Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
TINH TRANG ROI LOAN LIPID MAU TREN GAI MAI DAM NHIEM HIV-1 DIEU TRI THUOC KHANG VIRUS
Hoiing Thj Thanh Huyen*
Cross-sectional study of 69 FSWs HIV-1 infected;
(2) To measure lippidemia concentration using Cobas Intergra 400 plus ; (3) Data analysis using SPSS 15.0 for Window. Results: 1 1 % patients were hypercholesterolemia total, 20% patients were hypertriglyceridemia, 57% patients were hypo-high-density4ipoproteinemia- -cholesterol, 13% patients were hyper4ow-density- lipoproteinemia- -cholesterol va 12% patients were hyper non- high-density-lipoproteinemia.
Conclusion: The hyperlipidemia concentration among HIV infected patients after ARV was high, especially hypo-high-density-lipoproteinemia- cholesterol and hypertriglyceridemia.
Keywords: Lipid mau, HIV-1, Viet nam
I. OAT V A N O E
Theo bao cao ciia chuong trinh phoi hgp ciia Lien Hiep Quic vl HIV/AIDS (UNAIDS), hien nay tren thi gidi co khoang 33,4 trieu ngudi nhiem HIV trong do co khoang 30 trieu ngudi d cac nude dang va kem phat triln [4]. Cac phac do dilu tri bang thulc khang virus (antiretroviral therapy - ART-) da mang din hy vong keo dai cugc sing va cai thien chk lugng cugc song cho cac benh nhan HIV/AIDS nhung ding thdi cung gay ra nhimg roi loan chuyen hoa nhu rdi loan chuyin hda lipid, mdt nguy co hang dau cho cac benh ly tim mach. Tuy nhien, nhiJng bao cao ve roi loan chuyen hoa lipid va cac benh ly tim mach tren benh nhan nhiem HIV cdn han chi. Vi vay, nghien cim nay dugc tiln hanh nhSm muc tieu: "Ddnh gid tinh trgng rdi logn lipid mdu tren gdi I6N< TAT
Cac phac dd dieu tri bang thuoc khang virus la nguon hy vgng keo dai cugc sdng va cai thien chat WcJng cugc sdng cho cac benh nhan HIV/AIDS nhdng ddng thdi cung gay ra nhij'ng roi loan chuyen hoa nhd rdi loan chuyen hoa lipid, mgt nguy cd hang dau cho cac benh ly tim mach. Muc tieu: Oanh gia tinh trang roi loan lipid mau tren gai mai dam nhiem HIV-1 dieu tri bang thuoc khang virus. Odi tu'dng va phydng phap nghien cii'u: (1) Nghien ciTu mo ta cat ngang vdi ddi tu'dng la 69 gai mai dam dddc chan doan nhiem HIV-1; (2) Djnh lu'dng cac thong so hoa sinh tren may Cobas Intergra 400 plus; (3) Xd ly sd lieu bang phan mem SPSS15.0.
Ket qua: 1 1 % benh nhan tang ndng 36 cholesterol toan phan trong huyet thanh, 20%
benh nhan tang ndng do triglyceride, 57% benh nhan tang HDL-C, 13% benh nhan tang LDL-C va 12% benh nhan tang non-HDL Ket luan: Tinh trang roi loan lipid mau tren benh nhan nhiem HIV dang dieu hi bang ARV chiem ty le tu'dng ddi cao va chu yeu la tinh trang giam HDL-C va tang TG.
Tit khoa: Lipid mau, HIV-1, Viet nam
SUMMARY
DYSLIPIDEMIA I N FEMALE SEX WORKER HPV-1 INFECTED ANTIRETROVIRAL
TREATMENT
Antiretroviral therapy (ARV) hold great hope to have the longevity as well as the better quality life of HIV infected patients and dyslipidemia which is a well known risk factor for cardiovascular disease.Objective: To detect the changing lipidemia among female sex worker (FSW) HIV- Infected after ARV. Methods: (1)
Tru'dng Dal hgc Y Hal Phdng
367
HOI NGHj KHOA HOC BENH VIEN HUfU NGHj VIET Tl£P HAI PHONG LAN T H l f j ^
mgi ddm nhiJni HIV-1 dieu tri hdng thuoc khdng virus''
11. 061 Ta<?NG VA PHaONG PHAP NGHIEN ClfU 1. Doi hi^iig - phuong phap nghien cuu
Nghien ciru mo tii cat ngang vdi ddi tugng la 69 gai mai dam tu nguygn ky cam
f r
ket tham gia nghien ciru tai trai lao dgng so II, Ba Vi, Hii Ta>, I la ngi va tai trung tam phuc hdi nhan pham Thanh Xuan, Hai Phdng. Mau nghien ciru dugc thu nhan tir thang 6/2009 din thang 11/2010.
Ddi tugng tham gia nghien ciru dugc chan doan nhiem HlV-1 ihco ba phuong each ciia Bg y tc quy dinh, nghTa la 2 lan IlLISA duong tinh va 1 lan Western Blot duong tinh hoac 3 lan HLISA duong tinh vdi 3 loai test kit khac nhau.
- Loai khoi nghien cuu nhimg benh nhan AIDS cd nhiem triing co hdi, tien sir tac mach, CO thai va nhimg benh nhan khdng the tuan thu dieu tri trong it nhat 6 thang.
2. Phuong phap xet nghiem
Dinh lugng cac thdng sd hda sinh tren may Cobas Intergra 400 plus (Roche)
+ Lipid mau: Cholesterol toan phan (TC), Triglyceride (TG), Lipoprotein trgng
lugng phan tir cao (HDL-C) va Lipoprotein trgng lugng phan tir thap (LDL-C).
linh LDL-C va non-HDL theo cong thirc Fricdewald:
LDL-C (mmol/l) ~ TC - (HDL-C) - (0,45. IG) vdi dilu kien TG < 4,52 mmol/l non-HDL- TC (HDL-C) + alanine amino transferase (ALT)
- Dim so lugng CD4 tren may ELMA (Nhat)
- Do lugng hemoglobin (Hb) te bao mau tren may Celltax Alpha (Nhat).
3. Xu ly so lieu
Cac thdng sd xet nghiem danh gia theo chi so hda sinh ciia My
Danh gia tinh trang rdi loan chuyen hoa lipid theo National Cholesterol Fducation Program III guidelines. My [2].
LDL-C dugc danh gia la tang khi > 4,144 mmol/l.
- Su dung Wilcoxon Rank de tinh tong gia tri \ a so sanh sir bien ddi ciia cac chi so xcl nghiem \ a gidi han chi phep bang test x2.
Phan tich don bien danh gia sir lien quan cua cac bien ddng thdi tien hanli phan tich hoi qu) da bien xac dinh sir ddc lap ciia cac bien bring phdn mim SPSS 15.0. Sir khac biet c6 y nghia thdng ke khi p< 0,05.
I. KET QuA
3.1. Ket qua ve Lipid m^u:
Bdng. Lipid mau gai mai dam nhiem HIV-1 sau dieu tri bang thudc khang virus
TC TG HDL-C
LDL-C non-HDL
Ndng do Li Median
3,92 1,46 0,82 2,57 3,10
Did ( m m o l / l ) range 2,82 - 4,58 0,94 - 1,80 0 , 5 4 - 1 , 1 6 1,71 - 2,87 2,32 - 3,50
Trong 69 gai mai dam nhiem HIV-1 dilu tri bang thudc khang virus, cd 11% benh nhan tang ndng do cholesterol toan phSn trong huylt thanh, 20% benh nhan tang ndng do
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Y HOC VIET NAM T H A N G 10 - SO D A C BIET/2011
triglyceride, 57% benh nhan tang HDL-C, 13% benh nhan tang LDL-C va 12% benh nhan tang non-HDL.
111
in
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r- • ^ I N 1 . ,
Bieu di) 1: Sir llia\ doi \c nong do l.ipid mau sau AK'
3.2. Lien quan giira Lipid mau voi 69 hi6i, body mass index (BMI), CD4, Hb, ALT
Danh gia su lien quan gida nong do Lipid mau vdi do tudi, BMI, sd lugng CD4, lugng Hb va ALT bang phuang phap phan tich dot biln \ a phuong phap phan tich hoi quy da biln. Kit qua phan tich dot bien cho thiy do tuli. BMI lien quan cd y nghia thong ke vdi tinh trang tang TC, TG. LDL-C, non- HDL dong thdi lien quan tinh trang giam HDL-C vdi p< 0,05. Khi ^ilu chinh cho tk ca cac bien trong phan tich da bien cho thay CD4 la biln dgc lap vdi cac thdng sd trong xet nghiem lipid mau.
IV. BAN LUAN
Lieu phap dilu tri bang ARV cho cac benh nhan nhiem HIV da giiip cho viec tien lucmg benh dugc kha quan hon nhung ddng thai ciing mang din nhiing bien chung nguy hiem [3], Cac biln chung ve tim mach sau dieu tri bang ARV gap nhilu hon d ngudi tre tuli, trong do nhoi mau co tim la bien chimg nang nl thudng gap nhit dac biet d nhung benh nhan cd kem rdi loan lipid mau. [3].
Cac thulc ARV khdng chi la nguyen nhan
gay roi loan lipid mau ma con dugc chung minh la nguyen nhan gay tang nong do homocystein trong mau, hai ylu to nguy co nay co lien quan mat thiet vdi co che benh sinh ciia vira xo ddng mach, huylt khdi, tac mach va viem tuy [1]. Ngoai ra, cac thudc ARV con la nguyen nhan gay loan dudng md bilu hien bang phan bo md bat thudng tren CO thi ngudi benh \ a la nguyen nhan gay ra benh dai thao dudng, nhiem toan lactic, benh ly than kinh ngoai bien, hoai tir xuong. Tinh trang roi loan Lipid mau co the gap d 47 - 75% trudng hgp benh nhan sir dung thudc uc che protease.
Tinh trang rdi loan lipid mau tren benh nhan nhiem HIV dang dilu tri bang ARV trong nghien cim ciia chung tdi chiem ty le tuong doi cao va chii ylu la tinh trang giam HDL-C va tang TG. Theo Manuthu va Cs nghien cim so sanh tren 295 benh nhan HIV cd dilu tri va khdng dilu tri bang ARV cho thdy, ty 1? rdi loan Lipid mau tren nhimg benh nhan cd dilu tri ARV la 63,1% trong dd Cling chu ylu la tinh trang tang TG va giam HDL-C [2].
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HOI NGH! KHOA HQC BENH VIEN HCTU NGHj VIET TIER H A I PHONG LAN THL/37
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bao T C D i tu> nhien, k i t qu;i nghien ciru ciia 1993;76: 1423 1427.
chiing toi cho lliiiN si) lugng CD I dgc lap vdi 2. Manuthu F M , .Joshi, M D , Lule GN.
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do cac thudc khang virus gay ra. 4. UNAIDS, W orld Health Organization (WHO). AIDS Epidemic Update. UNAIDS.
T A I UEU THAM K H A O Gene\a. Switzerland: W HO; 2009J. Selhub.
1. Feingold KR, Krauss R M , Pang M. The Homocysteine metabolism. Annu. Rev. Nutr.
hypertriglyceridemia of acquired 1999. 19:217-46.
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