S O I - 2 0 1 0 TAP CHI PHONG CHONG BENH SOT RET VA CAC BENH KYSINH TRUNG 65
XAC DINH TRINH TRANG NHlfilM MAIM BENH KY SINH TRUNG TREN RAU QUA TRONG 6 NGOAI THANH HA NOI
Nguyin Khac Luc, Le Tran Anh, Dinh Thi Thanh Mai, D6 Ngoe anh
Tdm tdt
An rail sdng cd the cd nguy co nhiim nhieu mdm binh khde nhau. Nghiin citu ndy de xdc dinh tinh trgng d nhiim mdm binh ky sinh tning ran qud dugc ti'dng d khu vuc ngoai thdnh Hd Ndi. Trin 674 mdu rau qua thu thdp dicgc cd 563 mdu nhiim ky sinh triing (83,53), trong dd 78,69% man nhiim nhiiu mdm binh. Ty le nhiim ky sinh tning d rau la 86,5%, cao han ty li nhiim d qua (59,46%). Rau xd Idch nhiim cao nhdt (95,56%), tii'p theo la cdc logi cdi canh (91,11%), rau gia vi (85,63%), rau die'p (81,39%), ran cdi xoong (80,85%), rau mndng 71,74%, cdc logi rau khac 85,63%. 82,2% mdu nhiim dem bdo, ty li phdt hiin Balantidinm coli, Giardia lamblia vd Entamoeba histolytica Id 82,20%: 17,40% vd 8,61%, 5,93% mdu nhiim nang trimg cua Cryptosporidium. 48,66% mdn nhiim giun sdn, thicdng gap nhdt Id dn tning giun (35,91%), ngodi ra cdn phdt hiin tn'tng giun diia (10,53%), tri'cng giun tdc (5,64%), tn'cng sdn (0,3%).
L D A T V A N D ^
Rau xanh la mdn an khdng the thie'u trong khIu phln an hang ngay, cung cap cho co the nhieu loai vitamin nhu vitamin C, E, A, chat khoang va mdt so yeu to vi lucmg, chat xo, khang sinh thuc vat .... Tuy nhien rau xanh ciing cd the la ngudn nhiim nhieu loai mim benh vi khuin, virus, ky sinh triing... ne'u an rau khdng dam bao ve sinh. Ha Ndi la mdt thi trudng tieu thu rau xanh ldn. Cac huyen ngoai thinh Ha Ndi la mdt trong nhiing ngudn cung d p quan trgng cho thi trudng Ha Ndi, ne'u rau, qua trdng d day d nhiim cac mam benh se cd nguy ca nhiim tdi ngudi tieu diing. Chiing tdi tien hanh dieu tra tai mdt so khu vuc san xult rau d cac huyen ngoai thanh de xac dinh tinh trang d nhiim m i m benh ky sinh triing tren rau qua d thi trudng Ha Ndi, tir dd cd co sd de xua't cac bien phap phdng chd'ng thich hgp, bao ve ngudi tieu dung.
2. DOI TUONG VA PHUONG PHAP NGHIEN c t r u Phuang phap nghien ciiu: nghien cuu md ta elt ngang.
Dd'i tugng nghien ciiu: cac loai rau qua cd the diing de an sdng.
Rau: rau mudng, rau cai xoong, cai canh, rau can, xa laeh, cai ciic, rau gia vi (hanh, rau miii, rau ngd), diep ca, mdt so loai rau khac (thi la, ciic tan, rau lang...).
Qua: ca chua, dua chugt, dd qua, mudp ding.
Dia diem nghien ciiu: tai 8 xa thugc 4 huyen II xa Tien Dudng, Van Ndi huyen Ddng Anh, xa Tan Minh, Ha Hdi huyfn Thudng Tin, xa Tien Yen, Song Phuang huyen Hoai Diic, xa Yen Vien, Yen Thuang huyen Gia Lam.
Ky thuat lay mlu: la'y mlu nglu nhien cac loai rau qua, mdi mlu rau qua la'y it nhKt 100 g vao tiii nilon sach, dua v i phdng thi nghiem.
Ky thuat xet nghiem: xet nghiem rau theo phuong pblp Romanenco de tim mim benh ky sinh triing. Cac loai mam benh dugc xac dinb, phan loai dua theo dac diem hinh the theo phuong phap thudng qui [1].
Thdi gian nghien ciiu: thang 1 - thang 6 nam 2009.
66 TAP CHI PHONG CHONG BENH SOT RET VA CAC BENH KY SINH TRUNG SO 1 - 2 0 1 0
3. KET QUA VA BAN LUAN
Bdng 1: Ty le nhiem mdm benh ky sinh triing tren rau, qud
Loai rau / qua
Rau
Qua
Rau muong Cai xoong Cai canh Xa lach Gia vi Cai ciic Diep ca Rau khac Tdng (1) Ca chua Dua chugt Dd qua Mudp dang Qua khac Tdng (2) Tong so mau So sanh 1-2
So lirgng Mau nghien
Clhl
46 47 45 44 167
41 43 167 600 12 16 13 19 14 74 674
So nhiem 43 41 149 143 35 38 33 43 519
6 9 9 14
6 44 563
Ty le nhiem (%) Tren timg
loai 95,56 91,11 89,22 85,63 81,39 80,85 71,74 95,56 86,50
59,46 83,53 p<,001
Tren tong mauNC
6,8 7,0 6,7 6,5 24,8
6,1 6,4 24,8
1,8 2,4 L9 2,8 2,1
100
Trong sd 674 mlu rau /qua thu dugc cd 563 mlu nhiim ky sinh triing; ty le 83,53%. Cd 86,50% mlu rau, 59,46% mlu qua nhiim mim benh ky sinh trung, ty le nhiim cua rau va qua khac biet cd y nghia thdng ke; p < 0,001.
Cac loai ky sinh triing dudng rudt nhiim tii rau xanh cd the la cac loai dan bao, giun san. Ke't qua ngbien ciiu cho thly ty le nhiim mim benh tren cac mlu rau/qua ra't cao, 83,53%. Ket qua nghien ciiu cua mdt sd tac gia tren the gidi va Viet Nam tren rau ban d cac khu vuc thanh thi ciing rlt cao. Nghien ciiu ciia Mesquita VC va cdng su (1999) cho thly 96,1% mlu rau dugc ban d Rio de Janeiro nhiim cac loai mam benh ky sinh triing [9]. Tai Viet Nam nghien ciiu cua Nguyin Dire Ngan va cdng su (2000) tren 432 mlu rau xanh d thanh phd Thai Nguyen ty le nhiim d cac loai rau tii 50 - 95,83 % tiiy loai [5]. Dinh Thi Thanh Mai (2005) nghien ciiu tren 1260 mlu rau xanh d Hai Phdng thly cd nhiing loai rau nhiim tdi 83,3% [4]. Tai thanh phd Hd Chi Minh Ld Thi Nggc Kim (2006) dieu tra tha'y ty le nhiim mam benh ky sinh triing d cac mlu rau tai la 8,6 - 85,6% [3]. Trin Thi Hdng va cdng su nghien ciiu thly tha'y rau sdng ban tai cac chg tren dia ban thanh phd cd ty le nhiim mim benh ky sinh trung cao 97,1%, cd loai rau nhiim tdi 100% [2]. Rau, qua nhiim mim benh chu ye'u t^ ngudn nudc tudi, nudc rira, ngoai ra cd the do qua trinh che' bie'n thitc pham tai gia dinh
SOI -2010 TAP CHI PHONG CHONG BENH SOT RET VA CAC BENH KY SINH TRUNG 67
do dd ty le rau qua d cac khu vuc trdng nhiim mim benh cao la nguy ca Idn vdi ngudi tieu diing [8]. "
Cd su khac biet trong ty le nhiim mim benh ky sinh triing d cac loai rau, qua. Ty le nhiim mam benh ky sinh triing d rau la 86,50%, cao bom rlt nhieu so vdi ty le mlu qua nhiim mam benh ky sinh triing (59,46%, p < 0,001). Trong sd cle loai rau, rau xa lach cd ty le nhiim cao nhlt la (95,96%), sau dd la cai canh, rau gia vi, diep ca, cai xoong, thap nha't la rau mudng (71,74%). Ty le nhiim mim berih cao d cac loai rau thudng dimg an sdng nhu rau xa lach, rau gia vi, rau diep ca... Iam cho nguy co nhiim mam benh ky sinh trung tang len. Nghien ciiu cua mdt sd tac gia khac ciing cho thly, rau sdng thudng cd ty le nhiim cao ban so vdi cle loai rau khac. Nghien ciiu ciia Nguyin Diic Ngan va cdng su (2000) tha'y ty le nhiim triing giun diia d rau miii va rau xa lach la cao nhlt (87,50% va 95,83%) [5]. Nghien ciiu cua Dinh Thi Thanh Mai (2005) tha'y ty le tim thay tning giun d rau miii va rau xa lach la cao nha't (83,3% va 70%) [4]. Nghien ciiu ciia Le Thi Tuye't (2005) tha'y rau sdng cd ty le nhiim cac loai tning giun cao ban so vdi cac loai rau khac [7].
Bdng 2: Ca cdu nhiem mdm benh ky sinh triing tren rau qud
Chi tieu
Chiing loai mam benh Nhiem (don) giun san Nhiem (don) dan bao Nhiem ket hgp
Tong so nhiem giun san Tong so nhiem don bao So lugng mam benh Nhiem 1 mam benh Nhiem 2 mam benh Nhiem 3 mam benh
So lirgng
9 235 319 328 554
120 328 115
Ty le (%) Tren so mau
nhiem (n=563)
1,60 41,74 56,66 58,26 98,40
21,31 58,26 20,43
Tren tong mau NC (n=674)
1,34 34,87 47,33 48,67 82,20
17,80 48,67 17,06
Trong sd mlu nhiim ky sinh triing, 98,40% nhiim don bao, 58,26% nhiim giun san, cd 56,66% nhiim ket hgp ca giun san, don bao. Cd 21,31% mlu nhiim don mdt mim benh, cdn lai nhiim 2 - 3 mim benh. Mdt sd dieu tra tren the gidi va trong nudc nhu Mesquita VC va cdng su (1999), Trin Thi Hdng (2007)... ciing cd nhan xet la rau qua thudng nhiim nhieu loai mim benh ky sinh triing khac nhau, dieu nay Iam miic do anh hudng de'n siic khde ngudi tieu diing ciing nang ban [2], [9].
Trong CO clu nhiim, ty le nhiim dan bao rat cao, tdi 82,20%, chi cd 48,66% mlu rau qua nhiim mim benh giun san. Nghien ciiu ciia Le Thanh Phuong va Nguyin Van De (2009) tren 660 mlu rau d Nam Dinh ciing cho tha'y ty le nhiim giun san thap ban nhieu so vdi nhiim don bao [6]. Nghien cuu ciia Le Thi Nggc Kim (2006); Trin Thi Hdng (2007) tai TP.Hd Chi Minh ciing cho tha'y ty le mlu rau tai chg nhiim giun san thap ban so vdi nhiim don bao [3].
68 TAP CHI PHONG C H O N G BENH SOT RET VA C A C BENH KY SINH TRUNG SO 1 - 2 0 1 0
Bdng 3: Ca cdu nhiem mdm benh giun sdn
Loai mam benh
Au trung giun Tning giun dtia Triing giun tdc Tning san
So nhiem
242 71 38 2
T y l e ( % ) Tren so mau nhiem giun san
(n=328) 73,78 21,65 11,59 0,61
Tren tdng mlu NC (n=674)
35,91 10,53 5,64 0,30
Trong sd mlu rau qua nhiim giun san, 73,785 nhiim au trung giun (giun mde, giun luon), chie'm 35,91% tdng sd mlu nghien cihi. lu trung giun moc, giun luan cd the xam nhap qua da do dd cd the gay hai cho ngudi san xult, Itm thdng, che' bien, tieu thu rau. Ngoai ra Siu triing giun moc Ancylostoma duodenale cd thd lay nhiim qua dudrig tieu hda. Nghien ciiu ciia Trin Thi Hdng va cdng su tai 13 chg thugc dia ban thanh phd Hd Chi Minh thly rang trong co clu nhiim giun san thi cbu yeu la nhiim lu triing giun [2]. Ty le nhiim tning giun diia va giun tdc la 10,53% va 5,64%; ty le nhiim tning san (san la gan nhd, sin la rudt nhd) rat thap, chi cd 0,30%. Ty le nhiim triing giun diia ciia chiing tdi tblp.ban ke't qua nghien cuu cua mdt sd tac gia khac d Thai Nguyen, Thai Binh, thanh phd Hd Chi Minh. Nguyin Diic Ngan va cdng su (2000) xet nghiem mlu rau xanh tai Thii Nguyen ty le phat hien tning giun diia rat cao: tit 50 - 95,83% [5]. Le Thi Tuyet (2005) nghien cuu tai Thai Binh, thly ty le nhiim giun dua la 48,8%; giun tdc la 42,2% [7], nghien cim ciia Le Thi Nggc Kim (2006) tai thanh phd Hd Chi Minh ty le nhiim tning giun diia la 23,1% [3]. Tuy nhien ket qua nghien cuu nay cao hon thdng bao cua Le Thanh Phuong, Nguyin Van D i (2009) khi nghien ciiu tren cac mlu rau tai thanh phd Nam Dinh, ty le nhiim tning giun diia 2,7%, tning giun tdc 2,4% [6]. Ty le nhiim truing san rat thap ciing phu hcfp vdi thdng bao ciia da so cac tac gia, mdt so tac gia trong nghien ciiu ciia minh khdng tha'y tning san (Trin Thi Hdng, Dinh Thi Thanh Mai...) hoac thly vdi ty le rlt tblp [2], [4]. Ke't qua nghien ciiu ciia Le Thanh Phuang, Nguyin Van D i (2009) chi cd 0,3 % mlu rau nhiim tning san [6].
Bdng 4: Ca cdu nhiem mdm benh don bdo
Loai mam benh
Triing long Triing roi thia Amip ly
Cryptosporidium
So nhiem
554 117 58 40
T y l e ( % ) Tren so mau nhiem don
bao (n = 554) 100 21,12
10,47 7,22
Tren tong mlu NC (n=674)
82,20 17,36 8,61 5,93
Trong sd mlu nhiim don bao, 100% nhiim triing Idng. Day la loai mim benh ky sinh d dai trang ngudi, rat phd bien d lgn, cd the nhiing ngudi dan viing trdng rau da diing phan Ign de bdn cho rau. Triing Idng dai trlng cd the gay hdi chiing ly tuang tu nhu amip ly, tuy nhien hau qua nang n i ban do tac ddng co hgc cua triing Idng cd thd lam benh nhan thimg rudt.
Nghien Ciiu ciia Mesquita VC vl cdng su d Rio de Janeiro ciing cho tha'y cac loai m i m benh ky sinh trung phd bien nhlt II a'u triing giun, trung Idng [9] tuy nhien cac nghien ciiu d Viet Nam cdn it thdng bao loai don bao nay.
so 1-2010 TAP CHI PHONG CHONG BENH SOT RET VA CAC BENH KYSINH TRUNG 69
Cac loai don bio cd gap khac la triing roi thia, amip ly va Cryptosporidium (ty le nhiim tren tdng sd mlu nghien ciiu la 17,40%, 8,61% va 5,93%). Nghien ciiu cua Trin Thi Hdng va d thanh phd Hd Chi Minh ciing thay ken amip kha phd bien [2]. Nghien ciiu ciia Le Thanh Phuang, Nguyin Van De (2009) tren rau dugc tudi bang nudc thai tai thanh phd Nam Dinh tha'y cac loai don bao hay gap la Cryptosporidium (29,7%), triing roi thia (13,6%), amip chi cd (4,2%) [6].'
4. KET LUAN:
Nghien ciiu tinh trang nhiim mam benh ky sinh trung tren 674 mlu rau, qua d 8 xa thugc 4 huyen ngoai thanh Ha Ndi cho tha'y:
- Ty le nhiim mim benh ky sinh trung 83,53%; 82,20% mlu nhiim don bao, 48,67%
mlu nhiim giun san. Phln Idn (78,69%) mlu nhiim nhiiu mam benh.
- Ty le nhiim mim benh ky sinh trung d rau la 86,5%; cao ban cd y nghia so vdi ty le nhiim d qua (59,46%). Rau xa lach cd ty le nhiim cao nhat (95,56%), ty le nhiim d cac loai rau khac la: cai canh 91,11%, rau gia vi 85,63%, rau diep ca 81,39%, rau cai xoong 80,85%, rau mudng 71,74%, cac loai rau khac 85,63%.
- Ty le nhiim giun san: nhiim cao nhlt la au trung giun (35,91%), tiep theo la nhiim giun dua (10,53%), giun tdc (5,64%), san (0,3%). Ty le nhiim dan bao: trung Idng 82,2%, triing roi thia 17,40%, amip ly 8,61%, Cryptosporidium 5,93%.
TAI LIEU THAM KHAO
l.Bd mdn Sdt ret-Ky sinh triing -Cdn triing - Hoc vien Quan Y (1998 ), ".SeA nghiem mdm binh ky sinh trimg d rau xanh", Ky thuit ky sinh trung y hoc. Ha Ndi, trang 96-98.
2.Tran Thi Hdng va cpng su (2007) " Khao sdt ky sinh triing trin ran sdng bdn tgi cdc chg tren dia bdn thdnh phd Ho Chi Minh", Y hoc thanh phd Hd Chi Minh, chuyen d^ ky sinh triing sd 2 nam 2007, Dai hgc Y dupe thanh phd Hd CM Minh , trang 130-135.
3.Le Thi Ngpc Kim, Vu Dinh Phuong An, Tran Thi Hdng (2007). BChao sat ky sinh triing trSn rau sdng ban tai chp tren dia ban TP. Hd Chie Minh. Bdo cdo khoa hgc tai Hdi nghi Ky sinh tning todn qudc, 2007.
4.Dinh Thi Thanh Mai va cdng su (2005)" Ddnh gid miic do d nhiim trimg giun trin mdt sd'logi rau xanh sach vd chua sach a thdnh phd Hdi Phdng ", Y hpc thuc hanh, cdng trinh nghien cuu khoa hpc ciia sinh vien va can bd giang day tre Dai hpc Y Hai Phdng 2005, Bd y te xuat ban, trang 79-81.
5.Nguy6n Dure Ngan (2000) "Ddnh gid mice do d nhiim tri'mg giun trin mdt sd loai rau d thdnh phd'Thdi Nguyen", Ndi san khoa hpc cdng nghS y dupe, Chuyftn dl ky sinh triing chao milng hdi nghi ky sinh trung toan qudc l£n thii 27, Thai Nguyen 4- 2000, trang 54-57.
6.Lg Thanh Phuong, Nguyin Van De, Pham Ngpc Minh, Phan Thi Huong Lien, Truong Thi Kim Phuong (2009), Mam benh ky sinh triing trSn rau tudi bang nudc thai tai thanh phd va nong thdn tinh Nam Dinh, tap chi Y dupe hpc quan su, 34 (9), 33 - 37.
7.Le Thi Tuyei, Nguyin Qudc Tiin va cdng su (2005)," Tinh trang d nhiim triing giun trong cdc mdu ran tai xd Vu Phiic Thdnh phd'Thdi Binh", Tap chi phdng chdng bSnh sdt ret va cac b6nh ky sinh triing sd 6/2005.
B.Lanata CF, (2003), "Studies of food hygiene and diarrhoeal disease", Int J Environ Health Res. 2003 Jun;13 Suppl 1:8175-83.
9.Mesauita VC. Serra CM. Bastos OM. Uchda CM (1999). [The enteroparasitic contamination of commercial vegetables in the cities of Niteroi and Rio de Janeiro, Brazil] [Article in Portuguese]. Rev Soc Bras Med Trop. 1999 Jul-Aug;32(4):363-6.
70 TAP CHI PHONG CHONG BENH SOT RET VA CAC BENH KY SINH T R O N G SO 1 - 2 0 1 0
PARASITE CONTAMINATION IN VEGETABLES PLANTED IN THE SURROUNDINGS OF HANOI
Nguyen Khac Luc, Le Tran Anh, Dinh Thi Thanh Mai, Do Ngoe Anh
Abstract
The ingestion of raw vegetables represents an important means of transmission of several infectious diseases. The objective of the present study was to perform a parasitological evaluation of the vegetables and fruits planted in the surroundings of Hanoi, the capital city of Vietnam. Enteroparasites presented in 563 (83.53%) of 674 samples analyzed, mostly (78.69%) contaminated with more than one parasite. The frequency of vegetables contaminated was 86.5%, higher than that of fruits (59.46%). Contamination was highest in salad (95.56%), followed by cabad (91.11%), vegetables for spice (85.63%), lecttuce (81.39%), watercresses (80.85%), water spinach 71,74%, others 85,63%. Protozoan parasites were detected in 82.20%. Balantidium coli, Giardia lamblia and Entamoeba histolytica were found in 82.20%; 17.40% and 8.61% of the samples respectively. 5.93%
samples contaminated oocysts of Cryptosporidium. Intestinal helminthes presented in 48.66%
of the samples, the highest frequency was larvae (35.91%), followed by eggs of Ascaris lumbricoides (10.53%), Trichuris trichiura (5.64%) and flat helminthes (0.3%).
Can bd phan biSn TS Trinh Tuomg
Vien Sdt ret Ky sinh triing Con triing Trung LTong
