MOI TirONG QUAN GIITA NONG DO ACID URIC HUYET THANH VOI CAC THANH TO CUA HOI CHITNG CHUYEN HOA,
CHI SO SOKOLOW- LYON, CHlTC NANG THAN
Nguyen Vdn Hoang', Nguyin Anh VS^
TOM TAT
Muc tieu: Moi lien quan giua ndng dp acid uric huyet thanh vdi hgi chiing chuyen hda va tang huydt ap ngay cang dugc quan tam, do do chiing tdi tidn hanh dd tai nay nham muc tidu sau:
Mdi tuong quan giua ndng dp acid uric huyet thanh vdi tudi, gidi, cac thanh td ciia hgi chiing chuyen hoa, chi so Sokolow- Lyon, sy bidn ddi hinh thai va chuc nang than.
Doi tuxmg va phmmg phap nghien cuu: 305 benh nhan tudi trung binh 59,45±10,54 cd hpi chiing ehuydn boa theo tieu chuan IDF-2006. Nghien cuu thyc hien tai benh vidn tinh Phii Ydn.
Ket qua: C6 moi tuong quan miic dp vua giGa ndng dp acid uric huyet thanh vdi sd do vong bung (r = 0,4; p < 0,0i), huydt ap tam thu (r = 0,5; p < 0,001). huydt ap tam truong (r = 0,5;
p < 0,001), creatinin (r - 0.298; p < 0,001), glucose mau liic ddi (r = -0,3; p < 0,001).
Cd mdi tuong quan thuan khong dang ke giua ndng do acid uric huyet thanh vdi tuoi (r = 0,123;
p < 0,05). chi sd Sokolow- Lyon (r = 0,195; p < 0,001).
Ket luan: Nghidn ciiu cho thay ndng do AU huydt thanh co tuong quan vdi mpt so thanh td Clia hpi chiing ehuydn hda vdi miic dp khac nhau.
Tir khda; v^c/t^ur/c, Tdng huyet dp.
ABSTRACT
CORRELATION OF SERUM URIC ACID LEVELS WITH METABOLIC SYNDROME, SOKOLOV- LYON INDEX, AND RENAL FUNCTION
Nguyen Van Hoang', Nguyen Anh Vt/
Background: Relationship between serum uric acid levels with metabolic syndrome and hypertension are increasingly interested, so the aim of this study: Relation between serum uric acid levels and age, sex, metabolic syndrome, renal function.
Subjects and methods: 305 patients with an average age of 59.45 ± 10.54 had the metabolic syndrome according to IDF-2006. Research conducted at the Phu Yen hospital in a cross sectional study.
' Benh vi?n tinh Phu yen
" Bp mon Npi dai hpc Y Dugc Hui ' Phu yen Hospital
" Hue university of Medicine and Pharmacy
TAP CHI TIM MACH HOC VIETNAM SO 6 6 - 2 0 1 4 133 ^
Results: There are the moderate correlation between SUA concentration with systolic blood pressure (r 0,5; p < 0,001). diastolic blood pressure (r 0,5; p < 0,001).
waist circumference (r - 0,4; p < 0,01), serum creatinine (r - 0,298; p < 0,001), fasting glycemia (r = -0,3; p < 0,001) while diis correlation is weak widi age (r = 0,123; p < 0,05), Sokolow- Lyon index (r = 0,195; p < 0,001).
Conclusion: This study showed the SUA concentration m correlation with some components of metabolic syndrome.
Keywords: Uric acid, hypertension.
1. D A T V A N D E
Da cd nhidu cong trinh nghidn cuu ve mdi lidn quan gi&a acid uric vdi bdnh tang huyet ap, dai thao dudng, bdnh than, beo phi [1], [2].., nhung moi lidn quan giira ndng do acid uric huyet thanh vdi hdi chiing chuyen hda d bdnh nhan trdn 40 tudi it dugc cac tac gia de cap, do do chiing toi tien hanh dd tai '''Nghien ciru nong do acid uric huyet thanh a benh nhdn tren 40 tuoi kem hgi chimg chuyen hoa, co vd khong co tdng huyet dp" nham muc tieu sau: Khao sat ndng do acid uric huyet thanh d bdnh nhan cd hgi chiing chuyen hda tren 40 tudi, cd va khong cd tang huydt ap.
2. DOI TU^OfNG VA PHlTONG PHAP NGHIEN ClTU
- Tidu chuin chpn benh: Tit ca nhflng benh nhan > 40 tudi, ddn kham va dieu tri tai Benh vidn da khoa tinh Phii Yen, tir thang 5/2012 den thang 5/2013 dii tieu chuin chin doan HCCH theo IDF-2006 dua vao nghien cuu. Cd 305 benh nhan tham gia nghidn cuu dap iing tidu ehuan chpn benh.
Tieu chudn chdn dodn tang SUA
Tang AU mau khi: Nam > 70mg/l (420 micromol/1) Nu > 60mg/l (360 micromol/l)
- Tieu chuin loai tru: Dgt giit cdp, nhung bdnh nhan co bung bang, phii toan than, benh ly nhilm khuan, bdnh cip tinh nang, nghien rugu, cac t)enh he thdng, suy giap, cudng giap, dang su dung thuoc gay roi loan AU (thu6c didu trj ung thu. Salicylate, Igi tidu, Ethambutol, Pyrazinamid.
corticoid, Allopurinol).
3. PIHTONG PHAP NGHIEN ClTU Thiet ke nghien cuu: Md ta cat ngang.
4. KET QUA
4.1. Dac diem ehung cua doi tugng nghien ciru
Bang 1. Phan bo doi tirptig nghign ciru theo tu5i va gioi O9 tuoi
Nhom Nam(n=129) Nir(n=176) Tu6i(X±SD) P
<60 tu6i n=184
84 100
%
45,65 54,35 52,65±4,95
>60 n=121
45 76
%
37,19 62,81 69,79±8,09
>0,05
Chung n=305
129 176
%
42,3 57,7 59,45±10,54
0,008
T ^ CHi TIM MACH HOC VIET NAM S 6 66 - 2014 133
Bang 2. S3 thanh to cSu thanh nen HCCH S6 thanh t6 eiia HCCH
3 4 5 Tong cpng
n 135 126 44 305
%
44,26 41,31 14,43 100
P
<0,001
Bang 3. Tirang quan giira nong dp SUA vdi cac thanh to cua HCCH Tutmg quan
Acid Uric r P
VB 0,4
<0,001 HATTh
0,5
<0,001 HATTr
0,5
<0,001 Go
-0,3
<0,001 HDL-C
0,1
>0,05 TG
0,02
>0,05 Bang 4. NSTB SUA vol mdt s6 yeu to lidn quan
CAC YEU TO KHAC
Tang Glucose
HDI^e iynam HDI^e frnir
TG Creatinin
(\imoUl) Cl,„.
(ml/phut) SL (mm) Soi h$ tiet
ni^u
khong Co
<1.03
>1.03
<1.29
>1.29
<1.7
>1.7
<115
>115
<60
>60
>35
<35 Co Khong
Tang SUA (1) n
42 47 16 31 29 13 14 75 76 13 31 58 20 69 39 50
(X±SD) 461,38±68,11 489,32±94,64 538,19± 71,09 495,23± 63,75 446,62±95,94 420,08±45,63 507,57±80,93 470,27±83,66 468,05±74,24 523,38±119,78 483,32±97,59 472,29±76,24 493,85±74,52 471 ±86,25 480,87 ± 87,50 472,44 ±81,69
Khang tang SUA (2) n
46 170 29 53 76 58 39 177 212 4 52 164 18 198 58 158
(X±SD) 304,91 ±62,31 272,46±67,96 303,59±67,05 335,02±56,52 247,01±58,27 258,81±53,23 272,64±79,12 280.85±65,43 277,96±67,65 354,25±41,02 268,08±62,81 282,95±69.33 296,39±62,54 277,82*68,38 302,09±61,73 271.03±68,44
P(1.2)
<0,001
<0,001
<0,001
<0,001
0,001
<0,001
<0,001
0,001
TAP CHI TIM MACH HQC VffiT NAM SO 66 - 2014
Bang Tumig quan Acid Uric r
P
5. Tuomg qnan giihi Dong d9 SUA v6i cac VB
0,4
<0,001
HATTh 0.5
<0,001
HATTr 0,5
<0,0«1
thiinh to eiia HCCH Go -0.3
<0,001 HDL-c
0,1
>0,05 TG 0,02
>0,05
Tiiong qnBi pia Kid unc mau t tn Hu>
90 - • • *
«> T «•.__• • . 200 300
Bieu do 1. Bieu do tmmg quau giua nong do SUA voi HATTr
:
• •
«
T 1 " K ' ^ * ' |• . •
I t *
,
• <
• •
t,
t
1 •
T j
1 •• ,
•
»
J..- t<
1
• ^
•
Bieu dd 2. Bieu do tirong quan giira uong do SUA voi HATT
Bieu do 3. Bien do tunmg quan giira nong do SUA. voi vong bung
TAP CHI TIM MACH HQC VIET NAM S 6 66 - 2014
Bang 6. Danh gia nguy co tang SUA ciia cac thanh to HCCH Vong bung trong thanh tS HCCH duoc danh gia qua BMI
Thanh to BMI Glucose H D L - c TG HA Hang so
He so hoi quy 1.892 -0.595 0.764 0.101 2.525 -4.031
P
<0.001 0.088 0.017 0.811
<0.001
OR (95% CI) 6.64(3.60-12.51) 0.55(0.28-1.09) 2.15(1.15-4.02) 1.11 (0.48-2.54) 12.49(4.52-34.50)
1
Tidn hanh phan tich hoi quy logistic vdi cac bidn nay ta co bang hdi quy logistic nhijng yeu to gdp phan tang acid uric nhu sau:
Bang 7. Tutmg quan giira nfiug d? SUA vdi cac thanh to ciia HCCH Thanh to
BMI H D L - c HA He so
He sd tuffng quan 1.968 0.726 2.674 -4.488
5 p
<0.0001 0.0202
<0.0001
'•OR ( 9 5 % CI) 7.16(3.82-13.42) 2.07(1.12-3.82) 14.50(5.36-39.21)
•1
+ S U A - V B r - 0 . 4 p < 0 . 0 0 1 y = 7,31x + 339,68
Kel qua ciia chiing toi cho thay cd sir tuong quan thuan vira giiia nong do SUA vdi vong bung, beo phi. Kdt qua nay tuong dong vdi nhidu nghien ciiu khac tren cac doi tugng va phuang phap tinh khac nhau:
Chen LY va cs nghidn ciiu tren 2 374 ngudi. (} nam / nu, ndng dp SUA tuong quan thu|n dang kd vdi VB: r = 0.297 / 0.234 ) [13]. Nghidn cuu cua Lu va cs [21], cd 13.345 ddi tugng dugc khao sat cho thay VB tuong quan thuan vdi AU d ca 2 gidi nam va nu 13n lugt la (i= 0,185.
p=0,01 ) va(r= 0,512. p - 0 , 0 1 ).
Nguydn Diic Cdng \ a cpng sir, nghien cuu moi lien quan giiira ndng dp SUA vdi HA tren 43 bdnh nhan THA nguyen phat, kdt qua cho thay NDTB SUA vdi BMK 23kg/m2 (n=15):
329,1±82,0; BMI>23kg/m2 (n-28): 394,1±80,1), p<0,01 [2]. Tr3n HCru Dang va cs, khi nghien cuu anh hudng ciia thd trpng len ndng do SUA d 105 benh nhan DTD typ 2 cho thSy: Nong dp SUA d doi tucmg cd thd trgng binh thudng la 3I7.52±65.256jimoI/l, d benh nhan BP do 1 la 392,57±101,72 pmoi/l, BP do 2 la 591.00 ± 00 ^mol/I [3]. Nghien ciiu ciia Nguyen Thi Thiiy Hang cung cho thay cd sir tuong quan thuan vira phai giiia ndng do AU va chi sd khdi co thd (n=82, i= 0,42;
p<0.001)[10].
TAP CHI TIM MACH HOC VIET NAM SO 66 - 2014 136
Trong nghien ciiu djch tl hgc NHANES I (n^5926) [16], gia tri SUA trong tii phan vi cao nhat cd lidn quan vdi gia tri BMI cao d ca nam va nu. Mdt nghidn cuu tien ciju khac gom 433 nam gidi tre, khdng BP, khong THA dugc danh gia BMI, huydt ap, nong do SUA va mdt so tieu chi khac mdi nam trong vdng 5 nam va da chiing minh rang ndng dp SUA dir doan sy tang can va tang BP vd sau. Ngoai ra co nhidu nghidn cuu khae cho thay AU la nguy co ciia BP.
Khi nghien cuu mdi lidn quan ndng dp AU d 420 bdnh nhan dugc chan doan HCCH theo tieu chuan IDF- 2005, co BMI > 40 kg/m^ cho thay: Ty le tang SUA ehung la 34,28%. nam nhieu hon nii (51,72 so vdi 29,72%; p = 0.0002). Nam gidi cd tang SUA cd nguy co mSc DTD (p = 0,034). Phu nu cd tang SUA cd thd cd THA (p = 0,003), HCCH (p = 0,001), tang TG (p = 0,001) va GGT (p ^ 0,009), va giam HDL-c (p ^ O.OIl). Sau khi phau thuat ndi tSe da day, nong do SUA giam ttr 5,60±1,28 ddn 4,23±1,20 (p<0,0001). Ty Id tang SUA giam tir 48,3% ddn 17,2%
(p<0,0001) d nam, va tix 29,7% ddn 3,65 (p<0,0001) d nu. Cac tac gia ket luan rSng ndng do SUA CO lien quan vdi sy bat thudng chuyen hoa tren nhung ddi tudng nghien ciru. Sau phau thuat giam can. ty le tang AU va ndng do SUA ddu giam.
BP thong qua vdng bung khdng ngung gia tang tren thd gidi dac biet d cae nude phat tridn Cling vdi sy phat trien cua ndn kinh td. La tieu ehuan chinh trong chkn doan HCCH IDF, tien than cua bdnh tim mach va tieu dudng. BP anh hudng tren chuyen hda AU gdm tang san xuit AU va giam dao thai AU d than do anh hudng ciia tang insulin mau thii phat.
+ Vdi HUYET AP
S U A - H A T T r = 0.5 p < 0.001 y - 2 , 9 x +73,79 S U A - H A T T r r = 0.4 p < 0.001 y - 0,05x + 67,30
Ket qua nghidn ciiu cho thay cd su tucmg quan vira phai giira SUA vdi HATT va HATTr.
Kdt qua nay tuong ddng vdi rat nhieu nghidn euu trong nude va tren thd gidi.
Nguydn Diic Cdng va cdng sy, nghien ciiu mdi lidn quan giira nong do AU vdi HA tren 43 bdnh nhan THA nguyen phat, kdt qua cho thay co mdi tuong quan thuan kha chat che giira nong dp AU vdi HATT (i^0.629), va HATTr (i-0.578), p<001 [2]. Theo nghidn ciiu cua Nguyen Thj Thiiy Hang cung cho thSy cd sy tucmg quan thuan viia phai giiia ndng do AU va miic do THA (n=82, r= 0,23, p<0,05), giiia ndng do AU va thdi gian phat hien THA (n-82, r - 0,21; p<0,05) [2] Chau Ngpc Hoa va cs chiing minh co tuang quan thuan chat che giiia nong do SUA vdi phan dpTHA(r-0,7)[16].
Nghien ciiu cua Lu va cs [21]. co 13.345 d6i tugng dugc khao sat cho thay SUA tuang quan thuan vdi HATT / HATTr d ca 2 gidi nam / nu lin lugt la (r= 0,053. p-0,01) / (r= 0,078. p ^ 0,01) va (r= 0,192. p=0,01 ) / (i^ 0,015. p - 0,01). Nghien cuu cua Barbosa MC va cs trdn 756 ngudi (369 nit) phan theo ngu phan vi SUA cho thap huyet ap tmng binh ca tam thu lin tam truong ddu tang din tu ngu phan vj tSp nhit ddn cao nhat, p^0,001 [38].
Seungho Ryu va cs nghien cuu 10.802 nam gidi tudi tir 30-59 tai Han qudc theo doi tii nam 2002- 2009. Dilng phan tich h6i quy Cox dd danh gia anh hudng cua tang SUA (>7.0 mg/d) len cac ydu td nguy ca. Kdt qua cd 2496 ngudi dan ong cd tang AU (OR:48,7, KTC 95%: 46,8-50,7).
Tang SUA co tuong quan thuan vdi tu6i, BMI, HA. Tang SUA dy bao nguy ca tim mach va HCCH d nam gidi Han qu6c va thay doi each sdng lam giam SUA mau [24].
TAP CHI TIM MACH HQC VIET NAM SO 66 - 2014 137
Nhidu nghien ciiu vd mdi tuong quan giiia ndng do SUA vdi HA trdn nhieu doi tugng khac nhau nhung cd eiing kdt qua. Nghien cuu chiing tdi ciing tuong ddng vdi cac nghien cuu khac do la mdi tuang quan thuan giiia HA va SUA. Rat nhidu cac nghien cuu da cho thay AU la yeu t6 nguy CO dgc lap cua benh tim mach sau khi da hieu chinh. Do dd cho ddn hien nay, AU van dong vai trd trong co chd bdnh sinh ciia bdnh tim mach, benh THA va benh than, bdnh Gout.
Ca che gay THA cua AU rat phiic tap va chua hoan toan bidt r5, Theo Fei DI cd the do:
AU tang keo dai gay ra rdi loan npi md, tang sinh td bao co tron mach mau, kich hoat he renin - angiotensin, benh vi mach cau than, co mach dan ddn THA.
+ Vdi ©U*6fNG MAU r = -0,3 p<0,001, y = 424,53 - 11,83x
Ket qua nghidn ciiu cua chiing tdi cho thay cd sy tuong quan nghich vira phai giu^ nong dp SUA vdi dudng mau
Da CO nhidu cdng trinh nghien ciru de cap den mdi lien quan giua AU vdi glucose may nhung kdt qua khdng ro rang.
Nghien curu ciia Tran Hiru Dang va cs tren 105 benh nhan DTD 2 va nhom chiing 30 ngudi (khdng hi DTD2 va cac bdnh gay tSng SUA), eho thay NDTB SUA d benh nhan DTD 2 cao han nhdm chiing (344,45±0,93 ^imoI/1 / 255,87±0,73 ^mol/I ), p<0,0001 [3], Ld Thanh Hai va cs khi khao sat trdn 143 bdnh nhan cho thay gi&a AU va glucose tuong quan nghjch khdng cd y nghia thdng kd (r: -0,123; p>0,05) [4].
Nghien cuu ciia Lu va cs [21], cd 13.345 ddi tugng dugc khao sat cho thay glucose mau liic ddi tuong quan thuan vdi AU (r= 0,144. p=0,01) d nir, nhung tuong quan nghich d nam (r=-0,082. p= 0,01).
Nghien cuu ciia Barbosa MC va cs khi khao sat 756 ngudi (369 nam) chia SUA thanh ngu phan vi cho thay sy phan bd ndng do glucose tir ngu phan vi thap nhat den cao nhat nhu sau 92.00 ± 29.02 mg/dl: 88.31 ± 17.66mg/dl; 90.40 ± 20.30mg/dl; 91.87 ± 21.71mg'dl; 92.82 ± 18.50mg/dl;
p=0.39[ll].
Theo Dehghan A va cs, tren 4.536 ddi tugng co miic glucose mau binh thudng, trong thai gian theo doi trung binh lO.l nam co 462 doi tugng phat tridn tidu dudng, sau khi dieu chinh cho BMI. vdng bung, huydt ap, HDL-c cac tac gia cho r5ng SUA la ydu td nguy co ddc lap va manh me eho bdnh DTD 2 [15].
Nghidn euu ciia Chien KL va cs tren 2.690 doi tugng (35 - 97 tudi) khdng bi DTB 2. Tac gia kdt luan cd mdt sy lien kdt khidm tdn giiia SUA vdi ty le m4c DTD 2 d ngudi Trung Qu6c.
Sy lien kdt nay mot phan qua trung gian HCCH [14]. Ngoai ra, cd nghidn ciiu bao cao rSng acid SUA tuong quan thuan vdi HCCH, tuong quan nghich vdi dai thao dudng.
Nghien cim ciia Nan H va cs, SUA tang d giai doan tidn DTD 2, nhung giam d giai doan DTD 2 [23]. Giai thich eho mdi quan he nay la: Khi bi DTD, glucose mau tang cao, gay uc che tai hap thu AUd ong lugn gan dan den giam SUA.
Tdm Iai mdi quan he giira AU va Glucose mau rat phiic tap, c6 nhieu ket luan rat khac nhau, ddi lap nhau va ngay ca khac nhau giua 2 gidi do dd can cd nhung nghidn ciiu Idn dd xac dinh mdi quan he nay.
TAP CHI TIM MACH HOC VEfT NAM SO 66 - 2014 138
+ Vdi H D L - C r=0.1 p>0-05 TRIGLYCERID r= 0.02 p>0,05
Kdt qua nghiai cuu cua chiing tdi cho thSy ndng do SUA cd tuong quan vdi HDL - c va TG vdi r=0,l / 0,02, nhung khdng cd v nghTa p>0.05. Kdt quar nay khac vdi nhieu nghien ciiu khac
Theo Ly Lan Chi va cdng sy [7]. nghien ciiu mdi lien quan gitra ndng do SUA vdi lipid mau trdn 240 bdnh nhan THA nguyen phat kdt qua cho thay nong do AU tuong quan thuan miic dp nhe va trung bmh vdi CT (r = 0,185. p<0,05), TG (r - 0,413, p<0.001), LDL-c (r = 0,184, p<0.05). Nghidn ciiu cua Nguyen Thi Thtiy Hang eung cho thay cd sy tuong quan thuan giira ndng do AU va miic do THA, giiia ndng dp AU va thdi gian phat hien THA, giiia ndng dp AU vdi chuc nang than. Tuong quan thuan ch5t che giiia nong do AU vdi TG va CT, tuang quan nghich vdi HDL-c. Tuong quan thuan chat che giiia ndng do AU va chi sdkhdi co the [15].
Chen LY va cs n ^ d n ciiu trdn 2 374 ngudi. O nam gidi. ndng do SUA tuong quan thuan dang kd vdi VB (r = 0297). 6 i*u nu, mdi tuong quan chat che AU vdi TG(r = 0.329). VB (r = 0234).
Nam cd tang SUA co nguy co tang 1,634 lan HCCH so vdi nhiing ngudi khdng co tang AUmau [ti sd chdnh (OR) = 1,634, P = 0,000]. Phu nii tang SUA cd nguy co tang 1.626 lan HCCH (OR = 1.626, P = 0.000) so vdi nhiing ngudi khdng cd tang SU.-\. [13]
Seungho Rj'u va cs nghidn cuu 10.802 nam gidi tuoi tir 30-59 tai Han qudc theo do! tir nam 2002- 2009. Diing phan tich hdi quy Cox dd danh gia anh hudng eiia tang SUA (>7.0 mg/d) Idn cac yeu to nguy co. Ket qua cd 2496 ngudi dan dng cd tang AU (OR:48.7. KTC 95%: 46.8-50.7).
Tang SUA cd tuang quan thuan vdi tudi. BMI. ndng dp rugu. HA. HCCH, hsCRP. TG. GGT. va tucmg quan nghich vdi do Igc ciu than \ a HDL-c. Tang SUA dy bao nguy ca tim mach va HCCH d nam gidi Han qudc va thay ddi each sdng lam giam SUA [24].
Cac nghidn ciiu trdn ddu cd ehung ket qua la SUA tuong quan thuan vdi TG, tuang quan nghich vdi HDL - c, nhung kdt qua nghidn cuu eiia chiing tdi SUA khdng cd mdi tuong quan vdi TG va HDL - c. Dieu nay dugc giai thich la mau ciia chiing tdi la nhiing benh nhan bj HCCH., sd lugng benh nhan tien DTD va DTD cao (217/305 trudng hgp)
Ket qua bang 3.21 cho thiy cd mdi tuong quan thuan giiia ndng do SUA huyet thanh vdi tuoi, creatinin va chi sd Sokolow- Lyon
+ VdiTUOI r = 0 . 1 2 3 p < 0.05 } - 1.35x + 256.74
Ket qua nghien ciiu chiing tdi cho thi\ nong dp SUA tuong quan thuan khdng dang kd vdi tudi (r=0,123). Ket qua nay tuong ddng vdi mdtsd nghien ciiu khac nhu
Conen D va cs khao sat mat cat ngang trdn mdt dan sd ngau nhidn 1.011 ddi tugng tudi tir 25-64 tudi. Ty Id tang SUA nam / nir la 35.2% / 8.7%. SUA lidn quan chat che ddn TG d nam gidi cung nhu d phu nii (r = 0.73. d nam gidi va r = 0,59 d phu nii, p <0.001). Nong do AU cung lidn quan dang ke nhung mure do it han vdi tudi tae. BMI, huydt ap, rugu va sii dung didu tri ha hu\etap. [12]
+ Vdi CREATININ r = 0.298 p < 0.001 y = 0,74x + 272.93
Ket qua nghidn cuu cho thay ndng dp creatin tuong quan thuan vira phai vdi nong do SUA, r=0.298. Ket qua nay tuong dong vdi nhidu nghidn ciJru khac.
TAP CHi TIM M.\CH HOC M E T NA.M s 6 6 6 - 2 0 1 4 139
Nghidn ciiu ciia Nguyen Thj Thuy Hing cho thiy co sy tuong quan thuan giua ndng dO AU va mire do THA, giira ndng dp AU va thdi gian phat hien THA, giira ndng dp AU vdi chirc nang than thong qua nong do creatmin mau (n=82, r=0,35, p=0,01). Tuong quan thuan chat che giiia ndng do AU vdi TG va CT, tuong quan nghich vdi HDL-c. Tuong quan thuan chat che giiia nong do AU va chi sd khdi co the [10].
Chau Nggc Hoa va cs ehung minh cd tuong quan thuan chat che giiia ndng do SUA vdi day thit trai (he s6 tuong quan r-0,61), phan do THA (r=0,7), dam nieu vi thd (i-0,63) va creatinine mau (r=0,63) [5].
Nghien cuu cua Barbosa MC va cs trdn 756 ngudi (369 nu) phan theo ngu phan vi SUA cho thiy NDTB cua creatin tang din tir ngy phan vi thip nhat ddn cao nhat, p=0,001 [ I I ] .
Seungho Ryu va cs nghidn ciru 10,802 nam gidi tudi tii 30-59 tai Han Quoc theo doi tir nam 2002 - 2009. Diing phan tich h6i quy Cox dl danh gia anh budng cua tang SUA (>7.0 mg/d) len cac yeu td nguy co. Kdt qua co 2496 ngudi dan dng cd tang AU (OR:48,7, KTC 95%: 46,8- 50,7). Tang SUA cd tuang quan thuan vdi tudi, BM!, HA, TG, va tuong quan nghjch vdi dp loc cau than va HDL-c. Tang SUA dy bao nguy co tim mach va HCCH d nam gidi Han Qu6c va thay d6i each sdng lam giam SUA [24].
Ca che gay suy chuc nang than do AU dugc gia thich nhu sau:
- Gay boat hda he thong renin- angiotensin.
- Gay nhiing thay ddi vi mach va vidm d than.
- Giam dap litig ty didu hoa ciia than.
- Gay dai thyc bao mo ke va tham nhidm te bao T.
- Gay bdnh ly tidu ddng mach ddn.
+ Vdi SOKOLOW - LYON r = 0.195 p < O.OOI y = 2,69x + 269,95 Chau Nggc Hoa va cs ehung minh cd tuong quan thuan chat che gi&a ndng dp SUA vdi daythittrai(r=0,61)[5].
Mitsuhashi nam 2009 nghien ciiu sy lien quan giiia SUA va phi dai that trai d nam gidi Nhat Ban tren 3.305 cdng nhan nam tudi tir 35-66 tudi (tudi trung binh 48,0 ± 7,1) phi dai that trai theo tidu chuin Sokolow-Lyon va / hoac chi s6 didn the Comell). Cae ddi tugng dugc chia thanh 3 nhom theo muc tang SUA huyet thanh. C miic tang SUA cao nhit (0,39- 0,65 mmol/L hoac 6,6-11,0 mg/dl) cd ty Id tang len dang kd ciia phi dai that trai so vdi miic SUA thap nhat hoan toan dpc lap vdi tuoi, chi sd khdi co the, miic dp creatinin huydt thanh, THA [22].
4.2. Danh gia nguy cff cua cac thanb td HCCH vdi SUA
Xem xet nhiing thanh to cua HCCH (trong do vdng bung dugc thay BMI) lien quan den tang SUA, bing kJ thuat hdi quy logistic cho thiy tang SUA chju anh hudng nhidu nhit ciia THA [OR:14,50, KTC 95%: (5.36 -39.21), p < 0,0001] (Bang 3.21). Nghien cuu da phan tich Clia Grayson va cs d 55.607 ngudi tham gia: Tang AU phdi hgp vdi tang nguy co THA (RR:
1.41, KTC 95%: 1.23-1.58). Cu tang Img/dl ciia AU se tang nguy co Idn 1.13 (KTC 95%: 1.06- 1.20) d ngudi tre (p=0.02) va d phu nii (p=0,059). Tac gia kdt luan: Tang AU lam tang nguy co THA la ddc lap vdi cac YTNC truyen thdng, nguy co ro nhat d ngudi tre va phu n& [ 18].
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5. KET LUAN
- Cd mdi tuong quan miic dp vira giiia ndng dp acid uric huydt thanh vdi sd do vdng bung (r = 0,4; p < 0,01), huydt ap tam thu (r = 0,5; p < 0,001), huydt ap tam truong (r = 0,5; p < 0,001), creatinin (r = 0,298; p < 0,001). glucose mau luc ddi (r = -0,3; p < 0,001).
- Cd mdi tuong quan thuan khdng dang kd giua ndng do acid uric huyet thanh vdi tudi (r = 0,123; p < 0,05). chi sd Sokolow- Lyon (r = 0,195; p < 0,001).
TAI LIEU THAM KHAO
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