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研究生:楊燕萍
研究生(外文):YANG, YEN-PING
論文名稱:慢性B型肝炎患者血清維生素D3濃度與B型肝炎病毒量之相關性研究
論文名稱(外文):The study of correlation between serum vitamin D3 concentrations and HBV DNA levels in chronic hepatitis HBV
指導教授:吳牧臻吳牧臻引用關係
指導教授(外文):Wu, Mu-Chen
口試委員:柯萬盛陳淑齡
口試委員(外文):Ko, Wang-shengChen, Shu-Ling
口試日期:2017-06-02
學位類別:碩士
校院名稱:弘光科技大學
系所名稱:健康事業管理研究所
學門:商業及管理學門
學類:醫管學類
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:109
中文關鍵詞:慢性B型肝炎維生素DHBV DNA病毒量HBs表面抗原
外文關鍵詞:Chronic hepatitisVitamin DHBV DNAHBsAg
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目的:慢性B型肝炎是國人最常見的慢性肝病疾病,肝癌80%是B型肝炎帶原者,所以治療慢性B型肝炎是當前首要之務,目前治療B型肝炎只能抑制病毒而無法治癒,其因素很多,其中之一與宿主免疫失調有關,研究證實免疫與營養有關,其中維生素D證實與宿主免疫功能有關,研究也證實肝病的病程及預後與血清維生素D濃度有關。國內針對此研究甚少,故本研究目的為探討慢性B型肝炎血清維生素D3濃度與B型肝炎病毒量之相關性。
方法:本研究採橫斷面臨床研究,於2016年5月至9月間,在台灣中部海線地區某區域教學醫院之肝病門診,收集60名慢性B型肝炎病患,針對人口學特徵、血清維生素D3濃度、血液及生化檢查與B型肝炎病毒學之檢驗值,進行統計分析。
結果:慢性B型肝炎患者血清維生素D3平均濃度20.9±5.6 ng/mL,其中缺乏與不足狀態者達88.3%,足夠狀態只為11.7%。慢性B型肝炎患者之性別、身體質量指數(BMI)、HBs表面抗原量、丙胺酸轉胺酶(ALT)與血清維生素D3濃度有顯著相關性。慢性B型肝炎患者之血清維生素D3濃度、HBe抗原、HBs表面抗原量、丙胺酸轉胺酶(ALT)、天門冬胺酸轉胺酶(AST)與HBV DNA病毒量有顯著相關性,尤其是血清維生素D3濃度及HBs表面抗原量與HBV DNA病毒量。
結論:本研究證實血清維生素D3濃度與HBs表面抗原量和HBV DNA病毒量有相關性存在,所以應用維生素D3在臨床治療學是值得進一步研究及探討,或許未來維生素D3能成為合併治療的一環。
Aim: Chronic hepatitis B is one of the most common chronic diseases that affects our population. The 80% of hepatic cancer patients are carriers of hepatitis B virus, making treatment of chronic hepatitis B as a priority. So far, the management for hepatitis B is merely suppressing the virus without a total cure of the disease. There are a number of key factors which contribute to the poor treatment outcomes, such as the imbalance of host immunity, the nutritional status, and vitamin D levels. Previous literatures have shown a link between serum vitamin D concentration and the pathogenesis of hepatic diseases. Due to a lack of research in Taiwan, this study aims to explore the correlations between serum vitamin D3 concentration and HBV DNA levels in chronic hepatitis B patients.
Methods: This study utilises cross-sectional clinical studies. Between May and September of 2016, 60 chronic hepatitis B patients were collected from a liver disease clinic within a teaching hospital located in the mid coastal region of Taiwan. Data regarding demographics, serum vitamin D3 concentrations, blood cell analysis, biochemical tests and HBV DNA levels were collected and analysed.
Results: Chronic hepatitis B patients had a mean value of 20.9±5.6 ng/mL of serum vitamin D3 concentration. Up to 88.3% of patients were either deficient or insufficient, where only 11.7% of patients showed adequate vitamin D3 levels. The gender, BMI, hepatitis B surface antigen levels, and ALT levels are significantly relevant to serum vitamin D3 levels in chronic hepatitis B patients. Also, serum vitamin D3 concentrations, HBe status, HBs levels, ALT and AST levels are shows statistical significance with HBV DNA levels. In particular, serum vitamin D3 concentrations and hepatitis B surface antigen levels were strongly correlated with HBV DNA levels.
Conclusion: This study shows there is significant correlations between serum vitamin D3 concentrations with hepatitis B surface antigen levels and HBV DNA levels. Vitamin D3 status may become a factor in the multifaceted treatment of hepatitis B in the near future. Thus, supplementing vitamin D3 in the clinical management for these patients should be further studied.
目錄
誌謝 I
摘要 II
ABSTRACT IV
目錄 VI
表目錄 VIII
圖目錄 IX
縮寫表 X
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 6
第三節 名詞解釋 7
第二章 文獻探討 9
第一節 B型肝炎 9
第二節 維生素D之生理病理學及其疾病相關性 23
第三節 維生素D缺乏與肝臟疾病 35
第四節 維生素D與慢性B型肝炎 39
第三章 研究材料與方法 46
第一節 研究流程 46
第二節 研究架構 47
第三節 研究對象 48
第四節 研究變項與檢驗方法 50
第五節 資料處理與統計分析方法 62
第四章 研究結果 65
第一節 研究樣本之描述性統計 65
第二節 各研究變項與血清維生素D3濃度之統計分析 71
第三節 各研究變項與HBV DNA病毒量之統計分析 77
第五章 討論 84
第一節 慢性B型肝炎患者血清中維生素D3濃度之分佈 84
第二節 人口學特徵與血清維生素D3濃度之相關性 86
第三節 B肝病毒學指標、血液及生化檢查與維生素D3濃度之相關性 87
第四節 人口學特徵與B型肝炎病毒量之相關性 88
第五節 維生素D3濃度、B肝病毒學指標、血液及生化檢查與B型肝炎病毒量之相關性 89
第六章 結論與建議 92
第一節 研究結論 92
第二節 研究限制 94
第三節 研究建議 95
參考文獻 96
中文文獻 96
英文文獻 97
附錄 108
基本資料問卷 108
人體試驗委員會試驗同意書 109

表目錄
表1 維生素D體內濃度常用的標準 27
表2 人口學變項 50
表3 慢性B型肝炎患者之人口學基本特徵 67
表4 慢性B型肝炎患者之B肝病毒學指標、維生素D3、血液及生化檢查之分佈 70
表5 不同人口學特徵與血清中維生素D3濃度之統計分析 73
表6 B肝病毒學指標、血液及生化檢查與維生素D3之統計分析 76
表7 人口學特徵與HBV DNA病毒量之相關分析 78
表8 B肝病毒學指標、血液及生化檢查與HBV DNA病毒量之相關分析 80
表9 維生素D3與HBV DNA病毒量之相關分析 81
表10 HBV DNA病毒量與人口學特徵、B肝病毒學指標、血液及生化檢查之線性迴歸分析 83

圖目錄
圖1 B型肝炎自然病史 12
圖2 B型肝炎感染者致癌危險因子 15
圖3 維生素D的合成代謝過程與生理作用 24
圖4 維生素D缺乏相關性疾病 34
圖5 B型肝炎病毒致病機轉 40
圖6 維生素D之荷爾蒙功能 42
圖7 維生素D抗B型肝炎病毒之機轉 43
圖8 研究流程 46
圖9 研究架構 47
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