Hpl NGHI KHOA Hpc CIJA Hpl H 6 A SINH Y DtUfC HA NQI VA CAC TINH PHIA BAC LAN THg XVlll
TAI U | U THAM KHAO:
1. Adachi, J., Kumar, C , Zhang, V., Olscn, J.V., and Mann, M. (2006). The human urinary proteome contains more than 1500 proteins, including a large proportion of membrane proteins, Genome Biol. 7, pp. 80.
2. Coon, J. J., Zurliig, P and SchmitI, K.P.
(2008), CE MS analysis of the human urinary proteome for biomarker discovery and disease diagnostics. Proleomic! Clin Appl. 5(9) pp, 34-.18
3. Getting, W.S., Rogers, T.B., Krick, T.P., Mai:is, A..I., and llirahim, H.N.
(2006), Urinary beta2- microglobulin is associated with acute renal allograR rejection, Am J Kidney Dis, 47(5), pp, 898-904,
, Spahr, C.S., Davis, M.T., McGinley IM.D., ct al. (2001), Towards defining the urinary proteome using liquid chromatography-tandcm mass spectrometry. 1. Profiling an unfractionated tryptic digest, Proteomics.
1(1), pp. 93-107.
. Susan ,I.A (2010), Transplantation:
Integrative peptidomics identifies acute renal transplant rejection biomarker^, Nature Reviews Nephrology. 6, pp. 249.
. va Minh J hilt, Tran The Thinh, Nguyen Thj Minh Phiromg, Nguyen Bich Nhi, Phan Viin Chi (2006) Phan tich cdc glycoprotein trong huyel thanh ngu6i. Tgp chi cong nghe sinh hoc, 4(1):
13-22.
NGHIEN Ciiu MOT SO CHi S6 LIPID HUYil TimNG Of BENH NHAN SAU GHEP T H A N TAI B | N H V I E N V I | T Oljnc
NguySn Thj Hoa*. Ha Phan Hal An**, Phgm Thifn Sgoc TOM TAT:
Tang lipid trong HT \i biin chi>ng thui/ng gap sau ghSp than, c4c thu6c ire chk m\hn djch (LTCMD) c6 anh hifong khic nhau din n6ng se>
mjt si5 chi s6 lipid trong huyit tirong (HT) Mi,ic tieu: 1) Khio sit ndng af mfl s6 chi s6 lipid trong HTib$nh nhin sau ghip thin 2) So sinh 31/ thay aSl mit s6 chi s6 lipid trong HT d binh nhin sau ghip thin Oiiu trj bing cyclosporin hoic tacrolimus. B 6 | tu'i/ng phu'vng phip nghiin cipu: NghiSn ciru mO ta, tiin ciru trSn 26 b$nh nhan suy thjn man giai Jogn cu6i da dupc
* Truing Bai hoc Y Duvc Thii Nguyin.
"Trudng Dai itQc Y Hi Nti 36
ghSp than tai Banh vian Viat Oirc nam 2009- 2010 nhSm 1) 9 banh nhan diiu trj bang cyclosporin (Neoraf- Novartis-CsA). nh6m 2) 17 banh nhan diiu tri bang tacrolimus (Prograf', Astellas-Tac), banh nhan dirvc I4y mSu tai thin diim trudc ghap than, sau ghap than 3 thang vi 6 thang Kit q u i : Ndng JJ cholesterol trong HT tai thiri aiim trudc ghap than, sau ghap than 3 thang, 6 thang tuong irng la 3,83±0,93mmol/L, 5,88±1,24mmol/L, 5,32±1,09mmol/L, nhbm banh nhan diiu trj bang CsA c6 xu hudng cao hon so vdl nhdm banh nhan diiu tri bang Tac. Ning dO
Y HQC VigT NAM T H A N G S - 2/2012 trlglycerid trong HT t^i thdi 6\irn trudc ghdp thdn,
sau ghdp thdn 3 thdng, 6 thdng tuong Crng Id 1,77±1.16mmol/L, 3.28±1,76mmol/L, 2.60±1,31mmol/L. N6ng 30 HDL-C trong HT tgi thdi dt^m trudc ghdp th$n. sau ghdp thdn 3 thdng. 6 ttidng t u o n g i>ng Id 1.07±0,38mmol/L, 1,07±0,38mmol/L, 1.31±0,28mmol/L. nhdm b$nh nhdn ai^u tn bdng CsA c6 xu hudng cao hon so vdi nh6m bdnh nhdn di^u trj bdng Tac. N6ng dO LDL-C trong HT t^ii thdi d i l m trudc ghdp thdn, sau ghdp thdn 3 thdng, 6 thdng tuong ung Id 2,09±0,74mmol/L, 3.28±1,76mmol/L.
2,97±0,87mmol/L, nh6m bdnh nhdn aidu tr| bdng CsA cd xu hudng cao hon so vdi nhdm b$nh nhdn dl^u tri bdng Tac. Kdt lu|in 1) Tdng n6ng dO mOt s6 chi s6 lipid trong HT d bdnh nhdn sau ghdp thdn, tgi thdi diem sau ghdp thdn ghdp thdn 3 thdng nfing dd cholesterol trong HT cao hon cd y nghla so vdi thOi d i l m sau ghdp 6 thdng. 2) 0 nhdm bdnh nhdn d i l u tri bdng CsA. n6ng 6d mOt s6 chi s6 lipid trong HT cd xu hudng cao han so vdi nhdm bdnh nhdn s u dyng bdng Tae
TCr khoa: Ghip thin, thudc ire chS miin djch. rdi loan lipid.
S U M M A R Y :
STUDY ON PLASMA LIPID LEVELS IN RENAL TRANSPLANTED PATIENTS IN VIET DUC HOSPITAL
Hyperlipidemia following successful renal transplantation is frequent The immunosupressive therapy seems to affect differently to lipidemic profile. Object 1) To determine of plasma lipid levels in renal transplanted patients 2) To compare plasma lipid levels in renal transplanted patients, treated w/ith cyclosporin (CsA) and tacrolimus (Tac) Method:
The research Vi^as carried out in 26 patients, transplanted in Viet Due hospital Group 1. 9 patients using CsA; group 2 17 patients using Tac. Plasma lipid (total cholesterol, triglycerid, HDL-C, LDL-C) were examined before transplatation, 3 and 6 months posttransplantation Results: The plasma total cholesterol levels at pretransplantation, 3 and 6
months after transplantation was 3,83±0,93mmol/L, 5,88±1,24mmol/L, 5,32±1,09mmol/L. respectively, in the cyclosporin group, plasma total cholesterol level was higher than that in the tacrolimus group with no statistically significant difference The plasma triglycerid levels at pretransplantation, 3 and 6 months after transplantation was 1,77±1,16mmol/L. 3,28±1,76mmol/L, 2,60±1,31mmol/L. respectively. The plasma HDL- C levels at pretransplantation, 3 and 6 months after transplantation was 1,07±0,38mmol/L, 1,07±0,38mmol/L, 1,31±0,28mmol/L, respectively, in the cyclosporin group, plasma HDL-C level was higher than that in the tacrolimus group with no statistically significant difference. The plasma LDL-C levels at pretransplantation, 3 and 6 months after transplantation was 2,09±0,74mmol/L, 3,28±1,76mmol/L, 2,97±0,87mmol/L.
respectively, in the cyclosporin group, plasma HDL-C level was higher than that in the tacrolimus group with no statistically significant difference. C o n c l u s i o n : 1) Hyperlipidemia is frequent in renal transplantation, plasma cholesterol level at 3 month was significant higher than at 6 month. 2) In the cyclosporin group, plasma lipid level was higher than that in the tacrolimus group with no statistically significant difference.
Keywords: renai transplantation, immunosuppressant, dyslipidemia
I. OAT VAN of:
Ghep than la sy lua chon tdt nhat cho BN suy than man giai doan cudi, ghep than cd nhung dae diem uu viet hon Ipc mau chu ky ve chat luong cudc sdng, gia trj kinh te va thdi gian sdng them cua BN [2]. Thanh eong cua viec ghep than kliong ch! la van de phau thuat ma cdn la qua trinh dieu tri chdng thai ghep va theo doi cac bien chung sau ghep.
Hpl NGHI KHOA HpC CpA Hpl H6A SINH Y DUgc HA NQI VA CAC TINH PHIA BAC LAU THIJ XVlll Sau ghip th$n. BN phdi sir dving thuAc
UCMD lau dai. Cdc iluioc IICMD thiremg dirvc sir dung 14 nh6m ire ch^ calcincurin (CNl). nhom thuAc chAng tflng sinh l^ bdo lympho T vd corticoiil Vi^c .sir dyng iSu ddi nhihig thuoc ndy c6 the gay cdc bien chirng nhu roi lo^in lipid/HT (HT). tSng huyet jip (THA), m thio ducmt: (DTD) vi inh hudng den chiic nSng than. [10] trong d6 nguy hiem nhat la bien chimg tim mgch, dSy la nguyen nhan gay tijr vong hang dau d b^nh nhdn sau ghcip thdn.
Roi logn lipid trong HI lii bien chimg thudng gdp sau ghip thdn vai ly 1^ khac nhau theo thdi gian sau ghep. cao nhat d thdi diem sau ghip 6 thang, cd 12 lien quan den \ ice sir dung thuoc U'CMD lieu cao. R6i logn lipid trong HT thudng gdp Id: tdng cholesterol, triglycerid vd LDl.-C trong HT, gidm HDL-C trong HT vd thay doi chat lugrng cua lipoprotein nhu tdng su nhay cam cua LDL-C vdi qua trinh oxy hda [5]. Ty 1$ roi logn lipid trong HT d BN ghep than co xu hirdng cao hem so vdi BN Ipe mdu chu ky, roi loan nay CO thi len den 60%. Viec theo ddi chdt ch6 mpt so chi so lipid trong HT ed y nghTa thtrc tien va gid tri khoa hpc, cung cdp nhOng thdng tin quan trpng giup thdy thuoc lam sdng theo dai va diiu tri djr phdng cdc bien chimg d BN ghep than. Vi vay de tai ndy dupc thue hi$n muc tieu: 1. Khdo sat s\f ili:i\
ddi nong dp mpt sd chi so lipid trong HT a b?nh nhan sau ghep thgn; 2. So sdnh n6ng dp mpt so chi sd lipid trong HT d bC'nh nhan sau ghep than diiu trj bdng C's.A hodc Tac.
II. oo'l TUONG VA PHaONG P H A P NGHIEN CCrU:
2.1. Doi tu-tmg nghien cuu
* Gom 26 benh nhan suy than man giai doan cuoi dupc ghep than tai Benh vi^n Viet 38
Dire ndm 2009-2010, b$nh nhdn dupc ldy mau tgi thdi diim trudc ghip thdn, sau ghip th(in 3 thdng vd sau ghip thgn 6 thdng.
Cdc m3u mdu tTnh mgch dupc l^y vdo bu6i sdng, luc ddi, ngay trude khi udng thu6c ijrc chi miSn djch (tgi thdi diem sau ghip than 3 thdng, 6 thdng) dk djnh lupng:
- N^ng do mOt so chi s6 lipid trong HT:
cholesteroltp. triglycerid, HDL-C, LDL-C.
- Tiiu chuan rdi logn lipid HT theo hdng s6 sinh hpc ngudi Viet Nam ndm 1992 vd HOi tim mgch Viel Nam ndm 1998 (cholesterol rp £5,2 mmol/l, triglycerid ^ , 3 mmol/l, IIDI.-C < 0.9 mmol/l, LDL-C huyet thanh £ 3,4 mmol/l).
2.2, Phuong phap nghien ciru Phuong phdp nghiin cim tiin cihi mo td, theo ddi dpc trpng thdi gian 6 thdng sau ghip.
Cdc kyi thugt xet nghi?m djnh lupng cholesterol rp. triglycerid. HDL-C, LDL-C dupc lam theo cdc qui trinh chudn thong thudng tren ma) Olympus-AU 400 ciia Nhgt.
Cdc so li^u duyc xu ly theo phuong phdp thong ki y hpc sir d\ing phdn mim Stata 10.
III. KET QUi. NGHIEN CCTU:
.^.1. Ddc diem b^nh nhan sau ghip than Tudi lai thdi diem ghep thgn rdt tre, tuii trung binh: 37.2 ± 11.6. cd 5 b?nh nhdn tren 50 tudi (19,3°o). Tudi than cho rdt tre, tuii trung binh 30,2 i 11..^.
Gidi nam la 21.8 (80%). nir 5 (19,2%.) Thdi gian clia\ than nhdn tao ngdn, thdi gian trung binh: 12.4 ± 12.1 thdng, so benh nhan chira phdi cha> than nhan tao la 3 (11,5%).
Ngudn than tir ngudi cho ciing huyet thdng Id 4 (15,4%), tir ngudi cho song khong ciing huyit thing la 16 (61,5%), ngudn than tir ngudi chet mdt nao la 6 (23,1%).
Y HQC VigT NAM T H A N G B - 2/2012
3.2. Nong dg mQt so chi s6 hda sinh HT d nhdm bfnh nhan nghi£n cuu
Bieu do L Ndng dg lipid trong HT d nhdm b^nh nhan nghien cuu
Nhgn xit: Sau ghep t h ^ . ndng dp mpt so chi sd lipid trong HT cao hon so vdi thdi diem trude ghep vdi sy khde bi?t cd y nghTa thong ke (p<0,05). Tang nong dp cholesterolip, triglycerid trong HT sau ghep th^. Tai thdi diem sau gh^p 3 th^ng, nong dp cholesterolxp trong HT cao hem cd y nghTa so vdi thdi diem sau ghep 6 thang.
Bang 1: Ty le rdi loan mpt sd chj sd lipid trong HT d nhdm benh nhan nghien cuu Chi s i
Choiesterolrp Triglycerid HDL-C LDL-C
Trudv ghdp (1) n 4 5 9 1
%
15,4 19,2 34,6 3.8
Sau ghep 3 thdng (2) n 18 17 2 12
%
69,2 65,4 7,6 46,2
Sau ghdp 6 thdng (3) n 11 10 0 5
%
42,3 38,6 0 19.2
P
(1,2)<0,01,(1,3)<0,05 (1,2)<0,01,(1,3)>0,06 (1,2)<0,05,(1,3)<0,05 (1,2)<0,01,(1,3)>0,05
Nhgn xit: Sau ghep than, ty le rdi loan lipid trong HT cao hem cd y nghTa so vdi thdi dilm trudc ghep. Tai thdi diem sau ghep 3 thang ty Ie rdi loan lipid trong HT cd xu hudng cao hem so vdi thdi diSm sau ghep 6 thang vdi sy khac biet khdng ed y nghia thdng ke (p>0,05).
Nong dp mot so chi so hda sinh HT d benh nhan ghep thain dieu tri bang cyclosporin hoac tacrolimus
mmoI/L
Thai gian
Jmtrc ghdp Sau gh6p 3 Ihdng Sau gtidp 6 Ui&ig
Biiu dd 2. Ndng dp choiesterolrp trong HT d benh nhan ghep than dieu tri bang cyclosporin hoac tacrolimus
Nhgn xet: Ndng dp choiesterolrp trong HT d nhdm b?nh nhan dieu tri bang CsA cd xu hudng cao hon so vdi nhdm benh nhan dieu trj bang Tac vdi p>0,05.
39
Hpl NGHI KHOA HQC C U A J H 0 L H 6 A SINH Y Dt/pC H A NQI V A C A C TJNH P H I A B A C L A N THtf XVlll mmol/L
• Nhdm C«A
• Nh6m T M
Th£ri gian
Bieu do 3. Nong dp triglycerid trong HT d benh nhan gh^p th^n di^u trj bang cyclosporin ho^c tacrolimus
Nhgn xit: Nong dp intiKxcnd U(HI[1; HT d nhdm b^nh nhan dieu trj bSng Tac cd xu hudng cao hon so vdi nhdm benh nhan dieu trj bang CsA \ di p>0,05.
Thirigian ycgn«p S«uoMp3intng S M gh*p«Vilno
Biiu dd 4. Ndng dp HDL-C trong HT d b?nh nhan ghep th$n dieu tri bang cyclosporin hoac tacrolimus.
Nhgn xit: Ndng dp HDL-C trong HT d nhdm benh nhan dieu trj bjng CsA cd xu hudng cao hon so vdi nhdm benh nhan dieu trj biing Tac vdi p>0.05.
mmol/L
ssuaMp3v>*^ Sau gndp 6 Ihang
Thcfi gian
Bieu do 5. Ndng dp LDL-C trong HT d benh nhan ghep than di6u tri bSng cyclosporin hoac tacrolimus
40
Y HQC VigT NAM T H A N G B - 2/2012
Nhgn xit: Ndng dp LDL-C trong HTl d nhdm benh nhan dieu tri bang CsA cd xu hudng cao hon so vdi nhdm b§nh nhan dieu trj bang Tac vdi p>0.05.
3.3. Su* d^ng thuoc it benh nhan sau gh£p than Bdng 3: Sir dung thudc d nhdm benh nhan nghien euu
C h i s 6 Li^u thu6c CNl (mq/nqdy) Ndnq dO CNl (nq/mL) Li^u corticoid (mq/nqdy) Lieu cellcept (q/nqdv)
Sau qhdp 3 thdng Nhdm CsA 250,0±62.5 169,8±70,0 11,0±2,4 1,41±0,34
Nhdm Tac 7,8±2,9 9,4±2,6 10,7±3,1 1,46±0,21
Sau ghdp 6 thdng Nhdm CsA 246,4±50,9 154,3±24,9 4,6±3,6 1,47±0,05
Nhdm Tac 6,7±3,1 8,8±2,9 6,1±1,6 1,49±0,30
P
>0,05
>0,06
CNl: Caicineurin Inhibitor (thuoc uc che calcincurin)
Nhgn xit: Lieu luemg thudc uc che caicineurin, nong dp thuoc dc che caicineurin trong gidi hgn cho phep. Hai nhdm benh nhan kha tuomg dong ve lieu cellcept, lieu corticoid tai cic thdi diem nghien cuu
IV. BAN L U A N :
Tudi tai thdi diem ghep than rat tre. tudi trung binh la 37,2±11,6 cd 5 benh nhan (19,3%) cd tudi tai thdi diem ghep tren 50 tudi. Tudi than cho cung rdt tre, tudi trung binh la 30,2±11,5. Tudi tai thdi di^m ghep cang cao cang lam gia tang nguy co tir vong do benh tim mach, benh ac tinh va cac bien ehung nhiem trung lien quan den tinh trang suy giam mien dich qua muc. Tudi than cho ciing anh hudng rat Idn den ket qua cua than ghep, theo ghi nhan cua Co quan dieu phdi tang ghep Lien bang Hoa Ky (United Network of Organ Sharing-UNOS) cho thSy tuoi than cho cang cao thi muc lpc cau than cung nhu hoat dpng bii trir ciia than cang giam do sd don vi than hoat ddng d ngudi Idn tudi bi giam, day cd thl la nguyen nhan gay benh than ghep man tinh [9]. Nghien cuu d 315 BN ghep than tir nam 1983-2000, tai cac thdi diem sau ghep 1 nam, 5 nam va 10 nam trong dd cd 68 BN duoc ghep than tir ngudi cho tren 50 tudi (trung binh 55,3±4,8) so vdi 247 BN cd tudi than cho dudi 50 tudi, ket qua cho thay: d nhdm BN ghep than tir ngudi hi^n than cao tudi cd ty le DTD, ndng
dp creatinin/HT sau 1 nam va 10 nam cao hem cd y nghTa so vdi nhdm BN ghep than tir ngudi hien than tre tudi. Tuoi tai thdi diem ghep cung nhu tudi than cho trong nghien cuu nay thap hem so vdi nghien cuii cua Despina va Mohammad.
Thdi gian Ipc mau ehu ky cd anh\hudng dang ke den ket qua sau ghep than. Gj^ BN ghep than tir ngudi cho sdng cung nhiKtir ngudi cho chet nao, nhu'ng BN ed thdi giaiV lpc mau chu ky cang dai, cang anh hudng xau den ket qua ghep than. Theo ket qua- nghien cim ciia Keith tren 30.294 BN ghep than tir ngudi cho chet nao cho thay: d nhdm BN CO thdi gian lpc mau chu ky trudc ghep tren 4 nam thi ty le giam 25% creatinin/HT trong 24 gid dau sau phau thuat, ty le BN can lpc mau chu ky ngay trong tuan dau sau ghep cao hem cd y nghTa so vdi nhung BN co thdi gian trudc ghep dudi 12 thang [6]. Trong nghien ciru nay, vdi thdi gian lpc mau chu ky trudc ghep trung binh la 12.4 thang trong dd cd 3 benh nhan (11.5%) chua phai lpc mau chu ky, day cd the la yeu td thuan !ai de mot sd chi sd hda sinh/HT chua thay doi nhieu trong nghien cuu nay.
41
Hpl NQHj KHOA HQC C O A HQI H 6 A SINH Y DUQC H A N Q I V A C A C TJNH PHJA B A C L A N THtf XVlll
Nguon th$n ghip cd dnh hudng ddng kd kk 6 nghiSn curu ndy, den ket qua sau ghip th$n. Nira ddi sAng
trung binh ciia th§n ghdp tir ngudi cho s6ng dai hon so vdi nguon th§n tir ngudi cho ch^t nao [9]. Nghien cuu d 252.910 BN ghdp th$n tgi Hoa Ky tCi nam 1989-2009 cho thdy: nira ddi song trung binh cua than ghdp tir ngudi cho chet nao la 6.6 nam (1989) tang Ifin 8 nam (1995) va dgl 8,8 nam vio nam 2005 nhung van thap hem so \di thgn ghdp lir ngudi cho song (11 nam v^o nam 1989 va tang len 11.9 nSm vdo nam 2005) [7]. t o sy khde biet ndy cd the do chat \ugn^ cua thgn hien tir ngudi cho s6ng dupc ddnh gid can thdn hon cdn thgn hiC'n tir ngudi cho chet ndo dugc ddnh gid rat vpi vdng, trong dieu kien hit sue khd khdn. Nguyen nhan cua chet nao d nudc ngodi thudng do com THA dan den thieu mdu eye bp vd tdn thuang npi mgc td chdc ngogi vi tgng hien tram trpng trong khi dd nhiJng tdn thucmg nay cua tgng hien tir ngudi cho sdng thudng it nghiem trpng hon.
Trong nghien curu nay ngudn thgn tir ngudi cho ciing huyet thdng Id 4 (15,4%), tir ngudi cho sdng khdng ciing huyet thdng Id 16 (61,5%). Mohammad nghien ciru tren benh nhan sau ghep than cd ngudn than ghep tir ngudi sdng cho ket qua: ty 1? tdng cholesterol Id 27% (cyclosporin: 15,2%; tacrolimus:
11,8%), triglycerid la 8%, LDL-C Id 27,5%
(cyclsporin: 13,5%); tacrolimus: 12.2%) [8].
Ngugc Iai, trong nghien ciru cua Teplan tren benh nhan cd ngudn than tir ngudi chet mdt nao thi ndng dp thudc LTCMD du\ iri d muc cao (190 ± 30 ng/mL), ndng dp lipid trong HT tang cao. Trong nghien ciru cua chung tdi cd 23,1% ngudn than tir ngudi chet mat ndo nhung nguyen nhan chet nao trong nghien cuu nay deu do tai ngn giao thdng, phdi chang day cung la mpt Iy do d6 ndng do mpt sd chi sd lipid trong HT thay ddi khdng dang
R6i logn m0t so chi so lipid trong HT Id biiln chimg thudng g$p sau ghdp than. Ty 1?
r6i logn lipid trong HT dao dpng tir 20-63%.
Cd rat nhiiu ydu t6 dnh hudng den n6ng d^
lipid trong HT nhu tudi. chi s6 khoi co thi, n^ng dp lipid trudc ghdp, r6i logn chirc ndng th$n ghdp... trong dd thu6c LTCMD Id nguyen nhan chinh gdy r6i logn lipid trong HT. Cac thuoc U'CMD khde nhau cd the tdc dpng khde nhau din m^t s6 chi s6 lipid trong HT.
CsA gdy roi logn lipid HT, mirc dp roi logn phy thupc vdo liiu CsA cung nhu ning d$
CsA trong mdu. CsA gay r6i logn hogt dpng ciia cua sterol 27 hydroxylase ldm giam qua trinh tong h(7p acid mgt. CsA cdn kich thich 3 hydroxy-3 methylglutaryl coenzym A (HMG-CoA) reductase, la enzym can cho qud trinh tdng hpp cholesterol. CsA cdn ldm tdng triglycerid do uc che hogt dpng cua lipoprotein lipase. Corticoid gay tang choiesterolrp do kich thich hoat ddng cua HMG-CoA reductase, gay tdng tdng hpp VLDL-C \ a gidm hogt dpng ciia lipoprotein lipase [3]. Corticoid lam tang tdng hpp triglycerid do kich thich hoat ddng ciia insulin d gan hay hogt hda enzym giai phong triglycerid dytriJ.
Trong nghien ciru na\, ndng dp mpt so chi so lipid trong HT tdng rd ret sau ghep thgn. tgi thdi diem sau ghep 3 thdng cd xu hudng cao hon so \'di thdi diem sau ghep 6 thdng, CO 16 lien quan den \'iee sir dung thuoc U'CMD lieu cao hon \d chuc ndng than chua dn dinh d giai dogn nay. Ty le tdng cholesterolip va triglycerid d benh nhan ghep than Id kha cao, ty le tSng choIestetolTP tai thdi diem 3 thdng \ a 6 thdng tuomg ung la 69,2%. va 42.3%>, I< le tdng triglycerid tgi thdi diem 3 thdng vd 6 thang tucmg ung la 65,4%
va 38,5%. Ty le tangcholesterolip trong
Y HQC VigT NAM T H A N G 8 - 2/2012
nghien cuu cua chung tdi cao hon so vdi cua tac gid Bili Vdn Mgnh cd the do tieu chu^
chan dodn tdng cholesteroljp trong nghiSn cuu nay la >5,2mmol/L cdn tieu chuan chdn dodn tang choiesterolrp trong nghien cuu cua Bui Van Manh Id &5,5mmol/L [ 1 ].
Ket qud nghien cuu cua chung tdi gan gidng vdi nghien curu cua tdc gia Despina cd le do nhOtig yeu td nhu tudi, gidi, nguon thgn ghep ciing nhu \icc sir dyng thudc U'CMD (cyclsporin, tacrolimus va corticoid) trong nghien ciiu ciia chung tdi phii hpfp vdi nghien cim tren [4]. Ket qua ndy cao hem so vdi nghien cuu cua Mohammad cd le do tdt cd benh nhan trong nghien cvm ciia Mohammad dupc ghep than tir ngudi cho ciing huyit thdng. Ket qud nghien cuu cua chung toi thap hon so vdi nghien euu ciia Teplan cd the do trong nghien cuu ciia Teplan cd tudi tgi thdi diem ghep cao hon, ndng dp cyclosporin duy tri cao hem va tat cd benh nhan trong nghien curu cua Teplan dupc ghep thgn tir ngudi cho chet nao [9].
Cyclosporin duoc eoi nhu Id yeu td gay rdi loan lipid trong HT hon so vdi tacrolimus. Trong nghien cuu cua chimg tdi, ndng dp mdt sd chi sd lipid trong HT d nhdm benh nhan dieu tri bang cyclosporin cd xu hudng cao hon so vdi nhdm benh nhan dieu tri bang tacrolimus song su khac biet nay khong cd y nghTa thdng ke (p>0,05). Trong nghien cuu cua tac gia Despina va Mohammad khi so sanh ve anh hudng ciia cyclosporin vd tacrolimus den mdt so chi sd lipid trong HT d benh nhan sau ghep than eung chua tim thdy sy khac biet ve ndng dp cdc chi sd nay giira hai nhdm benh nhan.
V . KET L U A N :
Tir ket qua nghien cuu thu dupc cho phep dua ra mdt sd ket luan sau:
1. Tang ndng dp mdt sd chi sd lipid trong HT d benh nhan sau ghep than, tai thdi diem sau ghep than ghep than 3 thang nong dp
cholesterol trong HT cao hem cd y nghTa so vdi thdi diem sau ghdp 6 thdng.
2. 6 nhdm benh nhdn diiu tri bdng CsA, nong dp mpt so chi so lipid trong HT cd xu hudng cao hon so vdi nhdm benh nhdn su dyng bang Tac.
TAI LIEU T H A M K H A O :
1. Bili Viin M a n h (2009), "Nghien ciru lam sdng, cgn lam sing vk mpt so chi so m i l n djch d b?nh nhan sau ghep th^n", Lugn in tien sT Y hpc.
2. Lc The T r u n g , VQ vSn Kien (2002). "Ghdp th^n", B^nh hpc ngoai khoa, Nha xuat bdn Quan dpi Nhan dan, trang 139-156 3. Baciiou S, CrLstol J P , and M o u r a d G
(2009), "Dyslipidem,ia following kidney transplantation: diagnosis and treatment", Curr Diab Rep, 9 (4). pp. 305-311.
4. Despina N, Konstantinos G , and M o u l a k a k i s (2008), "Correlation between lipid abnormalities and immunosuppressive therapy in renal transplant recipients with stable renal function", Int Urol Nephrol, 40, pp. 521-527.
5. I S A B E L B C (2002), "Hyperlipidemia: A riskfactor for chronic allograft dysfunction".
Kidney International. 61 (80), pp. 73-77.
6. Keith DS, Cantarovich M , Paraskevas S, et al. (2008), "Duration o f dialysis pretransplantation is an important risk factor for delayed recovery o f renal function following deceased donor kidney transplantation", Transpl Int, 21 (2), pp. 126-132.
7. L a m b K E , L o d h i S, and Meier-Kriesche H U (201 i ) . "Long-term renal allograft survival in the United States: a critical reappraisal". A m J Transplant, 11 (3), pp.
450-462.
8. Shirali AC,Bia M J (2008), "Management o f cardiovascular disease in renal transplant recipients". Clin J A m Soc Nephrol, 3 (2), pp.
491-504.
9. Shrcstha B M , J L l H , and Sheffield Kidney Institute U (2007), "Factors Influencing Long- term Outcomes following Renal Transplantation: A Review". J Nepal Med Assoc 46 (167), pp. 136-142.
43
