Tài liệu hạn chế xem trước, để xem đầy đủ mời bạn chọn Tải xuống
1
/ 101 trang
THÔNG TIN TÀI LIỆU
Thông tin cơ bản
Định dạng
Số trang
101
Dung lượng
1,72 MB
Nội dung
B Y T TRNG I HC Y H NI U TH HIP ĐáNHGIáCHỉSốSCORETRONGSàNGLọCNGUYCƠLOãNGXƯƠNGPHụNữMãNKINH Chuyờn ngnh: Ni Xng khp Mó s : 62722010 LUN VN BC S CHUYấN KHOA CP II Ngi hng dn khoa hc: PGS.TS NGUYN TH NGC LAN H NI - 2015 LI CM N hon thnh lun ny, tụi xin chõn thnh cm n: Ban Giỏm hiu, Phũng o to sau i hc, B mụn Ni tng hp -Trng i hc Y H Ni; Ban lónh o Bnh vin Bch Mai, Khoa C xng khp, Khoa Khỏm bnh theo yờu cu - Bnh vin Bch Mai;Ban lónh o Bnh vin Bc Thng Long ó to mi iu kin thun li cho tụi sut quỏ trỡnh hc v hon thnh lun c bit, tụi xin by t lũng bit n sõu sc ti PGS.TS Nguyn Th Ngc Lan nguyờn phú trng b mụn Ni Tng hp - Trng i hc Y H Ni, ngi ó ht lũng dy bo, dỡu dt tụi sut quỏ trỡnh hc v trc tip hng dn tụi hon thnh lun ny Vi tt c lũng kớnh trng, tụi gi li cm n chõn thnh ti cỏc Thy,Cụ giỏo, cỏc anh ch Bỏc s, iu dng khoa C xng khp, khoa Khỏm cha bnh theo yờu cu-Bnh vin Bch Mai, nhng ngi thy ó tn tỡnh hng dn, dỡu dt tụi thc hnh lõm sng hng ngy sut thi gian hc v gúp ý cho tụi hon thnh lun Tụi xin chõn thnh cm n ti cỏc Thy, Cụ Hi ng chm lun ó cho tụi nhiu ý kin quý bỏu hon thin lun ny Tụi xin trõn trng cm n cỏc Thy,Cụ B mụn Ni tng hp-Trng i hc Y H Ni ó ht lũng dy d, ch bo tụi quỏ trỡnh hc v hon thnh lun Cui cựng, tụi cng xin vụ cựng bit n gia ỡnh, bn bố v ng nghip luụn l nhng ngi ng viờn, khớch l v ng h nhit tỡnh giỳp tụi vt qua mi khú khn cuc sng v hc H Ni, ngy 10 thỏng 11 nm 2015 u Th Hip LI CAM OAN Tụi l u Th Hip, hc viờn Bỏc s chuyờn khoa II khúa 27, chuyờn ngnh Ni Xng khp, Trng i hc Y H Ni xin cam oan: õy l lun bn thõn tụi trc tip thc hin di s hng dn ca PGS.TS Nguyn Th Ngc Lan Cụng trỡnh ny khụng trựng lp vi bt k nghiờn cu no khỏc ó c cụng b ti Vit Nam Cỏc s liu v thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan, ó c xỏc nhn v chp nhn ca c s ni nghiờn cu cho phộp ly s liu v xỏc nhn Tụi xin hon ton chu trỏch nhim v nhng cam kt ny H Ni, ngy 10 thỏng 11 nm 2015 Ngi vit cam oan u Th Hip CC CH VIT TT AUC : Area Under the Curve (Din tớch di ng cong) BMC : Bone Mineral Content (Khi lng cht khoỏng xng) BMD : Bone Mineral Density (Mt xng) BMI : Body Mass Index (Ch c th) CSTL : Ct sng tht lng CX : C xng ựi DEXA : Dual Energy X ray Absorptiometry (Hp th tia X nng lng kộp) TNC : i tng nghiờn cu MX : Mt xng OSTA : Osteoporosis Self assessment Tool for Asian index (ch s t ỏnh giỏ loóng xng cho ngi chõu ) ORAI : Osteoporosis Risk Assessment Instrument (Cụng c ỏnh giỏ nguy c loóng xng) OSIRIS SCORE : Osteoporosis Index of Risk (Ch s nguy c loóng xng) : Simple Calculated Osteoporosis Risk Estimation (Tớnh toỏn n gin c lng nguy c loóng xng) SD : Standard Deviatio ( lch chun) Se : Sensitivity ( nhy) Sp : Specificity ( c hiu) PPV : Positive Predictive Value (Giỏ tr d bỏo dng tớnh) NPV : Negative Predictive Value (Giỏ tr d bỏo õm tớnh) VKDT : Viờm khp dng thp WHO : T chc Y t th gii(World Health Organization) MC LC T VN Chng 1: TNG QUAN TI LIU 1.1 i cng v loóng xng 1.1.1 nh ngha loóng xng 1.1.2 Phõn loi loóng xng 1.2 Loóng xng ph n sau kinh 1.2.1 Vi nột v kinh 1.2.2 C ch bnh sinh loóng xng ph n sau kinh 1.2.3 Mt s nguy c gõy loóng xng 10 1.2.4 Triu chng lõm sng 13 1.3 Cỏc phng phỏp ỏnh giỏ tỡnh trng loóng xng 14 1.3.1 Phng phỏp o MX bng Hp th tia X nng lng kộp 14 1.3.2 Cỏc phng phỏp ỏnh giỏ tỡnh trng loóng xng khỏc 15 1.4 Ch s SCORE v mt s mụ hỡnh tiờn lng nguy c loóng xng 15 1.4.1 Ch s ORAI 15 1.4.2 Ch s OSIRIS 16 1.4.3 Ch s OSTA 16 1.4.4 Ch s SCORE 16 1.5 Tỡnh hỡnh nghiờn cu v bnh loóng xng v ngoi nc 21 Chng 2: I TNG V PHNG PHP NGHIấN CU 23 2.1 a im v thi gian nghiờn cu 23 2.2 i tng nghiờn cu 23 2.3 Phng phỏp nghiờn cu 23 2.3.1 Thit k nghiờn cu 23 2.3.2 Phng phỏp 23 2.3.3 C mu 24 2.3.4 Cỏch chn mu v phng phỏp thu thp s liu 24 2.3.5 Cỏc bc tin hnh nghiờn cu 28 2.4 Phõn tớch v x lý s liu 28 2.5 Khớa cnh o c 29 Chng 3: KT QU NGHIấN CU 30 3.1 c im ca i tng nghiờn cu 30 3.1.1 c im chung 30 3.1.2 c im MX o bng phng phỏp DEXA ca TNC 33 3.2 c im kho sỏt ch s SCORE ca TNC 38 3.2.1 T l nguy c loóng xng theo ch s SCORE ca TNC 38 3.2.2 Liờn quan ch s SCORE vi tỡnh trng loóng xng theo T-score 38 3.2.3 Liờn quan ch s SCORE trung bỡnh vi tui 39 3.2.4 Liờn quan ch s SCORE trung bỡnh vi BMI 40 3.2.5 Liờn quan ch s SCORE trung bỡnh vi tỡnh trng kinh 40 3.2.6 Liờn quan ch s SCORE trung bỡnh vi tin s VKDT, dựng Estrogen, góy xng sau 45 tui 41 3.3 ỏnh giỏ giỏ tr ca ch s SCOREso vi o MX bng phng phỏp DEXA 42 3.3.1 nhy, c hiu ca ch s SCORE vi T- score -1 SD 42 3.3.2 nhy, c hiu ca ch s SCORE vi T- score -2.5 SD 45 3.3.3 Giỏ tr ca ch s SCORE chn oỏn sng lc loóng xng48 Chng 4: BN LUN 51 4.1 c im ca i tng nghiờn cu 51 4.1.1 c im chung ca i tng nghiờn cu 53 4.1.2 c im v MX o bng phng phỏp DEXA ca TNC 54 4.2 c im kho sỏt ch s SCORE ca TNC 64 4.2.1 T l phõn tng nguy c ca TNC theo ch s SCORE 65 4.2.2 Liờn quan ch s SCORE vi MX tớnh theo T-score 65 4.2.3 Liờn quan ch s SCORE vi mt s yu t nguy c 66 4.3 ỏnh giỏ giỏ tr ca ch s SCOREso vi o MX bng phng phỏp DEXA n gii t 45 tui tr lờn 68 4.3.1 Giỏ tr ca ch s SCORE d oỏn MX thp 69 4.3.2 Giỏ tr ca ch s SCORE d oỏn loóng xng 70 4.3.3 ỏnh giỏ giỏ tr ca ch s SCORE 71 4.4 Hn ch ca ti 76 KT LUN 77 KIN NGH 78 TI LIU THAM KHO PH LC DANH MC BNG Bng 1.1 Cỏc v cỏc yu t liờn quan n loóng xng 18 Bng 2.1 Cỏc bin s v ch s nghiờn cu 27 Bng 3.1 Phõn b TNC theo tin s góy xng 33 Bng 3.2 T-score trung bỡnh 34 Bng 3.3 T-score trung bỡnh v nhúm tui 35 Bng 3.4 T-score trung bỡnh v BMI 35 Bng 3.5 T-score trung bỡnh v tỡnh trng kinh 36 Bng 3.6 T-score trung bỡnh v tin s VKDT, dựng Estrogen, góy xng 37 Bng 3.7 c im ca SCORE trung bỡnh theo tỡnh trng loóng xng 38 Bng 3.8 Ch s SCORE trung bỡnh vi tui 39 Bng 3.9 Ch s SCORE trung bỡnh vi BMI 40 Bng 3.10 Ch s SCORE trung bỡnh vi tỡnh trng kinh 40 Bng 3.11 Ch s SCORE vi tin s VKDT, dựng Estrogen, góy xng 41 Bng 3.12 nhy c hiu ca ch s SCORE vi T- score -1 SD 42 Bng 3.13 Ch s SCORE vi T- score -1 SD 43 Bng 3.14 Ch s SCORE vi T- score -1 SD CSTL 44 Bng 3.15 Ch s SCORE vi T- score -1 SD CX 44 Bng 3.16 nhy, c hiu ca ch s SCORE vi T- score -2.5 SD 45 Bng 3.17 nhy, c hiu ca ch s SCORE ti cut off 14 v 15 chn oỏn sng lc loóng xng 46 Bng 3.18 Ch s SCORE vi T- score -2.5 SD 47 Bng 3.19 Ch s SCORE vi T- score -2.5 SD ti CSTL 47 Bng 3.20 Ch s SCORE vi T- score -2.5 SD ti CX 47 Bng 3.21 Giỏ tr ca ch s SCORE 48 Bng 3.22 Mi liờn quan gianguy c loóng xng theo SCORE v loóng xng theo T-score 49 DANH MC BIU Biu 3.1 Phõn b TNC theo tui 30 Biu 3.2 Phõn b TNC theo BMI 31 Biu 3.3 Phõn b TNC theo tui kinh 31 Biu 3.4 Phõn b TNC theo thi gian kinh 32 Biu 3.5 Phõn b TNC theo tin s VKDT v tin s dựng Estrogen 32 Biu 3.6 T l loóng xng 33 Biu 3.7 T l loóng xng v nhúm tui 34 Biu 3.8 T l nguy c loóng xng theo ch s SCORE 38 Biu 3.9 Liờn quan gianguy c loóng xng theo SCORE v t l loóng xng 39 Biu 3.10 ng cong ROC vi T-score-1SD 43 Biu 3.11 ng cong ROC vi T-score -2,5SD 46 Biu 3.12 Phõn b TNC theo ch s SCORE ti cut off v 14 50 DANH MC HèNH NH Hỡnh 1.1 Mi liờn quan RANK/RANKL/OPG v mt xng 77 KT LUN Qua nghiờn cu ỏnh giỏ nguy c loóng xng theo ch s SCOREso sỏnh vi o mt xng bng DEXA 290 ph n sau kinh t 45 tui tr lờn, chỳng tụi rỳt mt s kt lun sau: c im kho sỏt ch s SCORE ca TNC - Nguy c thp (SCORE6) chim t l 7,2% (90,5% s ph n khụng mc loóng xng) - Nguy c trung bỡnh (614) chim t l 22,4% (84,6% ph n mc loóng xng) Giỏ tr ca ch s SCOREso vi o MX bng phng phỏp DEXA * Trong chn oỏn sng lc nguy c gim MX (T-score -1SD): - im cut off = 6: + Se 95,1% v Sp 20,9 % + AUC 0,776 im ct ny tng t nh nghiờn cu gc * Trong chn oỏn sng lc nguy c loóng xng (T-score -2,5SD): - Ti im cut off 15 (nh nghiờn cu gc), b sút thờm 7,9% i tng b loóng xng nhng khụng c sng lc - im cut off = 14: + Se 39,3% v Sp 93,3% + AUC 0,779 Nh vy, cn dch chuyn im cut off t 15 v 14 phự hp ỏp dng vi ph n Vit Nam 78 KIN NGH - Ch s SCORE l mt cụng c n gin, cú th ỏp dng vic xỏc nh nguy c loóng xng ph n sau kinhphự hp vi iu kin Vit Nam d phũng v iu tr loóng xng mt cỏch tit kim v hiu qu - Cn dch chuyn im cut off t 15 v 14 phự hp vi ngi Vit Nam TI LIU THAM KHO NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2001) Osteoporosis prevention, diagnosis and therapy JAMA, 285(6), 785-795 Reginster J.Y, Burlet N (2006) Osteoporosis: A still increasing prevalence Bone, 38(2 Suppl 1), S4-S9 Strom O, Borgstrom F, Kanis J.A, et al (2011) Osteoporosis: Burden, health care provision and opportunities in the EU A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA) Arch Osteoporos, 6(1-2), 59-155 Burge R, Dawson-Hughes B, Solomon D.H, et al (2007) Incidence and economic burden of osteoporosis-related fractures in the United States 2005-2025 J Bone Miner Res, 22(3), 465-475 Nguyn Vn Tun (2012) Góy xng v t vong: mt nn y t cng ng Y hc thng thc, iDoc.vn Vedi S, Purdie DW, Ballard P, Bord S, Cooper AC, Compston JE (1999) Bone remodeling and structure in postmenopausal women treated with longterm, high-dose estrogen therapy Osteoporos Int, 10(1), 52-58 Lydick E, Cook K, Turpin J, Melton M, Stine R, Byrnes C (1998) Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density Am J Manag Care, 4, 37-48 Ungar JW, Josse R, Lee S et al (2000) The Canadian SCORE questionnaire: optimizing the use of technology for low bone densityassessment simple calculated osteoporosis risk estimate J Clin Densitom; 3(3), 26980 Ben Sedrine W, Devogealer P, Kaufman M et al (2001) Evaluationof the simple calculated osteoporosis risk estimation (SCORE) ina sample of white women from Belgium Bone, 29(4), 374380 10 M Karkucak, E Capkin, S Kerimoglu, et al (2008) Performance of simple calculated osteoporosis risk estimation in a sample of women with suspected osteoporosis in the turkish population Rheumatol Int, 28, 825830 11 Laura Gonzalez-Lopez, Jorge I, Gamez-Nava, et al (2012) Performance of Risk Indices for Identifying Low Bone Mineral Density and Osteoporosis in Mexican Mestizo Women with Rheumatoid Arthritis J Rheumatol, 39, 247-253 12 Nguyn Th Ngc Lan (2011) Loóng xng nguyờn phỏt, Bnh hc c xng khp ni khoa, Nh xut bn Y hc, H Ni 13 Sipos W, Pietschmann P, Rauner M,et al (2009) Pathophysiology of osteoporosis Wien Med Wochenschr, 159(9-10), 230-234 14 Trng i hc Y Dc thnh ph H Chớ Minh, B mụn ph sn (1998) Thi kinh, Sn ph khoa, NXB thnh ph H Chớ Minh, 789 15 V Matkovic (1994) Timing of Peak Bone Mass in Caucasian Females and Its Implication for the Prevention of Osteoporosis J Clin Invest, 93(2), 799-808 16 Nguyn Th Thanh Hng (2012) Osteoporisis, a major health problem in Viet Nam life style factors and determinants of bone mass 17 Robling AG, Castillo AB, Turner CH (2006) Biomechanical and molecular regulation of bone remodeling Annu Rev Biomed Eng, 8, 455-498 18 Arnaud CD, Sanchez SD (1990) The role of calcium in osteoporosis Pubmed, Annu Rev Nutr, 10, 397-414 19 Amanzadeh J, Reilly RF Jr (2006) An evidence based approach to its clinical consequences and management Nat Clin Pract Nephrol, 2, 136-148 20 Schubert L, DeLuca HF (2010) Hypophosphatemia is responsible for skeletal muscle weakness of vitamin D deficiency Arch Biochem Biophys Aug 15 500(2), 157-161 21 Massey LK, Hollingberry PW (1998) Acute effects of dietary caffeine and aspirin on urinary mineral excretion in pre- and postmenopausal women Nutr Res, 8, 845-851 22 Lacey DL, Timms E, Tan HL, et al (1998) Osteoprotegerin ligand is a cytokine that regulates osteoclast differentiation and activation PubMed, Cell, 93(2),165176 23 Richards JB, Zheng HF, Spector TD (2012) Genetics of osteoporosis from genome-wide association studies: advances and challenges Nature Reviews Genetics, 13(8), 576-588 24 Charatcharoenwitthaya N, Khosla S, Atkinson EJ, et al (2007) Effect of blockade of TNF-alpha and interleukin-1 action on bone resorption in early postmenopausal women J Bone Miner Res, 22(5), 724-729 25 Hughes DE, Dai A, Tiffee JC, et al (1996) Estrogen promotes apoptosis of murine osteoclasts mediated by TGF-beta Nat Med, 2(10), 1132-1136 26 Ledger GA, Burritt MF, Kao PC, et al (1995) Role of parathyroid hormone in mediating nocturnal and agerelated increases in bone resorption J Clin Endocrinol Metab, 80(11), 3304-3310 27 Rao S.S, Budhwar N, Ashfaque A (2010) Osteoporosis in men Am Fam Physician, 82(5), 503-508 28 Pacifici R, Brown C, Puscheck E, Friedrich E, Slatopolsky E, Maggio D, et al (1991) Effect of surgical menopause and estrogen replacement on cytokine release from human blood mononuclear cells Proc Natl Acad Sci USA, 88(12), 5134-8 29 Nguyn Thy Khờ (2011) Hormon sinh dc v loóng xng, Loóng xng, gy xng, hormon v cỏc yu t liờn quan Hi ngh loóng xng thng niờn ln th VI, 30 Nguyn Vn Tun (2008) Loóng xng, Tp san Thụng tin Y hc, s 7, 34, 51 31 Cortet B, Guyot MH, Solau E, et al (2000) Factors influencing bone loss in rheumatoid arthritis: a longitudinal study Clin Exp Rheumatol, 18(6), 683-690 32 Asomaning K, Bertone-Johnson ER, Nasca PC, et al (2006) The association between body mass index and osteoporosis in patients referred for a bone mineral density examination J Womens Health (Larchmt) 15(9), 1028-1034 33 Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA,Tu JV (2000) Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry CMAJ , 162, 1289-94 34 Sedrine WB, Chevallier T, Zegels B, Kvasz A, Micheletti MC, Gelas B, et al (2002) Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometry Gynecol Endocrinol , 16, 245-250 35 Reginster JY, Ben Sedrine W, Viethel P, Micheletti MC, Chevallier T, Audran M (2004) Validation of OSIRIS, a prescreening tool for the identification of women with an increased risk of osteoporosis Gynecol Endocrinol, 18(1), 3-8 36 Koh LK, Sedrine WB, Torralba TP, et al (2001) A simple tool to identify Asian women at increased risk of osteoporosis Osteoporosis Int, 12, 699-705 37 Ninh Th Nhung, Phm Ngc Khi (2005) Nghiờn cu loóng xng ph n 40-65-tui ti mt s vựng sinh thỏi tnh Thỏi bỡnh Tp y dc hc quõn s, 2(30), 53-58 38 V Th Thanh Thy, Trn Th Tụ Chõu, Nguyn Vn Tun , et al (2003) Assessment of low bone mass in Vietnamese: Comparison of QUS calcaneal ultrasonometer and data-derived T-scores J Bone Miner Metab, 21(2), 114-119 39 Mai Cụng Danh, Nguyn Ngc Phng v cng s (2006) Cỏc yu t liờn quan n bnh lý loóng xng ph n kinh sng ti thnh ph H Chớ Minh Tp y hc d phũng, 5(16), 40-45 40 Th Khỏnh H (2007) Mt s yu t liờn quan gõy loóng xng ngi cao tui Tp Nghiờn cu y hc, 5(53), 144-149 41 ng Hng Hoa, on Vn , Hong c Kit (2008) Nghiờn cu mt xng vựng c xng ựi ca ngi bỡnh thng bng phng phỏp o hp th tia X nng lng kộp Lun ỏn tin s Y hc, Hc vin Quõn y, H Ni 42 Kanis J.A, Johnell O, Oden A, et al (2008) FRAX and the assessment of fracture probability in men and women from the UK Osteoporos Int, 19(4), 385-397 43 G Maalouf, Gannagộ-Yared MH, Ezzedine J, Larijani B, et al (2007) Middle East and North Africa consensus on osteoporosi Journal Musculoskelet Neuronal Interact, 7(2), 131-143 44 Ann-Charlotte, Grahn Kronhed (2003) Community-based osteoporosis prevention: Physical activity in relation to bone density, fall prevention, and the 148 effect of training programmes The Vadstena Osteoporosis Prevention Project, Sweden 45 Anoop Kuttikat, Roderick Grant, Kuntal Chakravarty (2004) Management of Osteoporosis Journal Indian Rheumatol Association, 12, 104-118 46 International Osteoporosis Foundation (2008) Beat the Break Know and reduce your osteoporosis risk factors Report annual of International Osteoporosis Foundation, 1-14 47 Lờ Anh Th (2009) Nhng tin b chớnh lnh vc loóng xng v thỏch thc chn la-qun lý iu tr loóng xng Bỏo cỏo khoa hc chuyờn cp nht mi chn oỏn, iu tr loóng xng v bnh xng khp Hi Loóng xng thnh ph H Chớ Minh 48 International Osteoporosis Foundation (2005) Invest in your bones Move it or Lose it How excercise helps to build and maintain strong bones, prevent falls and fractures, and speed rehabilitation, Report annual of International Osteoporosis Foundation 49 International Osteoporosis Foundation (2010) The Breaking Spin, Report of International Osteoporosis Foundation 50 V Th Thu Hin, Shigeru Yamamoto, Lờ Th Bch Mai v cng s (2004) Kho sỏt tỡnh hỡnh loóng xng v cỏc yu t nguy c ph n H Ni nm 2003 Hi ngh loóng xng Bnh lý õm thm, Vin Dinh Dng - Hi Thp Khp Hc Vit Nam - Anlene 51 Nguyn Trung Hũa, Nguyn Vn Tp, o Vn Dng (2015) ỏnh giỏ hiu qu mt s bin phỏp can thip cng ng phũng chng loóng xng ngi t 45 tui tr lờn ti Thnh ph H Chớ Minh Lun ỏn tin s y hc Vin V sinh dch t trung ng 52 V Th Thanh Thy, Trn Ngc n (1998) Nghiờn cu nhng yu t liờn quan n nguy c lỳn t sng loóng xng sau kinh Cụng trỡnh nghiờn cu khoa hc bnh vin Bch Mai, NXB Y hc, II, 64-69 53 Trn Th Tụ Chõu (2002) Nghiờn cu mt s biu hin lõm sng v c xng khp v o mt xng gút bng siờu õm trờn ph n kinh H Ni Lun thc s y hc Trng i Hc Y H Ni 54 Trn Hu Dng, Nguyn Trung Hũa, Trn Nguyn Tr My (2008) Nghiờn cu tỡnh hỡnh loóng xng v cỏc nh hng kinh nguyt, s ph n trờn 45 tui ti qun Gũ Vp, TP H Chớ Minh Sinh lý hc Vit Nam, Thỏng 12(3), 54 - 58 55 Nguyn Th Thanh Hng, Phm Th Minh c v cng s (2009) Peak bone mineral density in Vietnamese women Ach Osteoporos (1- 2), 9-15 56 Nguyn ỡnh Nguyờn (2010).Vai trũ ca cỏc yu t nguy c tiờn oỏn góy xng K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, 35-40 57 Bựi c Vn, Nguyn Vn Tớn, Bựi Vn D (2010) T l loóng xng v cỏc yu t nguy c trờn bnh nhõn 50 tui ti khoa ni BVKKV Cỏi Nc-C Mau Tp Y hc thnh ph H Chớ Minh, 14, 418-423 58 H Phm Thc Lan, Phm Ngc Hoa, Nguyn Vn Tun v cng s (2011) Chn oỏn loóng xng: nh hng ca giỏ tr tham chiu Thi S Y Hc, v 59 Hong Th Bớch, Nguyn Th Ngc Lan (2013) Nghiờn cu yu t nguy c loóng xng v d bỏo nguy c góy xng theo mụ hỡnh Garvan v FRAX ph n t 60 tui tr lờn Lun thc s y hc Trng i Hc Y H Ni 60 Nguyn Th Ngc Phng, Mai Th Cụng Danh (2001) Xỏc nh mi tng quan gia tỡnh trng loóng xng vi tui v BMI ca ph n n o mt xng ti bnh vin T D Bỏo cỏo khoa hc hi ngh thp khp hc ti ASEAN ln th VI, 90-91 61 To Th Minh Thỳy, Nguyn Th Ngc Lan (2012) Nghiờn cu cỏc yu t nguy c ca loóng xng v ỏnh giỏ nguy c góy xng theo mụ hỡnh FRAX n gii 50 tui tr lờn Lun thc s y hc Trng i Hc Y H Ni 62 Sureeat Saengsuda (2013) Prevalence of Osteoporosis and Osteopenia in Thai Female Patients at Rajavithi Hospital Journal of Health Science 22(2) 63 Nguyn Vn Hựng, V Th Thanh Thy, Trn Th Tụ Chõu (2001) Bc u ỏnh giỏ mt xng bng mỏy PIXI (DEXA) Bỏo cỏo khoa hc hi ngh thp khp hc ti ASEAN ln th VI, 54 - 62 64 Th Khỏnh H (2008) Tỡm hiu mt xng, tỡnh trng loóng xng v mt s yu t nh hng ph n sau kinh Tp Nghiờn cu Y hc, 58(5), 75-81 65 Nguyn Vn Tun (2007) Loóng xng chn oỏn, iu tr v phũng nga, Nh xut bn Y hc, H Ni 66 Nguyn Th Hoi Chõu (2002) Kho sỏt mt xng v tỡm hiu nhng yu t liờn quan n bnh loóng xng ca ph n thnh ph H Chớ Minh v mt s tnh Tõy Nam B Tp sinh lý hc VII (2), - 67 Hodson, J and J Marsh (2003) Quantitative ultrasound and risk factor enquiry as predictors of postmenopausal osteoporosis: comparative study in primary care BMJ 326(7401), 1250-1251 68 De Laet C, Kanis JA, Oden A, Johanson H , et al (2005) Body mass index as a predictor of fracture risk: a meta-analysis Osteoporos Int 16(11), 1330-1338 69 NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2001) Osteoporosis prevention, diagnosis, and therapy JAMA, 285(6), 785-95 70 V ỡnh Chớnh (1996) Nghiờn cu loóng xng v mt s yu t liờn quan ti loóng xng ph n sau kinh thuc huyn Cm Bỡnh tnh Hi Hng Lun phú tin s y dc khoa Trng i Hc Y H Ni 71 Pouilles JM, Tremollieres F, Ribot C (1995) Effect of menopause on femoral and vertebral bone loss J Bone Miner Res 10(10), 1531-1536 72 Rodriguez Garcia A, Diaz-Miguel Perez C, Vazquez Diaz M, et al (1999) Bone ultrasound in healthy women and bone mass related factors Med Clin (Barc) 113(8), 285-289 73 Louis V Avioli (1994) Clinicians manual on osteoprosis Science Rheumatology, London 74 Nguyn Th Ngc Lan (2011) Cỏc bnh v xng Bnh hc c xng khp ni khoa Nh xut bn Y hc, 273-286 75 Nguyn Vn Quý (2011) Nghiờn cu mt xng bnh nhõn viờm khp dng thp Lun thc s y hc Trng i Hc Y H Ni 76 Trn Th Minh Hoa (2011) Nghiờn cu mt xng bnh nhõn viờm khp dng thp iu tr ti khoa khp, Bnh vin Bch Mai Tp Y hc thc hnh, 6(767), 34-37 77 Nguyn Vnh Ngc, Cn Xuõn Quý (2012) Nghiờn cu mt xng v yu t liờn quan bnh nhõn viờm khp dng thp Bỏo cỏo khoa hc i hi loóng xng H Ni ln th II, Hi ngh khoa hc ln th IV, 63-70 78 Gough AK, Lilley J, Eyre S, et al (2004) Generalised bone loss in patients with early rheumatoid arthritis Lancet, 344, 23-27 79 Toyoda T, Inokuchi S, Saito S, et al (1996) Bone loss of the radius in rheumatoid arthritis Comparison between 34 patients and 40 controls Acta Orthop Scand, 67(3), 269-273 80 Sinigaglia L, Nervetti A, Mela Q, et al (2000) A multi center cross sectional study on bone mass in Rheumatoid arthritis J Rheumatol, 27, 2582-2589 81 Joffe I, Epstein S (1991) Osteoporosis associated with rheumatoid arthritis: Pathogenesis and management Semin Arthritis Rheum, 20(4), 256-272 82 Shumaker SA, Legault C, Kuller L, et al (2004) Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women's Health Initiative Memory Study JAMA, 291(24), 2947-2958 83 Trn Vn Nam, Nguyn Vn Cụng (2010) BMD v góy xng K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, 34 84 Cadarette SM, Jaglal SB, and Murray TM (1999) Validation of the Simple Calculated Osteoporosis Risk Estimation (SCORE) for Patient Selection for Bone Densitometry OsteoporosInt, 10, 8590 85 Gourlay ML, Miller WC, Richy F, et al (2005) Performance of osteoporosis risk assessment tools in postmenopausal women aged 4564 years Osteoporos Int.;16(8),921-927 86 Brenneman SK, Lacroix AZ, Buist, et al (2003) Evaluation of Decision Rules to Identify Postmenopausal Women for Intervention Relatedto Osteoporosis Dis Manag, 6(3),159-68 87 Von Mỹhlen D , Visby Lunde A, Barrett-Connor E, et al (1999) Evaluation of the simple calculated osteoporosis risk estimation (SCORE) in older Caucasian women: the Rancho Bernardo study.Osteoporos Int, 10 (1), 79-84 88 Cass AR, Shepherd AJ, Carlson CA (2006) Osteoporosis Risk Assessment and Ethnicity: Validation and Comparison of Clinical Risk Stratification Instruments J Gen Intern Med, 21(6), 630635 89 P Mottaghi, M Karimifar, et al (2010) Osteoporosis Screening Tools in Iranian Postmenopausal Women IRCMJ, 12(2), 122-126 PH LC S phiu PHIU IU TRA I THễNG TIN C NHN Mó s nghiờn cu H v tờn Nm sinh: Tui: Ni hin ti: S nh thụn/ph Xó/phngQun/HuynTnh/ thnh ph Dõn tc: Tụn giỏo: Ngh nghip hin ti: A Ngh tnh ti B Ngh hot ng T nm 19 n Tng s nm Ngh nghip trc õy: A Ngh tnh ti B Ngh hot ng T nm 19n nm Tng s nm Trỡnh hc vn: 10 in thoi: II HI BNH Chn oỏn bnh hin ti Bỏc i khỏm bnh ln ny c chn oỏn bnh gỡ ? Bnh c chn oỏn: Tin s iu tr thuc loóng xng T trc n gi bỏc ó bao gi iu tr loóng xng cha? A.Cú B Cha Tin s góy xng: - Bỏc cú b góy xng bao gi khụng? A.Cú B.Khụng - Nu cú thỡ góy xng V trớ no Tui no - Bỏc cú c chn oỏn góy lỳn t sng tht lng bao gi khụng ? A Cú V trớ no B Khụng (Nu hin ti cú chp X quang thỡ cp nht luụn kt qu) Lớ góy: A T nhiờn hoc sau mt chn thng nh (bc ht, ho ) B Tai nn giao thụng hoc sinh hot C Khỏc: Tin s gia ỡnh: - Tronggia ỡnh h hng cú b góy xng d dng khụng? A Cú B Khụng - Góy tui - Lớ góy: A Do tai nn giao thụng B Do tai nn sinh hot C T nhiờn hoc sau chn thng nh (bc ht) D Khỏc (ghi rừ lớ ) - Quan h ca mỡnh vi ngi góy xng: Tin s dựng thuc Bỏc cú dựng thuc Estrogen bao gi khụng ? A Cú B Khụng Nu cú : Tờn thuc .liu .mg/ngy, bao lõu Tin s b bnh viờm khp dng thp Bỏc cú c chn oỏn bnh viờm khp dng thp khụng? A Cú B Khụng Nu cú bao nhiờu nm: B ókinh hay ct bung trng? A Món kinh Nm bao nhiờu tui?: B Ct bung trng Nm bao nhiờu tui?: C Cha kinh III KT QU O MT XNG Chiu cao: cm Cõn nng:kg BMI: Kt qu MX: CX CSTL Region BMD (g/cm2) T-score Region L1 Neck L2 Trock L3 Inter L4 Total Total Wards BMD (g/cm2) T-score IV PHN TNG NGUY C LONG XNG DA VO CH S SCORE Ch s SCORE - Nguy c cao: - Nguy c trung bỡnh: - Nguy c thp: 30-34,38,39,42,43,45-47,49 1-29,35-37,40,41,44,48,50- 15 101 ... sát số SCORE phụ nữ mãn kinh từ 45 tuổi trở lên Đánh giá giá trị dự đoán nguy loãng xương số SCORE so với đo mật độ xương phương pháp DEXA 3 Chương TỔNG QUAN TÀI LIỆU 1.1 Đại cương loãng xương. .. cường cận giáp trạng thứ phát 1.1.1.2 Loãng xương thứ phát Là loại loãng xương tìm thấy nguy n nhân số bệnh số thuốc gây nên 1.2 Loãng xương phụ nữ sau mãn kinh 1.2.1 Vài nét mãn kinh Mãn kinh tình... phương pháp đánh giá tình trạng loãng xương khác 15 1.4 Chỉ số SCORE số mô hình tiên lượng nguy loãng xương 15 1.4.1 Chỉ số ORAI 15 1.4.2 Chỉ số OSIRIS 16 1.4.3 Chỉ số OSTA