nhirng dac diem lam sdng va bdnh hoc kha dac bidt
difdc dac trung bdi vidm xuydn thdnh (toan bd vdch rudt), khdng dd'i ximg, khu trii vd ddi khi tao d vidm u hat [3]. Ton thUdng da he thdng cd the cd nhQng bieu hidn khdc d ngoai dudng tieu hda nhu khdp, da,... vd cd the gdp ba't ky d lira tudi nao nhung khdi dau bdnh thudng d do tudi thap nien thif hai hoac ba. Cho den nay nguyen nhan gay bdnh van chUa sang td. Ty Id mac bdnh d My vd mdt sd nudc Tdy au trong giai doan 1975 -'l985.vao khodng 2,3 - 9,8/100.000 ddn. T^'le benh Crohn (CD) tai Thuy dien la 4,9/100.000 (giai doan 1985-1989) da tang ldn 8,3/100.000 dan (1990- 2001); d nudc Anh Id 3,9-8,3/100.000 dan trong cung khoang thdi gian. Hien nay, ty Id nay da tang dang ke d nhieu nudc tren the gidi [6].
Tai chdu A, mdi cd rat ft qudc gia nghien cifu va cdng bd ty Id mac benh rudt viem (IBD) ndi chung (gdm 2 the b%nh la viem dai trang loet (UC) vd bdnh Crohn (CD). Theo mdt nghidn ciTu d Hong kong, tj' Id mac benh Crohn (CD) tU 0,3/100.000 (1986-1989) tang tdi 1,0/100.000 (1999-2001). Mdt nghien cifU khdc gan ddy nha't kdo ddi 15 nam tai Tnjng qudc da phdt hien 143.511 ca mac benh rudt vidm (IBD), trong did, 140.120 ca vidm dai trdng loet (UC) va 3391 ca benh Crohn (CD). Cdc tdc gia da nhan thay ty Id benh Crohn (CD) dUdc phdt hien trong 5 nam cud'i tang gap 8,5 lan so vdi 5 nam dau tien khi bat dau nghien culi [6].
Cho de'n nay d Viet Nam chua cd tdi lieu nao cdng bd ve t^ Id benh rudt viem (IBD) ndi chung cung nhu 2 the benh cda nd Id viem dai trang Iodt (UC) va benh Crohn (CD). Hdn niira, van cdn ft cdng trinh nghien ciru ve md benh hoc benh Crohn (CD), ddng thdi nhiimg nghien cifu ndy chua cap nhat nhirng tieu chuan md bdnh hoc Nottingham 2000 (din theo 2). Do vay, chung tdi bdo cdo 2 ca bdnh Crohn (CD) dUdc chan dodn sau phau thuat ngoai khoa tai Benh vidn Oai hoc Y Ha ndi.
B A O C A O CA BENH - Benh an 1
Benh nhdn: Nguydn V. Th. 48 tudi, nam. Vdo vidn:
22/2/2011 vdi 1^ do dau bung vung quanh rdn; ra vidn:
04/3/2011.
Y HOC THI/C HANH (782) • SO 9/2011 21
