T A I L I E U THAM K H A O
1. Nguyen Khde Lieu (2003), "Chan dodn vd didu trj va sinh. Vign BVSKBMVTSS". Nhd xult ban Y hge.
2 Trin Due Phin, Phan Thj Hoan, La Dinh Trung (2009), "Tinh hinh thidu nang sinh san d 18 phudng xd cua Thai Binh". Yhgc thwc hdnh, 6 (664), 45 - 48.
3. Phan Hodi Trung (2004), Nghign cuu tinh an todn va tae dgng eua bdi thude "Sinh tinh thang" ddn sd lupng vd ehdt luyng tinh trCing, Lupn vdn tiin sy y hgc, Tru'dng Dai hpe Y Ha Ngi.
4 American Urological Association (2001), Infertility", Report on optimal evaluation of the infertile male, Inc,
5. Bernd Rosenbusch (2010), Somatic chromosomal abnormalities in couples undergoing infertility treatment by intracytoplasmic sperm injection. Joumai of Genetics, Vol, 89, No. 1,
6 Hull M, G„ Kelly N J. and Hinton R. A. (1985).
Population study of causes, treatment and outcome of infertility. British Medical Journal, 291,1693 -1698.
7. Larsen U. (2000), Primary and secondary infertility in sub-Saharan Africa. Intemational Joumai of epidemiology, 29 (2), 285 - 291.
8. Lee J, Y., Dada R , Sabanegh E , Carpi A., Agarwal A. (2011), Role of genetics in azoospemiia, Umlogy Volume 77, Issue 3, Pages 598 - 601
ROI LOAN DUNG NAP GLUCOSE
or N H O N G NGlAl c 6 YEU TO NGUY C0 DAI THAO DUATNG
TOM T A T
Muc tidu: Xic dinh tj Ip rdi logn dung ngp glucose d nhOng ngwdi cd yiu td nguy ca cOa bdnh dil thdo dwdng vi mdi lidn quan giwa tinh trang rdi logn dung ngp glucose vdi cdc yiu td nguy ca.
Phwang phip: tiin ciru. md td. cdt ngang trpn 613 ngwdi cd yiu td nguy ea tudi td 30 - 69 dwac lim nghidm phip dung nap glucose vdi 75 g. Ket qua: tj Id rdi logn dung ngp glucose d 613 ngwdi cd yiu td nguy ca li 27.4%: tmng dd: rdi logn glucose luc ddi Id 4.2%; gidm dung nap glucose miu li 8.5%; bdnh nhdn cd cd rdi logn glucose luc ddi vd gidm dung nap glucose mdu la 4,6%; dii thdo dwdng thwc sw Id 10,1%. Ty Id roi loan dung nap glucose d ngudi cd 1 yiu td nguy ca li 13,1%; 2 yeu td nguy ca li 19.6%, ngwdi cd 3 yiu td nguy ca Id 26,9% vi ngwdi cd 4 yiu td nguy ca li 43,1%. Cd mdi lien quan mit thiet giQa tinh trgng rdi logn dung ngp glucose vdi bio phi.
tdng vdng eo, ting huyit ip vi tudi Ket luan: tj Id rdi logn dung nap glucose d ngwdi cd yiu td nguy ca li 27,1%, nhimg ngwdi cing cd nhieu yiu td nguy ca thi tj Ip rdi loan dung ngp glucose cang tdng..
Tip khda: Fidi logn dung nap glucose, yiu td nguy ca SUMMARY
Objectives: Determine the mte of intolerance glucose in people with risk factors of diabetes.
Methods: The cmss-sectional study, involved 613 subjects aged 30-69 with risk factors of diabetes.
Results: The rate of intolerance glucose is 27.4%:
them are 10.1% diabetes, 17.3% impaired glucose tolerance and/or impaimd fasting glucose In this study. It show a close mlation bebfjeen the intolemnce glucose condition and age, obesity, waist circumference, hypertention. The mom risk factor, the more increased possibility of tolemnce glucose disorder Conclusions: The rate of intolemnce glucose in people with risk factors of diabetes is 27.1%. The more risk factor, the more incmased
VU BfCH NGA, T I ^ N V A N OAI Trwdng Dgi hgc YHa Npi possibility of tolerance glucose disorder
Keywords: intolerance glucose, diabetes DAT V A N Dfi
Ddi thdo dudng la bgnh ly ngi tidt chuydn hda phd bidn trdn thd gidi ed xu hudng ngdy cdng gla tdng. Id mgl trong ba bgnh khdng Idy phat tridn nhanh n h l l (ung thu, tim mgch, dai thao dudng). Ndm 1994 sd ngudi m i c bdnh tren loan thd gidl la 110 trieu ngudi, ude tinh ddn nam 2030 sd benh nhdn dai thao dudng trgn thd gidi se tang tdi 350 trigu ngudi. Ldm sao de ngdn ehdn duyc s y gia tang cua benh eung nhu hgn ehd nhO'ng bien ehii'ng md bgnh ed thd gdy ra cho ngudi bgnh? Nguygn nhgn eua benh ngodi ydu td di truyen thi cde ydu td nhu: beo phi, tuoi, ldi sdng, mdi Irudng, chd dd dinh dudng. cOng gdp phdn quan trpng vao eo ehd bgnh sinh ciia benh. Vi vdy dd han chd va giam tde hai eOa bgnh thi bign phap hO-u higu n h l l la phat hien sdm nhung ngudi ed ydu to nguy cu d l phdng bgnh, Ninh Binh la mgt tinh dang trgn dd phdt tridn vi vgy kgo theo s u thay ddi ldi sdng, hdnh vi, ehd dg dinh dudng eiJa ngudi ddn Chinh dieu dd dd lam tang kha nang mdc bdnh tdt, ddc bigt la ddi thdo dudng. Vi vay chiingtdi thye hien dd tai nhdm mue ligu: " Xdc djnh ty 1^ rdi loan dung ngp glucose d nhung ngud'i ed ydu td nguy e o cua bgnh ddi thdo d u o n g tai tinh Ninh Binh vd mdi lien quan v d i cdc ydu t d nguy e o "
D 6 | TU'aNG VA PHU'ONG P H A P NGHIEN CLTU I . D d i tuyng: Trong thdi gian 10-6/2011-12/2011 chung tdi nghidn ciru trgn 613 ngudl cd it nhit mdt ydu td nguy co ddi thdo dudng nhu: thira can - beo phi, tang huydt dp, bdo byng, trong do tudi 30-60 tai phudng Bich Ddo Ihanh phd Ninh Binh
2. Tigu e h u i n loai trip
- NhCrng ngudi dang mang thai, dang mdc benh, hoac dimg cac thude cd anh hudng den rdi loan chuyen hda glucose, ngudi da duoc ehan doan v^
didu tri dai Ihao duong, ngudi khdng chap nhdn tham
V HQC THV'C HANH (872) - SO 6/2013
gia nghidn ciru,
3. P h y o n g phdp nghidn c u u : Nghidn CI^U tidn ciru md t l e l t ngang, thu thdp s6 lidu theo mSu bdnh an nghidn ciru thdng n h l l , bao gdm: hdi bgnh; kham lam sdng; xdt nghigm,
4. Tidu c h u i n ddnh g i l dup-e sd dgng trong nghidn e u u : Tigu c h u i n e h l n dodn dai thao dudng va rdi logn dung ngp glucose theo WHO (2006)[8].
Phan logi tdng huydt dp theo JNC Vll, Ddnh gid ehl sd vdng bpng binh thudng eua ngudi chdu A theo WHO - 2008, Ddnh gia BMI eho ngudl chau A theo WHO - 2004[6], Danh gia tl sd vdng byng - vdng hdng binh thudng theo WHO - 2008[7],
5. Xu> ly sd l i ^ u : Todn bd sd ligu duyc xir ly b i n g phdn mdm SPSS 16 0. Sir dyng test khi binh phuong dd so sdnh tl lg cdc bidn dinh tinh vdi a = 0,05 vd tinh chi sd tuong quan OR vdi khodng tm cdy Cl 95%
KETQUAVABANLUAN,
1. Tinh trgng rdi logn dung ngp glucose Trong nghidn ciru cua chOng tdi thi tdng sd ngudi cd llnh trgng rdi loan dung ngp glucose Id 168 ngudl chidm 27,4%- trong dd rdi logn dudng mdu liic ddi (IFG) Id 4,2% ; gidm dung ngp glucose (IGT) Id 8,5%
, ea IGT vd IFG Id 4,6% ; ddi thdo dudng Id 10,1%, Kdt qua cOa chiing tdi eao hon trong nghign ciru cOa Nguydn Thj Ngpc Huydn d nhu'ng ngudi trong dg tudi trgn 30 tgi ndi thdnh Hd Ngi vd mgt huygn ngogi thanh Ihl IJ lg ddi thdo dudng vd giam dung ngp glucose Id 7,6% vd 7,6%[3]. S d di" kdt qud cua chiing tdi cao hon cac nghign ciru trong nude vl ty IS ddi thdo dudng vd gldm dung nap glucose d Viet Nam vd trgn thd gidi ngdy cang tang ciing vdl sy phdt tridn ciia kinh td. Mdt khac cac nghien eiru dd chu ydu la tren cdng dong ddn c u , trong khi nghidn eiru ciia chiing tdl eh! thye hign trdn nhung ngudi tCr 30-69 tudi vd cd ede ydu td nguy eo cua bgnh ddi thdo dudng.
2. Lign quan giua tinh trang rdi loan dung nap glucose vd cae ygu t d nguy c o :
Bang 1. Lien quan glu-a rdi loan dung ngp glucose (RLDNG) vdl huydt ap
HuySt ^p rang HA Binh thL^dng
RLDNG 54,3%
45,7%
Binh thij&ng 28,9%
71,1%
P
<0 05 OR (CI95%)
2,95 (2,03.4,29) Norman M.Kaplan, MD (2000) eho t h l y cd ldi 50% tnrdng hyp dai thao dudng mdi duyc c h i n doan cd tang huydt ap Dai thdo dudng ed tang huydt dp Idm tang ty lg t u vong do bgnh 1^ lim maeh. Ddng thdi su kdt hop giO'a 2 bgnh ndy ldm thiic ddy nhanh eae bien chirng eua ddi thao dudng nhu bidn chirng m i l , than, t h i n kinh. Trong nghidn ciru eiia chiing tdi thi t;/ le THA trong nhdm roi logn dung ngp glucose la 54,3% vd ngudi ed tdng HA thi nguy eo mdc rdi logn dung nap glucose g i p 3 l l n ngudi binh thudng. Tg van Binh vd cpng s y (2002), tai 4 thdnh phd Idn Hd Ndi, Hai Phdng, Da NSng, TP.Hd Chl Minh cho t h l y ngudl cd tdng huydt ap ed nguy eo eao m i c ddi thdo dudng g i p 3 l l n so vdi ngudi khdng tang huydt ap.
Nghidn ciru d Tusinia eho thly, ty Ig THA d nhOng bgnh nhan ddi thdo dudng cao gdp 3 l l n so vdi nhOng ddi tuyng binh thudng vd chidm 33%.
Bdng 2. Lign quan giO-a rdi logn dung ngpglliose vdi BMI
40.3
BMI RLDNG Binh thudng p 0R(GS5%[
2 ^ BMI a 23 I 35.3 ~\~ 59J [ < 0.05 j (1.87-M3) ,
Trong nghidn ei^u cua chiing tdi cho thly nnung ngudl cd BMI > 23 thI nguy eo m i e rdi logn d u n ^ g p glucose eao g i p 2.42 so vdi ngudi ed BMI < 23 (p<0,05), Mgt sd nghidn ciru trudc ddy eOng eho thly mdi hgn quan eCia rdi logn dung ngp glucose vdi thi>a edn bdo phi nhu nghidn eiru cda Nguydn Thj Nggc Huydn (0R=1,67; p<0,05) hay Tg Vdn Binhiva cgng s y trSn loan qude (2002): nhdm BMI a 23 nguy ctr mde dai thao dud'ng cao gdp 2 l l n so vdi nhdm BMI
< 23, Anoop Mesra va Naval K.Wikram nam 2002 nghign ciru trgn nhdm ngud'i An Dg ehl ra ring bfeo phi la ydu td quan trpng n h i t d i n ddn tinh tr^ng khang Insulin, tdng 1/3 l l n so vdi can n i n g Iy tudng se iam gidm ddn 40% hogt dgng cua lnsulin[5].
Bang 3. Lidn quan giira rdi logn dung nap glucose vdi vdng eo
V6ng eo Vdng eo cao Binh thu-fi-ng
RLDNG 63,8%
36,2%
Binh thi/d-ng 31.6%
68,4%
P
< 0 06 OR ..%
(CI95%r 3.S3',)|I (2,61.5,™
Ngudl cd vdng eo tdng (Nam £90em; nU S80d"
cd nguy eo m i c roi logn dung ngp glucose cao gcE' 3,83 l l n so vdl vdng eo binh thudng. So vdi n ^ ^ cuu cua Trdn Thj Mai Hd (2004) tai thdnh phd ' ' ^ Bdi d ddi tuong trdn 30 tudi thi ty Ig nh&ng ngudi bdo byng chidm hon 66% Irong nhdm rdi logn dung ngp glucose[2]. Theo Me Raw-Hill (2002) cd khodng 60%
nh&ng ngudi ddi thdo dudng type 2 cd vdng eo tdng (nam >102, nd >88).Nhu vgy kdt qua nghidn cuu cua ehiing tdi eung gidng n h u ede nghign ei>u trong vS ngodi nude khde khi nhdn t h l y vdng eo tdng la yeu t i nguy eo eao eua bgnh dai thao dudng.
Lien quan giu'a RLDNG vd'i tudi
p < 0.05 30-39 40-49 50-59 60-69 Bidu dd 2. Mdi lidn quan giua rdi logn dung ngp gl
tudi
Trong nhdm ed tinh trgng rdi logn dung n?p glucose thi dg tudi ttr 30 - 39 chiem 3%,tir 4(M9 chidm 19,6%, tir 50-59 ehidm 44,0%, tir 60 ddn 69 ehidm 33,3%. NhO-ng ngudi trong dg tuoi 50-70 c6 nguy cu mdc rdi logn dung nap glucose cao gip 2,26 ldn so vdi nhdm ngudi trong dg tudi id 30 - 50. Trin
Y HQC THV'C HANH (872) - SO 6 ^ 3
Mmh Long nghign eiru tgi Nghg An ndm 2010 thi tf lg rdi logn dung ngp glucose tgng d i n theo dp tudi.
Nh&ng ngudi trong dd tudi 45-69 thi nguy c o mde bgnh dai thao dudng gdp 2,1 ldn va tldn ddi thdo dudng Id 1,78 l l n so vdi dg tudi tir 30-44[4], Trong 3d d chau Au thi ty le m i e ddi thdo dudng type 2 thudng xdy ra d dg tudi sau 50 vd ehidm 85-90% sd bgnh nhdn ddi thdo dudng type. Nhu vdy, chiing ldi cOng thu duoc kdt qua tuong ddng so vdi ede nghign CO'U trong vd ngodi nudc, ty Ig rdi logn dung ngp glucose tdng theo tu6i.
Lidn quan gi&a RLDNG vd'i siy tdng h ^ p ede ygutd nguy CO
1 y^u 2 y4u 3 y^u 4 y^u
t6 t6 t6 t6 P*°'05
Bilu do 3, Moi lien quan giO'a rdi lo^n dung ngp glucose vdi SU' tdng hyp cdc yeu t6 nguy co Trong nghign eiru nay ehiing tdi thdng kg edc ydu td nguy c o nhu thira ean,vdng eo tang, tang huydt dp Ty Ig rdi loan dung ngp glucose d nhdm ed 1 yeu to nguy c u Id 13 1 % vd ty le ndy tdng d i n theo sd lirong ydu id nguy eo. Ndu cd 4 ydu td nguy eo thi ty Ig roi loan dung nap glucose ehiem tdi 4 3 , 1 % So sdnh vdi nghien ciru Ta Vdn Binh vd cgng sy: nhdm c6 1 yeu td nguy eo thi tl lg ddi thao dudng la 3,4%, rdi loan dung ngp glucose Id 6,5%; 2 yeu td la 6,5%
vd 11,4%; trgn 3 yeu td nguy eo la 12,0% va 20.5%[1]. Qua nghign ei>u cua chiing tdi vd Ta Vdn Binh thi s y hinh thanh vd phdt tridn cua rdi loan dung ngp glucose la s y phdi hop cua nhieu ydu td nguy CO Mdt ngudi cang cd nhieu yeu td nguy eo thi kha ndng mae rdi loan dung nap glucose edng tdng.
K^T LUAN
Ty Ig rdi logn dung ngp glucose d 613 ngudi ed ydu td nguy c o Id 27,4%. trong dd: rdi logn glucose luc ddi Id 4,2%, gidm dung ngp glucose mdu Id 8,5%;
bgnh nhdn ed ed rdi logn glucose lOe ddi vd gidm dung ngp glucose mdu Id 4,6%; ddi thdo dudng thye sy Id 10,1%, Ty Ig rdi logn dung ngp glucose d ngudi ed 1 ydu td nguy eo Id 13,1% ; 2 ydu td nguy c o Id 19,6%; ngudi cd 3 ydu td nguy eo Id 26,9% vd ngudi ed 4 ydu td nguy c u Id 43,1%, Cd mdi lign quan mgt thilt giua tinh trgng rdi logn dung ngp glucose vdi bdo phi, tdng vdng eo, tang huydt ap va tuoi.
T A I LigU THAM K H A O
1, Tg van Binh (2007), " Nhung nguydn Ij nin ting bpnh Ddi thio dudng tdng glucose mdu". Nhd xult ban Yhoc
2 Trdn Thj Mai Hd (2004),Tm hieu mpt sd yeu tS nguy ca cua bpnh Dii thdo dudng d ngudi td 30 tudi trd ldn tgi thdnh phd Ydn Bdi, Y hoc Thyc hanh, sd 5, tr.32- 45
3. Nguyin Thj Ngpc Huyen (2005), Nghidn cdu thuc trgng bpnh Dai thio dudng, rdi logn dung ngp glucose vd mpt sd yeu td lidn quan d mpt sd qupn npi thanh va mpt huypn ngogi thanh Hd Npi. Y hpc Thye hanh, so 8, p.33-39
4 Trdn Minh Long (2010), "Mo ta mpt sd yeu td lidn quan Ddi thao dudng type2 va Dai thao dudng tCr 30-69 tudi tai tinh Nghg An nam 2010", Y hgc Thyc hanh,tr.37- 55
5 Anoop Misra and Naval K.Vikram (2002) 'Insulin resistance syndrom and Asian Indians", Current Science, Vol 83,No,12. p.14-84
6 Ttie Lancet (2004), Appropriate Body mass index for Asian population and its implieation for policy and intervention strategies. Public health, p,157
7. WHO (2008) lVa;s/ circumference and waist - hip ratio. Report of a WHO expert consultation, p27
8 WHO, IDF (2006) Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia, p1.7, p,21
DANH GIA KET QUA DIEU TRj SARCOMA MO MEM T2N0M0 TAI DENH VIEN K
TOM T A T :
Myc tidu nghidn CO'U: Danh gid ti Ip tdi phdt tgi chd, di cin phdi, thdi gian sdng thim 5 ndm vd mpt sd yiu td inh hwdng cOa Sarcoma md mim T2N0M0. Ddi twgng nghidn cwu: 108 BN, SCMM giai dogn T2N0M0. Phwong phdp nghidn cwu: Md td hdi cdu. Kit qud: 108 BN SCMM diiu tri bing phwong phip phiu thuit, phau thupt + xg tri, phiu thuit + xg tri + hda tri cho kit qui: benh gpp d mgi Ida tudi, td 40-60 tudi chiim 41,7%. nam/nd li 1:1,1.
Phdn bd u ed thi bit cd vi trt ndo nhwng d chi da sd.
chiim 46,3%. Md binh hge da dgng, u thin kinh de khi nhiiu vdi tl Ip 36,1%. Ti Id tit phit tgi chd chO
BUI X U A N N O I , NGUYEN V A N TUYEN Benh Vipn K
yiu xiy ra tmng vdng 2 ndm dau tidn, di cin phdi Id 40%. sdng thdm toin bp 5 ndm Id 57,3%, sdng thdm 5 ndm khdng bpnh td 45,7% Cdc yiu td inh hwdng din sdng thdm 5 nim gdm. vi tri u. kich thwdc u, giai dogn bpnh. the md bpnh hgc, dp md hgc vd phwang phip PT
Tw khda: Sarcoma md mim T2N0M0 EVALUATING OF TREATMENT RESULTS OF SOFT TISSUE SARGORMAS T2N0M0 AT K HOSPITAL
SUMMARY
Objects: Evaluating the local reoeeurence, tung metastases lasting the 5 years of life and some affected factors to soff tissue samomas T2N0M0
T H Q C THVC H A N H (872) - SO 6/2013