探討黃蜂與火蟻叮咬傷造成之嚴重過敏反應病人臨床表現與處置及蜂膠萃取物抑制主動脈瘤生成研究

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林彥瑜(Yen-Yue Lin) 查詢紙本館藏

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探討黃蜂與火蟻叮咬傷造成之嚴重過敏反應病人臨床表現與處置及蜂膠萃取物抑制主動脈瘤生成研究
(Investigation on the clinical presentation and management of Vespidae sting and Formicidae sting patients with anaphylaxis and the inhibitory effect of propolis extract in aortic aneurysm formation)

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★ 臨床研究慢性腎臟疾病與腎病相關併發症

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摘要(中)

昆蟲是是地球上種類和數量最多的動物，因此昆蟲與人類必定會產生相互的利害關係。昆蟲造成人類傷害中，膜翅目叮咬受傷事件占有巨大份額，其中又以黃蜂類(Vespidae)、火蟻類(Formicidae)螫傷事件為多且較嚴重，因此本論文的主軸將以急診的角度，探討膜翅目昆蟲對人類所造成嚴重過敏反應 (anaphylaxis)與其他身體健康危害的問題，以及蜂膠成份中咖啡酸苯乙酯(CAPE)對於主動脈血管瘤生成上的影響。第一章是研究膜翅目昆蟲叮咬傷，其中以黃蜂類及火蟻類叮咬傷為急診兩大因動物致傷的來診原因，黃蜂和火蟻都是屬於膜翅目(Hymenoptera)昆蟲，所造成對人體的傷害和表現，十分類似，也時常造成嚴重的過敏反應，火蟻叮咬傷患者出現過敏反應發生率更高，並且比黃蜂蜇傷患者在急診滯留時間更長。但黃蜂叮咬患者有更高的併發症和更高的入院率，尤其是更容易出現嚴重過敏反應。實驗室數據中，以肌酸激酶(creatine kinase)，對於急診評估黃蜂蜇傷患者的嚴重性有價值。黃蜂和火蟻叮咬傷發生率都與溫度呈正相關，並且在週末的發生比率也較高。第二章是研究急診嚴重過敏反應(anaphylaxis)之病人，在臨床治療上之各項評估。嚴重過敏反應(anaphylaxis)是可能致死的疾病，幾乎所有指引都將腎上腺素(epinephrine) 放在第一線使用的藥物，但是研究中發現近幾年來腎上腺素(epinephrine)在急診使用率卻仍然偏低，而病人的預後卻沒有因此不佳，歸究原因可能是急診治療包括給水、平躺、生命徵象維持，以及抗組織胺和類固醇使用，可能彌補了腎上腺素使用不足所帶來的不良影響，另外急診醫師也能選擇性地將腎上腺素用在有較嚴重過敏反應的病人上，例如:由救護車送診之病人、出現嚴重呼吸道症狀、低血壓及意識改變病人。第三章是研究探討蜂膠中咖啡酸苯乙酯 (caffeic acid phenethyl ester, CAPE)成份是否有抑制腹主動脈瘤生成的作用。在動物實驗方面，利用Ang-II 誘導的 AAA老鼠模型，CAPE能夠有減少主動脈直徑的擴大，另外透過先導性細胞實驗，發現CAPE可能通過抑制炎症信號通路，例如p65激酶來抑制內皮層功能障礙。該研究的結果証明 CAPE具有抑制主動脈瘤成生的潛力。

摘要(英)

Insects are the most species and number of animals on the earth, and there must have both harmful or beneficial interactions between the two species. Hymenoptera is a large order of insects, and the Vespidae and Formicidae stings are the most common and serious causes of animal injuries met in the emergency department (ED). Allergic reactions are the most common problem for most insect injuries met in ED, and the most severe allergic reaction is anaphylaxis. The overall objective of this dissertation was to study{title}. Chapter One was aimed to study difference of clinical presentations, managements, and outcomes between Formicidae sting and Vespidae sting patients in Taiwan. The results indicated clinical comparison on Vespidae stings and Formicidae stings, and they were the two major causes of ED visits due to insect attacks. Formicidae sting patients presented with a higher rate of allergic reaction and spend more time in ED than Vespidae sting patients. But, Vespidae sting patients had higher complications and higher rates of admission, especially with an anaphylactic reaction. Both groups have positively correlated with temperature and had a higher rate on weekend days. Chapter Two was to evaluate the clinical management of patients with severe allergic reactions(anaphylaxis) in ED. Underuse of epinephrine in anaphylaxis patients may not a serious problem in ED. ED physicians tend to use epinephrine in severe symptoms of anaphylaxis, and the deicing factors to use epinephrine were sent via ambulance, hypotension, airway compromise, and conscious change. Among those severe presentations, hypotension was the most tolerating situation. Emergent care focuses first on the airway, breathing, and circulation may also compensate for the under usage of epinephrine. The importance of epinephrine use on anaphylaxis is still should be emphasized especially not in ED. Chapter Three was to examine the effect of bee propolis-derived caffeic acid phenethyl ester (CAPE) on angiotensin II-induced abdominal aortic aneurysm. The results indicated that CAPE could reduce the expansion of the aortic diameter and that CAPE attenuated Ang II-induced cell growth and inflammation of human aortic smooth muscle. Western blot analysis indicated that CAPE inhibited the Ang II-induced increasing the phosphorylation s of ERK, p38, and P65 proteins. However, CAPE treated alone did not alter the phosphorylations of these proteins. These results suggest that CAPE attenuates Ang II-induced cell growth and inflammation possibly through the ERK, p38, and p65 pathways and that CAPE may have the potential to prevent the formation of AAA.

關鍵字(中)

★ 昆蟲咬傷
★ 過敏反應
★ 嚴重過敏反應
★ 主動脈瘤

關鍵字(英)

★ Insect bite
★ Allergic reaction
★ Anaphylaxis
★ Aortic aneurysm

論文目次

Table of Contents
Chinese abstract...........................................i
English Abstract..........................................iii
Declaration................................................v
Acknowledgments...........................................vi
Table of Contents.........................................vii
List of Figures.............................................x
List of Tables...........................................xiii
Abbreviations..............................................xv
1.General introduction………………….……………………………………1
2.Chapter One Difference of clinical presentations, managements, and outcomes between Formicidae sting and Vespidae sting patients in Taiwan..................................................................3
Abstract……………………..............…...............................................4
Introduction…..............................................5
Materials and Methods.....................................................6
Results.....................................................8
Discussion.................................................11
Conclusion.................................................20

3. Chapter Two The clinical management and outcome of anaphylaxis patients in Taiwan.............................21
Abstract ..................................................22
Introduction ..............................................24
Materials and Methods......................................25
Results....................................................27
Discussion.................................................30
Conclusion.................................................41
4. Chapter Three Caffeic Acid Phenethyl Ester Attenuates AngiotensinII-induced Abdominal Aortic Aneurysm.42
Abstract...................................................43
Introduction...............................................44
Materials and Methods......................................45
Results....................................................48
Discussion.................................................50
Conclusion.................................................53

5. General conclusion......................................54
6.References...............................................56

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指導教授

褚志斌高永旭(Chih-Pin Chuu Yung-Hsi Kao)

審核日期

2022-1-24

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