You are on page 1of 10

TNG NG HUYT BNH NHN CNG GIP

Trng Th Thy Lan1, Nguyn Thy Khu2


TM TT TNG NG HUYT BNH NHN CNG GIP MC TIU NGHIN CU: Xc nh t l i tho ng v ri lon ng huyt tng lc i bnh nhn cng gip HYPERGLYCEMIA IN HYPERTHYROID (CG) v cc yu t lin quan. PATIENTS PHNG PHP NGHIN CU: nghin cu ct ngang, i tng nghin cu gm 1 2 Trng Th Thy Lan , Nguyn Thy Khu 642 bnh nhn ang iu tr CG ti Trung SUMMARY tm chn on y khoa MEDIC t 9/2004 OBJECTIVES: to determine the frequency of n 3/2004. ng huyt c o trong diabetes mellitus (DM) and impaired fasting giai on cng gip v trong giai on glucose in hyperthyroid patients and related bnh gip vi mu tnh mch vo lc sng, sau khi nhn i 8 gi. Chn on i tho factors. ng theo tiu ch ca WHO (1998). METHODS: cross-sectional study. 642 patients were recruited from MEDIC medical diagnostic KT QU: T l ri lon ng huyt center from September 2003 to March 2004. tng lc i l 29,9%, i tho ng l Venous blood sample was obtained after an 7,6%. Trong s bnh nhn i tho ng, overnight fasting (about 8-10 hours) during c 1,1% bnh nhn bit i tho ng hyperthyroid period and euthyroid state, and the t trc, 3,7% bnh nhn c pht hin i tho ng trong giai on CG v diagnostic criteria of WHO (1998) was used. 2,8% bnh nhn c pht hin i tho RESULTS: The frequency of IFG was 29.9%, ng sau giai on CG. Trong 49 bnh diabetes mellitus was 7.6%, in this group: 1.1% had nhn i tho ng, c 48 bnh nhn been diagnosed DM before, 3.7% were diagnosed (98%) t 31 tui tr ln,37 bnh nhn at the same time of hyperthyroid status and 2.8% chim t l 75,5%- ang iu tr bng were diagnosed after hyperthyroid status had thuc vin h ng huyt v tt c iu resolved. 48 of 49 patients (98%) were > 31 years p ng vi thuc. C s lin quan gia old, 37 patients (75.5%) were treated with oral bnh i tho ng vi tui v tnh trng hypoglycemic agents. There were relationships bo ph. between diabetes and age, the sex and obesity. KT LUN: nhm bnh nhn CG, t l CONCLUSION: In hyperthyroid patients, the ri lon ng huyt tng lc i l prevalence of IFG and diabetes mellitus were 29,9% v t l i tho ng l 7,6%. 29.9% and 7.6% respectively, nearly double the Chng ti ngh cn tm sot bnh i prevalence of DM in the community. We suggested tho ng bnh nhn CG, c bit that we should screen for diabetes in hyperthyroid cc i tng t 31 tui tr ln. subjects, especially people aged 31 years old and over.

AT VAN E: Cng giap (CG) la mot benh ly noi tiet rat thng gap. Trong so cac benh nhan b benh ly tuyen giap phai nhap vien, CG chiem a so cac trng hp. Hormon tuyen giap lam tang hoat ong chuyen hoa cua toan bo te bao cua cac mo c the, anh hng tren chuyen hoa lipid, protid, glucid. Tren
1 2

Bnh vin a khoa trung tm An Giang B mn Ni tit i hc Y Dc TP H Ch Minh

benh nhan CG, hormon giap gay roi loan kiem soat ng huyet co the thuc ay ai thao ng (T) tiem an boc phat thanh T co trieu chng.(4)(8) Roi loan ng huyet khi oi (RLH) la mot roi loan xuat hien trc benh T (thng la T tp 2), va co mot y ngha quan trong trong viec theo doi va tien lng benh. Nguy c bien chng tim mach tren ngi co RLH cung cao hn ngi bnh thng.(6) Va neu ap dung cac bien phap phong nga khong dung thuoc nh tiet che hoac luyen tap the lc ung cach, ngi ta co the giam c ty le dien tien t RLH en T.(27) S khac biet ve TSLH T gia nhom benh nhan CG va cong ong c ghi nhan cac quoc gia nh Nhat ban nam 1992 (7,6% vs 3,9%, lan lt)(22) va nam 2002 (8,7% vs 2,3%-8,1%, lan lt).(24)(26)(28)(29) Tai Viet Nam cha co cong trnh rieng nao nghien cu ve tnh trang tang ng huyet benh nhan CG nen khong ro TSLH T nhom benh nhan nay la bao nhieu. Xuat phat t thc tien tren, chung toi tien hanh e tai Tang ng huyet benh nhan cng giap" vi nhng muc tieu cu the nh sau: - Xac nh TSLH benh T va RLH benh nhan CG. - Xac nh moi tng quan gia T vi mot so yeu to lien quan nh tuoi, gii, tnh trang beo ph (BP). OI TNG VA PHNG PHAP NGHIEN CU: Bang phng phap nghien cu cat ngang, mo ta va phan tch vi ky thuat chon mau lien tiep cac benh nhan co chan oan CG c ieu tr tai phong kham noi tiet cua trung tam chan oan Y khoa Hoa Hao t thang 9/2003 en thang 3/2004. C mau can thiet cho nghien cu c tnh theo cong thc: n=Z 50%
2 1- / 2

p (1 p ) : d2 vi = 0,05 ( sai lam loai 1)

p:

Do cha tm thay chnh xac ty le tang ng huyet benh nhan CG tai thanh pho HCM nen e c mau u ln, chung toi lay p = 50% va can phai tm chnh xac ty le nay. Khong a vao nghien cu cac oi tng nh: benh nhan a c ieu tr on nh tnh trang CG, hoac ang dung thuoc anh hng en ket qua H nh: glucocorticoid, thiazide, chen , phenyltoin, acid nicotinic, diazoxid, interferon , thuoc nga thai co oestrogen. Xet nghiem ng huyet c tien hanh vao hai thi iem: luc khi phat CG va giai oan CG on nh va ang c ieu tr duy tr. Mau benh pham la mau tnh mach c lay vao luc sang sm sau khi nhn oi 8 gi, ng huyet tnh mach c o bang phng phap glucose oxidase. Chan oan benh da vao tieu ch chan oan cua WHO (1998). Co benh khi ng huyet tng khi oi cua hai lan th cach nhau 1 ngay eu > 7

mmol/L. RLH khi ng huyet tng khi oi > 6,1 mmol/L va < 7 mmol/L. Chan oan BP khi BMI > 25 kg/m2 (tieu chuan cua WHO nam 2000 ap dung cho ngi chau A). BP vung bung c chan oan khi ty le vong eo / vong hong (VE/VH) > 0,95 nam va 0,85 n (tieu chuan chau Au) hoac khi chu vi vong eo (VE) > 90 cm nam va 80 cm n (tieu chuan chau A). Cac d lieu can thu thap gom cac bien so oc lap gom: tuoi, gii, chieu cao, can nang, vong eo, vong hong c ghi nhan bi ngi nghien cu va bien so phu thuoc la tr so ng huyet tng c thc hien bi phong xet nghiem cua trung tam chan oan Y khoa MEDIC. Cac d lieu c nhap va x ly bang phan mem Epi-info 2002. Phep kiem 2 mc y ngha p < 0,05 c s dung e xac nh moi lien quan gia cac bien so. KET QUA: Co 642 benh nhan CG c a vao nghien cu. ac iem lam sang cua oi tng nghien cu: So oi tng c nghien cu gom 90 nam (14%) va 552 n (86%), ty le nam / n la 1/6,1 Bang 1: Cac tham so ac trng cua mau nghien cu (n=642) Bien so Tuoi - Nam - N n 642 90 552 BMI - Nam - N 550 83 467 Eo/hon g - Nam - N Eo - Nam - N 596 86 510 596 86 510 Trung bnh 43,7 43,2 43,8 21,5 22,3 21,4 0,81 0,86 0,80 73,1 79,3 72,1 LC 12,1 11,3 12,2 3,1 3,0 3,1 0,07 0,07 0,07 9,0 9,9 8,4 Toi thieu 18 18 18 12,6 15,4 12,6 0,57 0,69 0,57 54 60 54 Toi a 77 74 77 36,0 29,7 36,0 1,14 1,02 1,14 104 102 104 p=0,0 00 p=0,0 00 p=0,0 13 p gii ns

H oi - Nam - N

642 90 552

6,1 6,3 6,1

1,9 2,2 1,9

4,0 4,2 4,0

30,2 20,1 30,2

ns

Tan suat lu hanh RLH va T: Bang 2: TSLH T va RLH (n=642) Nhom benh nhan N H bnh thng RLH T - a biet - C* cung CG - C* sau CG Cong 51 29 10 1 3 6 90 Nam % 56,7 32,2 11,1 1,1 3,3 6,7 100,0 n 350 163 39 6 21 12 552 N % 63,4 29,5 7,1 1,1 3,8 2,2 100,0 n 401 192 49 7 24 18 642 Chung % 62,5 29,9 7,6 1,1 3,7 2,8 100,0

* C: Chan oan ac iem dan so mac benh T Bang 3: Ty le hien mac T va ty le BP trong nhom benh nhan T (n=49) Nam TS/n* ai thao ng BMI (chau A) BMI (chau Au) VE/VH** VE (chau A) VE (NCEP-ATP-III ) 10/90 2/9 0/9 1/10 2/10 0/10 % 11,1 22,2 0,0 10,0 20,0 0,0 N TS/n* 39/55 2 10/39 5/39 17/38 16/38 4/38 % 7,1 25,6 12,8 44,7 42,1 10,5 Chung TS/n* 49/64 2 12/48 5/48 18/48 18/48 4/48 % 7,6 25,0 10,4 37,5 37,5 8,3 2 test, p gii ns ns ns <0,05 ns ns

* : Tong so / so trng hp ** : VE/VH > 0,95 nam va 0,85 n Tuoi mac benh trung bnh la 52,9+ 12,2, toi thieu la 25, toi a la 76: nam 49,3 + 8, n la 53,8 + 13, s khac biet khong co y

ngha thong ke (p = 0,3). Gia o tuoi va benh co quan he chat che (p<0,05), ty le mac benh tang dan theo o tuoi, cao nhat o tuoi tren 70 (20%). Ty le nam mac benh nhieu hn n, tuy nhien s khac biet khong co y ngha thong ke (p>0,05). Ty le BP vung bung theo tieu chuan VE/VH n cao hn nam, s khac biet nay co y ngha thong ke (p<0,05). ac iem dan so RLH: Bang 4: Ty le hien mac RLH va ty le BP trong nhom benh nhan RLH (n=192) Nam TS/n* Ty le hien mac BMI (chau A) BMI (chau Au) VE/VH** VE (chau A) VE (NCEP-ATP-III ) 29/90 8/28 0/28 1/28 7/28 0/28 % 32, 2 28, 6 0,0 3,6 25, 0 0,0 N TS/n* 163/55 2 18/141 2/141 42/153 36/153 7/153 % 29, 5 12, 8 1,4 27, 5 23, 5 4,6 Chung TS/n* 192/64 2 26/169 2/169 43/181 43/181 7/181 % 29, 9 15, 4 1,2 23, 8 23, 8 3,9 2 test, p gii ns <0,05 ns <0,05 ns ns

* : Tan so / so trng hp ** : VE/VH > 0,95 nam va 0,85 n Trong dan so RLH, ty le nam BP theo tieu chuan cua WHO ap dung cho chau A nam cao hn n, va ty le nam BP vung bung theo tieu chuan VE/VH thap hn n, s khac biet nay co y ngha thong ke (p<0,05). Cac ch so anh gia beo ph: Bang 5: Trung bnh cac ch so BP tren cac oi tng Bien so So ngi (n) BMI (kg/m2) VE/VH Eo (cm) H bnh thng 401 21,1 3,0 0,79 0,07 71,5 8,5 RLH 192 21,9 3,1 0,82 0,08 74,6 9,2 T 49 23,3 3,9 0,86 0,07 79,7 8,0 0,000 0,000 0,000 p

TSLH T tren nhom benh nhan BP cao hn nhom khong BP, s khac biet nay co y ngha thong ke (p<0,05). Ve TSLH T gia hai nhom BP va khong BP da tren BMI: theo tieu chuan cua WHO ap dung cho chau A, ty so chenh lech la 2,8 (KTC 95% la 1,4 - 5,8, p = 0,003), theo tieu chuan cua WHO ap dung cho chau Au, ty so chenh lech la 11,6 (KTC 95% la 3,2 - 41,5, p = <0,001). Chung toi khong the phan tch ty so chenh lech ve TSLH T tren nhom benh nhan BP va khong BP nam v mau nho. n, ty so chenh lech ve TSLH T tren nhom benh nhan BP va khong BP vung bung la 3,5 (theo tieu chuan VE/VH), 3,4 (theo tieu chuan VE chau A), 3,8 (theo tieu chuan VE cua NCEP-ATP-III). Cac benh ly ket kp va tien s gia nh: Bang 6: Ty so chenh lech ve TSLH T gia hai nhom co hoac khong tang huyet ap, RLCH lipid hoac tien s gia nh T. Bien so Nam Tang huyet ap RLCH lipid TS** gia nh T 22,2 48,1 4,4 TSLH N 18,8 41,3 4,5 Chung 19,3 42,2 4,4 p gii ns ns ns T OR* 6,9 (3,8 12,7) 12,9 (5,0 33,1) 9,3 (4,1 -21,0) p 0,000 0,000 0,000

* : Ty so chenh lech ( KTC 95%) ve TSLH T gia hai nhom co hoac khong tang huyet ap, RLCH lipid, tien s gia nh T ** : Tien s gia nh T BAN LUAN Benh ai thao ng TSLH T trong nhom benh nhan CG la 7,6% cao hn TSLH chung tren toan the gii (4%) vao nam 1995, ca nhng nc phat trien (6,2%, nam 2000) va nhng nc ang phat trien (3,5%, nam 2000),(26) cao hn cac quoc gia trong khu vc chau A: Hong Kong (4,6%, nam 1993);(21) Bangladesh (5,2%, nam 1997)(26); tuy nhien thap hn TSLH Singapore (8,6%, nam 1992) va nhng ngi Singapore goc An o (12,9%, nam 1998); Ma Lai (9,3%, nam 1998); Trung Quoc (8,1%, nam 1998).(19) Nhng ty le nay cao hn rat nhieu khi so vi TSLH benh T trong cong ong tai Ha Noi (1,2% nam 1990),(1) tai Hue (0,96% nam 1992-1993)(2) va tai Tp Ho Ch Minh (2,52% nam 1992-1993).(3) S khac biet nay mot phan do thi iem tien hanh nghien cu cua chung toi cach xa cac nghien cu tren hn 10 nam,

mot khoang thi gian can thiet, u co nhng bien oi ve mat kinh te, xa hoi va moi trng anh hng en TSLH benh. Va khi so sanh vi nghien cu mi ay tai thanh pho Long Xuyen nam 2001 (TSLH 4%)(5) va tai thanh pho Ho Ch Minh nam 2001 (TSLH 3,8%)(12) th TSLH trong nghien cu cua chung toi cung cao hn ang ke. S khac biet ve TSLH T gia nhom benh nhan CG va cong ong con c ghi nhan cac quoc gia khac. Tai Nhat Ban nam 1992, TSLH T benh nhan CG la 7,6% (n=647) cao gan gap oi so vi cong ong Nhat luc bay gi la 3,9% (n=9133).(22) Tai Bangladesh nam 2002, TSLH T tren nhom benh nhan CG (gom Basedow va bu giap a nhan hoa oc) la 8,7% (n=65) va nhom benh nhan Basedow ty le nay la 11% (n=45) (24) cao hn han khi so sanh vi TSLH T trong cong ong Bangladesh (2,3%-8,1%).(26)(28)(29) ieu nay cho thay rang tren nhom benh nhan CG, tha hormone giap la yeu to quan trong anh hng len viec ieu hoa ng huyet. Tuoi Tuoi mac benh trung bnh nhom benh nhan CG la 52,9, TSLH o tuoi di 40 la 2,9% va tren 40 la 10,4%, s khac biet nay co y ngha thong ke (p<0,005). TSLH T tang dan theo tng nhom tuoi, thap nhat nhom tuoi di 30 (1,4%) va cao nhat nhom tuoi tren70 (20%). ieu nay con c ghi nhan qua nghien cu cua Ichiro Komiya va cs. tren nhom benh nhan CG Nhat nam 1992 (0,8 va 15,8 theo th t).(22) Thc te, TSLH T rat thap o tuoi 20-30 v tuoi khi phat benh phan ln xay ra nhng ngi tren 40 tuoi, sau o TSLH se tang dan theo tuoi.(28) My, TSLH nhom benh nhan tren 60 tuoi la 19%-19,3% (theo NHANES III va NHANES 19992000).(25) Hy lap, TSLH nhom benh nhan tren 70 tuoi la 20,3%.(14) Tuy nhien, TSLH se giam nhe i nhom benh nhan ln tuoi hn. Tng t nh vay, nhom benh nhan CG, TSLH cung tang dan theo o tuoi, ieu nay do: * Tha hormon giap dai dang xay ra trong mot thi gian dai se dan en tnh trang giam dung nap glucose va thuc ay T tiem an tien trien thanh T that s. * Cac nguyen nhan khac nh: s suy giam chc nang sinh ly cua te bao theo o tuoi, e khang insulin ngay cang tang va s van ong ngay cang giam i khi tuoi tang len, nhng tien bo trong cham soc sc khoe cong ong cung nh trong ieu tr benh T a lam gia tang tuoi tho cong ong va keo dai cuoc song cua benh nhan, va tnh chat cong don cua mot benh man tnh cung gop phan lam TSLH T nhom benh nhan CG tang dan theo tuoi. Khi so sanh vi nghien cu trong cong ong cua Pham inh Tuan va Nguyen Thy Khue nam 2001 tai Tp Long Xuyen, TSLH

lu hanh T trong moi nhom tuoi cua nghien cu cua chung toi eu cao hn.(5) ieu nay cang chng to rang tha hormone tuyen giap anh hng len s chuyen hoa ng huyet benh nhan CG tren moi la tuoi. Khi phan tch nhom ngi mac benh t 18 39 tuoi (gom 7 ngi) chung toi nhan thay so benh nhan tap trung ong nhat o tuoi 33 (2/7 ngi), so con lai rai rac mot ngi cac o tuoi t 25 en 37. V the ty le benh nhan T t 31 tuoi tr len chiem a so (98%). Ngoai ra TSLH benh tuoi di 31 la 1,2% (1/85), con o tuoi t 31 tr len, TSLH nay la 8,6% (48/557), ong thi t so chenh lech cao (OR=7,9 vi khoang tin cay 95% la 1,158,2 (p=0,02). So vi nghien cu cong ong gan ay (OR=3,3 gia hai nhom tuoi tren va di 40 (p<0,001)(12) th thay rang T xuat hien sm vi nguy c cao hn cong ong rat nhieu. T nhng d lieu tren , chung toi e ngh tuoi tam soat benh T tren nhom benh nhan CG nen bat au t 31 tuoi tr len. Gii Mac du tai mot so quoc gia, TSLH n cao hn nam nh My, TSLH T n cao hn nam, va TSLH nam tang len Anh, An o. Co s khac biet ve ty le nam/n tuy theo s phi nhiem khac nhau vi cac yeu to nguy c T khac nhau.(7) Nhn chung, TSLH n gii bao gi cung cao hn nam gii qua mot so nghien cu ve dch te trong nc cung nh tren the gii.(10) Nhng mot so nc nh Nhat , An o, Hy lap, Phan Lan TSLH nam gii lai cao hn n gii.(14)(32) Trong nghien cu cua chung toi, TSLH nam la 11,1% cao hn n la 7,1%, s khac biet nay khong co y ngha thong ke. Tuy nhien, ty le nam/n trong tong so benh nhan b CG la 1:6,1 so vi ty le nam/n nhom benh nhan CG co T la 1:3,9. Nghien cu cua Ichiro Komiya va cs. Nhat cung cho ket qua tng t (1;4,1 so vi 1:1,1). Ket qua nay cho thay rang hormon giap tac ong len khau chuyen hoa ng huyet nam vt troi hn n.(22) Roi loan ng huyet tng luc oi TSLH RLH c ghi nhan la 29,9% qua la kha cao neu so vi cong ong (4,7% Long Xuyen va 3,6% thanh pho Ho Ch Minh nam 2001).(5)(12) Va neu xet di goc o o la nguon bo sung lam gia tang TSLH T trong tng lai mot khi thieu bien phap han che s phat trien thanh benh ngi co RLH th con so 29,9% nay that s phai c quan tam.S chenh lech gia tr gia hai TSLH T (7,6%) va RLH (29,9%) ngi CG tng t nh tren con c ghi nhan tai Bangladesh nam 2002, tren nhom benh nhan Basedow ty le nay la 11% va 54%; tren nhom benh nhan bu giap a nhan hoa oc, ty le nay la 5% va 85%.(24) Beo ph

Trong nghien cu nay khi s dung 3 ch so tren e anh gia mc o BP tren cac oi tng ang ieu tr tnh trang CG co H bnh thng, RLH va T, chung toi nhan thay: * Gia tr trung bnh cua cac ch so tang dan theo cac oi tng co H bnh thng, RLH va T. S khac biet nay eu co y ngha thong ke (p<0,01). * nhom benh nhan CG co BP, TSLH T cao hn han so vi nhom benh nhan CG khong BP (p<0,05). * BP toan than theo tieu ch chan oan cua WHO ap dung cho chau Au co gia tri tien oan manh nhat. BP toan than theo tieu ch cua WHO ap dung cho chau A co gia tr tien oan yeu hn BPVB. Nhan xet nay phu hp vi nghien cu cua Han TS va cs. tai Ha Lan nam 1998: TSLH T cao hn nhom co BMI, ty le VE/VH, VE cao.(16) Qua can va BP, ac biet la BPVB co lien quan ro ret en TSLH T tp 2(13)(14)(23) va ty le VE/VH va VE la nhng yeu to tien lng oc lap cho T tp 2.(9)(11)(17)(18)(20)(30)(31) Nh vay, ngoai yeu to tha hormone tuyen giap th BP chnh la yeu to tien oan quan trong cho benh T. ieu nay kha phu hp vi nhan nh cua Gonzalo MA va cs. nam 1996 khi cho rang dung nap glucose b anh hng khong ang ke ngi CG co can nang bnh thng. Khi can nang tang len se hien dien tnh trang e khang insulin.(15) * TSLH BP tang dan theo cac nhom benh nhan co H bnh thng, RLH va T, s khac biet nay co y ngha thong ke (p<0,005). ieu nay cung phu hp vi cac nghien cu cong ong khac gan ay.(5)(6)(12)(14) Chung toi cha ghi nhan cac nghien cu tnh trang BP va moi lien quan gia BP vi T benh nhan CG. KET LUAN Qua nghien cu cat ngang, mo ta co phan tch tren 642 benh nhan CG t thang 9/2003 en thang 3/2004, ket qua cho thay: - TSLH T la 7,6% (khoang tin cay 95% la 5,8%-10%), cao hn nhieu so vi ieu tra dch te thanh pho Ho Ch Minh (2,52%) nam 1992-1993 va Long Xuyen (4%) vao nam 2001. * TSLH T gia tang theo tuoi, va co s thay oi ro ret nhat o tuoi 31 tr len. * oi vi phai, ty le n mac benh trung bnh la 7,1% thap hn nam la 11,1% - Ngoai ra, TSLH RLH la 29,9% (khoang tin cay 95% la 26,4%-33,6%) cao hn rat nhieu so vi TSLH T. - Co s lien quan gia T va tuoi. - Co s lien quan gia benh T vi BP toan than va BPVB.

T nhng ket qua tren, chung toi co mot vai iem e ngh bo sung trong viec theo doi ng huyet benh nhan CG nh sau: - Nen theo doi ng huyet luc oi nh ky v de thc hien, tnh trang CG gay roi loan ng huyet luc oi vi ty le rat cao va ay chnh la yeu to tien oan cho T trong tng lai. - Nen tap trung vao cac benh nhan CG t 31 tuoi tr len (theo WHO ap dung cho cong ong la 45) TAI LIEU THAM KHAO

1. 2. 3. 4. 5.
6.

L Huy Liu: i tho ng- Bch khoa th bnh hc tp 3. Nh xut bn T in Bch khoa H Ni. 2000:146-156 Mai Th Trch: Nhn xt v mt vi thay i lm sng v nghin cu trong bnh i tho ng nc ta trong vng 30 nm qua. Y hc Tp HCM. Chuyn ni tit. 1997;2:4-10 Mai Th Trch, ng Th Bo Ton, Dip Th Thanh Bnh v cs. Dch t hc v iu tra c bn v bnh i tho ng ni thnh Tp HCM. Y hc Tp HCM. 2001;5(4):24-27 Phm nh Lu. Chuyn ha glucid, Sinh l h ni tit Sinh l hc Y khoa, Trng i hc Y Dc thnh ph H Ch Minh. 2000:12-99 Phm inh Tun. Kho st t l i tho ng trong cng ng dn c thnh ph Long Xuyn, tnh An Giang. Y hc Tp H Ch Minh. 2003:7(1):14-19 Beatriz DAgord Schaan, Erno Harzheime Isue Gus. Cardiac risk profile in diabetes mellitus and Impaired fasting glucose. Rev. Sude. Pblica. 2004;38(4):1-7 http://www.scielo.br/pdf/rsp/v38n4/en (accessed 19 October 2004) Bennett PH. Epidemiology of diabetes mellitus. In: Rifkin H, Porte D. Diabetes Mellitus : theory and practice, 4 th edition. Elsevier. 1990:357-377 Bullock J, Boyle J, Wang MB. Thyroid gland. In: Bullock J, Boyle J, Wang MB. Physiology - National Medical series for independent study, 3rd edition. 1995:527-532 Chan JCN. Heterogeneity of diabetes mellitus in the Hong Kong Chinese population. The Chinese University of Hong KongPrince of Wales Hospital Diabetes Research and Care Group. HKMJ 2000;6:77-84

7.
8. 9.

10. Chou P, Li C, Tsai S. Epidemiology of type 2 diabetes in Taiwan. Diabetes Research and Clinical Practice. 2001;54(1):529-535

10

You might also like