TAP CHl Y DU-OC tAM SANG 108 Tap 10 - SA 3/2015
Nghien cwu r6i loan lipid mau fr benh nhan Giit dieu tri tai Khoa Noi Than Khop Benh vien Trung uo-ng Quan
*doi108
Dyslipidemia in gouty patients treated at the Department of Nephrology .and Rheumatology in 108 Military Central Hospital
-' xrSn Hdng Nghi ^enh vien Trung uang Qudn doi 108
^ T 6 m tat
Muc tieu- Nghien cdu dac diem rdi loan lipid (RLLP) mau tren benh nhan Gut dieu tri tai Khoa Ndi Than - i. Khdp Benh vien TaOD 108. Dot tddng vd phdang phap: 107 benh nhan Gut d i l u tri t d thang 3/2013 den
thang 04/2015 dddc xet nghiem Choiesteerol, triglyceride, LDL-C HDL-C, so sanh ddi chdng vai 99 ngddi binh thddng tdang ddng ve gidi, tudi, BMI. Ket qua: Benh nhan Gut cd cholesterol, triglycerid, LDL-C cao han , - va HDL-C tha'p hdn cd y nghia thdng ke so vdi nhdm chdng (p<0,05). Ty le rdi loan lipid mau chung la 82,86%
" (87 BN) chu yeu la tang TG (73,33%, 73 BN), g i i m HDL-C (62,61 % 67 BN). Rdi loan typ IV theo phan loai
" Fredrickson la hay gap nha't d benh nhan Gut (57 BN, 53,2%) Kit luan: RLLP mau thUdng xuyen song hanh
•' cung benh Gut va can dieu tri ca cac RLLP de d d phdng cac benh tim mach cho benh nhan Gut.
Tdlriido-Rdi loan lipid mau, g u t
Summary
Obiective- Study on the dyslipidemia in gouty patients treated at the Department of Nephrology and Rheumatology in 108 Military Central Hospital. Subject and method: Serum total Cholesteral (CHO), HDL- cholesterol (HDL-C), Triglyceride (TG) were measured on 99 normal subjects (control) and 107 gouty patients from March 2013 to April 2015. Result The cholesterol and triglyceride concentrations of the gouty goup were significantly higher than those of the control one, whereas HDL was lower (p<0.05).
82 86% of the patients had hyperlipidemia, of whom hypertriglyceridemia accounted for 73.33% and low HDL-C was 62.61%. Type IV of dyslipidemia based on Fredrickson classification was the most common disturbance (53.2%). Conclusion: Dyslipidemia was a common comorbidity in gouty patients and need to be treated to prevent cardiovascular diseases.
Keywords: Dyslipidemia, gout.
'han bi?n khoa hgc. TS. NGUYEN DUG HAI
Vol10-N°3/20l|s
Bang 4. TSn suSt cac kieu rdi loan lip.d mau d nhom benh nhan Gut theo phan loai
FREDRICKSON
Bang 5. So sanh t * le roi loan lipid vdi m o t so tac gia t r o n g nUdc
Nfrdn xet: Rdi loan lipid t y p iV theo phan loai FREDRICKSON (tang TG ddn thuan) cd ty le cao nhat.
4. Ban luan
4.1. Ve die diem ciia nhom nghien cdu Nghien cdu cua chdng tdi cho thay cang ngay Gdt khdng cdn la benh cua t u d i t r u n g nien nda ma cd t h d la m d i de doa cho ca n h d n g ngddi tre cd Idi sdng t h u d d n g , che dd iin thda chat beo va d a m . Nghien cdu cua chdng tdi ghi nhan 100% la nam gidi do ddi t d d n g phuc vu cua chung tdi chu yeu la cac can bd quan d o . tai chdc hoac hUu t r i . Tuy nhien, theo cdng t r i n h nghien cdu cua tac gia Yu KH tren 1079 benh nhan Gut tal Taiwan [81 t d 1993 - 2000 th) ty le n d mac benh Gut cd t a n g so vdi cac nghien cdu trUdc do (8%) [101. Trong nghien cdu cua Chung t d i , roi loan lipid mau la benh ly di kem t h d d n g giip nhat (76,6%), u e p theo la Cao huydt ap (42,9%), dai thao d u d n g (11,7%). Day la cac yeu t d nguy cd t h d d n g gay ra n h d n g hau qua nang ne tren t i m mach.
4.2. Roi loan chuyen hda lipid » benh nhan Gut Gut la m d t benh ly viem khdp cd dac diem la sd lang d o n g cac tinh the urate trong va ngoai khdp ket hop vdi rdi loan chuyen hda axit uric. Rdi loan nay thUdng nam trong benh canh chung vdi cac rdi loan chuyen hda khac nhd: Rdi toan chuyen hda lipid, dddng,...Dddi day la so sanh ket qua rdi loan chuyen hda lipid t r o n g nghien cdu cua chung tdi vdi m d t sd tac gia khac.
Trong n h d m nghien cdu cda chdng tdi thdi giffl 2 nam 2013-2015, chung tdi nhan thay ty le mat phai rdi loan chuydn hda lipid cao hdn cac tac gfi khac cd t h d do n h d n g thay ddi ve chd dp an va dirt d d d n g cua ngddi dan vdi thanh phan chat beo va chat dam ngiiiy cang t i i n g . Vi vay, ngay nay vdi dial kien sdng nang cao, can cd chd d d an udng chUa hep ly d m d t bd phan idn n g d d i dan la mot trong n h d n g ydu t d g d p phan lam tang t y le miSc cac benti t h u d c rdi loan chuydn hda t r o n g d d cd benh Gut. Ket qua t h u duec a bang 3 cho tha'y t h d t d thddng gap cua cac thanh phap rdi loan lipid ISn Iddt la: Tiing TG 69 2%, giam HDL-C (61,7%), tang CHO 66,4%, tang LDL-C (58,9%); Trong d d tang TG la dac diem noi bat nhat cua rdi loan chuydn hda lipid d benh nhan Gilt Sd lieu cda Chung tdi phu h d p vdi ket qua nghien cdu cua mdt sd tac gia trddc day [21, [61, [71, [81, [91, Triglycerid liii loai m e m a u duac tao ra t d chuyen hra d u a n g (gluco, cac loai d d d n g t r o n g ngu c d d . B j diem tang triglycerid mau nay cd le lien quan ta che dd an nhieu t i n h bdt, dUdng (cam, ngd, khoai san...) cda ngddi Viet Nam.
Bang 6. So sanh phan loai cac kieu rdi loan chuyen hda lipid theo Fredrickson vdi mot so
tac gia trong nddc
Tac gia
NguyenThu Giang (2003)
Nguyen Thi Phuang (2006)
Typ IV Typ lib
35,7% 25%
57,14% 22,07%) Chung toi 1 ^g^o^ 1 17,8%
(2013-2015) J _ _ 1
Typ lla
3,6% 5,19%
5,6%
24
TAP CHi Y DLTOC LAM SANG 108 Tap 1 0 - s a 3/2015
Theo each phan loai cac kieu rdi loan chuyen hda cda Fredrickson, ket qua cua chdng tdi cho thay t y p IV chiem t-) le cao nhat (56,l»/o), tiep theo la t y p II b (17,8%) va thap nhat la typ lla (5,6%). Ket qua nay cung p h u h o p vai m o t sd cdng trinh nghien cdu t r d d c day:
Ty le t y p IV (tang triglycerid dan thuan) cao nhat
• kha nang cd lien quan den dac diem che dp an cda - n g u d i Viet Nam nhieu t i n h bdt n h u da de cap den
•, phan t r e n . 0 ca the ngudi, mdc dd cao triglyceride ,, t r o n g mach m a u d i n d e n x e vda d d n g mach (xo
;, cdng d d n g mach) gay nguy co ve cac benh t i m .. mach va d d t quy. Ngoai ra, tang TG cdn cd the dan ,. den m d t bien chdng nang h d n , do la viem
. t u y cap.
- 5. Ket luan
; Nghien cdu rdi loan lipid mau tren 107 benh '•i nhan Gut dieu tri tai Khoa ndi Than - Khdp, Benh
•.- vien T U C J D 108 cd so sanh ddi chdng vdi 104 ngddi v> c h d n g , chung tdi nhan thay:
;: - Benh nhan Gdt cd cholesterol, triglycerid, LDL-
=,- C cao h e n va HDL-C t h a p hen cd y nghia t h d n g ke so ,„Tvdi n h d m chdng (p<0,05).
- Ty le rdi loan lipid mau chung la 82,86%o (87 -T BN), chu yeu la t a n g TG (73,33%, 73 BN), giam HDL-C ,'i(62,61%o,67BN).
! i - Rdi loan t y p IV theo phan loai Fredrickson la ''", hay gap nhat d benh nhan Gut (57 BN, 53,2%)).
"' Kien nghj: Cac bac si can nhan thdc ddoc rdi ''• loan chuyen hda lipid n h u m d t benh ly song hanh cung benh Gut de dieu tri rdi loan lipid mau, dU iiilK p h d n g cac bien chdng t i m mach nguy hiem.
KftOli'
Tai lieu t h a m khSo
1 Tran Ngoc An (1999) Benii gijt. Benh thap khdp Nha xuat ban Y hoc Ha Ndi, tr. 278-300.
2 Nguyen Thu Giang (2004) Rdi loan Lipid mdu d binh nhdn viem khdp Gout. Luan van Thac si Y hoc.
3. Hdi ddng khoa hoc - Hdi Tim mach hoc Qudc gia Viet Nam (2008) Kiem sodt cdc yeu td nguy ca tim mach Khuyen cao 2008 ve cac benh ly tim mach va chuyen hda. NhaxuatbanYhoc, tr. 9-18 i Nguyen Thi Ngoc Lan (2004) Senii gut Benh hoc
noi khoa sau dai hoc, trudng Dai hoc y Ha Noi, Nha xuat ban Y hoc, tr. 412-421.
5. Vd Tam (2012) Benii Gut Phac dd Chan doan va dieu tri cac benh ce xuong khdp thddng gap, Hdi thap khdp hoc Viet Nam, tr. 117-123
i. Nguyen Kim Thuy (1998) Bgc diem Idm sdng va moi lien quan gida binh Gout vdi mdt so benh ndi khoa khac Tap chi Y hoc thdc hanh sd 5.
7. Le Anh Thd va cs (2001) Bdc diem cua cdc binh viim khdp Gout tgi BV Chd Ray 1999-2001 Bao cao tai HN Thap Khdp hoc toan qudc nam 2002 Hdi Thap Khdp hoc Viet Nam.
B. HK. Choi et ai (2007) Prevalence of the Metabolic Syndrome m patients with gout Arthritis &
Rheumatism57(1).109-115
9. Rho Y et al (2004) Prevalence of the metablolic syndrome in gout patients. Annual of the Rheumatic liiseases.TheEiarJournai, Berlin. 1473-1481.
10. Yu KH, Luo'sF (2003) Young age of onset of gout in Taiwan. Rheumatology, Oxford.
