臺灣博碩士論文加值系統

中文摘要
目的：以非侵入性電腦斷層冠狀動脈血管攝影的方式，決定在新陳代謝症候群與非新陳代謝症候群者中，何項心血管疾病危險因子與亞臨床表現之冠狀動脈粥狀硬化有關。
研究方法：從2004年7月至2008年12月，共有550名沒有冠狀動脈疾病臨床證據的受試者，接受靜脈注射顯影劑電腦斷層冠狀動脈血管攝影及血液生化檢驗。
主要結果評估：亞臨床表現冠狀動脈粥狀硬化的定義為：有硬化鈣化斑塊存在於任何一部位，或冠狀動脈完全沒有鈣化斑塊，但有位於冠狀動脈前三分之一近端處的非鈣化斑塊。
研究結果：在所有550位受試者中，290位受試者（38％）符合新陳代謝症候群診斷標準。在以多變量分析方式中發現：符合新陳代謝症候群診斷本身即為與亞臨床表現冠狀動脈粥狀硬化之獨立相關因子（ 勝算比= 3.40，95％置信區間：2.34-4.96，P＜0.001 ）。多變量邏輯回歸分析顯示：在非新陳代謝症候群者，空腹血糖值 > 110 mg/dL / 診斷有糖尿病，是為亞臨床表現冠狀動脈粥狀硬化之獨立指標 （ 勝算比=1.40，95％置信區間：1.08-1.82，P＜0.05 ）。在新陳代謝症候群者中：血液中總膽固醇 / 高密度脂蛋白膽固醇的比值 > 4.2％，是為亞臨床表現冠狀動脈粥狀硬化之獨立指標（ 勝算比=4.44，95％置信區間：1.93-10.20，P＜0.001 ）。
結論：新陳代謝症候群與非新陳代謝症候群兩組受試者之於亞臨床表現冠狀動脈粥狀硬化的心血管疾病危險因子不同：對非新陳代謝症候群者與對新陳代謝症候群者個別而言，「空腹血糖值> 110 mg/dL / 診斷有糖尿病」和「血液中總膽固醇 / 高密度脂蛋白膽固醇的比值 > 4.2％」，分別為其亞臨床表現冠狀動脈粥狀硬化的獨立指標。

Abstract
Objective: To determine the risk factors associated with subclinical coronary atherosclerosis (CA) assessed by coronary computed tomographic angiography (CTA) in subjects with or without metabolic syndrome (MetS).
Research Design and Methods: Case-controlled, cross-sectional study in single medical center. From July 2004 to December 2008, 550 consecutive subjects without clinical evidences of coronary artery disease received contrast-enhanced coronary CTA. Recognition of MetSyn was based on the ethnicity-modified National Cholesterol Educational Program Adult Treatment Panel III (NCEP ATP-III) criteria. Any presence of coronary artery calcification (CAC) or, absence of CAC with noncalcified plaques among the proximal third major coronary artery segment(s) was defined as subclinical CA.
Results: In total 550 subjects, 290 (38%) subjects were defined with MetS. MetS as a whole was independently associated with subclinical CA in multivariate analysis (OR=3.40, 95% CI=2.34 to 4.96, P<0.001). Multivariate regression analysis revealed that fasting blood glucose?d110mg/dL or the diagnosis of diabetes mellitus was the independent indicator of subclinical CA in non-MetS subjects (OR=1.40, 95% CI=1.08 to 1.82, P<0.05) while total cholesterol (TC) / high density lipoprotein-cholesterol (HDL-C) ?d4.2% was the independent indicator of subclinical CA in MetS subjects (OR=4.44, 95% CI=1.93 to 10.20, P<0.001).
Conclusions: Risk factors of subclinical CA in coronary CTA are different between subjects with and without MetS. Fasting blood glucose?d110mg/dL / diagnosis of diabetes mellitus and TC/HDL-C?d4.2% are independent indicators for subclinical CA defined by coronary CTA study in non-MetS and MetS subjects respectively.

Key words: Metabolic syndrome, Cholesterol ratio, and Coronary atherosclerosis

Contents

Signature Page
Thesis Approval Form
Chinese Abstract -------------------------------------------------------------------------------- ⅰ
English Abstract --------------------------------------------------------------------------------- ⅲ
List of Tables ------------------------------------------------------------------------------------- v
Chapter 1 Introduction ----------------------------------------------------------------------- 1
Chapter 2 Methods --------------------------------------------------------------------------- 4
2.1. Study Population ------------------------------------------------------------------- 5
2.2. Definition of Metabolic Syndrome (MetS) ------------------------------------ 6
2.3. Biochemical measurements ----------------------------------------------------- 7
2.4. Coronary artery calcification and non-calcified plaque assessment ---- 7
2.5. Statistical analysis ----------------------------------------------------------------- 9
Chapter 3 Results ----------------------------------------------------------------------------- 11
3.1. Clinical characteristics between MetS and non-MetS subjects ---------- 12
3.2. Coronary CTA characteristics in MetS and non-MetS subjects --------- 13
3.3. Difference according to the presence of CA in subjects with or without- 14
3.4. Univariate regression analysis for predictors of subclinical CA ---------- 14
3.5. Multivariate regression analysis for the predictors of subclinical CA --- 15
Chapter 4 Discussion ------------------------------------------------------------------------- 17
4.1. Coronary atherosclerosis detected with coronary CTA in MetS
Subjects ------------------------------------------------------------------------------
18
4.2. Fasting blood glucose and diabetes mellitus are associated with
subclinical CA in non-MetS subjects ------------------------------------------
20
4.3. Total cholesterol to HDL-C ratio is associated with subclinical CA in
MetS subjects ----------------------------------------------------------------------
20
Chapter 5 Conclusions ---------------------------------------------------------------------- 23
Chapter 6 Study limitations ----------------------------------------------------------------- 25
References ---------------------------------------------------------------------------------------- 27

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