Y HOC VIET HAM THANG 6 • SO 1/2015
TAI UEU T H A M KHAO
1. Kieu Van Tuan, Tran Viet Hiing, Nguyen Manh Tru'dng va CS (2012); Vai tro ciia noi soi ruot non bong ddn trong chan doan va dieu trj benh ly ruot non. Tap chi y hpc Y hpc thyc hanh, so 12 ; trang 98-1
2. Do Xuan Hdp (1977). Mach man cua da day.
Giai phau butiq, NXB Y hoc, tr. 130-131.
3. Shishido T, Oka S, Tanaka S, et al (2012).
Outcome of patients who are undergone total enteroscopy for obscure gastrointestinal bleeding.
World J Gastroenterol; 18 (7): 666-672 4. Brunnler T, Klebl F, Mundorff 5, et al
(2008). Significance of Scintigraphy for the
localisation of obscure gastrointestinal bleeding.
Vi/orld J Gastroenterol, 14: 5015-5019 Strate LL, Orav EJ, Svngal S (2003). Early predictor of severity in acute lower intestinal tract bleeding. Arch Intern Med; 163: 838-843 Liu K, Kaffes AJ (2011). Review article: The diagnosis and investigation of obscure gastrointestinal bleeding. Alimentary Pharmacology and Therapeutics; 34: 416-423 RamchandanI M, Reddv DN, Gupta R, et al (2009). Diagnostic yield and therapeutic impact of single balloon enteroscopy: series of 106 cases.
3 Gastroenterol Hepatol 2009; 24:1631-163
NGHIEN CU'U HiNH THAI, CHU'C NANG THAT TRAI 6* BENH N H A N ROI LOAN DUNG NAP GLUCOSE BANG SIEU AM DOPPLER TIM
Nguyen Trung Kien*, Hoang Nghia Nam*, Tran Van Kiln*
T 6 M TAT
Nghien cult 100 b^nh nhan roi loan dung nap glucose (59 bgnh nhan khong tang huyet ap (THA), 41 b?nh nhan cd THA) va 100 ngu'di co dung nap glucose binh thudng. Cac doi tu'dng nghien cdu khong co benh tim m^ch.
Ket qua sieu am Doppler tim cho thay co sy thay doi ve hinh thai d nhom roi loan dung nap glucose (RLDNG) nhu* tSng khoi lu'dng va be day thanh that tril. Mpt so chi so chu'c n3ng tam tru'dng (CNTTr) that tr^i c6 nhieu bien doi nhif ting van toe dinh song A, tl'ch phan van toe song A, giam ty le VTIE/VTIA, keo deli thdi gian giam toe song E va thdi gian gian cd dSng the tfch, ty le roi loan CNTTr d nhom nay cao hdn hSn so vdi nhom ehuTig. Cac roi loan ve hinh thai yth chijfe ning that trai nSng hdn d nhom RLDNG khi c6 kem theo t3ng huyet ap, tang chi so khoi ed the.
SUMMARY
INVESTIGATING LEFT VENTRICULAR STRUCTURE AND FUNCTION I N I M P A I R E D
GLUCOSE TOLERANCE BY DOPPLER ECHOCARDIOGRAPHIC
* B?nh vien Quan Y 4 - Quan khu 4 Chju traeh nhi?m ehinh: Hoang Nghia Nam Email: [email protected] Dt: 0913054311 NgJy nhan b i i : 1/4/2015
Ngiy phan bi?n khoa hpc: 4/5/2015 Ngiyduy?t bai: 20/5/2015
One hundred pahents of impaired glucose tolerance (59 patients with IGT without systemic hypertension, 41 IGT with systemic hypertension) and 100 men of normal glucose tolerance were Included in this study. Ali of them had no symptoms or signs of chronic heart failure.
By Doppler echocardiography, the authors have shown that the left ventricular mass in impaired glucose tolerance was significantly lager than those of the normal group. Peak late filling velocity (VA), VTIA, deceleration time (DT) and isovolumie relaxation time (IVRT) were higher, while the mitral E/A wave ratio and ratio of VTIE/VTIA was lower in the impaired glucose tolerance In comparation with normal group.
Morphological disorders and left ventricular function were more severe in patients with hypertension and increased body mass index.
I. OAT V A N OE
Roi loan dung nap glucose (RLDNG) la mot khai niem dUtfc uy ban quoc gia ve benh dai thao du'dng (DTD) cua My du'a ra tCf nhuiig nSm 1979, va den nam 1998 du'cJc WHO cong nhan.
Roi loan dung nap glucose khong chi la yeu t6 nguy ccf cao cho su" phat trien cua benh dai thao du'dng ma ngay ca giai doan nay da xuat hien nhieu bien chutig 6 cac cd quan tim mach, mat, than va than k i n h [ l ] ,
Sieu am Doppler lim tren benh nhan RLDNG cho phep phat hien, danh gia du'dc anh hu'dng cua RLDNG den hinh thai, chu'c nang that trai
Y HOC V|6T NAM THANG 6 - SO 1/2015
II. OOI TirONG VA PHLTOfNG PHAP NGHiEN CUU
- Doi tu'dng ngiiien cu'u; gom 200 ngu'di, tuoi trung binli 35 - 73, du'dc i<ham va dieu tn tai Benli vien Quan y 4, cilia tiianh hai nhom:
+ l^hom RLDNG gom 100 benh nhan, tuoi trung binh 60,27 ± 6,2, nhom nay cung du'dc chia thanh hai phan nhom:
. Phan nhom fUDNG khong "mA: 59 benh nhan.
. Phan nhom RLDNG co THA: 41 benh nhan.
+ Nhom chu'ng: 100 ngu'di \&\oe manh, co nghiem phap dung nap glucose binh thu'dng, tuoi trung binh 60,12 ± 5,6.
- Tat ca cac doi tu'dng nghien cihj du'dc i<ham iam sang, lam nghiem phap dung nap glucose, xet nghiem, ghi dien tam do, X quang tim, phoi.
- Sieu am Doppler tim tren may PHILIPS HD- UXE dau do da tan, tien hanh tai khoa Chan doan chu'c nang Benh vien Quan y 4.
III. KET QUA NGHIEN Ciru
3.1. Ket qua c^c th6ng so sieu am Doppler tim d b^nh nhan RLDNG
Bang 1, So sanh cac thong so ve hinh thai va chu'c nang tam thu that trai giu^ hai nhom nghien dlu ^ ^ ^___
' ' Nhom chOlig
Thong SGIIVSd (mm)
LPWd (mm) LVMI(g/m"j PET(ms)
ET(ms) PET/ET Tei index
(n = 100) 8,67 11,28 8,76 ± 1,22
!8,18 ± 14,68 76,18+11,8 307,58 ± 26,7
0,24 ± 0,04 0,45 ± 0,08
RLDNG (n = 100) 9,42 ± 1,24 9,72 ± 1,25 98,86 ± 12,35
81,76±11,23 312,58±31,25 0,26 ± 0,06 0,56 ± 0,12
<0,05 :0,01
<0,01 :0,05
>0,05
<0,05
<0,05
Bien ddi hinh thai: tang chieu day thanh that trai, tang chi so khoi Iddng cd that trai Thay ddi CNTTh: PET keo dai, PET/ETtang, tang chi so Tei
Bang 2, So sanh cac thong so danh gia chCfc nang tam tru'dng that trai giffa hai nhom nghien cijXi
Th6ng sS VA (cm/s) VE/VA DT (ms) vnA (cm) VTrr(cm) VTIE/VnA IVRT (ms) RLCNTTr 0 6 1 06 2 06 3
Nhom chu'ng (n = 100) 57,82±9,25 1,02±0,28 182,38±17,38
5,12 ± 1,03 12,36±1,52
1,43±0,36 89,13±9,67 06 (6,00%) 06 (6,00%) 0 (0%) 0 (0%)
RLDNG (n = 100) 67,17±11,56 0,85 ± 0,32 190,68±23,48
6,58±3,42 12,58±3,28 1,16±0,38 98j28±9,26 38 (38,00%) 27 (27,00%) 11 (11,00%) 0 (0%)
P
<0,0S
<0,01
<0,05
<0,05
<0,05
<0,05
<0,05
< 0,001
< 0,001
<0,01
Nhdm KLDNGcd: VA, VTIA tang, ty ii VE/VA giam. Thdi gian DT, IVRT kid dai Cd 38 binh nhin (38,0 %)bt roi loan CNTTr that trai
MS liin quan cac thong sosiiu im Ddppier tim vdi tang huyet ap, chi sd khoi cd the va mi loan lipid mau dbenh nhan RLDNG
3.2. Moi lien quan vdi tang huyet ^p
Bang 3, So sanh cac thong so ve hinh thai va chCrc nang tam thu giO'a nhdm roi loan dung nap glucose c6 tSng huyet ap vdi i<h6nq tang huyet ap
I \ B I n M / ?
Thdng so IVSd (mm) LPWd (mm)
RLDNG Khong THA
(n = 59) 9,02 ± 1,13 9,16 11,52
Co THA (n = 41) 9,78 ± 1,28 10,27 ± 1,68
;0,05
<0,05
Y HOC VIET NAM T H A N G 6 • SO 1/2015
LVMI (qtm')~
PET (ms) ET(ms)
PET/ET
80,71 ± 9,55 312,16 ± 28,16 0,26 ± 0,03 0,51 ± 0,09
109,08 ± 13,56 83,28 ± 9,62 314,25 ± 28,67
0,27 ± 0,04 0,59 ± 0,11
<0,01
>0,05
>0,05
>0,05
= 0,05
Chieu day vach iien that, thanh sau that trai, chi so khoi iddng cd that trai va chi sd Tei d nhom cd THA tang so vdi nhdm khong THA (p< 0, OS).
Bang 4. So sanh cac thong so ve hinh thai va chu'c nang tam thu that trai giii'a roi loan dung
Thong so IVSd (mm) LPWd (mm) LVMI(q/m') PET (ms) ET(ms) PET/ET Tei index
Nhom chu'ng (n = 100) 8,67 ± 1,28 8,76 ± 1,22 88,18 ±14,68 76,18 ± 11,8 307,58 ± 26,7
0,24 ± 0,04 0,45 + 0,08
RLDNG (n=59) 9,02 ± 1,13 9,16 ±1,52 92,51 ± 12,36
82,34 ± 9,55 312,16 ± 28,16
0,26 ± 0,03 0,51 ± 0,09
P
> 0 , 0 5
> 0 , 0 5
> 0 , 0 5
> 0 , 0 5
>0,05
> 0 , 0 5
<0,05 Nhdm RLDNG co chi so Tei tang hdn so vdi nhdm chung.
Bang 5, Cac th6ng so danh gia chiJc nang tam tru'dng that trai giiJa nhdm roi loan dung nap glucose cd taiig huyet ap va ithdnq tanq huyet ap
Thong so VA (cm/s) VE/VA DT (ms) AT (ms) vnA (cm) VnT(cm) VnE/VTIA IVCT (ms) IVRT(ms) RL CNTTr
0 6 1 06 2 Nhdm RLDNG cdng cd VA i
Nhom RLDNG Khong THA
(n = 59) 62,53 ± 12,72
0,93 + 0,26 187,25 ± 22,53 66,72 ± 15,53 6,38 ± 1,15 12,46 ± 3,12
1,17 ±0,35 67,50 ± 8,25 93,52 ± 8,64 17 (28,82%) 13 (22,04%) 4 (6,78%)
Co THA (n = 41) 73,85 ± 12,27
0,75 ± 0,25 195,62 ± 23,7 66,89 115,38 6,87 ± 2,48 12,76 + 2,18 1,13 ±0,27 70,56 ± 9,28 105,13 ± 9,75 21 (51,22%) 14 (34,15%) 7 (17,08%)
<0,05
<0,01 c0,05
>0,05
>0,05
>0,05
>0,05
>0,05
;0,05
<0,01
>0,05
<0,05
VTIA tang, ty ii VE/VA giam, thdi gian DT, IVRT keo dai, ty ii rS ban CNTTr that trai cad hdn sd vdi nhdm chifng.
Bang 6, Cac th6ng so chij'c nang tam tru'dng giii'a nhdm roi loan dung nap glucose khong tang huyet ap vdi nhdm chu'ng
Thong so VTIA (cm) V l l l (cm) vnE/VTIA IVRT (ms) RLCNTTr 0 6 1 05 2
Nhdm chu'ng (n = 100) 5,12 ± 1,03 12,36±1,52
1,43±0,36 89,13±9,67 06 (6,00%) 06 (6,00%) 0(0%)
RLDNG (n = 59) 6,38+1,15 12,46 ± 3,12
1,17 ± 0,35 93,52 + 8,64 17 (28,82%) 13 (22,04%) 4 (6,78%)
P
<0,05
>0,05
<0,05
<0,05
<0,05
Y HOC VIET NAM THANG 6 - S01/2015
Da CO Sd thay doi mpt sd thong sod nhdm RLDNG khong THA so vdi nhdm chdng nhd: IVRT keo dai, VUA ting, ty li VTIE/vnA giam, ty li rdi loan CNTTr that trai cao hdn han so vdi nhdm chdng, sd khac nhau cd y nghia thong ke(p < 0,05).
3.3. Moi lien quan vdi chi so khoi cd the
Bang 7. Cac thdng so ve hinh thai va chu'c nang tam thu that trai giiJa nhdm roi loan dung nap glucose cd tanq va khong tang chi so khoi cd the
Thong so Dd (mm) Ds (mm) IVSd (mm) LPWd (mm) LVMI (g/mO PET/ET
FS(%) EF(%)
Nhom RLDNG BMI<23kg/m'' j BMI > 23 kg/m-"
(n = 54) (n = 46) 44,18± 3,84
28,11 ± 2,73 8,97 ± 1,53 9,12 ± 1,68 97,86 ± 25,18 0,26 ± 0,03 38,03 ± 5,26 67,41 ± 7,13
0,50 ± 0,09
9,95 ± 1,26 10,43 ± 1,41 105,26 ± 27,46 0,26 ± 0,03 37,41 ± 5,15 66,17 ± 6,28 0,60 ±0,11
<0,05 c0,05 cO.OS
>0,05
>0,05
;0,05
Nhom RLDNG cd BMI k 23 kg/rrf cac chi so: IVSd, LPWd, L VMI va chi so Tei deu tang so vdi nhdm BMI < 23 kg/nf (p < 0,0S).
Bang 8. Cac thong so danh gia chu'c nang tam tru'dng that trai cua nhdm roi loan dung nap glucose cd tSng va khdng tang chi so khoi cd the
Th6ng sS VE (cm/s) VA (cm/s)
VE/VA DTJms) AT (ms) VTIT(cm) vnE/VTIA IVRT (ms) RLCNTTr
Nhom RLDNG BMI < 23 kg/m''
(n = 54) 59,53 ± 12,26 62,93 ± 11,47 0,95 ± 0,32 189,25 ± 27,53
65,79 ± 12,74 12,29 ± 3,74 1,16 ± 0,27 95,07 ± 12,56
16 (29,63%)
BMI -a. 23 kg/m'' (n = 46) 53,27 ± 11,68 72,15 ± 13,53 0,74 ± 0,25 192,36 ± 28,67
68,12 + 11,35 12,92 ± 3,56
1,15 ± 0,36 102,05 ± 17,63
22 (47,83%)
P
<0,05
<0,05
<0,01
>0,05
>0,05
>0,05
>0,05
>0,05
<0,05 Nhdm RLDNG cd ting chi so khoi cd the (Bivil
> 23 kg/m') cac chi so VE giam, VA tang, ty le VE/VA giam cd y nghia so vdi nhdm RLDNG cd chi so BMI < 23 kg/m'. Ty le roi loan CNTTr that trai 6 nhdm RLDNG ting dii so BMI cao hdn cd y nghia so vdi nhdm RLDNG khong tang chi so BMI.
3.4. MSI lien quan vdi roi loan lipid mau - Cac chi so ve hinh thai, CNTTh that trai giiis hai nhdm RLDNG cd va khdng cd roi loan lipid mau chua thay sy khac biet cd y nghia (p > 0,05).
- Nhdm RLDNG cd roi loan lipid mau cac th6ng so danh gii CNTTr da cd sir thay doi so vdi nhdm khong roi loan lipid mau, nhung sif khac biet khong cd ij nghia thong ke (p > 0,05).
IV. BAN L U A N
So sanh vdi nhdm chutig, mic dii kich thu'dc nhi trai va that trii chua thay doi nhutig chieu day vach lien that va thanh sau that trii da tang len (9,42 ± 1,24 mm va 9,72 ± 1,25 mm so vdi 8,67 ± 1,28 mm va 8,76 ± 1,22 mm; p <0,05), dan den tang chi so khoi lu'dng cd that trii (98,86 ± 12,35 g/m' so vdi 88,18 ± 14,68 g/m').
Cac chi so dinh gia chu'c nang tam thu
(CNTTh) nhu' phan so tong mlu (EF%), chi so co
ngan sdi cd (FS%), the tich that trii cuoi tam
tru'dng (EDV), the tich that trai cuoi tam thu
(ESV), the tich nhat bdp (SV) chua thay si/ khac
biet so vdi nhdm chu'ng. Nhung mot so chi so
tam thu tren Doppler dong chay qua van BMC da
Y HOC VIET NAM THANG 6 - SO 1/2015 cd bien doi nhu': thdi gian PET keo dai (81,76 ±
11,23 ms so vdi 76,18 ± 11,8 ms; p < 0,05), dan den tang ty le giii'a thdi gian tien tong mau va thdi gian tong mau (PET/ET), tang chi so Tei (0,55 ± 0,09 so vdi 0,45 ± 0,08; p < 0,05).
Ki'ch thu'dc buong that trai thi tam thu va tam tru'dng chu'a thay doi, phan so tong mau trung binh khong cd sd khac nhau, nhuTig nhieu chi so tam trUdng da cd bien ddi ro ret nhu' van tdc dinh song A va tich phan van toe sdng A tang (67,17 ± 11,56 so vdi 57,82 ± 9,25 cm/s va 6,58 ± 3,42 so vdi 5,12 ± 1,03 cm; p < 0,05), lam cho ty le VE/VA va V T I E / v n A giam. Thdi gian giam toe sdng E (DT) va thdi gian IVRT cung bi keo dai (98,28 ± 9,26ms so vdi 89,13 ± 9,67 ms; p <0,05). Nhu' vay cd the ndi RLDNG da gay ra bien doi nhieu tdi chiJc nang tam tru'dng (CNTTr) that t r i i .
Khi ap dung c i c tieu chuan de phan do roi loan CNTTr nhan thay cd 38/100 (38,0%) l3enh nhan RLDNG bj roi loan CNTTr that trai, trong dd 71,06% do 1 va 28,94% dp 2, khong cd tru'dng hdp nao it 6o 3.
Khao sat mdi lien quan cua tang huyet ap (THA), chi s6 khoi cd the (BMI) va roi loan lipid m l u vdi hinh t h i i va chu'c nang that trai d benh nhan rdi loan dung nap glucose, chung tdi nhan thay da cd sir thay doi ve hinh thai giiia hai nhdm cd THA va khdng THA cung nhu' giiia hai nhdm cd tang BMI va khdng tang BMI nhy tang chieu day vach lien that, thanh sau that trai va chi so khdi lu'dng cd that trai. Con d nhdm RLDNG cd rdi loan lipid m l u chu'a cd sir thay ddi ve cau true so vdi nhdm khdng cd rdi loan lipid mau. CNTTh that t r i i da cd sir bien ddi d nhdm RLDNG cd THA va tang BMI so vdi nhdm khdng THA v l BMI n h y tang chi so (p < 0,05). Oa cd s i ; thay doi ro CNTTr d nhdm cd THA va tang BMI nhu': v$n toe dinh sdng A v l tich phan van toe thdi gian sdng A tang (73,85 ± 12,27 cm/s va 72,15 ± 13,53 cm/s so vdi 62,53 ± 12,72 cm/s va 62,93 ± 11,47 cm/s; p < 0,05), lam cho ty le VE/VA. Thdi gian giam toe sdng E (DT) va thdi gian IVRT cung bj keo dai (195,62 ± 23,7 ms va 105,13 ± 9,75 ms so vdi 187,25 ± 22,53 ms va 93,52 ± 8,64 ms; p <0,05). Nhu' vay cd the ndi d nhiilig benh nhan RLDNG khi kem theo THA, tang BMI thi CNTTr that trai roi loan nang ne hdn.
Nhieu t i c gia nghien ciiu hinh thai va chu'c n i n g that t r i i d benh nhan RLDNG: Ilercll A va cs (2001) nghien ciru 457 benh nhan ngu'di da
dd cd RLDNG d Hoa Ky nhan thay tang chieu day thanh sau that t r i i tam tru'dng (LPWd), tang khoi lu'dng cd that trai, VA tang, tj- le VE/VA giam.
Bajrakatari (2006) va mpt so tac gia khac [6,7]
nhan thay d benh nhan RLDNG cd sir khac biet mot so chi sd sieu am so vdi nhdm chimg: VE giam, VA tang, ty le VE/VA giam.
V. KET LUAN
Sieu am Doppler tim cho phep phat hien du'dc nhiTng thay ddi ve hinh t h l i va chu'c nang that trai d benh nhan RLDNG.
Bien ddi ve hinh thai d nhdm RLDNG chu yeu la tang chieu day vach lien that, thanh sau that trai va chi sd khdi lu'dng cd that trai.
Trong cac chi sd d i n h gia chirc n i n g tam thu that trai chi cd PET va ty le PET/ET t i n g . Cac chi sd khIc chua bien ddi so vdi nhdm ehirng.
Chirc nang tam tru'dng that trai cd nhllu bien ddi so vdi nhdm chirng nhiT tang tfch phan van tdc sdng A, giam ty le VTIE/VTIA, keo dai thdi gian giam tdc sdng E va thdi gian gian cd dong the tich, ty le roi loan CNTTr d nhdm nay cao hdn han so vdi nhdm ehirng.
Cac rdi loan ve hinh thai v l chirc nang that trai nang hdn d nhdm RLDNG khi cd kem theo tang huyet I p , tang chi sd khoi ed the.
TAI L l I U T H A M K H A O
1. Ta Van Binh ( 2 0 0 6 ) , Benh dai thao dirdng - Tang c^lucose mau, Nha xuat ban y hoc. Ha N6I.
2. Nguyen Hai Thuy ( 2 0 0 9 ) , BSnh tim mach trang dai thao du'dng, Nha xuat ban dai hQC Hue.
3. Thai Hong Quang ( 2 0 0 5 ) , "Mpt so yeu to nguy CO tim mach d benh nhan dai thao dudng typ 2", Y hoc thu'c hanh, (507), tr. 31-36.
4. Bajrakatari G., Koltai M.S., Ademaj F., Rexhepaj N., Qirko S., Ndrepepa G. (2006),
"Relationship betv;een insulin resistance and left ventricular diastolic dysfunction in patients with Impaired Glucose Tolerance and type 2 diabetes'.
Internal J Cardiol, pp. 206-207.
5. Ilercil A., Devereux R.B., Roman M. (2001),
"Relationship of impaired glucose tolerance to left Ventricular structure and funaion: The Strong Heart Study", Am Heart J, (141), pp. 992-998.
6. Okura H., Inoue H., Toman M., et al. (2010),
"Impaired Glucose Tolerance as a Detemiinant of Early Deterioration of Left Ventricular Diastolic Function in Middle-Aged Healthy Subjects', The American Journal of Cardiology, (85), pp. 790-792.
7. Olatunbosun S.T., Jack S.D., David S., Schade D.S. ( 2 0 1 1 ) , "Glucose Intolerance', Diabetes Obes Metab. (7), pp. 2-8.
