Y HOC VIET NAM T H A N G 11 - SO 1/2011
DAC DIEM HINH THAI VA CHUTC NANG DONG MACH CANH
0 BENH NHAN TANG HUYET AP CO ROI LOAN LIPID MAU
B A N GSIEU AM DOPPLER
Le T h j Ve*, N g u y i n Thj K i m Thuy*
TOM T A T
Casd Bien doi hinh thai va chirc nang dong mach canh la bien chirng do tang huyet ap va vOra xd dong mach gay ra c6 lien quan vdi bien chimg tim mach.
Muc dich: Oanh gia sU bien ddi hinh thai, chirc nang dong mach canh bang sieu am Doppler b benh nhan tang huyet ap c6 rdi loan lipid mau.
Ddi tuong: gom 40 benh nhan tang huye't ap, 22 nam va 18 nu", tudi trung binh (60,02 ± 11,5) den kham va dieu trj tai benh vien TWQD 108 tCr thang 7/2007 - 4/2008 va 30 ngUdi lam chirng cung tudi gidi vdi nhom benh. Phuong phap nghien cdu: tien ciru cat ngang, mo ta, so sanh. Dung sieu am Doppler va sieu am B - mode do do day Idp noi - trung mac dong mach canh va do van tdc tam thu (Vs), tam trUOng (Vd), tinh chi sd sire can (Rl) cua dong mach canh chung 2 ben. Sd lieu thdng ke dUdc xCr ly tren phan mem SPSS 15.0.
Keif luan:
Do day Idp noi trung mac, ty sd do day idp noi trung mac tren dUdng kinh long mach cua dong mach canh chung b nhom benh nhan tang huyet ap c6 rdi loan lipid mau cao hdn so vdi nhom chimg ( p<0,05).
Ty le t»enh nhan c6 mang vira xd b dong mach canh Chung 2 ben cua nhom benh nhan tang huyet ap c6 roi loan lipid mau cao hdn so vdi nhom chimg (28,3% va 31,7% so vdi 6,7% va 13,3%; p< 0,05 va p<0,01).
- Van tdc tam thu, tam trUdng va chi so sire can ciia nhom benh nhan tang huyet ap c6 rdi loan lipid mau khong khac biet so vdi nhom chimg (p>0,05).
Titkhda: Tang huyet ap, rdi loan lipid mau, dpng mach canh, sieu am Doppler.
ABSTRACT
Morphological characteristics and function of the carotid artery in patients with hypertension have
dyslipidemia by Doppler ultrasound
Background: Changing pattems and functional carotid artery is complicated by hypertension and atherosclerosis causes related to cardiovascular complications.
Purpose: Evaluating of variable forms, functions by carotid Doppler ultrasound in patients with hypertension and dyslipidemia
Subjects: Sun/ey 40 patients with hypertension, 22 males and 18 females, mean age (60.02 ± 11.5) to the examined and treated in 108Hospital from
* Benh vien 108
Phan bien khoa hgc: PGS.TS. Nguydn Van Quynh
September 7/2007-4/2008. Of course, having 30 controls with the same age, sex and diseases.
Research Methodology: prospective cross- sectional, descriptive, comparative. Using Doppler ultrasound and B-mode ultrasonic thickness measuring intemal carotid and middle membranes measured systolic velocity (Vs), diastolic (Vd), the resistance index (Rl) of the common carotid artery 2 parties. Statistics are processed on SPSS 15.0 software.
Conclusion:
Intima- media thickness and the ratio of film thickness on the inner diameter of our high desert of the carotid artery in patients with hypertension who have a higher dyslipidemia than the control group (p <0.05)
The percentage of patients with fibrous plaque in the carotid artery, in general, belonging to two groups of patients with hypertension with a higher dyslipidemia than the control group (28.3% and 31.7% compared to 6.7%
and 13.3%, p <0.05 and p <0.01).
Velocity of systolic, diastolic and resistance indices of hypertensive patients with dyslipidemia are not different from the controls (p> 0.05).
Keywords: hypertension, dyslipidemia, carotid artery, Doppler ultrasound
I. OATVA'NOE
Vi/a x d dong mach lam bien ddi ddi cau true noi mac ci!ia cac dong mach Idn va vira. NhCTng bien chirng cCia vuTa x d dong mach la nguyen nhan hang dau gay tCr vong va benh tat d cac nudc phat trien. Tang huyet ap va rdi loan lipid mau ddng vai trd quan trong trong viec hinh thanh mang vOra x d la nguyen nhan chCi yeu ciia cae benh ly mach mau nao, benh tim thieu mau cue bo, suy tim va suy than. Nhieu nghien ciru thay mdi lien quan hinh thai, chirc nang cCia dong mach canh vdi cac benh ly nay, phirdng phap tham dd danh gia tdn thUdng ddng mach canh ngoai so bang sieu am Doppler m a u c d nhieu u'u the va do tin cay cao. Vi vay, muc tieu:
Danh gia sir bien ddi hinh thai, chirc nang dong mach canh bang sieu am Doppler mach d ngudi benh tang huyet ap c6 rdi loan lipid mau.
57
Y HQC VIET NAMTHANGII -SO 1/2011 II. 001 TUpNG VA PHUONG P H A P NGHIEN COU
1. Odi tirdng nghien curu
Gom 40 benh nhan durdc cha'n doan la THA nguyen phat, nam dieu tri tai Benh vien 108 tir 7/2007 4/2008. Trong dd 22 nam, 18 nur. Tudi trung binh (60,02 ± 11,57), dao dong (30-76) va 30 ngurdi khde manh lam chirng.
Tieu chua'n chon benh nhan: Cac benh nhan dirde cha'n doan tang huyet ap nguyen phaL tudi tren 18.
Tieu chua'n loai trir: THA thir phat do diing thudc, THA trong thai nghen, THA trong mot sd benh thirc the. RL lipid mau thir phat.
2. Phifdng phap nghien ciiru: Nghien ciru tid'n cim, md ta eat ngang, so sanh bdnh chirng. Cac benh nhan dirde kham lam sang, xet nghiem mau, dien tam do, sieu am Doppler DM canh.
Sieu am: he thdng sieu am Doppler mau SONOS 7500, dau dd da tan 2 4 MHz dat tai
khoa c h i n doan chirc nang Benh vien 108. Sir dung phirdng phap sieu am B- mode do Idp ndi - trung mac dong mach canh 2 ben
Vj tri do: Dirdi cho chia ddi ciia DMC chung khoang 2 cm.
Cac thdng sd do: Do do day noi trung mac (DDNTM), do dirdng kinh long mach (DKLM) cCia DMC chung, tinh ty sd DDNTM/ DKLM cua DMC chung, do tdc do ddng mau (Vs, Vd) tir do tinh chl sd sire can (Rl).
3. Cac tieu chuan chan doan di/dc sir dung trong nghien ciiru
+ Chan doan THA theo JNC 7 [5]
+ Chan doan va phan loai rdi loan lipid mau theo khuyen cao cua Hoi Tim mach hoc Viet Nam nam 2008 [3].
4. Xur ly tho'ng ke: Cac sd lieu thdng ke dUdc xir ly tren phan mem SPSS 15.6.
III. KET QuA NGHIEN CCfU
Bang 1. Dac diem chung cua cac Oac diem
Tudi
Thdi gian phat hien benh HA TTh (mmHg)
HATTr (mmHg) Gidi Nam (%)
NU (%) Cac yeu td nguy cd Tien sir nghien thudc la
Gia dlnh co ngUdi THA BMI >23
ddi tirdng nghien ciru
So BN n= 40 60,02 ± 11,57
7 ±6,5 160 ± 17,5 120 ± 12,6
22(55) 18(45) 7(17.5) 17(42,5,5)
15(37,5)
Tudi trung binh cua nhdm nghien ciru 60,02, ty le nam 22 (55%), nGr 18 (45%). Yeu td nguy cd gap nhieu nhat la tien sir gia dinh THA (42,5%), beo phi (37,5%).
Bang 2. Ket qua xet nghiem mau giura nhdm THA cd RL lipid mau vdi nhdm chimg Chl so Nhom chiimg (n= 30) THA +RL lipid mau (n= 40)
Hong cau ((trieu/l) 4, 56 ± 0,2 4,73 ± 0,3 p>0,05
HST(g/l) 123 ±1,4 125± 2,4 p>0,05
Hematocrit (%) 42 ± 0,2 41± 0,3 p>0,05
Glucose (mmol/l) 4,7 ± 0,6 5,1± 0,8 p>0,05
Ure (umol/l) 7,3 ± 2,7 7,1± 8,2 p>0,05
Creatinin (amol/1) 91,7 ± 65,5 88,3 ± 27,3 p>0,05
Acid uric (mmol/l) 328,9 ± 67,2 387,7 ±111,8 p>0,05
GOT 25 ± 4,7 27 ± 1,3 p>0,05
GPT 22 ± 5,2 23 ± 6,1 p>0,05
Khdng c6 sir khac biet cac chi sd huyet hoc va sinh hda giura nhdm THA co RL lipid mau v6i nhdm chirng p >0,05
58
Y HOC VIET NAM THANG 11 - SO 1/2011 Bang 3. Ty le cac rdi loan chuyen hda lipid d nhdm benh nhan THA
RLCH lipid Tang cholesterol + tang LDL-C
Tang cholesterol + tang LDL-C+ Tang Triglycerid
Giam HDL- C ddn thuan Tang Triglycerid ddn thuan Tang Triglycerid + giam HDL-C
Tang cholesterol + tang LDL-C + giam HDL- C Tang cholesterol + Tang Triglycerid + giam HDL-C
Cpng
SdBN 12
8 3 4 4 6 3 40
Ty le % 30 20 7,5 10 10 15 7,5 100
Tang cholesterol va tang LDL-C chiem ty le cao nhat (30%), sau dd den tang cholesterol, tang LDL-C va tang Triglyerid chiem 20%
Bang 4. Cac chi sd hinh thai va chirc nang dong mach canh chung d benh nhan THA cd va
khong cd RL lipid mau.
Chi sd DDNTM
(mm) DKLM (mm)
DDNTM/
DKLM Vs (cm/s) Vd (cm/s) Chi so sifc
can C6MVX
(n, %)
Phai Trai Phai
Trai Phai Trai Phai Trai Phai Trai Phai Trai Phai Trai
Nhom chirng (n= 30) 1,23 ±0,22 1,21 ±0,18 8,32 ±0,97 7,97 ± 0,79 0,148 ±0,022 0,152 ±0,022 71,92 ±22,58 67,19 + 18,37 21,32 ±5,28 21,23 ±5,61 0,694 ± 0,0594
0,681 ±0,042 4(13,3%)
2 (6,7%)
THA + RL lipid mau (n= 40) 1,39 ±0,34
1,36 ±0,23 8,52±1,17 8,15 ±0,96 0,164 ±0,037 0,168 ±0,028 64,73 ±16,79 69,41 ±20,90 19,97 ±5,94 21,33±6,16 0,687 ±0,071 0,686 ±0,059
19(31,7%) 17(28,3%)
P
<0,05
<0,05
>0,05
>0,05
<0,05
<0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
<0,05
<0,001
DDNTM. ty sd DDNTM/DKLM cua DMC chung b nhdm benh nhan THA cd RL lipid mau tang cao hdn so vdi nhdm khdng cd RL lipid mau khac biet c6 y nghTa ( p<0,05)
Ty le CO MVX ci DMC chung cCia nhdm benh nhan THA c6 RL lipid mau (28,3- 31,7%) cao hdn so vdi nhdnn khong cd RL lipid mau (6,7-13,3%), sir khac biet c6 y nghia vdi (p<0,05 vap<0,01)
Tdc do tam thu, tam tn/dng va chi sd sire can CI nhom benh nhan THA cd RL lipid mau khdng khac biet so vdi nhdm cd RL lipid mau, (p>0,05).
IV. BAN LUAN
Qua nghien ciiru hinh thai va chirc nang OMC chung d 40 benh nhan THA cd rdi loan lipid mau tudi trung binh (60,02 ± 11,57), dao
<Jong (41-75). Trong dd 22 (55%) nam, 18 (45%) nCr, 18,9% cd tien sur gia dinh THA, 42,5%, beo phi (37,5%) va nghien thudc la la 17,5% (Bang
1). Tudi va gidi eOa nhdm nghien ciru cung tUdng tir vdi cac tac gia trong va ngoai nUdc [2,5], Da sd eac tac gia deu rut ra ket luan tudi cao, gidi tinh la nhung mot yeu td nguy cd khdng thay ddi dUdc, nam gidi cd nguy cd mac benh THA cao gap 1,4 lan nu gidi. C6 sutUdng quan chat che giu'a tien siT gia dinh va benh THA.
Cac yeu td nguy cd nhu' beo phi, hut thude la lien quan den rdi loan lipid mau va VXDM [1].
So sanh ket qua xet nghiem huyet hoc va sinh hda giCra nhdm THA cd RL lipid mau vdi nhdm chirng khdng thay sU khac biet cd y nghTa ((p>0,05) (Bang 2).
Danh gia ty le RL lipid mau cCia nhdm nghien ciru thay ty le benh nhan tang cholesterol va tang LDL- C chiem cao nhat (30%), sau dd den tang cholesterol, tang LDL-C va tang Triglyerid chiem (20%) (Bang 3).
Nghien ciru do day noi trung mac cCia DMC
d nhdm THA cd RL lipid mau tha'y DMC chung59
Y Hpc VI|T NAM T H A N G I I -SO 1/2011 phai va trai deu cao hdn so vdi nhdm chirng sir
khac biet cd y nghTa thdng ke vdi p<0,05. Ty sd DDNTM/DKLM d nhdm benh nhan THA co RL lipid mau cCia DMC chung phai va trai cung cao hdn so vdi nhdm chimg khac bidt cd y nghTa thdng ke vdi p<0,05 (Bang 4). Ket qua cung tu'dng tir nhU nhan xet cua nhieu nghien cdu. Pham Van Minh nhan thay ty sd DDNTM/DKLM cua DMC chung d nhdm tang lipid mau typ Ha (0,134 ± 0,018), typ lib (0,138 + 0,026) va typ II (0,136 ± 0,022) deu Idn hdn so vdi nhdm chimg (0,102 ± 0,027) khac bidt c6 y nghTa thdng ke vdi p<0,001 [2].
Sieu am Doppler la phUdng phap khdng xam nhap cd vai tro quan trpng de danh gia tdc dp ddng mau qua phan tich phd Doppler. Thdng qua tdc do ddng mau cd the tinh toan chi sd sire can ddng mach. Ket qua nghien ciru cho thay tdc do tam thu, tdc dp tam tru'dng va chi sd su'c can d benh nhan THA la 67,12 68,67 cm/s, 20,42 21,30 em/s va 0,684- 0,689. Tdc do tam thu va tam trirdng cCia DMC chung d nhdm THA cd RL lipid mau (64,59 71,31cm/s va 20,04 21,85 cm/s) khdng khac biet so vdi nhdm chirng (62,42 - 65,79 cm/s va 19,25- 20,31 cm/s). Do vay, chl sd sire can DMC chung cua nhdm THA cd RL lipid mau (0,685- 0,687) chi/a khac biet so vdi nhdm chirng (0,686 0,689), (p>0,05). Ket qua nghien ciru cCia chiing tdi khac Pham Van Minh tdc do tam trirdng d nhdm tang lipid mau typ Ha. typ lib va typ II (14,21 ± 5,39 cm/s; 13,64
± 5,26 cm/s va 13,95 ± 5,34 cm/s) giam hdn so vdi nhdm chirng (17,27 ± 3,80 cm/s) khac biet cd y nghTa thdng ke vdi (p<0,01) dan den chi sd sire can d DMC chung d nhdm tang lipid mau typ lla. typ lib va typ II (0,711 ± 0,079; 0,777 ± 0,074 va 0,740 ± 0,076) tang cao hdn so vdi nhdm chirng (0,706 ± 0,048) ( p<0,00 ) [2]
Trong nghien ciru nay thay ty le benh nhan THA cd MVX 6 DMC chung la tir 21,1% ddn 25,6%.
Ty le cd MVX cJ DMC chung cua nhdm THA cd RL lipid mau (28,3- 31,7%) cao hdn so vdi nhdm khdng cd RL lipid mau (6,7- 13,3%), sir khac biet cd y nghTa thdng ke vdi p<0.05- 0,01.
Nhan xet nay cCia chiing tdi cung tUdng tir nhir ket qua nghien ciru cua nhieu tac gia khac.
Poli A. va cs. [6] cung thay sir xuat hien MVX 6 cac benh nhan c6 RL lipid mau typ II (14/36 benh nhan) nhieu hdn so vdi nhdm kliong c6 RL lipid mau (1/31 ngirdi), p<0,05. Tac gia thay rang MVX tap trung chO yeu d hanh canh (10 benh nhan). Cantu- Brito C. va cs [4] nghien ciru tren
60
ngudi cao tudi thay ty le MVX d DMC chung la 56,5%, tang DDNTM cCia DMC chung la 41,1%.
Khdng c6 sir khac biet ve tdn thirdng VXDM b ca nam va nOr. Cac tac gia thay rang VXDM c6 lien quan vdi tudi (p<0,001), tang cholesterol.
V. KET LUAN
Qua nghien ciru hinh thai va chirc nang DMC chung d 40 BN tang huyet ap chiing tdi rut ra nhurng ket luan sau:
Do day noi trung mac, ty sd do day Idp npi trung mac/dUdng kinh long mach ciia dong mach canh chung d nhdm benh nhan tang huyet ap cd rdi loan lipid mau cao hdn so vdi nhdm tang huyet ap khdng cd rdi loan lipid mau khae biet cd y nghTa ( p<0,05).
Ty le benh nhan c6 mang vCra xd b ddng niaeh canh chung 2 ben cua nhdm benh nhan tang huye't ap cd rdi loan lipid mau cao hdn so vdi nhdm chirng (28,3% va 31,7% so vdi 6,7%
va 13,3%; p< 0,05 va p<0,01).
Tdc do tam thu, tam trirdng va ehi sd sire can cua nhdm benh nhan tang huyet ap ed rdi loan lipid mau khdng khac biet so vdi nhdm chirng (p>0,05).
TAI UEU THAM KHAO
1. Pham Gia Khai va cong sir (2003), "Dich te hpc tang huyet ap tai mien Bac Viet nam". Ky yeu cac de tai khoa hoc Hoi nghi tim mach mien Tmng md rpng lan thir II - Tap chi Tim mach hoc, 36, tr. 30-31.
2. Pham Van Minh (2002), Danh gia cac thdng so sidu am Doppler ddng mach canh chung d nhdng ngudi cd tang lipid mau typ li, Luan van Thac sy y hpc.
3. Pham Nguyin Vinh (2010), Oieu tri rdi loan lipid mau: chien lUdc dieu tri sau NCEP-ATP III (Treatment of Dyslipidemia Strategic Management after the NCEP-ATP III guidelines), Bao cao chuyen de
4. Cantu- Brito C, Rodreguez-Saldaua J., Reynoso-Marenco M. T. et al. (1999),
"Cardiovascular risk factors and carotid atherosclerosis detected by ultrasonograph/', Salud Publica. Mex., 41(6), pp. 452- 459.
5. Health Care Guideline:Hypertension Diagnosis and Treatment, Thirteenth Edition November 2010, Institute for clinical systems improvement 6. Poli A., Tremoli E., Colombo A. et al. (1988),
"Ultrasonographic measurement of the common carotid artery wall thickness in hypercholesterolemic patients. A new model for the quantitation and follow-up of preclinical atherosclerosis in living human subjects".
Atherosclerosis, 70(3), pp. 253- 261.
