Tap chf Tai MQi Hpng Vidt Nam - Volume (57-9). N°3 - July, 2012
NGHIEN CUtJ GIA TR| CUA CAC TEST BI vOl Dl NGUYEN Byi B 6 N G Of BENH NHAN VMDU>fN DO Byi BONG
Vd Vdn Sdn*, Dinh Viit Tuyen**, Phgm Vdn Thuc*
VuMinh Thgc***, Nguyin Thj Lua*
T Q M TAT
Viic chdn dodn cdc binh dj ung thu&ng dugc dga tren lien sir df irng, khdm ldm sdng vd cdc test bi di xdc dfnh di nguyen gdy binh. Trong so cdc test in vivo, chiing toi coi trgng do nhdy vd dg dgc hi^u cua test lay da vd test ngi bi Viem mui dj irng nghe nghiip (VMDlfNN) Id binh rdt thu&ng gap & cdc nhd mdy, xi nghiip co lugng bui cao nhu nhd mdy bong, len, sgi, lanh...Mgc 0ch Id xdc dinh gid ti cua test lay da vd test ngi bi trong chdn dodn dgc hiiu binh VMDlfNN do bui bong Doi tugng vd PPNC: 254 benh nhdn dugc chgn co bieu hiin VMDlfNN da bui bong vd 30 cdng nhdn khoe mgnh khong bi di irng cua Cong ty da dugc ldm cd hai test bi v&i di nguyin triet xudt tie bui bong Ket qud Test lay da: Do nhgy: 68,9% & muc do duang tinh chu yiu tic (+-^) tr& lin (chiim (85,14%). Do dgc hiiu: 90%. Test ngi bi: Do nhgy: 95,28% & muc dg duang tinh chu yiu tic (++) vd (+++) (chiim (62,81%). Dg dgc hiiu: 90%. So sdnh 2 test: Test ngi bi v&i di nguyen biti bong cho do nhgy cao han test tdy da (p<0,001). Dg dgc hiiu cua 2 test ndy khong CO su khdc biet (p> 0,05).
SUMMARY
Evaluation of skin tests in workers with OAR to cotton-dust in Hang Kenh company Diagnosis of allergic diseas was usually based on clinical examination, allergic history and cutaneous tessts to determine the causative allergen. As several in vivo test exitst, we consider necessary evaluation of sensibility and speccificty of skin prick lest (SPT) and intracutaneous test (ICT). Occupational Allergic Rhinitis (OAR) is a disease often seen in the factories with high concentration of processing dust as. Cotton, wool, flax textile. The purpose of this study was to determine the value of SPT and ICT to specific diagnosis of
OAR to cotton dust. Co 254 chosen patients suffering fi-om OAR to cotton dust and 30 healthy workers in the company were underwent both kind of tests with cotton dust extract.
Results: skin prick test: Sensibility was 68,90%, mainly in (++) and (+++) degrees.
Specificity was 93,3%. skin intracutaneous test: Sensibility was 95,28%, mainly in (++) and (+++) degrees. Specificity was 90,0%. Sensibility of ICT was greater than sensibility of SPT. No difference was found comparing specificity of both tests.
Key Words: Occupational Allergic Rhinitis (OAR)
* D^i hoc Y Hai Ph6ng
**Bfnh vifn Xanh P6n
* Bfnh vifn Tai mui hong TW
Nhan bai 15/6/2012. Duyft in 25/6/2012 41
Tap chf Tai MQi Hpng Viet Nam - Volume (57-9). N°3 - July. 2012
1. DAT VAN Bt
Trong may chyc ndm g^n day, s\r phoi hpp giira cdc chuyen khoa trong nghien ciiu VMDU" dd mang lgi nhOng thdnh cdng t6l d?p khdng nhihig vc chan dodn ddc hifu, md cdn ve ket qua dicu in. Dc clian dodn mpt bfnh dj ung nh4t thi^t phdi qua cdc budc: Khai thdc tien sd dj img, khdm lam sang vd lam cac test dj ling invivo va in vitro. Cdc xdt nghifm phyc vy cho chdn dodn VMDU" dugc dp dyng ngdy cdng cd hf thong va hifu qud hon. Trong dd, trudc het la vai trd quan trpng cua cdc test bao bi gdm: test lAy da (prick test), test npi bi (intradermal test) do nhidu tdc gid de xuat va thuc hifn. Pasteur, V.R (1964), T.J.
Sullivant (1981), Zetlertrom (1980). Ngodi ra, cdn cd cdc logi test, test kich thich mui, test kich thich phd quan cujig dugc dp dyng rat hidu qua trong chdn doan cdc bdnh di ling do nghe nghidp. Dya tren nhimg co sd ve lam sang vd xet nghifm dd phdt hifn dj nguyen gdy VMDU* Id vifc vd ciing quan trpng. Nd giiip ngudi thay thudc dd ra bifn phap didu tri phii hgp va hifu qud nhdt.
Trong bdi cdnh hifn nay, nude ta dang d giai dogn cdng nghiep hda manh me, sy d nhiem mdi trudng do bui sdn xudt ngdy mpt tang, dnh hudng xdu tdi sdc khde ngudi lao dpng, dac bift Id cdc chuyen ngdnh dft, may vdi nguyen lifu la bdng, len, sgi lanh... ty Id mdc VMDU" d nhung ngdnh nghd ndy rdt cao. Nghien cdu dd tdi nay vdi myc dich:
1. Khao sat va danh gia gid tri ciia cac test bi trong chan dodn dac hifu benh VMDl/NN do bui bong.
2. So sanh dp nhdy va dp dac hifu
ciia 2 test ndy dc khfing djnh thdm gid tq rieng ciia moi test.
2. D 6 I T U ' Q N G VA PHUOfNG PHAP NGHIEN CifV
2.1. Doi tvgng nghien cihi 2.1.1. Nhdm bgnh nhdn
Bao gom 254 bfnh nhdn cd bilu hifn V M D U N N , dugc lya chpn trong qud trinh khdm Idm sdng vd khai thdc tien su di img ti mi cho 780 cdng nhan dang ldm vifc tgi cdng ty thdm Hdng Kenh. Qud trinh dieu tra va khdm dugc thyc hifn theo mau cua Td chdc Y te Thd gidi vd bdng tinh diem.
Tu6i ciia bfnh nhan tir 22 - 55.
2.1.2, Nhdm chung
Gdm 30 cdng nhdn cung Ida tudi vdi nhdm bfnh nhan, khde manh, khdng mdc bfnh VMDU" ciing nhu cdc bfnh khdc, Idm nhdm chiing trong cdc test in vitro nham phdn dnh ro su khdc bift ve ket qua cua hai nhdm.
2.2. Phuong phdp nghien cuu:
2,2.1. Chgn bgnh nhan: Dugc thyc hifn bdng khai thdc tien su vd khdm Idm sdng
2.2.1.1. Khai thdc tien sir vd khdm ldm sdng
Vdn dd khai thdc tidn sd di iing dugc thuc hifn dya theo:
+ Mau 25*" cua WHO vd hdi tidn sd di irng.
+ Mau cdu hdi chi tidt cd tinh didm cd ISAAC (International study of allergy and asthma childhood 1994)
Vd vifc khdm ldm sdng vd tinh didm, chung tdi dya theo mau:
+ Thang cho dilm ddnh gid cac trifu 42
Tap chf Tai MQi Hpng V i f t Nam - Volume (57-9). N°3 - July. 2012
chiing miii ciia Bent Weeke va Niels Mygind. Copenhagen, Dan Mgch 1985.
+ Bdng cau hdi ddnh gid trifu chiing mui cua bfnh nghd nghifp dudng hd hdp (phan mili) dugc copy tu bp cau hdi cua Institude of occupatlnonal medicine trong British Journal of Industrial Medicine 1988.
+ Mdt sd cau hoi chi tidt vd lam sang dugc xem xet vd bd sung.
2.2 2.2. Khdm todn diin
NhGng bdnh nhan dugc chpn, se dugc khdm da khoa todn thd dd nhdm loai trir eac bdnh chuyen khoa khdc. Td dd chpn ra dugc nhdm bfnh nhdn nghien ciiu gdm 254 benh nhdn, nhdm chiing 30 bfnh nhan.
2.2.3, Ldm test bi
Tien hdnh lam cdc test bi tren cd 2 nhdm nhdm benh va nhdm chiing de so sdnh.
2.2.4, Xir ly kit qua: Dimg phuong phap thdng kd y hpc de xd Iy ket qua:
3. KET QUA NGHIEN CUtJ
3.1. So sanh ket qua ciia cac test bi giiia nhdm bdnh nhan va nhdm chiing, chiing tdi cd ket qud sau:
Bang 1; Gdp dng cue test lay da vdi dj nguydn byi bdng
Nh6m Ket qua N T y l *
(%)
B$nh nhSn (+) 175 68,90
VMDU'NN
(-)
79 31.10
Nh6m chu-ng (+)
2 6,7
(n=30)
(-)
28 93.3
Nhgn xet: Ty If phdn iing duong tinh d nhdm VMDU* dat 68,9% trong khi d
nhdm chung chi dgt 6,7%. Sy khdc bift nay cd y nghTa. (P<0,001).
Bdng 2: Mdc dd phdn dng di/ong tinh ciia test Idy da
MiJcdO Ohis6 S6 b$nh
nhdn Ty 1$ %
(+)
26 14.86
(++)
61 34.86
(+++)
49 28
(++++)
39 22.28
T6ng
175 100 P< 0,001
Nhan xdt: Da sd cdc trudng hgp duong tinh deu d muc 2+ trd Idn
Bdng 3: Ddp dng cua test ndi b) vdi di nguydn byi bdng.
Nh6m NC K^t qua
N T y l ^ %
B^nh nhan + 242 95.28
VMDU'NN (n=254)
12 4.72
Nh6m chi>ng + 3 10.00
(n=3)
27 90.00
Nhgn xet: Test ndi bi vdi di nguyen byi bdng d BN VMDU" nghd nghifp dgt ty If duong tinh khd cao (95,28%). Nhdm chdng cd ty Id duong tinh Id 10%. Sy khdc bidt vd dp nhgy cua 2 nhdm cd y nghia thdng kd (P< 0,001).
Bdng 4: Mdc dd duong tfnh cua test n$i bl:
MLFC
N
%
+<9 mm 37 15.29
++9- 12mm
84 34,71
+++13- 20mm 68 28,10
++++>20
53 21,90
Tong s6 242 100 Nhan xet: Mile dp duong tinh ++ tro len chiem dai da so cac truong hi?p, trong do
43
Tap cht Tai MQi Hpng Vidt Nam - Volume (57-9). N°3 - July. 2012
chii ydu la muc (++) vd (+++). Td kit qud thu dugc d trdn giOa 2 logi 3.2. So sdnh dp nh§y vd d9 ddc hifu ^^st, chiing tdi cd bdng so sdnh sau ddy:
cua test l^y da vi npi bi vdi dj nguyen ("dng 5) byi bdng
Bdng 5: So sdnh dO nh$y vd dp d$c hi$u cua test Idy da vd nOi bl.
So Scinh Kk qud test
Uyda N«lbi P
DO nhSy BN
254 254
+ 176 242
79 12
%
68,90 95,28
<0,001
09 ddc hi$u n
30 30
+ 2 3
28 27
%
93,3 90
>0,05
Nhdn xet: Dp nhdy cua test npi bi cao hon ciia test ldy da mdt each cd y nghTa thdng ke (P<0,001). Dp ddc hidu ciia 2 test ndy ddu khd cao, sy khde nhau vd dp ddc hifu eua 2 test nay chua cd y nghia th6ng kd (p>0,05)
4. BAN LUAN
4.1. Vai net ve dac tinh dj nguyen ciia bui bong
Nhiing ddc tinh cua di nguyen bdng dd dugc nghien ciiu d nhilu noi khdc nhau tren the gidi.
Bui bdng thyc ra khdng phdi chi don gian chi Id mdt chit, ma Id sy pha trpn tdng hpp ciia nhidu chdt. Da s6 trong dd Id nhimg chdt cd hogt tinh sinh hpc. Didu ndy dupe phdn dnh tgi Hif p hpi Y te va an todn lao ddng d My (The U.S.OHSA) vdi dinh ngliTa "byi bdng la byi xudt hifn trong
khdng khi qua trinh gia cdng, didu che bong. Byi nay ed thi chua m$t hon hpp nhidu chat, bao gom cd bui dat, sgi, mdnh thyc vgt khdc, vi khuan, ndm moc, cac ch^
ban, thuoc dipt trimg vd cdc thdnh p h ^ kahcs nhau, dugc tich luy trong qud trinh gieo trdng, chdm bdn, thu hogch luu kho hodc che bien tiep theo" [2]. Ngoai ra cdn nhieu ylu to khdc tdc dpng vao lam cho tinh chat cua byi bdng d moi vung ciing trd ndn khdc nhau, nhu khf hdu, ddt dai, cdn trung, sau bp, phucmg phdp thu hogch, diiu kifn nhd kho chiia, ddu md may, trong qua trinh che bien... Nhimg ddc diem nay thudng dugc cdc tdc gid nhin mgnh trong ddnh gid vai trd gay benh dj irng cua byi bdng.
- Dj nguyen byi bdng ^ dupe dua vao sd dyi^ dl chdn dodn va didu tri ddc hifu V M D U N N dugc Idm test ldy da vdi di I ^ ; I Q ^ byi bdng, phdn ung duor^ tinh xdy ra d 175
Tap chf Tai Mui Hpng Vift Nam - Volume (57-9). N^S - July, 2012
dudng (68,90%). Ty If ndy tuong duong vdi ket qua cua nhidu tdc gja trong nude va ngodi nude khi nghien ciiu VMDU do cdc nguyen nhdn khdc nhau [1,7,8,11,17,18].
Tes ldy da hidn dang Id mpt trong nhihig bifn phdp ddc hifu dugc su dyng rdng rai trong chdn dodn cdc bfnh di ung.
Theo nhgn dinh cua nhilu tdc gid, test nay ed dp tin cgy ldn hon so vdi test npi bi, do it gap trudng hgp duong tinh gdi. 0 trong nude, cdc nghidn cim ciia cdc tac gid Nguyen Nang An, Phan Quang Dodn, Trinh Manh Himg, Phgm Vdn Thuc... eho thay ty If duong tinh cua test lay da ndm trong khoang td 65 - 71%; Nghien cdu ciia Eriksson N.E... Holmen A. keo dai 11 nam (1981 - 1992) cho 7099 bfnh nhan ldm test Idy ra vdi cac di nguyen khac nhau cho thay mdc dp duong tinh trong khodng 65- 70% [17]. Nghien ciiu cdu Codina-R va cdng su [15] cho 365 bfnh nhan VMDU vdi hot ddu nanh thay ty If duong tinh cua test ldy ra chi la 59,4%. Del-Rio-Navaro- B.E vd cdng su lai cd ket qud test Idy da duong tinh 92,5% [16]. Tasman A.J va Wizel A. nghien cdu d benh nhdn viem mui di ung vdi bdt mi thdy ddp dng cua test ldy ra vdi cdc di nguyen khac nhau thi ty If duong tinh chenh lech khd Idn [23].
Thyc ra, ket qud cua cdc tac gid khac nhau khdng nhieu cd the cd nhihig sai If ch kdt qua do ki thugt lam test, do ndng dp di nguyen thu w... Dp nhgy cua test lay da tuy khdng cao nhung it duong tinh gid, vi
muc dp Idm ton thuong da it hon, khoi lugng dung dich dua vdo da cung it hon ndn it kich thich da gay duong tinh gid hon so vdi test npi bl.
Ve muc dp duong tfnh cua test lay da:
Q bang 2 chting tdi thay dgi da sd bfnh nhdn cd ddp dng td mdc (++) trd len (85,14%). Trinh Manh Hung [8] lam test lay da vdi di nguyen byi nhd d 171 bfnh nhdn thiy mdc duong tinh (+) tdi 53%. So sdnh nhihig kit qud tren ed the thdy muc dp man cam d nhung ngudi bi VMDU do byi bdng manh hon d ngudi VMDU" byi nhd.
4.2. Test npi bi
Ket qua test ndi bi cua chiing tdi trdn 254 benh nhan VMDILTNN cho ty If: duong tinh 95,28% am tinh 4,72%. Dp nhay ciia test nay rat cao. Nhdm chiing cd ty If duong tinh Id 10%. Ket qud nay phu hgp vdi nghien cdu cua nhieu tdc gid khdc [9, 11, 13, 16]. Mae du dp nhgy cao song test npi bi thudng cd lan mdt ty le duong tinh gid vd cd nhung phan img khdng ddc hieu (do kim tiem gay tdn thuong trong da nhieu hon d test lay da, lugng thudc thu dua vdo ldn hon, tdi 0,2 - 0,3ml).
Ngodi ra, test ndi bi tuy cd dp nhay eao nhung ciing de tai bidn hon so vdi test Idy ra. Da ed mpt so tdc gia neu nhung trudng hpp shock phdn ve khi lam test npi bi [11].
So sanh hai test lay da vd npi bi (bdng 5) chung tdi thdy dp nhdy cua test lay da kem hem so vdi ndi bi (p<0,001). Dp dgc
Tap chf Tai MOi Hpng Vift Nam - Volume (57-9). N°3 - July, 2012
hifu khde nhau khdng cd y nghTa (p>0,05).
Cdc tdc gid Phgm Vdn Thuc, Phan Quang Dodn, D.R.Navaro, Dreborgs khi so sdnh hai logi test nay deu cho nhgn xdt tuong ly [7,11,16].
Test lay da dii dp nhgy khdng cdo bdng test npi bi song vi ky thugt don gidn vd dp an todn cao, rat nhieu tdc gid dd dl nghj trudc tidn chi nen Idm test lay da. neu test ldy da am tinh ho^c nghi ngd thi mdi tien hdnh test npi bi [11.20].
Tuy nhien, trong qud trinh nghien cdu vd VMDU"NN do byi bdng, chiing tdi dd xem xet, can nhdc vd van tien hanh dong thdi cd 2 test bi. Ly do chu yeu la vdi V M D U N N , lugng di nguyen md bfnh nhan hit vao qua ldn. Nhiing ngudi cd phdn dng di ling manh khdng chiu dyng dugc dd phai bd nghe ngay tu thcri gian dau. Nhihig ngudi cdn try Igi dugc vdi nghd dan dan sd cd su dung ngp d mdt mdc dp nhdt dinh vdi di nguyen. Vi vdy khi Idm test lay da vdi lieu di nguydn thdng thudng. Nhieu trudng hpp khdng thay cd ddp irng ducmg tinh, du d bfnh nhan van ed bidu hifn lam sang.
Test ndi bi dupe Idm song song vdi test Idy da trong trudng hgp ndy s6 la bifn phdp nhdm trdnh bd sdt bfnh nhan. Ddng thdi vide so sdnh cac test in invo trong bfnh V M D U N N ciing se cho thdy dugc gid trj rieng cua mdi test.
5. KET LUAN
Dya tren kdt qud test ldy da va test npi bi vdi di nguyen bui bdng d cdng nhan
Cdng ty thdm Hdng Kdnh Hdi Phdng, chung tdi cd mOt s6 kit lu$n sau day:
Test liy da: DQ nh$y: 68,90% vdi muc dO duong tinh chii ylu tir (++) trd len (chilm 85,14%). Dp d$c hifu: 93,3%%.
Test n0i bi: D Q nh§y: 95,28% d muc dp duong tfnh chu ylu Id (++) vd (+++) (chilm 62,81%). Dd ddc hifu: 90%.
So sdnh 2 test: Test npi bl vdi dj nguydn byi bdng cho d$ nhgy cao hon test lay da (p<0,001). Dp ddc hifu cua 2 test ndy khdng ed sy khdc bift (p>0,05).
TAI LI^U THAM KHAO 1. Nguyen Ndng An, Phan Quang Doan,
Vu Minh Thyc, Trdn Nggc Tuyin (1996). "Budc dau nghien ciiu bfnh di ling byi bdng d cdng nhan Nhd may Det 8-3 Hd Npi". Ky ylu cdng trinh nghien cihi khoa hgc tap III
2. Phan Quang Doan, Vu Minh Thyc, Nguyen Thj Van (1999). "Bfnh di dng trong cdng nhdn Dft 8-3 Ha Npi". Tgp chi Y hpc thyc hdnh, S6 1, tr. 8-10 3. Do Hdng Quang, Phiing Thanh Huong,
Vu Minh Thyc (1998), "Didu chd vd nghien ciru mpt sd ddc tinh hda sinh cua d) nguyen byi bdng". Bdo cdo Hpi ngh{
khoa hpc Tudi trd cdc trudng Dai hpc Y dugc todn qudc, Hd Ngi.
4. Awotedu-A.A.; Oyejide-M; Ogunlesi-A Onakedo-B.O. (1992), "Skin sensitivity patterns to inhalant allegens in Nigerian asthmatic patient", East-Afri-Med-J,
46
Tap chf Tai Mui Hpng Vidt Nam - Volume (57-9). N°3 - July. 2012
Nov..69(ll),pp.631-636.
5. Chalal-I; Horat-M; Segalen-C (1998), standardized allerge extracts and phazet". I-Allergy clin; immuna;. Now, 82, pp 878-881.
6. Cinkotai-F.F.; Rigby-A; Seabon D.et col (1998), (Recent trends in the prevalence of byssiontic symptoms in the lancshire textile industry", Briish Journal of industrial Medicine, Vol. 45, pp. 782- 789
7. Codina-R; Ardusso-i; Lockey-R.F; Crisci- C. Bertoya-N (2000). "Sensitization to soybean hull allergems in subjects exposed to different levels of soybean dust inhalation in Argentina, I. Allergy - Clinp immunol. Mar, 105(3), pp. 570-576 8. Del - Rio-Navarro-B.E; Mercado-Ortiz-
V; lerma Ortiz; et col (1996).
"Comparison of 2 skin test mothods for the diagnosis of allergic diseases" Rev-
Allerg, Mex., Jut-Aug 43(4), pp. 100- 103
9. Erksson-N.E.; Holmen-A. (1996) „Skin pick tests with standardized extract of inhalant allergens in 7099 adult patiens with asthma and rhinitis; cross sensitization and ralationships to age, sex, month of birth and year of testing"
Invest-AUergol-Clin immunol. Jan-Feb;
6,pp.36-46
10. Grabbe-J; Zuberbier-J (1993), "Skin pick - test to commin allergens in adult atopic eczema and rhinitis patients reproducibility on dublicate and repeated". Dermatology, 186(2), pp.
113-117
11. John-A.B; Lee-H.S; Lee-F.Y; Chung- H.H (1996) "Allergen skin test and total IgE in adults with rhinitis in Singapore". Asian-Pac-J. Allergy- Immunol,Jun, 14(1), 9-12
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