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NGHIN CU TNH HNH BNH BU C LA TUI HC SINH T 8-10 TUI TI TNH LM NG NM 2003

Nguyn Vn Chnh, Trn Hu Dng Trung tm phng chng bnh x hi Lm ng , Trng i Hc Y Khoa Hu. Summary Prevalence of goitrous in students ageing from 8-10 years old in Lam dong province. Aims: To study the prevalence of goitrous and evaluate the average urine iodine level in students ageing from 8-10 years old in Lam dong province. Methods: This was cross sectional study. The study was performed on 3000 students ageing from 8-10 years old. The samples were taken by simple randomized from all primary schools of Lam dong province. Diagnosis of goitrous basing on clinical examination. Classification of goitrous degree basing on WHO standard. Evaluation of iodine deficiency basing on WHO UNICEF ICCID standard. Result: Prevalence of goitrous in students ageing from 8-10 years old in Lam dong province was 7.23%. Prevalence of male students was 6.56%, which of female students was 7.91%. Average urine iodine level was 15.9mcg/dl. Conclusion: Prevalence of goitrous in Lam dong population decrease after ferforming the national iodine program. I. T VN Bnh bu c v c bit l tnh trng bu c do thiu it tr em ang l mt vn bc xc cho nhiu nc trn th gii. Theo t chc y t th gii (1990) trn th gii c trn 1572 triu ngi (chim 29% dn s ton cu) c nguy c b mc cc ri lon do thiu it, trong c khong 655 triu ngi b bnh bu c (chim 12% dn s ton cu). Ti khu vc ng nam l khu vc c nguy c cao nht (vi cc ch s tng ng 62% v 35%). Vit Nam l mt nc nm trong vng b thiu it, theo kt qu iu tra dch t hc nm 1993 ca T chc Unicef v Bnh vin Ni tit Trung ng th kh nng 94% s dn Vit Nam c nguy c b mc cc ri lon do thiu it, trong 16% thiu nng, 45% thiu va v 23% thiu nh, ch c 6% khng b thiu. Bnh Bu c v cc ri lon do thiu it l vn y t x hi ca nc ta. Lm ng l mt tnh cao nguyn min ni c nguy c e da b cc ri lon do thiu it. Vi tm quan trng ca vn c nu trn, chng ti tin hnh ti ny nhm cc mc tiu c th nh sau: 1/. Xc nh t l mc bnh bu c la tui hc sinh t 8-10 tui 2/. nh gi thc trng mc i t niu trung v tr em t 8-10 tui. II.I TNG V PHNG PHP NGHIN CU 2.1- i tng nghin cu: C mu: tnh theo cng thc 4.p.q n= e2 S n cn khm: n = 576 em hc sinh. t tin cy cao hn chng ti chn 3000 em hc sinh khm. Phng php chn mu:- Cc trng hc cp I trong Tnh lp danh sch v nh s th t, ly tng s trng chia cho 30 l khong cch chn mu. Chn cc em hc sinh t 8 - 12 tui- Mi trng ly ngu nhin 100 em hc sinh trong c 50 em nam v 50 em n khm iu tra. Thi gian nghin cu: Tin hnh khm iu tra ct ngang ti thi im thng 11 - 12 nm 2003. 1

Khm bu c: Khm lm sng pht hin bu c 30 cm ghi phiu iu tra (phn bu c theo qui nh ca WHO, ICCIDD). nh lng it niu: Theo khuyn co ca WHO, UNICEF, ICCIDD (1994) th ly mu nc tiu vi t l l 40%: 40 em x 30 cm = 1200 mu Mu nc tiu c bo qun v a v la b Trung tm dinh dng Thnh ph H ch minh nh lng it niu. Tiu chun nh gi phn mc thiu it: (Theo WHO - UNICEF - ICCIDD Geneve 9/1993) Ch s Thiu it nh Thiu it va Thiu it nng T l tr em 8 -10 tui mc bnh 5 - 19,9% 20 - 29,9% > 30% bu c It niu 5 - 9,9mcg/dl 2- 4,9mcg/dl < 2mcg/dl 2.6- X l v phn tch s liu: - Theo chng trnh Epi-Info Version 6 v Microsoft Ex cel. III. KT QU Bng 1: T l hc sinh theo tui v gii tu Hc sinh nam Hc sinh n Tng s S lng 8 9 10 Tng cng 344 463 702 1509 T l % 11,47 15,43 23,40 50,30 S lng 370 442 679 1491 T l % 12,33 14,73 22,64 49,70 S lng 714 905 1381 3000 T l % 23,80 30,17 46,03 100

- Nhn xt: Tng s nam c khm 1509 chim t l 50,3% v n 1491 chim t l 49,7 %. Khng c s khc bit gia hai gii vi p >0,05. Bng 2: T l bu c chung Tnh hnh bu c Tng s T l % Khng bu c 2783 92,77 C bu c 217 7,23 Tng ccng 3000 100 Nhn xt : T l bu c chung ca hc sinh l : 7,23%. Khng bu c l 92,77%. Bng 3: T l bu c theo phn vng kinh t Phn vng kinh t Thnh th Nng thn X c bit kh khn TS trng c khm 11 13 6 TS Hc sinh c khm 1100 1300 600
2

= 5,984 P = 0,048 T l % Bu c 5,82 7,69 8,92

S lng hc sinh bu c 64 100 53

Tng cng 30 3000 217 7,23 Nhn xt: S khc bit c ngha thng k t l bu c theo phn vng kinh t. cc x c bit kh khn t l bu c ghi nhn c l 8,92%, vng nng thn l 7,69%, vng thnh th l thp nht (5,82 %). 1

Bng 4: T l bu c theo gii tnh Gii tnh C bu c Nam N 99 118 Tn sut hc sinh Khng bu c 1410 1373
2

=2,05

P= 0,1525 T l % bu c 6.56 7.91 P= 0,29 T l % bu c 8.12

Tng cng 1509 1491 = 1,11 Tng cng 714

Bng 5: T l bu c theo sc thi dn tc Dn tc Tn sut hc sinh C bu c Thiu s 58 Khng bu c 656

Kinh 159 2127 2286 6.96 Nhn xt: T l bu c hc sinh ng bo thiu s l 8,12%. hc sinh ngi Kinh l 6,96% Kt qu it niu Bng 6- Kt qu xt nghim nh lng iode niu Biu hin mc thiu ht iode Mc iode niu Tn sut T l % qua mc iode niu mcg/dl Thiu ht iode nng Thiu ht iode va Thiu ht iode nh Thiu ht iode Khng thiu ht iode Tng cng Mc it niu trung v 80 60 40 20 1.04 0 0 - 1,9 2 - 4,9 5 - 9,9 > 10 = Biu : Nng it niu 16.68 6.86 75.42 0 1,9 2 4,9 5 - 9,9 < 10 10 20 >20 12 79 192 283 515 353 1151 15, 9mcg/dl 1,04 6,86 16,68 24.58 44.75 30.67 100.0

Nhn xt: Thiu it nh chim 16,68%.Thiu it va chim 6,86%.Thiu it nng chim 1,04%.C 24,58% (283/1151) s mu nc tiu c hm lng it niu di 10mcg/dl. Bng 7- Phn b hm lng it niu theo gii tnh 2 =2,94 P= 0,08 Mc iode niu ( mcg/dl) Gii tnh Nam < 10 135 10 465 Tng cng 600 % biu hin mc thiu ht iode qua mc iode niu 22.5

N 148 403 551 26.9 Nhn xt : Khng c s khc bit hm lng iode niu gia nam v n . iu ny cng ph hp vi kt qu kho st t l bu c. Bng 8 - Lin quan gia hm lng it niu v tnh trng bu c Tnh trng Mc iode niu ( mcg/dl) % biu hin mc thiu ht iode qua mc bu c < 10 Tng cng 10 iode niu C bu c Khng bu c 2 Nhn xt: = 30 253 5,31 56 812 P 86 1065 = 0,021 34.88 23.75 OR = 1,72

IV.BN LUN 4.1.2 T l bu c: Bu c l mt biu hin ca thiu I-t, t l bu c phn nh mc thu nhp I-t ca qun th, khi b sung I-t cho vng thiu I-t lun phi dng ti t l bu c la tui hc sinh t 8-10 tui gim st. V la tui ny rt nhy vi s can thip, ngng s dng l 5%, trn ngng l vn cn tnh trng thiu I-t, di ngng 5% l khng cn thiu I-t. Trong iu tra ny s liu ca chng ti vi t l mc bu c hc sinh tiu hc Tnh Lm ng l 7,23 % (tnh n thi im thng 12/2003) biu hin tnh trng cn thiu I-t nh. So snh vi t l bu c la tui hc sinh c iu tra nm 1994 l 29,1 %, n nm 2001 t l bu c gim i r rt (13,2 %). 4.1.3. T l bu c vi cc tui v gii V gii: hc sinh n c t l bu c (7,91%) v t l bu c hc sinh nam (6,56%). S khc bit khng c ngha thng k t l bu c gia nam v n vi p = 0,1525. iu ny hon ton hp l bi v trong mt vng mc thiu it l nh nhau th t l bu c gia nam v n hc sinh di 10 tui l gn nh nhau, nhng nhu cu it n nhiu hn nam nn thng bu c xy ra n nhiu hn nam. Cng nh nh gi ca Trn Thanh H, Hong Kim c v cng s v thc trng CRLTI ca hc sinh tiu hc trong ton quc. 4.2.1 It niu: Gn nh ton b It niu thu nhp hng ngy ca c th u thi ra theo nc tiu bn mc It niu l ch s quan trng hng u trong gim st chng trnh can thip mt s It cho vng thiu It, It niu ch c th dng nh gi cho qun th. Ngng nng It niu ca mt qun th cho vng can thip mui It l 1020mcg/dl, di ngng l thiu It, trn ngng l tha It. nh gi v it niu, iu tra thng c 3 hnh thc nh gi: l mcg It/g Creatinin (c nhiu tc gi trn th gii s dng nh F.Aghini, Combardi v cng s - 1993

ti vng Toscana ca , Bilabina v cng s - 1994 ti vng Amiens Cng Ho Php) hoc hnh thc mcg it /24 gi hay mcg/dl. Chng ti chn hnh thc nh gi it niu vi mcg/dl v ly nc tiu hc sinh vo bui sng l thi gian phn nh tng i ng tnh trng thu nhp It trong 24 gi. Trong iu tra ca chng ti: n = 1151 mu nc tiu, mc it niu trung v l 15,9 mcg/dl. Trong c 24,58% s mu nc tiu c hm lng it niu di 10mcg/dl. Cc gi tr trung v v trung bnh u ln hn ngng: 10mcg/dl. Cn di ca khong tin cy IC 95% ca hc sinh tiu hc ca tnh Lm ng u nm trong mc khuyn co (10 20mcg/dl). 4.2.2 S hc sinh c nng it niu bnh thng: Nng it niu xem nh l bnh thng: 10 45 mcg/dl. Trong kho st ca chng ti c 827 hc sinh (t l 71,8%) c nng it niu bnh thng v khng v s khc bit gia cc nhm tui. Nghin cu ca V Phng v cng s (1994 1998) v nng it niu ca hc sinh cc trng Nguyn Tri Phng, Phong Sn, Vnh Linh (Tha Thin Hu) ghi nhn t l hc sinh c it niu bnh thng l 68%; 41,8% v 58,39% tng ng. T l hc sinh c it niu bnh thng ca chng ti cao hn cc tc gi khc, tuy nhin khng khc bit c ngha. 4.2.3 S hc sinh c nng it niu thp: Nng it niu di 10mcg/dl xp vo nhm c nng thp. Trong kho st ca chng ti c 283 hc sinh c nng it niu di 10mcg/dl, chim t l 24,58%. Trong mc thiu it nh 5 99 mcg/dl l 192 hc sinh (16,68%), mc thiu it va 2 4,9 mcg/dl (6,86%), mc thiu it nng di 2mcg/dl (1,04%). Trng hp c nng it niu thp nht trong mu kho st ca chng ti l 0,4 mcg/dl. 4.2.4 S hc sinh c nng it niu cao Mc it niu trn 45mcg/dl c xp mc cao. Trong kho st c 41 hc sinh trn mc ny (t l 3,56%), trong c mc cao nht ghi nhn c l 185mcg/dl v 03 hc sinh c nng it niu trn 50 mcg/dl. Nng it niu bao nhiu c xem nh l nhim it? Mt s tc gi nc ngoi nh: F. Aghini Lombardi cho rng: nhim it khi nng it niu trn 45mcg/dl, Jean Lubetzki nng trn 400mcg/24 gi cng c xem l qu ti. Vit Nam, 1993 ng Trn Du nu Vn liu lung it dng trong cng tc phng bnh BC v n n cho rng vi liu lng cung cp hng ngy t 500mcg tr ln c th xy ra nguy c khng mong mun mt s ngi nhy cm, kim sot it qua thc phm trong nhn dn l cn thit . KT LUN Qua khm iu tra bu c 3000 hc sinh t 8 n 10 tui ti 30 trng tiu hc tnh Lm ng v kho st 1151 mu nc tiu cng thi im nghin cu nng it niu, chng ti nhn thy: 1. T l bc c chung ca hc sinh t 8 10 tui cc trng tiu hc tnh Lm ng l 7,23%. - T l bu c ca hc sinh nam: 6,56% - T l bu c ca hc sinh n: 7,91% 2. Nng it niu: Nng it niu trung v l: 15,9mcg/dl, nm trong ngng khuyn co ca WHO. Nng it niu thp di 10mcg/dl l 24,58%, trong c 1,04% l thiu it nng di 2mcg/dl. Nng it niu trong gii hn bnh thng chim: 44,75% Nng it niu cao (trn 20mcg/dl) chim 30,67%. Trong c 3 trng hp it niu trn 50mcg/dl (0,26%). TI LIU THAM KHO 1

1. B Y T: (2000) iu tra ton quc cc ri lon thiu it nm 2000, chng trnh quc gia phng chng cc ri lon thiu it Ti liu tng kt hot ng nm 2000 H Ni, Tr. 2 ph lc. 2. Vn Chnh v cng s (1993), kho st tnh hnh bnh bu c ti tnh Lm ng, tr. 11-20. 3. Trn Hu Dng (1997), Khm tuyn gip, Ni tit hc gio trnh sau i hc, tr.104105, tr. 106- 108. 5. ng Trn Du (1996), Bnh bu c tn pht, Tp ch cc ri lan thit it s 21/4/1996, B Y T, Tr.8 10. 6. ng Trn Du (1996) i cng v cc hu qu do thiu it,Bnh tuyn gip v cc ri lon do thiu it, Nh xut bn Y hc , tr. 368 - 371. 7. Nguyn Tr Dng (1996) nh lng it trong nc tiu, Bnh tuyn gip v cc ri lon do thiu it, Nh xut bn Y hc, tr.133-142. 8. V H (1994), Nhng yu t ch th nh gi s thiu it v cc chng trnh kim sot chng - Tp san cc ri lon do thiu it, tr. 21-51. 9. Vng L (2001), n hp tc Vit Nam - Australia v phng chng cc ri lon do thiu it 1994-1997, Tp ch Ni tit v Chuyn ha s 3 qu 1/2001,Tr.52-57.

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