臺灣博碩士論文加值系統

背景
心臟冠狀動脈側枝循環(Collateral Circulation)在急性心肌梗塞時可提供梗塞區血流,減少心肌缺氧及梗塞範圍,長期而言可改善心臟功能,減少心室瘤(Aneurysm)形成及延長生命.血管內皮生長因子(VEGF)及轉形生長因子(TGF-β)對於血管新生扮演一定的角色.一些研究探討生長因子濃度影響側枝循環的形成但缺少局部濃度的證據.我們探討是否心臟內(冠狀動脈竇,Coronary Sinus-CS)及右心房(Right Atrium-RA)內血管內皮生長因子(VEGF)及轉形生長因子(TGF-β1)濃度與側枝循環有否相關.
方法
從2000年三月到2001年十月,51位接受心導管病人評估進行此研究.47位可收集到完整資料以供研究. 完整病史,導管資料分別記錄於不同時期且檢視者彼此不知相互資料.病人接受心導管前以Goodale-Lubin導管收集冠狀動脈竇(CS)及右心房(RA)內血液以供分析
結果
無側枝循環者有30位(63%),一度側枝循環者有5位(11%),二度側枝循環者有7位(15%),三度側枝循環者有5位(11%).所有有冠狀動脈側枝循環的病人其血管狹窄程度皆大於70%.30位無冠狀動脈側枝循的病人中,10(21%)位血管狹窄程度小於50%, 11(23%)位血管狹窄程度介於50-70%, 9(19%)位血管狹窄程度大於或等於70%, 冠狀動脈側枝循環較發達的病人(二度及三度)其冠狀動脈竇(CS)內血管內皮生長因子(VEGF)濃度較高(P = 0.044).將有無冠狀動脈完全阻塞病人血中生長因子濃度做比較，發現冠狀動脈竇內(CS)血管內皮生長因子(VEGF)濃度於完全阻塞病人身上明顯大於無完全阻塞病人(P=0.037). TGF-β1濃度在無側枝循環者比一度側枝循環者(P = 0.049)及三度側枝循環者(P = 0.018)低.糖尿病病人有疾病的血管數有較高的傾向，側枝循環數目較無糖尿病病人低且生長因子濃度較無糖尿病病人低，但無達到統計學上的差異
結論
冠狀動脈竇內(CS)血管內皮生長因子(VEGF)與轉形生長因子(TGF-β1)濃度與側枝循環之程度有相關.糖尿病病人冠狀動脈竇(CS)及右心房(RA)之血管內皮生長因子(VEGF)與轉形生長因子(TGF-β1)比無糖尿病病人有較低的傾向.這可能和糖尿病病人側枝循環較無糖尿病病人差有關.

Background
In acute myocardial infarction, collateral circulation can contribute significant amount of blood flow, decrease infarct size, improve left ventricular function, reduce the likelihood of left ventricular aneurysm formation, and improve survival. Vascular endothelial growth factor (VEGF) and transforming growth factor beta (TGF-β1) are believed to play important roles in vivo. Whether the focal or systemic growth factors concentration influences the formation of collateral vessels should be elucidated. For this purpose we test the hypothesis that growth factors in the coronary sinus (CS) and right atrium (RA) concentration are related to collateral circulation formation.
Method
From March 2000 to October 2001 51 patients scheduled for diagnostic coronary artery angiography were evaluated for possible recruitment into this study at the Kaohsiung Medical University Hospital. 6F Goodale-Lubin catheter for blood sampling was inserted into the coronary sinus and right atrium. Completed data was gathered with 47 patients. The reviewers didn’t know the growth factors data when interpreting the coronary anatomy and collateral circulation grade.
Result
Thirty (63%) of the patients had no collaterals. Five (11%) had grade 1 collaterals, seven (15%) had grade 2 collaterals and five (11%) had grade 3 collaterals. All of the patients with angiographic evidence of collateral filling have more than 70% coronary artery stenosis. In 30 no collaterals patients, ten (21%) of them has coronary artery stenosis less than 50%, eleven (23%) between 50 and 70%, nine (19%) more than 70%. Patients with good collaterals (grade 3 and 2) have higher VEGF concentrations in CS (P = 0.044). Compared with non-total occlusion, patients with total coronary artery occlusion have higher VEGF concentrations in CS (P = 0.037). TGF-β1 in the coronary sinus of grade 0 is lower than those in grade 1 (P= 0.049) and grade 3 (P= 0.018). There is a trend of higher diseased vessels in diabetic patients. The diabetics have few collaterals and lower growth factor concentrations but not meet statistical significance.
Conclusion
There is a relationship between collateral circulation grade and VEGF/TGF-β1 concentrations. The diabetics have lower VEGF and TGF-β1 concentrations in CS and RA, which may be correlated with poor collateral circulation formation.

目次
1. 碩士論文電子檔案上網授權書
P 1
2. 口試通過証明 P 2
3. 中文摘要 P 3
4. 英文摘要 P 4
5. 序言 P 5
6. 前言 P 7
7. 方法與材料 P 9
8. 結果 P 13
9. 討論 P 16
10. 結論 P 21
11. 參考文獻 P 22
12. 附錄 (表及圖) P 27

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