P CHfY DUOC LAMSANG 108 Tap 12-S6 7/2017
im hieu ty le mieroalbumin nieu va m6i lien quan gifra licroalbumin nieu vol khang insulin 6" benh nhan tang uyet ap co roi loan glucose luc doi
revalence of microalbuminuria and the association between MAU and isulin resistance in hypertensive patients with impaired fasting glucose
^ y l n Thi Hdng Van*, 'Benh vien Bgch Mai iam Thai Giang** "Vien Nghien cuu Khoa hoc YDugc Ldm sdng 108
Muc tieu: Nghien cQu nham x l c dinh ty le mieroalbumin nieu (MAU) va mdi lien quan giUa MAU vdi tinh trang khIng insulin d benh nhan tang huyet l p cd rdi loan glucose mau lue ddi. Ddi tugng vd phuang phdp: Nghien cQu tien cQu, md t l , e l t ngang 230 benh nhan tang huyet ap co rdi loan glucose m l u luc ddi va 230 ngudi blnh thUcfng. Tien hanh nghiem p h I p dung nap glucose dudng udng thuc hien cho c l hai nhdm nghien cUu. Xet nghiem MAU trong mau nudc t i l u ngau nhien. D i n h g i l khang insulin bang chi so ndng do insulin mau luc doi, chi sd HOMA-IR, chi sd QUICKI. Kit qud: Ty le MAU {+) is nhdm nghien cQu la 29,6%, eao han so vdi nhdm chQng 119,1%, (p<0,01). Trong phan nhom nghien eOu ty le MAU {+) tang d i n theo mQc dp t i n g dUdng m l u , l l n IQpt la 18,3%, 29,3% va 39,4% 6 nhdm khdng rdi loan dung nap, rdi loan dung nap glucose va nhom dai thao dudng. Chi sd HOMA-IR d nhdm MAU (-i-) cao hPn so vdi phan nhdm MAU (-) (4,67 ± 3,69 so vdi 3,09 ± 2,98) va chi sd QUICKI g i l m hPn (0,78 + 0,11 so vdi 0,84 ± 0,11), (p<0,01). Benh nhan co khang insulin theo HOMA-IR lam tang nguy ca MAU (+) len 2,72 lan (OR = 2,72, 95%CI: 1,39 - 5,29; p<0,01) va khang insulin theo QUICKI lam tang nguy cP MAU (-I-) len 2,86 lan (OR ^ 2,86, 95%CI: 1,47 - 5,56; p<0,01). Kit ludn: TJ le mieroalbumin nieu (MAU) d nhom nghien cQu la 29,6%, so vdi nhdm chQng la 9,1%, (p<0,01). Cd mdi lien quan giQa MAU v l tinh trang khang insulin d benh n h i n tang huyet ap ed rdi loan glucose m l u luc doi.
Tdkhda: MAU, khIng insulin, tang huyet l p , rdi loan glucose mau lue ddi.
immary
Objective: Research to determine the prevalence of microalbuminuria and the association between MAU and insulin resistance in hypertensive patients with impaired fasting glucose. Subject and method:
Descriptive cross-sectional study on 230 hypertensive patients with impaired fasting glucose and 230 normal people. Glucose tolerance test on both the study and control groups. We tested MAU in urine test sample. Insulin resistance is assessed by fasting blood insulin levels index, HOMA-IR index, QUICKI index. ResultThe prevalence of MAU (+) in the study group is 29.6%, which is significantly higher than in thecontrolgroup(9.1%), the difference was statistically significant (p<0.01). In subgroups of the study, the prevalence of MAU (-(-) increases along with increased blood sugar levels, respectively 18.3%, 29.3%
and 39.4% in normal glucose tolerance, impaired glucose tolerance and diabetic groups, the difference
dy nhdn bdi: 04/5/2017. ngdy chdp nhdn ddng: 10/5/2017
u&iphdn hdi • Phgm Thdi Giang. Email: [email protected] - Vien Nghien cim Khoa hgc YDufrc Ldm sdng 108
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.l2-N7/201
was statistically significant (p<0.001). In subgroup with MAU {+), the HOMA-IR index is higher than in subgroup with MAU (-) (4.67 ± 3.69 vs 3.09 ± 2.98) and the QUICKI index is lower (0.78 ± 0.11 vs 0.84 ± 0.11), the difference is statistically significant (p<0.01). The insulin resistance (by HOMA-IR index) increased the risk of MAU (+) up to 2.72 (OR = 2.72, 95%C11.39 - 5.29; p<0.01) and the insulin resistance (by QUICKI index) increased the risk of MAU (-I-) up to 2.86 (OR = 2.86, 95%CI: 1.47 - 5.56; p<0.01).
Conclusion: The prevalence of MAU (+) is 29.6% and the control group is 9.1% (p<0.01). There is an association between insulin resistance with MAU (+).
Keywords: MAU, insulin resistence, hypertension, impaired glucose tolerance. .
I . D a t v a n d e
Hien nay, tang huyet I p (THA) va d l i t h I o dQdng (DTD) dang t r d thanh mdi lo ngai ddi vdi toan xa hdi do ty ie khdng ngulig gia tang, lam I n h hQdng trQc tiep den sQc khoe, giam sQe lao ddng va chat lupng eude sdng eua ngUdi benh. THA l l m t d n thuang mao mach cau than, g l y phdng thich cytokine va tang m i t protein qua mang day eau than. Albumin nieu thudng dUpc xem la mdt ch!
^ e m tdn thuong tai than tQ giai doan sdm. TrQde d l y ehung ta chi xet nghiem dam nieu dai the (Macroalbumin nieu), tuy nhien khi cd dam nieu dai the, tdn thQPng than da nang va ket qua dieu tri ban che. Hien nay, nhd sU ed mat cCia xet nghiem Mieroalbumin nieu (MAU), benh than ed the dUOc p h l t hien sdm hon va hieu q u i dieu tri se cao hpn.
Ben canh dd, MAU v l g i l m dp Ipc cau than cdn la mdt yeu t d dU b l o manh cda ele bien ed t i m mach nhu benh ly mach v i n h va t d vong do tim [1 ], [2]. d nude ta d l cd nhieu nghidn cUu ve MAU d benh nhan DTD h o l e THA nhung ft nghidn cQu tren ddi tQpng THA cd rdi loan glucose mau ddi (tien dai thao dQdng) theo Tieu ehuan p h l n ioai cda Hiep hdi D l i thao dudng My 2003. Do vay, nham gdp p h l n vao viee phat hien sdm va q u I n ly t d t eac bien chUng man tfnh, chung tdi tien hanh nghien cQu nham mue tieu:
Tim hiiu ty li mieroalbumin nieu vd ddnh gid mdi liin quan gida mieroalbumin niiu vdi khdng insulin d binh nhdn THA nguyin phdt cd roi logn glucose mdu luc ddi.
2.06i tUdng va phUdng phap 2.7.DdftWgng
Nghien cUu dQpc tien hanh tren 460 benh nhan (BN) tai Khoa KhIm bdnh Benh vien Bach Mai tQ
t h i n g 9/2011 den t h i n g 9/2014, chia l l m hai nhoir Nhdm benh va nhdm ehUng.
Tiiu chudn lua chgn i Nhdm nghien cQu: BN dupe ehan doan TH,
nguyen phat theo p h l n loai eua Hpi Tim mach Quocgi Viet Nam khi huyet I p t i m thu (HATTh) > 140mniHi v l ^ o a c huyet ap tam trUPng > 90mmHg va roi loai glucose mau lue ddi theo Tieu chuIn cua Hdi DTD Ho K^ 2003: Glucose mau luc ddi tQ 5,6 - 6,9mmol/L
Nhdm chQng: Gdm 230 ngUdi khde manh, eo curij dp tudi va gidi tinh vdi nhdm benh, khdng co tien si THA, xet nghiem glucose m l u lue ddi < 5,6mmol/L
Tieu chudn logi trd
BN da dQpe ehan doan DTD tU trude hoac noni dp glucose m l u luc ddi s 7mmol/L, khdng cdtiensi THA hay da dupe ehan doan THA thQ phlt; dang c(
bien ehdng d p tinh; dang dung mdt sd thudc anl hQdng den ket q u i xet nghiem nhU nhon glucocorticoid, niacin...
2.2. Phdong phap 2.2.1. Thiit ke nghiin cdu
Nghien cQu theo phuong p h I p md t l , d ngang, cd so s i n h .
2.2.2. Ngi dung nghien cdu Do huyet dp (HA)
Mdi benh nhan dugc do 2 l l n , d c h nhau I phut, sau d d lay ket q u i trung binh. D i n h gia ke q u i theo p h l n loai cda Hdi Tim mach qudc gia Vie Nam nam 2008.
Dinh lugng glucose mdu (Go) khi ddi PhUPng phap djnh IQpng: Do UV A Hexoklnase, dd nhay dat tdi 0,04mmol/L.
,P CHlYDUOC LAM SANG108 Tap 12-56 7/2017
Nghiem phdp dung nap glucose dddng uong VDNG)
Nghiem phap nay dQpc thQe hidn cho e l 2 ldm nghien cUu va nhdm ehdng. TrQde ngay l l y au BN nghi ngai, khdng lam viee nang, an udng le dp giau cacbon hydrat. Bdnh n h i n nhin an qua im (tdi thieu 8 - 1 0 tieng) v l sang n g l y l l y m l u
>nh n h i n nhjn an sang.
Lay mau l l n 1 de djnh lUpng ndng dp glucose I insulin luc ddi (Go va lo), cho benh n h i n uong 75g idng glucose h o i tan trong 250ml nude sdi d ^ jupi, udng het t r o n g vdng 5 phdt. Dung sau 2 gid / m l u l l n 2 de djnh lUpng glucose va insulin tai di diem 120 phut (G,2o va luo).
D i n h g i l ket qua theo Hdi DTD Hoa K]/ (ADA) 2003:
Neu G,2o < 7,8mmol/L: Dung nap glucose binh Udng (DNGBTl.
Neu G,2o tQ 7,8 - 1 1 mmol/L: Rdi loan dung nap ucose (RLDNG).
NeuGi2o> n , 1 m m o l / L : 0 T D . Chi s6 ddnh gid khdng insulin
Chi sd HOMA-IR (Homeostasis Model Asessment sulin Resistance) - chi sd khang insulin:
HOMA-IR=lo(pU/ml)x(Go(mmol/L)/22,5.
Diem eat gidi ban: TU phan vj cao nhat trong ldm chQng.
Chi sd QUICKI (Quantitative Insulin Sensitivity leck Index) - eh! so kiem tra dp nhay eua insulin:
QUICKI = 1/log do-t-Go)
D i i m e l t gidi han: TU p h l n vj nhd n h l t trong ldm chUng.
Theo khuyen d o cua Td chQc Y te The gidi, ling insulin ddoc xac i^nh khi chi so HOMA-IR cao (n tQ p h l n vj cao n h l t trong nhdm chQng.
Dinh Idang mieroalbumin niiu vd tinh mdc Igc cdu than
Djnh iQOng mieroalbumin nieu va creatinin nieu, t i n h ACR:
MAU dQpe djnh tQpng theo phupng phap do dp due mien djch (Immunoturbidimetric) tren m I y BM - Hitachi 912 cda hang Boehringer Ingelhein (DQc) tai Khoa Sinh hda Benh vien Bach Mai.
Xet nghiem n l y dQpc lam sau khi d l lam xet nghiem t o n g phan tfch nQde tieu: Protein nidu am tinh, khdng cd hdng c l u , bach c l u trong nQde tieu.
Xet nghiem iQpng albumin vdi ndng dp cua ereatinin trong cung mau nUde tieu. So sanh ty sd albumin/creatinin (albumin/creatinine rate: ACR).
Danh g i l ket q u i :
ACR (ty" sd albumin/creatinin): < 30pg/mg mieroalbumin: (-)
ACRtQ30 den 300pg/mg: mieroalbumin (-I-) Tinh mQc Ipe c l u than dUa v I o ndng dp creatinin mau.
Ude doan dp Ipc c l u than tQ creatinine huyet thanh theo edng thUe MDRD (Modification of Diet in Renal Disease):
eGFR (ml/min/1,73m^) 1,86x[(Cre/84,4)-
^''='']x[audi)^'^"]
(x0.742:VdinQ).
2.3. Xdlysoliiu
T i t ca cac sd lieu dUpc xd If bang phan mem SPSS 16.0 tai Khoa Djch te hpe - TrUdng Dai hpc Y Ha Ndi. SQ dung d c phep thdng ke md t l ve ty' le %, trung binh, dp lech e h u I n , g i l trj Idn n h l t va nhd n h l t v l d e phep kiem djnh thong ke.
Ket qui
Bdng 1 . Oac di4m chung cua ddi tugng nghien ciiti 3ac diem chung
u6i hieu cao (cm) an nang (kg) ong bung (cm) 'HR VII
Nhom chlimg (n = 230) (X ± SD) 62,84 ± 8,47
1,58 ±0,07 56,7 ± 8,42 81,93 ±7,51 0,89 ± 0,05 22,56 ± 2,25
Nhom nghien aHu (n = 230) (X ± SD) 64,05 ±8,13
1,59 ±0,07 53,42 ±8,14 85,20 ± 6,70 0,91 ± 0,04 23,09 ± 2,20
P
>0,05
>0,05
>0,05
<0,05
<0,05
>0,05
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY VoLl2-N7/20l7
Nhdn xit Cac thdng sd tuoi, chieu cao, d n nang, BMI giQa 2 nhdm nghien eQu tQPng dUPng so v6i nhdm chQng, sU khIc biet khdng cd y nghTa thong ke (p>0,05). Cac thdng sd vong bung, WHR glQa 2 nhdm nghien cQu khIc biet ed y nghTa thdng kd (p<0,05).
d
Bang 2 . So sanh eGFR va MAU giuTa 2 nhom nghien cuTu Thong so
eGFR MAUTB MAU(-)
MAU(+)
Nhom chijrng 82,05 ± 22,87 11,81 ±11,75
209 90,9%
21 9,1%
Nhom nghien cihi 77,14±16,22 17,40 ±13,55
162 70,4%
68 29,6%
P ~ 1
<0,01
<0,01
<0,01
Nh^n xet: eGFR va MAU trung blnh d 2 nhom khac biet co y nghTa thong ke (p<0,01). MAU {+) d n nghien cijfu 29,6% cao hon sovcfinh6mch0hg9,l%;p<0,01.
Bang 3. So sanh eGFR va Thdng s6
eGFR MAU trung binh
MAU (-)
MAU (+)
DNGBT(n = 60) 76,57 ±17,98 14,59 ±11,22
49 81,7%
11 18,3%
IVIAU giiira cac phan nhom cua nhom nghien cuTu RLDNG (n = 99)
77,27 ±1,49 18,31 ±15,50
70 70,7%
29 29,3%
OTD(n = 71) 77,43 ±1,65 18,51 ±12,21
43 60,6%
28 39,4%
P
>0,05
>0,05 p'-><0,01 p'-'<0,01 p"<0,01
Nhdn xit eGFR va MAU trung binh glQa d c phan nhdm cua nhdm nghien cQu khIc biet khdng z6) nghTa thdng kd. Trong phan nhdm nghien cUu ty le MAU {+) tang dan theo mQc dp tang dUdng mau, lar lupt la 18,3%, 29,3% v l 39,4% d nhdm khdng rdi loan dung nap, rdi loan dung nap glucose v l nhdm dai thac dudng, MAU (-I-) eao n h l t d phan nhdm DTD, thap nhat d p h l n nhdm DNGBT sU khIe biet rat cd y nghi;
thdng ke (p<0,01).
Bdng 4. So sanh gia trj trung binh khang insulin giOa hai phan nhom Thong so
Go G120
lo 1120 HOMA-IR
QUICKI
MAU (+) (n = 68) 6,22 ± 0,39 10,26 ±2,38 16,63 ±12,34 89,74 ± 63,44 4,67 ± 3,69 0,78 ± 0,11
MAU (-) (n = 162) 5,99 ± 0,33 9,20 ± 2,53 11,62 ±11,21 76,83 ±71,91 3,09 ± 2,98 0,84 ±0,11
P ...
<0,01
<0,01
<0,01
<0,01
<0,01 J
<0,01 Nhan xet: Glucose va insulin 6 thdi diem khi doi va th4i d i i m 120 phut sau khi lam NPDNG * nhim o MAU (+) khac biet so vdi nhom co MAU (-) (p<0,01).
^PCHlYOagcUMSANG108 Tap 12-So 7/2017
Bang 5. Nguy ca Ichang insulin d BN MAU (+) Thdng so
Khang Insulin theo HOMA-IR Khang Insulin theo QUICKI
n
%
n
%
MAU (+) (n = 68) 54 79,4%
54 79,4%
MAU (-) (n = 162) 95 58,6%
93 57,4%
OR
2,72
2,86
95%CI
(1,39-5,29)
(1,47-5,56) P
<0,01
<0,01 Nhdn xet BN cd k h I n g insulin theo HOMA-IR l l m tang nguy CO MAU (+) len 2,72 l l n (OR = 2,72, 95%CI:
,39 - 5,29; p<0,01) va k h I n g insulin theo QUICKI lam t i n g nguy ea MAU {+) len 2,86 lan (OR = 2,86; 95%CI:
,47-5,56;p<0,01).
I. Ban l u a n
Mieroalbumin nieu dupe coi nhu mdt dau hieu ot nhat p h l n anh roi loan chQc nang ndi mac, la lau hieu sdm de danh g i l t o n thQOng than, MAU dn la yeu t d nguy ca mac benh v l tQ vong do d c lenh tim mach d c l nhQng benh n h i n d l i thao [udng va khdng dai t h I o d u d n g , dong thdi la mdt eu t d d u bao nguy ca suy than sau nay [1], [2]. Rdi san glucose mau luc ddi dupc coi la giai doan tien fai thao dudng (prediabetes). & giai doan nay hudng chua cd cac trieu chUng t d n thuong ve than 3 rang, cac xet nghiem mau nhU ure, ereatimin, iQe Ipc cau than van d t r o n g gidi han binh thQdng a protein nieu (-). Vi vay de danh g i l tdn thQang lian d giai doan sdm ngudi ta dUa v I o ndng dp licroalbumin nieu.
Ket q u i nghien cQu cua chung tdi cho t h I y ty le lAU (+) d nhdm nghien cQu la 29,6%, cao hon ban D vdi nhdm chQng la 9,1%, sQ k h I c biet cd y nghTa l d n g ke (p<0,01). Ket q u i nghien cQu eua Mennno .Pruijm tren 1255 ddi tUpng d i n sd ndi chung nhan lay ty le MAU (-I-) d ngUdi cd RLGLD trong d d tudi 5 - 64 la 23,6% [1]. Nghien cUu eua Marin R tren 010 BN THA cd RLGLD, ty le MAU (-I-) chiem tdi 8,3%, eao hOn r l t nhieu so vdi nghien cQu cQa iiung tdi [3]. Trong nghien eUu MAPS i/lieroalbuminuria Prevalence Study) thQe hien tren 549 BN d l i thao dQdng type 2 cd THA d 10 qude gia oac lanh t h d eda chau A (gdm Trung Qude, Hdng 5ng, Indonesia, Malaysia, Pakistan, Phllippin, ngapore, Han Qude, Dai Loan v l Thai Lan) cho thay
tan s u i t MAU la 39,8% va albumin nieu lam sang la 18,8% [4j. T i n s u i t MAU (-I-) trong nghien eUu eua ehung tdi khIe vdi ket qua cua t i e g i l khac ed the do d c h lua chpn benh nhan, phuong phap d i n h gia MAU thudc loai djnh tfnh, ban djnh lupng hay djnh lupng. PhUPng phap l l y m l u nude ti^u 24 gid khd thUe hien dUpe vdi da sd ngudi benh nen iQa chpn phuang p h I p tinh ACR eua eung m l u nQde tieu la each thue hien thuan tien nhat. Mat khIc ddi tUpng eua ehung tdi 11 nhQng benh nhan cd THA va RLGLD chQ chua mac d l i thao dudng nen ty- le MAU (-I-) eung se t h I p hOn so vdi cae ddi tupng m I c THA kem theo dai t h I o dUdng.
Tat c l bdnh n h i n trong nghidn eUu dupe l l m NPDNG, ket q u i cd 60 ngudi DNGBT, 99 ngUdi RLDNG va 71 ngUdi bj dai thao dUdng. Trong phan nhdm nghien cQu ty le MAU (-I-) tang d i n theo mQe dp tang dQdng m l u : 0 nhdm khdng rdi loan dung nap, rdi loan dung nap glucose va nhdm d l i t h I o dQdng lan iQpt la 18,3%, 29,3% v l 39,4%, MAU (+) cao nhat d p h l n nhdm dai thao dudng, thap n h l t d phan nhdm DNGBT (p<0,01). Ty le nay eda ehung tdi thap hon ban so vdi nghien cQu eua Marin R va edng su nghien cQu tren 7625 BN THA trong dd cd 1459 BN khdng ed RLGLD, 3010 BN cd RLGLD va 3156 BN bj DTD thi t^ le BN ed MAU (-I-) lan iQpt 11 39,34%, 48,3% va 65,6% [3]. Jianzhong Xiao va cdng su nghien cQu tren 6092 ngQdi Trung Qudc cd RLDNG thi t y le MAU {+) d nam va nQ lan iQpt la 32,6% va 34,3% [5]. Co the nhan thay mQc dp rdi loan glucose mau d n g tang thi ty le MAU (+) cang Idn. Nghien cdu DCCTtren 1441 BN dai thao dudng type 1 thay
35
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d nhdm dieu trj tieh cue (glucose mau 8,2mmol/l, HbAlc 7,2%) g i l m 39% nguy eo xuat hien mieroalbumin nieu, 64% nguy ea benh than kinh, 46% nguy ea d c bien chUng maeh m l u Idn so vdi nhdm dieu trj thdng thudng (glucose m l u 12,8mmol/l, HbAlc 9,1%) [71.
Nhieu nghien cQu cung cho t h I y kiem solt t d t glucose m l u gdp p h l n lam g i l m nhieu bien ehUng vi maeh va maeh m l u Icfti. Do vay kiem solt glucose mau tdt se gdp p h l n I I g i l m t^ le MAU (-I-) d BN dai thao dudng va giup l l m g i l m ty le bien chQng than d BN dai t h I o dUdng. Khi da ed d i u hieu MAU (-I-) thl van de khdng che glucose va huyet ap d n g c l n dUOc quan tam chat ehe hon de ban ehe sU p h l t trien cQa bien chQng than.
Trong nghien cQu eua ehung tdi ket q u i glucose m l u luc ddi d nhdm nghien cQu cd g i l trj trung binh la 6,07 ± 0,37mmol/l, d nhdm chQng ed g i l trj la 4,85
± 0,47mmol/l. Ket qua glucose m l u sau 2 gid lam NPTDH d nhdm nghien eUu ed g i l trj trung binh la 9,52 ± 2,53mmal/l, lam NPTDH trung binh d nhdm chQng ed gia tri trung blnh la 7,26 ± 1,92mmol/l (p<0,001). Ket q u i insulin mau luc ddi d nhdm nghien cQu cd gia trj trung binh la 13,09 -•- l l , 7 6 p U / m l , nhdm chQng cd g i l trj la 6,57 + 2,61pU/ml. Ket q u i insulin mau sau 2 gid l l m NPTDH d nhdm nghien eUu ed g i l trj trung binh la 80,65 ± 69,63MU/ml, 6 nhdm chQng cd g i l trj I I 57,4
± 43,61 pU/ml (p<0,001). Ndng dp GO v l G120,10 va 1120 d p h l n nhdm d l i t h I o dQdng cao nhat, tiep theo den phan nhdm RNDLG va thap nhat d phan nhdm DNGBT.
Nhieu cdng trinh nghidn cQu deu cho t h I y rang: Tang chi sd HOMA-IR ddng t h d i g i l m pha tiet sdm cua insulin la yeu t d dU doan cho sQ p h l t trien cua benh d l i t h I o dUdng d d nhQng ddi tQpng cd dung nap glucose binh thQdng v l rdi loan dung nap glucose. Nghien cQ^ eua Steven M Haffner trong nghien cQu San Antonio Heart Study cho thay mdi lien quan chat ehe gida khang insulin tinh theo chi sd HOMA IR vdi glucose m l u va insulin luc ddi eung nhu sau khi lam nghiem p h I p dung nap glucose ( r - 0,98) [8]. Theo nghien cQu eua Haffner va cdng sQ cho t h I y tang insulin m l u khi ddi l l m tang nguy eo d l i t h I o dudng len 6,95 l l n , g i l m pha
tiet sdm cua insulin lam tang nguy ea cua dai thao dudng len 20 lan [10]. Theo nghien cUu eua Helain va cdng sU tren 2283 ngUdi chUa d l i t h I o dudng, theo ddi trong 7,6 ± 1,8 nam cho t h I y chi sd HOMA- IR ed mdi lien quan chat che vdi nguy eP bi dli thao dudng, t^' le p h l t trien d l i t h I o dudng la 6,3%, 14,6% va 30,1% Ung vdi phan v j t h U nhat, thU hai va thQ ba eua ehi sd HOMA-IR [11 ].
Khang insulin ed the ehinh la nguyen nhan gay tang glucose m l u thQ p h l t va tang glucose mau lai lam tang bai xuat albumin nieu va mdi li^n quan giQa khang insulin va MAU cd the do tang glucose m l u insulin mau ed I n h hUdng den huyet dong b tieu c l u than do lam gian mach cau than, tang liAi lupng ddng mau den than, tang ap luc thuy tinh trong tieu c l u than va tang bai x u l t albumin nieu.
T i n g ndng dd insulin cdn lam rdi loan chdc nang noi mac, tang tfnh t h a m eua thanh maeh v l lam tang sieu Ipc albumin qua nUdc tieu. Ngoai ra gilm dp nhay cQa insulin Hen quan den rdi loan chuyen hoa cda cac te bao va dien the trong tieu d u than, lam t i n g sinh m I n g d l y , phi dai va tang sinh cle t l bao npi mac, gay lang dpng lipid thue day qua trinh ton t h u p n g than. Ket q u i nghien cQu cda chung tfli chi sd HOMA - IR 6 nhdm cd MAU (+) la 4,76 ± 3,69, cao han so vdi nhdm MAU (-) I I 3,09 ± 2,98, ehi sd QUICKI d nhdm ed MAU (-t-) I I 0,78 ± 0,11 thap hon so veil nhdm cd MAU (-) la 0,84 ± 0,11 sU khac nhau co y nghia thdng ke (p<0,05). Khi d i n h gia nguy co MAU {+) d BN THA ed RLDNG ket q u i cho thay BN khang Insulin theo HOMA-IR lam tang nguy ca MAU (+) len 2,72 lan (OR = 2,72, 95%CI: 1,39 - 5,29; p<0,01) va khang Insulin theo QUICKI lam tang nguy cP MAU (+) len 2,86 l l n (OR = 2,86; 95%CI: 1,47 - 5,56;
p<0,01). Ket q u i nghien cUu cua ehung tdi eung phii hpp vdi nghien cQu cda mpt sd t i e gia nhU Aneliya 1 Parvanova, Hoehner CM, Mykkanen Leena va nhieu tac gia khac [2], [3], [8], [9].
5. Ket l u a n
Ty le mieroalbumin nieu (MAU-i-) d nhorr nghien eQu eao hon so vdi nhdm ehUng vdi ty I?
tuang Qng la 29,6%, so vdi 9,1%, (p<0,01). Cd mdi lien quan glQa MAU + va tinh trang khang insulin &
benh n h i n tang huyet I p cd rdi loan glucose mau luc ddi.
, TAP CHl Y DUqc LAM SANG 108 Tapl2-S67/2017
Tai lieu tham khao
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