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S THAY I HM LNG TSH MU GIT MT VNG BU C A PHNG

Nguyn Thanh H, Nguyn Tr Dng v CS.Bnh vin Ni tit Trung ng.

The changes in the dried bloodspot TSH level on the filter paper in the

endemic goiter area.

A study on 564 neonates and 962school age children (SAC) 8-12 years intwo areas: Ha noi city and threecommunes in Hoai duc district (Ha tay

province) showed that dried neonatecord blood TSH level and SAC wholeblood TSH level on filter paper inendemic goiter areas, iodine deficiencywas higher in Hoai duc than in Ha noicity ( 8.607+- 6.812 and 7.22+-4.159;5.15+-4.39 and 3.77+- 2.03 mu/l(P14.15mu/l, mean while therate of dried blood TSH cut of value

should be lower than 3%.The author suggests that the

determination of TSH in the dried bloodspot of neonates and SAC is usful for theassessment of endemic goiter and ID

status.

Tm ttNghin cu trn trn 564 tr s sinh

(TSS) v 962 tr em hc ng 8 -12 tui(TEH) ca hai khu vc H Ni (ni thnh) vhuyn Hoi c - H Ty (3x) cho thy Hoi

c l khu vc c bnh bu c a phng(BCP) v H Ni l ni khng c BCP. Ti

Hoi c, hm lng TSH mu git cung rnca tr s sinh (TSHSS) v TSH mu git ton

phn ca TEH (TSHTE), trn giy thm ucao hn H Ni tng ng l 8,607 6,812(TSHSS) v 7,22 4,159 ; 5.15 4,39 v 3,77 2,03 (TSHTE) ; (X SD ; n v: mu/l) vi p< 0,01. Ti phn v 97% (im ngng) TSHSSkhu vc H Ni v Hoi c tng ng l14,15mu/l v 25,9mu/l. So vi khu vc khng c

BCP (ni thnh H ni), th t l mu c hmlng TSH ln hn im tn xut 97% l14%(i vi TSHSS) v trn 20% (i vi TSHTE),

trong khi t l hm lng TSH cao hn gitr ngng cn phi thp hn 3% ( vngkhng c BCP). Nhng kt qu trn chng t vng BCP th hm lng TSH mu git thayi. S thay i ny thy r khng ch hmlng TSH mu git s sinh m c TEH.Tc gi gi rng vic xc nh TSH trong mu

git kh TSS v TEH c ch cho vic nhgi tnh trng thiu i-t v BCP.

1. T VN Trong tnh hnh hin nay khi vic dng mui i-t c trin khai trn phm vi ton

quc vic iu tra nh gi BCP v CRLTI s gp nhiu kh khn nu ch da vo hmlng i-t niu. nhiu nc tin tin trn th gii vic xc nh hm lng TSH mu ton

phn c p dng ngoi mc ch pht hin suy gip bm sinh v mt s bnh bm sinhkhc n cn gip ch trong vic kim sot cc ri lon do thiu it. Hin nay nc ta cngang trin khai nghin cu nh lng TSH mu git s sinh trong iu tra pht hin sm suygip bm sinh ti khu vc thnh ph H ni, tuy nhin cha c nghin cu no c tin hnh vng BCP. V vy chng ti tin hnh nghin cu ny nhm mc ch tm hiu s thayi hm lng TSH mu git ca khu vc BCP Hoi c- H Ty v cung cp thm s

liu cho cc ng nghip trong vic nghin cu suy gip bm sinh ti vng BCP ni vic lymu gt chn v huyt thanh cn gp nhiu kh khn.

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2. I TNG V PHNG PHP NGHIN CU

2.1. i tng:- Tr s sinh.- Hc sinh 8 - 12 tui.

2.2. a im:Huyn Hoi c - H Ty (3 x ven sng y) v H Ni (Thnh Quang - ng a).2.3. Phng php:

S dng phng php nghin cu m t. C mu tnh theo cng thc mu hai nhm -m t, tnh c n = 384 ( tin cy 95%).

+ Mu nc tiu TEH: ly 1/4 s hc sinh khm. S mu cn ly l: 384/4 = 96 mu(thc t chng ti lm 141 mu). Ly mu theo phng php ngu nhin h thng.

+ Mu git TEH- Cch ly mu: cm ly ngn tay gia, sau khi st trng sch, dng kim chch ri nn

tht nh nhng vi git mu v thm vo nhng vng trn trn giy thm. Cc ng tckhc ca vic ly mu git TEH tng t ly mu cung rn TSS nu trn.

- S lng mu: ly mu mu git ca 1/2 s TEH c khm. S mu cn ly l:384/2 = 192 mu (thc t lm 197 mu).

+ Sng lc s sinh: tt c tr c sinh ra ti trm y t ca 03 x ti Hoi c v lymu git tr s sinh ti Bnh vin Bo v B m v Tr s sinh H Ni.

- S lng mu: ti 03 x ca huyn Hoi c ly mu git ca tt c cc chu csinh ra ti trm y t x trong thi gian 1 nm. Ti khu vc H Ni ly c 384 mu mu gits sinh.

- Cch ly mu: ly mu cun rn tr s sinh ngay sau khi ct cung rn. kh tnhin t giy thm c git mu trong thi gian t 2 n 6 gi nhit phng. Sau khigit mu trn giy thm se kh, bnh phm c gi v labo hocmon Bnh vin Ni titTrung ng v c bo qun trong t lnh nhit 20C n 80C.2.4. Ch tiu v cc thng s cn thu thp

- Khm bu c kt hp siu m chn on xc nh TLBC.- Ly mu mu git cung rn TSS v TEH nh lng TSH.- Ly nc tiu TEH nh lng i-t niu.

3. KT QUB ng 1 : Phn b TSH mu git tr s sinh

VT: mU/lKhu vc Min Max 25% 50% 75% 90% 95% 97% 99% 99,9%H ni

(n =384)

0 32,3 5,1 6.5 9,3 12,1 13,6 14,15 19,4 26,0

Hoi c(n =180)

0,4 38,7 4,2 6,3 11,1 18,4 21,8 25,9 33,2 34,5

Nhn xt:- hu ht cc im tn xut tng ng th hm lng TSH mu git s sinh ca khu

vc H Ty u ln hn ca khu vc H Ni.- Ring im tn sut 97% mc TSH TSS ca H Ni v Hoi c tng ng l

14,15mu/l v 25,9mu/l. S mu mu git ca tr s sinh H Ty c hm lng TSH ln hn14,15mu/l (im ngng) l 14%.

- Ti im tn sut 99% hm lng TSH TSS ca H Ni l 19,4 mu/l v hm lng

TSH TSS ca khu vc Hoi c l 19,4mu/l. S mu mu git ca TSS H Ty c hmlng TSH ln hn 19,4mu/l l 8%.

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Bng 2: So snh TSH mu git tr s sinh H Ni v Hoi cVT: mU/l

Cc gi tr H Ni (n= 384) H Ty (n = 180) pX SD * 7,22 4,159 8,607 6,852 < 0,001

Min 0 0,4Max 32,3 38,7

*: Trung bnh lch chunNh n xt : Hm lng TSH mu git ca tr s sinh Hoi c ln ca tr s sinh H

Ni c ngha thng k vi p < 0,001.

Bng 3: Phn b hm lng TSH mu git hc sinhVT: mU/l

Khu vc Min Max 25% 50% 75% 90% 95% 97% 99% 99,9%H ni

(197)

0,9 22,3 2,6 3,6 4,6 5,8 6,1 6,9 8,0 8,4

Hoi c(185)

0,4 30 2,3 3,9 6,2 10,0 13,1 17,0 21,5 25,3

Nhn xt: Ti v tr th 97% hm lng TSH mu git ca hc sinh H Ni l 6,9mu/l,ca hc sinh H Ty l 17,0mu/l v c 20% s mu ca hc sinh H Ty c hm lng TSHln hn 6,9mu/l. Ti v tr th 99% hm lng TSH mu git ca hc sinh H Ni l 8,0mu/ml, ca hc sinh H Ty l 21,5 v c 13% s mu ca hc sinh H Ty c hm lngTSH ln hn 8,0mu/l.

B ng 4 : So snh hm lng TSH mu git HS H Ni v Hoi c.VT: mU/l

Cc gi tr H Ni (n =197) H Ty (n = 185) pX 1SD * 3,77 2,03 5,15 4,39

Min 0,9 0,4< 0,001

Max 22,3 30,0Nh n xt: Hm lng TSH mu git ca hc sinh H Ty ln ca hc sinh H Ni c

ngha thng k vi p < 0,001.B ng 5 : T l bu c hc sinh H Ni v Hoi ca im S khm S mc T l bu c (%)

H Ni (1) 400 6 1,5Hoi c(2) 562 13 23,0

P1-2 < 0,01Nh n xt : TLBC ca Hoi c cao hn ca khu vc H Ni c ngha thng k (p