TAP CHi Y HOC VIET NAM TAP 459 - T H A N G 10 - SO 2 - 2017
NGHIEN ClfU DAC BIEM LAM SANG, CAN LAM SANG a BENH NHAN LAO PHOI TAI PHAT
TOM TAT
Muc tieu: Mo ta dae diem lam sang, can lam sang cf benh nhan lao phdi tai phat sau lao mdi. Phu'dng phap: Tien cdu ket hdp v6i hoi eini, mo ta d 55 benh nh3n lao phdi tai phat sau lao phoi mdi, nam dieu' tn tai Benh vien 74 Trung Udng. Benh nhan nghien cyu dydc luei chon theo tieu chuan ciia CTCLQ6, thdi gian nghien ciru t y thang 01 (2014) den thang 12 (2015).
kit qua va ket luan: Tong so 55 benh nhan, nam 78,2%, nff: 21,8%, tuoi trung binh: 56,98 ± 17,01, tai phat sdm: 49,2%, tai phat muon: 50,8%. Sot ve chieu: 63,6%, chan an: 63,6%, met moi: 54,6%, ho Miac ddm: 74,6%. Ton thu'dng xd voi: 96,4%, not:
89,1%, tham nhiem: 69,1%, hang: 58,2%. Baeh cau hinh thu'dng: 69,1%, Hb giam: 60,0%, Hb trung binh:
119,5 ± 45,2. Hay gap AFB (1*): 30,9%. Ty le khang thuoc: 51,6%, khang 1 thuoc: 62,5%, 2 thuoc:
31,3%, 3 thuoc: 6,2%, MDR: 6,2%. Khang vdi SM:
56,5%, E: 21,7%, INH: 17,4% va khang vdi R: 4,4%.
Tiridma: Lao phoi tai phat, lam sang, can lam sang SUMMARY
THE STUDY OF CLINICAL, PARACLINICAL CHARACTERISTICS I N THE RELAPSED PULMONARY TUBERCULOSIS PATIENTS
Objectives; To describe the clinical, para- clinical characteristics in the relapsed pulmonary tuberculosis patients after newly oulmonary tuberculosis. Method:
A retrospective and prospective, descriptive study was conducted in the 55 relapsed pumonary tuberculosis patients after newly pulmonary tuberculosis in the Central 74 Hospital. All subjects of the studv were diagnosed base on criterion of National Tuberculosis Control Programme. Results and conclusion: A total of 55 pabents, male: 78,2%, female: 21,8%, average age: 56,98±17,01, early tvDe: 49,2%, late type: 50,8%. Slight fever at evening: 63,6%, fabque: 54,6%, anorexia: 63,6%, productive cough: 74,6%. Lesions of TB in chest X- ray: fibre- calcification: 96,4%, node: 89,1%, infiltrate: 69,1%, cavity: 58,2%. Normal WBC: 69,1%, low Hb: 60,0%, average Hb: 119,5 ± 45,2, frequent AFB (1*): 30,9%. Drug resittance: 51,6%: 1 drug:
62,5%, 2 drugs: 31,3%, 3drugs: 6,2%, MDR: 6,2%.
Resisted with: SM: 56,5%, E: 21,7%, INH: 17,4%, and resisted with R: 4,4%.
Keywords: Relapsed pumonary tuberculosis, dinical, para-dinieal
'Binh vien 74 Trung udng
Ch|U trach nhiem chinh: Nguyen Hoang Kim Email: [email protected] Ngay nhan bai: 1.8.2017 Ngay phan bien khoa hpc: 28.9.2017
Ngay duyet bai; 3.10.2017
Nguyen Hoang Kim', Vu Quang Dien'
I. OAT VAN OEBenh lao van la mot van de ldn eua su'c khoe toan eau, gay benh eho hang trieu ngu'di moi nam, la nguyen nhan hang thir 2 gay td vong trong cac nguyen nhan nhiem triing. Theo Chu'dng trinh chong lao Quoc gia (CTCLQG), Viet Nam, nu'dc thu" 14 trong 20 nu'dc co so ngu'di mac lao cao nhat toan c^u. Lao phoi tai phat (LPTP) sau dieu tri lao mdi ehiem ty le tu' 1-13%
theo cac nghien cu'u [7]. Trong nhiJng nam gan day ky thuat Gene-Xpert du'dc u'ng dung de sang loc lao khang da thudc d benh nhan LPTP, vi vay se cd nhieu thay doi ve dae diem lam sang, can lam sang. Chi'nh vi vay chiing toi tien hanh de tai nham mue tieu: Mo ta dac diem lam sang, can lam sang d benh nhan LPTP.
H. OOI TUONG VA PHU'ONG PHAP NGHIEN CUTJ 2 . 1 . Dol tu'tfng nghien cu'u: Nghien cu'u du'dc tien hanh d 55 benh nhan lao phoi tai phat sau lao phoi mdi, dieu tn tai Benh vien 74 Trung u'dng, thdi gian nghien cu'u: tu" thang 01/2014 den thang 12/ 2015. Benh nhan tuoi td 16 tuoi trd len. ©u'dc chan doan lao pho'i tai phat theo tieu ehuan eua CTCLQG [1].
2.2. Phu'dng phap nghien cu'u Thiet ke nghien ciru; hoi euli ket hdp vdi tien cu'u, mo ta. 55 benh nhan, bao gom; tien cu'u 29, hoi cu'u 26 benh nhan.
2.3. Phu'dng phap thu thap, xu' ly so lieu:
Thu thap hd sd luU trU, phdng van, tham kham benh nhan, nhupm soi ddm tru'c tiep tim AFB, Gene -Xpert, nuoi cay ddm, khang sinh do vi khuan lao theo hu'dng dan eiia CTCLQG [1].
Chup X.quang phoi, phan tieh theo ton thu'dng ed ban eiia lao phoi va cac xet nghiem khae. So lieu ddric phan tich tren chu'cJng trinh SPSS 15.0.
III. KET QUA NGHIEN CU'U
3 . 1 . Dac diem lam sang cua benh nhan nghien CIKJ
Bang 3 . 1 . Tuoi, gidi va the tai phat Oac diem
Tuoi trung binh (X ± S D ) T^i phat sdm Tai phat muon
So bSnh nhdn f n = 5 5 )
43
Ty le ( % ) 78,2
21,8 56,98 ± 17,01
49,2
VIETNAM MEDICAL JOURNAL H°2 - OCTOBER - 2017
Nhin xet: Nam gidi ehiem ty le cao (78,2%), Tuoi trung binh eua benh nhan: 56,98 ± 17,01, Ty le 2 the tai phat tu'dng du'cJng nhau.
Bing 3.2. Trieu chij'ng lim sang
Ho khac ddm
So benh nhan ( n " = 5 5 ) Ty Ie
(°/o)
63,6 63,6
Tang Da nhan trung ti'nh
tang Lympho tang
_29J
_ 2 3 ^
Nhan xet: Sd benh nhan cd bleu hien sot ve chieu '(63,6%), Chan an (63,6%), met mdi (54,6%), ho khac ddm (74,6%).
3.2. Dac diem can lam sang cua benh nhan nghien cu'u
Bing 3.3. Hinh thii tdn thu'dng cd bin tren X.quang pho'i
Trunq binh ( A ± s p j | 9^12 ± 2.56 f^hinxit:Chu y§Li benh nhan cd bach cauc mire binh thu'dng (69,1%), baeh eau'tang co 2 9 , 1 % , baeh eau trung binh d gidi han binh thu'dng. Baeh eau da nhan trung tfnh tang chiem tren mot nii'a sd benh nhan (51,0%), bach cau lympho tang chiem ty le thap (23,7%).
Bing 3.5. Die dii'm hemoglobin mau Hemoglobin So benh nhan I Ty1e~
( g / l ) I ( n " = 5 5 1 I fo/oi Hb binh thu'dng
Hb giam
Hinh thai Tham nhiem
Not Hang Xdvoi
So benh nhan (n = 5 5 )
38 49 32 53
Ty le ( % ) 69,1 39,1 58,2 96,4
Tmng binh ( X ± SD)
33
119,5
±45,2
Nhan xet: Benh nhan co nhieu ton thu'dng xen ke, trong dd ton thu'dng xd vol chiem ty le cao (96,4%), tiep den la td'n thu'dng not (89,1%), ton thu'dng tham nhiem (69,1%), ton thu'dng hang (58,2%)._
Bing 3.4. Dae diem bach cSu miu ngoai vi
Nhin xet: So benh nhan ed hemoglobin giam chiem b/ le eao (60,0%), trung binh Hb c(
mire thap.
Bang 3.6. Mii'c do du'dng tinh cua AFB trong ddm
Bach cau Giam Binh thu'dng
So benh nhan (n = 5 5 )
1 38
T y l e 1,8 69,1
Mu'c do AFB 1-9 AFB Du'Ong tinh 1"^
Du'dng tinh 2*
Du'dng tinh V Gene-xpert (+)
So benh nhan I Tyle (n = 5 5 ) I (%1
30,9
5,5 Nhan xit: Sd benh nhan cd AFB du'dng tinh 1 chiem ty le cao hdn cac mu'c do khac (30,9%).
Bang 3.7. Bac diem khang thuoc Dac diem jchanj^ thuoc
Khanq thuoc Khanq 1 thuoc Khanq 2 thuoc Khanq 3 thuoc Khanq da thuoc (MDR) Khang v6i tiYnq thuoc
Khanq Sl^l KhanqINH Khanq E Khanq R
So benh nhan (n = 3 1 ) 16 10 5 1 1 So liTdt l<hang (n = 2 3 )
13 4 5 1
Ty le (%) 51,6 62,5 31,3 6,2 6,2 Tv le (%)
56,5 17,4 21,7 4,4 Nhan xet; So benh nhan co vi l<huan lao l<hang thuoc chiem ty le 51,6%, trong do: Ithang VG mot thuoc: 62,5%, khang 2 thuoc: 31,3%, co 01 tru'dng hdp khang vdi R+INH (MDR). Khang v * SM (56,5%), khang vdi E va INH (21,7 va 17,4%), mot tru'dng hdp khang vdi R.
hdn so vdi mot so nghien cu'u tru'dc do ve L l ^ [2], [3]. So benh nhan co bieu hien sot ve chgu (63,6%), Chan an (63,6%), met mdi (54,6%), to khac ddm (74,6%). So sanh vdi ket qua cila cac IV. BAN LUAN
Ve lam sang: Nam gidi chiem ty le cao d benh nhan nghien ciJu (78,2%). Tuoi trung binh cua benh nhan: 56,98 ± 17,01. Ket qua nghien cu'u cua Chung toi phii hdp vdi cac nghien cim tru'dc ve LFTP vdi nam gidl chiem ty le cao [2], [3], [7]. Tuoi trung binh, ty le the tai phat muon cao
nghien aiu tru'dc [2], [3] chung toi thay ty le cac trieu chutig lam sang d benh nhan trong ngNen cuij cua chung toi nhin chung thap hdn. Si/ khac
210
TAP CHl Y HOC VlgT NAM TAP 459 - THANG 10 - SO 2 - 2017 biet tren theo chung toi la do benh nhan trong
nghien cu\i ciia chung tdi du'dc sang tpc eac tru'dng hdp lao khang da thuoc, mot nhdm dai dien ma eac nghien cdu tru'dc van xep vao lao phoi tai phat.
Ve can lam sang: Benh nhan co nhieu ton thu'dng xen ke, trong dd ton thu'dng xd vol chiem ty le eao (96,4%), tiep den la ton thu'dng not (89,1%), ton thu'dng tham nhiem (69,1%), ton thu'dng hang (58,2%). U Thanh Phiic [4]
thay d benh nhan tru'dc tai trj: xd hang (50,0%), not hang (29,2%). Hoang Thj Phu'dng [5] thay 95,0% cd ton thu'dng hang va xd liang d benh nhan tru'dc tai trj. Cd sy' khac nhau ve hinh thai ton thu'dng la do doi tu'dng nghien ciili d moi nghien cu'u cd si/ khac nhau. Cac nghien ciTu tru'dc cung thay sd lu'dng bach cau, bach eau lympho d benh nhan LPTP thu'dng d miTc binh thu'dng, tang bach c^u, tang ty le bach rau da nhan trung tfnh gap d mot so tru'dng hdp cd bpi nhilm vi khuan ngoai lao [2], [3]. Hb mau thu'dng thap d benh nhan LPTP cung du'dc eac nghien cu'u chi ra [6]. MuTc dp AFB(+) trong ddm d cac nghien culi tru'dc hay gap (-^) 2* va 3* [2], [3]. Mac du du'dc sang lpc lao khang da thuoc ngay tCr dau cho doi tu'dng nghien ciiXi bang xet nghiem Gene- Xpert, nhu'ng chung^toi van gap 01 tru'dng hdp MDR. Ket qua vi khuan lao khang thuoc trong nghien cuXi ciia chiing tdi thap hdn so vdi ket qua eiia cac nghien cu'u tru'dc [2], [3].
Co sir khac biet ve mu'c dp AFB va t / le khang thuoc, theo chiing toi la vi doi tu'dng MDR trong nghien cu'u cua chung toi da du'dc sang Ipc bang Gene-Xpert ngay tir (^u.
V. KET LUiSkN
Qua nghien culJ 55 benh nhan lao phoi tai phat sau lao phoi mdi tai Benh vien 74 Trung u'dng chung toi riit ra mot so ket luan sau: Dac
diem lam sang: Ty le nam: 78,2%, nO': 21,8%, tuoi trung binh: 56,98±17,01, tai phat sdm:
49,2%, tai phat muon: 50,8%. Bieu hien: Sotve chieu: 63,6%, chan an: 63,6%, met mdi; 54,6%, ho khac ddm: 74,6%. Can lam sang: Ton thu'dng xdvoi: 96,4%, not: 8 9 , 1 % , tham nhilm: 69,1%, hang: 58,2%. Bach cau d gidi han binh thu'dng:
69,1%, Hb giam: 60,0%, Hb trung binh: 119,5 ± 45,2. AFB du'dng tinh 1* chiem ty le cao hdn cae mire do khac (30,9%). Ty le khang thuoc:
51,6%, khang 1 thuoc: 62,5%, 2 thuoc: 31,3%, 3 thuoc: 6,2%, khang da thuoc (MDR): 6,2%.
Khang vdi SM; 56,5%, E: 21,7%, INH: 17,4% va khang vdi R: 4,4%.
TAI L l | U T H A M KHAO
1. B6 Y Te- CTCLQG (2015), "Hddng dan quan iy benh lad, NXB y hgc.
2. Hoang Ha (2009), NghiSn edu mot sd dac dii'm lam sang, can lam sang, smh hpc r:ua vi khuan lao d benh nhan lao phoi dieu tri lai, Luan an tien sT y hoc, Tru'cing dai hoc Y Ha Ngi.
3. Hy Ky Phooncj (2001), DSc diem iam sang, can lam sang va ket qua tai tri 6 benh nhan lao phoi tai phat tai Benh vien lao va binh phoi Ha Noi nam 1997-2000, Luan van tot nghiep BSCKII, tru'dng dai hoc YHa Noi.
4. \k Thanh Phiic {X^^^V'^Nghien edu dae diem iam sang, can lam sang va tmh hinh khang thua:
cua benh nhan dieu tn dieu tn lai sau bo tri', Luan van thac sT y hoc, Tru'dng dai hoc Y Ha noi.
5. Hoang Thj Phu'tfng (1999J, " Nhan xet nguyen nhan bo tn va mot so dae diem Jam sang, c|n lam sang qua 35 benh nhan lao phoi du'dc dieu_tri tai tri", Hoi nghi khoa hoc ve lao va benh phoi, Vien lab va benh ph6i-9/l999, tr. 45.
6. Crofts J.P., Andrews N J., Barker R.D., et al (2010),
"Risk factors for recunent tuberculosis in England and Wales, 1998-2005", Thrxax, 65, pp. 310-14.
7. Songyi H., Soonduck K., Jongsoon P., et al (2003), "Characteristics of Relapsed Patients with Pulmonary Tuberculosis Registered at Two Public Health Centers in Seoul", Korean Journal of Epidemiology, 25(2), pp. 92-99.
DANH GlA T A C D U N G DIEU TRI DAI THAO DlTffNG TYP 2 THE KHI AM LU'O'NG HU* TREN THITC NGHIEM CUA BAI THUOC
"TRI B A DIA H O A N G H O A N "
Nguyen Vinh Quoc*, Tran Cong Tru-ong*
TOM TAT
*Vien Yhoc CO truyen Quan dpi Chjii traeh nhiem chinh: Nguyen Vinh Quoc Email: [email protected] Ngay nhSn bai: 4.8.2017 Ngay phan bien khoa hoc: 29.9.2017 Ngay duyet bai: 4.10.2017
Myc tieu: danh gia tac dung cita bai thuoc Tn ba dia lipang hoan tren mo hinh eh^upt cong trang du'dc gay dai thao du'dng typ 2 the khi am ludng hi/.
Phu'dng phap nghien cihi: ^ay mo hinh chuot cong trang dai thao du'dng typ 2 the khi am lu'dng hd bang tiem phiic mac dung djch STZ 1 % lieu 30 mg/kg 1 lan duy nhat va nude sae bai thuoe ha khi lieu 9g/kg/ngay trong 14 ngay lien tyc; chuot dai: tieu chuan sau gay
