Y HQC Vl|T NAM THANG 3 - s 6 1/2013
LIEN QUAN GIUTA NONG DO HOMOCYSTEIN MAU VA MOT Sd CHI SO CAN LAM SANG is BENH NHAN DAI THAO D O ^ G TYP 2
N g u y i n Thj T h a n h T h u y S Oo T r u n g Quan^
N g u y e n Oanh Oanh^
on n o patients of Friendship Hospital (55 in type 2 diabetic patients and 55 in nondiabetic patients) from 5/2011 to 4/2012.
Results and Conclusions: Plasma Hey levels in microalbuminunc diabetics were higher than in normoalbuminuncs (15,94±7,95 vs 12,06±3,l3 pmol/l, p=0,00003); Plasma Hey levels in type 2 diabetic patients with carotid lesions were higher than in nondiabetic patients (12,38±3,18 so vdi 10,44±3.12;
12,68±4,46 so vdi 11,07+2,80 pmol/l, respectively), however no statistically significantly difference; Plasma Hey levels and HbAlC, MAU were correlated m diabetic patients (r = 0,107 ; r = 0,211 respectively);
Keywords: homocysteine, HbAlC, microalbuminuna, carotid, type 2 diabetic patient
I.
OAT VANo i
Oai thao dffdng la mot benh thudng gSp nhat trong cac benh nol tiet. Hien nay nd trd thanh mpt trong nhffng van de thach thffc nhat ciia the ky 2 1 .
Homocysteine (Hey) la mpt acid amin co chffa nhdm sulfur. Tang Hey la 1 yeu to nguy cd dpc lap ciia benh tim mach va cung lien quan vdl cac bien chffng DTD, beo phi va hpi chiitig chuyen hda. Tang Hey mau tren BN OTD typ 2 se tao thanh mot yeu to nguy cd kep tac dpng lam gia tang cac nguy cd xuat hien nhieu bien chutig nhu xd vffa dpng mach, benh ly ve than, than kmh, tim mach va tff vong d BN DTO typ 2 [5].
Tren the gidl da co rat nhieu cong trinh nghien cffu cho thay co sff lien quan giffa nong dp Hey trong mau va benh mach vanh, nao;
benh ly than, mat d BN DTD. O BN OTO typ 2, nong dp Hey trong mau con la sU tien Iffdng co y nghia cac kha nang mac cac benh tim mach va tff vong.
6 Viet nam, con it nghien ciiu ve Hey nol Chung va Hey vdi cac yeu to khac trong benh DTD typ 2 noi rieng, vi vay chiing toi tien hanh thffc hien de tai "Lien quan giu^ nong do Homocysteine mau va mot so chi so can ISm sang d ijenh nhan dai thao du'dng typ 2" vdi muc tieu: Tim hieu mol lien quan giG3 nong dp Homocystein mau vdl HbAlC, T d M T A T
Oai thao du'dng (DTD) la mot b?nh thUdng gSp nhat trong cac benh npi tiet va dang trd thanh mpt trong nhffng van de thach thffc nhat ciia the ky 21.
Homocystein (Hey), mgt thiol chffa amino acid, noi bat len nhLf la mpt yeu to quyet d|nh cho cac rdi loan chuyen hoa pfiffc tap trong vai nSm qua. TSng Hey mau tren BN DTD typ 2 se tao thanh mpt yeu to nguy CO kep tac dpng lam gia tSng cac nguy cd xuat hien nhieu bien chimg.
Muc tieu: Tim hieu moi lien quan giij'a nong do Hey mau v6i HbAlC, microalbumin ni?u (MAU) va tinh trang xO vi?a dong mach (DM) canh d BN DTO typ 2.
Doi tUtfng va phu'dng phap: nghien cffu benh - chifng UO benh nhan (BN) ciia Benh vien Hffu nghi:
55 BN OTD va 55 BN khong OTD tff S/2011 den 4/2012.
Ket qua va ket luan: Nong do Hey d nhom OTD CO MAU (+) cao hon nhom DTD co MAU (-) co y nghia thong ke: 15,94±7,95 so vcd 12,06±3,13 (pmol/i) vdi p=0,00003; Nong do Hey ciia BN co ton thUdng DM canh (hep, mang xcJ vffa) d nhom DTD cao hdn nhom khong DTD (fan lUOt 12,38±3,18 so vdi 10,44±3.12; 12,68+4,46 so vdi 11,07+2,80 pmol/l) (p>0,005); Nong do Hey mau va HbAlC mau chUa thay CO moi tUOng quan chat che (r = 0,107); Nong do Hey mau va MAU d nhdm BN DTD co moi tUdng quan thuan (r = 0,211).
Tu'khoa: homocystein, HbAlC, microalbumin, dong mach canh, dii thao du'dng
SUMMARY
RELATIONSHIP BETWEEN HOMOCYSTEINE LEVEL AND SEVERAL PARACLINICAL CHARACTERISTICS IN TYPE 2 DIABETIC
PATIENTS
Background: Diabetes is undoubtedly one of the most challenging health problems in the 21st century. Homocysteine, a thiol containing ammo acid, has emerged as a determinant for many complex metabolic disorders in the past few years.
Hyperhomocysteinemia in Type 2 Diabetes make to a double nsk factor create to increment complications.
Objectives: The aim of the study was to examine the relationship of Hey level with HbAlC, microalbuminuna (MAU) and carotid atherosclerosis in type 2 diabetic patients.
Methods: A case - control study was carried out 1. Binh Vlin Huu nghi; 2. Dai hoc y Hi noi; 3 Hgc vien q Phin bien khoa hpc: GS.TS. Nguyin Khanh Trgch
Y HOC VI$T NAM THANG 3 - SO 1/2013
microalbumin nieu va ttnh trang xd vud dong mach canh d benh nhan dai thao dddng typ 2.
II. o d l TUONG VA PHUONG PHAP NGHIEN COU 2 . 1 . fioi tiTcfng nghien cihi: UO b§nh nhan dieu trj npi t r t tal cac khoa ciia benh vien HQlj nghj tff 5/2011 den 4/2012, dudc chia l^m 2 nhdm:
- Nhom chirng: gom 55 ngUdi khong mac benh OTD (dffdng mau < 5,6 mmol/l)
Nhdm benh: gom 55 benh nhan DTO typ 2 (chan doan theo tieu chuan ciia TCYTTG - 2002)
Tieu chuan loai trff: DTO typ 1, cac loai OTO khac cd nguyen nhan; Tien sff mac cac benh ly than, gan; Oang cd bien chffng cap: hon me, nhiem khuan cap tinh; Cd benh ly kem theo:
viem khdp dang thap, parkinson, suy giap, carcinoma, HC kem hap thu; Dang dieu trj bang
cac thuoc vitamin 86, B12, folate, chong co giat, gian phe quan.,,)
2 . 2 . Phu'dng p h a p n g h i e n cu'u:
T h i e t ke n g h i e n cufu: mo ta cat ngang Nol d u n g n g h i e n cu'u:
+ Tuoi, gidi
+ Xet nghiem dinh Iffdng nong do Hey mau liic doi tai Cong ty cong nghe va xet nghiem Y hpc (MEDLATEC) tren may ADVIA Centaur XP ciia hang Siemens, phffdng phap mien dich canh tranh, ky thuat huynh quang phan cUc,
+ Xet nghiem: Glucose liic ddi, HbAlC, Microalbumin nieu (MAU); sieu am doppler dpng mach canh lam tai Benh vien Hffu nghi.
2.3. Xff ly so l i e u : bang chUdng trinh phan mem SPSS 16,0 va Epidata 3.0.
III. KET QUA NGHIEN CIJlU
1 , Moi l i e n q u a n g i C a n o n g d o H o m o c y s t e i n m a u vdi H b A l C , m i c r o a l b u m i n n i e u va t i n h t r a n g x d vu'a d p n g m a c h c a n h d BN D T D t y p 2
Bang 1. So sanh nong do Homocystein mau vdi mffc do HbAlC HbAlC
Nam
ua
Chung
Homocystein
HbAlC < 7%
HbAIC> 7%
P HbAlC < 7%
HbAlC > 7%
D HbAlC < 7%
HbAlC > 7%
P
Dai thao du'dng X ± S D
13,82±5,10 12,78±5,23
>0,05 12,16±3,72 12,59±3,18
>0,05 13,51+4,84 12,73±4,77
N 18 25 4 8 22 33
>0,05
Nong dp Hey d nhdm OTO kiem soat dffdc dudng mau va khong kiem soat dUdc dudng mau khac biet khong cd y nghTa thdng ke d ca hai gidi va nhom chung ( > 0,05),
BTB
Homo^/slEii Nam
Nu- Chunq
P
MAU Bu'tfng tinh
17,55±9,02 11,91+2,79 15,94+7,95
>0,05 n 5 3 8
Am tinh 12,01+3,09 12,24±3,46 12,06±3,13
>0,05 n 35 9 47
P
>0,05
>0,05 0,00003 Nong do Hey trung binh is nhom OTD c6 MAU (+) cao hdn nhdm OTO cd MAU (-) cd y nghia thong y& (p=0,00003). . , ..
Homocystein
Hep (Jong mach
Khonq hep
1 Iben
Bai thao dudng X ± S B 13,23±5,14
N 43 13,31+4,70 1 5
Khong dai thao di^dnq X ± S D
11,59+2,86 11,85+4,96
n 46 3
P
>0,05
>0,05
Y HQC VlgT NAM T H A N B 3 • S61;2I>13 canh
Mang xo vffa
Hep 2 ben
Chunq P Khonq c6 C6 mang xd
vifa 1 bSn 2 ben Chung P
11,72±1,60 12,38±3,18
>0,05 14,02±5,S7 12,65±3,34 12,69±4,7e 12,68±4,46
>0,05 7 12 15 9 31 40
9.73±1,99 10,44±3.12
>0,0S 11,98+3,07 10,54+2,52 11,34±2,96 11,07±2,80
6 9 20 12 23 35
>o,os 1
>0,OS.
>0,05
>0,05
>0,05
>0.05
>0,05
• '
1
Nong dp Hey d nhdm DTO khong hep hay hep OM canh phai hay trai cao hdn nhdm khong OTO;
nong do Hey d nhdm OTD khong cd hay cd mang xd vffa DM canh phai hay trai cao hdn nhom khong OTO, tuy nhien chffa cd y nghTa thong ke (p> 0,05).
2. Tu'dng q u a n giu'a n o n g d p H o m o c y s t e i n m a u v a d u ' d n g m a u luc d o i , MAU cua b e n h n h a n d a i t h a o d u ' d n g t y p 2:
2.1. Moi tu'dng quan giO'a nong dp Homocystein mau va du'dng mau Idc doi d BN DTD: Mdi tffdng quan giffa nong dp Hey mau va dffdng mau liic doi d benh nhan DTD cd tUdng quan nghich vdi r = -0,245, p > 0,05 theo phffdng trinh hoi quy tuyen tinh y = 15,802 - 0,383x.
2.2. Moi tu'dng quan giii'a nong dp Homocystein va HbAlC d BN DTD: Moi tffdng quan giffa nong dp Hey mau va HbAlC d BN DTO CO tffdng quan nghich vdi r = 0,107; p > 0,05 theo phUdng trinh hoi quy tuyen tlnh y = 14,790 - 0 , 2 1 8 x .
2.3. Mdi tu'dng quan giO'a nong dp Homocystein mau va MAU d benh nhan DTD: Moi tUdng quan giffa nong do Hey mau va MAU d nhdm BN DTO la tffdng quan thuan, vdi r
= 0,211; p > 0,05; phUdng trinh hoi quy tuyen ti'nhy -12,081 +0,053 x .
IV. BAN LUAN
4 . 1 . M o l l i e n q u a n giu'a n o n g d o H o m o c y s t e i n m a u v d i H b A l Q m i c r o a l b u m i n n i e u v a t i n h t r a n g x d v f f a d o n g m a c h c a n h d BN fiTD t y p 2 :
So sanh mdc do HbAlC vdi nong do Homocystein mau: Chiing toi nghien cffu thay nong dp Hey d nhom OTO kiem soat dffdc dffdng mau (HbAlC < 7%) va khong kiem soat dUde dffdng mau (HbAlC > 7 % ) khac biet khong co'y nghia thdng ke d ca hai gidi va nhdm chung (>0,05). Ket qua nay ciia chitng toi tffdng tff nhff ciia Pham Quang Thanh [1], Ly do cd the la nong do Hey va HbAlC la hai yeu t d ddc lap vdi nhau trong viec danh gia ton thUdng macli mau d BN OTO va do BN OTD nghien cffu dang dieu tri tich
cUc nhSm kiem soat dffdc dudng mau trong khi viec dieu trj nham giam nong dp Hey chffa dudc thffc hien va chffa dffdc chu y den nhieu.
Trong nghien cffu cua chung toi nong do Hey mau trung binh d nhom BN DTD khong kiem soat dUdc dudng huyet la: 12,73 ± 4,77 (n = 33/55) cao tffdng tff nhff trong nghien cffu ciia Pham Quang Thanh: 11,05 ± 3,94 (n = 47/56)
^ci\ p > 0,0006 [ 1 ] .
Theo Passaro A. va cpng sff: nong dp Hey mau cd lien quan den nong dp dffdng, HbAlC trong mau va co moi lien quan thuan vdi thdi gian bj benh OTO; dii moi quan he giii^
Homocystein va benh OTD la nhff the nao, dffdng nhU cai thien viec kiem soat dffdng mau se lam giam nong dp Hey d BN OTD. Trong 95 BN DTD theo doi trong 3 nam, nhffng BN vdi cai thien viec kiem scat dffdng huyet dffdc tinh bang
% HbAlC ed nong do Hey thap hdn so vdi nhffng BN CO tang HbAlC sau 3 nam [ 7 ] .
Nong do Homocystein mau cua benh nhin dai thao dddng typ 2 theo MAU
Trong nhieu nghien cffu djch te, MAU va Hey mau dffdc xem xet nhU la nhffng dau hieu chi diem ciia rdi loan hoat dpng mang trong (endothelial) va chi ra sff dff bao ciia benh madi vanh [ 4 ] .
Cac BN OTO dffdc chia thanh hai nhom:
nhom MAU 20-200 pg/phiit la dUdng tfnh, nhom MAU <20 pg/phiit la am tinh.
Nghien ciru ciia chung toi cho thay, nong do Hey d nhdm OTO co MAU ( + ) (15,94±7,95) cao hdn nhom DTD cd MAU (-) (12,06±3,13) co y nghia thong ke (p = 0,00003), tUdng dffdng vdl cac nghien cffu ciia Pham Quang Thanh [1] va DUdng Thi Tuyet [ 2 ] , Ozmen B [ 6 ] .
Lanfredlni va cpng sff cung da tim thay moi lien quan manh giffa Hey mau va chffc nang than suy giam [ 6 ] . Chf mpt vai nghien cffu tim ra
Y HQC VlgT NAM THANG 3 - SO 1/2013 nhffng khac biet khong dang ke trong nong do
Hey glti^ BN OTO typ 2 cd MAU (-) va ngffdi khoe manh. Mol lien quan g i i j ^ Hey va MAU con phai ban cai nhi^u. Mpt so tac gia tim thay mdi lien quan giffa Hey mau va MAU trong benh OTO, mpt so khac thi khong [ 6 ] . Cdn trong nghien cffu ciia chiing toi thay nong dp Hey d nhom OTO cd MAU (-) la (12,06±3,13) tffdng dffdng vdi d nhdm chffng la (11,40±2,91) vdi p = 0,058.
Nong do Homocystein mau cua BN DTD typ 2 theo ton thddng dgng mach canh
Cae bien chffng mach mau ldn d BN OTO khong phai la bien chffng dac hieu ciia benh DTO. Tffdng quan giffa tang glucose mau vdi bien chiihg mach mau Idn khong ro rang nhu tffdng quan glucose mau vdi bien chffng vi mach.
Nong dp Hey mau cao la yeu to gay pha huy thanh maeh dan den roi loan chffc nang van mach, tao huyet khoi gay ton thUdng ca mach mau ldn va he thdng vl mach [ 3 ] .
Nghien ciTu cua chung toi thay nong do Hey d nhdm OTD khdng hep, hep 1 ben va hep 2 ben dpng mach canh phai hay trai eao hdn nhom khong DTD, nhffng sff khac biet nay chua cd y nghia thong ke (p> 0,05); nong dp Hey d nhdm DTO khong ed, cd mang xd vffa 1 ben va co mang xd vffa 2 ben dpng mach canh phai hay trai cao hdn nhom khong DTD, tuy nhien chffa c6 y nghia thong ke (p> 0,05). Ket qua nay ciia chung toi khac nghien cffu ciia Pham Quang Tlianh la nong dp Hey d BN DTD ed mang xd vffa hay hep dpng mach canh so vdi BN OTD khong CO mang xd vffa hay khong hep dong mach canh khac biet eo y nghTa thdng ke (p< 0,05) [1]. Co sff khac biet nay cd the do doi tffdng nghten cffu ciia Chung tdi cao tud'i hdn, nhieu benh phdi hdp hdn... tao nhffng yeu t d nguy cd gdp phan lam tang Hey d nhffng BN khdng cd mang xd vffa.
4 . 2 . Tu'dng quan giij'a nong do Homocystein mau va du'dng mau luc doi, HbAlC va MAU ciia BN f>Tfi typ 2:
Moi tddng quan giO^ nong do Homocystein va HbAlC d BN DTD
Qua nghien cffu, chiing toi thay nong dp Hey mau va HbAlC mau chffa thay ed mol tffdng quan chat che (r = 0,107; p > 0,05); ket qua nay cung giong vdl ket qua nghien cffu ciia Dffdng Thi Tuyet (r = -0,042; p > 0,05) va Hoogeveen (1997) (r = -0,02; p=0,7}. Cae ket qua nay cang img hp gia thuyet mffc do kiem soat dffdng mau cua BN OTD typ 2 va nong dp Hey la hai yeu to dpc lap vdi nhau.
Moi tddng quan giu^ nong do Homocystein mau va MAU d benh nhan DTD
Qua nghien cffu ehiing toi thay mdi tffdng quan giffa nong dp Hey mau va MAU d nhom BN OTO cd mdi tffdng quan thuan bien r = 0,211; p
> 0,05; ket qua nay tffdng tff ciia Pham Quang Thanh [ 1 ] .
V. KE'T LUAN
Qua nghien eirU 110 BN gom 55 BN OTO va 55 BN khong DTO, chiing toi co mot so nhan xet sau:
K Nong dp Hey d nhdm OTO kiem soat dffdc dffdng mau va khong kiem soat dffdc dffdng mau khae biet khong co y nghTa thong ke d ca hai gidi va nhdm chung.
•y Nong dp Hey d nhom OTO cd MAU (+) cao hdn nhom OTO cd MAU (-) cd y nghTa thdng ke: 15,94+7,95 so vdi 12,06+3,13 (pmol/l) vdi p=0,00003
'r- Ndng do Hey ciia BN cd ton thUdng OM canh cd hep hay co mang xd vffa d nhdm DTO cao hdn nhdm khong OTD, tuy nhien chUa co y nghTa thdng ke: tan Iffdt 12,38+3,18 so vdi 10,44±3.12; 12,68±4,46 so vdi 11,07+2,80 pmol/l.
> Nong do Homocystein mau va HbAlC mau chffa thay co moi tffdng quan chat che (r = 0,107; p > 0,05).
> Nong 6q Homocystein mau va MAU d nhdm BN OTO co mdi tUdng quan thuan (r = 0,211; p > 0,05).
TAI UEU THAM KHAO
1. Pham Quang Thanh (2008), Danh gia moi lien quan giffa nong do Homocystein mau vdi microalbumin meu va do day I6p noi trung mac dpng mach canh d benh nhan dai thao du'dng type 2, Luan van thac si y hgc, TrUdng Oai hpc y Ha npi, 75 trang
2. DUUng Thi Tuyet (2006), Nghien cffu nong do Homocystein mau va moi lien quan v6i mot so chl 50 can lam sang d benh nhan dai thao dUdng type 2, Luin van thac si y hoc, TrUcJng Dai hpc y Ha noi, 69 trang
J. Alan N. Ellas and Steven Eng (2005), Homocysteine concentrations in patients with diabetes mellitus - relationship to microvascular and macrovascular disease. Diabetes, Obesity and Metabolism, pp. 117-121
1. Huang E.J, Kuo W.W, Chen Y.J, Chen T.H, Chang M.H, Lu M.C, Tzang B.S, Hsu H.H, Huang CY, Lee S.D (2005), Homocysteine and otherbiochemical parameters in Type 2 diabetes
Y HQC VlgT NAM THANG 3 • s 6 1/2013 mellitus with different diabetic duration or diabetic
retinopathy, Clin Chim Acta, 9.
Huijberts MS, Becker A, Stehouwer CD (2005), Homocysteine and vascular disease in diabetes: a double hit, Clin Chem Lab Med, 43 (10), pp. 993 - 1000
Ozmen B., Ozmen D., Turgan N., Habif S., Mutaf I , Bayindir O. ( 2 0 0 2 ) , Association Between Homocysteinemia and Renal Function in
Patients wid) Type 2 Diabetes Mellitus, Annals of Clinical & Laboratory Science, vol. 32, no. 3, pp.
279-286
Passaro. A, Calzoni. F, Volpato. S, Dalla Nora E, Pareschi P. L, Zamboni P. F, Fellin.R, Solini A. ( 2 0 0 3 ) , Effect of metabolic condd on homocysteine levels in type 2 diabetic patients: a 3-year MIow-up, Journal of Internal Medidne, Vol. 254, Issue 3, p. 264-271
NGHIEN cQU DAC DIEM L A M SANG VA HlNH ANH CHUP CAT L0P VITJNH LONG NGUC CO BOM KHi TRUNG THAT OT BENH NHAN NHOVC 0 0
Phan T h a n h H i e u * , Phan V i ^ t N g a * , N h u ' O i n h Sdn*
T O M T A T
Nghien cirU dac diem lam sang va hinh anh chup c3t Idp VI tinh long ngUc d 45 BN nhUOc cd co tuoi trung binh la 43,91 ± 8,56; t^ le nff/nam la 2/i chiing toi thay:
- Cac trieu chffng khcJi phat hay gap la la sup mi (82,22%), nhin doi (64,43%), yeu chi (68,88 %) va kho thd (11,11%).
- Bieu hien lam sang thUcJng thay la sup mi (84,44%) chil yeu la sup mi do II va dp I I I , nhin doi (75,55%), kho nuot, sac, nghen (73,33%), nhai moi (55,55%), noi kho (33,33%), yeu chi (68,88%). Phan do theo Osserman: nhom 1(24,44%), Ila (24,44%), lib (51,11%), mffc do nhe 48,88% va vffa 51,12%..
- Ket qua chup CLVT long ngi/c co bOm khi trung that thay ty le BN co bat thUdng tuyen ffc la 73,34%
trong do: qua san tuyen ffc (11,11%), u tuyen ffc (62,22%). Nhom Ila va l i b co ty le u tuyen ffc la 72,73% va 73,91%.
Tlf khoa: Benh nhUOc cd, u tuyen ffc, chup cSt Idp VI tt'nh.
SUMMARY
STUDYING OF THE CLINICAL CHRACTERISTICS AND IMAGE OF THORACIC CT WITH MEDIASTINALGASPUMP I N MYASTHENIA
PATIENTS
Studying of the clinical charactenstics and image thoracic CT with mediastinal gas pump in 45 patients with myasthenia gravis have an average age of 43.91
± 8.56; female/male is 2/1, we found:
- The common symptoms onset are fall eyelids (82.22%), diplopia (64.43%), weak legs (68.88%) and dyspnea (11.11%).
* Benh vien 103, Hoc vien quin y
Phan bien khoa hpc: PGS.TS. Nguydn Minh Hifn
- The common clinical manifestations are fall eyelids (84.44%) (level I I and III), diplopia (75.55%), dysphagia, choke, choking (73.33%), chewing fatigue (55.55%), said difficult (33.33%), weak legs (68.88%). The Osserman typs are group I (24.44%), Ila (24.44%), l i b (51.11%), mild level (48.88%) and medium level is 51.12%.
- Chest CT Scan result with mediastinal gas pump shows the percentage of patients with abnonnal thymus is 73.34%: the thymus is abnormally large (11.11%), thymus gland tumors (62.22%). The rate of thymus gland tumors of the group Ila and lib are 72.73% and 73.91%.
Keywords: disease myasthenia gravis, thymus gland tumor,CT- Scan.
I. o/iT
VANo i
Nhffdc cd (Myasthenia disease) la benh tU mien mac phai ciia qua trinh dan truyen than kinh lien quan tdi ton thUdng cac thu cam the Acetylcholine d xl nap than kinh - cd lam cho benh nhan (BN) bi yeu cac cd van va nhanh mol cd khi van d p n g ^ ' l Trong nhffng thap nien gan day da cd nhieu edng trinh nghien CLTU (NC) ve benh nhUdc cd, cac tac gia cho rang cd mcfi lien quan giffa t)enh nhUdc cd va tdn tal tuyen ffc d cae BN nay. Cd nhieu phUdng phap dieu tri nhUdc cd nhffng ket qua van cdn rat han ch^.
Do vay viec nhan biet dung dac diem lam sang, nguyen nhan va dieu t n sdm la rat can thiet de lam giam nguy cd tff vong, giam sd lan nhap vien va chi phi dieu tri ^'''. Tren cd sd dd chung toi thffc hien de tal nham muc tieu:
