V Hoc TP H6 Chi Minh ' Fhu Ban Tap 39 "^ So 5 ' 201? Nghier, cuu V hoc
'LESTEROL 3NGTiP2
Ddo Thj Tliaiih Biidi*Le Quang Viidi'*
N 5 N G Dp NON-HDL CHOLESTEROL a NGJJCfl DAI THAO Dl/ONG TIP 2
TOMTAT
Muc tiiu Xdc dmh riong do non HDL-C a nguai dai thao duang tip 2
Boi tuang vd phuang phdp: Thiii ki'nghien cuu mo td cat ngang co so sanh dd duac thuc Men trin 174 henh nlidn ddi thdo duang tip 2 tren 5 niim, dang dteu tri tai khoa tim mqch va khoa noi tiei binh viin Nguyin Trdi trong khoang thai gian tit thang 11/2010 den thang 7/2012. MSu mdu duac lay vao sang sam (nhin ddi it nhai 12 gia) di'do duang huyei, HbAIC, ma mdu theo qui djnh chuan. Nong do cholesterol HDL-C, LDL-C, triglyceride, non-HDL-C duac do true tie'p 30 henh nhan khong co tUn sir ddi thdo duang va tang huyii dp duac diing ldm nhom tham chieii
Kei qud. Non- HDL-C tang ddng ked berih nhdn ddi thdo duang tip 2 co liay khong co tdng huyei dp kem theo sa vcn nhom tham chieu.
Ket luan- Non-HDL-C gia tang a binli nlidn dai tlido duong tip 2 co hoac khong co tang huyii dp kem theo.
Tie khoa: Cholesterol khong phai lipoprotein mat do cao, ddi thdo duang tip 2 ABSIRACr
NON-HDL CHOLESTEROL IN TYPE 2 DIABETES MELLITUS
Dao Thi Thanh Binh, Le C2uang Vinh
* Y Hoc TP. Ho Chi Minh * Supplement of Vol. 19 - No 5 - 2015:143 -147 Objectives- This study eaxamined the level of non-HDL-C in a control population, type 2 diabetes mellitus pahents.
Methods and subjects: comparative cross-sectional descriptive research conducted on 174 patients diagnosed type 2 diabetes mellitus over 5 years, hospitalizing at heart or endocrinal ward of Nguyen Trai hospiialfrom Nov 2010 to July 2012. The blood samples were taken in the early morning (at least a 12-h overnight fast) and analyzed to determine serum total cholesterol, HDL-C, LDL-C, tiiglycende, non HDL- C, glycemia, HbAIC. 30 persons without diabetes mellitus and hypertension participated in control group.
Results: The level of non-HDL cholesterol was higher significantly (p<0,01) in type 2 diabetes mellitus with or without hypertension than in control group Conclusion: Non-HDL was elevated in type 2 diabetes who suffering hypertension or noi.
Keywords: Non high density lipoprotein cholesterol, type 2 diabeies mellitus
DATVANDE ^^' h^nh nhan DTD tip 2 hoac tien DTD tip 2 thubng cb dac diem roi loan lipid mau ciia hoi Benh nhan dai thao duong tip 2 (DTD tip ^^^^ ^.^^^g^^ ^^^ ^g^ loan ijp,^ ^ ^ (RLLM) 2) cb nhieu nguy co mac benh mach mau ion. ^.- ^^--^ ^ ^^-^ p - j ^ tip 2 cb dang tang Ngubi bi DTD tip 2 khbng cb tien sir benh tun triglycerides, giam HDL-C (high density mach cb ciing nguy co nhu ngubi khong DTD lipoprotein cholesterol) va LDL (loiv density tip 2 nhung cb tien sir benh tim mach. Ngoai lipoprotein) tuong d^i bmh thuang vbi uu the
* Benli Vien Nguyin Trai ** Berth Vien Phu San Trung l/cmg
Tac eiii liqi lac. PGS U Quanff Vinh DT. 0903.421702 Email: dr.lequangvinhPyahoo com
Hpi Nghl Khoa Hpc Cong Nghe BV. T n m g V u o n g nam 2015 l'*3
.Nghien cuu 1 hoc 1 Hoc TF, Hb Chi Minh Phu Ban Tap V> ' So F ' 2015 cac phan tu LDL nho dac.
Xo vua la mot qua trinh phuc tap. Hen quan nhi'eu yeu to, bao gom mien dich, dbng mau, noi tiet to. RLLM la yeii to nguy co hang dau ciia tien trinh xo vira mach mau va bien co mach vanh Cac nha nghien cuu da ket luan rang bien chung nang ne cua DTD tip 2 cb the dupe phong ngiia hay tri hoan bang tach dieu tri tich cue tinh trang tang duong huyet va cac y^u to nguy co tim mach. Tang LDL-C la mot yeu tb nguy co benh mach vanh va hien duoc xem la muc tieu dieu t n tien phat trong phong ngira va dieu trj benh tun mach"''. Non-HDL- C dupe tinh bang hieu so giiia cholesterol toan phan va HDL-C, bao gom tat ca cholesterol co trong nhimg phan tir bpoprotein sinh xo viia tiem an nhu VLDL (very low density lipoprotein), IDL (intermediate density lipoprotein) va LDL, N h u vay, Non-HDL-C phan anh nong do cholesterol cua tat ca cac lipoprotein sinh xo \nja, dupe dimg ngay cang nhieu de du bao nguy co berth tim machi^"".
Dieu nay dac bift cb ich tren benh nhan DTD tip 2 von CO nong do LDL binh thubng hoac tang nhe. Khbng kiem soat tot non-HDL-C con cb the dua den dieu t n kem hieu qua b benh nhan DTD tip 2'''. Diem thuan loi kiii sir dung non-HDL-C nhu la cong cii sang Ipc, vi chi can do cholesterol toan phan va HDL-C, khong lien quan tbi thbi di&m lay mau luc no hoac dbi, trong khi LDL-C phai duoc do khi dbi va ket qua thubng it chinh xac hon khi triglyceride >400mg/dL, khi cb su hien dien ciia Chylomicrons va benh nhan c6 roi loan betalipoprotein mau. DTD tip 2 lam tang nguy CO benh tim vit mach mau ngoai bien tir 2-7 lan. Tuy nhien, cho den nay, b Viet Nam co rat it nghien cuu ve vai trb ciia non-HDL-C trong benh ly DTD. Vi vay, nghien ciiu nay duoc thuc hien vbi muc tieu: Xac dmh nong dp non- HDL-C b benh nhan DTD tip 2.
DOI TUONG - PHUONG PHAP NGHIEN CLT-:
D o i hrong nghien ciiu
174 b | n h nhan da duoc chan doan dai thao duong tip 2 tren 5 nam, dang n i m vien tai khoa tim mach va khoa noi het benh vien Nguyin Trai trong khoang thbi gian tir thang 11/2010 den thang 7/2011 dong y tham gia nghien niu, Cac b^nh nhan nay duoc ghi nhan khong diing thuSc dieu chinh lipid mau trong vong 3 thang trubc khi tham gia nghien cuu (hbi benh va xem so dieu trj ngoai tni). Chimg toi thu n h ^ them 30 benh nhan khong c6 tien sir dai thao dubng va tang huyet ap t u nguyen tham gia vao nghien ciiu dupe sir d u n g lam nhbm tham chieu.
Co mau dupe chon thuan Ipi P h u o n g phap n g h i e n cuu:
Thiii k^nghien aiu Nghien ciiu mo la cat ngang TieM chuan loai trie
Benh nhan cb ben sir benh than hoac bi benh cap tinh
Phu nii cb thai hoac cho con bu Quy trinh nghien ciht
+ Benh nhan dupe hbi benh, tham kham va lam xet nghiem can lim sang, Mau mau dupe lay vao sang som (nhin dbi it lUiat 12 gib) de do dubng huyet, HbAIC, lipid mau theo qui dinh chuan. Nong dp choleterol, HDL-C, LDL- C, triglyceride, non-HDL-C duoc do dac true tiep.
+ Do mach-huyet ap sau khi benh nhan nghi ngoi 15 phut. Tang huyet ap khi huyet ap tam thu >140 mmHg va/hoac huyet ap tam truong > 90 mmHg hoac khi cb tmn sir tang huyet ap dang dieu tri.
+ Cac doi tupng nghien niu duoe chia lam 3 nhom:
Nhbm A: nhbm khong b} dai thao dubng (nhom tham chieu).
Hoi N g h i K h o a Hpc Cong Ngh^ BV. T n m g V u o n g n a m 2015
V H p c T r Ho Chi Minh • Phv Ban Tap 19 ' So ,\h6m B: nhom <lii thao duims (trin 5 nam)
Nhbm C: nhbm da. thao dubng (tren 5 nam) va eb tang huyet ap
P h a n tich thong ke
Cac so heu duoc thu th?p va xii ly bSng phan m^m thong ke SPSS 19.0. Ket qua dupe trmh bay b dang trung binh + do lech chu&i cho cac bien so lien tyc. Kiem dinh t-test duoc dimg de so sanh trung binh giiia hai nhbm.
Ket qua duoc xem la cb y nghia khi p<0,05.
KETQUANGHIENajtJ
Chiing tbi da tien hanh tham kham lam sang va xet nghiem sinh hoa mau cho 174 ngubi benh dai thao dubng va 30 ngubi bmh Bdng 2' So sanh cdc thdnh phan lipid mau giiia cdc n
5*2015 Nghien cuu ^ hpc
thubng tinh nguyen tiiam gia nghien cuu cb tuoi til 34 deh 94 (tubi TB ± DLC; 69,6 +10,9).
Bdng 1: Ddc diein chung ciia doi tuang nghiin
Bien Gim (nam/
n&) Tu6i (nam)
Nhom A, n=30 8/22 68,23 ±
23,12 Nhom B,
n=37 10/27 68,59 ± 13,02
Nhom C, n=137
39/98 69,36 ± 12,09
P
0,063 Bang 1 cho thay khong co sp khac nhau ve dp tuoi trung binh cua cac doi tupng tham gia vao nghien ciiu giiia cac nhbm (sic dung phep kiem t-test cho timg cap) Sy phan bo gibi tinh trong 174 benh nhan la 49 nam (28,2%) va 125 nu (71,8%). Thbi gian m i c DTD tir 5 deh 45 nam, trung binh la 10,43 ± 7,78 nam.
Bien Cholesterol tp (mg/dL)
Tnglycende (mg/dL) HDL-C (mg/dL) LDL-C (mg/dL) Non-HDL-C (mg/dL)
Nhom A U5,56± 32,23' 152,78±4513- 49,54*28,45*
115, 53±3215 95,23 ± 34 32-
Nhom B 202.17 ±52.41 187.54+91,71 42,94 ±9,51 127,59 + 41,47 165,27± 54,91
NhomC 208,29 ± 60,29 2(B,25± 89,79 43 10 ± 13,81 128,29*W,04 159,49±51,0D Cdc gia tri duoc trinh bay diroi dang trung binh ± do
lech chuan 'Khac biel co y nghJa giita cdc nhdm Bang 2 cho thay cac thanh phan lipid mau b cae nhbm doi tucmg khae nhau. Su khac biet cb y nghia giira nhom A vbi nhbm B va nhbm C vbi P lan luot la 0,046 va 0,042. Cholesterol toan phan. Triglyceride, non-HDL-C b nhbm B va nhbm C deu cao hon dang ke so vbi nhbm tham chieu. Nhbm B va nhom C ciing eb thanh phan HDL-C thap hon d i n g k§' so vbi nhbm tham chieii. Tuy nhien sy khae bi^t nay khong cb y nghia thong kg vbi P = 0,12. LDL-C b nhbm tham chieu khong cho thay khac biet vbi nhbm benh (P>0,05).
BANLUAN
Ngubi bfnh dai thao dubng hoac tang huyet ap co khuynh huong roi loan lipid mau vbi nong do triglyceride cao va HDL thap.
Mac dil nhieu nhieu yeu to cb vai trb sinh xo viia b ngubi dai thao dubng nhung bat
thubng lipoprotein dupe xem la yeu t5 then chot. Nhieu benh nhan benh maeh vanh vln xuat hien bien eo tim mach mae dii da dat duoc LDL-C mue tieu. Vi viy, gan day, nhieu tae gia khuyen cao nen diing non-HDL-C trong du bao benh tim mach b benh nhan DTD tip 2 n h l m lam giam nguy co them niiai"l Cb nhieu loi diem khi do non-HDL-C.
Trubc tien, khong can gia djnh moi li§n quan giira VLDL va triglycerid b benh nhan DTD tip 2. Thii hai, non-HDL-C bao gom danh gia tat ca lipoprotem ma chiia lipoprotein smh xo vira, db la VLDL, IDL, LDL va lipoprotein (a).
Sau cimg, non-HDL-C cb nhieu thuan Ipi trong thuc hanh lam sang, do la b?nh nhan khong can nhm dbi va cb the danh gia o benh nhan cb triglycend > 400mg/d!, re tien, dang tin cay^-^-'^. Trong cac thong so lipid mau, non-HDL-C la thbng so tuong quan tot nhat vbi Apo B, lipoprotein sinh xo viia manh nhatl>, hien duoc xem la muc tieu dieu tri
H o i N g h i K h o a Hpc Cong N g h ? BV. T n m g V u a n g n a m 2015
N g h i e n ; u u ^ hoc •l Hoc TP. Hb Chi M i n h * Phu Ban Tap 19 ' So 5 ' lipid. Benh nhan DTD tip 2 can dat duoc muc
tieu non-HDL-C <130mg/dL (NCEP III) Nghien a i u crua chiing tbi ghi nhan o nhirng ngubi DTD tip 2 tren 5 nam, non-HDL- C tang o ngubi eb hoae khong eb kem tiieo tang huyet ap. Trong khi db, LDL - C lai khbng cho thay su khac biet giiia nhbm ciiung va nhbm benh. Kannel WB da cbng nhan ich loi ciia non-HDL-C tren benh nhan DTD tip 2".
Trong nghien cuu SHEP (SystoHc Hypertension in the Elderly Program) tren 4736 benh nhan phbng ngira tien phat va thii p h a t non-HDL-C dupe xem la yeu to d u bao doc lap benh mach vanh bat chap nong dp triglyceride trong khi LDL-C bi mat gia trj d u bao khi triglyceride >400mg/dIP>. Ngoai ra, non-HDL-C chii khong phai LDL-C dupe xem la chi bao dpc lap cua benh tim mach khi dua triglyceride vao mb hinh'^'.
Chiing tbi ciing nhan thay gia tri cua non- HDL-C b nhbm benh (nhbm B va nhom C) vuot tren gibi han binh thubng (130mg/dL), gan gap dbi so vbi nhbm chiing. Vi vay can phai danh gia nguy co va dieu tri day du b nhiing benh nhan DTD tip 2 do co nguy co mac benh va hi vong tim mach cao.Viec do non-HDL-C tuong doi don gian, khong can nhin dbi, Doi vbi LDL -C, can phai dimg cong thiic Friedewald de tinh toan, cb the khbng chinh xac khi cb tSng triglyceride qua nhieu.
Nghien ciiu cua chiing tbi cho thay khbng khae bift ve LDL - C giiia nhom chiing va nhbm benh, Phan tich nhung benh nhan DTD tip 2 tong hpp tir 4 nghien ciiu doan he tien ciiu'*' cho thay nguy co tir vong tuong doi b BN dai thao dubng (so vtn khbng DTD tip 2) la 7,2 b nhimg ngubi tang non-HDL- C(>130mg/dL) va LDL-C thap (<lOOmg/dL);
5,7 doi viJi nhung ngubi cb non-HDL-C thap (<130mg/dL) vk t5ng LDL-C (>100mg/dL)t«.
Ket qua nghien ciiu ciia chung toi cho thay sy gia tang ciia non-HDL-C b benh nhan dai thao dubng, tit db eho thay Ipi ich dac biet ciia viec theo dbi nong dp non-HDL-C trong dieu
t n DTD tip 2 Uu diem cua nghien ciiu lii cac so lieu \'e nong do lipid trong mau dupe dt>
dac tryc tie'p ma khong phai tinh tu cbng thiic nen giam bbt sai so. Trx>ng khi db, han che cua nghien ciiu la nghien cniu cat ngang, tren mpt nhbm doi tupng da bi dai thao dubng tip 2 tren 5 nam nen chua the ap dung cho dan so dai thao dubng trong cbng dbng.
KETLUAN
Non-HDL-C gia tang b benh nhan dai thao dubng ti'p 2 cb hoac khbng co tang huyet ap kem theo.
TAI UgUTHAMKHAO
1 Ballantyne CM. Andrew TC, Hsia JA et al (2001).
Correlation of tion-HDL cholesterol with apolipoprotein B; effect of 5 liydroi.ymethylg!uteryl conenzyme A reduclase inhibitors on non-HDL cholesterol levels Am j Cardial, 88 265-69
2 Frost PH, Davis BR. Burlando A] (1996) Serum lipids and inadence of coronary heart disease Findings from the Systolic Hypertenaon in the Elderly Program (SHEP) Circulfllion, 942381-8
3 Jiang R, MB Schulie, Li T, Rifai N at al (2001) .Mon -HDL cholesterol and apolipoprotein B predict cnrdiovascular disease ev«tts among men nith type 2 diabetes Duibeles Care. 27 1991-1997
4 Kannel WB (2006). n i e Franun^am study its 30 year legacy and future promise. J Atherosder Thromb. 6 60-66 Kawamoto R. Oka Y. Tomila H, et al (2005) Non HDL- Choleslerol as a predictor of carotid atherosclerosis in the elderly I Allaroscler Thranb. M 143-148 6 Liu I, Sempos C, Donahue RP et al (2004), Joint
diBtnbuHon of non HDL and LDL cholesterol and coronary heart disease nsk prediction among individual with and without diabetes I Alherosckr Thtomh, B6 71-6 7 Lu W, Resnick HE, Jablonski KA et al (2003) Non-HDL
cholesterol as a predictor of cardiovascular disease in type 2 diabetes. Diabetes care, 26(1) 16-23
a MenotB A, Spagnolo A, Scanga M et al (1992) Mullivanalc prediction of coronary deaths in a 10 fear follow-up of an Italian occupational male cohort. Ada cardial, 47.311- 20
9 Pelers AL aoOS) Chmcal relei'ance of Non-HDL cholesterol m pahents n-ith diabetes ainico; Dmheles vol 26 13-7
10 Ridker. Rifai N . Cook NR et al (2007) Non-HDL cholesterol, apolipoprotein A-I and BlOO, standard lipid measures, lipid ratios, and CRP as nsk factor for
cnrdio< T ; ^ I Med J
326 - 33
Third report of the Kational Cholesterol Educi Program I.NCEP) Expert Panel on DetecBon. Evalua and Treatment of High Blood Cholesterol in A<
.', 294
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