TCNCYH Phu trwong 74 (3) -2011
KHi MAU DONG MACH 0 BENH NHAN VIEM TUY CAP
Nguyin Thj Van Hdng Trwang Dai hoc Y Hi Ndi Nghien ciru nhim doi chiiu kit qua khi mau ddng mach vdi cie mux: do viem tuy cip theo bang aim Imrie va Balthazar Doi twang: benh nhan viem tuy cip tai khoa tieu hda va khoa aiu tri tich cwc benh vien Bach Mai. Nghien cuv tiin ciru. Kit qua 90 benh nhan viem tuy cip. Ty le nam/ nW la 2,3/1, Diim CTSI tmng binh a nhdm benh nhin cd aim Imrie < 3 li 3,6 ±2va>3li 6±2, kit qua khac nhau cd y nghTa thong ke p = 0,01. Pa02 < 70 mmHg a nhdm viem tuy cip cd Imrie < 3 aim la 12,5%, nhdm viem tuy cip nang Imrie > 3 aim la 30,7%. Pa02 < 70 mmHg nhdm viem tuy cip nh? CTSI 0-3 aim li 11,4%, viem tuy cap vwa vi nang CTSI 4-10 aim li 21,7%. Kit luin: 1, Kit qua khi miu ddng mach vdi Pa02 < 70 mmHg la gia tri ngwang dinh gii mire do viem tuy cip nang. 2, Kit qua Pa02 giam <
70 mmHg gap nhiiu hon a nhdm viem tuy cip nang cd diim Imrie >3li 30,7% so vai nhdm Imrie nhe <3la 12,5% sw khic bi$t p = 0,05. Kit qua Pa02 giim < 70mmHg a cie nhdm CTSI vira vi nang nhiiu han nhdm chi sd CTSI nhe cd p = 0,18. 3, Giam pH miu, giam PaC02 va giam bicarbonat miu gap nhiiu a cie nhdm viem tuy cip nang nhwng khac biet khdng cd y nghTa.
Tir khoa: viem tuy d p , Imrie, CTSI chi s6 danh gia mu-c do trilm trong viem tuy d p , khi mau dong mach
I. OAT
V A NDt
Khi miu ddng mach l i thdng tin dugc u-ng dung nhiiu trong thye hinh lam sing. Khi miu ddng mach phan inh tinh trang roi loan thdng khi, rdi loan thing bing kiim toan, rdi loan nude v i dien giai. Khi miu ddng mach cdn dugc su- dung nhu mdt thdng so theo ddi dinh g i i tidn lugng ning cua benh. Ton thuang nhieu hd ca quan dugc phan inh thdng qua k i t qua khi m i u ddng mach trong dd cd bdnh vidm tuy cap. Vidm tuy c i p l i benh tiin triin cap tinh cd dien biin ning tiiy theo viem tuy cap t h i phii ne hay t h i hoai tu-. Viem tuy c i p t h i hogi tu- cd nguy ca tu- vong cao. Nhii'ng thay doi v i khi miu ddng mach l i d i u hieu phan i n h trung thinh tien lugng benh. Hidn nay cd nhiiu gia thiit ve su thay doi khi mau ddng mach trong viem tuy cip ning trong dd vai trd cua cytokin dugc luu y die bidt: 1 Gia thiit nay cho ring khi benh tien triin ning, eic cytokin dugc giai phdng die biet l i cie chemoeytokin d i n d i n chit t i bio hing loat, 2 Gia thiit cho ring enzym eua tuy dugc giai phdng hoat hda he thong kallikrein-kinin, g i y ting tiit cie chit giin mach nhu bradykinin, serotonin d i n din phti n i v i xuit tiit djch. Cd gia thiit giai thich sy roi logn khi m i u ddng mach d benh nhin ton thuang tuy ning do khdng phCi hgp giua thdng khi vi tudi miu d phoi, han e h i khuyich t i n oxy phi nang - mao mach, v i q u i trinh giy chit t i bio, diy chinh l i ca ehi xuat hidn hdi ehCpng tyy phoi d bdnh nhin vidm tyy eip;.ea e h i n i y dugc khic phyc
sdm se cai thien ty Id tu- vong. Nghien CLPU khi miu ddng mach d benh nhin viem tuy cip giup ed them cie bing chCpng giai thich tinh trang tinh trang suy tang d benh nhin viem tuy cip. Bk t i i nay dugc tiin hinh vdi muc tieu: Doi chiiu kit qua khi miu ddng mach vdi cie mCpc dp viem tuy cip theo bang diem Imrie v i Balthazar.
11. D Q I TU'QNG VA PHU'QNG PHAP
1. Nghien ciPU tiin cu'u: dugc thye hien trong thdi gian tip thing 1/2010 din thing 7/2010 tai khoa Tidu hda v i khoa Hoi SCPC cip CCPU benh vidn Bach Mai.
2. Ddi tu'O'ng: Tidu chuin lya chpn benh nhin dugc chin doin x i c djnh viem tuy cip khi ed trieu chCpng dau bung tren rdn, dau can, xuat hidn dot ngdt cd t h i cd tinh trang bung chudng, phan Cpng thinh bung kem vdi 1 trong 2 diu hidu c i n lim sing.
Sinh hda: hoat dp amylase trong miu ting > 2 lin binh thudng (binh thudng: < 220mmol/l)
CT (chup c i t Idp vi tinh): cd hinh anh viem tuy cip. Tidu chuin loai trii-: viem tuy man, ung thu tuy, ting amylase miu ngoii tuy.
3 Tieu chuin danh gia: tinh trang viem tuy cip theo bang diim Imrie v i Balthazar (xem bang diim Imrie).
Tieu chuin dinh g i i mCrc dp vidm tgy cip ning khi cd til- 3 d i u hipu trd Idn.
TCNCYH Phu trwong 74 (3) -2011 Bang diem Imrie:
Tudi
Bach c i u mau Dudng mau
Albumin huyit thanh Pa02
Ure mau LDH mau Canxi mau
> 5 5
> 15G/I
> lOmmol/l
< 32 g/l
< 60 mmHg
> 16mmol/l
> 600U/1
< 2mmol/l
Bang diem Balthzar: bang diim dinh gii mCpc dp viem tuy cap dya vao cac chi sd tren hinh anh chup CT bung cd tiem thude can quang.
CTSI (CT severity index) chi sd dinh gia mipc dp trim trpng gdm tdng diim miPc dp viem +
diim hoai tu' tuy
Nhe Trung binh Nang
0 - 3 diem 4 - 6 diem 7-10 diem Bang diem Balthzar:
MU'C d p viem tuy c i p Do A tuy binh thudng
Dp B tuy to toan bp hay tipng phan b d tuy cdn rd net Op C viem va tham nhiem md m d quanh tuy, mat dudng v i i n cua b d tuy
Op D Cd 6 djch quanh tuy
Op E cd 6 djch quanh tuy va xa tuy
D i i m 0 1 2 3 4
MCPC d p hoai tip t u y Khdng hoai t u Hoai tu- < 30% tuy Hoai tLP 30 - 50% tuy Hoai t u > 50% tuy
D i i m 0 2 4 6
III. KiTQUA
Nghien CCPU dugc thuc hien tren 90 benh nhan viem tuy cip, nhip vien tai khoa tieu hda va khoa diiu trj tich cue benh vien Bach Mai. LCpa tuoi viem tuy cap hay gap tuoi trung nien < 50 tudi, ty le nam/nu- 2,3/1.
Bang 1. Phan dp viem tuy c i p theo Balthazar (n = 90 benh nhan) Phan dp viem tuy cap theo Balthazar 0 / /o
MCPC dp viem
MCPC dp hoai tCp tuy
Op A O p B D d C D p D D p E
Khdng hoai tLP tuy Hoai tLP < 30%
Hoai tu- 30 -• 50%
4 2 10 26 22 65 15 7
6,2 3,1 15,6 40,6 46,7 72,2 16,7 7,8
Hoai tLP > 50% 3,3
Tong sd 90 100,0
72,2% benh nhan khdng cd hoai tu tuy (viem tuy c i p the phii ni). Hoai tu tuy > 30% chiem 11,1%.
Bang 2. Phan dp viem tuy c i p theo chi sd CTSI ddi chiiu vd-i diim Imrie (n = 90) Phan bd benh nhan viem tuy cap theo chi sd CTSI
Diem Imrie 0 - 3 diem 4 - 6 diem 7 10 diim Tong so
< 3
> 3 Tong so
n 40
4 44
% 44,4
4,5 48,9
n 21 15 36
% 23,3 16,7 40,0
n 3 7 10
% 3,3 7,8 11,1
n 64 26 90
% 71,0 29,0 100,0
TCNC YH Phu trwong 74 (3) 2011 Nhdm viem tuy cip phin dp nang theo bang diim CTSI la 10 benh nhin, theo bang diem Imrie l i 7 benh nhin, tuy nhien trong nhdm CTSI nhe ed 4 benh nhan cd diem Imrie nang.
Bang 3. Diem CTSI trung binh o- cac nhdm viem tuy cip theo phan dp Imrie Diem Imrie n % Diim CTSI trung binh
<3 64 72J 3,6 ± 2 001
~^ 26 28^9 6 T 2
Diim CTSI trung binh d nhdm BN ed diim Imrie < 3 va > 3 la khac nhau cd y nghTa thong ke p = 0,01.
Bang 4. Sy phan bd khi mau dpng mach d" benh nhan viem tuy cip theo bang diim Imrie va chi sd CTSI
Ket qua khi mau dpng mach
Diem Imrie Chi sd CTSI
nhe < 3 ning > 3 0-3 diem 4-6 diem 7-10 diim n % n % n % n % n %
<7,35 33 51,6 8 30,8 26 59,1 11 30,6 4 40,0 pH 7,35-7,45 18 28,1 10 38,4 12 27,3 12 33,3 4 40,0 Pa02mm
Hg
>7,45
< 6 0
> 6 0
13 1 63
20,3 1,6 98,4
8 5 21
30,8 19,2 80,8
6 1 43
13,6 2,2 97,8
13 2 34
36,1 5,6 94,4
2 3 7
20,0 30,0 70,0
<35 19 29,6 16 61,5 11 25,0 18 50,0 6 60,0 pgQO,
35-45 44 68,8 8 30,8 32 72,8 17 47,2 3 30,0 mmHg
>45 1 1,6 2 7,7 1 2,2 1 2,8 1 10,0 HCO3
mmol/l
<23 49 76,6 18 69,2 36 81,8 24 66,6 7 70,0 23-28 5 7,8 5 19,3 3 6,8 6 16,7 1 10,0
> 2 8 Tong sd
10 64
15,6 100
3 26
11,5 100
5 44
11,4 100
6 36
16,7 100
2 10
20,0 100 Biiu hien toan miu imrie nhe 33/64 benh nhan (51,6%), nhdm Imrie nang 8/26 benh nhan (30,8%) PaC02 giam < 35mmHg.
Nhdm Imrie < 3 diim l i 29,6%, nhdm Imrie > 3 diem la 61,5.
Chi sd CTSI 0 - 3 diem 25%, CTSI 4 - 6 diem 50% va CTSI 7-10 diem 60%.
Giam bicarbonat miu:
Nhdm Imrie < 3 l i 76% v i Imrie > 3 l i 69,2%.
Chi sd CTSI 0 - 3 diem, 4 - 6 diim v i 7 -10 diem ty le nay lin lugt la 81,8%, 66,6%, v i 70%.
Su khic biet giCi-a cac nhdm l i khdng cd y nghTa thing ke.
Bang 5. By phan bd Pa02 a cac nhdm viem tuy cip theo bang diem Imrie va chi sd CTSI Pa02
(mmHg)
> 9 0 80-90 70-80
< 7 0 Tong
CTSI 0 n 7 16 16 5 44
- 3 diem
% 16,0 36,3 36,3 11,4 100
CTSI 4 n 18 10 8 10 45
• 6 diem
% 39,2 21,7 17,4 21,7 100
Imrie n 15 21 20 8 64
< 3
% 23,4 32,8 31,2 12,5 100
Imrie n 10
5 3 8 26
> 3
% 38,5 19,3 11,5 30,7 100
TCNCYH PhLi truxyng 74 (3) - 2011
Kit qua Pa02 giam < 70 mmHg gap nhiiu han d nhdm viem tuy cap cd diem Imrie > 3 l i 30,7% so vdi nhdm Imrie < 3 la 12,5% su khac biet p= 0,05.
Kit qua Pa02 giam dudi 70mmHg chiim 16,6%
so benh nhin. Pa02 giam gap d t i t ca cie nhdm viem tuy cap ning cung nhu nhe. Sy khac biet v i ehi so Pa02 < 70 mmHg d 2 nhdm viem tuy c i p ed CTSI nhe so vdi nhdm CTSI vii-a va nang cd p = 0,18.
IV. BAN LUAN
Dinh g i i mipc dp viem tuy c i p ddng vai trd quan trpng trong thye hinh lim sing. Odi vdi cie trudng hgp viem tuy c i p ning (thi hoai tu-) benh thudng tiin triin ning vdi nhiiu bien ehCpng nhu nhiim khuin, suy da tang v i ty Id tu- vong cao [9].
Do viy cac trudng hgp viem tuy cip nang benh nhin cin dugc theo ddi v i diiu tri die biet, nhieu trudng hgp cin i p dung phuang phip Ipc miu giup Ipai bd cac cytokin [8]. l/ng dung 2 bang diim Imrie va Balthazar de dinh g i i mCpc dp viem tuy cip. Bang diim Imrie su- dung 8 thdng so danh g i i mu-c dp viem tuy cip, khi ed tip 3 yeu to trd len l i viem tuy cip miPc dp ning. U'u diim bang diim Imrie dan gian d i ding i p dung d eic khoa lim sang. 90 benh nhin viem tuy cap dugc nghidn CCPU
trong dd viem tuy cip mCpc dp ning theo bang diim Imrie l i 26 benh nhan, chiim 28,9%.
Ddi chiiu cie y i u td tien lugng viem tuy c i p theo bang diim Imrie vdi ehi sd CTSI cho thiy theo phin dd Imrie cie benh nhan viem tuy c i p mCpc dd nhe cd ehi so CTSI trung binh l i 3,6 ± 2 diim thip han ed y nghTa thing ke so vdi nhdm viem tuy c i p mCpc dd ning cd ehi so CTSI trung binh 6 ± 2 vdi p < 0,01 [1]. Phin dp viem tuy c i p theo k i t qua chup CT cd tiem thuoc can quang giup dinh g i i chinh xic tinh trang viem tuy c i p eic mCpc dp tu djch quanh tuy hay xa tuy kem them mCpc dp hoai tLP tuy [2]. Theo CTSI bdnh nhin vidm tuy cip mCpc dp nhe l i 44 ngudi chiem 48,9%, mCpc dp vii-a l i 36 ngudi chiim 40% v i mCpc dp nang la 10 ngudi chiim 11,1%. Sd benh nhin viem tuy c i p mCpc dp ning trong nghien CCPU cao han so vdi k i t qua cua t i c gia ArvanitakisC mCpc dp ning chiim 5,9%.
Trpng nghien CCPU ed 25/90 benh nhan (27,8%) ed ten thuang haai tu- tuy. Hpai tu- mu'c dd < 1/,3 tuy chiim 16,75%, 10 bpnh nhin ed heai tu- >1/3 tuy
diu thude nhdm CTSI nang tCi- 7-10 diem, 9/10 benh nhan ed tiin trien l i m sang ning vdi bieu hien suy da tang can nim diiu trj tai khoa diiu trj tich cue. Chi so CTSI cd g i i trj phan loai mCpc dp viem tuy c i p dong thdi cd g i i trj cao trong tien lugng benh [2].
Oo luang khi m i u ddng mach dugc thye hien tren t i t ca cac benh nhin viem tuy cip. Nhiim toan l i mdt trong nhii-ng biin chCpng ning eua vidm tuy cap. Nhiim toan la d i u hieu bio hieu tinh trang suy thin hay ning han la suy da tang. Viem tuy cip nang cd hidn tugng tich tu djch trong to chCpc din din giam huyet ddng d i n d i n vide Ipc d ciu thin giam, han nCi-a tinh trang thiiu cxy to chipc giy hoai tu- te bio, nhiim toan te bao, tang ion H*
trong miu, giam bicarbonat huyit tuang din tdi toan chuyin hda [3,8]. Theo phin dp Imrie bieu hien toan mau chiim 33/64 benh nhin (51,6%) vdi nhdm Imrie nhe < 3 diim v i 8/26 benh nhin (30,8%) vdi nhdm Imrie > 3 diem. Tinh trang thdng khi va giam bicarbonat m i u k h i thudng gap [4]. Theo phin dp eua Imrie cd 16/26 benh nhin (61,5%) nhdm Imrie > 3 diim ed PaC02 < 35 mmHg, trong khi dd nhdm Imrie < 3 diim ty Id niy chi chiim 29,6%
(19/64 benh nhin), vdi phin dd Balthazar ty Id nay lin lugt l i 25%, 50%, v i 60% tuang Cpng d cac nhdm nhe vira v i ning. Giam bicarbonat miu gap d 76% sd benh nhin viem tuy c i p cd diim Imrie
< 3 v i 69,2% ed diem imrie > 3. Theo phin do Balthzar ty Id niy lin lugt l i 81,8%, 66,6%, v i 70%
vdi cie nhdm CTSI nhe vii-a v i ning. Sy khic biet giii-a eic nhdm l i khdng ed y nghTa thong kd.
Phin ap oxy m i u ddng mach < 60 mmHg [6]
ehi g i p d 6 bdnh nhan chiim 6,7%. Tit ca cie benh nhin d i u ed tinh trang suy hd hip trdn lim sing ning c i n phai thdng khi nhin tao ed xim nhip k i t hgp vdi eic bien phip hdi su-c tich cue [1,8] (Ipc ming miu, din luu djch ming bung).
Nhii-ng benh rihin c i n ed thdng khi hd trg bit dau iit phin i p oxy ddng mach < 70mmHg. Hau het cie benh nhin nhdm niy ed eic bien ehCpng ning sau dgt viem tuy c i p nhu nhiem triing, nang gia tuy, 6 tu djch trong 6 bung...[5,6,8]. Niu cit ngang Pa02 < 70 mmHg theo phin dp Imrie < 3 l i 8/64 benh nhin (12,5%), so vdi nhdm Imrie ning ^ 3 diim l i 8/26 (30,7%) bdnh nhin sy khic bidt l i c6
<l nghTa thong kd vdi p = 0,05. Tuang ty nhu chi s6
TCNCYH Phu trwong 74 (3) - 2011 CTSI nhe ehi ed 5/44 benh nhin (11,4%) cd Pa02
< 70 mmHg cdn d nhdm CTSI vira v i ning l i 10/46 benh nhin (21,7%). Kit qua Pa02 trong nhiiu trudng hgp khdng phan i n h chinh xic tinh trang ton thuang tuy cd the ly giai do hau hit cie bdnh nhin khi nhip vien trong tinh trang nang xu- tri cip CCPU da thdng khi hd trg [4] cho benh nhin nen kit qua Pa02 ting cao han, ed trudng hgp Pa02 > lOOmmHg nhung khi theo ddi tiin triin bdnh ning len Pa02 da lai giam di trong 72 gid tiep sau dd. Niu phoi hgp ca 2 nhdm thdng tin Pa02 v i cie ehi sd dinh g i i mCpc dp nang eua benh CTSI hay diim Imrie thi vide dinh gia tien lugng benh nhin chinh xic han. Pa02 < 70 mmHg d cie nhdm viem tuy cip nang theo Imrie hay Balthazar diu cd bien chCpng ning, thdi gian nam vien liu han, cin phai cd nhieu can thiep ho trg diiu trj [6,8]. De cd thdng tin Pa02 phan i n h chinh xac mu-c dp suy hd hip d benh nhin vidm tuy cip nhieu khuyin cio dugc d i nghi lim khi mau ddng mach trude khi thdng khi hd trg, hay khi theo ddi niu benh nhan cd tinh trang biin chuyin nghi ngd ning cin lim khi miu ddng mach niu Pa02 giam so vdi thdng tin trude dd l i diu hieu bio hieu benh nang [6, 8].
V. K^T LUAN
Kit qua khi miu ddng mach vdi Pa02 < 70 mmHg l i gii trj ngudng danh g i i mCre dp viem tuy cip ning.
Kit qua Pa02 giam < 70 mmHg gap nhiiu han d nhdm vidm tuy c i p ning ed diim Imrie s 3 l i 30,7% SP vdi nhdm Imrie nhe < 3 l i 12,5% sy khic bidt p = 0,05.
Kit qua Pa02 giam < 70mmHg d cie nhdm CTSI vira v i ning nhieu han nhdm ehi sd CTSI
nhecd p = 0,18.
Giam pH miu, giam PaC02 v i giam bicarbonat miu gap nhiiu d cie nhdm viem tuy cip ning nhung khic biet khdng ed y nghTa.
TAI LIEU THAM KHAQ
1. ArvanitakisC, (1999). Acute pancreatitis gastroenterology and hepatology 23, 211 - 226.
2. Balthazar E.J, Robinson D.L, Megibow E.J, (1990). acute pancreatitis: value of CT in establish- ing prognosis Radiology 174: 331-336.
3. Daniel Jackson W, (2001). pancreatitis etiology, diagnosis and management Currento opinion in pediatric Vol 134, 447 - 451.
4. Nguyin Thi Van Hdng, (2010). Tinh trang khi miu ddng mach d benh nhin xa gan, tap ehi nghien CCPU Y hpc, Trudng Dai hpc Y H i Ndi, vol 69, No 4, 64 - 70.
5. Nguyin Trpng Hiiu, (2009). Nghien CCPU gii tri lnterieukin-6 v i protein C phan Cpng trong dinh gii mCpc dp ning nhe cua viem tuy cip luin i n tiin sT Y hpc, Trudng Dai hpc Y H i Ndi.
6. PeterA.B, Martin L.F, (2006). Practice guide- lines in acute panereatiti American journal of gas- troenterology 101: 2379 - 2400.
7. SimchukE, Traverso LW, Nukui Y, Kozarek RA, (2004). Computed tomography severity index is a predictor of outcomes for severe pancreatitis Am J Surg.
8. Triester SL, Kowdley KV, (2002). Pronostie factors in acute pancreatitis J din gastroenterol 34:
167-176.
9. Wubu, Johannes RS, Sun X et al, (2008).
The eariy prediction of mortality in acute pancreati- tis: A large population-based study Gut 57, 1698.
Summary
ARTERIAL BLOOD GAS IN ACUTE PANCREATITIS
Arterial blood gas is one of the important factor for predicting severity and progession of severe acute pancreatitis. Objectives: to evaluate arterial blood gas analysis according to severity of acute pancreatitis by Imrie score and Computer tomography severity index. Methods: A prospective study of all patients diagnosed with acute pancreatitis (AP) at GI department and ICU in Bach mai hospital. Results: There were 90 patients with AP. Male/ female: 2.3/1. We classified 64 patients (71.1%) as having mild AP (Imrie < 3) and 26 patients (28.9%) as having severe AP (Imrie > 3). In mild group, the mean CTSI score was 3.6 ± 2 and those of severe grpup was 6 ± 2, respectively, p = 0.01). Hypoxia (Pa02 < 70 mmHg) in mild AP group (Imrie
< 3) was 12.5% and those of severe group was 30.7%. By CTSI scoring system. Hypoxia (PaOs < 70 mmHg) in mild AP group (CTSI 0-3) was 11.4% and those of moderate and severe AP group (CTSI 4 - 10) was 21.7%.
TCNCYH Phij trwong 74 (3) - 2011
Concltsion: 1, Arterial blood gas analysis with Pa02 < 70 mmHg should be used as a cutoff value for evalu- ating severity of acute pancreatitis. 2, Hypoxia (Pa02 < 70mmHg) almost occured in the severe AP group (Imrie > 3) was 30.7% as compared to the mild AP group (Imrie < 3) was 12.5% with statistically different (p = 0.05). 3, The low pH of blood. Pa CO2 and bicarbpnat level occur in the severe AP grpup no statistically different (p > 0.05).
Key word: acute pancreatitis, Imrie, CT severity index, blood arterial gas
NGHIEN CU'U LIJA CHON KY THUAT TRONG CHAN DOAN
SOT DENGUE/SOT XUAT HUYET DENGUE TAI BENH VIEN BACH MAI
Le Thj Ngan, Vu Thj Tu'O'ng Van Benh vien Bach Mai So sinh ky thuat RT-PCR vai cie ky thuit phit hien KN NS1 vi phit hien KT khing vims dengue de irng dung vao cie giai doan lam sang thich hap. Doi twang nghien cwu: 242 mau mau cua nhung BN dwvc chin doin lim sang la SD/SXHD vio aiu tri tai benh vien Bach Mai trong nam 2006 va 6 thing diu nam 2007. Phwang phip nghien ciru:
Nghien ciru tiin cwu va md ta cat ngang tai phdng xet nghiem. Kit qua va kit luan: So sinh cac ky thuat di img dung vao cie giai doan lam sing thich hap: Ky thuit ELISA phit hien KT da phit hien sam KT IgM dac hieu vims dengue sau 3 ngay mac benh va dat kit qua cao tren 90 % tai cac ngay 5, 6, 7 cua benh. Kha nang phat hien KT IgM bang ky thuat sac ky mien djch chi dat ty le cao a ngay thir 7 cua benh (79,1 %). Ky thuit ELISA phat hien KN NS1 va ky thuit RT-PCR phit hien ARN virus rit cd gia tri chin doan trong 3 ngay diu tien cua benh vai ty le (+) twang img la 68,2%
va 75%. Tir ngiy thir 4 trd a, kha nang phat hien ARN vims bang ky thuat RT-PCR giam dang ki trong khi ky thuit ELISA phit hien KN van phit hien dwac KN NS1 trong mau vdi ty le cao ngay ca khi KT IgM die hieu vims dengue xuit hien (67,4 % NS1 dwang tinh a ngay thw 7 cua benh). Ky thuat RT-PCR phii hap di chin doan trong 3 ngay diu cua benh; Nen ip dung ky thuat SKMD va ky thuit ELISA phit hien khing thi tir ngay thw 4 tra d?; Ky thuit ELISA phit hien KN NS1: tir ngay thir 1-9.
Tir khoa: RNA cua virus dengue, NS1, Khang t h i khang dengue IgM/IgG dengue
I. DAT
V A N 0 &Theo udc tinh eua To chCre Y t i T h i gidi (TCYTTG), hien nay ed tdi 2,5 d i n 3 ty ngudi song trong viing nguy ca mac benh, mdi nim cd tdi 50 - 100 trieu trudng hgp mic SD v i 500.000 trudng hgp SXHD phai nhip vidn, trong dd 90 % l i tre em dudi 15 tuoi [2]. 0 Viet Nam benh SD/SXHD xuit hien d 61/61 tinh thanh, chu y i u t i p trung d miin Nam v i la mdt trong 10 benh ed ty Id mic v i tu- vong cao nhit, so mic dCrng thCr 5, tCr vong dCpng thCp nhit trong 26 benh truyin nhiim giy djch [5].
Vide phit hidn sdm v i dung cin nguydn giy benh se giup ieh rit nhiiu cho dieu trj cd hieu qua, giam ty Id tu- vong va dy bio sdm dugc vu djch SD/SXHD ed the xay ra. Ciing vdi sy phit trien cua khoa hpc ky thuit, nhipng nghien CCPU v i benh SD/SXHD d i giup che vide chin doin cin nguyen eua benh SD/SXHD ngiy cang hoin thien han.
Hidn nay, bdn canh cie ky thuit miin djch phit hien
khing the, cdn cd cac ky thuat miin djch phit hien khing nguyen (KN) NS1 eua virus dengue trong miu cua benh nhin (BN) bj nhiim virus dengue.
Tuy nhien, vide chpn lya ky thuit chin doin thich hgp tiiy thude v i o tirng thdi diim liy miu cua benh nhin d i i p dung cho eic phdng xet nghidm (XN) lim sing l i rit c i n thiit. Dd la ly do ehCing tdi tiin hinh d i t i i vdi muc tieu: So sinh ky thuit RT-PCR vdi eic ky thuit phit hien KN NS1 vi phit hien KT khing virus dengue d i u-ng dung vao eic giai doan lam sing thich hgp.
II. D 6 | TU'QNG VA PHU'QNG PHAP
I . D d i tu'O'ng
Ddi tugng v i ed m i u nghidn CCPU: 242 BN dugc chin doin lim sing l i SD/SXHD vio diiu trj tai benh vidn Bach Mai tir thing 1/2006 dio thing 6/2007). Bdnh nhin dugc lya chpn thep tidu chuan cua To chCrc Y t i T h i gidi [7].
