Một số biểu hiện lâm sàng xương khớp của bệnh nhân được chuẩn đoán HIV tại khoa cơ xương khớp, bệnh viện bạch mai (2008 - 2010)

MOT SO BIEU HIEN LAM SANG XUONG KHOTP CUA BENH NHAN DUUC CHAN DOAN HIV

TAI KHOA CO XUONG KHGTP, BENH VIEN BACH MAI (2008-2010)

TOM TAT

Mijc tieu: Khao sat cac bleu hipn lam sing ca xuong

khap cua bpnh nhin dtrgc chin doin HIV tpi khoa khap

Benh vipn Bach Mal.

Doi tirgng vi phuong phip nghien ciru: Xic djnh cac

tripu chung lim sing xuong khap va cic bpnh xuong

kh&p ciia 12 bpnh nhin tin dau tien dtrgc chin doin

HIV den kham vi dieu tri tpi khoa Ca Xtrang khap bpnh

vipn bpch mal trong th&i gian 2 nam tir 2008-2010

Kit qua: Khao sit 12 bpnh nhan HIV dtrang tinh (10

nam, 2 nir vol tuoi tmng binh 26,5+4) cho thay ciC bleu

hipn lam sang hay gap la dau xuong kh&p 6/12 (50%),

viem mang hopt djch kh&p goi, kh&p co chin 6/12 (50%),

dau cgt song thit lung 5/12 (41,6%). Bpnh ly kh&p hay

gap li bpnh ly cgt song khdng xic dinh 6/12 (50%),

nhiim khuan kh&p vi phan mim 5/12 (41,6%)

Kit lupn: Bpnh ly cgt song khdng xic djnh li bpnh

kh&p hay gap nhit & bpnh nhan HIV duong tinh.

Tir khoi: bpnh kh&p, HIV, bpnh ly cgt song khdng

xac dinh.

SUMMARY

Objective: To study the clinical spectmm of

rheumatic diseases in HIV positive patients

Methods: 12 patients refered with rheumatologycal

manifestations, who were positive HIV diagnosed in

Rheumatology department Bach mai Hospital from 2008

to 2010 were analyzed retrospectively regarding clinical

features.

Results: There were 10 male and 2 female, with

mean age was 26.5+4 years. Arthritis was found In 6/12

(50%), synovitis (knee and ankle) in 6/12 (50%), low

back pain 5/12 (41.6%). Undifferentiated

spondyloathropathy was diagnosed in 6/12 (50%), septic

arthritis In 5/12 (41.6%)

Conclusions: Undifferentiated spondyloarthropathy Is

a common rheumatic manifestation in HIV positive

patients

Keywords; arthritis, HIV, undifferentiated

spondyloarthropathy.

DAT VA N D £

Co hon 50% b?nh nhdn du-pc chan dodn vd dieu trj

HIV CO bieu hipn benh ly co xu-ong nhu viem khop

nhiem khuan, hpi chirng Reiter, viem khdp vay nen,

benh ly eo....[1, 3, 5, 6). Tuy nhien nhij-ng trieu chirng

eo xu-ong khop d bpnh nhdn nhilm virus HIV nhu'ng

chu'a du'pc chan dodn HIV \p\ bilu hipn vdi nhieu hinh

thdi vd mirc dp khdc nhau: dau khdp, viem khdp, viem

eo, yeu eo, viem khdp nhiem khuan...[5,6,7]. Ddy la

nhirng tripu chirng lam sdng eo xu'ong khop eo thi gdp

d bat cir bpnh nhdn mde bpnh eiia hp thdng vdn ddng

hoac viem kho'p do vius chinh vi vdy tren thyc te Idm

sdng cdc tru-ong hpp bpnh nhan ndy thu'O'ng bj bd qua

hode chan dodn vd dieu trj nham Idm anh hu'dng nhilu

din khong nhOng sire khoe nguo'i benh md con Idm gia

tdng nguy eo gdy Idy nhilm eho cpng ddng khi ngu'oi

bpnh HIV khdng dupe kilm soat. Chung toi tiln hanh

TRA N TH! MINH HOA

khao sdt nay nham muc dich tim hiiu nhO'ng bieu hi§n

eo xuong kho'p a cac benh nhdn lan dau tien dutfc

chan dodn HIV din khdm va dilu trj tai khoa khop benh

vien Bach mai trong 2 ndm tir 2009 den 2010 de lu'u' y

cac bde sy Idm sdng trong chan dodn tinh trgng HIV.

06l TU'Q'NG, PHU'ONG PHAP NGHIEN CLFU

Nghien eiru mo ta cdt ngang vd hdi ciru 12 benh

nhdn co cae bieu hipn

bpnh ly co xuong khdp lan dau tien dupc chan doan

HIV din khdm vd dieu tri tpi khoa Khop bpnh vipn Bach

mai trong 2 ndm (2009-2010)

KtT QUA NGHIEN CU'U

1. Dac diem bpnh nhan:

Trong sd 12 benh nhan duoc chan dodn HIV du'O'ng

tinh CO 10 bpnh nhan nam vd 2 bpnh nhan nO" vol tuoi

trung binh Id 26,5±4 (benh nhdn it tudi nhat Id 18 va

nhilu tudi nhat Id 36), vdi dpc dilm nghe nghipp va hpc

van 2 ngudi Id thp' xay dyng tu do, 7 ngudi khong c6

nghi nghipp cd djnh, 1 ngudi Id sinh vien vd 2 nguo'i la

npi trp. Thdi gian tir khi eo tripu chirng d co xircng

khdp din thdi dilm dugc xdc djnh Id HIV duong tinh

trung binh Id 9 thdng (sdm nhat Id 8 thdng Idu nhat la 16

thdng). Co 7/10 bpnh nhdn nam ed tiln su" nghipn chich

ma tuy (tir 1 nam din 6 nam, trong dd cd 2/10 bpnh

nhan nam hipn tai dang chich ma tuy ngdy 1-2 lan) Ba

bpnh nhan nam khong eo tien sir nghipn hut ma tuy

nhung co tiln sir quan hp tinh dye khong an toan

(khong su- dung bao cao su, co quan hp tinh dye vai

nhilu ddi tupng). Hai bpnh nhdn nu khong ed tien sii

nghipn chich ma tuy nhung khai thac tiln sir gia dinh thi

mpt bpnh nhan co chdng lam thp xdy dyng ty do

thudng xuyen sdng xa gia dinh vd mpt bpnh nhan co

chdng lam nghi lai xe dudng ddi (rat tile chiing toi

khong tilp xiic dupc vd Idm xet nghipm xdc djnh HIV

eua 2 ddi tupng ndy). Nhu vdy ea 12 ijpnh nhdn deu la

nhung ngudi tre tudi vd co eae ylu td nguy co cao

nhilm HIV: nghipn chich ma tuy, quan hp tinh dye khong

an toan.

2. Cac bieu hipn lam sang co" xyong khop a 12

bpnh nhan nghien ciru

Bang 1 Cdc bilu hipn Idm sang xuong khdp d 12

bpnh nhdn nghien eiru

Cac bieu hien idm sang

Dau xu'ffng khccp

Viem mang hoat djch khap gdi.

Viem khcrp boin co chdn

Viem khdp i>c don

Oau opt sdng thdt lunq

Thieu m^u

Ban xuat huyet

B0nh nhdn (n=12)

6 (50%)

4 (33,3%)

2(16,6%

1 (8,3%)

5 (41,6%)

1 (8,3%)

1 (8,3%)

Kit qua cua bang 1 cho thay 6/12 (50%) bpnh nhdn

cd tinh trpng dau mdi xuong khop kiiu gia cum, day

cung la mpt trong nhung bilu hipn thuong ggp o nhung

bpnh nhdn viem khdp do virus, ty lp nay tuong doi cao

hon so vdi nghien cuu ciia Krishman KK [4] tren 29

bpnh nhdn chi co 20% bpnh nhdn ed bilu hipn dau

24 Y HOC THl/C HANH (755) - SO 3/2011