Y HOC VIET NAM THANG 5 • SO 2/2015
NGHIEN CU'U NONG DO TROPONIN I TREN BENH NHAN NHOI M A U CQ TIM CAP
T O M TAT
Thiet ke nghien CLTU cat ngang, mo ta co phan tfch. Tong so benh nhan la 66, du'dc chan doan xac djnh NMCT ST chenh len va c6 thcfi gian dau ngu'c den luc nhap vien <24 gid. Benh nhan du'dc thu thap ket qua ve cac chi so nhan trac, huyet ap, Bilan lipid mau, dien tim; lay mau 4 lan (mdi vao vien, 5 gid, 24 gid sau nhap vien, 7 ngay sau dau ngu'c) de do nong dp cac chi' diem sinh hpc: TnICK, CK-MB, LDH.Xir ly so lieu bSng phan mem SPSS 15.0, ve du'dng cong ROC va dien tfch du'di du'dng cong, tinh dp nhay, dp dSc hieu trong chan doan NMCT,
TWkhoa: Nong do, troponin, nhoi mau cd tim SUIVIMARY
RESEARCH CONCENTRATION OF T R O P O N I N I I N PATIENTS W I T H ACUTE MYOCARDIAL INFARCTION
Cross-sectional study design, descriptive analysis.
The total number of patients was 66, was diagnosed with myocardial infarction wiUi ST elevation and duration of chest pain and hospitalization <24 hours.
Patient outcomes were collected anthropometric indices, blood pressure, blood lipid profile, ECG; blood taken 4 times (the new hospital, 6 hours, 24 hours after admission, 7 days after chest pain) to measure the concentration of biological markers: TnICK, CK- MB, LDH.Xu data analysis using SPSS software 15.0, drawing curves and area under the ROC curve, calculated the sensitivity, specificity in the diagnosis of myocardial infarction.
Keywords: concentration, troponin, myocardial infarction
I. OAT VAN o l
Nhoi mau cd tim la mpt cap ciru tim mach thu'dng gap, cd nhieu bien chirng nguy hiem, gay ty le tir vong cao. Tai My, nam 2004, co 1.565.000 ca nhap vien vdi chan doan HCVC, trong do 669.000 ca DTNKOD, 896.000 ca
* Dai hpc Y DWdc CSn Thd Chju trach nhiem chfnh: Du'dng Xuan ChU Email: [email protected] Ot: 0913794789 Ngay nhan bai: 10/2/2015
Ngay phan bien khoa hoc: 10/3/2015 Ngay duyet b^i; 2/4/20i5
Duong Xuan Chu*, Le Kim Khanh*, Phan Thi Trung Ngpc*, Tran Do Hung*
NMCT. Tren the gidi moi nam eo 2,5 trieu ngu'cfi chet do benh nhoi mau cd tim, trong dd 30%
chet trong giai doan cap tinh ciia benh, 10 den 15% chet tru'dc khi den benh vien va trong vong mpt nam sau do eo them 5-10% tir vong nda. 0 cac nu'de dang phat trien ty le benh mach vanh cung gia tang mpt each nhanh chdng. Tien lu'dng benh phu thupc vao chan doan, phat hien, dieu tri va dl/ phong sdm hay mupn [ i j .
Gia trj CLia Troponin I trong chan doan nhoi mau cd cap da du'dc nhieu nghien ciru tren the gidi va 6 trong nu'de tien hanh nghien ciru, rieng tai Benh vien Da khoa Trung u'dng Can Thd chift CO nghien ciru nao de cap den. Do vay, chiing toi thdc hien de tai: "Nghien cWu nong do
Troponin I trin benh nhin nhoi miu cd tim cip"wd'\ hai muc tieu nhu' sau;
1. Khao sat s& bien doi nong do Troponin I, CK, CK-MB, LDN va mot so yeu to nguy cd: chi so nhin trac, huyet ap, roi loan glucose mau va bilan lipid mau d benh nhin nhoi mau cd tim cap.
2. So sanh va danh gia mdi t&dng quan giuS Troponin I vdi CK, CK-MB, LDN tren binh nhan nhoi mau cd tim cap.
II. OOI TU'QIMG VA PHUaNG PHAP NGHllN CLTU 2.1. Odi tu'dng nghien cii'u
Chpn tat ca benh nhan khong phan biet tuoi, gidi, nhap vien tai khoa hoi sire cap cdu va khoa npi tim maeh Benh vien Oa khoa Trung u'dng Can Thd tir thang 05/2009 den thang 9/2010 co cdn dau that ngu'c kieu vanh, sau do tien hanii tham kham lam sang, lam cac xet nghiem de chan doan NMCT.
2.1.1, Tieu chui'n chgn benh Benh nhan du'dc chan doan xac djnh NMCT ST chenh len va co thdi gian dau ngu'c den liic nhap vien <24 gid.
Tong so benh nhan du'dc chpn la 66.
2.1.2. Tieu chui'n chin doin nhoi mau cd tim (NMCT)
a. Theo neu chuan kinh dien cua TCrTTG (1978) Gom CO 3 tieu chuan, chan doan NMCT khi CO 2 trong 3:
Y HOC VIET NAM THANG 5 - SO 2/2015
- Cdn dauthat ngu'c kieu vanh keo dai tren 20 phiit.
- Bien doi ST-T tren dien tam do va (hoac) co sdng Q hoai tir.
Bien doi men tim dac hieu CK-MB, hoac Troponin I [ 5 ] .
Ngudng chan doan NMCT; CK-MB >25 U/L (37''C), Troponin I >2ng/mL (ngu'dng chan doan NMCT ciia phong sinh hoa khoa xet nghiem BVOKU/ Can Thd).
b. Theo tieu chui'n mdi cua ESC/ACC/AH/VWHF (2007)
Co 1 trong nhiJng yeu to sau cho phep chan doan nhoi mau c d t i m :
l-Co sir tang va/ hoac giam cac chat chi diem cd tim (dac biet la troponin) kem theo it nhat mpt trong nhutig dau chirng sau;
+ Trieu diijfng lam sang thieu mau cue bo aJ tim.
+ Thay doi ciia dien tim cho thay cd dau hieu thieu mau cue bp mdi (ST-T mdi bien doi hoac block nhanh trai mdi xuat hien),
+ Sy" xuat hien ciia cac song Q benh iy tren dien tim.
+ Bang chimg cho thay mat viing cd tim con song mdi hoac su' bat thu'dng roi loan van dpng viing mdi xuat hien.
2-Dpt td do tim xay ra tru'dc khi lay mau hoac vao lue tru'dc khi xuat hien cac chat chi Jlem tim trong mau.
3-061 vdi can thiep mach vanh qua da d ihffng benh nhan cd tri so troponin gap 3 lan :inh thu'dng.
4-Ooi vdi phau thuat cau noi mach vanh d
nhUng benh nhan co tri so troponin gap 5 lan binh thu'dng.
5-Cac bang chiitig benh hpc cho thay NMCT [2].
2.1.3. Tieu chui'n loai trW
Chung toi ioai trir khoi nghien ciTu cac doi tu'dng CO cac benh hoac tinh trang co the lam tang Troponin nhu": chan thu'dng cd, suy tim, viem cd tim, soc do mpi nguyen nhan, nhiem trung, suy than, mang may tao nhip, suy giap, dang sir dung thuoc nhom statin, co bang chirng nhoi mau cd tim cap tru'dc dd >10 ngay va benh nhan khong hpp tac.
2.2. Phu'dng phap nghien cu'u 2.2.1. Thiet ke nghien cWu: Nghien ciTu cat ngang mo ta, cd phan tfch, thu thap so lieu tien ciru.
2.2.2. Thu thip dit lieu
Moi benh nhan trong mau nghien ciru du'dc khao sat theo phieu nghien ciru vdi quy trinh sau: tien hanh hoi tien sir, benh sir, kiiam lam sang de chpn li/a doi tu'dng nghien ciru dat tieu ehuan quy dinli. Cae xet nghiem du'dc lay mau dam bao diing quy trinh tai Benh vien Da khoa Trung u'dng Can Thd, tat ca cac dD" kien du'dc ghi chep vao phieu nghien ciTu.
2.3. Xir ly sd lieu
- Xd ly so lieu bang phan mem SPSS 15.0.
- Thong ke mo ta: Cac bien dinh lu'dng du'dc bieu hien bang gia tn trung binh va dp lech chuan, cac bien dinh ti'nh du'dc bieu hien bang ty le %.
. KET QUA
3 . 1 . NhuYig d | c diem chung cua mau nghien cu'u 3.1.1. Phin bo binh theo nhom tud'i vi gidi tinh
Bang 3.1. Oac die'm nhom tuoi ya gidi tfnh doi tu'dng nghien ciru Dac diem nhom tuoi va gidi tinii
Gidi tinii Nff Nam Nliom tuoi
Nhom 60 tuoi trd len Nhom du'di 60 tuoi
n (O/o) 21 (31,8) 45 (68,2) 48 (72,7) IS (27,3) 3.1.2. Thdi gian khdi phit dau ngWc din nhip vien cua doi tWdng nghien cWu:
Bing 3.2. Thdi gian khdi phat dau ngiTc Tlidi gian i<hdi phat dau ngu'c (gid)
Tru'dc 6
> 6 - 1 2
> 12 - 24 Tong
N (%) 22 (33,3) 21 (31,8) 23134^) 125(100)
Y HOC VIET NAM THANG 5 - SO 2/2015
3.1.3. Cic yeu to nguy cd
Bing 3.3. Mo ta cac yeu to nguy cd cua mau nqhien ciru
4
Yeu to nguy cd BI^I (kg/m2): (trung binh ± do iech chuan) Beo phi theo BI^I (Bi^ll >23): n (%) Vong eo (cm): (trung binh ± do iech chuan) Beo phi thee VE: n (%)
Beo phi dang nam (theo VE/Vi^): n (%) Tang huyet ap: n (%)
Roi ioan du'dnq mau: n (%) Tang Cholesteroi mau: n (%) Tang Triglyceride mau; n (%) Tanq LDL-c mau: n (%) Giam HDL-C mau; n (%)
n=66 21,3 ± 2,6
17 (25,8) 77,6 ± 10,9
16 (24,2) 27 (40,9) 45 (68,2)
31 (47,0) 31 (47,0) 34 (51,5)
28 (42,4) 39 (59,1) 3.2. Sd thay doi niong do Troponin I ,
Bang 3.4. So sanh su' bien doi nong Nhdm b^nh
NMCT ST chenh len
Men CK CK-MB
LDH Troponin 1
CK, CK-MB, LDH d benh nhan nh'oi mau do cac men theo thdi qian
Bien doi men theo thdi gian
< 6 g i d 538,7
46,5 668,1 16,42
>6-12gid 717,5
71,8 812,1
28,0
>12-24 gid 600,2
61,8 924,8 35,6
>7 ngay 161,3 22,6 669,9 7,5
cd tim cSp
P 0,001 0,001 0,002 0,001 3.3. So s^nh gia tri troponin I vdi cl<, ck-mb v^ Idh trong chan doan nhoi miu cd tim cap 3.3.1. Sd thay doi nong do Troponin I d binh nhin NMCT cap so vdi gii trj binh thddng
Bang 3.5. Stf thay doi nong do Troponin I theo thdi gian
Gia trj trung binh Troponin I (ng/ml)
Do lech chuan Sd' fan tang so vdi mij'c binh thu'dng (0,1 ng/ml)
P KTC 9 5 %
Thdi Trong 6 gid
(22 bn) 16,4 30,7 164 0,021 2,67 - 29,89
gian tir luc dau ngu'c den xet nghiem
> 6 - 1 2 g i d (43 bn)
28,0 57,3 280 0,003 10,25 - 45,55
> 12 - 24 gid (66 bn)
35,6 50,0 356 0,001 23,19-47,78
Sau 7 ngay (66 bn]
7,5 10,1
75 0,001 4,87 - 9,86 3.3.2. So sinh Troponin I vdi cic men kinh dien d binh nhin NMCT cap
Bang 3,6. So sanh Troponin I vdi cac men i<inh dien d thdi diem tru'dc 6 qid Cac men thdi diem
tru'dc 6 gid Troponin I (<2 ng/ml)
CK (bt <190 U/L) CK-MB (bt <25 U/L) LDH (bt < 450 U/L)
So BN 22 22 22 22
SS BN cd l<et qua
> binh thu'dng U (50,0) 12 (54,5) 10 (45,5) 12 (54,5)
Gia trj trung binh 16,4 538,7 46,5 668,1
Sd' Tan tang 8,2 2,8 1,9 1,5
Y HOC VIET NAM THANG 5 - SO 2/2015
Bang 3.7. So sanh Troponin I vdi cac men l<inh dien d thdi diem > 6 - 12 qid Cac men thdi diem > 6
- 1 2 gid Troponin I (2 ng/mi)
CK (bt <190 U/L) CK-MB (bt <25 U/L) LDH (bt < 450 U/L)
SoBN 43 43 43 43
Sd BN cd l<et qua
>binh thu'dng 35 (81,4) 25 (58,1) 28 (65,1) 31 (72,1)
Gia trj trung binh
28,0 717,5 71,8 812,1
Sd I'an tang 14 3,8 2,9 1,8 Bing 3,8, So sanh Troponin I vdi cac men l<inh dien d thdi diem trirdc >12- 24 qid Cac men thdi diem >12
- 24 gid Troponin I (<2 ng/ml)
CK (bt <190 U/L) CK-MB (bt <25 U/L) LDH (bt < 450 U/L)
So BN 66 66 66 66
Sd BN cd ket qua
> binh thu'dng 60 (90,9) 42 (63,6) 38 (57,6) 52 (78,8)
Gia trj trung binh 35,6 600,2 61,8 924,8
Sd Tan tang 17,8 3,2 2,5 2,1 Bing J. A So sanh Tro
Cac men thdi diem 7 ngay Troponin I (< 2 ng/ml)
CK (bt <190 U/L) CK-MB (bt <25 U/L) LDH (bt < 450 U/L)
ponin I \ So BN 66 66 66 66
dl cac men l<inh dien d thdi diem 7 nqay So BN cd ket qua
> binh thudng 42 (63,6) 11 (16,7) 6 (9,1) 49 (74,2)
Gia trj trung binh
7,5 161,3 22,6 669,9
So fan tang 3,8 0,8 0,9 1,5 3.4. Sir tu'dng quan glu'a Troponin X vdi CK, CK-MB, LDH
Bing 3.10. Tu'dng quan giii'a Troponin I vdi men CK, CK-MB, LDH tru'dc 6 gid Tu'dng quan
Nhdm NMCT ST chenh len CK
CK-MB LDH
Troponin I (Tu'dng quan Spearman) r
0,764 0,756 0,232
P 0,006 0,007 0,492 Bang 3,11, Tu'dng quan glu'a Tropon
Tu'dng quan Nhdm NMCT ST chenh len
CK CK-MB
LDH
n I vdi CK, CK-MB, LDH thdi diem 6-12 gid Troponin I (Tl/dn
r 0,605 0,623 0,654
J quan Spearman) P 0,001 0,001 0,001
Y H O C VIET NAM THANG 5 - S6' 2/2015
Bing 3,12. Tddnq quan qiifa Troponin I vdi CK, CK-MB. 1 DM d thdi diem 12-24 qid Tu'dng quan
Nhdm NMCT ST chenh ien CK CK-MB
LDH
Troponin I (Tu'dng quan S p e a r m a n ) r
0,497 0,587 0,540
P 0,001 0,001 0.001 Bang 3.13. Tddnq quan qlUa Troponin I vdi CK, CK-MB, LDH sau 7 nqav
Tu'dng quan Nhdm NMCT ST chenh len
CK CK-MB
LDH
Troponin I (Tu'dng quan S p e a r m a n ) r
0 , 4 9 8 0,116 0 , 5 2 0
p 0 , 0 0 1 0,353 0 , 0 0 1 IV. BAN LUAN
4.1. SU bi§n dd'i nong do Troponin 1, CK, CK-MB, LDH
Trong nghien cull nay, chiJng toi chpn cac thdi diem khao sat gia trj cac men la: trUdc 6 gid, 6 -12 gid, >12 - 24 gid, va sau 7 ngay (sau khdi phat dau ngUc). Ket qua cho thay cd SLT khac biet nong dp cac men theo thdi gian va sir khac biet nay cd y nghia thong ke.
4.1.1, Sd bien ddi ndng dd Troponin I, CK, CK-MB, LDH theo thdi gian -Troponin I tang sdm trong 6 gid dau sau dau ngifc va dat cy'c dai vao thdi diem 12- 24 gid, van cdn cao hdn ngudng chan doan NMCT cap vao ngay thu' 7. NhU vay Troponin i .^ng sdm va keo dai, ket qua nay phu hdp vdi y van.
- Men CK tang sdm (trUdc 6 gid sau dau ngUc), dat nong dp cu'c dai vao thdi diem >6-12 va trd ve binh thudng vao ngay 7.
- Men CK-MB thay ddi nong dp qua cac thdi diem xet nghiem cd sy khac biet cd y nghia thong ke (p<0,05), dat nong dp ci/c dai vao thdi diem >6- 12 gid, sau dd giam va trd ve binh thu'dng sau 7 ngay. Dieu nay phu hop vdi y van.
- Men LDH tang nhe vu'dt ngudng tren gia tri binh thu'dng vao thdi diem tru'dc 6 gid, dat nong do cu'c dai vao thdi diem >12-24 gid, va sau 7 ngay van cdn cao hdn gia tri binh thudng. Ket qua nay phii hdp nhieu tac gia nhu Vasudevan, M.
Kemp, Donald Schcrlber cho thay LDH cd the diing trong tru'dng hdp benh nhan den mupn [7],
4.1.2, Sl/ bien doi niong do Troponin I, CK, CK-MB, LDH tai moi thdi die'm khao sat
Trong nghien ziiM cua chung toi. Troponin tang sdm tir <6 gid (gap 8 ^n gia tri ngudng
chan doan (2ng/mL), dat dinh luc 12-24 gid; van cdn cao luc 7 ngay. CK-MB tang sdm iuc <6gifl, dat dfnh iuc 6-12 gid va khi xet nghiem vao ngay thii' 7 trd ve binh thu'dng, dieu nay ciing phii hd):
vdi cac tac gia M. Kemp, Donald Schreiberri Chung tdi cung cd ty so CK-MB/CK >2.5% [7], Rieng LDH dat nong dinh vao thdi diem 12-24 gid, sdm hdn so vdi cac nghien cuti ciia M.
Kemp, va 1 sd tac gia khac cd the giai thicil do chung tdi loai trir khdi mau nghien culj nhiilig tru'dng hdp cd the iam tang Troponin I ma khSni ioai trir het nhD'ng tru'dng hdp tang LDH ngoi NMCT cap. Tuy nhien van phu hdp so vdi ngliiai cu'u cua M. Kemp, LDH van cdn tang keo daiJei thdi diem 7 ngay, nong dp dinh so vdi gia tri trei ngudng binh thudng khong cao nhd Troponin!
hoacCK, CK-MB[7].
Trpng nghien ciru ciia Le Thi Bich Thuan, tii gia ghi nhan tren 69 benh nhan NMCT xuyii thanh, nSng dp Troponin I tim tang ro ret 19 i 6ng/ml va nong dp nay gia tang cd y nghTa 63i 9ng/mi vao gid thir 24, so vdi nghien cuU dl chung tdi nong dp cua Trpponin I vao thdi dial
>12-24 gid thap hdn (35,6 ± 50,0) [4]
Theo Bemadette Cummins va cs, cac tacgfi da ghi nhan Trppomn I tim tang sdm trong vom 4-6 gid, dat den nong dp dinh tninc binh (112ng/mi, 20 - 550ng/mi) vao luc 18 $ va hay cdn cao hdn binh thudng den 6-8 ngii sau NMCT, ve thdi gian phii hflp vdi nghien c*
cua Chung toi [6].
Theo tac gia Ta Thi Thanh Huong, nongili trung binh ciia Troponin 1 tren NMCT ia 15 56,1 21.28ng/mi, cao hdn nong dd trung binli I Trpponin I tren ngUdi binh thu'dng cd y ngii thong ke (p < 0.001), thdi die'm
14 ngi
Y HOC VIET NAM THANG 5 - 3 0 2/2015
(4,67 ± 5,7 ng/ml) thap htfn trong nghien cuTu ciia chiing toi (7,5 ± 10,1), co the do thdi diem xet nghiem tre hOn 3-7 ngay [7].
4.2. So sanh gia trj Troponin I vdi CK, CK-MB va LDH trong chan doan nhoi mau cd tim cap
Theo y van. Troponin I eo the tang tren 20 lan gia tri nguSng chan doan, trong nghien ciTu ciia chimg toi ia 17,8 lan. Qua khao sat ciia chimg toi cho thay trong cac men kinh dien, CK va CK-tAB tang sdm ciing Troponin I, d giai doan muon CO sd tang LDH cimg Troponin I nhu'ng cac men kinh dien nay con tang trong nhieu benh ly khac ngoai NMCT cho nen Troponin I la CO gia trj hdn het, Hdn nu'a. Troponin I luon cao hdn han so v6l CK-MB va LDH. Ben canh viec gia tang nong dp, ban chat Troponin I (la protein cau triic te bao cd tim) cung khac han cac men tim kinh dien (la cac men xue tac phan irng) do vay Troponin the hien tfnh chuyen biet cho tim.
Do chiing toi chi khao sat nhom NMCT cap (NMCT ST chenh len) nen can co nghien cij'u them ve Troponin I va cac men tim kinh dien trong NMCTST khong chenh len va dau that ngu'c khong on djnh de thay ro hdn vai tro Troponin I, dong thdi tinh du'dc dp nhay, do dac hieu va gia tri tien doan du'dng, gia trj tien doan am ciia xet nghiem nay [7].
4.3. Mdi tu'dng quan giO'a Troponin I vdi CK, CK-MB, LDH
Khi khao sat Troponin I va cac men tim qua cac thdi diem sau dau ngi/e cho thay:
- Moi tu'dng quan glu'a Troponin I va CK: co sy*
tu'dng quan thuan, miTc dp kha chat vao thdi diem 6 gid (r=6,76 va p=0,006), tu'dng quan thuan mii'c dp vii^ thdi diem 6-12 gid, 12-24 gid va 7 ngay sau dau ngu'c (r=0,605 va p=0,001;
r=0,497 va p=0,001; r=0,498 va p=0,001). Nhu"
vay qua cac thdi diem khao sat deu co sir tu'dng quan thuan giu^ Troponin I va CK.
- Moi tu'dng quan giiJa Troponin I va CK-MB: co SlT tu'dng quan thuan kha chat vao thdi diem 6 gid (r=0,76 va p=0,007), tu'dng quan thuan miTc do vira d thdi diem 6-12 gid, va 12-24 gid (r
=0,623 va p=0,001; r =0,665 va p=0,001), khong co su" tu'dng quan d thdi diem sau 7 ngay [r=0,116 va p=0,353). Khi doi chieu vdi bang bien thien nong do cac men theo thdi gian cho thay den thdi diem sau 7 ngay men CK- MB da :rd ve gia tn binh thu'dng trong khi Troponin I /an con cao. Theo Bemadette Cummins va cs, Jinh cua Troponin I cd tu'dng quan thuan vdi CK-
MB (r-0,75, p<0,0001) so vdi nghien ciTu cua chimg toi la r^0,623.
- Moi tu'dng quan g\da Troponin I va LDH qua cac thc^ diem sau dau ngu'c nhu" sau: khong co tu'dng quan vao thcfi diem 5 gid (r=0,23 va p=0,49), tu'dng quan thuan miTc dp vifa thdi diem 6-12 gid,
>12-24 gid va sau 7 ngay (r=0,665 va p=0,001;
r-0,540 va p=0,001; r=0,520 va p=0,001). Khi doi chieu vdi bang bien thien nong do cae men theo thdi gian cho thay d thdi diem tru'dc 6 gid nong do LDH chu'a tang.
V. KET LUAN
5.1. Bien doi nong do Troponin I Nong do Troponin I eiia nhom NMCT ST chenh len tang cao gap 8 lan gia trj ngu'dng 2ng/mL tif thdi diem tru'dc 6gid, dat gia trj cao nhat la vao thdi diem 12-24 gid (35,6 ± 50) va sau 7 ngay van con tang, sd bien thien nong dp theo thdi gian co su' khac biet co y nghia thong ke (p=0,001).
Bien do/nong do dc men CK, CK-MB, LDH a benh nhan NMCT ST chenh len: CK, CK- MB, va LDH bat dau tang tru'dc 6 gid, CK, CK-MB flat dinh d thdi diem 6-12 gid, LDH dat dinh 6 thdi diem 12-24 gid. Sau 7 ngay, CK va CK-MB deu trd ve gidi han binh thu'dng trong khi LDH van con d mu'c cao. Cic yeu to nguy cd bgnh mach vinh:
Yeu to nguy cd chiem ty le eao nhat la tang huyet ap, tang Trglycerid va giam HDL-c, ke den la roi loan glucose mau, tang cholesterol toan phan.
5.2. So sanh Troponin I va cac men Itinh dien trong NMCT cap
- Thdi diem tru'dc 6 gid, co SLT tang cao ciia Troponin I (gap 8,2 lan gia trj ngu'dng chan doan NMCT cap), ke tiep la CK gap 2,8 lan ngUdng tren gia trj binh thu'dng.
- Thdi diem 6-12 gid, tat ca cac men deu cd su"
tang cao nhu'ng noi trpi van la Troponin I (gap 14 lan gia tri ngu'dng chan doan).
- Thdi diem 12-24 gid. Troponin I dat dinh do do tang gap 17,8 lan gia tn nguSng chan doan, CK, CK-MB cd chieu hu'dng giam so vdi thdi diem 6- 12 gid, LDH dat gia tn cao nhat (gap 2,1 lan nguQng tren gia tn binh thu'dng).
- Thdi diem 7 ngay sau dau ngu'c. Troponin I da giam nhu'ng van cdn tang tren ngu'dng (gap 3,8 lan gia tn ngu'dng chan doan), CK, CK-MB trd ve gia tn binh thu'dng, LDH van con tang (gap 1,5 lan nguSng binh thu'dng).
Y HOC V I | T NAM THANG 5 - SO 2/2015 5.3. Sd tu'dng quan giO'a Troponin I vdi
CK, CK-MB, LDH
- Co moi tu'dng quan thuan kha chat giii'a Troponin I vdi CK (r=0,76 va p-0,006) va CK-MB (r=0,76 va p^0,007), khong c6 su" tUdng quan giii'a Troponin I va LDH thi d thdi diem tru'dc 6 gid (r=0,23 va p=0,49).
- Co moi tu'dng quan thuan miTc do vda glu'a Troponin I vdi CK (r=0,605 va p = 0 , o d l ) , vdi CK- MB (r=0,623 va p-0,001), va LDH (r=0,654 va p=0,001) d thdi diem 6-12 gid.
- Cd moi tu'dng quan thuan miTc do viTa giO'a Troponin I vdi CK (r=0,497, p - 0 , 0 0 i ) , vdi CK- MB (r=0,587, p=0,001), va LDH (r=0,540, p=0,001) d thdi diem 12-24 gid.
- Cd moi tu'dng quan thuan mii'c dp vifa giu'a Troponin I vdi CK (r=0,498, p = 0 , 0 0 i ) , va LDH (r=0,520, p=0,001), nhu'ng khong cd sd tu'dng quan glu'a Troponin I va CK- MB (r=0,116, p=0,353) d thdi diem sau 7 ngay.
TAI Ll|U T H A M KHAO
1. Nguyen Huy Dung (2002), "Benh mach vanh", Nha xuat ban Yhpc- Ha npi.
Hoi Tim mach Viet Nam (2008), "Khuyen cao 2008 ve cac benh ly tim mach va chuyen hoa ", IVha xuat ban y hoc, chi nhanh thanh phd Ho Oil Minh, tr.1^3-179
Ta Thj Thanh Hu'dng, NguySn Huy Dung (2010), "So sanh gia tn ciJa Troponin I tim va cac men kinh dien trang chan doan benh nhoi mau cO tim cap", Chuyen de Tim mach hpc, 06: tr. 23-27.
Le Thi Bich Thuan (2000), "Nhan xet gia tn dinh lu'dng men Troponin I trong chan doan benh mach vanh", Ky yeu toan van cac cong trinii nghien c&u khoa hpc. tr.694-700.
Adams Jesse E., Schechtman Kenneth.B,, and al. (2007), "ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angma/Non-ST-Elevation l^yocardial Infarction", JACC, 50(7): pp. 1-157.
Cummins B., Auckland M.L., and Cummins P. (1987), "Cardiac-specific troponin-I radioimmunoassay m the diagnosis of acute myocardial infarction". Am Heart J. , 113: pp.
1333-1344.
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"Biochemical markers of myocardial injury", Bridst) Journal of Anaesthesia, 93(1); pp, 63±73.
TINH TRANG DINH DU'O'NG VA KHAU PHAN CUA BENH N H A N UNG THIT DAI - TRITC T R A N G DIEU TRI HO \ CHAT TAI BENH VIEN BACH MAI
Pham Thj Thu Huotig*, Cao Thi Thu Huong*
T O M TAT
Muc tieu: Xac d|nh tinh trang dmh duBng va khau phan ciia benh nhan ung thU dai -try'c trang dieu tri hoa chat. Phu'dng phap: Dieu tra cat ngang du'dc tien hanh tren 70 benli nhan ung thu' dai -tri/c trang dieu tri hoa chat tai Trung tam Y hgc hat nhan va ung bUdu, benh vien Bach Mai. Cac doi tu'dng nghien ciru dupe do chieu cao, can trpng lu'dng cd the va phan loai tinh trang dinh dUQng theo to chiTc Y te the gidi dt/a vao chi so khoi cd the (BMI), danh gia nguy ca dmh dudng theo cong cu danh gia toan dien chii quan (S6A- Subjective Global Assessment), phong van khau phan 24 gid qua, Ket qua: Ty le suy dmh du'Sng theo
* Vien Dinh dudng
Chju trach nhiem chinh: Pham Thi Thu HiTdng Email; [email protected] Ot: 0912417339 Ngay nhan bai: 5/1/2015
Ngay phan bien khoa hoc; 30/3/2015 Ngay duyet bai: 2/4/2015
BMI du'di 18,5 kg/m^ la 58,6%. Ty le nguy ci dinh du'Sng theo phu'dng phap SGA la 55,7%. Ty le thieu mau la 57,1%. Ty le benh nhan c6 albumin huyet thanh <35g/l la 31,4%. 100% benh nhan du'dc nuoi phoi hdp du'dng tinh mach va du'dng mieng. N3ng lu'dng va protein/ngay trung binh khau phan ciia benh nhan la 1359,9 kcal va 70g. Ket lugn; Benh nhan ung thU dai true trang dieu tri trj hoa chat co ty le suy dinh du'Sng cao. Nuoi du'dng tinh mach va du'dng mieng cho benh nhan tai benh vien da dap iTng nhu a u khuyen nghi
S U M M A R Y
N U T R I T I O N A L STATUS AND DIETARY INTAKE OF COLON - RECTUM CANCER PATIENTS W I T H CHEMOTHERAPY
AT BACH M A I HOSPITAL Objectives: To determine nutritional status and dietary intake of colon- rectum cancer patients.
Methods: A cross sectional survey was implemented
