Tap chl Y Dugc Hoc - Tru&ng Bai hgc Y Dugc Hue- Tqp 6, si 6- thdng 1/2017
MOT so YEU T 6 NGUY CO CUA B I N H TAY CHAN MIENG NANG
Thai Quang Hdng', Binh Thanh HuV, Trdn Binh Binh' (1) Nghien c&u smh Tru&ng Dgi hgc Y Duqc - Dgi hgc Hui
(2)Tru&ng Dgi hgc Y Dugc - Dgi hoc Hui Tdm tat
D|t van de: Bgnh TCM la bgnh truyen nhilm do enterovirus gay ra. Bgnh lanh ti'nh va t y gidi hgn trong vdng 7-10 ngay. Tuy nhien, trong mdt sd trUdng hpp bgnh diln tien ngng vdi cac biln eh&ng than kinh, tim mgeh v i cd the t& vong nlu khdng dupc phat hign v i dieu trj kip thdi. Nhgn ra mpt sd yeu td nguy ea eua bgnh tay chan migng ngng l i rit quan trpng. Dya vao cic yeu td nguy ea nay, cie bie sT b tuyen y te ea sd cd the nhanh ehdng phan logi bgnh nhin tay chin migng va ed t h i i dp x& ly thich hpp: ehuyen bgnh nhin tay chin mieng cd nguy ea cao xuat hign biln ch&ng vao bgnh vign sdm de theo doi chgt che v i x& Vj tilp theo, trong khi nh&ng nguo'i ed nguy ca thap cd t h i dupe eham sde ngogi tni sau khi giao due v i t u van cho eha me bgnh nhi Odi tupng va phuang phap nghien c&u: Nghien c&u bgnh ch&ng dya vao bgnh vign dupc tien hinh tren 150 ca bgnh la benh nhan TCM ngng {t& 2b trfif len), 150 ca ch&ng la bgnh nhan TCM nhe (dp 1,2a) vdi tigu chi kit ddi theo nhdm tudi, gidi tinh, dan tfie va dja ban cu trO. Ca ca bgnh va ca ch&ng deu nhap vign dilu tri tai eOng mpt bgnh vign va duang tinh vdi EV hogc EV71 (ky thuit PCR). Nhdm benh va nhdm ch&ng dupc so sinh vdi nhau ve cac y l u td cd the anh hudng den m&c dp ngng cua benh TCM Kit qua: Tieh hoi quy logistic eho thay eae yeu td nguy ca trude khi tre nhgp vign dieu trj: la suy dinh dudng, khfing dupe bu me hoan toin trong 6 thing dau, hpc van cua me thap va cham sdc tre dm chua tdt; cae y l u to nguy ca khi tre nhgp vign dieu trj: dinh nhigt > 39°C, khfing cd diu hieu loet d mieng, bgnh s&gigt minh, tang bgch cau va tae nhan gay benh l i EV71. Ket lu^n: Nh&ng ylu td lam gia ting nguy ea mac TCM ngng bao gom: suy dinh dudng t h i thap cdi (OR=l,84 - KTC9S%: 1,05-3,22); khdng dupc bu me hoin toin trong 6 thing dau {OR^2,03 - KTC95%: 1,08-3,84); hgc van eua ngudi me thap (OR=2,77 - KTC95%: 1,06-7,28); nhdm b i me ehim sdc tre dm chua tdt (OR=3,93 - KTC95%: 2,40-6,44); dinh nhigt > 39°C {OR=3,63-KTC95%: 1,91-6,90); Khdng ed dau higu loet migng {OR=2,45-KTC95%: 1,28-4,69); Benh s& gigt minh (OR=9,93-KTC95%: 4,89-20,14); Tang bach cau a 11,0 (K/pl) (OR=2,52-KTC95%-1,36-4,69); Benh nhan nhilm EV71 (OR=2,46-KTC95%: 1,29-4,69).
T& khda: yiu td nguy ca, binb tay chdn miing ngng Abstract
RISK FACTORS
FOR HAND-FOOT-AND-MOUTH DISEASE
Thai Quang Hung', Dinh Thanh Hue', Tran Dinh Binh' (l)PhD student of Hue University of Medicine and Pharmacy ~ Hue University
(2) Hue University of Medicine and Pharmacy Background: HFMD is an infecti'ous disease caused by enterovirus. The disease is benign and self-limiting within 7-10 days. How^ever, in some cases, the disease progresses to severe neurological, cardiovascular complications and can be fatal if not detected and treated in time. Identifying some risk factoid of severe HFMD is very important. Based on these risk factors, doctors at grassroots level can quickly classify HFMD patients and adopt appropriate handling approaches: either transfer HFMD patients at high risk complicati'ons to the hospital early to closely monitor for subsequent treatment, while those with low risk ean be given outpatient care after counseling patients' parents. Methodotagy: A case-control study based on hospital was conducted in 150 eases of severe HFMD (from level 2b or higher) and 150 eases of mild HFMD (level 1, 2a), matching by age, gender, ethnicity and area of residence. Both cases and controls were hospitalized at the same hospital and were positive for EV or EV71 (PCR). Cases and controls were compared in terms of factors which can affect the severity of HFMD. Results: Logistic regression showed that the risk factors before patients' hospitalization included: malnutrition, not exclusive breastfeeding in the first 6 months, low maternal education, and poor care for sick children. The risk factors after patients' hospitalization Included: peak temperature £ 39°^ with
B'mh Binli^mail tdbinh dhyd@gmait cc 10/12/2016; Nadv dSni^^nw2lA2^m!M
|l2S JOURNAL OF MEDICINE AJ
Tqp chi Y Dugc Hqc - Tru&ng Bpi bpc Y Dugc Hui- Tgp 6, so 6 - thdng 1/2017 no signs of mouth ulcers, startling history, increase of leukocytosis, and EV71 as pathogen. Conclusion: Factors increasing the nsk of severe HFMD include stunting malnutnti'on (OR = 1.84 - 95% Cl: 1.05 to 3.22); not be exclusively breastfed for the ft rst 6 months (OR = 2.03 - 95% C|-108 to 3.84); Low maternal education (OR = 2 77 - 95% Cl: 1.06 to 7.28); poor maternal care for patients (OR = 3.93 - 95% Cl: 2.40 to 6.44), peak temperature 5 39oC (OR = 3.63 95% C1-: 1.91 to 6.90); No signs of oral ulcers (OR = 2.45 95% CI-. 1.28 to 4.69); Startling history (OR ^ 9.93 95% C1-: 4.89 to 20.14); increase of leukocytosis > 11.0 (K/pl) (OR = 2.52 95% CI-. 1.36 to 4.69); EV71- infected patients (OR = 2.46 95% C1-. 1.29 to 4 69).
Keywords: risk foctors, severer hand-foot-mouth disease l.DATVANOt
Bgnh tay chin mieng la bgnh thudng gap dtre em vdi dgc trung la sdt nhe kem phit ban dien blnh dgng san mun nude b ldng ban tay hoae Idng ban chan, ed hoae khfing cd loet mieng. Hau het cac trudng hpp bgnh deu diln bien nhe. Tuy nhien, trong mfit so trudng hpp, bgnh cd the diln bien ning va giy ra nh&ng bien ch&ng nguy hilm nhu viem nio-ming nao, vigm ca tim, phii phfii cap dan den t& vong neu khdng duoc phit hien sdm va dieu tn kjp thdi [10].
Bgnh tay ehan migng hign dang la van de s&e khde cdng cfing d Viet Nam. Th& nhat, day la benh truyin nhilm mdi ndi trong mdt khoang thPi gian gan day vdi sd mac cao, trong dd cd mdt sd trudng hop xuat hign bien ch&ng va mfit sd it trudng hpp gay t&vong, gay lo lang cho ngudi dan va gay qua tai cho eae bgnh vign vdn da qua ddng. Th& hai ta cae thdng tin ve bgnh tay chin mieng b Vigt Nam cdn it, dac biet la nh&ng yeu td anh hudng din m&e do ning nhe ei!ia benh tay chan mieng. Trong bdi canh nhu vgy, ehung tfii thyc hien de tai nay nham. tim hieu nh&ng yeu td liln quan din tinh trgng ning ciia benh tay chan mieng.
2. D 6 | TU'gfNG VA PHU'ffNG PHAP NGHIEN CLTU 2.1. odi tuang nghien e&u: tre dudi 5 tufii, mac benh tay chin migng nhip vign dieu trj.
2.2. Thiet ke nghien c&u; nghien c&u benh ch&ng dua vio bgnh vign Ca bgnh la nh&ng bgnh nhan mac TCM ngng nhgp vign dilu trj tgi benh vign Bing 3.1. Die diem ket ddi gi&a
da khoa tinh Dak Lak va bgnh vign Nhi Ddng Nai. Ca eh&ng la nh&ng bgnh nhin mac bgnh TCM nhe nhip vien dieu tn tai eung benh vign.
Dinh nghTa ea bgnh: (i) cd trigu eh&ng tam sang ciia benh tay chan mieng nhu sdt, phat ban dang munnudcdtay, chan, migng cd kem loet hpng hoae khdng; (ii) dupe xae dmh m&e dp ngng (2b trd len) theo tieu chuan eiia Bd Y te (iii) ed xet nghiem PCR duang ti'nh vdi enterovirus Dinh nghTa ea ch&ng: (i) cd trieu ch&ng lam sing ciia bgnh tay chan migng nhu sdt, phat ban dang mun nudc dtay, chan, migng ed kem loet hpng hogc khdng; (ii) dupc xac djnh m&c dfi nhe (do 1 v i 2a) theo tifiu ehuan eua Bp Y te (iii) CO xet nghiem PCR duang ti'nh vdi enterovirus.
Ca eh&ng dupe kit dfii vdi ea bgnh theo nhdm tudi, gldi ti'nh, dan tfic va dia ban eu tru.
Nhdm bgnh va nhdm ch&ng dupe so sanh vdi nhau ve eae yeu td ed the anh hudng den m&c dp nang ciia benh. Cac yeu td anh hudng den m&e dp nang benh cd the chia thinh hai nhdm: nhdm cae yeutd trude khi tre mac bgnh TCM va nhdm cae yeu td khi tre mac bgnh TCM v i nhip vien dilu trj.
X&ly sdlieu: s& dyng phan mem Stata 10.0, ti'nh ty Ig phin tram, ty sd sd chgnh (OR) va khoang tin cgy 95% eiia OR eho phan ti'ch dan bien va da bien (hdi quy logisti'e).
3. KET QUA
3.1. Oge dilm kit ddi cua nhdm bgnh v i nhdm ch&ng
nhdm benh va nhdm ch&ng
TUOI (thang) Gi6i ti'nh Dan tpc Noi Cl/ tru
<12 12-35 36-59 Nam Kinh Dan tdc Thanh pho Nonathon
Nhom b#nh (150) Tan so
22 110 18 101 49 136 14 58 92
%
14,7 73,3 12,0 67,3 32,7 90,7 9.3 38,7 61.3
Nhom chi>ng (150) Tan so
22 110 18 101 49 136 14 58 92
%
14,7 73,3 12,0 67,3 33,7 90,7 9,3 38,7 61,3
Gia trj p
>0,05
>0,05
>0,05
>0,05
JOURNAL OF MEDICINE A( 1291
Tap chi Y Dugc Hoc - Truimg Dgi bgc Y Duvc Hue - Tip 6, si 6 - thdng 1/2017 3.2. Cac ylu to liln quan €en tinh trgng nang ciia benh tay chan migng
D l tim hieu eic mdi liln quan gi&a cic yeu td va bgnh nghign e&u, chung tdi xep cae yeu td nghien c&u thanh cie nhom:
(1) cic yeu td thudc ve mdi trUPng gia dinh (2) cic y l u td trudc khi tre mac bgnh (3) cae yeu td ngay khi nhgp vign khim v i dieu tri Va dudi day la eic mdi lien quan theo cac nhdm ylu td nghiin c&u
Bang 3.2. Lien quan gi&a cae yeu td thufic ve gta dinh mdt trudng va mac TCM ngng Yeutd
Dign ti'eh nha b binh quan Logi nen/sin nha Loai nudc sinh hogt Loai hdxis&dung
Oan vj so sinh
< 20mVngudi Xi mang/dat Nude gieng/ho
Khdng hpp VS OR 1,45 1,30 1,36 0,82
KTC95%
0,89-2,35 0,53-3,29 0,79-2,34 0,31-2,15 Cae yeu td thufic gia dinh mdi trudng khdng lien quan den tinh trgng ngng cua benh TCM.
Bing 3.3. Phan ti'eh dan bien: lien quan gi&a cie yeu td trudc thdi diem nhip vien va mac TCM nang Ylu tfi
Sinh non (tudi thai) Thilu cin sa sinh (gr) Th&tu sinh tre So eon trong gia dinh Suy dinh dudng the gay com Khdng bu s&a me hoan toin (6 thing dau) Tiem chimg khdng day dii
Tiep xiic nhdm (nha tre) Cham sdc tre dm ehua diing Khdng khim ban dau/ty y mua thuoc Hoc van eiia me (tilu hpe trd xudng) Nghe nghigp me (tam nfing)
Oan vj so sanh
< 37 tuan
< 2500 gr Con th&
>3 Cc Cc Cc Cc Cc Cc Cc Cc
OR 1,30 1,24 0,85 1,49 2,27 1,84 1,33 1,06 4,12 1,63 2,96 0,97
KTC95%
0,53-3,29 0,45-3,49 0,53-1,38 0,68-3,34 0,89-6,27 1,05-3,24 0,76-2,34 0,65-1,71 2,48-6,87 1,02-2,60 1,14-8,59 0,60-1,58 Khi xet don le t&ng yeu t d trong eae nhdm
trude khi tre mac bgnh TCM eho thay cie y l u td:
(1) Khdng dupc bu me hoan t o i n trong 6 thing dau sau sinh, (2) Suy dinh t h i thap cdi, (3) hpe
van cua me thap; (4) eham sdc tre dm chua dung;
(5) khdng tdi kham ban dau tgi ea sd y te l i eae yeu td lam gia tang kha nang mac benh tay chin migng nang.
Bang 3.4. Phan ti'ch da bien (hdi quy logistic): lien quan gi&a cac ylu to trudc thdi diem nhgp vien va mae TCM ngng
Yeutd
Khdng bil s&a me hoan t o i n (6 thing dau) Suy dinh dudng thap cdi
Hpc van eua me thap Cham sde tre dm chua day dii
Opn vjso sinh Cd Co Cd Cd
OR 2,03 1,84 2,77 3,93
KTC95%
1,08-3,81 1,05 - 3,22 1,06 - 7,28 2,40 - 6,44
I 1 3 0 lOURNALO
Tgp ch! Y Duvc Hgc - Tru&ng Bgi hqc Y Dugc Hue- Tdp 6, so 6- thdng 1/2017 Co 4 yeu to nguy ca dfic lap l i m gia tang nguy ca mac bgnh TCM ning la: (1) khdng bii me hoan toan trong 6 t h i n g dau; (2) suy dinh dudng the thap cdi; (3) hoc v i n cua me t h i p ; (4) eham sdc tre dm chua day dii.
Bing 3.5. Dge diem lam sang nhdm bgnh va nhdm ch&ng D i u hieu lam sing
(1) Sdt eao {> s g x )
(2) Sdt keo dai (a 38.5°C & >3 ngay) (3) Loet migng
(4) Ndn dl (5) Bgnh s& giat minh (6) Tigu chiy
Nhdm bgnh Tansd
123 105 74 19 135 20
%
82,0 70,0 49,3 12,7 90,0 13,3
Nhom ch&ng Tan sd
62 28 119 9 61 23
%
41,3 18,7 79,3 6,0 40,7 15,3
Gii tri p
<0,05
<0,05
<0,05
<0,05
<0,05
>0,05 Nh&ng dau higu chi xay ra d nhdm bgnh: run ehi, 11 bl, y l u ligt chi, eo giat, diu higu mang nao, dau higu mat nudc, maeh nhanh, thd nhanh, shock
Nhdm bgnh va nhdm eh&ng cd 6 dau hieu lim sang vdi ty le xuat hign khic nhau; trong khi dd, d nhdm bgnh edn ed them 11 trigu ch&ng khie, eung vdi ty Ig khae nhau. Cic dau higu cd d ea 2 nhdm cd the la nh&ng ylu td nguy ea va dupe dua vio phan ti'ch tim mdi lien quan.
Bang 3.6. Phan ti'eh dan bien: liin quan gi&a cie dau higu lam sang v i egn lim sang va mae TCM nang Ylu tfi
Dinh nhigt (>39"C) Sdt > 38,5''C va > 3 ngay Loet mieng Nfin di Bgnh s& giat minh Baeh eau (> 11,0 K/pl) Nhilm EV71
Dan vj so sanh Cd Cd Khfing
Cd Cd Cd Cd
OR 6,47 10,17 3,94 2,27 13,13 2,90 3,47
KTC95%
3,70-11,40 5,74-18,12 2,30-6,79 1,01-5,10 6,81-26,25 1,77-4,77 2,05-5,88 Trong phan ti'ch dan bien, cie y l u t d l i m sang v i cgn lam sang lam gia tang nguy ea mae TCM ngng la. (1) Sfit cao (> 39°C); (2) Sdt keo dai (> 38,5''C va keo dai tren 3 ngay); (3) Khfing loet mieng; (4) Bgnh s&gigt minh, (5) Ndn di; (6) tang bgch eau; (7) t i e nhan gay benh la EV71. Sau khi phan ti'ch da bien cic y l u t d nay v i loal bo nh&ng y l u t o khdng ed y nghTa thdng ke p > 0,05, ehung tdi dupc bang dudi day.
Bing 3.7. Phan ti'ch da bien eic yeu t d l i m sang-cgn lam sang va bgnh TCM ngng Yeu t o
1. Sot cao (S 39°C) 2. Khong toet m i i n g 3. Benh si> giat minh 4. Tang bach cau (2 11,0 K/ ni) 5. Tac n h i n gay b#nh ia EV71
Qdn vj so sanh Co Co Co Cd Co
OR 3,63 2,45 9,93 2,52 2,46
ICTC95%
1,91 - 6,90 1,28 - 4,69 4,89 - 20,14
1,36-4,69 1,29-4,69 Nhdn xet: t& bang 3.7 cho thay cic dau higu tam sing va cgn tam sing nhu sdt eao, khong loet migng, bgnh s& giat minh, tang bgch cau (> 11,0 K/pl), t i e nhin gay bgnh la EV71 t i nh&ng yeu t d nguy cP dfic l i p ddi vdi tinh trang ngng eiia bgnh tay chan mieng.
DPHARMACV 131 I
Top chi Y Dugc Hqc - Tru&ng Dqi bqc Y Duvc Hui -Tqp 6, si 6- thdng 1/2017
4 . BAN LU$N
4.1. Mfit sdyeu tdthudcvegia dinh mol trud-ng Trong nghien e&u nay, mpt sd y l u to thupe gia dinh mdi truPng nhu: dign ti'eh nha 6 binh quin, logi san/nen nha, logi nuPcsinh hogt, logi hdxi s&dung khdng lien quan vdi tinh trgng bgnh tay chin migng ngng. Nh&ng yeu t d dupc Met k l phia trgn ed le lien quan den kha nang mic bgnh TCM han la kha nang xuat hign benh TCM ngng.
4 . 2 . M p t SO y e u t d t r u d c t h d i d i e m t r e m a c b g n h T C M
- Bd s&a mf hodn todn trong 6 thdng dau:
trong nghign c&u cua chung tdi, tre khdng dupc bu me hoan toan trong 6 thing dau k l t& khi sinh cd kha nang mac bgnh TCM ngng gap 2,03 lan (KTC 95% t& 1,08 - 3,81) so vdi tre dupe bii s&a me hoin t o i n . Ket qua eiia chiing tdi cung phu hpp vdi k i t qua nghien e&u eiia Li va cfing sp [11] cho thay tre dupe bii me nguy ca mac TCM ngng giam xudng so vPi tre khdng dupe bii me (OR = 0,514, KTC 95% = 0,309-0,856). Them vao dd, mfit sd nghien e&u khac da xic djnh mdi lien quan gl&a bu s&a me hoan toan v i kha nang mac benh TCM nhu nghign e&u benh ch&ng dpa v i o cfing dfing ciia Lin va cfing sp [12) cho thiy bu s&a me cd k h i ning bio vg tre t r i n h (giam) mac bgnh TCM vdi 0R= 0,63 (KTC 95% = 0,47- 0,85); nghien c&u ciia Zhu va epng sp [17] cung cho ket qua tuang tp, tre duac bu me hoan toan gitip giam nguy ea mac bgnh TCM (OR = 0,401, KTC 95%
0,229 - 0,704).
6 Vigt Nam, theo mot sfi nghien e&u, t^ Ig tre khfing dupe bO me hoan t o i n trong 6 thing dau dao dpng tiiy theo khu vyc nghifin c&u t& 51,6% [6]
d i n 81,0% [4]. Mfit nghiin c&u gan day eiia Nguyin Van Thjnh d Lam Odng [2], ty le khdng duac bu s&a me hoan toan trong 6 thing d i u la 79,7%. Van de nay can dupe luu y trong cic chuang trinh truyen thfing giio due s&c khde ve lpi ich ciia s&a me trong 6 thing dau ciia tre trong vigc bao ve tre trudc cic bgnh truyen nhiem, trong dd cd bgnh tay chan migng.
- Suy sinh dudng: t r e suy d i n h d u d n g l i m gia t i n g nguy c a m a c cae benh n h i l m t r i i n g , t r u y e n n h i e m ngng h a n so v d i n h & n g t r e k h d n g bj suy d i n h duo'ng. Ket qua nghien c&u eua e h u n g t d i eho thay, suy d i n h d u d n g (dge b i g t la t h e t h a p cdi) cd nguy e a mac b g n h TCM nang g i p 1,84 lan (KTC 95%: 1,05- 3,22) so v d i t r e k h d n g bj suy d i n h d u d n g . T h e o Tang Chi T h u p n g va c d n g s y [5] t r o n g nghien e&u tien l u p n g bgnh T C M , eho t h a y k h d n g ed s u lign q u a n gl&a tinh t r a n g d i n h d u & n g va nguy c a bien c h & n g t r o n g n h d m nghien c & u . Ket q u a nay khac v d i k i t qua ciia e h u n g t d i , ed l l do t i c gia da phan chia tinh
t r g n g d i n h d u d n g t h a n h 4 n h d m ( b i n h t h u d n g , SDD n h e / t r u n g b i n h , SDD ngng, b e o phi) n e n k h d p h i t hign d u a c s u k h i e b i g t v e t y lg b g n h T C M b i l n c h & n g gi&a cac n h d m ( g i i t r i p = 0,06). N g h i i n c&u eua Nguyen Oinh Thoai [3] t a i b g n h v i g n Q u a n g N a m n a m 2014 cho t h a y ed s p lign q u a n gi&a suy d i n h d u d n g t h i n h e c i n v d i m & c d p ngng ciia b e n h T C M . - Trinh do hqc vdn cda ngu&i me: eung la m f i t y e u t d c d lien q u a n d e n tinh t r g n g n i n g cua bgnh T C M . Tre b n h d m ba m e c d hpe van t h i p ( m i l ch&
hogc bae tieu hpe) c d nguy c a mac TCM ngng eao h a n so v d l t r e t h u p c n h d m ba m e c d h p c van t &
THCS t r d len (OR = 2,77, KTC95%: 1,06-7,28).
- Th&c hdnh chdm sdc tre dm: khi t r e d m , vige e h a m sde va n u d i d u d n g t r e t r o n g giai d o a n nay cung i n h h u d n g rat n h i e u d e n tinh t r g n g n i n g cua bgnh.
Tre t h u d c n h d m b i m e ed t h u e hanh c h a m sdc khi t r e d m ehua t d t (kigng k h e m a n , u o n g , u t r e t r o n g c h a n , che b i l n t h & e an k h d n g p h d h p p ) c d nguy co mac TCM n a n g gap 3,93 lan (KTC95%: 2,40-6,44) so v d i t r e t h u p c n h d m ba m e cd t h y e h a n h eham sdc t r e d m t o t . K i t q u a n i y la c a s d c h o n h & n g c h u a n g t r i n h giao d y e s&c k h d e t i p t r u n g t u v i n c h o c i c ba m e each n u d i d u d n g va c h a m sdc khi t r e d m
4 . 3 . C i c d a u h i g u l a m s a n g , c | n l a m sang - Sd't tren 39°C: bgnh TCM t h u d n g c d sdt nhe kem t h e o n d i m g n n u d e b long ban tay, ban e h i n . Cf n h & n g t r u d n g h a p TCM n i n g , b g n h n h a n cd t h i n n h i g t cao h P n . Trong nghign c&u ciia c h u n g t d i , bgnh n h i n TCM cd s d t t r g n 39°C t h i kha nang xay ra b i l n c h & n g gap 3,63 l a n ( t & 1,91 d e n 6,90) so v d i bgnh nhan TCM c d s d t d u d i 39''C. K i t q u i c h o thay sdt t r e n SS'C la m d t tieu c h i quan t r p n g l i l n quan d i n b g n h TCM ngng va c i j n g phu h p p v d i nhieu nghign c&u cua e i e t a c gia khac n h u Yang va cs [16] (n=356;
OR=2,7; KTC 9 5 % = l , 5 - 4 , 8 ) ; Ooi va cs [13] (OR=2,3;
KTC 9 5 % = l , l - 4 , 5 ) ; Chang va cs [6] (OR=2,5; KTC 9 5 % = l , 2 - 5 , 8 ) ; Chen va cs [7] (OR=5,0; KTC 95%= 4,0- 6,3).
- Ddu hiiu loet & miqng cung la d i u higu hay ggp t r o n g b g n h T C M . Trong t o a n b p m a u nghien c & u , t y lg b g n h n h a n T C M k h d n g c d dau higu loet m i g n g ehiem la 3 5 , 6 % ( 1 0 7 / 3 0 0 ) (hay c d dau higu l o e t m i g n g l i 64,4%). Bgnh nhan T C M k h d n g kem l o e t m i e n g t h i k h i nang x i y ra b i e n c h & n g t a n g len OR=2,45 (1,28 d i n 4,69) so v d i b g n h n h i n TCM cd kem l o e t m i g n g .
Lien quan d e n d a u higu l o e t m i g n g va b i e n ch&ng ciia b g n h T C M , m f i t s d nghign e&u k h i c c u n g cd y nghTa t u a n g t y . Dau higu l o e t m i g n g l i m p t t r o n g n h & n g y e u t d lam g i i m nguy eo mae b g n h T C M ngng hogc t & v o n g . Nghign e&u ciia Tang Chi T h u p n g [5]
cho t h a y d n h d m ed bien c h & n g (n=200) t ^ lg c d
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Tqp chi Y Duvc Hqc - Tru&ng Dgi hoc Y Dugc Hui -Tdp 6, so 6- tbdng 1/2017
l o e t m i e n g e h i l m 5 6 , 5 % ; d n h d m khfing b i e n c h & n g {n=219) t y lg ed loet m i g n g l i 78,5%, s d ehenh OR = 0,6 (0,4-0,9). N g h i i n e&u eiia Chong va epng sU [9]
so sanh cae d a u h i g u l a m sang b n h d m TCM t & v o n g (n=7) v i n h d m T C M k h d n g t & v o n g (n=131) cho t h a y t y le cd l o e t m i g n g b n h d m t & v o n g do TCM la 57,0%, t r o n g khl d d t y l g nay d n h d m TCM k h o n g t & v o n g la 96,0%, s y k h i c bigt n i y cd y nghTa t h o n g ke v d i p <
0,05. Nghien e&u ciia Yang va cs t h i m chi edn cd k i t qua O R = 0 , 0 0 1 .
- Benh sd gigt minh: t r o n g n g h i i n c&u n i y , bgnh s& g i i t m i n h d u p c ghi nhgn qua n g u d i nha ciia bgnh n h a n ke lgi. Ket qua la bgnh n h a n T C M c d bgnh s& gigt m i n h t h i kha nang x i y ra b i l n c h & n g (2b+) gap 9,93 lan ( t & 4,89 d e n 20,14) so v d i b g n h n h i n TCM k h d n g cd b g n h s& gigt m i n h . T h e o Tang Chi T h u a n g va es [ 5 ] , t y Ig gigt m i n h d n h d m T C M ngng t i 9 0 , 5 % , b n h d m T C M nhe la 5 9 , 8 % (OR=6,3, p <0,05), t y Ig gigt m i n h t & nghien c&u cua ehung t d i thap b a n , cd t h e la d o s$ b g n h n h i n T C M d b e n h vien c h i i n g t d i nhe h a n so v d i b g n h v i e n Nhi d o n g 1 . Tuy vay, k i t qua ehung van cho t h a y cd m f i i hen q u a n gi&a t r i g u c h & n g g i i t m i n h v d i bgnh TCM n g n g . K i t qua nay cung p h u h p p v d i n h & n g nghien e&u k h i e eho rang b g n h s& gigt m i n h la m p t dau higu eanh b i o k h i n i n g b g n h ehuyen sang tinh t r a n g n a n g , ed bien ch&ng [ 1 4 ] .
- Tang bqch cdu: bgnh nhan TCM ed bgch cau t i n g (> 11,0 K/pl) t h i kha nang xuat hign bien eh&ng cao gap 2,52 ian { t & 1,36 d e n 4,69). Bgch cau t a n g t r o n g cac t r u p n g h p p nang d u p e m p t so t i c gia cho rang c d l i l n quan d e n p h i n &ng v i e m . Bgnh nhan cang nang, phan &ng v i e m cang n h i l u v i bgch cau t a n g .
- Tdc nhdn gdy bqnh: t i c n h i n gay b e n h T C M la n h d m virus d u P n g r u p t (Enterovirus) t r o n g d d t h u d n g ggp n h a t la CV A 1 6 v i EV71. Do d i e u k i i n ky t h u i t , t r o n g nghign c&u nay, c h u n g t d i chi xae d j n h EV71 va c i c EV k h i c (khdng phan logi). Ket qua cho thay, bgnh nhan T C M do EV71 cd nguy cP x u a t
hign b i l n eh&ng ngng cao h a n gap 2,46 l l n (1,29 d i n 4,69) so vdl b g n h n h i n n h i l m c i e EV khac. 6 Vigt N a m , nghien e&u cua N g u y i n Thi Thanh Thao va es [1] ve tae nhan gay b e n h T C M nang d khu v y c phia n a m n a m 2011-2013 cho t h a y EV71 l i t i c nhan ehiem u u t h e gay bgnh TCM ngng v i t & v o n g so v d i e i c EV khae d k h u v u e phia n a m . Trong 200 m l u xet n g h i g m d u a n g ti'nh vdi enterovirus, EV71 ehiem 95%, c i e EV k h i c n h u CA6, CA12, CA24, CoxB3 va Rhinovirus ehiem 5% con Igi. K i t qua ciia chiing t d i eung p h i i h p p vPi k i t qua ciia m f i t sfi t i e gia khae t r o n g khu v y c : Yang va cs [16], Fang va cs t r o n g m f i t nghi&n c&u gfip [ 9 ] .
S.K^LUAN
6 eiing d p t u d i , eCing g i d i ti'nh, cilng dan tpc va ciing nai e u t r u , t r e mac b g n h tay chan m i g n g cd n h & n g yeu t d sau day l i m gia t a n g kha nang mac b g n h tay e h i n m i g n g n a n g :
5 . 1 . Nh&ng y l u t o dinh d u & n g
- suy d i n h d u d n g t h e t h a p cdi (0R=1,84 - KTC95%: 1,05-3,22)
- khdng d u p c bu me hoan t o a n t r o n g 6 t h i n g d a u (OR=2,03 - KTC95%: 1,08-3,84)
Nh&ng yiu td thubc bd me
- hpc van eua n g u d i me t h a p (OR=2,77 - KTC95%: 1,06-7,28)
- n h d m ba m e c h a m sde t r e d m c h u a t d t (OR=3,93 - KTC95%: 2,40-6,44)
5.2. Nhu'ng yeu t d lam sang va c | n lam s i n g - sdt > 39°C {OR=3,63 - KTC95%: 1,91-6,90) - k h d n g c d loet m i e n g (OR-2,45 - KTC95%: 1,28- 4,69)
- b g n h s& gigt m i n h {OR=9,93 - KTC95%: 4,89- 20,14)
- t a n g bgch c l u > 11,0 (K/pl) ( O R = 2 , 5 2 - KTC95%:
1,35-4,69)
- b g n h nhan n h i l m EV71 (DR=2,46 - KTC95%:
1,29-4,69)
TAI UEU T H A M KHAO
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