臺灣博碩士論文加值系統

背景
本研究旨在評估服用安美達（anastrozole）或泰莫西芬（tamoxifen）對於台灣女性早期乳癌病患在血脂方面的影響。血脂檢測項目包括總膽固醇（total cholesterol, TC），三酸甘油脂（triglycerides, TG），高密度脂蛋白（high-density lipoprotein-cholesterol, HDL-C），低密度脂蛋白（low-density lipoprotein-cholesterol, LDL-C），載脂蛋白A-1（apolipoprotein A-1, ApoA-1），載脂蛋白B （apolipoprotein B, ApoB），總膽固醇與高密度脂蛋白之比值（TC/HDL-C ratio），低密度脂蛋白與高密度脂蛋白之比值（LDL-C/HDL-C ratio）及載脂蛋白B與載脂蛋白A-1之比值（ApoB/ApoA-1 ratio）。
方法
本研究是前瞻性世代研究，研究期間為2009年2月至2010年4月。在本研究中，所有病患已接受過手術、化學治療、及（或）放射治療，且第一次服用安美達（每日1次，每次1毫克）或泰莫西芬（每日2次，每次10毫克）。經病患簽署受試者同意書之後，於病患未服藥前（基準值）、12週、24週、36週及48週時，經隔夜空腹後抽血檢測血脂相關項目。
結果
本研究共納入68位患者。經由混合效應模式分析結果，並調整干擾因子以避免干擾效應；這些干擾因子包括有病患年齡、身體質量指數、未服藥前各血脂基準值及相較於基準值其身體質量指數變化值。在總膽固醇與低密度脂蛋白的檢測值，服用安美達這組的病患相較於泰莫西芬者，與未服藥前基準值相比增加較多，且增加值在24週後其統計值具有意義（分別增加18.5 mg/dL與22.3 mg/dL）。然而在安美達這組的病患相較於泰莫西芬者，在12週後其載脂蛋白A-1與未服藥前基準值相比降低16.3 mg/dL且達統計顯著差異。而總膽固醇與高密度脂蛋白之比值、低密度脂蛋白與高密度脂蛋白之比值及載脂蛋白B與載脂蛋白A-1之比值，服用安美達這組的病患相較於泰莫西芬者，在24週時與未服藥前基準值相比增加較多（分別增加0.73、0.70與0.12），且增加值在統計上具有意義。
結論
從本研究結果顯示，對於服用安美達的台灣女性病患，在服藥24週後，總膽固醇及低密度脂蛋白其血中濃度上升且載脂蛋白A-1血中濃度下降。服用安美達將會對於心血管危險因子有不良的影響。依據本研究結果建議對於有心血管疾病高風險之病患，在服用安美達期間需定期檢測血脂項目。

Background
This study intended to evaluate changes in serum lipid profiles in Taiwanese women receiving anastrozole or tamoxifen for early stage breast cancer. The serum lipid profiles included total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), apolipoprotein A-1 (ApoA-1), apolipoprotein B (ApoB), TC/HDL-C ratio, LDL-C/HDL-C ratio and ApoB/ApoA-1 ratio.
Methods
It was a prospective cohort study between February 2009 and April 2010. All patients had completed surgery, chemotherapy, and/or radiotherapy and were initially taking 1 mg of anastrozole once daily, or tamoxifen 10 mg twice daily. Patients consenting to participate in this study had blood drawn after overnight fasting and lipid profiles evaluated at baseline, 12 weeks, 24 weeks, 36 weeks and 48 weeks.
Results
Sixty-eight women were enrolled in the study. The study was analyzed by a Mixed-effects model and adjusted for differences by factors to prevent confounding effects. The factors measured at baseline included age, body-mass-index (BMI), each parameter self and BMI differential value compared with baseline. In TC and LDL-C levels, the anastrozole group increased more than the tamoxifen group, and difference in the change from baseline after 24 weeks was significant (18.5 mg/dL; 22.3 mg/dL respectively). However, the anastrozole group decreased ApoA-1 by 16.3 mg/dL more than the tamoxifen group and showed significant difference in the change from baseline after 12 weeks. TC/HDL-C, LDL-C/HDL-C and ApoB/ApoA-1 ratios increased in the anastrozole group more than the tamoxifen group (0.73; 0.70; 0.12 respectively) and difference in the change from baseline at 24 weeks was significant.
Conclusion
This study indicates that anastrozole significantly elevates the levels of TC, LDL-C and decreases the level of ApoA-1 in Taiwanese women with breast cancer after 24 weeks of treatments. Anastrozole had a detrimental effect on cardiovascular risk factors. Patients taking anastrozole need to check lipid profiles routinely if they have risks of cardiovascular disease.

目錄
中文摘要...................................................I
Abstract.................................................III
致謝.......................................................V
表目錄..................................................VIII
圖目錄..................................................VIII

第一章 緒論............................................1
第一節 流行病學...............................1
第二節 病因學.................................2
第三節 乳癌的診斷.............................5
第四節 乳癌的分期.............................8
第五節 癒後因子...............................9
第六節 臨床治療策略...........................9
第七節 賀爾蒙輔助療法與血脂之影響............13
第八節 賀爾蒙輔助療法對心血管疾病之影響......15
第九節 心血管危險因子與心血管疾病之關係......16
第十節 研究目的與重要性......................17

第二章 材料與方法.....................................19
第一節 研究設計與研究對象....................19
第二節 病患收錄及排除條件....................20
第三節 統計分析方法..........................22

第三章 研究結果.......................................24
第一節 病患收錄狀況描述......................24
第二節 病患飲食與用藥習慣描述................25
第三節 身體質量指數差異值變化趨勢描述........28
第四節 血脂基準值與差異值變化趨勢描述........29
第五節 血脂差異值結果描述....................37

第四章 討論與建議.....................................43
第一節 研究資料分析之討論....................43
第二節 對臨床醫師之建議......................44
第三節 研究限制..............................44

第五章 結論及未來方向.................................47
第一節 結論..................................47
第二節 未來方向..............................47

參考文獻.................................................49

附錄.....................................................57
附錄一 縮寫及簡稱............................57
附錄二 同意臨床試驗證明書....................58
附錄三 身體健康情形及飲食狀況評估調查表......60
附錄四 受試者同意書..........................63

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