HOI THAP K H 6 P H O C VIET NAM: HQI NGHj KHOA HOC TOAN QUOC LAN THLf IX
NGHIEN CLTU CAC YEU TO NGUY CO XO V Q A DONG MACH d BENH NHAN GUT MAN TINH
• •
Nguyen VTnh Ngoc*, Nguyen Ba Khanh*''
TOM TAT
Cac nghien cflu nfldc ngoai khang djnh mdi lien he giu^ gut va tang acid uric mau vdi xO vfla dpng mach la yeu to cd tac dpng manh nhat gay nen nhflng bien cd tim mach cap tfnh hoac man tfnh. Viet Nam dfldng nhfl chfla cd nghien cflu chi tiet nao ve van de nay. Muc tieu nghien cufu: Khao sat cac yeu td nguy cO xd vuia dpng mach d benh nhan mac benh gut man tfnh. Odi tu'dng nghien cu'u: gdm 131 benh nhan mac benh khdp dieu trj npi tru tai Khoa Khdp benh vien Bach l^ai, tfl ngay 1 thang 9 nam 2009 den 31 thing 3 nam 2010, gom hai nhdm: 71 benh nhan nam mac gut man tfnh va nhdm chflng la 60 benh nhan khong mac benh gut. Phu'dng phap nghien cu'u: mo ta cat ngang. Ket qua nghien cu'u: ty le cua cac yeu td nguy cO xO vu^a dpng mach nhfl sau: rdi loan chuyen hda lipid (92,9%), tang CRP > 0,5 mg/dL (88,7%), tang acid uric mau > 420 l^mol/L (81,7%), an nhieu thflc an cd nhieu chat beo (64,8%), tang huyet ap (57,8%), uong nhieu rflpu (53,5%), hut thuoc la (42,3%), beo phi vdi BI^II > 23 (39,4%), dai thao dfldng (22,5%). Ket luan: Oa thong ke dflpc 9 yeu to nguy cO xO vfla dpng mach 6 benh nhan gut man tfnh, trong do cac yeu to nguy cO cd ty le cao nhat la rdi loan chuyen hda lipid (92,9%), tang CRP (88,7%), tang acid uric mau (81,7%), an nhieu thflc an cd nhieu chat beo (64,8%).
SUMMARY
There are a relashionship between gout, hyperuricemia and atherosclerosis, responsible for severe caviovascular evens. Aim: identify risk factors of atherosclerosis in patients with chronic gout. Objects: 131 arthritis patients hospitalized in the Rheumatology Department, Bach Mai hospital from September 1, 2009 to March 31, 2010, included 71 male patients with chronic gut and 60 others rheumatic patients as a control group. Method: Cross-sectional descriptive.
Results: Prevanlences of risk factors for atherosclerosis: lipid metabolism disorders (92.9%), increased CRP> 0.5 mg / dL (88.7 %), increased blood uric acid> 420 Mmol/L (81.7%), eating more foods high in fat (64.8%), alcohol abuse (53.5%), hypertension (57.8%), smoking (42.3%), obesity with BMI > 23 (39,4%), diabetes (22.5%). Conclusion: were indentified risks factors for atherosclerosis in chronic gout patients. The essentials factors were: lipid metabolism disorders (92.9%), increased CRP>
0.5 mg / dL (88.7%), increased blood uric acid>
420 Mmol/L (81.7%), eating more foods high in fat (64.8%),
I. DATVAN DE
Gut la bpnh roi loan chuydn hda rat thudng g^p d Viet Nam ciing nhu tren thd gidi. Hien nay nhieu nghien curu trdn thd gioi da tim thiy mdi lien he gifla gut v i ting acid uric m i u vdi xo vfla dpng mach la yeu td cd tic dpng manh nhit gay ndn nhumg bidn c6
* Khoa Khdp Binh viin Bach Mai
** Dgi hpc Y Hd Npi
Y HQC VigT NAM THANG 7/2011 - SO OAC BIET
tim mach cap tinh ciing nhu man tinh nhu khim can lam sing: XQ tim phdi, didn tim nhdi miu co tim, tai bidn mach nao, dau cich dd, XQ khdp, sidu im d bimg, xet nghidm hdi... Viet Nam dudng nhu chua cd mdt hda sinh, nudc tidu, edng thflc miu, tdc dp nghidn cuu chi tidt naq vd vin dk nay. Do miu ling. Cic sd lieu dugc nhip vi phin tich viy chflng tdi tidn hanh de tii nhim muc tidu:
Khio sit cac ydu td nguy co xa vua dpng m?ich d bdnh nhan mic bdnh gflt man tinh IL PHl/aNG PHAP NGHIEN CUtJ
2.1. Doi tirong nghien cun
Gdm 131 bdnh nhan mic bdnh khdp didu tri ndi tru tai Khoa Khdp bdnh vidn Bach Mai, tfl ngay 1 thing 9 nim 2009 ddn 31 thing 3 nam 2010. Benh nhin dugc chia thanh hai nhdm. Nhdm thfl nhit gdm 71 bdnh nhan nam mic gut man tinh, chin doin xac dinh theo tidu chuin Bermett va Wood (1968). Nhdm thfl 2 gdm 60 bpnh nhan nam gidi khdng mic bdnh gut, cd cic die didm vd tudi tuong t^r nhu nhdm bpnh nhin mic bdnh gut.
2.2. Phirong phap nghien ciru
Nghien cflru md t i cit ngang, dua vio mau didu tra thdng nhat vi hd so bdnh in.
Hoi bpnh nhin vd tidn sfl ban thin, gia dinh.
Xac dinh cic thdng sd lim sing. Cic tham
trdn phin mem STATA 8.0.
I I I . KET QUA NGHIEN CUtJ
3.1. Dac diem chung eua nhom benh nhan nghien cihi
Tit ci 131 bdnh nhin nghien cflu cfla chflng tdi ddu la nam gidi (100%). Dp tuoi tmng binh cfla nhdm bdnh nhin mic bdnh gflt li 59,4 ± 10,9 tudi vi nhdm chflng li 59,9
±11,1 tudi. Khdng cd sir khic bidt vd dp tuoi trung binh gifla hai nhdm (p > 0,05).
3.2. Cac yeu to nguy co xo vira dpng m^ch
3.2.1. Cdc yiu to nguy ca ve loi song Ty 1? cic bdnh nhin mic bpnh gflt m ^ tinh cd hflt thudc li trong qui khfl ho^c hipn tai cdn hflt li 42,3%. Ty Id uong nhidu rugu la 53,5% vi ty 1? in nhidu thflc in cd nhidu chit bdo li 64,8%. Ty Id bdnh nhan mic bdnh gflt man tinh cd BMI > 23 li 39,4%, cao hom cd y nghia thdng kd so vdi nhdm chflng (p <
0,05).
3.2.2. Roi logn chuyin hda lipid
Bang 3.1. Ty Id rdi lo^n chuydn hda lipid miu
Yeu to nguy ctf
Tang triglycerid Ting cholesterol TSng LDL Giam HDL
Rol loan chuven hda lipid bat ki T6ng so
Nhom gut n
43 24 22 53 66 71
o/o 60,1 33,8 30,9 74,6 92,9 100
Nhom n 29 19 18 27 50 60
chuTng o/o 48,3 31,7 30 45 83,3
100
P
>0,05
>0,05
>0,05
<0,05
<0,05
HOI THAP K H 6 P HOC VIET NAM: HQI NGHj KHOA HQC TOAN QU6c LAN THLf IX 3.2.3. Tdng huyet dp
Bang 3.2. Ty Id ting huyet ip cfla cic nhdm nghidn cflu
Thong so HA tam thu > 140 mmHg HA tam trflOng > 90 mmHg
Tang HA (HA tam thu > 140 hoac HA tam trflOng > 90)
Tien sfl THA
Tang HA va/hoac tien sfl THA Tong so
Nhdn xet: Ty Id t i n g huydt ap h o i c c
Nhom gut n
33 25 33 33 41 71 d tidn si
% 46,5 35,2 46,5 46,5 57,8 100 I tang hi
Nhom chu'ng n
16 12 17 16 26 60 lydt i p cu
% 26,7
20 28,3 26,7 43,3 100 a nhdm
P
<0,05
<0,05
<0,05
<0,05
<0,05
jdnh nhan r
bdnh gut la 57,9%, cao hom cd y nghia thong kd so vdi nhdm chflng (p < 0,05).
3.2.4. Ndng dp glucose mdu
Ndng dp glucose miu tnmg binh cua nhdm bdnh nhan mic bfnh gut la 6,3 ± 3 , 3 mmol/L, cua nhdm chumg la 5,6 ± 1,9 mmol/L. Sir khic bidt khdng cd y nghia thdng kd gifla hai nhdm (p < 0,05).
3.2.5. Protein Cphdn ihtg
Bang 3.3. Ty Id cic mflc ndng dp CRP cua cic nhdm nghien cflu
Thong so
CRP < 0,1 (mg/dL) CRP 0,1-0,3 (mg/dL) CRP > 0,3 (mg/dL) CRP > 0,5 (mg/dL)
CRP trung binh (mg/dL)(X ± SD) Tdng so
Nhom gut n
1 3 67 63
% 1,41 4,23 94,4 88,7 10,3 ± 9,7 71 100
Nhom chu'ng n
4 9 47 40
% 6,7
15 78,3 66,7 4,1 ± 5,7 60 100
P
>0,05
<0,05
<0,05
<0,05
<0,05
Nhgn xet: Ty 1? bdnh nhan mic bpnh gut man tinh cd nong dp CRP > 0,5 mg/dL la 88,7%, cao hon cd y nghia thdng kd so vdi nhdm chumg (p < 0,05).
Y HOC VIET NAM THANG 7/2011 - SO OAC BIET
3.2.6. Acid uric mdu
Bang 3.5. Ty Id tang acid uric miu ciia nhdm nghidn curu
Thong so
AU< 420 pmol/L AU > 420 pmol/L AU trung binh (pmol/L)
Tong sd
Nhdn xet: Ty Id t i n g acid uric m
Nhom gut n
13 58
% 18,3 81,7 544,2 ± 127,4
71 100
Nhom chu'ng n
38 22
% 63,3 36,7 390,6 ± 121,9
60 100
P
<0,05
<0,05
<0,05
i u cfla nhdm bdnh nhan m i c bdnh gut la 81,7%, cao hom
CO y nghia thdng kd so vdi nhdm chflng (p < 0,05).
3.2.7. Cdc thdng so xet nghidm khde:
Nhdm bdnh nhin mic bdnh gflt cd ndng dp creatinin miu trung binh, sd lugng bach ciu, tdc dp miu ling trung binh sau 1 gid vi 2 gid cao hon cd y nghia thong kd so vdi nhdm chung (p < 0,05).
IV. BAN LUAN
4.1. Dae diem BMI 6- benh nhan mic b^nh gut
Ty lp bdnh nhan mic bdnh gut cd BMI cao hon gidi ban binh thudng li 39,4%, cao hom rd rang so vdi nhdm ddi chflng vdi 20%.
Ket qui nghidn cuu cfla chung tdi khdng khic bipt nhidu so vdi nghidn cflu cfla cic tic giikhic[l],[2].
4.2. Ty 1§ roi loan chuyin hoa lipid oi b^nh nhan mic bfnh gut
Cd 92,9% sd bdnh nhin cfla chflng tdi bidu hipn rdi l o ^ chuydn hda lipid, tuong tu ket qua cua Ph^un Thi Didu Ha (2003) la 85%
[1], nhung cao hom so vdi cic tic gia nudc ngoii vdi ty lp roi loan lipid miu dao dpng tfl 25% ddn 60% [5].
4.3. Dae diem cua tang huyet ap tren bf nh nhan mie benh gut man tinh
Ty Id ting huyet ip trdn cic bdnh nhin mic bdnh gut theo nghidn cflu cfla chflng tdi li khi cao 57,8% so vdi ty Id khoing 40%
cfla cic tic gii trong nudc khic [2] vi 35- 69% cfla cic tic gii nudc ngoii [3].
4.4. Ty le dai thao dudng cua cac benh nhan gut
Ty 1? dii thio dudng trong nhdm bpnh nhan mic bdnh gut cua chflng tdi li 22,5%.
Didu niy cho thiy rd ring dii thio dudng li nhumg tinh trgng phd bidn trdn bdnh nhin mic bdnh gflt vi theo cic sd lieu cfla nude ngoai ty Id niy dao ddng tfl 12,3% den 25,9% [5].
4.5. Ty le tang nong do protein C phan ung cua eae benh nhan gut
Trong nghidn cflu cfla chflng tdi, ty Id ting CRP trdn 0,5 mg/dl li 88,7%, cao hon ty Id ting CRP cfla nhdm chflng mdt each cd y nghia thdng kd (p < 0,05). Theo Baker JF (2005) nhumg ngudi cd ndng dp CRP cao thi nguy CO mic cic bdnh tim mach hay tfl vong
HQI THAP K H 6 P HOC VIET NAM: HOI NGHI KHOA HOC TOAN QUOC LAN THLT IX V. KET LUAN
Ty If cae yeu to nguy co cua xo vfra dong mach tren benh nhan mSc benh gut man tinh
Da xie dinh dugc 9 ydu td nguy co xo vfla dpng mach 6 bdnh nhan gut man tinh.
Cic yeu td nguy co quan trpng nhit Ii: rdi loan chuyen hda lipid (92,9%), ting CRP (88,7%), tang acid uric miu (81,7%), in nhidu thflc in cd nhidu chit bdo (64,8%).
TAI LIEU THAM KHAO
1. Ha Pham Thi Dieu, "Nghidn curu rdi loan chuyen hda lipid d bdnh nhan Gflt"
Ludn vdn tdt nghiep bdc sy y khoa, trudng Dai hpc Y Ha Npi. (2003),
2. Yen Tai Dif u "Mpt sd ydu td nguy co giy bdnh d bdnh nhan gflt tai khoa khdp bdnh
vidn Bach Mai". Ludn dn chuyin khoa cdp IL Trudng DH Y H i Npi. 2000
Baker JF "Serum uric acid and cardiovascular disease: recent developments, and where do they leave us?" Am JMed;\n: p816-826. 2005 Brodov Y "Usefulness of combining serum uric acid and C-reactive protein for risk stratification of patients with coronary artery disease (Bezafibrate Infarction Prevention [BIP] study)". Am J Cardiol. 104(2): pl94-198. 2009
Hyon K "Prevalence of the metabolic syndrome in patients with gflt: The Third National Health and Nutrition Examination Survey" American College of Rheumatology volume 57 issue 1; p
109-115.2007.
