Tap chl Tai MOi Hong Vidt Nam - Volume (57-9). W3 - July, 2012
DAC DIEM LAM SANG VA GIA TR| TEST IN VIVO TRONG CHAN DOAN HEN PHfe QUAN Dl (J>4G NGHE NGHlfP
Nguyin Quang Hiing*, VHMinh Thgc**
TOM TAT
Nghien ciru thirc hiin trin 7tS0 cong nhdn dit thdm. v&i khai thdc tiin sif df dng, thdm khdm ldm sdng vd test bi dc xdc dfnh nguyin nhdn ciia hen phi qudn do bgi bong. Kit qud cho thdy ty li Hen phi qudn nghe nghiip do bui bong tgi cong ty dit thdm Id 6.28%, chti yiu ggp & nhirng phdn xu&ng trgc tiip co nong dg byi cao. Biiu hiin ldm sdng chd yeu Id tire ngtrc (100%), kho lh& (100%). nghe phdi cd ran rit (79.59%), ho khac dam (40,81%).
Nhirng ddu hiiu ndy thu&ng xudt hiin trong luc ldm viic, gidm di hodc mdt hdng khi khong tiip xuc v&i but bdng. Tien hdnh test lay da v&i df nguyin bui bong cho dg nhgy Id 67,35%
vd test ngi bi la 93,88%. Chung toi khuyen cdo nin tiin hdnh test lay da tru&c, khi test lay da dm linh hoac nghi ng& se tien hdnh test ngi bl
SUMMARY
Clinical features and the value of test in vivo for diagnosis of cotton dust induced asthma This study was carried out the exploitation of allergic history and clinical examination with dermal test of 780 textile workers to determine the cause of cotton dust induced asthma. Which was showed that 6,28% of worker suffered cotton dust induced asthma, primarily in department with high degree of cotton dust pollution. Major clinical symptoms and signs were chest's tightness (100%) , wheezing (100%), pulmonary stridor by auscultation (79,59%), cough with sputum (40,81%) which occurred frequently at working time and reduced or disappeared completely after working time. Of asthmatic workers, prick-tests with cotton allergen were positive in 67,35% of cases and intradermal tests
were positive in 93,88%. We recommended to perform the prick-test first and only perform intradermal test when prick test ins negative or suspected.
1 DAT VAN D E ^^^^ ^^^ ^V^% kha hifu qud song vifc xdc dinh cdc di nguydn gay bfnh cdn gdp nhieu Hen phe qudn Id mdt bfnh hay gdp tren ^hd khdn. Trong dd, cdc di nguyen nghd lam sdng ndi khoa vdi cdc bidu hifn ldm ^ghj^p ,^ ng^ygn ^hdn chu ylu gdy ra hen san tir nhe den ndng. Vifc dieu tri con hen p^g q^dn nghd nghifp d cdc nude cd ky phe qudn hien nay dd ed nhieu thudc vd bift ^^^ ^^^^ t^dn cao. Ngudi ta da xdc dinh
*DaihQcYHaiPh6ng ^ ° ^ 8 ^^^ ^^'^ *^^^^ *^^^ "^^^ *=.° "^uSn
** Bfnh vifn Tai mui hpng TW goc tir dpng vdt, thuc vdt, hda chdt, byi...
Nh$n Mi 15/6/2012. Duyet in 25/6/2012
Tap chf Tai Mui Hpng Vidt Nam - Volume (57-9). N°3 - July, 2012
CO the gdy ndn hen phi qudn nghd nghifp[6]. Trong dd bui bdng Id mOt trong nhiing tdc nhan gdy bdnh ddng chii y vd dd dugc nghien ciru d nhidu nude trdn thd gidi: My, Thuy Sy, ...gan ddy Id Ai Cgp, Soudan, An Dp vd Trung Quoc Id nhiing nude cd ngdnh ddt bong phdt tridn [6]. d Vift Nam, cd mdt vdi bdo cdo budc ddu nghien cuu tinh trang di iing vdi byi bdng d nha may det 8 - 3 [1,4] nhung chua ed bdo cdo ndo chi tiet, hf thdng ve hen phd qudn nghe nghidp do bvii bdng d cdc cdng ti, xi nghifp cd sur dung cdc sgi bdng la nguyen lidu chil ydu trong sdn xuat.
Cdng ty dft thdm Hang Kenh - Hai Phdng Id CO sd sdn xuat thamt rir nhieu ndm nay. Anh hudng cua biii bdng trong sdn xuat cua cdng ty gay nen mot sd bfnh di ung nghd nghifp chidm ty If dang ke, trong do cd bfnh hen phd qudn nghd nghifp. Tir trudc tdi nay, chua ed mdt nghien ciiu ndo danh gia tdc dpng cua byiu bdng nghd nghidp gay hen phe quan cho cdc cdng nhan tai cdng ty. Vdi ly do dd chiing tdi tidn hanh dd tdi ndy nhdm mue dich sau day:
1. Bvdc dau nghien ciru mot so dgc dilm ldm sang cua hen phe quau di ung nghe nghiep tai Cong ty Dft tham Hang Kenh - Hai Phong.
2. tTng dung test in vivo trong vifc xac dinh di nguyen gay nen tinh trang hen phe quan nghe nghep cua cdng nhan trong cong ty det tham.
Tir dd nhdm dua ra mpt so bifn phdp hChi hifu nhdm phdng vd chong bfnh hen phe qudn nghe nghifp, thvrc hifn cdng tdc chdm sdc vd bdo vf siie khde ban dau cho cdng nhan tai Cdng ty.
2. D 6 I TU^gfNG vA PHU'ONG PHAP NGHIEN CUtJ
2.1. Doi tvgmg nghien cihi.
Gdm 780 cdng nhan Cdng ty ddt thdm Hdi Phdng, phdt hidn hen phe qudn nghd nghifp do bui bdng theo tieu chuan: Benh nhan cd eon khd thd cd cu trdn 1 nam, cd lien quan chdt che vdi svr tiep xiic byi nghd nghifp trong qud trinh san xuat. Con khd thd ed cir giam di khi ngimg lam vifc trong cdng xudng hodc mat di khi nghi mdt thdi gian.
Cd mdt test duong tinh vdi di nguyen bui bdng duge che tir bui cua cdng ty. 30 cdng nhan khde mgnh, khdng mac cdc bfnh hen phd qudn vd cdc bdiih khdc dupe thucr test bi vdi di nguyen byi bdng (lam nhdm chiing).
2.2. Phuong phdp nghien ciru.
Tham khdm, khai thdc tidn sir ket hgp mau 25B ( dieu tra cdc bfnh di iing ), mdu cau hdi nghien ciiu ve hen phd qudn nghd nghiep vd cdc bfnh phdi tdc nghen. Bfnh nhdn nghi ngd hen phd quan nghd nghifp dugc tidn hdnh test bi vdi di nguyen byi bdng. Di nguydn ndy dugc didu chd tgi phdng di nguyen Vidn Tai Mui Hpng Trung LTong. Dimg phuong phdp thdng ke y sinh hpc dd xd ly ket qud nghien ciru.
29
Tap chl Tai Mui Hpng Viit Nam - Volume (57-9). N°3 - July. 2012
3. KET QUA N G H I 6 N CiltJ 3.1. Ty If mic hen phe quin nghJ nghifp do bvi bong tjii c6ng ty Dft thim
Bing 1: Nghiin ci>u ty l i mic hen phi quin nghi nghiip
Gi6i Binh nhin hen phi quin S i cing nhin dup'c khim
%
Nam 4 54 7.40
N&
46 726 6 20
Ting 49 780 6 28 t = 0 35. p>0.05 Ty le mdc hen phe qudn dj iing nghe nghifp d cdng ty Ddt thdm Hdi Phdng chiem 6.28%, khdng cd su khdc bift ve gidi vdi P>0.05.
3.2. Su- phan bo bfnh nhan theo lira tuoi.
Bang 2: Nghidn ciru sy phdn bd hen ph^ quan nghe nghidp do bgi bdng theo Ida tuot.
\ Li>a
\tuoi C h ! \ tiiu \ Binh nhin
%
20-29
C
0 30-39
12
24 49 40-49
35
71.43
t=4.6. p<0.01 250
2
4.08 Ting
s i
49
100
3.3. T^ If hen phe qudn nghi nghifp do bi^i bdng theo tuhi nghe.
3.3.1. Sy phdn bi tin sudt mScb^nh hen phi qudn nghi nghidp do bgi bdng theo tuSi nghi
Bdng 4: Nghidn cdu sy phdn bd tdn su^t m^c bdnh hen phd qudn ngh^ nghi$p do byi bdng
theo tudi nghd.
Ty Id hen phd qudn nghe nghidp ciia cdc cdng nhdn cdng ty Dft thdm thudng gap d Ilia tudi trdn 30.
\ Tuii V g h i C h r \ tiiu \ Binh nhin
%
11-15
5 10.20
16-20
16 32.65 P<0.01
21.26
10 20,41
26-30
17 34 69 P >0.06
>30
1 2.05
Ting
49 100
Svr phan bd hen phe qudn nghe nghifp hay gdp d tudi nghe tir 16 - 30 ndm.
3.3.2. Ty Ig mdc bgnh hen phi qudn nghi nghigp do bgi bong theo tuoi nghe.
Bdng 5: Nghidn ciru ty Id mdc b^nh hen ph6 qudn ngh^ nghidp do byi bdng theo tudi ngh^.
\ Tuii
\ nghi CW \ tiiu \ Binh nhin
S i cing nhin
I l - l s
5 106
16- 20
16 264
21- 25
10 213
26- 30
17 148 P >0.05
>30
1 2
Ting
49 780
Hen phe qudn nghd nghidp hay ggp tir 16-30 ndm tudi nghe.
Tap chf Tai MGi Hpng Vidt Nam - Volume (57-9). N°3 - July, 2012
3.3.4. Khai thdc tiin sA df img cda cdc b§nh nhan hen phi qudn nghe nghidp do b^i bdng tgi cdng ty dgt thdm.
3.3.4.1. Tien sir dj img cd nhdn.
Bang 6: Khai thdc ti^n sd dj irng cd nhdn cua cdc b$nh nhdn hen ph^ qudn nghd nghidp.
\Tiin
\ su- Chi\
tiiu \ Binh nhin
%
Chim
5 10.20
Hen phi quan
lOc nhi 8 16.33
IVIiy day sin ngi'a
29 59.18
Viim mOidi i>ng
32 65.30
Di Cmg tht>c i n
9 18.37
Thuoc
2 4.08
Cd 65.30% benh nhdn cd tidn sii viem miii di ling, 59.18% bdnh nhdn cd tien sir me day san ngira. Cd 16.33% bdnh nhan cd tidn sir hen phd quan liic nhd da dn djnh, nhung khi vdo ldm vifc tgi cdng ty tdi phdt con hen phe quan dj iing nghe nghifp.
3.3.4.2. Tien sir di img gia dinh.
Bang 7: Khai thdc tiln sir djuwngs gia dinh cua cac b#nh nhdn hen phe quan nghe nghidp.
\ r i e n SLP C h l \ tiiu ^ \ Binh nhin
%
P
06 tien sir d|
u'ng gia dinh 29 59.18
Khing c6 tien sij d| LFng gia dinh
20 40.81 t=1.81, p>0.05 Trong sd 49 cdng nhdn hen phd qudn nghd nghiep cd 59.18% sd cdng nhdn cd tidn su dj iing gia dinh.
3.3.4.3. Khai thdc tiin sir cdc yeu to lien quan t&i can hen phi qudn.
Bdng 8; Khai thdc tiSn sd cdc ydu td lidn quan tdi con hen ph6 qudn.
\ Y i u t i C h l \ tiiu \
Binh nhin
%
Bui nghi nghiip
49 100
Bui nhi 19 38 77 P<0.001
Thu'c i n
9 18.37
Thuic
2 4.08
3.3.4.4. Biiu hiin ldm sdng cua can hen phi qudn nghe nghiip do bui bong.
Bang 9: Nghien c d u bieu hi&n ldm sdng can hen phe quan n g h i nghidp do byi bdng cua
cdc cdng nhdn bj b f n h .
Khi l i m viec T n i u ChCrng Tu'c ngyc
K h i tho Ho k h i c ddm T h a <
16lin/phCit Tho 1 6 -
. 20 lan/phCit Tho >20 Ian/phut
Ran rit Ran rit.
ran n g i y B i n h nhan 49 49 20 25 12 12 39 10
%
100 100 40.81 5 1 0 2
24.49
24.49 79 59 20.41
Luc ngh!
ngffi n g o i i cong ty Benh n h i n 19 8 2 0 49 0 8 0
%
38.77 16.32 4.08 0 100
0 16.32
0 p>0.001 p>0.001
p>0.001
p>0.001 j
31
Tap chl Tai Mui Hong Viit Nam - Volume (57-9). N°3 - July. 2012
Cic trifu chiing lam sing tic ngvrc, khi tha, ho khac dtai, ran rit, ran ngiy xudt hiin ro khi lain vi$c. Khi nghi ngai khong tiSp xiic vdi moi truimg lim vifc gidm di r6 ret, CO y nghia thing ke (p < 0.001).
3.3.4.5. Ty le mdc hen phi qudn nghi nghiep do bui hong Irong cdc phdn xudng.
Bang 10: Nghiin ci>u ty l i mic hen phi quin nghi nghiip do bui bing trong cic phin mibn^
cua cing ty
Phin xi/ing
Hinh chinh Det Tia SCra chO-a
tham Ch^p len Bing gii
Hen phi quin
2 30 11 4 1 1
S i cing nhin trong
phan xu'i'ng
136 212 84 40 27 34
%
1.47 14.15 13.09 10 3.70 2 94
P<0.05
p>0.05
3.4. Testify da.
Bdng 11: Nghidn cirua gid trj cua test lly da trong chdn dodn hen phi qudn nghi nghi$p do
bgi bdng.
Nghidn ciiu ty le hen phe quan do byi nghd nghiep tgi cdng ty Dft tham, thay ty Id hen phe quan gap nhidu d phdn xudng ddt (14.15%),xudng tia (13.09%), xudng sua chira tham (10%), khac biet (p<0.05).
3.3.4.6. Kit qud nghien cuu test da trong chdn dodn hen phe qudn nghe nghiip do biii bong.
\ Nhim
C M \ tiiu \ n
%
Binh nhin hen phi quin
(n=49) Du'ong
tinh 33 67.35
Am tinh 16 32.65
Nhim chi>ng (n=30) Duang
tinh 2 6.67
Am tinh 28 93.33 P<0.001
Ket qud test lay da vdi bui bdng tren cac benh nhan hen phe qudn nghe nghifp cho gid trj duong tinh khd cao 67.35%.
Trong khi do, test lay da cua nhdm chiing (khde mgnh) cho gid tn duang tinh 6.67%.
Sir khac biet ndy cd y nghia vdi p<0.001.
3.4.1 Test ngi bl
Bdng 12: Nghidn cdu gid trj ciia test nOi bi trong chdn dodn hen phi qudn nghi nghi§p do
bgi bdng.
\ N h i m C h t \
tiiu \ n
%
Binh nhin hen phi quin
(n=49) Dyang
tinh 46 93 88
Am tinh 3 6.12
Nhim ChCrng (n=30) Du-ang
tinh 3 10
Am tinh 27 90.00 P<0.001
Tien hdnh thu test ndi bi vdi biii bdng tren nhimg bdnh nhdn hen phd qudn vd 30 cdng nhan khde manh lam chdng, ket qud
Tap chf Tai Mui Hpng Vidt Nam - Volume (57-9). N°3 - July. 2012
thu dupe ty Id duang tinh 93.88% d6i vdi d ndm cdng nhan khde mgnh binh thudng bfnh nhan bi hen phd qudn nghd nghifp. Id 10%.
Trong khi dd ty Id duong tinh vdi byi bdng
3.4,2. So sdnh dd nhgy vd dg dgc higu cda test liy da vd test n^i bi v&i di nguyen bui bong.
Bang 13: So sdnh dd nhdy vd dO ddc hidu cua test lly da vd test nOi bl vdi dj nguydn bgi bdng.
\ T u i i
\ nghe
Chi tieu \ L i y da N i i b I
D i n h i y
n
49 49
Difong tinh
33 46
Am tinh
16 3
%
67.35 93.88 P<0.001
0 i d i e h i i u
n
30 30
Du-ang tinh
2 3
Am tinh
28 27
%
93 33 90 P<0.05
so sanh dp nhgy cua hai test, ket qua cho thdy dp nhgy cua test ndi bi vdi di nguydn bui bdng cao hon so vdi test lay da vdi p < 0.001.
So sanh dp dgc hifu cua hai test kdt qud cho thay dp ddc hifu ciia hai test vdi di nguydn bui bdng khdng cd sy khdc bidt p > 0.05.
4. BAN LUAN
4.1. Dac diem lam sang ciia hen phe quan do bui bong tai cdng ty dft tham.
Tham khdm 780 cdng nhan d cdc phan xudng khac nhau, ket qud cho thay ty le hen phd qudn nghe nghidp chiem 6.28%.
Ty Id ndy thdp han so vdi mpt sd tac gid nude ngoai nghien ciiu trudc kia, nhung phu hpp vdi nhung nghien ciiu gan day cua Pauli-G, Bessot-J.C, Kopferschmitt trong khoang dao ddng tu 2% den 15% tgi Phap [7] va Meredith tai Anh td 2% - 6% [6]. 6 Vift Nam, chua cd mot cdng trinh nao di
sau nghien cuu ve hen phe qudn nghe nghiep, nhung vdi ty If 6.28% sd cdng nhan d cdng ty ddt tham cd bieu hifn hen phe qudn do byi bdng la con sd dang luu y.
Cdc bfnh nhan hen phe quan d liia tudi tren 30 khdng cd sy khdc bift vd gidi. Nghien cdu giira tudi ddi vd tudi nghe nhdn thay tudi nghe cd bieu hien hen phd quan trdn 10 nam, ty If tang hon d nhung cdng nhdn cd tudi nghd trdn 25 ndm (11.49%, p<0.05).
Sy phu hpp vdi tudi ddi hay gap hen phd quan d tren 30 tudi.
Nghien ciiu ty If mdc hen phd quan nghe nghiep trong cac phan xudng d cdng ty, ket qua cho thay phan xudng dft, tia va sua chiia thdm cd ty If hen phd qudn nghd qudn nghd nghiep cao hon (14.15%, 13.09%, 10%) so vdi cdc phan xudng khac (p<0.05). Khdo sat ndng dp byi d cdc phdn xudng ciia cdng ty bang may do cua Nhgt Ban nhan hifu Digital-Dust-Indicator P5H2 cho thay ndng dd byi d 3 phan xudng ndy
33
Tap chf Tai MGi Hong Vidt Nam - Volume (57-9). N°3 - July. 2012
cao ban hdn so vdi cdc co sd khde. Nhu vgy, chung to cd moi lien quan ch$t chd giU ty If mdc bfnh hen phe qudn do byi bdng d cdc phdn xudng vdi nong dp byi tang cao.
Day cung Id van dc md cdng ty can quan tam dd gidm n^ng dp byi d cdc phdn xudng ndy, han che toi da ciia byi nghd nghifp len sue khde ciia cdng nhan.
Nghien ciiu tien sd dj umg cdc nhan vd gia dinh ciia cdc cdng nhdn bj hen phe qudn nghd nghifp do byi bdng, thu dupe 59.18%
so bfnh nhdn cd tidn su dj iing gia dinh.
Tien sir viem mui di img cd 65.30% , 59.18% cd may day san ngda vd 16.33% cd tien sii hen phe qudn luc nhd nhung dd on djnh khi trudng thdnh trudc khi vdo cong ty. Day la dau hieu ddng luu y d nhiJng cdng nhan cd hen phe qudn nghe nghifp sau ndy. Ndu nhimg cdng nhan dupe lam xet nghifm co dia dj img ket hpp vdi tidn su di ung ca nhan trudc khi vdo cdng ty se cd y nghia rat tdt trong vifc tuyen chpn cdng nhan vdo Idm viec d nhimg mdi trudng ed ndng dp bui dd gdy di iing. CJ nhihig ngudi cd co dia di img binh thudng (nghia la khdng cd ca dia di irng) cd thd ldm vide tdt trong nhidu ndm ma khdng bi hen phd quan hoac cdc benh dj iing khdc.
Ngupc lgi, nhiing ngudi cd co dja di ung rdt manh, cd tien su di iing cd nhan vdi nhieu loai di nguyen thi se cd nguy co mdc hen phe quan hoac cdc bdnh dj img khde ngay trong nhiing nam ddu vao ldm vifc.
Nhimg ngudi nay thudng phdi bd nghd hoac chuydn cdng tdc khac khdng lien quan tdi moi trudng lao ddng de gay di iing.
Rieng nhdm ngudi cd co dja di ung d miic
trung binh, m^t so ft ngudi cd the tir tir quen d4n vd chju dvmg dupe vdi nong d$ dj nguyen tdng dAn, vSn tiep tyc ldm vifc binh thudng, m$t s6 khdc den mpt nong dp dj nguydn nghe nghifp ndo dd cd th^ xudt shieenj tinh trgng dj img ckp can phdi nghi ngoi ho$c dieu trj. NhOng ngudi ndy van cd the tiep tyc ldm vifc d nSng dp dj nguydn dupe coi Id dudi ngudng gdy man cdm.
Cdc yeu t6 lien quan tdi con hen ph^
qudn cua cdc cdng nhdn bj bfnh, cho thay 100% so cdng nhan xuat hifn con hen phd qudn do tiep xiic vdi byi nghe nghifp. Day Id chi tidu rat quan trpng trong chan dodn bfnh ket hpfp vdi bieu hifn lam sdng md chua cd su irng dyng cdc test in vivo ho^c in vitro. Ngodi ra, cd 38.77% so cong nhdn bj bfnh cd tien su hen phe qudn khi tiep xiic vdi byi nha, 18.27% sd cdng nhdn cd tidn su hen phe quan do thuc dn.
Nghidn cuu bieu hien lam sdng d cdc cdng nhan bj bfnh, nhgn thay con hen phe quan xdy ra khi Idm vifc duprc bdo trudc bdng dau hifu ca ndng hay g$p d hau het cdc bfnh nhan la tuc ngyc (100%), khd thd (100%), ho khgc ddm (40.81%). Dau hifu thyc the dupe thdm kham bdi y te co quan hodc khdm djnh ky tgi cho Iiic dang Idm vifc cho thay 51.02% so cdng nhan cd tan sd thd chgm < 16 Idn/phiit, 24.49% sd cdng nhdn hen ph^ qudn cd tan sd thd binh thudng td 1 6 - 2 0 Idn/phiit va 24.49% sd cdng nhan cd tin s6 thd >20% Idn/phiit.
Nghe phdi thdy 79.59% sd cdng nhan bi hen phe qudn cd ran rit la chu y^u vd 20.41% sd cdng nhdn cd kem cd ran rit vd
Tap chi Tai MQi Hong Vidt Nam - Volume (57-9). N°3 - July, 2012
ran ngay. So sdnh cdc dau hifu co ndng vd thvrc thd cda cdc cdng nhdn bi bfnh trong liic lam vifc vd trong trgng thdi nghi ngoi , khdng ldm vide tai cdng ty, chiing tdi nh§n thay sir khac bift r5 ret cd y nghta thdng kd.
Sir khdc nhau cua cdc dau hidu Idm sang rat ed gid tri trong vifc xac djnh hen phe qudn do byi nghe nghifp. Nhung vdn dd can d§t ra la cdng nhan khdng the bd cdng vide neu khdng ed dieu kifn chuyen ddi sang cdc co sd khde tot han. Do vdy c4n phdi cd bifn phdp dieu tri tai cho vd phdng hp cho cdng nhdn tdt de trdnh con hen ph^ qudn. Hdu het cdc cdng nhan ddu sit dvmg khdu trang trong luc Idm vide vd thay khau trang khi thay da bam nhieu byi. Neu kdt hpp giira cdi thifn mdi trudng lao dpng, kham siic khde dinh ky de phat hifn sdm ddu hifu bfnh do nguyen nhan nghd nghifp hoac gidi min cdm vdi di nguyen cd the ngan chgn duprc can hen phe quan trong liic lam vifc, tang kahr nang lao ddng cho cdng nhdn.
4.2. Gia tii ung dung cua test in vivo trong chan doan nguyen nhan gay hen phe quan nghe nghiep do bui bong.
Test lay da vdi di nguyen byi bdng tren 49 bfnh nhdn dugc chan doan la hen phd qudn nghd nghifp va 30 cdng nhan khde manh khdng hi bfnh gi. Ket qud test lay da duong tinh d cdc cdng nhan bi bfnh chiem 67.35%. Ty Id ndy tuang duong vdi ket qua nghien cdu cua nhieu tdc gid trong vd ngodi nude khi thd vdi nhidu di nguyen khdc nhau [1,2, 5].
Test n0i bi vdi di nguyen bui bdng tren cdc cdng nhan hen phd quan nghe nghifp
va 30 cdng nhdn khde mgnh ldm chung.
Ket qudn dp nh^y cua test npi bi vdi dj nguyen byi bdng chiem 93.88%. Nhgn xdt ndy ciing phd hpp vdi nghien curu ciia mpt s6 tdc gid trong vd ngodi nude [1,2, 5]. Dp nh^y ciia test ndi bi cao hon hdn so vdi test lay da (p<0.001) song test npi bi thudng cd Ian mft ty If duong tfnh gid vd cd nhthig phdn ung khdng d$c hifu do kim tiem gay ton thuong trong da nhieu hon test lay da [4, 5]. Mpt so tdc gid neu len tac dvmg khdng mong muon gdy sdc phdn vf khi ldm test npi bi vdi nhung dj nguyen khac nhau trong mpt vdi trudng hgp [3].
Do vay, mac dii test npi bi cd dp nhgy cao hon test lay da, nhung cdc tdc gid deu thong nhdt ldm test ldy da trudc khi lam test npi bi. Neu test lay da am tinh hoac nghi ngd thi mdi tien hdnh thdm test ndi bi vdi ndng dp chudn xdc [3,5]. Khi kdt hpp cd test lay da vd test npi bi de xac dinh di nguyen bui bdng gay hen phd qudn nghd nghifp d cac cdng nhdn dft thdm, chiing tdi thay 100% cde benh nhan deu cd phdn ling duong tinh it nhat vdi mdt test.
5. KET L U ^
5.1. Ty Id hen phd qudn nghd nghiep do by bdng tai cdng ty Dft thdm Hang Kenh - Hdi Phdng la 6.28% vdi liia tudi hay gdp tren 30 tudi, tudi nghd trdn 10 nam va khdng cd su khdc bift vd gidi. Ty If hen phe qudn nghd nghidp gap d nhimg phdn xudng inrc tidp sdn xuat, ed ndng dp bui tdng (ddt, tia, sua chiia thdm) cao hon so vdi cdc phdn xudng khdc (P<0.05).
Tap chl Tai Mui Hpng Viit Nam - Volume (57-9). N°3 - July, 2012
5.2. Bieu hifn lam sing : 1)0 ning:
Tile ngvc (100%), khi thd (100%), ho kh?c dom (40.81%). Thvrc th^: Thd ch^m <I6 lin/phit (51.02%), nghe ph6i c6 ran rit (79.59%). Nhihig diu hi?u Iflm sing thuiTig xu^t hi^n trong luc lim vi§c, giim di hoic m4t hin khi nghi ngai , khi kh6ng tiip xuc v6i byi nghe nghi?p.
5.3. Dp nhiy test lay da In 67.35%, test npi bi la 93.88%. Nen tjmg dyng lest lay da tnioc, khi test lay da im tinh hoic nghi ng6 sg tien hanh test npi bi.
TAI L l f u THAM KHAO 1. Nguyen Ning An, Phan Quang Doin,
Vii Minh Thuc, Tran Ngpc Tuyen (1996). "Budc ddu nghien ciru benh di ung bui bdng a cdng nhdn del 8/3 Hd Noi'. Ky yeu cong trinh nghien cuu khoa hpe. Tap III, 12-16.
2. Phan Quang Doan, Vu Minh Thuc, Nguyen Thj Van (1999). B$nh di mg trong cdng nhdn det 8/3 Hd Ngi, Y hpe thuc hanh s5 1/1999.
3. Ph^m Vin Thiiv, Phiing Minh Son.
ung di^ng di nguydn btit nhd Irong chdn dodn ddc hi^u hen phe qudn tgi Hdi Phdng. Y hpe thye hinh s6 388/2000, 169-171.
4. Bessot-J.C, Pauli-G (1999). L'asthme professionnel. Editions Margaux Orange. 3-19,136,491-502.
5. Chalal-I, Horat-M, Segalen-C (1998).
Comparison between modified skin test with standardized allergen axtracts and phazet. J. Allergy Clin. Immunol. Nov, 82,878-881.
6. Meredith-S, Me Donal-J.C (1994).
Work related respiratory disease in the United Kingdom, Report on the SWORD project.
7. Pauli-G, Bessot-J.C, Kopferschmitt- M.C (1999). Asthme professionnel- Maladies immunoallergiques-Maladies respiratoires d'origine professionnel.
Masson. 81 - 93.