臺灣博碩士論文加值系統

心臟血管疾病泛指身體不同部位的血管疾病，在台灣地區其相關疾病之總死亡率超越癌症。週邊血管疾病是心臟血管疾病其中之一員，一般認為它與其他心臟血管疾病有共同的危險因子。本研究探討上下肢血壓比(以下簡稱ABI)以及脈搏波傳導速度(以下簡稱PWV)的檢查結果，與傳統心臟血管疾病危險因子之相關性。
本研究目的，希望針對臨床上無週邊血管疾病症狀的受檢者: (1) 籍ABI, PWV 測量，了解週邊血管疾病的盛行率、(2) 了解傳統心臟血管疾病危險因子與ABI, PWV 測量之相關性、(3) 探討ABI、PWV與其他心臟血管疾病及Framingham risk score之相關性、(4) 探討ABI, PWV的測量，對於諸如代謝症候群、冠狀動脈疾病、腎功能異常、頸動脈硬化等問題，提供預測的可能性。
研究方法: 自2008年2月至2013年4月間，從中部某醫學中心之健檢中心收集ABI及PWV檢查結果共2085次，研究這結果與人口學、一般健檢實驗室結果、心臟電腦斷層、頸動脈超音波以及顱內超音波之間的相關性。
研究結果: (1) 從卡方檢定結果及無母數分析結果得知週邊血管疾病在各種心臟血管相關疾病之分佈情形，與其他文獻之發現差別不大、(2)從分析中亦發現大部份心臟血管相關危險因子與PWV具有相關性，但與ABI的相關性較少、(3)以PWV 1400cm/s 作為參考值，則異常之PWV對於冠心症、代謝症候群、頸動脈內膜增厚、頸動脈輕度阻塞的勝算比分別為: 2.49, 2.97, 3.55 及4.11；而對於費明罕危險分數十年達10%之勝算比，分別是男性 5.2、女性 14.0，(4) 以 PWV推估其他心臟血管疾病，接受器操作特性曲線下面積分別為: 冠心症0.689、代謝症候群0.676、頸動脈內膜增厚、頸動脈輕度阻塞0.699，而ABI則為 0.613, 0.601, 0.609 及 0.577。

Cardiovascular disease is a major and important board spectrum disease in Taiwan, that its total death rate exceed the one of cancer in recent years. Peripheral vascular disease is one kind of cardiovascular disease, which share the same risk factors generally.
For those healthy persons who do not have clinical evidence of peripheral aterial disease, we are interested in (1) To understand the disease prevalence by measuring ankle-brachial index and pulse wave velocity (2) The relationship between these markers and risk factors of cardiovascular disease (3) The relationship between different cardiovascular outcomes and Framingham risk scoring system, and (4) The predictive value of these markers to other cardiovascular outcomes.
Method: This is a cross-sectional study. From February 2008 to April 2013, we collected totally 2085 of ABI and PWV measurements at health check-up center of one Medical Center in central Taiwan. We studied the relationships between ABI, PWV and other parameters such as: demographic datas, general laboratories profile, results of MDCT, carotid songraphy and transcranial doppler..
We concluded that (1) In our study, the prevalence of peripheral artery disease related to other cardiovascular diseases is similar to previous reported, and has been summarized in the tables of Chi-square test and Mann-Whitney U test in this report, (2) Most of the traditional cardiovascular risk factors were significantly related to PWV, but not to ABI, (3) When PWV ≥ 1400cm/s, odds ratio for coronary artery disease, metabolic syndrome, carotid intima thickening, and mild carotid stenosis were 2.49, 2.97, 3.55 and 4.11 respectivetly. For a 10% 10-year risk of Framingham score, the odds ratio of PWV ≥1400 cm/s were 5.2 for men and 14.0 for women, and (4) The area under the curve under the receiver operator curve were 0.689 for coronary artery disease, 0.676 for metabolic syndrome, 0.699 for carotid intima thickening and mild stenosis with different PWV cut-off value, and corresponding 0.601, 0.613, 0.609 and 0.577 with ABI.

中文摘要 ..…………………………………………………..…………………I
英文摘要 .………………………………………………..……………………II
致謝詞 …………………………………………..……………………………III
目錄 .…………………………………………………….……………………IV
表目錄 ..…………………………………………………..…….……………VII
圖目錄 .…………………………………………………………….…………IX
第一章 緒論..……………………………………………….……….…………1
1.1 研究背景與動機..……………………………….……….…………1
1.1.1 研究背景.………………………………….…….……………1
1.1.2 研究動機.………………………………….……….…………1
1.2 研究目的……………………………………………………………2
1.3 研究範圍與流程..…………………………………..………………2
1.3.1研究範圍……………………………………….…….…………2
1.3.2 研究流程.………………………………….…..…….…………2
第二章 文獻回顧及探討………………………………………………………3
2.1 週邊血管疾病之定義及流行病學.………….…….…….……………3
2.2 週邊血管疾病之危險因子.………………….…….…….……………4
2.2.1 抽煙與週邊血管疾病.………………….…..…….……………4
2.2.2 糖尿病與週邊血管疾病.……………………..…..……………4
2.2.3 高血壓與週邊血管疾病.……………………...….……………5
2.2.4 高血脂症與週邊血管疾病.…………………...….……………5
2.2 5 肥胖與週邊血管疾病.………………………...….……………6
2.2.6 慢性腎臟病與週邊血管疾病.……………..…….………….…6
2.3 下肢血壓比以及脈搏波傳導速度之臨床應用.……..….……………6
2.3.1上下肢血壓比.…………………………….……….……………7
2.3.2脈搏波傳導速度.……………………….…….....………………8
2.4週邊血管疾病與心臟血管疾病之關係..………….…………...………9
2.5以週邊血管疾病作為預測因子...………………………….….………9
第三章 研究方法.……………………………………...…….……….………10
3.1 研究資料..…………………………………….………………...……10
3.2 研究設計………………………………………..……………………10
3.3 研究使用之變數定義……………………….…………….…………11
3.4研究項目與統計方法………….……………….………….…………17
第四章 研究結果與分析.…………………………………………….………18
4.1 ABI及PWV測量結果.…….…………………..……………………18
4.2 ABI與各類別變項之卡方檢定.………………….……….…………20
4.3 ABI 與各類別變項之組間無母數Mann-Whitney U檢定…………24
4.4 PWV與各類別變項之卡方檢定…………………….………………29
4.5 PWV與各類別變項之組間無母數Mann-Whitney U 檢定………...32
4.6 ABI與各連續變項之Mann-Whitney U 檢定…….……...…………38
4.7 PWV與各連續變項之Mann-WhitneyU 檢定……….……..………38
4.8 ABI與各連續變項之簡單線性迴歸分析
(Simple liner regression)……………………………………….……43
4.9 PWV與各連續變項之簡單線性迴歸分析
(Simple liner regression)…………………………………….………44
4.10 ABI 與PWV之羅吉斯迴歸分析(Logistic regression)……………46
4.11以ABI以及PWV作為其他血管疾病診斷之勝算比研究….……52
4.12 ABI以及脈搏波傳導速度(PWV)與傳統心血管危險分數(Framingham 10-year risk score)之相關研究………………………56
4.12.1 Framinghan risk score與 ABI及PWV之相關.…………….56
4.12.2 Framinghan risk score本研究樣本男、女性差別….……..…56
4.12.3以ABI分組探討Framinghan risk score之平均值差異…… 57
4.12.4以PWV分組探討Framinghan risk score之平均值差異....…58
4.13以ABI以及PWV預測其他心血管疾病…………….….…………63
4.13.1 ABI以及PWV預測代謝症候群………..…………..………63
4.13.2 ABI以及PWV預測冠狀動脈疾病………..………...………65
4.13.3 ABI以及PWV預測頸動脈出現內膜增厚………..…...……66
4.13.4 ABI以及PWV預測頸動脈出現輕度阻塞輕度阻塞………68
4.13.5 ABI以及PWV預測頸動脈出現中度阻塞輕度阻塞...……69
4.13.6 ABI以及PWV預測腎功能異常……………………….……70
第五章 討論……………………..……………………………………………72
5.1 研究結果討論………………….…………….………………………72
5.2 研究限制…………………………….………………….……………77
參考文獻………………………………………………………………………79

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