臺灣博碩士論文加值系統

本研究目的在於分析代謝症候群患者之飲食型態與心血管疾病指標─高敏感度C-反應蛋白(hs-CRP)的關係。自2008年5月至12月於台北市國泰綜合醫院內分泌新陳代謝科門診進行收案。實驗期間共收了40名醫師診斷為代謝症候群患者，其中12位男性，28位女性，平均年齡為55±12歲。由營養師以24小時飲食回憶法進行飲食調查，並測量血液生化值及體位。結果顯示受試者的血液hs-CRP值與收縮壓及舒張壓均呈顯著的負相關性(r=-0.416及-0.371, p=0.022及0.044)，與各項血液生化數值皆無顯著相關性。但與飲食攝食量相關性分析中顯示hs-CRP與油脂類攝取量 (r=0.405, p=0.009)存在顯著的正相關，其中並與多元不飽和脂肪酸攝食量呈現顯著的正相關性(r=0.344, p=0.03)。由於血液中hs-CRP濃度越高罹患心血管疾病的危險性越高，因此以個案hs-CRP濃度分成低、中、高三組，結果顯示hs-CRP中、高群比低hs-CRP群的病患有較高的體脂率及血液三酸甘油酯(TG)濃度。以身體質量指數(BMI)分組後，發現標準體位的LDL-C比體重過重者高，體重過重者hs-CRP比標準體位者較高。未來研究可以針對飲食組成與hs-CRP的關係作更深入的探討。

The purpose of this study was to assay the relationship between high sensitivity C-reactive protein (hs-CRP) and anthropometric measurements, blood biochemistry and dietary intakes in diabetic patients with metabolic syndrome. From May to December, 2008, 40 outpatients with diagnosed metabolic syndrome, 12 male and 28 females, the average age of 55±12 year were recruited from Cathay General Hospital Endocrine Branch in this study. The dietary investigation included 3-day dietary record and 24-hour diet recall by the dietitian, and the blood biochemistry values, blood pressure, as well as the anthropometric measurements were examined. The results showed that there were inverse correlation between blood hs-CRP values and the systolic pressure, hs-CRP and the diastolic pressure (r = - 0.416 and - 0.371, p=0.022 and 0.044, respectively). However, there is a positive correlation between fat intake and hs-CRP (r=0.405, p=0.009), especially polysaturated fatty acid(r=0.344, p=0.03). If participants were divided into 3 groups based on their hs-CRP levels, i.e. Low: hs-CRP< 1 mg/L, Medium: 1 mg/L<hs-CRP< 3mg/L and High: hs-CRP> 3 mg/L, medium and high groups have higher body fat and the blood triglyceride (TG) concentrations than low hs-CRP group. Based on the BMI, participants with ideal body weight had higher LDL-C and lower hs-CRP than the overweights.

目錄

第一章 前言………………………………………………………………1
第二章 文獻回顧…………………………………………………………3
一、糖尿病的盛行率與死亡率……………………………………3
(一) 國外糖尿病的盛行率與死亡率…………………………3
(二) 國內糖尿病的盛行率與死亡率…………………………4
二、糖尿病與代謝症候群…………………………………………4
(一) 代謝症候盛行率與死亡率………………………………4
(二) 糖尿病與代謝症候群的相關性…………………………5
三、C-反應蛋白質 (CRP) ………………………………………7
(一) 臨床測定CRP的目的……………………………………7
(二) CRP vs hs-CRP………………………………………………7
(三) CRP與疾病的關係…………………………………………8
1. CRP與心血管疾病………………………………………8
2. CRP與糖尿病……………………………………………8
3. CRP與癌症………………………………………………9
4. 其他………………………………………………9
(四) CRP與營養的關係……………………………………………9
第三章 材料與方法……………………………………………………11
一、研究目的……………………………………………………11
二、研究對象……………………………………………………11
三、研究流程……………………………………………………12
四、體位檢查……………………………………………………14
五、血壓測量……………………………………………………15
六、血液生化分析……………………………………………………15
七、飲食分析方法……………………………………………………16
八、統計分析方法……………………………………………………17
第四章 結果……………………………………………………………18
一、受試者基本資料………………………………………………18
(一) 受試者的體位資料及血壓………………………………18
(二) 受試者的血液生化值…………………………………18
(三) 受試者的飲食資料………………………………………19
二、hs-CRP與體位及血壓的關係…………………………………19
(一) 體位測量 (身高、體重、腰圍、臀圍、體脂肪) ……………19
1. hs-CRP濃度與人體測量值的相關性…………………19
2. hs-CRP濃度分級與人體測量值的比較………………20
(二) 血壓………………………………………………………21
1. hs-CRP濃度與血壓的相關性(收縮壓、舒張壓)………21
2. hs-CRP濃度分級與血壓的比較……………………21
三、hs-CRP與血液生化值的關係………………………………21
(一) 血脂肪指標 (總膽固醇、低密度脂蛋白膽固醇、高密度脂蛋白膽固醇、三酸甘油酯) ……………………………………21
1. hs-CRP濃度與血脂肪的相關性…………………21
2. hs-CRP濃度分級與血脂肪的比較………………21
(二) 血糖指標 (飯前血糖、飯後血糖、糖化血色素、胰島素) ………………………………………………………………22
1. hs-CRP濃度與血糖的相關性…………………………22
2. hs-CRP濃度分級與血糖的比較………………………22
四、hs-CRP與飲食的關係…………………………………………23
(一) hs-CRP與熱量及三大營養素攝食的關係………………23
1. hs-CRP濃度與熱量及三大營養素攝食的相關性……23
2. hs-CRP濃度分級與熱量及三大營養素攝食的比較…23
(二) hs-CRP與六大類食物攝食的關係………………………24
1. hs-CRP濃度與六大類食物攝食的相關性……………24
2. hs-CRP濃度分級與六大類食物攝食的比較…………24
五、體位分組與血液生化值及飲食資料之關係……………………25
(一) 體位分組與血液生化值…………………………………25
1. 血脂指標………………………………………………25
2. 血糖指標………………………………………………25
(二) 體位分組與攝食的關係………………………………26
1. 體位分組與熱量及三大營養素攝食的關係…………26
2. 體位分組與熱量及六大類食物攝食的關係…………26
第五章 討論……………………………………………………………40
一、hs-CRP與體位、血壓的比較…………………………………40
二、hs-CRP與血液生化值的比較…………………………………40
三、hs-CRP與飲食的比較…………………………………………40
四、研究限制……………………………………………………41
五、未來研究……………………………………………………41
第六章 結論…………………………………………………………42
參考文獻…………………………………………………………………43

圖表目錄

圖一、收案流程…………………………………………………………12
表一、界定代謝症候群之臨床診斷準則(2007年台灣) ………………13
表二、受試者年齡及體位、血壓測量值…………………………………28
表三、受試者血液生化資料 ……………………………………………29
表四、受試者的飲食資料………………………………………………30
表五、hs-CRP與受試者之年齡、體位測量及血壓的相關性……………31
表六、hs-CRP與受試者血液生化間的相關性…………………………31
表七、hs-CRP與熱量及三大營養素間的相關性………………………32
表八、hs-CRP與飲食間的相關性………………………………………32
表九、以hs-CRP濃度的危險程度分組後的受試者年齡、體位測量及血壓資料……………………………………………………………………33
表十、以hs-CRP濃度的危險程度分組後的受試者血液生化資料……34
十一、以hs-CRP濃度的危險程度分組後的受試者熱量及三大營養素攝取資料……………………………………………………………………35
表十二、以hs-CRP濃度的危險程度分組後的受試者飲食資料………36
表十三、以體位分組後的受試者血液生化資料………………………37
表十四、以體位分組後的受試者熱量及三大營養素攝取資料………38
,表十五、以體位分組後的受試者飲食資料……………………………39



附錄目錄

附錄一：國泰醫院人體試驗委員會通過函…………………………50
附錄二：受試者同意書………………………………………………51
附錄三：24小時飲食回憶紀錄表……………………………………5

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