THAY odl
M O TSd CHJ TIEU
M I I NDjCH OT BENH NHAN VIEM MUI Dj UfNG DO Di NGUYEN
L O N GVU OU0C DIEU TRI MIEN DICH DAC HIEU DUUNG DUIDTI LUUl
TOMTAT:
Nghiin ciru can thigp theo ddi dgc, tw ddi chimg cho 40 bgnh nhin dwgc chin doan xae djnh la viim mui dj img do dj nguyen Idng vu tgi Hal Phdng. Kit qua sau 6 thing diiu tq cic eh! tieu mien djch deu eai thign rd rgt so vdi trwdc diiu tri ed y nghTa thdng ke: Test kieh thich mui sau diiu tn cd 7,5 % (-) va 70 % (+) so vdi trwdc dieu tri dwang tinh 100%, tmng dd chu yiu la (++) vi (+++): 87,5 %; Phan ung tieu bgch ciu: tnrdc diiu tri 100% dwang tinh, sau diiu tri 35 % am tinh; Phan ung phan huy Mastoeyte: tnrdc dieu trj 92,5 % dwang tinh, sau diiu trj 37,5 % im tinh. IgE toin phin trwdc diiu tri 523,59 ± 369,83, sau diiu tri 315,24 ± 230,47 Ul/ml; IgG toin phin tnrde dieu tri 1000,33 ± 111,62, sau dieu trj
1862,95 ± 276,69 mg%,.
Twkhda : viem mui dj img, dj nguyen Idng vu SUMMARY
CHANGES IN SOMES IMMUNOLOGICAL INDICATORS IN PATIENTS WITH ALLERGIC RHINITIS DUE TO FEATHER ALLERGEN TREATED BY USING SPECIFIC SUBLINGUAL IMMUNOTHERAPY
Auto controlled follow-up study included 40 patients with allergic rtiinitis due to feather allergen at Haiphong City. After 6 months of treated by specific sublingual immunotherapy (SLIT) with feather allergen 300IR/ml all immunological parpmeters significantly had been impmved (p<0.05) such as: Before the treatment, 100%, of nasal pmvoeation test (NPT) was positive, but after the tmatment the number mduees and 7.5% with NPT have negative:, especially number of patients with NPT (++) .and (+++) deemase from 87.5%, to 22.5%.
Destmying leucocyte test befom tmatment: 100%, wem positive and after 35%, negative (p<0.05); Decomposition mastoeyte test befom tmatment: 92.5% wem positive and 37.5%, negative (p<0.01). Momover, the tmatment makes change." In semm immunoglobulin, such as reduction of total IgE level (before the tmament, IgE level was 523.59 Ul/ml, after the treatment that was 315.24 Ul/ml), incmase in total IgG synthesis (before the treament IgG levels were 1,000.33 mg%, and after the treatment that was 1.862.95 mg% (p < 0.05).
* Keywonjs: Allergic .rhinitis; Feather allergen;
sublingual immunothempy. ^ DATVANOfe
D i l u tri vigm mui dj ung (VMDLf) theo c a e h l bgnh sinh, hay cdn gpi lg MDDH, lg mpt phuang phap d i l u tn duy nhit iam thay ddi s u t i l n t r i l n qua trinh t u nhien bgnh ly dj ung, ed higu qua lgu dai ddi vdi VMDLf. Dj nguyen dupe dua vao ea t h i ngudi bgnh dj ung vdi l i l u nho tang d i n cho tdi khi dgt tdi l i l u iam giam hogc m i t din cac trigu ehung dj ung d nhii'ng l i n t i l p xiic sau vdi dj nguygn gay bgnh. Trgn t h i gidi MDDH da dupe ung dyng rpng rai trong d i l u tn eac bgnh dj ung vg higu qua da dupe Chung minh. D i l u trj MDDH cd 2 dudng phd bien d l dua dj nguygn vgo ca t h i lg dudng tiem trong
N G 6 T H A N H BINH - Trudng Dai hgc Y Thii Binh V U MINH THUC - Benh vien Tai Mui Hgng Trung uong
da (SIT) vg dudng nhd dudi luai (SLIT). Trong dd, SLIT t h i hign dupe s u uu vigt han bdi tinh an togn va mue dp thugn tign eho bgnh nhan.
Mgt khgc dj nguyen Idng vu (DNLV) da dupe dieu e h l vg c h u i n hda tgi Vipt Nam. Han nii'a ty Ig m l e VMDU' do DNLV tgi Vigt Nam lg tuang ddi cao, dgc bigt la d nhirng ngudi lgm vigc tgi nai e h l b i l n Idng vu vg chgn nudi gia e l m (26,15-32,5%).
Ndi tdi bgnh dj ung la ndi d i n vai trd trung gian eua IgE vg mpt sd macker mien dieh khac. Xet nghigm cae c h i t nay d cac bpnh nhan dupe d i l u tn theo phuang phap mien djch dgc higu trudc, trong vg sau r i t ed gig tri- Dua tren nhirng s u thay ddi ciia cac xet nghigm mien djch k i t hpp vdi s u thay ddi eac trigu ehung lgm sgng ed t h i dgnh gia chinh xgc dupe higu qua cua MDDH ddi vdi VMCLf. Vi vgy, nghien cuu s y thay ddi cgc chi tieu mien djch d bgnh nhan VMDLC do DNLV d i l u tn b i n g MDDH dudng dudi luai lg h i t sue e i n thiet va hiru ich.
Vi vgy chiing toi nghien cuu d l tgi nay vdi myc tieu:
Danh gia sw bien ddi mgt sd chi tieu mien djch &
bgnh nhan bgnh nhan VMDW do DNLV sau 6 thing dieu trj mien djch dgc higu dwdng dwdi Iwdi.
D 6 I TU'P'NG VA PHLCQNG P H A P NGHIEN CIJU 1. o d i tu'p'ng nghien c i r u
Gdm 40 bgnh nhan dupe c h i n doan xic djnh la VMDLT do DNLV dupe dieu trj b i n g MDDH dudng dudi luai.
* Dja d i l m thue hign: tgi khoa Mien djch-Dj ung iam sang, Dgi hpc Y Hai Phdng.
* Thdi gian t u 01/2009-12/2009.
2. P h u a n g phap nghien ciru
2.1. T h i l t k l nghien c i r u : Nghien cuu can thigp theo doi dpc, t u ddi ehung.
2.2. P h u a n g phap nghien eu'u.
2.2.1. Phwang phip dieu trj MDDH
- T i l n hanh tgi khoa Mien djch-Dj ung iam sang, Dgi hpc Y Hai Phdng.
- Dj nguyen Idng vij do Bgnh vign Tai mOi hong Trung uong san x u i t , ndng dp 10 IR/ml, 100 R/ml vg 300 R/ml.
* Ky thugt t i l n hgnh: Theo quy trinh dieu tn ciia Bousquet:
Thi b i t d i u nhanh ( d i l u trj b i t d i u , tgng lieu): thudc sir dung vgo budi sgng liic doi. L i l u s u dung cd dupe b i n g each bdp vao bp phgn bam, thudc bam true t i l p vao dudi ludi vg d l ygn trong vdng 2 phiit trudc khi nudt. Thudc dupe sir dung theo kieu tgng lieu hang nggy eho d i n khi dgt dupe l i l u duy tri. Thdi gian thudng keo dgi 1 thgng.
Thi duy tri: L i l u duy tri dupe sir dyng la 4 lilu (ndng dp 300 IR/ ml) /ngay. Ndng dp 300 IR/ ml Ja dupe ehung td trong cae thu nghipm lam sang cd ddi chung lg ndng dp thich hpp n h i t d l nhanl, chdng dgt dupe lieu tieh luy higu qua.
Y HOC THl/C H A N H (741) - SO 11/2010
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Trpng qua trinh d i l u tri, ehung tdi theo ddi va cd ghi chep tinh trgng dien b i l n bgnh theo hd sa cug moi bgnh nhgn vg lgm cgc xet nghiem mien djch d cae thdi d i l m trude d i l u tri va sau dieu tn 3, 6 thang.
2.2.2. Nghien cuu cac chi tieu mien dich.
- Test kich thich mui (Nasal provocation test).
* Nguyen ly: Nhd dung djch DNLV vao mui d l tai tgo Igi bgnh canh lgm sang. Neu bgnh nhgn x u i t hign trigu ehung eiia can vigm mui dj ung thi test d u p e coi lg duang tinh
* Tiin hanh: Bpnh nhan d u p e logi t r u d p i viem c l p . Nhd vgp mdi ben mui 2-3 gipt n u d c mudi sinh ly lam chung, n l u khdng cd phan ung gi thi sau 15 phiit b i t d i u nhd 3 gipt dung djch DNLV vao mdi ben mui, ndng dp tang d i n t u 1000, 2000, 5000 d i n 10000 PNU/ml.
Nhgn djnh k i t qua sau 20 phut.
* Danh gii kit qua:
- Test gm tinh: bgnh nhgn khdng cd b i l u hign tren khi thir d i n ndng dp 10000 PNU/ml.
- Test duang tinh: bgnh nhan ed it n h i t 2 trigu ehung co nang, hogc dgnh gia khach quan qua dp thdng khi cua mui qua guong Glazel trudc va sau khi iam test vg tinh trgng niem mgc hdc mui va cudn dudi: xung huyet, phii n l , tgng x u i t t i l t . Ghi Igi ndng dp t h i p n h i t gay con dj ung.
- Duong tinh (+) Dap ung d ndng dp 10000 PNU/ml - Duong tinh (++)Dap ung d ndnc, dp 5000 PNU/ml - Duong tinh (+++)Dap ung d ndng'dp 2000 PNU/ml - Duong tinh (++++) Oap ung d ndng dp 1000 PNU/ml
- Phan ung tieu bgch cau dgc higu
* Nguyen ly: Trong cae phan ung dj ung, phue hpp khang nguyen khgng t h i khdng nhung lgm phgn huy t l bao mastoeyte ma cdn lam phgn hiiy t l bao bgch cau hgt. Dua vgo ty sd phgn hiiy cua nhirng t l bgo ngy d l danh gia k i t qua ciia phan ung.
* Dgc ::et qua:
10-20% ' • 21-30%
31-40%
> 4 0 % - Phan wng phan huy mastoeyte
* Nguyin ly: Sau giai dogn man cam, khi dj nguyen xgm nhgp vao c a t h i se k i t hpp vdi :ae kich thich dgc higu g i n tren mang t l bao mast d l tao ^.huc hpp KN - KT. Phuc hpp nay sau khi hinh thanh se lac dpng true t i l p len mang t l bao mastoeyte, iam thay ddi c l u true mang eung nhu eae c h u y i n hda npi tgi t l bgo. K i t qug la t l bao bj b i l n ddi thogt hgt irong bao t u a n g . <•'"
* Danh gii kit qua:
+ Phan ung gm tinh (-): sd lupng mastoeyte d lam thi nghigm khdng thay ddi vdi lam kinh chung hogc ty lg phgn hiiy < 10%.
+ Phgn ung d u a n g tinh khi d lam thi nghigm t l bgo bj phgn hiiy nhieu han d lam chung eu the:
- Duong tinh (+):Sd te bao phgn huy t u 10 - 20%
- Duong tinh (++): Sd t l bao bj phgn hiiy > 20 - 30%
- Duang tinh (+++): Sd t l bao bj phan hiiy > 30 - 40%
- Duang tinh (++++): So te bgo bj phan huy > 4 0 % - Djnh Iwgmg IgE toin phan
* Nguyen ly: Ky thugt ELISA xet nghigm IgE toan p h i n trong h u y l t thanh dua irgn nguyen ly bgnh kpp
D u j n g tinh (+) '^uong tinh (++) Duong tinn (+++) Duong tinh (++++)
(Sandwich) n h u sau: eac p h i i n nhua da g i n khgng the dan ddng khgng IgE sau khi ii vdi h u y l t thanh eiia bgnh nhan hogc cgc c h u i n (standard) se tgo thanh phuc hpp anti - IgE + IgE. Phue hpp tren se g i n vdi khang the khang IgE g i n men (khang t h i khang IgE ngudi cua de g i n men percxydase) tgo thanh phuc hpp anti - IgE + IgE + anti-lgE g i n men. Phuc hpp nay se hign mau khi il vdi c a c h i t TMB va m u e dp dgm nhgt ciig mgu co c h i t ty lg thugn vdi ndng dp IgE trong h u y l t thanh.
Nong dp IgE eua cac bpnh nhan se dupe tinh togn sau khi so sanh vdi d u d n g cong c h u i n b i n g p h i n mIm may tinh TCWIN2. K i t qua d u p e tinh ra dan vj Ul/I.
- Djnh Iwgmg IgG toan phan trong huyet thanh:
* Nguyen /y.Khang t h i trong h u y l t thanh c i n djnh lupng ddng vai trd n h u mpt khang nguyen se k i t hpp vdi eac khang khang t h i tgc thanh phue hpp KN+KT.
S u k i t hpp nay tgo thanh hinh anh tua la \irng d trong dung djeh va d u p e do d u p e b i n g phuang phap do dp due. Ndng dp cua KT ti Ig thugn vdi dp dgc va dupe do ddi c h i l u vdi mpt dung djch c h u i n cug KT cd ndng dp b i l t trudc n h u cac p h u a n g phap do b i n g quang hpc.
* Cac b u d e t i l n hanh ky thugt:
- x a e djnh d u d n g c h u i n vdi tung dung djch IgG. Moi dung djch c h u i n cd mpt ndng dp khgc nhau.
- T i l n hanh do eae mau h u y l t thanh eua BN va may t u dpng tinh k i t qua ra m g % .
3. XLP ly s d ligu: Sd ligu thu d u p e trong qua' trinh nghien cuu d u p e xii' ly b i n g c h u a n g trinh SPSS lo.O.
K t T QUA NGHIEN CLCU L T e s t k i c h t h i c h m i i i
^^::^^^^^-M
BTrirdc dieu trj DSau dieu tri
JI?
lis €S9
(-)
(+) (++) (+++)B i l u dd 3.1. Test kieh thich mui trude va sau d i l u trj Nhgn xet: - T r u d e d i l u tn 100% bgnh nhgn cho kit qua d u a n g tinh nhung khdng ed trudng hpp ngo
(++++), ehu ylu la (++) va (+++): 87,5%.
- Sau dilu tri, chii ylu bgnh nhan d nhdm (+): 70%;
khdng cd bpnh nhgn nao (+++) vg cd 7,5% eho kit qua
( - ) •
2. Phan i r n g t i e u bgc c l u dgc higu
Bang 1. Phan ung tieu bgch c l u dgc higu trude va sau dieu tri
MCrcdg
Duang tinh
Am tinh (+) (++) (+++) (++++)
Tong
Trude dieu trj n
17 15 5 3
%
42,5 37,5 12,5 7,5 100
Sau digu tri 6 thang n 18
7 1 0 14
%
45,0 17,5 2,5
0 65,0 35,0
P
p<0,05
Nhgn xet: - Chi sd tieu bgch c l u dgc hipu gidm rd rgt sau dieu trj d t i t ea eac bgnh nhan.
- Sau dieu tn cd 35% bgnh nhan eho k i t qua am tinh, s u khac bigt cd y nghTa thdng ke, p<0,05.
94 Y HOC THUC HANH (741) - S 6 11/2010
3. Phgn Cpng phan h u y Mastoeyte
Bang 2. Phan ung phgn huy Mastoeyte trudc vg sau dilu tri
Mircdg
Duang tinh(1)
Am tinh (2)
(+) (++) (+++) (++++)
Tong
Trude digu tri n 11 17 7 2 3
% 27,5 42,5 17,5 5,0 92,5
7,5
Sau (Jigu tri 6 thang n 17
7 1 0 15
% 42,5
17,5 2,5 62,5 37,5
P
Pl,2<0,01
Nhgn xet: - Sau 6 thgng dieu trj, ty lg bgnh nhgn cd phan ung gm tinh eao hon so vdi trudc d i l u tn (37,5%), CO y nghTa thdng ke vdi p < 0,01.
- Mue dp duong tinh eua phan ung phgn huy Mastoeyte ed xu hudng giam d i n v l (+) d i n (+++) chilm 62,5%, khdng cdn bgnh nhan nao d mue (++++).
4. Ham lup'ng IgE togn p h i n
Bang 3. Ham luang IgE toan p h i n trong h u y l t thanh truac va sau d i l u tr.
Thg'i dilm Trudc dilu tri Sau (3ieu
trj
Thgp nhit 163,92
90,73
Cao nhgt 1498,75
837,30
523,59 315,24
SD 369,83 230,47
<0,05 Nhgn xet: Ham luang IgE toan phan trung binh d bgnh nhgn giam di rd rgt, s u khgc bigt cd y nghTa thdng ke, p<0,05.
5. Ham lu'p'ng IgG toan p h i n
Bang 4. Ham lupng IgG toan p h i n trong h u y l t thanh trudc va sau dieu tri-
Thdi (Jilm TrucS'c 0\h\i tri ' Sau (}i4u
trj
Thip nhgt 810 1206
Cao nhgt 1257 2398
X 1000,33 1862,95
SD 111,62 276,69
P
<0,05 Nhgn xet: Sau dieu tri tat ca cgc bgnh nhgn deu cd ham lupng IgG tgng rd rpt, s u khac bigt cd y nghTa
thong ke, p<0,05. . n BAN LUAN " ••
1. Test kieh t h i c h m u i
Test kich mui la phuang phap r i t nhgy cam va cd gig tri trong c h i n dogn dj ung dgc hipu dgc bigt la nhirng trudng hpp VMDLf. Trong nghien c u u nay chung tdi sir dung test kich thich mui d l c h i n doan va danh gia higu qua dilu tq MDDH. Sau 6 thang d i l u .rj chiing tdi nhgn thay cd 7,5% cho k i t qua (-1, trong .-'.hdm duang tinh chii yeu lg (+) so vdi trude dieu tri 100% bgnh nhgn eho kit qua duang tinh chii y l u lg (++) va (+++) c h i l m 87,5%. Nhu vgy ty Ig vg cac muc dp duang tinh cua test kich thich mui giam n h i l u sc vdi trudc d i l u tri (p<0,05).
Ket qua nay cua chiing tdi tuang duong vdi k i t qua eua Imleat va Vu Minh Thuc khi d i l u tri MDDH bang dj nguygn P. te dudng d u d i ludi cho bgnh nhan VMDU" va cao han k i t qua nghien c u cua Trjnh Mgnh Himg khi dieu tri b i n g dudng tigm trong da cho bpnh nhgn hen phi quan dj ung.
2. Phgn Ung tieu bgch c l u dgc hipu va phan hiiy Mastoeyte
40 bgnh nhgn dupe lay mgu lgm phan ung tieu bach c l u dgc higu. K i t qua chiing toi t h i y sd bgnh nhan cho test duang tinh vdi DNLV la 100%. Sau 6 thang dieu tri MDDH, khdng eon bgnh nhan nao d muc dp (++++).
Muc dp duong tinh ciia phan ung da chuyen v l (+) c h i l m 45% va 2 (++) la 17,5%, ehl con 2,5% bgnh nhan cho ty Ig duang tinh d muc dp (+++). Dgc bigt sd bgnh nhan eho ty Ig phan ung gm tinh tgng ro rgt chiem 35%.
S u khac bigt nay so vdi ty Ig phan ung gm tinh trudc d i l u tri CO y nghTa thdng ke vdi p < 0,05. Nghien cuu cua tac gia Trinh Mgnh Hiing lgm xet nghipm vdi dj nguygn byi nhg ciia Phap t h i y ty lg dap ung duong tinh la 74,67% va muc dp dap ung duang tinh chii y l u d muc (+). Nhu vgy, ea v l ty lg duong tinh eung nhu muc dap ung duong tinh, k i t qua eiia ehiing tdi deu d muc cao han.
Cung nhu phan ung tieu bgch c l u dgc higu, phan ung phgn hiiy mastoeyte d cgc bgnh nhgn VMDU' do DNLV dupe tien hanh trude luc d i l u tri va cho ty Ig duong tinh 92,5%, ehu y l u tgp trung d muc dp duang tinh d (++) la 42,5%, chi cd 17,5% d mue dp (+++) va 5% d muc dp (++++). K i t qua nay eung phii hpp vdi nghien cuu eiia Trinh Mgnh Himg. Sau 6 thang <Jieu tri, khdng edn bgnh nhgn ngo cho ty Ig duong tinh (++++), chii y l u tgp trung d mue dp (+) vg 2 (++), tuy nhien mue dp (++) da giam ro rgt so vdi trudc ehi eon 17,5%. Dgc bigt ed 37,5% bgnh nhan eho phan ung phgn hiiy mastoeyte gm tinh. Ty Ig ngy ed y nghTa thdng ke so vdi trude d i l u tri vdi p < 0,01.
3. B i l n ddi ham lu'p'ng IgE
IgE la khang t h i g i n lien vdi bpnh ly dj ung typ I, nd ddng vai trd quan trpng nhat trong co e h l dj ung. 0 ngudi binh thudng ham luang ciia nd dao dpng trong khoang 0 - 1 3 5 Ul/ml. Khi m l e cac bgnh dj ung, ham lupng eiia nd cd t h i tgng tdi hang chuc, thgm chi hgng tram l i n . Tuy nhien, moi dj nguyen gay dj ung deu co mpt khang t h i dgc hipu, do vgy d l c h i n doan xgc djnh nguyen nhan gay bgnh vigc djnh lupng IgE dgc higu la phuang phgp cd gia tri n h i t giiip ieh eho c h i n doan tren iam sang. Chiing tdi tien hanh djnh luang ca IgE toan p h i n va IgE dgc higu trude va sau d i l u tri. Neu ham lupng IgE toan p h i n ed s u thuyen giam theo t i l n trinh dieu trj chung td phuang phap d i l u tn da cd hipu qua.
Tac gia Delaunois L. cung cd nhgn xet khi t i l n hanh dieu tri MDDH tren 73 bgnh nhgn thay 9 1 % bgnh nhan cd hgm luang IgE trong h u y l t thanh giam vg cd ket qua dgnh gia tren lgm sgng lg tdt. Hgm lupng IgE toan p h i n trong huyet thanh ciia cac bgnh nhan trudc dieu tri MDDH, ehiing tdi thu dupe k i t qua la: 523,59 ± 369,83 Ul/ml. K i t qua nay eao han han so vdi nhdm ngudi binh thudng (212,70 ± 95,05 Ul/ml). Nghien cuu ciia Trinh Mgnh Hiing d 39 bpnh nhan HPQ cho t h i y ham lupng IgE toan p h i n la 484,79 ± 64,30 Ul/ml, cao hon ro rgt so vdi ngudi binh thudng. Ket qua nghien cuu cua Doan Thj Thanh Ha tren 80 bgnh nhan viem mui dj ung vdi bui nha la 370,26 Ul/ml, cua Vii Van San tren 73 bgnh nhan viem miii dj ung vdi bui bdng len la 473,33 Ul/ml, ciia Vo Thanh Quang va Vu Minh Thgc tren 40 bpnh nhgn viem mui dj ung do DNLV lg 510,43 ± 385,44 Ul/ml. Nhu vgy k i t qua djnh lupng IgE toan p h i n tuy khdng tuang duang giira cac nhdm nghien cuu tren cac bpnh nhan dj ung nhung deu eao hon so vdi ngudi binh thudng (p<
0,01).
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Sau dilu tri 6 thang bing MDDH vdi dj nguyen DNLV ndng dp 3001FR/ml, ham lugng IgE giam xupng rd rgt cdn 315,24 ± 230,47 Ul/ml (ed mpt sd bgnh nhan cd ndng dp IgE < 100 Ul/ml), Kit qua nay so vdi trudc dilu tri ed su khae bipt ed y nghTa thdng ke (p < 0,01). Dilu dd gian tilp xae djnh su giam d i n eua IgE dgc higu vdi dj nguyen DNLV d eae bgnh nhgn HPQ dang duac dilu tri MDDH . Nhgn xet nay cung phii hpp vdi kit qua eiia Trinh Mgnh Himg tiln hgnh dieu tri MDDH vdi D. pte eiia Phap chp eac bgnh nhgn HPQ tgi Vigt Nam, nhung hgm lupng IgE togn phin sau MDDH giam khdng nhilu so vdi nghien cuu ciia chiing tdi (484,79 - 347,17 Ul/ml).
Kit qua giam hgm lupng IgE cua chiing tdi phii hpp vdi kit qua eiia Vd Thanh Quang vg Vu Minh Thuc khi tiln hanh dilu tri MDDH vdi DNLV cua Vipt Nam san xuit d cac bgnh nhan viem mui dj Ung (510,43 -293,78 Ul/ml).
4. Bien ddi ham lu'p'ng IgG toan phin
Bgn cgnh su thuygn giam hgm lupng IgE toan phin, chiing tdi tiln hanh djnh lupng ham lupng IgG togn phin trong huylt thanh. lgG4 duac coi lg khang t h i bao vg d nhii'ng bgnh nhgn bj dj ung vdi mpt logi dj nguyen ngo dd sau khi dupe tiln hanh dilu tri MDDH vdi dj nguyen dd. Da cd rit nhilu tac gia dua ra nhgn xet ring bgnh nhgn VMDLT sau khi dilu tri MDDH ed ham lupng lgG4 cao han nhdm ehUng (nhdm ngudi binh thudng vg nhdm ngudi bj VMOLf khdng dupe dilu tri MDDH).
Nhung do dilu kipn hipn tgi eiia Vigt Nam, ehua triln khai dupe ky thugt djnh lupng lgG4 nen vigc tiln hgnh xae djnh hgm lupng IgG toan phin truce vg sau <Jilu tri MDDH theo tung thdi dilm cung gd|:. phin dgnh gig dupe higu qua dieu tri ddi vdi bgnh nhan khi thiy ham lupng IgG tang len. Khi djnh lupng hgm lupng IgG tpan phin d cgc bpnh nhan dilu tri MDDH vdi DNLV trude vg sau dilu tri 6 thgng, kit qua ciia ehung tdi cho thiy ham lupng IgG trudc dilu tri lg 1000,33 ± 111,62 mg%.
ham lupng nay cd giam han so vdi nhdm ngudi binh thudng (p < 0,01) va cd su biln ddi ngupc so vdi ham lupng IgE togn ptiln. Dilu dd chung td d cgc bgnh nhgn VMOLf do DNLV ed sir nhgy cam vdi dj nguygn vg tang san xuit khang t h i dj ung (IgE) va giam san xuit khgng the bao vp ('gG). Dieu ngy eung phu hpp vdi muc dp duang tinh cac test da, phan ung phgn huy mastoeyte, phan ung tigu bgch c l u dgc higu. Sau 6 thgng dilu tri MDDH bang DNLV 300 ndng dp IR/ml ham lupng IgG tgng len 1862,95 ± 276,69 mg% SP vdi trudc dilu tri (p <
0,01). Dilu dd Chung td sau dilu tri MDDH bing DNLV, cac bgnh nhgn VMDL/ da tang lupng khgng t h i bao vg.
Su tang len eua ham lupng IgG cung vdi su giam xudng eua IgE sau dilu tri so vdi trudc dilu tri chung td dap ung miln djeh da thay ddi, t h i hign d chd cac test liy da, phan ung phan hiiy mastoeyte, phan ung tieu bgch c l u dgc higu da gianr, hln muc dp duang tinh. Tit ca cgc thay ddi nay phii hpp vdi su tdt len cua eae trigu chung lgm sgng sau dilu tri. Kit qua nay ciia ehiing tdi la tuang duang kit qua dilu tri ciia Vd Thanh Quang va Vu Minh Thuc cung nhu kit qua ciia Imleat va Vu Minh Thgc va eao han kit qua cua Phgm Van Thue va cpng su khi dilu tri bing dj nguyen bgi nha va bui ldng vu theo dudng tigm trong da.
Nhu vgy sau 6 thgng dilu tri VMDU" do DNLV bing MDDH dudng dudi ludi vdi DNLV ndng dp 3001R/ml chimg tdi nhgn thiy ed su cai thign rd rgt ve eac chi tieu mien djeh, nhu vgy cung gidng nhu dj nguygn D. pte.
DNLV eung da duac ehuan hda vg dua vao dilu tq cho bgnh nhgn lg higu qua va dung vdi ea ehl bgnh sinh.
Hon nii'a phuang phap nay the hign dupe su uu vigt han vdi dudng tiem vi tinh an toan rit eao, khdng cd trudng hpp nao xay ra tai biln do dj nguygn vg cung khdng cd t)gnh nhan nao phai bd dd dieu tri vi tgc dung phg eua dj nguyen.
KtTLUAN
Sau 6 thang dilu tri cac chi tigu mien djch diu cai thign rd rgt:
- Test kich mui cd 7,5%i eho kit qua (-), trong nhdm duong tinh chu y l u la (+): 70 %.
- Phan ung tieu bgch cau dgc higu: sau dilu tq cd 35,0 % eho kit qua am tinh khdng cdn bgnh nhgn ngo ed phan Ung (++++), muc dp (+++) chi cdn 2,5 %.
- Muc dp am tinh cua phan ung phan huy mastoeyte tgng tu 7,5 len 37,5 %; duang tinh cua ed xu hudng giam din v l duang tinh (+) d i n (+++) chilm 62,5%, khdng edn bpnh nhan nao duang tinh d mue (++++).
- Hgm lupng IgE togn phin giam cd y nghTa thdng kg:
Trudc dilu tq: 523,59 ± 369,83 Ul/ml.
Sau dilu tri: 315,24 ± 230,47 Ul/ml.
- Hgm lupng IgG toan phin tang ed y nghTa thdng ke:
Trudc dilu tri: 1000,33 ± 111,62 mg%.
Sau dilu tri: 1862,95 ± 276,69mg%.
T A I L I $ U THAM K H A O
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