Vietnam Journal of Physiology 16(3), 12/2012 ISSN: 1859-2376
NGHIEN CLPU C H I S 6 CHCTC N A N G CO TIM T H A T P H A I 6 B | N H N H A N BA!
THA0DU'b'NGTYPE2
Hodng Dinh Anh B^nh vi^n 103, Hgc vi^n Qudn y Nhdn bdi 15/4/2012; sCra bdi 10/6/2012; chip nh§n ddng 12/9/2012
Nghidn cO-u chi s6 chCic ndng ca tim thit phdi (Tei thit phii) bing sidu dm Doppler tim d 60 b$nh nhdn ddi thdo dudng type 2, tudi trung blnh Id 55,0 ± 8.7 vd 30 ngudi blnh thudng tudi trung binh Id 58,4 ± 9,3. Myc tidu nghiin cdu id ddnh giS si/ biin ddi chlsd chOc nSng thit phii vd mdi lidn quan vdi thdi gian mdc b$nh. tdng huyit dp d b$nh nhdn ddi thdo dudng type 2. Kit qud cho thiy cd tSng ch! sd Tel dcd2 nhdm. nhung d nhdm b$nh Tei thit phdi IS 0.59 ± 0.39 tdng cao hon so vdi d nhdm chOvg 0,38 ± 0.15. Chua thiy mil lidn quan giO'a Tei thit phdi vdi thd^ gian mdc b0nh va tinh trgng tdng huyit Sp di kdm.
Ti> khoa: chl s6 chOc ndng ca tim thit phii, dSi thdo dudng type 2 I.DjjTVANDe
Ddi thao dudng (DTD) Id mdt bdnh khd phi biin, chiem ty Id 60 - 70% trong ting s i cac b?nh npi tiet vd Id mdt trong nhOng vin d l sOc khde dupc quan tdm hdng dlu trong thi gidi hidn dai. Con s i ndy se tdng Idn 300 Iridu ngudi vdo ndm 2025 [2].
Benh dai thdo dudng gay anh hud'ng Idn den hd tim mgch, dac bidt Id tdng tan suit bj tang huyit dp (THA), vO-a xa ddng mgch (VXSM), rol loan chO'c ndng tim. Bdnh tim mgch la nguyen nhan chu ylu gay tu vong vd tan phi d bdnh nhdn dai thao dudng type 2 [1], [2]. [4]
Cdc nudc tren the gidi va Vldt Nam, dd cd mdt so nghidn cOu ve chT s6 chO'c nang ca tim thit trdi (Tel thit trdi) vd TDI trong ddnh gia chOc ndng thit trai d bdnh nhdn ddi thdo dudng type 2, nhung chua thiy nghidn cii'u ve chi sd Tei that phai d bdnh nhdn ddi thdo dudng type 2. Do vdy chung tdi tiln hdnh nghien cuu nay nhlm cac myc tidu: i) danh gid sy biin doi chO'c nang va chl s i Tei thit phai bing sieu dm Doppler tim a bdnh nhdn ddi thao dudng type 2; vd ii) xdc djnh mii lidn quan giOa chi s i Tel thit phai vdi thdi gian mac bdnh vd tdng huyit dp di kdm d b$nh nhdn ddi thdo dudng type 2.
2. D 6 I TU'gNG VA PHU-aNG PHAP NGHliN CCfU
2.1. D i i tvpng nghidn cO'u
- Nhdm chOng: 30 ngudi binh thudng, phan bo tuii vd gidi tuang duang vdi nhdm b|nh nhan.
Khdng mic bdnh DTO type 2, bdnh tim mach, hd hip, ndi tilt chuyen hda thdn tilt nigu.
- Nhdm bdnh: 60 bdnh nhdn, tit cd dlu nlm dllu trj ndi trO tgi Khoa Al 1, Bdnh vidn 103 tO thdng 2 din thang 6/2011.
* Tidu chuin lya chpn bdnh nhdn:
Dii tupng dupc chpn Id nhu'ng bdnh nhdn DTD type 2 dupe chin dodn theo tidu chuan cua To chuc Y te thi gidi (WHO) 1998:
+ Nong dp dudng huyit lOc ddi (sau an it nhit 8 gid) a 7,0 mmol/l (a 120 mg/dl) + Nong dd dudng huyit d thdi diem bit ky
£11,1 mmol/I (a 200 mg/dl).
+ Ning dd dudng huyet 2 gid sau uing 75 g glucose (nghidm phdp dung ngp glucose) £ 11,1 mmol/l (s 200 mg/dl).
- Nghidn cOu theo phuang phdp tiln cOu, md ta vd cit ngang cd so sdnh dii chO-ng..
2.2. Phuang phdp nghien cij>u
* Thdm dd ddng chay qua van 3 Id vd ddnh gid chi s i Tei:
+ Thdng qua phi van 3 Id trdn sidu dm Doppler, do dgc cdc thdng so VE, VA, VE/VA;
thdi gian tdng tic sdng E (AT), thd'i gian giam tie sdng E (DT), tich phdn cac vdn tic sdng E, sdng A vd tich phdn todn tdm truang d l danh gid chOc ndng that phdi,
+ Sieu am Doppler dbng chiy qua van flOng mach ph6i; D6ng chiy qua van acng m$ch phii flu'p'c tham d6 6 mat cat trgc ngSn canh lie trai vM vi tri cita s4 flat tai vj tri v6ng van dOng mach phii.
- Thfti gian toan tam thu (th*i gian a) la thiri gian to lOc ddng din ICic m& van ba la, 6utyc tinh bSng khoSng each tir lac l<6t thilc vin tic ding d i diy thit phii cua chu chuyin tim tnri^c tM lilc bit diu ddng chiy d i diy thit phii cila chu chuyin tim tiip theo (hinh 1), ngoii ra cin du'oc llnh theo thM gian tCr lilc
bit diu din lilc kit thilc cDa phi Doppler ii6n tgc cua phi hfr van ba la.
- ThM gian ting mau qua thit phii (th*l gian b) duoc tinh bing khoing each ttr lOc bit diu din lilc kit thiic ding ting miu thit phii (hinh1).
- Chl s i Tei thit phii du'O'C xic djnh la thfti gian co ding t h i tich thit phii + thM gian giin CO ding t h i tich thit phii = a - b.
a - b Tel t h i t phii =
Phi qua van 3 l i Phi qua van OMP Hinh 1. cac phi qua van 3 i i , van DMP v i cich tinh Tel thit phii 3. K6T QUA NGHIDN c(ru vA BAN LUAN
Bing 1.0ac diim v i tuii, gid'i cQa nhdm DTD type 2 v i nhdm chCrng.
Kit qui nghiftn ci>u du-oc trinh biy tren cic bing 1+6.
Nhdm tuoi 40-50 51-60 61-70
>70 Cing(%) Tuii trung btnh
Nhdm chii-ng (n = 30) Nam (%)
4 (40,0) 2 (20,0) 3 (30,0) 1 (10,0) 10 (33,3)
NO (%) 5 (25,0) 10(50,0) 5 (25,0) 0 (0,0) 20 (66,7)
COng(%) 9 (30,0) 12 (40,0)
8 (26,7) 1 (3,3) 30 (100) 55,0 ± 8,7
Nhdm DTO (n = Nam (%) 12 (33,3) 12 (33,3) 8 (22,2) 4(11,1) 36 (60,0)
NO' (%) 1 (4,2) 9 (37,5) 8 (33,3) 6 (25,0) 24 (40,0)
60) Cing(%)
13(21,7) 21 (35,0) 16 (26,7 10(16,7) 60(100) 68,4 ±9,3 PDTO > 0,05
cac s i lieu o bing 1 cho thiy tuii trung binh cda nhim nghien cCru l i 58,0 ± 9,3, thip nhit i i 40, cao nhit l i 77. Nhim tuii chiim ty l i cao nhit l i 51 - 60 (36%), nhung nhdm DTB type 2 d dO tuii thip 40 -
50 CQng kha nhliu (21,7%). Diiu nay ph(J hp'p vd'i xu hud'ng gin diy cho ring 'binh BTD type 2 dang ngiy cing t r i hda", thain chl c6 nhliu binh nhan OTD type 2 nhd hon 30 tuii.
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Vietnam Journal of Physiology 16(3), 12/2012 ISSN: 1859-2376
Bing 2. Thd'i gian phit hien benh & nhim DTD type 2.
Thd'i gian p h i t hien ( n i m )
< 2 2 - 5 6 - 1 0
> 1 0
Thdi gian p h i t hien b i n h trung binh
S i benh nhan (n = 60) 17 27 9 7
Ty le (%) 28,3 45,0 15,0 11,7 4,5 ± 4 , 2 ( 1 - 1 8 ) Ket qua trdn bdng 2 cho thiy thdi gian
phdt hidn bdnh trung binh Id 4,5 ± 4,2 ndm. Trong dd ly 1$ bdnh nhdn DTD type 2 ed thdi gian phdt hidn bdnh ngin (2 - 5
ndm) chiim da s i (45%). Dilu ndy phu hpp vdi mOt s i quan dilm hidn nay cho ring b$nh ngdy cdng dupc phdt hidn sdm han [1].
Bdng 3. Cdc thdng s i sidu dm ddnh gid chuc ndng thit phai.
Thdng so sieu i m VE (cm/giay) VA (cm/giay) E/A DT (mill giay) AT (mill giay) VTIE VTIA VTI
Nhdm chLrng (n = 30) I.X±SD) 62,1 ± 12,7 61,2 ± 12,6 1,03 ± 0 , 1 6 144,3 ± 52,7
67,0 ± 1 7 1 9,5 ± 2 , 5 5,5 ± 1,1 15,0 ± 2 , 9
Nhdm BTD (n= 60)
{X±SD)
59,5 ± 1 2 , 4 62,5 ±15,3 1,01 ± 0 , 3 3 127,2 ± 6 4 , 7 65.4 ± 2 1 , 3 7,2 ± 2,8 6.7 ± 2 , 9 14,2 ± 3 , 7
P
>0,05
>0,05
>0,05
<0,05
>0,05
< 0,001
>0,05
>0,05 Kit qua tren bang 3 cho thay cdc dlu hidu
thay doi chuc ndng tdm tnpang thit phai d' nhdm DTD type 2 chua nhieu, chT cd giam thd'i gian giam tdc sdng E van 3 la (DT) vd giam tich phdn vdn tdc sdng E van 3 la (VTIE). Hi$n tgi cac nghidn cuu v l chOc ndng tdm truang Ihit phdi chua nhilu, chO ylu cd mdt s i nghidn cOu ve chOc nang tdm thu thit phai trdn bdnh nhdn
cd bdnh tim bim sinh cd shunt trdi - phai nhu thdng lidn thit hay tO' chOng Fallot, bdnh nhan ed tdng dp lye ddng mgeh phii [4], [5]. Tuy nhien s^r khde bidt giOa DT vd VTIE trong nghidn eOu cOa ehung tdi qua van 3 Id cua nhdm bdnh nhdn vd nhdm diO'ng cho thiy da bit dlu cd giim chOc ndng tdm truang ^at phai d nhdm b0nh.
Bang 4. Ch? s i Tel thit phdi d nhdm bdnh nhdn nghidn cuu.
Thdng s6 sieu am ET (mill giay) TST (mill giay) TST/ET Tei that phai
Nhdm chl>ng (n = 30)
(XISD)
265,1 ± 28,3 372,2 ± 37,4 1,41+0,12 0,38 ± 0 , 1 5
Nhdm DTD (n = 60)
(X±SD)
236,9 ± 33,4 366,3 ± 4 1 , 6 1,58 ± 0 , 3 7 0.59 ± 0,39
P
< 0,001
>0,05
< 0,001
<0,05
Theo Nguyin Tuin Hii chl s i Tei cOa thit phii trdn benh nhin thdng lidn nhi cd thd'i gian co ding thi tich v i Ihdl gian giin ding thi tich kdo dil hon so vd'i d' ngu&l binh thudng, thd'i gian ting mau thit phii ngin hon so vdl 6 nguM blnh thui'ng, chi s i Tei thit phii Wn hon rd ret so vd'i * nguM blnh thudng (0,30 ± 0,04 so vdi 0,21 ± 0,02) (p < 0,05) 13).
Eidem v i cs. cho thiy chl s i Tel thit phii ir ngud'i binh thudng khoi manh t i 0,28 ± 0,04, * tri em l i 0,32 ± 0,03 [4]. Ishll v i C8.
nghien CLPU tren 150 ngud'i btnh thui'ng tuii tir 1 - 18 tuii, thiy chl s i Tel thit phii la 0,24
± 0,04 (theo [4]). Vonk va cs. cho ring Tel thit phii l i ch! s i cd thi si> dgng dinh gii
ttnh trang tang ap iuc ddng mach phii * binh nhan mic binh tu mlin, chl s i Tel thit phii trin 98 binh nhin l i 0,41 ± 0,21. Tic gii cQng thiy cd si; biin dii chi>c ning tam thu thit phii khi Tei thit phii > 0,36 [5].
So sinh cic chl s i Tei thit phii trong nghiin cUu cua chung tdi b c i nhdm chi>ng v i nhdm nghiin cUu diu cao ho»n so vdl kit qui nghidn cCru cOa cic tic gia khac, nhung Tel thit phii tang nhiiu hon so v*l ft nhdm chi>ng cd y nghTa (p < 0,05). Diiu nay cho thiy rii lean chi>c ning thit phii xiy ra tren binh nhin DTD la rit rd rit, song ngufirng danh gla rii ioan ta bao nhliu thi trong nghiin cCru niy chua d$t ra dugrc.
Bing S. Liin quan giO'a chl s i Tel thit phii theo thd'i gian phit hiin benh ft binh nhan DTD type 2.
Chi s i ET (milt giay) TST(mili giay) TST/ET TST-ET (mill giay) Tel that phii
Phin nhdm DTB theo thfti (
<2 nam (n = 17) 237,9 ± 46,3 374,9 ± 66,4 1,67 ±0,64 137,1 ±66,9 0,69 ± 0,67
2 - 5 nam (n = 27) 240,4 ±25,7 369,3 ±26,5 1,55 ±0.14 128,9 ±25,2 0,55 ±0,16
lan phat hien benh (n= 60 ) 5 - 1 0 nam
(n = 9) 233,1 ±28,0 341,2 ± 37,6
1,47 ±0,16 108,1 ±34,1 0,50 ±0,15
>10 nam (n = 7) 226,6 ±41,1 369,6 ± 22,2 1.70 ±0,47 143.0 ±47,6 0,72 ± 0.50
P
>0,05
>0,05
>0.05
>0,05
>0,05 Kit qua trSn bang 5 cho thiy sv chenh
tech v i cic chi s6 Tei thit phii theo thfti gian mic benh chua cd y nghTa thing k i (p
> 0,05). ChCing tai thiy chl s i Tel cao nhit 6 nhdm mic benh trin 10 nim v i thip nhit
ft nhdm mic binh tU 5 - 10 nim. Kit qui niy ehirng t i Tel thit phai cOng da cd nh&ng biin d i l theo thfti gian mic binh vi cic biin nhQ'ng tim mach liu dai ft benh DTB type 2.
Bang 6. Lien quan giO'a ohi s i Tei thit phii 4 nhdm DTB type 2 c6 v i khdng cd THA.
Chi s i ET (mlli giay) TST TST/ET TST-ET(mili giay) Tei thit phii
OTO cd THA (n = 36) 238,1 ± 35,9 365,4 ± 44,9
1,58 ±0,43 127,2 ±47,6 0,59 ± 0,44
DTD khdng THA (n = 24) 235,1 ± 29,9 367,6 ±37,1
1,59 ±a27 132,5 ±36,1 0,6010,30
P
>0,05
>0,05
>0,06
>0,05
>0,05
Vietnam Journal of Physiology 16(3), 12/2012 ISSN: 1859-2376
Kit qua trdn bang 6 cho thiy hiu hit cdc thdng s i thdi gian vd chl s i Tei thIl phdi giO'a hai nhdm cd vd khdng cd THA diu khdng khac bilt. THA chu ylu anh hudng Idn thit trai. Theo Duong Quang Huy ehl s i Tei thit trai cd moi lidn quan r5 vdl tinh trgng THA [2], tuy nhidn trong nghidn cO'u cua chOng tdi v l Tei that phai chua cd mii lidn quan, chOng td THA il dnh hudng Idn chO'c ndng ttilt phdi.
4. K£T LUAN
Thdi gian ting mdu thIl phdi d b|nh nhdn DTD type 2 rOt ngdn so vd'i binh thudng (ET:
236,9 ± 33,4 miii gldy so vdi 265,1 ± 28,3 mill gidy).
- Cd tdng cao chf s i Tei thit phai d bdnh nhdn DTD type 2 vdi Tel trung binh Id 0,59 ± 0,39.
- Chua Uiay mil lien quan glua blln dil ehl s i Tei thIl phai vdi thdi gian phdt hidn bdnh va tinh trang tang huyit dp.
TAI LIEU THAM KHAO
1. Ta Van Binh (2006) Bdnh dai thdo dudng - Tang glucose mdu. NXB Y hpc, Hd Npi.
2. Duvng Quang Huy (2006) Nghidn cOu chf so chuc nang ca tim (chl s i Tei) thit trdi a bgnh nhdn dai thdo dudng typ 2, Ludn vdn thgc sy y hoc; Hpc Vidn Qudn y.
3. Nguygn Tuln Hai (2005) Ddnh gid blln doi chOc ndng thit phdi bdng chi s i Tel d bdnh nhdn thdng lien nhT. Luan vdn tit nghidp bae sT ndi tru bgnh vidn.
4. Eidem BW, O'Leary PW, Tei 0, et al.
(2000) Usefulness of the myocardial
perfonnanee index for assessing right ventricular function In congenital heart disease. Am J Cardiol. 86(6):654-658.
5. Vonk tVIC, Sander MH, van den Hoogen FH, et al. (2007) Right ventricle Tei-lndex:
a tool to increase the accuracy of non- invasive detection of pulmonary arterial hypertension in connective tissue diseases, Eur J Echocardlogr. e(5):317-321
SUMMARY
Study of myocardial performance index of right ventricle
(right ventricle Tel) in patients of diabetes mellitus type 2
Hoang Dinh Anh Hospital 103, IVfilitary Medical University
Received 15 April 2012; revised 10 June 2012; accepted 12 September 2012 Study 60 patients with diabetes type 2, averaged age was 55.0 ±8,7 and 30 control subjects with averaged age of 58.4 ± 9.3. The aim of the study was to evaluate performance index of the right ventricle and the relationship with time of disease and hypertension in diabetes mellitus type 2 patients. The result showed that RV Tei index increased in both groups, but Tei RV in the diabete type 2 group was 0.59 ± 0.39, which was higher than that in the control group (0.38 ± 0.15). There was no significant relation between Tei RV with time of desease and hypertension state in the diabete mellitus type 2 group.
Key words: Tei RV, diabete type 2
DANH GIA MLPC OQ PHAT TRI^N T H ^ L y C VA KI^N THLTC, THAI OQ. THI/C HANH V£ Y SINH HOC CClA SINH VIEN NAM CUOl KHOA GIAO OyC IHt
C H A T , DAi HQC HUt K H 6 A 2009-2013
Trdn Dinh Blnh\ Nguydn Thj Minh Hu#^
^ Truvng D^i hQC YDu^, Dgi hgc Hue ' Khoa Gido dye Thi chit, Dgi hgc Hue Nhdn bdi 18/10/2012; sO-a bdl 26/10/2012; chip nhdn ddng 15/11/2012
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