15.Bs Thuy Lan-tang Dh Cuong Giap

8/6/2019 15.Bs Thuy Lan-tang Dh Cuong Giap

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TNG NG HUYT BNH NHN CNG GIP

Trng Th Thy Lan1, Nguyn Thy Khu2

HYPERGLYCEMIA IN HYPERTHYROIDPATIENTS

Trng Th Thy Lan1, Nguyn Thy Khu2

SUMMARY

OBJECTIVES: to determine the frequency of

diabetes mellitus (DM) and impaired fasting glucose in hyperthyroid patients and relatedfactors.

METHODS: cross-sectional study. 642 patientswere recruited from MEDIC medical diagnosticcenter from September 2003 to March 2004.Venous blood sample was obtained after anovernight fasting (about 8-10 hours) duringhyperthyroid period and euthyroid state, and thediagnostic criteria of WHO (1998) was used.

RESULTS: The frequency of IFG was 29.9%,diabetes mellitus was 7.6%, in this group: 1.1% hadbeen diagnosed DM before, 3.7% were diagnosedat the same time of hyperthyroid status and 2.8%were diagnosed after hyperthyroid status hadresolved. 48 of 49 patients (98%) were > 31 yearsold, 37 patients (75.5%) were treated with oralhypoglycemic agents. There were relationshipsbetween diabetes and age, the sex and obesity.

CONCLUSION: In hyperthyroid patients, the prevalence of IFG and diabetes mellitus were29.9% and 7.6% respectively, nearly double the

prevalence of DM in the community. We suggestedthat we should screen for diabetes in hyperthyroid

subjects, especially people aged 31 years old andover.

TM TT

TNG NG HUYT BNHNHN CNG GIP

MC TIU NGHIN CU: Xc nh t li tho ng v ri lon ng huyttng lc i bnh nhn cng gip(CG) v cc yu t lin quan.

PHNG PHP NGHIN CU: nghincu ct ngang, i tng nghin cu gm642 bnh nhn ang iu tr CG ti Trungtm chn on y khoa MEDIC t 9/2004n 3/2004. ng huyt c o trong

giai on cng gip v trong giai onbnh gip vi mu tnh mch vo lc sng,sau khi nhn i 8 gi. Chn on i thong theo tiu ch ca WHO (1998).

KT QU: T l ri lon ng huyttng lc i l 29,9%, i tho ng l7,6%. Trong s bnh nhn i tho ng,c 1,1% bnh nhn bit i tho ngt trc, 3,7% bnh nhn c pht hini tho ng trong giai on CG v2,8% bnh nhn c pht hin i tho

ng sau giai on CG. Trong 49 bnhnhn i tho ng, c 48 bnh nhn(98%) t 31 tui tr ln,37 bnh nhn -chim t l 75,5%- ang iu tr bngthuc vin h ng huyt v tt c iup ng vi thuc. C s lin quan giabnh i tho ng vi tui v tnh trngbo ph.

KT LUN: nhm bnh nhn CG, t lri lon ng huyt tng lc i l29,9% v t l i tho ng l 7,6%.Chng ti ngh cn tm sot bnh itho ng bnh nhn CG, c bit cc i tng t 31 tui tr ln.

AT VAN E:

Cng giap (CG) la mot benh ly noi tiet rat thng gap.Trong so cac benh nhan b benh ly tuyen giap phai nhapvien, CG chiem a so cac trng hp. Hormon tuyen giap lamtang hoat ong chuyen hoa cua toan bo te bao cua cac moc the, anh hng tren chuyen hoa lipid, protid, glucid. Tren

1Bnh vin a khoa trung tm An Giang2B mn Ni tit i hc Y Dc TP H Ch Minh

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benh nhan CG, hormon giap gay roi loan kiem soat nghuyet co the thuc ay ai thao ng (T) tiem an bocphat thanh T co trieu chng.(4)(8) Roi loan ng huyet khioi (RLH) la mot roi loan xuat hien trc benh T (thngla T tp 2), va co mot y ngha quan trong trong viec theo doi

va tien lng benh. Nguy c bien chng tim mach tren ngi coRLH cung cao hn ngi bnh thng.(6) Va neu ap dung cacbien phap phong nga khong dung thuoc nh tiet che hoacluyen tap the lc ung cach, ngi ta co the giam c ty ledien tien t RLH en T.(27)

S khac biet ve TSLH T gia nhom benh nhan CG vacong ong c ghi nhan cac quoc gia nh Nhat ban nam1992 (7,6% vs 3,9%, lan lt)(22) va nam 2002 (8,7% vs 2,3%-8,1%,lan lt).(24)(26)(28)(29)Tai Viet Nam cha co cong trnh rieng naonghien cu ve tnh trang tang ng huyet benh nhan CG

nen khong ro TSLH T nhom benh nhan nay la bao nhieu.Xuat phat t thc tien tren, chung toi tien hanh e tai

Tang ng huyet benh nhan cng giap" vi nhng muctieu cu the nh sau:

- Xac nh TSLH benh T va RLH benh nhan CG.

- Xac nh moi tng quan gia T vi mot so yeu to lienquan nh tuoi, gii, tnh trang beo ph (BP).

OI TNG VA PHNG PHAP NGHIEN CU:

Bang phng phap nghien cu cat ngang, mo ta va phantch vi ky thuat chon mau lien tiep cac benh nhan co chanoan CG c ieu tr tai phong kham noi tiet cua trung tamchan oan Y khoa Hoa Hao t thang 9/2003 en thang 3/2004.C mau can thiet cho nghien cu c tnh theo cong thc:

n = Z 21- / 2 p (1 p ) : d2 vi = 0,05 ( sai lam loai 1) p:50%

Do cha tm thay chnh xac ty le tang ng huyet benhnhan CG tai thanh pho HCM nen e c mau u ln, chung toilay p = 50% va can phai tm chnh xac ty le nay.

Khong a vao nghien cu cac oi tng nh: benh nhana c ieu tr on nh tnh trang CG, hoac ang dung thuocanh hng en ket qua H nh: glucocorticoid, thiazide, chen ,phenyltoin, acid nicotinic, diazoxid, interferon , thuoc nga thai cooestrogen.

Xet nghiem ng huyet c tien hanh vao hai thiiem: luc khi phat CG va giai oan CG on nh va ang cieu tr duy tr. Mau benh pham la mau tnh mach c lay vaoluc sang sm sau khi nhn oi 8 gi, ng huyet tnh machc o bang phng phap glucose oxidase. Chan oan benh da

vao tieu ch chan oan cua WHO (1998). Co benh khi nghuyet tng khi oi cua hai lan th cach nhau 1 ngay eu > 7

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mmol/L. RLH khi ng huyet tng khi oi > 6,1 mmol/L va < 7mmol/L. Chan oan BP khi BMI > 25 kg/m2 (tieu chuan cua WHOnam 2000 ap dung cho ngi chau A). BP vung bung c chanoan khi ty le vong eo / vong hong (VE/VH) > 0,95 nam va0,85 n (tieu chuan chau Au) hoac khi chu vi vong eo (VE) >

90 cm nam va 80 cm n (tieu chuan chau A).Cac d lieu can thu thap gom cac bien so oc lap gom:

tuoi, gii, chieu cao, can nang, vong eo, vong hong c ghinhan bi ngi nghien cu va bien so phu thuoc la tr song huyet tng c thc hien bi phong xet nghiem cuatrung tam chan oan Y khoa MEDIC. Cac d lieu c nhap vax ly bang phan mem Epi-info 2002. Phep kiem 2 mc yngha p < 0,05 c s dung e xac nh moi lien quan giacac bien so.

KET QUA: Co 642 benh nhan CG c a vao nghien cu.

ac iem lam sang cua oi tng nghien cu:

So oi tng c nghien cu gom 90 nam (14%) va 552 n(86%), ty le nam / n la 1/6,1

Bang 1: Cac tham so ac trng cua mau nghien cu (n=642)

Bienso

n Trungbnh

LC Toithieu

Toi a p gii

Tuoi

- Nam

- N

642 43,7 12,1 18 77 ns

90 43,2 11,3 18 74

552 43,8 12,2 18 77

BMI

- Nam

- N

550 21,5 3,1 12,6 36,0 p=0,013

83 22,3 3,0 15,4 29,7

467 21,4 3,1 12,6 36,0

Eo/hong

- Nam

- N

596 0,81 0,07 0,57 1,14 p=0,000

86 0,86 0,07 0,69 1,02

510 0,80 0,07 0,57 1,14

Eo

- Nam

- N

596 73,1 9,0 54 104 p=0,000

86 79,3 9,9 60 102

510 72,1 8,4 54 104

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H oi

- Nam

- N

642 6,1 1,9 4,0 30,2 ns

90 6,3 2,2 4,2 20,1

552 6,1 1,9 4,0 30,2

Tan suat lu hanh RLH va T:

Bang 2: TSLH T va RLH (n=642)

Nhom benhnhan

Nam N Chung

N % n % n %

H bnhthng

51 56,7 350 63,4 401 62,5

RLH 29 32,2 163 29,5 192 29,9

T

- a biet

- C* cung CG

- C* sau CG

10

1

3

6

11,1

1,1

3,3

6,7

39

6

21

12

7,1

1,1

3,8

2,2

49

7

24

18

7,6

1,1

3,7

2,8

Cong 90 100,0 552 100,0 642 100,0

* C: Chan oan

ac iem dan so mac benh T

Bang 3: Ty le hien mac T va ty le BP trong nhombenh nhan T (n=49)

Nam N Chung 2

test, pgii

TS/n* % TS/n* % TS/n* %

ai thao ng 10/90 11,1 39/552

7,1 49/642

7,6 ns

BMI (chau A) 2/9 22,2 10/39 25,6 12/48 25,0 nsBMI (chau Au) 0/9 0,0 5/39 12,8 5/48 10,4 ns

VE/VH** 1/10 10,0 17/38 44,7 18/48 37,5 0,95 nam va 0,85 n

Tuoi mac benh trung bnh la 52,9+ 12,2, toi thieu la 25, toia la 76: nam 49,3 + 8, n la 53,8 + 13, s khac biet khong co y

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ngha thong ke (p = 0,3). Gia o tuoi va benh co quan hechat che (p0,05). Ty le BP vung bung theo tieu chuan VE/VH n cao

hn nam, s khac biet nay co y ngha thong ke (p


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TSLH T tren nhom benh nhan BP cao hn nhom khong BP,s khac biet nay co y ngha thong ke (p


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mot khoang thi gian can thiet, u co nhng bien oi vemat kinh te, xa hoi va moi trng anh hng en TSLH benh.Va khi so sanh vi nghien cu mi ay tai thanh pho LongXuyen nam 2001 (TSLH 4%)(5) va tai thanh pho Ho Ch Minh nam2001 (TSLH 3,8%)(12) th TSLH trong nghien cu cua chung toi

cung cao hn ang ke.

S khac biet ve TSLH T gia nhom benh nhan CG vacong ong con c ghi nhan cac quoc gia khac. Tai NhatBan nam 1992, TSLH T benh nhan CG la 7,6% (n=647) caogan gap oi so vi cong ong Nhat luc bay gi la 3,9%(n=9133).(22) Tai Bangladesh nam 2002, TSLH T tren nhom benhnhan CG (gom Basedow va bu giap a nhan hoa oc) la 8,7%(n=65) va nhom benh nhan Basedow ty le nay la 11% (n=45)(24) cao hn han khi so sanh vi TSLH T trong cong ongBangladesh (2,3%-8,1%).(26)(28)(29) ieu nay cho thay rang tren

nhom benh nhan CG, tha hormone giap la yeu to quan tronganh hng len viec ieu hoa ng huyet.

Tuoi

Tuoi mac benh trung bnh nhom benh nhan CG la 52,9,TSLH o tuoi di 40 la 2,9% va tren 40 la 10,4%, s khacbiet nay co y ngha thong ke (p


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lu hanh T trong moi nhom tuoi cua nghien cu cua chungtoi eu cao hn.(5) ieu nay cang chng to rang tha hormonetuyen giap anh hng len s chuyen hoa ng huyet benh nhan CG tren moi la tuoi.

Khi phan tch nhom ngi mac benh t 18 39 tuoi (gom7 ngi) chung toi nhan thay so benh nhan tap trung ongnhat o tuoi 33 (2/7 ngi), so con lai rai rac mot ngi cac o tuoi t 25 en 37. V the ty le benh nhan T t 31tuoi tr len chiem a so (98%). Ngoai ra TSLH benh tuoi di31 la 1,2% (1/85), con o tuoi t 31 tr len, TSLH nay la8,6% (48/557), ong thi t so chenh lech cao (OR=7,9 vikhoang tin cay 95% la 1,158,2 (p=0,02). So vi nghien cu congong gan ay (OR=3,3 gia hai nhom tuoi tren va di 40(p


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Trong nghien cu nay khi s dung 3 ch so tren e anhgia mc o BP tren cac oi tng ang ieu tr tnh trang CG coH bnh thng, RLH va T, chung toi nhan thay:

* Gia tr trung bnh cua cac ch so tang dan theo cac oitng co H bnh thng, RLH va T. S khac biet nay euco y ngha thong ke (p


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T nhng ket qua tren, chung toi co mot vai iem engh bo sung trong viec theo doi ng huyet benh nhan CGnh sau:

- Nen theo doi ng huyet luc oi nh ky v de thchien, tnh trang CG gay roi loan ng huyet luc oi vi ty lerat cao va ay chnh la yeu to tien oan cho T trong tng lai.

- Nen tap trung vao cac benh nhan CG t 31 tuoi tr len(theo WHO ap dung cho cong ong la 45)

TAI LIEU THAM KHAO

1. L Huy Liu: i tho ng- Bch khoa th bnh hc tp 3. Nh xut bn T in Bch khoa H Ni.2000:146-156

2. Mai Th Trch: Nhn xt v mt vi thay i lm sng v nghin cu trong bnh i tho ng ncta trong vng 30 nm qua. Y hc Tp HCM. Chuyn ni tit. 1997;2:4-10

3. Mai Th Trch, ng Th Bo Ton, Dip Th Thanh Bnh v cs. Dch t hc v iu tra c bn v bnhi tho ng ni thnh Tp HCM. Y hc Tp HCM. 2001;5(4):24-27

4. Phm nh Lu. Chuyn ha glucid, Sinh l h ni tit Sinh l hc Y khoa, Trng i hc Y Dcthnh ph H Ch Minh. 2000:12-99

5. Phm inh Tun. Kho st t l i tho ng trong cng ng dn c thnh ph Long Xuyn, tnh AnGiang. Y hc Tp H Ch Minh. 2003:7(1):14-19

6. Beatriz DAgord Schaan, Erno Harzheime Isue Gus. Cardiac risk profile in diabetes mellitus and Impairedfasting glucose. Rev. Sude. Pblica. 2004;38(4):1-7 http://www.scielo.br/pdf/rsp/v38n4/en (accessed 19October 2004)

7. Bennett PH. Epidemiology of diabetes mellitus. In: Rifkin H, Porte D. Diabetes Mellitus : theory andpractice, 4 th edition. Elsevier. 1990:357-377

8. Bullock J, Boyle J, Wang MB. Thyroid gland. In: Bullock J, Boyle J, Wang MB. Physiology - NationalMedical series for independent study, 3rd edition. 1995:527-532

9. Chan JCN. Heterogeneity of diabetes mellitus in the Hong Kong Chinese population. The Chinese Universityof Hong KongPrince of Wales Hospital Diabetes Research and Care Group. HKMJ 2000;6:77-84

10. Chou P, Li C, Tsai S. Epidemiology of type 2 diabetes in Taiwan. Diabetes Research and Clinical Practice.

2001;54(1):529-535

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http://www.scielo.br/pdf/rsp/v38n4/enhttp://www.scielo.br/pdf/rsp/v38n4/enhttp://www.scielo.br/pdf/rsp/v38n4/enhttp://www.scielo.br/pdf/rsp/v38n4/en

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15.Bs Thuy Lan-tang Dh Cuong Giap