S THAY I HM LNG TSH MU GIT MT VNG BU C A PHNG

Nguyn Thanh H, Nguyn Tr Dng v CS. Bnh vin Ni tit Trung ng. The changes in the dried blood spot TSH level on the filter paper in the endemic goiter area. A study on 564 neonates and 962 school age children (SAC) 8-12 years in two areas: Ha noi city and three communes in Hoai duc district (Ha tay province) showed that dried neonate cord blood TSH level and SAC whole blood TSH level on filter paper in endemic goiter areas, iodine deficiency was higher in Hoai duc than in Ha noi city ( 8.607+- 6.812 and 7.22+-4.159; 5.15+-4.39 and 3.77+- 2.03 mu/l (P<0.01) respectively. Respectively at the 97th centile (cut of point), cut of value TSH neonates in Ha noi and Hoai duc, it was 14.15mu/l and 25.9mu/l, there were 14% of samples taken from Hoai duc having TSH level>14.15mu/l, mean while the rate of dried blood TSH cut of value should be lower than 3%. The author suggests that the determination of TSH in the dried blood spot of neonates and SAC is usful for the assessment of endemic goiter and ID status. Tm tt Nghin cu trn trn 564 tr s sinh (TSS) v 962 tr em hc ng 8 -12 tui (TEH) ca hai khu vc H Ni (ni thnh) v huyn Hoi c - H Ty (3x) cho thy Hoi c l khu vc c bnh bu c a phng (BCP) v H Ni l ni khng c BCP. Ti Hoi c, hm lng TSH mu git cung rn ca tr s sinh (TSHSS) v TSH mu git ton phn ca TEH (TSHTE), trn giy thm u cao hn H Ni tng ng l 8,607 6,812 (TSHSS) v 7,22 4,159 ; 5.15 4,39 v 3,77 2,03 (TSHTE) ; (X SD ; n v: mu/l) vi p < 0,01. Ti phn v 97% (im ngng) TSHSS khu vc H Ni v Hoi c tng ng l 14,15mu/l v 25,9mu/l. So vi khu vc khng c BCP (ni thnh H ni), th t l mu c hm lng TSH ln hn im tn xut 97% l14% (i vi TSHSS) v trn 20% (i vi TSHTE), trong khi t l hm lng TSH cao hn gi tr ngng cn phi thp hn 3% ( vng khng c BCP). Nhng kt qu trn chng t vng BCP th hm lng TSH mu git thay i. S thay i ny thy r khng ch hm lng TSH mu git s sinh m c TEH. Tc gi gi rng vic xc nh TSH trong mu git kh TSS v TEH c ch cho vic nh gi tnh trng thiu i-t v BCP.

1. T VN Trong tnh hnh hin nay khi vic dng mui i-t c trin khai trn phm vi ton quc vic iu tra nh gi BCP v CRLTI s gp nhiu kh khn nu ch da vo hm lng i-t niu. nhiu nc tin tin trn th gii vic xc nh hm lng TSH mu ton phn c p dng ngoi mc ch pht hin suy gip bm sinh v mt s bnh bm sinh khc n cn gip ch trong vic kim sot cc ri lon do thiu it. Hin nay nc ta cng ang trin khai nghin cu nh lng TSH mu git s sinh trong iu tra pht hin sm suy gip bm sinh ti khu vc thnh ph H ni, tuy nhin cha c nghin cu no c tin hnh vng BCP. V vy chng ti tin hnh nghin cu ny nhm mc ch tm hiu s thay i hm lng TSH mu git ca khu vc BCP Hoi c- H Ty v cung cp thm s liu cho cc ng nghip trong vic nghin cu suy gip bm sinh ti vng BCP ni vic ly mu gt chn v huyt thanh cn gp nhiu kh khn.

2. I TNG V PHNG PHP NGHIN CU 2.1. i tng: - Tr s sinh. - Hc sinh 8 - 12 tui. 2.2. a im: Huyn Hoi c - H Ty (3 x ven sng y) v H Ni (Thnh Quang - ng a). 2.3. Phng php: S dng phng php nghin cu m t. C mu tnh theo cng thc mu hai nhm m t, tnh c n = 384 ( tin cy 95%). + Mu nc tiu TEH: ly 1/4 s hc sinh khm. S mu cn ly l: 384/4 = 96 mu (thc t chng ti lm 141 mu). Ly mu theo phng php ngu nhin h thng. + Mu git TEH - Cch ly mu: cm ly ngn tay gia, sau khi st trng sch, dng kim chch ri nn tht nh nhng vi git mu v thm vo nhng vng trn trn giy thm. Cc ng tc khc ca vic ly mu git TEH tng t ly mu cung rn TSS nu trn. - S lng mu: ly mu mu git ca 1/2 s TEH c khm. S mu cn ly l: 384/2 = 192 mu (thc t lm 197 mu). + Sng lc s sinh: tt c tr c sinh ra ti trm y t ca 03 x ti Hoi c v ly mu git tr s sinh ti Bnh vin Bo v B m v Tr s sinh H Ni. - S lng mu: ti 03 x ca huyn Hoi c ly mu git ca tt c cc chu c sinh ra ti trm y t x trong thi gian 1 nm. Ti khu vc H Ni ly c 384 mu mu git s sinh. - Cch ly mu: ly mu cun rn tr s sinh ngay sau khi ct cung rn. kh t nhin t giy thm c git mu trong thi gian t 2 n 6 gi nhit phng. Sau khi git mu trn giy thm se kh, bnh phm c gi v labo hocmon Bnh vin Ni tit Trung ng v c bo qun trong t lnh nhit 20C n 80C. 2.4. Ch tiu v cc thng s cn thu thp - Khm bu c kt hp siu m chn on xc nh TLBC. - Ly mu mu git cung rn TSS v TEH nh lng TSH. - Ly nc tiu TEH nh lng i-t niu. 3. KT QU Bng 1: Phn b TSH mu git tr s sinh Khu vc H ni (n =384) Hoi c (n =180) Min 0 0,4 Max 32,3 38,7 25% 5,1 4,2 50% 6.5 6,3 75% 9,3 11,1 90% 12,1 18,4 95% 97% 99% VT: mU/l 99,9% 26,0 34,5

13,6 14,15 19,4 21,8 25,9 33,2

Nhn xt: - hu ht cc im tn xut tng ng th hm lng TSH mu git s sinh ca khu vc H Ty u ln hn ca khu vc H Ni. - Ring im tn sut 97% mc TSH TSS ca H Ni v Hoi c tng ng l 14,15mu/l v 25,9mu/l. S mu mu git ca tr s sinh H Ty c hm lng TSH ln hn 14,15mu/l (im ngng) l 14%. - Ti im tn sut 99% hm lng TSH TSS ca H Ni l 19,4 mu/l v hm lng TSH TSS ca khu vc Hoi c l 19,4mu/l. S mu mu git ca TSS H Ty c hm lng TSH ln hn 19,4mu/l l 8%.

Bng 2: So snh TSH mu git tr s sinh H Ni v Hoi c H Ty (n = 180) 8,607 6,852 0,4 38,7 *: Trung bnh lch chun Nhn xt: Hm lng TSH mu git ca tr s sinh Hoi c ln ca tr s sinh H Ni c ngha thng k vi p < 0,001. Bng 3: Phn b hm lng TSH mu git hc sinh Khu vc H ni (197) Hoi c (185) Min 0,9 0,4 Max 22,3 30 25% 2,6 2,3 50% 3,6 3,9 75% 4,6 6,2 90% 5,8 10,0 95% 6,1 13,1 97% 6,9 17,0 99% 8,0 21,5 VT: mU/l 99,9% 8,4 25,3 Cc gi tr X SD * Min Max H Ni (n= 384) 7,22 4,159 0 32,3 VT: mU/l p < 0,001

Nhn xt: Ti v tr th 97% hm lng TSH mu git ca hc sinh H Ni l 6,9mu/l, ca hc sinh H Ty l 17,0mu/l v c 20% s mu ca hc sinh H Ty c hm lng TSH ln hn 6,9mu/l. Ti v tr th 99% hm lng TSH mu git ca hc sinh H Ni l 8,0 mu/ml, ca hc sinh H Ty l 21,5 v c 13% s mu ca hc sinh H Ty c hm lng TSH ln hn 8,0mu/l. Bng 4: So snh hm lng TSH mu git HS H Ni v Hoi c. VT: mU/l Cc gi tr H Ni (n =197) H Ty (n = 185) p X 1SD * 3,77 2,03 5,15 4,39 Min 0,9 0,4 < 0,001 Max 22,3 30,0 Nhn xt: Hm lng TSH mu git ca hc sinh H Ty ln ca hc sinh H Ni c ngha thng k vi p < 0,001. Bng 5: T l bu c hc sinh H Ni v Hoi c a im S khm S mc T l bu c (%) H Ni (1) 400 6 1,5 Hoi c(2) 562 13 23,0 P1-2 < 0,01 Nhn xt: TLBC ca Hoi c cao hn ca khu vc H Ni c ngha thng k (p < 0,01). T l bu c (TLBC) ca khu vc H Ni tng ng vi vng khng c BCP v TLBC ca khu vc Hoi c tng ng vi vng BCP mc va. Bng 6. So snh hm lng i-t niu hc sinh H Ni v Hoi c VT: g/dl Khu vc X SD Mean Min Max 25% 75% H ni 34,77 25,82 29,4 5,0 284,0 20,8 45,0 (n =197) H Ty 9,75 10,94 5,4 1,5 58,0 3,3 10,4 (n = 141) Nhn xt: Cc gi tr hm lng i-t niu ca hc sinh khu vc H Ty u ln hn khu vc H Ni c ngha thng k (P < 0,01). Hm lng i-t niu ca hc sinh khu vc H

Ni tng ng vi vng khng thiu i-t cn hm lng i-t niu ca hc sinh khu vc H Ty tng ng vi vng thiu i-t mc nh 4. BN LUN - 3 x ven sng ca Hoi c H Ty l khu vc BCP mc va v c tnh trng thiu it, trong khi Thnh Quang - ng a - H Ni l khu vc khng c BCP, khng c tnh trng thiu it. Cn c vo s liu bo co ca chng trnh v kt qu iu tra ny c th ni rng Hoi c - H Ty (3 x) l vng BCP, thiu i-t mc va v H Ni (ni thnh) l khu vc khng c BCP, khng thiu it. Kt qu ny cng tng t s liu iu tra ca Chng trnh Phng chng bnh bu c nm 1998 v s liu ca ng Trn Du v tnh trng BCP ti Vn Cn - Hoi c [1],[2]. Nh vy tri qua 20 nm cho n nay tnh trng BCP Vn Cn vn tn ti vi mc va. - C s thay i hm lng TSH mu git s sinh ti vng BCP. cc im tn xut tng ng th hm lng TSH mu git s sinh ca khu vc H Ty u ln hn ca khu vc H n. Ti im tn xut 97% hm lng TSH mu git tr s sinh H Ni l 14,15mu/l, ca tr s sinh ca Hoi c l 25,9mu/l v c 14% s mu c hm lng TSH ln hn 14,15mu/l. Ti im tn xut 99% hm lng TSH mu git ca tr s sinh H Ni l 19,4 mu/l, ca tr s sinh H Ty l 33,2mu/l v 8% s mu ca tr s sinh H Ty c hm lng TSH ln hn 19,4mu/l. Mc trung v TSH mu git giy thm ca tr s sinh H Ni l 6,6mu/l. Theo s liu nghin cu trc y ca chng ti ti thnh ph Adelaide- australia (khu vc c xc nh l khng c BCP v khng thiu it) th im tn xut 97% hm lng TSH mu git cung rn ca tr s sinh gc Vit l 13,96mu/l [4]. Theo Fisher D.A. v Sach S. th gi tr ny l 9,5 mu/l, dao ng t 1-20mu/l tu theo phng php nghin cu [6]. Cc s liu ny cng tng ng vi kt qu nghin cu ca chng ti v mt s tc gi khc [7]. Hm lng TSH mu git TEH cng bin i vng BCP v c tnh trng nthiu i-t tuy khng nhiu, iu ny cng ph hp vi kt qu nghin cu ca chng ti [8], [9]. - Hm lng TSH mu git, t l bu c v i-t niu ca hai khu vc iu tra, u cho kt qu tng ng v tnh trng BCP v thiu it, n vy c th ni TSH mu git l mt ch s c gi tr cn nghin cu thm v c th p dng trong iu tra nh gi cc ri lon do thiu i-t (CRLTI) v bnh BCP. Hin nay mt s nc tin tin trn th gii v ang p dng phng php xc nh hm lngTSH mu git trong iu tra nh gi CRTLI v BCP [ 7], [ 8], [9 ]. Mt s tc gi cho rng ch s ny nu lm chnh xc c th thay th cho mt cuc iu tra [7], [9 ]. y l mt xt nghim c nhiu u im, n c th thay th vic ly mu tnh mch trn cng ng, rt tin li v c th p dng ngay c nhng vng xa xi ho lnh ni c tnh trng BCP. Tuy nhin cn lu n nhng hn ch ca k thut Li cm n Tc gi xin trn thnh cm n cn b phng CCK, khoa TDCN, Ktv. Nguyn Phng Khanh Bnh vin Ni tit Trung ng tham gia v gip ; cm n s phi hp v gip ca Bnh vin Bo v B m v Tr s sinh H Ni ; cm n S Y t, TTYTDP H Ty, TTYT huyn Hoi c v cc thy c gio, ph huynh hc sinh cho php, t chc v to iu kin chng ti tin hnh khm, ly mu. TI LIU THAM KHO 1. Chng trnh PCCRLTI(1998), Bo co tng iu tra dch t hc bu c H Ty nm 1998- Bo co Tng kt chng trnh PCCRLTI nm 1998. 2. ng Trn Du(1990),"Tnh hnh bnh bu c c pht hin min Bc nc ta", K yu cng trnh nghin cu khoa hc, Chng trnh chng Bu c Vit Nam 19711990,14 tr. 3-8)

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Nguyn Th Hon, Nguyn Thu Nhn, Cao Quc Vit v Cs (2001), "Chng trnh sng lc s sinh, Bnh suy gip trng bm sinh lm im ti H Ni 1998-2001", K yu ton vn cc ti khoa hc, Hi Ni tit -i tho ng Vit Nam, tr. 11-25 4. Costante-G(1997), " The statistical analysis of neonatal TSH results from congenital hypothyroidism screening programs provides a useful tool for the characterization of moderate iodine deficiency regions", J-Endocrinol-Invest, 20(5), p. 251-256 5. Wu L.L., Sazali B.S., Adeeb N.,(1999),"Congenital Hypothyroid Screening Using Cord Blood TSH", Singapore Med, Vol 40(01)