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H91 DONG KHOA H9C CUA T~P CHi

Trinh bay bia: Nguyen f)ang Tu

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TRVONG £)~I HOC V DV<;SCHUEHUE UNIVERSITY OF MEDICINE AND PHARMACY

, ,TAP CHI. -

Y Dildo 1100• •JOURNAL OF MEDICINE AND PHARMACY

So 142013

Hue, 4 - 2013

9 Nghien ClTUnong dQ lipid mau va tinh trang gan nhi~m mo' 0' tre thira can-bee phi tai 64-73khoa Nhi, Benh vien Trung irong HuSStudy on the blood lipid concentrations and hepatic steatosis in overweight-obesechildren aged 2-15 years at Pediatrics Department. Hue Central Hospital

Nguyen Thj C~r

Nghien cuu dQ thanh thai ure tLl~n, dQ thauh thai creatinin tuan 0' benh nhan SUY than 74-80man giai dean cu6i thfim phan phuc macThe relationship between weekly clearance of urea and creatinine in end-stage renaldisease patients treated with continuous ambulatory peritoneal dialysis

Hoang Vitit Tlujng

10

11 Nghien ciru thanh ph~11 hoa hoc phan dO<;l11n-hexane cua cay Bu de tia (Uvaria 81-86grandiflorai thu hai tai Quang TriConstituents of n-hexane fract ion extracted from Uvaria grandifiora collected fromQuang Tri province

t.e Thj Bich Hien, u Thj Hong O(lIIh, H6 Vi?t D1I'Cva Quoc Hung, Nguyin Thj Hoiti

................................................. __ __ -_ -..-..

12 Nghien clJ'L1gia tri tien luong ClW nong dQ hs-CRP, fibrinogen, bach cau, t6c de) 15ng 87-94mall a benh nhan tai bi6n mach mall nao giai doan capStudy 011 the prognosis value of hs-CRP. fibrinogen, white blood cell, bloodsedimentation rate in acute stroke patients

u Chuyen, U Thj Hang

13 Tlnr type cum A/H7N9: Kha nang gay benh va bien phap phong chong 95-100Subtype A/H7N9 influenza: Pathogenicity and preventive measures

Trdn Dinh Binh

14 Khao sat nurc d(> non nghen va ch~t luong song cua thai phu non do thai trong rura 101-109d~LIthai k)Severity and quality of life among pregnant women suffering nausea and vomitingduring the first half of pregnancy

Nguyin Thi Bich Ngoc, Nguyen Vii Quoc Huy

15 Danh gia h ieu qua di~u tr] dau vai gay bang cham ClI'U, xoa b6p va thuoc thang \10-117Evaluation of the effectiveness of acupuncture, massage and traditional medicineremedy in neck shoulder pain

Nguyin Thj Tim.................................................. - - - ' ,........ . .

16 Nghien ciru xac dinh kieu gene cagA va vacA cua Helicobacter pylori 0' benh nhan 118-125LIng tlnr da dayDetermination of Helicobacter pylori cagA gene and vacA genotypes in patients withgastric cancer

Ie Quy Hung. Hi! Thj Minh Thi

17 B6 tuc kien tlurc sau dai hoc: 126-132Cap nhat di~u tri hQi clurng ruot kich thichUpdate 011 the management of irritable bowel syndrome

Trdn Van Huy

18 Thong tin Y Duoc 133-134Nguyen Thi Anh Phuong

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NGHIEN cuu NONG DO LIPID MAu vA TiNH TRANGGAN NHIEM M6' (J TRE THlfA CAN-BEO PHi"

T~I KHOA NHI, BeNH VleN TRUNG U'O'NG HUE

Ngllyill Tlli c~B(J1/10/7 Nhi. Truong Dai h9C YDuoc Hili

Tom t~tD~t v~n d~: Beo phi tre em dang la v~n o~ sire khoe uu tien tlur 2 trong cong tac phong chong cac b~nhtai cac 11L1'6cchau A hien nay, 6 Viet Nam, beo phi 0' tre em tuy da OLl'Q'cbao dong nhung van chua c1trqcquan tam dung nurc boi gia dinh va nhan vien y t~, Cac cong trinh nghien ctru v~ beo phi va cac v~nd~

lien quan c1~n beo phi 0' ngLl'oi 16n tuong o6i nhi~u nhung cac nghien cuu v~ v~n o~ nay 6' tre em canIt. le te. C6 bang clurng cho thAy co m6i lien quan chat che giu'a beo phi voi roi loan lipid mau V3 gannhiern me 6' tre em rna chinh nlnrng r5i loan do lam anh huong o~n sire khoe, sir phat tri~n th.~111chilitinh mang cua tre em. Muc tieu cua o~ tai nhiim khao sat nong oQ lipid mau va tinh trang gan nhieml1lo6' tre b] thua can-bee phi. D6i tU'C;rng va phuo'ng phap nghicn ctru: Tre tlura can-bee phi (TC·- BP)tiI2 o~n 15 tu6i o~n kharn tai khoa nhi benh vien Trung Uong Hu~ trong tho'i gian khoang tir thang 5 niim20 II o~n thang 6 nam 2012. T6ng s6 benh nhan duoc chon la 40 tre. Phuong phap nghien ciru: m6 tadlt ngang. Tre trong nghien ciru se duoc lam xet nghiem Lipid mau va sieu am gan d~ danh gia tinh tr~nggan nhiem mo. K~t qua: C6 sir bien o6i v~ nong oQ 6' tAt ca cac chi s6 Lipid mau 0' tre TC-BP so \(1inhom chung, 37,5% tre co tang cholesterol mau; 50% tre tang triglycerid (TG), 25 % tre giam n6ngoQHDL-C mau; 17,5% tre TC - BP trong nghien cuu co tang nong oQ LDL-C mau. Tinh trang gan nhi~mmO' (GNM) chiern 40% tre TC-BP, Chu yeu la GNM oQ I (chiem 81,3%), Chi co I truong hop c6 tlnhtrang GNM oQ III (6,2%).TY I~ G M tang len dfin theo tuoi tuy nhien sir khac biet khong co y nghiathong ke (p>0.05), Tre beo phi trung tam co ty I~ G M cao hon beo phi ngoai vi nhung chira co y nghiathong ke. C6 S~I' lien quan nong oQ TG rnau va cholesterol mau va tinh trang gan nhiel11 mo. K~t lu~n:Nghien cuu cho thay co sir r6i loan nong oQ Lipid mau va tinh trang gan nhiern mo' o' tre TC-BP va com6i lien quan nong oQ TG mau va cholesterol mau voi tinh trang gan nhiem mO' a tre TC-BP,Tic kluia: thira can-bee phi, gan nhiem mo, r6i loan lipid rnau

AbstractSTUDY ON THE BLOOD LIPID CONCEl\TRATIONS AND HEPATIC STEATOSIS IN

OVERWEIGHT-OBESE CHILDREN AGED 2-15 YEARS AT PEDIATRICS DEPARTMENT,HUE CENTRAL HOSPITAL

Nguyen Thi(IIDept. of Pediatric. Hue University of Medicine and Pharmacy

Background: Nowadays, childhood obesity is the 2"d priority health issue in the prevention and controlof diseases in Asian countries, In Vietnam, obesity is alarming in children but not interested appropriatelyby the family and medical staff, Obesity and obesity-related conditions in adults are relatively studied

- Dia chi lien M: Nguyln Thi elf, email: binhcll@yahoo.com- NgiIy nhdn bai: .1513120/3 '"Ngily d6ng y dang: 114120/3"Ngay xud: ban: 3014120/3

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frequently, however, in children they are much fewer and rather sporadic. There is evidence of a closeassociation between obesity, dyslipidemia and hepatic steatosis in children; such disorders affect health,development and even lives of children. The aim of this study is to evaluate lipid profile and hepaticsteatosis in overweight/obese children. Subjects and Methods: Overweight/ obese children aged 2 to15 years who had a clinic visit at the Pediatric Department, Hue Central Hospital from May 20 II toJune 2012.40 children with eligibility criteria were included in the study. Method: descriptive cross-sectional. Lipid profi Ie and liver ultrasound in these children were done to evaluate the status of hepaticsteatosis. Results: There is a change in concentration of all lipid parameters in overweight/obese groupcompared to the control group. 37.5% of children with hypercholesterolemia; 50% of children withincreased blood triglyceride. 25% of children with low blood levels of HDL-C; 17.5% of children withelevated blood LDL-C level. 40% of children with hepatic steatosis, mainly steatosis grade I(81.3%),and only one case of hepatic steatosis grade III (6.2%). Fatty liver ratio increased gradually with agebut the difference was not statistically significant (p> 0.05). Central obese children showed a higherrate of fatty liver than peripheral obese children but there was no statistical significance. There is anassociation between blood levels of triglycerides, cholesterol and fatty liver. Conclusion: The studyshowed disturbances in blood lipid concentrations and fatty liver in overweight/obese children, and acorrelation between blood levels of triglyceride and cholesterol with fatty liver status.Key words: Overweight-obesity. hepatic steatosis. disturbances, blond lipids

I.D~IVANDtBeo phi tre em hien nay ail tro thanh vfin d~

sue khoe uu tien tlur 2 trong cong tac phong chongcac benh tai cac ruroc chau A va dang duoc xernnlur lit mQt thach thirc 16n d6i voi dinh dirong, sirekhoe cua th~ gioi th~ ky 21. 6 Viet Narn, beo phi o·treem tuy da OlfQ'C bao dong nhung v~n chua duoc

quan tam dung mire boi gia dinh va nhan vien y t~.

Cac cong trinh nghien ciru v~ beo phi va cac vfind~ lien quan d~n beo phi a nguoi lon urong d6inhi~linlurng cac nghien ciru v~ v~n d~ nay O·treem eon it, le te. Co bang chirng cho th~y co moilien quan chat che giira beo phi voi r6i loan lipidmallo' tre em ma ch inh nhlrng r6i loan 00 lam anhhuong d~n sire khoe, S~Tphat tri~n tham c.hi la tinhmang cua tre em r8 J.

M~lc-tieu:1. Khao sat nong at) lipid mau \'(7 nurc at) gall

nhimmif J tre tit 2 ddn 15 tu6i thira cdn - beo phi

tui Khoa Nhi BVTW Hui2. Tim hieu 1Il6i lien quail giira 111117 trang rJi

IV(1I1lipid mau. gOIl nhiilllll1ir va nurc {1c}thira can

-beo phi.

2.nOITU'QNG VA PHU'ONG PHAPNGHIEN

C(fU2,1. D6i nrong: Tre thira can-bee phi (IC -

Tap chi Y DU'(;)'c hoc - Truong D~i hoc Y Dune Hu~ - sf> I ~

BP) nr 2 d~n 15 tu6i d~n kharn tai khoa Nhi. benhvien Trung Hong Hu~ trong thoi gian khoang nrthang 5 narn 20 II d~n thang 6 nam 2012.

Tieu chuan chon tre vao d&i tlf9'ng nghien

ciru: Tre TC - BP don thu~n tir 2 d~n 15 tuoi.

Khong co benh Iy lam anh lurong d~n lipid mauva gan nhi~m mo.

Tieu chu~n ch~n doan TC - BP va phan mire

d() ciia TC - BP: D~Ta theo ph an loai cua WHOvoi quan the tharn chieu theo Chu~n tang tnrongcua WHO 2007 [12].

Chan dean dQ nang cua IC - BP:• 95th> BMI ~ 85th

: tlura can• 99th> BMI ~ 95th

: beo phi nnrc do.trung binh• BMI ~ 99th

: beo phi nangTieu chuan loai trir: Khi co it nhat mot trong

cac bi~u hien sau:- Nhirng tre co chi s6 BMI tang nhung do benh

Iy khac nhir hQi clurng than hu, xo gan c6 chuong,

hQi clurng Cushing ...- Nhirng benh nhan co benh gan b~m sinh. di

truyen, viern gan do vi khuan. vi rut.- Tre co r6i loan lipid rnau do dung thuoc truce

do: dong k inh, benh tim mach, thuoc ire ch~ mien.djch, cortisone ...

Tieu chu~n chon nhorn clnrng: Hi~n naychua co tai lieu nghien ciru nao v~ nong dQ Lipid

65

mall binh thuong o' tre em Viet Nam. Cac nghienciru cua cac tac gia trong mroc v~ r6i loan Lipidrnau a tre em phan nhi~u dua vao tieu cllll~n cuaNelson 2007. Vi vay, toi chon nhorn chung d~lam gia tri tham chi~u danh gia r6i loan Lipidmau. Nhung tre chon vao nhorn clurng se co dOtuoi, gioi tuong duong tre nhom TC-BP, co chis6 BMI trong gioi han binh thuong. Nhirng treducc chon vao nhorn chung la nhC'rng tre di~utri tai Khoa Nhi BVTW Hu~ vi benh s6t sieuvi, hoac tieu chay cap khong sir dung thuoc vakhong co nhirng benh kern khac anh huang d~nLipid mau, Xet nghiem Lipid mall khi tre khoibenh. Ty I~ chon beuh/chung: 111.

Tieu chuan danh gia r6i loan Lipid rnau:Dua vao ket qua Lipid mau cua nhom clnrng.

Tang Cholesterol toan phan, Triglycerid,Lipoprotein ty trong th~p (LOL-C) khi gia tri dodiroc cua nhung chi s6 nay o' nhom TC-BP lon hongia tri X + 2S0 cua nhom clnrng.

Giani Lipoprotein ty trong cao (HOL-C) khi

gia tri do duoc cua chi s6 nay a nhom TC-8P th§p11O'ngia trj X - 2S0' cua nhom clurng,

Tieu chufin danh gia beo ki~u trung tam:dira theo chi s6 vong eo/vong rnong (WHR) duocxac djnh khi WHR > 1 a tre nam va WHR > 0,85 atre nC'r.6 tre < 9 t1l6i thi chi s6 nay >1.1 [I]

2.2. Phuong phap nghien ciru: Nghien clrumo ta cat ngang.

- CIU!,l ciJ m/ill: chon vao nghien ciru t§t canhirng benh nhan TC - BP tir 2 d~n 15 tu6i vaokhoa nhi benh vien Trung Uong Hu~ trong khoangthai gian nr thang 5/20 I I d~n thang 6/2012 thoaman tieu chuan chon benh 6' tren, tong s6 benhnhan duoc chon 40 benh nhan.

- TIIlI ,"(ip 11l{1Il: Tre du tieu chuAn chon benhse duoc kharn lam sang. lam xet nghiem lipidmau va lam sieu am gan d~ danh gia tiuh tranggan nhi~m mo. Danh gia 'r6i loan lipid mau b~ngeach so sanh voi lipid mau cua nhorn clnmg. Danhgia I11Lrcdo gan nhiern m6' tren sieu am dira theoHagen - Ansert [3].

3. KET QUA3.1. Danh gia S\}' bi~n d&i lipid mau va tinh trang gan nhiern 010' 0' tre thira can-bee phi3.1.1. 51!' bid" iJiJiLipid nuiu

Bang 3.1. N6ng do trung binh cua cac chi s6 lipid mall theo gio!~

Loai Lipid Don vi Nam NCP p

Cholesterol toan phan (X"±SD) mmol/I 4,71 ± 0,85 3,93 ± 0,68 < 0,05

Triglycerid (X"±SD) mmol/I 2,63 ± 1,18 2,74 ± 1,62 > 0,05

Lipoprotein ty tronq cao (x±SD) mmol/I 1,18±O,31 1,14 ± 0,26 > 0,05

Lipoprotein ty tronq thap (X"±SD) mmol/I 2,43 ± 0,79 1,53 ± 0,53 < 0,05

Co sir khac biet co y nghia thong ke v~ nong dO trung binh Cholesterol toan phan va LOL-C theo giaio' tre TC-BP (p <0,05),

Khong co su khac bier co y nghla v~ nong do trung binh cac chi s6 Triglycerid, HOL-C mall a trebeo phi theo gioi (p>0,05),

Bang 3.2. Phan b6 nong do trung binh Cholesterol toan phan/rnau 6' tre TC - BP

va nhorn clnrng theo tu6i

N6ng dQ trung binh CT tre TC - BP N6ng dQ trung binh CT nhornTu6i ch(Pn~ p

n (x+SD) mmol/I n (x+SD) mmol/I<6 10 4,40 ±1,01 10 3,27 + 0,78 < 0,05

6 - 10 17 4,36 + 0,83 17 3,63 + 0,57 < 0,05>10-15 13 4,89 ± 0,79 13 3,98 + 0,63 < 0,01Chung 40 4,55 + 0,87 40 3,65 + 0,68 < 0,05

(

Co su tang mot each r6 ret nong dO cholesterol toan phan/mau o' tre TC-BP 0' t~t ca cac nhorn t1l6isovoi nhom clurng (p < 0,05)

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Bang 3.3. T~n suat tang cholesterol toan phan/mau a tre thira can-bee phi theo tuoi

;u6iTang Cholesterol toan phin

%p

n

< 6 (n = 10) 2 20,0

6 - 10 (n = 17) 7 41,2> 0,05

>10-15(n=13) 6 46,2

Chung (n = 40) 15 37,5

37,5% tre TC - BP trong nghien ciru co tang cholesterol rnau. Tre TC-BP hra tu6i ~ 6 tu6i co tY I~tang cholesterol cao hou tre < 6 tuoi.

Bang 3.4. Nong do trung binh Triglycerid mau cua nhorn TC - BP va nhorn clurng theo tu6i

N6ng dQ trung binh TG nhorn TC N6ng dQ trung binh TG nhom

Tu6i - BP ch(vng p

n (x±SD) mmol/l n (x±SD) mmol/I

<6 10 2,40 ± 1,53 10 1,38 ± 0,47 >0,05

6 -10 17 2,46 ± 1,27 17 1,46 ± 0,58 <0,01

>10-15 13 3,09 ± 0,98 13 1,78 ± 0,32 <0,01

Chung 40 2,66 ± 1,26 40 1,55 ± 0,50 <0,01

Nong c10 trung binh triglycerid o' nhom tre TC-BP cao hon co y nghTa so voi nhom clnrng.

6 tre < 6 tuoi: khong co sir khac biet nong dO trung binh Triglycerid a nhorn chirng va nhom TC-BP

Bang 3.5. T~n suat tang triglycerid mau a tre thira can - beo phi theo tu6i

Tu6iTang Triglycerid rnau

pn %

< 6 (n = 10) 4 40,0

6 - 10 (n = 17) -5 29,4 < 0,05

>10-15(n=13) 11 84,6

Tong (n = 40) 20 50,0

50% tre TC-BP trong nghien ciru co tang Triglycerid. Ty l~ tang TG cao nh~t la nhorn tuoi > J 0- J 5(84,6%). Co str khac biet v~ t~n suat tang TG' theo hra tuoi o' tre beo phi (p<0,05).

Bang 3.6. Nong do trung binh HDL-C mau cua nhom TC - BP va nhom clurng theo tu6i

N6ng dQ HDL-C nhom TC - BP N6ng dQ HDL-C nhorn ch(vngTuOi p

n (x±SD) mmol/I n (x±SD) mmol/I

<6 10 1,15 ± 0,34 10 1,29 ± 0,24 >0,05

6 -10 17 1,17±O,19 17 1,45 ± 0,23 <0,01

>10-15 - 13 1,20 ± 0,37 13 1,57 ± 0,23 <0,05

Chung 40 1,18 ± 0,29 40 1,44 ± 0,23 <0,01

C6 su khac biet co y nghia thong ke nong dO HDL-CT a tre TC-BP so voi nhom clnrng (p<O.O J).

6 tre < 6 tu6i, khong co sir khac bier v~ nong do trung binh cua HDL-C gifra nhorn TC-BP vanhom chirng.

Tapchi Y Dune hoc - Truong D~i hoc Y OU'Q:c Hu~ - sa I~ 67

Bang 3.7. T~n SlI~tgiam HDL-C mall 0-tre tlura can-bee phi theo tuoi

Tu6iGiarn HOL-C

pn %

< 6 (n = 10) 2 20,0

6 - 10 (n = 17) 3 17,6 >0,05

>10-15(n=13) 5,

38,5

Chung (n = 40) 10 25,0

25,0% tre TC-BP trong nghien ciru co giam nong oQ HDL-C mall. Khong co sir khac biet v~ t~n suat giamHDL-C theo ILIa tubi tre bi TC-BP

Bang 3.8. Nong clQ trung binh LDL-C mau o' tre tlura can-bee phi

Tu6i n N6ng de?trung binh LOL-C (x ± SO) mmol/l P

< 6 tuoi 10 2,26 ± 0,98

6 - 10 tuoi 17 2,16 ± 0,84 > 0,05

> 10 - 15 tuoi 13 2,34 ± 0,72

Chung 40 2,25 ± 0,82

ong clQ trung binh cua LDL-C tre TC -BP trong nghien ciru 1£12.25 ± 0.82 mrnol/l. Khong co sir khacbiet co y nghia v~ nong oQ trung binh cua LDL-C theo hra tubi (p>0.05).

Bang 3.9. Nong oQ trung binh LDL-C mall cua nhom TC - BP va nhorn clurng.

N6ng de? LOL-C nhom TC - BP N6ng de? LOL-C n~om chwngTu6i

n (-X±SD) mmol/I n (x±SD) mmol/I p

<6 10 2,26 ± 0,98 10 1,76 ± 0,53

6 -10 17 2,16±0,84 17 1,87 ± 0,54 >0,05>10-15 13 2,34 ± 0,72 13 1,89 ± 0,55

Chung 40 2,25 ± 0,82 40 1,85 ± 0,54

Khong co sir khac biet co y nghia v~ ncng clQ trung binh LDL-C nhorn TC - BP va nhorn clnrng.

Bang 3.10. T~n suat tang LDL-C mall o· tre thua can-bee phi theo tuoi

Tang LOL-C mauTu6i p

n %

< 6 (n = 10) 2 20,0

6 - 10 (n = 17) 3 17,6 >0,05

>10-15(n=13) 2 15,4

Chung (n = 40) 7 17,5.Co 17,5% tre TC - BP trong nghien ciru co tang nong oQ LDL-C mall. Khong co SI,fkhac biet v~ t~11

suat tang LDL-C theo lira tuoi tre bi TC -BP (p>0.05)

68 Tap chi Y DU'Q'choc - Truong Dai hoc Y DU'Q'cHu~ - s6 I~

3.1.2. Tinh trung gall Illtilm mii iJ tre thica ciin-beo pili

Bang 3.11. T ~n 511~tva In ire oQ gan nh i~11l1110'(ytre TC - B P

Tinh tranqKh6ng

C6 gan nhiem mOova mLPcdQgan nhiem mOo

TongDQI DQ" DQ '"n 24 13 2 1 16

TV Ie % 60 32,5 5 2,5 40

40% tre TC-BP co tinh trang gan nhiem 111<5',chu Y~lI la gan nhiern mO' oQ I

Bang 3.12. Tinh trang gan nhi~l11111o' theo t1l6i

Gan nhiem mOoTu6i P

n %

< 6 (n = 10) 3 30,0

6 - 10 (n = 17) 7 41,2> 0,05

>10 -15 (n = 13) 6 46,2

Khong co sir khac biet v~ tinh trang gan nhiern 1110'theo t1l6i 0' tre TC-BP

Bang 3.13. Tinh trang gan nhi~111 mo' theo gioi

Gan nhiem mOoGi&i p

n %

Nam (n = 32) 12 37,5>0,05

NO>(n= 8) 4 50,0

Khong co W khac biet tinh trang gan nhiem mo' theo gioi 0' tre TC-BP

Bang 3.14. Tinh trang gan nhiern mo' theo mire oQ TC - BP

Gan nhiem mc'7 pMLPCdQ TC-BP

n %

NhOm TC (n = 4) 1 25>0,05

Nh6m BP (n = 36) 15 41,7

Khong co 51,!khac bier tinh trang gan nhi~111 1110'theo mire oQ TC-BP

Bang 3.15. Tinh trang gan nhiern 1110'theo ki~lI beo phi

Gan nhiem mOo p

n %

BP trung tam (n = 10) 6 60>0,05

BP nqoai vi (n = 30) 10 33,3

Khong co W khac bier v~ tinh trang gan nhiern 1110'va ki~lI beo phi

Tap chi Y DU'Q'c hoc - Truong Dl,li hQC Y DlI'Q'c HlI~ - sf> l.t 69

3.2:-MBi lien quan gifroa tinh trang gan nhi~m mO'va lipid mau (y tre thira can-bee phi 2-15 tu6i

Bang 3.16. 6ng do trung binh cua cac chi s6 lipid rnau cua nh6m co GNM va nh6m khong c6 G M

Thong s6N6ng dQ trung binh cac chi s6 lipid mau (x ± SO mmol/l)

pNhom co GNM Nhorn khong co GNM

Cholesterol toan phan 4,96 ± 0,91 4,29 ± 0,75 < 0,05

Triglycerid 3,29 ± 1,47 2,25 ± 0,95 < 0,05

Lipoprotein tY tronq thap 2,48 ± 0,96 2,10 ± 0,70 >0,05

Lipoprotein ty trong cao 1,16 ± 0,25 1,19 ± 0,32 >0,05

C6 str khac biet co y nghTa thong ke v~ nong dO trung binh cac chi s6 Cholesterol toan phan vaTriglycerid mau giu'a 2 nhom c6 GNM va khong co GNM,

Khong co sir khac biet v~ nong do trung binh cac chi s6 LDL-~ va HDL-C mall giu'a 2 nh6m co GN 1va khong co GNM 0' tre TC - BP,

Bang 3.17. Lien quan gina tinh trang gan nhiem mo va tang cholesterol roan phan

Gan nhi~m m&Tang choleserol toan ph~n

Co Khong

C6 8 7

Kh6ng 8 17

P > 0,05

Khong co W lien quan giira tinh trang GNM va tang cholesterol toan phan 0' tre TC- BP

Bang 3.18. Lien quan giifa tinh trang gan nhi~m mo va tang triglycerid mall

Tang TG\ Gan nhi~m m&

Co KhongC6 12 8

KhOng 4 16P < 0,05

C6 sir lien quan gifra tinh trang GNM va tang TG rnau a tre TC- BP

Bang 3.19. Lien quan giira tlnh trang gan nhiSm mo va tang LDL-C

Gan nhi~m m&Tang LOL-C

Co Khong ,

C6 5 2

Kh6ng 11 22

P > 0,05

Khong co W lien quan gitra tinh trang GNM va tang LDL-C mall 0' tre TC - BP,

Bang 3.20. Lien quan giira tinh trang gan nhi~m mo' va giarn HDL-C

Gan nhi~m rnoGiarn HOL-C

Co Khong

C6 5 5

Kh6ng 11 19

P >0,05

Khong co su lien quan giira tinh trang GNM va giarn HDL-C mall 0' tre TC - BP

70 Tap chi Y OU'Q'C hoc - Truong Dai hoc Y OllVC Hu~ - S6 l.t

4. B4

maudn-

ngtr

th~lAyphu

pl1l1t~ bnoimatt6nLip'

tuymQtph~ngh

trollthaIdQnnghph~tretoai

naytru

Tritrfr

nelmath~ngl

T~

M

va

M

4. BAN LU~N4.1. Danh gia s,! bi~n d6i n6ng dQ lipid

mau va tinh trang gan nhi~m mO' i1 tre thiracan-beo phi

4.1.1. S{f hMIl (IJi Lipid nuiu: Hien nay amroc ta, clura co mot t ieu chuan nao danh chovi~c chan doan r6i loan lipid mau 0' tre em,Mot s6 truong hop nguoi ta su dung tieu chuan

~h~n dean r6i loan lipid rnau 0' tre em theoelson 2007, nhung tieu chuan nay danh cho

ngtrc)'i nuoc ngoai do do k~t qua nghien ctru coIh~ bj anh huong vi vay chung t6i quyet dinhI~y lipid cua nhorn chirng d~ so sanh co Ie sephu hop hen.

Su: biill (IJi tluutlt pIt/ill cholesterol totinpIt/ill: Cholesterol la thanh t6 chu yeu cua mangI~ bao va cling la y~u t6 chinh d~ t6ng hop cacnoi t6 nlur glucocorticoid, aldosteron va acidl11~t.Ngoai ra cholesterol can la nguyen lieu d~t6ng hop nen vitamin DJ trong co' th~, Nlur vayLipid co vai tro r~t quan trong d6i v6i CO' the.IUyuhien chung chi co IO'i khi 0' trong CO' th~ voimo~ hrong thich hO'P, neu bj r6i loan cac thanhph~1l nay se gay ra nhirng h?u qua xau. hirngnghien ciru cho th~y khi ham luong cholesteroltrong mau qua cao thi se tich dong lai trenthanh dong rnach vanh va d~n d~n benh XO' vitadong mach vanh voi nhi~u bi~n chirng. K~t quanghien ciru cho thay co su bi~n d6i r6 ret thanhphAn cholesterol toan phan a tre TC-8P. 37,5%Ire trong nghien CLfLIco tang nong do cholesterolloan phan, khong co S~I'khac bier v~ W r6i loannay theo cac hra tu6i (bang 3.2 va 3.3). ong dotrung binh cholesterol roan phan a tre TC - 8Pla 4,55 ± 0,87 mrnol/l, so voi nhorn clnrng 3,65 ±0,68 11111101/1.K~t qua cua chung t6i cling nrongnr W ghi nhan cua mot s6 tac gia khac [5],[6].

S{f bii" oJi 'tlul"h plu111 triglycerid nuiu:

Triglyceride co vai tro la nguon nang hrong dirtru cho cac hoat dong cua co the. Tuy nhien.n~LI ham IU'Q'ng triglyceride trong co th~ caoma HDL-C thap hoac LDL-C cao thi cling coIh~ gay t6n hai khong nho cho sire khoe. hi~unghien Cll'Ucho th~y r~ng tang TG la y~u t6 nguy

T~p chi Y DU'Q'c hQc - Tru'o'ng D:;ti hQc Y DU'Q'c Hu~ - S6 I ~

co doc I?p cua xo vtra dong mach, tac dong xaud~n benh mach vanh, vi vay str phat hien r6iloan TG rnau va tang TG a benh nhan beo phico y nghia trong viec phong ngira cac tai bientim mach [II]. K~t qua bang 3.4,va 3.5 cho thaynoug do trung binh triglycerid a nhom tre TC-8Pcao hon co y nghia so voi nhom clurng o' t~t cacac hra tu6i ngoai tnr a nhom tre < 6 tLl6i. 50% treTC-8P trong nghien ciru co tang triglycerid mall.

ong do trung binh Triglycerid a tre TC - 8Pla 2,66 ± 1.26 mmol/L, nhorn clurng la 1,55 ±0,50 mrnol/L. Theo nghien ciru cua Hoang ThiTin nong dO trung binh triglycerid la 1,83 ±1.2911111101 [5], cua Bui HLlI1g Vi~t nong dO trungbinh triglycerid la 2.0±0.6 mrnol/I [6]. hu V?ynong dO trung binh Triglycerid trong k~t qua cuachung toi hoi cao hen cac tac gia khac, ngay canong do trung binh triglycerid cua nhom clurngtrong nghien cuu cua chung toi cling cao hon sovoi gia tr] triglycerid binh thuong cua Nelson.Phai chang do ch~ do an cua cac vung khac nhaud~n d~n nong dO triglycerid mau khac nhau, dieunay dn nghien ClfLI them. Ty I~ tang TG trongnghien cirucua chung toi thap hon so v6i cac tacgia khac trong nuoc (Nghien ciru cua NguyenTh] Hoa: 72,9% [3], nghien ciru cua Hoang Thi

Tin la 67,7% [5]. 8ui HLlI1g Vi~t ty I¢ nay la 88%[6]) nlnrng lai cao hon mot s6 nghien ciru tainuoc ngoai. Di~u nay co Ie do tap quan an uongcua d6i nrorig nghien ciru khac nhau cling nhirsir dung tieu chi danh gia khac nhau.

Lipoprotein ty trong cao: duoc coi la loaicholesterol "co IQ'i". K~t qua bang 3,6 va 3.7cho thay: 25% tre TC-8P trong nghien ciru cogiarn nong do HDL-C mau, K~t qua cua chungt6i tuong duong voi cac tac gia khac [3],[5],[6]

Lipoprotein ty trong t"lip: duoc goi lacholesterol "co hai" do tich tu nhi~L1 0' dongrnach. gop phan trong viec hinh thanh cac rnangXO' vira dong mach khi~n dong mach ngay canghep di, can tro' tuan hoan mall. dJ d~n d~n cacbenh Iy tim mach cling nhu nhi~L1 bi~n chungkhac. H<;Ithap nong dQ LDL-C trong rnau la mucdich chu yeu cua cac phuong philp di~L1 tri tang

71

cholesterol mau. N~u nong d9 LDL-C trong mau

cao (> I OOmg/dl) se lam tang nguy CO" mitc cac

benh mach vanh, benh mach mall ngoai bien vad9t quy.

K~t qua bang 3.8,3.9 va 3.10 cho th§y 17.9%tre TC-BP trong nghien ciru co tang noug dQLDL-C mall. Khong co SI.J khac biet v~ tan suattang LDL-C theo lira tuoi tre bi TC-BP (p>0,05).Nong d9 trung binh cua LDL-C tre TC-BP trongnghien ciru la 2,25 ± 0,82 I11mol/1. Khong co sukhac biet co y nghia v~ nong dQ trung binh cuaLDL-C theo lira tuoi (p>0,05).

Nhu vay tre trong nghien ciru cua chung toi.co W r6i loan ca bon chi s6 lipid mall, do la 111Qtchi diem x§u cho tien luong sau nay: nguy cohQi clnrng chuyen hoa, bien chirng tim mach. Viv~y can phai co k~ hoach tarn soar di~u tr] ngaycho tre.

4.1.2. Tinh trang gall Illtiim mil ij Ire thiraciin-beo phi: Tlnrong qua trinh nhi~m mo' xuathien khoang 3 tuan sau khi tac dong cua benhnguyen va co th6 bien m§t khoang 6 ngay V6"ich~d9 di~lI tr] t6t. N~u khong phat hien va kh6ng di~utri thi nr gan nhiem mo' don thuan co th~ dien tientoi viern gan rno; xo gan va ung thir gan. K~t quacua chung t6i cho thay da s6 tre bi gan nhiern mo'a I11UCdQ nhe nhung cling dii XU At hien GNM dQII, III a tre TC-BP. Vi v~y, viec tarn soat GNM atre TC-BP la dt dn thiet d~ phat hien kip thoi va

\

co bien phap di~u tri cang som Gang t6t. TlIY sir

khac biet chua co y nghia thong ke (co th~ do s6m~lI con nho) nlurng ket qua cling cho thay tinhtrang gan nhiem mo' g~p t~n su§t cao hon o' tre bibeo phi so voi tre thira din. Vi vay, dn chu y t~mscat tinh trang GNM ngay khi tre chi moi bj thuadin va dira ra bien phap di~u tri cang sorn cangtot. K~t qua cling cho th§y nhirng tre co ki~u beephi trung tam co tY I~ bi gan nhiem mo' cao honnhom tre beo ngoai vi. I)i~u nay cling dii duoc d~cap trong y van.

Mac du tY s6 WRH clura duoc xac dinh cho treem nhung theo nhi~u nghien Clru cho thAy khi treco ty s6 WRH cang cao thi nguy CO" bi GNM cangtang. 6 ngu'o'i l6"n, d~ng BP lien quan o~n 111lrcoQ

72

nang cua GNM, beo phi trung tam la yeu t6 nguy

CO" cua GN M [7J, [I OJ. Trong nghien ciru cua AjayDuseja co 92% truong hop gan nhi~m mO"bj beophi trung tam [7]. Nghien ciru o' nguoi 10'n cua BuiThi Hoa ghi nhan gan nhiel11 1110"g~p nhi~u o' benhnhan bee phi dang nam, trong do vong bung trungbinh o' benh nhan nam la 94,92 ± 6,47 ern, va benhnhan nfr la 91,54 ± 8,96 em [2].

4.2. M8i lien quan gifra tinh trang gan nhi~m

mo' va cac chi s8 lipid mau

K~t qua nghien cuu cho tlu1y co W tang cao f6ret nong dQ TG mau va Cholesterol roan ph~n/mallo' tre co gan nhiem mo' (bang 3.16). Theo nghienciru cua G. Perseghin [9] cho thay co m6i lienquan giira tinh trang tang TG rnau va gan nhiem1110".K~t qua cua cluing toi cling tuong tir ghi nh~ncua m9t s6 tac gia khac [2],[5].[9].

M~c du CO" ch~ gay gan nhiern mo' o· tre TC-BPv~n clnra duoc bi~t mot each d~y du nlurng nhi~lItai li~lI dii cho thay co rnoi lien quan giira tangTG va gan nhiem mo. Gan nhi~m mo' la 1ll9t quatrinh tich tu TG duoi dang nhirng hat vi motrongt~ bao gan.

V~~ tinh trang gan nhiem mo' co anh lurong d&nChlfC'nang gan, d~n W huy hoai t~ bao gan? D~ tra loicall hoi nay dn phai co sir nghien cuu them.

5. KET LU~N5.1. S" bi~n dBi lipid mau va tinh trang gan

nhi~m mO'it tre TC-BP5.1.1. S{/' bi811ilJi Lipid nuiu- 37.5% tre TC - BP trong nghien ciru co tiing

cholesterol roan phan. Co str tang mot each r6 retnong dQ cholesterol mau o· tre thira can - bee phi at§t ca cac nhorn tu6i so voi nhom clnrng (p < 0,05).

- 50% tre tlura din bee phi trong nghien ciru cotang TG. Nong dQ trung binh triglycerid 0' nhomtre TC-BP cao hon co y nghia so vo'i nhom chungo' dt ca cac lira tu6i ngoai tnr a nhom tre <;: 6 tu6i,

- 25% tre TC-BP trong nghien ciru co giamn6ng oQ HDL-C mall. Co str khac biet co ynghla th6ng ke n6ng d9 HDL-CT 0' tre TC-8Pso v6'i nhom chlrng (p<O,OI), d~c bi~t 0' It'ra tu6ittr 6 tu6i tro' len,

T~p chi Y DU'(;rchQc - Tnn)"ng Dl.li hQc Y DU'Q'cHu~ - S6 l.t

- Inong

5./ciin-b

-4Chu y

trurrn:<..iNM

d() th

trang(25%thon

I.

2.

..,.J.

4.

5.

6,

7,

T

glly

.Xrem

oro111a 1I

lienlieniem

h~n

-BPlieutangquaong

d~n. loi

an

ang

r~thi 0-

05).CO

omungroi.

iam, )BP

luoi

TAl LltU THAM KHAo

- 17,5% Ire TC - BP trong nghien cuu co tangn6ng do LDL-C rnau.

5./.2. Till" trang gall I1hi€m mil if Ire thirociill-beo phi

- 40% tre TC-BP co tinh trang gan nhi~m mo.Chll Y~lI la GNM dO I (chiern 81,3%). Chi co Iinrong I1Q"P co tinh trang GNM dO 3 (6,2%).TY I~GNM tang leu d§n theo tubi tuy nhien W khac bietkhong CO)' nghia thong ke (p>0,05)

- Tinh trang gan nhiern 1110'tang theo rrurccl9 tlura call- beo phi: 41,7% tre beo phi co tinhtrang gan nh i~111mo. nh i~u hon so voi tre thira din(25%), Illy nhien W khac biet nay chua co y nghiath6ng ke.

I. Le Thi Hai (2002), "Thira can, beo phi a tre em,

each xay dung thuc don cho tre beo phi", Dinh

duiing hill/ SClI1g,tr.354-370.

2. Bui Thj Thu Hoa (2007), Nghien ClI7/ bilan lipid a b~nh

nhcin gall nhie/II 1/1(/phat hien qua sieu dui. Luan van

thac sl y h9C, Truong Dai 119CY DUQ"cHlI~.

3. Nguy~n Th] Hoa (201 0), "Dac di~1l1benh nhan beo

phi va hieu qua di~u tr] beo phi tai khoa dinh duong

benh vien Nhi D6ng J (1998-2008)". TCDD & TP6

(3+4), tr. 127-129

4. Nguyen Pluroc Bao Quan (2006), Sieu din hung

t611gquat, Nha xuat ban Y hoc, tr.115-14 7.

5. Hoang Thi Tin (2006), D(lc diem cua tre thira can

- beo phi, sieu dtn co gan nhilm 1/10' tai Khoa Dinh

duiing, Benh vien Nhi Dong f - Nail/ 2005 - 2006,

Luan thac si y h9C, Truong Dai h9C Y Duoc Thanh

ph5 H6 Chi Minh.

6. Bui Hung Viet (20 10). Nghien CII?1 nhiing bien t/6i

hinh thai va chtrc nang thc1t trai o tre em 5 - 15

t1l6i thira can - beo phi tai Benh vien Nhi dong Cdn

Tho', Luan an chuyen khoa dp II, Truong Dai h9C

Y Ducc Hu~.

7. Ajay Duseja, R Murlidharan, A Bhansali, Sunil

Sharma, Ashim Das et al (2004), "Assessment

of insulin resistence and effect of metformin in

nonalcoholic steahepatitis - a premilinari report",

Tap chi Y Dune hoc - Truong D~i hoc Y DU'Q'cHu~ - s6 I ~

- 60% tre beo phi trung tam co tinh trang gannhi~m rno, cao hon so vo'i tre beo phi ngoai vi

(33,3%) tuy nhien sir khac biet nay chua co ynghia thong ke (p>0,05).

5.2. Lien quan tinh tn,m'g gan nhi~m mo' valipid mau

- Co su khac biet co y nghia thong ke v~ nong

do trung binh cac chi s6. cholesterol toan phan vaTG mall giira 2 nhorn co GNM va khong co GNM0- tre TC - BP,

- Khong co W khac biet v~ nong do trung binhcac chi s6 LDL-C va HDL-C mau giira 2 nhorn coGNM va khong co GNM 0-tre TC - BP.

Indian )01/1'1/01 of Gastroentorology, 23 (I),

pp. 12-15.

8. Ting Fei Ho, FRCP Edin (2009), "Cardiovascular

Risks Associated With Obesity in children and

aldolescents", AIIII Acad Med Singapore 2009.

9. G. Pereghin, R. Bonfanti, S. Magni, G. Lattuada,

F. De Cobelli et al (2006), "Insulin resistance

and whole body energy homeostasis in obese

adolescents with fatty liver disease", A/II) Pliysiol

Endocrino Metab, 9 ( 1). pp. 1-2.

10. F. Peres - Aguilar, S. Benllooch, M.

Berenguer, J. Berenguer (2004), "Nonalcololic

steatohepatitis: Physiopathological, clinical and

therapeutic implication" Revista Espanola

Enfemedades Digestivas, Aran Ediciones. S.L.

96(9), pp 628 - 684.

II. Sarah E. Barlow and the Expert Committee

(2007). Expert Committee Recommendations

Regarding the Prevention, Assessment, and

Treatment of Child and Adolescent Overweight

and Obesity: Summary Report. PEDIATRICS Yol.

120 Supplement December 2007, pp. S164-S192

(doi: 10.1542/peds.2007 -2329C).

12. WHO (2007), Obesity: Preventing and managing

the global epidemic, WHO technical Report Series

894 Geneva.

73