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NHN XT V THC TRNG BU C V THIU I-T QUA NGHIN CU 2 NHM X TRC C S KHC NHAU V T L TR EM 7-15 TUI MC BU C

Chu Th Lan, Phm Ngc Khi Trng i hc Y Thi Bnh Tm tt: Nghin cu c thc hin qua iu tra ct ngang theo phng php dch t hc m t, sau nghin cu Bnh - Chng c tin hnh da trn kt qu siu m tuyn gip. i tng nghin cu l 3.228 tr em 7-15 tui, trong c 1.473 tr em 2 x huyn V Th v 1.755 tr em 2 x huyn Hng H, Thi Bnh. Cc x ny c chia thnh 2 nhm: Nhm x 1 l 2 x c t l bu c cao, Nhm x 2 l 2 x c t l bu c thp. Kt qu nghin cu cho thy: - T l tr em mc bu c nhm x 1 l 12,1% cn nhm x 2 l 7,1%, t l bu c tng ln tr em nhm 8 -12 tui v n cao hn nam. - nhm x 1, tr em BC th c hm lng it niu thp hn tr em khng BC, ng thi tr em thiu it th c dung tch tuyn gip ln hn nhm khng thiu i-t. - Ngc li, nhm x 2 th khng c s khc bit v hm lng it niu gia 2 nhm tr em BC v khng BC, khng c s khc nhau v dung tch tuyn gip gia nhm thiu i-t v nhm khng thiu i-t. 1- T VN Theo T chc Y t Th gii (WHO) c tnh c ti 1,6 t ngi ang sng trong khu vc thiu ht it trong t l mc bnh ton cu l 12%. S ngi b mc bnh bu c nhiu nht cc nc chu , chu Phi. Ti ng Nam c khong 175 triu ngi b bu c, chim 26,7% tng s b bu c ca th gii [9]. Vit Nam l mt nc nm trong khu vc thiu it, chnh v vy m ngay t nm 1994, Vit Nam cam kt vi WHO, UNICEF, ICCIDD l s thanh ton cc ri lon do thiu ht it vo nm 2005. Cc gii php nhm phng chng bu c v cc ri lon do thiu ht i-t trong nhiu nm qua gp phn gim t l bu c xung r rt nhng tnh hnh thiu i-t v bu c nhiu ni vn cn mc cao [2; 3; 5; 7]. Kt qu iu tra dch t hc bnh bu c v tnh hnh thiu ht it Thi Bnh ca mt s tc gi {4; 8] trong qu trnh thc hin chng trnh Quc gia v phng chng cc ri lon thiu ht it cho thy t l ngi dn Thi Bnh b thiu it cn kh cao, ng thi t l bu c ca tng x trong mt huyn cng c s khc nhau. Vy ti sao ngay Thi Bnh cng c 1 s x t l bu c cao, cn 1 s x bn cnh li c t l bu c thp? gp phn l gii vn trn, chng ti tin hnh nghin cu ti: Thc trng thiu it, bnh bu c tr em 7 15 tui v yu t lin quan mt s x nng thn Thi Bnh''. y, chng ti xin trch bo co kt qu nghin cu ca mnh vi mc tiu nghin cu:

Mc tiu nghin cu: nh gi thc trng thiu it v bnh bu c ca tr 7 - 15 tui ti 2 nhm x trc c s khc nhau v t l mc bu c. II- I TNG V PHNG PHP NGHIN CU 2.1. i tng nghin cu + a im nghin cu: Chng ti tin hnh nghin cu 2 huyn V Th v Hng H u nm ven sng Hng, trin khai tt cc hot ng thc hin chng trnh Quc gia v phng chng bu c v cc ri lon do thiu ht it. Cc x nghin cu c chia thnh 2 nhm: Nhm x 1 l 2 x c t l bu c cao (T l tr em bu c trn 12%). Nhm x 2 l 2 x c t l bu c thp (t l tr em bu c di 7,0%). + i tng nghin cu l tr em tui 7 - 15 (hc sinh t lp 1 n lp 9). + Nghin cu c tin hnh trong thi gian t 8/2003 - 3/2004 2.2. Phng php nghin cu + Thit k nghin cu: Nghin cu c thc hin qua mt cuc iu tra ct ngang theo phng php m t, sau nghin cu Bnh - Chng c tin hnh da trn kt qu siu m tuyn gip. + Tnh c mu v phng php chn mu: - C mu khm lm sng xc nh bu c c p dng theo cng thc tnh mu cho vic kim nh s khc nhau gia 2 t l. C mu theo tnh ton l n = 2.246. - C mu cho xt nghim it niu theo tnh ton cho nghin cu ny l 220 mu. - C mu nghin cu bnh - chng tnh ton c cho nghin cu ny l 228 cho nhm bnh v 228 cho nhm chng. - Phng php chn mu: phi hp phng php chn mu c mc ch vi chn mu ngu nhin. Da vo kt qu khm lm sng (2001-2002) ca Trung tm Y t d phng tnh Thi Bnh chn ra mi huyn 5 x c t l bu c cao (t l tr em bu c ln hn 12%) v 5 x c t l bu c thp (t l tr em bu c thp hn 7%). T 5 x ca mi nhm li bc thm chn 1 x, ti mi x tin hnh bc ngu nhin 2 lp trong 1 khi. Khm lm sng cho ton b hc sinh trong cc lp chn hc sinh tiu chun vo nhm BC (lm sng v siu m xc nh l bu c. Khng ly bnh nhn cng gip) v nhm i chng (l tr em khng mc bu c cng nhm tui, cng gii, cng thn xm vi nhm bnh). + Cc k thut p dng trong nghin cu - iu tra hi cu kt qu khm lm sng BC nm 2001-2002 chn ra 4 x nghin cu tip theo. - Khm lm sng phn loi ln bu c theo WHO 1992 - S dng my siu m chuyn dng kim tra dung tch tuyn gip my sch tay SSD 500 - ALOCA Nht bn, u d tn s 7,5 MHz. Tr c siu m t th ngoi nga c, i din vi thy thuc. - nh lng it niu ti khoa Ho sinh ca Bnh vin Ni tit Trung ng theo phng php ng hc xc tc, da trn nguyn l ca phn ng Sandell Kolthoff. nh gi mc thiu it da vo t l bu c v hm lng it niu. Theo quy nh ca WHO/ UNICFF/ ICCIDD (1992) - S liu nghin cu c x l trn phn mm EPI INFO 6.0 3- KT QU NGHIN CU

Bng 1: T l tr em mc bu c ti cc nhm x thuc huyn V Th v Hng H nm 2002 Nhm x c t l BC trn 12% Nhm x c t l BC thp di 7% S TT Tn x % mc Tn x % mc Huyn V Th 1 Bch Thun 12,6 ng Thanh (*) 7,0 2 Song Lng 14,0 Song An 7,0 3 V Vn (*) 13,0 V Hi 5,0 4 Dng Ngha 13,0 V Vinh 7,0 5 Hng L 14,5 Tn Lp 6,6 Huyn Hng H 1 ip Nng 12,5 Minh Tn 7,0 2 ng 13,0 Minh Khai 7,0 3 Bnh Lng 16,5 Hng An (*) 7,0 4 c Lp 14,0 Thi Hng 6,8 5 Ph Sn (*) 13,0 Phc khnh 6,5 Ghi ch: (*) l x c chn vo nghin cu tip theo Kt qu bng 1 thu c qua hi cu v s liu khm lm sng bu c ca Trung tm Y t d phng Thi Bnh nm 2001 2002 cho thy ngay cng 1 huyn cng c khng t nhng x c t l tr em BC (di 7,0%) thp hn kh nhiu so vi cc x khc (trn 12,0%). Qua chn ngu nhin tin hnh nghin cu tip theo 4 x, trong c 2 x l V Vn v Ph Sn thuc nhm x 1 cn ng Thanh v Hng An thuc nhm x 2. Bng 2: T l tr em mc bu c ti cc nhm x nghin cu Nhm x 1 Nhm x 2 So Nhm tui snh n % BC N % BC Nhm 7 tui 149 174 Ia 12 8,0 10 5,7 p>0,05 Ib 0 0 0 0 II 0 0 0 0 III 0 0 0 0 Cng 12 8,0 10 5,7 Nhm 8 12 tui 819 786 2= Ia 94 11,5 48 6,1 13,90 Ib 6 0,7 6 0,6 p<0,001 II 0 0,0 0 0,0 III 0 0,0 0 0,0 Cng 100 12,2 54 6,8 Nhm 13 15 tui 669 631 2= 9,04 Ia 79 11,8 40 6,3 p<0,05 Ib 9 1,3 9 1,4 II 0 0,0 0 0,0 III 0 0,0 0 0,0 Cng 86 12,8 49 6,8 1591 Tng cng 7 -15 1637 2= 198 12,1 113 7,1 tui 11,57 C BC p<0,001

Kt qu nghin cu c trnh by bng 2 cho thy rng t l bu c tr 7 tui nhm x 1 l 8,0% cn nhm x 2 l 5,7%. Nhng n tui ln hn th t l bu c tng cao r rt, nhm x 1 c 12,2% tr em 8-12 tui mc bu c cn nhm x 2 th t l l 6,8%. Tr em 13 -15 tui mc bu c nhm x 1 l 12,5% nhm x 2 l 7,7%. Nh vy t l tr em mc BC nhm x 1 cao hn nhm x 2 mt cch r rt (p < 0,05). Bng 3: T l tr em mc bu c theo gii cc nhm x nghin cu Nhm x 1 Nhm x 2 Tng s Gii tnh S S n % n % n % BC BC Nam 781 72 9,2 908 44 4,8 1689 6,8 N 856 126 14,7 683 69 10,1 1539 12,7 Cng 1637 198 12,1 1591 113 7,1 3228 9,6 2 = 31,87 So snh 2= 11,62 ; p < 0,001 2= 16,32 ; p < 0,001 p < 0,001 Kt qu nghin cu bng 3 cho thy c s chnh lch v t l bu c theo gii trong mu nghin cu, nhm x 1 nam l 9,2%, n l 14,7%, nhm x 2 nam l 4,8%, n l 10,1%. Chung ca 2 nhm x nam 6,8% v n 12,7%. Nh vy trong c 2 nhm x, t l bu c n cao hn so vi nam gii, s khc bit ny c ngha thng k vi p < 0,001. Bng 4: Dung tch trung bnh (ml) ca tuyn gip tr em b bu c cc nhm x nghin cu Nhm x 1 Nhm x 2 Nhm tui (n = 223) (n = 223) p X SD (ml) X SD (ml) Nhm 8 - 12 tui Nam p<0,05 6,99 1,71 5,67 1,70 N p>0,05 7,82 2,19 6,90 2,83 Nhm 13- 15 tui Nam p>0,05 9,96 2,38 9,90 2,94 N p<0,05 11,98 2,34 10,15 2,92 Kt qu nghin cu v dung tch tuyn gip nhm tr em b bu c bng 4 cho thy s khc nhau gia nam v n cng la tui, cng nhm x cng tng t nh tr em khng BC: dung tch tuyn gip ca n ln hn ca nam (p < 0,05). So snh gia 2 nhm x cng gii v cng nhm tui cho thy dung tch tuyn gip nhm x 1 lun ln hn nhm x 2, trong nam 8-12 tui v n 13-15 tui nhm x 1 c dung tch tuyn gip cao hn mt cch c ngha thng k vi p < 0,05. T kt qu bang 3 v bng 4 cho thy 1 dc im chung l n mc BC nhiu hn nam, dung tch tuyn gip n BC ln hn ca nam BC cng nhm tui, dung tch tuyn gip ca tr em BC nhm x 1 ln hn tr em BC nhm x 2 cng nhm tui. Bng 5: T l tr em thiu it 2 nhm x nghin cu Nhm x 1 Nhm x 2 (n = 223) (n = 223) Mc thiu it niu So snh SL % SL %

Khng thiu i-t 159 71,3 153 68,6 Thiu i-t nh 49 22,0 48 21,5 p > 0,05 Thiu i-t va 15 6,7 22 9,9 Thiu i-t nng 0 0,0 0 0,0 C thiu i-t 64 28,7 70 31,4 p > 0,05 Kt qu nghin cu bng 5 cho thy rng t l thiu it tr em nhm x 1 l 28,7% cn nhm x 2 l 31,4%, s khc bit gia 2 nhm x l khng c ngha thng k vi p > 0,05. Tr em cc x ny ch yu l thiu it mc nh v t gp thiu it mc va, khng gp trng hp no thiu it nng. Nh vy gia 2 nhm x tuy khc nhau r rt v t l BC nhng li khng khc bit nhau v t l thiu i-t. Bng 6: Dung tch trung bnh (ml) ca tuyn gip theo tnh trng thiu it Nhm thiu it Nhm khng thiu So snh Nhm Nhm (n = 134) it (n = 312) tui x test t p X SD (ml) X SD (ml) 8-12 Nhm 8,22 2,61 6,75 2,84 t= 3,04 p<0,05 tui x 1 t= 0,95 p>0,05 6,70 2,78 6,65 3,26 13-15 Nhm 9,99 3,83 8,13 2,98 t= 3,01 p<0,05 tui x 2 t= 0,13 p>0,05 8,26 2,82 8,16 3,34 Kt qu bng 6 cho thy Nhm x 1, ni c t l bu c cao th dung tch tuyn gip tr em nhm thiu i-t ln hn nhm i chng vi (p < 0,05). Nhng nhm x 2, ni c t l bu c thp th khng c s khc bit v dung tch tuyn gip gia nhm thiu i-t v nhm i chng vi p > 0,05. Bng 7: So snh hm lng it niu ( g/100ml) tr em nhm BC so vi nhm chng It niu nhm BC It niu nhm khng Nhm ( g/100ml) BC ( g/100ml) So snh nghin cu (n=223) (n=223) Median Mode Median Mode Nhm x 1 11,9 8,0 17,2 10,5 p < 0,05 Nhm x 2 15,7 8,0 15,6 20,8 p > 0,05 Kt qu nghin cu c trnh by bng 7 thy rng hm lng i-t niu ca tr bu c nhm x 1 l 11,9 g/100ml, thp hn c ngha thng k (p < 0,05) so vi nhm khng BC. Trong khi th nhm x 2 li thy rng hm lng i-t niu gia 2 nhm tr BC v nhm khng BC l tng ng nhau. Bng 8: Hm lng it niu (( g/100ml) nhm c dung tch tuyn gip bnh thng vi nhm c dung tch tuyn gip ln It niu It niu Nhm ( g/100ml) nam ( g/100ml) n nghin cu (n=152) (n=294) Median Mode Median Mode Dung tch tuyn gip bnh thng 16,0 20,8 15,8 8,0

Dung tch tuyn gip ln 13,7 7,6 13,2 8,,0 So snh p > 0,05 p > 0,05 Kt qu bng 8 cho thy nam v n c dung tch tuyn gip bnh thung th u c hm lng it niu tng ng nhau v xp x 16 g/100ml, trong khi th nhm c dung tch tuyn gip ln th hm lng it thp hn r rt. 4- BN LUN Kt qu nghin cu trnh by bng 1 n bng 5 cho thy rng ngay trong cng 1 huyn nhiu nm trin khai cc hot ng tham gia thc hin chng trnh Quc gia v phng chng bu c v cc ri lon do thiu ht it nhng vn thy t l bu c tr em nhm x 1 cao hn nhm x 2 mt cch r rt (p < 0,05), nu so snh vi t l tr em BC qua hi cu kt qu do Trung tm Y t d phng Thi Bnh iu tra 2 nm trc y th thy rng t l bu c t khc bit, nhm x 1 vn thuc nhm x c t l mc BC cao v nhm x 2 th nm trong nhm x c t l mc BC thp ca 2 huyn. T l thiu it v mc bu c nhm x 1 l tng t vi tnh hnh mc bu c ca tr em nng thn Thi Bnh qua nghin cu trc 3-5 nm ca 1 s tc gi khc [4; 8]. Kt qu nghin cu c trnh by bng 6 n bng 8 cho thy rng tr em bu c nhm x 1 c hm lng i-t niu thp hn c ngha (p < 0,05) so vi nhm khng BC. Trong khi th nhm x 2 li thy rng hm lng it niu gia 2 nhm tr BC v chng l tng ng nhau. Mt khc kt qu nghin cu cng cho thy vn bu c tr em nhm x 2 khng ch n thun lin quan n thiu it, phi chng ngoi yu t thiu ht i-t ra th cn c nhng yu t khc lin quan n dung tch tuyn gip ca tr em tui hc ng. Nh vy l nhng x c t l tr em mc bu c cn cao th c s khc bit r rt v hm lng i-t niu gia tr em mc BC so vi tr em khng mc BC, cn nhng ni c t l BC thp th khng cn thy r nh hng ca thiu ht i-t ti t l BC na. Nghin cu ca mt s tc gi khc mt s vng nh H Ty [1], Hng Yn [1; 2], Hu Giang [2]; Ct B [6] cng tm thy nhng vng tuy s thit ht it cn thp nhng li c t l bu c kh cao. Nhiu tc gi [1; 2; 6; 7; 8] cng bt u tm hiu cc yu t lin quan n bu c i mi cc hot ng phng chng bu c ti cng ng cho ph hp. 5 - KT LUN - T l tr em mc bu c nhm x 1 l 12,1% cn nhm x 2 l 7,1%, t l bu c tng ln tr em nhm 8 -12 tui v n cao hn nam. - nhm x 1, tr em BC th c hm lng it niu thp hn tr em khng BC, ng thi tr em thiu it c dung tch tuyn gip ln hn nhm khng thiu i-t. - Ngc li, nhm x 2 th khng c s khc bit v hm lng it niu gia 2 nhm tr em BC v khng BC, khng c s khc nhau v dung tch tuyn gip gia nhm thiu i-t v nhm khng thiu i-t. 6 - NGH i vi cc x cn c t l bu c cao th cn tip tc ph mui it cho ton dn. i vi cc x c t l bu c gim thp th cn nghin cu k v cc yu t khc ngoi thiu i-t c bin php can thip thch hp.

Comments on actual situation of goiter and iodine inadequacy from the study conducted in 2 commune groups that had different goiter prevalence rates of children 7-15 years old Chu Thi Lan, Pham Ngoc Khai Thai Binh Medical College Summary: This is a descriptive cross-sectional study combined with a case-control study conducted after the ultrasonic screening of the thyroid. The study subjects were 3,228 children 7-15 years old, of which 1,473 were from 2 communes of Vu Thu district and 1,755 were from 2 communes of Hung Ha district, Thai Binh province. These communes were classified into 2 groups: high prevalence of goiter (group1) and low prevalence of goiter (group 2). The findings are follows: - The goiter prevalence rate: group 1: 12.1% and group 2: 7.1%; highest at the age group 8-12 year old, and higher among women other than among men. - In the group 1, the urinal iodine content of the goiter children was lower than that of the non-goiter children; the thyroid volume of those in the iodine inadequacy group was higher than that of the iodine adequacy group. - While, in the group 2, there was no difference of urinal iodine contents between children of the goiter and children of the non-goiter group; no difference of thyroid volume between children of the iodine inadequacy and children of the iodine adequacy group. TI LIU THAM KHO 1- ng Trn Du (1990), "i mi v tng cng cng tc phng chng bnh bu c, n n v ri lon do thiu ht it Vit Nam", Hi tho Quc gia phng chng cc bnh thiu it H Ni, 2- Phan Vn Duyt v cs (1990), ''Bu c Hu giang'', Hi tho quc gia phng chng cc bnh ni tit - H ni, tr. 51 -61. 3- Nguyn Thanh H, Nguyn Tr Dng (2002) ''iu tra tnh trng bu c v s dng mui it ti 3 x ven sng y thuc huyn Hoi c'', Tp ch y hc D phng, (4), tr. 40 - 41. 4- Nguyn Thanh H, Hong Kim c v CS (2000), "nh gi thc trng cc ri lon it ca hc sinh tiu hc ton quc 1998", K yu ton vn Cng trnh Nghin cu Khoa hc ni tit v chuyn ho, NXB Y hc, tr . 223-224. 5- Nguyn Quang Huy (2002), Nghin cu tnh hnh s dng mui it v bnh bu c tr 8 - 12 tui ti 3 x huyn V Th tnh Thi Bnh, Lun n thc s Y khoa, Trng i hc Y Thi Bnh. 6- L M (1996) "Dch t hc cc ri lon do thiu it", Bnh tuyn gip v cc ri lon do thiu ht it, NXB Y hc, tr . 372 - 377. 7- Phan Huy Nhu v cs (1995) , ''Lin quan cc yu t nguy c ca cc ngun nuc dng trong sinh hot vi bnh bu c ti o Ct B - Hi phng, Tp ch Y hc, (12) 8- Thi Hng Quang (2001), ''Bnh bu c a phng v bu c tn pht'', Bnh ni tit, NXB Y hc, tr. 186 - 187. 9- Nguyn Vinh Quang, (2001), '' Tnh trng thiu it hc sinh ph thng c s v hiu qu 1 s bin pht can thip ti V Th, Thi Bnh'', K yu ton vn cc Cng trnh Nghin cu Khoa hc hi Ni tit - i tho ng Vit Nam, tr. 180 - 192.

10-WHO/UNICEF/ICCIDD (1993), ''Globa prevulence of iodine Deficiency Disorders, Micromutrient deficiemcy infomution system, p. 1.

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