sức khoẻ sinh sản, tập 4 số 1

SC KHE SINH SN, Tp 4, S 1, Thng 2 2014 i

BAN BIN TP

Tng bin tp

PGS.TS.VTHNHUNG

Ph Tng bin tp

BS.PHANVNQUYN

BS.TRNBNHTRNG

BAN TH K

Trng ban

ThS.HONGTHDIMTUYT

U vin

BS.TNGQUANGTHI

BAN C VN

GS.TS.TRNTHLI

GS.TS.NGUYNDUYTI

ThS.NGUYNTHNHNGC

TS.PHMVITTHANH

TS.BIPHNGNGA

ThS.NGUYNVNTRNG

TO SON

128HngBng,P12,Q5,TP.HChMinh

inthoi:(08)39.552.517

(08)39.551.894

Email:[email protected]

TNG QUAN Y VN1 QuanimmitrongxtrThuyntci

Nguyn Th Hng Vn

6 CpnhtthngtinvchnonThuyntci

Nguyn Th Thanh

10 GitrxtnghimTryptasetrongThuyntci

Phan Thanh Hi

13 TtmsotHPVbngdngcDelphiScreener

V Th Nhung

17 DphngTinsngit

Hong Th Dim Tuyt

20 Tngquanvrilontnhdctuiquanhmnkinh

Hunh Nguyn Khnh Trang

NGHIN CU26 Tngquangiabohanhgianhvatrmcm

thaiphthanhphHChMinh

Nguyn Th Nh Ngc, Phm Thnh c,

Nguyn Vn Trng, Trn Th M Duyn

32 Nhnmttrnghpungthvitrnggiaiontinxaciutrthanhcngvilu

T Th Thanh Thy

38 ngdnghc thuytMercer-pht trins tngtcm-convaomhnhchmscnhmtnghiuquvicnuiconbngsamivibamsinhconso,trccnnnglcsinhthp

L Th Trc Mai,Boonyanurak, Puangrat,Vitoonmaeta, Manasaporn

THNG TIN CP NHT44 Cpnhtthngtinvchngngaunvnphn

mangthai

Nguyn Th Bch Duyn

48 ngdngkhng th IgY (Ovalgen) trongphngngavaiutrbnh

Nguyn Vn Sa

51 SanglcnhimHumanPapillomavirus(HPV)ctcungbngphngphpPCR:uimcavicnhmnvngE6/E7

L Quang Thanh

58 Thngtinyhc

MC LC

Chu trch nhim xut bnTng gim c: Chu Hng Cng

In 1.000 cun kh 20 x 28 cm ti cng ty TNHHNGUYNQUANGHUY,26BCPhanVnTr,Phng7,QunGVp,TP.HCM.S ng k k hoch xut bn: 23-2013/CXB/332-185/YH ngy 02/01/2013.S xut bn: 405/Q-YH ngy 05/11/2013.In xong v np lu chiu qu IV/2013.

SC KHE SINH SN, Tp 4, S 1, Thng 2 2014ii

Sc khe sinh sn nhn ng nhng bi vit lin quan n chuyn ngnh Chm sc sc khe sinh sn v cc chuyn ngnh c ni dung lin quan, c phn chia theo cc phn c lit k di y.

Tng quan y vn.

Nghin cu khoa hc.

Ti liu cp nht.

Nhng bi vit s c Ban bin tp xt chn ng da trn nhng nh hng ch ca Ban chp hnh Hi Ph Sn TP. H Ch Minh.

Nhng iu kin c bn:

Nhng cng trnh nghin cu khoa hc c gi tr, mi hon thnh hoc b tc cng trnh c,...

Bi tng quan ngn gn, cp nht kin thc y hc hin i p ng nhu cu thc hnh ca bc s, dc s v nhng cn b y t khc,

Bi vit bo co trng hp lm sng him hoc ni dung su sc trong chn on v iu tr,

Bi gi ng trn Ni san ca Hi Ph Sn thnh ph H Ch Minh th khng cng lc gi ng trn cc phng tin truyn thng khc.

Bi khng c ng s khng c tr li bn tho.

Quy nh v hnh thc trnh by:

Bi trnh by dng WORD, vi font Arial, c ch 12.

Cc bi vit nghin cu khoa hc khng qu 06 trang A4 (k c bng, biu v ti liu tham kho).

Cc bi vit khng phi l nghin cu khoa hc khng qu 04 trang A4 (k c bng, biu v ti liu tham kho).

Tt c cc bi vit phi c ti liu tham kho, nu l bi dch, phi ghi r ngun.

Ti liu tham kho ch ghi nhng ti liu chnh (khng nn qu 10 ti liu trong 1 bi vit). Trnh by trch dn ti liu tham kho theo chun Vancouver.

V d:

...

Nhng bo co cng b gi y rng phc misoprostol hiu qu cao hn v t tc dng ph v bin chng hn nhng prostaglandins khc.412

...1.WorldHealthOrganization.Safeabortion:technical

andpolicyguidanceforhealthsystems.Geneva(Switzerland):WorldHealthOrganization;2003.

2.TangOS,HoPC.Medicalabortioninthesecondtrimester.BestPractResClinObstetGynaecol2002;16:23746.

TH L NG BI

Bi vit gi v cho Ban bin tp: BS. PHAN VN QUYN

Email: [email protected]

Quy nh nhun bt hin hnh ca Hi Ph Sn TP. H Ch Minh.

Bi tng quan: 300.000/trang A4.

Bi dch: 150.000/trang A4.

Bi nghin cu khoa hc: 400.000/trang A4.

Rt mong nhn dc s ng gp ca cc bn hi vin.

SC KHE SINH SN, Tp 4, S 1, Thng 2 2014 1

Thuyn tc i (TTO) l mt bin chng him gp nhng thng gy t vong c khi u khng d on c v cng khng ngn nga c.1 Tuy nhin, chn on sm, hi sc nhanh chng, sanh em b ng lc v iu tr cc di chng do kp bao gm bc s gy m, bc s sn khoa v chuyn vin hi sc c th ci thin kt qu cho m v thai nhi.5

Bnh thng trong sut thai k, mng i cn nguyn vn tch bit tun hon m v nc i. c TTO xy ra, nc i phi vo tun hon m. iu ny thng c khi sn ph v mng i trong 78% trng hp. Cc triu chng ca TTO xy ra 14% bnh nhn trong vng 3 pht sau v mng i.2 Kh nng xm nhp vo tun hon m khi c chn thng t cung, rch on di t cung, nhau bong non ti im bm nhau thai.

Lch s

Meyer u tin bo co mt trng hp thai cht lu lin quan n t vong m do nc i vo phi gy thuyn tc phi vo nm 1926,6 nhng Steiner v Lushbaugh u tin m t r rng hi chng ny trong bo co tm ph n cht bt ng do sc sn khoa lin quan n cc cht ca thai trong mch mu phi m vo nm 1941.7 H a ra gi thuyt rng nc i c y vo tun hon m trong cn co tht. Steiner v Lushbaugh cng m t bng chng thc nghim hi chng ch v th sau khi tim tnh mch nc i ca ngi, c nhiu cht gy hoc phn su dn n du hin lm sng tng t nh m t trong khm nghim t thi ca tm sn ph khi sanh lin quan n cc t bo vy c ngun gc t thai nhi trong cc mch phi. Trn c s nghin cu ng vt thc nghim h tr pht hin bnh ly chi tit trong tm

Quan im mi trong x tr Thuyn tc i Nguyn Th Hng Vn,* Ths.BS.CKII.*BV.QucTngNai,[email protected]:0903833645

TNG QUAN Y VN

Hnh1.Thuyntci(Ngunhttp://library.med.utah.edu/)

T bo vy trong mch mu phi

SC KHE SINH SN, Tp 4, S 1, Thng 2 20142

trng hp t vong m bt ng do tc nghn vt ly ca cc mch mu phi vi t bo ca thai nhi (hnh 1), Steiner v Lushbaugh xut mt bnh ly sn khoa mi TTO.

Chn on TTO da trn lm sang, shin din ca bin chng bao gm ngnghhp,sctim,rilonngmuvingmunimchlanta(DIC)vatimthaibttoankthpvishindincacctbaovykhngnhntrongmungmchphikhnglabnhlcaTTO.Nm1995Clarkkhngnhcctbaovycathainhictm thy trong tun hoan phi trong 73%trnghptvongcaTTO.2Ngoaira,chc50%bnhnhnvichnonlaTTOccc t baovy ca thai nhi cpht hintrongmungmchphi.Shindincacctbaovytrongtunhoantrongthigianchusinhkhngphi lun lungn linviTTO.Mungimctbaovythaicthxyratrongqutrnhtcathetervaongmch phi va c gim thiu bng cchlamtheoccphngphpcxutbiMasson.Tuynhin, sxut hin ccmnhvnm ca thai nhi rt quan trng va phhpvichnoncaTTO.

McdphnlncctrnghpTTOxyra trongchuynd, nm1995Clarkkhngnhrngc19%cctrnghpxyratrongmlythaikhikhngcchuynd.ngtanhnthyctinsdngtrong41%bnhnhn.63%xyrathainam,stngnggia lm sang,phnnghai phavanhngthayivhuytnghccaTTOgingbnhnhn scphnv.Clarkxut rngTTOlamindchvanghthayitntTTOthanhhichngphnvca thai linquan phn ng khng nguyn - khng th.Cngquanimnay,Bensonchorngnhauthai,thainhivaiphnsulavtlgyscphnvkhngmindchchtngi.8

T l xut hin v t vong

Thuyn tci lamthi chngkhng tin

TNG QUAN Y VN

lngtrcphngnga,gytvongcao,khngcmtxtnghimchnonchiunao,khngiutrchiunaonhnghimkhixyravalataihatrongkhichuyndsanhhaytrongmlythai.

NghincuvtlxuthincaTTOvatltvongchothycmtscithintltvongngkticcnctintintrongnhngnmgny.Nm1979Morganxemxt272caTTOtrongyvnAnhvabocotltvong86%,trongs,25%cccatvongxyratrongvng1giutinsaukhi khi pht triu chng.nnm1995,ClarkxutbnngkqucgiacaTTOxemxt46trnghpTTOvabocotltvongmla61%.2TrongnghincucaClark,hn50%bnhnhnchttrongvngmt giu tinvahai phnba cc ca tvongxyratrongvng5gixyraTTOvachc15%nhngngisngstkhngdichngthnkinh.

TuynhingnyGilbertboco t ltvongthphn27%trongmtnghincudatrndnsnm1999.TheoTuffnell12c37%mtvongdoTTOAnhnm2005.TheoKramer(2006)Canadat lTTOla6,1/100.000casanhvac13%tvongm.11 TiMnghincucaAbenhaim(2008)tlTTO la 7,7/100.000va 21,6% t vong.10 cnm2010RobertbocotlTTOla3,3/100.000vatvong35%.TheoTchcY tThgii (2010)c17ca tvong trn100.000casanhva25%trongstvongdothuyntcphivathuyntci.

Yu t nguy c

cthgimtltvong,hinnayngitacpnnhngnguycc thxy raTTOcththeodivaphthinsmkhisnphvaosanhcrivaomttrongnhngyutnguycnay.

-Tuimcaovaathai.10,11,12,13

-Truyndchvaoivacatheterpsuttrong


tcung.13

-Phivachci.

-Dngvathainam.5

-Chnthngbngkn.

-CtchkhucTC.

-Mlythai.10,12

-Gyttysngvangoaimangcng.

-Thailuvaphthaitamcnguytthhai.5

-Khiphtchuynd.11

-Phnsunhumnci.9

-Tinsngit,bongnhauthai,nhautino.

-Vmangi.2,13

-Vtcung.

Triu chng

C rt nhiu triu chng c th xy ra khinghi ng sn ph bTTO i nhng c cctiuchuncaraccthythucchngayla:-Tnhinsnphhhuytptngttrongkhitrcsnphhoantoanbnhthng.

-Tmtikhthvaphphicpgythiuoxytngt.

-Rilonngmuvachymubtthngcccquantrongcthnhtlattcung

-Timthaichmbtthng.-Snphlncncogitvangngtim.

Tt c cc triu chng trn u xut hintrongvng30phtlcchuynd,angmlythai,haysnphangsthaihocctcungangdnn.

Cn lm sng

-X-quangngcthngcth thyphphivithmnhimmkevaphnang.

-ECGcththynhptimnhanh.RilonSTvaTbtthng,cthiumuhaynhimu.

-Siumtimcththysuythttricpdogimcobphocsiumtimquathcqun

Quan im mi trong x tr Thuyn tc i

csdntngtthtphitrongvng10phtsaukhixuthinthuyntci.3

-Hinnayvinhiutinbtmraccchtchimsinhhcchiuchngminhcsxuthincaccchtthucvthainhixuthintrongtunhoanmnhzinccoproporphyrin la cht trong phn su thainhi,serumtryptase(bnhthng


iu tr

Nhn bit sm TTO, tch cc hi sc timmch va iu tr phng nga cc di chngcbitn laiucn thitci thinkh nng thanh cng.Nghin cu gn ybo co gim t l t vong t 61% - 86%nhng nm 1990 cn 13,3% - 44% nhngnm2000.10,12

Vikpcan thipsmbaogmbcssnkhoavabcsgymhiscvachuynvinhiscsecithinktcccamvatr s sinh. Theo di vi ng mch xmln, tnh mch trung tm va catheter ngmchphi, sium timqua thcqun,tngthngtiutoiukinchohisctnhtrngkhilngvasnphmmu,iutrtnghuytpvabnhphi,ctimvarilonchcnngthn.

Phngphptipcnxmlnhisccbocobaogmlcmu,ECMO(ExtraCorporeal Membrane Oxygenation),timphinhnto,thitbhtrthtphi,vathuyntcngmchtcung.Chosnphhtkhkhdungprostacyclinvanitricoxideht(NO)tcdngnhccthucginmchphitrctipvacsdngthanhcngiutrcomchphicptnh.4

Kt qu

-Trongnm2010,OixcnhmtsyutgytvonglinquanntvongmsnphTTObaogm:asn,mlntui,vababiuhinlmsang:ngngtim,khth,vamtthc.Ngoaira,mcSialylTnhuytthanhcaohnngkbnhnhnvithuyntcigytvongvacthtinlngcaktquxu.

-Trongnm2009,MatsudaxemxtcchslmsangcachnbnhnhnchtvTTO timt trung tm chm sc i hcgianm1989va2000.Mttltvong44,4%cboco.Matsudatmthymtskhcbitngkchoccnnnhn

sngvachtvkhongthigiantrungbnht lc khi pht triu chng lm sang vaiu tr la 48 pht (10-90 pht) va 137,5pht(75-180pht).14

-Cccquanb tn thng thnngknhngngiccusngsovingicht.Vvy,chnonsmvaiutrTTOlartquantrngchossngcn.bnhnhnsngsttronggiaionucaTTOihimtcchtipcnanganhchmsccbitcccquanbaogmphi,tim,gan, thn,vang tiuha.Khong thigiansanhsaukhimngngtunhoanlinquannktccttnhtla5n15pht.15 StehrmtmttrnghpTTOchiscmvatrssinhthanhcngsaukhimngngtimtrckhisanh,crilonngmu, xut huyt nng va tmu di baogan.Chmtkhong thigianngnca9pht quyt nh tin hanh perimortemnggpvaoktquthanhcng.Phttrinhthngcnhbolinnganhchomlythaikhncpbaogmmlythaikhichtlartquantrngcthhiscthanhcng.ivitrnghpcaTTOtithiimmlythai,ccbinphphiscngaylptctrongkhivncntrongphngmcthtoiukinchomtktqutt.15,16

- Knight bo co kt qu thanh cng vinhngphngthciutrbaogm:cttcung,thaymu,thayhuyttng,vadngyutVIItithp.

-Ktquthainhi:mcdktquchusinhcbocolachc21%,50%nhngtrssinhctnthngthnkinhvnhvin.Clarkboco60%bnhnhncTTOtrongkhithaicnsngtrongtcung.Mcdtlsngstcathainhicbocola79%,chc39%nhngtrsngstkhngd chng thn kinh.2Trong nm2010, tltvongchusinhla135/1.000casanh.12 Thigianngngtunhoannkhisanht5n15phtcthkhngchcithinktquchothainhimacncthtothunli

TNG QUAN Y VN


chohiscbamvabcsphuthutphicchunbthchincucmkhimvacht.2

Kt lun

-Thuyntcigytlmcbnhvatvongmcao.

-Chnonsmvaiutr tchccsecithinktquchomvatrssinh.

-Thuyntcikhngngnc,khngthontrc,valamtchnonloitr.

-Thuyntcinncnghingnhngbnhnhnmangthaixuthintngtcasuyhhp,ngng tim,cogit,chymubtthng,va/hocchmnhptimcathainhikhnggiithchclinktvimtphnngloiphnv.

-Thuyntcicthxyrabtclcnaotrongqutrnhchuynd,sinhngmo,mlythai,vatronggiaionhusn.

-Sphihpnhiuchuynnganhnhmchnon sm, tip cnhiu qu, hi sc tchccva thchin sanhnhanh chng la rtquantrngbtknguynnhntvonglag.Vicnaygipcithintinlngcngnhktcccamvathainhi

Ti liu tham kho

1. GistRS,StaffordIP,LeibowitzAB,etal.Amnioticfluid embolism. Anesth Analg 2009;108(5):15991602.

2. ClarkSL,HankinsGD,DudleyDA,etal.Amnioticfluidembolism:analysisofthenationalregistry.AmJ Obstet Gynecol 1995;172(4 Pt 1):11581167;discus-sion11671169.

3. Stanten RD, Iverson LI, Daugharty TM, et al.Amniotic fluid embolism causing catastrophicpulmonary vasoconstriction: Diagnosis bytransesophageal echocardiogram and treatmentby cardiopulmonary bypass. Obstet Gynecol2003;102(3):496498.

4. McDonnell NJ, Chan BO, Frengley RW. Rapidreversal of critical haemody-namic compromisewithnitricoxideinaparturientwithamnioticQuidembo-lism. Int J Obstet Anesth 2007;16(3):269273.

5. Dildy GA, Belfort MA, Clark SL. Anaphylactoid

syndromeofpregnancy(amnioticfluidembolism).

In: Belfort MA, Saade G, Foley MR, Phelan JP,

Dildy GA, eds. Critical Care Obstetrics. 5th ed.

Wiley-Blackwell;2010:466474.

6. MeyerJ.Emboliapulmonaramniocaseosa.Bras/

Med1926;2:301303.

7. Steiner PE, Lushbaugh CC. Maternal pulmonary

embolismbyamnioticfluid.JAMA1941;117:1245.

8. Benson MD, Kobayashi H, Silver RK, et al.

Immunologic studies in presumed amniotic fluid

embolism.ObstetGynecol2001;97(4):510

9. RomeroR,KadarN,VaisbuchE, et al.Maternal

death following cardiopul-monary collapse after

delivery:Amniotic fluid embolism or septic shock

duetointrauterineinfection?AmJReprodImmunol

2010;64(2):113125.

10.Abenhaim HA, Azoulay L, Kramer MS, et al.

Incidence and risk factors of amniotic fluid

embolisms:apopulation-basedstudyon3million

births in theUnitedStates.AmJObstetGynecol

2008;199(1):49.e149.e8.

11.KramerMS,RouleauJ,BaskettTF,etal.Amniotic-

fluid embolism and medical induction of labour:

a retrospective, population-based cohort study.

Lancet2006;368(9545):14441448.

12.KnightM,TuffnellD,BrocklehurstP,etal.Incidence

andriskfactorsforamniotic-fluidembolism.Obstet

Gynecol2010;115(5):910917.

13.Morgan M.Amniotic fluid embolism.Anaesthesia.

1979;34(1):2032.

14.MatsudaY,KamitomoM.Amnioticfluidembolism:

acomparisonbetweenpatientswhosurvivedand

thosewhodied.J IntMedRes2009;37(5):1515

1521.

15.Katz V, Balderston K, DeFreest M. Perimortem

cesarean delivery: were our assumptions

correct?AmJObstetGynecol 2005;192(6):1916

1920;discussion19201921.

16.Stehr SN, Liebich I, KaminG, et al. Closing the

gap between decision and deliveryamniotic

fluid embolism with severe cardiopulmonary and

haemo-staticcomplicationswithagoodoutcome.

Resuscitation2007;74(2):377381.

Quan im mi trong x tr Thuyn tc i


Cp nht thng tin v chn on Thuyn tc i Nguyn Th Thanh,* TS.BS.*BmnGMHSHPhmNgcThchTP.HCM,Email:[email protected]

i cng

Thuyn tc i (TTO) l mt cp cu thm ha sn khoa, xy ra t ngt khng c triu chng bo trc, trong lc ang chuyn d hay ngay lp tc sau sanh. Trong dng nng, bnh nhn kh th d di kem tnh trng sc vi ngng tim ngng th, i khi kem theo co git, a n t vong m. Bnh cnh lm sng a dng v khng c cc xt nghim chn on c hiu nn thng phi a n vic lm t thit xc nh nguyn nhn t vong trong bi cnh thm ha. nhng ngi sng st, din tin cng rt nng do tnh trng ng mu ni mch lan to (DIC) gy ra chy mu nghim trng v hi chng suy a tng. Ngay khi nghi ng thuyn tc i, vic x tr a chuyn khoa phi mc ti u hi sc ngng tim ngng th hiu qu, chng ti ri lon ng mu v cho php ly thai nhanh chng. Trong nhng nm gn y, t vong do thuyn tc i c khuynh hng gim. Mt phn, do cc phng php chn on tt hn cho php ngh n thuyn tc i trc cc bnh cnh lm sng khng r rng. Mt khc, do s tin b ca cc phng php gy m v hi sc trong kp a chuyn khoa ti ch cng vi bc s sn khoa v nhi khoa trong chm sc cc sn ph ny.

Sinh ly binh thng cua nc i

Dch i thi im trc 20 tun v kinh ch l dch siu lc ca huyt tng m qua nhau v cc mng, v ca huyt thanh thai nhi qua da. Thnh phn ca dch i thay i theo tui thai. Vo cui thai k, dch i nhc trng v giu cc t bo trc vy ca

da thai nhi, lng t, mucine, v i khi phn su (gi y mt bt thng d dng tiu ha hay suy thai). Trong dch i c cc cht tin ng mu (procoagulant), nhiu prostaglandine E2 (PGE2) ngay t u thai k; v c nng cao PGF2 v PGE2 vo lc chuyn d, cng nh c yu t m. Gi thit v s di chuyn sinh ly ca dch i trong lc c thai v khi sanh c mt s tc gi a ra, nhng ngi ta khng bit chnh xc iu g khin mt s di chuyn dch i thm lng thnh mt bnh cnh lm sng nghim trng, ngoi tr c th do lng ln dch i i vo trong tun hon m.

Sinh ly bnh lm sng

Trong TTO, dch i i vo tun hon m trong giai on s thai. ng xm nhp ca dch i thng qua rch mng i, hay v t cung hay cc mch mu c trong c t cung. Thuyn tc i gy ra tnh trng sc v tc ng ln ng mu.

Tinh trang sc

Cc hiu bit v sinh ly bnh ca tnh trng sc t ngt trong TTO t nhiu tin b. Gi thit hin nay l c ch kp: huyt ng do tc c hc cc mao mch phi, v p ng vim hay thng tn do cc thnh phn trong dch i phng thch t do trong tun hon phi v sau trong tun hon h thng.

ap ng huyt ng

Ba p ng lm sng (h hp, huyt ng v thn kinh) c th xy ra mc t hoc nhiu sau khi cc thnh phn ca thai i vo mu m.

TNG QUAN Y VN


p ng h hp ban u tng ng vi tc nghn mao mch phi a n tng p lc ng mch phi, cc shunts trong phi, sau , tnh trng thiu oxy m nghim trng. Tng p ng mch phi sm c gii thch bng hai c ch, mt l hin tng c hc n thun do tc cc mao mch phi bi cc thnh phn khng ha tan ca dch i (vy da, tc, mucine), kt hp vi s co mch mu phi do endotheline c trong dch i (endotheline l cht co mch) v cc cht khng ha tan khc leucotriene, thromboxane A2 v acid arachidonic.

Giai on 2: p ng huyt ng. Giai on u c suy tht phi. Sau suy tht tri vi biu hin ph phi cp (70%) v try mch. H hi chc nng tht tri do nhiu nguyn nhn tham gia: thiu oxy m, hin tng tng quan qua li gia hai tht vi s di lch ca vch lin tht v pha tht tri do dn tht phi, co tht mch vnh gy gim lu lng mu mch vnh v tc dng c ch co bp c tim trc tip ca endotheline trong dch i.

p ng thn kinh giai on u hay tr hn, s suy h hp v huyt ng a n suy thn kinh vi triu chng a dng, BN co git, l m, hn m.

ap ng min dch d ng

Phn ng dng phn v vi dch i cng c cho l gy ra cc phn ng huyt ng. Clark v cs l nhng ngi u tin a ra c ch ny vi cc d kin sau: 41% thai ph trong ng ky quc gia ca Hoa K c tin cn d ng hay c a d ng (atopie),1,2 khng c bng chng v mi lin quan gia lng dch i v mc nng ca cc thng tn, v cui cng i khi ngi ta tm thy trong tun hon m nhiu cht mang tnh khng nguyn c ngun gc ngoi lai t thai i vi c th m, cc cht ny c th c hot ng nh khng nguyn.

Cc thay i huyt ng v cc ri lon ng mu trong TTO c th xy ra do cc yu t th dch bao gm histamine, serotonine, prostaglandine, leucotrien v cc enzyme hy protein. Tt c cc cht trung gian ny u c tham gia trong cc tnh trng sc khc nh l sc phn v, sc nhim trng. Gi thit ny vn cn bn ci. c bit, cc tc gi gi y rng nu thuyn tc i l mt phn ng dng phn v vi cc khng nguyn thai th nng tryptase trong mu m phi tng. Ngoi ra, trong cc nghin cu quan st gn y, gi tr tryptase tng khng hng nh cc sn ph b TTO. C ch bnh sinh hp dn ny cn tip tc c nghin cu.

Tac dung trn ng mau

Hin tng chy mu nghim trng thng ghi nhn trong TTO c th l do tnh trng ng mu ni mch lan to (DIC) khi pht bi dch i giu cc yu t hot ho qu trnh ng mu. Triu chng thng gp nht l chy mu nng lan to m khng c nguyn nhn sn khoa no. Nguyn nhn ca ri lon ng mu vn cha bit r. Mt s tc gi gi y rng lng ln yu t m c trong dch i chu trch nhim trong vic hot ho chui dng thc ng mu. Yu t m kt hp vi yu t VII hot ho con ng ngoi sinh ca qu trnh ng mu. Ngoi ra, tc dng ging thromboplastine (thromboplastine-like) ca dch i hot ho s kt tp tiu cu v hot ho yu t X.6 Cc ri lon ng mu ny xut hin hoc ngay lp tc hoc th pht khi ngi m sng st sau giai on ban u. Trong ng ky quc gia ca Hoa K, 83% BN c cc du hiu lm sng hay sinh hc ca ri lon ng mu do tiu th.2 Trong mt bo co lot ca ca 53 BN, 72% c triu chng chy mu v 66% c ng mu ni mch lan to.

Xet nghim cn lm sng

Thuyn tc i xy ra t ngt i hi u tin cho vic iu tr triu chng cu mng,

Cp nht thng tin v chn on Thuyn tc i


TNG QUAN Y VN

iu ny loi tr tm thi cc kho st cn lm sng. Cc xt nghim sinh hc dng hng dn hi sc nhng khng c hiu ca thuyn tc i khng c cp y.

Xet nghim chn oan sinh hoc

Chn on sinh hc c th v phi c thc hin khi cc bin php hi sc hiu qu c khi s hoc sau khi t vong (post-mortem). Vic tm cc thnh phn ca dch i (t bo thng b, cht gy, lng t, phn su) c thc hin bng mu m ly tnh mch ngoi vi hay trung ng, trong dch ra ph nang ph qun (PQ-PN), v/hoc trong m phi ca m trong tnh hung t vong m. C cc yu cu thn trng i vi s ng tin cy ca tng xt nghim. S hin din ca phn su trong dch i c quan st thy khi thai ngy, tng t i vi lng t v cht gy; nhng nu TTO xy ra sm hn, cc thnh phn k trn s khng c. Ngay c s hin din ca t bo vy da tm thy trong mu m trong TTO, mt s tc gi cng cn bn ci v ngun gc thai nhi ca cc t bo ny.

Cc phng php tm cc thnh phn ca dch i. Cc t bo vy da ca dch i c tm trn knh hin vi mt c c bch cu sau nhum xanh Nil nhn r cc th m, rt nhiu sau tun 35 v kinh. Ky thut tm trn knh hin vi trc tip ny c b sung thm bi cc ky thut ho m (histochimie) hay ho m min dch (histoimmunochimie).5 Cc ky thut phc tp ny khng c hiu, cc khng nguyn t bo pht hin khng phi l ca ring dch i. V phn su, cht gm nhiu thnh phn, c tm bng xt nghim coproprophyrine Zn thit lp chn on TTO.4

S tng t phn ng dng phn v ca TTO a n ngh tm s tng tryptase trong mu m, c lin quan vi hin tng mt ht ca t bo ln (mast cell). nh lng tryptase ny rt ng ch y, v t cc

i trong vng 6 gi sau khi xy ra tai bin, ngc vi histamine ch thong qua.3

Phac ly cac bnh phm trong trng hp nghi ng thuyn tc i

Khuyn co ly cc bnh phm cng nhanh chng cng tt v gi ti cc phng xt nghim chuyn khoa. Ti Php c phc hng dn ly bnh phm (www.alrf.asso.fr) v tn phng xt nghim chuyn khoa.

Ly mau me

Mu m c ly tnh mch trung ng hay nu khng c tnh mch trung ng th ly mu m tnh mch ngoi vi hay trong bung tim khi m t vong. Mu c ly trong ng EDTA tm t bo thai nhi v trong mt ng kh nh lng tryptase (lp li mi 2 gi v nh trong huyt tng xy ra mun). Nu c, nn ly mu m trc khi truyn mu.

Ly dich ra ph quan-ph nang

BN t ng ni kh qun th my, nu tnh trng cho php, ngi ta c th lm ra ph qun-ph nang ti thiu tm t bo thai nhi trong dch ra ph qun-ph nang. Bnh phm c ly trong chai hay ng kh. Nu s vn chuyn bnh phm khng th lm ngay, phi bo qun bnh phm dch ra ph qun-ph nang 4oC v bo cho bc s xt nghim bit v vic gi bnh phm ny.

Cach ly bnh phm khac

Nu chng may m t vong, cn bo co vic t vong do thuyn tc i ny. Cc bnh phm m cn ly cc c quan khc nhau: phi, thn, no, sau , gi bnh phm n phng xt nghim gii phu bnh v ghi r mc ch ca xt nghim ny.

Cac kt qua, bin lun kt qua

Xt nghim trn knh hin vi thc hin trn mu c c bch cu ca mu m v cn lng ly tm ca dch ra ph qun-ph nang sau nhum mu. Kt qu l khng c hay c (bn


nh lng) cc t bo thng b c ngun gc t dch i trong mi trng nghin cu.

Kh khn ca chn on xt nghim l c im ngun gc dch i ca cc t bo thng b trong mu m, v th cn kt hp tm trong mu m v tm trong dch ra ph qun-ph nang.

Cac xet nghim cn lm sang khac

Vic thc hin X-quang phi v siu m tim c th nh hng chn on v hng dn hi sc.9 Ch thc hin cc xt nghim ny khi tnh hung lm sng n nh hay hng dn hi sc.

Tin lng me v con

Trongccnmgny,tinlngcaTTOdngnhtthnnhcctinbtrongxtr a chuyn khoa ban u. Tuy nhin scithinnaydngnhtlinquannccdngTTOnngnhcccacaClark(sngst39%vasngstkhngdichng15%).2 Ngngtimngngthlanguynnhnchnhca tin lng sng km va di chng thnkinhcam.Shindincadchiphnsuva tvongthainhi trongtcungla tinlng xu.Trong cc trng hp din tinthunli,dintinkhngcchiu.Cuicng, sxy ra thuyn tc i khng chngchnhcthaivsau(dcgithitsinhlbnhvdngmindch).

C t s liu v tin lng thai nhi. Tin lng sng st v thn kinh ca thai nhi tng ng vi thi gian ch bt con cc sn ph nng c ngng tim.

Kt lun

Thuyn tc i l mt bnh ly nghim trng. Vn cn nhiu iu cha sng t trong sinh ly bnh, vic chn on kh khn do thiu cc tiu chun chn on lm sng v cn lm sng ng tin cy. Vic mt tai bin sn khoa n c xy ra t ngt phi ngh n chn on TTO. Vic chn on v iu tr phi nhanh chng, hiu qu. Siu m c vai tr quan trng trong tnh hung ny. iu tr ch yu l iu tr triu chng, bao gm cc phng php iu tr cm mu mi

Ti liu tham kho

1. Benson MD, Kobayashi H, Silver RK, Oi H,Greenberger PA, TeraoT. Immunologic studies inpresumedamnioticfluidembolism.ObstetGynecol2001;97:510-4.

2. Clark SL, Hankin GD, Dudley DA, Porter TF.Amniotic fluid embolism: analysis of the nationalregistry.AmJObstetGynecol1995;172:1158-67.

3. Fineschi V, Gambassi R, Gherardi M, TurazilliE. The diagnosis of amniotic fluid embolism: animmunohistochemical study for quantificationof pulmonarymast cell tryptase. Int J LegalMed1998;111:238-43.

4. Kanayama N, Yamazaki T, Naruse H, SumimotoK, Horiuchi K, Terao T. Determining zinccoproporphyrininmaternalplasma,anewmethodfordiagnosingamnioticfluidembolism.ClinChem1992;38:526-9.

5. KobayashiH,CoiH,HayakawaH,AraiT,MatsudaY,GotohK,etal.HistologicaldiagnosisofamnioticfluidembolismbymonoclonalantibodyTKH-2thatrecognizes Neu-Ac alpha 2-6 Gal NAc epilope.HumPathol1997;28:428-33.

6. Uszynski M, Zekanowska E, Uszynski W,Kuczynski J. Tissuefactor (TF) and tissue factorpathwayinhibitor(TFPI)inamnioticfluidandbloodplasma:implicationsforthemechanismofamnioticfluidembolism.EurJObstetGynecolReprodBiol2001;95:163-6.

Cp nht thng tin v chn on Thuyn tc i


Gi tr xet nghim Tryptase trong Thuyn tc iPhan Thanh Hi,* *TTChnonYkhoaMedic,email:[email protected]

Tryptaselamtproteinctcngphnlyprotein,chtnaydobchculoidngbao(mastocyte)phngthchkhinthamdvaotcngphnvdng.Bnhthngtrongmungi lanh lngTryptasekhngphthin,saukhiphnngphnv,dngbaophngthchTryptasevaomuvakodait2-4gi.

NngTryptase11,5ng/mlmuchothycphnngphnvcadngbao.Tronghnh1,nngcaTryptasevaHistaminetrong mu sau mt phn ng phn v chothyviclymumukhinaothphhpvanuchmtrsebmtnhgi(sau6gixyraphnng).

TNG QUAN Y VN

Tryptase v thuyn tc i

CchcaTTOccngnhnhinnaylaphnngphnvcacthkhidchithotvaomudovccmchmutcungkhichuynd.Cc tcgi tm thy shindincaTryptasetrongcccnTTO,rtphhpvitnhhunglmsang,nhngcmtstrnghpcngkhngtmthyTryptase,

ansnghingkinTTOladophn

ngphnv.Nhngcmtstcgichola

phi lymumu ng vi thi immi

tmraTryptasehindintrongmu.

VaitrC3vaC4trongmu,theotcgi

Benson (2001), khi Tryptase m tnh, C3

vaC4 c gi tr nhy xc nhTTO t

88-100%, chuyn bit la 100%, a ra


Gi tr xt nghim Tryptase trong Thuyn tc i

mtgiithichvTryptasekhinaodngtnhkhinaomtnhtrongTTO.

Qui trinh xet nghim Tryptase khi nghi ng thuyn tc i

Trc mt trng hp lm sang nghi ngTTO,lymutnhmch10ml,chialamhaing,mtngcchtkhngngEDTAvamtngkhngckhngng.Sau, lymumusau1gi,2gisauva24gisaucnkchpht,nhvyc4mumuvithigiankhcnhau.

Phn tch kt qu Tryptase

1.NuTryptase>11,5ng/mltngcaottcccthiim:chnonxcnhlaTTO.

2.NuTryptase(-),C3,C4dngtnh:xcnhnlaTTO.

3.NuTryptase(-),C3,C4mtnh:loitrTTO.

4.TrongtrnghptvongmaTryptase(+),

cthgiithchlaTTOkhigiiphutthi

khngchngminhcTTO.

Kt lun

XtnghimmuTryptasekhilmsangnghi

ngTTOgip chn onTTO, cng la

bngchngcaphnngphnv, to tin

choccnghincuvchnonsmva

dphngTTOcngnhthcyiutrcp

cukpthibnhlnay

Tham kho

1. CurrentAllergy&ClinicalImmunology,June2010

Vol23,No.2

2. Schwartz LAB: Diagnostic value of tryptase in

anaphylaxis and mastocytosis. Immunol Allergy

ClinNorthAm.2006Aug;26(3):451-463

3. BensonMD:A hypothesis regarding complement

activation and amniotic fluid embolism. Med

Hypotheses.2007;68(5):1019-25.Epub2006Nov

16.

CNG TY TNHH MTV THIT B Y T 509 L Vn S , P.2 , Q.Tn Bnh , TP.HCM : (08)22480407 - 0908660826 - website : www.thietbiykhoa.org

Vi mc ch h tr thit b chn on v iu tr bnh ti phng mch ring ca Qu Bc s, Cng ty Y C chng ti ch cung cp cc loi thit b y t cao cp sn xut ti Nht Bn, Hoa K, c, Anh, Hn Quc nh sau :

My siu m hiu HONDA sn xut ti Nht Bn My o in tim hiu SUZUKEN sn xut ti Nht Bn My o lang xng FURUNO sn xut ti Nht Bn

My soi CTC, t lnh, t in vng LEEP LEISEGANG sn xut ti c My Doppler tim thai, Monitor Sn khoa ULTRATEC sn xut ti Anh

My t, iu tr da bng Laser SNJ sn xut ti Hn Quc My theo di bnh nhn, o kh mu KTMED sn xut ti Hn Quc


T tm sot HPV bng dng c Delphi ScreenerV Th Nhung,* PGS.TS.*BmnPhSnHYKPhmNgcThch Email:[email protected]

Ung th c t cung (UTCTC) l bnh ly ph bin, ng hng th hai trong cc ung th ph n trn th gii.7 Mi nm c khong gn 500.000 trng hp mi mc v khong 250.000 ca t vong v cn bnh ny m 80% cc trng hp t vong l thuc v cc nc ang pht trin - ni cha c chng trnh tm sot ung th c t cung c trin khai.

Trong thp nin 70, Human papilloma virus (HPV) c m t nh mt trong nhng tc nhn gy bin i t bo c t cung (CIN), tin ca ung th c t cung.3 Nhiu nghin cu trn th gii khng nh s lin quan mt thit gia HPV v ung th c t cung. Ngi ta phn bit cc typ nguy c thp t khi lm tin trin n ung th v cc typ nguy c cao thng gy ung th. Nhng tn thng mc cao (HSIL) c th pht trin t tn thng mc thp hoc trc tip t cc tn thng do nhim HPV tn ti ko di v 70% l do 2 typ virus HPV 16, HPV18. V th, vic tm sot pht hin tnh trng nhim HPV ht sc cn thit qun ly sc kho sinh sn cng nh ra bin php can thip sm ph hp. 7

Tm ly ph n rt ngi i khm ph khoa. y l mt tr ngi cho vic tm sot ung th c t cung bng pht t bo c t cung gi tt l Pap test. Mc d tnh hu ch ca Pap test l hin nhin, xt nghim ny vn mang mt s nhc im nh s ph thuc rt ln ca kt qu vo kinh nghim ca ngi c cng nh cht lng mu bnh phm. Do , vn cn cn n nhng phng php xt nghim khc b sung gip hiu qu tm sot bnh tt hn. Xt nghim HPV DNA c hu

ht cc c quan qun ly sc khe trn th gii a vo chng trnh tm sot UTCTC kt hp vi Pap test.

to iu kin thun li cho nhng ph n khng thng xuyn i khm ph khoa nhng vn c th lm xt nghim tm sot HPV, mt dng c mi sn xut ti H Lan tn l Delphi Screener c gii thiu ch em s dng, qua c th t ly mu dch m o ca mnh ri gi n phng xt nghim phn tch tm HPV.

Delphi Screener l mt ng u trn thit k tng t ng bm tim, dng t vo trong m o, chiu di khong 22,5cm. Phn a vo trong m o di khong 10cm. Dng c ny thch hp cho tt c ph n. Bn trong ng c cha 5ml dung dch nc mui sinh ly v trng, dung dch ny c bm vo trong m o, i trong vng 3-5 giy ri c ht tr li trong ng v ng c rt ra khi m o. Hin din trong ng lc ny l dung dch cha t bo m o c t cung b trc ra, sau s c bm vo mt ng nghim chuyn v phng xt nghim tm HPV trong vng 24 gi v trong mu khng c cht bo qun bo m cht lng ca bnh phm. Cc bc thc hin t ly mu dch m o lm xt nghim tm sot HPV c m t theo hnh sau y:

TNG QUAN Y VN


TNG QUAN Y VN

Chthch:

1.HnhdngcDelphiScreener

2.Gtembomcadngc

3.Cmcndngcnhngkhngnvontung

4.tdngcvomo.

5.yvomonhngvncnmtphnngnhnthyngoimo.

6.vontungrigitrong3giydungdchncmuisinhltrongngchyvomo.

7.Bungtayntdchtrongmochtlivotrongngvrtngrakhimo.

8.lnntungydchtrongngvo1ngnghimikmtheodngc.

9.ynpngnghim..

10.Gimunphngxtnghim.


T tm sot HPV bng dng c Delphi Screener

Phng php t ly mu dch m o - c t cung theo nh m t trn l mt phng php tm sot HPV nguy c cao ng tin cy. iu ny c chng minh qua nghin cu thc hin bi Patti E. Gravitt v cs thc hin Hoa K trn 268 bnh nhn ung th c t cung - bnh nhn t ly mu dch m o tm HPV DNA nh tnh v nh type so snh vi cc mu do bc s ly trc tip trn c trong v c ngoi c t cung. Kt qu cho thy c s tng ng gia 2 cch ly mu ny rt tt l 88,1%; = 0,73 (KTC 95%: 0,610,85) 6

Nghin cu ca Charlotte H. Lenselink v cs thc hin H Lan trn 96 bnh nhn chia lm 2 nhm. Nhm I c 45 ngi trong 62,2% HPV dng tnh v nhm II 51 ngi trong 25,5% HPV (+). Tt c nhng ngi ny u c t ly mu dch m o v c khm ph khoa, h c cc bc s c kinh nghim lm pht t bo c t cung m o v thc hin xt nghim nhng dung dch (liquid- base). S tng ng v kt qu tm HPV gia phng php t ly mu v do bc s ly mu nhm I l 93,3% v nhm II l 100%. 1

Nghin cu ca Murat Gk v cs Noord-Holland v Flevoland (H Lan) nm 2006-2007 5 vi s tham gia ca 13 phng xt nghim, hn 800 Bc s v 28.073 ph n khng i khm ph khoa trong chng trnh tm sot ung th c t cung. Trong 27.792 ngi ng ky phng php t ly mu (nhm I) v 281 ngi ng ky n gp bc s (nhm II) lm xt nghim tm sot HPV. Kt qu cho thy t l tun th lm xt nghim nhm t ly mu cao hn nhm i khm bc s (27,5% so vi 16,6%). S khc bit c y ngha thng k (p= 0,001). Nhng ngi c HPV (+) s c mi n gp bc s lm Pap v soi c t cung. S trng hp c chn on CINII l 1,3% v CIN III l 1% nhm I. Trong khi nhm II, s trng hp c chn on CINII l 0,8%

v CIN III l 0,5%. iu ny cho thy nhy ca tm sot HPV bng phng php t ly mu khng km hn bc s ly mu.iu kin thc hin phng php t ly mu:- Trc khi ly mu 2 ngy khng c bm

ra m o, khng dng thuc dit tinh, hoc vaseline, khng t thuc dit nm.

- Khng nn ly mu khi ang c kinh.- Dng c Delphi Screener ch dng mt ln

ri b, khng c ti s dng.

Delphi Screener c s dng nhiu quc gia trn th gii nh H Lan, Phn Lan, , c, Malta, Hoa K, Singapore. Theo kho st v s chp nhn ca ngi s dng th a s u khng thy c g tr ngi, phng php t ly mu khng lm au v thc hin d dng 4,8. Trong nghin cu ca Igidbashian v cs 4 th 77,6% bnh nhn thch t ly mu vi Delphi Screener hn l c bc s ly mu.

Tm li, da trn nhiu nghin cu c thc hin trn th gii, c th kt lun rng phng php t ly mu c th em li hiu qu tt cho vic tm sot HPV nguy c cao trong s nhng ph n khng i khm ph khoa nh k. Bng cch ly mu nh ri gi mu n phng xt nghim c th gip tng bao ph ca chng trnh tm sot ung th c t cung mt cch hu hiu. thc hin iu ny cn phi c s t chc tt trong vn cung cp dng c t ly mu v phng xt nghim c kt qu, t vn cho nhng trng hp HPV dng tnh bnh nhn c theo di v iu tr ng mc

Ti liu tham kho

1. Charlotte H. Lenselink, Roosmarie P. de Bie,Dennis van Hamont et al (2012) Detection andGenotyping of Human Papillomavirus in Self-ObtainedCervicovaginalSamplesbyUsingtheFTA Cartridge: New Possibilities for CervicalCancerScreeningJ.Clin.Microbiol.Dec2 0 1 250:123870-3876.

2. Delphi Bioscience B.V.Glashorst 126.3925 BV


Scherpenzeel.UserInstructionsDelphiScreener

3. Hyo-Pyo Lee & Sang-Soo Seo. 2002. Theaplication of human papillomavirus testing tocervical cancer screening. Yonsei MedicalJournal43(6)763-8.

4. Igidbashian, Sarah; Boveri et al (2011) Self-Collected Human Papillomavirus TestingAcceptability: Comparison of Two Self-SamplingModalities.JournalofWomensHealth(15409996). Mar2011, Vol. 20 Issue 3, p397-402.6p.1BlackandWhitePhotograph,1Illustration,3Charts.

5. Murat Gk, Danille A M Heideman,Folkert JvanKemenade(2010)HPVtestingonselfcollected cervicovaginal lavage specimens asscreening method for women who do notattend cervicalscreening:cohortstudyBMJ 2010; 340 doi:http://dx.doi.org/10.1136/bmj.

c1040

6. Patti E. Gravitt1, James V. Lacey Jr., LouiseA. Brinton et al (2001) Evaluation of Self-Collected Cervicovaginal Cell Samples forHuman Papillomavirus Testing by PolymeraseChain Reaction Cancer EpidemiolBiomarkersPrevFebruary200110;95

7. RenskeDMSteenbergenHumanpapillomavirusesand cervical cancerdevelopment ColposcopyManagementoptions.5:35-46.

8. Yvonne Deler, Melanie Schuster, ElenaVartazarowa et al (2011) Cervicovaginal Self-Sampling Is aReliableMethod forDeterminationofPrevalenceofHumanPapillomavirusGenotypesinWomenAged 20 to 30Years.J.Clin.Microbiol.2011,49(10):3519.DOI.10.11.28/JCM.01026-11.


D phng Tin sn gitHong Th Dim Tuyt*, TS.BS.*BV.TD-Email:[email protected]

Tinsngit (TSG)sngit (SG) lamttrongnmtaibinsnkhoa.ccnctrnth gii va ti Vit Nam, TSG-SG la mttrong nhng nguyn nhn hang u gy tvong m, ch sau bng huyt sau sanh vanhim trng. TheoT chcY t Th gii,c tnhkhuvcchuPhivachuckhong1/10tvongmlinquannTSG,trongkhichuM la tinhcc trnghptvongclinquannTSG-SG.

TSGchim7-10%ccthaik,cxemlanhngthaikcnguyccaocncchtheodivaqunlthaicnthnvTSGlamtngtltvongvabnhttchocmva thai.Ngoaira,iuquantrngphnlncc trnghpTSGc thdphngcvacnhiumcdphngkhcnhauvinhngmctiudphngkhcnhautngmc.3

- D phng cp 1: nhmmc ch khm,sanglccngnhthchinccxtnghimtruytmccitngnguycbTSGkhithaiktrn20tun.Viccitngnguy c cao, c nhng ch theo di,nung,nghngi,lamviccngnhsdngccthucngnchnTSGxyra.

- D phng cp 2:phthinsmTSGtrckhibinchuynsangTSGnng.

- D phng cp 3: iu trTSGnng hiuqunhmgimthiutiaccbinchngxyrachomvathai.

D phng cp 1

Cac xet nghim sang loc TSG sm

Cp nht quan im ca T chc Y t Th gii v d phng cp 1 TSG

- Ngh ngi ti ging, hn ch cn ng th cht:theokhuyncocaTchcytThgii,vicnghngivahnchvnngth cht khng c xem lamt phngphpiutrdphng.Thcvy,quaccnghincu,chngminhvicnghngitigingkhngcithinktquchocmvathai.5

- Hn ch n mn:ktqunghincuca603 i tng c thai ti Thy in, sosnhgiahainhmdnghamlngnatrimingay20mmol/ngayva50mmol/ngay,cho thy khng c s khc bit mang nghathngkvtlTSGRR1,1195%CI0,491,94).TheokhuyncocaTchcYtThgii2012,7hnchmuiiviccsnphtrongsutthaiknhmphngnga TSG khng c khuyn co. Tuynhin,HingkhoahcsonthokhuyncoTchcYtThgiiuthngnhtrngccsnphnnctvnmtchnychtvanhtlakhngnnnqunhiumuitrongthaiklacnthit.

- B sung calcium: theokhuyncaocaTchcY tThgii,vicbsungcalciumvi liu 1,5-2g/ngay, c bit nhng khuvcclngcalciumavaocththp,chiuqutrongvicngnngaphttrinTSG.7Thtvy,tktqunghincugpca Cochrane vi 15.730 sn ph trong13 nghin cu th nghim lm sang, chs nguy c tng i pht trin TSG la0,45(95%CI0,310,65),tclabsung

TNG QUAN Y VN


calciummingayviliukhcao1,5-2gmingayctcdnglamgimmtcchcngha thngkvicpht trinTSG.Tuynhin,vicbsungnaynnckhiusmtrctunlth20cathaik.

- Aspirine liu thp: Aspirine75mgnncbsungmingaychoccthaiphcnguyccaobTSG.Vicbsungnaycngnncbtusmtrctunlth20cathaik,ttnhtlattunl12cathaik.

- T chc Y t Th gii khng khuyn co b sung vitamin D, hay s dng cc cht antioxidant nh vitamin C, vitamin E trong vic ngn nga TSGvktqunghincucha chngminh tnh hiu qu va antoancaccbinphpnay.

D phng cp 2

Gia tri cac triu chng lm sang trong tin lng TSG

Huyt p

Huyt pc thbdaong linquanncckthutohuytp.Cnlu,trnhccsaislinquannkthutohuytp.

-osaukhinghngitiging15pht,o2lncchnhau6ting

-TthoHA

+oHAbngphngphpcindngngnghechnhxchnmyoHAint.

+BaooHA:tngngkchccnhtaycabnhnhn.

-KthutoHA:KorotkofV.

Huyt p laduchngquan trng trongchnonTSG.Vvyvicxcnhchnhxchuytpcabnhnhnrtcnthit.Tuynhinlu,ccaohuytpcthlaTSG,vakhngcbiuhincaohuytptheotiuchunHiphiTimmchThgii ti thiimkhmcngkhngcloitrTSG.1

m niu: la mt trong nhng du chngchnonxcnhvachnonmcTSG. Cc du chng m niu hng nTSGnng.

-mniu24gi5g/24gi.

-Quethmniu:3g/L(1+).Xtnghimnaycuim:nhanh,dthchinnhngihinctiu>2l/ngay.

-Gitrtinondng(+):96%,(3-4+):32%.

-Gitrtinonm:34%.

au thng v hay h sn phi

Khicctriuchngnayxuthincnnhanhchngtruytmvaloitrvgantrongbaohay ngoai bao Glisson. Theo thng k, ckhong 1-2% bnh nhn TSG nng va 4-12%bnhnhnhi chngHELLPc triuchngauhsnphihaythngvbvgan.Khi,tltvongmvaconrtcaolnltla69-42%,vatvongcon60%.

Nhc u: trung bnh n nhiu, tng cnhay lin tc. Nhc u ci thin sau khitruynMgSO4, c50-70%bnhnhnnhcusephttrinthanhSG.

Ri lon th gic:baogmnhnm,nhni,m im thng gp.M t gp hn.ctnhckhong1-2%bnhnhnTSGva15%bnhnhnSGc triuchngm.15%BNmtintrinSG(Cunningham.1995).

Gia tri cac triu chng cn lm sang trong tin lng TSG

Hematocrit (Hct)

-Hct tng: c cmu, gim th tch tunhoannimch,bongbnhnngln.

-Hctgim:cthchintngtnhuytvalachimcahichngHELLP.

-Cnloitrccyutnhhng:chnung,rilontiuha,st

TNG QUAN Y VN


D phng Tin sn git

Tiu cu (TC)

-TC


Tng quan v ri lon tinh dc tui quanh mn kinhHunh Nguyn Khanh Trang, PGS.TS.

Tnhdclamtphnquantrngkhngththiuctrongisngcangiphnvatrirngsuttrongcucsng.Ngaynay,vnchmscsckhesinhsnbaogmluncchmscsckhetnhdc.Nghincu v tnh dc nhm gip cho ngi phnhiurhnvacimvnhngthayitnhdccamnh.tuitinmnkinhcangiphnlagiaioncnhiuthayivnititvatmsinhl,nghincunhngthayicmxctnhdctronggiaionnaygipchongiphncmthythoimivattinhntrongcucsng.

Thi k tin mn kinh

Kodaikhong2-5nmtrckhikinhnguytngnghn.Ngungccamithayitrongthiknayladosgimpngviccnitit t hng sinh dc (gonadotropin), dnnnhngrilontrongstrngthanhcanonbao.utinlngprogesteronegim,rinltestrogenecnggim.Xutphttsgimcchotngcabungtrngvihin tng cn kit nang non.Nang nonkhng hot ng nn khng ch tit cestradiolvakhngc rngrngnnkhngcprogesterone.FSHvaLHlitng,saunhLHvngdn.CngEstrogene tngivinhngbiuhin lmsang: (i)Tngtnhthmthanhmchkhinngiphnbauv,dbph.(ii)Chtnhnctcungtrongvalngsutchuk.(iii)Rilonkinhnguyt: rongkinh, ronghuyt, cngkinh.(iv)Hichngtinmnkinhxuthinhocnngthmnucsn:tngcn,chng

bng trn bng di, au v, ri lon tmtnhnhlou,cngthngbtan...

cimsinhhccatuitinmnkinhlamttnhtrngcngestrogentngi,ngha lakhngphidoestrogentngmaladothiuhockhngcprogesteronegimbt tc dng ca estrogen. Vic o lngnngnitittrongthiktinmnkinhkhng c ngha.La giai on bt u cnhngrilonnititcthngiphn.ylagiaioncnhiubinisinhlbnthn,binicthkotheonhiurilonthnkinh,chcnngcth,cthannhiubnhbnhtt.Nunhcsquantmngmc,chngtacthphnghoctracthphthinsm,kpthi.

Thi k mn kinh

Chbitcquahicu,thnglasaukhikhngckinhlintip12thngmicthgilamnkinh.Mnkinhcnghalakhngthykinhhangthngna.lathikchuyntipgiaccnmthngcnkhnngsinhvinhngnmthnghtsinh.Cckkinhtrnnngaycangtthngxuynhnhaytmuhnvacuicngthngnghnkhngcnthykinh.Huqucamnkinhcthlamchongiphncmthyphngbcnngmt,nhcu,mtngvm,hayqun, ri lon tm ldbunng, ti thn, km tp trung suy ngh,mtmi, v m hi m, chng mt, hi hp,tccuchi.aunhiunimtcchmh,aukhpvaauc,tngcn2.Huht

TNG QUAN Y VN


phnutriqualnhanhkinhcuivaolatuign506.Khignngiaionnay,ngiphnccctriuchngbohiuspmnkinh,ngitagiylathikchuyntiphaygiaiontinmnkinh6.

p ng tinh dc ngi ph n

pngtnhdcngiphnbchiphibi nhiu yu t: tm l, hoan cnh chungquanhvasinh l (ni tit,mchmucvathnkinh).MastersvaJohnsonmtpngtnhdcngiphnqua4giaion:(i)Giaionhammun.(ii)Giaionkchthch. (iii) Giai on cc khoi. (iv) Giaionthgin.

Cmtskhcbitrtlntrongcchpngtnhdcmiphnkhcnhau,vamigiaioncapngtnhdccthbnhhngbituitc,bnhtt,thucmen,ruvaccchtkchthchkhc.

V phng din gii phu hc, m vtlaninhycmnhtiviphn lnphn.Kchthchmvtcthdnnmtshngphntnhdcmnhmevacthgynncncckhoiasphn.Ccvngnhycmkhcbaogmuv,v,miln,minhvamtmcthnlamo.

Giai on ham mun Ham mun la giaion ch quan c iu khin bi trungtmkchthchnhycmvidopaminnmhthnglimbictrnno.Testosteronecnhhngngiaionhammunnamvan.Cmgichammuncthkhingbiyutbntrong(stngtng)hocyutbnngoai.

Giai on kch thch bao gm thay i vphngdinsinhlvanhngcmgicnitnhchquan,cchiphibihthnkinhph giao cm.Kch thch tnh dc lam giatng lng mu n m o gy nn hintngsunghuytvalamthayitnhthmcaccmaoqundnnthmdchquaccnimmcmo.Dchnayctcdngbi

trnmo.Tronggiaionnaynhp tim,nhpth,vahuytpgiatng,mtcmgicmplantrankhpcth,vcngto,uvsncng,danibngvakm theomttnhtrngcngctoanthn.mvtvamiln,minhnto,mobkodaivadnrng ra, t cung rt cao lnpha trnvngchu.ylamtchunbvthcmonhmchunbsnsangchosgiaohp.

Giai on cc khoaiKhikchthchlnnttimsednngiaioncckhoi.Vphngdinsinhl,cckhoilagiaiongii phng t ngt tnh trng cng c c hnh thanh trong giai on kch thchvacchiphibihthnkinhgiaocm.Tronggiaioncckhoicnhngcncothtkhngt(315cn)cacccbaoquanh mo, humnva tng sinhmn,miccokodaikhong24giyvacchkhong0,8giy.Scothtcatcungcngccmnhnbimtsphn.Nhiuphntcckhoingaytrckhigiaohp,khimvtckchthch.Khcvinamgiicmtgiaiontrsaukhixuttinh,ngiphncthtnhiulncckhoitrongmtlngiaohp.

Giai on th gin Sau khi t c cckhoi, tnh trng cng c c gii phng,ngiphncmtcmgicthgintoanthn.Nhngthayisinhltronggiaionkchthchdntrvbnhthng.Hintngsunghuytmvt,mo,miln,minhmtisau510pht.

Nhiungingh rngquanh tnhdcbtuvimongmun,dnnkchthchvasautcckhoi.TheoACOGiunaycthngvinamgii,phnngtnhdccangiiphctphn.ivinhiuphn,mongmunkhngphilcnaocnglaimkhiu.Ngiphncthcthcyquanhtnhdcbiulcmxccamnh.Cckhacnhthchtvacmxccatnhdcngayckhitcckhoikhngxyra.1

Tng quan v ri lon tnh dc tui quanh mn kinh


Cc ri lon chc nng tinh dc n gii

TheoA.Phillipsc4loivntnhdcphn:

-Ri lon ham mun khi ngi ph nkhngquantmnquanhtnhdc.

-Rilonkchthch:khingiphnkhngcmthymtphnngtnhdc trongcthmnhhockhngpngvikchthchtnhdc.

-Ri lon cc khoi: khi ngi ph nkhng thtcckhoihocaukhitcckhoi.

-Rilontnhdcau:khingiphnbautronghocsaukhiquanhtnhdc.9

-Rilonchcnngtnhdccthxyrabtcgiaionnaotrongpngtnhdc.

Nguynnhncbnnhtcatnhdcgimphnlasmtcnbngnititt,trongcnhiuhnhthc.Progesteronelartquantrng trong qu trnh kch thch hammuntnh dc. S gim sn xut t nhin trongqutrnhtinmnkinhcthdnngimhammuntnhdc.mobkhvathanhmobmngdonhhngcasgimestrogensdnnquanhtnhdcaun.8

TheoDavid, ri lon tnh dc ph nthng thy nht la gim ham mun tnhdc,xyrakhiphnkhngthyhngththm ch ch cn mun trnh xa tnh dc.Nguynnhnrtadng,cvyuttinhthnlnthcht.Nhngcbanguynnhntnhinthnggpnhtla:tuitc,bnhttvavai trcangihnphi. (i)Tui tc:khiphnt35tuitrln,bcquagiaiontrngthanhtnhdc,slohocctbaongmodinra.Canglntui, lulngmucungcpchostunhoanvngquanhxngmusegim,nhhngtistitdchbitrnmo,dnntnhtrngsuygimhammuntnhdc.(ii)Bnhtt:

ph n b stress lin tc hoc mc chngtrmcmdbsuygimchcnngtnhdc.Ngoaira,tnhtrngnaycnxyranhngngi mc bnh i tho ng, bnh timmch, suygan,ung thc tcung,unangbungtrng.(iii)Vaitrcangihnphi:ngihnphingvaitrquantrngtrongduytrhammuntnhdcphn.Dochunhhngcagiodcvnho,tngiohaynhngttngcnnphnthngtthhinhammunhnsovinamgii.3

TheonghincucaTrishaMacnair, c40%phnbccvntnhdc,nguynnhn c thdobnh l, nhng thng linquannyuttmlnh:7

-Skchthchbanukhngyhockhnghiuqu.

-Trmcm.

-Lmdngtnhdc.

-Cmgicxuhhaytilivtnhdc.

-Smangthai.

-Cngthngvamtmi.

TheoGraziottin(2003),nguynnhngiaohpautuitinmnkinhdonhiuyutnhsinhhc,tmltnhdc,cngnhcchthngnititkhcnhaunhmchmu,min dch, thn kinh. Giao hp au tuitinmnkinhnguynnhnla:

-Vim m h - m o: la nguyn nhnthng gp trong giao hp au tui tinmnkinh.

-Teomh-modohintnggimnitit.

-Cothtcsanchu:audocchphnxkhikchthchnhvimbangquang.

Vit Nam, gii php thc hin chinlc dn s la m rng va nng cao chtlng chng trnh SKSS/KHHG, giiquyttngbc,ctrngimccnidungd phng va iu tr v sinh, ung th v,

TNG QUAN Y VN


ungthngsinhsn,ccbnhlinquannSKSSphn,quantmthchngnphngvaiutrccbnhlinquannthik tinmnkinhvamnkinhcaphn,chmlocbitivinhngbnhthnggpnhlongxng,rilonkhcnhcnbcha,ramhinhiuvbanm,ccrilonsaumnkinh.4

Tnm1990nnay,mtstcgitinhanhnhincumtskhacnhvsckhosinh sn caphn tinmnkinhvamnkinhnh:nghincuvrongkinh,tinmnkinhtrnnhngbnhnhniutr tiVinbovBam-Tremtrong3nmt1991-19935.Cngtnm1994,vnsckhophnquanhmnkinhbtucquantmnhiuVitNam.Mcdcnhiucngtrnhnghincuvsckhovabnh ttmiitngphn,cccngtrnhnghincuchcpvcimsinh,tlbnhnichunghocnghincumtvaikhacnhvsckhosinhsnmiitngphn.Tuynhinvnchacnghincunaovrilontnhdccaphn,nmtrongkhungcnhchungcangiVitNam,quannim,truyn thng, oc, lun l, tngioto ra s khc nhau vmc hammuntnhdc.Mccngbnhhngcamilinhgiagianhvaxhi.

Nghin cu ct ngang kho st 245 phn t 45 n 49 tui ti 5 phng thucqun8 thanhphHChMinh, trong thigian t10/2/2012n30/3/2012.Bngcuhidatrnnntngbngcuhinhgichcnngtnhdcn(TheFemaleSexualFunctonIndexFSFI).Ktqutlphntui45-59brilontnhdcla89,39%(219/245)KTC95%(87,4-93,3).Tlriloncchnhthicmxctnhdc:rilonhammun: 98,4%,KTC 95% [96,8 - 99,9]; rilonkchthch:99,2%,KTC95%(98-100);ri lon bi trn: 99,2%, KTC 95% (98 -100);rilonkhoicm:93,1%,KTC95%(91,5-94,7);rilonthomn:95,5%,KTC

95%(94,9-96,1);rilonau:52,2%,KTC95%(45,72-58,73).Ccyutlinquancchnhthirilontnhdc:plckinht(p=0,000);plccngvic(p=0,000);plcchmscconci,gianh(p=0,000).10

Hiubitvccyuttmsinhlvagiiphucagiaionquanhmnkinhtcngtml,bsungnitit,qunlccbnhmntnh gip h tr hiu qu nhm gip cucsng tnh dc ca ph n ngay cang thnghoavattphn

Ti liu tham kho

1. ACOGEducationPamphletAP072YourSexualHealth

2. TrnThMinhChu (2001):Mn kinh, sch snphkhoatpIIBmnsn.tr689695.

3. David A. Baram.(2002). Sexuality, sexualdysfunction and sexual. NovakGynecology, 13rdedition.LippincottWilliams&wilkins.

4. onKhiHon (2002),Dns -Khochhogianh,Bigingsauihc,TrngihcYkhoaThiNguyn,Tr.114116.

5. LThanhVn,LuThHng(1994),Nghincuvrongkinh,tinmnkinhtrnnhngbnhnhniutrtiVinbovBm-Tremtrong3nmt19911993,NhxutbnYhc,Tr.1315.

6. TrnMinhMn,LNgc(1999),Giithiuchungvhichngmnkinh,bokinhvmnkinhcchkhcphc,NhxutbnYhc,tr.6374.

7. TrishaMacnair(2001),Femalesexualdysfunction;BBChealthinMarch.

8. Laumann,E.O.Paik.A&Rosen.R.C(1999).SexualdysfunctionintheUnitedstates.JAMA281:537544.

9. Nancy A. Phillips, MD.(2000). Female SexualDysfunction.EvaluationandTreatment.AmericanFamily Physician July 1, http://www.aafp.org/afp/20000701/127.html.

10.HunhThThuTho,HunhNguynKhnhTrang(2013)T l ri lon tnh dc v cc yu t linquanphntui4549tiqun8thnhphHChMinh.YhcthnhphHChMinh.HinghKHKTHYDTpHCMlnth30.Phbncatp17.S1nm2013,trang11-16.

Tng quan v ri lon tnh dc tui quanh mn kinh


Tng quan gia bo hnh gia inh v trm cm thai ph thnh ph H Ch MinhNguyn Th Nh Ngc,* Phm Thnh c, Nguyn Vn Trng, Trn Th M Duyn*TrungTmNghinCu&TVnScKheSinhSn-16DLyBnBch.PTnThiHa.QTnPh Email:[email protected]

TM TT

Bohnh(BH)donhngngithntronggianhngycngtrnnmtvncasckhecngng.ctnhcanhngnghincuvbohnhtrongvngmtnmtrcthaikdaongtrongkhong426%,bohnhgianh(BHG)khngchnhhngtrnsckhethxcmcnnhhngnhiunsckhetmtrcaphn..

Phng php: mtnghincuonhtrnthaiphti4bnhvincaTP.HCMnkhmthaitrongkhongt36tuntrln.Phngvncthchinkhinkhmthailnuv4-6tunsausinh.trn1.450phntthng1nthng8nm2012.

Kt qu:phnbBHtrcsinhconguycbtrmcmcaohn7,6lnsovinhomkhngbBH;tlnyl6,2lnsaukhikimsotccyutkhc.

Kt lun: nghincunymtlnnakhngnhmitngquangiaBHGvsckhetmtr,cbitltrmcmcangiphnnhtltronggiaionnhycmnhmangthaivhusn.

ABSTRACT

Domestic violence (DV) by intimate partners is becoming a social issue of community health. Researches estimated that women victims of DV within one year before pregnancy varies from 4 to 26%, DV has its impacts not only on physical but also on mental health. Method: a prospective study was carried out at 4 hospitals of HCM City on 1.450 pregnant women from at least 36 weeks. Interviews were performed at her first antenatal visit and 4-6 weeks after delivery from January to August 2012. Results: women who were victims of prenatal violence had 7,6 times increased risk for depression compared to those without DV, this risk was 6,2 times after controlling for other factors. Conclusion: this study once again confirmed the correlation between DV and mental health, especially depression, in sensitive periods such as during pregnancy or post-partum.

NGHIN CU


t vn

Bo hanh do nhng ngi thn trong gianhngaycangtrthanhmtvncasckhecngng.ctnhcanhngnghincuvbohanhtrongvngmtnmtrcthaikdaongtrongkhong426%.1CcnghincuNicaragua,ChiL,AiCpvaCambodia bo co c 4 ngi th c mtngibbohanhthxchaytnhdctrongthi gian mang thai do ngi phi ngu.2 iu nay cho thy bo hanh i vi ngiph n thng gp hn nhng bin chngca thaiknhi thongva tinsngit, la nhng bnh l thng xuyn csanglc.

Phncnhiunguycbbohanhhntrong thi k hu sn.Mt nghin cu tiThuincho thy24%phnbedabo hanh hay lm dng th xc, tnh dctrongthikhusn.3Trongthikhusn,Gielenghinhnbohanhgianhtngcaot1019%vamctrmtrnghnsovithiktinsn.4

BohanhnhhngnchtlngcucsngcLeungnghincutrnccnhm1.614 bnh nhn sn ph khoa ti HngKngchothytlchung7,2%phncphngvnbocotngbbohanh;cn 12,7% nhmn ph thai; trong khichc1,8%nhmnkhmhimmun;4,7% bnh nhn ph khoa va 10,9%nhmsnkhoa.Sovinhmkhnghbbohanh,chscht lngcucsng trungbnhcanhmcbbohanhthphncnghacvsckhethxc,tinhthn,lnmitrngsngvaccmiquanhxhi.5

Bohanhgianhkhngchnhhngrrttrnsckhethxcmacnnhhngnhiunsckhetmtrcaphn.Leungvacngstrongmtnghincutincuvaonm20002001trn838phnnsinhtimtbnhvingingdytiHngKngghinhn t lbohanhgianhc th l la

16,6%; s dng thang im trm cm sausinhcaEdinburgh(EPDS)vahthngchshngngaycaStein(SDSS)vaongay2hay3sausinh,12ngaysauxutvinva6tunsausinhuchothychsEPDScaohncnghatrongnhmbbohanhsovinhmkhng,quanstnayngclivichsSDSS.6

iunaycngtngtccncphttrin; Bacchus va cng s thc hin mtnghin cu ti Anh mc d c mu nhcngchothychsEPDSnhngphnmang thai tng b bo hanh cao hn sovinhmchng(9,2sovi7,7vip=0,006).Bin chng sn khoa nh chy mu trc37tun,vism,caohuytp,aulng,nghnnng,thiumu,ithong,tinsngit,nhimtrngtiu,quanstcchothynguyctngnhmbohanh(OR=3,2CI1,47,3)kcsaukhichiuchnhvinhngyutnguyckhcnhtui,htthucl,vacccimkinhtxhikhc.7

Thang im phng thc mu thun(ConflictTacticsScales)doStraussxut,csdngtrongnhiunghincut1992vihn70.000itngthamgiatnhiunnvnhokhcnhau,trntnht20qucgia va c nh gi. Nm 1996 chiuchnh(RevisedConflictTacticsscalesCTS2)nhmocthmnhnglntncngcangiphinguvavicsdngknngthngthuyt.

Cng c sang lc trm cm sau sinhEdinburgh EPDS bao gm c 10 cu hiv cm gic ca ph n trong tun l vaqua, c pht trin nhmgip cho nhngnhnvinyttuyncstiLivingstonvaEdinburgh khi thy s dng pht hinccbambtrmcmsausinhnhnghincnhgisdngctrcsinh.Theo nghin cu ca Bacchus im ct12/13khisdngsausinh,phncnhiukh nng b bnh trm cmmtmc nao;nuthchintrcsinh,nhngph

Tng quan gia bo hnh gia nh v trm cm thai ph thnh ph H Ch Minh


ntngng14/15ckhnngcaoblonthn (dysphoria) trong thai k.20 Tuy nhinchsEPDScnckimchnglibngchnonlmsangxcnhchnon.Trongnhngtrnghpnghing,bngcuhinncthchinlisau2tun.Thangim nay khng dng pht hin nhngbnhtmthnhayrilonnhncch.

Phng php nghin cu

NhmnhgimitngquangiaBHGva trmcmphnmang thaichng titinhanhmtnghincuoanh trn thaiphtiTP.HCMtibnhvinHngVng,bnhvinPhsnQucT,khoasnbnhvin Hc Mn, khoa sn Bnh vin Thcnkhmthaitrongkhongthaik36tun tr ln.Phngvnc thchin lnunhmthuthpnhngcimcaitng,phthinbohanhvatrmcmtrongthikmang thaivi thangimCTS2vaEPDS; sau thu thp thng tin lin quanntnhtrngsckhocasnphvathainhitrongvng24gisausinh;snphcphngvnln2vao4-6tunsausinh.ivi nhng sn ph khng tr li ti khm,tmmicchlinlcbngth,nnhahayphngvnquainthoi.

Kt qu

Nghin cu thu nhn tng cng 1.450 phn (c tui thai trn 36 tun va c a chrrang,chophplinlctrlisausinh)tthng1nthng8nm2012, trongsmtdu0,9%cnli1.387phnhoantt

phngvn.

Tuitrungbnhcaitngnghincu29,054,79vitrnhhcvntrungbnhla11nm(11,23,9);trongkhingichngla32,76,25va11,64,0.Tllaongtrcgnvilaongchntay(vla33,2%va30,1%;chng40,6%va44,1%).Khngcthaiphnaosdngmatu,ch0,2%cthiquenhtthucvaungru.

Gn50%cccpvchngsngring;scnlisngchungvigianhbnvhocbn chng.a s c tnh trng kinh t gianhtrungbnh,77%cngtrongnithanhtng ng vi phn b chung ca thanhph;hnphnnaphnbitclutphngchngbolcgianhtiVitNam(bng1).

Bng1.cimdnsnghincu

N=1387 %Tnhtrnghnnhn

Chungsng 1.385 99,9

Lid 2 0,1Nh

Ring 693 50

ViGv/chng 694 50

Tnhtrngkinhtgianh

Ngho/khokhn 52 3.8

Trungbnh 1.246 89.8

Khgi/giu 89 6,4

Vngcng

Nithnh 1.078 77,7

Ngoithnh 309 22,3

LutphngchngBLG

Bit 746 53,8

Khngbit 641 46,2

NGHIN CU

Bng2.Tltrmcmchung

EPDS Trc sinh

N=1.387(%)

95% KTC Sau sinh

N=1.387 (%)

95% KTC

ChsEPDSSD[Khong] 3,60,05[022] 3,53,7 3,10,04[021] 3,03,2

13* 51(3,7) 27(2)

10 nm. m bo s bo v chng li un vn cho b m v tr s sinh, cc thai ph ny s nhn c ba liu vaccine c cha c t un vn v c t bch hu gim c lc. Lch chng nga c khuyn co l 0, 4 tun, v 6 n 12 thng. Tdap nn thay th 1 liu Td, tt nht

Cp nht thng tin v chng nga un vn ph n mang thai


t tui thai 27 n 36 tun ti a ha p ng khng th ca m v truyn khng th th ng cho tr s sinh.

- Tim vaccine un vn tng cng (booster) ph n mang thai. Nu thai ph c ch nh tim vaccine tng cng nga un vn v ho g trong thai k, nn dng Tdap. Thi gian ti u l tui thai t 27 n 36 tun ti a ha p ng khng th ca m v truyn khng th th ng cho tr s sinh.

- Qun l vt thng cho ph n mang thai. L mt phn ca chm sc vt thng chun ngn chn bnh un vn, vaccine cha c t un vn c th c khuyn co cho vt thng thai ph nu ln tim

tng cng Td trc 5 nm. Nu thai ph c khuyn khch tim tng cng Td, nhn vin y t nn dng loi Tdap.26

- Ph n mang thai. Cc bc s chm sc trc sinh cn thc hin chng trnh tim chng Tdap cho tt c thai ph. Nhn vin y t nn tim chng mt liu Tdap trong sut mi thai k cho bnh nhn, khng phn bit tin s c nhn Tdap hay cha.

- i vi ph n r rng trc y khng c chng nga Tdap, nu Tdap khng c chng nga trong sut thai k. Nn chng nga Tdap c ngay lp tc sau khi sinh.

Lch tim chung cho ph n la tui sinh sn v ph n mang thai khng bit hoc chung nga un vn khng y u hoc ln chung nga cui cng > 10 nm.25

Liu TT hay Td

Ch inh Thi gian bao v

1 Ngaylnugpthaiph(ttnhtlattun27cathaik) Khng

2 tnht4tunsauTT1 1-3nm

3 tnht6thngsauTT2 tnht5nm

4 tnht1nmsauTT3hoctrongthaiktiptheo tnht10nm

5 tnht1nmsauTT4hoctrongthaiktiptheo tuisinhvacthluhn

Cc i tng khng nn tim vaccine un vn hoc nn ch.27

-Btcnginaotngbmtphnngdngedatnhmngsaukhitimmtliu vaccine hoc d ng nng vi bt kthanhphnnaocavaccinethkhngnntimvaccine.

- i vi vaccine cha khng bao ho ga(Tdap): bt c ngi nao c bnh l no(hnmhoccogittrongthigianvaigivakhnghiphcsau24gi)trongvng7ngaysaukhitim1liuTdap,thkhngnn tim Tdap tr khi pht hin nguynnhnkhcngoaivaccine.NhngnginaycthtimTd

Ti liu tham kho

1. Owusu-Darko, S., K. Diouf, and N.M. Nour,Elimination of maternal and neonatal tetanus: a21st-centurychallenge.Rev,2012.5(3-4):p.e151-7.

2. Prevots,D.R.,Neonataltetanus.BullWorldHealthOrgan,1998.76Suppl2:p.135-6.

3. Liu,L.,etal.,Global,regional,andnationalcausesofchildmortality:anupdatedsystematicanalysisfor2010withtimetrendssince2000.Lancet,2012.379(9832):p.2151-61.

4. WHO, Maternal and neonatal tetanus (MNT)elimination. Available on http://www.who.int/immunization/diseases/MNTE_initiative/en/index.html,2012.

5. Ngc,H.T., Bo co kt qu thc hin cng tctim chng m rng, khu vc pha Nam, nm2012, inHingh tngktdn timchngmrngvchng trnhphngchngbnhdikhu

THNG TIN CP NHT


vcphaNam,2012.2012,VinPasteurTPHCM.

6. Demicheli,V.,A.Barale, andA.Rivetti,Vaccinesforwomentopreventneonataltetanus.CochraneDatabaseSystRev,2013.2013(31).

7. Vaccinesforpregnantwomen.NationalnetworkforimmunizationInformation,2009.

8. CDC,Updatedrecommendationsforuseoftetanustoxoid, reduced diphtheria toxoid, and acellularpertussis vaccine (Tdap) in pregnant women--Advisory Committee on Immunization Practices(ACIP),2012.MMWR,2013.62(7):p.131-5.

9. Scott, L. and P. McCormack, Reduced-Antigen,Combined Diphtheria, Tetanus, and AcellularPertussis Vaccine, Adsorbed (Boostrix).BioDrugs,2012.27(1):p.75-81.

10.Booy,R.,etal.,Adecennialboosterdoseofreducedantigen content diphtheria, tetanus, acellularpertussis vaccine (Boostrix) is immunogenic andwell tolerated in adults. Vaccine, 2010. 29(1): p.45-50.

11.Halperin, S.A., et al., Tolerability and antibodyresponse in adolescents and adults revaccinatedwithtetanustoxoid,reduceddiphtheriatoxoid,andacellular pertussis vaccine adsorbed (Tdap) 4-5yearsafterapreviousdose.Vaccine,2011.29(46):p.8459-65.

12.Halperin,S.A.,etal.,Immuneresponsesinadultsto revaccination with a tetanus toxoid, reduceddiphtheria toxoid, and acellular pertussis vaccine10 years after a previous dose. Vaccine, 2012.30(5):p.974-82.

13.Halperin, S.A., et al., How soon after a priortetanus-diphtheria vaccination canonegiveadultformulation tetanus-diphtheria-acellular pertussisvaccine?PediatrInfectDisJ.,2006.25(3):p.195-200.

14.Talbot,E.A.,etal.,Thesafetyof immunizingwithtetanus-diphtheria-acellular pertussis vaccine(Tdap)lessthan2yearsfollowingprevioustetanusvaccination:Experienceduringamassvaccinationcampaign of healthcare personnel during arespiratoryillnessoutbreak.Vaccine,2010.28(50):p.8001-7.

15.Beytout, J., et al., Safety of Tdap-IPV given onemonthafterTd-IPVboosterinhealthyyoungadults:aplacebo-controlledtrial.HumVaccin.,2009.5(5):p.315-21.Epub2009May1.

16.Edsall,G.,etal.,Excessiveuseof tetanustoxoidboosters.Jama.,1967.202(1):p.111-3.

17.Levine, L., J. Ipsen, Jr., andJ.A.McComb,Adultimmunization. Preparation and evaluation ofcombined fluid tetanusanddiphtheria toxoids foradultuse.AmJHyg.,1961.73:p.20-35.

18.Newell, K.W., et al., The use of Toxoid for theprevention of Tetanus neonatorum preliminaryreport of a double-blind controlled field trial. BullWorldHealthOrgan.,1964.30:p.439-44.

19.Hardegree, M.C., et al., Immunization againstneonataltetanusinNewGuinea.BullWorldHealthOrgan.,1970.43(3):p.439-51.

20.Rasmussen,S.A.,etal.,Vaccinesandpregnancy:Past, present, and future. Semin Fetal NeonatalMed,2013.2013(16):p.00123-6.

21.Zheteyeva,Y.A.,etal.,Adverseeventreportsaftertetanus toxoid, reduced diphtheria toxoid, andacellular pertussis vaccines in pregnant women.AmJObstetGynecol,2012.207(1):p.14.

22.Healy, C.M., M.A. Rench, and C.J. Baker,Importance of timing of maternal combinedtetanus,diphtheria,andacellularpertussis(Tdap)immunizationandprotectionofyounginfants.ClinInfectDis,2013.56(4):p.539-44.

23.Kirkland,K.B.,etal.,Kineticsofpertussisimmuneresponsestotetanus-diphtheria-acellularpertussisvaccine inhealth carepersonnel: implications foroutbreak control. Clin Infect Dis., 2009. 49(4): p.584-7.doi:10.1086/603555.

24.Halperin, B.A., et al., Kinetics of the antibodyresponse to tetanus-diphtheria-acellular pertussisvaccine in women of childbearing age andpostpartumwomen.ClinInfectDis,2011.53(9):p.885-92.

25.WHO, Core information for the development ofimmunization policy 2002 update. Available onwww.who.int/reproductivehealth/publications/maternal_perinatal_health/immunization_tetanus.pdf2002.

26.ACOG, Update on immunization and pregnancy:tetanus, diphtheria, and pertussis vaccination.ObstetGynecol,2013.121(6):p.1411-4.

27.CDC, Update: Vaccine Side Effects, AdverseReactions, Contraindications, and PrecautionsRecommendationsof theAdvisoryCommitteeonImmunizationPractices(ACIP).1996.

Cp nht thng tin v chng nga un vn ph n mang thai


Min dch th ng l chuyn khng th c sn t mt c th ny sang mt c th khc, v d min dch th ng t M sang Con. So vi min dch ch ng c to ra do vc xin, min dch th ng c nhng li im nh: tc dng ti ch v nhanh, an ton, c th dng cho mi i tng t tr s sinh ti ngi ln bao gm c ph n mang thai, cho con b v cc bnh nhn b suy gim min dch (tr trng hp mn cm vi cc thnh phn t trng g). Vi nhng thnh tu mi v cng ngh sinh hc, min dch th ng ngy cng c ng dng rng ri trong y hc phng v iu tr bnh, trong khng th IgY ngy cng c gii chuyn mn quan tm nghin cu do c nhiu u th vt tri so vi cc khng th khc.

IgY l gi?

Immunoglobulin Y (vit tt l IgY) l mt dng khng th ch yu thy loi chim v l lp khng th ch yu c trong huyt thanh g v lng trng g, trong khi khng th IgG li thng tm thy ngi v ng vt c v. IgY c cu trc rt ging IgG nhng kch thc phn t ln hn v v mt khng nguyn, IgY c nhiu im ging vi IgA (khng th c nhiu trong ng rut v sa ng vt) hn l IgG.1

Nhng u th cua IgY 1

gia cm, khng th IgY c chc nng tng t nh IgG trn ng vt c v. Nhng so vi IgG, khng th IgY c i lc mnh gp 3-5 ln v c kh nng phn ng nhanh hn trn cng mt khng nguyn. Th nghim trn ng vt gy nhim vi rt cng cho thy tnh hiu qu vt tri ca IgY so vi IgG khng cng loi khng nguyn.Ngoi ra, so vi IgG, khng th IgY c mt s u im sau:- Khng bm vo Fc receptor v khng gy

kch hot h b th ca ngi.- V mt tin ha, do gia cm cch xa ngi

hn ng vt c v nn d dng ch IgY c hiu lc cao khng cc khng nguyn kh tnh.

- IgY c trong khu phn n hng ngy ca ngi nn rt an ton.

- D kim sot iu kin v sinh trong chn nui g m bo c mt sn phm IgY sch. Vic cm s dng khng sinh cho g cc nc tin tin nh Nht Bn l mt v d.2,5

Nhng li im cua vic dng IgY so vi khng sinh 1

- Khng gy khng.- Tc dng chn lc: ch tc ng ln vi khun

gy bnh, khng gy nh hng ti cc vi khun c ch.

- C tc dng trn vi rt.

Khng th IgY c sn xut nh th no?

Khng nguyn ch t vi trng hay vi rt c v hot ha, trn vi cht b th tim

ng dng khng th IgY (Ovalgen) trong phng nga v iu tr bnh Nguyn Vn Sa,* TS.*VinnghincumindchGifu(IRIG-Nhtbn),email:[email protected]

THNG TIN CP NHT


min dch cho g . Vc xin thch hp cho mc ch ny thng dng cng ngh b th nc trong du (water in oil). Sau khi tim min dch, ngi ta kim tra hm lng khng th c hiu trong trng sau thu hoch lng trng, phun sy to bt trng ri tch m, tinh ch ly khng th IgY.1

Nhng sn phm ng dng khng th IgY

Nghin cu ng dng khng th IgY cho vic phng v iu tr bnh trn ngi v gia sc c tin hnh nhiu nm cc nc tin tin. c bit ti Nht Bn, Vin nghin cu min dch Gifu (IRIG) l c s i tin phong v nghin cu ng dng IgY. Sn phm IgY ng dng cng ngh ca vin IRIG c s dng rng ri ti Nht Bn v nhiu nc trn th gii. Ovalgen F - khng th IgY thu c t lng trng g sau khi tim min dch hn hp cc vi rt cm H1N1, H3N2, B v cm gia cm H5N1. Ovalgen F c tc dng khng cc vi rt cm H1N1, H3N2, B v cm gia cm H5N1 v dng trong vin ngm v mng lc trong khu trang gim thiu nguy c nhim cm.1 Ovalgen DC - khng th IgY thu c t lng trng g sau khi tim min dch men glucosyltransferase (Gtase) ca vi khun S. mutans - tc nhn gy bnh su rng. Ovalgen DC c ch s bm dnh ca vi khun S.mutans vo b mt rng, c ch s hnh thnh glucan bi vi khun S.mutans do vy c tc dng phng nga v h tr iu tr su rng, gip rng khe mnh.3Ovalgen PG - khng th IgY thu c t lng trng g sau khi tim min dch men Gingipain ca vi khun P.gingivatis - tc nhn gy bnh vim li, vim nha chu trn ngi. Gingipain l men gy phn hy cc m v t bo, gip P.gingivalis lin kt vi cc vi trng khc trong khoang ming to mng bm trn rng (biofilm), gy vim li v c lin quan ti cc bnh chng khc nh sinh non, bnh tim mch, i tho ng. Ovalgen PG c

ch tc ng ca vi khun P.gingivatis vo li, ngn nga v h tr iu tr vim li.4 Ovalgen DC v Ovalgen PG c s dng trong vin ngm v kem nh rng tng hiu qu phng v tr bnh su rng v vim li, vim nha chu.Ovalgen HP - khng th IgY khng men urease c trn b mt vi trng Helicobacter pylori tc nhn gy vim lot v ung th d dy.6Ovalgen RV - khng th IgY khng rotavirus gy tiu chy tr s sinh.7 Gn y mt nhm nghin cu ti Thy in8 dng IgY iu tr thnh cng mt s bnh nhn mc chng x nang phi mn tnh do Pseudomonas aeruginosa gy ra. Kt qu ny m ra mt kh nng mi cho vic dng IgY iu tr cc bnh mn tnh ng h hp khng p ng vi khng sinh

Ti liu tham kho

1. Rahman S. et al., Human Vaccines&Immunotherapeutics,2013,9:5,1039-1048

2. IkemoriY.etal.,VeterinaryMicrobiology,1997,58:105-111

3. NguyenVSetal.,JADA,2011,142:943-949.

4. YokoyamaK.Etal.,JournalofOralScience,2007,49:201-206.

5. ProceedingsoftheJapaneseSocietyofAgriculturalChemistry,TokyoUniversity2010.

6. Suzuki H et al., Alimentary Pharmacology &Therapeutics2004,20:185-192

7. RahmanSetal.,Vaccine,2012,30:4661-4669.

8. NilssonEetal.,PediatricPulmonology,2008,43:892-899.

ng dng khng th IgY (Ovalgen) trong phng nga v iu tr bnh


Sng lc nhim Human Papillomavirus (HPV) c t cung bng phng php PCR: u im cua vic nhm n vng E6/E7ClinChemLabMed2005;43(11):1171-11772005byWalterdeGruyterBerlinNewYork.DOI10.1515/CCLM.2005.203.

L Quang Thanh,* BS.*BnhvinTD

Tm tt

NhimHPVtpnguyccaolanguynnhncnthitgyungthctcung.PhthinnhimHPVbngkthutPCRlamtphngphpsanglcyhahn.Tuynhin,slachn vng s dng k thut PCR c nghaiviccchin lcsang lcHPVtrnchnonlmsangvaxtrungthctcung.onmiPCRnhmnvngL1hocE1cthkhngngtincyvabstnhiutrnghpbnhtintrin.TrongkhicconminhmtrctipvaovngE6hocE7, y la vngmha cc tc nhngyungth,cachunghnbiv:1)vngL1/E1bmtkhicstchhpADNcavirusvaoADNcakch,trilivngE6/E7khngbaogibmt,ylatintrnhc trng khng th thiu ca din tin tnhimHPVntou;2)trnhtnucleotideE6/E7chothytbinnghn.

M u

Hunh100%bnhung thc tcung ladocctpHPVnguyccaogynn.1,2iunay cho thy phng php tin cy phthin nhimHPVc lin quanngk nchnonva tin lngbnh.CcphngphpthngthngnhthinnayphthinvirutusdngkthutPCR.Tuynhin,cc xt nghimPCR thng ch nhm nvng100-500bpkhuchi,trongkhihgencaHPVti7,9kb,docnhiu

lachnvngkhuchi.Mivngucskhcbitvctnhsinhhcvacimtrnh t,dos lachnvngmctiulathenchtkthutPCRphthinHPVcktqungtincy.Mctiucatngquannaylaxemxtcclachnvalgiinguynnhnmtschinlcphbinhinangsdngcthdnnktqumtnhgi, dnnnhng tcng lm sangkhngphhp.

S tch hp virut

Cac dang vt l ca HPV ADN

BgenHPVcnhiuvngbaogm:vngiuhangcdng(URR),vngkimsotdai(LCR),vnggensm(E1,E2,E6vaE7),vavnggenmun (L1vaL2).3ng thi,cngcnlu lacschnglngiaccvng link:v dnhE6, chng lnmtphnngkviE7(hnh1).

Sauqutrnhnhimbnhcamttbaobiumctcung,chuiADNcaHPVlcuvncntdobntrongtbao,trnghpnaycgiladngbsung.ivinhngtbaonhimtpnguycthp(tp6va11)thADNcaHPVvntiptcduytrdngbsung.3Dngbsungcngbiuhintrongttctrnghpnhimtpnguyc cao gy tn sinh trong biu m c tcungmcthp(CIN1),vathngxuyntrongCIN2vaCIN3.4 Tuynhin,trongccdng tbaoung thc tcung,ADNca

THNG TIN CP NHT


virutthngctchhpvaohgencatbao.3Stchhplatincabinictnh,phttrinungth.2,4,5Linquannsanglc,iuquantrngnhtcnlu,lastchhpdnnmtnhngvngln,thngnhtlaE2vaE1,nhngcngcthlaL1vaL2.iunaytramttrngilnchocckthutPCRclinquannonminhmnnhngvngmathtrabmton.

Hnh1.BgenHPV

Tch hp virut va bnh ung th

TrongtbaoungthbnhimHPV16,cthhindinhaidngbsungvatchhp(3).iviungthctcungchaHPV16,mtnghin cu cho thy44%dng tchhp,44% dng b sung va 11% c c hai dngADNHPV.6Mtnghincukhccngphthin11/25trnghpchcHPVtchhp.7

SlngnhiucaADNHPV16clinquanvistintrinnhanhchngcatnthngCIN.8Trong trng hp caHPV18,ADNHPVc tchhpvakhuchi trongbadngtbao(9).Trong68trnghpungth c t cung, 75%cADNcaHPV16hoc18.10ctnhbanula36-71%cho

dng b sung, 22-39% cho dng tch hp,va6-25%chochaidng(11).Mtphngphp lin quan n real-timePCR csdngsanglctnhtrngtchhpbngcchxcnhtlE2/E6vacththchhpgimsttintrincabnh.8

Tch hp virut va tin ung th

Trongtrnghplonsn,mtbocobanulunstchhpcaADNHPV16trong86%trnghp,nghala,xyratronggiaiontinungth.12TrongccmuCIN,dng tch hp c tm thy trong 3/7trnghpdngtnhviHPV16.10Nhiukhnngstchhplamtctnhcastintrindnnctnh,iunaycnurtrongmtnghincuchothyHPVc tch hp trong 3/100 mu sinh thitCIN, nhng chim n 81% trong s 69trnghpungth.4HPV16laphbinnht(58%),vatrongsnay,72%ctchhpva27%chladngADNHPVbsung.Trongs cc trng hp c dng tch hp, 80%chladngADNcaviruthindintrongtbao,vach20%cchaidngbsungvatchhp.MtnghincugnychothyHPVtchhp(chyulaHPV16)trong80%trnghpCIN3,63%trnghpCIN2va36% trng hp CIN1.13 S vngmt cadngbsung(ngha la tchhpy)la36%,25%va7%tngngvitnggiaion.Tlcadngtchhpsovibsungkhngkhcnhautrongtnggiaion,cngnhtilngvirut.13

Tch hp ca HPV16 so vi HPV18

Trongnghincunitrn,1151trnghpung thc tcungcHPV16,71%chcdngtchhp,20%ccdngtchhpvabsung,va10%chcdngbsung,trongkhittc17trnghpungthchaHPV18chcdngtchhp.SkhcbitnayladoctnhtintrinmnhvanhanhcachnglonsnlinquannHPV18,vadortthchhpvixtnghimsanglc.Tngt

THNG TIN CP NHT


nhvy,ccnghincukhcchothytrong23trnghpungthcHPV18,hiulcbin i ln hn, tt c cADNHPV tchhp,vichmttrnghpccADNdngbsung.4

Vi tr gen tch hp

TchhplinquannstoncaADNHPVvalammtmtphncabgen.Quanstbanuvccdngtbaoungthctcungchothycsmton2-3kbtrongbaogmccvngE2nL2.9iuquantrnglacssaochpE6-E7trongcctbao.Ngi tacnphthinc lakhungcm(ORF)E1,E2,E4vaE5bginondoADNtbaochbxmnhp,chothynhngvtrnaychnhlaccvtrtchhp.14mRNAHPVbiuhinslaiviondchotoanbORFE6vaE7vamtphnnhORFE1,iunaychothyylanhngphnchindincagenHPV.Khngphthin c s lai ORF L1 va L2, cho thyccvngnaybtonhockhngcncsaochp.Tngtnhvy,trongmtnghincuvsumuungthctcung,vngE6/E7cthyvngidngtchhp,nhngvngE2bmt.15E2, cngnhhuhtE1,cngbmtontrongungthctcungcchaADNHPV16.16

Trongmtnghincubndngv tnhcADNHPV16tchhpvamtontrongccvngE1/E2vaL1/L2,khngv tr tchhpchiunaohindintronggiitrnhtvirut.17TchhpbgencavirutvaoADNcanhimscthngicctbaoungththngphvhoclammtonORFE2,dnnsmtbiuhincagenE2,nhnglitiptccbiuhincaocaE6vaE7.18

Vi tr gen i vi t bin

MtchinlcsanglcHPVkhcbngPCRlanhmncctbincaADNHPVxyratrongvngL1cabgenHPV,nhngtbinnayctnsutthphnsovivngE6.iunaycthnhhngntrungthc

caonmiPCRvadonhhngnkhnngphthinshindincaHPV.

Ti sao tch hp xy ra?

StchhpcaADNHPV16dnntngmRNA trng thinnhvamhaccgencavirutsinhungE6vaE7.19iunaysechim,tnhtmtphn,nngproteinE6vaE7caohnccqunthviADNHPV16 tch hp so vi cc qun th trongADNchhindindngbsung.18Do,cc tbaoviADNtchhppht trinnhanhhncc tbaochcADNHPVbsung, ngha la, s tch hp em li li thtngtrng.18

ProteincaE6linktp53lamtchtcchquantrngcachuktbao,vakhibtchhpADNHPVlamchonbbthot,dnnhintngtbaotngtrngkhngkimsotc.ylacssinhhcchosphtsinhungth.Trongungthctcung,vnsinhunglavngE6vaE7.Phncnlicabgencthcvaitrtrongslytruynvirutvaotbaomicakch,nhnggyrabnhungthlaproteincmhabiE6vaE7.StchhpcaADNHPVxyrasmtrongqutrnhphttrinungthvangvaitrquantrngnhcchkchhotstintrinttinungthsangungth.2,4,5

Phng php pht hin HPV bng PCR

PCR lin ng L1

PhngthcnaycngcgilaonmilinngnhmvaovngcbotncaoL1cabgenHPV.TphponmilinngbaogmccchthngvaoccphnkhcnhaucavngL1.3

CngcphngphpPCRmakhuchiADNtrongvngcbotnE1bngcchsdng2onmi.3

Sng lc nhim Human Papillomavirus (HPV) c t cung bng phng php PCR


Cach tip cn gc E6

Chin lcPCRnay hng vao vngmctiu gy ung th la E6, E7,3 bi v vngnaycnhngkhcbitlnnhttrongtrnht nucleotide gia cc tpHPV khc nhauvaluncgilicctbaobnhim.PhngphpnaykhngchxcnhHPVdng tnh,macnphnbitccc tpHPVnguy c t caon thp, v d, bngcch to ra sn phm PCR khc nhau vkch thc i vi cc tp c nguy c caohaythphocbngcchsdngccchinlc real-timePCR.nh lng bng real-timePCRc thcungcp tt ccc thngtin quan trng v lng virus vi nghatinlng.20VicphnnhmHPVdatrnstngngvtrnhtgiaccvngE6caHPVtngng,3 bngcchsdngcconmichiutheonhmnguyc.Gitrcaphngphpnaycxcnhn3 vacungcpmtphngtintrctipthucccloithngtincnthitchovicraquyt nh lm sang. Tt c cc loi HPVchyuhinnaycbit,doonmithchhphngvaovngE6/E7thucccloikhcnhau,vackhnngchobitliungiphncbnhimHPVnguyccaohaykhng,ng thic thc tnghpvaddang tchhpvaocngmtngphnng.Vicsdngcconminhmvao vngE6/E7 lam cho c hi b st lynhimkhxyra.Chiphcngthphn,docntbchn.Do,xtnghimE6ngtincyhnngdngsanglcrngrisoviphngthctipcnL1.Hnna,qutrnhnaychothylabtkxtnghimHPVnaocngchnnphthintpHPVnguyccao.3ChonlcnayctnhtmtbPCRthngmihngvaovngE6/E7cphttrin.3

Cac nghin cu so sanh oan mi L1 va E6

LithcavicnhmnvngE1hocL1lackhnngphthincnhiu,cthlattc,cctpHPV.Btlichyumac

lekhngxyralanuviruschhindinduynhtdngtchhp,thctxyranhiubtthngtintrin.Nhvy,chcaPCRcthkhnghindinccvngkhcngoaiE6vaE7.Mtkhc,vichngvaoccvngE6E7sephthin ttcccmu nhim HPV nguy c cao, min la csdngonmi cho tt c cc loiHPVlinquan.Phngphpphthinnhhngmnhmen t lphthinHPVcnhnmnhtrongmtnghincuvungthhumn,trongngitathyrngphngphptnhycmnhtphthinHPVlaPCR s dng onmi lin ng L1 (t l16%),trongkhionmichiutheotpnhmvaovngE6mangliktqudngtnhti46%.21

PCR L1 c th pht hin phn ln cctrnghpcccloiHPVnguycthp6hoc11,nhngcthnhgikhngngmcsnhimHPVtpnguyccao16hoc18.PhnmnhcamuADNtrongccmc nh bng formalin c kho st.21 GiithchhplhnccholadosmtADNgenHPVsaukhitchhp,cthlasmtoncaL1vaL2.21SmtsaochptccvngnaycchngminhtrongcctbaobnhimHPV16.21

TringcviL1,ivimtloiHPVnht nh, cc genE6 vaE7 c bo tncao,17,21vadosnhimHPVvthcthcphthinhuhtcctrnghpcshindincaADNvirus.21

Trongmtnghincutoandingiiquytvn nay,mt lot cc b onmi linngcthnghim,kccconmihng vao cc phn khc nhau ca vngL1.3Bng cchkim tra vi tt c cc cpmi,cngnhonmihngvaovngE6hocE7,98%trongs355musinhthittccbnhnhnung thc tcungxm lncphthindngtnhviHPV.Tuynhin,vicsdngchmtbmichothytlphthinthphnnhiu.Thtth

THNG TIN CP NHT


vkhilurngonmichiutheotp(HPV11,16,18,31,33va35)phthinbnhnhnnhimHPVnhiu hn so vi bmilinngnhycmnht.Hnna,da trnktqusdngonmi linng,smtonL1hindin23trongs56(41%)mu.CcdliutranhlunmnhmechnglitincycavicsdngduynhtmtonmilinngL1.

Trongccnghincukhc,baogm635[43622)va19923)]muungthctcungtTyBanNha,Columbia,vaBrazil,HPVchcphthin85%mukhisdngchmtbonmi linng.C sngthunlavicsdngmttronghaiphngphpMY-PCRhocGP+-PCRsenhgithpsutthcscaHPVtrongccmuctcung.3

ThnghimsosnhE7vionmighpcitinL1(MY11/GP6+vaGP5+/GP6+)trong152muchothythnghimE7cnhyvatlphthincaohn(24).Cctcgicngchrarnghuhtcctrnghpung th c t cungdng tnhviHPV18chchaADNHPVtchhp.4,17MttrongsnhngnguynnhncbncamtnhgiladomtonhoctchhpnhhngncctrnhtL1vaE1,vasginontrongvng L1 xy ra thng xuyn hn i viHPV18sovinhiuloiHPVkhc.1,2Trongmt nghin cu gm 69.290mu, s thiukhuchi ttccc tpHPVkhisdngphng php MY09/11 khin cc tc giphithliccmuxtnghimmtnhbngPCRnhmnvngE7chiutheotp.25 Trongcctpcxtnghim,phngphpnaychothyHPV51laloithnggpnhtkhng c pht hin bng on mi linng (72%), tip theo la cc loi 39 (12%),18va35(7%)va66(3%).CngvisthiutnhchiuiviccloiHPVnhtnh,26cctcginaycholasmtL1dotchhp (1) lamtkhnngc thxy ra,cbitiviHPV18.

Viccbngchngnutrn,dngnhs dng on mi hng vao vng E6/E7cattccctpHPVnguyccaothnggplachinlcchnonchnhxcnht.

kin chuyn gia

Mcdccbngchngchothyrngstchhpcthlamtbcquantrngtrongqutrnhtintrinnctnh,chnhdostchhpmaikhicthtrathchthciviphngphptipcnPCRclinquannonmihngvaovngL1.iunaylamtngslolngvvicbstHPVbngphngphpPCRnuonmianghngvaovngtbinhocbinikhc,ngayckhivngnaykhngbmton.Cnghala,csmtonvacctbintravncnxemxtnghimtckhinhmnvngL1viphngphpPCRlinng.Trili,iunaytckhnngxyraivivngE6 hocE7.ng thi cc v tr cha tbincbitlamgiatngtimnnggyungthcnctrnhkhithitkonmi.Trong thc t,mi loiHPVnhtnhuctrnhtADNE6/E7ring.3iunayrtcngha,bivonmichiuhngvaovngE6ckhnnglaihalnhnrtnhiusovionmilinnghngnvngL1.nghacanhngphthinnayla trongkhisang lcnhngphnbCINcthsephthinhuhtnhimHPVkhionmiL1csdngchoPCR,nhngmtsphnctnthngtintrinhncthbbstvsmtL1trongqutrnhtchhp.cbitlanhngphnrtcncchnonchnhxc,vnhucuiutrcahlnhnvagphn.

Mtvnkhphbinlacconmithoibincsdngkhuchitrnh tL1khngphi100%ng tin cy,dosbinitrnhtnhiuhnvngnaycabgenHPVkhisoviE6,vadocthkhnglaihahocdnnmisai.Mtkhc,doscocaE6giacctpHPV



khcnhaunnvicphthinHPVbngonmiE6ihiphngphpPCRchiuchotngtpHPV,vvylamtngthmkhilngcngvicvachiph.DokhnngmtL1,cvhplhnkhisdngutaycconmihngvaovngE6/E7.

Nhvy,tnhlintccaccdngADNHPVlactht.DngbsungcxuhngidinchosnhimHPVsmhocCIN1,va, vi s tin trin n ung th, tn sutHPV tchhp tng ln.Vicxcnh t lcamidngc thidinchomtnhhngbanungiaioncabnhctcungdoHPVgyra.Hnna,dovngE6/E7cbo tnva ccvngL1/E2 cxuhngbmtonkhibnhtintrin,vicnh lng tngi ca biu hinE6va/hocE7vabiuhinL1va/hocE2cthgipara:

-nhgivgiaioncabnhdoHPV;

-nhginguyccabnhdoHPVphnbnhim;

-CchthcphnloihocphngiaionphnbnhimHPV,nhngkhngbbnhdoHPV,vaonhmnguychocnhmkhngcnguyctintrinthanhbnh.

Tuynhin,do37-71%ungthctcungcADNHPVdngbsung,vicphthinnhimHPVdaidngcthquantrnghnvicphthin tchhpADNHPVnhginguychocgiaioncabnhdoHPVphnbnhim.

Trin vng

Vic pht hin HPV ngay cang c chpnhnrngriladongtincyhnsovixtnghimtbaohc(Papanicolaousmearphttbaoctcung)trongsanglcungthctcung.KtkhiPCRccpbngsng ch vao ngay 28 thng 3 nm 2005,theo phm vi bo h bng sng ch vngHPVE6tiHoaKvachuunm2008,vatoanbbgenHPVtictrongcngmt

nm,vicsdngPCRtrongquy trnhxtnghimchnonlmsangphttrinkhnhanh.Tc,chnhxc,tincy,khnngcchpnhn,squenthucvachiphthpcaHPVPCRgipntrthanhmtphngtinchnhtrongsanglcungthctcungnhktrongvngvainm.Trnthc t,nhyvagi tr tinonc thtng ng vi tiu chun vang la soi ctcung.3tciunay,quan trnglachinlcsdngPCRngtincynhttrnlmsangnncthngqua.

im ni bt

Ccchin lcPCRHPVhngnvngE6/E7cthlacachunghnsoviL1donhngnguynnhnsau:

-E6vaE7laccvngsinhungcaHPV;

-E6vaE7cbotnsaukhinhimbnh,trongkhiE2vaL1cthbmton;

-E6vaE7chothykhnngbotntrnhtmnhme,khnggingccvngkhcvdnhL1;

-Sngnhtca trnh tE6ivimitpHPVsetckhnngxyrasghpsaionmitrongPCR;

-TrnhtE6/E7khcnhaugiacctpHPVnguyccaovanguycthp,dotoraskhcbitchnonbngcchsdngPCRxtnghim;

-ViclachntngthE6/E7cthmanglilachntiuchoPCR

Ti liu tham kho

1. WalboomersJM,JacobsMV,ManosMM,BoschF,KummerJA,ShahKV,etal.Humanpapillomavirusis a necessary cause of invasive cervical cancerworldwide.JPathol1999;189:129.

2. Bosch FX, Manos MM, Munoz M, Sherman M,JansenAM, Peto J, et al. Prevalence of humanpapillomavirus in cervical cancer: a worldwideperspective.JNatlCancerInst1995;87:796802.

3. Morris BJ. Cervical human papillomavirusscreeningbyPCR:advantagesoftargetingtheE6/E7region.ClinChemLabMed2005;43(11):1171

THNG TIN CP NHT


1177

4. Cullen AP, Reid R, Campion M, Lorincz A.Analysis of the physical state of different humanpapillomavirusDNAsinintraepithelialandinvasivecervicalneoplasms.JVirol1991;65:60612.

5. VernonDD,UngerER,MillerDL,LeeDR,ReevesWC. Association of human papillomavirus type16 integration in theE2 genewith poor disease-free survival from cervical cancer. Int J Cancer1997;74:506.

6. YiuKC,HuangDP,ChanMK,FooW.Thephysicalstate of human papillomavirus type 16 DNA incervical carcinomas of Hong Kong Chinese.Oncogene1991;6:133942.

7. WattsKJ,ThompsonCH,CossartYE,RoseBR.Sequence variation and physical state of humanpapillomavirus type 16 cervical cancer isolatesfromAustralia and New Caledonia. Int J Cancer2002;97:86874.

8. Peitsaro P, Johansson B, Syrjanen S. Integratedhumanpapillomavirus type16 is frequently foundincervicalcancerprecursorsasdemonstratedbyanovelquantitativereal-timePCRtechnique.JClinMicrobiol2002;40:88691.

9. Schwarz E, Freese U, Gissmann L, Mayer W,Roggenbuck B, StremlauA, et al. Structure andtranscription of human papillomavirus sequencesincervicalcarcinomacells.Nature1985;314:11114.

10.Fukushima M, Yamakawa Y, Shimano S,HashimotoM,SawadaY,FujinagaK.Thephysicalstateofhumanpapillomavirus16DNAincervicalcarcinoma and cervical intraepithelial neoplasia.Cancer1990;66:215561.

11.Park JS, Hwang ES, Park SN,AhnHK, UmSJ,KimCJ, et al. Physical status and expression ofHPV genes in cervical cancers. Gynecol Oncol1997;65:1219.

12.PfisterH,FuchsPG.Relationofpapillomavirusesto anogenital cancer. Dermatol Clin 1991;9:26776.

13.AnderssonS,SafariH,MintsM,Lewensohn-FuchsI, Gyllensten U, Johansson B. Type distribution,viralloadandintegrationstatusofhigh-riskhumanpapillomaviruses in pre-stages of cervical cancer(CIN).BrJCancer2005;92:2195200.

14.ShirasawaH,TomitaY,SekiyaS,TakamizawaH,Simizu B. Integration and transcription of humanpapillomavirus type 16 and 18 sequences in celllinesderivedfromcervicalcarcinomas.JGenVirol1987;68:58391.

15.ChooKV,PanCC,HanSH.Integrationofhumanpapillomavirustype16intocellularDNAofcervicalcarcinoma: preferential deletion of the E2 geneand invariableretentionof the longcontrol region

and the E6/E7 open reading frames. Virology1987;161:25961.

16.Matsukura T, Kanda T, Furuno A, Yoshikawa H,Kawana T, Yoshiike K. Cloning of monomerichuman papillomavirus type 16 DNA integratedwithincellDNAfromacervicalcarcinoma.JVirol1986;58:97982.

17.WagatsumaM,HashimotoK,MatsukuraT.Analysisofintegratedhumanpapillomavirustype16DNAincervical cancers: amplification of viral sequencestogether with cellular flanking sequences. J Virol1990;64:81321.

18.Jeon S, Allen-Hoffmann BL, Lambert PF.Integration of human papillomavirus type 16 intothe human genome correlates with a selectivegrowthadvantageof cells. JVirol1995;69:298997.

19.Jeon S, Lambert PF. Integration of humanpapillomavirus type 16 DNA into the humangenomeleadstoincreasedstabilityofE6andE7mRNAs: implications for cervical carcinogenesis.ProcNatlAcadSciUSA1995;92:16548.

20.Schlecht NF, Trevisan A, Duarte-Franco E,RohanTE, FerenczyA,Villa LL, et al. Viral loadasapredictorof theriskofcervical intraepithelialneoplasia.IntJCancer2003;103:51924.

21.NoffsingerAE,SuzukL,HuiYZ,GalAA,Fenoglio-Preiser CM. Differential sensitivities of E6 type-specificandL1consensusprimersinthedetectionof human papillomavirus in anal carcinoma.ModPathol1995;8:50914.

22.Munoz N, Bosch FX, de Sanjose S, Tafur L,IzarzugazaI,GiliM,etal.Thecausallinkbetweenhumanpapillomavirusandinvasivecervicalcancer:apopulation-basedcase-controlstudyinColombiaandSpain.IntJCancer1992;52:7439.

23.Eluf-NetoJ,BoothM,MunozN,BoschFX,MeijerCJ, Walboomers JM. Human papillomavirus andinvasive cervical cancer in Brazil. Br J Cancer1994;69:1149.

24.Huang L-W, Chao S-L, Chen P-H, Chou H-P.Multiple HPV genotypes in cervical carcinomas:improved DNA detection and typing in archivaltissues.JClinVirol2004;29:2716.

25.Depuydt CE, Vereecken AJ, Salembier GM,VanbrabantAS,BoelsLA,vanHerckE,etal.Thin-layer liquid-based cervical cytology and PCR fordetectingandtypinghumanpapillomavirusDNAinFlemishwomen.BrJCancer2003;88:5606.

26.Gravitt PE, Peyton CL, Alessi TQ, WheelerCM, Coutlee F, Hildesheim A, et al. Improvedamplificationofgenitalhumanpapillomaviruses.JClinMicrobiol2000;38:35761.



Metoclopramid an ton trong thai k

Bjorn Pasternak et al.

Ph n c iu tr bng metoclopramide chng nn khi mang thai khng c nguy c tng kt qu bt li nh sy thai, thai cht lu, v tr d tt bm sinh, theo kt qu t mt nghin cu mi t an Mch. Nghin cu c cng b trn s ra ngy 16 thng 10 ca JAMA.Metoclopramide, mt loi thuc thng c s dng cho iu tr chng bun nn v nn trong thai k, c cho l an ton, nhng thng tin v nguy c d tt c th v thai lu cha y , cc tc gi lu y rng hu ht ph n b bun nn v nn khi mang thai c th c iu tr vi nhiu phng php. Tuy nhin 10% n 15% cn phi c iu tr bng thuc. iu tr u tin bng thuc khng histamin v vitamin B6, nhng nu cc la chn tht bi, metoclopramide thng l s la chn tip theo. Cc nghin cu trc y c mu nghin cu tng i nh tm thy khng c vn khi s dng metoclopramide trong thai k iu ny cng cho thy metoclopramide khng lm tng nguy c d tt bm sinh. Tuy nhin v nghin cu nh nn khng mnh iu tra nguy c t vong ca thai nhi lin quan n tip xc vi metoclopramide trong thai k. Tin s Pasternak v cc ng nghip trong Khoa Dch t hc nghin cu thuc vin Statens Serum Institut, Copenhagen, an Mch thc hin mt nghin cu cn c vo d liu quc gia bao gm sc khe ton quc 1997-2011 ghi nhn c 1,2 triu ca mang thai v kt thc thai k trn cc ph n mang thai c s dng metoclopramide so vi nhng ngi khng dng.

Kt qu khng thy c lin h gia s dng metoclopramide v d tt bm sinh (t l nguy c 0,93, khong tin cy 95%, 0,86-1,02) trong nghin cu thun tp c i chng. Trong s 28.486 ph n dng metoclopramide trong tam c nguyt u tin ca thai k, sanh 721 tr c d tt bm sinh ln, chim t l 25,3/1.000 trng hp sanh (khong tin cy 95%, 24,5-27,1). Nhm i chng gm nhng ph n khng ung thuc cng cng sanh tr d tt c t l tng ng, c 3.024 tr d tt trn 113.698 ph n khng dng thuc chim t l 26,6/1.000 ca sanh. Hn na, cc nh iu tra khng tm thy bng chng cho thy metoclopramide c lin kt vi bt k ca 20 phn loi ca d tt, bao gm c cc khuyt tt ng thn kinh, chuyn v ca cc mch mu ln, khuyt tt thng lin tht, thng lin nh, t chng Fallot, coarctation ca ng mch ch, h mi, h hm ch, hp hu mn/trc trng, v thiu chi. Nghin cu cng cho thy khng c mi lin h gia vic s dng ca thuc metoclopramide v gia tng nguy c sy thai, sinh non, nh cn, cc vn pht trin ca thai, hoc thai cht lu. Cc tc gi kt lun iu tr chng nn i bng metoclopramide c coi l an ton trong thai k. Nghin cu ny c h tr ca Hi ng nghin cu y t ca an Mch

JAMA. 2013; 310:1601-1611.Lc dch BS.Phan Vn Quyn

Thng tin y hc


iu tr progesterone d phng sm trong thai k gim t l sanh non

Markham et al.

Nhm nh gi tr liu d phng progesterone nh hng n t l sinh non t nhin ti pht ph n mang thai c tin s sinh non trc . Mt nghin cu thun tp hi cu c thc hin nh gi kt qu ca ph n mang thai vi mt hoc nhiu ln sinh non trc c chm sc trc khi sinh ti mt phng khm sanh non duy nht. iu tr d phng bng progesterone c thc hin t nm 2004 ti 2008. T l sinh non trc 37, 35, v 32 tun ca thai k c so snh theo thi gian. D liu thu thp trn 1.066 ph n c tin s sinh non t nhin mt hoc nhiu ln c chm sc trong khoa sinh non v sanh trong khong ngy 01 thng 1 nm 1998 n ngy 30 thng 6 nm 2012. Tui thai lc bt u iu tr d phng progesterone trc khi sanh gim ng k sau khi thng qua mt qu trnh hn khm thai sm hn (trung bnh 19,1 tun trc nm 2003, 16,2 tun t nm 2004-2007, v 15,2 tun t nm 2008-2012, P < 0,01), v s dng progesterone gia tng t 50,8% sn ph trong 2004-2007 n 80,3% sau nm 2008 (P < 0,01). Sau khi iu chnh d liu v c im dch t gm chng tc, ht thuc, c khu c t cung, v s ln sinh non trc, cc tc gi ghi nhn c gim t l sinh non t nhin c y ngha thng k trong nhng nm 2008-2012 so vi 1998-2007, trc 37 tun (c hiu chnh [OR] 0,75, 95% khong tin cy [CI] 0,58-0,97) v 35 tun (c hiu chnh OR 0,70, 95% CI (0,52-0,94) tun tui thai.

Kt lun: vi iu tr d phng progesterone sm trong thai k gim t l sinh non ti pht trc 37 hoc 35 tun tui thai

Obstetrics & Gynecology: January 2014 - Volume 123 - Issue 1 - p 3439Lc dch BS.Phan Vn Quyn

Ph n iu tr CIN III c nguy c b ung th c t cung v m o khi tui gi

Bjrn Strander et al.

Ph n iu tr tn sinh trong biu m c t cung III (CIN III) c nguy c gia tng ung th xm ln sau tui 60, c bit l nu vic iu tr mi gn y, theo mt nghin cu da trn dn s Thy in ca Tin s Bjrn Strander v cng s t Trung tm ung th khu vc ti Bnh vin i hc Sahlgrenska ti Gteborg, Thy in cng b ngy 14 thng 1 trong BMJ. Pht hin ny cho thy rng ph n c iu tr CIN III cn phi c theo di trong mt thi gian di. Cc tc gi phn tch gi tr hn 3 triu ph n - nm trn d liu thu thp trong mt khong 50 nm t ph n b CIN III. H pht hin ra rng nguy c mc bnh ung th c t cung hoc m o 2,39 ln cao hn ph n b CIN III so vi dn s chung (95 % khong tin cy [CI], 2,26-2,53), v nguy c t vong l 2,35 l

sức khoẻ sinh sản, tập 4 số 1

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