x u i t bang may tach te bao tfl ddng Cobe - Spectra hpc tap 1, Nha x u i t b i n Y hpc, tr. 62 - 64.
tai Vien H u y i t hpc Truyen mau", Luan van bac sy 4_ Council of Europe Publishing (2001), Plate- chuyen khoa II. lets: Apheresis, Guide to the preparation use and
2. Le Thi Thanh Mai (2006), Nghien cflu sfl quality assurance of blood components, 7 th Edi- thay ddi mdt sd chl sd h u y i t hpc, hda sinh cua tien, pp.121 - 125.
khdi tieu c l u bao q u i n d 4°C va 22°C tai vien ^ ^^^^ ^ Dieterlen A, Guerin E (1996), Size Huyit hpc Truyen mau Tmng fldng, Luan van thae ^ ^ ^ ^ ^ ^ p ^ change behaviour of platelets during sy y hpc, Trfldng Dai hpc Y khoa Ha noi. ^j^^^gg 1^ response to hypotonic shock, Vox sang,
3. Pham Quang Vinh (1991), Tieu cau, H u y i t Vol 70, pp.50 - 52.
Summary
CHANGE OF THE MORPHOLOGY AND QUANTITY OF PLATELET IN THE PLATELET CONCENTRATE AFTER SEPARATING FROM DONOR'S BLOOD UNITS USING
AUTOMATIC CELL COUNTER MACHINE
Study about the change of the morphology and quantity of platelet in platelet concentrate after separating and preserving for blood transfusion is very necessary. Objective: Identify changes in term of morphology and quantity of platelet concentrate separating from blood samples of blood donors using Hemonetics and Cobe Spectra auto - machines. Methods: 20 platelet concentrate units were separated from donor's blood samples using Hemonetics auto machine (10) and Cobe Spectra machine (10). Platelets were counted using automatic cell counter machine Sysmex - SF 3000 and the change of platelet morphology was observed using Electronic microscope. Result and Conclusion: both morphology and quantity of platelet and platelet concentrate were changed after preserving for one, two, three, four and five days. Using platelet concentrate after a long time storing may effect on the quality of treatment for the patients.
Key word: Platelet, Platelet amount and morphology, electric microscope
NGHIEN CLfu DO DAY NOI TRUNG MAC D O N G MACH CANH 6 BENH NHAN CO BENH MACH VANH
Le Thanh Hang', Dinh Thj Thu Hfldng^
'Benh vien Hdu nghj Viet Xd; "Tntdng Dai hgc Y Ha Ngi
Muc tieu: (1). Dinh gii do diy ndi trung mac (BDNTM) ciia dgng mach canh (DMCa) bang sieu am Doppler d benh nhan benh mach vinh. (2). Tim hieu mdi tuang quan gida BDNTM ciia DMCa vi mde do hep ciia dgng mach vinh (DMV). Bdi tugng va phuang pbap ngbien cdu: do BDNTM cua DMCa tren sieu am 2D vi M - mod tai DMCa gd'c vi hinh canh tren miy sieu am LG500. Dinh gii mde do hep DMV bang chup DMV xoi nen. Nghien cdu 96 benh nhan bdnh tim thieu mau cue bd vi 57 benh nhin chdng. Ket qua: BDNTM DMCa do tai hinh canh Idn han do tai DMCa gd'c trong ca 2 nhdm, Nhdm benh: 0,87 ±0,19 mm (phai): 0,89 ±0,19 mm (trii) so vdi 0,77 ± 0,02 mm (phii); 0,78 ± 0,17 mm (trii); Nhdm chdng 0,78 ± 0,03 mm (ben phai vi trai bang nhau) so vdi 0,65 ± 0,02mm (phai); 0,65 ± 0,02 mm (trii), BDNTM d
TCNCYH Phu trWdng 62 (3) - 2009
nhdm bgnh tim thieu miu cue bg (BTTMCB) Idn han nhdm chdng (p < 0,01). BDNTM tang theo sd lugng ddng mach vinh (DMV) bi hep > 70%o, nhUng chl cd BDNTM ciia DMCa gde trii cd mdi lien quan cd y nghTa thdng ke vdi mde do hep DMV (p < 0,001). Ket luan: BDNTM DMCa d nhdm BTTMCB tai hinh canh diy hOn do tai DMCa gde, tang dan theo tudi, diy han nhdm chdng, BDNTM DMCa gde trai cd gii trj tien luang ve sU ton tai Ciia it nhai 1 vj tn DMV bj hep > 70%o.
Tfl khoa: Be day noi trung mac, benh mach vanh
I. DAT VAN DE
Benh tim t h i i u mau cue bp (BTTMCB) la loai benh thfldng gap, dien bie'n phflc tap vdi b i i n chflng nguy hiem, de doa tfnh mang ngfldi benh. Giai doan sdm cua q u i trinh xd vfla ddng mach I I sfl d l y len cua Idp ndi trung mac ddng mach. Tai Viet Nam, da cd 1 sd cdng trinh nghien cflu v l dp d l y ndi trung mac (BDNTM) d ngfldi binh thfldng, ngfldi tang huyit ap, d i i thao dfldng (DTD), nhflng chfla cd nghien ci'fU day du v l BDNTM cua ddng mach c i n h (DMCa) d benh nhan cd BTTMCB. Do vay, nghien cflu nay dfldc t i i n hanh vdi muc tieu:
1. Ngbien cdu do day ngi trung mac dgng macb cinh d benb nban mac benh tim thieu mau cue bg bang sieu am Doppler.
2. Bddc dau tim bieu mdi tuang quan giifa be day ngi trung mac cua dgng mach canh vdi mde do tdn thuang cua dgng mach vanh.
II. DOI TUONG VA PHUONG PHAP NGHIEN CCu
1. Dd'i tfldng nghien cflu
Nghien cflu t i i n hanh tren 95 ngfldi difpc c h i n dean x l c djnh cd BTTMCB (gdm 2 nhdm cd BTTMCB man tfnh va nhdm nhdi m l u cd tim (NMCT)). K i t qua dfldc sc s i n h vdi nhdm chflng khdng cd BTTMCB gdm 57 ngfldi.
Dja d i i m va thdi gian nghien cflu: tai vien Tim mach Viet Nam tfl 10/2000 den 9/2001.
2. Phu'dng phap nghien cu'u Nghien cflu e l t ngang theo trinh tfl:
- Kham lam sang toan dien v l chi tiet theo
m l u benh an rieng.
- Sieu am Doppler DMCa gd'c, doan hanh d n h de d i n h gia cac thdng sd':
+ B D N T M D M d n h (do tai 2 vi trf D M d n h gd'c va hanh d n h ) .
+ Dfldng kfnh mang xO vOa (danh g i l theo NASCET).
- Chup D M V chpn Ipc t i t d benh nhan d nhdm BTTMCB.
3. Xu' ly ket qua: bang phan m i m SPSS 10.0 ; k i i m djnh ANOVA.
III. KETQUA VA BAN LUAN 1. Tudi, gidi
Nghien cflu 95 benh nhan BTTMCB (76 nam, 21 nfl, tudi trung binh 59,2 ± 7,9) va 57 ngudi binh thifdng (28 nam, 29 nfl, tudi trung binh 58,7
± 10,6) (p > 0,05). Ty le nam d nhdm BTTMCB n b i l u hdn nhdm chflng (p < 0,01).
2. Ket qua sieu am Doppler mach 2.1. Be day ngi trung mac
Qua bang 1 tha'y: BDNTM DMCa do tai 2 vj tri cua nhdm BTTMCB cao han nhdm chdng cung do tudi. BDNTM DMCa ting din theo tudi.
2.2. So sanh BDNTM gida nhdm NMCT va BTTMCB man tinb
BDNTM do tai DMCa gd'c cua nhdm NMCT thi day hdn nhdm BTTMCB: 0,83± 0,2 va 0,78 ± 0,93, khi do tai hanh d n h cung cho k i t q u i tfldng tfl 0,93 ± 0,23 va 0,88 ± 0,1 9 (p < 0,05).
Chup chpn Ipc DMV d nhdm BTTMCB, tdn thfldng
hep DMV la 76%, trong 73 tnJdng hdp cd hep DMV So s i n h sfl k h l c nhau v l B D N T M vdi mflc dp c l n can thiep thi t i n thflong 1 than DMV la chu y i u hep D M V (dfla v i e sd D M V bj hep > 70%) trong 42,1 %, hep 2 than 27,5% va hep 3 t h i n 20,8%. nhdm BTTMCB, chung tdi tha'y (bang 2).
Bang 1. BDNTM ciia BM canh hai ben nhom chdng va nhom BTTMCB
B D N T M DMCa nhdm BTTMCB(mm) B D N T M DMCa nhdm chflngfmm) Lu'a tudi Canh gd'c Hanh canh Canh gd'c Hanh canh
3 0 - 39
4 0 - 4 9
5 0 - 5 9
6 0 - 6 9
> 7 0
TB
Bang Phai 0,60 ±
0,0 0,64 ±
0,13 0,78 ±
0,03 0,80 ±
0,17 0,84 ±
0,12 0,77 ±
0,02
Trai 0,60 ±
0,0 0,73 ±
0,22 0,79 ±
0,16 0,80 ±
0,17 0,84 ±
0,09 0,78 ±
0,17
Phai 0,70 ±
0,0 0,7 ±
0,11 0,88 ±
0,15 0,90 ±
0,23 0,91 ±
0,12 0,87 ±
0,19
2. BDNTM d cac vi tri BM trong
Mflc do hep D M V
0 1 2 3
P
n
23 32 21 20
Trai 0,70 ±
0,0 0,72 ±
0,15 0,90 ±
0,18 0,91 ±
0,21 0,94 ±
0,08 0,89 ±
0,19
Phai 0,50 ±
0,0 0,57 ±
0,19 0,62 ±
0,14 0,71 ±
0,16 0,78 ±
0,01 0,65 ±
0,02
Trai 0,5 ±
0,0 0,57 ±
0,12 0,59 ±
0,12 0,69 ±
0,14 0,85 ±
0,13 0,55 ±
0,02
nhom BTTMCB so vdi sd than BMV B D N T M DMCa gd'c (mm)
Ber 0,65 0,75 0,81 0,98
<
1 phai
± 0 , 1 0
± 0 , 1 3
± 0 , 1 8
± 0 , 1 8 0,05
Ben 1 0,67 ± 0,76 ± 0,83 ± 0,93 ±
trai 0,09 0,13 0,14 0,21
< 0 , 0 5
B D N T M h, Ben phai 0,74 ± 0 , 1 3 0,83 ± 0 , 1 3 0,92 ± 0 , 1 3 1,02 ± 0 , 2 7
< 0 , 0 5
Phai 0,60 ±
0,0 0,75 ±
0,28 0,75 ±
0,14 0,83 ±
0,16 0,84 ±
0,10 0,78 ±
0,03
bep > 70%o anh canh (i
Trai 0,50 ±
00 0,64 ±
0,01 0,76 ±
0,19 0,85 ±
0,20 0,90 ±
0,00 0,78 ±
0,03
mm) Ben trai 0,78 0,91 0,91 0,96
<
± 0 , 1 9
± 0 , 2 0
± 0 , 1 8
± 0 , 1 5 0,05 Ket qua d bang 2 cho tha'y: ngtfdi cd nhieu vj tri DMV bj hep thi BDNTM DMCa cung Idn ban ngudi cd it vj tri DMV bj hep.
Bang 3 cho thay: BDNTM tai cic vj tri canh gde, hinh canh nhdm NMCT tang len theo mde do hep ciia DMV (r = 0,45; p < 0,05). Trong 96 benh nhin BTTMCB, cd 45 benh nhan bj NMCT (nam 82%o).
Khi so sanh BDNTM giita cic nhdm benh nhan bl NMCT cap, NMCT cu va nhdm BTTMCB chung tdi thi'y BDNTM do tai hanh canh day ban do tai DMCa gd'c, nhifng khong thay sd khac biet cd y nghTa thdng ke giifa 3 nhdm.
TCNCYH Phu trWdng 62 (3) - 2009
Bang 3.
So nhanh D M V bi hep
0 1 2 3
P
Tim mdi
n
2 20 12 11
tuang quan gida sd nhanh BMV bi h^p BDNTM DMCa gd'c (mm) Ben phai
0,55 ± 0 , 0 7 0,76 ± 0 , 1 4 0,81 ± 0 , 1 8 0,98 ± 0 , 1 9
Ben trai 0,55 ± 0 , 0 7 0 , 7 8 \ 0 , 1 4 0,83 ± 0 , 1 5 0,99 ± 0 , 2 5
< 0 , 0 5
va BDNTM BMCa B D N T M hanh Ben-phai 0,55 ± 0 , 0 7 0,76 ± 0 , 1 4 0,81 ± 0 , 1 8 0,98 ± 0 , 1 9
< 0 , 0 5
canh (mm) Ben trai 0,55 ± 0 , 0 7 0,78 ± 0 , 1 4 0,83 ± 0 , 1 5 0,99 ± 0,25
< 0 , 0 5
IV. BAN LUAN
Do B D N T M cua DMCa tai hanh d n h day hdn do tai DMCa gd'c d d 2 nhdm benh va chflng. Tai h i n h d n h : nhdm benh: 0,87 ± 0,19 ( p h i i ) ; 0,89 ± 0,19 (trai) so vdi 0,77 ± 0,02 ( p h i i ) ; 0,78 ± 0,17 (trai); Tai DMCa gd'c: nhdm chflng: 0,78 ± 0,03 (ben p h i i va t r i i bang nhau) so vdi 0,65 ± 0,02 (phai); 0,55 ± 0,02 (trai), B D N T M d nhdm BTTMCB Idn hdn nhdm chflng (p < 0,01). B D N T M DMCa trong nhdm nghien cflu cua cac tac g i l A n dp day hon kdt qua cua chung tdi (1,02 vs 0,80min) [4]. Chung tdi t h i y B D N T M cua DMCa gd'c va hanh d n h 2 ben d nhdm chflng va BTTMCB deu tang len thee tudi (p < 0,01). Cd md'i tfldng quan chat gifla B D N T M va tudi d nhdm BTTMCB va nhdm chflng: tudi cang eao thi B D N T M xu hfldng ngay cang d l y (r = 0,43 va 0,37 d nhdm b e n h ; 0,35 va 0,48 d nhdm chflng; p < 0,01). Gariepy J va cdng sfl (1993) [2] lam sieu am B mode do be d l y npi trung mac D M C a , D M dui d nam khde manh va ngifdi tang Lipid mau t h i y md'i tifOng quan gifla tudi va B D N T M (r = 0,48;
p < 0,05). El - Barghouti (1 997) [1 ] khi danh gia B D N T M cua DMCa vdi d c yeu t d V X D M d ngfldi binh thifdng va ngfldi DTD thay cd md'i tifong quan khdng chat gifla tudi va B D N T M d ngfldi DTD (r = 0,267; p < 0,01). Khdng cd sfl khac nhau ve B D N T M d ben phai va trai cua c l 2 nhdm (p > 0,05). B D N T M cua DMCa gd'c
va hanh canh n h d m BTTMCB Idn hon nhdm chflng (p < 0,05). N g h i e n cflu cua C. Held [5]
cung cho kdt q u i tfldng tfl khi do B D N T M cua DMCa d benh nhan dau that ngflc dn djnh.
Chung tdi t h i y B D N T M d nhdm NMCT Idn hdn ban nhdm BTTMCB tai c l 2 vj trf D M d n h gd'c, hanh d n h (p < 0,05). Ket q u i nghien ciTu nay cung tfldng tfl k i t qua nghien cflu cua C.Held, H j e m d a h i va cpng sfl [5].
Sd sanh sfl khac nhau v l B D N T M vdi mflc do hep D M V (difa vao sd D M V bj hep > 70%) trong nhdm BTTMCB, chung tdi t h i y (bang 2):
B D N T M DMCa do tai 2 vj trf ( d n h gd'c va hanh c i n h ) d nhdm BTTMCB cd md'i tifOng quan thuan vdi so' lfldng D M V bj hep, ngifdi cd n h i i u DMV bj hep > 7 0 % thi npi mac DMCa cang day (p < 0,05). B D N T M tai cac vj trf d n h gd'c, hanh d n h nhdm NMCT tang len theo mflc dp hep cua D M V (r = 0,45; p < 0,05). K i t q u i nay tfldng tfl Yamamoto [7] khi sieu am 102 ngfldi NMCT c i p (43 - 79 tudi) do B D N T M tai d n h gde, hanh c i n h va D M dui chung t h i y B D N T M tang theo mflc dp hep cua D M V (r = 0,68; p < 0,01).
Visona va cdng sfl t h i y B D N T M DMCa d benh nhan bi benh mach vanh (1,45 ± 0,95 mm) cao hdn nhdm chflng (0,87 ± 0,1 m m ; p < 0,005) [6]. Geroulakos va cpng sfl [3] t h i y BDNTM DMCa khdng chi day hdn d ngifdi bj benh mach v i n h ma cdn cd md'i tifOng quan tuyen tfnh vdi sd Iflpng D M V bi hep (r = 0,44, p < 0,0001).
V. KET LUAN
Nghien cflu do b l day ndi trung mac (BDNTM) cua DMCa bang sieu am Doppler tren nhdm benh nhan BTTMCB cd ddi chieu vdi nhdm ngfldi bmh thfldng cho phep rut ra mdt so k i t luan nhfl sau:
1. BDNTM cua DMCa d nhdm BTTMCB ldn hdn nhdm chflng cung dp tudi, BDNTM cua DMCa tang dan theo tudi d c l hai nhdm chflng v l BTTMCB. BDNTM cua DMCa tai vj trf hanh cinh Idn hdn rd ret so vdi BDNTM do tai DMCa gd'c.
2. Sfl day len cua BDNTM DMCa, dac biet tai DMCa gd'c trai lien quan chat vdi sd Ifldng tdn thfldng hep cua DMV, BDNTM cua DMCa gd'c trai cd g i l tri tien Ifldng dpc lap ve sfl tdn tai cua ft nhit mdt vj trf DMV bj hep dang ke can phai can thiep. Tuy nhien, BDNTM chfla the dfl bio tinh trang NMCT c i p .
TAI LIEU THAM KHAO
1. Barghouti. N, Elkales .R, Nicolaides. A, Geroulakos et all (1997). " The ultrsound evalution of carotid Intima Media Thickness and its relation to risk factor of atherosclerosis in normal and diabetic population . Int, Angiol Mar No 16 (1), pp. 5 0 - 5 4 .
2. Gariepy .J , Simon .A, Massoneau.M, et all, (1995) "Wall thickness of carotid and femoral arteries in male subject with isolated hypercholesteronemia. Atherosclerosis, No 113 (2), pp. 141 - 151 .
3. Geroulakos G, O'Gorman DJ, Kalodiki E et all(1994) "The carotid intima - media thickness as a marker of the presence of severe symptomatic coronary artery disease. Eur Heart J; 15: pp. 781 - 5.
4. Gupta Hansa,MD, Kartikeya Bhargava MD, Manish Bansal MD et all. 2003 "Carotid Intima -Media Thickness and Coronary Artery Disease: an Indian Perspective" Asian Cardiovasc Thorac Ann: 11: pp. 2 1 7 - 2 2 1 .
5. Held.C, Hjemdahi . SV, Erksson , Bjorkander .L, Forslund et all ,(2001). " prognostic implication of Intima Media Thickness and plaque in the carotidfemoral arteries in patient with stable angina pectoris ", Eur heartt journal, pp. 52 - 72.
6. Visona A, Pesavento R, Lusiani L et all (1996) "Intimal medial thickening of common carotid artery as indicator of coronary artery disease. Angiology;47: pp. 5 1 - 6 .
7. Yamamoto. V, Vamano .S , Miami .S, Nomura.K, Fukui. (1998). "carotid artery atherosclerosis in patient with myocardial infraction " journal cardiol, No32 (5), pp. 307 - 313.
Bang chC viet tat
BDNTM: be d l y ndi trung mac; BTTMCB:
benh tim thiiu mau cue bd; DMCa: ddng mach cinh; DMV: ddng mach vanh; DTD: dai thao dfldng; NMCT: nhdi mau cd tim; VXDM: vfla xd ddng mach; IHD: ischemic heart disease: benh tim thiiu mau; IMT: intima - media thickness: b l d l y ndi trung mac.
Summary
CAROTID INTIMA - MEDIA THICKNESS AND CORONARY ARTERY DISEASE
Objective: to determine whether carotid intima - media thickness (IMT) is associated with coronary artery disease. Methods: A case - control study was performed among ischemic heart diseases group (96 subjects) compared to control normal group (57 subjects). IMT assessments were done at common carotid& carotid bifurcation with LG500 ultrasound machine. Coronary artery stenosis severity was determined by number of significantly diseased coronary vessels on selective coronary angiography. Results: IMT at common carotid was significant higher in IHD patients (0.77 ± 0.02 on the right; 0.78 ± 0.17 on the left)
TCNCYH Phu trWdng 62 (3) - 2009
compared to control people (0.65 ± 0.02 m m and 0.65 ± 0.02inm correspondingly). Similar IMT results were also reported in carotid bifurcation site (0.87 ± 0.19 (R) & 0.89 ± 0.19mm (D) in I H D group compared to control group (0.78 ± 0.03 mm both in R& L). However only IMT at left common carotid considerably related to number of diseased coronary vessels. Conclusions: IMT at common carotid and carotid bifurcation increased with age, significantly higher in I H D group compared to control group. Left common carotid IMT was independent predictor of at least one diseased coronary vessel need intervention.
Keywords: Carotid Intima - Media Thickness, Coronary Artery Disease
VAI TRO CUA SIEU AM DOPPLER TRONG CHAN DOAN BENH HUYET KHOI T I N H MACH SAU CHI D U 6 |
Dinh Thi Thu Hfldng Tnfdng Dai bgc Y Ha Ngi
Muc tieu: nghien cdu gii trj ciia phuang phap sieu im Doppler mach trong chan doan benh huyet khdi tmh mach sau chi dudi. Bdi tUgng va pbuang pbap nghien cdu: md ta, tien edu tren 100 benh nhin nghi ngd bj huyet khdi tTnh mach siu chi dUdi. Cic benh nhan dugc lam sieu am Doppler mach (ddi chieu vdi ket qui chup tTnh mach d 20 benh nhan). Ket qua: de chan doin cd huyet khdi, sieu am Doppler mach co do nhay 100%o, song cdn ban che trong chan doin chinh xic vj tn tic tTnh mach viing dng chin va cic tTnh
•mach trong d bung. Tac tinh mach chin trii gap nhieu han so vdi chan phai, vimg diii khoeo nhieu han vung dng chin. Ket luan: sieu im Doppler mach la phuang phip cd gia tri cao trong chan doin huyet khdi tTnh mach chi dudi vdi do nhay cao.
Tfl khda: huye't khd'i tlnh mach, sieu am mach mau
I. DAT VAN DE
H u y i t khd'i tTnh mach s l u (HKTMS) la mdt benh thfldng gap, la nguyen nhan gay tfl vong cao dflng thfl 3 sau benh mach vanh va ung thif. Benh thifdng cd bien chflng nang nhfl t i c mach phdi hoac suy tlnh mach sau h u y i t khd'i nen viec c h i n doan sdm, chfnh xac d l d i i u trj kjp thdi I I r i t can thiet. Do dd chung tdi tien h i n h nghien cflu d l tai nay n h l m muc tieu:
Nghien cdu gia tri cua phuang phap sieu am Doppler mach trong cbin doan benh huyet khdi tinb mach sau chi dudi (HKTMSCD).
II. DOI TUONG VA PHUONG PHAP NGHIEN CLfu
1. Ddi tfldng nghien cii'u: d c benh n h i n
kham va dieu trj tai vien Tim mach Qud'c gia vdi bieu hien nghi ngd bi benh h u y i t khd'i tTnh mach sau chi dfldi.
2. Phfldng phap nghien ciJu: kham l l m sang, hdi benh tim d c yeu td nguy cd theo mau benh an.
Sieu I m Doppler mach cho t i t c l nhflng dd'i tfldng n l y bang m i y GE Logiq 500 vdi d i u dd 7,5 MHz.
Dd'i c h i i u k i t q u i sieu I m Doppler mach vdi ket q u i chup tlnh mach cua 20 benh nhan, danh gia dd n h l y , dd dac hieu cua phflong phap sieu am Doppler mach trong chan doan benh h u y i t khdi tTnh mach s l u chi dfldi.
in. KETQUA
1. Tudi va gidi: tdng sd'cd 100 benh nhan (45 nam, 55 nfl), tudi trung binh: 47,2 ± 1 5,5 nam.
