Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
OE KHANG INSULIN 6 BENH NHAN TANG HUYET AP VO CAN
Hoang Dang Mich''
TOM TAT
De danh gia tUdng quan giu'a de khang insulin v6i mot so yeu to ciia hoi chu'ng chuyen hoa d benh nhan tang huyet ap vo can, chung toi nghien cii'u 43 benh nhan tang huyet ap vo c3n co de khang insulin va hoi chimg chuyen hoa. Sir dung thiet ke nghien ciTu mo ta cat ngang, cac doi tu'dng dUdc chon lien tiep vao nghien cuTu. Xet nghiem chay tren may sinh hoa tU dpng ciia hang Roche, ap dung tieu chuan chain doan hoi chirng chuyen hoa ciia NCEP ATP III cho ngUdi chau A Thai Binh DUdng (2001). Ket qua: Tu'dng quan giCte de khang insulin vdi huyet ap tam tru'dng, huyet ap tam thu, dUdng huyet doi lan lUdt la 0,44;
0,42; 0,65. Tu'dng quan r giO'a de khang insulin vdi BMI, vong bung, Triglycerid, HDL-C lan lUdt la 0,12;
0,14; 0,02; 0,13. Co moi tu'dng quan nghich giu'a de khang insulin v6i Cholesterol, r = -0,73. Ket luan: So lieu ciia chiing toi cho thay moi tu'dng quan yeu giu'a de khang insulin v6i huyet ap tam thu va huyet ap tam tru'dng. Khong thay moi tUdng quan giiJa de khang
insulin vdi BMI, vong bung, Triglycerid, HDL-C. Co moi tu'dng quan manh giu'a de khang insulin vdi du'dng huyet doi. Dac biet tUdng quan giu'a de khang insulin vdi Cholesterol la tu'dng quan nghjch. Cac ket qua nay can dUdc nghien ciTu them.
SUMMARY
Objective: Evaluating the correlations between the insulin resistance to some factors of metabolic syndrome in patients with essential hypertention.
Design and method; A cross-sectional study was performed in 43 subjects those were rolled in study non randomly. Using automatic biochemical machine of Roche company to investigate concentration of insulin at flating. Applying diagnosis' criteria of metabolic syndrome by NCEP ATP I I I for Asian-Pacefic.
Results: r-correlation (Pearson) of insulin resistance
with systolic blood pressure, diastolic blood pressure, flating glucose plasma were 0,44; 0,42; 0,65 respectively while have no correlation between insulin resistance with BMI, abdomen circumference, Triglycerid, HDL-C (r were 0,12; 0,14; 0,02; 0,13 respectively). Particularly, the correlation between the insulin resistance with Cholesterol was converted line, r = -0,73. Conclusions/ Our data indicate that the correlation between insulin ressistance with systolic and diastolic blood pressure was weak. The correlation between insulin ressistance with BMI, abdomen circumference, Triglycerid, HDL-C were not found. The correlation between insulin ressistance with flating glucose plasma was strong. There is the correlation of converted line between insulin ressistance and Cholesterol. These correlations should be more studied.
I. OAT V X N OE
Trong so nhiJng nguoi tang huyet ap vo can ty le mac hgi chung chuyen hoa rat cao.
Ddy la hoi chimg co benh sinh rdt phuc tap, trong do, de khang insulin co vai tro dugc coi la rat quan trgng. Vay de khang insulin lien quan nhu the nao voi cac bieu hien 1dm sang, sinh hoa o nhom benh nhdn nay? Cac nghien cim trong nuoc moi chi neu ty le mac hoi chimg chuyen hoa a nhimg benh nhdn tang huyet ap. Nhimg nghien cuu moi lien quan giira de khang insulin voi nhiJng yeu to ciia hoi chimg chuyen hoa 6 nhom benh nhdn nay chua nhihu va co nhimg kht qua trai ngugc nhau. Nghien cuu cac moi lien quan giiia de khang insulin voi cac yeu to cua hoi chung chuyin hoa va bieu hien 1dm sang 6 benh nhdn tang huyet ap c6 the cho biht y nghia
* Benh vien hitu nghi Viet Tiep Hdi Phong
quan trgng ciia dc khang insulin qua ciic chi so xet nghiem va trieu chimg benh.
Do \ay. chimg toi nghicMi cu'u dc tai nay vai muc tieu: Xac dinh tu(7ng quan giCia insulin mau \a\ mgt so yeu l6 vii tri(;u chirng cua hc)i chirng chuyen hc)a o bcMih nhan tang huyet ap \xi can.
II. 061 TUpNG VA PHUONG PHAP NGHIEN CUU 1. Doi tu-Q-ng nghien ciiu
Tong SCI 43 benh nhan tiing huyet ap vo can CO hgi chirng chuyen hoa va de khang insulin dugc chgn lien tii»p vao nghien ciru.
Thcri gian tir 2/2008-9/2009.
2. PhuoTig phap nghien ciiu
Thiet ke nghien ciru mo ta cdt ngang.
Sir dung tieu chudn chan doan hgi chirng chuyin hoa theo NCEP ATP 111 ap dung cho nguoi chdu A (2001).
Sir dung phan loai tang huyet ap cii .INC VII 2003: doi tugng dugc coi la TH^
khi huyet ap tam thu > 140 mmHg va/ hoa huyet ap tdm trucrng > 90 mmHg hoac daiij diing thuoc dieu tri THA |6].
Dc khang insulin khi co 2 tieu chi duai day:
Nong do insulin mau liic doi > 9,98 ^Ul/ml dugc goi la limg nong do insulin.
- Chi si) HOMA (Homeostasis Mode As.sessment), la chi sc") khang insulin (IR Insulin Ressistance). Binh thucmg IR tir 0,56-
1,4. Irong de khang insulin thi IR >2,56.
Chi so khoi co the (BMI) tinh bang th^
trgng (kg)/binh phuong chieu cao.
3. Xii' ly so lieu So lieu dugc xir ly bang phan mem thong ke SPSS 15.0. Sir dung thuat toan tuong quan Pearman.
I. KET QuA NGHIEN ClfU
Y = 0,70x - 6,63
2 1 /
Bieu do 1: Sir tuong quan giira IR voi huyet ap tam thu
Tuong quan giira de khang insulin voi huy^t ap tam thu la yhu voi r = 0,44, p < 0,05.
Y = 0,12x-4,80
2 \ ,
Bieu do 2: Sir tucmg quan giira IR voi huyet ap tam truang
Tuong quan giira d^ khang msulin voi huyk ap tam truong 6 mire y6u voi r = 0,42, p < 0,05.
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
Y = 0,15x+ 1,38
V o n a l i t m o
Bieu do 3: Sir tucmg quan giira IR \ oi vong bung
Khong CO tuong quan tuyen tinh giira de khang insulin vai vong bung, r = 0,14, p > 0,05.
Y = 0,14x + 3,39
<^°
Bieu do 4: Su tuong quan giira IR voi BMI
Khong thdy tuong quan giira dh khang insulin voi BMI, r = 0,12, p > 0,05.
Y = 0 , 6 7 x + l , l l
Bieu do 5: Su tuong quan giira IR voi glucose mau
Co tuong quan tuy§n tmh manh giira dh khang insulin voi Glucose huyk, r = 0,615, p < 0,01.
Y = 7,27 - 0,24x
Bieu do 6: Sir tuong quan giira IR voi cholesterol
Co m6i tuang quan nghich giira de khang insulin voi Cholesterol mau, r
0,73, p >0,05.
Y = 0,06x4-6,19
Bieu do 7: Sir tuong quan giira IR vcVi TG
Kliong thiiy lucmg quan giira dc khang insulin voi Triglycerid, r = 0,02, p > 0,05.
Y - 2,28x 4- 4,22
. 1 .
Bieu do 8: Sir tuong quan giira IR voi HDL-C
Khong thdy tuong quan giira dl khang insulin voi HDL-C, r = 0,13, p > 0,05.
IV. BAN LUAN
1. Tuong quan giua de khang insulin vol huyet ap: Nghien ciiru ciia chiing toi cho thdy moi tuong quan yeu giira de khang insulin voi huyet dp tdm thu a nhirng nguoi tang huyet dp vo can, r=0,44. Tuong tu nhu vay, tuong quan giira de khang insulin voi huyet dp tdm thu cung a mire yeu, r=0,42.
Moi tuong quan giira huyet dp voi dc* khang Insulin da dugc nghien cim vii kk qua con khac nhau, mot so tac gid cho rdng tdng huyet dp gdy ra de khang Insulin. Toi na>
nhieu y kien iing ho gia thiCt dh khang Insulin gdy tdng huyet dp voi bdng chirng Insulin Iiic doi tuong quan ro \cVi huyet ap tdm thu [2]. So lieu ciia chiing toi cho ihdy mdi tuang quan yeu giua dh khang Insulin voi huyet dp. Nghien cuu khac 6 benh nhdn tang huyet dp thdy co dh khang insulin [3].
2. Tuong quan giua de khang Insulin voi vong bung, BMI: Trong mgt s6 nghien cim trong va ngoai nuoc cac tdc gia thdy rdng
tang vong bung co gia tri du bao sir xuat hien ciia de khang Insulin [5]. Trong nghien ciru nay chiing toi khong thdy moi tuong quan giira de khang insulin vai vong bung, r=0,14 va cung khong iha\ co tuomg quan giiia de khang insulin vcVi BMI, r=0,12. Tuy nhien thong kc ciia chung toi cQng chi ra rang dieu do khong co y nghTa thong ke, ca hai trucrng hgp r deu lan hem 0,05. Mot so tac gia nghien ciru sau hon da neu y kien beo bung luon CO de khang insulin hon beo toan the va tuong quan giua de khang insulin voi vong bung chdt che hon voi BMI [1]. K^t qua nghien ciai ciia chiing toi cQng cho thay khuynh hucjng do (vong bung: r=0,14; BMI:
r=0,12).
3. Tuong quan giira de khang insulin
\6i Glucose, Cholesterol, Triglycerid, HDL-C: Cac tdc gid Trdn Thira Nguyen, Trdn Htm Dang, Tran Trung Thong, Ngo Dinh Chdu thdy rang roi loan tang duang mau la rat ro ret a nguoi beo phi hon hop co
Y HOC VIET NAM THANG 10 - SO DAC BIET/2011
dh khang insulin [4]. S6 lieu trong nghien ciru cua chiing toi cho thdy c6 tucmg quan tuyen tinh manh giiia dh khang insulin voi tang duong huydt, r=0,61 voi p<0,001. Dieu nay noi nen moi quan he phuc tap giua tang huyet dp voi de khdng insulin va tang duong mdu. Ddu la khoi ddu va tang huylt ap co tang duong mdu, co de khang insulin thi nen ggi la tang huyet dp vo can hay khong ?
Khi nghien ciru benh nhan tang huyet ap CO thira cdn, Dao Thj Dira. Ngu> CMI Hai Thu>
nhdn thdy moi tuong quan giira de khang insulin voi Triglycerid chat che hon voi HDL-C [1]. Trong nghien cim na> chiing toi khong thdy tucmg quan giiia de khang insulin voi Triglycerid. r=0,13 va voi HDL-C, r=0,02. TUN nhien nliirng ket qua nay deu khong CO y nghia thong ke. p>0,05.
Cholesterol khong phdi la tieu chi chdn dodn hgi chung chuyen hoa, trong nghien cuu nay chung toi nhdn thdy co moi tuong quan nghich giira de khang insulin voi Cholesterol, r=-0,73 nhung khong co y nghia thong ke voi p>0,05.
MSi tuong quan giiia de khang insulin voi cac yhu to ciia hgi chung chuyen hoa von da rdt phuc tap. Cac d6i tugng nghien cuu dang dugc can thiep bang cac thuoc ha huyet ap, ha duong mau va thuoc ha lipid mau lam cho lien quan von c6 cua chiing bi thay doi do vay cdc kht qua nghien cuu khac nhau tham chi trai ngugc. Cac mdi lien quan nay cdn dugc nghien ciiu o nhimg benh nhdn tang huylt ap vo can phat hien lan ddu.
V. KET LUAN
So lieu ciia chiing toi cho thdy a nguoi tang huyet ap vo can co m6i tuong quan yhu giua dh khang insulin voi huylt dp tdm thu va huylt ap tam trucrng. Khong thdy m6i tuong quan giiia dl khang insulin voi BMI,
vong bung, Triglycerid, HDL-C. Co moi tuong quan manh giua dc khang insulin voi duong huycl da\. Dac biet tuong quan giiia de khang insulin vcVi Cholesterol la tuong quan nghich. Ciic ket qua nay can dugc nghien cim tliem 6 benh nhan phat hien lan ddu.
TAI LIEU THAM KHAO.
1. Dao Thi Dira, Nguyen Hai Thuy, (2006). "
Lam sang, duong mau va lipid mau a benh nhan tang huyet ap co thira can tai khoa Tim Mach benh vien VN-TD Uong Bi (2005- 3/2006) ", Ky yeu cac de tai nghien ciru khoa hpc Hoi nghi npi tiet va Dai thao ducrng mien Trung lan thu V Tap chi y hoc thirc hanh
14&I5. 2006, trang 390.
2. Le Thanh Hai (2006). "Cap nhat khang insulin, yeu to nghuy co moi trong benh ly tim mach "Ky yeu cac de tai nghien ciru khoa hoc Hoi nghi npi tilt va Dai thao duong mien Trung \in thir V Tap chi y hoc thuc hanh
14&15.7-2006, trang 556.
3. Trinh Thanh Hung, Thai Hong Quang, Do KhSc Nghiet (2003). "Dinhlugng insulin huylt hanh a benh nhan dai thao duong Ion tuoi bang phuong phap mien djch dien hoa phat quang " Hoi noi tiet va Dai thao duong Viet Nam, Hoi Dai thao duong va noi tiet thanh pho Ho Chi Minh. Hoi nghi khoa hoc toan qu6c lan 2. Nha xuit ban y hoc, trang 242.
4. Tran Thua Nguyen, Tran Huu Dang, Tran Trung Thong, Ngo Dinh Chau (2006). "
R6i loan dung nap Glucose mau a nguoi tang trong beo phi co de khang insulin ".Ky yeu cac dl tai nghien ciru khoa hoc Hoi nghi noi tilt va Dai thao duong mien Trung lan thu V.
Tap chi y hoc thuc hanh 14&15.7- 2006, trang 456.
5. Ngo Dinh Nhan, Tran Hiru Dang, Tran Trung Thong (2009). "Nghien ciru de khang inulin tren cac doi tuong beo phi ". Bao cao khoa hoc Hoii nghj Noi tilt Dai thao duong Viet Nam - lan V Tap chi y hoc thirc hanh, trang 265.
