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研究生:陳麗娟
研究生(外文):Li-Chuan Chen
論文名稱:腹膜透析病患葉酸、維生素B-6及維生素B-12攝取狀況與認知功能的關係
論文名稱(外文):The Relationship Between Dietary Intake of Folate, Vitamin B-6 and Vitamin B-12 and Cognitive Function of Peritoneal Dialysis Patients
指導教授:魏燕蘭魏燕蘭引用關係
指導教授(外文):Ien-Lan Wei
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:護理學系
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:90
中文關鍵詞:腹膜透析認知功能同半胱胺酸維生素
外文關鍵詞:peritoneal dialysiscognitive functionhomocysteinevitamin
相關次數:
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血漿同半胱胺酸是心血管疾病的危險因子之一,同半胱胺酸亦被認為是造成認知功能障礙的危險因子。同半胱胺酸代謝須要葉酸、維生素B-6及維生素B-12的參與。腹膜透析病患常有營養不良及由透析液中流失水溶性維生素的情形。因此本研究以北部某醫學中心腹膜透析一個月以上的病患為研究對象,探討腹膜透析病患的認知功能狀況、血漿同半胱胺酸的濃度以及飲食中葉酸、維生素B-6與維生素B-12的攝取情形。研究工具為飲食攝取頻率問卷(Food Frequency Questionnaire)及簡短智能狀態測驗(Mini-Mental State Examination, MMSE)。共97位腹膜透析病患參與本研究,平均年齡54.1 ± 12.8歲,平均體重62.1 ± 13.4公斤,體位平均值為23.9 ± 4.1公斤/公尺2。MMSE量表平均得分為27.6 ± 3.4分,有認知功能障礙的受試者11位(11.4 %)。血漿同半胱胺酸濃度平均為26.5 ± 7.8 μmol/L(12.8~45.6 μmol/L),僅有5位病患在正常範圍,94.8 %病患血漿同半胱胺酸濃度>15 μmol/L。研究對象每日的熱量攝取為1798.5 ± 486 kcal,有69 %的熱量攝取量較建議量低。蛋白質每日攝取量69.3 ± 23.7 g,有60 %的攝取量低於建議量。每日由食物所攝取的葉酸為209.4 ± 145.2 μg,維生素B-6為1.4 ± 0.7 mg,維生素B-12為6.0 ± 6.4 μg。但有78位研究對象有服用維生素補充劑,每日總共由食物及補充劑所獲得的葉酸、維生素B-6及維生素B-12量為4151.6 ± 2154.9 μg,3.8 ± 3.4 mg及9.8 ± 8.9 μg。本研究的腹膜透析病患每日葉酸、維生素B-6及維生素B-12的總攝取量與MMSE量表得分無相關;血漿同半胱胺酸濃度與MMSE量表得分也無相關。血漿同半胱胺酸濃度與維生素B-6及維生素B-12的攝取量間無相關,但與每日葉酸總攝取量間有顯著負相關。研究結果顯示,參與本研究的腹膜透析病患的飲食攝取狀況不佳,除有60 %以上的受試者熱量及蛋白質的攝取量分別低於其建議量外,受試者無法單由飲食的食物中獲得足夠量的葉酸及維生素B-6,但仍有將近20 %受試者沒有補充這些維生素;甚者,將近95 %的受試者血漿同半胱胺酸濃度高於正常值,11 %有認知功能障礙,是值得關注的健康議題。
Plasma homocysteine is a risk factor for cardiovascular disease and cognitive dysfunction. The metabolism of homocysteine requires folic acid, vitamin B-6 and vitamin B-12. However, peritoneal dialysis patients are usually malnourished and deficient in water-soluble vitamins. This study examined the cognitive function, plasma level of homocysteine and dietary intake of folic acid, vitamin B-6 and vitamin B-12 of peritoneal dialysis patients who received the dialysis treatment for more than one month. Food Frequency Questionnaire and Mini-Mental State Examination instruments were used in the study. Total 97 peritoneal dialysis patients participated in the study. The mean age was 54.1 ± 12.8 years old. Although the average score of MMSE was 27.6 ± 3.4, there were 11 subjects (11.4%) with scores lower than 24 and suggested impaired cognitive function. Plasma homocysteine concentrations were 26.5 ± 7.8 μmol/L (12.8 ~ 45.6 μmol/L). There were only five subjects’ plasma homocysteine concentrations were in the normal range. About 95% of subjects had plasma homocysteine concentrations greater than 15 μmol/L. The average daily calorie and protein intake of subjects was 1798.5 ± 486 kcal and 69.3 ± 23.7 g, respectively. Daily intake of folic acid, vitamin B-6 and vitamin B-12 from diet was 209.4 ± 145.2 μg, 1.4 ± 0.7 mg and 6.0 ± 6.4 μg, respectively. There were 78 subjects who were taking vitamin supplements. The daily total intake of folic acid, vitamin B-6 and vitamin B-12 from diet as well as supplements was 4151.6 ± 2154.9 μg, 3.8 ± 3.4 mg and 9.8 ± 8.9 μg, respectively. There was no correlation between the daily total intake of folic acid, vitamin B-6 and vitamin B-12 and MMSE score of the subjects. The plasma concentrations of homocysteine did not correlate with the daily total intake of vitamin B-6 and vitamin B-12 of the subjects, but negatively correlated with daily total intake of folic acid. Results of this study indicated that the dietary intake condition of the subjects was poor. About 60% of the subjects did not meet the recommended intake levels of calorie and protein, respectively. All subjects could not obtain sufficient amount of folic acid and vitamin B-6 from their diet. However, there were about 20% of the subjects did not take vitamine supplements. Moreover, the health issues gave particular concern were that approximately 95% of the subjects had plasma homocysteine levels above normal and 11% of the subjects had impaired cognitive function.
誌謝 I
中文摘要 II
英文摘要 IV
目錄 VI
第一章 前言 1
第一節 動機與重要性 1
第二節 研究目的 3
第二章 文獻回顧 4
第一節 腹膜透析 4
第二節 透析病患的認知功能 6
第三節 同半胱胺酸與認知功能 8
一、腹膜透析病患高同半胱胺酸血症 8
二、高同半胱胺酸血症與認知功能 9
三、同半胱胺酸造成認知功能障礙的機轉 10
四、同半胱胺酸與葉酸、維生素B-6及維生素B-12 12
(一)葉酸 12
(二)維生素B-6 12
(三)維生素B-12 13
(四)同半胱胺酸 14
五、葉酸、維生素B-6、維生素B-12與同半胱胺酸的關係 15
六、葉酸、維生素B-6及維生素B-12與認知功能 17
第四節 腹膜透析病患葉酸、維生素B-6及維生素B-12的營養狀況 20
第三章 研究方法與工具 22
第一節 研究架構 22
第二節 研究方法 23
一、研究對象 23
二、研究人數 23
第三節 研究工具 25
一、人口學資料 25
二、飲食攝取頻率問卷 25
三、簡短智能狀態測驗(Mini-Mental State Examination;MMSE) 29
第四節 研究倫理的考量 31
第五節 資料處理與統計分析 32
第四章 結果 33
第一節 研究對象之基本資料 33
一、研究對象之個人特性 33
二、研究對象之腹膜透析特性 34
三、 研究對象之體位及血壓值 35
四、研究對象之生活習慣 36
五、研究對象之血液生化值 36
六、研究對象之合併症 37
第二節 研究對象之認知功能狀態 48
第三節 研究對象之營養素攝取情形 49
一、總熱量及三大營養素攝取狀況 49
二、維生素攝取狀況 50
三、各類食物攝取量及攝取頻次 57
第四節 血漿同半胱胺酸濃度與認知功能之關係 61
第五節 同半胱胺酸與飲食葉酸、維生素B-6、維生素B-12攝取量之關係 61
第六節 飲食中葉酸、維生素B-6、維生素B-12攝取量與認知功能之關係 61
第五章 討論 66
第六章 結論 72
第七章 研究限制及建議 73
參考文獻 74
附錄二 簡短智能狀態測驗 91
附錄一 飲食攝取頻率問卷
附錄二 簡短智能狀態測驗

圖目錄
圖 一、同半胱胺酸的代謝路徑 ........................................................................15
圖 二、研究架構圖 ......................................................................................... .... 22

表目錄
表一 研究對象之基本資料 39
表二 研究對象之基本資料 40
表三 研究對象之腹膜透析狀況 41
表四 研究對象之體位及血壓值 42
表五 研究對象之生活習慣 43
表六 研究對象之生活習慣 44
表七 研究對象之健康食品及維生素補充劑情形 45
表八 研究對象之血液生化值 46
表九 研究對象之合併症 47
表十 研究對象之MMSE得分 48
表十一 研究對象每日熱量、能量營養素、膳食纖維及膽固醇的攝取 53
表十二 研究對象每日飲食攝取各項營養素 54
表十三 研究對象補充劑葉酸、維生素B-6及維生素B-12攝取 55
表十四 研究對象有無額外補充葉酸、維生素B-6及維生素B-12攝取 56
表十五 研究對象每日各類食物攝取量 58
表十六 研究對象各類食物攝取頻次 59
表十七 研究對象年齡別蔬菜、水果攝取頻次 60
表十八 研究對象血漿同半胱胺酸濃度與認知功能之關係 62
表十九 研究對象同半胱胺酸與葉酸、維生素B-6及維生素B-12之關係 63
表二十 研究對象認知功能與人口學變相之關係 64
表二十一 研究對象認知功能與葉酸、維生素B-6及維生素B-12之關係 65


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