臺灣博碩士論文加值系統

中文摘要
口腔粘膜下纖維化(oral submucous fibrosis，簡稱OSF)為一種長期慢性的口腔粘膜病變，僵硬的粘膜會限制開口的大小，進而造成生活不便。研究指出，OSF為口腔癌癌前病兆之一，且口腔癌死亡率位男性癌症死亡率的第五位。有研究指出營養素缺乏與OSF及口腔癌的發生有關，但相關的證據很少。本研究的主要目的是要了解OSF與口腔癌患者的飲食、生活習慣、營養及免疫狀況，以作為日後臨床治療的參考。本實驗收集台中、彰化等地的OSF與口腔癌患者，參與者需填寫一份飲食生活問卷及24小時飲食回憶記錄，以了解患者之飲食、生活習慣及每日飲食攝取狀況，並收集患者的血液樣本以進行營養狀況及免疫功能分析。結果顯示，OSF及口腔癌患者約有96.4%有嚼食檳榔習慣，92.8%有抽煙習慣，65%有喝酒習慣。患者在熱量、維生素E、B2、B6、C、niacin、鈣及鐵質的攝取均低於每日飲食建議攝取量。營養狀況方面，OSF及口腔癌患者體內維生素E、B1、硒及鋅均有偏低的現象且患者體內維生素B6濃度隨著疾病嚴重度增加而降低。在免疫功能方面，T淋巴球百分比與CD4/CD8比值隨病情嚴重度增加有逐漸下降的趨勢。由以上結果可知，OSF及口腔癌患者有飲食攝取不足、營養不良及免疫反應敏感性降低等情形。若配合飲食行為糾正及營養補充將對這兩種疾病的預防及臨床上的治療有很大的幫助。
關鍵字: 口腔粘膜下纖維化、口腔癌、營養、免疫、飲食習慣

Abstract
Oral submucous fibrosis (OSF), an obscure oral pathosis, is characterized by an abnormal accumulation of oral submucous collagen fibers, epithelium atrophy, and the resultant limitation of mouth opening. Studies indicated that OSF was one of precarcinogenic lesions and mortality of oral cancer is the fifth cause of cancer-related death among men. The reasons for the occurrence of OSF and oral cancer were still unknown. Some studies showed that it is closely related to nutritional deficiency, but it is limited to the related evidence. The purpose of this study is to understand the life style, diet behavior, nutritional assessment and immune function of patients with OSF and oral cancer, and the data colleted could be served as a reference on clinical therapy. Subjects were recruited from Taichung and Changhua. To understand the life style, diet behavior and daily intake of patients with OSF and oral cancer. The subjects got to complete a life a style questionnaire, 24-h diet recall, and the blood samples were collected to examine the nutritional status and immune function. The results show that 96.4% of OSF and oral cancer patients had the habit of chewing betel quid. And, 92.8% of them favored smoking and 65% of them favored drinking. The intake of energy, vitamin E, B2, B6, C, niacin, calcium, and iron for all patients were all lower than daily recommended nutrient allowance (RDNA). The nutritional status showed that the content of vitamin E, B1, selenium and zinc were lower in all patients and vitamin B6 was decreased with the severity of disease. The evaluation of the immune showed that, the relative percentage of T-lymphocyte and the ratio of CD4 and CD8 were also gradually decreased with the severity of disease. In conclusion, patients with OSF and oral cancer had poor diet intake, malnutrition and depressed immune-response sensitivity, etc. Correct diet advice and nutrition supplement could be greatly helpful to prevention and clinical therapy of OSF and oral cancer.
Key words: OSF, oral cancer, nutrition, immune, diet behavior

目錄
頁次
表次………………………………………………………………...I
圖次……………………………………………………………….III
中文摘要………………………………………………………….IV
英文摘要………………………………………………………….VI
壹、前言……………………………………………………………1
貳、文獻整理………………………………………………………2
一.口腔粘膜下纖維化……………………………….………….2
(一)臨床症狀…………………………………….…………...2
(二)盛行率……………………………………………………3
(三)發生原因…………………………………………………4
(四)臨床診斷…………………………………….…………...7
二.口腔癌………………………………………………………..8
(一)臨床症狀…………………………………………………9
(二)發生原因……………………………………….………...9
(三)盛行率及致死率………………………………………..12
(四)口腔癌的治療方式及存活率…………………………..13
三.口腔粘膜下纖維化與口腔癌之關係………………………14
四.檳榔…………………………………………………………15
(一)本省檳榔果實的種類…………………………………..15
(二)檳榔嚼塊的型式………………………………..………15
五.檳榔嚼塊成分與口腔粘膜下纖維化及口腔癌之
關係 ……………………………………………………...17
(一)檳榔果實的化學組成…………………………………..17
(二)檳榔嚼塊成分與口腔粘膜下纖維化發生之關
係 ………………………………………………...20
(三)檳榔嚼塊成分與口腔癌發生之關係…………….…….20
六.不良的生活習慣與口腔粘膜下纖維化及口腔癌
發生的相對危險率………………………………………24
七.嚼食檳榔習慣與口腔粘膜下纖維化及口腔癌發
生的關係…………………………………………………….25
參、研究目的…………………………………………………….26
肆、材料與方法………………………………………………….27
一.實驗材料……………………………………………………27
(一)血液樣本收集…………………………………………..27
(二)生活習慣及飲食內容資料收集………………………..27
(三)病患臨床症狀紀錄……………………………….…….28
二.化學藥品……………………………………………………29
三.儀器設備……………………………………………………34
四.實驗設計……………………………………………………35
五.實驗方法……………………………………………………36
(一)血漿中硫醇含量測定……………………………………36
(二)血漿中總酚類化合物含量測定…………………………36
(三)血漿中脂質過氧化物含量測定…………………………37
(四)血漿中總蛋白質含量測定………………………………37
(五)抗氧化性脂溶性維生素-血漿中retinol及
-tocopherol濃度測定…………………………………...38
(六)水溶性維生素……………………………………………39
1. 血漿中維生素C濃度測定…………………………….39
2. 紅血球中維生素B1含量測定…………………………40
3. 紅血球中維生素B2含量測定…………………………40
4. 血漿中維生素B6含量測定……………………………41
(七)血液生化值分析方法……………………………………44
(八)血漿中微量元素含量分析………………………………51
(九)免疫狀況測定……………………………………………52
六.統計分析……………………………………………………53
伍、結果…………………………………………………………..54
一. 受測者特性…………………………………………………..54
二. 口腔粘膜下纖維化和口腔癌患者之生活飲食行為
調查………………………………………………………...58
三. 口腔粘膜下纖維化和口腔癌患者之每日飲食攝取
狀況………………………………………………………...69
四. 口腔粘膜下纖維化和口腔癌患者體內脂質過氧化
狀況及血液中抗氧化物質含量…………………………...73
五. 口腔粘膜下纖維化和口腔癌患者體內水溶性營養
素含量……………………………………………………...77
六.口腔粘膜下纖維化和口腔癌患者體內微量元素含量……..79
七.口腔粘膜下纖維化和口腔癌患者之血液生化值分析……..79
八.口腔粘膜下纖維化和口腔癌患者之免疫狀況……………82
陸、討論………………………………………………………….86
一、口腔粘膜下纖維化和口腔癌患者之嚼食檳榔、
抽煙及喝酒習慣………………………………………….86
二、口腔粘膜下纖維化和口腔癌患者之飲食攝取………….…88
三、口腔粘膜下纖維化和口腔癌患者之營養狀況…………….90
四、口腔粘膜下纖維化和口腔癌患者之免疫功能………….…95
柒、結論…………………………………………………….……97
捌、參考文獻……………………………………………………99
玖、附錄………………………………………………………….116

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