Bước đầu đánh giá rối loạn lo âu trên các bệnh nhân mắc một số

DIEN DAN Y HOC
Nghien cii'u khoa hpc
Btrdc dau danh gia roi loan lo au
tren cac benh nhan
mac mot so benh ly dj iJng
Nguyin Van Ooan*, Trjnh Ngoe Anh**
TOMTAT
Budc diu danh gia rii loan lo au tren cac benh nhan mac mot si benh ly di dng tai khoa Di dngMiSn djch lam sang Benh vien Bach Mai
Muc tieu; 1) Khao sat ehung vi ty le nhan each lo au d ngudi benh trong mot sdbenh ly di dng.
2) Danh gia mde do lo au tren ngudi benh trong mot si benh ly dj dng. Dat vin di: stress lo au cung
cac benh ly di dng dang ngay cang gia tang, nhiiu nghien cdu gin day tren thi gidi da ghi nhan mil
lien he gida lo au va cac benh ly di dng. Bdi tuang va phuong phap nghien cilu; 1. Dii tuang: 152
benh nhan dugc kham hay nam vien diiu tri dugc chin doan mot trong cac benh ly di dng tai khoa
Dj dng - MDLS Benh vien Bach Mai (2007-2008); 2. Phuang phap: md ta cat ngang; Ke't qua va ban
luan; 1. Vi dac diim nhan each lo au: Cac benh nhan mac benh ly di dng hiu hit cd dac diim nhan
each lo au td mde vda din cao, dac diim nhan each lo au cao nhat gap d cac benh nhan do tudi >40
tuoi, la can bd cdng nhan vien chdc. 2. Vi mde do lo au: mde do lo au tang din theo tudi, mde lo a
cao nhit d do tudi >40, benh nhan hen phi quan. Khdng cd su khac biet vi mde lo au gida 2 gidi,
ngudi da lap gia dinh hay chua, khoang thdi gian mac benh di dng va viec cd hay khong cd benh ly
man tfnh khac di kem. Ke't luan; cac benh nhan dj dng cd mde do lo au td mde vda din cao, tang din
theo tuoi va khdng cd su khac biet mde do lo au gida 2 gidi, da lap gia dinh hay chua, cd hay khdng
cd benh ly man tfnh khac di kem.
LDATVANDE
Cung vdi tdc do phat trien nhanh chdng ciia
nen kinh te thi trudng la sy gia tang tinh trang d
nhiSm mdi trudng, viec su dung tbudc va hda chat
khong diing chi dinh, nhjp do sdng khan truang,
nhiSu stress. CIc benh di ung nhu viSm miii dj
iing, hen phS quan, dj irng tbudc... cQng vi vay ma
cd xu hu(5ng ngly clng gia tang. Cung vdi sy gia
tang ciia cic benh ly liSn quan dSn dj irng-mien
djch thi stress vl lo au ciing da trd thanh phd biSn
trong cude sdng bien dai. NbiSu nghiSn ciru gan
day da ghi nhan mdi liSn quan giira lo au va van dS
dj irng d ngudi trudng thanh cQng nbu d thanh
thieu nien [2].
O Viet Nam bien chua cd ngbien ciru nao vS
van dS nay, vi vay nham gdp phan tim hieu thSm
ve mdi liSn quan giira cic benh ly dj irng va tinh
trang lo au, cbung tdi tien hinh nghiSn ciru dS tii
nly vdi cic muc dich chinh:
l.Khdo sdt ehung vi ty le nhdn cdch lo du ff
.ngudi binh trong mot sd benh ly di iing.
2.Ddnh gid miic do lo du trin ngudi binh
trong mot sd benh ly di iing.
* Khoa Dj Ung - Miin dich lam sang - Benh vien Bach Mai
** Ldp Y6 - Dai hoc Y Ha Ngi
So 46 (Ttnang 11/2009) Y HOC LAM SANG |
45
DIENDAN Y HOC
Nghien cifu khoa hpc
II. TONG QUAN
Di ung II nhirng trang thai khlc nhau ctia sy
biSn ddi tinh phan ting cua ca the, m l mot trong
nhiing biSu hien quan trgng la sy man cam ctia nd
ddi vdi nhung tic ddng khlc nhau ciia mdi trudng.
Lo au la bien tugng phln iing ty nhien ciia con
ngudi trudc khd khan, de dga ciia ty nhiSn vl xa
hdi, la tin hieu bio dgng bio trudc mdt nguy hiS'm
sap xay dSn.
Rdi loan lo au la su lo sg qui muc trudc mdt
tinh hudng xay ra cd tinh chat ma hd, lap lai vl
keo dai gay anb hudng tdi sy thich nghi vdi
cude song.
Trong Y van ThS gidi tiing cd nhiSu tai lieu ghi
nhan vS mdi liSn he giira cle rdi loan tam ly lo au
vl benb ly dj iing. Trong dd cd 2 hgc thuySt ldn da
dugc nSu ra nhlm ly giai ve mdi liSn he nay [2].
-Hgc thuyet sinh vdt [2]
Hoc thuySt sinh vat cho rang cle loai hinh di
ung vl cle roi loan lo au deu ed cle moi liSn he
cbung vS hda hgc than kinh vl hda hgc can triic.
Dya trSn cic bang chirng nghien ciru cho tbay tre
em hay xlu hd vl gugng gao thudng cd tang cudng
hoat ddng ciia he than kinh giao cam, thSm vao do,
cle bieu hien dj irng ciing nhu cic banh vi lo au
dSu cd mdi liSn he vdi he thdng limbic vl true
dudi doi-tuyen ySn (theo Kagan ciing cdng sy
1987,1988; Arcus, 1994). He thdng limbic liSn
quan dSn qua trinh diSu chinb cam xiic va cd liSn
he vdi true dudi doi-tuySn ySn nham kiem solt cle
phan ung ciia ca tbS trudc cic stress cap (Matthew,
2001).
Mot gil thiSt khac lai cho rang lo au vl cle
benh ly di irng cd mdi liSn he vS mat di truySn. CIc
moi liSn he vS di truySn da dugc chi ra la cd thS ly
giai tdi hon 75% mdi tuong quan (covariance)
giira cle benh ly di iing vl cle trieu chirng tam
benh hgc d cle tre em sinh ddi (Wamboldt,
Schmitz, & Mrazek, 1998). Gil thuySt nly phii
hap vdi cle nghiSn ctru ciia Slattery ciing cdng sy,
2002 va ciia Kagan (1991) trong dd cha me ciing
cac thanh viSn khlc trong gia dinh cua tre bj benh
ly dj irng di kem vdi rdi loan lo au cd ty IS mic
benh ly di irng cao ban so vdi nhdm chirng.
-Thuyit nhan thiic-hdnh vi
Hoc thuySt nly nhan manh vai trd cua mdi
46
IY HOC LAM SANG So 46 (Ttiang 11/2009)
trudng trong sy tiSn trien ddng thdi ctia cle benb
ly dj ung va rdi loan lo au. Hgc thuySt vS nhan
thuc-hlnh vi da thira nban rang thuySt diSu kien
hda kinh diSn da ly giai mdi liSn quan giira lo au
vl dj iing, trong dd lira tudi tre em vl thieu nien da
cd cac biSu hien dj irng (tir cac kich thich khong
diSu kien) lo au trudc sy tii diSn cua cic biSu hien
nly. Do dd tre se trai qua cam gilc lo au va sg hai
(dip irng cd diSu kien) di kem vdi cle trieu chiing
cua benh ly di irng (trd tblnb kich thich c6 diSu
kien). Hai trong cic nghiSn cuu da cung cap bang
chirng vl ung hd cho hgc thuyet nay la nghiSn cihi
ciia Craske (2001) chirng minh rang tiSn subj hen
ddng vai trd quan trgng trong sy tiSn triSn ciia cac
rdi loan hoIng sg va chting sg khoang rdng (agoraphobia), nghiSn ctru ciia Goodwin (2003) chi ra
rang cac con hen dy bao trudc cho sy tii diSn ciia
cle con hoIng sg.
Mdt sy ly giii khlc tir hgc thuySt nly cho rang
biSu hien di kem ciia rdi loan lo au trong cle benh
ly dj iing liSn quan dSn mdi trudng va viec gay dyng
hinh mau tir cha me. Ket qui ttr cle nghiSn ctru ciia
Butz and Alexander (1993), Bussing ciing cong sy
(1996), vl Slattery (2002) da chiing minh rang cac
tre bat chudc theo cle phln iing lo au cua cha me
trudc cic kich thich gay dj iing. ThSm vio do, cae
nghiSn ciru ctia Gupta (2000), Wamboldt ciing cong
sy (1998) da dua ra them cac bang chiing cho rang
mirc dd.lo au cao d cha me ddng vai trd quan trong
trong viec gia tang mirc lo au d tre.
Nhu vay d ca hai hgc thuySt trSn deu cd sy ly
giai cho mdi lien he giira rdi loan lo au vl cac benh
ly dj iing, tuy nhiSn ca bai hgc thuySt nay dSu e6
nhung ban che, ddi hdi can cd cic nghiSn ciru sau
hon nhlm cung d p thSm cac bang chiing iing ho.
- Cdc nghien ciiu tren thi giffi
Trong thyc banh y hgc tren the gidi da cd kha
nhiSu cic ngbien cuu ban luan vS cic khia canh
khac nhau ciia mdi lien quan giira roi loan lo au va
cle benh ly dj (ing
Theo nghiSn ciiu ciia Donaldson va Rosen
(1966) vS benh ly phu mach di truySn da nhan thay
stress va lo lu II mot trong nhDng ySu td nguy ca
lam gia tang tin sd ciia cic dgt biing phlt cSp tinh
ciia benb [7].
Theo nghien ciru ciia H. Hashizume ciing cdng
su trich ra tu tap chi chuyen dS Da liSu ctia Anh
DIENDAN Y HOC
Nghien cii'u khoa hpc
Qudc [9] thi stress va cle rdi loan tam ly ma hay
gap nhat la lo au llm nang ne thSm cle bieu hien
ngoai da trSn cic benh nhan cd viSm da tiSp xtic,
tir dd cac tic gil da dat van dS vS mdi liSn quan
giira lo au vdi cle rdi loan boat ddng ciia he thdng
miSn djch. Trong cle nghiSn cuu cua minh, cic tic
gia da sir dung thang lo au Spielberger nham dinh
gil mirc do lo au trSn cic benh nhan cd va khdng
c6 cic benh ly di irng. Va ket qua tir cle nghiSn
cuu dd da cho thay, mirc do lo au gap d cic benh
nhan cd benh ly viSm da tiSp xiic dac biet cao hon
so vdi cle benh nhan khdng cd benh ly dj irng nhat
II vS chi sd nhan cleh lo au (STAI-T) nham danh
gil miic do lo au trudng diSn d cic benh nhan nay.
Ciing ddng thdi trong nghien cuu nay, cac tie gia
da tiSn hanh danh gil va nhan thay lugng IgE toln
phan trong buySt tuang tang song song ciing vdi
mirc do lo au danh gil theo chi sd nhan each lo au
(STAI-T), ty IS STAI-T/STAI-S, trong khi lai
khong cd mdi liSn quan ddi vdi chi sd trang thai lo
au (STAI-S), mirc do ngira trSn lam sang, sd lugng
bach cau li toan trong mlu ngoai vi va ty IS
Thl/Th2 ty IS nghjch holn toln vdi muc do chi sd
nhan elch lo au va ty IS STAI-T/STAI-S. Sy tdng
hgp IgE trong mlu la sy dieu boa ve chirc nang
giira 2 loai tS bao Thl-te bio san xuat Interferon
gamma va Th2-tS bao san xuat Interleukin
gamma, khi cle tS bio Th2 boat ddng manh ban,
ca thS se tang tdng bgp IgE. Cac tac nhan gay
stress tam ly va lo au dSu tic ddng thdng qua true
dudi ddi- tuySn ySn lam tang cudng giai ph6ng
hormone tuySn vd thugng than II cortieoid va kich
thich he thdng than kinh giao cam llm tang mirc
giai phdng catecholamine. Ca hai loai hormone
tren deu cd tic dung diSu hda ddi vdi sy biet boa
vS chirc nang ciia cac tS bao T cting cic tS bio
miSn dich khlc. Do dd, nhiSu kha nang cic stress
cap tinh vl rdi loan lo au lap lai trudng diSn trSn
cle benh nhan viSm da tiSp xiic llm gia tang mirc
do lo au trudng diSn trSn cac benh nhan nly vl cd
the da kich thich llm tang cudng dip irng mien
djch qua ele tS bao Th2. Tir dd cac tic gia riit ra
kSt luan td nghiSn ctiu nly va cho rang cic benb
nhan cd benb ly viSm da tiSp xiic cd miic do lo au
cao ban so vdi cic benh nhan khong cd benh ly dj
ung va d nhtrng benh nhan nly miic do lo au
trudng diSn ctia hg cao se lam tang cudng mirc
tdng hgp IgE trong buySt tuong thdng qua xu
hudng lam tang boat ddng cua cic tS bao Th2
[4][5][6][12].
Gin day nhit cic ngbiSn cuu ciia Hashizume
Cling cdng su [10] da cho thay nhirng benh nhan
cd bieu hien dj ung thudng bdc Id cic rdi loan vS
tam ly dac trung bdi lo au, tram cam vl hung
cam. CIc stress cam xiic llm khdi phlt cac trieu
cbung ciia benh di irng khdng chi bdi lam gia
tang muc do lo au m l cdn gay rdi loan chirc nang
diSu hda miin djch. CQng theo cic nghiSn ciru
ciia cle tic gil thi cle benb nhan cd rdi loan lo
au thudng biSu bien mgt mdi liSn quan mat thiSt
vdi cle biSu hien lam sing ciia benh ly dj trng.
CIc stress cap vdi tinh chat lap di lap lai vl dien
biSn man tinh cd xu hudng anh hudng rd ret dSn
dien biSn benh ciia benb nban ban la cic lo au
tai thdi diSm hien tai. Cac rdi loan vS tam ly nay
da llm gia tang dip trng miSn djch qua tS bao
Th2 do sy rdi loan diSu hda ciia he thdng than
kinh miSn dich dan dSn llm tram trgng them cac
biSu hien benb dj ung. Tandospirone, mdt chat
ddng van tai receptor 5-hydroxytryptamine IA
vdi tie dung giai lo au, chdng tram cam da c6
tic dung cai thien rd ret cle trieu chirng ctia
benh dj ung thdng qua viec kiSm solt tblnb cdng
cac rdi loan vS cam xiic [11] [13].
Cho dSn nay viec tim kiSm cac phuong pblp
dieu trj mdi, dac hieu theo ca chS benh sinh, cd
hieu qua, cd chat lugng, ban chS cic diSn biSn
khdng mong mudn, dac biet II nhCng van dS anh
hudng tiSu eye liSn quan dSn cle benh ly dj irng
dang la hudng phan dau ciia cic nhl khoa hgc
chuySn nglnh trSn toln the gidi. Tir nhirng kSt qua
nghiSn ciru trSn da md ra mdt hudng nghiSn ciru
mdi vS phuong thirc can thiep diSu trj trong cic
benh dj irng do II cle can thiep vS tam ly nhu
thudng xuySn theo ddi dinh gil, kiem solt mtre do
lo au di kem vdi biSu hien benh dj ung nhu II nSn
tang dS gdp phan lam cii thien tinh trang benh dac
biet tren cic benh nhan dj irng cd biSu hien rd ring
cle rdi loan vS lo au [8].
III. DOI TU^UNG VA PHITDNG PHAP NGHIEN CITU
Chiing tdi chgn 152 benh nhan dugc khIm
hoac nam vien diSu trj tai kboa Dj iing miSn
djch lam sang, Benh vien Bach Mai. Benb nhan
So 46 (Ttiang 11/2009) Y HOC LAM SANG j 4 7
DIENDAN Y HOC
Nghien cu'u khoa hpc
dugc chan doan mdt trong sd c i c benh di ung
sau: viSm mui dj irng, hen phe quan, dj irng
tbudc, dj ung thuc an, dj irng my pha'm, dj irng
hda chit, viSm da tiSp xtic... theo diing tiSu
chuan cha'n doln, tudi 15-85, ty nguySn tham
gia. Loai trir cic benh nhan: benh nhan khdng
dti tiSu chuan chan doln mgt benh ly di ting
nio, benh nhan nhd tudi (<I5 tudi), cd cic
benb ly kSm theo khdng thich hgp cho nghiSn
cuu (rdi loan phlt triSn tam than...), khdng
ddng y tham gia.
Phuong pblp nghiSn cuu la md ta cat ngang.
Phuang pblp thu thap thdng tin bang phong van
tryc tiSp theo bd eau hdi va tap trac nghiSm dinh
gil mirc do lo au ciia cac benb nhan dya vio cle
cht so trang thai lo au vl chi sd nhan each lo au
theo thang lo au Spielberger [1].
Thang lo au Spielberger do Charles
Spielberger pblt minh ra vio nam 1970 bao gom
40 cau hdi trie nghiSm de danh gil muc do lo au
tai thdi diSm dugc phdng vln (chi sd trang thii lo
au STAI-S) va muc do lo au trudng diSn (cbi so
nhan elch lo au STAI-T) vdi cbi chua day 10
phiit. So vdi cic thang dinh gil lo au khlc, cle
cau hdi trong bd cau hdi cua Spielberger khdng bi
anh hudng kSt qui bdi cle trieu chiing thyc thS
ciia benh nhan do dd la tbang lo au duge sir dung
rdng rai nhat trong cac nghiSn ciru vS lo au va c6
thS Ip dung d hau khap cic benh nhan thugc moi
chuySn khoa trSn lam sing. Thang danh gil nly
da dugc dich ra ban 40 thu- tiSng trong dd cd ban
chuan hda tiSng Viet ciia Bd mdn Tam ly Y hoc,
Trudng Dai hgc Y HI Ndi [1].
Pban loai muc do lo au theo thang Spielberger:
<30
31-45
46-64
>64
Lo
Lo
Lo
Lo
au
au
au
au
miic do thap
miic dd vita
miic do cao
CO xu hudng benh ly
IV. KET QUA VA BAN LUAN
- Danh gil cbung: kSt qua nghiSn ciiu thu dugc trSn 152 benh nhan mac benh ly di irng nhu sau:
!,•
Thap
So benh nhan
Ty le (%)
8
5,26
Viirc dd chi sd nhan each lo au
Vtra
Cao
Benhly
83
60
1
54,61
39,47
0,66
KSt qua nay cho thay chi cd 5,26% sd benh
gidi ban tren ciia muc lo au vira.
nhan II cd mtic do lo au thap (khdng ding ke)
Day cd thS ndi la cac con sd ding bio dong
con cd tdi gan 95% (144/152) benh nhan cd mirc
v l gan tuang ty vdi kSt qua nghiSn ciru ctia
lo au tu vira trd len trong dd lo au tir muc do cao
Stauder (2002) khi dng thu dugc trSn 646 benh
trd ISn cd tdi 61 benh nhan (chiSm 40%).
nhan dj ung vdi mirc do lo au trung binh II 42,9
Muc do chi sd nhan cleh lo au trung binh
ctia man nghiSn ctru la 44,11 ± 9,307 tuc II d
Ngbe
nghiep
CInbg
Lam rugng
Hgc sinh
Noi tra
Khac
Tong sd
48
± 10,7 [3]
- Dinh gil muc lo au theo nghS nghiep:
Mirc do cbi sd nban
Thap
Vita
3(5)
32 (48)
1(5)
14 (48)
2(8)
11(78)
2(40)
2(40)
each lo au (%)
Benb ly
Cao
31 (47)
0
14 (47)
0
4(14)
0
0
1(20)
Tong sd
66
29
17
5
0
24 (72)
10 (26)
1(2)
35
8
83
60
1
152
IY HOC LAM SANG So 46 (Ttiang 11/2009)
DIEN DAN Y HOC
Nghien cii'u khoa hpc
Trong 2 nhdm nghS nghiep chinh ciia mau
nghiSn eun cung chinh la 2 nhom nghS nghiep co
ty IS benh nhan cd chi sd nhan cleh lo au mirc do
cao la nhiSu nhit (47% can bd cdng nhan viSn
chuc vl 47% ngudi lam rudng).
Trong sd cic benh nhan cd chi sd lo au d mtre
cao cd dSn 5 1 % la cin bd cdng nhan viSn chirc.
- Dinh gil mirc do lo au theo tudi
STAI-T
n
<20
Mean
42± 10
22
20-29
Mean
41± 11
21
30-39
Mean
41 ± 8
20
Do tudi
40-49
Mean
48 ± 11
23
50-59
Mean
45±9
25
60-69
Mean
46 ± 8
30
>70
Mean
45 ± 7
11
Trudc hSt khi tien hanh nghiSn cihi mdi tuong quan giira mirc do lo au theo tudi chiing tdi nhan tbay miic
do lo au ctia cic benh nban tang dan tbeo tudi vdi miic y nghla thong kS (p = 0.007 theo Pearson test). Trong
dd cic nhdm tudi ttr >40 tudi hau hSt dSu cd mde do lo au ttr muc cao trd ISn (trung binh > 45).
Nhu vay, van dS rdi loan tam ly lo au nSn dugc dac biet quan tam vdi cle benh nhan di irng tu tudi
trung niSn trd di.
•
- Dinh gil theo benh ly dj ling da (dang) mac:
Benb ly di dng
n
Tudi
STAI-T
Di itng tbudc
Mean
74
45 ±21
42 ± 10
4- Trong 152 benh nhan dugc nghien cuu 2
benh ly gap chti ySu va ndi bat blng dau II dj irng
tbudc (74 benh nhan chiem 48,68%) va hen phS
quan (65 benh nhan chiem 42,76%), cac benh ly dj
ling khlc chi chiSm 8,56% (13/152 benh nhan).
+ Trong sd 74 benh nhan dugc chan doln dj iing
tbudc ty IS nam/nir la 54/46, do tudi tmng binh II45
± 21. Chi so nhan each lo au tmng binh II42 ± 10.
-I- Trong sd 65 benh nhan hen phe quan dugc chan
doan ty IS nam/nir II 49,2/51,8, do tudi trung binh la
56 ± 15. Chi sd nhan each lo au tmng binh II46 ± 9.
-I- Tir kSt qui thu dugc cho thay cle benh nhan
hen phS quan co xu hudng lo au trudng diSn vdi
mtJC do cao ban so vdi cic benh nhan dj irng tbudc
(Mann Whitney test p <0,05). Tuy nhiSn kSt qua
tren day co thS' chua cbinb xlc do cic benh nhan
hen phS quan cd do tudi cao ban han so vdi cic
Hen phe quan
Mean
65
56 ±15
46 ± 9
benh nhan dj irng tbudc.
- CIc ket qua khlc:
-I- Dinh gil theo gidi: chi sd nhan cleh lo au d
nam la 44 ± 10 va d nir la 44 ± 8.
KSt qua nghien ciin cho thay sy khac biet vS
muc do nhan each lo au giiJa 2 gidi la kbdng ding
kS (Mann Whitney test p>0,05).
-I- Dinh gil theo tinh trang hdn nhan:
Chi sd nhan cleh lo au trung binh ciia 127 benh
nhan da lap gia dinh la 45 ± 9 va ciia 25 benh nhan
chua lap gia dinh II 42 ± 9.
Nhung ngudi cd gia dinb cd mirc do lo au khdng
khlc biet mgt cleh cd y nghTa so vdi nhirng ngudi
chua lap gia dinh (Mann Whitney test p > 0,05).
-i- Danh gil theo cd hay khdng cd benh ly man
tinb khlc kem theo
KSt qui cho thay nhirng benh nhan cd benh ly
So 46 (Ttiang 11/2009) Y HOC LAM SANG |
49
DIENDAN Y HOC
Nghien cifu khoa hpc
man tinh kem tbeo (nhu viSm da khdp dang thap,
lupus ban do, dii thIo dudng, tang huy St Ip... ma
khdng phai benb ly dj ung) khdng cd khlc biet
ding kS vS miic do lo au so vdi nhimg benh nban
kbdng cd benb ly man tinb kem tbeo (Mann
Whitney test p>0,05).
-1- Dinh gil theo khoang thdi gian bj benh. kbdng
cd sy khlc biet ding ke vS mirc do lo au giiia cac
nhdm bj benh vdi khoang thdi gian bj benh khlc
nhau (cle nhdm bi benh <1 nam, 1-5 nam, 5-10 nam
va >10 nam). (Kruskal Wallis test p>0.05).
V. KET LUAN
Qua nghiSn ctru d i n h g i l budc dSu vS roi loan
tam ly lo au tren c i c benh nhan c6 benh ly dj iing
nhu trSn chiing toi di dSn mdt sd kSt luan sau:
- Ve dac diem nhan c l e h lo au: cac benh nhan
m l c benb ly dj ung ban hSt cd dac diem nhan cleh
10 au tir mirc vtra dSn cao, dac diSm nhan each lo
au cao nhat gap d cle benh nhan do tudi >40 tuoi,
11 can bo cdng nhan viSn chtrc.
-VS mtre do lo au: muc do lo au tang dan theo
tudi, mirc lo au cao nhit a do tudi >40, benh nhan
hen phS quIn. Kbong c6 sy k h l c biet vS mirc lo au
giira 2 gidi, ngudi da lap gia dinh hay chua,
khoang thdi gian mac benh dj iing va viec cd hay
khong cd benh ly man tinb k h l c di kem.
TAI LIEU THAM KHAO
1. Cdc test trac nghiem tdm ly Bd mdn Tdm ly Y hoc
trudng Dgi hoc Y Hd Ndi 1999.
2. AbbyH.Friedman and TracyL.Morris (2006) Allergies
^\
3**
50
and Anxiety in Children and Adolescents: A Review of
the Literature. Springerlink 2006
3. Adrienne Stauder, Munika Kovacs (2002): "Anxiety
Symptoms in Allergic Patients: Identification and
Risk Factors "
4. Buske-Kirschbaum A, Geiben A, Hellhammer D.
Psychother Psychosom (2001) Psychobiological
aspects of atopic dermatitis: an overview; 70:6-16.
5. Buske-Kirschbaum A, Gierens A, Hollig H et al
(2002) Stress-induced immunomodulation is altered
in patients with atopic dermatitis. Journal of
Neuroimmunology; 129:161-7.
6. Del Prete G (1992) Human Thi and Th2 lymphocytes: their role In the pathophysiology of atopy.
Allergy; 47:450-5.
7. Donaldson VH, Rosen FS (1966) Hereditary angioneurotic edema: a clinical survey. Pediatrics 37:1017.
8. EricB.Weiser (2007) The Prevalence of Aiulety
Disorders Among Adults with Asthma: A MetaAnalytic Review. Springerlink 2007
9. H. Hashizume; T. Horibe; A. Ohshima, T. Ito; H Yagi;
M. Takigawa (2005) Bristish Joiinal of Dermatology
152(6) 1161-1164. Blackwell Publishing
10: H. Hashizume, Hideo, Takigawa, Masahiro (2006)
Current Opinion In Allergy & Clinical Immunology
6(5): 335-339.
11. Paul - Fundamental Immunology 5th edition (2003)
Chapter 3
12. Rostalng L, Tkaczuk J, Durand M et al (1999)
Kinetics of intracytoplasmlc Thi and Th2 cytokine
production assessed by flow cytometry following in
vitro activation of peripheral blood mononuclear
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13. Roy Patterson (2002) Patterson's Allergic Diseases
6th ed Chapter 4.
SUMMARY
INITIAL EVALUATION OF TRAIT AXIETY ON ALLERGIC PATIENTS AT DEPARTMENT OF
ALLERGOLOGY AND CLINICAL IMMUNOLOGY IN BACH MAI HOSPITAL
Introduction: stress, axiety along with allergic diseases have been becoming more and more common, many
studies all around the world have confirmed the relasonshlp between anxiety and allergic diseases. Object and
method: I. Object: 152 out-patients and in-patients diagnosed one of some allergic diseases at the
Department of Allergology and Clinical Immunology (2007-2008). Method: Cross-sectional surveys. Goals:
1. Generally Investigate on levels of trad anxiety in allergic patients. 2. Evaluate scores of trad axiety in allergic patients. Results and discussions: 1. Levels of trad axiety: generally, allergic patients had moderate to
high level of trad axiety; highest levels of trait axiety were seen in patients who were officials at the age over
40. 2. Scores of trad axiety: scores of trait axiety increased with ages, highest score were seen in patients at
the age from 40-49 and had asthma; there were no difference between sexes, different marital status, duration
of allergic diseases or whether having associated non-allergic chronic diseases or not. Conclusions: allergic
patients had moderate to high level of trad axiety; scores of trad axiety increased with ages; meanwhile there
were no difference in level of axiety between sexes, marital status or whether having associated non-allergic
chronic diseases or not.
IY HOC LAM SANG So 46 (Thang 11/2009)