VIETNAM MEOICAL JOURNAL N°1 . MARCH - 2018 2. Nguyin Thi Hong Dan (2011), Kien thiTc, thUc 4.
hanh phdng'bien chiTng ciia ngudi benh dai thao (JUcfng tuyp 2 tai huyen Khoai Chau tinh HUng_Yen nam 2010, Luan van Thac sy Y te cong cgng,
Tru'dng Dai hoc Y te cong cong. Ha Ngi. s.
J. Be Thu Ha, Nguyen Kim Lu'dng (2009),
"Nghien ciTu thUc trang benh dai thao dUcfng dieu tri tai Benh vien da khoa tinh Bac Kan", Tap chi Y hoc thyc hanh. 679(10), tr. 60 - 63.
Lili Y, Jing S, Yaoyao B et ai (2016), Prevalence of type 2 diabetes mellitus among inland residents in China (2000-2014): A mete- analysis, 3 Diabetes Investig, 7(6): 845-852. | D|ing Thi Hang Thi (2013), "Kien tiiiTc, t t i # hanh phdng bien chimg ban chan cua ngu'di bSffl dai thao dudng tuyp 2 tai Benh vien 19-8 Bo cong m 2012",TapchiY hgc thu'c hanh. 856(1), tr. 38-4. ';
s y THAY DOI NONG DO VITAMIN B12, FOLATE VA MOT SO CHI SO HOA SINH M A U (T BENH N H A N THIEU M A U
T O M TAT
Muc tieu. nghien ciTu su' thay doi nong do vitamin B12, folate va mot so chi so hoa sinh mau d benh nhan tfiieu mau. Dot tu'dng va phddng phap nghien cuir. Benh nhan dUdc chan doan thieu mau (theo tieu chuan ciia WHO) gom 66 benh nhan dieu trj tai Benh vien Quan y 103, dUdc kham va xet nghiem ciian doan nguyen nhan thieu mau, xac dmh nong do vitamin 812, folate mau, chiTc nang gan va mgt sd chi sd hoa sinh mau; xac dinh moi tu'dng quan giiTa vitamin B12, folate vdi nong dg hemoglobin huyet tUdng. Kit qui: nhom benh nhan thieu mau bi b&nh bach C3U chiem t / le cao nhat (21,21%), benti da u tiiy xu'dng chiem 16^67%, thieu cac ;^eu to dinh du'dng (12,12%), benh ly mat mau mat sat man tinh (12,12%), benh u lympho ac tinh va huyet tan mien dich (4,55%). Ty le benh nhan cd vitamin B12 huyet thanh binh thiTdng chiem ty le cao nhat (84,85%), trong do t / le benh nhan co Folate huyet thanh binh thu'dng chiem t / le 87,88%; benh nhan giam vitamin B12 (9,09%), giam Folate huyet thanh (6,06%). Nong do hemoglobin huyet tu'dng cd siT tu'dng quan thuan vdi nong do vitamin B12 huyet tu'dng (y = 0,0025x + 82,233), tUdng quan nghich vdi nong do folate huyet tu'dng (r=-0,31),(y = -l,4287x + 96,591). Nong dd enzym GGT tren benh nhan thieu mau cd tang nhe (85,39 ± 53,41 U/L);AST, ALT, bilirubin trong gidi hah binh thu'dng. Hemoglobin co moi tu'dng quan nghich vdi nong do protein huyet tUOng (y = -0,1021x' + 91,107). Kit luan: Da so benh nhan thieu mau cd nong do vitamin B12, folate huyet tu'dng binh thu'dng.
Co moi tu'dng quan nghich giij^ nong do hemoglobin vdi nong do folate huyet tu'dng.
Ti/'Aftos; thieu mau, hemoglobin, vitamin B12, folate SUMMARY
THE CHANGE OF CONCENTRATION OF VITAMIN B12, FOLATE AND SOME BLOOD
BIO-CHEMICAUNDEX I N ANAEMIA PATIENTS
*Hgc viin Quin y
Chju trach nhiem chinh: Nguyen Van Bang Email: [email protected] Ngay nhan bai: 24.12.2017 Ngay phan bien khoa hoc: 5.2.2018 Ngay duylt bai: 12.2.2018
Nguyen Van Bang*, Nguyen Thanh Xuan*
ObjectsXo study the alter of concentration of vitamin B12, folate and the number of blood bio- chemicalindex in anaemia pabents. Subjects and methods: patients were diagnosed as anaemia (according to cntenon of V/HO), included 66 pahents treated m Hospital 103, examined and tested to diagnose anaemia reasons, defined blood vitamin B12 concentration, blood folate; function of liver and a number of blood biochemical index; defined correlation between vitamin B12, folate with plasma hemoglobin concentrahon. ffe^u/te.-anaemia patients group suffered from leukemia has highest rate (21.21%), Mulbple Myeloma (MM) (16.67%), tiie lack of nutritional factors (12.12%), the loss of chronic blood, iron (12.12%), Malignant Lymphomas and hemolytic anaemia (4.55%). The percentage of patients with normal plasma vitamin B12 concetration had highest rate (84.85%), while the percentage of patients with blood normal folate had rate 87.88%, patients has decreased blood vitamin B12 concentration (9,09%), folate (6.06%). Plasma hemoglobin concentration has agreeable correlation with plasma vitamin B12 concentration (y = O.0025X + 82.233), opposite correlation with plasma folate concentration (r=-0.31), (y = -1.4287x + 96.591).
Plasma GGT concentration in anaemia patients has increased lightly (85.39 ± 53.41 U/L);AST, ALT, bilirubin have normal value. Hemoglobin has opposite.
correlation with plasma protein concentration (y = i"
0.1021X + 91.107). Conclusion: The most anemic' patients have normal concentration of vitamin B12 and folate in plasma. There is a negative con^laton between concentration of hemoglobin and concentration of folate in plasma.
Key iwwtfe.'anaemia, hemoglobin, vitamin B12, folate.
I.OjciTVANOll
Benh nhan thieu mau cd nhieu nguyen nhan khae nhau. Hien nay, thieu mau du'dc phan ehia theo nguyen nhan va cd che benh sinh la day dii hdn; thieu mau diTdc chia thanh 4 nhdm Idn:
chay mau, eung cap thieu cac yeu t d tao mau (thieu mau dinh du'dng), tai cd quan tao mau va nguyen nhan huyet tan. Thieu mau cd the lien quan den eac yeu to tao mau nhu" vitamin 612, Folate (acid folic, vitamin B9), sat, protein.. Vai
TAP CHl Y HOC VigT NAM TAP 464-THANG 3-SO 1 -2018 trd eiia vitamin B12 trong viee hinh thanh eac te
bao mau: tai tiiy xu'dng vitamin B12 tham gia vao qua trinh tru'dng thanh va nhan len ciia cac ddng te bao mau, trong dd ehii yeu la ddng hdng cau, thieu vitamin B12 lam giam sd lan phan bao dan den thieu mau hong cau to, cd the giam nhe ca 3 ddng te bao mau; ngoai ra vitamin 812 edn tham gia vao qua trinh tong hdp te bao than kinh, nhan ddi eua ADN trong te bao, tdng hdp Methionin [6], Nhin ehung vitamin B12 rat can thiet cho qua trinh nhan len cua te bao, tham gla vao ChiTc nang eiia he thong than kinh, chdng met mdi va kich thieh.Folate (cdn goi la: acid folic, vitamin B9) la mot coenzym trong sir tao thanh tetrahydrofolate (THF), mpt chat cd vai trd van chuyen ddn vj 1 C trong chuyen hda cac acid nucleic va eac acid amin. THF cung tham gia vao qua trinh td'ng hdp nucleotide pyrimidine, can thiet cho sir phan chia te bao binh thu'dng.
Folate cung can thiet cho s i / san sinh cac hong eau (acid folic gdp phan tao nen cac te bao mau, thieu acid folic dan den thieu mau hong cau to.
Protein ciJng la thanh phan tham gia vao qua trinh tao mau, day la Ioal thieu mau khong ehi thieu protein ddn thuan ma thu'dng kem thieu sat, vitamin, acid folic... [7], cd the gap trong cac nguyen nhan: che dp an ngheo protid, thdi quen an kieng d ndi tap tuc lac hau, xay ra vdi phu nir CO thai, sau de, hap tliu kem do benh ly
du'dng rudt, mat protein trong bdng, nhiem khuan nang keo dai. Chinh vi vay ehiing tdi tien hanh nghien ciTu: sd thay ddi nong dp vitamin B12, folate vi mdt sd chi sd hda sinh miu d benh nhan thieu miu.
II. DOI TU'ONG VA PHU'ONG PHAP NGHIEN CUTJ 1 . Doi tu'dng nghien cu'u: Benh nhan du'dc chan doan xac dinh thieu mau (theo tieu chuan cua to ehire y te gidi), dieu trj tai Khoa AM7- Benh vien Quan y 103. Sd lu'dng: 66 benh nhan.
Thdi gian dieu tri: TiT thang 1/2017 den thang 10/2017.
Vat lieu nghien eiTu: ehi so hoa sinh mau, huyet hpe thiTc hien tren may Olympus AU640;
XT4000i (Sysmex - Nhat Ban), hda chat do hang cung cap.
2. Phu'dng phap nghien cu'u - Thiet ke nghien cu'u eat ngang ed phan tieh.
- Benh nhan dieu trj npi tru chan doan xae dinh thieu mau (theo WHO) khi: nong dp hemoglobin trong mau ddi vdi nam < 130g/L, nu" <
120g/L, phu ntr cd thai, cho con bu <110g/L[3].
- Cae bien sd, ehi sd nghien eiTu:
+ Benh nhan du'dc kham, xet nghiem de chan doan cac nguyen nhan gay thieu mau.
+Xet nghiem nong do hemoglobin mau, vitamin B12, acid folic, chu'c nang gan va mdt sd chi sd hda sinh mau.
Phu'dng phap dinh lu'dng, gla tri tham chieumot so chi so hoa sinh Ten x e t nghiem
AST (U/L) ALT fU/L) GGT (U/L) Bilirubin TP(pmol/L)
Creatinin (pmol/L) Ure (mmol/L) Glucose (mmol/L) Cholesterol TP (mmol/L)
Triglvcerid( mmol/L) Protein (g/L) Acid Uric (pmol/L)
LDH (U/L) CPK (U/L) Vitamin B12 (pg/mL)
Folate (nq/mL) Na-" (mmol/L)
K*(mmol/L) CI"(mmol/L)
Phu'dng phap Do quanq donq hoc Do quanq donq hoc Oo quang dong hoe
Do quanq Oo quanq ddnq hoc Oo quang dong hoc Enzym do quang Enzym do quang Enzym do quang Oo quanq Oo quang Oo quang Oo quang Oo quanq Oo quang Oo quanq Oo quang Oo quang
Gia tri tham chieu 0 - 4 0 0 - 4 0 1 1 - 5 0 0 - 1 7 , 1 5 0 - 1 1 0 2,5 - 7,5 3,9 - 6,4 3,9 - 5,2 0,46 - 2,3 4 6 - 8 2 140 - 420
0 - 2 4 7 240 -190 208 - 963 7,2 - 15,4 135 - 145 3,5 - 5,0 98 - 106 - Tim hieu mdi tu'dng quan qida Vitamin B12, Folate huyet tu'dng vdi nong dp Hemoglobin huyet tu'dng.
- Xd ly so lieu: sd dung phan mem Excel, EpiCaie 2000. Oanh gia he sd tu'dng quan.Gia trj ciia r:
-1 < r < + l . r am la tu'dng quan nghich, r du'dng la tu'dng quan thuan. Neu r > 0,7: tu'dng quan rat chat ehe; r = 0,5 - 0,7: tu'dng quan kha chat che; r = 0,3 - 0,5: tu'dng quan miTe dp vira; r < 0,3: rat ft tu'dng quan.
VIETNAM MEDICAL JOURNAL N°1 - M A R C H - 2 0 1 8 III. KET QUA NQHIEN CLTU
Bang 1; phan bdddi tu'dng nghien cdu theo dac diem benh ly (n=66}
Dac diem benh ly Benh bach cau Benh SUV tuy xu'dnq Benh da u tiJv xUdnq Roi loan sinh tuy Benh U lympho ac tinh Benh ly mat mau, mat sat man tinh (tn, da rang
kinh, unq thu" dai trUc tranq, nhilm qiun moc) Huyet tan mien dich hluyet tan bam sinh Thieu cac yeu to dinh du'dnq
Cac nguyen nhan khac
So lu'dng (n) 14 4 11 4 3 8 3 4 8 7
Ty le (%) 21,21
6,06 16,67 6,06 4,55 12,12 4,55 6,06 12,12 10,6 Nhan xet: b i n h nhan thieu mau bj benh bach cau chiem ty le eao nhat (21,21%), benh da u tiiy xu'dng'chiem 16,67%, thieu cae yeu to dinh du8ng chieni^ 12,12%, benh ly mat mau mat sat man tinh chiem 12,12%, benh u lympho ac tinh va huyet tan mien dich chiem 4,55%.
Bang 2: SU bien doi ndng dp Vitamin B12, Folate huyet tddng ciia ddi tddng nghien cdu(n=66)
chi so Vitamin B12
(pg/ml) Folate (ng/ml)
Hb (q/L)
MCrc do Binh thu'dng
Tanq Giam Binh thu'dnq
Tanq Giam
Gia tri trung binh ( x ±SD) 536,04 ± 240,49
9,81 ± 5,76 83,02 ± 25,24
n 56 4 6 58 4 4
T y l e ( % ) 84,85
6,06 9,09 87,88 6,06 6,06 Nhan xet; ty e benh nhan co vitamin 812 huyet thanh binh thu'dng chiem ty le cao nhat (84,85%), trong do ty ie benh nhan co Folate huyet thanh binh thi/cJng chiem ty le 87,88%. Ty le benh nhan co giam vitamin B12 chiem 9,09%, benli nhan giam Folate huyet thanh chiem 6,06%.
H S T ISO
100 50 0
y = 0.0025x +82.233 n=66, p<0,05, r=0,26
200
V i t a m i n YK^') f n p / m l )
400 600 800 1000 1200 1400
Bieu doliSd tu'dng quan giij'a Hemoglobin va Vitamin B12 huyet tu'dng
Nhan xet: Hemoglobin co si/ tu'dng quan thuan vdi nong do vitamin B12 huyet tu'dng, phu'dng trinh tu'dng quan: y = 0,0025x + 82,233.
150 100
H S T , (g/L)-
Folate (ng/ml) 10
y = -1.4287x +96.591 n=66,p<0.05, r=-0.31
20 BiS'u do 2: Md/ tddng quan gida Hemoglobin vdi folate
Nhan xet: Hemoglobin cd mdi tu'dng quan nghjch vdi ndng dp folate huyet tu'dng (r=-0,31), phu'dng trinh tu'dng quan y = -l,4287x + 96,591.
TAP CHI Y HOC VIET NAM TAP 464 - THAHG 3 • SO 1 - 2018
150 100 HST
(g/L)
y = -0.1021x + 91.107 n=66, p<0,05, r=-0.24
protem (g/L)
0 20 40 60 80 100 120 140
Bang 3: Sd thay ddi mgt so'enzym gan d ddi tddng nghien c&u (n=66)
Chi tieu nghien cu'u AST (U/L) ALT (U/L) GGT (U/L) Bilirubin toan phan (ijmoL/L)
Bilirubin tru'e tiep (pmoL/L)
Gia t r U r u n g b l n h ( x " ± S D ) 38,34 ± 27,94 29,06 ± 23,88 85,39 ± 53,41 18,19 ± 15,74 7,32 ± 6,10 Nhan xet: Ndng dp enzym GGT tren benh nhan thieu mau cd tang nhe (85,39 ± 53,41 U/L).
AST, ALT va Bilirubin trong gidi han binh thu'dng.
Bang 4: Ket qua xet nghiSm mdt so chi sd
Bieu dd 3: Mdi tUdng quan gida hemoglobin vdi protein huyet tUdng Nhan xet: Hemoglobin cd mdi tu'dng quan nghich vdi ndng dd protein huyet tu'dng, phu'dng trinh tu'dng quan y = -0,1021x + 91,107.
nhan gay thieu mau cung cd nhieu nguyen nhan, Theo nghien cu'u eua Aaron S va cs (2005) [5]
thay cac yeu t d anh hu'dng^ den sii xuat hien benh thieu mau hong cau khdng Id ed 60% benh nhan an chay; 15,9% benh nhan nghien ru'du;
9,5% benh nhan tieu chay man tinh; 1,6% da cat hoi trang; 6,3% benh nhan icem hap thu.
Cae nguyen nhan gay thieu vitamin B12 ed the gap do benh Biermer la benh benhk tu' mien, do khang the khang da day, khang yeu td ndi (GMP), benh canh dien hinh, trieu chuYig than kinh nang; ed the gap trong cac benh du'dng tieu hda nhu'; cat doan da day, rudt: giam, mat yeu to ngi, giam hap thu, viem rudt giam hap thu;
mgt so nguyen nhan san day, lao, tui thiTa d du'dng tieu hda; do thudc: iTc che tac dung cua B12 nhu* khang sinh (neomycin, nlfurantin, sulfamid...), chong dgng kinh (sodanton...), cac thuoe ehong ung thu"; thude lam giam hap thu B12 nhu' EDTA (lam mat canxi d rudt): benh xd gan, viem gan man, nhiem ddc nhiem trung man, benh mau ac ti'nh, ung thu'... deu gay rdi loan chuyen hda va dd trd vitamin 812, phu nu' cd thai, eho eon bu do tang nhu eau B12 hoac nhu'ng ngu'di an kieng khem thieu B12 do cung cap thieu. Trong nghien cu'u cua ehung tdi ty le benh nhan cd ndng dp vitamin B12, folate binh thu'dng chiem ty le 84,85% va 87,88%, benh nhan giam nong do vitamin B12, folate trong mau ehiem 9,09% va 6,06% do trong nghien cu'u cd nhdm nhiJng benh nhan thieu mau dinh duSng, dimg hda chat trong qua trinh dieu trj, khang sinh ed anh hu'dng den qua trinh hap thu B12 va acid folic vi vay ma ed giam ndng dp 812 va folate huyet tu'dng. Nguyen nhan thieu acid folic ed the do eung cap thieu (nguon thu'c an ngheo acid folic), hap thu kem (tieu ehay keo dai, cat doan da day rudt non, lao rudt), tang nhu cau suT dung, ii'c che do thudc (neomycin, hydantoin, PAS, methotrexat, 5FtJ... cac thudc cd tranh chap vdi acid folic). Ty le benh nhan cd tang vitamin B12 trong nghien eiJu chiem 6,06%, hoa sinh mau d ddi tddn
Clii tieu nghien cu'u Giucose (mmol/L)
Ure (mmol/L) Creatinin (pmol/L)
Protein (q/L) Cholesterol (mmoL/L)
Triciycerid (mmoL/L) LDH (U/L) CPK(U/L) Acid Uric (pmol/L)
Na* (mmol/L) K*(mmol/L) Ci"(mmol/L)
g nghien ahi (n=66) Gia tri trung binh
( X ±SD) 5,47 ± 2,94 6,38 ± 4,84 97,32 ± 57,09 71,01 ± 11,62 3,40 ± 0,99 1,78 ± 1,23 360,09 ± 265,21
103,63 ± 94,07 384,39 ± 214,97 137,59 ± 3,92
3,81 ± 0,52 104,59 ± 2,82 thieu mau cd tang nhe huyet thanh (360,09 ± Nh$n xdt: benh nhan
nong dd LDH trung binh 265,21 U/L).
IV. BAN L U A N
Bdi tu'dng nghien cdu cua chung toi bj benh baeh cau chiem ty le cao nhat (21,21%), sau dd nhdm benh nhan bj benh da u tuy xu'dng chiem vj tri thijf 2 (16,67%), thieu cae yeu to tao mau ehiem 12,12%. Do benh nhan chung tdi dieu tn ed nhieu nhom benh nhan khae nhau va nguyen
VIETNAM MEDICAL JOURNAL N°1 - MARCH - 2018 ed the do trong nghien cu'u cua chung tdi cd
nhij'ng benh nhan bi benh viem gan ket hdp, benh nhin bj benh baeh^^cau tuy m^n ho|c nfiO'ng benh nhan du'dc chan doan da hdng eau sau mdt thdi gian dai dieu tri hda chat dan den bi dc che tiiy xu'dng va thieu mau d giai doan sau, do vay ma khi xet nghiem ed the 812 tang trong mau.
Trong nghien cu'u cua ehiing tdi, gia tn LDH trung binh huyet tu'dng tang nhe (360,09 ± 265,21 U/L), theo chung tdi nguyen nhan tang cd the do benh nhan chiing tdi nghien cu'u ed nhu'ng benh nhan u lympho ae tinh, thieu mau huyet tan nen ed tinh trang hoai tif te bao do vay dan den tang LDH huyet tu'dng; LDH eung cd the tang trong nhu'ng tru'dng hdp benh nhan ed viem nhiem, tronp benh u lympho ac ti'nh, kahler dang tien trien hoae dap u'ng kem vdi dieu tri hoae tien lu'dng benh xau.
Trong nghien cii'u khdng tim thay sii tddng quan giu^ Hb va protein huyet tu'dng, nghien ciiu cua Nguyen Trgng Ha va es (2017) [2] tren benh nhan xd gan eijng khdng thay ed tu'dng quan giua Hb vdi protein mau d benh nhan xd gan.
V. KET LUAN
- Nhdm benh nhan thieu mau bj benh bach eau ehiem ty le cao nhat (21,21%), benh da u tuy xu'dng chiem 16,67%, thieu eac yeu t d dinh dddng (12,12%), benh ly mat mau mat sat man tinh (12,12%), benh u lympho ac tinh va huyet tan mien dieh (4,55%). Ty le benh nhan cd vitamin B12 huyet thanh binh thu'dng chiem ty le eao nhat (84,85%), trong do ty le benh nhan cd Folate huyet thanh binh thu'dng chiem ty le
87,88%; benh nhan giam vitamin 812 (9,09%), giam Folate huyet thanh (6,06%).
- Ndng do hemoglobin huyet tu'dng co sif tu'dng quan tiiuan vdi ndng do vitamin 812 huyet tu'dng (y-0,0025x + 82,233), tu'dng quan nghich vdi ndng dd folate huyet tu'dng (r^-0,31), (y =- ' l,4287x + 96,591). Ndng dp enzym GGT tren benh nhan thieu mau cd tang nhe (85,39 i \ 53,41 U/L); AST, ALT, bilirubin trong gidi han \ binh thu'dng. Hemoglobin ed mdi tu'dng quan nghich vdi ndng dp protein huyet tu'dng (y = - 0,ld21x +91,107).
TAI UEU T H A M KHAO
1. Do Tien Dung, Pham Quang Vinji, Nguyen Tuan Tiing va cs (2011), Tim hieu nong itj vitamin B12 va acid folic d mot so benh nhan ttilgij mau hong cau to gap tai khoa Huyet hpc- TruySr mau benh vien Bach Mai, Tap chf ngiiien cub t*
hoc, 1„5, 572-578.
z.. Nguyen Trong Ha va cs (2017), Nghien ciTu &k diem thieu mau d benh nhan xd gan, TapchiYtwc
Viet Nam, tap 458, so 2 (9), 61-64. f 3. Hgc vien Quan y (2004), "Bg/ qiang^ huy^hoc^wi
s3/7p",„Nha xuat ban Quan ddi nhan dan. Ha Noi.
1. Nguyen Hoai Thu (2015), Nghien cu'u dacdih lam sang, xet nghiem, danh gii dip u'ng dfki t^
benh nhin thieu miu do thieu vitamin B12 t-^/Wt aad Folic tai vien Huyet hoc- truyen mau trung udng, Luan van thac sT y hoc, Ha Npi.
5. Aaron S, et al. (2005), "Clinical and laboratory features and response to treatment in patients presenting with vitamin B12 deficiency- related neurological syndromes", Neurollndia, 53: 55-58.
6. Hoffbrand (2013), Anaemia- B12 and folate deficiency, Nike CKS.
7. Uma Khanduri and Archna Sharma (2Q07), Megaloblashc anaemia: Prevalence and causatws factors. The National medical Mjmai of India, lQ:\Tli^.
THCri GIAN SONG THEM KHONG BENH BENH NHAN UNG THir VU HAI BEN GIAI DOAN I, II TAI BENH VIEN K
Hoang Anh Dung*, Le Hong Quang*, Pham Van Binh*, Phan Thanh Duong*
T6MTAT
Ung thu' vu la benh ung thu pho bien nhat d phu niJ nhieu nUdc tren the gidl. Trong do, ung thu vii hai ben gSp d 4^- 20% benh nhan ung thu' vu nguyen phat du'dc phlu thuat. Ung thu' vu hai ben lieu cd ben lu'dng xau hdn so vdi ung thu' vu mot ben. Dd van con
*Benh vien K Trung i/dng Chiu trach nhiem chinh: Hoang Anh Dijng Email: [email protected] Ngay nhan bai; 14.12.2017 Ngay phan bien khoa hgc: 30.01.2018 Ngay duyet bai: 8.2.2018
la cau hoi cdn nhieu tranh cai. Nghien ciru cua chung tdi nham muc tieu danh gia thdi gian_s6ng Bian khong benh benh nhan ung thU vii hai ben giai do^
I, II tai Benh vien K. Ddi tddng va phudng pm nghien cud: Tii thang 1/2013 den thang 9/201^
chiing toi nghien ciTu tren 18 benh nhan ung t^^'f hai ben dong thdi va 14 benh nhan ung thif vu Ifll ben khong dong thdi giai doan I, I I tai Benh vt^n K.
Benh nhan du'dc danh gia cac dac dieni ve tai phatva thdi gian sdng them kiiong benh theo timg lo?l M thu'. Kit qua: V6i thdi gian theo doi trung binh W thang (7 - 28 thang), nghien cifu tren 32 benh nhar ung thU vu hai ben giai doan I, I I chiing toi ghi nhan I benh nhan ung thu" vu hai ben dong thdi tai ptiatta
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