HOI NGHj KHOA HOC LAN THQ IV • HOI TIET NIEU - THAN HOC VIET NAM
KHAO SAT NONG DO LIPID MAU TREN BENH NHAN HOI CHLTNG THAN HI/ NGUYEN
P H A TNGLfOl TRl/dNG THANH
,., ,, Vo Tam*, Nguyen Hoang Thao*
TOMTAT
Muc tieu: Khao sat ndng dp ciia cac thanh phan lipid mau va tim hieu mgt sd mdi tUdng quan
tren benh nhan Hoi chu'ng than hU nguyen phat ngUdi trUdng thanh.
OOI tUdng nghien citu: Tren 35 benh nhan Hpi chu'ng than hU nguyen phat
Ket qua: Nong do TC(12,95 ± 4,82 mmol/l),TG (5,55 ± 3,34 mmol/l), LDL-C (8,81 ± 3,92 mmol/l) deu tang cao so gia trj binh thudng cd y nghia thdng ke (p < 0,01). Trai lai, HDL-C (1,79 ± 0,73 mmol/l) khong khac biet so vdi gia tri binh thudng (p > 0,01). Theo phan loai ciia Fredrickson: Rdi loan lipid mau thudng gap nhat la typ Ila va lib 97%. Co sU tUdng quan gifta TC va protein mau (r = - 0,490, p < 0,01) TC va albumin mau (r = - 0,418, p < 0,01), TC va protein nieu (r = 0,37, p < 0,1), TG va protein mau ( r = - 0,286, p < 0,1), HDL-C va protein mau (r = - 0,401, p < 0,05), LDL-C va protein mau (r = - 0,432, p < 0,01), LDL-C va protein nieu (r = 0,267, p > 0,05), LDL-C va albumin mau (r = - 0,406, p < 0,01).
RESUME
OBSERVATION DE LA CONCENTRATION DE LIPIDEMIE CHEZ LES PATIENTS DE SYNDROME NEPHROTIQUE PRIMAIRE DE
L'ADULTE
Objectif: Rechercher la concentration de lipidemie et la correlation chez les patients de syndrome nephrotique primaire de I'adulte.
Population et methode: Cette etude s'est fait sur 35 patients de plus de 16 ans ayant ete
hospitalises pour syndrome nephrotique primaire.
Resultat: Cholesterolemie (12,95 ± 4,82 mmol/l), Triglyceridemie (5,55 ± 3,34 mmol/l), LDL-C (8,81 ± 3,92 mmol/l) sont augmentees. Type Ha et n b sont plus frequentees d'apres la dassifiration de Fredrickson
LDATVANDE > "
Hdi chiimg than hu la mdt benh ly thudng gap vdi bilu hien tdn thuong tdi thieu hoac nhiing tdn thuang day va thoai hoa mang day ciia mao mach ciu than nguyen phat hay thii phat [4].
Trong hdi chiing than hu, do mit qua nhilu protein qua nudc tilu lam protein mau giam manh, day la nguyen nhan chinh dan din cac trieu chiing Iam sang va bilu hien sinh hoa cua benh, ke ca tang lipid mau. Rdi loan nay lai gay ra cac bien chiing khac nhu xa viia ddng mach, lam xo hoa cm than, tao thuan lgi cho tang ngtmg tap tilu cau gay huylt khdi finh mach va tac mach phdi. Day la biln chiing nguy hilm nhung Iam sang ngheo nan nen la nguyen nhan gay tir vong cho benh nhan nlu khong dugc phat hien sdm va dilu tri kip thdi [4], [11], [12].
Nhiing nghien ciiu gan day da chi ra rang tang lipid mau trong hdi chiing than hu cd the lam benh tien trien nang ban. Bdi vi tang lipid mau se din den xo hda clu than, ca dng than va td chiic ke, Iam tiln triln nhanh ban din suy than man, giai doan cuoi ciia cac benh than ndi chung. Mat khac, viec dilu tri tang lipid mau cd the Iam giam cac tin thuang cau than [10].
* Tntmg Dgi hge Y Dugc Hue
Y HOC VIET NAM THANG 11 - 5 0 2/2010
Do dd, chiing tdi tiln hanh nghien ciiu de tai: "Khao sat nong do Lipid mau tren benh nhan Hoi chung than hu- nguyen phat nguoi trudng thanh" vdi cac muc tieu:
1) Khao sat ndng do cua cac thanh phin Upid mau: Cholesterol, Triglycerid, HDL-Cholesterol, LDL-CholesteroI tren benh nhan Hdi chiing than hu nguyen phat ngudi trudng thanh. : :f-s.a: K-:
2) Tim hieu mdi tuong quan giira cac thanh phan ciia lipid mau tren vdi: Protein mau. Albumin mau. Protein nieu.
I I . DOI TU'DNG VA PHU'DNG PHAP NGHIEN CU'U
2.1. Doi tugng nghien cuu
Gdm 35 benh nhan HCTH nguyen phat, tuoi tir 16 trd len, dugc chan doan xac dinh va dang dieu tri tai khoa Ngi Than Tiet Nieu - Benh vien TW Hul (1/2009 - 10/2009).
- Tieu chuan chgn benh nhan: Chan doan HCTH dua vao sau tieu chuan lam sang va can lam sang: (1) Phii (2) Protein nieu >
3,5g/24gid (3) Protein mau < 60g/l, Albumin mau < 30g/l (4) Lipid mau > 900mg%.
Cholesterol mau > 250mg%) hoac
>6,5nunol/l (5) Dien di protein mau:
Albumin giam, ty A/G < 1, a2 globulin, P globulin tang (6) Nudc tieu cd tru md, tinh the ludng chiet.
Trong dd tieu chuan (2), (3) la bat huge, cac tieu chuan khac cd the cd, khdng day du cQng dugc coi la cd hdi chiing than hu [4].
- Tieu chuan loai tru: Loai trir ra khdi ddi tugng nghien ciiu nhiing benh nhan HCTH thir phat do benh he thdng, benh ac tinh, berth chuyen hda, nhiem ddc thai nghen, cac benh nhiem ddc, cac benh Iy mach mau than, nhiem triing, benh mau va benh nhan HCTH nguyen phat dimg cac thudc lam tang lipid mau nhu thudc ngira thai, thudc iic cbl beta,...
2.2. Phuong phap nghien cuu
-Nghien cuu dugc tien hanh theo phuong phap md ta cat ngang.
-Tat ca cac benh nhan dugc ditih lugng protein mau, albumin mau, protein nieu 24 gid va lipid mau bang may phan tich tu ddng Hitachi 704 tai khoa Sinh hda Benh vien TW Hul.
Rieng dinh Iugng lipid mau sir dung kit hda chat ciia hang Beohringer Matmheim va phuang phap so mau enzym.
Bang 2.1 : Phuong phap dinh lugng lipid mau
Xet nghiem TC
TG
HDL-C LDL-C
Phu'dng phap
PhUdng phap so mau dung enzyme
PhUdng phap so mau dimg enzyme
PhUdng phap so mau dung enzyme
Phan U'ng
CHOD-PAP (Cholesterol Oxidase Phenazon AminoPeroxidase)
GPO-PAP (Glycerolphosphat Oxidase Phenazon Amino Peroxidase)
CHOD-PAP sau khi tao tiia vdi acid phosphotungstic va ion Mg^'^
Tinh theo cdnq thu'c Friedelwald LDL = CT - ( HDL + TG / 2,2 )
- Dua theo kit qua ciia hdi chau A - Thai Binh Duong vl xa vua ddng mach, benh Iy mach mau va Hdi Tim mach hgc Viet Nam 1998.
vp h 'k- .;-5».
^
HOI NGHj KHOA HOC LAN THLf IV • HOI TIET NIEU - THAN HOC VIET NAM
B a n g 2.2: Ket qua lipid mau theo Hdi Chau A Thai Binh D u a n g
Xet nghiem Gia trj binh thUdng (mmol/l)
TC
^ 5,2 ^ TG
< 2,3
LDL-C
< 3 , 2
HDL-C
>0,9
Sir dung phan loai rdi loan lipid mau theo phan loai cua Fredrickson.
Bang 2.3: Tdm tat phan loai lipid mau theo Fredrickson [13]
Typ I Ila lib III IV V
Thanh phan lipoprotein chinh Chylomicron
LDL-C LDL-C, VLDL-C
IDL-C VLDL-C VLDL-C, Chylomicron
Roi loan lipid (mmol/l) TG > 11,5 LDL-C > 3,4 LDL-C > 3,4 va TG > 1,4
TC > 5,2 va TG > 1,4 TG > 1,4 TG > 11,5
Thudng gap Hiem Thudng gap Thudng gap
Hiem Thudng gap
It gap
2.3. Phuffng phap xir ly so lieu:
Tit ca cac sd lieu thu dugc qua nghien ciiu dugc xu ly bang may vi ti'nh theo phuong phap thdng ke y hgc. . . .. . , , ,
I I I . KET QUA VA BAN LUAN 3.1. Bang phan bo theo do tuoi
Do tuoi n=35
%
16-25 22 62,86
2 6 - 3 5 4 11,43
3 6 - 4 5 1 2,86
4 5 - 5 6 4 11,43
>56 1 11,43
- Do tudi trung binh ciia ddi tugng nghien cim la 29,71 ± 18,28 tudi, nhdm cao nhat nSm trong do tudi tir 16 - 25 tudi chilm 62,86%.
3.2. Bang phan bo theo gidi
Gidi Nam Nu'
n 22 13
»/o 62,86 37,14
- Ty le nam/nu trong nghien ciiu cua chiing tdi la 1,69/1, phu hgp vdi cac nghien ciiu trong va ngoai nudc la thudng gap d nam hom nu.
3.3. Bang nong do trung binh cac xet nghiem lien quan
Xet nghiem Protein mau (q/l)
Albumin mau (g/l) Protein nieu (q/24h)
Gia trj trung binh 45,23 ± 10,26
11,19 ± 5,52 _ 6,96 ± 4.97
Y HOC VIET NAM THANG 11 -SO 2/2010
- Cac kit qua xet nghiem vl protein mau, albumin mau, protein nieu phii hgp vdi tieu chuan ciia HCTH diln hinh.
3.4. Bang nong do trung binh cua lipid mau
Lipid TC (mmol/l) TG (mmol/l) HDL-C (mmol/l) LDL-C (mmol/l) TC/HDL-C LDL-C/HDL-C
Gia trj trung binh 12,95 ± 4,82
5,55 ± 3,34 1,79 ± 0,73 8,81 ± 3,92 8,46 ± 7,03 5,90 ± 5,02
Gia trj binh thu'dng
<5,2
<2,3
>0,9
^3,2
< 5
< 5
P
p < 0,01
p > 0,01
- Cac thanh phan ciia lipid gdm TC, TG, LDL-C, ty TC/HDL-C deu tang cao so vdi gia tri binh thudng, trong khi HDL-C nam trong gidi ban binh thudng (p < 0,01) va ty LDL- C/HDL-C ciing khdng khac biet cd y nghia (p > 0,01). Nhu vay, nghien ciiu ciia chiing tdi ciing nhu nghien ciiu cua cac tac gia trong va ngoai nudc khac, cac chi sd TC, TG, LDL-C deu tang cd y nghia thdng ke cdn HDL-C khac biet khdng cd y nghia thdng ke so vdi gia tri binh thudng hoac so vdi nhdm chiing khde manh cung do tudi.
3.5. Bang ty le benh nhan co roi loan thanh phan lipid mau
Thong so roi loan Co rdi loan it nhat mdt thdng sd Khong rdi loan
n = 35 33
2
% 94,29
5,71
- Da sd cac benh nhan deu cd rdi loan lipid mau, chiem 94,29%) va chii yeu rdi loan ca 3 thanh phin lipid mau (hay gap la tang TC, LDL-C, TC).
3.6. Bang ty le roi loan lipid mau theo phan loai ciia Fredrickson
Typ n = 33
%
I 0 0
Ila 6 18,18
l i b 26 78,79
III 1 3,03
IV 0 0
V 0 0 - Rdi loan lipid mau thudng gap nhat la typ lib chiem 78,79%), sau dd la typ Ila (18,18%) va typ III (3,03%). Khdng gap trudng hgp nao rdi loan lipid theo cac typ I, IV, V.
3.7. Bang tuotig quan giua tirng thanh phan lipid mau vol protein mau, albumin mau va protein nieu
Lipid
Thong so
TC TG
Protein mau (g/l) r
- 0,490 0,286
P
<0,01
<0,1
Albumin mau (g/l) r
- 0,418 - 0,221
P
<0,01
>0,05
Protein nieu (g/24 gid)
r 0,37 - 0,084
P
<0,1
>0,05
HOI NGH! KHOA HOC LAN THlf IV • HOI TIET NIEU - THAN HOC VIET NAM
HDL-C LDL-C
0,401 - 0,432
<0,05
< 0,01
- 0,254 -0,406
>0,05
<0,01
0,177 0,267
>0,05
<0,1 - TC, LDL-C tuang quan nghich vira phai vdi protein mau va albumin mau, tuong quan thuan it chat che vdi protein nieu. HDL-C tuong quan nghich vira phai vdi protein mau. TG tuong quan nghich it chat che vdi protein mau. . . ; . . .
IV. KET LUAN
Qua khao sat ndng do lipid mau tren benh nhan HCTH nguyen phat ngudi trudng thanh, chimg tdi nit ra mgt sd ket luan nhu sau:
1. Da sd cac benh nhan deu cd rdi loan lipi'^ ..du va chil yeu rdi loan ca 3 thanh phan lipid mau (hay gap la tang TC, LDL-C, TC) cdn HDL-C trong gidi ban binh thudng. Cac typ rdi loan lipid mau thudng gap nhat theo phan loai Fredrichson la typ lib va Ila.
2. TC, LDL-C deu tuong quan nghich vdi ca protein mau Ian albumin mau (p<0,01). HDL-C tuong quan nghich vdi protein mau (p<0,01). Cac thdng sd khac khdng cd tuong quan hoac chi tuong quan it chat che.
TAI LIEU THAM KHAO CHINH
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2. Nguyen Minh Dung, Vo Phung (2006),
"Nghien cuu ndng dp Lp(a) huyit thanh a benh nhdn hpi chimg than hu tien phdt trudc vd sau dieu trj", Luan an Chuyen khoa cap 11, Trudng DH Y Dugc Hue.
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5. Nguyin Hai Thuy (2008), "Roi logn lipid
mdu", Giao trinh sau dai hgc chuyen nganh Ngi tiet va Chuyen hoa, Nha xuat ban Dai hoc Hul, 246 - 279.
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116. , j
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Internal Medicine, 119(4), 263 - 269.
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"Study of hyperlipidemia in adults with nephritic syndrome", Joumal of Postgraduate Medicine (JPGM), Volume 31, Issue 3, pp 140 -145.
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10. S.D.Ricardo, Harry van Goor, J.R.Diamon (1997), "Hypercholesterolemia and Progressive Kidney Disease: The Role of Macrophages and Macrophage-Derived Products", Lipids and the kidney, (Keane WF, Hori WH, Kasis BL), Contributions to Nephrology Basel, Karger, 120, 197-201.
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