JOURNAL OF 108 - CUNICAL MEDICINE A N D PHARMACY
Khao sat n6ng do glucagon-like peptide-1 6* benh nhan dai thao dirong typ 2 chSn doan ISn dau
Assessment of glucagon-like peptide-l(GLP -1) concentration in patients with first-diagnosed type 2 diabetes meUitus
L£ Dinh Tuan", 'Trucmg Bgi hoc YDugc ThdiBinh Nguyin Thi Phi Nga", ^^^ "Hoc viin Quan Y Trin Thi Thanh Hda"** "'Benh viin Noi Hit Trung umg
Muc tiiu: Xac djnh ndng dp glucagon-like peptide-1 d benh n h i n dai t h I o dUdng r^p 2 chan doan lan d i u . Ddi tUOng vd phuang phdp: Nghien cUu md t l cit ngang tr&n 170 benh nhan d^i thao dudng typ 2 chan doan lan dau tai Benh vien Noi tiet Trung uong va 52 ngudi binh thudng. Kef qud: Ndng do trung binh GLP-1 khrd6ila7,31 ±3,65pmol/l (cao nhatla22,74pmol/l,thlpnhatla 1,53pmol/l). Ndng d6 trung binh sau an 2 gid la 12,82 ± 4,37pmol/l (cao nhat la 21,65pmol/l, thap nhat la 3,04pmol/l); ndng dp trung binh GLP-1 khi ddi va sau 2 gid lam nghiem phap cua nhdm benh nhan d l i thao dudng typ 2 thap hdn sov6i ngudi binh thudng (cle ndng dp eCia nhom chUng lan lupt: 12,97 + 5,85pmol/l va 16,26 ± 6,79pmol/l;
p<0,05); tJ le benh nhan dai thao dudng typ 2 cd g i l m ndng do GLP-1 khi ddi la 60,6%, ty le giam nong dp GLP-1 sau an 2h la 9,1%; chUa thay lien quan giua nong d6 GLP-1 khi doi vdi tuoi va gidi tinh (p>0,05).
Kit ludn: 6 benh nhan dai thao dudng typ 2 chan d o l n lan dau cd giam bai tiet glucagon-like peptide-1 d khi doi va sau an. ChUa thay lien quan giUa nong dp GLP-1 khi doi vdi tudi va gidi tinh.
Ti/khoa: Dai thao dudng typ 2 chin d o l n lan dau, glucagon-like peptide-1.
Summary
Objective: To determine concentration of fasting and 2h-postprandial GLP-1 in patients with first- diagnosed type 2 diabetes meilitus (f2DM). Subject and method: This is a cross - sectional descriptive study on 170 f2DM patients at National Endocrinology Hospital and 52 patients as control group. Result:
The average of fasting GLP-1 concentration was 7.31 ± 3.65pmol/l (min: 22.74pmol/l, max: 1.53pmol/l).
The 2h-postprandial GLP-1 was 12.82 ± 4.37pmol/l (min: 21.65pmol/l, max: 3.04pmol/l); the fasting concentration and 2h-postprandial concentration of GLP-1 in f2DM was lower significantly than the control group (12.97 ± 5.85pmol/l and 16.26 ± 6.79pmol/l; respectively; p<0.05); in f2DM, the rate of decrease of fasting GLP-1 was 60.6% and 2h-postprandial GLP-1 was 9.1%; there was no relationship between GLP-1 and age, sex (p>0.05). Conclusion: in patients with type 2 diabetes, the fasting and 2h- postprandial GLP-1 were lower than the non-diabetes (control group). There was no relationship between GLP-1 and age and sex.
Keywords: Firstly-diagnosed type 2 diabetes meilitus, glucagon-like peptide-1.
Ngdy nhdn bdi. 07/12/2016, ngdy chdp nhgn ddng:08/12/20J6
Nguaiphdn hdi: Le Dinh Tudn. Email: [email protected] - Trudng Dai hgc YDuac Thdi Binh
TAP CHlY DUOC LAM SANG 108 Tap 12-Sd 2/2017
1. Dat van d e
Glueagon-like peptide-1 (GLP-1) la mdt thanh vien CO b i n cua incretin, dupe phat hien v I o d i u nhdng nam 1980. GLP-1 la m d t peptide cd 30/31 axit amin, dUpc t o n g hop v l bai tiet bdi te bao L, e l e te bao n l y cd ehO yeu d doan cudi hdi t r l n g v l dai trang. GLP-1 kieh thich b l i tiet insulin va Uc che bai tiet glucagon sau an do vay nd l l m g i l m glucose m l u . GLP-1 kich thfch tuy t l i sinh va tang sinh, chdng lai sU chet theo chUOng trinh cua te bao p, ddng t h d i GLP-1 edn ed tac dung chdng xo vufa maeh m l u , b i o ve than kinh, bao ve tim [5]... Nam 1986, t i c g i l Nauek va CS [11] tan dau tien da p h l t hien ra hi#n tUpng g i l m hieu Ung incretin 6 benh nhan dai t h I o dUdng t y p 2 so vdi ddi t u p n g ngudi khde manh. Nhieu nghien edu ve GLP-1 da edng bd chUng minh d bdnh nhan d l i thao dUdng ty^p 2 g i l m bai tiet GLP-1 d c l trang t h l i co b i n v l sau I n , lam suy g i l m kieh thfch b l i tiet insulin, day dupe eol la CO ehe quan t r p n g trong dien bien cua benh d l i t h I o dudng. Hien nay, d Viet Nam ed rat it nghidn eUu k h I o sat ndng dp GLP-1 huyet thanh 6 benh n h i n d l i thao d u d n g t y p 2, d i e biet la benh nhan chan doan lan dau. Vi v l y , ehung tdi tien h l n h nghien edu de tai vdi muc tieu Khdo sdt nong do GLP- 1 huyit thanh khi doi va sau 2 gid Idm nghiim phdp dung ngp glucose d benh nhdn ddi thdo dudng typ 2 chdn dodn Idn ddu.
2. Doi XiiOng va phUtfng phap 2.1. Ddi tirang
Gdm 222 ddi tUpng chia thanh 2 nhdm: Nhdm benh n h i n (BN) dai t h I o dUdng (BTD) typ 2:170 BN DTD typ 2 chan d o l n lan dau. Nhdm chdng: 52 ngudi binh t h u d n g .
Tiiu chudn chgn ddi tugng Nhdm BN DTD t y p 2
BN duoc lay tai Khoa K h I m benh h o l e dang dieu trj ndi tru tai Bdnh vien Ndi tiet Trung UPng.
BN dupc ehan doan DTD t y p 2 lan d i u , chUa dugc sii d u n g cae bien p h I p didu trj n l o nham ha glucose m l u (GM).
CIc BN ddng y tham gta nghien cdu.
Nhdm chdng: Ngudi cd sUe khde binh t h u d n g t h d n g qua kham lam sang, c l e xet nghiem v l t h a m d d chUe nang co b i n d lan kham sde khde hien tai va s6 k h I m benh d nhufng lan gan day cCia BN (neu cd) tai Khoa Kham benh Benh vidn Ndi tiet Trung UOng, ed t u o i , gidi tuong dUong vdi nhdm nghidn cdu.
Tiiu chudn logi khdi nghien cdu Nhdm benh nhan DTD t^p 2
DTD t^p 1, DTD cd nguydn nhan: Viem tuy man, u tuy, u tuyen yen,...
Hdn md, tien hdn me, ha dudng huyet, con tang huyetap kjch phat.
CIc benh nhiem trung: Lao, HIV, viem gan cap, viem phoi - phe quan...
X P gan mat bu, suy tim mat bu, suy than nang (giai doan 3,4), thieu m l u n l n g , cd thai, dau that ngUe on djnh, khdng dn dinh, thieu nang vanh, tai bidn maeh m l u nao, nhdi mau eotim, rdi loan ddng mau.
BN gia yeu, suy kiet nang, rdi loan t i m t h i n . BN da phau t h u l t tieu hda, dang dieu tri ele benh dng tieu hda: Viem loet da day t l trang, viem rudt, viem dai trang cap - man tinh.
BN dang dieu tri ung t h u , nghien rUpu.
BN khdng hpp t i e , khdng thu thap dd ehi tieu nghien cdu.
Nhdm chdng
NgUdi d l phau thuat dng tieu hda, nghien rUpu.
NgUdi dang dieu tri cac bdnh I;? dng tieu hda tU trudc: Viem loet da d l y ta t r l n g , viem rudt, viem dai t r l n g c a p - m a n tfnh.
Thda c l n beo phi, tang huyet ap.
Rdi loan lipid mau.
NgUdl khdng hpp t i c , khdng thu thap du chi tieu nghien cUu.
2.2. Phuang phdp
Thiet kenghien ciiu: Tidn cUu, md t l cat ngang, ed so s i n h vdi nhdm ehdng.
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.l2-N'2/2017
Chgn mau:
Nhdm BN DTD typ 2: Chpn mau cd chCi dfch, trong nghien cUu nay ehung tdi thu thap dugc 170 BN DTD typ 2 chan doan l l n dau.
Nhdm chUng gdm 52 ngUdi binh thudng tUPng ddng ve tudi, gidi vdi nhdm BN DTD typ 2.
Noi dung nghien ci^u
Kham lam sing: Tudi, gidi. Tien sd ban t h i n , tien sU gia dinh: Cd anh chj em bd me rudt bj DTD. KhIm toan dien: Tieu hda, tim maeh, hd hap, tiet nieu...
Can lam sang va tham dd chUc nang: Djnh luong GM khi ddi, HbAlc, GLP-1 va cae xet nghiem GOT, GPT, ure, creatinin, ele t h l n h phan lipid m l u .
Nghiem p h I p tang GM: Chi djnh: BN cd GM khi d d i < 7 , 0 m m o l / l [ l l .
CIc budc tien hanh:
Khdng I n , hdt thudc hoac tap luyen it nhat 8 gid trudc khi l l y mau mau dau tien. Khdng an trong thdi gian lam nghiem phIp, cd the udng nude.
Mdt mau m l u tinh mach dau tien khi BN den kham, day I I g i l trj GM lue ddi. Cho BN udng 75g glucose pha trong 200ml nude dun sdi de ngudi, udng trong 5 phut. Lay m l u tTnh mach xet nghiem lai GM sau 2 gid udng.
Ket qua: Neu mau GM sau 2 gid lam nghiem phap
> 11,lmmol/l ddi tUpng dupc chan doan la DTD.
Dinh lupng hooemon GLP-1:
Tat c l cle ddi tUpng nghien cUu deu dupc djnh lupng ndng da GLP-1 khi ddi. Vdi mau GLP-1 sau udng 75g glucose, d nhdm BN DTD chung tdi thu t h I p dupc 33 BN sii dung nghiem p h I p t i n g GM de chan doan OTD typ 2, d cle BN nay chung tdt lay mau de dinh lupng xac dinh ndng GLP-1 eung vdi mau xet nghiem glucose sau 2 gid lam nghiem p h I p tang GM. 6 nhdm chUng chung tdi tien hanh dinh lupng xlc djnh ndng GLP-1 sau udng 75g glucose tren 36 ddi tupng.
Nguyen ly: DUa tren p h l n Ung dac hieu giUa khang the dupc gan d d l y gieng ELISA vdi khang nguyen GLP-l ed trong huyet thanh cCia BN, ket hpp /di su chuyen mau cua cp chat d i e hieu trong p h l n ing ELISA, do mau d m I y phd quang ke cd bUdc idng450nm[3].
NOi xet nghiem: Trung tam Y Dupc hpc Quan sir - Hpe vien Quan Y.
Lay m l u tTnh maeh d 2 thdi diem: Lln 1: Khi m BN nhjn an it nhat 8 gid. Lan 2:2 gid sau khi BN uong 75g glucose (nghiem p h I p tang glucose mSu). (Sng nghiem ehUa chat ehdng ddng EDTA va cho sin chat Ue che enzym DDP-4 trudc khi lay mau. Bg KFT ELISA do Nhat B i n san xuat. M I y dpc ELISA hang Thermo.
DPn vi tinh: pmol/l, n h i n djnh ket qua difa theo g i l trj trung binh va do l e c h j i h u l n v^ ndng do GLP- 1 eua nhdm ehUng thudng ( X ; SD):
Gilm: GLP-1 < X - SD; binh thudng: GLP-1 s X - SD, Tiiu chudn sddung trong nghiin cdu Tidu chuan chan d o l n dai t h I o dudng: Chin d o l n DTD theo khuyen e l o ADA nIm 2015 [2]. Chan d o l n dUa v I o 1 trong 4 tieu chuan:
GM luc ddi (it n h l t 8 gid sau an) > 7,0mniol/l.
Xet nghidm dupe thUc hien it nhat 2 lan.
GM ngau nhien > 11,1 mmol/1 kem theo trieu ehdng kinh dten cua t i n g glucose huyet.
GM 2 gid sau nghiem p h I p dung nap glucose (udng trong 5 phut 75g glucose hda trong 200ml nudc)> 11,1 mmol/L
HbAlc £6,5%.
Tieu chuan chan doan dai t h I o dUdng typ 2:
Theo Hiep hdi DTD Qudc te (IDF) nam 2005 van dung phu hpp vdi dieu kien Viet Nam [1].
Benh khdi phat cham, thudng khdng ro trieu chUng: Bat dau tU t d , c l e dau hidu an nhieu, uong nhieu, dai nhieu, gay sut can khdng rd ret.
Bteu hien l l m sang the trang thudng beo, tien sU gta dinh ed ngudi m I c benh DTD typ 2, dac tfnh d i n tde ed t y le m I e benh cao, hay gap chiing gai den (acanthosis nigricans), hdi ehOmg budng triJng da nang.
Xet nghiem: Ndng dd insulin, C-peptid huyet tupng binh t h u d n g hoac tang, it cd tinh trang tang ceton m l u .
Dieu t n : Khdng le thudc insulin, dung cac thu6c ha glucose m l u theo dUdng udng cd hieu q u i
2.3. xa ly so liiu: XCf (j? so lieu bdng phan mem SPSS 16.0.
TAP CHl Y DUOC U M SANG 108 Tap 12-So 2/2017
3. Ket q u i
B i n g 1 . Dac diem ve tuoi, gidi cua 2 nh6m nghien ci]ru Chi tieu
Gi6i
Tuoi (nam)
Nam [n; (%)]
NQ[n;(%)l S 6 0
> 6 0 Trung blnh
Nhom BN DTD typ 2 (n = 170) 90 (52,9) 80(47,1) 124(72,9) 46(27,1) 55,00 ±10,35
Nhom chihig (n = 52) 22 (42,3) 30(57,7) 41 (78,8) 11 (21,2) 52,73 ± 9,93
P
>0,05
>0,05
>0,05 Nhdn xet: Khdng cd sU k h I c biet ve tuoi va gidi gida 2 nhdm nghidn cUu (NC).
Bang 2. Dac d i i m BMI v l mot so xet nghidm hoa sinh mau chi tigu
BMI (kg/m'j GM kill doi (mmol/1) C-peptid (nmol/l) SCOT (UI/L) SGFT(UI/L) Ure (mmol/1) Creatinin mau (Mmoi/I) Triglycerid (mmol/1) Cholesterol (mmol/1) HDL-C (mmol/1) LDL-C (mmol/1)
Nhom BN OTO typ 2 (n = 170) 22,38 ± 2,81 11,90 ±4,49 0,86 ± 0,54 29,95 ±18,10 36,61 ± 23,81 5,54 ±1,45 76,75 ±13,38
2,71 ± 2,02 5,35 ±1,33 1,25 ±0,42 3,15±1,11
Nhom chuTng (n = 52) 20,67 ±1,78
5,29 ± 0,50 0,62 ± 0,26 24,00± 11,17 22,92 ± 17,24 5,32 ±1,57 74,80 ±16,79
1,27 ±0,54 4,25 ± 0,65 1,24 ±0,40 2,40 ± 0,66
P
<0,001
<0,001
<0,001
<0,05
<0,001
>0,05
>0,05
<0,001
<0,05
>0,05
<0,001 Nhdn xet: Chi s6 BMI, ndng dp GM, C-peptid, SGOT, SGPT, triglycerid, cholesterol, LDL-C d nhdm NC eao hdn cd y nghta t h d n g ke so vdi nhdm chdng.
Bdng 3. Nong dd lorn nhat, nhd nhat va nong do trung binh cua GLP-1 GLP-1
(pmol/D
Khid6i
Sau an
Nhom BN DTD typ 2
(n=170) NhomchuYig
(n = 52)
Min
1,53 5,78
lUax 22,74 24,29
Trung binh 7,31 ± 3,65 12,97 ±5,85
P
<0,05
Chi so gidi han GLP-1 CLia nhom chifng: X - SD: 7,12 BN BTB typ 2 (n = 33)
Nhom chdng (n = 36)
3,04 9,37
21,65 32,08
12,82 ±4,37
16,26 ±6,79 <0,05 Ch! so gidi han CLP- i sau an 2h cOa nhom chdng: X - SD: 9,47
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.l2-N'2noi7
Nhan xet: Nong dp trung binh GLP-1 cCia nhom BN BTB typ 2 thap hon co y nghta thong k§ so vfli nhom ngudi blnh thddng (p<0,05). N6ng do trung blnh GLP-1 cila nhom BN BTB t;?p 2 sau an 2 gid deu thap hdn so vdi nhom ngddi blnh thddng cd ^ nghTa thong ke (p<0,05).
Bang 4. T^ ie su thay tfoi nong dp GLP-1 d nhom BN DTD typ 2
GLP-1 Khi doi (n = 170]
Sauan2h (n = 33)
Giam Blnh thddng
Gidm Blnh thddng
So iUdng 103 67
3 30
TJie%
60,6 39,4 9,1 90,9 Nhdn xit: Ty Id BN cd g i l m ndng dp GLP-1 khi ddi cao (60,6%). Ty le BN cd g i l m ndng dd GLP-1 sau I n 2 g i d thap (9,1%).
BIng 5. Dac diem ve nong do GLP-1 khi doi theo tuoi va gidi cac nhom BN DTD typ 2
Tuoi va gidi
Tudi (nam)
Gidi
<60
>60 P Nam
NO P
GLP-1 (pmoi/l) Nhom BN DTD
typ 2 (n = 170) 7,46 ±3,78 6,90 ± 3,27
>0,05 7,09 ±3,58 7,55 ±3,73
>0,05
Nhom chihig (n = S2) 13,22 + 5,69 12,02 ±6,61
>0,05 12,89 ±6,28 13,02 ±5,63
>0,05 W/jdn xet; Ndng dd trung binh GLP-1 khi ddi cua cac nhdm nghien cUu ed xu hudng g i l m d eac ddi tuong £ 60 tudi, tuy nhidn su khae biet khdng ed y nghia thdng ke (p>0,05). Ndng dp trung binh GLP-1 khi ddi d nU cua cle nhdm nghien cUu cd xu hUdng cao hon so vdi nam, tuy nhidn su khac biet khdng ed y nghia thdng ke (p>0,05).
4. Ban luin
N I m 1986, tae g i l Nauckva es [11] da phat hien ra hien tupng g i l m hieu Ung incretin d BN DTD typ 2
thdng qua thUc nghiem thay d BN DTD typ 2 co hien tupng giam rd ret hieu Ung incretin so vdi doi tuanq ngUdi khde manh. Hien nay, cd nhieu nghidn ciJu de cap den van de ndng dp GLP-1 d BN DTD typ 2 da dupc edng bo. Ndng dp GLP-1 trong nghien aju nay tuong t u eua eac t i c g i l : Jakob Ryskjaer [6] nghien cdu tren 40 BN DTD t y p 2 mdi chan d o l n thIy nong dp GLP-1 trung binh khi ddi la 7,3 ± 0,6pmoW, ddoi tupng BN da dupe didu trj ndng dp GLP-1 trung binh la 10,2 ± 2,1 pmol/l khdng cd sU khIc bi^t giCia nong dp GLP-1 d ddi tupng BN sU dung eac nhom thu6c dieu trj DTD khIe nhau. T i e g i l Mai-Britt Toft- Nielsen (2001) [91 nghien edu tren BN DTO typ 2 [n = 54) thay ndng dd GLP-1 khi ddi trung binh la 6,6 ± 0,5pmol/l. Nghien eUu eua Tina Vilsboll va CS (2001) [13] tren BN DTD t y p 2 mdi ehan d o l n (tudi trung binh 52 nam, H b A l c t r u n g binh 9,2%) thay ndng do GLP-1 trung binh khi ddi I I 7,0± l,Opmol/lthaph0n c d y nghTa thdng ke so vdi ngudi khde manh (11,0±
l,Opmol/l). Daisuki Yabe va CS (2010) [4] thay nong dp trung binh eda GLP-1 khi ddi d BN DTD la 15,5 + l,7pmol/l khdng cd sU khIc biet vdi ndng dp GLP-1 d nhdm ngUdi binh thudng (15,7 ± l,Opmol/i}. Nhi/
v l y , ket q u i ndng dp GLP-1 trong nghien ciiuti/cjng ddng vdi mdt sd t i c gia, tuy nhien ndng dp GLP-16 nhdm BN DTD chan d o l n lan dau thap hon sov6i tac g i l Daisuki Yabe dieu nay cd the do su khac biet ve ddi tuong nghidn cUu, khIc biet ve chung toe, khac biet ve phuong p h I p , ky thuat djnh luong GLP- 1 v l khIc biet ngudn gdc xuat xU cCia bp KIT xet nghiem hormon.
Ket qua nghien cdu eua chung tdi cung thay, ndng do GLP-1 trung binh sau an d nhdm BN DTBtyp 2 chan doan lan dau thap hon cd)/ nghia thdng keso vdi nhdm ngudi binh thUdng (p<0,05). Hien nay c6 nhieu nghien eUu ve nhjp bai tidt GLP-1 sau cicbiJa an chuan d l dupe edng bd eho ket q u i tUOng ti^
Nghidn eUu eua L Pala va CS (2010) [8] tren 56 doi tupng nghidn cdu, trong dd ed 15 BN cd roi loan dung nap glucose huydt, 13 BN DTD X)tp 2 va 28 ngudi cd dung nap glucose huyet binh thUdng, sau khi eho ele dot tupng sU dung 75g dUdng bSng dudng uong. Ket qua nghien cUu cho thIy, sau 30 phut udng glucose, nong dp GLP-1 do dUOc 6 BN
TAP CHl YDl/OC LAM SANG 10 Tap 12-So 2/2017
DTD typ 2 va BN cd rdi loan dung nap glucose huyet deu t h I p hon so vdi ngudi cd dung nap glucose huyet binh t h u d n g . Tuy nhien khdng ed su khae biet cd y nghia thdng ke giUa ndng dp GLP-1 d ddi tUpng cd rdi loan dung nap glucose huyet va ddi tUpng cd DTO typ 2 (p>0,05). Vaag AA va CS (1996) [12], nghien cdu tren 12 BN DTD typ 2 va 13 ngudi binh thudng trong gia dinh khdng cd ai bj DTD, thay ndng dp GLP- 1 khi ddi trung binh eua ddi tUpng BN DTD g i l m cd y nghia thdng ke so vdi nhdm chiing (p<0,05). Kirsten Vollmer (2008) [7] va Daisuki Yabe v l es (2010) [4]
cung ghi nhan ndng dp eua GLP-1 d BN DTD t^p 2 tang cd y nghia thdng kd sau khi udng 75g glucose hole ele bUa I n chuan. Tuy nhien cae t i e g i l deu nhan thay khdng cd sU khac biet gida ndng dp GLP-1 sau I n d ngUdi binh t h u d n g va BN DTD.
Ket q u i nghien edu (Bang 4) cho thay ty le BN ed g i l m ndng dp GLP-1 khi ddi d nhdm BN DTD typ 2 ehan d o l n lan dau la 60,6%, ty' le BN cd g i l m ndng dp GLP-1 sau an la 9,1%. N h u vay, d BN DTD t y p 2 chan d o l n lan dau, ndng dp GLP-1 d trang thai co b i n g i l m nhieu hon so vdi sau an. Nhieu nghien eUu d l chUng minh GLP-1 mac du g i l m ndng dp eP b i n nhung ndng dp sau I n t h u d n g it thay ddi ma ehu yeu I I sU thay ddi v^ nhjp bai tiet GLP-1. So vdi ngudi binh t h u d n g ndng dd GLP-1 dupc bai tiet thudng dat dinh cham hon, nhung tang cao keo dai hon (khoing 2 - 3 gid sau I n ) , d ngudi binh thudng thdi gian 6i ndng d d GLP-1 quay t r d ve trang thai eo ban thudng 90 phut sau bOa an, dieu n l y phu hpp vdi sutang glucose m l u sau an [12]. Mac du dinh bai tiet GLP-1 d BN DTD t y p 2 thap hPn so vdi ngUdi binh thudng, nhUng ndng dp GLP-1 lai t i n g cao keo dai hon dieu nay ed the g i l i thich nguyen nhan la do su tang GM sau an d cda BN DTD typ 2. NhU chung ta da biet GLP-1 chju su kfeh thich bai tiet cda GM kha manh do d BN DTD t y p 2 GM sau I n t h u d n g tang rat eao va keo dai, khi ndng dp GM tang se kich thich te bao L dUdng rudt bai tiet GLP-1 lien tuc do dd ndng dp cOa nd t i n g eao trong huyet thanh. Mac du cd su tang bai tiet sau an nhung sU d i p Ung eua te bao L vdi su tang GM la cd gidi ban, vi v l y ndng
dp GLP-1 khdng the bai tiet dat ngUdng nham ha thap GM ve binh thudng.
Ket q u i nghien cUu (BIng 5) cho thay ndng dp GLP-1 trung binh khi ddi v l sau an cd xu hUdng giam 6 ddi tUpng > 60 tuoi d c l 2 nhdm, tuy nhien sU khIe biet ehua ed y nghia thdng ke (p>0,05). Ket q u i nghidn eUu cCia ciic t i e g i l Kirsten Vollmer va CS (2008) [7], Minako Yamaoka va CS (2010) [10] eung thay khdng cd mdi tuong quan giQa ndng dp GLP-1 so vdi tudi. Ket q u i nghien cUu nay eung t h I y ndng dp trung binh GLP-1 khi ddi d nU gidi cd xu hUdng cao hPn so vdi nam gidi, tuy nhien, sU khIe biet giUa 2 gidi khdng ed y nghTa thdng kd (p>0,05). Kdt q u i nghien cdu cua eae t i e g i l cung ed su khIc biet:
nghien cUu cua Vaag AA va CS (1996) [12] t h I y ndng dp GLP-1 d nUa eao hpn nam gidi. Kirsten Vollmer va CS [7] thay ndng dp GLP-1 d nU cao hon nam d e l ddi tupng duoc sU dung glucose bang dUdng udng va sau an (p<0,05). Minako Yamaoka va CS (2010) [10] lai thay ndng dp GLP-1 trung binh cda nam khdng cd su khIe biet so vdi nU...
Qua nghien edu 170 BN DTD typ 2 chan doan lan dau tai Benh vien Ndi tiet Trung UOng so s i n h vdi 52 ngudi binh thudng rut ra ket luan sau:
Ndng dp trung binh GLP-1 khi ddi la 7,31 ± 3,65pmol/l (cao nhat la 22,74pmol/l, thap nhat la l,53pmol/l}. Ndng dp trung binh sau an 2 gjd la 12,82 ± 4,37pmol/l (cao nhat la 21,65pmol/l, thap nhat la 3,04pmol/l).
Ndng dp trung binh GLP-1 khi ddi v l sau 2 gid l l m nghiem p h I p t i n g glucose m l u cda nhdm nghien cUu thap hon cd y nghTa thdng ke so vdi ngudi binh thudng {cle ndng dp cua nhdm chdng lan lupt: 12,97 ± 5,85pmol/l; 16,26 ± 6,79pmol/l;
p<0,05).
Ty Id benh nhan cd g i l m ndng dp GLP-1 khi ddi la 60,6%. TJ le benh n h i n cd g i l m ndng dp GLP-1 sau an 2 gid la 9,1%.
Ndng dp trung binh GLP-1 khi ddi eua eac nhdm nghien eUu khac biet khdng cd y nghia thdng ke d cac nhdm tuoi va gida nam vdi nOf {p>0,05).
JOURNAL OF 108 -CLINICAL MEDICINE AND PHARMACY
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