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研究生:謝緯穎
研究生(外文):Wei Ying Hsieh
論文名稱:紅斑性狼瘡患者中醫辨證與甲褶微血管形態之關聯性探討
論文名稱(外文):The association of TCM pattern identification and nailfold capillary morphology in SLE patients
指導教授:張恒鴻張恒鴻引用關係
指導教授(外文):H. H. Chang
學位類別:碩士
校院名稱:長庚大學
系所名稱:中醫學系傳統中醫學
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
論文頁數:103
中文關鍵詞:全身性紅斑性狼瘡甲褶鏡中醫辨證雷諾氏現象中醫疾病辨證分類編碼系統
外文關鍵詞:Systemic lupus erythematosus (SLE)Nailfold capillaroscopyTCM pattern identificationRaynaud’s phenomenonB-code recording system
相關次數:
  • 被引用被引用:2
  • 點閱點閱:610
  • 評分評分:
  • 下載下載:70
  • 收藏至我的研究室書目清單書目收藏:1
本研究探討全身性紅斑狼瘡(SLE)患者中醫證型與其甲褶微循環血管形態及臨床症狀之的關係,期望能有助於確定診斷,並對於全身性紅斑狼瘡的中醫辨證提供形態學上之證據。我們採用中醫辨證問卷,結合中醫疾病辨證分類編碼系統(B-code)進行紀錄,並利用甲褶微循環形態學定量性描述(Quantitative Nailfold Capillaroscopic Morphology Description,QNCMD)分析微循環影像,並探討中醫證型與微循環異常指標之間的關係。
研究結果顯示甲褶微循環形態表現為狼瘡型(SLE pattern)之病患,出現「鬱滯」證的機率較高,且紅斑狼瘡皮膚異常症狀與「鬱滯」證顯著相關;而「濕熱」證與微血管變長與變寬(Enlarged Dimensions of Capillaries)的程度有相關之趨勢,並且微血管變長與變寬和蛋白尿之有無具有顯著相關。
甲褶微循環形態分析可能有助於全身性紅斑狼瘡病人之中醫辨證,值得進一步研究。
The relationship between systemic lupus erythematosus (SLE) traditional Chinese medicine (TCM) pattern identification and the morphology of nailfold capillary and clinical syndrome were discussed in this study. These results were expected to assist the diagnosis of SLE and to provide the morphological evidence for TCM pattern identification. The questionnaire of TCM combined with B-code recording system and the morphological images of nailfold capillary which were analyzed by quantitative nailfold capillaroscopic morphology description objectively were performed to discuss the relationship between the TCM pattern identification and the abnormal morphology in SLE patients.
The results revealed that the nailfold capillary in patients with SLE pattern were found with stagnation pattern, classified by TCM, more frequently. In addition, the skin symptoms were found significantly correlated to the stagnation signature. Moreover, the damp heat pattern was found with trend correlated to the degree of Enlarged Dimensions of Capillaries. Furthermore, the degree of Enlarged Dimensions of Capillaries was found significantly correlated with the degree of proteinuria. These results indicated that the SLE patient’s morphological analysis of nailfold capillary may be helpful for TCM pattern identification and worth for further study.
目 錄
指導教授推薦書
口試委員會審定書
授權書iii
誌謝v
中文摘要vi
英文摘要vii
目錄viii
第一章 研究背景與研究目的1
第二章 文獻回顧3
2.1全身性紅斑狼瘡的現代醫學述3
2.1.2全身性紅斑狼瘡的流行病學3
2.1.3全身性紅斑狼瘡之病因4
2.1.4全身性紅斑狼瘡之臨床表徵與診斷6
2.1.5全身性紅斑性狼瘡的治療8
2.1.6全身性紅斑性狼瘡疾病活動度量表10
2.2全身性紅斑狼瘡之中醫論述12
2.2.1全身性紅斑狼瘡之中醫病名12
2.2.2全身性紅斑狼瘡之中醫病因病機13
2.3甲褶鏡…14
2.4甲褶微循環形態學定量性描述22
2.5甲褶鏡在中醫臨床的相關研究探討23
2.6微循環基本生理與相關影響因素26
2.7全身性紅斑狼瘡與微循環的關係27
2.8全身性紅斑狼瘡之中醫辨證28
第三章 材料與方法30
3.1全身性紅斑狼瘡患者之篩選30
3.2實驗方法與步驟31
3.3統計方法33
第四章 結果34
4.1 SLE患者之基本資料34
4.2甲褶微循環血管形態34
4.3臨床檢查35
4.4 SLEDAI九項臨床症狀表現35
4.5中醫證型分析35
4.6蛋白尿檢測與各變項分析35
4.7血管形態分析結果與各變項分析36
第五章討論37
5.1中醫證型分析37
5.2 臨床資料分析39
5.3 SLE血管形態與各種變異項關係性分析40
5.4 SLE腎炎與非腎炎病人44
5.5 SLE與雷諾氏症候群之有無44
5.6 研究限制47
第六章結論48
參考文獻50
附錄58

圖 目 錄
圖一研究架構圖2
圖二研究流程圖31
圖三正常的甲褶微血管形態61
圖四硬皮症早期甲褶微血管形態61
圖五硬皮症活動期甲褶微血管形態62
圖六硬皮症後期甲褶微血管形態62
圖七狼瘡型 (SLE pattern)之甲褶微血管形態63
圖八乳突下靜脈叢之甲褶微血管形態63
圖九陽虛夾有厥症之證型甲褶微循環形態64
圖十血虛或血瘀或氣血兩虛之證型甲褶微循環形態64

表 目 錄
表一The definition of nailfold capillaroscopic patterns based on
quantitative nailfold capillaroscopic observation65
表二CTDs with RP67
表三 SLE 40例之基本資料68
表四 SLE 40例之甲褶微血管形態分析69
表五 SLE 40例之臨床檢查70
表六 SLE 40例之SLEDAI臨床症狀分佈71
表七 SLE 40例之中醫證型72
表八之一 SLE患者蛋白尿檢測與基本資料之交叉表73
表八之二 SLE患者蛋白尿檢測與血管形態之交叉表74
表八之三 SLE患者蛋白尿檢測與皮膚與免疫指標異常之交叉表75
表八之四 SLE患者蛋白尿檢測與SLEDAI臨床症狀之交叉表76
表八之五 SLE患者蛋白尿檢測與中醫證型之交叉表77
表九之一 SLE患者血管形態分析結果與基本資料之交叉表78
表九之二 SLE患者血管型態分析結果與臨床症狀之交叉表79
表九之三 SLE患者血管型態分析結果與中醫證型之交叉表80
表十之一 SLE患者氣虛證與臨床症狀分佈之交叉表81
表十之二 SLE患者鬱滯證與血管形態分佈之交叉表82
表十之三SLE患者濕熱證與血管形態分佈之交叉表83
表十之四SLE患者卡方檢定Lambda分析83
表十一之一 SLE患者Ramified與臨床症狀分佈之交叉表84
表十一之二 SLE患者Ramified與中醫證型分佈之交叉表85
表十二之一 SLE患者雷諾氏症與SLEDAI臨床症狀分佈之交叉表86
表十二之二 SLE患者雷諾氏症與中醫證型分佈之交叉表87
表十二之三SLE患者有無雷諾氏症與血管形態之交叉表88
表十二之四SLE患者年齡與血管形態之交叉表89
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