Y Hpc TP. Hb Chi Minh * Tap 21 * So 2 * 2017 NghiSn ciiu Y hgc
SUY MON 6 BENH NHAN UNG T H U TAI BENH VIEN THONG NHAT TP. HO CHI MINH: TAN SUAT VA MOI LIEN QUAN V6l TICH TUOI
Nguyen Tim Linh*, Thdn Hd Nggc The^*, Trinh Thi Bich Hd**
TOM TAT
Dqt van M: Hiin nay, ung thu la cdn binh gdy tu vong hdng dau trin thi'gi&i. Mdt tiong nhdng nguyen nhdn gdy t& vong a benh nhdn ung thu Id tinh trqng suy mon. Suy mdn do ung thu da dugc chung minh ldm tdng ti li tie vong, gidm dung nap thuoc tdii hoa tri, tang ddc tinh hda tii, keo ddi thai gian dieu trf, suy gidm tinh tiqng ch&c ndng, tdng bim ch&ng, tang so'lan tdi nhdp viin. Tqi Viit Nam chua nghiin deu ddy du ve iinh trqng suy man & benh nhdn ung thu. Tqi Binh viin Thdng Nhdi thdnh phd'Hd Chi Minh, tinh tiqng suy mon do ung thu chua dugc chan dodn vd dieu tri ddy du. Vt vdy chung tdi thuc hiin nghien c&u a cdc binh nhdn dang diiu tri tqi khoa Ung bu&u Binh viin Thdng Nhdi deddnh gid tinh trqng suy mon.
Mifc tieu: Xac dinh ti li suy mon a binh nhdn ung thu tqi benh vien Jhdhg Nhdi TP. Ho Chi Minh vd mdi liin quan giua suy man v&i tich tudi a dm tugng binh nhdn ndy.
Phuang phdp nghien c&u: Nghien c&u tien c&u vd md td cat ngang dugc thuc hiin trin 359 binh nhdn ung thu tqi khoa Ung bu&u Binh vien Thong Nhat thdnh pho'Ho Chi Minh tii thdng 10 nam 2015 di'n thdng 05 ndm 2016. Suy mon a benh nhdn ung thu dugc ddnh gd theo tiiu chi chan dodn cua dong thudn quoc tendm 2011.
Kei qua: Trong sS'359 binh nhdn ung thu, c6127 binh nhdn nu (35,4%) vd 232 binh nhdn nam (64,6%), ty li nam : nie = 2:1, tuot trung btnh: 64,9 ± 12,5 (32-95 tudi) Ty li binh nhdn ung thu bi suy mon chm dodn theo dong thudn qud'c ti'2011 ld40,4%>. Tl li suy mon theo tiiu chi 1 (sut cdn > 5% trong 6 thdng) Id 35,1%,, theo tiiu chi 2 (sut cdn >2% kem BMI < 20) Id 26,7%>, theo tieu chi 3 (siit cdn > 2°/o kem tinh tiqng gidm khdi ca - sarcopenia) Id 34,4%>; khong cd su khac biet vi ti le suy mon chdn dodn theo tihi dhi 1 v&i tieu chi 3, cd su khac biit CO y nghia thdng ki vi H li suy mdn theo tiiu chi 2 v&i tiiu chi 1 (p<O,001) vd tiiu chi 3 (p=0,001). Co khodng 15°/o binh nhdn ung thu th&a cdn, beo phi dugc chan dodn suy mdn. Ti li suy mdn cr nam cao hem nu (44,4% so vdi 33,1%>), p<0,05; ti lisuy mdn a binh nhdn ung thu co di can Id 70,8°/o, nhom khong di can Id 25,1%, p<0,001.
Co mdi lien quan giiea suy mdn v&i tich tuoi, phuang trinh lien quan giua nguy ca suy mon v&i tudi: log OR = tudi X 0,046-3,485.
Kei ludru Ti li suy mdn a binh nhdn ung thu chdn doan theo tiiu chi dong thu&n qud'c te'2011 Id 40,4%. Co moi liin quan giua suy mdn vai tich turn; so vai m&c 75 tudi. binh nhdn ung thu tiin 75 tudi nguy ca suy mdn cao han, benh nhdn ung thu duoi 75 tuoi nguy ca suy mdn th^ han.
Titkhoa: suy mdn, ung thu, sut cdn, chi sd'khdi ca thi] gidm khoi ca.
ABSTRACT
CACHEXIA IN ADVANCED CANCER PATIENTS AT THONG NHAT HOSPTTAL IN HO CHIMINH CTTY: PREVALENCE AND RELATIONSHIP BETWEEN CACHEXIA AND AGING.
Nguyen Tien Linh, Than Ha Ngoc The, Trinh Thi Bich Ha
* Y Hoc TP. Ho Chi Minh * VoL 21 - No 2 - 2017; 81 - 88 Backgrounds: Currently, cancer is a fatal disease in the world tap. One of the causes of mortality in patimts with cancer is cachexia. Cachexia due to cancer has hem shown to increase mortality, reduced tolerance to
* Benh vien Thong Nhat, TP HCM. ** B9 mon Lao khoa - D?i hpc Y Duoc TP HCM
Tdc gid liin lac: ThS. BSCK2. Nguyin Ti&i Linh DT: 0913819214 Email: [email protected]
81
N g h i e n curu Y hgc Y Hgc TP. Ho Chi Minh * T$p 21 * So 2 * 2017
chemotherapy, increased toxicity of chemotherapy, prolonged the duration of treatment, impaired functional conditions, increased complications, increasing the number rehospitalizations. In Vietnam, there are no adequate studies on cachexia in cancer patimts. At Thong Nhat Hospital in Ho Chi Minh City, cachexia in cancer patimts IS not diagnosed and adequately treated. So we conducted the study in patients who were tieated at the Department of Oncology at Thong Nhat Hospital to evaluate cachexia conditions.
Objectives: Determine the prevalence of cachexia in cancer patients at Thong Nhat Hospital in Ho Chi Minh City and ihe relation between age and cachexia in this type of patient.
Methods: There was a prospective and cross-sectional study on 359 cancer patients at the oncology department of Thong Nhat hospital in Ho Chi Minh City from October 2015 to May 2016. Cancer cachexia was assessed by using the criteria from the 2011 Intemational Consensus.
Results: Among 359 cancer patients, there were 127 female patients (35.4%) and 232 male patients (64.6%), the proportion of male: female ^ 2:1, the average age: 64.9 ± 12.5 (32-95 years old) The rate of patients with cancer cachexia was diagnosed based on the 2011 International Consensus was 40.4%).
Cachexia which met the criterion 1 (weight loss> 5% in 6 months) was 35.1%>, met the criterion 2 (weight loss> 2% with BMI <20) was 26.7%, met the criterion 3 (weight loss> 2% and decrease in skeletal muscle mass - sarcopenia) was 34.4%; There was no difference in the rate of cachexia diagnosed based on the criterion 1 versus criterion 3, there was a significant difference in the rate of cachexia diagnosed based on the criterion 2 when compare to criterion 1 (p <0.001) and to criterion 3 (p = 0.001). Approximately 15%, of cancer patients who were overweight, obesity were diagnosed cachexia. Cachexia rate in males was higher than for female (44.4% versus 33.1%), p <0.05, Cachexia rate in patients with metastatic cancer was 70.8%, non-metastatic group was 25.1%, p<0.001. There was a relationship between cachexia and integrated age (aging), equation on relation between cachexia and age: log OR = age x 0.046 - 3.485
Conclusions: The prevalence of cachexia in advanced cancer patients diagnosed based on the criterm of interrmtional consensus in 2011 was 40.4%, There was a relationship between the cachexia and integrated age;
when compare to patients at 75 years old: cancer patients above 75 years old had higher risk of cachexia, and cancer patients under 75 years old had lower risk of cachexia
Keywords: cachexia, cancer, weight loss, body mass index, reduced muscle mass
DAT VAN DE 150.000 ngu-oi mic moi va khoang 50 - 70 nghin nguoi tii vong vi ung thu*^^*.
Hien nay, ung thu la can benh gay tii , , , . » , vong h t a g dau tien the gidi. Tai My, theo ^ ' '^°"8 "^^^ "Su^^" ' * = " 8"'' *" ™"8
TT-^ I.-- ll- tr T.'> /A • ,- o benh nhan ung thu la tinh trang suy mon Hiep hoi img thu Hoa Ky (Amenean Cancer ° , „ , . ^ . Society - ACS), nam 2014 co 1.665.540 truong (cachexia), va dugc cho la nguyen nhan gay tit , £ ,. , coe Tin . ' L J* vong 6 20-40% benh nhan ung thu<'^'^.
hgp mac moi va 585.720 truong hgp tu ^ . ^ vongl"). Theo bao cao cua co quan quoc te ve Suy mon do ung thu da dugc chung jninh ung thu (Intemational Agency for Research on 1™ 'ang ti le tii vong, giam dung nap thuoc khi Cancer, lARC) ciia to chiic Y te the gioi nam ^oa tri, tang dgc tinh hoa tri, keo dm thoi gian 2012 the gioi co khoang 14,1 trieu nguoi mac dieu tri, suy giam tinh trang chiic nang, ttag ung thu moi, du bao so benh nhan ung thu W^" '*'in& ' ^ 8 so Bn tai nhap vienH™.
moi phat hien trong nam 2035 se len den xap Tren the gioi da c6 nhieu nghien ciiu danh xi 24 trieu, tiic la gia tang 70% so voi nam gia tinh trang suy mon a benh nhan ung thu voi 2012. Tai Viet Nam, hang nam co khoang nhieu beu chi khac nhau<^. Truoc nam 2011, tieu chi chah doan suy mon do ung thu chua thong
82
Y Hpc TP. Ho Chi M i n h * Tap 21 * S^ 2 * 2017 N g h i e n ciiru Y hpc
nhat. Nam 2011, trong qua trinh eo gang dura ra mpt ti^u chi chah doan, mot hpi nghj dong thuan quoc te ve suy mon do ung thu diinh thiie dupe to chiic. Hpi nghj da dua ra dinh nghaa va tieu chi ehah doan suy mon do ung thu va mpt he thong phan l o ^ cho suy mon do ung thu*^.
Tai Viet Nam chua nghien eiiu day du ve tinh trang suy mon 6 benh nhan ung thur. Tai Benh vien Thong Nhat thanh pho Ho Chi Minh, tinh trang suy mon do ung thu ehua dupe chah doan va dieu trj day du. Ve ehan doan: chua co tieu chi chan doan dupe thong nhat. Ve dieu tri, van dieu trj nhu linh trang suy dinh duong thong tiiucmg.
Nhan thay ^ m quan trpng va can thiet ciia vail de, chiing toi thue hien nghien ciiu a eae benh nhan dang dieu tri tai khoa Ung buou de tim cau tra loi cho eae van de sau: ti le suy mon 6 benh nhan ung thu la bao nhi&u? Moi lien quan giiia suy mon do ung thu voi tieh tuoi? nham gjiip eho vi?c dieu trj benh nhan ung thu ^ y dii hon, ciing nhu de co Ihem dii Ueu ve suy mon a benh nhan Viet Nam bi ung thu.
DOITU'gNG-FHU'CNGFHAPNGHIENaJXJ Thiet k^ nghien cihi
Nghien euu tiai ciiu, mo ta cat ngang co phan tich.
Doi tupng nghien cmi Tieu chi chgn h$nh
Benh nhan da dupe chah doan img thu bang giai phlu b?nh dang dieu trj t?i khoa Ung buou b&ih vi?n Tiiong Nhat TP.HCM dong y tham gia nghien aiu.
Tim chilo^i tru:
- B^nh nhan dupe chan doan ung thu kem cac benh (ciing gay tinh trang suy mon): Benh phoi tac nghen man tmh, suy tim m?n, viem da khop dgaig thap, benh Ihan man giai do^n cuoi, hpi ehiing suy giam mien dich mac phai.
- B?nh nhan khong biet can n|ing ciia minh tmdc d6.
B$nh nhan khong dong y tham gia nghien ciiu.
Phuang phap nghi&n curu Thu thg,p so liiu
D3n sS nghien cihi dupe t i ^ hanh danh gia tinh trang suy mon theo tieu chi dong thuan quoc te 2011: benh nhan ung thu dupe chan doan suy mon khi thoa mpt trong 3 tieu ehi sau:
1. Giam can > 5% trong 6 thang qua (khong CO tinh trang doi don thuan); hoae.
2. BMI < 20 va giam can > 2%; ho|ic 3. Chi so CO xuong {Appendicular skeletal muscle index) phu hop voi tinh trang gjam khoi eo (sarcopenia): nam < 7,26 kg/m2; nii < 5,45 kg/m2 va giam can > 2%.
Doi voi tieu chi 3, de tinh chi so co xuang, chiing toi sii dung phuong phap tinh dien tich CO canh tay khong bao gom xuong (Arm Muscle Area - AMA) theo nhan trac hpe. Theo huong dan ciia dong thuan 2011: di$n tich co canh tay khong xuong phu hpp voi sarcopenia khi nam <
32 cm^ nii < 18 cm^
Di?n tich ea eanh tay khong xuong theo nhan trac hpc co the dupe tinh tir t4 so ehu vi giiia canh tay (Mid Arm Circumference - MAC) va be day nep gap da vimg co tam dau (TSF - Triceps skin fold) theo Heymsfield bang phuong tiinh sau (36):
AMA (doi vol Nam) = [(MAC (cm) - TT x TSF(cm)2/4Ti]-10cm2
AMA (doi vol Nu) = [(MAC (cm) - TI x TSF(cm)V4n]-6,5em2.
B$nh nhan ung thu dua vao nghien ciiu se dupe kham 13m sang, hoi (hoac truy xuat tu dii Ueu luu trii) can nang trong khoang Ihoi gian 6 thang truoc nhap vien, do chieu cao, can nang liie nhgp vien bang can do chieu cao va can nang TZ -120 aia eong ty Horse head, Thuang Hai, Trung Quoc. Do chu vi giiia canh tay (Mid Arm Circumference - MAC) bang thuac day va dp day nep gap da vimg co tam dau (triceps skin fold - TSF) biing dung eu Skinfold caliper (SUm
N g h i e n cuu Y hgc Y Hpc TP. Ho Chi Minh » T$p 21 • S^ 2 * 2017
Guide Skinfold CaUper ciia cong ty Healthcheck Systems Inc, san xuat t?i My).
Tmtg ketx&ly soli$u
So U|u dupe xCr ly biing phan mem SPSS 16.0 for windows.
MdtddQlieu
- Bim so djnh tinh: trinh bay duoi d ^ g ty le.
- Bian so dinh lupng: trinh bay duoi dang trung binh va dp l?eh chuan neii phan phoi chuan, neii phan phoi khong chujui trinh bay duoi d?ng trung vi va khoang tii vi. Dung phep kiem Shapiro - Wilk de Idem phan phoi co chuan kh6ng?
PhSn tich so li^u
- Dimg phep kiem McNemar de so sanh hai ti 1| khi ap dung 2 tieu chi chah doan khac nhau.
(Myc tieu 1).
- Dung phep ki&ri chi binh phuong de so sanh hai bi&i djnh tinh (Co hieu chinh Fisher).
- Dimg hoi qui logistic de xac djnh mcS Uen quan gjua suy mon va tuSi.
- Su khac biet co •y nghia th^ng ke khi gja trj p < 0,05 voi dp tin qiy 95%.
KET QUA NGHIEN CtJtJ
Dac diem ve nhan trac hpc c i ^ mau nghien cuu
Dan so nghien ciiu bao gom 359 b?nh nhan suy ung thu. Trong do, eo 127 b | n h nhan nii (35,4%) va 232 benh nhan nam (64,6%), ty I?
namaiii = 2:1, tuoi himg binh: 64>9 ± 12,5 (32-92 tu6i). Nhom tuoi ehiem ti 1? cao nhat 60-69 tuoi (29%). Chi so khoi co the (BMI) trung bmh: 21,7 ± 3,05. Tl 1| eae nhom BMI: thieii can: 16,7%, binh thucmg: 49,3%; Ihira can, beo phi: 34%.
Dien tich ea eanh tay trung binh 6 nii la 27,55
± 7,55 cm2 6 nam la 34,09 ± 7,51 on^. Co 266 benh nhan (74,1%) sut can > 2% va 126 benh nhan (35,1%) syt can > 5% trong 6 thang.
Tan suatt cac loai ung thu
"Hn suSt cae logi ung Ihu trong nghien ciiu la: ung thu dai true trang: 29%; ung thu phoi:
21,7%; ung thu da day: 13,1%; gan: 10,9%, vii:
9,7%, lymphoma: 5,2%, cac ung thu con lai: dau mat c6, tuy, tien liet tuy&v buong tning chion ti
\% duoi 5%.
Ti If suy mon theo dl5ng thuan 2011 va ti 1$
suy mon Iheo t&ng tieu chi chan doan Mau nghien ciiu 359 benh nhan ung thu, CO 145 benh nhan suy mon, chiem ti le 40,4%.
Ti le suy mon theo tieu chi 1 tuang tu tieu ehi 3. Ti le suy mon theo tieu ehi 2 thap horn co y nghia thong ke so voi tieu d u 1 va tieu chi 3 (Bieu do 1 va 2).
64.9 73.3 65.7
• Suy mdn
Ti6u chfTifiu chfTigu chf 1 2 3
Biai do 1. Ti lisuy mon a berth nhdn ung thu theo tieng tiiu chi tMn dodn
Ti If suy mon theo gioi, chi so khoi ca the (BMI) va di can
Bdng 1. Ti lisuy mon theo gi&i, BMI, di cdn:
Gift
Nh6m BMI Giai doan
Nam Nir Ttiilu cSn Binh thu&ng
Diira cdn B6ophl Oic§n Chu'a di cdn
Suy mdn, n,(%) 103(44,4)
42 (33,1) 56 (98.2) 78 (43,3) 10(12,5) 1 (2,4) 85 (70,8) 60 (25,1)
Khdng suy mdn, n, (%) 129(55,6)
85(66,9) 1 (1,8) 102 (66,7)
70(87,5) 41 (87,6) 35(29,2) 179 (74,9)
Gii t r p 0,037
< 0,001
< 0,001
Moi lien quan giua suy mon voi tich tuoi:
Phuong trinh lien quan giiia ti so chenh OR vcd tuSi: Log (OR) = hioi x 0,046 - 3,485.
Y Hpc TP. H o CM Minh * Tap 21 * So 2 * 2017
Bim do 3. Mm liin quan giua suy mon v&i tich tuoi
& benh nhdn ung thu.
BAN LUAN
Hpi ehiing chan an suy mon thuang gap 6 doi tupng benh nhan ung thu. Trong nhiing nam gan day, tam quan trpng ciia viec danh gja hpi chiing chan an suy mon 6 doi tugng benh nhan nay dupe nhan manh boi nhimg nghi&i ciiu cho thay tinh trang suy mon lam tang ti le tu vong, giam dung nap thuoc khi hoa tri, tang dpc tinh hoa tri, keo dai thoi gjan dieu tri, suy giam tinh trang chiie nang, tang bi&i chiing, tang so Kn tai nhap vienP-^^. Vi vay, viee danh gia tinh trang suy mon 6 benh nhan ung thu giiip cho viec dieu tri 6 doi tupng benh nhan nay toan dien hon.
Ti 1^ suy mon or benh nhan ung thu theo dong thuan 2011
Dua tren dong thuan quoe te ve tieu chi ehah doan suy mon trong ung thu nam 2011, ti le suy mon a benh nhan ung thu trong nghien ciiu nay la 40,4% cao hon trong nghien ciiu eiia Lei Sun tren 390 benh nhan ung thu tai b$nh vien Ung fhu thanh pho Vii Han, Trung Quoc (35,9%y^. Su khac biet nay co le do su khac nhau ve ti le ung thu phoi trong mau nghien ciiu va ti le suy mon trong ung thu phoi: trong nghien ciiu aia Lei Sun, ung thu phoi chiem ti le 33,8%
rihung ti le suy mon ciia ung thu phoi chi 25,8%;
trong khi nghien ciiu nay, ung thu phoi ehiem ti le 21,7% nhung ti le suy mon len den 43,6%.
Trong nghien ciiu eiia Blum va epng suO>, sii dung tieu ehi 1 (sut can > 5%) va tieu ehi 2 (BMI <
Nghien ctru Y hoc
20 va bat ky sut can > 2%) de chan doan suy mon, ti le suy mon la 46,3%. Trong nghien ciiu nay, ti le suy mtm khi sii dung tieu chi 1 va 2 la 36,5%. Su khae biet nay la do ti le benh nhan syt can > 5% trong nghien ciiu eua Blum cao hon nghien ciiu nay (45% so voi 35,1%). Chan doan suy mon khong chi eo loi cho viee xae dinh va hieu biet r5 ve tinh trang nay ma con quan trpng trong viee ehuan bi cham soc dac biet va dieu tri suy mon. De tieu chi chan doan co gia tri va eo the ap dung tfii phai co dp nhay va dp dac hieu eao. Truac khi co dong thuan quoc te ve tieu chi chah doan suy mon nam 2011, nhieu tieu chi chah doan khac nhau da duac ap dung de ehah doan suy mon. Nghien ciiu ciia WaUengren va epng su*"' cho rang ti Ie suy mon thay doi rat ldn dua vao tieu chi duac sii dung, nghien ciiu cho thay ti Ie ti le nay thay doi rat rpng tCr 6 den 82%.
Nghien eiiu nay eiing nhu nhieu nghien 0^(33.9.13) cho thay ti le suy mon trong ung fhu la kha cao, khoang 40%, thiet nghi trong thuc hanh Iam sang, ngoai chan doan ung thu va cac b&nh di kem, benh nhan ung thu can dupe danh gia them tinh trang suy mon, nham dfeu tri day dii, gop phan eai thien chat luxmg song va keo dai tuoi thp cho berih nhan ung thu.
Ti le suy mon Iheo timg lieu chi chan doan Trong nghien eiiu nay, ti Ie suy mon khong giong nhau khi ap dung tieu chi chan doan khac nhau. Tl le suy mon theo tiing tieu chi 1,2,3 Ian lupt la: 35,1%, 26,7% va 34,3%. Khi dat gia thuyet rang, ca ba tieu ehi ehah doan dupe de xuat se cho ti le suy mon tuang tu nhau va nhat quan o benh nhan, khong phu thupe vao tieu chi dupe ap dung, bang phep kiem McNemar, nghien a i u nay eho thay ti Ie suy mon khae biet eo y nghia thong ke giira cac tieu chi: 1 va 2, p < 0,001; 2 va 3, p = 0,001. Ti Ie suy mon tuong tu giira tieu ehi 1 va 3, p = 0,728. Cac tieu chi chan doan tren khong dua ra ket qua giong nhau gay nhieu kho khan cho nghien a i u va thuc hanh lam sang.
Trong nghien eiiu ciia Blum va cpng SUP>, tac gia sir dung tieu ehi 1 va 2 de danh gja ti le suy mon 6 benh nhan ung thu tiai triCTi, ket qua eho thay
8S
N g h i e n ciiu Y hpc Y Hpc TP. Ho Chi Minh * Tap 21 * So 2 * 2017
CO EU khac nhau ve ti Ie suy mon khi ap dung tieu chi ch&i doan khac nhau: ti le suy mon tiieo chi 1 la 45,1% (388/861 benh nhan) va tiieo tieu chi 2 la 11,5% (99/861 benh nhan), tac gia khong dung tieu chi 3 de danh gia.
Tac gia Scarlet F.Endna trong nghien cihi ve suy mon a benh nhan ung thu phoi cung cho ket qua tuong tu (su khac biet giira cac tieu ehi: 1 va 2, p < 0,0001; 1 va 3, p = 0,021; 2 va 3, p< 0,0001)(i2).
Ti le suy mon khi ap dung tieu ehi chain doan dua vao chi so khoi co the (tieu chi 2) eho ket qua thap hon. Co the gjai fhich do ehi so khoi CO the (BMI) < 20kg/m2 lam hep chan doan, nham thang vao nhom benh nhan thieii can va gan nhu loai trir nhimg nhom BMI khac. So benh nhan fhieu can trong mau nghien ciiu nay chi chiem ti Ie 16,7% (thap hon nhieu so voi nhom can nang binh fhuong: 49,3% va fhap hon nhom du can: 22,3%) dan den viec danh gja bing tieu ehi 2 cho ti le thap. Trong nghien ciiu ciia Scamet F.Endna, ti Ie nhom thieu can va ti Ie suy mon theo chi 2 tuong ling la: 6,2% va 8%. Trong nghien ciiu ciia Blum, tae gia khong tong ket ti Ie nhom thieu can nhung bao eao eo 88 berih lihan CO ket qua danh gia khac nhau khi ap dung 2 tieu chi ch&i doanPi.
Tieu chi 1 va 2 de ap dung hem tieu chi 3 do viec danh gia khoi co co nhieu phuang phap khac nhau nhu phucmg phap nhan trac, phuong phap eat lop dien toan de danh gia khoi co lung, phuang phap phan tich trd khang dien sinh hpe (Bioeleetrieal Impedance Analysis - BIA) de dan den ket qua khae nhau. Trong tieu ehi 1 va 2, suy mon dupe hieu la khi eo nhiing fhay doi can nang hay chi so khoi ea the. Tieu ehi 3 Uen quan den mat khoi ca, nhieu nghien ciiu da bao eao ti le teo CO eao ngoai nhom can nang binh thudng va fhieu can thi ciing gap d nhdm thira can va beo pW. Trong nghien ciiu eiia tae gia Lisa Martin va epng su^, tae gia ciing eho fhay benh nhan ung thu beo phi ciing co tinh trang suy giam khoi co va su suy giam khoi ea nay Uen quan den tien lupng song cdn xau, khong phu fhupc vao ehi so khdi ea the. Trong Ihue hanh
lam sang, b&ih nhan ung fhu thira can beo phi cung ean ducfe danh gia ve suy mdn dua tren sut can va danh gia khoi co.
Bdngl. Ti lisuy mdn & binh nhdn ung thu tiong mdt sd'nghiin c&u
Tac gia (tieu chi SLF di^ng) Kathleen M. Focx (sut can > 5%)
Chting toi (sgt can > 5%) D.Blum {syt can > 5% hope BMI < 20
kem syt can > 2%) Chung tSi (sut can > 5% tioac BMI < 20
Item syt can > 2%) Lei Sun (Dong ttiugn 2011) Chung toi (D6ng thupn 2011)
TT l# suy mdn [%) 37,6 35,1 46,3 36,5 35,9 40.4 Ti le suy mon theo gioi
Theo ket qua nghien ciiu nay, ti Ie suy mon d nam la 44,4% cao han nii la 33,1%, su khac biet nay cd y nghia tiiong ke Vdi p = 0,037. Blum va cpng su cho thay trong nhdm suy mon, nam chi&i ti le cao hon nii (59% so vdi 41%, p <
0,01)f^''; nghien cihi cua Scamet F.Endna ciing cho thay nam gidi teo ca rihieu hem nii (57,1% so vdi 46,8%, p < 0,001)(^t. Harvie va cpng su*^' bao cao trong qua trinh hda tri, nam gidi thudng giam luong chat beo tu do va tieu hao nang lucmg nghi nhieu, dieu nay khdng quan sat dupe d nii gidi; Baraeos va cpng SUP' eiing nhan fhay da so nam gidi du tieu ehuan chan doan teo eo, trai ngupc vdi nii gidi. Ket qua nghien eiiu nay ciing nhu nhieu ngJiien cihi vira de cap gpi y ehiing ta nen chii y doi tupng nam gidi frong danh gia suy mdn d benh nhan ung thu.
Ti le suy mon theo nhom BMI
Ve ti le suy mdn trong tiing nhdm BMI, nghien eihi nay eho fhay ti le suy mdn trong nhdm nhe can la 98,2%, trong nhdm can nang binh thudng la 43,3%, cd khoang 15% benh nhan thira can, beo phi dupe chan doan suy mdn.
Suy mdn la mpt tinh trang de bi ehe lap.
Thue te, teo ea d l bi che day khi co beo phi*".
Ngoai ra viee ca the giii nude khd phat hien tinh trang huy co va gay khd khan trong viec chah doan suy mon. Trong nghien oiu nay, khoang 8% benh nhan thira can beo phi duoc chan doan
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Y Hpc TP. Ho Chi Minh * Tap 21 * So 2 * 2017 Nghien ciiu Y hpc
suy mdn theo tieu chi 3. Trong mpt nghien ciiu ve tinh trang giam khoi ea (sarcopenia) d benh nhan ung thu beo phi, tac gia Caria M M Prado va epng sir cho thay cd 15% b|nh nhan beo phi bi suy mdn theo tieu chi 3. Ngoai ra, tac gia edn ghi nhan tinh trang teo co la yeu to tien lupng doe Igp vdi chi so khoi ca the (HR 42 [95% CI 2.^7.2], p<0.0001 )<!"'. Trong nghien cuu ciia minh, tae gia Scarlet F.Endna nhan fhay cd 12,7% ung fhu phdi ed BMI > 30 (beo phi) bi suy mon fheo tieu dli 3t^l]. Trong nghien ciiu nay, chi so ca xuang (Appendicular skeletal musde index) trong tieu chi 3 dupe danh gia qua dien tich vimg co eanh tay bang phuang phap nhan trac, mpt phuang phap phu thupe vao kinh nghiem cua ngudi quan sat va khd ap dung d benh nhan qua beo, do vay trong thue hanh lam sang, nhung benh nhan ung thu beo phi nen dupe danh gia khoi eo bang phuang phap do hap phu nang lupng tia X kep (dual energy x-ray absorptiometry - DEXA) hoac tinh dien tieh ca that lung bang chup cat ldp vimg bung hoae phucmg phap phan tich dien trd sinh hpc (bioelectncal impedance).
Ti le suy mon khi co di can
H le suy mdn d nhdm benh nhan cd di can la 70,8% cao hem nhdm ehua di can Ia 25,1%, su khac biet nay ed y nghia thong ke vdi p < 0,001.
Nghien ciiu eiia D.Deans cho thay Uen quan giiia suy mdn va gjai doan di can aia benh, ti le suy mdn cang cao khi giai doan benh cang tre'*', nghien eiiu ciia D. Dewys cho thay ti Ie suy mdn fang khi so nai hi di can tang'^J. Khi khoi u phat trien va di can xa, khoi u tiet nhieu yeu td gay suy mon, tucmg tac giiia khoi u vdi ca the ngudi benh cting tangi^ lam tinh trang mat khoi ea tang. Hinh anh thudng thay frong fhuc hanh hang ngay la hinh anh "da bpc xuomg" d benh nhan ung fhu giai doan cudi. Tir ket qua nghien ciiu nay eiang nhu ket qua cac nghien eiiu viia tiinh bay, chung tdi cho rang trong thuc hanh hang ngay, khi benh nhan ung thu cd di can, ehiing ta nen ehii y van de ch&i doan va dieu tri suy mdn nham eai thien chat lupng cupc song, keo dai tudi fhp cho benh nhan.
Moi lien q u a n giua suy mon vdi tich tuoi:
Nghien ciiu nay eho fhay ed moi Uen quan giua suy mdn vdi tich tuoi ed y nghia tiiong ke vdi p < 0,001. Dua theo phuang trinh xac dinh ti so chenh OR tiieo tuoi, ta fhay, d miic 75 tuoi, ti sd chenh OR = 1. So vdi tudi 75, benh lihan tren 75 tudi ed nguy ca suy mdn eao hon (OR > 1), benh nhan dudi 75 tudi nguy co suy mon fhap hon (OR < 1). V: du d benh nhan 85 tuoi nguy co suy mdn so vdi tuoi 75 tang gap 2,6 Ian; d benh nhan 65 tuoi nguy ca suy mdn so vdi tudi 75 ehi bang 0,32 Kn.
Theo tae gia Ronenn Roubenotf'", ngudi eao tudi cd nhieu fhay ddi trong thanh phan eo the va chuyen hda nang luang va protein do nhiing tac dpng true tiep cua qua trinh ti'ch tudi va benh ly xay ra trong qua trinh tich tudi. Nhung tiiay ddi nay thudng xay ra dudi eae hinh thiie: Hao mdn (wasting), suy mdn (cachexia), va giam khoi CO (sarcopenia). Hao mdn la su mat trpng luang khdng chii y, xay ra ehu yeu do ehe dp an uong khdng day du. Suy mdn, mat khae, de cap d&i mat khdi ca cd hoac khdng kem mat khoi md aia CO the. Trong suy mdn, dae diem noi bae la tang chuyen hda (hypermetabolism) va tang di hda (hypercatabolism), do dap img protein pha cap (Acute phase protein response) qua trung gian eae cytokine. Giam khoi ca la tinh trang mat khoi luong ca va Uen quan den tich tuoi. Ngupc Iai vdi sarcopenia, hao phi va suy mon cd the xay ra d ngudi ldn tudi va la ket qua cua benh ly trong qua trinh tfch tud'i hoac do eae van de tam trinh ti'ch tudi nhu tren nen d ngudi cao tuoi m3c ung thu, ngoai suy mdn do ung thu, ngudi eao tudi se gia tang nguy ca suy mdn do tich tuoi. Vi vay trong thuc hanh, ehiing ta can chii y van de suy mdn d benh nhan ung fhu, dae biet d benh nhan cao tudi (tren 75 tudi).
KET LUAN
Ti le suy mdn d benh nhan ung thu chan doan fheo dong thuan quoc te 2011 la 40,4%. Ti le suy mdn do ung thu gap nhieu d nam ban nu, ti le suy mdn d nhdm benh nhan cd di can la 70,8%,
N g h i e n c u u Y hpc Y Hpc TP. Ho Chi Minh * Tap 21 * S 6 2 * 2017
cd khoang 15% benh nhan thira can beo phi duac chan doan suy mdn. Cd moi Uen quan gitia suy mdn do ung thu vdi tich tudi: so vdi miie tudi 75, benh nhan ung fhu tren 75 tudi nguy eo suy mdn cao han, benh nhan duoi 75 tuoi nguy ca suy mdn thap hem.
T A I L I E U T H A M KHAO
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Ngdy nhan bdi bdo. 01/11/2016 Ngdy phdn biin nhdn xel bdi bdo: 18/11/2016 Ngdy bdi bdo dtegc dang: 01/03/2017
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