TCNCYH 70 (SJ - 2010 TAI LIEU THAM KHAO 2. D6 Nho Hon, Nguyin Chi Dung, Hans 1. Nguyin Chi Dung, Vu Qudc LOdng (1997): Limberg (2008): Danh gia nhanh mu Ida cd the Djch tl bpc benh mat hot d tre em dfldi 15 tudi phdng tranh dflpc tail 6 tinh thanh Viet Nam. tai 1 sd vung Viet Nam hien nay. Tap chf Nghien Cdng trinh NCKH cap Bp, Benh vien Mat cflu Y hpe. Volume 3. Sd 3,1997, tr 8-14. Trung fldng. Summary RAPID ASSESSMENT OF ACTIVE TRACHOMA, TRICHIASIS AND BLINDNESS PREVALENCE IN THE COMMUNITY OF NAM DINH, THAI BINH, HAI DUONG PROVINCES Assessment of active trachoma and TT prevalences is necessary for Trachoma Control planning. Objectives: (1). To evaluate active trachoma prevalence in under 16 children and TT prevalence in 40 years and older population. (2). To assess Blindness prevalence and causes in 40 years old and over popu- lation in the community. Method: Cross - sectional prescriptive study on 5201 children and 9554 persons of 40 years old and over. Results: Active trachoma prevalence in children in 3 provinces is 0%, TT preva- lence in ThaiBinh is 4.48%, in NamDinh is 1.44% and in HaiDuong is 1.28% in the population of 40 years old and over, but mainly found in the group of 70 and over. Prevalence cf blindness in the popula- tion of 40 years old and over is 4.17% in ThaiBinh, 2.52% in NamDinh and 1.24% in HaiDuong. Main cause of blindness is still cataract (3.3% in ThaiBinh, 2.3% in NamDjnh, 0.9% in HaiDuong), trachoma blindness is 0.1 %(ThaiBinh), 0.03% (NamDinh) and 0% (HaiDuong). Conclusion: To control of Blinding trachoma, promotion of TT surgery, especially in the population under 70 years old is necessary and feasi- ble target in some years. Keywords: assessment of active trachoma and TT THONG BAO DAU TIEN VE NGHIEN CL/U GIA TRj PIVKA - II TRONG CHAN DOAN UNG THU GAN 6 BENH NHAN VIET NAM NHIEM VIRUS VIEM GAN B Bui Xuan TrOdng, Nguyin Khanh Trach Benh vien Bach Mai Ung thd gan (UTC) rat pho bien vi cd ty Id td vong cao Alpha - fetoprotein (AFP) li dau an sinh hoc duy nhat ddac sd ddng de chin doin UTC tai Viet Nam, nghien cdu cic dau an sinh hoc khac nhu PIVKA - II (protein t^o ra do sU thieu hut vitamin K) cdn rat han chi. Muc tieu: budc diu dinh gia vai trd cua PIVKA - II trong chin doin ung thd gan d benh nhin Viet Nam nhiim virus viem gan B. Ddi ttfgng va phuang phap: nghien cdu bao gom 104 bdnh nhin nhiim virus viem gan B (HBV) ddac chia lam bdn nhdm, ngddi lanh mang virus (NLMVR), viem gan man tinh (VGM), xa gan (XG) va UTC. AFP ddac xic dinh bing ELISA, PIVKA - II duac xic djnh bing Eitest PIVKA - II cua cdng ty Eisai, Nhat Ban. Ndng do HBV - DNA vi kiiu gen cua HBV duac xic djnh tdang dng bang real - time PCR va PCR - RFLP. Chin doan UTG ddac xic djnh bang md bdnh hoc Ket qua: PIVKA - II cd dd nhay cao han va dd die hieu thip han AFP d tat ca cic mde ning dd phan 88
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TCNCYH 70 (SJ - 2010
T A I L IEU T H A M K H A O 2. D6 Nho Hon, Nguyin Chi Dung, Hans
1. Nguyin Chi Dung, Vu Qudc LOdng (1997): Limberg (2008): Danh gia nhanh mu Ida cd the
Djch t l bpc benh mat hot d tre em dfldi 15 tudi phdng tranh dflpc ta i l 6 tinh thanh Viet Nam.
tai 1 sd vung Viet Nam hien nay. Tap chf Nghien Cdng trinh NCKH cap Bp, Benh vien Mat
cflu Y hpe. Volume 3. Sd 3,1997, tr 8 - 1 4 . Trung fldng.
Summary
RAPID ASSESSMENT OF ACTIVE TRACHOMA, TRICHIASIS AND BLINDNESS
PREVALENCE IN THE COMMUNITY OF NAM DINH, THAI BINH, HAI DUONG PROVINCES
Assessment of active trachoma and TT prevalences is necessary for Trachoma Control planning.
Objectives: (1). To evaluate active trachoma prevalence in under 16 children and TT prevalence in 40
years and older population. (2). To assess Blindness prevalence and causes in 40 years old and over popu
lation in the community. Method: Cross - sectional prescriptive study on 5201 children and 9554 persons
of 40 years old and over. Results: Active trachoma prevalence in children in 3 provinces is 0%, TT preva
lence in ThaiBinh is 4.48%, in NamDinh is 1.44% and in HaiDuong is 1.28% in the population of 40
years old and over, but mainly found in the group of 70 and over. Prevalence cf blindness in the popula
tion of 40 years old and over is 4.17% in ThaiBinh, 2.52% in NamDinh and 1.24% in HaiDuong. Main
cause of blindness is still cataract (3.3% in ThaiBinh, 2.3% in NamDjnh, 0.9% in HaiDuong), trachoma
blindness is 0.1 %(ThaiBinh), 0.03% (NamDinh) and 0% (HaiDuong). Conclusion: To control of Blinding
trachoma, promotion of TT surgery, especially in the population under 70 years old is necessary and feasi
ble target in some years.
Keywords: assessment of active trachoma and TT
THONG BAO DAU TIEN VE NGHIEN CL/U GIA TRj PIVKA - II
TRONG CHAN DOAN UNG THU GAN 6 BENH NHAN VIET NAM
NHIEM VIRUS VIEM GAN B
Bui Xuan TrOdng, Nguyin Khanh Trach
Benh vien Bach Mai
Ung thd gan (UTC) rat pho bien vi cd ty Id td vong cao Alpha - fetoprotein (AFP) li dau an sinh hoc duy
nhat ddac sd ddng de chin doin UTC tai Viet Nam, nghien cdu cic dau an sinh hoc khac nhu PIVKA - II
(protein t^o ra do sU thieu hut vitamin K) cdn rat han chi. Muc tieu: budc diu dinh gia vai trd cua PIVKA - II
trong chin doin ung thd gan d benh nhin Viet Nam nhiim virus viem gan B. Ddi ttfgng va phuang phap:
nghien cdu bao gom 104 bdnh nhin nhiim virus viem gan B (HBV) ddac chia lam bdn nhdm, ngddi lanh
mang virus (NLMVR), viem gan man tinh (VGM), xa gan (XG) va UTC. AFP ddac xic dinh bing ELISA, PIVKA - II
duac xic djnh bing Eitest PIVKA - II cua cdng ty Eisai, Nhat Ban. Ndng do HBV - DNA vi kiiu gen cua HBV
duac xic djnh tdang dng bang real - time PCR va PCR - RFLP. Chin doan UTG ddac xic djnh bang md bdnh
hoc Ket qua: PIVKA - II cd dd nhay cao han va dd die hieu thip han AFP d tat ca cic mde ning dd phan
88
TCNCYH 70 (SJ - 2010
tich. Ket hap hai dau an cd do die hi$u cao ban va ty Id chan doin dung tdt ban. Nong do PIVKA - II va AFP
deu ting din td nhdm NLMVR ddn VGM, XC va cao nhat d nhdm UTC, sd khic bidt la cd y nghTa thdng ke
(p < 0,05). Phan tich dan bien cho thi'y tuoi (> 50), kieu gen C cua HBV, AFP (> 20ng/mL) va PIVKA - II (> 40
mAU/mL) la nhOng ye'u td nguy ca cd f nghTa thdng ke ddi vdi XG va UTG. Tuy nhien, phin tieh da bien cho
thiy chi cd tuoi (> 50), kiSu gen C cua HBV va PIVKA - II (> 40 mAU/mL) la nhdng ydu td nguy ca cd y nghTa
thdng ki ddi vdi XC va UTG. Kit luan: PIVKA - II la diu in sinh hgc, cd gii trj va cd vai trd hd tra tdt AFP
trong chan doin UTC.
TO khoa: ung thO gan, virus vi€m gan B
I. DAT VAN DE Ung thu gan la mdt trong sau loai ung thU phd
bi ln nhat tren the gidi, d nam gidi ung thU gan
dflng hang thd ba sau ung thU phdi va ung thU da
day. Virus viem gan B (HBV: hepatitis B virus),
virus viem gan C (HCV: hepatitis C virus) va rUdu
la nhflng nguyen nhan hang dau gay xd gan (XG)
va ung thu gan (UTG). D i n nay, mac du nh i lu
loai t h i he thude thupe nhdm chat tUdng ddng
nucleotide (nucleot/side analogue) dfldc p h l t trien
thanh cdng, cung nhfl viee trien khai ap dung
dieu trj bang Peg - interferon (Pegasys, Pegintron)
rpng rai hPn, nhflng hieu q u i dieu trj viem gan B
man tfnh van chfla dfldc nhfl mong ddi. Chung ta
v in ehUa dat dUpc khai niem lam sach HBV trong
dieu trj viem gan B man tinh, HBV va benh ly do
HBV gay nen van la mpt g i nh nang cho nhan
loai, ddng thdi cung la mpt thaeh thflc cho y hpe.
Hien nay, tren toan the gidi, mdi nam ed khoing
0,5 trieu benh nhan UTG mdi dUde p h l t hien.
Mpt so' nha nghien edu y hpe nhan djnh, so' benh
nhan UTG v i n t i l p tuc gia tang trong mpt vai
th|p k'y tdi.
Khoang 85 - 90% benh nhan UTG cd kem
theo XG d cac mfle dp khae nhau. Hieu qua d i l u
trj UTG phu thupe vao giai doan p h l t trien eua
khdi U, benh ly gan va toan than, ed di can hay
chUa ed di can. UTG dflpc phat hien sdm, dac
biet tren benh nhan tdn thfldng XG chfla nang, ed
tien Iflpng tdt va cd k h i nang keo dai eupc sdng
tren 5 nam rat cao. Day ehinh la ly do nh i lu nha
y hpe di sau t im h i l u nghien cdu va dUa ra cae
g i i i p h l p ehan dean UTG giai doan sdm. Cung
vdi sU phat trien cua chuyen nganh ehan do ln
hinh I n h , chup cat Idp vi tinh (CT) va cpng hudng
tfl hat nhan (MRI), y hpe ngay cang cd kh i nang
chan do ln ung thfl gan d giai doan sdm va giai
doan rat sdm. Tuy nhien, d CT va MRI deu cd
g i l thanh d i u tUdng dd'i cao, hdn nfla v l mat trang
th i l t bj cung khd trien khai lam cdng tac sang Ipe
trong cpng ddng. Do vay hien nay, sieu am
thudng qui k i t hpp vdi xet nghiem alpha - fetopro
tein (AFP), vdi UU diem g i l thanh re va d l trien
khai van la phUPng p h l p chu y l u dUdc I p dung
tren the gidi de sang Ipe v l phat hien benh nhan
UTG giai doan sdm. NhUng nhUpe diem cua sieu
am la phu thudc vao nang Iflc cua ngUdi lam, thdi
diem tie'n hanh lam trong ngay va the trang benh
nhan, do vay sieu am cd dp nhay dao ddng cao.
AFP cho d i n thdi diem hien tai van la mpt dau an
(marker) sinh hpe chUa the thay the trong chan
do ln va theo ddi hieu q u i d i l u trj UTG. Tuy
nhien trong chan do ln UTG, viec sfl dung AFP cd
the bd sdt tdi 40% benh nhan, ben canh dd nh i lu
benb nhan viem gan v l xd gan cung ed tang ndng
dp AFP tUdng ddi cao va ndng dp AFP khdng cd
md'i tUPng quan chat che vdi kich thUde khd'i U
gan [4, 5, 7].
Trong mpt vai thap k"/ g i n day, viec tim ra
mpt marker sinh hpe ed kha nang thay the hoae
hd trp cung AFP trcng chan doan sdm va theo doi
hieu qu i d i l u UTG dUdc d e nha y hpe khdng
ngOng quan tam nghien cdu. D i n nay cd hang
chuc marker sinh hpe da dUdc tim ra, nhUng chi
cd khoang hdn 10 marker trong sd dd dupe danh
89
TCNCYH 70 (SJ - 2010
g i l la cd trieri vpng kha quan trong thflc hanh lam
sang [7]. Mpt trong d c marker dd la PIVKA - 11,
mpt protein dUdc tac ra do sU tieu hut vitamin K,
hay edn dupe gpi la des - gamma - carboxy
prothrombin (DCP). Vai trd cua PIVKA - II trong
chan doln va theo ddi hieu qua d i l u trj UTG ngay
cang duoc quan tam nghien eflu d cpng ddng
benh nhan thupe eac khu vfle khac nhau tren the
gidi. Mpt so' nghien edu nhan thI'y PIVKA - II ed
g i l trj cao hdn AFP trong chan doan va tien lUpng
d benh nhan UTG [3, 9, 10]. Tuy vay, nhieu nha
nghien edu ddng nhat quan diem PIVKA,- II va r'
AFP cd tac dung hd trp nhau, PIVKA - II ehUa thflc
sfl cd kh i nang vflpt trdi hoan to ln d l ed t h i loai
bd dflpe AFP trong thflc hanh lam sang.
La nflde thupe vung tay T h i i Binh DUPng, mpt
trong nhflng khu vfle ed ty le nh i lm HBV eao nha't
t h i gidi vdi dfldng lay truyen chu y l u tfl me sang
con, ty le nh i lm HBV tai mpt sd tinh - thanh d
Viet Nam ed the Idn hdn 1 5% dan sd [2, 8]. HBV
la nguyen nhan hang d i u gay viem gan man
(VGM), XG va UTG. Tai Viet Nam, UTG cung la
mpt trong nhflng ung thU phd b i l n nha't va ed ty le
tfl vong cao. Vdi khoing 75% dan sd sd'ng tai
ndng thdn va d i l u kien cham sdc y t l edn chUa
ddng deu gifla ndng thdn va thanh thj, do vay rat
nhi lu benh nhan UTG tai Viet Nam khi di kham
d giai doan benh da mudn hoae rat mudn. D i l u
nay ly giai tai sao ty le benh nhan UTG ed ddi
sd'ng keo dai tren 5 nam edn kha thap. Viec sang
Ipc benh nhan UTG tai Viet Nam v l can ban
cung dUa chu y l u vao sieu am va cd hay khdng
ed k i t hdp vdi xet nghiem AFP (do nh i lu benh
vien nhd va phdng kham chUa ed kha nang trien
khai lam AFP). Nhflng den nay, tai Viet Nam viec
nghien edu eac da'u a'n sinh hpe thay the hay hd
trp eung AFP trong thflc hanh lam sang edn rat
han c h i , chfla cd nghien edu di sau tim hieu gia
trj cua PIVKA - II trong ehan doan va theo ddi tien
lupng hieu qu i d i l u benh nhan UTG. Do vay
nghien cflu nay dUdc t i l n hanh vdi muc tieu:
Budc diu danh gia vai tro cua PIVKA - ll trong
chan doan ung thtf gan d benh nhan Viet Nam
nhiem virus viem gan B.
II. DOI TUONG VA PHUONG PHAP
NGHIEN CLfu
1. Doi tOdng nghien cOu: nghien cflu bac gdm
104 benh nhan nhiem virus viem gan B, 88 nam
va 16 nfl, tudi trung binh 36,6 ± 15,8 (17 - 70
tudi). Dd'i tupng nghien cflu dfldc chia lam bdn
nhdm, 40 ngfldi lanh mang virus (NLMVR), 14
benh nhan viem gan B man tfnh (VGM), 25 benh
nhan xd gan (XG) va 25 benh nhan ung thU gan
(UTG). Tat e l benh nhan deu dfldc kham, dieu tri
va theo ddi djnh ky tai benh vien Bach Mai, Ha
Npi. De xac lap "tieu chuan vang" tfnh dp nhay
va dp dae hieu, ta't d benh nhan UTG d iu dUpe
chan doan x l e djnh bang phan tich md benh hpe
dfla tren manh td ehfle sinh thiet gan hoac chpc
hut t l gan dfldi sfl hfldng d i n cfla sieu am.
2. PhOdng phap nghien cffu: do d i l u kien hien
nay tai Viet Nam chfla trien khai lam xet nghiem
PIVKA - II, de d i m b i o tfnh ddng bp cua k i t qua
xet nghiem, m l u benh nhan trong nhdm nghien
edu sau khi thu thap dUdc quay li tam t i ch bo
thanh phan hflu hinh, p h i n huyet thanh cdn lai
dUdc luu trO d nhiet dp am sau (- 80°C), sau dd
dupe ehuyen qua phan tich tai TrUdng Y, Dai hpe
Kobe, Nhat B i n .
Ndng dp HBV - DNA dupe x l c dinh bang
phUdng phap real - time PCR, kieu gen eua virus
viem gan B dfldc phan Icai bang phfldng phap
PCR - RFLP. Ndng dp alpha - fetoprotein (AFP)
dflpe xae djnh bang phfldng p h l p ELISA vdi kit
cua cdng ty AbboL Hoa Ky; ngfldng g i l tri x lc
djnh gifla binh thfldng va bat thfldng la 20 ng/mL.
Ndng dp PIVKA - II dflde x l e djnh vdi kit Eitest
PIVKA - II cua cdng ty Eisai, Tokyo, Nhat B in ;
ngUdng gia trj xac djnh gifla binh thfldng va bat
thfldng la 40 mAU/mL.
90
TCNCYH 70 (SJ - 2010
3. XO ly sd lifu: cac thuat toan Khi binh phfldng
(X ), Fisher's exact test, Mann - Whitney U test
(Wilcoxon rank sum test), phan tieh ddn bien
(univariate analysis) va phan tich da bien (multivariate
analysis) dfldc sfl dung de xfl ly sd lieu. Q u i trinh dUdc
lam tren may tinh vdi chUdng trinh STATA cua Hoa
Ky. Gia trj p = 0,05 (vdi dp tin cay 95%) la ngudng
x lc djnh sfl khIe biet ed y nghTa thdng ke.
I. KETQUA Bang 1. Dac diem nhom benh nhan nghien ctfu
Dac dien
so sanh
Tong sd
(n = 104)
Chan doan lam sang
NLMVR
(n = 40)
VGM
(n = 14)
XG
(n = 25)
UTG
(n = 25)
Tudi
(nam)
Nam/Nfl
ALT
(UI/37°C/L)
HBeAg (-)
Anti - HBe (-I-)
Kieu gen B
Kieu gen C
H B V - D N A
(logcopies/mL)
AFP
(ng/mL)
36,6 ± 15,8
( 1 7 - 7 0 )
88/1 6
36,0 ± 65,4
(5 - 447)
75 (72,1%)
63 (60,6%)
75 (72,1%)'
29 (27,9%)'
5,3 ± 2,1
(2 ,6 -9 ,7 )
155,9 ± 2 9 5
(0 - 894)
21,5 ± 3 , 9 '
( 19 -41 )
33/7
11,9 ±4,5=- '
(7 - 30)
21 (52,5%)''
17 (42,5%)''' =
32 (80%)'
8 (20%)=
5,6 ±2,3=
(2,6-9,7)
7,5 ± 24,9''
( 0 -155 )
38,1 ± 12,9'"''
(1 7 - 64)
11/3
90,8 ± 83,5'
(38 -279)
14(100%)' '
1 3 (92,9%)''
1 3 (92,9%)=
1 (7,1%)=
3,8 ± 1,6='''
(2,6 - 6,4)
119,1 ±251,9' ' ' =
(2,2 - 824)
47,9 ± 12,8'' =
( 18 -69 )
21/4
26,9 ±28 ,9= ' '
( 5 - 107)
19 (76%)
1 8 (72%)=
1 6 (54%)
9 (35%)
5,5 ± 1,9"
(2,5 - 8,7)
201,3 ±324,2 ' '
(0 - 863)
48,5 ± 11,3' =
(30 - 70)
23/2
53 ± 102,9'
(5 - 447)
1 9 (76%)
1 5 (60%)
14(55%)=
11 (44%)=
5,5 ± 2 , 1 ' '
(2,6 - 9,5)
417,1 ±
365,2''' =
(0 - 894)
PIVKA-II
mAU/mL)
7255,5 ± 19692,4
(4 - 75000)
30,9 ± 8,2'
( 17 -50 )
130,4 ±256,9=
(4 - 959)
12041,3 ±
27291,8'' = (13-75000)
1 8050,8 ±
25638,1' ' =
(15-75000)
NLMVR: ngUdi lanh mang virus, VGM: viem gan man, XG: xd gan, UTG: ung thU gan