TANG HOMOCYSTEIN HUY^T THANH LIEN QUAN Vdl XQ V O A DONG MACH O B E N H NHAN SUY THAN MAN
Od Gia T u y l n \ N g u y i n Vdn Tuydn*
^Trudng Dpi hpc Y Hd Ndi. 'Bdnh vidn Da khoa Due Giang 0 bdnh nhdn suy th$n mpn (STM) giai dopn cudi Ipc mdu ehu ky, tdng ndng dd homocystein todn phan cd lidn quan vdi xa vua ddng mpch vd huyit khdi. Tuy nhidn d bdnh nhdn STM ehwa Ipc mdu ehwa dwac di cdp Nghidn cwu dwac thwc hidn nhim khdo sdt ndng dd homocystein huyit thanh d bdnh nhdn suy th$n mpn chua dieu trj thay thi vd tim hiiu mdi lidn quan gida dd ddy Idp ndi tmng mpc ddng maeh cdnh vdi ndng dd homocystein huyit thanh. Kit qud cho thiy. ndng dd homocystein d BN STM Id 26.39 ± 10.15 pmol/L cao han cd y nghia so vdi nhdm BN khdng STM (p < 0.001). Cd mdi lien quan giifa ning d0 homocystein huyit thanh vdi dd ddy Idp ndi tmng mpc cua ddng mpch cdnh theo phwang trinh tuyin tinh:
Dd ddy ndi tmng mpc (NTM) = 0.62 + 0.01'hey (r = 0.32; p < 0.05). Cd sw rdi lopn rd rdt vi ndng dp homocystein huyit thanh d bdnh nhdn suy thdn mpn. Bdnh nhdn cd ndng dd homocystein huyit thanh tdng cdng cao dd ddy Idp ndi ttung mpc cua ddng mpch cdnh cdng ddy.
Td kh6a: suy thdn m^n, homocystein, dO ddy NTM
I. DAT
VANDt
Suy thdn man (STM) lam thdn mat dan kha ndng dieu chinh thdng bing nOi mO, giam vd tien d i n m i t kha ndng bdi tilt cdc chit edn bd duge sinh ra trong qud trlnh chuyin hda, Suy thdn ndng se lam rdi logn kha ndng dilu hda kilm toan, dilu hda nudc diOn gill, gdy tdn thuang nhilu ca quan nOi tang trong ea t h l vd ddn d i n hdng logt nh&ng biln logn v l sinh hda cOng nhu Idm sdng eua ede ea quan trong ea t h l , trong dd ed sg biln ddi v l ndng dO homocystein mdu [1,5], Nh&ng nghiOn c&u gan ddy eho Uily ed mdi tuang quan gi&a tdng homocystein todn phin vd bOnh ly xa v&a mgch mdu dOng mgch vdnh, dOng mgch d n h vd dOng mgch ngogi biOn, cdc tdc gia eho ring rdi logn ch&c ndng nOi mge, phi dgi t l bdo ea tran mgch mdu, tdng hlnh thdnh ede chit oxy hod eiia lipid vd tdng ddng mdu Id cde ylu td ehlnh gdy nOn finh trgng xa v&a mgch mdu ndy [9],
Tgi ViOt Nam dd ed d l tdi nghiOn eui^ v l rdi logn homocystein d bOnh nhdn thdn nhdn tgo chu ky. Tuy nhiOn, nghiOn c&u dan thuin xem xet sg biln ddi ndng dd homocystein
huylt thanh trong STM nhung ehua d l cdp d i n mdi liOn quan gi&a sg biln ddi ndng dO homocystein huylt thanh vdi mdt sd ylu to nguy ca fim mach trong STM. Han t h l nua n l u d giai doan suy thdn sdm bOnh nhdn ehua phii lpc mdu thi sg biln ddi dd diln ra nhu t h l ndo? Chinh vl v$y nghiOn cuu ndy dugc filn hdnh vdi myc tieu: 1) Khao sdt ndng dO homocystein huylt thanh d bOnh nhdn STM ehua dilu trj thay t h l , 2) Tim hieu mdi liOn quan gi&a ndng dd homocystein huylt thanh vdi dd ddy Idp ndi trung mge cua ddng mgch cinh d nhdm bOnh nhdn nOu trOn,
II. D 6 I TU'ANG VA PHU'ONG PHAP
1. odi tugng
63 bOnh nhdn duge ehln dodn STM ehua dilu trj thay t h l vdo dilu trj nOi tru tgi khoa Thdn Tilt niOu bOnh viOn Bgch Mai bao gom 34 nam vd 29 n&. T'du chuan ehln dodn suy thdn mgn: tdn thuang thdn kOo ddi > 3 thdng, cd gilm m&c lpc c l u thdn < 30 ml/phOt.
TiOu chuln logi tru: bOnh nhdn ed mOt trong cdc bOnh sau: bOnh ly de tinh.-bOnh ly
14 TCNCYH 78 (1) . 2012
viOm man tinh di kOm, dang ed viOm nhilm d p tinh, suy thdn cap, bOnh gan nhiem sit, STM nhung da dilu trj thay t h l .
2. Phuang phdp
Su dung phuang phdp tiln c&u mO ta elt ngang.
Nghien c&u dugc tien hdnh tgi Khoa Than -Tilt nieu bOnh viOn Bgch Mai tu thdng 01/2010 d i n thdng 08/2010.
3. Quy trinh
BOnh nhdn dwgc hdi va thdm khdm theo mOt mdu benh dn riOng thilt k l phgc vu cho muc tiOu nghien c&u: Oo chilu cao, cdn ndng, filn su bOnh tdt...
Xet nghiem can lam sing Cdch lly mau xOt nghiOm:
+ Cae mdu mdu nghiOn cuu duge lly vdo budi sdng luc ddi, sau dd dugc dua ngay tdi phdng xet nghiOm trong vdng mOt vai phiit va duge bao quan d nhiet dO - 30°C cho d i n thdi dilm djnh lugng. Cae thong sd trong xOt nghiOm mau ciing dwgc lly vdo mot thdi dilm d benh nhan ehua dieu trj thay t h l than. Ngdy lay nudc filu 24h di djnh lugng mOt sd chT sd cimg ngay vdi l l y mdu lam xet nghiOm.
Xet nghiOm:
+ COng th&c mdu: Sd lugng hdng clu, huylt sic td, sd lugng bgch c l u , eOng thuc bach cau, sd lugng filu c l u .
+ Sinh hda mdu: UrO, creafinin, acid uric, dudng, diOn giai dd mdu, SGOT, SGPT, protein todn phin, albumin mdu.
+ Ojnh lugng ndng dO homocystein huylt thanh: trOn hO thdng Bayer ADVIA Centaur tgi khoa sinh hda bOnh viOn Bgch Mai theo phuang phdp miln djch huynh quang,
+ SiOu dm doppler do dO ddy Idp nOi trung mge (NTM) cua dOng mgch canh ldm tai khoa ehln dodn hlnh anh bOnh viOn Bach Mai vd do mOt ngudi Idm duy nhit (ThS, Nguyin Xudn Hiln),
4. Phuang phap xii> ly sd lieu
Su dung phan mim SPSS 18,0 d l xu ly sd liOu, Cdc thugt todn dp dung: Su dung thudt todn T - test d l ddnh gid vd so sanh cde thOng sd thuc nghiOm, sg khac biOt ed y nghTa thdng kO khi p < 0,05, Tim mdi tuang quan gi&a 2 biln bing tuang quan PEARSON (-1 ^ r < 1),
III. K^T QUA
Qua nghiOn cuu trOn 63 bOnh nhdn STM chua dilu trj loc mau chu ky, trong dd sd bOnh nhdn nam l i 34 bOnh nhdn chilm 54 %. n& Id 29 bOnh nhdn chiem 46%,
Bang 1. Mdtsd Suy than Chisd X ± S D
UrO (mmol/l)
Creafinin (Mieromol/I) Protein (g/l)
Cholesterol (mmol/l) Triglycerid (mmol/l) HDL - C (mmol/l) LDL - C (mmol/l)
dac diem v§ xet ngh Giai doan IV
(n = 11) 28.06 ± 9,60 575,91 ±244,.14
70,24 ± 7.4 5,04 ± 2,27 2,06 ± 0,77 0,99 ± 0,4 3,12±1,73
liem mau ciia nhdm benh nhdn nghien cii>u Giai doan V
(n = 52) 38,32 ±12,97 931,04 ±319,72
70,32 ± 8,27 4,31 ± 1,11 1,97 ±0.96 0,97 ±0,33 2,43 ± 0,93
Chung (n = 63) 36.53 ±12.99 869.03 ± 334,93
70,31 ± 8,07 4,45 ± 1,38 1,99 ±0,93 0,98 ± 0,34 2.55 ± 1.12
P
<0,01
< 0,001
>0,05
>0,05
> 0,05
>0,05
>0,05
TCNCYH 78 (1) - 2012 15
Ndng dO protein mdu gi&a hai giai dogn suy thdn trong nghlOn c&u khOng cd sg khde biOt vdi p > 0,05, KhOng ed sg khde biOt gi&a cde thdnh phin ciia lipid mdu d hai giai dogn suy thdn vdi p > 0,05,
2. Ndng dd homocystein h u y l t thanh d nhdm b^nh nhdn nghiOn ciru
Cf ddy ehiing tdi khdng ed dilu kiOn ldm nhdm ch&ng eho nOn lly chf sd homocystein d ngudi binh thudng (theo Huynh Vdn Nhudn ndm 2008) dugc quy wdc Id nhdm tham chilu. Tdc g i i djnh lugng homocystein cd ciing phuang phdp vdi chung tOi,
Bdng 2. Ndng d ^ homocystein h u y l t thanh d^ nhdm b^nh nhdn nghlOn cii'u vd nhdm tham c h i l u
Gid'i Nam Nir Chung
Chisd (n = 34) (n = 29) ^ nhTm°Nctmo^L) 28,20 ±12,01 24,2617,05 26,39 ±10,15 > 0,05
nhZTcTpmo^L), '^'^' ^ ' ' ' ' ^•^^ ^ ' '^^ ^'^^ ^''^^ < °-°^
p < 0,0001 < 0,0001 < 0,0001
Ndng dO homocystein huylt thanh eua nhdm STM eao han so vdi nhdm tham chilu d ca hai gidi, Sg khde biOt ndy ed y nghTa thdng kO vdi p < 0,0001.
3. Do ddy ngi trung mac dong mgch canh nghien cu>u so vd^i ngu'd^i binh thu'd'ng
O ddy chiing tdi khOng cd dilu kiOn Idm nhdm ch&ng cho nOn l l y dd ddy nOi trung mge dOng mgch canh ngudi binh (Theo Le Vdn Sy - 2000) Idm nhdm tham chilu,Trong nghiOn c&u ndy tdc gia nghiOn c&u dO ddynOi trung mac dOng mgch cinh d ngudi binh thudng vd ngudi cd ylu t6 nguy ca xa v&a dOng mach [5],
Bang 3. Dg ddy ngi trung mge d ^ n g mgch canh nghiOn c i r u so vd'i n g u d i binh t h u d n g nhdm tham c h i l u
Ddng mgch cdnh gdc
Dgng mach cdnh trong
Nhdm nghiOn c&u Nhdm tham chilu
P Nhdm nghiOn c&u Nhdm tham chilu
P
Ben phai X ± S D 0,91 ± 0,35 0,63 ±0.18
< 0.0001 1.01 ±0.35 0.89 ± 0.25
<0.01
BOn trdi X i S D 0.90 ± 0,30 0.65 ±0.19
< 0.0001 1.03 ±0,34 0,86 ± 0.29
< 0,0001
DO ddy nOi trung mge dOng mgch canh thdm dd eiia nhdm nghiOn c&u ddy han so vdi nhdm tham chilu cd y nghTa thdng kO vdi p < 0,0001.
16 TCNCYH 78(1) 2012
4. Mdi tuang quan giii'a homocystein huylt thanh vd dd ddy n$l trung mge dgng mgch canh
DO ddy dOng mgch canh gdc phai
2.S0-
2.00-
1.S0-
1.00-
0 5 0 -
OOCh 0.00
— I — 20.00
1 40.00
1 60.00
DO ddy NTM = 0,62 + OOrhey r = 0,32 v d p < 0,05
Lugng Homocystein trong mau
Bilu dd 1. Mdi tuang quan giii'a homocystein huylt thanh vd do day ngi trung mac dgng mach cdnh
Cd mdi tuang quan gi&a homocystein huylt-thanh vd dO day nOl trung mge eOa dOng mgch canh (r = 0,32; p < 0.01).
IV. BAN LUAN
Rdi loan ndng do homocystein d benh nhan suy than man: MOt han c h l ciia nghiOn c&u nay Id chua danh gid trOn nhdm eh&ng md diirig nhdm tham chilu ( nhdm ngudi binh thudng ciia tdc gia khde dd ldm) d l so sdnh vdi cung phuang phdp djnh lugng. Ndng dO homocystein huylt thanh trong nhdm bOnh nhdn STM la 26,39 ± 10,15pmol/L, cao han cd y nghTa thdng ke so vdi nhdm tham chilu 9,56
± 1,92Mmol/L (p < 0,0001) [3]. So vdi mOt sd ngniOn c&u eiia eae tdc gia nude ngoai trOn nhdm bOnh nhan suy thdn mgn giai dogn cudi loc mdu chu ky cung eho k i t qua tuang tg [7].
Tac gia Paul F. va cdng sg eho thiy ndng dO
homocystein huylt thanh gia tdng theo tudi cd y nghTa thdng kO (p < 0,001). Sg tuang quan gi&a ndng dO homocystein huylt thanh theo tudi vd gidl ehua dugc bilt mOt cdch ro rdng, cd t h l Id do ed nhilu y l u td anh hudng den sg gia tdng ndng dO homocystein, ddc biOt Id finh trang suy giam ehue nang thdn vd giam k h i ndng chuyin hda homocystein tgi thdn.
Theo Nguyen Ddc Hodng d bgnh nhdn tai biln mgch ndo, ndng dO homocystein huylt thanh d gidl nam eao han n& ed y nghTa thdng kO (p < 0,01) va ed mdi tuang quan thudn vdi tudi (r = 0,225; p < 0,01), dilu nay ed t h l do ddi tugng nghiOn c&u eiia tdc gia Id nh&ng ngudi ed dO tudi tuang ddi cao vd khOng bj suy thdn [2].
TCNCYH 78(1)--2012 17
Mdi tuang quan giiPa ndng dd homocystein vd 6g dgy Idp n^l trung mge ddng mgch cdnh: Theo tdc g l l Wilcken, mOt trong nh&ng ngudi sdm nhit ghi nhdn sg rdi logn chuyin hda methionin Id y l u td nguy ca trong bOnh mgch vdnh sdm vd ndng dO trung binh homocystein huylt thanh d bOnh nhdn suy thdn mgn lpc mdu bdng thdn nhdn tgo ehu ky tu 25 30pmol/l so vdi ngudi binh thudng Id 12 15Mmol/L. Tdc gia Kes P cQng cho thiy tdng homocystein huylt thanh d 85% bOnh nhdn suy thdn man vd ndng dO homocystein trung binh Id 24,76 ± 11,04pmol/L, Kes P nhdn thiy ring bOnh nhdn suy thdn mgn giai dogn cudi gia tdng fi 10 tu vong thudng do hdu q u i cua bOnh fim mgch, ddc biOt Id biln cd nhdi mdu ca fim [7], Manns BJ khao sdt 218 bOnh nhdn suy thdn mgn loc mdu bing thdn nhdn tgo chu ky thiy t i n suit xa v&a dOng mach chilm fi 10 45,9% vd ndng dO trung binh ciia ca nhdm Id 26,7pmol/L. Ndng dO homocystein d nhdm xa v&a dong mgch tdng eao cd y nghTa so vdi nhdm khOng xa v&a ddng mgch (p = 0,036). Tdc g i i k i t ludn ed mdi tuang quan gi&a gia tdng ndng dO homocystein huylt thanh vd xa v&a dOng mach d gidi nam bj suy thdn mgn giai dogn cudi loc mdu bdng thdn nhdn tgo chu ky, nhung khdng xay ra d gidi n& [8],
Qua nghiOn c&u trOn 63 bOnh nhdn suy thdn mgn cd muc lpc c l u thdn dudi 30 ml/ph eho thiy tgi t i t ca cdc vj tri thdm dd cua dOng mgch cinh thl dO ddy nOi trung mge cua nhdm bOnh nhdn nghiOn c&u d i u tdng eao han iio vdi nhdm tham chilu vd sg khde biOt ndy r i t cd y nghTa thdng kO (p < 0,0001) (bang 3), Wald Davi S thiy ring ndng dO homocystein toan phin llOn quan d i n t i n suit bOnh ly fim thilu mdu cgc bO (OR = 1,32; 1,19 1,45), thuyOn tie tTnh mgch sdu cd hay khdng ed nhdi mau phdi (OR = 1,6; 1,15 - 2,22) vd dOt
quy (OR = 1,59; 1,29 1,96), Gilm ndng dO homocystein todn phin 3pmol/L so vdi m&c hiOn tgi, sO gilm nguy ea bOnh fim thilu mdu cgc bO 16% (11 20%), huylt khdi tTnh mgch sdu 25% (8 38%) vd dOt quy 24% (15- 33%) .Vincent vd eOng sg nghiOn c&u bOnh nhdn STM giai doan cudi thiy ndng dO homocystein todn phin liOn quan vdi cdc biln Chung xa v&a ddng maeh vd huylt khdi, dOc ldp vdi cdc y l u td nguy ea truyin thdng vd thdi gian lpc mdu. Ty 10 eho mdi liOn quan gi&a cdc v l n d l mgch mdu vd ndng dO homocystein todn phin Id 2,9 [6).
Xa v&a dOng mach chilm ty 10 45,9% bOnh nhdn STM Ndng dO trung binh homocystein ciia tat ea nhdm Id 26,7Mmol/L Ndng dO homocystein todn phin nhdm xa v&a dOng mgch Id 28,6Mmol/L vd nhdm khdng xa vua dOng mgch Id 25,0pmol/L. Cd mdi tuang quan gi&a gia tdng ndng dO homocystein todn phan vd xa v&a dOng mgch d gidi nam lpc mdu bing thdn nhdn tgo ehu ky [8].
Theo bilu dd 1 ed sg tuang quan thudn m&c dO vua gi&a dd ddy ndi trung mge dOng mgch cinh vdi ndng dd homocystein (r = 0,32;
p < 0,05), nghTa Id ndng dO homocystein huylt thanh cdng eao thi ldp ndi trung mge dOng mgch cinh edng d l y vd nguge Igi. Phii ehdng d bOnh nhdn suy thdn mgn gdy nOn rdi loan nhilu y l u td v l sinh hda trong dd ed sg tdng lOn ciia homocystein huylt thanh dd gdp phin gdy nOn tdn thuang thdnh mgch mdu cu thl Id ldm ddy ldp nOl trung mge eiia dOng mach canh vd qud trlnh ndy se tilp tgc diln biln n$ng lOn khi muc ipc c l u thdn ngdy cdng giam di. viOc ndy cung ddng nghTa vdi qud trlnh xa v&a ddng mgch edng xay ra nhanh han vd nguy ca v l cde biln ed fim mgch xay ra ngdy edng nhilu han.
18 TCNCYH 78 (1) ^ 2012
V. K^T LUAN
Ndng dd homocystein huylt thanh d bOnh nhdn suy thdn mgn ngay d thdi dilm suy thdn ehua dilu trj thay t h l dd ed sg biln logn rO rOt (p < 0,001). KhOng cd sg khde biOt v l ndng dO homocystein d hai gidi nam vd n&. Khi suy than cang ndng ndng do homocystein huylt thanh cdng tdng, d bOnh nhdn cd ndng dO homocystein huylt thanh tdng edng eao dO day Idp nOl trung mge eiia dOng mgch cinh cdng ddy. Kit q u i ndy cung eht ra ring d bOnh nhdn suy thdn mgn ngay e l khi cd MLCT dudi 30ml/phut ede biln ed v l fim mgch se xay ra edng nhieu han ehlnh vl vdy c i n ed mpt c h l do chdm sdc kilm tra, ddnh gid vd dilu trj tich cgc ede rdi logn do suy thdn man gay ra ndi ehung vd ddc blOt la homocystein ndi riOng d l ngan ngua vd han c h l cdc biln cd fim mach eho bOnh nhdn suy than man.
Mat khac khi bOnh nhan suy than mgn den giai dogn phai dilu trj thay the bing than nhdn tgo chu ky mot v l n d l c i n dat ra Id su dgng phuang phdp loc mau ndo? Loai mdng loc ndo. hO sd slOu loc Id bao nhiOu? c h l do loc ra sao? Vdi mge fiOu nhim loai bd hiOu qua homocystein huylt thanh,dl gdp phin trdnh hoac hgn c h l cde biln cd ve fim mgch d nhdm bOnh nhdn vdn da ed nhilu nguy ca nay.
TAI LIEU THAM KHAO
1. Dinh Thj Kim Dung (2004). Suy thdn man tinh. Benh than nOi khoa, nhd xult ban Y hoc, 284 - 304.
2. Nguyin Dii'c Hodng (2007). NghiOn c&u ndng dO Homocystein mdu, mOt y l u td nguy ca d benh nhdn tai biln mgch mdu ndo tgi bOnh viOn Trung uang Hul. Lugn an tiln sT yhoc, 78-103.
3. Huynh Vdn Nhuyin (2008). NghiOn c&u biln ddi ndng dO homocystein mdu vd hiOu qua dilu trj d bOnh nhdn suy thdn mgn chgy thdn nhdn tgo chu ky. Ludn dn filn sy y hpc, chuyOn ngdnh nOi thdn filt niOu, Ogl Hpc Y Hul.
4. Ddo Bill Quy Quyln, D^ng Vgn Phudc (2005). Homocystein trong suy thdn mgn. Y hoc thdnh phd Hd Chl Minh, 9 (2), 48-52.
5. Le Van Sy (2000). NghiOn c&u dO ddy nOi trung mge dOng mgch d n h d ngudi binh thudng vd ngudi cd ylu td nguy ca xa v&a dOng mgch bdng siOu dm mgch. Ludn dn thgc sy y hpc, ChuyOn nghdnh nOi khoa, Ogl Hoe Y Hd NOI.
6. Douglas Shemin, Kate L. Lapane, Andrew G. Bostom (1998). Plasma Total Homocysteine and Hemodialysis Access Thrombosis, A Prospeefive Study. Am J Kidney Dis. Sep; 32 (3): 475-481. Medline.
7. Kes P (2000). Hyperhomocysteinemia in end-stage renal failure. Acta Med Crotia; 54 (4-5): 175-181. Medline.
8. Manns BJ, Burgess ED (1999).
Hyperhomocysteinemia and the prevalence of atheroselerofic vascular disease in patients with end-stage renal disease. Am J Kidney
Dis.OCT; 34 (4): 669.
9. Nair AP, Nemirovsky D et al (2005).
Elevated homocysteine levels in patients with end-stage renal disease. Mt Sinai J Med. Nov;
72(6): 365-373. Medline.
10. Paul F. Jacques, Irwin H Rosenberg, Gail Rogers, Jacob Selhub et al (1999).
Serum total homocysteine concentration In adolescent andadult Americans: results from the third Nafional health and Nutrion Examinafion Survey. American Journal of Cllncal Nutrifion, 3 (69), 482-489, March 1999.
TCNCYH 78 (1) - 2012 19
Summary
ASSOCIATION BETWEEN HYPERHOMOCYST(E)INEMIA AND ATHEROSCLEROTIC VASCULAR DISEASE IN
PREDIALYSIS PATIENTS
Hyperhomocysteinemia is now recognized as an independent risk factor for atherosclerotic cardiovascular disease in patients with normal renal function. Hyperhomocyst(e)inemia is common in pafients with predialysis, but still unknown in Vietnam. This study was designed to evaluate serum homocystein and look for an association between hyperhomocyst(e)inemia and atherosclerotic vascular disease in patients with end-stage renal disease (ESRD). The result indicated that plasma Hey level in prepafients was significantly higher in normal controls (26.39 ± lO.ISpmol/L, 9.56 ± 1.92pmol/L) with p < 0.001. Whereas the median serum tHcy was significanfiy higher in the pafients with thicker infima media (elM), the linear regression and correlation is CIM = 0.02 + 0.01 * hey (r = 0.32; p < 0.5). In conclusion, there is an association between hyperhomocysteinemia and atherosclerotic vascular disease in predialysis patients.
Prospective studies need to further examine the relationship between homoeyst(e)ine level and atherosclerosis with chronic kidney disease.
Keywords: chronic kidney disease, Hyperhomocyst(e)inemia
TY LE M A C HOI CHLPNG CHUYDN HOA 6* NGU'O'I TRU'DNG THANH TAI
T I N HTHAI BJNH NAM 2009
Nguyin Hodng L o n g \ Dd Dodn Lgi^, Nguyin Nggc Quang^, Le My^
'e<5 Y ti. 'Tmdng Dpi hpc Y Hd N0i
Ty lp mdc hdi ehung chuyin hod (HCCH) dang cd xu hwdng gia tdng d cdc nwdc dang phdt triin song ehwa ed nhiiu nghidn cwu d Vipt Nam. Nghidn cwu nhim muc tidu xdc djnh ty Id hidn mic HCCH vd mdt so yiu td lidn quan d ngwdi tmdng thdnh tpi tinh Thdi Binh. Kit qud cho thiy ty Id mic HCCH thay ddi tw 5,7%
theo IDF din 24,1% theo NCEP ATP III vd tdng din theo nhdm tudi vd chi sd BMI vdi hiu hit cdc tidu chuin. Mdi lidn quan gida gidi vdi HCCH rit khde nhau theo tidu chuin chin dodn. Kit ludn: Ty Id mic HCCH thay ddi rit idn tuy theo tidu chuin dwac dp dpng. Cin cd nhdng nghidn cwu, phdn tich sdu han vi tidu chuin chin dodn HCCH phu hap cho cdng ddng ddn cw d Vidt Nam.
Td khoa: HOi chirng chuyin hod, ty 10 hiOn mdc, ti§u chuln chin dodn, ngud"! truang thanh
I O A T V A N D ^ ^^^^' ^^ ^^^^ ^ *^ *^^ ^'*^' (^"^^^ ^^^ ""^
djnh nghTa thdng n h i t "HCCH Id mOt nhOm Khdi niOm HOi eh&ng e h u y i n hda dd d u g e ede rdi logn liOn quan d i n c h u y i n hda cdc b i l t d i n t& nh&ng ndm 1920 nhung d i n c h i t bao gdm rdi logn lipid mdu. bOo bung, nh&ng ndm 1980 cde fiOu c h u l n e h l n dodn tdng h u y l t dp, rdi logn glucose mdu khi eua HCCH van edn n h i l u tranh cdi. Ndm ddi" [8]. Mdc dii vdy, hiOn van dang tdn tai
~20 TCNCYH 78 (1) - 2012