臺灣博碩士論文加值系統

近年來國內醫療設備及電腦科技進步，各大醫學中心自費健檢查盛行，以心臟血管檢查為最普遍。心血管冠狀動脈鈣化對於國人的健康具有長期性的影響；有文獻顯示心臟血管疾病之危險因子，主要包括年齡、性別、抽菸、各項心血管相關生化因子等；過去臨床醫療都著重在生化因子或飲食健康及運動方面的研究，但在放射線影像學上的研究一直是較為缺少的。 而本研究是利用放射線影像觀察並測量與冠狀動脈鈣化嚴重度之關係，研究收集2011年12月到2013年4月間，接受自費健檢的702位受檢者中，同時接受64切電腦斷層冠狀動脈血管攝影與低劑量胸部電腦斷層健康檢查者；年齡從23~83歲，其中有效樣本120人，由冠狀動脈鈣化分數及心胸比、胸主動脈弓鈣化量、年齡、性別、體脂肪、慢性病等資料，將鈣化分數分五級進行分析。結果發現冠狀動脈鈣化嚴重度與胸主動脈弓鈣化量及年齡有高度相關(P<.001)，冠狀動脈鈣化分數與性別沒有顯著相關性(P=.381)，胸主動脈弓鈣化量與性別亦無相關(P=.108)，但冠狀動脈鈣化嚴重度與體脂肪及心胸比、有無抽菸或是慢性病史分析時發現並無特別之相關性。綜合以上結論應可提供臨床醫師在看診或檢查之依據，並且可針對心臟血管疾病健康篩檢前之初步評估提供參考資訊。

With the recent development of the domestic medical equipment and computer technology, health check of self-charge in all medical centers become popular, especially in the cardiovascular department. The impact of coronary artery calcification on health lasts long; it is studied that the factors contribute to cardiovascular diseases include age, sexuality, smoking, and other related biochemical factors. The clinic medicine treatment focused in the past on the biochemical factors or diet and exercise instead of radio-graphic study. While the relationship between the radiography and coronary artery calcification is studied hereby, with 702 objects participating at their own expenses during December 2011 and April 2013 and 64 ones accepting health examination by 64cut coronal CT artery angiography with low-dose chest CT. Their age varies from 23 to 83 years, with viable objects 120 people, whose calcification can be classified to five levels considering the thoracic aortic arch calcification, age, gender, body fat and chronic diseases, etc., It comes out in the experiment that coronary artery calcification is closely connected with thoracic aortic arch calcification and ages (P<.001), with less obvious relationship with sexuality (P=.381), neither the thoracic aortic arch calcification and ages with sexuality (P=.108). However, the coronary artery calcification is found to have little unique connection with the body fat, cardiothoracic ratio, convulsion and chronic diseases. The experimental results in this paper can be the clinical reference and facilitate the health preliminary assessment of cardiovascular condition.

口試委員審定書 I
誌謝 II
中文摘要 III
英文摘要 IV
目錄 V
圖目錄 VII
表目錄 VIII
第一章 緒論 1
1.1 前言 1
1.2 研究背景與動機 3
1.3 文獻回顧 4
1.4 研究目的 5
第二章 心血管系統基礎概論 6
2.1 心臟組成 6
2.2 冠狀動脈系統 7
2.3 動脈粥樣硬化及血管硬化 8
2.4 心臟肥大 10
第三章 材料與方法 11
3.1 研究樣本 11
3.2 64切電腦斷層的基本原理 12
3.3 Agatston鈣化分數 13
3.4 研究架構 15
3.5研究假設 16
3.6 統計分析 16
第四章 研究結果 17
4.1 研究對象 17
4.2 心臟血管鈣化分析 25
4.3 冠狀動脈鈣化分數關聯因子 26
4.4 主動脈鈣化與心臟肥大關聯因子 28
第五章 討論與限制 31
5.1 胸主動脈弓鈣化量的分析 31
5.2 受檢者鈣化分數的分析 32
5.3 慢性病史對心血管疾病的影響 33
5.4 肥胖對冠狀動脈鈣化的影響 34
5.5 研究限制 35
第六章 結論 36
參考文獻 37

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行政院衛生福利部“2007台灣地區高血壓、高血糖、高血脂之追蹤調查研究。中華民國一百年一月

陳明豐。冠狀動脈與心臟病。三版。台北。吳氏圖書有限公司。中華民國八十六年一月，第106-198頁