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NONG Bd hsCRP vA MOT SO CHf SO HOA SINH HUYET TITONG (y BENH NHAN DAI THAO DirONQ MOT MAC TAI BENH VIEN TRirONG DAI HOC Y KHOA THAI NGUYEN
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M(ic tieu: 1) Xac dinh n6ng dp hsCRP va mpl so chi s6 hoa sinh huyet tucmg a benh nlian DTD mdi mic t^i bcnji vi?n ttuong dai hpc Y khoa Thai Nguyen. 2) Phan tich moi lien quan gida nong dO hsCRP vcri n6ng dp glucose, ty 1?
HbAiC va mpt so yeu t6 khac. Doi tircmg va phuang phap nghien ciiu: nghien ciiu mo ta, cit
^ • g l t r e n 52 b^nh nhan d4i thao duong (BN
• P P B i mcri phat hi«n lan dau. Ket qua: I)
•Noiig'dpTisCRP, glucose, ty 1| HbA|C tuong ittil 14 3,37±2,0I mg/L; ll,2±4,l mmoW,;
9.1 ±1,8 %, tj I? BN tang n6ng dp hsCRP huyet lircmg li 51,9%. 2) N6ng dp hsCRP o nhom BN Ihila can beo phi la 3,94±2,l 9 mg/L, nh6m khong thta can bio phi U 2,60±1,44 mg/L. N6ng dO hsCRP^huyet tuong c6 tucmg quan v4i chi so BMI, nJng dp gluocse, HbAlC vi mpt so thanh phJn lipid huy^t tuong. KSt lujn: 1) Ting nong d« hsCRP va mpt s6 chi s6 h6a sinh huy& tuong 0 nh6m b«nh nhSn DTO type 2 moi mic. 2) NSng d? hsCRP ting theo chi so kh6i co th4 va c6 m6i tirong quan thujn, co y nghta v « mpt so chi so h6a sinh huy^t tucmg.
Tir khia: hsCRP, dai thio duimg m6i phit tii$n
• TruingDgi hpc YDupc Thdl Nguyen Chju trtch nhi?m chinh: Nguyen Thj Hoa Email: [email protected] Ngiy nhjm bii: 9.9.2016 Ngiy phin bi?n khoa hgc: 15.9.2016 Ngiy duyet bii: 1.12.2016
Nguyin Thi Hoa*, TrSn Bao Ngpc*
SUMMARY
PLASMA hsCRP AND SOME BIOCHEMISTRY IN NEWLY DIAGNOSED TYPE 2 DIABETES IN THAI NGUYEN MEDICAL COLLEGE
HOSPITAL
Objective: 1) Evaluate the values of plasma hsCRP and some biochemistry in newly diagnosed type 2 diabetes. 2) Analyze the correlation behveen hsCRP with other factor.
Method: a cross-sectional study of 52 new diagnosed type 2 diabetes. Resuh: 1) The mean values of plasma hsCRP, glucose and HbAlC were3,37±2,01 mgA,; 11,2±4,1 mmoI/L; 9,l±1.8
%, respectively, the rate of elevated hsCRP wL 51,9%. 2) Plasma hsCRP concentration in overweight and obesity were 3,94±2,19 mg/L and in normal weight were 2,60±1,44 mg/L.
Plasma hsCRP concentration correlated median and positive with BMI, glucose, HbAiC and lipid profile. Conclussion: 1) Increasing levels of hsCRP and some biochemistry tests in newly diagnosed type 2 diabetes. 2) Plasma hsCRP levels increased with body mass index and correlated widi some biochemistty tests.
Key word: hsCRP, diabetes.
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Bai thao du6ng (DTD) la rngt van di silc khoe c6ng dong noi c0m tren tota the gioi v6i ty 1$ bi6n chiing rat cao. Bjnh dmyc dSo trung boi r6i lotm chuyin h6a glucid man tinh. Ty If bSnh co xu huong phit trien ttag dan theo thoi gian v i theo t6c d0 phit trien cuaxahSi.
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HNKH Y DlJaC - KY NIEM SO NAM NGAY TRUYDN T H 6 N G TRlffiTJG CAO B A N G Y THAI NGUYEN (1966-2016)
Hien tuong vifim man tinh co phai la tac nhan gay DTD hay khong? Day ia van dk ngay cang dugc quan tam hcm [3]. High sensitive C-reactive protein (hsCRP), la mot marker cua hien tugng viem man tinh, day la mot protein do gan tong hgp cimg vm mot s6 yeu to khac nhu yeu to hoai tu m6 va interleukin 1 va interleukin 6. Nhung ylu to nay co anh huong den xa vua mfich va la y§u t6 nguy ca gay benh tim mach. Cho den nay, CO nhieu bang chiing cho rSng cac yeu to viem CO the dong vai tro trung gian quan trong trong sinh benh hpc, la cau n6i giiia benh DTD va c^c benh ph6i hgp khac thong qua CO ch§ viem trong do hsCRP, la din Sn nhgiy c ^ ciia h? thong viem, lien quan den tinh tr?ng tang glucose huy6t, khang insulin vh DTD type 2 [5]. Han n&a, theo nghien ci3ru cOa t^c gia Nakanishi 6 396 nam va 551 nOr nguoi MJ goc Nh|t, dugc xac dinh la khong bi mSc DTO bing su dung nghifim phap tang duang huyfit luc doi bSng dudng uong va xet nghi?m hsCRP huyfit tuong t^i th£ri difim nghien ciiu. Nhung doi tugng nay dugc theo d5i trong vong 6,5 nSm tiep theo.
Kfit qua nghien cuu cho thdy 6 nhom d6i tugng c6 n6ng do hsCRP a tu ph§n vi cao thi nguy CO bi DTD cao hon 2,84 Ian so vdri doi tugng c6 n^ng dp hsCRP 6 tu phan vi thap [7]. Tdc gia Wang (2006) nghien cim 6 620 d6i tugng khong mSc DTO v^ dugc dinh lugng nong dg hsCRP tai thcri difim nghifin ciiu. CSc doi tugng niy dugc theo doi tifip tyc trong 11 nSm dfi xac dinh ty lfi DTD mSc mdi hang n5m, kfit qua cho thiy ty 1? mic DTD tang dSn tir 10.8; 16,6 va 28/1000/nara tuang ting voi nong dg hsCRP 6 tii phan vi thSp, trung binh va cao. Nhiing ngudi co nong dg hsCRP huyfit tuong d di phan vi cao thi nguy co h\ mkc DTD cao gip 1,75 lin so vdi nhiing ngudi c6 ndng dp hsCRP d tu
phfin vi thdp [6]. Ndng dg hsCRP huy^t tuang cao cd lifin quan dfin tifin trifin cua benh DTD. N6ng dO hsCRP d nh&ng benh nhan DTD mdi mSc thay ddi nhu the nao? Vi vay, dfi tai nay dugc thuc hifin vdi muc tifiu: '
1. Xac dinh ndng dg hsCRP va mgt s6 chi so hda sinh huyfit tuong d b?nh nhan DTD mdi mac tai benh vifin trudng D^i hgc Y khoa Thai Nguyen.
2. Phan tich moi lifin quan giua nong dO hsCRP vdi ndng dO glucose, t>' 1? HbAlC vi mgt sd yfiu td khac.
II. OOI TUgwe VA PHI/ONG PHAP NGHIEN CUU 2.1. Boi t m ^ g nghien cihi Gom 52 BN DTD type 2 mdi dugc phfit hi?n ISn ddu tai bfinh vi§n trudng d^i hgc Y khoa ThSi Nguyfin nam 2016.
BN khdng tang huyet ap, chua dugc diku trj vdi bat kJ loai thuoc h? glucose, thuoc h?
dp hay thudc h& lipid mdu.
+ Tifiu chuan chgn ddi tugng nghifin ciiu:
Chgn theo chu dich, cd mlu t h u ^ tifin.
+ Tieu chuan lo^i trir ddi tugng nghien ciiu: Tifin sd d5 su dyng cac thuoc dieu trj DTD vk roi loan chuyen hda lipid, cd thai hoac cho con bu.
+ Cac tifiu chuan chan dodn:
- Tifiu chudn chdn dodn DTD theo tiSu chudn ciia WHO nam 2001.
Tifiu chudn chdn dodn tdng hsCRP:
Binh thudng, nong dg hsCRP d d?ng v^t (<0,6mg/mL). Tang ndng dg hsCRP khi hsCRI^3 mg/L [4].
Tieu chuan rdi lo^in lipid huyM tuong theo tifiu chudn cua Hgi tim m^ch Vi?t Nam nam 2006:
- Ndng dO cholesterol huy^t tucmg £5,2 mmol/L.
- Ndng dg triglycerid huyet tuong il,7<i mmol/L.
162
Y HOC w e r NAM TAP 448-THAMG 12 . . i r t H j i c a i ^ . M i a
- Nong d§ HDL-C huyjt Mong < 1,0 mmol/L.
- N6ng dp LDL-C huyit tuong > 3,1 nunol/L.
+ Doi tuong nghien cihi diroc liy mau lihh mach vao bu6i stag, liic ddi. Mau mau duiTC ly tam ijy huy« tuong va lam xet nghi?m ngay.
2.2. ThM gian nghien ciru Ttrthfag 1/2016-10/2016 2.3. Dia dilm nghien cihi
Khoa x a nghifm, khoa Kham b?nh B?nh vien Truong Dji hpc Y khoa Thai Nguyen.
^
2.4. Phirong phdp nghien cihi Mo ta cat ngang
2.5. Thiet bj nghien cmi
Miy x a nghi?m sinh h6a tvr dgng OLYMPUS AU480.
H6a chat do htag BECKMAN COULTER cung cip.
2.6. Chi tieu nghien ctru
Djnh luong n6ng dp hsCRP theo phuong phap miln djch do dp due. Dinh lucmg glucose va mpt s6 thtah phin lipid huyet nrong theo qui trinh chuin, thuc hipn tren may AU 480.
- Xac djnh ty IS HbAIC theo phuong phap miln dich do dO due, thuc hi?n tr6n may AU 480.
- Chi tieu lam stag: tufii, chi s6 kh6i co the (BMI), huyit ap tai da (HATD), huyit «p toi thieu (HATT).
2.7. Ky thuat thu thap s6 Ufu Thu thjp s6 li^u theo mau benh ta.
2.8. Phuong p h i p xu- ly s5 li^u Theo phuong phap thong kS y hpc.
111. Kfr QUA NGHI§N CO'U
3.1. Mpl si i^c aim ldm sing d nhdm nghien cttu
Bins 3 1 - a a c dilm Mm sinp; i> henh nhin dii thiin tf.ri^n,. ^H mJc
uI'T- ""• t ^ " ^ ' ' ' ' * ' ^ " ^ ' ™ " ^ •=" ••' •>•« " ^ g binh 14 57,7±5 6 ( n t a ) c6 6
(kg/m ), ty le nam chiem 44,2%, ntt chilm 55 6% ^ J . M ^ . O Bi0R3.2. Ning dp hsCRP v i glucose fr benh nhin d i i .h4„ it,.!^^ - ^ ^ ^ ,
Nhom N f _ «. . .. : '
Nh^n jcA: Nong dg hsCRP, glucose vd «r is HKA r ,•- —Z ' — ' ^^^
blnh nhta c6 n6ng d0 hsCRP 4 ,a 4 7 c a p ™ 5 l ' , 9 4 " ^ ™ " " ' ' " * *^™«- '^ '^
HNKH Y D i r p c - Id NiEM SO N A M N G A Y T R U Y £ N T H 6 N G T R U I N G CAO S A N G Y THAI MGUYeN (1S66-201S)
Bang 3 J . Nong do lipid huyit tinmg o benh nhan d i i thio ivtime miH mic ^ NhomNC
Chi so
Cholesterolip (mmol/L) Triglycerid (mmol/L)
HDL-C (mmol/L) LDL-C (mmol/L)
X±SD 5,46±1,54 2,6I±2,15 0,91±0,17 3,12±2,01
Binh thirong n 18 17 12 22
%
34,6 32,7 23,1 42,3 Ty le roi loan 1 thanh phin lipid huyit tuong
Rii loan lipid n 34 35 40 30 44
%
65,4 ; 67,3 76,9 57,7 84,6 Nh^n xet: Ndng do mdt sd thanh phan lipid huyfit tuang deu cao hcm mdc binh thuii^
(theo tifiu chudn cua Hoi tim ni^tch Viet Nam), ty bfinh nhan tSng ndng dg cholesterolrp 14 65,4%, tang triglycerid la 67,3%, tang LDL-C la 57,7%, giam ndng dg HDL-C la 76,9%, ty 1§
rdi l o ^ mgt thanh phdn lipid huyfit tuong Id 84,6%.
Bdng 3.4. B0c diem lam sdng, ndng dp hsCRP vd mgt s6 chi s6 hda sinh huyit tuang d nhdm bjnh nhdn DTD theo nong do hsCRP huyit tuang
'~~ ^ - ^ ^ J J h o m N C Chi so ^ ^
Tuoi (ntai) BMI (kg/m^) HATD (mmHg) HATT (mmHg) Glucose (mmol/L)
HbAlC (%) Cholesterolrp (nunol/L) Triglycerid (mmol/L)
HDL-C (mmol/L) LDL-C (mmol/L)
hsCRP <3mg/L (11=25) 57,6±5,4 21,9i2,8 120,4±9,2 75,2±7,9
8,8±l,0 7,96±0,94 4,92±0,95 I,95±I,I6 0,95±0,17 2,84±0,64
hsCRP>3mg/L (n=27) 57,7±5,8 24,7±2,3 I28,2±7,6 81,2±5,6 13,5±4,6 I0,I7±I,83
6,60±l,58 4,36±3,35 0,77±0,I2 3,73±0,65
P
>0,05
<0,0I
<0,01
<0,0I
<0,0I
<0,0I
<0,05
<0,0I
<0,0I
<0,01 Nh^n xil: 0 nhdm b?nh nhta DTD c6 ntog dp hsCRP khong binh thudng (hsCRI^3mg/L) thi chi s i BMI, huyit ap cting nhu mOt so chi so hoa sinh cao hon so vdi nh6m bpnh nhta DTD c6 nong d0 hsCRP binh thutag (hsCRP<3mg/L), vdi svr khic bijt c6 f nghia thing ke p<0,0l.
3.2. luii lien quan giira ning ip hsCRP v&i mpt si yiu li khic
Bing 3.S. Tmmg quan giira nong d§ hsCRP vdi m$t s i chi s i hitt sinh d nhdm b^nh n h i n S T S
C h i s i Tuii ( n t a ) BMI (kg/m^) Glucose (mmol/L) 164
n 52 52 52
r 0,02 0,31 0,73
P
>0,05
<0,05
<0,05 a
Mjj,
! w ^
YHOC VltTllAMTAl'44»-THAMG12-SO BAC BIET-Mlli _HbAlC^%J_
CholesterolTj, (mmol/L) Triglycerid (mmol/L) _HDL-Ci!nmolX)_
LDL-C (mmol/T.I
52 52 52 52 52
0,66 0,51 0,33 -0,16 0,48
<0,05
<0,05
<0,05
>0,05
,^^-fe « ^ r d , t l > L - C • ' ' ™ " " ^° * ^ ^ - ^ ' " " " ''"^^' " ™ B nhu cholesteroL '^ Bang3.i. Lien quan v&i BMI
lift
C h i s ihsCRP (me/Li Glucose (mmol/L)
HbAIC (%)
BMI<23 (n=22) 2,6(>±1,44 9,13±2.04 2,60±1.44
Bivna23 (n=°30) 3,94±2.19 12,90±4,60 3,94±2.I9
<0,0I
<0,05 - , l ? ™ " f •• ' ^ , ' ^ ° " "^"^ " ^ ^ •'TD e6 thira eta, beo phi, n6ng dp hicRP. g l u o l huyi - ^ luong cao hon co y nghla so voi b?nh nhta khong tiiCra eta beo phi.
I a IV.BANLUAN , ^ , ,
mil hsCRP l« m„l. • 1.- *" ^ ^^^" ""^^ 8'"™"=' '* y*" ' ° d\r bta
* J t ^ 1 t ? r ' " ' " ' " " " BTD6ngu«trungtuii(trichdlntheo[5]).
5 S I t h h K/ J ' J ' " """ ''" •"""« * ^^-^ ^ ^ B™ "« phit hipn lin
J f « m m ^ t n * nhu bto phi, DTB type 2 v4 diu, kit qui nghien e*u eua chtag .61 cho A y ngiy eing e6 nhiiu btag chtag liSn .hiy: ning dp hsCRP huyit 1 ^ 1
^ q ™ giua unh « ^ g khtag insulin va hipn 3,37.2,01 mg/L, ty li bpnh n h i ^ Z ^ i 7 8 V 7 " • ' " " n h [7]. Nghien cuu cua Mc hsOU- huyl, tuong>3mg/L l i SI 9% ^ ' S D ^ d c t f ^ ' f ^ ' ^ ' " " ' ^ . " ^ n s h i t a e ^ n i y C a e ^ g t a i e l o o n s i * ta d ^ 1 h T T ! '"• ' ' ^ ' " ™ " * ' * " ^*" ' - •*= 8i* Vu Xuta Nghia
«m d i ^ ft,e hpn trta 5.888 nguod tinh (3,37±2,0I mg/L so voi 2,3 ± 0 9 mf/L)
*»? r d t . ^ 1 " " " ' ' '^^^ * ^ " . h i t a e t a d 5 8 B N DTD mdi p h l i h i r n l k
• tamir T " f " " ' = * ' " ' " "**•= *^" ' ^ ^^nh vien Lta khoa Tnmg uong. Cd
*' " I g ' T n g l r n ^ C n X t : ^ f - ™ ^ " - ' O c k h i c ^ L v i cho thiy Cd 45 ngudi bj DTD. diy » L d m tah D T n ' ""^t!" " ' " " ^ ' ' ' '**
ngudi cd ning dp hsCi«. eao hon cd y ^ g h " ! l " " ^ ^ ' " " ' 7 ^ ? '*"* ''^"
so vdi nhdm ngudi khong DTD 5 H ^ ™ " - ^ ^ khi bpnh d i diln biin ntag vdi
r ^^"''- '^" '^ ^= -^ ^^ ^' ~ - S i ; .rLrhri:
165
Ki NIgM 50 NAM N G A Y -reUYgN THdNG TRUdNG C A O B A N G Y THAI NGUYgN 11966-2016)
CUU cua tac gia Vu Xuan NghTa vdi ndng do glucose, HbA|C tuang
^ | l a 8,5±2,6 mmol/L, 7,9% [1], Kfit qua nghien cuu cua chung tdi vfi ndng do hsCRP cung nhu ndng do glucose, ty lfi HbA|C dfiu thSp hon so vdi kfit qua cua tac gia Vu Van Nguyfin nghien curu d 69 benh nhan DTD tai Hai Duong, vdi ndng do hsCRP, glucose, HbAlC hiang ung la 6,8±4,4 mg/L, 18,4±6,9 mmol/L, 10,6±2,5%, ty le benh nhan cd ndng dd hsCRP huyfit tuan^3mg/L la 63,8%. Cd su khac bi?t nay c6 thfi do ddi tugng nghien cuu cua chung tdi trfi hon (57,7 (nSm) so vdi 63,5 (nam)), dfii tugrng nghifin cmi cua chung tfii la nh&ng b?nh nhan den kham ngoai tru cdn doi tugng trong nghien ciiu cda tac gia Vu Vfin Nguyfin la nhiing bfinh nhfin dieu tri ngi tru dfin ca sd y tfi da cd trifiu chung lam sang. Vi v|y, cac chi sd c$n lam sang nhu glucose, HbA|C cung nhu mgt so thanh phan lipid huyfit tuang trong nghifin cuu cua chdng tdi deu thap hon so vdi nghien cdu cua tdc gia Vu Vfin Nguyen [2]. Ndng dO hsCRP huyet tucmg trong nghifin cdu cua tdc gifi Gupta d 54 b?nh nhan DTD mdi mac lfi 4,07±1,96 mg/L [3], kfit qua nghifin cim nfiy gan giong so vdi nghien cuu cua chung tdi.
Tac gifi Amanullah nghifin cuu vfi ndng dg hsCRP huyfit tuang d 400 bfinh nhan DTD vfi 40 ngudi khde manh binh thudng, kfit qufi nghifin cdu cho thfiy nfing dg hsCRP huyfit tucmg d nhdm b?nh nhan DTB la 4,8
±3,4 mg/L, cao hon cd y nghta so vdi nhdm chung la 2,5±2,9 mg/L. CJ nhdm b?nh nhan DTD cd nong dg hsCRP huyet tucmg
>3mg/L cd chi sd BMI, huyfit ap, ndng dg
glucose, HbAlC cao ban cd y nghia so vdi nhdm bfinh nhan DTD cd ndng dg hsCRP<3 mg/L. Ndng dg hsCRP cd moi tuang quan thuan, muc do vua, cd y nghia vdi chi sk BMI, glucose, HbAlC [4]. Ket qua nghifin cuu nfiy gfin gidng vdi nghifin ciiu cua chi'ing tdi.
Lifin quan giua DTD va beo phi co the Ik nhung yfiu td vifim dugrc san xuat bdi mo md. Cac yfiu to vifim nfiy cd the anh hudng den khang insulin vfi hfip thu glucose, thuc dfiy gan tfing tdng hgp acid beo va tang hsCRP. Mgt trong nhihig ca che lifin quan dfin yfiu to viem nay lfi do finh hudng d^n chk viln chuyfin GLUT4 tren bfi m§l te bko [4]. Vi vay, gluocse, HbAiC, hsCRP huyet tuong d nhdm bfinh nhfin thira can, bdo phi cao hon so vdi nhdm binh thudng (ket qua
bfing 3.5). ^ Cd mdi tucmg quan thu^n, miic dO vira, .
cd f nghTa giUa nong do hsCRP huyet tuong vdi n6ng dg mgt so thanh phan lipid huyet tuong, moi lien quan nfiy cd the do s\f hinh \ thfinh te bfio bgt tfing lfim tfing nong dg mgt sfi thanh phfin lipid mfiu, dfic bi§t lfi 1^
triglycerid, day lfi kieu rdi lo^n lipid mfiu thudng gfip nhat d b?nh nhfin DTD vfi h0u qua dan den rdi loan chdc nfing nOi m^ic. Ket qua nghifin cuu cua chung tdi cho thay: yeu td vifim cd Hen quan chat chS vdi khfing insulin vfi DTD, dieu nay ciing tuong dong vdi gifi thuyet cho rfing viem ddng vai tr6 quan trgng trong co che sinh b?nh hgc ciia DTD [3].
S««i|i|
VHOCVlETMAIIT«P4M-THANG12-SOMCKIfT.«i.c V. Kfr LUAN
1. Ttag n4ng dd hsCRP, glucose, mpt so J * W i phin lipid huyit tuong va tJ K HbAIC d benh nhta DTD mdi mSc. Ty le benh nhta ij DTD cd ndng dp bsCRF>3mg/L li 51,9%. 0 I nhdm bpnh nhta DTD mdi mic cd ndng dp I isCR1^3mg/L thi ndng dp glucose, lipid I huyet tuong ctag nhu huyit ap cao hon ed y 1 nghTa so vdi nhdm benh nhta cd ndng dp r hsCRP binh thudng.
*'' 2. Ndng dp hsCRP huyit nrong cao hon a nhdm benh nhta DTD cd thira eta, beo I pM. Nong dp hsCRP huyit tuong ed' mdi .luong quan thuan, kha chjt, ed y nghla vdi I nSng dd glucose, tJ lp HbA,C va tuong quan '^fliuJn, mile dp vira, ed i nghta vdi n^ng dp
> cholesterol, uiglyeerid cung nhu nong dp I LDL-C huyit tucmg.
TAIUIUTHAMKHAO
1. va Xuin Nghla, Pham Thing, Vii Thj Thanh Huyin (2014), "Ning dp protein phan tag C v4 interleukin 6 a benh nhan ddi thio dudng mdi dirpc phit hien", Tgp chi Y- Thrgc hpc Qudn su, si 5, trang 77-82.
2. VO VJn NguySn (2015), "Thuc tmng bfnh Bii thao dirdng type 2 mdi phit hifn dilu trj ndi ml tsi khoa Npi tilt Benh vifn Da khoa
tinh Hii Duong trong 6 tfitag dau nim 2013", Hgi ngM Khoa hgc Tinh Kan Tum 25/5, trang 21-29.
J. Abha Gupta, Kumar D (2015), "To study the association of high sensitivity C-reactive protein witii ne«l> diagnosed DM type 2", ,/i4CM16(l),tningl2-l5.
4. AmaiiuUah ,5, Abdiilla Jarari, MaralikrishQan Govindan, et al, (2010),
"Association of hs-CRP with Diabetic and Non-diabetic individuals", Jordan Joumal of Biological Sciences. 1995-1763, trang 7-12.
5. Barrilay JI, Abraham L, Hcckbert SR, et al. (2001), "The relation of markers of inflammation to the development of glucose disorders in the elderly: the Cardiovascular Health Smdy", Diabetes. SO (10), trang 2384-2389.
6. Zhiqiang Wang (2006), "C-reaotive protein and the risk of developing type 2 diabetes in Aboriginal Australians", Diabeles Research and Clinical Practice. 12. trang 10-19.
7. Shuhei Nakanishi, Kiminori Vamane, Nozorau Kamei, et al (2003), "Elevated C- Reactive Protein Is a Risk Factor for the Development of Type 2 Diabetes in Japanese Americans", Diabeles Care 26, 26 trang 2754-2757.
