9 beo phi nhi ths Chi

8/6/2019 9 beo phi nhi ths Chi

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C IM LM SNG CA TR THA CN V BO PH

Nguyn Th Dim ChiKhoa Nhi Bnh Vin Trung ng Hu

Clinical chararistics of children withoverweight and obesityObjective: evaluate the clinical chararistics ofchildren with overweight and obesityMethods: 45 overweight and obesity chilrenaged 6 - 15 years are diagnosed byanthropometric measurements, and their clinicalcharacteristics of overweight and obesity areevaluated.Results: The mean waist circumplex (wc) inchildren with dyslipidemia was 73.31 8cm, mean whr was 0.94 0.04, there is nodifference in wc andwhr between the groupswith and without dyslipidemia.the height in group with dyslipidemia lowerthan group without dyslipidemia (p


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Minh, H Ni v Hi Phng t l bo ph hc sinh xp x 10% . Ti Hu, theo NguynTh Li, t l tha cn hai trng tiu hc l 2,2% , theo Phm Vn Dng l 7,6%.

Vic pht hin sm tr tha cn -bo ph c th gip t vn ch n thch hp v hotng th lc nhm d phng sm hn nhng hu qu do tha cn - bo ph gy ra.Mc tiu ti : Kho st mt s c im lm sng ca cc tr tha cn-bo ph t 6 n 15

tui c ri lon lipid mu.

II. I TNG V PHNG PHP NGHIN CU

1. i tng nghin cu- 45 tr tha cn - bo ph t 6 -15 tui c giy mi n khm v t vn ti phng Ni

tit, khoa Nhi, Bnh vin Trung ng Hu cu Trung tm Y t Hc ng thnh ph Hu- Thi gian nghin cu: 05/2003 - 05/2004

2. Phng php nghin cuPhng php nghin cu ct ngang m t phn tch lm sng - cn lm sng bao gm:

hi bnh s, thm khm cc du hiu lm sng v lm xt nghim.

2.1. Tiu chun chn bnh nhn

+ Tr tha cn - bo ph:* Tiu chun chn on tha cn - bo ph:nh gi tha cn : CN/CC >+2SD so vi NCHS vi tr 9 tui ( xin tham kho ph lc 5 - 8).Phn loi tha cn theo WHO .i vi tr +2 SD n +3SD : tha cn I+ CN/CC>+3SD n +4SD : tha cn II+ CN/CC>+4SD : tha cn III

i vi tr >9 tui : BMI = cn nng (kg)/ chiu cao2 (m)+ BMI>85th Percentile n 90th Percentile : tha cn I+ BMI>90th Percentile : tha cn II

nh gi bo ph :Khi tr c tha cn v c BDNGD c tam u v c sau vai(90thPercentile).

+ Tin s sn khoa bnh thng, khng c cc d tt bm sinh+ Pht trin tinh thn, vn ng bnh thng+ Khng c tin s dng thuc: Corticoid, Depakine hoc cc thuc c th lm thay

i lipid mu.2.2.Tiu chun loi tr

Tr ang s dng cc loi thuc lm nh hng lipid mu, hoc mc cc bnh: hichng thn h, hen, bnh tim mch...

2. 3. Tham s nghin cu

+ Tui: Cch tnh tui thc hin theo cch tnh ca T chc y t th gii.

+ Cn nng: o bng dng c cn bn Trung Quc c hiu chnh trc khi s dng

v kim tra li sau khi o 20 ngi. t cn v tr n nh. i tng ci b o qun ngoich mc o qun mng, khng i dp guc, khng i m v cm vt, ng nh nhng ln


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ngay gia cn, khi kim ng h bo trng lng hon ton ng yn mi c kt qu. Ktqu c ghi bng kilgram v sai s khng qu 100g.

+ Chiu cao ng: o chiu cao bng dng c o l thc g, ly mu thc dy TrungQuc hoc thc o chiu cao gn lin vi cn. i tng ng thng vi t th thoi mi, hai chnchm li hnh ch V, mt nhn thng, bo m 4 im trn c th chm vo thc o : vng chm,

xng b vai, mng, gt chn. Ngi o ko ke gn sn trn thc o ln cho qu u, h xungn chm nh u. Kt qu tnh bng n v mt (m) v sai s khng qu 0,5 cm.

+ o lp m di da: Ngi ta thng chn ni o nhng ch c nhiu m nht nhmt sau cnh tay, gc di xng vai. S dng compa o np gp da HARPENDEN skinfoldcaliper do Anh sn xut, hai u compa l hai mt phng, tit din 1 cm2, m bo khi compa kpvo da bao gi cng c mt p lc khng i khong 10-20 g/mm 2 vi khong chia 0,2 mmnhng c th c chnh xc ti 0,1mm. o ti 2 v tr: c tam u v gc di xng b vai.

Ch o hay dng nht mt sau cnh tay gi l np gp da trn c tam u: o taytri, t th thng t nhin. Vo da mt im gia sau cnh tay cho st ti lp cn nng vo b dy ca lp da vo ln. Khi o, b mt ca compa song song vi trc cnh tay. im

o gc di xng vai, ngi o cn ln theo ct sng xc nh b xng vai v gc di. ngi bo, nn qut nh tay ra pha sau s xc nh d dng hn. Mi v tr o hai ln v lytr s trung bnh . Kch thc ny l mt ch tiu nh gi tnh trng pht trin ca c.

+ nh gi t s vng eo/vng mng: l ch s nh gi mc phn b t chc m dida v m trong bng. tr em v v thnh nin, phn b m trung tm c th c ghinhn c tng quan thun vi hin tng ni cn bng ng -Insulin bt thng [39]. Ch sny :N bnh thng


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nh gi kt qu: da vo bng tr s huyt p bnh thng cc la tui.


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Bng 2.1. Tr s huyt p bnh thng cc la tui

Tui theonm

Tm thutrung bnh

95 t l bch phn tr bnh thng

Tui theonm

Tm trngtrung bnh

95 t l bch phn tr bnh thng

6 nm 100 15 6 nm 56 87 nm 102 15 7 nm 56 88 nm 105 16 8 nm 57 99 nm 107 16 9 nm 57 910 nm 109 16 10 nm 58 1011 nm 111 17 11 nm 59 1012 nm 113 18 12 nm 59 1013 nm 115 19 13 nm 60 1014 nm 118 19 14 nm 61 1015 nm 121 19 15 nm 61 10

Nhng s huyt p vt qu 95 s bch phn c xem l THA.Nhng s huyt p nm gia 90-95 bch phn cn theo di, kim

tra .

2.2.4. Phng php x l s liuTt c s liu thu thp trn mu bnh n nghin cu c x l theo

phng php thng k y hc theo chng trnh Epi Info 6.0.

III. KT QU NGHIN CUQua nghin cu ri lon lipid mu 45 tr tha cn - bo ph t 6 n 15 tui ti mt s

trng tiu hc v trung hc c s ti thnh ph Hu, chng ti ghi nhn kt qu nghin cunh sau:

1. Phn b nhm tui theo giiBng 3.1. Phn b nhm tui theo gii

6- 0,05Nam 19 52,8% 17 47,2%N 8 88,9% 1 11,1%

Chung 27 60% 18 40%

3. Ch s khi c th (BMI)Bng 3.3. Ch s khi c th (BMI) trung bnh

Chung Nam (n = 36) N (n = 9) p


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BMI trung bnh 23,4 2,66 23,76 2,85 21,96 0,84 < 0,05

4. So snh c im ca cc tr tha cn - bo ph t 6 n 15 tui c v khng ri lon lipidmu

Nhm c RLLM

(n = 36)

Nhm khng RLLM

(n = 9) pChiu cao trung bnh 133.59 12.55 139.83 12.24 p< 0,05Cn nng trung bnh 40.93 2.66 44.82 10.15 p >0,05Huyt p tm thu TB 100.33 12.16 104.22 15.51 p >0,05

Huyt p tm trng TB 61.72 7.48 61.67 7.37 p >0,05CN/CC trung bnh 3.44 1.78 3.15 0.62 p >0,05

BMI trung bnh 23.53 2.87 23.06 2.21 p >0,05Vng eo trung bnh 73.31 8 76.67 9 p >0,05

Vng mng trung bnh 77.71 8.31 80.63 9.33 p>0,05VE/VM trung bnh 0.94 0.04 0.95 0.06 p >0,05

Nhn xt: Chiu cao trung bnh ca nhm c ri lon lipid mu nh hn ca nhmkhng c ri lon lipid mu ( p 0,05

Ng ngy 6 16,6% 2 22,2%OR= 0,7p>0,05

Bu tru 4 11,1% 2 22,2%OR= 0,44p>0,05

Rn da 5 13,8% 5 55,5%OR= 0,13p 0,05

Mi hai gi 1 2,7% 0 0% p>0,05au lng 4 11,1% 0 0% p>0,05


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au xng khp 3 8,3% 0 0% p>0,05

Acanthosis nigricans 4 11,1% 3 33,3%OR= 0,25

p>0,05IV. BN LUN

1. Phn b theo giiNhm nghin cu nam chim 80%, n chim 20%.

2. Phn b nhm tui theo giiLa tui 6-


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VE trung bnh ca nhm c RLLM l 73.31 8 cm, khng c s khc bit c nghathng k v VE trung bnh gia nhm RLLM v nhm khng RLLM.

VM trung bnh ca nhm c RLLM l 77.71 8.31, khng c s khc bit c ngha thng kv VM trung bnh gia nhm c RLLM v nhm khng RLLM.

VE/VM trung bnh ca nhm c RLLM l 0.94 0.04, khng c s khc bit c ngha

thng k v VE/VM trung bnh gia nhm c RLLM v nhm khng RLLM.Chiu cao trung bnh ca nhm c ri lon lipid mu nh hn ca nhm khng c ri lonlipid mu (p


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22,2%. T l rn da nhm c ri lon lipid mu cao hn nhm khng c ri lon lipid mu(p0,05).

Qua nghin cu cho thy khng c s khc bit v triu chng lm sng gia nhm cri lon lipid mu v nhm khng ri lon lipid mu do khng th da vo lm sng

chn on c tr tha cn, bo ph c ri lon lipid mu hay khng. chn on chcchn ri lon lipid mu phi lm bilan lipid mu.IV.KT LUN

* c im lm sng ca cc tr tha cn- bo ph t 6 n 15 tui.VE nhm c RLLM l 73.31 8 cm, khng c s khc bit c ngha thng k v VE

trung bnh gia nhm RLLM v nhm khng RLLM.VM nhm c RLLM l 77.71 8.31, khng c s khc bit c ngha thng k v VM trung

bnh gia nhm c RLLM v nhm khng RLLM.VE/VM nhm c RLLM l 0.94 0.04, khng c s khc bit c ngha thng k v

VE/VM trung bnh gia nhm c RLLM v nhm khng RLLM.Chiu cao nhm c RLLM nh hn ca nhm khng c RLLM (p


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predictors of adult disease", Pediatrics, (101), pp. 518 - 525.10. Flier Jeffrey S. and Foster Daniel W. (1998), "Obesity", Williams textbook of

Endocrinology, pp. 1074.

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9 beo phi nhi ths Chi