Nghien cihi YDHCT Viet Nam
TREN BENH NHAN ROI LOAN CHUYEN HOA L I P I D MAU NGUYEN PHAT CUA TRA TAN ALISMA
Study on cholesterol lowering effects of t h e soluble t e a Alisma in patients with p r i m a r y dyslipidaemias
" Vu Van Sou ', ** Nguyin Tuan Binh ', *** NguySn Nhiruc Kim ^ 'Benh vien Yhpc cS truyin - Bp Cong an, ^ Truong Dai hpe YHd Npi T6m tSt
Muc tieu: Ddnh gid hieu qud ciia tra hoa lan Alisma tren mpt so chi so sinh hoc va sinh hoa tren b^nh nhdn roi loan chuyen hoa lipid man nguyen phdt. Theo doi tdc dung khong mong muon • cua trd hoa tan Alisma. Ddi tupng nghien cil'w: 60 b?nh nhdn duoc chdn dodn xdc dinh roi loan chuyen hoa lipid nguyen phdt vao dieu n-i tai Binh viin Y hoc co truyen Bp Cong an tic thdng 4- 11/2009. Phuang phdp: Nghien cim can thiep ldm sdng mo co so sanh trudc sau Kit qud: Vdi lieu chudn ve chi so lipid mdu. Hieu qud tot dat 60,0%. hieu qud trung binh (33.33%), khong hiiu qud (6,67%)). Kit lugn: Tra tan Alisma co hiiu qua lam giam cdc chi so lipid mdu trin 93.3% truong hpp, trong do hieu qud lot dgt 60.0%. Khong ldm thay doi cdc tri so cong thirc mdu, chire ndng gan thdn. cdc chdt diin gidi vd glucose mdu
Til kh6a:lRoi lo^n chuyen hoa lipid mdu; Trd tan Alisma
Summary
STUDY O N C H O L E S T E R O L L O W E R I N G E F F E C T O F T H E S O L U B L E T E A A L I S M A IN P A T I E N T S W I T H P R I M A R Y D Y S L I P I D A E M I A S Objectives: To assess the effects of soluble tea Alisma through some biological and biochemical criteria in patients with primary dyslipidaemias; Following the unwanted effects of the tea. Subjects: 60 patients who were diagnosed primary dyslipidaemias treated at the Traditional Medicine Hospital, Ministry of Public Security from 4-11/2009. Methods: The clinical intervention study, comparing the result before and after treatment. Results: base oneself on plasma lipid profile, good result reached 60,0%. moderate reached 33.33% and poor result was 6,67%.
Conclusions: Soluble tea Alisma had effect on reducing blood lipid parameters in 93,3% of cases, in which good result reached 60.0% The soluble tea did not affect the CBC, liver and kidney function, electrolytes and blood glucose.
Keywords: dyslipidaemias; soluble tea Alisma.
Oja chi lien h?: Nguyin Tukn Binh - Benh vi?n YHCT Bp cong an Ngiy n h | n b^i: 08/4/2015 Dja chi email: [email protected] Ngay ph^n bifn: 20/5/2015 Phan bien khoa h^c: PGS.TS. Tran Qu6c Binh Ngiy dSng bao- 26/6/2015
* BS; ** TS.BS; *•* PGS.TS
Journal of research In viet nam traditional medicine and pharmacy
I. DAT VAN DE
Rdi loan lipid mau da tra thanh mdt vin dd rat dugc quan tam, bai tinh pho bien va hgu qua phiic tap cua nd va la mdt ydu td quan trpng trong danh gia, didu tri va tien lugng mot so bdnh ly tim mach. Theo cae nghien ciiu dich td hoc cho thay, co mdi tuang quan ty le thuan giira ndng dp cholesterol, triglycerid mau vai ty le viia xo dpng mach, nguy co mac bdnh mach vanh ciing nhu tu vong do benh mach vanh.
Hien nay, y hpe hien dai da sii dung nhieu bien phap dd dieu tri rdi loan ehuyen hoa lipid mau nhu che dp an, sinh hoat dieu dp, ren luyen the luc va dung thudc. Khi diing thuoc dd dat hieu qua dieu tri phai diing keo dat gay nen nhiing tac dung khdng mong mudn.
Theo y hoc co truyen, rdi loan lipid mau thupc chiing dam thap va duge ehia lam nhieu the benh voi cac bidu hidn khac nhau. Cac thudc co ngudn gdc thao mpc dd didu tri chirng dam thap da va dang duge sir dung rdng rai tren lam sang.
Tra tan Alisma duge bao chd tir vj traeh ta duoi dang tra tan, da dugc Vien Khoa hoc va Cdng nghd Viet Nam nghidn curu va ehimg minh c6 tac dung dieu tri chiing rdi loan chuyen hoa lipid mau trdn thuc nghidm. Tuy nhidn, chua co cdng trinh khoa hgc
nao nghidn eiiu de danh gia hidu qua trdn lam sang, chiing tdi thuc hidn de tai nay nham 2 muc tieu:
1. Ddnh gid hiiu qua cua trd hoa tan Alisma trin mpt so chi so sinh hgc vd sinh hda tren tinh nhan roi loan lipid mdu nguyin phdt
2. Theo doi tdc dung khong mong mudn cua trd hoa tan Alisma.
IL CHAT LIEU, DOI TU'ONG VA PHUONG P H A P NGHIEN ClTU
2.1. Chat lieu nghien cihi: Tra hoa tan Alisma 3g san xuat tai Benh vien YHCT Bg Cdng an
2.2. Doi tuong, dia diem, thoi gian va chat lieu nghien cuu
* Tieu chudn lua chon theo y hoc hien dai: Benh nhan dugc chpn nghien cim phai dam bao cac tidu chuan:
- Tir tir 40-70 tudi ke ca nam va nii Dugc xac dinh co rdi loan chuydn hda lipid mau dua vao tidu chuan Valencia 1987.
- Tu nguyen tham gia nghien ciiu.
- Ddng y lam cac xet nghiem day dii, diing thai didm.
* Tieu chudn lua chon theo y hoc CO truyen: Bdnh nhan ed bieu hien cua chiing dam thap theo y hpe cd truyen.
* Tieu chudn logi trir:
Roi loan chuyen hoa lipid do dung thuoc
- Khdng tuan thu Heu trinh nghien cuu
Nghien cihi YDHCT Viet Nam Sd 45-2015
- Mac benh suy tim, suy gan, ung thu, lao, phu nii c6 thai...
' Dia diim vd thai gian nghien cim: Tir thang 4-11/2009 tEii Bdnh vien Y hpe cd truyen Bd Cdng an.
2.3. Pbuvng phap nghien cuu
* Ca mdu nghien ciru: n=60
* Thiet ki nghien cuu: Nghien eiiu thir nghiem lam sang mo c6 can thiep va so sanh truoc sau.
* Cdc chi tieu nghien cuu: Danh gia truoc va sau dieu tri: Trieu chumg y hpe cd truyen (met moi, an kem, dSy bung, cham tieu, ng^i v ^ dpng, sac thai beu, rdu day, nhat, mach trSm sap); Chi sd nhan trac (can nang, ehi sd BMI, huydt ap); Chi s6 lipid mau (Cholesterol, Triglycerid, HDL- Cholesterol, LDL-Cholesterol) va cac chi tieu c|n lam sang khac; Tae d\mg khdng mong mudn (danh gia trong va sau dieu tri).
* Phuang phdp ddnh gid kit qud:
* Tieu chuan danh gia theo y h^c CO truyen: Dua theo tieu chuin nghidn ciiu lam sang cua Bd Y te Trung Qudc:
+ Hidu qua tdt: Khdng chd dugc cac trieu chiing lam sang (tdng s6 didm giam=70%)
+ Hieu qua trung bmh; Cac tri?u chiing lam sang co bidn chuyen (tong sd diem giam=30%).
-!- Khdng hieu qua: Trieu chiing khdng cai thi^n hoac tang (tdng sd diem giam=30%).
* Tieu chuSn danh gia theo y hpe hien dai: Hidu qua trdn eac thanh phan lipid mau:
+ Hieu qua tot: Cholesterol giam tir 20% tra Idn; Triglycerid giam tii 40% trd len; HDL-Cholesterol tang tir 0,26 mmol/1 tra len; LDL-Cholesterol giam dat 3,9 mmol/1.
+ Hieu qua trung binh: Cholesterol giam tir 10-20%; Triglycerid giam tir 20-40%; HDL-Cholesterol tang 0,21- 0,26 mmol/l; LDL-Cholesterol giam dat 4,0-4,9 mmol/l.
+ Khdng hi^u qua: Cholesterol giam duoi 10%; Triglycerid giam duoi 20%; HDL-Cholesterol tang duoi 0,12 mmol/1; LDL-Cholesterol con tren 4,9 mmol/1.
* Cdc chi tieu theo doi khdc: So sanh su thay ddi cac chi so xet nghiena, chi sd can nang, BMI, huydt ap; Danh gia tac dung khdng mong mudn.
* Phuang phdp xie ly so lieu: Cac sd lieu dugc xii ly theo phuong phap thdng kd y sinh hpe, phin mdm Epi- infor 6.04.
I
Journal of research In viet nam traditional medicine and pharmacy No 4t
III. KET QUA NGHIEN ClTU
3.1. Daic diem ciia cac doi tirgrng nghien cuu
Bang 3.1: Dac diem chung cua eac dot tuong nghien ciru D9C dilm chung
Cac chi so nhan trac
Chi so huyet ap
MOt s6 chi s6 lipid mau
Chieu cao (cm) Can nang (kg)
BMI Huyet ap tam thu (mmHg) Huyet ap tam truong (mmHg)
Cholesterol (mmol/1) Triglycerid (mmol/1) HDL-Cholesterol (mmol/1) LDL-Cholesterol (mmol/1) Tu6i tnmg binh
Benh nhan (n=60) X±SD 167,97±3,73
63,90±7,17 23,52±1,45 121,41±15,55
78,83±9,44 5,95±1,22 4,51±2,45 0,88±0,21 3,74±1,18 48,93±6,21 Nhan x&: Chi so BMI cua nhom doi tugmg nghien cihi la 23,52±1,45, luong cholesterol trung binh 5,95±1,22 mmol/1. Tuoi trung binh cua nhom doi tuong nghiSn cihi 14 48,93±6,21.
• T i n g Tr IgljcerU m i u dontbuan
• Ting l^ldiniuliSn h ^
Bieu d^ 3.1: Dac diem roi loan lipid mau ciia cac doi tuong nghien ciru N h ^ xet: Ty 1? tang cholesterol mau don thuin chidm ty le (15%), tang triglycerid mdu don thuin (21,67%), tang lipid mau hdn hgp (63,33%).
Ngliien cOu YDHCT Viet Nam Sd 45-2015
Bang 3.2; Cac benh ly tim m^ch kem theo
n
%
Tang huyet ap 19 31,67
Benh m^ch vanh
7 11,67
Tai bien mach mau
nao 8 13,33
Xff viia dong mach ngoai vi
2 3,33
I
1
36 1 60 ; Nhan xet: Tang huyjt ap la benh kem theo chiem ty le cao nhat (31,67%), tai bien mach mau nao (13,33%), benh mach vanh (11,67%), xo viia dong mach ngoai vi(3,33%).
3.2. Hien qua tren cac chi tieu Upid man sau 60 ngay dieu tri
Bang 3.3: Sii thay doi mot so thanh phan lipid mau sau 60 ngay dieu trj Chi so lipid man
Cholesterol (mmol/1) Triglycerid (mmol/1) HDL-Cholesterol (mmol/1) LDL-Cholesterol (mmol/1)
N„(n=60)
^±SD 5,95±1,22 4,51 ±2,45 0,88±0,21 3,74±1,18
NM(n=60)
^ ± S D 4,92±1,0 3,18±1,56 0,96±0,16 2,94±1,08
Pt-s
<0,001
<0,001
< 0 , 0 5 J
<0,001 Nhan xet: Su thay d6i mot so thanh phan lipd mau sau 60 ngay dieu tri co y nghia thdng ke voi p<0,05.
3.3. Hieu qua ciia tra hoa tan Alisma tren cac chi tien theo doi khac Bang 3.4: Sy thay doi cac chi so nhan trac Thm gian
Chi so huyet ap Can nang (kg)
BMI
N„(n=60) Z ± S D 63,9a±7,17 23,52±1,45
Nso(n=60) X±SD 62,35±7,17 22,94±1,52
Pt-s
>0,05
>0,05 Nhan xet: Tra hoa tan Alisma khong lam thay doi cac chi so nhSn trac (p>0,05)
Journal of research in viet nam traditional medicine and pharmacy No 45 - 2015
Bang 3.5: Sur thay doi chi so huyet ap o doi tuong nghien cuu Dan vi tinh: mmHg
Thbti gian Chi so huyet ap
Huyet ap tam thu Huyet ap tam truofng
N„(n=60) X±SD 121,67±15,55
78,83±9,44
NM(n=60)
^±SD 117,5± 12,65
75,73±7,61
Pi-.
>0,05
>0,05 Nhan xet: Tra hoa tan Alisma lam thay doi huydt ap o cae doi tugng nghien ciiu khdng CO y nghia thdng kd (p>0,05).
Bdng 3.6: Thay ddi trieu chiengy hpe co truyen sau 60 ngdy diing trd hoa tan Alisma
Hif u qua dieu tri Trif u chung
Co thi nJng ne An dSy chuong Tuc ngirc, su6n
Met moi Mach hoat Luoi nh(?t beu Reu t r ^ g ban Tieu tien it Dji ti?n mat
Tong so bfnh nhan
(n=60) 53 38 34 52 55 51 50 12 34
Het n 17 21 12 14 18 6 22
3 14
%
32,07 55,27 35,30 26,92 32,73 11,76 44,0 25,0 41,17
Giam n 30 15 17 31 31 29 20 7 13
%
56,60 39,47 50,0 59,62 56,36 56,86 40,0 58,33 32,84
Khong thay doi n 6 2 5 7 6 16 8 2 7
%
11,33 5,26 14,70 13,46 10,91 31,38 16,0 16,67 20,59 Nhan xet: Khi dimg tra hda tan Alisma, hau hdt cac tridu chihig y hoc ed truydn ddu giam tir 32,84% ddn 59,62%.
Nghien cOu YDHCT Viet Nam Sd 45-2015
3.4. Hien qua theo cac tieu chuan danh gia
3 ( n ^
l O H
/^
/'
33 •»
5334't
^ ^ J 3 ^ 3 ; ^ ^ H
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• YhQctiipnibl
• Yhpccotniym
H ) ^ qua tot Hlfu qua trung KhfingU^uqua
Bieu do 3.2: Ket qua theo tieu chuan cua y h9c hien dai va y hoc cS truyen Nhan xet: Bidu dd 3.2. eho thdy hi?u qua tdt (60,0%), trung bmh (33,33%o), khdng hidu qua (6,67%). Theo tidu chuan y hpe cd truydn: Hidu qua tdt (43,33%), trung bmh (53,34%), khdng hidu qua (3,30%).
3.5. Tac dung khong mong muon
Bang 3.7: Su thay ddi cac ehi tieu can lam sang khac Chi tien theo doi
Ure (mmol/1) Creatinin (mmol/1)
ALT (U/I) AST (U/I) Hong cau (M/1)
Bach c4u (K/1) Tieu cau (K/1) Hb (g/dl) Glucose (mmol/1)
Na^ (mmol/I) K* (mmol/1)
N„(n=60) X±SD 6,82±9,51 105,4±11,7 29,66±6,26 32,23±8,2 4,19±0,05 6,49±0,82 209,3±15,5 138,43±11,0 5,39±0,72 141,11±2,32
4,22±0,33
N„(n=60) X±SD 5,09±0,7 103,7±11,9 24,76±5,33 29,4±7,47 5,38±6,73 6,73±0,8 209,1±14,9 137,2±10,9 5,36±0,6 139,94±2,03
4,13±0,28
P
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05 Nhan xet: Benh nhan udng tra hoa tan Alisma chua thay co tac dung phu nao trong nghien ciiu nay.
Journal of research in viet nam traditional medicine and pharmacy
IV. BAN LUAN
4.1. Ve d^c diem cua doi tugng tham gia nghidn cuu
CJ nghien ciiu nay chiing tdi th4y ty Id b^nh nhan c6 tang cholesterol mau dan thuan la 15,0%i, tang triglycerid don thuin la 2l,67%o, tang lipid mau hon hgp la 63,33%. Ty 1?
tang lipid hdn hgp nay tuong duong ket qua nghidn eiiu cua Bui Thi Min (55%), Vu Viet Hang (50,75%), Nguydn Nhugc Kim (56,25%), Tang Thi Bich Thiiy (56,6%). Tuy nhien, trong nghien cihi ciia chiing tdi ty 1?
tang triglycerid cao han cac nghien eiiu truac.
- Cdn ndng vd BMI: Kdt qua sau 60 ngay didu tri, can nang trung binh giam 1,55 kg, chi so BMI giam trung binh 0,57. Tuy nhidn, sy thay ddi nay khdng CO y nghTa thdng kd vai p>0,05.
Beo phi va thiia can la yeu td nguy co cua viia xo ddng m^ch. Do vay, vide kidm soat tang can ddi vai bdnh nhan rdi loan lipid mau la rat can thidt. Y hpe cd truyen ehia hinh the eon ngu6i lam 3 loai: Phi, eao, nhuc va cho rang, chimg phi phat sinh la co lien quan ddn thap dam va khi hu "Phi nhan da dam thap", nguai beo phi thuong c6 nhieu dam thap va dugc ggi la "nguai dam trd". Nguoi beo khi hu sinh han, ban sinh thSp, thSp sinh dam. Nhu vay, giira tinh tr?mg beo phi va chirng dam thap CO lien quan chat che vol nhau.
Mdi tuong quan thu|n giiia BMI cao va rdi loan lipid mau da dugc nhan thdy trong cac nghidn ciiu cua Pham Khue, Nguyen Nhugc Kun, Hoang Khanh Toan, Via Viet HSng.
4.2. Kit qua trdn HA va cac trif u chung lam sang
* Chi so huyet dp: Huydt ap ciia benh nhan sau didu tri giam 4%, s\r thay ddi khdng co y nghTa thdng kd vai p>0,05. Theo y hpe cd truyin, tang huydt ap thupc chiing "huydn vung",
"diu thdng", trong do tang huydt ap the dam thap hay gap d nguoi beo phi va co cholesterol eao.
* Trieu chung ldm sdng: Cac trieu ehiing met mdi, an day truong, rdu luoi trang ban, dai tidn nat, co the nang ne, mach hoat, tieu tien it dugc cai thidn 6 da sd cac truong hgp. Sau dieu tri cac trieu chiing lam sang dugc cai thidn ro a da sd cac trudng hgp (78,1%), chi CO sd it truong hgp khdng cai thidn tridu chiing (<18,8%). Tac dung tuong duong nghidn ciiu ciia Bui Thi Man vd vien BCK. Ty l? cai thien trieu chiing la >83% bdnh nhan, ty Id khdng hieu qua 16,67%, thap hon so voi ket qua nghidn ciiu cua Tang Thi Bich Thliy ve vidn HCTl, ty le cai thien trieu ehiing la 96,7%, ty Id khdng hieu qua la 3,3,%.
4.3. Ket qua tren cac ehi so lipid mau
Nghien cihi YDHCT Viet Nam So 45 - 2015
- Ket qua tren cac thanh phan lipid mau, kdt qua nghien ciiu ciia chiing tdi cho thay, tra hoa tan Alisma eo hidu qua didu chinh eae ehi sd lipid mau vai cac truong hgp co rdi loan lipid mau.
Sau 60 ngay didu tri, chi sd cholesterol, triglycerid, LDL- cholesterol tren bdnh nhan nghidn ciiu giam CO y nghTa thdng ke voi p<0,001, chi sd HDL-cholesterol o ddi tugng tang voi p<0,05. Nhu vay, tac dung ha lipid mau cixa tra hoa tan Alisma la rit kha quan. Nhung do thai gian ciia chiing tdi con han chd, ehua theo doi dugc hidu qua didu chinh lipid mau sau khi ngimg thudc, ciing nhu ty Id tai phat bdnh. Day ciing la mpt dieu cSn thidt de mis r^ng nghien ciiu, khing dinh them.
- Tra tan Alisma dugc t^o ra tii cao khd Trach ta (Alisma plantago) lg (tuong duong lOg tr^ch ta) va ta dugc vira du dong trong tiii thidc 3gam.
Duoi d£ing bdt hoa tan, min vira phai, mau vang sang ddn vang sam, mui tham dac trung cua dugc lieu, vi nggt nhe. Thanh p h ^ ehii ydu ciia trach ta theo nghien ciiu ciia y hpe hien dai:
Alisol A, Alisol B, Alisol A monoaeetate, Alisol B monoacetate, Epialisol asparagine, choline, tinh dAu, alcaloit, vitamm B12, Kali.
Ket qua nghien eiiu dugc ly hien dai ve UEich ta la: Phin traeh ta hoa tan trong met, trach ta cdn chidt xuSt va cdn trach ta ddu co tac dung ha pipid huyet thanh ro. Trach ta eon co tac dung cai thien chiing nang chuydn hoa lipid eua gan va chdng gan nhidm ma.
Trach ta con co tac dung Igi tidu va lam cho natri, kali, clo, urd thai ra nhieu ban. Cao cdn chidt xuat trach ta edn CO tac dung ha huyet ap nhe. C6n chidt xuat phan trach ta hoa tan vao nuoc CO tac dung lam gian mach vanh ro. Thudc eon co tac dung chdng ddng mau. Mpt sd nghien ciiu buoc d4u cho thay nuac sac trach ta con co tac dung ha duong huydt. Theo y hoc cd truyen trach ta con co tac dung Igi nieu trii thap, nen co tac dung trir thip hoa dam, rit phii hgp dd didu hi chiing dam thap.
Lidu lugng, each dimg: ngay diing 4 lan, mdi lin 1 tiii hoa trong 100 ml nuoc sdi. Lieu trinh cho mpt dgt dieu tri la 60 ngay.
Trdn co so phan tich khoa hpe vS thanh phan hoa hpe, tac dung dugc ly cua vi thudc trach ta (thanh phin chinh la Alisma), kdt hgp voi ly luan y hoc cd truydn va phan tich kinh nghiem thuc tidn lam sang chung tdi cho ring, tra hoa tan Alisma co kha nang cai thidn tmh trang rdi loan lipid mau. Kdt
Journal of research in viet nam traditional medicine and pharmacy
qua thu dugc gop phin khing dinh mdi lidn quan giiia chung dam thip cua y hoc cd truydn va hdi chiing rdi loan lipid mau eua y hpe hien dai va gop phan hidn dai hda eac chd phim CO ngudn gdc tir thao dugc cua y hpe cd truyen.
4.4. Su thay doi cac chi tieu can lam sang khac
Cac chi sd ALT, AST, Urd, Creatmin, glucose, Na^, K"^, Hdng ciu, B£ich cau, Tidu ciu va Hb sau nghien ciiu CO thay ddi, nhung sy khac bidt khdng CO y nghia thdng kd (p>0,05).
4.5. Tac duing khdng mong mu^n eiia tra hoa tan Alisma
Trong 60 bdnh nhan nghien ciiu khdng CO bdnh nhan nao cd bieu hien man ngiia, ndn, budn ndn, ia chay, dau diu hay tao bdn.
V. KET LUAN
Tra tan Alisma co hidu qua lam giam cac chi sd lipid mau tren 93,3%
truong hop, trong do hidu qua tdt dat 60% va hidu qua trung binh 33,3%.
Alisma cai thien tdt cac trieu chiing lam sang eua chiing dam thap theo y hoc ed truyen.
Alisma khong lam thay ddi cac chi sd cdng thirc mau, ehiic nang gan, than, glucose mau va cac chat dien giai.
TAI LIEU THAM KHAO 1. Hoang Bao Chau (1997),
"Dam am", Npi khoa y hoc cd truyen, Nha xuit ban Y hpe, tr: 326-343.
2. Pham Tu Duomg (1994), "Hdi chiing tang lipid mau", Bdch khoa thu b?nh hoc. Tap 2, tr: 289-294.
3. Hpi tim mach Viet Nam (2006), "Khuyen cao ve cac benh ly tim mach va chuyen hda giai doan 2006-2010", Nha xuit ban y hoc Chi
nhanh Thanh phd Ho Chi Minh, tr:
365-384.
4. Pham Gia Khai (2007), "Tinh hinh benh tim mach a Viet Nam", Bdo cdo hoi nghi tim mgch mien Trung md rang, thang 7/2007.
5. Do Tat Loi (2000), Nhitng cdy thuoc vd vi thudc Viet Nam, Nha xuat bany hoc, tr; 217.
