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研究生:黃朝麟
論文名稱:以血液淨化方法移除血液循環中之Photofrin作為減緩皮膚光敏感性之治療方法
論文名稱(外文):Removing circulatory photofrin by blood purification as a means of eliminating skin photosensitivity
指導教授:楊台鴻
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:醫學工程學研究所
學門:工程學門
學類:綜合工程學類
論文種類:學術論文
論文出版年:2003
畢業學年度:92
語文別:中文
中文關鍵詞:光動力療法皮膚光敏感性血液淨化血液透析血液灌洗
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使用Photofrin做為光動力療法的光敏感性藥物時,其最主要的副作用為為時長達兩個多月的皮膚光敏感性。有很多減緩皮膚光敏感性的方法被提出,但是沒有一個方法可以確切達到保護皮膚的目的。病人通常需要嚴格避免照光長達兩個多月。臨床上Photofrin通常是靜脈注射每公斤體重2.0 mg 的劑量,48小時後再給予波長630 nm的照光治療。Photofrin注入人體後,除聚集於腫瘤處外,亦聚集於內臟及皮膚處。皮下組織處的Photofrin可歷兩個多月不衰,維持一穩定的濃度。而血液循環中的Photofrin 48小時後很快就被身體移除至一很低的濃度,然後於兩個多月內持續緩慢衰退。就皮下組織處的Photofrin長期維持一穩定的濃度而言,無明顯的証據可顯示皮膚光敏感性與其呈正相關。假如血液循環中的Photofrin是造成皮膚光敏感性的主要原因,如能以血液淨化的方法於48小時照光治療後短時間內移除血液循環中的Photofrin,使其低於造成皮膚光敏感性的域值,當可縮短皮膚光敏感性的期間及減緩其嚴重程度。本研究比較血液透析及血液灌洗兩種血液淨化方法於體外實驗下移除血液中Photofrin的有效程度。實驗顯示游離態Photofrin可被血液透析移除,而血液灌洗無法有效移除游離態Photofrin。至於結合態Photofrin,因其分子量太大,無法被血液透析移除。移除結合態Photofrin需考慮其他的血液淨化方法。以血液淨化方法移除血液中Photofrin有助於瞭解造成皮膚光敏感性的機制並有可能減緩皮膚光敏感性的嚴重度。

摘要-------------------------------------------------------------I
英文摘要------------------------------------------------------III
目錄------------------------------------------------------------IV
圖表目錄-----------------------------------------------------VII
第一章 緒論---------------------------------------------------1
1-1 前言-------------------------------------------------------------------------1
1-2 研究目的與動機----------------------------------------------------------2
第二章 簡介及文獻回顧------------------------------------4
2-1 光動力療法簡介----------------------------------------------------------4
2-1-1 光動力療法的源起------------------------------------------------4
2-1-2 光動力療法的原理------------------------------------------------5
2-1-3 光敏感性藥物------------------------------------------------------5
2-2 Photofrin引起之皮膚光敏感性--------------------------------------7
2-3 Photofrin於生物體內之分佈(distribution)與排泄(elimination)
-----------------------------------------------------------------------------8
2-3-1 Photofrin於老鼠(mice)體內之分佈與排泄------------------8
2-3-2 患者經靜脈注射Photofrin後其藥物動力學的初步研究
---------------------------------------------------------------------9
2-4 造成Photofrin引起皮膚光敏感性的機制--------------------------10
2-4-1 老鼠全腳反應模式(murine whole-foot response model)
---------------------------------------------------------------------10
2-4-2 老鼠耳朵腫漲反應模式(mouse ear-swelling response
model,ESR model)--------------------------------------------11
2-5 血液淨化療法簡介-----------------------------------------------------13
2-5-1 血液透析----------------------------------------------------------13
2-5-2 血液灌洗----------------------------------------------------------14
第三章 實驗材料與方法----------------------------------24
3-1 實驗材料-----------------------------------------------------------------24
3-2 實驗藥品配製-----------------------------------------------------------26
3-3 實驗儀器-----------------------------------------------------------------28
3-4 實驗步驟-----------------------------------------------------------------29
3-4-1 以Photofrin 生理食鹽水水溶液進行實驗----------------29
3-4-2 以500 ml Photofrin新鮮冷凍血漿水溶液進行血液透析及血液灌洗實驗-----------------------------------------------30
3-4-3 以1000 ml Photofrin新鮮冷凍血漿水溶液進行血液透析實驗---------------------------------------------------------31
第四章 實驗結果------------------------------------------37
4-1 Photofrin生理食鹽水水溶液的濃度變化-----------------------37
4-2 Photofrin新鮮冷凍血漿水溶液進行血液透析後於透析液中的累積排除量-----------------------------------------------------38
第五章 討論------------------------------------------------41
5-1 造成Photofrin引起皮膚光敏感性機制的探討-----------------41
5-2 實驗方法的探討------------------------------------------------------43
5-2-1 人類模式--------------------------------------------------------43
5-2-2 動物模式--------------------------------------------------------44
5-2-3 體外模式--------------------------------------------------------44
5-3 以血液淨化療法移除血液循環中的Photofrin------------------45
5-4 造成Photofrin引起皮膚光敏感性機制的假說-----------------47
5-5 以血液淨化療法作為減緩Photofrin皮膚光敏感性的治療方法
-------------------------------------------------------------------------49
第六章 結論-------------------------------------------------52
第七章 參考文獻-------------------------------------------53

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