Please use this identifier to cite or link to this item: http://hdl.handle.net/11455/92606
DC FieldValueLanguage
dc.contributor許美鈴zh_TW
dc.contributorMeei-Ling Sheuen_US
dc.contributor.author王怡梅zh_TW
dc.contributor.authorYi-Mei Wangen_US
dc.contributor.other生命科學院碩士在職專班zh_TW
dc.date2014zh_TW
dc.date.accessioned2015-12-16T03:56:02Z-
dc.identifierU0005-0701201421274200zh_TW
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[31] Inzitari D, Hachinski VC, Taylor DW, Barnett HJ. Racial differences in the anterior circulation in cerebrovascular disease. How much can be explained by risk factors? Arch Neurol 1990; 47: 1080-1084. [32] Guo X, Pantoni L, Simoni M, Bengtsson C, Bjorkelund C, Lissner L, et al. Blood pressure components and changes in relation to white matter lesions: a 32-year prospective population study. Hypertension 2009; 54: 57-62. [33] Marcus J, Gardener H, Rundek T, Elkind MS, Sacco RL, Decarli C, et al. Baseline and longitudinal increases in diastolic blood pressure are associated with greater white matter hyperintensity volume: the northern Manhattan study. Stroke 2011; 42: 2639-2641.zh_TW
dc.identifier.urihttp://hdl.handle.net/11455/92606-
dc.description.abstract背景 腦中風為台灣國人的第三大死亡原因,而大部分的缺血性中風的病理生理因素是動脈粥樣硬化。由於顱內外動脈血管的結構以及分佈位置不同,因此也可能是由於不同的疾病危險因素導致。過去的研究主要都著重於已經罹患中風的族群,結果不一而產生了相互矛盾,本研究希望能透過非中風的族群,針對動脈硬化分佈的不同而與其相關的危險因素也不同的想法,釐清此想法並做深入探討。 方法 本研究為橫斷面研究,納入200位未曾發生過腦血管疾病之受試者參與研究 (111位男性以及89位女性,平均年齡62.9 ± 8.9歲)。經過簽署書面同意書後,所有研究受試者均須要接受顱外和顱內彩色杜普勒超音波檢測,以確認顱外動脈或顱內動脈是否有超過50%的血管狹窄或阻塞現象。並評估心血管疾病相關的危險因素:發炎反應、肥胖、缺乏運動、吸煙、糖尿病、高血壓、血脂異常和腎功能不全等危險因子,實驗室檢測包括白血球計數、糖化血色素、空腹血糖、肌酸酐及多項血脂肪相關測定,並記錄身體質量指數、收縮壓、舒張壓、平均動脈壓及脈壓。將所收集之因子利用多邏輯斯迴歸分析模型來評估心血管疾病的危險因素與顱外或顱內動脈狹窄之間的關係。 結果 所有200位研究對象中,顱外動脈狹窄的盛行率有13.0% (26例),顱內動脈狹窄的盛行率有37.6% (53例)。由多邏輯斯迴歸分析顯示,脈壓(pulse pressure)愈高(OR= 1.240, 95% CI: 1.006-1.528, p= 0.041)以及未接受降血脂藥物治療(OR= 0.207, 95% CI: 0.062-0.684, p= 0.010),其顱外動脈狹窄的風險則愈高,此兩種因子為顱外動脈狹窄的獨立預測因子;而舒張壓(Diastolic blood pressure)愈高(OR= 1.326, 95% CI: 1.040-1.690, p= 0.023)與接受高血壓藥物治療(OR= 3.879, 95% CI: 1.355-11.101, p= 0.012),其顱內動脈狹窄的風險則愈高,此兩種因子為顱內動脈狹窄的獨立預測因子。 結論 我們的研究結果顯示,不同的風險因素影響動脈粥樣硬化分佈。在顱外血管的動脈粥樣硬化過程中,脈壓以及未接受降血脂藥物治療扮演著重要的角色。而在顱內血管的動脈粥樣硬化過程中,則是由舒張壓以及降血壓藥物治療扮演著重要的角色。zh_TW
dc.description.abstractBackground Stroke is the third leading cause of death in Taiwan. In most of ischemic strokes the underlying pathophysiology is atherosclerosis. Since the vessel structures and locations of extracranial and intracranial arteries are not the same, we assumed that the risk factors for their atherosclerosis will be different. Previous studies, mainly focusing on stroke population, yielded conflicting results. This study was carried out in order to determine the risk factors of extracranial versus intracranial atherosclerosis among stroke free subjects. Methods This cross-sectional study enrolled 200 subjects without history of cerebrovascular disease (111 men and 89 women, with age of 62.9 ± 8.9 years (mean ± SD)). All participants underwent extracranial and intracranial color-coded duplex sonography to detect presence of extra- and intra- cranial artery stenosis. Significant stenosis was defined as a more than 50% stenosis or occlusion of the extracranial and intracranial arteries. The patients were evaluated for the cardiovascular risk factors: inflammation, obesity, physical inactivity, smoking, diabetes mellitus, hypertension, dyslipidemia, and renal dysfunction. Laboratory tests included white blood cell count, haemoglobin A1c, fasting plasma glucose, creatinine, and lipid profiles were collected. We also measured body mass index, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse pressure. Multiple logistic regression models were employed to assess cardiovascular risk factors between extracranial and intracranial artery stenosis. Results Of the study subjects, 13.0 % (n= 26) had ≧50% extracranial artery stenosis, and 37.6% (n= 53) had ≧50% intracranial artery stenosis. Results of multiple logistic regression analysis demonstrated that the pulse pressure (OR=1.240, 95% CI: 1.006-1.528, p=0.041) and no statin use (OR=0.207, 95% CI: 0.062-0.684, p=0.010) were independently associated with extracranial artery stenosis whereas diastolic blood pressure (OR=1.326, 95% CI: 1.040-1.690, p=0.023) and anti-hypertensive treatment (OR=3.879, 95% CI: 1.355-11.101, p=0.012) were found to be independent contributors of intracranial artery stenosis. Conclusions Our study result revealed different risk factors were associated with distributions of atherosclerosis. For extracranial vessels, pulse pressure and no statin use played more important role in their atherosclerosis. As for intracranial vessels' atherosclerosis, diastolic blood pressure and use of anti-hypertensive treatment contributed more significantly.en_US
dc.description.tableofcontentsContents ACKNOWLEDGEMENTS I ABBREVIATIONS III ABSTRACT IN CHINESE IV ABSTRACT IN ENGLISH VI CONTENTS VIII LIST OF TABLES XI LIST OF FIGURES XII CHAPTER 1 INTRODUCTION 1 1.1. THE IMPACT OF ISCHEMIC STROKE 1 1.2. PATTERNS OF ISCHEMIC STROKE ACROSS GEOGRAPHICAL AREAS 1 1.3. HYPOTHESIS 2 CHAPTER 2 METHODS 3 2.1. CONCEPTUAL FRAMEWORK 3 2.2. PARTICIPANTS 4 2.3. DEFINITION AND ASSESSMENT OF CARDIOVASCULAR RISK FACTORS 4 2.4. ULTRASOUND PROTOCOL 6 2.4.1. Extracranial color-coded duplex sonography (ECCS) 6 2.4.1.1. Extracranial color-coded duplex sonography protocol 6 2.4.1.2. Diagnostic criteria of extracranial artery stenosis 6 2.4.2. Transcranial color-coded duplex sonography (TCCS) 7 2.4.2.1. Transcranial color-coded duplex sonography protocol 7 2.4.2.2. Diagnostic criteria of intracranial artery stenosis 8 2.5. STATISTICAL ANALYSIS 9 CHAPTER 3 RESULTS 10 3.1. CHARACTERISTICS OF PARTICIPANTS 10 3.2. BASELINE CHARACTERISTICS OF THE STUDY GROUP WITHOUT AND WITH EXTRACRANIAL ARTERY STENOSIS 11 3.2.1. Baseline characteristics of the study group without extracranial artery stenosis 11 3.2.2. Baseline characteristics of the study group with extracranial artery stenosis 12 3.2.3. Comparison of baseline characteristics between the study group without and with extracranial artery stenosis 13 3.3. BASELINE CHARACTERISTICS OF THE STUDY GROUP WITHOUT AND WITH INTRACRANIAL ARTERY STENOSIS 14 3.3.1. Baseline characteristics of the study group without intracranial artery stenosis 14 3.3.2. Baseline characteristics of the study group with intracranial artery stenosis 15 3.3.3. Comparison of baseline characteristics between the study group without and with intracranial artery stenosis 16 3.4. MULTIPLE LOGISTIC REGRESSION ANALYSIS TO DETERMINE THE PREDICTOR OF EXTRACRANIAL ARTERY STENOSIS 17 3.5. MULTIPLE LOGISTIC REGRESSION ANALYSIS TO DETERMINE THE PREDICTOR OF INTRACRANIAL ARTERY STENOSIS 18 CHAPTER 4 DISCUSSION 19 4.1. MAJOR FINDINGS 19 4.2. MECHANISMS OF EXTRA- AND INTRA- CRANIAL ARTERY STENOSIS 20 4.2.1. Hypertension and cranial artery stenosis 20 4.2.2. Diabetes mellitus and cranial artery stenosis 22 4.2.3. Dyslipidemia and cranial artery stenosis 23 4.2.4. Prevention strategies for cranial artery stenosis 23 4.3. STUDY LIMITATIONS 24 4.4. CONCLUSIONS 24 REFERENCES 25 APPENDIX 46 (一) 人體試驗委員會通過證明函(1) 46 (二) 人體試驗委員會通過證明函(2) 48 (三) 臨床研究受試者說明及同意書(1) 50 (四) 臨床研究受試者說明及同意書(2) 57 (五) 個人健康及生活狀態評估問卷 65 List of Tables Table 1. Extracranial color-coded duplex sonography detection of extracranial artery stenosis: diagnostic criteria 30 Table 2. Transcranial color-coded duplex sonography detection of ≧50% intracranial stenosis: diagnostic criteria and accuracy 31 Table 3. TCCS detection of <50% intracranial stenosis: diagnostic criteria and accuracy 32 Table 4. Demographic Characteristics of study population 33 Table 5. Baseline characteristics of the study group without and with extracranial artery stenosis 34 Table 6. Baseline characteristics of the study group without and with intracranial artery stenosis 35 Table 7. Multiple logistic regression analysis to determine the predictor of extracranial artery stenosis 36 Table 8. Multiple logistic regression analysis to determine the predictor of intracranial artery stenosis 37 List of Figures Figure 1. Ten Leading Causes of Death in Taiwan in 2012 38 Figure 2. Carotid duplex 39 Figure 3. Carotid artery systems 40 Figure 4. Example of right internal carotid artery (ICA) stenosis 41 Figure 5. Methods for calculating percent carotid artery stenosis 42 Figure 6. Transcranial Doppler 43 Figure 7. Circle of Willis 44 Figure 8. Example of right middle cerebral artery (MCA) stenosis 45zh_TW
dc.language.isoen_USzh_TW
dc.rights同意授權瀏覽/列印電子全文服務,2017-01-10起公開。zh_TW
dc.subject顱外動脈狹窄zh_TW
dc.subject顱內動脈狹窄zh_TW
dc.subject脈壓zh_TW
dc.subject舒張壓zh_TW
dc.subjectextracranial artery stenosisen_US
dc.subjectintracranial artery stenosisen_US
dc.subjectpulse pressureen_US
dc.subjectdiastolic blood pressureen_US
dc.title探討非中風患者其顱外血管狹窄及顱內血管狹窄之獨特相關的心血管危險因素zh_TW
dc.titleDistinctive Cardiovascular Risk Factors between Extra- and Intra- Cranial Artery Stenosis in Stroke Free Subjectsen_US
dc.typeThesis and Dissertationen_US
dc.date.paperformatopenaccess2015-01-10zh_TW
dc.date.openaccess2017-01-10-
item.languageiso639-1en_US-
item.openairetypeThesis and Dissertation-
item.cerifentitytypePublications-
item.grantfulltextrestricted-
item.fulltextwith fulltext-
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
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