DAC DIEM
L A M S A N G ,CAN
L A M S A N G0 BENH
N H A N D A I THAODlTONG TYP 2 CAO TUOI DIEU TRI TAI BENH VIEN DA KHOA TRUNG UONG
T H A INGUYEN
TOM T A T
^ Muc tieu: Md ta dgc diem lim sing, ein lim sing, bien ehung mgn tinh vi mgt so binh kit hgp & ngu&i bgnh DTDJyp 2 cao tuoi dieu trj tgi BVDKTW Thii Nguyen. Doi tugng va phuong phap nghien cuu: md ta cat ngang tren 418 bgnh nhin DTD typ 2 cao tuoi dugc quan ly dieu trj ngogi tm tgi BVDKTUTN tu thing 3 den thing 5 nam 2011. Ket qua: 418 bgnh nhin DTD typ 2 cao tuoi gdm nu 54,8%, nam 45,2%. BMI tmng binh 22,66± 2,86kg/m2. The trgng tmng binh chiim 52,2%: thua cin, beo phi 42,8%. Ti lg beo tmng tim 82,1%. Th&i gian phit hign binh 1- 5nam: 45,2%: 5-
Wnarn: 30,9%: >10 nam 7,4%. Tang HATT dan dgc 53,8%: tang HATTr dan dde 38,5%. Glucose huyit tuang vi HbAlc tmng binh la 7,69 ± 2,71mmol/l vi 7,61
± 1,07%. Glucose miu mirc tot li 35,9%, muc kim la 47,4%. HbAlc muc tot li 18.2%, muc kem la 52,6%.Trigu chung lim sang kinh dien eua bgnh: khit 31.8%: uong nhiiu 31,3%: tieu nhiiu 28,2%: gay siJt 20,1%. Trigu Chung mgt mdi 63,2%: nhin ma 66,3%. Roi logn chuyen hda lipid 63,4%: bien chung rang 63,6%:
Tang huyit ap 53,8%: bien chung tim mgch 37,6%: bien Chung thgn 25,6%; NMCTim lgng 0,5%.
Tukhda: dai thao du&ng typ2, bgnh nhin cao tuoi SUMMARY
Objective: to describe clinical manifestation and lab characteristics, chronic complications and combined diseases in elder patients with type-2 diabetes In Thai Nguyen Central General Hospital. Subjects and methodology: a cross-sectional study on 418 elder patients with type-2 diabetes In Thai Nguyen Central General Hospital from March to May 2011. Results: 418 elder patients with type 2 diabetes in which female accounted for 54.8% and males 45.2%. The mean BMI Index was 22.66±2.86kg/m2. The normal physical status occupied 52.2%, and overweight and obesity 42.8%.
The rate of central obesity approached 82.1%. The duration of detected diabetes of 1 to 5 years accounted for 45.2%: 5-10 years 30.9%: more than 10 years 7%.
The prevalence of the alone systolic hypertension was 53.8% and the alone diastolic hypertension 38.5%.
Plasma glucose and HbAlc on average was 7.69 ± 2.71mmol/l and 7.61 ± 1.07%, respectively. Blood glucose at better level was 35.9% and at worse level 47.4%. HbAlc at better level was 18.2% and at worse level 52.6%. Classic clinical symptoms of the diabetes Include thirst (31.8%): over-drinking (31.3%); over- urination (28.2%); thin (20.1%). Other symptoms with high rates comprise fatigue 63.2%; dim vision 66.3%;
trouble In lipid metabolism 63.4%; dental complications 63.6%; hypertension 53.8%; cardiovascular complications 37.6%; renal complications 25.6%; and silent myocardial Infraction 0.5%.
Keywords: type-2 diabetes, elder patients
NGUYEN TH! THU MINH, N G U Y I N KIM Ll/ONG, Benh vien Da khoa Trung uang Thdi Nguyen,
N G U Y I N KHANG SON - Dai hgc YHd N^i
DAT VAN D ^
Ciing vdi sy phdt triln cua y hpc, tuli thp cua con ngudi ngdy cdng tdng, nhbm ngudi cao tuli hiOn nay chiem khoang 11,0% dan s l , dy bdo se tdng IOn 20,0%
vdo ndm 2021. Dai thdo dudng(DTD) la mflt trong nhu'ng bOnh mgn tinh thudng gdp, ti 10 mic bOnh tang IOn theo tuli. Ti 10 mIe d nhbm ngudi cao tuoi chilm khoang 40,0% trong cflng dong. Khoang 10,0% ngudi cao tuoi cb bflnh DTD khOng dupc chin dodn vd dilu trj kjp thdi, 20% cb rli logn dung ngp glucose, cb nguy ca phdt triln bOnh mgeh mdu Idn liOn quan din ddi thdo dudng. Cdc bien chirng mgn tinh thudng gdp d ngudi DTD Id gidm thj lyc, mil Iba do ton thuang vbng mgc, hogi tu' chi do bflnh mgch ngogi vi, bOnh ly thin kinh, bflnh mgch vdnh, tai bien mgch ndo, suy thdn mgn...Cdc biln chipng ldm suy giam chit lupng cuflc sing eua ngudi bflnh DTD eao tuoi. Bflnh viOn Da khoa Trung uang Thdi NguyOn dang khdm vd quan ly gin 3.000 bOnh nhdn ddi thdo dudng, trong db ngudi bOnh DTD cao tuoi chilm 50 - 55%. D l tim hilu thOm v l dgc dilm ldm sdng cua ngudi bflnh DTD cao tuoi tgi khu vye Thdi NguyOn, chiing tbi tiln hdnh d l tdi ndy nham myc tiOu:
MO ta dgc dilm lam sang, cgn ldm sdng d ngudi bflnh DTD typ 2 cao tuoi dieu trj tgi BVDKTW Thdi NguyOn.
- Xdc djnh ti 10 biln chu'ng vd mflt s l bflnh kit hpp d ngudi bflnh DTD typ 2 eao tuli.
0 6 l TU'ONG VA PHU'ONG P H A P NGHIEN CU'U 1 Ddi lup'ng nghiOn CLFU.
- D l i tupng nghiOn cu'u: ngudi bflnh DTD typ 2 eao tuoi.
- Dja dilm nghiOn cuu: Phbng dilu trj ngogi trii Khoa Khdm bOnh BOnh vifln Da khoa Trung uang Thdi Nguyen.
Thdi gian: tip thdng 3.2011 din thdng 9.2011.
2. Phuang phap nghien ciPU.
- Phuang phdp nghien cu'u: mfl ta d t ngang.
- Mau nghiOn cu'u:
+ Cd mau: thugn tiOn.
+ Chpn mlu:
Lya chpn doi tupng nghiOn cu'u:
BOnh nhdn tu 60 tuli trd IOn (theo Ludt ngudi cao tuoi so: 39/2009/QH12 d a Quic hfli Nudc CHXHCN ViOt Nam, ngudi cao tuli Id ngudi cb dfl tuli tip 60 tuli trd IOn).
BOnh nhdn dupc chin dodn ddi thdo dudng typ 2 theo tiOu chuln chin dodn cua ADA ndm 1998 vd khuyln cdo cua Hfli Nfli tilt-DTD Viflt Nam 2009:
• Khdi phdt bflnh trOn 40 tuoi
• Bflnh tiln triln tip tip
• Glucose mdu > 11,1 mmol/1 d bit ky thdi dilm ndo kem theo cdc triflu chipng: uing nhilu, ddi nhilu, giam can. dudng niOu vS c» ceton niflu.
• Hogc Glucose mSu liic dbi > 7mmol/l khi bOnh
Y HOC T H I ; C HANH (787) - SO 10/2011 25
nhSn nhjn dbi sau 6 - 8 gid.
• HoSc Glucose mSu ^11.1 mmol/1 d thdi dilm 2 gid sau nghiOm phSp dung ngp Glucose.
- ChitiOu nghiOn CLPU.
+ Chi tiOu chung: tuli, gidi, thdi gian phSt hifln bflnh (<1 nSm, tip 1- 5 nSm, 5 - 1 0 nSm, > 10 nSm)
+ Chi tiOu ISm sSng: khSt nudc, uing nhiiu, dSi nhilu, silt cSn, dau d i u mOt mbi, mit ngu, dau ngyc, khb thd, phii, nhin md, s i n ngipa. Do HA, do chilu cao, cSn ndng, vbng byng, vbng mbng. KhSm ehuySn khoa mSt, khSm chuyOn khoa rdng hdm mdt.
+ Chi tiOu d n ISm sSng: Glucose huylt tuang luc dbi. Cholesterol TP, triglycerid, HDL-C, LDL-C,SGQT vS SGPT. ure mdu, Creatinln, HbAlc, Protein niOu, Ceton niOu, DiOn tim, Soi ddy mit.
- Chin dodn vd phdn logi tdng HA theo JNC Vll.
- Odnh gid muc dfl kilm sodt cdc y l u t l d bOnh nhdn dSi thSo dudng theo khuyln cdo ciia Hfli Nfli tilt Ddi thdo dudng ViOt Nam 2009.
- Xu- ly s l liOu blng chuang trinh SPSS 17.0.
KtT QUA NGHIEN CLTU
1. DSc dilm ISm sSng, c^n ISm sSng:
Bang 1. DQc dilm v l dfl tuli vd gidi ' ^ Q i d i
OptUAi.^
6 0 - 6 9 7 0 - 7 9 2 80 Tdng T ± S D
Nam n 106
72 11 189
% 56,1 38,1 5,8 100 68,7 ± 6,2
Nu n 146
72 11 229
% 63,8 31,4 4.8 100 68,4 ±6,1
T6ng n 252 144 22 418
% 60,3 34,4 5,3 100 es.st 6,1
P
>0,05
>0,05 Tuli trung binh 68,6 ± 6,1
BOnh nhan cb dfl tuli tip 60 69 chilm ti 10 cao 60,3%.
Bang 2. T h l trgng ciia nhbm nghiOn cii'U theo chi s l 3M1, chi s l B/M bflnh ly vS gidi
" ^ Q i d i Thlti^ng.,
Gky Trung
binh Thifa can
Beo phi d p i Beo phi
dP2 Tdng
~ X ± S D VB/VM bpnh ly
Nam n 10 94 50 33 2 189
% 5,3 49,7 26,5 17,5 1,1 100 22,77± 2,71
156 82,5
Nu n 11 124
50 38 6 229
% 4,8 54,1 21,8 16,6 2,6 100 22,57± 2,98
187 81,7
Tdng n 21 218 100 71
8 418
% 5,0 52,2 23,9 17,0 1,9 100 22,66± 2,86
343 82,1 P
>0,05
>0,05
>0,05 BMI trung binh ciia nhbm nghiOn ciru IS 22,66±
2,86 kg/m2
BOnh nhSn eb t h l trgng trung binh chilm 52,2 %, thipa cSn vS bOo phi 42,8%.
BOo trung tSm chilm ti Ifl eao 82.1%, khflng d sy khSc biflt v l ti Ifl bOo trung tSm giu-a 2 gidi nam vS nu- vdi p > 0,05.
Bang 3. Thdi gian phSt hiOn bOnh cua nhbm nghiOn euu
Thdi gian phdt hi$n bpnh
< 1 nam 1-5 nam 5 - 1 0 nam
>10 nam TPng s6
n 69 189 129 31 418
% 16,5 45,2 30,9 7,4 100
- va so bpnh nnan cd mai gian pnai inpn u^mi lu- i-o nSm (45,2%). Thdi gian phSt hiOn bOnh tu >10 ndm (7,4%).
BSng 4. D$e dilm v l huylt Sp
Chl 86 huylt ap HATT HATTr
X ± S D 137,7*4-7,6
83,6 ± 9,2 HATT 2 140 va HATTr i 90mmHg
TI Ip tang HA n
225 161 153
% 53,8 38,5 36,6 Chi s l HATT vS HATTr trung binh trong gidi hgn blnh thudng.
BOnh nhSn tSng huylt Sp tSm thu dan dflc 53,8%.
TSng HATTr dan dflc 38.5%. TSng d HATT vS HATTr 36,6%.
BSng 5. ThOu chung ISm sSng ciia nhbm nghiOn ciru Tripu Chung lam sdng
Khat nudc UPng nhiSu TiPu nhidu Gdy sut Dau dSu Dau ngyc
Khd thd Phil Nhln md
Mpt mdi Sdn ngu-a
Mdt ngu Khdng tripu chirng
Tdn sudt 133 131 118 84 120 139 49 28 277 264 81 37 112
% 31,8 31,3 28,2 20,1 28,7 33.3 11,7 6,7 66,3 63,2 19.4 8,8 26,7 CSe triOu chu-ng ISm sSng kinh diln d a bOnh nhu- khSt nudc. uing nhieu. tilu nhilu gSp vdi ti 10 28.2 den 31.8%. Triflu chung nhin md chilm ti 10 cao 66.3%.
Cb 26.7% bOnh nhSn khflng cb triOu chirng lam sSng.
Bang 6. HSm lupng glucose huylt tuang vS HbAlc, lipid mSu
Chisd Glucose (mmol/1)
HbAlc (%) Triglycerid (mmol/1) Cholesterol TP(mmol/l)
HDL-C (mmol/1) LDL-C (mmol/1)
n 418 418 418 418 418 418
X±SD — 7,69 ±2,71 7,61 ±1,07 2,51 ±1,69 5,02 ± 0,92 1,16 ±0,24 2.91 ±0,81 HSm lupng glucose huylt tuang vS HbAlc, triglycerid mSu trung binh cao han muc binh thudng, s\f khSc biOt d y nghTa vdi p < 0.05.
Bang 7. DSnh giS sy kilm soSt glucose mdu theo khuyln eSo eua Hfli Nfli tilt - DSi thSo dudng Viflt Nam 2009
^ " \ M u c d p C h i s i " ^ ^ Glucose (mmol/1) HbAlc (%)
T i t n 150
76
% 35,9 18,2
Chdp nh|ln dupc n 70 122
% 16,7 29,2
KPm n 198 220
% 47,4 52,6 Ngudi bOnh kilm soSt glucose mSu kem theo chi s l glucose vS HbAlc chiem ti Ip eao 47.4% vS 52,6%, kilm soSt t i t ehi chilm 35.9% vS 18,2%.
26 Y HOC THUC HANH (787) - SO 10/2011
Bang 8. Sy kiem sodt cdc lipid mdu theo khuyln cdo cua Hfli Nfli tilt - DTD Viflt Nam
Triglycerid (mmol/1) Cholesterol TP(mmol/l) HDL-C (mmol/1) LDL-C (mmol/1)
1W
79 126 231 311
% 18,9 30,1 55,3 74,4
Chdp nhpn dupc
69 170
61 75
% 16,5 40,7 14,6 17,9
KPm
270 122 126 32
64,6 29,2 30.1 7,7 Triglycerid dupc kiem soatlot chiem 18.9%. kiem sodt kem 64,6%.
- HDL-C dupc kilm sodt tot chilm 55,3%. kilm sodt kem 30,1%.
3.2. Bien chung mgn tinh d ngudi bOnh DTD cao tuoi
Bang 9. Biln chung mgn tinh hogc bflnh ly kit hpp d nhbm nghien ciPU
Bidn chu-ng Tang huyPt ap Roi logn chuyen h6a lipid mau
BC rang Dgc TTT tdn thuang vdng mgc
Bien chung tim NMCT im lang Bien Chung th|n
Loet ban chan Bpnh phoi tdc nghen mgn tinh
Gout mgn Sdi mat Viem loet da day
Tdn sudt 225 265 266 195 127 157 2 107
17 132
76 16 14
% 53,8 63,4 63,6 46,7 30,3 37.6 0,5 25.6
4,1 31,6 18,2 3,8 3,5 - Ti 10 ggp cao nhit Id roi logn chuyin hba lipid chilm 63.4%, tang huylt dp 53.8%.
Bilu hiOn v l rang 63.6 % trong db ti 10 mit rang toan bfl Id 20(4.8%) cbn lgi hdu hit la viOm quanh rang.
viOm Ipi.
T i n thuang mat Id 268 bflnh nhdn chilm ti 10 64,1%(trong db due TTT 46,7 %; ton thuang vbng mgc 30,3%).
B A N LUAN
1. Dgc diem lam sang va cgn lam sang cua bpnh nhan dai thdo dudng cao tuoi
Qua 418 doi tupng nghiOn ciPU Id bOnh nhdn ddi thao dudng typ 2 cao tuli dilu trj ngogi tru tgi Bflnh vifln Da khoa Trung uang Thai NguyOn, chiing tfli thiy:
Ti 10 gap nhilu nhit la dfl tuoi 60 - 69 chilm 60,3%
trong nghien cuu, dfl tuoi 70-79 chilm 34,4%. cbn trOn 80 tuoi thdp nhit vdi 5,3%. NghiOn cuu cua Nguyen Thj Nhgn tgi Hul tren 94 bOnh nhan ddi thdo dudng typ 2 cung thay nhbm bflnh nhan dudi 80 tuli chilm 96.8%[4]. Chung tfli ggp ti ifl nu' 54,8% eao han nam 45,2% sy khac biflt cb y nghTa vdi p < 0,05, kit qua nay eung phii hpp nghiOn ciru cua cdc tac gia khde [2,3,4].
Chung tOi thiy ti 10 bOnh nhdn t h l trgng trung binh (52,2%), tuang ty cde nghiOn cii'U trong nudc vd khu vuc chau A. Tuy nhiOn. ti 10 beo trung tam chilm tdi 82,1%. Beo trung tdm hay beo phi dgng nam Id y l u t l nguy ca tim mgch nbi chung vd dgc bipt trOn bflnh nhan ddi thdo dudng cao tuoi thi thdy thuoc Idm sdng edng d n phai luu y d l kilm seat y l u to trOn ngudi bflnh nham ngdn ngipa sy tiln triln eua cac biln chu'ng.
v l thdi gian plidt hifln bflnh, chung tfli nhgn thiy ti
10 cao nhit Id bOnh nhdn dypc phdt hifln trong khoang tip 1- 5 ndm (45,2%). 5-10 ndm dupc thing kO d 30,9%
s l trudng hpp. Nhu vdy da s l bOnh nhdn trong nghiOn cipu dupc phdt hifln khi tuli da cao trOn 50 tuli. Phai chdng bOnh nhan ddi thdo dudng trong nhbm ndy phdt hifln mufln khi bflnh tiim tdng tip thdi gian ddi trudc db.
Ngudi ta cQng eb nhdn xOt ring: tuli khdi phdt bflnh ddi thdo dudng typ 2 edng cao thi ti 10 tu- vong cung tdng I0n[1,6].
Cde triflu chipng Idm sang kinh diln cua bflnh nhu khdt nudc, uing nhilu, tilu nhilu, gly siit cdn chiing tfli gdp trOn nhbm bflnh nhdn nay vdi ti 10 lln lupt Id 31,8%;
31.3%; 28,2%; 20,1%; khbng triflu chu'ng 26,7%. Kit qua thip han nghien ciru Hodng Trung Vinh tgi Hd Nfli vdi ti 10 66,6%; 74,8%; 55,24%[5]. Cdc triOu chung ISm sdng kinh diln cua bOnh ggp trong nghiOn cii'U ndy khOng cao cb t h l do mau nghiOn cii'U chpn d nhbm ngudi bOnh dieu trj ngogi trii, khi glucose mdu da s l dupc kilm sodt d mu'c tot vd chip nhgn dupe thi cac triflu chO-ng trOn eung dupe khong chl. Trong mlu
nghiOn ciru ndy ehiing tbi thiy da s l bflnh nhdn cb triOu chu-ng mflt mbi (63,2%), nhin md 66,3%.
Qua phdn tich chung tbi thiy hdm lupng glucose, HbAlc trung binh (7,69±2,71; 7,61 ±1,07) thip han mflt s l nghiOn cuu khdc [2,3,4] do doi tupng nghiOn ciru ciia chung tfli la nhbm bOnh nhdn cao tuli dieu trj ngogi tru nOn kilm sodt glucose mdu tuang doi I n djnh, cdc nghien cii'U tren tiln hdnh d bflnh nhdn nfli trii khi bflnh nhdn cb glucose mdu qud cao hogc do cdc biln chirng cua bflnh. Tuy ham lupng trung binh cua glucose, HbAlc d mu'c chip nhgn dupc nhung ti Ifl bflnh nhan dupc ddnh gid d mu-c kilm sodt kem vdn cbn cao. Ti 10 bflnh nhdn cb glucose huylt tuang d mu-c kem chilm 47,4%, HbAlc kem chiem 52,6%, chi s l triglycerid kem Id 64,6%. MiPC HbAlc trong nghiOn cu-u cua chung tfli cung tuang ty mflt so tde gia nhu Brownlee M nam 2000 cb kit qua kilm sbat kem Id 58,2%; Torninaga M nam 2000 la 52,2% [dan tu 5]. Lupng triglycerid trung binh la 2,51 ± 1,69 khbng cao han nhieu so vdi gid trj binh thudng, nhung ti Ifl bflnh nhdn cb hdm lupng triglycerid, HDL-C d mu'c kilm sodt kem vdn d ti 10 eao vdi 64,65 vd 30,1%.
NghiOn cuu cua chung tfli thay ti 10 tang huyet dp tdm thu dan dflc 53.8%, tdng huyet dp tdm truang dan dflc 38,5%. Kit qua tuang ty nghiOn cuu cua tdc gia HoSng Trung Vinh vdi ti 10 tdng huylt dp la 60,9%.
NguyOn Thj Nhgn (57,45%) [4.5]. Dgc dilm tang huylt dp bOnh nhan ddi thdo dudng Id ti 10 tdng huylt dp tdm thu dan dflc cao. Tang huylt dp vd ddi thdo dudng se ldm biln chipng mgch mdu vd nguy ca tu vong tang gip hai lln so vdi bOnh nhdn tdng huyet dp khflng bj ddi thdo dudng.
2. Biln chu'ng va bpnh kit hp'p d bpnh nhan dai thSo dudng cao tuli
Trong nghiOn cii'U nSy, ti 10 biln chu-ng vS bOnh kit hpp cao nhat Id r l i logn chuyin hba lipid mdu vd tang huylt dp (63,4% vd 53.8%). Tuang ty nhu vgy. ti 10 gdp tang huylt dp trong nghiOn cii'U cua Hodng Trung Vinh Id 60.95%, roi logn chuyin hba lipid mdu vdi cde thdnh phin lipid bpnh ly tip 52,3% d i n 68,5%. Nguyen Thj Nhan ti 10 tang huylt dp 57,45%, roi logn chuyin hba lipid mdu Id 82,98% [4,5].
Biln chirng mgn tinh cua ddi thdo dudng typ 2 cao
Y HOC THU'C HANH (787) - SO 10/2011
27tuli chiing tbi ghi nhdn dupc chu y l u IS t i n thuang mSt d 268 bOnh nhdn chiem ti 10 64,1%(trong db dye TTT 46,7 %; t i n thuang vbng mgc 30,3%). NghiOn ciru cua Nguyen Kim Luang tgi ThSi NguyOn cho thiy ti Ifl dye thiiy tinh t h l Id 52,94%, bflnh vbng mgc ddi thdo dudng chiem 22,94% [2]. Khb cb t h l phdn biOt dupc dye thiiy tinh t h l do ddi thdo dudng vdi dye thiiy tinh t h l tuli gid eua ngudi khOng bj ddi thdo dudng trong nghiOn cuu bdi doi tupng chpn m l u deu tip 60 tuli trd IOn. Nhung ngudi ta cung thiy ring khi bj ddi thdo dudng thl dye thuy tinh t h l xdy ra sdm han, nhanh han, hai mit dye khflng ding diu, mit dye trudc, mit dye sau.
NghiOn cuu cua chiing tfli thiy ti 10 eb biln chung d rdng 63,6%. Ket qud ndy tuang ty nghiOn ciru cua Nflng Thj Phuang Mai tgi Thdi NguyOn 2006 [3], Ti 10 mit rdng todn bfl qua thing kO Id 20(4,8%), ddy Id t i n thuang do bflnh dai thdo dudng nhung cung eb t h l mit rdng do sinh ly hodc bOnh ly v l rdng d ngudi cao tuli.
Biln chirng tim mgch chiing tbi gdp 157 bOnh nhdn chiem 37,6% trong db bao gim can dau thdt ngyc, thilu mdu ea tim cyc bfl, nhii mdu ca tim vd suy tim d giai dogn 1,2. Nhii mau ca tim im ldng chilm ti 10 0,5%, tuy Id ti 10 rat thip nhung d l i tupng nghiOn CLPU Id nhbm bOnh nhdn dang dupc theo dbi dilu trj ngogi tru nOn dilu ndy cung luu y cdc thiy thulc ISm sdng trong vifle quan ly vd theo dbi bOnh nhdn.
T i n thuang thdn chiing tbi gdp 107 bflnh nhdn chiem 26,6%. Ti 10 dupe xdc djnh dya vdo protein niflu (+) vd suy thgn d cdc muc dfl nOn k i t qua thip han so vdi cdc nghiOn cu-u khSe [2,4,5]. Nlu djnh lupng dupe microalbumin niOu cho toSn bfl mau nghiOn CLPU eb le ti 10 ton thuang thgn se cao han nhilu.
Mflt s l tinh trgng bOnh kit hpp nhu: bflnh phii tie nghen mgn tinh, gout mgn, soi mgt, viOm Ibet hdnh td trdng ggp vdi ti 10 lln lupt Id: 31,6%; 18,2%; 3,8%;
3,5%. Nhu-ng bflnh ly k i t hpp nay iiOn quan nhilu d i n tuli cao cua ngudi bflnh edng ldm tdng thOm y l u t l nguy ca doi vdi bflnh nhan ddi thdo dudng cao tuoi.
K^T LUAN
1. Dgc dilm Idm sdng, d n idm sdng:
Ti 10 ggp o- nu- 54.8% cao han nam 45.2%.
- Tuli trung binh 68,6± 6,1, chii yeu Id dfl tuli 60 - 69 chiem ti 10 60.3%.
BMI trung binh Id 22,66± 2,86kg/m2. T h l trgng trung binh chilm 52,2%; thipa cdn 23.9%; bOo phi dfl 1 chilm 17.0; dp 2 chilm 1.9%. Ti 10 beo trung tdm 82,1%.
Thdi gian phdt hifln bflnh 1- 5nSm: 45,2%; 5- lOnSm: 30.9%; >10 ndm 7.4%.
Ti 10 tdng HATT dan dflc 53.8%; tSng HATTr dan
dflc 38.5%.
HSm lupng glucose huylt tuang vS HbAlc trung binh IS 7.69 ± 2.71 mmol/1; 7.61 ± 1.07 %. Ti Ifl bpnh nhSn cb glucose mdu d miPC t i t Id 35.9%, muc kem la 47,4%.Tt 10 bOnh nhdn eb HbAlc d mu-c t i t Id 18.2%, muc kSm Id 52,6%.
TriOu chu-ng ISm sSno kinh diln cua bflnh d ngudi cao tuli: KhSt 31,8%; uing nhilu 31,3%; tilu nhilu 28,2%; g l y silt 20,1%.
TriOu chirng gdp vdi ti 10 cao Id mOt mbi 63,2%;
nhin md 66,3%.
2. Biln chu-ng mgn tinh vd bflnh k i t hpp: Rli logn chuyin hba lipid 63,4%; biln chipng rdng 63,6%; Tang huylt dp 53,8%; biln chung tim mgch 37,6%; bien chu-ng thdn 25.6%.
TAI LI$U THAM K H A O
1. Tg Vdn Binh (2006), bOnh ddi thdo dudng-tdng glucose mdu. NXB Y hpc, 16; 311-27.
2. Hodng Thj Dpi, Nguyin Kim Luang (2007):
NghiOn ciru thyc trgng ddi thdo dudng typ 2 dilu trj ngogi trii tgi BOnh viOn da khoa TW Thdi NguyOn. Ky y^u todn vdn cdc d l tdi nghiOn ciru khoa hpc. Hfli nghj khoa hpc toSn quic ehuyOn ngdnh Nfli tilt vd chuyin hba lan thip 3. Nxb Yhpc: 902-12.
3. Nbng Phuang Mai, Nguyin Kim Luang (2007), Tinh trgng bflnh quanh rdng d bOnh nhdn ddi thao dudng typ 2 dilu trj tgi Bflnh vifln da khoa TW Thai NguyOn. Ky y l u todn vdn cac d l tSi nghiOn ciru khoa hpc. Hfli nghj khoa hpc todn quic chuyOn ngdnh Nfli tiet vd chuyin hba l l n thip 3. Nxb Y hpc: 879-86.
4. Nguyen Thj Nhgn (2006), Dai thdo dudng d ngudi gid. Tgp chi YHTH, 548: 75 - 83.
5. Hodng Trung Vinh (2007), Ode dilm ldm sang, d n lam sdng d bOnh nhdn ddi thdo dudng typ 2 ngudi
> 60 tuli. Ky y l u todn vdn ede d l tdi nghien ciru khoa hpc. Hfli nghj khoa hpe toSn quoc chuyOn nganh Npi tiet vS chuyin hba l l n thu 3. Nxb Y hpc: 382-88.
6. Ho P Jean, Turtle John T(2001), Ebtablishing the Diagnosis. Diabetes in Old Age. The 2nd edition: 25 - 34.
7. Meneilly G S (2001). Pathophysiology of Diabetes in the Elderly. Diabetes in Old Age. The 2nd edition: 17- 22.
8. Sorensen L, Yue D K (2001), Screening and Treatment Strategies for Diabetes Complications in the Elderly. Diabetes in Old Age. The 2nd edition: 41 -49.
9. Muggeo M, Zoppini G et at (2001), Mortality and its Predictors in Typ 2 Diabetes. Diabetes in Old Age.
The 2nd edition: 103-15.
NGHIEN curu HOAT DO CUA YEU TO DANG THAP (RF) 0 BENH
N H A NVIEM KHQfP DANG THAP
T R A N THj MINH HOA
Khoa Cv Xuong Khdp, Bgnh vign Bgch Mai
TOM T A T
Mgc tiiu. Khao sit hogt dd cda yiu to dgng thip &
bgnh nhin viim kh&p dgng thip vi moi lien quan v&i th&i gian mac bgnh vi cic ehi s6 viim
Doi tugng vi phuang phip nghiin ctfu. 120 binh
duang tinh diiu trj ndi tnj tgi khoa kh&p bgnh vign Bgc/i mai tu 2/2008-2/2011
Kit qua. Hogt dg tmng binh cua yeu to dgng thip RF tmng huyit thanh cua 120 bgnh nhan viim kh&p d^ng thip ti 175,85+78,25 lU/mi Hogt dp cua yiu to dgng nhin duge chin doan viem kh&p dgng thip cd RF thip RF cd mil Hin quan thugn vai nong dd protein C
28 Y HOC THl/C HANH (787) - S6 10/2011
