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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 葉力森 | |
dc.contributor.author | Shen-Yang Tsai | en |
dc.contributor.author | 蔡聲揚 | zh_TW |
dc.date.accessioned | 2021-06-13T07:57:13Z | - |
dc.date.available | 2016-07-27 | |
dc.date.copyright | 2011-07-27 | |
dc.date.issued | 2011 | |
dc.date.submitted | 2011-07-21 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/36329 | - |
dc.description.abstract | 骨關節炎(osteoarthritis, OA),又稱退化性關節病(degenerative joint disease, DJD)是一種非炎症性退化性的關節軟骨病變,無論人或動物,此疾病皆為中老年族群中最常見的問題之一。軟骨本身很差的再生能力再加上目前仍無有效逆轉病程的治療方式,也造成了骨關節炎在處理上的複雜性。
由於幹細胞具有分化的能力,能夠藉由新生組織,達到適當修復及癒合的效果,近年來已受到再生醫學領域的高度關注。以關節注射方式植入幹細胞,屬微創的外科治療方式,就機制上來說,間葉幹細胞有能力促進軟骨的新生及抑制關節內的發炎反應,進而延緩甚至改善關節炎的病程,故有機會成為關節炎治療的替代療法之一。 本研究第一部分,將利用系統性文獻搜尋的方法,以實證醫學的角度,探討動物關節內注射間葉幹細胞於治療骨關節病之臨床成效。研究共納入11篇動物相關研究文獻,種別包含鼠、兔、豬、羊、馬及犬隻,文中詳列出文獻所提之受試動物、研究材料、評估方式、試驗結果…等,並以美國FDA網站公布之實證醫學指導原則,針對各文獻實驗設計及研究方法的品質做分級。結果顯示,因相關研究極少,且各研究間之實驗異質性大,無法進行統合分析提出一有效之結論,不過就個別研究成果來看,以關節內注射提供間葉幹細胞的治療方式,大多數結果顯示的確能在關節內進行某種程度的組織修復效果。 第二部分的研究,將利用豬隻脂肪來源的異種間葉幹細胞,治療犬隻骨關節炎,並評估其治療效果。受試動物包含三隻臨床上患有膝部退化性骨關節炎的犬隻,以關節注射方式,植入每個關節約500萬個間葉幹細胞。關節炎病程評估方式包括:主觀性之骨科學檢查評量、飼主問卷評量,以及客觀性之放射學檢查與犬隻步態測力板分析。結果顯示在經過間葉幹細胞關節注射治療的三隻犬隻,無論是骨科學檢查、飼主問卷及測力板數據皆顯示能減緩膝部骨關節炎之症狀,進而達到患肢功能上的改善。 雖然以關節內注射間葉幹細胞之治療方式於實驗動物及臨床上的初步成果皆顯示有某種程度的治療效果,然而間葉幹細胞關節內作用機制尚未完全被證實,因此在將此療法納入常規治療前,其治療劑量、合適療程、介入時間點…等相關資訊,仍需經過日後更多大規模臨床試驗的證實。 | zh_TW |
dc.description.abstract | Osteoarthritis, also referred as degenerative joint disease(DJD), is a disease process associated with non-inflammatory, degenerative changes in the tissues of synovial joints and loss of articular cartilage, it is a common diagnosis in the clinic of aged population in both human and veterinary medicine. The poor regenerative capacity of cartilage and no available curative treatment options complicate satisfactory management of osteoarthritis.
Recently, stem cell therapy plays an important role in regenerative medicine due to its capacity to differentiate into new tissue to achieve proper tissue repair. Intra-articular injection of suspended stem cells, as a minimal invasive surgical option, could provide as an alternative therapy to osteoarthritis due to its effect of cartilage regeneration and immunomodulation mechanism, and therefore, stop or reverse the disease progression of osteoarthritis. In chapter three, we systematically review the articles related to intra-articular mesenchymal stem cell injection in animals and consider them in the light of evidence-based (veterinary) medicine. A total of 11 studies from various animal species including rat、rabbit、porcine、goat、horse and dog were included. The study materials, evaluation methods and primary outcome of each study were analysed along with the evaluation of the study design and grading of the study quality by use of the FDA’s EBM scoring system. Evaluation of efficacy in published trials was hampered by the low number of studies and their heterogeneity nature, but most of individual study shows intra-articular stem cell injection could have positive therapeutic effect to a certain degree. In chapter four, we use porcine adipose-derived mesenchymal stem cells as a stem cell source to treat canine osteoarthritis and evaluate its therapeutic effects. A total of 3 client-owned dogs with nature course of stifle degenerative joint disease were included in our study. We delivered approximately 5x106 stem cells per joint suspended in phosphate buffered saline via direct intra-articular injection. The outcome revealed that the score of doctor assessment, owner assessment, peak vertical force and vertical impulse of affect limb were functionally improved after intra-articular injection of mesenchymal stem cells. Although some studies, whether in experimental animal models or in clinical trial, have provided promising results of intra-articular stem cell therapy in osteoarthritis, the information is still limited. The actual mechanism of stem cells participating in tissue repair, optimal number of cells needed to be injected, proper therapeutic protocols or the appropriate time point of intervention still remains to be discovered in the future. | en |
dc.description.provenance | Made available in DSpace on 2021-06-13T07:57:13Z (GMT). No. of bitstreams: 1 ntu-100-R98643007-1.pdf: 2508551 bytes, checksum: a670620d1b0db63b8c6e488958f3443c (MD5) Previous issue date: 2011 | en |
dc.description.tableofcontents | 誌 謝………… ……………I
中文摘要 ……………………II 英文摘要 ……………………IV 目 錄…………………………VI 圖 次…………………………IX 表 次…………………………X 第一章 序言 1 第二章 文獻探討 2 第一節 犬隻骨關節炎 2 一、 定義與流行病學 2 二、 病因與病生理機制 2 三、 臨床症狀與診斷 4 四、 現行常規治療方式、最新研究方向及成效分析 7 五、 病程進展及療效評估 19 第二節 幹細胞於獸醫疾病治療應用及關節內之作用機制 21 一、 幹細胞簡介 21 二、 間葉幹細胞來源 22 三、 免疫反應 23 四、 給予途徑 24 五、 獸醫領域之臨床應用 24 六、 關節內之作用機制 25 七、 間葉幹細胞應用之可能風險 27 第三節 探討疾病治療效果之實證醫學方法 28 一、 實證醫學之緣起與內涵 28 二、 探討疾病治療效果之實證醫學方法 29 三、 以系統性回顧輔助實證醫學 30 四、 實證醫學於獸醫領域之應用 33 第四節 參考文獻 34 第三章 關節內注射間葉幹細胞於治療動物創傷性及退化性骨關節炎之實證醫學研究 43 第一節 前言 43 第二節 檢索策略與試驗納入條件 44 第三節 文獻評估方式 45 第四節 資料收集及分析 47 一、 鼠隻相關研究 47 二、 兔隻相關研究 50 三、 豬隻相關研究 53 四、 羊隻相關研究 54 五、 馬隻相關研究 56 六、 犬隻相關研究 58 第五節 綜合比較 60 第六節 討論 62 第七節 參考文獻 66 第四章 關節內注射豬隻脂肪來源間葉幹細胞於治療犬隻膝部退化性骨關節炎之臨床效用評估-先期研究 69 第一節 簡介 69 第二節 材料與方法 70 一、 豬隻脂肪來源間葉幹細胞 70 二、 受試動物 72 三、 手術過程 73 四、 關節炎評估方式 73 五、 統計方式 77 第三節 結果 78 一、 基本資料 78 二、 醫師骨科學檢查評量 79 三、 飼主問卷評量 81 四、 影像學檢查評分 83 五、 步態分析測力板數據 85 第四節 討論 88 第五節 參考文獻 94 第五章 結論與未來展望 97 附錄1、試驗性治療飼主同意書 99 附錄2、飼主評估問卷 101 附錄3、測力板原始數據 102 | |
dc.language.iso | zh-TW | |
dc.title | 關節內注射間葉幹細胞於治療動物創傷性及退化性關節病之實證醫學研究與犬隻臨床應用之效用評估 | zh_TW |
dc.title | Evidence-based study of intra-articular mesenchymal stem cell injection in animals with traumatic and degenerative arthropathies and evaluation of clinical therapeutic effects in dogs | en |
dc.type | Thesis | |
dc.date.schoolyear | 99-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 闕玲玲,林中天 | |
dc.subject.keyword | 間葉幹細胞,成體幹細胞,關節注射,骨關節炎,退化性關節病,實證醫學, | zh_TW |
dc.subject.keyword | mesenchymal stem cell,adult stem cell,intraarticular injection,osteoarthritis,degenerative joint disease,evidence-based medicine, | en |
dc.relation.page | 105 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2011-07-21 | |
dc.contributor.author-college | 獸醫專業學院 | zh_TW |
dc.contributor.author-dept | 臨床動物醫學研究所 | zh_TW |
顯示於系所單位: | 臨床動物醫學研究所 |
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