黃天祥2006-07-262018-07-112006-07-262018-07-112005http://ntur.lib.ntu.edu.tw//handle/246246/23701由於醫療的進步，脊髓損傷者的壽命 明顯增加，因此心血管疾病已成脊髓損傷 者重要的死因。據流行病學調查發現脊髓 損傷者具有較正常人為高的心血管疾病盛 行率及死亡率。心血管疾病的危險因子包 括高血脂症、高血壓、胰島素抗性及肥胖 等，這些危險因子也被稱為代謝症候群。 回顧文獻脊髓損傷者有較高比率的血脂異 常、胰島素抗性及體脂肪比率。 近年來的研究已知脂肪組織分泌很多 脂肪細胞激素包括瘦素及adiponectin 等， 這些細胞激素被認為與胰島素抗性有極大 的關係。尤其adiponectin 及其受體在體內 及體外之研究都證明與胰島素抗性及心血 管病態生理有明顯的關係。 我們針對62 位男性脊髓損傷者測量 身高、體重、腹圍、血壓，並抽血測定飯 前血糖、胰島素、高密度脂蛋白、三酸甘 油脂、瘦素、adiponectin ，計算HOMA (代 表胰島素敏感度)，以多重回歸分析尋求各 因子之相關性並求取適當模式。 結果發現，脊髓損傷者之瘦素比正常 人來得高，且與損傷程度有關；然脊髓損 傷者之adiponectin 有比正常人偏高趨勢。 肥胖者8%、血壓偏高者6%、血糖過高者 11%、三酸甘油脂過高者>50%、高密度脂 蛋白偏低者>50%及胰島素阻抗者29%， HOMA 偏高。一般人所用的代謝症候群標 準似難以應用在脊髓損傷者。The improvement of medical care and rehabilitation has greatly prolonged the life expectancy of subjects with spinal cord injury (SCI). Thus, cardiovascular disease has become the leading cause of death in person with SCI. The epidemiologic study had shown SCI had higher prevalence and mortality rate of cardiovascular disease (CVD). The risk factors of CVD included hyperlipidemia, hypertension, insulin resistance and obesity; they also known as metabolic syndrome. In papers review, SCI people had higher ratio of hyperlipidemia, insulin resistance and increased adiposity. Recently various adipocytokines such as leptin and adiponectin are implicated in the pathogenesis of insulin resistance. Furthermore, in vitro and in vivo studies have confirmed the antidiabetic and antiatherosclertic activity of adiponectin. We recruited sixty-two male subjects with SCI for this study. After overnight fast, various anthropology data such as body height, weight, waist circumference are collected, as well as blood pressure. Then, blood is drawn for the measurement of fasting plasma glucose, insulin, high density lipoprotein (HDL), triglycerol, leptin, adiponectin. HOMA was calculated to reveal insulin sensitivity. Multiple regression analysis will be performed to analyze the relation among these factors. Men with SCI have significantly higher serum leptin levels than able-body controls and the serum leptin levels correlate with the degree of neurological deficit. SCI subjects had a tendency of higher serum adiponectin level than able-body controls. We found that 8% of SCI subjects had obesity, 6% hypertension, 11% hyperglycemia, elevated triglycerol >50%, decreased HDL >50% and 29% with insulin resistance. The HOMA value was higher than reference level. The criteria of metabolic syndrome in general population seemed hard to apply in SCI.application/pdf179000 bytesapplication/pdfzh-TW國立臺灣大學醫學院內科脊髓損傷代謝症候群胰島素抗性瘦素心血管疾病spinal cord injurymetabolic syndromeinsulin resistanceleptincardiovascular disease[SDGs]SDG3reporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/23701/1/932314B002177.pdf