HM LNG KM HUYT THANH TR MC CC BNH NHIM TRNG

Nguyn B Triu(*), Trn Th Minh Dim(**), Phan Th Kim Ngn(**), Hong Trng S(**)

(*): Bnh vin a khoa Nng. (**): Trng i hc Y- i hc Hu SERUM ZINC CONTENTS IN TM TT INFECTIOUS CHILDREN Mc ch: Kho st nng km Objective : to evaluated the levels of serum bnh nhi mc bnh nhim trng zinc in children with infectious disease i tng v phng php: Patients and methods: The cross-sectional Nghin cu ngang c thc hin trn study realized on 93 children including 63 93 tr, gm 63 tr b nhim trng ti infectious pneumonia and diarrhea and 30 din (vim phi v tiu chy) v 30 tr normal children hospitalized in Pediatric bnh thng nhp vin ti Khoa Nhi Department of Hue central hospital from Bnh vin Trung ng Hu t 6/2002 6/2002 to 6/2003. n 6/2003. Results: Serum zinc contents of pneumonia, Kt qu: Hm lng km huyt thanh ca tr vim phi v tiu chy ti din diarrhea and normal children were 62.16 ln lt l 62,16 7,86 g/dl v 7.86, 62.97 7.72 and 77.52 10.36 62,97 7,72 g/dl; ca nhm chng g/dl, respectively. The more time of having pneumonia and diarrhea reinfection l 77,52 10,36 g/dl. Tr vim the children had, the less serum zinc phi v tiu chy ti din cng nhiu contents they had (p < 0.001). Serum zinc ln, HLZn HT cng gim (p < 0,001). contents in reinfectious pneumonia children HLZn HT tr vim phi ti din c with malnutrition was lower than in that km suy dinh dng thp hn tr children without malnutrition (p < 0.001). vim phi ti din khng km tnh Serum zinc contents was lower in children trng suy dinh dng (p < 0,001). with more than 14 days of diarrhea than in HLZn HT tr c thi gian tiu chy children with less than 7 days of diarrhea (p ko di > 14 ngy thp hn bnh < 0.001). Serum zinc contents in positive nhn c thi gian tiu chy < 7 ngy Mantoux reaction children was higher than (p < 0,001). in negative reaction ones (p < 0.001). HLZn HT tr c kt qu phn ng Conclusion: There were significant the Mantoux dng tnh cao hn so vi reduction of serum zinc levels in children tr c kt qu with reinfectious disease and longer m tnh (p < 0,001). duration Kt lun: Bnh nhi b mc bnh nhim trng ti din v ko di c hm lng km huyt thanh cng thp . 1. T VN Km l mt vi cht dinh dng quan trng cho mi hnh thi ca s sng. c bit i vi tr em, nu thiu km s li nhiu hu qu xu cho sc kho tr nh gim trng lng lc sinh, chm pht trin th lc v tr tu v sau, suy gim kh nng p ng min dch ca c th, tng nguy c mc cc chng nhim trng nh tiu chy, vim ng h hp cp...[1,2,9]. Ti Vit Nam, nghin cu chuyn ho ca km, c bit l nh hng ca km i vi s ti din ca cc bnh nhim trng tr em, hin c t ti liu cp. Bi bo ny chng ti trnh by hm lng km huyt thanh tr mc cc bnh nhim trng thng gp, vi mc tiu nghin cu: 1 Xc nh hm lng km huyt thanh tr mc cc bnh nhim trng (vim phi v tiu chy) ti din thng gp; 2 Xc nh s lin quan gia hm lng km huyt thanh vi mt s c im lm sng tr mc cc bnh nhim trng.

2. I TNG V PHNG PHP NGHIN CU 2.1. i tng nghin cu: Tr t 2 - 60 thng tui vo khm v iu tr ti khoa Nhi, Bnh vin TW Hu t thng 6/2002 n thng 6/2003. 2.2. Phng php nghin cu: nghin cu ngang trn mu ngu nhin 2.2.1. Chn mu: chn ngu nhin nhng tr b vim phi v tiu chy c chn on theo tiu chun ca T chc Y t Th gii (TCYTTG). Nhm chng gm 30 tr n khm sc kho ti khoa Nhi, Bnh vin Trung ng Hu. Nhng tr ny khng c tnh trng nhim trng hay tiu chy. Tiu chun loi tr: tr c tin s vim phi hoc tiu chy khng r rng; tr ang dng thuc c cha km hoc thuc c ch min dch; tr suy dinh dng nng. 2.2.2. Chn on lm sng: khm tng qut, khm cc triu chng bnh vim phi v tiu chy. Kim tra chng BCG. Cn o trng lng v chiu cao, nh gi v phn loi suy dinh dng (SDD) theo tiu chun ca TCYTTG. 2.2.3. Cn lm sng - inh lng km huyt thanh (thc hin ti Trung tm Phn tch i hc Hu): ly 2 ml mu tnh mch, tch ly huyt thanh v bo qun -20 0C cho n khi phn tch mu. nh lng km huyt thanh bng phng php von ampe ho tan anod (ASV) trn my phn tch in ho Metrohm. - Hm lng km huyt thanh (HLZnHT) c nh gi theo tiu chun [1,3,8]: Di 70 g/dl: thiu km. T 70 n 130 g/dl: bnh thng. T 59,8 n < 70 g/dl: gim nh. T 40,3 n < 59,8 g/dl: gim r. Di 40,3 g/dl: gim nng - Phn ng Mantoux c thc hin ti khoa Vi sinh Bnh vin Trung ng Hu. 2.2.4. X l s liu bng phng php thng k y hc 3. KT QU Mu nghin cu gm 63 bnh nhi b vim phi v tiu chy ti din c chn on theo tiu chun ca TCYTTG, gm 32 tr vim phi ti din v 31 tr tiu chy ti din. Nhm chng gm 30 tr. 3.1. Hm lng km huyt thanh Bng 1: Hm lng km huyt thanh ca tr nhim trng v nhm chng Km huyt thanh ( g/dl) Nhm n Bnh thng Gim nh Gim r (X SD) 6 14 12 Vim phi 32 62,16 7,86 (18,75%) (43,75%) (37,50%) 31 8 10 13 Tiu chy 62,97 7,72 (25,81%) (32,26%) (41,93%) 30 24 6 0 Nhm chng 77,52 10,36 (80%) (20%) * HLZnHT trung bnh nhm chng nm trong gii hn bnh thng v khng c tr no c HLZnHT gim r. Mc km huyt thanh ca nhm bnh thp hn so vi tiu chun (70 g/dl). a s tr vim phi v tiu chy c mc km huyt thanh gim nh v gim r, khng c trng hp no c mc km huyt thanh gim nng. 3.2. So snh hm lng km huyt thanh gia nhm chng v nhm tr nhim trng Bng 2: Hm lng km huyt thanh ( g/dl) ca tr nhim trng so vi nhm chng theo gii Km huyt thanh Gii p Nam N > 0,05 (X SD) Vim phi 63,10 8,53 60,59 6,66 Tiu chy 62,97 8,16 62,98 7,33

Nhm chng 75,13 7,50 79,62 12,19 p < 0,001 < 0,001 * HLZnHT ca hai nhm bnh v chng gia nam v n khng khc bit nhau (p > 0,05). HLZnHT nhm bnh (nam v n) u thp hn nhm chng ( p < 0,001). Bng 3: Hm lng km huyt thanh ca tr nhim trng so vi nhm chng theo tui Km huyt thanh ( g/dl) Tui TB Nhm n Bnh Gim nh Gim r (X SD) (thng) thng Nhm chng 30 20,73 24 6 0 77,52 10,36 Vim phi 32 21,55 6 14 12 62,16 7,86 Tiu chy 31 15,60 8 10 13 62,97 7,72 p > 0,05 < 0,001 Tui trung bnh, hm lng km tr nhim trng cng thp nhm chng (p < 0,001). 3.3. Lin quan gia hm lng km huyt thanh vi mt s c im lm sng Bng 4: Hm lng km huyt thanh lin quan vi tnh trng dinh dng Km huyt thanh ( g/dl) Nhm Bnh Gim nh Gim r (X SD) thng Vim phi ti din khng 5 8 3 65,92 SDD 5,86 Vim phi ti din c SDD 1 6 9 58,39 7,95 SDD - 2SD 1 4 1 65,77 3,90 SDD - 3 SD 0 2 8 53,97 6,24 p (khng SDD/c SDD < 0,01 p (SDD-2SD/SDD-3SD) < 0,001 *HLZnHT ca tr vim phi ti din c km SDD thp hn tr vim phi khng km SDD (p< 0,01). HLZnHT ca tr SDD-3 SD thp hn so vi tr b SDD-2 SD (p< 0,001). Bng 5: Hm lng km huyt thanh lin quan n thi gian tiu chy Km huyt thanh ( g/dl) Thi gian tiu chy Bnh thng Gim nh Gim r (X SD) < 7 ngy 7 7 1 62,12 5,78 7 - 14 ngy 1 1 5 59,79 6,30 > 14 ngy 0 4 7 57,74 5,35 p < 0,001 * HLZnHT ca tr tiu chy ko di > 14 ngy thp hn so vi tr c thi gian tiu chy < 7 ngy (p < 0,001) Bng 6: Lin quan gia hm lng km huyt thanh vi s ln mc vim phi Km huyt thanh ( g/dl) S ln mc vim phi Bnh thng Gim nh Gim r (X SD) 3 ln 6 11 2 66,30 5,15 4 ln 0 2 5 60,03 6,37 0 1 5 5 ln 52,73 6,59 p < 0,001 * Tr vim phi ti din cng nhiu ln, HLZnHT cng gim (p < 0,001) Bng 7: Lin quan gia phn ng Mantoux vi hm lng km huyt thanh

Km huyt thanh ( g/dl) Vim phi ti din Tiu chy ti din Dng tnh 68,55 0,21 67,43 8,36 m tnh 61,73 7,94 62,50 7,66 p < 0,001 < 0,05 * HLZnHT ca tr c kt qu phn ng Mantoux dng tnh cao hn so vi tr c phn ng Mantoux m tnh (p < 0,001). 4. BN LUN Phn ng Mantoux 4.1. Hm lng km huyt thanh Qua kt qu bng 1, chng ti nhn thy: Hm lng km huyt thanh ca tr nhm chng l 77,52 10,36 g/dl, nm trong gii hn bnh thng v ph hp vi tiu chun ca TCYTTG v cc nghin cu ca mt s tc gi trong v ngoi nc[2,3,4]. Nm 1998, Hong Th Thanh nghin cu trn 39 tr tui trung bnh 10,7 thng vi kt qu l 93,73 19,18 g/dl. H. P. S. Sachdev nghin cu 20 tr, n , tui trung bnh 7,7 thng vi hm lng km huyt thanh l 96,39 14,82 g/dl [8]. - Hm lng km huyt thanh ca tr vim phi v tiu chy ti din ln lt l 62,16 7,86 g/dl v 62,97 7,72 g/dl. Nh vy, trong thi k b nhim trng ti din HLZnHT thp hn so vi mc km bnh thng. Kt qu ny cng ph hp vi nghin cu ca cc tc gi trong ti liu [4,6,9], theo khi b nhim trng c th s gia tng tiu th nng lng v cht vi dinh dng km, ng thi xy ra hin tng thc bo kch thch bch cu gii phng cc cht trung gian ni sinh: Leucocyte Endogenous Mediator (LEM) l yu t chnh tham gia vo qu trnh phn b li km trong c th; km t t chc c v xng s c huy ng ti gan, sau , mt phn km vo tun hon tp trung ti ni tn thng v cc nhim khun, c bit LEM c tc dng lm tng o thi km qua nc tiu, cc yu t ny l gii nguyn nhn gy gim km huyt thanh tr b nhim trng. 4.2. So snh hm lng km huyt thanh gia nhm chng v nhm tr nhim trng Kt qu bng 2 v 3 cho thy HLZnHT tr vim phi v tiu chy theo gii v tui khng khc bit nhau (p > 0,05) v thp hn so vi nhm chng (p < 0,001). Kt qu ca chng ti khng khc bit so vi nghin cu ca cc tc gi trong ti liu [1,3,4,8]. 4.3. Lin quan gia hm lng km huyt thanh vi mt s c im lm sng * Lin quan n tnh trng SDD: Khi tr b vim phi, tnh trng thiu km v cc vi cht dinh dng c hiu khc s tip tc gy ra chn n, nhim trng, chm tng trng v cui cng l SDD. Tht vy, t kt qu bng 4 cho thy tr vim phi ti din c km SDD th HLZnHT gim ng k so vi nhm khng km SDD (p < 0,01) v tr SDD cng nng HLZnHT cng gim (p < 0,001). * Lin quan n thi gian tiu chy: Theo [1,4], trong c th km l vi yu t khng c c quan d tr v c na i sng sinh hc ngn, v th thiu km d xy ra khi b tiu chy nhiu ln; ngc li, khi km gim s lm chm s ti sinh ca lp nhy nim mc rut, gim tit cc enzym vn chuyn b bn chi, gp phn gy tiu chy ti din. Kt qu bng 5 cho thy HLZnHT gim nhiu nhng tr c s ngy b tiu chy tng ln, c bit nhng tr c thi gian tiu chy ko di > 14 ngy th HLZnHT gim ng k. * Lin quan n s ln mc vim phi: Kt qu bng 6 cho thy s ti din nhiu ln ca bnh vim phi cng gy gim km huyt thanh. Khi HLZnHT gim s

nh hng n chc nng ca h min dch, c bit l cc lympho T, gp phn gy suy gim kh nng khng ca c th lm tr d mc bnh nhim trng [5, 6] * Lin quan n phn ng Mantoux: qua bng 7 cho thy nhng tr c kt qu phn ng Mantoux m tnh th HLZnHT thp hn so vi nhng tr c phn ng Mantoux dng tnh. Nh trnh by trn khi tr b nhim trng HLZnHT gim thp nh hng n hot ng ca h min dch c th, hu qu l c th phn ng km vi cc tc nhn xm nhp chnh v th s cho kt qu phn ng Mantoux m tnh [7]. 5. KT LUN T kt qu nghin cu hm lng km huyt thanh 63 tr c tui t 2 - 60 thng b vim phi v tiu chy ti din v 30 tr cng tui nhng khng mc bnh nhim trng, chng ti c nhng kt lun sau: 1. Hm lng km huyt thanh ca tr nhim trng ti din Hm lng km huyt thanh ca tr vim phi v tiu chy ti din ln lt l 62,16 7,89 g/dl v 62,97 7,72 g/dl thp hn so vi hm lng km huyt thanh ca nhm tr i chng c cng la tui: 77,52 10,63 g/dl 2. Lin quan gia hm lng km huyt thanh vi mt s c im lm sng ca tr nhim trng ti din - Hm lng km huyt thanh ca tr vim phi ti din c suy dinh dng thp hn hm lng km huyt thanh ca tr vim phi n thun. - Hm lng km huyt thanh cng gim khi s ngy tiu chy tng ln, c bit gim r nhng tr tiu chy ko di (57,74 5,35 g/dl) - Hm lng km huyt thanh lin quan n tnh trng ti din nhiu ln ca vim phi. - Hm lng huyt thanh ca tr nhim trng ti din c phn ng Mantoux m tnh l 62,50 7,66 g/dl thp hn so vi tr c phn ng Mantoux ( +): 67,43 8,36 g/dl. 3. Qua kt qu thu c khi thc hin ti, chng ti kin ngh: - nh gi hiu qu b sung km nhng bnh nhn tiu chy v vim phi ti din - Nghin cu nh hng ca km ti s thay i mt s ch tiu v min dch ca c th nhng tr tiu chy v vim phi ti din.

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