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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 簡國龍 | |
| dc.contributor.author | Chih-Hsuan Yen | en |
| dc.contributor.author | 顏志軒 | zh_TW |
| dc.date.accessioned | 2021-06-16T08:04:11Z | - |
| dc.date.available | 2016-10-20 | |
| dc.date.copyright | 2014-10-20 | |
| dc.date.issued | 2014 | |
| dc.date.submitted | 2014-07-01 | |
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/57985 | - |
| dc.description.abstract | 背景
中央動脈硬化已知在許多心血管疾病中扮演重要角色。然而，有關不同區段之血管動脈硬化脈波速 ( PWV) 與B型排鈉利尿胜肽 (BNP) 之相關性研究仍有許多未知之處。 材料與方法 本研究自2009至2011年總共研究了一千二百五十五名 (平均年齡六十二點六歲；百分之四十七點八為男性)中度至重度心血管危險性 (大於等於兩個危險因子) 且保存性左心室收縮射出分率的個體。使用日本歐姆龍公司 VP-2000 機器評估不同區段之血管動脈硬化脈波速 (心股區段 hf-PWV、臂踝區段 ba-PWV、心頸區段 hc-PWV) 並使用機器檢驗血液中B型排鈉利尿胜肽濃度。 結果 將所有參與者依照心股區段血管動脈硬化脈波速分成四分位，高的心股區段血管動脈硬化脈波速有明顯較大的年紀、較多的女性、較差的腎功能、較高的血壓值及左心室心肌質量參數，以及較高的B型排鈉利尿胜肽濃度指數(P值皆小於0.05)。心股區段血管動脈硬化脈波速與B型鈉利尿胜肽濃度相關性最好(相關係數=0.28，檢定結果P值小於0.01)。經過多變量迴歸分析校正，心股區段與臂踝區段血管動脈硬化脈波速皆與較高的B型排鈉利尿胜肽濃度相關(beta-值相對應心股區段、臂踝區段分別為8.3, 6.4，檢定結果P值皆小於0.01) 。外加於左心室心肌質量參數，心股區段與臂踝區段血管動脈硬化脈波速分別可多提供預測較高B型排鈉利尿胜肽濃度指數 (>100 pg/ml)的效應(C 統計量分別從0. 63 增至0.71與0.63 增至0.69， P值皆小於0.01) 但只有心股區段血管動脈硬化脈波速可增加0.7%再分組後改善預測B型排鈉利尿胜肽濃度機率(P值等於0.029)。 結論 我們的研究報告指出區段血管動脈硬化脈波速與較高的B型排鈉利尿胜肽濃度相關。不同區段血管動脈硬化脈波速代表不同影響且與心肌過度壓力負荷有臨床上的相關性。 | zh_TW |
| dc.description.abstract | Background:
Central arterial stiffness had been shown to play a key role in cardiovascular diseases. However, evidence regarding such arterial stiffness from various arterial segments in relation to B type natriuretic peptide (BNP) remained elusive. Materials and methods: The project consecutively studied 1255 participants (mean±SD age: 62.6±12.3 years, 47.8% men) with preserved left ventricular ejection fraction (LVEF)>=50% and at least two risk factors. Arterial pulse wave velocity (PWV) was measured by an automatic device (VP-2000; Omron Healthcare, Japan) for heart-femoral (hf-PWV), brachial-ankle (ba-PWV), and heart-carotid (hc-PWV) segments. BNP concentrations were measured. Results: Participants in the highest quartile of hf-PWV were older, more female percentage, worse renal function, higher blood pressure, left ventricule mass index (LVMI) and serum BNP level, compared with those in the lowest quartile (all P<0.05). Hf-PWV was strongest associated with elevated serum BNP (r=0.28, p<0.01). Both hf-PWV and ba-PWV were related to elevated serum BNP level after adjusted (beta coefficient= 8.3, 6.4 respectively, both P<0.01). Adding both hf-PWV and ba-PWV to LVMI, the area under receiver operating curve were respectively increased from 0.63 to 0.71 and from 0.63 to 0.69 significantly (p<0.01) to predicting high BNP (>100 pg/ml) but only hf-PWV had significant better 0.7% ability to predict a high BNP concentration (P=0.029). Conclusion: Our study showed that significant segmental PWV was associated with BNP concentration, implying that arterial stiffness was associated with the myocardial pressure overload. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-16T08:04:11Z (GMT). No. of bitstreams: 1 ntu-103-R01849034-1.pdf: 1113709 bytes, checksum: a7f4bd8d9fbc851099751a5c1fdb98a9 (MD5) Previous issue date: 2014 | en |
| dc.description.tableofcontents | 致謝 2
口試委員會審定書 3 中文摘要 4 Abstract 6 Acronyms- Abbreviations 8 List of tables 11 List of figures 12 Chapter 1 Introduction 13 1.1 Research background 13 1.1.1 Research motivation 13 1.1.2 Preserved EF heart failure and BNP 13 1.1.3 Left ventricle mass index, preserved EF function and BNP 15 1.2 Risk factors for CHD and intermediate to high risk population 15 1.3 Pulse pressure, pulse wave velocity and heart failure 16 1.3.1 Pulse pressure and heart failure 16 1.3.2 Pulse wave velocity and heart failure 17 1.4 Arterial stiffness, central aortic PWV, muscular ba-PWV and BNP 17 1.4.1 Central aortic and carotid PWV 17 1.4.2 Muscular ba-PWV and BNP 18 1.5 Anti-arterial stiffness medical treatment mechanism 19 1.6 Research gap 20 1.7 Study aim and significance of the study 20 Chapter 2 Research hypothesis 21 3.1 Hypothesis and objectives 21 Chapter 3 Materials and methods 22 3.1 Study design 22 3.2 Study flow diagram 22 3.3 Study participants characteristics 23 3.4 Definition of risk factors 23 3.5 Echocardiography 24 3.6 Pulse wave velocity 25 3.7 Laboratory measurements 25 3.8 Sample size and power estimation 26 3.9 Statistical analysis 27 Chapter 4 Results 29 4.1 Basic characteristics of the study participants 29 4.1.1 Correlation between hf-PWV, ba-PWV, hc-PWV and BNP 29 4.1.2 Multiple regression model for continuous BNP concentrations 30 4.2 Hf-PWV, ba-PWV associated with binary BNP 30 4.3 Other important clinical factors of BNP concentration 30 4.3.1 Calibration with receiver operating curve 31 4.3.2 Reclassification with net reclassification improved, integrated discrimination improvement 31 4.3.3 Reliability test 32 Chapter 5 Discussion 33 5.1 Pulse wave velocity and BNP concentration 33 5.2 Segmental pulse wave velocity, aortic arterial PWV, muscular arterial PWV and carotid arterial PWV 34 5.3 Biological mechanism 35 5.4 BNP and coronary artery disease, body mass index and chronic renal disease ………………………………………………………………………………………………………………….36 5.4.1 Coronary artery disease 36 5.4.2 Body mass index and obesity 37 5.4.3 Chronic renal disease 38 5.5 Pulse wave velocity, preserved EF heart function and BNP 39 5.6 Pulse wave velocity and treatment 40 5.7 Clinical implication 42 5.8 Significance and weakness of our study 42 5.9 Conclusion 43 References 65 | |
| dc.language.iso | en | |
| dc.subject | 血管動脈硬化 | zh_TW |
| dc.subject | 保存性收縮功能 | zh_TW |
| dc.subject | B型排鈉利尿胜? | zh_TW |
| dc.subject | 脈波速 | zh_TW |
| dc.subject | Arterial stiffness | en |
| dc.subject | Pulse wave velocity | en |
| dc.subject | B type natriuretic peptide | en |
| dc.subject | preserved EF function | en |
| dc.title | 區段血管硬化在保存性收縮功能暨中度至高度心血管風險族群與B型排鈉利尿胜肽之關聯性研究 | zh_TW |
| dc.title | Segmental Arterial Stiffness in Relation to B type Natriuretic Peptide with Preserved Systolic Function in Intermediate-to-high Risk Patients | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 102-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 季瑋珠,葉宏一,杜裕康 | |
| dc.subject.keyword | 血管動脈硬化,脈波速,B型排鈉利尿胜?,保存性收縮功能, | zh_TW |
| dc.subject.keyword | Arterial stiffness,Pulse wave velocity,B type natriuretic peptide,preserved EF function, | en |
| dc.relation.page | 70 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2014-07-01 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 流行病學與預防醫學研究所 | zh_TW |
| 顯示於系所單位： | 流行病學與預防醫學研究所 | |
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| ntu-103-1.pdf 未授權公開取用 | 1.09 MB | Adobe PDF |
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