臺灣博碩士論文加值系統

脂締素為脂肪組織所分泌的細胞激素，具有調節身體能量代謝、提高組織細胞對於胰島素之敏感性、抗發炎及抑制血管新生之生理作用。許多文獻已經指出肥胖為婦女罹患乳癌之重要危險因子，且婦女體內脂締素濃度與肥胖呈現負相關，因此本研究提出假說：婦女血漿內的低脂締素濃度可能為肥胖與乳癌間的重要致癌機轉，並利用以醫院為基礎之病例269名及269名配對對照個案的病例對照研究，評估病例組與對照組體內之脂締素濃度及其與乳癌之間的相關性。研究結果發現相較於血漿脂締素濃度小於最低四分位者者，脂締素濃度介於第一四分位與第二四分位之間、脂締素濃度介於第二四分位與第三四分位之間和脂締素濃度最高第四分位者罹患乳癌的危險對比值分別為1.63倍(95%信賴區間 0.98~2.74)、1.40倍(95%信賴區間 0.82~2.39)及1.13倍(95%信賴區間 0.66~1.93)，且在停經前或是停經後的婦女及乳癌細胞為動情激素受體陽性或是陰性之病例對照的比較中均可觀察到脂締素濃度與乳癌間的負相關趨勢。藉由不同體位及其體內脂締素濃度與乳癌之相關性，推測脂締素濃度可能為停經前婦女罹患乳癌的危險因子，而也可部分解釋停經後婦女罹患乳癌的原因。希望未來有前瞻性之追蹤研究及與乳癌相關致癌機轉之分子研究以更能確定血漿脂締素濃度與乳癌之因果關聯性。

Adiponectin is secreted from the adipose tissue, which modulating energy balance, increasing insulin sensitivity of various types of cells, and having a preventive role of anti-inflammation and anti-angiogenesis on cells. Based on the literature that obesity is an important risk factor of breast cancer and adiponectin is inversely related to obesity, we hypothesize that lower plasma adiponectin levels are associated with increased risk of breast cancer in women. A hospital-based case-control study involving 269 incident breast cancer cases and 269 cancer-free matched controls was conducted to evaluate this hypothesis. Questionnaire information and blood samples were taken from each subject. Plasma levels of adiponectin were measured by radioimmunoassay and the results were analyzed using logistic regression models. The study results showed that the odd ratios of breast cancer for women in the highest quartile, the second quartile and the third quartile of plasma adiponectin compared to women in the lowest quartile of adiponectin levels were 1.63(95% CI: 0.98~2.74), 1.40(95% CI: 0.82~2.39) and 1.13(95% CI: 0.66~1.93), respectively. Further prospective follow-up studies and mechanistic studies are needed to elaborate causal relationships between adiponectin and breast cancer risk.

第一章 前言
第二章 文獻探討
第一節 肥胖的流行趨勢
第二節 肥胖與乳癌之相關
第三節 肥胖增加罹患乳癌危險性的可能機轉
第四節 脂締素(adiponectin)與乳癌之相關
第三章 研究目的
第四章 材料與方法
第一節 研究設計
第二節 研究對象
第三節 資料收集
第四節 實驗方法
第五節 資料分析
第五章 結果
第一節 研究對象基本人口學特性及乳癌危險因子分布情形
第二節 體位因素與罹患乳癌相關性
第三節 體位變項與血漿脂締素之相關性
第四節 血漿脂締素與罹患乳癌之相關性
第五節 體位因素對於脂締素濃度與乳癌相關性之影響
第六節 血漿脂締素與罹患賀爾蒙受體陽性乳癌之相關性
第七節 血漿脂締素與罹患賀爾蒙受體陰性乳癌之相關性
第八節 脂締素濃度及體位指標與乳癌相關性之多變項分析
第六章 討論
第一節 體位、疾病狀態及停經狀況對於脂締素濃度的影響
第二節 血漿脂締素濃度與婦女罹患乳癌之相關性
第三節 停經前婦女體位指標對於脂締素濃度與乳癌相關性之影響
第四節 停經前婦女與脂締素濃度相關之罹患乳癌的致癌機轉
第五節 停經後婦女體位指標對於脂締素濃度與乳癌相關性之影響
第六節 停經後婦女與脂締素濃度相關之罹患乳癌的致癌機轉
第七節 脂締素與其他疾病相關之研究
第八節 脂締素與乳癌相關研究間之比較
第九節 研究限制
第七章 結論與建議
第八章 參考文獻

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