黃孝平臺灣大學：化學工程學研究所陳永論Chen, Yung-LunYung-LunChen2007-11-262018-06-282007-11-262018-06-282007http://ntur.lib.ntu.edu.tw//handle/246246/52231第一型糖尿病患者必依賴外加胰島素的注射來控制血糖濃度以維持生命。血糖之控制良窳，攸關許多併發症之發生機率。因此血糖控制至為重要。 最近在血糖監測硬體方面已有連續血糖監測器(CGMS)之問世，提供病患更為詳細的血糖監測。本研究主旨即在於以CGMS為工具探討此類病人體內血糖之動態模式以及相對之血糖控制方式。首先，透過連續性血糖量測器(CGMS) 記錄病人血糖之連續變化。 然後，針對Jiaxu Li et al.(2006) 及Hovorka et al.(2005)所提出的兩種第一型糖尿病模型略作修改，透過記錄之臨床數據建立屬於病人的血糖動態模型。確定了病人模型後，即據以研擬胰島素之用量方式，並與實際情形比對以檢驗兩種模型之可行性。本研究同時將提供量化及系統化的血糖控製策略供醫生參考，以提高用藥之效率。第一種控制策略為一般病患常用的Bolus加上基本胰島素注射來控制體內血糖，第二種控制策略則以單餐為基準，透過最適化策略來決定一套胰島素施打的方式。文中將比較此兩種控制策略下，體內血糖的變化，並討論其優劣。People with type 1 diabetes must rely on exogenous insulin for survival. A good control of blood glucose will substantially reduce the possibility of complication. In this research, modeling the blood glucose using the clinical data of a type-1 patient from a continuous glucose monitoring system (CGMS) is studied. Two models, DDE model of Jiaxu Li (2006) and physiological model of Hovorka (2006) are considered for this modeling of blood glucose. Appraisal of the results from the two models is made. The appraisal includes its ability to estimate the amounts of insulin needed for basal and bolus injections, its ability to predict the future blood glucose, and its sensitivity to detect hypoglycemia and hyperglycemia. The basal and bolus injections mentioned are aimed to maintaining a fasting blood glucose and a postprandial blood glucose within a reasonable range, respectively. Control strategies for patients that use continuous subcutaneous infusions via an insulin pump or discontinuous subcutaneous basal and bolus injections are presented. Comparisons between these two strategies in terms of blood glucose and insulin dosage are also made.摘要....................... ...........................I Abstract.......... ....................................II 目錄.............. ....................................III 圖索引............ ....................................IV 表索引............ ....................................VII 1.緒論................................................ 1 1.1 前言.......... .....................................1 1.2 文獻回顧...........................................2 1.3 研究動機與目的 .....................................6 1.4 組織章節.......................................... 7 2.第一型糖尿病模型之回顧... ............................8 2.1 體內醣類的代謝 .....................................8 2.2第一型糖尿病血糖模式之回顧..........................10 3.模型修改及驗證...................................... 26 3.1 糖尿病血糖DDE模式之修改............................26 3.1.1 DDE模式回歸結果-進食血糖消化之速率以脈衝函數表示 27 3.1.2 DDE模式回歸結果-進食血糖消化之速率以指數函數表示 32 3.1.3 DDE模式兩種進食項修正下模擬結果之比較........... 37 3.2 Hovorka模型之增補................................. 43 3.3 結果討論:......................................... 54 4.極大值原理.......................................... 56 5.血糖控制策略........................................ 64 5.1 Bolus的應用在此模式中的探討....................... 64 5.2控制策略(1): Bolus及基本胰島素注射................. 65 5.3 控制策略(2): 最適化控制策略....................... 66 5.4 設定點之修改...................................... 68 5.5 結果討論(1)....................................... 78 6. 結論............................................... 83 A.附錄................................................ 85 B.附錄................................................ 93 參考文獻.............................................. 993204607 bytesapplication/pdfen-US血糖胰島素第一型糖尿病最適化控制blood glucoseinsulintype 1 diabetesoptimal control[SDGs]SDG3thesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/52231/1/ntu-96-R94524087-1.pdf