7. kemhuyetthanhqn

8/6/2019 7. KemhuyetthanhQN

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HM LNG KM HUYT THANH TRMC 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 HuSERUM ZINC CONTENTS IN

INFECTIOUS CHILDRENObjective : to evaluated the levels of serum

zinc in children with infectious diseasePatients and methods: The cross-sectionalstudy realized on 93 children including 63infectious pneumonia and diarrhea and 30normal children hospitalized in Pediatric

Department of Hue central hospital from6/2002 to 6/2003.

Results: Serum zinc contents of pneumonia,diarrhea and normal children were 62.167.86, 62.97 7.72 and 77.52 10.36 g/dl, respectively. The more time ofhaving pneumonia and diarrhea reinfectionthe children had, the less serum zinccontents they had (p < 0.001). Serum zinccontents in reinfectious pneumonia childrenwith malnutrition was lower than in thatchildren without malnutrition (p < 0.001).Serum zinc contents was lower in childrenwith more than 14 days of diarrhea than in

children with less than 7 days of diarrhea (p< 0.001). Serum zinc contents in positiveMantoux reaction children was higher thanin negative reaction ones (p < 0.001).Conclusion: There were significant thereduction of serum zinc levels in childrenwith reinfectious disease and longerduration

TM TT

Mc ch: Kho st nng km bnh nhi mc bnh nhim trngi tng v phng php:

Nghin cu ngang c thc hin trn93 tr, gm 63 tr b nhim trng tidin (vim phi v tiu chy) v 30 trbnh thng nhp vin ti Khoa Nhi

Bnh vin Trung ng Hu t 6/2002n 6/2003.

Kt qu: Hm lng km huyt thanhca tr vim phi v tiu chy ti dinln lt l 62,16 7,86g/dl v62,97 7,72g/dl; ca nhm chngl 77,52 10,36 g/dl. Tr vim

phi v tiu chy ti din cng nhiuln, HLZn HT cng gim (p < 0,001).

HLZn HT tr vim phi ti din ckm suy dinh dng thp hn trvim phi ti din khng km tnhtrng suy dinh dng (p < 0,001).

HLZn HT tr c thi gian tiu chy

ko di > 14 ngy thp hn bnhnhn c thi gian tiu chy < 7 ngy(p < 0,001).

HLZn HT tr c kt qu phn ngMantoux dng tnh cao hn so vitr c kt qum tnh (p < 0,001).

Kt lun:Bnh nhi b mc bnh nhimtrng ti din v ko di c hmlng 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 nhgim trng lng lc sinh, chm pht trin th lc v tr tu v sau, suy gim kh nngp 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, hinc t ti liu cp. Bi bo ny chng ti trnh by hm lng km huyt thanh trmc 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 (vimphi v tiu chy) ti din thng gp;

2 Xc nh s lin quan gia hm lng km huyt thanh vi mt s c imlm sng tr mc cc bnh nhim trng.

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2.I TNG V PHNG PHP NGHIN CU2.1. 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 nhin2.2.1. 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 nkhm sc kho ti khoa Nhi, Bnh vin Trung ng Hu. Nhng tr ny khng c tnhtrng nhim trng hay tiu chy. Tiu chun loi tr: tr c tin s vim phi hoc tiuchy khng r rng; tr ang dng thuc c cha km hoc thuc c ch min dch; trsuy dinh dng nng.2.2.2. Chn on lm sng: khm tng qut, khm cc triu chng bnh vim phi vtiu chy. Kim tra chng BCG. Cn o trng lng v chiu cao, nh gi v phn loisuy 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 -200C 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 hc3. 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 tidin. 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

Nhm nKm huyt thanh ( g/dl)

Bnh thng Gim nh Gim r (X SD)

Vim phi 326

(18,75%)14

(43,75%)12

(37,50%) 62,16 7,86

Tiu chy31 8

(25,81%)10

(32,26%)13

(41,93%) 62,97 7,72

Nhm chng

30 24

(80%)

6

(20%)

0

77,52 10,36* 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 vitiu chun (70 g/dl). a s tr vim phi v tiu chy c mc km huyt thanh gimnh 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 nhmchng theo gii

Km huyt thanh(X SD)

Gii pNam N > 0,05

Vim phi 63,10 8,53 60,59 6,66Tiu chy 62,97 8,16 62,98 7,33

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Nhm chng 75,13 7,50 79,62 12,19p < 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

Nhm nTui TB(thng)

Km huyt thanh ( g/dl)Bnh

thngGim nh Gim r (X SD)

Nhm chng 30 20,73 24 6 0 77,52 10,36Vim phi 32 21,55 6 14 12 62,16 7,86Tiu chy 31 15,60 8 10 13 62,97 7,72

p > 0,05 < 0,001Tui 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

NhmKm huyt thanh ( g/dl)

Bnhthng

Gim nh Gim r (X SD)

Vim phi ti din khngSDD

5 8 3 65,92 5,86

Vim phi ti din c SDD 1 6 9 58,39 7,95SDD - 2SD 1 4 1 65,77 3,90SDD - 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 kmSDD (p< 0,01). HLZnHT ca tr SDD-3 SD thp hn so vi tr b SDD-2 SD (p 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 giantiu chy < 7 ngy (p < 0,001)

Bng 6:Lin quan gia hm lng km huyt thanh vi s ln mc vim phi

S ln mc vim phiKm huyt thanh ( g/dl)

Bnh thng Gim nh Gim r (X SD)3 ln 6 11 2 66,30 5,154 ln 0 2 5 60,03 6,37 5 ln 0 1 5 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

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Phn ng Mantoux Km huyt thanh ( g/dl)Vim phi ti din Tiu chy ti din

Dng tnh 68,55 0,21 67,43 8,36m 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

4.1. Hm lng km huyt thanhQua kt qu bng 1, chng ti nhn thy: Hm lng km huyt thanh ca tr nhmchng l 77,52 10,36 g/dl, nm trong gii hn bnh thng v ph hp vi tiuchun 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 ktqu 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 l62,16 7,86 g/dl v 62,97 7,72 g/dl. Nh vy, trong thi k b nhim trng tidin HLZnHT thp hn so vi mc km bnh thng. Kt qu ny cng ph hp vinghin cu ca cc tc gi trong ti liu [4,6,9], theo khi b nhim trng c th s giatng 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 EndogenousMediator (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 tunhon tp trung ti ni tn thng v cc nhim khun, c bit LEM c tc dnglm 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 trngKt 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). Ktqu 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 tngtrng v cui cng l SDD. Tht vy, t kt qu bng 4 cho thy tr vim phi tidin 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 tkhng c c quan d tr v c na i sng sinh hc ngn, v th thiu km d xy rakhi b tiu chy nhiu ln; ngc li, khi km gim s lm chm s ti sinh ca lp nhynim mc rut, gim tit cc enzym vn chuyn b bn chi, gp phn gy tiu chyti din. Kt qu bng 5 cho thy HLZnHT gim nhiu nhng tr c s ngy b tiuchy tng ln, c bit nhng tr c thi gian tiu chy ko di > 14 ngy thHLZnHT gim ng k.

* Lin quan n s ln mc vim phi: Kt qu bng 6 cho thy s ti dinnhiu ln ca bnh vim phi cng gy gim km huyt thanh. Khi HLZnHT gim s

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nh hng n chc nng ca h min dch, c bit l cc lympho T, gp phn gy suygim 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 ngMantoux 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 ngkm vi cc tc nhn xm nhp chnh v th s cho kt qu phn ng Mantoux m tnh[7].

5. KT LUNT 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 bnhnhim trng, chng ti c nhng kt lun sau:1. Hm lng km huyt thanh ca tr nhim trng ti dinHm 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 canhm tr i chng c cng la tui: 77,52 10,63 g/dl2. Lin quan gia hm lng km huyt thanh vi mt s c im lm sng catr nhim trng ti din- Hm lng km huyt thanh ca tr vim phi ti din c suy dinh dng thp hnhm 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 gimr 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 l62,50 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.

TI LIU THAM KHO[1]. Nguyn Thanh Danh (2002). Vai tr ca yu t vi lng km trong phng chng suydinh dng tr em, Lun n tin s y hc, Trng i hc Y Dc Thnh ph H Ch Minh.

[2]. Nguyn Xun Ninh (1999), "Km v sc kho tr em",Dinh dng v sc kho trem cng ng, Nh xut bn Y hc, H Ni, tr. 165-175.[3]. Hong Th Thanh, Nguyn Gia Khnh (1997), "Mi tng quanb ca hm lngkm huyt thanh vi biu hin lm sng v mt s ch tiu sinh ho trong mu ca bnhnhn tiu chy ko di", Thng bo khoa hc ca cc trng i hc, tr. 111-115.[4]. Bhandari N, Bhan M. K, et al (1996), "Increased diarrheal and respiratory morbidity inassociation with zinc deficiency a preliminary report", Acta-Paediatr, Medline, 85(2), pp: 75-80.[5]. Lira P. I, Asworth A, Morris S. S (1998), "Effect of zinc supplementation on themorbility, immune function, and grpwth of low-birth-weight, full-term infants in

Northeast Brazil",American Journal of Clinical Nutrition, 68(2), pp: 418-424.[6]. RinK L, Gabriel P (2000), "Zinc and the immune system", Proc-Nutr-Soc, medline,59(4), pp: 541-552.

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[7]. Shankar A. H, Prasad A. S (1998), "Zinc and immune function: the biological basisof altered resistance to infection", American Journal of Cliniccal Nutrition, 68(8), pp:447-463.[8]. WHO (1996), Trace elements in human nutrition and health, Geneva.[9]. WHO (2001),Environmental health criteria 221-ZINC, Geneva.

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7. kemhuyetthanhqn

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