NGHIEN CUU TiNH HINH, DAC DI^M LAM SANG BENH DA/NIEM MAC VA STIs d NGUdi NHIEM HIV/AIDS TAI TRUNG TAM DA Ll£u HAI PHONG TU 7/2008 D^N 8/2010*
Dao IVt^nh Khoa^ Vu Thi Hyo'ng^ Nguyen Sy Hoa^
t Trung tam Da lieu Hai Phdng, ^Bpnh vipn Da lieu Trung trang
Trcng qua trinh nhiem HIV/AIDS, ngudi bpnh ed the bj mic cic bpnh nhiim trung co hii, trong dd ci cie bpnh da, niim mpc vi cie nhiim trung liy truyen qua dudng tinh dpe (STIs). Ti ip mie bpnh da, nlem mpc vi STIs d ngucri nhiim HIV/AIDS tpl Hii Phdng nam 2009 li 15%. Niu dupe phat hiin sdm va dieu iri kip thdi eae binh niy thi chic chin si gdp phin lim kio dii tuoi Ihp va nang eao chit lupng cugc sdng doi vdl nguui nhiem HIV/AIDS. Qua nghien cdu 1.733 ngudi nhiim HlV/AlDS mie bpnh da, niem mae vi STIs lai Tmng tim Da liiu Hii Phdng lu 7/2008 din 8/2010, chimg tii thay tiii mie benh da, mim mac chiim 77%, STIs chiem 20% va nhdm mic ci 2 bpnh da, mim mac vi STI chiem 3%. Nghien cuv eua chOng tdi eung cho thay cic binh da, niim mac hay gap nhit li binh sin ngua (32%), bpnh zona (8,9%), binh viem da dau (6,9%). Cie STI hay gip nhit li binh sui mio ga f15?4), bpnh herpes sinh dpe (1,2%), binh liu (1%), binh giang mai (0,5%). Cic thuung ton cabin dda, nlem mac vi STIs a ngudi nhiem HlV/
AIDS eOng gling nhud nguui khing nhiim HIV/AIDS nhung biiu hl$n lim sing d ngudi nhiem HIV/AIDS tbi ram rp hem vi cd mic mpt si binh rit hiim gap.
tir khoa: b$nh da/niem mac, STIs, ngyW nhiem HIV LOATVANDfe
HIV la loai vinjt gay nen hgi chung suy giam mien dich mic phai a nguai (AIDS). Duong lay cOa HIV dyge xac dinh \i lay qua ducmg miu, duo'ng tinh di,JC va dy&ng mg sang con [2], Trong qua trinh nhiem HIV, chuyen sang giai doan AIDS roi tu' vong, ngydi b$nh thuong mic cac nhiem trijng ccr hpi, trong dd CO cac b#nh da/niem mac va STIs (Sexually Transmitted infections) [5]. TI I? mic bgnh da lilu o ngydi nhiem HIV/AIDS tai Hal Phong nam 2009 la 15% [3]. Neu phit high scrm va 'dieu tri kip thai cac bgnh da/niem mac va STI 6 ngydi nhiem HIV/AIDS se gop phan nang cao chat lygng cugc song va keo dai thdi gian s6ng ciJa ngydi nhilm HIV/AIDS.
Hal Phdng la mgt thSnh ph6 cd ti Ig ngydi
nhiSm HIV chiem tdi 0,5% dan so, la 1 trong 5 tinh/thanh co s6 ngydi nhilm HIV cao nhit cua ca nyde [4]. Dyge su giup dd cua Sd Y t l Hal Phdng, Benh vign Da lilu Trung uong, DA Life gap, CDC,... Trung tam Da lieu Hal Phdng (TTDL) dugc lua chgn la noi trien khai dieu tn cac bgnh da/niem mac va STIs d ngydi nhilm HIV/AIDS. Tir 7/2008 din 8/2010 da CO 1.733
• bgnh nhan (BN) dugc dilu tri theo dich vg nay L4 nhO'ng ngydi true tiep dilu tri BN, ChOng t6i nghlSn cilu de tai "Nghien cdu tinh hinh, dgc diem ISm sang bgnh da/niem mgc va STIs d ngydi nhilm HIV/AIDS tai Trung tam Da lilu Hai Phdng tir 7/2008 den 8/2010" vdi muc tieu:
Xac dinh ti Ig mac cac bgnh da/nlem mgc va STIs tren ngudi nhilm HIV/AIDS tir 7/2008
361
TCNCYH Phy trUdng 80 (3B) - 2012 din 8/2010 tgi Trung ldm Da lilu Hdl Phbng.
- Nhdn xbl ddc dilm Idm sdng b0nh da/
nlem mge va STIs d ngudi nhlSm HIV/AIDS, II. D 6 | TU'P'NG VA PHU'ONG P H A P 2.1. Doi tuyng nghien cdu
Tit ed BN bi b0nh da vd STI nhilm HIV/
AIDS den Trung tdm Da lilu dilu trj bao gim:
BN cb bilu hi0n b0nh da. nidm mgc vd STIs duye 11 phbng khdm ngogi trii ciia Hdl Phbng chuyin din Trung tdm Da lilu.
BN da lieu din Taing tdm Da lilu d l duye tu vin. xdt nghi0m vd phdt hi0n eb nhilm HIV/AIDS.
BN nhilm HIV ty din khdm ehO'a b0nh da lilu tgi Tnjng tdm Da lieu.
Cdc nguIn khdc chuyin BN eb bilu hign b0nh da, nldm mge vd STIs nhilm HIV din Trung tdm Da lieu H3i Phbng.
2.2. Phuang phdp nghien cuu Thilt k l nghibn cuu: Mb ta edi ngang.
Cd mlu: thu0n ti0n, todn bb.
Cdc budc tiln hdnh Thbng tin ehung: lull, gldl..
Khdm ldm sdng:
Xdt nghi0m 2.3. XCe li s o ligu III. K^T QUA
3.1. Tinh hlnh bgnh da lilu d ngudi nhilm HIV/AIDS tgi Trung tdm Da lieu Hai Phbng Bang 1. Thbng tin chung (n = 1 733)
Thong tin Nhcm tuoi Tong Tl Ig (%) Ti Ig (%)
< 15t 0 0
Nam 15t-49t
1 386 80 82
>49t 38 2,2
<15t 1 0,05
Nir 15t-49t
304 17,5 18
>49t 5 0,3
Tong
1733 100 100 Nam chiem tT ig cao ban nO 4,5 lan, chu ylu t§p trung d nhdm lull tCr 15 din 49 va d ca 2 gidl chiem tl 1# 97,5%.
Bieu dd 1. Phan bo cac nhdm bgnh da, STIs va da ket hap vdi STIs Nhdm bgnh da chiem ti 1$ cao nhat (77%) sau den nhdm STI (20%) va nhdm kit hgp da vdi STI chi chiem 3%.
Lte.
Bleu dd 2. Phan bd cac nhom benh da/niem mac va STIs
Nhdm STI m i c nhieu nhat sau den nhom benli da do vi riit, benh da viem, benh n i m va ki sinh triing, bgnh da do vi khuan ,khdng cd BN cc u.
Bieu dd 3. Ty Ig mac mgt sd benh lay truyen qua d y d n g tinh due Bgnh sill mao ga chiem ly Ig cao nhal (15%) sau den herpes sinh due, viem am dgo do vl khuan, viem am dao do n i m , bgnh lau, giang mai la benh chiem ti le thap nhat (0,5%).
H?l Nam NSm VDD VDM lielUl
Bleu do 4. Ty Ig mac mgt so bgnh da/niem mgc
Sin ngya chilm ti Ig cao nhlt trong cac bgnh da (32%), sau dd d i n zona, viem da dau, nam iudi, hgt com, nam ndng, viem da mO.
363
TCNCYH Phy trUdng 80 (3B) - 2012
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Bieu do 5. Ty Id mac mot sb benh trong tihoin benh da do viriit Zona ehinm Ii Ig cao nhat (8,9%) sau do den niyn co'm, herpes va u mem lay.
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Bieu db 6. TI le mac mbt so benh trong nhbm bgnh da do vi khuin Viem da mu chilm li le 2,7%, khong gap bgnh u mach do vi khuan vd myeobacterium
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Bleu do 7. Ti Ig mac nhom bgnh do nam va ki sinh triing
B$nh nam Candida d migng chilm t! Ig cao nhit (5,4%), n^m ndng 3,8%, nim sflu 0,2%, bgnh ki sinh trung ghe 1,2%.Viem da mu chilm ti Ig 2,7%, khdng ggp bgnh u mgch do vi khuin v^ myeobacterium.
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Bgnh viem da dau chiem ly Ig cao nhal (6,9%), liep den bgnh vay nin, cac bgnh khac chilm 2,3%.
3.2. Dgc diem lam sang bgnh da/niem m^c va STIs d* ngu'di nhilm HIV/AIDS
Thuong ton co ban: Khong khac vdi nhyng ngydi khong nhilm HIV/AIDS.
Kich thuac thyang ton: thydng to ban doi vdi nhu'ng ngydi khdng nhilm HIV/AIDS.
Vi tri thyang ton: Bgnh sill m^o ga cd t h l gap khdng nhung d ca quan sinh due ma con gap d da, migng, hgu mon, nach, vu.
MCrc dp bleu hign lam sang: ram rp, nhieu thuong ton, phan bo tren dign rdng, cd the co bleu hien toan than. Ghe, zona, viSm da mu, sill mao ga, giang mai, ...
Mlc bgnh hilm gap: cd 3 trydng hap mlc bgnh nam sau do chijng Penicillium Marneffei g§y nen.
Bgl nhiem: d i bi bgl nhilm nhu zona bgl nhiem, san ngua bgi nhiem, viem da mu.
IV. BAN UUAN
Sau tren 2 nam triln khai thyc hign dy an, da tiep nhan dilu tn cho 1.733 BN mac bgnh da/niem mgc va STIs d ngydi cd nhiem HIV (bang 1). Nam cnlem ti Ig (82%) nhigu hon nO' (18%), gap 4,5 lan (bang 1). DSy cOng \i ti Ig
thugn vdi ti le gldl tinh nhilm HIV/AIDS cua Hal Phdng [4]. Ca 2 gidi, nhdm tuoi 15-49 chiem ti Ig cao nhat (97,5%) (bang 1). Tl Ig tuoi BN cao nhlt la trong nhdm 15-49t. dilu nay cang khang dinh ring ylu to nguy ca, tinh hinh dich t l thudng tgp trung d nhdm tuoi nSy [5],
Nhdm bgnh da chilm dai da so vdi ti Ig 77%. Nhdm STI chilm 20%. Nhdm BN mac dong thdi kit hgp bgnh da va STI chiem ti Ig thap nhat (3%) (bilu do 1). Nhu vay, qua s6 lieu va ti Ig mac cac benh da lilu tren cho thiy cac bgnh da chllm chij ylu. Va 1 BN cd thl mac 2 bgnh da va STI ciing 1 thdi diem.
Nhdm cac bgnh da do viriit chilm ti Ig cao nhat 13,5% tilp din la nhdm bgnh da viam 10,5%, nam va ki sinh triing 10,5%, bgnh da do vl khuan 3% va cac bilu hign khac (47,8%) chua ggp cac khdi u (bilu d l 2).
Bgnh sill mao ga chllm ti ii bao nhat 15%.
Thap nhat la bgnh giang mai (0,5%) (bilu do 3). Theo 1 s6 tai ligu thl khoang 70-80% tong s6 ngydi nhilm HIV/AIDS la bi lay nhilm qua dydng tinh duo va nghien ciru nay cho thay ti Ig STI d ngydi nhilm HIV la 23%. Hign nay, bgnh stii mio ga do vlrOt Human Papilloma Viriit (HPV) la bgnh thydng gip nhlt d nhO'ng
TCNCYH Phy trUdng 80 (3B) - 2012 ngudi khbng nhilm HIV/AIDS, nlu nhilm typ 16. 18, 26 d l din din ung thu [2] vd qua nghien ciru ndy cho Ihly bgnh cOng mlc nhilu nhlt trong nhbm STI d ngudi nhilm HIV/AIDS.
Ty 10 b0nh sin ngua eao (32%) phii hyp vdi nhdn dinh ciia 1 s l tdc gid cho thiy ngua la 1 bieu hi0n ngodi da quan trgng vd thudng ggp nhat [1]. Theg k l l qua nghien cdu ciia chiing Ibi thl bgnh zona chilm tl 10 eao nhlt (8,9%) sau 66 din myn cam (4.3%), herpes vd u mlm Idy eb ti 10 mde nhu nhau (0,1%) (bilu db 5). TI 10 mlc b0nh zona Id tuang dli cao cb nhung bieu hi0n lam sang kha rim rb. Vdi ll Ig mdc va bilu hi0n Idm sdng khde thudng nhu vdy cb t h l coi zona Id 1 trong nhdng b0nh chl dilm ciia nhilm HIV/AIDS [5].
Chiing tbi ehi g^p b0nh vidm da mil vdi tl 10 2,7% (bleu do 6) va khbng gdp b0nh u mgch tryc khuan vd Mycobarterlum trong khi nghien cuu khdc d Bdc My ti Ig ndy Id 40% va thudng bi d nhung ngudi eb CD4< 50 te bao/mm3 [5].
Benh nam Candida d migng ehi ehilm eb 5.4% (bleu db 7). Theo 1 nghien euu khdc thl cb ldi 90% ngudi nhilm HIV/AIDS bj mlc b0nh ndy [5]. Cb t h l nghien cdu eua chiing tbi mdi theo dbi Iren 2 nam, nlu theo dbi trong thdi gian ddi cd ddi nhdng ngudi b0nh ndy thi ty 10 mlc b0nh nay chac chin se cao han nhieu.
Nghien cdu ciia chiing tbi con eho thiy da ggp b0nh nam sau la Penieilllnosis vdi tl 10 0,2% (bilu do 7), thap han rat nhlu so vdl nghien cdu d Thai Lan. 6" Thdi Lan b0nh nay dung hdng thd 3 trong s6 cdc nhilm triing ca hpi sau b0nh lao vd Cryptococcosis [5]. B0nh ndy thudng chi xuat hi0n d nhung ngudi cb CD4 < 100 t l bdo/mm3. 3 trudng hyp mlc b0nh nay dd duye dieu tr| khbi bdng Amphoterlclne B va Ilraconazol.
B0nh viem da dau chilm ti 10 ddng k l (6,9%) cbn bgnh vay nen chi ehlem 1% (bilu
d l 8). B0nh vlbm da d l u Id b0nh eb the g^p d nhCrng ngudi khbng nhilm HIV vd eb ca d nhdng ngudi nhilm HIV/AIDS, tuy nhien ti 10 ndy cao han d ngudi nhilm HIV/AIDS. Chinh vl v0y trong qud trinh khdm dilu trj b0nh da lilu thbng thudng, nhdng trudng hyp mlc b0nh viem da dlu chUng tbi thudng tu van eho BN d l Idm xdt nghl0m sdng lgc HIV.
Ting kit qua 1.733 BN v l dgc dllm Idm sdng cho thiy nhdng ngudi nhilm HIV/AIDS thl hay bi cde nhilm triing ca hbi vd bilu hl0n lam sdng ciia nhdng b0nh nay thubng rim rb, da dgng vd Irim trgng han nhdng nguai khbng nhilm HIV/AIDS, thdm chl mdc nhdng b0nh md ngudi khbng nhiem HIV/AIDS khbng mlc. Cy t h l , chiing tbi thiy nhilu BN mlc b0nh zona vdi nhdng bieu hign ram rg, thuang tin xult hi0n trbn todn bb da d 1 chdn hole 1 tay Cb nhieu BN xuat hi0n thuang ton zona b vung mgt va eo. Bleu hl0n nay cung Id dlu hieu chl dilm eho chiing tbi tu van vd tien hanh xdt nghi0m de phat hign HIV. B0nh siii mdo gd d nhung ngudi khbng nhiem HIV/AIDS rat ll khi xult hl0n thuang ton d da vd nai khae ngoai sinh dye. nhu'ng d ngudi nhiem HIV/AIDS chung tbi ggp nhieu trudng hyp thuang ton sCii khbng nhung cb d viing sinh dye. hgu mbn md cbn cb d da, d ndeh, d mt0ng vd d vii. Thuang t i n sill rlt to. Trong nhilu nam qua, chiing toi chua gdp trudng hyp nao mde b0nh nam sau Penicillinosis nhung chl trbn 2 nam qua chiing tbi da ggp 3 trudng hyp mlc b0nh ndm sdu Penicillinosis va 100% la d ngudi nhiem HIV/
AIDS. Dilu nay cdng ldm eho ta thay h0 thing mien dich ciia ca t h l la vb ciing quan trong, khi hg thong miln djeh bj suy giam, bj pha vd se khbng cbn hdng rao bao vg nua, do vgy cac vi khuan, viriit, nam, ki sinh triing,... de ddng nhan len vd gay bgnh vdi nhdng bilu hien Idm sang trim trpng, khac thudng.
V. K 6 T LUAN
Tinh hinh bgnh da/nlem mgc va STI d ngydi nhiem HIV/AIDS den TTDL kham va dieu tri tU'7/2008-8/2010
So luang BN mlc cac benh da/nlem mgc va STIs din kham chu'a bgnh la 1.733 ngudi.
Nam gidl chilm 82%, cao han nu gidi 4,5 lln, nu' 18%.
Tuol BN tgp trung chO yeu tu' 15-49t la 97,5%, dg tuol tren 49t chiem ti Ig 2,45% va dudi 15 tuli chi chllm 0,05%.
Nhdm bgnh da/nidm mgc chilm ti Ig cao nhlt (77%), sau dd din nhdm STIs (20%) va thip nhat la nhdm ket hgp da va STIs (3%).
Nhdm cac bleu hign khac chilm ti le cao nhat (47,8%) tilp din Id nhdm cac STIs chiem ti Ig 23%, bgnh da do virut 13,5%, da viem 10,5%, nim va ki sinh trung 10,5%, benh da do vl khuan 3% va chya gap cac khdi u.
Ti le mac STIs: benh sill mao ga chllm li le cao nhat (15%), sau dd la din bgnh herpes (1,2%), bgnh viem am dao do nim va viem am dgo do vl khuan cd ti Ig ngang nhau (1,1%), bgnh lgu (1%), bgnh giang mai (0,5%).
Ti Ig mlc bgnh da/niem mac: san ngCra chilm ti le cao nhat (32%) din zona (8,9%), viem da dlu (6,9%), nam d migng (5,4%), mun cam 4,3%, nim ndng (3,7%), viem da mu (2,7%).
Dac dllm lam sang cac bgnh da/niem mgc va STIs d ngydi nhilm HIV/AIDS
thuang tin nhieu han, dign tich rdng han, cd nhilu thu'ong ton bgi nhilm han so vdi nhOng ngydi khdng nhiem HIV/AIDS.
NhO'ng ngydi nhiem HIV/AIDS khi l l bao CD4 giam mgnh thi de mac dc bgnh nam sau nhu Penicillinosis (Penicillium Mameffel-PM).
Cd mgt so bgnh xult hign thuang tin d nhung vi tri khac Ihudng.
TAI LIEU THAM KHAO 1. Bgnh vien Da lieu Thanh pho Hd Chi IVllnh (2003). Bgnh hpc Da lilu.
2. Bg Yte, Cgc Phdng chong HIV/AIDS (2008). Chan doan va dilu tri cac nhilm triing lay truyen qua dydng tinh dgc. Nha xult ban Yhgc.
3. Dao IVIanh Khoa, Vu Thi Hyang va cong sir (2009). Nghien ciru linh hinh va dac diem lam sang ciia 820 BN da lilu d ngudi cd HIV/AIDS tgi Hai Phdng tU' 10/2008 - 9/2009.
Hgi nghi Khoa hgc chl hgi Da lllu Hai Phdng - 11/2009,
4. S d Y t l Hal Phdng, Trung tam Phong chong HIV/AIDS (2010). Sa kit 6 thang nam 2010 dy an phdng chlng HIV/AIDS Hai Phdng.
5. Vign Da lilu Quoc gia (2009). Chan doan va dieu tri cac nhilm triing lay truyen qua dudng tinh due va bgnh da/nlem mac tren ngydi cd HIV/AIDS.
Chii thich*: Bai da dugc dang tren Tap chi Y hoc thuc hanh cua Bg Y l l so 742+743 va duac trinh bay poster tai Hgi nghi khoa hgc v l HIV toSn quIc lln thy IV thang 12/2010.
Bilu hign lam sang ram rd han, so lyang Summary
STUDY ON SITUATION, CLINICAL MANIFESTATIONS OF THE SKIN, MUCOUS MEMBRANE DISEASES AND STIS IN HIV/AIDS INFECTED PEOPLE IN DERMATOLOGY
CENTRE OF HAI PHONG CITY FROM JULY 2008 TO AUGUST 2010
In the process of infecting HIV/AIDS, patients may be infected with opportunistic Infections, including skin, mucous membrane diseases and STIs (Sexually Transmitted Infeelions). The rate of morbidity skin.
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T C N C Y H P h y trUdng 8 0 ( 3 B ) - 2 0 1 2
mucous membranes and STIs In HIV/AIDS infected people In Hal Phong In 2009 was 15%. If detected early and promptly treated of these infections, will surely contribute to prolong the longevity and improve the quality of the life for people with HIV/AIDS. Over time of research on 1.733 patients with HIV/AIDS who had the skin, mucous membrane diseases and STIs at Dermatology Center of Hai Phong city from July 2008 to August 2010, the results show that 77% patients had the skin, mucous membrane diseases, 20% of patients had STIs and 3% of patients had both groups skin diseases and STIs. Our research also shows that the skin, mucous membrane diseases In HIV Infected people were most common prurigo (32%), herpes zoster (8.9%), seboirtioic dermatitis (6.9%). The most common STIs were condilomata acuminata (15%) and herpes simplex (1.2%), gonorrhea (1%), syphilis (0.5%). All basic lesions of HIV infected patients are the same basic lesions of patients without HIV/AIDS infection. But in HIV infected patients, clinical manifestations are more frantic, and with certain rare diseases.
K e y w o r d s : HIV, A I D S , STIs
K^T QUA Dieu TR! UNG THU' DU-QNG VAT BANG PHAU T H U A T MOHS TAI BENH VIEN DA LlEU TRUNG WONG
Nguyen Sy Hoa Bpnh vipn Da li^u Trung tfong
Nghiin ciru dupe thpv hiin nhim dinh gii kit qui tim sing, tim ly ngudi binh sau phiu thuit cit bo doan ducmg vat do ung thu ti bio ga/ bing phiu thuit Mohs Kit qui eho thiy 13 trong si 23 tnrdng hpp ung thu ti bio vay duong vit dupe phiu thuit theo phuang phip Mohs. 69.9% bpnh nhin tren 50 tuii.
Sau 19 thing theo ddi, khing cd truirng hpp nio tii phit. Bpnh nhin thoii mil, hai ldng han tmng sinh hdpt nhu tiiu tiin, quan hi tinh dpc: chua cd trudng hpp nio trd tpi dd tii phat. Phiu thupt cit dopn duang vit dd ung thu ti bio viy theo phuung phip Mohs mang ipi nhiiu uu diim nhu giO- duvc tii da dogn duung vpt sau cit bd ti chirc ung thu. boat dpng tinh dpc, tiiu tiin tit han cac phuang phip khae. Tim Ijr ngudi bpnh duvc eai thipn han. it mie cam han.
T i r k h o a : U n g t h u ' du'O'ng v a t , u n g t h i r te b a o vay.
I. OAT V A N B 6 duang v^t Id ung thy t l bSo vay, thydng ggp Ung thu dyang v$t 14 mpt logi u I c " " 9 " ' * ' * " ' " * • ' " * ' '™"9 " ' * " "^ " 9^P '^°'"
tinh cd kha nang di can din cac ca quan phG " " 9 " ° ' ' '''*• ^ '"'? *^ "=30 nyde Tay Au, ung tgng gay ti le tCr vong cao. Tren 95% ung thy " i " tlfong vgt chllm khoang 0,4 - 0,6% cac