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標題: | 第二型糖尿病、慢性腎病、糖尿病腎病之動脈血壓諧波指數特徵 Characteristics of Harmonic Indexes of the Arterial Blood Pressure Waveform in Type 2 Diabetes Mellitus, Chronic Kidney Disease and Diabetic Nephropathy |
作者: | Chen-Kai Liao 廖振凱 |
指導教授: | 陳中平(Chung-Ping Chen) |
關鍵字: | 第二型糖尿病,慢性腎病,糖尿病腎病,血壓,勁度,諧波指數,快速傅立葉轉換, Type 2 diabetes mellitus,Chronic kidney disease,Diabetic nephropathy,Blood pressure,Stiffness,Harmonic index,Fast Fourier transform, |
出版年 : | 2021 |
學位: | 博士 |
摘要: | 第二型糖尿病、慢性腎臟病和糖尿病腎病是全球性的重要疾病。第二型糖尿病和慢性腎臟病之間存在著因果關係,並且第二型糖尿病和慢性腎臟病均與心血管疾病相關。經由動脈勁度的觀察,可得知心血管情形,因此測量動脈勁度指標可以視為心血管風險的替代指標。因為血壓波形會受到動脈勁度的影響,因此藉由測量分析血壓波,可推知動脈勁度。眾多血壓波分析方法中,諧波分析特別適合於測量血壓波形訊號,因為心跳是準週期性的。然而,因尚不清楚第二型糖尿病受試者的橈動脈搏動所產生的血壓波的哪一些諧波指數會受影響。因此,本研究的目的是探討第二型糖尿病和非第二型糖尿病患者的血液動力學是否有顯著差異,以及哪些諧波指數有顯著差異。此外,糖尿病是慢性腎臟病的最常見危險因子。同樣地,目前尚不清楚患者動脈搏動的血壓波諧波指數是否會隨著慢性腎臟病和糖尿病腎病的變化而改變。本文的另一個目的是研究有無慢性腎臟病的患者以及有糖尿病腎病和非糖尿病腎病的患者(定義為無糖尿病且無慢性腎臟病的患者)的諧波指數是否不同。經由諧波分析,就不會因為不同人診脈而有主觀上的差異;即使不同人測量,只要用同樣的科學方式進行脈波診斷,都能建立客觀的結果。本研究收案期間是2017年12月至2019年1月,我們分別從國立台灣大學附設醫院家庭醫學部和台北榮民總醫院內科部招募第二型糖尿病,慢性腎臟病,非第二型糖尿病和非慢性腎臟病患者作為實驗組和對照組。以測量儀器ANSWatch® Model TS-0411擷取受試者左橈動脈五分鐘的血壓波訊號之後,使用快速傅立葉轉換,算出血壓波的第一到第十諧波的振幅比(Cn值)。本論文中,總共32位第二型糖尿病,15位非第二型糖尿病,27位慢性腎臟病(包括14個糖尿病腎病)和59位非慢性腎臟病(包括11個非糖尿病腎病)受試者。由分析結果得知,第二型糖尿病患者的第一諧波C1 (p = 0.031)和第五諧波C5 (p = 0.041)有顯著差異。但是,與非慢性腎臟病患者相比,慢性腎臟病患者的諧波指數沒有顯著差異。糖尿病腎病組與非糖尿病腎病組的諧波指數也無顯著差異。本研究顯示,以非侵入方式測量橈動脈血壓波的諧波特徵是一種潛在且易於執行的方法來區分因第二型糖尿病所引起的血液動力學變化。 Type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and diabetic nephropathy (DN) are significant public health issues worldwide. T2DM and CKD's relationship is potentially causal, and both T2DM and CKD correlate with cardiovascular disease. Arterial stiffness is also a critical factor that can be thought of as a surrogate marker of cardiovascular risk. Blood pressure waveforms (BPW) would be affected by arterial stiffness. Harmonic analysis is particularly appropriate for measuring BPW signals because heartbeats are quasiperiodic. Nevertheless, it was unclear which harmonic indexes of BPW from subjects’ radial artery pulses would be affected by T2DM. Therefore, this study's objective is to investigate whether and how harmonic indexes can be used to discriminate hemodynamic differences between patients with T2DM and non-T2DM. Moreover, diabetes mellitus (DM) is the most common cause of CKD. Similarly, it was unclear whether harmonic indexes of BPW from patients’ arterial pulses would change in association with CKD and DN. The other objectives of this dissertation were to examine whether harmonic indexes were different between patients with and without CKD as well as patients with DN and non-DN (defined as people without DM nor CKD). It helps us to build objective results no matter who conducts the examination instead of pulse diagnosis in the traditional way. We enrolled T2DM, CKD, non-T2DM, and non-CKD patients as experimental and control groups, respectively, from the Department of Family Medicine in the National Taiwan University Hospital and the Department of Internal Medicine in Taipei’s Veterans General Hospital from December 2017 to January 2019. Five-minute left radial BPW signals of the enrolled patients were captured by ANSWatch® Model TS-0411. Amplitude proportions (Cn values) were calculated from harmonics 1–10 of the BPW using fast Fourier transform. Thirty-two T2DM, 15 non-T2DM, 27 CKD (including 14 DN), and 59 non-CKD (including 11 non-DN) subjects were enrolled. T2DM patients had significant differences in C1 (p = 0.031) and C5 (p = 0.041). However, CKD patients did not have a significant difference in Cn compared to non-CKD patients. DN group also had no significant difference in Cn from the non-DN group. The study suggests that analyzing the harmonic characteristics of non-invasively measured BPW of the radial artery may be a potential and easy-to-perform approach to discriminate T2DM-induced hemodynamic changes. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/74182 |
DOI: | 10.6342/NTU202100156 |
全文授權: | 有償授權 |
顯示於系所單位: | 生醫電子與資訊學研究所 |
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