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Ở Các Đ I Tƣ Ng Khám Và Điều Trị Tại Viện St Rét-K Sinh Tr Ng BỘ GIÁO DỤC VÀ ĐÀO TẠO VIỆN HÀN LÂM KHOA HỌC VÀ CÔNG NGHỆ VIỆT NAM HỌC VIỆN KHOA HỌC VÀ CÔNG NGHỆ ----------------------------- Dƣơng Thị Hồng NGHIÊN CỨU ĐẶC ĐIỂM NHIỄM GIUN LƢƠN (Strongyloides) Ở CÁC Đ I TƢ NG KHÁM VÀ ĐIỀU TRỊ TẠI VIỆN S T RÉT-K SINH TR NG – CÔN TR NG TRUNG ƢƠNG NĂM 2017 -2018 LUẬN VĂN THẠC SỸ SINH HỌC Hà Nội – 2019 BỘ GIÁO DỤC VÀ ĐÀO TẠO VIỆN HÀN LÂM KHOA HỌC VÀ CÔNG NGHỆ VIỆT NAM HỌC VIỆN KHOA HỌC VÀ CÔNG NGHỆ ----------------------------- Dƣơng Thị Hồng NGHIÊN CỨU ĐẶC ĐIỂM NHIỄM GIUN LƢƠN (Strongyloides sp.) TRÊN CÁC Đ I TƢ NG KHÁM VÀ ĐIỀU TRỊ TẠI VIỆN S T RÉT-K SINH TR NG – CÔN TR NG TRUNG ƢƠNG NĂM (2017 -2018) Chuyên ngành: Động vật học Mã số: 8. 42. 01. 03 LUẬN VĂN THẠC SỸ SINH HỌC NGƯỜI HƯỚNG DẪN KHOA HỌC: Hướng dẫn 1: TS. Phạm Ngọc Doanh Hướng dẫn 2: TS. Nguyễn Quang Thiều Hà Nội – 2019 L I CAM ĐOAN T i xin cam oan y l ề t i do ch nh t i thực hiện dưới sự hướng dẫn của TS Ph m Ngọc Do nh v TS Nguyễn Qu ng Thiều. C c s liệu kết quả nghi n cứu trong ề t i l trung thực v chưa từng ược c ng tr n một c ng tr nh nghi n cứu khoa học hoặc luận văn/luận n n o kh c. T i xin ho n to n chịu tr ch nhiệm với những lời cam oan tr n. H Nội ng y 22 th ng 5 năm 2019 Dƣơng Thị Hồng L I C M ƠN ể ho n th nh luận văn n y t i xin y t l ng iết n s u sắc ến TS Ph m Ngọc Do nh Viện Sinh Th i v T i nguy n Sinh vật v TS Nguyễn Qu ng Thiều Viện S t rét – Ký sinh trùng C n trùng Trung ư ng tận t nh hướng dẫn chỉ dạy những kiến thức về chuy n m n thiết thực v những chỉ dẫn khoa học quý u trong su t qu tr nh t i học tập v viết luận văn. T i xin tr n trọng cảm n Ban L nh ạo Viện S t rét - Ký sinh trùng - C n trùng Trung ư ng v Ban gi m hiệu Trường Cao ẳng Y tế ặng Văn Ngữ tạo iều kiện thuận lợi cho t i ược học tập v nghi n cứu n ng cao tr nh ộ. T i xin tr n trọng cảm n c c thầy c gi o tại c sở o tạo Học Viện Khoa học v C ng Nghệ thuộc Viện H n l m Khoa học v C ng nghệ Việt Nam, Khoa sinh Th i v T i Nguy n sinh vật hướng dẫn t i trong qu tr nh học tập tại y. T i xin tr n trọng cảm n v y t l ng iết n ến L nh ạo v c c c n ộ vi n chức Khoa Kh m ệnh chuy n ng nh - Viện S t rét - Ký sinh trùng- C n trùng Trung ư ng gi p tạo iều kiện t t nhất cho t i trong qu tr nh thu thập mẫu thực hiện ề t i. T i xin y t l ng iết n s u sắc tới PGS. TS. Tạ Thị Tĩnh cùng gia nh ạn è ồng nghiệp ủng hộ v ộng vi n chia sẻ gi p t i trong su t qu tr nh học tập l m việc v nghi n cứu ho n th nh luận văn. N i ng 22 th ng 05 năm 2019 Dƣơng Thị Hồng DANH MỤC TỪ VIẾT TẮT SLBC S lượng Bạch cầu BCAT Bạch cầu i toan DNA Deoxyribonucleic acid EDTA Ethylendiamin Tetraacetic Acid - Ống lấy m u có chất ch ng ng ELISA Enzyme - linked Immunosorbent assay - Kỹ thuật miễn dịch li n kết enzym Hb Hemoglobin - huyết sắc t SLHC S lượng Hồng cầu OD Optical Density - Mật ộ quang NIMPE.HD National Institute of Malariology, Parasitolgoy, and 08.PP/11 Entomology (Viện S t rét - Ký sing trùng - C n trùng Trung ư ng) PCR Polymerase Chain Reaction - phản ứng chuỗi Polymerase. rRNA Ribosomal Ribonucleic Acid AST Aspartat transaminase ALT Alanin transaminase MỤC LỤC MỞ ẦU ............................................................................................................ 1 CHƯƠNG 1. TỔNG QUAN .............................................................................. 3 1.1. KHÁI QUÁT CHUNG VỀ GIUN LƯƠN VÀ BỆNH GIUN LƯƠN Ở NGƯỜI ............................................................................................................... 3 1.1.1. T c nh n g y ệnh v v ng ời ph t triển ............................................... 3 1.1.2. H nh th i giun lư n .................................................................................. 5 1.1.3. Nguồn bệnh v con ường nhiễm bệnh giun lư n ................................... 6 1.1.4. Triệu chứng l m s ng v cận l m s ng ệnh giun lư n ........................... 7 1.1.4.1. L m s ng .............................................................................................. 7 1.1.4.2. Cận l m s ng. ..................................................................................... 10 1.1.5. Chẩn o n nhiễm giun lư n ................................................................... 10 1.1.5.1. Xét nghiệm ký sinh trùng ................................................................... 10 1.1.5.2. Kỹ thuật miễn dịch ............................................................................. 11 1.1.5.3. Kỹ thuật ph n tử ................................................................................. 12 1.1.6. iều trị bệnh giun lư n .......................................................................... 13 1.1.7. Ph ng ệnh ............................................................................................. 13 1.2.TÌNH HÌNH NHIỄM GIUN LƯƠN TRÊN THẾ GIỚI ............................ 14 1.3.TÌNH HÌNH NHIỄM GIUN LƯƠN TẠI VIỆT NAM ............................. 15 CHƯƠNG 2. PHƯƠNG PHÁP NGHIÊN CỨU ............................................. 19 2.1. ỐI TƯỢNG NGUYÊN LIỆU ỊA IỂM VÀ THỜI GIAN NGHIÊN CỨU ............................................................................................................. 19 2.1.1. Thiết kế nghi n cứu. ............................................................................... 19 2.1.2. i tượng nghi n cứu............................................................................. 20 2.1.3. Nguy n liệu nghi n cứu ......................................................................... 20 2.1.4. ịa iểm v thời gian nghi n cứu .......................................................... 20 2.2. NỘI DUNG NGHIÊN CỨU ..................................................................... 20 2.3.PHƯƠNG PHÁP NGHIÊN CỨU .............................................................. 21 2.3.1. C mẫu nghi n cứu ................................................................................ 21 2.3.2. Phư ng ph p chọn mẫu ......................................................................... 22 2.4.CÁC KỸ THUẬT ÁP DỤNG ................................................................... 21 2.4.1. Thu tập th ng tin về triệu chứng l m s ng............................................. 21 2.4.2. Lẫy mẫu ph n v mẫu huyết thanh ........................................................ 21 2.4.3. Xét nghiệm huyết học ............................................................................ 21 2.4.4. Xét nghiệm sinh hóa............................................................................... 21 2.4.5. Xét nghiệm ph n t m ấu trùng giun lư n ............................................... 22 2.4.6. Kỹ thuật xét nghiệm ELISA t m kh ng thể kh ng giun lư n ................ 22 2.4.6.1. Ngu ên tắc hoạt đ ng của b kit ....................................................... 22 2.6.4.2. C c bước thực hiện ELISA: ............................................................... 24 2.4.7. ịnh loại h nh th i v ph n tử c c giai oạn ph t triển của giun lư n .. 25 2.5. IỀU TRỊ CHO BỆNH NHÂN ................................................................ 28 2.6. CÁC BIẾN SỐ VÀ CHỈ SỐ NGHIÊN CỨU: .......................................... 28 2.6.1. Mục ti u 1............................................................................................... 28 2.6.2. Mục ti u 2 v 3 ....................................................................................... 28 2.7. PHƯƠNG PHÁP XỬ LÝ VÀ PHÂN TÍCH SỐ LIỆU ........................... 29 2.7.1. Phư ng ph p nhập liệu ........................................................................... 29 2.7.2. Phư ng ph p ph n t ch s liệu ............................................................... 30 2.8. SAI SỐ VÀ BIỆN PHÁP KHẮC PHỤC .................................................. 30 2.9. ẠO ỨC TRONG NGHIÊN CỨU........................................................ 30 CHƯƠNG 3. KẾT QUẢ VÀ THẢO LUẬN ................................................... 31 3.1. ẶC IỂM HÌNH THÁI CÁC GIAI OẠN PHÁT TRIỂN CỦA GIUN LƯƠN NGOÀI MÔI TRƯỜNG ...................................................................... 31 3.2. ỊNH DANH ẤU TRÙNG GIUN LƯƠN DỰA TRÊN DỮ LIỆU PHÂN TỬ ............................................................................................................. 38 3.3. ẶC IỂM NHIỄM GIUN LƯƠN Ở CÁC ỐI TƯỢNG NGHIÊN CỨU ............................................................................................................. 43 3.3.1. Nhiễm bệnh theo nhóm tuổi. .................................................................. 43 3.3.2. Ph n bệnh nh n theo giới t nh ........................................................... 44 3.3.3. Ph n bệnh nh n theo nghề nghiệp..................................................... 45 3.3.4. Ph n bệnh nh n theo ịa phư ng ...................................................... 46 3.4. ẶC IỂM LÂM SÀNG VÀ CẬN LÂM SÀNG CỦA BỆNH NHÂN NHIỄM GIUN LƯƠN ..................................................................................... 47 3.4.1. ặc iểm l m s ng ................................................................................. 47 3.4.1.1. Chỉ số sinh hiệu khi nhập viện ............................................................ 47 3.4.1.2. Triệu chứng lâm s ng bệnh nhân nhiễm giun lươn ............................ 47 3.4.2. ặc iểm cận l m s ng của bệnh nh n nhiễm giun lư n....................... 49 3.4.2.1. C c chỉ số huyết học ........................................................................... 49 3.4.2.2. C c chỉ số sinh hóa ............................................................................. 50 3.4.2.3. Xét nghiệm phân tìm ấu trùng giun lươn ............................................ 50
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