臺灣博碩士論文加值系統

中文摘要
過去使用ion-exchange方式測醣化血色素(HbA1C)，會受到carbamylated Hb之干擾，使得末期腎病變血液透析(HD)的糖尿病病人在HbA1C之應用上受到限制。醣化血色素代表最近2-3個月葡萄糖的平均濃度，血液透析病患因紅血球大量的破壞，造成紅血球生成素(EPO)下降，使得醣化血色素值比正常人來的低。本研究利用affinity HPLC的方法，克服carbamylated之干擾，並探討HbA1C是否可以正確反應出血液透析病人血中glucose level﹐並探討一種新的降血糖藥物Rosiglitazone(AvandiaR)，對於患有腎功能不全及血液透析糖尿病患者的治療效果。
我們收集了303位病患(其中包括69位健康成人、43位糖尿病人、137位糖尿病血液透析病人、54位非糖尿病血液透析病人)探討血清中葡萄糖和醣化血色素間的相關性。發現健康成人和非糖尿病血液透析病患間的葡萄糖濃度沒有差異，但醣化血色素的濃度卻有顯著的差異(p<0.05)。糖尿病血液透析和非糖尿病血液透析病患之間的葡萄糖和醣化血色素濃度都各自呈現有相關性。在非糖尿病血液透析病患(Non-DM HD)中的葡萄糖和醣化血色素濃度二者間的相關性並不顯著（r=0.151,p=ns）；但在糖尿病患與糖尿病血液透析(DM HD)兩組中則是呈現正相關（r=0.617,p<0.05），所以在末期腎病變患者如果要利用HbA1C來推算血糖濃度，則只適用在糖尿病患者身上，其換算公式為Glu=25.1(HbA1C)+3.5。
此外，我們用藥物治療58位糖尿病患者 (28位腎功能正常，30位腎功能不全)，每人每天服用4 mg rosiglitazone藥物治療共6個月。在第2、4、6個月各抽一次血，檢測飯前飯後glucose及HbA1C，結果顯示第2、4、6個月的各項報告均有顯著下降（p<0.05）。因此，我們推論rosiglitazone藥物，可以提高細胞胰島素的敏感性，對於糖尿病患者的治療是有效的。

Abstract
The traditional way by employing the ion-change method to measure glycosylated hemoglobin (HbA1c) can be influenced by carbamylated Hb, which limits the application of HbA1c in diabetic dialysis patients. The HbA1C level usually represents the glucose level within recent 2~3 months.The breakdown of large amount of erythrocytes and decrease of EPO make the glycosylated Hb higher in dialysis patients than normal adults. Therefore, the HbA1c in patients with renal disease represents the glucose levels less than 2-3 months. In this study we have tried to employ the affinity HPLC method to overcome the interference of carbamylated Hb and to clarify whether the HbA1c can repressent the glucose level accurately. In addition, the effect of a new hypoglycemic agent, rosiglitazone, was measured in patients with impaired renal function and end stage renal disease.
Three hundred and three patients (69 normal healthy adults, 43 diabetic patients without dialysis, 137 diabetic dialysis and 54 non-diabetic dialysis patients) were included in the study to examine the relationship between serum glucose and HbA1c. No significant difference in serum glucose levels was found between normal adults and non-diabetic dialysis patients, however, significant difference（p<0.05）was existed in HbA1C levels. Significant difference was also found in serum glucose and HbA1c levels between diabetic patients with and without dialysis. The correlation of glucose and HbA1c levels in non-diabetic dialysis patients was not significant（r=0.151, p=ns）, however, the correlation was significant in diabetic patient groups (with and without dialysis)（r=0.617, p<0.05）. Only in the diabetic patients can the HbA1c level be used to represent the glucose level. The formula is Glucose = 25.1(HbA1C) + 3.5.
Besides, we treated 58 diabetic patients (28 with normal renal function, 30 with impaired renal function) by 4 mg rosiglitazone daily for 6 months. Serum glucose (fasting and postprandial) and HbA1c levels were measured in the second, fourth and sixth months after the treatment. Fasting serum glucose, postprandial serum glucose and HbA1c levels all showed significantly progressive decrease within 6-month treatment period, except that, in diabetic patients, the HbA1C levels in the beginning and the second month showed no significant difference. We conclude that rosiglitazone, which increases cellular insulin sensitivity, can be used effectively in diabetic patients with or without renal impairment.

目 錄
誌謝………………………………………………………………..Ⅰ
目錄………………………………………………………………..Ⅲ
表目錄……………………………………………………………..Ⅴ
圖目錄……………………………………….…………………….Ⅵ
中文摘要…………………………………….…………………….1
英文摘要…………………………………….…………………….3
第一章 緒論………………………………………………. ..5
1.1 研究動機……………………………………………….. .6
1.2 研究目的……………………………………………….. .7
1.3 簡介糖尿病……………………………………….……. .8
1.4 醣化血色素…………………………………………….. .11
1.5 糖尿病與脂肪代謝…………………………………….. .16
第二章 材料與方法……………………………………... …19
2.1 檢體來源及收集時間……………………………… ...20
2.2 生化儀器與檢驗項目分析……………………………..21
2.3 醣化血色素儀器………………………………………..27
2.4 統計分析………………………………………………..28
第三章 結果……………………………………………… …29
3.1 基本資料分析……………………………………………30
3.2 檢驗結果分析……………………………………………31
第四章 討論…………………………………………… ……40
4.1 糖尿病和醣化血色素間的關係探討……………………41
4.2 糖尿病與高血脂關係的探討……………………… ……42
4.3 Avandia藥物與糖尿病的關係探討………………… …...43
第五章 結論……………………………………………… …55
參考資料…………………………………………………………..57

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