請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/37555
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 陳保中(Pau-Chung Chen) | |
dc.contributor.author | Hung-Bin Tsai | en |
dc.contributor.author | 蔡宏斌 | zh_TW |
dc.date.accessioned | 2021-06-13T15:32:32Z | - |
dc.date.available | 2008-08-13 | |
dc.date.copyright | 2008-08-13 | |
dc.date.issued | 2008 | |
dc.date.submitted | 2008-07-14 | |
dc.identifier.citation | 1.Liu CH, Liu CJ, Kao JH. Interferon-based therapy for dialysis patients with chronic hepatitis C: progress and challenges. Nephrology (Carlton) 2007;12:8-10.
2.Rahnavardi M, Hosseini Moghaddam SM, Alavian SM. Hepatitis C in hemodialysis patients: current global magnitude, natural history, diagnostic difficulties, and preventive measures. Am J Nephrol 2008;28:628-40. 3.Huang CC. Hepatitis in patients with end-stage renal disease. J Gastroenterol Hepatol 1997;12:S236-41. 4.Furusyo N, Hayashi J, Kakuda K, et al. Acute hepatitis C among Japanese hemodialysis patients: a prospective 9-year study. The American journal of gastroenterology 2001;96:1592-600. 5.Masuko K, Mitsui T, Iwano K, et al. Infection with hepatitis GB virus C in patients on maintenance hemodialysis. N Engl J Med 1996;334:1485-90. 6.Lai MY. Combined interferon and ribavirin therapy for chronic hepatitis C in Taiwan. Intervirology 2006;49:91-5. 7.Hu KQ, Lee SM, Hu SX, Xia VW, Hillebrand DJ, Kyulo NL. Clinical presentation of chronic hepatitis C in patients with end-stage renal disease and on hemodialysis versus those with normal renal function. The American journal of gastroenterology 2005;100:2010-8. 8.Kalantar-Zadeh K, Daar ES, Eysselein VE, Miller LG. Hepatitis C inflection in dialysis patients: a link to poor clinical outcome? Int Urol Nephrol 2007;39:247-59. 9.Kalantar-Zadeh K, McAllister CJ, Miller LG. Clinical characteristics and mortality in hepatitis C-positive haemodialysis patients: a population based study. Nephrol Dial Transplant 2005;20:1662-9. 10.Kalantar-Zadeh K, Kilpatrick RD, McAllister CJ, et al. Hepatitis C virus and death risk in hemodialysis patients. J Am Soc Nephrol 2007;18:1584-93. 11.Lysaght MJ. Maintenance dialysis population dynamics: current trends and long-term implications. J Am Soc Nephrol 2002;13 Suppl 1:S37-40. 12.Peng YS, Chiang CK, Hsu SP, Pai MF, Hung KY, Kao JH. Influence of Hepatitis C Virus Infection on Soluble Cellular Adhesion Molecules in Hemodialysis Patients. Blood Purif 2005;23:106-12. 13.Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. J Am Soc Nephrol 2001;12:2797-806. 14.Kalantar-Zadeh K, McAllister CJ, Lehn RS, Lee GH, Nissenson AR, Kopple JD. Effect of malnutrition-inflammation complex syndrome on EPO hyporesponsiveness in maintenance hemodialysis patients. Am J Kidney Dis 2003;42:761-73. 15.Stenvinkel P, Heimburger O, Paultre F, et al. Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 1999;55:1899-911. 16.Morena M, Canaud B, Terrier N, Canaud L, Cristol JP. Oxidative stress complex syndrome: The dark side of the malnutrition-inflammation complex syndrome. Hemodial Int 2007;11 Suppl 1:S32-8. 17.Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis 2001;38:1251-63. 18.Ho LC, Wang HH, Peng YS, et al. Clinical Utility of Malnutrition-Inflammation Score in Maintenance Hemodialysis Patients: Focus on Identifying the Best Cut-Off Point. Am J Nephrol 2008;28:840-6. 19.Saran R, Bragg-Gresham JL, Rayner HC, et al. Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney Int 2003;64:254-62. 20.Enia G, Sicuso C, Alati G, Zoccali C. Subjective global assessment of nutrition in dialysis patients. Nephrol Dial Transplant 1993;8:1094-8. 21.Dwyer JT, Larive B, Leung J, et al. Nutritional status affects quality of life in Hemodialysis (HEMO) Study patients at baseline. J Ren Nutr 2002;12:213-23. 22.Leung J, Dwyer J, Miller J, Patrick SW, Rocco M, Uhlin L. The role of the dietitian in a multicenter clinical trial of dialysis therapy: the Hemodialysis (HEMO) Study. J Ren Nutr 2001;11:101-8. 23.Kalantar-Zadeh K, Block G, McAllister CJ, Humphreys MH, Kopple JD. Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients. Am J Clin Nutr 2004;80:299-307. 24.Burrowes JD, Larive B, Chertow GM, et al. Self-reported appetite, hospitalization and death in haemodialysis patients: findings from the Hemodialysis (HEMO) Study. Nephrol Dial Transplant 2005;20:2765-74. 25.Carrero JJ, Qureshi AR, Axelsson J, et al. Comparison of nutritional and inflammatory markers in dialysis patients with reduced appetite. Am J Clin Nutr 2007;85:695-701. 26.Daugirdus JT, Stone JCV. Physiological principles and urea kinetic modeling in: Daugirdus JT, Blake PG and IngTS (editors). Handbook of dialysis, third edition, Lippincott Williams & Wilkins 2001:15-45. 27.Depner TA. Quantifying hemodialysis. Am J Nephrol 1996;16:17-28. 28.de Vinuesa SG, Goicoechea M, Kanter J, et al. Insulin Resistance, Inflammatory Biomarkers, and Adipokines in Patients with Chronic Kidney Disease: Effects of Angiotensin II Blockade. J Am Soc Nephrol 2006;17:S206-12. 29.Tarkun I, Cetinarslan B, Turemen E, Sahin T, Canturk Z, Komsuoglu B. Effect of rosiglitazone on insulin resistance, C-reactive protein and endothelial function in non-obese young women with polycystic ovary syndrome. Eur J Endocrinol 2005;153:115-21. 30.Komulainen P, Lakka TA, Kivipelto M, et al. Serum high sensitivity C-reactive protein and cognitive function in elderly women. Age Ageing 2007;36:443-8. 31.Liu CH, Liang CC, Lin JW, et al. Pegylated interferon alpha-2a versus standard interferon alpha-2a for treatment-naive dialysis patients with chronic hepatitis C: a randomised study. Gut 2008;57:525-30. 32.Belle. Gv, Fisher. L, Heagerty. PJ, Lumley. TS. Biostatistics: A methodology for health sciences, 2nd edition. Hoboken, NJ: John Wiley & Sons Inc 2004. 33.Kalantar-Zadeh K, Kopple JD, Humphreys MH, Block G. Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant 2004;19:1507-19. 34.Kalantar-Zadeh K, Miller LG, Daar ES. Diagnostic discordance for hepatitis C virus infection in hemodialysis patients. Am J Kidney Dis 2005;46:290-300. 35.Lemos LB, Perez RM, Lemos MM, et al. Hepatitis C among predialysis patients: prevalence and characteristics in a large cohort of patients. Nephron 2008;108:c135-40. 36.Iwasa Y, Otsubo S, Sugi O, et al. Patterns in the prevalence of hepatitis C virus infection at the start of hemodialysis in Japan. Clin Exp Nephrol 2008;12:53-7. 37.Nascimento MM, Bruchfeld A, Suliman ME, et al. Effect of hepatitis C serology on C-reactive protein in a cohort of Brazilian hemodialysis patients. Braz J Med Biol Res 2005;38:783-8. 38.Lee CM, Lu SN, Hung CH, et al. Hepatitis C virus genotypes in southern Taiwan: prevalence and clinical implications. Trans R Soc Trop Med Hyg 2006;100:767-74. 39.Yu ML, Chuang WL, Chen SC, et al. Changing prevalence of hepatitis C virus genotypes: molecular epidemiology and clinical implications in the hepatitis C virus hyperendemic areas and a tertiary referral center in Taiwan. J Med Virol 2001;65:58-65. 40.Kao JH, Chen PJ, Lai MY, et al. Genotypes of hepatitis C virus in Taiwan and the progression of liver disease. J Clin Gastroenterol 1995;21:233-7. 41.Tardif KD, Waris G, Siddiqui A. Hepatitis C virus, ER stress, and oxidative stress. Trends Microbiol 2005;13:159-63. 42.Nascimento MM, Suliman ME, Bruchfeld A, et al. The influence of hepatitis C and iron replacement therapy on plasma pentosidine levels in haemodialysis patients. Nephrol Dial Transplant 2004;19:3112-6. 43.Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int 2003;63:793-808. 44.Chiang CK, Ho TI, Hsu SP, et al. Low-density lipoprotein cholesterol: association with mortality and hospitalization in hemodialysis patients. Blood Purif 2005;23:134-40. 45.Valenti L, Pulixi EA, Arosio P, et al. Relative contribution of iron genes, dysmetabolism and hepatitis C virus (HCV) in the pathogenesis of altered iron regulation in HCV chronic hepatitis. Haematologica 2007;92:1037-42. 46.Ozdemir A, Yalinbas B, Selamet U, et al. The effect of hepatitis C virus infection on insulin resistance in chronic haemodialysis patients. Yonsei Med J 2007;48:274-80. 47.Hsu CS, Liu CJ, Liu CH, et al. High hepatitis C viral load is associated with insulin resistance in patients with chronic hepatitis C. Liver Int 2008;28:271-7. 48.Gane E, Pilmore H. Management of chronic viral hepatitis before and after renal transplantation. Transplantation 2002;74:427-37. 49.Zumrutdal A, Ozer B, Singan M, et al. Effect of anti-HCV positivity on markers of malnutrition and inflammation in hemodialysis patients. Ren Fail 2007;29:85-90. 50.Kidney disease: improving global outcomes (KDIGO). Kidney Int Suppl 2008:S1-99. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/37555 | - |
dc.description.abstract | 背景:雲嘉地區是台灣C型肝炎與末期腎臟病高盛行率區域,在此區的血液透析患者通常有較高罹患C型肝炎與心血管疾病的危險。希望藉此研究來了解C型肝炎對血液透析患者之發炎反應與營養的短期影響,並提供更多資訊有助於C型肝炎整體防治策略。
研究目標:我們認為C型肝炎血液透析患者具有獨特的新陳代謝與全身發炎反應特性,能與臨床不良狀況作連結,也會導致臨床上較高心血管併發症的發生。 研究設計:本研究為一前瞻性追蹤研究,進行於嘉義市某一區域教學醫院,完整收集171位規則血液透析(包含76位C型肝炎血液透析患者)的臨床資料與發炎性生物標記特性。胰島素阻抗定義根據HOMA胰島素阻抗指數而營養不良發炎反應計分表用以記錄營養不良發炎反應症候群的嚴重程度。病人的食慾與營養狀態應用食慾與營養狀態評量表及上臂中圍測量來作整合性評估。血液透析患者的全身發炎狀態以高敏感度C反應蛋白來測量。C肝病毒的基因型與病毒RNA以聚合酶連鎖反應測定。我們使用上臂中圍、主觀營養評估和食慾與營養評分表來測量病人七個月的營養狀況變化。預後評估以前瞻性追蹤血液透析患者七個月營養不良發炎反應計分表分數變化。 結果: 171位長期透析病人追蹤七個月後,58位C肝抗體陽性與至少一次HCV-RNA陽性(HCV-RNA titers > 50 IU/mL)患者歸為活性C肝組,18位C肝抗體陽性但兩次HCV-RNA陰性為不活動C肝組, 其餘95位C肝抗體陰性者為非C肝組。在活性C肝組中,51人(87.9%)有持續性C肝病毒血症,7人(12.1%)有間歇性C肝病毒血症, 當中44.8%為genotype 1b, 31%為genotype 2a.。活性與不活動C肝組病人經歷透析期間均較非C肝組為久(64.0±54.1 month vs. 67.9±54.0 vs. 42.3±36.0 month, P <0.05)。第一與第七個月比較皆發現活性C肝組在肝功能指數為三組中最高但三酸甘油酯為最低。經過七個月追蹤並分析營養不良發炎反應計分表細項,活性C肝組較非C肝組病人在共病症狀態(1.6±0.8 vs. 1.7±0.7, P <0.05)、血清白蛋白指標(1.1±0.8 vs. 0.7±0.7 P < 0.05)、肌肉萎縮程程度(1.6±0.8 vs. 1.3±0.8, P <0.05)與體脂肪含量(0.5±0.7 vs. 0.3±06, P <0.05)有明顯差異且總分較高(MIS score: 6.9±4.0 vs. 5.3±3.3, P<0.05).。以廣義估計方程式(GEE)模式作回歸分析,在校正C肝病毒活性、性別、中央化年紀、中央化身體質量指數、透析後體重、食慾狀態、標準化蛋白質代謝率、嚴重腦血管疾病後發現活性C肝感染為營養不良發炎反應複合症候群之顯著獨立危險因子(β= 0.82, P <0.05, CI= 0.16-1.49)。 結論: 本研究證實C型肝炎病毒感染為臺灣長期血液透析患者營養不良發炎反應複合症候群之獨立危險因子。營養不良發炎反應計分表可以作為C肝血液透析患者短期臨床預後之有效評估工具。 關鍵詞: C型肝炎、病毒活性、營養不良發炎反應症候群、血液透析、尿毒症相關食慾不良 | zh_TW |
dc.description.abstract | Background: High prevalence of hepatitis C virus (HCV) infection and end-stage renal disease is noticed in Yunlin, Chiayi area in Taiwan. Patients with maintenance hemodialysis (MHD) in this area have the highest risk for HCV infection and cardiovascular disease. Understanding the natural history of HCV and its association with inflammation, nutrition and outcomes in dialysis patients may provide more information for anti-HCV management strategies in dialysis and other patient populations.
Objective: We hypothesize that HCV infected MHD patients have distinct metabolic and inflammatory characteristics that can be linked to malnutrition-inflammation complex syndrome (MICS) and leads to higher clinical complications. Design: A prospective longitudinal study was conducted in one regional teaching hospital during Sept. 2007 to March 2008. A cohort of 171 MHD patients including 76 HCV subjects was recruited. Basic data and dialysis characteristics were collected. Anti-HCV antibody was detected with a third-generation enzyme immunoassay while HCV genotype and viral load were analyzed by polymerase chain reaction twice in the first and last month. Insulin resistance was defined by HOMA-IR index. Nutritional and appetite status were evaluated by appetite and diet assessment tool and anthropometric evaluation. Inflammatory status was measured by high sensitivity C-reactive protein. Outcome evaluation was based on malnutrition-inflammation score to rate the severity of MICS in first month and followed prospectively at the seventh month. Results: Of 171 enrolled patients, 58 having anti-HCV positive with at least one positive HCV-RNA titer (HCV RNA > 50 IU/mL) were categorized as active HCV group, 18 anti-HCV positive with two negative HCV-RNA titers as inactive HCV group, 95 negative anti-HCV titers as non-HCV group. Active HCV group had 51 (87.9%) persistent and 7 (12.1%) intermittent HCV viremia patients with 44.8% genotype 1b and 31% genotype 2a. Active and inactive HCV group experienced longer dialysis vintage then non-HCV group (64.0±54.1 month vs. 67.9±54.0 vs. 42.3±36.0 month, P <0.05). Serum triglyceride level was lowest and GPT level was highest in active HCV group during the first and seventh month. After 7 months follow-up, Active HCV group had significant difference from non-HCV group in MIS component as co-morbidity (1.6±0.8 vs. 1.7±0.7, P <0.05), albumin index (1.1±0.8 vs. 0.7±0.7, P <0.05), muscle wasting (1.6±0.8 vs. 1.3±0.8, P<0.05), decreased fat stores (0.5±0.7 vs. 0.3±0.6, P<0.05) and higher total MIS score (6.9±4.0 vs. 5.3±3.3, P<0.05). After adjustment of HCV activity, sex, centered age and body mass index, posthemodialysis weight, appetite status, normalized protein catabolic rate, severe cerebrovascular accident, marginal regression analysis by GEE model denoted HCV infection as a significant independent predictor of MICS (β= 0.82, P <0.05, CI= 0.16-1.49). Conclusions: This study proves active HCV infection as an independent predictor of MICS in Taiwanese MHD patients. MIS can be used as an assessment tool to evaluate the short-term clinical outcome in HCV-MHD patients. Key words: Hepatitis C, virus activity, malnutrition-inflammation complex syndrome (MICS), hemodialysis, uremia-associated anorexia | en |
dc.description.provenance | Made available in DSpace on 2021-06-13T15:32:32Z (GMT). No. of bitstreams: 1 ntu-97-R94841007-1.pdf: 933643 bytes, checksum: 3dbea9b386eb6fe4bf948d39fe99fe6c (MD5) Previous issue date: 2008 | en |
dc.description.tableofcontents | 口試委員會審定書..........................................i
誌謝.....................................................ii 中文摘要................................................iii Abstract..................................................v Index...................................................vii Lists of Tables and Appendix.............................ix Introduction..............................................1 Materials and Methods.....................................2 (1)Study population......................................2 (2) Malnutrition-inflammation score......................3 (3) Appetite and diet assessment.........................4 (4) Anthropometric evaluation............................4 (5) Laboratory assessment................................4 (6) Statistical analysis.................................6 Results...................................................7 Discussion...............................................10 (1) HCV prevalence of MHD patients in Southern Taiwan...10 (2) HCV and malnutrition in MHD patients................11 (3) HCV and systemic inflammation in MHD patients.......12 (4) HCV infection and reverse epidemiology..............13 (5) HCV and iron status in MHD patients.................13 (6) Active and inactive HCV infection versus insulin resistance in MHD patients..........................13 (7) Implications and future directions..................14 (8) Study limitations...................................15 (9) Conclusion..........................................15 Acknowledgements.........................................16 References...............................................16 Table 1..................................................20 Anti-HCV positivity, viremia and genotypes among the 171 patients in the first month and seventh month follow-up Table 2-1................................................21 Geographic, hematologic, biochemical data, dialysis parameters, nutritional markers of all patients in the first month Table 2-2................................................24 Geographic, hematologic, biochemical data, dialysis parameters, nutritional markers of all patients after seven months follow-up Table 3-1................................................27 Components of malnutrition-inflammation score between active HCV, inactive HCV and non-HCV patients in the first month Table 3-2................................................28 Components of malnutrition-inflammation score between active HCV, inactive HCV and non-HCV patients in the seventh month Table 4..................................................29 Marginal regression analysis of factors influence malnutrition-inflammation score in maintenance hemodialysis patients during seven months using the GEE method Figure 1.................................................30 Possible factors affect malnutrition-inflammation complex syndrome in maintenance hemodialysis patients Appendix 1...............................................31 Components of Comprehensive Malnutrition- inflammation Score (MIS) (in English) Appendix 2...............................................33 Comprehensive Malnutrition-inflammation Score Sheet (in Chinese) Appendix 3...............................................35 Appetite and Diet Assessment Tool Charlson Co-morbidity Index Appendix 4...............................................36 Will HCV activity increase malnutrition and inflammation burden in maintenance hemodialysis patients? | |
dc.language.iso | en | |
dc.title | C型肝炎病毒活性對長期血液透析患者營養不良發炎反應複合症候群之短期影響 | zh_TW |
dc.title | The short-term influence of hepatitis C virus activity on malnutrition-inflammation complex syndrome in maintenance hemodialysis patients | en |
dc.type | Thesis | |
dc.date.schoolyear | 96-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 高嘉宏(Jia-Horng Kao),洪冠予(Kuan-Yu Hung) | |
dc.subject.keyword | C型肝炎,病毒活性,營養不良發炎反應症候群,血液透析,尿毒症相關食慾不良, | zh_TW |
dc.subject.keyword | hepatitis C,virus activity,malnutrition-inflammation complex syndrome (MICS),hemodialysis,uremia-associated anorexia, | en |
dc.relation.page | 36 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2008-07-14 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 職業醫學與工業衛生研究所 | zh_TW |
顯示於系所單位: | 職業醫學與工業衛生研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-97-1.pdf 目前未授權公開取用 | 911.76 kB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。