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研究生:黃如鈺
研究生(外文):Ju-yu Hwang
論文名稱:漸進式減重與胃繞道手術對內臟脂肪分佈之影響
論文名稱(外文):The effects of the distribution of visceral adipose tissue after stepwise reduce weight and Gastric Bypass by quantification CT
指導教授:林瑞興林瑞興引用關係
指導教授(外文):Ray-shing Lin
學位類別:碩士
校院名稱:國立屏東教育大學
系所名稱:體育學系
學門:民生學門
學類:運動休閒及休閒管理學類
論文種類:學術論文
畢業學年度:97
語文別:中文
論文頁數:56
中文關鍵詞:漸進式減重胃繞道手術內臟脂肪電腦斷層掃描
外文關鍵詞:stepwise reduce weightgastric bypassvisceral adipose tissueCT scan
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漸進式減重與胃繞道手術對內臟脂肪分佈之影響
摘要

目的:本研究目的在討論漸進式減重(代餐和運動訓練)與胃繞道手術對肥胖成年人內臟脂肪分佈情形與脂肪量之變異,及人體測量值(體重、BMI、腰圍、臀圍)改善情形之相關性。方法:本研究範圍之實驗對象為漸進式減重(27≦BMI<40)與胃繞道手術(35≦BMI<45)兩組,招募肥胖成年人每組各20名,年齡18至65歲,符合代謝症候群診斷標準2項或以上者為實驗對象,依據BMI符合的標準予以分組,漸進式減重組必須接受三個月的減重課程,胃繞道手術組在手術後第一月、第三月追蹤減重效果。受試者在減重前以電腦斷層掃描(computed tomography, CT scan)測量和計算腰椎第二節下端至第五節上端腹內脂肪、皮下脂肪,以及心包膜內脂肪和心包膜內外脂肪,並以GE Advantage Workstation 4.2版之Volume Viewer 2 Voxtool 6.5.0軟體分析,完成三個月胃繞道觀察與減重課程進行後側。統計方法以獨立樣本單因子共變數分析(組別×前、後測)考驗漸進式減重課程與胃繞道手術介入的效果,並以皮爾遜積差相關考驗心包膜內脂肪、腹部脂肪改變量與體重、腰臀圍及BMI改變之相關性,顯著水準定為α< .05。結果:經過漸進式與胃繞道手術減重後,漸進式組在體重、BMI、腰圍下降的比例達7.5%、7.8%、7.6%;胃繞道組在體重、BMI、腰圍、臀圍下降的程度為18.3%、19.0%、12.2%、9.8%,在脂肪量上,漸進式與胃繞道在內臟脂肪量於三個月後分別減少12.2%、40.5%,皮下脂肪量分別減少17.1%、31%,心包膜內脂肪量漸進式減少5.2%,胃繞道減少12.4%。在漸進式組L3-4單張的腹部、內臟與皮下脂肪,皆與L2-5的腹部脂肪、內臟脂肪及皮下脂肪有極高的相關性(r=.97、r=.98、r=.95,p<.05),在胃繞道至少有r=.88以上的相關性。結論:透過漸進式減重(代餐與運動)和胃繞道手術治療對於肥胖成年人心包膜脂肪與腹部脂肪均有改善,效果其中漸進式減重以皮下脂肪下降程度較佳;胃繞道手術減重則是內臟脂肪下降程度較佳。測量腹部單張L3-4脂肪量與改變量可作為評估腹部脂肪、皮下脂肪、內臟脂肪量與改變量。

關鍵詞:漸進式減重、胃繞道手術、內臟脂肪、電腦斷層掃描
The effects of the distribution of visceral adipose tissue after stepwise reduce weight and Gastric Bypass by quantification CT

Abstract
Purpose: This purpose of this study was to discuss about the distributing variation of visceral adipose tissue (VAT) and the volume after stepwise reduce weight (low caloric meal replacements and exercise training) and laparoscopic gastric bypass. Method: To divided the participants into two groups according to BMI: stepwise reduce weight (27≦BMI<40) and gastric bypass (35≦BMI<45), each group including 20 obese adult (age 21-57 y), all subjects need to conform with at least two metabolic syndrome diagnosis standards. The stepwise reduce weight group were asked three months reduction curriculum. As to the gastric bypass group were request for conduct a series records of weight loose condition after operation at the first and the third month. To measure the abdomen at L2-lower endplate to L5 upper endplate for VAT, subcutaneous adipose tissue (SAT) and epicardial adipose tissue (EAT), pericardial adipose tissue (PAT) by CT and calculating through in three months intervene. These data were analyzed by Ancova (group×time) with repeated measure to examine any changes after reduction curriculum and gastric bypass. Pearson correlation coefficient will be used to examine the change level of EAT, total abdominal adipose tissue (TAT), weight, WC, HC. The statistical significant level is determined at α<.05. Result: Result: After stepwise reduce weight and gastric bypass, in step reduce weight group, the variation of weight、BMI and WC were been decreased 7.5%, 7.8%, 7.6%. As to gastric bypass group the changes on weight, BMI, HC and WC had reduced 18.3%, 19.0%, 12.2% and 9.8%. On fat volume, the visceral fat had decreased12.2%、40.5%; the subcutaneous fat decreased 17.1%、31% individually. The pericardial fat were decreased 5.2%、12.4% in stepwise reduce weight and gastric bypass. The correlations and variance correlation are significant among TAT,VAT, SAT with the single image L3-4 (r=.97, r=.98, r=95, p<.05). Furthermore the correlation PAT at least (r=.88, p<.05) in gastric bypass. Conclusion: Through stepwise reduction weight and gastric bypass, the treatment result improve the effect change of EAT and TAT. On stepwise, was focused on reduction of the fat in SAT and gastric bypass is focus on reducing VAT. The single image L3-4 the volume and change volume was a standard as the volume and changed volume in abdominal fat, subcutaneous fat and visceral fat.

Keywords: stepwise reduce weight, gastric bypass, visceral adipose tissue, CT scan
目 次
謝誌................................................................................................................................. I

中文摘要......................................................................................................................... II

英文摘要......................................................................................................................... III

目次................................................................................................................................. IV

附錄次............................................................................................................................. VI

圖次................................................................................................................................. VII

表次................................................................................................................................. VIII



第壹章 緒論................................................................................................................ 1
第一節 研究背景............................................................................................... 1
第二節 研究目的............................................................................................... 2
第三節 研究重要性........................................................................................... 2
第四節 研究範圍與限制................................................................................... 3
第五節 名詞操作性定義................................................................................... 4
第貳章 文獻探討....................................................................................................... 8
第一節 內臟脂肪堆積對健康負面影響的相關研究....................................... 8
第二節 漸進式減重課程介入對內臟脂肪量與心血管危險因子影響之相關文獻.......... 9
第三節 胃繞道手術後對內臟脂肪量與代謝因子改變之研究....................... 11
第四節 結語....................................................................................................... 12
第參章 研究方法與實施步驟............................................................................... 13
第一節 研究設計與架構................................................................................... 13
第二節 研究流程............................................................................................... 15
第三節 實驗對象............................................................................................... 17
第四節 研究工具............................................................................................... 17
第五節 實驗步驟與流程................................................................................... 19
第六節 資料處理............................................................................................... 24
第肆章 結果與討論.................................................................................................. 25
第伍章 結論與建議.................................................................................................. 47
第一節 結論....................................................................................................... 47
第二節 建議....................................................................................................... 47
參考文獻....................................................................................................................... 48


































附 錄 次
附錄一 人體試驗計畫同意書....................................................................................... 53
附錄二 基本資料與脂肪改變量百分比....................................................................... 55

































圖 次
圖1-5-1胃繞道手術圖................................................................................................ 6
圖1-5-2腹部脂肪測量-切片範圍................................................................................ 6
圖1-5-3腹部脂肪測量-腰椎第二節至第三節位置.................................................... 6
圖1-5-4腹部脂肪測量-腰椎第三節至第四節............................................................. 7
圖1-5-5腹部脂肪測量-腰椎第四節至第五節位置..................................................... 7
圖1-5-6心包膜內脂肪測量圖-肺動脈最長最完整位置............................................. 7
圖1-5-7心包膜內測量位置.......................................................................................... 7
圖1-5-8心包膜內外脂肪量測量位置(橫切面)...................................................... 7
圖1-5-9心包膜內外脂肪量測量位置(額切面)...................................................... 7
圖3-1-1 研究架構圖..................................................................................................... 14
圖3-2-1研究流程圖...................................................................................................... 16
圖3-4-1運動踏板.......................................................................................................... 18
圖3-5-1腰椎第二節下端至第五節上端腹部影像圖(額切面).............................. 21
圖3-5-2腰椎第二節下端至第五節上端腹部影像圖(縱切面).............................. 21
圖3-5-3 腹部脂肪分析-腹內脂肪測量........................................................................ 21
圖3-5-4 腹部脂肪分析-腹部脂肪測量........................................................................ 21
圖3-5-5 腹內脂肪量..................................................................................................... 21
圖3-5-6 腹部脂肪量..................................................................................................... 21
圖3-5-7 隆凸至橫隔膜心包膜內影像圖(額切面)................................................. 22
圖3-5-8 隆凸至橫隔膜心包膜內影像圖(縱切面)................................................. 22
圖3-5-9 心包膜內脂肪測量......................................................................................... 22
圖3-5-10 心包膜內外脂肪測量................................................................................... 22
圖3-5-11 心包膜內脂肪量........................................................................................... 22
圖3-5-12 心包膜內外脂肪量....................................................................................... 22
圖4-4-1 胃繞道手術介入三個月對於腹部脂肪之改變............................................. 39
圖4-4-2 胃繞道手術介入三個月對於心包膜脂肪之改變......................................... 39




表 次
表3-5-1 Xenical與Redutil的簡介...................................................................................... 23
表4-1-1受試者基本資料之描述性統計...................................................................... 26
表4-1-2受試者基本資料之變異數同質性考驗.......................................................... 27
表4-2-1基本資料改變情形表...................................................................................... 28
表4-2-2腹部脂肪改變情形表...................................................................................... 29
表4-2-3心包膜脂肪改變情形表.................................................................................. 30
表4-3-1、體重、BMI、腰圍、臀圍與心包膜脂肪之相關性................................... 31
表4-3-2、體重、BMI、腰圍、臀圍與心包膜脂肪之改變量相關性. ..................... 31
表4-3-3、體重、BMI、腰圍、臀圍與腹部脂肪之相關性........................................ 32
表4-3-4、體重、BMI、腰圍、臀圍與腹部脂肪之改變量相關性........................... 32
表4-3-5、心包膜脂肪與腹部脂肪之相關性............................................................... 33
表4-3-6、心包膜脂肪與腹部脂肪之改變量相關性................................................... 33
表4-3-7、心包膜脂肪與右冠狀動脈脂肪、冠狀靜脈脂肪之相關性....................... 34
表4-3-8、心包膜脂肪與右冠狀動脈脂肪、冠狀靜脈脂肪之改變量相關性........... 34
表4-3-9、腹部脂肪與各節腰椎脂肪之相關性........................................................... 35
表4-3-10、腹部脂肪與各節腰椎脂肪之改變量相關性............................................... 35
表4-4-1 基本資料之共變數效果比較表..................................................................... 36
表4-4-2 腹部脂肪之共變數效果比較表..................................................................... 37
表4-4-3 心包膜脂肪之共變數效果比較表................................................................. 38
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中文文獻
甘能斌(2005)。八週不同的減重計畫介入對大專肥胖女學生身體質量指數及血脂肪的影響。體育學報,38(2),27-40頁。
李威傑(2004)。肥胖症的外科治療。臺灣醫學,6(1),64-69。
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郭家驊、蘇福新、李毓國、陳美枝(2004)。運動抑制肥胖的機轉。運動生理暨體能學報,創刊號,33-42。
高小雅。(2004)。坊間減重方法與醫院減重班探討。輔仁大學體育學刊,3,259-272。
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1. 甘能斌(2005)。八週不同的減重計畫介入對大專肥胖女學生身體質量指數及血脂肪的影響。體育學報,38(2),27-40頁。
2. 甘能斌(2005)。八週不同的減重計畫介入對大專肥胖女學生身體質量指數及血脂肪的影響。體育學報,38(2),27-40頁。
3. 李威傑(2004)。肥胖症的外科治療。臺灣醫學,6(1),64-69。
4. 李威傑(2004)。肥胖症的外科治療。臺灣醫學,6(1),64-69。
5. 郭家驊、蘇福新、李毓國、陳美枝(2004)。運動抑制肥胖的機轉。運動生理暨體能學報,創刊號,33-42。
6. 郭家驊、蘇福新、李毓國、陳美枝(2004)。運動抑制肥胖的機轉。運動生理暨體能學報,創刊號,33-42。
7. 高小雅。(2004)。坊間減重方法與醫院減重班探討。輔仁大學體育學刊,3,259-272。
8. 高小雅。(2004)。坊間減重方法與醫院減重班探討。輔仁大學體育學刊,3,259-272。
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