臺灣博碩士論文加值系統

過去六年來，國人十大死因當中，心臟疾病及腦血管疾病分占第二、三名。由於冠心症及腦中風皆源自於動脈硬化，再者，因心血管疾病發作時通常都有近10年的前期發展。動脈硬化發生阻塞，在超過50%阻塞之前是無症狀的，待阻塞超過75%而產生心絞痛時，則為時已晚。而冠狀動脈鈣化指數 (CACS) 已被證實為預測血管硬化的獨立性因子，卻不知其與國人之飲食及生活型態之相關性，故本研究之主要目的在於評估 CACS 與飲食及生活型態的關聯性。
研究方法是以1993-1996國民營養健康狀況變遷調查中的飲食問卷及認知與行為問卷為參考，加以修改後，選取生活型態、飲食習慣、飲食認知及食物攝取頻率四項資料，收集台中市某區域教學醫院自費接受電腦斷層心臟鈣化指數健康檢查的個案共計90人 (男性70位及女性20位)。
分析結果顯示，全體個案 (n=90) 的平均年齡為55.3±9.4歲 (男性53.9±8.6歲，女性60.4±10.7歲)。以身體質量指數 (BMI) 值為判定標準，男性及女性的肥胖率各為 34.3% 及25%。男性及女性之收縮壓及舒張壓平均值皆已超過行政院衛生署所訂定之正常標準值 (120/80毫米汞柱)，且均達高血壓前期 (警示期) 之範圍內。全體個案中，共計有33人 (36.7%) 評估為代謝症候群 (MetS) 患者 (男性40%，女性25%)。男性平均腰圍 (89.6±8.0公分) 已達國民健康局所訂定之90公分標準上限，其中有32人 (45.7%) 腰圍過大。全體個案平均 CACS 是183.1 (男性173，女性218.5)，對應冠心症風險皆已達到中等程度。將 CACS 與基本資料、代謝性生化指標、生活型態、飲食型態及飲食認知進行卡方檢定 (chi-square test)，發現 CACS 與年齡 (P = 0.003)、腰圍 (P = 0.027)、總膽固醇 (P = 0.03)、低密度脂蛋白膽固醇 (P = 0.032)、家族疾病史中之高血壓 (P = 0.001)、心臟病 (P = 0.016) 及腦血管疾病 (P < 0.001)、運動習慣 (P = 0.039)、運動時間 (P = 0.03)、速食習慣 (P = 0.044) 及水果食用量 (P = 0.049) 呈現顯著相關性。
綜觀本研究結果，CACS 確實與心血管疾病之相關年齡、腰圍、血脂生化指標、相關疾病、運動及飲食因素呈現顯著相關性。

The incidence of cardiovascular events is increasing with the modern lifestyle. It takes long time for atherosclerotic cardiovascular disease developing. Since it has no symptom before the vascular obstruction to achieve 50%-in-diameter narrowing, most people are not aware of their risk of atherosclerotic cardiovascular disease. Coronary artery calcium score (CACS) of computed tomography has been proven to be an independent prognostic factor for atherosclerotic coronary artery disease, especially for the asymptomatic population. This study was designed to test the correlations among CACS, diet, and lifestyle.
A questionnaire (revised from Nutrition and Health Survey in Taiwan; NAHSIT) of lifestyle and dietary behavior was proposed to persons who accepted CACS analysis in the Health-Examination center of a local hospital from May 2010 to February 2011. Data were collected from a total of 90 subjects (70 males and 20 females).
The mean age of the 90 subjects was 55.39.4 years old (male, 53.98.6; female 60.410.7). There were 24 males (34.3%) and 13 females (65%) with body mass index (BMI) above 27. The average systolic and diastolic blood pressures of the male and female subjects were higher than the normal values (120/80 mmHg). The average waist circumference (WC) for males was 89.68 cm. However, the WC measures of 32 males (45.7%) were over 90 cm criterion for central obesity.
It was estimated that 33 cases (36.7%) suffered from metabolic syndrome (MetS), including 28 males (40%) and 5 females (25%). The average CACS for males and females were 173 and 218.5, respectively, which indicated an intermediate risk for coronary events. The results of chi-square test revealed that CACS was significantly correlated with age (P = 0.003), WC (P = 0.027), total cholesterol (P = 0.03), low-density lipoprotein cholesterol (P = 0.0032), family history of hypertension (P = 0.001), heart disease (P = 0.016) as well as stroke (P < 0.001), exercise habit (P = 0.039), exercise duration (P = 0.03), fast-food consumption frequency (P = 0.044), and fruit intake amount (P = 0.049) in male subjects.

中文摘要...................................................................................................i
Abstract.............................................................................................. iii
致謝...........................................................................................................v
目錄........................................................................................................ vi
圖目錄.....................................................................................................ix
表目錄...................................................................................................... x
第一章 前言及研究目的.................................................................... 1
第二章 文獻探討................................................................................ 3
第一節 動脈硬化 .......................................................................... 3
一、動脈硬化的形成.............................................................. 3
二、動脈硬化的因素.............................................................. 8
三、動脈硬化的相關疾病.................................................... 10
四、冠心病與代謝症候群.................................................... 11
第二節 冠狀動脈硬化之評估方式................................................ 12
一、侵入性檢查.................................................................... 12
二、非侵入性檢查................................................................ 13
三、Framingham風險評估................................................... 15
第三節 電腦斷層冠狀動脈鈣化指數之計算及表現................... 16
第四節 飲食及生活型態的目標及方法....................................... 22
一、降低心血管疾病風險之飲食及生活型態目標........... 25
第三章 材料與方法......................................................,................,.. 32
第一節 施測對象........................................................,.................. 32
第二節 工具................................................................,.................. 32
一、電腦斷層....................................................,.................. 32
二、鈣化評分概要...............................................,............... 34
三、問卷..................................................................,............ 34
第三節 統計方法.............................................................,........... 37
第四章 結果與討論.......................................................................,... 38
第一節 受訪者基本資料............................................................. 38
第二節CACS 與BMI 及腰圍之關聯性....................................... 43
第三節CACS 與 MetS 判定項目之相關性.............................. 45
第四節 CACS 與運動、抽菸及喝酒之相關性.......................... 48
第五節 CACS 與飲食之相關性. .............................................,.. 50
第六節 CACS 與其他項目之相關性.................................... ..... 53
第伍章 結論..................................................................................... 56
第六章 建議..................................................................................... 58
參考文獻............................................................................................. 59
附錄..................................................................................................... 67

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