r LE NHIEM VIRUS VIEM GAN VA MOT SO DAC DIEM LAM SANG, CAN LAM SANG BENH VIEM GAN QT BENH NHAN SUY THAN MAN CO LOC MAU CHU KY
TAI BENH VIEN DAI HOC Y THAI BINH
NGUYEN DUY Cl/ONG, PHAM D A N G THUAN Bg mdn Hdi sdC cap ciiU Tru&^g DH Y Dugc Thai Binh I TOM T A T
tNghiin cdu khio sit ty id nhidm vims viem gan B.
}us viem gan C vi nhin xit mot so die diem lam sing v^ can lim sang cua viem gan d benh nhan suy thin man cd loc mau chu ky (Lt/ICK) tai khoa than nhin tao benh vi&n Dai hoc Y Thai Binh cho thay:
* Ty Id nhiim Chung HBV. HCV la 35.2%.
+ Ty te nhiim HBV hoSc HCV lin lugt la 8.8% vi 28.6%. dong nhiim ca HBVva HCV la 2.2%.
+ d benh nhan LMCK thi tinh trang viem gan rat tiay gip vdi cic trieu chdng lam sing dien hinh nhu:
m$t moi. ngda, gan to, roi loan tieu hda, dau ha sudn ptiii, hoang dan. Cac trieu chung can lam sang cua viim gan bieu hien ro nhai la: giam protein - Albumin miu, ting men gan. Trong dd a nhdm nhiim virus vi6m gan bieu hien cac trieu chung lam sang va can l&m sing ro ret hon nhom khong nhidm.
Tukhda: viem gan, suy than man.
SUMMARY
PREVALENCE OF HEPATITIS VIRUS AND SOME CLINICAL FEATURES, CLINICAL ANIFESTATIONS OF HEPATITIS IN CHRONIC RENAL FAILURE PATIENTS ON DIALYSIS CYCLE
The study surveyed the prevalence of hepatitis 8 vims, hepatitis C virus and some remarks and clinical characteristics of subclinical hepatitis in patients wtth chronic renal failure on heamodialysis Results shows that-
+ Overall prevalence of HBV. HCV was 35 2%, + HBV or HCV prevalence was 8.8%, and respectively 28 6%o. both HBV and HCV co-infection was 2.2%.
+ In patients with liver inflammation LMCK is very common with the typical clinical symptoms such as fatigue, itching, enlarged liver, digestive disorders, right upper quadrant pain, jaundice. The symptoms of t)epalitis subclinical manifestation are: reduced protein - blood albumin, liver enzyme elevations. In Itie gmup that hepatitis virus infection manifest clinical symptoms and more pronounced subclinical Infection group
Keywords: hepatitis, clironic renal failure.
DAT VAN D^
Virus vjfem gan B, C la mpt trong nhCi'ng nguyen nhan chil yeu gay viem gan cap tinh V6i nhG-ng ngu'dl binh thu'ang viem gan cap da la mot ton thLfong nghiem trpng, gay hau qua nhu mo gan bi hiiy hogi, chu'c nang gan dSc biet la chifC nang chuy4n h6a vi thai tri> chat doc bi suy giam. Neu vifim gan xay ra tren benh nhan STM thi nhung hau
qua ndy c5n nang n^ hffn rit nhi^u [1]. Nhiim Vims viem gan khong nhOng gfiy tbn hai tryc tiep cho ngif&i b$nh mi nhCtng benh nhan ndy n^u khong difoc phdt hi#n, quan if sd ii ngudn 13y nhiim rSt nguy hi^m cho c5ng dong, trirc tiep la cic b$nh nhdn cCing (3ieu trj, nhSn viin y ti hdng ngdy tryc t i i p d i i u tri cho benh nhdn vd cpng d6ng dan CLF trong xa h^i [2]. Do vdy vi^c ddnh gid dung ty le nhiim virus v\hm gan vd tinh trang viem gan d b$nh nhdn IQC mdu chu ky c6 J nghTa het su-c quan trpng de kjp thd'i d i i u tri cQng nhu* co bi^n phap each ly tir do nhSm ndng cao chilt lu'p'ng cupc s6ng cung nhu g6p phSn Idm tSng tuoi thp cCia b^nh nhdn. Muc ti&u cua d i tdi;
- Nhdn xet ty 1# nhiem vims viem gan d b§nh nhan suy than mgn c6 lpc mdu chu V.y tai khoa Thdn nhdn tgo b#nh vi^n Oai hoc Y Thdi Binh.
- Nhdn xet m6t s6 dac d i i m Idm sdng vd cdn idm sdng cua viem gan d bpnh nhdn suy thdn man cd lpc mau chu ky.
D 6 1 TUONG VA PHU'aNG PHAP NGHIEN CLTU 1. £)6i tu'p'ng nghien CLPU
Tiiu ehuin chgn bdnh nhin
- T^t ca cdc b$nh nhan suy thdn mgn c6 Ipc mdu chu kjf tai bdnh vi^n Dgi hpc Y Thdi Blnh.
- D6ng y tham gia nghidn cil-u.
2. Phmfng phdp nghign cdu
2.1. Thiet ke nghidn cdu: Mfl ta dt ngang, tiin
CLPU.
2.2. Thdi gian nghi&n cdu: Td 01/2013 din 06/2013,
2.3. Thu thip miu nghiin cdu
+ Hoi khai thdc cdc tridu chiing ca ndng cua vifim gan vims. M§t m6i, r6i logn tidu hda, set, dau ha su-dn phai, vang da, vdng mit...
+ Khdm thyc t h i phat hidn cdc tridu chung vd hdi chiing: Hodng dan, suy te bdo gan. tdng dp lyc tTnh machcCra...
+ Xdt nghidm HBsAg, anti-HCV tai khoa Vi smh benh vi$n Dai hoc Y Thdt Binh
+ Xdt nghidm men gan (ALT, AST), Potein, Albumil, Bilimbil (tryc tiep - gidn tiip) tai khoa Hda sinh bpnh vien Dgi hpc Y Thdi Binh.
- Phdt hien HbsAg b4ng test nhanh - Phdt hidn anti-HCV. Ky thudt ELISA t h i hd 3 - Men gan {ALT, AST), Potein, Albumil, Bilimbil (trnc tiep - gian tiip) bdng phu-cng phdp d^ng hpc enzym trdn mdy t y ddng
2.4. Phin tich vi xu If so U^u: B^ng phSn mim Epi-lnfo 6.0
V HOC THirc IIANII (905) - SO 2/2014
K £ T QUA VA BAN LUAN
1. Ddc d i i m cDa ddi tho'ng nghidn CCPU Bang 1. Phdn b6 theo gi6i cua d i l typ-ng nghidn
GI6i Nam Na T6ng
N 55 36 91
%
60,44 39,56 100
11.9S 16M
1=1 '^a
_a_
1S6S
* 1
:3L
2JA7
1 U'
'fs
J
<20 10-19 30-39 4 0 . 4 9 S0-S9 £60
Biiu dd 1. Phan bd theo tudi cua d6i tiTQ-ng nghien cu>u Ti le benh nhdn Nam (60,44%) nhieu han Nu' (39,56%). Ph^n ldn bdnh nhan LMCK tai Thdi Binh nam CT do tuoi taing nidn vd'i dp tuoi tmng binh la 47,34 ±12.45.
Bang 2. Thd'i gian Ipc mdu cua benh nhan Thd'i qian loc mau
< 1 nam 1 - 2 nam 2 - 3 nam 3 - 4 nam
£ 4 nam T6ng
n 22 29 16 11 13 91
24,17
%
31,87 17,58 12,09 14,29 100 Ty 1$ b$nh nhdn cd thdi gian Ipc mdu 1-2 ndm cao nh^t(31,87%), t i e p d d t d < 1 nam la 24,17%.
2. Ty Id nhidm virus viem gan 6- bdnh nhdn suy than man cd lpc mdu chu ky tai khoa thdn nhan tao bdnh vidn Dai hpc Y Thdi Binh
Bang 3 Ty Id nhiem virus viem gan B.C HbsAg
Anti HCV Dong nhiim HbsAg
va Anti HCV + + +
-
n 8 83 26 65 2 89
8.79
%
91,21 28,57 71,43 2,20 97.80
giam. SLTC de khdng bj suy gidm d6ng Uid'i bdnh nhdn phai p h i u thu$t tao l6 dd thdng ddng - tTnh mach (FAV) de loc mdu ldu ddi, sau dd hdng t u i n phdi d i n bdnh vien lpc mdu 3 l^n, m6i iSn 4 t i i n g vdi he thfing t u i n hcdn ngodi c a t h i , k i t hp'p vd'i tidm, truyen djcii, t n j y i n mau nhieu iSn, dCing lgi qua lpc. ddy mdu... vl v|iy nguy c a Idy n h i i m virus vidm gan B, C a nhdm b$nh nhan ndy Id rSt cao.
Cd 32 BN (35,2%) nhiem virus viem gan B, C. Ket qua ndy phii hpp vd'i nghidn CLPU tai_khoa thdn nhdn tao benh vidn Bach Mai cua Nguydn Cao Ludn vd cpng s y [1], tO thang 10-2001 den 9-2005 thi ty le nhiim vims vidm gan dao ddng tCc 39,9% - 51,8%, nhyng thap han trong nghien cu'u cua Hpang Trung Vinh, PhOng Phyang Thao, Pham Thuy Hu'dng [3], tren 330 BN STMT du'p'c LMCK tai Benh vien 103 vd Benh vien Bach Mai_thi ty le nhiem chung HBV, HCV la 64,9%, ty I? nhiem HBV hoac HCV l i n lyat la 10,2% vd 49,2%; d6ng nhiim ca HBV vd HCV Id 5,5%. Cd the giai thich k i t qua ndy Id do benh nhdn suy thdn man den giai doan cuoi, phai loc mdu lidn tyc thi khdng chi cd than bi suy md hau het cdc ca quan khdc dd bi anh hu'd'ng va su'c de khdng bi suy
3 H h l i M l M l sKMngMiilm
Bieu dd 2. Lien quan giii'a thvi gian lpc mau va nhiim virus viem gan
Ty le nhiim virus viem gan a nhdm benh nhdn cd thai gian LMCK > 4 ndm cao nh^t chiem 69,23% tiip d i n la nhom 1-4 nam c h i i m 60%. K i t qua ndy giing vd'i nghien CLKU cua B.Dussol vd cs (1995) [4], thi ty l§
nhiim HCV d- cac benh nhdn Ipc mdu chu ki' tdng theo thai gian Ipc mau 10% mdi ndm. Tf l# ndy Id 9%
a cac bdnh nhan loc mdu chu ky du'di 3 ndm, 20%
benh nhan loc mdu chu kf tu 4-6 ndm, 57% a b§nh nhan Ipc mdu tren 10 ndm. Da s6 cdc tdc gia d i u cho rdng bdnh nhdn Ipc mdu cdng ddi thi vide truyen miu cdng nhieu vi vdy tJ 1$ nhidm HCV cOng cao.
3. Mpt s 6 dac d i i m Idm sdng vd can lam Scing Bang 4. Dac d i i m Idm sdng cua vidm gan a b^nh nhan suy than man
^^^,,Virus Lam san^.^
Met moi ROI loan tigu hda Nqij-a Oau ha syan phai
Vang da, vanq mit Gan to, lach to
Nhiem n 22 10 17 10 3 14
(n = 32)
%
68.75 31,25 53,13 31,25 9,38 43,75
Ktidnq nhiem (n =59) n 20 13 18 17 4 18
%
33,90 22,03 30.51 28,81 6,78 30,51 Cac tneu chu'ng Idm sdng dien hinh nhu- m§t moi (46,15%). ngira (38,46%), gan to (35,16%), r i i loan tidu hda 25,27%, dau HSP 29,67%, hodng ddn 7,69%. Trong dd a nhdm b$nh nhdn nhidm virus viem gan bieu hien cdc tridu chO-ng Idm sdng rd r^t hffn nhom khdng nhidm. Cd t h i giai thich k i t qud ndy la do d' bdnh nhdn LMCK cd ty lp nhidm viais vidm gan rat cao tdi 35,17% trong s6 ndy nhiiu bpnh nhdn dd chuyen sang viem gan mgn vdi cdc tridu chCrng Idm sang dien hinh, han nO'a d b$nh nhdn LMCK chLPc nang than suy giam n^ng ndn khd ndng thdi ddc qua du'dng t i i t nipu dd miit tu' dd Idm tdng gdnh n|ng thai ddc cua gan, mdt khdc nhdm b$nh nhdn ndy phdi dung nhieu logi t h u i c trong qud trinh d i i u trj phlin ndo cung anh hu'dng d i n chCrc ndng gan
Y HOC THi;C HANH (905) - s6 2/2014
Bang 5 Dac diem can Idm sdng cua b$nh nhdn ntiidm virus viem qan
^ - - , ^ ^ ^ Virus
iam sang ^ - - - . ^ Tanq GOT Tang GPT Tanq Bilirubin TP Giam Protein maii Giam Albumin
mSu N h i l m
n 11 10 3 9 1
n = 32)
%
34.38 31.25 9,38 28.13 3,13
Khdng nhiSm (n = 59) n 12 11 4 2 0 8
%
20.34 18.64 6.78 33,90 13,56 Cac trieu chiing can lam sdng cua vidm gan b i i u hien rd nhat id: giam protein mdu (31,87%), tang GOT (25,27%), tang GPT (23,07%), giam Albumin mdu (9,89%) va tang Bilimbil la 7.69%. Trong dd d nhdm nhiem virus viem gan b i i u hen cdc tri$u chijng can Idm sang rd ret han nhdm khdng nhidm. K i t qua n^y phu hp'p vdi nghien cO'u ciJa Hodng Tmng Vmh, Phung Phu'Ong Thao, Pham Thuy Hyd'ng [3], dd chi ra ty le BN cd men gan tang d" phdn nhdm HBsAg(+) va phdn nhom HCV(+) cao han so vd'i phdn nhdm HbsAQ{-) va HCV(-)
KET LUAN
1. Ty le n h i l m virus vidm gan
- Ty l§ nhiem virus vidm gan cua b^nh nhdn LMCK tai Thai Binh ia 35,2% trong dd nhidm HCV Id 28,57% va nhilm HBV 8,79%, d i n g nhiim Id 2,20%.
- Thdi gian LMCK cang dai thi ty 1$ nhiim vinjs viem gan cang cao.
2. Mpt sd dac d i l m Idm sdng vd cdn Idm sdng CLia viem gan
- 6" benh nhan LMCK thl tinh trang vidm gan rat
hay g$p vdi cdc tridu chung Idm sdng d i i n hinh nhu-:
m$t moi, ngu'a, gan to. r i i loan tidu hda. dau HSP, hodng dan. Trong dd d nhdm benh nhdn nhiim vims vidm gan bieu hi^n cdc tneu chi>ng Idm sdng rd r$t han nhdm khdng nhiim.
- Cdc tridu ChLFng cdn Idm sdng cua vidm gan b i i u hidn rd nhat Id' gidm protein mdu, tdng men gan, giam Albumin vd tdng Bilimbil. Trong do cr nhdm nhiim virus viem gan b i i u hien cdc tridu chung cdn ldm sdng rd rdt han nhdm khdng nhiim.
TAI LIEU THAM KHAO
1. Nguydn Cao Ludn, Nguyin Nguydn Khdi vd cdng SLP (2000). T i n h trgng nhiem virut vidm gan B vd virut vidm gan C trdn cdc bdnh nhdn lpc mdu tgi khoa thdn nhdn tao-benh vidn Badi Mai tCr 3/1997-4/2000, Bio cio khoa hge kf nidm ngiy thinh lip Benh vidn B^eh Mai
2. Nguyin Cao Ludn, Nguyin Nguydn Khdi, Hd Lu-u Chdu vd cs (2004). "Tinh trgng Idy nhiim vims vien gan C vd bien phdp d i phdng Idy chdo tgi khoa Th$n nhdn tao bdnh vien Bgch Mai 2001 - 2002', Cdng trinh nghien CLFU khoa hpc B^nh vi#n Bach Mai 2003 - 2004, nhd xu^t ban Y hpc, tr 346 -361
3. Hodng Tmng Vinh, PhOng Phyang Thao vd cs (2005). "Ty Id vd ddc d i i m nhiim virus vidm gan B. C d* b^nh nhan suy thdn mgn tinh d i i u trj b i n g lpc mdu chu kjf" Tap chl thdng tin y dugc, s6 thdng 4/2009
4. Dussol,B.,Berthezene.P.,Bmnet.P..&Beriand,Y.
(1995), "Hepatitis C virus infection among chronic dialysis patients in the southeast of France". Nephrol Dial Transplant, 10(4), 477-8
NGHIEN CUU TON THU0NG TAI TRONG DO TIENG ON CAO TAI Xl NGHIEP DA GIAY
NGUYEN D A N G Q U O C CHAN - Khoa Y Dugc - D^i hgc Di NSng TOM T A T
Dit van de: Suy giam thinh luc do ti bio Idng ngo^i cua co quan Corti tai tmng bj thuang tdn khd phijc hoi gay nen bdi tiep xde thudng xuydn vdi tiing 6n Irong Ihdi gian dai (8 gid/ngiy, trin 6 thing). Bdnh dik nghi nghiep thudng xiy ra trong mdi tmdng lao
<10ng t^i Viet Nam va dang cd xu hudng gia ting. Do v^y c^n cd cic g'al phip ngin ngua hidu qui han tu vi$c quan lam day du, dung mdc vi tinh treng giim sue nglie cua cong nhan.
W(jc tieu: Danh gii mdc dd d nhiim tiing dn vi gi^m thinh li/c cua cong nhin da giiy trong 4 nim 2005-2008
Phuang phip nghien cuu: Cit ngang md ti, ti6u chi chon miu: 1206 diim mdi trudng tao dpng (MILD) cd tieng on cao. sau dd ehon 1800 ngudi lao
<Kng (NLD) lam viec trong eic MTLD cd tiing dn tren 85dBA t^i cic xi nghiep da giiy.
Thdi gian thu^ hien: Tu thing 01/2005 din 12/2008.
Ket qua: Nganh Da giiy ed tf li sd diim in vugt
li 13,3%, cd muc dd d nhiim tiing dn eao vugt muc vi eudng dd eao nhit 6dBA. Tf Id DNN Da giiy li 1,5%. Tf Id DNN d nam gldl trong nginh Da giiy li 3,8% gap 3 lan so vdind 1,2%.
Ket luin: Trong nginh nghd Da giiy cho thiy, do 7 - 8 diim mdi trudng lao ddng thl cd 1 ifiim vugt mdc cho phep vi trong 67 NLD d mdi tnrdng tidng 6n eao vugt muc thl cd 1 hi DNN. Khi NLD lim vide ting thim 1 nim thl nguy ea hi DNN ting Idn 1,1 lin.
Tdkhda: giam thinh luc do dn.
SUMMARY
DAMAGE OF THE "INNER EAR DUE TO WORKPLACE NOISE IN WORKERS OF FOOTWEAR LEATHER MANUFACTURING ENTERPRISES
Background: Noise-Induced Hearing Loss Is common occupational disease, it tends to incmase gmdually. Hearing Loss can be caused by environmental noise exposum. Controlling noise within the woritplaee can help to prevent fmm losing hearing.
Objectives: To assess noise-exposed level and
V HOC TIIUC H.VMI COS) - S 6 2/2014
