Professional Documents
Culture Documents
Tm tt
Mc tiu ti : Xc nh kch thc bnh thng
ca tuyn gip ngi trng hnh
i tng v phng php : 677 hc sinh v sinh
vin c tui t 15 - 23 ti Thnh Ph Hu , c
nng iode niu bnh thng, c kim tra siu
m tuyn gip vi u d 7,5 MHz theo phng
php ca R.Guterkunst .
Kt qu : Th tch thu phi ln hn thu tri
tuyn gip trong tui 15 - 23 c nam ln n.
( p: 0.05 - 0.001 ).
Kch thc tuyn gip : Th tch ton phn tuyn
gip ca nam v n theo tng tui ln lt nh
sau tui 15 l 10.44 2.79 cm3 v 10.53 2.88
cm3, tui 16 l 10.53 2.35 cm3 v 10.12 2.76
cm3, tui 17 l 12.82 2.58 cm3 v 12.82 2.58
cm3, tui 18 l 11.52 2.77 cm3 v 11.15 2.45
cm3,tui 19 l 12.08 2.89 cm3 v 11.59 2.37
cm3,tui 20 l 10.59 3.08 cm3 v 12.23 2.80
cm3,tui 21 l 11.83 2.94 cm3 v 11.24 2.94
cm3,tui 22 l 10.50 2.63 cm3 v 10.95 2.63
cm3 v tui 23 l 11.84 2.80 cm3 v 11.74
2.78 cm3. Th tch tuyn gip ln nht nam 17
tui l 12,82 2,58 cm3 v n l 20 tui vi s
o l 12,23 2,8 cm3. Th tch tuyn gip ti a
( X + 2SD) ca ngi trng thnh l 17.98 cm 3
( nam ) v 17.83 cm 3 ( n gii ) .
Tng quan Th tch tuyn gip tng dn theo
tui v tng quan thun trong tui t 15 - 23
vi r = 0.06144 i vi nam v r = 0.14422 i
vi n. C s tng quan thun cht ch nht t
15 - 17 tui nam ( r = 0.882224 ) v t 15 - 20
tui n ( r = 0.929615).. Th tch gip tng
quan thun vi chiu cao i vi nam ( r =
0.26457) ln n ( r = 0.16278 ). Th tch tuyn
gip tng quan thun vi trng lng c th
i vi nam ( r = 0.34684 ) cng nh n ( r =
0.31640 ). .C s tng quan thun gia BMI v
th tch tuyn gip i vi nam ( r = 0.24839 ) ln
n ( r = 0.23065 ) .c bit th tch tuyn gip s
I. T VN
Tuyn gip l mt trong nhng tuyn ni tit quan trng bc nht ca c th v bnh
tuyn gip cng l mt th bnh thng gp trn lm sng, trong bu gip cng l mt
trong nhng triu chng rt quan trng hng n chn on bnh tuyn gip.
Theo ti liu ca T chc y t th gii ( TCYTTG ) mt ngi c xc nh l c
bu gip khi thu bn ca tuyn gip ln hn t tn cng ca ngn tay ci ca ngi .
Nhng s kt lun ny thng mang tnh ch quan v ch yu da vo kinh nghim ca
ngi khm.
Tuy nhin chng ta cng bit nh gi tuyn gip qua khm lm sng cn ph
thuc mt s yu t ti ch nh c vng c thay i do mp hay gy, yu t ton thn nh
gii tnh, tui, chiu cao, cn nng, ch s dng mui iode d phng v cc dn cht tng
t v.v.. V th vic xc nh bnh nhn c bu gip hay khng l mt vn ht sc nghim
tc, cn c cn nhc v ht sc t nh trc khi i n kt lun.
Tht vy kch thc tuyn gip l mt thng s quan trng trong chn on bnh
tuyn gip trn lm sng, trong sng lc bnh l ca tuyn gip khi iu tra dch t thiu ht
iode. Mt s cng trnh ghi nhn c mt sai s kh cao khi so snh vi tuyn gip ln qua
khm lm sng v siu m tuyn gip khi nh gi v t l bu gip qua cc iu tra v dch
t hc.
Ngy nay kch thc tuyn gip c xc nh chnh xc hn nh vo mt s k thut
chn on hnh nh nh siu m gip, CT Scan, Cng hng t ht nhn, trong siu m
tuyn gip l mt k thut an ton, khng xm nhp, t hoc hu nh v hi, kinh t, c ng,
d thc hin c bit cho kt qu nhanh vi chnh xc cao, sai s khng ng k.
V phng din sinh l v gii phu, qua y vn ghi nhn kch thc v trng lng
tuyn gip ca ngi bnh thng pht trin ngay t khi cn phi thai v tng dn theo la
tui t s sinh cho n lc trng thnh sau gim dn th tch v khi lng khi v gi.
Tuy nhin cc nc i sng kinh t thp, do tng trng c th thng chm, vic
nh gi th tch tuyn gip lin quan theo tui v th c th khng cn thch hp, trong
trng hp ny th tch tuyn gip l hm s ca ch s nhn trc.
Trc y nh gi th tch tuyn gip chng ta phi vay mn s liu nc ngoi
so snh. V th vic tm kim mt hng s v kch thc tuyn gip bnh thng cho ngi
Vit Nam tui trng thnh t trc ti nay y vn cha cp nhiu.
Mt s y vn nc ngoi ghi nhn tuyn gip ca ngi bnh thng pht trin ti
a t tui 14- 18 nhng khng xc nh r v tui. V vy kho st th tch tuyn gip
ca tui t 15 tui ca ngi Vit Nam tr ln l vic lm cn thit, v t xc nh
tui no tuyn gip c th tch ti a v hon chnh, c s sau ny khng nh c bu gip
cho ngi Vit Nam mt cch khoa hc v khch quan.
Mc tiu
1.Kho st siu m tuyn gip ca hc sinh trung hc v sinh vin i hc ( t 15 tui n 23
tui ) xc nh kch thc tng thu gip, th tch ton phn ca tng i tng qua xc
nh th tch tuyn gip ti a ca ngi trng thnh.
2. Xc nh s tng quan gia th tch tuyn gip vi tui, chiu cao, cn nng, ch s kh
c th v din tch da theo gii tnh trong tui ni trn.
III.I TNG V PHNG PHP NGHIN CU
1. i tng c chn:
i tng nghin cu 677 ngi gm 250 hc sinh ( tui t 15-17) hc sinh trng Quc Hc
Hu v 427 sinh vin ( tui t 18-23 ) i hc Hu.
Tt c i tng trn khng c bu gip ( TCYTTG )
Trong c 569 hc sinh v sinh vin c kim tra minh chng c xut nhp Iode bnh thng
vi nng iode niu: 150 -450 g. iode/ g creatinin niu.
2. i tng khng nghin cu:
i tng c bu gip ( theo TCYTTG ) bt c giai on no, hoc siu m c hnh nh
bt thng
3. a im nghin cu.
Trng Quc Hc, Bnh vin Trng i hc Y Khoa Hu, Phng khm bu c Thnh ph
Hu, Phng khm Clinic
4. Thi gian nghin cu: trong 2 nm t thng 12/2000 n thng 12/2002.
2. Phng php nghin cu .
2. 1. C mu chn:
Mi tui chn ngu nhin t 60 - 100 em chia lm 2 gii nam v n
2.2. Cc bc tin hnh
Bc 1: Chun b i tng nghin cu:
Bc 2: Khm lm sng: cc thng s lm sng trong nghin cu ny bao gm:
Cn nng ( kg ), o chiu cao ( cm ), nh gi ch s khi c th (BMI ), o din tch da:
S=W 0,425 x H0,725 x 71,84x10-4
Bc 3: Khm tuyn gip: Phn bu gip ( TCYTTG -1994 )
Bc 4. Siu m tuyn gip:
My siu m TOSHIBA (Nht) v MEDISON ( Nam Triu Tin ).
Phng php siu m: 2 bnh din (2D.) v s dng u d Linear ( 7.5 MHz
Cc thng s v kch thc ca tuyn gip: Eo tuyn gip, Tnh th tch tng thu gip theo
phng php ca R.Guterkunst : V = a x b x c x /6 tnh bng cm3
- Th tch tuyn gip ton phn: Thu phi (cm3) + Thu Tri ( cm 3 )
Bc 5. So snh v nghin cu tng quan:
1. So snh th tch trung bnh cu thy pha v thy tri gip theo tu theo gii
2. So snh th tch tuyn gip ton phn theo tng tui theo gii.
3. ng gi cc tng quan gia th tch tuyn gip ln lt vi:
- Th tch ton phn tuyn gip v Tui theo gii
- Th tch ton phn tuyn gip v Cn nng theo gii: theo tng nhm nh vi hng cn 45,
45-50, 51-55. 56-60, 61-65, 66-70, 71-75kg.
- Th tch ton phn tuyn gip v Chiu cao theo gii: tng nhm c chiu cao ln lt l: (
145, 145-150, 151-155, 156-160, 161-165, 166-170, 171-175, 176-180, >180 cm.
- Th tch ton phn tuyn gip v BMI theo gii theo nhm c BMI t 15,
16,17,18,19,20,21,22,23,24,25
- Th tch ton phn tuyn gip v Din tch da theo gii theo nhm c din tch da cch nhau
0.1 m 2 v c 8 nhm t 1,1. 1,2. 1,3. 1,4. 1,5. 1,6. 1,7. 1,8 m2.
Bc 7. Xc nh th tch trung bnh tuyn gip ngi trng thnh
X l cc s liu bng phng php thng k Y hc
III. KT QU & BN LUN
3.1. C IM LM SNG CA NHM NGHIN CU
3.1.1. Phn b v nhm tu theo gii:
Bng 3.1: Phn b tui v gii cc i tng nghin cu
Tu
Nam
N
Tng cng (T l )
15
51
39
90
13.29%
16
34
37
81
11.96%
17
30
48
78
11.52%
18
33
36
69
10.19%
19
34
45
79
11.67%
20
47
39
86
12.70%
21
37
37
74
10.93%
22
31
30
61
09.01%
23
30
39
69
10.19%
Tng cng
327( 48.30%)
350( 41.70%)
677
T l cc nhm tui khng khc bit , t nht l 9,01% v cao nht l 13,29%.
3.2. IODE NC TIU:
Bng 3.4. Kt qu kho st v iode niu
T Iode/creatinin( (g/ g)
S lng (n)
T l (%)
66
11,60
< 100
100 - 450
498
87,52
5
0,88
> 450
Tng cng
569
100%
87,5% c nng iode niu bnh thng ( 100 -450 g /gcreatinine )
3.3. KT QU V SIU M TUYN GIP
3.3.1. Th tch tng thu gip ( siu m ) theo tui v gii tnh:
Bng 3.5: Th tch tng thy gip theo tui ca nam v n
Tui
Th tch gip nam (cm3)
Th tch gip n (cm3)
Thy phi
Thy tri
p
Thy phi
Thy tri
p
15
5.69 1.69 4.75 1.31
< 0.001
5.59 1.42
4.95 1.54
< 0.001
16
5.81 1.49 4.73 1.21
< 0.001
5.52 1.71
4.61 1.36
< 0.037
17
6.71 1.40 6.11 1.56
< 0.05
6.17 1.60
4.85 1.32
< 0.001
18
5.98 1.73 5.54 1.31
< 0.05
5.94 1.36
5.21 1.31
< 0.009
19
6.50 1.54 5.58 1.63
< 0.003
6.14 1.61
5.44 1.18
< 0.006
20
5.82 1.50 4.77 1.70
< 0.001
6.53 1.45
5.71 1.58
< 0.004
21
6.51 1.83 5.32 1.45
< 0.001
5.98 1.69
5.26 1.46
< 0.01
22
< 0.05
5.44 1.42 5.06 1.43
5.83 1.52
5.12 1.29
< 0.02
23
6.32 1.62 5.52 1.38
< 0.01
6.35 1.84
5.39 1.14
< 0.001
V thu phi ln hn tri tuyn gip ( p : 0.05 - 0.001 ) nam ln n gii.
+ Thu phi ln hn thu tri tuyn giap:
Muller-Leisse C v cng s (1988), Takalo RM v cng s ti Phn Lan ( 1991 ),
Klingmuller V v cng s (1991) i hc Justus Liebig, Geressen CHLB c, Nygaard B
v cng s (1993) ti an Mch, Schonrman L v cng s (1995) u xc nhn nh trn.
+ Th tch hai thu gip khng khc bit:
Phm Vn Choang, Hong Kim c, Nguyn B S (1996), Nguyn c Thun, V Phng,
Nguyn Hi Thy (1998) .
Kt qu chng ti : Thu phi tuyn gip ln hn tri ph hp vi y vn khi nghin cu trn
qun th ln ca cc tc gi nc ngoi.
Tnh th tch gip cn phi o th tch tng thu mt ri cng li l ph hp nht.
3.3.2.Th tch ton phn tuyn gip
Bng 3. 6. So snh th tch tuyn gip ton phn gia nam v n gii
V gip ( cm3 )
V gip ( cm3 )
Tu
Chnh
p
Nam gii
N gii
15
0.09
10.44 2.79
10.53 2.88
> 0.05
16
0.41
10.53 2.35
10.12 2.76
> 0.05
17
18
19
20
21
22
23
Th tch tuyn
12,23 ( 2,8 cm3.
V
(cm 3)
1.80
12.82 2.58
11.02 2.55
< 0.001
0.37
11.52 2.77
11.15 2.45
> 0.05
0.49
12.08 2.89
11.59 2.37
> 0.05
1.64
10.59 3.08
12.23 2.80
< 0.001
0.59
11.83 2.94
11.24 2.94
> 0.05
0.45
10.50 2.63
10.95 2.63
> 0.05
0.10
11.84 2.80
11.74 2.78
> 0.05
gip ln nht nam 17 tui l 12,82 ( 2,58 cm3 v n l 20 tui vi
14
12,82
12 10.44
10
12,23 11.83
12.08
11.84 11.74
11.52
11.24 10.95
11.15 11.59
11.02
10.59
10.5
10.5310.53
10.12
8
Nam
4
2
0
15
16
17
18
19
20
21
22
23
Tui
Biu 3.1. Biu din th tch tuyn gip ton phn gia nam v n gii
Bng 3.7. Tng quan gia th tch tuyn gip v tui theo gii
HSTQ
tui
Nam
N
r1
15-17
0,8822
0,5437
r2
15-18
0,6438
0,7539
r3
15-19
0,6635
0,8747
r4
15-20
0,2237
0,9296
r5
15-21
0,2996
0,7779
r6
15-22
0,2547
0,5759
r7
15-23
0,2547
0,6373
Vi s tng quan ny i vi n gii th tch tuyn gip tng i giao ng v pht trin
ti a nht vo tui 20 v nam tui 17. s pht trin tuyn gip cn lin quan n gii
tnh vi th tch tuyn gip ti a i vi nam gii tui 17 v i vi n gii l 20 tui.
2. Th tch gip v cn nng
Th tch tuyn gip c khuynh hng tng theo trng lng trong tui 15 -23 tui c
nam ln n. C s tng quan thun cht ch gia th tch tuyn gip vi trng lng c th vi r
= 0.34684 i vi nam v r = 0.31640 i vi n.
Berghout A, Wiersinga WM, Smits NJ, Touber JL (1987) i hc Amsterdam, H Lan,
Golkowski (1993), Hsiao YL v cs (1994) Muller Leisse C, Troger J, Khabipour F, Pockler
C (1988),
Ho SS, Metreweli C (1995) bnh vin Prince, Wale, Hng Kng, Phm Vn
Choang, Hong Kim, Nguyn B S, Nguyn c Thun, V Phng, Nguyn Hi Thy (1998) :
Th tch tuyn gip tng dn vi trng lng
Chng ti ghi nhn c s tng quan thun gia th tch tuyn gip vi trng lng
c th vi r = 0.34684 i vi nam v r = 0.31640 i vi n.
Tng quan gia tro
ng l
ng (P) vathtch tuy
n giap nam
20.00
15.00
10.00
y =0.1541x +3.3726
5.00
R2 =0.1203
30
40
50
60
70
80
Biu 3.4: Tng quan gia th tch tuyn gip v trng lng nam gii Vi r =
0.34684, n = 327 v p < 0.01
3. Th tch tuyn gip v chi cao.
C s tng quan thun gia th tch tuyn gip vi chiu cao vi r = 0.26457 i vi nam v
r = 0.16278 i vi n. Muller Leisse C, Troger J, Khabipour F, Pockler C (1988),Gomez JM,
Marvall FJ, Gomez N, Guma A, Soler J Barcelona, Ty Ban Nha (2000) ].Phm Vn
Choang, Hong Kim c, Nguyn B S (1996) Nguyn c Thun, V Phng, Nguyn
Hi Thy (1998) Th tch tuyn gip lin quan n chiu cao. Chng ti : c s tng quan
thun gia th tch tuyn gip vi chiu cao vi r = 0.26457 i vi nam v r = 0.16278 i
vi n.
T ng quan gia T htch giap vachi
u cao
2 0 .0 0
y = 0 .1 1 8 7 x - 8 .2 1 5 6
R2 = 0 .0 7 0 1
1 5 .0 0
1 0 .0 0
5 .0 0
120
130
140
150
160
170
180
190
Biu 3.6: Tng quan gia V tuyn gip v chiu cao nam gii vi
0.26457, n = 327 v p < 0.01
r=
20.00
R2 =0.0617
15.00
10.00
5.00
10
15
20
25
30
BMI
Biu 3.8: Tng quan gia th tch tuyn gip v BMI nam gii vi r = 0.24839, n =
327 v p < 0.01
5. Th tch gip v din tch da
Muller-Leisser C, Troger Klabirpour F, Pockler C (1988) Klingmuller V, Fiedler C, Otten A,
Egidi R, Koch C (1989) i hc Justus, Liebig, Giessen c Takalo RM v cng s ( 1991)
Xu F, Sullivan K, Houston R, Zhao J, May W, Maberty G (1995) Atlanta, Gergia M,
Delange F (1997) gim c ICCIDD trng nhm Thyromobil ,Gomez JM, Maravali FS,
Gomez N, Guma A, Soler J (2000), Trn B Thoi v Nguyn Hi Thu ( 2001 ) ; gip tng
quan vi S da.
V gip tng theo S da tui 15 -23 tui c nam ln n.
S da vi r = 0.31937 i vi nam v r = 0.29664 i vi n.
V tuyn giap
T
ngquandi
nt
chdavath
t
ch giapn
y=8.7843x- 0.9207
R2 =0.088
20.00
15.00
10.00
5.00
1.00
1.20
1.40
S(da)
1.60
1.80
Biu 3.10. Tng quan gia V gip v S da n ( r = 0.29664, n = 350 v p < 0.01 )
6..Th tch tuyn gip ti a ca tng tui
V gip ti a ( cm3 )
Nam gii
V gip ti a( cm3 )
N gii
15
16.02
16.29
16
15.23
15.64
17
17.98
16.12
18
17.06
16.05
19
17.86
16.33
20
16.75
17.83
21
17.71
17.12
22
15.76
16.21
23
17.44
17.30
Mt tuyn gip ca mt c nhn c gi l ln khi th tch tuyn gip ca c nhn
c s o ln hn hoc bng th tch tuyn gip trung bnh ca mt ngi bnh thng ( cng
tui vi tuyn gip 0 ca TCYTTG ) cng 2 ln lch chun ( SD ) Theo R.
Gutekunts, F Delange, Wieland. Meng chng ti c kt qu bng trn :
V gip ti a ca ngi trng thnh l 17.98 cm3 ( s o nam gii 17 tui ) v 17.83
cm3 ( s o ca n gii 20 tui).
Nh vy Th tch ti a ca tuyn gip ngi trng thnh l 18 cm 3 .
xut cng thc tnh kch thc tuyn gip c th p dng cng thc sau y:
Gii
Nam
N
V gip/ cao
(cm3/ m )
6,87 1,69
7,31 1,75
V gip/ cn
(cm3/ kg )
0,22 0,05
0,25 0,06
V gip/ BMI
( cm3/ BMI)
0,60 0,15
0,60 0,14
KT LUN
1. Kch thc tuyn gip:
- V thu phi tuyn gip ln hn V thu tri tuyn gip trong tui 15 - 23 k c nam ln
n. ( p: 0.05 - 0.001 )
V gip ti a ca ngi trng thnh nam gii l 17.98 cm 3 ( 17 tui ) v ca n gii l
17.83 cm 3 ( 20 tui ).
2. Tng quan
- Tui: V gip tng dn theo tui v tng quan thun vi tui t 15 - 23 vi r = 0.06144
i vi nam v r = 0.14422 i vi n. S tng quan thun cht ch nht t 15 - 17 tui
i tng nam ( r = 0.882224 ) v t 15 - 20 tui i tng n ( r = 0.929615).
- Chi cao: c s tng quan thun vi V gip ( r = 0.26457 nam v r = 0.16278 n.)
- Cn nng: c s tng quan thun cht ch vi V gip ( r = 0.34684 nam gii v r =
0.31640 n gii.)
- BMI: c s tng quan thun cht ch vi V gip (r=0.24839 nam gii v r=0.23065 n
gii )
- Din tch da : c s tng quan thun cht ch S da ( r = 0.31937 nam gii v r = 0.29664
n gii.)
Kt lun : Th tch tuyn tng dn theo tui v tng quan n chiu cao, cn nng, BMI v
din tch da. Th tch tuyn gip ti a ca ngi trng thnh c th l 17.98 cm 3 ( nam
17 tui ) v n gii l 17.83 cm 3 ( 20 tui ).
TI LIU THAM KHO