Nghiên cứu đặc điểm lâm sàng và nguyên nhân dị ứng thức ăn ở trẻ em tại viện nhi trung ương

B Y T TRNG I HC Y H NI NG TH Lấ VINH NGHIÊN CứU ĐặC ĐIểM LÂM SàNG Và NGUYÊN NHÂN Dị ứng thức ăn trẻ em bệnh viện nhi trung -ơng LUN VN BC S CHUYấN KHOA CP II H NI - 2015 B Y T TRNG I HC Y H NI NG TH Lấ VINH NGHIÊN CứU ĐặC ĐIểM LÂM SàNG Và NGUYÊN NHÂN Dị ứng thức ăn trẻ em bệnh viện nhi trung -ơng Chuyờn ngnh: Nhi - Hụ hp Mó s: CK.62.72.16.10 LUN VN BC S CHUYấN KHOA CP II Ngi hng dn khoa hc: PGS.TS Lấ TH MINH HNG H NI - 2015 DANH MC CH VIT TT BAT Basophil Activation Test (Test hot húa t bo ỏi kim) IgE Immunoglobulin E HRF Histamine releasing factor (yu t gii phúng histamine) NIAID National Institute of Allergy and Infectious Diseases (Vin cỏc bnh d ng v truyn nhim) OFC Oral food challenge (test kớch thớch vi thc n ng ming) WAO World Allergy Organization (T chc D ng Th gii) WHO World Health Organization (T chc y t Th gii) MC LC T VN Chng 1: TNG QUAN 1.1 Khỏi nim 1.2 Dch t hc d ng thc n 1.2.1 Trờn th gii 1.2.2 Ti Vit Nam 1.3 C ch bnh sinh d ng thc n 1.3.1 D ng thc n qua trung gian IgE-loi I 1.3.2 D ng thc n khụng qua trung gian IgE 1.3.3 Cỏc yu t lm tng tỡnh trng d ng 1.4 Phõn loi d ng thc n 1.5 Nguyờn nhõn d ng thc n 1.5.1 D nguyờn thc n 1.5.2 Phn ng chộo gia cỏc d nguyờn thc n 10 1.6 Biu hin lõm sng ca d ng thc n 11 1.6.1 Phn ng d ng thc n qua trung gian IgE 12 1.6.2 Phn ng d ng thc n khụng qua trung gian IgE 14 1.6.3 Cỏc biu hin lõm sng ng tiờu húa tng bch cu ỏi toan 15 1.7 Mt s xột nghim chn oỏn d ng thc n 16 1.7.1 Xột nghim da vi d nguyờn thc n: 16 1.7.2 Xột nghim mỏu 17 1.7.3 Test kớch thớch vi thc n (OFC) 17 1.7.4 Ch n loi tr vi thc n gõy d ng 19 1.8 Chn oỏn d ng thc n 19 1.8.1 Khai thỏc tin s 19 1.8.2 Khỏm lõm sng 21 1.8.3 Xột nghim 21 1.9 Chn oỏn phõn bit 21 1.10 iu tr d ng thc n 22 1.10.1 iu tr c hiu 22 1.10.2 iu tr khụng c hiu 23 1.10.3 Tin trin v d phũng 24 Chng 2: I TNG V PHNG PHP NGHIấN CU 25 2.1 i tng nghiờn cu 25 2.1.1 Tiờu chun la chn i tng nghiờn cu 25 2.1.2 Tiờu chun loi tr 25 2.1.3 Tiờu chun chn oỏn 25 2.1.4 a im nghiờn cu 25 2.1.5 Thi gian nghiờn cu 26 2.2 Phng phỏp nghiờn cu 26 2.2.1 Thit k nghiờn cu: 26 2.2.2 C mu v phng phỏp chn mu: 26 2.2.3 Cỏc bc thu thp s liu 26 2.2.4 Bin s v cỏc ch s nghiờn cu 26 2.2.5 Lm sch v x lý s liu 29 2.2.6 o c nghiờn cu 30 Chng 3: KT QU NGHIấN CU 32 3.1 c im chung ca i tng nghiờn cu 32 3.1.1 Phõn b tr d ng thc n theo nhúm tui 32 3.1.2 Phõn b tr d ng thc n theo gii 32 3.1.3 Phõn b tr d ng thc n theo a d sng 33 3.1.4 Tin s sinh ca i tng nghiờn cu: 33 3.1.5 Tin s nuụi dng 34 3.1.6 Tin s gia ỡnh v d ng 35 3.2 c im lõm sng ca d ng thc n ca i tng nghiờn cu 35 3.2.1 Tui xut hin triu chng d ng u tiờn 35 3.2.2 Tn xut tr b d ng thc n theo tin s b bnh 36 3.2.3 Thi gian xut hin triu chng d ng sau tip xỳc vi d nguyờn36 3.2.4 Thi gian xut hin triu chng theo nhúm tui 37 3.2.5 c im lõm sng d ng thc n ca i tng nghiờn cu 38 3.2.6 Biu hin lõm sng theo nhúm c quan 39 3.2.7 Biu hin lõm sng d ng thc n theo nhúm tui 40 3.2.8 Tn sut biu hin lõm sng cỏc c quan 41 3.2.9 S c quan biu hin lõm sng theo tn sut b d ng thc n 41 3.3 c im cn lõm sng ca i tng nghiờn cu 42 3.3.1 Kt qu test ly da vi cỏc d nguyờn thc n 42 3.3.2 Kt qa test ỏp da vi cỏc d nguyờn thc n 43 3.3.3 c im test ly da theo nhúm tui 44 3.3.4 Kt qu xột nghim bch cu ỏi toan mỏu ngoi vi 45 3.3.5 Kt qu xột nghim hng cu phõn 45 3.3.6 Kt qu nh lng IgE ton phn huyt 46 3.3.7 Kt qu nh lng IgE c hiu vi cỏc d nguyờn thc n 47 3.4 Xỏc nh mt s thc n gõy d ng ca i tng nghiờn cu 48 3.4.1 Mt s thc n gõy d ng thc n tr em 48 3.4.2 Thc n gõy d ng ca i tng nghiờn cu theo nhúm tui 49 3.4.3 Tỡm hiu mt s thc n gõy d ng theo ch n dm 50 3.4.4 ỏnh giỏ tỡnh trng ng mc d ng thc n 51 Chng 4: BN LUN 54 4.1 c im chung ca i tng nghiờn cu 54 4.1.1 Nhúm tui 54 4.1.2 c im v gii 55 4.1.3 a d 55 4.1.4 Tin s sinh ca i tng nghiờn cu: 56 4.1.5 Tin s nuụi dng ca nhúm nghiờn cu 56 4.1.6 Tin s d ng gia ỡnh ca i tng nghiờn cu 58 4.2 c im lõm sng d ng thc n tr em 58 4.2.1 Tui xut hin triu chng u tiờn 58 4.2.2 S ln tr b d ng thc n tin s 59 4.2.3 Thi gian xut hin triu chng sau tip xỳc vi d nguyờn 60 4.2.4 Thi gian xut hin triu chng theo nhúm tui 61 4.2.5 Biu hin lõm sng d ng thc n ca i tng nghiờn cu 61 4.2.6 Biu hin lõm sng d ng thc n ca tr em theo nhúm c quan v nhúm tui 63 4.2.7 S c quan biu hin triu chng d ng thc n tr em 64 4.2.8 S c quan biu hin triu chng theo tn sut b d ng thc n65 4.3 Mt s xột nghim cn lõm sng d ng thc n tr em 65 4.3.1 Test ly da vi cỏc d nguyờn thc n 65 4.3.2 Patch test vi d nguyờn thc n 66 4.3.3 Xột nghim bch cu ỏi toan mỏu ngoi v 67 4.3.4 Xột nghim hng cu phõn 68 4.3.5 Xột nghim IgE ton phn v IgE c hiu 68 4.4 Mt s thc n gõy d ng ca i tng nghiờn cu 70 4.4.1 Thc n gõy d ng tr em 70 4.4.2 Nguyờn nhõn gõy d ng thc n theo nhúm tui 71 4.4.3 Thc n gõy d ng theo ch n 72 4.4.4 Tỡnh trng ng mc d ng thc n ca bnh nhõn nghiờn cu 72 KT LUN 74 KIN NGH 75 TI LIU THAM KHO PH LC DANH MC BNG Bng 1.1 Nguy c phn ng chộo gia cỏc d nguyờn 11 Bng 3.1 Thi gian xut hin cỏc triu chng d ng theo nhúm tui 37 Bng 3.2 c im lõm sng d ng thc n 38 Bng 3.3 c im lõm sng d ng thc n theo nhúm tui 40 Bng 3.4 S c quan biu hin lõm sng theo tn sut b d ng thc n 41 Bng 3.5 Kt qu test ly da vi cỏc d nguyờn thc n 42 Bng 3.6 Kt qu patch tets vi d nguyờn thc n 43 Bng 3.7 So sỏnh test ly da dng tớnh theo nhúm tui 44 Bng 3.8.Nng IgE c hiu vi cỏc d nguyờn thc n 47 Bng 3.9.Thc n gõy d ng tr em 48 Bng 3.10.Thc n gõy d ng thc n theo nhúm tui 49 Bng 3.11 Thc n gõy d ng theo ch n dm 50 DANH MC S Biu 3.1 Phõn b theo nhúm tui 32 Biu 3.2 Phõn b theo gii 32 Biu 3.3 Phõn b theo a d 33 Biu 3.4 Tin s thai sn 33 Biu 3.5 Cỏch thc nuụi dng 34 Biu 3.6 Tui n dm 34 Biu 3.7 Tin s gia ỡnh 35 Biu 3.8 Tui xut hin triu chng d ng u tiờn 35 Biu 3.9: S ln tr b d ng thc n 36 Biu 3.10 Thi gian xut hin cỏc triu chng sau tip xỳc vi thc n 36 Biu 3.11 Tn sut cỏc triu chng d ng thc n 39 Biu 3.12 Tn sut c quan 41 Biu 3.13 T l bch cu ỏi toan 45 Biu 3.14 Xột nghim hng cu phõn 45 Biu 3.15 Nng IgE ton phn 46 Biu 3.16 c im v tỡnh trng ng mc d ng sa 51 Biu 3.17 Tỡnh trng ng mc d ng gia cỏc loi hi sn 52 Biu 3.18: 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Ngh nghip: Ngy vo vin: a ch: mó HSBA: in thoi liờn lc: II BNH S Tin s: 1.1 Bn thõn: Con th my: Tin s thai sn: thiu thỏng cõn thỏng Cõn nng Thiu cõn Ghi chỳ Tin s dinh dng n sa m hon ton thỏng u n sa cụng thc Nuụi nhõn to Loi thc n n dm: Nuụi hn hp Tui n dm: trc thỏng Sau thỏng Ghi chỳ: Tin s bnh d ng Tn thng da: My ay Phự mch Viờm da d ng Hụ hp: Viờm mi d ng Khũ khố Hen ph qun Tiờu húa: au bng Nụn/bun nụn a mỏu Viờm d dy rut HC ming d ng Sc phn v Khỏc: D ng thuc D ng vaccine - Thi gian xột nghim triu chng: - V trớ tn thng:: Ghi chỳ: Tin s d ng thc n 24h Tui phỏt hin d ng thc n S ln d ng thc n ln > ln Loi thc n: 1.2 Gia ỡnh Tin s ca b Cú bnh d ng Khụng cú bnh d ng Tin s ca m Cú bnh d ng Khụng cú bnh d ng Tin s anh ch em rut Cú bnh d ng Khụng cú bnh d ng III Khỏm lõm sng Ton thõn Chiu cao: cm HA Niờm mc: Cõn nng: kg Mch: St: Da B phn Hụ hp Tiờu húa Ton thõn Cỏc b phn khỏc IV Xột nghim - Test kớch thớch - Ch n loi tr Cể DNG ANTIHISTAMIN V/HOC COORTICOID??? KT QU PRICK TEST Ngy lm / / Chng dng Chng dng mm mm DN BNG DNH KT QU mm mm mm mm mm mm mm mm KT QU PATCH TEST Ngy lm / / _ Ngy c / / Chng õm DN BNG DNH KT QU BC S: Cỏc panel IU DNG: _ Cụng thc mỏu: HC HGB BC NEUT LYM EO Creatinine Glucose GOT GPT CRP Na+ K+ Cl- IgE TP IgE-c hiu Sinh húa mỏu Ure Canxi Protein mỏu Cỏc xột nghim khỏc: TC DANH SCH BNH NHN STT H V TấN GII TNH NGY SINH M BNH NHN NGY KHM Nguyn Hong P Nam 8/12/2013 14526354 24/6/2014 o Quy D Nam 8/12/2013 13423963 1/7/2014 Nguyn Th Khỏnh L N 7/11/2013 14160419 1/7/2014 ng Ngc Huyn A N 1/2/2014 14201807 8/7/2014 Lờ c A Nam 28/11/2007 10239269 8/7/2014 Ngụ S H Nam 24/9/2008 12273981 8/7/2014 Ngụ Th Qunh N N 23/10/2006 12273983 8/7/2014 Nguyn Minh A N 7/2/2014 14256138 12/8/2014 Nguyn Hong Minh N N 17/3/2014 14272683 12/8/2014 10 Ngụ Nht N Nam 25/9/2013 13376394 19/8/2014 11 V Minh T Nam 9/10/2013 14287021 19/8/2014 12 Nguyn H A N 10/3/2014 14283416 26/8/2014 13 Bựi Minh Nam 17/3/2014 14244490 27/8/2014 14 Bựi H L N 13/6/2014 14281582 28/8/2014 15 Trng Nh T N 16/4/2014 14307870 9/9/2014 16 Nguyn Nh Nam K Nam 16/9/2013 14323714 2/10/2014 17 V Gia L N 28/4/2014 14333728 14/10/2014 18 Nguyn Minh K Nam 27/7/2014 14354030 21/10/2014 19 Nguyn Cnh Nht M Nam 15/5/2014 14259496 21/10/2014 20 Minh N N 4/4/2014 14295287 22/10/2014 21 Dng Phỳ Q Nam 13/9/2013 14294686 28/10/2014 22 Phm Minh A N 1/5/2014 14305060 28/10/2014 23 H Tin M Nam 26/4/2014 14022212 28/10/2014 24 Phm Phng N N 19/5/2015 14560666 4/11/2014 25 Trn Th H C N 8/4/2014 14330246 4/11/2014 26 Phm Minh C N 14/5/2014 14189789 11/11/2014 27 m Cụng Quang H Nam 31/5/2014 14067915 18/11/2014 28 on Khỏnh H N 5/9/2013 13133202 25/11/2014 29 Phm Bỡnh M Nam 9/4/2014 14309579 10/12/2014 30 Phan Bo L Nam 30/4/2014 14415695 23/12/2014 31 Bnh Tun M Nam 11/9/2014 14297096 23/12/2014 32 Bựi Nht M Nam 7/6/2011 13163691 23/12/2014 33 Phm Minh T Nam 7/7/2014 14274241 30/12/2014 34 Trn H Bo P N 25/9/2013 14411830 30/12/2014 STT H V TấN GII TNH NGY SINH M BNH NHN NGY KHM 35 Nguyn Thỏi P Nam 14/8/2014 14348598 20/12/2014 36 Nguyn H A N 17/6/2014 01094519 13/1/2015 37 Nguyn Th Hng T N 26/10/2014 15029016 20/1/2015 38 Nguyn Hng V N 21/3/2012 12425265 21/1/2015 39 Lờ Quang T Nam 13/9/2013 13329612 22/1/2015 40 Nguyn Tựng Chi M N 30/11/2013 14186561 22/1/2015 41 Phan Bo A Nam 10/1/2014 15052338 26/1/2015 42 Bựi Bo N N 13/10/2014 14395194 28/1/2015 43 Nguyn Vn Nam 23/7/2014 15031867 2/2/2015 44 Phan Diờ A N 21/8/2014 15044110 2/2/2015 45 Hong Ngc Mai C N 28/10/2014 15039922 3/2/2015 46 Trn Gia B Nam 1/10/2013 14049342 3/2/2015 47 Trng Ngc Nh Y N 18/7/2014 14253071 10/2/2015 48 H Gia H N 5/12/2012 13130212 2/3/2015 49 Dng Tin Nam 16/1/2014 15084739 2/3/2015 50 Khng Tu A N 19/9/2014 15088460 11/3/2015 51 Dng Quc P Nam 18/1/2014 15065609 12/3/2015 52 Nguyn Quý Huy A Nam 8/2/2015 15087169 16/3/2015 53 Trn Bo C N 31/8/2014 15089238 16/3/2015 54 Trnh Mai L N 12/10/2014 15048299 16/3/2015 55 Nguyn Tho N N 24/8/2014 14333919 17/3/2015 56 Nguyn Trn Bo N N 8/9/2014 12323821 18/3/2015 57 Trn Ngc K 25/12/2013 14193974 19/3/2015 58 Hong Th Ngc A N 5/9/2014 15103559 19/3/2015 59 Nguyn Hu Yn N N 19/12/2014 15676797 20/3/2015 60 Lờ Trn Tho N N 20/1/2015 15078092 30/3/2015 61 Trn Xuõn T Nam 16/2/2015 15106055 31/3/2015 62 on Th Kim N N 16/9/2014 15109486 1/4/2015 63 Nguyn Lờ Gia B Nam 8/2/2015 15057543 1/4/2015 64 Phm Khỏnh T Nam 7/2/2015 15057164 3/4/2015 65 Nguyn Vn Nam 9/2/2015 15113249 6/4/2015 66 Nguyn Th Huyn T N 8/9/2014 15077159 6/4/2015 67 Nguyn Th H M N 4/12/2014 15072315 6/4/2015 68 Nguyn Th Thu G N 24/11/2014 15126505 6/4/2015 69 Lờ Khỏnh H N 20/11/2004 05043550 7/4/2015 70 Lý Anh T N 7/11/2014 156513663 7/4/2015 Nam STT H V TấN GII TNH NGY SINH M BNH NHN NGY KHM 71 Lõm Nht H N 4/9/2014 15059547 15/4/2015 72 Nguyn Th Thanh H N 28/8/2014 15141402 20/4/2015 73 Bựi Ngc D N 11/4/2014 15141028 21/4/2015 74 Nguyn Anh K Nam 19/3/2014 15143920 22/4/2015 75 Nguyn Hong Nht M Nam 15/7/2014 14100194 22/4/2015 76 Nguyn Cao M Nam 31/10/2014 14004229 22/4/2015 77 Phm Trớ V Nam 13/12/2014 15175570 12/5/2015 78 Phan Bo M Nam 1/12/2014 15184975 21/5/2015 79 Nguyn Thnh N Nam 16/2/2015 15167190 26/5/2015 80 Nguyn Ngc A Nam 24/4/2015 15152575 2/6/2015 81 Nguyn Hiu K Nam 15/7/2014 15001106 10/6/2015 82 Hong Linh C N 20/12/2014 15196236 11/6/2015 83 Nguyn Th Kim L N 31/10/2014 15220160 11/6/2015 84 Ngụ Linh C N 23/11/2014 15240122 29/6/2015 85 Phựng c K Nam 6/9/2015 15211578 30/6/2015 86 Bựi Trn Khỏnh C N 20/2/2015 15233470 30/6/2015 H Ni, ngy thỏng 11 nm 2015 Xỏc nhn Phũng KHTH Bnh vin Nhi Trung ng ...B Y T TRNG I HC Y H NI NG TH Lấ VINH NGHIÊN CứU ĐặC ĐIểM LÂM SàNG Và NGUYÊN NHÂN Dị ứng thức ăn trẻ em bệnh viện nhi trung -ơng Chuyờn ngnh: Nhi - 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