cung thi n i n md thdn lit cung tranh banh rau, l i y thai sau dd c i t tCf eung. Trudng hpp seo md cQ dfnh cQng nen md byng dii rdng, bdc tach gd dfnh trUdc khi md tiJcung. Trong trudng hpp bi dpng sau khi md tiJcung l i y thai mdi bilt rau cdi rdng lupc, thi nSn binh tTnh khdng cd bdc rau, se gdy chay mdu ndng h o i c thdng bdng quang nguy hilm.
Hidn nay d mpt sd nude cd n i n y hpc phit t r i l n , ky thuit niil mach trudc khi phSu thudt rau t i l n dao vd rau c i i ring lupe da dupc thUC hidn. Ky thudt ndy cho phdp kiem soat tdi da sU ch^y mdu trong khi ph§u thuit.
5. Tai bien vd xur tri.
Phdn tich 39 trudng hpp rau cdi r i n g lupc dUdc xCr tri phdu thudt trong nghidn c i ^ ndy da ghi n h i n dUpc 19 InJdng hdp ed tai b i l n cho me chiem ty Id 48,7%, Trong sd n i y tai b i l n chay mau ndng phSi truyin tit 2 ddn vj mdu trd ldn cd 15 trudng hpp (38,5%); tdn thuong bdng quang 9 trudng hdp (23,1%), trong dd tdn thUdng do rau d i m xuyen 5 trudng hpp (12,8%), do phliu thudt 4 tnidng hdp (10,3%); tat b i l n chay mau lai 2 tnidng hpp (5,1%). Trong nghien ciifu ndy khdng cd trudng hdp tCr vong me ndo do rau cdi rdng lUdc. B i d cao eiia Sentilhen nghiin edu n i m 2011 cho thiy t j le tCf vong do rau cai rdng lUdc tai Benh v i i n Angers, Phap la 7% do mat mau nang [4],
KgT LUAN
1. T;^ le g i p rau cai ring lupc l i 0,11%; ty l i rau eai rang lUdc/ rau tien dao Id 5,15%, Trong tdng sd 39 benh nhdn rau cai rang lUdc cd 69,2% ed seo md lay thai cu. Tneu chijfng lam s i n g cOa benh ly rau c i i
rdng lupc rat nghdo nan, d^u hidu ra mau chiem 41%
v i thudng gdp trdn benh nhdn rau tien dao. Chan doan bang sieu dm vdi Doppler mau phdt hiin dupc 48,7% rau cdi rdng lupc.
2. V l xit trf phau t h u i t cd 8 2 , 1 % phai cat tit cung, ty Id b^o t6n dUdc tijf cung 17,9%. Tai bien chi!i y^u Id chay mau n i n g 38,5%, tdn thuong bang quang 2 3 , 1 % .
TAI LI$U THAM KHAO
1. Bach e l m An (201i;," Nh$n xit mit si trudng hi?p rau cii ring luac xim tin bing quang trin vit mo cO'-Tap chf San phu khoa 4/2011-tr 195-201.
2. Trdn Danh CuPng (2011), " Chin doin tau cii ring luac bing siiu im Doppler miu'- Tap Chi San phu khoa4/2011-tr119-124.
3. Nguyln Ddrc Hinh (1999;, "So sinh mi liy thai vi rau tiin d$o 2 giai dqan 1989-1990 vi 1993-1994 t^i Viin BVBMTSS"-Tap chf thdng tin y dUdc-12/1999-tr 107-111
4. L. Sentilhen v i CS (2011)-"Rau cii ring /upc"- Bdo cdo khoa hoc- Hoi nghi San Phu khoa Viet Phdp- HdNpi 4/2011,
5. Dinh Van Sinh (2010), 'Nhin xit chin doin vi thii dd xd tri rau tiin dao 8 thai phij cd seo mi td cung tai Binh viin phu sin Trung uang trong 2 nSm 2008- 2009°- Ludn vdn thac sy y hoc- Dai hoc y H i Ndi.
6. Clark SL, Koonings PP, f^helan JP (1985),
"Placenta previa accrete and prior cesarean section' - Obstet and Gynecol- Vol 66-p 89-92.
7. Miller DA, Chollel JA, Goodwin TM (1997), ' Clinical risk factor of previa placenta accrete'. Am. J.
Obstet and Gynecol- July, 177(1)- p 210,
SO SANH SUTHAY DOI CAC TEST IN VITRO TROOc VA SAU DIEU TRj MIEN DjCH DAC HIEU or BENH NHAN VIEM M O I Dj llfNG DO DERMATOPHAGOIDES PTERONYSSINUS
HUYNH QUANG T H U A N , NGUYEN D A N G DUNG
Hpc vi^n Quin y N G U Y I N TRONG T A I - Dai hpc Ykhoa Vinh
TOM TAT
Ngiy nay di dng chiim mdt vi tri quan trong trong y hoe hiin dai, trin thi gidi 15-20% din sd bi di (mg, trong dd 20% binh nhin man cim vdi di nguyin dudng khi. Tdi nim 2015 ed thicd tdi 1/2 dan si mic binh dj dng. Di nguyin bui nha li mdt tmng nhdng nguyin nhin thdng thudng nhit ciia cic binh atopy, chiim ty le Idn trong viem mui dj ting. Chiin luac diiu tn viem mui di dng phu thuic vao 4 nguyin ly ca bin la tranh tiip xuc vdi di nguyin, dHu tri thuic, diiu tri mien dieh die hiiu va tuyen truyin giao diic cho binh nhin. Miin dich die hieu cd 2 dudng chO yiu:
dudng tiem dudi da (SCIT-Subcutaneous
Immunotherapy) va dudng nhd dudi ludi (SLIT - Sublingual Immunotherapy).
Dii tuang va phuang phap: 120 benh nhin dupc chia 2 nhdm diiu tri miin dich die hiiu dudng tiim vi dddng dudi ludi td thing 6/2010-6/2012, so sanh suthay dil cae xit nghiim in vitro.
Kit qui va ban luan: so sanh cac xit nghiim in vitro trin 2 nhdm binh nhan VMDUdo dj nguyin mat biji nhi D.pte chung tdi thiy 2 phuang phip nay diu cd hiiu qui rd rit va tuang ddOng nhau, sit khac b/if khdng ed y nghTa thong ki (p>0,0S).
Tdkhda: di dng, di nguyin dudng khi, di nguyin bui nha.
Y HOC THirC HANH (848)-sd 11/2012
SUMMARY
Nowadays allergy occupies an important place in modem medicine, the world 15 - 20% of the population are allergic, in which 20% of patients with airway allergen sensitization. By 2015 there may be up to half of the population have allergies. House dust allergens is one of the most common causes of the disease atopy, large proportion of allergic ihinitis. Allergic rhinitis treatment strategy depends on four basic principles is to avoid contact with allergens, drug treatment, specific immune therapy and educate patients. Specific immune has two main lines:
Subcutaneous Immunotherapy (SCIT) and Sublingual Immunotherapy (SLIT).
Subjects and methods: 120 patients were divided into two groups-spedfic immunotherapy injections and sublingual from 6/2010 - 6/2012, compared to the change in vitro tests.
Results and discussion: comparison of in vitro tests on two groups patients VMDU by dust allergens home D.pte we see two methods are remarkably effective and the same, the difference is not statistical significance (p> 0.05).
Td khoa: allergy, allergen sensitization, House dust allergens
OAT VAN oi
Ngdy nay dj iifng chilm mpi vj tri quan trpng trong y hoc hiin dai, tren the gidi 15 - 20% dan sd bj dj Cfng, trong dd 20% benh n h i n mdn cam vdi dj nguyen dudng khi, Dj dng vdi mat byi n h i la mpt ITnh vUc dac biit thii vi vd cd trien vpng trong di ifng hoc h i i n dai. sir quan tam tdi dj nguydn nay khdng ngimg lang len, tnrdc het do sii m i n cam vdi di nguyen byi n h i la mpt trong nhiing nguyen n h i n thdng thudng nhat cOa cae benh atopy, chiem t f le Idn trong benh dl img chung. Bdnh viem mui di dng la mdt van de sdc khoe cdng ddng, ldn d nhieu khia canh khac nhau, bao gdm ca vide lam giam chat lUdng cudc sdng. mat nang suat lao ddng, giam kha nang hpc tap, chi phi tdn kem de dieu trj, thdm chf tir vong khi chiing t i l n trien thdnh hen,
Chien lUdc dieu tri vidm mui dj Cfng vd hen phu thudc vao 4 nguyen ly cd ban la tranh tiep xuc vdi dj nguyen, dieu tri thudc, dieu trj m i i n dich ddc hieu (SIT), v i tuyen tmyln giao due cho binh nhan.
Muc dfch ciia ^ e u tri mien djch d i e hieu (Specific immuno therapy -SIT) l i lam clio binh nhan trd nen dung nap ddi vdi di nguyen m i hp m i n cam bang cdch eho tiep xdc deu dan vdi chfnh nhiing d| nguyen do. Vdi hai dudng dua thudc vdo ed the:
- Dudng tiem dudi da gpi l i SCIT (Subcutaneous Immunotherapy)
- Dudng dudi ludi gpi Id SLIT (Sublingual Immunotherapy)
De cd nhung ddnh gia budc dau hidu qua ciia cac phuong phap dieu tn chung tdi t i l n h i n h so sdnh thay ddi cdc trieu chifng lam sang cd nang sau dieu tri MDDH bang dudng dUdI ludi va dUdng tiem d benh nhdn v i i m mui dj Cfng do dj nguyen D.pteronyssinus.
D6\ T U O N G VA PHUONG P H A P NGHIEN ClJU 1. Do'i tupng nghien cihi.
Chiing tdi lUa chpn 120 b i n h nhdn cd dii cdc yeu cau ve t i i u chuin lira chpn b i n h n h i n nghiin cCfu, chia thdnh 2 nhdm,
- Nhdm I: 60 b i n h nhdn d i l u tri MDDH bang SLIT.
- Nhdm 11: 60 bdnh n h i n d i l u tri MDDH bang SCIT.
Nghiin eCfu dUOc thue hien tai Benh vien Tn/dng Dai hoc Y Hai Phdng (Khoa Dj dng - miSn djch Idm sang) tir thdng 6 /2008 den thdng 6 /2012,
2. PhUdng phap nghien cdu.
Nghien cCfu DTH can thiep thCr nghiem Idm sdng.
3. Cdc p h i n ufng chan d o i n danh gia hl^u qua dieu trj
3.1. Phan dng phin huy ti bio mastocyte ^ Nguyin ly. D\ nguyin ket hop vdi khdng the gan tren be mdt t l bao mast boat h o i phan Cfng l i m tan te bao.
Bang 1. Danh g i i mirc dp cOa phan Cfng p h i n h u j mastocyte
Mifc do
(-)
(+) M (+++) (+*++)Bi^u hien (so vPi lam chijmg) Stft^baobiDhanhu*<10%
S61£ bdo bl phdn hu} ta 10-20%
S6 \& bdo bi phdn hu} tir 20-30%
Stf tg bdo bi phdn hu} tCt 3040%
S6t€bdobiphdnhuf>40%
3.2. Phan dng tieu b^ch du die hl$u Nguyen ly: Phdc hdp DN-khang the gan d mdng te bao bach cau hat khi cd tdc dpng eiia bd the se lam phdn h u j bach cau hat,
DUdng tinh i(+) n l u chT sd tieu bach e l u tU 10%- 20%
DUdng tfnh 2(+) neu chi sd t i i u bach cau tir 2 1 % - 300%
Duong tmh 3(+) neu ehi sd tieu bach cau tir 3 1 % - 40%
Duong tfnh 4 (+) neu chi so tieu bach cau trin 40%
3.3. Djnh lupng IgE toin phin Vong huyet thanh
K? thudt ELISA xet nghiem IgE todn phan trong huyet thanh diia tren nguyen ly bdnh kep (sandwich) nhu sau: cdc phien nhiia dd gan khang the ddn ddng khdng IgE sau khi u vdi huyet thanh ciia benh nhin hoic cac chuan (standard) se tao thinh phCfc hpp anti-lgE+lgE. PhCfC hop tren se gan vdi khdng the khang IgE gan men (khang the khang IgE ciia ngUdi dd gan men peroxidase) tao thdnh phCfc hdp anti- IgE+lgE+anti-lgE*. PhCfc hpp ndy se hien mdu khi Ci vdi CO chat TBM vd mCfe dp d i m nhat cda mau cd chat tl thuan vdi ndng dp IgE trong huyet thanh. Nong dp IgE ciia cdc benh nhdn se dUdc tinh loan sau khi so sanh vdi dUdng cong chuan bang phan mem may tinh TCWIN2,
Y HOC THUC HANH (848) - SO 11/2012
3.4. Blnh luipng IgG toin phin trong huyit thanh
Nguyin If-. Kh^ng t h i trong huyfift thanh c i n djnh luong a6ng vai trb nhu m6t lihSng nguyen sS k f t hdp vdi cac khSng I<h4ng t h i tao thinh phte h(?p KN-KT.
Sir kSt hap nSy tao thinh ta io iCtng mM thdi gian vS ngudi ta do di;oc b i n g phuong phap do dd due. Ndng dd CLia KT ll Id thuSn vdi dd due vi dupc do ddi chidu vdi mot dung dich ohuSn c i a KT c6 ndng St) bilt tr- udc nhu cic phudng phap do quang.
4. PhUdng phdp dieu trj mien djch d$c h i ^ u .
• Lilu iuong duoc d i l u chinh trdn co sd tinh phSn Ung ciia moi bdnh nhan. dUdc tSng mdt c i c h iiSn tuc h i n g n g i y cho d i n khi dat dUOc l i l u toi da md bdnh nhan cd t h i dung nap duoc.
4.1. Biiu tri nilin dfch die hiiu dudng dutil fuel
Bang 2. Quy trinh d i l u tri VIVtDLT bSng phudng phap dudng dudi iudi
Ngiy 1-4 1-3-4-6giol
ThIbJidSu (25naav) Ngay 5-8 1-3-6-10 giot
Ngiy 9-16 1-2-4-6-6-12-16-
20 giot 100 IR/mi
Ngay 17-25 M-8-10-12-14- 16-18-20 giot 300iiVmi Tiii duy tri (300 ilV mi)
20 giol / ngay
4.2. Diiu trj miin djch d^c hi$u dudng tiim B a n g 3. Q u i t r i n h d i e u tri IV1DDH b a n g d u d n g t i e m
Tiifli qian tifim Thang lliCl nliat (2 mQi/tuan)
Tuan 1 Tuin 2 Tuan 3 Tuan 4 Thang thii 2 (ImOi/luan)
Tuan 1 Tuan 2 Tuan 3 Tuan 4 ThanglhLf3(1m0i/tuan)
T u a n i Tuan 2 Tuan 3 Tuan 4 ThSnglhi4(1mOi/tuSn) Thanglhtf5(1m0i/tuan) Thanglhij[6{lm0i/tuan)
Thang thiJ 7 d i n thang thul 12:
1 mQi/2tuan hoSc 1 mui/lhang tuy theo ti^n triln
iam sang
Lifiu luonq (ML) 0.1 0.2 0,3 0,4 0,1 0.2 0.3 0.4 0,1 0,2 0,3 0.4 0.1-0.4 0.1-0,4 0,1-0.4
LiSu duy th 0,4 Ninq d« il^
1 1 1 1 10 10 10 10 100 100 100 100 300 300 300
300
5. Phan tich so'lieu.
Sd l i i u dupe phan tich bang phan m i m SPSS vdi cac lest thdng ke loan thUdng dung trong y te.
K £ T Q U A NGHIEN cCru
1. So sanh tien trien ciia phan i ^ g phan huy mastocyte.
B5ng 1. Kdt qua phan Cfng phdn huy- mastocyte
M X
Am tinh 1*
2t 3*
4*
OLTdnq i\i& iudi (n=60) TnnSc digutri SL
0 15 19 13 13
%
0 25 31,66 21,66 21,66Sau difiutri SL 33 14 11 2 0
5S.0
%
23,33 16,33 3,33
0
Dirdnq tiSm (n=60) Tn/dc dilutn SL
0 13 19 17 11
%
0 21.66 31.66 28.33 18.33Sau diiutri SL 37 12 6 3 0
61.66
%
20.0 13.33 5,0
i
P (trudc.
sau diiutri)
<0,05
D (dudnq dufli iuOi, dirdnq tifim) > 0,05 Kdt qua d i l u trj nhdm dUdng dudi li/di vd dudng tiem cung tUOng dUOng nhau thdng qua phan itng phdn h u j mastocyte (p>0,05),
2. So sdnh tien tri^n cua phan Ling tieu bach c i u d^c h i ^ u .
Bang 2. Kdt qua phan Cmg l i i u bach cau ddc hieu
MOC DO Am tinh I t 2t 3t 4*
Dirdnq dudi ludi (n=60) Tnrdc diSutn SL
0 19 14 13 14
%
0 31.66 23.33 21.66 23,33Sau diau tri SL 31 16 10 3 0
%
51,66 26,66 16,66 5,0
0
Dudnq tiam (n=60) Trudc diau tri SL
0 15 19 16 10
%
0 25,0 31.66 26.66 16,66Sau diiutri SL 35 14 7 4 0
58,33
%
23,33 11,66 6.66 0
P (tniaiD.
sau diiutri)
<0.05
p [dudnq dud) iuai. dirdnq Ham) > 0.05 H i e u q u a d i e u tri d U d n g d U d i l u d i , d u d n g tiem khdng cd sukhac biit (p>0,05).
3. So sdnh s u t h a y doi cua ham lUdng IgE toan p h i n .
Bang 3. Ket qua hdm lupng IgE t o i n phan truPc, sau d i l u tn (ddn vi Ul/ml)
Thd dilm
Dirdng duilniirCh
Dudng Iiam
ThSp nhat Cao nhat X SD T h i p n h i t Cao nhat X SD P (tnrdc. sau diau tri)
Trudc diau tri 163.9 1426.8 679.96 339,65 163.9 1499.7 635.6 331.73
Sau diau tri
79.1 851.3 334.59 193.11 78.1 889,3 323.71 187.05
<0.05
p [dudng dudi iudi.
tiam)
>0.05
Hdm lupng IgE todn phan sau dieu tri deu giam co y nghTa thong ke ct ca 2 nhdm dung dUdng dUdi lu8i va dudng tiem (p<0,05).
So sanh ket qua dinh lUpng IgE toan phan trong huyet thanh cho thay giu^ 2 nhdm dudng dUdi liidi dudng tiem khdng cd s i i khac biet (p>0,05).
Y HOC THirc HANH (848) - sO 11/2012
4. So sanh s i / thay doi cua h i m lupng IgE d i e hieu.
Bang 4. K i t qua ham lupng IgE d i e hieu (Ul/ml) Th«dilm
Dudng dudi
iudi
Dudng Iiam
ThlpnhA Cao nhit X SD Thip nhit Cao nhat X SD P (tnrdc. sau dilu tri)
Trudc difiu tri 0,48 120,6 34,33 26.11 0,55 115,7 32.05 26.91
Sau didu tri 0.25 52,1 6,45 4,03 0,26 42,7 9,64 6,44
<0.05
p (dudng tiam)
>0.05
Sau dieu tri hdm lUpng IgE d i e hidu deu giam ed y nghTa thdng ke so vdi trudc d i l u trj (p<0,05) d ca 2 nhdm dCing dudng dudi ludi vd dudng tiem.
So sdnh ket qua hdm lupng IgE d i e hiiu trudc va sau dilu tri cCia nhdm dung dUdng dudi ludi v i dudng tiem khdng cd sukhac biet (p>0.05),
5. So sanh s i / t h a y doi cua ham lUdng IgG toan p h i n
Bang 5. K i t qua h i m lUpng IgG (mg%) Th« dilm
Dudng iudi
Dudng tiam
Thip nhit Cao nhit
X SD Tiiipnhit Cao nhit X SO P (trudc. sau diau tri)
Tnrdc diau tri 809 1319 1014.22
95.46 810 1257 990.93
88.12
Sau diiu tri 1206 2399 1856.32 226.35 1206 2399 1862.97 240,30
<0.05
p (dudng du* lua, tiam)
>0,05
TrUde dieu trj h i m lUdng IgG deu thap hdn so vdi sau dieu trj d ca 2 nhdm diing dudng tiem v i dudng dudi luPi, sir k h i c b i i t ed y nghTa thdng ke (p<0,05).
Ket qua djnh lupng IgG sau dieu tri bang dUdng dudi luai, dudng tiem eijng khdng c d s u khdc biet (p>0,05).
BAN L U A N
1. Thay doi ctia phan iing phan huy Mastocyte.
D i y l i phuong phdp gian tiep xdc <Snh IgE toan phan. Phan Cfng duong tfnh chCfng td trong huyet thanh ngUdi VMDLf cd khang the d\ Cmg IgE.
K i t qua phan Cmg phdn h u j mastocyte d benh nhdn d i l u tri duPng dudi ludi cho thay:
Trudc deu tri sd binh nhdn cd phan Cfng phin hu;/
te bdo mast dUOng tfnh Id 60 ngudi, chilm ty le 100,0%.
Sau dieu tri, t j Id benh n h i n cd phan Cmg (-) tang ldn 55,0% (33 binh nhin). Sd lupng benh nhdn duong ti'nh d tat ea cae mCfc (+), {++), (+++) v i (++++) deu giam. Khdng cdn benh nhan cd mCfc dUdng tinh (++++), giam ti:r21,66% xudng cdn 0,0%.
So sinh vdi dudng tiim:
Tnidc dieu tri sd benh nhdn cd phan Cmg phdn buy te bao mast di/dng tinh la 60 ngUdi, chiem tf Id 100,0%.
Sau dieu trj ty Id b i n h nhdn ed phan Cmg (-] tdng len tdi 61,66%. Sd lUdng benh nhdn dUdng tfnh d cac mCit deu giam. Luong benh nhdn cd mCfc duong tinh {++++) ban dau cd 11 ngUdi (18,33%), sau dieu tri khdng cdn benh nhdn ndo d mite 3d ndy,
Ket qua n i y cao hdn ket qua nghien cCfU ei^a Nguydn N h i t Linh, Im Lead, D o i n Thanh Ha khi d i l u tri VMDU bang dudng tiem vd dudng dUdi ludi vdi di nguyen bui n h i D.pt, ty Id md cdc tdc gia nay dUa ra Id khoang 45 - 50% phan Cmg i m tinh sau dieu tri.
2. Bien doi hdm lupng IgE vd IgG.
Him lupng IgE toin phin trong huyit thanh trudc vi sau dlAi trj.
6 benh nhan dupc d i l u tri dudng duPi ludi Trudc dieu tri:gid tri thdp nhSt ct^a IgE toan phan huyet thanh Id 163,9 Ul/ml, cao nhit Id 1426,8 Ul/ml;
tmng binh Id 679,96 ± 339,65 (Ul/ml).
Sau dieu trj: Gia trj thap nhat la 79,1Ul/ml; cao nhat la 851,3Ul/ml: tmng blnh la 334,59±193,11UI/ml
So vdi phuong phap dieu tri dudng Item:
Trudc dieu tri:gid tri thap nhat ci!ia IgE loan phin huylt thanh la 163,9UI/ml; cao nhat l i 1499,7 Ul/ml;
trung binh la 635,60 ± 331,73 (Ul/ml).
Sau dieu tri: gia tri thap nhit Id 78,1 Ul/ml, cao nhat Id 889,3 Ul/ml; trung binh Id 323,71+187,05UI/ml So sanh 2 tmng binh hdm lUOng IgE truPc vd sau d ca hai phuong phap dieu tri eho thay sau dieu trj ham lupng IgE loan phin huylt thanh giam hOn so vdi trudc dieu tri v6i p<0,05.
Dudng tiem vd dudng dudi ludi khdng cd su khac biit (p>0,05),
Him litgmg IgE die hieu trudc vi sau dieu trr.
C i c ket qua cila dieu tri dudng dudi ludr Gia tri k i t qua hdm lUdng IgE ddc hieu trong huyet thanh trudc va sau dieu tri eung khdc biet,
Trudc dieu tn: g i i tri thap nhi't cda IgE dae hieu huyet thanh la 0.48Ul/ml, cao nhat l i 120,8 Ul/ml;
trung binh la 34,33 ± 26,11 (Ul/ml).
Sau dieu tri: gid tri thap nhat la 0,25 Ul/ml, cao nhat la 52,1 Ul/ml, tnjng binh la 8,45 ± 4,03 Ul/ml
Ket qua dudng tiem:
Trudc dieu trj.gia trj thap nhd't ciia IgE d i e hieu huyet thanh Id 0,55Ul/ml; cao nhat l i 115,7 Ul/ml, tmng binh Id 32,05 + 26,91 (Ul/ml),
Sau d i l u tri: g i i tri thap nhat la 0,26 Ul/ml; cao nhat la 42,7 Ul/ml, tmng binh Id 9,84 ± 8,44 Ul/ml
So sanh 2 tmng binh ham lupng IgE trudc va sau dieu tri d ca hai phUdng phip cho thay sau * l u In h i m lupng IgE d i e hieu huyet thanh giam hdn so vdi trudc dieu trj vdi p<0,001.
Dudng tiem vd dudng dudi ludi khdng cd su khac biet (p>0,05)
Him lupng IgG toin phin trong huyit thanh Dudng dudi ludi.
Tn/6c dieu tri: gia tn thap nhat: 809 mg%; cao nhat:1319mg%, trung binh: 1014.22 ± 95.46 (mg%)
Sau dieu tri, gia tri thap nhd't: 1206mg%; cao nhat: 2399mg%; tmng blnh 1856.32 ± 226.35 {mg%)
Y HOC THUC HANH (848) - s6 11/2012
K i t qua cda dUdng tiSm:
Trudc d i l u trj: gia trj th^p nhfit: 810 mg%; cao nhit: 1257mg%; tmng blnh: 990.93± 88.12 (mg%)
Sau d i l u tri: gid tri t h i p nhit: 1206mg%; cao nhit: 2399mg%; tmng blnh: 1862,97 ± 240.30 (mg%)
Nhu vdy sau d i l u trj, hdm lUdng IgG todn p h i n huylt thanh tdng l i n so vdi tmdc khi d i l u tri. Su khdc biit ndy cd y nghTa thdng kd vdi p<0,05. Dudng tidm vd dudng dUdi ludi khdng cd sii khdc bidt (p>0,05)
Nghiin cCru cda chung tdicho t h i y hdm lUpng IgG t i n g ldn sau d i l u tri cd y nghTa thdng k i . S i i t i n g Idn ciia hdm luwng IgG cCing v6i su gidm xudng ciia IgE sau d i l u trj so vdi tnidc d i l u trj chiJng td ddp Cmg miSn dich Ihay ddi, t h i hidn bSng chd cac test l i y da, test kich thich mQi, giam hlin mCrc dd duong tinh. T i t ca nhOng thay ddi ndy phd hpp v6i vide cdc triiu ehCmg l i m sdng tdt l i n sau d i l u tri.
Theo cd c h l cGa VMDU thi su hinh thdnh cdc triiu ehCmg ldm sdng l i do sUtdc ddng cda cac c h i t trung gian hoa hpc nhU histamine, prostaglandin..., v i cdc cytokin dupe giai phdng tii cac t l b i o mastocyte vd t i c ddng d i n n i i m mac mui gdy ndn. Sau d i l u trj MDDH dudng dUdi lUdi. sii thay ddi IgE vd IgG tUdng ddng vdi sU b i l n ddi cac test lay da, test kich thfch miji va phan Cmg phdn h u j mastocyte l i bang chCmg khach quan chCmg td dap Cmg m i i n djch da thay ddi.
I Pbiiiihia\li
Hinh 1, Hi^u qua mien djch Sdc hl§u bing dj nguyfin tren cac chl so miln dich
Kg'T LUjBiN
Qua nghiin cCfu d i l u trj MDDH dudng dudi ludi, dudng tidm trdn 120 bn VMDLf do dj nguyen mat bui nhd D.pt, so sanh cdc xet n g h i i m in vitro chdng t6i t h i y ed cSi thien tuong dudng nhau, su khac bidt khdng cd y nghTa thdng kd (p>0,05).
T A I L I $ U THAM K H A O
1. VQ Minh Thue (1990), Vai trd cOa dj nguyin bui nhi trong cic binh dj dng. Ludn vdn Tiln s? Y hoc, Mockba, lr.40-45.
2. Vu Minh Thuc (2001), 'Miin dieh liiu phip trong diiu trj viim mOi dj ling", Hdj nghj khoa hpc Hoa Sinh y dupc, tr.14-20.
3. Berger WE, (2001), Treatment update: allergic rhinitis. Allergy Asthma Proc. 22:191-8
4. Calderon MA, Alves B, Jacobson M, et al. (2007),
"Allergen injection immunotherapy for seasonal allergic rhinitis". The Cocharane Databasw of Systematic Reviews, Issue 1.
5. Cosmi L. Santariasci V, Angeli R, et al. (2006),
"Sublingual immunotherapy with Dermatophaoides monomerie allergoid down-regulates alllergen-specific immunoglobulin E and increases both interiemn- gamma and interieukin 10 production'. Clin Exp Allergy, 36; 261-272.
6. Jutel M, Akdis Mm Blaser K, et al. (2006), 'Mechanisms of allergen specific immunotherapy: T-cell tolerance and more', /Ulergy: 61: 796-807,
7. Mellin B, Tonnel AB, Scherpereel A, Douay B, Leprince D, Goldstein N et al, (2004), "Allergic rhinitis due to house dust mites: evaluation of the efficacy of specific sublingual immunotherapy', Allergy , 59:491-497.
a, Moingeon P. Batard T. Fadel R, et al. (2006),
"Immune mechanisms of allergen-spedfic sublingual immunotherapy, Allergy.; 61:151-165.
9. Pham-Thi N, de Blie J, Scheinmann (2006),
"Sublingual immunotherapy in the treatment of children', Allergy.; 61 {Suppl 81): 7-10.
KHAU P H £ N C A N X I CUA BA ME DANG CHO CON BU
TAI HUYEN HOAI Dl)b- HA Ndi
NGUY£N VI$T HONG VU TH! THU HIEN, SHIGERU YAMAMOTO OAT VA'N oi
Bang chdng tir nhiJng nghien ciiu g i n day da chung minh dinh dUdng canxi cd vai trd rat quan trong vdi sCfc khde xUdng [1], Dinh dudng canxi d i y dd v i lien tuc trong sudl cudc ddi khdng nhiJmg giup du phdng cdi xUdng 10c nhd, ma cdn gdp phan eho CO the dat dUdc khoi lupng xUdng dinh cao lue trudng thanh vd han c h l tdc dp mat chat xUdng khi
cao tudi, tCr do giam bdt dupc t j le loang xuong cho cpng ddng [2, 3].
NhCmg nghien cCru trudc ddy da cho thiy: t j le cdi xuong d tre em va ty le loang xUdng d Viet Nam khd cao so vdi eac nude khac trong khu vUC [4, 5].
Hdn niJfa, khau phan canxi 6 ngiidi trudng tiianh Viet Nam chUa dap Cfng dUdc nhu cau khuyen nghi [6].
Y HOC THlTC HANH (848) - s 6 11/2012