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研究生:謝宏杰
研究生(外文):Hung-Chieh Hsieh
論文名稱:台灣慢性精神分裂症患者之胰島素阻抗指數與候選基因相關性研究
論文名稱(外文):Association Study between HOMA-IR Score and the Candidate Genes among Chronic Schizophrenic Patients in Taiwan
指導教授:藍祚鴻藍祚鴻引用關係
指導教授(外文):Tsuo-Hung Lan
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:遺傳學研究所
學門:生命科學學門
學類:生物訊息學類
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:89
中文關鍵詞:精神分裂症胰島素阻抗指數候選基因
外文關鍵詞:schizophreniaHOMA-IR ScoreCandidate Genes
相關次數:
  • 被引用被引用:1
  • 點閱點閱:183
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:2
在台灣,精神分裂症在一般人群約有0.3-0.5%的終生盛行率。在其慢性化的病程中,不僅是患者之精神狀況會因疾病而逐漸退化,其身體之功能可能因多種原因較一般大眾更容易老化,再加上其社會上弱勢地位以及自我照顧能力下降,因而往往被忽略或照顧,因此重視慢性精神分裂症患者之身體健康狀況,已是精神醫療服務的從業者責無旁貸之任務。
近期的研究顯示精神分裂症患在就醫後,因長期服用傳統或新一代的抗精神病藥物,而會有較高的代謝症候群的發生率之的問題,並且代謝症候群又與胰島素阻抗有密切的關係。此外代謝症候群是第二型糖尿病的早期警訊,因而形成健康上非常大的隱憂,故值得作進一步的病因分析及研究。而以目前醫學界的研究發現所形成的共識結論,第二型糖尿病的病因應為環境因素及遺傳因素所共同導致,而遺傳因素則為多基因遺傳模式,已有相關之基因被陸續提出中,冀望這些基因的發現能對未來代謝症候群的防治能有所貢獻。
所以這個研究的主要目的在於慢性精神分裂症的患者中,是否可發現有與代謝症候群相關的基因,因此我們選取了209位來自精神科專科醫院的參與者,用其HOMA(Homeostasis Assessment)值來代表胰島素阻抗之嚴重度,並選取了四個候選基因,以哈溫平衡檢視選樣偏差,另以多變項線性迴歸分析來去除可能的環境共同作用因子之影響,其結論發現,在以與代謝症候群有意義相關之兩個重要環境因子(年齡及BMI值)為變項校正下,ADRB3這個基因與慢性精神分裂症患者之HOMA值具有相關性,而其它之候選基因則無。這個結果在未來可能可以運用在精神分裂症患者的代謝症候群相關議題上,包括用藥選擇的考量、生理指標監測的計劃、日常照顧的活動安排、親屬間的遺傳諮詢、以及未來有關該議題研究,提供一項參考的依據。其亦可以再做進一步之不同族群之相同研究,確認是否有相同的結果,以更了解代謝症候群和ADRB3這個基因的關係。
Schizophrenia, with the life prevalence around 0.3%- 0.5% in Taiwan, usually deteriorates cognitive function of patients in its chronic natural history of the disease. The patients with schizophrenia not only have an increased risk of morbidity and mortality from different physical illness because of several causes such as cardiovascular disease and diabetes mellitus, but also are minor to acquire general medical cares due to social-economic status and poor self-care that needs supports from psychiatric caregivers.
Furthermore, most patients received long term treatment of anti-psychotics, and up to 50% of them had significant metabolic syndrome, the problem of that are mainly associated with insulin resistance. Metabolic syndrome will increase the risk of the type II diabetes mellitus and cardiovascular diseases, which has been reported in past studies. Recently, most of professionals conclude that both environmental factors and genetic factors including many related genes found cause type II diabetes mellitus. The related genes may provide information about prevention of metabolic syndromes.
The aim of this study is to find whether there are susceptible genes contributing to metabolic syndromes in the patients with chronic schizophrenia or not. We recruited 209 patients with schizophrenia from one psychiatric center in this study. HOMA (Homeostasis Assessment) score representing the severity of insulin resistance were applied, and 4 candidate genes were chosen for comparison purpose. By using Hardy-Weinberg Equilibrium test, we exclude the possibility of deviation of stability in allele distribution. After adjusting for other possible confounders, the multiple linear regression models indicates there is association between ADRB3 and HOMA score. This result may apply in the issue about metabolic syndrome of the patients with chronic schizophrenia in the future, and give reference of choosing prescription, plans of physical monitoring, arranging daily activity, genetic counseling for relative, further research in the same issue of the patients with chronic schizophrenia. Furthermore, the same research of different population will be done to confirm the association between ADRB3 gene and metabolic syndrome.
永遠的感謝……………………………………………………… ii
中文摘要………………………………………………………… iv
英文摘要………………………………………………………… iv
目錄……………………………………………………………… viii
第一章 緒論…………………………………………………… 1
第二章 文獻探討……………………………………………… 3
第一節 精神分裂症的生理議題…………………………… 3
第二節 代謝症候群的相關介紹…………………………… 5
第三節 精神分裂症與代謝症候群的相關議題…………… 15
第三章 研究材料和方法……………………………………… 29
第一節 研究樣本…………………………………………… 29
第二節 研究方法…………………………………………… 30
第四章 研究結果……………………………………………… 34
第一節 樣本與人口學特性………………………………… 34
第二節 哈溫平衡定律……………………………………… 35
第三節 候選基因的多形性與HOMA值的關係……………… 40
第五章 討論…………………………………………………… 46
第六章 結論與建議…………………………………………… 50
參考文獻………………………………………………………… 52
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