Y Hpc VI^T NAM THANG 6 -S6'2/2013
LIEN QUAN GlffA SlTTHAY DOI CHI SO HUYET OONG CAC MACH NAO CHINH VflTl MOT SO YEU TO NGUY 0 0 TANG HUYET AP
TOM TAT:
Oat van de: U'ng dung sieu am Doppier xuyen sp (Transcranial Doppier Sonography - TCD) de thSm dd cac mach mau nao la mot trong nhu'ng phu'dng phap rat pho bien hien nay. Muc tieu: Xac djnh mdi lien quan giu^ sU thay doi cac chi sd huyet ddng cua cac mach nao chinh vdi mot so yeu td nguy cd tSng huyet ap. Doi tu'dng nghien cuTu: 112 benh nhan tang huyet ap dUOc kham va dieu tn tai khoa Npi 4 - Tim mach benh vien A Thai Nguyen t y thang 6/2008 den thang 6/2009 va 49 benh nhan khong mac benh bm mach. PhUdng phap nghien CLTU: mo ta, ben ciTu.
Ket qua: Cac chi so van tdc trong nhdm cd dai thao dudng, RL lipid mau thay ddi nhieu hdn so vdi nhom hut thuoc la trong do van toe trung binh giam 24%, van toe toi da giam 21%. chi so mach dap tang 13%, chi so khang mach tang 9%. Dai thao dUdng va rdi loan lipid mau la nhffng yeu td nguy cd lam tang kha nSng xuat hien cac rdi loan huyet dgng cac mach nao chfnh: van tdc trung binh (OR tUdng img: 8,6- 13,9;7,4-12,4 (p<0,05)), chi sd mach dap (OR tUOng yng: 9,8-15,5; 11,7-21,5 (p<0,05)), chi sd khang mach (OR tu'dng dng: 6,3-10,4; 6,6-11,3 (p<0,05));
van toe toi da (OR tu'dng dng: 2,5-3,9; 1,5-3,5 (p<0,05)); Hilt thudc la khdng lam thay doi van tdc tdi da (p>0,05), cd lam thay dd'i van toe trung binh, chi so mach dap, chi sd khang mach vdi OR tUdng dng: 2,6- 4,9 (p<b,05), 3,3-4,3 (p<0,05), 2,8-3,6 (p<0,05). Ket luan: Cd lien quan gitfa sy thay dd'i cac chi so huyet dpng cac mach nao chinh vdi cac yeu td nguy cd tang huyet ap (dai thao dUdng, rdi loan lipid mau).
Keyword: chi sd huyet dgng, tang huyet ap, sieu am xuyen sg
SUMMARY;
THE RELATION BETWEEN THE CHANGES IN HEMOKINESIS OF PRIMARY CEREBRAL VESSELS
AND SOME RISK FACTORS OF HYPERTENTION Introduction: The applicabon of Transcranial Doppier Sonography - TCD to survey cerebral blood vessels is one of the common methods today.
Objective: To idenbfy the relation between the changes in hemokinesis of pnmary cerebral vessels and some nsk factors to high blood pressure.
Samples: 112 hypertentlon patients who were being treated at Cardiology Division, Internal Medicine Department #4 between June 2008 and June 2009
* Trudng Ddi hgc Y Thai Nguyen Phan bi$n khoa hpc: PGS.TS Trkn Van Ri^p 72
Nguyen Tien Dung*
and 49 ordinary people. Research methods:
descriptive and prospective study. Results: Velocity amongst patients with diabetes and Lipid RL vaned much more than that amongst smokers, in which the velocity reduced at 24%, the maximum velodty decreased 2 1 % , the pulse increased 13%, anb-pulse index increased 9%. Diabetes and lipid disorder are risky factors to disordered hemokinesis of pnmaiy cerebral vessels: average velodty (OR equal to: 8,6- 13,9;7,4-12,4 (p<0,05)), pulse (OR equal to: 9,8-15,5;
11,7-21,5 (p<0,05)), chi 50 khang mach (OR tu'dng yng: 6,3-10,4; 6,6-11,3 (p<0,05)); maximum velcjcity (OR equal to: 2,5-3,9; 1,5-3,5 (p<0,05)); Smoking does not affect the maximum velocity (p>0,05), but makes average velocity, pulse and anb-pulse index changed with OR at: 2,6-4,9 (p<0,05), 3,3-4,3 (p<0,05), 2,8-3,6 (p<0,05). Conclusion: There is a relation between the '"hanges in hemokinesis indicators of cerebral vessels and risk factors to hypertension, (diabetes, blood lipid disorder).
Keyword: hemokinesis, hypertension, Tianscranel Doppier Sonography
I. OAT V A N oi:
U'ng dung sieu am Doppier suyen so (Transcranial Doppier sonography - TCD) de tham dd cac mach mau nao la mdt trong nhihig phu'dng phap rat pho bien hien nay. Theo khuyen cap oia eiia hdi nghi tim mach (2004) tai Ha Npi, chup cat Idp vi ti'nh, chup mach cpng hu'dng t d va sieu am Doppier suyen sp la mot trong nhiJng phudng phap khdng the thieu dddc trong chan doan va dieu tri eae benh mach mau nao [ 4 ] .
6 Viet Nam nhiTng nam gan day viec siT d u n g T C D trong lam sang cdn rat han che.
Nguyen Van Tien (2000) da cd ket qua nghien cdu ve mach mau nao bang TCD d ngu'di binh thu'dng [ 4 ] , [ 5 ] . Nguyen Viet Thang (2005) da du'a ra nhu'ng nghien cuXi vie mach mau nao cl benh nhan dai thao du'dng.
Tuy nhien chu'a cd tac gia nao nghien cijfu chi tiet ve huyet dpng mach mau nao d benh nhan tang huyet ap, mpt trong nhiTng benh co nguy cd tai bien mach mau nao. Xuat phat tif tinh hinh thiTc tien tren, ehung toi tien hanh nghien ciTu de tai nham muc tieu: Xae dinh moi
Y HQC VlgT NAM THANG 6 - SO 2/2013 lien quan glife SLT thay ddi chi so huyet dpng ciia
cac mach nao chfnh vdi mpt sd yeu t d nguy cd tang huyet ap.
II. D 6 | TUpNG VA PHUONG PHAP NGHIEN COU:
- Odl tu'dng nghien cu'u
+ Nhdm benh: 112 benh nhan tang huyet ap dUcfc kham va dieu tri tai khoa Npi Tim mach benh vien A Thai Nguyen tiT thang 6/2008 den thang 6/2009.
+ Nhdm ChiTng: 49 benh nhan khdng mae benh tim mach vao dieu tri tai khoa Npi Benh vien A Thai Nguyen trong eiing thdi gian tren.
- Phu'dng phap nghien CU\J
+ Thiet ke nghien citu: Sir dung phu'dng phap nghien culi mo ta, tien eulj.
+ Ky thuat chpn mau: Chpn mau cd chu dich; Ky thuat chpn mau thuan tien
- Phu'dng t i e n nghien cu'u
+ May sieu am Doppier "Rimed", dau dd 2MHz de lam SA xuyen sp theo phu'dng phap Doppier ngat quang phd' mau ddng mau hu'dng ve phia dau dd dude coi la du'dng, hu'dng ngu'dc lai du'dc coi la
am. Cac chi sd dude danh gia tren cd sd phd mau ciia ddng mau. Cac ket qua dddc lull lai trong phan mem cua may vi ti'nh va du'dc ghi tren giay.
+ Cac mach mau du'dc tham dd - Odng mach nao tru'dc (Anterior Cerebral Artery - ACA)
- Odng mach nao gida (Middle Cerebral Artery - MCA)
- Ddng mach nao sau (Posterior Cerebral Artery - PCA)
- Odng mach than nen (Basilar Artery - BA) - Ddng mach ddt sdng (Vertebral Artery - VA) - Chi tieu nghien ciTu
- Van tdc tam thu tdi da (Peak Systolic Velocity - Peak)
- Van tdc trung binh (Mean Velocity - Mean)
= (Peak - 2DV)/3
- Chi sd mach dap (Pulsatility Index - PI) = (Peak - DV)/Mean
- Chi sd khang mach (Resistivity Index - RI)
= (Peak - DV)/Peak
- Xd ly sd lieu: Sd lieu du'dc xii ly phan ti'ch theo phu'dng phap thdng ke y hpc.
III. KET QUA NGHIEN CUU:
Bang 1. Cac yeu t d nquy cd thu'dnq gap d benh nhan tang huyet ap Cac veu to nguv cd
Dai thao di/cinq Roi loan lipid mau Hut thuoc la
n 25 36 49
Tj le % 22,3 32,1 43.8 Nhan xet: Hut thudc la la yeu t d nguy ed ehiem ty le cao nhat (43,8%) sau dd la rdi loan lipid mau (32,1%) va dai thao du'dng (22,3%).
Bang 2. So sanh van tdc toi da cac mach mau nao theo cae yeu t d nguy cd
^ ^ ^ ^ ^ Nhom Mach mau ^"~--^^^
MCA ACA PCA VA BA
Oai thao du'dng (1) n SO 50 50 50 50
X±SD
68 ± 17 56 ± 14 56 ± 2 1 49 ± 10 4 9 ± 9
Roi loan lipid mau (2) n 72 72 72 72 72
Xt.SD
70 ± 14 53 ± 13 55 ± 9 47 ± 16 48 ± 11
Hut thuoc la (3) n 98 98 98 98 98
X±SD
67 ± 9 55 ± 16 52 ± 14 50 ± 13 52 ± 9
P (pl-2,p2-3,pl-
3)
*,*,**
**,*,**
*,*,**
*,*,**
**,*,**
Chii thi'ch: p>0,05: ~> 0; p<0,OS: — • * ; p<0,01: — » . * * ; p < 0 , 0 1 : - V * *
Nhan xit: Van toe toi da ehung cho cac mach mau nao khae biet khdng nhieu giii'a cac yeu td nguy cd, trong dd dai thao du'dng cd b/ le SLT khac biet khdng cd y nghia thong ke (p> 0.05).
^ ^ ^ ^ ^ Nhom Mach mau ^ ^ ^ ^ ^ MCA
ACA PCA
Dai thao du'dng (1) n 50 50 50
X±SD
47 ± 13 41 ± 8 42 ± 11
RL lipid mau (2) n 72 72 72
X±SD
48 ± 10 39 ± 7 41 ± 11
Hut thuocla (3) n 98 98 98
X±.SD
51 ± 14 38 ± 9 38 ± 12
P (pl-2,p2-
3,pl-3) 0,*,*
*,*,*
0,'.'
Y HOC VIET NAM T H A N G 6 - S 6 2/2013
^^"^^^^^ Nhom Mach mau ^^^^^^
VA BA
Dai thao du'dng (1) n 50 50
X + SD 34 ± 18 36 ± 9
RL iipid may (2) n 72 72
X±,1D 31 ± 15 32 ± 14
Hut thudc la ( 3 ) n 98 98
X±SD 29 ± 11 31 ± 15
P (pl-2,p2-
3 , p l - 3 )
*,*,*
•,o,»
a7iJ^/?/c/7.-p>0,05: — • O ; p<0,05: — > * ; p < 0 , 0 1 ; — • * * ; p < 0 , 0 1 : _ • * * *
Nhan xit: Van tdc trung binh chung cho cac mach mau nao khac biet giii'a cac yeu to nguy cd, SLT khac biet ed y nghla thdng ke (p< 0.05).
Bang 4. So sanh chj sd mash dap mach mau nao theo cac yeu t d nguy cd
^ ^ ^ - ^ ^ ^ Nhom Mach mau ^ ^ ^ - ^ ^ MCA
ACA PCA VA BA
Da n 50 50 50 50 50
thao du'dng (1) X±SD 0,84 ± 0,13 0,86 ± 0 , 1 1 0,79 ± 0,12 0,88 ±0,15 0,88 ± 0 , 1 1
RL iipid mau C2) _ n
72 72 72 72 72
X±SD 0,77 ± 0,12 0,82 ± 0,15 0,83 ± 0,13 0,83 ± 0,13 0,78 ± 0,12
Hut thuoc ia (3) n 98 98 98 98 98
X±SD 0,80 ± 0,06 0,76 ± 0,12 0,73 ± 0,15 0,82 ± 0,08 0,81 ± 0,06
P (pl-2,p2-
3,pl-3)
*,*,*
*,*,*
*,*,*•
*,o,«**,*,*
C7?i/f/j/c/).-p>0,05: — * - 0 ; p<0,05: — • * ; p < 0 , 0 1 : — » . * * ; p < 0 , 0 1 : _ # . * * *
Nhan xet: Ch'i so mach dap chung eho cae mach mau nao khac biet giu'a cae yeu to nguy cd, siT khac biet ed y nghTa thdng ke (p< 0.05).
Bang 5. So sanh chi sd khang mach mach mau nao theo cae yeu to nguy cd
^ ^ \ ^ Nhom Mach mau^^^^
MCA ACA PCA VA BA
Dai thao dudng (1) n 50 50 50 50 50
X±SD 0,57 ± 0,08 0,55 ± 0,07 0,54 ± 0,09 0,55 ± 0,06 0,53 ± 0,03
RL lipid mau (2) n 72 72 72 72 72
X ± SD 0,52 ± 0,07 0,54 ± 0,08 0,50 ± 0,06 0,55 ± 0,03 0,55 ± 0,12
Hut thuoc ia ( 3 ) n 98 98 98 98 98
A' ± SD 0,48 ± 0 , 1 1 0,49 ± 0,06 0,48 ± 0,05 0,43 ± 0,12 0,51 ± 0,09
P (pl-2,p2-
3,pl-3)
*,*,*
O , ' , '
* , 0 , *
o,*,»
o,',o Chu thich: p>0,05: — » - 0 ; p<0,05: — » - * ; p<0,01: — • * *
Nhan xet: Chi sd mach khang mach chung cho cae mach mau nao cd khae biet gitiS cae yeu to nguy c d ( p < 0.05).
Bang 6. Lien quan gida cae yeu t d nguy cd vdi van toe tdi da eae mach mau nao Cac veu td nguy cd
Dal thao dL/6ng Co Khonq OR
(95% CI) P
RL lipid mau Cd Khonq OR
(95% Cl) P
Hut thuoc la Co Khonq OR (95% CI) P
MCA { n = 3 0 )
20 5 3,7 (1,4-9,8)
<0,05 16 20 3,5 (1,4-9,4)
<0,01 10 39 2,2 (0,8-6,3)
>0,05 ACA (n=38)
23 2 2,8 (1,2-6,9)
<0,05 17 19 2,3 (0,9-5,8)
<0,05 13 36 2,3 (0,9-5,8)
<0,05
PCA ( n = 2 8 )
17 8 2,5 (0,9-6,6)
<0,05 11 25 1,5 (0,6-4,1)
>0,05 9 40 2,1 (0,7-5,8)
>0,05 VA ( n = 2 3 )
16 9 3,9 (1.3-11,7)
<0,05 9 27 1,5 (0,5-4,2)
>0,05 7 42 1,7 (0,6-5,4)
>0,05
BA (n=17)
5 20 3,8 (0,3-5,7)
<0,05 10 26 2,1 (0,2-3,6)
>0,05 8 41 1,5 (0,3-7,5)
>0,05 Nhan xet: Cac yeu t d
dang ke den van tdc toi da
nguy ed: RL lipid mau, dai mach mau nao.
thao du'dng, hut thuoc la khdng co anh hu'dng
Y HQC VIET NAM THANG 6 • s 6 212013
Bang 7. Lien quan qi&a cac yeu to nquy cd vdi van toe trunq binh mach mau nao Cac yeu td nguy cd MCA
( " = « 8 1 ACA ( " = 5 2 )
PCA ( n = 4 0 )
VA
( " = 3 8 ) ( " = 2 2 ) Dai thao du'dng
Khonq OR
(95% CI) P
11,7 (3,3-44,8;
<0,01 13,9 (3,5-63,9)
<0,01 9,95 (3,2-32,5)
<g,oi 8,6 (2,9-26,8)
<0,01
(2,95-30,8)
<0,05
RL lipid mau 35 28 25 12
11 24
OR (95% CI)
12,4 (4,3-37,4)
<0,01 12,3 (4,1-38,5)
<0,01 11,5 (4,2-32,9)
<0,01 9,2 (3,4-25,6)
<0,01
7,4 (2,3-22,3)
<0,05
28 23 21
Khonq 21 26 28 41
OR (95% CI)
3,9 (1,7-9,5)
<0,05 4,7 (1,9-11,6)
<0.05 2,4 (1,0-5,7)
<0,05 2,0 (1,6-15,0)
>0,05
3,5 (1,2-10,8)
<0,05 Nhan xet: Oai thao du'dng, RL lipid mau, hut thuoc la la cac yeu to lam tang nguy cd thay doi van toe trung binh eae dong mach nao vdi cac mu'c do khae nhau.
- Bong mach nao giii'a (MCA) vdi OR tu'dng u'ng la: 11,7; 12,4; 3,9 (p<0,01).
- Ddng mach nao trifdc (ACA) vdi OR tlTdng irng la:13,9; 12,3; 4,7 (p<0,01).
- Dong mach nao sau (PCA) vdi OR tu'dng iJng la:9,95; 11,5; 2,4 (p<0,01).
- Oqng maeh dot song (VA) vdi OR tlTdng Crng la:8,6; 9,2; 2,0 (p<0,01).
- Bong maeh than nen (BA): vdi OR tu'dng iJng la:9,4; 7,4; 3,5 (p<0,01).
Bang 8. Lien quan giu'a cac yeu to nquy cd vdi chi so maeh dap mgeh mau nao Cac yeu td nguy cd
Dal thao du'dng Co Khonq OR (95% CI) P
RL lipid mau Cd Khong OR (95% CI) P
Hijt thuoc la Co Khonq OR (95% CI) P
MCA ( n = 5 0 )
22 3 15,5 (3,9-7,1)
<0,01 30
6 14,0 (4,6-44,3)
<0,01 34 15 6,7 (2,7-16,8)
<0,05
ACA (n=48)
21 4 11,7 (3,3-44,8)
<0,01 31
5 21,5 (6,6-75)
<0,01 29 20 3,4 (1,4-7,96)
<0,05 PCA (n=45)
20 5 9,9 (3,1-34,3)
<0,01 29
7 15,5 (5,3-47,9)
<0,05 24 25 1,9 (0,8-4,5)
>0,05 VA ( " = 3 7 )
19 6 12,1 (3,8-40,3)
<0,05 26 10 15,4 (5,3-46,2)
<0,01 23 26 3,1 (1,3-7,6)
<0,05 BA (n=24)
14 11 9,8 (3,1-31,5)
>0,05 18 18 11,7 (3,7-38,9)
<0,01 15 32 2,7 (0,9-7,5)
<0,05 Nhan xet: Dal thao du'dng, RL lipid mau, hut thuoc la la cac yeu to lam tang nguy ed thay doi chi so mach dap cac mach:
- Ogng mach nao giiJa (MCA) vdi OR tiTdng irng la:15,5; 14,0; 6,7 (p<0,01).
- Bdng mach nao triTde (ACA) vdi OR tu'dng irng l a : l l , 7 ; 21,5; 3,4 (p<0,Cl).
- Bdng mach nao sau (PCA) vdi OR tu'dng irng la:9,9; 15,5; 1,9 (p<0,01).
- Bdng mach dot song (VA) vdi OR tu'dng u'ng l a : 1 2 , l ; 15,4; 3,1 (p<0,01).
- Bdng mach than nen (BA); vdi OR tu'dng irng la:9,8; 11,7; 2,7 (p<0,01).
Bang 9. Lien
Y HOC VIET NAM THANG 6 - SO 2/2013
^uan qliJa cac yeu t d nquy ed vdi chi Cac yeu to' nguy cd
Dai thao dudng Cd Khonq^
OR (95% CI) P
RL lipid mau Co Khonq OR (95% CI) P
Hilt thuoc la Cd Khonq OR (95% CI) P
MCA ( n = 4 6 )
20 5 9,4 (2,9-32,3)
<0,01 28
8 11,3 (4,0-32,8)
<0,01 28 21 3,3 (1,4-7,9)
<0,01
ACA ( " = 4 2 )
19 6 8,8 (2,9-28,5)
<0,01 26 10 9,8 (3,6-27,2)
<0,01 27 22 3,4 (1,3-9,6)
<0,05
30 khanq mach maeh mau nao PCA
( n = 4 4 ) 19
6 7,9 (2,6-25,2)
<0,01 26 10 8,4 (3,1-22,9)
<0,05 24 25 2,1 (0,9-4,8)
>0,05
VA ( " = 3 9 )
17 8 6,3 (2,2-18,7)
<0,01 23 13 6,6 (2,5-17,6)
<0,05 21 28 1,9 (0,8-4,5)
>0,05
BA { " = 2 6 )
15 10 10,4 (3,4-32,9)
<0,01 14 12 6,7 (2,3-19,5)
<0,05 13 36 1,4 (0,5-3,7)
>0,05 Nhan xet: Dal thao dudng, RL lipid mau, hut thuoc la la eae yeu t d lam tang nguy cd thay doi chi sd khang mach ciia:
- Bpng mach nao giffa (I^CA) vdi OR tUdng irng i a : l l , 7 ; 12,4; 3,9 (p<0,01).
- Bdng mach nao trUdc (ACA) vdi OR tu'dng irng la:13,9; 12,3; 4,7 (p<0,01).
- Bdng mach nao sau (PCA) vdi OR tUdng img la:9,95; 11,5; 2,4 (p<0,01).
- Bpng maeh dot song (VA) vdi OR tUdng irng ia;8,6; 9,2; 2,0 {p<0,01).
- Bong mach than nen (BA): vdi OR tUdng iing la:9,4; 7,4; 3,5 (p<0,01).
iV. BAN LUAN:
Tang huyet ap cd mdi tu'dng quan lien tuc va cd mire dp vdi tang nguy cd benh mach vanh va dot quy. Tuy nhien eae nguy cd khac nhu hiit thudc ia, rdi loan lipid mau, tang dUdng huyet cQng dan den tang manh nguy cd tai bien maeh vdi bat cir mu'c tang huyet ap nao. Vdi cae ddng mach nao chfnh d benh nhan tang huyet ap nguy ed dao ddng manh, tiiy thupc vao s u hien dien cua cac yeu to nguy cd. Cac yeu t d nguy cd ehinh anh hudng len tuan hoan nao eung ehiem ty le cao, theo ket qua nghien ciru tren bang 1 rdi loan iipid mau chiem 22,3%, cdn dai thao dudng chiem 22,3%.
Nghien ciru sieu am Doppier xuyen sp cae ddi tUdng hep ddng maeh nao giii'a (r^CA) benh nhan BTD d trudng td'ng hdp Hong Kong -Trung Qude Thomas GN, Lln 3W, Lam WW va CS (2003) nhan thay THA, RL iipid mau va BTD ed lien quan chat che vdi hep maeh mau nao.
Tac gia Thai Hong Quang (2001), cung nhan thay ty le BN THA rat cao, chiem tdi 5 0 % trong tdng sd benh nhan DTB [ 3 ] . Tac gia eho rang THA, RL lipid mau lam benh vifa xd ddng mach thu'dng gap hdn va xuat hien sdm hdn ngUdi khong bi DTO. Nhti'ng yeu to nay ket hdp vdi DTB hinh nhd cd tac dyng ti/dng tac lam eho 76
benh vifa xd ddng maeh tien trien ngay cang nang; Tang du'dng huyet, tang insulin huyet, tang dong mau
Bai thao dudng thudng dl kem vdi THA va vi^a xd mach mau nao la yeu to gay nen xuat huyet nao va nhoi mau nao[7]. Benh nhan DTD ed sd IUdng nhoi mau nao Idn hdn va khi bj nhoi mau nao thi mire dp ian toa rdng hdn [1]. Ty le nhoi mau nao d benh nhan DTB cao hdn d tat ca eae dd tudi, tang len theo thdi gian bi benh, dp nang eiia THA va suy t i m . Ngdde lai chay mau nao it gap d quan the B T B , benh nhan BTB + THA cd ty le xuat huyet nao cung thap hdn cl ngu'di khdng BTB [ 6 ] .
Trong nghien curu cua chiing toi, mdi lien quan nay dUdc xac djnh bang gia trj OR cho thay: BTB va rdi loan lipid mau lam ton thuWng cac mach mau nao chinh bieu hien bang sU roi loan huyet ddng tren cac mach mau nay d benii nhan tang huyet ap. anh hu'dng nhieu nhat den van tdc trung binh (OR tu'dng ung: 8,6-13,9;7,4- 12,4 (p<0,05)) va chi so mach dap (OR tu'dng irng: 9,8-15,5; 11,7-21,5 (p<0,05)), it hdn vlS chi sd khang mach (OR tu'dng u'ng: 6,3-10,4;
6,6-11,3 (p<0,05)) va rat it doi vdi van toe tdi * (OR tu'dng irng: 2,5-3,9; 1,5-3,5 (p<6,05)).
Y HQC VIET NAM THANG 6 - S g 2/2013 Hut thudc la la mdt yeu to nguy cd chinh, cd
the dieu chinh cua xd vQla dpng mach d ca quan the nguy cd thap lan nguy cd cao. Khoang 8 0 % eae tru'dng hdp t d vong do benh dpng maeh vanh moi nam d MT co the la do hut thuoc la, thuoc la la nguyen nhan chinh ciia benh ly mach mau ngoai bien. Bang phan tfch thong ke da bien co the thay thuoc la gop phan vdi cac yeu to nguyen nhan dpc lap eua cac ton thu'dng mach mau. Hut thuoc la la mpt yeu to nguy cd phu thupc cholesterol va hoat dpng hiep dong vdi cac yeu to nguy cd khae lam tang nguy cd eua benh dpng mach vanh va ton thu'dng cac maeh mau nao [ 2 ] .
Trong nghien CLTU eiia chung toi ket qua bang 1 cho thay ty le benh nhan co yeu to nguy cd nay la cao nhat (43,8%) tuy nhien cae thay doi huyet dong tren cac mach nao chinh: van toe toi da (Peak), van toe trung binh (Mean), chi so maeh dap (PI) va chi so khang mach (RI) khong hoac It chju anh hu'dng bdi yeu to nguy cd nay hdn so vdi cac nguy cd khac (Bang 6,9).
V. KET LUAN:
Co lien quan glffa su" thay doi cac ehi so huyet dpng cac maeh nao chinh vdi cac yeu to nguy ed tang huyet ap (dai thao du'dng, roi loan lipid mau).
VI. KHUYEN N G H I :
Ooi vdi nhO'ng benh nhan tang huyet ap nen lam sieu am Doppier xuyen sp nham phat hien sdm tinh trang roi loan huyet dpng tuan hoan nao nhat la d cac doi tu'dng co dai thao du'dng va roi loan chuyen hoa lipid de cd hu'dng theo doi va dieu t n kjp thdi.
T A I UEU T H A M K H A O :
1. Nguyen Van Bang (1997) Djch te hgc tai bien mach mau nao. Tai bien mach mau nao. Nxb Y hoc, tr.9 - 37., tr.9 - 37.
2. Oo Trung Quan (2001), Benh dai thao du'dng, Nxb Y hpc.
3. Thai Hong Quang (2001), "Benh cua tuyen tuy", Benh noi tiet, Nxb Y hoc, tr. 218 - 384.
4 Nguyen Van Tien (2000), Mpt so nhan xet ve ky thuat tham do mach mau nao bang sieu am Doppier xuyen so, Y hpc thUc hanh, tr 31- 33.
5. Nguyen Van Tien, (2001), Bu'dc dau ngWen cu\j huyei dpng cua dpng mach chfnh trong nao bang sieu am Dopple xuyen so, Y hpc thuC hanh, tr.30 - 32.
6. Elmore EM, Mosquera A, Weinberger J. (2003) The prevalence of asymptomatic intracranial large - vessel occlusive disease: the role of diabetes, J Neuroimaglng, Jul; i3(3):224-7.
7. Spector K.S (1998). "Diabetes cardiomyopathy", Clin -cardiol, pp.885-887.
NGHIEN CUIU GIA TRj CUA ADA DjCH MANG PHOI TRONG CHAN DOAN TRAN DjCH MANG PHOI DO LAO
Nguyen Nang Vien*, Dong Khac Hu'ng**, Nguyen Hai Cong*
T O M TAT:
Boi canh: Tran dich mang phoi (TDMP) do lao]a the benh pho bien nhat trong cac benh lao ngoai phoi.
Chan doan bang phu'dng phap lam sang, can lam sang khong dac hieu con nhieu kho khan. Chung toi tien hanh nghien ciiu nay de xac djnh hieu qua cua xet nghiem ADA dich mang pho'i trong chan doan Jao mang phoi. Boi tu'dng va phu'dng phap: 88 benh nhan TDMP, bong do co 54 benh nhan TDMP do lao va 34 TDMP ac tinh du'dc phan tich bang mot nghien CUU ten ciJtJ, mo ta cat ngang. ADA djch mang phoi duWc xet nghiem blng phu'dng phap cua Galanti va Glu'sti. Sir dung du'dng cong ROC de xac dinhgia tn nguBng ciia ADA trong lao mang phoi. Ket qua: Co sU khae biet nong do ADA djch mang phoi trung binh giu'a 2 nhom'(p<0,00i). Gia tri ngudng ciia ADA dich mang
phoi trong chan doan lao mang phoi la > 31,5 U/L, v6i dp nhay la 87%, do dac hieu 100%, gia trj tien doan dUdng 100% va tien doan am la 83%. Dien tich dU6i dudng cong ROC la 0,984. Ket luan: Xet nghiem ADA dich mang phoi la mpt phu'dng phap co dp nhay, do d§c hieu cao va phii hdp trong chan doan nhanh cac tru'dng hdp TDMP do lao.
Td khda: Lao, TDMP, adenosine deaminase, TDMP ac tinh
SUMMARY:
STUDY ON DIAGNOSTIC VALUE OF ADENOSINE DEAMINASE IN TUBERCULOUS PLEURAL EFFUSION
Background: Tuberculous pleural effusion is the most common form of the extra pulmonary
* B^nh vign Ph^m Nggc Th^ch. " Hgc vi?n Quan Y " " Bgnh vi^n 175 Phan bien khoa hpc: PGS.TS Nguyen Huy L^c
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