Transplantation Center of Hungarian National Institute of Hematology and Immunology.All samples were frozen in a rate - controlled programmed freezer using DMSO (dimet hylsulfoxide) in combination with hydroxyethylstarch(HES) as cryoprotectants and stored at - 196°C in liquid nitrogen until used. Results: the cell viable rate, CD34+ cell count and PBSC function were well maintained during storage, this resulted in rapid engraftment and hematopoietic recovery (mean platelet and granulocyte recovery tJmes were 12.25 ± 1.7 days and 11.0 ± 1.0 days respectively). Conclusion: PBSC cryopreservation was performed safely and well effectively.
Keywords: cryopreservation. Peripheral Blood Stem cell (PBSC), Cryoprotectant (DiVlSO, HES)
NGHIEN CLfu MOI LIEN QUAN G I Q A
NONG DO LIPID HUYET THANH VA LIEU PHAP L/C CHE MIEN DjCH d BENH NHAN SAU GHEP THAN
Nguyin Thj H o a \ Pham Thien Ngoc^ Ha Phan Hai An^
• > '. ; ^Tnfdng Dai hgc Y DUOC Thii Nguyen,-Tntdng Dai hgc Y Ha No
Cac thudc dc che miin djch (UCMD) cd the cd anh hudng khae nhau den nong do lipid huyit thanh.
Muc tieu: (1) Xic djnh nong do lipid huyit thanh d benh nhan sau ghep than. (2) Tim hieu mdi Hen quan gida ndng do lipid huyet thanh vdi viec sd dung thud'c iJCMD va mdt sd yiu td khie. Bdi tugng va phuang phap nghien cdu: md ta, dt ngang tren 41 benh nhan sau ghep than dn djnh. Nhdm 1: 22 benh nhin dieu trj bang cyclosporin; nhdm 2: 19 benh nhin dieu trj bing tacrolimus. Kit qua: (1) Ty IS tang cholesterol huyit thanh li 41,5%. Ty IS tang triglycerid li 31,7%o. Ty IS giam HDL - C huyit thanh li 19,5%o. Ty le tang LDL - C huyet thanh li 19,5%o. (2) Cd sU tuang quan gida nong do tacrolimus, lieu corHcoid, nong do albumin huyet thanh, tudi vi BMI vdi mgt sd thinji phin lipid huyet I'lanh. Kit luan: (1) Ty IS tang cic thinh phin lipid huyet thanh li khi cao d benh nhin sau ghep than. (2) Thude UCMD lam tang nong do lipid huyit thanh, mde do anh hudng cua thudc UCMD din nong do lipid huyit thanh chUa cd sU khic biet gida
eac loai thudc UCMD. ,.
Tii khoa: Ghep than, tang lipid, thuoc iifc che mien djch
I. D A T V A N D E thud'c U C M D thifdng dflpc sfl dpng la thud'c flc Vdi nht-fng tie'n bd vtfdt b|c trong ITnh vflc che caleineurin, thud'c citd'ng chuyen hda va corti- ghep tang, ghep than la sfl Ifla chpn tot n h i t cho coid. Viec sfl dung e l e thud'c U C M D thtfdng gay benh nhan suy than man giai doan cud'i. Thanh . ra c l e bie'n cht'fng nhfl beo phi, tang huye't ap, i-d'i cdng cua viSc ghep than khdng chi la v i n de loan lipid, tieu dfldng sau ghep...[5, 8]
p h i u thuat m l cdn la q u i trinh dieu tri chd'ng t h i i Sau ghep than, tang lipid m l u I I bie'n chflng ghep va theo ddi c l e bie'n chflng sau ghep. thfldng gap, ton tai dai dang va cd lien quan de'n Sau ghep than, benh n h i n p h i i sfl dung thud'c benh tim maeh sau ghep [3]. Sfl dpng thud'c flc che m i i n dich (UCMD) sud't ddi. Ba nhdm UCMD la ye'u to chinh anh hfldng de'n tang lipid
sau ghep than. Mflc dp I n h hfldng cua thud'c U C M D den nong dp lipid mau php thupc v i o loai thud'c va lieu lflpng thud'c UCMD ma benh nhan sfl dung [5, 8].
Tai Viet Nam, so' benh nhan dtfdc ghep than d trong nfldc cung nhfl d ntfdc ngoai ve n g l y c l n g tang. VI vay, viec dieu tri, theo ddi c l e bie'n chflng sau ghep la v i n de c i p thie't. Hai thud'c UCMD thupc nhdm ifc che calcineurrin thfldng dtfpc sfl dung tai Viet Nam la cyclosporin va tacrolimus. Mac du thud'c UCMD cd I n h hifdng rd ret de'n nong dp lipid huye't thanh nhflng mflc dp va loai thud'c sfl dung cd I n h hfldng nhfl the' nao cdn chfla rd rang. VI vay, chung tdi tie'n hanh de tai nay vdi muc tieu:
t.Xac dinh ndng do lipid huyit thanh d benh nhan sau ghep than.
2. Tim hieu mdi USn quan gida ndng do lipid huyit tbanb vdi viec sd dung thudc UCMD va mgt sd yiu td kha c.
II. DOI TUONG VA PHL/ONG PHAP NGHIEN CL/U
1. Do'i tUdng nghien cu'u
Gom 41 benh nhan, cd thdi gian sau ghep than on dinh ft n h i t 6 thang, dang dtfpc dieu tri ngoai tru tai Khoa Than - Lpc mau benh vien Hflu nghi Viet Dflc va chia thanh 2 nhdm:
Nhdm 1: gom 22 benh nhan dtfdc dieu tri bang thud'c flc che caleineurin cyclosporin (neoral).
Nhdm 2: gom 19 benh nhan dfloc dieu tri bang thud'c flc che caleineurin tacrolimus (prograf).
C I c dd'i tflpng nghien cflu dflpc lay mau tTnh mach vao bud'i s i n g , luc ddi, ngay trfldc khi ud'ng thud'c. M l u dflpc ly tam l i y huye't thanh lam c i c xet nghiem:
Xac dinh nong dp cholesterol, triglycerid, HDL - C, LDL - C.
Xic dinh nong dp cyclosporin hoac tacrolimus.
Tieu chuan chpn benh nhan:
- Benh nhan sau ghep than d'n dinh dfla vao nong dp creatinin huye't thanh dao dpng trong k h o i n g binh thfldng + 3 0 % .
- Tieu chuan ro'i loan lipid huye't thanh theo hang so' sinh hpc ngfldi Viet Nam nam 1992 va Hpi Tim mach Viet Nam nam 1998:
- Nong dp cholesterol huyet thanh >5,2 mmol/l.
- Nong dp triglycerid huye't thanh >2,3 mmol/l.
- Nong dp HDL - C huye't thanh < 0,9 mmol/l.
- Nong dp LDL - C huye't thanh > 3,4 mmol/l.
2. Phuong phap nghien cu'u
Phflpng phap nghien cflu md t l , cat ngang.
C I c ky thuat xet nghiem dinh lifpng cholesterol, triglycerid, HDL - C, LDL - C, glucose, albumin, creatinin huye't thanh dtfdc l l m theo c i c quy trinh chuan thdng thfldng tren may Olympus - AU 400 cua Nhat.
Dinh Itfpng nong dp cyclosporin bang ky thuat m i i n dich huynh quang phan ctfc tren may Ax- sym cua Abbott va tacrolimus bang phflpng phap quang phd' tren may Olympus - AU 400 cua Nhat.
C I c so' lieu dtfpc xfl ly theo phfldng phap thd'ng ke y hpc sfl dpng phan mem EPIINFO 6.04.
IILKETQUA
1 . Dac diem benh nhan sau ghep than
Tud'i tai thdi diem ghep than rat tre, tuoi trung binh:
35,1 ±11,5, cd 2 benh nhan tren 50 tuoi (4,9%).
Thdi gian chay than nhan tao ngan, thdi gian trung binh: 1 3,4 ± 21,7, so' benh nhan chay than nhan tao dfldi 12 t h i n g la 31/41(75,6%).
Thdi gian sau ghep t h | n trung binh: 25,3 ± 1 7,8.
BMI trung binh: 20,7 ± 2,8, BMI > 25 la 5 (1 2,5%). Khdng cd trfldng hpp nao BMI > 30.
53,7% nguon than khdng cd thdng tin, ngudn than ghep la ngtfdi song la 43,9%, nguon t h | n tfl ngtfdi che't m i t nao I I 2,4%.
2. Nong do lipid huyet thanh o( benh nhan sau ghep than
Bang 1. Nong do lipid va mgt sd chat kbac trong huyit thanh d nhom benh nhan nghien cdu
Chf so'
Cholesterol (mmol/l) Triglycerid (mmol/l)
n 41 41
A x a U 5,04 ± 1,55 2 , 1 7 ± 1,13
Roi loan n (%) 17 (41,5) 13 (31,7) HDL - C (mmol/l) 41 1,25 ± 0 , 2 9 8 (19,5) L D L - C (mmol/l) 41 2,88 ± 1 , 2 1 8 (19,5) Ty le rd'i loan mpt thanh phan lipid 27 (65,9) Glucose (mmol/l)
Albumin (g/l) Creatinin (pmol/l)
41 41 41
4,98 ± 1,35 43,8 ± 3,6 120,4 ± 29,7
4 0 19
(9,7) (0) (46,3)
Nhan xet bang 1: trj sd trung binh cac chl sd tren trong huye't thanh deu nam trong gidi ban binh thifdng. Ty le tang cholesterol huye't thanh la 41,5%o, triglycerid huyet thanh la 31,7%o va LDL - C li
19,5%o, ty IS glim HDL - C huyit lhanh la 19,5%o, ty le ting glucose huyet thanh la 9,7%o trong dd 7,3%o sd benh nhan phai sd dung thudc dieu trj Heu difdng.
Bang 2. Nong do lipid va mgt sd chat khac trong huyit thanh d benh nhan sau ghep than theo thudc diiu tri
Chi
so'Nhdm cyclosporin (n = 22) Nhdm tacrolimus (n = 19) X + S D % roi loan X i S D % roi loan Cholesterol (mmol/l)
Triglycerid (mmol/l) H D L - C (mmol/I) LDL - C (mmol/l) Glucose (mmol/l) Albumin (g/l) Creatinin (pinol/I)
4,94 ± 1,2 1,9 ± 0 , 6 5 1,21 ± 0 , 4 6 2,88 ± 1,01 4,94 ± 0,78 43,7 ± 3,4 131,7± 30,9
19,5 12,2 12,2 9,8 2,4 0 34,1
5,17 ± 1,9 2,48 ± 1,48
1,3 ± 0 , 5 3 2,86 ± 1,43 5,02 ± 1,46 42,5 ± 3,5 107,4 ± 22,7
22 19,5
7,3 9,8 7,3 0 12, 2
> 0 , 0 5
> 0 , 0 5
> 0 , 0 5
> 0 , 0 5
> 0 , 0 5
> 0 , 0 5
< 0 , 0 5 Nhin xet bang 2: ndng do lipid, glucose, albumin huyet thanh d hai nhdm dieu trj chtfa cd stf khac biei cd y nghia thdng ke. Tuy nhien, nong do cholesterol, triglycerid, glucose huyet thanh d nhdm benh nhan dieu trj bing tacrolimus cd xu htfdng tang cao hon so vdi nhdm benh nhan dieu trj bang cyclosporin.
3. Sii dung thuoc d benh nhan sau ghep than
' ' Bang 3. Sd dung thudc d nhdm benb nhan nghiSn cdu Nhdm cyclosporin Nhdm tacrolimus Chl so
Lieu thud'c CNI (mg/ngay) Nong dp CNI (ng/ml) Lieu cortieoid (mg/ngay) Lieu ccllcept (g/ngay) Sfl dpng thud'c ha lipid Sfl dung thud'c tieu dtfdng
n 22 22 17 22 2 1
X ± S D 205,4 ± 64,4 104,6 ± 2 1 , 6 3,8 ± 1,9 1,4 ± 0 , 3
4,9%
2,4%
n 19 19 16 19 3 2
X ± S D 4,8 ± 2,1 9,1 ± 2,8 7,4 ± 6,7 1,4 ±0,4
7,3%
4,9%
< 0 , 0 5
> 0,05
> 0 , 0 5
> 0,05
CNI: Caleineurin Inhibitor (thudc ifc che caleineurin)
Nhan xet: Lieu ItfOng cung nhd nong do thudc t'fc chi caleineurin, lieu ItfOng thudc Cellcept diu nam trong gidl ban cho phep. Sd benh nhan khdng sd dung cortieoid la 19,5%o, lieu cortieoid d nhdm cyclosporin thap ban so vdi nhdm tacrolimus, stf khac biet niy cd y nghTa thdng ke vdi p < 0,05. Khdng cd sd khic nhau ve ty te tieu difdng, sd dung thude ha lipid d hai nhdm dieu trj.
4. Mot so ye'u to' lien quan vdi nong do lipid huye't thanh sau ghep than
Bang 4. Tuang quan gida nong do lipid huyit thanh vdi tbudc LfCMD va mgt sd chi sd khac Chi so
Cholesterol n = 41 Triglycerid n = 41 H D L - C
He so r P r P r
Cyc - 0 , 0 9
k - 0 , 0 5
k - 0 , 1 3
Tac - 0 , 3 1
< 0 , 0 5 - 0 , 0 7
k - 0 , 3 2
Cortieoid 0,31
< 0 , 0 5 - 0 , 0 7
k
0,43
Albumin - 0 , 3 8
< 0 , 0 5 0,03
k - 0 , 4
Glucose 0,17
k 0,28
k - 0 , 1 2
Tuoi 0,57
< 0 , 0 5 0,28
< 0,05 0,3
BMI 0,49
< 0 , 0 5 0,17
k 0,06 n = 41 p k < 0 , 0 5 < 0 , 0 5 < 0,05 k < 0,05
U 3 L - C r - 0 , 0 6 - 0 , 3 0 0,18 - 0 , 3 2 0,19 0,52 0,59 n = 41 p k < 0 , 0 5 k < 0 , 0 5 k < 0,05 < 0,05
Cyc: cyclosporin; Tac: tacrolimus; k: p > 0,05. • ,
Nhan xet: Ndng do cac thanh phan lipid khdng ttfang quan vdi nong do cyclosporin, glucose huyet thanh, cd sU ttfang quan nghjch giifa nong do tacrolimus vdi nong do cholesterol, HDL - C va LDL - C huyet thanh. Cd sU ttfong quan thuan giifa lieu cortieoid vdi nong do cholesterol, HDL - C huyet thanh.
Cd sU ttfong quan nghjch gida albumin huyit thanh vdi cholesterol, HDL - C va LDL - C huyit thanh.
Cd sd ttfang quan thuan kha chat glifa nong do cholesterol, LDL - C htiye'l thanh vdi tudi vi BMI.
IV. BAN LUAN
Tud'i tai thdi diem ghep r i t tre, chl cd 2 benh nhan (4,9%) cd tud'i tai thdi die'm ghep tren 50 tuoi (2 benh nhan nay deu p h i i sfl dung thud'c ha lipid mau, 1 benh nhan bj tieu difdng), nong dp lipid huye't thanh d nhdm > 50 tudi cao hon nhdm
< 50 tud'i. Nhfl vay, tud'i tai thdi diem ghep cang cao, cang nhieu bie'n cht'fng sau ghep [8|.
Ve chi so khdi cd the (BMI): cd 1 2,5% beo phi dp I, BMI trung binh la 20,7. Nong dp lipid huye't thanh d nhdm BMI > 25 cao hon so vdi nhdm BMI binh thtfdng, ket q u i cua chung tdi phu hpp vdi nghien ct'fu cua Teplan [1 0].
Ve ngudn than ghep: ngudn than ghep tfl ngifdi sd'ng la 43,9%; 53,7% ngudn than ghep khdng cd thdng tin, 2,4% ngudn than ghep tfl ngtfdi che't m i t nao. Mohammad nghien cflu tren benh nhan sau ghep than cd ngudn than ghep tfl ngtfdi sdng cho ke't qua: ty le tang cholesterol I I 27% (cyclosporin: 15,2%; tacrolimus: 11,8%), triglycerid la 8%, LDL - C la 27,5% (cyclsporin:
13,5%; tacrolimus: 12,2%) [7]. Ngflpc lai, trong nghien cflu cua Teplan cd ngudn than tfl ngifdi chet m i t nao dan de'n viec sfl dung thud'c LJCMD phai duy tri d ndng dp cao hon (190 ± 30 ng/ml), ndng dp lipid huye't thanh tang cao [10]. Trong nghien cflu ctia chung tdi chl cd 2,4% ngudn than tfl ngtfdi che't m i t nao, p h i i chang day cung la mpt ly do de sfl thay ddi ndng dp lipid huye't thanh khdng dang ke d nghien ct'fu cua chung tdi.
Ndng dp thudc UCMD dtfpc cho la an toan va hieu qua d benh nhan ghep than la 80 - 100 ng/ml ddi vdi cyclosporin, 6 - 8 ng/ml ddi vdi tacrolimus [9]. Trong nghien cifti cua chung tdi, ndng dp cyclosporine la 104,6 ng/ml, tacrolimus-la 9,1 ng/ml gan gidng vdi nghien ct'fu cua Tang va McCtine [6, 9]. Ndng dp cyclosporin trong nghien ct'fu cua chung tdi thap hon nhieti so vdi nghien ct'fu cua Teplan va cua Hjelmesaeth [5, 10].
Cyclosporin, lam tang ndng dp LDL - C huye't thanh do cyclosporin t'fc che q u i trinh tdng hdp receptor LDL - C d gan d i n de'n tang c l sd Itfdng LDL - C cung nhfl tang kha nang oxy hda cua L13)L - C [3].
Tacrolimus I n h hifdng den chuyen hda glucose do lam g i l m sfl bai tie't insulin cua tuy, mtfc dp I n h hifdng phu thupc vao lieu Iflpng stf dung. Trtfdc tien, tacrolimus lam tang khang insulin. Neu duy tri d mtfc lieu chuan thi khdng cd sfl khac nhau giiTa cyclosporin va tacrolimus len chuyen hda glucose [2]. Vdi ndng dp thud'c UCMD d mflc dp t h i p , vfla du de duy tri than ghep r i t cd the d l y I I mpt ly do lam cho ndng dp lipid huye't thanh thay ddi chtfa d i n g ke d thdi diem nghien ctfu cua chting tdi.
Lieu cortieoid trong nghien cflu cua chung ldi la 5,53 ± 5,1 mg/ngay; nhdm 1 la 3,8 ± 1,9 mg/ngay;
nhdm 2 la 7,4 ± 6,7 mg/ngay, lieu cortieoid trong nghien cflu cua chung tdi t h i p hpn so vdi mot sd nghien ct'fu khac (5, 6]. Day cung cd the la ly do de sfl thay ddi lipid huye't thanh chtfa d i n g ke d thdi die'm nghien ct'fu eua chung tdi vi cortieoid cd the lam tang tdng hop triglycerid do lam tang hoat ddng cua insulin tai gan hoac do kfch thich hoat dpng eua enzym g i i i phdng triglycerid [3].
0 38 ngtfdi Viet Nam binh thtfdng; dp tudi trung binh ia 33,6 ± 7,9, ndng dp cholesterol huye't thanh: 4,14 ± 0,7; triglycerid huye't thanh:
1,39 ± 0,64; HDL - C huye't thanh: 1,33 ± 0,35;
LDL - C huyet thanh: 2,3 ± 0,48 [1]. 6 30 benh nhan suy than man chay than nhan tao, cd dp tudi trung binh la 32,1 ± 8,4, ndng dp cholesterol huye't thanh: 4,26 ± 0,87, ty le lang cholesterol la 33,3%; triglycerid huyet thanh: 1,9 ± 0,57, ty le tang triglycerid la 2 0 % ; HDL - C huyet thanh:
1,09 ± 0,39, ty le giam HDL - C I I 26,7%; LDL - C htiyet thanh: 2,41 ± 0,72, le tang LDL - C la 13,3%, ty le rd'i loan mpt thanh phan la 66,7%
[1]. Trong nghien cflu cua [Huynh Van Nhuan ty le rd'i loan cholesterol la 15%, triglycerid la 6,67%, HDL - C chiem 53,3%, LDL - C 1 5%.
Tri sd trung binh cua cholesterol, triglycerid, I IDL - C, LDL - C trong nghien ct'fu cua chung tdi cao hon so vdi ngtfdi binh thtfdng cung nhfl so vdi benh nhan suy than man chay than nhan tao cung dp ludi. Ty le tang cholesterol, triglycerid, LDL - C trong nghien ct'fu cua chung tdi cao hon so vdi nghien cflu cua Dinh Thi Kim Dung va Huynh Van Nhuan nghien ctfu tren benh nhan suy than man chay than nhan tao [ 1 , 2]. Ke't q u i nghien ct'fu ctia chung tdi gan gid'ng vdi nghien ct'fu cua mpt so' tac g i l khac (3, 7] I I do nhflng yeu to' dtfdc coi la I n h htfdng den ndng dp lipid m l u nhfl tudi, gidi, BMI, viec sfl dung thudc UCMD (cyclsporin, tacrolimus va cortieoid) trong nghien cflu cua chung tdi phu hpp vdi nghien cflu cua hai t i c g i l tren. Tuy nhien, ke't q u i nghien ct'fu cua chung tdi t h i p hdn nhieu so vdi nghien ctfu cua Hjelmesaeth va Teplan [5, 10] ed the do tudi tai thdi die'm ghep cung nhfl ndng dp cyclosporin trong nghien ct'fu cua Hjelmesaeth cao hon nhieu so vdi nghien ct'fu cua chting tdi, trong nghien cflu cua Teplan ngudn than tfl ngtfdi chet m i t nao, BMI r i t cao (35,5 ± 3,2) va ndng dp cyclosporin (190 ± 30 ng/ml) cao hpn nghien ct'fu cua chung tdi.
Cyclosporin difpc coi nhtf la ye'u td lam tang lipid huye't thanh hon so vdi tacrolimus [2, 6). Trong nghien ct'fu cua chung tdi, ndng dp cholesterol va triglycerid, HDL - C chtfa khac nhau d 2 nhdm, p h i i chang do trong nghien cflu cua chung tdi duy tri ndng dp cyclosporin va tacrolimus d mflc rat t h i p nen cyclosporin va tacrolimus cd I n h htfdng gidng nhau len lipid huye't thanh [7]. Tuy nhien, ndng dp triglycerid d nhdm tacrolimus cd xu hfldng cao hon so vdi nhdm cyclosporin cd the do lieu cortieoid d nhdm tacrolimus cao hon so vdi nhdm cylcosporin, cortieoid cd the lam tang tdng hdp triglycerid do lam tang hoat dpng cua insulin tai gan hoac do kich thich boat dpng cua enzym g i i i phdng triglycerid 13].
Mpt sd yeu t d lien quan de'n tang lipid huye't
thanh sau ghep than nhfl: tieu dtfdng, beo phi, rd'i loan cht'fc nang than, thudc dieti tri tang huye't I p . . . dac biet I I thud'c UCMD 14, 6]. Trong nghien ct'fu cua chung tdi, thudc UCMD caleineurin tacrolimus cd md'i tfldng quan nghich vdi ndng dp lipid huye't thanh cd the do vdi lieu Itfdng va ndng dp thudc d mt'fc cho phep nen chtfa I n h hfldng den ndng dp lipid huyet thanh. Ndng dp lipid huyet thanh (cholesterol, HDL - C) cd tfldng quan thuan vdi lieu Itfdng cortieoid, ke't q u i
nghien cflu cua chung tdi phu hpp vdi nghien ct'fu cua Despina va Mohammad [3, 7].
Cd sfl ttfong quan t h u | n chat che gifla tudi, BMI vdi ndng dp lipid huye't thanh. Ke't qua nghien ct'fu cua chung tdi phu hop vdi nghien ct'fu cua Teplan [ l O j . Tuy nhien, trong nghien ct'fu cua chung tdi ndng dp lipid huye't thanh t h i p hon so vdi nghien ct'fu cua Teplan vl tudi va BMI trung binh trong nghien cflu cua chung tdi t h i p hdn nhieu so vdi nghien ct'fu cua Teplan. ,, V . K E T L U A N . •,:<,• •, •> \r.-\<.
Tfl ke't qua nghien ci'fu thu dtfpc cho phep dtfa ra mdt so ke't luan sau:
1. Thuoc LfCMD lam tang ndng do lipid huye't thanh, mu'c do anh huo'ng cita cyclosporin va tacrolimus de'n nong do lipid huye't thanh chUa cd sU khac nhau cu the:
- Ty le tang cholesterol la 41,5%: nhdm cyclosporin chie'm 19,5%, nhdm tacrolimus chie'm 22%.
- Ty le tang triglycerid la 31,7%: nhdm cyclosporin chie'm 12,2%, nhdm tacrolimus chiem
19,5%.
- Ty le giam f l D L - C la 19,5%: nhdm cyclosporin la 12,2%, nhdm tacrolimus la 7,3%.
- Ty le tang LfJL - C la 19,5%: tang deu d c l hai nhdm.
2. Co sU tUdng quan nghjch giCi'a ndng do tacrolimus vdi cholesterol, HDL - C va LDL - C huye't thanh
Cd sfl tifong quan thuan gifla lieu cortieoid vdi ndng dp cholesterol va EIDL - C huyet thanh.
Cd sfl ttfong quan thuan gifla ndng dp albumin huye't thanh vdi ndng dp cholesterol, HDL - C v l LDL - C huye't thanh.
Cd sfl ttfong quan thuan k h i chat giifa tudi, BMI vdi ndng dd cholesterol va LDL - C.
T A I L I E U T H A M K H A O
1. Dinh Thi Kim Dung (2003). "Nghien ct'fu rdi loan lipoprotein huyet thanh d benh nhan suy than man". Luan an tien sT Y hpc, 141 trang.
2. Huynh van Nhuan (2008). "Nghien cflu ndng dp homocysteine va lipoprotein (a) d benh nhan suy than man chay than nhan tao chu ky". Tap chi khoa hpc Cdng nghe Binh Dinh, 1 pp 1 5 - 2 1 .
3. Despina N, Konstantinos G, and Moulakakis (2008). "Correlation between lipid abnormalities and immunosuppressive therapy in renal trans- plant recipients with stable renal function". Int Urol Nephrol, 40, pp, 521 - 527.
4. Djamali A, Samaniego M, Muth B, et al.
(2006). "Medical care of kidney transplant recipi- ents after the first posttransplant year". Clin J Am Soc Nephrol, 1 (4), pp. 623 - 4 0 .
5. Hjelmesaeth J, Hartmann A, Midtvedt K, et al. (2001). "Metabolic cardiovascular syndrome after renal transplantation". Nephrol Dial Transplant, 1 6 (5), pp. 1 047 - 52. •
6. McCune TR, Thacker LR, II, Peters TG, et al. ( 1 9 9 8 ) . "Effects of t a c r o l i m u s on h y p e r l i p i d e m i a after s u c c e s s f u l r e n a l transplantation: a Southeastern Organ Procurement Foundation multicenter clinical study". Transplan- tation, 65 (1), pp. 8 7 - 9 2 . ' •'
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Summary
THE CORRELATION BETWEEN SERUM LIPID LEVELS AND IMMUNOSUPPRESSIVE DOSE IN RENAL TRANSPLANTED PATIENTS
hlyperlipidemia is a frequent complication in renal transplantation. The type and level of immunosuppressive drugs used can also adversely impact post transplant hyperlipidemia. Objective: 1. Determination of serum lipid concentration in post renal transplant patients. 2. Finding out relation between of serum lipid concentration with immunosuppressive dose and another factor. Method: The research were carried out in 41 post renal transplanted patients Viei Dtic hospital; group 1: (n=22) are treated with cyclosporin; group 2: are treated with tacrolimus. Results: hypercholesterolemia were 41,5%; hypertriglyceridemia were 31,7%; elevated levels of LDL cholesterol and reduced levels of HDL cholesterol were 19,5%. There is a possitive correlation between cortieoid doses and serum lipid levels. There is a strong correlation between age, BMI and serum cholesterol, LDL - C levels. Conclusion: immunosuppressive agents are increased serum lipid levels, cyclosporin and tacrolimus have similar effect on serum lipid.
Keywords: Renal transplantation, hyperlipidemia, immunosuppressive medications