TAP CHf Y DirOC L A M SANG 108 Tap 11-So 5/2016
Danh gia sir thay d6i nong do creatinin o* benh nhan hep dong mach than dutfc can thiep dong mach than qua da tai Benh vien Bach Mai
Changes of blood creatinine patients witli renal artery stenosis undergoing percutaneous renal artery angioplasty in Bach Mai Hospital
Le Van Cirong* *Benh vien Da khoa tinh Thanh Hoa Pham Manh Hung** **Benh vien Bgch Mai VuDiSn Bi6n*** ***Benh vi^n Trung uang Qudn dgi 108
Tom tat
Muc tiiu: Nghien cUu nay nham muc dich danh gia sU thay ddi va cae yeu t d lien quan den sU c i i thien nong dp creatinin huyet tuong d nhUng benh nhan dupc can thiep ddng mach than qua da. Bdi tugng vd phuang phdp: 70 bdnh n h i n hep dang ke ddng maeh than dupc can thiep ddng mach than (dat stent) va theo ddi sU thay doi creatinin sau can thidp 6 t h i n g . Kit qud: Tuoi trung binh eua nhdm nghidn cUu la 64,1 ± 14,0 tudi va nam gidi ehidm 61,4%. Ndng dp creatinin huyet tUOng trung binh d t h d i diem sau t h i n g g i i m khdng cd y nghTa so vdi trUdc can thiep (103,3 ± 29,6 so vdi 117,2 ± 56,2pmol/L, p=0,1705). T;y Id c i i thien, dn djnh va tang ndng dp creatinin l^n lUpt la 12,1%; 78,8% va 9,1%. T)f Id c i i thien ndng dp creatinin t o t hon d bdnh nhan cd tang ndng d d creatinin va NT - ProBNP trUdc can thidp.
TJ Id c i i thIdn kem d nhOng trudng hpp cd protein nieu dUOng tinh. Kit ludn: Can thiep dpng mach t h i n khdng i n h hudng tdi sU thay ddi ndng dd creatinin trung binh d thdi diem 6 thang. Cac ydu t d nhU:
Ndng dp creatinin ban dau, NT - ProBNP, protein nidu i n h hUdng tdi ty le c i i thien ndng dd creatinin.
TUkhda: Hep ddng mach than, can thiep ddng mach t h i n qua da.
Summary
Objective: This study aims t o evaluate changes of creatinine levels and Its relative factors in patients undergoing percutaneous renal artery angioplasty. Subject and method: Stenting for 70 patients with significant stenosis of the renal arteries and follow-ups their changes of serum creatinine concentrations after procedures 6 months, flesu/f; The average age is 64.1 ± 14.0 years old and men accounts for 61.4%.
After 6 months, concentration of the plasma creatinine decreases statistically insignificantly compared to baseline creatinine (103.3 ± 29.6 vs 117.2 ± 56.2|imol/L, p=0.1705). The Improvement, stability and increased rates for creatinine are 12.1%, 78.8% and 9 . 1 % % respectively. Factors affect blood creatinine concentration include baseline creatinine, NT - proBNP and urine protein. Conclusion: Average creatinine levels unchange after renal artery angioplasty 6 months. Factors such as the baseline creatinine, NT - proBNP, protein uria affect improvement of creatinine concentration.
Keywords: Renal artery stenosis, percutaneous renal artery angioplasty.
Afeoy nfian 11/7/2016. ngay chdp nhan 20/10/2016
NguM phdn hdi: Le Van Cu&ng, Email:[email protected]
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.11-N°5/2016
1 . D a t v a n d e
Hep d d n g mach t h a n la n g u y e n n h a n t h U d n g g a p nhat t r o n g n h d m t a n g h u y e t ap t h U phat. N d chiem t J le 5 - 10% b d n h n h i n t a n g h u y d t ap d My, va la y e u t d n g u y eo gSy suy t h a n k h d n g h o i p h u c [5]. CCing v d i sU p h a t t r i e n k h d n g n g U n g cua nganh t i m maeh can t h i d p va d i e n q u a n g can t h i d p , g i i i q u y e t hep d p n g maeh t h a n de lam g i a m h u y d t ap k h d n g edn la t h a c h thUc Idn t r o n g t h u c t i e n lam sang, h i e m khi p h i i d a t ra ehi d j n h ngoai khoa. Do d d , ehOng t d i t i e n h i n h n g h i d n eUu nay n h I m Ddnh gid su thay doi huyet dp d 70 binh nhdn hep ddng mgch thdn dugc can thiep dong mgch than qua da tgi Vien Tim mgch Viet Nam - Benh viin Bgch Mai.
2. Doi tirpng va phuong phdp 2.1. Ddi tugng
70 bdnh nhan hep d p n g mach t h a n dupc can thiep d d n g maeh t h a n qua da tai Vien Tim mach Viet Nam, Bdnh vidn Bach Mai tU t h a n g 01/2012 den 05/2015.
Tiiu chudn chgn binh nhdn
Bdnh nhan hep d i n g ke (> 70%) d u d n g kinh Idng d d n g maeh t h i n kem theo:
Tang huyet ap khang t n .
Khd khong c h ^ huyet ap d benh nhan dang dupe kiem soat t o t h u y ^ t ap.
Tang huyet ap va teo t h a n m d t ben khdng d o cac nguyen nhan khac.
Suy t i m xung huyet tai phat.
Phu p h o i cap xuat hidn d o t n g d t khdng rd nguyen nhan.
Dau t h a t ngUc khdng d n d j n h . Loan s i n x o co d d n g maeh t h i n . Hep nang d d n g mach t h a n hai bdn.
Suy t h a n man tidn t h e n d benh nhan cd m d t than.
2.2. Phuang phdp 2.2.1. Phuang phdp nghien eUu
Nghien eUu m d ta tien cUu, t h e o doi trUdc sau.
2.2.2. Dja diem vd thdi gian nghiin cUu
Vien T i m mach - Bdnh v i e n Bach Mai, t U 01 /2012 d d n 05/2015.
2.2.3. Cdc budc nghiin cUu
Hdi b e n h , d o eh! sd huyet ap t a m t h u va huyet ap t a m t r u o n g .
Xet n g h i e m n d n g d o creatinin, NT - ProBNP m a u , Sieu a m D o p p l e r d p n g maeh t h a n trudc can t h i e p .
T d n g phan tich n U d e t l e u .
Can t h i e p d d n g mach thein qua da t h e o phuong p h a p Seldinger.
Xet n g h i e m n o n g d p creatinin m a u 6 t h i n g sau can t h i e p .
Tieu ehl danh gia t h a y d d i huyet ap (6 t h i n g so vdi trude can thidp):
C i i t h i e n : Creatinin g i a m > 2 0 % so vol t r U &
can t h i d p .
Khdng thay d d i : Creatinin t h a y d d i (tang hoac giam) t r o n g khoang ± 2 0 % so v d i trudc can thiep.
Tang (nang len): Creatinin t a n g t h e m > 20% so vdi mUe creatinin t r u d c can t h i e p .
2.2.4. Cdc ehl tieu nghien ci^
Tang creatinin: Creatinin > 120pmol/L vdi nam va > 106 vdi nOf.
Protein nidu: D u o n g t i n h va a m t f n h . Chi sd sUe e^n d d n g mach t h a n (Rl): Ngoai gia tri t r u n g binh, khi phan t i c h yeu t d t i e n lUpng lien quan den Rl, chung t d i 1 % n g u d n g Rl = 0,8 de cd the so sanh vdi cae t i e g i i khac.
NT ProBNP: Binh t h u d n g , t a n g (^ 14,47 pmol/L).
Hep d d n g mach t h i n : Khi mUe d p hep dUdng kinh d d n g maeh t h a n (dupc t i n h t h e o edng thUe) >
50%. Hep nang khi t h d n g sd nay > 70%. Khi phan tfch ydu t d tien l u p n g lidn quan den mUe dp hep, ehung t d i lay n g u d n g 8 0 % de ed t h e so sanh vdi cac nghien cUu d nUde ngoai.
TAP CHf Y DUOC LAM SANG 108 T a p n - S o 5 / 2 0 1 6
Hep 16 vao; Trong v d n g 10mm tfnh tU Id vao ddng mach t h a n
Hep t h a n : Hep nhanh ehfnh d p n g maeh t h a n ma khdng phai lo vao.
Hep hai ben: Khi m d t ben hep > 70% v i ben ddi dien hep > 5 0 % d u d n g kfnh long mach.
Thdi gian phat hien t a n g huyet i p (nam).
Tudi phat hien t a n g huyet ap (tuoi).
Tang huyet ap: Huyet ap t d i da > 140mmHg va/hoae huyet ap t d i thieu > 9 0 m m H g hoac bdnh nhan dang sii d u n g t h u d e ha huyet ap.
Phan loai t a n g huyet ap: Theo khuyen eao eua Hdi Tim mach hpc Viet Nam nam 2008.
2.2.5. Xi^ If so liiu
Bang p h ^ n m e n SPSS 18.0. Ket q u i dupe x e m ed y nghTa t h d n g ke d mUc p<0,05.
3.K£tqud
3.1. Dgc diim chung
B i n g 1 . Dac d i e m chung Thong so
Gidi (nam) Tudi trung binh Tudi nam Tudi nU
Gia trj ( T B ± S D hoac %) 61,4% (43/70)
64,1 ± 1 4 , 0 ( 1 7 - 8 4 )
64,3 ± 1 2 , 6 (23-82) 63,7 ±16,2 (17-84)
p=0,8326
3J2. Thay doi nong do creatinin huyit tuwig Bang 2 . Sif thay doi nong d o creatinin sau
can tliiep
"-^— Creatinin Thofi di^m ^ ^ ^ ^ ^ ^ Trudc can thi&p Sau can thi&p 6 thang
T B ± S D (limol/L) 117,2 ±56,2 103,3 ±29,6
P
0,1705
Bieu do 1 . Ty le c^i thien creatinin sau can thiep
3.3. Cac yiu to anh hudng tdi ning to benh nhan khong t h a y doi va t a n g n o n g flo creaUnin sau can thiep creatinin duoc g o p thanh n h o m 'Wnong cai t h i e n "
Trong so 70 benh nhan nghien cUu, theo doi 6 " ° " 9 ^ 9 creatinin khi phan tich cac yeu t d 5nh t h i n g CO 4 t r u d n g h o p tCr vong, 66 trUOng h o p auoc '^''c'rig &i" s u t h a y Sol n6ng d o creatinin huyet theo doi n o n g dp creatinin huyet t u o n g . NhOng ^^'*i 6 thang sau can thiep.
i
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.11 - N-SCTle -
B a n g 3 . T u S i
Tu6i
Trung binh 2 70
< 7 0 Tong
Cai thien nong &g creatinin Khong
62,7 ±14,5 24 34 58
Co 70,3 ± 8 , 2
6 2 8
T6ng
30 36 66
P
0,0783
0,079
Bang 4 . Gidri
GiOl Nam NO
Tong
Cdi thien nong Sd creatinin Khong
36 22 58
Co 6 2
»
Tong 42 24 66
P
0,385
Being 5. Huyet ap trUdc can thidp
ThOi gian phat hien tang huyet ap
Chi so huyet ap
Trung binh
< 1 0
> 1 0 Tong Huy^t ap tam t h u Huy^t ap tam truong
Cdi thien creatinin Khong
6,6 ± 5 , 7 38 20 58 159,0 ± 2 3 , 8 89,7 ±14,7
Co 5,5 + 3,9
6 2 8 154,3 + 37,4 83,8 ± 1 6 , 0
l o n g
44 22 66
P
0,7972
0,462
0,6844 0,4432
BSng 6. Nong 4 6 NT - ProBNP va ty le cai thien creatinin
NT-ProBNP
Trung binh a 14,47
< 14,47 Tong
Cdi thien creatinin Khong
41,92 ±97,21 32 26 58
Co 127,37 ±151,97
7 1 8
Tong
39 27 66
•
P
0,0106
0,083
T ^ P C H I Y D I T O C L A M SANG 108 Tap 11-So 5/2016
Bang 7 . N 6 n g d o creatinin trifdc can t h i e p
Creatinin
Trung binh Tang Khong tang
Cdi thien creatinin Khdng
99,5 ±28,8 10 48
Co 202,9 ± 8 2 , 4
7 1
Tong
17 49
P 0,0001
0,000
Bdng 8. Chi so Rl
Rl
Trung binh
<0,8 a 0,8 Tong
Cai thien creatinin Khong
0,71 +0,07 49
9 58
CO 0,68 ±0,07
5 3 8
l o n g
54 12 66
P 0,4092
0,152
BSng 9. Protein nieu
Protein nieu
Duong tinh Am tfnh
Tong
Cdi thien creatinin Khong
29 29 58
C6 1 7 8
Tong 30 36 66
P
0,046
4.1. Ddc diim chung
Trong nghidn cUu eua chung t d i , nam gldl chiem t;^ Id 61,4%, nuf gidi chiem t y le 38,6%. Ket q u i cung phiJ hpp vdi Pham Minh Thdng va CS. nam gidi ehidm 65,5% [1]. Nghien cUu cCia Prajapati J S va CS.
nam gidi ehidm 77,9% [8]. Trong nghien edu eda Fujihara, M. va CS, t y le nay la 82,6% [4].
Tudi trung binh cua n h d m nghien cUu la 64,1 ± 14,0 tudi, thap nhat la 17 t u d i va eao nhat 84 t u d i . Tuoi eua nam gidi (64,3 ± 12,6) khdng ed sU khac biet ed y nghTa t h o n g kd so vdi nCf gidi (63,7 ± 16,0).
Nghien eUu eCia Prajapati J S va CS t u d i t r u n g binh thap hon, vdi t u d i t r u n g binh ehi la 55,87 ± 11,85 tudi [8]. 6 Vidt Nam, nghien cdu cOa Vu H o i n g Vu va Truong Quang Binh d 13 bdnh nhan tai Benh vien
Dai hpc Y DUpe Thanh p h d Hd Chf M i n h , t u d i t r u n g binh eCia n h d m nghien cUu la 40 ± 20 [2]. Tudi t r u n g binh t h a p hon so vdi nghien cUu cOa ehung t d i , d o t r o n g nghidn eUu nay cd 6/13 t r u d n g h p p dupe ehan d o i n hep D M t h a n do Takayashu, d i y la nguyen nhan hep d d n g mach t h a n d n g u d i tre t u d i , k h d n g p h i i d o x O v U a .
4.2. Suthay doi nong dd creatinin huyet ti/cmg Trong nghidn cdu cua Burket MW. va CS. khdng ed su k h i e biet ve n d n g dp creatinin d t h d i diem 6 t h i n g (1,4 ± 0,8mg/dL) so vdi trUde can thiep (1,6 ± l,1mg/dL) vdi p>0,05 [3]. Trong sd 37 bdnh nhan cd suy t h a n trUde can thidp (creatinin > l,6mg/dL), 16 t r u d n g h p p (43%) cd giam d a n g kd, 9 t r u d n g h p p (24%) khdng thay ddi va 12 t r u d n g h p p (32%) t a n g creatinin d t h d i diem 6 t h i n g . Trong khi vdi 86
93
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY V o M l - N ' 5 / 2 0 ! e -
trUOng h o p khong suy t h a n , 23 trUOng h o p (27%) co t a n g creatinin sau 6 t h a n g .
Phan tich t o n g h p p cCra Leertouwer, TC. va CS.
ghi n h l n th£y 30% t r u d n g h o p c6 cJi thiSn va 3 8 % trUSng h o p on d j n h chOc nang than flol vdi benh nhan hep d o n g mach t h a n duoc can thiep B M t h a n qua da (dat stent va nong b o n g don thuan) [6].
Nghien cOu cCia c h i i n g t o i , B i n g 2 cho thSy n o n g d 6 creatinin t r u n g b i n h d cac t h d i d i e m 6 t h a n g (103,3 ± 29,6iimol), t h a p hon khong c6 y nghia so vd'i t r u d c can t h i e p (117,7 ± 56,2Mmol), p > 0 , l . VOi nguBng cat ± 2 0 % doi vOi t h a y doi n o n g d p creatinin, c h u n g t o i nhan t h a y co 8 trUPng h p p (12,1%) cai thiSn n o n g d p creatinin, 52 trUOng h p p (78,8%) o n d j n h n o n g d o creatinin va 6 truOng h p p (9,1%) t a n g n o n g d p creatinin h u y ^ t t h a n h ( B l l u
doi).
4.3. Mot so yiu to anh hudng tdi thay doi nong do creatinin huyit tuang
Bang 3 cho t h ^ y khdng co m o i lien quan giOa t u 6 i va thay doi nong dp creatinin huyet thanh cCia n h o m nghien cUu va dieu nay t u o n g t u n h u k^t qua nghien ciJu cCia cac tac gid nUOc ngoai [4], [7]. Nam 2015, Mousa, AY. va CS. t o n g h p p cac nghien cOu danh gia ket qud can thiep €)M t h a n t r o n g y van dua ra nhan d m h rSng t u o i khong phai la yeu t o co m o i lien quan tcti cdi t h i ^ n chOc nang than [7]. M o t nghien cOu 6 Nhat Bdn, t u o i t r u n g binh cCia n h o m khong cai thien chOc nang t h a n sau can thiep la 75 ± 7, cao hon P n h o m co cai thien chOc nang than vdi t u o i t r u n g binh 72 ± 8, nhUng sU khac biet nay khdng cd ^ nghTa t h d n g k^ d cd phdn tich ddn b l ^ n (p=0,11) va da bien (p=0,16) [4].
Mdt nghien cUu P Nhat Bdn cCia Fujihara, M. va CS., t y le nO d nhdm cd cai thien chu'c nang thdn chi^m 12%, thdp hdn 8% so vdi n h d m khong cdi t h i ^ n [4]. Mac d u vay, su khac biet nay la khdng cd y nghta t h d n g ke, p=0,31. Ket qud tis nghien cOu cua Zeller, T. va CS. lai cho thay, cdl t h i | n chdc nang than t o t hon d nO gidi, nhung day khdng phdi la yeu t o nguy co ddc lap khi phan tfch da bien [10].
T r o n g nghiSn cOu cua c h i i n g t o i (Bdng 4), t ^ le nO d n h d m cdi t h i e n n o n g d d creatinin h u y ^ t tUdng la 2 5 % (2/8 t r u d n g hpp), t r o n g khi 37,9% (22/58 trUPng hpp) la t y 16 d n h d m k h d n g cdl thien, p=0,385. Do vay, g i d i t f n h k h o n g cd m o i lien quan iSn sU t h a y doi n d n g d d creatinin huyet t u o n g ciia n h d m nghien cOu.
Thong so HA
Trong n g h i e n ciJu nay, c h i i n g t d i ghi nhan n h d m cd cai t h i e n n d n g d d creatinin co t h d i gian phat hien t a n g huyet dp la 5,5 ± 3,9 n a m , cao hon khdng cd ^ nghta so v d i n h d m k h d n g cai t h i e n nong d d creatinin (6,4 ± 5,7 nam), p=0,8906 (Bdng 5).
TUOng t u , t y IS cdl t h i e n n d n g d d creatinin cQng khdng cd sU khac biet d nhOng b e n h nhan cd thdi gian phat hi$n t a n g h u y e t a p < 1 0 h o a c > 1 0 n a m .
Ve chi sd huyet dp, bdo cao tO nghien cOu Burket M W va CS chi s6 huyet ap t a m t h u va tdm t r u d n g trUdc can thiep khdng dnh h u d n g den thay doi chiJc nang than sau can thiep [3]. NghiSn ciiu cCia chiing t d i . Bang 5 cho thdy, chi sd h u y f t ap tdm thu ft n h d m cd (154,3 ± 37,4mmHg) va khdng (159,0 ± 23,8mmHg) cai thien n d n g d d creatinin khdng cd sU khac bitt, p=0,6844. B d i vdi chi sd huyet dp tdm trUPng, sU khac biet cung khdng cd y nghta t h d n g ke, 83,8 ± 16,0mmHg va 89,7 ± 14,7mmHg, p=0,4432.
Nong id NT-ProBNP
Khdng cd nhieu nghien cdu cOa cdc tde gid nUdc ngoai de cdp tdt m d i lien q u a n giOa n o n g do BNP va mOc d p cdi t h i e n chiic nang t h a n d b e n h nhan hep B M than dupc can t h i e p qua da. Nghien cdu cCia Fujihara, M. va CS. d Nhdt Bdn c h o thay, n d n g dp BNP 6 n h d m cd cdi t h i e n chile nang t h a n t h a p hdn cd;? nghta so vdi n h d m khdng cdl t h i e n chiic nang than (60 ± l O l p g / m L so vdi 146,4 ± 2D5pg/mL, p=0,0472) [4]. Tuy n h i e n , khi phdn tfch da b i ^ n , cac tac gid ket ludn, day k h d n g phdi la y & t o nguy co ddc lap d u d o a n cai t h i e n chdc nang t h a n d benh nhan hep B M t h a n d u p c can t h i e p qua da, (OR = 0,99 (vdi m d i pg/dL) 9 5 % Cl [0,99 - 1 , 0 0 ] , p=0,06) [41.
Trong nghiSn cilu cCia chdng t d i , Bdng 6 cho thay, ndng dp NT - ProBNP t r u n g binh d n h d m benh nhdn cd cdi thidn n d n g d d creatinin huyet thanh la
TAP CHf Y DUpc U M SANG 108 Tap 11-So 5/2016
127,37 ± 151,97pmol/L, cao hdn cd ]^ nghTa so vdi ehi so nay d n h d m khdng eai t h i ^ n ndng d d creatinin (41,92 ± 97,21pmol/L), |:M),ai06. Mac d u t y Id c i i thidn huyet i p d nhC^g t r u d n g hpp ed n d n g d p NT - ProBNP a 14,47pmol/L (17,9%) eao hon d t r U d n g h c ^ ndng dp N T - ProBNP < 14,47pmol/L (3,7%), nhUng sU khae biet khdng cd y nghTa t h d n g ke, p=0,083.
Wong do creatinin huyet tuang
Cd rat nhieu nghien cufu nham muc ^ c h t i m cac yeu t d i n h hUdng t d i chUc nang t h a n sau can t h i e p ddng mach than nhUng n d n g dp creatinin huyet thanh trUdc can thiep la yeu t d dUpc de cap nhieu nhat vdi ket q u i dUa ra cd nhieu tranh cai [7].
Bao cao nghien cdu eCia Burket, M. W. va CS. d 127 trudng h p p hep > 60% dUcftig kfnh d d n g maeh t h i n [3]. Khi nghidn cUu cac yeu t d anh h u d n g ddn thay doi ndng dp creatinin sau 6 t h i n g , cac tac g i i ket luan rang ndng dp creatinin h u y ^ t t h a n h trUdc can thidp khdng phai la yeu t d anh hucmg den su thay ddi ndng d p creatinin (tuong tU n h u cae yeu t d tudi, gidi, mUe d p hep d d n g maeh t h i n , sd d d n g mach than dupe dat stent, ehi sd huyet ap ban dau).
Nam 2003, nghien edu cCia Zeller, T. va CS. cho ket qua trai ngupe, n d n g dp creatinin huyet t h a n h ban dau eang cao thi mdc dp g i i m creatinin cang nhidu [10]. P h i n tfch da bien eung eho thay n d n g dp creatinin trudc can thidp la yeu t d nguy c d doe l i p d u doan thay ddi chUe nang t h a n d bdnh nhan hep ddng mach t h i n dUpc can thidp qua da.
Sd lieu tu" Bang 7 t r o n g nghidn eUu cOa chiing tdi cho thay, trong sd 8 t r u d n g hpp e i i thidn ndng d d creatinin, cd tdi 7 benh nhan, chiem 87,5% cd mdc creatinin tang. Trong khi d d , t r o n g 58 trudng h p p khdng c i i thidn ndng d d creatinin, chi ed 17,2% (10 benh n h i n ) tang creatinin trude can thidp. SU khac biet rat c d ; / nghTa t h d n g ke, vdi p=0,000. Tuong t u , ve chi sd ndng dp creatinin, ndng dp creatinin t r u n g binh trude can thidp d n h d m ed cai thidn n d n g d p creatinin la 202,9 ± 82i4Mmol/L, eao hdn rat cd y nghTa t h d n g kd so vdi ehi sd d n h d m khdng e i i thien nong dp creatinin, vdi p=0,0001. TU ket q u i nay, chOng tdi thay r^ng t y Id e i i thien ndng dp creatinin tdt hon d nhdm bdnh nhan cd ndng dp creatinin huy^t thanh trude can thiep tang.
ChlsoRI
Nghidn eUu eiia Fujihara, M. va CS. d 108 t r u d n g h p p h e p d d n g mach t h a n c d b e n h t h a n m a n t f n h (miire Ipe cau t h a n < 6 0 m l / p h u t / 1 , 7 3 m ^ c h o t h a y c h i sd Rl cua n h d m cai t h i e n mdc loc cau t h a n (tang >
10% so vdi ban dau) la 0,65 ± 0,2, t r o n g khi d n h d m k h d n g cSi thien mdc Ipc cau t h a n (tang g i a m t r o n g p h a m vi ± 10%) la 0,73 ± 0,1, p=0,01 [4]. TU n g h i d n c d u nay, cae tac g i i dUa ra m d c Rl < 0,7 la mdc g i u p d u d o i n vide cai t h i e n chdc nang t h § n d b e n h nhan dat stent d d n g mach t h a n . Gia t h i e t dUpc dUa ra d day la ehl sd Rl t h a p ed t h e p h i n anh chdc n a n g t h a n t d t (viable kidney function) [4]. Nghien edu cCia Radermacher, J. va CS. [9] dua ra ket luan, ehi sd Rl >
0,8 cd gia t r i t r o n g d u doan chdc nang t h a n t i e n trien nang hon so vdi n h d m c d Rl < 0,8, vdi d p nhay va dp dac hieu lan lupt la 90 va 93%.
So lidu t U Bang 8 t r o n g nghidn edu cua ehung t d i cho thay, gia t n Rl d n h d m c d cai t h i d n n d n g d p creatinin h u y l t t h a n h sau can thiep d d n g mach t h a n la 0,68 ± 0,07, t h a p hem so vdi n h d m k h d n g e i i t h i d n , vdi ehl sd Rl la 0,71 ± 0,07. Tuy nhien, sir khae bidt ve chi sd R! t r u n g binh cCia hai n h d m khdng cd y nghTa t h d n g kd, p=0,4092. TUdng t u , kiem d i n h Fisher vdi b i n g 2 x 2 d b i n g nay chung t d i eung k h d n g t i m thay ed m d i lidn quan gida t ^ le c^i t h i d n n d n g d p creatinin vdi mdc Rl > 0,8 va < 0,8.
Protein niiu
Nghien edu Fujihara, M. va CS. d Nhat B i n , n d n g dp proteinin nidu (trudng h p p protein nieu d u o n g tlnh) d n h d m khdng eai thien eao hdn k h d n g cd y nghTa so vdi n h d m ed cai t h i d n n d n g d p creatinin (1,6 ± 1,1 so vdi 1,4 ± 1,0mg/dL, p=0,42) [4]. Cac tac gia c u n g dUa ra n h i n dinh rSng, vide xuat hidn protein nidu k h d n g ed m d i lidn quan den t h a y ddi n d n g d p creatinin huyet tuOng d t h d i ffiem 12 t h i n g sau can thiep t h a n h cdng d d n g maeh t h a n .
Trong nghien c d u eua ehdng t d i , B i n g 9 eho thay, t r o n g sd 30 t r u d n g h p p ed protein nieu dUdng tfnh (tai m d t t h d i ^ e m ) , ehi cd 1 t r u d n g h p p e i i thien ndng d p creatinin huyet t h a n h , c h i e m 3,3%.
Trong khi d 36 t r u d n g hpp ed protein nidu am t i n h , t y le cai thien n d n g d p creatinin huyet t h a n h la 19,4%, su khac bidt ed y nghTa t h d n g kd, vdi p=0,046.
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JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY VoL11-N°5/2016
5. Ket luan
Ndng dp creatinin huydt t u o n g giam khdng ed ^ nghTa t h d n g kd d t h d i d i e m 6 t h i n g sau can t h i e p so vdi trudc can t h i e p .
Cac yeu t d t u o i , n h d m t u d i (> 70 va < 70 tudi), gidi, ndng dp NT - ProBNP huyet tUOng, ehi sd Rl, t h d n g sd huyet ap khdng phai la ydu t d g i u p d U doan dap dng ha n d n g d o creatinin sau can t h i e p d d n g mach than qua da.
T^ le c i i t h i e n n d n g d p creatinin t d t h o n d n h d n g b e n h nhan n d n g d p creatinin t r u d c can t h i e p va NT - ProBNP t a n g e u n g nhU p r o t e i n n i e u (dUdng tfnh).
T a i l i e u t h a m k h a o
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