TCNCYH Phij trWdng 62 (3) - 2009
NGHIEN CLfu MOI LIEN QUAN G I Q A T Y LE MAC SA SUT TRI TUE VA MOT SO YEU TO NGUY CO 5 NGU'OI CAO TUOI TAI
HUYEN BAVI - H A NQI (2005 - 2006)
Le Quang CUdng
B6 mon Than kinh - Trddng Dai hgc Y Ha Noi Tang huyet ap (THA), tai bidn mach nao (TBMN), bdnh Parkinson (PD), chan thuang sg nao va dii thio dUdng (DTD) dugc coi li nhdng yeu td nguy ca gay sa sut tri tue (SSTT). Muc tieu: nghien cdu mdi lien quan gida ty le mic SSTT vi cic yeu td nguy ca neu tren d cdng dong Ba Vi - Ha Ngi. Doi tUgrng va phuang pbap ngbien culy; 260 benh nhan SSTT trong cgng dong 7712 dan tai Ba VI - Ha Ndi duac cac bic sT chuyen khoa than kinh kham va hdi benh dua tren bd ciu hdi phdng van thdng nhat. Ket qua va kit luan: so ngddi mic SSTT d nhdm THA cao ban d nhdm khdng THA 1,5 lan (95%o Cl = 1,07 - 2,0), d nhdm tien sd bj TBMN cao ban d nhdm khdng cd tiin sd bj TBMN 8,4 lan (95%o Cl = 5,36 - 12,8), d nhdm khong bj PD khoang 4,8 lan (95%o Cl = 2,62 - 8,32), d nhdm tien sd chan thuang sg nao cao ban nhdm khdng cd tien sd chan thuang sg nio 2,9 lan (95%o Cl = 1,47 - 5,29). Khong thay st/ khac biet cd y nghTa gida ty le hi$n mac SSTT d nhdm bj dai thio dddng vi nhdm khdng bj dii thio dUdng (95%oCI = 0,24 - 8,76).
Can cd giai phip dieu tri yeu td nguy ca de gdp phan ban chi ty le SSTT d ngUdi cao tuoi.
Td khoa: Sa sut tri tu$, ye'u td nguy co
I. DAT VAN DE
Cung vdi sd gia tang cua tudi thp, ty le c l e benh ly hay gap d ngUdi gia nhg SSTT (SSTT) cdng tang theo. Cd nhieu yeu t d dUpc eho la yeu t d nguy CO g i y SSTT nhU tai bien mach m l u nao (TBMN), benh Parkinson (PD), THA (THA), cha'n thddng so, d i i t h i o dUdng [ 1 , 2, 3, 4 ] . Tuy nhien, quan diem n l y khdng p h i i ldc nao cung thdng nhl't tiiy tdng t i e g i l . Tai Viet Nam, trong nhdng t h i p ky gan d i y , md hinh cac yeu t d nguy eo ddi vdi SSTT da dan theo xu hgdng eua c l e ngdc phat' trien tdc 11 ty le cac benh ly khdng n h i i m trdng nhg tim mach, thoai hda, c h i n thuong tang rd ret.
De tim hieu eae thdng tin can thiet ve mdi lien quan gida yeu t d nguy co de'n SSTT v l ty le hien m l c loai benh nay tai cpng ddng, gdp phan phuc vu cong t i c cham sdc sdc khde nggdi cao tudi, chung tdi tie'n h i n h de tai: " N g h i e n cdu mdi lien quan gida ty le hien mac SSTT va mpt sd yeu t d nguy CO d ngUdi eao tudi tai huyen Ba Vi - Ha Npi (nam 2005 - 2006)" nham muc tieu:
Phin tich sU USn quan giita mgt sd yeu td benh ly giY SSTT va ty IS SSTT d ngUdi cao tudi tai huyen Ba Vi - Ha Ngi.
II. DOI TLfONG VA PHLfONG PHAP NGHIEN CLfu
1. Dja diem va ddi tUcfng nghien cufu
Nghien cdu thgc hien tai huyen Ba Vi thupe tlnh Ha N p i . Ddi tgpng I I 250 nggdi cao tudi da dupe xac djnh la SSTT sau dieu tra djch t l hoc 7712 nggdi tai cdng ddng nay trong giai doan 2005 - 2006.
2. Phuo'ng phap nghien cufU
Benh n h i n dgpc e l e b l e sT chuyen khoa than kinh tham kham, hdi benh. Ty le SSTT dgpc so sanh gida nhdm cd ye'u t d nguy cd va khdng thdng qua ti xul't chenh (OR). Cac bien sd nghien cdu thgc hien dda tren phdng vl'n va phieu dieu tra:
-I- T i i n sd THA: dUa theo tieu chuan JNC - VII (2003) eua H p i tim mach Hoa Ky, cu the THA khi cd huyet ap t i m thu > 140 m m H g va/ hoac huye't ap tam trUdng > 90 m m H g .
-I- Tien sd bj T B M N : xac djnh t i i n sd cd c l e thieu sdt than kinh x l y ra dot ngpt, tdn tai qua 24 gid, ed tham k h i o cac giay ra vien (neu cd).
+ Tien sd PD; tien sd hoac hien tai bi PD.
-I-Tien sd chl'n thgong sp nao: chl'n thgong sp cha'n thgong td tren 30 phut.
nao hd bao gdm e l phiu thuit than kinh. Chl'n -r-.> , ^,. , , < , -I-Tien sg dai thao dgong.
thuong so nao kfn vdi m l u tu trong sd hoac dap 3 x d i ' " ^ I " "
xgdng chay mlu hoac tdn thUdng thin kinh khu gd Ii6u dilu tra dgpc phan tfch, blng phln tru. Ndt, ldn sp hoac mat y thdc hoac mi't nhd sau mem Epi infor 6.0.
IILKETQUA /
1. Lien quan gida tang huyet ap va sa sut tri tu?
Bang 1. Mdi USn quan giifa tiin sd THA va SSTT SSTT
T H A Co Khong OR 95% Cl
Khdng Cd Cpng
n
199 57 256(%) (4,2) (6,1) (4,5)
n
4.521880 5.401
(%) (95,8) (93,9) (95,5)
1
1,51,07-2,00
Nhin xet: ty le hiSn mSc SSTT d nhdm THA cao han d nhdm khong THA 1,5 lan (95%, Cl =1,07- 2,0).
2. Lien quan gida ty 1$ hi$n mic SSTT va tai bien mach nao
Ty le hien mac SSTT d nhdm t i i n sd bj TBMN la (26,2%) cao hdn d nhdm khdng cd tien sd bi TBMN (4,1 %) 8,4 lan (95%C1 =5,35-12,81), (p< 0,001). , . .,
3. Lien quan gida b^nh Parkinson va sa sut trf tu^
Bang 2. Moi lien quan giifa PD va SSTT
SSTT
PD Cd Khong OR 95% Cl
Khong Co Cpng
n
241 17 258(%) (4,3) (17,7) (4,5)
n
5.36679 5.445
(%) (95,7) (82,3) (95,5)
1
4,8- 2,62 - 8,32
Nhan xet: ty le hien mac SSTT d nhdm bi PD cao ban ty 1$ nay d nhdm khong bi PD khoang 4,8 lan (95%, Cl = 2,62 - 8,32).
Bang 3. Moi liSn quan giifa tiin sd chan thuang sg nao va SSTT
SSTT
Tien sd cha'n thuong so nao Co Khong OR 95% Cl
Khdng Cd
n (%) 247 (4,4)
13\ (11,8)
n C/o) 5.345 (95,6)
97 (88,2)
1
2,9 1,47 - 5,29 Cdng 250 (4,6) 5.442 (95,4)
TCNCYH PhtJ trWdng 62 (3) - 2009
Nhin xet: ty le hldn mic SSTT d nhdm tiin sd chin thdang sg nao cao ban nhdm khong cd tien sd chan thdang so nao 2,9 lin (95%o Cl = 1,47 - 5,29).
Bang 4. Moi lien quan giifa tiin sd dai thao dUdng va SSTT
SSTT
Dai thao dUdng Cd Khong OR 95% Cl
Khdng
Co
Cpngn 257 2 259
(%)
(4,5) (9,1) (4,5)n
5.42020
5.440(%)
(95,5) (90,9)•(95,5)
1 2,1
0,24 - 8,75
Nhan xet: khong thi'y stJ khac bi^t cd y nghTa va nhdm khong bi dai thao dddng (95%, Cl = 0,24
IV. BAN LUAN
Khi phan tfch v l md'i lien quan gida ty le nggdi THA va ty le mac SSTT, chung tdi n h i n thl'y d nhdng nggdi THA ty le mac SSTT cao hdn 1,5 lan nhdng nggdi khdng bi THA (95% Cl = 1,07 - 2,0, p < 0,05). Ke't qua nay cung phu hop vdi nhieu nghien cdu tren the gidi khi xem THA la mpt yeu to nguy cd eua SSTT. Theo Whitmen RA, THA lam tang nguy cd SSTT khoang 2 0 % edn Reinberg S [7] nhan thl'y ty le n l y la 2 4 % .
P h i n tfch vai trd eua tai bie'n mach nao, chung td.i thay tien sd T B M N la mpt yeu t d lien quan den viee tang ty le m l c SSTT (OR = 8,4; 9 5 % Cl = 5,36 - 12,81). N h i n xet nay phii hdp vdi n h i i u nghien edu tren the gidi khi xem T B M N I I mpt yeu t d nguy cd cda SSTT. Fujishima M n h i n tha'y g i l m ty le mdi mac T B M N trong nhdng nam gan d l y do q u i n ly tdt T H A da lam giam ty le mac SSTT [1 ] . Theo Ivan T B M N lam tang nguy cd SSTT [2J. Nhdng nggdi bi T B M N chie'm 19,3% bj SSTT so vdi 11 % d nhdm chdng.
Ve mdi lien quan gida ty le SSTT va benh Parkinson, Stewart A nghien cdu trong hai nam tren 140 benh n h i n Parkinson va 572 chdng d nhdng ngUdi tren 65 tudi cho tha'y nguy co tUOng ddi (RR) eua ty le mdi mac SSTT la 1,7 (95% Cl =
gida ty le hi$n mac SSTT d nhom bj dai thao difdng - 8,76).
1,1 - 2,7) sau khi da chuan hda theo tudi, gidi, trinh dp hpc vl'n [6]. Rajput thi'y nguy cd nay cdn cao hdn (RR = 3,7), tUOng tg Breteler tha'y nguy co tuong dd'i (RR) bj SSTT d benh n h i n Parkinson la 3,0 (95% Cl = 2,9 - 3,1) [trich td 6] . N h g vay, hau het e l e t i c g i l deg cho rang PD cd md'i lien quan tdi ty b mac SSTT, eu the d nhdng nggdi bj PD thi nguy eo mac SSTT cao hOn nhdm khdng bj Parkinson. Nghien cdu eua ehung tdi cung n h i n thl'y ty le mac SSTT 6 nhdm bj PD eao hdn nhdm khdng bj PD 4,8 lan (95% Cl = 2,62 - 8,32).
Mdi lien quan gida t i i n sd chl'n thgong so nao va SSTT v i n cdn dang dgpc nghien edu. Cd t i c g i l cho rang tdn thUOng d nao cd the lam khdi p h l t q g l trinh t h o l i hda d i n de'n SSTT [5].
Nghien cdu cua chdng tdi n h i n thi'y & nhdm cd t i i n sd cha'n thgong sp nao ty le mac SSTT eao hon nhdm binh thgdng 2,9 lan (95%C1 = 1,47 - 5,29). Ben canh c i c nghien cdu cho rang chi'n thgong so nao ed lien quan den SSTT nhg neu tren, cung lai cd e l e nghien cdu chga thd'ng nhi't.
Theo Mehta KM, tien sd cha'n thuong sp nao (da dgpc chuan hda theo tudi, gidi, trinh dp hoc van) khdng thl'y mdi lien quan vdi SSTT (OR = 1,0;
9 5 % Cl = 0,5 - 2,0) [3]. Tuy nhien, theo Plassman BL mdi lien quan cua chi'n thUdng sp nao va SSTT
phy thupc v^o mde dp cda cha'n thddng sp nao [4]. Neu cha'n thddng sp nao nh? (mi't y thdc dddi 30 phut) thi khong cd lien quan de'n SSTT. Cdn khi chi'n thgdng sp nao mde dp trung binh v l nlng thi cd mdi lien quan vdi SSTT (tgdng dng vdi OR = 2,32; 95% Cl = 1,04 - 5,17 va OR = 4,51; 95% Cl
= 1,77 - 11,47). Trong nghien cdu nly ehung tdi chUa cd dilu kien chia ra cle mde dp eua chi'n thtfdng sp nao nen thl'y can ed nhdng nghien cdu tiep de tim hieu them ve mdi lien quan nly.
D i i thao dgdng dgdng nhg lam tang nguy co phat trien SSTT. Bang chdng ve md'i lien quan gida d i i thio dgdng v l SSTT edn cd nhdng y kie'n t r i i nggpc nhdng nhin ehung cle t i c g i l deu cho rang dd I I mdi lien quan d i i thio dUdng cd xu hgdng lam tang len ty le mac benh Alzheimer.
Fujishima M nhin thiy dai thio dddng la yeu to' nguy ed ddi vdi SSTT mach mau [1]. Whitmen RA va cs. [7] nhan thi'y d i i thio dddng l l m tang nguy cd SSTT khoang 40% so vdi ngUdi binh thgdng [7], cdn Reinberg S, d i i thao dgdng lam tang nguy cd mac SSTT len 46% [5].
Trong nghien cdu cua chdng tdi, khdng thl'y md'i lien quan gida d i i thao dgdng va SSTT. Tuy nhien, ddi tUdng SSTT bj dai thao dgdng trong nghien cdu cua chdng tdi cdn qua ft, do dd chga the dUa ra dUde ke't luan gi ve mdi lien quan nly.
Ngoai ra, vi nghien cdu dieu tra cpng ddng nen ehung tdi khdng cd dieu kien de lam c l e xet nghiem de chan doln chfnh xac d i i thio dgdng m l chu yeg qua khai thae hdi benh nhdng benh nhan da dgpc chan doln d i i thio dgdng td trgdc nen chac chan se edn bd sdt nhieu nggdi bj d i i thao dgdng. Vl vay, can p h i i ed nhdng nghien cdu tiep theo de xem xet mdi lien quan nly.
V. K I ' T LU/SiN .
Dda tren ket q u i thu difdc, chung toi tha'y cac ydu td b^nh 1>/ m^ch m l u v l cd che thoai hda c6 vai trd rd rang trong co che gay benh cda sa sut tri tug. Cln p h i i cd cac bi^n phip de chan doin v l dieu tri sdm cac ye'u td nggy cd nay.
TAI LIEU T H A M KHAO
1. Fujishima M, Kiyohara Y (2002), "Incidence and risk factors of dementia in a defined elderly Japanese population". Annals of the New York Academy of Sciences, (977); 1 - 8.
2. Ivan CS, et al (2004), "Stroke may double the risk of dementia". Stroke, (04);1244 - 1245.
3. Mehta KM, Ott A, Kalmijn S (1999), "Head trauma and risk of dementia and Alzheimer's disease", The Rotterdam Study, Neurology,(53);
1959- 1962.
4. Plassman BL, Havlik RJ, Steffens DC et al (2000), "Documented head injury in early adulthood and risk of Alzheimer's disease and other dementias". Neurology, (55): 11 58 - 1166.
5. Reinberg S (2005), "Dementia risk factors determined", Neurology, (26); 320 - 324.
6. Stewart A, William J (2002), "Risk of dementia compared to Age - matched Controls", Parkinson's disease, diagnosis and management, Stewart A Factor, Demos Medical Publishing, Inc, New York.
7. Whitmen RA, Sidney S, Selby J, Johnston SC, Yaffe K (2005), "Midlife cardiovascular risk factors and risk of dementia in the late life".
Neurology, 64 (2): 2 7 7 - 2 8 1 .
TCNCYH PhtJ trWdng 62 (3) - 2009
Summary
S T U D Y O N T H E R E L A T I O N B E T W E E N P R E V A L E N C E OF D E M E N T I A A N D ITS RISK F A C T O R S A M O N G E L D E R L Y PEOPLE I N B A V I D I S T R I C T , H A N O I ( 2 0 0 5 - 2 0 0 6 ) Hypertension (HT), stroke (Sk), Parkinson disease(PD), cranial traumatism (CT), diabetes (Diab) are considered as risk factors of Dementia (DM).Objective: Explore the relationship between prevalence of DM and its risk factors in Bavi - Hanoi. M e t h o d : 7712 people (including 260 dementia patients identified in the community) were clinically examined and interviewed by neurologists based on questionnaire.
Result and conclusion: the number of dementia patients suffered from HT was 1.5 times higher than that of normal group (95%C1 = 1.07 - 2.0), the number of dementia patients suffered from Str was 8.4 times higher than that of normal group (95% Cl = 5.36 - 12.81), the number of dementia patients suffered from PD was 4.8 times higher than it is in normal group (95% Cl = 2.62 - 8.32), the number of dementia patients suffered from TC was 2.9 times higher than that of normal group (95% Cl = 1.47 - 5.29). No significant difference between the number of dementia patients who suffered from diabetes and normal group (95% Cl = 0.24 - 8.76). Risk factors should be carefully considered in the prevention to reduce the number of D M among the elderly.
Keyword: dementia, risk factors
DAC DIEM LAM SANG VONG NGON, VONG TRI, VONG HANH TRONG BENH ALZHEIMER
N g u y i n Kim V i f t
B6 mon Tim thin - Trddng Dai hoc Y Ha Ndi
Vong ngdn, vong tri, vong hinh la Heu chuan chin doan sa sut tri tuS theo DSM.4, song cho den nay d ViSt Nam chda cd nghiSn cdu nio ve ITnh vuc nay. Muc tieu: md ta cic biiu hien vong ngdn, vong tri, vong hanh vi tic ddng cua chdng tren cac boat ddng thudng ngay cua benh nhan Alzheimer. Doi tUang va phuang phap ngbiSn cdu: md ta, tidn cdu, theo ddi dgc vdi sit sd dung MMSE vi CT sg nao 35 bdnh nhin dap dng tieu chuan chin doan benh Alzheimer cua DSM - 4 tai mgt sd bdnh vlSn Tim thin Trung UOng vi Hi Ndi trong 5 nim. Kit qua: vong ngdn, vong hinh xuat hien td giai doan sdm cua benh. O giai doan toin phit: vong ngdn cd d 100%o cac bdnh nhin (gom ca vong ngdn tiip nhan - 100%o, va vong ngdn bieu hien - 48,6%). Vong tn cd d 71,4%o cic bSnh nhan (die biet li vong tn thj giic - 48,6%p). Vong hinh cd d 82,4%o cic bSnh nhan (die biSt li khd khSn trong sd dung cic trang thie't bi trong gia dinh - 77,1 %o). Suy giam kha nang ddi phd vdi cac nhu cau cua eudc sdng cd d lOOVo cic bdnh nhan sau. 2-3 nim bj bSnh (mat kha nSng tit chim sdc ban than - 25,7%o). Kit luan: vong ngdn, vong tn, vong hanh ra't phd bien, rai da dang song cd Hnh die trUng cua bSnh Alzheimer. Cac bieu hiSn nay thudng xua't bidn sdm vi phdi hgp vdi nhau lim cho bSnh nhan nhanh chdng mit kha nSng tit lip trong cic boat dgng sd'ng thudng ngiy.
Td khoa: vong ngon: mat kha ndng suf dung ngon ngd. Vong t r i : mat kha ndng nhan bie't. Vong hanh: mat kha nang thUc hl?n nhffng hoat dpng co muc dich (trong khi khong cd tdn thUOng d h? thdng van dpng).
Alzheimer: b$nh sa sut t r i tu$ do teo nao