Nồng độ homocystein huyết tương ở bệnh nhân lọc máu chu kỳ được bổ sung Acid folic và Vitamin nhóm B

Nguyen Thj Hoa vd Dtg Tgp chi KHOA HQC & C6NG NGHE 165(05): 37-42

N6N G fib HOMOCYSTEIN HUY£ T TlTOfNG 6 BEN H NHAN LOC MAU

CHU K t BXrOC BO SUNG ACID FOLIC VA VITAMIN NHOM B

Nguyin Thi Hoa'*, Hodng Nggc Kham*

Duong Hlng Thdi',Tr^n Bao Nggc'

'Trudng Dgi hgc Y Dugc - DH Thdi Nguyen.

^ Benh vi?n A Thdi Nguyen

TOM TA T

Tdng homocystem (Hey) huylt tuong rat thu6ng g5p d benh nhSn suy thgn man Igc mdu chu ky

(LMCK) vd Id ylu tl gia tdng nguy co bfnh tim mgch. Vi vdy, dieu Ui giam Hey huylt tuong la rat

cdn thiet. Myc tieu: Ddnh gia kit qua lam giam nlng dd homocystein huylt tuong d BN suy than

mgn LMCK bSng bo sung acid folic, vitamin BI2, vitamin B6 Dli tu-OTig vd phuo'ng phap

nghien cfru: nghien ciiu md td, cdt ngang Uen 63 BN suy th|n man Igc mdu chu ky (BN STM

LMCK), chia thinh 2 nhdm: nhdm 1 gim 32 BN STM LMCK don thuin. Nhom 2: ^Im 31 BN

STM LMCK kit hgp vdi bo sung vitamin. Kit qud: Sau 3 thdng LMCK don thudn, ndng df Hey

huylt tucmg Id 39,0±I9,4 \imo\lL, khong c6 su khic biet so vdi thdi dilm ban dlu (38,4±20,5

^mol/L). Sau 3 thdng LMCK ket hgp vdi bl sung vitamin, nlng do Hey huylt hrong Id 28,8±13,2

^mol/L, gidm c6 y nghta so vdi thdi diem trudc bo sung vitamin (39,0±17,0 |imol/L). So vdi thdi

dilm trudc bl sung, nlng df Hey huylt tuong giam trung binh Id 10,22±5,96 |imol/L, gidm

28,4±6,9%. Kit ludn: Bl sung vitamm c6 hifu qud Idm giam nong df Hey huylt mong.

Tir khda: suy thgn mgn, homocystein, Igc mdu chu ky, binh lim mgch, viim man tinh

DAT VAN DE

Tang homocystein (Hey) huyet tuong la mgt

trong nhii'ng ylu to nguy ea bfnh tim mach.

Hey Id aeid amin khong can thiet doi vdi eo

thf, dugc hinh thdnh tir qua trinh chuyen hda

ciia methionin. Hey duge chuyen hda theo hai

eon dudng Id vgn chuyin nhdm sulfua va

methyl hda. Qua trinh methyl hda can ca chat

la aeid folic, dugc xiic tdc bdi enzym

methionine synthetase c6 vitamin B^ la chat

cung phoi hgp vdi enzym nay. Phdn dng vgn

chuyen nhdm sulfua can enzym cystathion

synthase cd coenzyme la vitamin B^.

0 BN LMCK thudng cd thilu hyt vitmin 8,2

do tinh trgng dinh duang kem. Hon nQ'a,

ngudn thiic an giau vitamin B12 thudng cd

hdm lugng kali eao nen rlt nguy hilm doi vdi

BN, vi vay BN LMCK thudng phai hgn ehe

nhirng thiic an ndy. Vitamin B]2, acid folic la

chdt cd trgng lugng phdn tii trung binh nen

cung cd thi bi Ioai bd qua Igc mau d nhiing

BN sii dung mang lge cd hifu suat sieu Igc

cao. Vi vgy, nong df Hey huylt tuang thudng

tang d BN LMCK [9].

Tel 0982502072. Email: hoanguyeniM74®yahoc

Tang Hey cd lifn quan den xo viia mach va

lam gia tdng nguy co benh tim mgch. Vi vdy,

vifc dieu trj gidm Hey d nhiing BN ndy Id rat

can thiet de gidm nguy co benh tim mach. 0

cgng dong, viee dilu tri giam 25% Hey lien

quan din giam 11% nguy co benh mach vanh

vd gidm 19% nguy ca dot quj [7].

Trfn thf gidi cd kha nhieu nghien ciiu vf hieu

qua ciia viec dieu trj gidm Hey bdng acid

folic, vitamin Be, vitamin B12 [3], [ 5], [7].

Nghifn Cliu cua Azadibakhsh ve hifu qua

dieu tri giam Hey cua acid folic, vitamin B12

dan thudn hoae kit hgp, ket qua cho thdy viec

su dyng kit hgp aeid folic va vitamin B12 co

hieu qua giam Hey han so vdi viec su dyng

don thuan [3]. Ngodi acid folic vd vitamin

B12, tde gia Heinz cdn bo sung them vitamin

Be trong thdi gian 6 thdng d BN STM LMCK,

kit qua cho thay sau bl sung cac vitamin tren

trong thdi gian 6 thang, hifu qud dieu tri giam

Hey dugc cdi thifn rd rft [5].

Tgi Vift Nam, tdc gia Huynh Van Nhugn

(2008) da nghien ciiu vl hifu qua cua dilu tri

giam Hey d BN STM LMCK. Tuy nhien, thdi

gian bfl sung vitamin trong nghien ciiu tren la

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