THUC TRANG TRE M A C HQI CHL/NG TUKYTRENTHEGIOI TS Nguyen Thj Mai Lan Hoc vien Khoa hoc xd hoi T O M TAT Hpi chi'fng tifky hien dang duoc nhieu qudc gia quan tdm Tre' mdc hpi clu'fng ndy chiem mgt ty le ddng ke ddn sd ctia cdc nudc vd ldng ddn theo thai gian Cdc nghien cifu cho thdy co stf khdc giffa cdc chdu luc vd cdc qudc gia giifa khu vuc ihdnh thi vd nong thon, giifa tre' em nam vd ire' em nu ve sd luang ire mac hpi chiing ndy Xu hudng tdng ndy co the phdn dnh sif gia ldng thifc su ty le mdc benh, nhioig cung phdn dnh nhCfng nguyen nhdn khdc nhU lieu chi chudn dodn hpi chifng tif ky co thay doi; ngdy cdng co nhieu cong cu giiip chud'n dodn chinh xdc hpi chiing tuky Tu khoa: Hoi chifng tuky; Ty le mdc hgi chimg tuky Ngdy nhdn bdi: 14/12/2012; Ngdy duyet ddng bdi: 25/12/2012 Dinh nghTa va cac khai niem lien quan Hdi chflng tu ky la hdi chung rdi loan tam sinh ly d tre em Dac di^m co ban cua hdi chflng tu ky la han che' kha nang giao tie'p va tuong tac xa hdi, cung nhu cd nhfltig hanh vi kem da dang, lap di lap lai (DSM-IV, Hdi Than kinh My 2004) Hpi chflng tu ky cd th^ dupc chu^n doan chfnh xac cho tre tir 18 thang tudi trd len (Turner et al, 2006) Tiiy theo trieu chflng, tre cd th^ mac hdi chflng tu ky d cac mflc dp khac nhau: tir thi^u nang tri tue cho de'n cd mdt sd kha nang khac thudng; cd nhflng tre di hpc va sinh hoat binh thudng nhung cung co tre sud't ddi phu thudc vao bd me va ngudi cham sdc (Miles et al, 2005) Theo Kanner - ngudi tien phong ITnh vuc nghien cflu nay, cd ba da'u hieu chfnh cua hdi chflng tu ky la han che giao tie'p xa hdi, rdi loan ngdn ngu va cd hanh vi lap di lap lai Kanner phan biet hdi chflng tu ky vdi benh tam th^n phan liet d tre em dua tren quan he xa hdi Tre mSc benh tam th^n phan liet cd xu hudng cd lap ban than khdi cac mdi quan he hien cd, cdn tre mac hdi chfltig tu ky thudng bi han che giao tie'p vdi nhulig ngudi xung quanh (Mesibov&Sheai20l6) ' TAPCHITAMLtHOC,Sdl (166), 1-2013 63 Phdt tridn quan didm cia Kanner, nhidu cdng cu chudn dodn da dupc xdy dung: DSM-IV-R cua Hdi Tdm Vj hpc My; ADI-R cua Rutter, Le Cout; lCD-10 cua Td chic Y td the gidi; CARS cua Schopler vd ddng nghidp (1980) Mac di dinh nghTa tu ky khdng thay ddi, mdi cdng cu lai khac ft nhidu vd phan loai cdc dang tu ky vd cdc tridu ching cia ty ky Ngay nay, ngoai tu ky mic dCi nang tuong ing vdi cdc tidu chi cua Kanner, cdn cd cdc dang nhe hon nhu hdi ching Asperger (tre cd ky nang giao tiep xa hdi kdm, nhung khdng bj thidu nang tri tud), cham phdt tridn trf tud, hdi ching Rett, bdnh chdm phat tridii ngdn ngtt va benh rdi loan phat tridn lan tda dang chua xdc dinh (PDDNOS) Vi the, hidn nay, thay vi dung dd chi mdt hdi ching ridng biet, t i tu ky dupc ding dd chi nhdm rdi loan phat tridn gdy ban chd kha nang giao tiep vd tuong tdc xa hpi hay cdn gpi la rdi loan ty ky (Yates & Le Couteur, 2008) Hdi ching ty ky thu&ng keo dai den sud't ddi, dnh hudng nghidm trpng den sinh boat cia ca ngudi bdnh va nhing ngudi chim sdc ngtrdi ty ky Nhing rdi loan vd thdn kinh t i nhung nam phat tridn ddu ddi cd thd anh hudng ddn nhidu mat qua trinh phat tridn cua trd Kd't cue Id de'n Idn, trd thi'ch ing kem vdi nhttng ddi hdi cia xa hdi Day cttng Id nguyen nhan vi hdi ching tu ky dupc liet vdo nhdm cac hdi ching rdi loan phdt tridn Ian tda (Miles et al, 2005) Thdng ke ve tinh hinh mac hpi chimg ttr ky tren the gidri 2.1 Tinh hinh mdc hdi chiing tulcy a My vd cdc nudc chdu Au Nghidn ciu qui md Idn ddu tidn vd hdi ching ty ky dupc Lptter thuc hidn nam 1966 Trong 78.000 trd em t i de'n 10 tudi d Middlesex, Vuong qud'c Anh Lotter phat hidn mdt didu la c i 10.000 tre cd mpt tre mdc ty ky vd ty le P tre em nam cao ban nhieu so vdi tre em ntt (Holaday, 2012) Ty le tang nhe thdnh 2/10.000 tre thdp ky 70 (Kawamura, Takahashi & Ishii, 2008) Tuy nhien, de'n cudi the ky XX thi thdng kd vd tinh hlnh mdc hdi ching ty ky tang vpt ^ cd cdi nhln bao qudt hdn vd xu hudng tang gidm cua hdi ching ty ky qua thdi gian, Fombonne (2002) da tdng hop td't cd cac nghidn ciu dupc dang tren cdc tap chi tidng Anh vd tinh hinh mdc hdi ching ty ky vd cdc benh rdi loan phdt tridn lan tda Tinh de'n nam 2Ppi, cd 32 de tai thudc loai ndy Ty 14 mdc tu ky trung binh la 8,7/10.000, dd mdi nghidn ciu tim duoc mdt ty le khdc nhau: thdp nha't la 0,7/10.000, cao nhdt la 72,6/10.000 Nghien ciu cd nhdm khdch thd cang nhd vd dupc thyc hien cdng gdn ddy thi ty le tim dupc cang cao Ne'u loai nhttng nghien ciu cd dp chfnh xdc thd'p (do nhdm khdch thd nhd hon 10.000), cdn Iai 19 dd tai, vdi ty Id mdc tu ky trung binh la 10/10.000 64 TAP CHI TAM LY HOC, Sd (166), 1-2013 Ngoai ra, rdt nhidu trd cd bidu hien cua tu ky nhung khdng dap ing d i tdt ca cdc tidu chuan dd dupc chudn dodn mdc hdi ching ty ky Theo tieu chudn hien nay, nhttng tre rd't cd the dupc chudn dpan mdc benh rdi loan phdt tridn lan tda dang chua xac djnh (PDDNOS) Ty le tre thudc nhdm cao gdp 1,5 Idn ty Id tre mdc ty ky (tic Id 15/10.000) Trong dd, ty Id tre mdc hdi ching Asperger thd'p ban Idn so vdi ty Id tre mdc ty ky Nghidn cihi tren cua Fombonne dupc cdng bd nam 2002 vd chi vdi ndm cud'i thd ky XX ddu thd ky XXI, Fombonne da quan sdt thdy xu hudng tdng bd't thudng len 40 - 60 trd mdc hdi ching ty ky va cdc bdnh rdi loan phat tridn lan tda so vdi ly Id I - 2/10.000 tre nhu trudc ddy (xem bang I) Bdng 1: Thd'ng ke linh hinh Ire mdc hfli chi'fng luky qua mol so'nghien cdu gdn ddy (theo Fombonne, 2002) PDDNOS '' + hoi chftng Asperger Benh tu ky Tuoi Berlrand el al., 2001 Baird el al 2000 Chakrabarli & Fombonne, 2001 Tyle (tren 10.000) PDD" noi chung Tyle nam/ nit Khong bi thieu n^ng tri tue % Tyle (tren 10.000) Tyle nam/ nit Khong bi thieu nang tri tue % Tyle (tren 10.000) 51 67.5 - 10 40.5 2.2 37 27.0 3.7 30.8 15.7 60 27.1 4.5 4-7 16.8 3.3 29 44.5 4.3 57.9 94 61.3 'PDD (Pervasive DevelopmeiUal Disorder): Benh rdi logn phdl trid'n lan loa ''PDDNOS (Pen'asive Developmental Disordei Not Olhern'ise Specified) Benh roi loan phdt li lai lan toa dgng chua xdc dinh Ndi tie'p nghien cuu ciia Fombonne, Catherine Rice (2006) va nhdm nghien ciiu thupc Trung tam Y te' du phdng My da so sanh ty le tre mac tu ky nam 2002 vdi nam 2006 qua sd lieu trung tam thu thap dupc Neu nam 2002, cfl 10.000 tre cd 64 tre bi tu ky, thi de'n nam 2006, sd tang len 91/10.000 tre Khdng nhflng the, ty le mac tu ky tang tren mpi phuong dien: gidi tfnh (cfl 10.000 tre nam va 10.000 tre nfl thi cd 143 tre nam va 32 tre nfl mdc tu ky), ve sac tdc (ty le tre da trang mac tu ky tang 55%, tre da den mac tu ky tang 41%) Cung nam 2006, Baird va ddng nghiep cung da thdng ke dupc Anh cd 116/10.000 tre mac hpi chflng tu ky TAP CHI'TAM Ly HOC, Sd (166), - 2013 65 Nguydn nhdn nao ddn tdi xu hudng tdng bd't thudng nay? Mdt Id, nhttng tie'n bd ITnh vyc nghidn ciu hdi ching ty ky da cho phdp viec chuan dodn dupc tidn hanh sdm hPn va chfnh xdc hem Hai la, nhttng thay ddi trorig each djnh nghTa hdi ching ty ky va cdc dd'u hieu nhan biet ty ky Nhidu tre trudc day dupc chudn dodn la khdng mic tu ky, gid cd thd dupc liet vdp hdi ching rdi loan phdt tridn lan tda dang chua xac dinh hoac thdm chf du tieu chudn dd chudn dodn la mdc hdi ching ty ky Nguydn nhdn t h i ba la mic sd'ng tang cao khidn cho ca bdc sT va ngudi ddn deu chu trpng den viec phdt hien sdm va chua tri sdm hdi ching ty ky Di the nao di ntta, ching ta khdng thd phi nhdn rdng ty le tre ty ky dang thyc sy tang thdi gian gdn ddy (Tanoue el al, 1988) Vd mat gidi linh, tre em nam mdc ty ky nhidu gdp 4,2 ldn so vdi tre em ntt Ty Id dupc khdng dinh qua nhidu nghidn ciu d) tre vtta bi ty ky vtta hi thidu nang trf tue, khdng cd md'y chdnh Idch ty Id nam n i (ci tre nam mdc ty ky thi cd trd n i mdc ty ky), nhung nd'u tre khdng bi thidu ndng trf tud hoac bl nhe thi ty Id chdnh lech nam ntt tang vpt Nhin chung, chi cd 30% tre ty ky phdt tridn tri tud binh thudng, cdn lai 30% bi thidu nang mic dp nhe va 40% bi thidu nang mic dd nang de'n rdt ndng Vi thd sp lupng trd nam mdc ty ky cao hpn ban sp vdi trd ntt (Fombonne, 2002) Ngoai thidu nang trf tud, tre ty ky cdn thudng xuydn mdc phai mdt sd bdnh khac nhu ddng kinh (17% tre ty ky mdc benh nay), hdi ching nhidm sdc thd X dd gay, rubella bdm sinh (Fombonne, 2002) Dia vj xa hdi khdng anh hutjng dd'n ty Id tre mdc ty ky Mdt sd nghidn ciu qui md nhd phdt hien ty le tu ky cao d ngudi nhap cu vd mdt sd nhdm dan tdc, nhung nhing nghidn ciu qui md Idn khdng tim thd'y md'i lidn he 2.2 Tinh hinh mdc hdi chdng tu Icy a chdu A Hien vdn cd rdt ft cac nghien ciu vd hdi ching ty ky d chdu A, mac di chau luc ddng gdp mdt phdn ddng kd vao ddn sd the gidi Theo thd'ng ke cua Xiang Sun vd Carrie Allison (2008), t i nam I97I de'n nam 2008, cd 26 nghidn ciu qui md ldn ve hdi ching ly ky dupc thyc hidn d chau A (xem bang 2) Trong 26 nghidn ciu dupc chpn, cdc nghien ciu d Nhdt Ban chiem phdn ldn (13 nghien ciu), cdn lai cd nghien ciu d Trung Qud'c, p Israel, diran, I d Ddi Loan vd I d Indonesia Cd 2/3 cdc nghidn cttu tap trung vdo ddn cu dd thj, sd cdn Iai nghien ciu ca khu vyc dd thi va khu vyc ndng thdn Nhdm khdch thd nghien ciu cua mdi de tai cung khac ft nhidu ve dd tudi, ty Id nam n i vd dp Idn cua nhdm khach thd Tfnh trung binh, cdc nghidn ciu o Trung Qud'c cd khpang 25.521 khach the, nhing nghien ciu a Nhdt cd khoang 597.003 khach thd 66 TAP CHI TAM Lf HOC, Sd (166), - 2013 Bdng 2: Thong ke cdc nghien cAu d chdu A ve ty le mdc tix ky tinh de'n ndm 2008 (theo Sun & Alison, 2008) Tuoi Tyle mic benh (tren 10.000) Kanner " - 12 2.6 Nhai Kanner - 15 1,7 Nhai Kanner - 14 I.l Nhai Kanner Sd luong khach the Tyle nam/ ntt TT Ndm Chu nhiem de tai Quoc gia Tieu clll/ Thang du 1971 Yamazaki Nhai 1971 Haga Miyamolo 1971 Nakai 1971 Tanino 1980 Hoshino Nhai Kanner 609.848 - 18 2.3 1983 Ishii & Takahashi Nhai DSM-III' 35.000 - 12 16.0 1987 Maishuishi Nhai DSM-III 32.834 - 12 16.4 1988 Tanoue Nhai DSM-III 507.003 0-7 13.8 4.1/1 1989 Sugiyama Nhat DSM-III 12 263 0-5 13.0 2.1/1 10 1992 Ohlaki Nhat DSM-III-R 35.366 - 14 11.7 11 1996 Honda Nhai ICD-10' 537 0-5 21.1 2.6/1 12 2005 Honda Nhai ICD-10 35,716 0-5 19.0 2,5/1 13 2008 Kawamura Nhai DSM-IV 12,263 13.0 2,8/1 14 1987 Taokuo Tai Trung Qudc RuIIer" 457.200 0.32 6.5/1 CCMD-2R' DSM-IIIR DSM-IV 10.802 - 14 2.8 4.1/1 U - D 15 2000 Weiwu Luc Trung Qudc 16 2002 Weiwu LUG Trung Qudc CARS' + Ihang danh gia Chung vfi mijc dp phai Irien 3.978 2-6 17.9 2.5/1 17 2txa Weihua Wang Trung Qudc CCMD-2-R CARS 7.488 2-6 12.3 2/1 18 2003 Luzhong Ren* Trung Qudc 19 2004 Rong Guo Trung Qudc CCMD-2-R CARS 3.606 2-6 13.8 Toin nam 20 2007 Shuguang Yang Trung Qudc DSM-IV 10.412 - 12 5.6 5/1 250.0 TAP CHI'TAM Lt HOC, Sd (166), 1-2013 67 21 22 23 2008 1992 2001 Feng Zhang Wignyosumarlo Davidovilch CARS DSM-IV 25.521 1-6 9.8 Indones ia CARS 5.I20 4-7 11.7 Israel DSM-III-R DSM-IV Trung Qudc 26,160 0- 12 9.9 1,113,90 0- 14 9.0 24 2004 Kamer Israel 25 2007 Almad Ghanizadch Iran DSM-IV 2.000 5- 10 190.0 Chuanyu Chen Dai Loan ICD-9 328.802 u-12 40.7 26 2008 3,2/1 CliTi Mcli: * Ngltieii cicii ciu diing lliaiig daiili gia sa bd de plidn logi Ire mac lie ky va khdng mdc III ky: " Kanner Ddnli gid ctia bac si dua Iri'u cdc lien chi Leo Kanner dita ra: '' DSM-rtl/lll-R/li^ (Diagnostic and Slalislical Manniiat of Mental Disorder - lU/llI.Revised/tV')- Cam nang plidn loai va clmdn dodn benh lain Iv tdi bdn ldn Idn co ciiinh sua vd Idn 4: ' lCD-9/10 (Inlernalional Classification of Diseases) • He IhO'ng phdn loai benh ldl qudc te, ldi bdn tdn rd 10 ^ Rimer Ddnli gtd ci'ia bdc si dua tren c dc lien chi Michael Riiltcr dua ra: 'CCMD-2-R (Chinese Classification of Menial Disorder - - Revised): He Ihdng phdn togi benh tdm ihdndlreeni Trnng Qudc (chi diing lgi Trung Quoc) tdi bdn ldn co chinb sua: ^ CARS (Childlwod Antisni Rating Scale) Tliang ddnh gid tir ky d lie em Nhin chung, ty le tre ttt - tuoi mdc tu ky cao hon so vdi cdc nhdm tudi khac Tuang ty nhu d phuang Tay, tre em nam mdc ty ky nhidu hon tre em ntt Do ke't qud thd'ng kd phy thudc vdo tidu chf vd cdng cu chuan dodn bdnh nen Sun vd Allison loai bd nhttng nghien ciu chi ding thang so bd ma khdng cd danh gid chuydn mdn cua bdc sT hoac nha tdm ly Kdt qua Id so sdnh hai nudc duac nghidn ciu nhidu nhd't - Nhdt Ban va Trung Qudc thi ty Id tre mdc bdnh b Nhdt Ban (15,5/10.000) cao hon so vdi d Trung Qudc (10,4/10.000) Tfnh chung, ty 16 mdc ty ky dchdu A la 11,6/10.000 Cung theo tdng kd't cua Sun vd Allison (2008), vd gidi tfnh, tre em nam dd mdc ty ky han tre em ntt, mac du ty le chfnh xdc thay ddi qua ting nghien ciu Vd mic dp phat tridn tri tue cia trd tu ky, 66,4% tre ty ky d Nhat Ban cd chi sd IQ binh thudng, dd ta't ca cdc trudng hop tu ky d Trung Qud'c deu bj cham phdt tridn tri tud Hai nha nghidn ciu Zhang va Ji (2005) ly giai rang, nhing tre bj ty ky nhung khdng bi cham phdt tridn trf tud cd the thfch ing vdl mdi trudng gia dinh vd trudng hpc td't hon, nen kha nang thdy cd va bd me nhan benh cua tre thap hpn Do Nhat Bdn cd didu kien chdm sdc y te tdt hdn va dan trf cao hon d Trung Qud'c ndn bd me cua tre bi tu ky d Nhdt nhdn benh va dua tre di khdm sdm han d Trung Qud'c, cd tre thfch ing td't TAP CHI TAM Lf HOC, Sd (166), - 2013 vdi mdi trudng binh thudng Ung hd hudng giai thich nay, ngbtea ciu ,tai tinh Thidn Tan, Trung Qud'c Zhang vd Ji (2005) thyc hidn thd'ng ke dupc ty le mdc tu ky d tre thdnh thi cap hdn hdn tre ndng thdn Do cdc gia dinh d thdnh phd thudng cd hpc vdn cao hon va thu nhdp td't hon, trd mdc ty ky d khu vyc thi thudng sdm nhan dupc sy cham sde y td va tdm ly t i gia,dinh vd cac CP sd y te Dd udc luong ding ty Id mdc ty ky d chdu A (hay bd't ky chdu luc ndp), vdn dd ddt la Idm sap dd bd me sdm nhan bie't ddu hieu tu ky p tre vd dua tre di kham sdm chau A, thd'ng ke cho thdy bd me thudng dua tre dep khdm vd chudn dodn bdnh ty ky ndu tre cham ndi hoac cd khd nang ngdn ngu kdm Ngoai ra, nhidu bd me cung lo ldng ndu tre ft giao tie'p xa hdi hoac van ddng qud mic, nhung md'i quan tdm Idn nha't vdn Id kha nang ngdn ngtt Vi the, da sd tre d chau A duac chudn dodn tu ky vao khoang - tudi (Juneja et al, 2004; Kalra et al, 2005) 2.3 Tinh hinh mdc benh tren the gidi ndi chung Di tdng cdng sd lupng nghidn ciu vd hpi ching ty ky Id rdt Idn, nhung mdi nghidn ciu lai cd nhung each dinh nghia tu ky vd su dung nhttng cdng cu chudn dodn khdc nhau, nen viec so sdnh va tdng kdt cdc nghien ciu la rdt khd khan, ding nhu Sun vd Allison (2008) da chi Trong mdt nd lyc tdng hpp them nhidu nghien ciu mdi sau 2008, Elsabbagh vd cpng sy (2012) dua sd thdng kd la 17/10.000 cho hdi ching ty ky vd 62/10.000 cho cac benh rdi loan phat trien lan tda sau tham khao hon 600 nghidn ciu tren toan the gidi Ngodi ra, nhdm nghien ciu khdng tim md'i lidn he ndo gitta cac dieu kien kinh te, xa hdi, van hda vd dia Iy vdi mic dd mdc ty ky Didu ndy ching td rdng, hdi ching ty ky khdng phu thudc vao cdc ye'u to ben ngodi md cd nguydn nhan sinh hpc Chi cd gidi tfnh va kha nang phdt trien trf tue Id hai yeu td dn dinh nhat qua cdc nghien ciu: tre nam mdc hdi ching ty ky nhieu hon trd nu va rdt ddng tre tu ky bi thidu nang trf tue Tuy nhien, khd cd thd dua mdt sd chfnh xdc vd ty le nam/ntt hay ty le thidu nang trf tud binh thudng bdi sd ndy thay ddi qua ting nghien ciu Tinh ttt nam 1960 dd'n nay, ty le tre mdc hdi ching ty ky tang ddn theo thdi gian Xu hudng tang cd thd phdn dnh sy gia tang thuc su ty le mdc hpi ching ty ky, nhung nhdm nghien ciu cua Elsabbagh cho rdng hai van de khdc cung cdn duoc quan tdm Mdt la, hdi ching ty ky khdng cdn chi mdt hpi ching rieng biet ma chi mdt nhdm hdi ching vdi nhung mic dp nang nhe khdc nhau, vi the sd lupng ngudi dap ing cdc tidu chf hdi ching ty ky tang Hai Id, cdng ngdy cdng cd nhidu cdng cu giup chuan doan chfnh xac hdi ching ty ky TAPCHITAMLtHOCSdl (166), 1-2013 69 Tai lieu tham khao Juneja M., Mukherjee S.B., & Sharma S., A descriptive hospital based study of children wiih auiism, Indian Pediatrics, 42, tr 453 - 458, 2004 Miles J.H., Takahashi T.N., Bagby S., Sahota P.K., Vaslow D.F., Wang C.H., Hillman R.E & Farmer J.E., Essential versus complex aiaism: Definition of fuiidameiilal prognoslic suhslyles, Americal Journal of Medical Genetics, 135, tr 171 -180,2003 Mesibov G B., Shea V., & Schopler E (with Adams L., Burgess S., Chapman S M., Merkler Ei, Mosconi M., Tanner C, & Van Bourgondien M.E.), The Teacch approach to autism spectrum disorders New York: Springer, 2005 Turner L.M., Stone W.L., Pozdol S.L & Coonrod E.E., Follow - up of children with autism spectrum disorders from age two lo age nine, Autism, 10, tr 243 - 265, 2006 Yates K & Le Couteur A., Diagnosing auiism Paediatrics and Child Health, 19, tr 55 - 59, 2008 Zhang X & Ji C.Y., Autism and menial retardation of young children in China, Biomed Environ Science, 18, tr 334 - 400, 2005 ™ TAP CHI TAM Lf HCDC, Sd' (166), 1-2013 ... mac tu ky tang tren mpi phuong dien: gidi tfnh (cfl 10.000 tre nam va 10.000 tre nfl thi cd 143 tre nam va 32 tre nfl mdc tu ky), ve sac tdc (ty le tre da trang mac tu ky tang 55%, tre da den mac... phat hidn mdt didu la c i 10.000 tre cd mpt tre mdc ty ky vd ty le P tre em nam cao ban nhieu so vdi tre em ntt (Holaday, 2012) Ty le tang nhe thdnh 2/10.000 tre thdp ky 70 (Kawamura, Takahashi... so sanh ty le tre mac tu ky nam 2002 vdi nam 2006 qua sd lieu trung tam thu thap dupc Neu nam 2002, cfl 10.000 tre cd 64 tre bi tu ky, thi de'n nam 2006, sd tang len 91/10.000 tre Khdng nhflng