iTAP CHl Y DUOC L«,M SANG 108 Tap 10 - S6 3/2015
< Nghien cuu su- anh hnong giua tign su gia dinh, nhom
^mau d6i voi benh ly da day ta trang tai Benh vien Da 1 khoa Qu6c te Phiic lam
J Study of the influence between family history, blood group for
« gastroduodenal diseases at the Phuc Lam International General Hospital
"; TrSn Trong Dirtfng', Nguyin Tuan Binh" 'Cue Y ti. Tdng cue Hgu cdn - Ky Ihugl, Bo Cong an
^' * "Benh viin Y hoc CO truyen, Bd Cong an
Tom tat
/Muc tliu: Tim hieu t J le cac nhdm mau va yeu t d den sd gia d'lnh trong benh viem, loet da day, loet ta trang d benh nhan den kham va dleu t n tai Benh vien Ba khoa Qudc te Phuc Lam. Ddi tddng vd phddng phdp-150 benh nhan duoc ndi soi, dieu tra tien sd gia dinh va xet nghiem mau tai Benh vien Ba khoa Quoc te Phuc Lam tU thang 1 den thang 12 nam 2011. «e't gua: Cd 50/150 benh nhan viem da day, loet da diiy ed 53/150 benh nhan vii 47/150 benh nhan bl loet ta trang. Ty le benh nhan bi benh viem da diiy loet da day, loet ta trang khac nhau khdng cd y nghia thdng ke (p>0,05) Ty le cae nhdm mau trong benh ly da day ta trang nhU sau: Viem da day: Nhdm A:35,4%, B:39,2%, AB:50,0%, 0:25,8%. Loet da diiy:
Nhdm A-42 0%, 6:31,4%, AB:16,7%, 0:37,1%. Loet ta trang: Nhdm A:22,6% , B:29,4%, AB:16,7%, O: 37,1%.
TJ le benh nhan ed tien sd gia dinh lien quan de'n nhdm mau nhd sau. Nhdm O 46,8%, nhom A 35,5%, nhdm B 25,5% va nhdm AB 16,7%. Ket ludn: Nhdm mau O cd lien quan den tlen sd gia dinh mac benh da day ta trang cao hon eac nhdm mau khac,
Tdkhda: Benh ly da diiy - ta triing, nhdm mau, tien sil gia dinh.
Summary
Objective- Contribution t o the rate of blood groups and family history factors In inflammatory disease stomach ulcers, duodenal ulcers at the Phuc Lam International General HospitaL Subyect and method: 150 patients v^ere endoscopically invesdgated family history and blood « * « ^ ' ^ P ' ^ " ; Lam intemational General Hospital from January to December 2011 Result: There were 50/150 pa len.s with gastritis, gastric ulcer 53/150 patients and 47/150 patients with duodenal ulcer. The rate of patients with ydbuiLii, y a i i . . . . _ .tJ _ „ . Jiff^, H^r,ifirantiv/fn^nn-^^ Rnnd orouDs in the r a t e o f a a s t r i t i s . q a s t r c u c e r b J / i ^ u p d u e M w a M u - . , , . - - 1 . ,u 4. c g ritls gastric ulcers, duodenal ulcers did not differ signiflcantly (p>0.05) Blood groups ,n the rate of oa c and d l o d e n a l as follows: Gastritis' Group A:35,4«/o, B:39.2%, AB'50.0%, 0:25.8%. Peptic ulcer:
gastric and duodenal «^ AB-167% 0:37.1%. Duodenal ulcer Group A-22.6%, B:29.4«/o, AB:16.7%, 0-3°7 1%, The percentage of patients with a family history of blood related to the following groups:
group O 4 6 8 % 35 5% group A, group B 25,5% and 16.7% group AB. Conclusion: Blood type O is related
?o family histor; of gastroduodenal disease higher than the other types Keywords: Gastroduodenal disease, blood groups, family history factors.
Phan br?n khoa hpc: TS. NOUEN TIEN THINH
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1 , Dat van de
Benh viem, loet da day ta trang da dupc nhieu tae gia trong va ngoai nUdc nghien cdu, NgUdi ta thay cd nhieu yeu t d lien quan den sd hinh thanh va dien bien cua viem, loet da day, ta trang. Nha khoa hpc ndi tieng ngddi Ao la den si Karl Landsteiner da doat giai Nobel do phat hien ra cae n h d m mau cua con ngddi vao nam 1901. Tren the gidi cd n h d n g cdng trinh nghien cdu ve mdi lien quan gida yeu t d gia dinh, nhdm mau trong viem va loet da day ta trang. Nhieu tac gia cho rang loet ta trang hay gap hdn d ngddi cd n h d m mau 0 , t r o n g khi ung t h d da day hay gap hdn d n h d n g ngudi ed n h d m mau A, d Viet nam chua cd nhieu cdng trinh nghien edu moi lien quan gida nhdm mau va benh \y da day ta trang.
De g d p phan t i m hieu t h e m ve van de tren, chung tdi tien hanh de tai: "Nghiin cdu sd anh hddng gida tien sdgia dinh, nhdm mdu vdi binh ly dg diy-td trdng tgi Binh viin Da khoa Quoc te Phuc Lam" nham muc dich:
1. Nhdn xit ty le cdc nhdm mdu trong binh ly dg day - td trdng cua cdc binh nhdn ddgc kham vd dieu tri tai Binh viin Phuc idm.
2. Nhdn xet ty li tlen sdgia dinh bi benh lien quan den nhdm mdu.
2. Doi tUtfng va phUPng phap 2.1. Bdi tdgng nghien cdu
2.1.1. Tieu chuan chpn benh nhdn - Benh nhan cd trieu chdng lam sang n h u | t h u o n g vi, p hoi, 0 chua, day b u n g , kho tieu,
- DMc chan doan ndi soi viem da day. Its day, loet ta trang,
- Dupc xet n g h i e m n h d m m a u ABO, - Tudi t d 17 den 70.
2.1.2. Tieu chuan logi trd: IVlo cat da day, i huyet da day, ung t h u da day.
2.2. Phdang phap nghien cdu 2.2.1. Thiet ke nghien cdu: Hoi cdu, md ta cat ngt 2.2.2. Npi soi dg day td trdng
Mo ta t d n t h d o n g tai da day ta trang gom: Vi™
da day, loet da day, loet hanh ta trang. . Danh gia viem da day theo he t h d n g Sydney ™
Danh gia loet da day - ta trang theo tieu chuij cua Hdi Ndi soi Nhat ban.
Chup anh eac t o n t h d o n g qua npi soi va xDlj ket qua qua may t i n h .
2.2.3. Xet nghiem nhdm mdu: D i n h nhdm mau he ABO tren phien nhda tai p h d n g xet nghiem
2.3. Xd ly sd lieu: Xil ly ket qua bang phuoilg phap t h d n g ke y hpc Epiinfo 6.04.
3. Ket qua
T d t h a n g 1 den t h a n g 12 nam 2011 cd 150 b e j i nhan du deu chuan Ida chpn dupe dua viio dien nghien eUu. BUdc dau chung tdi cd ket qua nhd sail Gdm 150 benh nhan duoc kham va dieu tri tai
Benh vien DKQT Phdc Lam t d thang 1 den thang 12 nam 2011.
Bang 1 . Tien silr gia dinh va benh \y da day - ta trang
Ket qua noi sol Viem da day Loet da day Loet ta trang
Cong
CotiensLfll) n 14 23 17 54
T y l e % 28,0 43,4 36,2 36,0
Khong cd tlen sijr(2) n
36 30 30 96
Ty le % 72,0 56,6 63,8 64,0
Tong so (3) n 50 53 47 150
T y l e % 33,3 35,4 31,3 TOO
P
(3:1:2)< 0,01
Nhan xet: Ty Ie chung: Co tien sCf 36,0%; khong co tien sCf 64,0%. Sii khac biet la c6 y nghia t h o n g ke >^
p < 0 , 0 1 . •
; TAP CHl Y DUQC LAM SANG 108 Tap 10-S4 3/2015
Nhom mau 0 ( 1 ) A (2) B(3) AB(4) Cong
Bang 2. Ty le nhom mau cua cac benh nhan nghien cOfu Nam
n 37 16 21 2 76
Ty le % 59,7 51,6 41,2 33,3 50,7
NU n 25 15 30 4 74
Ty le % 40,3 48,4 58,8 65,7 49,3
Tong so n 62 31 51 6 T50
Ty le % 41,3 20,7 34,0 4,0 TOO
P
(T2)<0,01 (3:4) > 0,05
IVhan xit: Ty le benh nhan viem loet da day hanh ta trang gida n h d m mau O vii A khac nhau cd y nghia thdng ke vdi p<0,01. Gida eac n h d m khac, sd khac biet khdng cd y nghia t h d n g ke vdi p>0,05.
Nhom mau
0 ( 1 ) A (2) B(3) AB(4) Cong
Bang 3 , Ty le nhom mau trong benh ly da day - ta trang Benh ly
Viem da day n 16 11 20 3 50
Ty le % 32,0 22,0 40,0 6,0 TOO
Loet da day n 23 13 16 1 53
T y l e % 43,4 24,5 30,2 1,9 TOO
Loet ta trang n 23 7 15
2 47
T y l e % 48,9 14,9 31,9 4,3 TOO
Tong so n 62 31 51 6 150
Ty le % 41,3 20,7 34,0 4,0 TOO
(1:2:3 4) > 0,05
IVhan xet: Nhdm mau O ed ty le cao nhat t r o n g loet ta trang (48,9%), nhdm A trong loet da diiy (24,5%), nhdm B t r o n g viem da diiy (40,0%), n h d m AB t r o n g viem da day (6,0%) SU khac biet ve ty le gida cae n h o m mau trong cac n h d m benh ly khdng cd y nghia t h d n g ke (p>0,05).
Bang 4. Tlen sd gia dinh va nhom mau
Nhom mau
0(1) A (II) B(lll) AB(IV)
Cong
Co tien sCr{1) n 29 11 13 1 54
Ty le % 46,8 35,5 25,5 16,7 36,0
KhongCO n 33 20 38 5 96
tie'n sd (2) Ty le % 53,2 64,5 74,5 83,3 64,0
Tong n 62 31 51 6 T50
so (3) Ty le %
41,3 20,7 34,0 4,0 TOO
P
(1,2 3) < 0,01 (V21ll)<0,01 (1:11:111) > 0,05
Nhdn xet: Ty le chung cd tien sd vi> khong ed flen sd khae nhau ed y nghia t h d n g ke vdi p<0,05. Ty le ' bSnh nhan ed t i e n sd va khdng cd tien sd gia dinh t r o n g nhdm mau B khac nhau ed y nghia t h d n g ke vdi
• p<0 05 T r o n g eac n h d m khae, sd khac biet khdng cd y nghia t h d n g ke vdi p>0,05.
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4. Ban luan
4.7. Bgc diem benh nhan nghien cdu Trong nghien cdu nay chung tdi gap benh nhan cd do tuoi thap nhat la 17 va cao nhat la 70, t r o n g dd cd 76 nam va 74 nd. Ty le nam va n d la 1,03:1. D p tuoi t h u d n g gap nhat la 31 den 50 tudi, chiem ty le 48,7%. D p t u o i t d 21 den 30 va 51 den 60 cd ty le t u o n g duong nhau la 18,7% vii 19,3%, Dudi 20 t u o i cd 7 benh nhan, t r o n g d d ed 5 nam va 2 nd. Chung tdi gap 13 t r u d n g hdp d dp t u d i 61 den 70, t r o n g dd ed 6 nam va 7 nd.
4.2. Ket qua ndl soi dg day - td trdng Trong nghien edu nay chung tdi gap 50/150 benh nhan bi viem da day ehiem ty le 33,3%. Loet da day ed 53/150 benh nhan chiem ty le 35,4% va 47/150 benh nhan loet ta trimg chiem ty le 31,3%. Ti le benh nhan bi benh viem da day, loet da day, loet ta trang khac nhau khdng ed y nghia t h d n g ke (p>0,05).
4.3. Ty le nhdm mdu trong benh ly dg day - td trdng
De flm hieu t;y' le cac n h d m mau t r o n g benh ly da day ta trang, chung tdi flen hanh xet nghiem nhdm mau ddi vdi 150 benh nhan nghien edu. Ket qua cho thay nhdm mau O cd sd lupng benh nhan d d n g nhat vdi 62 ngddi, chiem t^ le 41,3%. Nhdm mau A cd 31 benh nhan va chiem ty le 20,7%. Nhdm mau B ed 51 benh nhan, ehiem ty le 34 %. Nhdm mau AB cd ty le thap nhat (4% vdi 6 benh nhan ).
Ty le gida nhdm mau O va A khae nhau ed y nghia t h o n g ke vdi p<0,05. Gida cac nhdm mau khac sd khae biet khdng ed y nghi t h d n g ke vdi p>0,05,
Ket qua cua chung tdi t d d n g t u nghien cdu eua Tesfahun Tadege [4] ve ty le nhdm mau O va A nhung cao hon d n h d m mau B va thiap hpn d n h d m mau AB.
SU khac biet ve ty le nam va n d t r o n g cac n h d m mau khdng cd y nghia t h d n g ke vdi p>0,05.
Phan tich ve m o i lien quan gida cac nhdm r T i M | vdi benh ly da day ta trang chung t d i nhan thay: ^ r '
Nhdm mdu A: Trong v i e m da day ed 11 /31 bWI nhan, chiem 35,4% va gap chd yeu d viem t r d t ^ t r o n g loet da day cd 13/31 benh nhan, chiem tJ l | ^ 42,0% va t r o n g loet ta trang cd 7/31 benh nii chiem t y le 22,6%. N h d m mau A gap nhieu t r ^ loet hang vi va mat trUde hanh ta trang hon cac y khac. Ty le n h d m mau A t r o n g cac nhdm benl)!p viem va loet khac nhau khdng cd y nghia t h d n g 4 , j , vdi p>0,05. , n
Nhdm mdu B: Trong viem da day cd 20/51 betf: ., nhan, chiem 39,2%; t r o n g loet da day cd 16/51 bt^ •:
nhan, chiem t^ le la 31,4% vii t r o n g loet ta trang cf , 15/51 benh nhan, chiem t y le 29,4%. Nhdm m a u f gap chu yeu t r o n g viem t r d t loi va loet hang vj hcai cae t h e viem va vj t r i loet khae. Ty le nhdm mauB t r o n g cac n h d m benh ly viem, loet khac nhau khong cd y nghia t h d n g ke vdi p>0,05.
Nhom mdu AB: Trong viem da day cd 3/6 benfi nhan deu la nd, chiem 50%; t r o n g loet da day co 1/6 benh nhan la nam, ehiem ty le la 16,7% va trong loet ta trang ed 2/6 benh nhan m d t nam va mot nil, chiem t y le 33,3%, Ty le n h d m mau AB trong ciic n h d m benh ly khae nhau khdng ed y nghia thdng ke vdi p>0,05.
Nhdm mau O: Trong viem da day cd 16/62 benh nhan, ehiem 25,8%; t r o n g loet da day cd 23/62 benh nhan, chiem tJ- le la 37,1% va t r o n g loet ta trang co 23/62 benh nhan, chiem t y le 37,1%. J</ le nhom mau 0 t r o n g cae n h d m b e n h ly khac nhau khong co y nghia t h o n g ke vdi p>0,05.
Ket quS nghien cdu cua Tesfahun Tadege [4!
eho thay n h d m mau O chiem fl? le 43%, nhdm mau A 23,5%, n h d m mau B 22,5%, n h d m m a u AB 11%.
Cac nghien cdu ve n h d m mau tren the gidi cho thay ty le viem loet da day-ta trang d nhdng ngddi tf nhdm mau O cao hdn 30%-35% so vdi nhdm khae.
Nguyen nhiin la do dae diem eau tao phan ttt eua miing te bao d n h d n g ngddi cd n h d m mau 0 CO chda chat "gay hap d a n " vl khuan Helicobater pylaB tao dieu kien t h u a n loi de chdng vi khuan nay cUtrOj
TAP CHl Y DU'ac LAM SANG 1 T i p 10-S6 3/2015
sinh soi va gay t o n t h u a n g thanh da day gay viem roi loet, Con nhufng ngudi t h u o c n h o m mau A lai de bi ung t h u hon cac n h o m mau khac. Brigic E va cs.
[1] nghien cUu ve cac n h o m mau bao g o m cac cau hoi ve m d i lien quan giCfa n h o m mau vdi cac benh ly da day ta trang nhat dinh cho thay n h d m mau O chiem uu the hdn t r o n g mdi lien quan den viem da day so vdi cac n h d m mau khac. M o t nghien cUu cua Y. Rasmi va cdng sU [5] da t i m each de xac dinh viec phan phdi cac n h d m mau ABO d benh nhan PUD d Iran. Trong so 81 benh nhan nghien cUu gom 51 nam va 30 nO cd do t u o i 49 ± 18 nam. Cac n h d m mau ABO dUOc phan phdi t r o n g ddi tUOng nghien CLTU n h u sau: 3 7 , 1 % (30/81) cho n h d m A, 23,4%
(19/81) cho n h d m B, 35,6% (28/81) cho n h o m 0 va 4,9% (4/81) cho n h o m AB. Theo ket qua nay n h d m mau ABO d d n g m o t vai tro quan t r p n g d nhCfng benh nhan loet da day. Tan sd cua n h o m mau ABO gap d hau het cac roi loan tieu hoa da dugc nghien cu'u. Nhdm mau O cd nguy co cao phat tnen loet ta trang. Tac gia cung chi ra rang mac du m d t so dieu tra cho thay cd m d i tUdng quan giUa nhdm mau O va nhdm mau A vdi loet da day, nghien cu'u cDa tac gia khong thay cd sU tUOng quan.
R, Doll va cdng sU [3] nghien cCru n h d m mau ABO va t i n h trang tiet dich da c6 nhUng ket luan rang n h d m mau O va dich tiet anh hUdng den nguy CO phat trien cua 6 loet da day ta trang hoac cd lien quan vdi nhau, nhUng ma khdng phu thudc vao sU hien dien cua cac chat t r o n g n h d m mau tiet ra.
4.4. Ty le nhom mdu lien quan den tien sU gia dinh
Trong nghien cCfu nay chung tdi gap 54/150 benh nhan d tat ca cac n h d m mau cd tien sCr gia dinh bl benh ly da day ta trang chiem t y le 36%. Ty le chung benh nhan cd tien sCr gia d i n h va khdng cd tien SLf gia d"inh khac nhau cd y nghTa t h d n g ke v6i
= p<0,005.
•^ Ty ie cd tien sCr gia dinh t r o n g n h d m mau 0 la '' 46,8% (29/62 benh nhan). Ket qua cua chung toi f cung phu h o p nhieu nghien cu'u t r o n g va ngoai ' nude cho rang ve yeu to di truyen, nhUng ngUdi co
^' nhdm m a u 0 t y le loet ta trang cao hOn cac n h o m I mau khac. Gia d i n h cd ngUdi bi benh tieu hoa thi ty
le benh cao hOn cac gia dinh khac. Theo nghien cu'u cua L Honwich va cs. [2] thi khdng cd sU khac biet giUa n h d m mau va gidi tinh d benh nhan binh t h u d n g hay bi loet ta trang.
Nhdm mau A cd 11/31 benh nhan cd tien sif, chiem ty le 35,5%. Nhdm mau B cd 13/51 benh nhan, chiem ty le 25,5% cd tien sCr gia dinh. Rieng n h d m mau AB chi cd 1/6 benh nhan cd lien quan den tien sCf gia dinh, chiem ty le 16,7%.
Ty le benh nhan cd tien sU va khdng cd tien sir gia dinh t r o n g n h d m mau B khac nhau cd y nghia t h d n g ke vdi p<0,05. Nghien cUu cCia Wei-Cheng You va cs[6] tai Trung Qudc ve n h d m mau va lich svS gia dinh mac benh ung thU hen quan den t o n t h u o n g precancerous da day cho thay rang yeu t d di truyen d d n g m d t vai trd t r o n g viec phat t n e n t d n t h u o n g precancerous da day. Trong cac n h d m khac, sU khac biet khdng co y nghTa t h d n g ke vdi p>0,05.
NhUng ngUdi trong gia d'mh bi benh da day ta trang chCi yeu ia bo, me, anh em trai, hoac anh trai (em trai) va em gai (chi gai). Chung tdi khong gap trudng hpp nao cd ciing chi em gai bj benh. Cd the do sd benh nhan nghien cCfu cua chung toi cdn han che.
5. Ket luan
T>' le benh nhan mac benh da day - ta trang cao hdn d ngUdi cd nhdm mau 0 (chiem ty le 41,3%), va t h u d n g gap la loet hanh ta trang (chiem ty le 48,9%).
Ty le benh nhan mac benh da day - ta trang cd tien SL; gia dinh lien quan den n h d m mau O la cao nhat, chiem ty le 46,8%
Tai lieu tham khao
Brigic E, Ter^ic S, lljazovic E, Cickusic E (2002) Association between chronic gastritis in childhood, Helicobacter pylori an(j ABO blood groups. Med Arh 56(3): 57-58.
2. L Honwich, DA.P.Evans, RB Mc Connell et al (1966) ABO blood groups in gastric bleeding Gut 7:680 3. R Doll, H Drane, A. C Newell (1961) Secretion of
blood group substances in uodenal, gastric and stomal ulcer, gastric carcinoma, and diabetes me//;tus. Gut 2: 352-359,
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Tesfahun Tadege, Yohannes Menglstu, Kassu Desta (2005) Seroprevalence of Helicobacter pylori Infection in and its Relationship with ABO Blood Groups. EthiopJ.HealthDev 19(1).
Y Rasmi, M. SadreddinI, T. Peirovl (2009) Frequency of ABO Blood Groupin Peptic Ulcer Disease in Iranian Subjects. Pakistan Journal of Biological Sciences 12(13): 991-993.
)A/el-Cheng You, Jun-Ling Ma, Wei-dong Liu, at al (2000) Blood type and family cancer history In relation to precancerous gastric lesions. International Journal of Epidemiology 29:405-407.
