vai nhom nguoi khong su dung bao cao su hoac khong sir dung bao cao su thudng xuyen.
TAI LIEU THAM KHAO
1. DH Y duoc TPHCM, 2004. Virus hoc. NXB DH Y duoc TPHCM Nguyln Ba Due & Ngd Thu Thoa 1995-"Nghien ciru cac bien phap ca ban phong ngira va phat hien sdm ung thu cd tir cung trong cpng ddng". Thdng tin y dupe,
11:23-7.
2. Nguyln Trong Hilu (2004), "Tan xuat nhiem HPV d phu nu- TP HCM va Ha Npi", Tap chi phu san, tap 4 (2), tr 64-72.
3. Nguyln Chan Hiing (2004). "Dich te hpc ung thu". Ung budu hpc ndi khoa. NXB Yhpc, tr
16-19.
4. Vu Thj Nhung 2004 "Nhan xet budc dau vl lien quan giua cac type HPV (Human
Papilloma Virus) va cac tdn thuong tien ung thu- Ung thu cd tu cung tai Benh vien Hung Vuong". Npi san San Phu Khoa So Dac biet Binh Duong 14-15/7/2004.Trang 170-175.
5. Vu Thj Nhung (2006), "Khao sat tinh hinh nhiem cac typ HPV d phu nir thanh phd Hd Chi Minh bang ky thuat sinh hpc phan tir", de tai cap co sd,55.
6. Hd Van Phuc (2009),"Ty le nhiem HPV va cac yeu to lien quan ciia phu nu dp tudi 18-69 tai thanh phd Hd Chi Minh", Tap chi San khoa, tr 17-21.
7. Munoz, N& et al (2002). "Role or parity and human papiloma virus in cervical cancer", Lancet.359 (9321 ).Pp. 1093-1101.
8. Scheure, M.E (2005). "Human papiloma infection: biology, epidemiology,and prevention", Int Gynecol cancer. 15Pp.727-746.
NGHIEN CLTU NONG DO HDL-TG TRONG HUYET TUONG CUA BENH NHAN TANG HUYET AP CO DAI THAO DUONG DIEU TR|
TAI BENH VIEN HU*U NGHj VIET TIEP HAI PHONG Tran Hoai Nam1, Phan Hai Nam2, Dao Van Tung1
TOM TAT
Benh tang huyet ap (THA) cd dai thao dudng (DTD) chiem ty lee cao d nude ta. Benh gay nhieu bien chu'ng nguy hiem, gay tir vong va tan phe suot ddi. Benh thudng cd roi loan lipoprotein huyet tUdng va tang TG trong HDL (HDL-TG). Qua nghien cuU tren 163 benh nhan THA cd DTO chung toi thay : Nong dp HDL-TG d benh nhan tang cao hdn so vdi nhdm chu'ng (p<0,05), cao nhat la nhdm benh cd bien chu'ng. Cd sU tUdng quan thuan chat che giCTa nong dp HDL-TG vdi TG huyet tUdng (r>0,8; p<0,001), tUdng quan thuan vdi Cholesterol toan phan va LDL cholesterol.
' Benh vien Viet Tiep Hdi Phdng
: Hpc vien Qudn y
SUMMARY
In Vietnam, the morbidity of arterial hypertension accompanied diabetes mellitus is high.These diseases have many dangerous complications,might cause death and disable in the whole life.There are disturbances of plasma lipoprotein and augmentation of TG in HDL (HDL-TG).The results of our study on
163 patients affected from hypertension accompanied diabetes showed that : the concentration of HDL-TG of the patient group increased in comparison with that of the normal group (p< 0,05),reached the highest level in the patients with complications.There were positive and close correlation between the concentrations of
Y HOC VIET NAM THANG 8 • SO 2/2010 HDL-TG and plasma TG (r> 0,8; p< 0,001), positive
correlation between HDL-TG and total cholesterol and LDL-cholesterol.
I. OAT VAN OE
Roi loan lipoprotein mau la mot trong nhung vln de duoc cong dong quan tam, nhat la o benh nhan dai thao duong tip 2, tang huyet ap, co the ciing xult hien voi cac yeu to nguy co ciia benh ly dong mach vanh (DMV) va dpt quy. Roi loan tiem in la de khang insulin va tang insulin mau se thuc dly nhanh qua trinh tien frien cua benh tang huyet ap, dai thao duong va la con duong gin nhat dan toi hpi chung X chuyen hoa.
Roi loan lipoprotein huyet tuong d nhom doi tupng nay dac trung boi tang lipoprotein ty trpng rat thap (VLDL) va giam lipoprotein ty Uong cao (HDL) De chan doan tinh Uang roi loan lipoprotein mau thuong dinh lupng nong dp cholesterol TP, triglycerid TP, HDL.C, LDL.C va thly roi loan lipoprotein d nhom doi tupng nay dac trung bdi su tang friglyceride, giam HDL-C. Nhieu cdng trinh nghien ciru cho thay HDL giau TG td ra kem hieu qua Uong vipc chuyen cholesterol ester cho te bao gan thdng qua thu the SR-B1. Day la yeu td gdp phin lam tang nguy co benh mach vanh va dot quy d nhUng bpnh nhan tang TG mau.
ii. Myc TIEU
1. Xac djnh ndng dp triglyceride trong HDL d nhiing benh nhan tang huyet ap, dai thao dudng typ II.
2. Tim hieu moi lien quan giua ndng dp HDL-TG vdi ndng dp lipid mau d nhirng benh nhan tang huyet ap, dai thao dudng typ II.
III. OOITU0NG VA PHUONG PHAP NGHIEN CLfU 1. Doi tupng:
Nhdm chung (nhdm 1): Chpn ngau nhien 42 ngudi binh thudng khoe manh den kham sire khoe dinh ky tai bpnh vipn da khoa huu nghi Viet Tiep Hai Phdng.
Nhdm benh gdm 163 benh nhan THA va DTD type 2 dupe kham va dieu Ui tai benh vien hiru nghi Viet Tiep Hai Phdng
2. Tieu chuan lua chpn;
Nhdm chirng (nhdm 1): Khdng mac benh THA, khdng DTD la ngudi khoe manh binh thudng tudi tir 18-50, khdng cd benh ly gan, benh than va cho ket qua xet nghiem lipid mau binh thudng.
Nhdm benh la benh nhin dupe chan doan xac dinh la THA, DTD typ 2 cd bidn chung DMV va/hoac dot quy hoac khdng cd bien chimg.
- Chan doan DTD typ 2 theo tieu chuan chan doan DTD cua WHO (1998)
- Chin doan THA. theo WHO va hdi THA qudc te (International Society of Hypertension - ISH) da thdng nhlt gpi la THA khi HATT > 140 mmHg va/hoac H ATTr > 90 mmHg
3. Phuong phap nghien ciru: Su dung phuong phap nghien cuu md ta cat ngang cd sir dung nhdm chirng
* Ddi tupng nghien cuu deu dupe xac dinh tudi gidi, do huyet ap, kham ndi khoa tdng quit.
Can lam sang: ECG, Xquang tim phdi, sieu am d bung, cdng thirc mau.
- Do huyet ap: Huyet ip do vao budi sang thuc day, tu the ngoi, do 3 lan each nhau 15 phut bang huyet ip ke ddng hd da hieu chinh bang may do huyet ap thuy ngan.
- Cac xet nghiem sinh hoi miu: Glucose, triglyceride, cholesterol, HDL-C, HDL-TG, SGOT, SGPT, Creatinine, protein, albumin dupe thuc hien tren may AU 600 ciia hang OLYMPUS Rieng LDL.C tinh theo Friedelwald LDL.C
= CT - (HDL-C+ TG/2,2 ) khi TG < 4,5 mmol/l.
*Ky thuat dinh lupng Triglycerid trong HDL (HDL-TG) dupe tien hanh nhu sau:
Budc 1: Gay tua cic thinh phan lipoprotein khac ngoai HDL cu the:
- Cho vao efpendorg 1.5ml (dng nghiem) 400 p.1 thudc thir gdm acid phosphotungstic vi magnesium clorid dung de ket tua VLDL, LDL.
- Them vao dd 200 ul huyet tuong benh nhan.
- Lac deu trong 40 giay hoac vortex trong 4 giay va de trong nhiet do phong 10 phiit. Sau do quay li tam 10000 vdng/phiit trong 10 phiit.
- Diing pipepette hiit phan djch trong phia tren ong nghiem cho vao pipet nho.
Budc 2: Dinh luong Triglycerid trong HDL bang phuong phap GOP-PAP,
Thuoc thii ciia hang Olympus Life Science Research Europa GmbH(Germany) tren may hoa sinh tu dpng AU 600, sau do ket qua tinh duoc nhan voi he so pha loang.
IV. KET QUA VA BAN LUAN 1. Dac diem doi tirong nghien ciru
O nguoi binh thuong (nhom 1) chii yeu
<55 tuoi chiem 71,4%, vdi dp tudi trung binh la
49,5. Trong nhdm 1 khdng cd su khac bipt giira 2 gidi nam va nu ve dp tuoi trung binh va ti If trong nhdm.
Trong nhdm THA-DTD (nhdm 2) chii yf u d nhdm tuoi 56-65 chiim ty If 37,7% va dp tuoi 66-75 chiem ty If 34,6%, co su khac bift phan bo gidi tinh cung nhu tuoi trung binh cho tirng gidi trong nhdm nay. Ket qua nghien cuu cua chung tdi rat phii hop vdi ket qua dieu tra djch te hpc ciia Ford ES, Giles WH nam 2002 d Hoa Ky cho thay: neu ty Ip DTD type 2 d nhdm tudi 20-39 la
1,6% dan so thi d dp tudi 50-59 la 12,4% va P nhom tudi 60-75 chiem ty If cao nhat dat tdi 21,1% dan sd va rdi ty If nay giam dan d cac nhdm tudi sau [11].
Bang 1: Dac diem nhdm nghien ciiu theo gidi
— N h o m Gidi
Nhom chu'ng THA-DTD
— N h o m
Gidi N % n °/o
Nam 20 47.6% 62 38%
NCJ- 22 52.4% 101 62%
Bang 2: Dac diem ciia nhdm tudi d nhdm nghien ciiu Nhom
Tuoi
Nhom chu'ng THA-DTD
Nhom
Tuoi N % n °/o
<45 16 38.1% 8 4.9
46-55 14 33.3% 23 14.1
56-65 8 19.0% 61 37.4
66-75 3 7.1% 56 34.4
>75 1 2.4% 15 9.2
Bang 3: Dp tudi trung binh theo nhdm va phan theo gidi
^~"~^~^^^Th6ng so
Nhom Tuoi Nam NO" P
Nhdm chimg 49.45 ± 12.2 50.5 ±13.57 48.93±11.68 >0.05 THA-DTD 64.33±9.46 61.68+10.38 65.98±8.49 0.0001
Y HOC VIET NAM THANG 8 • SO 2/2010 2. Ndng dp HDL-TG a nhom nghien ciru
Bang 4: Nong do HDL-TG va cac chi sd lipid khac d nhdm nghien cuu
^ ^ ^ — ^ ^ ^ Chi so
Nhom NC HDL-TG TG CT HDL-C LDL-C
Nhom chu'ng (nhdm 1) 0.25±0.006 2.26±1.36 5.18±0.87 1.19±0.23 3.22±0.66 THA-OTD (nhdm 2) 0.34±0.18 3.9±4.23 5.7±1.61 1,11+0.27 3.6+1.51
P <0.0001 <0.0001 0.006 0.084 0.013
Dua vao ket qua ndng dd HDL-TG so vdi cac chi sd lipid mau khac a bang 4 ta thly ndng dd HDL-TG d ngudi binh thudng (nhdm 1) la thap hon hln so vdi nhdm benh nhan DTD phdi hop vdi THA va sir khac biet nay cd y nghTa thdng ke vdi P<0,0001. Ngoai ra chi sd triglyceride, cholesterol mau toan phan va LDL-cholesterol giua cac nhdm nghien cuu ddu cd sir khac biet cd y nghTa thdng ke vdi P<0,05. Trong khi dd chi sd HDL-C lai khdng cd su khac biet giua cac nhdm benh vdi nhau.
Bang 5: Ndng dd HDL-TG va cac chi sd lipid khac d nhdm benh nhan THA cd dai thao dudng
^ ^ ^ ^ ^ ^ Chi sd
Nhom NC HDL-TG TG CT HDL-C LDL-C
THA-OTD khdng bien
chu'ng 0.32+0.15 3.5+3.3 5.5+1.2 1.13+0.26 3.5+1.2 THA-DTD cd bien chu'ng 0.43+0.25 6.3±6.1 6.5±2.5 1.05+0.31 4.2+2.4 P <0.05 <0.05 <0.05 >U05 <0.05 Can cu vao ket qua thu dugc d bang 5, ndng dp HDL-TG va triglyceride toan phan d nhung ddi tuong tang huyet ap kem dai thao dudng cd bien chung dot quy hoac ddng mach vanh cao hon han nhung truong hpp khong cd bien chung va sir khac bipt nay cd y nghTa thdng ke vdi P<0,05.
cac chi so lipoprotein a nhom 2
HDL-TG TG CT HDL-C LDL-C ES khong bien chtrng H co bien chiing
Bieu do 1. Chi sd lipoprotein cac ddi tupng trong THA cd DTD
Ndng dp cholesterol toan phan va LDL-cholesterol nhpm cd bien chiing cao hon han so vdi nhdm khong bien chiing , khac biet cd y nghTa thdng ke vdi p<0,05.
Nong clp HDL-cholesterol d nhom co bien chiing thip hon so vai nhom khong bien chiing song sy khac biet khong co y nghTa thong ke vdi p>0,05.
Theo bang 6, mac du cac chi sd HATT, HATTr cung nhu ndng dp HDL-TG va dp tudi trung binh theo gidi nam va nu d ddi tupng cd bien chiing cao han han so vdi cac ddi tuong khdng cd bien chung trong nhdm benh THA nhung su khac biet nay khdng cd y nghTa thdng ke vdi p>0,05.
Bang 6: Dac diem HDL-TG theo dp THA
Do THA HDL-TG P
Dp 1 (n=147) 0.31+0.15
>0,05
Dp 2 (n=80) 0.33+0.12 >0,05
Dp 3 (n=9) 0.31+0.11
>0,05
Can cur vao sir phan chia dp THA so sanh vdi ndng dp HDL-TG cho thay khdng cd su lien quan nao giua 2 chi sd va sir khac biet khdng cd y nghTa thdng ke vdi p>0,05.
3. Moi tuong quan cua HDL-TG voi cac chi so hoa sinh khac
Bang 7: Danh gia sir tuong quan giua cac chi so sinh hoa d cac nhdm nghien ciiu
HDL-TG glucose TG CT HDL-C LDL-C
HDL-TG
r P r P r P r P r P
1 -0.07 >0.05 0.5 0.001 0.21 >0.05 -0.2 >0.05 0.22 >0.05 2 0.13 >0.05 0.89 0.001 0.6 0.001 -0.4 0.001 0.61 0.001 Can cu vao viec danh danh gia su tuong quan giua ndng dp HDL-TG vdi cac chi sd sinh hoa khac (Bang 7) thay: O ngudi binh thudng cd moi tirong quan thuan giua ndng dp triglyceride vdi ndng dp HDL-TG, trong khi do d nhdm bpnh nhan THA phdi hpp DTD thi su tuong quan thuan nay la rat chat che (r=0,89) cd y nghTa thdng ke vdi P<0,001.
Trigljjjerid Trigly^rid
Bieu do 2: Sir tuong quan va tuyen tinh giua Triglyceride va HDL-TG d cac nhdm nghien cuu Ngoai ra d nhdm ket hop DTD vdi THA thong ke p<0,001 vdi ndng dp cholesterol toan ndng dp HDL-TG tuong quan thuan cd y nghTa phan va LDL-cholesterol.
Y HOC VIET NAM THANG 8 - SO 2/2010 Dac biet d nhirng benh nhan DTD ket hop
THA ndng dp HDL-TG va HDL-C co mdi tuong quan nghich mang y nghTa thong ke voi p<0,001.
Trong khi do chiing toi khong tim thay moi tuong quan nao giira nong dp HDL-TG vdi nong dp glucose d cac nhom nghien ciiu.
V. BAN LUAN
Thong qua cac ket qua nghien cuu chung toi nhan thay d nhung benh nhan tang huyet ap va dai thao duong type 2 thanh phan HDL co su thay nong dp triglyceride va cholesterol so voi nhirng ngudi binh thudng. Ngay ca khi ndng dp HDL-cholesterol la binh thudng thi thanh phan lipid ben trong phan tir lipoprotein ty trong cao da cd sir thay, ddi cu the ndng dp triglyceride tang cao va ty le HDL-C/HDL-TG dao nghich so vdi ngudi binh thudng va su thay ddi nay cang rd rang lion khi cd ndng dp HDL-C thap. Ngoai ra khong co moi lien quan nao giua chi sd huyet ap hay ndng dp glucose huyet tuong vdi ndng dp triglyceride trong thanh phan lipoprotein ty trong cao. Sir thay doi nay la do trong chuyen hoa lipoprotein, HDL va VLDL trao ddi vdi nhau thanh phan lipid. HDL chuyen cholesterol ester cho VLDL ddng thdi nhan lai triglyceride tir VLDL thpng qua protein van chuyen lipid la CETP [10], ket qua la trong thanh phan HDL luong cholesterol bi giam trong khi luong triglyceride tang len. Sir thay ddi dd lam anh hudng den chuyen hoa va chirc nang cua HDL.
Theo Nguyen Hai Thuy ciing cac tac gia khac [3], [4], [5] vai trd ciia TG va HDL dugc chii y hon la cholesterol va LDL trong rdi loan lipid mau va la nguy co quan trgng nhat gay benh tim mach thdng qua VXDM Triglyceride va HDL-TG la yeu td nguy co' tim mach dpc lap, nhat la benh ly tim mach.
Theo Pham Thj Mai [7] ciing cac nghien cuu khac TG trong HDL thuc day toe dp thiiy phan lipid ciia chiing bdi enzym hepatic lipase. Do vay khi trong HDL ndng dd TG tang len va CT giam xuong [ 12] se anh hudng den chuyen hda, chirc nang:
- Khi HDL chua nhieu TG se la co chat thich hgp cho enzym hepatic lipase, enzym nay se thiiy phan TG trong HDL va chuyen HDL 2 thanh HDL 3. Nhu vay, ddi sdng HDL 2 se ngan hon khi chung chiia nhieu TG hay sir thay ddi ve chat lugng HDL cdn cd the dan den giam sd lugng HDL [2], [6], [7].
- Theo nghien cuu Skeggs J.W va R.E Morton qua tin' nghiem tren vitro da cluing minh duoc rang: trong qua trinh chuyen chd nguoc cholesterol, HDL giau TG td ra kem hieu qua trong viec chuyen cholesterol ester cho te bao gan thdng qua thu the SR-Bl[l2]. Vay day la yeu td gdp phan lam tang nguy co benh mach vanh d nhung benh nhan tang TG mau [13].
Theo nghien ciru cua Le Thanh Hai va cdng su [1] nong dp triglyceride cao la thdng sd lipid huyet thanh duy nhat cd lien quan vdi tang nguy co benh nhdi mau nao. Can tien hanh djnh luong triglyceride huyet thanh d benh nhan nhdi mau nao de can thiep kjp thdi. Chi sd CT/HDL la mpt chi so sinh xo vira quan trgng ap dung trong lam sang doi vdi bpnh nhdi mau nao.
Theo Festa A, Agostion RJ; Howard (2002) [9] dau hieu sdm cua hien tuong khang insulin d nhung ngudi beo phi la sir gia tang TG luc ddi, tang ndng dp HDL-TG va giam nong dp HDL-C. Gan day ngudi ta chii y hdi chirng tang TG/giam HDL kem theo tang acid beo khdng ester hda cd gia trj tien luong cao trong benh tim mach, LDL nhd va dam dac, tang LDL oxy hda va giam HDL 2.
Tang lipoprotein giau triglycerid, tang ty sd triglycerid/HDL-C cd gia trj tien doan cao benh tim mach. Nhieu bang chiing cho thay phdi hop giam HDL-C vdi tang triglycerid la hien dien tinh trang khang insulin va nguy co cao vdi benh mach vanh [9].
Cd nhieu nghien ciiu cho thay d nhung ngudi tang huyet ap cd thira can, phan tir HDL chua nhieu TG va lugng apoA-I it hon, gia tang sd lugng cua VLDL vdi kich thudc ldn hon va nhieu TG, cd nhieu LDL oxi hda va dudng hda,
phan tir HDL giam so lirong nhirng giau TG va dpi song ngan.
Qua nghien ciru nay chiing toi cung nhan thay nong dp triglyceride toan phan va HDL- triglyceride co moi tirong quan. Moi tuong quan nay la rat chat che trong cac truong hop benh DTD ket hop voi tang huyet ap voi r =0,89.
VI. KET LUAN
- Q nhom benh nhan THA ket hop dai thao dudng typ 2 co sir tang nong dp triglyceride trong lipoprotein ty trong cao so vdi ngudi binh thudng.
- Cd mdi tuong quan thuan giira ndng dp triglyceride trong HDL vdi triglyceride toan phan trong huyet tuong.
TAI LIEU THAM KHAO.
1. Le Thanh Hai va CS (2004), Nghien ciiu sir thay ddi ndng dp lipid huyet thanh d benh nhan nhdi mau nao, tap chly khoa Viet nam.
2. Mai The Trach, Nguyen Thy khue (2003). Ndi tiet hoc dai cuong, NXB Y hoc. TP. Ho Chi Minh, trang 409-450, 583-590.
3. Nguyen Hai Thiiy (2008), "HCCH" trong giao trinh sau dai hoc chuyen nganh npi tiet va chuyen hda, Nha xuat bdn Dai hoc Hui, trang 313-357
4. Nguyen Hai Thiiy (2008), "Rdi loan lipid mau" trong giao trinh sau dai hpc chuyen nganh npi tiet va chuyen hda, Nhd xuat bdn Dai hoc Hui, trang 246-304.
5. Nguyen Hai Thiiy, Rdi loan lipid mdu, sinh ly benh
va chon thudc dieu tri. bai giang npi khoa, 2006.
6. Pham Thi Mai, Pham Trung Ha (1993), "RPi loan chuyen hoa lipid d benh nhan dai thao dudng". Tap chi Y hoc thuc hanh. Tap 39, trang 28-29
7. Pham Thi Mai (2007), Sir thay ddi ndng dp triglycerid trong HDL d benh nhan dai thao dudng type 2 va ngudi thira can. NXB Y hoc TP.
Ho Chi Minh, tap 11, trang 82-86.
8. Pham Gia Khai. "Dac diem benh tang huyet ap tai Ha Npi". De tdi cap nha nude ma so KH 11-04. Hd Noi 1999.
9. Festa A, Agostion RJ; Howard (2002),"
Chronic subclinical inflamation as part of the insulin resistance syndrome; the insulin resistance atherosclerosis study", Circulation;
102: pp 42-27.
10. Lamarche B, Rashid S, Lewis G (1996), "HDL metabolism in hypertriglyceridemic states and overview", Clin. Chim, Acta. 286, pp. 145-161.
11. Lamarche B, Levesque S (2008), The metabolic syndrome: Definition, prevalence and management, J. Nutrigenomics, 1: 100- 108.
12. Skeggs J. W. and R. E. Morton (2002), "LDL and HDL enriched in triglycerid promote abnormal cholesterol transport", Journal of Lipid Research 43, pp. 1264-1374.
13. Rashid S et al. (2003), "Mechanisms of HDL lowering in insulin resistant, hypertriglyceridemic states: The combined effect of HDL triglyceride enrichment and elevated hepatic lipase activity", Clinical Biochemistry 36. pp.421-429
