Tap chl Tai MDI Hpng ViSt Nam - Volume (57-9), N°3 - July. 2012
THAY DOI XET NGHIEM INVITRO
d BENH NHAN VIEM MUI DI U N G DIEU TRI MIEN DICH DAC HIEU DU'OfNG Dl/dl LlTdl BANG DI NGUYEN
DERMATOPHAGOIDES PTERONYSSINUS
Huynh Quang Thugn ', Nguyin Trpng Tdi **, Nguyin Dinh Phuc***
TOM TAT
Viem mdi di ung (VMDU) Id mdt trong nhimg benh di itng du&ng hd hip hay gap trong chuyen khoa tai mUi hgng (TMH) vd chuyen khoa di itng, nguyen nhdn chii yeu la do mgt bui nhd Dermatophagoides pteronyssinus. Mien dich lieu phdp (MDLP) Id phuang phdp dieu tri theo ddng ca che benh sinh, ldm Ihay ddi lien trien lu nhien cua benh di itng, cd hieu qud. Mien dich lieu phdp dudng dudi ludi dugc dp dung chinh thirc Iren the gidi tir ndm 1998 vd dugc Td chuc Y le The gidi (WHO) dd khuyen cdo cdc nude nen dp dung thay the dudng tiem. Doi tirgng va phirffng phdp: 45 benh nhdn viem mUi di img do mat bui nhd D.pte dugc dieu tri miin dich ddc hieu dudng dudi luoi vd ddnh gid su thay ddi qua cdc xet nghiim in vitro. Ket qud va bdn lugn: Sau 24 thdng dieu Iri phdn ung tieu bgch cdu dgc hieu vdphdn huy mastocyte pdm nhiiu cd vi sd trucmg hgp duang linh vd mdc do ducmg tinh: hdm lugng IgE lodn phdn vd IgE ddc hieu Iren litng benh nhdn deu gidm Iren 20% so vdi trudc diiu tri.Hdm lugng IgG tren timg benh nhdn Idng han 20% so vdi Irudc diiu tri. Ket lugn: diiu h-i miin dich dgc hiiu duang dudi ludi Idc ddng vdo ca che binh sinh Idm gidm tinh trang phd huy ti bdo mast, hgn chi cdc mediator viim ... ddn din thay ddi cdc xet nghiim in vitro. Diiu ndy cho Ihdy viec dieu Iri mien dich ddc hiiu bdng di nguyen D.pte cUng cho kit qud khd quan.
Tirkhda: viim mUi di itng gidm mdn cdm ddc hiiu, Dermatophagoides pteronyssinus, SUMMARY
Changes in patient testing invitro allergic rhinitis specific immunotherapy sublingual allergen by dermatophagoides pteronyssinus
Huynh Quang Thuan - Military Medical University.
Nguyen Trong Tai - Vinh Medical University Nguyen Dinh Phuc - ENT Hospital
Allergic rhinitis is one of allergic respiratory disease common in ENT and allergy specialist, the cause is mainly due to house dust miles Dermatophagoides pteronyssinus. Immunotherapy is Ihe heatmenl according to the pathology, which changes the natural progression of allergic disease, to be effective. Immunotherapy sublingual formally applied in the world since 1998 and Ihe World Health Organization has recommended that all countries should adopt alternative injection. Subjects and Methods:
4S patients with allergic rhinitis due to house dust mite immunotherapy D.pte be specific sublingual and evaluate the change over tests in vivo and in vitro. Results and discussion:
* HQC vi4n qudn y.
"DaihQCrkhoa Vinh.
Tap chf Tai MOi Hong Vift Nam - Volume (57-9). N°3 - July, 2012
After 24 months of treatment white blood cells react and degrade specific mastocyte much reduced both in number of positive and the positive degree, levels of total IgE and specific IgE on each patient were reduced more than 20% compared to before the treatment Levels of IgG in each patient increased mare than 20% compared to before the treatment. Conclusion Specific immunotherapy sublingual impact on reducing the pathology .status destroying mast cells, limiting the inflammatory mediator... to change the tests in vivo and in vitro This .suggests that the .specific immune therapy with allergens D.pte also positive results.
Key words: allergy rhinitis. Specific immunotherapy. Dermatophagoides pteronyssinus.
1. D^T VAN t)t Hifn nay MDLP chu yeu su dung theo Vidm mui di ung (VMDLO la mpt trong hai dudng
nhdng bfnh dj ung dudng hd hap, hay gdp trong chuyen khoa tai miii hpng (TMH) vd chuyen khoa di ung. Cd rat nhidu nguyen nhan gdy di dng dudng ho hap nhu byi nhd, phan hoa, thye phdm, hda my phdm ...., trong dd mgt bui nhd Dermatophagoides pteronyssinus duyc xdc dinh Id nguyen nhdn chu yeu gay vidm miii di ung.[2], [6]
Trong mdy chuc nam gdn day, sy phdi hyp giua cdc chuydn khoa trong nghien cuu VMDU* da mang lgi nhimg thdnh cdng tot dep khdng nhimg vd chdn doan ddc hifu, ma cdn ve kdt qud didu tri. Cd rdt nhilu phucmg phdp duyc dp dung trong diiu tri benh VMDU, trong do miln dich lifu phdp (MDLP) da duoc rdt nhieu cac tdc gia trong vd ngodi nude ap dung.
Muc dich cua mien dich lifu phdp Id ldm cho bfnh nhdn trd nen dung ngp ddi vdi di nguyen md hp man cam bdng each cho tiep xue ddu ddn vdi chfnh nhimg di nguyen do. Didu tri mien dich Id phuang phdp duy nhdt cd thi dem lgi khd ndng ldm thuyen gidm lau ddi, vinh viin phdn lan hogc tdt cd cdc triiu chimg di ung bdng cdch tdc dgng trite tiip len he miin dich.
Dudng tiem dudi da gpi la SIT (Specific Immunotherapy)
Dudng dudi ludi gpi Id SLIT (Sublingual Immunotherapy)
Dudng dudi ludi (SLIT) duyc sg dgng chinh thuc trdn the gidi Id ndm 1998. Vdi nhihig nghien cdu cua cdc tdc gid va tdng kdt hifu qud trong dieu tri MDDH bdng dudng dudi ludi cua hang di nguyen Stallergen, Td chuc Y tl ThI gidi (WHO) da khuyen cdo cdc nude nen dp dung dudng dudi ludi thay the dudng tidm.
Xudt phdt tu van de tren, chung tdi tien hanh : Ddnh gid thay doi cac xit nghifm in vitro or bgnh nhdn viem mui di ung dirge diiu tri ""^^ dich dgc higu duvmg dudi lu&i b&ng di nguyen Dermatophagoides pteronyssinus.
2. D 6 I TUgfNG VA PHUONG PHAP NGHIEN Ciru
1. Doi tiryng nghien cihi
Nhihig 45 bfnh nhan duyc chdn dodn xdc dinh vidm miii di dng do D.pteronyssinus duyc didu tri mien djch ddc hifu dudng dudi ludi.
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Tap chf Tai MOI Hpng VIM Nam - Volume (57-9). N°3 - July. 2012
* Dja diem thijrc hifn: Khoa Di ung Mien dich L ^ sang, Benh vi$n D^i hpc Y Hai Phong.
* Thoi gian : tir 03/2008 dfo 12/2011 2. PHU'ONG PHAP NGHlfiN CU'U 2.1. Thiet ke nghien ciru: Nghien cuu can thiep theo doi dpc, tu doi chiing.
2.2. Phirong phjp v^ ky thuat Ap dung trong nghien cihi
2.2.1. Phdc do diiu trj
Su dyng v^o buoi s^g luc d6i. Lilu six dung CO dupe bang each nh6 ir\tc tigp vdo dudi luai vd de yen trong vong 2 phut tnrdc khi nuot.
Bang 2.1 P h i c dA diAu trj LPMD d u i i n g d u 6 i lu»l v4i D pte ThI lin cdng (25 ngiy)
N g S y 1 - 4 1 - 3 - 4 - 6 g l Q l
NgSy 5 - 6 1 - 3 - 6 - 10 giot
N g i y 9 - 1 6 1 - 2 - 4 - 6 - 8 - 1 2 - 1 6 - 2 0 gipt
too IR/ml
NgSy 1 7 - 2 6 5 - 6 - 8 - 1 0 - 1 2 - 1 4 - 16 - 1 8 - 2 0 gipt
300 IR/ml Thi duy tri (300 IR/ml)
Bi^utiiduytri, liSudn djnh: MOt khi da dat di/pc, lieu toi da dupe s u dyng hcing ngSy nho 1 6 - 20 gipt nong dp 300 IR/mi
2.2.2. Bdnh gid thay doi cdc xet nghiem.
Thoi diem danh gia la sau 2 nam dieu tii lien tuc.
Dua vao mure dp tien trien ciia cac xet nghiem can lam sang:
•. Phdn irng phdn hdy ti bdo mast
* Nguyin ly: Dura vao su bien ddi hinh thai cua te bao mast dudi tac dung cua di nguyen va khang th6 IgE trong huyet thanh benh nhan. Sau khi da man cam, neu di nguyen lai xam nhap vao co thS se c6 sir ket hop di nguyen vdi khang the dac hieu gSn tren mang t6 bao mast. Phiic hpp nay lam tS bao mast bi phan hiiy.
•. Phdn itng tiiu bgch cau dgc hieu
* Nguyen /y.Phiic hop di nguyen khang the gin d mang te bap b^ch cau hat khi CP tac dpng cua bd thS s€ lam phan buy bach cau hat.
Phan ling dupe coi la ducmg tinh khi chi sd tieu bach ciiu dac hieu tir 10% trd len.
•. Dinh litgng IgE todn phdn trong huyit thanh
Ky thuat ELISA xet nghiem IgE trong huyet thanh dua tren nguyen ly banh kep (SANDWICH)
•. Dinh lirpng IgE dac hifu trong huyet thanh theo phiromg phap hoa phat quang
Nguyin ly: Cac bi polystyren gjn Streptavidin van nang se kSt hpp vdi cac di nguyen didu chS. Phiic hpp nay se gjn vdi IgE dac hieu trpng huyjt thanh tao thanh phiic hpp di nguyen - IgE dac hi$u. Sau dp phiic hpp nay se gin vdi khang th6 khang IgE cd danh dSu bang phiic hpp Ruthmium- Tris (bipyiridyl) va tripplylamin TPA. Sau 2 chu ky u nia, phan cdn lai ciia phiic hpp cd gan chat danh dau se dupe do hoat dp phat
Tap chl Tai MQI Hpng Viai Nam - Volume (57-9). N°3 - July, 2012
quang. Ket qua se dupe tinh ra don v| KU/L sau khi doi chieu vdi dudng cong chuan da dupe xay d\mg trudc khi c h ^ mau.
>. Djnh lugng IgG todn pllUn trong huyet thanh.
Nguyen li: Khtag the trong huyel thanh can dinh lupng ddng vai trd nhu mpt khing nguySn si ket hpp vdi cic khdng khdng the tao thdnh phiic hpp mien djch KN-KT. Sv kk hpp ndy t^o thdnh ket tiia lo liing mpt thdi gian vd ngudi ta do dupe bdng phuang phdp dp dp dye. Npng dp khdng the ty Ip
thu^n vdi dp dye va dupe doi chieu vdi mpt dung djch chuan cua khdng the cd nong dp biit trudc.
3. KfcT QUA NGHlfcN CCtl .^.1. Ddc diem chung nhdm nghien cihi.
Tren 45 b?nh nhan (18 nO vd 27 nam) VMDLT vdi D.pte chiing tdi gdp nhieu nhat d nhdm 16-29 tuoi cjhilm 53,3%, nhdm 40-49 tudi chiem 31,3»/Jr39-39 tuoi chiem 13,3% vd nhdm il nhat 50-55 tudi chiem 2,3%.
3.2. Hieu qua dicu tri vc mdt can lam sdng.
3.2.2. Cdc test in vitro u. Phdn Itng phan huy mastocyte.
Bdng 3.1 Sv phdn huy mastocyte tnrdc va sau diiu tn (%)
Miicad Tnrdc diiu tri Sau dieu tri
P
N 45 45
Thip nhdt 14
5
Cao nhdt 57 32
<0.001 X 31,96
17 (t=19.83)
SD 10.93
7.57
"
1.631.13 1 Sau didu tri midn dich ddc hifu, phdn Phdn tfch tren tdng bfnh nhan trudc va
1
ung phdn huy mastocyte d cdc bfnh nhan sau didu tri thay cd sy giam rd rft vdi cd sy thay ddi vl ty Id phan huy tu 31,96 ± p<0,01, t = 19,83.
10,93% xudng 17 ±7,57%.
b. Phdn ung tieu bgch cau dgc higu.
Bdng 3.2, Tidu bgch cdu ddc hi$u tn/dc vd sau difeu tn (%) MCrcdi}
Trudc dieu trj Sau diiu trj P
N 45 45
Thdp nhdt 14
3
Cao nhdt 55 34
X 30.89 16,64
SD 11.66
8,83 SE 1,74 1,32
<0.01 (t=17.9)
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Tap chi Tai MQI Hong Vi6t Nam - Volume (57-9). N°3 - July. 2012
Trudc diiu tri 100% b?nh nhan cd phdn img tieu bach cau ducmg tinh d cdc miic dp khdc nhau.
Sau 24 thdng dieu trj MDDH, khong con b?nh nhan ndo cd phdn iing tieu bach ciiu ddc hieu d miic dp4(-i-). Cd 11 bpnh nhan (24,44%) cd miic dp tieu huy b?ich c. Thay doi ham litgng IgE toin phin
Bdng 3.3 Hdm lupng IgE todn phdn (Ul/mi) trudc va sau didu tn cau ve am tinh.
Miic dp tieu bach cdu tir 30,89 ± 11,66 xuong cdn 16,64 ±8,83.
Phan tfch bang so sdnh trudc vd sau dieu tri tren timg bpnh nhan thdy cd su khdc biet ro rpt vdi dp tin cay tren 99% (t=
17.9)
Muc dp Tnrdc diiu tn
Sau diiu trj P
n 45 45
Thdp nhdt 161.9 78.1
Cao nhdt 1426.8
851.3
~
743,46 357,27
SD 393.77 234.52
SE 58.70 34.96
<0.001 (t=13.2) - Trudc dieu tri: Gid tri ciia IgE toan
phin huylt thanh thdp nhdt la 161,9 Ul/ml;
cao nhdt la 1425,8 Ul/ml.
- Sau dieu tri: Gid tri thdp nhdt cua IgE toan phdn huylt thanh la 78,lUI/ml, cao
nhat la 851,3 Ul/ml.
Phan tich thdy cd sy thay ddi ro rft tren tat ed cde bdnh nhan d thdi diem trudc vd sau didu tri 24 thang vdi dp tin cay tren 99% (t= 13,2);
d. Thay doi hdm lurgmg IgE dgc higu.
Bdng 3.4 Nong dd IgE (KU/I) ddc hifu tn/dc vd sau dieu trj Mi>cd$
Tnrdc diiu trj Sau diiu tii
P
n 45 45
Thdp nhat 0.65 0.24
Cao nhat 120.8
53,1
5c
40,74 10,14
SD 32,31 11,10
SE 4,82 1,65
<0.001 (t=8,37) Trude dieu tri: Gid tri ctia IgE dac
hieu huySt thanh thdp nhit Id 0,65 KU/1;
cao nhdt Id 120,8 KU/1.
- Sau dieu tri: Gia tri cua IgE ddc hieu trong huyit thanh thdp nhdt Id 0,24 KU/1,
cao nhdt Id 53,1 KU/1.
Cd su khdc biet rd ret tren cdc benh nhdn ve ndng dp IgE dac hieu trudc va sau dieu tri, s\r khdc biet cd y nghia thong ke vdi p <0,01 (t=8,37)
Tap cht Tai MQi Hpng Vift Nam - Volume (57-9). N''3 - July, 2012
c. Hdm lugng IgG todn phhn
Bdng 3.5. Hdm luyng IgG trdn b$nh nhdn trudc vd sau didu trj {mg%)
Tnrdc diiu trj Sau diiu trj
P
N 45 45
Thdp nhdt 808 1217
Cao nhdt 1318 2499
X 1010,16 1878,09
<C.001(t=26,07) SD 123.48 284,79
SE 18.41 42,45
- Trudc dieu trj: Gid trj cua IgG todn phdn huyit thanh thap nhat Id 808 mg%;
cao nhit Id 1318 mg%>.
- Sau dieu trj: Gid tq thap nhdt ctia IgG todn phan huyet thanh Id 1217 n\%%, cao nhat Id 2499 mg% .
Phdn tich thdy cd s\r thay doi rd rpt tren tat cd cdc benh nhan d thdi diim trudc vd sau dieu tri 24 thang, su thay ddi c6 y nghia thdng ke vdi p <0,01;
4. BAN LUAN
4.1. Dac diem chung nhdm bfnh nhan . VMDU cd chieu hudng bdt ddu tu liic cdn tre vd qua nhieu nam sau cdng trd nen xdu hon rdi gidm di vdo liic tudi gid.
Nghien cuu cua chung tdi phii hpp vdi cdc tdc gid P.B.Bpggs (2000) [1] 80% ngudi bj VMDU" da cd trieu chung ddu tien cua benh xudt hien trudc 20 tudi vd cd nhieu ngudi xudt hipn trudc 10 tudi; Noel Rodringuez [6], David P.Skoner [4] cho thdy trieu chiing VMDU' xudt hipn trudc tuoi 20 chiim 80% cdc trudng hpp, d tudi 2-3 chiim 20% vd khoang 40% d tre dudi 6 tudi.neu tren. Su phi hpp cua tdt cd cdc nghien ciiu trta day xudt phdt tir ca chi benh sinh cua VMDU. Yiu t6 nguy co bao gdm gen va mdi trudng sdng . Khi co the
da dupe di truyen khd ndng tgo ra khdng thi IgE vdi mOt chat gay dj iing (vi dp mat b\ii nhd) thi ngay khi ca thi tiep xiic vdi mpt so lupng dj nguyen vira dii, lap tiic ca thi tgo ra cdc khdng the IgE ddc hipu vdi dj nguyen dd. CJ lira tuoi thanh thiiu nien, ddy Id luc CO thi cd hp thong miln djch hodn chinh di sinh ddp img khdng thi manh nhdt vd VMDU the hipn rd rdng nhat. Liia tuoi nhd hodc cao tuoi, ddp img mien djch hodc chua hodn thipn hodc da bj gidm siit nen ty Ip mdc bpnh it han. Tuoi cdng cao, ty Ip viem miii mdn tinh khdng do dj iing chiim vj tri noi d-pi do rdi loan than kinh tu chu tai mui va tdn thuang niem mgc miii do cdc yeu td mdi trudng khdc nhu hod chit dpc hai, 6 nhiem khdng khi, vi khudn, vi riit..
Nghien ciiu ciia chiing toi ciing nhu cua David P.Skoner [4], Dodn Thj Thanh Hd [2], Vu Thj Minh Thuc [3] tren cac bpnh nhan viem miii dj img cho thdy khdng cd s\f khdc bipt giua nam vd nO.
4.2. Sir thay doi cac test in vitro tren bfnh nhan vieemmuix di irng dir^c diiu trj mien djch ddc hifu dirdng dirdd Iir&i
a. Phdn ling phan hdy mastocyte.
Day la phuang phap gidn tiip dinh lupng IgE dac hieu. Phdn umg tiin hdnh don gidn, it tdn kdm va cdn gia tri di chin 80
Tap chl Tai Mui Hpng Vidt Nam - Volume (57-9). N°3 - July, 2012
dodn bfnh di ung ndi chung vd VMDU"
ndi ridng.
Ket qud cua chdng tdi sau 24 thdng diiu tri MDDH, phdn ung phdn buy mastocyte d cac bfnh nhan VMDU" do DN D.pte thay cd su gidm ro rft vdi p<0,01, t= 19,83
Kit qud Dodn Thanh Ha [2] Id 72/80 BN (90%) cd ket qua phdn huy mastocyte duong tinh, trong dd duong tinh dp mpt chilm tdi 62,5%. Theo cdc tdc gid thi ty If thodt hgt tren 10% (da trd chung di nguyen va chdng huyet thanh) duoc xem Id duong tinh, tuy nhien trong nhihig trudng hprp nghi van cdn ldm lgi xet nghifm vi cd nhieu yeu td anh hudng den ty If te bao thodt hgt dan den kit qua sai lech, ddc biet trong trudng hop ty If phan huy mastocyte thap dudi 20%.
b. Phdn ung tieu bgch cdu dgc hiiu.
Tnrdc didu tri 100% bfnh nhan ed phdn img tieu bgch cdu duong tinh d cdc mdc dp khac nhau.
Sau 24 thang diiu tri MDDH, khdng con benh nhan ndo cd phdn dng tieu bgch cau dge hifu d mdc dp 4(+). Cd 11 bfnh nhan (24,44%) cd muc dp tidu buy bgch cdu vl am tinh.
Muc dp tieu bgch cdu Id 30,89 ± 11,66% xudng cdn 16,64 ± 8,83%.
Kdt qua cua nghidn cdu chi sd tieu bach cau dge hidu va phan huy TB mastocyte Id httmg duang vdi kdt qua nghien cuu cua VuMinh Thuc [3].
c. Thay doi hdm lugng IgE todn phdn Ddp dng dieu hod tdng hpp IgE la dgc trung cda bfnh VMDU". Do dd, nhdng thay doi vd ddp ung mien dich do hifu qua cua MDLP mang Igi da cd tdc dpng len co chd tdng hpp IgE. Theo mpt sd tdc gia [3], [5],[7], [8], dieu tri mien dich dj nguyen ddc hifu cd tde dung cai thifn trifu chdng lam sang vd lam thay ddi ddp dng miln dich dgc hifu vd khdng dac hifu d BN VMDU*. Gidm tdng hpp IgE ddi vdi bfnh di dng la mpt ddp dng tdt vi giam hien tugng viem di dng do IgE gay nen. Hifu qud cua MDLP thd hifn ro nhat tren sir thay ddi cua IgE ddc hieu huylt thanh.
Nghien cdu tren 30 benh nhan duoc didu tri midn dich lieu phap dudng tiem bang di nguyen bui nhd cua Doan Thi Thanh Hd [2] cho ham luong IgE trudc diiu la 475,51 ± 312,30 lU/ml, sau didu tri la 311,98 ± 227,23 lU/ml. Nghien cdu tren 43 bfnh nhdn duoc didu tri mien dich lifu phdp bdng di nguyen Idng vd dudng nhd dudi ludi ciia Vii Thi Minh Thue [3] cho hdm luong IgE trudc diiu la 583,46 ± 389 lU/ml, sau 24 thang diiu tri Id 298,03 ± 225,09 lU/ml.
Trong nghien cdu cua chung tdi thdy cd s\r thay ddi tren tit cd cdc bfnh nhdn d thdi dilm trudc vd sau diiu tri 24 thang vdi dp tin cay tren 99% (t-13,2);
d. Thay ddi hdm lugng IgE dgc hieu Cung vdi su tang ndng do IgE toan phan thi cd mdt sd luong IgE ddc hifu, cde khang thd ndy kit hpp vdi di nguyen phu hpp. Ket qud dinh lupng ndng dp cac khang thd IgE
Tap chl Tai Miii Hpng Vidt Nam - Volume (57-9). N°3 - July. 2012
dac hipu trudc vd sau dieu tri MDDl 1 mpt trpng nhihig yiu t6 quan trpng di ddnh gid hipu qud ciia phuong phdp diiu trj.
Trpng ngliien cim cua chiing toi cd s\r khdc biet rd rpt tren timg bpnh nhdn ve nong dp IgE ddc hipu tnrdc va sau dieu trj, sv khdc biet cd y nghia thdng ke vdi p <0,01 (t^8,37)
Nghien cim cua Vii Minh Thpc [3] sau diiu tri 24 thdng bang MDDH vdi dj nguyen DNLV nong dp 3001R/ml, hdm lupng IgE ddc hipu gidm nhieu tir 37,651 ± 32.844 (trudc dieu tri) xuong cdn 11,237 ± 9,994 KU/1 (sau diiu tri).
e. Thay doi hdm litgng IgG todn phan Co che ciia MDLP cho thiy sir tang sinh cdc khdng the thupc ldp IgG nay cd tdc dung bdo ve ca the: ngdn chdn khdng cho IgE gdn vdo cdc te bdo mast vd basophil do dd khdng gay ra hipn tupng thodt hat ciia ti bdo.Vi vay tang tdng hpp IgG Id mpt phdn trong ddp ling cd Ipi do MDLP mang lai [3],[4], [5].
Ohashi - Y, Nakai - Y vd cdng s\t [7] da tim hieu tien trinh tu nhien cua lgG4 vd IgE d nhOng benh nhdn VMDU md khong dupe dieu tri (theo ddi 8 nam). Cdc tac gid ndy thdy rang, nhihig bpnh nhan VMDU md khdng dupe dieu tri thi khdng cd sv thay ddi ddng ke ciia hdm lupng IgE ddc hipu vd IgG4 trong suit thdi gian theo ddi. Tit dd, cac tdc gid nhan dinh rdng: sy gidm hdm lupng IgE vd tang IgG4 sau MDDH ro rang la ket qua eua su diiu biin mien djch cua CO thi ngudi benh bdi MDDH.
Nghien ciiu ciia Dodn Thj Thanh Hd [2]
trudc khi dieu trj cdc BN cd hdm lupng IgG trang blnh Id 1128,12 ± 138,70 mg/dl, sau dicu trj lupng IgG tdng len Id 1637,56 ± 236,93 mg/dl (p< 0,001).
Trong nghien ciiu cua chung tdi, sau 24 thdng diiu trj MDDH bdng DN D.pte thiy cd sv thay doi rd rpt tren tat cd cdc benh nhan d thdi diim trade vd sau diiu trj 24 thdng, sv thay doi cd y nghTa thong kg vdi p<0,01;
Dieu dd chimg td sau dieu trj MDDH bang dj nguyen D.ple, cdc bpnh nhan VMDU da tdng lupng khdng thi bdo vp.
Kit qud ndy ciia nghien cim Id tuong dirong ket qud dieu tri cua cua Vu Minh Thyc, Phgm Vdn Thirc [3] , E)oan Thj Thanh Hd [2] khi diiu trj VMDU bang dj nguyen bsii nhd theo dudng tiem dudi da vd long vii theo dudng nhd dudi ludi.
S. KET LUAN
Ket qud nghien cuu sau 24 thdng dieu tri budc ddu cd hipu qua rd rpt Irftl cdc x6t nghipm in vihx), s\f thay ddi IgE va IgG hrong dong vdi sv bien ddi phdn iing phan huy mastocyte Id bdng chiing khdch quan chimg td ddp img miln djch da thay ddi, khdng thay trudng hpp ndo cd tai biin phdi dimg dieu tti. Hon nira dudng diing la dudng dudi luoi nen khdng gay khd khdn eho bpnh nhan ttong qud trinh diiu tri lau ddi ke ca ttong nhirng trudng hpp benh nhdn phdi di xa CO sd y ti 1-2 tudn. Chi sau 2 tudn dupe hudng dan cdn k5 vi cdch svt dvng thuoc benh nhdn da tv diiu tri tgi nhd ma khdng can phai din ca sd y ti nhu trong eac ttudng hpp diiu tti bang dudng tiem. Diiu 82
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ndy cdng khdng dinh diiu trj VMDLT do DN D.pte bdng MDDH dudng dudi ludi vdi ndng dd 300 IR/ml Id an todn vd hifu qua ca vl mgt diiu tri vd kinh te nhu mpt so tdc gid trong vd ngoai nude da khuyin cdo.
TAI LI?U THAM KHAO 1. Boggs. P.B. (2000), Viem mdi di img, Tdi
lifu djch tidng Vift, Nxb Y hpe, Hd Npi.
2. Dodn Thj Thanh Hd (2002), Nghien cuu chdn dodn vd diiu tri w/e« dich vim mm df ung do di nguyen bui nhd.
Luan an Tien sT Y hpc, Vifn Vf sinh dich te Trung uong. Ha Ndi.
3. Pham Vdn Thuc, Vu Minh Thuc, Nguyen Trpng Tai, Nguyen Van Yen, Huynh Quang Thugn, Vu Thi Tudng Van, Doan Mai FhuoTig (2011), Miin dich dgc hieu bdng di nguyen,tap 1-2, Nxb Y hpc.
4. David P.Skoner (2001), Allergic rhinitis:
Definition, epidemiolgy, pathophysiology.
detection and dianosis, J Allergy Clin hnmunol, 108: S2-8.
Giovanni Pasalacqua, Erkka Valovirta, Ranny Van Weissenbruch, Franco Frati, Cristoforo Incorvaia, Paola Puccinelli (2007), Sulingual specific immunotherapy, Sinergie S.r.I.
Noel Rodringuez-Perez, Jose A Sacre-Hazouri, Maria d'J Ambriz- Morcno (2011), Allergic rhinitis- clinical pathophysiology, diagnosis and treatment, US Respiratory disease, 7 (l),pp.53-58.
Ohashi Y., Nakai Y., Ikeoka H.
(1989), "Increased ciliary beating frequency of nasal mucosa following immunotherapy for allergy", Ann. Otol.
Rhinol. Laryngol., May, 98 (5pt 1), 350-4.
Richard F. Lockey, Dennis K.
Ledford, (2008), Allergens and Aller gen Immunotherapy, fourth edition.
Publisher: Informa Health Care.
