臺灣博碩士論文加值系統

研究之目的：心率變異（HRV）的減退是心肌梗塞以後患者死亡的一個獨立預報因子。由代謝症候群（MetS）、糖尿病及高敏感度C反應蛋白（hs-CRP）引起的心血管事件是血液透析患者主要的罹病率與死亡率。因此本實驗針對透析病人做心率變異（HRV）與代謝症候群（MetS）（美國國家膽固醇教育計畫成人治療指引第III版分類與國際糖尿病聯盟分類）、糖尿病及高敏感度C反應蛋白（hs-CRP）血清濃度的探討。
材料與方法：我們徵求23名長期血液透析的患者，排除年齡在40歲以下，年齡在75歲以下 ，血液透析的期間在3個月以下，心臟節律異常，脈弱，精神異常，感染活動期和惡性腫瘤活動期。實驗過程中，分別讓每位志願者在血液透析（前透析期間）之前，先休息20分鐘，接著心律大師®腕式生理監視器（ANSWatch ®）測試15分鐘。 測試的時間大约7分鐘。心律大師®腕式生理監視器（ANSWatch ®）的數據被下載到筆記電腦貯存。 另外一個測試在 透析後的30分鐘。透析前的抽血安排於實驗當天血液透析前。
主要成果：針對尿毒症患者代謝症候群（美國國家膽固醇教育計畫成人治療指引第III版分類）、糖尿病與高敏感度C反應蛋白血清濃度高於3等3個風險因素的有無，在透析前實驗結果各別為(14.88±7.94(n=17)v.s.24.5±4.76(n=6) ;13.27±7.48(n=11)v.s.21.17±7.48(n=12); 14.54±8.1(n=13)v.s.21.1±7.48(n=10) ) ，得知有心率變異（HRV）（p<0.05）顯著偏低。依代謝症候群（美國國家膽固醇教育計畫成人治療指引第III版分類）危險因子數區分;（1）危險因子數小於等於2，（2）危險因子數等於3，（3）危險因子數大於等於4。結果危險因子與心率變異（HRV）有負向趨勢。透析前（24.5±4.76(n=6) v.s. 17.11±9.45(n=9) v.s.12.38±5.34(n=8)）與透析後 （21±4.38 (n=6) v.s. 17.44±6.21 (n=9) v.s. 11.5±5.24 (n=8)）。再比較美國國家膽固醇教育計畫成人治療指引第III版分類的代謝症候群、代謝症候群（美國國家膽固醇教育計畫成人治療指引第III版分類）因子數大於等於4、糖尿病與高敏感度C反應蛋白血清濃度高於3等4個風險因素，尿毒症患者代謝症候群（美國國家膽固醇教育計畫成人治療指引第III版分類）危險因子數大於等於4，得知有心率變異（HRV）最低值。
結論:
尿毒症患者代謝症候群（美國國家膽固醇教育計畫成人治療指引第III版分類）、糖尿病與高敏感度C反應蛋白血清濃度高於3等3個風險因素有較低的心率變異（HRV），顯示有自主神經系統的損傷。代謝症候群（美國國家膽固醇教育計畫成人治療指引第III版分類）危險因子的增加伴隨著心率變異（HRV）的下降，亦顯示自主神經系統的損傷的嚴重性。再比較美國國家膽固醇教育計畫成人治療指引第III版分類的代謝症候群、代謝症候群（美國國家膽固醇教育計畫成人治療指引第III版分類）因子數大於等於4、糖尿病與高敏感度C反應蛋白血清濃度高於3等4個風險因素，尿毒症患者代謝症候群（美國國家膽固醇教育計畫成人治療指引第III版分類）危險因子數大於等於4得知有心率變異（HRV）最低值，表有較高的心血管疾病危險性。

Purpose:
A decrease in heart rate variability (HRV) is known to be an independent predictor of mortality after myocardial infarction. Metabolic syndrome (MetS), diabetes mellitus(DM) and high-sensitivity C-reactive protein(hs-CRP) level are known to play important roles in cardiovascular morbidity and mortality. Therefore we investigated the heart rate variability (HRV) in uremic patients with respect to metabolic syndrome (MetS)( Asia definition of NCEP-ATP III and IDF), diabetes mellitus(DM) and high-sensitivity C-reactive protein(hs-CRP) level to find out their correlation with cardiovascular risk in these patients.
Materials and methods:
A cross-sectional cohort study involving 23 patients on maintenance hemodialysis at the Dialysis Unit of The Taipei City Hospital, Yangming Branch. Patients with the following conditions were excluded: <40 years old, >75 years old, hemodialysis history <3 months; presence of cardiac arrhythmia, weak pulses, psychosis, infection or malignance. Each participant took a 20-min rest before the HRV evaluation with ANSWatch ® . The test which last 7 minutes was taken 30 minutes prior to hemodialysis session (pre-dialysis period) and 30 minutes following dialysis session (post-dialysis period). Data in ANSWatch® was downloaded to a notebook computer immediately following the test for review and storage. The blood sample was taken in the same day before hemodialysis.
Results:
Uremic patients with metabolic syndrome（NCEP-ATPIII）, DM and hs-CRP > 3 have lower HRV when compared to uremic patients without those conditions( 14.88±7.94(n=17)v.s.24.5±4.76(n=6); 13.27±7.48(n=11)v.s.21.17±7.48(n=12);14.54±8.1(n=13)v.s.21.1±7.48(n=10) ) in the pre-dialysis period( all P value < 0.05). We separate the metabolic syndrome（NCEP-ATPIII）to 3 group: The number of risk factors and HRV was found to have negative correlation. Risk factors≦2, risk factors=3 and risk factors≧4 (24.5±4.76(n=6)v.s.17.11±9.45(n=9) v.s.12.38±5.34(n=8)) in the pre-dialysis period and (21±4.38 (n=6) v.s. 17.44±6.21 (n=9) v.s. 11.5±5.24 (n=8)) in the post-dialysis period. Patients with risk factors of metabolic syndrome ≧4 has the lowest HRV.
Conclusion:
Uremic patients with metabolic syndrome（NCEP-ATPIII）, DM and hs-CRP > 3 have lower HRV which indicating impairment of autonomic nervous function, especially found in the pre-dialysis period. In the metabolic syndrome（NCEP-ATPIII）group, the increase in the risk factors of metabolic syndrome was correlated with the decrease of HRV, indicating the impairment of autonomic nervous function, especially found in the pre-dialysis period. Patients with risk factors of metabolic syndrome≧4 have the highest risk of cardiovascular disease because they have the lowest HRV.

目錄
中文摘要……………………………………………………… 壹
第一章 前言…………………………………………………… 1
第二章 文獻探討……………………………………………… 2
第三章 材料與方法……………………………………….…… 4
第四章 結果……………………………………………………. 16
第五章 討論………………………………………. …………… 31
第六章 結論……………………………………………………… 35
參考文獻………………………………………………………… 36
附錄
英文摘要………………………………………………………… 42

圖目錄
圖3-1………………………………………………………… 5
圖3-2………………………………………………………… 6
圖3-3………………………………………………………… 7
圖3-4………………………………………………………… 8
圖3-5………………………………………………………… 9
圖3-6………………………………………………………… 9
圖3-7………………………………………………………… 10





表目錄
表3.1……………………………………………………… 15
表4.1……………………………………………………… 17
表4.2……………………………………………………… 19
表4.3……………………………………………………… 21
表4.4……………………………………………………… 22
表4.5……………………………………………………… 25
表4.6……………………………………………………… 26
表4.7……………………………………………………… 27
表4.8……………………………………………………… 29
表4.9……………………………………………………… 30

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