JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.5- N°5/2010
Nghien cuu anh huong cua benh vay nen den chat Iugng cuoc song nguoi benh
Studying the impact of psoriasis on the quality of life
Bui Thj Van, Nguyin Thi Kim Oanh, Dang Van Em Benh vien Trung uang Quan dgi 108
Tomtat
Nghien cffu anh hudng cua benh vay nen de'n chat lUpng cuoc sdng cua 178 benh nhan cho tha'y: anh hudng rat nhieu 21,9%, nhieu 55,1% va it 23,0%. Trong do, anh hudng de'n trieu chffng va cam giac (rat nhieu 28,7%, nhieu 54,5%), de'n hoat dpng hang ngay (rat nhieu 9,0%, nhieu 42,6%, I't 49,9%), den hoat dong xa hoi (rat nhieu 7,5%, nhieu 34,8%, it 37,7%), de'n hoc tap va cdng tac (rat nhieu 9%, nhieu 34,8%, it 35,4%), de'n quan he ca nhan va HDTD (rat nhieu 10,7%, nhieu 32,6%, it 56,7%), de'n viec dieu trj (rat nhieu 20,8%, nhieu 48,3%, ft 30,9%); the thong thudng ft anh hudng den CLCS va the khdp anh hudng nhieu nhat (58,2%); mffc do benh cang nang thi cang anh hudng de'n chat lUdng cuoc sdng con tudi benh, giai doan benh khong anh hudng ro ret den chat lUdng cuoc sdng.
Summary
Studying the impact of psoriasis on the quality of life in 178 patients with psoriasis has shown that: very deep impact (VD.I), deep impact (D.I), and small impact (S.I) are 21.9%, 55.1% and 23.0%, respectively.
Effect on symptom and feeling are VD.I - 28.7%, D.I - 54.5%; effect on daily activities (VD.I - 9.0%, D.I - 42.6%, S.l - 49.9%); effect on social activities (VD.I - 7.5%, D.I - 34.8%, S.I - 37.7%); effect on studying and working (VD.I - 9.0%, D.I - 34.8%, S.l - 35.4%); effect on social relations and sexual relations (VD.I - 10.7%, D.I - 32.6%, S.l - 56.7%); effect on treatment (VD.I - 9.0%, D.l - 42.6%, S.l - 30.9%); psoriasis vulgaris has smallest impact and arthritis has deepest impact (58.2%) on quality of patiens' life. The more serious of the disease, the deeper impact on quality of life. In contrast, age and stages of disease has been shown no clear effect on quality of patients' life.
1. Oat van de dich va cae yeu td khdi ddng (tress, nhiem khuan khu Vay nen la mot benh da man tinh thudng gap d tru, chan thUdng da, mot sd t h u d c . ) tham gia vao sU Viet Nam eung nhU tren the gidi. Benh chiem 1-4% phat sinh va phat trien benh vay nen [1], [3], [8].
dan sd [1], [3], tien then thanh tffng ddt xen ke giai Da sd benh vay nen ft gay nguy hiem eho eupc doan khdng hoat dpng. sdng ngudi benh nhung gay anh hudng nhieu chat Benh vay nen ehia lam hai the, vay nen thdng lupng cude sdng ngudi benh. Do benh man tinh, keo thudng (vay nen the mang, ddng tien, cham, gipt) va dai ehUa dieu trj khdi ma ehi lam sach tdn thUPng va vay nen cae the nang khac (vay nen khdp, dd da toan duy tri SIJ" lam sach dd phai cd che dp lam viec sinh than, vay nen mun mu). hoat va dijng thudc dung phUdng phap keo dai... de Sinh benh hpe benh vay nen eho tdi nay van edn lam benh nhan ehan nan, bi quan. Dieu dd anh hudng nhieu van de ehUa rd, song hau het cac tac gia deu khdng nhd den chat lupng cude sdng (CLCS) cCia cho rang ed 3 yeu td chfnh la di truyen, rdi loan mien ngUdi benh [2], [5], [7]. Oe danh gia thuc chat benh
Tap 5 - S o 5/2010 TAP CHi Y DUOC LAM S A N G 108
anh hudng cQa benh vay nen den chat lupng sdng cua ngudi benh, chung tdi tien hanh de tai: "Nghien cffu anh hudng cua benh vay nen den chat lupng cude sdng ngudi benh" vdi muc dfch sau:
1. Xac djnh anh hudng cOa benh vay nen den cac hoat dgng cua benh nhan.
2. Danh gia su lien quan giUa lam sang (cac the benh, miic do benh, tuoi benh) vdi chat luong cugc song.
2. Ddi tupng va phudng phap
2.1. Doi tugng nghien ciiu - v
Ddi tupng nghien cffu gdm 178 benh nhan dupe chan doan xac djnh la vay nen cac the dupc dieu trj npi, ngoai tru tai Khoa Da L i i u - Dj ffng, Benh vien Trung UPng Quan dpi 108 trong thdi gian tU thang 2/2006 den thang 6/2008.
- Tieu chuan chan doan: dua vao lam sang va giai phau benh ly.
- Tieu chuan chpn benh nhan: cac the vay nen:
vay nen thdng thudng va cac the dae biet khae, mpi Iffa tudi, benh nhan ddng y hpp tac nghien cffu.
- Tieu chuan loai trff: benh nhan cd rdi loan tam than, cac benh nang khac kem theo, benh nhan khdng ddng y hpp tac nghien cffu.
2.2. Phuang phap nghien ciiu
Phuong phap nghien cuu: Tien cuU, md ta cat ngang.
Cae budc nghien cffu:
- Lap phieu nghien cffu gdm phan hanh ehinh, the benh, mffc dp benh, giai doan benh, anh hudng cOa benh den chat lupng cude sdng theo bd cau hdi.
- Danh gia anh hudng ci!ia benh vay nen de'n chat lupng eude sdng theo Finlay AY, Khan GK, Lewis VL [5].
He thdng ehi sd danh gia chat lupng cude sdng dupe dua tren bang DLQI (Dermatology Life Quality Index) bao gdm 10 eau hdi. Muc dich chinh ci!ia bang cau hdi nay la danh gia anh hudng cffa benh vay nen den chat lupng cuoc sdng cffa hp trong thdi gian qua.
Khi tra Idi cau hdi, ngudi benh se lUa chpn va danh dau vao mot trong nhffng cau tra Idi cho moi cau hdi:
1. Thdi gian qua, ban cam tha'y da ngffa, dau, nhffe nhdi nhieu nhu the nao ?
2. Thdi gian qua, ban cam tha'y ngupng ngap, xau hd, va mat tutin vi can benh cCia ban nhu the nao ?
3. Thdi gian qua, ban cam tha'y benh da can trd eac hoat ddng (di mua sam, cham sdc nha cffa, lam vudn) cua ban nhu the nao ?
4. Thdi gian qua, benh da eOa ban bj trd ngai nhu the nao bdi quan ao ban mang ?
5. Thdi gian qua, mffc dp anh hudng tU benh da cija ban den eae hoat ddng xa hdi hay hoat dpng giai trf nhu the nao ?
6. Thdi gian qua, benh da khien ban cam thay khd khan nhu the nao trong hoat dpng the thao (HDTT) ?
7. Thdi gian qua, benh da cd khien ban khdng the di lam hay di hpe dupc khdng? Neu khdng. Mffc dp anh hudng den cdng viee hay viec hpe eija ban nhu the nao?
8. Thdi gian qua, benh da da gay khd khan eho ban nhu the nao trong cude sdng vp ehdng, tinh yeu, vdi ban be hay ngudi than ?
9. Thdi gian qua, benh da da gay khd khan trong ddi sdng tinh due (HDTD) eCia ban nhu the nao ?
10. Thdi gian qua, van de dieu trj da gay anh hudng nhu the nao. Vi du: lam nha cffa ldn xdn hay ma't thdi gian cua ban ?
Cho diem theo thang diem nhu sau: anh hudng rat nhieu: 3 diem, anh hudng kha nhieu: 2 diem, anh hudng ft:1 diem va khdng anh hudng: 0 diem.
Quy djnh danh gia mffc dp anh hudng eija benh vay nen den chat lupng cude sdng dUa vao tdng sd diem cua benh nhan ed dupe: anh hudng ra't nhieu: tff 20 den 30 diem, anh hudng kha nhieu: tff 10 den 19 diem, anh hudng ft: tff 1 den 9 diem va khdng anh hudng: 0 diem.
Tdng diem tdi da la 30 va tdi thieu la 0, diem cang eao chffng td chat lupng cude sd'ng eang giam (nghTa la benh da ed anh hudng nhieu den chat lupng eude sdng ngUdi benh). Chi sd chat lupng eupc sdng cd the dupe tinh dudi dang % tren tdng sd 30.
2.3. Xii lysdlieu
- So sanh 2 gia trj trung binh va 2 ty le diJng T- test-student.
- Cd y nghTa thd'ng ke vdi p<0,05.
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.5-N°5/2010
3. Ket qua nghien cffu
3.1. Danh gia anh hudng ciia benh vay nen den CLCS
Bang 3.1. Mffc dp anh hudng ci!ia benh vay nen den CLCS I )i< • i" 1: r .-^ r
Mffc dd n
%
Khdng 0 0
it
41 23,0
Nhieu 98 55,1
Rat nhieu 39 21,9
Tdng 178 100,0 100% benh nhan vay nen bj anh hudng den chat lupng cude sdng eua hp. Trong dd, benh vay nen anh hudng den CLCS d mffc dp nhieu chiem ty le eao nha't 55,1%, rat nhieu chiem 21,9%, anh hudng it 23% va khdng cd benh nhan khdng anh hudng.
' o;'?o\«1 ioO.
Bang 3.2. Cac loai anh hudng ci!ia benh vay nen den CLCS (n=178)
Phan loai anh hudng Trieu chffng va cam giae (n= 178) Hoat dpng hang ngay
((n=178)
Hoat dpng xa hdi va TDTT
(n=178)
Cdng viee va hpe tap
(n=178)
Quan heca nhan va hoat ddng tinh due
(n=178) Viec dieu trj (n=178)
Khdng n
0
0
0
37
0
0
%
0
0
0
20,8
0
0
it
n
30
88
67
63
101
55
%
16,8
49,4
37,7
35,4
56,7
30,9
Nhieu n
97
74
62
62
58
86
%
54,5
41,6
34,8
34,8
32,6
I ^ . . .
48,3
Ra't nhieu n
51
16
49
16
19
37
%
28,7
9,0
27,5
9,0
10,7
20,8
Anh hudng ci!ia benh va'y nen b mffc rat nhieu chiem ty le cao nha't la trieu chffng, cam giac (28,7%), tiep den hoat ddng xa hdi va TDTT (27,5%), dieu trj (20,8%).
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Tap 5 - S O 5/2010 TAP CHl Y DUOC LAM SANG 108
3.2. Mdi lien quan giOa lam sang vdi CLCS
B a n g 3.3. Lien quan giffa the benh vdi C L C S (n=178)
!':
300%
or''?*;
"di;.'
^ \ Mffc dp
^ a n h hudng The benh ^x.
Thdng thudng (n=127) Dd da toan than
(n=13) Vay nen khdp
(n=24) Vay nen mun mu
(n=14) P
Khdng n
0 0 0
0
%
it
n
41 3 5
6
%
32,3 23,1 20,9
42,9
Nhieu n
82 7
5 5
%
64,6 53,8
20,9 35,7
Rat nhieu n
4
3 14
3
%
3,1 23,1 58,2 21,4
< 0,001
Nhdm benh nhan vay nen khdp bj anh hudng CLCS rat nhieu eao nha't (58,2%).
Bang 3.4. Lien quan giffa mffc dp benh vdi CLCS (n= 178) f i - ;
ii\'
\ . Mffc dp N ^ h hudng Mffc dp benh N.
Nhe (n=37)
Vffa (n=77)
Nang (n=64)
Tdng P
Khdng
n
0
0 0
%
0
0
0
it
n
11
30
0 41
%
29,7
38,9 0
Nhieu
n
26
43
29 98
%
70,3
55,9
39,1
Rat nhieu n
0
4
35 39
%
0
5,2 60,9
,u. , , <0,001
6 nhdm benh nhan nang thi CLCS bj anh hudng rat nhieu la 60,9%.
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.5-N''5/2010
4. Ban luan
4.1. Anh hudng ciia benh vay nen den CLCS Qua ket qua bang 3.1 eho tha'y 100% benh nhan vay nen deu bj anh hudng de'n chat lupng eupc sdng.
Trong dd, chij yeu anh hudng mffc dp nhieu 55,1%, rat nhieu 21,9% va it 23%. Ket qua nay cung phu hpp vdi nghien cffu eija De Korte-2004 la tat ea benh nhan vay nen deu anh hudng den chat luong sdng cQa hp va ehu yeu la d mffc nhieu [4].
SU anh hudng den sau nhdm eha't lupng eupc sdng dupc neu tai bang 3.2 cho thay anh hudng nhieu va rat nhieu xay ra d nhdm trieu chffng, cam giac chiem t^- le cao nha't 83,2%, tiep den la viec dieu tri 69,1%, hoat dpng xa hdi, the thao 62,3%, hoat ddng hang ngay 50,6%, cdng viec, hpe tap 43,8% va thap nha't la quan he ea nhan, hoat dpng tinh due 43,3%.
Ket qua eija ehung tdi cung phu hpp vdi nghien cffu cua Lewis. VJ., Finlay. AY. (2005) [6] la nhdm trieu chffng va cam giae chiem t^y- le cao nha't vdi cac bieu hien ngffa, rat tff it den rat nhieu. Ngffa lam cho benh nhan phai gai, cang thing than kinh, mat ngij dan den anh hudng den toan trang eua ngUdi benh va tao nen vdng xoan benh ly lam benh cang nSng va dai dang.
Cam giac ehung cua nhffng benh nhan la de cau gat, khd chui, khd sd, ludn cd thai dp lan tranh va hp eho rang minh dang bj danh gia qua nhffng bieu hien benh ly tren da. Chinh dieu nay lam cho hp ludn mac cam va mot sd cd y tudng tu sat. Theo Bhosle va edng sU, 2006 [2] "Benh vay nen la benh da phd bien tai My.
Bieu hien man tinh cCia benh cd tac dung xau de'n eupc sdng cCia benh nhan, benh edn cd mdi lien he tdi tinh trang suy nhupc va khuynh hudng ttj" sat d nhffng ngudi mac benh. Cai gia ci!ia benh di ddi vdi sU suy gam chat lupng cude sdng, nang suat lao dpng giam, nghi viec thudng xuyen va chi phi ehffa trj". NhU vay, benh vay nen anh hudng de'n chat lupng cude sdng cCia ngudi benh d ea 6 nhdm d eac mffc dp khac nhau.
Do vay, den nay mue dich dieu trj benh vay nen la nang cao chat lupng eupc sdng eho hp.
4.2. Mdi lien quan giOa lam sang vdi CLCS Anh hudng cDa benh vay nen de'n chat lupng cuoc sdng da dUdc De Korte va cdng sU, 2004 [4] neu
"Benh nhan mac benh vay nen dupc cdng bd la dm j yeu ve the chat, rdi loan cac chffc nang, mot cP the d l nhilm benh va day ao giac, han che trong nhffng hoat ddng thudng xuyen, cac hoat dpng xa hdi va eupc sdng. Phan ldn cac benh nhan vay nen nang deu di ddi vdi viec cd mot mffc dp thap ve chat lUpng eupc sd'ng". Ke't qua cija ehung tdi tai bang 3.3, bang 3.4 eho tha'y chat lupng cude sdng ciia ngUdi benh cd lien quan vdi the benh va mffc dp benh. Trong dd, mdi mac benh bi anh hudng den chat lupng eupc sdng nhieu hon la bj benh da nhieu nam. Ket qua nay phu hpp vdi nghien cffu cua Skevington va edng su, 2006 [7]; the benh cang nang (vay nen dd da toan than, vay nen khdp va vay nen mun mu) bj anh hudng den chat lupng eupc sdng nhieu hon the thdng thudng (bang 3.3) va mffc dp benh cang nang thi chat lupng eupc cang bj anh hudng nhieu hon (bang 3.4). Ke't qua nghien effu eua chung tdi phu hpp vdi ket qua eua Skevington va edng sU, 2006 [7] va Zaehariae va eong sff [8].
5. Ket luan
1. Anh hudng eCia benh vay nen den chat lupng eupc sdng ngUdi benh: 100% benh nhan vay nen deu bj anh hudng den chat lupng eupc sdng vdi anh hudng rat nhieu 21,9%, nhieu 5 5 , 1 % va it 23%. Trong do, anh hudng nhieu nha't la nhdm trieu chffng, cam giac (nhieu 54,5%, rat nhieu 28,7%) va anh hudng it hPn la quan he ca nhan, hoat dpng tinh due (nhieu 32,6%, rat nhieu 10,7%).
2. Lien quan giffa lam sang vdi CLCS: The thdng thudng it anh hudng den CLCS (rat nhieu 3,1%) va the khdp anh hudng nhieu nha't (rat nhieu 58,2%).
Mffc dp benh cang nang thi anh hudng den chat lupng eupc sdng cang nhieu.
Tai lieu tham khao
1. Bd mdn Da lieu- Hpe vien Quan y (2008), Benh vay nen, Benh da va hoa lieu, Nha xua't ban Quan dpi Nhan dan, Tr. 140-156.
2. Bhosle. MJ., Kulkarni. A., et al. (2006), "Quality of j life in patients with psoriasis", Healh quai life i
Outcomes, pp.35. . , _., , . J
Tap 5 - S O 5/2010 TAP CHi Y DUCIC LAM SANG 108
3. Christophers. E.M., Mrowiet. Z.U. (2003), 6. Lewis. VJ., Finlay. AY. (2005), "A critical review of
"Psoriasis, Fitzpatrick's Dermatology in general quality-of-life Scale for Psorisis", Dermatol din, 23 Medicine, The Mcgraw-Hill, Sixth edition. Vol 2; (4), pp.707-16.
pp. 407-426. 7. Skevington SM., Bradshaw J., et al. (2006), "How 4. De Korte. J., Sprangers. MA., Members. FM. does psoriasis affect quality of life ? Assessing an
(2004), "Quality of life in patients with psoriasis", J Ingram-regimen outpatient programme and investig Dermatil Sympproc, 9(2), pp.140-147. validating the WHOQOL-100", Br J Dermatol, 154 5. Feldman. SR., et al. (2005), "Entanereept (4), pp. 680-691.
improves the health-related quality of life of 369 8. Zaehariae R., Zaehariae H., et al. (2002), Quality patients", Br J Dermatol, 132 (2), pp.236-44. of life in 6497 Nordie patients with psoriasis", Br J
Dermatol, pp.1006-16.
dv'.?••-(' ?•
Nghien cufu tinh hinh, dac diem benh Herpes tai Benh vien Da lilu Trung uong tirl/2007 den 12/2009
Chracteristics of Herpes simplex at the National Hospital of Dermatology and Venereology from 1/2007 to 12/2009
Nguyen HOu Sau Trudng Dgi hgc Y Ha Ngi
Tom tat
Herpes (mun rpp) la benh da do virus herpes simplex (HSV) gay nen. Virus gay benh dUOe ehia lam hai nhdm: HSVl va HSV2. HSVl gay benh chu yeu d da vung mat va niem mac mieng. Virus HSV2 lai gay benh chu yeu d bp phan sinh due va la benh lay truyen qua dUdng tinh due. Muc tieu: Khao sat tinh hinh, dae
is-, diem benh Herpes tai Benh vien Da lieu Trung Udng. Ddi tUdng va phffdng phap nghien effu: Phffdng phap4,;,, md ta cat ngang dffa tren eac dff lieu eua 2107 benh nhan bj Herpes den kham va dieu trj tai Khoa kham
benh, Benh vien Da lieu Trung ffdng tff thang 1/2007 den het 12/2009.
Ket qua: Trong thdi gian 3 nam da cd 2107 benh nhan Herpes chiem 0,4% tdng sd benh nhan mac uf,ii benh da, trong dd 69,1% benh nhan mac herpes da- niem mac mieng va 30,9% bj herpes sinh due. Benh vi r mac d ca hai gidi. Herpes da-va niem mac mieng gap d nff nhieu hdn nam (63,2% va 36,8%; p<0,05), ngUde lai, herpes sinh due thi nam lai nhieu hdn nff (85% va 15%; p<0,01). 84,2% benh nhan d Iffa tudi tff 16 den 60 va chu yeu d nhdm ngUdi lao dpng (60%).
Ket luan: Trong thdi gian 3 nam cd 2107 benh nhan bj herpes chiem 0,4% so benh nhan da den kham tai Benh vien Da lieu Trung Udng. Sd ngUdi bi herepes da-niem mac mieng nhieu hdn sd benh nhan bj herpes sinh due. Lffa tud'i tff 16 den 60 cd ti le mac benh cao nhat va ehu yeu d nhdm ngUdi lao dpng.
Tff khda: benh herpes, virus herpes simplex.
Phan bien khoa hgc: PGS.TS. D A N G VAN EM