臺灣博碩士論文加值系統

研究顯示長期接受血液透析的患者，容易造成身體代謝上的改變及營養失衡的問題，因而增加其併發症及死亡率。本研究主要在探討藉由給予複方蛋白質膳食補充品對於長期接受血液透析治療患者之營養改善情形及體內抗氧化能力與自由基含量的變化。本研究共納入45位受試者，平均年齡為60歲，每星期接受血液透析治療3次，每次透析時間3.5~4.5小時，並且接受血液透析治療至少3個月以上。實驗介入期為一個月(4週)，在複方蛋白質膳食補充品介入前、後(第0 週、第4週)評估血液生化值、總抗氧化能力、自由基含量、體位測量、臨床症狀及飲食情形，於介入期每天依患者個別營養需要量給予複方蛋白質膳食補充品1~2包。介入複方蛋白質膳食補充品一個月(4週)後，受試者體位包括體重、身體質量指數(BMI)、腰臀圍比(WHR)、皮下脂肪厚度(TSF)、上臂環圍 (MAC)、上臂肌肉環圍(MAMC)均無顯著影響。然而血漿中總抗氧化能力(TEAC)方面，飲用複方蛋白質膳食補充品後，無論是透析前或是透析後都有顯著增加(p＜0.01)；而全血中之超氧陰離子之含量，飲用複方蛋白質膳食補充品4週後，其透析前、後全血中之含量皆有明顯地降低 (p＜0.05)。生化分析方面，飲用複方蛋白質膳食補充品4週後，血漿白蛋白、鈣及鐵的濃度均有明顯地增加，而血漿膽固醇、透析後肌酸酐、尿酸及鉀的濃度均有明顯地下降。除此之外，由飲食紀錄的結果得知，飲用複方蛋白質膳食補充品4週後，受試者的實際熱量都有明顯增加的情形(p＜0.05)；而三大營養素蛋白質、脂質、碳水化合物的攝取比例，在飲用複方蛋白質膳食補充品4週後均有顯著地增加(p＜0.01)。另外，在臨床生理症狀方面，便秘、食慾不佳及疲倦都有明顯地改善。綜合上述結果，給予複方蛋白質膳食補充品，不但可以增加受試者透析前後的抗氧化能力，降低體內自由基含量及血中膽固醇含量，同時還可以改善受試者之營養與生理症狀。

Studies show that patient who receives hemodialysis for a long term could easily suffer form metabolic change and nutritional imbalance, and the morbidity and mortality are thus increased. The main objective of this study is to understand the nutritional improvement and antioxidant status of the patients who have taken hemodialysis for a long term by giving of dietary supplement with compound proteins. 45 patients(with average age of 60 years old)accept three times of hemodialysis every week and for at least three months were included in this study. The experimental period is 4 weeks. A antioxidant status, free radical content, anthropometric factors, biochemical analyses, physiological symptoms and diet condition were measured before and after 4 weeks of intervention of dietary supplement with compound proteins. The nutrition supplement is given every day according to the individual need of nutrition. Results showed that no significant difference was found in anthropometric measurements, including body weight, BMI, WHR, TSF, MAC, MAMC. Total equivalent antioxidant capacity (TEAC) of the plasma was significantly increased after the intervention of dietary supplement with compound proteins before and after hemodialysis. The levels of superoxide anion radical in the whole blood were greatly decreased after giving the dietary supplement with compound proteins before and after hemodialysis. The nutritional status in serum showed that albumin, calcium, iron were obviouly increased, but cholesterol, post-dialysis creatinine, uric acid, and potassium were reduced. Diet record showed that the daily energy intake were increased after 4 weeks of intervention. In addition the intake of protein, lipid and carbohydrate were also greatly increase (p＜0.01). Physiological symptoms, including constipation, anorexia and fatigue were all improved after intervention. In summary, intervention of dietary supplement with compound proteins could improve the antioxidant status, blood cholesterol, nutritional status and physiological symptoms.

目錄
頁次
表次………………………………………………………………………Ⅰ
圖次………………………………………………………………………Ⅱ
附錄………………………………………………………………………Ⅲ
中文摘要…………………………………………………………………Ⅳ
英文摘要…………………………………………………………………Ⅵ
壹. 前言…………………………………………………………………1
貳. 文獻整理……………………………………………………………3
一、 複方蛋白質…………………………………………………3
（一） 乳清蛋白………………………………………………3
（二） 乳鐵蛋白………………………………………………4
（三） 大豆蛋白………………………………………………6
二、 腎臟的生理與功能…………………………………………7
（一） 腎臟的構造……………………………………………7
（二） 腎臟的生理功能………………………………………8
三、 慢性腎衰竭與血液透析……………………………………10
（一） 慢性腎衰竭……………………………………………10
（二） 血液透析………………………………………………10
四、 血液透析患者之營養狀況………………………………11
五、 血液透析患者與營養相關之併發症………………………12
（一） 心血管疾病……………………………………………12
（二） 感染及免疫功能………………………………………13
（三） 氧化壓力……………………………………………14
六、 血液透析患者營養狀態評估………………………………15
（一） 體位測量………………………………………………15
（二） 生化檢驗………………………………………………16
（三） 飲食紀錄………………………………………………18
七、 血液透析患者的營養介入方法……………………………18
參. 研究目的…………………………………………………………20
肆. 試驗設計與流程……………………………………………………21
一、 試驗設計……………………………………………………21
二、 試驗流程圖…………………………………………………22
伍. 材料方法……………………………………………………………23
一、 試驗材料……………………………………………………23
（一） 複方蛋白質膳食補充品……………………………23
（二） 人體試驗……………………………………………23
1. 基本資料收集……………………………………24
2. 血液樣品收集……………………………………24
(1) 參與之受試者………………………………24
(2) 血液收集與處裡……………………………25
二、 試驗用藥…………………………………………………26
三、 試驗儀器…………………………………………………27
四、 測定項目…………………………………………………28
五、 測定方法…………………………………………………29
（一） 蛋白質測定…………………………………………29
（二） 氮代謝物測定………………………………………30
（三） 其他生化值與電解質測定…………………………31
（四） 血脂質測定…………………………………………34
（五） 血球測定……………………………………………35
（六） 總抗氧化能力測定…………………………………35
（七） 超氧陰離子自由基測定……………………………36
六、 營養狀態評估……………………………………………36
1. 體位測量………………………………………………36
2. 熱量需求分析…………………………………………38
3. 生理症狀評估…………………………………………39
4. 飲食評估………………………………………………40
七、 統計分析……………………………………………………41
陸. 結果與討論……………………………………………………… 42
一、 受試者基本資料…………………………………………42
二、 對受試者體位之影響……………………………………42
三、 對受試者血漿抗氧化性之影響…………………………45
1. 血漿中總抗氧化能力測定……………………………45
2. 全血中超氧陰離子自由基含量測定…………………45
四、 對受試者營養狀況之影響…………………………………48
1. 血液蛋白質及其代謝產物之影響……………………48
2. 血脂質之影響…………………………………………49
3. 血液電解質及礦物質之影響…………………………52
4. 飯前血糖及肝功能之影響……………………………52
5. 血球之影響……………………………………………55
6. 受試者熱量需求與實際熱量攝取情形………………55
7. 三大營養素攝取之影響………………………………58
五、 對受試者生理症狀之影響…………………………………60
柒. 結論…………………………………………………………………63
捌. 參考文獻……………………………………………………………64
玖. 附錄…………………………………………………………………76

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