臺灣博碩士論文加值系統

血清白蛋白（serum albumin）常用來評估一個人的營養狀態，低白蛋白血症（hypoalbuminemia）出現於營養不良，或罹患腎臟病、肝病、肝硬化、肝癌患者。本研究以糖尿病患為模式，探討糖尿病病患白蛋白尿是否影響血清白蛋白，進一步探討血清白蛋白是否適用於糖尿病患之營養評估，並探討其他可能影響糖尿病病患血清白蛋白減少或變化的因子，如：尿液中白蛋白與尿液中肌酸酐比值UAR（urine albumin/urine creatinine ratio）、糖化血紅素(A1C)、身高、體重、年齡、身體質量指數(BMI)、肌酸酐(Creatinine)、麩胺酸丙酮酸轉胺西每（Glutamate pyruvate transaminase；GPT）等因子。
收案期間共收集苗栗市某地區醫院，定期追蹤之糖尿病患參與本研究，排除肝功能異常者，排除未定期追蹤病患，故納入本研究分析的受試者共218位，男性102位（46.8﹪），女性116（53.2﹪）。
研究結果顯示，尿液中白蛋白與尿液中肌酸酐比值UAR，與血清白蛋白間具有顯著的差異（p＜0.05）。其他分析因子：糖化血紅素、身高、體重、年齡、身體質量指數、肌酸酐、麩胺酸丙酮酸轉胺西每，則無顯著差異。
糖尿病患因血糖控制不佳，引發腎病變，腎病變導致白蛋白自尿中排出，而使血清中白蛋白降低，血清中白蛋白降低與UAR有顯著差異，且研究發現UAR大於300μg/dl時，不適合用血清白蛋白做為營養評估指標。

Serum albumin is commonly used to estimate a person’s nutritive condition and hypoalbuminemia appears on patients with nutrition deficiency, kidney disease, liver disease, liver cirrhosis or liver cancer. In this study, diabetic patients were investigated to explore the possibility whether serum albumin was affected by albumin urine, furthermore, to discuss the suitability of using serum albumin to evaluate the nutritive condition of diabetic patients, and to discuss other possible factors which may cause the decrease or variations of serum albumin in diabetic patients, such as UAR (urine albumin/urine creatinine ratio), A1C, height, body weight, age, BMI, Creatinine, GPT (Glutamate pyruvate transaminase) etc.
During the study period, data of periodically monitoring diabetic patients from one district hospital in Miaoli city were collected. Patients with abnormal liver functions and patients who have not been periodically monitored were excluded. Total 218 patients, 102 males (46.8%) and 116 females (53.2%), were enrolled for evaluation.
The result showed that there were statistically significant differences between urine albumin/urine creatinine ratio and serum albumin (p<0.05). Other factors, such as A1C, height, body weight, age, BMI, Creatinine and GPT (Glutamate pyruvate transaminase), however, showed no significant difference.
In diabetic patients, poor control on blood sugar results in kidney pathological change which increases urine albumin excretion, and relatively decreases serum albumin.

目錄
致謝…………………………………………………………Ι
目錄…………………………………………………………Ⅲ
表目錄………………………………………………………Ⅴ
圖目錄………………………………………………………Ⅵ
中文摘要……………………………………………………1
英文摘要……………………………………………………3
第一章 前言………………………………………………5
1-1研究動機…………………………………………5
1-2研究目的…………………………………………6
1-3簡介糖尿病………………………………………6
1-4糖尿病的定義……………………………………7
1-5糖尿病的分類……………………………………9
1-6糖尿病流行病學…………………………………11
1-7糖尿病併發症風險………………………………12
1-8糖尿病併發症……………………………………13
第二章 材料與方法…………………………………18
2-1研究對象…………………………………………18
2-2研究設計…………………………………………18
2-3統計分析…………………………………………19
2-4研究進行時間..…………………………………19
2-5生化儀器與檢驗項目分析………………………19
第三章 結果……………………………………………23
3.1基本資料分析……………………………………23
3.2研究結果分析……………………………………23
第四章 討論……………………………………………37
4-1研究分析方法……………………………………37
4-2糖尿病與微量白蛋白尿…………………………39
4-3糖尿病與血清白蛋白……………………………41
4-4糖尿病與糖化血色素……………………………42
4-5糖尿病與身體值量指數…………………………44
4-6糖尿病與肌酸酐…………………………………45
第五章 結論……………………………………………46
參考資料…………………………………………………48
【附錄】研究資料收集及分析資料……………………55

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