臺灣博碩士論文加值系統

研究背景：第二型糖尿病 (T2DM) 是一種進展性的代謝疾病，其中有相當多的糖尿病患儘管服用降糖藥物仍無法維持血糖目標。腎素-血管收縮素系統(RAS)被認為與胰島素阻抗的發展有關，之前的研究也顯示腎素-血管收縮素系統（RAS）抑制可能會改善葡萄糖代謝。

研究目的：在標準降糖治療的基礎上添加腎素-血管收縮素系統（RAS）抑制劑可能改善第二型糖尿病 (T2DM) 病患者的血糖控制

研究方法：這項前瞻性世代研究調查了將腎素-血管收縮素系統（RAS）抑製劑Valsartan添加入標準降糖治療中對糖尿病患者血糖控制、血壓和血脂的影響。
收案標準是在研究收案時接受Metformin治療的第二型糖尿病(T2DM)成年人。對照組在無降壓藥物的情況下繼續接受Metformin治療，而實驗組在接受Metformin治療的基礎上額外服用80毫克的Valsartan。

研究結果：這項研究招募了203名患有第二型糖尿病(T2DM)的受試者，透過共同決策方式將他們分配到不同的治療組。在治療了24週後，接受額外Valsartan治療的受試者顯示出較低的平均糖化血色素（HbA1c）水平（6.22％ vs 6.77％，P < 0.001），收縮壓（123 mm Hg vs 131 mm Hg，P < 0.001），舒張壓（73.6 mm Hg vs 77.4 mm Hg，P = 0.009），以及降低的低密度脂蛋白膽固醇水平（81 mg/dL vs 91.3 mg/dL，P = 0.0024），相較於接受Metformin單一療法的受試者。

研究限制：本研究為非隨機設計，可能會導致臨床結果的潛在偏差[13]。此外，觀察時間為24周可能不能代表長期結果，而且腎素-血管收縮素系統（RAS）抑制對血糖控制的有效性可能需要進一步研究，並具有更長的觀察時間。並且，飲食和生活習慣在血糖控制中起了重要的作用，所以兩組之間觀察到的血清糖化血色素(HbA1c)差異可能不僅僅是由於腎素-血管收縮素系統（RAS）抑制所引起的。

研究結論：第二型糖尿病患者合併有高血壓，使用Metformin 藥物治療無法達到適當的血糖控制，腎素-血管收縮素系統（RAS）抑制劑會是可行的選擇。

 

Background
Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder in which a considerable number of affected patients cannot maintain glycemic goals despite glucose-lowering medications. The renin-angiotensin system (RAS) has been implicated in the development of insulin resistance, and preceding studies suggest that RAS inhibition may improve glucose metabolism.

Objective
The investigators hypothesized that the addition of RAS inhibitors to standard glucose-lowering therapy may improve glycemic control in patients with T2DM.

Methods
This prospective study investigates the effect of adding the RAS inhibitor Valsartan to standard glucose-lowering therapy on glycemic control, blood pressure, and plasma lipid profile in diabetic patients. Inclusion criteria were adults with T2DM who were receiving metformin therapy at study enrolment. The control group continued metformin therapy without antihypertensive drug, whereas the experimental group received 80 milligrams of Valsartan in addition to metformin therapy.

Results
The study enrolled 203 participants with T2DM who were assigned to the treatment groups by shared decision making. After 24 weeks of therapy, participants receiving additional Valsartan demonstrated lower mean serum glycosylated hemoglobin A1c (HbA1c) (6.22% vs. 6.77%, P < 0.001), systolic blood pressure (123 mm Hg vs. 131 mm Hg, P < 0.001), diastolic blood pressure (73.6 mg Hg vs. 77.4 mm Hg, P = 0.009), and reduced low-density lipoprotein cholesterol levels (81 mg/dL vs. 91.3 mg/dL, P = 0.0024) compared to recipients of metformin monotherapy.

Limitations
The non-randomized design can lead to potential bias in the clinical findings[13]. Furthermore, the observation time of 24 weeks may not be representative of long-term outcomes, and the efficacy of RAS inhibition on glycemic control may require future studies with a longer observation time. Furthermore, dietary habits play an essential role in glycemic control, and the observed difference in serum HbA1c between treatment cohorts may not arise solely from RAS inhibition.

Conclusion
RAS inhibition may be a feasible option for diabetic patients with concomitant hypertension who are inadequately controlled with pharmacologic regimens involving metformin.

謝 誌 (致謝) --------------------------------------------------------------------- I
中文摘要-------------------------------------------------------------------------- II
英文摘要------------------------------------------------------------------------- IV
英文縮寫全名與中英文對照表---------------------------------------------- VI
表目錄---------------------------------------------------------------------------- IX
圖目錄----------------------------------------------------------------------------- X
第一章 緒論-----------------------------------------------------------------------1
第一節 研究背景與動機-------------------------------------------------- 3
第二節 研究目的----------------------------------------------------------- 5
第二章 文獻探討
第一節 糖尿病與併發症-------------------------------------------------- 6
第二節 糖尿病與腎素-血管收縮素系統（RAS）之間的關聯----- 7
第三節 腎素-血管收縮素系統（RAS）作用機轉--------------------- 8
第四節 腎素-血管收縮素系統（RAS）機轉與血糖的關聯性------ 10
第三章 研究設計
第一節 受試者選擇-------------------------------------------------------11
第二節 研究方案----------------------------------------------------------12
第三節 結果分析----------------------------------------------------------13
第四節 倫理聲明----------------------------------------------------------14
第五節 統計分析----------------------------------------------------------15
第四章 研究結果----------------------------------------------------------------16
第五章 討論--------------------------------------------------------------------- 18
第六章 研究限制--------------------------------------------------------------- 21
第七章 結論與建議------------------------------------------------------------ 22
參考文獻-------------------------------------------------------------------------- 23

 
表目錄

表格1 參加研究的參與者的基準特徵------------------------------------ 26
表格2 藥物治療24週後臨床參數的變化-------------------------------- 27
表格3 治療24週後達到血糖目標的勝算比----------------------------- 28

 
圖目錄

圖一 腎素-血管收縮素系統機轉------------------------------------------- 29
圖二 與腎素-血管收縮素系統相關有利於降血糖的機轉------------- 30
圖三 研究流程圖--------------------------------------------------------------- 31
圖四 腎素-血管收縮素系統抑制與血清糖化血紅蛋白水平相互作用的敏感性分析----------------------------------------------------------- 32

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