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研究生:劉文生
研究生(外文):Wen-Sheng Liu
論文名稱:基因檢測模式分析患者給藥治療的影響性-利用糖尿病用藥進行效益分析
論文名稱(外文):The impacts on utilizing genetic testing to analyze the clinical treatment:An analysis of the effectiveness on drugs of diabetes
指導教授:方至民方至民引用關係
指導教授(外文):Cher-Min Fong
學位類別:碩士
校院名稱:國立中山大學
系所名稱:高階經營碩士班
學門:商業及管理學門
學類:其他商業及管理學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:中文
論文頁數:108
中文關鍵詞:限制酵素切割片段多型性聚合酵素鏈鎖反應基因多型性檢測磺基尿素類第二型糖尿病個人化醫療藥物基因學
外文關鍵詞:personalized medicinepharmacogeneticRFLPPCRSNPSulfonylureatype 2 diabetes
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中文摘要
目前臨床醫學治療,醫生對於患者給藥一般會依據臨床經驗,加上各種生化檢驗數據來做給藥判斷,但生化檢驗只能提供一般初步生理反應數據,雖然足夠提供醫生對疾病的判斷,而對於用藥部份並沒有太大的幫助,因此醫生會依據傳統臨床用藥經驗,採用嘗試錯誤的醫療給藥方式。使用第一線藥品或低價、低劑量藥品進行治療,如此將會造成醫療時效延長、患者醫療品質降低,或產生嚴重副作用,並會讓用藥成本增加。因此可利用基因多型性檢測模式輔助,進行基因多型性﹙SNP﹚分析,確認基因類型就可預測用藥結果,並與現有的生化診斷體系接軌,加速檢驗醫學從表型診斷轉向基因型診斷,並預防藥物副作用,提高療效,再進行藥物治療,進而加速治療效果、控制病情,減少藥物誤用或濫用的情況,節省健保用藥成本。
應用的方法:本研究以藥物基因學(Pharmacokinetic)角度探討一種可精確偵測糖尿病基因類型與預測用藥結果,能精確投藥之檢測方法,其特徵在於利用聚合酵素鏈鎖反應與限制酵素切割片段多型性等技術進行病人不同基因的多型性分析,再藉由單因子變異數分析ABCC8-E16基因多型性與第二型糖尿病藥物治療之影響,ABCC8-E16基因型的病患適合給予Sulfonylurea(磺基尿素類)降血糖藥物治療(P<0.05),可將此結果提供醫師作為糖尿病藥物治療的參考依據,更可節省醫療院所給藥費用及縮短臨床用藥時間,對藥物臨床開發和未來的「個人化醫療」影響深遠。
第二型糖尿病, 磺基尿素類, 基因多型性檢測, 聚合酵素鏈鎖反應, 限制酵素切割片段多型性, 藥物基因學, 個人化醫療
Abstract
According to recent clinical treatment, doctors give patients medicines based on clinical experience and biochemical data. However, biochemical data simply provides an initial physiology reaction. Although the data is enough for doctors to diagnose diseases, it does not help much for doctors to indicate the most useful medicine. Therefore, doctors will use the first line, cheap or low dose medicine to cure patients by previous clinical experience. It will not only extend the time of treatment but also lower the medical quality. Not to mention the side effects and increases the cost. Consequently, using SNP(Single Nucleotide Polymorphism)will help doctors to find out different patients’ genotype and forecast the result of medicine. It will control disease efficiently and decrease the medical costs.
Methods: This study will be discussed with an accurate test of how to check the genotypes of diabetes mellitus and predict the result of treatment from pharmacogenetic. The method was using PCR (Polymerase Chain Reaction) and RFLP (Restriction Fragment Length Polymorphism) to analyze patients’ different genotype. Besides, this study uses the One-Way ANOVA to interpret the relationship between ABCC8-E16 and type 2 diabetes. In conclusion, the antidiabetic drugs- Sulfonylurea derivatives are suitable for ABCC8-E16 genotype patients. This result can be a reference for doctors to remedy diabetics. It will not only save the cost but also shorten the time of treatment, and it will impact deeply for personalized medicine in the future.

type 2 diabetes, Sulfonylurea, SNP, PCR, RFLP, pharmacogenetic, personalized medicine
目錄頁次
論文審書........................................................Ⅰ
致謝詞............................................................Ⅱ
中文摘要........................................................Ⅲ
Abstract .........................................................Ⅳ
圖目錄............................................................Ⅶ
表目錄............................................................Ⅷ
第一章 緒論.....................................................1
第一節 研究動機與背景.................................1
第二節 研究目的.............................................3
第三節 研究流程與架構.................................4
第四節 研究範圍與限制.................................6
第二章 文獻探討.............................................8
第一節 糖尿病形成的原因與分類.................8
第二節 糖尿病治療與藥物分析...................17
第三節 糖尿病檢測方式簡介 ......................38
第四節 市場分析及進入策略探討...............50
第三章 研究方法...........................................52
第一節 研究設計...........................................52
第二節 研究對象...........................................52
第三節 研究步驟...........................................54
第四節 研究方法...........................................55
第五節 統計方法...........................................62
第四章 資料分析與研究討論.......................63
第一節 利用本實驗方法及技術...................63
第二節 研究討論...........................................64
第三節 研究結果...........................................66
第四節 研究資料分析及研究探討...............67
第五章 市場分析...........................................69
第一節 市場定位...........................................70
第二節 市場導入策略與運用.......................73
第三節 市場1%佔有率的攻掠策略.............75
第六章 討論與建議.......................................80
附件
同意書............................................................84
參考文獻........................................................89
中文文獻........................................................89
英文文獻........................................................91
參考文獻
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