Tgp cbl YDuvc hgc - Tru&ng Bgi hqc Y Dugc Hui- Tgp 6, so 4 - thdng 8/2Q16
LIEN QUAN Gt&A C H I SO BMI VPI MOT SO DAC DIEM LAM SANG VA CAN LAM SANG CilA BENH LAO PHOI VA SU THAY o6\
CHi SO BMI SAU 1 THANG DIEU TRj
Duang Quang Tuan, Tran Hiing, Nguyin Minh Tam Tru&ng Dgi hgc Y Duuc Hue - Bgi hgc Hue Tdm tat
B|t van de; Benh lao hign nay van l i mdt van de s&c khde toan cau, ty lg mac lao dang cd xu hudng giam dan nhyng ty Ig t& vong do lao van cdn khi cao. Chi sd khdi ca the - Body Mass Index (BMI) l i mpt thdng sd quan trpng dinh gia tinh trgng nhilm trimg mgn va tinh trang dinh dudng ciia bgnh nhin lao. Mdi Men quan gl&a suy dinh dudng va lao da duae nghien c&u t& lau nhu'ng vin cdn rat it nghign c&u dapc tiln hinh b Vigt Nam. Myc tieu: (1) Tim hliu mdi lien quan gi&a chi sd BMI vdi mpt sd dgc diem lam sang v i cin lim sing eiia benh lao phdi; (2) Khao sit sy thay ddi ve chi sd BMI eua bgnh nhan lao phdi sau 1 thing dieu tri Phypng phip: Nghien e&u tien c&u dupe thye hign tren 101 benh nhan dupe chan doin lao phdi dang dieu tri tgi Khoa Lao, Bgnh vien Trung UPng Hue trong khoang thdi gian t& 04/2014 din 04/2015. Ket qua: Yeu td gidi v i thdi gian mac bgnh lien quan mgt t h i l t tpi chi sd BMI ciia benh nhan Phan ldn cic trudng hpp nghien e&u la Lao phdi AFB {-) chilm 68,3% va dac diem tdn thuang thudng ggp la tdn thuong khdng ed hang va tdn thuang dp 1 theo ATS. Nghign c&u cung da eho thay sy thay ddi dang ke ve chi sd BMI ciia benh nhan sau dieu trj 1 thing theo phac dd.
Tir khda: chisoBMI, thay doi BMI, lao phdi Abstract
RELATIONSHIP OF BMI AND CLINICAL AND LABORATORY CHARACTERISTICS OF PATIENTS WITH TUBERCULOSIS AND
CHANGES IN BMI AFTER 1-MONTH TREATMENT
Duong Quang Tuan, Tran Hung, Nguyen Mmh Tam Hue University of Medicine and Pharmacy - Hue University Background: Tuberculosis (TB) remains a common disease globally. Even though the incidence rate of TB infection has decreased, mortality caused by TB cases is still high. Body mass index (BMI) is a popular and useful index to evaluate the nutrition status, and lower BMI is strongly associated with higher mortality. In Vietnam, how/ever, the relationship between BMI and elinieal and laboratary characteristics in paHents with TB has not been extensively studied. Objectives: (1) To investigate the association of BMI and clinical and laboratory aspects in patients with TB, (2) To figure out changes in BMI of patients with TB after 1-month treatment. Method: All adults over 18 years old with TB who admitted to the Department of Tuberculosis of the Thua Thien Hue Central Hospital, were included in a prospective study from 4/2014 to 4/2015. Results:
Gender and durati'on of TB were closely related to BMI of patients. The majority of participants had negative sputum AFB with level (-), at 68.3% and the common TB lesions didn't have cavitary lesions on the chest X-ray and at grade I of ATS. The study also showed a significant change in BMI of participants after one month of treatment.
Key words: BMI, changes in BMI, pulmonary tuberculosis
1. OAT VAN OE
Bgnh lao hien nay vin la mpt van de s&c khde (ty Ig mae lao 2013 giam 41% so vdi nam 1993) toan cau, ty Ig mic lao dang cd xu hudng giam dan nhung ty lg t& vong do lao vin la mgt trong nh&ng
Tgp chi Y Dugc hgc - Tru&ng Ogi hgc Y Duvc H •-Tgp 6, SI
nguyen nhan gay t& vong hing dau t h i gidi [5, 20].
Vigt Nam xip th& 12 trong 22 qudc gia ed ginh ngng ve bgnh lao cao nhat tren toan clu vdi ti Ig hign mac lao l i 190 000 ngudi, mic mdi la 130.000 ngudi, 17.000 t& vgng do lao [20]. Trong do, lao phdi la the lao phd bien nhit d ngudi Idn, ehiem 80% sd bgnh lao, dge biet nh&ng bgnh nhin bi lao phdi ed AFB duang tinh trong dam la ngudn liy chinh trong bgnh lao.
Mdi lien quan gi&a lao va tinh trang dinh duo'ng da dyoc de cgp rgng rai tren toan t h i gidi; lao cd t h i dan tdi suy dinh dud'ng va suy dmh dudng cd the dua tdi benh lao [11]. Theo nhieu nghign c&u, iao dl song hanh vdi suy dinh dudng ddi vdi nh&ng bgnh nhin nhap vign, trong ca cac nudc phat trien v i dang phit trien [2], [13], [16], [8]. Lao va suy dinh duo'ng tao thanh mot vdng luin quan lim cho dieu tri lao kem higu qua, gia tang phan &ng phy thudc khing lao, gia tang nguy cP t& vong do lao. Hiiu biit ehi sd khdi ea the - Body Mass Index (BMI), mdt thdng sd quan trpng danh gii tinh trgng nhilm trimg man va tinh trgng dinh dudng eiia bgnh nhin, khdng nh&ng giup phdng ng&a va lam giam nhilu biln ch&ng eiia benh ma edn ed the du'a ra k l hoach cy the ve dinh dud'ng trong qui trinh dilu trj [40], tyng budc ning cao chit lupng dilu trj. Do do chiing tdi tiln hinh de tai "Liin guan giii'a chisd BMI v&i m^t so dqc diim lam sdng vd cqn ldm sdng cdo binh lao phdi vd sq' thay ddi cbi so BMI sau 1 thdng ddu tri" vdi 2 myc ti'lu:
1. Tim hieu moi lien quan gida chl sd BMI v&i mdt sodgc diem Idm sdng va cgn lam sdng cua binh nhdn lao phoi.
2. Khda sdt su- thay doi ve chl sd BMI cua binh nhdn lao ph6i sau 1 thdng dieu tri.
2. OOI Tl/gWG vk PHirffNG PHAP NGHIEN CCTU Z.l. Thd'i gian nghign c&u v i dja diem nghien c&u: Nghien e&u dupe tien hinh t& 04/2014 den 04/2015 tgi khoa Lao - Bgnh vign Trung yang Hue.
2.2. Ddi ti/png nghien c&u: Cic bgnh nhan t y 18 tudi trd lgn, dupc chan doin xie djnh lao phdi, dieu trj tai Khoa Lao-Bgnh vien Trung uang Hue
Tiiu chudn li/a chqn:
Benh nhan t& 18 tudi trd len, dypc chan doan lao phdi theo tieu chuan eua chuang trinh ehdng lao qude gia va VifHO. Do thdi gian nudi eay dai va xet nghigm nudi eay chua dupc lam thudng quy ngn chimg tdi ehpn bgnh nhan theo tigu ehuin sau:
- Lao phdi AFB duang ti'nh: phai ed 2 tigu ban AFB duang ti'nh t& 2 miu dam khac nhau hoge 1 I 78 lOURNAlOFMEDlClNE AND PHARMACY
tieu ban AFB duang ti'nh kem theo hinh anh Xquang phdi nghi lao
- Lao phdi AFB am ti'nh: Xet nghigm dam AFB am ti'nh it nhit 6 miu khic nhau qua 2 lan kham each nhau 2 tuan, ed tdn thuang nghi lao trgn Xquang phdi va khdng d i p &ng vdi dieu tr] khang sinh pho rpng sau 10 -15 ngay.
- Lao phdi tai phat. bgnh nhan da dieu tri lao, dupc thiy thudc xic djnh la khdi hay hoan thanh dieu tri nay mae bgnh trd Igi vdi AFB(+) trong dim.
Tiiu chudn logi trir:
- Ddi tupng dudi 18 tudi
- Cie bgnh nhan trude khi vao khoa Lao da dypc chin doin v i dang dilu tq lao phdi khdng dung theo quy djnh cua CTCLQG.
- Bgnh nhan dang dieu trj bgnh lao phdi theo chl dp dilu tri ngogi trd, vio vign vi tie dyng phy eiia thude khang sinh ch&a bgnh lao.
- Cic bgnh nhin cd cic bgnh nhilm triing khae kem theo.
- Bgnh nhan t& ehdi tham gia nghign c&u.
2.3. Thiet ke nghign c&u: Nghign e&u tiln c&u 2.4. C& m l u : Trong thdi gian ti'en hanh nghien e&u, t& 04/2014 d i n 04/2015, chung tdi da thu thap dupc 101 trudng hpp lao phdi dip &ng vdi eae tieu chuan lya chpn eua nghien c&u.
2.5. Phu'ang phap tien hinh nghiin c&u odi typng nghien e&u se dupc phdng van v l cac dgc dilm lam sing ciia bgnh dya tren bp cdng cy soan sin v i tham kham lam sang. Cae dac diem cgn lim sang ciia ddi tupng nghien e&u du(i/c ghi nhgn t& k i t qua cgn lam sang, ho sa luu tr& eiia Khoa Lao, Bgnh vign Trung yang Hue. Cac bien ve chilu cao, ein nang dupc thu thgp d 2 thPi diem, trude khi dilu tri v i 1 thing sau dieu tn.
2.6. Xir ly v i phan tich so ligu: Cic kit qua thu dupe s l dupc xir ly theo phuang phip thing ke y hpc t r i n cae phan mem EXCEL 2010, Medcalc 12.5.0.
3. KET QUA
Trong thdi gian tiln hinh nghien c&u, t&
04/2014 d i n 04/2015, chdng tdi da tien hanh nghiin c&u 101 trydng hpp lao phoi, dupe dilu tri tgi khoa Lao - Bgnh vign Trung uang Hue, 69 bgnh nhan la nam (68,30%), sd bgnh nhin n& la 32. Tudi trung binh la 51,66+17,31, 50,74±16,22 ddi vdi nam va 53,66 ± 19,58 ddi vdi n& (p=0,44). 32 bgnh nhan lao phdi AFB (+) (31,68%), 69 bgnh nhan lao phdi AFB (-)
Tgp chi Y Duvc bgc - Tru&ng Dgi hgcY DUQC Hue -Tgp6,sS4- thdng 8/2016
3.1. Chi sd BMI va cac d$c dilm lam sing, c|n lim sang 3.1.1. Liin quan gi&a chisd BMI vd cdc ddc diem Idm sdng
> f t
r
I • BinhIhuvng o i G l y a g 1 s G a y d 5 2 B G i y d ^ S srhiracan I
Bieu do 3.1. Phin bd chl sd BMI cua bgnh nhin lao phdi
Nhqn xet: BMI d m&e binh thuang ehiem ty Ig cao nhat vdi 47,5%, bgnh nhin b m&c gay ehiem 49,5%, trong dd gay dp 3 ehiem ty Ig thap nhat, 9,9%.
Bing 3.1. Phan bd BMI cOa bgnh nhan lao phdi theo eic die dilm lam sang 0|c diem
Gi6i ti'nh Nam
m
Tuoi
<20 2 0 - 4 0 4 1 - 6 0
>60 Hut thuoc la Co Khong
Thofr gian phat hi^n benh
< 1 thang (1) 1-3 thang (2)
> 3 thang (3)
n
59 32
3 28 40 30
64 37
65 27 9
%
68,3 31,7
3,0 27,7 39,6 29,7
63,4 36,6
64,4 26,7 8,9
X ± SD
18,85*2,09 18,1112,45
18,27±2,00 1S,53±2,07 19,35+1,89 17,75*2,54
18,67±2,17 18,51*2,34
18,84±2,21 18,67+2,06 16,78+2,20
P
<0,05
>0,05
< 0,05 vdi (3)
< 0,05 vdi (3)
< 0,05 v6i (1), (2) Nhgn xet: Ty Ig nam mac bgnh cao han n& (lln
lupt 68,3% va 31,7%). BMI trung blnh nhdm nam cao han n& (18,85kg/m^so vdi 18,llkg/m') vdi p<0,05.
Bgnh nhan b nhdm tudi 41-60 chiem fy- lg cao
nhat, BMI nhdm nay eung cao nhat, 19,35kg/m^
Nhdm tudi <20 chiem ty Ig thap nhat, 2,97%, BMI nhdm >60 tudi d m&e thap nhit, 17,75kg/m^.
Phan Idn bgnh nhan nhgp vign khi trigu ch&ng xuat hign trong vdng <1 thing (64,36%), ehi
AND PHARMACY 79 I
Tgp ch! Y DUQC hqc - Truimg Dgi hgc Y Buqc H -Tgp 6, Si - thdng 8/2016
8,91% bgnh nhan nhgp vign vdi trigu ch&ng xuat hign benh >3 thing (p<0,05). BMI d nhdm phit hien trong vdng > 3 thing. BMI d nhdm phit hign hign bgnh <1 thing va 1-3 thing khae nhau khdng bgnh <1 thing v i 1-3 thing eao han nhdm phit ed y nghTa thdng kg.
3.1.2. Liin quan gida chi so BMI vd cdc dqc diim cgn tdm sdng
Bing 3.2. Phan bd BMI eiia bgnh nhan lao phdi theo ket qui soi kinh hien vi tryc tiep BIVII(i<g/m')
The iao n
%
X ± SD P
AFB(*) 32 31,7 19,1112,25
>0,05
AFB(-) 69 68,3 18,38±2,19
Tfing c§ng 101 100
W/ipnxef. Lao phdi AFB (-) ehiem tylg cao han AFB gi&a nhdm lao AFB {-) v i AFB (+) (19,llkg/m^ so vdi (+), lan lupt la 68,3% v i 31,7%. Cd sy khac bigt ve BMI 18,38kg/m'), nhung khdng cd y nghTa thdng ke.
Bang 3.3. Phin bd BMI cita bgnh nhan lao phdi theo tdn thuang ed hang/khdng cd hang tren hinh anh Xquang
^ — — „ _ , ^ r 6 n thu-ofng BiVII (l(g/m') --,__
n
%
X ± SD P
Khong c6 hang 81 80,2 18,6512,27
Co hang 20 19,8 18,45+2,10
>0,05
Tong cpng 101 100
Nhgn xet: Ton thuang khdng ed hang ggp phd han nhdm cd hang, 18,65 kg/m^so vdi 18,45kg/m bien han, vdi 80,2%. BMI nhdm khdng cd hang cao nhung sy khae bigt khdng ed y nghTa thdng ke.
Bang 3.4. Phan bd BMI ciia lao phdi theo tdn thuang trgn Xquang theo ATS (1990)
^ — _ _ ^ ATS BIUIi|i<g/m>| ^—^—-____
n
%
X ± SD P
B o i 70 69,31 18,8312,30
Q^li 31 30,69 18,1212,00 p> 0,05
Nhgn xet: Phan ldn benh nhan cd ton thuang do 1, vdi 69.31%. Khong cd ton th 3.2. Sy thav doi BMI sau 1 th^ng hoa trj ii^u ngan ngay
Bang 3.5. BMI cija b|nh nhan lao ph6i tru'dc va sau dieu tr BiUi (i<g/m'|
Tru'dc dieu tri Sau dieu trj
n 101 101
Tl± SD 18,6212,22 19,3012,37
TSng c$ng 101 100
j-crng do ill.
P
<0,0001
kg/i
Nhqn xet: BMI tang sau 1 thing dieu tri, 19,30kg/m' so vdi 18,62kg/m^ vdi p < 0,0001, tang thgm 0,68
lOURNAL OF MEDICINE At
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N* 20
19
18
17 •
19.71
18.85 ^.-^-"''''''^
^
18.41— • Ham ' - • ' - Nff
Toroc flilu tn Sau d i l u tn Th6i gtan
Bieu do 3.2. So sanh thay ddi BMI eua bgnh nhan lao phdi trydc va sau dieu tn theo gidi Nhqn xet: Du'dng bleu diln cua nam dde han ciia n& do dp tang BMi ciia nam nhanh hPn n& (4,56% so vdi 1,66%).
4. BAN LU$N
Nghien e&u eiia ehung tdi dypc tien hanh trgn 101 bgnh nhin lao phdi den dieu trj tgi Khoa Lao, Bgnh vign Trung uang Hue. Phan IPn ddi tupng nghien e&u la nam gidi, ehilm 68,3% va tgp trung chii y l u d nhdm tudi > 40 tudi. Nam gidi thudng lign quan nhieu han den hogt ddng gang s&c, tilp xue vdi nhieu yeu t d nguy ca nhu hut thudc, udng rupu va sy xuat hign trigu ch&ng khdng dien hinh khien n& gidi it di khim vi trieu ch&ng cua benh lao. Them vao do, khl dl khim, ty lg xgt nghigm AFB (+) cua n&
thap han nam [17] la nh&ng ly do khien ty lg bgnh lao nam gidi cao ban n& gidi. Ly giai cho kit qua do tudi chinh ciia ddi tupng nghign e&u la trgn 40 tudi, day l i giai doan eic bgnh mgn ti'nh bat dau xuat hign nhy d i i thao dudng, loet dg diy t i trang, ddng thdi eae thdi quen nhu' udng rapu, thude la eung nhu tilp xiie vdi eic yeu td nguy eP khic lim tang nguy ea ehuyen lao so nhilm sang lao bgnh.
4.1. Lien quan giu'a chi sd BMI v i cic die diem lam sing va c|n lam sang cua bgnh nhan lao phdi
4.1.1. Liin quan giii'a chi sd BMI vd cdc ddc diim tam sdng
Theo Bilu do 3.1, chiing tdi nghiin c&u cd khoang mpt n&a bgnh nhan nhgp vign vdi tinh trang suy dinh dud'ng, trong dd gly dg 1, dp 2, do 3 chllm ty Ig lln lupt la 26,7%, 12,9%, 9,9%. Sy tic ddng qua lgi gi&a 'ao va suy dinh dudng da dupc de cap qua nhieu nghien c&u, trong dd nghidn c&u ciia Lonnroth.K. (2010), tdng hpp ciia 6 nghign c&u dupe tien hanh tgi nhieu nude t r i n cho thay cd mpt mdi lien chit ehi gi&a BMi va ty Ig mac lao [10]. Lao dan
tpi suy dinh dudng va suy dmh dadng lam d l mac lao. Tinh trgng suy dinh dudng trong bgnh nhan lao da duqic de cgp tdi nhieu nghign e&u, d cac nade dang phit triln cung nhu eic nudc phat trien. Ket qua niy phii hpp vdi nhieu nghien e&u b cic nubc dang phit trien khac [2], [8], [12], [16]. Ket qua nay phii hpp vdi nghien c&u eiia Dodor, E. (2008), benh nhan d m&e gay chiem 51%, trong dd gay dp 1,2, 3 ehiem lln lupt l i 24%, 12% v i 15% [6], nghiin e&u cua Abdirahman, F. (2002), bgnh nhan b m&e gay chilm 57%, trong dd gay dg 1,2, 3 chiem lan lupt la 22%, 14%, 21% [6] . Tuy vgy, ket qua nghien c&u khdng tuang dong vdi Nguyen Thj Xuin Anh (2009), vdi 84% bgnh nhan vio vign vdi BMI d m&c gay [1].
Ve phan bd BMI theo dp tudi, kit qua nghiin c&u ciia chiing tdi cho thay BMI trung blnh b nhdm 41- 60 tudi l i cao nhat, 19,35 kg/m2, xep th& 2 la nhdm tudi 20-40 vdi 18,53kg/m2, 2 nhdm tudi niy cd BMI trung binh xep b m&c blnh thudng (>18,5kg/m2).
Trong khi dd, 2 nhdm tudi cdn lai cd BMI b m&c gay dp 1, BMI trung blnh thap nhat l i nhdm tudi >60, vdi BMi l i 17,75 kg/m2.
Nghien e&u cung da chl ra BMI trung binh d nhdm nam cao ban nhdm n&, BMI cCia nhdm nam rai vio m&c blnh thudng (18,85±2,09 kg/m^), trong khi BMI nhdm n& thupc m&c gay dp 1 (18,11±2,45 kg/m^). Sy khac bigt niy cd y nghTa thdng kg, vdi p<0,05. Kit qua nay tuang dong vdi kit qua nghiin c&u ciia Abdirahman, F. (2002), BMI trung blnh ciia nam la 18,4 kg/m', cao han BiVII trung binh ciia n&, 17,9 kg/m^ vdi p<0,001 [2] hay nghien e&u eiia Bhargava, A. (2015), BMI ciia nam cao han n& (16
>i|
Tgp ch! Y DUQC hgc - Tru&ng Bgi hgc Y Duoc Hue -Tgp 6, si 4- thdng 8/2016
kg/m^ v i 15 kg/m') [4]. d n& gidi, cac trigu eh&ng xult hign khdng dien hinh khien hp bd qua v i khdng di kham. Them vao dd, xet nghigm AFB (+) it han so vdi gidi nam din tdi tinh trgng benh nhan n& phit hign bgnh va dieu tn khi bgnh da keo dai [17], luc nay tinh trang suy dmh du&ng da tram trpng han Ddng thdi, mdt khi d i mae lao, n& gidi ed tinh trgng dm ngng hon [17].
Ty lg hut thude l i b ddi tuang nghien e&u chung tdi deu d m&c eao (han 60%). So sinh vdi cie nghien c&u khic, ty le hut thudc l i trong nghign c&u cua Wang, J, Y. (2007) la 39,6%, cua WHO dua ra la 20%
[18], ty Ig hiit thudc l i trong benh nhin lao trong nghien c&u khi eao. Sy khie biet dd cd the do sy khac nhau ve thdi quen hiit thude gi&a eic viing dupc khio sat. Theo dilu tra eiia WHO [19], ty lg hilt thudc I i CLia ngudi Vigt Nam thugc hang cag nhat t h i gidi, 15 trigu nguPi hut thudc la, chiem 23,8% din sd; 33 trigu nguPi khdng hut thudc la dang bj tilp xuc thy dgng vdi khdi thude tai nha; 5 tngu ngudi tiep xtic khdi thudc l i thu dpng tai nai lim vigc. Tim hieu ve thudc l i va lao, nghien e&u eiia Arcavi, L (2004) khang dinh hiit thudc la giy anh hudng tdi cau true ciia dudng hd hap va lim suy giam hg miin djch. Ngudi hiit thudc l i cd nguy co mae bgnh phdi tang gap 2-4 lan so vdi ngudi khdng hiit, trong dd dang iuu tam la benh lao [3]. Kit qua eiia ehiing tdi cho thay khdng ed sy khae bigt ve BMI gi&a 2 nhdm cd va khdng hiit thudc l i .
Nghiin c&u chung tdi cho thiy 64% bgnh nhan phat hign cac trieu ch&ng bat thudng v i d i n kham trong vdng thing dau tiln. Con sd niy la 90% neu ti'nh trong vdng 3 thing dau tien. So sanh vdi nghien e&u cua Dodor. E. (2008), ty le niy la 63% [6]. Diy i i mpt thdng sd the hign sy thanh cdng ciia CTCLQG khi phat hign dupe phan ddng benh nhan lao trong vdng 3 thing dau eiia bgnh. Ket qua eiia ehung tdi ehi ra ed sy khic bigt cd y nghTa thdng kg ve BMI b nhdm <1 thing v i nhdm >3 thing (18,84±2,21 kg/
m' so vdi 16,7S±2,20 kg/m^) vdi p <0,05. Ddng thdi cd sy khic bigt ed y nghTa thdng ke ve BMI d nhdm 1-3 thing eao han nhdm > 3 thing (18,67±2,06 kg/
m' so vdi 16,78±2,20 kg/m^) vdi p<0,05. Tuy nhien, ehua tim thay sy khic bigt ed y nghTa thdng kg ciia chl sd BMI gi&a nhdm phat hign benh < 1 thing va 1-3 thing. Theo nghign cyu cua Nguyen Thj Xuan Anh (2009), trong nh&ng benh nhan cd BMI < 18,5 kg/m^, thdi gian mac bgnh > 3 thing chiem t^ lg ban 70%, cao han han thdi gian mac bgnh dudi 3 thing, sy khac bigt eo y nghTa thdng kg vPi p<0,05[ll. Thdi gian mae benh eang dai, anh hu'dng ciia bgnh lao
I 8 2 JOURNAL OF MEDICINE AND PHARMACY
len CP the cang nhieu, ehan an, giam hap thu dinh du'dng keo d i i epng vdi tang hogt dpng phin giai protein, lipid gay nen tinh trang suy dinh dudng trong lao.
4.1.2. Liin quan gida chi sd BMI vd cdc ddc diim cqn Idm sdng
Tir Bang 3.2, ket qua ciia ehiing tdi cho thiy lao phdi AFB (-) cao han AFB (+) 2 lan. Trong khi do, nghign c&u ciia Nguyin Thj Ngpc Anh (2007) cd 52%
bgnh nhan AFB (+), nghien c&u ciia Dodor, E. (2008), 90% bgnh nhan AFB (+) [6], 66% benh nhan ed AFB (+) theo nghien e&u eiia Bhargava.A.(2013) [4]. Sy khic nhau dd ed the la do sy khac bigt dd cd the l i do miu chua du Idn, ngoai ra ed the do phuang phip xet nghiem b Bgnh vien Trung uang Hui, phuang phip chan doin uu tign duac thye hign la xet nghigm soi true tilp, khdng phai l i nudi cay.
Phuang phap niy cd nhupc dilm ta chi cho ket qua duang ti'nh 65-80% so vdi nudi eay d nh&ng viing cd tt Ig nhilm HIV thap. Han n&a, ket qua soi tryc tiep thu'dng ed xu hudng (-) neu benh nhin nhilm HIV, nhat la b glai doan sau ciJa HIV, so vdi nh&ng bgnh nhan khdng nhilm HIV. Nh&ng ylu td khich quan tren cd t h i gdp phan lam giam t / Ig phan tram bgnh nhin AFB (+) cua nghign c&u. Ket qua ciia ehiing tdi chi ra BMI b nhdm lao phdi AFB (+) va AFB (-] l i khie nhau, 19,11 ± 2,25 kg/m^ so vdi 18,38 ± 2,19 kg/
m^ nhung sy khac bigt nay khdng cd y nghTa thdng ke. Nghign c&u ciia Dodor, E. (2008) eung eho thay khdng cd mdi lign quan gi&a tinh trang dinh dudng vdi kit qua dam [6].
Ve phan loai tdn thapng trgn hinh anh Xquang, kit qua nghign c&u ciia chiing tdi cho thay tdn thypng khdng cd hang chiem uu the han, tren 30%, gap 4 lan nhdm tdn thuang cd hang, tuong t y vdi ket qua nghiin c&u cOa Karyadi.E (2000), ty Ig khdng cd hang ehiem 66% [9]. Nghiin e&u cua chung tdi chua tim thay sy lien quan cd y nghTa thdng ke gi&a chi sd BMI v i dge diem ton thuang hang/
khdng ed hang tren hinh anh X quang Xet ve m&c dp tdn thuang theo phin dd ATS (1990), khdng cd bgnh nhan nao ed tdn thuang dg 111, phan Idn l i tdn thuang dp I (chilm 70%). Kit qua nay la phti hpp vi day chinh la dang tdn thuang eiia nh&ng trudng hpp dapc chan doin v i dilu trj sdm. Nghien c&u eua chung tdi chi ra BMI gi&a nhdm tdn thUPng dp 1 khac vdi nhdm tdn thuPng d§ 11, 18,83±2,30kg/m' so vdi 18,12+2,00 kg/m^ nhung khdng ed y nghTa thdng k l . BMI trung binh nhdm tdn thuang dd I cao ban dp II tuy nhien mdi lien quan gi&a BMI va phan dp tdn thuang khdng cd y nghTa thdng ke.
Tqp chi Y Duvc bgc- Tru&ng Ogi hoc Y DuQc Hue- TSp 6, si 4 - thong 8/2016
4 . 2 . S y t h a y d d i c h i s d B M I sau 1 t h i n g d i e u t r j T h e o B i l u d d 3.2, nghien c&u ciia c h u n g t d i c h o t h a y ehi s d B M I t a n g sau 1 t h i n g d i e u t r j , 1 9 , 3 0 k g / m ' so v d i 1 8 , 6 2 k g / m ^ s y k h i e nhau cd y nghTa t h d n g ke, v d i p < 0 , 0 0 0 1 . N g h i i n c&u ciia Dodor, E. (2008) eho t h a y B M I sau 2 t h i n g d i l u t r i t a n g t & 1 8 , 7 k g / m ' len 1 9 , 5 k g / m ' , t a n g t h g m 4,3%. B M I t i n g sau 1 t h i n g d i e u t r j t h e o phac d o la d l h i i u , cd n h i l u c a ehe d l ly giai d i e u nay, t r o n g d d s y e i i t h i g n tinh t r g n g c h i n a n , g i i m s& d y n g nang l u p n g va g i a m s y rdi logn c h u y e n hda la n h & n g e a c h l c h i n h .
Tuy n h i e n , n l u b i e t k i t h o p gi&a hda t n lieu va m p t ehe d p d i n h d i / d n g p h i i h p p t h i ket q u i se cai t h i e n h o n n h i e u . T h e o n g h i i n c&u eiia P a t o n , N. I.
(2004), n e u ed m d t c h e d p d i n h d u o ' n g p h i i h o p ngay t & t h d i d i e m b a t d a u d i e u t r i t h i can nang ciia b g n h n h i n se d u p c cai t h i e n ro r g t , s y t a n g t r u ' d n g can ngng tiep t y c t h e h i g n ro r g t so v d i n h d m c h & n g d giai d o a n sau d d [ 1 4 ] . T h e o n g h i g n c&u eua Paton, N. I. (2004), n e u ket h p p d i e u t r j t h u d e k h i n g lao v d i ehe d p d i n h d u d n g p h i i h p p (600-900 Kcal/ngay, 2 5 - 3 7 , 5 m g p r t o t e i n / n g a y ) , can n i n g ciia b g n h n h a n t a n g t h g m 2,6 kg sau 6 t u a n , so v d i 0,8 kg eua n h d m e h & n g ehi d i l u t r i t h u d c k h a n g lao [ 1 4 ] . Ben cgnh n h & n g k i t qua cd y nghTa m a nghien c&u d e m Igi, nghien e&u ciia c h u n g t d i v i n c d n n h & n g t d n t a i : T h &
nhat, m i u chu'a d i i l d n , so v d i cae n g h i e n e&u k h i c , nghien c&u cua c h u n g t d i c d m i u k h i k h i g m t d n , m l u c i n g l d n c i n g l i d g i d i g n t d t c h o q u a n t h e . T h &
hai, nghien c&u ehua xac d j n h t y Ig d d n g n h i e m HIV t r o n g b g n h nhan lao, d i n t d i vigc ehua t h e d a n h gia a n h h u ' d n g cua n h i e m HIV len tinh t r g n g d i n h d u d n g ciia b g n h nhan lao va n g u p c lgi. T h & ba, nghign c&u c h u a d i sau d y p c s y t i n g can sau 1 t h i n g d i e u t r j l i chii yeu t a n g p h a n n i g ciia e a t h i , m d e a hay m d m d , va t y Ig gia t a n g t & n g phan n h u t h e n a o .
D e d i n h gia d u p c khia cgnh nay, d d i hdi e a c t h d n g sd k h i c n h u khdi l u p n g nac (Lean Body Mass) hay lu'png m d (Fat Mass). M d t sd nghien e&u da ehi ra s y t i n g B M I sau dieu trj chij y l u d phan m d v a khdng cd s y t h a y d d i r d rang v l khdi l u p n g ngc. Trong khi d d , mac d i l l i t h d n g sd d u p e s& d y n g t r o n g l i m sang d l d a n h g i i t r i n h t r a n g n h i l m t r i i n g m g n hay tinh t r g n g d m h d u d n g t r o n g l i m sang, ehi s d B M I khdng phan b i g t rgch rdi l u p n g m d va khdi l u p n g ngc.
5. K ^ L U $ N
N g h i g n e&u eiia e h u n g t d i da chi ra d u p c tinh t r g n g d i n h d a & n g kem ciia bgnh nhan lao liie n h g p v i g n , d d n g t h d i nghign c&u da eho t h a y s y t h a n h edng ciia C h u a n g t r i n h c h d n g lao qudc gia. Nghien e&u cdng da chi ra d u p e yeu t d gidi va t h d i gian mae b e n h lign q u a n m g t t h i e t t d i B M I eua benh n h i n . K i t q u i N g h i g n e&u cung da eho t h a y s y t h a y d d i d i n g ke ve chl s d B M I ciia bgnh n h i n sau d i e u trj 1 t h i n g t h e o phae d d . Cac k i t q u i t r g n d a c u n g cap bang c h & n g h & u ich t r o n g cdng t i c c h a m sdc s&c khde c p n g d o n g c i i n g n h u t r o n g chan d o i n va d i e u t r i lao.
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