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研究生:杜皖媺
論文名稱:黑芝麻粉對長期血液透析病患腎性貧血之影響
論文名稱(外文):The Effect of Black Sesame Meal on Renal Anemia of Long Term Hemodialysis Patients
指導教授:溫惠美博士、陳景川博
學位類別:碩士
校院名稱:國立屏東科技大學
系所名稱:食品科學系
學門:農業科學學門
學類:食品科學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:117
中文關鍵詞:腎性貧血血液透析重組人類紅血球生成素生體利用率
外文關鍵詞:Renal anemiaHemodialysis(recombinant human rythropoietinr-HuEPO)Bioavailability
相關次數:
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腎性貧血是長期血液透析病患常見的現象,但許多補充鐵劑的治療方式,幾乎都有其缺點或副作用, 因此本研究徵求特定病患11名,針對個人之鐵質數據,分成鐵缺乏組,過量組及正常組等3組,利用天然食物-黑芝麻粉,對病患進行鐵質補充,並評估供應黑芝麻粉對長期血液透析病患之血液生化鐵質狀況,r-HuEPO需要量及貧血症狀的相關性等方面之影響。
結果顯示:病患雖有良好的熱量及鐵質攝取,但是營養不良與鐵質狀況缺乏等情形仍存在透析病患中,但供應黑芝麻粉後,有顯著性改善。不論實驗組或對照組,黑芝麻粉對供應3個月、供應6個月或停止供應後之鐵質狀況的血液生化指標之相關性,均有顯著性差異(p<0.05)。另外,亦發現黑芝麻粉供應期間,對三組病患之鐵的生體利用率,有正相關性,只是需時較長。
病患鐵蛋白異常升高,究因於輸血及泌尿道發炎之影響,但供應黑芝麻粉後,發現鐵過量組之鐵蛋白確有下降的趨勢,卻又不影響HB 、Hct的降低,證明黑芝麻粉確能促進血清鐵蛋白正常。此外,黑芝麻可有效的改善腎性貧血,可減少r-HuEPO之施打量,且有顯著性差異(p<0.05)。透析病患在貧血症狀方面,因輸血獲得非常大的改善,且供應黑芝麻粉後可持續其良好狀況,貧血症狀之改善應與黑芝麻粉有正相關(p<0.05)。
Renal anemia is easy to happen on the Long Term hemodialysis patients. But, most of the iron-supplement treatments have
their own disadvantages or side effects. Therefore, this study asked for 11 certain patients and focused on their individual blood-iron to classify into 3 groups, which were iron-deficiency, iron-overloading, and iron-normal group. Meanwhile, using natural source of black sesame meal on these patients as the iron supplement to evaluate its effects on the patients blood biochemical and iron-status changes, the requirement of r-HuEPO, and the correlation with anemia symptom.
The results revealed even patients had the good calory and iron intake, malnutrition and iron-deficiency symptoms were still existed on the hemodialysis patients, But, it was significantly improved after supplying the black sesame meal. No matter on the experiment groups or the control group, their blood biochemical indexes had the significant good correlation with black sesame meal treatment, which either supplied after 3 months,6 months, or stopped supplying after 3months(p<0.05)Besides, iron bioavailability also had the good correlation with black sesame meal on the three groups, but which need longer periods to be occurred
The unusual increment of serum ferritin happened on some patients may be due to their blood transfusion and urinary tract infection. But, supplying black sesame meal instead, the decrement tendency of serum ferritin, which was not shown on the hemoglobin or hematocrit, seemed to be able to prove the effect of black sesame meal on keeping the serum ferritin normal. Black sesame meal can also improve the renal anemia, and reduce the r-HuEPO dose requirement significantly(p<0.05). As to the anemia symptom, dialysis patients got improved greatly from the transfusion, and still stayed in good condition after supplying the black sesame meal.
目錄中文摘要----------------------------------------------Ⅰ英文摘要----------------------------------------------Ⅲ誌謝--------------------------------------------------Ⅴ目錄--------------------------------------------------Ⅵ圖索引-----------------------------------------------ⅩⅡ表索引-----------------------------------------------ⅩⅢ壹、前言------------------------------------------------1貳、文獻回顧--------------------------------------------3一、腎性貧血--------------------------------------------3(一)、腎性貧血原因-------------------------------------4(二)、腎性貧血之臨床特性-------------------------------4(三)、腎性貧血症狀-------------------------------------5(四)、腎性貧血的診斷-----------------------------------5(五)、腎性貧血的治療-----------------------------------7二、紅血球生成素(erythropoietin簡稱EPO)----------------9(一)、r-HuEPO(recombination human erythropoietin)------10三、體內鐵質狀況與腎性貧血之關係-----------------------11(一)、鐵蛋白(Serum ferritin)--------------------------11(二)、鐵質狀況(Iron status)---------------------------11(三)、鐵劑藥物與紅血球生成素的使用方法----------------12(四)、鐵缺乏分類--------------------------------------12(五)、鐵缺乏與鐵過量之合併症與鐵劑之使用-------------13(六)、鐵值需要量--------------------------------------14四、飲食中鐵之攝取與腎性貧血之關係---------------------15(一)、台灣地區鐵攝取量與缺鐵率的關係------------------15(二)、鐵的飲食來源------------------------------------15(三)鐵質生體利用率-----------------------------------16(四)、鐵的正常生理------------------------------------19(五)、鐵的代謝機制------------------------------------20(六)、鐵平衡------------------------------------------24四、芝麻簡介-------------------------------------------27(一)、芝麻的功能-------------------------------------29五、血液透析成本--------------------------------------33參、 實驗設計-----------------------------------------34一、 研究目的------------------------------------------34二、研究架構-------------------------------------------35(一)、研究對象---------------------------------------36(二)、 研究進行時間-----------------------------------36(三)、基本資料填寫------------------------------------36(四)、血液生化抽血檢驗,與鐵值需要量,Kt/V計算---------37(五)、24小時飲食回憶熱量鐵量評估表-------------------37(六)、記錄r-HuEPO使用量------------------------------37(七)、記錄供應前與供應後2次之貧血症狀之相關分析------38(八)、供應對象之分組---------------------------------391、鐵缺乏組(試驗組1)-------------------------------392、鐵過量組(試驗組2)--------------------------------393、鐵正常組(對照組)----------------------------------39(九)、血液樣本採集與分析------------------------------40(十)、樣品萃取分析鐵含量------------------------------40四、儀器設備------------------------------------------40(一)、自動生化分析儀---------------------------------41(二)、血液生化分析儀----------------------------------41(三)、高速離心機-------------------------------------41(四)、全自動血球計數儀--------------------------------41(五)、COBAS INTEGRA機---------------------------------41(六)、藕合電漿光譜儀(Inductively Coupled Plasma Emission Spectroscopy)---------------------------------42五、資料處理與統計分析---------------------------------42(一)、血液生理值檢查項目標準值及檢驗意義-------------42(二)、運鐵蛋白飽和度----------------------------------42(三)、Kt/V計算公式-----------------------------------42(四)、鐵值需要量的計算公式---------------------------42(五)、實驗結果統計與分析------------------------------43肆、結果與討論-----------------------------------------45一、樣品鐵含量萃取分析------------------------------------------------45二、受測者之特性---------------------------------------47三、供應黑芝麻粉對三組血液生化值之影響-----------------49(一)、黑芝麻粉對病患血液值之改變----------------------49(二)、供應黑芝麻粉對鐵質生化值之改變------------------53四、鐵缺乏組血液生化相關性分析-------------------------56五、鐵過量組血液生化相關性分析-------------------------58六、鐵正常組(對照組)之血液生化相關分析-----------------60七、供應黑芝麻粉對r-HuEPO使用劑量之影響---------------62八 、供應黑芝麻粉對三組r-HuEPO使用劑量相關性分析------64九、鐵缺乏組貧血症狀相關性分析-------------------------66十、鐵過量組貧血症狀相關性分析-------------------------68十一、鐵正常組貧血症狀調查相關性分析-------------------70十二、供應黑芝麻粉之前後貧血症狀之變化-----------------72十三供應黑芝麻粉對尿素氮(BUN)之影響------------------74十四、供應黑芝麻粉對肌酸酐(Cretinine)之影響------------76十五、供應黑芝麻粉對白蛋白(Albumin)之影響--------------78十六、供應黑芝麻粉對鐵需求量之影響---------------------80十七、供應黑芝麻粉對Kt/V之影響------------------------82十八、供應黑芝麻粉前三組鐵質狀況之比較-----------------84十九、供應黑芝麻粉後3個月三組鐵質狀況之比較-----------84二十、供應黑芝麻粉後6個月三組鐵質狀況之比較-----------85二十一、停止供應黑芝麻粉後3個月三組鐵質狀況之比較-----85伍、結論-----------------------------------------------88陸、參考文獻-------------------------------------------90附錄一、同意書----------------------------------------111附錄二、供應者基本資料問卷評估表----------------------112附錄三、24小時飲食回憶熱量鐵量評估表-----------------114附錄四、接受血液透析治療的尿毒症患者貧血症狀調查表----115圖索引圖一、小腸細胞對鐵的吸收、代謝與轉移--------------------20圖二、鐵的代謝流程-------------------------------------22圖三、鐵的代謝與EPO的關係-----------------------------23圖四、研究架構流程圖-----------------------------------35圖五、黑芝麻粉鐵含量萃取分析圖-------------------------46圖六供應黑芝麻粉對尿素氮(BUN)之影響---------------- ---75圖七、供應黑芝麻粉對肌酸酐(Cretinine)之影響-----------77圖八、供應黑芝麻粉對白蛋白(Albumin)之影響--------------79圖九、供應黑芝麻粉對鐵需求量之影響---------------------81圖十、供應黑芝麻粉對KT/V之影響------------------------83圖十一、供應黑芝麻粉前三組鐵質狀況之比較---------------86圖十二、供應黑芝麻粉後3個月三組鐵質狀況之比較---------86圖十三、供應黑芝麻粉後6個月三組鐵質狀況之比較---------87圖十四、停止供應黑芝麻粉後3個月三組鐵質狀況之比較-----87表索引表1、台灣地區19-50歲兩性鐵攝取量與缺鐵率的關係--------15表2、台灣常見食物鐵含量-------------------------------17表3、芝麻營養成分表芝麻營養成分表---------------------28表4、 血液生理值檢查項目標準值及檢驗意義--------------43表5、三組受測者之特性記錄-----------------------------48表6、供應黑芝麻粉對血液值之改變-----------------------52表7、供應黑芝麻粉對三組鐵質生化值之影響---------------55表8、鐵缺乏組織之血液生化相關性分析-------------------57表9、鐵過量組之血液生化相關性分析---------------------59表10、鐵正常組(對照組)之血液生化相關性分析-----------61表11、供應黑芝麻粉對*r-HuEPO使用劑量之影響------------63表12、供應黑芝麻粉對三組r-HuEPO使用劑量相關性分析----65表13、鐵缺乏組貧血症狀調查相關性分析------------------67表14、鐵過量組貧血症狀調查相關性分析------------------69表15、鐵正常組貧血症狀調查相關性分析------------------71表16、供應黑芝麻粉之前後貧血症狀之變化----------------73
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