Nghiên cứu biến đổi số lượng và hình thái mẫu tiểu cầu ở bệnh nhân giảm tiểu cầu chảy máu ngoại vi nguyễn thị minh phương

Y HOC VIET NAM THANG 2 - SO
2/2014
mg/ngay. Tan suat sff dyng heroin hang ngay
eua benh nhan giam di rd ret: tru'dc dieu tri 1,24
lan/ngay;
giai
doan dd lieu 1,07 lan/ngay sau 7
ngay, 0,33 lan/ngay sau 30 ngay va sau 3 thang
dieu tri la 0,08 lan/ngay. Ty te benh nhan dffdc
chuyen girl den cac
dich
vu y te khac nhff: Dieu
trj ARV la 44,5%, dieu tn nhiem triing cd
hdi
30,8%,
cung cap BKT sach 21,3%, tff van xet
nghiem HIV ty nguyen 8,3%, Oa sd benh nhan
dang dffdc
dieu
trj tai cac cd sd deu cho biet hp
rat hai Idng, hai Idng vdi cac djch vy ddn tiep
benh nhan, thai dp bac sy lam viec, thai dp nhan
vien tff van cung nhff hai Idng vdi thai dp
eiia
cae
nhan vien cdng tac tai
cd
sd dieu trj Methadone.
TAILlgUTHAM
KHAO
1.

B$
Y te (2013), Bao cao ket qua hoat ddng
phong chdng HIV/AIDS 6 thang dau va phUOng
hffdng nhiem vu 6 thang cudi nam 2013.
Bo Y te (2009), Bao cao ket qua trien
khai
thi
diem
dieu tri nghien cac chat dang thuoc phien
bang thuoc Methadone tai TP. Hai Phong va TP,
Ho
Chi
Minh nam 2008, tr, 1- 9,
Bp Y te (2005), "Cac cong trinh nghien
CLAJ
khoa
hoc ve HIV/AIDS
giai
doan 2000-2005",
Tap
chi
Y
hoc thifc hanh nam 2006.
Bp Y te (2007), Hu'dng dan xay
di/ng
khung cac
can thiep
dPa
tren hoat dong cua cac cd sd dieu
tri

Methadone
,yi5
Noi, tr, 5- 24.
Bp Y te (2010), Hudng dan dieu tri thay the
nghien cac chit dang thudc phien bang thuoc
methadone,
Ha Noi, tr, 3- 25.
Trung tam phong chong
HIV/AIDS
Ha Npi
(2013),
Bao cao ket qua hoat dong phong chong
HIV/AIDS 5 thang dau va phUOng
hUdng
nhiem
vu 6 thang
cuoi
nam 2013,
Thu tu'dng Chinh phu
(2012),
Chien
\Mc
qudc
gia
phong chdng HIV/AIDS
d
Viet
Nam den nam
2020 va tam nhin 2030,
NGHIEN

Ciru
BIEN DOI SO LU'O'NG VA HINH THAI MAU TIEU CAU
6"
BENH NHAN
GIAM
TIEU CAU
JVlAU
NGOAI VI
T6M
TAT
Giam tieu cau thu'dng gap trong cac benh ly huyet
hpc cung nhU khong huyet hpc. Xet nghiem
tiiy
do
ddng mpt vai trd quan trong trong chan doan, Muc
tidu:
Tim hieu
sif
bien
ddi
sd
lUdng
va
hinh
thai mau
tieu rau d benh nhan giam
tieu
cau mau ngoai
vi.
Doi

tffdng
va phu'dng
phSp
nghien
cffu:
hoi cffu ket
hijp
tien
ciru,
mo ta, cat ngang
dUdc
thyc hien d
BVrWQD
108
ty
2008-2013, Ket qua: 400 trUdng hpp
giam tieu
au
mau ngoai
vi
ddn thuan hoac kem
giam
HC Tuoi trung binh la
53,2
tuoi
{14-94
tudi),
Oa so
cic BN nhom
tuoi

>45
tud'i,
Xuat huyet giam
tieu
cau
vo
c3n
(ITP)
la
nguyen nhan pho
bien
nhat
tiep
theoja
glim
sin
tiiy,
bach cau cap, 57,25% BN so lu'dng mau
tieu
c3u
trong
tiiy
binh thu'dng hoac giam nhffng hinh
thai vln binh thu'dng. Trong 97/400 BN tang so
lUdng
m§u
ti^u du
vdi
hinh thai dang non thi hau het la ITP
KSt

lu^n:
Tiiy
do la xet nghiem quan trong de chan
do^n
xac djnh nguyen nhan giam tieu cau.
Titldida:
Giam
teu
cau,
Chpc
hiit
bjy
xUOng
(tiiy
do)
•
Khoa
huyet
hpc lam
sang
Benh
vi$n
TWQD108
PhAn
bl$n
khoa hgc: PGS.TS Nguyen Lieu
Nguyen Thj Minh
Phuong*
SUMMARY
STUDY OF CHANGES IN NUMBER

AND MORPHOLOGY OF
THE MEGAKARYOCYTES IN PATIENT
WITH THROMBOCYTOPENIA
Thrombocytopenia
i5
commonly encountered in
haematological and
non-haematological
disorders.
Bone marrow aspiration plays a major role
in
diagnosis. Objective: to analyse the changes
in
number and morphology of the megakaryocytes
in
patient
with
Thrombocytopenia, Patients and
methods: This restrospective and prospective cross-
sectional study was carried out at 108 military central
hospital.
Results: 400 cases
with
thrombocytopenia.
Mean age of patients was 53,2 years. Maximum
number of cases was seen
in
age group of above 45
years. Idiopathic thrombocytopenic purpura (ITP) was
the commonest cause followed by hypoplastic marrow,

acute leukaemia respectively. Most patients increased
number of megacaryocyte
with
immature form is ITP.
Conclusion: bone marrow aspiration
is
an important
diagnostic modality to determine the aetiology of
thrombocytopenia.
Keywords: Thrombocytopenia, bone marrow
aspiration
YHOC
VIET
NAM
THANG 2 - SO 2/2014
I.
BAT VAN DE
Tieu cau (TC) ddng mpt vai trd quan trpng
trong ddng mau va cam mau khi thanh maeh bi
ton thffdng. Giam so iffdng tieu cau
(thrombocytopenia) se tang nguy ed ehay mau.
Giam TC thffdng gap trong thyc hanh lam sang.
Mae
dii
ed rat nhieu nguyen nhan gay giam tieu
cau nhffng cd the chia ra lam 4 nhdm
chinh:
Suy
giam kha nang sinh tieu cau, tang
hiiy

TC hoac
tieu thu TC, giam TC do phan bd va mat mau Idn
(Levine,
2003)
[4],
Cac chf djnh
tiiy
do thffdng
dffdc dffa ra khi giam tieu cau khdng giai thfch
dydc hoac khi cd giam 3 ddng ngoai mau vl. Bleu
hien lam sang thffdng gap d eac benh ly gay
giam TC la xanh xao, met mdi,
laeh
to, hach to,
sot, ehay mau, giam can, va gan to (Tariq et al,,
2010).Tham kham lam sang ky cang va xet
nghiem mau ngoai vi cd the giiip djnh hffdng
chan doan. Tuy nhien xet nghiem tuy do la rat
can thiet gdp phan quan trpng khang djnh chan
doan.
Chpc hut
tiiy
xydng de lam
tiiy
dd la
thii
thuat xam lan nhffng an toan dffdc thffc hien
thffdng quy trong eae benh vien de tim cac
nguyen nhan gay giam tieu eau (Egesie et al.,
2009) ngay ca trffdng hdp cd giam tieu cau nang

(Kibria et
al.,
2010) [2]. Mue tieu
eiia
nghien cffu
nay la danh gia vai trd cua
tiiy
xffdng trong cac
trffdng hdp giam tieu cau.
II.
OOI TU'ONG
VA
PHt/CTNG PHAP NGHIEN OJM
2.1.
Doi tu'dng nghien cu'u: 400BN giam
tieu cau mau ngoai vi dieu trj tai Benh
vienTWQO
108.
Loai trff cac trffdng hdp Iffdng dich hut
tiiy
xffdng khdng
dii
de dpc xet nghiem hoac
tiiy
kho
khd hilt
djch,
benh nhan dang sff dung cae thuoc
cd kha nang gay
giam

tieu cau, BN ung thff
dieu
trj hda ehat hoac xa trj.
2.2.
Pliffdng pliap
nghien
cu'u:
Hoi
ciitj
ket hdp tien
cffu,
md ta cat ngang
Chi tieu nghien
cffu:
Cac trieu chffng lam
sang,
xet nghiem mau ngoai vi va tuy do
dypc
phan ti'ch chi tiet. Tieu cau dffdc coi la giam khi
sd Iffdng dffdi 150 G/L. Cdng thffc mau dffdc
dem bang may tff dpng. So Iffdng mau tieu
can
binh thffdng (mdt mau tieu cau / 1 den 3 vi
trffdng), tang (hdn hai mau tieu cau / 1 vi
trffdng), giam (mpt mau tieu cau / 5 den 10 vi
trffdng), Thay doi hinh thai
ciia
mau tieu cau la
cac bien ddi dang non, loan san va nhan trd.
Sd lieu nghien cffu dffdc xff ly bang phan mem

SPSS 18.0
. KET QUA
Bang 1: Dac diem chung cua cac
BN
nghien cffu
Tuoi
Gidi
<15
16-30
31-45
46-60
>60
Nam
NO-
Sot
Xuat huyet
Da
xanii,
niem mac
ntidt
Gan
to
Lach to
Hach to
Dau xu'dng
Cac trieu
chCrnq
khac
So
lu'dng BN

6
45
72
140
137
251
149
134
235
290
92
106
65
47
82
Ty le
%
1,5
11,25
18
35
34,25
62.8
37.3
33,5
58,75
72,5
23
26,5
16,25

11,8
20,5
400 BN giam
tliu cau du tliu
chuan d&dc chpn vao nghien
c&V.
Tudi
trung btnh ia 53,2
tuoi (14-94
tudi).
Nhdm
tudi
th&dng
gap nhit la >45 tudi
(69,25%,
trong sd
400
binh
nhan).
62,8% la
nam
g'i&
37,3% la
n&gidi
vdi ty li
nam:n&la
1,6:1.
Trieu ch&ng
lam sang
th&dng

gap nhit la da
xanh,
h^
mac nhdt (72.5%) sau do den xuit huyet
da,
niim mac
hoac
phu tang (58,75.0%), sdt
(33,5%) w
gan
lach
to
lan l&dt la
23,
% va
26,5%.
y HOC VIET NAM THANG 2 • SO 2/2014
Bang
2:
Xet nqhiem mau nqoai
vi
cua
cac
BN nqhien
cu'u
Cac chi
so
mau ngoai
vi
Hb

rq/il
Tonq
so
iu'dnq
bach cau
(G/L)
So
iydnq
tuyet doi BC
hat
(G/L)
So
iu'Onq
tieu cau
(G/i)
Hinh thai
te bao
Hinh thai hong
cau
HC Binh thu'dng dang
sac
HC Nho, nhu'dc sac
HCto
Te bao
bat
thu'dng mau ngoai
vi
Gia
tri
trunq binh (Mean

± SD)
106,46 ±27,16
19,45±41,77
7,78
±
24,9
63,62±33,39
So
lu'dng BN
(n=
400),
ty le
(«/o)
326 81,5%)
39 (9,75%)
35 (8,75%)
93 23.25%)
Kit qua cong th&c
mau cua 100
BN giam TC thay
so
luang TC trung binh
la
63,62±33,39 G/L,
so
luang BC trung binh
19,45±41,77
G/L
va hong cau binh
thu'dng,

dang sac chiem 81.5%.
Bang
3:
Mat
do te
bao
tuy
xi/dnq
d
cac BN nqhien ciru
Sd tlTdng
te
bao
tuy (G/L)
So iu'dng binh thu'dng (30-100
G/L)
Tuy tang
so
luang
te
bao (>100
G/L)
Tuy qiam
so
lu'dnq
te
bao
(<30
G/L)
Tong

sd
Sd lu'dng
BN
194
97
109
400
Ty le
(%)
48,5%
24,25%
27,25
100
Ve
mat do
tebao
aia tuy
xUdng
thay
tiiy
tang so
IWdng tebao
d
24,25%
BN,
so
Iddng binh thudng
d
•18,5%
va giam d

2725%
Bang
4:
So
iu'dng mau tieu
car
Chan doan
Bach cau lympho cap
Bach cau
tuy
cap
Giai doan cap
ciJa
bach cau
tijy
man
H6I chu'ng thu'c bao
Cu'dng lach
Giam san
tuy
Xuat huyet giam tieu cau
vo
can (FTP)
Roi ioan sinh
tuy
Thieu mau HC
i<h6ng
io
Di can ung thu vao
tuy

xUdng
Xdtuy
T3ng
sinh
ac
ti'nh dong Piasmocyte
Xdgan
Nhiem trung
Tong
sd
tuy XUdng
d
cac BN
vdi
Sd
lu'dn
Khong
gap
7
24
0
0
0
21
0
0
0
0
0
0

0
0
52
:ac Chan doan khac nhau
3
Mau tieu cau
(n=
Binh
thu'dng
4
2
3
5
2
21
22
4
5
0
0
7
11
10
96
Giam
9
27
2
3
1

43
0
11
28
13
3
5
2
3
150
400)
tang
0
0
1
3
6
0
67
4
4
12
2
1
2
0
102
Tong
50
20

53
6
11
9
85
89
19
37
25
5
13
15
13
400
Tyl?
(%)
5
13,25
1,5
2,75
2,25
21,75
22,25
4,75
9,25
6,25
1,25
3,25
3.75
3,25

100
K& qua
tuy do
cho thay
ITP la pho
bien nhat
(89
BN,
22,25%). Nguyen nhan
pho
bien
thd
2 la giam
san
tuy
(85
BN 21,75%)
sau dd la
AML
(53
BN,
13,25%). Thieu mau hdng cau khong
to
(9,25%),
di
cSn
ung
thd
vao
tuy

xddng (6,25%),
roi
loan sinh
tuy
(4,75%), tang sinh
ac
tinh ddng piasmocyte
(3,25%) va nhiem trung
gay
giam TC(3.25%).
Y HOC VIET NAM THANG
2 -
SO 2/2014
Bang
5:
Moi
lien quan giffa so iffdng va hinh
thai
mau tieu cau d
tiiy
dd cac
BN
giam TC
Hinh thai
Khonq gap
Hinh thai roi ioan
Hinh thai binh thu'dnq
Dang te bao non
Tdng
sd

Sd lu'dng
Khonq qap
52
0
0
0
52
Binh thu'dnq
0
12
84
0
96
Giam
0
5
145
0
150
Tang
0
5
0
97
102
Tong sd
52
22
229
97

400
Sdl&dng
va
hinh
thai
mau
tiiu
cau
trong tuy do
cd
mdi liin
quan
vdi
benh.
229/400
BN
chiim
57,25%
CO
so
l&dng
mau tieu cau trong tuy binh
thwdng hoac giam nh&ng
hinh that van binh
th&dng.
Co
97
tr&dng
hdp co
tang

sd
l&dng
mau
tieu
cau vdi
dang
non
hoac ch&a
tr&dng
thanh.
Trong
so
do
hau het
la
cac
tr&dng
hdp
FTP.
Hinh
thai Idi
loan d&dc
thiy
trong
tit
ca
cac
tr&dng
hdp
rdi

loan sinh
tuy.
IV. BAN
LU^N
Giam tieu eau thffdng gap trong cac rdi loan
huyet hpe khac nhau bao gom ed rdi loan sinh
tiiy
hoae khdng ed rdi loan
(MeKenzie,
1996) [5].
Mpt so benh huyet hpc ehi bieu hien giam tieu
eau ddn thuan hoac kem theo giam 2 ddng khac.
Chpc hilt tuy xffdng de lam
tiiy
do la mdt xet
nghiem an toan va hffu
leh
nham xac djnh ehan
doan cudi cung [6]. Trong nghien cffu
eiia
chung
tdi dp tudi hay gap nhat la >45 tudi
(59,25%,
trong sd 400 BN). Trong mdt nghien cffu
ciia
Muhury
va es (2009), da sd eae BN dffdi 10 tudi
[6].
Tudi trung binh trong nghien cffu
ciia

chiing
tdi la
53,25
tudi .
(62,8%)
la nam gidi (37,3%) la
nff gidi vdi ty le
nammff
la
1,6:1.
Trong nghien
cffu
eiia
Muhury va es giam TC thffdng gap d
nam hdn la nff d dp tuoi 10 nam dau tien [6].
Trong nghien cffu
ciia
chung tdi trong 400
BN giam tieu eau 8.6 % giam 3 ddng. Nghien
cffu
ciia
Jha
etal.
(2008) [l],Bashawri va cs.
(2002), va Pudasaini va cs. (2002) [7] ty le xet
nghiem
tiiy
do de danh gia giam 3 ddng lan
Iffdt
la 17.34%, 11.9% and 50%. ITP la phd

bi§n
nhat thay d 89 BN (22,25%). Cac nghien effu
khae eae ty le nay lan Iffdt la
6.21%,
14.5%,
6,8% va 5%
kibria
va es 2010 [2]; Ahmad va cs
2011;
Pudasaini va cs 2002;Knodke va es 2001)
[3],
[7]. Nguyen nhan phd' bien thff 2 gay giam
tieu eau la giam san
tiiy
(85/400 BN chiem
21,75%) sau dd la bach eau
tiiy
cap (53 BN,
13,25%). Trong 53 trffdng hdp AML, the phd
bien la AML-M2 (22 BN), sau do la
AML-Ml
(8
BN) va AML-M4 (7 BN). Tffdng tff nhff nghien
cffu cua chiing tdi thi bach cau cap cung la
nguyen nhan phd bien thff 3 gay giam tieu cau
trong nghien cffu
ciia
Savage va cs (1999) va
tffdng tff nhff nghien cffu
ciia

Varma va Dash
(1992). Cac nghien cffu khac (Egesie va cs 2009;
Gayathri va cs
2011;
Jha va cs 2008; Kibria va cs
2010) eung thay baeh cau cap la benh mau ac
tinh
phd bien nhat va bach cau cap ddng tuy pho
bien hdn ddng lympho. Thieu mau hong cau
khdng Id thay d 37 trffdng hdp (9,25%). Nghien
cffu
ciia
chung toi thay bach cau cap la nguyen
nhan thff 3.
Niazi
va cs (2004),Jha va cs (2008)
Gayathri va cs (2011) thay thieu mau hong cau
khdng Id la nguyen nhan phd bien thff 2 cdn
d
nghien cffu
ciia
ehung tdi la giam san tuy. So
sanh vdi nghien cffu
eiia
ehiing tdi thi thieu mau
giam san
tiiy
gap lan Iffdt d 19%, 29% and 14%
trong cac nghien cffu (Gayathri va cs
2011;Knodke va es 2001; Niazi va cs 2004).

Chiing tdi cung gap tang sinh ac tinh piasmocyte
nhffng vdi ty le thap (3,25 %) va rdi loan
sinh tiiy
(4,75%).
Cac nghien effu khac nhff cua Kibria va
cs 2010; Laishram va cs 2008) thay
t/
Ie
da u
tiiy
xffdng tff 0.94% tdi
4.1%
va rdi loan sinh
tiiy
tff 2% to 7.9%. Ve so Iffdng va hinh thai mau
tieu cau thi tang sd Iffdng va dang non dffdc thay
trong hau het cae trffdng hdp FTP. George va cs
(1994) va Levine va es (1999) cung cho ket qua
tffdng tff.
V. KET LUAN
Ciing vdi cac trieu
chiffig
lam sang thi xet
nghiem
tiiy
do la mdt bffdc quan trpng de chan
doan xac djnh cac benh ly huyet hpc cd giam tieu
cau.
Xuat huyet giam tieu cau vd can la nguyen
nhan pho bien nhat gay giam tieu cau trong

nghien cffu
ciia
chung tdi. 57,25% BN sd Iffdng
mau tieu cau trong
tiiy
binh thffdng
ho3c
giam
nhffng hinh thai van binh thffdng. Trong sd 97
BN tang sd Iffdng mau tieu cau vdi hinh thai dang
non thi hau het la cac trffdng hdp ITP. Hinh thai
rdi loan dffde thay trong tat ea cac trffdng hdp
roi
loan sinh
tiiy.
Y
HOC
VlfT
NAM
THANG 2 -
SO
2/2014
TAI
LIfU
THAM
KHAO
1.
Jha, A., Sayami,
G.,
Adhikari,

R.
C,
Panta, D.,
Jha,
R.
(2008). Bone marrow examination
in
cases
of pancytopenia. 3 Nepal Med
Assoc,
47, 12-17.
2.
Kibria, S. G., Islam, M. D. U. (2010).
Prevalence of Hematological Disorder: A Bone
MantJW
Study of
177
Cases In a Private Hospital
at Fandpur.
Farldpur
Med.
Coll J, S, 11-13.
3.
Knodke,
K.,
Marwah,
S (2001). Bone marrow
examination in cases of pancytopenia. J Academy
QinMed,!,
55-59.

4.
Levine, F. C. (1999). "Idiopathic"
thrombocytopenia. Arch Intern Med,
88,
701-728.
I 13. Levine, S. P. (2003). Thrombocytopenia:
pathophysiology and classification. In Greer
3P,
Foerster
J, Lukens
JN,
et al. (Eds.),
Wintrobe's
clinical hematology 11th ed. (vol. 2, pp. 1530-
1532). Philadelphia:
Lippincott
Williams
&
Wilkins.
MeKenzie
S.
B.
(Ed.), (1996). Textbook of
hematology, 2nd ed.
Painsylvania:
Willaims&
Wilkins.
Muhury, M., Mathai, A. M (2009).
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alterations in thrombocytopenia: A

bone marrow
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THirC
TRANG AN TOAN VE SINH THITC PHAM TAI
BEP
AN TAP THE
COA
MOT
"SO
DOANH
NGHIEP
-
THANH
PHO HAI
DiraNG
NAM 2013
TbM
TAT
Nghien

ciiff
thUe trang An toan ve sinh
thiTc
pham
t?i
cic
bep 3n tap the (BATT)
ciia
doanh nghiep tren
dja ban thanh phd Hai DUdng , ket qua cho thay : Dien
tich phong che bien <
lOOm^
chiem ty le nhieu nhat
(50%);
di?n
ti'ch phong an
200-500m^
chiem
t/
le
nhiSu
nhat (45%); Cdn ed 44% BATT chUa dat yeu
cau ve
thii
tuc hanh chinh; 17,5% khdng dat yeu cau
ve
CO
sd ha tang; 20% BATT
ngudi
phuc vu (NPV)

khdng mang day
dii
bao hp lao dpng
khi
lam
viec;
20%
NPV khong sff dung dung
cy
sach khi che
bien;
Tren cac mau xet nghiem deu thay co ty le nhiem
vi
sinh vat (VSV): tren
thi/c
pham
chin,
dung cu chira
(Jyhp
thu'c pham
chin,
ban tay NPV, Trong do ty le
nhiem VSV tren ban tay NPV la cao nhat: Coliform
(72,5%);
E.coli
(25,0%); S.aureus(32,0%).
SUMMARY
SAFETY
SITUAHON
IN FOOD HYGIENE AT

CANTEENS OF SEVERAL BUSINESSES -
HAI DUONG CITY IN 2013
Research the current status of food safety and
hygiene in the canteens of businesses
in
Hai
Duong
city,
the results show that processing room area <
lOOm^
acmunting
for largest proportion (50%), dining room
area of 200 - 500
m^
accounting for the largest
preiportion
(45%); there are 44% of the canteens is
'
SdYte tinh
Hal
DuVng
"
TnAlmg
Cao
dSng
Y
teHai
Phdng
Phin
b/^n

khoa hgc: GS.TSKH Nguyen VSn Hien
Dinh Huy
Hung*,
Vu
Due
Long**
unsatisfactorily on administrative procedures;
17.5%
is
unsatisfactorily on infrastructure, 20% waiters do not
carry adequate labor protection at work; 20% waiters do
not use clean utensils when processing; In the
specimens founded microorganism ratio on cooked
food,
containers of cooked food , hands of waiters. In which
the infection rates on the waiters' hands is the highest;
Coliform (72.5%), E,
coli
(25,0%), S, aureus (32,0%),
I.
OAT VAN
OE
An toan ve
sinh
thffc pham(ATVSTP) hien
dang la mdi quan tam
Idn
ciia
nhieu Qudc gia
tren the

gidi,
Tren the gidi ffdc
tfnh,
hang nam cd
khoang 3 - 5 ty ngu'di bj tieu ehay, ed 3-5
trieu
ngLfdi
tff vong, khoang 1.400 trieu
Iffpt
tre
em/nam bi mac benh tieu chay
,trong
sd dd 70
% nguyen nhan do an, udng thi/e pham bj d
nhiem [5],[6]. Tai Viet Nam, sd trffdng hdp ngd
ddc thffc pham cd xu hffdng ngay cang
gia
tang[l],
Theo thdng ke chffa day du
ciia
cue
ATVSTP
trong cac nam
2007-2011,
toan qudc da
ghi nhan 927 vu
NOTP
vdi 30.733 ngu'di mac va
299 ngffdi chet. Trung binh cd 185 vu/nam, trong
dd sd vu ngd ddc tai bep an tap the chiem tff

12,7 den 20,6% tong sd vu moi nam, Tuy nhien
day chi la sd iieu thdng ke chu'a day du
,thffc
te
con sd ngd dpc thffe pham hang nam cdn eao
hdn rat nhieu[2]. Theo ffdc tinh
eiia
WHO, d Viet
Nam con sd ngd dpc thffe pham hang nam
khoang tren 8 trieu ngffdi [5]. Hai Dffdng la mdt