Y HOC VIET NAM THANG 3 - S6" 1/2012 - Xuat huyet dddi da chiem ty le cao nhat
(63,8%), cd 24,6% sd benh nhan xuat huyet ndi tang; 20,3% sd benh nhan xuat huyet ca dddi da va npi tang.
- Ty le benh nhan co xuat huyet va mirc dp nang cua xuat huyet cd lien quan tdi mu'c do giam tieu cau. Cac benh nhan cd SLTC dddi 10 x lOVl CO ty le xuat huyet va mirc dp xuat huyet dang ke (mem mac, ndi tang) cao hdn nhieu so vdi cac nhdm cdn lai.
TAI UEU J H A M K H A O
1. Nguyen Thj Minh An, Pham Quang Vinh, Vu Thj Minh Chau va cs. (1995), "Tinh hinh benh Id- xe- mi cap 6 mgt so benh vien dja phUdng va trong benh vien Bach Mai", Ky yeu cong trinh nghien cdu l<hoa hoc dai hoc Y Ha Noi, Tap 4, tr, 185- 192,
2. Nguyin Thj Thu Hoa (2005), Mgt sd thay do!
lam sang va te bao mau ngoai vl d benh nhan laxemi cap dong tiiy sau dieu tn hda chat tan
cong bang phac do "3 + 7 " Luan van Tot nghiep bac sly khoa, Trudng Oai hoc Y Ha Noi.
Nguyen Thj Lan Hu'dng (2001), Nghien cub roi loan dong- cam mau tren mgt sd benh nfiin mac binh mau ac tfnh tai khoa lam sang cac benh mau, Vien Huyet hoc- Truyen mau, Luan van tot nghiep bac sT ndi trii benh vien, trUdng Dai hoc Y Ha Npi.
Do Trung Phan, Bach Quoc Khanh, Tran Thj Kieu My va cs. (2001), "Ket qua dieu trj Id- xe- mi cap the M3 bang ATRA tai Vien Huyet hpc- Truyen mau trong 2 nam 1999- 2000", Yhoc Viet Nam. 2, tr. 8- 14.
Tru'dng Thj Nhu" Y (2004), Khao sat mgt so bien chu'ng va doc tinh thudc thu'dng gap do hoa tn lieu tren benh nhan Icfxemi cap dong tuy tai Vien Huyet hgc- truyen mau, Luan van tot nghiep bac si ngi trii benh vien, TrLidng Dai hgc Y Ha Noi.
Higuchi T., Mori H., Niikura H. et al. (1998),
"Disseminated intravascular coagulation in acute lymphoblastic leukemia at presentation and in early phase of remission induction therapy", Ann.
Hematoi., 76(6), pp. 263- 269.
DANH GIA ANH HlAJNG CAC YEU TO TIEN LimNG TRONG OIEU TRI HOA CHAT DOI VOTI BENH LYMPHOMA
Nguyen Trung Chinh*
T6M TAT
Phan tfch dOn bien ket qua dieu trj 80 benh nhan ULAKH do ac tfnh trung gian va do ac tinh cao dupc dieu tn bang 2 phac do CHOP (Cyclophosphamide, Doxorubicin, Vmcnstine, Prednisolone) va DHAP (Dexamethasone, Cisplatin, Cytosar) cd tac gia riit ra ket luan;
Cac yeu to anh hudng den dap ifng hoan toan.
sdng them toan bp. sdng them khdng benh gdm:
+ Hoi chimg B' khdng c6 hpi chi/ng B tdt hOn cd hpi chimg B
+ Tinh trang toan than: < = 2 diem tdt hdn > 2 diem.
+ Sd vi tri ngoai hach: < = 1 vi tri ngoai hach tot hon > 1 vj tri ngoai hach,
+ Tinh trang tham nhidm tuy xUdng, khong tham nhi^m tdt hOn co tham nhilm.
+ Milt LDH: LDH binh thudng tdt hdn LDH tang, + Giai doan lam sang giai doan I, 11 tdt hdn giai doan III, IV,
• B§nh vien VAJGD 103
Phan bien khoa hgc: PGS.TS. Le VSn Don
SUMMARY
SOME FACTORS OF PROGNOSTIC IN TREATMENT OF MALIGNANT LYMPHO
ADENOMA NON- HODGKIN Univariate analysis on the results of treatments on 80 Non-Hodgkin's Lymphoma patients with CHOP(Cydophosphamide, Doxorubicin, Vincristine, Prednisolone therapy and DHAP(Dexamethasone, Cisplatin, Cytosar) therapy reveal that the factors that affect the Complete Remission, Overall sun/ival, Disease-Free survival are:
+ B symptoms No B symptoms is better than B symptoms,
+ Performance Status, <= 2 points is better than > 2 points.
+ Number of extranodal sites of disease: <= 1 sites is better than > 1 sites.
+ Bone marrow involvement status. No bone marrow involvement is better than bone marrow involvement.
Y Hpc VIET NAM THANG 3 - SO 1/2012 + LDH amount: Normal LDH Is better than
increased LDH
+ Clinical stage, Ann Arbor stage I, II, are better than Ann Arbor stage III, IV.
I.
OAT V A NOE
U lympho ac tfnh khong Hodgkin (ULAKH) la mot trong mu'di benh ung thu hay g§p. Theo ddc tinh nam 2001 nudc ta c6 1420 benh nhan nam mdi mic, chiem t;^ le 4,9/100.000 dan, cao thir 6 trong tdng so cac loai benh ung thu va CO 828 benh nhan nCf mdi mac, chiem t^ le 2,4/100,000 dan, cao thuf 11 trong long so cac benh ung thu.
Do tfnh chat "he thdng" cua benh, dieu tn hoa chat luon la pfiudng phap dieu trj chinh cho cac benh nhan ULAKH. Cho den nay, da cd rat nhieu phac do da tioa chat dUdc ap dung dieu tri ULAKH do ac ti'nh trung gian va do ac tinh cao nhUng t^ le benh nhan khong dat dap img hoan loan vdi dieu tri, tai phat sdm, thdi gian sdng tfiem ngan vin rat cao. Danh gia tien lUdng rat can thiet trong dieu tri va theo doi benh nhan.
NhL^ng benh nhan tien lucJng tdt c6 the dieu tri bang cac phac do "nhe" hdn, ngUdc lai nhuTig benh nhan tien lupng xau can dieu tn bang cac phac do manh, dieu trj tang cUdng, cung co.
Chung tdi tien hanh nghien ciru de tai
"Nghien cuu mdt sdyeu td anh huong den ket qua dieu tri U lympho ac tinh khong hodgkin bang phac dd CHOP va DHAP"
nham muc tieu: Danh gia anh hudng cda mpt so dac diem lam sang, xet nghiem den t^ le dap U'ng va thdi gian sdng them cda benh nhan ULAKH do ac tinh trung gian va do ac tfnh cao dUdc dieu trj theo phac do CHOP va DHAP.
II. 06l TUONG VA PHUONG PHAP NGHIEN COU 2.1 Bdi tupng nghien cuu: La cac benh nhan ULAKH do ac tinh trung gian va dp ac tinh cao mdi chan doan dupc dieu tri tai Benh vien TUQD 108 tU thang 1-2000 den th^ng 10- 2007 theo phac do CHOP va DHAP.
2.2 Phuomg phap nghien cuu: Nghien cUu tien cUu, md ta cat ngang, theo ddi dpc.
2.3 Cac chi tieu nghien cuu chinh:
- Cac chi tieu lam sang, xet nghiem: Tuoi, hdi chu'ng B, tinh trang toan than, so vi tri tdn IhUdng ngoai hach, giai doan lam sang theo Anri Arbor, loai te bao B va T, linh trang tham nhiem tuj- xuong, mifc LDH mau.
- Dap Lftig vdi dieu tri: Danh gia dap ifng vdi dieu tri theo tieu chuan cda To chi/c Y te The gidi.
- Thdi gian sdng them: Danh gia thdi gian song them toan bd, thdi gian song them khdng benh.
2.4 Xu ly sd lieu: So lieu dupc xCr 1^ tren phan men thdng ke y hpc SPPS 1 i .5. So sanh cac ty le bang test ANOVAR. Thdi gian song them dupc udc lupng bang phuong phap Kaplan Meier. So sanh thdi gian sdng them bang Log Rank test. Cac so sanh khac biet cd y nghfa thd'ng ke vdi p < 0,05.
III. KET QUA NGHIEN CQU 3.1 Dac diem benh nhan.
Td thang 1-2000 den thang 10-2007 co 80 benh nhan dupc dupc dieu tri nglu nhien theo phac do CHOP (40 benh nhan) va DHAP (40 benh nhan). DSc diem lam sang va xet nghiem cda cac benh nhan nghien cilu dupc torn tat d laang 3.1.
Bang 3.1: Dac diem lam sanq va
Dac diemGidi Nam NO Tudi
>60
Hoi chirng B
Khdng Cd
Tinll trang toan thian
< 2 di^m
xet nghierr
Nhom CHOP n 31 9 24 16 26 14 17Ty le % 77,5 22,5 60 40 65 35 42,5
Nhom DHAP n 31 9 25 15 19 21 20
Ty le % 77,5 22,5 62,5 37,5 48 52 50
Ca 2 phac do n 62 18 49 31 45 35 37
Ty le % 77,5 22,5 61,2 38,3 56,3 43,7 46
Y HOC VIET NAM THANG 3 • SO 1/2012
> = 2 cJ/em So VI tri ngoai hach
<= 1 Vl tri Loai te bao Te bao B Te bao T Tham nhiem tuy xuong
Khong Co Mac LDH
Binh thudng T^ng
Giai doan Ann Arbor Giai doan 1, II Giai doan III. IV
23 33 7 32 8 30 10 21 19 18 22
57,5 82.5 11,5 80 20 75 25 53 47 45 55
20 31 9 30 10 30 10 25 15 18 22
50 77.5 22.5 75 25 75 25 63 37 45 55
64 16
18 60 20 46 34 36 44
54 80 20 78 22 75 25 58 42 45 55
3.2 Quan he gida dap ung vdi dieu trj va cac dac diem lam sang, xet nghiem.
Phan ti'ch t^ le DUHT theo cac du6i nhdm cda cac dac diem: tuoi, hpi chu'ng B, tinh trang toan than, sd vi trf ngoai hach, tinh trang tuy xUdng, mUc LDH, giai doan benh the hien tdm tat 6 bang 3.2,
Bang 3.2: Dap Ung hoan toan theo dac diem benh nhan.
Dac diem TUOI
< = 60
> 6 0 Hoi chiing B
Khdng Cd
Tinh trang toan than
< 2 diem
> = 2 diem So vi tri ngoai hach
< = ivi tn
> 1 vi tri Loai te bao
TebaoB Tebao T
Tham nhiem tuy xuong
Khdng Cd Mirc LDH
Binh thudng TBng
Giai doan Ann Arbor Giai doan i, it Giai doan Hi. iV
Nhom CHOP Ty le %
75,0 62.5 92.3 28.6 88.2 56.5 75.8 42.9 71.9 62.5 84.4 12.5
85.7 52.6 94,4 50.0
P1 0,398
0,000
0,03
0.064
0,605
0.000
0.023
0.002
Nhom DHAP Ty le %
76,0 73,3 94,7 57.1 90,0 60,0 90,3 22,2 76,7 70,0 83,9 44,4
88,0 53,3 100 54,5
P2 0.850
0.006
0.028
0.000
0.673
0.000
0.014
0,04
Chunq 2 Ty le %
75,5 67.7 93.3 45.7 89,2 58.1 82.8 31.3 74.2 66,7 84.1 28,4
87,0 52,9 97.2 52.3
3hac do P3 0.448
0,000
0.000
0.000
0,529
0.000
0,001
0,000
Nhan xet: Cac nhom yeu to dap img hoan
B (PI =' 0,000; P2 = 0,006, P3 = 0,000), Tinh 0,000), So vi tri ngoai hach (PI = 0,064; P2 = 0 0,000: P 2 = 0,000; P3 = 0,000), IVIiTc LDH (PI -- Arbor (PI = 0,002: P2 = 0,04; P3 = 0,000).
toan l^hac biet c6 y nghia thong ke la: Hoi chirng trang toan than (P1 = 0.03; P2 = 0,028; P3 = 000; P3 = 0,000), Tham nhiem tuj xirong ( PI =
= 0,023; P2 = 0,014; P3 = 0,001), Giai doan Ann
Y HQC VIET NAM THANG 3 - SO 1/2012
3.3 Quan he giua sdng them toan bp vdi cac dac diem lam sang, xet nghiem Phan tich sdng them toan bp theo cac dudi nhdm cda cac dac diem: tuoi, hpi chUng B, tinh trang toan than, sd vi trf ngoai hach, tinh trang tuy xUdng, mUc LDH, giai doan benh the hien tdm tat 6 bang 3.5.
Bang 3.3: Sd'ng them toan bd theo dac diem benh nhan.
Dac diem Tuoi
< = 60
>m
Hoi chifng B Khdng Co
Tinh trang toan than
< 2 did'm
> = 2 diem So VI tri ngoai hach
<=i vi tri
> 1 vl tri Loai te bao
TebaoB Tebao T Tham nhilm tuy xuang
Khdng Cd Mirc LDH
Binh thudng TSng
Giai doan Ann Arbor Graf doan 1,11 Giai doan III, IV
Nhom CHOP OS (%)
72,90 32,08 78,84 15.18 85,71 34,16 69.05 x 60.00 43.75 68.18 60,16
80,36 33,34 82,35 35,80
P I 0.049
0.000
0.000
0.000
0.021
0,000
0,000
0,000
Nhom DHAP OS (%)
74,60 53,33 93,75 29.94 86.54 45.70 78.94 19.44 80,00 19,50 78,70 0
90.51 23,70 93.75 37.92
P2 0.036
0,243
0.002
0.000
0.003
0.000
0.000
0.003
Chunq 2 phac do OS (%)
73.84 40.04 63.73 51.06 85.82 38.21 73.25 16,16 68,43 30,04 72.81 29.41
35.56 28.92 87.27 36.85
P3 0.003
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Nhan xet: Cac nhom yeu to song them toan bp l^hac biet c6 ^ nghTa thong l^e la: Tuoi (PI = 0,049; 1=2 = 0,036: P3 = 0,003), Hoi chifng B (PI = 0,000; P2 = 0,243; P3 = 0,000), Tinh trang toan than (P1 = 0,000; P2 = 0,002; P3 = 0,000), So vi tri ngoai hach (P1 = 0,000; P2 = 0,000; P3
= 0,000), Loai te bao B;T (P1 = 0,021; P2 = 0,003; P3 = 0,000), Tham nhiem tu^ xifdng ( P1 = 0,000; P 2= 6,000; P3 = 0,000), Mite LDH (PI = 0,000; P2 = 0,000; P3 - 0,000), Giai doan Ann Arbor (PI = 0,000; P2 = 0,003; P3 = 0,000).
3.4 Quan he giua song them khong benh vdi cac dac diem lam sang vi xet nghiem Phan tich song them toan bo theo cac di/6i nhom cOa cac dac diem: tuoi, hoi chimg B, tinh trang toan than, so vi tri ngoai hach, tinh trang tuy xUOng, mClc LDH, giai doan benh the hien torn tat CI bang 3.4.
Bang 3.4: Song them khonq benh iheo dac diem benh nhan
Dac diemTUOI
< = 60
>60 Hoi chimg B
khdng Cd
Tinh trang toan than
< 2 diSm
Nhom CHOP DPS (%)
82,22 53,33 77,78 33,33 84.62
P I 0.048
0.050
0.001
Nhom DHAP DPS (%)
87.05 56.57 87.84 32.00 85.56
P2 0,012
0.050
0.045
Chung 2 ph DPS (%)
84,48 54.83 82,16 32,97 85,07
ac do P3 0,001
0,017
0.000
Y HOC VIET NAM THANG 3 - SO 1/2012
> = 2 di^m Sd vi tri ngoai hach
<= 1 VI tn
> 1 vi tn Loai te bao
T^ bao S Te bao T
Tham nhiSm tuy XUdng
Khdng Co MiTc LDH
Binh thudng Tang
Giai doan Ann Arbor Giai doan i, II Giai doan iii, IV
57,54 81,18
X
72.29 37.50 75.40 00
83.33 55.56 87.60 47.73
0.000
0.108
0.007
0.011
0.010 58.33
74.5
X
85.15 31.25 81.00 00
89.64 26,79 88,89 42,86
0,000
0,050
0,158
0,000
0.016 56,97 77,48
X
80,91 25,0 77.40 00
87.83 44.69 87.63 45.53
0.000
0.006
0,011
0,000
0,000
Nhan xet: Cac nhdm yeu td sdng them khdng benh khac biet cd </ nghTa thdng ke la: Tuoi (PI = 0,'048; P2 = 0,012; P3 = 0,001), Hpi chu'ng B (PI = 0,050: P2 = 0,050; P3 = 0,017). Tinh trang toan than (P1 = 0,001; P2 = 0,045; P3 = 0,00), Sd vi tri ngoai hach (PI = 0,000; P2 = 0,000;
P3 = 0,000). Loai te bao B;T (PI = 0,108; P2 = 0,050; P3 = 0,006), Tham nhiem lu9 xUdng ( PI = 0,007; P 2= 0,158; P3 =0.011), IVIurc LDH (PI =0,011; P2 = 0,000; P3 = 0,000), Giai doan Ann Arbor (P1 = 0,000; P2 = 0,016; P3 = 0,000).
IV. BAN LUAN
4.1 Dac diem lam sAng va xet nghiem Cac dac diem ve tuoi, gidi, hdi chCfng B tinh trang toan than, sd vi tri ngoai hach. cd tham ntiiem tuj' xuong. mut LDH, giai doan lam sang trong nghien CLOJ cua chung toi tUdng ddi phu hpp vdi cac nghien cuU cd thiet ke tUdng tU.
Du an nghien ctTu cac yeu td tien lupng Qudc te nghien cuU d 3273 benh nhan ULAKH dp ac tinh trung gian d mpi lira tuoi, ty le benh nhan nam chiem 63%, tudi tren 60 chiem 41%, cd tham nhiem tuy xuong chiem 22%, LDH tang chiem 40%, giai doan Hi, IV chiem 66%
t^J'
Naoto Tomita va cs nghien culi o 177 benh nhan ULAKH loai lan toa te bao B te bao Idn 6 ngUdi Idn tuoi thay: T;^ le nam chiem 57%, tuoi tren 60 chiem 49%, cd hpi chu'ng B chiem 29%, tinh trang toan than > = 2 diem chiem 27%, c6 hdn 1 vj tri tdn thuong ngoai hach chiem 20%, mu'c LDH tSng chiem 55%, giai doan III, IV chiem 49% [2].
- Ve the md benh hpc va loai te bao:
Nghien ciru cda chung tdi tuong ddi phu hpp vdi mpt sd nghien cu'u trong nudc. Theo Nguyen Phi HCing, trong sd 93 benh nhan ULAKH dd ac tinh trung gian va do ac tinh cao t^ le WF5' la 21%, WF6 la 30%, WF7 la 23%,
loai te bao B chiem 77,1%, loai te bao T chiem 15,7% [3].
4.2 Cac yeu td anh hudng den dap dng hoan toan, sdng them toan bg va sdng them khong benh
TU bang 3.4; chiing toi thay cac yeu to anh hudng d^n dap Ong hoan toan, sdng them toan bp, sdng them khong benh gom:
+ Hpi chutig B: khdng cd hpi chCfhg B tdt hdn CO hpi chifng B (Sdt >38°C. giam can> 10% trpng lupng cd the, ra mo hdi trdm ban dem)
+ Tinh trang toan than: < = 2 diem tot hdn > 2 diem (2 diem la nam tai giudng< 30% thdi gian)
+ So vj tri ngoai hach: < = 1 vj trf ngoai hach tdt hon > 1 vj tri ngoai hach.
+ Tinh trang tham nhiem tu;}' xUong: khdng tham nhilm tot hdn cd tham nhiem.
+ MiJc LDH: LDH binh thudng tdt hdn LDH lang.
+ Giai doan larn sang; giai doan I, II tdt hon giai doan III, IV.
Ket qua nghien cCfu cda chung tdi cung phu hpp vdi mpt sd nghien cUu da cdng bo.
Cac nhdm yeu td dupc khao sat bao gdm: Gidi (nam va nU); Tudi (< = 60 ludi va > 60 tuoi);
Giai doan Ann Arbor (II, II va^lll. IV); V| Iri xam
lan ngoai hach (tu^' xUdng, dng lieu hoa, gan,
phdi w...); So vj tri ngoai hach (< = i vj tri va
Y HOC VIET NAM THANG 3-SO 1/2012
>1 vi IrQ; U kich thudc Idn (khdng cd va cd);
Tinh trang toan than (< 2 diem va > = 2 diem);
Hdi chdng B (khdng cd va cd); MUc LDH (binh thudng va lang; MUc albumin mau (binh thudng va tang); Mirc p2 -Microglobulin mau (binh thudng va lang). Cac nhdm yeu t d khac biet cd
^ nghTa thd'ng ke ve dap irng hoan toan, song them toan bd, song them khong benh gom.
tudi (P1 < 0 , 0 0 1 ; P2 < 0 , 0 0 1 ; P3 < 0,001), giai doan Ann Arbor ( P I < 0 , 0 0 1 ; P2 < 0,001; P3
<0,001), Iham nhiem tuy xddng ( P I < 0 , 0 0 1 ; P2 < 0,001; P3 < 0,001), tham nhiem gan ( P I
<0.001; P2 < 0 , 0 0 1 ; PS < 0,001). tham nhidm lach ( P I < 0 , 0 0 1 ; P2 < 0 , 0 0 1 ; P3 < 0,001), sd vi Iri ngoai hach ( P I < 0 , 0 0 1 ; P2 < 0 , 0 0 1 ; P3
<0,001), linh trang toan than ( P I < 0 , 0 0 1 ; P2
<0,001; P3 < 0,001), hdi chu'ng B (P1 < 0 , 0 0 1 ; P2 < 0,001; P3 < 0,001), mOfc LDH ( P I < 0 , 0 0 1 ; P 2 < 0,001; P 3 < 0,001) [1].
Naoto Tomita va cs phan tich cac yeu t d tien lupng cua 177 benh nhan ULAKH lan toa, le bao Idn, te bao B dupc dieu trj theo cac phac do: CHOP + lia xa, AC'OMP-B + cung c d bang ML-Y9, hoa chat lieu cao + ghep te bao goc lao mau l u than. Cac n h d m yeu to cd gia tri tien lupng dd'i vdi dap ifng hoan toan bao gom:
gidi ( ni/td't hon n a m , p ~ 0,07); giai doan Ann Arbor (I, 11 tdt hdn III, IV, p < 0,001); mirc LDH (binh Ihudng tdt hon tang, p < 0,001); Tinh trang loan than (< 2 diem tdt hon > = 2 diem, p
< 0,001); S d vj tri x a m ian ngoai hach (< = 1 vj Iri tdt hdn > l ' vj tri, p < 0,001); Hdi chirng_ B (khdng cd tdt hdn cd, p < 0,001); tham nhidm t u ^ XUdng (khdng t h a m nhiem tdt hdn cd tham nhiem t u ^ xUcfng, p = 0,01); U kich thudc Idn (khdng cd tdt hdn c d , p = 0,06). Trong cac nhdm Iren khi phan tich vdi thdi gian sdng them khdng benh va sdng them toan bd thi cac nhdm gidi va u kich thudc Idn khdng khac biel cd ^ nghTa thdng ke ve sd'ng I h e m khdng benh va cac nhdm u kich IhUdc Idn khdng khac biet cd y nghTa thdng ke ve sd'ng toan the [2].
Trong nghien ciru ci!ia c h i m g tdi t)i le dap ifng hoan loan nhdm < = 60 tuoi khac biet khdng co y nghTa thd'ng ke vdi nhdm > 60 tudi.
NhiTrig sd'ng them loan bp va sd'ng them khdng
benh khac biet cd y nghTa Ihd'ng ke giijfa 2 nhdm.
Nhdm < = 60 tudi tdt honnhdm > 60 tudi.
V. KET LUAN
- Cac yeu t d anh hudng den dap ifng hoan loan, sd'ng them toan bd, sdng them khdng benh gom:
+ Hdi chifng B: khong cd hdi chUng B tot hon cd hdi chu'ng B
+ Tinh trang loan than: < = 2 diem tdt hdn
> 2 diem.( Bac thang qui djnh the trang cCia nhom ung thu)
+ S d vj Iri ngoai hach: < = 1 vj tri ngoai hach tdt hon > 1 vj tri ngoai hach.
+ Tinh trang tham nhidm t u ^ xUdng: khdng tham n h i l m tdt hon cd tham nhiem,
+ Mifc LDH: LDH binh thudng tdi hOn LDH tang.
+ Giai doan lam sang: giai doan I, II tdt hdn giai doan III, IV.
- Dap img hoan toan khac biet khdng cd y nghTa thdng ke giCfa 2 nhom tudi va 2 loai te bao B; T nhUng sdng them toan bd va sdng them khdng benh khac biet cd y nghTa Ihdng ke giCra 2 nhdm. Nhdm < = 60 tudi lot hon > 60 tudi. Loai te bao B tot hon loai te bao T.
TAI LIEU THAM KHAO
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