1. Ty I~ mang Khang nguyen be m~t virut Viem gan - B DIIClng tinh phan batheo de;; tueSi.
Trang 2.363 mau huyet thanh ella tat ca nhung ngLioi dLi<)C Thu nghi$m vi} HBsAg dLi<)c xep theo 7 do tuoi khac nhau. ket qua cho thay nhLi sau (Bang 1).
D91uOi s6 mau HB,Ag Ty I~ Ph~m vi d9 tin c~y Xac suat huy€t thanh (+) ('Yo) cuatY I~. 1 - P%
< 1 - 5 112 10 8.92 892 ± 4.704 >95% ......... 6 - 15 290 40 13.79 13.79 ± 3.332 16 - 25 351 63 17.94 17.94 ± 2.744 26 - 35 934 106 11.34 11.34 ± 1.764 ..._...-....•.._...-..._.._...- ... ...•...•... 36 - 45 486 81 16.66 16.66 ±3.136 ... ... 46 - 55 137 12 8.75 8.75 ± 4.508 .. ... ...... " 56 53 13 24.52 24.52 ± 10.976 Tong cOng 2363 325 13.75 13.75 ± 0.784
Trang 2.363 mau mau dLi<)c lam Thu nghi$m HBsAg c6 325/2363 mau dLiong tinh. Chiem ty 1$ 13.75%. xel gia tri thong ke bang nghi$m phap chuan voi p=5% la c6 AP=1.96 voi do tin cay 1 - pOlo =0,95.
2. Ty I~ mang Khang nguyen bi> m~l virul Viem gan - 8 Dlidng linh phiin bolheo cac nhom do; It/ling khac nhau (81mg 2).
Nhom doi tLiong So mau HBsAg TYI! Philm vi do tin cay huyet thanh (+) (%) cua tY I~
Khbe milnh 1732 163 09.41 09.41 ±01.176
... ... ...... ...
B~nh nhan Viem gan 161 83 5555 5555 ± 07.448
Benh nhan khac 135 30 22.22 22.22 ± 06860
Xo gan 09 07 7777 7777 ± 27.048
Ung thLi gan 05 05 (')
Cho mau 312 37 1152 1152 ± 03332
(') ChUa linh vi som~ucon thap.
Qua bang 2 ta thay ty 1$ mang H8sAg (+) 0 nhom XcJ gan rat cao (77.77%). Tuy nhien so m~ucua Nhom XcJ gan va Ung thU gan con qua thap bOi than nhan cua so benh nhan nay qua cha:n doan Lam sang deu dUa so doi tUt;Jng nay ve cac b$nh vi$n Idn 0 Tp. HCM va Ha Noi d~ chua trio Vdi doi
tUt;Jng Ung thU gan do dieu ki$n va hoan canh t(li Lam 80ng chi thu nhiin dUt;Jc 5 ca Ung thU gan va dac biet ca 5 ca nay trong huyet thanh deu xuat hi$n HBsAg (+), vi ccJ som~u con thap nen chUa danh gia Iy Ie la 100%.
Co mot dieu chi'ic chi'in so b$nh nhan XcJ gan nay co Iy Ie HBsAg (+) kha cao so vdi quan th~ chung cua ngUOi binh Ihuong cho nen ngoai HBsAg co
th~khao sat tMm ve H8eAg hoi;ic cac dau an mi~n dich khac.
Song dl,!a vao1 so cong trinh da nghien cuu ve ngUOi benh HCC co HBsAg trong huyel thanh da dUt;Jc danh gia nhU sau :
• Tren 76 benh nhan HCC da dur,1c xac chuan ly Ie nay la 82%, phil hr,1p
voi ly Ie dEi thong bao eva WHO - 1983 la 80 - 90% benh nhan HCC CJ
Chau Ava Chau Phi c6 HBsAg trong mau (Phan Thj Phi Phi, Ha Van M:;10 - EJ(li hoc Y - HN& Vien Quan y 108 HN 1993).
• B~ng ky thuiil RIA, nghien cuu tren 14 ea HCC thay 72% s6 nay c6 HBsAg (1987 - Hoang Thvy Nguyen, Nguy~nThu Van - Vien VSDTH - HN) xac dinh HBsAg vol Kit ELISA tl,l san xual kel qua cho Ihay 54% b$nh nhan HCC c6 HBsAg (+). Thl,lc te s6 benh nhan nay chua dur,1c xac
chuan ma chi dl,la vao chan doan Lam sang (Theo bao cao cva Nguy~n
Thu Van t(li hQi nghi Mi~ndich hoc vi$n Quan Y - 1992).
• Ph(lm Hoang Phi$t chan doan HCC, ehv yeu b~ng xae dinh AFP voi ky thuiil Ouchlerloney thay c6 76.8% b$nh nhan c6 HBsAg. Nhung cOng chua loai bodur,1c 56 AFP DI,lr,1ng tinh gia (1992).
• Tren 16 benh nhan HCC dEi xac chan eva benh vien K Ha No; ket qua cho thay c6 76% HBsAg (+) vol ky thuat Elisa, Ihu6c thll Organon
(Nguy~nGiang - 1989).
Nh6m benh nhan Viem gan chiem ty 1$ cOng rat cao (55.55%). Ty Ie HBsAg (+) cva Nh6m Cho va Hien mau la 11.52% thap hcm so va; nh6m benh nhan khac (22.22%) vi da c6 51,1 sang loc trong qua Irinh kiem tra mau, 56 nguol cho va ban mau chuyen nghi$p sau khl Thll nghiem c6 HBsAg (+) dEi bi 10(11 bo, khuynh huang hien nay de tranh lay nhi~m HBV cOng nhu HIV la khi that can thiet thi nguoi lrong cilng mol gia dinh khong
n~m trong nh6m e6 nguy cd cao cho mau la t6t nhal (Hit nhien la phai
Bang 3:
Muc do mang HBsAg(+)tren nhung doi tlic;lng khac nhau lei Tlnh Lam £long
HB,Ag 1+)% 80 70 60 50 40 30 20 10 o %' %' ~ !l ~ ~ £loi tliong '" '" '$ iJ· ~ .>$' ..£ :§ .f? .& ..~ t! <> s: ~ ~ '$ ~. ~ ~ -~ '%' Q;,' ~ ~ ~~ #
3. Ty I~ mang Khang nguyen be mat virut Viem gan - B Dliang tinh trang nhom Nhiin vien Y te. (Bang 4).
El6 lu6i Somau HBsAg TV Ie Ph?m vi do lin caY
huyellhanh (+) (%) cua IV Ie
18 - 50 122 12 9.83 9.83± 5.096
Trang 122 Irliong hOp Nhan vien Y Ie dlioc lam xal nghiem HBsAg, co 12/122 Irliong hop Dliang tinh - chiem tv 1$ 9.83%. Nhli vay tv 1$ trang nh6m nay luong duong voi tv Ie HBsAg Duong tinh trang nh6m nguoi khoe m?nh (9,41%).
4. So sanh ty I~ mang HBsAg DLiong tinh giua Nam va Nu. Bang 5
Gioi s6 mau HBsAg TV 1$ Ph"m vido tin c$y
huyet thanh (+) (%) cuatvl$
Nam 1227 194 15.81 15.81 ±1.960 ...,... ... ....... ...
N[) 1136 131 11.53 11.53 ±1568
Voi so li$u thu nhan dLlc;JCW 2 giol Nam va N[). Bling nghi$m phlip thong ke, ta co I t I ,;; 1.96. Do do Sl! khac nhau g;[)a 2 tv 1$ nhiem Virut HBV cua Nam vii N[) Iii hoiln toiln ngllU nhien, khong co ynghTa thong ke vai do tin cay P~ 0.95.
5. So sanh de;; chinh xac cua cac phLlong phap Thllnghi~mHBsAg. f)e danh gia do chinh xac cua cac phLlong phap Thti nghiem HBsAg, trong ph"m vi de tili nily cling da Thti nghi$m tren cung mot so mau huyet thanh (n =70) dLlc;Jc kiem tra bling ky thuat mien dich men (Elisa) vai sinh vat ph~m Iii Micro Elisa - HBs; Elisa IMx HBsAg (Abbott) vii ky thual ngLlng ket hong cau thu dong ngLlc;Jc (SERODIA - HB s).
Ket qua cho thay nhLl bang sau: Bang 6
Micro Elisa-HBs SERODIA-HBs ELISA 1M, HB,Ag
sn Eloiltic;Jng (Vi~nVSDTH-HN) (Japan) (Abbott-USA)
n HBsAg (+) n HBsAg (+) n HBsAg (+)
1 NgtilJi khbe m.nh 30 3 30 3 30 3
.... ... ...-.....,...,
2 Ngtibi cho mau 30 4 30 3 30 4
...... ... ... ...•....
3 Nhan vien y te' 10 1 10 1 10 1
TOng cOng 70 8 70 7 70 8
Trong 70 mau huyet thanh co 8 mau HBsAg (+) Ian thli nhal voi Thti nghi$m ELISA, bo Kit Micro Elisa - HBs do Labo Viem gan Vien v$ sinh Dich te hoc Hil noi san xuat. So huyet thanh nily dLi<;!c test I"i Ian thli 2 vai Kit SERODIA - HBs do hang Fujlrebio -inc (Nhat) vii song song test Ian thli 3 vai Kit Elisa IMx - HBsAg hilng Abbott Laboratories. Ket qua cho thay tLlC1ng dLlC1ng nhau.
A. SANG ElQC KET QuA HSsAgKit Micro· Elisa (Vi$n VSDTH . Ha NQi)