臺灣博碩士論文加值系統

研究目的：
本研究以非侵入性的動脈硬化篩檢儀測量脈搏傳導速度(pulse wave velocity , PWV)，除探討心臟血管疾病危險因子與脈搏傳導速度相關性外，亦聚集心臟血管疾病危險因子以代謝性症候群及其組成方式探討其與脈搏傳導速度相關性。
研究方法：
本研究為橫斷式研究，以某職場員工為研究對象，研究工具包括生活型態問
卷、體位測量包括身高、體重、腰圍、臀圍，並計算身體質量指數及腰臀比等；血壓包括收縮壓、舒張壓和心跳；血液生化值包括總膽固醇、三酸甘油酯、高密度膽固醇、血糖、高密度C反應蛋白及胰島素等；動脈硬化測量則以非侵入性動脈硬化篩檢儀求得脈搏傳導速度。
研究結果：
在除資料收集不完整及檢測數值異常者後，本研究分析樣本有754人(男性
491人，女性263人)。男女性平均年齡分別為50.8歲及50.3歲，脈搏傳導速度分別為1496.9及1418.7(公分/秒)。在多變項邏輯斯迴歸分析，控制年齡、吸菸、喝酒、疾病史及模式內其餘自變項後，發現男女性的體脂率和收縮壓數值愈高者，其動脈硬化異常(1400公分/秒)的危險性愈高，且有統計上的顯著差異(p<0.05)，以85百分位為界定時，男性的收縮壓、心跳及胰島素和女性的體脂率、收縮壓、心跳、血總膽固醇、血尿酸及血脂蛋白[a]數值愈高者，其動脈硬化異常的危險性則愈高，且有統計上的顯著差異(p<0.05)。在代謝性症候群及其組成方面，男性血壓偏高和符合代謝性症候群任一項者與女性血壓偏高、腰圍偏高和符合代謝性症候群任一、二、三及四項者，動脈硬化異常(1400公分/秒或85百分位)的危險性則愈高。
結論：
對台灣地區成年人來說，體脂率、血壓及代謝性症候群為動脈硬化重要的危險因子，且代謝性症候群及其組成比單一心臟血管疾病危險因子更具有預測動脈硬化的能力，其中又以女性較佳。在代謝性症候群影響動脈硬化的組成變項依次為血壓、血糖及腰圍，然而，未來研究應確認代謝性症候群與動脈硬化間相關及如何更有效預防心臟血管疾病。

Objectives：
The purpose of this study was to evaluate the association between cardiovascular risk factors and arterial stiffness pulse wave velocity (PWV) among adult Taiwanese.Furthermore,
we also examined the association of metabolic syndrome and its components between PWV to explore which component was most
associated with subclinical atherosclerosis among adults.
Methods：
Totally 754（491 men and 263 women）were included in this cross-sectional survey.A structure questionnaire was performed to evaluate their lifestyle and disease history.Anthropometric variables were measured using standard method included body
height, weight, waist and hip circumference. Systolic blood pressure and diastolic blood pressure was measured by standard method.Plasma choleserol,triglyceride,high density lipoprotein
cholesterol (HDL-C) and glucose level were also measured using standard methods . Arterial stiffness were measured using
non-invasive method by Colin VP-1000.
Results：
The mean age of study men and women was 50.8 and 50.3 year , the mean PWV was 1496.9 and 1418.7(cm/sec) for men and women respectively. In multiple logistic regression analyses, after adjusting for the potential confounders,body fat and SBP were significant positively associated with abnormal PWV using the
criteria of 1400cm/sec in both men and women. In further analyses, we used 85th percentile cutpoint as the definition of abnormal PWV , SBP , heart rate(HR) and insulin level in men and body fat , SBP , HR , total cholesterol , uric acid and lipoprotein(a) level in women were significant positively associated with abnormal PWV. In the final analyses, we compared the component of metabolic syndrome to explore which was the most associated with abnormal PWV. Higher BP in men and higher BP and central obesity in women were the most significant components that positively associated with abnormal PWV among adult Tawianese.
Conclusion：
From this study, we found body fat , BP and the componet of metabolic syndrome were the significantly factors associated with abnormal PWV. More interestingly ,the componet of metabolic syndrome especially BP was more significant
associated with abnormal PWV than single cardiovascular factor. The component of metabolic syndrome such as high BP, abnormal glucose level and central obesity were significant associated with abnormal PWV especially among women.
However ,further studies are needed to evaluate the possible mechanism of metabolic syndrome on atherosclerosis which can provide a better prevention on cardiovascular disease.

表目錄……………………………………………………………………IV
圖目錄……………………………………………………………………XI
附錄………………………………………………………………………XII
中文摘要…………………………………………………………………XIII
英文摘要…………………………………………………………………XV
第一章 緒言……………………………………………………………1
第一節、研究背景及重要性………………………………………………1
第二節、研究目的…………………………………………………………3
第二章 文獻探討………………………………………………………4
第一節、動脈硬化致病機轉………………………………………………4
第二節、不同動脈硬化指標之比較………………………………………6
第三節、不同動脈硬化指標與心臟血管疾病之相關………………………8
第四節、心臟血管疾病危險因子與動脈硬化之相關……………………10
第三章 材料與方法………………………………………………………20
第一節、研究設計與研究樣本……………………………………………21
第二節、研究工具…………………………………………………………21
第三節、心臟血管疾病危險因子之定義…………………………………27
第四節、統計分析方法……………………………………………………29
第五節、統計考驗力估計…………………………………………………34
第四章 結果……………………………………………………………35
第一節、 基本人口學描述與分布…………………………………………35
第二節、 個案疾病史及生活型態和身體指數、血壓、血液生化值及脈搏
傳導速度異常百分比……………………………………………38
第三節、 個案身體指數、血壓及血液生化值與脈搏傳導速度之斯皮曼相
關係數……………………………………………………………39
第四節、 個案身體指數、血液動力學因子及血液生化檢測值與脈搏傳導
速度單變項迴歸分析……………………………………………41
第五節、 個案身體指數、血液動力學因子及血液生化檢測值與脈搏傳導
速度多變項迴歸分析……………………………………………44
第六節、 個案身體指數、血液動力學因子及血液生化檢測值與脈搏傳導
速度單變項邏輯斯迴歸分析……………………………………46
第七節、 個案身體指數、血液動力學因子及血液生化檢測值與脈搏傳導
速度多變項邏輯斯迴歸分析……………………………………50
第八節、 不同動脈硬化程度個案身體指數、血液動力學因子及血液生化
檢測值分布與比較………………………………………………52
第九節、 代謝性症候群組成變項異常盛行率……………………………53
第十節、 代謝性症候群組成變項與脈搏傳導速度迴歸分析……………54
第十一節、代謝性症候群組成變項與脈搏傳導速度邏輯斯迴歸分析…55
第五章 討論………………………………………………………………57
第一節、脈搏傳導速度信度與效度………………………………………57
第二節、性別和年齡與脈搏傳導速度相關性探討………………………59
第三節、身體指數與脈搏傳導速度相關性探討…………………………61
第四節、血液動力學因子與脈搏傳導速度相關性探討…………………63
第五節、血液生化檢驗值與脈搏傳導速度相關性探討…………………65
第六節、代謝性症候群組成變項脈搏傳導速度相關性探討……………69
第七節、研究限制…………………………………………………………71
第六章 結論……………………………………………………………72
第七章 參考文獻………………………………………………………74

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