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研究生:詹雯娟
研究生(外文):Wen-chuan Chan
論文名稱:維生素C與維生素E之補充對第2型糖尿病患凝血及抗凝血因子活性之影響
論文名稱(外文):Effect of vitamin C and E supplements on activity of coagulation and anticoagulation factors in type 2 diabetic patients
指導教授:詹恭巨詹恭巨引用關係
學位類別:碩士
校院名稱:靜宜大學
系所名稱:食品營養研究所
學門:醫藥衛生學門
學類:營養學類
論文種類:學術論文
論文出版年:2006/06/
畢業學年度:94
語文別:中文
論文頁數:91
中文關鍵詞:第2型糖尿病維生素E維生素C凝血因子抗凝血因子總抗氧化狀態
外文關鍵詞:type 2 diabetes mellitusvitamin Evitamin Ctotal antioxidant statuscoagulation factoranticoagulation factors factor
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摘 要

研究指出,糖尿病發生率有逐年增加的趨勢,而高血糖所造成之氧化緊迫,可能會促進心血管性併發症之發生。本研究目的在探討抗氧化維生素之補充對第2型糖尿病患凝血及抗凝血因子活性之影響。本研究將52位第2型糖尿病患者,採雙盲隨意之方式分為安慰劑組(corn starch)、維生素C組(500 mg/day)、維生素E組 (400 mg α-TA/day)及維生素C+E組 (500 mg/day+400 mg α-TA/day),收集受試者服用補充劑第0及8週之空腹血液,分析各組血漿總抗氧化狀態、脂質過氧化產物濃度、發炎指標CRP濃度、血漿中凝血因子VII及抗凝血因子之抗凝血酶III與蛋白C的活性變化。結果顯示,抗氧化維生素C及E之補充,均能有效改善血漿中總抗氧化狀態並顯著降低血漿中MDA及CRP濃度。另外,抗氧化維生素之補充也可顯著的降低糖尿病患血漿中促凝血因子VII之活性。維生素C的補充可有效增加血漿中抗凝血酶III之活性,而維生素C及維生素E之合併補充則可顯著增加血漿中蛋白C之活性。綜合上述結果得知,給予第2型糖尿病患補充抗氧化維生素,可降低高血糖所誘發之氧化緊迫,達到改善體內發炎反應及凝血機制異常之效果,進而減少血栓性心血管併發症之發生。

關鍵詞: 第2型糖尿病、維生素C、維生素E、總抗氧化狀態、凝血因子、抗凝血因子
Abstract

Hyperglycemia-induced oxidative damage plays an important role in the pathogenesis of thrombotic complications in type 2 DM patients. Therefore, the purpose of this study was to investigate the effect of vitamin C and vitamin E supplements on blood coagulation in DM patients. Fifty-two type 2 DM patients were randomly assigned into four experimental groups in this placebo controlled, double-blinded study. Treatments including placebo group, vitamin C (500 mg/d) group, vitamin E (400 mg α-TA/d) group and vitamin C+E group. After 8 weeks’ supplementation, plasma concentration of malondialdehyde (MDA), total antioxidant status (TAS), inflammatory marker (C-reactive protein, CRP), activity of coagulation factor VII and anticoagulation factors (protein C, PC & antithrombin III, AT-III) were measured. The results of this study showed that plasma TAS was increased, and MDA and CRP concentrations were decreased by supplementing antioxidative vitamins to DM patients. Factor VII activity was significantly lowered by vitamin supplementation, however, AT-III activity increased only in vitamin C group, and activity of PC increased only in vitamin C+E group, when compared to placebo group. In conclusion, vitamin C and vitamin E supplements may have beneficial effects to alleviate oxidative stress in type 2 DM patients. Improvement on chronic inflammation and coagulation/ anticoagulation balance also contributed to the prevention of thrombotic complications.

Key Words:type 2 diabetes mellitus, vitamin C, vitamin E, total antioxidant status, coagulation factor, anticoagulation factors factor
目 錄

頁次
目錄……………………………………………………………………I
圖目錄…………………………………………………………………IV
表目錄…………………………………………………………………IV
中文摘要………………………………………………………………V
英文摘要………………………………………………………………VI


第一章 前言…………………………………………………………1

第二章 文獻回顧……………………………………………………3
第一節 糖尿病之簡介…………………………………………………3
第二節 糖尿病之慢性併發症…………………………………………6
第三節 氧化壓力與糖尿病………………………………………… 14
第四節 發炎反應與糖尿病………………………………………… 17
第五節 凝血因子與糖尿病之關係………………………………… 19
第六節 維生素C及維生素E 對糖尿病之影響………………………23
第七節 研究目的…………………………………………………… 27

第三章 材料與方法………………………………………………… 28
第一節 實驗藥品…………………………………………………… 28
第二節 人體試驗與研究設計……………………………………… 29
第三節 實驗分析方法……………………………………………… 34
一、血漿總抗氧化狀態之分析………………………………… 34
二、血漿丙二醛含量之測定…………………………………… 35
三、血漿中凝血因子VII活性之測定……………………………36
四、血漿中第三抗凝血酶活性之測定………………………… 37
五、血漿中蛋白C活性之測定………………………………… 38
六、血漿中C-反應蛋白含量之測定…………………………… 39
第四節 統計分析……………………………………………… 40
第四章 結果……………………………………………………………41
第一節 受試者之基本資料……………………………………………41
第二節 受試者之生活型態及飲食習慣………………………………41
第三節 維生素C、E之補充對第2型糖尿病患體內抗氧化狀態
之分析…………………………………………………………42
一、維生素C、E之補充對第2型糖尿病患血漿總抗氧化狀
態之影響………………………………………………………42
二、維生素C、E之補充對第2型糖尿病患血漿MDA濃度之影響…43
第四節 維生素C、E之補充對第2型糖尿病患體內凝血因子活性
之分析…………………………………………………………43
一、維生素C、E之補充對第2型糖尿病患血漿factor VII活
性之影響………………………………………………………43
第五節 維生素C、E之補充對第2型糖尿病患體內抗凝血因子活
性之分析………………………………………………………44
一、維生素C、E之補充對第2型糖尿病患血漿AT-III活性之
影響……………………………………………………………44
二、維生素C、E之補充對第2型糖尿病患血漿PC活性之影響… 44
第六節 維生素C、E之補充對第2型糖尿病患體內血漿發炎指標
之分析…………………………………………………………45
一、維生素C、E之補充對第2型糖尿病患體內血漿CRP濃度
之影響…………………………………………………………45

第五章 討論……………………………………………………………55
第一節 受試者基本資料之探討………………………………………55
第二節 維生素C、E之補充對第2型糖尿病患體內抗氧化狀態之
探討……………………………………………………………56
ㄧ、維生素C、E之補充對第2型糖尿病患血漿總抗氧化狀態
之影響…………………………………………………………56
二、維生素C、E之補充對第2型糖尿病患血漿MDA濃度之影響…57
第三節 維生素C、E之補充對第2型糖尿病患體內血漿CRP濃度之
探討……………………………………………………………59
第四節 維生素C、E之補充對第2型糖尿病患體內凝血因子活性
探討……………………………………………………………60
第五節 維生素C、E之補充對第2型糖尿病患體內抗凝血因子活
性之探討………………………………………………………63

第六章 結論……………………………………………………………67

第七章 參考文獻………………………………………………………68

圖 目 錄

圖1. 葡萄糖及游離脂肪酸經由粒線體電子傳遞鏈產生超氧陰離子
自由基之機轉……………………………………………………8
圖2. 高血糖誘發慢性併發症的共同機轉……………………………9

表 目 錄
表1. 不同型式維生素E之活性換算…………………………………24
表2. 第2型糖尿病患受試者之基本資料……………………………46
表3. 第2型糖尿病患受試者生活型態及飲食習慣之比較…… 47-48
表4. 第2型糖尿病患者給予維生素C及E補充前與後對血漿總抗氧化
狀態之影響…………………………………………………… 49
表5. 第2型糖尿病患者給予維生素C及E補充前與後對血漿MDA濃度
之影響………………………………………………………… 50
表6. 第2型糖尿病患者給予維生素C及E補充前與後對血漿凝血因子
VII活性之影響…………………………………………………51
表7. 第2型糖尿病患者給予維生素C及E補充前與後對血漿第三抗凝
血酶活性之影響……………………………………………… 52
表8. 第2型糖尿病患者給予維生素C及E補充前與後對血漿蛋白C活
性之影響……………………………………………………… 53
表9. 第2型糖尿病患者給予維生素C及E補充前與後對血漿C反應蛋
白濃度之影響………………………………………………… 54
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