C H U Y 6 H pg: Hdi NGHI KHKT CAC TINH VUNG DUVgN HAI BAC B Q LAN THCT NHAT
SV Tl/ONG QUAN GILTA HbAlc VA ROI LOAN LIPID MAU 0 BENH NHAN DAI THAO DlTonVG TIP 2
Bui Dii'C Long^
T O M T ^ T
Li do: Rdi loan lipid mau lam tSng nguy c d benh tim mach d benh nhan dai thao du'dng tip 2.
Muc t i e u : Danh gla sU tu'crng quan gida ham lu'dng HbAlc vdi ndng dp cac thanh phan lipid mau d benh nhan dai thao dudng tip 2.
Phu'dng phdp: 314 benh nhan dai thao du'dng tip 2 du'dc dinh IUdng HbAlc va cac thanh phan lipid mau. So sanh nong do cac thanh phan lipid mau giiJa nhom kiem soat kem (KSK) (HbAlc > 8%) va nhdm kiem soat t o t (KST)(HbAlc < 8 % ) , tinh mdi tu'dng quan giu'a ham lu'dng HbAlc va nong d p cac thanh phan lipid mau nay.
Ket qua: Nong do mpt sd thanh phan lipid mau thay ddi cd y nghTa d nhdm KSK so vdi nhom KST. Co s d tu'dng quan giiJa ham lu'dng HbAlc vdi nong dp cac lipid mau d benh nhan dai thao du'dng tip 2.
Ket luan: Ham lu'dng HbAlc tu'dng quan vdi nong dp cac thanh phan lipid mau d benh nhan dai thao du'dng tip 2, dieu nay gdi y HbAlc cd the la mot chi sd tien lu'dng sy" rdi loan lipid mau, mdt trong nhij'ng nguy c d tim benh t i m mach d cac benh nhan nay.
70" khoa: HbAlc; dai thao du'dng; rdi loan lipid mau.
S U M M A R Y
CORRELATION BETWEEN HbAlc AND DYSLIPIDEMIA I N TYPE 2 DIABETES MELLITUS
Background: Dyslipidemia increases the risk of cardiovascular diseases in type 2 diabetes mellitus.
Objective: To assess the correlation between the
level of HbAlc and those of lipid components in type 2 diabetic patients. Methods: This study wascondudEd on 314 type-2 diat)etic patients. They were categorized as having good glycaemic controlled group (HbAlc <
8%) (n=120) and poor glycaemic controlled group (n=194) (HbAlc > 8%). The level of HbAlc and ttiose of lipid components were evaluated and compared.
Results: There were significant increases in total cholesterol, triglycerides, and LDL-choiesterol levels m poor glycaemic controlled group when comparing with those of good glycaemic controlled group. There were significant correlations between the level of HbAlc and those of lipid components. Conclusion: There were con-elations between the level of HbAlc and those of lipid components in type 2 diabetic patients. Our findings suggest HbAlc may be a marker for predictkm- of dyslipidemia in type 2 diabetes mellitus.
Keywords: HbAlc; diabetes mellitus;^
dyslipidemia. '
I- OjBkT V A N O i
Danh gia ham luang Hb A1 c la mpt trong nhung chi tieu trong ki6m soat dilu tri dai.
thao dudng. Benh dai thao dudng dupc kiem;
soat dieu tri tdt s6 giam dugc nguy ca maci benh tim mach. Dai thao dudng tip 2 lami tang nguy c o benh mach vanh len 2 dSn 4.
lan. Trong cac nguyen nhan dugc de cap dens thi rdi loan chuyen hoa lipid la mot troi^
nhung nguyen nhan quan trpng nhSt. Roi^
loan lipid mau xay ra d hau het benh nhan dai thao dudng tip 2, trong do hay gap nhSt la^
tang triglyceride (TG) va giam HDL>
cholesterol (HDL-C). Rdi loan lipid mau ^
* B4nh vien da lihoa tinh Hat Duang
430
Y HOC VlgT NAM T H A H G S - SO D A C BigT / 2013
hau qua cua rdi loan chuyen hoa, trong dai tiiao dudng tip 2 sir khang insulin 1^ nguydn nhan chu yeu dan den cac rdi loan nay. Mac du tang LDL-choiesterol (LDL-C) dugc coi la y§u to nguy ca chinh ddi vdi b?nh mach vanh nhung nhiJng rdi loan ve HDL-C va TG trong mau ciang dugc coi la cac yeu td nguy CO gay xa vii-a ddng mach [6]. Cac nghien cvru cho thay cd su tuang quan giQa cac chi so nay vdi ndng dp glucose mau d benh nhan dai thao dudng tip 2 [7]. HbAlc phan anh tuong doi chinh xac tinh trang kiem soat glucose mau trong vdng 6-8 tuan trudc khi lay mau xet nghiem. Chung tdi dat cau hdi lieu ham lugng HbAlc cd tuang quan vdi nong dp cac thanh phan lipid mau, ma nhimg r6i loan cua chung dugc coi la nguy ca chinh d6i vdi benh tim mach. De tra ldi cau hdi nay chiing tdi tien hanh nghien cuu nham muc tifiu danh gia sir tuong quan giua ham lugng HbAlc vdi ndng dp cac thanh phan lipid mau dbenh nhan dai thao dudng tip 2.
II- PHUONG PHAP NGHIEN CCTU Boi tirorng nghien cihi: gdm 314 benh nhan dai thao dudng tip 2 vao dieu tri tai khoa Npi tiet cua Benh vien Da khoa Tinh Hai Ducmg tir thang 6/2012 den thang 12/2012. Cac benh nhan cd rdi loan chuc nang gan, than, cac benh li ve than kinh hoac vong mac dugc loai khdi nghien cuu nay.
Phirong phap: Nghien cihi cat ngang mo ta. B$nh nhan dugc chia lam 2 nhdm dua vao ham lugng HbAlc trong mau. Theo
nghien curu ACCORD (Action to Control Cardiovascular Risk in Diabetes)[4], khi HbAlc < 8% se lam giam dang ke ty Ie mSc cac benh tim mach; cac khuyen cao gan day cung dua ra muc tieu dieu tri cho timg ca the la HbAlc < 6-8%. Vi vay nhiJng benh nhan dai thao dudng cd ham lugng HbAlc > 8,0%
(n= 194 ) dugc xep vao nhdm kiem soat kem (KSK), nhiing benh nhan co ham lugng HbAlc < 8,0% (n^ 120 ) dugc xkp vao nhdm ki^m soat tdt (KST).
Cac mau mau xet nghiem dugc lay theo quy trinh chuan vao budi sang luc benh nhan doi. Xet nghiem cac thdng sd glucose mau luc ddi, CT. TG, LDL-D, va HDL-C bing phuang phap do quang diem cudi tren may HITACHI - 917 (Nhat Ban). Ham lugng HbAlc dugc do theo phuang phap ai Iuc Boronate bang may Clover Ale (Han Quoc) theo quy trinh hudng dan cua nha san xuat.
XuU so lieu: So lieu dugc thdng ke phan tich so sanh giGa 2 nhdm benh nhan nhd phkn m^m SPSS 19.0 biing phuang phap so sanh trung binh 2 mau ANOVA va tinh tucmg quan nhi bien Pearson.
Ill- KET Q O A N G H I E N C O U
Mot so thong s6 v^ d6i tuong nghien cuu;
Benh nhan tre tudi nhat 43 tudi, gia nhat 80 tudi. Thdi gian mac benh dai thao dudng tir 2 n5m trd len. Su khac biet khdng cd y nghia thdng ke v^ tudi, gidi, chi sd huyet ap va thai gian mic benh giira 2 nhom nghien cuu (Bang 1).
Bang 1. Mot s6 thong s6 v l d6i tupng nghien cvru Thong s o
Nam NJ Tuoi
Nhom KSK (n= 194)
98 96 62,75 ±14,14
Nhom KST (n= 120 )
67 53 62,72 ±15,08
P
0,98
431
CHUVeN Bi: H<ll MGH| KHKT CAC T I N H V O H S DUY^M HAI B A C B O LAN THCT NHAT
Huyet ap tam thu (mmHg) Huyet ap tam tru'tfng (mmHg)
Thdi gian mSc benh (nSm) Glucose mau (mmol/l) HbAlc (%)
130,05 ± 19,9 80,15 ± 10,8 7,23 ± 4,28 11,00 ±5,12 10,78 ±2,01
129,25 ± 19,8 78,9 ± 10,6 6,36 ±4,14 7,72 ±4,28 6,5 ± 0,89
0,37 0,32 0,31 0,00 0,00 Nong d9 cdc th^nh phan lipid mdu:
Cac th^nh phkn CT, TG va LDL-C d nhdm b?nh nhan dugc kiem soat kem cd ndng dp cao han mpt each cd y nghia thdng ke so vdi nhdm dugc kiem soat tdt vdi p lan
lugt \k 0,003; 0,000; va 0,017. Nong do HDL-C d nhdm kiem soat kem thap hon so vdi nhdm kiem soat tdt, tuy nhien s\i khac bi?t khdng cd y nghia thdng ke, p > 0,05 (Bang 2).
Bang 2. Nong do cac thanh phan lipic T h a n h ph'Sn
CT TG HDL LDL-C
N h o m KSK 5,1 ± 1,33 4,02 ± 1,87 0,95 ± 0,40 2,59 ± 0,91
mau a 2 nhom benh nhan dai thao duong N h o m KST
4,65 ± 1,31 2,35 ± 1,63 1,02 ± 0,54 2,35 ± 0,81
P 0,003 0,000 0,188 0,017 Sir tirong quan giira ham lirong
HbAlC va nong do cac thanh phan lipid mau d benh nhan dai thao dudng:
Co su tuang quan thuan chieu giii'a ham Iugng HbAlc vdi ndng dp CT, TG va LDL-C trong mau benh nhan dai thao dudng vdi r
lan lugt la 0,136; 0,501 va 0,137 (p < 0,05).
Ham lugng HbAlc tucmg quan nghich chieu vdi ndng dp HDL-C, tuy nhien mdi tuong quan nay khdng chat che vdi r = -0,066 va p
> 0,05 (Bang 3).
Bang
HbAlc
3. Tuong quan r (Pearson)
P
„
giiJa ham luong HbA 1 c va nong do cac thanh phan lipic Glucose
0,760 0,000
CT 0,136 0,016
TG 0,501 0,000
HDL-C - 0,066
0,247 mau
LDL-C 0,137,"' 0,016 S IV- BAN LUAN
n
Mpt phan glucose mau gSn vol hemoglobin A trong hdng cSu (glycosilate hoa) tro thanh glycated hemoglobin hay HbAl. HbAl g6m 3 loai HbA I a, HbAlb va HbAlc, trong do HbAlc chiSm phin lon (60%). d benh nhan dai thao duong, glucose mau tang cao se lam tang lugng hemoglobin glycosilate hoa, do do HbAlc tang cao. Su
gia tang nay ty le thuan voi su tang cao cua glucose mau, dac bi?t glucose mau sau an.
Doi song trung binh cua hong cSu keo dai khoang 120 ngay do do ham luong HbAlc trong mau phan anh tuong doi chinh xac tinh trang kiSm soat glucose mau trong vong 6-8 tuin truoc khi liy mau xet nghiem. Vi vay hien nay nguoi ta cong nhan HbAlc la mot chi s6 trong chin doan benh, viec kiem soat 432
Y HOC VlgT NAM T H A N G 5 - SO B A C BigT / 2013
ham lugng H b A l c ciing la muc tieu kiem soat trong di8u tn dai thao d u d n g [ l ] .
Rdi loan lipid mau d benh nhan dai thao dudng thudng bilu hien b i n g tang TG, tSng LDL-C va giam HDL-C, trong dd tang TG 1^
rfii lo?n hay gap nhat trong dai thao dudng tip 2 [2]. Tinh trang tang glucose mau va khang insulin dan den tang san xuat v^ g i ^ thanh lpc VLDL triglyceride, giam hoat dpng cua lipoprotein lipase, giam qua trinh tao apolipoprotein B, lam tang cholesterol, do dd lam tang nguy co viJa x a dpng mach.Tang nhe glucose mau lam tSng s ^ xuat LDL-C, sir khang insulin cung lam giam thanh Ipc LDL-C, hau qua lam tang LDL-C trong mau.
Cac phan tu LDL-C rkt d l bi oxy hoa va dong vai trd chinh trong qua trinh gay x a vua dong mach. Tang glucose mau lam tang boat dfing CLia men lipase d gan, tang chuyen hoa HDL-C Iam cho HDL-C giam trong dai thao dudng tip 2 [5]. H b A l c tang cao cung la nguy CO dpc l^p cua benh tim mach. Khi HbAlc < 8,0% giam dang ke nguy c a benh tim mach [4].
Trong nghien cuu cua chung tdi, mdt sd thanh phan lipid mau thay ddi theo hudng bat lai d nhdm benh nhan dai thao dudng tip 2 dupc kiem soat dieu tri kem. Su thay ddi cac thanh phan lipid nay tuong quan mdt each cd y nghTa thdng ke vdi ham lugng H b A l c trong mau. Mpt vai nghien cuu gan day cung cho ket qua tuang tu nghien cdu cua chung toi [3;7]. Ket qua nay cho thay H b A l c ngoai la yeu to dai dien de chan doan, theo ddi dieu tri, con la mdt chi sd cd the ung dung dugc troi^ ddnh gia, tien lugng tinh trang rdi loan lipid mau d benh nhan dai thao dudng tip 2.
Trong nghien cuu nay, mdi tuang quan nghich chilu gida H b A l c va HDL-C khdng CO f nghia thdng ke, d i l u nay cd the do mau ighien cdu cua chung tdi chua du ldn. Vi v^y
can cd nhiJng nghien cdu tiep theo de danh gia chinh xac moi tuang quan nay.
V- KE'T LUAN
Qua ket qu^ nghien cuu chung tdi thay cd su tuang quan giua ham lugng HbAlc vdi nong dp mpt sd thanh phan lipid mau d benh nhan dai thao dudng tip 2, dieu nay ggi y HbAlc cd the la mdt chi sd danh gia tinh t r ^ g roi loan lipid mau cung nhu cac nguy ca benh tim mach d nhdng benh nhan nay.
TAI UEU THAM K H A O
1. ADA (2013); ADA Clinical Practice Recommendations; Diabetes Care; 36:SI-S2;
doi:10.2337/dc]3-S001.
2. Bener A. et al. (2007); Lipids, lipoprotein (a) profile and HbAlc among Arabian Type 2 diabetic patients; Biomedical Research; pp 97-102.
3. B o d h e C , etal. (2012); HbAlc: Predictor of Dyslipidemia and Atherogenicity in Diabetes Mellitus; Internadonal Journal of Basic Medical Sciences and Pharmacy, Vol. 2, No.
l,pp 25-27.
4. Genuth S. et al. (2012); Clinical Implications of the ACCORD Trial; Journal of Clinical Endocrinology & Metabolism, 97, pp 41-48.
5. Joslin's Diabetes Mellitus 14th Edition (2004); Lippincott Williams & Wilkins, Chapter 33: Pathophysiology and treatment of lipid disorders in diabetes, pp 567-571 6. Meng H.T et al. (2004); Pioglitazone
Reduces Atherogenic Index of Plasma in Patients with Type 2 Diabetes; Clinical Chemistry; pp 1184-1188,
7. Parmar D., et al. (2012); A Correlation between Dyslipidaemia and Glycaemic Control in Type 2 Diabetic Patients; NJIRM;
Vol.3(l);p46-48. [2]
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