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1.Mc ch :
Xc dnh th tch tuyn gip ca ngi ln trn
40 tui
2.i tng & Phng php :
470 ngi trn 40 tui c nng iode niu bnh
thng c kim tra bng siu m tuyn gip
vi u d 7,5 Mhz. Th tch tnh theo phng
php R Gutekunst
3. Kt qu :
. Th tch tuyn gip ca ngi trn 40 tui
- 10,90 1,88 cm3 ( nam ) v 9,29 2,02 ( n )
tui 50 - 59
- 11,24 3,16 cm3 ( nam ) v 8,56 2,26 ( n )
tui 50 - 59
- 10,28 3,38 cm3 ( nam ) v 7,57 2,42 cm3
( n ) tui 60 - 69
- 9,31 3,47 cm3 ( nam ) v 7,09 3,11 cm3 ( n
) tui 70
Th tch trung bnh (cm3) ton b tuyn gip
nam v n gii nh sau:
Th tch thu phi ln hn thu tri tt c cc
nhm tui ca c hai gii c ngha (tr cc
nhm tui trn 50 n )
Th tch tuyn gip ngi trn 40 dao ng t
11,24 3,16 n 9,31 3,47cm3 i vi nam
gii, 9,29 2,02 n 7,09 3,11cm3 i vi n
gii tu theo tui nh hay ln.
Th tch tuyn gip gim dn t tui 40-49
n v 50-59 nam.
Tng quan gia th tch tuyn gip vi cc yu
t tui v ch s nhn trc theo gii : Th tch
tuyn gip ngi trn 40 tui tng quan :
vi tui: r = - 0,206 (p < 0,01) i vi nam, r = 0,341 (p < 0,01) vi n.
vi chiu cao: r = 0,221 (p < 0,01) i vi nam, r
= 0,344 (p < 0,01)vi n.
vi cn nng: r = 0,426 (p < 0,01) i vi nam, r
= 0,365 (p < 0,01) vi n.
vi BMI: r = 0,364 (p < 0,01) i vi nam, r =
0,248 (p < 0,01) vi n.
vi din tch da: r = 0,398 (p < 0,01) i vi
nam, r = 0,408 (p < 0,01) vi n.
4. Kt lun .
Tuyn gip ca ngi ln bnh thng nh li
dn sau 40-50 tui i vi n v sau 50-60 tui
i vi nam.
TM TT
2
I. T VN
Trong c th con ngi, tuyn gip l tuyn ni tit ln nht. Th tch v trng lng
ca tuyn tng dn t khi sinh ra cho n lc trng thnh (c th t 20-25ml, nng 20-30
gam v c lin quan vi tui, gii tnh, chiu cao, cn nng, din tch da... Sau tuyn gip
c khuynh hng nh li dn khi v gi . Tuy nhin, th tch tuyn bt u gim t tui
no, gi tr chun cn bao nhiu v c cn tng quan vi cc ch s nhn trc trn na
khng, th cha c ti liu no cp c th, gy kh khn trong vic chn on bu gip
nhng i tng ny
V vy, vic nh gi kch thc ca tuyn gip l iu ht sc quan trng trong vn
qun l cc bnh tuyn gip.
Hin nay, vic xc nh kch thc v cu trc tuyn gip theo cch thng thng vn
qua nhn s trn lm sng, ri phn loi theo tiu chun ca T chc Y t th gii (WHO),
phng php ny thng ch quan v c nhiu sai st nht nh .Siu m tuyn gip l mt
trong nhng k thut thm d hnh nh (cng vi x hnh, X quang, CT scan, MRI...) khch
quan v chnh xc hn. y l xt nghim an ton, khng xm nhp, t hoc hu nh v hi,
kinh t, c ng, d thc hin v cho kt qu nhanh vi chnh xc cao (c bit trong vic
pht hin bu gip nhn) .
Vit Nam hin vn cha c nhiu nghin cu bng siu m v kch thc v cu trc
tuyn gip ngi trn 40 tui. Vic nh gi th tch tuyn gip trn cc i tng ny cn
phi vay mn s liu tiu chun ca nc ngoi i chiu.
Mc ch:
1. Kho st kch thc bnh thng ca tuyn gip ngi trn 40 tui bng siu m
hai bnh din (2D).
2. Xc nh s tng quan gia th tch tuyn gip vi tui , chiu cao, cn nng, ch
s khi c th v din tch da theo gii cc i tng ny.
II. I TNG V PHNG PHP NGHIN CU
2.1. i tng nghin cu
2.1.1. i tng chn
- Ngi = 40 tui, c tr ti phng Hi Thnh - ng Hi (y l mt phng nm
vng ven bin, khng thiu it theo iu tra ca Chng trnh phng chng cc ri lon thiu
it Trung ng v tnh Qung Bnh nm 1999
- Khng c bu c ( 0 theo tiu chun ca WHO).
2.1.2. i tng loi tr
- c bu c (WHO), bnh tuyn gip tng iu tr ngoi khoa hay x tr, Siu m pht
hin nhn gip, b bnh nng km theo.
2.1.4. Thi gian nghin cu : T thng 7/2003 n thng 7/2004.
2.2. Phng php nghin cu
2.2.1. Thit k v chn mu
y l nghin cu m t ct ngang.
Chn mu theo phng php ngu nhin phn tng: Chia lm 4 nhm tui: 40-49, 50-59, 6069 v =70 tui. Mi nhm tui chn ngu nhin khong 80-120 ngi, nam n s lng
tng ng nhau.
2.2.2. Cc bc tin hnh
Bc 1: Chun b i tng nghin cu
Bc 2: Khm lm sng cc ch s nhn trc bao gm:
(1) Cn nng (kg):
(2) o chiu cao (cm):
(3) o din tch da
c tnh theo cng thc S = W0,425 x H0,725 x 71,84 x 10-4
3
S l din tch da (m2), W l trng lng c th (kg) v H l chiu cao c th (cm)
(4) o ch s khi c th (BMI):
Bc 3: Khm tuyn gip nh gi theo WHO (1993)
Bc 4: Siu m tuyn gip, s dng my siu m Aloka (Nht Bn) vi u d Linear 7.5
MHz. Siu m kiu B hai bnh din (2D).
- Tnh th tch thu gip: Theo Gutekunst R vi V= a X b X c X p/ 6
V l th tch mt thu (cm3), a l chiu cao (di) mi thu (cm),
b l chiu
rng (ngang) mi thu (cm), c l chiu dy (su) mi thu (cm)
Th tch tuyn gip ton phn = V Thu tri + V Thu phi
Tnh V tuyn gip trung bnh ca tng thu, ton b tuyn v gii hn trn
X l s liu : chng trnh EPI INFO 6.04 v EXCEL 2000 h tr.
III. KT QU NGHIN CU
Chng ti kho st c 470 i tng trn 40 tui, Kt qu nh sau:
Bng 1. Phn b i tng nghin cu theo tui v gii
Nhm tui
Nam
N
Chung
T l %
40 - 49
44
59
103
21,9
50 - 59
49
62
111
23,6
60 - 69
65
67
132
28,1
47
77
124
26,4
70
Tng cng
205
265
470
100,0
Khng c s khc bit gia nam v n cc nhm tui (p > 0,05).
1. Kt qu siu m tuyn gip
1. Th tch tuyn gip ca ngi bnh thng
Bng 2: Th tch tng thu gip theo nhm tui ca nam gii
Nhm tui
Th tch thu gip ca nam (cm3)
p
Thu phi
Thu tri
Chnh
40 - 49
0,75
< 0,01
5,83 1,06
5,08 1,00
50 - 59
0,85
< 0,05
6,04 1,70
5,19 1,66
60 - 69
0,72
< 0,05
5,50 1,82
4,78 1,74
0,81
< 0,05
70
5,06 1,86
4,25 1,89
Th tch thu phi ln hn thu tri tt c cc nhm tui c ngha thng k (p <
0.05), chnh lch trung bnh l 0,78cm3 (p < 0,001).
Bng 3: Th tch tng thu gip theo nhm tui ca n gii
Nhm tui
Th tch thu gip ca n (cm3)
p
Thu phi
Thu tri
Chnh
40 - 49
0,45
< 0.05
4,87 1,10
4,42 1,15
50 - 59
0,28
> 0,05
4,42 1,28
4,14 1,25
60 - 69
0,47
> 0,05
4,02 1,28
3,55 1,33
0,37
> 0,05
70
3,73 1,76
3,36 1,47
Th tch trung bnh thu phi ln hn thu tri c ngha nhm tui 40-49 (p < 0,05).
chnh lch trung bnh gia thu phi v thu tri l 0,39cm3 (p < 0,01).
2. Th tch tuyn gip ton phn
Bng 4: Th tch tuyn gip ton phn ca nam v n
Th tch t/gip
Th tch t/gip ca
Chnh
p
Nhm tui
ca nam (cm3)
n (cm3)
40 - 49
1,61
< 0,01
10,90 1,88
9,29 2,02
50 - 59
2,68
< 0,01
11,24 3,16
8,56 2,26
4
60 - 69
2,71
< 0,01
10,28 3,38
7,57 2,42
2,22
< 0,01
70
9,31 3,47
7,09 3,11
Chung
2,36
< 0,01
10,44 3,13
8,08 2,65
Th tch tuyn gip ton phn ca nam ln hn ca n mi nhm tui (c ngha
thng k vi p < 0,01), chnh lch trung bnh l 2,36cm3.
Th tch tuyn gip trung bnh ca nam trn 40 tui l 10,44 3,13cm3 ln hn ca
n trn 40 tui l 8,08 2,65cm3 (p < 0,01).
Th tch tuyn gip c xu hng nh dn t nhm tui 50-59 nam v 40-49 n.
Th
tc
h
tuy
n
gi
p
(c
m3
)
12
11.24
10.90
10
10.28
9.29
9.31
8.56
7.57
7.09
Nam
N
4
2
0
40-49
50-59
60-69
= 70
Nhmtu
i
Biu 1. Th tch tuyn gip ton phn theo nhm tui ca nam v n
3 . Tng quan gia th tch tuyn gip vi tui v cc ch s nhn trc theo gii
1. Tng quan gia th tch tuyn gip vi tui
2.
Thtch (cm3)
20
R =0.0423
15
10
5
0
0
20
40
Tu
i
60
80
100
5
Biu 3.2. Tng quan gia th tch tuyn gip vi tui nam
Thtch (cm3)
20
15
10
5
0
0
20
40
Tu
i
60
80
100
6
T ng quan gia thtch v i BMI namgi i
Thtch (cm3)
20
15
10
y =0.441x +0.9334
R =0.1326
0
10
15
20
BMI
25
30
35
Biu 3.4. Tng quan gia th tch tuyn gip vi BMI nam gii
5. Tng quan gia th tch tuyn gip vi din tch da (BSA)
C s tng quan thun va phi gia th tch tuyn gip v BSA vi r = 0,398 (p < 0,01)
nam, r = 0,408 (p < 0,01) n. Khng c s khc bit v th tch tuyn gip gia nam v n
cc nhm din tch da.
20
y =8.3644x - 3.5719
2
R =0.1661
15
10
5
0
1.0
1.1 1.2
1.3
1.8 1.9
2.0
Biu 3.5. Tng quan gia th tch tuyn gip vi din tch da n gii
IV. BN LUN
1. Th tch tng thu gip
V quan im Thu phi ln hn thu tri tuyn gip
Muller L.C v CS (1988) siu m gip 1080 i tng t 7-20 tui, sng ti vng Speyer
v Neckargemund thuc CHLB c ghi nhn thu phi ln hn thu tri, vi chnh l
0.8cm3 mi la tui . Nygaard B v cng s (1993) siu m tuyn gip cho 391 ph n an
Mch ghi nhn thu phi ln hn thu tri vi chnh lch trung bnh l 1,37cm3 .
Schorman L v cng s (1995) siu m gip cng ghi nhn thu phi ln hn thu tri .
Mai Trng Khoa, Lng Linh H (2002) siu m gip ghi nhn t 8-14 tui th tch thu phi
chnh lch khng r rt so vi thu tri (p > 0,05), nhng t 15 tui tr ln th tch thu phi
ln hn thu tri (p < 0,05).
7
Nguyn Hi Thu v CS (2002) siu m gip 677 i tng tui 15-23 cng ghi nhn thu
phi ln hn thu tri tuyn gip trong cc tui trn (p < 0,05 - 0,001) V quan im th
tch hai thu khng khc bit nhau
Phm Vn Choang, Hong Kim c, Nguyn B S (1996) siu m tuyn gip bng u d
5.0MHz cho 580 tr 7-14 tui, thy thu phi ln hn thu tri khng c ngha thng k (p
> 0,05)
Kt qu nghin cu ca chng ti 421 ngi trn 40 tui (191 nam v 230 n) cho thy th
tch thu phi ln hn thu tri tuyn gip c hai gii, vi chnh trung bnh 0,78cm3
nam (p < 0,001) v 0,39cm3 n (p < 0,01). Kt qu ny ph hp vi a s cc kt qu
nghin cu trc ca cc tc gi trong v ngoi nc, l thu phi ln hn thu tri tuyn
gip.
T kt qu nghin cu ny, chng ti rt ra kt lun l khng nn o kch thc ca mt thu
suy on ra th tch ton phn, m cn phi o kch thc ca tng thu mt ri cng li
th chnh xc hn.
2. Th tch tuyn gip ton phn
2.1. Th tch tuyn gip v gii tnh
Berghout A v CS (1987) Trng i hc Amsterdam (H Lan) siu m cho 50 ngi
tui t 20-70 (gm 50 nam v 50 n), o c th tch tuyn gip trung bnh nam l 12,7
4,4cm3 ln hn n l 8,7 3,9cm3 vi p = 0,0014 .
Muller L.C v cng s (1988) i hc Heidelbeig (CHLB c) siu m tuyn gip cho
tr 7-20 tui ghi nhn di 10 tui th tch tuyn gip khng khc bit gia nam v n nhng
tui dy th th tch tuyn gip ca n hi ln hn nam .
Gomez J.M v cng s (2000) nghin cu 268 ngi (134 nam, 134 n) khng mc bnh
tuyn gip, thy th tch tuyn gip ca nam 9,19ml ln hn ca n 6,19ml (p = 0,001) .
Rago T v cng s (2001) khi siu m cho 482 ngi th thy th tch tuyn gip ca nam
12,9 3,6ml ln hn ca n 9,2 ,9ml (p < 0,0001)[78].
Mai Trng Khoa, Phan S An (2002) siu m tuyn gip 140 ngi bnh thng (gm 60
nam, 80 n) ghi nhn th tch thu phi, thu tri v chung hai thu ca nam gii u ln hn
ca n gii (p < 0,05) .
Mai Trng Khoa, Lng Linh H (2002) nhn thy th tch tuyn gip ngi bnh thng 816 tui ca nam v n chnh lch cha r rt (p > 0,05), nhng t 17 tui tr ln th tch
tuyn gip ca nam ln hn ca n (p < 0,05) .
Kt qu nghin cu ca chng ti 421 i tng (gm 191 nam, 230 n) cho thy th tch
tuyn gip trung bnh ca nam gii l 10,44 3,13cm3 ln hn ca n gii 8,08 2,65cm3
(p < 0,01) v tng nhm tui th th tch tuyn gip ca nam cng u ln hn ca n c
ngha thng k (p < 0,01).
2.2. Th tch tuyn gip v tui theo gii
Theo y vn v mt sinh l v gii phu, th tch v trng lng tuyn gip tng dn theo tui
k t khi sinh ra, t gi tr ln nht la tui trng thnh, sau tuyn s nh li dn sau
tui 50 .
Nygaard B v cng s (1993) an Mch siu m tuyn gip cc la tui 15, 30, 45 v 60
tui, ghi nhn th tch tuyn gip ln lt l 12, 18, 18, v 18cm3
Tajtakova M v cng s (2003) siu m cho 347 ph n tui sinh (160 ngi tui 20-29 v
187 ngi tui 30-40), ghi nhn th tch tuyn gip n 20-29 tui l 8,78ml, nh hn n
30-40 tui l 10,66ml (p < 0,01) .
Mai Trng Khoa, Lng Linh H (2002) o th tch tuyn gip ngi bnh thng 8-80 tui
nhn thy th tch tuyn gip ca nam v n c xu hng tng dn theo tui v t gi tr cc
i la tui 25-30, sau gim dn khi tui tng ln .
8
Xut pht kt qu trn tuyn gip ph n c kch thc b hn nam gii. V vy khng th c
s o chung ca nam v n, Chnh v vy th tch tuyn gip cn lu theo gii. Tht vy kt
qu nghin cu ca chng ti ghi nhn ngc li :
Th tch tuyn gip bt u nh li t tui 40 - 50 tui. V vy c s tng quan nghch th
tch gip vi vi tui: r = -0,206 (p < 0,01) nam v r = -0,341 (p < 0,01) n. Th tch
tuyn gip trung bnh t gi tr ln nht l 11,24 3,16cm3 nam gii tui 50-59 sau
gim dn, cn n t gi tr ln nht l 9,29 2,02cm3 tui 40-49 sau th gim
dn.
Bng 4.1: Th tch tuyn gip trung bnh cc nhm tui ca nam v n
Nhm tui
40 - 49
50 - 59
60 - 69
Nam
10,90 1,88
11,24 3,16
10,28 3,38
Th tch
3
(cm )
N
9,29 2,02
8,56 2,26
7,57 2,42
70
9,31 3,47
7,09 3,11
9
Muller L.C v cng s (1988) nghin cu trn 1080 hc sinh kho mnh 7-20 tui cho thy s
lin quan gia th tch tuyn gip vi din tch da l tng quan cht ch nht . Gomez J.M,
Maravall F.J, Gomez A, Guma A, Soler J (2000) nghin cu 268 ngi ln cho thy th tch
tuyn gip tng quan thun vi din tch da vi h s r = 0,48 (p = 0,0001) . Delange F
(1997), Gim c U hi Quc t Phng chng cc ri lon do thiu it (ICCIDD), trng
nhm nghin cu Thyromobil cng chng minh th tch tuyn gip tng quan cht ch vi
din tch da v khuyn co rng cc nc chm pht trin th nn dng din tch da thay cho
tui tnh tng quan vi th tch tuyn gip .
Nguyn Hi Thu v cng s (2002) ghi nhn c s tng quan thun gia th tch tuyn gip
vi din tch da ngi 15 - 23 tui vi r = 0,31973 nam v r = 0,29664 n .
Kt qu nghin cu ca chng ti ghi nhn c s tng quan thun gia th tch tuyn gip
v din tch da c hai gii, vi r = 0,398 (p < 0,01) nam, r = 0,408 (p < 0,01) n.
Tm li : ngi trn 40 tui th tch tuyn gip thay i , vi tr trung bnh t 1,24 3,16
n 9,31 3,47cm3 i vi nam, 9,29 2,02 n 7,09 3,11cm3 i vi n gii n.
2.7. Ngoi yu t tui tc v gii tnh th khi tnh th tch tuyn gip cn tham kho thm cc
ch s nhn trc c tng quan sau:
Vtg/Chiu cao
Vtg/Cn nng
Vtg/BSA
Vtg/BMI
3
3
3
2
(cm /m)
(cm /kg)
(cm /m )
(cm3/v BMI)
Nam
6,49 1,92
0,19 0,05
6,62 1,87
0,48 0,14
N
5,39 1,72
0,17 0,05
5,78 1,78
0,38 0,12
IV. KT LUN
Qua siu m tuyn gip ca 470 ngi trn 40 tui sng vng khng thiu it chng ti i
n mt s kt lun sau:
1. Th tch tuyn gip trung bnh ( cm3) ca ngi trn 40 tui ca nam v n nh sau:
- 10,90 1,88 cm3 ( nam ) v 9,29 2,02 ( n ) tui 50 - 59
- 11,24 3,16 cm3 ( nam ) v 8,56 2,26 ( n ) tui 50 - 59
- 10,28 3,38 cm3 ( nam ) v 7,57 2,42 cm3 ( n ) tui 60 - 69
- 9,31 3,47 cm3 ( nam ) v 7,09 3,11 cm3 ( n ) tui 70
Th tch thu phi ln hn thu tri tt c cc nhm tui ca c hai gii c ngha (tr cc
nhm tui trn 50 n )
Th tch tuyn gip ngi trn 40 dao ng t 11,24 3,16 n 9,31 3,47cm3 i vi
nam gii, 9,29 2,02 n 7,09 3,11cm3 i vi n gii tu theo tui nh hay ln.
Th tch tuyn gip gim dn t tui 40-49 n v 50-59 nam.
2. 1. Th tch tuyn gip tng quan nghch
vi tui: r = - 0,206 (p < 0,01) i vi nam, r = - 0,341 (p < 0,01) i vi n.
2.2. Th tch tuyn gip tng quan thun
vi chiu cao : r = 0,221 (p < 0,01) i vi nam, r = 0,344 (p < 0,01) i vi n.vi cn nng : r = 0,426 (p < 0,01) i vi nam, r = 0,365 (p < 0,01) i vi n.
vi BMI: r = 0,364 (p < 0,01) i vi nam, r = 0,248 (p < 0,01) i vi n.
vi din tch da: r = 0,398 (p < 0,01) i vi nam, r = 0,408 (p < 0,01) i vi n.
Kch thc tuyn gip ca ngi ln bnh thng nh li dn sau 40-50 tui i vi n v sau
50-60 tui i vi nam.
TI LIU THAM KHO
1/ Phm Vn Choang. ( 2000 ) Kt qu siu m tuyn gip trong 3 nm 1993-1995 ti Vin
Ni tit. K yu ton vn Cng trnh Nghin cu Khoa hc Ni tit v Chuyn ha. Nh Xut
bn Y hc 5.2000. Trang 23-26.
2/ Nguyn Hi Thy.( 2000 ) Siu m tuyn gip . Chn on v iu tr bnh tuyn gip Nh
xut bn Y hc H Ni.Tr. 79-99
3/ Fobble. F (1995), Thyroid gland - Color Duplex sonography - Principles and clinical
10
applications - Thieme.
4/ Gomez J.M, Maravall F.J, Gomez N, Guma, Soler J (2000), Determinants of thyroid
volume as measured by ultrasonography in healthy adults randomly selected, Clin Endocrinol
(Oxf), 53(5), pp 629-34.
5/ Muller L. C, Troger J, Khabirpour F, Pockler C (1998), Normal values of thyroid gland
volume: Ultrasound measurements in schoolchildren 7 to 20 years of age , Deutsch Med
Wocheschr 2; 113(48), p 1872-5.
6/ Nygaard B. , Peter Gideon, Harriet Dige Petersen (1993). Thyroid volume and
morphology and urinary iodine excretion in Danish municipality, Acta Endocrinologica. 1993.
129: 505-510.
7/ Palmer P.E.S (1995), Manual of Diagnostic Ultrasonography, WHO Geneve, 1-41, p 302305.
8/ Parker T (1995), Thyroid. Textbook of Ultrasonography, Mosby, p 351-359.
9/ Zimmermann M, Saad A. ( 2000) Thyroid ultrasound compared with world Heath
Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions
of mild and severe iodine deficiency, Eur. J Endocrinol, 143(6) pp 727-31
10/ Berlin X. , J Tramalloni, C. Swagier.( 1999 ) Rgion cervicale. cho Doppler vasculaire et
viscrale. Masson (1999).
11/ Paulette J.( 1993) Manuel dultrasonographie generale de ladulte. (1993).
12/ Rouanet. J.P, Daclin P.Y. ( 2001 ) . IRM et Thyroide, 2eme dition. Elsevier