臺灣博碩士論文加值系統

偏頭痛是全人類共同的疾患。長期罹患偏頭痛的病人，不但生活品質大受影響，嚴重者甚至會出現憂鬱現象。雖然偏頭痛的藥物早已盛行，它的致病機轉仍然未明(Marrif et al, 2010, Tuncel et al, 2008)。目前許多學者認為是神經血管的失調。在生化表現上，鎂離子、血清素、神經肽、氧化壓力等都是受關注的焦點。鎂離子與偏頭痛的關係，已有許多研究報告；氧化壓力升高與偏頭痛的關係，是最近幾年受到矚目的議題(Shukla et al, 2004)。本論文研究，希望能從臺灣偏頭痛的病人上，闡明是否有鎂缺乏的狀態，與氧化壓力的關連性。
實驗內容是以非生理期、非頭痛期、沙鹿、大甲、苗栗三地的頭痛病人共50人，包括無預兆型偏頭痛(MO)35位，預兆型偏頭痛(MA)6位，緊縮型頭痛(TTH)9位。無頭痛的對照組共有41人。兩者進行紅血球鎂濃度與氧化壓力指標丙二醛(MDA)超氧化物歧化酵素(SOD)、過氧化氫酶(catalase)、過氧化氫(H2O2)麸胱甘肽過氧化酵素(GPx)、麸胱甘肽(GSH)、氧化態麸胱甘肽(GSSG)的比較。另外，我們也評估血清中C反應蛋白(hs-CRP)的差異。實驗結果發現：紅血球中鎂濃度與氧化壓力指標，在無預兆型偏頭痛(MO)患者與對照組之間並無差別。如果以女性病人來對照比較，氧化壓力指標中，超氧化物歧化酵素(SOD)出現明顯的差異( p =0.03)；丙二醛(MDA)和過氧化氫酶(catalase)這兩項雖有差異，但未達統計學上意義( p = 0.07,p=0.06)。女性無預兆型偏頭痛(MO)患者這三個項目均低於女性對照組。如果比較四組頭痛類型之中，預兆型偏頭痛(MA)患者有最高的脂質過氧化情形(MA = 0.96±0.21 > 0.85±0.13 (control), 0.80 ±0.09 (TTH), 0.81±0.13(MO)nmol/l/mgHb)，但未達顯著差異標準(sig.= 0.08)；預兆型偏頭痛(MA)過氧化物H2O2濃度也是最高(ANOVA analysis sig.= 0.01＜α)。同時，預兆型偏頭痛(MA)有最好的抗氧化系統超氧化物歧化酵素(SOD) (ANOVA analysis sig.= 0.03)及麸胱甘肽過氧化酵素(GPx)(GPx = 38.20±8.44 > 35.93±6.79 (control),32.67±2.24 (TTH), 34.86± 6.13(MO)nmol/min/ml/mgHb。 若比較所有頭痛患者與對照組，血清中C反應蛋白(hs-CRP)呈現明顯差異(p= 0.04)，頭痛患者的發炎指數較高。
在本研究結果顯示，紅血球鎂濃度，於非頭痛期，頭痛病人與對照組並無差別；頭痛者即使在非頭痛期，體內仍有低度發炎的現象；女性無預兆型偏頭痛(MO)的病人，在非頭痛期，比正常無偏頭痛者，有較高的抗氧化能力超氧化物歧化酵素(SOD)；預兆型偏頭痛(MA)患者，在四群頭痛類型中，表現最高的氧化壓力及最強的抗氧化系統。

Migraine is a very common and very suffering disease of human bodies. Because chronic migraine suffers have poor life quality and are bothered by depression. Even the therapy of migraine is popular since long time ago, its underlying etiology is uncertain till now (Marrif et al,2010,Tuncel et al, 2008). The current opinion about pathophysiology of migraine is neurovascular dysfunction. On the basis of biochemistry, serotonin, neuropeptides, magnesium, and oxidative stress are the foci. The role of magnesium in the pathogenesis of migraine was revealed by many previous studies. The phenomenon of the higher oxidative stress in migraineurs is noticed in recent years (Shukla et al, 2004). In this study, the inter- action between low magnesium state, high oxidative stress and migraine will be evaluated. The relationship between oxidative stress and magnesium can be further demonstrated in Taiwanese.
50 cases of headache (42 women and 8 men)were compared with 41 cases of control group (31 women and 10 men)from 3 regions (Shalu, Dajia, and Miaoli countries).The headache patients were evaluated about the serum and erythrocyte level of magnesium and erythrocyte parameters of oxidative stress during non-menstrual stage, headache-free period. The parameters of oxidative stress include melondialdehyde (MDA), superoxide dismutase (SOD), catalase, H2O2, glutathione peroxide (GPx), reduced glutathione (GSH), oxidized glutathione (GSSG). They comprised of 9 cases of tension-type headache (TTH), 35 cases of migraine without aura (MO), 6 cases of migraine with aura (MA). We also compare the levels of high-sensitive C-reacting protein(hs-CRP), creatinine, calcium between headache patients and control group.
As the results, there is no difference between migraine without aura (MO) and control group in all parameters. If we focus on female population, significant difference is noted in superoxide dismutase (SOD) between migraine without aura (MO) and control group (p = 0.03): MO group has lower level of SOD. There are 2 items (melondialdehyde, catalase) lower in migraine without aura (MO) than control group but no significant difference (p = 0.07, 0.06). Among the four subtypes of headache (control, tension-type headache: TTH, migraine without aura: MO, migraine with aura: MA), MA group has highest level of melondialdehyde (MDA): MA MDA = 0.96±0.21 > 0.85±0.13 (control), 0.80±0.09 (TTH), 0.81± 0.13(MO)nmol/l/mgHb, even it does not reach the significance. It also appeared the highest level of H2O2 (ANOVA analysis significance = 0.01<α). At the same time, MA group also has the best level of superoxide dismutase (SOD) (ANOVA analysis significance = 0.03), and glutathione peroxide without significance (GPx): MA GPx = 38.20±8.44 > 35.93±6.79 (control), 32.67±2.24 (TTH), 34.86±6.13 (MO)nmol/min/ml/mgHb. All headache patients were compared with control group to reveal no significant difference in all parameters except higher high-sensitive C-reacting protein (hs-CRP): the headache patients are under low grade of inflammation.
There is no significant difference of erythrocyte magnesium between MO and control groups as Thomas’s study (Thomas, 2000),also lack of difference in oxidative stress. But the female population demonstrates significantly lower SOD level in MO group than control group. This study also shows low grade of the inflammation state with higher level of hs-CRP in all the three common types of primary headache patients.The MA group reveals the highest oxidative stress and the most powerful anti-oxidative ability in headache-free period.

目錄
學位論文電子檔案上網授權書
論文指導教授推薦書
論文口試委員會審定書
致謝
中文摘要 ……………………………………………………i
英文摘要 ……………………………………………………iv
目錄 …………………………………………………………vii
縮寫表 ………………………………………………………ix
一、 緒論 ………………………………………………1
二、 文獻回顧 …………………………………………3
1. 偏頭痛的介紹與分類 …………………………3
2. 偏頭痛的病生理學 ……………………………6
3. 偏頭痛與鎂的研究 …………………………12
4. 偏頭痛和氧化壓力的關係 ……………………15
5. 鎂與氧化壓力的關聯 ………………………17
三、 材料與方法 ………………………………………18
四、 結果 ………………………………………………37

五、 討論 ………………………………………………55
六、 參考文獻 …………………………………………59
附件一 頭痛症狀與生活失能狀態調查
附件二 人體試驗委員會同意書

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