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MOI Tt/ONG QUAN GlCfA DO DAY LC(P NOI TRUNG MAC DONG MACH CANH VCil CAC YEU TO NGUY CO V O A \p MACH MAU 6 PHU NLf MAN KINH MAC H O I C H I J N G CHUYEN HOA
T R A N OINH DAT, T R A N NAM VIET H O N G Trddng CDYT Binh Dinh, BVDK thh Binh Dinh
1. DAT VAN DE 3. KET QUA NGHIEN CCJfU
Mdt sd nghien cifu g i n d i y ghi 3.1. TUdng quan hdi quy ddn bien giOa IMT vdi cac YTNCMM n h i n cd tl le tang dang k l hdi ^ ^ . ^ ^ ^ ^ . . ^ ^ ^ ^ ^ ^ ^ ^ ^^. ^ ^ chO^ng chuyen hoa (HCCH) d phu yTNCMM
nO man kinh (PNMK). Tgi Viet Nam, tuy chUa cd sd lieu thd'ng ke cy the nhUng chac chan sd ngudi m i c HCCH dang tang len.
Sd PNMK chet do benh tim mgch cao g i p 10 lan ung thu vu.
Cac bien p h i p can thiep nham g i i m cac y l u td nguy cd cua benh ly tim mgch d PNMK se mang Igi Ipi ich Idn cho sufc khde cdng ddng.
Sieu am vdl dau dd>7.5 MHz cd thd nhin thay va do dupc cac Idp cua thanh ddng mach v i b l day cua m i n g vCTa xd (MVX), vi vay cd the phat hien sdm cac tdn thUdng thanh mgch. Dieu nay cd y nghTa r i t quan trpng vdi cac t h i y thudc lam sang trong viec nghi§n ciiu mdi lien quan giiJa vQa xP ddng mach vdl cac yeu td nguy cd mach mau {YTNCMM) nhlm de ra cac bien phap dy phdng, dieu tri tich cyc lam giam hoac m i t cac y l u td nguy cd de gop p h i n lam giam ti le m i c benh tim mach.
Tif thyc te tren chung tdi thUc hien de tai nay vdi myc tieu: K h i o sat mdi tuong quan giOa dp day Idp ndi trung mac ddng mach c i n h chung vdi mpt sd y l u td nguy cd mach mau gdm: tudi, tudi man kinh, thdi gian man kmh, huyet ap, vdng bung, lipid mau, glucose mau, hsCRP, insulin, estrogen, va lestosteron.
2. PHUONG P H A P , D O I TUONG NGHIEN ClJfU: Gdm 130 PNMK m i c HCCH tgi Benh vien Da khoa tinh Binh Dinh tif thang 04 den thing 09 nam 2011.
liUT Cac chi tieu
Tudi (nam) Tudi man i<inti (nam)
Thdi gian man l<inh (TGMK), (nam) Huyet ap tam thu (HATT), (mmHg) l-luyet ap tam trudng (HATTr) (mmHg) BH/II (Kqlnf)
Vong bung (VB) Estradiol (pg/ml) Testosterone (ng/ml) Insulin (ItLII/ml) Glucose (mmol/L) Cholesterol toan phan (mmol/L) HDL-C (mmol/L)
Triglycerld (mmol/L) LDL-C (mmol/L) hsCRP (mg/L)
iiUT BMCC (m=130) r
0,190 - 0.142 0,244 0,313 0,314 0,094 0,394 -0,162 - 0,086 0,291 0,119 0,087 -0.312 0,234 0,119 0,305
P
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IMT ddng mgch c i n h chung tUdng quan thugn vdi tudi; TGMK; HATT;
HATTr; VB; insulin; TG; hsCRP va tUdng quan nghjch HDL-C. IMT DMCC khdng cd tUdng quan vdi TMK, BMI, estradiol, testosterone, glucose mau luc ddt, CT, NonHDL-C va LDL-C
3.2. Mpt vai dd thj tUdng quan hdi quy ddn bien giQa IMT vdi cac YTNCMM (Xem trang 13)
3.3. TUdng quan hdi quy da bien giCfa IMT vdi cac YTNCMM Bang 3 2- TUdng quan hdi quy da bien giOa IMT DMCC vdi cic YTNCMM
(Constant) TGMK (nam) HATT (mmHg) VB (cm) Insulin pU/ml HDL (mmol/L) TG (mmol/L)
B -0,266 0,005 0,002 0,005 0,003
•0,117 0,013
P
0,182 0,216 0.197 0.175 - 0.237 0.148
t
2.555 2.938 2.198 2.208
• 3,237 1,993
P
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D6 th! 3.1: Tuang quan IMT DMCC vdi thdi gian man kinh 6 PNMK m l c H C C H , IMT c o tUdng quan t h u a n vdi T G M K
n = 130, r = 0,244, p < 0 , 0 0 1 , y = 0,007x + 0,744
Do thi 3.2: TUang quan IMT DMCC vdi vong bi^ng 6 PNMK m i c H C C H , IMT co tUdng quan l h u | n vdi VB
n = 130, r = 0,394, p < 0 , 0 0 1 , y = 0,009x + 0,048
HuyH t t m t b n Vw (ninHfl)
DS thj 3.3: Tuang quan IMT DMCC vdi huyS't ap tim thu d PNMK m i c H C C H , IMT co tUdng quan thuSn vdi HATT
n = 130, r = 0,313. p < 0,001, y = 0,003x + 0,343
D6 thi 3.4: Tuang quan IMT DMCC vdi nong d^ HDL-C 6 PNMK mk: HCCH, IMT co tUOng quan nghich vdi HDL-C
n = 130, r = -0,312, p < 0 , 0 0 1 , y = -0.154x + 0,987
Q u a k h i o s a t t u o n g q u a n h d i q u y d o n b i l n , x a c d i n h y l u t d n a o c d t U d n g q u a n v d i d p d a y I d p n d i t r u n g m g c ( I M T ) , t i l n h i n h k h i o s i t t U o n g q u a n h d i q u y d a b i e n giOa I M T v d i c a c y e u t d n a y , c h u n g t d i n h a n t h a y I M T ch? t U d n g q u a n c d y nghTa t h d n g k e v d i m d t s d y e u t d n g u y c d ' t u o n g q u a n n g h i c h v d i n d n g d p H D L - C , v i tUPng q u a n t h u a n v d i H A T T , V B , T G M K , n d n g d p i n s u l i n m a u l u c d o i v a T G .
T i r g i a trj t u y ^ t d d i c u a h e s d p, x e t c a c y e u t d n g u y c d c d mUc a n h h u d n g l a m t a n g I M T n h i l u n h l t t h e o t h d t i ; l a : g i i m n d n g d p H D L - C , t a n g h u y l t i p t a m t h u , t a n g v d n g b u n g , t a n g t h d i g i a n m a n k i n h , t a n g n d n g d d I n s u l i n m a u lOc d d i v a t a n g T G .
P h U d n g t r i n h tUOng q u a n h d i q u y d a b i e n giOa I M T v d i c a c y l u t d n g u y c d m g c h m i u t r e n d U p c b i l u d i l n n h u s a u :
y = 0 , 0 0 5 X ( T G M K ) + 0 , 0 0 2 x ( H A T T ) + 0 , 0 0 5 x (VB) + 0,003 x (Insulin) - 0 , 1 1 7 x ( H D L - C ) + 0 , 0 1 3 x ( T G ) - 0 , 2 6 6 4 . K ^ T L U A N
D d d i y I d p n d i t r u n g m g c d d n g m g c h c i n h c h u n g d p h u nO m a n k m h m i c h p i chiTng c h u y i n h d a , t U d n g q u a n t h u ^ n v d i t u d i , t h d i g i a n m a n k i n h , v d n g b y n g , h u y l t a p t a m t h u , h u y l t i p t a m t r U d n g , t r i g l y c e r l d , i n s u l i n , h s C R P ; v a t U d n g q u a n n g h j c h v d i l i p o p r o t e i n t l t r p n g c a o . T r o n g d d g i i m n d n g d p l i p o p r o t e i n t? t r p n g c a o , t a n g h u y l t a p t i m t h u , c 6 m d c d d i n h h U d n g l i m t a n g I M T n h i l u h d n s o v d i c a c y l u t d n g u y c d k h a c . n
