y HOC VIET NAM THANG 5 - SO 2«014 Trong nghien ciiu nay, chung tdi da thff phan
tich mot sd yeu t d cho la cd the co lien quan den sff xuat hien cua rd chay du8ng chap sau mo cat TQ do ung thff, nhffng ch! duy nhat xac dinh dffdc yeu to xam lan cua u (pT) la cd y nghla: U cd dp xam lan ra Idp ngoai cung cua thanh TQ (T3) cd nguy cd bj BC ro duQng chap gap 4,5 lan nhieu hdn so vdi u d mffc T2 (a>n nam trong thanh TQ) (bang 3). Tuy nhien chung toi lai chu^
gap BC rd duQng chap nao d u T4, cd the la vi sd iffdng BN cua chung toi gap con chu'a du nhieu.
Ngoai ra, do han che cua mpt nghien cffu hoi cffu, chac chan cdn nhieu yeu to khac nffa ma Chung ^ i chffa the khao sat va xae djnh dffdc.
V. KET LUJSLN
Bien chffng ro duSng chap gay tran djeh mang phdl sau mo cat TQ do ung thff cd t y ie 2,5%. Cd the phat hien sdm BC nay neu ngay d i u sau md Iffdng djcli dan Iffu khoang ngffc ra vdi khdi Iffdng bat thffdng (300-500ml). Viec dieu tri nen bat dau bang bao ton, neu sau 3 ngay ma Iffdng djeh hang ngay ra tang len nhieu {>1000ml) ttii nen mo lai de that ong ngffc. Phat hien sdm va dieu trj dung each, ket qua se kha quan: khong cd tff vong va di chffng khdng nghiem trpng.
T A I LIEU T H A M K H A O
1 . Merrigan BA, W i n t e r DC, O'SulHvan GC.
Chylothorax. Br J Surg 1997; 84: 15-20 z. Sjoerd M. Lagarde, Jikke M. T. OmIoo, Keen
de Jong, et a l . Incidence and Management of Chyle Leakage After Esophagectomy. Ann Thorac 5L//S 2005;80:449-54
J . Staats BA, Ellefson RD, Budahn LL, et al. TTie lipoprotein profile cf diykxis and nondiylous pleural effusions. Mayo Om fiocl9S0; 55:700-4.
4. Merigliano 5, Molena D, Ruol A, Zaninotto G, Cagol M, Scappin S, Ancona E. Chylothorax complicating esophagectomy for cancer: A plea for early thoracic duct ligation. J Thorac Cardiovasc 5i//3 2000;119:453-7.
5. Benedix FR, Schuiz H, Scheidbach H, Lippert H, Meyer Fr. Successful conservative treatment of chylothorax following oesophagettomy^
clinical algorithm. 5>i;52010, 48(3): 86-88 6. Tachibana M, Kinugasa 5, Yoshimura H,
et a l . Does fibrine glue reduce lymph leakage (pleural effusion) after extended esophagectomy?
Prospective randomized clinical trial. World J Surg 2003; 27: 776-781.
7. Gomez-Caro AA, Moradiellos Diez FJ, Marron CF, Larru Cabrero EJ, Martin de Nicolas JL, Conservative management of postsurgical chylothorax with octreotide. Asian Cardiovasc Thoradc Ann 2005; 13: 222-224.
NGHIEN CU'U DAC DIEM KHANG INSULIN VA CHU'C NANG TE B A O BETA fr B|NH NHAN DAI THAO DU'CTNG TYPE 2 CHAN DOAN LAN DAU
T6M TAT
De tim hieu ve kh^ng insulin va chffc nSng te bao beta d b?nh nhSn (BN) dai thao du'dng (OTO) type 2 theo mo hinh HOMA-2 va tim hieu moi lien quan giOa khdng insulin vdi chi so khoi cd the (BMI), vdng eo, ting huyet ap, lipid mau, nghien cffu da dU^c tien hanh tren 112 benh nhan OTD type 2 duWc chan doan lan dau tai B?nh vien Oa khoa tinh Thai Binh, thu du'dc ket qua nhu' sau:
- Mffc dp tang H0MA2-IR: 198,6%; giam H0MA2-
%S: 51,7%; giam H0MA2-%B: 75,41%
*Bp mdn Ha Slit dp ctiu Tnr&ng DH YDUgc Thai dinh
**Khoa Th$n va Lpc mau Benh vien 103 Phan bi$n khoa hgc: PGS.TS Nguyen Ngpc Chu'c
Nguyen Duy Cu-frng*, Ho^ng Trung Vinh**
- Ty le BN tang insulin mdu: 66,9%; (chdng insulin:75,0%; giam chffc nSng te bao beta: 97,3%;
giam dp nhay insulin: 75,0%
- Nong dp insulin, H0MA2IR tUdng quan thu(ln, H0MA2-%S va H0MA2-%B tu'dng quan nghjch vdi BMI.
- a benh nhan t3ng chu vi vong bung va chi so vdng bung/vdng mong (WHR) cd nong do insulin, H0MA2-IR cao hdn; H0MA2-%S, H0MA2%B thap hdn;
ty le ddi tu'png tdng insulin, H0I^A2-1R, gidm H0MA2-
%S deu cao hdn so vdi BN cd chu vi vong bung vd WHR binh thffdng.
- O bgnh nhan c6 roi loan lipid mau nong d$
insulin, H0MA2-IR cao hdn, H0|wiA2-%S va H0MA2%
B thap hdn so benh nhan khong cd rdi loan lipid mdu.
Tit khda: 0^\ thao du'dng typ 2; khdng insulin; te bao beta.
36
Y HOC VIET NAM T H A N G 5 • SO 2/2014
SUMMARY
STUDY O N I N S U U N E RESISTANCE AND BETA-CELL F U N C T I O N I N TYPE 2 DIABETES
PATIENTS WAS THE FIRST T I M E DIAGNOSED
To learn about insulin resistance and beta-cell function in type 2 diabetes patients according to HOMA-2 model and understand the relationship between insulin resistance, body mass index (BMI), waist circumference, hypertension, hyperlipidemia, research was conducted on 112 type 2 diabetes patients was the first time diagnosed in Thai Binh province, obtained the following results:
- H0MA2-IR increase: 198.6%; reduce H0MA2-% S:
51.7 %; reduce H0MA2-% B: 75.41 %
- Hyperinsulinemia patients: 66.9 %; insulin resistance:
75.0 %; reduced beta-cell function: 97.3 %; decreased insulin sensitivity: 75,0 %
- The concentration of insulin, H0MA2IR correlated, H0MA2-% S and H0MA2-% B was inversely correlated with BMI.
- In patients witti increased waist drcumference and waist circumference index/hip (WHR) insulin concenbations, higher H0MA2-IR; H0MA2-% S, H0MA2-% B lower; rate increases insulin objects, H0MA2-IR, reduce H0MA2-% S were higher tiian patients with waist circumference and WHR normal.
- In patients with dysllpldemia. Insulin levels, higher H0MA2-IR, H0MA2-% S and H0MA2-% B lower than patients without dysllpldemia.
Keyvifords: Diabetes type 2; insulin resistance;
beta cells I.OATVXNDI
odl thao dudng (DTD) type 2 dang gia tSng nhanh ehdng va trd thdnh mpt van de dffdc t£ chffc y ^ th€ gidl d$c bi$t quan tam trong cham sdc sffc khde cpng dSng, Theo Uen doan DTD the gidi (IDF), n3m 2011 sd ngufti bi OTD tren toan the gidi Id 366 trl$u ngudi, dff doan so ngffdi mac benh se tSng len 552 d1$u ngffdi vao nam 2030 [1],[2].
Tai Viet Nam, theo dieu tra Qudc gia ve tinh hinh b$nh DTD va yeu to nguy cd nam 2002- 2003, ty le DTD toan quoc la 2,7%. Theo ffdc tinh, den nSm 2025 cd khoang 2.555.000 ngffdi mSc b^nh ddi thao dffdng [ 3 ] . Benh dai thao dffdng gdy nhieu bien chffng cd quan dich va hien dang Id mpt trong nhffng b§nh dffng hang dau gSy tdn phe va tff vong.
Trong sinh b f n h hpc cua DTD, tang nong dp glucose mau cd lien quan mat thiet den sff thay d5l ve c h u t n3ng cua insulin cd the do te bao bSta cua tuyen tuy bai thiet khong day dit, do k6m sff dyng Insulin d te bao ho^e do ffc che bai
tiet va tac dung cua insulin. Oe tap trung vao tim hieu sff khang insulin va chffc nang te bao beta chung toi tien hanh nghien CUXJ de tai nay nti3m muc tieu: Danh gia dii so khang Insub'n, chut: nang tibao beta tiieo md hinh HOMA-2 va tim hl&j m^
lien quan glOa khang insulin vt^ dii so khdi ai the, vdng eo, tang huyit ap, lipid mau d benh nhan dai thao du&ng type 2 dudc chi'n doan Sn dSu.
II. o d l TU'ONG VA PHU'OfNG PHAP NGHIEN COU 2 . 1 . D o i tu'dng nghien c i h i .
Odi tffdng nghien cffu bao gom 2 nhdm:
+ Nhdm nghien cffu: 112 benh nhan DTD type 2 dffdc chan doan lan dau tai benh vien Da khoa tinh Thai Binh chffa diieu t r i .
+ Nhdm chffng khoe manh: 37 ngffdi binh thffdng cd dp tuoi tren 40 khdng ed benh tlm mach, THA, than kinh, benh npi tiet khae, khong dung corticoid.
2.1.1. TiSu diuSn lu^ clign
* TMu chuan lua chgn nhdm chufy - Nhffng ngffdi khde manh, khong m i e ede benh cap hoac man tinh.
Tuoi > 40
- Deu cd nong dp glucose mau luc ddi d mffc binh thffdng (<5,6 mmol/l)
* Tieu chuan lua chgn benh nhan - B^nh nhan dffdc chan doan OTO type 2, chan doan IBn dau chu^ dieu trj.
- Tieu chuan chan dodn DTD theo WHO 1999 va ADA 2004 khi cd 1 trong 3 tieu ehuan [ 2 ] .
* Glucose mau d thdi diem bat ky >11,1 mmol/l
• Glucose mdu luc dol > 7,0 mmol/l, xdt nghiem sau 6 - 8 gid khdng Sn.
• Glucose mau d thdi diem 2 gid sau khi lam nghiem phdp tang glucose mdu > 11,1 mmol/l.
2.1.2. Tieu chuS'n io^i trit
* Tieu chuan ioai triy nhdm diuhg:
- Cd ngffcfi than nhff bo, me, eon, anh chj em rupt mac benh DTD
- Mhc cac benh npi tiet ndi chung - Phu nff da dffde xae nhan cd hpi chffng buong trffng da nang.
- Phu nff cd tien sff san khoa dde b i f t nhff thai chet Iffu, say thai, OTO thai ky, sliih eon n$ng
> 3600 gram hoac cd tien sff sinh con
<2500gram
- Cd tang huyet ap, benh dpng maeh vanh hodc dot quy nao,
- Ngffdi dang sff dung mot so thuoc dnh hffdng tdi ehffe nang te bao beta nhff oKticold, tiiuoc tranh thai,
Y HOC VIET NAM THANG S - SO 2/2014 - Mac benh gan than hoac dang mac cac benh
cap tinh.
* Tieu chuan loai trd benh nham - Benh nhan OTO type 2 da du'dc dieu tri d tuyen tru'dc.
- OTO thiJ phat sau benh ly npi l(hoa hay benh npi tiet l<hac
- cic benh nhan OTO thai nghen, benh nhan OTO typ 1.
- Oang mac 1 so benh cap tfnh nhu* nhiem Ithuan huygt, hon me do OTO hay do 1 so nguyen nhan lihac nhu' nhoi mau cd tlm , suy tlm nang.
- Oang co benh gan- than mu'c dp nang.
- BSnh nhan siir dung thuoc lam thay doi tinh nhay cam ciia Insulin mau va gay tang glucose mau (steroid, cathecholamin, chen beta, ldi tieu).
- Binh nhan bd cuoc trong qua trinh nghien ojli.
2.2. PliiTdng phap nghien cuTu
- Thiet ke nghien ciju: tien ciiu, mo ta, cat ngang, so sanh nhom chiJng va nhom benh
- Oja diem nghien diii: Benh vien da khoa tinh Thai Binh.
- Thdi gian nghien ciJu; tir thang 3/2013 den thang 10/2013.
• Xac dinh cac chi so khang insulin va chu'c nang te bao beta
+ Tinh toan chtte nang te bao beta va chi so khang Insulin bang phan mem mo hinh HOMA -2 ( Copmputer Homeostatic Model Assessment) phien ban 2.2.2 nam 2007, chay tren nen giao dien excel. Phan mem HOMA-2 dUdc cung cap qua website (wv«w.OCDEM.ox.ac.uk)
+ Cac kS qua b'nh toan du'dc phien giai nhu sau;
• H0MA2-IR_ins: khang Insulin tinh theo cap nong dp glucose, insuiln
• HbMA2-B%jns: chu'c nang te bao beta tinh theo cap nong dp glucose, insulin.
• HOMA -2%S_lns: dp nhay insulin tinh theo cap npng dp glucose Insulin
- Cac ket qua xet nghl?m dudc chuan hoa ddn vj tru'dc khi diia so lieu vao chuttng trinh HOMA-2 de tfnh toan. Glucose du'dc chuin hoa theo ddn vj la mmol/l, insulin du'dc chuSn hoa theo ddn v| pU/ml
2.3. Phin tich v l xu' 1^ sS lieu Cac ket qua xet nghigm, tham kham tren lam sang du'dc xCr ly theo phu'dng phap thong ke Y hpc vdi phan mem EPI INFO 6.0 va SPSS 16.0.
III. K ^ Q U A N G H I E N CO'U
3.1.0$c diem chung doi tu'dng nghien cu'u Bdng 1. Phan bo doi tu'dng nghien cuti theo nhom tuoi Nhim tuoi
<50 50-59
-^^^h-
Nhom chu'ng (n = 37)
37,8 13j5 59,5 ± 8,6
Nhom bgnh (n = 112)
27
J M _ 37,5 25,0 24,1 Tuoi trung binh cua nhom chu'ng khoe manh
tuttng du'dng nhdm benh nhan. Phan bo tuoi nhdm chiing va nhom benh nhan khong co sU khac biet co y nghTa thong ke (p >0,05). Tuoi trung binh trong nghien ciin cua chiing toi cao hdn so vdl nghien diu ciia Tran Van Hien (2007)
62,1 ± 11,18
>0,05
>0,05 tren 150 benh nhan OTO type 2 dUdc phcit hl$n lan dau tai BV Noi Tiet co do tuoi trung binh la 51,1 ±8,8 [5].
Nghien ciiti ciia Oao Thi DiiS (2007) tren 155 benh nhan OTO dUdc phat hien lan dau cho thay tuoi trung binh la 52,6 ±14,7 [4].
Bang 2. Phan bo doi tu'dng nqhien ciTu theo gidi
Gidi tinh Nam
Nff
Nhom chiimg (n = 37) n 15 22
40,5
%
59,5
Nhom benh (n = 112) n
44 68
39,3
%
60,7 P
>0,05 Tmng tuhg nhdm, doi tddng nddeu chiim ty le cao hdn so vdl nam. Ty le gidi giO^ 2 nhdm khac U^
khong cd nghla thong ki. Kit qua cua chung tdi cung tddng td nhd kit qua nghidn cdu cua Trin VSn
Y HOC VIET NAM THANG 5 - SO 2/2014
Hien bin 150 benh nhan DTV type 2 phat hien lan dau tai benh vien Ndi tiit nam la 45,3% nO" la 54,7% [5].
3.2. Nong dd insulin, chi sc Bangs. Nonq do insulin
Chi so Insulin CiiU/ml) Chi so gidl han H0MA2- IR Tif phan vi tren
Mu'c do tanq (%) H0MA2- %S Chi sog[di han Miit do qlam (%) H0MA2-%B Chi so gidi han Mirc do giam (%)
Ichang insulin theo mo hinh H0MA2 /a cac chi so khanq Insulin
Nhom chu'ng (n = 37) 8,56 ± 3,74 4,82 den 12,3
1,46 ± 0,51 1,95 92,87 ± 41,67 51,2 den 134,54
125,95 ± 46,76 79,2 den 175,72
Nhom benh (n = 112) 18,81 ± 10,28
4,36 ± 4,21 Tangl9S,e'/o 39,77 ± 30,76 Glam57,17<>A
30,96 ± 18,18 Giam 7S,41<i/<,
P
< 0,001
< 0,001
< 0,001
< 0,001
Ket qua nghien cffu ciia chung toi cho thay d nhdm DTD type 2 cd chi sd khang insulin cao hdn nhdm ehffng, ed y nghTa thdng ke (p<0,001). Chi so HOMA- IR trung binh d nhdm OTO type 2 la 4,36 ± 4,21 cao hdn nhdm chffng Id 1,46± 0,51. Ket qua cua chung tdi thap hdn ket qud nghien effu eua Nguyen Kim Lffdng (2001) khdo sat tinh trang khdng insulin theo ehi
so HOI^A-IR 6 49 benh nhan DTO type 2 la 6,69
±1,45 cao hdn nhdm chung la 0,8 ±0,08 vdi p = 0,01) [7]. Tuy nhien, tinh trang tdng H0MA2-IR Id chae chan d nhuhg b^nh nhan DTD type 2, va la ket qua thong nhat trong cac nghien cffu da tien hanh, tren cac benh nhan DTD da dieu tr!
hoac chan doan lan dau.
Bang 4, Ty le benh nhan theo mii'c bien dol Insulin, cac chi so H0MA2 Chisd
Insulin H0MA2-IR H0MA2-<iiS H0MA2-'>iB
Binh thu'dng (< 12,3) Tanq > 12,3 Binh thi/dnq (< 1,95)
TSng > 1,95 Binh thudng (> 51,2)
Giam < 51,2 Binh thUdnq (> 79,2)
Giam < 79,2
So lu'dng fn = 112)
37 75 28 84 25 75 3 109
Tyi?
(%)
33,1 66,9 25,0 75,0 25,0 75,0 2,7 97,3 Chffc nang te bao beta H0MA2-%B trung
binh l l 30,96 ± 18,18%, chung toi nhan thay ngay t^l thdi diem benh OTO mdi dUdc chan doin chffc ning te bao beta giam dang ke lan Iff^ II 97,3% cao hdn so vdi nhom chiitig la 8,1% (p < 0,001). Nghien cifu ciia chiing toi cao hdn aia Nguyin Thj Thu Thio (2012) thay ty le b|nh nhin OTO type 2 mdi chan doan cd tj' le glim chffc ning te bio b4ta chiem 82,2% [6].
OlSu niy phil hfp vdl nhan djnh ciia nghien cffu UKDPS cho thay chffc ning te bio beta da suy
glim nhleu nam trudc khi co tang glucose mau do khiem khuyet chffc nang te bio beta ciia dio tuy xay ra sdm trffdc khi co OTO v l lien quan den ai che dieu hoa glucose huyet va giam nh?y d m Insulin d cac mo.
Op nhay insulin H0MA2-%S trung binh d nhom OTD la 39,77 ± 30,76 % thap hdn nhom chifng II 92,87 ± 41,67%, co y nghTa thong ke (p<0,001). Khi so sinh vdi chi so H0MA2-%S d nhom chutig chiing toi nhan thay ngay tai thdi diem chan doan benh Hn diu dp nhay insulin
Y HOC VIET NAM THANG 5 - SO 20014 giam 75% so vdi nhdm chimg la 10,8%. Ket qua
nay phiJ hdp vdi ket qua cua Nguyen Cdng Dffc nhan thay 70,8% benh nhan giam dp nhay insulin d benh nhan OTD type 2 chan doan lan dBu.
Nhieu nghien cffu cho thay tinh trang khdng insulin lien quan tdi mpt loat cac bien chffng, nhat la cac bien ehffng mach mau va ed mdi lien
quan mat thiet tdi cac yeu td nguy cd nhu" beo phi roi loan lipid mau tao nen mot vong xoan benh ly lam cho tinh trang khang insulin va sff tien trien cua DTO ngay cang phffc tap hdn. Vi vay phat hien sdm tinh trang khang insulin va cdi tiiien dp nhay cua insulin cd the lam cham cGng nhff giam nguy cd DTO.
Bangs. Lien quan Chisd Insulin (pU/ml)
H0MA2- IR H0MA2-%S H0MA2-%B
qlffa Insulin va cac chi so H0MA2 vdl chi so khoi cd the BMI < 23 Icg/m^
{n=43) 9,58 ± 3,42 1,68 ± 0,65 69,87 ± 29,95 33,94 ± 18,12
BMI > 23 kg/m2 (n=69) 24,56 ± 8,82
6,03 ± 4,62 21,01 ±7,78 26,19 ± 17,43
P
< 0,001
< 0,001
< 0,001
<0,05 Chi s5 khing Insulin theo HOMA-2 d nhdm benh
nhin cd BMI > 23 kg/m2 (6,03 ± 4,62) cao hdn nhom benh nhin co BMI <23 kg/m2 (1,68 ± 0,65), CO y nghla thong ke.Chi so do nhay insulin HOMA-%S d nhdm co BMI > 23kg/m'2 (21,01
±7,78) thap hdn nhdm ngffdi benh cd BMI <
23kg/m2 (69,87 ± 29,95), cd y nghTa thong ke.
Chi so HOMA-%B d nhom ngffdi benh co BMI >
23kg/m2 (26,19 ± 17,43) thap hdn nhom ngffcfl benh co BMI <23kg/m2 (33,94 ± 18,12).
Bang 6, Tffdnq quan qlOa insulin, cac chi so H0MA2 vdi chi so khoi cd thg Thdng so
H0MA2- IR H0MA2- %S
Phu'dng trinh y = 1,05 X - 20,14 y =-9,55X j-263,1
BMI (kg/m-T
0,601 -0,75
<0,001
<0,001 I H0MA2-%B |_ y =-1,78 X +10,64 T -0,237 I <0,05
BMI tddng quan thuan mdc do rat chit Che vdi H0MA2-IR; tddng quan nghich mdc dg rat chat che vdi fiOMA2-%S va tddng guan nghich mdc dd yiu vdi HOMA.
Bang 7. Lien quan giii^ bien dol Insulin v l cac chi so H0MA2 vdl chi so khoi cd the Chi so
Tanq Insulin Ting H0MA2- IR Glim HOI4A2- %S Glim H0MA2-"%B~
BMI <23 kg/m^
n (%) 7(16,3) 15(34,9 15(34,9) 41(95,3) Chffc ning te_bao beta bien dpi lien quan vdi chi sS khoi cd the. Moi tffdng quan thuan mffc dp ciiat gISa chi so khanj insulin H0MA2-IR vdi chi so khoi cd the, da the hien moi lien quan co tinh lopic ciia cac chi so tren, nghTa la chi so khoi cd the dng cao thi H0MA2-IR cing tang, dong nghTa vdi rang tinh trang khang insulin. Ngffdc tai, moi tffdng' quan nghjch co y nghTa gliici
BMI >23 kg/m^
n(°/») 68 (98,6)
69 (100) 69 (100) 68(98,6)
<0,001
< 0,001
< 0,001
>0,05 H0MA%B vdl chi so khoi cd the da ndi len rang:
chi so khoi cd the cing cao thi chffc nang te bao beta cang giam.
Ket qua niy cung tffdng tff nhff nhieu nghiin ciru khac: nghien cu'u ciia l^guyen Trung Vinh (2006) nqhien cffu trin 134 benh nhan OTO type 2 deu khang djnh khang Insulin v l chffc nang t l bio beta tffdng quan thuan chat che vdl BMI [8], Bang 8. Lien quan qiiia nong dp Insulin, cac chi so t^0MA2 vdi rot toan lipid (RLLP) mlu
Chi so Insulin (pU/ml)
H0MA2- IR H0MA2 -%S
RLLP tn = 89) 21,17 ±10,12
5,04 ±4,47 32,15 ±25,91
23,01 ± 12,4
Khong RLLP (n = 23) 9,66 ± 3 , 6 6 1,73 ± 0,74
),21 ± 30,75 33,02 ± 18,91
< 0,001
< 0,001
< 0,001
<0,05
Y HOC V l ^ NAM THANG 5 - SO 2/2014
N^g ddmsiin va H0MA2IR cac benh ntian ril toan lipid mau cao hdn cd y nghia thong kesowjS cac b&ih nhan khdr^ rdi han llpkl mau (p < 0,001). Do nhay Insulin, chdc nang tibao beta d cac benh nhan rm'k3an lipid mau deu thap hdn cac benh nhari con lai (p < 0,001 vap < 0,05).
Bang 9. Lien quan giii^ bien doi nonq do insulin, cac chi so H0MA2 vdi roi ioan lipid mau Chis£i
Ting insulin Tang H0MA2-IR Glim H0MA2 %S Giam H0MA2%B
RLLP (n=89) 70 (78,7) 75 (84,3) 75 (84,3) 86 (96,6)
Khong RLLP (n=23) 5 (21,7) 9 (39,1) 9 (39,1) 23 (100)
P
< 0,001
< 0,001
< 0,001
>0,05 Ket qui nghien CUXJ ciia chiing t&i cung cho
thay CO moi tffdng quan thuan mffc dp yeu glO:a chi so H0MA2-IR vdi TG. Ket qui ciia chung toi tffdng tff nhff ket qui cua Nguyen Trung Vinh (2006) [8]. Trong ket qui nghien cifu ciia chiing toi cho thay ty le khing Insuiln cd sff khac biet gliJa 2 nhdm ting LDL-C v l khong tang LDL-C la 93,5% so vdl 67,9%, co y nghTa thong ke. Khong cd sff khac biet v l ty te gam chffc nang te bao beta d 2 nhom.
Nhff v|y da s5 cic thong sd lipid mlu trpng nhdm b|nh nhan OTO type 2 chan doan lan dau c6 bien dSl ro r|t. O binh nhin OTO type 2 ca tSng CT, ting TG v l ting LDL-c trong mau cang tlm tSng thim tinh trang khang insutin. Vi vay de glim cic bien chifng cung nhff giam tinh trang khing Insutin d b|nh nhan OTO type 2 chiing ta oin phai kham phit hten tinh trang roi loan lipid kem theo ngay khi b|nh nhan dffdc chan doan OTO tan dau v i dieu trj tot cic roi loan lipid dd.
IV. KIT LU$N
Khao sit 112 benh nhin OTO type 2 dffdc chan doan lan dau tai benh vien Oa khoa tinh Thai Binh Chiing toi rut ra mpt so ket tuan ve chi s5 khing Insutin, chffc ning te bap beta va mpl liln quan vdl 1 so chi so d b|nh nhan dai thio dudng type 2 chin doin tan dau nhff sau:
- Ting nSng dp Insulin miu v l ting H0MA2-IR, glim H0MA2%S v l H0MA2%B
- Mffc dp ting H0MA2-IR: 198,6%; giim H0MA2-%S; 51,7%; glim H0MA2-%B: 75,41%
TV t| BN ting Insutin mlu: 66,9%; khang msulln:7S,0%; glim chffc ning te bid bita:
97,3%; glim dp nhay insulin: 75,0%
- Nong dp Insulin, H0MA2IR tffdng quan thuan, H0MA2-%S, H0MA2-%B tffdng quan nghjch cc y nghla vdi BMI
- 6 benh nhin tang chu vl vong bung, WHR c6 nong do Insulin, H0MA2-IR cao hdn, H0MA2-%S, H0MA2%B thap hdn; ty le dol tffdng tang Insulin, H0MA2-IR, giam H0MA2-%S deu cao hdn so vdl BN CO chu vi vong bung, WHR binh thffdng.
- 6 benh nhin co roi loan lipid mau nong dp insulin,' H0MA2-IR cao hdn, H0MA2-%s) H0MA2% B thap hdn; ty le dpi tffdng ting insulin, H0MA2-IR, giam H0MA2-%S deu cao hdn so benh nhin khpng cp RLLPM.
TAI L I | U THAIVI KHAO
1. Intemational Diabetes Federation (2011), Diabetes feds. Diabetes AHas, 4th edition.
2. IDF, Global Diabetes Plan 2011- 2021.
3. Ta van Binh (2006). Dich te hgc b^nh dai thao Ming Viet Nam, NXB Y hpc Ha Npi.
4. Dao Thj Difa (2008). Nghien ciiU clllt lu'png cuoc song benh nhan dai thao di/cfng. T^p chi y hoc thUc lianh so 616 + 617, tr 349 - 357.
5. Tran Van Hien, Ta Vin Binh (2007). NghlSn cuu r^ loan Lipid mau d benh nhan dai thdo du'dng typ 2 tan dau dUdc phat hien tai b§nh vien noi tiet Trung Udng. Hgi nghj idioa hgc toin qudc chuyin nghanh noi tiit va chuyen hda lan thd 3, b-660 669
6. Nguyin Thj Thu Thao, Nguyen Thy Khue (2005). Bien chffng man tren benh nhan DTD type 2 mdi dian doan. Tap chi Y Hgc thdc hinh, B§ Y te; 507 - 508: 679 - 692.
7. Nguyen Kim Lu'dng, Thai Hong Quang (2001).
"Benh mach mau va roi lo?n chuyen hoa Lipid d benh nhan dai thao dudng Type 2 ". Ky yiu toin i^n cong trinh nghien cdu khoa hgc ngi tiet va idi loan chuyen hda, Nha xuat ban y hpc; Trang 411- 416. 5
