血漿同半胱胺酸濃度與冠狀動脈心臟病及其用藥之相關性探討

The association studies of plasma homocysteine level with coronary artery disease and with the drugs used

鮑冠吟(Kuan-Yin Pao)

指導教授 ： 高純琇 ； 黃瑞仁

國立臺灣大學/醫學院/臨床藥學研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.01729

摘要

血漿同半胱胺酸濃度偏高已被逐漸認為是動脈粥狀硬化疾病之危險因子之一。由於測定方法的改善及趨於標準化，血漿同半胱胺酸有機會成為將來心血管疾病篩檢項目之一，因此有必要建立國人本土性資料作為臨床評估及治療參考。
本研究目的為收集冠狀動脈心臟病高危險群病人之血漿同半胱胺酸濃度及其各影響因子，並瞭解高同半胱胺酸血症之盛行率，分析同半胱胺酸在國人冠狀動脈心臟病所佔之角色，探討如何由血漿同半胱胺酸濃度評估冠狀動脈心臟病之危險性。同時瞭解本研究病人群在冠狀動脈心臟病之傳統危險因子-高血壓、血脂異常及糖尿病的控制情形，與其治療藥物之處方型態。
在血漿同半胱胺酸之相關因子研究方面，採用前瞻性橫斷面研究法，邀請台大醫院心臟內科門診病患加入研究，排除慢性腎臟疾病或最近Scr＞1.5 mg/dL、懷孕、併用仿單所列會影響同半胱胺酸測定之藥品、長期酗酒、因精神或肢體障礙無法配合研究進行的病患後，抽血測定血液生化值及進行生活飲食習慣之問卷訪談。
在傳統危險因子控制目標達成率及所用藥品處方型態分析方面，以回溯性調閱病歷及橫斷面調查方式，取得研究病患該次門診用藥及危險因子控制情形資料並加以分析。
自民國92年9月至民國93年4月底，共納入175位病患。全體病患之空腹血漿同半胱胺酸濃度平均值為10.47 ± 3.48

關鍵字

高同半胱胺酸血症 ； 血漿同半胱胺酸 ； 冠狀動脈心臟病 ； 處方型態 ； 治療目標達成率

並列摘要

Elevation of plasma homocysteine has been recognized as one of risk factors of atherosclerotic disease. Due to the progress of of detecting method standardization, plasma homocysteine may become a routine screening tool for cardiovascular disease. It is necessary to set up the local data bank for clinical evaluation and treatment of cardiovascular disease.
Objectives of this study: (1) to investigate the level of plasma homocysteine and the prevalence of hyperhomocysteinemia, and to evaluate the factors that may influence it; (2) to find out the role of homocysteine in coronary artery disease and the proper cut-off point of plasma homocysteine to evaluate the presence of coronary artery disease; (3) to understand the control condition of traditional risk factors of cardiovascular disease, especially hypertension, dyslipidemia and diabetes mellitus.
The study subjects were recruited from ambulatory setting of cardiology in National Taiwan University Hospital. Exclusion criteria were patient with chronic renal disease or Scr > 1.5 mg/dL, pregnancy, concomitant drugs that list in the instruction of detecting homocysteine, alcoholism and the patients with mental disorder or verbal difficulties that cannot follow orders. Blood samples of included patients were drawn for biochemistry tests. Data of lifestyle was collected during the interview with researcher. The medication data and the monitoring parameters of hypertension, dyslipidemia and diabetes mellitus were collected by reviewing the medical charts of these patients.
From September 2003 to April 2004, there were 175 patients included in the study. The average fasting plasma homocysteine concentration was 10.47 ± 3.48

並列關鍵字

coronary artery disease (CAD) ； Plasma homocysteine ； prescribing pattern ； therapeutic goal ； hyperhomocysteinemia

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