• • TAP CHl NGHIEN CU'U Y HQC
KHAO SAT N 6 N G DO ACID URIC HUY^T THANH dy BENH NHAN DAI THAO DU'aNG TYP 2 CAO TU6l
CO HOI CHU'NG CHUYEN HOA
v o Thj Thanh Huy§n^•^ Hd Trdn H u ' n g \ Dinh Thj Thu Hu-wng'
^Tni&ng Dai hgc Y Ha Npi, ^Binh viin Lao khoa Tmng uang. ^Binh vipn da khoa Phd Nil Nghien cuv nhim khio sat ndng dg acid uric huyit thanh a binh nhin dai thio dwdng typ 2 cao tuoi cd hdi chung chuyen hda. Kit qua cho thiy nong dp acid une huyit thanh tmng binh li 347,9 ± 85,5 pmol/l. ty le tang acid uric huyet thanh a benh nhin dii thio dwdng typ 2 cao tu6i cd hdi chung chuyin hda la 22%
Nhdm binh nhin kiem soil dwang mau a muc tot va chap nhin dwgc cd nong dp axit uric trung binh cao han nhdm kiem soil dwdng miu kim (p < 0,05). Tdm lai. tang acid urie huyit thanh co mdi lien quan vcri beo bung, tang triglycerid, HbAIC. HDL - C vi khdng co moi lien quan vol tang huyit ap va then gian mic bpnh dai thao dudng.
Til khoa: dal thao dipcrng, acid uric h u y l t thanh, hgi chu'ng chuyin hoa
I. DAT VAN oe
Oai thao d u d n g typ 2 la mot benh r l i logn chuyen hda do khang insulin, giam t i l t insulin hodc k i t hpp ca hai Bdnh d y p c dac tru'ng bdi tinh trgng tang giucose mdu vd r l i loan e h u y i n hda cac chdt carbohydrat, protid, lipid. Odi thdo d u d n g typ 2 cd lidn quan d i n cdc b i l n CO tim mach trong dd hdi chu'ng chuyen hda ddng mpt vai trd quan trpng [1], Hdi chu'ng chuyen hda bao gdm mpt nhdm cdc y l u td nguy c a tim mach nhu khang insulin, tdng h u y l t ap, roi logn dung ngp glucose, roi loan lipid mau la v l n d l sfl'c khoe cpng dong. S y pho b i l n eua hpi chi/ng chuyen hoa dang gia tdng tgi Vidt Nam do c h l dp dn gidu chdt beo, nhO'ng bu'a dn thu'a ndng luang vd it hoat dpng t h l lye [2] Acid uric h u y l t thanh la san pham cuoi cflng cua qua trinh chuyen hda purin d n g u d i . Cde
Dia chi lien h$- VQ Tht Thanh Huyen. BQ mon Ndi tdng hgp. Tmtmg Dai hoc Y H^ N^i
Email [email protected] Ngay nhan- 23/3/2015 Ngay duac chip thuan 31/5/2015
nghien c d u dieh t l t r u d c ddy dd ehdng minh s u tdng acid uric h u y l t thanh gdn l i l n vdi tdng nguy co h u y l t dp cao, bdnh tim mgch [1] va bdnh than man tinh [2] Tdng n l n g do acid uric h u y l t thanh cdn la y l u t l nguy ea d i n d i n benh dpng maeh ngogi vi [3]. Nhidu bdng chfl'ng cho thdy acid une h u y l t thanh cd t h l cd vai trd quan trong trong sinh bgnh hpe cua hdi chfl'ng chuyen hda va dai thdo dudng [4; 5], Mpt s l nghien c d u g i n day chi ra rdng acid uric h u y l t thanh cd t h l dong vai trd nhdn qua trong s u phdt tnen cfla hoi chdng chuyen hda vd giam n l n g do acid uric huyet thanh cd t h l ngdn chdn hoac ldm dao ngypc cac thdnh p h l n cua hdi chfl'ng chuyen hda [3 - 5], Tai Viet Nam, cae nghien cu'u v l m l i hen quan giu'a acid uric h u y l t thanh vd hdi chfl'ng c h u y i n hda thuc hidn trdn d l i tupng ddi thao d y d n g typ 2 edn khd khidm t i n [6], ddc bidt trdn d l l t u a n g n g u d i cao tuoi. Chinh vl vdy nghidn c d u ndy d y p c t h y c hidn vdi muc tidu khao sdt nong do acid uric huylt thanh d benh nhan dai thdo dudng typ 2 cao tuoi cd hoi ehdng chuyen hda
TAP CHi NGHIEN CU'U Y HQC -
II. D 6 | TU'gNG VA PHU'ONG PHAP
1. Ddi t u v n g
Doi tuang nghien cdu Id bdnh nhdn khdm va dieu tn ngoai trfl tai khoa Khdm bdnh - Bdnh vien Ldo khoa Trung uang tu' thdng 1/2014 d i n thdng 9/2014
Tieu chuan chgn benh nhan: Cdc bdnh nhdn tfl" 60 tuoi trd len d y a c chan dodn ddi thao dudng typ 2 cd hpi chdng chuyen hda, Chan doan ddi thao dudng theo tieu chuan cua Higp hdi dai thdo dydng Hoa Ky (ADA) 2012, chan doan hpi chdng chuyen hda theo tieu chuan cfla NCEP - ATP 111 (2005) danh cho ngu'di chau A [7]. K i t qua kiem soat du'dng mau d y p c ddnh gid d y a theo k h u y i n cdo muc tidu kiem sodt du'dng mdu cfla ADA 2012 ddnh cho ngydi cao tuoi [8]: t i t < 7,5%, ehdp nhdn du'ae- 7,5 - 8,5%, kem > 8.5%
Tieu chuan loai benh nhan: Benh nhdn mdc cde bdnh nhy hpi chijng Cushing, c y d n g gidp. suy gidp, ddi thdo nhat, gout, nhidm khuan ndng, benh cdp tinh, cae bdnh mau dc tinh, nghien ru'ou, hodc dang d i l u tn t h u l c ldm thay doi n l n g dd acid uric nhu- thuoc lai tieu, eyclosporine hoac buoi t l i trydc hom xet nghiem dn thflc Sn gidu purin (ham luang punn khoang 150 - 1000 mg purin m i l 100 g thuc pham) nhu' thit gd, chim cut. thd, thit thfl rirng, phu tang dpng vat vd cdc thyc pham tfl' npi tang dpng vat (pa td gan, xuc xich.,,). Cdc san pham tfl' thit idn men: nem chua, trdng cd:
triJng cd tuyet, triJng cd muoi, so didp, cd trich, cd thu, ea h l i , tdm eang, tdm hflm, cd earn, cd mdi
2. P h y a n g phap
Thiet ke nghien CLFU: md ta cdt ngang C d mdu: dp dung cdng thde
(Zi.<.z)=' p x ( l - p )
Vdi 2,^2= 1.96; p= 0,25 [4]; d = 0,04 thi n 5 450. Nghidn cfl'u ndy d u a c thue hidn trdn 551 bgnh nhdn.
Phuo'ng phap tien hSnh
Bdnh nhdn d u a c hdi tien si>, khdm Idm sdng theo mdu bdnh dn thong n h i t Cdc xet nghiem d u p c t h y c hidn vao buoi sdng sau 8h
•:• lOh nhin ddi.
CSc bien so nghien ciru: Thdng tin chung v l d l i tuang vd chi so nhdn Irdc hpe: tuoi, gidi, thdi gian phdt hidn bgnh, tidn su' sfl' dung eac t h u l c dieu tri ddi thdo dudng, chidu cao, cdn nang, vdng bung, chi s l k h l i ca the (BMI) Cdc bdnh ly phdi hap- r l i loan lipid mdu, tdng h u y l t dp. Xdt nghidm can lam sdng xdt nghiem mdu: acid uric, ure, creatinin, GPT, GOT, dudng mdu Iflc ddi, HbAic, bilan lipid mau cholesterol todn p h l n , tnglycend, L D L - Cholesterol, HDL - Cholesterol. Tdng acid uric h u y l t thanh du'pc xdc djnh khi aeid une h u y l t thanh > 416 \imo\l\ a nam vd > 399 pmol/l d nu- [5].
3. Xu' ly s d lieu
Cac so heu dupe xfl" ly va phan tieh bdng phdn mem t h i n g kd y hpc SPSS 1 6 0 Sfl' dung cac thudt todn. tinh ty le p h l n tram, tinh gid tri trung binh. Sfl' dung test -^ de phdn tich m i l lien quan giO'a cac b i l n S y khde bidt c6 y nghta thong ke khi p < 0,05.
4. Dao dfl'c nghien cu'u
Tdt ca cdc doi t u a n g trong nghidn cfl'u deu t u nguygn ky giay dong y tham gia Cae thdng tin cua bdnh nhan deu d u a c bao mat va ctii phuc vu eho muc tieu nghidn ciJu
• TAP CHi N G H l i N cO'U Y HQC
III. K^T QUA
I . D a c d i l m c h u n g
T i n g sd 551 bdnh nhdn ddi thdo dudng typ 2 tLF 60 tuoi t r d Idn cd hdi chung chuyen hda d y a c tuyen chpn vao nghidn cfl'u tuoi trung binh Id 70,7 + 6,8, nhdm tuoi 60 - 69 c h i l m ty Id cao nhat 47%. nhdm tuoi tu' 80 tuoi trd ldn chiem ty Id thap nhdt 12%. Ty lg bdnh nhdn nu' c h i l m 65,7% cao han nam ( c h i l m
34,3%), ty Id nam nu' Id 0.52 Ndng dd acid uric h u y l t thanh trung blnh cua cde bdnh nhan Id 347,9 ± 85,5 pmol/l. trong dd c6 121/551 bdnh nhdn cd tdng acid urie h u y l t thanh, c h i l m ty Id 22%.
2. A c i d uric h u y l t t h a n h va dai thao du'dng
Moi lien quan giO'a th&i gian mac dai thao die&ng va nong dg acid uric huyet thanh
B a n g 1. T h d i gian mdc dai thdo du'd'ng va ndng d p acid uric h u y l t t h a n h T h d i gian mdc dai t h a o d u d ' n g n ( n - 5 5 1 ) A U H T T B (pmot/l)
< 5 ndm 349,9 ± 82,9
353,5 ± 82.6
Nhdm bgnh nhdn cd thdi gian mdc ddi thdo dudng tren 10 nam c6 acid une h u y l t thanh trung binh cao han cdc nhdm khac Tuy nhien s u khde bidt giO'a cdc nhdm Id khdng cd y nghTa t h i n g kd (p > 0,05).
Moi lien quan giira dw&ng mau iuc doi va nong dd acid uric huyet thanh Bang 2. D u ' d n g mau luc ddi va n d n g dp acid uric huydt t h a n h
Kidm s o a t ducmg m a u Du'dng mauTB
A U H T T B ( M m o l / l ) ( X ± S D ) Tot (5,5 - 7,2 mmol/l)
Chap nhan diFO'c (7,3 -10mmol/l) 251 198
6,1 ± 0 , 7 8,4 ± 0 , 8
357,2 ± 87,8 340,4 + 86,3 K e m ( > 10 mmol/l)
Nhdm bdnh nhdn k i l m sodt dudng mdu lflc ddi d mijc tot va chap nhdn d u a c cd nong dp acid uric trung binh cao han nhdm kiem sodt dudng mau kdm. S u khdc biet ve gid tn trung binh d cdc nhdm khdng cd y nghTa thong ke.
TAP CHi NGHIEN CLPU Y HOC •
Moi lien quan giira HbAle va nong dp aeid uric huyet thanh
Bang 3. Lien quan giOa H b A l e vd n d n g dp acid uric h u y l t t h a n h t r u n g binh
Kiem sodt H b A l e n = 527 HbAICxs A U H t a (pmol/l) p
Tot vd chap nhgn d u p c 423 6,74 ± 0,9 353,3 + 89.9
<0,05 Kdm (HbAIC > 8,5%) 104 9,67 ± 0.9 330,14 + 63,9
Nhdm k i l m sodt HbAIC d mfl'c t i t vd chap nhdn du'ae ed nong dd axit uric trung binh cao hon nhdm cd H b A l e kiem soat kem S y khac bigt giu'a cdc nhdm cd y nghTa thong kd, p < 0,05.
Lien quan giira cSc thinh phan cua hgi chimg chuyen hoa va nong dg acid uric huyit thanh trung-binh
Bang 4. Lien quan giira cac thanh phdn cua hpi e h i r n g c h u y i n hda v d n d n g d o acid uric huydt t h a n h t r u n g b i n h
Bien so TSng huy§t ap Khong tSng huyet Sp B6o bung Khong beo bung TSng Triglycerid Tngiycend binh thu'ong Giam H D L - C HDL - C blnh thuo'ng
n 490
61 325 226 309 240 334 215
A U H T T B (pmol/l) ( X ± SD) 350,35 ± 8 7 , 2 328,21 ± 6 8 , 0 354,48 ± 79,2 337,75 + 91.2 355,75 ± 84.9 337,12 ± 85.0 353.59 ± 86.5 338.31 ± 8 3 . 1
P
Co s y khac biet v l n l n g dd acid une trung binh giO'a nhdm beo bung vd nhdm cd vdng bung blnh thydng- Nong dp acid uric h u y l t thanh tnjng binh cua nhdm tdng triglycerid vd nhdm giam HDL - C deu cao han nhdm tnglycend vd HDL - C binh thudng. Nong 66 acid uric h u y l t thanh trung blnh cua nhdm cd tdng h u y l t dp cao han nhdm khdng tdng h u y l t ap nhung s u khac biet giO'a cdc nhdm Id khdng c6 y nghta t h i n g ke (p> 0,05)
• TAP CHi NGHI§N CU'U Y HQC M6i lien quan gii^a cSc thanh phan cua hdi chung ehuyen hoa vS cac mCre nong dg acid uric huyet thanh
Bang 5. M d i lien quan giiPa cac t h a n h phdn cua hpi chfl'ng ehuydn hda va cSc mu'c n d n g do acid uric h u y l t thanh
Vong bung (cm) Triglycerid
HL C (mmol/l) D u a n g mciu doi
N h o m Q1 (< 236pmol/l)
82.46 ± 7 . 0 1.83 ± 1.03 1.25 + 0,31 8,2 ± 2 , 8
Nhom Q2 (286 - 345 pmol/l) 84,9 ± 7 . 1 2.55 ± 2.86 1.16 ± 0 . 2 8 8.5 ± 2 . 9
Nhom 0 3 (345,1 - 396
pmol/l) 84.9 ± 7 . 4 2 , 1 7 ± 1 . 5 6 1.12 ± 0 . 2 6
8.1 ± 3 . 7
Nh6m Q4 (> 396pmol/l)
86.2 ± 7.4 2.49 ± 2 . 0 1 1.10 ± 0 . 2 4 8,0 ± 2 . 9
P
< 0.001
<0.05
< 0.001
>0.05
Khi so sdnh vdi tu" phdn vj thu- n h i t cua gia tn acid uric, nong dp acid uric h u y l t thanh c6 m l i lien quan vdi vdng bung, triglycerid vd HDL - C (p > 0.05). Khdng ed m l i lidn quan giua dudng mau lflc ddi vd acid uric huydt thanh (p > 0,05),
IV. BAN LUAN
K i t qua nghidn c d u cho thdy ndng do acid uric trung blnh Id 347,9 ± 85,5 pmol/l vd ty Id tang acid uric h u y l t thanh d benh nhdn dai thao d u d n g typ 2 cao tuoi cd hpi chfl'ng ehuyen hda la 2 2 % . Huynh Ngoc Linh va cdng s y (2012) [6] nghidn cu'u ty le tang acid uric h u y l t thanh d bgnh nhdn trdn 35 tuoi d i l u trj tai bdnh vidn da khoa thdnh p h i Ca lyiau thdy acid uric trung blnh Id 413.08 ± 57,89 pmol/l,
Oa sd bdnh nhdn cd thdi gian mdc bdnh Id trdn 5 ndm. c h i l m tdi 60,6% tong s l benh nhdn K i t qua nghien cfl'u thay nhdm bdnh nhdn n l n g 66 acid uric huyet thanh a cac bdnh nhdn cd thdi gtan mdc ddi thdo d y d n g d u d i 5 ndm Id 349,9 + 82.9 [jmol/1, trdn 10 nam la 353,5 ± 82,6 [jmot/t, nhdm c6 thdi gian mdc bdnh tren 10 ndm cd acid uric h u y l t thanh trung binh cao han cac nhdm khdc tuy nhidn s y khdc bidt giO'a cdc nhdm Id khdng cd
^ nghTa t h i n g kd, Cd t h l ndi thdi gian mdc ddi thdo dudng typ 2 d benh nhdn cao tuoi cd hdi chfl'ng chuyen hda khdng lien quan tdi n l n g dp acid une h u y l t thanh K i t qua eua chflng tdi tuong t y nhy k i t qua nghidn cu'u cfla tdc gia Shokoofeh Bonakdaran va cpng s u (2011) nghien cdu trdn 1275 bdnh nhdn ddi thdo d y d n g cho thay khdng cd m l i hdn quan giua thdi gian mdc bgnh dai thdo dudng vd nong do acid uric huyet thanh [3] Nhu vdy, thdi gian mdc ddi thdo dudng cd the khdng chiu nhilu anh hydng cua nong do acid une huyet thanh. Dieu ndy cd the ly giai do acid une h u y l t thanh tdng n h i l u ndm trudc khi bdnh nhdn d u a c chan dodn
Nong dp acid uric h u y l t thanh trung binh cua nhdm benh nhdn c6 kiem sodt dudng mdu ddi tot td 357,2 + 87,8 pmol/l cao hon so vdi nhdm k i l m sodt dudng mdu ddi d mdc c h i p nh^n d y p c (340,4 + 86,3 Mmol/t) vd nhdm k i l m sodt dudng mdu ddi kem (339,6 ±
TAP CHi NGHIEN c O U Y HQC • 76,5 Mmol/l), tuy nhidn s y khdc bidt giu-a cdc nhdm khdng c6 y nghTa t h i n g kd vdi p > 0,05.
Phai chdng n l n g dd dudng mdu cao khdng anh hu'dng gl d i n nong dd acid uric h u y l t thanh? Trdn t h l gidi nghidn cfl'u v l van d l nay cdn nhieu tranh cai nhu nghidn cfl'u cfla tac gia Anthonia Ogbera vd cdng su' (2010) tien hdnh tgi Nigeria tren 601 bdnh nhdn ddi thao dudng typ 2 t h i y rdng nong dp acid uric huylt thanh va dydng mdu lflc ddi khdng cd su hdn quan vdi nhau vdi r = 0,001, p = 0,08 [8]- Shokoofeh Bonakdaran vd cdng s y (2014) khi nghien ciJu m l i quan hd giOa n l n g dp cao acid uric h u y l t thanh vd hdi chfl'ng c h u y i n hda a 1978 bdnh nhdn ddi thdo dudng typ 2 tgi Iran cung t h i y c6 moi lien quan nghjeh giu'a nong dd acid uric h u y l t thanh vdi dudng huylt lflc ddi [10]. Co the thdy ed n h i l u nghidn cfl'u cho k i t qua khdc nhau v l m l i hen quan giu'a tdng dudng mau vd n l n g dd acid uric huylt thanh, tuy nhien nhu'ng nghidn cfl'u gdn day nhdt da s6 cho rdng vide tdng dudng mdu cd m l i lien quan nghjeh vdi nong dp acid uric huylt thanh. K i t qua cua chflng tdi tuy nong do acid uric huyet thanh d nhdm k i l m sodt dydng mdu tot cao hon nhur>g s y khdc bidt khdng co y nghTa thong ke, dieu ndy cd t h l Id do nghien cfl'u chi ddnh gid du'ae m l i hdn quan giu'a nong dd d y d n g mdu do tai mdt thdi d i l m vdi nong dp acid uric h u y l t thanh, nhy vdy dudng mdu tflc ddi cung chua phan dnh mpt edch chinh xdc nong d | dydng mau thudng xuydn cfla ngudi bdnh.
HbAIC phan dnh nong dd dudng huyet trong mpt khoang thai gian, 2 - 3 thdng, nd eung td m^t trong nhO'ng muc tieu d i l u tri bdnh dai thdo dydng K i t qua nghien ciiu cho t h i y n l n g dd acid uric h u y l t thanh trung binh cua nhdm kiem sodt HbAIC t i t vd c h i p nhdn duoe cao han nhdm k i l m sodt HbAIC kdm (p < 0,05), K i t qua ndy cua chflng tdi cung
tuang t u vdi nghidn c d u cua Shokoofeh Bonakdaran vd cdng s y (2014) nghidn cflu m i l quan hd giu'a nong dp cao acid uric h u ^ thanh vd bdi chfl'ng c h u y i n hda d bdnh nhdn ddi thdo dudng typ 2 tai Iran cung cho thiy cd m l i lien quan nghjeh giu'a nong 66 acid uric h u y l t thanh vd H b A I C [10] Oe giai thich dieu ndy n h i l u nghien cfl'u dd chung minh nong dp acid une d benh nhdn ddi thdo dudng type 2 t h i p han d nhO'ng n g y d i khdng bj ddi thdo dudng [11; 12] hogc ngay trong nhO'ng bdnh nhdn ddi thdo d u d n g thi nhdm cd dudng mdu cao iai cd n l n g dd acid uric h u y l t thanh thap han nhdm kiem sodt d u d n g mau chdt che [5;
10]. Ly do d y p c dua ra thiJ nhat Id do lupng dydng mdu d bdnh nhdn ddi thdo dudng gop phan tang bdi tiet acid uric d than. Thfl' hai Id s y ddp fl'ng vidm efla dai thdo dudng cd vai trd bao vd. Mdt khdc, tdng acid urie huyet thanh da ducec c h d n g minh gay ra r l i loan chu'c ndng ndi md vd giam san x u l t aeid nitric. Giam acid nitric cd the Idm giam insulin - kich thich d u d n g di vdo trong co x y o n g , gdp phan vdo s y de khdng insulin va gdy ddi thdo d u d n g . Ngoai ra, tang aeid uric h u y l t thanh cd lien quan d i n s y oxy hda - d i l u nay ddng mpt vai trd quan trpng trong bdnh sinh cfla dai thdo dudng typ 2 Trong m i l quan he nhdn qua nay thyc chat khd c6 the xdc djnh d u p c y l u t l ndo la nguydn nhdn.
y l u to ndo Id k i t qua.
Nhdm bgnh nhdn tdng h u y l t dp cd nlng do acid une h u y l t thanh trung binh Id 350,35 ± 87,2 pmol/l cao han nhdm khdng tdng huydt dp Id 328,21 ± 68,0 pmol/l, tuy nhidn s u khdc bigt giu'a hai nhdm khdng cd y nghTa thing ke vdi. Nghien c d u cfla chflng tdi cflng thiy cd m i l hen quan giu'a triglycerid, HDL - C vd beo bgng vdi nong 66 acid uric h u y l t thanh.
Nhdm bdnh nhdn bdo bung cd nong dp acid uric h u y l t thanh trung blnh cao hon nhdm co
• TAP CHi NGHIEN CI>U Y HQC vdng byng binh thu'dng. N l n g dd axit uric
h u y l t thanh trung binh cfla nhdm tdng triglycerid vd nhdm giam HDL - C deu cao han nhdm tnglycerid vd HDL - C blnh t h y d n g . S y khdc bidt giO'a cdc nhdm Id cd y nghTa t h i n g kd. Nhu-ng ngudi cd acid uric d tfl' phdn vi eao n h i t cd nguy c a cd n h i l u y l u td trong thdnh phan cua hOi c h y n g chuyen hda hon so vdi nhO'ng ngudi cd acid uric d tfl- phdn vi thap nhit. Rd rdng tang huyet dp c6 m l i hen quan chat che vdi tang acid uric h u y l t thanh. C a c h l d u a c biet den bao gom gidm luu luang mdu thdn (mfl'c Ipc c l u thdn giam) kich thich tdi h i p thu urat, ton t h u a n g vi mgch ddn d i n t h i l u mau cue bd, t h i l u mdu cue bp cd lien quan d i n tdng san xuat lactat gdy ngdn t i l t urat d dng tuan gdn vd tdng tong hap acid uric do tdng phdn hfly RNA - DNA vd tdng purin trao doi c h i t , lam tang acid une va cdc phan u-ng oxy hda thdng qua anh hudng cua xanthine oxidase, t h i l u mdu cue bd gdy ra tdng san xudt xanthine oxidase va tang acid une h u y l t thanh vd tang cdc phan u'ng oxi hoa. K i t qua trong nghien ci>u nay tuy n l n g dp acid uric h u y l t thanh d nhdm tdng h u y l t dp cao han nhdm khdng tang h u y l t ap nhung s y khdc bidt khdng cd y nghTa t h i n g ke cd t h l do doi t u a n g cua chflng tdi Id nhO'ng ngu'di cao tuoi, tdng h u y l t dp lau ndm, t h u l c ha ap hay dflng Id nhdm fl'c c h l men c h u y i n . chen thu t h l Angiotensin, chen kdnh canxi, dc c h l beta giao cam, i j c c h l alpha, cac thudc ndy it nhilu cd anh h y d n g tdi n l n g dd acid une
Acid uric h u y l t thanh ddng vai tro quan trong trong hdi chdng chuyen hda, Tuy nhidn, ca che c a ban cua m l i quan he ndy vdn chya d u a c b i l t rd mdc du dd cd n h i l u nghidn cfl'u dd d y p c thyc hi$n trong Unh v y c ndy Nghidn ciJu gan ddy chi ra rdng tang acid uric h u y l t thanh cd t h l chiu trdch nhidm mdt phan cho s u mdt can bdng ndi t i l t t i l n viem trong cac te
bdo ca tran mach mdu vd md m d . Id mdt c a che ca ban cfla tinh trang viem cap vd khdng insulin d nhO'ng ngudi c6 bdnh tim mgch vd hpi chyng chuyen hda Giam acid uric d chudt bdng allopunnol cd t h l cai thign s y mdt edn bdng n|i t i l t t i l n viem trong mo m d bdng cdeh giam san x u l t monocyte chemoattractant protein-1 (MCP-1) vd tdng san luang cua adiponectin Ngodi ra, giam san xuat acid uric trong chudt bdo phi Idm giam xam nhdp dgi thuc bdo trong cdc md m d vd giam de khdng insulin, Cd t h l s y de khang insulin Id ca c h l sinh ly bgnh eho m i l quan he ndy [5]
V. K£T LUAN
Tdm tgi. nghidn c d u da cho thdy n l n g dd acid une huyet thanh cd m l i lidn quan vdi H b A I C , beo bung, triglycerid, HDL - C, vd khdng cd m l i hen quan vdi tang h u y l t dp, thdi gian mdc bdnh dai thdo du'dng, n l n g dd d y d n g mau tuc ddi. N l u tdc dung ed lpi cua d i l u tri ha aeid uric huyet thanh t h i p cd t h l d y a c xdc nhdn bdi cdc nghidn c y u lam sdng trong t y a n g tai thl do nong dd acid une h u y l t thanh d bdnh nhdn ddi thao d y d n g typ 2 se giflp bdc sy ed chidn luac d i l u tri hap li-
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Nhdm nghidn ci>u tran trpng cam an Ban gidm doe va eac phdng ban Benh vien Ldo khoa Trung u a n g dd tao didu kien giup d d trpng qud trinh nghidn cu'u
TAI LIEU THAM KHAO
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Summary
EVALUATION OF SERUM URIC ACID LEVELS IN ELDERLY TYPE 2 DIABETIC PATIENTS WITH METABOLIC
SYNDROME
The purpose of this study was to evaluate serum une acid concentrations in elderiy type 2 diabetic patients with metabolic syndrome. The results showed that the mean concentration of serum acid uric was 347.9 ± 8 5 5 pmol/l, the rate of hyperuricemia in elderly type 2 diabetic patients with metabolic syndrome was 22%. Patients with good and acceptable levels of glyeemlc control had higher levels of serum uric acid than those with poor glycemic control (p < 0.05) There was correlation between serum une acid concentration and abdominai obesity, triglycerides, HbAIC, and HDL-C. There was no association between serum uric aeid concentra- tion and hypertension, duration of diabetes, and fasting blood glucose levels
Keywords: diabetes, serum uric acid, metabolic syndrome
56 TCNCYH 94 (2) - 2015
