Top chi Y Dugc Hqc - Tru&ng Dqi hgcY Dugc Hui -ldp 6, so 6- thdng 1/2017
NGHIEN C&U s y BIEN DO! NONG Od PROCALCITONIN HUYET THANH d BENH NHAN BENH THAN MAN GIAI OOAN CUOI
Ngo Thi Khanh Trang', Hodng Biii Bdo' (1) Nghiin c&u smh Tru&ng Dgi hgc Y Dugc - Dgi hgc Hue, chuyen ngdnh Ngi Thgn - tiet meu
(2) Bg mdn Ngi, Tru&ng Dgi hgc Y Duqc Hui Tdm tat
D|t van d l : Mge dii procalcitonin (PCT) da dupe xem nhu la mpt dau an viem mdi b bgnh nhin Ige miu nhung van de nay chya dupe nghien c&u d Vigt Nam. Muc tieu eua nghien e&u la khao sit sy biln ddi ndng dg PCT huyet thanh va mdi lien quan gi&a PCT huyet thanh vdi cae yeu td viem khac (hs-CRP, IL-6), ylu td dinh dudng (albumin, prealbumin, BMI), bien cd bgnh tim mgch (suy tim, tai biln mgch mau nao, b§nh mach vanh, can tang huyit i p khan cap) sau 1 nam theo ddi. Ddi tupng va phuang phap: 174 bgnh nhan BTM giai dogn cudi khdng cd bleu hign nhiim triing (57 bgnh nhan chUa Ipc miu, 56 benh nhan LMB lien tye ngogi tru, 61 bgnh nhan LMCK). Danh gia dinh dudng (BMI, albumin, prealbumin huyet thanh), viem (hs-CRP, IL- 6), Cac bien eo bgnh tim mach dupe ghi nhgn trong sudt 12 thing theo ddi (suy tim, tai bien maeh mau nao, bgnh mach vanh, can tang huyet i p khin elp). Ket qui: Trung vj (t& phan vi) ciia ndng dp PCT huyet thanh la 0,44 ng/ml (0,23 - 0,98). Cd 45,4% bgnh nhan tang ndng dp PCT (>0,5ng/ml), day la diem eat gpi y chan doan nhiem triing d ngudi khdng cd bgnh than mgn. Nh&ng bgnh nhan LMCK cd ndng do trung binh eung nhu cd ty lg tang ndng dp PCT huyet thanh eao hPn so vdi nh&ng bgnh nhan chua Ipe mau va LMB. Nh&ng bgnh nhin tang ndng dp PCT huyit thanh cd trung binh BMI thap han. Nong dp PCT huyet thanh tuang quan thugn vdi ndng dp IL-6. So vdi nh&ng bgnh nhin cd ndng dp PCT< 0,5ng/ml, nh&ng bgnh nhan cd ndng dg PCT >0,5ng/ml tang nguy ca xuat hien bien cd benh tim mgch trong 12 thing theo ddi (HR: 2,09; KTC 95%:
1,31-3,33; p=0,002). Kit luin: Trong trudng hpp khdng ed nhilm trCing, ndng dp PCT huyit thanh d bgnh nhan BTM giai dogn cudi ed the tang do giam dao thai hay tang tdng hpp. Ngoai ra, PCT ed the ddng vai trd l i dau an phan anh tinh trang vigm mgn m&e do thap, lien quan vdi nguy ea biln cd bgnh ti'm mgeh cao b bgnh nhan BTM glai dogn cudi.
Tir khda: procalcitonin, binh thqn mgn giai dogn cudi Abstract
SERUM PROCALCITONIN LEVELS IN PATIENTS WITH END-STAGE RENAL DISEASE (ESRD)
Ngo Thi Khanh Trang', Hoang Bui Bad (1) PhD stdudent of Hue University of Medicine and Pharmacy - Hue University
(2) Hue University of Medicine and Pharmacy Background: Although procalcitonin (PCT) has been described as a new marker of inflammati'on in dialysis patients, it has not been studied in patients with end-stage renal disease (ERSD) in Viet Nam. The objective of this study was to evaluate: serum PCT levels in patients with ERSD and its association to other inflammation (hs-CRP, lL-6) and nutritional (aibumin, prealbumin, BMI) factors and the cardiovascular disease (CVD) events (heart failure, cerebrovascular disease, coronary heart disease, urgence hypertension) after l-year follow-up.
Subjects and methods: Atotal of 174 patients without infection (include: 57 predialysis patients, 56 continuous ambulatory peritoneal dialysis patients, 61 hemodialysis patients) were enrolled. Inflammatory markers (PCT, hs-CRP, IL-6) and nutritional parameters (albumin, prealbumin, BMI) were determined. CVD events (heart failure, cerebrovascular disease, coronary heart disease, urgence hypertension) were evaluated during 12 months of follow-up. Results: The median baseline serum PCT levels of them were 0.44 ng/ml (0.23 - 0.98).
Of them, 79 patients (45.4%) had baseline serum PCT levels of over 0.5 ng/ml, which is the cut-off point suggesti've of sepsis in non-dialytic individuals. Hemodialysis patients was associated with significantly higher
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JOUBKAL OF MEDICINE AJ
Tgp chl Y Dugc Hgc • Tru&ng Dqi hgcY Dugc Hui- Tdp 6, so 6- tbdng 1/2017 PCT values than predialysis and peritoneal dialysis patients. The patients with elevated PCT plasma levels had the BMI tower. PCT and lL-6 were positively correlated with each other. Compared to patients with serum PCT levels of under 0.5 ng/mt, patients with serum PCT levels of over 0.5 ng/ml had an increased CVD risk in 12 months of follow-up (HR: 2.09; 95% Cl: 1.31-3.33; p=0.002). Conclusion: In the absence of infection, PCT may increase due to reduced renal elimination and increased synthesis. Furthermore, serum PCT could serve as a marker of low-grade inflammation, which substantially increase CVD events risk in patients with ERSD.
Keywords: Procalcitonin, end-stage renal disease
1. DJE^T VAN DE
Hign nay, cac nghign c&u gpi y PCT khdng chi la dau an sinh hpc cua viem va nhilm triing ma cdn la ehit gidng cytokine tien viem. Ndng dp PCT tang trung binh d bgnh nhan BTM ma khdng ed bieu hign nhiem triing da dupc eh&ng td qua nhieu nghien c&u (2), [5]. Vin d l nay chua duac cic tie gia trong nude de cgp den. Xuat phit t& thyc t l t r i n , chung tdi tien hanh nghien ciru de tai: "Nghien clhi s&
biin ddi nbng d^ procalcitonin huyet thanh & bqnh nhan bqnh thqn mqn giai doqn cudi" nham myc tieu:
1. Khao sdt s& biin doi nong dq procalcitonin huyit thanh & binh nhan benh thdn mgn giai doqn cudi.
2. Tim hiiu mdi lien quan vd tuang quon gi&a nbng dq procalcitonin huyit thanh v&i cdc yiu td:
viim (hs-CRP, interleukin 6), dmh du&ng (BMI, albumin vd prealbumin huyit thanh) vd bien cdbinh tim mgch (suy tim, tai biin mgch mdu nao, binh mqch vdnh, can tdng huyit dp khdn cdp) sau 1 nam theo dbi
2. DOI Tl/QNG VA PHl/CNG PHAP NGHIEN CU'U 2.1. Odi tupng nghiin c&u
Nghien c&u dupc tien hanh t& thing 1/2014 den thing 10/2015 tai khoa Ndi Than Ca Xuang Khdp va khoa Thgn nhin tao Bgnh vien Trung uang Hui.
Chiing tdi thyc hign khio sat 174 bgnh nhan dupc ehia lam 3 nhdm: nhdm bgnh nhan bgnh th|n mgn giai dogn eudi dang dilu trj bao ton (57 bgnh nhan), nhdm bgnh nhin bgnh thgn man giai dogn cudi Ipe mang byng (56 ngudi) va nhdm bgnh nhan bgnh th|n mgn giai dogn cudi Ipe mau ehu ky (61 bgnh nhin).
2.1.1. TiSu chudn chgn b$nh
2.1.1.1. Tiiu chudn chon binh nhan binh thqn mgn giai dogn cudi dieu trj bda tbn
- Bgnh nhan bgnh than mgn do VCT mgn v i VTBT mgn vdi m&c Ipc eau thgn < 15 ml/phiit/l,73m^
- Chua dupe dieu trj bang cic phuang phap thay t h i than suy: Ipe mau chu ky, hoae Ipc mang bgng, hoge ghep thgn.
-Khdng s&dyng s&dyng cic djch truyen albumin.
acid amin it nhit trong vdng 1 thing trude khi chpn bgnh lim xet nghigm.
- Khdng sdt; khdng cd dau hieu viem, nhiem trting; cdng th&e mau cd sd lupng bgch eau < lOG/L.
- Tudi trudng thanh > 18 tudi - Ddng •y tham gia nghien e&u.
- Khdng ed tigu chuin loai tr&
2.1.1.2. Tieu chuan chgn binh nhdn binh thgn mgn giai doqn cudi Igc mdng bgng
- Lpc ming bung lien tye ngoai tru it nhat da dupc 2 thing (khi tinh trang sau phlu thugt dgt Catheter vao d byng da dn djnh va bgnh nhin da thuan thyc quy trinh thay djch).
- Bgnh nhan BTM do VCT mgn va VTBT mgn.
- Khdng s&dungs&dyngcaedieh truyin albumin, acid amin it nhit trong vdng 1 thing trudc khi chpn bgnh lim xet nghigm.
- Khdng sdt; khdng ed dau higu viem, nhiem triing; edng th&c mau cd so luong baeh cau < lOG/L - Khdng dang trong tinh trgng viem phuc mge, nhiem trimg ehin dng.
- Chua t&ng ghep than.
- Tudi trudng thanh £ 18 tudi - Ddng V tham gia nghign c&u.
- Khdng CO ti'eu ehuan logi tr&
2.1.1.3. Tliu chuan chqn binh nhbn binh thgn mqn gioi doqn cudi Igc mdu chu ky
- Lpc miu it nhat da dupe 2 thing.
- Bgnh nhan BTM do VCT mgn va VTBT mgn - Khdng s& dyng s& dyng cic dich truyen albumin, acid amin it nhat trong vdng 1 thing trudc khi chpn bgnh lam xet nghigm.
- Khdng sdt; khdng cd dau higu viem, nhiem triing; edng th&e miu ed sd lupng bgch eau < lOG/L.
- Chua t&ng ghep thgn.
- Khdng dang trong tinh trgng vigm tie clu ndi dgng-ti'nh mgch.
- Tudi trudng thanh > 18 tudi - Ddng 9 tham gia nghign c&u.
- Khdng ed tigu chuan loai tr&
2.2.2. Tieu chudn loqi trd
- Bgnh nhan phii, cd chudng phit hign tren lim sang.
!9|
Tap chi Y Duvc Hoc - Truimg Bqi bqc Y Dugc Hue -Tdp 6, si 6- thdng 1/2017 - Co kem theo mdt trong cac bgnh 1^ sau: benh ae ti'nh, benh phdi man ti'nh, xa gan, bgnh t y mien tiln triln can s& dung thudc &c ehe mien d|ch
- Dot cap suy thgn mgn.
- Co can thigp phau thugt trong vong 1 thing trude khi chpn bgnh lim xet nghiem.
- Cd s& dung eie thude khang viem, khang sinh trong vdng 1 thing trudc khi chpn bgnh lim xet nghigm.
2.2. Phuang phap nghign c&u
Phuang phip nghien c&u eat ngang, ed theo doi dpc biln cd benh tim mgeh trong 12 thing.
Cac bien sd lam sing: tudi, gidi, ein ngng, chieu eao.
Cic bien sd cgn lam sang: albumin, prealbumin, proeateitonin, hsCRP, lL-6.
Cae bien eo tim mgch gdm: TBMMN, suy tim, cPn THA cap tinh, bgnh mgch vanh (can dau that ngyc, nhoi miu catim).
Phuang phap djnh lupng procalcitonin huyet thanh:
+ Theo phuang phap djnh lupng miln djch dign hda phit quang ECLIA, dupc thye hiSn tren may Cobas e 501, khoa Sinh hda, Bgnh vign Trung uang Hue.
+ Ndng dp PCT dupc bleu thj bang dan vj ng/ml.
Gia trj binh thudng PCT < 0,05 ng/ml. Xic djnh tang ndng dg PCT khi > 0,5ng/ml [5).
Cac mau miu tTnh maeh dupc lay vao buoi sang, luc ddi, trudc lpc (ddi vdi bgnh nhin toe miu va lgc ming byng).
X&l^sdligu: SPSS 22.0 3. KET QUA NGHIEN CU'U
Bing 1. Die dilm chung Niidm nghien ci>u
Oac (Jilm ^~"-^^^^
Tuoi
Gidi
18-59
>60 X±SD (nam)
Nam Muf
Ciiung (N=174) n 124 50
%
71,3 28,7 48,11 ± 15,10
83 91
47,7 52,3
DTBT (N=57) n 37 20
%
64,9 35,1 50,83 ± 16,67 24 33
42,1 57,9
LMB (N=56) n 42 14
%
75 25 47,66 ± 12,82
34 22
60,7 39,3
lUCK (N=61)
n 1 %
45 16
73,8 26,2 45,98 ± 15,36 25 36
41,0 59,0 Nhgn xet: Ty lg bgnh nhan tgp trung d dg tudi 18 - 59 trong nhdm chung cung nhu cae nhdm bgnh DTBT LMBvaLMCK.
Ty lg bgnh nhan nam/n& trong nhdm nghien c&u chung la 83/91.
Bing 2. Nong dd procalcitonin huyet thanh d bgnh nhin BTM giai doan eudi x,^^ Nhdm
Xrighten
^ o r u Procalcitoniri^
(ng/ml)
<0,5
>0,5 Trung vi (Khoang t&
vi)
ciiung {N=174)
n 95 79
%
54,6 45,4 0,44 (0,23 - 0,98)
BTBT (N=57) (a) n 43 14
%
75,4 24,6 0,26 (0,13-0,49)
LMB (N=56)
(b) n 41 15
%
73,2 26,8 0,34 (0,23 - 0,54)
LIVICK (N=61) (0 n 11 50
%
18,0 82,0 1,13 (0,60 - 2,31)
P
(a)&(b)
>0,05
>0,05 (b)8i(c)
<0,001
<0,001 (c)S(a)
<0,001
<0,001
Nhgn xet:
- Ty Ig tang ndng dp procalcitonin b nhdm ehung
l i 45,4%. vj nong dp procalcitonin d nhdm LMCK cao han so -Ty Ig tang nong dp procalcitonin eijng nhutrung vdi DTBT va LMB vdi p<0,001.
I 3 0 lOURN;
Tqp chi Y Duvc Hoc - Tru&ng Dgi hgc Y Duvc Hui- Tdp 6, si 6- thang 1/2017 Bangs. Lien quan gi&a su tang ndngdd procalcitonin huyet thanh vdi eae yeutd dinh dudng
^~~~"~'""~--....„_^^^^ PCT (ng/ml) Ylu td ^^~~'~~~~~~-,„_^^^^
BMI (kg/m=) Albumin (g/l) Prealbumin (g/l)
X±SD X±SD X + SD
< 0,5 (N = 95) 19,95±2,80 36,36±4,87 0,32±0,10
> 0,5 (N = 79) 18,80±2,71 37,26±4,51 0,31±0,09
P
<0,01
>0,05
>0,05 Nhgn xet:
Tri sotrung binh BMI dnhdm bgnh nhan cd ndngdd PCT>0,5 ng/ml thip honsovdi nhdm benh nhaned ndng dd PCT < 0,5 ng/ml cd y nghTa thdng ke.
Bang 4. Sy tuang quan gi&a nong do procalcitonin huyet thanh vdi yeu td viem va dinh dudng
^'"""~~-~—....^^^^ Procalcitonin Yeu td ^~~~~~~-~~~-.,,^^^^^
hs-CRP lL-6 BMI Albumin Prealbumin
r
0,20 0,47 -0,05 0,18 0,06
P
<0,05
<0,01
>0,05
<0,05
>0,05 Nhdn xet: Cd mol tuang quan thugn m&c trung binh gi&a ndng dp procalcitonin vdi ndngdd lL-6.
Bang 5. Lien quan gl&a su tang ndng do procalcitonin huyet thanh vdi biln cd tim mach
^ . . PCT (ng/ml)
Bi^n cd ^v^^^
Khdng Cd
<0,5 (N = 95) n
54 31
%
67,4 32,6
>0,5 (N=79) n 36 43
%
45,6 54,4
P
<0,01 Nhgn xet: Ty Ig xuat hign bien ed tim mgch d nhdm benh nhan ed nong dp PCT>0,5ng/ml cao ban so vdl b nhdm benh nhan cd ndng dp PCT< 0,5ng/ml (p<0,05).
Bang 6. Phin ti'eh hdi quy COX da bien ve sy anh hudng eiia tang ndng dd PCT huyet thanh len nguy ca xuat hign bien ed Hm mach
Cac yeu td (N=174) Procalcitonin > 0,5
(ng/ml) Tudi > 60
N&gidi
HR 2,09 1,04 1,35
KTC 95%
1,31-3,33 0,62-1,73 0,85-2,15
Gia tri p 0,002
0,88 0,20 Nhdn xet: lang ndng do PCT huyet thanh lien quan dpe lip vdi nguy cP xult hien bien cd tim maeh.
D PHARMACY 3 1 I
p chi Y Duvc Hoc - Tru&ng Doi hqc Y Duvc Hui- Tgp 6, si 6- thdng 1/2017
Survival Function fof patten
Chu thich:
Nhdm PCT<0,5:0 Nhdm PCT >0,5:1
Bieudd 1. Nguy ca bien ed tim mgch theo sy tang ndng dp PCT huyet thanh 4. BAN LUAN
4.1. Ndng dd procalcitonin b bgnh nhan bgnh t h i n mgn giai dogn cudi
Kit qui ciia chiing tdi eho thay cd den 45,4%
bgnh nhan trong nhdm ehung va dgc bigt la t^ Ig IPn bgnh nhan LMCK (82%) ed ndng dp PCT >0,5ng/ml mge dii trong thiet ke nghien e&u chiing tdi da logi tr& nh&ng bgnh nhan cd sdt va sd tupng bgch eau
>10G/L. Trong thyc t l , bgnh nhan BTM giai dogn cudi dilu tri LMCK ddi liie thieu eic tngu ch&ng chii quan nhung khi bgnh nhin d l bj nhilm triing ngng hay nhiem triing miu thi cic trigu ch&ng khieh quan nhu sdt eao, nhjp tim nhanh, khd thd v i / hogc hg huyit i p se xuat hign. Vi viy, tang dan dpe PCT khdng ddng nghTa vdi bgnh ly nhiem triing giai doan sdm.
Ichihara K khao sit tren 125 bgnh nhin Ipc miu khdng cd dau higu nhiem trting hg thdng eho thay nong dg PCT d hau het bgnh nhan BTM giai dogn eudi dieu tri bang LMCK tuang t y nhu b ngUdi khde manh (0,24 ± 0,22 ng/ml). Tuy nhign, 27/125 benh nhan (ehiem ty Ig 21,6%) cd nong dp PCT tren m&c 0,3ng/mt trong dd cd 9 bgnh nhan (ehilm ty Ig 7,2%) cd nong dg P a trgn 0,5 ng/ml dii khdng cd bieu hign nhiem trimg [4].
De danh gii sy khic bigt ve nong dd PCT gi&a bgnh nhin LMB vdi ngudi khde mgnh, Opatrna S va cgng sy da tien hinh nghign c&u trgn 28 bgnh nhin LMB dn djnh, khdng cd bieu hign nhilm trimg hg thdng v i qui tai djch, khdng ed tien s& phau thugt hay nhilm triing trong vdng 3 thing trudc thdi diem nghien c&u. Kit qua cho thay: nong dp PCT d bgnh nhan LMB (trung vj: 0,33ng/ml) cao han so vdl
I 3 2 lOURNALOF MEDICIUE AND PHARMACY
ngudl khde manh (trung vi: 0,18ng/ml) vdl p<0,001, tuang quan thu|n vdi CRP, tuang quan nghjch vdi ch&e nang thgn cdn Igi [7].
Nhuvgy, tuang t y cie nghien c&u khic, chiing tdi cung eh&ng td tang PCT d bgnh nhan BTM glai dogn cudi m i khdng cd dau higu nhilm triing. Ngoai ra, kit qua ciia chiing tdi cdn the hien ndng dp PCTtrung binh CLia nhdm LMCK cao hPn so vdi nhdm LMB va bgnh nhin BTM giai dogn cudi trudc Ipe mau. Theo nghign c&u ciia Herget-Rosenthal va epng sy, nong dp PCT trung binh b bgnh nhan BTM giai dogn 1-lV khdng khac biet so vdi nhdm ch&ng. Tuy nhien, nong dp PCT b bgnh nhan BTM glai dogn V v i LMB cao hpn so vdi nhdm eh&ng va nhdm bgnh nhin BTIVl glai dogn l-IV. Ndng dp PCT d bgnh nhan LMCK cao han ed ^ nghTa so vdi bgnh nhan LMB va BTM d cic giai dogn [3]. Nguyen nhin cua sy tang nong dp PCT ed the la do giam MLCT hay tang tdng hpp PCT bdi eic t l bio mau dan nhan ngogi bign [2].
4.2. Mdi lien quan va tuang quan gi&a n&ng dq proealcitonin huyet thanh vdi cac yeu td: vilm (hs- CRP, interleukin 6), dinh dU&ng (BMI, albumin vi prealbumin huyit thanh) va bien eo bgnh tim mgch sau 1 nam theo doi.
Ket qua nghien c&u cho thay ed mdi tuang quan thugn m&e trung binh gi&a ndng dp procalcitonin vdi ndng dp lL-6. Bgn cgnh do, ehiing tdi eung ch&ng td dupe trj sd trung binh BMi d nhdm bgnh nhan cd nSng dp PCT> 0,5 ng/ml thap ban so vdi nhdm benh nhin cd ndng dg PCT < 0,5 ng/ml cd)/
nghTa thdng ke. Oieu nay gpi y sy tang nong dp PCT huyet thanh b bgnh nhin BTM giai dogn cuoi khdng cd bilu hign nhiim triing tren lam sang la sy phan
Tqp chi Y Duqc Hqc - Tru&ng Ogi hgc Y Duvc Hue- Tgp 6, si 6- thdng 1/2017
a n h tinh t r g n g v i e m m g n m & c d p t h a p t r o n g m d i t r u d n g u r e m a u eao.
T r o n g n g h i e n e&u eiia c h u n g t d i , t i n g n d n g d p PCT h u y e t t h a n h (>0,5 n g / m l ) ndi l l n v d i m p t vai t r o q u a n t r p n g t r o n g vigc d y b a o n g u y c a b i e n ed tim maeh d b g n h n h i n BTM glai d o g n c u o i . D i e u d d cCing d a d u p c s i n g t d d a n q u a m p t s d n g h i e n e & u khae, n h a t la t r o n g k h o a n g t h d i gian gan d i y :
- T h e o n g h i g n c & u ciia Erren M v i c p n g s y , n d n g d p PCT t a n g t u a n g q u a n v d i m & e d p t d n t h u a n g m a c h m a u b b g n h n h a n ed b g n h mgeh v i n h va b g n h d p n g m g c h ngogi b i l n [ 1 ] ,
- N g h i e n e&u A t h e r o G e n e S t u d y t h y e hign t r e n 2 1 3 1 b g n h n h i n b g n h m g e h v a n h v d i t h P i gian t h e o d d i t r u n g b i n h 3,6 n a m , k i t q u a n h u sau: Cd 95 b g n h n h a n t & v o n g d o n g u y e n n h a n tim m g e h , 85 b g n h n h a n n h d l m i u cP tim k h d n g t & v o n g . N h & n g b g n h n h a n t & v o n g d o n g u y e n n h a n tim mgeh ed n d n g d p PCT cao h a n ( 0 , 0 2 1 n g / m l so v d i 0,015 n g / m l ; P < 0 , 0 0 0 1 . N o n g d § PCT b n h & n g b g n h n h a n hpi c h & n g v a n h cap eao h a n so v d i n h & n g b g n h n h i n c a n d a u t h a t n g y c d n d j n h (0,016 so v d i 0 , 0 1 4 n g / m l , p < 0 , 0 0 0 1 ) . P h i n ti'ch h d i q u y COX, n d n g d g PCT t i n g lien q u a n d e n t & v o n g d o b g n h tim mgeh (HR:
1,34; 9 5 % Cl: 1,08-1,65, P=0,0070), K i t qua nay c h & n g t d PCT t a n g cd </ nghTa tien l u p n g n g u y cP t &
v o n g d o b g n h tim m g c h [ 8 ] .
Cae n g h i g n e&u gan day c h & n g t d PCT con d u p c x e m n h u la m p t d a u I n ciia v i e m m g n m & c d p t h a p b b g n h n h i n BTM giai d o g n cudi c h u a Igc m i u va d i e u t r i Ipe m i u [ 2 ] , [ 5 ] . Ngoai ra, d i i vai t r d sinh ly
t r o n g qua t r i n h v i e m ciia PCT v i n con ehua r d n h u n g cd b a n g c h & n g c h o t h i y PCT c d dgc ti'nh eiia chat h d a d n g d p n g b g c h eau va d i e u hda s y t d n g h p p NO b d i eae t e b i o ndi mac d i n d e n n h & n g t i c d d n g bat Ipi c h o e a t h e [ 2 ] , [ 6 ] .
5. KET LUAN
5 . 1 . Nong d p procalcitonin 6* b e n h n h a n bgnh t h g n mgn giai d o g n cudi
- T r u n g vl ( t & p h a n vl) cua n d n g d p PCT h u y e t t h a n h la 0,44 n g / m l (0,23 - 0,98). Cd 4 5 , 4 % b g n h n h a n t a n g n d n g d p PCT ( > 0 , 5 n g / m l ) , d i y l i d i e m eat g p i y ehan d o a n n h i l m t r i i n g d ngu'di k h d n g cd b e n h t h g n m a n .
- N h & n g b e n h n h i n LMCK cd n d n g d o t r u n g b l n h c u n g n h u cd t y lg t a n g n o n g d o PCT h u y e t t h a n h cao h a n so v d i n h & n g b g n h n h a n c h u a lpc m i u v i LMB.
5.2. M d i lien quan va t u a n g quan gi&a n&ng d d procalcitonin h u y i t t h a n h v d i cac yeu t d : v i l m (hs- CRP, interleukin 6 ) , dinh d u & n g ( B M I , albumin va prealbumin huyet t h a n h ) va bien cd bgnh tim mach sau 1 n a m t h e o d o i .
- N h & n g b g n h n h a n t a n g n d n g d p PCT h u y i t t h a n h cd t r u n g b i n h B M I t h a p h a n .
- N o n g d p PCT h u y e t t h a n h t u a n g q u a n t h u g n v d i n d n g d g IL-6.
- So v d i n h & n g b g n h n h a n cd n o n g d d PCT<
0 , 5 n g / m l , n h & n g b e n h n h a n ed n d n g d p P C T > 0 , 5 n g / m l t a n g n g u y ca x u l t hien bien c d b g n h tim m g c h t r o n g 12 t h i n g t h e o d o i (HR: 2,09; KTC 9 5 % . 1 , 3 1 - 3,33; p=0,002).
T A I L I I U T H A M KHAO
1. Erren M, et al (1999), "Systemic inflammatory parameters in patients with atherosclerosis of the coronary and peripheral arteries", Arterioscler Thromb Vase Biol, 19, pp. 2355 - 2363.
2. Herget-Rosenthal S, Klein T, Marggraf G, et al (2005),
"Modulation and source of procalcitonin in reduced renal function and renal replacement therapy", Scand J Immunol, 6 1 , pp. 180-5.
3. Herget-Rosenthal S, Marggraf G, et al (2001),
"Procalcitonin for accurate detection of infection in haemodialysis", Nephrol Dial Transplant, 16, pp. 975-9.
4. Ichihara K, et al (2015), "Serum proealcitonin level in chronic hemodialytic patients w i t h no evidence of
bacterial infection". Renal Replacement Therapy, pp 2-9.
5 LevelC,ChauveauP,DelmasY,etaI(2001),"Pracalcitonin:
a new marker of inflammation in haemodialysis patients?"
Nephrol Dial Transplant, 16, pp. 980-6.
6. Maruna P, et al (2000), "Physiology and genetics of procalcitonin", Physiol Res, 49 (1), pp. 57-61.
7. Opatrna S, et al (2005), "Procalcitonin levels in peritoneal dialysis patients". Peritoneal Dialysis International 25, pp. 470-472.
8. Sinning CH, et al (2011), "Association of Serum Procalcitonin W i t h Cardiovascular Prognosis in Coronary Artery Disease - Results From t h e AtheroGene Study", Circ J, 75, pp 1184 - 1 1 9 1 .
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