va dieu tri, NXB Y hoc, tr.9-22.
6. Dao Phong Tin (2003), Hing so sinh hpc ngirdi Viet Nam, NXB Y hpc, tr. 148.
7. Doan Van Tilp, Chu Qudc Tripd-ng, Vu Dang Nguyen (2000), Nghien cuu tac dung ciia phireng phap bim huyet Phong tri tren lam sang va liru huyet nao, dien nao d benh nhan thieu nang tuin hoan nao man tinh, Tap chi Cham ciru Viet Nam, (36), tr. 10-11.
8. Bodo M., Pearce F.J., Baranyi L. et al.
(2005), Changes in the intracranial Rheoencephalogram at lower limit of cerebral blood flow autoregulation, Phisiol Meas, 26(2): S1-17.
9. larullin K (1990), Clinical Rheoencephalography, Medicine Publishing, Moscow, pp. 18-78, 108-162.
SUMMMARY
Parameters of rheoencephalography in diabetes type 2 at hospital of Hue college
of medicine and pharmacology Hoang Khanh Hang, Ho Xuan Linh
Nguyen Thi Phireng Anh Hue College of Medicine and Pharmacy Study on 40 patients with type 2 diatebes at aged over 40 to determine their parameters for cerebral blood flow. We measured the parameters on the patients with type 2 diabetes and the normal people with compact machine Rheoscreen-MEDIS (Germany).
The result showed that the crest pointed wave was 22.5%, the crest obtuse wave was 62.5%, the crest arch wave was 15%, the crest auxiliary wave was 10%. Intensity of cerebral blood flow in patients with type 2 diatebes was less than that in the normal people (p < 0.01). The parameters showed that cerebral blood pressure in type 2 diatebes was higher than that in the normal people (Crest time p < 0.01). ABF of the patients was less than that of the normal people (p < 0.01).
Key words: rheoencephalography, type 2 diabetes
DAC DIEM THIEU MAU CUA BENH NHAN THALASSEMIA NGUOI LOU TM KHOA HUYET HOC - TRUYEN MAU BENH VIEN BACH MAI
Vu Minh Phueng, Phan Thj Phipcrng
Dai hpc Y Ha npi Muc dp thieu mau d benh nhan thalassemia nguoi Ion cd lien quan den the benh
thalassemia. Muc tieu cua nghien cdu nay la: (1) Xac dinh cac the benh thalassemia d ngiroi Ion dupe diiu trj tai khoa Huyet hoc- truyen mau benh vien Bach Mai. (2) Md ta muc do thieu mau d tung the thalassemia. Nghien ciru dupe tien hanh tren 63 benh nhan tu 16 tuoi trd len dieu trj d Khoa Huyet hpc - truyen mau BV Bach Mai dupe chan doan xac djnh thalassemia bang dien di huyet cau to, lam xet nghiem huyet do. Ket qua cho thay: (1) Ty le a- thalassemia la 20,6%, ^-thalassemia tang HbA2 don thuan la 11,1%, ^-thalassemia cd HbF don thuin la 11,1%, p°-thalassemia/HbE la 11,1%, f-thalassemia/HbE la 46%. (2). Ty
le thieu mau nang o the fi-thalassemia/HbE cao nhat (55,55%,), nong do Hb giam nhidu nhat 6 the (S-thalassemia/HbE (68,7 ± 17,5g/L).
TCr khoa: thalassemia ngwdi Ion, thieu mau 1. DAT VAN BE
Thalassemia la mpt nhom benh ve he th6ng huyet hgc thuong gap 6 cac benh nhan bj tan mau bam sinh. Benh xuat hien do su tdng hgp thieu hut mot loai chudi globin nao do cua hemoglobin lam hong cau di vd, gay cac bieu hien thiiu mau tan mau man tinh. Tuy theo su thiiu hut tong hgp chudi globin la mach alpha hay mach beta ma goi la a-thalassemia, B-thalassemia. Sir thiiu hut cac chudi globin nay tao nen cac the thalassemia khac nhau, cd the gay ra cac muc dp thiiu mau khdng tuong duong [6], & Viet nam da cd nhieu nghien cuu ve thalassemia tren benh nhi, nhung hau nhu it tien hanh tren ngudi Idn [1], [2], [3], Vi vay chung tdi tiin hanh nghien cuu nay vdi 2 muc tieu chinh:
1. Xac djnh cac the benh thalassemia &
ngtroi Ion diroc didu tri tai khoa Huyet hoc- truyen mau benh vien Bach mai.
2. Md la mux do thieu mau d tdng the thalassemia.
2. DOI TUXXNG VA PHU"0*NG PHAP NGHIEN CU'U
2.1. Ddi tuang nghien cuu: 63 benh nhan tuoi tir 16 tro len dugc chan doan thalassemia dua tren tieu chuan dien di
Bang 1. Ty le cac
huyet sac to dugc diiu trj tai Khoa Huyit hpc - truyen mau Benh vien Bach Mai tir 06/2009 din 12/2009
2.2 Phuang phap nghien cuu: cac benh nhan dugc tham kham lam sang, lam he so chi tiit, dugc lam cac xet nghiem huyit do, dien di huyit cau to.
2.3. Tieu chuin chin doan: dua tren kit qua dien di huyit sic to
- a-thalassemia : cd HbH - B-thalassemia don thuin:
+ Tang HbA2 don thuin: HbA2 >3,5%, khdng cd HbF
+ Cd HbF: cd HbF - B-thalassemia/HbE:
+ B*-thal/HbE: cd HbF, HbE, HbA1 giam + B°-thal/HbE: cd HbF, HbE, khdng cd HbA1
- Phan mire dp thieu mau thep tieu chuin cua Tc chirc y te thi gidi.
3. KET QUA NGHIEN CU'U
3.1 Vi ty le cac thi thalassemia va thanh phan hemoglobin
Kit qua nghien ciru vi ty le cac the thalassemia va thanh phin hemcglobin dugc trinh bay tren cac bang 1-2.
Qua bang 1 thay rc benh B-thalassemia chiim ty le cac nhlt (79,4%).
thi benh thalassemia.
The SP lugng Ty le (%)
a-thalassemia HbH 13 20,6
Don thuin Cd HbF 7 11,1
B-thalassemia Don thuin
Tang HbA2 dgn thuin 7 11,1 79,4 B-thalassemia
Phpi hgp B+-thal/HbE 29 46,0 79,4
Phpi hgp Bu-thal/HbE 7 11,1
Tcng SP 63 100
Bang 2. Ty le cac thanh phan Hb a cac the thalassemia.
The HbA1(%) HbA2(%) HbH(%) HbF(%) HbE(%)
•-thalassemia (HbH) 80,85 ±6,90 1,65 ±0,57 17,51 ± 7,06 P-thalassemia
cton thuan
Tang HbA2
San thuan 93.16 ±2,01 6,84 ±2,10 P-thalassemia
cton thuan C6 HbF 54,14 ±23,70 3,44 ± 1,13 42,41± 24,31 B-thal/Hb ph6i
hop P*-thal/HbE 67,6 ± 18,1 24,8 ± 10,5 37,0 ± 12,2 B-thal/Hb ph6i
hop (3"-thal/HbE 48,7 ±7,9 51,3± 7,9
Ket qua tren bang 2 cho thay HbA1 khong co 6 3°-thal/HbE, giam nhiiu 6 the p*-thal/HbE va B-thal don thuan co HbF, giam it d the p-thal tang HbA2 don thuan va a-thalassemia. HbF chiem ty le cao nhat o the p°-thal/HbE va B-thal don thuan co HbF don thuan.
3.2. Muc dp thieu mau va ham luang huyit ciu t i a benh nhan thalassemia theo cac thi benh
Mire dp thieu mau va ham lirgng huyet ciu to (hemoglobin) o benh nhan thalassemia theo cac the benh dirge trinh bay trong cac bang 3-4.
Bang 3. Mire dp thiiu mau g cac the benh thalassemia.
Mire dp thiiu mau
a-thalassemia (HbH) (n = 13)
B-thalassemia Mire dp
thiiu mau
a-thalassemia (HbH) (n = 13)
Tang HbA2 don
thuin (n = 7) Co HbF
(n = 7) p-thal/HbE (n = 36) Mire dp
thiiu
mau n % n % n % n %
Nang 6 46,15 3 42,86 3 42,86 20 55,55
Vira 6 46,15 4 57,14 4 57,14 11 30,56
Nhe 1 7,70 0 0,00 0 0,00 3 8,33
Khong 0 0,00 0 0,00 0 0,00 2 5,56
So lieu tren bang 3 cho thay ty le thiiu giira cac nhom khong co y nghTa thong ke mau nang cao nhat d thi B-thal/HbE. Tuy vdi p> 0,05.
nhien sir khac biet vi ty le thiiu mau nang Qua bang 4 thiy rd nong dp Hb thip Bang 4: Lirgng huyit ciu tc d benh nhan thalassemia
Hb(g/L) HbH (n = 13)
P-thalassemia Hb(g/L) HbH
(n = 13) Tang HbA2 don thuin (n = 7)
Cd HbF
(n = 7) P-thal/HbE (n = 36) Hb(g/L)
n % n % n % n %
<60 1 7,69 0 0,00 1 14.28 10 27,78
60-79 7 53,85 4 57,14 3 42,86 14 38,88
80-99 5 38,46 2 28,57 3 42,86 10 27,78
100-120 0 0,00 1 14,29 0 0,00 1 2,78
> 120 0 0,00 0 0,00 0 0,00 1 2,78
Trung binh 76,4 ± 13,0 76,4 ± 14,7 75,1 ± 13,5 68,7 ± 17,5
nhat d the P-thal/HbE cung nhir ty le co Hb dudi 60g/L cung cao nhat o the nay.
4. BAN LUAN
4.1. Dac diem phan loai thalassemia va sic thay doi cac thanh phim Hb a nhom benh nhan nghien ciru
* Ty le cac thi thalassemia
Nghien ciru tren 63 benh nhan thalassemia thay ty le B-thalassemia chiem phan Ion (79,4%), trong do a-thalassemia thi HbH chi co 20,6%. Theo y van thi a- thalassemia gom 4 thi chinh: a-thalassemia thi an, a-thalassemia thi nhe, benh HbH va benh Hb Bart (phii thai nhi). Ngoai the Hb Bart la thi nang, co thi chet trong thdi ky thai nhi hoac sau sinh thi cac thi tren deu la the nhe, it phai truyen mau, do dd it phai vao vien [6]. Cd le vi thi ma ty le a- thalassemia trong nghien ciru nay thap.
Trong cac benh nhan mac thi B-thalassemia d nhdm nghien ciru nay, chiing tdi thay ty le P-thalassemia/HbE (dj hop tir kep) tirong doi cao (57,1%), trong khi dd nhdm p- thalassemia don thuan cd ty le thap hon (22.2%). Kit qua nay cung tirong tir nhir vdi nhdm a-thalassemia, nhdm p-thalassemia don thuan cd bieu hien nhe hon nen cd thi phai vao vien it hon nhdm p- thalassemia/HbE. Chiing tdi khdng gap trirdng hgp p-thalassemia dong hgp tir nao trong nghien ciru, trong khi Nguyen Cdng Khanh va cong sir khi nghien ciru d benh nhi lai thay cd tdi 1/3 p-thalassemia dong hgp tu [1]. Cd sir khac nhau nay cd le vi day la thi nang nen benh nhan hilm khi song din tuoi trudng thanh.
Theo kit qua nghien ciru cua But Van Vien trong thdi gian tir thang 9/1994 den thang 2/1998 tren ngirdi Mirdng d Hoa Binh thi HbH chiem 11,7%: P-thalassemia don
thuan la 24,9% va p-thalassemia/HbE chiim 63,4% [3], Kit qua nay cung kha tirgng irng vdi nghien ciru ciia chung tdi. Song muon cd mdt ban do thalassemia tirong doi chinh xac ciia Viet Nam thi cd le phai can cd nhirng nghien ciru vdi co miu dai dien cho cac viing trong ca nirdc.
* Ty le cac thanh phin Hb & cac the thalassemia
0 nhdm a-thalassemia HbH cd ty le HbH la 17,51 ± 7,06 %. So vdi kit qua nghien ciru ciia Dirong Ba Trirc thi kit qua ciia chiing tdi cd phan cao hon (ty le cua Duong Ba True la 11,6±5,7%). Cd sir khac nhau nay cd le do nghien ciru cua Dirong Ba Trirc tiin hanh tren mot co mlu Idn hon va tren benh nhi [2].
0 nhdm p-thalassemia thay ty le HbA1 giam nhiiu g thi P-thalassemia phoi hgp va p-thalassemia cd HbF don thuan. Ty le HbF tang manh a the p°-thalassemia/HbE va p- thalassemia cd HbF don thuan. Ty le HbE d the p°-thalassemia/HbE cao hon the B*- thalassemia/HbE. Kit qua nay kha tuong dong vdi cac nghien ciru cua Nguyln Cdng Khanh [1], Bui Van Vien [3], George [4] va Bagott [5].
4.2. MiVc do thiiu mau 6' nhdm benh thalassemia trong nghien cuu
Thiiu mau o mire do vira va nang chiem da so, ty le thiiu mau nang cua nhdm HbH la 46,15%, ciia nhdm P-thalassemia/HbE la 55,55%, cac nhdm cdn lai la 42,86%. Theo nghien ciru cua Dirong Ba Trirc thi 63%
benh nhan HbH cd mire dp thiiu mau vira, trong khi dd o benh p-thalassemia dong hgp tir thi 71,1% d mire thieu mau nang, chi cd 28,9% thiiu mau vira: d benh p- thalassemia/HbE cd 68,3% thiiu mau nang va rat nang, chi cd 30,6% thiiu mau vira [2].
Ket qua nghien cCru cua chung toi kha tuong dong vdi tac gia nay, cung nhu" theo cac tai lieu kinh dien thi mire dp thieu mau a B-thalassemia phoi hpp nang hon 8- thalassemia don thuan va a-thalassemia HbH [6],
Theo bang 4 thi lupng huyit cau to d nhdm B-thalassemia/HbE cung thap hon so vdi cac nhdm khac. Nhir vay mice dp thieu mau tang tuong irng vdi bat thu'dng nhieu hay it cua chudi globin.
5. KET LUAN
Nghien ciru tren 63 benh nhan thalassemia ngirdi Idn d Khoa Huyet hpc truyen mau Benh vien Bach mai cho thay:
- Ty le a- thalassemia la 20,6%, B- thalassemia tang HbA2 don thuan la 11,1%, B-thalassemia cd HbF don thuan la 11,1%, B°-thalassemia/HbE la 11,1%, B*- thalassemia/HbE la 46%.
- Ty le thieu mau nang d the p- thalassemia/HbE cao nhat (55,55%), nong dp Hb giam nhat d the p-thalassemia/HbE (68,7 ± 17,5g/L).
TAI LIEU THAM KHAO
1. Nguyln Cong Khanh (1985), Nghien ciru mdt SP dac diem lam sang va huyet hpc benh Beta-thalassemie d ngirdi Viet Nam, Luan an Tien sy, Trirdng Dai hpc Y Ha Ndi.
2. Duxeng Ba Tryc (1996), Dac diem lam sang va huyet hpc benh HbH d tre em Viet Nam. Birdc dau tim hieu tan suat Anpha-thalassemia d Viet Nam, Luan an Tien sy, Trirdng Oai hpc Y Ha Ndi.
3. Bui Van Vien (2000), Mdt SP dac diem lam sang, huyet hpc benh hemcglpbin E va tan suit ngirdi mang gen hemoglobin E d dan tdc Mirdng Hda Binh, Luan an Tien sy Y hpc, Trudng Dai hpc Y Ha Npi.
4. George E., Faridah K., Sivagengei K.
(1988), Hemoglobin E- beta thalassemia, Reexamined. Singapore Med J., 29:45- 47.
5. Baggott J. (1992), Gas transport and regulatipn, Textboek pf bipchemistry with clinical ccrrelatiens, Thomas. M. Devlin.
Wiley- Liss, 1025-1058.
6. Hoffbrand A.V. (2006). Essential Hametology. 72-94.
SUMMARY
Subtypes and anemia characteristic of the adult thalassemia patients in department of hematolgy and blood
transfusion in Bach Mai hospital Vu Minh Phuong, Phan Thi Phuong
Hanoi Medical Univesity Anemia severity in the thalassemia
patients may depend on the subtypes of thalassemia. Objectives of this study were (1) Identifying the subtypes of the adult thalassemia patients who had treated in the department of Hematology and Blood transfusion in Bach Mai hospital. (2) Describing the anemia seventy of the subtypes. 63 adult thalassemia patients were taken haemoglobin electrophoresis.
Results and conclusions: (1) Rate of a- thalassemie HbH was 20.6%, ^-thalassemia with increase HbA2 was 11.1%, [}- thalassemia with HbF was 11.1%, /3°- thalassemia/HbE was 11.1%, (3*- thalassemia/HbE was 46%. (2) Rate of severe anemia was highest in §- thalassemia/HbE (55,5%), and hemoglobin level was lowest in /3-thalassemia/HbE (68,7
± 17,5g/L) too.
Key words: adult thalassemia patient, anemia subtypes
