Y HQC VlgT NAM THANG 7 • SO 2/2014 thu' MCF-7. a thdi diem 72h, SAC 50mM, lOOmM
va djch chlet tdl den vdi nong do tinh theo SAC la 0,625mM, 0,125mM, 0,25mM, 0,5mM, I m M cd tac dung u'c che ro ret te bao MCF-7 so vdl nhdm chutig C P < 0 , 0 1 va p<0,05).
TAI LIEU THAIVI KHAO
1 . Nguyen Ltnh Toan, Dich chiet toi ly scJn u'c ch§
phat trien te bao ung thu' tuyen tien iiet ngufli dong PC-3 in vitro, Y du'dc hoc Quan si/ - Nam 2011 2. Das A, Banfk NL, Ray SK. Garlic compounds
generate reactive oxygen species leading to activation of stress idnases and cysteine proteases fiar apoptosis in human glioblastoma T98G and U87MG cells. Cancer. 2007;110(5):1083-95.
3. Huang YS, Xie N. Su Q, Su 3, Huang C, Liao QJ. Diallyl disulfide inhibits the proliferation of MCF-7 human colon cancer rails by Inducing
differentially expressed genes. Mol Med Report.
2011 May-Jun;4{3): 553-9.
4. Lee BC, Park BH, Kim SY, Lee YJ. Role of Bim in dialiyi trisuifide-induced cytotoxicity in human cancer cells. 2 Ceil Biochem. 2011 Jan; 112(1): 118-27.
5. Meyer K, Ueberham E, Gebhardt R. Influence of organosulphur compounds from garlic on the secretion of matrix metalloproteinases and their inhibitor TIMP-1 by cultured HUVEC cells. Cell Biol Toxicol 2004;20:253-60.
6. Sasaki J, Lu C, Machiya E, Tanahashi M, Hamada K. Processed black garlic (Allium sativum) extracte enhance anti-tumor potency against mouse tumors. Medicinal and Aromatic Plan Science and Biotechnology 2007,1 (2), 278-281.
/ . Xiao D, Li M, Herman-Antosiewicz A, Antosiewicz J, Xiao H, Lew KL, Zeng Y, Marynowski SW, Singh SV. Diallyl trisul^de inhibits angiogenic features of human umbilical vein endothelial cells by causing Akt inactivation and down-regulation of VEGF and VEGF-R2. Nutr Cancer 2006;55:94-107.
K H A O S A T M O I LIEN Q U A N GlfrA HUYET KHOI
TINH MACH SAU CHI DU-ai Vffl TINH TRANG SUY TIM
Cy BENH N H A N S U Y TIM MAN TINH
T 6 M TAT
Myc tieu nghien citu: Tim hieu mol lien quan cua huyet khoi Unh mach sau (HKTMS) vdi tinh tr?ng suy tim d benh nhan suy tim man tinh.
€>di tuVng va Phuun^ phap nghien cuTu: mo ta, c3t ngang, tien ctiu. 136 benh nhan dieu tri noi tru tai Binh vien Nhan Dan Gia Oinh, TPHCM tir thang 4/2011 den ^ahg 3/2013 du'dc xac djnh cd suy tim man tinh mut: do n i , IV tiieo Phan lo^i chuTc nana cua Hoi Tim Null l/dc (NYHA-FC). Khao sat bSng sieu am doppler tinh mach chi du'di bi co chan tdi nep ben 2 chan.
Kit q u ^ : Ti te HICTM5 chi du'di d' benh nhan suy tim man tinh mu'c do NYHA III/IV la 42,6%
(58/136BN). Benh nhan suy tim NYHA IV cd ti le HJCTMS cao hdn (NYHA I I I : 31,3%, NYHA IV: 70%, p=0,0001). Qua phan tfch hoi qui da blen, mu'c do suy tim NYHA IV la yeu to nguy cd dpc l|p doi vdi HKTMS (OR 4,51, KTC 95% 1,86-10,94, p=0,001).
K a luan: Benh nhan suy tim cd nguy cd cao doi vdi HKTMS va nguy cd tang tiieo dp chifc nang NYHA III/IV.
TO'khoa: Huyet khoi tinh m?ch sau, Suy tim
S U M M A R Y
THE R E L A T I O N S H I P BETWEEN THE SEVERITY OF HEART FAILURE
*B$nh vien Nhan Dan Gia Oinh TP. Ho ChU^lnh
** BSnh vien 103 - Hoc vien Quan Y Phan bien khoa hgc: PGS-TS Le Vi?t ThSng
Huynh Van An*, Nguyen Oanh Oanh**
A N D THE I N C I D E N C E OF DEEP VENOUS T H R O M B O S I S ( D V T ) OF THE LOWER L I M B S I N PATIENTS W I T H C H R O N I C HEART FAILURE Purpose: Determine the relationship between tiie severity of heart failure and the incidence of Deep Venous Thrombosis (DVT) of the lower limbs in patients hospitalized witii chronic heart failure.
Materials and method: Descriptive, cross sectional and prospective study. Since April, 2011 to March, 2013, there were 136 patients treated In Nhan Dan Gia Dinh Hospital, HCMC were diagnosed as chronic heart failure grade I I I , IV according to New York Heart Association Functional Classification (NYHA- FC). Research by using Doppler ultrasound the lower limbs' veins from the ankles to the inguinal folds in both legs.
Results: The incidence of DVT of the lower limbs of patients with chronic heart failure grade I I I , IV by NYHA-FC is 42.6% (58/136 patients). Heart failure patients classified as NYHA IV have a higher incidence of DVT (NYHA I I I : 31.3%, NYHA IV: 70%, p=0,0001).
Multiple logistic regression analysts Identified the NYHA IV functional class as an independent predictor of DVT (OR 4.51, 9 5 % a 1.86-10.94, p=0.001).
Conclusion: Patients with heart failure have a high risk for DVT and the risk increases according to NYHA III/IV functional class.
Keywords: Deep Venous Thrombosis, Heart failure
Y HOC VIET NAM THANG 7 - So 2/2014 I. OAT VAN OE
Benh nhan (BN) co suy tim thi dac biet d i hinh thanh Huyet khoi tmh mach sau (Hi<TMS) chi du'di, dan den Thuyen tac phoi (TTP).
Cac BN CO suy tinn it huyet co phan suat tong mau thap hOn thi co nguy cd thuyen tac huyet I<h6i cao hdn. Tuy nhien cung co val nghien cu'u khong cho suy tim it huyet ia yeu to nguy cd doi vdl Thuyen tac huyet khoi tinh mach (TTHiCrM).
Tan suat Hi<TP^S cf BN suy tim it huyet dUdc cong bo cung dao dpng rat rang tu' 10-59%.
Tru'dc day va ngay ca hien nay, tai Viet Nam, viec Chan doan HKTMS va thuc hien cac bien pliap phong ngu'a huyet khoi tinh maj:h sau clio cac BN nhap vien dieu tn vi mpt nguyen nhan npi hoac ngoai khba chuS du'dc tien hanh thUdng quy, nhat la cac BN co suy tim man tinh, nhu'ng ngu'di cd nguy cd doi vdi HKTI^S vi cd sU it tre tuan hoan cung nhu' han che van dpng.
Hien chu^ co nhieu nghien cu'u ve lanh vUc nay tai Viet Nam, va chUa cd nghien cffu nao thUc liien tren doi tu'dng suy tim man tinh.
tHifc tieu nghien cu'u la tim hieu moi lien quan cua huyet khoi tinh mach sau vdi tinh trang suy tim is benh nhan suy tim man tinh.
II. OOI TUONG VA PHI/aNG PHAP NGHIEN COU Nghien cutJ tien CLTU, mo ta, cat ngang.
136 BN dieu tri noi tru tai Benh vien l^hai Dan Gia Binh, TPHCM iiS thang 4/2011 den thani 3/2013 dUdc xac dinh cd suy tim man tinin mij do III/IV theo Phaii loai chirc nang cua Hpi Tit NChj tide (NYHA-FC: New York Heart Associatia Functional Classification).
BN dUdc do dien tam do de danh gia vi nhip, ghi nhan nhjp'xoang hoac rung nhT; du'di thuc hiin sieu arn doppler tim mau, ghi nham thong so ve phan suat tong mau (EF%); duot khao sat he tTnh mach sau 2 chi dudi tCr co ciiaf tdi nep ben bang sieu Sm doppler tinh mach.
'Iiit ly so lieu bang phan mem SPSS 21.0. K§
qua nghien cihj dudc trinh bay vdi dp tin cat 95%. Chung toi sir dung test x (Chi-square) ji so sanh, kiem dinh sir khac biet giii^ 2 ti le, si dung test t-student de so sanh 2 trung binh. GK trj p < 0,05 du'dc xem la cd •/ nghTa thong ke.
III.KETQUA
Chung toi ghi nhan 58/136 BN (42,6%) d HKTMS chi du-di^
3.1. Oac diem vie nhjp tim tren dl^n tam dc Phan tich nhjp tren ket qua ghi diin tam <!{
cua BN, cd 24/136 BN (17,6%) cd rung nhT, coi Iai la nhjp xoang.
3.2. Oac diem ve sieu am tim Dac diem ve phan suat tong mau (EP/o) that tral Plian suat tong mau that trai trung binh cui nhdm BN nghien ciru la 52,4 ± 14,3%.
Bing 1. Phan nhdm phan suat tonq EF%
< 20%
20 - 29%
30 - 39%
40 - 49%
> 50%
Tonq
Tan sd (n) 1 7 17 37 74 136
mau (EF%) that trai Tan suat (%)
0,7 5,1 12,5 27,2 54,4 100
Ti suat don {%) 0,7 5,9 18,4 45j.6 100,0
Co 62/136 BN (45,6%) cd phan suat tong miu that bai giam (EF <50%) bong do hau hit EF trm, khoing 20 - <50%. Chicd 1 BN (0,7%) ed EF <20%.
3.3. iviu'c do suy tim (theo NYHA]
70,6% (96/135) BN CO Suy tim do III, 29,4% (40/136) BN cd suy tim do IV. Ti le suy tim dp III IV trong nhom BN nghien ciiu la khoang2:l.
3.4. Moi lien quan cua huyet l<hoi ttnh mach sau vdi rung nhT Binp 2. Lien quan giua HKTMS va rung nhT
Nhjp xoang Rung nhi
Nhdm khong HKTMS (n=78)
(n,%)
-fpW w
Nhdm cd HKIMS (n=58)
(n,%)
Gia trj p p = 0,087 44T75;9'
14 (24,1'
Chung tdl ghi nhin chua cd lien quan co y nghia thong ke giliS rung nhi va HKifa vdi p<0,05.
3.5. i^lot lien quan cua huyet khoi tinh mach siu vdi phan suat tong mau thSt trai Phan suat tong mau that trai (EF%) trung binh ciia 2 nhdm cd HKTMS va khong cd HKTMS li lUdt la 53,6 ± 14,9 va 51,6 ± 13,9. Chung tdi chffa thay cd khac biet co y nghia thong ke phan su tong mau trung binh giu^ 2 nhdm cd HKTMS va khong cd HKTMS vdi p>0,05.
Y HOC VlgT NAM THANG 7 - SO 2/2014 Bing 3. Lien quan qiffa phan
Phan nhom BN t h e o EF°/o
< 2 0 % 20-29%
30-39%
40-49%
> 5 0 %
< 5 0 % (n=62)
> 5 0 % (n=74)
suat tdng mau that trai va HKTMS Nhom khong
HKTMS ( n = 7 8 ) (n,»/o) 1 (1,3) 4 (5,1) 8 (10,3) 24 (30,8) 41 (52,6)
• 37 (47,4) 41 (52,6)
Nhom CO HKTMS (n = 5 8 ) {n,»/o)
0 3 (5,2) 9 (15,5) 13 (22,4) 33 (56,9) 25 (43,1) 33 (56,9)
Gia trj p 0,654
0,616 Khi chia BN thanh cac nhdm theo EF% tff
thap den cao (<20%, 20-29%, 30-39%, 40-49%
va > 50%), chiing toi chffa ghi nhan sir lien quan giiii HKTMS vdi mffc dp giam phan suat tong mau that trai vdi p>0,05.
3.6. MSI liSn quan cua huyet khoi tTnh mach sau vdi mu'c do suy tim NYHA I I I / I V Bang 4. Lien quan giifa mffc dp suy tim NYHA III/IV va HKTMS
Chung toi cung chffa thay cd khac biet cd y nghTa thong ke giua nhdm BN cd giam phan suat tong mau that tral (EF% < 50%) va nhdm BN khong giam phan suat tdng mau vdi p>0,05.
WSc dp suy t i m ( t h e o N Y H A ) NYHA I I I (n,%)
(n=96) NYHA IV ( n , % )
{n=40)
N h o m khong HKTMS ( n = 7 S )
66 (68,8)
12 (30,0)
Nhdm CO HKTMS ( n = 5 S )
30 (31,2)
28 (70,0)
OR (KTC 9 5 % ) Gia tri p 5,13 (2,30-11,45)
p = 0 , 0 0 0 1 *
Ti le HKTMS d nhdm suy tim NYHA IV la 70,0% (28/40 BN) so vdl ti le HKTMS d nhdm suy tim NYHA III la 31,3% (30/96 BN). Khac biet cd y nghTa thong ke vdi p=0,0001.
Cd lien quan cd y nghTa thdng ke giffa d suy tim NYHA IV va HKTMS (OR 5,13, KTC 95%
2,30-11,45) vdi p=0,0001. BN suy tim NYHA IV cd nguy cd HKTMS cao hdn so vdi BN suy tim NYHA III.
Phan tich hoi qui da bien, chung toi ghi nhan suy tim NYHA IV la yeu to nguy cd doc lap doi vdi HKTMS vdl OR 4,51 (KTC 95% l,'86-i0,94) vdi p=0,001.
IV. BAN LUAN
4.1. Moi lien quan ciia huyet khoi tTnh mach sau vdi rung nhT
BN od rung nhT od ti le HKTMS la 58,3% so vdi BN od nhip xoang cd ti le HKTMS la 39,3%. Tuy vay, chiing toi ghi nhan chua cd lien quan cd y nghia thong ke giiia rung nhT va HKIWS vdi p<0,05.
Nhieu nghien ciiu trffdc day chumg minh cd sff lien quan giffa giam chffc nang tam thu that v j nguy cd thuyen tSc huyet khoi, nhffng khd thuyet phuc vl thffdng cd rung nhT, mpt yeu to nguy cd ddc lap doi vdl thuyen tac huyet khoi, d BN cd phan suat tong mau thap. Tuy nhien, tffdng tff ghi nhan ciia chiing toi, cd nghien ciiu cho thay rung nhT khong ket hdp vdl tang nguy cd ciia thuyen tac huyet khoi [2].
* Cd y nghla thdng_ kS 4.2. Moi lien quan glD'a huyet khoi tinh mach sau vdi tinh trang suy tim man tinh
Theo nghien ciru SIRIUS, tren nhdm BN npl khoa ngoai tni khong cd benh phoi man, cho thay suy tim man cd lien quan dpc lap vdi TTHKT>1, nguy cd tang gap 3 lan [7]. Belch (1981) nhan thay BN suy tim nam vien khong dffdc phong ngua huyet khoi cd ti le HKTMS la 26%. '
Ket qua nghien cull ciia chiing toi ghi nhan ti le HKTMS d BN suy tim man tinh NYHA III/IV la 42,6%. Trong nghien culi ve dff phdng HKTMS tren BN noi khoa (MEDENOX), ti le HKTMS d BN suy Hm NYH/\ III/IV khong dffdc dff phdng la 15%.
Suy dm li yiu tdnguy ed ddi vdl benh nhin ngoai tni
trong nghien cutj Sinus, nghien cuXi benh- chffng da trung tam, BN dffdc xac djnh HKTMS chi^dffdi va nhdm chimg tffdng dong theo gidl va tuoi. i^han tich ddn bien cho thay suy tim man ti'nh noi bat cd y nghTa d nhdm benh so vdi nhdm chirng (OR 2,93; KTC 1,55-5,56; p=0,001). [3]
Suy tim la yeu to nguy ed doi vdl binh nhin npi bu
Piazza va cpng sff so sanh 685 BN cd tien sff suy tim vdl 3890 Bl^ khong cd tien sff suy tim trong 1 nghien cffu hoi cinj 5451 BN cd HKTMS dffdc khang djnh bang sieu am. BN cd suy tim cd tang tan suat cac benh ket hdp nhff benh than kinh gom dot quy (33% so vdi 26%, p='0,0002), benh phoi cap gom viem phoi (31% so vdl 15%, p=0,01) va hpi chffng mach vanh cap (11% so
Y HOC VIET NAM THANG 7 - S6' 2/2014
vdi 42%, p<0,0001) gop phan lam mffc dp nang ciia benh tram trpng hdn BN khdng cd suy tim.
Hdn nua, cac BN co suy tim cd kha nang cd cac yeu to nguy cd TTHKTM ciia tinh trang bat dpng (53% so vdi 42%, p<0,0001), nhilm triing cap, (33% so vdi 27%, p=0,01) va benh phoi tac nghen man tinh (29% so vdi 12%, p<0,0001).
Dffdi 1/2 so BN (46%) cd suy tim rol sau dd cd hinh thanh HKTMS da dffdc phdng ngffa TTHKTM. Tdm iai, sff ket hdp ciia mffc do_trarri trpng ciia benh, tang tan suat ciia cac yeu to nguy cd TThlKTM, va ti le phong ngffa TTHKTM thap lam tang nguy cd gap ba ddi vdi cac BN cd suy tim. [6]
Suy tim man tinh la yeu to nguy cd doc lap doi vdi HKTMS (OR 2,93, KTC 95% 1,55-5,56, p=0,001) [7]. BN suy tim cd nguy cd cao doi vdi HKTMS va nguy cd tang theo dd chffc nang NYHA [5].
Suy tim la yeu to lam tang nguy cd TTHKTM. BN cd suy am thi dac biet de hinh thanh TTHKTM [6].
4.3. Moi lien quan giu'a huyet khdl tinh mach sau vdi phan suat tong mau that trdi
Khi so sanh sff lien quan giffa ti le HKTMS d BN suy tim man vdl phan suat tong mau that trai, ket qua nghien cffu ciia chiing toi chffa thay cd moi lien quan cd <i nghTa thdng ke giffa mffc dp cao thap ciia phan suat tong mau (EF%) that tral va HKTMS.
Howell va cpng sff ghi nhan nguy cd TTHKTM t3ng khi phan suat tong mau giam, BN cd phan suat tdng mau tff 20-40% nguy cd mac benh tang len 2,8 lan va phan suat tdng mau <2b%
nguy cd nay tang len den 38,3 lan (OR 38,3; KTC 95% 9,6-152,5). Suy tim la yeu to nguy cd doc lap ddi vdi TTHKTM va nguy cd tang dang ke khi phan suat tong mau giam. [4]
Cd bSng chuTig gdi y nguy cd ddi vdi TTHKTM trong suy tim cd the tffdng quan vdl chffc nang that tral. Bang chu y la trong phan tich tffdng quan 2114 BN khong cd tien can rung nhi trong nghien cffu dot tff do tim trong suy tim ghi nhan doi vdi mol 5% tang ciia phan suat tong mau thi ket hdp vdl giam 18% doi vdi TTHKTM.
Hdn nua, trong 1 nghien ciiu benh chffng ve HKTMS cho thay suy tim lam tang nguy cd HKTMS 2,6 ian, trong dd nol bat IJ tang nguy cd 38,3 ian d nhuhg benh nhan cd phan suat tong mau <20%.
Phan ti'ch da bien cho thay giam phSn suat tong mau ket hdp dpc lap vdl nguy cd thuyen tSc huyet khpl d nff (RR cho mol 10% giam la 1,53, KTC 95% 1,06-2,20, p=0,02), nhffng khong lien quan d nam [1].
0 BN cd rol loan chffc nang tam thu that tral va nhip xoang, tan suat hang nam thuyen tac huyet khoi thi thap. Mffc do rSl loan chffc nang
that trai dUdc dinh IUdng bang phan suat tpng mau (EF%)thi ket hdp Six. lap vdl nguy cd thuyen tac huyet khoi'd nff, nhffng d nam thi khdng.[1]
Trong nghien cffu thuan tap SCD-HeFT, BN suy tim cd trieu chutig, on dinli va EF% < 35%, tl le TTHKTM tiiy thuoc vao mffc dd roi loan chffc nang that trai.
a BN dffdc xac dinh suy tim it huyet, co phan suat tdng mau cang thap thi cd nguy ccf thuyen tac huyet khoi dpng mach cang cao. Sff ket hdp giffa suy tim ff huyet va TTHKTM la do mau chay cham cd khuynh hffdng ddng cue nhff VIrchow da de cap hdn tram nam trffdc. Cd tinh trang tang ddng man tinh trong suy tim ff huySt, gdp them vao tinh trang ff mau tTnh mach. [5]
Mpt nghien cull mdi day chuhg minh rang giam phan suat tdng mau that trai la dau hieu tien doan cd y nghTa cua TTHKTM; tuy nhien, trong nghien cffu cua Ota va cpng sff, khdng co sff khac biet cd y nghTa ve phan suat tdng mau tiiat trai giffa nhdm cd va khdng cd HKTMS, vi nhdm suy tim cd phan suat tdng mau that trai binh thffdng bao gom cac BN cd suy tim tam trffdng hoac suy tim ben phai [5].
4.4. Mdi lien quan giu'a huyet khdl tinh mach sau vdi mu'c do suy tim NYHA I I I va IV
Ti le HKTMS is nhdm suy tim NYHA IV ciia chiing toi la 70,0% (28/40 BN) cao hdn ti le HKTMS d nhdm suy tim NYHA III la 31,3%
(30/96 BN) cd V nghTa thong ke vdl p=0,0001.
Alikhan va cdng sff ghi nhan ti le HKTMS S BN suy tim sung huyet la 14,6% va ti le HKTMS cao is cac trffdng hdp suy tim ff huyet nang (NYHA III: 12,3%, NYHA IV: 21,7%).
Tai Nhat Ban, Ota va cpng sff ghi nhan m Hen quan glifa mffc do nang ciia suy tim ff huyet va ti le HKTMS. BN suy tim NYHA IV cd tl le HKTMS cao hdn (NYHA I I : 4,4%, NYHA III;
4,8%, NYHAJV: 25,5%, p<0,01). [5]
Chung tdl ghi nhan cd mdi lien quan cd y nghTa thdng ke giffa niffc dd suy tim NYHA IV va HKTMS. BN suy tim NYHA IV cd nguy cd HKTMS cao r5 ret so vdl BN suy tim NYHA III (OR 5,13, KTC 95% 2,30-11,45) vdi p=0,0001.
Tffdng tff, Ota va cpng sff cung dua den ket luan HKTMS thffcfng xay ra d BN suy tim ff huyet, mii'c do chffc nang NYHA la yeu to nguy cd cao (OR 3,74, KTC 95% 1,72-8,16, p<0,01). Bd chffc nang NYHA la yeu to tien doan dpc lap HKTMi ' Bay la nghien cffu dau tien d Nhat Bari phat hien tan suat cao HKTMS is BN suy tim ff huyet naiig va ket qua nay gdi y cac nha lam sang tin rang iS BN chau A cd suy Hm ff huyet cung bi HKTMS nhff cac BN phffdng Tay. Mpt diem mdi khac ciia nghien cuU nay la tang nguy cd TTHKTM lien
Y HOC VIET NAM THANG 7 - SO 2/2014 quan tdi mffc dd NYHA, dac biet la nguy cd cffc
cao doi vdi BN NYHA IV tai Nhat Ban. [ 5 ] O BN suy tim ff h u y a narig, dan den ff mau Hnh mach, dieu nay cd ve la riguy cd cua HKTMS.
Gia thuyet nay dudc ho t r d bdi ket qua nghien cull ciia Ota va cpng sir la tinh co dan ciia TM chu dffdi, mpt chi dieni cua ff mau Hnh mach, t5ng CO y nghTa d BN suy tim ff huyet cd HKTMS qua phan tich hoi qui da bien (OR 4,43, KTC 9 5 % 1,36-14,43, p<0,05) [5). Cac iy do dan den sff khac biet nhff the la do mffc do suy tim nang hdn lam han che hoat dpng ve the chat, sinh hoat thffdng ngay cDng bj h?n che. Chinh sff kem van dpng vl suj; Hm nay lam tang it miu tinh mach, lam tien then cac cue mau ddng d tTnh mach sau.
V. K i t LU/SlN
B$nh n h i n suy tim cd nguy cd cao doi vdi HKTMS va nguy cd tang theo do chffc nang NYHA I I I / I V . Ti 1$ HKTMS d nhdm suy tim NYHA IV (70%) cao hdn ti le HKTMS d nhdm suy tim NYHA I I I (31,3%), cd ^ nghTa thong ke vdl p=0,0001.
Mffc dd suy tim NYHA IV la yeu to nguy cd ddc i p dSi vdi HKTMS (OR 4 , 5 1 , KTC 9 5 % 1,86- 10,94, p=0,001).
T A I LIEU THAIVI KHAO
1. Dries DL, Rosenberg YD, Waclawiw MA, et al (1997), "Ejection fraction and risk of thr^3mt)oembolic events in patients with systolic dysfunction and sinus rhythm: evidence for gender differences in the studies of left ventricular dysfunction trials", J Am CoU Cardiol, 29, pp.
1074-1080.
2. Dunkman WB, Johnson GR, Carson PE, et al.
The V-HeFT VA Cooperative Studies Group (1993), "Incidence of tiiromboembolic events in congestive heart failure" Circulation, 87(suppl), VI94-VI101.
3. Hobbs R, Hampton E (2004), "Heart Failure and Venous Thromboembolism: A Major Hidden Risk;
Heart Failure as a Risk Factor for Venous Thromboembolism", Br J Cardiol, 11(1).
4. Howell MD, Geiaci JM, Knowlton AA (2001),
"Congestive heart failure and outpatient risk of venous thromboembolism: a retrospective, case- control study", JC//7 Epldembl. 54(8), pp. 810-816.
5. Ota S, Yamada N, Tsuji A, et al (2009),
"Inddence and Clinical Predictors of Deep Vein Thrombosis in Patients Hospitalized With Heart Failure in Japan", Ore) 73, pp. 1513-1517.
6. Piazza G, Seddighzadeh A, Goldhaber SZ (2008), "Heart Failure in PaHents With Deep Vein Thrombosis", Am J Cardiol, 101, pp. 1056-1059.
7. Samama MM (2000), "An epidemiologic study of risk factors for deep vein thrombosis In medical outpatients: the Sinus study". Arch Intern Med., 160, pp. 3415-3420.
NGHIEN Ciru, LU'A CHON VA DE XUAT CHUNG ENTEROVIRUS
TRONG S A N X U A T VAC XIN P H 6 N G BENH TAY CHAN MIENG TAI VIET NAMT 6 M TAT
Benh TCM biing phat t?i Viet Nam trong nam 2012 da xac dinh du'dc cSn nguyen gay benh chinh la EV71 (chiem 68,2%), ffong do chiing EV71-C4 chiem tdl 58.44%. E« lya chpn c^c chiing vi nit phii hdp phuc vv cho viec nghi§n cffff san xuat vSc xin phong benh, 200 mau benh pham dffdng b'nh vdi chun^ E V 7 K 4 da duac lya chpn de nudi cffy phan l?p. Ket qua da thu nh|n duljc 127 chiing vi nJt vdi 100 chung da dffpc gial trinh tff va so sanh vdi ket qua giai trinh t y nucleotide tsisisc nuoi cay. Sff tffdng dong ciia ket qua giai tiinh tff nucleotide giOa trudc va sau nudi cay thu nh|n duijc la 96%. Trong so 100 chung vi nit da giai binh ti/, cd 35 chffng co trinh tff viing VPI tffdng ddng cao vil" khac biet vdi c^c chung vi nit con Iai cung nhff
LS Van Duyft^ T? Difu Ngan''^, Nguyin Kim Thu'''^, Nguyin Van Kinh'•^ Nguyin Vu Trung''^
mpt so_chung da dffdc sff dung de nghien cuff v3c xin tren the gidi. Trong so cac chung nay, cd 7 chung thoa man cac tieu chi lua chpn de nghien cuff san xuat vSc xin nhu^ la chiing gay benh pho bieh nhSt, cd trinh tff tudng dong cao nhat (99,4 - 99,6%), cd tfnh diat di truyen d|c ffuTig cho cac chung gay bgnh tai Viet Nam va kha nang phat trien tot tren cac te bao nuoi cay.
Tir khoa; Tay Chan Mieng, Vac xin. Nucleotide, Genotype, EV71, C4, Coxsackie, VPI
L Tnfdng Bflhfc YHa Nil 2 Binh vlin Benh Nhiet ddi Trung ddng Phin biin klioa hfc: PGS.TS LS HiSng Hinh
SUIVIMARY
STUDY, SELECT, A N D PROPOSE ENTEROVIRUS S T R A I N S FOR VACCINE
PRODUCTION OF H A N D , FOOT, AND MOUTH DISEASES I N V I E T N A M In Viet Nam, HFMD outbreak in 2012 has identified the cause of the illness was EV71 (accounting for 68.2 % ) , induding EV71 - C4 spedes
