thu CTC tdng Idn 3,8 i l n d nhQ-ng phy n d mang thai dO thdng t d 7 I l n trd Idn [14] O cdc phy n d mang thai nhilu l i n vd sinh nhilu con, viing ranh gidi ldt try ldn ra c i ngodi CTC Id y l u t i t h u i n lpi tgo d i i u k i i n ak HPV d i ldy nhiim han Vl vdy, ede phy n d cd s l i l n mang thai nhiiu vd sinh nhiiu eon ed nguy ea cao nhilm HPV,
K £ T L U A N :
- S i phy n d di khdm phy khoa vd xdt nghiim nhiiu nhit Id khoing t u l i 40-49 vdi 35,4%,
- Ty 1$ nhiim HPV ehung tgi c i n g d i n g Id 10,2%.
- Ty 1$ nhilm HPV t h i p n h i t d nhdm t u i i s 29 (18.8%) vd eao nhit d nhdm t u l i 40-49 (29,4%).
- Ty id nhiim HPV tdng eao d nhdm phy n d quan h$ tinh dye i l n d i u <18 t u i i vd ed >4 i l n mang thai.
Ngda thai b i n g bao cao su ed t} l i nhilm HPV t h i p nhit
T A I L I E U THAM K H A O
1. GLOBOCAN 2008 (lARC) Section of Cancer Information (2/7/2013)
2. Sellers JW et al (2000), HPV Prevalence and Cervical Cancer Incidence by Age CMAJ;163:503.
3. Didn tich, ddn s l vd mdt dd ddn s l ndm 2011 phdn tiieo dia phuang. Ting cyc Thing kd Vidt Nam
4. Ddn s i nd tmng binh phdn theo dia phuang, Theo Tong eye thing ke Vigt Nam.
5. Melnikow J, Nuovo J, Willan AR, Chan BK &
Howell LP (1998), Natural history of cervical squamous intraepithelial lesions: a meta-analysis, Obstet Gynecol, 92(4). pp, 727-735.
6. Dodn Thi Phuang Thdo & Nguyin Sao Tmng (2007), T i n thuang trong thupng md va ung thu d tii' cung d l i chiiu t l bdo hpe - glai phau bdnh, Y hgc Thinh phd Hd Chl Minh, 4(4), lr.78-84.
7. VQ Thi Nhung (2007), Khao sat tinh hinh nhiem cdc typ HPV d phy nd Thdnh p h i H i Chi Minh bang ky thudt sinh hpc phdn td. Sdo cio tai Hdi thio dinh gii nhu eiu xiy dung chuang trinh phdng chdng ung thuco to- eung t^i Vidt Nam. Hd Npi 13-14 thdng 12- 2007.
8. LS Trung Thp. Trin Vdn Hpp (2009). NphiSn cuu ty Id nhiim HPV d cdng ding Hd Npi, tim hieu mpt s6 y l u t i lidn quan. Y hpc Thdnh phd Hd Chl Minh. Phy bdn eda tdp 13. S l 1 -2009,185-190.
9. NguySn Bd Ddc (2007), T i n g quan v i ung thtf cl t d cung. Tap chl Y hpc, S l ddc bidt, Chuydn de Virus sinh u nhii d ngudi (HPV), m i l lidn quan vdi viem, u dudng sinh dye ddc bidt ung thu e i tu cung , Thdng 1 / 2007, tr 9 8 - 1 0 4 .
10. Kjaer SK. (2002), Type specific persistence of high risk human papillomavims (HPV) as indicator of high grade cervical squamous intraepitheliallesions in young w^omen. population based prospective follow up study. BMJ Volume 325 14 Sep, p 1-7.
NGHIEN CliU BIEN DOI CHUC NANG LOC MAU CUA THAN Of BENH NHAN TANG HUYET AP NGHUYEN PHAT
NGUYINVINHHUNG, HA HOANG KIEM, DINH THJ KIM DUNG T6M TAT
Mijc tidw Ting huyit ip li mdt bdnh rit thudng g$p d nhiiu nude trdn thi gidi. Ting huyit ip ti nguydn nhin chlnh giy suy thin glai do^n cudi chidm 46%. TSng huyit ip lim biin mi eiu tnic vi chOc nSng IQC miu eOa th$n Di tii thi/c hidn v& muc tidu:
Dinh gii si/ thay ddi eOa mOc IQC ciu th$n d cic bdnh nhin ting huyit ip nguydn phit Phuang phip: Tiin cOv. md ti, cit ngang,. Kit qui vi kit ludn: Nghidn cOv 228 trudng /jpp ting huydt ip nguydn phit cho thiy: 50% li nam gidl tudi tmng binh li 59,3 ± 9.6; nO"
gidi chiim 50% tudi tmng binh 59.1 ±9.1. Huyit ip tim thu(mmHg) 168,9 ± 11,8 Huydt ip tim tnrang (mmHg) 95,4 ± 8.1. Huyit ip tmng binh(mmHg) 119,9
± 9,3. Muc IQC ciu thdn d nhdm bdnh giim han so vdi nhdm ehung (88,4 ml/phut/1,73m2 so vdi 90,6 ml/ph0t/1,73m2) nhung khdng c6 •y nghTa thdng kd p=0,31. MOc IQC ciu thin d nhdm ting huyit ip giai ctogn / cao han nhdm ting huyit ip gial ao$n II vi III (94,3 ml/ph0t/1,73m2 so vdi 86,5 ml/phut/1.73m2 vi 77.6 ml/ph0t/1,73m2) ed j? nghia thdng kd vdi p=0,04 vi p=0,004 M&e IQC ciu th$n tuang quan nghich vdi huyit ip rd, r = - 0,331; p = 0.003 edng thOc tuang quan MLCT = 156,9-0,57x HATB
Ttr khda: tSng huyit ip, muc IQC ciu th$n
SUMMARY
Backgmund: hyperiension is the imporiant factor to kidney disease pmgmssion and prevents eanjiovascular risk. HTA cause GFR decmase. The target blood pmssum below 130/80 mmHg[3j can impmve mnal function. Patients and Method: 228 case studies of primary hypertension flowup by GFR test. Result and Conclusion: men 50%. age average 59.3 ± 9.6; women 50%, age avemge 59.1 ± 9.1.
Systolic blood pressum (mmHg) 168.9 ± 11-8.
Diastolic blood pmssum (mmHg) 95.4 ± 8.1. The mean blood pmssum (MBP) (mmHg) 119.9±9.3.Glomemlar filtmtion mte (GFR) decreased mom in HTA compared with normals (88.4ml/mn/1J3m2 compamd with 90.6 ml/mn/173m2) but no statistically significant p = 0.31.
Glomemlar filtmtion mte in hypertensive grade 1 is higher hypertension of grade 2 and 3 (94 ml/mn/1,73m2. compamd with 86 and 77 ml/mn/1.73m2) with statistical signiricance p=0.04, p=0,004. GFR con-elate well with biQOdpmssure, r = - 0.331. p = 0003 eormlation formula: GFR = 156.9•
0.57 x MBP
Keywords: Hypertension, Glomemlar mmtion mte
Y HOC THUC HANH (875) - S6 7 W
DAT VAN D £
Tang huylt dp(THA) Id m i t b$nh r i t thudng g§p d nhilu nude trdn t h i gidl. Cl chdu Au vd B l c MJ?. ty Id THA d i u kha eao. chiim t u 15 - 20%. Tai MJ (2002) ed 28,6% ngudi trudng thdnh b| bdnh;
Canada (1995) 22%; Tdy Ban Nha (1996) Id 30%; tgi Phdp tJ l i THA ldn tdi 4 1 % (1994); Trung Q u l c (2002) Id 27%; Mexico (1998) Id 19,4%; Venezuela (1997) Id 36,9%; Cu Ba (1998) Id 44%, Hungaria (1996) Id 26,2%, Albania (2003) 31,9%, Philippins (2000) 23%, Malaysia (2004) 32.9.[1][3] Bdnh thdn do tdng huyet dp Id tinh trgng bdnh thdn md th$n bi t i n thuang do nguydn nhdn tdng huyit dp kdo ddi Suy thdn do tdng huylt dp Id nguydn nhdn thudng g$p ddng thd 2 gdy suy thdn giai dogn c u i i d ngudi da tring chiim 23% vd Id nguydn nhdn chinh gdy suy thdn gial dogn euli ehilm 46%. Trdn t h i gidl dd cd nhilu nghidn cdu v i tdng huylt dp gdy b i l n d l i mdc lpc d u thdn(MLCT), tuy nhidn d Vidt Nam cd chua nhilu cdng trinh v l v i n d i ndy. V) vdy ehung tdi t i l n hdnh nghidn cdu dk tdi" Nghidn euu biin ddi ehOc ning loc miu cOa th$n d bdnh nhin ting huyit ip nguydn phit' vdi myc tidu: Ddnh gid s p thay d l i cOa cht s i mde lpc d u thdn d edc b^nh nhdn tdng huylt dp nguydn phdt
D O I TLPpNG, PHU'ONG P H A P NGHIEN Cl>U Ddi t u p n g nghidn c d u
- Tidu c h u i n chpn bdnh nhdn' t i t cd ede bdnh nhan tang huyet dp nguyen phdt, khdng ed tien su bdnh than t i l t nigu, khdng dang bi m i c t i l u dudng, nhiim triing t i l t nidu, dang su dyng cdc thulc gdy tdng huylt dp
- Tieu c h u i n logi trd: cdc bdnh nhdn cd tien sd binh thdn, khdng t p nguyen tham gia nghien edu, t u l i dudi 40.
P h u c n g phdp nghidn c d u :
Tdng huyit dp duac c h i n dodn vd phdn loai theo tidu c h u i n cua JNC Vll: Tdng huylt dp khi huyit dp tdm thu >= 140 vd/hodc huyit dp tam truang >=90 mmHg.
- Mdc Ipc d u thdn dupe do b i n g creatinin ndi smh- nudc tieu thu gdp trong trong 24 gid vd do n i n g dd creatinin mdu vd nude t i l u tinh theo edng thde:
MLCT = (U xV/P) x(1,73/S) (MLCT: mdc lpc d u thdn, U:ereatinin n i i u (mieromol/1); V : t h l tich nude tiiu 24 gid (ml); P. creatinin mdu(micromol/l); S di$n tieh da ca the(m2))
S i lidu tdp hpp vd x u ly' theo todn t h i n g kd y hpc K £ T QUA vA BAN LUAN
1. Dac d i l m v l g i d i trong nghidn c i f u Bang 1 : Ti Id nam vd nd trong nghidn cdu n
%
Nam 114 50%
Nir 114 60%
T6ng 228 100%
Cd 76 b i n h nhdn tham gia vd tudn thu d i y dii edc ydu d u cua nghien nghien edu. Nam gidi 36 ngudi (47.4%), nO- gidi 40 ngudi (52.6 %). Nhiiu nghidn cdu tren t h i gidi dd ehi ra r i n g tJ l i tdng huyit dp dudng nhu eao han d nam gidi so vdi n d gidi trudc
t u l i 55, nhung sau dd Igi cao han d n d gidi. Nguydn nhdn ed t h i do s p m i t tde dyng bdo v i mgch mdu qud n i l tilt t i n d d phy n d sau mdn kinh trong khi thdnh mgch eua nd gidi trong d i t u i i ndy ludn xa cdng han nam gidi eiing tuli[3]. Trong nghidn cdu cOa Phgm Gia Khdi, s l ngudi m l e THA d gidi nam nhilu han n d (p < 0,001) d b i t kJ Ida t u i i ndo. Tde gid di d i n k i t ludn gidi nam Id mdt trong nhdng y i u t l lidn quan ch$t chd vdi THA [1]. Cd t h i vl nam gidi ed nhilu thdi quen x i u nhu hiit thuic Id, u i n g rupu bia. Do dd hp bj THA nhilu han so vdl nd gidi [1][3]
2. D$c d i l m v l t u i i trong nghidn c u u Bdng 2 Die d i l m t u i i theo gidi tinh d nhdm b$nh vd ehung
Tuli x±SD
P
B^nh Nam 59,3 ± 9,6
NO 59,1 ±9,1 0,910
Chdnq Nam 1 Nd 60,6 ± 9,7 159,3 ±9.4
0,441 1 T u l i tmng binh nhdm b i n h trong nghidn cdu Id 5g,2±9,3 so vdi chdng Id 60±9,6; khdng cd sp khde bidt ed y nghta thing kd gida nhdm bdnh vd nhdm chdng p=0,437. T u l i gida gidl nam vd nd khdng ed su khde bi^t cd y nghTa d nhdm b$nh Id 59,3 vd 59,1(p=0.91); d nhdm chdng 60,6 vd 59,3 (p=0.441).
T u l i eao Id mdt y i u t i nguy c a lidn quan chdt chd vdi tdng huyit dp d i i u ndy cd t h i giai thich do thay d l i ve gidl p h i u vd chdc ndng hd thing tim mgch khl t u i i cdng cao, Idm eho sdc cdng dpng mgch ngoai bidn tdng Idn gdy tdng huylt dp[1]
3.0$c d i i m ehung v§ h u y l t dp
Bang 3: Trung blnh huyit dp tdm thu, tdm tarang, taing blnh
Q^c didm HA trung binh
(mmHg) HA tam thu (mmHg)
HA tdm truang (mmHg)
B$nh 119,9 ±9.3 168,9 ±11,8 95,4 ±8,1
Chunq 84.5 ±7,1 111,9 ±7,8 70,9 ± 7.5
0.001 P 0.003 0.012 Huylt dp d nhdm benh eao han h i n nhdm ehdng:
p=0,001 vdl huylt dp tmng binh, p=0,003 vdi huyit dp tdm thu, p=0,012 vdi huylt dp tdm truang. 6' nhdm binh, huylt dp tam thu (168 mmHg) eao han nhdm chdng (11 ImmHg) tdi 50mmHg vd khdc bidt ed y nghTa cao p=0,003. Huylt dp tdm tnj-ang nhdm bgnh cao han nhdm chdng 25mmHg nhung p nhd han (p=0,012)
4. Chi s d m d c Ipc cdu th$n trong nghien c d u B5ng 4- Chi s i mue Ipc e l u thdn(ml/phut/1.73m2) theo nhdm t u l i
Tu6i 40-50 50.60 61-70
>70 Gi6i Nam Nam
m
ND Nam
NO Nam
NO- B$nh 119.7 ±13,0 101,6 i 18,5 98:8 ±14,1 80,5 ± 14,9 87,6 ±13,3 73,3 ±11,8 79,3 ±12,9 71,6 ±13,0
Chl>nq 112,5 ±12,6
95,3 ± 9,4 105,6 ±16,8
84,7 ± 9,4 94,0 ± 20,5 76,6 ± 12,8 87,7 ±19,1 71,6 ±9,9
P 0.16 0,32 0,11 0,21 0,19 0,31 0,11 0,99
Y HOC THUC HANH (875) - SO 7/2013
Mue Ipe d u thdn d nhdm b i n h gidm han so vdi nhdm ehdng (88,4 so vdi 90.6) nhung khdng ed j - nghTa thing kd p=0,31 .Xdt theo gidi tlnh th) nam gidi nhdm b$nh t h i p han nhdm chdng (95,9 so vdi 98,3) trong khi nd gidi thi tuang duang (81,0 vd 81,4). O nhdm b i n h nhdn tdng huyit dp cd t u l i 40-50 mdc Ipe e i u t h i n cao hpn nhdm chdng cd d nam (119 so vdi 112) vd d n d (101 so vdi 95) tuy nhidn sp khdc bi|t ndy khdng ed y nghia t h i n g kd p=0,15 vd p=0,32.
Tdc gid Zelveian PA ndm 2011 ddnh gid v l huylt dp 24h vdi t i n thuang thdn d bdnh nhdn tdng huylt dp nguydn phdt tdc g i i dd nghidn edu trdn 120 bdnh nhdn trong dd ed 97 nam t u l i tmng blnh Id 50,2 ± 0,6 t d 23 d i n 65, tdng huyit dp dd 1: 98bn , tdng huylt dp d i 2: 22 b i n h nhdn. Nghidn cuu ndy cho t h i y cd sp tuang quan nghjch gida gid tri eua mgch ban ddm vd gidm MLCT d nhdng b$nh nhdn cd tdng huyit dp nguydn phdt.p]
5. O^e d i l m mde lpc c i u th$n theo glal dogn tdng h u y l t dp
Bang 5: Mdc Ipc d u thdn (ml/phiit) theo giai dogn THA
Gidl Nam NLP
P Tdng n=228
Giai do«in 1 (X ± SD)
(a) 104,8±13,0
90,7±16.2 0.02 94,3±16.5
Giai dopn 11 (x±SD)(b) 92,5±18.4 76,3±17,3
<0.001 86.5±19,5
Giai dogn 111 {x±SD)(c) 79,4±15.0 76.0±21.9 77.6±18.4
P pb/a (0.04)
pc/a (0.004) pert) (0.12) Mdc Ipc d u thdn gidm rd r i t theo gial dogn tdng huyet dp (giai dogn I Id 94,3; giai dogn II Id 66.5; gial doan 111 Id 77.6 vdi p=0,04; p=0,0004; p=0.12. Mdc Ipc d u thdn d nam giam lidn tyc t u giai dogn I d i n giai dogn III. Trong khi d n u mde Ipe d u thdn giai dogn II vd giai dogn 111 tuang t p Theo nhdm t u i i : mdc Ipe d u thdn giam rd theo t u i i . d$c biit Id giai doan li (p cd y nghTa) trong khi tdng huyit dp giai doan III mdc Ipe c i u thdn d cdc nhdm t u i i d i u tuang tp (p>0.05).
6. T u a n g quan m u c Ipc cdu th$n v d i h u y l t dp trung binh:
r = - 0.331, p = 0,003. Cdng thirc tuang quan' MLCT = 156,9 - 0,57 x HATB
D l thi 1: Tuang quan mde Ipc d u thdn vd huyit dp tmng blnh
, „
l...
8 a S ° °
".%:-
" • S . 8
.
• I f
Theo bdo edo cua KDOQI 2002 cdc tdc gid t i n g hpp nhiiu nghidn euu vd chi ra moi tuang quan ch$t
chd ciia con s l huylt dp trung binh vdi mdc Ipc ciu thdn vd n i n g d i protein n i i u . Cf nhdm tdng huylt dp nhg mdc Ipc d u thdn khdng thay d i i vd eon s l gilng nhau d mpi mdc d i protein n i i u . H u y i t dp cdng tdng eao MLCT edng gidm nhanh. Ct nhdm nhdng ngudi tdng huyit dp d i 2 huylt dp tnjng binh t d 98 - 107 mmHg. MLCT d t i t c i cdc b i n h nhdn d i u gidm theo thdi gian vd mde dd huyit dp. Tuy nhidn t i e d i gidm khdng qud nhanh 3 - Sml/phiit/ndm. M§e dii vdy, nlu protein n i i u > 3g/l, MLCT sd gidm t h i p , b i n h nhdn sd nhanh chdng tiin tdi suy thdn giai dogn culi[3].
Tde gid Puttinger ndm 2003 nghidn cdu tgi Ao nh$n t h i y b$nh th^n tdng h u y i t dp Id nguydn nhdn chlnh gdy suy thdn giai dogn e u l i Khi chdc ndng th§n dd suy ndng d i i u tri k h i n g c h i huyit dp vd duy tri chipc ndng thdn r i t khd khdn. Theo ddi md b i n h hpc b$nh nhdn dupc k h i n g c h l huylt dp t i t tdc gid thiy ring chdc ndng t h i n cd t h i d i t h i i n p h i n ndo[4]
K £ T L U A N
Tdng huyit dp Id y i u t i i n h hudng tdi tiln triln cua b i n h thdn vd cdc nguy ca tim mgch eho ngudi b$nh Nghidn cdu 228 trudng hpp tdng huylt ^p nguyin phdt cho t h i y : 50% Id nam gidi tuli tmng binh Id 59,3 ± 9,6; n d gidl chiem 50% t u i i tmng blnh 59.1 ± 9.1. Huylt dp tdm thu(mmHg) 168.9 ± 11,8.
Huylt dp tdm tarang (mmHg) 95,4 ± 8.1. Huylt dp trung blnh(mmHg) 119,9 ± 9.3. Mde Ipc d u th|n it nhdm b i n h giam han so vdi nhdm chdng (88,4 ml/phOt/1.73m2 so vdi 90,6 ml/phiit/l ,73m2) nhung khdng cd 9 nghTa t h i n g kd p=0,31. Mdc Ipc d u th|ln d nhdm tdng huylt dp giai dogn I cao han nhdm tdng huyit dp giai dogn II vd III (94.3 ml/phut/1,73m2 so vdi 86,5 ml/phut/1,73m2 vd 77,6 ml/phut/1,73m2) c6 y nghTa t h i n g kd vdi p=0,04 vd p=0,004. Mirc loc d u thdn tuang quan nghich vdi huylt dp rd, r = - 0.331; p
= 0,003. cdng thdc tuang quan: MLCT = 156,9 - 0,57 x HATB. Tlnh trgng tdng huyet dp cdng n$ng thi mi>c loc d u thdn cdng suy gidm t r i m trpng
T A I L I $ U THAM K H A O
1. Phgm Gia Khdi Nguyen Ldn Vidt. Pham ThSi San vd c i n g sp, (2003), ' T i n s u i t tdng huyet dp vd cdc y i u t i nguy ea d cdc tinh phia B l c Viet Nam 2001-2002", T^p chl Tim m^ch hpc Vi$t Nam, 33, pp.
9-15
2. Zelveian PA, Buniatian MS, Oshchepkova EV, Lazareva NV, Rogoza AN. (2011), "Indices of static and dynamic components of pressure load (assessed by 24-hour blood pressure monitering) and the state of renal funtion in patients with essential hypertension",Kardiologiia;51(4):31-8.
3 Peterson JC, Adler S, Buritart JM.
(19g5),'Blood pressure control, proteinuria and tiie progression of renal disease- The Modification of Diet in Renal Disease Study" Ann Intern Med 123:754- 762.
4. Puttinger H, Soleiman A, Oberbauer R. (2003),°
Regression of hypertensive nephropathy during tiiree years of optimal blood pressure control'. Wien kiin Wochensehr. Jul 15;115(12):429-31
Y HOC THT;C H A N H (875) - s 6 7/2013