-NGHIEN cuu KHOA HOC
KHAO SAT MOI TUONG QUAN GIUA GLUCOSE MAU, HbAIC VA MUC LOC CAU THAN 6 BENH NHAN DAI THAO DUONG TYP 2 MOI PHAT HIEN
N g u y e n V a n Chuong'
T 6 M TAT:
Nghign ciiu tien hanh tren 91 benh nhan dai thao duang typ 2 mai phat hign tai Benh vien Nhan dan 115 nham xac dinh moi tuong quan giira glucose mau voi miic Ipc cau than uac doan bang cong thiic Cockcroft- Gault a bgnh nhan DTD typ 2 moi phat hign. (2) Xac dinh moi tuang quan giira HbA 1C vai miic loc cau than a benh nhan DTD typ 2 moi phat hien
Thiet kg nghign cuu mo ta cat ngang; kham lam sang, xet nghigm glucose mau va HbAlc cho tat ca cac benh nhan nghign cim.
Kgt qua: Khong c6 moi tuang quan giua miic Ipc cau than va duong man, 6 nhung benh nhan DTD typ 2 moi dugc phat hien (p>0,05). Co moi tuang quan tuygn tinh nghich miic dp vita, giira miic loc cau than va HbAlc c6 y nghia th6ng ke (r = -0,391, p<0,001)
Ket luan; HbAlc danh gia miic loc cau than tot han duang mau.
Tir khoa: Dai thao duong; glucose mau; HbAlc; miic Ipc cau than
SUMMARY
CORRELATION BETWEEN GLYCEMIA, HbAc AND GLOMERULAR FILTRATION RATE
FN PATIENTS DIABETES TYPE 2 DIAGNOSED FOR THE FIRST TIME
The study were performed over 91 patients diabetes type 2 diagnosed for the first time in 115 people hospital.
Ho Chi Minh city
Objective: To identify the correlated rate between
glycemia with predicted GFR of Cockcroft - Gault in thepatients diabetes type 2 diagnosed for the first time and)Toidentify the correlated rate between HbAIC with predicted GFR of Cockcroft-Gaultinthe
Methods: cross-sectional prospective study. Clinical examination, blood glucose and HbAlc testing for all study patients
Result. Glycemie had no correlation with predicted GFR of Cockcroft - Gault in the patients diabetes type 2 diagnosed for the first time (p>0,05). HbAlc had negative correlation with predicted GFR of Cockcroft - Gault in thepatients diabetes type 2 diagnosed for the first time(r=-0,391;p<0,001).
Conclusion:HbAlc was better thang lycemiato control theearly decreasing stage of GFR
Keywords:Diabete type 2, Glycemia, HbAlc, GFR.
D^T VAN DE
Bign chiing than la mot trong nhijng bien chiing nang ne nhat d6i voi benh nhan (BN) dai thao duong (DTD), nguy ea dSn dgn tan phg va tir vong do suy th^n.^ Khong nhiing the, bign chimg than con anh huang tai chat luon^
song ciia nguai benh, no ciing tac dong rat xau den su xuil hien, tien trien va gia tang ciia cac bien chimg man tinh khac nhu tang huygt ap, benh ly mach mau Ion, benh ly vong mac mat, nhigm toan....
Suy than do DTD dang la van dg toan cau, dg lai cac hau qua nang ne, ganh nang kinh tg cho gia dinh va xa hoi.
Theo thong ke, ti le bign chiing suy than a cac benh nhan DTD typ 1 khoang 35%, va typ 2 khoang 15 din 60%[3].
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Tai My benh than giai doan cuoi 43,8% la do DTD[4].
Triin Van Hai nghien cihi 2008-2009 tai Benh vien Chg Ray bien chiing than la 36% [1].
Viec nghien ciru tim hieu sau vg moi lien he giira nong dp duong mau, kiem soat duang mau, va miic loc cau than (MLCT) gop phan phat hign sam, kigm soat, theo doi, ngan ngCra va han chg tich cue cac ton thuang cau than dg lam giam hau qua suy than giai doan cuoi dan den tir vong.
Vi vay chung toi tign hanh nghien ciiu dg tai vai cac muc tieu sau:
1. Tim moi tuong quan giua glucose man vai miic loc cau than uac doan bang cong thiic Cockcroft-Gault a benh nhan DTD typ 2 moi phat hien.
2. Tim moi tuong quan giiia HbA 1C vai MLCT 6 benh nhan DTD typ 2 mai phat hien
2. DO! TUOfNG VA PHUONG PHAP 2.L Doi tirong nghiSn cihi
Nghien ciiu dugc thuc hien tai BV Nhan dan 115 voi 91 truang hgp DTD typ 2 moi phat hien.
+ Chin doan DTD theo tieu chuSn ADA 2010 + Dong y tham gia nghign ciiu
- Tieu chuan loai trir;
+ Benh nhan da dugc chan doan DTD truoc do.
+ Bgnh than khong do DTD.
+ Benh nhan khong hpp tac nghign ciiu.
2.2. Phirtfng phap nghien cihi
- Thiet kg nghien cim: tien ciru, mo ta cat ngang
- Ghi nhan cac chi so nhan trac: Tuoi; gioi tinh; can nang; thoi gian bi benh;
- Tat ca cac xet nghigm BUN, creatinin huygt thanh, glucose mau, HbA 1C, dugc thuc hien tai phong xet nghiem BV Nhan dan 115 theo quy trinh da dugc chuan hoa theo quy dinh cua Bo Y tg. Cac doi tugng dugc dan nhin an 12 gio, khong an sang vao hom xet nghiem. 6 gia 30 phiit lay 2 ml mau, Dinh lugng glucose mau tinh mach huyet tuong liic doi (sang) theo phuang phap glucosesidase.
Dinh lugng HbAIC theo phuang phap dien di Dinh lugng creatinin mau: cac mau thir thuc hien bang phuong phap dpng hoc Jaffe. Tinh do thanh Ipc creatinin uoc doan tir cong thiic Cockcroft- Gault:
MLCT= (140 - tuoi) x can nang (kg) 72 X creatinin huyet thanh (mg/dL)
(Neu la nir: x 0,85) 2.3. Phan tich so lieu
So lieu thu dugc xir ly theo cac thuat toan thuang dung trong thong ke y sinh hoc sir dung phan mem SPSS 22.0 (2013)
Xac dinh gia tri trung binh cua cac chi so (SD): tuoi, duang mau, HbAIC, creatinin huyet thanh; miic loc cau than uac tinh.
- Tim he so tuong quan (HSTQ) giira miic loc cau than VOI glucose mau va HbAIC. (Tim he so tuong quan khi so sanh 2 bign so lign tuc: He so tuang quan Pearson, ngu bien so c6 phan phoi binh thuang va he so tuong quan Spearman ngu bign so c6 phan phoi khong binh thuang).
3. KET QUA N G H I £ N CUtJ
- Tuoi trung binh 57,45 ± 13,24 (nam), nam 45/91 chilm 49,50%;nir 46/91 chiem 50,50%.
Bang 1. Gia tri creatinin, glucose mau, HbAlcvd MLCT luc m&i chdn doan cua BTNC
Bang 2. Phan do benh than mgn theo KDIGO 2012.
Xet nghiem Creatinin (mg/dL) Glucose mau (mg/dL) HbAlc (%) MLCT (ml/phut)
X 0,96 248,5 11,0 73,43
SD 0,45 120,7
3,2 28,11 Nhan xet: Gia tri trung binh ciia glucose mau va HbAlc cua nhom nghign ciiu tang cao. Trong khi do MLCT lai giam.
ml/phut/l,73m^
Do 1 (> 90) Do 2 (60-89) Do 3a (45-59) Do 3b (30-44) Do 4 (15-29)
ConR
n 29 37 14 5 6 91
%
31,9 40,7 15,4 5,5 6,6 100 Nh|n xet: Ty le benh than man do 2 tra len chigm 72,6%. Khong c6 dp 5.
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NGHIEN CUU KHOA HOC
Bang 3. HSTQgiira MLCT v&iglucose man va HbAIC
Chi so Glucose mau
HbA,c
MLCT r -0,243 -0,391
P 0,051
0,0
Nhan xet: Co moi tuong quan tuyen tinh nghich miic dp vira giua MLCT va HbAIC CO y nghia thong ke voi i^-0,39I; p<0,OOL Khong CO moi tuang quan giiia MLCT va glucose mau, voi r=-0,243; p>0,05.
Bieu do 1:
Moi tu-ffng quan giira MLCT vd glucose mau. Moi tu-ffng quan giira MLCT vd HbAlc.
4. BAN LUAN
Trong nghien ciiu cua chiing toi kgt qua cho thay: Tu6i trung binh cua nhom nghien ciiu la 57,45 ± 13,24 (nam);
nam 45/91 chigm 49,50%; nir 46/91 chigm 50,50%.
Ket qua nghien ctru bang I cho thdy gia tri trung binh liic mai chan doan ciia creatinin 0,96 ± 0,45 (mg/
dL), glucose mau 248,5 ± 120,7 (mg/dL), HbAlc 11,0
± 3,2 (%) va MLCT 73,43± 28,11 (ml/phiit). Duang mau cao nhat liic dugc chin doan la 725 mg/dL va HbAlc la 18%, creatinin 4,0 mg/dL va MLCT thSp nhat la 15,79 ml/phiit digu nay chiing to r§ng BN da c6 thai gian bi benh tir kha lau ma khong dugc phat hien.
Ton thuang than am tham dien ra trong thai gian dai khong CO trigu chirng lam sang, dgn khi phat hien thi benh da chuygn a nhirng giai doan nang han.
Phan loai benh than man theo KDIGO (2012) khi CO DTD mac dii chua c6 t6n thuong thuc thg thi v§n phan loai la benh than man do 1. C) cac benh nhan nghien ciiu chiing toi ghi nhan ty Ig bgnh than man
dp 2 ehigm cao nhdt vai 40,7%; c6 6,6% benh nhanbj bgnh than man dp 4.
Ket qua khao sat moi tuang quan giira duang mau, HbAlc voi miic loc cau than o cac benh nhan nghien ciiu chung toi nhan thdy:
Nhieu nghign ciiu ve m6i tuang quan giira miic Igc cau than va duang man a nhirng nguai binh thtrong cung chi ra rang: giira miic loc cSu than va duang mau CO moi tuang quan vai nhau (tuygn tinh nghich), c6 y nghia thong kg, CJ cac benh nhan nghign ciiu chimg toi nhan thay giua miic loc c4u than va duang mau khong CO moi tuang quan vai nhau (p>0,05). Nhu vay, khi duong mau a giai han binh thuong, duang mau c6 mfii tuang quan vai miic Igc c§u than, nhung khi duang mau tang (roi loan dung nap glucose, dai thao duang), moi tuang quan nay khong con nira.
Giiia mire loc ciiu than va HbAlc c6 m6i tuong quan tuyen tinh nghich, miic do vua c6 y nghia thong ke (r=-0,391; p<0,doi). Dieu nay cho thdy, HbAlc
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a gioi han binh thuang hay tang deu c6 moi tuang quan vai miic loc cau than, hay danh gia miic dp kigm soat duong mau thi HbAlc t6t han, xac dinh dugc hemoglobin glycosylat hoa truac do vai thang. Nghien ciiu ciia chimg toi cung c6 digm tuang dong vai Le Thanh Ha ,ti le suy than va HbAlc c6 sy khac biet c6 y nghTa thong ke (p=0,032), nhom kiem soat duong mau kem CO ti le suy than tang gap 3 lan so vai kigm soat duong mau vira va t6t[2].
Nghign Ciiu trong 4 nam ve diln tien tu nhign ciia bgnh than o ngudi da do bo tgc Pima c6 roi loan dung nap glucose, hoac DTD typ 2 c6 thai gian mac benh va tigu dam dai the khac nhau cua Nelson va cong su, da cho thay nhiing phat hien moi quan trong nhu su tang tuoi man can than keo dai a benh nhan c6 tieu dam binh thuang va tieu dam vi the, sir bao ton miic loc cau than a bgnh nhan c6 tigu dam binh thuang va tieu dam VI the, toe dg giam phan suat sign loc cau than va miic loc cau than (khoang llml/phiit/nam) 6 benh nhan c6 tieu dam dai the[6]. Mot nghign ciru gan day ciia Vandana cho thay trong dan so chung, tang duang mau ma khong DTD c6 the lien quan dgn tang nguy ca tii vong. Tang duang mau thuang gap trong bgnh than m^n, tuy nhien moi lign he giira dau hieu tang duong mau man tinh la glycosylated hemoglobin va hau qua cua no thi chua dugc nghign ciiu. HbAlc dugc xem nhu la dau hieu chi diem moi nguyen nhan tir vong, c6 lign quan den viec lam tang ti le tii vong a benh nhan
bgnh than man tinh[5]. Trong nghign ciru ciia chimg toi cac benh nhan mai dugc chan doan DTD lan dau vi thg dgu CO duong mau va HbAlc tang, mot so benh nhan den vai giai doan sam khi do loc cau than binh thuang (cao nhat la 125,6ml/phiit), nhung phan lan benh nhan den khi do loc cau than da giam (thap nhat la'l 5,74 ml/phut).
Viec phat hien suy than giai doan som trong benh ly than do dai thao duong gop phan dang kg giiip ngan chan tign trien den suy than giai doan cuoi mot each CO hieu qua. Do vay, danh gia miic loc cau than la viec lam ngay tu khi c6 dau hieu roi loan dung nap glucose hay dai thao duang dgn digu tri lan dau.
5. KETLUAN
Qua nghign ciiu moi tuang quan giiia mire igc cau than vdi duongmau va HbAlc a 91 benh nhan DTD typ 2 mai dugc phat hien, buac dau chimg toi riit ra mot so ket luan sau:
- Khong CO moi tuong quan giiia mire loc cau than va duang mau, o nhiing benh nhan DTD typ 2 mai dugc phat hien (p>0,05).
- Co moi tuong quan tuyen tinh nghich miic do viia, giira miic loc cau than va HbAlc c6 y nghia thong ke (r=-0,39I;p<0,001).'
Nhu vay, HbAlc la mot chi so dang quan tam danh gia sam mire loc cau than trong cac truong hgp duang mau tang.
TAI LIEU THAM KHAO
1. Tr4n Van Hai, Biln chimg man tren benh nhan DTD typ 2 liic moi chan doan, Luan van bac si chuygn khoa cap 2, 2009. HVQY
2. Lg Thanh Ha, Mpt so nhan xet benh than do dai thao duang tip 2 6 nguai c6 tuoi, Luan van tot nghiep bac sy chuyen khoa 2 chuyen nganh Lao khoa, 2004, DHYD TP H6 Chi Minh.
3. Nguygn Thy Khue, Benh than man do dai thao duang, Bai giang sau dai hpc, 2012, DHYD TP Ho Chi Minh.
4. K/DOQL,Clinical Practical Guidelines and Clinical Practical Recommendations for Diabetes and Chronic Kidney Disease, 2007,Am J Kid Dis, Vol 49 (2) supple 2.
5. Menon V., GreeneT, PereiraA.A, WangX., Beck G.J., Glycosylated Hemoglobin and Mortality in Patients with Non diabetic Chronic Kidney Diaease, Jam Soc Nephron, 2005, 16, p 3411-3417
6. ParvinhH.H., "Initiation and Progression ofDiabetic Nephrology", The New England JMed, 1996, 335: pl683-1683.
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