Đánh giá mối liên quan giữa triệu chứng lâm sàng, hình ảnh nội soi, mô bệnh học, HP và PH dịch vị của bệnh lý dạ dày - tá tràng trên bệnh nhân xơ gan

•At^ hi

DANH GIA MOI LIEN QUAN GIlTA TRIEU CHUfNG LAM SANG, HINH ANH NQI SOI.

MO DENH HOC, HP VA PH DjCH Vj CUA DENH LY DA DAY - TA TRANG

TREN BENH NHAN XO GAN

TOMTAT :

Nghien ciru nay nhim muc tieu khao sat moi lien

quan giUa cae ton thirong da day - ta trang qua ngi soi

tren bgnh nhan xa gan vai chi so Child - Pugh, gdp

phan theo ddi, tien lirgng bgnh. Qua so sanh trigu ehdng

lam sang, hinh anh ndi soi, md bgnh hge, HP va pH djch

vj vdi giai doan ton thuang theo Child-Pugh tren 40 benh

nhan xa gan cd viem va/hoae loet da day, ta trang, cae

tie gia eho thay: Cae trigu chieng lam sang thuang gap

cua viem loet da day, ta trang a bgnh nhan xa gan la :

dau thugng vj (77,50%,): con cao, ndng rat thugng vj

(37,50%,). Cac trigu ehung ca nang nay tang ten theo

muc dg ngng eua xa gan theo ehi so Child-Pugh vdi

p<0,05.

Tren hinh anh ngi sol: cae typ ton thuang viem, hinh

anh ton thuang vi the dg day, ty lg nhiem HP va dg pH

djch vj khdng cd mdi Hen quan vol ehi so Child-Pugh, vai

p > 0,05.

Tie khoa: ton thieang da day - ti trang, ehi so Child -

Pugh,xa gan.

SUMMARY

This study aims at surveying the relationship

between gaster-duodenum injury by endoscopy images

of interstitial hepatitis patients with Child-Pugh,

contributing to monitor and foresee diseases. By

comparision clinic symptoms, endoscopy images,

pathologic histology, HP and pH gastricjuice in Injury

period according to Child-Pugh index of 40 interstitial

hepatitis patients with infamed and/or ulcerative gaster￾duodenum, the authors have found that:

1. Clinic symptoms of Inflamed and ulcerative gaster￾duodenum occur frequently in interstitial hepatitis

patients are: upper abdominal pain (77.50%,): metus

(62.50%,): feeling of disturbing and buming in the upper

abdomen (37.50%). These mechanical energy

symptoms will increase according to serious level of

interstitial hepatitis according to Child-Pugh index with

p<0.05.

2. In endoscopy Images : Inflamed Injury types,

microsome gastritis injury Images, HP infection rate and

pH gastric juice do not relate to Child-Pugh index, with

p>0.05%.

Keywords: hepatitis, Child-Pugh, endoscopy images.

OAT VAN DE

Xo gan la mpt trong nhi/ng bpnh ly tieu hoa man tinh

CO ty Ip tu' vong cao bdi cho di n nay vi n ehua cd

phuong phap dilu tri d$c hipu. De danh gia chCre nang

t l bao gan va tien lugng bpnh xa gan dugc giai phiu

lam giam ap lyc tTnh mgeh eCra, nam 1964, Child va

Turcotte d l xuit mpt bang phan loai va din nam 1972,

Pugh da bd xung, thay chi tieu tinh trang dinh duong

bang iy le prothrombin. Bang phan loai Child - Pugh d l

MEN SARIN, BUI NGUYEN KIEM

TRAN VIET TU

thue hipn tren lam sang va kha chinh xac nen duge su'

dyng rdng rai d nudc ta eung nhu tren the gidi [2].

Viem, loet da day ta trang la benh thUdng gSp d Viet

Nam cung nhu cac nude khae tren the gidi [3]. Theo

thdng ke cua Td chCre Y t l Th l gidi, cd khoang 5-6%

dan sd ndi chung mac benh [2]. Tu lau, cac nha khoa

hpe da nhan thiy ty le tdn thuong da day - ta trang d

bpnh nhan xo gan eao hon hin so vdi ngudi khdng xo

gan [4].

Theo mpt sd tae gia, xo gan se di n di n suy giam

cac yl u td bao vp va tang eae yl u td pha huy da day.

Su suy giam cac yl u td bao vp do gan giam tdng hgp

glycoprotein (chit nhiy trong hang rao bao vp niem mac

da day), giam sinh tdng hgp Prostaglandin, lam giam

ddng mau din niem mac da day va cudi eung lam giam

su d l khang niem mac [1]. Tang cae yl u td pha huy

niem mpc dp day do tang gastrin thu' ptiat. Su gia tang

gastrin se di n di n tang kieh thich t l bao thanh tilt acid

ehlorhydric, lam tang qua trinh pha huy niem mac da

day, ta trang, lam xuit hien cac tdn thuong viem loet [1].

Tuy nhien, mdi lien quan giu'a xa gan va bpnh ly da

day - ta trang nhu th l nao, dang la vi n d l dugc eae

nha khoa hpe trong va ngoai nude quan tam nghien

cuu. Nghien cufu nay nham muc tieu khao sat mdi lien

quan giO'a eae tdn thuang da day - ta trang qua npi soi

tren bpnh nhan xo gan vdi ehi sd Child - Pugh, gdp

phin theo doi, tien lugng benh. Muc tieu nghien eCru :

Danh gia mil lien quan giira trigu chimg lam sang,

hinh anh ngi sol, md benh hgc, pH djch vj va HP eua

bgnh ly dg day- ta trang vdi chi so Child-Pugh d bgnh

nhan xagan.

DOI TUONG vA PHUONG PHA P NGHIEN CLfU

1. Doi tUdng nghien cifu

Gdm 40 benh nhan dupe chan doan xac djnh xa gan

dilu tri npi tru tai Khoa AM I Bpnh vien 103. Sau dd

dugc chin doan viem va/hoac loet da day, ta trang bang

phUdng phap ndi soi tai Khoa Tieu hoa

Thdi gian tuf thang 5/2007 de'n thang 5/2008.

2. PhUdng phap nghien cifu

2.1. Phuong phap nghien eCfu : md ta cat ngang.

2.2. Tieu ehuan chpn benh nhan :

+ Tieu chuan chin doan xo gan : Theo 5 ehi tieu

danh gia chCre nang gan eua Child-Pugh.

+ Tieu chuan ehin doan viem va/hoac loet da day, ta

trang : Cd tdn thuang viem va/hope loet da day, ta trang

dugc xac djnh qua npi soi da day dng mem va md bpnh

hpe bang sinh thilt theo Hp thdng Sydney.

+ Chi tieu danh gia dp pH djch vj : Binh thudng : pH

1,5-3; Tang toan : pH < 1,5; Thilu toan : pH > 3.

+ Chi tieu danh gia nhilm HP tren md tJenh hpc vung

sinh thilt duge nhupm Giem sa : Nhilm nhe : (+) < 25 vi

Y HOC THVC HANH (667) - SO 7/2009 73