V i e t n a m J o u r n a l of Physiology 2 1 ( 1 ) , 3 / 2 0 1 7 I S S N : 1 8 5 9 - 2 3 7 6
alternatively: 5,33 ± 0,73 and 3,64 ± 0,36 (L), RV 1,34 ± 0,54 and 0,96 ± 0,39 (L), Raw 1.43 ± 0,59 and 2,37± 0,78 (cm H20/l/s). sRaw 4,67 ± 2,07 and 5,89 ± 1,83 (emH20.s).
The TLC and RV value is higher in male than in female but the Raw and sRaw is lower in male than female. The TLC, RV value is related positonally with height, weight. Raw value is related negatively and sRaw is dependent from these index. All TLC, RV, Raw and sRaw value don't change according to age. these index have the same value in two sex
Keywords: Body Piethysmogrph, total lung capacity (TLC), residual volume (RV), resistance in airways (Raw), specific resistance in airways (sRaw)
N 6 N G D p NT-ProBNP HUYfiT T U ' a N G C d GIA TRj C H A N DOAN SUY TIM TREN BENH N H A N SUY THAN MAN GIAI DOAN C U 6 l C 6 LOC M A U CHU KY
Nguyen Thj T u a n \ Pham Thj Thanh Thuy^
T 6 M T A T : Myc tieu: Xdc djnh nong dd NT-proBNP huyet twang cd gia tri chin dodn suy tim trdn bdnh nhan suy thdn man giai doan cudi dang Ioc mau chu ky vd xde dinh mdi twang quan giira nong do NT-proBNP huyet twang vai phan dd suy tim trdn ede bdnh nhdn trdn. Doi twgng va phwcng phap nghien cwu: ChOng tdi thye hidn nghien cieu tren 119 ngw&i dwgc phdn thdnh 3 nhdm, nhdm ehii'ng gdm 43 ngwai binh thwang khdng suy than va khong suy tim, nhdm nghien cieu 1(N1) gdm 32 bdnh nhan suy than nhung khdng suy tim, nhom nghidn ciru 2(N2) gdm 44 benh nhdn suy than ed suy tim. Kit qua:
Thiy diem cit nong dg NT-proBNP ed gia tri chin dodn suy tim tren benh nhan suy thdn m$n giai doan cuoi dang IQC mdu chu ky tdt nhit Id 1802.00 pg/ml (xdt nghidm NT- proBNP ed dg nhay Id 88,64% vd dd ddc hidu Id 84,37%, dipn tieh dw&i dw&ng cong AUC Id 0.945). Ndng dd NT-proBNP tdng din theo mu'c do suy tim: do I (2708,25 ± 1314.36 pg/ml), dd li (8098.77 ± 4523.40 pg/ml), do ill (14748,50 ± 9012.24 pg/ml) va do IV (30843,50 ± 9902,04 pg/ml) cd mdi twang quan thudn giira ndng do NT - proBNP va phan do suy tim.
* TO- khoa: Lge mdu chu ky, NT-proBNP.
, > t h i t nguc, suy tim, roi loan nhip chiem t y l e 1 . D A T V A N D E , * ,,.' , . . . . . . . . , . , , - , den 4 5 % a benh nhan suy than man giai NhOng bien chung tim mgch d bgnh . *• > ' j - .- . u ' • \- ..-
^ . . r . 7 . . ]. doan CUOI, trong do suy tim thuang ia hau n h i n suy than n h u bpnh maeh v i n h , dau ; *. . , - u- u *• u
' • qua CUOI cung cua cac bpnh tim mach khac nhau. Du vgy, viec chan doan suy tim ' Bgnh vign Trung U'ang Quan dpi 108 cho c i c bgnh n h i n nay Igi khdng de dang
• Tac gia ctiiu trach nhiem chinh: tjo s y triing lap c i c trigu chung ciia suy Pham Thj Thanh Thiiy (j^^ y^ g,jy (^^p p^y, pf^^^ g|g,m ggpg ^^^^^
Email: [email protected] 1^^^^ ^^^
Nqiy nhgn b i i : 19/12/2016 .,_ ' „ . , _ ,. „ . , . A . , , . ; K, t , L r,h4r, hifin oAMonntK NT-proBNP la mgt chat chi dau smh Ngay nhgn phan bign. 24/12/2016 > 1.= u .- j = - J ^ ^ Ngay chip nh§n dang: 28/12/2016 ^pc cua bgnh suy tim, de s u dung, nhanh
V i e t n a m Journal of Physiology 2 1 ( 1 ) . 3 / 2 0 1 7 I S S N : 1 8 5 9 - 2 3 7 6
chdng dae biet r l t tien lgi trong trudng hpp bgnh nhan n i n g . khd thd cap hogc gap khd khan d i lam sieu i m tim [3].
Tuy nhien, vai trd cua NT-proBNP van chua d u g c nghien cOu d l y dO d benh nhan suy than mgn giai dogn c u i i dang d i i u tn thay the th^n. X u l t phat tO eac ly do tren, ehiing tdi t i i n hanh de tai, vdl 2 muc tieu:
1. X i c dinh n i n g dp NT-proBNP huyet tuang cd g i i trj chan doan suy tim trdn bgnh nhan suy than man glal dogn c u i i dang lpc mau chu k^;
2. X i c djnh m i l tuang quan giOa n i n g dp NT-proBNP h u y i t tuong vdi phan dg suy tim trdn c i c bgnh nhan tren.
2. D 6 I TU'aNG VA PHU'aNG P H A P NGHIEN CllrU
2.1. Doi tu'O'ng nghien cu'u 119 ngudi d u g c chia thanh 3 nhdm - Nhdm chOng: 43 ngudi khde mgnh khdng suy t h i n , khdng suy tlm.
- Nhdm nghien cOu: chia thanh 2 nhdm + Nhdm N 1 : g i m 32 bpnh n h i n suy thgn dp 3A, 3B v i 4, khdng suy tim,
+ Nhdm N2: g i m 44 benh n h i n suy thgn dp 3A, 3B v i 4, cd suy tim.
2.2. Phvo-ng phap nghien cOu - Nghien cuu tien cuu, md t i e l t ngang cd so s i n h vdi nhdm doi chung.
- Tieu chuan chan doan suy tim: theo N Y H A v i E F % .
- Tieu chuan lya chpn: bgnh nhan suy t h i n do 3A, 38 va 4 cd loc m i u chu ky.
- Tieu e h u l n loai t r u : sdc. tang i p p h i i , hdi chOng suy hd hap c l p , COPD, thieu m i u ngng, khdng d i n g y tham gia v i khdng tuan thii diing qui trinh nghien cuu.
Bang 3.1. P h i n bo bpnh nhan theo IOa t u i i d nhom chOng v i nhdm bpnh n h i n suy than mgn cd Ipc m i u chu kJ
- C i c chi tieu nghign cOu: nong dp NT-proBNP, ehi so sldu am tim (EF%). X i c dinh NT-proBNP theo phuang p h i p mien djch dipn hda phat quang.
- XO ly s i lieu tren p h l n m i m SPSS 2 2 . 0 v i M e d C a l c 1 3 . 1 .
3. K i t q u a nghien cii'u va ban luan 3.1. Mpt so dgc d i i m cua doi tu'O'ng nghien cu'u
3.1.1. Dac diem vi tuii Nhan xet bang 3.1: Trong ca hai nhom, dp t u i i 50 - 70 c h i i m ty le cao n h l t so vdi c i c dd t u i i k h i c (48,84% d nhdm chOng v i 61,84% d nhdm nghien cOu). Cd le x u l t phat t o ly do day l i dp tuoi cd nhiiu thay doi v i sOc khde, ngi t i i t . K i t qua cho t h l y , khdng cd s y k h i c bipt ve ty Ig c i c dg t u i i giOa 2 nhdm (p > 0.05).
C i c h phan chia v i ty Ig cOa c i c dg t u i i trong 3b t i i cua chiing tdi phii hgp vdi nghien cuu cua N g u y i n T h i n h T i m trgn cung doi t u g n g l i nhOng bpnh n h i n suy thgn mgn tinh giai dogn c u i i dang dugc lpc m i u chu ky [5].
3.1.2. Phan bi b$nh nhdn theo phdn dd suy tim trong nhom N2
K i t q u i v i phan dp suy tim trong nhdm nghien cOu cho t h l y , bpnh nhan suy tim dp I chiem ty le cao n h l t l i 34.09%, dp 11 l i 29,55%, dp Ml la 22.73% v i suy tim do IV chiem ty Ig thap n h l t (13.64%). Nhu vgy tl le benh nhan suy tim giam dan t u dg I d i n dg IV. Theo mgt so nghien cOu, nguyen nhan chinh gay t u vong d bgnh nhan Ipc mau l i bgnh tim mgch [8], [10].
Tuii
Nhdm c h u n g Nhdm nghien cOu48,84
p > 0.05 p > 0,05 p > 0,05
V i e t n a m J o u r n a l of Physiology 21(1), 3 / 2 0 1 7 I S S N : 1 8 5 9 - 2 3 7 6
Bang 3.2. Ty l# benh Mi>c d o suy t i m
D o i Dp II D 6 I I I D o IV
nhan theo phan dg suy tim a CO lpc mau chu k^
S6 lu'O'ng (n=44) 15 13 10 6
benh nhan suy th^n man Ty l i %
34,09 29,55 22,73 13,64 3.2. Ket q u a xac d j n t i cac chi so nghien cu'u
3.2.1. C W s d NT-proBNP, EF(%) cua nhim Nl, N2
Bang 3.3. Chi so NT-proBNP, EF(%) cila nhom N l va N2
„ , . . , N h o m N I Chl s o , „,^^
(n=32) NT-proBNP (pg/ml) 2029,88 ± 1674,74
EF (%) 64,34±3,84 Nhom N2
(n=44) ' ' 11555,78 ±11976,58 < 0,001
52,84±10,93 < 0,001 Bang 3.4. Chi so NT- proBNP, EF(%) trong nhom N2 theo phan dp suy tim
Nhom N2 Cac c h i (n = 44)
s d Suy t i m d p 1 Suy t i m d o II n = 15(1) n = 1 3 ( 2 ) NT- 2708,25±1314,36 8098,77+4523,40 proBNP
p p(1-2) < 0,005; p(2-3) EF (%) 60,93+3,90 55,39±6,25
p p ( 1 - 2 ) < 0 , 0 5 ; p ( 2 - 3 ) ' Bang 3.5. So s^nh c^c chl so NT - proBNP,
Suy t i m dp III Suy t i m d o IV n = 10(3) n = 6 ( 4 ) 14748,50±9012,24 30843,50±9902,04
< 0,05; p(3-4) <0,01
46,00±8,06 34,80±13,14
< 0,05; p(3-4) < 0,01
EF% cua nhom N l vol nhom chirng Nhom
Cac chT s o Nhom chu'ng (n = 43) N T - p r o B N P (pg/ml) 92,16 ± 8 0 , 8 1
P
EF% 67,90 ± 5,78 P
Nhom N1 (n = 32) 1289,25 ± 636,00
< 0,001
64,34 ± 3,84
< 0,005
"~Chi so NT-proBNP ciia nhdm N2 (11555,78 + 11976,58) cao han {5lln) nhdm N l (2029,88 ± 1674,74) vdi p <
0,001, NT-proBNP d u g c phdng thich khi cd tang sOc nen huyet ddng hpc tgi tim (tOc t h i n h tim bl gian, phi dgi hogc t i n g i p l y e t i c dpng len t h i n h tim). NT-proBNP gia tang nong dd tren nhung benh nhan suy tim (bao gom c l suy tim tam thu v i
suy tim t i m truang). Ngugc Igl vdi NT- proBNP, chl so EF (%) ciia nhdm N l cao han nhdm N2 vdl p < 0,001.
Chl s i NT-proBNP cd s y khac biet giua c i c phan dp suy tim trong nhdm N2 vdl p
< 0,05 v i p < 0,005. T u g n g t y nhu v i y doi vd'i chl so EF(%). P h i n dp suy tim ty lg thugn vdi gia trj NT-proBNP va ty Id nghjch vdi gia trj EF(%).
V i e t n a m Journal of Physiology 21(1), 3/2Q17 I S S N : 1 8 5 9 - 2 3 7 6
K i t q u i trong nghien cOu ciia chiing tdi phli hgp vdl c i c nghien cOu tren bgnh n h i n suy tim man, cua cac tac gia nhu H o i n g Anh T i i n v i cpng s y [4], N g u y i n Thi Thu Dung, Dang Van Phudc [1], Nguyin Minh H i n g [2], Emdin [9]. K i t qua cung tugng dugng vdi nghien cuu tren cac benh n h i n suy than man dang lge m i u ehu ky cd suy tim eua cac t i e gia Nguyen T h i n h T i m , H o i n g Bui Bao [6], Anwaruddln [7].
C i hai nhdm d i u khdng bi suy tim nhung cd s y k h i c bigt rat Idn v i ehi s i NT-proBNP v i chi s i EF%. Gia trj chi s i NT-proBNP tren nhdm N1 la 1289,25 ± 636,00 cao hgn so vdi nhdm chOng (92,16
± 80,81) vdl p< 0,0001. D i i u nay cd t h i ly' giai bdi tinh trgng bpnh n h i n suy than man giai dogn c u i i , dang lpc m i u chu ky:
i 25000 : 2000D
- NT-ProBNP bl tich ty Igi trong m i u vi thgn g i n nhu khdng cdn chuc nang Ipc ndn khdng thai d u g c qua dudng tieu.
- Ap Iyc len t h i n h tam t h i t ciia benh nhan suy t h i n man dang lpc m i u ludn ludn cao do c i c nguyen nhan t i n g huyet i p , u nude, muoi vi than g i n nhu khdng cdn chOc nang lpc. Trong khi Ipc mau thi i p luc n i y Igi thay doi mdt c i c h dot nggt. d i y la y i u t i chinh kich thich tang t i i t NT- proBNP.
- T i c dp g i i n g hda eua NT-proBNP g l i m di trong hgi chOng tang urg m i u .
- o i l vdi loc m i u chu ky dung phuang phap lpc thdng thudng, thi NT-Pro BNP khdng d u g c lpc qua m i n g lpc, dp v i y nong dp NT-Pro BNP trong h u y i t tuong khdng giam sau khi Ipc m i u v i ludn r l t cao [7].
T"
Bieu d o 3.1. Tuang quan giua NT-proBNP v<^i phgn dp suy tim 2 0 . 4 9 2 S X
4 0 0 0 0 1- 3 5 0 0 0 - 3 0 0 0 0 -
? s n o n - 2 0 0 0 0 - 1 S O O O - -I o o o o - 5 0 0 0 ~
n
= 4 8 3 9 9 . 3 4 1 7 - - 0-7S09
x:
S u y Ttign = 1 Bieu do 3.2. T u a n g quan giua NT-proBNP vai EF%
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V i e t n a m J o u r n a l of Physiology 2 1 ( 1 ) , 3 / 2 0 1 7 I S S N : 1 8 5 9 - 2 3 7 6
Chl s i EF% cua nhdm N l (64.34 ± 3,84) cd s y khae biet so vdi nhdm chOng (67.90 ± 5,78) vdi p < 0,005. Do i p luc len t h i n h tam t h i t ciia benh nhan suy than mgn dang Igc mau bang than nhan tgo ludn cao (do tang h u y i t i p , 0 nude, m u i l ) , nen tam that d i n gian mdng va EF% g l i m d i n .
3.2.2. Twong quan cua nong do NT- proBNP voi phdn do suy tim va gia tri EF% cua cac benh nhdn
Cd m i i t u a n g quan t h u i n giua nong dp NT-proBNP va phan dp suy tim. Ndng dd NT-proBNP v i EF(%) ed m i l tuang quan nghjch mOc trung binh vdi r = - 0,7809.
Trong c i c nghien cuu, c i c t i e gia nude n g o i i d i cap d i n t i m quan trgng cua s y lien hg giua ndng dp NT-proBNP vdl c i c b i i n c i tim mgch, suy tim sung h u y l t va ty le t u vong d nhdm benh nhan
suy than man glai doan c u i i . Ban than NT-proBNP khdng ggy ddc eho tim, nhung NT-proBNP chinh la san p h l m cua tinh trang tang ganh eho tim gay ra, nd l i hgu qua cua nhi>ng rdi logn tim mgch trong suy than man va cung chinh la d l u i n chi d i i m cho tinh trang bpnh [7].
3.3. Gia trj chan d o i n suy tim cua chi so NT-proBNP huyet t u c n g
Bang 3.6. G i i tn chan doan suy tim ciia chi so NT-proBNP h u y i t tuang g benh nhan suy than mgn ed lpc m i u chu ky Diem cat NT-
proBNP (pg/ml) 1530 1802
2152
Dp nhay (%) [Cl 95%]
95,45 [ 8 4 , 5 - 9 9 , 4 ]
88,64 [ 7 5 , 4 - 9 6 , 2 ]
81,82 [ 6 7 , 3 - 9 1 , 8 ]
Do dac hieu (%)[CI 95%]
65,62 [ 4 6 , 8 - 8 1 , 4 ]
84,37 [67,2 - 94,7]
93,75 [79,2 - 99,2]
L R ( + ) [Cl 95%]
2,78 5,67 13,09
LR(-) [Cl 95%]
0,07
0,13 0,19
Dien tich du'6'1 du'O'ng cong
[Cl 95%]
0,945
TT sd kha dT (Likelihood ratio) d u a n g (LR(+)) v i tr sd kha dT am (LR(-)) la hai thdng s i ndi tai cua xet nghiem, nd khdng chju anh h u d n g bdi t i n s u i t cua mau nghien cOu. Hai thdng so nay t u a n g ddi d l s u dung nen ngay cang d u g c khuyen cao trong y van. N i u tl sd kha dT d u a n g > 10 thi xac s u i t mac benh r l t cao khi k i t qua d u a n g , n i u ti sd kha dT am ^ 0,1 thi x i c s u i t mac bgnh r l t thap khi k i t qua am (vdi d i i u kign x i c s u i t m i c benh t r u d c khi l i m xet nghigm la tren d u a l 50%) [5].
Chung tdi chpn diem c i t ndng dp NT- proBNP cd g i i trj c h i n doan suy tim t i t n h i t trgn benh nhan suy thgn mgn la 1802 (pg/ml). Tai do xet nghiem NT-proBNP cd dp nhay l i 88,64% v i dp dac hieu l i 84,37%. Khi ndng dp ndng dp NT-proBNP
dudi 1530 (pg/ml), cd the g i n nhu logl trO suy tim (LR(-) = 0,07). Khi ndng dd nong dd NT-proBNP trgn 2152 (pg/ml), cd the chan d o i n suy tim r l t chac c h i n (LR(+)
=13,09). Gia trj n i n g dp NT-proBNp cd s y gia t i n g theo dp tuoi. tuy nhien do m l u nghien cOu nhd cho nen chiing tdi khdng tinh d i i m cat theo dp tuoi.
Dlpn tich dual d u d n g cong ROC- Area under the ROC curve (AUG) la 0.945 (nam trong khoang 0,9-1,0) nhu v i y dd chinh x i c cua xet nghiem NT-proBNP trong chan d o i n suy tim la rat tot.
4. K^T LUAN
1. Diem cat ndng dp NT-proBNP cd g i i trj e h l n d o i n suy tim tren bgnh nhan suy than mgn giai doan c u i i dang lpc m i u chu ky tot nhat l i 1802 pg/ml. Xet nghipm NT- proBNP cd dd nhgy l i 88,64% va dp dac
V i e t n a m Journal of Physiology 2 1 ( 1 ) , 3 / 2 0 1 7 I S S N : 1 8 5 9 - 2 3 7 6
hipu l i 84,37%, dipn tich d u d i d u d n g cong AUC l i 0.945.
2. Nong dp NT-ProBNP a benh n h i n khdng bi suy tim nhung suy t h i n mgn giai dogn CUOI dang Ipc mau chu ky (1289,25 ± 636,00 pg/ml) cd k h i c s y biet so vdi nhdm chOng (92,16 ± 80,81 pg/ml) vdi p< 0,0001.
Nong dp NT-proBNP tang d i n theo mOc dp suy tim: dp I (2708,25 ± 1314,36 pg/ml), dg ll (8098,77 ± 4523,40 pg/ml), dp 111 (14748,50 ± 9012,24 pg/ml) va do IV (30843,50 ± 9902,04 pg/ml).
Cd m i l t u a n g quan t h u i n glOa nong dp NT-proBNP va p h i n dg suy tim.
TAI LiEU THAM K H A O 1. N g u y i n Thj Thu D u n g , Dang Van Phu'd'c (2010), M i l tugng quan giua NT- proBNP vdi c i c giai dogn trong q u i trinh t i i n t r i i n cua suy tim, Hdi Tim mgch Hoa Ky, Chuyen d i Tim mach hoc. 3-2010, tr.
22-28.
2. N g u y i n Minh H o n g , Nguyen Thj Thuy, N g u y i n Van Q u y n h v i cs (2012), Nghien c u u s y b i i n d i i n i n g do NT- proBNP d bgnh n h i n suy tim mgn tinh do tang h u y i t i p , Tgp chi Y d u g c l i m sang 108, s6 05, tr.8-13.
3. £>ang Van Phu'd'c (2009), D l u I n sinh hpc NT-proBNP trong c h i n d o i n suy tim.
4. Hoang A n h T i i n , Huynh Van Minh, Le Thj Phuxyng A n h va cs (2009), Danh g i i s y b i i n doi nong dg NT-proBNP t r u 6 c v i sau dieu trj ndi khoa tfch c y c d bgnh nhan suy tim mgn, Tgp chi Npi khoa, tr.
823-829
5. Nguyen Thanh Tam (2011), G i i tri chan d o i n suy tim ciia BNP h u y i t t u a n g d benh n h i n suy t h i n mgn giai dogn c u i i chua d i i u tn thay t h i t h i n . T g p c h i Y H o c T P H C M . 1 5 ( 1 ) : 4 6 1 .
6. V o Van V a n , Hoang Biii B i o , Huynh Van IVIinh (2009), Nghien cuu n i n g dp N-Termlnal B-type Natriuretic peptide h u y i t t u o n g t r u d c v i sau lpc m i u d bgnh n h i n suy than mgn giai dogn c u i i , Tgp chl y hpc thyc h i n h Bg Y te, s i 658+659, tr. 534-538.
7. A n w a r u d d l n S, Lloyd-Jones OM, Baggish A et al (2006), Renal function congestive heart failure, and amlno- termlnal pro-brain natriuretic peptide measurement: results from the ProBNP Investigation of Dyspnea In the Emergency Department (PRIDE) Study. J Am Coll Cardiol. 47(1):91-7.
8. Cleland JCF, Carubelli V, Castlello T, et al (2012), Renal dysfunction in acute and chronic heart failure: prevalence, incidence and prognosis. Heart Fail Rev, 17:133-149.
9. Emdin M, Passino C, Prontera C et al (2007), Comparison of brain natriuretic peptide (BNP) and amino-termlnal ProBNP for early diagnosis of heart failure, Clin Chem., 53(7):1289-97.
10. Hickman PE (2011), Biomarkers and Cardiac Disease in Patients vi/lth End- Stage Renal Disease on Dia lysis.,Clin Biochem Rev, 32(2);115-9.
SUMMARY
CONCENTRATION OF NT-PROBNP IN PLASMA
THERE ARE VALUE DIANOSTIC HEART FAILURE IN PATIENTS WITH CHRONIC RENAL FAILURE CYCLE FITER BLOOD
Nguyen Thi Tuan^ Pham Thi Thanh Thuy^
^National Central Military Hospital No 108 Objective: Identify the role of NT-proBNP testing in heart failure diagnosis and to determine the association between NT-proBNP and grading of heart failure in patients
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V i e t n a m Journal o f Physiology 2 1 ( 1 ) , 3 / 2 0 1 7 I S S N : 1 8 5 9 - 2 3 7 6
with chronic renal failure, who were having periodic dialysis. Subject and method: Cross- sectional study of 76 patients. Result: The best cut point of the concentration of NT- proBNP which has diagnostic value for heart failure in patients with chronic renal failure, who were having periodic dialysis is 1802 pg/ml (NT-proBNP testing had a sensitivity of 88.64% and a speciffeity of 84.37%, area under the curve AUC is 0.045). NT-proBNP concentration increases with the level of heart failure: Level I (2706.25 ± 1314.36 pg/ml).
level II (8098.77 ± 4523.40 pg/ml), level III (14748.50 ± 9012.24 pg/ml) and level IV (30843.50 ± 9902.04 pg/ml). Conclusion: There are positive correlation between the concentration of NT - proBNP and the level of heart failure.
Keywords: end-stage chronic renal failure, heart failure, periodic dialysis, NT-proBN.
TlNH TRANG DINH DU'ANG V A DAC D I E M K H A U P H A N AN C D A T R £ E M 1-5 T U 6 l TAI CAC TRU'ONG M A M NON
TREN D j A B A N T H A N H P H 6 VINH, NGHE AN
N g u y i n Ngoc H i e n ' "
T 6 M T A T : Nghidn ciru md fa tinh tr^ng dinh dwang vd khiu phin dn & tre em 1-5 tudi tai cac trw&ng mim non trdn dia bdn thanh phd Vinh, Nghd An. Cd 980 tre mim non 1-5 tudi dwgc lya chgn eho nghien cieu bdng phwang phdp chgn miu ngiu nhien phdn ting.
Kit qua nghidn cwu eho thiy: Trung binh z-seore can n$ng/tudi (Waz) Id 0,027 (g5% Ci -0,073 - 0,134); Trung binh z-score chieu caoAudi (Haz) Id -0,727 (95% Cl -0,821 - - 0,633). Cd 18 tre (1,83%,) suy dinh dwang thd nhe edn, 84 tre (8.57%,) tre suy dinh dwang the thip coi va cd 47 tre (4,79%>) thira can; trung binh khiu phin ciJa tre 1-2 tudi. 2-3 tudi, 3-4 tuoi vd4- 5 tudi cd miec trung binh khiu phin thyc te tin iwgt la 956 keal (dat 81,0% khuyin nghj), 1026 keal (d$t 86.9% khuyin nghi), 1138 keal (dat 96,4%, khuyin nghj) vd 1322 kcai (dat 89,9% khuyen nghj).
TIP khda: Dinh dwang, khiu phin, mim non, nghd an.
, . ^ tuoi) a trd em d u d i 5 tuoi da g i i m tO 1 . D A T V A N D E ^ ^^ ^ . ^ 2001 x u i n g cdn 17,5% nam
Tinh trang dmh d u g n g cua tre em Viet _ „ , _ . ^^-, _ _ „ , ^ _ j . u J -
• =* . > , - , .- 2010 va 14% nam 2015. Suy dmh duang Nam trong ba thap ky qua da d u a c eai ^^^ ^. * •• , u " * - * •<-\ - * -
. . X ^^ \ •• . 1 ^ - 1 . the t h l p COI (chieu cao tren tuoi) a tre em thien dang ke. Dieu tra giam sat dmh . .. ,. . x. .- .. ., .r, AO/ - ~ i n n ^
^ , .,.- r,. .. J - d u a l 5 tuoi da giam t u 43,4% nam 2000 du'ong hang nam oua Vien Dmh du.o.ng ^ . ^ ^9,3% nam 2010 va 24,9% nam cho thay suy dinh dl^ong o tre em d u d i 5 ^ ^ ^ ^ ^^ ^^^ ^.^^ ^^^ ,. ,^, tuoi da giam deu va ben vung. Ty lg suy > , , . . . : , . 1 * • • ,1 * A _ ^u- =
^ t . , , / . , o Viet Nam. hign tai eu 4 tre em thi van dinh d u a n g the nhe can (can nang tren . J * • u- j ' u J - l u *
^ . \ . w ^ ^ ^ .| j^g 1^1 gLiy jjipj,^ duang thap coi.
Cd r l t n h i i u nguygn nhan dan d i n suy
^Trudng Dal hoc Vinh dinh d u d n g , mpt trong nhung nguygn ' T a c gia chju trich nhiem chinh: n h i n do li^dinh d u d n g khong hgp 1;^ bao
Nguyen Ngpc Hien gdm ca t h i i u v i thOa dinh d u d n g [2]. S i Fmail: [email protected] Ijgu khao s i t tinh trgng dinh d u d n g khu Ngay nhgn bai: 24/10/2016 vuc Dong Nam A (South East Asian Ngay nhgn phin bign: 30/11/2016 ^^^^.^-^^ Survey - SEANUTS) cho t h l y d
Ngiychlpnhandang'26/12/2016 '
