NGHIEN CUtJ KHOA HOC
NHAN XET MOT SO DAC DIEM DICH TE HOC LAM SANG CUA BENH NHAN GLOCOM DIEU TRI TAI KHOA MAT BENH VIEN DA KHOA TINH THAI BINH
TRONG 3 NAM (2005 - 2007)
Hd Trung Kien*, Nguyen Manh NghTa*, Iiiii Thi Hdng* Ddo Thi Ldm Huong**
TOM TAT
Muc tieu: nhdn xci mol sd ddc diem dich ic hoc Idm sdng cua benh nhdn (BN) glocom dieu iri Igi khoa Mdt, Benh vien da khoa tmh Thai Binh trong 3 ndm 2005-2007.
Doi tu-ong va phu-oiig phap: nghien cini hdi cim h6 sohenh dn cua 975 BN glocom (1161 mdt) dd diiu tri igi khoa Mdt BJ'DK Thdi binh trong 3 ndm 2005-2007. Kit qud: BN glocom chiim ti le 16.8% Irong long so BN mdt dieu tri tgi khoa. 97,4% BN co do tuoi tren 40. Ti le nam: nir Id 1:1, 7. Hinh ihdi glocom nguyen phdt chiim ti le ~9.6%. Tiin su glocom trong gia dinh gap a 22.3%> BN. 54,8% BN co thi luc dudi dnt 3m.
Da so BN CO nhdn dp cao tren 25 mmHg khi vdo vien (79,2%o). Phdn Ion BN (92%)) khong biit gi hodc rdt ma ho ve benh cua minh.
Ket luan: glocom Id mot benh mdt ndng, gap nhieu d lira tuoi tren 40. Khong co su khdc biet ro ret vi khd ndng mdc benh giira nam vd nit. Do thieu hieu hiet ve benh nen BN thudng din vien khdm vd diiu tri a giai dogn inuon. khi chirc ndng Ihi gidc da bi dnh hudng nhieu.
Tir khoa: glocom, ddc diem dich te hoc.
\. DAT VAN DE
Glocom la mdt trong nhung ngu) en nhan hang dau gay mil loa d nude ta ciing nhu tren the gidi.
Do cac spi than kirih thi giac bi tdn thuang khdng hoi phuc nen khdng cd phuang phap dieu tri nao phuc hdi thi lire cd hieu qua. Tuy nhien, cd the phdng chong mii Ida do gldcdm gay nen neu benh duac phat hien sdm va dieu tri kip thdi.
Theo cac tac gia Quigley H.A va Broman A, udc tinh tren the gidi den nam 2010 cd 60,5 trieu ngudi bi gldcdm, nam 2020 con so nay tang len tdi 70,6 trieu ngudi, trong dd so ngudi mil ca 2 mat udc tinh nam 2010 la 8,4 trieu ngudi, nam
2020 la 11,2 trieu ngirdi [6].
Tai Viet Nam, theo sd lieu ciia Benh vien Mat Tmng Udng nam 2007, t) trpng mil 2 mat dp gldcdm la 6,5%, dimg hang thii hai sau bcnh due the thuy tinh. Udc tinh sd mil trong dan do benh gldcdm la 28.000 ngudi [2J.
De danh gia tinh hinh BN gldcdm den kham va dicu tri tai khoa Mat, Bcnh \ ien da khoa tinh Thai Binh trong 3 nam (2005 - 2007), chiing tdi tien hanh de tai nghien ciiu vdi muc tieu: Nhan xet mdt so dac diem dich te hpc lam sang cua BN gldcdm dieu tri tai khoa Mat, Benli vicn da khoa tinh Thai binh trong 3 nam (2005 - 2007).
*BVda khoa Thdi Binh, **BVMat Trung uang
Nhan khoa Viet Nam (So 23 - 2011) 11
NGHIEN c u l l KHOA HQC
II. D 6 I T U ( ? N G VA PHiiaN(; P I I A P NGIIIKN (iTii
\. Doi tuang nghien cim
Tat ca BN duoc ehan doan gldcdm, dicu In ndi tni tai khoa Mat, BV da khoa tinh lliai Binh tir nga) 01 thang 01 nam 2003 den hct nga\ 30 thang
12 nam 2007.
2. Phuffng ph^p nghien cii'u
Nghien ciiu hoi ciru md la, thu thap thdng tin tir bpnh iin, dien vao mau phieu dicu tra thiet ke tmdc.
3. Phuang phap xii Ii so lieu
So lieu dupe xir li bang phan mem SPSS 16.0, (';ic bicn so dupe phan tich bang cac test thong ke thich hpp.
III. KET QUA VA BAN LUAN
1. Ti le benh nhan gldcdm so vdi cac benh mat khac
Hdng I. li le BN gldcdm so vdi cdc hgnh mdt khdc Nam
Nam 2005 Nam 2006 Nam 2007
Tdng
So BN glocom 289 319 367 975
Tong .so BN mit 1416 2189 2190 5795
Ti le (%) 20,4
14,6 16,7 16.8 Trung binh hang nam, so BN gldcdm dieu tri
tai khoa mat chiem ti le 16,8%. Tuy nhien, con so nay van chua phan anh dupe chinh xac so BN vi
chua tinh den luong BN dieu tri ngoai tni, dieu tri tai mdt so ca so Nhan khoa khac cua tinh hoac vuot len tuvcn tren.
2. Tuoi
Bdng 2. Phdn bo BN theo do tuoi (n = 975 BN) Tuoi
S o B N Ti le (%)
0 - 9 0 0
1 0 - 1 9 6 0.6
2 0 - 2 9 5 0,5
3 0 - 3 9 14 1.4
4 0 - 4 9 79 8.1
5 0 - 5 9 289 29,7
> 6 0 582 59,7 Ti le mac benh gldcdm tang dan theo tuoi, phan
Idn tap trung d dp tuoi tir 40 trd len (97,4%). So vdi nhdm dudi 40 tuoi su khac biet cd y nghia thpng kc 3. Gidi
63%
vdi p < 0,001, Kcl qua cua chiing tdi cung phii hgp vdi ket qua nghien cim cua mpt so tac gia khac la benh gldcdm gap chu N eu d ngudi tren 40 tuoi [1.5].
37%-i
DNam
• Nu
Biiu ad 1. Phdn bd binh nhdn theo gidi (N=975 BN)
12 Nhan khoa Viet Nam (So 23 - 2011)
NGHIEN CUU KHOA HQC
BN nu bi gldcdm nhi6u hon nam: nfr chiCmi ti le 63%, nam 37% (1,7:1). Su khac biet vc gidi khdng cd y nghTa thong ke. Theo giai thich cua mpt so tac gia do cdu tao giai phau mat nir gidi nho
hon nam gidi, tien phdng ndng han va the thuy tinh day han, than kinh nhay cam han la cac yeu to thuan Ipi de xuat hien can gldcdm gdc ddng a nfr gidi | 5 | .
4. Tiin su gia dinh co benh nhan glocom
Bdng 3. Tien sii cd henh gldcdm trong gia dinh Hinh thai
Quan he
Glocom goc dong nguyen pliat Glocom goc md nguyen phat
(+) (-) (+) (-) (+)
Ong, ba 19 175
2 1 21
Bo, mc L%
38 1 2 157
Anh, chj em ruot thjt
24 170
0 3 24
Ho hiing gan
191 0 3 3
Tong 202 574 3 9 205
Ti Ic (%) 26 74 25 75
Tl le BN gldcdm gdc ddng nguyen phat cd tien su benh trong gia dinh la 26% Ti le na) a BN gldcdm gdc ma la 25"i>. Hau het nhirng BN dd cd bd me ha) anh chi em mdt. dng ba bi gldcdm. Theo nghien ciru ciia Yuan HP (2007), ti le mac benh gldcdm gdc ddng nguyen phat d cac ddi tupng cd tien sir gia dinh cao hon so vdi cac
ddi tuong khdng cd tien su gia dinh [8J. Ddi vdi gldcdm gdc md ngu) en phat thi nga)' nay. vai trd ga)' bcnh cua gen GLCIA da dupe xac nhan, vi
\ a) xac dinh va dieu tri sdm trong nhung gia dinh cd ngudi bi gldcdm gdc md nguyen phat ddng vai trd quan trpng trong cdng tac phdng chdng mii loa do gldcdm gay ra [4].
5. Hinh thai glocom
Bdng 4. Ti le giua cdc hinh thdi glocom (n = 975 BN) Hinh thai Glocom
Glocom goc md nguyen phat Glocom goc dong nguyen phat Glocom thii phat, Glocom kliac
Tong
SoBN 12 776 187 975
Ti le (%) 1,2 79.6 19.2 100 BN gldcdm gdc ddng nguyen phat chiem da sd vdi
ti le 79,6%. Gldcdm gdc md nguyen phat chiem ti le 1,2%. Theo AlsagofFZ (2000) ngudi chau A cd tien de gen va cau tnic giai phau thuan lai cho ddng gdc tien phdng: the thuy tinli day, mong mat phang ddng vai trd quan trpng trong sinh berth hpc ciia gldcdm gdc ddng nguyen phat [3]. Tuy nhien, ti le giira cac hinh thai gldcdm trong nghien ciru nay ciing chua thuc su phan anh diing thuc chat ti
le giira cac hinh thai gldcdm. Do gldcdm gdc ddng thudng cd trieu chirng cap tinh ncn BN tim den vien kham va dieu tri sdm. Ngupc lai, gldcdm gdc md vdi bieu hien kin dao, am tham ncn hay bi bd qua.
Chi den khi thi luc giam nhieu, gay anh hudng den sinh hpat, lap dpng BN mdi di kham thi da d giai dpan mudn. Ngoai ra phan Idn BN gldcdm gdc md nguyen phat kham tai phdng kham cd the dupe kc dan dieu tri ngoai tni ma khdng nhap vien dieu trj.
Nhan khoa Viet Nam (So 23 - 2011) 13
NGHIEN CUtJ KHOA HOC
6. Trieu chirng co" nang
Hang 5. Irien chirng ca ndng (n = 975 UN)
^"^^~~-^Tii(ni chimg So BN ^ ^ ^ ^ .
SoBN Tile Co)
Nhirc null
9.-'^s
''4.7
Nhin m<V
9 ( . ?
98.7
Dau 1/2 (lau 123 12.6
Nhin den quang xanh do
101 10,^
Non hoJic huon non
149 15.1 Trieu chung eo nang ma BN gap nhieu nhat
la nhin md (98,7",,)- "buc mat (94.7",,) Nhirc mat kcm md nhicu la dau hicu C-A\I tinh eua gldcdm goc
ddng. BN chi di dieu tri khi da cd cac trieu chirng lam rp, nang. ga\ anh huang den cupc song, sinh lioal ca nhan.
7. Tri^u chiing thuc the
lidng 6. Cdc tri{'u chirng thirc the (n = 1161 mat) Trieu
chung n
%
Cuoiig tu ria 1068
92
Phil GM 991 85.3
Gian loi CM
3 0,2
Thoai lioii mdng niiit
31 2.7
Dong tu giiin, meo
986 85
Mat phan
\,\ (long tii 979 S4,3
T(")n thuoTng vicn sac to
154 13.2
Phu due the thuy tinh
992 85.4 8. Thi luc
Bdng 7. Thi lire khi vdo vien (n = 1161 mdt)
^ ~ ~ ~ - ^ ^ T h i luc So mat^^^v..^.^^
. So mat Ti 1? (%)
ST(-) 20 1,7
ST (+) - DNT<3m
616 53.1
DNT 3m
<1/10 232 20.0
1/10-<
3/10 166 14.3
4/10-
<7/l(l
" 9
6,8
>7/10 48 4.1
Tong 1161 100 So mat cd thi luc kem, dupe cpi la mil chiem
54,8%, trpng dd da sd BN cd mire thi hre dnt < 3m chiem ti le 53.1%; 20 mat da mil hpan toan, chiijm ti Ic 1,7%.
Theo tieu chuan ciia To chirc Y tc the gidi thi nhirng mat cd thi luc da chinh kinh toi da tir dnt 3m trd xudng dupe xep la mii, nhu va) sd mat mii trong
nghien ciru cua chimg tdi kha cao \di ti Ic 54,8%.
Han nua, tai tu) CMI tinh, chua cd dieu kien kiem tra thi tnrdng cho tat ca BN gldcdm. Nen tren thuc tc.
sd mat mil do bCmh gldcdm cdn cao han con so tren vi neu xet den tlii tnr(img thu hep han 10" quanh diem djnh thi tning tam se dupe xep vap loai mil.
dii cho thi Urc trung tam cdn tdt.
9. Nhan ap
Bdng 8. Phdn bo nhdn dp cua BN khi vdo viin (n = 1161 mdt) ---...^^^^Nhan iip
So mat ^^----...^^
So mat Ti le (%)
< 25mmHg 243 21,0
26 - < 32mmHg 456 39.2
> 32mmHg 463 39,8
Tong 1161 100
14 Nhan khoa Viet Nam (Sd 23 - 2011)
NGHIEN CUU KHOA HOC
Da sd BN gldcdm vao vien vdi tinh trang ap cao la yeu to quan trpng chinh gfu' tpn thupng nhan ap cao (79%). Trong so dd, 463 mht cd nhan khdng hoi phuc dau d^y than kinh thi giac trong ap rat cao (> 32 mmHg), chiem ti le 39,8%. Nhan benh gldcdm.
10. Tinh trang teo 16m dia thi giac
Bdng 9. Ti Ie Idm /dTa (n = II6I mat)
^~"~'~--~-.,^^^^ L O n i / d l a S o m a t ^~~~~"~---^^^
So mat Tl Ic {%)
Kh(")ng soi to
719 62.0
<3/10
191 16.4
4/10 - < 7/10
97 S.3
> 7/10 154 13.3
Tong
1161 100
Da so mat luc vao ^•ien khdng soi dupe dTa thi 62" o). Sd mcit da cd ldm teo dTa thi giac rdng dac do cac mdi trudng trong suot bi md due (chicm hieu ciia bcnh gldcdm chiem ti Ic 13,3%.
11. Nhan thuc ciia benh nhan ve benh glocom trudc khi den vien
Bdng 10. Nhdn thirc cua BN ve henh gldcdm
^~~~~~---...Nhan thiic S o B N ^ ^ - ^ - ^ . . . ^
n
% Tdng(%)
Da duoc clian doan glocOni Co
166 17
Khong 809
83 975(100%)
Da (lui/c dicu trj ha NA Co
113 11.6
Khong 862 88,4 975 (100%)
Biet minh ci) benh gl(')C(')m
CO
78 8
Khong 897
92 975 (100%)
Da du'oc tu van
> e benh
CO
30 3
Khong 945
97 975(100%)
Ti le benh nhan biet la ma hoac khdng hieu biet gi ve can benh minh mac cdn kha cao (92%). Chi cd 3% BN da dupe tu vSn dieu tri benh. 17% BN da dupe xac dinh chan doan trudc khi vao vien nhung ciing chi cd 11,6% da dupe dicu tri cap ciru Su khac biet giua 2 nhdm la cd y nghia thdng ke vdi p < 0,001.
Nguyen nhan cd the do BN chii yeu la ndng dan (79,5%) ncn mire dp nhan thuc va tiep can vdi thdng tin ve benh tat cdn han che. Trong nhieu tnrdng hpp chi cd ngudi nha BN gap gd, trao ddi vdi bac sT vc bcnh va phuong phap dicu tri cho BN.
12. Thoi gian tu- khi benh nhan phat hien bi benh den khi nhap vien
Bdng 11. Thai gian BN bi binh din khi nhap vien (n = 975 BN)
"^----...^^^Thoi gian S o B N ^~^~~-~--~.-.^^
S o B N Ti le (%)
< 2 4 h
225 23.1
24 - < 48h
119 12,2
48 - 72h
86 8,8
> 7 2 h
545 55,9
Do thieu hieu biet ve miic dp nguy hiem (55,9%). Su khac biet giua cac mpc thdi gian cua benh, khdng dupe dieu tri va theo ddi day BN den vien kham va dieu tri la cd y nghia dii nen phan Idn BN den vien dieu tri mupn thpng ke vdi p < 0,05
Nhan khoa Viet Nam (Sd 23 2011) 15
NGHIEN CUtJ KHOA HOC
IV. KET LUAN
BvMih gldcdm. mdt trong nhung ngmeii nluin quan trpng ya> nui Ida khdn;', eo kha iiaiij', iidi phuc, la mpt bcnh mat tirong cloi plid hien \oi li Ic trung binh hang nam la 16.8",, (loii!'. tdng so BN dieu In tai khoa Mat Benh \icn da klma linh Thai Binh, Hinh thai gideom goc donii ngu)en phat chiem da so (79.6" o)
Bcnh ha) xuat hien o lira tudi lien 40 (97.4"„) Tudi cang cao thi li le m;ie benh gldedni cang l;iiig Do tudi tren 60 chicm ti le cao niiiit la >'-).T'n Sd mac bcnh giira nam \ a mi la I I ,7 26" „ BN gldcdm nguyen phat cd tien su benh gldcdm trong gia dinh.
li Ic na> a gldcdm gdc ddng la 26%. gdc md 25"/;, Da .so BN (92%) khdng biet gi hoac biet rat mp h(*) \ e bpnh gldcdm ma minh dang mac. Vi \a\, clii den khi mai cd eae tneu chirng ram ro do nhan ap eaci. eiiire luing, giam silt tram trpng BN mdi den kham \ a dieu tri a eae eir sa nhan khoa De han chi- li le mu loa do bcnh gldcdm gii) ra. can phai xay dung lie lii(Mig quan I) \a theo ddi BN glocom tai tii\ en ca sa. lang cudng cdng tac truyen thong giao cHic sire khoe tai edng ddng cho nguoi dan \e tinh 1)10 bien. mire dp ngu) hiem cua bcnh glocom khi kidng duoe phat hien sam \a dieu In kip thdi, theo dii lau dai.
TAI LIEU THAM K H A O
1. DO THj THAI HA (2002). "'Nghien ciiu mdt sd dac diem dich te hpc lam sang ciia BN gldcdm dieu tri tai khpa Tpng hpp Vien Mat TW tir 10/2000 den 8/2002". Lugn vdn thgc .sT Yhoc, Trudng Dai hpc Y Ha Ndi.
2. DO NHU' HON ( 2007). '^Cdng tac phdng chdng mil Ida a Viet Nam nam 2008 -2009, hudng tdi muc tieu toan cau Thi Giac 2020", Ky yeu nhdn khoa, 1-18.
3. ALSAGOFFZ, AUNG T, ANG L P.K (2002),
"Long term clinical cpurse pf primar) angle - closure glaucoma in an Asian population", Ophfhalmologv,
107, pp 2300-2304.
4. BEZIN MF. BECHETOILLE A. HAMARD P, VALTOT F. BERKANl M, BELMONDEN A, ADAM MF, DUPONT DE DINECHIN S. BACH JF,GARCHONH.J(1997),"Genetichcterogcneit) of primar)' open angle glaucoma and ocular h)'pertention:
linkage to GLICA associated with an increased risk of severe glaucomatous optic neuropathy'". Journal Med Genet, 34(7), pp 546 - 552.
5 BONOMl N. MARCHINI G. MARRAFFA M. ETAL (2000). "Epidemiology of pnmar)'angle - closure glaucoma" Ophthalmology, 107(5). pp 9 9 8 - 1003,
6. CASSON RJ. NEWLAND H S. MUECKE J, MC GOVERN S, ABRRAHAM L. SKEIN WK.
SELVAD, AUNG T (2007). •Pre\alcnce of glaucoma in niral M)anma, the Meiktila E)e Stud)"' British Journal of Ophthalmology; 90, pp 710 - 714.
7. QUIGLEY HA. BROMAN AT (2006).
"The number of people with glaucoma woridwide in 2010 and 2020" British .Journal of Ophthalmology', 90. pp 262 - 267
8. YUAN HP. YU H. XIAO Z, SHAO Z.B, ZHANG .XL. YANG B B . SUI H, ZHAO YS (2007), "The prcvalence of pnmar)' angle - closure glaucoma and its causes in rural area of Shuangyang distnct in Changchun, Jilin Province" Zhonghua
Yan Ke Za Zhi, 43(9), pp 775 - 778.
16 Nhan khoa Viet Nam (So 23 - 2 0 i i )
NGHIEN CUU KHOA HOC
SUMMARY
REMARKS OF THE EPIDEMIOLOGICAL CHARACTERISTICS OF THE GLAUCOMA PATIENTS IN DEPARTMENT OF OPHTHALMOLOGY, THAI BINH GENERAL HOSPITAL FROM 2005 TO 2007
Purpose: comments on epidemiology characlerislics of glaucoma patiens.
Materials and Method: retrospective study on y O palienls with 1161 eyes diagnosed glaucoma in Department of Ophthalmology. Thai Bmh General Hospital from 2005 to 2007.
Results: the glaucoma patients occupies 16.8%, of in patients for 3 years 97.4%> of glaucoma patients are at the age of over 40. The rate of male and female is 1:1.7. 22.3%) of glaucoma patients have a family history of glaucoma. 54.8% of the patients have an eye vision of under counter of finger 3m. Their intraocular pressure when entering the hospital mostly is under 25 mmHg, occupying 79.2%. 92% of the treated patients don t know or know vaguely about their disease.
Conclusions: glaucoma is a verv popular disease in Ihe community which can be easily sufferd by patients over 40 years old. There is no clear difference between male and female. Due lo poor understanding
of the disease, patients usually go to the hospital late when their eye vision function is badly affected.
Key words: glaucoma. epidemiolog\> characteristics.
Nhan khoa Viet Nam (So 23 2011) 17
