臺灣博碩士論文加值系統

體內微量元素的恆定與氧化壓力程度攸關糖尿病的致病與控制。本研究分別探討微量元素與氧化壓力相關生物指標在第一型糖尿病患體液中之分析及其間相關性以及血液透析對第二型糖尿病患體液中微量元素的影響。
第一部分：腎臟衰竭是糖尿病常見的併發症之一，而血液透析患者容易發生微量元素不平衡的情況，因此本研究主要探討糖尿病透析患者於透析前和透析後血清銅、鋅、鎂的變化。本研究利用火焰原子吸收光譜儀測定透析前和透析後的血清銅、鋅、鎂的濃度。研究結果顯示在糖尿病與非糖尿病透析患者在透析前後的血清銅、鋅、鎂有顯著變化（p<0.001），而且所有患者不論透析前或透析後，血清鋅都明顯低於對照組（p<0.001）。血清銅只在非糖尿病透析患者透析前比對照組低（p<0.01），其他則無明顯差異。從分析結果可知糖尿病性腎衰竭施行血液透析治療並不會顯著影響血清中銅、鋅、鎂的分佈情形。此外，透析患者血清中銅、鋅與鎂在透析後則較接近對照組的濃度值，因此血液透析治療應有助於腎衰竭患者血清中微量元素的恆定。
第二部分：本研究檢測第一型糖尿病患血清中銅、鋅、超氧化歧化酶（SOD）活性、血清與尿液的丙二醛（MDA）和尿液8-氫氧2''-去氧鳥糞核糖（8-OHdG）並探討血糖控制對這些生化參數的影響。研究結果顯示血糖控制不良（HbA1c≧9.0%）的患者血清銅、血清MDA、尿液MDA與8-OHdG均顯著高於血糖控制良好的患者（p<0.05），且血清中銅、尿液MDA與8-OHdG與HbA1c間呈顯著相關（p<0.05）。因此第一型糖尿病患嚴格控制血糖應可降低體內氧化壓力的程度。

The homoeostasis of trace elements and status of oxidative stress influence the pathogenesis and control of diabetes mellitus. In this study, trace elements and oxidative stress-related biomarkers in body fluids of type 1 diabetic patients were evaluated. In addition, we also investigated the effects of hemodialysis on the concentrations of trace elements in serum of patients with type 2 diabetes.
Part I: Renal failure is a common complication for patients with diabetes. Those patients under hemodialysis therapy are at risk of trace element imbalance. The aim of this study was to explore the possible changes of serum copper, zinc and magnesium in patients with type-2 diabetes or in non-diabetic patients. All of the patients were under hemodialysis therapy. Healthy subjects with matched age and sex were selected as control group. Serum copper, zinc and magnesium were determined using flame atomic absorption spectrometry. Significant differences of serum magnesium and zinc levels before and after hemodialysis were observed in patients with or without diabetes mellitus (p < 0.001). Zinc level of all patients was significant lower than the controls (p < 0.01). Significant low copper level was found only in non-diabetic patients after hemodialysis when compared to the control subjects. In addition, normalization of serum copper, zinc and magnesium in patients after hemodialysis therapy was observed. We may suggest that treatment by hemodialysis is beneficial for the homoeostasis of trace elements in renal failure patients.
Part II: This study aimed to analyze some biochemical parameters in blood or urine of patients with type-1 diabetes, including serum copper and zinc, serum superoxide dismutase(SOD) activity, serum malondialdehyde (MDA), and urinary MDA and 8-hydroxy 2''-deoxyguanosine (8-OHdG) and to evaluate the effects of HbA1c level on these parameters. The results indicated that markedly elevated levels of serum copper, serum MDA, urinary MDA and 8-OHdG were observed in the group of HbA1c greater than 9.0% (p < 0.05). Furthermore, a positive correlation between serum copper, urinary MDA, 8-OHdG and HbA1c level was found. These findings suggest that strict glycemic control may reduce oxidative stress in patients with type-1 diabetes.

中文摘要……………………………………………………………………… 4
英文摘要……………………………………………………………… 5
致謝…………………………………………………………………… 6
第一部分：第二型糖尿病洗腎患者於洗腎前和洗腎後銅、鋅、鎂的變化
第一章 前言
1.1 研究背景………………………………………………………… 7
1.2 研究目的…………………………………………………………13
第二章 實驗材料及方法
2.1 實驗材料…………………………………………………………14
2.2 實驗藥品…………………………………………………………14
2.3 實驗器材之清洗方法……………………………………………15
2.4 實驗儀器…………………………………………………………15
2.5 分析步驟…………………………………………………………15
第三章 結果與討論
3.1 微量元素分析的準確度及精密度………………………………16
3.2 糖尿病患血液透析前後微量元素之變化………………………17
3.2.1 血清銅濃度在血液透析前後之變化…………………………19
3.2.2 血清鋅濃度在血液透析前後之變化…………………………22
3.2.3 血清鎂濃度在血液透析前後之變化…………………………25
第四章 結論………………………………………………………… 27
第五章 參考文獻…………………………………………………… 28

第二部分：第一型糖尿病患血液與尿液中銅、鋅、氧化壓力狀態之檢驗及其間之相關性分析
第一章 前言
1.1 研究背景…………………………………………………………32
1.2 研究目的…………………………………………………………37
第二章 實驗材料及方法
2.1 實驗材料…………………………………………………………38
2.2 銅、鋅分析………………………………………………………38
2.3 Superoxide dismutase（SOD）活性分析…………………… 39
2.4 Malondialdehyde（MDA）分析…………………………………39
2.5 8-hydroxy 2''-deoxyguanosine（8-OHdG）分析…………… 41
第三章 結果與討論
3.1 分析準確度及精密度之確認……………………………………42
3.2 分析結果依血糖控制指標分組之差異…………………………44
3.3 所有分析值之間的相關性………………………………………44
3.4 血清中微量元素銅、鋅、氧化與抗氧化標記等之間相關性…48
3.5 血清中抗氧化指標的探討………………………………………51
3.6 氧化標記的探討…………………………………………………54
第四章 結論………………………………………………………… 60
第五章 參考文獻…………………………………………………… 61

第一部份 第五章 參考文獻

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第二部份 第五章 參考文獻

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