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系統識別號 U0007-2007201722055500
論文名稱(中文) 口服均衡營養補充品對血液透析患者發炎反應與氧化壓力之影響
論文名稱(英文) Effects of oral balanced nutritional supplement on inflammation and oxidative stress in hemodialytic patients
校院名稱 臺北醫學大學
系所名稱(中) 保健營養學研究所
系所名稱(英) Graduate Institute of Nutrition and Health
學年度 105
學期 2
出版年 106
研究生(中文) 阮庭洪
研究生(英文) Teng-Hong Un
學號 M507104026
學位類別 碩士
語文別 中文
口試日期 2017-06-13
論文頁數 98頁
口試委員 委員-蔡英傑
委員-楊淑惠
指導教授-趙振瑞
中文關鍵字 均衡營養補充品  發炎反應  氧化壓力  血液透析 
英文關鍵字 oral balanced supplement  inflammation  oxidative stress  hemodialysis 
學科別分類
中文摘要 美國腎臟病資料登錄系統 (The United States Renal Data System, USRDS) 2015年提出,台灣末期腎臟病 (end stage renal disease, ESRD)的發生率及盛行率皆位居世界第一,近年來臺灣地區透析患者的死亡率有不斷上升之趨勢,且心血管疾病為其主要死亡原因。發炎反應與氧化壓力皆為ESRD患者罹患心血管疾病的危險因子。過去研究皆為針對口服均衡營養補充品能否改善體內營養不良指標為主,故本實驗將再深入探討口服均衡營養補充品,對於血液透析患者體內發炎反應與氧化壓力之影響。100位血液透析患者平均分為2組,控制組維制正常飲食,實驗組根據每日建議熱量攝取量,每日補充一或兩包均衡營養補充品(每包含:熱量200大卡, 48% 碳水化合物, 32% 脂肪、20% 蛋白質、0.7%, w/w精胺酸,及4.8%, w/w麩醯胺酸 ) ,實驗期為12週。結果顯示實驗組補充均衡營養補充品 12 週後會顯著降低介白素6 (interleukin 6, IL-6)、腫瘤壞死因子-α (tumor necrosis factor alpha, TNF-α)、C-反應性蛋白 (C-reactive protein, CRP)、及丙二醛 (malondialdehyde, MDA) 之濃度,顯著增加介白素10 (interleukin 10, IL-10) 與及總抗氧化能力 (Total antioxidant capacity, TAC)之濃度。比較控制組與實驗組之第 12週間變化量,實驗組會使TNF-α與CRP 之濃度下降量顯著增加,IL-10之濃度增加量顯著上升,故補充均衡營養補充品12 週後可有效改善血液透析患者之發炎與氧化壓力指標。
英文摘要 According to the United States Renal Data System 2015 Data Report, Taiwan had the highest prevalence of end-stage renal disease (ESRD) in the world. Inflammation and oxidative stress are risk factors of cardiovascular disease in ESRD patients. Insufficient data show whether intake of oral balanced nutritional supplement can improve inflammation and oxidative stress in hemodialytic patients. Therefore, this study evaluated the effect of oral balanced nutritional supplement on inflammation and oxidative stress in hemodialytic patients. One hundred hemodialytic patients were recruited and divided evenly into two groups. The subjects in the control group were kept on their regular diet without supplement. The subjects in the treatment group were assigned one or two packages (43 g per package) of oral balanced nutritional supplement (200 kcal energy, 48% carbohydrate, 32% fat and 20% protein per package) containing arginine (0.7%, w/w) and glutamine (4.8%, w/w) daily for 12 weeks based on the recommended energy requirement. Serum interlukin-10 (IL-10) and total antioxidant capacity (TAC) levels in the treatment groupwere increased significantly at week 12. Moreover, serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and malondialdehyde (MDA) levels in the treatment group were decreased significantly at week 12. There were no significant differences for inflammatory and oxidative stress markers in the control group at weeks 0, 6, and 12. Increases in serum IL-10 level in the treatment group were significantly greater than those in the control group at week 12 compared with the baseline. Furthermore, decreases in serum TNF-α and CRP levels in the treatment group were significantly greater than those in the control group at week 12 compared with the baseline. Our results suggest that oral balanced nutritional supplement containing arginine and glutamine is effective for anti-inflammation and anti-oxidation in hemodialytic patients.
論文目次 目錄
第一章 緒論 1
第二章 文獻回顧 4
第一節 慢性腎臟病之分級 4
第二節 血液透析之過程與透析通路 6
第三節 透析患者之流行病學調查資料 7
第四節 透析患者之死亡率及死亡主因 8
第五節 氧化壓力與發炎反應 10
第六節 血液透析患者之營養狀態 16
第七節 口服均衡營養補充品對於營養狀況之影響 17
第八節 均衡營養補充品之比較 19
第九節 精胺酸與麩醯胺酸之介紹 21
第十節 研究動機與目的 22
第三章 研究設計與材料方法 23
第一節 受試者標準與數目 23
第二節 受試期飲食管理 25
第三節 飲食介入 26
第四節 實驗分組與分析項目 28
第五節 檢體分析 30
第六節 統計方法 41
第四章 結果 42
第一節 受試者基本資料與問卷結果 42
第二節 受試者飲用特殊營養食品情況與飲食攝取量 45
第三節 受試者肝臟功能、腎臟功能,發炎及氧化壓力指標之變化 48
第四節 受試者空腹血醣值、營養狀況指標,及血脂質之變化 56
第五節 受試者血液電解質之變化 62
第六節 受試者全血球計數評估 65
第七節 受試者尿液評估 69
第五章 討論 73
第一節 受試者飲食攝取量與遵從度 73
第二節 不同單一營養素對於發炎與氧化壓力指標之影響 74
第三節 受試者血醣與血脂之分析 82
第四節 受試者營養指標之分析 83
第五節 受試者全血球計之分析 86
第六節 研究優點與限制 87
第六章 總論 88
第七章 參考資料 89
附件一 TMU-JIRB通過證明函 95
附件二 問卷 96
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許志明、熊昭、陳鴻鈞、黃秋錦、黃尚志、吳麥斯、簡麗年、林彥仲、高治圻 (2016)。2015台灣腎病年報。台北:國家衛生研究院。
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