Y Hpc TF. Ho Chi Minh * Tap 21 * Sd 5 * 2017 Nghien cuu Y hpc
KHAO SAT T i LE, DAC DIEM SUY DINH D I / O N G - NANG Ll/ONG 6 BENH NHAN THAN NHAN TAO CHU KY
Le Dtnh Thanh*, Phan Xudn Tuac**, Hodng Trung Vinh**"
TOMTAT
M^c tieu: Khao sdt ty le, mpt so dac diem hien ^i lien quan deh hiiu hien suy dinh duong - nang luong (SDD-NL) d benh nhan (BN) than nhdn tao chu ky (TNTCK).
Dot tuong vd phuongphdp: 111 BN loc mdu bang TNTCK tai benh vien Nguyin Trai - Thanh pho"H6 Chi Minh duoc Jdido sdt cat ngang cac chi so albumin, prealbumin, cholesterol, chi sokhoi co the(BMI), muc do giam can trong 3, 6 thdng vd mot so chi so'khdc ChSn doan SDD-NL theo tieu chuan ciia Hoi dinh duong than hoc Quocte'.
Ket qua: Ty le SDD-NL - 27,9%. Ty le BN c6 giam cdc tieu chi chan doan SDD-NL bao gom: BMI - 68,5%, albumin - 69,4%, prealbumin - 68,5%, giam can - 35,1%, giam cholesterol - 4,5%, giam tebao lympho - 38,7%, thieii mdu - 82,9%, giam ferritin - 5,4%, giam transferrin - 73,9%.
K^ luam Benh nhdn TNTCK bieu Men SDD-NL - 27,9%; giam cdc chi soliin quan din dinh duong - nang luong gap v&i cdc ty le khac nhau.
TM" khoa: Than nhdn tao dtu ky, suy dinh duong - nang luong ABSTRACT
INVESTIGATION OF RATE, CHARACTERISTIC OF PROTEIN ENERGY WASTING IN PATIENTS WTTH MAINTENANCE HEMODIALYSIS
Le Dinh Thanh, Phan Xuan Tuoc, Hoang Trung Vinh
* Y Hoc TP. Ho Chi Minh * Vol. 21 - No 5 - 2017:19 - 22 Objectives: To survey rate and some of changed characteristics related to protein energy wasting (PEW) in patients with maintenance hemodialysis (MHD).
Subjects and methods: 111 MHD patients in Nguyen Trai Hospital, Ho Chi Minh City were cross- examined albumin, prealbumin, cholesterol, body mass index (BMI), weight loss in 3, 6 months and some other indexes. PEW was diagnosed according to the criteria of The Intemationcd Society of Renal Nutrition and Metabolism (ISRNM).
Results: Rate of PEW was 27.9%. Rates of patients with decreased criteria for diagnosis of PEW included:
BMI - 68.5%, albumin - 69.4%, prealbumin - 68.5%, weight loss - 35.1%, decreased cholesterol 4.5%, lymphopenia - 38.7%, anemia - 82.9%, decreased ferritin - 5.4%, decreased transferrin - 73.9%.
Coticli4sions: Rate of PEW in MHD patients was 27.9%; decreases in parameters related to PEW were seen withd
Key words: Maintenance hemodialysis, protein energy wasting
DAT VAN DE ^°^S **° P ^ ^^ ' ^ ^ '^ ^"y '^^^ duong - nang luong (SDD-NL). SDD-NL) thuang bieu hien Benh nhan (BN) loc mau bang than nhan tao ^ ^ ^^^ ^g ^^ ^-^^ ^ p b ^ ,^^ ^ i ^ ^ ^ ^ ^ dau chu ky (TNTCK) co nhieu nguyen nhan, y ^ tcf ^^ j ^ ^ ^ ^ ^ ^^ Xac dinh SDD - NL chii yeu nguy CO (YTNC) gay bien chiing va tii vong
* Benh vien Thong Nhat TP. Ho chi Minh ** B^nh vien Nguyin Trai IT. Ho Chi Minh *** Hgc vien Quan Y Tdc gia lien lac: PGS. TS. Hoang Trung Vinh DT: 0903.20.12.50 Email: [email protected] 19
N g h i e n ciiu Y hpc Y Hpc TP. Hb Chi M i n h * Tap 21 * So 5 * 2017
dua vao albumin, prealbumin, BMI, miic dp giam can dupe danh gia trong 3 hoac 6 thang, nong dp cholesterol, so lupng va chat lupng cac chat dinh duong dupe cung cap va mpt so chi so lien quan khac. Benh nhan TNTCK bieu hien SDD-NL CO ty 1§ cao, len d m 70 - 75% tiiy thupc timg doi tupng, timg thai diCTn, giai doan cua benh. Khao sat SDD-NL rat can thiet, lam co so cho chan doan, dieu tri va tien lupng toan dien.
D e tai nghien cuu n h l m muc tieu Khao sat ty le va mpt so dac diem cua SDD-NL 6 BN TNTCK.
DdllTJtlNG-FHU'CKGPHAPNGHIENCUtJ
Doi tupng
111 BN TNTCK duQC dieu tri tai benh vien Nguyen Trai - Thanh pho Ho Chi Minh thufic cac Ilia tuSi, thai gian loc mau va nguyen nhan gay suy than khac nhau.
Phuomg phap ThiH kei nghien deu
TiMi ciiu, cat ngang, quan sat, mS ta Noi dung nghihi cihi
Khai thac benh sii, kham lam sang va lam cac xet nghiem lien quan d a i dinh du&ng - nang lupng bao gom BMI, albumin, prealbumin, miic giiim can/3 thang hoac /6 thang, cholesterol huyet thanh, te bao l3mipho, ferritin, transferrin, hemoglobin (Hb). Ch&i doan SDD-NL dua v^o tieu c h u ^ ciia Hpi dinh duong Than hpc CJuoc te khi CO > 3 trong so cac bieu hien: BMI < 23 kg/m^, albumin < 38 g/1, prealbumin < 30 mg/dl, cholesterol < 2,95 mmol/1, giam can > 5%/3 thang h o a o 10%/6 thang.
Xii ly so lifu bSng phan mem SPSS 16.0 KET QUA
Bang 1. Ty le benh nhdn dua vdo nhom tuoi (n-111) Tuoi (nlim)
«30 30-40 41-50 61-60
>60
Sd lirpug (n) 8 16 26 29 32
TJI^CA) 7.2 14,4 23.4 26.1 28.8
B$nh nhan thupc cac nhom tuoi co ty le khac nhau.
Ty le benh nhan tang dan theo nhom tuoi, thap nhait < 30 tuoi, cao nhat > 60 tuoi.
Bang 2. Ty le binh nhdn dua vao thoi gian he mdu diuky(n=lll)
Thdn gian LiUCK (nam)
<1 1-3 3 - 6
>5
S6 lirong (n) 23 44 28 16
T*li(%) 20.7 39.6 26.2 14.4 Benh nhan co thai gian Ipc mau khac nhau.
Thoi gian loc mau tCr 1 - 3 nam chiem ty le cao nhat-
Thoi gian loc mau tren 5 nam chiein ty le thap nhat
Bang 3. Ty le benh nhdn dua vdo nguyen nhdn gay suy than man tinh (n=lll)
Nguygn nhdn Odi ttlSo ArifOQ
Tang huyet ap VCTMT VTBTiwn"
Than da nang+ LPBDHT
Sd lupng (n) 63 12 26 6 4
Tyi?(%) 66.8 10,8 23,4 6,4 3,5 Co 5 nhom nguyen nhan gay suy than man tinh voi cac ty Ie khac nhau.
Dai thao duong chiem ty le cao nhat.
Suy than man tinh do VTBTMT, than da nang hoac LPBDHT gap voi so lupng it.
Bim do 1. Ty le benh nhan co bien dot chi so dat tieu chuan ch^n doan SDD-NL (n=lll)
Cac chi so dat tieu chu&i chSi doan SDD-NL gap vol ty le khac nhau.
Giam BMI, pre-albumin, albumin gap vai ty le cao nhat.
Y Hpc TP. Ho Chi Minh * T^p 21 * So 5 * 2017 N g h i e n ciiu Y hpc So benh nhan co giam cholesterol dsit tieu
chuan chsm doan SDD-NL chiem ty le thap nhat.
Co SDD-NL (0=31)
• Kh&ngSDD-^X (D^O)
Bim dd 2. Ty li binh nh&n co bieu hien SDD-NL (n=lll)
Suy dinh duong - nang lupng gap vol ty le thap hon so vai khong co bieu hien SDD-NL.
Biai ^ 3. Ty li bien doi mot so chi so'khdc lien quan deh dinh duang (n=lll)
Trong so cac bieu hien khac lien quan den dinh duong thi thieu mau gap vai ty le cao nhat.
Giam ferritin chiem ty le thap nhat.
BAN LUAN
Suy dinh duong - nang lupng a BN noi chung hoac LMCK noi rieng xuat hien do nhieu nguyen nhan khac nhau va c6 nhieu bieu hien da dang. Tuy vay xac djnh SDD-NL thuang dua vao mpt so bieu hien chu yeu bao gom: miic can bang dinh duong cua co the, do cac thanh phan CO the, danh gia tinh trang USn quan d o i viem va chiic nang cac co quan'^). Trong cac chi so thuang dupe sii dung de xac dinh SDD-NL co the dinh lupng dupe bao gom BMI, albumin, prealbumin, cholesterol, phan tram can nang giam trong 3 hoac sau thang'''.
Khao sat bieu hien SDD-NL, theo tieu chuan cua Hpi dinh duong Thein hpc Quoc te o 111 BN TNTCK nhan thay co 27,9% bi^u hien SDD-NL.
Ket qua tren day co the noi khong cao so vol cac ket qua nghien cuu oia tac gia nuoc ngoai.
Larumbe MCT va cs nam 2016 cho thay ty le SDD-NL a BN benh than man (BTM) giai doan 1 - 4 dao dpng trong khoang 24 - 48%, con giai doan 5 CO hay chua co dieu tri thay the len dan 75%'^\ Tuy vay co the tac gia da khao sat theo tieu chuan chi&i doan, do vaiy ty le cao hon nhieu. Trong so cac tieu chi danh gia dinh duong thi viec xac dinh tinh trang, miic dp cung cap dinh duOTigcho BN cung rat quan trpng. Tuy vay neii khao sat ngau nhien, cat ngang ttu rat kho xac dinh cac tieu chi nay mot each khach quan, do do trong nghien ciiu oia chung toi khong co tieu chu&i Hen quan d&i cung cap dinh duong, bai vay ty le SDD-NL thap hon. Larumbe MCT va cs nam 2016 tai Tay Ban Nha khao sat a BN LMCK gap 36,4% SDD-NL trong do 7,3% miic do nang(*'. Sunggin Chung va cs nam 2012 cho biet theo doi tai cac thai diem khac nhau 6 BN LMCK nhan thay ty le SDD-NL dao dpng trong khoang 20 - 50%^. Iguacel CG va cs nam 2013 nhan thay ty le SDD-NL a BN LMCK tang dan theo thai gian di^u trj thay ihe'^K Sau 12 thang dieu ti tuong ling 40,5% va sau 24 thang la 41,1%
dua vao cac chi so xet nghiem mau va BMI, neu bo sung ca tieu chuan giam khoi lupng co thi ty le tuong ling la 47,3%. va 50% tai 2 thoi diem»i.
Giam albumin va/hoac giam prealbumin la nhiing bieu hien rat co gia tri trong chan doan SDD-NL a BN LMCK. Trong cac doi tupng nghien ciiu thi giam albumin, prealbumin deu gap vai ty le cao, tuong ling 69,4% va 68,5%.
Tran Chi Nam nam 2015 khao sat o BN LMCK nhan thay chi co 19,3% giam prealbumin; 44,6%
giam albumin^'. Tan suat giam albumin, prealbumin mau trong so BN SDD-NL cung gap vai ty le cao. Le Thi Thanh Xuan nam 2016 khao sat BN LMCK cho thay: 37,7% bieu hien SDD-NL cung dua theo tieu chuan chan doan ciia Hpi dinh duong Than hpc Quoc te'^. Qua do cho thay, ty le SDD-NL 6 BN LMCK trong nghien ciiu gap 6 gan 1/3 truong hop. Mac du khong phai ty le cao song cikig rat can co bien phap dieu tri thich hpp nhSm han che su xuat hien cac bien chiing tiep theo lien quan den
N g h i e n ciiu Y hpc Y Hpc TP. Ho Chi Minh * Tap 21 * S 6 5 * 2017
SDD-NL, nang cao chat lupng cu6c song cua nguoi benh'^.
KET LUAN
Cac chi SCI dat tieu chuaii SDD-NL 6 BN LMCK gap voi ty 1?: BMI < 23 kg/m^ - 68,5%,;
giam can trong 3 hoac 6 Ihang - 35,1%, giam prealbumin - 68,5%, giam albumin 69,4%, giam cholesterol - 4,5%.
Ty le suy dinh duong - nang lupng - 27,9%.
Mpt so bi^u h i | n khac hen quan den suy dinh duong: giam te bao lympho - 38,7%, giam ferritin - 5,4%, giam transferrin - 73,9%, thieu mau-82,9%.
TAI LIEU THAM KHAO
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89-99.
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Ngay nhan bai bdo: 24/05/2014 Ngay phan bien nhin xit bii bdo: 11/06/2014 Ngay bai bdo dteac dang. 05/09/2017
