Y Hoc T P . H o C h i M i n h * T a p 15 * So 2 * 2011 N g h i e n ciiu Y h o c
KHAO SAT PHU HOANG DIEM TRONG BENH LY VONG MAC DAI THAO DtfdNG BANG CHUP C A T L 6 P VONG MAC OCT
Vo Quang Hong BiAn*, Vo Thi Hodng Lan*, Nguyin Xuan Truang*
TOM TAT
Muc tieu: Khao sdt phu HD trong benh ly vong mac ddi thao dieang (DTD) bang chup cSt lap vong mac OCT.
Phucnig phdp: Nghien cieu tim cieu, cdt ngang, mo td cd ph&n tich hang loat ca benh nhan ddi thdo duong.
Benh nhan se duoc do thi luc kinh, kham l&m sdng, chup OCT HD vd chup mach huynh quang dekhdo sdt vung hodng diem.
Kei qud: Nghien cieu gom 267 mat cua 146 benh nhan vai ty lephii HD phat hien tren lam sdng Id 27%, ty lephit HD ti-en OCT Id 36%, ti-ong do phu nhe chiem 49%. phii trung binh 26%, vaphu nang 25%. Kliidgddy ti-ung binh vong mac HD £219 hoac > 320pm, thi co sie nhat tri cao giiea chan dodn phii HD tren l&m sang vai phii HD ti-en OCT.
K^ luan: OCT la phuang tien khdch quan dechah dodn vd theo doi phii HD do DTD nhieng kham day mat bang sinh hien vi vdi kinh Ididng tiep xdc van con co gid tri lam sdng.
Tie khoa: Phu hodng diem, bSnh ly vong mac, ddi thdo duong, chup cat lop vong mac.
ABSTRACT
USING OPTICAL COHERENCE TOMOGRAPHY (OCT) TO STUDY THE DMBETIC MACULAR OEDEMA
Vo Quang Hong Diem, Vo Thi Hoang Lan, Nguyen Xuan Tmong
* Y hoc TP. Ho Chi Minh * Vol. 15 - No. 2 - 2011:106 - 111 Purpose: Using Optical Coliei'ence Tomography (OCT) to study the diabetic macular oedema.
Method: Prospective, cross sectional - descriptive study with analysis in diabetic patients. These patients have had corrected visual acuity, clinical examination, OCT and Fluorescein fundus Angiography was used for macular analysis.
Result: Study in 267 eyes of 146 diabetic patients: clinical macular oedema is 27%, macular oedema in OCT is: "36% (mild:49°/o- modci-ate: 26% - sroei-e: 25%). Y^/hen the macular thickness is <219 or > 320pm, we found the agreement between clinical macular oedenm and OCT macular oedema.
Conclusion: OCT is an objective method for diagnosis and fbllow-up didactic macular oedema. However clinical examination with non contact lense still have the clinical value.
Key words: macular oedema, diabetes. Optical Coherence Tomography (OCT)
D A T V A N DE nhan dai thao duong (DTD) typ 2(*'"i. Tren lam sang, de chain doan phu hoang diem, can Phil hoang diem (HD) la nguyen nhan gay ^^ ^ ^ ^ ^ ^^^ p ^ ^ ^ ^ ^ ^ . ^ ^^ , ^ ^^^ ^ . ^ ^^^^
giam thi luc thuong gap nhat doi voi benh ^^^^ ^ . ^ ^.^^ ^^. ^ . ^ ^ ^ ^ . ^ ^...^ ^.^ ^^.
* Bo mfln Mat - Dai hpc Y Dirge TP H(:M
Tdcgid lien l^c: BS Vd Quang H6ng Didm. Email: [email protected]
107
Nghien c u u Y hpc Y Hpc TP. H o Chi M i n h * Tap 15 * So 2 * 2011
day mat gian tiep hay chup day mat hinh noi.
Mac dii 2 cauch kham day mit tren gan nhu duoc chap nhan la tieu chuan vang hay tieu chuan vang tren lam sang trong danh gia phu hoang diem, chung eo khuyet diem la chu quan, dinh tinh, doi hoi nguoi quan sat phai CO ky nang tot va kinh nghiem nhieu ciing nhu nguoi benh phai hop tac tot'i""'. Gan day, voi ky thuat chyp dinh khu su dung song anh sang co dp ket hgp thap OCT (Optical Coherence Tomography) hay goi gon hon va de hinh dung hon la ky thuat chup dt Idp vong mac OCT, ta co the de dang khao sat do day vong mac HD va tinh trang phii HD.
Thai gian de thue hi^n mpt lan ehyp cat lop vong mac OCT chi khoang 5-10 phiit (bao gom ca huong dan b^nh nhan)t'-3'5).Trong nghien cuu nay, ehung toi khao sat phii HD trong benh ly vong mgc dai thao duong bang chyp eat lop vong mac OCT nham khSng dinh uu diem cua phuong phap moi nay so voi phuong phap kham lam sang.
DOIIL/ONG -PHU'ONG PHAP NGHIENCUlJ Doi tupng nghien cuu la cae benh nhan DTD dang dieu tri b|nh DTD. Nghien cuu loai trir cac doi tupng sau: seo giac mac, due thuy tinh the, xuat huyet pha le the n3m tren true thi giac, mang truoc vong mac hoang diem, phu gai thi, CO cae benh khac ve vong m^c (thoai hoa hoang diem, tac ffnh maeh vong mac, lo HD...), viem npi nhan va da co laser quang dong vong mac hay phau thuat npi nhan.
Phuong phap nghien cuu la tien euu, cat ngang, mo ta co phan tich hang loat ca. Cac benh nhan se dupe khai thac benh sir de ghi nhan cac bien so nen trong do quan trpng la loai DTD, thoi gian mSc b?nh D7B va tinh trang Idem soat duong huyet. Benh nhan dupe do thi lue kinh, kham mat bSng kinh sinh hien vi voi kinh khong tiep xuc Superfield de danh gia phii hoang diem, dp nang eiia benh VMDTD, chup mach huynh quang, \'a chup OCT hoang diem.
Do chua CO so lieu dp day HD 6 nguoi Viet nam binh thuong, nen chung toi co thue
hien them mpt mau tham khao nho gom 30 nguoi binh thuong.
KET QUA NGHIEN CUtJ
O mau tham khao, chiing toi Ihu dupe ket qua nhu sau:
Bang 1: Dd day vd the tich vong nmc viing HD dia mat ngii'di binh thuang trong man tham Idido (n=60).
Gia tri ->
Dp d^y (tjm) Chinh gifra hoang
diem HDImm
The tich (mm')
HDImm H03mm HD6mm
TB ± BLC
144 ± 1 9 181 ± 1 8 0 1 4 2 ±
0 014 1,794±0.
094 6, 728 * 0,
358 Nho nhit
94 143 0. 112 1,590 5,936
L6n Nhit (1) 184 219 0,171 1,940 7,318
T B + 2 DLC (2)
182 217 0,170 1,982 7,444 Can o i vao ket qua dp day va the tich vong mac oia mat nguoi binh thuong trong mau tham khao, chung toi chpn miic gioi han giiJa vong mac binh thuong va vong mac phii la gia tri Ion nhat (1) hoac gia tii "TB+2DLC" (2) neii gia tri nao Ion hon. Cu the nhu sau:
Do day:
Chinh giua hoang diem: 184 \xm HDImm: 219 |jm
The tich:
HDImm: 0,171 mm=
HD3mm: 1,982 mm' HD6mm: 7,444 mm'
Mau nghien cuu gom 146 benh nhan (gom 267 mat) dupe kham lam sang va chup OCT, CO 105 benh nhan (gom 189 m5t) dupe chup m^ch huynh quang. Co 25 b#nh nhan chi duoc khao sat 1 mat vi mat kia khong thoa man tieu chuan chpn vao mau nghien cuu.
Tuoi trung binh cua nguoi trong mSu ngliien cuu la 56,3 tuoi (95%CI-54,8-57,8). Benh nhan nho tuoi nhat la 26 hioi. Ion hioi nhat la 73 tuoi. Trong mau nghien ciiu co 92 benh nhan nii (chiem 63%). Thoi gian phat hien mSc benh DTD
Y Hpc TP. Hb Chi Minh * Tap 15 * So 2 " Nghien ahx Y hpc
trung binh cua benh nhan trong mau nghien cuu la 8,2 ± 5,7 nam; ngSn nhat la 1 nam va dai nhat la 24 nam. Co 15 benh nhan DTD type 1 (chiem 10,3%) va va 131 benh nhan DTD type 2 (chiem 89,7%). Thoi gian phat hien mSc benh DTD 6 benh nhan DTD type 1 la 7,8 + 5,0 nam va type 2 la 8,2 + 5,8 nam. Thai gian phat hien mac benh D I D trung binh 6 benh nhan chua co benh VMDTD (4,9 ± 3,8 nam) ngan hon o benh nhan da co benh VMDTD (9,6 ± 5,7 nam) (kiein dinh Marm-Whitney, p<0,05). Co 84 benh nhan kiem soat duong huyet tot (chiem 57,5%), 33 Idem soat chua tot (chiem 22,6%) va 29 khong ro (chiem 19,9%). Trong nghien ciiu: 85 mat chua CO benh VMDTD (chiem 32%), 140 mSt co benh VMDTD khong tang sinh (chiem 52%) va 42 mat CO benh VMDTD tang sinh (chiem 16%).
Bang 2: Phan ho mire do benh VMDTD theo phan loai benh DTD
Phan d$
VMDTB Chu'a c6 VMDTB VMDTD Ishong
TS VMOTBTS
Tong so
Phin lo^i b#nh DTD Type1
0 8 (31%) 18 (69%) 26
Type 2 85 (35%) 132 (66%) 24(10%)
241
T6ng s6 85 (32%) 140 (52%) 42 (16%)
267 Kham lam sang bang den khe voi kinh khong tiep xiic, co 194 mat dupe danh gia la khong CO phii HD(chiem 73%), 60 mSt dupe danh gia la co phii HD (chiem 22%) va con lai 13 mk (chiem 5%) nghi ngo eo phii hoang diem.
Neu tinh gop nghi ngo la co thi ty le phii ¥S) tren lam sang cua mau nghien cuu la 27%. Ty le phii HD 6 benh nhan DTD type 1 la 77-81% (neu tinh gpp nghi ngo) cao hon nhieu so voi type 2 la 17-22%. 6 85 mk chua co benh VMDTD khong thay co phii HD tren lam sang. Ty le phii HD tren lam sang cang tang khi benh VMDTD cang nang. 6 mat co phii HD tren lam sang, so m i t CO benh VMDTD khong tang sinh va tang sinh gan tuong duong nhau.
Chi CO 105 b | n h nhan dupe chup mach huynh quang bao gom 189 mk. Trong so do CO 50 mat (chiem 26,5%) khong co ro huynh quang va 139 mat (chiem 73,5%) co ro huynh
quang tai hoang diem. Trong 50 mat khong co ro huynh quang, co 25 mat (50%) chua co benh VMDTD va 25 mat (50%) eo benh VMDTD khong tang sinh. Doi voi 139 mat co ro huynh quang, 97 mat (70%) co benh VMDTD khong tang sinh va 42 mk (30%) co benh VMDTD tang sinh. Dang chii y la toan bp 42 mk eo benh VMDTD tang sinh ciia mau nghien cuu deu co ro huynh quang tai hoang diem.
I
rin
Biew do 1: Phan bophii HD tren LS theo mite do benhVMDTD
Bang 3: Phan barb huynh quang theo mite do VMDTD
Chup mach huynh quang Khong ro
Coro Tong so
Phan do benh VMBTB Chu'a CO
25 (100%)
0 25
Khong TS 25 (20%)
97 (80%) 122
TS 0 42 (100%) 42
T6ng s6 50 (26%
)
139 (74%
189
)
Doi chieu voi chan doan phii HD tren lam sang, ta thay toan bp 50 mat khong co ro huynh quang deu dupe nhan dinh la khong CO phu HD tren lam sang. Doi vdi 139 mat eo ro till CO 66 mat khong c6 phii, 60 mat eo phii va 13 mat nghi ngo eo phii HD tren lam sang.
Bang 4: Phan bo do huynh quang theo tinh trang phii HD ti-en LS
Chup mach huynh quang
Khong do Co do
Phu HB tren LS Khong co
50 (43%) 66 (57%)
Nghi ngo*
0 13(100%)
Co 0 60 (100%)
T6ngs6 50 (26%) 139 (74%)
109
N g h i e n cmi Y hpc Y Hpc TP. H o Chi M i n h • Tap 15 * So 2 * 2011
I T6ngs6 | 116 | 13 | 60 | 189 | Chung toi de nghi phan loai phii HD tren OCT dua vao dp day vong mac (^m) vimg HDImm nhu sau:
< 219: chua co phii HDtien OCT 220-319: phii HD nhe tren OCT 320-419: phii HD trung binh tren OCT
> 420: phii HDnang hen OCT
Bang 5: Chan dodn phii HD tren OCT vd tren lam sang
PhilHB trenLS Khong CO
phu Nghl ngff
Cophij Tong so
Phu hodng dilm tren OCT Chua CO
5 219"
162 7 J 1 170
PhCinh^
220-319''' 31 4 13 48
PhuTB 320- 419"
1 0 24 25
Phu n^nga
42ff"' 0 2 22 24
Tong 56
194 13 60 267 Ta thay khi dp day trung binh vong mac HD<219 hoac >320|nn, thi co su nhat tri cao giiia chan doan phii HD tren lam sang voi phii HD tren OCT. Trong khi neu HD eo phii nhe tren OCT CO den 65% truong hpp dupe danh gia la khong CO phii tren lam sang.
Bang 6: Chan dodn phii HD tren OCT vd tren l&m
a i S o
Co phu Khengco
phii T(5NG
Phil HD trenLS C6phLi
65 8 73
Khong phu 32 162 194
T6NG 97 170 267 Neil xem OCT la phuong tien khach quan, dang tin cay trong chah doan phii hoang diem, ta CO the tinh dupe dp nhay cam va dp dac hieu cita phuong phap danh gia phii HD bang den khe voi kinh khong tiep xiic dua vao ket qua neu ra trong bang sau:
Dp nhay cam: 65/(65+-32) = 5%
Dp dae hieu: 162/(8+162) =95%
Dp chinh xac: (65+16)267 = 85%
He so Kappa: 0,659 He so Phi: 0,672
19 mat CO co keo pha le the hoang diem. Dp day vong mac HD trung binh oia nhimg mk nay la 392 + 104(am, khac co y nghia thong ke (t- test, pO,05) so voi nhiing mat khong co co keo (240±li4um). Tat ca cac mk co eo keo pha le the HD deu CO phii HD tren OCT. D§c biet tiong 9 mk chua co benh VMDTD nhung co phii HD (nhe) tren OCT, 3 mat (chiem 33%) co eo keo pha le the - hoang diem.
BAN LUAN
Ty le phii HD tren lam sang ehung oia mau nghien euu la 22%-27% {neii gpp luon nhung truong hpp nghi ngo). Ty le nay cao hon nhieu so voi ty le 9% theo tac gia BresnickP'. Nguyen nhan co le do so benh nhan co giam thi lue do phu HD den kham nhieu hon so benh nhan chua CO giam thi luc. Mot nguyen nhan khac co the la do each lay mau khac nhau. Ty le phii IiE)tren lam sang 6 nhom mat chua co benh VMDTD, CO benh VMDTB khong tang sinh, tang sinh Ian lupt la 0%, 23%, va 67%. Trong bai tong quan ve phii HD do DTD, sau khi tinh toan, tac gia Bresnick da neu ty le phii HD khi co benh VMDTD khong tang sinh nhe la 3%, khong tang sinh trung binh - nang la 38%, va tang sinh la 71%. Nhu v$y, ty le trong mlu nghien euu eiia chung toi cung tuong tu. Ty le nay giai thich tai sao phii HD la mpt trong nhiing nguyen nhan chii yeii gay giam thi luc 6 benh nhan DTD va cho thay 1am quan trpng ciia viec dieu tri phii HDDTB khi benh VMDTD cang nang.
Ty le ro huynh quang tai HD 6 nhom mat chua CO benh VMDTD, eo benh VMDTD khong tang sinh, tang sinh lan lupt la 0%, 80%, va 100%. Dieu nay phii hap voi co che benh sinh oia benh VMDTD va chung to khi benh VMDTD cang nang thi hang rao mau vong mac bi ton thuong cang ro. Nhiing m5t khong eo ro huynh quang tai HD khong thay co phii HD tren lam sang. Dieu nay hpp ly vi co che ciia phii HD la do ton thuong hang rao mau vong mac - bieu hien bang ro huynh quang tren chup mach huynh quang. Ngupc lai, eo 47% mat co ro
y H o c TP. H o C h i M i n h * T a p 15 * So 2 * 2011 N g h i e n cihi Y h o c huynh quang tai t © nhung khong co phii HD
tren lam sang co le do hang rao mau vong mac da bi ton thuong nhung cac thanh phan ciia vong mac v3n con hoat dpng bit trii dupe de giii cho vong mge khong bi phii''''^'**.
Ty le phii HD tren OCT 6 cae nhom mat co benh VMDTD 6 cac giai dogn khac nhau thi cao hon ty le phii HD tren lam sang. Trong so nhiing mat co benh VMDTD khong tang sinh, CO 20 mat khong co phii HD tren lam sang nhung CO phii HD tren OCT; 19 mat thupc nhom phii nhe (dp day ¥E) trong khoang 220-319^im), va 1 mat phii trung binh (dp day TE)380|jm).
Dieu nay cijng phii hpp vi kham lam sang de bo sot nhiing truong hgp phii nhe va cho thay eo the OCT la phuong phap nhay cam hon trong phat hien phii hoang diem.
Chiing toi nhan thay chan doan phii HD tren lam sang va tren OCT thong nhat nhau khi dp day HD binh thuong (< 219pm) hoac khi tang trung binh va nang (> 320 (Jm). Tuy nhien, chah doan phii HD tren lam sang va tren OCT khong thong nhat nhau khi dp day HD tang nhe trong khoang 220-319fim. Nhieu tac gia cung nhan thay khi dp day HD tang nhe thi kham lam sang kho phat hien dupe. Tac gia Brown va cs nghien euu 172 mat va cho biet kham mat bing den khe voi kinh tiep xiic khong the phat hien phii HD 6 77% truong hop do day vong mac tang nhe (200-300|am, luu y: miic gioi han binh thuong-phii chpn la 200|jm)P'^'5'. Ket qua ciia chiing toi la 65% mac dii chiing toi sir dung kinh khong tiep xiic co the la do khi kham chung toi biet truoc thi luc da co ehinh kinh ciia mpt so benh nhan va bi anh huong trong liic kham danh gia. Chiing toi da b'nh dupe dp phii hpp quan sat (observed hay raw agreement) eiia hai phuang phap danh gia HD phii (kham bang den khe voi kinh khong hep xiic va chup cat lop OCT) la 85% va he so kappa la 0,659.
Trong mlu nghien o i u ciia chiing toi co 19 mat CO eo keo pha le the - hoang diem, chiem ty 1| 19,6% trong tong so benh nhan co phii HD tren OCT. Trong mot nghien euu ve ty le bong
pha le sau o benh nhan eo phii HD do DTD, tac gia Gaucher va cs nhan thay ty le eo bong pha le the sau khong hoan toan va co keo tai HD doi voi nhiing mat eo phii HD do DTD la 53% so voi nhom mk khong co phii HD la 22,4% (8). Ty le aja chiing toi thap hon nhieu co the la do miic dp phu HD ciia hai mau khong giong nhau, CO mau nho khong ngau nhien va khong dai dien cho dan so.
K E T L U A N
Ty le phii HDDTD tren lam sang trong tong so mat benh nhan co benh DTD trong mau nghien ciiu la 22-27%, doi voi benh VMDTD khong tang sinh la 23-29%, VMDTDTS la 67- 76%. Dp day HD eiia mat benh nhan eo benh DTD va thi luc co tuong quan manh. Chain doan phii HD tren lam sang bang den khe voi kinh khong tiep xiie Superfield va tren OCT eo dp phii hpp chat che voi dp phu hpp quan sat la 85% va he so kappa la 0,659. Ty le eo co keo pha le the HD la 19,6% doi voi mSt co phii HD danh gia bang OCT va 0% 6 benh nhan khong eo phii hoang diein.
TAI LIEU T H A M K H A O
1 Baumann M, Gentile R C Uebmann J H et aL (1998).
"Reprodudbility of retina] thidoiess measurements in normal eyes using optical oaherenoe tomography". Ophthalmic Surg lasers,29(i),pp2SO-5.
2. Bresudc G H (1995). "Oedeme maculaire diabetique", hi ReHnopathieDiabetiqiie.Masson.Paiis,pp 315-335.
3 Btovm JC Solomon SD, Bressler SB, et al. (2004). "Detection of diabetk foveal edema: contact lens biomicroscopy compared with optical coherence tomography", Ardi Ophthalmol, 122 (3), pp, 330-5.
4 Browning DJ, McOwen MD, Bowen KM, Jr, et aL (2004).
"Comparison of the cLnical diagnoas of diabetic macular edema with diagnoas t ^ optacai coherence t o m o g r a j ^ ' " , Ophthabiwlog)/, 111 (4), pp. 712-5.
:i Gulla TA, Amador AG, Zinman B P003). "Diabetic retinopathy and diabetic macular edema: pathophysiology, screening and novel theraptes". Diabetes Care, 26 (9), pp. 2653-64.
6 Ferris FL, Patz A (1984). "Macular edema. A complication of diabetic retinopathy", Surp Opktbalnwl, 28 Supfi pp. 452-61.
7 Gaucher D, Tadayoni R, Ergjn^ A, et al. (20CB). "Optical coherence tomograjJiy assesanent of the vitreoretinal relationsiiip in diabetic macular edema", Aiyi j C^htiialmd, 139
&), pp. 807-13
8 Kinyoun J, Barton F, Fisher M„ et al. (1989).'Detechon of diabetic macular edema. Ophthalmoscopy versus photograph' - Early TreatmKit Diabetic Retinopatf^ Slui^' Report Number 5. T h e
Nghien cmi Y h o c Y Hpc TP. Ho Chi M i n h * Tap 15 * So 2 * 2011
ETDRS Researrfi Group", Ophthabnolosii, 96 (6), pp. 746-50; 12 Shimura M, Yasuda K, Nakazai%-a T, et aL (2003). 'X^uantilj-ing discuMon 750-1, alterations of macular thickness before and after panretinal 9 Kylstra JA, Brown ) C Jaffe G|, et al. (1999). T h e importance of piiotocoagulalion in patients with severe diabetic retinopathy
fkiorescewi an^ography m (banning laser treatmait of diabehc and good viatm", Ophthalmok^, 110 (12), pp. 2386-94.
inacularedHna",CVhffc(jinwfcsT/, 106(11),FP-JOeS-Ta. 13. Vo Thj Hc^ Lan (2000). Khao sat betili voiig nmc DTD bdng 10. NguyinThiTuyelMinha998).K?awsfl(KmsflngJiAiAiwJgiiwc chup madi huynh quang lai BV Cho JUy, T m o n g DHYD Tp.
DTD tqi BV O\o Ray, T m o n g DHYD Tp. HCM, Tp. H o Chi HCM, Tp. Ho O i i Minh. Luan van th^c a Y h o c Mmh. Luan van thac a Y h o t 14. WoIfend>erger TJ (1999). T h e historical discovery of macular 11. Pham v a n Hoang (2004), Dank gm hieu qua dwu tri benh ly vong edema", Doc Ophlhabnol, 97 (3-4), pp.207-16.
niflc DTD bing quang dong mng mac vai laser YAG 532, Tnrong DHYD Tp. HCM, Tp. H o O i i Minh, Lu|n van diuyen khoa cap
n.
NHOI MAU CO TIM CAP 6 BENH NHAN RAT TRE
Hodng Quoc Hoa * TOM TAT
D&t van de: Nhoi mdu ca tim (NMCT) cap ST chenh len thuong xay ra tren benh nhan (BN) tie tuoi trung nien tra di. Tuy nhien, xu huong nhoi mdu ca tim vai tuoi tre hoa ngay cang tang khong chi tren the gidi, md con a Viet Nam, dac biet Id nhom benh nh&n rai tre (tuoi < 35), vai nhimg diem khac biit co bdn so vai nhom benh nhan NMCT cap ST chenh len thuang gap. Chung toi thuc hien nghien dm quan sdt ndy nhdm khao sdt dac diem rieng biit cua nhom binh nlian NMCT tuoi rat tre ndy. Muc tieu nghien cuu :Khdo sdt -ue yeu to nguy ca, dac diem lam sdng, hinh thdi tan thuang mach vdnh vd dieu tri a nlwm benh nhan NMCT cap ST clienh len vai tuoi < 35 duoc chup vd can thiep mach vdnh tien phat tai Benh vien Nhan dan Gia Djnh tie 04/2009 deh 09/2010.
Phuang phdp nghien ciiu : Hoi dm, mo ta.
Ket qud: Tie 04/2009- 09/2010, ti-en 210 tne&ng hap NMCT c&p ST chenh len dieac chup vd can thiep mach vdnh tien phdt, chung toi chon duac 05 (2,4%) tmong hap tuoi < 35. 100% Id nam gi&i vai tuoi trung binh 32,6 ± 2,0, tuoi tie 30 deh 35. Roi loan chuyen hoa lipid, hut thuoc Id, tien can gia dinh co binh mach vdnh sam, thiea can, beo phi Id cdc yeu to nguy ca duac ghi nhan. Trong do, 100% trucmg hap co roi loan lipid mdu, 807o tneang hop co HDL-cholesterol thap dan dgc hoac kem vai cdc roi loan LDL- cholesterol hay Triglyceride mdu. Co 80% truang hap co hut thuoc Id nhieu, 80% truang hap co thiea canvdbeo phi. 100% tneang hop co dau nguc fan/ vdnh dien hinh, nhap vien sdm, binh canh l&m sdng nhe vai diem TlMl thap vd Killip 1. Tat cd deu CO sang thuang mach vdnh hep cd y nghia, 80% truang hap co huyei khoi gay tdc nglten Iwdn todn dbng chd}/ mach vdnh. Can thiep mach vdnh sam cho ty le thdnh cong cao: 100% thdnh cong ve mat thu thuat, 80%
tneang hgp chuc nang tdm thu tliat tidi bdo ton sau can thiep vdi tien lugng ngan liqn t^.
Ket luan: Nam gidi chiem tuyit doi trong nhdm nhoi mdu ca tim nguai rai tre. Nguyin nhan do xa viea mach vdnh vai cdc ym to nguy ca (YTNC) dien hinh: hut thuoc Id, roi loan lipid mdu, tien cdn gia dinh co benh mqch vdnh sam, thiea cdn, beo phi. Roi han lipid mdu chu yeii Id HDL-cholesti-d th^ kem LDL- cholesterol binh thuang Jwac tang lis -CRP tang cao chieng to vai tid quan ti-ong cua viem ti-ong ca che sinh binh NMCT a nguai rdi ti-e. Lam sdng vai dau ngiec kieu vdnh dim hinh, binh nh&n nhap vien sam. Benh canh lam sdng thieang nhe. can thiep mach vdnh tien phdt qua da cho kei qud toi vd tien lugng ngdn han khd quan.
Tit khoa: Nhoi mdu ca tim c^ ST chenh len, Rdi loan lipid mdu, Hut thuoc la, Thiea cdn, Beo phi, Dgng mach vdnh thii pham. Can thiep mqch vdnh tiin phdt qua da, Tien lugng ngdn han.
* Boih vien ^4han dan Gia Dinh, Tp Ho Chi Minh
Tdcgid lien lac. TS. BS. Hoang Quoc Hoa DT: 0913.155. 666