- Tdi phat. dl can chO ydu xay ra trong 2 ndm d l u lign
3. Sdng thgm 5 nam
- Ti lg sdng thgm toan bg 5 nSm la 57,3%, ti Ig sdng them 5 nam khdng bgnh Id 45,7%.
- Cde ydu td dnh hudng ddn sdng thdm 5 nam gdm: KTU, GDB, phuong phap PT.
T A I L I $ U THAM KHAO:
1, Nguyen Dgi Binh (2001), "Ung thu phin mdm'.
Bai giing Ung thw hgc 2001. Nhd xuit bdn Y hgc, tr.
238-244.
2, Matthew A. Clark, F.R.A.C.S, Cyril Fisher, et al (2005). "Soft-Tissue Sarcomas in Adults", The new England Joumai of medicine. 2005. vol. 353. 701-711.
3 Murray F, Brennan, Samuel Singer, Robert G, Maki, et al (2006), "Soft tissue sarcoma". Cancer pnnciples & Practice of Oncology, 7"" Edition, chapter
35, Lippincott William & Wilkins.
4. NCCN (2010), "Soft tissue sarcoma". Practice Guidelines in Oncology- June 2010.
5. Parkin D. M, et al (2002), "Caneer incidence in continents". MRC scientific publication, vol 7(155), 2002, pp, 70-736.
6. Peter W.T. Pisters, MD, et al (2003), "Soft tissue sarcomas". In: Cancer management: A Multidisciplinary Appmach. The Oncology Gmup, a division of SCP Communications. Inc. 2003, pp. 559-582.
7. Princy Francis, Heidi Maria Namlos, Christoph Muller (2007), "Diagnostic and prognostic gene expression signatures in 177 soft tissue sarcomas:
hypoxia-induced transcription profile signifies metastatic potential". SMC genomic. 14 Mamh 2007.
(hftp:/AAnvw. biomedeentral .com).
NGHIEN Cl)U GIA TRj NT-PROBNP
TRONG TIEN LU0NG NGAN HAN NHOI MAU CO TIM CAP KHONG ST CHENH LEN
T6M TAT
Af(iC tidu: Tmng nhdng ndm gin ddy BNP vi NT- pmBNP dang ndi ldn Id diu in sinh hgc gid mdt vai trd then chdt trong diiu tri vi tidn Iwgng bpnh tim mgch dd dUoc cdng nhpn trong chin doin suy tim vd tiipn nay diu in sinh hgc niy quan trgng tmng dinh gii rdi logn chdc ndng tim vi cd gid tri tmng tien luang bpnh nhdn nhdi mdu ca tim cip,cdc nghien cdu tmng vi ngodi nwdc cho thiy ring BNP vd NT- pmBNP tdng nhanh vd sdm cung cip thdng tin vi mpt tidn Iwgng vl vPy chung tdi cung cd muc tidu nghidn cdu gid tri NT-proBNP tmng tidn Iwgng ngdn hgn nhdi miu co tim cip khdng ST chdnh
Ddi twgng vd phwong phip nghidn cd^:
Nghien ciru dodn hp tiin cdu
sd dijng bp cdu hdi vd miu huyit thanh cda bpnh nhdn nhip vipn vdi chin dodn xdc (Tinh hpi chimg mgch vinh dp khdng ST chdnh bpnh vipn Chg Riy trong khdng thdi gian td thing 10-2010 din thing 6- 2011 bpnh nhin z 18 tudi
Kit qui: Cd 96 bpnh nhin hoin thinh miu nghidn cdu. Dp tudi tmng binh 67,99± 11,03 tudi,nd chiem 45,8% Nam nd tj Ip gin twang dwong nhau.
dpc diim ndng dp NT-pmBNP huyit thanh khio sit (iin 1}ngay IQc nhpp vipn cao han ndng dp NT- proBNP (ldn 2) mdt tuin sau, ndng dp NT-pmBNP (lin 1,2)ting cao hon nhdm bpnh nhin >65 tudi.ndng dp NT-pmBNP (lin 1.2) ting cao d nhdm bpnh nhin c6 phdn dp Killipt U cd j nghia thdng kd vdi P<0,001,ndng dd NT-pmBNP huyit thanh cd lidn quan chpt che vdi thang diim nguy ca TlMl (vdl P<0,001). Ndng dp NT-pmBNP huyit thanh cd lidn quan td vong bpnh nhdn nhdi miu ca tim khdng ST chdnh vdi p<0,001,phdn suit tdng miu thit trii cd
NGUYIN THI H6NG HU£
BM Npi - Dal hgc Y Dwgc Tp.HCM
lidn quan chpt chd ndng dp NT-proBNP.
Kit lupn: Nghidn cdu cua chung toi cho thiy tdng ndng dP NT-pmBNP cd lidn quan tidn Iwgngngin hgn tw vong bthe mie of NT-pmBNP in the short-tenn prognosis of myocardial Infamtion without ST segment bpnh nhin nhdi mdu ca tim khdng ST chdnh.
Td khda: nhdi mdu ca tim. nhdi mdu khdng ST chdnh, tien lugng ngin han.
SUMMARY
VALUE NT-PROBNP IN THE SHORT-TERM PROGNOSIS OF MYOCARDIAL INFARCTION WITHOUT NON ST SEGMENT
Objectives: In mcent years. BNP and NT-pmBNP is emerging as bigmari<ers play a key mie in the treatment and prognosis of cardiovascular disease has been mcognized in the diagnosis of heart failum and now this biomart^er important in assessing cardiac dysfunction and prognostic value in patients with acute myocardial infamtion, the domestic and intemational reseamh shows that BNP and NT- pmBNP incmased rapidly and soon pmvlde infonnation on pmgnosis so we also aims to study the role of NT-pmBNP in the short-term pmgnosis of acute myocardial infamtion.
Subjects and Methods: Reseamh cohort study using questionnaims and semm samples of patients admitted to hospital with a diagnosis of acute coronary syndmme without ST segment Cho Ray Hospital in the period fmm January 9-2010 to 6 - 2011 patients^ ISyearsofage.
Results: Sample of 96 patients completed the study. The avemge age 67.99 ± 11.03 years, women accounted for 45.8% of men and women almost
T H Q C THV'C HANH (872) - SO 6/2013
equal rate, characteristics serum NT-proBNP concentmtions sun/ey (time 1) now enter higher levels of NT-pmBNP (2) a week later, the concentmtion of NT-pmBNP (1.2) higher than the gmup ofpatients> 65 years of age. NT-pmBNP concentrations (1.2) am found in the gmup of patients with Killip-gmde s //
statistically significant with p <0.001, semm NT- pmBNP concenlmtbns am closely mlated to the scale of TlMl risk (p <0.001). NT-pmBNP semm concentmtions related mortality patients with myocardial infamtion without ST difference with p
<0.001. left ventricular ejection fmction Is closely mlated to the concentmtion of NT-pmBNP.
Conclusions: Our study showed increased levels of NT-proBNP conceming money short-terms of death myocardial infamtion patients without ST segment and stable angina.
Keywords: Acut myocardial Infamtion, Acut myocardial infamtion non ST segment the short term pmgnosis.
DAT VAN Dt
-Nhdi mdu co tim d p Id mgt bidn ed tim mgeh quan trpng bgnh tim do mgch vdnh, la nguydn nhan hang ddu gay t u vong vd dang ed khuynh hudng gia tdng d cac nude dang phat tridn*"*.
-NhOng Uigp nign v&a qua, t i n suit vd t& suit cua nhdi mdu eo tim ST ehdnh ldn cd gidm, do vige dp dyng rgng rdi eae phuong phap can lhi§p mgch vanh qua da hogc md tilt e l u dgng mgch vanh, nhung nhdi mau eo tim khdng ST chSnh vd dau thit ngue khdng dn dinh It duoe quan tdm hon'"'.
-Vidt Nam nh&ng ndm g i n day sd bgnh nhgn nhgp vign vl hgi ch&ng mgch vdnh d p ngdy mdt tdng vd ty Ig tu vong do nhdi mdu co t m d p tnang nhung ndm g i n day l u 26,6% den 39,6%'"'^'
Ndm 2010 theo thdng kg phdng kd hogch tdng hyp bgnh vign Chy R i y cd 7.421 trudng hyp ddn d p c&u vl dau thit ngyc, nhdp vign didu In hdi ch&ng mgch vanh d p 1538 trudng hyp, chup mgch vdnh d p cdu 385 tnrdng hup, d$t stent e l p euu 320 trudng hyp, t u vong 267 tnj'dng hyp.
Trong nh&ng ndm g i n day, BNP vd NT-proBNP dang ndi ldn la d l u I n sinh hpc gi& mdt vai trd then ehdl trong didu trj va tign luyng bgnh tlm mgeh, dd duye edng nhgn trong ehln doan suy tlm va hien nay d l u I n sinh hpe nay quan trpng trong danh gia rdi logn eh&c nang tim vd ed gia In trong tign luyng bgnh nhan sau nhdi mau co tim d p . Cdc nghign c&u trong vd ngoai nudc cho thly ring BNP va NT-proBNP tang nhanh va sdm"'^' Sy tang nhanh ciia BNP va NT-proBNP eung d p thdng lln quan trpng vd mgt lign luyng.
Do dd, chOng ldi tidn hgnh nghidn c&u gia trj cua NT-proBNP huydt thanh trong tign luyng ngdn hgn (30 ngdy) d nh&ng bgnh nhan nhdi mau eo tim d p khdng ST chenh ldn
Nghign c&u cua chOng 161 duyc thyc hien nhim xdc (Jnh mdi lien quan gi&a ndng dg NT-proBNP huydt thanh bdnh nhdn vd t u vong trong 30 ngdy sau nhdi mdu eo tim d p khdng ST chgnh lgn vd dau thdt ngyc
khdng dn djnh d ngudi Vigt Nam tgi khoa tim mgch bdnh vign Chy Riy,
D 6 1 TU'O'NG, PHU'ONG P H A P NGHIEN CU'U Nghign c&u dodn hg tidn c&u cd khdo sdt trSn 96 bgnh nhan a 18 tudi nhgp vign didu tri tgi khoa tim mach bgnh vign Chy R i y vdi ehln doan xac djnh nhdi mdu CO tlm khdng ST ehgnh lgn
Tidu chl chpn mdu
Bgnh nhan m l u phdi t h o i dii Irong tidu ehuin ehpn m l u
T u vong sdm 12 gid sau Tidu c h u i n logi t r u Cun dau Ihit ngyc.
Dau ngyc khdng phdi hgi chimg vanh d p : viSm co tim phinh bde tach dgng mgeh ehD, vigm mdng ngodi tim d p , . . ,
Bgnh nhan khdnq du tigu ehuin ehln doan Tigu c h u i n chan dodn nh&i mdu c o tim cip khdng ST chdnh ldn
Con dau ngyc kidu mgch vanh didn hinh kdo ddi >
20 phOt.
Sy bidn ddi dgng eua cde c h i t danh d l u t m (CK - MB) > 2 l l n tn sd binh thudng. Troponin I > 1ng/ml.
Sy bidn ddi ECG kidu thidu mau ci^e bg co bm nhung dogn ST khdng chdnh lgn.
Thdng tin bgnh nhan bgnh dn m l u , m l u huydt thanh bgnh nhdn duye l l y 2 l l n
L l n 1: l l y mau lOc bdnh nhdn mdi nhgp vao khoa tim mgeh sau khdi d i l m dau t h i t ngyc.
L l n 2: l l y mdu l l n 2; mdt t u i n sau l l n mgt, lly mdu dugc thye hign theo qui trinh sau.
Xi> ly sd li^u vd phdn tich s 6 li#u ChCing tdl su dyng phdn mdm SPSS 16,0 dd xu ly, Cdc bidn sd Ildn tgc duyc md ta bing trung binh ± dd Igch chuin, cdc bidn djnh tinh duyc md td dudi dgng phin trdm.
Phdp kidm T test b i t cdp d l khao sdt bien s6 dinh luyng od phdn phdi binh thudng.
So sdnh bdng phdp t vd ANOVA mdt chidu ddi vdi bidn sd ed phdn phdi binh thudng va phuong sal d cdc bidn phM thugc bang nhau, bdng phdp kilm djnh trung vi vd kidm djnh phi tham sd ddi vdi cdc t»ln sd ed p h ^ phdi khdng binh thudng.
So sanh ly lg p h i n trdm b i n g phdp kidm chi binh phuong x^ So sanh b i n g phdp t vd ANOVA,
xae (Inh s y tuung quan gi&a ndng dg NT-proBNP mau vd cdc bidn sd- bidn d\nh luyng bang hg so tuong quan Pearson ndu bidn sd ed phdn phdi binh thudng v4 bing hd sd tuong quan Spearman ndu cd phdn ph6i khdng phdi binh thudng.
xac dinh cdc ydu Id dnh hudng ddn t& vong, Diing phuong phdp hdi qui luydn tinh da bidn dd tim ra cdc ydu td cd ten luyng t> vong.
Ve dudng cong ROC vd tim dien tich dudi dudng cong ROC cua NT-proBNP.
Xdc djnh didm d t cua NT-proBNP lgi noi c6 (S ehinh xdc cua c h i n dodn cao nhit (tJ Ig am tlnh gil vS duong llnh gid t h l p nhit).
Cdc phdp so sdnh, hg s6 tuong quan... cd J nghia
Y HOC TH Vc HANH (872) - SO 6/M13
filing kg khi gid tri p < 0,05.
KfiT QUA Tudi
Trong 9 thdng thuc hign nghign e&u ed 96 bgnh nhdn duyc dua vdo nghien c&u gdm 36,5% dudi 65 tudi vd 63,5% Idn hon 65 tudi,
Tudi tmng binh la' 67,99 ± 11,03 tudi
M6I lien quan gi&a tudi vd ndng dg NT-proBNP huydt thanh bgnh nhan nhdm bgnh nhan <65 tudi 1} lg tip vong chidm 9,1%,thlp hon so vdi nhdm bgnh nhdn >
65 tudi chiem ty Ig t& vong 90,9%
Ndng d$ NT-proBNP h u y l t thanh
Thang dilm TlMl ed lidn quan ndng dg NT-proBNP huyet thanh bgnh nhan'"cd thang didm TlMl >4, ndng ag NT-proBNP(1)(2) tang cao hon nhdm bgnh nhdn ed didm TIMI<4,sy khae bigt ed y nghTa thdng kg vdi p<0,001.
Ndng dd NT-proBNP lien quan phgn sudl ldng mau thdt (T) EF d nhdm bgnh nhgn cd phdn suit tdng mdu thit (T) EF<45% cd ndng dd NT-pro BNP idn(1,2) eao han nhdm bgnh nhan ed EF> 45% ed y nghTa thdng ke vdi p <0,001,
Ndng dg NT-proBNP lien quan vdi dd loc d u thdn.
trong nghidn e&u eua chOng tdl thly nhdm bgnh nhan cd dg Ipe d u thdn s 51 ml/phut ndng dd NT- proBNP(1)(2) cao hon nhdm bgnh nhdn ed dg Ipc d u thdn > 51 ml/phiit, s u khde bigl ed y nghTa thdng ke vdi p{1) = 0,024, p(2)=0,b02.
Cd mdi li6n quan ndng dd NT-proBNP vd phdn sudl t&ig mdu thdt trdi Nhdm benh nhdn cd EF <45% ndng dfi NT-proBNP(1)(2) tang eao hun nhdm bdnh nhan ed EF>45%, sy khae bigt cd y nghia vdi p<0,001.
Cd mdi lign quan ndng dg NT-proBNP vd phdn dd Killip, ndng dd NT-proBNP (1)(2) vdi bgnh nhdn nhdm killip SII tang eao hon bgnh nhdn nhdm killip<ll Su khdc bigt cd y nghTa vdl p<0,6oi.
Ode diem t u vong trong nghien e&u
Benh nhdn tu vong chiem 11,5% c h i n dodn nhoi mdu eo tim khdng ST chenh len,nhdm khdng t& vong 88,5%
Nhdm bgnh nhdn ed phdn suit tdng mdu that (T) EF< 45% chidm ty Ig t u vong 90%.
N&ig dd NT-proBNP va t& vong, nong dg NT- proBNP lien quan ddn t u vong nhdm bgnh nhan l& vong c6 ndng do NT-proBNP mgu l l n 2 cao hon nhdm nt-pro BNPlln(1)sy
Phdn bd hieu s6 ndng do NT-proBNP (2-1) vd t&
vong trong nghien c&u
Bang 1. Phdn bd t& vong theo ndng dd NT-proBNP 2-
26,12
2 ty Id vong 3 (27,3) sy khdc bigl cd >? nghia tdng kg vdi p 0,004.
Bang 2. Phdn Hch da bidn ede ydu td nguy eo vdi t&
vong
Nong ad NT-proBNP BNP 2 > BNP 1 i! BNP 2 < BNP 1 g. TfinqcOnq
Tir vonq 8 (72,7) 3 (27,3) 11
Sdng cdn 25 (29.4) 60 (70,6) 85
Chunq 33 (34,4) 63 (65,6) 96
Ydu td nguy co Tuii
EF Kilip TlMl
Hgsdr 0^007 0,069 -0,450 -0,041
Gid tri T 0,085 0,513 -3,015 -0,409
P 0,933 0,609 0,003 0,684 1
e,11,p = 0,004. OR = 6,40. KTC 95%: 1,57 - Nh6m b^nh n h i n NT-proBNP l4n 2 > NTproBNP An 11} 1$ & vong chilm 8±27,7.
NhOm benh nhan NT-proBNP lan 1> NT-proBNP ISn
m sir Chung = 0,672, F = 12.22. p < 0.001 Nh$n x6t: C i c y6u t6 nguy co tir vong, tu6i, EF, Killip, TlMl c6 y nghTa thing k6 v6n p<0,001.
Gid tri cCia NT-proBNP (1) vi tign lirp'ng tu' vong NT-proBNP (1)
BJng 3. xac dinh aim cat NT-proBNP m^u (1) Didm cat
300 400 560 600 700
DO nhay 90,91 81,82 72,73 63,64 54,55
DO a^c hi#u 55,29 68,24 82,35 88,24 90,59
Dd Chlnh x&c 59,38 69,79 81,25 85,42 86.46 Chpn dilm d l la 560
Bieu dd 1: Oudng cong ROC bidu di§n NT-proBNP mau (1) v^i gia tn tien doSn tip vong. Dien tich dwd\ du'O'ng cong =
0,836
Gid tri cua NT-proBNP (2) va tien luung t u vong NT-proBNP (2)
. Dudng cong ROC bidu dien NT-proBNP mdu (2) vdi gid In tidn dodn l u vong
Dign tich dudi dudng eong = 0,912 Bang 4, Xde dinh didm e l l NT-proBNP mdu (2) Diem cat
300 400 500 600 650 700
Dd nhgy 90,91 81.82 81,82 63,64 81,82 45,45
DQ a$c hieu 52,94 77,65 85,83 92,94 81,18 97,65
Dd chinh xdc 57,29 78,13 85,42 89,58 81,25 91,67 Chpn dilm d l Id 650
Bang 5. Gid In lien dodn cita nong dg NT-proBNP mdu
DiSm cSi S650
<650 T6nq cdnq
TLK vonq 9(81,8) 2(18,2) 11
S6nq cdn 8 (9.4) 77 (90,6) 85
Chunq 17(17,7) 79 (82,3) 96
Y HQC THV'C HANH (872) - SO 6/2013
X2 = 35.04. p < 0,001, OR = 20.91. KTC 95%:
4.95-88,24
Dign tich dudi dudng cong ROC Id 0,912 Idn hon 0,5 eho thly ring ndng dg NT-proBNP (21 ed liSn quan mgnh vdi tidn luyng t u vong 30 ngdy nhoi mdu eo tim d p khdng ST chSnh ISn.
KET QUA VA B A N LUAN Tu&i
Trong nghtSn e&u eiia ehiing tdi Tudi trung binh Id: 67,99 ± 11,03 tu6l. Bgc didm ndy phti hyp vdl nghiSn e&u trong nude vd nghiSn e&u eCia nudc ngodi tac gid Drew E tudi trung binh 66,7 ± 10,2"^*,
Trong nghlSn c&u eiia ehiing ldi, phdn phdi tdn s u i t ndng dg NT-proBNP mdu bgnh nhdn khdng Id phdn phdi ehuin va ed phdn bd Igeh p h l i so vdi nghign c&u trong vd ngodi nude s y phdn bd ndng dg NTproBNP g i n tuung ty'^"*'.
Phdn bo ndng dg NT-proBNP trong nghiSn e&u ciia ehiing tdi ndng dd NT-proBNP(l) t u 33-1300 fmol/ml vd NT-proBNP(2) t& 47-1234 fmol/ml.
Kdl qua ciia chiing tdi tuong t y vdi kdt qud cac nghidn c&u trong nude''''ndng dg BNP t& 22-1920 fmol/ml nghign e&u nudc ngodi d u y c cdng bd nhu nghign c&u eiia Torbjern Omiand'"' ndng dg NT- proBNP cd phgm vi t& 442 ddn 1306 fmol/ml. Nghidn c&u cua Omiand vd es. ndng dg NT-proBNP t& 209 den 1790 fmol/ml'^''.
Sy khac bigt ndng do NT-proBNP trSn cae nghien c&u trong va nudc \i do edeh lay mau vd thdi didm l l y mdu huyet thanh nghidn e&u.
Trong nghien c&u eua ehung tdi m i u mdu duoc lay 2 l l n ; NT-proBNP (1) m i u d u y c lay vdo thdi didm ngdy ddu mdi nhap vien e h l n dodn dau t h i t nguc khdng 6n i^nh, nhdi mau eo tim e l p khdng ST ehSnh len vd NT-proBNP(2) lay mdu mdt ludn sau nhdp vien.
Nghign e&u cua ehiing tdi khdng ed tuong quan gi&a ndng dg NT-proBNP mau vd creatinine mdu ed the giai thich do ehiing tdi loai tru nhung bgnh nhan suy thdn mdn, bgnh nhdn ed creatinine mau >
2,5mg/dl, nhdm lam giam sy anh hudng cua s y tang ndng dd NT-proBNP mau.
Trong nghidn c&u eua ehiing tdi ndng dg NT- proBNP mau d bgnh nhan ed phan dd Killip 11| cao hun so vdi nhdm bgnh nhgn ed phdn dg Killip < 11, khdc bigt ndy cd y nghia vdi p < 0,001.
Trong nghidn c&u ciia T r i n Hda '^^\ cDng ghi nhdn ndng do NT-proBNP tdng theo nhdm bgnh nhdn cd Killip > 11, Giai thich cd sy tuong quan thuan Killip cdng Idn, thi ndng dd NT-proBNP mdu cdng tSng Mgt so nghien c&u tren thd gldi cho rdng, ndng dg NT- proBNP mdu tdng d i n theo phdn dg Killip.
Bang 6: So sdnh phdn s u i t ldng mdu vd t u vong giua cdc nghien c&u
Trong nghign c&u cOa chiing tdi ndng dg NT- proBNP mdu d bgnh nhdn ed dg Ipc c l u thdn <51 ml /philt cao hon nhdm bgnh nhdn cd dd Ipc c l u th§n >
51 ml/phut bdng phdp kidm Fisher vdi F = 5,25, p = 0,024 ed 'if nghTa
Theo nghign c&u cua (Omiand) ' ' nhdm bgnh nhdn ed dg Ipc e l u thgn <51 ml/phut ndng dg NT- proBNP mdu eao hon nhdm bgnh nhdn ed dg Ipc clu thgn > 51 ml/phiit (v&i r = 0,23, p = 0,001). Theo nghidn c&u Trdn Hda (16) ndng dg BNP tuong quan nghjch vdi dg Ipe edu c l u thgn vdi r = 0,23, p = 0,045 cd y nghTa thdng kg.
Trong nghign c&u cua chiing tdi so vdi nghign c&u eiia nudc ngogi vd nghign e&u trong nude nhu nghidn e&u ciia T r i n Thanh Tudn phdn s u i t tdng mau t h l p , ty lg t u vong tang*"'. Theo nghign c&u cua Omiand eho t h l y phan s u i t tdng mdu thit trdl EF<45% Id ydu td tiSn luyng t& vong mgnh.
Ty Ig t u vong trong nghign c&u chOng tdi Id 11,5%, ty Ig tir vong eiia chiing tdi t h l p hon cda nghiSn cuu T r i n Hda^^^* (12,5%), T r i n Thanh T u i n ' " ' t u vong (13,9%), tuy nhidn kdt qud nghiSn c&u eua ehung tdl edn cao hon kdt q u i nghidn euu cua Torbjcrn Omiand ty IS t& vong trong 30 ngdy la 2,4%.
Nghidn c&u ciia Galvani ty Ig t& vong trong 30 ngdy Id 6,4%, nghidn e&u eiia Chadotte Kragelund t j lg li>
vong 30 ngdy 2,4% vdi p < 0,001.
Trong nghign e&u eua chCing tdi cho thly phdn do Killip ^ II Id mgt ydu td tign dodn t u vong, phdn do Killip < 11 nguy c u t u vong 18,2% so vdi nhdm co phdn dg Killip £ II, chidm ty IS t u vong 63,7%, nghiSn c&u ciia ehiing tdi so sdnh vdi eae nghign c&u cua Morrow vd Lemos bgnh nhgn cd phan dg Killip > I nguy eo t u vong tang g i p 3,28 Idn, nghign e&u cua Galvani.
Trong nghign c&u eOa ehiing tdi, ndng dg NT- proBNP mau d nhdm t u vong cao hun so vdi nhdm sdng edn 735,21 ± 363,88 fmol/ml so vdi nhdm song edn 330,63 ± 219,48 fmol/ml. Trong nhdm t& vong bgnh nhan nhdi mdu co tim khdng ST chSnh lgn cd ndng dd NT-proBNP mdu cao hon nhdm benh nhSn dau thdt ngyc khdng 6n djnh, ndng dg NT-proBNP nhdm t& vong cao hon nhdm sdng s y khdc t)i$t cd y nghia thdng kg vdi p < 0,001.
Gid trj tien dodn cua ndng d$ NTproBNP Bang 7 So sdnh dien lich dudi dudng eong ROC trong mgt sd nghiSn c&u
Nqhifin CLKU cue Galvani Kraqelund Tr^n Thanh Tudn""
Chung tdi
Dien tich du'oi Qudnq conq ROC 0,727 0.763 0.836 0.836
Nghien cuu Omiand'"' TT Tu^n''"
Chiing tdi
TLK vonq 35,3 ± 3,7%
41,75 ±12.5%
36,4 ± 4%
Sdnq cdn 53,6 ± 1 1 % 57,6 ±12,9%
47.7% ±38%
P
< 0.001
< 0,001
< 0,002
Qua bang so sdnh trSn chiing tdi diSn tich ti dudng cong ROC cua ndng dd NT-proBNP mdu trong ddn sd chung vd NMCTKSTC Id 0,836 > 0,5 vdl OR = 12,44, eho t h l y xdt nghiem NT-proBNP mdu c6 gid trj eao vd tidn luyng t u vong. Dign tieh dirdi dudng cong ROC cOa ehiing tdi cao hon nghidn ci>u Tran Thanh T u i n vd cdc nghidn c&u khde trdn the gidi nhu cua Galvani,
Y H p c THV'C HANH (872) - SO 6/2013
Bang 8: So sdnh didm d t NT-proBNP mdu trong mgt sd nghign c&u
Nghidn ciru ' Omiand^'"
GalvaniErrorl Reference source not found.
TTTuIn'"' ChCinq tdi
Didm cpl 545 ftnol/ml 437 fmo! /ml
1068 fmol/ml 560 fmol/ml
Od nhav 61%
78.9%
66.7%
72,73%
Dd d^c hi$u 82%
56,75
72,5%
82,35%
Trong nghien e&u nay ehdng tdl ehpn didm e l t cua NT-proBNP Id nol cao n h l l (dg nhgy, dg dgc higu cao nhit) dd xde dinh gid tn d y dodn t u vong trong 30 ngdy, Nhd vdo dudng cong nhan dgng (ROC cunie).
Oiem d t ciia NT-proBNP(l) mdu Id 560 fmol/ml, vdi dd nhay 72,73%, dd chuygn 82,35%, dp ehlnh xdc 81,25% gid tri tign dodn t u vong khdng cao b i n g ddm d t ciia NT-proBNP (2), didn tieh dudi dudng cong ROC 0,912.
Didm cat cua NT-proBNP(2) mdu la 650 fmol/ml vdi dp nh?y 81,82%, dg chuygn 90,59%, dp ehlnh xdc 89,58%, gid tri tien dodn t u vong (+) 52,94%. Sy khdc bigt rd giua edc edng trinh nghign euu vd gia tn dy doan t u vong eua ndng dp NT-proBNP mdu, nghien c&u ciia Omiand vdi 609 benh
Trang nghiSn c&u eua chung tdi dp nhay, dd dae hi^u kha luong ddng vdi ket qua eiia Omiand va Galvani'^', tuy nhien ket qua didm d t cua chiing tdi khdc vdi diem d t Galvani S u khdc biet ve diem d t ciia chiing vdi cdc nghien e&u khdc do: Mau nghien ciru eiia ehung tdi qud nhd so vdi mdu nghidn c&u cua Galvani, nghien euu doan he da trung tam trgn hdng nghin benh nhdn nSn Galvani va Omiand chon dilm tnjng vj (median) lam didm d t va so sanh tu vong gi&a hai nhdm trgn vd dudi i^dm trung vi ndy"^'^.
K^T LUAN
Qua nghien c&u gid trj cua NT-proBNP trong lien liryng ngan han nhdi mdu eo tlm d p khdng ST chSnh lgn mdu nghidn c&u 96 bgnh nhan duoc thuc hign tai khoa ngi tim maeh bgnh vien Chu R i y ehiing tdi njt ra 3uac kdt ludn sau'
Lign quan giua ndng do NT-proBNP mdu v o l cdc ydu td ldm sdng
Tudi
Tudi cd lien quan vd>i Ndng dp NT-proBNP mdu
Nhdm tudi 565 tudi cd ndng dd NT-proBNP tdng cao hon nhdm tudi < 65 tudi, cd)/ nghTa vdi p=0,002
Cac ygu t d nguy c u tim mach
Nong do NT-proBNP tdng cd tuong quan den ydu tSng huydt ap cd y nghia thdng kg vdl p = 0,021,
Phan sudt tdng mdu thdt trdi (EF)
Ndng dd NT-proBNP mdu ldng cd mdi lien quan nghjch vdi phdn s u i t tdng mdu that trai (EF), EF <
45% ndng dd NT-proBNP mdu cao hon nhdm^ bgnh nhdn cd EF > 45%, s y khac bigt ed y nghia thong ke vdi p< 0,001.
Phdn dd Killip
Ndng dd NT-proBNP mdu tang cd liSn quan thugn vdl phdn dd killip, phdn dg killip £ 11 ndng do NT- proBNP tang eao cd phdn dd Killip < II. Sy khdc bigl cdy vdl p < 0,001.
Dd Ipc c l u thdn
Ndng dg NT-proBNP mau cd lign quan nghjch vdi dd Ipc c l u than, dg Ipe e l u thdn £ 51 ml/phOt ndng dd NT-proBNP mdu cao hun nhdm ed dd Ipc c l u thdn >
51 ml/phiit, Sy khdc bigt cd ^ nghia vdl p = 0,024 DiSm TlMl
Ndng dg NT-proBNP mdu ed lign quan thugn vdl thang d i l m TlMl, didm TlMl £ 4 ndng dp NT-proBNP tdng cao hon nhdm ed didm TIMI<4 Sy khac bigl ed y nghia vdi p < 0,001,
Lien quan giua cdc ygu td Idm sdng.cdn Idm sdng vd t & v o n g
-Tuoi cd ItSn quan vdi t u vong, nhdm tudi £65 tuoi chidm ty Id tu vong eao hon nhdm tudi < 65 tudi cd -j/
nghia vdi p=0,002
Cdc ydu td cd Ildn quan t u vong trong nghiSn cuu, tudi,phdn s u i t tdng mdu t h i t (T), phdn dg Killip, dilm TlMl, dp Ipe eau thgn.
Lien quan ndng dp NT-proBNP (1), NT-proBNP (2) vd t& vong
Nhdm t& vong cd nong dp NT-proBNP mdu (1) cao hun nhdm l u vong khdng t& vong. Sy khae bigl cd >> nghia vdi p < 0,001.
Nhdm t u vong cd ndng dp NT-proBNP mdu (2) cao hun nhdm khdng l& vong. Su khdc bigt ed y nghia vdi p < 0,001.
Hieu sd" NT-proBNP (2) > NT-proBNP (1) t& vong cao hon NT-proBNP(2)<NT-proBNP(1) tu vong t h l p hon.
xae djnh didm d t 560 fmol/ml NT-proBNP(l), dien tich dudi dudng cong ROC 0,836 khoang tin egy 95%, dd nhay 72,73%, dd chuydn 82,35%, dg chinh xdc 81,25%.
Xdc dmh didm d t 650 fmol/ml NT-proBNP(2), dien tieh dudi dudng eong ROC 0,912 khoang tin cdy 95%, do nhgy 81,82% dd chuygn 90,5.
K I £ N NGHj
Qua nghien e&u gia tn NT-proBNP trong tidn luong ngin hgn d bSnh nhan hgi ch&ng mach vanh d p khdng ST chenh riit ra nhung de nghj sau:
- Xem xet cd thd s& dung xet nghiem ndng dd NT- proBNP d benh nhdn hdi ehung mgch vdnh d p n h i m giup Icti eho viSc phan l i n g nguy cu, tien dodn cac bien ed tu vong tim mgch.
- Nen md rdng xdt nghigm ndng 3b NT-proBNP mdu vd cdc tuydn eo sd chua ed du phuung lien ehup mach vdnh, giiip ich eho vigc phan tang nguy eo trong tien luyng n g i n han va tidn luong Idu dai d bgnh nhan hgi ch&ng maeh vdnh d p
TAI LIEU THAM K H A O
1. Antman M, et al (2000), 'The TlMl Risk Score for Unstable Angina/Non-ST Elevation Ml", American Medical Association, 835-842.
2. Dang Vgn Phudc (2001), "Hgi chung mgch vanh
~rHQC THVC HANH (872) - SO 6/2013
d p Ojnh nghia va sinh ly bgnh". Ky yiu bdo do khoa hgc. Hpi tim mgch TP HCM
3, Dgng Van Phudc, Truong Quang Binh (2006),
"Sinh ly benh dgng mach vdnh" Nhd xult bdn y hpc TP HoChiMinh, 49-83,
4 Dgng Vgn Phudc, Vfl Thdnh Nhdn (2006-2010),
"Dau thit ngyc khdng 6n djnh vd nhdi mdu co tim khdng cd ST chdnh lgn", Khuyin cio hpi Tim mgch hgc Vipt Nam chin doin vi diiu tq, 107-181
5. De Lemos JA, Morrow DA, Bentley JH, Omiand T, Sabatine MS, McCabe CH, Hall C, Cannon CP, Braunwald E, (2001), "The prognostie value of B-Type natriuretic peptide in patients with acute coronary syndromes" The New England Joumai of Medicine, 345 1014-1021
6. Drew E. Fenton D, (2008), "Myocardial infarction
" In Medicine come, 327
7. Dumaine RL, Gibson CM , Gelfand EV, et al (2004), "For the TlMl study group. Association of glomerular filtration rate on presentation with subsequent mortality in non ST -segment elevation acute coronary syndrome observation in 13 307 pateints m five TlMl trial". European Heart Joumai,
8. Galvani M, Ottani F, Oltrona L, et al (2004), "N-
terminal probrain natriuretic peptide on admission has prognosis value across the whole speetnum of acute coronary syndrome". Circulation, 110. 128-134.
9, Killip T (1976), "Treatment of myocardial infarction in a coronary eare unit. A two year expenence with 250 patients" Am J Cardiol, 20: 457-464.181
10 Kragelund C, Granning B, Kober L et al. (2005),
"N-Terminal Pro-B-Type Natnuretic Peptide and Long- Term Mortality in Stable Coronary Heart Disease". The New England Joumai of Medicine, 666-675.
11. Omiand T, et al (2002), "NT-proBNP and long term mortality in acute coronary syndromes". CImulation, 106:2913-2918
12 Pfisler R, Schneider CA (2004), "Natriuretic peptide BNP and N-terminal probrain natriuretk: peptide:
establesshed laboratory markers in elincal practice or just perspective" Clinical chimica Acta. 349, 25-38
13 Phgm Nguydn Vinh (2006), "Bgnh hpc tim mgch" Nhd xuit bdn y hoc TPHCM, 77-138.
14. Trdn Thanh Tudn, Dpng Vgn Phudc (2008),
"Vai trd cua NT-proBNP trong tien luyng ngin hgnwhoi mau CO tim d p " Lupn vdn BS Npi trO chuydn ngdnh HQI tdng quit. TP.HCM
DANH GIA KET QUA DIEU TRj TON THU0NG OA DO XA TRj VUNG AM HO B A N G PHirONG PHAP CHUYEN VAT DA
N G U Y E N V A N TUYEN - Bpnh vien K
TOM T A T :
Muc tieu nghien cdu: Ddnh gid kit qud diiu tn tdn thwang da do xa tri vung dm hp bing phwang phap chuySn vgt da.
Ddi twgng nghien cwu 21 bdnh nhdn cd tdn thwang viem, loet da do xa tri vung im hP
Phwang phdp nghidn cww Md ti hdt cdu.
Phwong phip tien hanh Cit bo vung da ton thwang do xg tri tgi im hp, tao hinh bdng vgt da diy hinh chd Z mpt trong dui. Kit qui: Liin sgo todn bd li 66.6%, Itin sgo mpt phin. phii chdm sdc vit thwang 33.3% 100 % bpnh nhdn ra vipn hit vidm, lodt, chdy dich, dau vung dm hd
Kit luin Cd thi dp dung phwang phip ehuyin vat da hinh chw Z di dieu In bpnh nhin tdn thwang da do xa tri viing dm ho
Tw khda: xa tn vung dm hg, chuyin vgt da SUMMARY
Object-Evaluate the local flap - plasty surgery result of skin injury after radiation therary of vulva cancer
Subject 21 patiens with inflamation and ulceration at local vulva skin affer radiotherapy.
Method, retrospective-descnption. Removing all area skin injured after radiation, applied local Z - plasty flap surgery at the femeral inferior
Result: there were 66 6% patiens with total mcover of scar, sub total recover of scar and wound
cam after surgery was 33.3% .All patiens discharged from hospital were very good condition without vulva area inflamtion, ulceration and pain.
Conclusion: The local Z- plasty flap surgery method could apply on therapy for skin injury after local mdiation therary of vulva cancer
Keywords, skin injury, vulva cancer DAT V A N OE:
Ung thu am hg la bgnh It gdp chiem 3 -5 % cac ung thu_phi,i khoa, Tai Vigt nam ung thu am hg tuy \d bgnh dg phat hign, xong bgnh nhan thudng den kham va dieu trj d giai dogn mudn (giai doan 1I,III,1V).
Do vSy, nhidu benh nhan phai dp dung phuong phip xa tn bd sung sau md. Xa tri tai chd duye ehi djnh khi dien d t dm hd edeh bd tdn Ihuong ung thu ^ 8 mm, xdm l l n sdu tren 5 mm hoae xSm l l n mao mach, bach huydt. Lieu xg cdn dat tdi da la 55 gy [1]. Xa trj cd tac dung iam giam tai phat tai vCing trong ung thu' am hg, xong trong mdt sd trudng hyp gay bien Chung dai d i n g nhu viem, loet, dau keo dai lam anh hudng tdi e h l l luyng cudc sdng cua bdnh nhdn 0^
khac phgc Unh trang nay, ehiing tdi tien hanh phiu thual e l t bd viing da ton thuung do xg tri lai am hd, lao hinh lai b i n g phuong phdp chuyen vat da ddy, Nghien c&u eua chung tdi cd muc tieu id "Ddnh gia ket qua dieu tri ldn thuong da do xa trj vCing dm ho bang phuong phdp chuyen vat da".
DOI TU'aNG, PHU'aNG P H A P NGHIEN ClfU:
V HQC THV'C HANH (872) - SO 6/2013
