跳到主要內容

臺灣博碩士論文加值系統

(44.211.239.1) 您好!臺灣時間:2023/01/31 06:20
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

: 
twitterline
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:1
  • 點閱點閱:507
  • 評分評分:
  • 下載下載:60
  • 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
1.Lin, K. M., T. T. Cheng, et al. "Clinical Applications of Nailfold Capillaroscopy in Different Rheumatic Diseases." J Int Med of Taiwan 20: 238-247, 2009.
2.Gallucci, F., R. Russo, et al. "Indications and results of videocapillaroscopy in clinical practice." Advances in medical sciences 53(2): 149-157, 2008.
3.Cutolo, M., C. Pizzorni, et al. "Nailfold video-capillaroscopy in systemic sclerosis." Zeitschrift fur Rheumatologie, 63(6): 457-462,2004.
4.Wu, P. C., M. N. Huang, et al. "Diagnostic value of nailfold capillaroscopy to systemic sclerosis with Raynaud’s phenomenon: a preliminary study." Journal of Rheumatology ROC ,23(2): 37-42,2009.
5.Lambova, S. N. and U. Meller-Ladner "The specificity of capillaroscopic pattern in connective autoimmune diseases. A comparison with microvascular changes in diseases of social importance: arterial hypertension and diabetes mellitus." Modern rheumatology ,19(6): 600-605,2009.
6.Wu ,P.C, Huang, M.N et al., "Clinical Applicability of Quantitative Nailfold Capillaroscopy in Differential Diagnosis of Connective Tissue Diseases with Raynaud's Phenomenon." Journal of the Formosan Medical Association [accepted], 2012.
7.Kuryliszyn-Moskal, A., P. A. Klimiuk, et al. "Vascular endothelial growth factor in systemic lupus erythematosus: relationship to disease activity, systemic organ manifestation, and nailfold capillaroscopic abnormalities." Archivum immunologiae et therapiae experimentalis ,55(3): 179-185,2007.
8.Furtado, R. N. V., M. L. C. Pucinelli, et al. "Scleroderma-like nailfold capillaroscopic abnormalities are associated with anti-U1-RNP antibodies and Raynaud's phenomenon in SLE patients." Lupus, 11(1): 35-41,2002.
9.Riccieri, V., A. Spadaro, et al. "Nailfold capillaroscopy changes in systemic lupus erythematosus: correlations with disease activity and autoantibody profile." Lupus ,14(7): 521-525, 2005.
10.Christen-Zaech, S., R. Seshadri, et al. "Persistent association of nailfold capillaroscopy changes and skin involvement over thirty six months with duration of untreated disease in patients with juvenile dermatomyositis." Arthritis &; Rheumatism ,58(2): 571-576,2008.
11.劉佳祐,〈紅斑性狼瘡之中醫證治歸類研究〉,長庚大學傳統中醫學研究所碩士論文,民國98年
12.Greenberg, B. and M. Michalska. "Systemic lupus erythematosus. Measures to keep this unpredictable disease under control." Postgraduate medicine ,106(6): 213,1999.
13.Laliita, R. G.Systemic Lupus Erythematosus. 2nd ed. Ed. Lahita RG. New York, 1992;NY: Churchill Livingstone,D.A., Michael. M., Ward. TM., &; Bush R. "Socieconomic status and health in women with systemic lupus erythematosus." The Journal of Rheumatology.25.(9), 1720-1729,1998.
14.Osler, W. "On the Visceral Complications Op Erythema Exudativum Multiforme." The American Journal of the Medical Sciences, 110(6): 629,1895.
15.Lam, G. and M. Petri. "Assessment of systemic lupus erythematosus." Clinical and experimental rheumatology ,23(5): 120,2005.
16.Mok, C. and C. Lau. "Lupus in Hong Kong Chinese." Lupus ,12(9): 717,2003.
17.Abu-Shakra, M., R. Mader, et al. "Quality of life in systemic lupus erythematosus: a controlled study." The Journal of rheumatology, 26(2): 306,1999.
18.Blanco, F., J. Gomez-Reino, et al. (1998). "Survival analysis of 306 European Spanish patients with systemic lupus erythematosus." Lupus 7(3): 159-163.
19.黃惠娟等,〈門診紅斑狼瘡患者失能狀況、生活型態與生活品質之相關性探討〉,國立台北護理學院護理研究所,碩士論文,2004
20.林文香等,〈全身性紅斑狼瘡患者之求醫行為及其影響因素探討〉,《公共衛生》,第二十卷第三期,頁265-276,民國82 年
21.Danchenko, N., J. Satia, et al. "Epidemiology of systemic lupus erythematosus: a comparison of worldwide disease burden." Lupus 15(5): 308-318,2006.
22.Klippel, J. H. Primer on the rheumatic diseases,Springer Verlag,2007.
23.Kasper D.L, Braunwald E, et al. "Harrison's principles of Internal medicine." 16th ed. New York: McGraw Hill,2005.
24.Firestein, G. S. Kelley's textbook of rheumatology, 8th ed.,Chapter 74: pathogenesis of systemic lupus erythematosus,2008.
25.Lam, G. and M. Petri "Assessment of systemic lupus erythematosus." Clinical and experimental rheumatology 23(5): 120,2005.
26.虞有梅、白淑英,〈全身性紅斑狼瘡之臨床治療〉,《長庚藥學年報》,十二卷一期,頁5-8,九十四年
27.Curtis, J. R., A. O. Westfall, et al. "Population-based assessment of adverse events associated with longterm glucocorticoid use." Arthritis Care &; Research 55(3): 420-426,2006.
28.Chee-Seng Yee, et al."The use of Systemic Lupus Erythematosus Disease Activity Index-2000 to define active disease and minimal clinically meaningful change based on data from a large cohort of systemic lupus erythematosus patients". Rheumatology, 50:982-988, 2011.
29.Petri. ML. Oenovese. ML. Engle. E., &; Hochberg. ML "Definition. Incidence, and clinical description of flare in systemic lupus eiytheniatosus. A Prospective Chort Study."Arthritis and Rheumatism, 34(8), 937-944,1991.
30.Bombardier, C., D. D. Gladman, et al. "Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE." Arthritis Rheum 35(6): 630-40,1992.
31.Abrahamowicz, M., P. R. Fortin, et al. "The relationship between disease activity and expert physician's decision to start major treatment in active systemic lupus erythematosus: a decision aid for development of entry criteria for clinical trials." J Rheumatol 25(2): 277-84,1998.
32.黃春明、周昌德,〈感染與紅斑狼瘡疾病活動性之關連〉,《中國醫藥學院雜誌》,1(1),頁55-57,1992
33.劉秉昭,〈路志正教授運用經方治療紅斑狼瘡的經驗〉,《中國中醫藥信息雜誌》,第八卷第十一期,頁72-73,民國90 年
34.眭書魁,馬秀清,董燕平等,〈紅斑狼瘡的中醫病名研究〉,《河北中醫》,24(l):66-67,2002年
35.朱仁康,〈臨床經驗集〉,《人民衛出版社》,頁173-175,2005年
36.方福根,〈中西醫結合治18例系統性紅斑狼瘡臨床分析〉,《江西中醫藥》,(6):41~42,1999
37.陳潮祖,〈病機源流〉,《中醫治法與方劑》,《人民衛生出版社》,民國84 年
38.謝慶良、靳瑞,〈針灸與微循環:文獻探討〉,《中華針灸醫學會雜誌》,61-68,2003。
39.Lefford, F. and J. Edwards "Nailfold capillary microscopy in connective tissue disease: a quantitative morphological analysis." Annals of the rheumatic diseases,45(9): 741-749,1986.
40.Bukhari, M., S. Hollis, et al. "Quantitation of microcirculatory abnormalities in patients with primary Raynaud's phenomenon and systemic sclerosis by video capillaroscopy." Rheumatology ,39(5): 506-512,2000.
41.Kabasakal, Y., D. Elvins, et al. "Quantitative nailfold capillaroscopy findings in a population with connective tissue disease and in normal healthy controls." Annals of the rheumatic diseases, 55(8): 507-512,1996.
42.Boin, F. and A. Rosen . "Autoimmunity in systemic sclerosis: current concepts." Current rheumatology reports ,9(2): 165-172,2007.
43.Facina, A. S., M. L. C. Pucinelli, et al. "Capillaroscopy findings in lupus erythematosus." Anais brasileiros de dermatologia, 81(6): 527-532,2006.
44.阿依古力等,〈系統性紅斑狼瘡患者甲皺微循環與抗中性粒細胞漿抗體的關係〉,《新疆醫科大學學報》,29 (9),2006.
45.Kuryliszyn-Moskal, A., P. A. Klimiuk, et al. "Vascular endothelial growth factor in systemic lupus erythematosus: relationship to disease activity, systemic organ manifestation, and nailfold capillaroscopic abnormalities." Archivum immunologiae et therapiae experimentalis 55(3): 179-185,2007.
46.Gorska, A., O. Kowal-Bielecka, et al. "Impairment of microcirculation in juvenile idiopathic arthritis-studies by nailfold videocapillaroscopy and correlation with serum levels of sICAM and VEGF." Folia Histochemica et Cytobiologica 46(4): 443-447,2008.
47.Cutolo, M., C. Pizzorni, et al. "Nailfold video-capillaroscopy in systemic sclerosis." Zeitschrift fur Rheumatologie ,63(6): 457-462,2004.
48.Dolezalova, P., S. Young, et al. "Nailfold capillary microscopy in healthy children and in childhood rheumatic diseases: a prospective single blind observational study." Annals of the rheumatic diseases 62(5): 444-449,2003.
49.Aguiar, T., E. Furtado, et al. "Nailfold videocapillaroscopy in primary Sjögren’s syndrome." Angiology ,57(5): 593-599,2006.
50.廖偉敦,〈使用甲襞微循環影像辨識技術診斷紅斑性狼瘡與硬皮症之研究〉,靜宜大學資訊管理碩士論文,民國97年。
51.張晨等,〈系統性紅斑狼瘡的舌尖微循環觀察〉,《臨床軍醫雜誌》,37(3),2009。
52.陳志偉、顧美華、鄧迎蘇、錢起、強紅偉、王鳴軍,〈系統性紅斑狼瘡“證”與磷脂抗體及微循環研究〉,《上海中醫藥雜誌》,(10):19-20,2002 。
53.吳瑞勤等,〈活血化瘀與辨證分型治療系統性紅斑狼瘡〉,《華中醫學雜誌》,第25 卷第2 期,2001 年。
54.Guyton, A. C. and J. E. Hall . Textbook of medical physiology, Saunders Philadelphia, PA. A. pp.170-193,1991.
55.Szekanecz, Z. and Y. Shoenfeld. "Lupus and cardiovascular disease: the facts." Lupus ,15(11): 3-10, 2006.
56.沈思鈺、張永文、堯茹冰、董曉蕾、郭郡浩、胡冰、趙凌杰、蔡輝,〈中醫絡病理論與系統性紅斑狼瘡危象的証治關係〉,《貴陽中醫學院學報》,29(2):6-8,2006。
57.張恒鴻等,〈中醫疾病辨證編碼之研究〉,《中醫藥雜誌》,第十一卷第三期,頁123-128,民國89 年
58.洪裕強等,〈中西結合治療全身性紅斑性狼瘡病例報告〉,J Chin Med 20(1,2): 87-96, 2009.
59.戈莉莉等,〈103例急性腎炎甲褶微循環觀察與40例活血化瘀治療〉,《貴陽中醫學院學報》,4:25-28,1987。
60.劉志杰,〈傷寒論師承課堂實錄〉,《人民軍醫出版社》,頁268-292,2008。
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