TAP CHI Y DiXOC Hpc CXN THO - S6 11-12/2018
medicines questionnaire and the Morisky Medication Adherence Scale into Vietnamese.
Pharmacoepidemiol Drug Saf. 20!5;24: 159-160.
7. Eagle KA, Kline-Rogers E, Goodman SG, Gurfinkel EP, Avezum A, Flather MD, et al.
Adherence to evidence-based therapies after discharge for acute coronary syndromes: an ongoing prospective, observational study. Am J Med. 2004; 117:
73-81.
8. Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avom J. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002;288:455-461.
9. Kassab Y, Hassan Y, Abd Aziz N, Ismail O, AbdulRazzaq H. Patients' adherence to secondary prevention pharmasotherapy after acute coronary syndromes. Int J Clin Phami.
2013;35:275-280.
10. Naderi SH, Bestwick JP, Wald DS. Adherence to dmgs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med. 2012;125: 882-7.el.
11. Khanderia U, Townsend KA, Erickson SR, Vlasnik J, Prager RL, Eagle KA. Medication adherence following coronary artery bypass graft surgery: assessment of beliefs and attitudes. Ann Phamiacother. 2008;42: 192-199.
12. MorislQ' DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10; 348-354.
13. Morisky DE, DiMatteo MR. Improving the measurement of self-reported medication nonadherenee: response to authors. J Clin Epidemiol. 2011 ;64: 255-7; discussion 258-63.
14. Krousel-Wood M, Islam T, Webber LS, Re RN, Morisky DE, Muntner P. New medication adherence scale versus pharmacy fill rates in seniors with hypertension. Am J Manag Care. 2009;15:59-66.
15. Santo K, Kirkendall S, Laba TL, Thakkar J, Webster R, Chalmers J, et al. bterventions to improve medication adherence in coronary disease patients: A systematic review and meta-analysis of randomised controlled trials. Eur J Prev Cardiol. 20I6;23; 1065-1076.
(Ngdy nhgn bdi: 13/11/2017 - Ngdy duyit ddng: 05/01/2018)
CAC YEU TO TIEN LUOfNG NGUY CO TU^ VONG VA TAI mU^ VIEN TRONG M O T THANG SAU XUAT VIEN
6 BENH NHAN HQI CHlTNG VANH CAP
Li Kim Khdnh'*, Nguyin Th&n^, Thdi Nggc Diim Tran^, Nguyin Hmmg Thao\ Phgm Thi Tam', GS.TS. Taxis Katja^
1. Tru&ng Dgi Hgc YDuac Can Tho 2. Dgi Hgc Groningen, Hd Lan 3. Dgi Hoc YDugc Thdnh Phd Hd Chi Minh
*Email: [email protected] TOM TAT
Mgc tiiu nghien cuu: Xdc djnh ty 1$ tir vong vd tdi nhgp viin vd cdc yiu td tiin lugng nguy ea tir vong vd tdi nhgp viin trong mdt thdng sau xudt vi^n & binh nhdn hdi chung vdnh cdp.
Boi tuang vd Phuang phdp nghiin ciiu: Thuc hien nghiin euu tiin eiiu, cdt ngang md td tgi hai benh vien a thdnh phd Can Tha. Tated cdc b$nh nhdn nhdp viin tt-ong^ khodng th&i gian tir thdng 01/2015 den 10/2015 thoa tieu chudn dugc ehon vdo nghiin cuu. Mdi binh nhdn dugc theo ddi
TAP CHI Y D U g t HQC CAN THg - s 6 11-12/2018
ti-ong 1 thdng sau xudt vien nen nghiin cuu kit thiic vdo thdng 11/2015. Benh nhdn dugc chgn khi xuat vi$n v&i chdn doan: dau that nguc khdng dn djnh, nhdi mdu ca tim cd hogc khdng cd ST chenh lin. Thong tin vi dgc diim binh nhdn vd cdc yiu td tien lugng dugc thu thdp ta hd sa benh dn. Benh nhdn hogc nguai nhd benh nhdn dugc goi diin & thai diim mot thdng sau xudt viin di thu thgp thong tin vi biin c6 bdt lgi. Su dung hdi quy logistic di phdn tich s6 lieu. Kit qud: Cd 257 b^nh nhdn dugc chgn vdo nghien cOu vd dugc theo ddi mdt thdng sau xudt viin; tuoi trung binh (SD) la 64 (13); 61,5% la nam. Tyl4 tu vong vd tdi nhdp viin trong mgt thdng sau xudt viin ldn luat la 5,4% vd 14,4%. Yiu to tien lugng cd y nghTa cho nguy ca tu vong la: suy tim (OR = 8,96; 95% CI = 2,70-29,72), sdng Q hogi tir (OR = 3,59; 95% CI = 1,20-10.67). troponin T tdng (OR = 0,78; 95% CI = 0.73-0,84), rung nhi (OR = 7.09; CI 95% = 1.68-29.92) vd logn nhip thdt (OR = 12,98; 95% CI = 2,75-61,39). Yiu td tiin lugng ed y nghia eho ngi^ ca tdi nhdp vien Id: ke dan ddy du bdn nhdm thudc duac khuyin cdo (OR = 1,75; 95% CI = 1,04-2,96). suy gidm chuc ndng than (OR = 3,35; 95% CI = 1,64-6,86) vd sdng Q hogi tir (OR = 2,65; 95% CI = 1.27-5,52).
Ket ludn: Tyli tirta vong yd tdi nhdp viin trong mgt thdng sau xudt viin khd cao. Nen cd nghien eOu v&i quy mo l&n han di xdc dinh dugc thim ede yiu td tien lugng nguy ca tu vong vd tdi nhgp viin trin binh nhdn sau hgi chung vdnh cdp & Viet Nam.
Tu khod: yeu td tiin lugng, tu vong, tdi nhgp viin. hoi chihig vdnh cdp, Cdn Tha ABSTRACT
PREDICTORS OF O N E - M O N T H MORTALITY A N D REHOSPITALIZATION IN PATIENTS W I T H A C U T E C O R O N A R Y S Y N D R O M E IN VIETNAM Le Kim Khanh', Nguyen Thang,'', Thai Ngoc Diem Trang', Nguyen Huong Thao^,
Pham Thi Tam', Taxis KatJa,PhD^
1. Can Tho University of Medicine and Pharmacy 2. University of Groningen, The Netherlands 3. University of Medicine and Pharmacy at Ho Chi Minh City Objectives: We aimed to determine rates of mortality and rehospitalization within one month after discharge in patients with acute coronary syndrome (ACS) and to identify predictors of these adverse outcomes. Materials and Methods: We conducted a prospective cross-sectional study on patients with ACS in two public hospitals in Can Tho city, Viemam. All eligible patients admitted to the study hospitals between January and October 2015 were approached for participation. The follow-up period ended in November 2015. We included patients who survived during hospitalization with a discharge diagnosis of unstable angina, non-ST-elevation myocardial infarction (MI), or ST-elevation MI. We collected data of patient characteristics and potential predictors from medical records and interviewed patients/their relatives via telephone at one month after discharge to collect information on major adverse outcomes. We used logistic regression to analyze data. Results: Overall, 257 patients were included and completed the follow-iq), mean (SD) age 64 (13) years, and 61.5% males. Rates of mortality and rehospitalization within one month after discharge in patients with ACS were 5.4% and 14.4%, respectively. Predictors significantly associated with one-month mortality were heart failure (OR
= 8.96; 95% CI = 2.70-29.72), Q wave infarction (OR - 3.59; 95%CI = 1.20-10.67). increased tioponin T (OR = 0.78; 95% CI = 0.73-0.84). atrial fibrillation (OR = 7.09; 95% CI = 1.68- 29,92), and ventricular arrhythmia (OR = 12.98; 95% CI = 2.75-61.39). Predictors significantly associated with one-month rehospitalization were prescribing all four guideline-recommended medications (OR = 1.75; 95% CI = 1.04-2.96), renal insufficiency (OR = 3.35; 95% CI = 1.64- 6.86). Q wave infarction (OR = 2.65; 95% CI = 1.27-5.52). Conclusions: The rates of one-month mortality and rehospitalization in patients with ACS in Vietnam were high. Further larger studies
365
TAP CHf Y Dirge HQC CAN T H O - S6 11-12/2018
should be conducted to identify more significant predictors of adverse outcomes in Vietnamese patients with ACS.
Keywords: predictors, mortality, rehospitalization, acute coronary syndrome, Vietnam I. D A T VAN D E
Mdi nam cd khoang 17,9 ttieu ngudi tir vong vi cac benh tim mach, chiim ty le cao nhdt la cac benh m^ch vanh. M^c du cdc bSnh tim mach thudng dugc xem la m^t vdn dl ciia nhung qudc gia cdng nghiep hda va cd thu nh^p cao, thuc te hon 80% cac trudng hgp tii vong do cac benh ly tim mach d cac nude cd thu nhap thap va trung bmh [1,2].
Trong benh mach vanh, hgi chiing vanh cap (HCVC) la ngu^Sn nhan gay tu vong hang ddu [3]. T^i Viet Nam, cung nhu cac qudc gia cd thu nh^p thap va tnmg binh khac, ty le b$nh mach vanh dang tang nhanh ciing vdi sir phdt triSn cua kinh te-xa hgi. Ty IS nh|p vien do b?nh tim thilu mau cue bg tai Vien Tim Mach Viet Nam la 11,2% nam 2003, 18,8% nam va 24% nam 2007 [4]. Benh nhan song sdt sau HCVC phai ddi m^t vdi nguy CO cao cua nhilu biSn cd tim mach, bao gdm tii vong va tai nhap viSn do tai nhdi mau; nen vi?c danh gia cac ySu to tiSn lugng ddng vai ttd vd cimg quan ttgng [5]. Cac yeu td nay cd thS anh hudng dSn hudng xir tti, theo doi benh va ciing la co sd dS giai thich cho ngudi nha b?nh nhan. Vi vay, chiing tdi tiSn hanh nghien ciiu xac djnh "Cdc yeu to tiin luffng nguy cff ta vong vd tdi nhgp vi$n trong mdt thdng sau xudt vi^n & binh nhdn hoi chung vdnh cap" vdi muc tiSu: (1) xac dinh ty IS tir vong va tai nhSp viSn va (2) xac dinh cdc yen td tiSn lugng nguy co tir vong va tai nhap viSn ttong mdt thang sau xudt vi?n d b^nh nhan HCVC.
IL D O I TU'gfNG VA P H U ' O N G P H A P N G H I E N C U t J 2.1. Do! tiTQiig nghien cihi
B?nh nhan ndi tni tai benh vi?n Da khoa Trung uong Can Tho va benh vien Da khoa Thanh phd Can Tho cd mpt ttong cac chdn doan khi xudt vien la (1) dau thdt nguc khdng dn dinh, (2) nhdi mau co tim (NMCT) cdp khdng ST chSnh ISn va (3) NMCT cdp cd ST chSnh ISn. Loai tini cac trudng hgp: (1) ho sa bSnh an (HSBA) khdng cd dii thong tin ve dan thudc xuat vien hoac yiu td tien lugng; (2) HSBA tdi nhap vien cua ciing benh nh§n ttong thdi gian nghiSn ciiu; (3) benh nhan va ngudi thdn khdng ddng ^ tham gia nghien ctiu.
2.2. Phircmg phap nghiSn cihi
Thiet ke nghiin ctru: Tiin ciiu, cdt ngang md ta cd phin tich.
Cd m&u vd thdi gian nghiin cmi: Chpn tdt ca cac bSnh nhan thoa tieu chuan tir thdng 01/2015 din thang 10/2015. Mdi benh nhan dugc theo d5i hiln cd ttong 1 thdng sau xudt vien. Theo dSi biin cd cua benh nhan kit thuc vao thang 11/2015.
Thu thgp sd li^u: Gdm 3 budc: (1) Thu thgp s6 liiu tu HSBA: Tudi, gidi, tiin sit bSnh, yiu td nguy co, benh mdc kem, chdn dodn liic xudt vien, dac diim can lam sdng va iam sang, don thudc xudt vien va cdc yeu t6 tiSn lugng. (2) Phdng vdn ti'uc tiip binh nhdn khi ndm vien: Xin thdng tin liSn lac va ^ kiln benh nhan va ngudi tiiSn ddng ;? tham gia
TAP CHI Y DUgC HOC CAN THg - SO 11-12/2018
bpnh nhdn hay ngudi than d tiidi diim 1 thdng sau xudt vien dl tiiu thap thdng tin v l biin cd, nguyen nhan va thdi gian xay ra biin cd (nlu cd).
Xdc dinh ty li tii vong vd tdi nhgp vifn: Xac dinh dua vao ty IS so benh nhan tu vong hoac tai nh^p vien do tdt ca cdc nguyen nhan ttong 1 thdng sau xudt vien tten tdng sd benh itiian dugc phdng vdn. Neu mgt benh nhdn cd ca tai nhap vien va tii vong thi chi tinh biin cd nghiem ttgng nhdt la tii vong.
Xdc dinh cdc yiu tS tiin lu^g nguy ca tu-vong va tdi nhgp vi$n: Cdc ySutd tien lugng duprc phdn tich gdm: (1) sii dung du 4 nhdm thudc chinh dugc khuyin cao (chdng kSt tap tieu cau, chen thu till beta giao cam, lic chi men chuyin hay chen thu thS angiotensin E va statin); (2) sd yiu td nguy ca benh m ^ h vanh; (3) tiidi > 65; (4) nam gidi; (5) dd Killip 111 va IV; (6) tiin sir NMCT; (7) nhip tim > 85 idn/phiit; (8) suy tim; (9) suy giam chiic nang tiian; (10) sdng Q hoai tii; (11) nhdi mau vimg trudc; (12) rung nhi;
(13) loan nhip thdt; (14) ttoponin T tang; (15) sd lugng bach cdu bdt thudng; va (16) thilu nmu. Trong dd, cac y i u td (12), (13), (15) va (16) khdng ap dung cho hiln cd tai nhap vien.
Xu ly so liiu: KSt qua dugc trinh bay dudi dang: trung binh ± dd lech chudn cho cac biin dinh lugng; ty IS % cho cac bien dinh tinh. Xdc dinh cac ySu td tien lugng nguy ca tir vong va tdi nhap vien bang hdi quy logistic don biSn va da hiln (sit dung Backward Stepwise) vdi ty sudt chenh (odds ratio, OR) va khoang tin cay (confidence interval, CI) 95%. Kit qua cd y nghia thdng ke khi p < 0,05. Su dung SPSS 22.0.
2.3. Dfo diTC trong nghiSn cihi
Nghien ciiu dugc su ddng y cua Trudng Dai hgc Y Dugc Cdn Tha, benh vien Da Khoa Trung iTong Can Tho va bSnh vien Da Khoa Thanh Phd Cdn Tha. Cac b^nh nhdn dugc giai thich ro rang vS muc dich nghiSn ciiu va ddng y tham gia nghien ciiu. NghiSn ciiu dam bdo tinh bao mat rieng tu cua cdc doi tugng tham gia nghien ciiu.
ffl. KET QUA NGHIEN ClTU
Cd 322 benh nhan dugc chgn vao nghien ciiu. Sau 1 thang theo doi, cd 257 dugc danh gid ket qua; 65 benh nhan khong theo ddi dugc do: khdng Uen lac dugc (58) va tit choi tham gia (7).
3.1. D^c diem benh nhan nghien cuii
Dac diem benh nhan nghien ciiu dugc trinh bay ttong Bang 1.
Bang 1. Dac diem benh nhan nghien ciiu
D^c diem So binh nhin (N = = 257) 1 Tyl6(%) Thdng tin ban dau luc nliSp VJ|D
Tuoi (tning binli ± do lech cliuan) Nam giai
Co BHYT Dau nguc iuc nhap vi?n TitasuNMCT
67 ±13 158
201 184 74
61,5 78,2 71,6 28,8
367
T«P CHf Y Dl/<yC HQC CAN THO - s 6 11-12/2018 Dac di^m
Tifa sir PCV CABG Tien sii dpt quy
So bfnh nhin (N = 257) 11 15 LSm sang
Killip i n - r v Nhip tim > 85I/p
14 133
Tyl6(%) 4,3 5,8
5,4 51,8 Can lam sang
Troponin T tang Song Q hoai tur Nhoi mau vimg tnrac
204 60 130
79,4 23,3 50,6 Yeu to nguy ca
Tuoi > 65 Nam giai
Tien sir gia dinh mac BMV Hiit thuoc la Tang huyet ap*
Dai thao duang*
Roi lo^n lipid mau*
140 158 14 111 207 62 66
54,5 61,5 5,4 43,2 80,5 24,1 25,7 B|nh kim theo
Suy tim Suy than Rung nhT Lo^n nhip that
63 18 12 8
24,5 7,0 4,7 3,1 Chan doan khi xuat vien
HCVC khong ST chenh len HCVC 0(S ST chenh len
194 63
75,5 24,5 TH viet tat: BHYT, bdo hiem y ti; BMV, binh mgch vdnh; HCVC, hdi chung vdnh cdp; NMCT, nhdi mdu ca tim; PCI/CABG, can thi^p mgch vdnh qua da/ phdu thudt bac cdu ndi chu vdnh; *Yeu td nguy ca cUng Id binh kem theo
3.2. Ty 1^ tir vong va tai nh^p vien trong 1 thang sau xuat vi^n
Ty le tii vong va tai nbeip vi^n ttong 1 thang sau xuat vi$n dugc trinh bay d Bang 2.
Bang 2. Ty IS tir vong va tai nhap vien ttong 1 thang sau xudt vien Bien co
trong 1 thiing sau xudt vi§n Tai nhSp vi?n 1 thang Tir vong 1 thdng
So bfnh nhan g^p biin CO 0" cac the benh HCVC khong ST chenh
len,N,= 194(%) 30(15,5)
10(5,2)
HCVC c6 ST ChSnh len,N2 = 63(%)
7(11,1) 4(6,3)
T6ng so b£nh nhin gap cac bieD
CO
N = 257(%) 37(14,4)
14 (5,4) Tic viet tat: HCVC, hpi chimg vanh cdp
368
TiBtP CHI Y Di/gC HQC CAN THO - S6 11-12/2018 3.3. Cac yeu to tien lirong nguy cff tir vong trong 1 thang
Sau phan tich don bien, cac yeu td cd kha nang tiSn lugng nguy ca tir vong ttong 1 tiidng trinh bay d Bang 3.
Bang 3. Cac ySu td tien lugng nguy co tu vong ttong 1 thdng sau xuat vien Yen to
Suy tim Song Q ho^i tir Troponin T Rung nhr L09n nhip that
Tir vong 1 thang Hoi quy dtfn bien OR (CI 95%) 8,96(2,70-29,72) 3,59(1,20-10,67) 0,78(0,73-0,84) 7,09(1,68-29,92) 12,98(2,75-61,39)
P
<0,001 0,015 0,048 0,002
<0,001
sau xuat vi£n Hoi quy da bien OR* (CI 95%) 6,33(1,68-23,89)
- -
9,80(1,69-56,73)
-
P 0,006
>0,05
>0,05
>0,05 0,011 Tit viit tat: CI, confidence interval; OR, odds ratio; *Cdc bien tren dugc xit hdi quy logistic da biin vol md hinh Backward: Wald trong 2 blocks (cdc bien cd y nghia thdng ki sau block 1 dugc diiu chinh v&i tudi, gidi trong block 2)
3.4. c a c yeu to tiSn lirong nguy ctf tai nh^p vifn trong 1 thang
Sau phan tich don bien, cdc ySu td cd kha nang tien lugng nguy co tai nhdp vi^n ttong I thdng trinh bdy d Bang 4.
Bang 4. Cac yeu td tien lugng nguy co tai nhap vi^n ttong 1 thang sau xudt vien Yen to
Si> dung du 4 nhom thuoc Suy giam chuc nang th|n Sdng Q hoai tii
Tai n h | p vien 1 th^ng Hoi quy don bien
OR (CI 95%) 1,75(1,04-2,96) 3,35(1,64-6,86) 2,65(1,27-5,52)
P 0,001 0,001 0,007
HSi quy da bien OR* (CI 95%) 2,75(1,28-5,93) 2,89(1,30-6,42) 2,23(1,03-4,81)
P 0,010 0,009 0,041 Tir viit tat: CI, confidence interval; OR, odds ratio; *Cdc bien ti-en dugc xet hdi quy logistic da biin vdi mo hinh Backward: Wald ti-ong 2 blocks (cdc biin cd y nghia thdng ke sau block 1 dugc dieu chinh vdi tudi, gidi trong block 2).
TV. BAN L U A N
4.1. Ty le t u vong va tai nhap vifn trong 1 th^ng sau xuat vifo
Ty IS tii vong trong 1 thdng sau xudt vien d nghien cim chung tdi la 5,4%. Ty IS tu vong ngdn ban d nhdm HCVC khdng ST chSnh len thdp hon nhdm HCVC cd ST chenh ISn (5,2% so vdi 6,3%). DiSu nay phii hgp vi NMCT cdp cd ST chenh len Id thi bSnh nang han ttong HCVC. Tir dd cho thdy thdi gian dua benh nhan dSn benh vien k l tir khi khdi phat trieu chung ciing nhu thdi gian diiu tri tai tudi mau cho benh nhan rat quan ttpng.
BSnh nhan dugc tai tudi mdu cang sdm thi ban che dugc viec ddng mach vanh bi tac nghen qud lau lam co tim bi ho^i tii, giiip cai thiSn ty le tu vong d benh nhdn HCVC. Ket qua nghien ciiu chting tdi cho thdy ty IS tai nh|ip vien ttong 1 thang sau xuat vien la 14,4%. Trong dd, ty IS tdi nhap vien cua benh nhan HCVC khdng ST chenh ISn cao hon so vdi benh nhan HCVC cd ST chSnh len (15,5% so vdi 11,1%). DiSu nay cd till giai thich
TAP CHI Y Dl/gC HQC CAN THO - s 6 11-12/2018
do nhung benh nhan dugc chan doan HCVC cd ST chSnh ISn thi tiSn lugng b?nh se nang hon, nguy ca ddi mat vdi biSn cd tir vong sau HCVC cao hon. Trong nghiSn ciru chiing tdi, nlu benh nhan tai nh|ip vien rdi tii vong thi chi chgn biSn cd nghiSm trpng nhdt la ttr vong dS tinh; do dd ty IS tai nhap vien d nhdm benh nhdn HCVC cd ST chSnh ISn thdp ban.
4.2. Cdc yiu to tiSn lirgng nguy co- tit vong va tdi n h a p vien
Su dgng du 4 nhdm thuoc dugfc khuyin cdo: NhiSu nghien ciiu tren thi gidi da khao sdt viec phdi hgp ddy dii 4 nhdm thuoc chinh theo hudng din diSu tti cho benh nhan HCVC khi xudt vien nhdm muc dich phdng ngira thii phat cho benh nhan. Ddi vdi biin c6 tit vong, chung tdi chua tim ra mdi liSn quan giiia viec ap dung hudng din diSu tri vdi tii vong. Tuy nhiSn, ddi vdi biSn cd tai nhap vien, chiing tdi thay dugc viec dp dvmg hirdng dan diiu tri giiip gidm nguy co tdi nh^p vi?n (OR = 1,75; CI 95% = 1,04-2,96). NghiSn cihi trudc cho thdy tang sir dung cdc thudc theo hudng ddn diSu tri ttong giai doan cdp va phdng ngira thii phat giiip giam biSn cd tu vong 30 ngay sau HCVC [6].
Tudi vd tiin sir NMCT: Ket qua nghiSn ciru cita chiing tdi chua tim thay su anh hudng ciia cac yeu td nay dSn biSn cd tu vong va tdi nhap viSn ttong 1 thang sau xuat vien.
Suy tim: Phan tich da bien cho thay suy tim la yeu td tiSn lugng cho nguy ca tit vong ttong 1 thang (OR = 6,33; CI 95% = 1,68-23,89). Kit qua nay tuong til voi nghien cihi cua Bahit (2013) [7]. Tuy nhien, nghien ciiu chiing tdi khdng tim thay mdi HSn quan giiia yeu td suy tim va biin cd tai nhap vien.
Song Q hogi tir: Sdng Q hoai tir la mgt ySu to tiSn lugng cho bien cd tir vong (OR
= 3,59; CI 95% = 1,20-10,67) va tdi nhap vien (OR - 2,23; CI 95% = 1,03-4,81) ttong 1 thang sau xudt vien. Tuong tu, ttong 21.570 benh nhan tham gia thii nghiem GUSTO-1 da dugc loai trir cdc ySu td gay nhilu tten ECG, sdng Q khdng xudt hien ttong 21,3% sd benh nhan. So vdi nhdm cd sdng Q, bSnh nhan khdng cd sdng Q tten ECG cd ty IS bien chiing suy tim tiidp hon (8,5% so vdi 13,9%), tir dd lam giam ddng k l t^' IS tii vong ttong 30 ngay sau xudt vi?n (4,8% so vdi 5,3%) [8], Diiu nay cd till giai thich do ca tim da hi hoai tii khdng the hoi phuc nen anh hudng dSn chirc nang cua tim ve sau. Tuy nhien, khi xet md hinh hdi quy da biSn, cd the do bj dnh hudng bdi cdc y i u td khdc nSn sdng Q khdng cd y nghia thdng ke ddi vdi bien cd tii vong ttong 1 thang sau xuat vi^n.
Troponin T: Ket qud cho thdy benh nhan cd chi sd ttoponin T bdt thudng se lam giam ty IS tii vong ngdn ban (OR = 0,78; CI 95% = 0,73-0,84). Trai l?i, tix)ng nghiSn ciiu cua Ottani, nhiing benh nhan HCVC cd ttoponin T duong tinh lam tang ty IS tir vong hay tai nh6i mau ttong 1 thdng (OR = 3,44; CI 95% = 2,94-4,03) [9]. Tuy nhien, chung tdi khong thn ra moi lien quan giiia ttoponin T vd ty 1? tai nhap vien cua benh nhan.
Chuc ndng th&n: Kit qua phan tich hdi quy logistic da biin cho thdy chirc nang tiian giam vdi GFR < 60ml/phut/l,73m^ da ldm tang nguy ca tai nhap vien ttong 1 tiidng cd y nghia thdng kS. Tuy nhiSn, yiu to ndy chua cd y nghia khi xet mdi lien quan vdi bien cd tii vong. Dieu nay cung ttai vdi kit qua ttong nghien ciiu ciia Holzmann (2013), su suy
TAP CHf Y Dirge HOC CAN THg - s 6 11-12/2018
Rung nht: Rung nhT la yeu td anh hudng den nguy co tii vong ttong 1 thang (OR = 7,09; CI 95% ^ 1,68-29,92). Tuy nhiSn, ySu to nay khdng cd y nghia thdng ke khi phan tich hdi quy da bien do hi chi phdi bdi nhiSu ySu td khdc va cd thi cd yiu td gdy nhilu.
KSt qua cua nghien ciiu Berton (2009) cGng cho thdy tdn sudt xudt hiSn nhiing biin cd tim mach d nhdm cd rung nhi cao ban nhdm khdng rung nhT [1].
Logn nhip that: Loan nhip that la ySu td tien lugng cho nguy co tu vong ngdn ban sau HCVC. Ket qud ttong nghiSn ciru cua Piccmi (2008) ciing chiing minh diSu ndy [12].
V. K E T LUAJ^
Ty IS tir vong va tai nh^p ttong 1 thang sau xudt vien d bSnh nhdn hdi chiing vanh cap tai cac benh vi^n nghiSn cim tuong ddi cao, ldn lugt la 5,4% vd 14,4%. Cac yiu td cd thS tiSn lugng nguy ca tut vong ttong 1 thang la suy tim, sdng Q hoai tii, ttoponin T, rung nhi va loan nhip that. Cac yeu td cd the tiSn lugng nguy co tai nhdp vi?n ttong 1 thang gdm viec ap dung hudng dan diSu tri, suy giam chiic nang than va sdng Q hoai tir. Tien thuc tS lam sang, viec dua vao cac yeu td tien lupng da dugc chiing minh giiip bac sT can nhac ban trong viec sir dung thudc cho timg benh nhan cu thi. Tir dd, bSnh nhdn n h ^ dugc sir cham sdc y tS tich cue hon va dat dugc mdt ket cue lam sdng tot ban. Cdn cd nghien ciiu tiep theo dS ddnh gid cac yeu td anh hudng dSn biin c6 tir vong, tai nhap vi?n qua cac mdc 6 thang, 1 nam hoac Idu ban vdi cd mau lan hon.
TAI LIEU T H A M K H A O
1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Sttoke Statistics-2017 Update: A Report From the American Heart Association.
Circulation. 2017;135: el46-e603.
2. Dugani S, Gaziano TA. 25 by 25: Achieving Global Reduction in Cardiovascular Mortality. Cun- Cardiol Rep. 2016;18: 10-015-0679-4.
3. World Health Organization. The top 10 causes of death. 2017.
4. Nguyen VL, et al. [Vietnamese] Nghien cihi md hinh benh tat d benh nhan dieu tti npi tru tai ViSn tim mach Viet Nam trong thdi gian 2003-2007. Journal of Vietnamese Cardioiogy. 2010;52: 11-18.
5. World Health Organization. Prevention of Recurrences of Myocardial Infarction and Stroke Study (The PREMISE programme: Country project).
6. Eagle KA, Montoye CK, Riba AL, DeFranco AC, Parrish R, Skorcz S, et al. Guideline- based standardized care is associated with substantially lower mortality in medicare patients with acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice (GAP) Projects in Michigan. J Am Coll Cardiol. 2005;46:
1242-1248.
7. Bahit MC, Lopes RD, Clare RM, Newby LK, Pieper KS, Van de Werf F, et al. Heart failure complicating non-ST-segment elevation acute coronary syndrome; timing, predictors, and clinical outcomes. JACC HeartFail. 2013;!: 223-229.
8. Barbagelata A, Califf RM, Sgarbossa EB, Goodman SG, Stebbins AL, Granger CB, et al.
Thrombolysis and Q wave versus non-Q wave first acute myocardial infarction: a GUSTO-I substudy. Global Utilization of Stteptokinase and Tissue Plasminogen Activator for Occluded Arteries Investigators. J Am Coll Cardiol. 1997;29: 770-777.
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T»P CHI Y DLfgC HQC CAN THff - s 6 11-12/2018
9. Ottani F, Galvani M, Nicolini FA, Ferrini D, Pozzati A, Di Pasquale G, et al. Elevated cardiac ttoponin levels predict the risk of adverse outcome in patients with acute coronary syndromes. Am Heart J. 2000;140: 917-927.
10. Holzmann MJ, Sartipy U. Relation between preoperative renal dysfunction and cardiovascular events (sttoke, myocardial infarction, or heart failure or death) within three months of isolated coronary arteiy bypass grafting. Am J Cardiol. 2013;112: 1342-1346.
11. Berton G, Cordiano R, Cucchini F, Cavuto F, Pellegrinet M, Palatini P. Atrial fibrillation during acute myocardial infarction: association with all-cause mortality and sudden death after 7-year of follow-up. Int J Clin Pract. 2009;63: 712-721.
12. Piccini JP, Hranitzky PM, Kilam R, Rouleau JL, Whhe HD, Aylward PE, et al. Relation of mortality to failure to prescribe beta blockers acutely in patients with sustained venfricuiar tachycardia and ventticular fibrillation following acute myocardial infarction (from the VALsartan In Acute myocardial iNfarcTion trial [VALIANT] Registry). Am J Cardiol. 2008;102: 1427-1432.
(Ngdynhgn bai: 14/11/2017-Ngay duyet dang: 08/01/2018)
PHAN LAP VA N U O I CAY i t BAO G O C T R U N G M 6 TlT M O M 0 C H U O T N H A T T R A N G {SWISS)
Nguyin Thanh Tha/*, Trdn Ngpc V&\ Chi Thi Cdm H^
1. Khoa Huyet hoc - Binh viin Trung Ifang Hui 2. Bgi hoc Khoa hoc Hui
*Email: [email protected] TOM TAT
Bgt van de: Ti bdo gdc la te bdo chuyin biet, cd khd ndng tu ddi mdi thong qua phdn chia ti bao vd biet hod da ddng.Tibdogdc trung md tir m& cd tinh chdt ire chi - diiu hod miin djch.
tiet cdc cytokine va ede thu the miin djch dieu chinh vi mdi tnrdng ti-ong ghep. Vdi khd nang diiu biin mien dfch vd tiit cdc phdn tu chdng viem nin ti bdo goc trung md Id cdng cy hiiu qua trong diiu tii cdc binh mdn tinh. Muc tiiu nghiin cuu: nghiin cdu phdn lap sd luang ti bdo dan nhdn tir md md qua thdm dd ndng do collagenase vd thdi pan u collagenase. Boi tirgng va phirffng phdp nghiin cuu: Su dung chugt nhdt trdng gidng Swiss. Trong nghien cuu ndy, chung tdi khdo sdt ndng dg vd thai gjan u ciia collagenase cho viec phdn lap te bao gdc trung mo ma vd nudi cdy ti bdo gdc trung mo tu md. Ket qua: d mdi 1 mg md/mL collagenase it 50 phut thu dugc cdc te bdo dan nhdn cao nhdt: 4,77x105 ± 0,31x10^ ti bdo/g vd hiiu qud phdt tiiin ti bdo dgt trin 69,33%. Kit lugn: diing enzyme collagenase, it 50phdt, chimg toi thu nhgn dugc ti hao gdc trung md nhiiu nhdt
Tir khod: ti bdo goc trung md tu ma, enzyme collagenase, u, nudi cdy, biet hod.
ABSTRACT
ISOLATION A N D C U L T U R E OF A D I P O S E - D E R I V E D MESENCHYMAL STEM CELLS F R O M MICE(Swiss) A D I P O S E TISSUE
Nguyen Thanh Thuy, Tran Ngoc Vu\ Che Thi Cam H(^
I. Hue University, College of Sciences.
