TRUONG £)~I HOC Y DUQC HUEHUE UNIVERSITYOF MEDICINE AND PHARMACY

TRVONG £)~I HOC V DVQC HUEHUE UNIVERSITY OF MEDICINE AND PHARMACY

,TAP CHI•

Y DU'dc IIOC• •JOURNAL OF MEDICINE AND PHARMACY

S6082012

Hue, 04 - 2012

MUCLUC• •5C?P nhat v~ di~u tri n(>isoi xuat huyet tieu h6a do loet da day ta trang

Update on endoscopic therapy of peptic ulcer bleedingDang Ngoc Quy Hue, Trim Van Huy

2 12Nghien ciru SlJ bien d6i nong d(>CK, CK-MB va Troponin T trong mau 0 tregiai dean sa sinh som c6 ngatThe serum concentrations level of CK, CK-MB and cardiac Troponin Tinearly neonates with asphyxia

Nguyen Ngoc Minh Chdu, Phan Hung Vi?t

3 18K~t qua di~u tri glocom g6c dong nguyen phat bang dt mong m~t chu bienlaser Nd: YAG tai Khoa M~t B~nh vien C Da NAngThe outcome of Nd: fAG laser peripheral iridotom in patients with primary "angle closure glaucoma

Nguyen Hiiu Quoc Nguyen, Nguyen Nam Trung

4 25C~t tui mat n(>isoi mot cong (single port) tai Benh vien Trung irong Hu~Single port laparoscopic cholecystectomy in Hue Central Hospital

Pham Xudn Dong, Pham Nhir Hiep, H6 Hiiu Thien, Pham Anh Vii,Phan Hili Thanh, Nguyen Thanh Xuiin, Trim Nghiem Trung,

Pham Trung Vy, Van tu« Nhdn, t-s« Van Nghia

5 31Xay dung Module tra ket qua sang loc tnroc sinh va sa sinh true tuyen trenWebsite Ditatbamsinh.vnDesign modules for sending prenatal and neonatal screening results onlineon website ditatbamsinh. vn

Doan Htru Nh(lt Binh, Nguyln Hoang Bach, is Tudn Linh,Ha Th; Minh Thi, Nguyen Vi~tNhan

6 44Nghien ciru r6i loan phosphat, parathyroid hormon 0 benh nhan cao tu6i lQCmau dinh kyStudy of dysturbances of phosphate and parathyroid hormon in the elderlychronic hemodialysis patients

Nguyln Bach, Nguyln Th; L?, Vu Dinh Hung

7 51Nghien ciru nghiem phap gang sire d6i chieu voi k~t qua chup mach vanh 0benh nhan co can dau that ngircResearch on the exercise testing compare to the result of coronarygraphy inpatients with chest pain

Mang Thanh Chung, ts Th; Blch Thu(ln

8 58Nghien ciru d~c diem lam sang va k~t qua ph~u thuat u lanh tinh day thanhbang noi soi treoStudy on clinical characteristics and treatment result for benign vocal cordtumor with suspensive endoscopic laryngeal surgery

Truong Duy Thai, Phan Van Dung, Nguyen Tu Thd

Tap chi Y DU'Q'c hoc - Trutrng Dai hoc Y DU'Q'c Hu~ - S6 8 3

NGHIEN C(rU 51! BIEN DOl NONG DC) CK, CK-MBvA TROPONIN T TRONG MAu (y TRE GIAI DO~N

so SINH SOM CO NG~T

Nguyin Ngoc Minh csa«, Phan Hung Viff(1) Benh vien Trung uong Hu€

(2) so man Nhi, Truong Dgi h9C Y Duac Hu€

Tom dtMl}c tieu: Khao sat SlJ bi~n d6i nong d(>CK, CK-MB va Troponin T trong mau a tre giai deansa sinh som co ngat. Tim hieu moi lien quan giira sir thay d6i nong d(>CK, CK-MB va TroponinT voi mire d(>ngat, D~i tU'Q1lg va phuong phap: Bao gom 27 tre giai doan sa sinh sorn co ngatvoi apgar Sph nr 0-7 di~m di~u tri tai Nhi sa sinh- Khoa Nhi BVTW Hu~. T~t ca benh nhand~u diroc lam xet nghiern CK, CK-MB va Troponin T ngay tir khi vao vien. K~t qua: Nong d(>CK trung binh a nhom tre ngat la 1146,7±711,7U/L cao hon so voi nhom chirng (14S,6±26,4)voi p<O,Ol. Nong d(>CK-MB trung binh a nhorn tre ngat la 22,lS±13,78ng/ml cao hon h~n sovoi nhorn chirng (2,77±1,08) voi p<O,Ol. Ncng d(>Troponin T trung binh a nhorn tre ngat la0,099±0,08ng/ml cao hon so voi nhom chirng (SO,OI) voi p<O,OS.Nong d(>CK, CK-MB vaTroponin T tang co y nghia thong ke voi mire d(>nang ngat. K~t lu~n: Co SlJ gia tang nong d(>CK, CK-MB va Troponin T a tre sa sinh bi ngat. Co m6i lien quan co y nghia thong ke giira.nong d(>CK, CK-MB va Troponin T voi mire d(>nang cua ngat.

AbstractTHE SERUM CONCENTRATIONS LEVEL OF CK, CK-MB AND CARDIAC

TROPONIN T IN EARLY NEONATES WITH ASPHYXIANguyen Ngoc Minh Chau', Phan Hung Viet'

(1) Hue Central Hospital(2) Department of Pediatrics, Hue University of Medicine and Pharmacy

Objective: Investigate the change of serum Creatine kinase (CK), CK-MB and cardiac troponin Tconcentrations in early neonates with asphyxia. The relation between the change of serum Creatinekinase (CK), CK-MB and cardiac troponin T concentrations and degree of asphyxia. The serumCK, CK-MB and cardiac troponin T concentrations of asphyxiated newborn were measured in thefirst 24 hours after admission. Material and methods: Patients: 27 early asphyxiated neonateswith apgar mark at S minutes from 0-7. Study site: Neonatal of Pediatric department, Hue centralhospital. Methods: Prospective, description study. Results: Asphyxiated neonates had significantlyhigher concentration of CK, CK-MB and Troponin T than controls: mean CK 1146.7±711.7UILvs 14S.6±26.4, p<O.OI;mean CK-MB 22.1S±13.78ng/ml vs 2.77±1.08, p<O.Ol; mean Troponin T0.099±0.08ng/ml vs SO.OI,p<O.OS.The serum CK, CK-MB and cardiac troponin T concentrationsincreased significantly with severity of asphyxia. Conclusion: There is an increase in CK, CK-MBand Troponin T levels in neonates with asphyxia. Correlation with statistical significance betweenthe concentration ofCK, CK-MB and troponin T with severity of asphyxia.

12 Tap chi Y.Du·Q·choc - Truong D~i hoc Y DlfQ'CHu~ - S6 8

'0leiei

(>

a

II

1. D~TVAN DENgat sa sinh la mot trong nhirng

nguyen nhan quan trong gay nr vong vadi chirng than kinh nang n~ cho tre sa sinh

dac biet la giai dean sa sinh som. 15-20%tre c6 benh nao thieu khi sau ngat nr vong

a giai dean sa sinh. N gat c6 the xay ra

truce trong hay sau de gay ra giam oxy

d~n thai va tre sa sinh, lam bien loan S\I

trao d6i khi (tang khi carbonic) va giamtuoi mau d~n cac co quan (thieu mau CI,lC

bQ) d~c biet la tim va nao rnac du duocuu tien cap mau va oxy. Tuy vay khi ngat

nang, hai co quan nay v~n bi anh huang

nang n~ dira d~n t6n thuong thieu maukhong h6i phuc [1], [2].

Tren th~ gioi thai gian g~n day da c6

nhi~u nghien ciru cho thay co nhirng t6n

thuang tim rnach khi tre sa sinh ngat. 0Vi~t Nam thi chira th~y nghien CUll nhi~u.

Sir thay d6i r~t sorn cua cac men tim nhirCK, CK-MB, Troponin T a tre ngat nangthuorig c6 lien quan d~n mire d(> nang cua

t6n thuong tim va cling co gia tri Iantrong tien IUQ'ng benh [5], [6]. Day chinh

leiIy do d~ chung toi thuc hien d~ tai nay voi2 muc tieu:

1. Khiw sat su bidn a6i nong a6 CK, CK-ME va Troponin T Irong mau a Ire giai doansa sinh som co ngat.

2. Tim hidu mbi lien quan giiia S,! {hay

abi n6ng a6 CK, CK-MB va Troponin T vaimuc a6 ngat.

2. DOl TUQNG vA PHUONG PHA.PNGHIEN CUU2.1.D8i tU'Cfngnghien ciru

- Nh6m benh: g6m 27 tre giai doan sa

sinh sorn (0-6 ngay tuoi) duoc chfin do an

ngat sau sinh co chi s6 apgar 5 phut tir 0- 7

diem, khong mac cac di t?t b~m sinh, taiPhong Nhi sa sinh- Khoa Nhi BVTW Hu~tir OS/2009- 07/2010.

- Nh6m chirng: (D~ tim nong d(> CK,

CK-MB va Troponin T binh thuong a tresa sinh) chung toi da chon nhimg tre giai

dean sa sinh sorn khong bi ngat hay suy hohap, mac cac benh nhe da di~u tri 6n nhungkhong lam anh huang d~n nong d(> CK, CK-

MB va Troponin T, tai Phong Nhi sa sinh-

Khoa Nhi BVTW Hu~. G6m 30 tre.2.2.PhU'o·ng phap nghien ctru

- Thi~t k~ nghien ciru: nghien ciru ti~n

ciru, mo ta cat ngang

- Cach ti~n hanh: m6·i benh nhan c6 motphieu nghien ciru trong do ghi d~y du cacphan hanh chinh, benh sir, ti~n sir, trieuchimg lam sang, apgar 1 phut va 5 phut,I~y xet nghiern CK, CK-MB va Troponin T

trong 24 gio d~u vao vien.- Xu I;' s6 lieu: sir dung phan m~m

Medcalc 10.0.

3.KETQUA.3.1.f)~e di~rn nhorn nghien ciru

Bang 1. Dac diem chung nh6m nghien ciru

TuBi thai (tu~n) Can n~ng (gr)Gio'i

Narn Nfr

2420±841

Nh~n xet: Tu6i thai trung binh cua nh6m benh la 36,3±3,9 tuan, din nang ' trung binh2420±84I gam va ty I~ nam nir g~n tirong dirong nhau.

36,3±3,9

Tap chi Y DU"Q"choc - Truong D~i hoc Y DU'Q'cHu~ - sa 8

12 15

13

Bang 2. Tinh trang ngat sau sinh thee thang di~m Apgar 5 phut

De}ngat n 0/0

Ngat nhe (6-7d) 8 29,6

Ngat vira (4-5d) 14 51,9

Ngat nang (0-3d) 5 18,5

Tong 27 100

Nh~n xet: Trong 27 tre sa sinh ngat chu yeu la ngat vira chiem 51,9%, sau d6 la ngat nhe(29,6%). Ngat nang it g~p hon chiem 18,5%.

3.2. S,! bi~n d&inang de}CK, CK-MB va troponin T trong mau 0' tre giai doan SO'sinh SOm co ngat

Bang 3. Nong dQ CK, CK-MB va Troponin T & nh6m benh va nh6m chirng

Nang de} Nhom b~nh Nhom clnmg p- -

(X ± SD) (X ± SD)

CK(U/L) 1146,7±711,7 145,6 ± 26,4 <0,01

CK-MB(ng/ml) 22,15±13,78 2,77±1,08 <0,01

Troponin T(ng/ml) 0,099±0,08 ::;0,01 <0,05

Nh~n xet: N6ng dQ CK, CK-MB va Troponin T & nh6m tre ngat tang cao so voi nh6m chirng,sir khac biet c6 y nghia thong ke voi mire p<0,05.

3.3. M6i lien quan gifra s,! thay d&i nang de} CK, CK-MB va Troponin T vOl rmrc de} ngat

Bang 4. M6i lien quan gifra sir thay d6i nong dQ CK voi mire dQ ngat sau sinh theo Apgar 5 phut

De}ngatNang de}CK

n - p(X ± SD)

Ngat nhe 8 544,25±388,64

Ngat vira 14 1187,71±653,55 <0,05

Ngat nang 5 1995,6±86,96

Nh~n xet: Nong dQ CK tang lien quan c6 y nghTa thong ke veri mire dQ nang cua ngat (p<0,05).

Bang 5. M6i lien quan gitra sir thay d6i nong dQ CK-MB voi mire dQ ngat sau sinh theoApgar 5 phut

De} ngatNang de}CK-MB

n - p(X ± SD)

Ngat nhe 8 9,65±6,9

Ngat vira 14 24,53±11,04 <0,05

Ngat nang 5 36,5±9,15

Nh~n xet: Nong dQ CK-MB tang lien quan c6 y nghia thong ke voi mire dQ nang cua ngat(p<O,Ol).

14 Tap chi Y DU·Q·C hoc - Truong f>l.li hoc Y DU·Q"c Hu~- sa 8 T

Bang 6. M6i lien quan gitra su thay d6i nong dQ Troponin T voi mire dQ ngat sau sinh theoApgar 5 phut

DQ ngatNang de}Troponin T

TAng~O,Olng/mi >O,Olng/mi

Ngat nhe 3 5 8

Ng?t vita ° 14 14It;

Ngat nang ° 5 5

~tTBng 3 24 27

8,01 <0,05

Nh~n xet: Nong dQ Troponin T tang lien quan co y nghia thong ke voi mire dQ nang cua ngat(p<O,05).

4.BANLU~N4.1.D~c di~rn nhom nghien ciru

Trong nhorn nghien ciru chung toi gom27 tre sa sinh ngat co tuoi thai trung binh36,3±3,9 tuan, can nang trung binh 2420±841gam, nam/nir (12/15) la g~n tU011g dU011gnhau. Mire dQ ngat theo chi s6 apgar 5 phutchu y€u la ngat vita (51,9%), ngat nang chiemth§p nhfrt co 5 tnrong hop (18,5%).4.2. S'! bi~n dAi nang de} CK, CK-MB vaTroponin T trong mall iY tre giai doan sosinh som co ngat:

Trang nghien ciru.cua chung toi tai bang 3cho thfry nong dQ CK, CK-MB va Troponin Ttrong mau cua nhom tre ngat d~u tang len rfrtcao so v61 nhorn chirng voi sir khac biet co ynghia thong ke p<0,05.

Nong dQ CK toan phan va CK-MBtang cao hful 0 nhorn tre ngat tU011g irng la1146,7±711,7U/L, 22,15±13,78ng/ml so voichirng Ia 145,6 ± 26,4YU/L, 2,77±1 ,08ng/mI,p<O,O1. K~t qua nay ciing tU011g W 0 nghienciru Nguyen Tfrn Phu cho thay nong dQ CKroan phan va CK-MB tang cao 0 nhorn ngatco tonthuong tim cling nhu nhom ngat khongt6n thuong tim so voi nhorn chirng [3].

Nghien ciru chung toi ghi nhan nongd(> Troponin T 0 nhorn tre ngat tang cao(O,099±O,08ng/ml) so voi nhorn chirng(:::O,OIng/mI)voi mire p<0,05. Di~u nay phuhop voi k€t qua Costa S va cong su nghien ciru

Tap chi Y DU'Q'c hoc - Truong D~i hoc Y DU"Q"c Hu~ - S6 8

cho thay nong dQ Troponin T tang cao 0 29tre ngat la 0,15 (0,1-0,23) so voi 30 tre nhomchirng la 0,05 (0,02-0,23) voi p<O,OI va tangcao co y nghia thong ke 0 nhorn co dfru hieut6n thU011g co tim [8].

Theo Adcock L. M, 'n6ng dQ CK - MB vaTroponin T tang cao trong ngat [4]. Boo N.Y da ghi nhan nong dQ CK-MB va TroponinT tang cao 0 50 tre du thang co kho tho dongat trong 24 gio d~u sau sinh [5]. Correale M[7], Tarkowska A [14] d~u chi ra rang nong dQtroponin T tang cao 0 tre co tinh trang ho hfrpnang do ngat, va lien quan d~n bieu hien thieumau co tim tren.dien Him d6. Fonseca E nghienciru thay rang nong dQ CK cung voi CK-MBtang cao 0 nhorn tre kho tho do ngat so voinhom tre khong ngat va dien Him d6 co bieuhien thieu mau co tim trong nhom co CK-MBtang [9].

Theo nghien ciru cua Rajakumar P. S,nong dQ CK-MB tang rfrt cao 0 nhorn trengat (I21±77,4U/L) so voi nhorn chirng(28,2±20,2U/L), tuong tu Troponin T la0,22±0,28 so voi 0,03±0,0 18 [11].

Szymankiewicz M nam 2005 nghienciru cho thay nong dQ troponin T trong24 gio tuoi tang cao 0 nhorn 39 tre ngat(0,141 ±0,226 ng/ml) so voi 44 tre du thangkhoe rnanh (0,087±0, Ill) va chi ra rang voimire TnT>O,l ng/ml la co t6n thU011g co tim[12]. MQt nghien ciru khac cua ong nam

15

2006 tren 21 tre de non va 22 tre d6i clurngciing cho k~t qua nrong nr khi th~y nong dQCK-MB va Troponin T tang cao a nh6m ngatso voi chimg: CK-MB 18,35±14,8Ing/ml so v61II ,09±5, 17 voi p<0,05; TnT 0,287±0,190ng/mlso voi 0,II2±0,099 v61 p<O,OI [13].

Nhir vay, clnrng to nong dQ CK, CK-MBva troponin T tang cang cao cang c6 y nghia v~mat t6n thirong co tim v~ vi th~ cling nhtr Himsang do h?u qua v~ thi~u khi lau trong ngat.4.3.M5i lien quan gifra Sl}' thay d&i nAng d{)CK, CK-MB va Troponin T vo; mire d{)ngat

Qua nghien ciru, chung toi thay rang c6moi lien quan c6 y nghia thong ke giira SlJ giatang nong dQ CK, CK-MB va troponin T voidQ nang cua ngat (bang 5, 6, 7).

K~t qua nghien ciru chung toi cling phuhop voi Nguyen T~n Phu khi nghien ciru r6iloan tim rnach a tre sa sinh ngat cling cho thayc6 m6i lien quan c6 y nghia thong ke giira miredQ tang CK va CK-MB voi mire dQ nang cuangat tinh theo apgar [3].

Theo nghien ciru cua Boo N. Y nong dQTroponin T tang cao a tre c6 tinh trang ngatnang da chet hem nhirng tre da song s6t [5].

Clark S. J cling thay rang nong dQ CK vatroponin T tang cao a nh6m tre ngat nang [6].

Tarkowska A [14] chi ra rang nong dQTroponin T tang cao a tre c6 tinh trang h6hap nang do ngat, va lien quan d~n bieuhien thi~u rnau co tim tren dien tam d6.Rajakumar P. S cling thay rang nong dQCK-MB va Troponin T tang r~t cao a nh6m

tre ngat so voi nh6m chirng va lien quan d~nmire dQ nang ngat [II].

Nhir V?y qua nghien CUll chung toi chothay nong dQ CK, CK-MB va Troponin Ttang c6 mci lien quan voi mire dQ nang cuangat luc sinh. Gonzales da nghien ciru lamsang va gia tri tien do an nhirng r6i loan timmach a tre ngat cho thay c6 SlJ suy giamchirc nang tim mach va than kinh do thieukhi [10]. Khi tre ngat nang, SlJ thi~u khi diraden t6n tlurong da co quan va cac r6i loanchuyen h6a, oxy kh6ng du cung cap cho timva nao dira db thi~u mau cc tim nen nongdQ cac chat nay tang cao d~c biet la CK- MBva troponin T neu mire dQ t6n thuong co timnhieu se tang cao hon. Viec dinh hrong cacmen nay giup phat hien som tinh trang thieurnau co tim nharn tien hrong va dir phong

sorn [6], [7].

5. KtT LU~N1. Nong dQ CK trung binh a nh6m tre ngat

la 1I46,7±711,7U/L cao hem h~n so voi nh6mchirng (I 45,6±26,4) voi p<O,Ol.

Nong dQ CK-MB trung binh a nh6m trengat la 22,15±13,78ng/ml cao hem h~n so voinh6m chirng (2,77± 1,08) voi p<O,O I.

Nong dQ Troponin T trung binh a nh6mtre ngat la 0,099±0,08ng/mI cao hem so voinh6m chirng (SO,O I) voi p<0,05.

·2. Nong dQ CK, CK-MB va Troponin Ttang lien quan c6 y nghia thong ke voi mire dQnang cua ngat.

TAl LIt::UTHAM KHAo

1. Kattwinkel J (2006), T6ng quan va nguyen Iy

h6i sire, H6i SL!'C cdp ctru sa sinh, ban djch,

nha xuat ban Y hoc, tr. 1-9. 4.

2~ Ngat o' tre so sinh, H6i .nrc va cham sac so',sinh ndng cao, nha xuat ban Dai hoc Hu~, tr.

51-56.

3. Nguyen T~n Ph\J (2005), Nghien ctru 11191 sc5 5.rc5iloan tim much a Ire sinh ngat, Luan an

16

chuyen khoa dp " chuyen nganh nhi tirn

mach, Truong f)~i hoc Y Hu~.

Adcock L. M, Papile L. A (2008), Perinatal

asphyxia, Manual of neonatal care,Lippincott Williams & Wilkins, a Wolters

Kluwer, Philadelphia, pp. 518-528.

Boo N. Y, Hafidz H, Nawawi H. M,

Cheah F. C, Fadzil Y. J, Abdul-Aziz B. B,

Tap chi Y DU'Q'choc - Truong D~i hoc Y Dune Hu~ - sa 8

6.

7.

8.

9.

uan den

toi choponin T~ng cuairu lam

giarnthieu

hidua'i loan

o timI nong-MBotimg cacthi€uhong

ngatom

tn~veri

omveri

Td<)

rn

al

s

Ismail Z (2005), Comparision of serumcardiac troponin T and creatinine kinaseMB Isoenzyme mass concentrations Inasphyxiated term infant during the first 48h oflife, Journal of pediatrics and Child health,11(7), pp. 33-337.

6. Clark S. J (2006), Understanding cardiactroponin T in the newborn period, Americanjournal of respiratory and critical caremedicine, 173, pp. 816-817.

7. Correale M, Nunno L, leva R, Rinaldi M,GianFranco Maffei G. F, Magaldi RandBiase M. D (2009), Troponin in Newbornsand Pediatric Patients, Cardiovascular& Hematological Agents in MedicinalChemistry, 7, pp. 270-278.

8. Costa S, Zecca E, De Rosa G, De Luca D,Barbato G, Pardeo M, Romagnoli C (2007),Is serum troponin T a useful marker ofmyocardial damage in newborn infants withperinatal asphyxia?, Acta Paediatr, 96(2),pp.181-184.

9. Fonseca E, Garcia-Alonso A, Zarate A,Ochoa R, Galvan R. E, Jimenez-Solis G (1995),Elevation of activity of creatine phosphokinase(CK) and its isoenzymes in the newborn isassociated with fetal asphyxia and risk at birth,ClinBiochem, 28(1), pp. 91-95.

Tap chi Y Duo'c hoc - Truong D:;ti hoc Y DU'Q'c Hu~ - s6 8

10. Gonzalez de Dios J, Moya Benavent M,Castano Iglesias C, Herranz Sanchez Y(1997), Clinical and prognostic value ofcardiovascular symptoms In perinatalasphyxia, An Esp Pediatr, 47(3), pp. 289-294.

II. Rajakumar P. S, Vishnu Bhat B, Sridhar M.G, Balachander J, Konar B. C, Narayanan Pand Chetan G (2008), Cardiac enzyme levelsIn myocardial dysfunction In newbornswith perinatal asphyxia, Indian Journal ofPediatrics, 75(12), pp. 1223-1225.

12. Szymankiewicz M, Matuszczak- WleklakM, Hodgman J. E, Gadzinowski J (2005),Usefulness of cardiac troponin T andechocardiography in the diagnosis of hypoxicmyocardial injury of full-term neonates, BioiNeonate, 88(1), pp. 19-23.

13. Szymankiewicz M, Matuszczak-WleklakM, Hodgman 1. E, Gadzinowski J' (2006),Retrospective diagnosis of hypoxic myocardialinjury in premature newborn, J Perin at Med,34(3), pp. 220-225.

14. Tarkowska A, Furmaga-Jablonska W (2006),Review on the diagnostic role of cardiactroponins in pediatrics, Annales universitatisMariae Curie- Sklodowska lublin- Polonia,31(2), pp.1049-1 051.

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