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Ngọc BÁO CÁO LUẬN VĂN
Ngọc BÁO CÁO LUẬN VĂN
T VN
TNG QUAN
I TNG & PHNG PHP NGHIN CU
KT QU V BN LUN
KT LUN
T VN
X gan: bnh l tiu ha thng gp
Mt trong nhng nguyn nhn gy t vong hng u M
Nhim trng v NKDMB: bin chng nghim trng, hay gp
X gan + nhim trng: nguy c t vong cao gp 4 ln
Tnh trng suy gim min dch, thiu ht b th
C3, C4 huyt thanh, LDH dch bng: gp phn
chn on nhim khun dch mng bng
Cha c nghin cu ti Vit Nam
Mc tiu
1
2
nh gi nng LDH dch mng bng,
C3, C4 huyt thanh trc v sau iu tr
bnh nhn x gan NKDMB
TNG QUAN
LCH S NGHIN CU
X gan
Hi chng
suy t bo gan
Hi chng
tng p lc
tnh mch ca
Nhim khun
mng
bng
LCH Sdch
NGHIN
CU
nh ngha
S nhim khun ca
DMB m khng c
bng chng ngun
nhim trong bng
c th iu tr c
bng ngoi khoa
Triu chng
au bng
St
Gim nhu ng rut
i tin phn lng
Cm ng phc mc
Hi chng no gan
Hi chng gan thn
Chn on
BCNTT dch
250 TB/mm3
Cy DMB tm
thy vi khun
Albumin
iu tr
Chc tho
iu tr khc
European Association For The Study Of The Liver (2010). EASL clinical practice guidelines on the management of
ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. Journal of hepatology, 53 (3), 397-417.
C ch bo
v ca dch
c trng
Hot ng
thc bo ca
h lin vng
ni m
S bin i
h thng
min dch
Tng tnh
thm ca
rut
C ch
bnh sinh
S lan truyn
ca vi khun
Qu pht vi
khun ng
tiu ha
B th, C3, C4
Gan: sn xut hu ht cc
thnh phn b th
Vai tr p ng MD,
chng nhim khun
Hot ha b th: 3 con
ng
Nhiu nghin cu: s suy
gim C3, C4 BN x gan
NKDMB
Shalabya SA: C3 45
mg/dl c hiu 100%,
nhy 85%
Adreu M: C3< 80: yu t
tin on cho t NKDMB
u tin
ng
thay th
LDH (lactat
dehydrogenase)
LCH S NGHIN CU
Gii phng t tn thng
ca nhiu t chc
Bnh l gan: tng cao trong
gan b nhim c; tng
nh/bnh thng vi tn
thng mn tnh, x gan
LDH dch: phn bit dch
thm dch tit
Tng trong NKDMB
T s LDH dch/mu:
Lee HH: 0.4: nhy 76%,
c hiu 71%. Nu thm
BCTT> 240 H 100%
El-Touny v CS: >0.6: ch
s gin tip ca NKDMB
36 BN x gan NKDMB, iu tr ti
khoa Tiu ha BV Bch Mai,
t 11/2015 10/2016
Nghin cu theo di dc
PP thu thp
s liu
S nghin cu
Bnh nhn x gan
C c trng
C nhim khun DMB
LDH dch mng bng
C3, C4 huyt thanh
Mt s c im
LS, CLS
MT2
MT1
KT QU V BN LUN
Mt s c im chung
N
86.1%
Nam/n: 6.2
Nam
33.3%
12
10
8
6
4
2
0
40
41 50
51 60
61 70
>70
Mt s c im chung
Biu hin
S BN T l (%)
St
au bng
i tin phn lng
Cm ng phc mc
Hi chng gan thn
Bnh no gan
24
20
12
2
7
14
66.7
55.6
33.3
5.6
19.4
38.9
El-Motasem 2015
Hui-quiong 2009
Li Linghua 2006
B: 11.4%
146.73 141.01
13.3
689
169
839
0.05
1.56
LDH dch/mu
0.53 0.42
84.37 33.65
67.63 46.18
51.14 21.24
49 19
43 20
48.15%
22.2%
78.8%
Mc gim BCTT
U/l
LDH
Trung bnh
53.81 21.02
C4 (mg/dl)
13.03 6.36
100%
90%
80%
70%
71%
60%
50%
40%
30%
29%
10%
0%
C3
Gim
30
93.5%
20%
C4
Bnh thng
Bird G (1992), n = 11 :
74 (CI: 56-92) & 20 (CI: 16-24)
G.Bird 1992: mt s BN
x gan vi tn thng
vim gan ru m
khng NKDMB c th
c tng nng b th
JJ Fromkers 1982: hot
ha ch yu ng thay
th
C4 (mg/dl)
80.15 55.27
73.2 26.4
16.9 6.6
81.2 2.4
16.9 0.66
28 (CI: 20-36)
117 46
21 11.4
S BN (n)
13
T l (%)
41.9
45
18
58.1
< 80
29
93.5
80
6.5
C4 (mg/dl)
Andreu M
1993
Guarner C
1997
Danulescu
RM 2014
Tiu cu
C3 huyt thanh
C3
Tng quan ng bin vi s lng tiu cu
(r = 0.505, p < 0.01)
Tng quan nghch bin vi im Child Pugh
(r = - 0.432, p = 0.017)
S thay i sau t iu tr
Mc gim BCNTT
Gi tr tuyt i
(G/l)
Gi tr tng i
(%)
Trung bnh
3.573 7.641
0.18
32.77
70.44 27.95
16.51
98.97
32
363
165
536
0.12
LDHLCH
dch
S mng
NGHINbng
CU
Runyon
BA (1985)
Trc
Sau
Cao
nht
53.67 25.37 22
nht
135
Trung bnh
C3 (mg/dl)
C4 (mg/dl)
12.88 6.8
33
p
p1 = 0.672
p2 = 0.866
KT LUN
LDH DMB: 146.73 141.01 U/l.
T s LDH DMB/huyt thanh: 0.53 0.42
51.85% BN c t s 0.4, 22.2% trn 0.6
C3, C4 huyt thanh: 53.81 21.02 v 13.03 6.36 mg/dl
93.5% BN c C3 gim, 29% c C4 gim
C3, C4 nhm Child Pugh C thp hn nhm Child Pugh B
C3 tng quan ng bin s lng tiu cu, nghch bin
im Child Pugh
LDH dch tng quan nghch bin mc gim BCTT dch (%)
LDH dch mng bng sau t iu tr gim khng c
ngha thng k
Khng c s khc bit C3, C4 trc v sau iu tr
T s LDH MDB/huyt thanh gim