Y HQC VlgT NAM THANG 5 • SO 1/2011
DAC DIEM DICH T I HOC VA HAU QUA CUA Hdi CHUfNG THAN HIT TIEN PHAT: KINH NGHIEM CUA BENH V | £ N NHI TRUNG mOTNG
TrSn Oinh Long*, Nguyen Thi Quynh Hu'dng*, Ding Thi Ngoc Dung**
TOM TAT
HiDi chirng than hu tien ph^t (HCTHTP) la mpt hpi chimg hay g|p d tre em, no chiem tdi gan 50% b^nh nhan nhap vien tgi khoa Than tiet ni?u benh vi^n Nhi Trung uong. Muc dich; mo ta dSc diem djch te hpc vci hau qua ciia bqnh tU do dUa ra cac khuy§n c^o cSn thiet trong dieu tn b^nh. 06*i tUdng va phUdng phap nghien cCru: mo ta hoi ciiU ^68 trd < IS tudi dUOc chan doan HCTHTP nhap vien tai khoa Than- Tiet nieu b^nh vien Nhi Trung Udng trong v6ng 2 nSm (1/1/2009-31/12/2010). Ket qua: Tuoi m k bSnh trung binh ciia HCTHTP la 7.3 + 4.5 tuoi, trong do ty le tre tren 10 tuoi bi benh kha cao chrem tdi 37.6%.
Benh gap nhieu d tre nam, ty le nam/nU: 2.7/1. 25.9%
tre CO tien su' bi nhiem khuan hong va da. Ty le ha natri mau gSp 41.7 %. Ty le ha canxi Q3p cao 92.3 %.
Ket luan: Can ch3m soc tot cac nhiem trung da va hong cho tre nhat la tre tai cac vijng nong thon. Can khuyen cao khong dUi3C cho tre bi HCTHTP an nhat qua lau. Can dieu tri tich cUc canxi va vitamin D cho tre bj HCTHTP dang dieu tn corticoid,
Tir khoa: Hgi chu'ng than hU tien phat, hau qua, dich te hpc
ABSTRACT
Epidemiology and outcome of primary nephrotic syndrome : experience of National Hospital of
Pediatrics
The aim of this study was to investigate the epidemiology and outcome of children hospitalized with primary nephrotic syndrome in the National Pediatric Hospital. This retrospective study reviewed the records of 468 children with primary nephrotic syndrome hospitalized in the National Pediatric Hospital from lan. 2009 to Dec. 2010. The result sJiow that the average age was 7.3+4.5 years, boys/girl was 2.7/1. Patents with a thtiaat infection and skin infection was 25.9%. The hyponatremia was 41.7% and the hypocalcemia was 92.3%.
Conclusion: recommendatton for patient family to avotd alimentaton wittxxjt salt for long time Treat cataum and vitamin D any more for the patient using corticosteroids.
Keyword: Primary nephrotic syndrome, outcome, epidemiology
I. OATVANDE
Hdi chirng than hU (HCTH) la mdt hdi chimg
*Bg Mon Nhi, Tru'dng dai hoc YHa Noi
**Bp Man Hoa sinh, Tru'dng dai hoc YHa Noi Phan bien khoa hgc: PGS.TS. Ta Thanh Van 50
hay gSp d tre em va nd chiem 2.8% tre nhap vien tai benh vien Nhi Trung Udng [6] va gan 5 0 % tre nhap vien vao khoa Than-Tiet nieu benh vien Nhi Trung L/ong. Trong HCTH thi hay gap nhat la hpi chirng than h u tien phat(HCTHTP), no chiem tdi 9 0 % d tre em bi HCTH. Tai Viet nam da ed kha nhieu cdng trinh nghien ciru ve HCTH tuy nhien hau qua ciia benh va nhtTng khuyen cao trong dieu tri van ean dUPe cap nhat chinh vi the chiing tdi tien hanh nghien cub nay nhSm md ta dSe diem dich te hoc va hau qua cua benh t i r d d dua ra cac khuyen eao a n thiS tnDog dieu tri benh.
tl. o 6 l TUpNG VA PHUONG PHAP NGHIEN CDU Doi tddng nghiin cii'u:
Tat ea eac benh nhi < 15 tud'i dUOc chan doan HCTHTP nhap vien tai khoa Than-Tiet nieu benh vien Nhi Trung UOng trong vdng 2 nam (1/1/2005-31/12/2006).
Tieu chuan chan doan HCTHTP : Protein nieu > 50 mg/kg/24 gid; albumine mau < 25 g/l, Protid mau < 56 g/l (tieu chuan ciia ISKDC - International study of Kidney Diseases in Children) va khdng tim thay ngueyen nhan.
Tieu chuan loai trif: cac benh nhan bi HCin thir phat
Phddng phap nghien cud: PhUPng phap nghien citu md ta hoi ciru benh an
Chi so nghiin cdu:
-f Cac t h o n g t i n d j c h t e : tudi, gidi, ndi sinh (thanh phd se bao gom cac tre sdng d cac thanh phd va cae thj xa), tien sU mac benh nhiem trung, che dp an.
-t- Lam sang: Can nang, ehieu cao, nUdc tieu: sd lUdng, mau sac, phu, huyet ap
Milt do tang huyet ap theo chieu cao va gcfi [1]
Binh thudng: <97,5 dp bach phan (percentile) Tang huyet ap gidi han: Tii" 97,5 dp bach phan (percentile) den 97,5 do bach phan (percentile) + lOmmHg
Tang huyet ap chac chan: Tir 97,5 dp bach phan (percentile) + lOmmHg den 97,5 dp bach phan (percentile) -i- 30mmHg.
Tang huyet ap de doa: > 97,5 do bach phan (percentile) + 30mmHg.
+ Can lam sang:
- Xet nghiem nUde tieu: NUde tieu dUPc lay trong 24 gid va diing nUdc chdng thdi bang'dung djch HgCI, benh nhan dMc can va do the tich nUdc tieu ciia ngay hdm thu thap nUdc tieu.Protein nieu dinh lUdng: DUdc pha vdi dung dich trichloracetic 5%, do dd due bang may quang phd T60 ciia My va dUdc thUc hien tai khoa sinh hda.
Te bao nieu dUde dpc tai khoa huyet hoe bang kinh hien vi vat kinh 10 va 40
Ket qua:
Tir <5 Hong cau (Bach rau)/vi trudng; Rai rac TCr 5-10 Hong cau (Bach eau)/vi trUdng: (+).
Tir 10-20 Hong cau (Bach cau)/vi tnrdng: {++).
Td >20 Hong a u (Bach rau)/vi budng: {+++).
Xet nghiem mau: Djnh lUdng Protid, albumin mau, cholesterol mau, ure, creatinin mau, dien giai do mau dUdc do tren may Olympus AU.400 tai khoa Sinh hoa benh vien Nhi Trung Udng.
Y HQC V l g T NAM T H A N G 5 • SO 1/2011
Ha canxi mau khi Canxi ion mau < 1.0 mmol/l Ha Natri mau khi Natri mau < 130 mmol/l Kali mau khi Kali mau < 3.5 mmol/l Kali mau tang khi Kali mau > 5 mmol/l
Mire Ipc cau than tinh theo cdng thUc Swcharzt [5] :
- Chan doan giai doan suy than theo dp thanh thai Creatinine [4]:
-1- Binh thudng: > 90 ml/phut/l,73m^ cd the.
+ Suy than glai doan 1: 60-89
ml/phut/l,73m^cdthe.
+ Suy than giai doan 2: 30- 59 ml/phiit/l,73m^cdthe.
+ Suy than giai doan 3: 20- 29ml/phut/l,73m^ cd the.
+ Suy than giai doan 4:10-19 mi/phut/l,73m^ cd the.
-I- Suy than giai doan 5: < 10ml/phut/l,73m^
cd the.
Cay nude tieu tai khoa Vi sinh Benh vien Nhi Trung Udng
Cac sd lieu dUdc xd ly theo phUdng phap thdng ke y hoe tren chUdng trinh Epi-info 6.04
III. KET QUA NGHIEN CGUBang 1; Mot so dac diem dich te iam sanq cua HCTHTP Ndi si nil song
Vnanh thi Nonq thon Tuoi mac benti
< 12 thang 1-4 Tuoi 5-9 tuoi 10-15 tuoi aidi
Nam NO- HCTHTP
The l<hdi phat The tai phat Ddn thuan Ket hdp
So' benh nhan
62 406
6 174 112 176 342 126 282 186 410 58
%
13,3 86,7 1,2 37,2 24,0 37,6 73,1 26,9 60,3 39,7 90,0 10,0 BanQ 2; Pttan bo cac benh nhiem khuan tronq tien sCr
Viem da mil (n = 44) Viem honq ( n = 8 2 ) IVhiem Ichuan l<hac ( n = 1 0 ) B e n h d i u t i q (n = .101
HCTHTP d i n thuan n = 4 1 0
0 32 6 10
»/o 0 7,8 1,5 2,4
HCTHTP i<et hdp n = 5 8
44 50 4 0
V.
75,9 86,2 6,9 0
Y Hpc VI$T NAM THANG 5 - s6 1/2011
Bang 3: Cac hau qua ciia HCTHTP Cao huyit ip
Khdng Cd Nhiem khuan hd hap Nhiem md lien ket Veni phiic mac tien phat Bach cau trcng nUdc tieu Suy than gici doan 1 Suy than > giai doan 1 Ha Natri mau Ha Kali mai Ha canxi mau
Sd' b^nh nhan
413
25 105 41
455 34
0195
56 423
o/o
94,0
6,0 22,44
8,76 0,01 11,75 7,27
0 41,7 1,96 92,3
IV. BAN LUANTrong 2'nam (1/1/2009-31/12/2010) cd 468 benh nhan vdi HCTHTP nhap vien tren tdng sd 1037 benh nhan Than-Tiet nieu nhap vien, ehiem 45.1%. Benh nhan den tu' khu vdc ndng thdn chiem 86.7%, ehiing tdi gap tre den vien trong dp tudi 7.31 ± 4.59, dac biet la sd tre d lUa tudi Idn > 10 tudi gap kha cao (37.6%).
Da sd tre'bj HCTHTP la nam (73.1%) dae
b\ic cao trong HCTHTP ddn thuan (78.8%)nhung ngUdc lai trong HCTHTP ket hdp thi nu' gap nhieu hdn nam (67.24%). Theo nghien ciTu cja L.N.Tra (1986) thi ty le nam/nU la 4/1 [7].
Tre ed tien sU bi nhiem khuan d hong gap trong 82/468 (17.5%) trong HCTHTP, trong do HCTHTP ket hdp thi 86.2% benh nhan cd tien td viem hong; Tlieo L.T.H. Diep thi 33.7% so tre dudi 2 tudi bj HCTHTP trong tien sU ed viem hong [2]. Cdn theo Habib va CS thay rang 31Sb sd tre dudi 1 tud'i bj than hU trong tien sir da bj nhiem khuan mui hong [3]. So lieu ciia chiing tdi thap hdn han cac nghien ciru khae ed le la dn dp tudi ma chung tdi nghien ciTu Idn hdn cac ta . gia tren. 75.9% benh nhan ed tien sir nhiem triing da gap trong IHCTHTP ket hdp. NhU vay eniing tdi gap 126/468 (25.9%) benh nhan bj nhiem trung da va hpng, la cae nhiem trung cd che eham sdc va dieu tri khdi triet de dUdc cho tre.
NgUdc lai ea 10 benh nhan ed tiun sir bi di iing deu gap trong HCTHTP ddn thuan.
Hau het eae benh nhan cua chung tdi khdng cd tang huyet ap (94%), cao huyet ap chi ehiem ed 6% va gap trong HCTHTP kec hdp.
Cac bien chu'ng eiia HCTHTP, chiing tdi hay gap nhat la ha canxi mau, ehiem tdi 92.3%, dieu
nay eho thay viec bii canxi va vitamin D trong dieu tn prednisolon can dUdc bo sung hdn n&a.
Benh nhan bj ha nabri mau g5p 41.7% va tat ca sd benh nhan nay €eu cd che dp Sn nhat bong che dp Sn tai gia dinh biide khi den benh vien.
Cac bien chirhg tiep theo hay g3p la nhiem khuan dudng hd hap ehiem 22.44%, nhiem b^jng dudng tieu la 11.8% va 8.7% la viem md te bao.
Oieu nay cijng phu hdp vdi cac nghien eiru [2].
V. KIT LUAN
Tudi mae benh trung binh la 7.3 + 4.5 tuoi Ty le nam/nCT: 2.7/1
Benh nhan den tir khu vUc ndng thdn chiem 86.7% .
Tre ed tien sir bi nhiem khuan hong va da la 25.9%. Can cham sdc tot cae nhiem trung da va hpng cho tre nhat la tre tai cac viing ndng thdn.
Ty le ha natri mau gap 41.7 %, can khuyen eao che dp an cho gia dinh tre, khdng dUde cho tre an nhat qua lau.
Ty le ha canxi gap cao 92.3 %, can dieu trj tfch cue bil canxi va vitamin D cho tre dang dieu trj corticoid.
TAI UEU THAM K H A O
1. Andre JL, Deschamps JP, Gueguen R.
"Arterial blood pressure in 17067 children and adolescents. Variation with age and height". Ar. Fr. Pediatr. 1980, vol 37: 477-82.
2. Le Thi Hong Oi#p (2002), "Dae diem lam sang va dap iTng vdi corticoid trong giai doan dieu trj dau tien ciia HCTH tien phat d tre em dudi 2 tudi", 'uan van thac sy, trUdng Dai hpc Y Ha Ndi.
3. Habib R. (1993), "NephnDtie syndrome in
Y HQC_VI|T NAM THANG 5 - s 6 1/2011 the 1 st year of life" Inserm U. 192, Hospital
Necker-Enfant Malades, Paris, France . Hogg RJ, Furth S, Lemley KV, et al."National Kidney Foundation's Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents: evaluation, classification, and stratification." Pediatric.
2000, vol 111 (No 6): 1416-21.
Schwartz GJ, Brion LP, Spitzer A. The
use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am. 1987, vol 34(3):571-90.
Le N a m Tra ( 1 9 8 3 ) / "Hpi chiTng than hU", giao trinh Nhi khoa tap I I , nha xuat ban y hpc, tr. 15-30.
Le N a m Tra ( 1 9 8 6 ) , "HCTH tien phat", tap chi Y hoe thUc hanh, sd 3, tr.15-20.
HIEU QUA CUA LASER HUYNH QUANG
TRONG VIEC PHAT HIEN SAU RANG SQA CUA HOC SINH 7-8 TUOI
TOM TAT
Tinh trang sau rang sija phai quan tam, xac dinh dUDc ty le mac trenh, phuong phap phat hien mifc do ton thutJng sau r§ng phai chuan hoa trong cpng dong
Myc 6eu nghien cOu:
- Xac dmh ty le sau rang sita b hoc sinh 7- 8 tuoi ciia TnjGng Tieu hpc E)6ng ngac A TU Liem - Ha Ngi
- So sanh ket qua sau rang sua dutJc Icham bang laser huynh quang Diagnodent 2910 vdi phuang phap thong thuSng cua nhom do! tupng tren.
Ket qua: Ty le sau rang sda cua hoc sinh 7- 8 tuoi duQc kham bang thiet b; Laser co ty le tuung dUdng kht kham bing phuong phap thoig thudng (79,5%- 79,8%) Laser huynh Diagnodent co hieu qua tnang viec phat hen tdn thUdng sau rang sua hOn phuong phap thong thudng 6 nhom 7 tuoi
SUMMARY:
Effectiveness of the laser fluorescence for detection of caries primary of 7-11 year
Dental canes pnmary status should care,before incidence and prevalence can be recorded, a quantitative measurement is required that will required accurately the extent of the disease in a Population The aim of this study:
- To dentemiine the rate of dental caries pnmary of 7- 8 year DONG NGAC A School children.
To companson laser fluorescence performance with visual examination for detection of caries pnmary.
Methodology: The study war performed on 263children from 7 to 8 years in Dong ngac A
Nguyin Quoc Tmng * school. Childen were examined by two examined using Who cnteria and two examiner using DIAGNOdent device
Results The rate caries pnmarywere 79,8%
and The rate canes primary when usingthe visual method has a rate less than the DIAGNOdent device method(79,5% - 79,8%)
Keywords: canes pnmary, DIAGNOdent device
I. £>AT V A N o f
Giai doan hinh thanh va phat trien cung rang khi tre d lii^ tuoi 7- 8 tuol.la giai doan rat quan trpng ddi vdl sU phat trien cua ham r§ng, viec kham djnh ky rang la rat can thiet Dd' cd ca sd khoa hoc trong viec chSm sdc site khoe rang mieng cho hpc sinh Tardng Tieu hpc Odng ngac A, TU Liem - Ha Ndi dat dutJc hieu qua cao, chiing tdi tien hanh nghien cdu de tai (Danh gia hieu qua ciia Laser huynh quang trong vide phat hien sau rang sO:a cua hoc sinh 7-8 tuoi). Vdi myc tidu nghien cifu la:
- Xac dinh ty le sau rang sda d hpc sinh 7- 8 tudi cCia Trudng Tieu hoc Ddng ngac A, TU Liem - Ha Ndi So sanh ket qua sau rang suia dutic kham bang laser huynh quang Diagnodent 2910 vdi phuOng phap thdng thudng cua nhdm ddi tuOng tren.
II. o 6 l TUpNG VA PHUONG PHAP NGHIEN CCfU 1. 06'i tut^ng n g h i e n ciiru: 263 hoc sinh ' Vien Dao tao RSng l-iam fi/ISt- Trudng Dai hoc Y Hd N6i
Phan bien kiioa hgc: PGS.TS. Tru-cng Uyen Thai
