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Được viết: Thứ sáu, 19-10-2012

Tăng tiết mồ hôi có phải là một bệnh lý?

Theo khoa học, tăng tiết mồ hôi là một chứng bệnh, có tên gọi là Hyperhydrosis. Tại Việt Nam, chiếm khoảng  3 -5 % dân số, nam nữ dưới 50 tuổi, chứng bệnh này thường tác động đến một hoặc nhiều vùng cơ thể, thường nhất là lòng bàn tay, nách, lòng bàn chân hoặc mặt. Ra nhiều mồ hôi gây nên một gánh nặng tâm lý, khiến con người mặc cảm (71,8%) vì nó cản trở đến sinh hoạt thường ngày. Đa phần họ âm thầm chịu đựng và tuyệt vọng trong việc tìm kiếm giải pháp (48,7%). Những nghiên cứu sau đây sẽ giúp mọi người hiểu rõ hơn về chứng bệnh này, và cách điều trị như thế nào cho hiệu quả.

Nghiên cứu bắt đầu từ một khảo sát dịch tễ rộng lớn mới đây bao gồm 150.000 hộ gia đình tại Hoa Kỳ cho thấy tăng tiết mồ hôi khu trú gặp ở 2,8% khối dân số chung. Đàn ông và phụ nữ có tỉ lệ mắc bệnh bằng nhau và những người thuộc nhóm tuổi 25-64 tuổi có tỉ lệ mắc cao nhất: Tuổi khởi phát trung bình là 25 tuổi nhưng chủ yếu còn tùy thuộc vào vùng cơ thể bị bệnh. Tăng tiết mồ hôi tay và nách có tuổi khởi phát trung bình nhỏ nhất, lần lượt là 13 và 19 tuổi. Có đến 82% số BN bị tăng tiết mồ hôi bàn tay cho biết bệnh khởi phát từ lúc ấu thơ. Tăng tiết mồ hôi khu trú có vẻ khởi phát từ nhỏ nhưng người ta chỉ điều trị khi bắt đầu ở tuổi trưởng thành. Số BN bị bệnh ở nách là 51%, bàn chân 29%, lòng bàn tay 25% và mặt là 20%. Không có một nghiên cứu nào ghi nhận diễn tiến tự nhiên của bệnh khi tuổi tăng dần, nhưng theo kinh nghiệm, mức độ trầm trọng của việc ra mồ hôi dường như giảm đi khi BN trên 50 tuổi

SINH LÝ BỆNH:

Sinh lý bệnh của tăng tiết mồ hôi khu trú còn chưa được biết rõ. Mồ hôi được sản sinh từ các tuyến mồ hôi của cơ thể: Có đến 4 triệu tuyến mồ hôi, trong đó khoảng 3 triệu là tuyến mồ hôi ngoại tiết (eccrine sweat glands) và số còn lại là các tuyến đầu tiết (apocrine glands). Các tuyến mồ hôi được chi phối bởi sợi cholinergic của hệ thần kinh giao cảm. Chức năng cơ bản của chúng là bài tiết mồ hôi - một chất dịch trong, không mùi, có chức năng điều hòa thân nhiệt - mà tốc độ bài tiết chịu ảnh hưởng của các kích thích xúc cảm và vị giác. Tuyến mồ hôi ngoại tiết, là nguyên nhân biểu hiện của tăng tiết mồ hôi khu trú, được phân bố gần như khắp bề mặt cơ thể, dù vậy mật độ của chúng cao nhất là ở lòng bàn chân và trán, kế đó là lòng bàn tay và gò má. Tuyến mồ hôi đầu tiết là những tuyến tiết loại mồ hôi có mùi và được giới hạn chủ yếu tại nách và những vùng niệu sinh dục. Chúng không có liên hệ đến tăng tiết mồ hôi khu trú và chức năng của chúng được điều hòa bởi các tiến trình nội tiết. Cũng có những tuyến mồ hôi hỗn hợp gọi là tuyến đầu-ngoại tiết (apoeccrine glands), chủ yếu được tìm thấy ở nách và vùng quanh hậu môn. Vai trò của chúng trong sinh lý bệnh của tăng tiết mồ hôi khu trú hiện chưa rõ, dù vậy trên một số BN chúng chiếm đến 45% số tuyến mồ hôi được tìm thấy trong vùng nách.

Không quan sát được những thay đổi mô bệnh học nào của tuyến mồ hôi của những người bị tăng tiết mồ hôi khu trú, cũng như không có sự gia tăng về số lượng tuyến mồ hôi khu trú, cũng như không có sự gia tăng về số lượng tuyến mồ hôi hoặc kích thước tuyến. Đúng hơn là, tăng tiết mồ hôi khu trú có thể biểu trưng cho một rối loạn chức năng phức tạp của hệ thần kinh tự chủ, bao gồm cả các đường giao cảm lẫn đối giao cảm. Có thể có tố chất di truyền vì 30% - 50% số người có tiền sử gia đình tăng tiết mồ hôi. Trong một nghiên cứu của Shih và CS (1983), những người bị tăng tiết mồ hôi khu trú cho thấy ít bị chậm nhịp tim phản xạ trong đáp ứng với việc ngâm ngón tay trong nước lạnh. Một sự gia tăng hoạt tính giao cảm như thế thông qua các hạch T2 - T3 có thể gây ra tăng tiết mồ hôi lòng bàn tay. Tuy vậy, việc ra mồ hôi lòng bàn tay và bàn chân quá mức có thể đưa đến một vòng luẩn quẩn, vì tình trạng da bị lạnh do bốc hơi (mồ hôi) sẽ làm tăng xung động giao cảm qua cơ chế phản xạ, rồi đến lượt nó sẽ làm tăng bài tiết mồ hôi. Rối loạn chức năng đối giao cảm được qui kết trong một nghiên cứu của Birner P và CS (2000) so sánh sự biến thiên nhịp tim giữa những người bị tăng tiết mồ hôi khu trú với những đối tượng khỏe mạnh đối chứng. Các tác giả thấy rằng, mặc dù hoạt tính giao cảm có vẻ tương tự, những người bị tăng tiết mồ hôi khu trú có hình thái nhịp tim gợi ý có rối loạn chức năng đối giao cảm.          

Bảng 1. Những nguyên nhân của tăng tiết mồ hôi toàn thân và khu trú

        Tăng tiết mồ hôi khu trú

            Tăng tiết mồ hôi vô căn tiên phát

            Ra mồ hôi vị giác (Hội chứng FREY)

            Nguyên nhân thần kinh:

                 Bệnh lý thần kinh

                 Chấn thương tủy sống

        Tăng tiết mồ hôi toàn thân

        Nội tiết 

   Nhiễm khuẩn

                 Cường giáp

    Tim mạch

                 Cường năng tuyến yên

                Sốc

                 Tiểu đường 

                Suy tim

                 Mãn kinh

                Suy hô hấp

                 Mang thai

     Dược phẩm

                 U tế bào ưa Crôm

                 Fluoxetin

                 Hội chứng carcinoid

                Venlafaxin

                 Bệnh to cực

                Doxepin

        Thần kinh

    Ngộ độc

                 Bệnh Parkinson

               Nghiện rượu

                 Chấn thương tủy sống

               Lạm dụng thuốc

                 Tai biến mạch máu não

 

        Bệnh ác tính

 

                 Bệnh lý tăng sinh tủy

 

                 Bệnh Hodgkin

 

CHẨN ĐOÁN VÀ BIỂU HIỆN LÂM SÀNG:

 Bước đầu tiên trong đánh giá tăng tiết mồ hôi là phân biệt giữa tăng tiết mồ hôi toàn thân và khu trú. Tăng tiết mồ hôi toàn thân thường là một phần trong biểu hiện của một số bệnh lý căn nguyên khác, như là một bệnh nhiễm khuẩn hoặc ác tính hoặc một rối loạn nội tiết, và tăng tiết mồ hôi khu trú hay tăng tiết mồ hôi vô căn tiên phát lại xảy ra ở những người trước nay vốn khỏe mạnh (Bảng 1). Bệnh xảy ra nhiều nhất trong thập niên thứ hai và thứ ba của cuộc đời và có biểu hiện là ra mồ hôi quá mức ở cả hai bên khu trú trong phạm vi hố nách, lòng bàn chân, lòng bàn tay, mặt hoặc các vị trí đặc biệt khác. Ra mồ hôi vị giác (hội chứng Frey) cũng là một hình thức tăng tiết mồ hôi khu trú. Một tiền sử gia đình dương tính rõ rệt gặp trong 30%-50% số trường hợp. Hơn nữa, người bị tăng tiết mồ hôi khu trú thường không ra mồ hôi lúc ngủ. Như vậy, một bệnh sử tập trung vào vị trí ra mồ hôi quá mức, thời gian kéo dài của biểu hiện, tiền sử gia đình, tuổi khởi phát và việc không có bất kỳ một nguyên nhân rõ rệt nào cho phép ta phân biệt dễ dàng tăng tiết mồ hôi khu trú với tăng tiết mồ hôi toàn thân (Bảng 2). Mặc dù không có định nghĩa chuẩn của tăng tiết mồ hôi khu trú, việc bài tiết mồ hôi bởi các tuyến mồ hôi ngoại tiết đạt dưới 1ml/m2 /phút lúc ngủ và ở nhiệt độ phòng được xem như bình thường. Ngoài ra có thể đo tốc độ tiết mồ hôi ở những vùng giải phẫu học riêng biệt (như lòng bàn tay, nách) cho mục đích nghiên cứu (chẳng hạn như tốc độ tiết mồ hôi bình thường ở nách là dưới 20 mg/phút). Vì mục tiêu thực hành lâm sàng, bất kỳ mức độ ra mồ hôi nào làm cản trở đến sinh hoạt trong cuộc sống hàng ngày nên được xem như bất thường.

Chẩn đoán tăng tiết mồ hôi không cần đến thăm khám labo. Có thể sử dụng nghiệm pháp tinh bột - iod để phác họa vùng ra mồ hôi quá mức (Hình 1). Dung dịch iod (1%-5%) được thoa lên một bề mặt khô ráo, và sau vài giây tinh bột được rắc đều lên vùng này. Khi có mồ hôi, tinh bột và iod tác động lẫn nhau để lại một cặn lắng màu đỏ tía. Vùng có màu đỏ tía này xác định ống dẫn của tuyến mồ hôi. Mặc dầu để chẩn đoán bệnh không cần làm nghiệm pháp tinh bột iod, nhưng nó cho phép xác định định tính các vùng ra mồ hôi quá mức và qua đó ghi lại hình ảnh của các vùng này trước và sau khi điều trị.



          TPCN Hòa Hãn Linh - Không còn ám ảnh mồ hôi nhiều
          Ra mồ hôi tay có phải bệnh di truyền
          Mồ hôi nhiều có thể gây thiếu vitamin

Bảng 2. Tiêu chí chẩn đoán tăng tiết mồ hôi vô căn khu trú tiên phát

        Ra mồ hôi khu trú, thấy rõ, quá mức trong thời gian ít nhất 6 tháng không có nguyên nhân rõ ràng kèm theo ít nhất hai trong số các đặc điểm sau:

                 Ra mồ hôi hai bên và tương đối đối xứng

                 Tần suất ít nhất là một cơn một tuần

                 Ảnh hưởng đến sinh hoạt thường ngày

                 Tuổi khởi phát dưới 25 tuổi

                 Có tiền sử gia đình

                 Ngưng ra mồ hôi lúc ngủ

Tổn thương tâm lý xã hội là một khía cạnh đáng quan tâm của tăng tiết mồ hôi khu trú (Bảng 3). Trong một khảo sát tại Mỹ (Strutton DR và CS 2004) một phần ba số người tăng tiết mồ hôi nách cho biết việc ra mồ hôi của họ là khó có thể hoặc không thể chịu được và thường là gây trở ngại cho các sinh hoạt thường ngày; 35% số người cho biết thời gian nghỉ ngơi giải trí bị giảm đi do việc ra mồ hôi quá mức. Nhiều người tăng tiết mồ hôi khu trú sẵn sàng làm bất cứ việc gì để che giấu bệnh tình của họ, và các mối giao tiếp xã hội cũng bị tổn hại đáng kể, vì họ cảm thấy xấu hổ và mắc cỡ. Các hình thức hòa nhập xã hội đơn giản như bắt tay hoặc ôm nhau, cũng trở nên một việc gây bối rối. Tăng tiết mồ hôi khu trú cũng có một dấu ấn sâu đậm lên các sinh hoạt nghề nghiệp. Bất kể điều này, chỉ có 1/3 số người tham gia khảo sát đến tham vấn một bác sĩ về vấn đề của họ. Rõ ràng là, những thầy thuốc tuyến cơ sở có thể đóng vai trò quan trọng trong chẩn đoán bước đầu và lượng giá tình trạng bệnh lý này. Hiện có nhiều phương pháp điều trị tại chỗ, toàn thân, phẫu thuật và không phẫu thuật khác nhau (xu hướng hiện nay là tìm đến các sản phẩm hỗ trợ điều trị có nguồn gốc từ tự nhiên) có tỉ lệ hiệu quả trên 90%-95%.

Nguyễn Trang

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На данный момент в нашей стране
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Актуальные адреса точек вы найдете на интернет-ресурсе выбранной конторы, либо в тематических пабликах, описывающих популярные букмекерские конторы.

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Коэффициенты.
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Надежность.
Данный критерий формирует рейтинг лицензионным
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Вот несколько ключевых критериев для гемблеров, подобранных нашим обзорным ресурсом:


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Топовыми БК по России по количеству
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Коэффициенты.
Рейтинг букмекеров зачастую составляется исходя
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При обзоре букмекера особое внимание
было направлено на скорость оформления и расчета пари, общее количество предлагаемых ставок, количество маркетов в ней.



Отзывы о Букмекере.
Данный критерий формирует рейтинг лицензионным БК в плане выплаты денежных средств и обработки негативных обращений с
пользователями сайта. Каждый гемблер
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Если контора по неизвестным обстоятельствам
задерживает выплаты, то размер котировок и
промокоды не представляют большого значения.
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Виртуальный азартный клуб, в котором любой
заинтересованный человек делает ставки на
выбранные соревнования спортивного характера, называется букмекерская компания (БК).


На любое событие идет четкая работа аналитического отдела.

специалисты оценивают шансы на победу игрока
и формируют коэффициенты.

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перемножается с котировками.

Так определяется размер выигрыша.
Если ставка оказалась проигрышной, все
деньги остаются у организации.



На данный момент в России официально зарегистрированы несколько букмекерских контор.


Есть несколько форматов организации.
виртуальные платформы в интернете и наземные филлиалы (ППС).

Актуальные адреса пунктов ставок можно найти на web старничке выбранной конторы, или в тематических пабликах, обозревающих популярные букмекерские конторы.

Для ввода и вывода средств в офлайн точках принимают с обналиченными купюрами.

Выигрыш за пройденную ставку выплачиваются через кассу.



Поскольку современное общество предпочитает онлайн игры, пик популярности приходится на площадки контор в интернете.


Для комфорта своих клиентов,
кроме официальных сайтов, некоторые БК принимают ваши пари в мобильных приложениях.

Для стимулирования спроса создатели БК пытаются разработать уникальные бонусные программы, насыщая большей функциональностью
и возможностями.

Как подобрать БК

Любой игрок разрабатывает собственную систему оценок для выбора БК для игры онлайн формата.

Следует внимательно посмотреть на с
характеристиками сайта перед началом работы.

Основными критериями для выбора
принято считать систему промокодов, легальность работы
букмекера и размер коэффициентов и маржи.



Вот несколько ключевых критериев для гемблеров, подобранных нашим
обозревательным сайтом:

Глубина линии.
главными характеристиками данного списка является,
ассортимент составленных конторов https://itplanning.co.jp/previous/bbs/lounge_j0710.cgi маркеров для пари на исходы и гандикапы в
футбольных турнирах, а также росписьна иные голевые виды спорта.
Лучшими в РФ по рынкам принято считать Фонбет
и 1хставка.

Коэффициенты.
Рейтинг букмекеров зачастую составляется на основании размера кэфов.
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Проработка лайва.
Ставки, сделанные во время игры, находятся в
разделе Live. При обзоре букмекера мы делаем акцент на
скорость оформления и расчета пари, общее количество живой линии,
количество маркетов в ней.

Надежность.
Данный критерий дает характеристику легальным букмекерским конторам относительно скорости денежных переводов и обработки негативных обращений от клиентов компании.
любой игрок нуждается в уверенности что он получит свой выигрыш, если проводил
игру честно.
Если контора по каким-либо причинам не
выплачивает выигрыш, то размер котировок и бонусы не представляют большого значения.
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Виртуальный азартный клуб, в котором
любой заинтересованный
человек может заключить пари на различные спортивные события, называется букмекерская компания (БК).


По каждому соревнованию организована предворительная подготовка аналитического отдела.
специалисты оценивают шансы на победу игрока и формируют коэффициенты.

Беттер побеждает в том случае, если пари Прошло.

банкролл по ставке, перемножается с котировками.

Так рассчитывается итоговая прибыль.
Когда Пари не проходит, все деньги остаются у организации.


На данный момент В постоветском пространстве ведут свою деятельность на законных основаниях несколько букмекерских контор.

существует два формата их работы.
виртуальные платформы в всемирной паутине и наземные филлиалы (ППС).

Актуальные адреса пунктов ставок вы
найдете на сайте интересующего
вас букмекера, или в профильных группах, обозревающих популярные букмекерские конторы.

Для совершения финансовых операций в наземных филлиалах работают только
наличные.
Выигрышные средства игрок получает
через администратора.

Благодаря тому, что современное общество предпочитает
online развлечения, пик популярности приходится на виртуальные
букмекерские конторы.
Для большей оперативности, кроме
официальных сайтов, многие букмекерские конторы предлагают оформить ставки
на события в приложениях для IOS и Андроид.

Для стимулирования спроса создатели БК стараются разработать уникальные бонусные программы, с
самыми щедрыми условиями по рынку.


Как подобрать БК

Каждый беттер разрабатывает собственную систему оценок
для выбора БК для игры онлайн формата.

Следует внимательно ознакомиться возможности букмекера перед началом работы.

Основными критериями для принятия решения принято считать наличие бонусных предложений, легальность работы букмекера и размер коэффициентов
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Глубина линии.
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Лучшими в РФ по рынкам считаются Fonbet
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Коэффициенты.
Рейтинг букмекеров зачастую составляется исходя из величины коэффициента.

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Проработка лайва.
Ставки, которые оформляются игроками по ходу матча,
расположены в разделе Live. При обзоре букмекера особое внимание
было направлено на удобство билета и расчета пари, общее
количество живой линии, глубину росписи.


Надежность.
Данный критерий формирует рейтинг лицензионным БК относительно
скорости денежных переводов и решения конфликтных ситуаций от клиентов компании.
Каждый гемблер хочет быть
уверен в том, что он получит свой выигрыш, если проводил игру честно.

Если букмекер по неизвестным обстоятельствам задерживает выплаты,
то размер котировок и бонусы
не имеют никакого интереса.
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