TAP CHi Y HOC V l i T NAM TAP 465 - THANG 4 - SO 2 - 2018
NGHIEN Ctru A N H HU'6'NG CUA V I E N N E N "THANH N A O I " DEN CHU'C NANG vA HINH THE GAN, THAN TREN THO THITC NGHIEM
T O M TAT
Vien nen bao phim Thanh nao I dUdc ehuyen dang tCr vien hoan mem Thanh nao. De cd cd sd khoa iipc dio viee danh gia hieu qua dieu tri tren lam sang ciia vien Thanh nao I, chiing toi tien hanh nghien culi vdi muc tieu: Nghien ciiii anh hu'dng ciia Vien nen Thanh nao I den chiic nang va hinh die ciia gan than tren tho thUc nghiem. Ket qua nghien ciTu cho thay: tren ca ba Id tho, lo chiiYig uong nUdc eat 2ml/kg/ngay, Lo tn 1: uong vien nen Thanh nao I lieu 0,75 mL/kg (lieu cd tac dung tUdng du'dng lieu dCing tren ngu'di), Lo tri 2: uong vien nen Thanh nao I lieu 2,25 mL/kg {lieu cao gap 3 lan lieu dung tren ngUdi), lien tuc trong 12 tuan; Khong lam ttiay doi ket qua cac xet nghiem danh gia chu'c nang gan (ALT, AST, bilirubin toan phan, albumin va cholesterol), chiTc nSng than thdng qua dinh lu'dng nong dp creatinin huyet thanli. Khong gay ton thUdng ve mat hinh thai khi quan sat dai the cac cd quan ciia tho. Cau triic vi the gan, than ciia thd khong ed sii khac biet so vdi 16 chutig.
Tdkhda:Vi^n rien Thanh nao 1, ChiTc nang hinh thai gan va than.
SUMMARY
RESEARCH TO IMPACT OF COMPRESSORS
"THANH NAO I " TO FUNCTIONALITY AND HEPATITIS I N RABBIT EXPERIMENT
"Thanh nao I" table is transformed from Barium soft capsules. In order to have a scientific basis for evaluating the dinical efficacy of tablet "Thanh nao I"
table, we conducted a study aiming to: Study the effect of "Thanh nao I" table on the function and morphology of rabbit liver and kidney experiment.
Results of the study showed that rabbits consume 2ml/kg/day in the rabbit pool. Treatment 1:
Erythropoietin I tablet dose of 0,75 ml/kg (dose equivalent to dose Group 2: taking cerebrospinal fluid I tablets at a dose of 2,25 ml/kg (3 times higher than the human dose), continuous for 12 weeks; Do not alter the results of liver function tests (ALT, AST, total bilirubin, albumin and cholesterol), renal function through quantitative serum creatinine. No morphological damage observed in rabbit organs. The liver and kidney structure of rabbit was not different from tiie control.
Key words: "Thanh nao I" table. Kidney and liver morphology.
*Benh vien Y hgc co truyen, BoCongan
**Cuc Yte,Bd Cdng an
Chiu b^ch nhiem ehinh: Tran Trpng Du'dng Email: [email protected] Ngay nhan bai: 11/3/2018 Ngay phan bien: 3/4/2018 Ngay duyet bai: 16/4/2018
Pham Ba Tuyen*, Tran Trong Du'ffng**
I. OAT VAN DE
Rdi loan lipid (RLLP) la mdt trong cac yeu td nguy cd cao ciia benh tim mach nhu' v^a xd ddng mach, dot qui nao, benli ly mach vanh, benh dpng mach ngoai vi [l]...Theo y hpe hien dai (YHHD), ben canh dieu ehinh ehe dp an, k§t hdp van ddng tn lieu edn ed nhieu nhdm thudc ed hieu qua tdt dieu tn hdi chu'ng RLLP mau [2], [3]. Tuy nhien, thude ed nhieu tac dung khpng mong mudn nhu': tang men gan, dau ed, viem ed, hoai tir cd...[2], [4]. Cae nha khoa hpc dang cd xu hu'dng nghien cii'u cac thudc cd ngudn gdc tir nhien, it tae dung phu, gia thanh re, ed the sir dung lau dai [5]. Nhieu che pham YHCT da du'dc su' dung ed hieu qua tren lam sang. Tai Benh vien Y hoc cd truyen Bp Cdng an nhieu nam nay da sir dung vien hoan mem Thanh nao de dieu tn RLLP va tang huyet ap, thu du'dc ket qua tdt.
Tuy nhien qua trinh sir dung cdn mpt so han che nhu': Khdi lu'dng vien Idn, vd hoan mem de bong khi van chuyen, khd khan trong qua trinh bao quan; han sir dung ngan, thudc chu'a lu'dng du'dng cao nen mdt sd tru'dng hdp khdng sir dung du'dc (benh nlian dai thao du'dng). €)e khae phuc nhij'ng han ehe tren, chiing toi tien hanh nghien cii'u ehuyen dang vien hoan mem Thanh nao thanh dang vien nen bao phim Thanh nao I, dong thdi gia giam them 1 sd vj thudc nham lam tang hieu qua dteu tri eiia che pham. De cd ed sd khoa hoc cho viec danh gia hieu qua dieu tn tren lam sang can phai tien hanh nghien ciTu ddc tfnh ciia dang thudc ehuyen dang nay. Do vay, de tai dddc tien hanh nghien ciTu nham muc tieu; fllghien cdd inh hddng cua Vien nen Thanh nao 1 den chdc nang vi hinh the'cua gan than tren thd thdc nghiem.
II. €)dl TU'ONG VA PHLTONG PHAP NGHIEN CLTU 2 . 1 . Doi tUtfng nghien cu'u
* Thudc va cac hoa chat nghien cud:
Cdng thiTc eho 1 vien nen bao phim Thanh nao I.
Binh vdi 1,1 g Ha thii d: 0,9 q Y dT: 0,9 g NgUutat: 1,1 q
Ich mau: 1,1 g Trach ta: 0,7 g Tran bi: 0,4 q Sdn tra: 1,1 q Quy trinh_^chiet xuat du'dc thu'c hien tai Benh vien Y hoc Co truyen, Bd Cdng an
*May mdc, thiei bf va hda chat thi
VIETNAM MEDICAL JOURNAL H°2 • APRIL - 201S
nghiem: Kit djnh lu'dng cae enzym va chat ehuyen hoa trong mau: ALT, AST, bilirubin toan phan, albumin, cholesterol toan phan, creatinin ciia hang Hospitex Diagnostics (Italy) va hang DIALAB GmbH (Ao), dmh lu'dng tren may Screen master ciia hang Hospitex Diagnostics (Italy).
Cac hoa chat xet nghiem va iam tieu ban md benh hpc.
*Ddng vat thdc ngh/'e/m
"riid ehiing Nenzealand White, tdng b^ng, trpng lu'dng l,8-2,5kg, ea hai gidng, khoe manh, do Tmng tam chan nudi Vien Kiem nghiem eung cap.
- Siic vat du'dc nudi trong phdng thf nghiem 5-7 ngay tru'dc khi nghien eiru bang thiTc an chuan danh rieng (do Cdng ty lien doanh Guyomarc'h-VCN san xuat), udng nu'dc ttr do.
2.2. Phu'dng phap nghien cu'u
*NghiSn cdu doc tinh ban trddng dien iren thd theo dUdng udng:
Thd du'dc ehia lam 3 Id, moi td 10 con, moi con nhdt rieng mpt chuong.
- Ld ehirng: udng nu'dc eat 2ml/kg/ngay;
- Ld tri 1: udng vien nen Thanh n i o I lieu thap 0,75 ml/kg;
- Ld tri 2: udng vien nen Thanh nao I lieu eao 2,25ml/kg;
Thd diTdc udng nu'dc hoac thudc thd trong 12 tuan lien, moi ngay mpt lan vao budi sang.
*Cac chi tieu theo doi trUdc va trong qua tiinh nghien cdU:
' Oanh gia chu'c nang gan thdng qua dinh lu'- dng: ALT, AST, bilirubin toan phan, albumin va cholesterol toan phan trong mau.
- Oanh gia chirc nang than thdng qua dinh lu'- dng nong dp creatinin huyet thanh.
- Cae thdng sd theo dot du'dc kiem tra vao tru'dc luc udng thudc, sau 4 tuan uong thude, sau 8 tuan udng thudc va sau 12 tuan udng thudc.
- Md benh hpe:
+ Sau 12 tuan udng thuoc, thd du'dc md de quan sat dai the toan bp cac ed quan.
+ Kiem tra ngau nhien cau true vt the gan, than ciia 30% so thd d mot Id.
+ Cac xet nghiem vi the du'dc thdc hien tai Trung tam nghien eiru va phat hien sdm ung thu' - Uen hiep eac hot khoa hpc va ky thuat Viet Nam (do PGS.TS. Le Oinh Roanh dpc ket qu^ vt t l i ^ .
*Xd ly sd lieu; Qzc so tteu nghien cdu dddc xir ly thdng ke theo phu'dng phap t-test Student.
So lieu du'dc bieu dien du'di dang: ^± SD. Sir khae biet ed y nghTa khi p < 0,05.
111. KET QUA NGHIEN CO'U
Bang 3.1: Anh hUdng cua vien nen
Thanh nao I den hoat do AST (GOT) trong mau thd
Thdi gian TriTdc uong
thuoc Sau 4 tuan uong thuoc
p (tru'dc - sau) Sau 8 tuan uonq thuoc p (trddc -
sau) Sau 12 tuan uong thuoc p (trddc -
sau)
H o a t ( I 6 A S T ( U I / l ) Ld chdng
38,10 ± 6,76 40,80 ±
8,05
>0,0S 43,50 ±
11,38
>0,0S 42,20 ±
11,79
>0,05 Lotril 37,00 ±
13,10 39,70 ±
13,48
>0,05
16,22
>0,05 59,10 ±
14,93*
<0,05 Lotril 40,00 ±
16,09 45,27 ±
12,87
>0,05 44,09 ±
9,07
>0,0S 45,36 ±
19,29
>0,05 Nhan xet: sau 12 tuan uong vien nen Thanh nao I, hoat dp AST trong mau thd d Id tri 1 (udng vien nen Thanh nao I lieu thap) tang cao hdn so vdi Id chiTng va so vdi thdi diem tru'dc khi udng thude, sir khac biet cd y nghTa thong ke v6i p < 0,05. Hoat dp AST d id tri 2 (uong vien nen Thanh nao I lieu cao) khdng cd sd khae biet co y • nghTa so vdi Id chiTng va so sanh giu^ hai thdi diem tru'dc va sau khi udng thudc thir (p > 0,05).
Bang 3.2: Anh hUdng ciia vien nen Thanh nao I den boat dp ALT (GPT) irong mau thd
Thdi gian Tru'dc uong
thuoc Sau 4 tuan uong thuoc
p (trddc - sau) Sau 8 tuan uonq thuoc p (trddc -
sau) Sau 12 tuan uong thuoc p (tru'dc -
sau)
H o a t d 6 A L T ( U I / l ) Lo chdng
57,30 ± 5,06 56,10 ±
4,82
>0,0S 63,90 ±
11,73
>0,05 61,50 ±
12,81
>0,05 Lotril 55,40 ±
9,96 57,90 ±
8,67
>D,OS 58,40 ±
15,12
>0,0S 77,30 ± 13,82*»
<0,05 Lotril 57,09 ±
14,69 72,50 ±
27,29
>0,05 67,82 ±
13,66
>0,OS 63,09 ± 20,86
>0,05 Nhan xet: Sau 12 tuan udng vien nen Thanh nao I, hoat dp ALT trong mau thd d Id tn 1 (udng vien nen Thanh nao I lieu thap) tang cao hdn so vdi Id ehiTng va so vdi thdi diem tru'dc khi udng thuoc, sir khac biet ed y nghTa thdng ke vdi p < 0,05. Hoat dp ALT d Id trj 2 (uong vien nen Thanh nao I lieu eao) khdng cd sir khac biet cd ^ nghTa so vdi Id chu'ng va so sanh giu^ hai thdi diem tnj'dc va sau khi udng thuoc thir (p > 0,05).
TAP CHi Y HOC VIET NAM TAP 465 - T H A N G 4 - SO 2 - 2018
Bang 3.3: Anh hdd^g aia vien nen Thanh nao I den nong dp Bilirubin- 7P irong mau thd
Thdi gian TrU6c uong
thuoc Sau 4 tuan uong thuoc p (trudc -
sau) Sau 8 tuan uong thuoc p (trddc -
sau) Sau 12 tuan uonq thuoc p (trddc -
sau)
Bilirubin toan ( m m o l / i ) Ld chdng
12,16 ± 0,33 12,29 ±
0,22
>0,05 12,10 ±
0,22
>0,05 12,20 ±
0,31
>0,0S Lotril 12,29 ±
0,33 12,22 ±
0,34
>0,05 12,11 ±
0,22
>0,0S 12,19 ±
0,32
>0,05 phan
Lotril 12,20 ±
0,41 12,11 ±
0,31
>0,0S 12,21 ±
0,27
>0,05 12,17 ±
0,30
>0,0S Nhan xet: Vien nen Thanh nao I khdng anh hu'dng den nong dp Bilirubin-TP trong mau thd triTdc va sau khi trinh udng thude (p>0,05).
Bang 3.4: Anh hddng ciia vien nen Thanh nao I den nong do cholesterol trong mau thd
Thdi gian Tru'dc uong
thuoc Sau 4 tuan uonq thuoc p (trddc -
sau) Sau 8 tuan uonq thuoc p (trddc -
sau) Sau 12 tuan uong
thuoc p (trddc -
sau) Nhan xet
Cholesterol toan phan f m m o l / l ) Lo chdng
2,18 ± 0,29 2,31 ±
0,34
>0,05 2,08 ±
0,61
>0,05 2,17 ±
0,74
>0,0S Ket qua d
Lotril
2,22 ± 0,25
>o,os
2,06 ± 0,45
>0,0S 2,16 ±
0,46
>0,0S Dang cho t
Ldtrl2 2,45 ±
0,40 2,26 ±
0,21
>0,05 2,17 ±
0,56
>0,0S 2,46 ±
0,41
>0,05
^lay: sau 4 tuan, 8 tuan va 12 tuan udng vien nen Thanh nao I , nong dp cholesterol trong mau thd d ca Id t n 1 (uong vten nen Thanh nao I lieu thap) va Id trj 2 (uong vten nen Thanh nao I lieu cao) khdng cd sir khac biet cd y n^hTa so vdi id chutig va so sanh giiJa hat thdi diem tru'dc va sau khi udng thuoc thir ( p > 0,05).
Bang 3.S: Anh hUdng cua vien nen Thanh nao I den ndng dd albumin tiong mau thd
thuoc Sau 4 tuan uonq thuoc p (tru'dc -
sau) Sau 8 tuan uonq thuoc p (tru'dc -
sau) Sau 12 tuan uonq thuoc p (trddc -
sau) 0,31 4,83 ±
0,25
>0,05 4,77 ±
0,25
>0,05 4,71 ±
0,26
>0,05 0,27 5,00 ±
0,31
<0,05 4,80 ±
0,27
>0,0S 4,86 ±
0,28
>0,05 0,24 4,91 ±
0,19
<0,05 4,89 ±
0,29
<0,05 4,84 ±
0,31
<0,05 Nhan xet: sau 4 tuan, 8 tuanva 12 tuan udng vien nen Thanh nao I, nong dp albumin trong mau thd d Id tri 1 (uong vien nen Thanh nao I lieu thap) khdng ed su" khae biet cd y nghTa so vdi Id chu'ng va so sanh giCi'a hai thdi diem tru'dc va sau khi udng thudc thiT (p > 0,05).
Ndng dp albumin trong mau thd d Id tn 2 (uong vien nen Thanh nao I lieu eao) tang eao hdn so vdi thdi diem tru'dc uong thuoe, siT khac biet cd y nghta thdng ke vdi p < 0,05.
Bang 3.6: Anh hUdng cda vien nen Thanh nao I den ndng dd creatinin tmng mau thd
J^. . Tru'dc uong thuoc Sau 4 tuan uong thuoc p (trddc -
sau) Sau 8 tuan uong thuoc p (tru'dc -
sau) Sau 12 tuan
uonq thuoc p (tn/dc -
sau)
Creatinin (mq Ld chdng
1,05 ± 0,05 1,05 ±
0,05
>0,05 1,04 ±
0,05
>0,05 1,05 ±
0,05
>0,05 Lotril
1,05 ± 0,05 1,05 ±
0,05
>0,05 1,06 ±
0,05
>0,05 1,06 ±
0,05
>0,05 / d l )
La tri 2 1,05 ±
0,05 1,05 ±
0,05
>0,05 1,05 ±
0,05
>0,0S 1,05 ±
0,05
>0,05
Thdi gian Tru'dc uong
Albumin ( g / d l ) Ld chihig
1,71 ± Lotril
4,63 ± Ldtri2
4,53 ±
Nhan xet: Sau 4 tuan, 8 tuanva 12 tuan uong vien nen Thanh nao I, d ea id t n 1 (uong vien nen Thanh nao I lieu thap) va id tn 2 (udng vien nen Thanh nao I lieu cao), nong do creatinin trong mau thd khdng cd sir thay ddi khac biet cd y nghTa thong ke so vdi Id chiTng va so sanh giCTa hai thdi diem trUde va sau khi udng thuoc thir ( p > 0,05).
*Thay ddi ve md benh hgc:
- Oai the; Tren tat ea cac thd thu'c nghiem (ca id chirng va 2 id tri), khdng quan sat thay cd thay dot benh iy nao ve mat dai the eua cae ed quan tim, phoi, gan, lach, tuy, than va he thdng tieu hoa ciia thd.
VIETNAM MEDICAL JOURNAL N°2 - APRIL • 2018 - Vt the: Hinh thai vi the gan: Ld ehiTng va ca
2 Id trj: hinh anh gan binh thu'dng va thoai hda miTc dp nhe.
+ Hinh thai vi the than: Ld chu'ng va ea 2 id tri: hinh anh than dng lu'dn gan va cac cau true kliae binh thu'dng
IV. BAN LUAN
4 . 1 . Anh hu'dng cua vien nen Thanh nao I den chu'c nang gan, than cua tho thi nghiem: Tren ea hai Id thd, mpt Id uong vien nen Thanh nao I lieu thap (0,75 mLVkg) va mot Id udng vien nen Thanh nao I lieu cao (2,25 mL/kg) lien tuc trong 12 tuan, ket qua cho thay:
- Thanh nao lieu thap lam tang hoat dp AST, ALT so vdi Id chirtig va so vdi thdi diem tru'dc uong thudc (p < 0,05)
- Thanh nao lieu eao lam tang ndng dp albumin so vdi thdi diem tru'dc udng thuoc (p<0,05), tuy nhien khdng cd sii khac biet so vdi Id chirtig sinh hpc (p > 0,05)
- K h d n g lam thay ddi ket qua mpt sd xet nghiem danh gia chu'c nang gan; nong dp bitinjbin toan phan va cholesterol.
- Khdng lam thay doi ket qua xet nghiem creatinin trong mau thd sau 12 tuan udng thuoe thir lien tuc.
4.2. Anh hu'dng ciia vien nen Thanh nao Z den mo benh hoc gan, than ciia tho thi nghiem: Xet nghiem md benh hoc gan, than ciia thd khdng thay cd ton thu'dng rd ret ve mat
hinh thai cau true cae ed quan gan, than d thd thi nghiem. Khdng cd sir khae biet giu'a cae 16 va so vdi Id chirng.
V. KET LUAN
- Mau thuoe thir vien nen Thanh nao I khong gay ddc ti'nh ban tru'dng dien tren thd khi cho thd udng lieu 0,75 ml/kg/ngay (lieu cd tac dung tu'dng du'dng lieu dimg tren ngu'di) va lieu cao gap 3 ian (2,25ml/kg/ngay) trong 12 tuan lien tue uong thuoe.
- Cac chi sd theo ddt ve chu'c nang gan, chu'c nang than va md benh hpc gan, than deu nam trong gidi han binh thu'dng, khdng cd sir khac biet rd ret so vdi 16 ehutig.
TAI Ll|U T H A M KHAO
1. Ng^uyen Thanh Hien, Thu'dng Thanh Phii'(fng, Tran Du D^i "Di/ phong tien phat bien co fim mach do xd vQa - cap nhat cac khuyen cao hien hanh "ghuyin de tlm mach hoc2014TA tr 48-53' 2. Nguyen Huy Dung (2004), "Roi loan lipid
mau", Tlm mach hoc - Bai giing he noi ktioa, NXB Yhoc, tr 23-26. • - / 3. Pham TuT DUtfng (2007), "Cac thuoc dieu tri h6i Chung roi loan lipid mau", Thudc tim mach, NXB Y hpc Ha Noi, tr 647 - 688.
t. Pham TlT Du'dng, Nguyen Dinh Hai, Trtftfng Thanh Hu'dng va CS (2008), " Khuyen cao 2008 ciia Hoi Tim mach Viet Nam ve chan doan va flieu tii ra loaa lipid mau", NXB Y hoc Ha Noi, tr 476 - 502.
5. Nguyen Nhu'dc Kim (2014): "Roi ioan lipid mau theo y hpc co truyen". Tap chf dong v, so 487, tr 12-13, 26-28; so 490 tr 28-29
NGHIEN CU'U HIEU QUA KIEM S O A T TIEN TRIEN CAN THI TREN BENH N H A N DAT KINH ORTHO-K
T O M TAT
Mgc tieu: Danh_pia hieu qua kiem soat tien trign e|n tiij va mpt so yeu td lien quan cua kinh tiep xuc cuVig tham khf chinh hinh giae mac. Ddi tddng va phu'dng phip nghien cdu: Nghien culi mo 'ta, tien cull, khong doi ehiing, so sanh doe trudc va sau dieu tri tren 75 mSt (41 benh nhan) tai Benh vien Quan Y 103 tir 09/2015 den 09/2017. Ket qiia vi ban luan:
Mue dp tien trien can tnrdc dat kfnh tmng binh la 1,23
± 0,34D, nhdm tiieo doi 24 ttiang va 36 thang deu
''Benh viin Quan Y103,
**Benh vien Mit Tmng udng Chju trach nhiem chinh: Nguyen Dinh Ngan Email: [email protected] Ngay nhan bai: 2.2.2018 Ngay phan bien khoa hoc: 29.3.2018 Ngay duyet bai: 12.4.2018
Nguyin Dinh Ngan*, Le Xuan Cung**
thay xu hudng tien trien can tang dan. Nhung sau dSt kfnh mu'c dp tien trien can trung binh la 0,04 ± 0,120, giam ed y nghTa thong ke so voi trUde dat (p<O,O01).
Co tat ca 13 mat (26,7%) ben trien can, 'S mSt sau 12 thang (n=75) va 8 mat sau 24 thang (n=40) theo dBI, trong do 1 mat tang 1,00D; 1 mat tang 0,5D, con 1^1 11 mat tang 0,25D. MiTc dd tien tnen can sau flat kir*
Ortho-K ed lien quan den do can tru'dc dat (r = 0,234;
p= 0,045), nhung khdng lien quan den Kl, K2 va tuoi.
Tnjc nhan cau sau khi dat kinh co xu hu'dng dai them, so vdi tru'dc flat kinh lan IUdt la 0,18 ± 0,3 mm (p=0,765) d 12 thang va 0,21 ± 0,37mm (p=0,047)cl 24 thanp. Kei luin: Oat kfnh Ortho-K la phudng pfiap hieu qua trong ngan ngira tien trien can thi
Tdkhda: Ortho-K, can tiij, tien tnen cin
SUMMARY
STUDY OF MYOPIA CONTROL I N PATIENTS USING ORTHO-K 26
