TAP CHf NGHltN CCPU Y HQC "' " "
group of women s 35 years of age the rate of babies with Down and syndromes were to about 32.26% and 44.44% respectively while false positive rates are 23.14% and 23.08% respectively Approximately 22.58% of babies with Down syndrome and 27.78% of babies with Edwards syndrome were found in the group of women s 40 years of age, in which false positive rates were 4.97% and 5.06% respectively. Based on the "cut-off" of Prisca sofwave, high risk of Down syndrome due to matemal age was s 1/250, our study showed 29.03% of babies have Down syndrome and false positive rate was 14.02%. In conclusbn, the "cut-off' for screening of foetus with Down and Edwards syndrome due to maternal age was s 40 years of age, in which false positive rate for both of those syndromes was 5%, About 29.03% of babies were found to have Down syndrome based on.Prisca sofwave for high risk, and false positive rate was 14.02%.
Key words: Maternal age, Down syndrome and Edwards syndrome
NGHIEN CU'U MOT S 6 THAY 0 6 l MI§N DjCH TRONG VIEM NAO S&\ 0 NGU'O'I TRU'b^NG THANH
Nguyin Van Kinh, Thdn Manh Hung Trwdng Dpi hgc Y Ha Npi Viem nao sdi it gap, cd ty lp td vong cao, thwdng di lpi di chdng ndng ni. nhwng ca chi bpnh sinh ehwa dwac biet rd. Nghien cCru mpt so chl so mien dich trong bpnh viem nao sdi d ngwdi trwdng thanh. kit qua cho thiy. tmng viem nao sdi d ngwdi tnrdng thanh cd sw suy gidm cua ti bdo CD8. CD45. CDS. HLA - DR va ty lp CD4/CD8 so vdi nhdm chdng (p < 0,05). nhwng ti bao CD4 va CDI9 suy giam khdng cd y nghia (p > 0.n5). Tmng viem nao sau sdi cd swsuy gid''' cd chpn Ipc cua mdt sd ddng ti bao miin dich.
Tu khoa: so-i, viem nao, miln djch trong sai
I. DAT
VANDt
Bfnh sdi It phd biln d ngudi trudng thdnh ddc bift Id biln chung vidm ndo. Theo cdc y vdn, biln chung vidm ndo chf gdp 0,1% trong sd nhO-ng bfnh nhdn m i c sdi [5]. Tuy nhidn, ty If tu- vong biln ch^ng vidm ndo sdi cd t h i Idn d i n 10% vd nhu-ng trudng hgp sdng sdti .thudng d l Igi di chipng nfng nhu tdm ti.dn
hodc dfng kinh [1]. Cho d i n nay, ca c h l bfnh sinh vd nhO-ng biln ddi miln djch hpc trong vidm ndo sau sdi v i n Id v l n d l bdn cdi. Mfe dil cd bing chipng v l sg cd mdt ciia virus trong nhu md ndo, tiiy sdng, nhung mft sd gia thilt cho ring biln chirng viem ndo ciia sdi Id
kit qua ciia qud trinh ddp ipng miln djch thdng qua cdc trung gian t l bdo vdi protein myelin. Cdc nghidn ciPU ban d i u cung cho thiy trong vidm ndo sdi cd vai trd ciia cdc ddng t l bdo CD4, CDO [1, 4]. Tgi Vift Nam, cdc nghidn cuu v l midn djch trong vidm ndo sdi v i n cdn hilm. VI vdy, d l tdi ndy dugc thgc hifn nhim myc tieu: Nghidn ciPU mft sd chi sd miln djch trong mdu d ngudi trudng thdnh vidm ndo sdi.
II. OOl TUONG VA PHUONG
PHAP 1. Ddi t u g n g27 bfnh nhdn, tu-16 tudi trd ldn, khdng
TAP CHf NGHIEN CCPU Y HQC phdn biet gidi tfnh, dugc chin dodn xdrt djnh
nhiem sdi, trong dd 13 bfnh nhdn cd biln Chung viem ndo (nhdm bfnh), vd 14 bfnh nhdn khdng cd bien chung (nhdm chung), dd dilu tri tai benh vifn Bfnh Nhift ddi Trung u-ang tip thdng 12/2008 d i n thdng 7/2010.
2. Phuang phap
Thilt k l nghidn cuu tiln cuu bfnh - chung, Benh nhdn nhdm chung tuang ddng vdi nhdm benh v l 3 tidu chi: Tudi, gidi, thdi gian khdi phdt ciia bfnh sdi. Tiln hdnh khai thdc cdc thdng tin ca nhdn, cdc thdng tin ldm sdng.
Benh nhdn viem ndo duac dilu tri theo phdc dd cua Bo Y t l bing gammaglobulin.
Tidu chuan chan dodn nhiem sdi: Sdt, phat ban vd huyet thanh chin dodn sdi IgM duang tinh.
Tieu chuan chan dodn cd biln chung vidm nao: Cdc bilu hifn tdn thuang ndo (co gift, rdi loan y thuc, lift, hdn me...), k i t qua phdn tich djch nao tuy cd thay ddi v l sinh hda vd
Bang 1 . Dac d i l m lam sang
t l bdo.
Tidu chuln loai tru: tdn thuang ndo c6 lidn quan vdi cdc nguydn nhdn khde, hofc khdng Idm du cdc xdt nghifm theo ydu d u ciia nghien CLPU.
Cdc chl sd nghifen c^u: gdm Bach cau, hemoglobin, Tilu c l u , ure, creatinin vd mft SJ chl sd miln djch: CD45, CD19, CD3, CD4, CD8. Ty If CD4/CD8 vd HLA-DR. Cdc chf sd miln djch trong nghidn CLPU dugc Idm tai phdng sinh hoc phdn tu-, dan vj nghifen CLPU
Idm sdng Trudng Dgi hoc Oxford tai Hd Nfi.
Thdi dilm ddnh gid: Khi nhfp vifn vd sau 3 ngdy (nhdm bfnh).
3. Thu t h f p sd l i f u : Su- dgng bdng mdu bfnh dn thilt k l sdn.
4. Phan tich sd lieu: bdng phan mim SPSS 16.0 vd cdc thudt todn ung dgng.
III. K^T QUA
ciia cac nhdm nghien ciru Doi t u g n g nghien cii'u
Dac d i l m lam sang
Nhdm benh (n = 13)
Nhdm chii'ng
(n = 14) P(*)
^ ± S D
Tuoi trung binh (ndm) Thdi gian todn phdt (ngdy) sd ngay sdt (ngdy)
Thdi gian khdi phdt (ngdy)
22,6 ± 4,5 10,23 ±5,05 10,17±2,75
2,27 ± 1,28
23,2 ± 4,2 7,43 ± 2,53 8,43 ±2,13 1,57 ±0,93
>0,05
>0,05
>0,05
>0,05 Ngay xudt hien bien chung
(tinh tu khi khdi phdt) 6,2 ± 2.04 p (*): Kidm dinh Mann Whitney
Khdng cd sg khde biet v l tudi, sd ngdy khdi phdt trung binh, sd ngdy todn phdt trung binh hay sd ngdy sdt trung binh giu-a 2 nhdm.
p (*) KiSm dinh Mann - Whitney
Kit qua nghidn c^u cho thiy sg khde bift cd y nghTa thdng kd v l tdng sd bach clu giua 2 nhdm, nhung khdng co sg khde bift v l Cdc chi sd huylt hpc khde vd cdc chi sd hda sinh mdu (bang 2).
TAP CHf NGHIEN CU'U Y HQC
Bang 2. Kit qud ciia mft sd chl sd xdt nghifm huylt hgc vd hda sinh trong mdu ciia cdc nhdm nghidn CLPU
rhicAnnhionr.'p.. Nhdm bfnh Nhdm Chung ..
Chl sd nghien cuu (n = 13) (n = 14) ^ ' '
Huylt hpc (.V±SD)
H6a sinh (~± SD)
Tdng sd bgch d u (G/L) Tilu d u (G/L)
Bgch c l u lympho (%) Hemoglobin (g/L) Ure (mmol/L) Creatinin (pmol/L) K* (mmol/L) AST (Ul/L)
9,17 ±5,54 184,87 ±99,91
15,02 ±6,5 13,47 ± 1,87
5,05 ±2,27 79,41 ± 19,77
3,66 ± 0,48 107,42 ±94,69
5,38 ±3,22 134,53 ±30,06
13,27 ±5,86 13,2 ± 1,24 4,15± 1,09 98,84 ± 19,72
3,65 ± 0,27 103,08 ± 130,2
<0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05 ALT (Ul/L) 112,67 ±138,11 112,85 ± 119,78 >0,05 Bang 3. Cac chi sd miln djch trong mdu ciia 2 nhdm nghien ciru
tai thdi dilm vdo vien
Chi sd nghien cii'u Nhdm benh (n = 13) Nhdm chirng (n = 14) P H
.V±SD
CD45 (Tb/mm^) CD3 (Tb/mm^) CD8 (Tb/mm^) HLA-DR (%) CD4/CD8 CD4 (Tb/mm^)
1141,5 ±623,74 713,24 ±463,31 325,98 ± 259,32 16,59 ± 13,61
1,05 ±0,44 285,5 ±197,33
2442,9 ± 1669,98 1855,2 ±1392,75 1174,2 ±1066.57 32,5 ± 10.16
0,57 ± 0,28 519,87 ±320,53
<0,05
<0,05
<0.05
<0.05
<0,05
>0.05 CD19(Tb/mm^) 206,51-± 175,71 235,31 ± 125,47 > 0,05 (p*) Kiim dinh Mann - Whitney
Cd sg khde bift cd y nghTa thdng kd giO-a 2 nhdm v l sd lugng cdc t l bdo CD45, CD3, CD8 vd diu an miln djch HLA-DR, nhung khdng cd sg khde bift v l cdc ehi sd t l bdo CDI 9.
p(*) Kiim dinh hang Wilcoxon
Trdn bfnh nhdn vidm ndo sau sdi dugc dilu tri bdng Immunoglobulin cdc chi sd t l bdo miln djch CD45, CD3, CD4, CD8 vd HLA-DR cd sg hdi phgc rd rft (p < 0,05), sau 3 ngdy dilu trj (bang 4).
TAP CHf NGHlfeN CLPU Y HQC Bang 4. S u thay ddi cdc chi sd m i l n djch trong mau ciia nhdm b f n h theo t h d i gian
Chl sd nghien cii'u Ngdy 1 (n = 7) Ngdy 3 (n = 7) P(*)
A ± S D
CD45 (Tb/mm^)
Ty sd CD4/CD8
811,09 ±383,74 1957,7 ±491,95
1,01 ±0,47 1,30 ±0,46
<0,05
CD3 (Tb/mm^) CD4 (Tb/mm^) CDS (Tb/mm') HLA-DR (%) CD19(Tb/mm^)
456,47 ± 288,73 195,17 ±126,56 220,76 ±169,24 18,00 ±13,31 202,86 ± 238,32
1405 ±405,26 668,76 ± 161,50 586,04 ±281,08
6,24 ±6,19 227,35 ± 88,06
<0,05
<0,05
<0,05
<0,05
>0,05
>0,05
IV. BAN LUAN
Nghien cuu ndy dugc thgc hidn d 2 nhdm ddi tugng, gdm nhdm bfnh 13 bfnh nhdn (mdc sdi cd biln chung viem nao) vd nhdm chung 14 bdnh nhdn (mic sdi nhung khdng cd biln Chung), giu-a hai nhdrin tuang ddng v l cdc chl sd nhu dp tudi, gidi tinh vd sd ngdy khdi phdt trung binh (bang 1). Kit qua nghien cuu cho thiy, ngodi chi sd bach d u cd sg khde bift ed y nghTa thdng ke (p < 0,05), cdc chl sd khde v l huylt hpc vd hda sinh mau, khdng cd sg khac bift giu-a 2 nhdm (bang 2).
Ddi chilu vdi k i t q u i xet nghifm cdc t l bdo miln djch, nghien cuu cho thiy tf bdo CD45 (khdng nguyen hifn difn tren cdc t l bdo bach d u ) cung co sg khde bift ro rft giu-a nhdm bfnh vd nhom chung. Nhu vdy trong benh sdi biln chung viem ndo cd sg thay ddi cua cac ddng t l bao bach d u . Tuy nhidn CDI9 khdng nguyen dac trung cho ddng t l bdo lympho B khdng cd sg khde bift (p >
0,05) trong bfnh ly nay, trong khi t l bdo CD3 (khdng nguyen dac trung trdn t l bdo lympho T trudng thdnh) lai cd sg thay ddi dang k l giua 2 nhdm (p < 0,05). D i l u ndy chirng td d J f nh
nhdn sdi biln chung vidm ndo, ddng te bdo lympho T cd sg suy giam rd rft. Kit qua nghidn cuu cua Fleischer vd cfng sg cung dua ra nhdn xdt tuang tg. Theo tdc gia, trong vidm nao sau sdi' cd sg ddp ung miln djch cua t l bdo lympho T ddi vdi cdc t l bdo thdn kinh da bj nhilm virus sdi vd dugc xem Id ly do gdy suy giam te bdo ddng lympho T [3].
Ddi vdi ddng t l bdo lympho T, kit qua nghien cuu ndy cho thay, mac du ca t l bdo CD4 vd CDS d i u thuyen giam, nhung ddng te bdo CDS cd sg suy giam ro rft (p < 0,05) d bfnh nhdn cd biln chung viem ndo. Antoin- ette Tisho nghidn cuu ddp ipng cua t l bdo CD4 vd CDS d bfnh nhdn vidm ndo sdi cung nhdn thiy sd lugng t l bdo CD4 vd ty sd CD4/
CDS d bfnh nhdn sdi cd biln ch^ng vidm ndo giam thap rd rft so vdi nhdm chung. Nhu-ng thilu hgt ndy cd t h i cd lidn quan vdi biln Chung vidm ndo [2]. Tuang tg, kit qua nghidn cdu ndy cung cho thay trdn bfnh nhdn biln chipng vidm ndo sdi, ndng df phdn tu- HLA- DR giam rd rft.
Trong nghien ciru ndy, bfnh nhdn cd biln Chung vidm ndo dd dugc dilu tri bdng Immu- nogbbolin. Kit q u i sau 3 ngdy dilu tri cdc
TAP CHf NGHlgN CCPU Y HQC
ddng t l bdo miln djch cd sg hdi phgc rd rft (p < 0,05), vd ty sd CD4/CDS cQng cd phgc hdi, tuy nhidn khdng cd 9 nghTa thdng kd (p > 0,05) (bdng 4).
Nhu vfy k i t q u i nghidn ciPU cho thiy, trong vidm ndo sdi, cd sg giam ciia cdc ddng t l bdo CD3, CD4, CDS, CD45, HLA-DR, mfe dil ca c h l chua dugc nghidn ciPU.
V. K^T LUAN
Qua kit qua nghidn cuu sg thay ddi cdc cdc t l bdo miln djch trdn 13 ngudi trudng thdnh, cd biln chung vidm ndo sdi trong nhu-ng ndm 2009 2010, cho phdp dua ra kit lufn trong vidm ndo sdi cd sg suy gilm rd rft ciia cdc ddng t l bdo miln dbh CD45, CDS, ty sd CD4/CDS vd HLA-DR so vdi nhdm bfnh nhdn sdi khdng cd biln chung (p < 0,05), nhung sg suy giam cua t l bdo CD4 vd CD19 khdng cd y nghTa thdng kd (p > 0,05).
TAI LIEU THAM KHAO
I . A n n e G e r s h o n ( 2 0 0 5 ) . Measles.
Harrison's Principles of Internal Medicine 16th Ed, Part six - Infectious diseases, Section 15: p. 1184 85.
2 Antoinette Tishon, Hanna Lewicki, and et al (2006). CD4 T cell control primary measles virus infection of the CNS: Regulation is dependent on combined activity with either CDS cell or with B cell: CD4, CDS or B cells alone are ineffective. Virology, 347: 234 - 245.
3. Berchard Fleischer and Hans W.Kreth (1983). Clonal Expansion and Functional Analysis of Virus-Specific T Lymphocytes from Cerebrospinal Fruid in Measles Encephalitis"
Human Imonobgy, 7: 239 - 248.
4. Croxson, M.C, Anderson N.E et al (2002). Subacute measles encephalitis in an immunocompetent adult. J Clin Neurosci, 9 (5): 600-604.
5. Lee K.Y, Cho W.H, Kim S.H., et al (2003). Acute encephalitis associated with measles: MRI features. Neuroradiology, 45:
100-106.
Summary
CHANGES OF IMMUNITY IN MEASLES ENCEPHALITIS IN ADULT
Measles encephalitis is a rare disease but it has high mortality rate and severe sequelae and it's pathomecanism is still not clear. Objective of the study was to find out some immunity indexes with measles encephalitis in adult. The resuits showed that, there were difference between case group and control group of CDS, CD45, CD3, HLA-DR and the CD4/CD8 rate. However, there were not difference between case group and control group of CDI9, CD4. In conclusion, there were reduction of some immunity cells in measles encephalitis.
Key word: Measles, encephalitis, immunity in measles