1.
TRVONG £)~I HQC Y DVQC.HUE
HUE UNIVERSITY OF MEDICINE AND PHARMACY

2.
Tong bien t~p: GS.TS.TRAN HCfu DANG
Ph6 tong bien t~p: PGS.TS.vaTAM
H91 DONG KHOA H9C CUA T~P CHi
Trinh bay bia: Nguyen f)ang Tu
Uy vien Ban bien t~p:
- Va Tam
- Huynh Van Minh
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ThU' ky bt-en t~p:
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Banthu ky-tr! 51!:
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- Linda Murray
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Tong thu ky
Pho tong thu ky
Pho tong thu ky
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- PGS.TS. Nguyen Dung
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-PGS.TS. Nguyen Viet Nhan
- GS.TS. Bui Due Phu
- PGS.TS.Va Tam
- TS. Nguyen Minh Tam
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- ThS. BS. Bui HuyThai
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- PGS.TS.Va Van Thanq
- PGS.TS.Truong Thi Dieu Thuan
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3.
TRVONG £)~I HOC V DV<;SC HUE
HUE UNIVERSITY OF MEDICINE AND PHARMACY
, ,
TAP CHI. -
Y Dildo 1100• •JOURNAL OF MEDICINE AND PHARMACY
So 14
2013
Hue, 4 - 2013

4.
9 Nghien ClTUnong dQ lipid mau va tinh trang gan nhi~m mo' 0' tre thira can-bee phi tai 64-73
khoa Nhi, Benh vien Trung irong HuS
Study on the blood lipid concentrations and hepatic steatosis in overweight-obese
children 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 74-80
man giai dean cu6i thfim phan phuc mac
The relationship between weekly clearance of urea and creatinine in end-stage renal
disease 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 81-86
grandiflorai thu hai tai Quang Tri
Constituents of n-hexane fract ion extracted from Uvaria grandifiora collected from
Quang Tri province
t.e Thj Bich Hien, u Thj Hong O(lIIh, H6 Vi?t D1I'C
va Quoc Hung, Nguyin Thj Hoiti
................................................. __ __ -_ -..-..
12 Nghien clJ'L1gia tri tien luong ClW nong dQ hs-CRP, fibrinogen, bach cau, t6c de) 15ng 87-94
mall a benh nhan tai bi6n mach mall nao giai doan cap
Study 011 the prognosis value of hs-CRP. fibrinogen, white blood cell, blood
sedimentation 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 95-100
Subtype 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 101-109
d~LIthai k)
Severity and quality of life among pregnant women suffering nausea and vomiting
during thefirst 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 10-117
Evaluation of the effectiveness of acupuncture, massage and traditional medicine
remedy in neck shoulder pain
Nguyin Thj Tim
.................................................. - - - ' ,........ . .
16 Nghien ciru xac dinh kieu gene cagA va vacA cua Helicobacter pylori 0' benh nhan 118-125
LIng tlnr da day
Determination of Helicobacter pylori cagA gene and vacA genotypes in patients with
gastric cancer
Ie Quy Hung. Hi! Thj Minh Thi
17 B6 tuc kien tlurc sau dai hoc: 126-132
Cap nhat di~u tri hQi clurng ruot kich thich
Update 011 the management of irritable bowel syndrome
Trdn Van Huy
18 Thong tin Y Duoc 133-134
Nguyen Thi Anh Phuong
4 Tap chi Y Dune hoc - Truong f)~ihoc Y Dun'c Hu~- S6 l~
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5.
NGHIEN cuu NONG DO LIPID MAu vA TiNH TRANG
GAN 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~t
D~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~nh
tai cac 11L1'6cchau A hien nay, 6 Viet Nam, beo phi 0' tre em tuy da OLl'Q'cbao dong nhung van chua c1trqc
quan 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 can
It. le te. C6 bang clurng cho thAy co m6i lien quan chat che giu'a beo phi voi roi loan lipid mau V3 gan
nhiern me 6' tre em rna chinh nlnrng r5i loan do lam anh huong o~n sire khoe, sir phat tri~n th.~111chili
tinh mang cua tre em. Muc tieu cua o~ tai nhiim khao sat nong oQ lipid mau va tinh trang gan nhieml1lo
6' tre b] thua can-bee phi. D6i tU'C;rng va phuo'ng phap nghicn ctru: Tre tlura can-bee phi (TC·- BP)tiI
2 o~n 15 tu6i o~n kharn tai khoa nhi benh vien Trung Uong Hu~ trong tho'i gian khoang tir thang 5 niim
20 II o~n thang 6 nam 2012. T6ng s6 benh nhan duoc chon la 40 tre. Phuong phap nghien ciru: m6ta
dlt ngang. Tre trong nghien ciru se duoc lam xet nghiem Lipid mau va sieu am gan d~ danh gia tinh tr~ng
gan 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 (1i
nhom chung, 37,5% tre co tang cholesterol mau; 50% tre tang triglycerid (TG), 25 % tre giam n6ngoQ
HDL-C mau; 17,5% tre TC - BP trong nghien cuu co tang nong oQ LDL-C mau. Tinh trang gan nhi~m
mO' (GNM) chiern 40% tre TC-BP, Chu yeu la GNM oQ I (chiem 81,3%), Chi co I truong hop c6 tlnh
trang GNM oQ III (6,2%).TY I~ G M tang len dfin theo tuoi tuy nhien sir khac biet khong co y nghia
thong ke (p>0.05), Tre beo phi trung tam co ty I~ G M cao hon beo phi ngoai vi nhung chira co y nghia
thong 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 co
m6i 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
Abstract
STUDY ON THE BLOOD LIPID CONCElTRATIONS AND HEPATIC STEATOSIS IN
OVERWEIGHT-OBESE CHILDREN AGED 2-15 YEARS AT PEDIATRICS DEPARTMENT,
HUE CENTRAL HOSPITAL
Nguyen Thi(II
Dept. of Pediatric. Hue University of Medicine and Pharmacy
Background: Nowadays, childhood obesity is the 2"d
priority health issue in the prevention and control
of diseases in Asian countries, In Vietnam, obesity is alarming in children but not interested appropriately
by 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
64 Tap chi Y DU'Q'choc - Truong Dl;li hoc Y DU'Q'cHu~ - S6 U
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frequently, however, in children they are much fewer and rather sporadic. There is evidence of a close
association 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 hepatic
steatosis in overweight/obese children. Subjects and Methods: Overweight/ obese children aged 2 to
15 years who had a clinic visit at the Pediatric Department, Hue Central Hospital from May 20 II to
June 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 hepatic
steatosis. Results: There is a change in concentration of all lipid parameters in overweight/obese group
compared to the control group. 37.5% of children with hypercholesterolemia; 50% of children with
increased blood triglyceride. 25% of children with low blood levels of HDL-C; 17.5% of children with
elevated 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 age
but the difference was not statistically significant (p> 0.05). Central obese children showed a higher
rate of fatty liver than peripheral obese children but there was no statistical significance. There is an
association between blood levels of triglycerides, cholesterol and fatty liver. Conclusion: The study
showed disturbances in blood lipid concentrations and fatty liver in overweight/obese children, and a
correlation between blood levels of triglyceride and cholesterol with fatty liver status.
Key words: Overweight-obesity. hepatic steatosis. disturbances, blond lipids
I.D~IVANDt
Beo phi tre em hien nay ail tro thanh vfin d~
sue khoe uu tien tlur 2 trong cong tac phong chong
cac benh tai cac ruroc chau A va dang duoc xern
nlur lit mQt thach thirc 16n d6i voi dinh dirong, sire
khoe 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 vfin
d~lien quan d~n beo phi a nguoi lon urong d6i
nhi~linlurng cac nghien ciru v~ v~n d~ nay O·tre
em eon it, le te. Co bang chirng cho th~y co moi
lienquan chat che giira beo phi voi r6i loan lipid
mallo' tre em ma ch inh nhlrng r6i loan 00 lam anh
huong d~n sire khoe, S~Tphat tri~n tham c.hi la tinh
mangcua tre em r8J.
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 Hui
2. 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(fU
2,1. 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. benh
vien Trung Hong Hu~ trong thoi gian khoang nr
thang 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 mau
va gan nhi~m mo.
Tieu chu~n ch~n doan TC - BP va phan mire
d() ciia TC - BP: D~Tatheo ph an loai cua WHO
voi quan the tharn chieu theo Chu~n tang tnrong
cua 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 nang
Tieu 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 nay
chua co tai lieu nghien ciru nao v~ nong dQ Lipid
65

7.
mall binh thuong o' tre em Viet Nam. Cac nghien
ciru cua cac tac gia trong mroc v~ r6i loan Lipid
rnau a tre em phan nhi~u dua vao tieu cllll~n cua
Nelson 2007. Vi vay, toi chon nhorn chung d~
lam gia tri tham chi~u danh gia r6i loan Lipid
mau. Nhung tre chon vao nhorn clurng se co dO
tuoi, gioi tuong duong tre nhom TC-BP, co chi
s6 BMI trong gioi han binh thuong. Nhirng tre
ducc chon vao nhorn chung la nhC'rng tre di~u
tri tai Khoa Nhi BVTW Hu~ vi benh s6t sieu
vi, hoac tieu chay cap khong sir dung thuoc va
khong co nhirng benh kern khac anh huang d~n
Lipid mau, Xet nghiem Lipid mall khi tre khoi
benh. 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 do
diroc cua nhung chi s6 nay o' nhom TC-BP lon hon
gia 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§p
11O'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) duoc
xac djnh khi WHR > 1 a tre nam va WHR > 0,85 a
tre nC'r.6 tre < 9 t1l6i thi chi s6 nay >1.1 [I]
2.2. Phuong phap nghien ciru: Nghien clru
mo ta cat ngang.
- CIU!,l ciJ m/ill: chon vao nghien ciru t§t ca
nhirng benh nhan TC - BP tir 2 d~n 15 tu6i vao
khoa nhi benh vien Trung Uong Hu~ trong khoang
thai gian nr thang 5/20 I I d~n thang 6/2012 thoa
man tieu chuan chon benh 6' tren, tong s6 benh
nhan duoc chon 40 benh nhan.
- TIIlI ,"(ip 11l{1Il: Tre du tieu chuAn chon benh
se duoc kharn lam sang. lam xet nghiem lipid
mau va lam sieu am gan d~ danh gia tiuh trang
gan nhi~m mo. Danh gia 'r6i loan lipid mau b~ng
each so sanh voi lipid mau cua nhorn clnmg. Danh
gia I11Lrcdo gan nhiern m6' tren sieu am dira theo
Hagen - Ansert [3].
3. KET QUA
3.1. Danh gia S}' bi~n d&i lipid mau va tinh trang gan nhiern 010' 0' tre thira can-bee phi
3.1.1. 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 giai
o' 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 tre
beo 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 nhorn
Tu6i 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 < 0,01
Chung 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 t1l6iso
voi nhom clurng (p < 0,05)
66 Tap chi Y DU'Q'choc - Truong Dai hoc Y DU'Q'cHu~ - S6 I~
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Bang 3.3. T~n suat tang cholesterol toan phan/mau a tre thira can-bee phi theo tuoi
;u6i
Tang 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 c10trung 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
Tu6i
Tang Triglycerid rnau
p
n %
< 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(vng
TuOi 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 va
nhom chirng.
Tapchi Y Dune hoc - Truong D~i hoc Y OU'Q:c Hu~ - sa I~ 67

9.
Bang 3.7. T~n SlI~tgiam HDL-C mall 0-tre tlura can-bee phi theo tuoi
Tu6i
Giarn HOL-C
p
n %
< 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 giam
HDL-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 khac
biet 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 chwng
Tu6i
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 mau
Tu6i 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~

10.
3.1.2. Tinh trung gall Illtilm mii iJ tre thica ciin-beo pili
Bang 3.11. T~n 511~tva Inire oQ gan nh i~11l1110'(ytre TC - B P
Tinh tranq
Kh6ng
C6 gan nhiem mOova mLPcdQ
gan 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 mOo
Tu6i 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~111mo' theo gioi
Gan nhiem mOo
Gi&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 p
MLPCdQ 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

11.
3.2:-MBi lien quan gifroatinh trang gan nhi~m mO'va lipid mau (ytre 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 s6
N6ng dQ trung binh cac chi s6 lipid mau (x ± SO mmol/l)
p
Nhom 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 va
Triglycerid 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 1
va 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 Khong
C6 12 8
KhOng 4 16
P < 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 rno
Giarn 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. B
4
mau
dn-
ngtr
th~
lAy
phu
pl1l1
t~ b
noi
mat
t6n
Lip'
tuy
mQt
ph~
ngh
troll
thaI
dQn
ngh
ph~
tre
toai
nay
tru
Tri
trfr
nel
ma
th~
ngl
T~

12.
M
va
M
4. BAN LU~N
4.1. Danh gia s,! bi~n d6i n6ng dQ lipid
mau va tinh trang gan nhi~m mO' i1 tre thira
can-beo phi
4.1.1. S{f hMIl (IJi Lipid nuiu: Hien nay a
mroc ta, clura co mot t ieu chuan nao danh cho
vi~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 theo
elson 2007, nhung tieu chuan nay danh cho
ngtrc)'inuoc ngoai do do k~t qua nghien ctru co
Ih~ bj anh huong vi vay chung t6i quyet dinh
I~y lipid cua nhorn chirng d~ so sanh co Ie se
phu hop hen.
Su: biill (IJi tluutlt pIt/ill cholesterol totin
pIt/ill: Cholesterol la thanh t6 chu yeu cua mang
I~ bao va cling la y~u t6 chinh d~ t6ng hop cac
noi t6 nlur glucocorticoid, aldosteron va acid
l11~t.Ngoai ra cholesterol can la nguyen lieu d~
t6ng hop nen vitamin DJ
trong co' th~, Nlur vay
Lipid co vai tro r~t quan trong d6i v6i CO' the.
IUyuhien chung chi co IO'i khi 0' trong CO' th~ voi
mo~hrong thich hO'P, neu bj r6i loan cac thanh
ph~1l nay se gay ra nhirng h?u qua xau. hirng
nghien ciru cho th~y khi ham luong cholesterol
trong mau qua cao thi se tich dong lai tren
thanh dong rnach vanh va d~n d~n benh XO' vita
dong mach vanh voi nhi~u bi~n chirng. K~t qua
nghien ciru cho thay co su bi~n d6i r6 ret thanh
phAn cholesterol toan phan a tre TC-8P. 37,5%
Ire trong nghien CLfLIco tang nong do cholesterol
loan phan, khong co S~I'khac bier v~ W r6i loan
nay theo cac hra tu6i (bang 3.2 va 3.3). ong do
trung binh cholesterol roan phan a tre TC - 8P
la 4,55 ± 0,87 mrnol/l, so voi nhorn clnrng 3,65 ±
0,68 11111101/1.K~t qua cua chung t6i cling nrong
nr 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 dir
tru cho cac hoat dong cua co the. Tuy nhien.
n~LI ham IU'Q'ng triglyceride trong co th~ cao
ma HDL-C thap hoac LDL-C cao thi cling co
Ih~ gay t6n hai khong nho cho sire khoe. hi~u
nghien 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 xau
d~n benh mach vanh, vi vay str phat hien r6i
loan TG rnau va tang TG a benh nhan beo phi
co y nghia trong viec phong ngira cac tai bien
tim mach [II]. K~t qua bang 3.4,va 3.5 cho thay
noug do trung binh triglycerid a nhom tre TC-8P
cao hon co y nghia so voi nhom clurng o' t~t ca
cac hra tu6i ngoai tnr a nhom tre < 6 tLl6i. 50% tre
TC-8P trong nghien ciru co tang triglycerid mall.
ong do trung binh Triglycerid a tre TC - 8P
la 2,66 ± 1.26 mmol/L, nhorn clurng la 1,55 ±
0,50 mrnol/L. Theo nghien ciru cua Hoang Thi
Tin nong dO trung binh triglycerid la 1,83 ±
1.2911111101 [5], cua Bui HLlI1gVi~t nong dO trung
binh triglycerid la 2.0±0.6 mrnol/I [6]. hu V?y
nong dO trung binh Triglycerid trong k~t qua cua
chung toi hoi cao hen cac tac gia khac, ngay ca
nong do trung binh triglycerid cua nhom clurng
trong nghien cuu cua chung toi cling cao hon so
voi gia tr] triglycerid binh thuong cua Nelson.
Phai chang do ch~ do an cua cac vung khac nhau
d~n d~n nong dO triglycerid mau khac nhau, dieu
nay dn nghien ClfLI them. Ty I~ tang TG trong
nghien cirucua chung toi thap hon so v6i cac tac
gia khac trong nuoc (Nghien ciru cua Nguyen
Th] 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 tai
nuoc ngoai. Di~u nay co Ie do tap quan an uong
cua d6i nrorig nghien ciru khac nhau cling nhir
sir dung tieu chi danh gia khac nhau.
Lipoprotein ty trong cao: duoc coi la loai
cholesterol "co IQ'i". K~t qua bang 3,6 va 3.7
cho thay: 25% tre TC-8P trong nghien ciru co
giarn nong do HDL-C mau, K~t qua cua chung
t6i tuong duong voi cac tac gia khac [3],[5],[6]
Lipoprotein ty trong t"lip: duoc goi la
cholesterol "co hai" do tich tu nhi~L1 0' dong
rnach. gop phan trong viec hinh thanh cac rnang
XO' vira dong mach khi~n dong mach ngay cang
hep di, can tro' tuan hoan mall. dJ d~n d~n cac
benh Iy tim mach cling nhu nhi~L1 bi~n chung
khac. H<;Ithap nong dQ LDL-C trong rnau la muc
dich chu yeu cua cac phuong philp di~L1 tri tang
71

13.
cholesterol mau. N~u nong d9 LDL-C trong mau
cao (> IOOmg/dl) se lam tang nguy CO" mitc cac
benh mach vanh, benh mach mall ngoai bien va
d9t 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 dQ
LDL-C mall. Khong co SI.J khac biet v~ tan suat
tang LDL-C theo lira tuoi tre bi TC-BP (p>0,05).
Nong d9 trung binh cua LDL-C tre TC-BP trong
nghien ciru la 2,25 ± 0,82 I11mol/1. Khong co su
khac biet co y nghia v~ nong dQ trung binh cua
LDL-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 111Qt
chi diem x§u cho tien luong sau nay: nguy co
hQi clnrng chuyen hoa, bien chirng tim mach. Vi
v~y can phai co k~ hoach tarn soar di~u tr] ngay
cho tre.
4.1.2. Tinh trang gall Illtiim mil ij Ire thira
ciin-beo phi: Tlnrong qua trinh nhi~m mo' xuat
hien khoang 3 tuan sau khi tac dong cua benh
nguyen va co th6 bien m§t khoang 6 ngay V6"ich~
d9 di~lI tr] t6t. N~u khong phat hien va kh6ng di~u
tri thi nr gan nhiem mo' don thuan co th~ dien tien
toi viern gan rno; xo gan va ung thir gan. K~t qua
cua chung t6i cho thay da s6 tre bi gan nhiern mo'
a I11UCdQ nhe nhung cling dii XU At hien GNM dQ
II, III a tre TC-BP. Vi v~y, viec tarn soat GNM a
tre 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 s6
m~lI con nho) nlurng ket qua cling cho thay tinh
trang gan nhiem mo' g~p t~n su§t cao hon o' tre bi
beo phi so voi tre thira din. Vi vay, dn chu y t~m
scat tinh trang GNM ngay khi tre chi moi bj thua
din va dira ra bien phap di~u tri cang sorn cang
tot. K~t qua cling cho th§y nhirng tre co ki~u bee
phi trung tam co tY I~ bi gan nhiem mo' cao hon
nhom 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 tre
em nhung theo nhi~u nghien Clru cho thAy khi tre
co ty s6 WRH cang cao thi nguy CO" bi GNM cang
tang. 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 Ajay
Duseja co 92% truong hop gan nhi~m mO"bj beo
phi trung tam [7]. Nghien ciru o' nguoi 10'ncua Bui
Thi Hoa ghi nhan gan nhiel11 1110"g~p nhi~u o' benh
nhan bee phi dang nam, trong do vong bung trung
binh o' benh nhan nam la 94,92 ± 6,47 ern, va benh
nhan 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 f6
ret nong dQ TG mau va Cholesterol roan ph~n/mall
o' tre co gan nhiem mo' (bang 3.16). Theo nghien
ciru cua G. Perseghin [9] cho thay co m6i lien
quan giira tinh trang tang TG rnau va gan nhiem
1110".K~t qua cua cluing toi cling tuong tir ghi nh~n
cua m9t s6 tac gia khac [2],[5].[9].
M~c du CO" ch~ gay gan nhiern mo' o· tre TC-BP
v~n clnra duoc bi~t mot each d~y du nlurng nhi~lI
tai li~lI dii cho thay co rnoi lien quan giira tang
TG va gan nhiem mo. Gan nhi~m mo' la 1ll9t qua
trinh tich tu TG duoi dang nhirng hat vi motrong
t~ bao gan.
V~~ tinh trang gan nhiem mo' co anh lurong d&n
ChlfC'nang gan, d~n W huy hoai t~ bao gan? D~ tra loi
call hoi nay dn phai co sir nghien cuu them.
5. KET LU~N
5.1. S" bi~n dBi lipid mau va tinh trang gan
nhi~m mO'it tre TC-BP
5.1.1. S{/' bi811ilJi Lipid nuiu
- 37.5% tre TC - BP trong nghien ciru co tiing
cholesterol roan phan. Co str tang mot each r6 ret
nong dQ cholesterol mau o·tre thira can - bee phi a
t§t ca cac nhorn tu6i so voi nhom clnrng (p < 0,05).
- 50% tre tlura din bee phi trong nghien ciru co
tang TG. Nong dQ trung binh triglycerid 0' nhom
tre TC-BP cao hon co y nghia so vo'i nhom chung
o' dt ca cac lira tu6i ngoai tnr a nhom tre <;: 6 tu6i,
- 25% tre TC-BP trong nghien ciru co giam
n6ng oQ HDL-C mall. Co str khac biet co y
nghla th6ng ke n6ng d9 HDL-CT 0' tre TC-8P
so v6'i nhom chlrng (p<O,OI), d~c bi~t 0' It'ra tu6i
ttr 6 tu6i tro' len,
T~p chi Y DU'(;rchQc - Tnn)"ng Dl.li hQc Y DU'Q'cHu~ - S6 l.t
- I
nong
5./
ciin-b
-4
Chu y
trurrn:
<..iNM
d() th
trang
(25%
thon
I.
2.
..,
.J.
4.
5.
6,
7,
T

14.
glly
.X
rem
oro
111a1I
lien
lien
iem
h~n
-BP
lieu
tang
qua
ong
d~n
. loi
an
ang
r~t
hi 0-
05).
CO
om
ung
roi.
iam
, )
BP
luoi
TAl LltU THAM KHAo
- 17,5% Ire TC - BP trong nghien cuu co tang
n6ng do LDL-C rnau.
5./.2. Till" trang gall I1hi€m mil if Ire thiro
ciill-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 I
inrong I1Q"P co tinh trang GNM dO 3 (6,2%).TY I~
GNM tang leu d§n theo tubi tuy nhien W khac biet
khong CO)' nghia thong ke (p>0,05)
- Tinh trang gan nhiern 1110'tang theo rrurc
cl9 tlura call- beo phi: 41,7% tre beo phi co tinh
trang gan nh i~111mo. nh i~u hon so voi tre thira din
(25%), Illy nhien W khac biet nay chua co y nghia
th6ng 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 cogan 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
t1l6ithira 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 gan
nhi~m rno, cao hon so vo'i tre beo phi ngoai vi
(33,3%) tuy nhien sir khac biet nay chua co y
nghia thong ke (p>0,05).
5.2. Lien quan tinh tn,m'g gan nhi~m mo' va
lipid mau
- Co su khac biet co y nghia thong ke v~ nong
do trung binh cac chi s6. cholesterol toan phan va
TG mall giira 2 nhorn co GNM va khong co GNM
0- tre TC - BP,
- Khong co W khac biet v~ nong do trung binh
cac chi s6 LDL-C va HDL-C mau giira 2 nhorn co
GNM 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