B NH NHÂN M C B NH PH T C NGH N M N T NH

(1)

T M T T

M cti u:Xác nht l h ich ng chuy nhóa b nh nh n b nh ph i t cngh n m ntính.

Ph ng pháp: Thi t k nghi n c u m t c t ngang tr n 300 b nh nh n m c b nh ph i t c ngh n m ntính giai o n n nh i utr ngo itrú t i B nh vi n akhoa tnh Ninh Bnh. Ch n oán h ich ng chuy n hóa theo ti uchu n c aNCEP ATP III (2001). Ph ngiai o n b nh ph i t cngh n m ntính theo GOLD 2011.

K tqu : T l b nh nh n b nh ph i t c ngh n m n tính m c h i ch ng chuy n hóa là 30,3%.

85,8% b nh nh n có ít nh t 1ti u chí trong ti u chu n ch n oán h i ch ng chuy n hóa. B nh nh n b nh ph i t c ngh n m n tính giai o n GOLD B, C,Dcó nguyc m c h ich ng chuy n hóa caoh ngiai o nGOLDA v iOR (95%CI)= 1,82 (1,04-3,12).K tlu n:T l h ich ng chuy n hóa b nh nh n b nh ph i t cngh n m n tính giai o n n nh là 30,3%.

T khóa:H ich ng chuy nhóa,b nh ph i t c ngh n m ntính

ABSTRACT

PREVALENCE OF METABOLIC SYNDROME AMONG PATIENTS WITH CHRONICOBSTRUC- TIVE PULMONARY DISEASES

Objectives:the research aimed to evaluated the prevalence of metabolic syndrome in patients with chronic obstructive pulmonary diseases.

Methods: The research used cross-sectional study on 300 outpatients with COPD in Ninh Binh general hospital. Metabolic syndrome was de ned using criteria of the NCEP ATP III. Chronic obstructive pulmonary disease was classi ed according to criteria of the GOLD 2011.

T L H CH NG CHU N HÓA

B NH NHÂN M C B NH PH T C NGH N M N T NH

V ThanhBnh^1*, inh Th Thu Hi n², L Minh Hi u¹, L nh Tu n³

1. r ng h c D c há Bnh 2.B nh n akhoatnhNnhBnh 3.H c n u n

*Chutrách nhi mchính:V ThanhBnh Email: [email protected] Ngày nh nbài: 20/01/2022

Ngày ph nbi n: 21/02/2022 Ngày duy tbài: 07/03/2022

Results:the prevalence of metabolic syndrome was present in 30,3% of the chronic obstructive pulmonary diseases patients. 85,8% of patients with chronic obstructive pulmonary diseases had at least one component of metabolic syndrome The risk of metabolic syndrome was higher in subjects with GOLD stage B, C, Dcompared to those with GOLD stage A, OR (95%CI) =1,82 (1,04-3,12).

Conclusion: The prevalence of metabolic syndrome in patients with chronic obstructive pulmonary diseases was 30,3%.

Keywords: Metabolic syndrome, chronic obstructive pulmonary diseases

I. T V N

B nh ph i t c ngh n m n tính (Chronic Obstructive Pulmonary Disease COPD) làb nh m n tính th ng g p, là gánhn ng c a n n y t toànc u. COPD là nguy nnh n g y t vong ph bi nth 3tr nth gi i 1 . T iVi tNam,n m2019, COPD là1 trong3 nguy nnh n g y t vong hay g pnh t 2 .Cácb nhl ngm clàmt ng gánh n ng b nh t tvà nhuc u s d ng dchv ch m sócs ckh e b nh nh nCOPD 3 .

H i ch ng chuy n hóa (HCCH) là thu t ng d ng ch nh ng ng i có nguy c cao m c b nh timm ch và ái tháo ng. HCCH baog m m tnhóm cácy u t nguyc nh : ái tháo ng ho cti n ái tháo ng, béob ng,r i lo nlipid máu, t ng huy t áp, kháng insulin. c tính có kho ng 20 25% ng itr ng thành tr nth gi i có HCCH, và nh ng ng inày có nguyc t vong g p 2 l nvà nguyc t t do timg p 3 l nsov i nh ng ng ikh ng có HCCH 4.

T l b nh nh nCOPDm cHCCH vào kho ng 21 62%, caoh n 2 l nso v i t l m cHCCH trong qu n th d n s chung 5much of the disease burden and health care utilisation in COPD is associated with the management of its comorbidities (e.g. skeletal muscle wasting, ischemic heart disease, cognitive dysfunction.

Kho ng 50%b nh nh nCOPD có ít nh t 1ti uchí ch n oán HCCH.C ch b nh sinhc aCOPD và HCCH uli nquan n tnh tr ng vi m h th ng.

Các nghi n c uquan sát ch ras giat ng nguy

(2)

c xu t hi n cácb nh i kèm và bi nch ngc a COPD nh ng ng i ngm cCOPD và HCCH 6 . B nh nh nCOPD có HCCH th ng có b nh c nhl msàngn ngh nnh :khó th h n, FEV1 th p và c n nhi u thu c ki m soát b nh 7 multicenter study of 375 patients hospitali ed fora COPD exacerbation with spirometric con rmation was performed. We measured the components of the MetS and collected comorbidity information using the Charlson index and other conditions.

Dyspnea, use of steroids, exacerbations, and hospitali ations were also investigated. The overall prevalence of MetS in COPD patients was 42.9 %, was more frequent in women (59.5 %.

T iVi tNam, COPD là1trong các nguy nnh n g y t vong hay g p nh t. T l ng i tr ng thành có HCCH giat ng trong nh ngn m g n y.

V th chúngt ith chi nnghi n c unàyv i m c ti uxác nht l b nh nh nCOPDm cHCCH.

II. I T NG V PH NG PH P

NGHIÊNC U

2.1. i t ng nghi n c u

Nghi n c u ti n hành tr n 300 b nh nh n m c COPD giai o n n nh cqu n l và i utr ngo i trú t i phòng qu n l COPD, khoa Khám b nh, B nh vi n a khoa tnh Ninh Bnh, trong th igiant tháng 12n m2019 ntháng 10n m 2020.

2.2. Thi t k nghi n c u Nghi n c u m t c tngang.

2.3. Cách th cch n m u

p d ngc ng th ctínhc m ucho nghi n c u c tngang xác nht l :

Trong ó:

-n:c m u t ithi u c nnghi n c u

- : h s tinc y,v i m c tinc ylà 95%

th =1,96.

- p: là t l b nh nh n COPD có HCCH trong nghi n c u c aPhí Th Nga là 25,7% (p=0,257)

-d: là sais cho phép,v i m c tinc y95%

sais cho phépd =0,05

Chúng t itính c c m u t i thi u c n thi t là:n =1,96²x0,25x(1 0,25): 0,05²=294b nh nh n. Nghi n c uch nng unhi n300b nh nh n COPD giai o n n nh tham gia nghi n c u.

2.4. Thu th pth ng tin và ti uchí ánh giá Các b nh nh n COPD c th m khám l m sàng, ph ngv ntheob c u h ithi t k s n.T t c b nh nh n u c o ch c n ng th ng khí b ng máy KoKo PFT Spirometer, và ánh giám c t c ngh n d a vào ch s FEV1. M c t c ngh n cph nlo itheo ti uchu nGOLD 2009.

ánh giá tri u ch ng c n ng b ng b c u h i CAT và mMRC. Ph nlo igiai o nCOPD thành4 nhóm A, B, C,Dtheo GOLD 2011. Các xét nghi m sinh hóa máu: glucose, cholesterol toàn ph n, triglyceride, HDL-Cholesterol, LDL-Cholesterol c th c hi n tr n máy sinh hóa Cobas C702 c aNh t B n. Ch n oán HCCH theo ti uchu n c aNCEP ATP III,c nph icó ít nh tba trongs các ti uchí sau: (1) Béo trungt m: vòng eo 102 cm (nam gi i) và 88 cm (n gi i); (2) Huy t áp 130/85 mmHg; (3) Glucose máu ói 5,6 mmol/l ho c ang i utr ái tháo ng; (4) Triglyceride 1,7 mmol/l; (5) HDL Cholesterol <1,0 mmol/l (nam) và<1,3 mmol/l (n ).

2.6.X l s li u

S li u cnh pli u b ng ph n m mEpidata 3.1. Cács li u c x l theo thu ttoán th ng k trong y h c b ng ph n m m SPSS 16.0. Các bi nli n t c cth hi n d igiá tr trungbnh± l ch chu n. Các bi nph nnhóm cth hi n d i d ngt l %. Xác nhm ili nquan gi ahai bi n ph n lo i b ng ki m nh Chi bnh ph ng.

M ccó nghath ngk khip <0,05.

III.K TQU NGHIÊNC U

Qua nghi n c u300b nh nh n m cCOPD,b nh nh nnam gi ichi mph n l n v i t l 78,7% (236 b nh nh n).

(3)

B ng 3.1. c mchungc a t ng ngh n c u

c i m Giá tr

Gi inam(n; %) (236) 78,7

Tu i(n m) 70,80±9,22

Tnh tr ng dinhd ng

Thi u c n(n; %) (60) 20,0 Bnh th ng (n; %) (142) 47,3

Th a c n(n; %) (77) 25,7 Béo ph (n; %) (21) 7,0

Vòngb ng Nam (cm) 67,47±12,33

N (cm 71,58±10,84

Th igianm cCOPD(n m) 3,21±3,00

CAT 14,68±7,78

mMRC

0(n; %) 92 (30,7)

1(n; %) 122 (40,7)

2(n; %) 60 (20,0)

3(n; %) 23 (7,6)

4(n; %) 3(1,0)

GOLD

A(n; %) 95 (31,7)

B(n; %) 105 (35,0)

C(n; %) 59 (19,7)

D(n; %) 41 (13,7)

Cholesterol(mmol/l) 5,34±1,55

Triglycerid(mmol/l) 2,26±1,73

HDL Cholesterol(mmol/l) 1,70±0,58

LDL Cholesterol(mmol/l) 3,13±1,10

Glucose máu(mmol/l) 5,93±1,44

K tqu nghi n c u c achúngt ich ra:t l b nh nh nCOPD thi u c nchi m20% (60b nh nh n);

theo ph nlo iGOLD ph n l n b nh nh n GOLDAvàBchi m66,7% (200b nh nh n).

Hnh 3.1. l cáct uchí ch n oán HCCH b nh nh nCO D

(4)

B nh nh ncót ng triglycerid chi m t l cao nh t49,7%.B nh nh nbéo trungt m ch chi m8,7%.

B ng 3.2. l s l ngt uchí ch n oán HCCH b nh nh nCO D S l ng thành ph n c aHCCH S b nh nh n(n) T l ( )

Kh ng có ti uchí 43 14,2

Có 01 ti uchí 110 36,7

Có 02 ti uchí 56 18,7

Có 03 ti uchí 69 23,0

Có 04 ti uchí 17 5,7

Có 05 ti uchí 5 1,7

T l b nh nh nCOPD có ít nh t 1thành ph n c aHCCH là 85,8%.

B ng 3.3. l b nh nh nCO D m cHCCH Ph nlo iCOPD theo GOLD Kh ng có HCCH

(n; )

HCCH (n; )

OR (95 CI)

GOLD A 74 (35,4) 21 (23,1) 1,82

(1,04 3,12) GOLD B, C, D 135 (64,6) 70 (76,9)

T ng 209 (100) 91 (100)

T l b nh nh nCOPD có HCCH chi m30,3%.T l này có xuh ng th p h n nhómb nh nh n GOLD A,s khác bi tnày có nghath ngk v i p =0,023.B nh nh n m cCOPDm c GOLD B, C,Dnguyc m cHCCH caog p1,82l nGOLD A.

IV.B NLU N

COPD là b nh c c tr ng b i tnh tr ng vi m ngh h p m ntính.Tnh tr ng vi m m n tính kh ng ch khu trú ngh h p, các nghi n c u ch ratnh tr ng vi m h th ngm c th p (Low-grade systemic in ammation)c ng xu thi n b nh nh n COPD. y chính là nguy n nh n g y t ng nguyc xu thi ncác bi n c timm ch và HCCH 5 , 6much of the disease burden and health care utilisation in COPD is associated with the management of its comorbidities (e.g. skeletal muscle wasting, ischemic heart disease, cognitive dysfunction. Ki m soát t t b nh ng m c c ch ng minh có tácd ng làm gi mgánhn ng i u tr, n ng cao ch t l ng cu c s ng, gi m t l t vong b nh nh nCOPD 3 .

HCCH làtnh tr ng hayg p b nh nh nCOPD.

T l b nh nh n COPD có HCCH dao ng t 21 62% 5 , 8much of the disease burden and health care utilisation in COPD is associated with the management of its comorbidities (e.g. skeletal muscle wasting, ischemic heart disease, cognitive dysfunction. Theok tqu nghi n c u c achúng t i,t l b nh nh nCOPD có HCCH chi m30,3%.

K tqu nghi n c u c achúng t i c ng t ng t k tqu nghi n c u c a các tác gi khác tr n th gi i. Tr n i t ng ng i Vi tNam,t l HCCH

b nh nh nCOPD trong nghi n c u c achúng

t icó xu h ng cao h n so v i nghi n c u c a oàn Thanh H i 2013 (13,5%) và Phí Th Nga 2013 (25,7%).

Theo k tqu nghi n c u c aTr nQuangBnh n m 2011 th c hi n t i tnh Hà Nam y c ng là tnh nam ng b ng s ng H ng nh Ninh Bnh,t l HCCH ng i d ntr n40 tu ichi m 16,3% (14,0 -18,6), và có 82,4% ng i d n có ít nh t 1 ti u chí c aHCCH 9 . Trong nghi n c u c achúngt i, t l HCCH b nh nh n COPD là 30,3% vàt l b nh nh ncó ít nh t 1ti uchíc a HCCH là 85,8%. So v i k tqu nghi n c u c a Tr nQuangBnh,t l HCCH b nh nh nCOPD có xu h ng cao h n so v i qu n th d n s chung.S khác bi tnàyc ng cghi nh n các qu nth d n s khác tr nth gi i 5 , 9 , 10 much of the disease burden and health care utilisation in COPD is associated with the management of its comorbidities (e.g. skeletal muscle wasting, ischemic heart disease, cognitive dysfunction.

b nh nh nCOPD cós giat ng ho t ngc acác y u t g yvi m nh CRP, cytokin vi m, Ngoài ra,b nh nh nCOPD ít ho t ng th l c h nvà th ngs d ng các thu c nhh ng nchuy n hóa ng và lipid trongc th nh : c ng beta 2, corticosteroid, y c ng chính là cácy u t nguyc d n nHCCH.

(5)

Theo k t qu nghi n c u c a chúng t i, t l HCCH b nh nh nCOPD giai o nGOLD B, C, D(34,1%) caoh nsov igiai o n A(22,1%),s khác bi tcó nghath ngk v ip<0,05.B nh nh n COPD m c n ng (GOLD B, C, D) có nguyc m cHCCH caoh nsov i m c nh (GOLD A) v i OR = 1,82 (1,04 3,12). Tnh tr ng vi m h th ngm c th p t ng ho t ng,c ng nh n ng

cácd u nsinhh c c avi m, các cytokine ti n vi m t ng cao b nh nh n COPDm c n ng 6 . B n c nh ó, cácb nh nh nCOPD ngm c HCCH có tri u ch ngl m sàngn ng h n, FEV1 th p h n,c nli uthu ccaoh n ki msoátb nh 7multicenter study of 375 patients hospitali ed for aCOPD exacerbation with spirometric con rmation was performed. We measured the components of the MetS and collected comorbidity information using the Charlson index and other conditions.

Dyspnea, use of steroids, exacerbations, and hospitali ations were also investigated. The overall prevalence of MetS in COPD patients was 42.9 %, was more frequent in women (59.5 %. ychính là tác ng qual i c aCOPD và HCCH, vàc ng là m tkhó kh nvà thách th ctrong qu n l và i u tr COPD.

Nghi n c u c achúngt ilàm tnghi n c u c t ngang. Do ó, k tqu nghi n c u m i xác nh c b nh nh n COPD m c HCCH là ph bi n, c n cquant mtrong th chànhl msàng.V làm tnghi n c u c t ngang,n n k t qu nghi n c u ch a xác nh c nh h ng c a HCCH l nquá tr nh ki msoátb nh,c ng nh k t c c c a b nh nh nCOPD.

V.K TLU N

T l b nh nh nCOPD có HCCH là 30,3%.B nh nh nCOPD giai o nGOLD B, C,Dcó nguyc m cHCCH caoh nGOLDA v iOR=1,82 (1,04

3,12).

T ILI UTHAM KH O

1. The top 10 causes of death. <https://www.

who.int/news-room/fact-sheets/detail/the-top- 10-causes-of-death>, accessed: 27/09/2021.

2. Global health estimates: Leading causes of death. <https://www.who.int/data/maternal-new- born-child-adolescent-ageing/advisory-groups/

gama/gama-advisory-group-members>, accessed: 27/09/2021.

3. Vogelmeier C.F., Criner G.J., Martine F.J., et al. (2017).Global Strategy for the Diagnosis, Management and Prevention of Chronic Ob- structive Lung Disease 2017 Report: GOLD Ex- ecutive Summary. Respirology, 22(3), 575 601.

4. Alberti K.G.M.M., immet P., and Shaw J.

(2006). Metabolic syndrome-a new world-wide de nition.AConsensus Statement from the In- ternational Diabetes Federation. Diabetic Medi- cine, 23(5), 469 480.

5. Chan S.M.H., Selemidis S., Bo inovski S., et al. (2019). Pathobiological mechanisms un- derlying metabolic syndrome (MetS) in chronic obstructive pulmonary disease (COPD): clinical signi cance and therapeutic strategies. Pharma- cology Therapeutics, 198, 160 188.

6. SinD.D. and Man S.F.P. (2003). Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic in ammation in chronic obstructive pulmonary disease. Circu- lation, 107(11), 1514 1519.

7. Díe -Manglano J., Barquero-Romero J., Almagro P., et al. (2014). COPD patients with and without metabolic syndrome: clinical and functional di erences. Intern Emerg Med, 9(4), 419 425.

8. Wat H., Waschki B., Kirsten A., et al. (2009).

The metabolic syndrome in patients with chronic bronchitis and COPD: frequency and associated consequences for systemic in ammation and physical inactivity. Chest, 136(4), 1039 1046.

9. Binh T.Q., Phuong P.T., Nhung B.T., et al.

(2014). Metabolic syndrome among a middle- aged population in the Red River Delta region of Vietnam. BMC Endocrine Disorders, 14(1), 77.

10. Funakoshi Y., Omori H., Mihara S., et al.

(2010).Association between Air ow Obstruction and the Metabolic Syndrome or Its Components in Japanese Men. Intern Med, 49(19), 2093 2099.

11. Park B.H., Park M.S., Chang J., et al. (2012).

Chronic obstructive pulmonary disease and metabolic syndrome:a nationwide survey in Korea.

The International Journal of Tuberculosis and Lung Disease, 16(5), 694 700.