{"id":9344,"date":"2022-08-25T17:20:30","date_gmt":"2022-08-25T10:20:30","guid":{"rendered":"https:\/\/easymed.vn\/?p=9344"},"modified":"2022-08-25T17:20:30","modified_gmt":"2022-08-25T10:20:30","slug":"hoi-chung-de-bi-kich-thich","status":"publish","type":"post","link":"https:\/\/easymed.vn\/en\/hoi-chung-de-bi-kich-thich\/","title":{"rendered":"H\u1ed8I CH\u1ee8NG D\u1ec4 B\u1eca K\u00cdCH TH\u00cdCH"},"content":{"rendered":"

\u0110\u1ea0I C\u01af\u01a0NG<\/span><\/h3>\n

H\u1ed9i ch\u1ee9ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng (HCDBTT) l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi cao tu\u1ed5i, d\u1ef1 b\u00e1o nguy c\u01a1 cao nh\u1eefng b\u1ea5t l\u1ee3i v\u1ec1 s\u1ee9c kh\u1ecfe nh\u01b0 t\u00ecnh tr\u1ea1ng t\u00e9 ng\u00e3, khuy\u1ebft t\u1eadt, t\u0103ng s\u1ed1 l\u1ea7n nh\u1eadp vi\u1ec7n v\u00e0 th\u1eadm ch\u00ed l\u00e0 t\u1eed vong.<\/span><\/p>\n

Nh\u1eadn th\u1ee9c \u0111\u01b0\u1ee3c t\u1ea7m quan tr\u1ecdng v\u00e0 l\u1ee3i \u00edch trong vi\u1ec7c ph\u00e1t hi\u1ec7n, s\u00e0ng l\u1ecdc v\u00e0 can thi\u1ec7p s\u1edbm HCDBTT, trong hai th\u1eadp k\u1ef7 nay \u0111\u00e3 c\u00f3 r\u1ea5t nhi\u1ec1u t\u00e0i li\u1ec7u nghi\u00ean c\u1ee9u v\u1ec1 h\u1ed9i ch\u1ee9ng n\u00e0y \u0111\u01b0\u1ee3c <\/span>c\u00f4<\/span>ng b\u1ed1, tuy nhi\u00ean v\u1eabn ch\u01b0a c\u00f3 s\u1ef1 \u0111\u1ed3ng thu\u1eadn v\u1ec1 \u0111\u1ecbnh ngh\u0129a.<\/span><\/p>\n

Kh\u00e1i ni\u1ec7m v\u1ec1 HCDBTT xu\u1ea5t hi\u1ec7n l\u1ea7n \u0111\u1ea7u ti\u00ean v\u00e0o n\u0103m 1968 trong m\u1ed9t nghi\u00ean c\u1ee9u c\u1eaft ngang tr\u00ean c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng cao tu\u1ed5i trong c\u1ed9ng \u0111\u1ed3ng. Nghi\u00ean c\u1ee9u n\u00e0y \u0111\u00e3 ph\u00e1c th\u1ea3o HCDBTT nh\u01b0 m\u1ed9t ph\u1ea3n \u1ee9ng qu\u00e1 m\u1ee9c v\u00e0 kh\u00f4ng t\u01b0\u01a1ng x\u1ee9ng c\u1ee7a ng\u01b0\u1eddi cao tu\u1ed5i v\u1edbi nh\u1eefng s\u1ef1 ki\u1ec7n b\u1ea5t l\u1ee3i. \u0110\u1ebfn cu\u1ed1i n\u0103m 1990, Roocwood v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t HCDBTT l\u00e0 tr\u1ea1ng th\u00e1i trong \u0111\u00f3 ng\u01b0\u1eddi cao tu\u1ed5i c\u1ea7n s\u1ed1ng ph\u1ee5 thu\u1ed9c v\u00e0o ng\u01b0\u1eddi kh\u00e1c \u0111\u1ec3 th\u1ef1c hi\u1ec7n c\u00e1c ho\u1ea1t \u0111\u1ed9ng sinh ho\u1ea1t h\u00e0ng ng\u00e0y.<\/span> Sau \u0111\u00f3 <\/span>nh\u00f3m nghi\u00ean c\u1ee9u n\u00e0y \u0111\u00e3 nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t tri\u1ec3n th\u00e0nh ch\u1ec9 s\u1ed1 HCDBTT (Frailty Index (FI)), c\u00f3 kh\u1ea3 n\u0103ng d\u1ef1 \u0111o\u00e1n nguy c\u01a1 cao t\u1eed vong v\u00e0 ph\u1ea3i s\u1ed1ng trong c\u00e1c tr\u1ea1i d\u01b0\u1ee1ng l\u00e3o c\u1ee7a ng\u01b0\u1eddi cao tu\u1ed5i.<\/span><\/p>\n

V\u00e0o \u0111\u1ea7u n\u0103m 2000,Fried v\u00e0 c\u00e1c \u0111\u1ed3ng nghi\u1ec7p \u0111\u00e3 m\u00f4 t\u1ea3 HCDBTT v\u1edbi c\u00e1c ti\u00eau ch\u00ed kh\u00e1ch quan nh\u1eb1m t\u00e1ch bi\u1ec7t h\u1ed9i ch\u1ee9ng n\u00e0y v\u1edbi t\u00ecnh tr\u1ea1ng khuy\u1ebft t\u1eadt v\u00e0 t\u00ecnh tr\u1ea1ng nhi\u1ec1u b\u1ec7nh k\u00e8m theo. HCDBTT theo Fried (Phenotype of frailty) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng, g\u1ed3m n\u0103m ti\u00eau ch\u00ed: s\u1ee5t c\u00e2n kh\u00f4ng ch\u1ee7 \u00fd, y\u1ebfu c\u01a1 l\u1ef1c, s\u1ee9c b\u1ec1n v\u00e0 n\u0103ng l\u01b0\u1ee3ng k\u00e9m, s\u1ef1 ch\u1eadm ch\u1ea1p,\u00a0 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c th\u1ea5p. Ng\u01b0\u1eddi cao tu\u1ed5i c\u00f3 t\u1eeb ba ti\u00eau ch\u00ed tr\u1edf l\u00ean s\u1ebd ch\u1ea9n \u0111o\u00e1n l\u00e0 c\u00f3 HCDBTT.<\/span><\/p>\n

T\u00f3m l\u1ea1i, HCDBTT l\u00e0 m\u1ed9t tr\u1ea1ng th\u00e1i l\u00e2m s\u00e0ng x\u1ea3y ra do s\u1ef1 t\u00edch t\u1ee5 c\u1ee7a qu\u00e1 tr\u00ecnh suy gi\u1ea3m ch\u1ee9c n\u0103ng nhi\u1ec1u h\u1ec7 th\u1ed1ng c\u01a1 quan trong c\u01a1 th\u1ec3, \u0111\u1eb7c tr\u01b0ng b\u1edfi tr\u1ea1ng th\u00e1i d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 c\u0103ng th\u1eb3ng v\u00e0 d\u1ef1 \u0111o\u00e1n k\u1ebft qu\u1ea3 b\u1ea5t l\u1ee3i cho s\u1ee9c kh\u1ecfe. Y\u1ebfu t\u1ed1 c\u0103ng th\u1eb3ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 ki\u1ec7n, k\u00edch th\u00edch, ho\u1eb7c thay \u0111\u1ed5i g\u00e2y ra \u0111\u00e1p \u1ee9ng; n\u00f3 th\u01b0\u1eddng \u0111\u01b0\u1ee3c coi l\u00e0 ti\u00eau c\u1ef1c, nh\u01b0ng nh\u1eefng k\u00edch th\u00edch t\u00edch c\u1ef1c c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra ph\u1ea3n \u1ee9ng to\u00e0n th\u00e2n.<\/span><\/p>\n

T\u1ef7 l\u1ec7 HCDBTT \u1edf c\u1ed9ng \u0111\u1ed3ng trung b\u00ecnh l\u00e0 10,7%, t\u1ef7 l\u1ec7 ti\u1ec1n h\u1ed9i ch\u1ee9ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng l\u00e0 41,6%. T\u1ef7 l\u1ec7 HCDBTT t\u0103ng theo tu\u1ed5i v\u00e0 cao h\u01a1n \u1edf ph\u1ee5 n\u1eef so v\u1edbi \u1edf <\/span>nam gi\u1edbi<\/span>. Tuy nhi\u00ean t\u1ef7 l\u1ec7 m\u1eafc h\u1ed9i ch\u1ee9ng n\u00e0y gi\u1eefa c\u00e1c nghi\u00ean c\u1ee9u l\u00e0 l\u00e0 kh\u00e1c nhau, dao \u0111\u1ed9ng t\u1eeb 4,0% \u0111\u1ebfn 59,1%, t\u00f9y thu\u1ed9c v\u00e0o c\u1ed9ng \u0111\u1ed3ng d\u00e2n s\u1ed1 nghi\u00ean c\u1ee9u v\u00e0 ti\u00eau chu\u1ea9n \u0111\u1ecbnh ngh\u0129a c\u1ee7a HCDBTT s\u1eed d\u1ee5ng.<\/span><\/p>\n

C\u00c1C Y\u1ebeU T\u1ed0 LI\u00caN QUAN \u0110\u1ebeN H\u1ed8I CH\u1ee8NG D\u1ec4 B\u1eca T\u1ed4N TH\u01af\u01a0NG<\/span><\/h3>\n

Ch\u1ee7ng t\u1ed9c, c\u00e1c b\u1ec7nh \u0111i k\u00e8m, n\u1ebfp s\u1ed1ng, v\u00e0 t\u00ecnh tr\u1ea1ng thi\u1ebfu dinh d\u01b0\u1ee1ng \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t nh\u01b0 l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u00e1ng tin c\u1eady c\u1ee7a HCDBTT v\u00e0 t\u0103ng nguy c\u01a1 t\u1eed vong.<\/span><\/p>\n

Ch\u1ee7ng t\u1ed9c<\/span><\/span><\/h4>\n

Ng\u01b0\u1eddi<\/span> M\u1ef9 <\/span>g\u1ed1c Phi c\u00f3 HCDBTT cao h\u01a1n g\u1ea5p b\u1ed1n l\u1ea7n so v\u1edbi c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng <\/span>da tr\u1eafng<\/span>. C\u00e1c t\u00e1c gi\u1ea3 \u0111\u01b0a ra gi\u1ea3 thuy\u1ebft s\u1ef1 kh\u00e1c bi\u1ec7t ch\u1ee7ng t\u1ed9c nh\u1eb1m ch\u1ee9ng minh s\u1ef1 kh\u00e1c bi\u1ec7t \u0111a h\u00ecnh di truy\u1ec1n c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 bi\u1ec3u hi\u1ec7n c\u1ee7a ki\u1ec3u h\u00ecnh c\u1ee7a h\u1ed9i ch\u1ee9ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng. Tuy nhi\u00ean c\u0169ng c\u00f3 kh\u1ea3 n\u0103ng t\u1ef7 l\u1ec7\u00a0 m\u1eafc h\u1ed9i ch\u1ee9ng n\u00e0y trong s\u1ed1 ng\u01b0\u1eddi<\/span> M\u1ef9 <\/span>g\u1ed1c Phi cao h\u01a1n do h\u1ea1n ch\u1ebf trong ti\u1ebfp c\u1eadn ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe, gi\u00e1o d\u1ee5c ch\u1ea5t l\u01b0\u1ee3ng k\u00e9m v\u00e0 s\u1ef1 l\u1ef1a ch\u1ecdn vi\u1ec7c l\u00e0m \u00edt h\u01a1n.<\/span><\/p>\n

C\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc<\/span><\/span><\/h4>\n

C\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc l\u00e0m gia t\u0103ng nguy c\u01a1 cho HCDBTT. Trong m\u1ed9t nghi\u00ean c\u1ee9u d\u1ecdc ph\u00e1t hi\u1ec7n ra ti\u1ec1n s\u1eed b\u1ec7nh m\u1ea1ch v\u00e0nh, \u0111\u1ed9t qu\u1ef5, g\u00e3y x\u01b0\u01a1ng \u0111\u00f9i, b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u00e3n t\u00ednh, \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0<\/span> vi\u00eam <\/span>kh\u1edbp c\u00f3 m\u1ed1i li\u00ean quan c\u00f3 \u00fd ngh\u0129a v\u1edbi bi\u1ebfn c\u1ed1 xu\u1ea5t hi\u1ec7n HCDBTT trong ba n\u0103m. Nh\u01b0 v\u1eady, r\u00f5 r\u00e0ng l\u00e0 c\u00e1c b\u1ec7nh m\u1ea1n t\u00ednh c\u00f3 li\u00ean quan ch\u1eb7t ch\u1ebd v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n v\u00e0 ph\u1ed5 bi\u1ebfn c\u1ee7a HCDBTT.<\/span><\/p>\n

N\u1ebfp s\u1ed1ng<\/span><\/span><\/p>\n

N\u1ebfp s\u1ed1ng, h\u00e0nh vi s\u1ee9c kh\u1ecfe v\u00e0 t\u00ecnh tr\u1ea1ng kinh t\u1ebf x\u00e3 h\u1ed9i c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c <\/span>c\u00f4<\/span>ng nh\u1eadn l\u00e0 \u0111\u00f3ng g\u00f3p v\u00e0o nguy c\u01a1 ph\u00e1t tri\u1ec3n c\u1ee7a HCDBTT. S\u1ee9c kh\u1ecfe k\u00e9m, tr\u00ecnh \u0111\u1ed9 h\u1ecdc v\u1ea5n th\u1ea5p, \u0111i\u1ec1u ki\u1ec7n kinh t\u1ebf x\u00e3 h\u1ed9i ngh\u00e8o c\u00f3 li\u00ean quan v\u1edbi t\u1ef7 l\u1ec7 cao h\u01a1n xu\u1ea5t hi\u1ec7n h\u1ed9i ch\u1ee9ng n\u00e0y.<\/span><\/p>\n

T\u00ecnh tr\u1ea1ng suy dinh d\u01b0\u1ee1ng<\/span><\/span><\/h4>\n

Ch\u1ebf \u0111\u1ed9 dinh d\u01b0\u1ee1ng ngh\u00e8o n\u00e0n c\u0169ng g\u00f3p ph\u1ea7n gia t\u0103ng s\u1ef1 xu\u1ea5t hi\u1ec7n HCBBTT. M\u1ed9t trong nh\u1eefng bi\u1ec3u hi\u1ec7n c\u1ee7a suy dinh d\u01b0\u1ee1ng l\u00e0 m\u1ee9c ti\u00eau th\u1ee5 n\u0103ng l\u01b0\u1ee3ng h\u00e0ng ng\u00e0y. Nghi\u00ean c\u1ee9u cho th\u1ea5y m\u1ed1i li\u00ean quan gi\u1eefa s\u1ed1 kilocalo t\u1eeb kh\u1ea9u ph\u1ea7n th\u1ea5p h\u01a1n 21kcal\/kg\/ng\u00e0y v\u1edbi ng\u01b0\u1eddi cao tu\u1ed5i c\u00f3 h\u1ed9i ch\u1ee9ng n\u00e0y. Nghi\u00ean c\u1ee9u m\u1ed9t s\u1ed1 ch\u1ea5t dinh d\u01b0\u1ee1ng suy gi\u1ea3m (protein, vitamin A, C v\u00e0 E, canxi, folate v\u00e0 k\u1ebdm), \u0111\u1ed9c l\u1eadp v\u1edbi n\u0103ng l\u01b0\u1ee3ng ti\u00eau th\u1ee5, c\u0169ng li\u00ean quan \u0111\u00e1ng k\u1ec3 v\u1edbi HCDBTT.<\/span><\/p>\n

C\u00c1C GIAI \u0110O\u1ea0N C\u1ee6A H\u1ed8I CH\u1ee8NG D\u1ec4 B\u1eca T\u1ed4N TH\u01af\u01a0NG<\/span><\/h3>\n

C\u00e1c t\u00e1c gi\u1ea3 \u0111\u00e3 ph\u00e2n chia qu\u00e1 tr\u00ecnh ph\u00e1t tri\u1ec3n c\u1ee7a HCDBTT th\u00e0nh ba giai \u0111o\u1ea1n, m\u1ed7i giai \u0111o\u1ea1n \u0111\u1ec1u li\u00ean quan \u0111\u1ebfn s\u1ef1 suy gi\u1ea3m trong d\u1ef1 tr\u1eef c\u00e2n b\u1eb1ng n\u1ed9i m\u00f4i.<\/span><\/p>\n

Ti\u1ec1n h\u1ed9i ch\u1ee9ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng (Pre frailty)<\/span><\/span><\/h4>\n

Ti\u1ec1n HCDBTT l\u00e0\u00a0 giai \u0111o\u1ea1n l\u00e2m s\u00e0ng di\u1ec5n ra m\u1ed9t c\u00e1ch th\u1ea7m l\u1eb7ng, \u0111\u00e2y l\u00e0 m\u1ed9t tr\u1ea1ng th\u00e1i d\u1ef1 tr\u1eef sinh l\u00fd \u0111\u1ee7 \u0111\u1ec3 cho ph\u00e9p c\u01a1 th\u1ec3 ph\u1ea3n \u1ee9ng \u0111\u1ea7y \u0111\u1ee7 v\u1edbi b\u1ea5t k\u1ef3 t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh nh\u01b0 b\u1ec7nh c\u1ea5p t\u00ednh, t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c c\u00e1c y\u1ebfu t\u1ed1 c\u0103ng th\u1eb3ng, v\u1edbi m\u1ed9t c\u01a1 h\u1ed9i h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n.<\/span><\/p>\n

H\u1ed9i ch\u1ee9ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng<\/span><\/span><\/h4>\n

H\u1ed9i ch\u1ee9ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 ph\u1ee5c h\u1ed3i ch\u1eadm v\u00e0 kh\u00f4ng ho\u00e0n to\u00e0n<\/span> sau <\/span>khi m\u1eafc c\u00e1c b\u1ec7nh c\u1ea5p t\u00ednh m\u1edbi, c\u00e1c t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c c\u00e1c y\u1ebfu t\u1ed1 c\u0103ng th\u1eb3ng, c\u00f3 th\u1ec3 hi\u1ec3u r\u1eb1ng\u00a0 d\u1ef1 tr\u1eef sinh l\u00fd s\u1eb5n c\u00f3 kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 cho ph\u00e9p c\u01a1 th\u1ec3 h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n. Nhi\u1ec1u t\u00e1c gi\u1ea3 c\u0169ng th\u1ed1ng nh\u1ea5t HCDBTT l\u00e0 m\u1ed9t t\u1eadp h\u1ee3p bao g\u1ed3m nhi\u1ec1u bi\u1ec3u hi\u1ec7n tr\u00ean c\u00e1c l\u0129nh v\u1ef1c kh\u00e1c nhau nh\u01b0 suy dinh d\u01b0\u1ee1ng, ho\u1ea1t \u0111\u1ed9ng ch\u1ee9c n\u0103ng b\u1ecb ph\u1ee5 thu\u1ed9c, th\u1eddi gian n\u1eb1m t\u1ea1i gi\u01b0\u1eddng k\u00e9o d\u00e0i, l\u1edf lo\u00e9t c\u00e1c \u0111i\u1ec3m t\u1ef3 \u0111\u00e8, r\u1ed1i lo\u1ea1n d\u00e1ng \u0111i, suy nh\u01b0\u1ee3c t\u1ed5ng qu\u00e1t, s\u00fat c\u00e2n, ch\u00e1n \u0103n, t\u00e9 ng\u00e3, m\u1ea5t tr\u00ed nh\u1edb, g\u00e3y x\u01b0\u01a1ng h\u00f4ng, m\u00ea s\u1ea3ng, l\u00fa l\u1eabn v\u00e0 t\u00ecnh tr\u1ea1ng d\u00f9ng qu\u00e1 nhi\u1ec1u <\/span>thu\u1ed1c<\/span>. Quan tr\u1ecdng l\u00e0 HCDBTT kh\u00f4ng ph\u1ea3i l\u00e0 t\u00ecnh tr\u1ea1ng khuy\u1ebft t\u1eadt, d\u01b0\u1edbi t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 sang ch\u1ea5n t\u00e2m l\u00fd, h\u1ed9i ch\u1ee9ng n\u00e0y m\u1edbi d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng khuy\u1ebft t\u1eadt.<\/span><\/p>\n

BI\u1ebeN CH\u1ee8NG C\u1ee6A H\u1ed8I CH\u1ee8NG D\u1ec4 B\u1eca T\u1ed4N TH\u01af\u01a0NG<\/span><\/h3>\n

C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a HCDBTT c\u00f3 li\u00ean quan tr\u1ef1c ti\u1ebfp v\u1edbi nh\u1eefng t\u1ed5n th\u01b0\u01a1ng sinh l\u00fd do s\u1ef1 suy<\/span> gi\u1ea3m c\u00e2n <\/span>b\u1eb1ng d\u1ef1 tr\u1eef n\u1ed9i m\u00f4i v\u00e0 gi\u1ea3m kh\u1ea3 n\u0103ng ch\u1ecbu \u0111\u1ef1ng v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 c\u0103ng th\u1eb3ng c\u1ee7a c\u01a1 th\u1ec3. H\u1eadu qu\u1ea3 l\u00e0 d\u1eabn \u0111\u1ebfn t\u0103ng nguy c\u01a1 t\u00e9 ng\u00e3, suy gi\u1ea3m ch\u1ee9c n\u0103ng d\u1eabn \u0111\u1ebfn khuy\u1ebft t\u1eadt, t\u00ecnh tr\u1ea1ng d\u00f9ng qu\u00e1 nhi\u1ec1u <\/span>thu\u1ed1c<\/span>, gia t\u0103ng nguy c\u01a1 n\u1eb1m vi\u1ec7n, l\u00e2y nhi\u1ec5m ch\u00e9o v\u00e0 t\u1eed vong.<\/span><\/p>\n

\"\"<\/p>\n

H\u00ecnh 3.1:S\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a HCDBTT c\u00f9ng qu\u00e1 tr\u00ecnh l\u00e3o h\u00f3a<\/span><\/em><\/p>\n

C\u01a0 CH\u1ebe B\u1ec6NH SINH C\u1ee6A H\u1ed8I CH\u1ee8NG D\u1ec4 B\u1eca T\u1ed4N TH\u01af\u01a0NG<\/span><\/h3>\n
    \n
  • C\u1ea5p \u0111\u1ed9 1 – Thay \u0111\u1ed5i \u1edf m\u1ee9c t\u1ebf b\u00e0o<\/span><\/li>\n<\/ul>\n

    \u1ede m\u1ee9c \u0111\u1ed9 t\u1ebf b\u00e0o, s\u1ef1 t\u00edch l\u0169y s\u1ea3n ph\u1ea9m c\u1ee7a qu\u00e1 tr\u00ecnh oxy h\u00f3a l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n d\u1eabn \u0111\u1ebfn HCDBTT. B\u00ean c\u1ea1nh \u0111\u00f3 s\u1ef1 suy gi\u1ea3m nhi\u1ec5m s\u1eafc th\u1ec3, d\u1eabn \u0111\u1ebfn nh\u1eefng bi\u1ebfn \u0111\u1ed5i trong ph\u00e2n chia t\u1ebf b\u00e0o v\u00e0 t\u1ed5ng h\u1ee3p protein c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 suy gi\u1ea3m sinh l\u00fd \u1edf ng\u01b0\u1eddi cao tu\u1ed5i.<\/span><\/p>\n

    M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho th\u1ea5y\u00a0 t\u1ef7 l\u1ec7 t\u1eed vong \u1edf nh\u1eefng ng\u01b0\u1eddi cao tu\u1ed5i c\u00f3 nhi\u1ec5m s\u1eafc th\u1ec3 ng\u1eafn h\u01a1n g\u1ea7n nh\u01b0 g\u1ea5p \u0111\u00f4i so v\u1edbi nh\u1eefng ng\u01b0\u1eddi c\u00f3 nhi\u1ec5m s\u1eafc th\u1ec3 d\u00e0i h\u01a1n. Tuy nhi\u00ean, tr\u00ean m\u1ed9t nghi\u00ean c\u1ee9u c\u1eaft ngang c\u1ee7a Woo v\u00e0 c\u1ed9ng s\u1ef1 l\u1ea1i kh\u00f4ng t\u00ecm th\u1ea5y m\u1ed1i quan h\u1ec7 gi\u1eefa ch\u1ec9 s\u1ed1 FI (m\u1ed9t ch\u1ec9 s\u1ed1 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 h\u1ed9i ch\u1ee9ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng) v\u00e0 chi\u1ec1u d\u00e0i nhi\u1ec5m s\u1eafc th\u1ec3. Nh\u01b0 v\u1eady, chi\u1ec1u d\u00e0i c\u1ee7a nhi\u1ec5m s\u1eafc th\u1ec3 c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t d\u1ea5u \u1ea5n sinh h\u1ecdc c\u1ee7a qu\u00e1 tr\u00ecnh l\u00e3o h\u00f3a \u1edf m\u1ee9c \u0111\u1ed9 t\u1ebf b\u00e0o, tuy nhi\u00ean c\u00f3 th\u1ec3 kh\u00f4ng \u0111\u1ea1i di\u1ec7n cho HCDBTT. Do v\u1eady c\u1ea7n c\u00f3 th\u00eam nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u1ec3 kh\u00e1m ph\u00e1 c\u01a1 s\u1edf ph\u00e2n t\u1eed c\u1ee7a HCDBTT.<\/span><\/p>\n

      \n
    • C\u1ea5p \u0111\u1ed9 2- R\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a h\u1ec7 th\u1ed1ng<\/span><\/li>\n<\/ul>\n

      Tr\u00ean m\u1ed9t c\u1ea5p \u0111\u1ed9 cao h\u01a1n, c\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra qu\u00e1 tr\u00ecnh <\/span>vi\u00eam<\/span>, r\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a n\u1ed9i ti\u1ebft t\u1ed1, r\u1ed1i lo\u1ea1n mi\u1ec5n d\u1ecbch, k\u00edch ho\u1ea1t c\u00e1c con \u0111\u01b0\u1eddng \u0111\u00f4ng m\u00e1u v\u00e0 trao \u0111\u1ed5i ch\u1ea5t b\u1ea5t th\u01b0\u1eddng c\u00f3 m\u1ed1i li\u00ean quan m\u1eadt thi\u1ebft v\u1edbi HCDBTT.<\/span><\/p>\n

      R\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a qu\u00e1 tr\u00ecnh <\/i>vi\u00eam<\/i><\/strong><\/h5>\n

      Qu\u00e1 tr\u00ecnh<\/span> vi\u00eam <\/span>\u0111\u00f3ng m\u1ed9t vai tr\u00f2 quan tr\u1ecdng trong HCDBTT. Trong nghi\u00ean c\u1ee9u k\u1ebft h\u1ee3p c\u1eaft ngang th\u1ef1c hi\u1ec7n tr\u00ean \u00edt nh\u1ea5t ba qu\u1ea7n th\u1ec3 kh\u00e1c nhau \u0111\u00e3 x\u00e1c \u0111\u1ecbnh m\u1ed1i quan h\u1ec7 m\u1eadt thi\u1ebft gi\u1eefa HCDBTT v\u00e0 s\u1ef1 t\u0103ng cao c\u1ee7a cytokin\u00a0 IL-6, protein C ph\u1ea3n \u1ee9ng, c\u00e1c t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u, \u0111\u1eb7c bi\u1ec7t l\u00e0 b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n v\u00e0 b\u1ea1ch c\u1ea7u trung t\u00ednh.<\/span><\/p>\n

      M\u1eb7c d\u00f9 gi\u00e1 tr\u1ecb trung b\u00ecnh c\u1ee7a c\u00e1c d\u1ea5u \u1ea5n<\/span> vi\u00eam <\/span>kh\u00f4ng cao nh\u01b0 trong c\u00e1c b\u1ec7nh<\/span> vi\u00eam <\/span>nhi\u1ec5m, nh\u01b0ng n\u00f3 \u1edf m\u1ee9c \u0111\u1ed9 th\u1ea5p, m\u00e3n t\u00ednh v\u00e0 g\u00e2y ho\u1ea1t h\u00f3a c\u00e1c c\u01a1 ch\u1ebf<\/span> vi\u00eam <\/span>\u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i c\u00f3 h\u1ed9i ch\u1ee9ng n\u00e0y.<\/span><\/p>\n

      R\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a h\u1ec7 th\u1ed1ng n\u1ed9i ti\u1ebft<\/i><\/strong><\/h5>\n

      M\u1ed9t trong nh\u1eefng gi\u1ea3 thuy\u1ebft c\u01a1 ch\u1ebf c\u1ee7a HCDBTT l\u00e0 s\u1ef1 r\u1ed1i lo\u1ea1n c\u1ee7a c\u00e1c hormon \u0111\u1ed3ng h\u00f3a. \u00a0 Qu\u00e1 tr\u00ecnh l\u00e3o h\u00f3a c\u0169ng nh\u01b0 HCDBTT c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 thay \u0111\u1ed5i c\u1ee7a hormon sinh d\u1ee5c v\u00e0 hormon t\u0103ng tr\u01b0\u1edfng (IGF-1).IGF-1 \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c ph\u00e1t tri\u1ec3n c\u1ee7a c\u00e1c t\u1ebf b\u00e0o c\u01a1 v\u00e2n v\u00e0 c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng trong vi\u1ec7c duy tr\u00ec kh\u1ed1i l\u01b0\u1ee3ng c\u01a1 b\u1eafp khi l\u00e3o h\u00f3a.S\u1ef1 suy gi\u1ea3m nhanh ch\u00f3ng c\u1ee7a estrogen theo tu\u1ed5i \u1edf ph\u1ee5 n\u1eef<\/span> sau <\/span>m\u00e3n kinh v\u00e0 gi\u1ea3m d\u1ea7n c\u1ee7a testosterone \u1edf<\/span> nam gi\u1edbi <\/span>l\u1edbn tu\u1ed5i d\u1eabn \u0111\u1ebfn gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng c\u01a1 v\u00e0 s\u1ee9c m\u1ea1nh c\u01a1 b\u1eafp.<\/span><\/p>\n

      Ngo\u00e0i ra t\u1ed3n t\u1ea1i t\u01b0\u01a1ng quan ngh\u1ecbch gi\u1eefa n\u1ed3ng \u0111\u1ed9 hormon tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn dehydroepiandrosteron sulfat (DHEA-s) v\u00e0 HCDBTT. S\u1ef1 suy gi\u1ea3m c\u1ee7a n\u1ed3ng \u0111\u1ed9 DHEA-S v\u00e0 IGF-1 theo tu\u1ed5i g\u00e2y suy ra thi\u1ebfu h\u1ee5t l\u1edbn trong trong s\u1ee9c m\u1ea1nh, s\u1ee9c ch\u1ecbu \u0111\u1ef1ng, <\/span>gi\u1ea3m c\u00e2n<\/span>, t\u1ed1c \u0111\u1ed9 \u0111i b\u1ed9, v\u00e0 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t. H\u01a1n n\u1eefa DHEA-S c\u00f3 t\u00e1c d\u1ee5ng ng\u0103n ch\u1eb7n t\u00ecnh tr\u1ea1ng<\/span> vi\u00eam <\/span>g\u00e2y ra b\u1edfi y\u1ebfu t\u1ed1 h\u1ea1t nh\u00e2n kappa B(NFKB).Do \u0111\u00f3, n\u1ed3ng \u0111\u1ed9 c\u1ee7a DHEA-S gi\u1ea3m c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n l\u00e0m t\u0103ng\u00a0 t\u00ecnh tr\u1ea1ng<\/span> vi\u00eam <\/span>m\u1ea1n t\u00ednh v\u00e0 cu\u1ed1i c\u00f9ng g\u00e2y ra HCDBTT.<\/span><\/p>\n

      R\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a qu\u00e1 tr\u00ecnh \u0111\u00f4ng m\u00e1u<\/i><\/strong><\/h5>\n

      S\u1ef1 ho\u1ea1t h\u00f3a qu\u00e1 m\u1ee9c c\u1ee7a h\u1ec7 th\u1ed1ng \u0111\u00f4ng m\u00e1u c\u00f3 li\u00ean quan \u0111\u1ebfn l\u00e3o h\u00f3a<\/span>\u00a0suy gi\u1ea3m ch\u1ee9c n\u0103ng, v\u00e0 t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong , d\u1eabn \u0111\u1ebfn gi\u1ea3 thuy\u1ebft cho r\u1eb1ng d\u1ea5u \u1ea5n sinh h\u1ecdc c\u1ee7a \u0111\u00f4ng m\u00e1u ( D-dimer, y\u1ebfu t\u1ed1 VIII, v\u00e0 fibrinogen) v\u00e0 h\u1ee7y fibrin (tissue-type plasminogen activator [t-PA]) l\u00e0 d\u1ea5u hi\u1ec7u quan tr\u1ecdng trong c\u01a1 ch\u1ebf sinh l\u00fd s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a HCDBTT.<\/span><\/p>\n

      C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y D-dimer, fibrinogen, ch\u1ea5t \u1ee9c ch\u1ebf ho\u1ea1t h\u00f3a plasminogen(PAI) -1 v\u00e0 y\u1ebfu t\u1ed1 VIII t\u0103ng cao theo tu\u1ed5i.V\u00ec v\u1eady, r\u00f5 r\u00e0ng r\u1eb1ng qu\u00e1 tr\u00ecnh l\u00e3o h\u00f3a c\u00f3 li\u00ean quan v\u1edbi s\u1ef1 k\u00edch ho\u1ea1t c\u1ee7a c\u00e1c d\u1ea5u \u1ea5n \u0111\u00f4ng m\u00e1u.Tr\u00ean th\u1ef1c t\u1ebf \u0111\u00e1ng<\/span> ch\u00fa <\/span>\u00fd l\u00e0 t\u1ef7 l\u1ec7 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch v\u00e0 t\u1eafc ngh\u1ebdn m\u1ea1ch ph\u1ed5i t\u0103ng \u0111\u00e1ng k\u1ec3 trong ng\u01b0\u1eddi cao tu\u1ed5i.<\/span><\/p>\n

      C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y IL-6 c\u0169ng \u0111\u00f3ng m\u1ed9t vai tr\u00f2 quan tr\u1ecdng trong t\u1ed5ng h\u1ee3p v\u00e0 gi\u1ea3i ph\u00f3ng fibrinogen, y\u1ebfu t\u1ed1 m\u00f4,y\u1ebfu t\u1ed1 VIII v\u00e0 ti\u1ec3u c\u1ea7u t\u1eeb nhi\u1ec1u m\u00f4. Ng\u01b0\u1ee3c l\u1ea1i, D-dimer \u0111\u01b0\u1ee3c bi\u1ebft c\u00f3 kh\u1ea3 n\u0103ng k\u00edch th\u00edch s\u1ef1 t\u1ed5ng h\u1ee3p v\u00e0 gi\u1ea3i ph\u00f3ng c\u00e1c cytokin ti\u1ec1n <\/span>vi\u00eam<\/span>, bao g\u1ed3m IL-6 v\u00e0 b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n m\u00e1u ngo\u1ea1i vi.Nh\u01b0 v\u1eady qu\u00e1 tr\u00ecnh<\/span> vi\u00eam <\/span>v\u00e0 \u0111\u00f4ng m\u00e1u c\u00f3 kh\u1ea3 n\u0103ng t\u1ea1o th\u00e0nh m\u1ed9t v\u00f2ng xo\u1eafn t\u01b0\u01a1ng t\u00e1c v\u1edbi nhau.<\/span><\/p>\n

      R\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a chuy\u1ec3n h\u00f3a<\/i><\/strong><\/h5>\n

      S\u1ef1 gia t\u0103ng t\u00ecnh tr\u1ea1ng kh\u00e1ng insulin x\u1ea3y ra c\u00f9ng v\u1edbi qu\u00e1 tr\u00ecnh l\u00e3o h\u00f3a,d\u1eabn \u0111\u1ebfn s\u1ef1 suy gi\u1ea3m h\u1ea5p thu glucose c\u1ee7a c\u01a1 x\u01b0\u01a1ng.Barzilay v\u00e0 c\u00e1c c\u1ed9ng s\u1ef1\u00a0 \u0111\u01b0a ra\u00a0 k\u1ebft qu\u1ea3 v\u1ec1 m\u1ed1i li\u00ean h\u1ec7 gi\u1eefa kh\u00e1ng insulin v\u00e0 t\u0103ng nguy c\u01a1 1,5 l\u1ea7n m\u1eafc HCDBTT.\u00a0 Nghi\u00ean c\u1ee9u c\u1ee7a Abbatecola v\u00e0 c\u1ed9ng s\u1ef1 c\u0169ng m\u00f4 t\u1ea3 m\u1ed1i quan h\u1ec7 gi\u1eefa kh\u00e1ng insulin cao v\u00e0 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng c\u1ee7a HCDBTT, ch\u1eb3ng h\u1ea1n nh\u01b0 suy y\u1ebfu c\u01a1 x\u01b0\u01a1ng, c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 di \u0111\u1ed9ng chi d\u01b0\u1edbi, v\u00e0 suy gi\u1ea3m nh\u1eadn th\u1ee9c. Do \u0111\u00f3 kh\u00e1ng insulin \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t nh\u01b0 m\u1ed9t r\u1ed1i lo\u1ea1n trao \u0111\u1ed5i ch\u1ea5t c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng tr\u1ef1c ti\u1ebfp \u0111\u1ebfn HCDBTT. S\u1ef1 thay th\u1ebf d\u1ea7n c\u00e1c m\u00f4 n\u1ea1c b\u1eb1ng m\u1ee1 l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n g\u00e2y ra kh\u00e1ng insulin t\u0103ng v\u00e0 kh\u00f4ng dung n\u1ea1p glucose \u1edf nh\u1eefng ng\u01b0\u1eddi l\u1edbn tu\u1ed5i.Do \u0111\u00f3, c\u00e1c bi\u1ec7n<\/span> ph\u00e1p <\/span>can thi\u1ec7p trong t\u01b0\u01a1ng lai nh\u1eb1m \u0111i\u1ec1u ch\u1ec9nh kh\u00e1ng insulin c\u00f3 m\u1ed9t vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c ng\u0103n ch\u1eb7n ho\u1eb7c \u00edt nh\u1ea5t l\u00e0 l\u00e0m ch\u1eadm c\u00e1c \u0111\u1ee3t ti\u1ebfn tri\u1ec3n th\u00e0nh HCDBTT.<\/span><\/p>\n

      Ngo\u00e0i ra, t\u00ecnh tr\u1ea1ng s\u1ea3n xu\u1ea5t d\u01b0 th\u1eeba cortisol m\u1ea1n t\u00ednh \u0111\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 c\u0103ng th\u1eb3ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn \u1ee9c ch\u1ebf ch\u1ee9c n\u0103ng mi\u1ec5n d\u1ecbch, t\u0103ng t\u00ecnh tr\u1ea1ng kh\u00e1ng insulin, t\u0103ng kh\u1ed1i l\u01b0\u1ee3ng m\u00f4 m\u1ee1 v\u00e0 m\u1ea5t kh\u1ed1i l\u01b0\u1ee3ng n\u1ea1c.<\/span><\/p>\n

      R\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a h\u1ec7 mi\u1ec5n d\u1ecbch<\/i><\/strong><\/h5>\n

      H\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch t\u1ef1 nhi\u00ean l\u00e0 tuy\u1ebfn ph\u00f2ng th\u1ee7 \u0111\u1ea7u ti\u00ean ch\u1ed1ng l\u1ea1i ch\u1ea5n th\u01b0\u01a1ng v\u00e0 nhi\u1ec5m khu\u1ea9n \u1edf h\u1ea7u h\u1ebft c\u00e1c sinh v\u1eadt s\u1ed1ng. C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y c\u00f3 s\u1ef1 gia t\u0103ng t\u1ed5ng s\u1ed1 b\u1ea1ch c\u1ea7u, s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh v\u00e0 b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n c\u0169ng nh\u01b0 t\u0103ng \u0111\u00e1ng k\u1ec3 b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n\/\u0111\u1ea1i th\u1ef1c b\u00e0o qua trung gian <\/span>vi\u00eam <\/span>k\u00edch ho\u1ea1t mi\u1ec5n d\u1ecbch trong HCDBTT \u0111\u00e3 cung c\u1ea5p b\u1eb1ng ch\u1ee9ng g\u1ee3i \u00fd h\u1ed9i ch\u1ee9ng n\u00e0y li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a mi\u1ec5n d\u1ecbch t\u1ef1 nhi\u00ean.<\/span><\/p>\n

      B\u00ean c\u1ea1nh \u0111\u00f3, c\u00e1c nghi\u00ean c\u1ee9u c\u0169ng cho th\u1ea5y m\u1ed1i li\u00ean quan gi\u1eefa HCDBTT v\u00e0 mi\u1ec5n d\u1ecbch th\u00edch \u1ee9ng. B\u1eb1ng ch\u1ee9ng t\u1eeb m\u1ed9t nghi\u00ean c\u1ee9u \u0111\u00e1nh gi\u00e1 m\u1ed1i quan h\u1ec7 gi\u1eefa t\u1ebf b\u00e0o T v\u00e0 t\u1eed vong \u1edf ph\u1ee5 n\u1eef l\u1edbn tu\u1ed5i \u1edf c\u1ed9ng \u0111\u1ed3ng cho th\u1ea5y ph\u1ee5 n\u1eef cao tu\u1ed5i c\u00f3 h\u1ed9i ch\u1ee9ng n\u00e0y c\u00f3 s\u1ed1 l\u01b0\u1ee3ng cao h\u01a1n \u0111\u00e1ng k\u1ec3 CD8 so v\u1edbi ph\u1ee5 n\u1eef kh\u00f4ng c\u00f3 h\u1ed9i ch\u1ee9ng n\u00e0y.<\/span><\/p>\n

      S\u1ef1 thay \u0111\u1ed5i c\u1ee7a t\u1ebf b\u00e0o lympho B trong HCDBTT \u0111\u1ebfn nay c\u00f2n h\u1ea1n ch\u1ebf.<\/span><\/p>\n

        \n
      • C\u1ea5p \u0111\u1ed9 3 – Suy y\u1ebfu h\u1ec7 th\u1ed1ng<\/span><\/li>\n<\/ul>\n

        Thay \u0111\u1ed5i tr\u00ean h\u1ec7 c\u01a1- x\u01b0\u01a1ng- kh\u1edbp v\u00e0 nh\u1eadn th\u1ee9c th\u1ea7n kinh l\u00e0 nh\u1eefng th\u00e0nh ph\u1ea7n quan tr\u1ecdng c\u1ee7a HCDBTT trong c\u00e1c t\u00e0i li\u1ec7u nghi\u00ean c\u1ee9u v\u00e0 \u0111\u1ea1i di\u1ec7n cho suy gi\u1ea3m \u1edf m\u1ee9c \u0111\u1ed9 cao trong chu\u1ed7i c\u00e1c s\u1ef1 ki\u1ec7n sinh l\u00fd b\u1ec7nh.<\/span><\/p>\n

        Suy y\u1ebfu h\u1ec7 th\u1ed1ng c\u01a1 x\u01b0\u01a1ng<\/i><\/strong><\/h5>\n

        Teo c\u01a1 ng\u01b0\u1eddi gi\u00e0 (Sarcopenia) xu\u1ea5t hi\u1ec7n c\u00f9ng v\u1edbi qu\u00e1 tr\u00ecnh l\u00e3o h\u00f3a v\u00e0 l\u00e0 m\u1ed9t trong nh\u1eefng th\u00e0nh ph\u1ea7n ch\u00ednh trong ki\u1ec3u h\u00ecnh c\u1ee7a HCDBTT trong nhi\u1ec1u nghi\u00ean c\u1ee9u. Teo c\u01a1 ng\u01b0\u1eddi gi\u00e0 l\u00e0 h\u1eadu qu\u1ea3 n\u1eb7ng n\u1ec1 cho ng\u01b0\u1eddi cao tu\u1ed5i v\u00ec n\u00f3 g\u1eafn li\u1ec1n v\u1edbi nguy c\u01a1 suy gi\u1ea3m ch\u1ee9c n\u0103ng v\u00e0 t\u00e0n t\u1eadt. S\u1ef1 m\u1ea5t kh\u1ed1i l\u01b0\u1ee3ng c\u01a1 theo tu\u1ed5i kh\u00f4ng di\u1ec5n ra \u0111\u01a1n \u0111\u1ed9c m\u00e0\u00a0 \u0111\u01b0\u1ee3c g\u1eafn k\u1ebft ch\u1eb7t ch\u1ebd v\u1edbi s\u1ef1 t\u0103ng kh\u1ed1i l\u01b0\u1ee3ng m\u1ee1. S\u1ef1 gia t\u0103ng kh\u1ed1i l\u01b0\u1ee3ng m\u1ee1 v\u00e0 gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng c\u01a1 b\u1eafp c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p v\u1edbi nhau v\u00e0 d\u1eabn \u0111\u1ebfn teo c\u01a1 b\u00e9o ph\u00ec (Sarcopenic obesity). Trong nghi\u00ean c\u1ee9u g\u1ed3m 923 \u0111\u1ed1i t\u01b0\u1ee3ng tham gia t\u1eeb 65 tu\u1ed5i tr\u1edf l\u00ean cho th\u1ea5y nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 HCDBTT c\u00f3 m\u1eadt \u0111\u1ed9 v\u00e0 kh\u1ed1i l\u01b0\u1ee3ng c\u01a1 b\u1eafp th\u1ea5p h\u01a1n, kh\u1ed1i l\u01b0\u1ee3ng ch\u1ea5t b\u00e9o cao h\u01a1n nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng kh\u00f4ng c\u00f3 h\u1ed9i ch\u1ee9ng n\u00e0y. Teo c\u01a1 b\u00e9o ph\u00ec\u00a0 \u0111\u1eb7c bi\u1ec7t \u0111\u00e1ng lo ng\u1ea1i v\u00ec n\u00f3 g\u1eafn li\u1ec1n v\u1edbi k\u1ebft qu\u1ea3 ch\u1ee9c n\u0103ng t\u1ed3i t\u1ec7 h\u01a1n v\u00e0 g\u1ea7n nh\u01b0 t\u0103ng g\u1ea5p \u0111\u00f4i nguy c\u01a1 m\u1ea5t di \u0111\u1ed9ng trong 2,5 n\u0103m theo d\u00f5i.\u00a0<\/span><\/p>\n

        Trong\u00a0 nghi\u00ean c\u1ee9u c\u1ee7a Koster v\u00e0 c\u1ed9ng s\u1ef1 cho th\u1ea5y l\u01b0\u1ee3ng m\u1ee1 d\u01b0 th\u1eeba trong c\u01a1 th\u1ec3 l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh m\u1ea1nh m\u1ebd c\u1ee7a suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ec3 ch\u1ea5t \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i. Quan tr\u1ecdng h\u01a1n, ch\u1ea5t b\u00e9o \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i l\u00e0 \u01b0u ti\u00ean t\u00edch l\u0169y ph\u00e2n b\u1ed1 trung t\u00e2m, do \u0111\u00f3 l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 l\u1edbn \u0111\u1ed1i v\u1edbi r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a.<\/span><\/p>\n

        Suy y\u1ebfu h\u1ec7 th\u1ed1ng nh\u1eadn th\u1ee9c – th\u1ea7n kinh<\/i><\/strong><\/h5>\n

        C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y t\u1eadp trung v\u00e0o m\u1ed1i quan h\u1ec7 gi\u1eefa HCDBTT v\u00e0 ch\u1ec9 s\u1ed1 nh\u1eadn th\u1ee9c th\u1ea7n kinh bao g\u1ed3m m\u1ed9t lo\u1ea1t c\u00e1c bi\u1ec7n<\/span> ph\u00e1p <\/span>\u00a0nh\u01b0 nh\u1eadn th\u1ee9c, suy gi\u1ea3m c\u1ea3m gi\u00e1c (v\u00ed d\u1ee5, gi\u1ea3m th\u1ecb gi\u00e1c hay gi\u1ea3m kh\u1ea3 n\u0103ng nghe), v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 t\u00e2m l\u00fd (tr\u1ea7m c\u1ea3m). Suy gi\u1ea3m nh\u1eadn th\u1ee9c c\u00f3 kh\u1ea3 n\u0103ng d\u1ef1 b\u00e1o nh\u1eefng\u00a0 k\u1ebft qu\u1ea3 b\u1ea5t l\u1ee3i cho s\u1ee9c kh\u1ecfe \u0111\u1ed1i v\u1edbi nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 HCDBTT nh\u01b0 m\u1ea5t tr\u00ed nh\u1edb,suy gi\u1ea3m ch\u1ee9c n\u0103ng,t\u0103ng t\u00e1i nh\u1eadp vi\u1ec7n , \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i trong c\u00e1c tr\u1ea1i d\u01b0\u1ee1ng l\u00e3o v\u00e0 t\u1eed vong.<\/span><\/p>\n

        Suy gi\u1ea3m gi\u00e1c quan, ch\u1eb3ng h\u1ea1n nh\u01b0 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ecb gi\u00e1c, c\u0169ng li\u00ean quan \u0111\u1ebfn gia t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i. Nghi\u00ean c\u1ee9u theo chi\u1ec1u d\u1ecdc cho th\u1ea5y c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng l\u1edbn tu\u1ed5i gi\u1ea3m th\u1ecb gi\u00e1c, th\u1ecb l\u1ef1c c\u00f3 nguy c\u01a1 t\u1eed vong t\u0103ng 70% so v\u1edbi ng\u01b0\u1eddi kh\u00f4ng suy gi\u1ea3m th\u1ecb l\u1ef1c.<\/span><\/p>\n

        R\u1ed1i lo\u1ea1n c\u1ea3m x\u00fac (tr\u1ea7m c\u1ea3m) c\u0169ng l\u00e0 m\u1ed9t ch\u1ec9 s\u1ed1 nh\u1eadn th\u1ee9c th\u1ea7n kinh\u00a0 d\u1ef1 \u0111o\u00e1n khuy\u1ebft t\u1eadt ch\u1ee9c n\u0103ng \u1edf ng\u01b0\u1eddi cao tu\u1ed5i v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t nh\u01b0 m\u1ed9t th\u00e0nh ph\u1ea7n c\u1ee7a HCDBTT.<\/span><\/p>\n

        \"\"<\/p>\n

        H\u00ecnh 4.1.M\u00f4 h\u00ecnh s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a HCDBT<\/span><\/i><\/p>\n

        L\u00c2M S\u00c0NG<\/span><\/h3>\n

        HCDBTT\u00a0 l\u00e0 s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a r\u1ea5t nhi\u1ec1u l\u0129nh v\u1ef1c kh\u00e1c nhau, t\u00f9y thu\u1ed9c v\u00e0o ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n c\u1ee7a t\u1eebng t\u00e1c gi\u1ea3, bao g\u1ed3m:y\u1ebfu c\u01a1, m\u1ec7t m\u1ecfi, r\u1ed1i lo\u1ea1n th\u0103ng b\u1eb1ng, s\u1ee5t c\u00e2n, ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t th\u1ea5p, gi\u1ea3m x\u1eed l\u00fd v\u00e0 th\u1ef1c hi\u1ec7n v\u1eadn \u0111\u1ed9ng, c\u00e1ch ly x\u00e3 h\u1ed9i, thay \u0111\u1ed5i nh\u1eadn th\u1ee9c nh\u1eb9 v\u00e0 t\u0103ng kh\u1ea3 n\u0103ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng v\u1edbi nh\u1eefng y\u1ebfu t\u1ed1 c\u0103ng th\u1eb3ng. Trong \u0111\u00f3 s\u1ef1 k\u1ebft h\u1ee3p kh\u00f4ng v\u1eadn \u0111\u1ed9ng v\u00e0<\/span> gi\u1ea3m c\u00e2n <\/span>l\u00e0 quan tr\u1ecdng trong d\u1ef1 b\u00e1o t\u00ecnh tr\u1ea1ng khuy\u1ebft t\u1eadt v\u00e0 t\u1eed vong. M\u1ed9t b\u00e1o c\u00e1o v\u1ec1 s\u1ef1 \u0111\u1ed3ng thu\u1eadn c\u1ee7a m\u1ed9t nh\u00f3m c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u Italy v\u00e0<\/span> Hoa K\u1ef3 <\/span>\u1ee7ng h\u1ed9 c\u00e1c ti\u00eau ch\u00ed \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh HCDBTT v\u1ec1 th\u1ec3 ch\u1ea5t \u0111\u01b0\u1ee3c d\u1ef1a tr\u00ean suy y\u1ebfu trong l\u0129nh v\u1ef1c sinh l\u00fd bao g\u1ed3m: di \u0111\u1ed9ng, s\u1ef1 c\u00e2n b\u1eb1ng, s\u1ee9c m\u1ea1nh c\u01a1 b\u1eafp, x\u1eed l\u00fd v\u1eadn \u0111\u1ed9ng, nh\u1eadn th\u1ee9c, dinh d\u01b0\u1ee1ng, s\u1ee9c ch\u1ecbu \u0111\u1ef1ng v\u00e0 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t. Hi\u1ec7n nay c\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n HCDBTT c\u1ee7a Fried v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u01b0\u1ee3c nhi\u1ec1u t\u00e1c gi\u1ea3 \u0111\u1ed3ng t\u00ecnh v\u00e0 \u00e1p d\u1ee5ng, ti\u00eau chu\u1ea9n n\u00e0y \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a ba ho\u1eb7c nhi\u1ec1u h\u01a1n trong s\u1ed1 n\u0103m ti\u00eau ch\u00ed<\/span> sau <\/span>\u0111\u00e2y: s\u1ee5t<\/span> gi\u1ea3m c\u00e2n <\/span>kh\u00f4ng ch\u1ee7 \u00fd, t\u1ef1 c\u1ea3m th\u1ea5y ki\u1ec7t s\u1ee9c, y\u1ebfu c\u01a1 l\u1ef1c, t\u1ed1c \u0111\u1ed9 \u0111i b\u1ed9 ch\u1eadm v\u00e0 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t th\u1ea5p.<\/span><\/p>\n

        C\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng\u00a0 n\u00e0y \u0111\u1ea1i di\u1ec7n cho t\u00ecnh tr\u1ea1ng suy dinh d\u01b0\u1ee1ng, teo c\u01a1 ng\u01b0\u1eddi gi\u00e0, lo\u00e3ng x\u01b0\u01a1ng, m\u1ea5t c\u00e2n b\u1eb1ng v\u00e0 r\u1ed1i lo\u1ea1n d\u00e1ng \u0111i. Ki\u1ec3u h\u00ecnh c\u1ee7a h\u1ed9i ch\u1ee9ng n\u00e0y l\u00e0 \u0111\u1ed9c l\u1eadp d\u1ef1 b\u00e1o trong v\u00f2ng ba n\u0103m cho s\u1ef1 c\u1ed1 t\u00e9 ng\u00e3, gi\u1ea3m nhanh ch\u00f3ng di \u0111\u1ed9ng ho\u1eb7c gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng s\u1ed1ng h\u00e0ng ng\u00e0y (ADL), t\u00e1i nh\u1eadp vi\u1ec7n v\u00e0 t\u1eed vong.<\/span><\/p>\n

        B\u00ean c\u1ea1nh c\u00e1c ti\u00eau chu\u1ea9n \u0111\u00e1nh gi\u00e1 HCDBTT d\u1ef1a tr\u00ean c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u v\u1ec1 th\u1ec3 ch\u1ea5t c\u00f2n c\u00f3 c\u00e1c th\u00e0nh ph\u1ea7n quan tr\u1ecdng kh\u00e1c nh\u01b0 t\u00e2m tr\u1ea1ng, nh\u1eadn th\u1ee9c, khi\u1ebfm khuy\u1ebft gi\u00e1c quan v\u00e0 c\u00e1c kh\u00eda c\u1ea1nh kinh t\u1ebf – x\u00e3 h\u1ed9i – cu\u1ed9c s\u1ed1ng c\u1ee7a ng\u01b0\u1eddi cao tu\u1ed5i.<\/span><\/p>\n

        C\u1eacN L\u00c2M S\u00c0NG<\/span><\/h3>\n

        HCDBTT c\u00f3 li\u00ean quan m\u1eadt thi\u1ebft v\u1edbi qu\u00e1 tr\u00ecnh <\/span>vi\u00eam<\/span>, \u0111\u00f4ng m\u00e1u, r\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a n\u1ed9i ti\u1ebft t\u1ed1 v\u00e0 trao \u0111\u1ed5i ch\u1ea5t. Do \u0111\u00f3, c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc c\u1ee7a h\u1ed9i ch\u1ee9ng c\u0169ng c\u00f3 li\u00ean quan v\u1edbi c\u00e1c d\u1ea5u \u1ea5n\u00a0 c\u1ee7a c\u00e1c qu\u00e1 tr\u00ecnh n\u00e0y, bao g\u1ed3m s\u1ef1 t\u0103ng cao c\u1ee7a IL-6, CRP, fibrinogen, y\u1ebfu t\u1ed1 VIII, D-dimer v\u00e0 \u0111\u1ec1 kh\u00e1ng insulin, c\u0169ng nh\u01b0 s\u1ef1 suy gi\u1ea3m c\u1ee7a IGF-1, dehydroepiandrosteron (DHEAS), n\u1ed3ng \u0111\u1ed9 25-hydroxy-vitamin D (25 OHD) trong huy\u1ebft thanh.<\/span><\/p>\n

        M\u1ed8T S\u1ed0 TI\u00caU CHU\u1ea8N \u0110\u00c1NH GI\u00c1 H\u1ed8I CH\u1ee8NG D\u1ec4 B\u1eca T\u1ed4N TH\u01af\u01a0NG<\/span><\/h3>\n

        Hi\u1ec7n nay, ti\u00eau chu\u1ea9n \u0111\u00e1nh gi\u00e1 HCDBTT tr\u00ean ng\u01b0\u1eddi cao tu\u1ed5i v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c th\u1ed1ng nh\u1ea5t. C\u00e1c nh\u00e0 l\u00e3o khoa \u0111\u00e3 nghi\u00ean c\u1ee9u v\u00e0 x\u00e2y d\u1ef1ng r\u1ea5t nhi\u1ec1u ti\u00eau chu\u1ea9n kh\u00e1c nhau \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng n\u00e0y, tuy nhi\u00ean m\u1ee5c \u0111\u00edch cu\u1ed1i c\u00f9ng v\u1eabn l\u00e0 d\u1ef1 b\u00e1o nh\u1eefng k\u1ebft qu\u1ea3 b\u1ea5t l\u1ee3i trong s\u1ee9c kh\u1ecfe ng\u01b0\u1eddi cao tu\u1ed5i.<\/span><\/p>\n

        Thang \u0111i\u1ec3m HCDBTT Edmonton (Edmonton Frail Scale)<\/strong><\/h4>\n

        Thang \u0111i\u1ec3m HCDBTT Edmonton \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp d\u1ef1a tr\u00ean m\u01b0\u1eddi l\u0129nh v\u1ef1c v\u1edbi \u01b0u \u0111i\u1ec3m l\u00e0 \u0111\u00e1nh gi\u00e1 HCDBTT tr\u00ean c\u1ea3 l\u0129nh v\u1ef1c h\u1ed7 tr\u1ee3 v\u1ec1 m\u1eb7t x\u00e3 h\u1ed9i, \u0111\u00e2y l\u00e0 m\u1ed9t thang \u0111i\u1ec3m c\u00f3 gi\u00e1 tr\u1ecb, \u0111\u00e1ng tin c\u1eady v\u00e0 kh\u1ea3 thi \u0111\u1ec3 s\u1eed d\u1ee5ng th\u01b0\u1eddng xuy\u00ean b\u1edfi kh\u00f4ng c\u1ea7n ng\u01b0\u1eddi c\u00f3 chuy\u00ean m\u00f4n s\u00e2u v\u1ec1 l\u00e3o khoa.<\/span><\/p>\n

        Nhi\u1ec1u nghi\u00ean c\u1ee9u \u00e1p d\u1ee5ng thang \u0111i\u1ec3m n\u00e0y tr\u00ean c\u00e1c c\u1ed9ng \u0111\u1ed3ng kh\u00e1c nhau c\u0169ng ch\u1ee9ng minh t\u00ednh kh\u1ea3 d\u1ee5ng, c\u00f3 gi\u00e1 tr\u1ecb v\u00e0 \u0111\u00e1ng tin c\u1eady \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 h\u1ed9i ch\u1ee9ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng \u1edf ng\u01b0\u1eddi cao tu\u1ed5i, \u0111\u1ed3ng th\u1eddi h\u1eefu \u00edch cho c\u00e1c chuy\u00ean gia y t\u1ebf,trong nghi\u00ean c\u1ee9u v\u00e0 trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng.<\/span><\/p>\n

        B\u1ea3ng 7.1: Thang \u0111i\u1ec3m HCDBTT Edmonton<\/strong><\/p>\n

        \"\"<\/p>\n

        T\u1ed5ng \u0111i\u1ec3m l\u00e0 17 \u0111i\u1ec3m v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng khi \u22657\/17 \u0111i\u1ec3m.<\/span><\/p>\n

        Ki\u1ec3u h\u00ecnh c\u1ee7a h\u1ed9i ch\u1ee9ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng(Phenotype of frailty)<\/strong><\/h4>\n

        FFI \u0111\u00e3 \u0111\u01b0\u1ee3c Fried v\u00e0 \u0111\u1ed3ng nghi\u1ec7p \u0111\u1ec1 xu\u1ea5t g\u1ed3m n\u0103m ti\u00eau ch\u00ed: s\u00fat c\u00e2n kh\u00f4ng ch\u1ee7 \u00fd, t\u00ecnh tr\u1ea1ng y\u1ebfu c\u01a1, s\u1ee9c b\u1ec1n v\u00e0 n\u0103ng l\u01b0\u1ee3ng k\u00e9m, s\u1ef1 ch\u1eadm ch\u1ea1p, v\u00e0 m\u1ee9c ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c th\u1ea5p.HCDBTT x\u00e1c \u0111\u1ecbnh theo ti\u00eau ch\u00ed c\u1ee7a Fried ng\u00e0y c\u00e0ng nh\u1eadn \u0111\u01b0\u1ee3c s\u1ef1 \u0111\u1ed3ng thu\u1eadn ng\u00e0y c\u00e0ng cao c\u1ee7a c\u00e1c nh\u00e0 khoa h\u1ecdc, th\u1ed1ng nh\u1ea5t\u00a0 \u0111\u00e2y l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng bao g\u1ed3m nhi\u1ec1u d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng. B\u00ean c\u1ea1nh \u0111\u00f3 l\u00fd thuy\u1ebft c\u1ee7a t\u00e1c gi\u1ea3 \u0111\u01b0a ra t\u1ea1o \u0111i\u1ec1u ki\u1ec7n nghi\u00ean c\u1ee9u, t\u00ecm hi\u1ec3u c\u01a1 ch\u1ebf s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a h\u1ed9i ch\u1ee9ng n\u00e0y.\u00a0<\/span><\/p>\n

        Khi \u0111\u1ed1i t\u01b0\u1ee3ng nghi\u00ean c\u1ee9u \u0111\u00e1p \u1ee9ng ba trong s\u1ed1 n\u0103m ti\u00eau ch\u00ed th\u00ec x\u00e1c \u0111\u1ecbnh l\u00e0 c\u00f3 HCDBTT, t\u1eeb m\u1ed9t \u0111\u1ebfn hai ti\u00eau ch\u00ed l\u00e0 ti\u1ec1n HCDBTT (Pre-frailty), b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ti\u00eau ch\u00ed n\u00e0o l\u00e0 kh\u00f4ng c\u00f3 HCDBTT .<\/span><\/p>\n

        S\u1ee5t c\u00e2n kh\u00f4ng ch\u1ee7 \u00fd:<\/strong> gi\u1ea3m 4,5 kg ho\u1eb7c gi\u1ea3m 5% tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 so v\u1edbi n\u0103m <\/span>tr\u01b0\u1edbc<\/span>.<\/span><\/p>\n

        Y\u1ebfu c\u01a1 l\u1ef1c:<\/strong> c\u01a1 l\u1ef1c tay th\u1ea5p h\u01a1n 20% so v\u1edbi m\u1ee9c c\u01a1 b\u1ea3n (\u0111\u00e3 \u0111i\u1ec1u ch\u1ec9nh theo gi\u1edbi v\u00e0 ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3).<\/span><\/p>\n

        B\u1ea3ng 7.2: B\u1ea3ng quy \u0111\u1ed5i c\u01a1 l\u1ef1c tay theo gi\u1edbi v\u00e0 ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3:<\/strong><\/p>\n

        \"\"<\/p>\n

        V\u00ed d\u1ee5: \u0110\u1ed1i t\u01b0\u1ee3ng nghi\u00ean c\u1ee9u l\u00e0 n\u1eef, c\u00f3 ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3\u00a0 \u2264 23 v\u00e0 c\u01a1 l\u1ef1c tay \u2264 17kg th\u00ec t\u00ednh l\u00e0 m\u1ed9t ti\u00eau ch\u00ed c\u1ee7a HCDBTT<\/span><\/p>\n

        S\u1ee9c b\u1ec1n v\u00e0 n\u0103ng l\u01b0\u1ee3ng k\u00e9m:<\/strong>T\u1ef1 c\u1ea3m th\u1ea5y r\u1eb1ng ph\u1ea3i g\u1eafng s\u1ee9c \u0111\u1ec3 l\u00e0m m\u1ecdi vi\u1ec7c trong tu\u1ea7n qua v\u1edbi t\u1ea7n su\u1ea5t \u22653 ng\u00e0y trong tu\u1ea7n.<\/span><\/p>\n

        S\u1ef1 ch\u1eadm ch\u1ea1p:<\/strong> \u0110\u00e1nh gi\u00e1 d\u1ef1a tr\u00ean th\u1eddi gian \u0111i b\u1ed9 15 b\u01b0\u1edbc (4,57m) v\u1edbi t\u1ed1c \u0111\u1ed9 b\u00ecnh th\u01b0\u1eddng.Th\u1eddi gian \u0111i b\u1ed9 (t\u00ednh theo gi\u00e2y) \u0111\u01b0\u1ee3c so s\u00e1nh v\u1edbi m\u1ee9c c\u01a1 b\u1ea3n \u0111\u00e3 \u0111i\u1ec1u ch\u1ec9nh theo gi\u1edbi t\u00ednh v\u00e0 chi\u1ec1u cao. N\u1ebfu th\u1eddi gian \u0111i b\u1ed9 l\u1edbn h\u01a1n 20% m\u1ee9c c\u01a1 b\u1ea3n c\u0169ng nh\u01b0 nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n c\u00e1c b\u00e0i ki\u1ec3m tra \u0111\u01b0\u1ee3c t\u00ednh l\u00e0 m\u1ed9t ti\u00eau ch\u00ed cho HCDBTT.<\/span><\/p>\n

        B\u1ea3ng 6.3: B\u1ea3ng quy \u0111\u1ed5i th\u1eddi gian \u0111i b\u1ed9 theo gi\u1edbi t\u00ednh v\u00e0 chi\u1ec1u cao:<\/strong><\/p>\n

        \"\"<\/p>\n

        V\u00ed d\u1ee5: \u0110\u1ed1i t\u01b0\u1ee3ng nghi\u00ean c\u1ee9u l\u00e0 n\u1eef, c\u00f3 chi\u1ec1u cao nh\u1ecf h\u01a1n 159 cm v\u00e0 th\u1eddi gian \u0111i b\u1ed9 15 b\u01b0\u1edbc t\u1eeb 7 gi\u00e2y tr\u1edf l\u00ean ho\u1eb7c kh\u00f4ng th\u1ec3 \u0111i b\u1ed9 \u0111\u01b0\u1ee3c th\u00ec t\u00ednh l\u00e0 m\u1ed9t ti\u00eau ch\u00ed c\u1ee7a HCDBTT<\/span><\/p>\n

        Ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c th\u1ea5p: <\/strong>Ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c \u0111\u01b0\u1ee3c t\u00ednh b\u1eb1ng t\u1ed5ng s\u1ed1 kilocalo ti\u00eau hao trong m\u1ed7i tu\u1ea7n d\u1ef1a tr\u00ean phi\u00ean b\u1ea3n ng\u1eafn c\u1ee7a b\u1ed9 c\u00e2u h\u1ecfi c\u00e1c ho\u1ea1t \u0111\u1ed9ng <\/span>Minnesota leisure time physical activityQuestionnaire<\/span><\/i>. N\u1ebfu ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c < 20% so v\u1edbi ng\u01b0\u1eddi c\u00f9ng gi\u1edbi \u0111\u01b0\u1ee3c th\u00ec t\u00ednh l\u00e0 m\u1ed9t ti\u00eau ch\u00ed c\u1ee7a HCDBTT<\/span><\/p>\n

        Nam:<\/strong> <383 kilocalo l\u00e0 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c th\u1ea5p.<\/span><\/p>\n

        N\u1eef:<\/strong> <270 kilocalo l\u00e0 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c th\u1ea5p.<\/span><\/p>\n

        Th\u1eed nghi\u1ec7m \u0111i b\u1ed9 4m<\/strong><\/h4>\n

        Abellanvan Kan v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng t\u1ed1c \u0111\u1ed9 \u0111i b\u1ed9 m\u1ed9t qu\u00e3ng \u0111\u01b0\u1eddng 4m th\u1ea5p d\u01b0\u1edbi 0,8m\/s c\u00f3 li\u00ean quan \u0111\u1ebfn k\u1ebft qu\u1ea3 b\u1ea5t l\u1ee3i \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi cao tu\u1ed5i ( khuy\u1ebft t\u1eadt, suy gi\u1ea3m nh\u1eadn th\u1ee9c, ph\u1ea3i \u0111i\u1ec1u tr\u1ecb trong c\u00e1c nh\u00e0 d\u01b0\u1ee1ng l\u00e3o, t\u00e9 ng\u00e3, v\u00e0 t\u1eed vong).Do v\u1eady \u0111\u00e2y c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t <\/span>c\u00f4<\/span>ng c\u1ee5 nhanh ch\u00f3ng, an to\u00e0n, r\u1ebb ti\u1ec1n v\u00e0 c\u00f3 \u0111\u1ed9 tin c\u1eady \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 HCDBTT.<\/span><\/p>\n

        M\u1ed8T S\u1ed0 BI\u1ec6N<\/span> PH\u00c1P <\/span>PH\u00d2NG NG\u1eeaA H\u1ed8I CH\u1ee8NG D\u1ec4 B\u1eca T\u1ed4N TH\u01af\u01a0NG<\/span><\/h3>\n

        HCDBTT l\u00e0 t\u00ecnh tr\u1ea1ng ti\u1ebfn tri\u1ec3n b\u1eaft \u0111\u1ea7u b\u1eb1ng m\u1ed9t giai \u0111o\u1ea1n ti\u1ec1n l\u00e2m s\u00e0ng, do \u0111\u00f3 c\u00f3 nhi\u1ec1u c\u01a1 h\u1ed9i \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 ng\u0103n ng\u1eeba h\u1ed9i ch\u1ee9ng n\u00e0y. Lebel v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u1ec1 xu\u1ea5t m\u1ed9t c\u00e1ch ti\u1ebfp c\u1eadn ch\u1ed1ng l\u1ea1i HCDBTT b\u1eb1ng s\u00e1u ch\u1ebf \u0111\u1ed9 kh\u00e1c nhau: ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng th\u00edch h\u1ee3p v\u1edbi \u0111\u1ea7y \u0111\u1ee7 protein, vitamin v\u00e0 ch\u1ea5t kho\u00e1ng; th\u01b0\u1eddng xuy\u00ean t\u1eadp th\u1ec3 d\u1ee5c, luy\u1ec7n t\u1eadp m\u1ed9t m\u00ecnh ho\u1eb7c theo nh\u00f3m, ch\u1eb3ng h\u1ea1n nh\u01b0 \u0111i b\u1ed9, khi\u00eau v\u0169, t\u1eadp th\u1ec3 d\u1ee5c c\u00e2n b\u1eb1ng v\u1eadn \u0111\u1ed9ng v\u00e0 n\u00e2ng t\u1ea1; theo d\u00f5i th\u01b0\u1eddng xuy\u00ean k\u1ef9 n\u0103ng c\u01a1 b\u1ea3n c\u1ee7a c\u00e1 nh\u00e2n, ch\u1eb3ng h\u1ea1n nh\u01b0 \u0111i b\u1ed9, c\u00e2n b\u1eb1ng v\u00e0 nh\u1eadn th\u1ee9c; ph\u00f2ng ng\u1eeba nhi\u1ec5m khu\u1ea9n do c\u00fam, ph\u1ebf c\u1ea7u khu\u1ea9n v\u00e0 v\u1eafc-xin herpes zoster; \u0111\u1ec1 ph\u00f2ng c\u00e1c y\u1ebfu t\u1ed1 c\u0103ng th\u1eb3ng t\u1eeb c\u00e1c s\u1ef1 ki\u1ec7n nh\u01b0 ph\u1eabu thu\u1eadt, v\u00e0 ph\u1ee5c h\u1ed3i nhanh ch\u00f3ng<\/span> sau <\/span>khi s\u1ef1 ki\u1ec7n c\u0103ng th\u1eb3ng qua dinh d\u01b0\u1ee1ng v\u00e0 v\u1eadt l\u00fd tr\u1ecb li\u1ec7u ph\u00f9 h\u1ee3p.<\/span><\/p>\n

        Ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u0111\u1ec3 ph\u00f2ng ng\u1eeba, tr\u00ec ho\u00e3n s\u1ef1 h\u00ecnh th\u00e0nh, \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u1ea3o ng\u01b0\u1ee3c HCDBTT, v\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 trong teo c\u01a1 ng\u01b0\u1eddi gi\u00e0. C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng can thi\u1ec7p ph\u00f9 h\u1ee3p (ba l\u1ea7n m\u1ed7i tu\u1ea7n), d\u00e0i h\u1ea1n (s\u00e1u th\u00e1ng), ch\u01b0\u01a1ng tr\u00ecnh \u0111a d\u1ea1ng (trong \u0111\u00f3 bao g\u1ed3m \u0111\u00e0o t\u1ea1o s\u1ee9c \u0111\u1ec1 kh\u00e1ng), c\u00f9ng v\u1edbi t\u0103ng c\u01b0\u1eddng l\u01b0\u1ee3ng protein v\u00e0 c\u00e1c vi ch\u1ea5t dinh d\u01b0\u1ee1ng ch\u1ea5t l\u01b0\u1ee3ng cao, c\u00f3 th\u1ec3 c\u00f3 m\u1ed9t \u1ea3nh h\u01b0\u1edfng t\u00edch c\u1ef1c h\u1ea1n ch\u1ebf s\u1ef1 th\u00e0nh l\u1eadp v\u00e0 ti\u1ebfn tri\u1ec3n h\u1ed9i ch\u1ee9ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 suy gi\u1ea3m nh\u1eadn th\u1ee9c.<\/span><\/p>\n

        Bi\u1ec7n<\/span> ph\u00e1p <\/span>can thi\u1ec7p<\/span> thu\u1ed1c <\/span>bao g\u1ed3m hormon \u0111\u1ed3ng h\u00f3a (v\u00ed d\u1ee5 megestrol, ch\u1ea5t k\u00edch th\u00edch b\u00e0i ti\u1ebft hormon t\u0103ng tr\u01b0\u1edfng, testosterone v\u00e0 DHEA). Th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng cho th\u1ea5y trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 t\u1eadp th\u1ec3 d\u1ee5c, c\u00e1c c\u01a1 b\u1eafp c\u00f3 xu h\u01b0\u1edbng t\u0103ng kh\u1ed1i l\u01b0\u1ee3ng kh\u00f4ng c\u00f3 hi\u1ec7u l\u1ef1c v\u1ec1 s\u1ee9c m\u1ea1nh ho\u1eb7c ch\u1ee9c n\u0103ng; H\u01a1n n\u1eefa, t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a n\u00f3 \u0111\u00e3 h\u1ea1n ch\u1ebf t\u00ednh kh\u1ea3 thi. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 v\u1eady, th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u1edbi erythropoietin, \u0111\u1ed3ng v\u1eadn th\u1ee5 th\u1ec3 \u03b22-adrenergic, \u1ee9c ch\u1ebf men chuy\u1ec3n angiotensin v\u00e0 3-hydroxy Reductase coenzyme A3-methylglutaryl\u00a0 (statin) \u0111\u00e3 kh\u00f4ng ch\u1ee9ng minh \u0111\u01b0\u1ee3c l\u1ee3i \u00edch r\u00f5 r\u00e0ng.<\/span><\/p>\n

        Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c chi\u1ebfn l\u01b0\u1ee3c \u0111a ph\u01b0\u01a1ng \u0111\u00e1nh gi\u00e1, ph\u00f2ng ng\u1eeba, can thi\u1ec7p bao g\u1ed3m k\u1ebft h\u1ee3p ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t, dinh d\u01b0\u1ee1ng, t\u00e2m l\u00fd, y h\u1ecdc, s\u1eed d\u1ee5ng <\/span>thu\u1ed1c<\/span>, x\u00e3 h\u1ed9i v\u00e0 m\u00f4i tr\u01b0\u1eddng \u0111\u00e3 ch\u1ee9ng minh<\/span> hi\u1ec7u qu\u1ea3 <\/span>h\u01a1n trong n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng, ti\u1ebft ki\u1ec7m chi ph\u00ed ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe t\u1ed5ng th\u1ec3. B\u00ean c\u1ea1nh \u0111\u00f3 c\u0169ng c\u1ea7n thi\u1ebft \u0111\u00e0o t\u1ea1o chuy\u00ean s\u00e2u cho c\u00e1c chuy\u00ean gia y t\u1ebf trong b\u1ec7nh vi\u1ec7n v\u1ec1 ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n cao tu\u1ed5i v\u00e0 t\u1eadp trung v\u00e0o <\/span>c\u00f4<\/span>ng t\u00e1c ph\u00f2ng HCDBTT.<\/span><\/p>\n

         <\/p>","protected":false},"excerpt":{"rendered":"

        \u0110\u1ea0I C\u01af\u01a0NG H\u1ed9i ch\u1ee9ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng (HCDBTT) l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p \u1edf<\/p>","protected":false},"author":21,"featured_media":9345,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[66],"tags":[],"class_list":["post-9344","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lao-khoa"],"_links":{"self":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts\/9344","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/users\/21"}],"replies":[{"embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/comments?post=9344"}],"version-history":[{"count":1,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts\/9344\/revisions"}],"predecessor-version":[{"id":9350,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/posts\/9344\/revisions\/9350"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/media\/9345"}],"wp:attachment":[{"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/media?parent=9344"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/categories?post=9344"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/easymed.vn\/en\/wp-json\/wp\/v2\/tags?post=9344"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}