XAC 0!NH Tl Le NHliM VA CHUNG VIRUS HERPES SIMPLEX
GAY BgNH BANG KT THUAT PGR TR^N BfNH NHAN
LO^T SINH DUG TAI B^NH VlgN DA LlIu TRUNG UONG
Le Huygn My", Tran Lan Anh*
TOMTAT
Muc tiiu: xdc dinh ti le nhiim vd chung virus herpes simplex (HSV) gay binh bdng ki thudt PCR tren nhUng binh nhdn loit sinh due din khdm tql Binh viin Da liiu Trung Uang tU 1-10/2010.
Ket quA: tU1-10/2010 tql Binh vien Da liiu Trung uang, bdng ki thudt PCR ddphdt hien dupe 47 binh nhdn herpes sinh due, ehiim 0,03% tong so binh nhdn din khdm vd ehiim 1,77% tong so benh nhdn bi benh idy truyin qua dUdng tinh due (LTQDTD). Herpes sinh due ehiim da so (72,3%) trong ede benh nhdn bi loit sinh due hudng din benh LTQDTD, trong dd chu yiu Id chung HSV-2 (80,9%); chung HSV-1 ehiim
19,796. d cd 2 gidi chung HSVgdy benh nhieu nhdt vdn Id HSV-2 (83,87% vd 75,00%). Tuy nhiin, vdi HSV- 1, tiii nUgidi nhiim chung HSV-1 (25%) eao han nam gidi (16,13%). Nhiim chung HSV-1 hay gap dgiai doan tiin phdt han (31,8% so vdi 8%), trong khi nhiem chung HSV-2 hay gap d giai doan tdi phdt han (92% so vdi 68,2%).
Tfl khda: herpes sinh due, HSV, HSV-1, HSV-2, LTQDTD.
I.DATVAND^
Herpes sinh due la benh If loet sinh due gay nen do nhiem virus herpes simplex (HSV).
Theo nhieu nghien cflu tren the gidi, trong giai doan hien nay, herpes sinh due la benh If thudng gap nhat (khodng 70-80% eae trUdng hop) trong ede benh loet sinh due do ede benh lay truyen qua dUdng tinh due (LTQDTD) [3].
Nhiem HSV sinh due la nhiem sudt ddi, virus theo dudng than kinh cUtru tai ede te bao hach cdm gide canh cdt sdng gay nen nhflng dpt tdi phdt sau nay Nhieu trUdng hpp, nhiem HSV khdng bleu hien trieu chflng lam sang nhUng
*Benh vien Da lieu Trung uang
van ed khd nang lay lan virus. Cae nghien cflu eho thay, phan Idn cdc herpes sinh due la do chung virus herpes simplex-2 (HSV-2) gay nen.
Tuy nhien, mdt sd thdng bdo gan day cho thay herpes sinh due ed the gay nen do chung HSV- 1 va xu hudng ngay edng tang. 6 Viet Nam, ti le herpes sinh due eung cd xu hudng gia tang, tuy nhien ehUa cd nghien cflu cu the nao dupe edng bd.
Vdi mong mudn tim hieu ti le nhiem, ede chung HSV gay benh, chung tdi tien hanh de tai vdi muc tieu:
Xdc dinh ti li nhiim vd chung HSV gdy binh bdng ki thudt PCR trin nhUng binh nhdn loit sinh due din khdm tai Binh viin Da liiu Trung Uang.
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2. DOI TUONG VA PHUONG P H A P N G H I £ N C U U
2.1. Ddi tuong nghien cflu
Benh nhan cd loet sinh due, hudng den ede benh LTQDTD den khdm tai Benh vien Da lieu Trung UOng tfl 1-10/2010.
Tieu ehuan chpn: benh nhan bj herpes sinh due dupe phdt hien bang PCR, khdng phan biet tudi, gidi; ddng y tham gia nghien cflu.
Tieu ehuan loai trfl: benh nhan cd loet sinh due khdng do ede benh LTQDTD nhU dj flng thude, cdc benh da bong nUde tU mien, ung thu... da xae djnh tren lam sang; benh nhan khdng ddng y tham gia nghien cflu.
n = Z ii-^A^
P (1 - V)
Cd mau tdi thieu tfnh theo edng thflc n = 60.
- Cae bude tien hanh:
H- Khdm lam sang phdt hien ede vet loet va dinh hudng tdi ede loet do benh LTQDTD.
-I- Lam xet nghiem phdt hien nhiem HSV (chan dodn te bao hpe Tzanck, PCR). Ddng thdi lam xet nghiem loai trfl loet sinh due do giang mai RPR; test nhanh phdt hien HIV.
+ Cdc trudng hpp HSV (+), xdc djnh chung gay benh bang kT thuat PCR.
2.2. Phuong phap nghien cflu
-Thie't ke nghien cflu: tien cflu, md ta eat ngang.
-Cdmau:
2.3. Xfl li sd lieu
Xfl If sd lieu theo phuong phdp thdng ke y hpe, sfl dung phan mem SPSS 12.0.
3. KET Q U A N G H I £ N C U U
3.1. Ti le phat hien herpes sinh due trong tdng sd benh nhan den kham va tdng sd benh LTQDTD den kham
BAng 1.Tile herpes sinh due trong so binh nhan den khdm binh da lieu va kham binh LTQDTD Benh
Loet sinh due do HSV
Sd kham benh da lieu
n 47 141.258
% 0,03 100
Benh Loet sinh due do HSV Sd kham benh LTQDTD
n 47 2.662
% 1,77
100 Nhdn xit: t] le benh nhan herpes sinh due chiem 0,03% tdng sd benh nhan den khdm va chiem 1,77% tdng sd benh nhan LTQDTD.
Bang 2. Cdc tdc nhdn gay loet sinh due Tac nhan gay loet sinh due
Giang mai Herpes sinh due Khdng rd nguyen nhan
n 2 47
16
% 3,1 72,3 24,6
Nhdn xit: Herpes sinh due chiem da sd (72,3%) trong ede benh nhan bj loet sinh due hUdng den benh LTQDTD.
3 2 I DA LIEU H O C S6 04 (Thang 06/2011
3.2. Xac djnh chung virus herpes simplex gay loet sinh due 3.2.1. Dinh chung HSV bdng PCR
' • - " - " " ' • " ^ • • • • i " " • " • ' " • " —
Hinh 1. Ket quA PCR djnh chiing HSV Nhdn xit: ed 2 chung HSV dupe phat hien la HSV-1 va HSV-2.
3.2.2.77 li chung HS V gay binh trin binh nhan herpes sinh due
80.9%
H S V 1 H S V 2
Bieu dol.Ti li chung HSV gay herpes sinh due
Nhdn xit: chung gay herpes sinh due dupe phdt hien chu yeu la HSV-2 (80,9%); chung HSV-1 ehi chiem 19,1%.
3.2.3. Phdn bo chung HSV theo gidi, theo giai doan binh
BAng 3. Phan bo chung HSV theo gidi (n=47) Gidri
Nam Nfl Tdng sd
Nhiem HSV-1 5 4 9
Nhiem HSV-2 26 12 38
Tong so 31 16 47
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90.00% 1 80.00% - 70.00% - 60.00%
50.00%
40.00%
30.00%
20.00%
1000%
0.00% ^
iii'i:j%
25.00%
wmmi ^^M
, y;j.y/%^1 • ,
/5.UU%
^A^^M
1 ,
TLHSyitmipeiSD TLimimrpasSD TLHSYiUhTpa SB TLHS¥2/I&rpeiSD
noH nit nam nit
Bieu do 2: Ti li chiing HSV theo gidi
Nhdn xit bdng 3 vd bleu do 2: d cd 2 gidi, chung HSV gay benh gap nhieu nhat la HSV-2 (83,87%
va 75,00%). Tuy nhien vdi HSV-1, ti le nfl gidi nhiem chung HSV-1 (25%) eao hon nam gidi (16,13%).
BAng 4. Phan bo chiing HSV theo giai doan binh (n=47)
^ ^ ^ ~ - - - - _ _ ^ ^ Chung HSV Giai doan ^~~~~^^^^^^^
Herpes sinh due tien phdt Herpes sinh due tdi phdt
HSV-1 n
7 2
% 31,8
8,0
HSV-2 n
15 23
% 68,2 92,0
Tdng n
22 25
% 100 100 Nhdn xit: nhiem chung HSV-1 hay gap d giai doan tien phdt (31,8% so vdi 8%). Nhiem chung HSV- 2 hay gap d giai doan tdi phdt (92% so vdi 68,2%).
4. BAN L U A N
4.1.Tile phat hien benh herpes sinh due Tfl 1 -10/2010, bang ki thuat PCR chung tdi da phat hien dupe 47 trUdng hpp herpes sinh due (chiem 0,03%) tren tdng sd 141.258 benh nhan den khdm tai Benh vien Da lieu Trung UOng va chiem 1,77% tren tdng sd benh nhan LTQDTD.
Trong 65 trUdng hpp loet sinh due nghi do ede benh LTDTD, thi herpes sinh due chiem da sd 72,3%. Sd lieu eua chung tdi phij hpp vdi Lo Kuen Kong [6], cd tdi 90% ede trUdng hpp loet sinh due d Hdng Kdng la herpes sinh due.
Herpes sinh due dang chiem ti le cao trong ede loet sinh due hien nay la do benh nhiem virus ehUa chfla khdi. Nhieu trUdng hpp da nhiem virus nhUng khdng phdt hien ra hoac bj bd sdt do tudng nham la ede tdn thUOng tray xUde khi quan he tinh due, mac quan Idt qud chat, dj flng giay ve sinh hay dap xe dap... nen benh khdng dupe phdt hien va dieu trj. Mat khac, nhieu trudng hpp nhiem virus khdng bieu hien lam sang, neu van cd quan he tinh due khdng an toan cd the la ngudn lay lan virus trong edng ddng.
3 4 I D A LIEU H O C S6 04 (Thang 06/2011)
4.2. Xac dinh chung HSV gay benh
Trong 47 benh nhan herpes sinh due, ed 9 benh nhan nhiem ehUng HSV-1, chiem 19,1% va da sd (38 benh nhan) nhiem chung HSV-2, chiem 80,9%. d Viet Nam, chUa ed nhieu nghien cflu ve
chung virus gay benh di chung tdi ed the so sdnh.
So vdi mdt sd nghien cflu tren the gidi, ti le nhiem chung HSV-1 d tdn thuong sinh due cua chung tdi thap hon eae tae gid [2], [8], [7], [4], [5] va tUOng duong vdi Sen P [9] trong bang dUdi day.
gqng 5. Tile nhiim HSV-1 ddwdng sinh due trong mpt so nghiin eWu Tae gia
Sen P (2008) [9]
Lilly Namvar (2005) [5]
Kristen C. Pen"a (2009) [4]
N Ryder (1992-2006) [7]
C-W Chiam (2008) [2]
S S Sundaram (2009) [8]
Le Huyen My (2010)
Dja diem
Singapore Thuy Dien
My Oe Malaysia
Anh Viet Nam
Ti le nhiem HSV-1 or tdn thUOng sinh due (%)
20,6 29,2 32,0 35,0 42,4 46,1 19,1 Khde vdi eae virus gay benh d ngUdi, HSV khi
da xam nhap vao eo the se tdn tai sudt ddi dudi dang nhiem tiem tang va gay nen nhflng dot tai phdt sau nay. HSV hay gay nhflng nhflng tdn thuong d da, niem mae mat, mieng, sinh due.
Niem mac de bj tdn thuong hon da vl khdng ed Idp sflng day bdo ve. HSV-1 thudng lien quan den ede tdn thuong d vung mat, mieng edn HSV-2 hay gay tdn thuong vung sinh due. Nhieu nghien cflu gan day tren the gidi dang chflng td ti le nhiem HSV-1 d sinh due ngay cang tang.
N Ryder [7] da tdng ket ti le herpes sinh due do HSV-1 tai Oe qua cdc namnhUsau:
Nam 1992-1994 1995-1997 1998-2000 2001-2003 2004-2006
Ti le HSV 1 (%) 29,0 29,0 34,0 41,0 42,0
Day la mdt nghien cflu Idn tien hanh tai Oc tfl 1992-2006 vdi tdng sd 1.845 benh nhan herpes sinh due dupe xdc djnh chung HSV bang nudi cay, djnh loai tfl 1992-2004 va djnh chung bang
PCR tfl 2004-2006. Qua bang tren cho thay, ti le nhiem HSV-1 tren benh nhan herpes sinh due d Oc cd xu hudng ngay cang gia tang.
Mdt nghien cflu cua C-W Chiam (1982-2008) [2] tai Malaysia, mdt nUde Ddng Nam A gan gui vdi Viet Nam tren 118 benh nhan, khang dinh nhiem herpes sinh due (mdi nam trung binh 1 den 6 ca), ed tdi 42,4% la do HSV-1. Theo tac gid tren, neu nhU nhflng nam 90 tai Malaysia, HSV- 2 la nguyen nhan chu yeu eua herpes sinh due thi hien nay, HSV-1 dang lam thay ddi khuynh hudng nay.
Nghien cflu eua chung tdi cho thay, ti le nhiem herpes sinh due do HSV-1 la 19,1%.
Chung tdi chUa ed sd lieu eua tdc gid nao d trong nUde ve ti le nhiem HSV-1 tren benh nhan herpes sinh due de so sanh va xerin xet ve xu the nhiem ede chung HSV lay nhiem d Viet Nam.
Nghien eflu eua ehung tdi eung ehUa phdt hien dupe trUdng hpp nao ddng nhiem HSV-1 va HSV-2 do mau nghien cflu chUa du Idn. Nghien cflu eua Lilly Namvar tren 202 benh nhan herpes
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sinh due [5], thay cd 1 trudng hpp ddng nhiem HSV-1 va HSV-2. Nghien eflu eua Kristen C. Pen'a phdt hien HSV trong benh pha'm co tfl cung, am dao tren mau Idn tfl ede phu nfl den phdng khdm sdn phu khoa d 43 bang nUde My bang kT thuat Realtime PCR thay cd 8.294 trUdng hpp HSV duong tfnh, trong dd 12 trUdng hpp ddng nhiem HSV-1 va HSV-2, chiem ti le 0,15% [4].
Lf gidi sU xuat hien eua HSV-1 trong tdn thuong herpes sinh due, theo ehung tdi, nguyen nhan chu yeu la do quan he tinh due bang dUdng mieng - sinh due dang gia tang. Kinh te xa hdi ngay cang phdt trien, van de giao lUu, hdi nhap qudc te, sU phdt trien eua cdng nghe thdng tin khdng chi edi thien cupc sdng eon ngUdi ma edn thay ddi van hda, phong each sdng, hanh vi tinh due. Ket qud hanh vi quan he tinh due bang dudng mieng - sinh due ngay cang tang, khdng nhflng ddi vdi tinh due khac gidi ma ed tinh due ddng gidi, ed the vl the ma ti le nhiem HSV-1 dudng sinh due kha cao 19,1%. Viet Nam ehUa ed nhflng nghien cflu ve ti le HSV-1 d nhdm tinh due ddng gidi, nhUng tren the gidi da ed nhieu nghien eflu.Ti le HSV-1 tren tdn thuong hau mdn - sinh due d nhdm tinh due ddng gidi nam trong nghien eflu eua N Ryder [7] la 52%.
4.3. Phan bd ehung HSV theo gidri tinh
Nghien eflu ehung tdi eho thay, ti le nhiem HSV-1 trong sd herpes sinh due nam la 16,13%, herpes sinh due nfl la 25%. Ti le HSV-2 trong sd herpes sinh due nam la 83,87%, trong sd herpes sinh due nfl la 75%. Sd lieu cho thay ed sU khde biet ve ti le nhiem gifla ehung HSV-1 vdi ehung HSV-2. Tuy nhien, sU khde biet gifla cdc chung gay benh d cdc nhdm gidi tfnh khdng ed y nghTa thdng ke. Nhieu tdc gid tren the gidi ghi nhan.
ti le n h i i m HSV-1 d phu nfl cao hon so vdi nam gidi. Nghien eflu eua S S Sundaram [8] eho thay, ti le nhiem HSV-1 d nhdm benh nhan nfl la 54,4%, d nhdm benh nhan nam la 32,2%. Neu gidi thfeh If do ti le HSV-1 d phu nfl cao hon nam gidi la do ban tinh eua phu nfl thUdng quan he tinh due bang mieng nhilu hon ban tinh eua phai nam, thi A Wald [1] eho rang khdng thda ddng. Theo tdc gid nay ed le bd phan sinh due nfl de edm nhiem vdi HSV hon nam gidi do dien tfch phan niem mac rdng hOn, ddng thdi da vijng sinh due nam tuy mdng nhUng van cd Idp te bao sflng giup tang cUdng hang rao bdo ve tU nhien hon la nfl gidi.
Nghien eflu eua ehung tdi cho ket qud ti le HSV-1 d phu nfl la 25%, eao hOn nam gidi la 16,13%, tuy nhien sU khde biet ehUa cd y nghTa thdng ke. Cd le do sd lUpng m i u nghien cflu edn han che, tdng sd ca nhiem HSV-1 d ed hai gidi mdi ehi ed 9 trUdng hpp nen ehung tdi ehUa the dUa ra ket luan v l t i l e nhiim HSV-1 dphu nfled thUe sU cao hon d nam gidi khdng.
4.4. Phan bd tip HSV theo giai doan benh Nghien cflu cua chung tdi cho thay, nhiim HSV-1 d giai doan herpes sinh due tien phdt chiem ti le eao hon so vdi giai doan herpes sinh due tdi phat (31,2% so vdi 8%). Nhiim HSV-2 d giai doan herpes sinh due tdi phdt nhieu hon giai doan herpes sinh due tien phdt (92% so vdi 61,8%), sU khde biet ed y nghTa thdng ke vdi p<0,05. Ket qud eua chung tdi tUOng dUOng vdi nghien eflu eua TSC Theng (2004) [10], ti le HSV-1 d giai doan tien phat cd xu hUdng cao hon giai doan tai phdt. Khi nghien cflu tren cdc benh nhan herpes sinh due den khdm tai mdt phdng khdm cdc benh LTQDTD d Singapore,
3 6 I DA LIEU HOC S6 04 (Thang 06/2011)
TSC Theng nhan thay trong nhdm herpes sinh due tien phat, ed 19,3% trudng hpp nhiim HSV- 1 va 80,7% trudng hpp nhiim HSV-2, edn trong nhdm herpes sinh due tdi phdt, ed 4,7% trUdng hpp nhiim HSV-1 va 95,3% trUdng hpp nhiim HSV-2.
Nhu vay, ede benh nhan loet sinh due do HSV-2 ed khd nang tdi phdt eao hon so vdi nhiim HSV-1.
5. K£T L U A N
Ti le nhiim HSV:
-H Ti le benh nhan herpes sinh due ehiem 0,03% tdng sd benh nhan den khdm va ehiem TAI LI|U THAM K H A O
l.A. Wald (2006), "Genital HSV-1 infections", SexTransm Inf, (82), pp: 189-190.
2.C-W Chiam, Y-F Chan, l-C Sam (2010),
"Changing trends of genital herpes in Kuala Lumpur, Malaysia, 1982-2008" International Journal of STD & AIDS, (21), pp: 450-451.
3.EFolkers,AP0ranje,JNDuivenvoorden, J P W Van Der veen (1988), "Tzanck smear in diagnosing genital herpes", Genitourin Me, (64), pp: 249-54.
4.Kristen C. Pen'a, Martin E. Adelson, Eli Mordeehai, John A. Blaho (2010), "Genital Herpes Simplex Virus Type 1 in Women: Detection in Cervicovaginal Specimens from Gynecological Practices in the United States", Journal of clinical microbiology, (48), pp: 150-153.
S.Lilly Namvar, Sigvard Olofsson, Tomas Bergstro'm, and Magnus Lindh (2005),
"Detection and Typing of Herpes Simplex Virus (HSV) in Mucocutaneous Samples by TaqMan PCR Targeting a gB Segment Homologous for HSV Types 1 and 2". Journal Of Clinical microbiology,
1,77% tdng sd benh nhan LTQDTD.
-I- Herpes sinh due chiem da sd 72,3% trong ede benh nhan bj loet sinh due do benh LTQDTD.
- Chung HSV gay benh:
+ Chung gay herpes sinh due chu yeu la HSV-2 (80,9%); ehung HSV-1 ehiem 19,1%.
-(- d cd 2 gidi, ehung HSV gay benh thudng gap nhat la HSV-2 (83,87% va 75,00%). Tuy nhien, vdi HSV-1, ti le nfl gidi nhiim ehung HSV- 1 (25%) eao hon nam gidi (16,13%).
+ Nhiem ehung HSV-1 hay gap dgiai doan tien phdt (31,8% so vdi 8%). Nhiim ehung HSV-2 hay gap d giai doan tdi phdt (92% so vdi 68,2%).
43 (5), pp: 2058-2064.
6.Lo Kuen-kong, Chong Lai-yin (1995),
"Changing Pattern of genital ulcer in Hong Kong", Hong Kong Practitioner, 17 (9), pp: 412-419.
7.N Ryder, F Jin, A M MeNulty, et al (2009),
"Increasing role of herpes simplex virus type 1 in first-episode anogenital herpes in heterosexual women and younger men who have sex with men", 1992 -2006. SexTransm Infect, (85), pp: 416-419.
8.S S Sundaram, S Alderson, R Patel (2009),
"HSV-1 genital infection rare in men over the age of 35years". International Journal of STD & AIDS, (20), pp: 68.
9.Sen P, Sun Y J, Tan H H, Tan S H, Chan R (2008), "Comparison of nested-polymerase chain reaction and virus culture for the diagnosis of genital herpes simplex virus infection". Singapore Med J, 49 (6), pp: 466.
10. TSC Theng et a I (2004), "Genital Herpes in a Sexually-transmitted infection Clinic in Singapore: A 1-year Retrospective study", Ann Acad Med Singapore, (33), pp: 200-3.
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SUMMARY
DEFINE THE PREVALENCE AND THE TYPES OF HERPES SIMPLEX VIROS AMONG PATIENTS WITH GENITAL ULCER IN NATIONAL HOSPITAL OF DERMATOLOGY AND VENEREOLOGY
Objective: To estimate the prevalence and the types of herpes simplex virus patients with genital ulcer in National hospital of Dermatology and Venereology from January to October 2010 by PCR technique.
Results: From January to October 2010, by PCR technique we detected 47 cases of genital herpes, the prevalence of genital herpes among outpatients and STI patients was 0.03% and 1.77% respectively.
Of STI genital ulcers, almost was genital herpes (72.3%), HSV-2 represented 80.9% and HSV-1 19.1%. In male and female patients, percentage of HSV2 was 83.87% and 75.00%. The percentage of HSV-1 among female patients was higher than that of male (25% vs 26.13%). HSV-1 infetion was more common at primary stage than recurrent stage (31.8% vs 8%), but HSV-2 infection was more common at recurrent stage than primary stage (68.2% vs 92%).
Kev words: Herpes genital, HSV, HSV-1, HSV-2, STIs.
3 8 I D A LIEU H O C S6 04 (Thang 06/2011)
