N G H l i N d h l KHOA HOC
NGHIEN CQU THAY EXDI UPID MAU BENH VAY NEN THONG T H U O N G
Oang Van Em*, N g u y i n Thi Lan HifcAig**
T6MTAT
Nghien cdu triglycerid, cholesterol, HDL-c va LDL-c trong mau cua 3 n h o m : nhom vay nen t h d n g t h u d n g (50 benh nhan), n h d m benh da khac (50 benh nhan)va n h d m ngudi khde (50 ngudi). Ket qua cho thay triglyceride, cholesterol, HDL-c cua 3 n h d m s d t h a y doi khong cd y nghla t h o n g ke vdi p>0,05, cdn LDL-C n h d m vay nen giam hon n h d m ngudi khoe.
TdkhdaiVay nen t h o n g t h u d n g , triglyceride, cholesterol, HDL-c, LDL-c.
I.DATVAND^
Benh vay nen la m d t benh da t h u d n g gap d moi Ida t u o i , moi gidi, khap moi luc dia va benh chiem 1-3% dan sd the gidi [1], [3]. Sinh benh hoc benh vay nen cdn cd nhdng van de chda rd, nhung cho den nay da sd tac gia da t h d n g nhat cho benh vay nen la m p t benh co co dja di truyen va co co che t u mien dUOc khdi dpng bdi cac yeu t d stress, chan t h u o n g da, nhiem khuan khu t r u , m d t sd thudc, thdc an, thdi tiet khi h a u . . . Do v a y benh v5y nen den nay chUa dieu tri khoi dUpc ma chu yeu dieu tri de nang cao chat Idpng cudc sdng cho ngudi benh.
Qua theo ddi qua trinh dieu tri, chung t o i thay d m p t so benh nhan vay nen co m p t sd thay doi ve sinh hda mau n h u tang dUdng mau, tang lipid
• Benh vien Trung dang quan dgi 7 08 '" Benh vien cdng an 198
Phdn biin khoa hgc: PGS.TS Trdn Van Tien
mau, tang enzyme gan, tang acid uric... Trong dd, rdi loan chuyen hda lipid mau la hay gap nhat va da gay rat nhieu k h d khan cho viec Ida chpn phuong phap dieu tri. Do vay, chiing t d i da tien hanh "nghien cdu su thay doi lipid mdu trong benh vay nen thong thudng".
2. D6\ TU'ONG, PHI/ONG PHAP NGHIEN ClJU
2.1.Ddi tddng
Chung toi da nghien cdu tren 3 nhdm ddi tUOng:
- Nhdm benh nhan vay nen t h o n g t h u d n g : 50 benh nhan.
- Nhom benh khac (cung thdi gian dieu trj, cung tudi, cung gidi vdi nhom vay nen): 50 BN.
- Nhdm ngudi khoe (cung tudi, cung gidi vdi n h d m vay nen): 50 ngudi.
2.2. Phuong phap nghien cdu
-Thiet ke nghien cdu; Tien cdu, m d ta cat ngang - Cd mau: Mau thuan tien: Tat ca benh nhan
So 16 (Thang 07/2014) D A L l E U H Q C l 2 3
vay nen t h d n g t h d d n g dieu tri noi tru t d 5/20012 t h u t h a p cac so lieu can thiet, lay m a u xet nghia, den t h a n g 5/2013 va t d d n g dng vdi sd benh da + Nhdm ngddi khoe: t d van, tuyen chon,th khac dieu tri t r o n g t h d i gian do. t h a p cac so lieu can t h i e t va lay m a u xet nghiem.
-Cac budc tien hanh: - C h i tieu d a n h gia ket qua:
-l-Nhdm benh nhan vay nen: t i e p nhan benh + Ket qua xet n g h i e m lipid m a u (Triglyceride nhan, t h u t h a p cac so lieu can thiet, lay mau xet cholesterol, HDL-c, LDL-c) cua 3 n h o m . nghiem. + So sanh ket qua xet n g h i e m lipid mau ci
+ Nhdm benh da khac: tiep nhan, t u y e n c h o n , 3 n h d m .
3. KET QUA
3 . 1 . Dac diem cua 3 nhom
Bang 3.7. So sdnh tuoi, gidi cua 3 nhom
Chi so Tuoi Nam N d PASl
N h d m 1 48,7±4,3 46
4 18,27±8,97
N h o m 2 48,7±4,3
46 4
N h o m 3 47,7±4,1
46 4
P
Plp2>0,05 P2p3>0,05 P3pl>0,05
A//idnxer.Sosanh t u 6 i , g i d i c u a 3 n h d m t h i s d t h a y doi deu khdng c d y nghta t h o n g ke, deu vdi p>0,OS, 3.2. So sanh l<et qua xet nghiem nhom m d cua nhdm 1 va 2
Bdng 3.2. So sdnb ket qud xet ngbiem nbom md cua nhdm Ivd 2
chi
so
Triglycerid Cholesterol
HDL-C LDL-C
Nhom 1 n
50 50 50 50
X ± S D 1,92±1,2S 4,90±1,09 1,05±0,29 2,91 ±0,84
N h o m 2 n
50 50 50 50
5C±SD 1,72±0,90 4,51 ±1,03 1,09±0,27 2,76±0,64
P
>0,05
>0,05
>0,05
>0,05 Nhan xet: Ke\ qua t r u n g binh cac xet n g h i e m n h d m m d (triglycerid, cholesterol, HDL-c va LDL-c) cui 2 n h d m cho thay su thay doi khdng c d y nghla t h o n g ke, deu vdi p>0,05.
24 I DA L i i u HOC
So 16 (Thang 07/2014),3. So s^nh k ^ qui nhom m d cua nhom 1 va 3
Bdng 3.3. So sdnb kit qud nbdm mdcua nbom Ivd 3
NGHIEN CUU KHOA HOC
Chi so
Triglycerid Cholesterol
HDL-C LDL-C
Nhomi
n 50 50 50 50
X ± S D 1,92±1,28 4,90±1,09 1,05±0,29 2,91 ±0,84
Nhom 3
n 50 50 50 50
X ± S D 2,37±1,77 4,21±1,10 1,15±0,57 2,94±0,93
P
>0,05
>0,05
<0,01
>0,05
Nhdn xet: Ndng d p t r u n g blnh triglyceride, cholesterol, LDL-c cua 2 n h d m tUOng dUOng nhau vdi ip>0,05. Rieng HDL-c cua n h d m 3 cao hon n h d m 1 vdi p<0,01, nhung v l n t r o n g gidi han binh t h u d n g 1<1,5 mmol/l).[•
,3.4. So s^nh ket quS n h d m m d cua 3 nhom
Bdng 3.4. So sdnh ket qud nbdm mdcda 3 nhdm QAs6
Triglycerid
Cholesterol
HDL-C
LDL-C
Nhomi (1)
1,92+1,28
4,90+1,09
1,05±0,29
2,91 ±0,84
Nhom 2 (2)
1,72±0,90
4,51 ±1,03
1,09±0,27
2,76±0,64
Nhom 3 (3)
2,30±1,79
4,91 ±1,03
1,15±0,57
2,92±0,89
P P„.„>0,05 P„,„>0,05 P,„,<0,05 P„-»>°.05 P„.3,>0,05 P„.,>0,05 Pi,,2,>0.05 P„„<0.05 p„.„>ao5 P„„>0,05 P„„>0,05 P„„>0,05
Nhdn xet: Tat c^ cac chi sd n h d m m d cua 3 n h d m deu t r o n g gidi han b i n h t h u d n g . Tuy nhien, triglyceride n h d m 3 cao hon n h d m 2 cd y nghia vdi p<0,05 va HDL-c cua n h d m 3 cao hon n h d m 1 cd y nghia thdng ke vdi p<0,01.So 16 (Th^ng07/2014) D A U £ U H O C l 2 5
4. BAN LUAN
4 . 1 . So sanh ket qua nhom m d cua n h o m 1 va 2 Ket qua n h d m m d (triglyceride, cholesterol, HDL-c va LDL-c) tai bang 3.2 cua c h i i n g tdi cho thay gia t r i t r u n g binh cua tat ca cac chi t i e u n h d m m d gida n h d m 1 va n h d m 2 t h i sd t h a y d o i deu k h d n g c6 y nghia t h o n g ke vdi p>0,05.
Theo Cimit va cdng sd-1998, nghien cdu tren 21 benh nhan vay nen (PASt = 165,5 ± 4,4) va 20 n h d m chUng cho thay triglycerid cd tang hon n h d m chdng [2]; theo Orem va cdng sU-1999, nghien cdu tren 33 benh nhan vay nen nhe va 30 n h d m chdng cho thay triglycerid nhdm vay nen tang [5]; theo Rocha va cdng sU-2001, theo Seishima va cdng sU-1994, nghien cdu 28 benh nhan va^ nen PASI>30 va 28 nhdm chUng thi triglycerid nhdm vay nen tang cao [7], Ket qua cua chung toi tai bang 3.2 khdng phii hop vdi ket qua cua cac tac gia tren.Theo Mallbris va cong sU-2004, nghien cdu tren 200 benh nhan vay nen va 248 nhdm chdng thi triglyceride nhdm vay nen tuong dUOng nhdm ddi chdng [4] va theo Piskin va cqng sU-2003, nghien cdu 100 benh nhan vay nen nhe va 100 nhdm chUng thi triglycerid nhdm benh vay nen khdng tang tUOng dUOng nhdm chUng [6].
Ket qua cua chung tdl tai bang 3.2 phu hop vdi ket qua cua hai tac gia Mallbris va Piskin.
Theo Cimit va cong su-1998, cholesterol nhdm benh vay nen tang hon nhdm chdng [2]; theo Orem va cpng sU-1999, 33 benh nhan vay nen nhe va 30 nhdm chdng cho thay cholesterol nhdm vay nen tang rd ret so vdi nhdm chdng [5], theo Piskin va cong SU-2003, nghien cdu 100 benh nhan vay nen nhe va 100 nhdm chdng thi cholesterol n h d m benh vay nen tang cao hdn nhdm chdng [6]. N h u vay, ket qua cua chung tdi khdng phu hop vdi cac tac gia tren.Theo Seishima va cong sd-1994, nghien cdu 28 benh nhan vay nen PAS1>30 va 28 n h d m chdng cho
thay cholesterol n h d m vay nen t d d n g dUdng nhat chUng [7]; theo Mallbris va cdng su-2004, nghienoli, tren 200 benh nhan vay nen va 248 n h d m chdngth cholesterol n h d m vay nen tUong d u o n g nhdm da chUng [4]. Ket qua cua c h u n g tdi tai bang 3.2. phi h d p vdi ket qua cua hai tac gia Mallbris va Piskin. T Theo Seishima va c g n g sU-1994, n g h i e n J I 28 benh nhan vay nen PAS1>30 va 28 n h d m chiing cho t h a y HDL-c n h d m vay n e n t d d n g dUdng nhwn c h d n g [7]; t h e o Piskin va c p n g su'-2003, nghien cilu 100 benh nhan vay nen nhe va 100 n h d m chiJng t h i HDL-c n h d m benh vay nen k h d n g tang tirong d u o n g n h d m c h d n g i;6]. Ket qua cda chOng ttl k h d n g phiJ h d p vdi cac tac gia t r e n . T h e o Cimltva cpng su-1998, nghien cUu t r e n 21 benh nhan vay nen (PAS1=165,5±4,4) va 20 n h d m c h d n g cho thay HDL-c g i a m h o n n h d m c h d n g cd y nghia th6ng ke [2]; t h e o Orem va cpng sU-1999, 33 benh nhan vay nen nhe va 30 n h d m c h d n g cho thay HDL-c n h d m vay nen giam h d n n h d m chUng [5]. Nhi) vay, ket qua cua c h u n g t d i p h u h o p vdi cac tac q\i Cimit, Orem, Rocha la n h d m benh nhan vay nen cd HDL-c giam h d n n h d m c h d n g . Mallbris vacong sU-2004, n g h i e n cUu t r e n 200 b e n h nhan v^yn^i va 248 n h d m c h d n g cho thay HDL-c n h d m vay nen t a n g h o n n h d m d o i c h d n g [4]. Ket qua cua chOng tdi k h d n g p h u h p p vdl ket qua cua Mallbris.
Theo Cimit va cpng sd-1998,21 benh nhanvciy nen va 20 n h d m chdng cho thay LDL-c nhdm benh vay nen t a n g hdn n h d m c h d n g [2]; Piskin va cgng su'-2003, nghien cdu so sanh gida n h d m vay nen va n h d m c h d n g cho thay LDL-c n h d m benh vSy nen t a n g cao h o n n h d m c h d n g [6];Nhuvay,ketquacua chung tdi p h u h p p vdi Cimit, Piskin. Theo Orem va cpng sU-1999, nghien cdu 33 benh nhan vay nen nhe va 30 n h d m chdng cho thay LDL-c nhdm vSy nen tUong dUong n h d m chUng [5]; t h e o Mallbris va cdng su'-2004, nghien cdu tren 200 benh nhar
26 I DA L i i u HOC s6
6.16 (Thang 07/2014)NGHIEN CUU KHOA HOC
'ay nen va 248 n h d m c h d n g thi LDL-c n h d m vay 'ien t u o n g dUdng nhdm doi chdng [4]. Ket qua cua
" h u n g tdi khdng phii hop vdi cac tac gia tren.
;
4.2. So sdnh ket qua n h o m m d cua n h o m 1 va
;ih6m 3
Ket qua tai bang 3.3 cho thay n o n g do t r u n g binh cua triglyceride, cholesterol, LDL-c cua n h d m '1 va 3 thay doi k h d n g cd cd y nghia t h d n g ke deu Vdi p>0,05, cdn n o n g dp t r u n g binh cua HDL-c inhdm 1 t h a p hon n h d m 3 cd y nghla t h d n g ke vdi p<0,01. N h d vay, n h d m benh nhan vay nen cd mong dp HDL-c giam hon n h d m ngddi khoe.
Theo Cimit va cdng sU-1998 [2], Orem va cdng SU-1999 [5], Seishima va cdng sU-1994 [7]
thi triglyceride n h d m benh vay nen deu t a n g cao hon n h d m chdng. N h u vay, ket qua nghien cdu cua c h u n g tdi ve triglyceride k h d n g p h i i hpp vdi ket q u ^ cua cac tac gia tren.Theo Mallbris va cdng sU-2004 [4] thi triglyceride n h d m benh vay nen va n h d m chdng t u o n g d u o n g nhau. Ket qua cua chung t d i p h u h p p vdi hai tac gia tren.
So sanh ndng do cholesterol cua n h d m 1 va 3 tai being 3.3 c h o t h a y sdthay ddi cua 2 n h d m khdng c o y nghTa t h d n g ke vdi p>0,05.Nhuvay, benh vay nen k h d n g lam thay doi ndng dp cholesterol mau.
Theo C i m l t v a cdng sU-1998 [2], Orem va cpng sU- 1999 [5], Piskin va cdng sU-2003 [6] cholesterol n h d m benh nhan vay nen deu tang cao hon nhdm c h U n g . N h d v a y ket qua cua chung tdi k h d n g phu h p p vdi cac tac gia tren. Nhdng theo Seishima va cpng su'-1994 [7] va Mallbris va cpng sU-2004[4] thi ket qu5 cua c h u n g tdi p h u hpp.
So s^nh nong dp HDL-c tat bang 3.3 cua 2 nhdm cho thay sU thay doi cd y nghTa thdng ke vdi p<0,05.
N h u vay, trong benh nhan vay nen cd giam HDL-c nhi^u hdn nhdm ngddi khde.Theo Seishima va cpng SU-1994 [7] vh Piskin v^ cpng sU-2003 [6] thi HDL-c
nhdm benh nhan vay nen tUong dUong nhdm chdng. Ket qua cua chung tdj khdng phu hop vdi cac tac gia tren. Nhdng theo Cimit va cpng sU-1998 [2], Orem va cdng sU-1999 [5] thi HDL-c giam hon so vdi nhdm chdng va ket qua chung tdi phu hpp.
Theo Cimltva cdng sd-l 998 [2], Piskin va cdng sU-2003 [6] deu cho thay LDL-c nhdm benh nhan vay nen tang cao hon nhdm chdng. Nhu vay, ket qua cua chung tdi phu hpp vdi cac tac gia tren la LDL-c nhdm benh vay nen tang cao hon nhdm chdng. Theo Orem va cpng sU-1999 [5] va Mallbris va cpng sd-2004 [4] deu cho thay LDL-c nhdm benh nhan vay nen tddng duong nhdm chdng. Ket qua cua chung tdi khdng phu hpp vdi cac tac gia tren.
4.3. So sanh nhom m d c u a 3 nhom
Tai bang 3.4 cho thay ham luong trung binh cua triglyceride, cholesterol, LDL-c ca 3 nhdm thi sU thay doi khdng cd y nghTa thdng ke deu vdi p>0,05.
Rieng HDL-c cua nhdm 1 giam hon so vdi nhdm 2 va nhdm 3 co y nghia thong ke vdi p<0,01. Nhd vay, ket qua budc dau cho thay d benh nhan vay nen thdng thudng cd giam ham lupng HDL-c. Tuy nhien, de khang dinh ket qua nay thi van phai tiep tuc nghien cUu vdi mau ldn hon va quy m d rdng hon.
5. K I T LUAN
Qua nghien cdu nong dp tipid mau cua 50 benh nhan vay nen t h d n g thddng, 50 benh da khac va 50 ngudi khoe, chung toi cd mpt so ket luan sau:
- Triglycerid, cholesterol, HDL-c va LDL-c cua n h d m benh nhan vay nen t h d n g t h u d n g va n h d m benh da khac la tUong dUong nhau.
-Triglycerid, cholesterol va LDL-c cua nhdm benh nhan vay nen t h o n g t h d d n g va nhom ngudi khoe la t u o n g ddong nhau, nhung HDL-c gi5m hon n h d m ngudi khoe.
So 16 (Thang 07/2014) D A L l 6 U H Q C ] 2 7
NSHIEN COU KHOA HOC
. - • - • • 4
TAI UEU T H A M KHAO
1. Nguyen Xuan Hien, Nguyen Canh Cau, TrUpng Mdc Lpi (1992), "Benh vay n e n " Nha xuat ban Y h p c , 139 trang.
2. Cimsit G., Orem A., Deger et al. (1998), The variation o f serum lipoproein (a) level w i t h disease activity In psoriasis, Br J Dermatol, 138, pp. 917-9.
3. Gudjonsson JE., Elder JT (2008), Psoriasis Fitzpatrick's Dermatology in general Medicine.The M c G r a w - H i l l , Seventh edition, vol 1, pp. 1 6 9 - 1 9 3 . 4. Mallbris L., Akre O., Granath F., et al. (2004), Increased risk for cardiovascular mortality in psoriasis inpatients but not in outpatients, Eur J
Epidemiol, 19, p p . 179-197.
5. Orem A., Cimsit G., Deger O., e t a l . (1999),"nie significance o f autoantibodies against oxidativelj m o d i f i e d low-density lipoprotein (LDL) in patieift w i t h psriasis, G i n Chim Acta, 284, pp.81-8.
6. Piskin S., Gukok F., Ekuklu G., et a!. (2003), Serum lipid levels in psoriasis, Yonsei med J, 44, pp24-6.
7. Seishima M., M o r i S., Noma A. (1994), Serum lipid and apoliprotein levels in patients with psoriasis, Br J Dermatol, 130, pp.738-742.
STUDYTHE CHANGES OF LIPID BLOOD W I T H PSORIASIS VUGARIS
The study of triglyceride, cholesterol, HDL-c and LDL-c o f b l o o d of 3 groups: psoriasis vugaris group w i t h 50 patients, other skin diseses group w i t h 50 patients and healthy person g r o u p w i t h 50 persons.
Results showed that changes o f triglyceride, cholesterol, HDL-c o f 3 groups was no significant difference w i t h p>0,05, but LDL-cof group o f psoriasis vulgaris decreased t h a n healthy person g r o u p .
Keywords: psoriasis vulgaris, triglycerides, cholesterol, HDL-c, LDL-c
