NGHIEN CUU TAC DUNG CUA DIEN CHAM V6l VIEM KHCiP DANG THAP
PGS.TS VU THUdNG SON. TS NGUYEN TUYET MAI Benh vien Chdm cim TW
Muc tieu: Nghien cint ddnh gid tdc dung cita dien chdm trong dieu tri viem khdp dgng thdp. Ddi tugng vd phuong phdp nghien cuu: 34 benh nhdn viem klic'tp dgng ilidp duc/c dieu tri bdng dien chdm. Thd nghiem Idm sdng cd ddi chirng trudc sau dieu tri ciia nhdm nghien cif. Ket qud: chi sd Ritchie, Lee gidm ro ret sau so vdi trudc dieu tn. Dien chdm lam gidm thai gian cung khdp, sung khdp a nhdm nghien cdu. Ket ludn: Dien chdm cd tdc dung ldng khd ndng van dgng. gidm mirc do dau, gidm thdi gian cimg khdp budi sdng. Ndng do Globulin IgA, IgM, IgG, IL2, CRP cd thay dot khdc biet sau so vdi irudc dieu tri lgi nhdm nghien cint.
T u k h o a : V i e m k h d p d a n g thap, dien c h a m .
I. DAT VAN DE
Viem khdp dang thap (VKDT) (Reumatoid Arthritis - R A ) la mpt benh man tfnh rat thudng gap d mpi noi, mpi dan tpc vdi ty le vao k h o a n g 0 , 5 - 3 % dan sd tren 15 tudi.
N g u y e n nhan benh cdn chua rd, dupc xep vao nhdm benh tu m i l n . Benh bieu hien ve lam sdng la cdc dpt tien trien khd d u dodn xen ke cdc dpt thuyen giam, ddi khi bie'u hien cd he thdng. Hien nay viec nghien ciin cdc p h u a n g phdp dieu tri cac benh xuong khdp ngay cang dupc quan tam tfch cue.
T h e o Y hpc co t r u y l n , V K D T thudc chiing ty. T r o n g Y van cd c u n g de cap ve nguyen nhan, c o che benh sinh va cac phuong phap dieu tri benh nay, trong dd cd cham cii'u, xoa bdp bam huyet va diing cdc bdi thudc. Xuat phat tir tinh hinh thuc te tren, vdi m o n g m u d n ban che tdc dung phu ciia thudc va gdp phdn phat huy d u p c uu the ciia cham ciin c h u n g tdi tien hanh nghien ciin: D a n h gia tac diing ciia dien cham trong dieu tri mpt sd trieu chung trong viem khdp dang thap giai duan 1-2.
II. DOI Tl/aNG VA PH(/(JNG PHAP NGHIEN CUU
1. Dd'i tuong nghien ciru: Benh nhan VKDT dupc dieu tri tai benh vien Cham cii:u trung uong. Tieu chuan chdn doan ciia Hdi thap khdp Hoa Ky (ACR)
[1] Giai doan 1-2. Tir 16 tuoi trd len, khdng phan biet gidi, nghe nghiep. Nhdm nghien cun: 34 benh nhan, dupc dieu trj bdng dien cham don thudn.
2. Phuang phap nghien ciin: Thir nghiem lam sang tu dd'i chii'ng trudc sau dieu tri cua nhdm nghien cun. Tim hieu su bien ddi mot sd chi sd miln dich trudc va sau dilu tri d nhdm nghien cun.
- Cdc chi so danh gia: chirc nang van ddng theo chi sd Lee. Danh gia mii:c dp dau bang chi sd Ritchie. Thdi gian ciing khdp budi sang (tfnh bdng phiit).
- Phac dd huyet dien cham nhdm nghien cii'u: Chi tren: Hpp cdc, Ngoai quan, Lao cung, Bat ta, Kien ngung, Kien trinh, Ty nhu, Khiic tri, Thu tam ly. Chi dudi: Dpc ty.
Tat nhan, Luang khau, Huyet hai, Duong Lang tuyln, Tiic tam ly, Giai khe. Than mach, Tam am giao, Thdi xung. [2]
TAP CHI CHAM CUU VIET NAM
.KET QUA NGHIEN CUU
Bang 1: Dac diem lam sang cua n
. — Nhdm Cac c h i s d • —
Yeu td dang thap duong tinh Ty le khdp viem:
Ban ngon Ddt ngdn gan Co tay Co chan Ban ngon chan Cac khdp Idn (gdi, vai)
Thdi gian eirng khdp budi sang > 1 gid Hat dudi da
hom nghien cuu (n=34)
Nhdm nghien cuu
20/34
22/34 18/34 15/34 12/34 8/34 19/34 12/34 0
T y l e
58.8%
64.7%
52.9%
44,1%
35,2%
23,5%
55,8%
35,2%
0
Yeu td dang thap cd ty le 58,8% benh nhan ciia nhdm nghien cii'u. Benh nhan nhdm nghien ciin cd mdt so khdp viem chu yeu viem cac khdp ban ngdn ddt ngdn va khdp Idn nhu gdi.
Bang 2: Chi sd Ritchie, Lee trung binh theo thdi gian dieu trj (n=34)
Chi s d Ritchie tru
Thdi gian TrUdc dieu tri Sau dieu tri 20' 24h
1 tuan 2 tuan 3 tuan 4 tuan
ng binh theo thdi gian c
A ' + SD 12,32 + 2,49 9,38+ 1,98 7,08+ 1,42 7,75 ± 1,82 6,23 ± 1,30 5,52+ 1,30 3,76± 1,10
leu trj
P
<0,01
<0,01
<0,01
<0,01
<0,01
<0,01
Chi s d Lee trung binh theo thdi gian dieu trj A ' + SD
11,73+ 1,95 9,32+ 1,45 8,67x0,87 7,08+ 1,28 5,02+ 1,03 5,41 + 1,30 4,20+ 1,03
P
>0,05
<0.01
< 0,01
<0,01
<0,01
<0,01
Nhdn xet: Dien cham cd tac dung giam dau sau 24h, mirc dp giam dau cham lai sau 1 tudn va tiep tuc giain cham cho de'n cudi dpt dilu tri. Su chenh lech vl chi sd Ritchie cua nhdm nghien ciin sau dilu tri so vdi trudc dilu tri d cac thdi dilm 1-4 tudn. Chi sd Lee gidm (tii'c la klia nang van dpng khdp ciia benh nhan tang len) sau khi cham tir 1- 4 tuan.
Bang 3: Thdi gian cung khdp budi sang trung binh (phut) trudc va sau dieu tri
Thdi gian
TrUde dieu tri Sau dieu tri 20' Sau dieu tri 24h 1 tuan
2 tuan 3 tuan 4 tuan
Nhdm nghien ciiru (n = 34)
X i S D
52,35+ 17,37 52,35 ± 17,37 46,32+ 10,24 37,65+ 14,05 25,39 + 10,71 14,27+10,31 05,00 + 7,88
P
>0,05
<0,05
<0,01
<0,01
<0.01
<0.01
TAP CHI CHAM CUU VIET NAM
2^1
Nhdn xel: TTidi gian ciing khdp buoi sang trung binh giam d benh nhan nhdm I va 2 sau 1 - 4 tudn dien cham (p<0,05 -^ 0,001).
Bang 4: Mpt sd chi sd sinh hoa trudc va sau thdi gian dieu tri d benh nhan nhdm nghien cuu (n = 34)
Trudc dieu trj ML
(mm) CRP (mg/l) IgA (mg/dl) IgG (mg/dl) IgM (mg/dl) ii-2(pg/mi) Bd the C3 C4 (mg/dl)
Gid dau: 31,96+12,7 Sau 2h: 45,31 ±12,6 32,8+17,3
331,067+152,16 2202,58+1088,71 271,67 + 159,64 55,68 + 47,07 166,15+44,09 42,70+19,50
Sau dieu trj Gid dau: 21,82+18,23 S a u 2 h : 31,08+5,68 18,3+6,5
280,93+122,26 1558,25+350,36 196,42+86,50 85,05 ±39,56 159,28+52,29 37,15+16,46
P
<0,01
<0,01
<0,01
> 0 , 0 1
<0,01
>0,01
<0.01
>0,05
Nhdn xet: Trudc dilu tri tdc dp mau ldng va CRP cLia benh nhan VKDT thudng cao hon ngudi binh thudng. Sau mdt thdi gian dilu tri bdng dien cham, loc dp mdu ldng trung binh va CRP giam cd y nghia thd'ng ke vdi p<0,01. IgA, IgM, IgG diu giam so vdi trudc khi dilu tri trong dd IgG giam cd y nghla thdng ke (p < 0,01). Bd the C3, C4 cd gidm so vdi trudc khi dieu tri nhung khdng cd y nghla thdng ke (p>0,05). IL2 tang len so vdi trudc khi dieu tri cd y nghla thd'ng ke vdip<0,01
IV. BAN LUAN
1. Dua vao chi so Ritchie chiing tdi thay d nhdm nghien ciin miifc dp dau giam ngay sau 20 phiit dien cham vd theo thdi gian dieu tri (p<0,01). Ket qua nay cho thay rdng dien cham cd tdc dung gidm dau trong dilu tri benh VKDT. Dilu nay phii hpp vdi ket luan cua nhilu cdng trinh nghien ciiru khac nhu cua Shen va cdng su, Man va Baragar. [4]
Cac tac gid cung da tien hanh dien cham tren cac benh nhan viem khdp dang thap va thay rdng dien cham cd tac dung gidm dau rd ret trong dilu tri benh nay. Theo cac tdc gia thi dien cham cd the giam dau keo dai tdi 3 thang neu dupc dilu tri lien tuc.
2. Chi sd Lee trung binh trudc dilu tri la 11,7. Chi sd nay giam rd ret d nhdm dien cham sau 1 - 4 tudn dilu tri (p < 0,01). Kha
nang giam dau ciia dien cham ciing cd thi cho thay rdng benh nhan se van dpng tdt han khi dau gidm hay ndi each khdc chi sd Lee va chi sd Ritchie ty le ddng bien vdi nhau.
3. Thdi gian ciing khdp buoi sdng nhdm nghien ciru la 52,35 phiit, thdi gian cimg khdp giam d nhdm nghien ciin sau so vdi trudc dilu tri rd ret. Thdi gian ciing khdp budi sang giam la ket qud cua trieu chirng dau tai cdc khdp giam, khd nang van ddng trong ngay tang len do vay nhiing ngay tiep theo ciia lieu trinh dieu tri thdi gian de khdi dpng van ddng tai cdc khdp da rut ngdn lai.
4. Nhdm nghien ciin da cd su gidm sung cdc klidp sau so vdi trudc dilu tri. Khdp gdi dap Ltng ket qua dilu tri sdm nhat trong 24h la 33,62±3,83 (p < 0,01). Nhu vay, dien cham cd tac dung giam mdt sd trieu chirng nhu dau, tang kha nang van ddng, giam thdi gian eirng khdp budi sdng trong VKDT tuy nhien cdn cd thdi gian dilu tri lien tuc, dai ban thi se thu dupc ket qua tdt hon. Nhilu tdc gia da chiing minh dupc vai trd ciia dien cham dd'i vdi gidm sung klidp va cd ket luan dien cham cd tac dung chdng viem khdp.
Sunliquin thupc khoa cham ciin benh vien quan dpi Trung Qudc dung phuang phap cham kim am cho 150 benh nhan VKDT, sau 6 thang dilu tri 11,3% khdi benh, 31,3%
tien trien tdt, 51,3% dd. [3]
5. Ve mdt sd chi tieu xet nghiem mien dich nhdm nghien ciai, ndng dp Globulin
m® TAP
CHi CHAM CUU VIET NAMIgA, IgM, IgG trudc dieu tri cdn cao, sau dilu tri d nhdm dien cham ndng dp cac Globulin miln djch gidm, nhilu nhat la IgG.
(p < 0,01). IL2 dupc coi la yeu td tang cudng miln dich yeu, ddng vai trd quan trpng trong dilu hod miln dich, sau dpt dilu tri, IL2 tang han so vdi trudc dilu trj (p < 0,01). Tdc dp mau ldng giam, ndng dp CRP giam (p<0,01), ndng dp bo the khdng thay doi (p>0,05).
Trong qua trinh dilu tri bdng dien cham khdng thay cac trieu chii'ng theo ddi tang len hoac tai bien khac.
V. KET LUAN:
- Dudi tdc dung cua dien cham mpt sd trieu chirng trong viem khdp dang thdp gidm thdng qua chi sd Ritchie, Lee gidm sau so vdi trudc dilu trj. Dien cham cd tac dung tdi giam thdi gian cung khdp budi sang.
- Cdc chi tieu xet nghiem miln djch nhu ndng dp Globulin IgA, IgM, IgG, IL2, CRP cd thay ddi khdc biet sau so vdi trudc dilu tri tai nhdm dien cham.
TAI LIEU THAM KHAO
1. Pham Thj Ngpc Bich (1996). Nghien cint .xdy dung lieu chudn chdn dodn benh viem khdp dgng thdp tren benh nhdn Viel Nam, Luan van Phd Tien sy Y hpc, Hpc vien quan Y.
2. Nguyen Tai Thu, Tran Thuy (1997). Chdm citu sau dgi hgc. NXB Y hpc.
3. Liu X, Sun L, Xia J (1993). Effects of acupunlure and point - injection treatment on immunologic function in reuinatiod arrthritis. J tradit chin Med. 13(3), pp.174-178
4. Man SC, Baraga FD (1974). Preliminary clinical study of acupunlure in rheumatoid arlhrilis. ./Rheumatol, (22), pp. 1636-1645.
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