Xây dựng chính sách bảo vệ sức khoẻ cho quân nhân đóng quân tại các vùng ô nhiễm chất độc hoá học dioxin

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cue KHOA
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BAO CAO TONG HOP
DE TAI DTDL.2007G/52
XAY DlTNG
CHINH
SACH BAO VE SlTC KHOE CHO QUAN
NHAN DONG QUAN TAI CAC VUNG 6 NHIEM CHAT DOC
HOA HOC/DIOXIN
Chu nhiem de tai: Dai ta, PGS.TS Hoang Van
Luong
Cu quan chu tri: Hoc vien Quan y, Bo Quoc phdng
Ha Ndi - 2010
16 I
%
jl04$
BANG
CHtr
VIET TAT

CDHILDIOXIN:
Chat ddc hda hoc/Dioxin
CCB:
BTTS
DTBS
ppm
TCDD
LD50
ClTU
chien binh
Bat thudng thai san
Dl tat bam sinh
Parts per million (mot phan mot trieu)
Tetra-chlorodibenzo
- p dioxin
Lieu chet 50%
DOiN
VI THAM GIA NGHIEN CUtJ
1.
Cue
Chinh sach - Bo Qudc Phdng.
2.
Cue
Khoa hoc Cdng nghe va Mdi trudng - Bo Qudc Phdng.
3.
Bo Lao Dong thucmg binh va Xa hoi.
THANH VIEN THAM GIA NGHIEN
ClTU
>
1.

TS Tran Van Minh -
Cue
phd
Cue
Chinh sach.
2.
Ths. Tran Qudc Diing - Trudng phdng khoa hoc -
Cue
chinh sach.
3.
TS. Vu Thanh Thao -
Cue KJioa
hoc cdng nghe va Mdi trudng.
4.
Tran
Due
Hoan - Nguyen
Cue
phd Cue bao
trg
xa hoi -
BLDTB&XH.
5.
TS. Nguyin Hai Him - BLDTB&XH.
6. TS. Le Nam Cung -
Chii
Nhiem Chinh tri - Hoc vien Quan y.
7.
TS. Nguyen Duy Bac - Giang vien Hoc vien Quan y.
8. Ths. Nguyen Van Ba - Giang vien Hoc vien Quan y.

9. Bs. Nguyen The Tai - Hoc vien Quan y.
10.
Bs. Dang Tien Trudng - Hgc vien Quan
y.
MUC LUC
• •
MdDAU
1
Chuang 1. TONG QUAN TAI LIEU 3
1.
Anh hudng cua Dioxin den
sue
khoe cua con ngudi 3
1.1. Doc tinh cua Dioxin 3
1.2.
Tac hai cua CDDC/ Dioxin
tren
ngudi 3
1.2.1.
Tac hai
ciia
CDDC/Dioxin vdi
sire
khoe sinh san 7
1.2.2.
Kha nang gay benh ciia CDDC/ Dioxin 7
1.2.3.
Cac tac hai toan than va tren cac ca quan chuc nang cua ca the
10
1.2.4.

CDDC/Dioxin va ung thu 10
1.2.5.
Danh gia tac hai lau dai cua CDDC/Dioxin tren
sue
khoe eon ngudi
12
1.3. Mgt sd nghien cuu ve anh hudng cua Dioxin den
sue
khde con ngudi 13
2.
Muc do
6
nhiem va
Snh
hudng CDHH/Dioxin den moi trudng d cac
viing
ndng 17
3.
Mot so chu trucmg va chinh sach cua Nha
nude
19
5.i.
Tong quan vi
ddi
tirong chiu hau CBHH/Dioxin
& Viet
nam
19
3.2. Mot so chinh sdch da cd
ciia

Nhd nu&c vd Qudn dpi nhdm bdo ve
site
khde qudn nhdn dang song viing ndng 23
3.2.1.
Mdt sd che do bao dam
sue
khde cho quan nhan 23
3.2.2. Mdt sd che do luan chuyen can bo cho quan nhan 25
3.3. Mot so chinh sdch tra
cdp
cho
ngn
nhdn bi hdu qud CBHH/Bioxin 27
3.3.1.
Quylt dinh Sd 26 /2000/QD-TTg (3/2/2000) cua Thu Tudng Chinh
phu 27
3.3.2. Nghi dinh 07/2000/ND-CP ngay 9/3/2000 cua chinh phu 29
3.3.3.
Quydt dinh sd 120 /2004/QD-TTg (5/7/2004) cua Thu Tudng Chinh
phu 30
3.3.4. Quylt dinh
16/2004/QD-TTg
(5/2/2004) cua
thii
tudng Chinh phu 32
3.3.5.
Nghi dinh 54/2006/ND-CP (26/5/2004) ciia Chinh phu 32
3.3.6. Nghi dinh sd 07/2008/ND-CP (21/1/2007)
ciia
Chinh phu 35

3.3.7. Nghi dinh 67 /2007/ND-CP (13/4/2007)
ciia
Chinh
phii
36
3.3.8. Nghi dinh
105/2008/ND-CP
(16/9/2008) cua Chinh
phii
37
3.3.9. Danh gia tdng quat ve chinh sach ddi vdi ngudi bi hau qua chat doc
hoa
hoc 38
3.4. Thuc trang chl do, chinh sach cua quan nhan sdng lau dai d
vimg
hoa 40
hgc/Dioxin va nguyen nhan.
3.4.1.
Thuc trang chl dg, chinh sach ddi vdi nan nhan CDHH/dioxin noi
chung; mdi quan he vdi quan nhan dong quan lau dai d viing d nhidm
chit
do hoa hgc/Dioxin 40
3.4.2. Che do, chinh sach ddi vdi quan nhan sdng lau dai d viing d nhiem
CDHH/dioxin 42
Chuong 2. DOI
TUQfNG
VA PHlTONG PHAP NGHIEN
ClTU
49
2.1.

Doi
tu9Tig,
dja ban va thdi gian nghien cuu 49
2.1.1.
Ddi tugng nghien cuu 49
2.1.2. Cdng cu nghien cim
5
0
2.1.3.
Dia ban va thdi gian nghien cuu
51
2.2.
Phuong
phap nghien cuu 51
2.2.1.
Thiet ke nghien ciiru va
each
thiic thuc hien
51
2.2.2. Phuang phap nghien cuu 51
2.2.2.1.
Dieu tra dich te hgc 51
2.2.2.3.
Thao luan nhdm 52
2.2.2.3.
Dieu tra hdi cuu 52
2.3.
Noi dung nghien cuu 52
2.4. Phucmg phap phan tich va xu ly so lieu 55
2.5.

Han che cua de tai 55
2.6.
Van de dao
due
trong nghien cuu 55
Chuang
3.
KET QUA VA BAN LUAN 56
PHAN 1.
THlTC
TRANG
SLTC
KHOE QUAN NHAN DANG SONG
TAI CAC DIEM NONG 56
1.1. Nhimg thdng tin chung ve ddi tugng 56
1.2. Thuc trang ve hudng che do, chinh sach cua quan nhan tai 3 diem
ndng 58
1.3.
Thuc trang phai nhidm vdi CDHH/Dioxin cua quan nhan
59
1.4.
Thuc trang bdnh tat,
sue
khde cua quan nhan sdng viing ndng
61
1.4.1.
Tinh hmh benh tat chung qua kham bdnh
61
1.4.2.
Bieu hien benh ly qua chi sd mach, huylt ap va dien tam dd 65

1.4.3.
Kit
qua phat hien
bit
thudng vl
nude
tieu 66
1.4.4.
Nhiing rdi loan midn dich hgc cua quan nhan 66
1.4.5.
Nghien cuu biln ddi vl mau 68
1.4.6.
Tinh hinh
bit
thudng thai san va di tat
bim
sinh cua quan nhan,
vg/chdng quan nhan 69
PHAN II. ANH
HUdNG
CUA CDHH/DIOXIN DEN
SlTC
KHOE
CON
NGU'Ofl
QUA SO LIEU HOI CUtJ 72
2.1.
Mot so nghien
ciru
khdi nguon 72

2.2.
Nghien cuu cua de tai Z123 73
2.3.
Nghien cuu cua de tai doc lap cap Nha
nude
2002-2005 85
2.3.1.
Benh lidn quan vdi CDDC/Dioxin 85
2.3.2. Di dang bam sinh 85
2.3.3.
Bat thudng thai san 86
2.3.4. Tac hai
ciia
CDDC/Dioxin qua nghien cuu benh chung tai 3 bdnh
vien quan y: 108, 103 va 175 86
2.3.5.
Bien ddi cau tnic va chuc nang mdt sd gen 86
2.4.
Nghien cuu cua de tai doc lap cap nha
nude
87
PHAN
IIL
MU'C DO TON LUtJ CUA CDHH/DIOXIN TRONG MOI
TRU'OTNG
94
3.1.
Nong do Dioxin trong dat tai 3 diem ndng 94
3.2.
Nong do Dioxin trong mau

nude
va thuc pham tai 3 diem ndng 98
PHAN IV. DE XUAT CAC BIEN PHAP, CHINH SACH CHO CAC
QUAN
NHAN
DANG SONG
6
CAC DIEM NONG
102
4.1.
Bien phap tuyen truyen giao
due
102
4.2.
Mot so che do,
chinh
sach
trg
cap cho quan nhan dang ddng quan
tai
viing 6
nhiim CDHH/Dioxin
103
4.2.1.
Che do trg cap ddc hai
103
4.2.2.
Che do luan chuyen can bd
114
4.2.3.

Chd do hau phuang
126
4.3.
Mot so bien phap bao ve sue khde, ngan ngira tiep xuc 134
4.3.1.
Chl do kham
sue
khde dinh ky
134
4.3.2.
Chl do su dung thirc pham chiic nang, tang cudng mien dich, tang thai
ddc 138
4.3.3.
Cac bien phap phdng tranh
phii
hgp bao vd
siic
khoe cho quan nhan
ddng quan tai cac viing d nhidm CDHH/Dioxin
13
8
4.3.4. Chinh sach vl chl do an cho quan nhan ddng quan tai cac viing d
nhiem CDHH/Dioxm 141
4.3.5.
Che do an dilu duang cho quan nhan ddng quan tai cac vimg d
nhidm CDHH/Dioxin
142
KET
LUAN 143
KIEN

NGHI 146
TAI
LIEU THAM KHAO
147
PHVLUC
MdDAU
1.
Tinh
cSp
thiet
Trong cugc chiln tranh xam
luge
Viet Nam, quan ddi My da
sii
dung
nhieu loai chat ddc hoa hgc mdt
each
rgng rai lam trui la cay, diet cd, huy diet
mdi trudng, sinh thai. Theo sd lieu cua Bd Qudc phdng My: tir nam 1961
din
nam 1971, quan ddi My da rai xudng miln Nam Viet nam khoang 72 trieu lit
chat ddc hoa hgc, trong dd cd 42
tri?u
lit chat da cam mang ddc td Dioxin.
Tai
cugc Hdi thao Qudc td lan thir II ve chat ddc hoa hgc diet cd do My
sii
dimg
trong chien tranh Viet Nam va tac
h^i

lau dai
ciia
nd ddi vdi thien nhien va
con ngudi, td chirc tai Ha Ngi tir ngay
15 din
ngay
18
thang
11
nam 1993, da
dua ra ket luan: Chat dgc diet cd
ciia
My da gay ra nhiing tac hai nhu sau:
- Huy diet thidn nhien cay cd.
- Huy diet
siic
khoe con ngudi, gay nhidu bdnh tat nang ne.
- Gay nen nhung bidn ddi ve gen di truyen qua me hoac bd, gay
tai bidn
sirih san, quai thai, di dang, di tat
ciia
nhiing dira con sinh ra.
- Gay cac benh ung thu.
Lugng
CDHH/Dioxm
ma quan ddi My rai xudng mien Nam
Viet
Nam
dugc dua ra khac nhau, bdi cac tac gia khac nhau, trong dd thap nhat la theo sd
lieu

ciia
A.H.Westing - khoang 179kg, cdn theo J.Stellman la 366kg, cdn theo
Fokin (Nga) thi con sd dd phai ldn den
1000kg.
Chien tranh d Viet Nam da trdi qua tren ba chuc nam, nhung hau qua
ciia
nd dl lai thi
vin
cdn
rit
nang nl. Rieng sd ngudi la nan nhan cua CDHH/Dioxin
vao tren 3 trieu ngudi, chu ydu la ngudi Viet Nam.
Nhan thiic dugc tac hai
ciia
chat ddc hoa hgc chien tranh den
siic
khoe
con ngudi, ngay tir sau giai phdng mien Nam cac nha khoa hgc Viet Nam da tien
hanh cac nghien
ciiu
danh gia tac hai cua chat ddc da cam ddi vdi
siic Idioe
con
ngudi. Nam 1983, tai hdi thao qudc te lan
thii
nhat tai Viet Nam, Bach Qudc
Tuyen da trinh
biy
bao cao vl hau qua di tmyen cua
chit

diet cd, lam trui la cay
ddi vdi con ngudi. Tilp theo dd, Uy ban 10/80 dudi su chi dao
ciia
GS Hoang
Dinh
Clu
da tap hgp cac nha nghien
ciiu
trong va ngoai nganh y tl, ca quan va
dan y giai quydt nhimg
vin
dd nghien cim dp bach
nhim
dua ra
nhung
giai
phap han che tac hai
ciia
CDHH/Dioxin ddi vdi cac nan nhan bi nhidm
CDHH/Dioxin. Tuy nhien, nhimg nghien
ciiu
trdn ciing nhu ddi tugng ap dung
la chi la
cim
chiln binh, ngudi cd cdng vdi each mang da nghi huu, con chau
cua nhiing nan nhan bj anh hudng CDHH/Dioxin bi di tat, nhung chua cd mdt
nghidn
ciiu
nao trdn ddi tugng can bd sy quan sdng lau dai tai viing nong, va
chua cd de tai nao chuyen sau vl xay dung chinh sach bao vd

siic
khoe cho quan
nhan tai cac vimg d nhidm CDHH/Dioxin.
Dang, Nha
nude
va nhan dan Viet Nam da cd nhilu cd gang, tidn hanh
nhieu bidn phap khac phuc hau qua cua chidn tranh, trong dd cd viec trg giup
nhung nan nhan CDHH/Dioxin va
khic
phuc hau qua ciia loai chat ddc hoa hgc
nay
ddi vdi mdi
trudng bi d nhidm. Tuy nhidn, do nhidu nguydn nhan, ndn cdng
vide
dd chua thd dat dugc kdt qua nhu mong muon. Hien cd mdt thuc te la trdn
nhidu vimg dat bi nhiem loai chat ddc (d nhiing
miic
do khac nhau), van cd
ngudi dang lam an, sinh sdng va trong dd cd mgt bd phan thudc cac
lire
lugng
vii trang nhan dan Viet Nam. Vi vay,
vide
tidp tuc tidn hanh cac bidn phap dd
nhanh chdng tra lai su trong lanh cho mdi trudng, ddng thdi ban hanh kip thdi
/
r
r
"y
n^

nhiing chinh sach, chd do cd tinh chat dai ngd nhu thd nao nham hd trg cho cac
A
\ f
r
t
y.
ddi tugng ndi trdn la mgt
vide
lam can thidt cua cac cap cd tham quyen. Day la
mgt
vide
lam vira can thilt, vira the hien tinh nhan van cao ca, trong nhiing didu
r
kien thuc te cua chiing ta hien nay.
2.
Muc tieu de tai:
- Ddnh gid thuc trang
sue
khoe
ciia
qudn nhdn song tai viing nong 6
nhiem
b&i
chdt doc hoa
hoc/dioxin.
- De xudt chinh sdch,
bien
phdp bdo ve
site
khoe cho qudn nhdn dang

song tai viing nong.
Gi&i
han pham vi
nghien ciru
cua de tdi:
- Vung bi d nhidm bdi CDHH/Dioxm dugc lua chgn didu tra la
nhiing
vimg ndng. Viing ndng da dugc xac dinh va cd ten trdn ban do vd anh hudng
CDHH/Dioxin. Viing ndng dugc hieu la nhimg viing d nhiem tach biet vdi vimg
sach, cd ndng do PCDD tren 950 ppm.
- Ddi tugng nghien
eiiu
la quan nhan dang sdng tai vung nong vdi thdi
gian trdn 5 nam.
Chuong 1
TONG QUAN TAI LIEU
1.
Anh hudng cua Dioxin den
sire
khoe cua con ngudi:
l.I.
Bpc tinh cua Bioxin:
Dioxin la nhimg
chit rit
ddc, nhung dg ddc ciia chiing khdng gidng nhau.
Chit
cd do dgc cao
nhit
la 2,3,7,8 - TCDD va
1,2,3,7,8

PeCDD. Vi vay to
chirc Y td thd gidi da xac dinh he sd duang lugng ddc td ggi la WHO - TEF dh
tinh gia tri dgc tdng hgp cho ca hg PCDD, PCDF va PCB doi vdi cac ddi tugng
mdi trudng, trong dd cd 2,3,7,8 - TCDD va
1,2,3,7,8
- PeCDD la nhimg
chit
ddc nhat cd he sd 1, va trong cac dong phan ddc
ciia
PCDD he so nay nhd
din
cho
din
0,0001 ddi vdi OCDD.
Dioxin cd tac dung ddc
tiic
thdi va lau dai, trong dd tac ddng lau dai la
dang chu y
nhit.
Lilu chdt 50 % (LD50) cua 2,3,7,8 - TCDD ddi vdi khi la 70
ppb vugt phan ldn cac chat ddc quan
sir
thudng trang bi
ciia
quan ddi cac
nude
nhu sarin, tabun, yperit Qua tinh toan lilu lugng tmng binh cd thd lam
chit
ngudi trong mdt lln tidp xiic qua dudng an udng la 0,05 - 0,07 ppm. Nhung dilu
quan trgng la tac ddng tich liiy va keo dai trong nhidu nam

ciia
dioxin d ndng do
rat
thap.
Theo quy dinh cua Td chiic Y td Thd gidi thi lilu toi da cho phep ddi vdi
ngudi la
1
- 4 pg/kg ngay ddm, nghia la mdt ngudi cd can nang 50 kg trong mdt
ngay ddm chi cho phep mgt lilu lugng
rit
nhd la 50 - 200 pg (50 - 200
phin nghui
ty gam). Dioxin dugc coi la chat ddc bac nhat vi nd gay ra tac hai d lilu
rit
thip,
gay ra ung thu, di dang bam sinh, lam tang tac hai
ciia
phdng xa va chat ddc.
Phai nhidm vdi Dioxin, dac biet vdi 2,3,7,8-TCDD da dugc chiing minh la
nguyen nhan gay nen nhidu hau qua cd hai ddi vdi
siic
khoe con ngudi va ddng
vat. Ket qua nghien
ciiu
dich td hgc trdn nhung quan the bi phai nhidm cao trong
cdng nghiep cho thay cd su tang nguy ca mac bdnh ung thu phdi va cac loai ung
thu khac. 2,3,7,8-TCDD dugc coi la
chit
sinh ung thu manh ddi vdi ddng vat,
nhung nhiing nghidn

ciiu
gan day lai ggi y rang: phai nhidm vdi TCDD cd anh
hudng manh
nhit
tdi he thdng mien dich, sinh san va he than kinh.
Rat nhidu nghien
ciiu
dua ra cac lieu gay chet sau khi phai nhidm CDD
tren ddng vat. Gia tri LD50 cho mdi loai chat cimg loai khdng chi thay ddi gitta
cac loai ma cdn thay ddi giiia cac chiing khac nhau.
Gia tri LD50 trdn chugt cdng Sherman sau diing lilu duy
nhit
dudng udng
2,3,7,8 - TCDD dugc tinh toan la
22|ig/kg (due)
va 45
|ag/kg
(cai); va lln lugt
la 164
^ig/kg,
297
|ag/kg,
303
|ag/kg
trdn chugt cdng Fischer 344; 165
ng/kg
(due) va 125
|ag/kg
(cai) d chugt cdng Osborne - Mendel; 43
^g/kg

d chugt
cdng Sprague - Dawley cai, va lln lugt la 60 va
100 |ag/kg
d chugt Long Evans
cai va due. Lilu dan (gavage) 100 fig/kg gay
chit
95% chugt cdng Fischer 344
due,
va mgt
lidu
25
}ag/kg din
tdi
chit
25% chugt cdng
due
Sprague - Dawley.
Hon nira, gia tri LD50 dugc thdng bao la 4,2
^ig/kg
d chdn,
115 |^g/kg
d thd
trang New Zealand,
175 |ig/kg
d chugt lang Harley due, 0,6
ng/kg (dire)
va 2,1
|.ig/kg
(cai) d chugt lang Harley, va
1.157

|^g/kg hoSc
5.051
p.g/kg
d chugt
dit
Syrian. Mdt LD50 42 ngay d chugt lang Harley cai dugc xac dinh la 2,5
|ig/kg
khi trdn 2,3,7,8 - TCDD trong
diu
thuc vat va 19
|ig/kg
khi trdn 2,3,7,8 -
TCDD trong methyl cellulose.
Tang ty
Id tii
vong d chugt lang Harley khi bi phai nhidm vdi 0,03
|a,g/kg/ngay
2,3,7,8 - TCDD trong thiic an trong
11
ngay va d thd dang trong thdi
ky mang
thai
sau dimg 10 lidu hang ngay 1
|ig/kg
trong chd do an. Ngoai ra, 3
trong sd 12 khi rhesus dang mang thai chdt sau dung lidu duy nhat
l|ig/kg.
Trong
tit
ca cac nghidn

ciiu
tren, cac ddng vat ddu chet sau phai nhidm tidm tang mdt
vai ngay (gia tri trung binh thay ddi tir 9 - 43). Trong hau het cac dgng vat thi
nghiem, hgi chiing suy mdn nang xuat hien nhu la ydu td chinh dan tdi
tii
vong.
Trong cac thi nghiem thdi gian tmng han, tang
tii
vong d chugt cdng
Osbome - Mendel phai nhidm 2,3,7,8 - TCDD trong
diu
bing nudi qua dng
thdng da day vdi lilu 0,56
jig/kg/ngay
cho tdi 13
tuin.
Ty
Id
tir vong 5% (khdng
chdt trong nhdm chung) quan sat
thiy
d chugt cdng Sprague - Dawley phai
nhidm 2,3,7,8 - TCDD bang nudi qua dng thdng da day vdi lidu xap xi 0,8
|xg/kg
2,3,7,8 - TCDD/kg/ngay trong 13 tuan; tmdng hgp chdt dau tien xay ra
vao ngay thir 57. Bdn trong sd 7 chugt cdng
due
Sprague - Dawley diing lilu 1,6
^g/kg
2,3,7,8 - TCDD/kg/ngay

bing
nudi qua dng thdng da day da chdt trong
mdt nghien ciru 10 tuan; thdi gian tmng binh dan ddn chdt la 53,5 ngay. Tir vong
tang ciing
thiy
d chugt lang Harley phai nhidm hang ngay trong thiic an vdi lidu
0,03
|ig/kg/ngay
trong 60 ngay; 4 trong sd
10
chugt due chdt vao ngay thir 42
va 4 trong sd chugt cai chet vao ngay
thii
59. Trong nghidn
ciiu
sir dung thiic an
phai nhidm,
tit
ca cac chugt cdng Sprague - Dawley
due
dung thiic an lilu cao
4
nhit
(3,4
|ag/kg/ngay)
da
chit
trong vdng 4
tuin.
Chugt

nhit
C57BL/6 giam kha
nang sdng sdt sau phai nhidm vdi lilu 3
|ag/kg/ngay
2,3,7,8 - TCDD, 3 ngay 1
tuin
trong 25
tuin bing
nudi qua dng thdng da day. 5 trong sd 8 khi chdt trong
vdng 2 thang sau sir dung thirc an cd chira 0,02
|xg/kg/ngay;
5 trong sd 8 khi da
chdt trong vdng 9 thang sau
sii
dung thiic an cd chira
0,011
i^g/kg/ngay.
Trong tat
ca cac loai, xay ra hien tugng giam trgng lugng nhilu va
mit
md trudc khi
chit.
Ddng vat giam kha nang sdng sdt sau phai nhiem man tinh vdi CDD.
Phai nhiem man tinh vdi 2,3,7,8 - TCDD trong thirc an lam tang ty
Id
tir vong
so vdi nhdm chiing d chugt cdng Sprague - Dawley vdi lilu 0,1
|ig/kg/ngay.
Tang ty le
tii

vong d chugt
nhit
Swiss nhan 2,3,7,8 - TCDD qua dng thdng da
day vdi lilu 1,0
|ag/kg/ngay
va chugt
nhit B6C3F1
vdi lilu 0,36
|ig/kg/ngay.
Tu vong tang xuat hien sau khi phai nhidm cap tinh vdi cac chat CDD
khac.
Sau dung lilu don dudng
mi?ng
hon hgp
1,2,3,7,8,9
- HxCDD va
1.2.3.6.7.8
- HxCDD, gia tri LD50 dugc tinh toan lln lugt la 1.800
|ig/kg
va
800
|ig/kg
d chugt cdng Osbome - Mendel
due
va cai, va lan lugt la
750|j.g/kg
va 500
|ig/kg
d chugt
nhit

B6C3F1 due va cai. Ngoai ra gia tri LD50 ciing dugc
xac dinh cho nhidu chat khac trdn chugt lang (29.444
[4,g/kg
ddi vdi 1,2,3 -
TrCDD, 1.125
|ig/kg
ddi vdi
1,2,4,7,8
- PeCDD, 3,1
|ag/kg
ddi vdi
1,2,3,7,8
-
PCDD,70 - 100
|ig/kg
ddi vdi
1,2,3,6,7,8
- HxCDD, 60-100
|ag/kg
ddi vdi
1.2.3.7.8.9
- vdi HxCDD, va 72,5
|ig/kg
ddi vdi
1,2,3,4,7,8
- HxCDD) va d
chugt nhit (825
^ig/kg
ddi vdi
1,2,3,4,7,8

- HxCDD va 337,5
|ig/kg
vdi
1,2,3,7,8
- PCDD) sau dimg lidu dan dudng mieng bang nudi qua dng thdng
trong
diu
an.
6
chugt cdng Sprague - Dawley due, gia tri LD50 dudng mieng
ddi vdi
1,2,3,4,7,8
- PCDD,
1,2,3,4,7,8
- HxCDD va
1,2,3,4,6,7,8
- HpCDD
trdn
lln
trong
diu
thuc vat/acetone (95/5) lln lugt la 206, 887, 6.325
jig/kg.
Cac
ddng phan CDD khac cd ddc tinh
thip
hon, vi khdng
thiy
tac dung trdn
tii

vong
d nhung lidu cao hon cac lieu gay chdt
ciia
2,3,7,8 - TCDD, TrCDD, HxCDD
hay PCDD. Khdng
thiy
trudng hgp tir vong nao sau khi dung lilu don udng 1
xlO^
va 2
X
10^
{ig/kg
2,7 - DCDD lln lugt d chugt edng Sprague - Dawley va
chugt Swiss Webster. Ngoai ra, chugt cdng va chugt nhat sdng sdt sau dimg lidu
dan dp dudng mieng lln lugt la
1
x
lOSa
4 x
10^
Hg/kg
OCDD.
Qua cac
kit
qua nghidn
ciiu
d tren cho
thiy
2,3,7,8 - TCDD la
chit

ddc
nhit
trong sd
tit
ca cac
chit
ciing loai dugc
thii
nghiem, vdi lidu lugng chi
5
khoang vai
(ig/kg
trpng lupng co
thi
d
cac
thvc nghiem cip tinh da
din din til
vong cho tat
c4
cac loai dvpc thir nghiem.
Nguoc
lai, trong cac chit cimg loai
duoc
thil
nghigm, 2,7
-
DCDD
va
OCDD lai

la
chit it dpc nhit bdi vi
cac
ddng
vat dupe thir nghiem dgu sdng sdt ngay ca khi dimg
lilu
rit cao (g/kg trpng lupng
CO
thg).
O hau hgt
cac
loai, hpi chung suy mdn
la
tac dung dpc
chii
ygu ciia qua
trmh phai nhigm cap tinh va trung han vdi CDD. Dac
diim ciia
hdi chiing nay la
giam trpng lupng ca
thg,
giam md ma va cudi cimg la tit
vong.
Trong hau hgt cac
nghign cim keo dai (man
tinh),
nguygn nhan
tut
vong chua
xac

djtih.
Ddng vat phai nhilm vdi 2,3,7,8 - TCDD theo dudng
udng
giam kha
nang sinh san, mat qua trinh
trade va
sau lam td cua trimg vao nigm mac
til
cung, giam trpng lupng bp phan sinh dvc, giam ndng dp androgen,
va
thay ddi
chu ky dpng due
va ning
tning. Hien tupng mit qua trinh trudc va sau lam td
cua trimg vao niem mac tu cung tang cao gap d chudt
edng
CRCD diing ligu 0,5
Hg/kg/ngay
trpng 2 tuan trade khi giao
phdi.
Tang tigu buy phdi thai gap d chudt
edng Sprague - Dawley dimg lilu 0,125
pg/kg/ngay,
d chupt nhit CF -1 dimg
ligu 1,0
ng/kg/ngay,
va chudt nhit
NMRI
dimg lilu 9
pg/kg/ngay

vao
cac ngay
6
- 15 ciia qua trinh mang
thai,
d thd su mat qua trinh sau lam td ciia tning vao
nigm mac tir cung tang len d nhdm diing 0,25
pg/kg/ngay,
nhung khdng thay
tang d nhdm dimg 0,0
pg/kg/ngay
trong
cac
ngay
6-15
cua qua trinh mang
thai.
Ngoai ra, hien tupng say thai tang (10 trong sd 12 con) gap d khi sau khi
dung lieu duy nhat
1 ng/kg
theo
ducmg
udng.
Dpc tinh sinh
san
cdn gap d chupt
edng
cai khdng mang thai. Giam rd ret
trpng lupng hudng tning, ty le trimg rvng
va

sd lupng tning giai phdng gap d
chudt
edng
Sprague - Dawley
cai
nhan lieu duy nhat > 10
pg/kg
theo dudng
udng. Tac dvng tren ndng do
hocmpn
ciing thay d chudt edng. Trong vdng 24
gid sau khi dua lilu hoa chit
vao,
ndng dp LH
va
FSH tang cap cd y nghia, ndng
dp prplactin khdng thay ddi. Sau khi dimg 17
(5
- estradiol, LH
va
FSH giam
thap
hem
so vdi chiing.
2,3,7,8 - TCDD ciing
la
mdt chit dpc trgn sinh san cua ddng vat due.
Giam trpng lupng bpng tinh djch gap d chudt
edng
Sprague - Dawley sau khi

diing lieu duy nhit
4,5
pg/kg.
Ndng dp androgen giam.
Viem
mao
tinh hoan vdi su ddng vdn cua tinh triing d chupt edng Wistar
phai nhilm vdi lilu 4
pg/kg
trpng 7 ngay va giam trpng lupng cua cac ca quan
sinh san
due
ciing vdi su giam tetosterons va dihydrotetosterone huylt thanh
(dugc so sanh vdi cap ddi chimg), dilu nay cung quan sat dugc d chugt cdng
Sprague - Dawley sau khi bi diing 1 lilu 2,3,7,8 - TCDD duy
nhit 12,5|ig/kg
dudng udng.
Trong nghidn
ciiu
trudng dien vdi 2,3,7,8 - TCDD cho phai nhidm
0,00064
jxg/kg/ngay
trong thirc an da
l^m
tang ty
Id
say thai va
gi^m
kha nang
sinh san d khi, cdn ndu chi dung vdi lilu

0,00012
jig/kg/ngay
thi khdng
thiy
anh
hudng ddn qua trinh sinh
s^.
1.2. Tac hai cua CDHH/Dioxin tren ngudi
1.2.1.
Tdc hgi ciia CBHH/Bioxin
v&i sire khoe
sinh sdn:
- O
nam
gi&i:
anh hudng ldn su sinh tinh,
svr
di ddng cua tinh triing, hinh
lang
ciia
tinh trimg, ndng
dQ ciia
cac hormon quan trgng nhu gonadotropin, LH,
i^SH,
testosteron va eac androgen khac, ca quan dap
iing
vdi androgen, hanh vi
inh due va kha nang sinh san
liic
tmdng thanh. Nhidm Dioxin cdn cd

thi
gay
)at
thudng tinh hoan (tinh hoan nhd), cd the dan den hgi chiing tinh triing it,
/eu,
hmh dang bat thudng.
Ket qua phan tich dac diem tinh dich ciia mdt sd ngudi cd nguy ca phai
ihidm
chat da cam/dioxin tai Viet Nam, Trinh Van Bao,
Trin Diic
Phin,
2002
la dua ra mdt sd kdt luan sau:
* O cac ngudi Viet Nam khdng tiep
xiic
vdi chat ddc hoa hgc trong chien
ranh (nhdm II, IV), cac chi sd
ciia
tinh dich dat tidu chuan
miic
bmh thudng
F
r
heo qui udc qudc te.
*
6
cac
cim
chidn binh ngudi Viet Nam thudc nhdm da
true

tidp phai
ihidm
vdi
chit
dgc hoa hgc trong chiln tranh, nay sdng d midn Bac Viet Nam,
Jidi
lugng
tuih dich/lln
xuat tinh giam, pH cua tinh dich tang so vdi qui udc
[udc td, tuy nhien nhimg biln ddi nay khdng
thiy
cd anh hudng ddn chiic nang
inh san.
*
Nhui
chung,
hiu hit
cac
mlu
tinh dich dugc nghien
ciiu
ddu dat tidu
huin
bmh thudng theo qui udc, nhung sd ngudi cd mat do tinh triing <
20.10^
d
ihdm
cd phai nhidm vdi AO/Dioxin nhilu hon so vdi nhdm khdng phai nhidm.
* Chi sd mat do tinh triing giam (<
20.10^)

va
nhit
la khdng cd tinh triing
7
F
"y
F
F
a
dac didm quan sat thay d nhidu ngudi hiem mudn sinh sdng d vimg da bi rai
loac
viing cd chiia
chit
CDHH trong chidn tranh.
-
d
nir
gi&i:
Dioxin cd thd anh hudng ldn chu ky kinh, do dai va cudng do
hanh kinh,
tin suit
cua chu ky khdng phdng noan, ndng do cac hormon quan
trgng nhu FSH, LH, oestrogen, progesteron, hanh vi tinh
due,
kha nang thu thai,
kha nang mang thai du ngay.
Nghidn ciru dilu tra ca ban tai xa Trach Phong huyen Thanh Phu tinh
Bin
Tre va phudng 10 quan Tan Binh thanh phd Hd Chi Minh cho
thiy

ty
Id
sinh
t
IS,
r
con di tat bam sinh d nhdm cd nhidm chat da cam d xa Thanh Phong la 1,1% va
d phudng 10 quan Tan Binh thanh phd Hd Chi Minh la 5,4% cao ban nhdm
khdng nhilm
chit
da cam (0,4%) vdi p<0,05. Ty
Id
thai
chit
luu d nhdm cd
nhiem
chit
da cam la 0,8% va 0,34% cao hon nhdm khdng nhidm
chit
da cam
(0,02%) vdi
p<0,01.
Ty
Id
thai trirng d nhdm cd nhilm
chit
da cam la 0,73% va
3,74% cao hon nhdm khdng nhilm
chit
da cam (0,38%) vdi p<0,05. Ty

Id
sly
thai d nhdm cd nhidm chat da cam la 8,01% va 16,7% cao hon nhdm khdng
H^
F
nhidm chat da cam (3,63%) vdi p <0,05.
Hoang Dinh Cau, Ld Hdng Tham (2002) nghidn
ciiu
thuin tap hoi
ciiu
F
F
r
Siic
khoe smh san d thd he chau cac cuu chidn binh Ha Ndi da phuc vu chidn
tmdng
mien
Nam va
mien
Bac trong thdi gian chidn tranh chdng My, hien vd
F
y,
F
>
r
>
sinh sdng trong ciing nhung didu kien kinh td xa hdi nhu nhau, thuan nhat vd
cac yeu td nghidn curu, chi khac biet duy nhat bdi
sir
phai nhidm vdi ydu td nguy

ca la chat ddc hoa hgc trong thdi gian chien tranh cho thay:
* Tai bidn
suih
san da xuat hien d thd he chau cac CCB chdng My, vdi tan
suat tang cao d nhdm cd tiep
xiic
so vdi nhdm khdng tidp
xiic,
sir
khac biet cd y
nghia thdng kd. Say thai: RR
=
9,02; CI, 3,65 - 22,26; p < 0,0001; RD =
24,8/10000; AFe
=
88,9%. Thai
chit
luu: RR = 8,56 ; CI. 2,05 -
35,81;
p <
0,001;
RD = 9,38/10000; AFe =
88,3%.
f f
F F
* Di tat bam sinh ciing xuat hien d the he chau cac CCB chdng My, vdi
nhiing
dac diem sau:
1).
Tin suit

di tat
bim
sinh d chau cac cuu chidn bmh phuc vu chiln
\
F
t
F
trudng midn Nam (nhdm cd tidp xiic) la cao hon han so vdi nhdm khdng tidp
xiic.
Su khac biet nay cd y nghia thdng kd vdi RR
=
4,04; CI. 2,15 - 7,59;
p<0,0001;
RD
=
21,4/10000; AFe
=
75,2%.
2).
Do manh
ciia
su khac biet - nguy ca tuong ddi d thd he chau cao hon
1,8 lln so vdi nguy ca tuang ddi d
Fl.
3).
Trong cac loai di tat
bim
d
F2,
tuang tu tinh trang nhu d Fl, mac

diu
cd thd chua phat hien dugc mgt sd di tat kin dao khac, di tat he
thin
kinh nhu
cac dang thilu nang tri tue chilm vi tri cao
nhit
va tang cao hon d nhdm cuu
binh cd tidp
xiic,
lam ndn
sir
khac biet cd y nghTa thdng kd vdi p <
0,001.
Tilp
F
,
ddn la di tat ngoai hinh nhu cac bidn dang tay, chan ciing tang cao hon d
nhdm cd tilp xuc vdi y nghia thdng kd vdi p < 0,05.
4).
O nhdm cuu chidn binh cd tidp
xiic,
di tat
bim
sinh the he chau cd
gi&i
nam cao hon so vdi
nG,
vdi su can bang giira gidng ndi va gidng ngoai. Trong
khi d cac chau CCB A, DTBS gidi nir lai cao hon, vdi
sir

vugt trdi d gidng ngi.
5).
Cd
sir
giam dan tan
suit
TBSS va DTBS d thd he chau (F2) so vdi thd
he eon
(Fl),
didu nay
phii
hgp vdi nhan dinh cua mdt sd nha khoa hgc trudc day
va
sir
tat giam dan tai bidn san khoa d cac thd he sau, cung nhu hgp ly vd
sir
giam dan ddc td theo thdi gian ban phan huy.
Dioxin cd thd tao ra nhung thuong tdn rat sdm trong thdi ky bao thai lam
F
^
F
r
1
rdi loan su phat trien tidp theo
ciia
bao thai
chii
ydu theo hudng thidu san lam
cho thai phat tridn khdng hoan chinh.
Mdt sd didm lam cho cac di dang bam sinh do Dioxin cd nhimg net khac

biet vdi cac di dang bam sinh do cac tac nhan khac:
Tdn sSxudt
hien cao bdt
thuang:
trong didu kien mdi tmdng va sinh sdng
>
F
•*
nhu nhau d trdn mdt cdng ddng, Dioxin la tac nhan gay ra mdt sd di dang bam
F
t
F
y
sinh cao hon sd di dang bam sinh do tat ca cac tac nhan khac khoang hai lan.
Tinh da di
dgng:
Trdn ca
thi ciia
mdt tre em cd nhilu di dang phdi hgp
theo nhidu hinh thiic khac nhau.
Cd thd cd mdt di dang (teo ca) lidn quan ddn nhidu bd phan khac nhau
ciia
ca thd.
Cd
thi
cd cd nhilu di dang khac nhau, mdi di dang lidn quan
din
mdt bd
phan ca the.
Tinh

gia dinh: Mdt gia dinh cd
thi
cd nhilu con bi di dang
bim
sinh theo
nhilu thd thiic khac nhau.
1.2.2. Khd
ndng
gdy benh cua CBHH/Bioxin:
Ddn nay trdn thd gidi da cd
rit
nhidu cdng trinh nghidn cim vl Dioxin va
cac bdnh cd lidn quan vdi Dioxm. Vidn Han lam y hgc My ciing da cdng nhan
mdt sd bdnh cd lien quan vdi Dioxin nhu sau:
Cdc benh co bans
chims
co lien quan chdc chdn
v&i
CDHH/Dioxin:
- Ung thu phan mdm
{Sarcoma)
- Lymphoma non Hodgkin
- Hodgkin
- Bdnh tning ca do dor
(cloracne)
Cdc benh duac coi
Id
co
bdng chirng lien
quan

v&i
Dioxin:
- Ung thu dudng hd hap
(Respiratory cancer){ung
thu thanh quan, ung
»
F
thu phdi, ung ihu khi phd quan).
- Ung thu tidn liet tuyen
(Prostate
cancer).
- Bdnh da u tuy ac tinh
{Multiple
Myeloma).
F
- Bdnh gai sdng che ddi
{Spina
Bifida)
- Bdnh Porphyria Cutanea Tarda (bdnh rdi loan chuydn hoa
Porphyrin, dac tnmg bdi
sir
tang do man cam vdi anh sang, xuat hien cac ndt
phdng trdn da va cac tdn thuang khac, cd tang ham lugng porphyrin trong gan,
trong nude tilu).
F \
- Rdi loan than kinh ngoai bidn.
- Bdnh dai dudng typ 2.
Ngoai ra, cdn mdt sd bdnh khac hien nay tuy ngudi ta chua du chiing
F F
7

F
^
Cii
chac chan de kdt luan la cd lidn quan vdi
Dioxhi
nhung nhidu nha nghidn
ciiu
F
y
F
trdn thd gidi va d Viet Nam da canh bao vd mdi lidn quan
ciia
chiing vdi
F F
CDHH/Dioxin va danh muc cac bdnh cd lidn quan den CDHH/Dioxin ddn nay
vin
chua dugc cdng bd day
dii.
1.2.3.
Cdc
tdc hgi
todn
thdn vd
tren
cdc ca
quan chirc
ndng cua ca
the:
- Rdi loan tdm thdn
Idnh:

Cd thd cd
sir
lidn quan
giiia
phai nhiem Dioxin
va tang ty
Id
rdi loan tam than kinh. Tuy nhidn su khac biet cdn chua ro trdn
phuong dien thdng ke. Ngoai ra, cdn cd thd cd mdt thdi gian
tiim
In tir khi phai
fs/
F F
y
nhidm den khi khdi phat ra cac trieu chiing rdi loan tam than kinh. Ngudi ta cdn
thiy,
cd thd Dioxin gay ra hien tugng lao hda sdm bd nao con ngudi, lam cac tl
bao
thin
kinh bi pha
hiiy
sdm. Schulte va cs. (My, 1996); Liou va cs. (Taiwan,
1997),
Seilder va cs. (CHLB
Diic,
1996) da tim
thiy
cd
sir
lien he giiia phai

nhidm Dioxm va bdnh Parkinson.
Rdi loan ho hdp: Thdng tin vd tac hai cua CDHH/Dioxin ldn he hd
hip
ciia
ngudi cdn it. Goldman,
1973
khi nghidn cim vd anh hudng
ciia
mdt tai nan
10
cdng nghiep d
Diic
cho
thiy
ngudi bj nhidm dp 2,3,7,8-TCDD cd bilu hien
vidm phd quan va vidm thanh quan sau nhiem it ngay va vidm mang phdi
xuit
huyet sau nhidm
11
thang. Nhilu nghidn ciru khdng tim
thiy
cd
sir
lidn he giua
Dioxin va cac rdi loan hd
hip.
Nhung
O'
Tole
va cs. (1996) da nghidn cim trdn

cac CCB uc va da tim
thiy
cac rdi loan hd
hip
d nhung ngudi cd phai nhidm vdi
Dioxin (RR tir 1,6
din
4,1). Nhung nghidn ciru
gin
day cho
thiy
nhilu bdnh ciia
dudng hd hap, bao gdm ca nhidm triing cap va man, hen suyen, gian
phi
quan,
tran dich mang phdi cd lidn quan vdi nhiem CDHH/Dioxin
F
F
fs,
y
f
- Roi loan he thong mien
dich:
nhidu nghidn ciru cho thay cd
sir
tang bdnh
nhidm trimg d cac ddi tugng cd nhiem Dioxin, RR udc tinh
bing
2,8. Mdt nghidn
cim cua Ld Cao Dai, Nguyen Thj Nggc Phugng va CS. cung cho

thiy
ty
Id
tir
vong
ciia
tre em d vimg cd bi rai
chit
ddc da cam cao hon d vimg khdng bi rai.
- Ddi thdo
du&ng:
nhidu nghidn
ciiu
vd
vin
dd nay da cho
kit
qua trai
ngugc nhau. Henriksen va cs. nghidn
ciiu
tren cac CCB My da van chuyin
chit
ddc da cam va cac
chit
diet cd va trui la khac
tiic
la nhiing ngudi bj nhidm nang
Dioxin, ed
sir
gia tang bdnh dai dudng cd y nghta thdng kd (RR = 1,5) so vdi

nhom chimg. Tuy nhien, do ca chd bdnh sinh phiic tap, va chi khoang 50%
ngudi cd bdnh dai thao dudng la dugc
chin
doan ra, ndn dn cd thdm nghidn
F F F F
'itt
Ciiu
cd
loai
trir nhiing ydu td lidn quan ddn ca chd bdnh sinh dd cd thd khang
F
dinh mdi lien he nhan qua giiia Dioxin va bdnh nay.
- Roi loan chuyen hoa Lipid vd
Lipoprotein:
mdi chi tim thay tinh trang
tang triglycerid d trong phdng thi nghiem, tuy nhidn ciing cd nghidn
ciiu
bac bd
F \
y
van dd nay. Can cd nghidn
ciiu
thdm.
- Benh duang tieu hoa, ke cd nhiem doe gan: Cac nghidn ciru hien tai
chua chiing minh dugc mdi lidn he nhan qua giiia Dioxin va cac bdnh dudng
tidu hda, nhung cd thd cd tang men gan d nhiing ngudi bi nhidm Dioxin. Ty
Id tii
vong do cac bdnh dudng tidu hda tang d ngudi da bi nhidm Dioxin
15
nam vl

tmdc (Ramlow va
cs.
1996).
F
"\
- Roi loan tudn hodn:
F
y
/S,
Da sd cac
dii
lieu tmdc day cho rang
sir
phai nhidm vdi dioxin khdng gay
cac tdn thuong tim mach. Nghidn
ciiu
trdn 226 cdng nhan phai nhidm vdi
2,3,7,8-TCDD tir 1948 ddn 1969 trong qua trinh san
xuit
2,4,5-T
thiy
cd 52% sd
phai nhidm cd chiing ban do va ty
Id
dau that nguc va nhdi mau ca tim tang cao
hon nhdm chiing.
11
Tuy nhign chua cd nghign
ciiu
khing dinh mdi lign he nhan qua giua

Dioxin va
cac
benh nay. Mdt sd nghign cim cd nhic
din
kha nang bj cao
huylt
ap,
suy tim, suy dpng mach vanh, tai
biln
mach mau nap d nhdm cd phai nhilm
vdi CDHH/Dioxin cao hon d nhdm khdng phai nhiim.
1.2.4.
CDHH/Dioxin
vd ung thu:
Cac nghign cim da chi ra Dioxin cd thg gay ra mpt sd
Ipai
ung thu sau:
Ung thu dudng hd hap
va
phdi
Ung
thu
tuygngiap
Ung thu phan mgm
Ung thu he Lympho tap huylt: Lympho khdng Hodgkin, benh
Hodgkin, da u hiy, bgnh bach cau
Ung thu he tigu hda nhu
gan,
tvy, da day,thuc quan, dai trang
Ung thu tign

ligt
tuygn, than, tinh hoan
Ung thu nao - Ung thu
vu
d
phu
ntt.
Hien nay, cac cong trinh nghign cim vg
tac
hai cua Dioxin vdi mdi trudng
sinh thai va vdi site khog con ngudi, nghign cim ca ban vg ca chg
tac
dpng, vl
nhihig giai phap bap ve su
tac
dpng cua Dipxin ddi vdi mdi
tradng va
con ngudi
da duoc dang trong nhigu
bao cao
khoa hoc trgn thg gidi.
Cac
nghign cim
nay
tap chung
vao nhOng
hudng chinh sau day:
Dj
tat bam sinh
va

tai bign smh san;
Chi sd thdng minh; Nhirng bign ddi di traygn va ung thu; Nhihig bign ddi vg
mau va
he men chuygn
hoa;
Nhttng bign doi
vg
he mien djch.
1.2.5.
Bdnh
gid
tdc
hai
lau ddi cda CDHH/Dioxin
trin
site
khoe
con
ngudi:
Nghien ciru dg dua ra nhimg kgt
luan
vl anh hudng
ciia
Dioxin ddi vdi
sure
khog con ngudi la mpt
van
dg khd, nd ddi hdi
nhung
thigt ke nghign cim

phai rat chuan xac va phai than trpng khi edng bd kgt qua.
Trgn the gidi hang nam
vln
cd cac hdi
nghj,
hdi thao vg tac hai cua
Dioxin tdi sire khoe con ngudi. Tai Monterey thupc bang Califocnia (My) tir 13
- 17 thang 8 nam 2000 da
diln
ra hdi nghi vg Dioxin. Tai day mdt danh mvc vl
cac
benh
va
tat cd lign quan dgn Dioxin da dupe bd xung. Danh muc
nay
cd le
phii
hop vdi thue te benh ly lign quan vdi Dioxin d Viet Nam
nhilu
hon.
Tai Hdi nghj qudc tg ve Dioxin tai
Han
Qudc
hi ngay
9-^14
thang 9
nam
2001
mdi day da cd nhilu tac gia ndi den anh hudng
ciia

chat dpc hoa hpc cua My
da
sii
dvng d Viet
Nam:
" Ve anh huong cua chdt diet co
a
Viet Nam 1962
-
1971"
12
ciia Alvin
L. Young, ca quan nang lugng My;
"Md/
tru&ng
bi rdi chdt
rung Id
cdy
&
Viet
Nam vd khd ndng
nhiem
doc ddi
v&i
con
nguai''
ciia
Michael
Nev^on,
dai

hgc tdng hgp bang Oregon;
"Tinh
trgng
sue
khoe
eiia
ede cuu chien binh thuoc
qudn dodn hod hoe My timg tham chien
& Viet
Nam vd moi lien quan nong do
Dioxin trong huyit
thanh"
ciia
Han K. Kang, CDC Atlanta Cac nghidn cim
diu
khang dinh CDHH/Dioxin cd anh hudng ddi vdi
siic
khoe con ngudi.
Tuy nhidn, mdt sd nha khoa hgc My va cac
nude
ddng minh
ciia
My van
phii nhan tac hai
ciia
chat ddc Dioxin vdi
siic
khoe con ngudi: hg cho rang cac
nghidn
ciiu

trdn curu chiln binh
iic,
Han Qudc
diu
khdng cd
sir
khac biet giiia 2
nhdm cd va khdng phai nhidm (hg da khdng ndu rd rang thdi gian va phuang
thiic phai nhidm
ciia
cac cuu chiln binh nay nhu
thi
nao).
r
Mdt thuc td khach quan ma mgi ngudi phai thira nhan la cac nghidn
ciiu
^ Ft
vd anh hudng ciia CDHH/Dioxin ddi vdi con ngudi thi khdng the co thirc dia
nao cd day
dii
nhan chung, vat chimg cd gia tri khoa hgc va phap ly nhu d Viet
Nam, trdn chinh con ngudi Viet Nam - nhiing ngudi bi tidp
xiic
lau dai nhat, cd
T > T
fs,
F F
thd cd nhidu ca thd trong ciing mdt pha he phai nhidm
true
tidp hoac gian tidp

vdi CDHH/Dioxin
1.3.
Mpt so nghien
ciru
ve
dnh hir&ng
cda Bioxin den
sire
khde
con
ngirdi:
Ngay tir nhiing nam 70
ciia
the ky vira qua, khi chidn tranh Viet Nam cdn
F
fs/
F
y
chua kdt thiic, tir thuc tidn chidn tmdng midn Nam, cac nha y hgc Viet Nam la
Tdn That Timg va Hoang Dinh Cau da quan tam nghien
ciiu
tac hai
ciia
Dioxin
ddi vdi
siic
khoe con ngudi. Tai Hdi nghi orsay Tdn That Tung, Trinh Kim
•\
F
fs/

F t
-y
F F
anh da bao cao vd tinh trang dot bidn nhidm sac thd ca vd sd lugng va cau tnic
d
nhiing
ngudi bi nhidm
chit
ddc diet cay cd
ciia
My.
Nhan thiic dugc tac hai
ciia
chat ddc hoa hgc chidn tranh ddn
siic
khoe
con ngudi, ngay tir sau giai phdng mien Nam cac nha khoa hgc Viet Nam da tidn
F F
hanh cac nghidn
ciiu
danh gia tac hai cua chat ddc da cam ddi vdi
siic
khoe con
ngudi. Nam 1983, tai hdi thao qudc tl lln
thii nhit
tai Viet Nam, Bach Qudc
Tuyen da trinh bay bao cao vd hau qua di tmydn
ciia
chat diet cd, lam trui la cay
ddi vdi con ngudi. Tidp theo dd, Uy ban 10/80 dudi su chi dao cua GS Hoang

Dinh clu da tap hgp cac nha nghidn cim trong va ngoai nganh y tl, ca quan va
F F
'^ ' >
dan y giai quydt nhiing van
dQ
nghidn
ciiu
cap bach nham dua ra nhiing giai
phap han chd tac hai
ciia
CDHH/Dioxin ddi vdi cac nan nhan bi nhidm
CDHH/Dioxm.
13
Trong nhiing nam qua, cac nha khoa hgc Viet Nam nhu Tdn
Thit
Timg,
Hoang Dinh
Clu,
Nguydn Hung Phuc, Ld Cao Dai,
Biii
Dai, Nguyen Can,
Nguydn Thi Nggc Phugng, Vu Trieu An, Phan Thi Phi Phi, Dao Nggc Phong,
Nguydn Van Nguydn, Ld Bach Quang va nhilu ngudi khac da
diu
tu nhilu cdng
siirc cho cac nghidn cuu va dang nhilu bai bao trong va ngoai
nude
vl tac hai
ciia CDHH/Dioxin vdi con ngudi
Vi?t

Nam.
Nam 1982, Nguyen Hung Phuc va Cung Binh Tmng da tiln hanh dl tai
"Nghidn ciru hau qua trdn ngudi ciia
chit
dgc hoa hgc do My rai d miln Nam
Viet Nam va khdi thao bidn phap
khic
phuc" (dl tai mang ma so 52.02.05.02),
ddi tugng nghien cim la ngudi bi rai true tidp chat ddc hoa hgc thudc huyen
Gidng Chdm, tinh Bdn Tre, vdi cac ndi dung chinh sau:
Danh gia
sir
tdn luu
ciia
cac chat dgc hoa hgc chiln tranh d mdt sd dia
t
\
didm thudc midn Nam Viet Nam.
-
Dieu
tra xac dinh ca cau bdnh tat
ciia
nhiing ngudi da bi nhidm ddc true
^
F F
/•
tiep
do chat dgc hoa hgc chidn tranh.
- Danh
gia

dot bidn di tmydn trdn ddng vat thuc nghiem phai nhidm vdi
F
chat ddc hoa hgc.
F
t
\
-y
tsi
F
- Xac dinh nhiing bidn ddi vd di tmydn d nhiing ngudi bi nhidm chat ddc
hoa hgc chidn tranh va con cai cua hg.
- Khdi thao cac bidn phap khac phuc hau qua cua chat ddc hoa hgc chidn
tranh. Cac kdt qua nghidn
ciiu
da xac dinh su tdn luu
ciia
2,4-D ; 2,4,5-T va cac
san pham cua nd trong dat, da phat hien cac
din
xuat
ciia
aryloxiaxetic va asen.
- Kdt qua kham lam sang eho 1300 ngudi thay: bdnh suy nhugc
thin
kinh
cd ty
Id
cao (17,6 ± 4,70%, bdnh thilu mau (14,98%) vdi
d^c
didm hdng du

dudi 3 trieu, ty
Id
hdng cau ludi giam nhidu (cd 9,76% sd ngudi cd hdng du
ludi
dudi
10.000/mm3).
- Sinh hoa:
thiy sir
rdi loan hoat do enzyme SGOT va SGPT, giam ham
lugng albumin trdn dien di protein huylt thanh, tang
y
globulin, ed bidu hien
thuong va giam chirc nang td bao gan.
- Di tmydn va tai bidn sinh san: Didu tra 848 cap vg chdng
thiy tin
sd sly
thai la 12,20 ±
1,44%.
Dilu tra 3000 tre de sdng tmdc va sau khi bi rai
chit
ddc
thiy
tmdc khi rai sd tre di tat 0,14 ± 0,08%, sau khi
rai:
1,78 ± 0,35%.
14
Nam 1998, tai hdi thao qudc gia vl tac hai
ciia
CDHH/Dioxin, Tmng tam
Nhiet ddi Viet Nga da edng bd mdt sd

kit
qua nghidn cim trdn cac cuu chiln
binh va dua ra nhiing giai phap lam han chd tdc hai cho ngudi chiu hau qua
ciia
CDHHADioxin.
Nhung nam 1996 - 1999, Nguydn Van Nguyen, Ld Bach Quang va CS
(Hgc vidn Quan y) da tiln hanh
phin
y-sinh hgc cua du an Zl vdi 8 dl tai nhanh
vd tac hai
ciia
Dioxin, gdm: nghidn cim dich td hgc va lam sang, nghidn
ciiu
su
bidn ddi he thdng mien dich, he thdng di
tmyIn,
he thdng sinh hoa men, he
F F F
\
thdng mau va danh gia cac chi sd thdng minh va tdc do phan xa than kinh,
nghien curu tac dung
ciia
mdt sd thudc phuc hdi
siic
khoe va tang thai ddc.
Kdt qua nghidn
ciiu
cho
thiy:
Ty

Id
ngudi bi suy nhugc than kinh cao.
- Bdnh tim mach:
17,99%
(so vdi nhdm chimg 4,94%).
Bdnh da lidu: 5,78% (so vdi nhom chimg 0,52%).
- Benh
thin
kinh:
12,63%
(nhom chimg 2,53%).
F
- Ty
Id
tai bien sinh san d nhdm nghidn
ciiu
cao hon so vdi nhdm chiing
(34,54%
so vdi 14,96%).
- Tai khu vuc nghidn
ciiu
cd xu hudng tang ddng lympho B
(CD
19) va
t
giam ddng lympho T
(CD3,
CD4,
CD
18) va ty

Id
chuydn dang cua cac lympho d
F
nhdm nghidn
ciiu
thap hon ro ret so vdi chiing.
__ ^ ' '
F
\
F F
- Tan xuat vi nhan tang cao, bidu hien
sir
rdi loan vd sd lugng va cau
tnic nhilm
sic
thd. Phan tich
bing
ky thuat PCR thay 20,4% sd
mlu
khdng cd
phan ling, didu dd ndi ldn cd su thay ddi cau tnic gen P53 va gen
Alu
(nhiing gen
nay cd lidn quan ddn ca chd kidm soat ung thu qua cac san pham protein
ciia
nd).
t
t
- O nhdm nghidn
ciiu

ham lugng men esteraza tang cao chiing td ca thd
dang bi nhidm ddc.
-
6
nhdm ngudi nghidn
ciiu
ty
Id
thilu mau cao: giam sd lugng hdng
^
X
F
t
\
cau, tang ty
Id
bach cau, trong dd tang td bao lympho, giam tidu cau. Ty
Id
nhidm HbsAg d
miic
tmng binh cao (20,7%).
- Cac chi sd thdng minh va tdc do phan xa d tre em: Ty
Id
cac ddi
mgng tir 6-12 tudi d nhdm nghidn cim cd thdi gian phan xa cam giac
thip
hon
^
F
t

nhidu so vdi nhdm chimg. Ty
Id
cac ddi tugng tir
6-16
tudi d nhdm nghidn
ciiu
15
cd thdi gian phan xa cam giac van ddng cham chilm ty
Id
cao (24,7%) so vdi
nhdm chirng
(15,66%).
- Nghidn cim tham dd mdt sd thudc cd tac dung phuc hdi
siic
khoe va
loai thai
chit
dgc khdi ca
thi:
Sir dung 3 loai thudc: Quercetin (chilt tir hoa
hoe),
Flavonoit (chilt
xuit
tir vd dau xanh) va Damin (chilt
xuit
tir men bia).
Cac loai thudc nay la san
phim ciia
cac dl tai nghidn
cun

dp Nha
nude,
dp Bd
da dugc nghiem thu. Cac thudc nay co tac dung giai dgc thdng qua ca chl chdng
cac gdc tu do.
Dac biet da lay mau, tidn hanh phan tich ham lugng Dioxin tren 12
mlu
md md, kdt qua thu dugc cd
11
mau duong tinh vdi ham lugng Dioxin tir
10
ppt- 200ppt. Day la bang chiing khach quan khoa hgc cd y nghTa giiip cho nhiing
hudng nghidn
ciiu
mdi.
F
y
t F
Kdt qua didu tra di tat bam sinh trdn 10 phudng, xa cua thanh phd Bidn
Hoa cho thay:
- Ty le
mic
di tat
bim
sinh: 0,913 ± 0,018/1000 dan.
- Ty
Id mic
di tat
bim
sinh: 2,19 ± 0,83/1000 tre de sdng

- Bai nao la di tat
bim
sinh cd ty
Id
cao nhat chidm 23,2%.
Nam
1997-1999
Hgc vidn Quan y tilp tuc dugc giao nhidm vu nghidn
ciiu
nhung tac ddng hau qua lau dai
ciia
chat da cam ddn
siic
khoe con ngudi d khu
fSi
F F
vuc quanh san bay Da
Nang.
Kdt qua nghien
ciiu
cho thay:
- Ty
Id mic
di tat
bim
sinh: 2,18 + 0,32/1000 dan.
- Ty
Id mic
dj tat
bim

sinh: 5,38 ± 0,79/1000 tre de song.
r
F
- Ty
Id
bai nao chidm cao nhat: 34,2%.
- Ham lugng men Carboxyl- Esteraza d
miic
do cao va cd
sir
gidng nhau
F
t
giiia bd - con, me - con ngudi bi di tat bam sinh.
- Cd
sir
thay ddi clu tnic gen P53 va tang ty
Id
ngudi cd ham lugng
proteui P53 thip
va rat thap d nhdm nghidn
ciiu.
- Nhdm nghien cim cd ty
Id
mang
diu
In ung thu CEA va AFP cao hon
nhdm chiing.
- Hgc sinh thugc nhdm nghidn
ciiu

cd tri nhd, phan xa thinh giac - ngdn
ngii va thi giac - van ddng kem han hgc sinh nhdm ddi chiing, giam thilu tri tue,
tri
nhd,
sir chii
y
ciia
nhdm nghidn
ciiu.
16
- Dinh lugng Dioxin trong
11 mlu
md ngudi
thiy
3
mlu
cd ham lugng
Dioxin trdn
10
ppt.
Nam
1999-2000
Nguydn Van Nguydn, Ld Bach Quang va CS (Hgc vidn
Quan y) nghien
ciiu
anh hudng cua
chit
ddc da cam
din
sire khoe con ngudi d

san bay
Phii
Cat - Binh Dinh cho thay:
>
t
- Ve di tat bam sinh: Nhom ngudi sinh ra sau nam 1975 tai nhiing viing
sat san bay Phu Cat cd ty
Id
di tat
bim
sinh la: 5,22 ±
0,31
tinh trdn 1000 tmdng
hgp de sdng, ty
Id
nay cao so vdi cac viing khdng bj rai
chit
ddc da cam. Trong
dd cao
nhit
la cac dj tat vl
thin
kinh tmng uong chidm 30% trong tong sd 24 ddi
tugng di tat
bim
smb.
- vl biln ddi gene P53: Nhdm doi tugng nghidn cim d
Phii
Cat cd bidu
hien thay ddi clu tnic gen P53 d 29,27% ddi mgng. Ham lugng Protein P53

bmh thudng va bidn di trong huydt thanh
ciia
nhdm chiing va nhdm nghidn
ciiu
ddu (+) khdng cd
sir
khac biet.
- Ve
bidn ddi sinh
hoa va dau an khdi u: Nhdm ddi tugng nghidn cim cd
^
F
t
f f f
SU bidn
ddi tang boat do he men Carboxyl - esteraza. Ty
Id
cd cac dau an khdi u
(+) cao rd ret (22,40% cd AFP (+) va
25,41%
cd CEA (+)).
y
F F
- Vd chi
SO
thdng minh: cac chi sd tri md
ciia
nhdm tre em hgc sinh
liia
tudi 7-12 d khu vuc Phu Cat (tmdngCat Tan) thap hon so vdi trudng

Ngii
Hiep
(ddi chimg xa) va thap ban ca tmdng Nguydn Du - Da
Ning
(ddi chiing
gin).
Didu tra
siic
khoe trdn ddi tugng cuu chidn binh
thiy:
Ty
Id
di tat
bim
sinh, tai bien sinh san, ty
Id
bdnh lien quan d cuu chidn binh cd tiln
sii
tidp
xiic
F F
y
F
vdi chat ddc da cam cao ban so vdi
cim
chidn binh khdng cd tidn su tidp
xiic.
/
y F F
Dac biet nhung cuu chidn binh cd tidn

sii
tidp
xiic
chat dgc da cam hien dang
F
Ft
sdng d Phil Cat (nai la viing ndng chat ddc da cam) ty
Id
nay cao ban han.
2.
Muc do 6 nhiem va anh hudng CDHH/Dioxin den moi trudng d cac vung
ndng:
Nam
1962,
quan ddi My
bit diu sii
dung
chit
diet cd d Viet Nam vdi muc
F
dich lam rung la cay va pha hoai
miia
mang, chidn dich dat ten la Ranch Hand.
/
t F
Phuong tidn chu yeu dugc
sii
dung dd rai chat diet cd la may bay
C-123
va cac

phuang tidn rai mat
dit
khac nhu xe ca gidi, binh phun va tau sdng. May bay
t F
true thang ciing dugc
sii
dung
dQ
rai chat diet cd tai nhiing khu vuc xac dinh.
Khoang 72 trieu lit
chit
diet cd da dugc
sii
dung d Nam Viet Nam. Tuy nhidn
17