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研究生:楊惠玫
研究生(外文):YANG HUI-MEI
論文名稱:輕度智能受損與阿茲海默症老人的血清維生素B12、葉酸與造血相關指標
論文名稱(外文):Serum vitamin B12、folate and blood relative markers in the elderly patients with mild cognitive impairment and Alzheimer’s dementia
指導教授:蘭淑貞蘭淑貞引用關係
指導教授(外文):Shu-Jan Lan, Ph.D.
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:保健營養學系
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
畢業學年度:94
語文別:中文
論文頁數:90
中文關鍵詞:輕度智能受損
外文關鍵詞:Alzheimer’s diseasemild cognitive impairmentelderlyvitamin B12folate
相關次數:
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中文摘要
本研究的主要目的為比較不同嚴重程度阿茲海默症老人之血清維生素B12、葉酸與造血相關指標。受試者經臨床醫師診斷,依CDR(Clinical Dementia Rating, 臨床失智評量)分數(CDR = 0.5, 1, 2, 3)分為四組:1.輕度智能受損組(mild cognitive impairment, MCI組);2.輕度阿茲海默症組(Alzheimer’s disease, AD);3.中度AD;4.重度AD。各組有 51、 68、 50與 49人,共 218人參與。所有資料皆由病歷摘取。四組的MMSE得分各為27.1 ± 2.3、19.8 ± 4.7、16.4 ± 4.2 and 4.7 ± 2.7分。
MCI、輕、中、重度AD四組的血清維生素B12各為724.7 ± 410.7、656.1 ± 452.8、491.2 ± 215.1及328.6 ± 130.7 pg / mL;MCI或輕度AD的比中、重度AD為高。四組血清葉酸各為:14.1 ± 5.1、14.8 ± 6.5、13.0 ± 4.8及9.7 ± 3.9 ng / mL;MCI或輕度AD的比重度AD為高。根據Hb(Hct),四組貧血發生率各為43.1(33.3)、41.2 (42.6)、50.0(50.0)與36.7 %(24.5 %)。四組MCV過高發生率各為7.8、20.6、14.0與8.2 %。四組低Alb血症(即蛋白質 - 營養不良)發生率各為5.9、5.9、6.0與14.3 %。根據sGPT,四組的肝功能不佳佔2.0 ~ 2.9 %。

本研究結論:血清維生素B12隨MCI至AD嚴重度發展而下降。血清葉酸隨著AD嚴重度加重而下降。Hb與Hct或MCV相比,為貧血較敏銳之指標,四組中,重度AD的貧血(Hct)發生率雖最低,也達24.5 %。重度AD的低Alb血症發生率最高:14.3 %。本研究受試者肝功能不佳者佔2.0 ~ 2.9 %。
中文關鍵詞:輕度智能受損、阿茲海默症、老人、維生素B12、葉酸
Abstract
This study was to compare serum vitamin B12、folate and blood-making related factors in the elderly with mild cognitive impairment (MCI) or various severity of Alzheimer’s disease (AD). MCI or AD was diagnosed by doctors. CDR (clinical dementia rating) was used to evaluate cognitive function. CDR scores of 0.5 were classified as MCI;1 as mild AD;2 as moderate AD and 3 as severe AD. All data required for the study were extracted from medical charts. A total of 218 subjects involved: 51 were MCI, 68 were mild AD, 50 were moderate AD and 49 were severe AD.
MMSE scores in MCI, mild, moderate and severe AD groups were 27.1 ± 2.3、19.8 ± 4.7、16.4 ± 4.2 and 4.7 ± 2.7points, respectively. Serum vitamin B12 were 724.7 ± 410.7、656.1 ± 452.8、491.2 ± 215.1 and 326.6 ± 130.7 pg / mL. MCI or mild AD group had higher serum vitamin B12 than moderate and severe AD groups. Serum folate in four groups were 14.1 ± 5.1、14.8 ± 6.5、13.0 ± 4.8 and 9.7 ± 3.9 ng / mL. MCI or mild AD group had higher serum folate than severe AD group. Four groups had anemia according to Hb (Hct):MCI 43.1(33.3) %、mild AD 41.2(42.6) %、moderate AD 50.0(50.0) % and severe AD group 36.7 %(24.5 %). The prevalence of high MCV in four groups:7.8、20.6、14.0 and 8.2 %. Hypoalbuminemia occurred as 5.9、5.9、6.0 and 14.3 % in four groups. Poor liver function as indicated by high sGPT level was uncommon, only 2.0 ~ 2.9 % in four groups of subjects.
In conclusion, serum vitamin B12 and folate decline as AD deteriorates.
Anemia is common in the elderly with MIC or various degree of AD as indicated by blood related markers Hb、Hct or MCV and Hb is the most sensitive markers of anemia. Hypoalbuminemia occurs in 14.3 % of the elderly with severe AD, the highest prevalence among four groups. Keywords : Alzheimer’s disease, mild cognitive impairment, elderly,
vitamin B12, folate
目錄
中文摘要…………………………………………………………..……Ⅰ
英文摘要…………………………………………………………….….Ⅲ
致謝……………………………………………………………………..Ⅴ
目錄……………………………………………………………………..Ⅶ
圖目次…………………………………………………………………..Ⅸ
表目次…………………………………………………………………..Ⅹ
第一章 研究動機與研究目的…………………………………………1
第一節 研究動機…………………………………...………...…….1
第二節 研究目的……………………………………...……...…….5
第三節 研究假設……………………………………...……...…….6
第四節 名詞解釋………………………………………...…...…….7
第二章 文獻探討……………………………………………………..15
第一節 失智症與發生率……………………………...…………..15
第二節 輕度智能損害………....……………………...…………..17
第三節 阿茲海默症的發現與症狀………..…………..………….18
第四節 評估智能狀況的工具或量表…………………………….21
第五節 維生素B12…………….………………………….…….…24
第六節 葉酸…………………………………………………….…28
第七節 維生素B12、葉酸與阿茲海默症………………….……..31
第三章 研究架構及研究流程………………………………………..35
第一節 研究架構…………………………………………………..35
第二節 研究流程…………………………………………………..36
第三節 研究步驟…………………………………………………..37
第四節 統計分析…………………………………………………..39
第四章 結果…………………………………………………………..41
第一節 輕度智能損害、輕、中與重度阿茲海默症四組之比較...43
第二節 輕度智能損害、輕、中與重度阿茲海默症四組之特質
、體位與血清維生素B12、葉酸以及造血相關指標之
相關性………………….………….………………………52
第五章 討論…………………………………………………………..57
第六章 結論…………………………………………………………..62
第七章 研究限制……………………………………………………..64
第八章 建議…………………………………………………………..65
參考文獻…………………………………………………………..……67
附錄一、MMSE量表的得分與智能狀況的關係…………………….88
附錄二、CDR量表…………………………………………………….89

圖目次
圖1 - 1 維生素B12的化學結構……………………………….………14
圖2 - 1 維生素B12以輔酶的角色參與人體的生化反應……..…..….27
圖2 - 2 葉酸及維生素B12之輔酵素作用…………………….………30
圖3 - 1 研究架構……………………………………………….….…..35
圖3 - 2 研究流程……………………………………………….….…..36

表目次
表4 - 1 受試者之人口資料…………………….…………….………..78
表4 - 2 受試者與輕度智能受損組、輕度、中度與重度AD組
之年齡與體位測量……………………………………….…..80
表4 - 3 所有受試者與輕度智能受損組、輕度、中度與重度
AD組之體型過輕、體型恰當、體型過重或肥胖症
(根據BMI值)之分布………………………………..………81
表4 - 4 所有受試者與輕度智能受損組、輕度、中度與重度
AD組之MMES、血清維生素B12、葉酸、Hb、Hct、
MCV、Alb、sGOT與sGPT…………………………….…..82
表4 - 5 輕度智能受損組、輕度、中度與重度AD組之
血清維生素B12、葉酸、Hb、Hct、MCV、Alb、sGOT
與sGPT異常(過高、過低或大於顯示值)之分布
……………………………………………………..……….....83
表4 - 6 MCI組受試者(n = 51)MMES、年齡、身高、體重、
BMI、血清維生素B12、葉酸、Hb、Hct、MCV、Alb、
sGOT與sGPT之相關性
………………………….……………………………………....84
表4 - 7 輕度AD組受試者(n = 68)MMES、年齡、身高、體重、
BMI、血清維生素B12、葉酸、Hb、Hct、MCV、Alb、
sGOT與sGPT之相關性
……………………………………………..……………...…...85
表4 - 8 中度AD組受試者(n = 50)MMES、年齡、身高、體重、
BMI、血清維生素B12、葉酸、Hb、Hct、MCV、Alb、
sGOT與sGPT之相關性
…………………………………………………………..…..…86
表4 - 9 重度AD組受試者(n = 49)MMES、年齡、身高、體重、
BMI、血清維生素B12、葉酸、Hb、Hct、MCV、Alb、
sGOT與sGPT之相關性
…………………………………………………..………….87
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