VIETNAM MEDICAL JOURNAL H°1 • MARCH • 2018 HbAlc d ngffdi bj dai thao dffdng type 2. Va mcfi
lien quan nay gSp d nam nhieu hdn la nff.
Nhff vay, chung ta thay rang osteocalcin dd^c tiet ra ti!r te bao osteoblast co tac dung len chuyen hoa dffdng bang each tang tiet insulin cua tuy, giam de khang insulin va osteocalcin co lien quan tdi viec kiem soat dffdng huyet d benh nhan dai thao dffdng type 2.
V. KET LUAN
Ca tren thffc nghiem d chupt cijng nhff eae nghien cffu tren lam sang eh! ra rang osteocalcin CO lien quan den chuyen hoa glucose 6 benh nhan dai thao dffdng type 2 va tac dyng ien ehffc nang te bao p tuy lam tang khoi lffdng te bao, tang tiet insulin va giam sff de khang[ insulin d benh nhan dai thao dffdng type 2. O benh nhan kiem soat tot dffdng huyet thi nong dp osteocalcin cang cao.
TAI UEU THAM KHAO
1. Lee N K, H Sowa E Hinoi et al (2007),
"Endocrine regulation of energy metabolism by the skeleton", WC, 130(3), pp. 456-469.
, Ferron M, al. Marc D.McKee et (2012),
"Intermittent injeebons of osteocalcin improve glucose metabolism and prevent type 2 diabetes mmice", Bone, 50(2), pp. 568-575.
. Kimdblom jenny M., al Claes Ohlsson et (2009), "Plasma osteocalcin is inversely related to fat mass and plasma glucose in elderly S w e ^ men", J Bone Miner Res 2009, 24(5), pp. 785-791.
, Kanazawa I , Yamaguchi T Yamauchi M, et al.
(2011), "Serum undercarboxylated osteocaldn was inversely associated with plasma glucose level and fat mass in type 2 diabetes mellitus", Osteopoms Int, 22(4), pp. 187-19.
. Sarkar P.D., Choudhury A.B., et al. (2013),
"Relationships between serum osteocalcin levels versus blood glucose, insulin resistance and markers of systemic inflammation in central Indian type 2 diabetic patients", European Re«ew fyr Medical and Pharmacological Sciences 2013, 17, pp. 1631-1635.
. Rui Xuefei, Xu Bei, et al. (2014), "Differenlial pattern for regulating insulin secretion, insulin resistance, and lipid metabolism by oaeocalcin in male and female T2DM patients", Med Sd MaA 2014, 20, pp. 711-719.
Uu D.-M., Guo X.-Z., et al. (2015), "/\ssodaticn between osteocalon and gluoDse metabolism: a meta- analysis", osteopon:}S Int 2015, 26, pp. 2823-2833.
DANH GIA HIEU QUA CUA FOSAMAX PLUS cr BENH NHAN LOANG xiraNG Tir 40 TUOI TR6' LEN TAI THANH P H 5 VINH, NGHE AN
Cao Trirdng Sinh*
T 6 M TAT
Muc dich: Oanh gia hieu qua eua fosamax plus d benh nhan Icrang xffdng tff 40 tuoi trcl len. Doi Mdng vi phUdng phap: 60 benh nhan, 21 nam va 39 nff CO tuoi ddi t u 40 tuoi trd len, tuoi trung binh 58,8 ± 9,5, bi loang xuWng dang song d thanh pho Vinh.
Thdi gian: 20 thang tff 11/2015 den 7/2017, tai 25 phu'cfng xa cua thanh pho Vinh. Tat ca dffdc diJng fosamax plus (aledronat 70 mg + vitamin D3 5600 UI) moi tuan 1 vi€n, trong 6 thang va danh gia sau 1 thang, 3 tiiang 6 thang va 9 thang. Kei qua: ^ u 9 thang dieu bi diem so T- score tang tff -3,4 ± 0,7 lin -2,0 ± 0,78 mat do xUcfng tang tii 57,8 % ± 22,5 % ien den 77,4% ± 15,2%. Tac dung phu cua fosamax plus la: Phat ban, dj ffng : 6,7%; Dau bung: 10,0%;
Buon non, non: 5,0 %; Nong rat thupng vi: 10,0%; Q hdi - d chua: 10,0%. Viem loet thffc quan: 1,6%; T^b bon: 3,3%. Ket lu$n: Fosamax plus eo tac dung lam tSnp mat do xffdng d benh nhan loang xffdng tff 40 tuoi trd len. Tae dgng phu chu yeu la dau bung, buon non, nong rat thffdng vj.
*Dal hgc Ykhoa Vinh
Chju trach nhiem chinh: Cao Tnjdng Sinh Email: [email protected] Ngay nhan bai: 3.12.2017 Ngay ph^n bien khoa hoc: 2.2.2018 Ngay duyet bai: 13.2.2018
SUMMARY
TO EVALUATE THE EFFECTS OF FOSAMAX PLUS I N PATIENTS WITH OSTEPOROSIS AGB) 40 YEARS AND OLDER I N VINH d T Y , NGHE AN Aim: To evaluate the effect of fosamax plus in patients with osteoponasis aged 40 years and older.
Objects and methods: Sixty patients, 21 males and 39 females aged 40 years or older, had an average age of 58.8 ± 9.5 years, with osteoporosis in Vinh Qty.
Time: 20 months from 11/2015 to 7/2017, in 25 wards of Vinh city. All patients were given fosamax plus (aldronate 70 mg + vitamin D3 5600 UI) once a vredc, for 6 months and evaluated after 1 month, 3 months, 6 months and 9 months. Results: After 9 months of treatment, the T- score increased from -3.4 ± 0.7 to - 2.0 ± 0.78. The bone density increased from 57.8% ± 22.5% to 77.4% ± 15.2%. Side effects of fosamax plus are: Rash, allergy: 6.7%; Abdominal pain: 10.0%;
Nausea, vomiting: 5.0%; Epigastric buming: 10.0%;
Yogurt: 10.0%. Esophageal ulcer: 1.6%; Constipation:
3.3%. Conduston: Fosamax plus vrarks to increase bone density in patients with osteoporosis aged 40 years and older. Side effects are mainly abdominal pain, nausea, buming epigastric.
I.DATVANOlg
Loang xffdng dffdc dae trffng bdi sff giam khoi Iffdng xffdng va ton thffdng vi cau true eiia
TAP CHi Y HOC VigT HAM TAP 464 - THANG 3 - S01 - 2018
to ehffe xffdng, gay hau qua lam xffdng giam do tJiac va de gay. Tren the gidl, cd khoang 200 trieu ngffdi bj loang xffdng, cff 3 phu nff thi cd 1 ngffdi bj loang xffdng, ty le loang xffdng nam gidi la 145. Tai Chau Au cff 30 giay lai eo mot ngffdi bj gay xffdng do loang xffdng va tai Hoa Ky eo khoang 1,3 trieu ngffdi gay co xffdng dui do Itrang xffdng. Theo ffde tfnh cua To ehffc Y te The gidi, den nam 2050 chau A cd the se chiem 50% ty le ngffdi bj gay xffdng do loang xffdng tren the gidi. Tai Viet Nam, theo so lieu khao sat bffde dau eua Vien Dinh Dffdng, benh loang xuWig anh hffdng tdi 1/3 phu nff va 1/8 dan ong tren 50 tuoi. L/dc tinh tai Viet Nam so ngffdi gay co xffdng diji do loang xffdng den nam 2010 la 26.000 va den nam 2030 se la 41.000 ngffdi [1], [2].
Loang xffdng sau tuoi 40 la mat xffdng d xudng xop, gay lun cac dot song, dau dffdi xiidng quay, xuat hien trong vdng 15- 20 nam, dac biet la phu nff tudi man kinh. Hien nay tren the gidi, co khoang 50% phu nff tren 50 tuoi bi loang xudng, 40% phu tren 70 tudi bj gay xffdng do loang xffdng. Bdi vay viec dieu trj loang XLTdng sdm bang thuoc udng nham giam cac bien ehffng gay xffdng la rat quan trong nham giam ty le tan phe do loang xffdng. Do do chung tfii da tien hanh de tai nham: Danh gia hieu qua dieu trj cua Fosamax Plus d benh nhaan bang xffdng iff 40 tuoi trd len.
II. DOI Tl/pNG VA PHirONG PHAP NGHIEN CUU 2 . 1 . Soi tu'dng nghien cu'u
2 . 1 . 1 . Tieu chuan lu'a chon: Chon 60 benh nhan, 21 nam va 39 nff eo tuoi ddi tff 40 tudi trd len, tuoi trung binh 58,8 ± 9,5, bj loang xffdng dang song d thanh pho Vinh. Thdi gian: 20 thang tff 11/2015 den 7/2017, tai 25 phffdng xa eua thanh pho Vinh.
Chan doan loang xffdng dffa vao ti§u chuan eua WHO 1994, lay ket qua d 1 vj tri do. Trong nghien cffu nay chiing tdi chpn ket qua do d xffdng got de xac djnh ty le loang xffdng. Vi xffdng got la xffdng dac, chac nhat cd the, chju Iffc nhieu.
Bang 2 . 1 . Tieu chuan c h i n doan loang Xffdng theo WHO [2]
T-score
T-seore > - l -1 > T-seore > -2,5
T-score < - 2,5 T-score < -2,5 va cd mpt
hoac nhieu qay xffdng
Tinh trang mat dd xu'dng Mat dp xffdng binh
thffdng Giam mat d& xddng
Loang xffdng Loang xffdng nang
T-seore: Dp l§ch giffa mat dp xffdng benh nhan so vdi mat dp xiidng trung binh cua nhom ngffdi trffdng thanh tre tudi, khoe manh, eung gidi.
2.1.2. Tieu chuan loai triy
- Nhffng ngffdi benh suy gan, suy than man tinh, ngffdi bj benh ac b'nh.
- Nhffng ngffdi di dang hoac bj hat Tophy do benh Gout d eo tay va got chan 2 ben.
- Nhffng benh nhan bi loet da day ta trang - Ngudi dan khong dong y tham gm nghien cutj.
2.2. Phu'dng phap nghien ciij^u - Tat ca 60 benh nhan, sau khi dffdc chan doan loang xffdng dddc dung Fosamax Plus trong 6 thang moi tuan uong 1 vien vao 1 gid nhat djnh. Uong trffde lue an sang 30 phut, khong dffdc nam.
- Benh nhan diidc do mat dp xffdng 4 lan trong qua trinh uong sau 1 thang, 3 thang 6 thang va 9 thang udng thudc.
- May do mat dp xffdng la May Osteosys EXA 3000 sff dung c6ng nghe tia X - quang ky thuat sd, hap thu tia X nang Iffdng kep (energie X ray Absorptionmetry EXA). May thiet ke de do d eac vj trf xffdng got va xffdng quay de chan doan xac djnh loang xffdng, danh gia mffc do loang xffdng, dff bao nguy cd gay xffdng va theo doi dieu tri day la mot ky thuat tien tien khong xam lan, an toan eho ngffdi benh, ket qua chi'nh xae, cd gia trj chan doan cao.
- May xuat xff Han Quoc, co ehffc nang ehup anh va phan tich ehi tiet giup chan doan chfnh xac.
May cd kich thffde gpn nhe dffdc ket noi vdi may tfnh xaeh tay, van chuyen de dang thuan tien de dffa den cac tram y te xa de kham eho ngffdi dan.
III. K r r QUA
3 . 1 . Dac diem m l u nghiSn cihi Bang 3.1. pac diem mau nphiSn cdu Bien
so Nam
Nil' Tong
n 21 39 60
»/o 35 65 100
P
<0,0 5
Tuoi TB 54,5 59,7 57,8
±SD 9,9 8,7 9,5
P
< 0 , 05
Ty le loang xffdng 6 nff cao hdn cd y nghla so vdi nam gidi (p<0,05)
Tudi trung binh nhom nff bang xffdng eao hdn nam gidi (p<0,05)
3.2. Hieu qua dieu trj loSng xffong c6a fosamax plus
Bang 3.2. HiSu qua can thiep d nhom loang xddng diiu ttj bang Fosamax
Bien so Tru'dc CT -3,4 ±
Sau CT P(t-s)
0<0,05
VIETNAM MEDICAL JOURNAL N°1 - MARCH - 2018
% mat dp 0,7 57,8 ±
22,5 Sau can thiep 9 thang xffdng gdt tang len ro ret,
0,78 77,4 ±
15,2 T-score va mat dp
sff khac biet cd y nghTa thong ke vdi p <0,05
Bieu do 3.2. SUcai thifn cJiisS T-score theo tiidi gian
Chi sd T-score theo thdi gian d nhom benh nhan dddc dieu tri tang Fosamax tang len rd ret dae bi&
sau 9 thang dieu tri T-score tff -3,4 giam xuong - 2,6.
Sff khac biet eo y nghTa thong ke vdi p < 0,05.
3.3.Tacdung khong mong muon cua Fosamax Bang 3.3. Tac dung phu cua Fosa/nax Dau liieu tac dung pliu
Phat ban, di (tnq Hoai tur xu'dng ham
£)au bung Buon non, non Nong rat thu'dng vi
a hdi - d chua Viem ioet thu'c quan
Tao bon Tong
n ( n = 6 0 ) 4 0 6 3 6 6 1 2 28
°/o 6,7 0,0 10,0
5,0 10,0 10,0 1,6 3,3 46,7 Tac dung phu chu yeu cua Fosamax la dau bung, ndng rat thffdng vj va d hdi d chua. Chu^
gtii nhan trffdng hdp nao cd hoai tff xffdng ham sau khi dung thude.
IV. BAN L U A N
4 . 1 . Dac di€m cua m§u nghien cihi Theo ket qua nghien cffu, trong tong so 60 doi tffdng, thi ty d nam thap hdn nff: nam: 35%, nff: 65% (bang 3.1),
Theo nghien cffu cua Nguyen Trung Hoa, ty le loang xffdng d nam gidl (37,8%) thap hdn nff gidl (41,5%), lien quan nay cd y nghTa thong ke v ^ p<0,05, khi phan tfch tinh trang bang xffdng theo gidi d tffng dp tudi tac gia nhan xet (45-49 tuoi; nam 10,2 %, nff 4,8%, 50-54 tuoi: nam 17,5%, nff 13,7%; 55-59 tudi: nam 34,3%, nff 28,2%) [4]. Tuy nhien, d nhffng nhom tuoi cang Idn thi ty le nff bj bang xffdng eang cao hdn nam (60-64 tuoi: nam 42,5%, nff 58,5%; 65-69 tudi:
nam 4 6 , 1 % , nff 72,4%).
4.2. Hieu qua can thiep tren di€m sdT- score va % mat do xu'dng it nhom loang xu'dng du'dc dieu tr| loang xu'dng bang Fosamax (nhdm 3 }
Sau can thiep 9 thang diem sd T-score tang rd ret, tat ea benh nhan dffde theo ddi nhac niicl udng thudc theo tuan, danh gia tac dung cua Fosamax plus moi thang mpt lan. Sff eai Uiien mat dp xffdng, ehi sd T-score tang dan sau 1 thang, 3 thang, 6 thang va 9 thang dung thuoc.
Trffdc dieu tri T- score trung binh: -3,4 ± 0,7, sau dieu trj 9 thang T- score trung binh: -2,0 i 0,78, sff khac biet ed y nghTa thdng ke p <0,0S.
Nghien effu Liberman va cs, tren 994 pliu nti' man kinh va bang xffdng (chi sd T -2,5 hoac thap hdn) dffdc chia thanh hai nhom: nhom udng alendronate mdi ngay va nhdm placebo, dffdc theo doi 3 nam. Alendronate tang mat do xffdng (xffdng cot song tang 8,8%, xffdng c^
xffdng dui tang 5,9%, va mat dp xffdng toan cd the tang 2,5%) va giam ti le gay xffdng cot song khoang 50% [5].
Nghi§n cffu Orwoll ES va es, tren 241 dan ong vdi ehi sd T- score xffdng diJi 1-2 hay thap hdn va chi so T-score d xffdng cot sdng -1 hay thap hdn, cd tien sff gay xffdng. Qua hai nam dieu trj, so vdi nhdm placebo, alendronate tam tang mat d6 xudng ( 3 , 1 % d xffdng diii, 7 , 1 % d xu'dng cpt sdng) va giam chu ehuyen xffdng (Amino temninai Telopepbde giam 59% va phosphatase kiem dac biet cua xffdng giam 38%) [5]
Ti le gay xffdng cpt sdng la 7 , 1 % tiong nhdm placebo so vdi 0,8% trong nhom alendronate. Tuy nhien, khong cd khac biet ve ti le gay xffdng ngoai xffdng cpt song [5].
Alendronate la mot thuoc c6 hieu qua dieu tn loang xffdng do giucocortieoidlnduced gay nen, 6 eac benh nhan nam va nff, alendronate tang mat dp xffdng [5] va giam nguy cd gay xffdng cpt sdng (6,8% nhom alendronate so vdi 0,7%
nhdm placetio) sau 2 nam deu trj [5]. Cae nghi§n culi tren dda vao lieu l i ^ n g thuoc hang ngay.
Nhff vay eac nghien cuff khac cung nhff kS qua nghien cffu eua chung toi deu eho thay Fosamax (Bisphosphonates Alendronate) lam tang MDX va giam nguy ed gay xffdng.
4.4.5. Tac dung phu cua Fosamax Trong nghien cffu ciia chung toi tac dung phu cua Fosamax bieu hien khong dang ke: 6,7%
phat ban di ffng, dau bung 10%, buon non va non 5%, ndng rat vung thffdng vj 10%, d hdi, d chua 10%, viem loet thffc quan 1,6%, tao bon 3,3% (Bang 3.3. Hang I^lerck tien hanh nghien
142
TAP CHi Y HOC VIET NAM T^P 464 - THANG 3 - SO 1 - 2018 cffu mCi doi giffa Fosamax 70 mg/tuan tren 519
benh nhan va Fosamax 10 mg moi ngay tren benh nhan, cho thay tac dung phu cua Fosamax chil yeu la tren da day ta trang: nhff dau bung chiem 3,7%, kho thd 2,7%, d chua 1,9%, buon non 1,9%, soi bung 1,0%, tao bdn 0,8%; tae dung phu tren he cd xffdng nhff dau cd, dau khdp ehiem 2,9%; eo ed 0,2% [6].
I^Jghien cffu cua Robert va cong sff, so sanh tae dung eiia Aledronat tren 118 benh nhan vdi calcitonin npi mui tren 123 benh nlian eho thay tac dung phu cua Aledronat nhff sau: dau bung:
4,2%, d chua: 2,5%, buon non 3,4%, dau ngffc:
2,5%, tao bon: 0,8%, chay mui: 0,8% [7].
Nghien cffu eiia ehung toi eho thay tac dung phu cua Fosamax plus khong dang ke. Song viee uong thuoe dimg theo hffdng dan eua nha san xuat la rat quan trpng, nd giup giam thieu eae tae dung phu ciia thude dae biet la viem loet thffe quan.
V. KET lUfyti
Fosamax plus ed hieu qiia tren benh nhan loang xffdng, ty le tac dung phu c6 the chap nhan dffde.
TAI UEU T H A M KHAO
1. Nguyen Thj Ngoc Lan, Nguyen Thj Nhu' Hoa (2010), "Dinh gia hieu qua va tic dung 'l&iong mon^
muon tut thdi cua lieu phap truyen Aclasis tmng dieu tri loang xu'dng tai khoa Qi xu'dng khdp, benh vien Bach Mai', Tap chi Y hoc Lam sang Benh vien Bach Mai, so 58 thang 12 nani 2010.-^22-26.
A. WHO (1994), ''''Assessment orfracbyre risk and its application ID screening fyr po^menopausal o^sporosM'. Report of a WHO Study Group. Word!
Health Organization technical report series; 843: 1-129.
3. Liberman UA, Weiss SR, Broil J et al. (1995),
" Effect of oral alendronate on bone mineral density and the Incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Croud'. N Engl J Med 1995; 333 (22): 1437-1443.
1 . Nguyen Trung Hoa (2016) "Danh gii hieu qua mot so bien phap sau can thiep cong dong phong chong loang xu'dng d ngu'di iw 45 tuoi trd ien tai Thinh pho Ho Chi Mmh nam 2013-2015".
5. Orwoll ES, Ettinger M, Weiss S et al. (2000),
"Alendronate Ibr the treatment of osteoporosis in men". N Engl J Med 2000; 343: 604-610.
6. Micheal P Jeremiah et al (2015), Diagnosis and management of Osteoporosis, American Family Physician, Volume 92, Number 4, 262-263 7. Robert W Downs et al (2015), Comparaison of
Alendronate and Intranasal Caicitonin for Treatment of Osteoporosis in Postmenopausal Women, Journal of Clinical Endocrinology &
Metabolism, Vol 85, No 5: 1783-1788.
CAC YEU TO NGUY Ca NHIEM KHUAN BENH VIEN CUA CAC NHIEM KHUAN BENH VIEN THUCrNG GAP TAI KHOA HOI SITC TICH CU'C NHI
Ha Manh Tu3n' TOM TAT
Muc tieu: xac dmh cac yeu to ngui/ cd nhiem khuan benh vien (NKBV) tai khoa hoi sffc tich ciic Nhi.
ThiSt ke nghien cffu: Nghien cffu doan he tien effu, thffc hien tai benh vien Nhi Dong 1 trong thdi gian 14 thang. Cac bSnh nhan du tieu chuan nghien cffu dffOc theo doi suot qua trinh nam tai^khoa HSCC vdi cac bien sS dgc lap: dan so hoc, diem PRISM (pediatric risk score of mortality), tinh trang dinh dudng, can thi|p, dung thuoc va cac loai NKBV. Xac dmh yeu to nguy cd eua tu'ng loai NKBV bang hoi quy logistic da bien. Ket qua: Co 671 benh nhan dii beu chuan dUa vao nghien culi. Ty le NKBV chung la 23%, trong ^do viSm phoi benh vien (VPBV) chiem 49,4%, nhiem Idiuan huyet benh vien (NKHBV) 24,4%, nhiem khuan vet mo (NKVM) la 11,1%, nhiem khuan tiet nieu (I^KTN) 5,8%. Cac yeu to nguy cd NKBV ddi vdi tffiig
*Daihgc Ydddc TP. Hd Chi Minh Chju trach nhi|m ehinh: Ha Manh Tuan Email: [email protected] Ngay nhan bai: 14.12.2017 l^gay phan bien khoa hpc: 2.2.2018 Ngay duygt bai: 12.2.2018
loai NKBV: VPBV la dat noi khi quan (NKQ) (RR=22,3 (2,6 - 192,3)), dat NKQ > 5 ngay (RR=8,9 (2,7 - 30,0)), ire che thu the H2 (RR=3,0 (1,1 - 7,8));
NKHBV la thong TMTT (RR=4,1 (1,6 - 10,4), flat thong TMTT > 3 ngay (RR=6,4 (1,3 - 30,9), boc lo TM (RR=11,2 (4,7 - 26,9)), nuoi an TM (RR=3,4 (1,6 - 7,4); NKVM la phau thuat du'dng tieu hoa (RR= 6,6 (1,7 - 55,3), phau thuat nhilm dd (RR=3,2 (1,0 - 14,3)), dat dan Iffu (RR=3,8 (1,0 - 14,3), dat dan iu\J
> 5 ngay (RR= 5,1 (1,1 - 26,6); NKTN la dat thong tieu (RR= 1,13 (1,1-1,2), dat thong tieu > 3 ngay (RR=1,4 (1,1 - 1,8). Ket luan: Cac yeu td nguy cO NKBV tai khoa hoi sffc ti'ch ciic Nhi cho tffng loai NKBV gom CO VPBV la co dat NKQ, thdi gian dat NKQ > 5 ngay, dung thuoc LTC che thu the H2; NKHBV la dat thong TMTT, thdi gian dat > 3 ngay, co boc lo TM, nuoi an TM; NIWM la phau thuat dudng beu h6a_^loai phau thuat nhiem dd, co dat dan lUu va dat tren 5 ngay; NKTN la co dat thong tieu va dat > 3 ngay. Ket qua nay giup cho viec thUc hien eac bien phap phong ngffa NKBV cho tffng loai can thiep tai khoa HSTC nhi hieu qua hdn.
Tdkhda: nhiem khuan benh vien; hoi sffc tich cut nhi; yeu to nguy cd; viem^ phai benh vienj nhiem khuan huyet benh vien; nhiem khuan vet mo; nhiem khuan tiet nieu.
