JOURNAL OF 108 - CLINICAL MEDICINE A N D PHARMACY Vol.12 - N°5/2017
Khao sat n6ng do amylase huylt thanh o* benh nhan benh than man tinh giai doan cudi
Survey on concentration of serum amylase of end stage kidney disease patients
L6 Quang Hai*, *Benh vien da khoa Ndng Nghiep Nguyen Hmi Dung**, **Benh vien Bgch Mai Nguyen Thi Thu Hmmg***, ***Senh vien Thgn Hd Noi Le Vift Thang**** ****Benh vien Qudny IOS
Tom t i t
Muc tiiu: Xac djnh ndng do amylase mau va mdi lien quan vdi mot sd dac diem benh nhan benh thin man tinh giai doan cuoi. Bo/ tugng vd phuang phdp: Nghidn cdu cat ngang tren 108 b^nh nhan b&nh than man tinh giai doan cuoi cd mde Ipc cau than <15ml/phut/1,73m^ da (51 benh nhan chda Ipc mau, 57 benh nhan than nhin tao). Kitqud: Nong dp amylase mau trung binh nhom b&nh nhan la 82,0 + 40,1 U/L Co 74,1% benh nhin tang nong dp amylase mau. Khdng cd sii khac biet ve nong dp trung binh vaty'luting amylase m l u d nhdm benh nhan co va chda Ipc mau. Ndng dp amylase m l u tUOng quan nghjch vdi mdc Ipc cau than d nhdm benh nhan chda Ipc m l u , tUdng quan thuan vdi nong dp creatinine, cholesterol va triglyceride mau, vdi hesotuongquan lan li/ptla r = - 0 , 3 1 ; 0,31; 0,32; 0,35, p<0,05. Ket/uan; Tang amylase m l u la pho bien d b^nh nhan benh than man tfnh giai doan cuoi.
Tdkhda: B§nh than man tfnh giai doan cuoi, amylase huyet thanh, mdc Ipc cau than.
Summary
Objective: Determine the serum amylase level and its relation to some features of patients with end stage kidney disease. Subject and method: A cross-sectional study on 108 patients diagnosed with end stage kidney disease with glomerular filtration rate < 15ml/min (51 non-dialysis and 57 hemodialysis). Result: Average serum amylase level was 82.0 ± 40.1 U/L; 74.1% of the patients had increased serum amylase level. There was no significant difference in the rate and the average level of serum amylase between non-dialysis and hemodialysis patients. Serum amylase concentration negatively correlated to glomerular filtration rate, but positively correlated to serum creatinin, cholesterol, and triglyceride (r = -0.31; 0.31; 0.32; 0.35 respectivelly, p<0.05). Conclusion: Increase of serum amylase was common in end stage kidney disease patients.
Keywords: End stage kidney disease, serum amylase, glomerular filtration rate.
1 . Oat van de dieu trj than suy man tinh pho bien tai Viet Nam cho o- . ,. . - u • . * - nhdng benh n h i n benh than man giai doan cuoi.
Benh than man tmh giai doan cuoi ngay cang , , . T, ' . , . . ^. I u- *.,« i^,- A.Mr- rir <:in
„ • *- TU" L- L , . , . • . . . Mac du qua t n n h t h i n nhan tao Ipc ddoc cac san gia tang.Than nhan tao chu ky la mot phdong phap . . . Z. . , '. -^^ u„.i „ i „ , ..ro rroatinin ' • ^ y f t^ pham CUOI cung cua chuyen hoa nhd ure, creaiinm
• m l u . . . r a khdi co the de 6n dinh ndi mdi, tuy nhien
Ngdynhqnbdi: 15/02/2017. ngdy chap nhun ddng: 02/03/2017 nong dp cac chit nay van cao d nhdng ngay khong
Ngudi phdn hdi: Le Viet Thang, loc mlu. Nhdng roi loan tren ciiC ca quan d benh
Email: [email protected] - Benh vien Qudny 103TAP CHf Y Dl/OC LAM SANG 108 Tap12-S6 5/2017
nhan than nhan tao van con trong do ed eO quan tieu hoa. Tang amylase mau la bieu hien hay gap d benh nhan benh than man tfnh ndi ehung, benh nhan than nhan tao ndi rieng. Nhi^u nghien edu cho t h I y tang amylase mau khdng p h l i bieu hien cua viem tuy cap ma do mdc Ipc cau than g i l m . CJ Viet Nam cd it cdng trinh nghien cdu ve ndng dp amylase m l u d benh nhan benh than man tinh. Xuat phat t d nhdng ly do tren, ehung toi thde hien de tai nay vdi 2 muc tieu Khdo sdt nong do amylase huyit thanh d binh nhdn binh thdn mgn tfnh cd mdc loc cau than < 15ml/phut/1,73m^ da. Xdc dinh Hen quan nong dd amylase huyit thanh vdi mdt so ddc diem binh nhdn binh thdn man tinh giai dogn cudi 2. Ooi tuong va phUdng phap
2.1. Doi ti/ang
Ddi tdong la 108 benh nh§n benh than man tinh giai doan cudi (nhdng b§nh nhan cd mdc Ipc cau than (MLCT) < 15ml/phut/1,73m^ da) trong do cd 51 benh nhan chda Ipc mau v l 57 benh nhan than nhan tao (TNT) chu ky).
Tieu chuan chpn benh nhan: CIc benh nhan cd nguyen nhan benh than man ia viem cau than man va viem than be than man. Nhdm benh n h i n Ipc mau cd thdi gian than nhan tao chu ky > 3 t h i n g , Ipc mau bang qua Ipc cd he so sieu Ipc t h I p . Dieu tri Xh\iu mau, tang huyet ap ca the h o i theo hu"dng d i n cCia Hpi than hpc Qudc te. Dong y tham gia nghien cdu.
2.2. Phuang phdp
Nghien edu tien edu, m d ta, cat ngang nhdm benh n h i n nghien cdu.
Benh nhan ddoc hdi benh sd, kham l l m sang.
Cac xet nghiem can lam sang bao gom: Xet nghiem cdng thde mau, sinh hoa mau cle ehi sd:
Glucose, ure, creatinine, protein, albumin, cholesterol va triglyceride.
Nhdm benh nhan chda Ipc mau dddc tfnh MLCT theo cdng thde MDRD theo gidi, tuoi, nong dp ereatinin m l u . . .
Dinh luong amylase mau
Lay 5ml mau tTnh mach trade cupc loc mau vdi benh nhan Ipc m l u , vdi benh n h i n chua Ipc mau lay mau vao buoi sang sdm sau ngay vao vien.
M l u khdng chdng dong, dUOc ly tam tach huyet thanh.
Phdong phap djnh Idpng: Bang phddng phap enzyme.
Don vj tinh: U/L.
X l c djnh tang amylase mau: So vdi gia tri labo xet nghigm. Tang khi nong do amylase huyet thanh
> 90U/L.
Sd lieu dupc x d ly bang t h u l t t o l n thong ke y sinh hoc theo chuong trinh SPSS gom: So sanh cae bien dinh li/ong bang Test-T, nhieu bien dinh lupng bang ANOVA, cae bien dinh tinh va ty ie % bang X l
3. Ket qud
Tuoi trung binh 55,55 ± 13,06 tuoi, ty le nam la 38,9%, n d chiem 61,1%. Nhdm loc mau ed thdi gian TNT trung binh la 67,3 ± 39,4 t h i n g . Nong dp hemoglobin trung binh la 119,44 ± 18,62g/L.
3.1. Ddc diim nong do amylase mdu nhdm benh nhdn nghien cthi
Bdng 1 . Nong do amylase mau trung binh nhom nghien cUu
Amylase mau X±SD(U/I) Thap nhat Cao nhat
Nhom chua loc mau (n = 51) 86,82 ±12,01
19 175
Nhom loc mau (n = 57) 77,74 ± 9,88
22 160
Chung 82,0 ± 40,1
19 175
P
>0,05
Nong dp amylase mau trung binh nhdm benh nhan suy than man tfnh chda loc mau khdng khIe biet so vdi nhdm loc m l u , p>0,05.
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY
B i n g 2. Dac ^ e m nong do amylase mau nhom nghien cuTu (n Dac diem
Binh thudng (< 90U/I) Tang (> 90U/I)
S6 b&nh nhan 28 80
Vol.l2-N"5/2017
= 108) TJIe%
25,9 74,1
Nhdm benh n h i n benh than man tfnh cd MLCT < 15ml/phut/1,73m^ da cd tdi 74,1% benh n h i n tang nong dp amylase m l u .
Bdng 3. So sanh t$ le tang amylase giuCa 2 nhom loc mau va chUa loc mau
Amylase mau Blnh thudng (s 90U/I) Tang(>90U/l)
Nhom chua loc mau (n = 51) So benh nhan
16 35
TJIe%
31,4 68,6
Nhom loc mau (n = 57) SdbSnhnhdn
12 45
TJIe%
21,1 78,9
P
>0,05 Khdng ed sd khIe biet ve ty' le tang amylase mau gida nhdm benh nhan benh than man tfnh giai doan cudi cd va chda cd Ipc mau, p>0,05.
3.2. Mdi lien quan nSng do amylase mdu vdi mot so dac diim binh nhdn nghiin cCfu
Bdng 4. Lien quan nong do amylase mau vdi gidi (n = 108) GioH
Nam(n = 42) Na(n = 66)
P
Nong do amylase trung binh (U/L) 79,31 ±11,18 83,03 ±10,44
>0,05 Nong do amylase mau khong lien quan den gidi, p>0,05.
Bang 5. Lien quan nong dd amylase mau vdi thai gian loc mau (n = 57) Thdi gian loc mau (nam)
< 1 ( n = 11)
< 5 ( n = 15) 5 - < 1 0 ( n = 18)
> 1 0 ( n = 13)
p ANOVA
Nong dd amylase trung binh (U/L) 82,24 ±15,56 84,63 ±16,18 81,18±14,49 81,14± 14,12
>0,0S
Khong cd sd khac biet nong do amylase mau trung binh gida nhdm benh nhan ed thdi gian Ipc mau khac nhau, p>0,05.
Bdng 6. Tddng quan giiJia amylase mau vdi MLCT va mot so chi tieu sinh hoa mau d nhom nghien cUu (n = 108)
Chi so MLCT (n = 51) Ure
Creatinin (n = 108) Albumin Cholesterol Triglycerid
r -0,31 0,067 0,31 0,042 0,32 0,35
P
<0,05
>0,05
<0,05
>0,05
<0,05
<0,05
Phuong trinh tUtfng quan Amylase =-1,6317 XMLCT+111,46 Amylase = 337,2 x Ure -i- 76,343 Amylase = 0,0429 x Creatinin + 56,282 Amylase = 345,4 X Albumin-H02,34
Amylase = 9,645 x Cholesterol + 40,415 _ Amylase ^ 9,6048 x Triglycerid + 64,48 _
TAP CHlYDUCJC LAM SANG 108 Tap12-S6 5/2017
Co moi t d o n g quan thuan ed y nghTa gida nong dp amylase huyet thanh vdi creatinin, eholesterole va triglycerid huy^t t d a n g , taong quan nghjch vdi mdc Ipc cau than, p<0,05. Tuy nhign, khong cd tddng quan gida ndng dp amylase huyet thanh vdi ndng d d ure va albumin huyet t u o n g .
4. Ban luan
Td nhdng ket qua nghtSn edu tren, chdng toi dda ra mpt so y kien ban luan sau:
4.1. Dac diem nong do amylase mdu nhom benh nhdn nghien cvfu
Trong nghien cdu cCia chung toi, nong do amylase mau trung binh nhdm benh nhan suy than man tinh chda Ipc m l u khdng k h I c biet so vdi nhdm loc m l u , p>0,05. Lee SY va cong sd (2005) tai Han Qudc da nghien cdu 344 benh nhan trong d d 95 benh nhan loc mang bung, 105 benh nhan than nhan tao, 71 benh nhan ghep than va 73 benh nhan suy than chda dieu trj thay the. Ket q u i cho t h I y ndng do trung binh amylase m l u nhdm benh n h i n nay t i n g cao ed y nghTa so vdi nhdm chdng, p<0,001. Nguyen nhan tang amylase m l u la do than g i l m chdc nang, dan den dao thai amylase khdng ddpc g l y d lai amylase mau, day la ly do chfnh dan den tang amylase mau d benh nhan suy than man tinh (STMT). Chfnh vi vay, tang amylase m l u d benh nhan STMT thddng khdng kem theo bieu hien viem tuy hole tuyen nu'dc bpt. Mde dp tang amylase mau khdng cao so vdi nhdng ton thdong d p tfnh tai tuy nhd viem tuy, hoai t d t u y e n . . .
Ket q u i chung toi eho thay nhdm benh n h i n benh than man tfnh co MLCT < 15ml/phut/1,73m^
da CO tdi 74,1% benh nhan tang ndng dp amylase m l u . Bastani B va cpng sd (1987) nghi&n cdu nong dp amylase mau d 87 benh nhan trong do cd 43 benh nhan STMT than n h i n tao chu ky, 22 benh n h i n loc mang bung v l 22 benh nhan STMT chda loc mau. Ket qua cho t h I y cd tdi 75% benh n h i n cd ndng dp amylase mau t i n g hon mdc binh t h u d n g . Nasir K v l Ahamd A (2012) trong nghien cdu cua minh da t h o n g bao trong 247 benh n h i n benh than man tinh bao g o m c l nhdng benh n h i n Ipc mau chu ky v I o n h i p vi$n vdi bieu hien nghi ngd viem tuy cap, chi cd 17,4% benh nhan cd tang amylase mau.
Khong cd sd khac biet ve ty le tang amylase m l u gida nhdm bSnh nhan b&nh than man tfnh giai doan cuoi ed va chda ed Ipc mau, p>0,05. Nhdm benh nhan benh than man tfnh giai doan cudi cd v l chda cd Ipc mau deu cd tang ndng dp amylase mau, tuy nhien t^' le tang khdng cd sd khIe bi&t. Nhdm bdnh nhan TNT chu k j , mac dCi each ngay duoc Ipc mau, tuy nhien nhdng ngay khdng Ipc, ndng dp ure, creatinin van cao, benh nhan thudng vd nieu nen viec t h I i amylase qua nddc tieu bi han che, do vay ty le tang khdng cd sd khac biet la hop ly.
4.2. Moi lien quan nong do amylase mdu vdi mot so dac diem benh nhdn nghien cdru
Trong nghien edu n l y chOng tdi thay rang ndng do amylase mau trung binh d 66 benh nhan n d la 83,03 ± 10,44U/I, d 42 benh nhan nam la 79,31 ± 11,18U/i, g i l tri trung binh ed khIc nhau, tuy nhien khi kiem dinh ehung tdi khdng thay sd khac biet, p>0,05. Chung tdi cho rang, amylase mau tiet ra bdi tuyen tuy va c l e tuyen nddc bpt, nhdng tuyen nay I I nhdng tuyen ngoai tiet, viec tiet cae emzyme khdng lien quan den cac tuyen ndi tiet.
Khdng cd su khac biet nong dp amylase m l u trung binh gida nhdm benh nhan cd thdi gian Ipc mau khac nhau, p>0,05. Ket qua nghien edu cho thay ndng dp amylase mau d eac nhdm benh nhan cd thdi gian Ipc mau khIc nhau la khIc nhau. Nhdm benh nhan ed thdi gian Ipc m l u > 10 n I m cd nong dp amylase m l u trung binh thap nhat (81,14 ± 14,12U/I), nhdm benh nhan cd thdi gian Ipc m l u t d 1 - 5 nam cd nong dp amylase m l u I I cao n h l t (84,63 ± 16,18U/I), khIc bidt khdng ed y nghia, p>0,05. Nhd vay rd rang rang, ndng dp amylase m l u khdng lien quan den thdi gian Ipc mau. Nhieu nghien edu eho thay ndng do amylase m l u ehi I n h hddng trddc va sau cupc Ipc, cdn thdi gian ipc mau it I n h hudng den bien ddi amylase mau. Benh nhan STMT giai doan cudi sd dung than n h i n tao la phuong phap dieu tri, cac chdc nang cda than
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY VoL12-N''5/2017
khdng ddoc TNT dap dng day du d i e biet eac chdc nang ndi tiet. Mac du q u i trinh ipc mau ed sd dung thudc chong ddng va djch Ipc la nhdng chat I n h hudng den mdc dp tiet amylase m l u , tuy nhien, thdi gian ban huy cua c h i t chdng ddng thap, va thddng khdng ton tai trong mau sau 24 gid nen anh hddng eua cac chat nay len q u i trinh lau dai la khdng cd, chinh vi v l y thdi gian loc mau khdng lien quan den nong dp amylase mau.
Trong nghien edu ehung tdi cd 51 benh n h i n STMT chua Ipc m l u , nhdng benh nhan nay chung toi tim moi lien quan gida MLCT vdi nong dp amylase mau. Ket qua cho thay ed moi tUong quan nghjch mdc dp vda, cd y nghTa gida MLCT va nong dp amylase m l u , r = -0,31, p<0,05. Ket q u i nay cua ehung tdi phu hpp vcri cac ket q u i nghien cdu trong va ngoai nudc. Lee SY va cong su (2005) nghien edu ndng dp amylase mau eua 344 benh nhan suy t h i n man trong do cd 73 benh n h i n STMT chua dl^u tri thay the than. Ket qua cho thay cd mdi tUdng quan nghjch cd y nghTa gida he so thanh t h I i creatinin npi sinh vdi nong dp amylase mau, r= -0,148, p=0,012).
Nguyen €)inh Do va cpng sU (2000) nghien cdu 192 ddi tddng trong do ed 35 ngddi binh thudng, 157 benh nhan STM d eac giai doan khac nhau chUa Ipc mau chu ky. CIc doi tuong ddpc djnh lUong nong do amylase mau. Nhdm STM amylase m l u , lan Idot cda cle giai doan la: 286 ± 42U/I (giai doan I), 424 ± 73U/I (giai doan II), 529 ± 57U/I (giai doan III), 676 + 190U/I (giai doan tV). Nhd vay, theo Nguyen Oinh Op ndng dp amylase m l u tang d nhdng benh benh STMT d i e biet mdc tang lien quan den giai doan suy than man.
Ozkok A va cdng sd (2013) thay moi tUong quan thuan cd y nghTa gida nong dp amylase mau va nong dp creatinin m l u trong nghien edu 230 benh nhan benh than man tfnh, r = 0,173, p=0,009.
Ket qua nghien cdu eua chdng tdi eho thay co moi tdong quan thuan gida amylase m l u vdi nong dp cholesterol; triglycerid mau, r = 0,32; 0,35, p<0,05.
Ket q u i nay phCi hpp vdi eac nghien cdu cda cac t i e g i l nudc ngoai v l rd trong co che benh sinh cua rdi loan lipid mau. Nhieu nghien cdu da chi ra moi lien quan gida tang triglycerid vdi viem tuy d benh n h i n STMT va khdng STMT. Khi d i n h g i l ve c l e nguyen
nhan gay viem tuy: Sdi mat va nghien ruou la nguyen n h i n eua k h o i n g 80% trudng hop vi#m tuy.
Tang triglyceride m l u la nguyen nhan ddng hang t h d nhi, chiem k h o i n g 1 - 4 % sd trudng hpp (co nghien edu cho thay chiem den 7%). Cd sU lien he gida tang tnglyceride m l u mdc dp trung binh v6i viem tuy, trong khi nhdng tri sd Idn hon lOOOmg/dL se ed nhieu kha n I n g dan den viem tuy. Van cln nhieu nghien cdu sau hon ve moi lien quan giife tang amylase m l u vdi cac dac diem benh nhan benh than man tinh, de dda ra ddoc nhdng nhan xet toan dien hon.
5. Ket luan
Qua nghidn cdu nong do amylase mau d 108 benh nhan benh thcin man tfnh giai doan cuoi, chung tdi rut ra mpt vai nhan xet sau:
Nong dp amylase m l u trung binh nhdm benh nhSn I I 82,0 ± 40,1 U/L Co tdi 74,1% benh n h i n ting nong dp amylase m l u . Khdng cd sd khac biet ve nong dp trung blnh va ty le tang amylase mau d nhdm benh nhan cd va chda Ipc mau.
Nong dp amylase mau tuong quan nghjch v6i mde loc cau than d nhdm b^nh nhan chua Ipc mau, tuong quan thuan vdi nong dp creatinine, cholesterol va triglyceride m l u , vdi hi so tdong quan lan lUOt la r = -0,31; 0,31; 0,32; 0,35, p<0,05.
Tai lieu t h a m khdo
1. Nguyen Binh Dp, H I Hoang Kiem, Biii Ba Minh (2000) Thay doi ndng do amylase mdu trong viim cau than mgn. Cdng trinh nghien cdu Y hpc Quan sU, Hpc vien QuIn y so 2, tr. 27-31.
2. Bastani B, Mifflin TE, Lovell MA et al (1987) Scrum amylases in chronic and end-stage renal failure:
Effects of mode of therapy, race, diabetes and peritonitis. Am J Nephrol 7(4): 292-299.
3. Chen YH.Yang WCWang FM et al (2011) Risk factors associated with elevated serum pancret^r.
amylase levels during hemodialysis. Hemodial Int.
4. Kumar GS, Rafan SK, Jayabal A et al (2010) Serum lipase and serum amylase in chronic renal failure
TAP CHf Y DUOC L A M SANG 108 Tap 12-So 5/2017
patients on hemodialysis and renal transplant recipients. Kidney Intern 84: 386-394.
Lee SY, Lee KT, Kang TW et al (2005) Pancreatic enzyme elevations in Korean chronic renal failure patients. Korean J Gastroenterol 45(2): 125-129.
Nasir K, Ahamd A (2012) Clinical course of acute pancreatitis in chronic kidney disease patients in a single kidney center (PGTi) in Karachi. Arab J Nephrol Transplant 5(2): 87-90.
Ozkck A, Elcioglu OC,Cukadar T et al (2013) Low serum pancreatic enzyme levels predict mortality
and are associated with malnutrition-inflammation- atherosclerosis syndrome in patients with chronic kidney disease. Int Urol Nephrol 45(2): 477-484.
Vicki L, Royse MS, Donald M et al (2007) Pancreatic enzymes in chronic renal failure. Arch Intern Med 147:537-539.
