765

M LM SNG V CN LM SNG B NH NHN SUY THN MN U TR BO TN TI B NH VI N H R NG NG N

H H C KHNG C HI CHNG CHUY N HA

Tr n ng ng Khoa1, V Tam2 1H D C ,2H D Hu

Mc tiu: So s s l s g v l s g b S

v khng c HCCH.

i tng v phng php nghin cu: 1 3 b S u r bo b v k o ru g g C 0 / 009 08/ 010. HCCH o eo u u NCEP-A P III d o g u .

Kt qu: C s bo p HCCH b o g VB (8 ,9 7,18 ; s VB/V (0,970,06 , B I ( ,30 ,3 u o g g k so v k g HCCH v g r g g (80,186,06 ; (0,9 0,06 ; ( 3,3 ,67 . HA v HA r ru g b HCCH o k g c HCCH (149,94 ,76 Hg so v 13 ,0 30,0 Hg; 8 ,38 1 ,81 Hg so v 80, 1 ,70 Hg , HA s k b g g k. C oles erol o p v r gly er d HCCH o k g HCCH g g k vi ,3 1,97 ol/L so v ,8 ,1 ol/L v , 1,6 ol/L so v 1,7 1,30 ol/L g g. Glu ose l HCCH o g g k so v k g HCCH (7,91 3, 6 ol/L so v , 6 1,16 ol/L . N g d ur u HCCH l 0, 3 181,98 ol/L o k g c

g g k so v k g HCCH l 409,98 1 1,31 ol/L. N g e oglob u HCCH l 96,67 7,17g/L p g g k so v k g HCCH l 109,99 6, g/L. l u ru g b HCCH l 7, 3 0,89 l/p p g g k so v k g HCCH l 42,51 25,72ml/p.

ABSTRACT

CLINICAL AND SUBCLINICAL FEATURES IN THE CHRONIC KIDNEY

DISEASE PATIENTS AT THE CANTHO CENTRAL GENERAL HOSPITAL

WITH AND WITHOUT METABOLIC SYNDROME

Objective: to compare some clinical and subclinical features in the chronic kidney

disease (CKD) patients with and without metabolic syndrome (MS).

Patients and methods: 123 CKD patients with conservative treatment at The Cantho

Central General Hospital from 05/2009 to 08/2010 are investigated the component of MS

basing on the NCEP-ATP III criteria for Asian.

Results: Waist circumference in patients with the MS compared with patients

without the MS (85.947.18cm vs 80.186.06cm) and BMI (24.302.35 vs 23.322.67).

Systolic BP and diastolic BP in patients with MS are higher than those without MS

(149.9425.76mmHg vs 134.0530.05mmHg, 84.3812.81mmHg vs 80.2415.70mmHg).

Total Cholesterol and Triglyceride in patients with MS are higher significantly than those

without MS (5.341.97mmol/L vs 4.842.12mmol/L, 2.541.64mmol/L vs

1.751.30mmol/L). Serum uric acid in patients with MS is higher than those without MS

(440.43181.98mol/L vs 409.98151.31mol/L). Plasma glucose in patients with MS is higher significantly than those without MS (7.913.46mmol/L vs 5.561.16mmol/L).

766

I. V N Suy (S v g xe l d u qu

g . C b u l s g g sin p u vo ng nphron ng. Trong giai o u, l u g r u g l s g th g g o . Ng l , ro g g o u , r u g l s g g r r, r rng hn. S l b , d qu u g, l u b g g u g vo g ro g b b g uy v [2], [5].

H g uy o (HCCH Kyl l u vo 19 0 v g l v y s b p b v u qu . N u g u o y s d HCCH l g g guy b , b v uy g b k 3 , 9 .

S v HCCH v g l g v y o u. r g r u g u l qu g b l y uy r g u HCCH r b S . C g y v u So s l s g v l s g g HCCH v k g HCCH b nhn STM.

. NG V HNG H NGH N 2.1. i tng nghin cu

g g u g 1 3 b S g o g u r bo k o P - , -N , Lo B v K W C g 0 / 009 - 08/2010.

2.2. hng php nghin cu: g g, u. V u u o v b s u C o x S eo u

u ANAES 003 (Age e N o le dA rd o e dv lu o e S [2]:

Giai

o

H s cratinin (Ccr)

(mL/pht)*

B u suy

r u g

1 89 C r 60 B l

K g o HA.

2 60 > C r 30 Suy v HA, b u r lo C 2+, PO42-

.

3 30 > C r 1 Suy g C r u g r g l , r lo o k , u u.

4 Ccr < 15 Suy g o u

C r u g r g l , u r , v N +, guy g K+, v nn.

* H s r eo g Co k rof -Gault. - u u lo r suy p, p S , u r u l g

l p d u, g u, uy p r . - C o HCCH eo u u NCEP-A P III d o g u .

g HCCH k 3 ro g u u s u 9 + Bo ph tru g S o v g b g 90 , 80 .

767

+ Triglycerid mu t g 1 0 g/dL ( 1,7 ol/L . + HDL- g nam < 40mg/dL (< 1,03mmol/L). < 0 g/dL (< 1, 9 ol/L + T g HA HA 130 Hg v/ o HA r 8 Hg. + T g glu ose uy ng t k 110 g/dL (6,1 ol/L .

. Q NGH N 3.1. c im chung

3.1.1. Gii tnh

30

70

32,3

76,7

58,1

41,9

48,4

51,6

42,3

57,7

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ST giai

on I

ST giai

on II

ST giai

on III

ST giai

on IV

Chung

N

NAM

B u 3.1. P b u g u eo g

N x ro g u g u l ,3% v l 7,7%. S k b v g g o suy k g g g k v p>0,0 .

3.1.2. tui B g 3.1. P b u g u eo u

Nhm

u

G o suy Chung

I II III IV

n % n % n % n % n %

< 45 11 36,7 0 0,0 2 6,5 9 29,0 22 17,9

45 60 13 43,3 5 16,1 3 9,6 12 38,7 33 26,8

> 60 6 20,0 26 83,9 26 83,9 10 32,3 68 55,3

g 30 100 31 100 31 100 31 100 123 100

u B 48,0317,24 70,659,88 69,6813,11 55,3516,78 61,0317,27

p = 0,000

N x u ru g b u g u l 61,03 17,27. N u l o ro g u g u l >60 u l l ,3%.

3.1.3. Mc lc c u thn B g 3. . l u u g u

G o Suy

l u ( l/p

x KTC 95% Min Max I 67,66 8,91 64,33 70,98 60,09 87,72

II 37,56 6,08 35,33 39,78 30,08 50,59

III 20,60 4,16 19,07 22,12 15,06 29,89

IV 5,91 2,31 5,06 6,75 2,73 12,34

Chung 32,65 23,66 28,42 36,87 2,73 87,72

p = 0,000

768

N x l u ru g b u g u l 3 ,6 23,66ml/p. C s g d l u eo g o suy g g k. 3.2. c im lm sng

B g 3.3. l s g v k g HCCH

p H g uy Chung (n =

123) p

C (n = 81) Khng (n = 42)

BMI 24,30 2,35 23,32 2,67 23,96 0,039

VB (cm) 85,94 7,18 80,18 6,06 83,97 0,000

VM (cm) 88,53 5,41 86,90 4,12 87,97 0,088

VB/VM 0,97 0,06 0,92 0,06 0,96 0,000

HATT (mmHg) 149,94 25,76 134,05 30,05 144,51 0,003

HATTr (mmHg) 84,38 12,81 80,24 15,70 82,97 0,069

N x N u g g r B I, VB, V , VB/V , HA , HA r HCCH u o g g k so v k g HCCH go r V v HATTr.

3.3. c im v cn lm sng B g 3. . l s g v khng c HCCH

p H g uy

Chung

(n = 123) p C

(n = 81)

Khng

(n = 42)

TC (mmol/L) 5,34 1,97 4,84 2,12 5,17 0,023

TG (mmol/L) 2,54 1,64 1,75 1,30 2,27 0,001

HDL-c (mmol/L) 0,95 0,27 1,01 0,31 0,97 0,100

LDL-c (mmol/L) 3,47 1,29 3,08 1,37 3,33 0,122

Acid uric (mol/L) 440,43 181,98 409,98 151,31 430,03 0,354

Glucose (mmol/L) 7,91 3,46 5,56 1,16 7,11 0,000

Hemoglobin/mu(g/L) 96,67 27,17 109,99 26,42 101,22 0,010

Pro e u (g/ 1,18 2,01 0,99 1,86 1,11 0,258

Ur (mmol/L) 16,58 13,50 12,19 13,38 15,08 0,037

Creatinin (mol/L) 439,43 465,60 244,79 337,63 372,97 0,002

MLCT (ml/p) 27,53 20,89 42,51 25,72 32,65 0,001

N x C s k b g C, G, Glu ose, Hemoglobin/mu, Ur, Cre , LC k so s g y k g HCCH.

V. B N N HCCH l v s ro g y , HCCH g gy g g g r o

g , g k g go d b s g g p , , l o g y g , l s g , g l g 6 . N u g ro g v go p ru g g u HCCH r u g k u bo p , o g, HA, qu. C g g u HCCH trn g u b g uy g l S . Ng u g g 1 3 b S g o v LC ru g b l 32,65ml/p; u ru g bnh l 61,03; 7,7%.

Bo p xe l yu guy qu r g b v b k , bo p v HCCH l g yu y r S . eo k qu

769

k o s g v s g bo p B I, VB, V , VB/V o y s k u v k g HCCH v k qu B I HCCH l ,30 ,3 o g so v k g HCCH l 3,3 ,67. VB HCCH l 8 ,9 7,18 o g so v k g HCCH l 80,18 6,06 .V HCCH l 88, 3 , 1 o so v nhm khng c HCCH l 86,90 ,1 . s VB/V HCCH l 0,97 0,06 o g so v k g HCCH l 0,9 0,06. Ngo s V , s l b o g VB, VB/V , B I HCCH u o g g k k so v k g HCCH. u y o o p p v VB l p qu r g u y s d g o HCCH. g qu VB o VB/V g bo p d g , y v d g g g o lp r g, uy g u, g o s VB . S g g VB guy g G, g HDL-c mu v k g sul , gy HCCH 8 .

ro g g u g , HA HCCH l 1 9,9 ,76 Hg o g so v k g HCCH l 13 ,0 30,0 Hg. HA r HCCH l 8 ,38 1 ,81 Hg o so v k g HCCH l 80, 1 ,70 Hg. C g u s k b v r s uy p v k g HCCH r g S g Nguy L g Qu g, Daniel O. Young g g k qu g 1 , 1 .

R lo l p d u l ro g g HCCH g A P III ly p l g G v g HDL-c l u u o do y l guy qu r g gy x v g . K qu b g o y s k u b l l p d eo u b l o g HCCH so v k g HCCH. Do , HCCH guy b o , l k g r g p p s r lo l p d tr b S d p g HCCH, g guy vo g do b r g y. k qu y g y s g g k so s v u g u ro g v go g Nguy L g Qu g, D el O. ou g, S .H [1], [10], [11], [12].

eo g HCCH g glu ose o o g, uy v g glu ose y g v s k g sul ro g HCCH guy o g l r o, do u u glu ose u ro g HCCH r 6,1 ol/L eo A P III, eo ID l r ,6 ol/L. Ng u g k qu glu ose u ru g b HCCH l 7,91 3, 6 ol/L o g g k so v k g HCCH l , 6 1,16 ol/L. N u g r g u o y s k b v g glu ose u g l g glu ose u v k g HCCH r g S 1 , 6 , 7 , 9 .

Tro g suy , g d ur l k qu s g l u , g b g v/ o g p u g , go r do k g sul ro g S . g d ur y u vo g o suy , suy g g g d ur g u . Qu k o s g , d ur u HCCH l

440,43181,98 ol/L o so v k g HCCH l 09,98151,31mol/L. Tc g Nguy L g Qu g g g d ur u HCCH o so v k g HCCH ( 90,311 1,8 ol/L so v 36 , 8108, 9 ol/L 1 . u y o o p p v g d ur u l ro g g u u Kyl (19 0 d g o HCCH v l ro g 6 u u o HCCH theo AACE 2003 [9].

770

K qu g u g o y g ure, re HCCH o g g k k so v k g HCCH. LC HCCH p g g k so v k g HCCH ( 7, 3 0,89 l/p so v , 1 ,7 l/p . LC p r g suy , do eo k qu g k LC p g l suy g g g guy HCCH, u y p p b v suy g g r lo v uy g g u . S .H., K O.K. g u HCCH b b y s g r r v LC g v k g HCCH (61, L/p so v 94,2mL/pht) [10].

V. N - C s bo p HCCH b o g VB (8 ,9 7,18 ; s

VB/V (0,970,06 , B I ( ,30 ,3 u o g g k so v k g HCCH v g r g g (80,186,06 ; (0,9 0,06 ; ( 3,3 ,67 .

- HA v HA r ru g b HCCH o k g HCCH (1 9,9 ,76 Hg so v 13 ,0 30,0 Hg; 8 ,38 1 ,81 Hg so v 80, 1 ,70 Hg , HA s k b g g k.

- C oles erol o p v r gly er d HCCH o k g HCCH g g k v ,3 1,97 ol/L so v ,8 ,1 ol/L v , 1,6 ol/L so v 1,7 1,30 ol/L g g.

- Glu ose l c HCCH o g g k so v nhm khng c HCCH (7,91 3, 6 ol/L so v , 6 1,16 ol/L .

- N g d ur u HCCH l 0, 3 181,98 ol/L o

khng g g k so v k g HCCH l 409,98 151,31mol/L. - N g e oglob u HCCH l 96,67 7,17g/L p c

g g k so v k g HCCH l 109,99 6, g/L. - l u ru g b HCCH l 7, 3 0,89 l/p p c

g g k so v k g HCCH l 42,51 25,72ml/p.

H H 1. Nguy L g Qu g ( 008 , Nghin cu t l cc tiu chun xc nh hi chng

chuyn ha trn bnh nhn suy thn mn, Lu v s y , r g D Hu.

2. V ( 009 , Suy , Gio trnh Ni khoa sau i hc Bnh Thn-Tit niu, r g D Hu, NXB Hu, r g 1-235.

3. Nguy H y ( 008 , C o g uy , Bnh tim mch trong ri lon ni tit v chuyn ha, NXB Hu, rang 107-142.

4. Aiko P. J. et al. ( 00 , e bol sy dro e s sso ed w p red lo g- er re l llogr f fu o , o ll o po e r er o r bu e equ lly, American Journal of Transplantation, Vol.4, pp. 1675-1683.

5. Andrew S. L. et al. (2005), Def o d l ss f o of ro k d ey d se se I prov g Glob l Ou o es (KDIGO , Kidney International, Vol.67, pp. 2089-2100.

6. C e J. e l. ( 007 , Asso o be wee e e bol sy dro e d ro k d ey d se se C ese dul s, Nephrol Dial Transplant, (22), pp. 1100-1106.

771

7. Johnson D. W. et al. ( 007 , e bol sy dro e severe ro k d ey d se se prevalence, predictors, prognostic significance and effects of risk factor

od f o , Nephrology, 12(4), pp. 391-398. 8. Kirsren A. et al. ( 00 , Obes y s sso ed w worse g rd ov s ul r r sk f or

prof les d pro e ur progress o sul re l r spl re p e s, American Journal of Transplantation, Vol.5, pp. 2710-2718.

9. Rober H. E. e l. ( 00 , e e bol sy dro e, Lancet, Vol.365, pp. 1415-1428.

10. Shin M. H. et al. ( 007 , e prev le e of e bol sy dro e e ro k d ey d se se p e s, Chonnam Medical Journal, 43(2), pp. 88-93.

11. V z r N. D. ( 006 , Dysl p de of ro re l f lure: the nature, mechanisms, d po e l o seque es, Am J. Physiol Renal Physiol, Vol.290, pp. F262-F272.

12. Young D. O. et al. ( 007 , Prev le e of e e bol sy dro e de d lys s popul o , Hemodial Int., (11), pp. 86-95.