70 TAP CHI PHONG CHONG BENH SOT RET VA CAC BENH KY SINH TRUNG SO 4 - 2011
DANH GIA TY LE ROI LOAN DUNG NAP GLUCOSE,
DAI THAO DU^CKVG VA M Q T SO YEU TO NGUY CO & DOI TlTONG 30-69 TUOI TAI NOI THANH HAI PHONG NAM 2010
Do Manh Cvtimg, Nguyln Thi H6ng Trung tam Y tl Du phong - Hai Phong
Tomtdt
Nghiin ciru cdt ngang md td dugc tien hdnh tgi khu vuc ndi thdnh Hdi phdng a ddi tugng tu 30- 69 tudi nhdm xdc dinh ty li roi logn dung ngp glucose (RLDNG), ddi thao dudng (DTD), vd mdi liin quan vai cdc yeu td nguy ca cho kit qud
Tdng sd 3.500 doi tugng dugc diiu tra, trong do nam chiim 28,5% vd nii 71,5%. Ty li RLDNG chung Id 12,1 %, ty li DTD chung Id 6,1%, ty li rdi logn dung ngp dudng huyit luc ddi (RLDHLD) Id 24,4% trong do RLDNG a nam Id 9,1% vd nii: Id 13,3%, Ty li DTD a nam vd nir tirong iing Id 6,2% vd 6,1%. Cdc yiu td BMl, tdng huyit dp, hogt ddng thi life, vd tiin sic gia dinh mdc binh DTD cd Uin quan cd y nghia thdng ki vdi RLDNG vd DTD, vaip < 0,05.
1. DAT VAN DE
Benh DTD, trong do chu yeu la benh ddi thao dudng typ 2 chiem 85% d6n 95% trong tdng sd benh nhdn DTD, dang la mot trong nhung benh khdng lay nhiem phd biSn nhdt trdn toan cau. Benh DTD typ 2 cd toe do phat triSn rat nhanh. Hien nay dugc coi la mdt dich benh d nhieu nude dang phdt trien va nhung nude mdi cdng nghiep hda [1].
Theo hiep hoi DTD qudc tg (IDF), benh DTD la nguyen nhan gdy tii vong diing hang thii tu hoac thii nam d cdc nude phdt trien. Nhimg biSn chiing cua benh thudng pho bien, xudt hien d 50% sd benh nhan DTD. Cdc bien chiing nang de doa den tfnh mang ngudi benh cd die gap nhu benh mach vanh, benh mach mdu ngoai vi, dot quy, benh ly than kinh do DTD, cdt doan chi, suy than va mil mdt. Dd la nhiing nguyen nhdn thudng dan den tan tat vd giam tudi tho.
Tai Viet Nam, cung vdi su tang trudng cua nen kinh tS, ty le mdc benh DTD trong 10 ndm qua dang cd chifiu hudng gia tang. Tuy nhien, nhiing sd lieu ve DTD ciing chi mdi gidi ban d mot sd thanh phd Idn, nhihig sd lieu dai thdo dudng thai ky cung nhu wh cdc yiu to nguy ca gay benh DTD cdn rdt khiem tdn. Cdng tdc phdng chdng benh hdu nhu chua dugc de cap do chua ddnh gid hk tinh hinh benh tat. Hiiu biet \e benh cdn rdt ban chS, quan niem va thuc hdnh dihu tri, phdng benh DTD cdn rat nhieu diSm chua ddng [6,7].
Xudt phdt ttr muc dich nay, chdng tdi tiln hanh nghien cuu: Ddnh gid ty l^ mdc roi RLDNG, DTD vd cdc yiu to nguy ca & ddi tuang 30-69 tudi tai noi thdnh Hdi Phdng ndm 2010 vdi muc tieu:
Xdc dinh ty le roi logn dung ngp glucose, mdc benh ddi thdo ducmg.
$ 6 4 - 2 0 1 1 TAP CHI PHONG CHONG BENH SOT RET VA CAC BENH KY SINH TRUNG 71
Xdc dinh mot so yeu to nguy ca lien quan den roi logn dung ngp glucose, benh ddi thdo duomg.
2. DOI TirgfNG VA PHirONG PHAP NGHIEN CUtJ 2.1. Dia diem nghien cun
- Dia diem nghien ciiu tai khu vuc ndi thdnh Hdi Phdng Thai gian: 6-10/2010
2.2. Doi tuong nghien cun
- Ngudi trudng thdnh tii 30 den 69 tudi.
- Ddi tugng loai khdi nghien ciiu: la nhirng ddi tugng khdng dung do tudi, cd cdc benh Basedoww, suy gidp, Cushing, suy gan, suy than..., hodc dang su dung cac thudc cd anh hudng den chuyen hda dudng: corticoid, salbutamol, thudc chen p giao cam, hodc mdc benh cap tinh nhu nhiem khuan, lao phdi,...
2.3. Thiet ke nghien cun
- Nghien ciiu dich te hgc md td cdt ngang.
2.4. Cd mau
Ap dung lay cd mau toan bd doi tugng trong do tudi tir 30- 69 tudi tai cdc diem nghien ciiu.
2.5. Phirong phap chon mau
Chgn mau theo phuang phdp ngau nhien
• Budc 1: Chon qudn
Lap danh sdch cdc quan ndi thdnh theo thu tu: (tvr 1, 2,.. ..5)
- Chgn ngau nbiSn 2 quan theo danh sdch Id qudn: Hdng Bang, Ngd Quyen.
• Budc 2: Chgn Phuong (moi qudn chon 3 phuong) bang cdch L$p danh sdch cdc phuong theo tvmg qudn
- Chgn ngau nhien 3 phuong/ quan (2 qudn: 6 phuong) theo danh sdch
• Budc 3: Chgn ddi tugng nghidn ciiu
- Dieu tra l?p danh sdch cdc ddi tugng trong do tudi 30-69 tuoi tai 6 phuong dugc chgn.
T^ng sd ddi tugng trong do tuoi tren Id 3.500. Tien hdnh nghien ciiu toan bd sd ddi tugng nay.
2.6. Phu-OTig phap thu thap so lieu 2.6.1. X&c dinh ty If mSc RLDNG, DTD
Ldm xdt nghifm dudng mdu, ldm nghiem phdp dung nap glucose, vd ddnh gid kk qua theo tiSu chuan cua QMS 1999, ti6u chudn ADA ndm 2005 v6 RLDHLD, DH > 5.6 mmol/1.
72 TAP CHI PHONG CHONG BENH SOT RET VACAQ BENH KY SINH TRUNG 5 0 4 - 2 0 1 1
2.6.2. Xac dinh yeu to nguy co
Phdng vdn thu thap thdng tin ve nhan khdu hgc: tudi, gidi, dan tgc, nghe nghiep,...
theo bo phieu cua Vien ndi tiet Trung uang.
Tien sir ban than vd gia dinh lien quan den benh khdng lay nhiem
- Cdc ySu td lien quan: Tdng buySt dp (THA), BMI, boat dgng th6 luc... Cdc tieu chuan xdc dinh tang HA, BMI: theo tieu chuan cua Td chiic y te the gidi.
- Cdc thdng tin ve benh tat vd dieu tri benh.
2.6.3. Xu ly so lieu va phan tich so lieu
Su dung phdn mim EPI- INFO, SPSS dl xu ly so lieu
3. KET QUA NGHIEN ClTU VA BAN LUAN
3.1. Ty le roi loan dug nap glucose, mac benh dai thao dirong
Bdng 1: Ty le RLDHLD (Tieu chuan glucose huyet mao mach toan phan)
DHLD Binh thudng DHLD Tdng sd
n 2008
854 2862
Ty le (%) 57,4 24,4 100 Kit qud tren cho thay: Ty le RLDH LD chiem 24,4%
Bdng 2: Ty le RLDNG vd DTD (Tieu chuan glucose huyet mao mach todn phdn)
DH sau 2 gid lam NP
Binh thudng RLDNG DTD Tdng sd
n
2008 424 214 2646
Tyle(%)
57,4 12,1 6,1 100 Nghiem phdp dung nap glucose: RLDNG chilm ty le 12,1%, DTD (6,1%)
$ 6 4 - 2 0 1 1 TAP CHI PHONG C H 6 N G BENH S 6 T RET VA CAC BENH KY SINH TRUNG 73
Chan doan
Binh thudng DTD
RLDHLD RLDNG
Bdng 3: Ty le RLDNG vd DTD ph an theo nhdm tudi
Nhom tuoi 3 0 - 3 9
n 224
4 77 27
%
11,2 1,9 9,0 6,4
40- n 407
17 159
56
• 49
%
20,3 7,9 18,6 13,2
5 0 - 5 9 n
862 100 381 160
%
42,9 46,7 44,6 37,7
60- n 515
93 237
181 69
%
25,6 43,5 27,8 42,7
DTD, RLDHLD vd RLDNG tap trung chu yiu d cdc nhdm tudi 50 59 vd 60 -69 vdi cdc ty le tuomg dng Id:
- tu 50-59 chilm ty le DTD (46,7%), RLDHLD (44,6%), RLDNG (37,7%).
- tir 60-69 chilm ty le DTD (43,5%), RLDHLD (27,8%), RLDNG (42,7%).
Nhdm tudi 30 - 39 cd cdc ty le tuomg ung thdp hom vdi sir khdc biet cd y nghia thdng ke.
(P<0,05).
3.2. Cac yeu to nguy co* vol roi loan dung nap glucose, Dai thao dvong Bdng 4: Gidi tinh vdi RLDNG vd DTD
Gidi
Nam Nd
P OR
RLDNG Co
n 91 333
% 9,1 13,3
Khong n
592 1416
%
86,6 80,9
< 0,001 0 R = 0,65 95%CI(0,5-0,85)
DTD
Co n 62 152
%
6,2 6,1
Khong n 592 1416
%
90,5 90,3
>0,05 OR=0,98 95% CI (0,71-1,35)
Lien quan giiia gidi: Thdy RLDNG nii Id 13,3%, nam Id 9,1% vd thap ban nii 0,65 i k . vdi P <0,001, DTD ty le giiia nam (6,2%), nii (6,1%). Su khdc biet khdng cd ^ nghia diong kd (P>0,05.)
74 TAP CHI PHONG CHONG BENH SOT RET VA CAC BENH KY SINH TRUNG SO 4 - 2011
Bdng 5: BMI vdi RLDNG va DTD
BMI
BMI > 23 BMI < 23 P
OR
RLDNG Cd
n 211 213
%
15,4 10,0
Khong n
681 1327
%
76,3 86,1
< 0,000001 0R= 1,93 95% CI (1,55- 2,40)
DTD Cd
n 122
92
%
8,9 4,3
Khong n
681 1327
%
84,8 93,5
< 0,000001 0R= 2,58 95% CI (1,92- 3,47)
Chi sd BMI > 23 cd ty le RLDNG cao gap 1,93 lan so vdi BMI < 23, Ty le DTD lien quan din BMI > 23 cao gap 2,58 Idn so vdi BMI < 23
Bdng 6: Tdng huyet dp vdi RLDNG va DTD
Tang HA
Cd Khdng P
OR
RLDNG Cd
n 191 233
%
15,1 10,4
Khong n
642 1366
%
77,0 85,4
< 0,0000003 0R= 1,74 95% CI (1,4-2,17)
DTD Cd
n 132
82
%
10,4 3,7
Khdng n
642 1366
%
82,9 94,3
< 0,0000001 0R= 3,43 95% CI (2,53- 4,63)
YIU td tang huyit dp cd RLDNG cao gdp 1,74 Idn so vdi khdng tang HA, va DTD tang 3,43 lan so vdi khdng tang HA.
$6 4 - 2011 TAP CHI PHONG CHONG B I N H SOT RET VA CAC BENH KY SINH TRUNG 75
Bdng 7: Hoat ddng till luc vdi RLDNG vd DTD
Ho^t dong the lire
It boat ddng the luc Hoat ddng thi luc P
OR
RLDNG Co
n 245
179
%
18,0 8,4
Khdng n
730 1278
%
74,8 87,7
<0,01 0R= 2,40 95% CI (1,93-2,98)
DTD Co
n 113 101
%
8,3 4,7
Khong n 730 1278
%
86,5 93,0
<0,01 0R= 1,96 95% CI (1,46- 2,63)
It boat ddng till luc, ty le RLDNG 18,0% cd nguy co cao 2,40 Idn so vdi boat ddng^fbl lire (8,4%), nguy ca mdc DTD nhdm ft boat ddng thi luc la 8,3% cao 1,96 Idn so vdi nhdm hoat ddng (4,7%).
Ban luan
Chdng tdi tiln hdnh diiu tra trSn 3.500 doi tugng, tudi tu 30- 69 tiiudc khu vuc ndi tiidnh Hai phdng. Trong dd nd cd 2504 ddi tugng chilm 71,5%; nam cd 996 ddi tugng chiem ty le 28,5%. Kit qua trSn cho tiiay ty le nii tiiam gia nghi8n ciiu cao ban nam, (P < 0,05) tuong duong vdi nghidn ciiu cua Nguyen Thi Nggc Huyin vd Ta Vdn Binh [ 6 ]
- Ty le RLDNG d nii Id 13,3%, nam Id 9,1%. So sdnh kit qua nghiSn ciiu vl ty le RLDNG d nam vd nii chdng tdi tiidy cd su khdc biet co ^ nghia tiidng kd (P < 0,05). Dieu dd chung td cd mdt ty le ddng ke RLDNG d nii gidi vd tilm an nhilu khd ndng trd thdnh mdc benh DTD nlu khdng dugc phdt hiSn, tu vdn vd diiu tri kip tiidi. Trong nghidn ciiu ndy chdng tdi tiidy ty le DTD d nam vd nd tuomg iing la 6,2% va 6,1%.
DTD, RLDHLD vd RLDNG tap trung chu yiu d cdc nhdm tudi 50 - 59 vd 60 - 69 vdi cdc ty le tuomg iing Id:
Tu 50-59 chilm ty le DTD (46,7%), RLDHLD (44,6%), RLDNG (37,7%) Tu 60-69 chilm ty le DTD (43,5%), RLDHLD (27,8%), RLDNG (42,7%)
Nhdm tudi 30 - 39 cd cdc ty le tuomg iing tiidp born vdi cdc nhdm khdc (p < 0,05). Nhu v^y cd till ndi trong cdng ddng cdn mdt ty le dang kl sd ngudi mdc DTD, RLDHLD yd RLDNG tap tnmg d cdc nhdm tudi tu 50 - 59 vd 60 - 69. NIU khdng dugc phdt hien vd diiu tri kip tiidi till nguy ca DTD se ngdy cdng gia tdng trong nhimg ndm tdi tai Hdi phdng.
76 TAP CHI PHONG CHONG BENH SOT RET VA CAC BENH KY SINH TRUNG 5 0 4 - 2 0 1 1
* Ty le RLDNG Id rdi loan chuyin hod thudng kit hgp vdi tinh trang khdng Insulin cao, ngay nay RLDNG dugc xem nhu mdt giai doan tiln DTD. Ty le RLDNG Id mdt yiu td du dodn ty le DTD typ 2 trong tuomg lai.
Kit qua nghign ciiu (bang 2) cho thdy ty le RLDNG chung Id 12,1% so sanh vdi kit qud nghien ciiu cua tac gid Nguyen Thi Nggc Huyen va Ta Vdn Binh tai Ha ndi nam 2008, ty le RLDNG Id (7,6%) thdy ty le RLDNG cua chung tdi cao ban. Tuy nhien ty le DTD cua chung tdi tuomg duomg vdi ty le DTD tai cdc ket qua nghien ciiu cua cdc tdc gid tren.
Ty le DTD giiia nam va nii Id 6,2% vd 6,1%, (P> 0,05), nhung ty le RLDNG d nir Id 13,3%, nam la 9,1%. Su khac biet cd y nghia thdng ke (P < 0,05). Kit qua ndy tuomg duomg vdi nghien ciiu cua Le Minh Su [ 7 ]. Nhu vdy cd thi ndi trong cdng ddng cdn cd mdt ty le cao ngudi mdc RLDNG ma tap trung nhilu d nii. Id giai doan tiln DTD va benh DTD dugc phat hien mdi chi la phan ndi cua tang bdng. Ta Vdn Binh [ 2 ].
Nhirng ngudi beo cd BMI > 23, ty le RLDNG la 15,4% cao gdp 1,93 Idn so vdi BMI
< 23 (10,0%). Ty le DTD d ngudi cd BMI > 23 la 8,9%% cao ban d ngudi cd BMI < 23 Id 2,58 Idn (4,3%). BMI cd lien quan vdi RLDNG va DTD.
Ty le tang huyit dp mdc benh RLDNG, DTD cao hon ngudi binh tiiudng Id 1,74 va 3,43 lan . Kit qua cua chdng tdi ty le RLDNG chilm 15,1%, ty le DTD chilm 10,4%. 6 ngudi khdng tdng huyet dp thi ty le nay la 10,4% vd 3,7% vd cao ban trong nghien cuu cua Le Minh Su [7], ty le tang huyet dp mdc benh DTD (8,49%) vd tuomg duomg vdi nghien ciiu cua Nguyen Thi Nggc Huyin, Ta Vdn Binh va CS [ 6 ], ty le tdng huyit dp mdc benh DTD (13,0%).
Hoat dong the luc: Ket qud cho ta thdy nhiing ngudi cd thdi quen boat ddng the luc cd nguy ca mdc RLDNG la 8,4% va DTD la 4,7% thdp born so vdi nhdm ft hoat ddng thi luc 2,4 Idn va 1,96 Idn vdi cac ty le tuomg iing RLDNG vd DTD la 18,0% vd 8,3%. Kit qua nghien ciiu cua chung tdi tuomg duomg vdi ket qud nghien ciiu cua. Nguyen Thi Nggc Huyin, Ta Vdn Binh va CS [ 6 ]
4. KET LUAN
Ty le RLDNG va DTD
Tu kit qua nghien ciiu, chung tdi dua ra mdt sd kit luan sau:
Ty le RLDNG 12,1%, DTD 6,1%
Ty le RLDNG vd DTD phan tiieo nhdm tudi
+ tir 30- 39 chilm ty le DTD (1,9%), RLDHLD (9,0%), RLDNG (6,4) + tu 40- 49 chilm ty le DTD (7,9%), RLDHLD (18,6%), RLDNG (13,2%)
$ 6 4 - 2 0 1 1 TAP CHI PHONG CHONG BENH SOT RET VA CAC BENH KY SINH TRUNG 77
+ tu 50- 59 chilm ty le DTD (46,7%), RLDHLD (44,6%), RLDNG (37,7%) + tu 60- 69 chilm ty le DTD (43,4%), RLDHLD (27,8%), RLDNG (42,7%) - Mot so yen to lien quan den RLDNG va DTD
Ty le RLDNG d nir la 13,3%, nam la 9,1% va thdp born nir 0,65 Idn. Ty le DTD d nam (6,2%), nir (6,1%).
Ty le RLDNG la 15,4% d ngudi cd BMI > 23, cao gap 1,93 Idn so vdi BMI < 23 (10,0%). Ty le DTD d ngudi cd BMI > 23 la 8,9%% cao ban d ngudi cd BMI < 23 la 2,58 lan (4,3%).
Ty le RLDNG d ngudi cd THA la 15,1%, d ngudi khdng THA la 10,4% vd cao gdp 1,74 Idn d ngudi khdng THA vdi ty le tuang iing la 10,4% va 3,7%.
Ty le DTD d ngudi cd THA la 10,4%, d ngudi khdng THA la 3,7% va cao gdp 3,43 lan Ty le RLDNG d ngudi ft van ddng thi luc la 18,0% cao gdp 2,40 Idn so vdi ngudi cd boat ddng the luc, ty le nay la 8,4%.
Ty le DTD d ngudi ft van ddng tbi lire la 8,3% cao gdp 1,96 Idn so vdi ngudi cd boat dpng the luc, ty le nay la 4,7%.
TAI LIEU THAM KHAO
1. Ta van Binh (2000). Noi tik va roi loan chuyen hoa, tap 2, tr 8- 14.
2. Ta van Binh (2002). Ngucri benh dai thao duong cSn biet, nha xuk ban y hoc, Ha Noi, tr 9-11, 22 3. Ta van Binh, Hoang Kim LToc va cong su (2003). Phong va quan ly benh DTD tai Viet Nam, Nha xuSt ban y hoc, phan 2.
4.Ta van Binh va cong su (2006). Djch te hoc benh DTD a Viet Nam cac phuong phap dieu tri va bien phap du phong. Nha xudt ban Y hoc Ha noi
5. Ta van Binh, Hoang Kim U'dc va cong s\r (2002). Dich te hoc benh DTD va cac ydu t6 nguy co tai khu v\rc noi thanh cua 4 thanh ph6 Ha noi, Hai phong, Da nlng, thanh ph6 Ho Chi Minh. Nha xudt ban Y hpc, tr 21-32
6. Nguyen Thj Ngoc Huyen, Ta Van Bmh va cong su (2008). Danh gia ty le DTD va cac y6u to nguy ca t9i mOt quan noi thanh va mot huyen ngoai thanh Ha Noi. Tap chi va cac r6i loan chuyen hoa, tr 28- 35
7. Le Minh Su (2008).Thuc trang benh DTD a Thanh hoa. Tap chf va cac r6i loan chuygn hoa, tr 22- 25 8. IDF (2000). Diabetes Atlas 2000, ISBN 2- 930229-14- 4.
78 TAP CHI PHONG CHONG BENH SOT RET VA CAC BENH KY SINH TRUNG SO 4 - 2011
ASSESSEMENT PREVALENCE OF DIABETES, GLUCOSE TOLERANCE ffGT) AND RICK FACTORS IN THE AGE 30-69 IN SUBURBS HAI PHONG CITY, 2010
Do Manh Cuong, Nguyen Thi Hong Preventive Medical Center of Hai Phong city
Abstract
A cross-sectional study was conducted in suburbs Hai Phong city in order to determine the prevalence of diabetes, impaired glucose tolerance (IGT) and impaired Fasitng Glucose (IFG) and to explore their relationships with risk factors.
Results: 3500 adults aged 30 to 69 year old were surveyed , among whom the male comprised of 28,5% and the female: 71,5%. The prevalence of diabetes is 6,1% in overall, there was no significant difference about gender. The prevalence of IGT is 12,1% in overall, 9,1% in the male and 13,3% in the female. The prevalence of IFG is 24,4%.
BMI, hypertension, physical activity, family history of diabetes were significantly associated to diabetes and impaired glucose tolerance, with p<0,05
Can b6 phan bien PGS.TS. Le Xuan Hiing Vien Sot ret KST-CT TlT
