NGHIEN cOtJ KHOA HOC
NGHIEN CU'U DAC DIEM LAM SANG
BENH HAC VONG MAC TRUNG TAM THANH DICH
• • •
VA YEU TO LIEN QUAN
f Vii Thi Kim Lien', VU Quang DUng*, Hodng Manh Hiing' j
TOM TAT
IVIuc tieu: Mo ta dgc diem dich te vd Idm sang benh hdc vdng mgc trung tam thanh dich (HVMTTTD) va xdc dinh cdc yeu to nguy ca lien quan.
Doi tirong va phirong phap: Nghien ciiru mo td, chpn mdu lien tuc trong thai gian nghien ci'ni. Tdt cd cdc benh nhdn HVMTTTD dieu tri tgi Benh vien da khoa Trung uang Thai Nguyen tir 1 -12/2009 vd so lieu hoi ciiTA tic ho sa benh dn trong ndm 2007 - 2008.
Ket qua; Nghien ciru tren 52 benh nhdn (BN) nam gap nhieu han nu (73,1% nam; 26,9% nir), tuoi trung binh Id 42,6. Benh gap chii yeu a mot mat (mat phdi: 43.3%; mdt trdi: 46.2%o), dirai 50 tuoi de co nguy ca bi cd hai mdt (p < 0,05). Thi luc nhap vien thudng a mire 3/10 den 7/10 (38,5%)). Thdi gian nhap vien tap trung nhiiu vdo thdng 10, 11, 12 vd 4, 5, 6. 28,8% so BN nhap vien lan 2 vd 7,7% nhap vien Idn 3. Trieu chimg thudng gap; dm diem trung tdm (78,8%>) vd phii vong mgc trung tdm (71,2%,). Trieu chimg nhin vgt bien dgng gap nhieu han a Idn nhgp vien ddu tien (p < 0,01). BN co thi luc thdp thudng mdt dnh trung tdm hodng diem (p < 0,05). Cao huyet dp (11,5%,) vd dg ddy (11,5%) Id benh phoi hap thudng gap.
K^t luan: HVMTTTD thuang gap a tuoi trung nien, cd xu huang bi cd hai mdt a tuoi dudi 50, hay tdi phdt, thuang gap dau miia dong vd he, trieu chimg nhin vgt bien dgng thuong thdy a Idn ddu bi benh.
Tir Ithoa: Benh hdc vong mgc trung tdm thanh dich.
I. DAT V A N D E
Benh HVMTTTD (Central serous chorio- retinopathy) dugc biet den tir lau vai nhieu ten goi khac nhau nhir: viem vong mac trung tam tai phat, viem vong mac trung tam, viem HVM- TTTD, bong vong mac det nguyen phat vung hoang diem va benh vong mac trung tam thanh dich. Benh anh huang ca vong mac va hac mac nen thuat ngO dung hien nay la benh HVMTTTD.
Bi^u hien dac trung cua benh la xuat hien mpt bong thanh dich o dual lap vong mac cam thu.
Thanh dich nay dugc ro ri tu mao mac hac mac do su bi^n doi hang rao hoac cac chirc nang bam a bieu mo sac to v5ng mac [1].
'Bo mon Mdt, Tnr&ng Dai hoc Ydirac Thdi Nguyen
Benh gap chu yeu d giai nam, do tuoi tu 20 den 55 [9] vai tan xuat gap d nii nhieu hon tir 6 den
10 lan, nguoi chau A gap nhieu hon nguoi chau Au va chau My.
Benh HVMTTTD cap tinh thudng tu khoi va thj lire hoi phuc tot. Tuy nhien, benh hay tai phat tien trien thanh man tinh gay ra nhung thay doi d vong mac lam giam thi lire vTnh vien. BN da bi benh HVMTTTD 1 lan CO nguy co tai phat khoang 40 - 50% a chinh mat da bi benh [9]. Sinh benh hoc cua benh chua duoc hieu biet nhieu [3]. Benh bieu hien lam sang bang trieu chimg nhin mo, co am diem trung tam, roi loan sac giac, nhin hinh bien dang, thich img sang toi giam sut, hoang diem sam mau va co bong thanh dich duai vong mac viing hoang diem. Hien nay, chua cd thuoc
NGHIEN CCtU KHOA HOC
J
dac hieu d6 dilu bn benh HVMTTTD, chu yeu dieu tri noi khoa bang thuoc de giam trieu chimg va laser day mat khi co chi djnh.
Da CO nhieu cong trinh nghien ciru hoi ciru xac dinh mot so yeu to nguy co cho benh nay nhu:
gioi nam, stress, nguoi type A, dung Cortieoide va phu nii CO thai [5, 6, 7, 8]. Gan day, mot so nghien ciru ea benh ciing da chi ra rang, benh cao huyet ap va nhiem Helicobacter pylori ciing c6 lien quan toi benh nay [4, 10]. Mpt nghien ciru benh chirng v8 cac yeu to nguy ea voi benh HVMTTTD da chi ra viec diing khang sinh, uong nrgu, khong dieu tri cao huyet ap, cac benh ho hap di irng ciing la nhiing yeu to nguy eo eiia benh [8].
Tai Viet Nam, cong trinh nghien cim ve dac dilm dich te, lam sang va can lam sang benh HVMTTTD tai Benh vien Mat thanh ph6 H6 Chi Minh Cling da chi ra cac yeu to nguy co [2].
Chung toi thuc hien nghien cim nay tai khoa Mat, Benh vien da khoa Trung uong Thai Nguyen voi muc tieu:
1. Mo td dgc diem dich te vd Idm sdng benh HVMTTTD.
2. Xdc dinh cdc yeu to nguy ca cd lien quan.
II. DOI TUONG vA PHUONG P H A P
1. Doi tuong ngliien ciru
Tieu chuan chon doi tupng nghien ciiu:
- Tat ca cac BN dugc chan doan benh HVMTTTD dilu tri tai Benh vien da khoa Trung uong Thai
Nguyen bi thang 1 - 12/2009 va thu thap them s6 lieu nghien cim tir h6 so benh an nhung BN dugc e h k doan benh HVMTTTD dilu tn tai khoa trong nam 2007 va 2008.
- Loai trir nhiing BN co benh khac a mat kem theo nhu due thi thuy tinh, seo giac mac, viem mang bo dao, thoai hoa hoang diem Uioi gia.
2. Phu-oTig phap nghien cihi
- Nghien cim mo ta cat ngang va hoi cuu, chgn miu lien Uic trong khoang thoi gian nghien cuu.
- Ngi dung nghien cim:
+ Dac dilm dich tl: tuoi, gioi, dan tgc, nghe nghiep, thoi gian vao vien.
+ Dac dilm lam sang: thi lire vao vien, am dilm, nhin vat bien dang, anh hoang diem, tinh trang vong mac.
+ Benh toan than co lien quan.
- Phuong tien nghien cim: bang thi luc, sinh hien vi kham, kinh Volk, den soi day mat, bang luoi Amsler, thulc gian dong tir va benh an nghien cim hoi cim.
- Thu thap so lieu: gom 2 phan chinh
+ Kham lam sang: khai thac dac diem djch te, thir thi lire, kham ban phan truoc, soi day mat cho nhiing BN nghien ciru trong nam 2009.
+ Thu thap thong tin hoi cuu benh an trong nam 2007 va 2008, dien day du thong tin vao benh an nghien cuu.
- Phuong phap xir li so lieu: theo phan mem SPSS 16.0.
III. KET QUA VA BAN LUAN 1. Dac diem nhom benh nhan
Bdng 1. Phdn bo benh nhdn theo gi&i vd mat hi benh
~ ~ ~ ^ ~ ^ ^ ^ M a t benh Gioi ^ ^ ^ ^ ^ - ^ Nam
Nii Tong so
Tile(%)
MP 16
6 22 42,3
MT 18
6 24 46,2
2M 4 2 6 11,5
Tong so BN 38
14 52
Tile (%) 73,1 26,9 100 Nghien ciru tren 52 BN thay ti le BN nam cao hon BN ntr. So BN nam chiem 73,1% trong khi nii chi chilm 26,9%. Ket qua nghien cuu nay phii hgp voi ket qua nghien cim cua tac gia khac [3]. Nghien cim
NGHIEN CLTU KHOA HOC
cung thay rang, chii yeu BN bi benh a mgt mat (mat phai: 43,3%, mat trai: 46,2%). So BN bj ca hai mat it (chiem 11,5%). Khong co sir khac biet ve mat bi benh giiia giai nam va nii.
^ ^ ^ SoBN Nhom tuoi ^ ^ ^ Duoi 30
30 den duai 40 40 den duoi 50 50 den duai 60 Tren 60
Tong so
Bdng 2. Phdn bo benh nhdn theo nhdm tuoi vd gi&i Nam
BN 1 10 20 4 3 38
Tile (%) 2,6 26,3 52,6 10,5 7,9 100
NCr BN
0 9 5 0 0 14
Tile (%>)
0 64,3 35,7 0 0 100
Tong so BN
1 19 25 4 3 52
Tile (%')
1,9 36,5 48,1 7,7 5,8 100 p < 0,05
BN nghien cim co do tuoi tir 27 den 63. Tuoi trung binh mac benh la 42,6 ± 8,4. Benh gap nhieu a nhom tu6i bi 40 din duoi 50 (48,1%), tilp theo la nhom tuli tir 30 din duoi 40 (36,5%). S6 BN duoi 30 tuli va tren 60 tuoi chiem ti le thap. Nghien cim da tim ra co moi tuong quan trung binh giiia nhom tuoi va gioi voi p < 0,05 (test Pearson correlation: -0,312). BN nii chi gap d lira moi duoi 50. Ket qua nghien cim khac [12] ciing chi ra rang, benh hay gap 6 lira tuoi trung nien tir 30 den 50 tuoi, nam bi nhieu hon nii'.
Bdng 3. Phdn bo theo nhom tudi vd mdt bi benh
~~~ — ~ ~ ~ ~ ^ ^ _ _ _ ^ ^ Mat bj benh Nhom tuoi mac benh ~"— ___^
Duoi 30
Til- 30 din duoi 40 Tir 40 den duoi 50 Tir 50 den duoi 60 Tren 60 tuoi Tong so Tile
n
A,
n
A)
n
A)
n
% •
n
% n
%
MP 0 0 6 27,3
11 50 3 13,6
2 9,1
22 100
MT 0 0 10 41,7
12 50 1 4,2
1 4,2
24 100
2M 1 16,7
3 50
2 33,3
0 0 0 0 6 100
P < 0 , 0 5
Ket qua nghien cim thay rang co moi tuong quan trung binh giiia nhom tuoi va mat bi benh voi p <
0,05 (test Pearson correlation: -0,323). BN tuoi duoi 50 tuoi co nguy ca bi benh ca hai mat cao han so voi nhiing BN tren 50 tuoi.
Bdng 4. Phdn bo mire do thi luc khi vdo vien Muc thi luc
= 10/10
7 / 1 0 = < ^ < 10/10 3 / 1 0 = < - ^ < 7 / 1 0
<3/10
Tong so
S6BN 7 12 20 13 52
Ti le C/o) 13,5 23,1 38,5 25 100
NGHIEN c u l l KHOA HOC
Trong so cac truang hgp mic benh nhap vien, da s6 BN co thi luc giam a miic do tir 3/10 den duoi 7/10 (chilm 38,5%); 23,1% BN co thi lire a mire tir 7/10 din duoi 10/10. S6 BN co thi lire tit tren 10/10 chiem 13,5%.
2. Cac yeu to nguy co"
2. /. Thai diem nhap vien
Thoi gian
Bdng 5. Phdn bo thai gian nhap vien S6BN
Thang 1, 2, 3 Thang 4, 5, 6 Thang 7, 8, 9 Thang 10, 11, 12 Tong so
n 9 17
5 21 52
Ti le (%) 17,3 32,7 9,6 40,4
100 So BN nhap vien tap trung nhieu vao cac
thang 10, 11, 12 va cae thang 4, 5, 6 lan lugt chiem ti le 40,4% va 32,7%. Day la khoang thoi gian dau miia dong va dau he khi thoi tiet chuyen miia so lugng BN co bieu hien benh tang hon voi cac thang khac trong nam.
2.2. So Idn nhgp vien dieu tri
Trong thai gian nghien cim, eo 33 BN (63,5%) vao vien 1 lan va 28,8% so BN nhap vien lan 2,7;
7% BN nhap vien \h\ 3, khong co BN nao nhap vien tren 3 lan. Theo cac thong ke khac [1], benh nay hay tai phat, ti le tai phat la 30%) trong vong 2 nam. Mac du khoang thoi gian nghien ciiu ngan nhung thay so BN nhap vien lan 2 va 3 chiem mgt ti le tuong doi. Tuy nhien, nghien ciru nay con han che ve thoi gian, chua theo doi dugc cu the thai gian tai phat benh ciia moi BN va ti le tai phat.
2.3. Cdc trieu chimg Idm sdng
Bdng 6. Trieu chirng Idm sdng chinh
Trieu chiing LS ~~~~——____
Am diem
Nhin hinh bien dang Phil vong mac trung tam Xuat tiet vong mac Anh tiaing tam hoang diem
Co n 41 29 37 31 22
% 78,8 55,8 71,2 59,6 42,3
Khong n
11 23 15 21 30
% 21,2 44,2 28,8 40,4 57,7
Tong so n
52 52 52 52 52
% 100 100 100 100 100 Cac trieu chiing chinh thuang gap trong benh nay bao gom am diem, nhin hinh bien dang, phii vong mac trung tam, xuat tiet vong mac va anh trung tam hoang diem nhoe hoac mat. Trong nghien ciru nay;
78,8% BN CO am diem trung tam, nhin thay quang den truoc mat va 71,2% BN co phii vong mac trung tam.
Bdng 7. Lien quan giira so Idn vdo vien vd trieu chimg nhin vgt biin dgng
~——^__NJiin hinh bien dang So lan vao vien ~ ~ — — _ _ _ Lan thir nhat
Lan thir hai Lan thir ba Tong so
Co n 13 12 4 29
% 48,8 41,4 13,8
Khong n
20 3 0 23
% 87,0
13,0 28,8
p < 0 , 0 1
NGHIEN CLfU KHOA HOC
Ket qua nghien ciiu cho thay co 1 moi tuong quan trung binh giiia so lan nhap vien va dau hieu nhin vat bien dang. Dau hieu nhin vat bien dang gap nhieu hon o lan nhap vien dau tien co y nghia vai p
< 0,01 (test Pearson correlation: -0,439)
Nghien cuu thay rang, co moi tuang quan giiia thj lire khi vao vien va anh trung tam hoang diem (test Pearson correlation: 0,289). Voi BN co thj luc thap khi nhap vien, anh trung tam hoang diem mat, vai BN nhap vien co mire thi lire tot thuang con anh trung tam hoang diem.
2.4. Cdc yeu to todn thdn lien quan Bdng 8. Benh todn thdn phoi hap Benh kem theo
Cao huyet ap Viem loet da day Khac
Khong CO benh kem theo Tong so
S6BN 6 6 8 32 52
Tile 11,5 11,5 15,4 61,5 100 Trong nghien ciru nay, so lugng BN mac cac benh toan than phoi hgp chiem ti le khong nhieu. Hai benh phoi hgp thuang gap la cao huyet ap (11,5%) va da day (11,5%). Nghien cim ciia Cottieelh (2006) ciing tim thay moi lien quan gifla nhiem Helicobacter pylori voi benh HVMTTTD. Tac gia khac (Tittl, 1999) cung nhan thay benh cao huyet ap Cling gop phan lam phat benh nay. 61,5% so BN mac benh HVMTTTD trong nghien cim ciia chiing toi khong co benh toan than kem theo. Mac dii theo ket qua nghien ciru cua Haimovici (2004) ve cac yeu to nguy eo voi benh HVMTTTD, hg da tim ra benh tieu duong va diing steroid toan than, phu nu' CO thai va uong rugu la cac yeu to nguy co vai benh. Do so lugng BN trong nghien ciru nay
chua dii Ion va khoang 2/3 so lieu thu thap dugc tir benh an hoi ciiu cho nen viec khai thac cac yeu to nguy CO khac nhu hut thuoc, uong rugu chua dugc day du.
IV. KET LUAN
Nghien cim tren 52 BN dieu tri benh HVMTTTD tai Benh vien da khoa Trung uong Thai Nguyen trong thai gian 2007 - 2009 da tim hieu dugc dac diem dich te va lam sang cua BN, dong thai ciing thay mgt so yeu to lien quan mac dii so lugng BN khong nhieu va viec thu thap so lieu hoi cim tir benh an cu con chua day dii vai mgt so yeu to nguy co. Ket qua nghien cim thay rang:
- Ti le BN nam mac benh nhieu hon BN nu' (73,1% nam; 26,9% nu').
- Benh chu yeu o mgt mat (mat phai: 43,3%;
mat trai: 46,2%). BN duoi 50 tuoi co nguy ca bi benh ca hai mat (p < 0,05 test Pearson).
- Tuoi mac benh trung binh la 42,6, benh gap nhilu a nhom tuoi tir 40 din duoi 50 (48,1%). BN nu- gap nhieu a tuoi duoi 50 (p < 0,05 test Pearson).
- BN nhap vien thi luc giam chii yeu a muc do 3/10 din duai 7/10 (38,5%).
- Thoi gian nhap vien tap trung nhieu vao cac thang 10, 11, 12 va cac thang 4, 5, 6 khi thai tiet chuyen miia dong va he.
- Co 28,8% s6 BN nhap vien Idn 2 va 7,7%
BN nhap vien lan 3.
- Trieu chirng lam sang gap nhieu: am diem trung tam (78,8%) va phii vong mac trung tam (71,2%). Trieu chirng nhin vat bien dang gap nhilu hon a lan nhap vien dau tien. BN co thi luc thap anh trung tam hoang diem thuang mat. Cao huylt ap (11,5%) va da day (11,5%) la benh phoi hop thuang gap.
TAI LIEU THAM KHAO
/. "Hac vong mac trung tam thanh dich" [Online] tir trang web http;//ww\v.benhhoc.com/post/872/.
2. VO QUANG MINH, T R A N NGOC K H A C LINH (2006): "Khao sat dac diem dich te hgc va trieu chirng lam sang va can lam sang benh hac vong mac trung tam thanh dich tai beiih vien mat thanh
NGHIEN CUtJ KHOA HOC
pho Ho Chi Minh", Tgp chi Y hoc thuc hdnh, so 10, tr 74-76.
3. BENNETT, G, 1995: "Central serous retinopathy", Br J ophthalmology, vol. 39, pp. 605-18.
4. COTTICELLI. Let al, 2006: "Central serous chorioretinopathy and Helicobacter pylori", Eur J Ophthalmol, vol. 16 (2), pp. 274-8.
5. HAIMOVICI R, et al, 2004: "Risk factor for Central Serous Chorioretinopathy", The American Academy ofOpthalmology, vol. 111, pp. 244-249.
6. LEVY J, et al, 2005, "Central serous chorioretinopathy in patients receiving systemic corticosteroid therapy". Can] Ophthalmol, vol. 40, pp. 217-221.
7. LOPA Y.G; MICHAEL F.M, 1995,
"Electrophysiology of the retinal pigment epithelium in central serous chorioretinopathy", Documenta Ophthalmologica, vol. 91, no. 2, pp. 101-107.
8. MARMOR, M. 1997, "On the cause of serous detachments and acute central serous chorioretinopathy", Br J Ophthalmol, vol. 81, pp. 812-3.
9. KEAN TOH, 2007: "Chorioretinopathy, Central Serous" [Online] Emedicine specialities, ophthalmology, retina. Available at: http;//
emedicine. medscape. com/article/122 7025- oven'iew; Aeeesed: 10 October 2009.
10. TITTL, M.K, SPAIDE, R.F, WONG, D et al. 1999: "Systemic findings associate with central serous chorioretinopathy". Am J Ophthalmol, vol.
128, pp. 63-68.
SUMMARY
STUDYING CLINICAL CHARACTERISTICS AND RISK FACTORS FN PATIENS Vk^ITH CENTRAL SEROUS CHORIORETfNOPATHY
Purposes: To describe the clinical characteristics and risk factors in patients with central serous chorioretinopathy (CSCR).
Design: A descriptive study of 52 consecutive patients with central serous chorioretinopathy treated in Thai Nguyen General hospital from 2007 to 2009.
Results: CSCR was most common in male than in female (73.1% male; 26.9% female). A mean age was 42.6 years. CSCR presented mostly in one eye (OD: 43.3%,; OS: 46,2%), under 50 years easily had CSCR in both eyes (p < 0.05). Visual acuity at the time hospitalized commonly was 3/10 to 7/10.
Time admitted to hospital focused on October, November, December and April, May, June. 28.8%, and 7. 7% of CSCR patients were admitted to hospital at the second and third time. The common symptoms were positive scotoma (78.8%) and serous retinal detachment (71.2%o). Metamorphopsia was likely to present at the first time hospitalized (p < 0.01). Hypertension and stomachache were common systermatic diseases in CSCR patients.
Conclusion: CSCR is common in middle age, under 50years easily have disease in both eyes; likely to relapse, occuiring often in early winter and summer, metamorphopsia is likely to present at the beginning.
