HQI NGHI KHOA HpC L A N THLT Vll. HQI TI€'T NigU - T H A N HQC VigT NAM (VUNA)
Ty le thieu mau: 100%. Trieu chii'ng lam sang thieu mau: da long ban tay va niem mac mat nhdt, hoa mSt, chong mSt, nhii'c dau, mdng tay kho, giam hoat dpng the lu'c. Ty 1^ thieu mau mirc dp nhe: 7 1 , 1 % ; trung binh: 24,5% va nSng:
4,4%. Mifc dp thieu mau tu'dng quan thuan vdi mu'c dp suy than. Nong dp hemoglobin mau trung binh: 9,60 ± 1,71 g/dl. Loai thieu mau dang s3c, hong cau ki'ch thu'dc binh thu'dng la 57,8%; nhu'dc sac, hong rau ki'ch thu'dc binh thu'dng la 26,7%; nhu'dc s3c, hong cau nho la 13,3% va dang sSc, hong cau to la 2,2%. Ty le thieu sat: 22,2%.
TAI LIEU THAM K H A O :
1 Tran VSn Be (1998), "Benh ly hong cau", Huyet hgc lam sang, Nxb Y hpc, tr. 158 -182.
2 Bo m6n Npi Dai hpc Y Ha Npi (2001), "Chan doan thieu mau, phan loai thieu mau", Trieu chiing hgc Noi khoa tap 2, Nxb Y hoc, tr. 51-59, 3 Pham Van Bui (2011), "Benh than man tinh", So
tay chan doan va dieu tri benh Ngi khoa thu'dng gap, Nxb V hoc chi nhanh tp Ho Chf Minh, tr. 97-125.
Dinh Thj Kim Dung va cs (2001), "Oanh gia tac dung cua Eprex trong dieu tn thieu mau d benh nhan suy thSn man chu^ Ipc mau chu ky", YiTgc
Viet Nam, (4-5-6), tr. 80 - 86.
Tr^an Thj Anh Thu' (2008), Nghien ciiU dietSSn thiiu mau vi hieu qua dieu tri FrythropoieSn 6 b$nh nhan suy than man tai binh vien TW Hue, Luan an chuyen khoa I I , Oai hpc Y du'pc Hue.
Danguilan R. A., Balaccua G. P. (2010),
"Subcutaneous Epoetin alfa for Anemia in Chronic Renal Failure: A Post - Marketing Surveillance Study", Phillippine Journal of Internal Medidne, 48 (3), pp. 48 - 53.
National Kidney Foundation - K/DOQZ (2006),
"Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease", American Journal of Kidney Disease, 47 (3), pp. S17 - S27.
Prakash S., Walele A. (2001),''Experience with i- large dose (500 mg) of intravenous iron dextran and iron saccharate in pentoneal dialysis patients', Pent Dial Int, 21 (3), pp. 290-295.
Webb L., Gilg J., Wilkie M. (2012),
"Haemoglobin, Ferritin and Erythropoietin amongst UK Adult Dialysis Patients in 2010", N^rcm Qn Pract, National and Centre - Specific Analyses, 120 (1), pp. C145-C174.
TY LE SUY DINH D U S N G QUA DjNH LUtTNG ALBUMINE HUYET THANH a BENH NHAN BENH THAN MAN CHITA DIEU TRj THAY THE THAN
T r a n V a n V u * , T r a n Thj Bich H i / d n g * * , D a n g Van PhiTdc***
TOM TAT:
D^t van de & muc tieu: Djnh lu-tjng albumin huyet thanh (HT) la chi so danh gia tinh trang dmh du^ng hihj ich vdi do dac hieu cao. Muc Tieu: xac dmh ty le suy dinh dudng d b^nh nhan benh than man (BTM) chu'a dieu tn thay the than bSng albumin HT,
*Khoa Than - Benh vien Chd Ray, TPHo Chi Minh,
**Bgmdn Ngi - Dai hgc Y DUdc TPHo Chi Minh, '
*** Dai hoc Qudc Gia - TP Ho Chi Minh Phan bi#n khoa hpc: PGS.TS. Dinh Thj Kim Dung 372
Dol tu'dng & phu'Ong phap: Nghien ciiU ten ciJuvJ mo ta cat ngang thu'c hi?n tai khoa Than benh vien Chd Ray trong nSm 2011. Ket qua: Trong so 467 benh nhan BTM chu^ dieu tr| thay the ttian, co 230 benh nhan nu' (49,3%) va 237 benh nhan nam (50,7%), ty \e nam: niJ = 1,03:1, tuoi trung vj va
Y H p c VIET NAM THANG 8 - S6 D A C BIET/2013 khoang tit vj la: 46 (32-60). Dmh lu'dng albumin HT
bang phu'dng phap so mau vdi chat thit la brommocresol green (BCG) vdi ngudng danh gia chan doan suy dinh duQng (SDD) khi dinh lu'dng albumin HT
< 3,5g/dl.Vdi nguSng danh gia nay, ty le SDD d b^nh nhan BTM chua dieu tn thay the than la 12,4%; d benh nhan BTM giai doan cuoi chuS loc mau la 28,4%;
cl benh nhan BTM do OTD type 2 chu^ Ipc mau la 26,9%. Ty I? SDD thay doi theo ten trien cua BTM, dao dong trong khoang tif 10,3% - 46,6% tu'dng u'ng vdi giai doan 1 - giai doan 5. Ty 1? SDD gia t3ng co y nghia bat dau tu" giai doan 4 cua BTM. Ket luan: Sy suy giam chifc nSng than khong anh hUdng tru'c tiep den nong dp albumin HT. Ty le SDD d benh nhan BTM chua dieu tn thay the than xac dinh bang albumin HT la 12,4%. Nong do albumin HT suy giam co y nghTa tii' giai doan 4 gdi y nguy cO SDO gia tang khi eGFR < 30 nil/phul/1,73 m'da.
Tir khoa: suy dmh du'dng, benh than man, albumin.
SUMMARY:
SERUM ALBUMIN AS NUTRITIONAL MARKER IN NON- DIALYSIS CHRONIC KIDNEY
DISEASE PATIENTS Introduction & objective: Serum albumin is a useful tool in nutritional status assessment with high specificity. Obiective: To use serum albumin for nutritional status assessment in non-dialysis chronic kidney disease (CKD) patients. Patients & methods:
This IS a cross-sectional study undertaken at Nephrology Department of Cho Ray Hospital m 2011, 467 non-dialysis dependent CKD patents were enrolled in this study. Results: Of the 467 non-dialysis dependent CKD patients, 230 were females (49.3%) and 237 males (50.7%), giving a male to female ratio of 1.03:1, median age: 46 (32-60). Serum albumin concentration were determined by colorimetric method witji reagents is brommocresol green (BCG). diagnosis of malnutrition according to serum albumin level <3.5 9/dl. Prevalence of malnutrition in 467 non-dialysis dependent CKD patents were 12.4%, were 28.4% in patients with non-dialysis end-stage renal disease patients, were 26.9% in diabetc nephropathy patents.
The prevalence of malnutriton determined by serum albumin level varied across stage of CKD, ranged from 10.3% to 46.6% according to stage 1 to stage 5.
Prevalence of malnutriton increased significantly m stage 4 of CKD. Conclusion: The decline of renal function do not directly affect the concentration of albumin HT. Prevalence of malnutrition increased significant in stage 4 suggested there are increased nsk of malnutntion when eGFR falls below 30 ml/min/1.73 m^.
Keywords: Mainutrion, CKD (Chronic Kidney albumin.
I. O A T V A N D E :
Albumin huyet thanh (HT) bieu thj cho tinh trang d i / t r i j protein npi tang, du'cJc sii dung mgt each rong rai nhu' la chi so danh gia tinh trang suy dmh duQng (SDD) trong nghien cu'u cf cac doi tu'dng benh nhan khac nhau. Trong thu'c hanh lam sang ve dinh du'Sng, dinh lu'dng albumin HT van du'dc u'a chuong vi de thUc hien, it ton kem vdi dp dac hieu cao va la cong cu tien lu'dng ket qua lam sang, dac biet la d nhiJng benh nhan co benh man tfnh. 6 doi tu'dng benh nhan benh than man (BTM) dang dieu tri Ipc mau hay tham phan phuc mac, nhieu nghien cu'u tren the gidi da ghi nhan si/ pho bien cua tinh trang giam albumin HT. Hpi dong Lu'dng Gia ve ket qua dieu tri benh than (KDOQI 2000) da du^
ra cac khuyen cao trong thi/c hanh dinh du'Sng lam sang de nghi nen theo doi albumin HT dinh ky d nhij'ng benh nhan BTM giai doan cuoi dang dieu tri bang Ipc mau cOng nhu' chu'a Ipc mau 4.
Mpt so nghien cu'u cua Lu'u Ngan Tam thu'c hien tai benh vien Chd R i y danh gia tinh trang dinh du'Sng bang = albumin HT cho thay: Ty le SDD S benh nhan nhap vien chung la 31,9%, d benh nhan tru'dc phau thuat la 18,3%. Chung toi thu'c hien de tai nay nham muc tieu: Danh gia ty le SDD d benh nhan BTM chu'a dieu tri thay the than bang dmh lu'dng albumin HT.
Hpl NGHI KHOA HpC LAN THCT V|[, HQI T|£T NigU - THAN HOC VigT NAM (VUNA) II. DO! TUQNG VA PHl/ONG PHAP NGHIEN CGU:
2.1. Dol tu'dng nghien cu'u.
Tieu chi chpn b$ntr. nhCng benh nhan (BN) du'dc Chan doan BTM d ca 5 giai doan theo phan loai ciia KDOQI (2002), chu'a dieu tri thay the than va dong y tham gia nghien cu'u, tai khoa va phong kham Npi Than benh vien Chd Ray.
Tieu chi loai trir: Tieu dam 24 gid > 3g, C reactive Protein (CRP huyet thanh) >10 mg/L, BN dang dIJng cac thuoc ho5c mSc cac benh ly anh hu'dng den ket qua xet nghiem.
2.2. Phu'dng phdp nghien cu'u.
ThISt ite nghien ciJtu: Nghien cu'u tien cu'u, mo ta cSt ngang.
Thu thap so lieu; Cac xet nghiem sinh hoa du'dc thuc hien tai benh vien Chd Ray.
kibumin huyet thanh (HT):. djnh lu'dng albumin HT bang phu'dng phap so mau vdi chat thCr la brommocresol green, gia tri binh thu'dng cua albumin NT 3,5 - 5,5 g/dL.
Tieu chuan chan doan SDO khi djnh lu'dng albumin HT < 3,5g/dL; SDD nhe khi albumin HT tir 2,8 den < 3,5g/dL; SDD trung binh khi albumin HT tir 2,1 den < 2,8 g/dL; SDD nang khi albumin HT < 2,lg/dL.
Oanh gia phan loai BTM. Theo KDOQI nam 2002, BTM dUdc phan ra lam 5 giai doan du'a vao do thanh loc creatinine Udc doan (eClcr) tinh bang cong thu'c Cockcrofl Gauit hoac bang eGFR, Chung toi %i dung eClcr trong phan ioai BTM:
BTM giai doan 1 (eClcr > 90 mi/phut/l,73m^da);
BTM giai doan 2 (eCicr 60 89
mi/phijt/l,73m^da); BTM giai doan 3 (eClcr = 30 - 59 ml/phut/l,73m^da); BTM giai doan 4 (eClcr
= 1 5 - 2 9 ml/phut/l,73m'da); BTM glal doan S (eClcr < 15 ml/phut/l,73m'da).
Tong ttet xif ly so lieir. So lieu nghien ciili du'dc thu thap va xu' ly thong ke bang phan mem SPSS 16.0. De so sanh giO'a hai bien djnh iircfng co phan phoi khong chuan diing phep kiem Kruskal W/allis. Oe so sanh sir khac biet giite cac bien djnh tinh, chung toi diing phep kiem Chi binh phu'dng. Gia trj p < 0,05 du'dc xem la co y nghTa thong ke.
Hi. KET QUA NGHiEN COU:
Dol tu'dng nghien cii\j cua chiing toi ijao gom 467 benh nhan BTM chus dieu trj thay Uie than, vdi 230 BN nil' (49,3%) va 237 BN nam (50,7%), ti so nam: nil' la 1,03:1, tuoi tnjngviva khoang tir vj: 46 (32 - 60). Diing phep kiem Koimogorov - Smirnov de khao sat tinh chuan cua cac bien so cho thay tat ca cac bien so deu khong co phan phoi chuan nen dac tniYig thong ke (so lieu) du'dc trinh bay du'di dang trung v| va khoang tiT phan vi.
1. Dac diem chung cua doi tu'dng: BN du'dc phan bo deu d ca 5 giai doan BTM: Giai doan 1 CO 89 BN (44 nam, 45 nif); Giai doan 2 c6 96 BN (49 nam, 47 nif); Giai doan 3 co 94 BN (49 nam, 45 nCf); Giai doan 4 co 93 BN (46 nam, 47 nif); Giai doan 5 co 95 BN (49 nam, 46 ni?).
Bang J ; Cac diem chung ciia dan so nqhien cifu
Tuoi
(trunq vi - khoanq ti> vj) D^i thao du-eynq (n. %) Protein ni#u 24gl4 (g/24 gio) So tri^ong hi^p protein nieu
1g/24gii>(n. %) CRP huyet tllanh (mg/dL)
Chung (n = 467)
46 (32 - 60) 63 (13.5) 0.25 (°-1.3) 322 (68.9)
(1,0-2.7)
Nam (o = 237) (32 • 59) 31 (13,0) 0,28 ( ° - 1 . 4 ) 161 (67,9)
(1.0-3.0)
Nir (n = 230)
45 (32-61) 32 (13,9)
0,23 (°-1.2) 161 (70.0)
(0,8- 2.2)
Y H p c VIET NAM T H A N G 8 - S6'oAC BIET/2013
Nhan xet: gia tri trung binh cua protein nieu 24 gid < 3g va gia trj CRP huyet thanh ciia BN <
10 mg/L chirng to cac tru'dng hdp giam albumin HT trong nghien culi do nguyen nhan suy dinh duSng, khong phai do tinh trang that thoat dam qua nu'dc tieu hay giam tong hdp albumin do tinh trang viem.
Bang 2: £)anh gia do Ipc cau than bang dp thanh Ipc creatinin u'dc doan (eClcr) theo cong thirc Gockroft Gault
Creatinin HT (mq/dl) eClcr theo cong thi>c Gockroft Gaull(ml/phiiU1,73m'da)
Chung (n = 467) 1,6(0.9-3,8)
40,76 (17,39-81,28)
Nam (n = 237) 17(1,0-4,3)
40,18 (18,14-80,44)
NO' (n = 230) 1,45(0,8-3,4)
41.46 (17,20-82,11)
P 0.001 0.993 So truonq hop BTM theo qiai doan (n, %):
Giai doan 1 Giai doan 2 Giai doan 3 Giai doan 4 Giai doan 5
89(19,1) 96 (20,6) 94(20,1) 93 (19,9) 95 (20,3)
44 (18,5) 49 (20,7) 49 (20,7) 46 (19,4) 49 (20,7)
45(19,5) 47 (20,4) 45 (19,5) 47 (20,4) 46 (20,0)
0,994
Nhan xet: Chung toi nhan thay Creatinine HT 6 nam cao hdn cd y nghTa so vdi nH nhutig khi danh gia dp Ipc cau than di/a vao do thanh Ipc creatinin u'dc doan bang cong thifc Cockroft-Gault co hieu chinh theo 1,73 m^ da thi khong co su* khac biet co y nghia giu'a hai gidi.
2. Danh gia tinh t r a n g dinh du'Sng bang albumin huyet t h a n h : Albumin HT la chi so thu'dng duBc su" dung de danh gia tinh trang dinh du'Sng tren doi tu'dng BN Igc mau.
I 1
5/ei/dS J / 0 | n h lu'dng albumin HT theo giai doan benh than man
Bang3;Etac diem va phan loai tinh trang dinh du^ng theo dinh lUdnq albumin huyet thanh
N6ng do albumin huyet thanh (g/dL) S6 tn^d-ng hop albumin HT < 3,5 g/dL (n,%) S6 tnrang hg-p DTD c6 albumin HT < 3,5 g/dL (n,%) PtlSn loai mijc dp suy dinh dir&nq (n,%)'
• SDD nhe (albumine HT 2.8-3.5q/dL) - SDD tnino binh (albumine HT 2.1-2,8 q/dU - SDD nSnq (albumine HT < 2,1q/dL)
Chung (n = 467)
4,4 (3,8- 4,6)
68 (12,4)
17 (3,6) 45 (9,6) 12(2,6) 1 (0.2)
Nam (n = 237)
4,4 (3,9- 4.7)
27 (11.4)
11 (4,6) 22 (9,3)
5(2,1) 0(0)
Nir (n = 230)
4,3 (3,8- 4.6)
31 (13,5)
6 (2.6) 23 (10,0)
7 (3.0) 1 (0,4)
P 0,043
0,494 0,241
0,581
HOI NGH! KHOA HpC L f a THLf Vll, Hpi TlgT NI$U - THAN HOC VigT NAM (VUNA)
S6 trir*nq hop albumin HT < 3,5 g/dL tlieo timg giai BTIVI qiai doan 1
BTIVl qiai doan 2 BTM qiai doan 3 BTM qiai doan 4 BTM qiai doan 5
Chung (n = 467) doan BTM (n
6(10.3) 6(10,3) 6 (10.3) 13 (22,4) 27 (46,6)
Nam (n = 237)
%)
1 (3,7) 5(18,5)2 (7,4) 6 (22,2) 13(48,1)
NO (n = 230)
•5(16,1) 1 (3,2) 4(12,9) 7 (22.6) 14 (45,2)
P
0,209
1
Ghfchij: *Cac so lieu ty le SDD giu'a 5 giai doan BTM khac biet co y nghta thong ke (p<0,001) Nhan xet: Djnh lu'dng albumin HT 6 nam cao hdn co y nghTa so vdi nLJ", tuy nhien ty le SDD xac dinh bang nong do albumin HT khong co s y khac biet co y nghTa giO'a 2 gidi. Ty ie SDD du^ vao albumin HT ciia dan so nghien ciru la 12,4%; Ty le SDD d benh nhan BTM giai doan 5 la 28,4%
{27/95 tru'dng hdp). Trong nghien ciru co 63 benh nhan OTO type 2, thi 17 tru'dng hdp du'dc chan doan SDD (albumin HT < 3,5 g/dL) chiem 26,9%. Nong dp albumin HT bat dau suy giam co y nghia tu" glal doan 4 ciia BTM dong thdi ty le SDD xac dmh bang nong dp albumin HT tang theo tien trien benh than (bleu do 1).
3. Khao sat tu'dng quan giu'a albumin huyet thanh va Qg thanh loc creatinin u'dc doan (eClo-) Bang 4: Noi quan he tu'dng quan giiJa albumin HT va eClcr.
Albumine va eClcr Chunq (t§l ca BN) Benh nhan BTf^/l qiai doan 1 Benh nhan BTM qiai doan 2 Benh nhan BTM qiai doan 3 Benh nhan BTM qiai doan 4 Benh nhan BTM qiai doan 5
He so tu'o'ng quan (r) 0,321 0,124 0,133 0,155 0,045 0,172
r' 0,103 0,015 0,018 0.024 0.002 0.029
P
< 0,001 0.248 0.196 0.136 0.667 0,097 IV. BAN LUAN:
Ty le SDD xac djnh bang djnh lu'dng albumin HT la 12,4% thap hdn so vdi ty le SDD diTa theo cac nghien cifu khac (bang 5). Nguyen nhan co the do s y khac biet ve doi tu'dng nghien cCftJ, cac ngtiien cifu so sanh co doi tUdng la BN loc mau, co nguy cO SDD nhieu hdn.
Nghien cixu (nam) AparicioM vaCS(1999)6 A.A Alshatwi va CS f2007) 1 Nghien cii'u chung 161 (2012)
Qu6c gia Phap AiC§p Vi$l Nam
06i tu'9'ng BN LQC mau L13C m^u BTM chu'a Igc mau
Djnh iLPp-ng albumin HT (q/dl)
<3,5
<3,5
<3,5
Ty ie SDD (Vol 36%
81,3%
12,4%
r^ghlen ciru Campbell K L (2007) thu'c hien tai Uc cho thay ty le SDD is doi tu'dng BN suy than man giai doan cuoi chua loc mau ia 10%, thap hdn nhieu so vdi 2 8 , 4 % d nghien ciru chung toi. Tren doi tu'dng benh nhan BTM do DTB type 2, ty ie SDD theo ghi nhan cua Piotr J (2009) thUc hien tai Ba Lan la 16,3% thap hdn ket qua nghien cu'u cua chiing toi la 26,9%. Bieu nay co the do khau phan protein ciia ngu'di Viet Nam thap hdn so vdi ngu'di nu'dc ngoai dong thdi Uc va Ba Lan la cac quoc gia phat trien vdi ty ie SDD trong dan so chung thap chi c h i l m 5 % dan so trong khi ty le SDD trong dan so Chung Viet Nam la 9 % dan so (bang 6) [ 3 ] .
Y HOC VIET NAM THANG 8 - SO D A C B I $ T / 2 0 1 3
Bang 6: Ty le SDD danh gia bang dmh lu'dng albumin huyet thanh d BN benh than man giai Joan CUOI chu'a loc mau va benh than man do DTD type 2
Nghien CU'U (nam) Campbell KL (2007} 2 Piotr Jakuszewski va conq SIP (2009) 8 Nghien cuu chung toi
Qu6c gia Oc Ba Lan Vi?t Nam
D6i tu'o'ng BN 50 b^nh nh§n BTM giai dogn CUOI chu'a Ipc mau 49 b?nh nhSn BTM do OTD type 2 danq Ipc mau 63 b?nh nhan BTM do OTO type 2 chu'a loc mau 95 b?nh nhan BTM giai dogn cu6i chu'a IQC mau
Djnh luip-ng albumin HT (g/dl)
<3,5
<3,5
<3,5
Ty 1? SDD
(%)
10 16,3 26,9 28,4 4.1. Phu'dng phap dinh lu'dng albumin
Nuyet thanh va ngifSng danh gia.
Phu'dng phap so mau hien nay du'dc u'a [huong hdn vdi uU diem de thi/c hien va cho ket qua nhanh. Nguyen tac do cua phu'dng phap so mau la albumin co trong huyet thanh tac dung vdi diat thLT trong moi tru'dng cua dung dich dem succinate cd p H - 4,2 va tao ra phu'c hdp co mau.
Do dam mau ciia phu'c hdp ty le thuan vdi nong do albumin co trong huyet thanh. Hai chat thCr du'dc sir dyng thong dung nhat la Bromocresol xanh (BCG) va Bromocresol tim (BCP).
Tren lam sang phep do vdi BCP du'dc chu'ng minh la ft tin cay hdn so vdi BCG. Mot so nghien cihi thi/c hien tren doi tu'dng BN suy than man giai doan cuoi dang loc than cho thay xet nghiem djnh lu'dng albumin vdi chat thCr BCP cho ket qua ttiap hdn 19% so vdi ket qua do bang phep do do flue. Nguyen nhan du'dc cho la do dpc chat ure huyet ngan can sy gan ket giu'a chat thir BCP va albumin trong HT, hien tu'dng nay khong xay ra neu chat thir la BCG. Tir do, phu luc I ciia hu'dng dan cLia Hiep hoi than quoc gia Hoa Ky (KDOQI 2000) ve dinh du'dng trong suy than man da kiiuyen cao ve viec nen sir dyng chat thir BCG ti^ng phep do dinh lu'dng albumin HT 4. Nhu'ng do BCG khong chi gan vdi albumin ma con gan vdi globulin vi vay ket qua danh gia bang BCG cd the cao hdn so vdl lu'dng albumin thyc te dac biet la d khoang gidi han dydi. Tuy nhien, sy gan ket giiJa BCG va globulin la qua trinh xay ra cham va co the
•^hac phuc bang each do ngay khi BCG tiep xiic vdi
mau trong vong 1 phut. Oieu nay ly giai cho viec khoang gidi han binh thydng ciia cac nha san xuat chat thir BCG van la 3,5-5,5 g/dl.
Trong nghien cu'u ciia chiing toi^ xet nghiem djnh lydng albumin HT bang chat thir BCG ciia hang BIOLABO (Phap), phong sinh hoa da thyc hien theo dimg quy trinh cua nha san xuat yeu cau, trong do tuan thii chinh xac thdi gian do mau thir. He so bien thien (CV) ciia phydng phap dmh lydng albumin HT tai benh vien Chd Ray dao dpng trong khoang tir 1 , 1 % - 2,4%. Ngoai ra, khoang gia trj binh thu'dng ciia chi so albumin HT dydc quy dmh trong khoang 3,5 - 5,5g/dl.
Nhu'ng BN co nong do albumin HT <3,5g/dl dydc phan loai la SDD. Do vay, ket qua ciia albumin cua nghien cu'u la dang tin cay.
4.2. Vai tro danh gia tinh trang dinh du'dng ciia albumin huyet thanh 6 benh nhan BTM
Tinh trang giam albumin HT dydc ghi nhan mot each rat pho bien trong cpng dong benh nhan BTM. Sy suy giam chirc nang than khong anh hydng den nong dp albumin HT dan den day la chi so danh gia dinh dydng dydc sir dung rpng rai nhat tren doi tydng benh nhan BTM, va dong thdi la chi so can phai theo doi dmh ky theo khuyen cao cua KDOQI 2000.
Co nhieu nguyen nhan gay giam albumin HT d benh nhan BTM bao gom: suy dmh dydng, tinh trang viem hoac thir phat do mat dam qua nhieu qua du'dng nieu. De gia tang do dac hieu trong chan doan SDD ciia nong dp albumin HT, chimg toi loai trir nhu'ng benh nhan BTM cd dinh lydng 377
Hpl NGHj KHOA HQC L A N T»0 VH, H Q I T|£'T NigU - T H A N HQC VigT NAM (VUNA)
dam nieu tren 3 gam/24 gid, nhiTng BN dang trong tinh trang viem (nong dp CRP HT "^ 10 mg/dl) (bang 1). Ket qua ghi nhan du'dc tir nghien ciru ciia chitng toi cho thay djnh lyqing albumin HT d nu* thap hdn nam (p = 0,043). Ket qua nay tu'dng t y nhu" ket qua t i f nghien ciJli cua Renuka Devi va cong s y (2012) 10. Nguyen nh3n do van de sinh tong hdp albumin tai gan d nQ thap hdn so vdi nam (bang 3).
Nghien ciTu ciia Park GS (1997) d b^nh nhan BTM trydc loc mau cho thay co tinh trang giam albumin HT so vdi ngydi khong benh than [ 7 ] . Ngoai ra, mpt so nghien cilTu ciia Pollock CA (1997), Kopple JD (2000) cung cho thay albumin HT giam theo tien trien ciia BTM 5,9. Ket qua tCr nghien cuXi ciia chiing toi trung vj ciia albumin HT bat dau giam d nhOYig BN co eGFR <
30ml/phut/l,73m^da (bieu do 1). Theo Bergstrom J (1995) cac roi loan chuyen hda protein va nang lydng, roi loan noi tiet to, tinh trang chan an, buon non va non lien quan den SLT gia tang dpc tinh ure huyet va cac benh di kem nhy DTB, benh tim mach, viem... gop phan lam tang nguy cd SDD khi benh than tien trien.
Ket qua tir nghien ciru MDRD cho thay cho thay dinh lydng albumin HT bat dau giam khi eGFR < 60 m l / p h u t / l , 7 3 m 2 da 5. 6 nghien CLTU chung toi, nong dp albumin HT bat dau giam manh khi eClcre < 30 m l / p h u t / l , 7 3 m 2 da (p = 0,002) (bieu do 1). S\i khac biet nay co the do nghien ciTu MDRD co 657/1785 BN thyc hien che do an giam dam va hoac an it n5ng lypng. Oieu nay gdp phan tang nguy cd SDD the hien bang giam albumin HT d giai doan 3 ciia BTM. KDOQI (2000) khuyen cao can danh gia tinh trang SDD djnh ky d cac doi typng co GFR < 30 ml/phut/1,73 m2 da 4.
V. KET I U A N :
s y suy giam chu'c nang than khong anh hydng tryc tiep den nong dp albumin HT da gop phan tao thuan Idi cho vai tro danh gia tinh trang dinh dydng ciia chi so nay d doi tydng benh
nhan BTM. Ty le SDD d benh nhan BTM chua dieu tri thay the than xac djnh bang albumin HT la 12,4%; ty le SDD d benh nhan BTM giai doan cuoi chya Ipc mau la 2 8 , 4 % ; ty le SDD 6 benfi nhan BTM do OTO type 2 chuia Ipc mau la 26,9%. Djnh lydng albumin HT suy giam co y nghTa tir giai doan 4 gdi y nguy cd suy dinh dy9ng gia t5ng khi eGFR <• 30 ml/phut/l,73m^da.
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