TAP CHl Y HOC VIET NAM TAP 459 - THANG 10 • SO 1 - 2D17 Nguyen XuSn Tii (2004)j^ Tim hieu thUe tran^
dinh dU8ng va tap tinh an uong ciia ngu'di cao tuoi tai xa Tam Hulig, Thanh Oai, Ha Tay, Luan van tdt nghiep bac sy y khoa tru'dng Dai hpc Y Ha Npi.
Phan VTnh Thjnh (2000), ttm hieu tinh trang dinh duSng va tap tinh an uong ciia cac cu cao tudi tai mot phu'dng ngi thanh Ha Noi, Luan van tot nghiep bac sy y khoa triTdng Dai hoc y Ha Noi.
Pham Thang, Tap chi DS&Pf (so 4/2007), Website Tong cue DS-KHHGO.
6. "Cap nh^t ve thu'c tr^ng va mot so yeu to lien quan den tang huyet ap d ngUdi eao tuoi tai phu'dng PhUdng Mai, quan Dong Da, Ha Noi" - 2007 - Nguyen Thanh Ngde, Ta Manh CUdng 7. Vi6n dinh dUSng (2011), "K§t qua dieu tra Thu^
can - beo phi va mot so yeu to lien quan d ngu'di Viet Nam 25-64 tajoi", accessed 08/2016, from http://viendinhduong.vn/news/vi/150/62/a/ket- qua-dieu-tra-thua-can—beo-phi-va-mot-so-yeu-to- lien-quan-o-nguoi-viet"nam-25-64-tuoi.aspx.
NGHIEN CirU DAC DIEM CUA TON THiraNG VIEM PHOI KE TRONG BENH VIEM DA CO TIT M I I N
Nguyen Thi Thoa , Nguyen Thi Phu-ong Thuy 3 M TAT
MMC tieu: 1. Tim hieu dac diem lam sang va can Tl sang cua viem phdi ke trong benh viem da ed ty ien. 2. Khao_sat mdi lien quan ciia viem pho'i ke vdi ot so dac diem lam sang va can lam sang cita benh sm da cd tiT mien. Doi tu'dng va phu'dng phap jjhien cihi: Nghien ciTu tien cufu, mo ta eat ngang
=r\ 67 benh nhan du'dc chan doan viem da cd tU iin, dieu tri tai khoa Cd xu'dng Widp, benh vien Bach ai tiT 8/20i6 den 6/2017^ Ket qua va kSt luin:
3nh hay gap nhat d lufa tuoi tir 40 - 60 tudi vdi ty If '3c benh eiia nU/nam = 1,3/1. Ton thu'dng viem ph6i 5 gap d 37/67 benh nhan (chiem ty le 55,2%), tronj 3, lihutig dae diem lam sang thu'dng hay gap nhat im kho thd (67,6%), ho khan (56,8%), sot (37,8%), lies d phdi (18,9%) va dau ngi/c (16,2%). Khi do lire nang ho hap, 26/37 benh nh§n cd roi loan thdng li ban che, chiem t9 le 70,3%. NhOTig hinh anh ton lUdrig phdi hay gap nhat_^tren phim CT.Seanner phoi Ja cac BN ed viem phoi ke gom day to chii'c ke '5,7%), gian phe quan (1.3,5%) va hinh anh dong pc dang kinh md (5,4%). CT nhdm benh nhan cd ton iiTdng viem phS ke. do tuoi Idn hdn, thdi gian mac 2nh keo dai hdn va ndng do men CK trong huyet ianh tang cao hdn so vdi nhdm BN khong ed viem hoi ke. Tang cac chi so viem trong huyet thanh va nh frang thieu mau cung gap nhieu hdn^ d nhdm
§nh nhan cd viem phoi ke so vdi nhdm benh nhan nong cd viem phoi ke.
Td khoa: Viem da ed t y mien, ton thu'dng vi§m hoi kg, rSi loan thong khi han che.
UMMARY
INTERSTITIAL LUNG DISEASE AMONG PATIENTS W I T H POLYMYOSITIS Objectives: l.To explore the eharaeteristics of inical and sub - clinical of interstitial lung disease in atients witii polymyositis. 2. To determine the S^nh vien Bach Mai
Trddng Dai hgc Y Ha Ngi ^ hiu traeh nhiem ehinh; Nguyen Thj Thoa niail: nguyenthoa.nt40@gmail.eom gay nhan bai: 28.7.2017 gay phan bien khoa hoe: 8.9.2017 gay duyet bai: 15.9.2017
association of interstitial lung disease with other eharaetenstics of dinical and sub - clinical polymyositis. Subjects and methods: A cross- sectional study was conducted in 67 patients diagnosed with polymyositis from 8/2016 to 6/2017 at Department of Rheumatology, Bach mai hospital.
Results: The most common disease was in the age group of 40-60 years old with a female/male prevalence of 1,3/1. Interstitial pneumonia was reported in 37 out of 67 patients (55,2%), with the most common dinical features including dyspnea (67,6%), dry cough (56,8%), fever (37,8%), rales (18,9%) and chest pain (15,2%). When measuring respiratory function, 26/37 patients had limited ventilation, accounting for 70,3%. The most common signs from high - resolution computer tomography {CT scan) of patients with interstitial pneumonia were think organization interstitial lung (75,7%), bronchiectasis (13,5%), and blurry opacification (5,4%). In the group of patients with interstitial pneumonia, higher age, longer duration of disease and serum concentrations of serum CK increased more than pabents without interstitial pneumonia.
Increasing serum inflammation and anemia were more common in patients with interstitial pneumonia than in patients without interstitial pneumonia.
Keywords: polymyositis, interstitial pneumonia, limited ventilation.
\. DJSIT VAN OE
Viem da cd du'dc xep vao nhdm benh td mien vdi ton thu'dng ed ban la tinh trang viem man tinh ciia cac bd cd van. Tren lam sang, benh nhan thu'dng cd bleu hien yeu cd viing gde chi ddi xdng hai ben, lam benh nhan di lai khd khan.
Benh gap nhieu hdn d nD' gidi, do tuoi trung nien tir 40 - 50 tudi. Benh cd ton thu'dng d nhieu cd quan khac ngoai ed nhu": hd hap, khdp, tieu hda va tim mach. Nhu'ng ton thu'dng phoi hay gap trong benh viem da ed gdm viem phoi ke, viem phdi do sac, suy hd hap do yeu cae ed hd hap, trong dd viem phoi ke la mdt bien ehiTng thu'dng gap nhat va ed tien lu'dng xau. Khoang 30 - 75%
benh nhan viem da cd cd viem phdi ke va d mdt
VIETNAM MEDICAL JOURNAL N ' l - OCTOBER - 2017
SO benh nhan, viem phdi ke cd the xuat hien Xquang phoi thu'dng quy^va phim C.T.Scannei tru'dc khi ed trieu chiTng yeu cd tir vai thang den phdi theo 1 thang didm thong nhat, trong do cho vai nam [1]. K ^ qua cua nhieu nghien ciTu eho diem diTa vao^sy xuat hien eiia cac ton thu'dng thay, khdng cd mdi lien quan giiJa mu'e dp tien
trien eua tdn thu'dng viem cd va cac bleu hien lam sang ciia ton thu'dng phdi d nh^ng benh nhan viem da cd. Do dd, cac benh nhan cd tdn thu'dng phdi thu'dng du'dc phat hien mudn va anh hu'dng xau den hieu qua dieu tri. Nhihig benh nhan bi viem phoi ke cd thdi gian sdng ngan hdn so vdi eac benh nhan khdng cd viem phoi ke. Trong nghien ciili ciia Marie I nam 2002, ty le tir vong ciia benh nhan viem da ed cd viem phdi ke sau 1 nam la 5,6%, sau 3 nam la 9,6% va sau 5 nam la 13,5% [2]. Tai Viet Nam, da cd mdt sd nghien ciTu ve dac diem lam sang- can lam sang cua benh va hieu qua ciia cac thude dc che mien djch trong dieu trj benh viem cd tiT mien, tuy nhien chu'a cd nhieu nghien cii'u chuyen sau ve ^ n thu'dng viem phdi ke trong benh viem da cd. Do dd, chung tdi tien hanhnghien eiTu nham 2 muc tieu: 1. Tim hieu dac diem lam sang va can lam sang cua viem phdi ke trong benh viem da cdb/mlen. 2. Khao sat ma lien quan ciia viem phdi' ke vdi mot sd dac diem lam sang \m can lam sang cua binh wem da cxi tif mien.
IL €}dl TUONG VA PHU'ONG PHAP N G H I I N COXJ 1 . Doi tu'dng nghien cii'u: gdm 67 benh nhan du'dc chan doan viem da cd tiT mien theo tieu chuan chan doan ciia Bohan va Peter nam 1975, dieu tri tai khoa Cd xu'dng khdp, benh vien Bach Mai tiT 8/2016 den 6/2017. Benh nhan ddng y tham gia nghien CLTU.
2. Phu'dng phap n g h i i n cu'u -TTen cifu, md ta cat ngang.
- Oja diem tien hanh nghien ciTu: Khoa Cd xu'dng khdp, benh vien Bach l^ai.
- Thdi gian tien hanii nghien cii'u tiT thang 8/2016 den 6/2017.
- Tat ca cac benh nhan viem da cd tham gia nghien ciiXi deu diTdc hdi benh, khai thac tien suf, tham kham lam sang, lam cae xet nghiem can thiet, chup CT.Seanner phdi Idp mdng ed dp phan dai cao va do chirc nang hd hap. Cac ehi tieu nghien ciTu du'dc tien hanh thu thap theo mau benh an nghien ciTu thiet ke san.
- Oanh gia cac ton thu'dng phdi tren phim
tren phim, moi ton thu'dng du'dc danh gia co hoac khdjig, khdng phu thude vao miTc do lan toa ciia ton thu'dng.
- Xdl^ sdlleu: Nhap sd lieu va phan ti'ch so lieu bang Excel 2007 va SPSS 20.0.
III. KET QUA
1. Dac diem chung ciia nhom benh nhan nghien cii'u
Bang 3.1. Dac diem ve tuoi va gidi cua nhom benh nhan nghien edV
Oac diem
Tuoi
Gidi
< 4 0 4 0 - 6 0
> 6 0 Tong Nam r^o- Tong
So benh nhan 27 31 9 67 29 38 67
Tv le % 40,3 46,3 13,4 100 43,3 56,7 100 Nhan xet: Ket qua nghien edu tren 67 b§tiii nhan cho thay, viem da cd td mien hay gap nhSt d lira tudi tir 40 - 60 tudi (chiem ty Id 46,3%).
Benh it gap d nhu'ng ngu'di sau 60 tuoi. B^nh gap nhieu hdn d nd gidl vdi ty le mac benh ciia nir/nam = 1,3/1.
2. Dac diem lam sang cua nhom bgnh nhan nghien cu'u
Bang 3.2. Thdi gian mac benh cua nhom
benh nhin nghiSn cihi —,
" • ~ T y l e Thdi gian mac
benh (thang)
= 12
Jong,
"So BN 47
P/o
70,1 17,9
x±sp1
15,02 H 18,85 1 Nhin xet: Phan ldn cac benh nhan ngiii%
ciTu ed thdi gian mac benh du'di 12 thang (chi^m t / le 70,1%).
Bang 3.3. D$c didm ton thddng viem phojke ciia nhdmBN nghien culi
Ton thirtfng phoi
^Viem phoi ke Khong viem phoi ke
Tong
So benh nhan TyleVo^
55,2 _
Nhin xet: Trong nhdm benh nhan nghien edu, ton thu'dng viem phdi ke gap d 37/67 benii nhan, chiem ty le 55,2%.
3. D|ic diem can lam s^ng ciia nhom benh nhan nghien cii'u
Ton thu'dng phoi Dav to chLTc ke
Kinh md
Xquang phoi So benh nhan
19 1
Ty ie »/o 51,4
2,7
CT.Seanner phoi So benh nhan
28 2
Tv le % 75,7
5,4
TAP CHi Y HOC VigT NAM TAP 459 - THANG 0-SQ1 -2017 Xti phoi
Gian phe quan
1 1
2,7 2,7
2 5
5,4 13,5 Nhan xet: Trong 37 benh nhan viem da ed ed viem phoi ke, ton thu'dng hay gap nhat tren phim Xquang phoi la hinh anh day t d ehire ke, chiem ty ie 51,4%. Nh&ng hinh anh tdn thu'dng phdi hay gap nhat tren phim CT.Seanner phoi cua cac BN cd viem phoi ke gdm day to chu'c ke (75,7%), gian phe quan (13,5%) va hinh anh ddng dac dang kinh md (5,4%).
J 4 ^
Khong trieu chii'ng
Kho t h d Daungyc Ho khan Rales phoi
died nhdm BlVai viSm phdike ( thdc nang ho
hap R61 loan thdng khi
han che Binh thu'dng
So b e n h n h a n
26 11
n = 37) Ty le %
70,3 29,7 Nhin xet: Rdi loan thdng khi han che gap d 26/37 benh nhan vidm da cd cd viem phoi ke, chiem ty'le 70,3%.
Bang 3.6. Dac diem LS va CLS eua 2
BiS'u d63.1: Cac bleu hien lim sang eda tdn thu'dng viem phdi ke Nhan xet: O nhiJng benh nhan ed ton thu'dng viem phoi ke, cae dac diem lam sang thu'dng hay gap nhat gdm: khd thd (67,6%), ho khan (56,8%), sdt (37,8%), rales d phdi (18,9%) va dau ngde (16,2%).
Bang3.5. Dae diem rm loan tiiong khi han thanh va tinh trang thieu mau cung gap nhieu hdn d nhdm BN cd viem phdi ke so vdi nhdm BN khdng cd viem phdi ke.
IV. BAN LU&N
Viem da cd gap nhieu hdn d phu nd, lira tudi trung nien. Trong nhdm benh nhan tham gia nghien cu'u, \da tudi hay gap nhat la tiT 40 - 60 tudi (chiem ty le 46,3%) va cd 38 benh nhan niJ"
(chiem t>f le 56,7%). Viem phdi ke gap dJ<hoang 20- 80% benh nhan viem da ed va ed the xay ra d nhij'ng benh nhan khdng ed bieu hien trieu ehiTng lam sang ciia tdn thu'dng viem cd hoac viem cd rat nhe hoac viem cd xuat hien mudn.
Trong nghien ciTu cua ehiing tdi, cd 37 benh nhan bj viem phoi ke, chlem ty le 55,2%. 6 nhdm benh nhan cd ton thu'dng viem phdi ke, nhir'ng dac diem lam sang thu'dng gap nhat gdm khd thd (67,6%), ho khan (56,8%), sot (37,8%) va rales d phdi (18,9%). Tren lam sang, tdn thu'dng viem phdi ke trong giai doan dau thu'dng khd phat hien, khdng cd bieu hien trieu chii'ng hoac ehi xuat hien khd thd khi gang siTc hoac ho khan. Khi benh tien trien hoac ed kem theo bdi nhiem, se xuat hien them cac trieu chiTng khac nhu' sdt va nghe phdi cd rales nd. Theo ket qua ciia nhieu nghien eiTu, nhu'ng yeu t d tien lu'dng xau eiia viem phdi ke gdm: benh nhan Idn tudi d thdi diem bat dau bj benh ( > 45 tuoi), viem phoi ke ed bieu hien trieu chu'ng ve hd hap nhu* ho, Nh$n xet: 0 nhdm BN viem da cd cd tdn khd thd, do chu'c nang hd hap cd FVC giam, thu'dng viem phdi ke, dd tudi Idn hdn, thdi gian DLCO giam, khang the khang Jo-1 du'dng tinh va mac benh keo dai hdn v^ nong dd men CK trong khang dieu tn corticoid [3]. Nhutig^benh nhan bj tiuyet thanh cao hdn so vdi nhdm BN khdng cd viem phdi ke cd thdi gian song ngan hdn so vdi viem phdi ke. Tang cac chi so viem trong huyet cac benh nhan khdng cd viem phdi ke.
Lam sang - C a n L S Tuoi (X ±
SD) Thdi gian mac benh (X ± SD) Viem l!hdo(%) Sot (%) C K ( X ± SD) CRP tang Mau lang tanq (%) Hb giam
(%)
V i e m phoi Ice ( n = 3 7 ) 51,95 ±
12,17 17,03 ±
22,74 13,5 37,8 3654,4 ± 4506,62
29,7 64,9 24,3
K h o n g , v i e m p h o i i(e(n = 3 0 ) 38,63 ±
13,47 12,53 ±
12,46 10,0 23,3 1626,6 ±
2211,6 20,0 53,3 6,7
P
<
0,05
>
0,05
>
0,05
>
0,05
<
0,05
>
0,05
>
0,05
<
0,05
VIETNAM MEDICAL JOURNAL N°1 - OCTOBER • 2017 Trong nghien ciTu, d nhu'ng benh nhan cd tdn
thu'dng viem phdi ke, ton thu'dng tren Xquang phdi hay gap nhat la day t d chu'c ke chiem ty le 51,4%. Trong 37 benh nhan viem^da cd cd viem phdi ke, hinh anh tdn thu'dng phdi hay^ap nhat tren phim CT.Seanner phdi gom day to chiTe ke (75,7%), gian phe quan (13,5%) va hinh anh ddng dac dang kinh md (5,4%). Trong viem da ed, viem phdi ke cd the tien trien nhanh hoac man tinh, trong do, the tien trien nhanh gap nhieu hdn d nhiTng benh nhan cd khang the khang CADM-140. Nhu'ng benh nhan nay thu'dng khang vdi dieu tri thuoc corticoid va cae thude de che mien djch, dan den suy hd hap va tir vong [4].
Trong benli viem da od ed tdn thu'dng viem phdi ke, eae benh nhan thu'dng cd rdi loan thdng khi ban che khi do chdc nang hd hap. Trong nhdm bdnh nhan cd viem phdi ke, 26 benh nhan ed rdi loan thdng khi ban che, chiem ty le 70,3%.
Cac benh nhan b| viem phdi ke cd thdi gian mac benh keo dai hdn va ldn tudi hdn so vdi nhilYig benh nhan khdng cd viem phdi ke. Trong nghien ciTu ciia Marie I, nhdm benh nhan cd viem phdi ke cung gia hdn so vdi nhdm benh nhan khdng cd viem phdi ke [3]. Trong nghien cuXi cua chung tdi, ty le benh nhan cd cac chi viem trong huyet thanh tang va thieu mau cao hdn d nhdm benh nhan cd viem phdi ke so vdi nhdm binh nhan khdng cd viem phdi ke. Ndng do men CK trong huyet thanh trung binh ciia nhdm benh nhan cd viem phdi ke cung cao hdn so vdi nhdm benh nhan khdng cd viem phdi ke.
Trong nhieu nghien ciTu ve viem ed td mien cho thay, cac trieu chuTig sdt, viem mao mach quanh mdng tay, yeu cd viing gde chi, thieu mau, protein C trong huyet thanh tang, khang the khang synthetase deu cd lien quan chat che vdi tinh trang viem phdi ke trong benh viem da cd.
V. KET LUAN
- Benh hay gap nhat d lu'a tuoi tir 40 - 60 vdi ty le mac benh ciia nG'/nam = 1,3/1.
-Ton thu'dng viem phoi ke gap d 37/67 b§nh nhan (chiem ty le 55,2%), trong do, nhDtig die diem lam sang thu'dng hay gap nhat gom klio thd (67,6%), ho khan (56,8%), sdt (37,8%), rales d phdi (18,9%) va dau ngiTc (16,2%).
-Khi do chirc nang hd hap, 26/37 benh nlian cd rdi loan thdng khi ban che, chiem ty le 70,3%. Nhu'ng hinh anh tdn thu'dng phdi hay gap nhat tren phim CT.Seanner phoi ciia cic benh nhan cd viem phoi ke gdm day td chii'c ke (75,7%), gian phe quan (13,5%) va hinh anii ddng dae dang kinh md (5,4%).
- d nhdm benh nhan cd tdn thu'dng viem phSi ke, dp tudi Idn hdn, thdi gian mac benh keo dai hdn va nong do men CK trong huyet thanh tang cao hdn so vdi nhdm BN khdng cd viem phoi ke, Tang cac chi sd viem trong huyet thanh va tinh trang thieu mau cung gap nhieu hdn d nhom benh nhan cd viem phdi ke so vdi nhdm benh nlian khdng ed viem phdi ke.
TAI LIEU T H A M KHAO
1. P4arc L Miller, MD (2013), Clinical manifestations and diagnosis of adult dermatomyositis ami polymyositis.
2. Marie I , Hachulla E, Cherin P (2002]|
Interstitial lung disease in polymyositis aria dermatomyositis. Arthritis Rheum 2002; 47:614.
3. Li Zhang, Guoqin Wu, Di Gao (2016), Factors associated with Interstitial lung disease in patient with polymyositis and deimatomyositis: a systemla review and meta - analysis. PloS One.
4. Santo S, Uejima Y, Nanbu M (2016), Clinical analysis and outcome of interstibal lung disease complicated with juvenile dermatomyositis and juvenile polymyositis. Modern Rheumatology.
DAC DIEM LAM SANG, CAN LAM SANG (T BENH NHAN HEP MON VI DO UNG THir BIEU MO DA D A Y
Nguyin Huy TuSn', Pham Hoang Hi
IIVI TAT '^"9 ^^^ '^^ "^^y '^ ' ° ^ ' '^"9 ^^^ P^° '^'^"' t*^"^"? '^
dddc phat hi^n sdm do cac trieu ehimg lam sang ngheo nan, benh nhan thu'dng d^n vien do cac bien cliirhg trong do hay gap nhat la bien chuVig hep mon v(. Muc tieu: Md ta dac diem lam sang va can lam sang ciia benh nhan hep mdn vi do ung ttiiT bieu mo da day tai benh vlenHuU nghj ViSt DiTc. Doi tu'dng va phu'dng phap nghien cCTu: Md ta, hdi ctTu tren 75 benh nhan hep mdn vi do ung thU bieu mo da day du'dc dieu tri phlu thuat tai benh vien Hijli nghiViet Ode td 1/1/2012 den 31/12/2015. Ket qua: Bau
^B^h vi?n da khoa tinh Ha TTnh
^Dalhgc YHa Ngi
^Benh vien HuU Nghi Viet Ddc Ch[u trach nhiem chinh: Nguyen Huy Tuan Eniall: dr.huytuan@gmail.eom Ngay nhan bai: 13.7.2017 Ngay phan bien khoa hgc: 8.9.2017 Ngay duyet bai: 15.9.2017
