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研究生:蔡博宇
研究生(外文):Po-Yu Tsai
論文名稱:基質細胞衍生因子-1與血液透析患者的發炎及營養標記之關聯性
論文名稱(外文):Stromal Cell-Derived Factor-1 is Associated with Inflammatory and Nutritional Markers in Hemodialysis Patients
指導教授:張浤榮張浤榮引用關係
指導教授(外文):Horng-Rong Chang
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:醫學研究所
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:2017
畢業學年度:105
語文別:中文
論文頁數:30
中文關鍵詞:基質細胞衍生因子-1血液透析發炎
外文關鍵詞:Stromal cell derived factor- 1hemodialysisinflammation
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研究背景:基質細胞衍生因子(stromal cell-derived factor 1,SDF-1)的功能為在腎臟損傷時維持組織新生及再生恆定,然其對血液透析(HD)患者的效應尚未明瞭。
研究方法:本研究於2007年12月收錄152名血液透析患者,並持續追蹤至2012年12月。基質金屬蛋白酵素(matrix metalloproteinase-2/-9,MMP-2/-9)、骨髓過氧化酶(myeloperoxidase,MPO)、骨橋蛋白(osteopontin)及SDF-1利用酵素結合免疫吸附分析法測量;老人營養風險指標(Geriatric Nutritional Risk Index,GNRI)分數之計算方法為利用下列公式修正老年患者的營養風險指標:GNRI = [14.89 x 白蛋白(g/dL)] + [41.7 x(體重/理想體重)]。收錄五十名腎功能正常者作為對照組。
研究結果:對照組受試者平均年齡為40.06 ± 16.54歲,平均血清肌酸酐為0.76 ± 0.17 mg/dl;血液透析患者平均年齡為58.7 ± 14.07歲。相較於對照組,HD組的SDF-1(2946.62 ± 1314.2 pg/ml vs. 2242.99 ± 607.84 pg/ml, p<0.001)與MPO(64.9 ± 24.15 ng/ml vs. 55.39 ± 15.01 pg/ml, p = 0.012)較高,但骨橋蛋白(21.35 ± 41.02 ng/ml vs. 90.46 ± 130.87 ng/ml, p=0.017)、MMP-2(455.89 ± 175.15 ng/ml vs. 517.8 ± 220.86 ng/ml, p=0.077)與MMP-9(334.24 ± 179.18 ng/ml vs. 1165.05 ± 545.07 ng/ml, p<0.001)較低;SDF-1濃度與MMP-2(r = 0.31, p < 0.001)、MMP-9(r = 0.19, p = 0.021)、MPO(r = 0.532, p<0.001)及骨橋蛋白(r = 0.31, p<0.001)呈正相關,其與白蛋白(r = -0.192, p = 0.018)、GNRI分數(r = -0.227, p = 0.007)及標準化蛋白質代謝率(normalized protein catabolic ratio,nPCR)(r = -0.21, p = 0.012)呈負相關。
結論:SDF-1可能影響血液透析患者的發炎及營養狀態,然仍須進一步研究來探討。
Background:
Stromal cell-derived factor 1 (SDF-1) functions to maintain homeostatic tissue renewal and regeneration upon renal injury but its effects were not clear on hemodialysis (HD) patients.

Methods:
In December 2007, 152 HD patients were enrolled and received follow up until December 2012. Matrix metalloproteinase-2/-9 (MMP-2/-9), -myeloperoxidase (MPO), osteopontin and SDF-1 were measured by enzyme linked immunosorbent assay. The Geriatric Nutritional Risk Index (GNRI) score was calculated by modifying the Nutritional Risk Index for elderly patients based on the following formula: GNRI = [14.89 x albumin (g/dL)] + [41.7 x (body weight / ideal body weight)]. Fifty persons with normal renal function were enrolled as a control group.

Results:
The average age of the control group was 40.06±16.54 years old and the average serum creatinine was 0.76±0.17 mg/dl. The average age of HD patients was 58.7±14.07 years old. As compared with control group, the HD group had higher SDF-1 (2946.62±1314.2 pg/ml vs. 2242.99±607.84 pg/ml, p<0.001) and MPO (64.9±24.15 ng/ml vs. 55.39±15.01 pg/ml, p=0.012), but lower osteopontin (21.35±41.02 ng/ml vs. 90.46±130.87 ng/ml, p=0.017), MMP-2 (455.89±175.15 ng/ml vs. 517.8±220.86 ng/ml, p=0.077) and MMP-9 (334.24±179.18 ng/ml vs. 1165.05± 545.07 ng/ml, p<0.001 ). SDF-1 level indicated-positive correlations with MMP-2 (r = 0.31, p < 0.001), MMP-9 (r = 0.19, p = 0.021), MPO (r = 0.532, p<0.001) and oeteopontin (r=0.31, p<0.001), and negative correlations with albumin (r=-0.192, p=0.018), GNRI score (r=-0.227, p=0.007), and normalized protein catabolic ratio (r =-0.21, p = 0.012).

Conclusions:
SDF-1 may have a role in influencing the inflammation and nutrition status of HD patients but further studies are necessary to investigate this possibility.
第一章 緒論 1
第二章 研究設計 5
第一節 材料與方法 5
第二節 統計分析 7
第三章 研究結果 8
第四章 討論 13
第五章 結論 18
參考文獻 19
表格目錄
表 1. Demographic and clinical characteristics of the patients-------------------------------------------16
表 2. Correlation between SDF-1 and clinical and laboratory parameters. ----------------------------19

圖目錄
圖1. The differences inMMP-2, MMP-9, Osteoportin, and MPO between HD patients and patients in the control group. -------------------------------------------------------17
圖2. The SDF-1 level is higher in HD patients than in those of the control group ---------------------------18
圖3. SDF-1與Albumin之關聯性----------------------------21
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