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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 李啟明 | |
dc.contributor.author | Shih-Yin Fu | en |
dc.contributor.author | 傅詩茵 | zh_TW |
dc.date.accessioned | 2021-06-16T05:49:31Z | - |
dc.date.available | 2018-08-01 | |
dc.date.copyright | 2014-10-15 | |
dc.date.issued | 2014 | |
dc.date.submitted | 2014-08-08 | |
dc.identifier.citation | 1.Lund LH, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: thirtieth official adult heart transplant report--2013; focus theme: age. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2013;32:951-64.
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Metabolic risk factors for atherosclerosis in heart transplant recipients. American heart journal 1994;128:68-72. 8.Kugiyama K, Kerns SA, Morrisett JD, Roberts R, Henry PD. Impairment of endothelium-dependent arterial relaxation by lysolecithin in modified low-density lipoproteins. Nature 1990;344:160-2. 9.Valantine H, Rickenbacker P, Kemna M, et al. Metabolic abnormalities characteristic of dysmetabolic syndrome predict the development of transplant coronary artery disease: a prospective study. Circulation 2001;103:2144-52. 10.Halle AA, 3rd, DiSciascio G, Massin EK, et al. Coronary angioplasty, atherectomy and bypass surgery in cardiac transplant recipients. Journal of the American College of Cardiology 1995;26:120-8. 11.Ensley RD, Hunt S, Taylor DO, et al. Predictors of survival after repeat heart transplantation. The Registry of the International Society for Heart and Lung Transplantation, and Contributing Investigators. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 1992;11:S142-58. 12.Krysiak R, Okopien B. Lymphocyte-suppressing action of angiotensin-converting enzyme inhibitors in coronary artery disease patients with normal blood pressure. Pharmacological reports : PR 2011;63:1151-61. 13.Bae JH, Rihal CS, Edwards BS, et al. Association of angiotensin-converting enzyme inhibitors and serum lipids with plaque regression in cardiac allograft vasculopathy. Transplantation 2006;82:1108-11. 14.Kobashigawa JA, Katznelson S, Laks H, et al. Effect of pravastatin on outcomes after cardiac transplantation. The New England journal of medicine 1995;333:621-7. 15.Wenke K, Meiser B, Thiery J, et al. Simvastatin initiated early after heart transplantation: 8-year prospective experience. Circulation 2003;107:93-7. 16.Weis M, Pehlivanli S, Meiser BM, von Scheidt W. Simvastatin treatment is associated with improvement in coronary endothelial function and decreased cytokine activation in patients after heart transplantation. Journal of the American College of Cardiology 2001;38:814-8. 17.Kaczmarek I, Ertl B, Schmauss D, et al. Preventing cardiac allograft vasculopathy: long-term beneficial effects of mycophenolate mofetil. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2006;25:550-6. 18.Eisen HJ, Tuzcu EM, Dorent R, et al. Everolimus for the prevention of allograft rejection and vasculopathy in cardiac-transplant recipients. The New England journal of medicine 2003;349:847-58. 19.Keogh A, Richardson M, Ruygrok P, et al. Sirolimus in de novo heart transplant recipients reduces acute rejection and prevents coronary artery disease at 2 years: a randomized clinical trial. Circulation 2004;110:2694-700. 20.Mehra MR, Parameshwar J. Gene expression profiling and cardiac allograft rejection monitoring: is IMAGE just a mirage? The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2010;29:599-602. 21.Stewart S, Winters GL, Fishbein MC, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2005;24:1710-20. 22.Raichlin E, Edwards BS, Kremers WK, et al. Acute cellular rejection and the subsequent development of allograft vasculopathy after cardiac transplantation. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2009;28:320-7. 23.Yamani MH, Yousufuddin M, Starling RC, et al. Does acute cellular rejection correlate with cardiac allograft vasculopathy? The Journal of Heart and Lung Transplantation 2004;23:272-6. 24.Pethig K, Klauss V, Heublein B, et al. Progression of cardiac allograft vascular disease as assessed by serial intravascular ultrasound: correlation to immunological and non-immunological risk factors. Heart 2000;84:494-8. 25.Tuzcu EM, Kapadia SR, Sachar R, et al. Intravascular ultrasound evidence of angiographically silent progression in coronary atherosclerosis predicts long-term morbidity and mortality after cardiac transplantation. Journal of the American College of Cardiology 2005;45:1538-42. 26.Joshi PH, Rinehart S, Vazquez G, et al. A peripheral blood gene expression score is associated with plaque volume and phenotype by intravascular ultrasound with radiofrequency backscatter analysis: results from the ATLANTA study. Cardiovascular diagnosis and therapy 2013;3:5-14. 27.Jimenez J, Kapadia SR, Yamani MH, et al. Cellular rejection and rate of progression of transplant vasculopathy: a 3-year serial intravascular ultrasound study. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2001;20:393-8. 28.Lee CM, Wu YW, Chou NK, et al. Intravascular ultrasound evidence of angiographically silent allograft vasculopathy inversely correlates with circulating level of hepatocyte growth factor. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2006;25:1456-61. 29.Stoica SC, Cafferty F, Pauriah M, et al. The cumulative effect of acute rejection on development of cardiac allograft vasculopathy. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2006;25:420-5. 30.Yamani MH, Haji SA, Starling RC, et al. Myocardial ischemic-fibrotic injury after human heart transplantation is associated with increased progression of vasculopathy, decreased cellular rejection and poor long-term outcome. Journal of the American College of Cardiology 2002;39:970-7. 31.Potena L, Grigioni F, Ortolani P, et al. Safety and efficacy of early aggressive versus cholesterol-driven lipid-lowering strategies in heart transplantation: a pilot, randomized, intravascular ultrasound study. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2011;30:1305-11. 32.Luo CM, Chou NK, Chi NH, et al. The effect of statins on cardiac allograft survival. Transplantation proceedings 2014;46:920-4. 33.Masetti M, Potena L, Nardozza M, et al. Differential effect of everolimus on progression of early and late cardiac allograft vasculopathy in current clinical practice. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2013;13:1217-26. 34.Matsuo Y, Cassar A, Yoshino S, et al. Attenuation of cardiac allograft vasculopathy by sirolimus: Relationship to time interval after heart transplantation. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2013;32:784-91. 35.Rosenbaum DH, Adams BC, Mitchell JD, et al. Effects of early steroid withdrawal after heart transplantation. The Annals of thoracic surgery 2006;82:637-44; discussion 44. 36.Felkel TO, Smith AL, Reichenspurner HC, et al. Survival and incidence of acute rejection in heart transplant recipients undergoing successful withdrawal from steroid therapy. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2002;21:530-9. 37.Wehner J, Morrell CN, Reynolds T, Rodriguez ER, Baldwin WM, 3rd. Antibody and complement in transplant vasculopathy. Circulation research 2007;100:191-203. 38.Jane-Wit D, Manes TD, Yi T, et al. Alloantibody and complement promote T cell-mediated cardiac allograft vasculopathy through noncanonical nuclear factor-kappaB signaling in endothelial cells. Circulation 2013;128:2504-16. 39.Gonzalez-Vilchez F, Vazquez de Prada JA, Paniagua MJ, et al. Rejection after conversion to a proliferation signal inhibitor in chronic heart transplantation. Clinical transplantation 2013;27:E649-58. 40.Wissing KM, Pipeleers L. Obesity, metabolic syndrome and diabetes mellitus after renal transplantation: prevention and treatment. Transplant Rev (Orlando) 2014;28:37-46. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/56804 | - |
dc.description.abstract | 心臟移植為心臟衰竭末期的治療方式之一。藉由醫療技術的進步,逐漸減少移植一年內的急性細胞排斥,並改善病患存活率,然而對於移植一年後的存活率並無明顯進步,探究造成病患後期死亡的原因,植體血管病變為病因之一。
植體血管病變形態學上為侷限於植體的血管內層瀰漫性、同心圓式地增厚,由於如此,在治療上若執行血管再生術只能達到缺血性症狀的緩解,唯一確切的治療方式為再移植。造成植體血管病變的病因尚未確立,但從血管內層擴散性地增厚並侷限於植體的表現來看,應與移植後的免疫反應較為相關。 急性細胞排斥為移植後可能發生的排斥情況之一,其發生頻率隨著時間逐漸減少,而排斥發生時的治療方式為給予高劑量類固醇或調整免疫抑制劑組合。由於急性細胞排斥較植體血管病變容易處理,因此若能確立兩者之間的相關性則有助於改善心臟移植病患後期存活率。 本研究收錄了68位於心臟移植後12± 3個月區間接受血管內超音波檢查的病患,並以病歷審閱的方式蒐集移植一年內的急性細胞排斥情況、病患基本資料、共病症以及移植後用藥等資訊來進行分析。 初步分析各因子與血管內斑指數之相關性,則男性-女性對比、冠狀動脈心臟病-擴張性心肌病變對比、平均排斥分數與平均排斥次數之相關性達顯著。進一步以多變相逐步回歸分析確立各因子對血管內斑指數的影響力,平均排斥分數與平均排斥次數均再度被選入模式中。研究結果顯示,若病患於移植後一年內發生越多的急性細胞排斥則追蹤之冠狀動脈血管內層增厚程度可能越嚴重。 根據先前文獻回顧,預期HMG-CoA reductase inhibitor及mTOR inhibitor能夠減少植體血管病變,然而於本研究中藥物對血管內斑指數並無顯著影響力,可能因為於此研究中分析樣本數過少以及無法確定病患服藥順從性,而此為未來藥師可加強移植病患用藥衛教之著力點。 | zh_TW |
dc.description.abstract | Heart transplantation is one of the treatments for end-stage heart failure. With the advance of medicine, the survival of patients done heart transplantation gradually improves by reduceing the acute cellular rejction during 1 year following transplantation. However, there is no obvious improvement in long-term survival. And cardiac allograft vasculopathy (CAV) is one of the causes contributing to the death after 1 year. The morphology of CAV, which is limited to allograft, is diffuse and concentric vascular intimal thickness. Due to this, revascularization can only relieve ischemic symptom and the definite treatment is re-transplantation. Although the exact pathogenesis of CAV remains unknown, several lines of data suggest that it is primarily an immune-mediated disease. Acute cellular rejection is one kind of rejections after transplantation. The incidence of acute cellular rejection is centralized during the first year and decreases as the time passes. Giving steroid pulse therapy or modification of immunossuppresant is the method to deal with it. Acute cellular rejection is easier to manage than CAV and if the correlation between them can be established, it is helpful to ameliorate the survival.
The study comprises 68 heart-transplanted patients who receive intravascular ultrasound examination during 12± 3 months after transplantation. Through chart review, patients characteristics, comorbidity, the situation of acute cellular rejection and drug usage are collected. In univariate analysis, male, coronary artery disease, average rejection score and average rejection frequency are associated with the plaque index of CAV. In multivariate analysis, acute rejection score and acute rejection frequency are still significantly associated with the plaque index. The result reveals that the more acute cellular rejection, the severer intimal thickness will be detected. Based on previous literature, HMG-CoA reductase inhibitor and mTOR inhibitor are predicted to reduce CAV. Nevertheless, there are no drug-related effects detected in the study. Small sample size and poor compliance may be the reasons and it is the further point for pharmacists to focus on. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T05:49:31Z (GMT). No. of bitstreams: 1 ntu-103-R01451001-1.pdf: 1757998 bytes, checksum: 8012af9ceecfaf1c6e791d7ec5e52477 (MD5) Previous issue date: 2014 | en |
dc.description.tableofcontents | 第一章 緒論 1
第一節 心臟移植後植體血管病變簡介 1 第二節 免疫與非免疫因素致植體血管病變機轉 3 第三節 心臟移植後植體血管病變之預防與治療 5 第四節 研究目標與文獻回顧 7 第二章 研究方法 12 第一節 研究設計 12 第二節 病患收納條件 12 第三節 資料蒐集 12 第四節 統計分析 13 第三章 結果 15 第一節 病患特性 15 第二節 影響植體血管病變因子 19 第三節 影響移植後一年內排斥情況因子 22 第四章 討論 24 第一節 病患特性 24 第二節 與先前文獻之比較 25 第三節 預期之藥物相關研究結果 29 第四節 血管內斑指數與平均排斥分數相關性討論 30 第五節 研究限制 31 第六節 未來應用探討 32 第五章 參考文獻 33 | |
dc.language.iso | zh-TW | |
dc.title | 心臟移植後植體血管病變與急性細胞排斥相關性之研究 | zh_TW |
dc.title | Correlation between transplant arteriosclerosis and acute cellular rejection in cardiac allografts | en |
dc.type | Thesis | |
dc.date.schoolyear | 102-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 王水深,林慧玲 | |
dc.subject.keyword | 心臟移植,植體血管病變,急性細胞排斥, | zh_TW |
dc.subject.keyword | heart transplantation,transplant arteriosclerosis,acute cellular rejection, | en |
dc.relation.page | 36 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2014-08-08 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床藥學研究所 | zh_TW |
顯示於系所單位: | 臨床藥學研究所 |
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