男性脊髓損傷患者冠狀動脈心臟病危險因子之研究

Abstract

目的：欲瞭解男性脊髓損傷患者與心 臟血管疾病危險因子之相關性，並評 估其頸動脈硬化的決定因子。 材料與方法： 87 位脊髓損傷的男性病 人參與本研究。每位病人先接受隔夜 空腹十小時的血液檢查，再進行75 克 的口服葡萄糖耐受性測試，及頸動脈 硬化檢查。檢查用的HP4500 SONOS 頸動脈超音波，配備3-10MHz 的高顯 像的即時M-mode,及3.6MHz 的杜卜勒 的探頭。基本的血脂值、血清發炎指 標和葡萄糖耐量試驗所測血中葡萄糖 值、胰島素及相關因子，則用來與頸 動脈內中皮層厚度做相關的分析。 結果：空腹2 小時的曲線下血糖值與 葡萄糖面積值皆是總頸動脈內中皮層 厚度重要的決定因子。混合迴歸分析 年齡及身體質量比皆是重要的頸動脈 內中皮層的決定因子。血壓值，無論 是收縮壓或舒張壓，皆不是頸動脈內 中皮層厚度的決定因子。 結論：除了身體質量比外，75 克葡萄 糖耐量試驗發現血中葡萄糖值，無論 是空腹或糖水負荷後，皆是總頸動脈 內中皮層厚度重要的決定因子。為了 預防心血管疾病，應鼓勵脊髓損傷病 人，多運動及預防過重。

Aim: To identify the associated risk factors for cardiovascular disease in male patients with spinal cord injury (SCI) and to study their determinants of carotid atherosclerosis. Material and Methods: Eighty-seven male patients with traumatic SCI were recruited. After overnight fasting for 10 hours, baseline venous blood sample was obtained and then a 75-g oral glucose tolerance test (OGTT) was performed for each patient. HP 4500 SONOS carotid ultrasound equipped with 3-10 MHz high-resolution real-time M-mode and 3.6 MHz Doppler was also performed for each patient. Baseline lipid profile, serum inflammatory marker (hs-CRP) and blood glucose and insulin levels before and after OGTT were used to evaluate the associations with carotid intima-media thickness (IMT) in different segments of common carotid arteries (CCA). Multivariate regression analysis with mixed models was used to evaluate the associated determinants of CCA IMT. Results: Post-load 2-h glucose levels and glucose area under curve after OGTT were found as important determinants for CCA IMT in different segments. In addition to age, body mass index (BMI) also was identified as important determinant for carotid IMT. However, office systolic and diastolic blood pressures were not significant predictor for CCA IMT. Conclusion: OGTT identified glucose level at 120 minutes and BMI are two most important determinants for carotid atherosclerosis in male SCI patients. To 2 prevent cardiovascular disease in SCI subjects, exercise and weight control should be emphasized.