臺灣博碩士論文加值系統

糖尿病至今仍是國人十大死因之第四位，而血管病變是造成糖尿病死亡的主因之一，不僅造成身體及心理上的痛苦，更嚴重影響病人生活品質及增加健康照護費用。本研究主要是以140位第二型糖尿病患為實驗對象。分別測定血液生化值、視網膜病變、尿液蛋白、心跳速率，以作為判斷發生血管病變危險性的指標，並進一步探討血糖控制與腎病變和血管病變危險因子的相關性。實驗則以Olympus AU-600、indirect ophthalmoscope ID-1、photo slit lamp SL-7F and Holter-ECG MT-200等方法分別檢測。實驗設計將糖尿病患分成血糖控制良好（HbA1c＜7﹪）及血糖控制差（HbA1c≧7﹪）兩組；另外以Urinary albumin-to-creatinine ratio（ACR）值將糖尿病患依腎病變程度分成normoalbuminuria（ACR＜30）microalbuminuria（30≦ACR＜300）、macroalbuminuria（ACR≧300）等三組、視網膜病變進展的模式糖尿病無視網膜病變期(NDR)、非增殖期視網膜病變期(NPDR)、增殖期前視網膜病變期(PPDR)、增殖期視網膜病變期(PDR)、黃斑部病變等五組及心跳速率控制良好(HR＜100)、心跳速率控制差(HR≧100)等二組。結果顯示，糖尿病患血糖控制差者其空腹血糖值、膽固醇、三酸甘油酯等濃度及心跳速率均高於血糖控制良好者；而有蛋白尿者的空腹血糖值、HbA1c、總膽固醇、三酸甘油酯等濃度及心跳速率則高於無蛋白尿者，有視網膜病變者空腹血糖值、HbA1c、膽固醇、三酸甘油酯等濃度及心跳速率均高於無視網膜病變者。綜合實驗結果，第二型糖尿病患如果血糖控制差、有腎病變或視網膜病變情況發生的話，便會增加血管病變的嚴重性。

Diabetes is the fourth leading cause of death in Taiwan. Diabetes vascular complications is one of the major causes of mortality among DM patients. The vascular complications may induce not only physical suffering among DM patients, but also severely influence their psychological and social function. The quality of life of these patients may be disrupted and the substantial healthcare expenses may increase. The subjects of this study were 140 type 2 diabetic patients, In order to identify vascular complications risk factors, along with other measurements including glucose, triglyceride (TG), retinopathy, heart rate and urine albumin were investigated. In addition, the effects of glycemic control and renal dysfunction on vascular complications risk factors were also studied. Methods of the study included Olympus AU-600,Indirect ophthalmoscope ID-1, photo slit lamp SL-7F and Holter-ECG MT-200. All diabetic patients were classified into glycemic control subgroups according to HbA1c, albuminuria subgroups based on urinaryalbumin to creatinine ratio（ACR）, retinopathy and heart rate. According to results,　diabetic patients poor control group had higher levels of fasting blood sugar (FBS), triglyceride (TG), cholesterol and heart rate, than those in good controls. Diabetic patients with either microalbuminuria or macroalbuminuria had higher levels of fasting glucose, triglyceride (TG), cholesterol and heart rate, than those in good control group. Diabetic patients with retinopathy had higher levels of fasting glucose, triglyceride (TG), cholesterol and heart rate, than those in good control group. Diabetic patients with heart rate had higher levels of fasting glucose, triglyceride (TG), cholesterol and heart rate, than those in good control group. In conclusion, type 2 diabetic patients with poor glycemic control status, renal dysfunction, or retinopathy could increase the severity of vascular complications.

目錄

摘要.............................................................................................................I
Abstract.......................................................................................................III
誌謝………………………………………………………………….……V
圖表目錄
表目錄.........................................................................................................IX
圖目錄.........................................................................................................X
第一章 前言………………………………….………..……………….1
1.1研究目的………………………………………..……………........2
第二章 文獻回顧…………………………………………….………...3
2.1糖尿病的界定……………………………………………………..3
2.1.1 第1型糖尿病………………………………. ………………3
2.1.2 第2型糖尿病..........................................................................3
2.1.3 妊娠期糖尿病……………………………………….……….4
2.1.4 其它特定型糖尿病…………………………………………..4
2.2第2型糖尿病流行病學………………..…………………………4
2.3 糖尿病併發症.................................................................................5
2.3.1大血管病變…………………………………………..……….6
2.3.2小血管病變……………………………………….…….…….6
2.3.2.1 糖尿病視網膜病變流行病學……………………..…….6
2.3.2.2 糖尿病腎臟病變流行病學…………………….….…….7
2.3.3 糖尿病末梢神經病變……………………………..…………8
第三章 材料與方法...............................................................................10
3.1血液生化值測定.............................................................................10
3.1.1 Glucose測定............................................................................10
3.1.2 HbA1c測定.............................................................................11
3.1.3膽固醇測定.............................................................................13
3.1.4三酸甘油酯測定…………………...……….……….……….15
3.1.5尿液微白蛋白測定…………………………………….…….17
3.1.6高密度脂蛋白測定…………………………….…………….19
3.1.7低密度脂蛋白測定………………………….……………….20
3.2儀器設備………………………………………………….………21
3.2.1眼科儀器一覽表………………………………………….….21
3.2.2.24小時Holter心電圖………………………..…………...…22
3.3實驗設計.........................................................................................24
3.4 研究對象…………………………………...………………….…25
3.5實驗方法.........................................................................................25
3.5.1詢問病史..................................................................................25
3.5.2理學檢查..................................................................................27
3.5.3檢驗..........................................................................................28
3.6糖尿病自主管理教育………………………………...…….….....30
3.6.1結構面……………………………………………..………....31
3.6.2過程面……………………………………………..………....31
3.6.3結果面……………………………………………..…..….….32
3.7統計分析……………………………………………...…….….....32
第四章 結果...........................................................................................34
4.1 受試者的基本資料分析………………………..……….…….....34
4.2 血液生化值分析…………………………………………….…...34
4.3 視網膜病變……………………………….……………………...35
4.4 心電圖測試……………………………………………………....36
第五章 討論…………………………………………………….……..54
5.1 血糖控制與血管病變…………………………….………....…...54
5.1.1視網膜病變…………………………………….………….....54
5.1.2腎病變……………………………………………….……….55
5.1.3心跳速率………………………………………………….….58
5.2未來相關研究建議…………………………….………….....…...56
第六章 結論...........................................................................................58
參考文獻...................................................................................................59
附錄…………………………...................................................................65
作者簡介………………………………………………………………...75
























表目錄

表1 第2型糖尿病患的基本資料(I)………………………………………37
表2 第2型糖尿病患的基本資料(II)……………………………….……38
表3 第2型糖尿病患的基本資料(III)……………………………………39
表4 第2型糖尿病患血糖控制良好組及控制差組的臨床測量值比較…40
表5 第2型糖尿病患血糖控制良好組及控制差組的臨床測量值比較…41
表6 血糖控制良好、血糖控制差的第2型糖尿病患其臨床檢測值的相關性…………………………………………………………………….42
表7 輕微、嚴重蛋白尿的第2型糖尿病患其臨床檢測值的相關性…..43
表8 第2型糖尿病患有、無蛋白尿的臨床測量值比較…………..……44
表9 第2型糖尿病患無蛋白尿、輕微蛋白尿、嚴重蛋白尿的臨床測量值比較………………………………………………………………….45
表10 第2型糖尿病患有、無視網膜病變的臨床測量值比較……………46
表11 第2型糖尿病患非增殖期視網膜病變、增殖前期視網膜病變、增殖期視網膜病變、黃斑部病變的臨床測量值比較……………….47
表12第2型糖尿病患心率控制良好組與控制差組的臨床測量值比較..48












圖目錄

圖1 第2型糖尿病患血色素異常與血管病變(百分比%)……………….49
圖2 第2型糖尿病患血糖控制良好組與血糖控制差組罹病期比較…...50
圖3 第2型糖尿病患有視網膜病變、無視網膜病變的罹病期比較…...51
圖4 第2型糖尿病患視網膜病變不同階段的血糖值比較……………...52
圖5 第2型糖尿病患有蛋白尿、無蛋白尿的血糖值比較………...........53

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