KHOA HOC K? THUAT THtJ Y TJP XXIV SO 8 - 2017
XAC fijNH H A N G S O DirdfNG HUYET, GLYCOHEMOGLOBIN (HBA1C) VA INSULIN TRONG MAU CHO NUOI TAI THANH PHO CAN THtf
T>dn Thi Thdo, Trdn Nggc Bich Bo mon Thu y, Khoa Nong nghiep & SHlfD, Bai hgc Cdn Tha
T 6 M TAT
Dudng huyet Id mgt chi tieu xet nghiem co bdn diing dS ddnh gia tinh trgng rdi logn chuySn hoa glucid trong chan doan benh tieu duang. Muc tiSu ciia dd tdi nay la xdc dinh hdm lugng duong huyet, glycohenioglobin va insulin tr6n 480 con cho khoe manh dugc nuoi duong tgi thdnh ph6 Cdn Tho tu thang 6/2013 den thdng 6/2014 dl thiSt Igp nguang binh thu6ng ciia cac chi s6 ndy.
Ducmg huygt mao mach cua cho dugc do sau khi an 8 gia bdng que thii "One Touch Ultra 2" dya fren phan ung oxydase dac hieu glucose va doc kSt qua sau 5 gidy bdng may dpc tu dSng "One Touch Ultra 2 glucose". Dinh lugng HbAlc bdng phuong phap sdc ky long cao dp (HPLC). Dinh lugng duong huylt trong huySt tuong bang phuang phdp enzyme sit dung hexokinase va dinh lugng hoat Igc insulin bang phuang phdp dien hoa phat quang dua tren nguyen ly cua phdn iing mien djch kieu "sandwich", Tdt cd cac xet nghigm duang huyet trong huyet thanh, HbAl c va insulin dugc thuc hi?n tgi Khoa Xet nghiem, B?nh vien 121, thdnh pho Can Tho. 480 con ch6 khoe manh dugc chia thanh 3 nhom theo kh6i lugng bao gdm nh6mA:KL<9kg,B:9kg<KL<20kgvaC:KL>20kg; 4 nhom tu6i bao g6m nhomi (Tu6i <1), II (1< Tu6i <4) , in (4< Tu6i <7) vd nh6m IV (Tu6i >7); 2 gi6i tinh bao gom gidd tinh due va gi6i tinh cdi;
2 nh6m gidng bao gom giong cho ngi va giong cho ngoai.
KSt qua nghien cuu cho thay, gid tri tnmg binh ciia glucose trong mdu ngogi vi Id 84,29 mg/dL vai khoang doi chieu la 61,68-108,16 mg/dL. Gid tri trung binh ham lugng glucose trong huyet thanh Id 95,85 mg/dL vai khodng doi chieu la 69,97-120,88 mg/dL. Gia tri tmng binh ciia HbAlc tren cho khoe Id 4,36
%vd khodng doi chieu Id 2,72-6,01%. Gia tri trung binh ciia boat luc insulin tren cho khoe manh Id 12,56 filU/mL vd khodng doi chieu Id 5,02-20,01 pIU/mL. Gid Oi tnmg binh cua ham lugng glucose, cua nong d6 HbAlc vd boat luc insulin tren cho khoe khong phy thugc vao nhom khoi lugng, nhom giong, gioi tinh vd nhom tuoi vcfi P>0,05.
K6t qud xdc dinh chi so duong huyet, glycohemoglobin va insulin trong nghien cihi ndy co thg dugc SIT dimg ldm ngudng binh thudng trong chdn dodn benh ddi thao dudng a cho nudi tai khu vuc Dong bang song Cuu Long.
Tie khoa: chd khoe mgnh, dudng huyet, HbAlc, insulin, miic binh thudng
Determination of normal blood sugar, glycohemoglobin (HbAlc) and insulin levels in dogs in Can Tho city
Tran Thi Thao, Tran Ngoc Bich SUMMARY
Determination of blood sugar level is a fundamental examination used to assess glucid-metabolic disorder in the diagnosis of diabetes mellitus The objective of this study was to determine levels of blood glucose, glycohemoglobin and insulin from 480 healthy dogs in Can Tho city from June 2013 to June 2014 to set the normal threshold of these indexes.
Capillary blood sugar of the dogs was measured 8 hours after eating by "One Touch Ultra 2"
test strips with specific glucose-based oxidation reaction, then results were read in 5 seconds by
"One Touch Ultra 2 Glucose". Quantification of H b A l c was determined by High Pressure Liquid Ctiromatography (HPLC) and determination of plasma glucose concentration was excecuted by
enzyme method using hexokinase while insulin activity was quantified by electrochemical method based on the principle of immune reaction type "sandwich". All blood glucose, HbAlc and insulin tests were performed at the Department of Laboratory Medicine of Hospital 121, Can Tho City. 480 dogs were divided into 3 groups according to the body weight ( <9 kgs, >9 kgs to <20 kgs and
>20kgs respectively); 4 groups according to age (<1 year, >1 to <4 years, >4 to <7 years and >7 years, respectively); 2 groups according to sex (male and female) and 2 groups, according to breed (exotic and domestic breeds ).
The studied results showed that the average blood glucose concentration was 84.29 mg/dL, ranging 61.68 - 108.16 mg/dL. The mean serum glucose concentration was 95.85 mg/dL, ranging 69.97-120.88 mg/dL. The mean HbAlc value of the healthy dogs was 4.36%, ranging 2.72 - 6.01%.
The mean of insulin activity was 12.56 plU/mL, ranging 5.02 - 20.01 \i\/mL. Mean values of glucose, HbAlc content, and insulin activity in the healthy dogs were not depended on sex, age, breed and body weight groups.
The determination of the blood glucose, glycohemoglobin indexes and insulin activity in the present study could be used as thresholds for the diagnosis of diabetes mellitus in dogs in the Mekong Delta.
Keywords: healthy dogs, blood sugar, glycohemoglobin, insulin, normal levels.
I. MO DAU
Dudng huySt hay glucose mau la mdt chi tiSu xet nghifm ca ban diing dS ddnh gid tinh trang roi lo^in chuygn hda glucid nhu b&nh Iy tieu dudng hay hg dudng huygt. Tang glucose mau mgn tinh trong b?nh tigu dudng lam tdn thuong, rdi loan vd suy yeu chiic nang cua nhieu co quan khac nhau, dgc biet la tdn thuang mdt, than, thdn kinh, tim va mach mau, Khi lugng dudng mdu tang 16n trong thdi gian dli dai se lam tang lugng HbAlc (glycosylated hemoglobin). Do vdy khi lugng HbAlc tang len ddng nghia vdi lugng dudng trong mau da tang keo ddi trong thdi gian vua qua. Mat khac, ddi sdng ciia hong cdu la 120 ngdy, vi vdy lugng HbAlc se phan dnh lugng dudng trong mdu trong khoang 2-3 thang trd Igi ddy. Day Id nhirng xet nghifim rdt hihi ich cho viec chan dodn theo doi va danh gid hieu qud dieu tri d benh tieu dudng. Nguyen nhdn ciia benh tieu dudng do thieu hut insulin nhieu hogc it, khi khdng co insulin hogc insulin khdng hogt dgng dugc se ldm tang ndng dg glucose trong mdu. Khi xet nghi?m dinh lugng thdy ndng do insulin rdt thdp hogc khdng co se nghi tdi bfnh dai thao dudng type 1. Con neu thdy ndng dg insulin vdn binh thudng hoac tang nhe d ngudi beo phi se nghi tdi dgng b^nh ddi thdo dudng type 2.
Bfnh tigu dudng trgn chd Id mgt benh khong Idy mgn tinh, liSn quan den dinh dudng vd ldi s^g, CO toe d$ phdt trien rat nhanh d nhigu nude tren the
gidi. Bgnh tieu dudng ngdy cdng tang khong chi a ngudi, md b?nh tigu dudng ciing gia tang tren cho (Shauna S. Roberts, 2013). Viet Nam la mpt qu6c gia dang phdt trien nhanh chdng ve kinh te-xa hdi, cung vdi su thay ddi ldi sdng ciia ngudi nudi da gop phdn Iam gia tang ty le mdc benh tieu dudng tren chd. Nam 2015, ty le tigu dudng tren chd dugc phat hign tai thanh phd Sdc Trang la 5,31% (Trdn TM Thao vdcs, 2015).
Hi$n nay tren the gidi da cd mot s6 nghien cihi xac dinh chi sd dudng huyet va HbAlc, insulin tren chd nhung moi tac gia thu dugc nhirng ket qud khde nhau. Bdi le, su dyng phuang phap x^t nghigm khde nhau thi se cho ket qua khac nhau (Dd Dinh H6, 2005; Fall, 2007). 6 Vi^t Nam, nghign cuu ve Imh vyc ndy cdn rat han che. Do vdy, chiing tdi thyc hi?n khao sdt miic dudng huyet, glycohemoglobin vd insulin d mau cho khde mgnh nudi tai thanh phd Cdn Tha dS tog dung trong chdn doan vd digu hi benh tigu du6ng trgn chd d khu vuc Ddng bdng sdng Cuu Long, II. NQI DUNG, VAT LI^U VA PHU^ONG PHAP NGHIEN CUtJ 2.1. M^c dich va n$i dung
Xdc dinh chi so sinh hda glucose, glycohemoglobin (HbAlc) vd insubn tiong mau cua chd khde manh nhdm xdy dyng thang chuan
KHOA HQC KY THU^T THC Y T^P XXIV S6 8 - 2017
dg ling dyng vdo cdng tac chdn dodn vd dieu tri benh tigu dudng tren chd.
2.2. Doi tmjug va dia diem nghien clhi 2.2.7. Tieu chudn chpn lua ddi tir^g
- Chii nudi ddng y tham gia nghien cuu - Chd khde manh vg ldm sang dugc nudi duong tren dia ban thdnh phd Cdn Tho dya trgn cdc bidu hign nhu: b0 ldng mugt, khong cd benh i^odi da, lanh lgi, an udng binh thudng, khdng cd bilu hien bat thudng trong sinh hogt vd hanh vi (Huynh Thi Bgch Ygn, 2006).
2.2.2. Th&igian vd dia diim
- Thdi gian: Nghign ciiu dugc thyc hien tir thdng 6 nam 2013 den thdng 6 nam 2014.
- Dia diem thu thdp mdu: Mau mau chd dugc thu thgp tgi hg dan, tgi Benh xd Thu y, Dgi hgc Cdn Tho vd tai Phdng mach Thii y thu^c Chi cue Thu y thanh phd Cdn Tha.
- Dia diem xet nghiem mdu: Khoa Xet nghiem, Benh vifn 121, sd 2 dudng 30/4, phudng An Lac, qudn Ninh Kieu, thdnh pho Cdn Tho.
2.3. Phirong phap tien hanh
Mdu mau cua cho khde manh dugc thu thgp tut hd dan, tii mgt sd chd dugc dem den phdng mgch thu y dg tigm ngiia vd ldm dep. Thu thdp mlu theo cdc budc sau:
- Budc 1: Do dudng huygt ngoai vi bang cdch idy 1 giot mdu d vdnh tai hoac ngdn chdn (sau 8 gid khdng an), dung que thir "One Touch Ultia 2"
de xac dinh lugng dudng huyet vdi phuong phdp dac hieu dua tren phdn iing Glucose-oxydase. Dgc kgt qua sau 5 gidy bang may dgc ty ddng "One Touch Ultra 2" cua My.
- Budc 2: Ldy it nhdt khoang 4 ml mau d tinh mach chan trudc thii khde (sau 8 gid khong an) bang bam tiem vd trung, chia lam 2 phan dk phdn tich. (1) Phdn 1: Cho 2 ml man vdo dng nghiem cd chura chdt khang ddng EDTA de dinh lugng HbAlc bang phuang phdp sac ky long cao dp (HPLC) tren may xet nghiem Tosho G7 ciia Nhdt.
(2) Phan 2: Phdn mau cdn lai cho vdo dng nghi?m cd chdt khdng ddng heparin, chat Idy huyet tuong de dinh lugng dudng huygt bang phuong phdp enzyme sii dyng men hexokinase va dinh lugng insulin bang phuang phap dien hda phdt quang dua vdo nguyen ly ciia phdn iing mign dich kigu
"sandwich'Vd dugc phdn tich tren may sinh hda tu dgng Cobas E-411 ciia Nhat.
Bang 1. Phan bo mau khdo satchitieu Glucose, HbAlc va Insulin tren cho khoe m^nh theo giong, gio*! tinh, khoi lu'p'ng co" the va d$ tuoi
Nhom gi6ng Tong so mlu
N$i Tufii (nam tuoi)
Trpng lifg-ng (kg)
Gii'i tinh (con)
l(Tu6i<1) ll{1STu6i<4) III (4< Tu6l £7) IV (TuSi >7) A:TL<9 B:9<TLS20 C:(TL>20) D^^c
60 60 60 60 80 80 80 120
120 160 160 160 240 240 2.4. Xir ly s6 lifu
Nhap s6 li&i bdng phdn mgm Microsoft Excel 2010.
Ndng dg dudng huygt, HbAlc vd insulin dugc
trinh bay dudi dang X ± SD, Khodng ± SD dugc xem Id tri sd (hang sd) cua thii binh thudng (Ddn lieu cua Trdn Thi Dan, 2007).
Phan tich dnh hudng cua cdc ygu td vg gidng, tudi, gidi tinh, trong lugng, trong cdc gia tri tmng bmh cua hdng so sinh hda glucose, HbAlc va insulin tren chd khde manh bdng ANOVA, su dyng One Way Analysis of Variance dl phan tich
va so sdnh ttong phdn mem Minitab 16.0.
IH. KET QUA VA THAO L U ^ 3.1. Gid tri trung binh cua duimg huye^
glycohemoglobin vd insulin o* mdu ch6 khfie m^nh Bang 2. Trung binh chung cua hIing so Glucose, HbAlc va Insulin tren cho khde manh
Chf tieu Glucose* (mg/dL) Glucose"* (mg/dL) HbA1c(%) Insulin (glU/mL)
SLKS (con) 480 480 480 480
X±SD 84,92±11,62 95,85±12,94 4,36±0,825 12,56±3,77
Klioang doi cliieu 61,68-108,16
69,97-120,88 2,72-6 5-20,01 SLKS: so luang khao sdt,, * gb
Bang 2 th^ hign gia tri trung bmh chung cua ham lugng glucose trong mdu ngogi vi tren chd khde Id 84,92 mg/dL, dao dgng ttong khodng 61,68-108,16 mg/dL. Tri sd ndy khd phu hgp vdi kit qua nghign ciiu cua Fall (2009) va The Merck (2010) Id 62-108 mg/dL. Vi thi, tirong nghign ciiu ndy, hdng sd sinh ly ciia ham lugng glucose ttong mdu ngoai vi tren chd khde manh cd trj so dao dgng ttong khodng 62-108 mg/dL.
Gid tti trung binh ciia hdm lugng glucose ttong huylt tuong trgn chd khde manh Id 95,85 mg/dL, dao ddng trong khodng 69,97-120,88 mg/dL. Tri sd toi thieu ciia glucose cao hon ket qud nghign ciiru ciia Huynh Thi Bgch Yen (2006), nhung tri sd tdi da thi phu hgp (39-121 mg/dL). Tri so glucose ttong huygt tuong khd phu hgp vdi tri so dugc cong bo ttong The Merck Manual (2010) va AAHA (2010) ldn lugt la 76-119 mg/dL vd 70-120 mg/dL.
Gia tri trung buih cua HbAlc tten chd khde la 4,36% vd dao dgng ttong khodng 2,72-6%. Kit qud nay khd phu hgp vdi cdng bd cua Hasegawa (1991), tac gid vd cong su da thyc hien nghign cihi vdo thang 2 nam 1991 bang each sir dung phuang phdp HPLC (sdc k^ ldng cao dp) dg do HbA 1 c trgn 38 con chd binh thudng vdi kit qua la HbAlc dao dpng ttong khodng 2,6-6,41%. Tuy vdy, kit qud ndy sai khac vdi kit qud nghign ciiu cua Catchpole et al. (2008), tac gid da thilt kl mdt may (HbAlc Now) dg do n6ng do HbAlc ttong mdu cho. Cdc mdu mdu dugc thu thdp tir 50 con chd binh thudng vdi kit qud cho tiiay chi sd HbAlc tten chd binh
Jucose trong mdu ngoai vi; ** glucose trong huyet tucmg; Khodng doi chieu = XiSD
thudng dao ddi^ ttong khoang 3,7-5,6%, trung bmh 4,7%. Su sai khde nay cd thg do khac nhau ttong phuong phdp dinh lugng mau (Dd Dinh H6, 2005; John et al., 2007; Fall, 2009).
HbAl c la mdt thdng s6 hang ddu diing de kiem sodt glucose mau vd mgt tieu chi quan trgng trong ch§n dodn benh tigu dudng (Catchpole et al., 2008;
Malin, 2010). Trgn nhan y hien nay chpn ngudng HbAlc >6,5% (American Diabetes Association, 2011) dl xac dinh b^nh tilu dudng. Trong nghien ciiu ndy, kgt qua kiln nghi hang so sinh hoa glycohemoglobin (HbAlc) ttong mdu chd khoe manh cd gia tri trung binh la 4,36% voi tri so dao ddng ttong khoang 2,7-6,0%.
Gid tri trung binh chung ciia hogt lyc insulin ttgn chd khde la 12,56 pIU/mL vd biln dpng ttong khodng 5,02-20,01 pIU/mL. Trj so tdi da ciia msulin tii4p hon kit qud cua Malin (2010) la 5 don vi. Tdc gia nay da thu thdp mdu huylt thanh tren nhimg chd khde vd djnh lugng insulin tgi Phong thi nghiem Benh vien Thii y ciia Khoa Thu y, Dai hgc Khoa hgc Ndng Nghigp Thyy Diln (SLU) vcri kit qud Id tti s6 insulin ttgn chd khde nam ttong khodng gidi ban 5-25 ^lU/mL. Tuy nhiSn, no khS phu hgp vdi mdt nghien curu khde cda Ron Hines (2013), tdc gid da tdng hgp mgt si bdi bdo tur mm 2012-2013 vl cac chi tieu sinh ly trgn chd va meo, cdc mdu mdu dugc lay td cdc thu cung khde manh vd gui din phdng thi nghiem qudc gia dg phan tich vdi kit qud Id tiri s6 insulin ttgn chd khde nam ttong khodng 5-20 plU/ml.
KHOA HQC KY THU^T THO Y TAP XXIV SO 8-2017
3.2. Gia tri trung bioh ciia glucose, HbAlc \k insulin tren cho khoe theo nhom g^^ng Bang 3. Trung binh chung cua hang so Glucose, HbAlc va Insulin
tren chd khde theo nhom giong Chl tieu
Glucose (mg/dL)
HbAlc (%)
Insulin (iJlU/mL)
Nhdm giong Npi Ngogi
Npi Ngogi
N»l Ngogi
SL khao sat (con) 240 240 240 240 240 240
F ± S D 84,91±11,87 85,03±12,07 4,40*0,84 4,38±0,82 12,53±3,64 12,61*4,06
Bang 3 cho thdy, gid trj trung binh ciia glucose ttgn chd ngi Id 84,91 mg/dL, thdp ban ttgn chd ngoai (85,03 mg/dL), tuy nhien hai gid tri nay khde nhau khdng cd y nghia thdng kg (P>0,05).
Malm (2010) ciing nhdn dinh ring ndng dg dudng ttong mdu khdng phy thugc vdo nhdm gi6ng.
Gia tri trung binh cua HbAlc trSn nhdm gidng chd ngi Id 4,40%, cao hon ttgn nhdm gidng cho ngoai 4,38%, hai ty le ndy khde nhau khdng cd y nghia thing ke (P>0,05). Hien nay chua tim thdy kgt qud ndo khde so sdnh ndng dg HbAlc ttong mau cua cdc gidng chd. Tuy nhign, HbAlc phy thudc vdo ndng do glucose trong mau (Catchpole, 2008; American Diabetes Association, 2011,2001).
HbAlc hinh thdnh khi hemoglobin bi glycosyl hda (Glycosylate), nghia Id hdng cdu gan vdo hemoglobin khdng can xiic tdc ciia enzyme khi hdng cau tigp xuc vdi glucose. Trong mdu, HbA chilm khoang 97-98%, HbA2 chilm khodng 2,5%
vd HbF khodng 0,5%. HbA gdn vdi glucose tgi
dogn cudi vdi valin cua chudi p. Thdi ky dau, cau ndi glucose gan vdo hemoglobin cdn ldng leo, cdng ve sau cdu noi ndy ben viing hon va tdn tgi suot ddi sdng hdng cau, nhat la khi ndng dp dudng trong mau dn dinh (American Diabetes Association, 2011).
Gia tri trung binh cua msulin tten nhdm gidng chd ngi la 12,53 pIU/mL, thdp hon gidng chd ngoai (12,61 (iIU/mL) va khdng co sy khac bidt vl mat thdng ke (P>0,05). Ron Hme (2013) cOng cho rang hoat lyc insulin tten cho khde manh khdng phu thupc vao nhdm gidng.
3.3. Gia tri trung binh chung cua hdng so sioh hda glucose, glycosylated hemoglobin (HbAlc) vd insulin tren cho khoe theo gidi tinb
Cac gid tri trung binh chung ciia hang sd sinh hda glucose, glycohemoglobin (HbAlc) vd insulin tten chd khde theo gidi tinh cua chd dugc trinh bay ttong bdng 4.
Bang 4. Trung binh chung cOa Glucose, HbAlc va Insulin trgn chd theo gid'i tmh Chi tidu Gid'i tinh SL khao sat (con) Y±SD Glucose (mg/dL)
H b A l c (%)
Insulin (pIU/mL)
SL: SS luang
Dye Cdi Ogc Cdi Dye Cdi
240 240 240 240 240 240
83,76±11,51 84,16±11,01 4,19±0,84 4,35±0,82 12,17±4,62 12,97±3,65
Kit qud bang 4 cho thdy, gid tri trung binh ciia HbAlc ttgn chd cdi Id 4,35%, cao hon tren chd due (4,19%). Tuy nhidn, hai gid tri khac nhau khdng cd y ngMa tiidng kd (P>0,05). Dilu nay phi hgp vdi kit qud nghien ciiu cua Marca va Loste (2000), tac gid da dinh lugng HbAlc tiren 86 con chd khoe mgnh va kit ludn rdng HbA 1 c khdng phy thudc vdo gidi tinh.
Gid tri trung bmh ciia hdm lugng glucose tten chd dye Id 83,76 mg/dL, thdp hon ttgn chd cai (84,16 mg/dL) vd hoat tinh insulin ttdn chd dye Id 12,17 pIU/mL, thdp hon ttdn chd cdi (12,97 pIU/mL), bdi vi chd cai cd nhimg thay ddi vg kich thich to sinh san trong qud trinh dgng due cd thg gay khdng insulin tam thdi, lam tang glucose ttong mau d mpt giai doan nhdt djnh (Vosough, 2003). Thgm vdo do. Fall (2007), ciing cho rdng miic progesterone nOi sinh tten chd cai tang cao ttong qud trinh ddng dye cd the dan den hdm lugng hormone tang trudng cd ngudn gdc tuygn vii tang cao, tir dd lam tang sy dl khdng insulin, din din tang insulin ttong mdu. Cung nhu ttgn con ngudi, d nii gidi, lugng dudng ttong mdu nhung
ngdy cd kinh nguygt cao hon ngdy thudng, nhung insulin ttong mdu khdng gidm. Vg mat sinh Iy, insulin Id hormone do te bdo p cua tuyIn tyy tiltia chu ygu dg phdn dng vdi glucose, giiip van chuyln glucose tir thiic an vdo cdc te bdo diing Iam nang lugng. Tuy nhign sy sai khde gid trj ttung binh ciia ham lugng glucose va hogt tinh insulin trgn cho cdi va chd dye khdng co y nghla ve mat thdng ke (P>0,05). Vi vgy, hdm lugng glucose mau, ndng dO HbA 1 c vd hoat lyc msulin tten chd khoe khdng phy thuOc vdo gidi tinh. Ket qud nay phu hgp vin nhdn dinh cua Malm (2010), tdc gid cho rdng tten chd khde mgnh binh thudng, hau nhu gidi tinh khdng anh hudng den sy tiet insulin.
3.4. Gid tr; trung binh chung cua hang so sinh hda glucose, glycohemoglobin (HbAlc) v^
insulin trgn cho khoe theo tuhi
Liia tudi Id mgt ttong nhiing yeu to quan ttong cd dnh hudng ddn tinh ttgng siic khde ciing nhu b$nh tdt cua chd. Gid tri trung bhih cua ham lirong glucose, HbAlc vd hogt lyc insulin theo do tuoi dugc trinh bdy ttong bang 5.
Bang 5. Gia trj trung binh hang so glucose, H b A l c va insulin tren c h d khde theo nhdm tuoi Chi tieu
Glucose (mg/dL)
HbAlc (%)
Insulin (|jlU/mL)
Nh6m tuoi (nam) 1 (Tuoi el) ll(1<Tu6is4) III (4< Tuoi S7) IV (Tu6l >7) l(Tu6i<1) ll(1STu6lS4) III (4< TUOI S7) IV (Tuoi > 7) l(Tu6l<1) ll(1£Tu6ls4) III (4< Tu6l £7) IV (Tu4l >7)
SL khdo s i t (con) 120 120 120 120 120 120 120 120 120 120 120 120
lC±SD 83,47±12,62 83,25±11,65 85,00±11,76 92,05t12,16 4,36±1,02 4,17±0,84 4,27±0,82 4,44±0,85 13,4013,51 12,58±3,73 12,52±4,09 11,80*3,95 SL: So lu(mg
Bdng 5 cho thdy, nhdm I (Tudi <1) cd gia trj trung bhih glucose 83,47 mg/dL, nhdm tudi n (1<
Tudi <4) vdi gia tri trung bmh cua glucose Id 83,25 mg/dlL, nhdm ttidi HI (4< Tudi <7) Id 85,00 mg/dL
vd nhdm chd cd dg tudi ldn, nhdm IV (>7 nam) co hdm lugng glucose ttong mau cao nhat (92,05 mg/
dL). Dilu ndy cd the do qua trinh tdng hgp va ihoSi hda glycogen d gan vd ca xdy ra chgm ttong nhdm
KHOA HOC KY THUAT THtJ Y T^P XXIV SO 8 - 2017
chd ndy. Glucose vao mdu qua hai co che: Hdp thu tir mdt non thdng qua sy tidu hda thiic an va qua trinh thoai hda glycogen, sy ding phan fructose, galactose vd tan sinh dudng tii acid amin. Tign trinh hdp thu thay ddi theo mdc dd hoat ddng cua thyroxine vd hormone d bd may tieu hda. Tdt ca cac dilu ki$n tdc ddng len tien trinh tieu hda cua da day-rugt diu dnh hudng din hdp thu glucose (Knepen, 1997). Gan Id ngudn cimg cdp chinh de duy tri ham lugng glucose ttong mdu. Epinephrin va glucagon thiic ddy phdng thich glucose tii glycogen. Glucocorticoid tiiilc ddy qud trinh tan sinh glucose, ddi khang vdi tdc ddng gitun glucose mdu cua insulin. Tdt ca cac mo bdo cung sit dung glucose deu dan ttong qua trinh tgo nang lugng, ttong qud trinh chuyln ddi thanh sdn phdm khde (glycogen, pentose, md hay acid amin).
Vi the glucose chuyen tir mdu ra dugc dilu khiln bdi tdc dd sir dung glucose d md bao vao tdt ca cac thdi diSm. Insulin ldm tang t ^ do sit dung glucose bang each van chuygn vao bap co hoac md md hoac phosphoryl hda d gan (Dd Tnmg Quan, 2013). Tuy nhien, cac gia tri glucose tten chd khde manh theo nhdm tudi khac nhau khdng cd y nghia thdng kg (P>0,05).
Gid tri trung binh HbAlc tang ddn theo dd tudi va cao nhdt d nhdm chd gia, chd ldn hon 7 nam tudi (4,54±1,02). Huygt sdc td glycosyl hda (HbAlc) phdn dnh mice glucose mdu ttong vdng ttdn dudi 8 tudn tnrdc khi do, vi thg ndng dp HbAlc cao khi lugng dudng ttong mdu tang cao keo dai ttong sudt khoang thdi gian 2 thdng (American Diabetes
Association, 2011). Tuy nhidn, cdc gia tii tiling binh ciia HbAlc theo nhdm tudi tren chd khac nhau khdng cd y nghTa vl mat tiidng kg (P>0,05) (Marca va Loste, 2000).
Khac vdi gid tri cua HbAlc, gid tii tnmg buih cda boat luc insulin tten chd khde giam ddn theo dp tudi, cu thd nhu sau: nhdm chd 1 cd dd tudi <1 nam tudi gid tiri trung binh la 13,40 |iIU/mL; nhdm chd II (1< hidi <4) la 12,58; nhdm cho IE (4< tiidi
<7) Id 12,52 pIU/mL va nhdm chd >7 nam tudi cd gia tri insulin trung binh thap nhdt la 11,08 pIU/
mL. Bdi le, cho cdng gia siic de khang cang kdm, dg phat sinh benh, nhdt la sy rdi loan chuydn hda carbohydrate trong gan. Hon niia, chd cdng gid thi sy thoai hda vg cau true va suy giam vd chiic nang cua tg bao ndi chung, tg bao p cua tuydn tuy ndi rieng va lam giam xudt tiet insulin, ddng thdi lam giam dd nhay ciia thy thi tl bdo dich vdi insulm, ddn ddn suy ylu churc nang tilt insulin vao mau (Richard et a!., 2005). Tuy nhien, sy sai khac cac gia tri tnmg binh cua HbAlc vd boat lyc insulin giua cac nhom tudi ciia chd khac nhau khdng cd y nghia thdng ke (P>0,05). Kgt qua nay ciing kha phu hgp vdi nhan dinh cua Catchpole et al. (2008).
3.5. Gia tri trung binh ciia glucose, glycohemoglobin (HbAlc) vd insulin trSn chd khoe theo nhom trong lirong
Cac gia tri trung binh ndng dp glucose, HbAlc va boat lyc insulin tten chd khde theo nhdm ttgng lugng dugc trinh bay ttong bdng 6.
Bang 6. Trung binh nong dd hang so Glucose, HbAlc va Insulin tren chd khde theo nhdm trong lu'gng
ChltiSu Glucose (mg/dL)
HbAlc (%)
Insulin (iJlU/mL)
Trpng luwng (itg) A(TL<9) B(9<TLS20) C(TL>20) A(TL<9) B(9<TLS20) C(TL>20) A(TL<9) B(9<TLS20) C (TL >20)
SL IthSo sat (con) 160 160 160 160 160 160 160 160 160
YtSD 83,95±12,45 a5,41±11,86 85,46±11,24 4,3±0,86 4,28±0,91 4,44±0,84 12,18±4,02 12,74±4,14 12,79±3,6 SL: S6 luang; TL: Trong lutmg
Gid tti trung binh glucose ttong nhdm ttgng lugng A la 83,95 mg/dL, nhdm B Id 85,41 mg/dL va 85,46 mg/dL Id gid tri trung buih ciia glucose tren nhdm chd cd ttgng lugng C. Cdc gid tij tmng bmh ndy khac nhau khdng c6 y nghia thing kg (P>0,05). Vi vgy, ham lugng glucose trgn mdu ngogi vi cua chd khdng phy thudc vdo trgng lugng cotiil chd (Malin, 2010).
Thudt ngu HbAlc dung dl chi hemoglobin (Hb) hi glycosyl hda (Glycosylate). Hdng cdu ttong qua trinh luu hanh ldm chiic nang hd hdp c6 mdt ty Ip nhd Hb se gdn kit vdi glucose mau dd tao nen phdn tir HbAlc. Glucose cd the lidn kgt vdi Hb ttong mdu d bdt ky tiidi gian nao ttong sudt ddi sdng ciia hdng cdu bdi mpt phdn dng khdng cdn enzyme (Buim et al., 1978), qua trinh lien kit ndy la khdng thi dao ngugc va ti Ie HbAlc se tang ldn theo lugng dudng ttong mdu (American Diabetes Association, 2011). Gia tri trungbmh ciia HbAlc trdn nhdm chd cd ttgng lugng nhd, nhdm A Id 4,3
%, nhdm B la 4,28 %, nhdm C la 4,44%. Gia tii trung binh cua HbAlc giiia cdc nhom ttgng lugng khac nhau khdng cd y nghia thdng ke (P>0,05). Vi vay HbAlc trdn chd khoe khdng phy thudc vao tipng lugng ciia chd (Catchpole et al., 2008).
Insulin la mgt hormone dugc tigt ra d tg bdo 13 cua ddo tuy, khi lugng dudng ttong mdu tang thi kich thich tuyen tuy tiet insulin de giup te bdo dich hap thu nang lugng. Qud trinh tiet cua insulin diln ra ttong ca thi rdt nhip nhang thdng qua cdc chat chuygn chd GLUT2, GLUT4 vd ty sd ndng lugng ATp/ADP (Rutter, 2001). Gid tti ttung binh cua hoat tyc insulin d nhdm cho ttgng lugng A la 12,18 pIU/mL, nhom chd ttgng lugng trung binh B Id 12,74 pIU/mL va nhdm cd ttgng lugng Idn (nhdm C) cd gid tri trung binh cua hogt luc insulin Id 12,79 pIU/mL. Mdu mdu de dinh lugng hogt lyc insulin tten chd khde mgnh dugc ldy khi chd bi nhin ddi (sau 8 gid khong an) ndn gia tri trung bhih ciia msulin giira 3 nhdm ttgng lugng chd khde it thay doi. Insulin dugc tilt ra sau khi an, ndng dp insulin d ngogi vi tang Ign sau 8 phut, dgt dinh cao sau 30-45 phut va se trd lgi gia tii binh tiiudng sau 90-120 phiit (Dd Trung Qudn, 2013).
Cac gid tri ndy khac nhau khdng cd y nghia thing kg (P>0,05) ngn boat lyc insulin khdng phy thudc vao nhdm ttgng lugng ttdn chd khde manh.
IV. KET LUAN
N6ng dg glucose ttong mdu mao mgch cua cho khde mgnh Id 62-108 mg/dL, ttong huylt tuong Id 70-121 mg/dL vd ndng dd glycohemoglobin (HbAlc) Id 2,7-6,0%.
Chi sd hogt lyc insulin ttong huyet thanh ciia chd khde la 5-20 pIU/mL.
Ndng dg glucose ttong mdu ngoai vi, ndng dp HbAlc, ning dg glucose ttong huyet tuong va hogt lyc insulin tten chd khde manh khdng phu thugc vdo nhdm gidng, nhdm tudi, nhdm ttijng lugng vd gidi tinh cua chung (P>0,05).
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dog and cat, htTp://wv™'.2ndchance.info/
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Treating Canine Diabetes. htTp://tiiebark.com/
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