Tgp chi Y Dugc Hgc - TrU&ng Dgi hoc Y Dugc Hue -Tqp 6, so 6- thang 1/2017
NGHIEN C&u s u BIEN OOI FIBRINOGEN, hsCRP, VS VATHE TICH TON THUPNG NAO TREN CHUP CAT LpP VI TfNH P BENH NHAN
NHOI MAU NAO GIAI DOAN CAP
Nguyin B'mh Todn Tru&ng Bgi bgc Y OUgc Hui Tdm tat
Muc tieu: Xie dinh nong do eua hs-CRP, fibrinogen va tdc dp miu lang d bgnh nhan dfit quy nio va mdi tuang quan ciia chiing vdi kich thudc tdn thuang, cac yeu td nguy catim mgch va ton thuang than kinh qua thang diem NIHSS. Phuang phap: Mlu nghien e&u gom 90 bgnh nhan dfit quy nao dilu trj nfii trii tgi khoa Nfii Than kinh Bgnh vign Trung uang Hui t& thing 5/2016 din thing 12/2016, Bgnh nhan dpt quy nao lan dau, thdi gian t& khi khdi phit den khi vio vien trong vdng 72 gid. Oiem NIHSS, Glasgow, the ti'eh tdn thuong trgn CTscan, ndng dp fibrinogen, hs-CRP, toe dp mau lang Suae dinh gia tgi 2 thai diem vio vign va sau 72 gid. Tien hanh so sanh ndng do cie thdng sd theo the tdn thuang va tim mdi tuang quan. Ket qui: Ndng dp hs-CRP tuang quan thugn vdi diem NIHSS, t h i ti'eh tdn thuang, fibrinogen, tdc dp miu lang v i tuang quan nghjch vdi diem giasgow tgi ea 2 thdi dilm. Ndng dp fibrinogen tuang quan thugn vdi diem NIHSS, hs-CRP va tdc dd mau lang; tuang quan nghjch vdi dilm Glasgow tgi 72 giP. Tdc dp mau lang tuang quan thuan vPi dilm NIHSS, hs-CRP, fibrinogen va tuang quan nghjch vdi diem Glasgow tgi ca 2 thdi diem. Sau 72 gid, diem NIHSS, nong dp hs-CRP va fibrinogen la eae yeu td dpe lgp trong du bao dp ngng cua benh. Kit luan: Cae chi dilm viem tang trong bgnh nhan dfit quy. Ndng dp hs-CRP v i fibrinogen tang cao ban b nh&ng bgnh nhin ed diln tiln lam sing xau.
T& khoa: nbbi mau ndo, fibrinogen, hsCRP, tdc dg mau Idng, tien luang Abstract
CHANGES OF FIBRINOGEN, HSCRP, VS AND INFARCT VOLUME IN PATIENT WITH ACUTE ISCHEMIC STROKE
Nguyen Dinh Toan Hue University of Medicine and Pharmacy Objective; To assess the implicati'on of high-sensiti"vity C-reactive protein(hs-CRP), fibrinogen and erythrocyte sedimentation rate (ESR) in acute stroke and its correlati'on with the lesion size, vascular risk factors, and neurological impairment. Methods; We included 90 patients eonsecutivety admitted to Department of Neurology, Central hospital of HUE between May 2016 and Dec 2016, with first-ever stroke within the first 72 hours from onset. The fibrinogen, high-sensitivity C-reactiVe protein, erythrocyte sedimentation rate (ESR) were determined in plasma on admission and after 72 hours. The lesion size was evaluated by CTscan, neurological impairment was evaluated vt/lth the NIHSS and the Glasgow Coma Scale.
Results: There was a positi've correlation between the hs-CRP level and NIHSS, lesion size, fibrinogen, ESR and a negative correlation between the hs-CRP level and Glasgow at both times. There was a positive correlation between fibrinogen level and NIHSS, ESR, hs-CRP and a negati've correlation between fibrinogen level and Glasgow after 72 hours. We also found a positive correlation between ESR level and NIHSS, fibrinogen, hs- CRP and a negati've correlation between ESR level and Glasgow at both times. After 72 hours, the NIHSS, hs-CRP, fibrinogen levels were independent factors to predict clinical worsening. Conclusion: Inflammatory markers were associated with the acute stroke. The hs-CRP and fibrinogen were higher in patients with clinical worsening compared to those with stable clinical progression.
Key words: ischemic stroke, fibrinogen, hsCRP, VSS, pronostic
- Bja chl lien b$: Nguyin Binh Todn, email toanjosepb&yahoo com -Ngdy nhgn bi>i: 25/12/2016 Ngiiy ding y Mng 12/i/2017, Ngby lOiJk
ipchiYUugcngc- .
1. DAT VAN OE
Bgnh tai bien mgch miu nio do nhieu nguyen nhan gay ra, bgnh cd dien tiln nhanh va ph&c tgp, tl lg t& vong thudng cao trong 24-72 gid dau. Vi viy vige danh gii m&c dp ngng eung nhU dy doin dien ti'en ngng lam sang eua bgnh ddng vai trd rat quan trpng trong x& tri bgnh nhan tai bien mgch miu nao.
Trgn the gidi va trong nubc da cd nhieu edng trinh nghien e&u dupe tien hinh nham tim ra cic chat chi diem sinh hoc giup tign lupng sdm dupe dien tien ciia dot quy nao. Trong sd dd, cic chat chi diem smh hpc eiia viem ddng vai trd rat quan trong trong ca che bgnh sinh cung nhU trong dy bao tien lupng eua tai biln maeh mau nao[2),
Trong mfit nghien e&u benh ch&ng tren 63000 ngypi khoe mgnh da ghi nhgn nong dp hs-CRP tang eao l i yeu td dy doan mgnh cho nguy ea t& vong ngan hgn v i dii ban. Va nguy ca nay t h i m chi con eao ban n&a khi di kem vdi tang fibrinogen. Cf nh&ng ngudi v&a tang hs-CRP v&a ting fibrinogen trong t&
phin vj cao nhat ed nguy ea t& vong gan gap 9,6 lan so vdi nhdm thap nhatva nguyca t&vong tim mgch eao gap 13 lln.
Xuat phit t& nh&ng li do trgn ehiing tdi tien hanh de tai: Nghien c&u sq" biin ddi Fibrinogen, hsCRP, VS vd thi tich tdn thuang nao tren chgp cat l&p vi tinh & bqnh nhdn nhoi mdu ndo glai doqn cdp vdi 2 myetieu'
1. Xdc dinh m&c do rdi loqn cda Fibrinogene, hsCRP, VS & bqnh nhdn nhbi mdu nao giai dogn cdp.
2. Tim mil tuang quan gi&a cdc dau an sinh bgc nay v&i diin tiin Idm sdng qua thong diem NIHSS, thang diim Glasgow vd vbi thi ti'ch ton thuong nao tren hinh dnh chqp nao cat l&p vi ti'nh.
2. DOI TirONG VA PHU'O'NG PHAP NGHIEN CU^U 2.1. Ddi tupng nghien c&u
Odi tupng nghien c&u la 90 bgnh nhan dupc ehan doin nhoi miu nao dieu tri nfii tni tai Khoa Ndi TK-8VTWHuet& thing 05/2016 den thing 12/2016.
Bang 3.1. Phan bd ve dp
•> Tieu ehuan chpn bgnh;
Theo Td ch&c Y te The gidi trong Khuyin eao ve dy phdng chan doan va dieu trj Tai biln mgch miu nao dya vio eae tieu chuan lim sang va tdn thuang tren hinh inh chyp nao cat Idp vi tinh.
<• Tieu ehuan loai tr&;
- Bgnh nhin khdng dong)/ tham gia nghien c&u - Cd cae bgnh nang hogc cae bgnh giy phin
&ng viem khie nhu: Vigm phdi, vigm khdp, bgnh t y mien, nhoi miu ca tim, suy gan, suy thgn, ung thu, cd tien s& benh ly ve miu hogc ed bat thudng tren xet nghigm cdng th&e mau tai thdi diem nghien c&u, dang dieu trj vdi cac thude khing vigm khdng steroid trong vong 15 ngay, cd t i l n s& tai biln mgch miu nao
2.2. Phuang phap nghiin c&u 2.2.1. Thiit ki nghien c&u
Nghien e&u md ta cat ngang cd theo ddi dpc 2.2.2. Phuang phdp chqn binh Chung tdi chpn bgnh theo phUPng phip phi xic xuat vdi mlu thugn tign. Sd lupng 90 bgnh nhin.
2.2.3. Cdc bien nghien c&u + Tudi, giPi, nghe nghiep, ti'en s& bgnh + Kham lam sing, dinh gii diem NIHSS, Glasgow + Chgp CLVT sp nao, do t h i tich tdn thUPng theo cdng th&c V=l/2a.b.e.
+ Lay miu xet nghigm cdng th&e mau, tdc dp mau lang, hs-CRP, fibrinogen va eie xet nghiem sinh hoa khac: glucose, ure, ereatinin, SGOT, SGPT, cholesterol, triglycerid lan 1 vao sing hdm sau khi ddi.
Bgnh nhin duac danh gii IOc nhgp vign va sau 72 gid
2.2.4. Xd ly sd liiu
- X& IV sd ligu bang phuang phip thdng kg Y hpe vdi sy ho trp ciia phan mem Excel 2010, SPSS 19.0 va MedCalc 10.
3. KETQUA NGHIEN CLTU
3.1. Oge dilm chung cua nhdm nghiin e&u tudi trong nhdm nghien c&u
~~ ~-——______^ Nhdm benh
Nhdmtudi — - — _ _ _ ^
<50 51-70
>71 Tong Tudi thap nhit
Tuoi Idn nhat X±SD
NMN n 9 33 41 83
T^lg%
10,8 39,8 49,4 100 43 94 69,33+13,11
1431
iruang tigi ngc r uuqc tl •-thangl/2017 Tudi thudng gap nhat la tren 70 tudi, ed 41 truPng hpp chiem 49,4%
3.2. Nong dp hs-CRP, fibrinogen, TOML b bgnh nhin NMN
3.2.1. Nbng dq hs-CRP, fibrinogen,TDML & binh nhdn NMN khi vdo viin vd sau 72gi&
Bang 3.2. Ndng dfi hs-CRP, fibrinogen, TDML tgi 2 thdi diem
^~~~~~——-„„,^^^ Bgnh nhan Thdng sd ^~~~~~—-~~„„,^^^
hs-CRP(mg/L) Fibrinogen(g/L) TDML(mm/h)
NMN (n= 90) T l
16,84±29,5a 1,95±0,76 25,65±15,47
T2 29,72±39,75
2,36±0,58 32,30±18,25
P
<0,05
<0,05
<0,05 Sy khic bigt ve nong dp ciia hs-CRP, fibrinogen v i TOML ehung ea miu tgi 2 thdi dilm khi mdi vao v i sau 72gid deu ed y nghTa thdng ke vdl p<0,05.
3.2.2. Nbng db hs-CRP, fibrinogen, TDML & nhdm binb nhan Idm sdng diin tien nqng vd on djnh Bang 3.3. Nong dfi hs-CRP, fibrinogen, TDML theo diln tiln lam sang
"~'~~~~--~...^nh nang theo NtHSS Thfing sfi ^~~~~-~-~..„^^^^
hs-CRPl{mg/L) hs-CRP2{mg/L) Fibrinogenl(g/L) Fibrinogen2(g/L) TOMLl(mm/h) T0ML2(mm/h)
6n djnh n=45 16,18±25,41 16,73±23,92 2,21±0,52 2,43+0,60 26,32±19,97 29,68+18,65
Dien tien nang n=45 12,70±14,67 40,68±48,24 2,32±0,47 3,75t0,57 24,98±15,81 37,87±19,72
P
>0,05
<0,05
>0,05
<0,05
>0,05
<0,05 Khi ta ehia mau thanh 2 nhdm diln tien on dinh va dien tien nang len sau 72 gid theo diem NIHSS, ta thay nong dp hs-CRP, fibrinogen va TOML tiie dau khfing cd su khie bigt gi&a 2 nhdm, nhUng sau 72 gid ndng dp hs-CRP, fibrinogen, TOML trong nhdm diln tien ngng cao han nhdm dn djnh cd y nghTa.
3.3. Moi tuang quan va lien quan gi&a nong dp hs-CRP, fibrinogen, TDML vd'i NIHSS, the ti'eh tdn thuang va mpt sd thdng so ean lim sing
Bang 3.4. Mdi tuang quan gi&a hs-CRP, fibrinogen, TDML va mdt sd thdng sd lim sang va egn lim sang dthPi diem vao vign
Tuang quan NIHSS GCS
The ti'eh tdn thuang Glucose Baeh cau TOML Fibrinogen
hs-CRP r=0,265, p<0,05 r=-0,326,p<0,01 r=0,362, p<0,01 r=0,460, p<0,01 r=0,270, p<0,05 r=0,602, p<0,01 r=0,317, p<0,01
Fibrinogen r=0,14, p>0,05 r=-0,126,p>0,05 r=0,103, p>0,05 r=0,204, p<0,05 r=0,146, p>0,05 r=0,382, p<0,01
TDIVIL r=0,283, p<0,05 r=-0,374,p<0,05 r=0,156, p>0,05 r=0,255, p<0,05 r=0,069, p>0,05
hs-CRP tgi thPi diem mdi vao co mdi tuang quan vdi diem NIHSS, GCS, the ti'ch tdn thuang, glucose va bgch
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Tgp chl Y OUgc ngc - i ruong vgi ngc r uugc Hue - iqp 6,s6 6- thdng 1/2017 Bang 3.S. Mdi tuang quan eiia hs-CRP, fibrinogen va TOML vdi mpt sd thdng sd lam sang va ein lam sang d
thdi diem sau 72 gid Tuang quan
NIHSS GCS ThI ti'ch Glucose Bgch elu TOML Fibrinogen
hs-CRP r=0,476, p<0,01 r=-0,522, p<0,01 r=0,435, p<0,01 r=0,362, p<0,01 r=0,432, p<0,01 r=0,415, p<0,01 r=0,459, p<0,01
Fibrinogen r=0,334, p<0,01 r=-0,372, p<0,01 r=0,063, p>0,05 r=0,126, p>0,05 r=0,H4, p>0,05 r=0,378, p<0,01
TDML r=0,376 p<0,01 r=-0,384, p<0,01 r=0,118, p>0,05 r=0,242, p<0,05 r=-0,034, p>0,05
Tai thdi dilm sau 72 gid nfing dfi hs-CRP vin ed tuang quan vdi eic thdng sd lam sang va can lam sang nhu NIHSS, GCS, the ti'ch o tdn thuang, glucose mau, bgch clu vdi p<0,01.
3.4. Phan tich hoi quy da biln trong d u bio m&c dp ngng va d i l n tien ning 6- bgnh nhan tai bien m^ch Bang 3.6. Dign tich dudi dudng eong ROC eua mfit sd yeu td lam sang va cgn lim
trong dinh gia dien ti'en nang TBMMN Thong sd
Mgch Nhiet HATT HATTr Diem NIHSS Ll Oiem NIHSS L2 Oiem GCS Ll Bilm GCS L2 Bach cau 1 Bach cau 2 TDML Ll TDML L2 hs-CRP Ll hs-CRP L2 Fibrinogen Ll Fibrinogen L2 TT 0 nhoi mau L l TTo nhoi mau L2
D1|n tfch 0,570 0,523 0,613 0,602 0,604 0,832 0,505 0,165 0,465 0,497 0,575 0,564 0,507 0,723 0,576 0,741 0,608 0,615
P
>0,05
>0,05
>0,05
>0,05
>0,05
<0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
<0,05
>0,05
<0,05
>0,05
>0,05
KTC95%
0,475 - 0,706 0,396 - 0,638 0,490-0,715 0,443-0,682 0,475 - 0,714 0,719-0,889 0,314-0,557 0,069 - 0,217 0,273 - 0,530 0,379 - 0,647 0,380-0,645 0,469 - 0,724 0,360 - 0,621 0,581 - 0,818 0,403-0,670 0,591 - 0,831 0,456 - 0,728 0,460 - 0,736
Chi cd NIHSS tan 2, hs-CRP lan 2 va fibrinogen lan 2 l i ed y nghTa thdng ke va cd dign ti'ch dudi dubng eong ROC cao nhat nen cic yeu td niy liin quan den dien tiln nang tren lim sang.
Tgp chl Y Dugc Hgc - Truang Bqi hqc Y Dugc Hue -Tgp 6, so 6- thdng 1/2017
Bang 3.7. Cic biln dfic lgp dy bao dien tiln ngng sau khi phin ti'ch da biln Biln sd
FibrinogenL2 NIHSS2 hs-CRP L2
B 1,047 3,216 0,032
SE 0,436 1,145 0,006
P
<0,05
<0,05
<0,05 Oiem NIHSS sau 72 gid, nong dp hs-CRP sau 72 gid, ndng dfi fibrinogen sau 72 gia l i cic y l u td dde lgp co y nghTa trong dy bio diin tien ngng 72 gid b benh nhan nhdi miu nao giai dogn cap. Phuang trinh hdi quy da bien:
Diln tien ngng ^ -11,06 + l,125x Fibrinogen + 3,189x NIHSS+ 0,04x hs-CRP Kiem djnh igi ket qua cua phuang trinh vdi dien tiln ngng lam sang trong 72h:
Bing 3.8. Diem eat cua phuang trinh hoi quy da bien va diln tien ngng lam sing Dien ti'ch
0,819
Diem cat 22,65
Se 78,1
Sp 77,2
P
<0,01
KTC 95%
0,758-0,912
-^
- ^
^ -
J _ .
yy y'
Bilu do 3.1. Dien ti'ch dudi dudng eong gi&a phuang trinh hdi quy da biln va dien tiln ngng lim sang Nhu vay, dya vao phuang trinh hdi da biln ehung
tdi nhgn thay dilm cat tdi Uu de dinh gia dien tien ngng la 22,65 vdi Se=78,l%, Sp- 77,2%, AUC- ROC 81,9%; p< 0,01,
4. BAN LU^e^N
4.1. D|c d i l m chung cua nhdm nghiin c&u Tudi trung blnh chung ciia mlu nghien e&u la 69,33±13,11, tren 70 tudi chilm ti lg eao nhat trong c i 2 t h i va ehiem 49,4% trong toan mlu.
Tudi trung binh trong nghien c&u ehung tdi tuang duang trong nghien c&u eua Nguyen TuPng Vin vdi tudi trung binh l i 69,4±13,0 [5] va eao ban mfit sd nghien c&u khic nhu Le Thj Hang l i 63,26±11,72 [2]
4.2. Ndng dp hs-CRP, fibrinogen, TDML b b^nh nhan NMN
Ndng dp hsCRP tgi thdi dilm nhgp vign va sau 72 gid' deu tang cao cd y nghTa thdng kg (16,84±29,58mg/L va 29,72±3g,75mg/L, p<0,05).
Trong nghiin c&u eiia Ho Thupng Dung eung ghi nhan: trong blnh nhan NMN ndng dp hs-CRP tang cao v i ed sy thay ddi dfing hpc, eao nhat d thdi dilm 48-72 gid sau khdi phit dfit quy[l]. Trong nghiin c&u eiia Modrego ndng dp eiia CRP trong the XHN cao ban trong the NMN tgi ea 3 thdi diem: vao vign (43 so vdi 11,6}, sau 48 gid (71,6 so vdl 25,6} va khi xuat vign (57,8 so vdi 25,1). Dieu niy phii hpp vdi sinh ly hogt dfing ciia hs-CRP, sau khl khdi phit vigm hay tdn thuang md d p , su tdng hpp CRP ting len
I 146
Top ch! Y Dugc Hgc - Tru&ng Ogi hgc Y Dugc Hui- Tqp 6, si 6- thing 1/2017 trong vdng 6-12 gid va tang gap ddi mdi 8 gid, dgt
dinh dilm sau 36-50 gid.
Tdc dfi miu lang ting fi' ci khl nhgp vign va sau 72h vdi sy khac bigt ed ^ nghTa gi&a 2 thdi diem (25,65±16,47mm/h so vdi 32,3±18,25mm/h, p<0,05). Kit qua niy tuang t y vdi ket qua cua Zaremba v i cfing sy 26,8±ll,7mm/hlll] va ciia Le Thi Hang vdi nhdm NMN l i 24,70±15,17mm/h.
Ndng dp fibrinogen tang d ca diem mdi vao va thdi diem sau 72 gid, cd y nghTa thdng k l (l,95±0,76g/L so vdi 2,36±0,58g/L, p<0,05). Sy tang lln cua cic protein pha cap ma dgc bigt la hs-CRP va fibrinogen se thue day sy kit dinh cua t l bao hdng cau va lam tdc dfi miu ling tang len.
Sau 72 gid ndng dd cua ea hs-CRP, fibrinogen v i TDML d nhdm diln ti'ln lim sing ngng lln deu eao han d nhdm ed dien tien lam sang dn djnh ed y nghTa (40,68±48,24mg/L so vdi 16,73±23,92mg/L; p<0,05 vdi hs-CRP; 3,75±0,57g/L so vpi 2,43±0,60g/L;
p<0,05 vdi fibrinogen; 37,87+19,72mm/h so vdi 29,68+18,65mm/h; p<0,05 vdi TDML). Dieu nay mfit lan n&a eho ta thay dip &ng vilm ting dan sau 48- 72 gid va ndng dd hs-CRP, fibrinogen, TOML tang song song vdi m&c dp ngng eua nhoi mau nao.
4.3. Mdi tuang quan va liln quan gi&a nong d$
hs-CRP, fibrinogen, TDML vPi NIHSS, the ti'ch tdn thuang vi mpt sd thfing so cgn lam sang
Nfing dfi hs-CRP ngay tai thdi diem nhap vign da cd mdi tuang quan vdl rit nhilu cic thfing sd lam sang va cgn lam sang (bang 3.4).Tuang quan thugn vdi NIHSS (r=0,265, p<0,05) va the ti'ch tdn thuang (r=0,362, p=0,001), tuang quan nghjch vdi GCS (r=- 0,326,p<0,001). Tai thdi dilm sau 72 gid cae mdi tuang quan cd xu hudng mgnh han nhu vdi NIHSS (r=0,476, p<0,001) hay vdi GCS (r=-0,522, p<0,001).
Kit qua ghi nhgn cua chiing tdi tuang t y nhu trong nhieu nghiin c&u
Kit qua eiia ehiing tdi cijng tUOng dong nghiin e&u cua Shenhar va cfing sy [10] thyc hign trin 119 bgnh nhan dpt quy eho thay nong dp hs-CRP cd tuang quan vdi NIHSS tgi ci 2 thdi diem la mdi nhgp vign v i sau 3-5 ngiy vdi r=0,230, p= 0,017 khi mdi nhgp vign va r=0,437, p=0,007 o'thPi dilm sau 3-5 ngay.
Trong nghien c&u ehdng tfii cung ghi nhgn ed mdi tuang quan nghjch gi&a nong dp hs-CRP vdi diem GCS khi vao vign va cang rfi ban sau 72 glP (r=- 0,326,p<0,001 va r=-0,522,p<0,001 tuOng &ng). Le Thj Hang va cfing sy cung da ghi nhgn ed mdi tuang quan nghjch gi&a hs-CRP vdi diem GCS khi vao vign va liic ra vign (r=-0,423,p=0,001 v i r=-0,306,p=0,013 tuong &ng) [2],
Trong nghign c&u mdi Men quan gi&a nong dfi hs-CRP vdi ty lg t& vong sdm, dilm NIHSS va phan nhdm dpt quy trong 24h. Shahrzad Mohebbi v i cpng sy eho thiy ty lg t& vong ting lgn khi hs-CRP
> 21,5mg/L va tang ten den 13,3 tan khi bgnh nhan ed ddng thdi hs-CRP >21,5mg/L v i N1HSS>10. Kit qua eua nghiin e&u nay da chi ra rang ed mdi tuang quan gi&a hs-CRP va ty le t& vong trong tuan dau tien sau dfit quy. Ojnh tupng hs-CRP trong nh&ng gid dau tiln sau dot quy lam tang kha ning dy doan nguy ea t& vong sdm vdi diem cat tai 21,5 mg/L[7].
Qua bang 3.4 ta thay nong dp fibrinogen tgi thdi diem nhgp vign chi cd mdi tuang quan vdi ndng dp hs-CRP, TOML va glucose. Nhung sau 72 gid Ial tuang quan them vdi eae diem dinh gii dp ngng eiia bgnh tren lim sing l i NIHSS va GCS, van cdn tuang quan vdi hs-CRP va TDML nhung khdng vdl glucose Kit qua nghien c&u eua ehung toi tuang duang nghiin c&u Le Thj Hang vdi ndng dfi fibrinogen cd tuang quan vdi ca the ti'ch tdn thuang va GCS tgi thdi diem mdi vao vign [2]
Napoli va cfing sy nghien e&u trgn 128 bgnh nhin dfit quy ghi nhan ed mdi tuang quan gl&a nong dfi fibrinogen vdi hs-CRP (r=0,45, p<0,001) va vdi dp ngng lam sang theo dilm dpt quy (r=-0,33, p<0,001) eung nhu etia ndng dfi hs-CRP vPi dd ngng ciJa bfinh (r=-0,35, p<0,001). Nghign e&u niy eho thay nguy eP tang len di kem vdi tang ndng dfi hs- CRP la dpc lgp vdi anh hydng eiia fibrinogen lgn tien lupng benh[81
Tai 2 thdi diem khl mdi vao vign va sau 72giP TOML deu ed mdi tuang quan vdi ea N1HSS,GCS, glucose, hs-CRP va fibrinogen, mgnh nhat la vdi ndng dfi hs-CRP Tuy nhign Igi khdng ed mfii tuang quan nao vdi t h i ti'ch tdn thUPng va bgch cau tgi ea 2 thdi diem. Tuong t y trong nghien e&u eiia Kisialiou v i epng sy [6] trgn 105 bgnh nhan NMN cap da ghi nhgn cd mdi tuang quan gi&a kieh thude tdn thuang nao vdi t& phan vj th& 4 ciia TOML (OR=5,250;95%C1,1,002-27,514)
4.4. PhIn ti'eh hoi quy da bien trong du bao m&e dp nang va diln tien ngng d' bgnh nhin tai biln m^ch m i u nao
Chung tdi tiln hinh phan ti'eh dan biln va da bien cic thanh td ed the anh hudng den diln ti'ln nang trin lam sang qua bang 3.6. Ket qua trong eae blln lam sang chi cd dilm NIHSS lan 2, edn cae biln cgn lam sang ed ndng dp hs-CRP lan 2 va nong dp fibrinogen lln 2 l i cd y nghTa trong dy bio m&c dp ngng lam sang.
Tqp ch! Y Dugc Hgc - TruVng Ogi hqc Y Duvc Hui -Tap 6, si 6- tbdng 1/2017
Trong phan ti'eh da b i l n ca 3 y l u t f i nay d e u ed y nghTa t r o n g d u b i o m&e dfi ngng l i m s i n g . P h u a n g t r i n h d u b i o la-
D i l n tien nang = -11,06 + l , 1 2 5 x Fibrinogen + 3,189x N1HSS+ 0,04x hs-CRP
Khi k i e m d i n h Igi ket qua eua p h u a n g t r i n h v d i d i l n tien nang l i m sang t r o n g 72 g i d chting t f i i nhgn t h a y d i l m eat t d i u u d e danh g i i d i l n tien nang l i 22,65, p < 0 , 0 0 0 1 va S e = 7 S , l % , Sp= 77,2%, AUC- ROC 81,9%. V i y d i e m NIHSS, nong d p hs-CRP v i fibrinogen ghi nhan v i o t h d i d i e m 72 g i d la cac y e u t d dpe lgp t r o n g d y b i o d f i ngng ciia benh
W h i t e l e y va epng s u t r o n g m p t n g h i i n e&u tien e&u 8 4 4 b g n h n h i n d f i t quy n h i m tim m d i t u a n g q u a n va y nghTa tien l u o n g ciia c i e ehi d i l m v i e m n h u glucose, bach cau, IL6, hs-CRP fibrinogen luc m d i v a o vien v d i k i t cue xau ciia benh nhan sau d d t q u y da r i i t ra k i t l u i n : C i c chi d i e m v i e m n i y ed m d i lien quan d e n k i t cue xau ciia d f i t quy [12]
Zoppo va cdng s u da ghi nhan d n h & n g bfinh nhan d o t q u y cd n o n g d o fibrinogen t h a p h a n 4 , 5 g / L
ed k i t cue ch&c nang t d t h a n ngay ca khi da dieu chinh y e u t d t u d i va d p ngng ban d i u cua d o t quy vi v i y ho khang d j n h rang co mfii lien quan giti^a f i b r i n o g e n va dien tien d f i t quy, va n d dfic l i p vOi cae nguy c a t i m m g c h khae va m&e d o ngng eua d f i t quy.
5. K i r LUAN
5. 1 . Ndng d p hs-CRP, fibrinogen, tdc d p m a u lang b benh nhan nh&i m a u nao ^
- N d n g d f i hs-CRP fibrinogen va t d c dfi m a u lang d e u t a n g tgi t h d i d i e m m d i vao v i g n v i sau 72 g i d
5.2. T u a n g quan gi&a nong dp hs-CRF^
fibrinogen, tde d p m i u lang v d i m p t sd t h o n g sd l i m sang v i can lam sang
- N o n g d p hs-CRP Fibrinogen va tde d p m i u lang d e u t u a n g q u a n t h u g n v d i d i l m NIHSS, t h i t i c h t d n t h u a n g , glucose va t u a n g quan nghjch v d i d i e m Glasgow.
- O i e m N1HSS2, nong d p hs-CRP2 va fibrinogen2 la cac yeu t d d p e tap t r o n g d y b i o d p ngng ciia nhfii m a u nao sau 7 2 g i d
TAI LIEU T H A M KHAO
1. Ho Thuong Dung (2011), "Khao sat nong do Protein phan ii'ng C sieu nhgy (hs-CRP) va cac yeu to nguy co trong nhoi n^au i^ao cap", Tgp chi Nghien c&u Yhgc, 15(1), tr. 176-181.
2 L& Thi Hang (2012), Nghien cUu nbng do hs-CRP, fibrinogen, bgch cau, tic do long mau & binh nhan tai biin mgch mau nao, Lugn van thgc sy y hoc, Trudng Dgi hocY Dupc Hue.
3 Hoang Khanh (2013), "Chi diem sinh hpc trong dot quy nao", Ofit quy nao, Nha xuat ban Y hoc, tr 149,
4 Nguyen Dinh Toan va cs (2012), "Cac chat chi di^m sinh hoc trong nhfii mau nao", Yhgc thuc hdnh, Nha xuat ban Bo Y te.
5. Nguyen Tudng Van va Tran Xuan NghTa (2012),
"Nghien c&u sy bien doi nong dfi C-reactive Protein huyet t u o n g d bgnh nhan dfit quy nao 24 gid d§u t?i Bfinh vien C Da Nang", Tgp chi YDugc lam sang 108, 7(10), t r 116-123 6 Kisialiou A, Pelone G, Carrizzo A, et al (2012), Blood biomarkers role in acute ischemic stroke patients: higher Is worse or better, immunity & Ageing, 9:22.
7. IVlohebbi S et al (2012), Predictive role of high
sensitive C-reactive protein in early onset mortality after ischemic stroke, IrJ Neurol, 11(4), pp.135-139.
8. Napoli DM, Papa F, Bocola V (2001}, Prognostic Influence of Increased C-Reactive Protein and Fibrinogen Levels in Ischemic Stroke. Stroke, 32, pp.133-138.
9. Rothwell P M, Hoard S C, Power D A, et al (2004), Fibrinogen Concentration and Risk of Ischemic Stroke and Acute Coronary Events in 5113 Patients With Transient Ischemic Attack and Minor Ischemic Stroke, Stroke; 35, pp.2300-2305.
lO.Shenhar-Tsarfaty S, Ben Assayag E, Bova I, et al (2006), Wide range C-reactive protein efficacy in acute ischemic stroke patients, ActaNeurolScand; 114, pp 29-32.
11 Zaremba J, Skrobanski P, Losy J (2004) Acute ischaemic stroke increases the erythrocyte sedimentation rate, which correlates with early brain damage. Folia MorpholJ; 63(4), pp.373-376.
12. Whiteley W, Jackson C, Lewis S, Lowe G, Rumley A, et al (2011), The association of circulating inflammatory markers w i t h recurrent vascular events after stroke: a prospective cohort sludy. Stroke, 42(1), pp.10-16
