跳到主要內容

臺灣博碩士論文加值系統

(35.172.136.29) 您好!臺灣時間:2021/07/29 08:39
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

我願授權國圖
: 
twitterline
研究生:賀志豪
研究生(外文):Chih-Hao Ho
論文名稱:使用64列電腦斷層測定心包膜脂肪與冠狀動脈非鈣化斑塊之相關性
論文名稱(外文):The Association Study of Pericardial Fat Tissue and Noncalcified Coronary Plaque by 64 Multi-Detector Computer Tomography
指導教授:莊奇容
指導教授(外文):Chi-Long Juang
學位類別:碩士
校院名稱:元培科技大學
系所名稱:放射技術研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
畢業學年度:99
語文別:中文
論文頁數:60
中文關鍵詞:冠狀動脈鈣化心包膜脂肪非鈣化斑塊電腦斷層心血管疾病風險因子
外文關鍵詞:coronary artery calcificationpericardial fatnon-calcified coronary plaquerisk factor
相關次數:
  • 被引用被引用:0
  • 點閱點閱:226
  • 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:1
脂肪組織的累積通常在心血管疾病上扮演一個重要的角色;尤其是在斑塊形成早期所產生之非鈣化性斑塊,具有容易造成動脈壁之重組及剝落的能力,其對心血管疾病而言威脅性甚至超過鈣化斑塊。由於非侵入性之電腦斷層掃瞄技術得以於單一檢查中提供更多之訊息,不但可避免重複檢查所帶來的輻射劑量問題,更可以於不易測知的斑塊形成初期,及早預測心血管疾病發生並進行治療。因此本研究利用受檢者之電腦斷層數據,探討冠狀動脈非鈣化斑塊與更接近冠狀動脈之心包膜脂肪的關聯性。
最後使用 SPSS 17 統計軟體,針對所收集之心包膜脂肪體積與各單獨風險因子以獨立 t 檢定確立其相關性;非鈣化斑塊相關之多變量分析則以線性回歸檢定確認。


The accumulation of adipose tissue generally plays a key role in cardiovascular disease. Especially in the early stage of formation of coronary artery plaque, non-calcified plaque is able to induce arterial wall restructuring and peel-off easily, threat in terms of cardiovascular disease even more than the calcified plaque. Due to non-invasive Computer Tomography (CT) can provide more information in one examination, by use of this technique we not only can avoid excess radiation dose exposure from repeated scan but also can detect and treat the cardiovascular disease in advance. Therefore, we analyzed the CT data to investigate the relationship between atherosclerosis and the pericardial fat which is much closer to coronary artery.
From 2010 January to 2011 April, normal 64 multi-detector CT data of 100 physical examinee (80 males, 20 females; aged from 40 to 65) without any symptom of cardiovascular disease were acquired in Taipei City Hospital. Post-processing of images was then executed in the GE Advantage Workstation to measure the volume of pericardial fat and degree of lumen stenosis. At the same time, the existence and types of atherosclerosis were also confirmed. Finally, SPSS 17 package was employed to statistically establish the relevance between pericardial fat volume and each independent risk factor by the independent t. In addition, multivariable analysis of atherosclerosis was confirmed by multiple regression analysis.

中文摘要 I
Abstract I
致謝詞 II
目錄 IV
圖目錄 VI
表目錄 VIII
第1章 緒論 1
1.1 研究動機 1
1.2 研究目的 2
第2章 研究背景 4
2.1 冠狀動脈病變 4
2.2 心血管疾病風險因子 7
2.3 脂肪組織對心血管疾病的影響 8
2.4 心包膜脂肪之解剖及測量 9
2.5 心包膜脂肪與冠狀動脈病變 11
2.6 多陣列電腦斷層原理 14
2.6.1 電腦斷層基本原理 14
2.6.2 多陣列電腦斷層原理 15
2.6.3 冠狀動脈電腦斷層 17
2.7 多陣列電腦斷層評估心包膜脂肪 19
2.8 多陣列電腦斷層評估冠狀動脈斑塊 19
2.9 輻射劑量調控 21
第3章 材料與方法 23
3.1 研究設計 23
3.2 受試者主要納入及排除條件 23
3.3 試驗程序 24
3.3.1 檢查前準備 24
3.3.2 常規電腦斷層冠狀動脈檢查程序 25
3.4 多陣列電腦斷層評估心包膜脂肪 27
3.5 冠狀動脈斑塊測量方法 30
3.5.1 鈣化斑塊測量 30
3.5.2 非鈣化斑塊測量 32
3.6 冠狀動脈阻塞狀態評估測量 34
3.7 統計分析 36
第4章 結果與討論 37
4.1 受試者相關之描述統計量 37
4.2 心包膜脂肪大小與心血管疾病風險因子間之關係 39
4.3 不同斑塊型態與心包膜脂肪及風險因子間之關係 43
4.4 動脈阻塞狀況與斑塊型態及心包膜脂肪間之關係 46
第5章 結論 49
參考文獻 52
附件一 Framingham Risk Score Profile 58
附件二 受檢者原始資料 59
附件三 臺北市立聯合醫院人體試驗委員會計畫執行許可書 60

[1] Mahabadi AA, Massaro JM, Rosito GA, Levy D, Murabito JM, Wolf PA, O’Donnell CJ, Fox CS, Hoffmann U. Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study. European Heart Journal 2009;30:850-856.
[2] Bastarrika G, Lee YS, Huda W, Ruzsics B, Costello P, Schoepf UJ. CT of Coronary Artery Disease. Radiology 2009;253(2):317-338.
[3] Sarin S, Wenger C, Marwaha A, Qureshi A, Go M, Woomert CA, Clark K, Nassef LA, Shirani J. Clinical Significance of Epicardial Fat Measured Using Cardiac Multislice Computed Tomography. Am J Cardiol 2008;102:767-771.
[4] Sacks HS, Fain JN. Human epicardial adipose tissue: A review. American Heart Journal 2007;153( 6):907-917.
[5] Mazurek T, Zhang L, Zalewski A, Mannion JD, Diehl JT, Arafat H, Sarov-Blat L, O’Brien S, Keiper EA, Johnson AJ, Martin J, Goldstein BJ, Shi Y. Human Epicardial Adipose Tissue is a Source of Inflammatory Mediators. Circulation 2003;108:2460-2466.
[6] Abel ED, Litwin SE, Sweeney G. Cardiac Remodeling in Obesity. Physiol Rev 2008;88:389-419.
[7] Ding J, Hsu FC, Harris TB, Liu Y, Kritchevsky SB, Szklo M, Ouyang P, Espel and MA, Lohman KK, Criqui MH, Allison M, Bluemke DA, Carr JJ. The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr 2009;90:499-504.
[8] Greif M, Becker A, Von Ziegler F, Lebherz C, Lehrke M, Brὃdl U, Tittus J, Parhofer K, Becker C, Reiser M, Knez A, Leber AW. Pericardial Adipose Tissue
Determined by Dual Source CT is a Risk Factor for Coronary Atherosclerosis. Arterioscler Thrombvasc Biol published online Feb 19, 2009;Doi:10.1161/ATVB AHA.108.180653.
[9] Ahn SG, Lim HS, Joe DY, Kang SJ, Choi BJ, Choi SY, Yoon MH, Hwang GS, Tahk SJ, Shin JH. Relationship of epicardial adipose tissue by echocardiography to coronary artery disease. Heart 2008 94: e7 originally published online October 8, 2007, Doi: 10.1136/HRT. 2007. 118471.
[10] Iacobellis G, Assael F, Ribaudo MC, Zappaterreno A, Alessi G, Mario MD, Leonetti F. Epicardial Fat from Echocardiography: A New Method for Visceral Adipose Tissue Prediction. Obesity Research 2003;11(2):304-310.
[11] Flüchter S, Haghi D, Dinter D, Heberlein W, Kühl HP, Neff W, Sueselbeck T, Borggrefe M, Papavassiliu T. Volumeetric Assessment of Epicardial Adipose Tissue with Cardiovascular Magnetic Resonance Imaging. Obesity 2007;15(4):870-878.
[12] Gershlick AH, de Belder M, Chambers J, Hackett D, Keal R, Kelion A, Neubauer S, Pennell DJ, Rothman M, Signy M, Wilde P. Role of non-invasive imaging in the management of coronary artery disease: an assessment of likely change over the next 10 years. A report from the British Cardiovascular Society Working Group. Heart 2007 93: 423-431. DOI: 10.1136/HRT. 2006. 108779.
[13] Breen JF. Imaging of the Pericardium. Journal of Thoracic Imaging 2001; 16:47-54.
[14] Carr JJ, Nelson JC, Wong ND, McNitt-Gray M, Arad Y, Jacobs DR, Sidney S, Bild DE, Williams OD, Detrano RC. Calcified Coronary Artery Plaque Measurement with Cardiac CT in Population-based Studies: Standardized Protocol of Multi-Ethnic Study of Atherosclerosis (MESA) and Coronary Artery Risk Development in Young Adults (CARDIA) Study. Radiology 2005; 234(1):35- 43.
[15] Kitagawa T, Yamamoto H, Ohhashi N, Okimoto T, Horiguchi J, Hirai N, Ito K, Kohno N. Comprehensive evaluation of noncalcified coronary plaque characteristics detected using 64-slice computed tomography in patients with proven or suspected coronary artery disease. American Heart Journal 2007;154(6):1191-1198.
[16] Glass CK, Witztum JL. Atherosclerosis: The Road Ahead. Cell 2001;104:503-516.
[17] Arad Y, Goodman K, Roth M, Newstein D, Guerci A. Coronary Calcification, Coronary Disease Risk Factors, C-Reactive Protein, and Atherosclerotic Cardiovascular Disease Events. Journal of the American College of Cardiology 2006;46(1):158-165.
[18] D’Agostino RB, Grundy S, Sullivan LM, Wilson P. Validation of the Framingham Coronary Heart Disease Prediction Scores. JAMA. 2001;286(2):180-187. DOI:10.1001/JAMA. 286.2.180.
[19] Shimabukuro M. Cardiac Adiposity and Global Cardiometabolic Risk New Concept and Clinical Implication. Circulation Journal 2009;73:27-34.
[20] Silaghi A, Piercecchi-Marti MD, Grino M, et al. Epicardial Adipose Tissue Extent: Relationship with Age, Body Fat Distribution, and Coronaropathy. Obesity 2008;11(16):2424-2430.
[21] Taguchi R, Takasu J, Itani Y, Yamamoto R, Yokoyama K, Watanabe S, Masuda Y. Pericardial fat accumulation in men as a risk factor for coronary artery disease. Atherosclerosis 2001;157:203-209.
[22] Sarin S, Wenger C, Marwaha A, Qureshi A, Go M, Woomert CA, Clark K, Nassef LA, Shirani J. Clinical Significance of Epicardial Fat Measured Using Cardiac Multislice Computed Tomography. Am J Cardiol 2008;102:767-771.
[23] Gorter PM, De Vos PM, van Der Graaf Y, Stella PR, Doevendans PA, Meijs L, Prokop, M, Visseren FL.J. Relation of Epicardial and Pericoronary Fat to Coronary Atherosclerosis and Coronary Artery Calcium in Patients Undergoing Coronary Angiography. Am J Cardiol 2008;102:380-385.
[24] Hubert HB, Feinleib M, Mcnamara PM, Castelli WP. Obesity as an Independent Risk Factor for Cardiovascular Disease: A 26-year Follow-up of Participants in the Framingham Heart Study. Circulation 1983;67;968-977.
[25] Gorter PM, Van Lindert R, De Vos AM, Meijs J, Graaf Y, Doevendans PA, Prokop M, Visseren FL.J. Quantification of epicardial and peri-coronary fat using cardiac computed tomography; reproducibility and relation with obesity and metabolic syndrome in patients suspected of coronary artery disease. Atherosclerosis 2008;197:896-903.
[26] Berliner JA, Navab M, Fogelman AM, Frank JS, Demer LL, Edwards PA, Watson AD, Lusis AJ. Atherosclerosis: Basic Mechanisms - Oxidation, Inflammation, and Genetics. Circulation 1995;91:2488-2496.
[27] Sundaram B, Patel S, Agarwal P, Kazerooni EA. Anatomy and Terminology for the Interpretation and Reporting of Cardiac MDCT: Part 2, CT Angiography, Cardiac Function Assessment, and Noncoronary and Extracardiac Findings. American Journal of Roentgenology 2009;192:584-598.
[28] Schoepf UJ, Becker CR, Ohnesorge BM, Yucel EK. CT of Coronary Artery Disease. Radiology 2004;22(1):18-37.
[29] Vogl TJ, Abolmaali ND, Diebold T, Engelmann K, Ay M, Dogan S, Wimmer-Greinecker G, Moritz A, Herzog C. Techniques for the Detection of Coronary Atherosclerosis: Multi–detector Row CT Coronary Angiography. Radiology 2002;233(1):212-220.
[30] Mahesh(2009). MDCT Physics:The Basics Technology, Image Quality and Radiation Dose (1st ed.). LWW
[31] Dey D, Suzuki Y, Suzuki S, Ohba M, Slomka PJ, Polk D, Shaw LJ, Berman DS. Automated Quantitation of Pericardiac Fat From Noncontrast CT. Invest Radiol 2008;43:145-153.
[32] Djaberi R, Schuijf JD, Van Werkhoven JM, Nucifora G, Jukema JW, Bax JJ. Relation of Epicardial Adipose Tissue to Coronary Atherosclerosis. Am J Cardiol 2008;102:1602-1607.
[33] Dey D, Wong ND, Tamarappoo B, Nakazato R, Gransar H, Cheng VY, Ramesh A, Kakadiaris I, Germano G, Slomka PJ, Berman DS. Computer-aided non-contrast CT-based quantification of pericardial and thoracic fat and their associations with coronary calcium and metabolic syndrome. Atherosclerosis 2010;209:136-141.
[34] Bauer RF, Thilo C, Chiaramida SA, Vogl TJ, Costello P, Schoepf UJ. Noncalcified Atherosclerotic Plaque Burden at Coronary CT Angiography: A Better Predictor of Ischemia at Stress Myocardial Perfusion Imaging than Calcium Score and Stenosis Severity. American Journal of Roentgenology 2009;193:410-418.
[35] Wang TZ, Lee WJ, Shih FY, Huang CH, Chang YC, Chen WJ, Lee YT, Chen MF. Relations of Epicardial Adipose Tissue Measured by Multidetector Computed Tomography to Components of the Metabolic Syndrome Are Region-Specific and Independent of Anthropometric Indexes and Intra abdominal Visceral Fat. J Clin Endocrinol Metab 2009;94:662-669.
[36] Sundaram B, Patel S, Agarwal P, Kazerooni EA. Anatomy and Terminology for the Interpretation and Reporting of Cardiac MDCT: Part 1, Structured Report, Coronary Calcium Screening, and Coronary Artery Anatomy. American Journal of Roentgenology 2009;192:574-581.
[37] Becker CR, Saam T. Evaluation of Coronary Atherosclerotic Plaques. Cardiol Clin 2009;27:611-617.
[38] Kunita E, Fujii T, Urabe Y, Tsujiyama S, Maeda K, Tasaki N, Sekiguchi Y. Coronary Plaque Stabilization Followed by Color Code Plaque Analysis with 64-Slice Multidetector Row Computed Tomography. Circ J 2009;73:772-775.
[39] Achenbach S, Moselewski F, Ropers D, Ferencik M, Hoffmann U, MacNeill B, Pohle K, Baum U, Anders K, Jang IK, Daniel WG, Brady TJ. Detection of Calcified and Noncalcified Coronary Atherosclerotic Plaque by Contrast- Enhanced, Submillimeter Multidetector Spiral Computed Tomography A Segment-Based Comparison With Intravascular Ultrasound. Circulation 2004;109:14-17.
[40] Konishi M, Sugiyama S, Sugamura K, Nozaki T, Ohba K, et al. Association of pericardial fat accumulation rather than abdominal obesity with coronary atherosclerotic plaque formation in patients with suspected coronary artery disease. Atherosclerosis 2010;209:573-578.
[41] Ding J, Kritchevsky SB, Harris TB, et al. The Association of Pericardial Fat with Calcified Coronary Plaque. Obesity 2008;16(8):1914-1919.

電子全文 電子全文(本篇電子全文限研究生所屬學校校內系統及IP範圍內開放)
連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top