Nghien ctfu dac diem lam sang, nong do dtfcfng mau, hoat do
men transaminase va bilan lipid mau o? benh nhan gan nhilm md
Clinical features, serum levels of glucose, transaminase en2ymes, lipid and insulin fatty liver diseases
HOANG TRONG THANG TnfcJng Dai hoc Y du'dc Hue Abstract
Background: Fatty liver was the consequence of many diseases in which the non alcoholic steatose fatty liver (NAFL)is very common. Most of NAFL were asymptomatic, some with slight elevation of
transaminase enzymes, but NAFL is often related to glycemia and hyperinsulinism..
Aims: To study of clinical features, serum levels of glucose, transaminase enzymes, lipid and insulin in NAFL.
Patients and methods: This study was conducted on 90 NAFL and 35 controls. Fatty liver was based on liver ultrasonography. Levels of glucose, transaminase enzymes, lipid and insulin were measured with Hitachi 704 and ELECSYS
Results: The mean belly circomference in group of NAFL is significantly higher than that in the con- trol group (84,99 ± 7,08 cm vs. 78,54 ± 8,82cm, p<0,01). Mean BMl in third degree of NAFL group is higher than those of second and first degree group (26,36 ± 0,89 vs. 26,36 ± 0,89 and 21,5 ± 2,3). Per- centage of hepatomegaly in third degree, second degree and first degree groups were 20%, 19.6% and 17.6%, respectively.
Jaundice was found in 20% and 8,8% among third and second degree group, respectively. Dyslipi- demia rate among the third degree NAFL is higher than those in the first and second degree group: 57%
with cholesterol, 52,2% with triglyceride and 46,6% with LDL-C.
Elevated transaminase enzymes with the ratio of SGOT/SGPT> 1 in the first degree, second degree and third degree NAFL, and in control group were 47%, 50%, 60% and 37%, respectively.
Mean serum insulin level in NAFL was 9,04±7,21p.U / L, which is significantly higher than that in control group, 6,375,93iJ.U/L (p<0,05).
Tom tat
Gan nhilm md(GNM) la hau qua cua nhieu benh, trong do GNM khdng do rtfdu la rat thtfdng gap.
Phan Idn khdng cd trieu chtfng, mot sd ca tang men gan nhe, nhtfng thtfdng cd rdi loan dtfdng mau va ctfdng insulin. Muc dich NC: dac diem lam sang, dtfdng mau, hoat do men transaminase, bilan lipid va nong do insulin mau d BN GNM khdng do rtfdu.
Dd'i ttfdng va phtfdng phap nghidn ctfu: 90 Bn Gan nhilm md khdng do rtfdu va 35 ngtfdi chtfng.
Chin doan GNM dtfa vao SA. Dtfdng mau, bilan lipid mau, insulin mau dinh Itfdng bang may Hitachi
TAP CHf KHOA HOC TIEU H 6 A VIET NAM 2011 - TAP VI - s 6 23 1551
704 va may ELECSYS.
Kd't qua: Vong bung nhdm GNM: 84,99cm±7,08cm, cao hdn nhdm chtfng 78,54cm±8,82cm (p<0,01).
BMI d NM dd 3 cao'hdn dd 2 va dd 1(26,36±0,89 vs 26,36±0,89 and 21,5±2,3)..
Gan Idn trong GNM do 3: 20%, do 2:19,6% va do 1: 17,6%. Vang da: 20% trong GNM do 3, 8,8%
trong GNM dd 2.
Ti le rdi loan lipid mau trong GNM do 3: cholesterol: 57%, Triglycerid: 52,2%, LDL-C: 46,6%.
Tang men gan vdi SGOT/SGPT> 1 trong GNM dp 2: 47%, va 50% trong GNM do 3, so vdi nhdm chtfng chi 37,1%.
Ndng dd insulin mau d GNM la: 9,04±7,21|iU / L cao hdn nhdm chtfng 6,375,93 |LIU / L (p<0,05).
Dat vS'n dl
Gan nhilm md (GNM) la hau qua cua rlt nhilu benh, cac benh chuyen hoa do dung thud'c va do rd'i loan dinh dtfdng. Thtfdng cd lien quan de'n beo phi, rd'i loan chuyen hda lipid va khang insulin.
Gan nhilm md thtfdng lien quan dd'n beo phi va mtfc do beo phi, stf phan phd'i md bat thtfdng d d bung (beo phi ndi tang), la stf tang ti Id gitfa vong bung va vdng mdng, lien quan nhilu de'n mtfc dd chuyen hoa md
Gan nhilm md hidn dien d 76% benh nhan beo phi, 50% dai thao dtfdng (DTD)
Gan nhilm md khdng do rtfdu dtfdc ghi nhan la cd stf gia tang cac thanh phln cua dich t l hoc cua beo phi d vung Bac My va cac ndi khac tren the' gidi. Tai Trung Qud'c ty le benh nhan gan nhilm md da tang ttt 12,5% nam 1995 len 24,5% nam 2004 [10].
Trtfdc day, gan nhilm md dtfdc xem nhtf la mdt trang thai benh ly ttfdng dd'i lanh tinh, nhifng trong gin mdt thap nien lai day, cac nha khoa hoc cung nhtf cac nhl lam sang bat dlu xem day la mdt trang thai benh ly, ma cd the tie'n trien de'n nhtfng hau qua nghiem trong nhtf viem gan md, suy chtfc nang gan, xd hoa gan...
Chi cIn chd' dd tiet thtfc giam can, thi tinh trang gan nhilm md se dtfdc cli thien rd ret.
Nhilu cdng trinh nghien ctfu cho thay ty le khang Insulin cao d ngtfdi cd gan nhilm md cd the len de'n 95% va ngtfdc lai d ngtfdi xac dinh cd khang Insunlin chie'm ty le cao d benh nhan cd gan nhilm md. Khang Insulin cd vai trd quan trong trong benh sinh dai thao dtfdng tip II [2]. Do dd chung tdi thtfc hidn dl tai "Nghien ctfu dac diem lam sang, nong do dtfdng mau, boat do men Transaminase va ndng do Insulin d benh nhan gan nhilm md",
Dd'i ttfdng va phtfdng phap nghidn ctfu
Nghien ctfu dtfdc thtfc hien tren 125 ngtfdi, bao gom nhdm chtfng 35 ngtfdi va nhdm benh 90 ngtfdi tai bdnh vien Trtfdng Dai hoc Y Dtfdc Hue' va benh vien Trung tfdng Hue' trong nam 2008-2009.
l.Tidu chua'n chon bdnh: Benh nhan GNM khdng do rtfdu
Dtfa vao hinh anh sieu am cua Hagen-Ansert vdi 2 dac diem, do hdi am gan tang va tang hut am. GNM dtfdc chia thanh 3 mtfc:
Do 1: Gia tang nhe, do hdi am Ian tda cua nhu md, mtfc do hut am chtfa dang ke, nen vln cd xac dinh dtfdc cd hoanh va dtfdng bd cua cac tinh mach trong gan.
Do 2: Gia tang Ian toa do hdi am va do hut am, kha nang nhin thly cac tinh mach trong gan bi giam nhilu.
Do 3: Gia tang rd ret mtfc do hdi am, tang do hdt am de'n mtfc khdng cdn nhan dien dtfdc dtfdng bd cac tinh mach trong gan, cd hoanh va mot phln nhu md gan d phan thuy gan phai.
Tieu chuIn loai trtf
- Gan nhilm md do rtfdu, do ddng thud'c (Steroit, valproic acid, amidarone, perhexiline, tamoxifen, catecholamin,...)
Bdnh nhan da va dang dilu tri cac benh ndi tie't lam anh htfdng de'n chuyen hoa dtfdng nhtf benh ctfc to, Gushing, ctfdng giap, dai thai dtfdng...
2. Phtfdng phap NC: Day la nghidn ctfu md ta cat ngang, benh - chtfng.
Dtfa vao tiln stf, benh stf, lam sang, can lam
sang, vdi dinh Itfdng Glucose mau luc ddi. Insulin mau luc ddi, bilan lipid mau. Bilirubin, SGOT va SGPT.
Tieu chuan chan doan beo phi: Dtfa vao tieu chuan danh cho ngtfdi trtfdng thanh Chau A Thai binh dtfdng 2005: Beo phi ddi: BMI: 25-30, Beo phidd2BMI>30...
3. Cac ky thu$t xet nghidm
3.1. Sieu dm: Stf dung may sidu §m GE 5002 cua Nh§t san xu^'t, may Siemens cua Dtfc san xua't vdi dlu do 3,5 MHz.
Chin doan hinh anh gan nhilm md tren sieu am:
Do hut am gia tang, gan tang am min va ddng nhlt.
Do hdi am tang.
Cd hien ttfdng giim am vang phia sau.
3.2. Dinh lUcfng Glucose liic doi
Xet nghiem Glucose mau theo phtfdng phap GOD-PAP/xet nghiem ho quang phd vdi kit Glucose GOD.FS tren mdy AUTOMATIC ANA- LYZER HITACHI 704 Dtfc.
Gia tri Glucose theo may la 3,05 - 6,4mmol/lIt.
3.3. Binh liMng Insulin liic doi
Theo phtfdng phap miln dich huynh quanh (ECLIA: Electric Chemi- Luminescense Immuno Assay) tren may ELECS YS 1010 tai khoa sinh hda Benh vien Trung tfdng Hue'.
3.4. Djnh lUcfng Lipid mau [13]
Dinh Itfdng TC, TG, HDL-C tren may sinh hda Hitachi 704 va thud'c thtf Boehringer Mannheim tai khoa sinh hda Bdnh vien Trung tfdng Hue' va Benh vien trtfdng Dai hoc Y Dtfdc Hue
Lipoprotein CT TG LDL-C HDL-C CT/HDL-C
mmol/1 4,37 ± 0,41 1,68 ± 0,22
2,45 1,61 ± 0,11
3,8 ± 0,55
mg/dl 169 ± 15 147 ± 20
95,7 45,1 ± 0,43
15,7 ± 0,43 Xtf ly sd' lieu: bang phln mim SPSS, Medcalc va Excel 2003.
Kd't qua
1. Cac chi so' nhan trac
Bang 3.1: Bang tri trung binh vdng bung va VB/VM
Chi so' so sanh Vdng bung
VB/VM
Nhdm GNM n=90 84,99 ± 7,08
0,88 ± 0,53
Nhom chtfng n=35 78,54 ± 8,82
0,87 ± 0,04
P 0,001 0,141 Tri sd' TB vdng bung cua nhdm GNM cao hdn cd y nghia thd'ng ke so vdi NC (p<0,01).
Tri TB ciia VB/VM 6 GNM cao hdn nhdm chtfng khdng cd y nghia thdng ke (p>0,05).
2. Gan nhilm vaS qua SA.
TAP CHf KHOA HOC TIEU H 6 A VIET NAM 2011 - TAP VI - s 6 23 1553 Bang 3.2: Ke't qua GNM qua sidu am
GNM qua SA SdBN Ti le %
GNM I 51 56,66
GNM II 34 37,77
GNM III 5 5,55 Bang 3.3: So sanh tri TB vong bung gitfa nhom GNM va nhom chtfng Phan do GNM
Nhdm chtfng GNM do I GNM do II GNM do III
Toan bd
Gl6l NAM 78,06 ± 7,04 82,97 ± 7,86 87,13 ±7,39 89 ± 1,73 82,92 ± 8,039
Gl6l N0 79 ± 10,4 83,25 ± 6,36 85,89 ±4,83 88.75 ± 5,57 83,47 ±8,188
P
0,001
Tri trung binh VB ciia cac nhdm GNM cao hdn nhdm chtfng va d ntf gidi cao hdn nam gidi trong tifng phan do GNM, cd y nghia thd'ng ke (p<0,01).
Bang 3.4: So sanh gia tri TB cac chi sd'nhSn trac gitfa nhom GNM va nhom chtfng Chi sd'
can nang(kg) Vdng bung(cm)
VB/VM BMI
GNM 1(51) 58,12±7,58'^
83,08±7,24 0,88±0,05 23,26±2,36
^ N M 11(34) 61,91±8,84
86,91±5,18 0,89±0,56 23,58±2,09
GNM 111(5) 70,40±8,73 88,91±11,78
0,9±0,03 26,36±0,89
N C(35) 55,09± 7,86
78,54±8,82 0,87±0,04 21,50±2,31
P 0,001 0,001 0,061 0,001 Tri sd trung binh cua cac chi sd nhtf can nang, vdng bung va BMI cua nhdm GNM cao hdn cd y nghia thd'ng ke so vdi NC (p<0,01).
Ty sd VB/VM cua nhdm GNM cao hdn khdng cd y nghia thd'ng ke so vdi NC (p>0,05).
2. So sanh ty Id beo phi dang nam gitfa cac nhdm theo chi sd' VB/VM
Bang 3.5: So sanh ty Id beo phi dang nam gitfa cac nhom GNM va nhdm chtfng
Chi sd' so sanh
VB/VM Nam >0,9
Ntf >0,85
GNM I n=51 n 28
%
54,9
GNM II n=34 N 19
%
55,8
GNM III n=5 n 3
%
60
Nhdm chtfng n=35 n 15
%
42,8
P
0,614
Ty le beo phi dang nam difa vao chi sd VB/VM d cac nhdm GNM cao hdn NC khdng cd y nghia thd'ng ke (p >0,05).
3. Lam sang
Bang 3.6: Lien quan gitfa lam sang va mtfc dd GNM
^ ^ ^ ^ GNM Lam s a n g ^ ^
Gan to Vang mat,vang da
Dau ha stfdn phai
GNM I n=51 n
10 0 2
%
17,6 0 3,9
GNM II n=34 N
6 3 2
%
19,6 8,8 5,8
GNM III n=5 n
1 1 1
%
20 20 20
P 0,045 0,142 0,314 Ty le gan Idn trong ttfng nhdm GNM khac nhau, cd y nghia (p < 0,05).
Ty le vang mat, dau ha stfdn phki d cac nhdm GNM khac nhau khdng cd y nghia thd'ng ke (p>0,05).
4. C§n mm sang
4.1. Ty l^ roi loan bilan lipid vd mvtc do GNM
Bang 3.7: So sanh ty Id rd'i loan ttfng thdng sd'LIPID gitfa cac nhdm
Chi sd' so sanh TG>5,2mmol/l TG>2,3mmol/l HDL<0,9mmol/l LDL>3,12mmol/l
TC(X±SD) TG(X±5D) HDL-C(X±5D) HDL-C(X±5Z))
GNM I n=51 28(56,8)
24(47) 9(17,6) 18(35,3) 5,40±2,08 2,86±1,97 1,61±2,04 2,3 ±2,31
GNM II n=34 25(73,5) 20(58,8) 7(20,5) 20(58,8) 5,74 ±1,09 2,95 ± 2,01 1,22 ±0,41 3,21 ±1,21
GNM III n=5 4(80) 3(60) 1(20) 3(60) 18,8±8,08 3,16± 1,07
1,19 ±0,57 3,03 ± 1,07
P
<0,05
>0,05
>0,05
<0,05
<0,05
>0,05
>0,05
<0,05 -Ty le rd'i loan lipid mau va tri trung binh lipid mau d cac nhdm GNM hlu he't d do III cao hdn dd II, va do I.
Ti le rd'i loan va tri trung binh Cholesterol va LDL-C trong cac nhdm nhdm GNM d do III cao hdn do II va do I, stf khac nhau nay cd y nghia thd'ng ke (p<0,05).
- Ti le rd'i loan va tri trung binh Triglycerid va HDL-C trong cac nhdm nhdm GNM d do III cao hdn do II va do I, khdng cd y nghia thd'ng ke (p>0,05).
TAP CHf KHOA HOC TifeU H 6 A VlfeT NAM 2011 - TAP VI - SO 23 1555 4.2. Men gan va mvtc dg GNM
Chdng tdi lly diem cat gidi han tren cua men gan theo tai lieu cua Huseyin Saadettin Uslusoy la 30UI/L d nam gidi va 19UI/L d ntf gidi.
Bang 3.8: Lidn quan gitfa men gan tang va mtfc do GNM
^^^^^-^.^ GNM Men g^i^....^
tang(UI/L) ^ ^ SGOT
SGPT SGOT/SGPT >1
GNM I n=51 n 26 26 24
%
50,9 50,9 47
GNM II n=34 n 18 21 17
%
52,9 61,7 50
GNM III n=5 n 5 3 3
%
100 60 60
Nhdm chtfng n=35 n
16 19 13
%
45,7 54,3 37,1
P 0,158 0,797 0,005 Ty Id men gan tang xuat hien trong cac nhdm GNM cao hdn so vdi NC khdng cd y nghia (p>0,05).
- SGOT/SGPT >1 xuat hien trong cac nhdm GNM cao hdn so vdi NC cd y nghia (p<0,05).
4.3. So sanh chi so'Glucose mau Mc doi
Bang 3.9: Cac chi sd' Glucose mau hie ddi
Chi sd so sinh
Phan do
Nhdm chtfng D p i D o l l Do III
Glucose Go < 5,6 (mmol/L)
n 25
11 7 1
%
71,4 21,6 20,6 20
mau ddi
Go > 5,6 (mmol/L) n
10 40 27 4
%
28,6 78,4 79,4 80
P
0,077
Rd'i loan dtfdng mau theo do GNM cd stf khac nhau khdng cd y nghia thd'ng ke (p>0,05).
4.4. So sanh nong dg Insulin mau liic doi
Bang 3.10: Ning dd Insulin mau luc ddi
Chi sd' so sanh
Phan do
Nhdm chtfng Do I D o l l Do III
Insulin mau lo < 4,5
n 19
8 2 0
%
54,3 16,7 6,9
0
ddi(|iU / L) lo > 4,5 n
16 43 32 5
%
45,7 84,3 94,1 100
P
<0,01
Insulin mau trong ttfng do phan do GNM cd sif khac nhau cd y nghia thd'ng ke (p<0,01).
4.5. Phan bo cac doi tUffng GNM co hoac khong tdng chi so' lo
Bang 3.11: Bang phSn bd' cac dd'i ttfdng GNM cd tang hay khdng tang lo So sanh
lo > 4,5(|iU / L) I o < 4 , 5 ( | i U / L )
GNM 80 ngtfdi (64%)
10 ngtfdi (8%)
Nhdm chtfng 16 ngtfdi (12,8%) 19 ngtfdi (15,2%)
P 0,03
- Ty Id dd'i ttfdng GNM cd cd tang Insulin cao hdn nhdm chtfng, cd y nghia thd'ng ke (p<0,05).
- Gia tri trung binh cua Glucose mau ddi trong cac nhdm GNM cao hdn NC khdng cd y nghia thd'ng ke (p >0,05).
- Gia tri trung binh Insulin mau luc ddi trong nhdm GNM chung cao hdn NC cd y nghia thd'ng ke (p <0,05).
Ban lu$n
4.1. Cac chi sonhdn trac
-Tri sd trung binh cua cac chi sd nhtf can nang, vdng bung va BMI cua nhdm GNM cao hdn cd y nghia thd'ng ke so vdi NC (p<0,01).
Tri trung binh VB cua cac nhdm GNM cao hdn nhdm chtfng va d ntf gidi cao hdn nam gidi trong ttfng phan do GNM, cd y nghia thd'ng ke (p<0.01).
Ty le VB/VM ciia nhdm GNM cao hdn khdng cd y nghia thd'ng ke so vdi NC (p >0,05). Vl chi sd BMI, theo nghien ctfu cua Biii Thi Thu Hoa:
Tri trung binh BMI cua dd'i ttfdng GNM do I la 25,08 ± 2,97, cdn chdng tdi la 23,26 ± 2,36, thlp hdn. Tri tmng binh BMI cua dd'i ttfdng GNM do II va do III la ttfdng dtfdng
Tri trung binh BMI ciia dd'i ttfong GNM ndi chung, cua chung tdi la 23,56 ± 2,30, ttfdng dtfdng cua tac gia Pham Minh la 22,65±2,39, thap hdn ,cac tac gia Ratziu va cs ( 29,10), Garcia-Monzon (50,5), Dixon va cs (47,2) va Krisi A. Virtanen (30,9).
Beo phi dang nam: Beo phi la mot trong nhtfng yd'u td gdp phln vlo cd che benh sinh cua GNM va la ye'u td nguy cd gay nen benh ly GNM khdng do rtfdu.
Chdng tdi danh gia beo phi dang nam theo WHO, dd'i vdi nam VB/VM > 90, dd'i vdi ntf VB >
85, bit ke BMI la bao nhieu.
Ke't qua cua chung tdi d bang 3.5 cho thly beo phi dang nam d nhdm dd'i ttfdng GNM dd I cd 28 trtfdng hdp, chie'm 54,9%; GNM do II cd 19 trtfdng hdp, chie'm 55,8%; GNM do III cd 3 trtfdng hdp, chie'm 60%. Tat ca dlu cao hdn nhdm chtfng (cd 15 trtfdng hdp, chie'm 42,8%), stf khac biet nay khdng cd y nghia thd'ng ke (p>0,05).
Theo Uslusoy va cs thi ti le nay la 63,6% d cac dd'i ttfdng GNM.
4.2. Bac diem lam sang
Cac trieu chtfng lam sang nhtf gan Idn, cd stf phan bd' khac nhau gitfa cac nhdm, khac nhau hlu he't tap trung d nhdm GNM nang, cu the la d GNM do III cd 1 trtfdng hdp, chie'm 20%; GNM do II cd 6 trtfdng hdp, chie'm 19,6%; GNM do I cd 10 trtfdng hdp, chie'm 17,6%; cdn d NC khdng cd trtfdng hdp nao. Sif khac nhau nay cd y nghia thd'ng ke (p <0,05).
Ti le gan to ciia chung tdi la 13,6% trong tdng sd' cac dd'i ttfdng.
Theo Stephen A.Harrison tren lam sang cd the kham thly gan to de'n 50%, theo Huseyin Saadettin Uslusoy cd 29,2% gan to tren lam sing. Cung theo Huseyin Saadettin Uslusoy cd khoang 8% benh nhan GNM cd bieu hien dau nhe ha stfdn phai.
Theo chdng tdi cd bieu hidn dau nhe ha stfdn phii d cac nhdm GNM do III 20% do II, dd I, va NC lln Itfdt nhtf sau: 20%, 5,8%, 3,9%, va 2,8%.
TAP CHf KHOA HOC TIEU HOA V I 6 T NAM 2011 - TAP VI - S6 23 1557
Stf khac nhau nay khdng cd y nghia thd'ng ke (p>0,05)
Cdn bieu hien vang mat, vang da chi thly d GNM dd III cd 1 trtfdng hdp, chie'm 20%; do II cd 3 trtfdng hdp, chie'm 8,8%. Stf khac nhau nay cd y nghia thdng ke (p<0,05).
4.3. Roi loan Lipid mau
Tri sd' trung binh cholesterol trong nhdm GNM la 6,27±3,9 cao hdn cua Bui Thi Thu Hoa la 5,65±1,35, Pham Minh la 5,96±1,18. 6 nhdm GNM cua chung tdi cao hdn d nhdm chtfng cd y nghia (p<0,05) va nd ttfdng dtfdng cac ke't qua nghien ctfu cua cac tac gia khac.
Tri sd trung binh cua Triglycerid trong cac nhom GNM chung cua chung tdi la 2,90±1,94, so vdi Bui Thi Thu Hoa 2,40±1,52 va Pham Minh 2,19±1,31. Gia tri nay cao hdn d nhdm chtfng khdng cd y nghia thd'ng ke.
Tri sd trung binh cua LDL-C d nhdm GNM ciia chdng tdi ttfdng dtfdng vdi Bdi Thi Thu Hoa 3,43±1,13 va cua Pham Minh 3,66±0,99. Gia tri nay nhd hdn gia tri trung binh cua nhdm chtfng.
Stf khac biet nay cd y nghia thd'ng ke.
Tri sd trung binh HLD-C d nhdm GNM cua chdng tdi la 1,44±1,56, la cao so vdi nhdm chtfng, khdng cd y nghia thd'ng ke (p>0,05). Ttfdng dtfdng so vdi Bui Thi Thu Hoa 1,24±0,50 va Pham Minh 1,41±0,62.
Kd't qua: Rd'i loan lipid d nhdm GNM cd Triglycerid >2,3mmol/l la 6% so vdi nhdm chtfng 9,6% vdi (p>0,05).
Rdi loan lipid d nhdm GNM cd TC >5,2 mmol/1 trong nhdm GNM hdn nhdm chtfng, cd y nghia vdi (p<0,05).
Ty le rd'i loan LDL-Cholesterol trong nhdm GNM hdn nhdm chtfng (33,6% so vdi 8%) cd y nghia vdi (p<0,05).
Ty le rd'i loan HDL-Cholesterol trong nhdm GNM cao hdn nhdm chtfng (13,6% so vdi 4%) khdng cd y nghia (p>0,05).
4.4. Nong dg Glucose mau luc doi (GO) Chung tdi chon mtfc Glucose mau Idc ddi
>5,6mmol/l de nghien ctfu tinh trang rd'i loan dung nap Glucose mau ddi.
Qua bang 3.17 chdng tdi thly rang gia tri GO
gidi han tren la 23,3mmol/l va gidi han dtfdi la 3,5mmol/l. Hai gia tri trung binh cua ca hai nhdm bdnh-chtfng tuIn ttf la 6,418±3,93mmol/l so vdi 5,171±l,82mmol/l cd khac nhau, va stf khac biet nay cd y nghia thd'ng ke.
Ke't qua cua chung tdi cung ttfdng tif khi so vdi ke't qua nghien ctfu cua Pham Minh glucose mau luc ddi d hai nhdm benh-chtfng tuIn ttf la 5,45±l,13mmol/l so vdi 4,93±0,69mmol/l, ttfdng dtfdng Trin Thtfa Nguyen la 5,98±2,53mmol/l so vdi 4,62±0,63 mmol/1.
4.5. Nong do Insulin mau doi (10)
Trong nghien ctfu nay, chung tdi phan chia nong do insulin mau theo cac mtfc gia tri: Idn hdn, nhd hdn hoac bang 4,5mmol/l
Gia tri trung binh lo cua ca hai nhdm benh- chtfng tuIn ttf la 10,08±7,425mmol/l so vdi 6,3745±934mmol/l cd khlc nhau, va stf khac bidt nay cd y nghia thd'ng ke (p <0,05).
Ke't qua lo trong bang tren cho thly cd stf khlc nhau gitfa cac tac gia. Ly giai cho dilu nay cd thd do cd stf khac nhau vl do tudi va chiing tdc trong nhdm chtfng cua mdi nghien ctfu.
So vdi cac tac gia nhtf trong bing 4.1 thi hlu nhtf cac tac gia dlu cho ke't qua lo tren dd'i ttfdng GNM dlu cao hdn trong nhdm chtfng mot each cd y nghia.
Ke't lu§n
Qua nghien ctfu 90 benh nhan bi gan nhilm md khdng do rtfdu va 30 ngtfdi chtfng, chung tdi cd nhtfng ke't luan nhtf sau:
- Tri trung binh vdng bung d cac nhdm gan nhilm md (84,99±7,08), cao hdn nhdm chtfng (78,54±8,82). Sif khac nhau nay cd y nghia (P<0,01).
Tri trung binh cua BMI cua cac nhdm do III (26,36±0,89) cao hdn cac nhdm khac: dd II (26,36±0,89), do I (23,26±2,36) va nhdm chtfng (21,5±2,3). Stf khac nhau nay cd y nghia (P<0,01).
Gan to trong nhdm gan nhilm md do III (20%), cao hdn cac nhdm khac: do II (19,6%), dd I (17,6%). Stf khac nhau nay cd y nghia (p<0,05).
vang mat, vang da trong nhdm gan nhilm md
dd III (20%), cao hdn do II (8,8%). Stf k h a c nhau nay khdng cd y nghia (p>0,05).
- Dau ha stfdn phai trong n h d m gan n h i l m md do III (20%), cao hdn cac n h d m khac: do II (5,8%), do I (3,99%) va n h d m chtfng (2,8%). Sif k h a c nhau nay k h d n g cd y nghia (p>0.05).
Ti Id rd'i loan Upid mau va tri trung binh Upid mau d cac nhdm GNM do IH cao hdn dp II va dp I.
Rd'i loan lipid m a u trong n h d m G N M nhtf sau:
cholesterol toan p h l n (57%), triglycerid (52,2%), H D L - C (18,9%) va LDL-C (46,6%).
SGOT/SGPT > 1 d n h d m gan n h i l m m d dp I la 4 7 % ; dp II la 5 0 % ; dp III 6 0 % va n h d m chtfng 3 7 , 1 % . Sif k h a c nhau nay khdng cd y nghia (p<0,05). ^
Tri sd' trung binh Insulin trong gan n h i l m m d (9,04±7,21) cao hdn n h d m chtfng (6,375,93). Stf k h a c nhau nay cd y nghia (p<0,05) •
Tai li$u tham khao
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