HOI NGHI KHOA HOC BENH VIEN HGTU NGHI VI&T TI^P H A I PHONG LAN THLf 37
NGHIEN CCrU CHI SO HOMA
V6l CAC YEU TO CUA HOI
CHLTNGCHUYEN HOA 6 BENH NHAN TANG HUYET AP VO CAN
TOM TAT
Vai tro ciia de khang inslin trong hoi chu'ng chuyen hoa dUOc nhan manh qua nhieu nghien ciru.
Chiing toi thUc hien de tai nay nhSm xac dinh Mang quan giO'a de khang insulin vdi cac yeu to ciia hoi chimg chuyen hoa. Nghien ciru mo ta c3t ngang 117 ngudi t3ng huyet ap vo c3n dU(?c chpn khong ngau nhien, chung toi co 43 ngUdi mSc hoi chu'ng chuyen hoa kem theo bieu hien de khang insulin. Ap dung tieu chuan chan doan hoi chu'ng chuyen hoa ciia NCEP ATP III cho ngUdi chau A Thai Binh DUdng (2001). Sir dung chi so HOMA, xet nghiem lipid va insulin mau bang may hoa sinh t u dpng ciia hang Roche (Dire).
Ket qua thu dUdc: tUdng quan r (Pearson) giiJa chi so HOMA vdi vong bung, BMI, HATT, HATTr, Glucose, TG fan lUdt la 0,14; 0,82; 0,44; 0,42; 0,61; 0,02. So lieu ciia chung toi cho thay de khang insulin d ngUdi tang huyet ap vo can khong co tUdng quan vdi vong bung, TG; tu'dng quan yeu vdi HATT va HATTr; tu'dng quan tot vdi glucose mau, tu'dng quan manh vdi BMI. So lieu ciia chiing toi con nho, can cd nghien culi vdi so doi tu'dng Idn hdn.
SUMMARY
INSULIN RESISTANCE
WITH FACTORS OF METABOLIC SYNDROME I N PATIENTS WITH ESSENTIAL HYPERTENTION
Objectives: The roles of metabolic syndrome
was emphasized in many reports. We perform this
studty on sible of correlation between the insulin
resistance with factors of metabolic syndrome.
Afef/rocte; A cross-sectional study of 117 patients with essential hypertention that were rolled non randomly.
We find 43 patients those have metabolic syndrome and insulin resistence concomitantly. Using HOMA
* Benh vien hitu nghj Vi^t-Tiep Hdi Phdng
Hoang Dang Mjch*
index, investigating blood flating glucose and lipid by automatic biochemical machine of Roche company (German). Results: r-correlation (Pearson) between HOMA index with abdomen circumference, BMI, systoiis blood pressure, diastolic blcxxJ pressure, Glucose, Triglycerid was 0,14; 0,82; 0,44; 0,42; 0,61;
0,02 respectively. Conclusions: Our data show that insulin resistance have no correlation with abdomen circumference and TG; correlating weakly with systoiis blood pressure, diastolic blood pressure; that correlation was strongly v'.ith blood glucose and was closely with BMI.
I.
OAT VAN OEDe khang insulin co \ai tro rat quan trong trong hoi chimg chuyen hoa (HCCH).
Cac nucrc chiiu Au coi de khang insulin la mot trong nhimg tieu chuan chan doan HCCH, la trung tam cua sinh benh hoc HCCH. Cac nghien curu trong vai nam tra lai day da cho thay de khang insulin xuat hien
\ cVi ty lc cao trong cac quan the ngirai mac 1 ICCTl [4], ngircri tang hu> ct ap \ a ngucri dai thao dircmg t\pe 2. Chiing toi chon benh nhan tang huNct ap (THA) \ci can de nghien cim moi lien c^uan giira de khang inslin voi ciic >cu to cua HCCH nham dong gop them thong tin \ c \ tin de nay. Co mot so phuong phiip danh gia sir co mat cua tinh trang de khang insulin. Tinh chi so HOMA la phucmg phap chung toi sir dung trong nghien ciru.
Chiing toi tien hanh de tai nghien cuu nay
\6i muc tieu:
Xac dinh tirorng quan giiia chi so
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Y HOC VIET NAM THANG 10 - SO DAC BIET/2011 HOMA vai cac yhu th cua hoi chimg chuySn
hoa a nguai tang huylt ap vo can.
II. o6l TUpNG VA PHUONG PHAP NGHIEN COU 1. Doi tirong nghien cii'u: T6ng s6 117 benh nhan tang huyet ap vo can tai khoa Tim Mach benh vien hu-u nghi Viet Tiep Hai Phong dugc chon khong ngau nhien \ao nghien cuu. Thai gian 2008-2009.
2. PhiroTig phap nghien ciiu: Nghien , cuu mo ta cat ngang.
Ap dung tieu chuan chan doan HCCH , cua NCEP ATP 111 cho khu \irc chau A-Thai ,Binh Duang (2001).
Phan do tang huyet ap theo JNC Vll E (2003).
Lipid va insulin mau dugc xet nghiem tren may hoa sinh tir dc)ng ciia hang Roche (Due).
Chi so lTOMA== insulin x glucose/22,5 (Binh thucmg tii' 0,56-1,4). Co de khang Insulin khi > 2,56.
Tieu chuan loai trir: nhirng benh nhan co scit, cac bieu hien cap tinh khac, tang huyet ap CO nguyen nhan.
Xir ly SCI lieu theo phan mem SPSS 13.0.
Lay gia tri p co khac biet thong ke khi <0,05.
III. KET QUA NGHIEN CQU
Trong 119 benh nhan tang huyet ap nguyen phat co 71 benh nhan co hoi chung chuyen hoa (59,6%). Trong 71 benh nhan co hoi chung chuyen hoa co 43 benh nhan (60,5%) cc» de khang insulin (chi s6 HOMA > 2,56).
Tirmng quan giu-a chi so HOMA voi cac yeu to cua hoi chii-ng chuyen hoa 6" benh ': nhan co de khang insulin
Y = 0,70x - 6,63
Bieu do I: Tuomg quan giira chi s6 HOMA vai huylt ap tam thu r = 0,44; p < 0,05.
Y = 0,12x-4,80
Bieu do 2: Tuong quan giira chi s6 HOMA vai huylt ap tam truang r = 0,42; p < 0,05.
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HOI NGHj KHOA HQC BENH VIEN HUTU NGH| V I | T T I $ P HAI PHONG LAN THLf 37
Y = 0,15x+1,38
Bieu do 3: Tucrng quan giCra chi so HOMA vai vong bung, r = 0,14; p > 0,05.
Y = 0,14x + 3,39
. X ^ x
Bieu do 4: Tuang quan giua chi so HOMA vai BMI, r = 0,82; p > 0,05.
Y = 0 , 6 7 x + l , l l
Bieu do 5: Tuang quan giira chi so HOMA vai glucose mau. r = 0,61: p < 0.01.
Y = 0,06x + 6,19
Bieu do 6: Tucmg quan giii'a chi so HOMA vai TG, r = 0,02; p > 0,05.
IV. BAN LUAN
1. Tirffng quan giiia chi so HOMA v&i vong biing
Chi so HOMA trong nghien curu cua chiing toi khong co tucmg quan vai vong bung (r =0,14). Kit qua nghien ciiru cua Nguyen Thi Quynh Trang thi nhan thiy ring chi so HOMA co tuong quan ylu vai vong bung (r= 0,45) [3]. So dT co su khac nhau
nhu \ a> la do doi tugng nghien cuu ci chimg toi la bfnh nhan tSng huyet ap vo d con doi tugng nghien cuu cua Nguyen Quyr Trang la nhimg nguoi beo phi.
2. Tirffng quan giira chi so HOMA w huyet dp tam thu vd huyit dp tam triromg
Ket qua nghien cuu cua chiing toi ths chi s6 HOMA co quan he tuyIn tinh thuan \
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Y HOC VIET NAM THANG 10 - SO OAC BIET/2011
tuong quan nay la ylu voi huylt ap tam thu va huyet ap tam truang, r ISn lugt la 0.44; 0.42.
3. Tirang quan giira chi so HOMA v&i glucose mdu
Chi so HOMA co quan he tuyen tinh thuan va tuomg quan chat che voi glucose (r=
0,6i).
Nguyen Canh Toan nhan tha> cucrng insulin mau c6 quan he tuyen tinh thuan va tuong quan chat che vcyi glucose mau, nhung tac gia lai khong de cap den lien quan giira chi so khang HOMA \ a glucose [1], 12].
Nghien cim cua chiing toi \a Nguyen Canh Toan chua co sir tuomg dong do trong nghien cuu ciia chiing toi co mot so doi tugng mac hoi chirng chuyen hoa co de khang insulin nhung co glucose mau binh thuong hoac glucose mau thap.
4. Tiromg quan giira chi so HOMA v&i triglycerid
Nghien cuu cua chiing toi nhan thay chi s6 HOMA khong c6 tucmg quan voi triglycerid (r= 0,02).
Theo Nguyen Thj Quynh Trang, chi so HOMA CO tuong quan yeu voi ^triglycerid (r=
0,31) [3].
5. Twang quan giita chi s6 HOMA v&i BMI
So lieu thu dugc trong nghien ciiu cua chiing toi cho thiy chi s6 HOMA co tuong quan rit manh voi chi s6 BMI, r = 0,82. Dilu nay ggi y nhihig nguoi du can, beo phi gan nhu luon di doi voi dh khang insulin. Ngay
•'ca khi chi s6 HOMA khong co tucmg quan '>ai vong bung va triglycerid a nguoi tang
%uylt ap vo can thi 6 nguoi beo phi da dugc
thay CO moi tuong quan thuan yeu giira chi so HOMA voi hai yeu to niiy.
Nghien ciru ciia chung toi con han che bcri so lugng nho. Dc danh gia nhung tuong quan de cap tren can ci) nhieu nghien ciru tucmg tir.
V. KET LUAN
So lieu nghien cu'u ciia chung toi cho thiiy chi s6 HOMA khong tuong quan voi vong bung, nong dc) triglycerid mau; tucmg quan yeu voi huyet ap tam thu va huyet ap tam truong. De khimg insulin co tuomg quan thuan chat che voi nong do glucose mau va dac biet co tuong quan thuan manh voi BMI.
TAI LIEU THAM KHAO.
1. Nguyen Canh Toan (2007). " Nghien cuu khang insulin o benh nhan tang huyet ap CO roi loan glucose mau liic doi" Tap chi Tim mach hoc Viet Nam so 47 -2007, tr 479-483.
2. Nguyen Canh Toan (2007). "Nghien curu vai tro cua khang insulin trong hoi chimg chuyen hoa a benh nhan tang huylt ap".Tap chi Tim mach hoc Viet Nam s6 47-2007, tr 310-316.
3. Nguyen Thi Quynh Trang (2007).
"Khang insulin o nguoi beo phi" Ky yeu cac dl tai nghien cim khoa hoc Hoi nghi Noi tiet Dai thao duong mien Trung lan thir 4, tr 526-530.
4. Eckel R.H., Grundy S.M., Zimmet P.Z (2005). The metabolic syndrome.
Lancet, 365, pp. 1415-28.
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