NGHIEN cCru KHOA HOC
DAC DIEM LAM SANG
^VA CAC YEU TO UEN QUAN DEN BENH HERPES SINH DUC TAI BENH VIEN DA UiU TRUNG UONG
Le Huyen My*, Tran Lan Anh*'
TOM TAT
Muc tiiu: khao sdt dgc diem Idm sdng vd cdc yeu to lien guan den herpes sinh due tgi benh vien Da lieu Trung uang.
Ket qua: tU thdng 1 -10/2010,c647 benh nhdn loet sinh due do herpes gom 31 nam, 16nU. Nhom tuoi chiem ti le cao nhdt tU30 - 39 tuoi. Cdc trieu chUng cO ndng hay gap nhdt Id bong rdt 57,4%, dau 46,8%o, ngda 3 l,9%o. Phdn Idn vet loet co hinh bau due 63.8%o, mem mgi 100%) vd nong 93.6%o, dich trong 66%o.
Hach ben to chu yeu gap d benh nhdn herpes sinh due tien phdt 72,7%o. 72.3%o benh nhdn khong eo thoi quen sddung bao cao su khi guan he tinh due.
Tdkhda: herpes sinh due, HSV, LTQDTD.
I. DATVANDE
Herpes sinh due la benh li loet sinh due gay nen do virut herpes simplex (HSV). Trong giai doan hien nay, herpes sinh due la mdt benh thPdng gap nhat t r o n g cac loet sinh due do nhiem t r u n g lay truyen dPdng t i n h due (NTLTQOTD), khoang 70-80% cac t r a d n g hpp [5]. Nhiem HSV sinh dpc la nhiem sudt ddi vi virus theo dPdng than kinh cU trd tai cae te bao hach cam giac canh cdt sdng gay nen nhdng d p t tai phat sau nay. Nhieu trPdng hpp, herpes sinh due ed the khdng bieu hien trieu chdng lam sang nhPng van cd kha nang lay truyen virus. Vi the tai phat benh, tam li
*Bcnh vien Da lieu Trung irong
* * /id mdn /)i/ /n y/ Tnn'nii/ Diii /loi • ) Hd. \ di
lo lang, cang t h a n g , cam giac dau rat, ehi p h i dieu trj la n h d n g van de anh hPdng tdi chat lapng cudc sdng cua ngPdi benh. Nhiem HSV sinh due cdn lam tang nguy co lay nhiem HIV.
Ngoai ra, herpes sinh due ed the anh hPdng den phu n d mang thai, nhat la n h d n g t r a d n g hpp nhiem d 3 thang cudi thai, gay nen cac hau qua nghiem t r p n g cho thai nhi nhP xay thai, thai chet iPu, di tat bam sinh hoac gay nhiem herpes d tre so sinh vdi ti le t d vong cao. 6 Viet Nam, sd eae t r a d n g hpp nhiem herpes sinh due dang gia tang, tuy nhien tai Benh vien Da lieu Trung PPng chPa cd de tai nao nghien edu ve van de nay. V~i vay c h u n g tdi tien hanh de tai vdi muc tieu:
Khao sdt dde diem Idm sdng vd cdc yeu to lien quan den benh herpes sinh due tren benh nhdn
S6 03 (Thang 01 / 2011) D A L l E U H O C 3 9
NGHIEN CUtJ KHOA HOC
den khdm tgi Benh vien Da lieu Trung uang td thdng 1-10/2010.
II. DOI TUONG VA PHUONG PHAP NGHIEN CCU 1. Doi tUtfng nghien cuTu
La benh nhan cd loet sinh due hPdng de'n eae benh LTQDTD de'n kham tai Benh vien Da lieu Trung PPng td 1 -10/2010.
-Tieu chuan chpn: la benh nhan herpes sinh due dPpe phat hien nhd PCR, ed hoac khdng kem hach to; khdng phan biet tudi, gidi; ddng y tham gia nghien cdu.
- Tieu chuan loai trd: benh nhan ed loet sinh due khdng do cac benh LTQDTD: di dng thudc, do cac benh da bpng nPdc tp mi§n, do ung thp da xac dinh tren lam sang; benh nhan khdng ddng y tham gia nghien cdu.
2. Phucfng phap nghien ciiru
-Thiet ke nghien cdu: tien edu, md ta eat ngang.
- Cac bPde tien hanh:
4- Kham lam sang phat hien eae vet loet va dinh hPdng tdi cac loet do benh LTQDTD.
+ Lam xet nghiem PCR phat hien nhiem HSV nha chan doan te bao Tzanck, PCR. Ddng thdi lam mdt sd xet nghiem loai trd loet sinh due do cac nguyen nhan khac nha giang mai RPR; test nhanh phat hien HIV.
+ Nhdng benh nhan ed ket qua xet nghiem PCR ddOng tinh vdi HSV se ddpc nghien cdu dac diem lam sang va yeu td lien quan.
S.Xurlisoiieu
Xd li sd lieu theo phPPng phap thdng ke y hpe, sddung phan mem SPSS 12.0.
III. KET QUA NGHIEN CCU 1. Dac diem lam sang
1.1. Cdc dgc diim cua loet sinh due do herpes
Bang 1. Dgc diem vet loet
Dac diem vet loet
Vj tri vet loet (n=47)
So luong vet loet (n=47)
Kich thu'dc vet loet {n=47)
Mdi Idn Mdi be Quy dau Bao quy dau Than dPPng vat Quanh hau mdn It (1-2)
Vda (3-4) Nhieu (>5) Nhd(1-2mm) Vda (3-4mm) To (>5mm)
n 7 5 18
5 7 5 10 12 25 28
n
8
% 14,9 10,6 38,3 10,6 14,9 10,6 21,3 25,5 53,2 59,6 23,4 17,0
40 DA L i i u HOC S6 03 (Thang 01 / 2011)
NGHIEN ClTU KHOA HOC
Dac diem vet loet
Hinh dang (n=47)
Mat do (n=47)
Do sau (n=47)
Djch tiet (n=47)
Trdn Bau due Khdng xae dinh Chae
Mem Ndng Sau Khd Dich trong Djch mu
n 13 30 4 0 47 44 3 11 31 5
% 27,7 63,8 8,5
0 100 93,6 6,4 23,4 66,0 10,6 1.2. Triiu chdnq hach naoai biin
80 0%
70 0%
60.0%
50 0%
40.0%
30.0%
20 0%
100%
0.0%
727%
32 0%
Tien phat Tai phat
Biiu do 1. Trieu chdng hgch ngogi biin Trieu chdng hach ben to gap d 72.7% benh nhan herpes sinh due tien phat va 32% d nhdm tai phat. Sa khac biet cd y nghla thdng ke vdi p<0,05.
1.3. Ddu hiiu tien trieu
Bang 2. Ddu hiiu tien trieu
Tien trieu
Cd Khdng cd Tdng sd P
Nhom sa phat n 7 15 22
% 31,8 68,2 100
Nhom tai phat n 20
5 25
% 80 20 100 p<0,01
1,4. Trieu chdng tiit dich nieu dgo, am dgo Bang 3. Trieu chdng TDND, TDAD Trieu chufng
TDND/AD Cd trieu chdng
Khdng cd Tdng sd
n Nam
7 24 31
NQ 3 13 16
Tong
10 37 47
% 21,2 78,8 100 1.5. Cac trieu chUng canang
Bang 4. Triiu chdng canang cua loet sinh due do herpes
Trieu chufng CO nang Oau
Bdng rat Ngda Met mdi Sdt Tieu khd So trieu chuTng c o n a n g / m o t Bn
1 trieu chdng 2 trieu chdng 3 trieu chdng
> 4 trieu chdng Tdng sd
Soluot benh nhan
22 27 15 8 4 5 n 16 20 6 5 47
% 46,8 57,4 31,9 17,0 8,5 10,6
% 34,0 42,6 12,8 10,6 100
S6 03 (Thang 01 / 2011) D A L I E U H O C 4 1
NGHIEN CLtU KHOA HOC
2. Cac yeu to lien quan den herpes sinh due
Bang 5. Mpt sdyiu tdlien quan Tuoi, gidi, nghe nghiepNhom tuoi (n=47)
Gidi (n=47)
Nghe nghiep
(n=47)
Tmh trang hon nhan (n=47) Nguon lay (n=47)
SOrdung bao caosu (n=47) So li/cfng ban tinh (n=47) Trieu chufng cua ban tinh (n=47)
DPdi 19 20-29 30-39 40-49
>49 Nam Nd
Nghe nghiep Hpe sinh, sinh vien Ndng dan
Hau tri Cdng nhan N g h e t p d o
Can bd, cdng chdc Tdng sd
Ode than Lydj Cd gia dinh Mai dam Ban tinh Vp/ehdng Khdng xae djnh Cd s d d u n g
Khdng s d d u n g 1 ban tinh
>2 ban tinh Cd trieu chdng Khdng ed trieu chdng
Khdng rd
n 1 9 15 14 8 31 16 n 2 2 2 4 18 19 47 5 2 40
9 13 14 11 13 34 32 15 12 15 20
% 2,1 19,1 31,9 29,8 17,1 65,9 34,1
% 4,3 4,3 4,3 8,5 38,3 40,4 100 10,6 4,3 85,1 19,1 27,7 29,8 23,4 27,7 72,3 68,1 31,9 25,5 31,9 42,6
IV. BAN LUAN
1. Dac diem lam sang cua loet sinh due do herpes
1.1. Cdc triiu chUng canang
Trieu chdng co nang hay gap la bdng rat 57,4%, dau 46,8%, ngda 31,9%, met mdi 17%.
Chu yeu la nhdng trieu chdng cua tdn thaong tai eho, chung tdi khdng gap cac trieu chdng dau dau, dau eo nhd mdt sd tai lieu md ta, cd le do sd lapng benh nhan nghien eau edn han che. Mdt benh nhan cd the xuat hien mpt hay nhieu trieu chdng cP nang tren. Hay gap nhat la cd 2 trieu chdng eo nang trd len 42,6% va cd mdt trieu chdng cP nang 34%.
1.2. Cdc dgc diem cua loet sinh due do herpes
- Vj tri vet loet: vi tri thPdng gap nhat la quy dau 38.3%, tiep den la d mdi Idn va than dPPng vat 14,9%. Nghien cdu cua E Folkers (1988) [6], sd benh nhan cd tdn thaong d quy dau la 30/46 chiem 65,22%. Tuy nhien, tac gia cdn gap cac tdn thaong d nhdng vj tri khac nhP biu, mdng, mu, vung hang... tuy ti le ton thppng d nhdng vi tri nay rat thap.
- Sd Ippng vet loet: 53,2% benh nhan ed nhieu vet loet (>5), 25,5% benh nhan cd sd Idpng vet loet vda (3-4) va 21,3% benh nhan cd mdt hoac hai vet loet.
- Kich thade vet loet: da sd cae vet loet cd kich thade nhd (1 -2cm) 59,6%, cac vet loet ed kich thPdc vda (3-4em) va to (>5cm) chiem 23,4% va 17%.
Phan Idn eae vet loet cd hinh bau due 63.8%, mem mai 100% va ndng 93.6%. 66% benh nhan ed cae vet loet djch trong, 23,4% benh nhan ed cae vet loet khd, 10,6% benh nhan cd vet loet dich mu.
NhP vay, ddi vdi tdn thaong loet sinh due do herpes simplex, chung tdi nhan thay thddng gap
4 2 DA LlEU H O C S6 03 (ThangOl/2011)
NGHIEN CLTU KHOA HOC
nhat la nhdng vet loet hay thpc ra la nhdng vet trpt ndng hinh bau due, sd iPpng khoang 5-10 vet, kich tbPdc 1-2mm hoac 3-4 ddng thanh cum. Nhdng vet trpt nay mem mai, be mat khd hoac ed it djch trong. Hinh thai t h d hai chung tdi quan sat ddpc la tdn t h p o n g loet don dde, kich thade t d 5mm, ed le do nhdng vet trpt nhd lien ket lai vdi nhau, b d da cung, cd djch trong hoac djch m u d o b d i nhiem.Tradng hpp nay tdn thPPng thadng gay dau nhieu, cd the ed sdt.
1.3. Triiu chdng hgch ngogi biin
Hach ben to gap d 72,7% benh nhan herpes sinh due tien phat va 32% benh nhan herpes sinh due tai phat. Sp khac biet cd y nghla t h d n g ke vdi p<0,05. Hach ben to la trieu chdng gap tdi 80% d herpes sinh due tien phat [7], cdn trong herpes sinh due tai phat, trieu chdng nay chi gap d mdt sd benh nhan
7.4. Ddu hiiu tien triiu
d nhdm benh nhan bj herpes sinh due lan dau tien, ehi 31,8% benh nhan ed dau hieu tien trieu ngda, rat, khd chiu d noi sau dd xuat hien tdn thaong, trong khi d nhdm benh nhan herpes tai phat, ed tdi 80% benh nhan ed trieu chdng nay.
Spkhac biet ed y nghla thdng ke vdi p<0,01 .Theo Catriona Ooi [4], tien trieu la dau hieu ddi khi gap d herpes sinh due tien phat va thadng xuyen gap d herpes sinh due tai phat. Ngay d giai doan tien trieu, virus da dapc giai phdng tai tdn thPOng.
Do dd, viee giup benh nhan phat hien dapc trieu chang eua giai doan tien trieu, chu ddng kieng quan he tinh due hoac quan he tinh due an toan, sdm di kham va dieu tri se gdp phan giam sp lan truyen virus eho ban tinh va cdng ddng.
7.5. Triiu chUng tiit dich am dgo, nieu dgo Ti le tiet djch nieu dao d benh nhan herpes sinh due nam la 22.6%, ti le tiet dich am dao d
benh nhan herpes sinh due n d la 18,8%. Sp khae biet gida hai nhdm khdng cd y nghia thdng ke.
Ti le benh nhan ed trieu chdng tiet dich nieu dao, am dao trong nghien edu eua Andwele Mwansasu la 21.4% [3]. Ngoai tdn thPOng d bd phan sinh due ngoai, HSV cd the gay nhdng tdn thPong tai nieu dao nam hay am dao, cd t d cung cua nd. Do dd, nhiem HSV cung la mdt tae nhan eae thay thudc lam sang can Ipu y tdi khi kham benh nhan cd hdi chdng tiet dich am dao, nieu dao khi cae tac nhan t h d n g thadng nam, vi khuan... khdng dupe phat hien.
2. Cac yeu to lien quan den herpes sinh due -Dac diem tudi, gidi, nghe nghiep: tudi trung binh cua cac benh nhan loet sinh due do herpes trong nghien cdu la 38.06 ± 10,78. Ket qua nghien cdu cua Andwele Mwansasu (Tanzania) (2002), Ida tudi nhiem herpes sinh due rat khac, tudi trung binh la 29 va cd tdi 3/4 sd benh nhan dPdi 30 tudi [3]. Cd le nghien edu eua Andwele Mwansasu tien hanh tren cac benh nhan chau Phi, ho bat dau quan he tinh due t d rat sdm va thPdng ed nhieu ban tinh nen tudi mac benh tre ban, do d d sd benh nhan tudi dddi 30 chiem phan Idn.
-I- Nhdm tudi chiem ti le cao nhat la 30-39 tudi (31,9%). Nghien cdu cua chung tdi cd ket qua tdPng dPOng vdi nghien cdu eua Dang Hoang Anh va cdng sp (2007) [1]. Nhdm tudi 30-39 la nhdm tudi ed nhu eau boat ddng tinh due cao ddng thdi cd nhdng mdi quan he xa hdi rdng rai, neu cd cae hanh vi tinh due khdng an toan thi rat de nhiem eae benh LTQDTD, bao gdm ca herpes sinh due.
-I- Nghien cdu cua chung tdi ed 66% benh nhan nam va 34% benh nhan nd.Trong nghien
So 03 (Thang 01 / 2011) D A L l E U H O C 4 3
NGHIEN CUtJ KHOA HOC
cdu eua Dang Hoang Anh thi ed den 84,85%
benh nhan nam va chi ed 15,15% benh nhan n d [1]. Theo chung t d i , sd lieu benh nhan n d thap hon nam gidi cd the ehPa phan anh hoan toan thpc te do phu n d t h a d n g cd tam l i e ngai khi di kham, d d n g thdi d n d t r i e u chdng herpes sinh due thPdng khdng dien hinh hoac khdng bieu hien lam sang khien eho ti le phat hien thap ban.
-I- Hai nhdm nghe c d t i le benh nhan cao nhat la n h d m can bd, cdng chdc 40,4% va nhdm nghe t p do 38,3%. Cung nhP cae berih lay truyen qua dadng tinh due khae, ti le benh t h a d n g cao d nhdm nghe t p do vl nhdm nghe nay thpc chat bao gdm rat nhieu nghe nghiep khac nhau va ddi tPpng nay ehPa ed y thdc cao ve tinh due an toan, de bi mSc benh. Tuy nhien, ti le benh cao d nhdm can bd, cdng chdc la mdt van de can IPU tam. Mdt phan ed the do nghien cdu thpc hien tai Benh vien Da lieu Trung POng la tuyen chuyen mdn cao nhat nen t h a d n g dapc cae ddi tPpng ed trinh dp cao iPa chpn, nhPng cung ed the do cae benh nhan d nhdm nay do nhu eau lam an thPdng den cae nha hang, khach san, khu vui chPi, giai t r i . . . va quan he vdi gai mai dam, gai nha hang... nen de bi mac benh hpn.
- Ngudn lay: 29,8% benh nhan cho rang bi lay benh t d vp/ehdng. Sd benh nhan cho r3ng minh lay benh t d g a i mai dam la 19,1% trong khi nghien edu eua Oang Hoang Anh cho thay lay ehu yeu qua mai dam 46,97% [1 ]. Sp khac nhau ve ngudn lay d 2 nghien cdu, nhat la ti le lay qua gai mai dam d khu vpc phia Nam cao hon eua chung tdi cd the do phong each sdng d mien Nam "thoang" hon, ddng thdi ban chat t p nhien de gan gui khien hp de dang bde bach tam sp vdi thay thudc bon.
-Thdi quen s d d u n g bao cao su: phan Idn eae benh nhan khdng ed thdi quen sd dung bao cao su khi quan he tinh due 72,3%. Ddi vdi nam gidi, sd d u n g bao cao su d u n g each rat cd y nghia trong phdng ngda nhiem HSV khi tdn thaong d quy dau, daong vat va phai dam bao bao cao su che phu dPpc bet vung tdn thaong. NhPng sd dung bao cao su thpc sp cd y nghia bao ve ddi vdi phu nd. Nhieu nghien edu da chi ra viec dung bao cao su lam giam nguy cO mac HSV-2 d phu n d [2]. Ngoai ra, d u n g bao caosu khi quan he tinh due edn giam nguy eo nhiem HIV, nguy cP nay rat cao d benh nhan herpes sinh due. Nghien edu cua Oang Hoang Anh [1] cdn cho thay sd dung bao cao su lam giam ti le herpes sinh due lien quan tdi yeu t d tray xPdc khi quan he tinh due.
- Sd Ippng ban tinh va trieu chdng cua ban tinh Nghien edu cho thay 6 8 , 1 % benh nhan chicd mdt ban tinh, sd benh nhan cd t d hai ban tinh trd len la 31,9%. 25.5% benh nhan cho rang ban tinh ed trieu chdng cua herpes sinh due, 31,9%
benh nhan cho rang ban tinh khdng cd trieu chdng, 42,6% khdng biet ban tinh cd trieu chdng hay khdng. Mdt trong nhdng yeu t d nguy eo cua herpes sinh due la cd nhieu ban tinh. Khadija I Yahya-Malima [8] da ehi ra nguy cP nhiem herpes sinh due d nhdm phu n d ed t d hai ban tinh trd len gap 1,8 lan so vdi nhdm chi cd mdt ban tinh.
Ban tinh cd tdn thPong d bd phan sinh due cung la yeu td nguy co cua nhiem herpes sinh due.
Herpes sinh ed the gay nhdng anh hPdng tdi chdc nang tinh due, quan he xa hdi va cdng viee, phan Idn benh nhan t p ti ve tinh trang benh ban than, sp phai t h d n g bao cho ban tinh ve trieu chdng cua minh. Dieu nay cung phan nao giai thich mdt ti le Idn benh nhan khdng biet ban tinh cd trieu chdng hay khdng.
4 4 D A L I E U H O C s6 03 (Thang oi/2011)
NGHIEN CLTU KHOA HOC
V. KET LUAN
1. Dac diem lam sang cua loet sinh due do herpes
- Trieu chdng eo nang hay gap la bdng rat 57,4%, dau 46,8%, ngda 31,9%; cac trieu chdng met mdi, sdt chiem ti le thap bon 17% va 8,5%.
- Vj tri vet loet t h a d n g gap nhat la d quy dau 38.3%, mdi Idn va than ddong vat 14,9%.
- 53,2% benh nhan ed nhieu vet loet (>5), 25,5% benh nhan cd sd iPpng vet loet vda (3-4) va 21,3% benh nhan cd mdt hoac hai vet loet.
- Da sd cac vet loet cd kich thPdc nhd (1 -2cm) 59,6%
-Hach ben to gap d herpes sinh due tien phat 72.7%, herpes sinh due tai phat 32%.
- Dau hieu tien trieu d herpes sinh due tien phat la 31,8%, d herpes sinh due tai phat la 80%.
- 21.2% benh nhan ed trieu c h d n g tiet dich TAI UEU THAM KHAO
am dao, nieu dao, t r o n g do d nam 22.6%, d n d i a 18,8%.
2. Mot so yeu to lien quan cua herpes sinh due -Tudi trung binh eua benh nhan 38.06 ± 10,78, nhdm tudi chiem ti le cao nhat la 30-39 tudi 31,9%.
-Oa sd benh nhan la nam gidi chiem 66%, n d gidi 34%.
- Ngudn lay t d vp/ehdng chiem ti le cao hon 29,8%; do ban tinh 27,7%, gai mai dam 19,1%.
- Phan Idn cac benh nhan khdng cd thdi quen sddung bao cao su khi quan he tinh due 72.3%.
- 6 8 , 1 % benh nhan chicd mdt ban tinh, 31,9%
benh nhan cd t d hai ban tinh t r d len.
- Chi 25.5% benh nhan cho rang ban tinh cd trieu chdng cua herpes sinh due, phan Idn eae trPdng hpp 42,6% khdng biet ban tinh ed trieu chdng hay khdng.
/. Ddng Hodng Anh, Truang Le Tudn Anh (2007), "Khao sdt ti le vd cdc yeu to lien guan benh nhdn herpes sinh due tdi phdt den khdm tgi khoa Khdm benh, Benh vien Da lieu Thdnh pho Ho Chi Minh", Tgp ehi Sinh hogt KHKT Da Lieu cdc tinh phia Nam, guy I, tr 18-22.
2. A. Wald, A.G.M. Langenberg, E. Krantz, J.M. Douglas, H.H. Handsfield, R.P. DiCarlo, A.A.
Adimora, A.E. Izu, R.A. Morrow, and L. Corey (2005), "The Relationship between Condom Use and Herpes Simplex Virus Aeguisition" Annals of Internal Medicine, (143), pp 707-713.
3. Andwele Mwansasu, Davis Mwakagile, Lars Haarr, Nina Langeland (2002), "Detection of HSV-2 in genital ulcers from STD patients in Dar es Salaam, Tanzania", Journal of Clinical Virology,
(24), pp 183-192.
4. Catriona Ooi, Linda Dayan (2002),"Genital herpes: An approach for general practitioners in Australia". Australian Family Physician, 31 (9), pp 1-6.
5. E Folkers, A P Oranje, J N Duivenvoorden, JPW Van Der veen (1988), "Tzanck smear in diagnosing genital herpes", Genitourin Me, (64), pp 249-54.
6. John G. Beauman (2005), "Genital Herpes:
A Review". American Family Physician , 72(8), pp 1527-1534.
7. Khadija I Yahya-Malima, Bjorg Evjen-Olsen, Mecky I Matee, et al (2008), "HIV-1, HSV-2 and syphilis among pregnant women in a rural area of Tanzania: Prevalence and risk factors". BMC Infectious Diseases, (8), pp 75.
So 03 (Thang 01 / 2011) D A L l E U H O C 4 5
