Y HOC VIET HAM THANG 9 - SO 2/2014
NGHIEN CmJ MOT SO BIEU HIEN ROI LOAN NHAN THITC
<y BENH NHAN PARKINSON
T6M TAT
Ccf sd: R^ loan nhan tiii^c la bieu hien hay gap d bfnh nhan (BN) Parkinson, co anh hi/dng tdi chan doan dilu trj va chat lu'dng song cita BN. Mijc tieu:
nh|n xet cac bieu hifn roi loan nhan thu'c va moi lien quan vdi thdi gian mSc benh, giai do^n benh va mii'c dp ning d BN Parkinson. Dol tiT^ng va phu'dng phdp ngtiiSn c ^ : 30 BN Parkinson (23 nam, 7 nuO c6 tuoi m3c b|nh tmng binh la 71,77±7,57 du'dc kham 13m sang va lam mpt so trac nghiem tam V/. Ket quci:
Suy giam nhSn thirc thay d 53,33% so BN, trong do suy giam nh$n thu'c mite do nhe la 10%; mire do vuei
\k 43,33%, giam tri nhd 40,00%. BN mSc benh tir'6-10 nSm, giai doan 4 va mut dp rat nSng ve van dpng thi 100% suy giam nhan thdc. Ket lu$n: Suy giam nhan thiit kha thu'dng g^p d benh Parldnson, trifu chirng nciy tSng len ciing vdi giai doan benh, miTc dp nSng v i thcfi gian m§c b@nh.
TO"khoa: benh Parkinson, suy giam nhan thu'c.
S U M M A R Y
STUDYING SYMPTOMS COGNITIVE DISORDERS I N P A R K I N S O N ' S DISEASE
Background: The cognitive disorder symptoms are quite common in Parkinson's patients, affecting diagnosis, treatment and quality of life of patients.
Objective: To review t^e symptoms cognitive disorders and relationship with disease duration, stage and severity in patients with Parkinson's. Subjects and Methods: 30 Parkinson's patients (23 males, 7 females) with average age of disease was 71.77 ± 7.57 was clinical examed and psychological test.
Results: rate of the patient with cognitive impairment is 53.33%, including mild cognitave impairment is 10%;
moderation Is 43.33%, 40.00% memory decrease.
Patients are 6-10 years duration , stage 4 and severe disorder movement are 100% cognitive impairment.
Conclusion: Cognitive impaired is quite common in Parkinson's disease. The symptoms increased with disease stage, severity and duration.
Keywords: Parkinson's disease, cognitive impairment.
* B|nh vipn 103
Chju trach nhi^m chinh: Nhu" Dinh Sdn Eniail: [email protected] Dt: 0979723166 Phan bien khoa hpc: PGS.TS Phan Viet Nga Ngay ntian bai: 28.7.2014
Nhfr Dinh Son*
I. OAT V A N B E
Benh Parkinson la mpt trong nhiTng benh hay gap nhat ciia nhom benh do roi loan thoai hoa man tfnh he than kinh trung u'dng. Benh thu'dng gap d ngu'di cao tuoi (tren 50 tuoi). Ciing vdi xu hu'dng tuoi thp cang cao thi ty I? mac Parkinson se cang nhieu. Ngoai cac tri^u chiTng roi loan v3n dpng thi nhom trieu chirng suy giam nhan t\\iic gan day du'dc cac tac gia quan tam nhieu hdn.
C:ac trieu chiTng nay co anh hu'dng khong nho tdi chan doan, tien lu'dng, dieu trj cung nhu' chat lu'dng cupc song ciia BN mac Parkinson.
Vi vay chung toi tien hanh de tai nay nhSm muc tieu: Nh$n xet mgt sd' bieu hl$n suv giam nhan thu'c vi moi liin quan tdi ti%ai gian mac benh, glal doan b$nh vi mii'c d^
nang db$nh nhin Parkinson.
II. OOI TU-gnsiG v A P H U - O N G P H A P N G H I E N C O I J 2 . 1 . o d i t u ' d n g n g h i e n c i h i : gom 30 BN mac benh Parkinson lam nhom benh va 30 ngudi khoe manh lam nhom chiTng.
Tliu chui'n chon nhom b$nh: Chan doan benh Parkinson theo Hauser va cs {V^B7f'\
Co ca ba trieu chirng chinh (run, giam dpng, ciTng &d) hoac hai trieu chiTng chfnh vdi trieu chirng khong doi xtTng, loai triT cac nguyen nhSn gay hpi chiTng Parkinson, hoac run liic nghi, tri?u chu'ng khong doi xiTng. Cac benh nhan deu d^p irng tot vdi dieu trj bang L dopar.
Tieu chui'n loai triy nhdm binh: Cu'dng giap hoac suy giap. Tien sir nghien ma tuy hoac nghien ru'du. BN mu chiT hoac roi loan chiTc nSrig ngon ngO" nhu" dpc, nghe.
Tieu chui'n chon nhdm chuhg: Co dp tuoi, gidi va hpc van tu'dng du'dng nhom nghien ciru.
khong j n a c cac benh co anh hu'dng tdi chiTc nSng tam than, chu'c nang ngon ngu", khong mu chu".
2 . 2 . Phu'dng p h a p n g h i e n CIJ'U 2.2.1. Thiii ke nghien cift/; Tien ciru, mo ta, cat ngang, co doi chu'ng.
2.2.2. Cac bWdc tien hinh nghiin cuti, tieu chi nghien cu'u, danh gli
- Lira chpn BN theo tieu chuan chpn.
- Kham lam sang than kinh: BN Parkinson du'dc kham benh va lam benh an nghl§n ciru theo mau
Y HOC VigT NAM T H A N G 9 • SO 2/2014
thong nhat bao gom: kham noi khoa, tam than kinh, lam cac xet nghiem can lam sang.
- Oanh gia giai doan benh theo Hoehn va Yahr^
- Danh gia mu'c dp benh theo thang diem thong nhat danh gia benli Parkinson
- Lim mpt so trac nghiem trf nhcf: nhd tii, nhd day so...{ Hen hanh theo phu'dng phap cua phong trac nghiem tam ly, khoa Than kinh, Benh vien Lao khoa Trung Udng)
• SCr dung trac nghiem danh gia trang thai tam tri toi tliieu cua Folstein.
- Danh gia tri nhd tu*.
+ Nhd danh sach tfr: day tir gom co mu'di tir, da diTdc chpn san theo tieu chi: la nhu'ng ttr khac nhau, deu cd nghTa ro rang, cu the, moi tir gom hai Sm tiet va cac tir khong co mSi lien he ngu' nghia vdi nhau, nhSm tranh tac dpng ciia hien tt/dng hpc thupc Idng.
+ Nhd tir ngay: day tir du'dc dpc ro rang, di?m rai vdi toe dp 2 giay cho moi tir. Sau lan dpc thir nhat, y§u c5u nhac lai, moi tir nhSc dung clio 1 diem. Dpc lan thir hai, yeu cau nhac lai, moi tir nhac dijng cho 1 diem. Ope lan thiJ ba, yeu d u nhac lai, moi tir nhac dung cho 1 diem, long diem toi da ciia trac nghiem nay la 30 diem, tir 11 diem trd xuong la benli ly.
+ Nhd tir sau mpt lat: sau khoang 3 den 5 phut, ygu cau nhac lai day tir tren. Moi tir nhac dijng chp 1 diem. Tong diem toi da la 10 diem, tir 3 diem trd xuong la benh ly.
- Oanh gia sir chu y
Dpc xuol day so: cac day so gom cd tir ba cho den tam chir so (123,...), dpc cham tirng day
Bing 3.1: Mite dp suy qiam nhin thu'c theo
so, sau mot day, yeu cau nhac lai, dirng lai khi doi tu'dng dpc sal hai lan lien tiep hoac khong thy'c hien dUdc. Moi day sd nhac dung chp 1 diem. Tong diem tdi da cua trac nghiem nay la 12 diem, tCr 3 diem trd xuong la benh ly.
Phuong phip dinh gia: Moi lien quan giij^
cac bieu hien suy giam nhan thirc va mii'c dp benh, glal doan benh, thdi gian mac benh cua nhdm benh, so sanh vdi nhdm chiiYig
Nhdm chiihg: lamcactesttamlynhu'nhdmbenh 2.3. Xu' ly so lieu: so lieu du'dc xij' ly bang phan mem Epidata 3.1
III. Kfr QUA NQHIEN CU'U
3.1. Sac di€m Chung nhdm nghien cihi Nhdm benh cd 30 BN (23 nam, 7 nif), tuoi trung binh cua nhdm benh la 71,77±7,57 nhdm chirng la 74,98±7,31 Sy khac biet ve tuoi, gidi va trinh dp hpc van glDS nhdm benli va nhdm chiTng la khong cd y nghTa thdng ke vdi p>0,05.
3.2. Mot sSd|c diem lam s^ng nhom b$nh 3.2.1. Bic diSm thdi gian mic b$nh: Cd 70% BN vdi thdi gian mac benh tir 1-5 nSm, BN cd thdi gian mac tir 6-10 nam la 30%. Khong cd BN cd thdi gian mac benh < 1 nam hoac >10 nam.
3.2.2. B$c diem glal do^n b$nh vi mii'c dp b$nh: So BN mac benh d glal doan 2 va 3 la cao nhat vdi ti le lan lu'dt la 33,33% va 46,67%, giai doan 4 la 16,67%, giai doan 1 chi cd 3,33%.
MiJc dp nang ciia nhdm benh la: nhe (6,67%), viia 26,67%, nang (53,33%) va rat n^ng 13,33%.
Mu'cdo Khonq SGNT CdSGNT SGNT nhe SGIWvira Tonq
Nhom benh (n=30)
thanq diem MMSE SL
14 46,67
%
53,33 10,00
43,33
Nhom chu'ng (n=30y
SL20
66,6733,33 26,67
6,67 100,00<0,05
Nh$nxebly le BN cd suy giam nhan ttiiTc d nhdm benh cao hdn nhdm chimg trong dd suy giam nhan thiifc d mu'c do vira trong nhdm benh la 43,33%, so vdi nhdm chung (6,67%). Si/ khac biet nay la cd y nghia thSng ke vdi p<0,05.
Bing 3.2; Oanh qia suy
—___ Nhdm ChisS — _ _ _ Nhd tir Binh thu'dnq
Benh ly Tons
Nh6so Binh thu'dnq Benh iv Tinq
qiam tri nhd Nhdm benh (n=30)
n 18 12 30 23 7 30
60,00 %
40,00 100,00 76,67 23,33 100,00
Nhdm chCrnq (n=30]
n 27 3 30 28 2 30
90,00 %
10,00 100,00 93,33
6,67 100,00
P
<0,D5
>0,05
Y HOC VigT HAM T H A N G 9 - SO 2Q014
Suy giam
tri nhd 03 Khong Tong
12 18 30
40,00 60,00 100,00
3 27 30
10,00 90,00 100,00 <0,05 Nhin xet: Ty le BN co bieu hien suy giam tri nhd la 40% trong do giam nhd tir la 40%, nhd so la 23,33%. Sy" khac biet so vdi nhdm chu'ng la co y nghTa thong ke
Bang 3.3: Moi lien quan giO'a bieu hien suy giam nhan thu'c vdi thdi gian mac benh, giai doan Thdi gian mac benh
T.G (nam) 1-5 (n=21) 6-10 (n=9)
>10 (n=0) Cdng (n=30)
Cd SGNT (%) 7 9 0
33,33 100,00
0
Giai doan benh Giai doan l + 2 ( n = l l )
3 (n=14) 4(n=S)
Cd SGNT (%) 0 11
5 0,00 78,57 100,00
Mu'c do benh Mircdd Nhe + vira (n=10)
Nanq (n=16) Rat nanq (n=4)
Cd SGNT (%) 0 12 4 ,
00,00 75,00 100,00 16 (53,33%)
Nh$n xit: Cic BN nhdm benh parkinson cd thdi gian mac binh tir 6-10 nam, giai doan 4 cung nhii miic dp rat nang ve van dpng thi 100% cd suy glam nhan thu'c, d nhdm thdi gian mac b|nh 1-5 n3m, giai doan 3 va mifc dp nang cd tir 33,33% den 78,79% so BN b| suy glam nhan thu'c. Giai doan 1,2 va mire dp nhe, vira chui cd BN bj suy giam nhan thu'c.
IV. itM LUAN
4.1. D$c diem chung cua nhdm nghien cij'u 4.1.1. Bfc diim ve tuoi
Theo da sd taenia, benh Parkinson 1^
benh ciia ngu'di cao tuoi, thu'dng khdi phat d ngu'di^^tren 50 tuoi, hay gap nhat la 60 - 70 tuoi.
Nguyin Tlie Anh cd ty le mac benh cao nhat tir 60-69 tuoi. Tru'dng Thj thu Hu'dng thay dd tuoi trung binh cua_^BN Parkinson la: 69,1 ± 8,9"''".
Op tupi b-ung binh nhdm benh trong nghien cuU nay la: 71,77 ± 7,57. Benh Parkinson la benh thoai hda than kinh trung lidng tien trien tir tir, cae trieu chirng ciia benh thu'dng xuat hien sau khi hdn 50% te bao tiet dopamin d Hem den va the van bj tSn thu'dng.
Kit qua nghien ciili giai phau benh va hinh anh hpc cho thay trung binh moi nam BN Parkinson mat khoang 5% te bao than kinh tiet dopamin"'".
4,1.Z OSc diem vS gldl: Chung toi thay rSng ca nam va nii' deu mac benh Parkinson tuy nhien ty le nam mic cao hdn nCT, ti le nay phii hdp vdi eac nghien ciru tru'dc day "'''. Cd nhieu gia thiet du'dc duS ra nhu'ng cac tac gia deu nhac tdi hi^u qua bao ve ciia oestrogen ddi vdi te bao tiet dopamine, hdn niJa nam gidi cd nguy cd tiep xiic mdi tru'dng ddc hai nhieu hdn nii' ' * " .
4.1,3. Bac diem ve hgc vSn: Chijng tdi chpn hai nhdm cd sii tu'dng dong ve trinh do hpc van khong chon nhifng ngu'di cd roi loan tam than va mil chff de danh gia mii'c do roi loan nhan thu'c thdng qua cac test tam ly, tri nhd. Bao dam sir khach guan khi nghien diu.
4.2. VS bieu hien suy giam nhan thu'c
Bang 3.1; 3.2, cho thay ty l i BN cd suy giSm nh$n thu'c la 16 tru'dng hdp chiem tj' l | 53,33%, trong dd mu'c do suy giam nhan thirc nh? 1^ 3 (10%); miJc dp suy glam nhaii thu'c vii^ la 13 (43,33%). So vdi nhdm chu'ng su' khac bi$t cd <i nghla thong ke vdi p< 0.05.
Suy giam nhan thirc la trieu chiitig it gSp trong BN Parkinson, neu cd thu'dng d giai ddan mupn ciia benh. Nguyen Du (2009) thay ty \% siiy giam nhan thu'c la 46%. Hauser va cs cho rang sa Slit tri tue la trieu chung it gap, sa siit trong benh Parkinson la sa siit "du'di vd" khac vdi sa sut "vd nao" trong benh Alzheimer dd la giam tri nhd qan trong khi tri nhd xa va vifa cdn nguyen ven i^'".
Trong nghien ciru ciia chiing tdi ty le BN cd suy giam tri nhd la 40%, trong dd roi loari nhd tir la 40%, roi loan nhd so cd ty le it hdn (23,33%), si/_khac_ biet so vdi nhdm chijng la cd y nghTa thong ke. Theo cac tac gia: suy giam nh?n thuC va tri nhd cd the la do tac dpng cua ca cd chS benh sinh benh Parkinson vdi lao hda sinh ly va anh hu'dng ciia cac thuoc khang Parkinson, van de nay can du'dc nghien cii\i ky hdn ^^''^.
4.3. Ve moi lien quan giu'a cSc bigu hl|n roi loan nhan thu'c trieu vdi cSc bi^u hien chinh cua b i n h Parl<insbn.
Nhiihg BN cd thdi gian mSc benh tir 6-10
nam, giai doan 4 cung nhu" mu'c dp rat nSng ve
van ddng thi 100% cd trieu chiiiig suy giam
nhan thu'c, d nhdm thdi gian mSc benh 1-5 nSm
giai doan 3 va mii'c dd nang cua van donq da cd
tir 33,33% den 78,79% suy glam nhin thirc
Cac bieu hien roi loan nhan thu'c nang ien theo
giai doan va thdi gian ciia benh. Biju dd chiJnq
Y HOC VIET NAM THANG 9 - SO 2/2014 to CO SU* lien quan chat che giu'a bieu hien roi
loan n h i n thij'c vdi cac giai doan ciia benh. Ket qua nghien ciTu nay co ty le cao hdn cac tac gia khac la do BN nghien ciili co tuoi mac benh cao hdn. Tuy nhien do cd m l u nho, thdj gian nghien cull ngan nen de ket luan chac chan ve van de nay can co nhiJhg nghien cuXi tiep theo.
V. KET LUAN
Nghien cihj 30 BN mac benh Parkinson (23 nam, 7 nu") co tuoi trung binli la 71,77 ± 7,57 chung toi thay]
- Thdi gian mac benh ciia nhom benh tCr 1 den 5 nam la 70%, tu" 6 den 10 nam la 30%. Ty le BN d glai doan I, I I , I I I , IV, i n lu'dt la 2,33%, 33,33%, 46,67%, 16,67%. mire do nhe 6,67%, viia 26,67%, nang 53,33%, rat nang 13,33%.
- Suy giam nhan thirc thay d 53,33% so BN, trong do mu'c do nhe la 10%; mire do suy giam nhan thu'c v f e la 43,33%, giam t r i nhd 40,00%. Ty le BN suy giam nhan thirc tang theo thdi gian mac b§nh, giai doan benh va miTc do roi loan van dong.
TAI L I E U J H A M KHAO
1. Nguyin The Anh (2008), IVghien cuU mot sddac diem chut nang nhan thut d BN Parkinson cao tudi, Luan van thac sy Y hpc, Tru'dng OH Y Ha Npi.
i . Nguyen Du (2009), Nghien cuU dac diem cua r&:
loan nhan thut va rdi loan van dong d BN mac bSnh Parkinson cao tuo). Luan van thac sy, Hpc vien Quan y.
3. Lg Bu'c Hinh (2001), Benh Parkinson, NXBY hoc.
4. Tru'dng Thj Thu Hu'dng (2006), Nghien cuV roi loan nhan thut d BN mac benh Parkinson, Luan van tot nghiep bac sy chuyen khoa cap I I , Dai hoc y Ha Npi.
Fabbrini G., Latorre A., Suppa A., Bloise M., Frontoni M., and Berardelli A. (2013), Fatigue in Parkinson's disease: motor or non-motor symptom?. Parkinsonism Relat Disord 19 (2), pp:
148-52.
Hauser R.A. et a l , (1997), Parkinson's Disease - Questions and Answers. 2nd edition, Merit Pub Intl., 152 pages.
Ruzicka E. (1996^^ i^ental dysfunction In Parkinson's disease, Cas Lek Cesk 135 (7), pp:
199-203.
5.
6.
NONG DO BNP HUYET TiraNG TREN BENH NHAN BENH VAN HAI L A DO THAP
T6M TAT
^ Benh van hai la do thap hien nay van la nguyen nhSn quan trpng ciia suy tim va cac bien chirng tim in?ch d cac nu'dc dang phat trien. BNP la mpt hormon tim mach du'dc tiet ra bdi cdj:hat khi dap irng vdi tinh trang qua t i i ve ap lu'c va the ti'ch. O Viet Nam, vai tro cua BNP da du'gfc biet den trong cac benh ly suy tim, b?nh tim thieu mau cyc bp, nhu'ng chu^ co nghien ciTu n|o tren benh van hai la. Muc tieu: nghien ciru si/ bien dfii nong dp BNP huyet tu'dng tren benh van hai la do thap va moi lien quan v6i mpt so chi tieu lam sang va
^eu am tim. PhUPng phap;6i benh nhan benh van hai la do thap du'pc kham lam sang, sieu am tim qua thanh ngu'c danh gia miTc dp ton thu'dng van va mpt so dii so,' djnh lu'dng nong dp BNP huyet tu'dng bSng phu'dng ph^'p mien dich huynh quang.Ket qua: nong
* Benh vien 103
Chju b i c h nhi^m chinh: Nguyin Thj Huyen Trang Email; [email protected] Ot: 01689743998
Wian bi$n khoa hoc: PGS.TS. Nguyin Oanh Oanh Ng^y nh|n bai: 8.'8.2014
Nguyin Thi Huyen Trang*
Nguyin Duy Toan*, Bui Thuy Du-ffng*
dp BNP CO lien quan den mire dp suy tim, mii'c dp tSn thu'dng van hai la, tUPng quan nghjch vdi di|n tfch lo van 2 la (r = -0,337),phan suat tong mau that trai (r = - 0,451), tuttng quan thuan vdi dudng kfnh nh? trai (r = 0,543), du'dng kinh cuoi tam trUdng Oiat trai (r = 0,515),3p lUc dpng mach phoi (r = 0,486) nhung khdng CO lien quan vdi gidi, tinh trang rung nhi. Ket luan:trong benh van hai la do_ thap, BNP c6 th€ xem la mot biomarker danh gia ton thu'dng va tien then ciia b?nh.
Tu'khda:ben\\ van 2 la, nong dp BNP
S U M M A R Y
PLASMA BNP LEVELS I N PATIENTS W I T H RHEUMATIC M I T R A L VALVE DISEASE
Now aday, rheumatic mitral valve disease is still an importance cause of heart failure in developing countries. BNP is a cardiac hormon secreated from ventricular myocardium as a response to vetricular volume and pressure overioad. In Viet Nam, the role of BNP was knov;n in heart failure. Ischemic heart disease, but no previous study has conducted in rheumatic mitral valve disease.Alms:to assess BNP levels in patients with mitral valve disease and
13J
