NGHIEN ClTU NONG DO ACID URIC HUYET THANH 6 BENH XHAN HQI CHlTNG CHUYEN HOA CO VA KHONG CO TANG HUYET AP
Nguyin Vdn Hodng, Nguyin Anh VS"
TOM TAT
MiJic tieu: Moi lien quan giiia ndng dp acid uric huydt thanh vdi hpi chiing ehuydn hda va tang huyet ap ngay cang dugc quan tam, do do chiing tdi tien hanh dc tai nay nham muc tieu sau:
Khao sat ndng dp acid uric huydt thanh d bdnh nhan cd hdi ehung ehuydn hda cd va khdng cd tang huyet ap.
Doi tiTffng va phirong phap nghien cihi: 305 ijenh nhan tuoi trung binh 59,45±10,54 cd hdi chiing ehuydn hda theo tieu chuan IDF-2006 dugc chia lam 2 nhdm ed va khdng ed tang huydt ap. Nghidn ciiu thyc hien tai bdnh vidn tinh Phii yen.
Ket qua: Ndng dp AU nhdm benh cd tang huyet ap cao ban khdng co tang huyet ap (367,82±] 13,53 so vdi 273,17±91,I p<0,001); ty Id bdnh nhan tang AU trong nhdm bdnh cd tang huyet ap la 27.56% so vdi nhdm khdng cd tang huydt ap ty Id nay la 1.64%.
Ket luan: Cd sy khac bidt ve ndng dp AU d bdnh nhan bj mac hdi chimg ehuydn hoa co va khdng cd tang huydt ap.
Tu- khda: Acid uric, Tdng huyet dp.
SERUM URIC ACID LEVELS IN IMETABOLIC SYNDROME WITH AND WITHOUT HYPERTENSION
Nguyen Van Hoang', Nguyen Anh Vif
Background: Relationship between serum uric acid levels with metabolic syndrome and hypertension are increasingly interested, so the aim of this study: Survey of serum uric acid levels in patients with metabolic syndrome with and without hypertension.
Subjects and Method: 305 patients with an average age of 59.45 ± 10.54 had the metabolic syndrome accordmg to IDF-2006 is divided into 2 groups with and without hypertension. Research conducted at the Phu Yen hospital.
Results: The concentration AU in patients with h i ^ blood pressure is higher in patients without high blood pressure (367.82 ± 113.53 versus 273.17 ± 91.1, p <0.001). The rate of hypertension patients with high serum uric acid levels was 27.5 6% vs 1,64% in group widiout hypertension.
Benh vi?n tinh Phii yen
" Bp mon Npi dai hpc Y Dupe Hud ' Phu yen Hospital
*Hue universit> of Medicine and Pharmacy
TAP CHI TIM MACH HQC VIET NAM SO 66 - 2014 167
Conclusion: There are differences in the concentration of AU in patients with metabolic syndrome with and without hypertension.
Keywords: Uric acid, hypertension.
1. D A T V A N D E
Da cd nhidu cong trinh nghien ciiu vd mdi lidn quan giiia acid uric vdi bdnh tang huyet ap, dai thao dudng, benh than, beo phi [1], [2]..., nhung mdi lien quan giira ndng do acid uric huy^t thanh vdi hdi chiing ehuydn hoa d bdnh nhan trdn 40 tuoi it dugc cac tac gia de cap, do dd chiing tdi tidn hanh dd tai "Nghien cuu ndng do acid uric huyit thanh a binh nhdn trin 40 tuoi kem h^i ehung chuyin hoa. co vd khong co tdng huyit dp" nham muc tieu sau: Khao sat ndng d6 acid uric huyet thanh d bdnh nhan cd hpi ehung ehuydn hda trdn 40 tudi, cd va khdng cd tang huyet ap.
2. DOI TirONG VA PHlTONG FHAP NGHIEN ClTU
- Tidu chuan chpn bdnh: Tat ca nhung benh nhan > 40 tudi, ddn kham va didu tri tai Bdnh vien da khoa tinh Phii Ydn, tir thang 5/2012 ddn thang 5/2013 dii tieu chudn chdn doan HCCH theo IDF-2006 dua vao nghien ciiu. Cd 305 bdnh nhan tham gia nghien ciiu dap ung tidu chudn chpn benh.
Tieu chuan chan dodn tdng SUA
Tang AU mau khi: Nam > 70mg/l (420 micromol/1) Nir > 60mg/l (360 micromol/1)
- Tieu chuan loai trir: Qat giit cdp, nhung bdnh nhan cd bung bang, phii toan than, bdnh \^
nhidm khuan, bdnh cap tinh nang, nghidn rugu, cac benh he thdng, suy giap, cudng giap, dang sii dung thuoc gay roi loan AU (thudc didu tri ung thu. Salicylate, Igi tidu, Ethambutol, Pyrazinamid, corticoid, Allopurinol).
3. P H I / 0 N G PHAP NGHIEN CUtJ Thidt ke nghien ciiu: Mo ta cat ngang.
4. KET QUA
D ^ C DIEM CHUNG CUA DOI TlTgfNG NGHIEN ClTU Bang 1. Phan bo doi tuxmg nghien cirn theo tuoi va gidi
• .-...^^^ D9 tuoi Nhom ...^^^
Nam(n=129) Nir(n=176) Tn6i(X±SD)
P
<60 tudi n=184
84 100
%
45,65 54,35 52,65±4,95
>60 D=121
45 76
%
37,19 62,81 69,79*8,09
>0,05
Chung n=305
129 176
%
42,3 57,7 59,45±10,54
0,008
TAP CHi TIM MACH HOC VIET NAM SO 66 - 2014 168
Bang 2. So thanh to can thanh nen HCCH S6 tbanh to ciia HCCH
3 4 5 Tong cong
n 135 126 44 305
%
44,26 41,31 14,43 100
P
<0,001
Bang 3. Trj trung binh cdc thanh to HCCH giiia nhom cd va khdng c6 THA
"^^ -..^^^^ HA rHANHTOHcSr""---...,,^^^
Vong bung (cm) Glucose mau (ramol) Triglycerid (mmol/1) HDL-c (mmoW)
C6THA (X±SD) 93,05 ± 6,4 8,19 ±2.96 2,84 ±1.3 1,16±0.51
Khong THA (X±SD) 91,60 ±5,95
7,04 ±2,85 2,55 ±1,36 1,36 ±0,49
P
>0,05
<0,001
<0,01
<0,001 4.2. Khao sat nong do acid uric huyet thanh d benh nhan hdi chirng chnyen hda tren 40 tudi cd va khdng cd tha
Bang 4. Phan bo ty 1^ tang SUA theo gioi
SUA ^"~~---...^
Tang Binli thirong
Chung P(l,2)
Nam (1) n 47 82 129
%
15,41 26,89 42,3
Nir (2) n 42 134 176
%
13,77 43,93 57,7
<0,05
T6ng N(%) 89 (29,18) 216 (70,82) 305(100)
Bang 5. Ty ie vi NfiTB SUA if benh nhan co va khong co THA
\ . SUA T H A \ .
ca
Khong P
TSng SUA (1) n = 89
84 5
29,18%
27.56%
1.64%
Khong tang SUA (2) n = 216
121 95
70,82%
39.67%
31.14%
<0,0001
Chung 305 205 100
(X±SD) 367,82±113.53 273,17±91,1
<0,001
Il T A P CHI TIM MACH HQC VIET NAM S 6 66 - 2014
Bang 6. NDTB SUA d nhom co va khong c6 THA theo gioi
^ ^ SUA
T H A ^ ^ . Co THA Khong THA
Chung P(l,2)
Nam (1) n
92 37 129
(X±SD) 424,47±103,85
310,05±80,62 391,65±110,42
Nii (2) n
113 63 176
(X±SD) 321,70±99,66 251,5I±90,50 296,57±101,97
<0,001
P 0,001 0,001
Bang 7. Nong d9 SUA d benh nhSn THA cd vk khdng c6 tang acid uric
^ ~ - ~ - . T H A SUA ^ ^ ~ ^ ^ ^ _ ^
Tang SUA Binh thirong
Chung P(l,2)
Nam CO THA (1) n
45 47 92
(X±SD) 510,09 ±69,14 342,49 ±52,18 424,47 ±103,85
Nir c6 THA (2) n
39 74 113
(X±SD) 432,85±66,20 263,12± 53,67 321,70 ±99,66
<0,001
P
<0,001
<0,001
Bang 8. NBTB SUA theo phan d$ THA
~~~~~----____^^^ HA PhSn d9 THA ~~~~----.-____^^
HA toi Iru HA binh t h u ^ g HA binh thutmg cao THA 00 1 (nh«) THA tf$ 2 (trung binh) THA d§ 3 (nang) P
AU n=305
23 77 42 80 64 19
(X±SD) 269,35± 109,84 274,31±85,52 279,43± 63,77 348,6 ±88,24 421,80± 109,15 462,32 ±145,90
<0,001 5. BAN LUAN
5.1. Dac diem ehung 5.7./. ViluSi
Nghien ciru ctia chiing toi chpn d6i tuong >40 tu6i, tuoi trung binh 59,45±10,54, ty le HCCH gap a nir 57,7% cao hon nam 42,3%. Nhung ty le HCCH a nam <60 tudi cao hon nam
> 60 tuoi trong khi do ty le HCCH a nO <60 tu6i thip hem c nil > 60 tuoi, khong co str khac biet CO y nghia thdng ke, p>0,05.
TAP CHI TIM MACH HOC VIET NAM SO 66 - 2014 170
Cac nghidn cuu trdn cdng ddng cung dua ra nhan xet HCCH anh hudng 20-30% dan sd d tudi trung nidn, cd xu hudng gia tang theo tudi. nir gidi cao hem nam gidi va nhdm tudi >60 tudi cdty l d c a o n h d t [ l ] , [4].
5.1.2. Vi gi&i
Khi khao sat HCCH theo gidi, chiing tdi nhan thay ty Id HCCH d nu chiem 57,7% cao hon nam gidi chidm 42,3% co y nghTa thdng ke (p = 0,08). (Bieu do 3.1). Ket qua nghidn cuu ciia chiing tdi phii hgp vdi kdt qua ciia nhidu nghien ciiu tren cac ddi tugng THA, benh mach vanh, DTD deu cho rdng ty le HCCH d nu cao han nam. Nghien ciiu HCCH d bdnh nhan benh dgng mach vanh ghi nhan tan suat HCCH d nCr gidi cao ban nam gidi. Trong mdt nghidn cuu tai M>
cua Ford va cs cung cho thdy ty Id HCCH theo IDF d nir 60,1%, nam la 39,9% (p < 0,05) [11].
O phu nCr, tinh trang man kinh cd lidn quan vdi nhiing thay ddi su phan bd mo trong ca thd tir dang beo phan thap (hinh qua Id) sang dang BP the bung (beo kidu nam, hinh qua tao). Dieu nay hoan toan phu hgp vdi nhidu nghidn ciiu trong nude va trdn the gidi da chiing minh, ngudi phu nu phai ddi mat vdi nguy ca mac bdnh l\' tim mach nhieu ban nhat la sau tuoi man kinh.
Man kmh lam tang nguy ca mac HCCH len 60% sau khi dS didu chinh theo tuoi, BMI, boat dgng thd lire.
5.2. v e dac didm cua HCCH 5.2.1. Ve so yeu to cdu thdnh nin HCCH
Trong nghien cuu cua ehiing toi, cac yeu td cau thanh nen HCCH thi 3 ydu to chidm t\ Id cao nhat 44,26%, 4 ydu to co 41,31%, 5 yeu td cd 14,43%. Cach chgn mau va chgn tieu chuan chan doan HCCH co the tac ddng tdi cac ty le nay.
Vd ty Id timg thanh phan trong HCCH:
- Nghien ciiu cua chiing tdi, sau vdng bung (100%). tang TG hay gap nhat chidm 82.62%, tang dudng mau chidm 73%. THA chiem 67.21%.
- Theo Tran Thira Nguyen, Trdn Hiru Dang (2008) [5]. t\ Id HCCH (theo tidu chudn IDF 2006) d ngudi > 60 tudi la 38,96%. Cac ddu hieu thudng gap nhat la tang vdng bung (100%).
THA (77,78%), giam HDL-c (75,56%).
- Tran Van Huy va cs (2005) [3]. t> Id HCCH trong cdng ddng dan cu Khanh Hoa la cd su khac bidt d thanh thi 17,9%, ndng thdn 11,6%, midn niii 5%. HCCH tang theo tudi. nir mac bdnh cao ban nam. ty Id HDL-c thdp chidm 37% va vdng bung cd ts Id thap nhat 4%.
- Salminen va cs [13] cho thdy ty Id VB chidm 59,3%, tang TG chiem 75%, giam HDL-c la 68,9%, THA chidm 85,4%, tang dudng mau chidm 69,8%.
- Ty Id mac HCCH hien nay kha cao vao khdang 50-75 trieu ngudi. HCCH xay ra d 5%
ngudi CO thd trgng binh thudng, 22% ngudi thira can, 60% ngudi hi BP.
- Nghien ciiu cua ehung tdi ap dung tidu chuan chan doan HCCH cua IDF nam 2006, tidu chuan nay bat bupc phai cd tang vong bung, va ngudng glucose liic ddi (Go > lOOmg (5,6 mmol/1) ndn kdt qua cd thay ddi ty le so vdi cac tidu chuan khac.
TAP CHI TIM MACH HOC VIET NAM S 6 6 6 - 2 0 1 4 171
3.2.2. VS ndng id SUA (SUA) & ddi tu-ang nghien cm
Ket qua nghien ciiu cua ehung toi cho thiy ty le tang nong do SUA a binh nhan HCCH chiSm 29,18%, nam cao hon nii (15,41% so vai 13.77%). NDTB SUA 6 nam 391,65±110,42nmol1 cao hon nir 296,57± 101,97nmol/l, su khac biet co y nghia th6ng ke, p<0,05.
Tran van Trung va cs [7], khi khao sat 97 benh nhan DTD 2 thiy ty le tang SUA nam/nir lan luot la 30,93% va 19,59% va NDTB SUA nam/nii lin luot la 435,I03,21fimol/l/
346,42±2464,64^mol/l.
Chen LY va cs, khi khao sat 1.468 nam/906 nir, thiy ty le tang SUA: Nam 19,07%, va nil 3,42% [9].
Theo Conen va cs [10] khi nghien ciru 1.011 ddi tuong tu6i tir 25-64 tu6i. Ty le tang SUA cr nam gioi la 35,2% va nir la 8,7%.
Theo Chau Ngpc Hoa va cs, khao sat ndng do SUA a 736 benh nhan (375 benh nhan THA va 361 nguoi khong THA). 6 nguoi khong THA thn suat tSng AUla 18%. 6 benh nhan THA.TSn suat tang AU la 63%. Nong dp SUA thay d6i theo gioi, nam cao hon nir, tri so ISn luot la 401±62.4 mmol/L so vcri 384±59.5 mmol/L vol p < 0,001 [3].
Cac nghien cuu tren dupe thuc hien tren nhi^u d6i ttuong khae nhau nen kit qua ty le m3c tang SUA va NDTB cua SUA khac nhau va khae vol kSt qua nghien euu cua toi. Tuy nhien tat ca cac nghien ciru tren iiu co dilm tuong dfing do la ty le tang va NDTB SUA 6 nam gioi cao hon nir gioi. Dieu nay dupe cho la do thoi quen an uong, npi tiet.
5.2.3. VS ndng do SUA d benh nhan HCCH cd vd khong cd THA
- Ket qua nghien cuu cho thay trong so 89 benh nhan tang SUA: Co 84 (27,56%) ngu6i THA va 5 (1,64%) nguoi khong THA.
NDTB SUA nhom THA cao hon nhom khong THA (367,82±113,53nmol/l so vai 273,17±91,l^mol/l), nam eao hon nii (391,65±110,42^imol/l so vol 296,57±101,97nraol/l) sif khac biet nay eo y nghia thSng ke, vol p < 0,0001. Theo Chau Ngpc Hpa vii cs, khap sat nong dp SUA o 736 benh nhan (375 benh nhan THA va 361 nguoi khong THA). NDTB SUA 6 nguiri khong THA la 301.1±56.7mmol/L. Tjn suit tang AU la 18%. NDTB SUA a benh nhan THA la 394.1±72.2mmol/L.Tan suit tang AU la 63%. N6ng dp SUA thay d6i theo gioi, nam cao hon n&, trj s6 lin lupt la 401±62.4 mmol/L so voi 384±59.5 mmoI/L vol p < 0,001 [9]. Ket qua nay cho thay NDTB 6 ea 2 nhom THA va khong THA deu cao hon so voi ket qua cua ehung toi.
Khao sat nong dp SUA tren cac doi tugng THA nghien ciru ehung toi cho thay NDTB SUA 6 nam cap hon nii (424,47 ±103,85nmol/l so voi 321,70±99,66^imol/l) su khac biet co y nghTa thong ke, p < 0,001. Ket qua nay tuong ddng vol mpt s6 nghien cuu khae ve NDTB ciia SUA 6 benh nhan THA. nam cao hon nir.
Nghien ciJru cua Nguyen Thi Thuy Hang tren 82 benh nhan THA nguyen phat eho thay nong dp SUA tnmg binh nam/nii lin luot la 404,7±27,3(imol/l, va 330±48(tmol/l [8]. Theo Nguyin Dire Cong va cs. nghien cuu moi lien quan giiia nong dp AU voi HA tren 43 benh nhan THA nguyen phat, ket qua cho thiy ndng dp SUA ttung binh nam/nii lan lupt la 389,7±88,7nmol/l, va 385,5±74,4nmol/l [8].
TAP CHi TIM MACH HOC VIET NAM S 6 6 6 - 2 0 1 4 172
\
Cac nghidn ciiu nay cd kdt qua tuang ddng vdi kdt qua chiing tdi. Mdt didm ehung nhat d bdnh nhan THA, ndng do trxmg bmh SUA nam cao hon nir.
Khi khao sat ndng do SLA theo phan do THA (bang 7). NDTB SUA tir miic HA tdi uu ddn THA do 3 tuang ung nhu sau: 269,35= 109.8452pmol/I/274,31±85,52Mmol/l/279.43±
63.77pmol/l /348.6 ±88^4^molyr421,8ftt 109.15pmon 462.32 ±145,90pmol/l, su khac bidt cd y nghia thdng kd, p < 0,001. Ket qua nay tuong ddng vdi cac nghien ciru khae nhu cua Ngu\ln Thi Thuy Hdng [7], ndng do SUA tuang img THA do 1.2. 3 la 355,0±41,3pmol/l/372,6
±36.7|imoI/l / 4 3 7 , 9 ± 54.3pmol/l p<0,05).
- Khi khao sat \e mdi lidn quan giiia thdi gian bi THA vdi ndng do SUA. kdt qua nghidn cim cho thay cd 35.12% phat hien THA lan ddu, 32.68% mac bdnh< 5 nam, \ a 32,35% > 5 nam.
tuong img nong do SUA trung binh idn lugt la 292,9 ± 66,07pmol/l / 376.57 ± 84,02^imol/l / 440.67± 129,73 pmol/1. su khac bidt cd y nghia thdng ke.
Nghidn ciiu eua Nguyen Thi Thuy Hang trdn 82 bdnh nhan THA nguyen phat cho thdy co su tuang quan thuan giCra ndng do tang SUA vdi thdi gian phat hien THA, phat hien idn dau 15.6%. < 3 nam: 26.82%, 3 - 5 nam: 24,39%, > 5 nam: 32.92%, tuang img vdi NDTB eua SUA Idn lugt la: 363,2±63,3pmol/l/380,l±55,6pmol/l/385.0=53.9pmol/l/391,4±41,9nmol/l, su khac bidt cd y nghia thdng ke p<0.05 [8]. Kdt qua nay cho thdy tuy khdng tuong duang nhau \ e nong do, nhung cd cung nhan xet la thdi gian bi THA cang lau thi ndng do SUA cang tang.
Nhin ehung kdt qua nghien ciiu cua chiing tdi vd mdi lidn quan giiJa SUA va huydt ap cd mdt sd kdt qua tuang ddng so vdi cac tac gia khac dd la ndng do SUA d nam cao ban nu', kd ca trdn doi tuang THA - ngudi THA cao hem ngudi cd huydt ap binh thudng - thdi gian mac bdnh cang lau. tri sd HA cang cao thi nong do SUA cang tang.
Trdn thd gidi cd nhidu nghidn cuu da ehung minh rang benh nhan THA cd tang AU cd nguy CO bdnh mach vanh. bdnh mach nao gap 3-5 lan so vdi khong tang acid uric. Tang SUA dugc quan sat thdy d 25-60% bdnh nhan TILA. khdng dieu tri va gan 90% d ngudi cao tudi THA.
Didu tri giam AU bdng nhdm lie chd xanthin cd tac dung ha huyet dp. Tang SUA se tidn doan lam tang nguy ca tu vong d bdnh nhan suy tim, bdnh ddng mach vanh va dai thao dudng. Bdnh nhan bdnh mach vanh tang AU cd nguy ca di vong tang gap 5 lan. Vdi mdi miic tang 1 mg/dl AU nrong ung \ di tang 26% tu vong. 6 bdnh nhan dai thao dudng tip 2 co tang acid uric, tdn suat dot quy \ a tir vong ehung cung nhu tir vong do dot quy ddu gia tang.
Krishnan trong thu nghiem can thiep nhidu yeu td nguy ca (Multiple Risk Factor Intervention Trial) d 3073 nam gidi khdng hi hdi chimg chuyen hda va tang huydt ap. tuoi tu 35- 57 dugc theo ddi trung binh 6 nam. Kdt qua cho thay nam gidi cd huyet ap binh thudng ma ndng do acid uric huydt thanh liic dau cao thi cd nguy ca bi tang huydt ap trdn 80% (ty suat chdnh OR:
1.81; khdang tin ca> (CI) 95%: 1.59-2,07) so vdi ngudi cd nong do acid uric huyet thanh binh thudng. Cii tSng mdi mot dan vi AU huydt thanh thi tang 9% ngu} co mac tang huydt ap (ty suat chdnh OR: 1.09; khdang tin cay 95%: 1,02-1,17) [12].
Ket luan: Ndng do AU d nhdm bdnh hdi chimg ehuydn hda cd tang huydt ap cao ban nhdm khdng cd tang huydt i^. Mat khac nong do AU tang theo do tang huydt ap.
T A P CHI TIM MACH HQC V I E T NAM SO 66 - 2014 173
TAI LIEU THAM KHAO
1. Ly Lan Chi, Ngo Van Truydn (2009), "Ndng dp acid uric huyet thanh vdi Lipid mau trdn bdnh nhan tang huydt ap nguydn phat", Tgp chiy hoc thuc hdnh. (682 + 683), tr. 391-394.
2. Nguydn Diic Cdng, Nguydn Canh Toan (2006), "Mdi lien quan giiia ndng do AU huydt vdi huyet ap d bdnh nhan tang huyet ap nguyen phat", Tgp chi Tim mgch hoc Viet nam, (43), tr. 56-60.
3. Chau Nggc Hoa, Ld Hoai Nam (2009), "Khao sat ndng do acid uric huydt thanh d bdnh nhan tang huydt ap va ngudi binh thudng", Y hgc TP. Hd Chi Minh, (13), tr. 1 - 7.
4. Trdn Van Huy, Truang Tdn Minh (2005), "Nghien cuu hgi chiing ehuydn hda d ngudi Idn, Khanh hda, Viet Nam. Nhung tidu chuan nao phii hgp vdi ngudi Viet Nam Chau A".
Tgp chi tim mgch hgc Viet Nam, (40), tr. 9 - 22.
5. Huynh Van Minh, Doan Phudc Thudc va cs (2008), "Nghien cim dac didm djch te hpi chiing chuyen hda tren nhan dan Thira thidn Hud va trdn nhung ddi tugng ed nguy ca cao", Tgp chi YHgc thuc hdnh. (616-617), tr. 643-648.
6. Tran Thiia Nguydn, Tran Hiiu Dang, Tran Trung Thdng va cs (2006), "Nghidn ciiu hpi chimg chuyen hda d ngudi beo phi vdi BMI > 23", Tgp chi Yhgc thuc hdnh, (548), tr. 412-418.
7. Tran Van Trung, Huynh Thj Dung, Nguydn Hdng Ha va cs (2009), "Nghidn ciiu nong d?
acid urie huydt thanh d bdnh nhan dai thao dudng type 2 tai khoa Ndi A BVDK Tinh Binh Dinh", Tap chi noi khoa, (1), tr 409-417.
8. Nguyen Thi Thiiy Hdng (2011), "Nghidn ciiu ndng do acid uric huydt thanh tren bdnh nhan tang huydt ap nguydn phat". Tap chi Y Dugc hgc, (02), tr 77- 84.
9. Chen LY, Zhu WH, Chen ZW, Dai HL et al (2007): "Relationship between hyperuricemia and metabolic syndrome". J Zhejiang Univ Sci 8, pp.593-8.
10. Conen D, Wietlisbach V, Bovet P, et al (2004): Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country. BMC Public Health 4: 9.
11. Ford ES, et al (2008), "Prevalence of the Metabolic Syndrome Among U.S.
Adolescents Using the Definhion From the Intemational Diabetes Federation", Diabetes Care, 31,pp.587-589.
12. Krishnan E. et al (2007), "Hyperuricemia and Incidence of Hypertension Among Men Without Metabolic Syndrome", BMJ, 49(2), pp.298-303.
13. Salminen M, Kuoppama M, Vahlberg T, et al ( 2 0 1 1 ) , "Metabolic syndrome and vascular risk: a 9-year follow-up among the aged in Finland", Acta diabetol, 48(2), pp. 157-165.
TAP CHI TIM MACH HOC VIET NAM S 6 66 - 2014
