C IM LM SNG CA TR THA CN V BO PH

Nguyn Th Dim Chi Khoa Nhi Bnh Vin Trung ng Hu Clinical chararistics of children with overweight and obesity Objective: evaluate the clinical chararistics of children with overweight and obesity Methods: 45 overweight and obesity chilren aged 6 - 15 years are diagnosed by anthropometric measurements, and their clinical characteristics of overweight and obesity are evaluated. Results: The mean waist circumplex (wc) in children with dyslipidemia was 73.31 8 cm, mean whr was 0.94 0.04, there is no difference in wc andwhr between the groups with and without dyslipidemia. the height in group with dyslipidemia lower than group without dyslipidemia (p<0,05). hypertension was 6,6%, snore was 17,77%, buffalo hump was 13,3%, cutaneous striae was 22,22%, dyspnea on exertion was 24,44%, weary knees was 2,2%, back pain was 8,88%, articular pain 6,66% and Acanthosis nigricans was 15,55%. In group with dyslipiemia, the prevalence of dyspnea on exertion was 27,77%, snore was 16,66% and cutaneous striae 13,88%. buffalo hump was present 11,1% in group with dyslipidemia and 22,2% in group without dyslipidemia. Cutaneous striae in group with dyslipidemia higher than group without dyslipidemia (p<0,05). there is no difference in other clinical manifestations between these groups (p >0,05). Conclusions: Children with overweight and obesity have clinical characteristics and complications concerning metabolic syndrome. Tm tt Mc tiu: Kho st c im lm sng ca tr tha cn v bo ph. i tng v phng php : 45 tr em tui t 6 n 15 c chn on bo ph v tha cn. bnh nhi c kho st cc ch s nhn trc, c im v bin chng do tha cn v bo ph. Kt qu: nhm c RLLM c VE l 73.31 8 cm, VM l 77.71 8.31, VE/VM l 0.94 0.04. Khng c s khc bit c ngha thng k v VE,VM v t VE/VM so vi nhm khng RLLM. Chiu cao nhm c RLLM thp hn ca nhm khng c RLLM (p<0,05). T l tng huyt p l 6,6%., ng ngy l 17,77%., bu tru l 13,3%, rn da l 22,22%, kh th khi gng sc l 24,44%, mi hai gi l 2,2%, au lng l 8,88%, au xng khp l 6,66% v chng gai en (Acanthosis nigricans) l 15,55%. Nhm c RLLM ghi nhn kh th khi gng sc (27,77%), ng ngy (16,66%) v rn da (13,88%). T l bu tru nhm tr c RLLM l 11,1% v nhm khng c RLLM l 22,2%. T l rn da nhm c RLLM cao hn nhm khng c RLLM (p < 0,05). Ngoi ra, khng c s khc bit c ngha thng k v t l xut hin triu chng lm sng khc gia hai nhm ny (p >0,05). Kt lun: Tr tha cn v bo ph c c im lm sng v bin chng lin quan n hi chng chuyn ho gy ra.

I. T VN Tha cn - bo ph ang ni ln nh l mt vn sc kho ca cng ng cc nc v ang pht trin . vng chu - Thi bnh dng, bo ph l mt trong nhng yu t nguy c chnh ca cc bnh mn tnh khng ly nh bnh ng mch vnh, bnh i ng type 2. Bnh bo ph pht trin tc nhanh, c bit t l bo ph tui thiu nin tng ln mt cch nhanh chng trong s t l bo ph tr em tng hng nm 10% ti Trung quc, Vit Nam, vi s pht trin ca nn kinh t, ti cc thnh ph ln nh thnh ph H Ch

Minh, H Ni v Hi Phng t l bo ph hc sinh xp x 10% . Ti Hu, theo Nguyn Th Li, t l tha cn hai trng tiu hc l 2,2% , theo Phm Vn Dng l 7,6%. Vic pht hin sm tr tha cn -bo ph c th gip t vn ch n thch hp v hot ng th lc nhm d phng sm hn nhng hu qu do tha cn - bo ph gy ra. Mc tiu ti : Kho st mt s c im lm sng ca cc tr tha cn-bo ph t 6 n 15 tui c ri lon lipid mu. II. I TNG V PHNG PHP NGHIN CU 1. i tng nghin cu - 45 tr tha cn - bo ph t 6 -15 tui c giy mi n khm v t vn ti phng Ni tit, khoa Nhi, Bnh vin Trung ng Hu cu Trung tm Y t Hc ng thnh ph Hu - Thi gian nghin cu: 05/2003 - 05/2004 2. Phng php nghin cu Phng php nghin cu ct ngang m t phn tch lm sng - cn lm sng bao gm: hi bnh s, thm khm cc du hiu lm sng v lm xt nghim. 2.1. Tiu chun chn bnh nhn + Tr tha cn - bo ph: * Tiu chun chn on tha cn - bo ph: nh gi tha cn : CN/CC >+2SD so vi NCHS vi tr <9 tui, BMI (85th Percentile so vi NCHS vi tr > 9 tui ( xin tham kho ph lc 5 - 8). Phn loi tha cn theo WHO . i vi tr <9 tui : + CN/CC>+2 SD n +3SD : tha cn I + CN/CC>+3SD n +4SD : tha cn II + CN/CC>+4SD : tha cn III i vi tr >9 tui : BMI = cn nng (kg)/ chiu cao2 (m) + BMI>85th Percentile n 90th Percentile : tha cn I + BMI>90th Percentile : tha cn II nh gi bo ph :Khi tr c tha cn v c BDNGD c tam u v c sau vai(90th Percentile). + Tin s sn khoa bnh thng, khng c cc d tt bm sinh + Pht trin tinh thn, vn ng bnh thng + Khng c tin s dng thuc: Corticoid, Depakine hoc cc thuc c th lm thay i lipid mu. 2.2.Tiu chun loi tr Tr ang s dng cc loi thuc lm nh hng lipid mu, hoc mc cc bnh: hi chng thn h, hen, bnh tim mch... 2. 3. Tham s nghin cu + Tui: Cch tnh tui thc hin theo cch tnh ca T chc y t th gii. + Cn nng: o bng dng c cn bn Trung Quc c hiu chnh trc khi s dng v kim tra li sau khi o 20 ngi. t cn v tr n nh. i tng ci b o qun ngoi ch mc o qun mng, khng i dp guc, khng i m v cm vt, ng nh nhng ln

ngay gia cn, khi kim ng h bo trng lng hon ton ng yn mi c kt qu. Kt qu c ghi bng kilgram v sai s khng qu 100g. + Chiu cao ng: o chiu cao bng dng c o l thc g, ly mu thc dy Trung Quc hoc thc o chiu cao gn lin vi cn. i tng ng thng vi t th thoi mi, hai chn chm li hnh ch V, mt nhn thng, bo m 4 im trn c th chm vo thc o : vng chm, xng b vai, mng, gt chn. Ngi o ko ke gn sn trn thc o ln cho qu u, h xung n chm nh u. Kt qu tnh bng n v mt (m) v sai s khng qu 0,5 cm. + o lp m di da: Ngi ta thng chn ni o nhng ch c nhiu m nht nh mt sau cnh tay, gc di xng vai. S dng compa o np gp da HARPENDEN skinfold caliper do Anh sn xut, hai u compa l hai mt phng, tit din 1 cm2, m bo khi compa kp vo da bao gi cng c mt p lc khng i khong 10-20 g/mm 2 vi khong chia 0,2 mm nhng c th c chnh xc ti 0,1mm. o ti 2 v tr: c tam u v gc di xng b vai. Ch o hay dng nht mt sau cnh tay gi l np gp da trn c tam u: o tay tri, t th thng t nhin. Vo da mt im gia sau cnh tay cho st ti lp cn nng v o b dy ca lp da vo ln. Khi o, b mt ca compa song song vi trc cnh tay. im o gc di xng vai, ngi o cn ln theo ct sng xc nh b xng vai v gc di. ngi bo, nn qut nh tay ra pha sau s xc nh d dng hn. Mi v tr o hai ln v ly tr s trung bnh . Kch thc ny l mt ch tiu nh gi tnh trng pht trin ca c. + nh gi t s vng eo/vng mng: l ch s nh gi mc phn b t chc m di da v m trong bng. tr em v v thnh nin, phn b m trung tm c th c ghi nhn c tng quan thun vi hin tng ni cn bng ng -Insulin bt thng [39]. Ch s ny :N bnh thng<0,85 Nam bnh thng<1. Tr em <9 tui bnh thng <1,1. Tr em t 10 tui tr ln ging ngi ln Nhng mt s nghin cu gn y chng minh ch s ny khng ph hp vi chp ct lp vi tnh do vic s dng ch s ny tr em cn rt hn ch [13]. S dng thc dy c vch cm khng chun dn, ghi kt qu bng centimt vi mt s l. i tng ng thng, t th thoi mi, tay bung thng, th bnh thng, o lc i. Vng tht lng l vng b nht bng i qua im gia b di xng sn v nh mo chu trn mt phng ngang. o mc chnh xc 0,1 cm.Vng mng l vng ln nht i qua mng. i tng t th trn ,mc qun lt, vng o mt phng ngang . + Acanthosis nigricans: Acanthosis nigricans m t s dy da v tng sc t ca da cc np gp ch d b hm. Acanthosis nigricans (chng gai en) biu hin bng xm da np gp da c, khuu tay, pha lng cc k ngn tay . + Bu tru: L phn b m c th "kiu tru" (tp trung vng gian b vai, mt , c v thn). + Kh th khi gng sc: l biu hin kh th khi tr lm mt vic nng nh bng vc nng, i ln nhiu cu thang, sau chy b ...S khc nhau ch yu gia kh th khi gng sc nhng c nhn bnh thng v nhng bnh nhn suy tim mc hot ng cn thit gy ra triu chng. + o huyt p: Dng phng php nghe thng thng. S dng my o huyt p ng h ALK2 do Nht sn xut. Dng ti hi bao tay (Cuff) c kch thc thch hp vi tng la tui ph kn 2/3 cnh tay. o huyt p tay phi. Tr nm ngh ngi trn ging ti thiu 5 pht. Bt mch : bnh thng mch <100 ln /pht i vi tr nh v mch <80 ln/pht i vi tr ln. Khng c a ng nghe chn vo di gii bng khi o.

nh gi kt qu: da vo bng tr s huyt p bnh thng cc la tui.

Bng 2.1. Tr s huyt p bnh thng cc la tui

Tui theo nm 6 nm 7 nm 8 nm 9 nm 10 nm 11 nm 12 nm 13 nm 14 nm 15 nm Tm thu trung bnh 100 102 105 107 109 111 113 115 118 121 95 t l bch phn tr bnh thng 15 15 16 16 16 17 18 19 19 19 Tui theo nm 6 nm 7 nm 8 nm 9 nm 10 nm 11 nm 12 nm 13 nm 14 nm 15 nm Tm trng trung bnh 56 56 57 57 58 59 59 60 61 61 95 t l bch phn tr bnh thng 8 8 9 9 10 10 10 10 10 10

Nhng s huyt p vt qu 95 s bch phn c xem l THA. Nhng s huyt p nm gia 90-95 bch phn cn theo di, kim tra . 2.2.4. Phng php x l s liu Tt c s liu thu thp trn mu bnh n nghin cu c x l theo phng php thng k y hc theo chng trnh Epi Info 6.0. III. KT QU NGHIN CU Qua nghin cu ri lon lipid mu 45 tr tha cn - bo ph t 6 n 15 tui ti mt s trng tiu hc v trung hc c s ti thnh ph Hu, chng ti ghi nhn kt qu nghin cu nh sau: 1. Phn b nhm tui theo gii Bng 3.1. Phn b nhm tui theo gii 6-<9 tui n 16 4 20 T l 44,5% 44,5% 44,5% 9-15 tui n 20 5 25 T l 55,5% 55,5% 55,5%

Nam N Chung

2. T l tha cn, bo ph Bng 3.2. So snh t l tha cn v bo ph theo gii Tha cn Nam N Chung n 19 8 27 T l 52,8% 88,9% 60% n 17 1 18 Bo ph T l 47,2% 11,1% 40% p p > 0,05

3. Ch s khi c th (BMI) Bng 3.3. Ch s khi c th (BMI) trung bnh Chung Nam (n = 36) N (n = 9) p

BMI trung bnh

23,4 2,66

23,76 2,85

21,96 0,84

< 0,05

4. So snh c im ca cc tr tha cn - bo ph t 6 n 15 tui c v khng ri lon lipid mu Nhm c RLLM Nhm khng RLLM p (n = 36) (n = 9) Chiu cao trung bnh p< 0,05 133.59 12.55 139.83 12.24 Cn nng trung bnh p >0,05 40.93 2.66 44.82 10.15 Huyt p tm thu TB p >0,05 100.33 12.16 104.22 15.51 Huyt p tm trng TB p >0,05 61.72 7.48 61.67 7.37 CN/CC trung bnh p >0,05 3.44 1.78 3.15 0.62 BMI trung bnh p >0,05 23.53 2.87 23.06 2.21 Vng eo trung bnh p >0,05 73.31 8 76.67 9 Vng mng trung bnh p>0,05 77.71 8.31 80.63 9.33 VE/VM trung bnh p >0,05 0.94 0.04 0.95 0.06 Nhn xt: Chiu cao trung bnh ca nhm c ri lon lipid mu nh hn ca nhm khng c ri lon lipid mu ( p <0,05) 6.Triu chng lm sng ca cc tr tha cn - bo ph t 6 n 15 tui Bng3.4. Mt s triu chng lm sng ca cc tr tha cn -bo ph t 6 n 15 tui Tng huyt p Ng ngy Bu tru Rn da Kh th khi gng sc Mi hai gi au lng au xng khp Acanthosis nigricans n 3 8 6 10 11 1 4 3 7 T l 6,66% 17,77% 13,33% 22,22% 24,44% 2,22% 8,88% 6,66% 15,55%

Bng 3.26. Triu chng lm sng ca nhm c RLLM v nhm khng c RLLM Nhm c RLLM (n = 36) n 3 6 4 5 10 1 4 T l 8,3% 16,6% 11,1% 13,8% 27,7% 2,7% 11,1% Nhm khng RLLM (n = 9) n 0 2 2 5 1 0 0 T l 0% 22,2% 22,2% 55,5% 11,1% 0% 0% OR p p>0,05 OR= 0,7 p>0,05 OR= 0,44 p>0,05 OR= 0,13 p<0,05 OR= 3,08 p> 0,05 p>0,05 p>0,05

Triu chng lm sng THA Ng ngy Bu tru Rn da Kh th khi gng sc Mi hai gi au lng

au xng khp Acanthosis nigricans IV. BN LUN 4

8,3% 11,1% 3

0% 33,3%

p>0,05 OR= 0,25 p>0,05

1. Phn b theo gii Nhm nghin cu nam chim 80%, n chim 20%. 2. Phn b nhm tui theo gii La tui 6-<9 tui chim t l 44,5%, la tui 9-15 tui chim t l 55,5%. Trong khi , L Quang Hng ghi nhn la tui 6 - 11 tui c t l cao nht (45,4%), Trn Nguyn Vinh cng ghi nhn t l BP trong nhm nghin cu tp trung ch yu vo la tui <9 tui . 3. T l tha cn, bo ph Nhm tha cn chim 60%, nhm bo ph chim 40% . L Th Hi nhn thy bo ph mc nh chim a s 61,7% , tuy nhin khng c s khc bit c ngha thng k v tnh trng tha cn, bo ph gia nam v n (p >0,05). 4. Ch s khi c th (BMI) trung bnh ( tr 9- 15 tui) BMI trung bnh ca nhm nghin cu l 23,4 2,66. Weiss Ram v cng s nghin cu trn 31 tr tha cn t 4 n 20 tui ghi nhn BMI trung bnh l 24.5 . Nguyn Th Hoa nghin cu trn 81 bnh nhn bo ph t 2 n 15 tui ghi nhn BMI trung bnh 23,78 6,85 . BMI trung bnh ca nam ln hn ca n (p<0.05). Asayama Kohtaro cng ghi nhn BMI trung bnh ca nam ln hn ca n (p<0.001) . 5. Vng eo (VE) VE l mt trong nhng thng tin v phn b m c th tr em. Tr c VE mc 90 percentile so vi tr c VE mc 10 percentile th c nng LDL-C cao hn, HDL-C thp hn. Vng eo rt d o, c th gip nhn ra cc tr c nguy c c nhng nng lipid mu bt thng [36]. Bo bng cc tr bo ph t 12 n 14 tui thng phi hp vi mt ri lon lipid mu. iu ny c th lin quan vi mt nguy c tim mch tng ln v sau trong i sng. VE dng nh l mt ch im nhn trc thun tin v y thng tin cho nhng chuyn ho nh th [31]. 6. T s vng eo/vng mng (VE/VM) Lin quan vi m ni tng trong bng. Tng t s VE/VM i km vi tng Glucose mu, tng TG v gim HDL-C. Ch s ny tr em< 9 tui bnh thng <1,1, tr em t 10 tui tr ln ging ngi ln ( n bnh thng<0,85, nam bnh thng<1) . Mi tng quan gia VE/VM vi m c th v cc yu t nguy c t r rng tr em, tr nn r rng hn cc tr v thnh nin. Ch c sau khi im dy th dng nh VE/VM tr thnh mt ch im cho s phn b m v c th phi hp vi cc yu t nguy c thm vo nh ngi ln. C nhng bng chng l kiu phn b m c th c th quan trng thi k tr em. cc tr gi tui v thnh nin, vic ng m bng phi hp vi mt s yu t nguy c chuyn ho khng thun li , tng t nh ngi ln. Nhng quan h ny t r rng nhng tr gi v cc tr nam bo ph nh tui, do s phn b m c th thay i nhanh trong thi k dy th. Cc d kin ny gi rng s gim cn s lm gim c ngha hoc thm ch bnh thng ho cc mc ca nhng yu t nguy c chuyn ho ny, c bit khi lm mt m bng [60]. Gim cn r rng c mt tc dng c li i vi nhng yu t nguy c tim mch v c th c mt nh hng ln hn trong s nhng tr gi c bo ph bng.

VE trung bnh ca nhm c RLLM l 73.31 8 cm, khng c s khc bit c ngha thng k v VE trung bnh gia nhm RLLM v nhm khng RLLM. VM trung bnh ca nhm c RLLM l 77.71 8.31, khng c s khc bit c ngha thng k v VM trung bnh gia nhm c RLLM v nhm khng RLLM. VE/VM trung bnh ca nhm c RLLM l 0.94 0.04, khng c s khc bit c ngha thng k v VE/VM trung bnh gia nhm c RLLM v nhm khng RLLM. Chiu cao trung bnh ca nhm c ri lon lipid mu nh hn ca nhm khng c ri lon lipid mu (p<0,05). Chng ti cng cha tm c mt nghin cu no tng t v c im ca cc tr tha cn - bo ph c ri lon lipid mu so snh. 7. Tng huyt p: THA (tng huyt p) khng phi l mt triu chng lm sng him gp cc tr tha cn, bo ph. Tuy nhin, THA xy ra vi tn sut thp tr em. Mt nghin cu da vo cng ng M c nh gi l tt nht trn 6600 tr t 5-18 tui ch c 1% tr b tng huyt p trng din, nhng trong s ny 60% tr b tha cn . Mc Murray nghin cu trn 546 tr bo ph v 546 tr khng bo thy nhm bo ph c huyt p tm thu v tm trng cao hn tr khng bo mt cch c ngha (p<0,0001) . Kt qu ny cng tng t trong nghin cu ca Figueroa v cng s . L Quang Hng ghi nhn t l THA l 3,64% trn 55 tr bo ph t 2 tui n 15 tui .Trn Nguyn Vinh ghi nhn t l THA trn 30 tr bo ph t 6 n 11 tui l 10% .R .Unger v cng s ghi nhn t l THA trn 61 tr bo ph t 1 n 14 tui trong nhm nghin cu l 25% Nguyn Th Hoa ghi nhn t l THA trn 330 bnh nhn bo ph t 2 n 15 tui l 2,7% L Th Hi v cng s nghin cu nhm 312 tr tha cn, bo ph t 6 n 11 tui ghi nhn t l THA l 16,6%. Trong nghin cu chng ti t l tng huyt p l 6,6%. nhng trng hp ny l THA tm trng, khng c trng hp no l THA tm thu c l do nghin cu ca chng ti c mu nh v tr ch yu b tha cn, hoc bo ph a s ch mc nh. Ngoi ra, nc ta cha c mt tiu chun nh gi huyt p theo bch phn v no, vic p dng tiu chun ca ngi nc ngoi cho ngi Vit Nam l khng c tha ng lm, do kt qu c th b nh hng. Tuy nhin, trong nghin cu ca chng ti ch ghi nhn c 3 trng hp tr b THA km ri lon lipid mu, khng c tr no trong nhm khng ri lon lipid mu b THA. 8. Ng ngy: Cc ri lon v ng cc tr bo ph c th l mt nguyn nhn chnh ca kh nng hc tp st gim v nh hng thnh tch hc tp, mc du iu ny cn cn c khng nh thm. Cc triu chng gi ca mt ri lon gic ng bao gm ng ngy, trn trc ban m cng vi kh th, v m hi, i dm v bun ng ban ngy. i vi cc tr bo ph c bit bo ph nng, cn cn tm hiu xem c ngng th tc nghn lc ng hay khng. Cc nghin cu tr em gi l ngng th tc nghn lc ng xy ra khong 17% tr em v v thnh nin b bo ph .Trn Nguyn Vinh ghi nhn t l ri lon gic ng trn 30 tr bo ph t 6 n 11 tui l 3,33%. Nguyn Th Hoa ghi nhn t l ng ngy trn 330 bnh nhn bo ph t 2 n 15 tui kh cao 42,8%. T l ng ngy trong nghin cu chng ti l 17,77%. Theo Locard v cng s (1992), c s kt hp cht ch gia ng t, ng khng ngon gic v bo ph, tc gi ny gii thch l do hot ng tiu m ca c th ti a l v m nn t ng lm gim tiu m, nhng y cng ch mi l gi thuyt cha c chng minh. Bu tru: L phn b m c th "kiu tru" (tp trung vng gian b vai, mt , c v thn) Bu tru thng gp gy v cng ch c nhng tr bo ph nng v rt nng.L Quang Hng ghi nhn t l bu tru trn 55 tr bo ph t 2 n 15 tui l 14,55%.T l bu tru ca cc tr tha cn- bo ph t 6 n 15 tui l 13,3%.

Rn da: T l rn da l 22,22% .Rn da trng hoc thng hin din vng bng hoc vng i. Vt rn da do bo ph c mu trng hay hng nht, thng mt trong i, mt sau khp gi. Khc vi cc vt rn da trong hi chng Cushing thng c mt, bng , i .. v c mu , ta.Trn Nguyn Vinh ghi nhn t l rn da trn 30 tr bo ph t 6 n 11 tui l 10%. L Quang Hng ghi nhn vt rn da c mu trng hay hng nht, thng ch gp trong bo ph nng hoc rt nng, t l rn da l 14,6% trn 55 tr bo ph t 2 tui n 15 tui. Kh th khi gng sc: T l kh th khi gng sc ca cc tr tha cn - bo ph t 6 n 15 tui l 24,44%. Kh th khi gng sc : iu ny ch gp nhng tr bo ph nng tr ln, l biu hin kh th khi tr lm mt vic nng nh bng vc nng, i ln nhiu cu thang, sau chy b ..., nguyn nhn l do gim chc nng h hp th hin qua ri lon cc test chc nng h hp . Nghin cu ca Lazarus v cng s trn 2464 hc sinh la tui 9, 12, 15 c chng minh rng chc nng h hp gim cng vi s gia tng thnh phn m c th. Nu tnh trng bo ph tip tc duy tr v tng ln nhng tr ny th s xy ra mt bin chng khc nng n hn l ngng th khi ng. M c khong 17% tr bo ph mc phi tnh trng ny . Nguyn Th Hoa ghi nhn t l th mt trn 330 bnh nhn bo ph t 2 n 15 tui l 26,8%.Trn Nguyn Vinh ghi nhn t l kh th khi gng sc trn 30 tr bo ph t 6 n 11 tui l 20% .L Quang Hng ghi nhn t l kh th khi gng sc trn 55 tr bo ph t 2 n 15 tui kh cao 34,55% . Mi hai gi: I l mi hai gi 2,2%.Nguyn Th Hoa ghi nhn t l au u gi trn 330 bnh nhn bo ph t 2 n 15 tui l 17,5%. au lng: t l au lng l 8,88%. Nguyn Th Hoa ghi nhn t l au lng trn 330 bnh nhn bo ph t 2 n 15 tui l 3,7% . au xng khp: T l au xng khp l 6,66%. Trn Nguyn Vinh ghi nhn t l au khp trn 30 tr bo ph t 6 n 11 tui l 10%, thng l au lng, khp gi, khp c chn, khng c nng sng, khng c c ch chn thng. C ch l do cc khp phi chu mt p lc qu ti nn d au v d dn n thoi ho khp sm hn tr bnh thng.Bo ph nng cn gy nn mt bin chng him gp l cong xng i, xng chy, c ch l do cc u xng phi chu mt p lc qu ti lm ri lon s pht trin ca xng, lm xng dn dn b cong.L Quang Hng ghi nhn cong xng i, xng chy trn 55 tr bo ph t 2 n 15 tui l 1,82% [10]. Acanthosis nigricans: t l Acanthosis nigricans l 15,55%. Acanthosis nigricans m t s dy da v tng sc t ca da cc np gp ch d b hm. Acanthosis nigricans thng i km tng insulin mu v khng insulin. Bo ph, c bnh s gia nh b i ng type 2, v acanthosis nigricans l nhng yu t nguy c c ngha nht i vi T type 2 khi u lc tr. Tn sut xut hin Acanthosis nigricans cc bnh nhn BP c th cao ti 25% Likitmaskul S. v cng s nghin cu trn 35 tr bo ph t 5 n 15tui ghi nhn t l c biu hin Acanthosis nigricans rt cao 66,7%. Cc quc gia chu c hn 10% tr em b i tho ng type 2 l Nht Bn (21,3%), Singapore (19,0%), Malaysia (13,9%) v Thi Lan (11,5%) [56]. Da trn s ng gp ca BP i vi T ngi ln v tn sut xut hin ca Acanthosis nigricans cc tr em v v thnh nin tha cn, vic o lng insulin v ng mu lc i nn c bao gm mt cch thng quy nh l mt phn ca khm sc kho [34]. Phi chng cn c nghin cu thm v ri lon dung np glucose, i ng type 2 bng nghim php dung np ng cc tr c biu hin lm sng ny.

9. So snh c im lm sng ca nhm c v khng ri lon lipid mu Nhm c ri lon lipid mu, triu chng lm sng thng gp nht l kh th khi gng sc (27,77%), sau n ng ngy (16,66%) ri n rn da (13,88%). Nhm c ri lon lipid mu, t l bu tru l 11,1%, trong nhm khng c ri lon lipid mu, t l bu tru l

22,2%. T l rn da nhm c ri lon lipid mu cao hn nhm khng c ri lon lipid mu (p<0,05). Ngoi ra, khng c s khc bit c ngha thng k v cc triu chng lm sng khc gia hai nhm ny (p >0,05). Qua nghin cu cho thy khng c s khc bit v triu chng lm sng gia nhm c ri lon lipid mu v nhm khng ri lon lipid mu do khng th da vo lm sng chn on c tr tha cn, bo ph c ri lon lipid mu hay khng. chn on chc chn ri lon lipid mu phi lm bilan lipid mu. IV.KT LUN * c im lm sng ca cc tr tha cn- bo ph t 6 n 15 tui. VE nhm c RLLM l 73.31 8 cm, khng c s khc bit c ngha thng k v VE trung bnh gia nhm RLLM v nhm khng RLLM. VM nhm c RLLM l 77.71 8.31, khng c s khc bit c ngha thng k v VM trung bnh gia nhm c RLLM v nhm khng RLLM. VE/VM nhm c RLLM l 0.94 0.04, khng c s khc bit c ngha thng k v VE/VM trung bnh gia nhm c RLLM v nhm khng RLLM. Chiu cao nhm c RLLM nh hn ca nhm khng c RLLM (p<0,05). * Triu chng lm sng ca cc tr tha cn - bo ph t 6 n 15 tui T l tng huyt p l 6,6%, ng ngy l 17,77%., bu tru l 13,3%, rn da l 22,22%, kh th khi gng sc l 24,44%, mi hai gi l 2,2%., au lng l 8,88%, au xng khp l 6,66% v chng gai en (Acanthosis nigricans) l 15,55%. Triu chng lm sng ca nhm c RLLM v nhm khng c RLLM Nhm c ri lon lipid mu, triu chng lm sng thng gp nht l kh th khi gng sc (27,77%), sau n ng ngy (16,66%) ri n rn da (13,88%). Nhm c ri lon lipid mu, t l bu tru l 11,1%, trong nhm khng c ri lon lipid mu, t l bu tru l 22,2%. T l rn da nhm c ri lon lipid mu cao hn nhm khng c ri lon lipid mu (p<0,05). Ngoi ra, khng c s khc bit c ngha thng k v cc triu chng lm sng khc gia hai nhm ny (p >0,05). TI LIU THAM KHO 1. Phm Vn Dng (2002), Nghin cu tnh hnh bo ph v cc yu t nguy c tr em 6 - 10 tui ti hai trng tiu hc ni thnh thnh ph Hu, Lun vn Thc s y hc, trng i hc Y Hu, Hu. 2. L Th Hi (1997), "Tm hiu t l bo ph hc sinh ti hai trng tiu hc ni thnh H Ni", V sinh phng dch ,VII (2), tr. 48-52. 3. L Th Hi (2002), "Theo di tnh trng dinh dng v sc kho ca tr tha cn bo ph H Ni", Hi ngh khoa hc tha cn v bo ph vi sc kho cng ng, tr. 188203. 4. Nguyn Th Hoa (2002), "c im bnh nhn bo ph ti khoa dinh dng bnh vin Nhi ng 1 trong nm 2000-2002", Y hc thnh ph H Ch Minh, 7(1), tr. 206 -212. 5. L Quang Hng (1999), c im lm sng - xt nghim v cc yu t nh hng ca bo ph tr em, Lun vn Thc s y hc, trng i hc Y H Ni, H Ni. 6. Behrman Richard E. ,Kliegman Robert M., Jenson Han B. (2000), " Obesity", Nelson Textbook of Pediatrics, pp. 173. 7. Bray Geogre A. (1990), " Obesity", Present knowledge in Nutrition, pp. 24 - 34. 8. Colon R - Figueroa and coll. (1997), "Prevalence of obesity with increased blood pressure in elementary school - aged children", Southern Medical Journal, 90(8), pp. 806-813. 9. Dietz William H. (1998), "Health consequences of obesity in Youth : Childhood

predictors of adult disease", Pediatrics, (101), pp. 518 - 525. 10. Flier Jeffrey S. and Foster Daniel W. (1998), "Obesity", Williams textbook of Endocrinology, pp. 1074.