dudng chifc dien Bao ve sOfc khde tTnh Thai Nguyen, chiing tdi thu duoc eac ket qua nhu sau:
Ndng dp hs-CRP huyet thanh dao ddng rat Idn (0,1- 9,9mg/l). ndng do trung binh la 1,3±1,5 mg/t. Cd 53,7% ddi tuong ed ndng dd hs-CRP d miifc nguy cd thap, 46,3% d mCfc nguy cd trung binh hodc cao
Cd su khae biet ve ndng dd hs-CRP giiifa nam va nu", giiis ngudi nhieu tudi va ngiidi ft tudi (p<0,05).
Mdi liSn quan giiifa ndng dd hs-CRP vdi tdng huyet ap chua rd ret, su khac bi§t chua cd p nghTa thdng ke (p>0,05),
Cd su lien quan rd rdt giu'a ndng dd hs-CRP vdi Lipid mau, ehl so khd'i cd the, hOt thude la; tudng quan thuan giiifa ndng dd hs-CRP vdi Glucose mau,
khdng thay cd sU lien quan g i i ^ ndng dd hs-CRP vdi mpt sd thdi quen sinh hoat, it van ddng the lUC, udng nhieu rUdu, bia hang ngdy.
TAI LIEU THAM KHAO
1. Trjnii Xuan Cudng (2010), Khio sdt ndng dd HS - CRP huyet lUOng d bdnh nhdn hdi chOng ddng mach vdnh cip. Luan vdn thac sy Y hpc, Tnldng Dai hoc Y Ha Noi,
2 Hoang Qudc Hoa (2010), "Khao s^t nong do CRP d benh nhan hut thudc la ", Tap chi y hgc Thdnh phd H6 Chi h/linh, phu ban ci^a tap 14, sd 2.
3. Hoang Tieh Tuyen (2004), "Xet nghi6m C-Reaclive - Protein (CRP) de danh gia trang thai viem". Tap chi nghien cdu y hoc. tap 27, sd 1, tr 155-157.
4, Le Thi Thu HUOng (2012), "Lien quan giifa nong dp protein phan img C huyet thanh do nhay cao vdi mpt sd
yeu to nguy cd tim mach l^m sang d benh nhan dai thao dudng type 2", Tap chi ndi Hit ddi thdo dudng sd 7/2001.
Kp yiu toan vdn cdc di tdi khoa hgc. Ir 543-555.
5 Le Thi Thu HUdng (2012), "Lien quan giOra ndng do protein phan iJng C huyet thanh dp nhay cao vdi mpt sd ydu td nguy cd tim mach can lam sSng d b§nh nhSn dai thao dudng type 2", Tap chi ndi tUt dai thdo dUdng sd 7/2001. Kp yd'u todn vdn cac di 'tdi khoa hgc. tr 570-581, 6. Pham Quang Kinh (2010), "Nghian cCdi thanh phan mau: Glucose, A,urie, Cholesterol, Triglyceride, HDL-C, LDL-C, HS CRP vdi b#nh thite cSn beo phi vd cao huydt dp d nhom can bd cdng chirc tinh Quang Ninh", Tap chi Y hoc Vidt Nam. tlip 372, sd 2, tr 179-184,
7. Nguyin Thj Nhan, Tran Trpng Lam (2012),
"Nghien cifu ndng dp hs-CRP vk c^c yeu td nguy cd tim mach khac nhu rdi loan Lipid, tdng Glucose, tang huyet
^p d ngudi beo phi dang nam", Kp yiu tdn vdn cac di tdi khoa hoc. Tap chi ndi Hit ddi thao dudng sd 6/2012, tr 707-714.
8. Ho^ng Vdn Sdn vd cflng sU (2006), "Cong trinh nghien cilU CRP dp nhay cao (hs-CRP) trong mau ngUdi binh thudng va y nghTa ciia nd", Tap chi thdng tin Y duac sd 2/2006, tr19-21.
9. Le Thi Bich Thuan (2005), "CRP nguy cd tim mach va hoi chimg chuyen hoa". Tap chi y hoc thuc hanh (507- 508), tr 208-216.
10. Amanullah Safiullah, et al (2010), "Association, of hs-CRP with diabetic and Non - diabetic Individuals "
Jordan Jouranal3, (1) pp7-12.
XAC DjHH HAM LUVNG AXIT BEO W O O TRONG HUYET TUONG NGUdi BJNH THUfiTNG VA BENH NHAN DAI THAO DUONG TYP 2 B A N G SAC KY KHI KHOI PH^
TRjNH MINH VIET, LAI V A N HOA, N G U Y I N QUOC CHIEN Vien 69, BTL Bao ve Lang Chu tfch Hd Chi Minh NGUYEN GIA BINH, PHAM THj MINH HUYEN Benh vien Trung UOng Qudn dgi 108
TOM TAT
/\xit beo tu do (FFA- fme fatty acids) Id chi sd quan trong ddnh gid cdc bit thudng trong chuyin hda lipid d bdnh nhan dai thdo dudng typ 2 (DTDT2). Mdt sd nghien cdu eho thay thanh phan va ndng dd cOa chOng trong huyit tuang anh hudng tdi dd nhay cOa ti bdo vdi insulin vd iam giam khi ndng dung nap giucose qua cac chat trung gian. Nghidn cifu eda chung tdi tiUdc diu danh gia nhdng thay ddi vi thdnh phin eac FFA trong huyit tuang d mdt nhdm bdnh nhdn DTDT2 so vdi nhom ngudi binh thifdng, ddng thdi idm tiin di cdc nghien eifu tiip theo vi rdi loan chuyin hda lipid va axit bdo.
SUMMARY
FFA-fme fatty acids are important index for abnormalities of lipid metabolism in patients with type 2 diabetes mellitus. Some studies suggested that the composition and concentration of plasma FFAs
influenced insulin sensitivity and mediated impaired glucose tolerance. In this research, we initially evaluate the change in the composition of plasma FFAs in a gmup of patients compamd to a control group and outline further studies on lipid metabolism and fatty acids.
Keywords: diabetes mellitus (T2DM), free fatty acid (FFA), plasma.
DAT VAN OE
Cac ba't thudng ve lipid da dudc chifng mmh cd vai trd quan trong trong benh smh cCia rat nhieu benh, bao gdm dai thao dudng, xo vCia dpng mach, beo phi va benh Alzheimer [3], Lipid la thanh phan tao mang te bao, cung cap ndng lUOng cho eae qua trinh sinh hpc va ngay nay cdn dupe coi la kho du trtf tien chat ciia cac chat tmyen tin thif 2, DTDT2 la benh rdi loan ehuyen hda lipid dien hinh [10], axit beo tu do (FFA) la ehl sd quan trong danh gia cac bat thudng trong
Y HOC THlTC HANH (879) - SO 9/2013
ehuyen hda lipid cl benh nhdn 0T0T2. Ddc biet, mdt sd nghien cifu cho rang thdnh phan vd ndng dd FFA trong huyet tudng anh hudng d^n dd nhay vdi insulin vd giam kha ndng dung nap glucose qua cae ehSt trung gian [1]. Trong pham vi nh^t dinh, ed thd coi FFA \d cac dich hda dudc trong didu tri DT0T2, Vi vdy, nghidn cLiU mdt edeh hd thdng vd FFA trong huyet tuong ngUdi Id mdt vdn dd hdt sifc e^n thidt. G^n ddy dd cd bao cao cho thdy ed sU khde bidt rd rdng vd FFA todn phdn trong huydt tuong bdnh nhdn DTDT2 vd ngudi binh thudng [4], Ngudi ta cung chi ra rSng cd mdt sd axit beo lidn quan ehdt ehe hdn vdi DTDT2. Nhung d Vidt Nam. cho ddn nay chua cd mdt bdo cdo nghiSn edU todn dien ndo vd phdn tich dmh ti'nh vd dinh lUdng FFA trong huyet tuong benh nhdn DTE)T2 cung nhir6 nguSi binh thudng.
Chiing tdi sil dung slic kp khi - khdi phd de phan tieh cae thdnh phdn FFA, vl eho ddn nay nd vSn dUpc COI Id cdng cu tdt nhd't trong phdn tich cac axit beo
D 6 | TUpNG VA PHUdNG P H A P NGHIAN COU i.OditU^ng.
M^u nghien cifu la huyet tUdng tach tif mdu Id'y liic ddi cua hai nhdm' Nhdm benh nhdn D T 0 T 2 (n=30) va nhdm ngudi binh thudng (n=30). Tat ca deu lay tai khoa Hda sinh- Benh vien T m n g Udng Quan ddi 108, Benh nhan D T B T 2 duoe chan doan theo tieu chuan ciia A D A ndm 1997 (Oudng huydt liic ddi > 7,0 mmol/1), Mpt s d dae diem eiia hai nhdm dUOc the hien trong bang 1.
Bang 1: Mot s d dac diem cua hai rihdm nghien eifu
TUOI (nam) Nam (ngLTtf}
Ni? (ngudi) Glucose mdu liic 6d\
(mmol/L)
Ngudi binh thudrtg 55,7 ±5,6
15 15 3,9^.4
Benh nhan DTDT2 56,3 ±5,3
13 17 7.0-13.7
2. PhiTdng p h a p n g h i e n ciJru
2.1. Chiit axit beo vd tao din xudi metyl este cdc axit beo ti/do
Mdu mau (ehdng ddng bang EDTA_Na) dUdc ly tam ngay 3000 xg trong 10 phut de tach huye't tUdng sang mot dng eppendorf saeh vd bao quan d -80 dd C tdi khi phan tieh. Chiet lipid theo phuong phap Folch cd thay ddi, tdm tat nhu sau'
Lay 200 jiL huyet tUOng rdi them 2 mL hdn hop Folch (chloroform/metanol/nudc theo tp le 3/1/0,8 (v/v)), lac ky trong 5 phiit, ly tdm 3000 xg trong 5 phut, rdi chiet lay pha huU cd sang lo thiiy tmh sach, chiet Idp lai 2 lan tUdng tu. Thu gdp todn bd dich chiet vd thdi khd dudi ddng khi N2 d nhiet dp phdng, Sau dd them 50 fit metanol va 1,5 mL diazometan de este hda axit beo tu do trong 15 phiit, Thdi khd dudi ddng khi Nj d nhiet dd phdng, Hda tan sam phan thu duoc
trong 200 jiL diclorometan lam mau eho phdn tich sac k^ khf khdi phd.
2.2. PhSn tich GC-MS
Nghien cCfU ciia chiing tdi sCf dung he thdng sac ky khi-khdi phd Thermo Seientific ITQ 900™ GC/MS, phan tieh trdn cdt TFIACE TR-FAME GC (dai 30 m, ID 0,25 mm, film 0.1 nm). Nhidt dd Id opt dupc dat theo chu trinh dd duoe khao sat. bat dau tif l i t f ' C (giifS phiit), tdng 3"C/phut tdi 230°, tidp theo tdng 15"C/phiJl tdi 250''C, sau dd gii? 15 phiit d 250" C, Nhiet do budng bdm m l u ddt d 250° C, Si!f dung helium lam khi mang.
toe dd ddng hang djnh 1,0 ml/phiit, Bdm 1 ^L mdu, che ddeh'ia ddng (split), tJlS1:10,
2.3. Xde djnh axit ttdo ti/do
Cac FFA dupe xac dinh theo ti'nh eh^t khdng phan img vdi dc axit beo da este hda cOa diazometan, Cac FAME duoc xac ^ n h theo sae dd, phd dd cua mlu chuan (hdn hdp 37 axit beo metyl este cQa Sigma) va thu vien phd Wiley vdi khoang 870.000 ehdt.
Khi xac dmh dupe cac FAME, ta dinh lUdng chiing bang each xay dung dudng chudn theo dien tich peak rdi tinh ra kdt qua ciia tifng axit beo trdn phan men Qual browser ciia Xealibur. Cac ket qua dupe xif ly thdng ke, so sdnh cac ket qua bang t-tesL
K^T QUA VA BAN LUAN
Phdn tich GC-MS trong huyet tuong benh nhdn DT0T2 vd ngudi binh thudng da dinh t'nh va dinh luong duoe 17 axit beo tif do.
Ket qua thu duoe cho thay cac FFA trong huyet tUdng tach ra phu hpp vdi quy luat da biet ve sac W^ khi va khdi phd ciia cac FAME nhU sau:
Cac FAME duoc giai ra theo dd ddi cua chu&
carbon, dp bao hda va vi tn cua lien ket ddi dau tien, FAME bao hda ed mach ngan thi dupe giai ra trnflc, Vdi FAME khdng bdo hda ed cung sd carbon, khong bao hda da, khdng bao hda ddi, FAME khdng bao h6a ddn duoe giai ra lan luot theo so luong cae lien ket ddi.
2) FAME bao hda, khdng bao hda ddn, khdng bao hda ddi va khdng bao hda da cd the duoe phan biet nhd cac ion phan tCf va mot sd ion ddc trung ciia pho khdi,
+ FAME bao hda cd cac ion dac trung la m/z = 55, 74, 87, 143 va ion ed ban la m/z=74. FAME khdng bao hda don ed ede ion ddc trung la m/z=41, 55,69,74,83, 97 va ion cd ban la m/z 55. FAME khdng bao hda doi ed cac ion ddc tmng la m/z=41, 55, 67, 81, 95, 107 va ion CO ban m/z=67. FAME khdng bao hda da ed cac ion dde trung Id m/z=41, 55, 67, 79, 95, 108, 150 va ion cd ban la m/z=79,
+ Cac FAME khdng bao hda da cd mot sd ion chinh dung de xac dinh vj tri ciia lien ket ddi dau dUOC tinh tif dau metyl eua chudi carbon (thudng dudc g^
bang 'n'), Bac biet, cae ion m/z=108 va 150 la nhiing ion chia khda de phan biet 'n-3' va 'n-6' ciia cac FAME khdng bdo hoa da [8],
Y HOC THUC HANH (879) - SO 9/2013
,1.48-48 14 1700000:
leooooo-i 150O00O-:
nooooo-i
§ 1300000-
s
1200000- 1100000^
1000000^
900000^
Q
269 715 .,263
139E8 Channel 1 Analog p9
3K2 3 , 3 , 3724M''' « » « " ° « ,
1150000- 1100000- 1050000-
^ 1000000-=
Q 950000- 900000^
850000^
800000- 750000-
Q
\ 386 \ ™ 4 86 0
^ ^ , 0 05 0
u
16 57
I
vb 2212 ,18 53 1
C18:l,2
279
27 75 0 66 U 28 S6 9
0
/
Ti ^ Tl r-l Ai <N
u 0 u
2a J^ JrL^ -.130 4382 47 63 fJL
39E8 Cnannel 1 Analog 5478
Hinh 1: S i c do cac FFA trong huyet tUdng benh nhdn dai tti^o difdng typ 2 ((hinh A) va ngi/di binh thi/dng hinh B)
Ket q u a x a c d j n h F F A t r o n g h u y e t tuOng ( b a n g 2 ) cho thay.
Tdng h a m luUng F A A t r o n g h u y e t tUdng d b e n h DTDT2 c a o h d n r d r a n g s o v d i d ngUdi b i n h t h u d n g (p<0,05),
Thanh p h a n axit b e o t u d o t r o n g h u y e t tuOng x e t theo hai n h d m axit b e o b a o h d a v d axit b e o k h d n g b a o hda d a t h a y axit l a u r i c ( C 1 2 0 ) , m y r i s t i c ( C 1 4 0 ) , palmitic ( C 1 6 , 0 ) v a s t e a n c ( C 1 8 , 0 ) t r o n g h u y e t tUdng benh n h a n D T D T 2 c a o hOn r o r a n g s o v d i n h d m n g u d i binh t h u d n g ( p < 0 , 0 5 ) . N g U d c l a i , e a c a x i t b e o k h d n g bao h d a oleic ( C 1 8 - 1 n - 9 ) , l i n o l e i c ( C 1 8 ' 2 n - 6 ) , eicosenoic ( C 2 0 1 n - 9 ) , e i c o s a p e n t a e n o i c ( C 2 0 , 5 n - 3 ) , emcic ( C 2 2 : 1 n - 9 ) , d o e o s a h e x a e n o i e ( C 2 2 - 6 n - 3 ) lai giam thap h o n s o v d i ngUdi b i n h t h u d n g ( p < 0,05),
T d n g h a m l u p n g a x i t b e o t i f d o t r o n g h u y e t tUdng benh n h a n 0 T 0 T 2 c a o h d n n g u d i b i n h t h u d n g c h o thay, rdi loan c h u y e n h d a g l u c o s e c d t h e lien q u a n t d i nhung bat t h u d n g t r o n g e h u y e n h d a lipid v a axit b e o t r o n g j i u y e t tUOng [ 4 ] .
T d n g l u o n g F F A d n h d m b e n h n h a n D T D T 2 e a o hdn ngudi b i n h t h u d n g chO y e u d o t h a n h p h a n axit b e o bao hda. axit t i e o b a o h d a c d h a m l u o n g e a o t r o n g huyet t u o n g e d t h e Id n g u y e n n h a n l d m t a n g c d c b e n h nhu tieu d u d n g , d o t q u y , u n g t h u , v i e m k h d p , alzheimer.-.Vi v a y , c h u n g d u p c x e m l a n h d m c h a t b e o khong c d Ipi e h o e d t h e . N h d m a x i t b e o k h d n g b a o h d a d\igc x e m l a n h d m c h a t b e o e d Ipi e h o cO Uie. / \ x i t b e o lot nhat c h o sCfe k h o e l a a x i t b e o k h d n g b a o h d a d d n , ke tiep Id axit b e o k h d n g b a o h d a d a ( J . L u n n a n d H, E.
T h e o b a l d 2 0 0 6 ) . C h i m g c d t a c d u n g t d n g h a m l u o n g c h o l e s t e r o l e d loi H D L - C c h o e d t h e , g i a m c h o l e s t e r o l L D L - C c d h a i . K e t q u a n g h i e n eifu e i i a e h i i n g t d i p h i i h o p vdi n h i i n g q u a n d i e m d a duOc c o n g n h a n ndi t r e n .
B a n g 2 H a m lUdng F F A t r o n g h u y e t tUdng n g u S T b i n h t h u d n g v a b e n h n h a n D T B T 2 ( m g / L , X + S D , n = 3 0 )
ST T 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Axit beo C12,0 C140 C15D C16m-9 C161n-7 C160 C182n,6t C18 n-9c C18.1n-91 C18.0 C20:5n-3 C20:1n-9 C200 C226n-3 C225n-3 C22 4n,6 C221n-9 Tdng liiong FFA
Nqua bin H^m iuong 0,7 ±0,2 2,2 ± 0,6 0,8 ± 0.2 0,7 ± 0 2 4,4 ±1,7 9I,7±16,3 18,1±4,6 31,1±7,4 2,3±0,5 40.5±7,1 1,5 ±0,4 0.4 ±0,1 0,4 ±0,1 1.4 ±0,4 0.5 ±0,2 0,9 ±0,2 0,6 ±0,2 197,6+
40,3 (iliranq
T } i e ' ,
%
0,36 1,13 0,39 0.34 2.20 46,43 9,16 15,75 1,16 20,50 0.77 0.22 0.20 0.72 0.25 0.46 0.32 100%
B6nhnhan£)TBT2 Ham liMig
1.6 ±0.5 3,3 ±0,7 0,5 ±0,1 0,8 ±0,3 3,1 ±0.8 123.1±23.3 10.5 ±3.3 19.3*5.9 1,3 ±0,3 65,9±14,5 1,2 ±0,2 0.9 ±0,3 0,2 ±0,1 0,6 ±0,2 1,1 ±0,3 0,8 ±0,3 1,1 ±0.3 235.2±
51,1 Tjie",
%
0,67 1,39 0,19 0,36 1,32 52,32 4.44 8.19 0.57 28.03 0.51 0.37 0,10 0,26 0,46 0,33 0,48 100%
P
<0.05
<0,05
<0,05
<0,05
<0,05
<0,05
<0,05
<0.05
<0,05
<0,05
<0,05
<0.05
<0,05
<0,05
<0,05
>0,05
<0,05
<0,05 : Jp le (%) so vdi tong luong axit beo tu d h dupc trong huyet tuOng.
V HOC T H V C HANH (879) - SO 9/2013
Mdt khac, mdt sd nghidn ciiu da chCfng minh rang do dai cua cac axit beo cd vai trd quan trpng cho si/
trao ddi ndng lUdng vd dd nhay cam eCia td bdo vdi insulin. Dde biet, mdt sd tde gia da bao cao vd mdt enzym xuc tac ehuyen palmitat thdnh stearat, ddng vai trd ehinh tnang hidn tuong khang insulin [7, 9], Thi nghiem cOa ho da ehifng minh rktng vide chuyen ddi palmitat thdnh stearat Id mdt budc then ehdt cho sii xud't hidn khang insulin, Kdt qua nghidn cifu ciia chiing tdi eung phu hpp vdi nhiing bao c5o dd. Vdi \p Id C180/C160 tdng cao d nhdm bdnh nhdn DTOT 2 (0,54 d nhdm benh nhdn DTDT2 vd 0,44 d ngudi binh thudng).
Ket qua thu duoc d bidu dd 1 cung cho th^y, Ham luong axit oleic trong huyet tUdng cOa ngudi binh thudng eao hdn d benh nhan DTDT2. Dieu nay phii hdp vdi cac bdo cdo trudc day rang do nhay cam cfla cac td bdo vdi insulin d benh nhdn 0TDT2 ed the dudc e^i thidn khi chuyen tCr chd dd dn giau eacbonhydrat sang ehe dd giau axit beo khdng bao hda ddn cd ndng luong tUdng dUdng. Madigan vd cdng si/ chijfng minh rang thay ddi che dd dn udng tif axit linoleic sang axit oleic d i n den sU thay ddi ty' Id lipoprotein ty trpng thap (LDL) va lipoprotein tp trong cao (HDL) tren benh nhan DTDT2. Vi vdy, axit oleic dupc xem nhu mpt mat xich then chdt trong rdi loan chuyen hda va ehe dd dn hop ly ctia bdnh nhdn.
me/L
fll 1
O Ngvrori b i n h tliircmg
• B ^ n l i tihan d a i thao du-ong typ 2
1 S
Bleu do 1: Ham lL/9ng axit beo tudo trong huyet tiAing d hai nh6m nghien ciAi
S S
Axit beo khdng bao hda da n-3 (n-3 PUFAs) ddng vai trd sinh hoc quan trpng ddi vdi ngifdi khde v d ngudi benh. NhCmg nghien cdu gan day, da chimg mmh n-3 PUFAs ed tae dung khang viem, chdng x d vCfa ddng mach, lam ha huyet ap va lam giam tdc dung cDa triglycerid [2, 5]. Axit a-linolenic (C18,3n-3), Id axit beo thiet yeu quan trong nhd't ma ehi dupe eung cd'p tir che do dn udng. Hdn nCra, no cdn la chat nen de tdng hop ra 2 axit beo khong bao hda da n-3 quan trpng, axit eicosapentaenoic (EPA C20 5n-3) v d axit doeosahexaenoie (DHA C22:6n-3), rat quan trong eho s u chuyen hda ndng lupng va d p nhay ciia te bao vdi insulin (Sinclair et al,, 2002) Axit a-linolenic dUdc ndi dai mach vd khuf bao hda tao thanh EPA Id tien chat eua eac eicosanoid chd'ng viem. Mdt s d nghien cifu cho thay EPA ifc ehe interleukin I p (!L-ip), yeu t d hoai tilf khdi u (TNFa) va interleukin-6 (IL-6) c d vai trd quan trpng trong benh smh 0 T D T 2 va bidn chimg eiia nd
(Fenucci et al., 2006; Simopoulos, 2006). Nghien ciiu hien tai ciia chimg tdi c h o thay ham lupng DHA tren benh nhdn 0 T D T 2 thap hdn ngUdi binh thudng, cd ttie la nguyen nhdn lam giam d o nhay ciia te bdo vdi insulin d benh nhdn dai thao dudng, phCi hdp v6i cac nhdn dmh tnJde day.
Bang 4. H a m lupng cholesterol va triglycerid trong huye't tuong ciia hai nhom.
CWaS T6ng ii/ong FFA (mg/L)
Choiesteroi {mmoi/L) Tngiycend (mmoirt.)
Ngixd binti thudnq 197,6 ±40.3
2,9-5,2 0,8-2,3
Benh nhan DTDT2 2352 ±51,1
6.6 ±0,9 3.2 ±1.3 Mat khac, nhdm benh nhan DTDT2 cd ham liWng cholesterol nam trong khoang 6,6±0,9 mmol/L, cao hdn rd rang so vdi ngudi binh thudng (bang 4). Da thay ham li/png cholesterol huyet tUdng d nhdm benh nhafl dai thao dudng c d tiTdng quan thuan vdi ham ludng
Y HOC THirc HANH (879) - SO 9129^
mpt sd axit beo bao hda: lauric (r = 0,34), mynstic (r = 0,45), palmitic (r = 0,30) va cung cd tuong quan thudn vdi axit eicosapentaenoic (r =0,56); vdi cde axit beo khac thi chUa thay ed tuong quan ro ret, ed thd do sd lUdng mdu nghien cifu cdn nhd. Ham lupng triglycerid cd tuong quan thuan vdi hdm luong axit palmitic {r = 0,41) va stearic (r = 0,50). Jp le axit beo bdo hda eao trong mau dupe xem Id khdng tdt bdi nd lam tdng ludng LDL-cholesterol trong mau va Idm giam hap thu LDL- cholesterol d gan, luong LDL du thira trong mdu se bam vao thdnh mach vd dim tdi hinh thdnh cae mang xdviJTaddng maeh.
K^T LUAN
Bang sac ky khi khoi phd da xac dmh dupc 17 axit beo tif do trong huyet tuOng benh nhdri dai thdo dudng typ 2 vd ngudi binh thudng, vdi tdng ham luong Idn luPt Id 235,2 ± 51,1 va 197,6 ± 40,3 mg/l, trong dd cae axi'f palmitic, stearic, oleic, linoleic, myristic vd lauric chiem tren 96% tdng lupng axit beo tif do d ca hai nhdm,
Benh nhan dai thdo duPng typ 2 cd hdm luong cdc axit beo bao hda (82,5%) trong huyet tuong cao hon so vdi ngudi binh thudng (76,5% ); tdng lupng axit beo khong bao hda (17,5%) thap hdn so vdi ngUdi binh ttiUdng (31,7%). T^ le stearie/palmitic trong huyet d nhdm benh nhan dai thao dudng typ 2 (0,54) cao hdn d ngudi binh thudng (0,44),
Ham lupng mpt sd axit beo tiT do trong huyet tuOng benh nhan dai thao duPng typ 2 cd tuong quan thuan vLte phai vdi ham luOng tnglycerid va cholesterol,
TAI LIEU THAM KHAO
1, Bergman R N., & Ader M. (2000), Free fatty acids and pathogenesis of type 2 diabetes mellitus. Trends in Endocrinology and Metabolism. 11 351-356.
2. Geleijnse J. M,, Giltay E, J,, Grobbee D. E,, Donders A. R. T,, & Kok F. J. (2002), Blood pressure response to fish oil supplementation: Metaregression analysis of randomized trials. Journal of Hypertension, 20:
1493-1499.
3. Helms B, & van Meer G. (2006), Lipidome and disease. FEES Letters, 580 5429
4. Lapolla A., Sartore G,, della Rovere G. R., et al, (2006), Plasma fatty acids and lipoproteins in type 2 diabetic patients. Diabetes- Metabolism Research and Reviews, 22: 226-231.
5 Lee T. H., Hoover R. L., Williams J. D., et al, (1985), Effect of dietary enrichment with eicosapentaenoic and doeosahexaenoie acids on in vitro neutrophil and monocyte leukotriene generation and neutrophil function New England Journal of Medicine, 312, 1217-1224,
6, Ivlalsuzaka T,, Shimano H., Yahagi N., et al, (2002), Cloning an characterization of a mammalian fatty acyl- CoA elongase as lipogenic enzyme regulated by SREBPs. Journal of Lipid Research, 43' 911-920.
7 Matsuzaka T„ Shimano, H., Yahagi N., et al, (2007), Cmcial role of a long-chain falty axit elongase, Elovie, in obesity-induced insulin resistance. Nature Medicine, 13: 1193-1202
8 Mjos S. A., & Grahl-Nielsen O, (2006), Prediction of gas chromatographic retention of polyunsaturated fatty axit melhyl esters. Journal of Chromatography A, 1110 171-180.
9. Moon Y. A„ Shah N, A., Mohapatra S., Wamngton J. A., & Horton J, D. (2001), Identification of a mammalian long chain fatty acyl elongase regulated by sterol regulatory element-binding proteins. Journal of Biological Chemistry, 276, 45358-45366.
10 Slumvoll M„ Goldstein B. J , & van Haeften T. W.
(2005), Type 2diabetes' Principles of pathogenesis and therapy. The Lancet, 365: 1333-1346
TRIEU CHUfNG LAM SANG CUA TRE B| TIEU DAM TIEN PHAT TAI KHOA KHAM BENH - BENH VIEN NHI TRUNG U0NG
TOM TAT
Muc tieu: md ti ddc diim iam sang eda tri bi tiiu dim tien phat
Dii tuang va phuang phip nghidn cinj: Nghien cdu md ta tit ca eae tre dugc chin dodn tiiu dim tidn phat Irdn 5 tuii din khim tai khoa Kham benh- Benh vien Nhi Tmng uang trong vdng 6 thang (tU thing 08/2012 din thang 02/2013).
Kit qui: tudi tiiu dim tmng binh la 6.71 ± 1 45 tuoi. Tpid nam/nd= 4.8/1. 40%, tre bitiiu dim 4-6 lin irong mdt tuin. Tmng binh sd dem tiiu dam trong tuin d nhdm tri ed uong nude dem (4.8 ± 1.86 dem) cao hdn nhdm tre khdng udng nddc ddm (3.3 ± 1.23 dem).
Thing binh sd ddm tiiu dim trong tuin d nhdm tre cd iiin s&gia dinh (47 ± 1.98 ddm) eao han hin nhom tre
^iidng cd tiin sdgia dinh (3.4 ± 0.93 ddm) 42.9%, sd
T R A N H U Y K I N H , N G U Y I N TH! Q U V N H H U ' O N G Bg mdn Nhi, Trudng Dai hgc Y Hd Ngi NGUYiN AN GIANG - Benh vien 4, Qudn Khu IV
tre thi chiu dp luc tdphia gia dinh Tiiu dim inh hudng din giac ngd cue cha me chiim tp Id eao (41.5%,).
Kit luan: Trung binh sd dem tiiu dim trong tuin eao hon hin d nhdm tre cd udng nudc dem va nhdm cd tiin sd gia dinh bi tHu dim 42.9% sd tre chiu ip lue td phia gia dinh nhu bi dinh, ming khi Ire lieu dam. 41.5%, cha me cam thiy bi inh hudng nhieu den giac ngd.
Tdkhda: tiiu dam, tam ly, tao bdn SUMMARY
Objective To descnbe the clinical signs of children with primary enuresis.
Methods The study describes all children diagnosed with primary enuresis of 5-year-old at the Out-Clinie Department of National Hospital of
Y H(3C THUC HANH (879) - sO 9/2013
