Tap chl Tai Mui Hgng Vi$t Nam -Volume (58-14). N°2-Apr., 2013
TY LE VIEM M C I DI ifNG VA CAC YEU T 6 LIEN QUAN CUA HQC SINH TRUNG HQC CO SOf THANH PHO THAI BINH
NAM 2012
va Trung Kien , Phgm Kien Hiru , va Minh Thfic , Tdng Xuan Hdi T6M TAT
i 'ic'ni mui dj img (VMDU) la benh dirong ho hdp thuang ggp. Hpc sinh trung hpc ca sa (HS) mdc VMDU se dnh huang nhieu tdi su phdt trien. Mpt nghien cieu mo td ngang dd xdc dinh ty li VMDU a HS THCS Thdnh phd Thdi Binh Id: 23,1%. Trong do HS nu 56,3%- nam 43,7%, npi thdnh 26,5%, ngogi Ihanh 19,5%. Binh xudt hi?n vdo cdc thdng 10, 11, 12 Irong ndm. Test ldy da duang linh tren benh nhdn Id 55.0%, Ihu tu: di nguyen biti bong, bui nhd. long vU. Ty I? duang tinh vai 1. 2, 3 logi df nguyin lan lu(rt Id:
28,9%>,11,2%,1.2%> VMDU do di nguyen bid nhd a HS ngogi thdnh cao han HS npi thdnh, do di nguyen bui bong vd long vw a HS ngogi thdnh thdp han HS npi thdnh. VMDU cd ty U di hinh vdch ngdn vd cuon cao han hpc sinh khong mdc VMDU. 63,1% HS mdc VMDU co tiin su di img cd nhdn vd 65,5% cd tiin su di ung gia dinh.
Tir khda: Viem mUi di ung, bui bong, bui nhd, long vw SUMMARY
Allergicrhinitis (AR) is a popular respiratory disease. Middleschool students with AR will be affected to the health and growth. A cross-sectional study onmiddle school students in Thai Binh city indicated the rate ofAR up to 23.1 %. The proportion of male students is 56.3% and female students is 43.7%; The percentage of suburban is 26.5% and urban is 19.5%. The disease mostly happens in October, November and December. Prickets on patients shows the rate of 55% positive, the most popular allergens of AR include cotton dust, house dust, feathers. The positive rates with those types of allergens are:
28.9%, 11.2% and 1.2%, respectively. The percentage of AR caused by house dust allergen in suburban students is higher than urban students: thefeather and cotton dust allergens result in the lower rale of suburban students than urban students.
Malformed septum is often happen lo students with AR rather than students without AR. 63.1% of students with AR have medical history of allergic individuals and 65.5% of students withAR have familyhistory of allergy.
Key words allergic rhinitis, cotton dust, house dust, feathers
1. DAT VAN DE hip. Hien nay, VMDU dang ngay mgt gia Vidm miii di ling (VMDU) la mpt trong ^ § ""^ " ^^^ "^^'^ P^^* ^ ^ " ^^ ^ ^ g P^^^
nhiing bdnh rit thudng gap cua dirong hd *"^" ^ ^^-\SVo dan so). Day ciing la^nguyen nhan lam gidm chat lupng cupc song cua
^ BV Dai hpc Y Thdi Binh ngudi benh, tang thdi gian nghi hpc cua hgc
"Dai hpc Y dupe TP. H6 Chi Minh sinh, lam tang chi phi cho ndn y td.
;_ BV. TMH TW :
"" BV, Da khoa Nghe An Di nguyen trong di img dudng hd hap Nhan bdi 28.2. Duylt in 15.3.2013
Tap chl Tai MQi Hgng Vi$t Nam - Volume (58-14) N ° 2 - A p r , 2013
noi chung va trong VMDU ndi rieng cd nhieu loEii: bui bdng, Idng vu. phin hoa, byi go, mat bui nhd .... Trong dd phd bidn nhit la mat bui nha, byi bdng va Idng vu.
Hpc sinh trung hpc co sd, tir 11- 14 tudi Id thdi ky dang phdt tridn vd tdm sinh ly, VMDU anh hudng nhidu tdi sy phat trien ciia tre. Theo mpt nghien ciiu cua Nguydn Ngpc Chiic va cpng sy, trong liia tudi hgc sinh phd thdng trung hgc, ty Id VMDU la 19,3%.. Tuy nhien nghien ciiu nay da thuc hien cdch day ndm nam, vi$c thyc hien chan dodn ddc hieu vdi it loai di nguydn. Vi vay chiing tdi tien hdnh dd tai nham myc tieu:
Xdc dinh ty li benh viem mUi di img cita hpc sinh trung hpc ca sa thdnh pho Thdi Binh.
Tim hieu cdc yeu to lien quan din benh viim mQi di ung.
2. D 6 I TU'OfNG VA PHU'ONG PHAP NGHIEN CttJ
2.L Dia diem, thdi gian va doi tirong nghien cun
2.1.1. Ddi tirffng nghien ciru
Nghidn ciiu dupe thuc hien tai cdc trudng THCS tai Thdnh phd Thai Binh tir thang 10 nam 2011 den thang 2 nam 2012:
Hai nhom trudng thu nhan hpc sinh d 2 khu vyc sinh thai khdc nhau:
- Nhdm trudng npi thanh: thu nhan hpc sinh cua cac phudng ndi thdnh sdng trong mdi trudng d nhilm, bui.
- Nhdm trudng ngoai thdnh: thu nhan hpc smh cua cdc xa ngoai thdnh vdi ddc didm canh tdc phuc vy cho ndi thanh; trdng hoa, rau mau...
Tit ca cdc hpc sinh 1 1 - 1 4 tudi d cac tnrdng ndy dupe kham vd phdng van chia thanh 2 nhom:
- Nhdm nghien ciiu: Gdm nhirng ddi tugng bi VMDU"
- Nhdm so sanh: Gdm nhung ddi tugng
khong bi VMDU cung trudng, Idp, tudi gidi nhung khdc gia dinh.
2.2. Phvong phdp nghien ciru Thidt kd: Md td cit ngang Mau:
+ Cd mau: Toan bp (lOSlhpc sinh ciia 2 Trudng THCS Tran Phu va Vu Chinh Thai Binh)
+ Chgn mau: Nhidu giai d o ^ /.- Lap danh sach cac trudng THCS trong todn thanh phd Thai Binh: Hien tai thdnh phd Thdi Bmh co 19 trudng THCS trong do cd 10 trudng ndi thanh va 9 trudng ngoai thdnh.
2: Chgn trudng (co chu dich) + Trudng ndi thdnh: Trudng THCS Tran Phii.
+ Trudng ngoai thanh: Trudng THCS Vu Chinh
3: Chpn doi tupng tai cdc trudng nghien ciiu (mau toan bd). Chpn toan bd hgc sinh cdc Idp.
4: Phu huynh; dugc phdng van theo bd cau hoi.Tat ca cac ddi tugng hgc sinh ciing dugc phdng van theo bd phidu dieu tra va dugc khdm lam sang, ndi soi tai miii hgng bdi cdc bdc sT TMH. Tir cdc ket qua tren xdc dinh dupe nhdm VMDU va nhom khdng VMDU
5: Lam test lay da cho tat ca cac ddi tupng dugc chan dodn bi VMDU vdi 3 di nguyen : D.Pteronyssinus, bui bdng, long vii dd xdc dinh nguyen nhan VMDU.
- Ky thuat dp dyng trong nghien ciiu + Khai thac tien sir di img: Can cii vao mau 25b cua WHO vd hdi tien sir di ung.
+ Kham lam sang:
+ Ddnh gid miic phan ling cua test lay
79
Tap chl Tai Mui Hpng Vi#t Nam - Volume (58-14). N°2 - Apr., 2013
da: Am tinh{-), Nghi nga(±), Duong thinh nh?(+),Duong tinh vua(++),Duong tinh manh(+++), Duong tinh rat manh(++++).
3. KET QUA NGHIEN CfTU
3.1. Ty 1^ mdc VMDU if doi t y ^ g nghien cihi
Gl6i
Nam Nu Ting P
KhOng m S c n 352 341 693
%
50,8 49,2 64,1
M a c b$nh n 109 140 249
%
43,7 56,3 23,1 p<0,05
T6ng n 524 557 1081
%
48,5 51,5 100
3.2. Phan bo doi tirong theo lira tuoi va viing sinh thai
- Nhom 11 tudi chiem ty Id cao nhat(
31,5%)), nhom 12 tudi chiem ty Id thip nhit( 18,9%).
- Ty Id ddi tupng hai viing sinh thai la tuong duong nhau.
3.3. Phan bo doi tuong theo lira tuoi va gioi
Ty le nam va nu" la tuong duong nhau Bang 3-3. Ty 1$ mdc bfenh theo vung sinh thdi
Vijng S T
N g T h S n h N ThSnh T6ng
S o di^u tra SL 538 543 1081
%
49,8 60,2 100
S6mac
SL 105 144 249
%
19,5 26,5 23,1
Nhan xet: Ty 1? mdc VMDU la 23,1%.
Ty le mic VMDU d ngoai thdnh la 19,5%t, npi thdnh. Ket qua nghien ciiu nay
phii hpp vdi ket qud nghien ciiu ciia Nguyen Thj Hoai An , Vu Minh Thuc, Ph^m Vdn Thiic, Vu Vdn Sdn, nhung cao hon kdt qua nghidn ciiu cua Nguyin Nggc Chirc vd cpng sy cung dja bdn nghien ciiu cdch day 5 ndm. Theo chiing tdi, cupc sdng cdng hi?n dai, dd thj hda cang tdng thi cdng xuat hi?n nhidu dj nguyen, b?nh di ling noi chung va VMDU ngdy cang tdng Id hpp ly.
Ket qud nghien ciiu ndy ciing phu hpp vdi kdt qud nghien ciiu cua cac tdc gid nude ngoai: Glove, Cinkotai, Mraur X, ty le VMDU dao dgng tir 10%- 34,7%. Ty If VMDU d ddi tupng sdng d npi thdnh cao hem d ngoai thanh, theo chiing tdi, sy 6 nhiem khdng khi d vimg npi thanh cao hon viing ngoai thanh ndn co sy khdc biet ve ty le benh giiia hai vung ddn cu. Kdt qua ndy phii hgp vdi mgt nghien ciiu ciia Vii Minh Thyc: ty le VMDU d cgng ddng dan cu Ha Ndi la 29,05%..
3.4. Ty le mdc bfnh theo gidi Ty le mdc VMDU d nam la 43,7%, d nii Id 56,3%). Sy khdc biet co y nghia thdng ke vdi p<0,05
Bdng 3.5. Ty 1$ mdc b$nh theo tu6i Tu6l
11 tu6i 12 tu6i 13 tu6i 14 tu6i T o n g
K h S n g m a c n 242
167
225
198
693
%
34,9
24,1
32,5
28,5
64,1 M ^ c bSnh n 98
38
51
62
249
%
39,3
15,3
20,5
24,9
23,1 Tong N 340
205
276
260
1081
%
31,5
18,9
25,5
24,1
100
Tap chl Tai MOi Hpng Vi$t Nam - Volume (58-14). N°2 - Apr.. 2013
Nhan xet: Ty Id mdc VMDU cao nhit d liia tudi 11; 39,3%), thip nhit d Ida tudi 12:
15,3%). Su khac biet khdng cd y nghia thdng ke vdi >0,05.
Ket qud nay phu hgp vdi ket qud nghien ciiu ciia Nguyen Ngpc Chuc va cpng su, khdng thay sy khdc bi?t ve liia tudi.trong VMDU. Nhung neu so sanh ty 1? mac VMDU d Ilia tudi 11( 28,8%) va cdc liia tudi cdn lai(20,4%) thi sy khdc biet co y nghia thdng ke vdi p<0,05, nhu vay ty le VMDU gidm dan theo liia tudi. Ket qua nay khac vdi ket qua nghien ciiu ve VMDU nghd nghiep cua Vii Vdn San, Vu Minh Thuc, Jensen P.A da thdng nhat dua ra ket ludn; tudi nghe cdng cao thi mac benh VMDU cang nhidu. Theo chung tdi, tir liia tudi 12, 13,14, tre bit ddu day thi, yiu td ndi tidt anh hudng tdi ty le benh vd loai di nguyen gay VMDU d lira tudi hpc dudng la di nguyen gay VMDU quanh nam nhu: byi nha, mat byi nha, bui bdng.
Bidu dd 3.1. Ty le cac trieu chiing viem mui di ling xudt hien theo cac thdng trong nam (n=249)
Nhan xet: Cac trieu chimg VMDU xuit hien nhidu vao cac thdng 10,11, 12.
Kdt qua nay phu hpp vdi kdt qua nghien cuu cua Nguyen Ngpc Chiic vd cgng sy cac trieu chiing VMDU xudt hien nhidu vao miia ddng. Theo chiing tdi, thdi tidt lanh va khd cua cdc thang 10,11,12 lam niem mac miii phu nd, tang tidt. Mat khdc, theo cac kdt qua nghien ciiu, lupng mat bui nhd tang cao vdo cac thdng 10,11,12( 1712 con/ gram bui nha). day la loai di nguyen hay gap gay VMDU d Viet Nam.
Bdng 3,6 Ty 1$ d6i tupng nghifen cO-u phan Lcng vdi cdc logi dj nguyfin Di nguyfen
Bgi nha Bgi bdng L6ng vu
S 6 i 4 m XN 249 249 249
S6 duang tinh
48 61 28
TylS
18,9 24,1 10,8
Nhdn xet: Ty le duong tinh vdi bui bdng la cao nhit: 24,1%. Bui nhd Id 18,9%).
thip nhit la long vii: 10,8%
Bang 3.7. Ty 1$ doi tuong nghien cil-u phan ung vdi so dj nguyen So
DN
1 ioai 2 loai 3 ioai Tong
N(5i th^nh n 40 12 0 52
%
76,9 23,1
100.0
Ngoai thSnh n 32 16 3 51
%
62,7 31,4 5,9 100,0
P
>0,05
>0,05
>0,05
Nhan xet: Ty le d6i tucmg duong tinh voi 1 loai di nguyen 6 ngi thanh la 76,9%, ngoai thinh la 62,7. Ty le d6i tugng duong tinh voi 2 loai di nguyen o noi thanh la 23,1%, ngoai thaiih la 31,4%. Co 3 truong h(7p duong tinh voi ca 3 loai di nguyen. Su khac biet khong co y nghia th6ng ke voi
>0,05
Kk qua nay khong phu hop vcri ket qua nghien cuu cila Nguyin Ngoc Chiic va cpng su voi hai loai di nguyen la bui bong va bui nha thiy kk qua duong tinh voi di nguyen bui nha cao hon nhilu di nguyen b\li bong. Theo chung toi, di nguyen bui nha la loai di nguyen gay VMDU quanh nam, con di nguyen bui bong va long vii
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Tap chl Tai Mui Hpng Vi$t Nam -Volume (58-14). N°2-Apr, 2013
thudc lo^i di nguydn gay VMDU nghe nghidp( gay VMDU cho cdng nhan cdc xi nghi?p may, che bien Idng vu). Vdi sy phat trien ciia xa hpi, cdc san pham tieu diing sir dyng hdng ngdy dugc che bien tir spi bdng, Idng vii cang dupe sir dyng nhieu trong cpng dong gop phan lam ty Id duong tinh vdi hai loai di nguydn tren tdng, vd trreen mpt ddi tupng c6 the phan ung vdi nhidu loai di nguyen.
Bang 3 8 Ty 1$ ddi tupng nghifin cuu phan ling vdi cdc lo^i dj nguydn theo vCing ddn cu.
Loai DN
Bgi nha Bgi bdng Long vQ Tong
NOi t h i n h n 14 34 16 64
%
21,9 53,1 25,0 100,0
Ngoai t h i n h n 34 27 12 73
%
46,6 37,0 16,4 100,0
P
< 0 , 0 5
< 0 , 0 5
< 0 , 0 6
Nhdn xet: Ty le doi tupng duong tinh vdi di nguyen bui nha d ngoai thanh (46,6%) cao hon d ndi thanh( 21,9%).
Ty Id ddi tupng duong tinh vdi di nguyen bui bdng d ngoai thanh ( 37,0%o) thap hon d ndi thanh( 53,1%.).
Ty le ddi tupng duong tinh vdi di nguyen long vii d ngoai thdnh ( 16,4%) thap hon d ndi thanh( 25,0%i).
Su khac biet cd y nghTa thdng ke vdi <
0,05 Theo chiing tdi, nhd d ngoai thanh am thap, la didu kien thuan lpi cho mat bui nhd phat trien nen ty Id duong tinh vdi di nguyen byi nhd cao hon ndi thdnh . 0 ndi thanh su dung nhieu san pham tir bdng va long vii nhu chdn, ga, gdi dem, quan do...
nen ty Id duong tinh vdi di nguyen byi
bdng vd long vii cao hon ngoai thanh.
3.2. Mfft so yeu to li£n quan 6in VMDU Bdng 3.9. Ty 1$ mic b^nh vd dj hinh
vdch ngdn.
B^nh
Mic b^nh Khdng m i c T6ng
P
C6 di hinh n 66
52 118
%
26,5
6,3 10,5
Kh6ng d|
hinh n 183
780 963
%
73,5
93,7 89,5 p<0,05
T6ng n 249
832 1081
%
23,1
76,9 100
Nhan xet: Ty 1? ddi tupng bi vidm mui di ling cd di hinh vdch ngdn la 26,5%.
Ty le ddi tupng khdng bi viem mui di irng cd di hinh vdch ngan la 6,3%. Sy khac biet cd y nghia thdng ke vdi p<0,05.
Bang 3.10. Ty 1$ mdc b$nh vd dj hinh cudn mQi
B^nh
Mac bfnh Khong
mic l o n g
C6 d| hinh n 131 48 179
%
52,6 5,8 10,5
Khong di hinh n 118 784 902
%
47,4 94,2 89,5 p<0,05
Tong n 249 832 1081
%
23,1 76,9 100
Nhan xet; Ty Id ddi tupng bi viem miii di ling CO di hinh cudn miii la 52,6%.
Ty 1? ddi tupng khdng bi viem miii d\
img cd di hinh cudn miii la 5,8%. Sy khdc biet cd y nghia thdng ke vdi p<0,05.
Theo chiing tdi, di hinh cua cudn va vdch ngdn gay thay ddi sy luu thdng ciia
Tgp chl Tai Mui Hpng Vi$t Nam - Volume (58-14). N°2 - Apr, 2013 dong khdng khi trong hdc mGi, la gai kich
thich, lam sy man cam cua niem mac mui vdi cdc kich thich tang len. Sy kich thich co hgc vd sy thay ddi ddng khi co hpc ciia di hinh cudn va vdch ngdn lam giam khd nang loai bd cac tieu hat( ban chit mpt sd la di nguyen) cd trong khdng khi lam cho bpnh nhan de bi kich thich
Bang 3.11. Ti^n sCrdj u-ng cd nhdn
Bdng 3.12. Ti^n sddj i>ng gia dinh
Tien Sli di ung
B$nh di ling
May day Cham Vifim k^t mac Dj ling thiic 5n D| ling thg6c Hen ph^ quan S6t mua Viem mOi man Khong dj l i n g
S6BN (n=249)
41 6 53 28 3 37 20 75 92
%
16,5 2,4 21,3 11,2 1,2 14,9
8,0 30,1 36,9
Nhan xet: S6 benh nhan co tien su di ling ca nhan (63,1%) cao hem so benh nhan khong CO tiln su di ling ca nhan ( 36,9%).
Viem kit mac, viem miii man tinh va may day hay gap nhk trong tiln su di ling ca nhan.
Kit qua nghien cuu nay phu hgp voi kit qua nghien cim cua Nguyen Van Huong ( 65%), Doan TM Thanh Ha( 60%) Vu Cao Thien( 70%), Nguyin Nhft Linh(
70,59%). theo chiing toi, cac chdt trung gian h6a hpc dugc giai phong trong phan ling qua mdn s6 toi cac co quan dich gayra cac benh khac nhau: VMDU, hen phi quan, viem kit mac, may day... nen benh nhan bi VMDU de bi cac bSnh di ling khac.
M6i quan h§
C6 \\hn sir d|
ijng gia dinh
B 6 ho$c m$
B 6 vd m?
Anh chj em ruOt Khong c6 ti^n su* dj irng gia
dinh
S6 b^nh nhSn n= 249
82 41 75 86
%
32,9 16,5 30,1 34,5
Nhan xet; C6 65,5% so benh nhan co tien sir di ling gia dinh, cao hon so benh nhan khong co tien sii di ling gia dinh.
Tien sir co bo hoac me bi di ling la cao nhat( 32,9%), So benh nhan co anh chi em ruot bi di ling ciing chiem ty le cao la 30,1%.
Kit qua nay phu hgp voi ket qua nghien ciiu ciia cac tac gia khac: VQ Van San : 47,63% ,W.Frankline: 25- 45%, Nguyin Van Hucmg: 75% benh nhan VMDU CO tiln su gia dinh co nguoi bi VMDU. Theo Smith thi nguy co dl tre bi VMDU khi CO b6 hoac me bi benh qua man, va nguy co nay co the toi 50% hoac cao hon neu ca bo va me bi benh.
4. KET LUAN 4.1. Ty le mic VMDU
+ Ty le mac VMDU 6 hgc sinh THCS thanh phi Thai Binh la 23,1%. Trong do ngi thanh la 26,5%, ngoai thanh la 19,5%.
- Ty le mic VMDU 6 nO { 56,3%) cao honnam(43,7%).
- Benh xuit hien theo miia, vao cac thang 10,11,12.
- Test liy da duong tinh tren benh nhan la 55,0%, theo thii tu: di nguyen bui bong, bui nha, long vu. Co 28,9% s6 benh nhan duong tinh voi 1 loai di nguyen, 11,2% so benh nhan duong tinh voi 2 loai di nguyen
83
Tgp chl Tai MOi Hpng Vi^t Nam - Volume (58-14). N°2 - Apr., 2013
va 1.2% sd benh nhan ducmg tinh vdi cd 3 loai di nguyen,
- Nguyen nhan VMDU do dj nguyen byi nhd cua hpc sinh ngo^i thdnh cao hon hgc sinh ngi thdnh. Nguyen nhan VMDU do di nguyen byi bdng va long vu ciia hgc sinh ngoai thdnh thip hon hgc sinh npi thanh.
4.2. MQT S 6 YEU T 6 LIEN QUAN DfiN VMDU
- Hpc sinh mdc VMDU cd ty 1? di hinh vdch ngdn va cudn cao hon hpc sinh khdng mic VMDU.
- Hgc sinh mic VMDU cd 63,1% cd tien six di ung cd nhan vd 65,5% cd tien su di ung gia dinh.
TAI LIEU THAM KHAO 1. AD-ADO-NguyIn Nang An va Truong
Kiet dich (1986), Di img hpc dgi cuong, NXB Y hgc Hd ndi, tr 25-45.
2. Nguyin Nang An (2006), "Hen phd quan", Bdi gidng Di irng- mien dich lam sdng, NXB Y hpc Ha ndi tr 27-40 3. Dao Van Chinh, Nguyen Qudc Tuan
(1998), Di img hpc lam sdng, NXB Y hoc. Ha ndi.
4. Nguyen Nggc Chiic va cgng sy (2008), Thirc trgng viim miii df img vd hen phe qudn cua hpc sinh trung hpc ca sa thdnh phd Thdi Binh, de tai khoa hgc cdng ngh? cip tinh.
5. A. G. Palma-Carlos, M Branco-Ferreira, M L Palma-Carlos (2001), "Allergic rhinitis and asthma: more similarities than differences". Allergie et immunologic 1/07/200107; 33(6):237-41.
6. A G Togias (2000), "Systemic immunologic and inflammatory aspects of allergic rhinitis". The Journal of allergy and clinical immunology.
01/12/2000; 106 (5 Suppl): S247-50.
7. Stephen Holgate, Thomas Casale, Sally Wenzel, Jean Bousquet, Yamo Deniz, Colin Reisner (2005) "The anti- inflammatory effects of omalizumab confirm the central role of IgE in allergic inflammation." The Journal of allergy and clinical immunology.
01/04/200504/; 115(3):459-65.
8. Stephen T Holgate, David Price (2006).
"Improving outcomes for asthma patients with allergic rhinitis: the MetaForum conferences". BMC Pulmonary Medicine, 6(Suppl ):S 1 doi: 10.1186/1471 -2466-6- Sl-Sl