博碩士論文 110827013 詳細資訊




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姓名 劉庚奇(Geng-Chi Liu)  查詢紙本館藏   畢業系所 生物醫學工程研究所
論文名稱 利用皮膚交感神經活化之時序複雜度和多尺度分析萃取心房顫動或心臟衰竭患者治療與預後 之生理指標
(Utilizing Complexity and Multiscale Analyses of Temporal Burst Patterns of Skin Sympathetic Nerve Activity as Biomarkers for Treatment Response and Prognosis in Atrial Fibrillation and Heart Failure Patients)
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檔案 [Endnote RIS 格式]    [Bibtex 格式]    [相關文章]   [文章引用]   [完整記錄]   [館藏目錄]   至系統瀏覽論文 (2026-8-9以後開放)
摘要(中) 過去的研究指出交感神經系統(Sympathetic Nervous System)的過度活化與心律不整有關。但傳統的交感神經訊號量測方式必需使用侵入式的電極量測,除了需要專業人員操作,也沒辦法長時間量測,近期由高取樣率心電圖訊號進行皮膚交感神經訊號(Skin Sympathetic Nerve Activity, SKNA)分析的新技術。發現在心房顫動發生前SKNA訊號和星狀神經節活動有著相似的活動振幅的增加。由此可知SKNA訊號有高度潛力可替代傳統的自律神經量測方式。
目前已知交感神經系統活性變化和心房顫動的發生有關,我們便想證明由SKNA提取的參數能否對心房顫動電燒後是否復發具有預測性。同時我們也想了解SKNA是否能用來分辨心臟衰竭患者的嚴重程度。因此我們使用了三組不同的資料庫去做分析,分別是患有心房顫動之患者經過電燒治療後復發與否的組;患有心臟衰竭以及糖尿病之患者,吃下兩種不同種類的糖尿病藥物後的結果;患有心臟衰竭之患者,進入加護病房後,能活著離開的患者及不幸離世的患者。
以往的SKNA訊號的分析方法是將SKNA經過一系列處理成aSKNA後,透過設定閥值去定義出burst以及basleine後做活化分析(Burst analysis),來量化交感神經活動的動態變化。在觀察活化分析的結果後發現,其中burst的持續時間是最關鍵的係數。因此我們新增了針對aSKNA的時序複雜度分析的方法,用來分析burst在時間上的轉換模式。
摘要(英) Past studies have indicated a correlation between excessive activation of the Sympathetic Nervous System (SNS) and arrhythmias. However, traditional methods for measuring sympathetic nerve signals require invasive electrode measurements, necessitate skilled personnel, and lack the capability for prolonged monitoring. A recent advancement involves the analysis of Skin Sympathetic Nerve Activity (SKNA) using high-sampling-rate electrocardiogram signals. It has been discovered that the increase in activity amplitude of SKNA signals prior to atrial fibrillation occurrence is similar to that of stellate ganglion activity. This suggests significant potential for SKNA signals to replace conventional autonomic nervous system measurement methods.
Given the known association between sympathetic nervous system activity variation and atrial fibrillation occurrence, our aim is to ascertain whether parameters extracted from SKNA can predict post-electroablation atrial fibrillation recurrence. Additionally, we seek to determine if SKNA can differentiate the severity of heart failure in patients. To achieve this, we conducted analyses using three distinct databases: patients with atrial fibrillation who underwent electroablation therapy to assess recurrence; patients with heart failure and diabetes who were administered different diabetes medications; patients with heart failure admitted to the intensive care unit, distinguishing survivors from non-survivors.
Previous SKNA signal analysis involved processing SKNA into a derived form called aSKNA. Burst and baseline were defined using threshold settings, and Burst analysis was performed to quantify dynamic changes in sympathetic nerve activity. Notably, the duration of bursts emerged as a critical coefficient based on Burst analysis results. Consequently, we introduced a method for analyzing the temporal complexity of aSKNA, aimed at studying the transition patterns of bursts over time.
關鍵字(中) ★ 心房顫動
★ 皮膚交感神經訊號
★ 心臟衰竭
關鍵字(英) ★ Atrial Fibrillation
★ skin sympathetic nerve activity
★ Heart failure
論文目次 摘要 .............. i
Abstract ....... ii
誌謝 ............ iii
圖目錄 ........ vi
表目錄 ....... vii
一、 緒論 ................... 1
1.1背景 ........... 1
1.2目標 ........... 2
1.2.1 判斷心房顫動是否復發 ..... 2
1.2.2 判斷是否有治療心臟衰竭之效果 ................. 3
1.2.3 判斷加護病房(ICU)的病人能否存活 .............. 3
1.2.4 三組病患的趨勢 ........... 3
二、 原理 ................... 4
2.1皮膚交感神經活動訊號(SKNA) ......... 4
2.2 濾波器選擇 .... 5
2.3 加入新的Low-pass filter .............. 5
2.4 Window-size(ws)之大小範圍 .......... 6
三、 實驗方法 ........... 7
3.1資料處理 ....... 7
3.2 burst analysis 8
3.3 Shannon entropy: ................. 11
3.4 統計分析 ..... 12
四、 實驗結果 ......... 14
4 SKNA訊號 ....... 14
4.1濾波器的比較: . 14
4.2 aSKNA範圍的比較: ................. 15
4.3 活化分析(burst analysis): ........ 19
4.4 Shannon entropy: ................. 23
五、 結論 ................. 28
1. 參考文獻 ......... 30
附錄一 ...... 32
附錄二 ...... 33
附錄三 ...... 35
附錄四 ...... 35
參考文獻 [ 1 ] M. Kivimäki et al., "Long working hours as a risk factor for atrial fibrillation: a multi-cohort study", European Heart Journal, vol. 38, no. 34, pp. 2621-2628, 2017, doi: 10.1093/eurheartj/ehx324.
[ 2 ] A. Verma et al., "Approaches to Catheter Ablation for Persistent Atrial Fibrillation", New England Journal of Medicine, vol. 372, no. 19, pp. 1812-1822, 2015, doi: 10.1056/NEJMoa1408288.
[ 3 ] H. W. Choi, J. A. Navia, and G. S. Kassab, "Stroke Propensity Is Increased under Atrial Fibrillation Hemodynamics: A Simulation Study", PLOS ONE, vol. 8, no. 9, p. e73485, 2013, doi: 10.1371/journal.pone.0073485.
[ 4 ] T. Kusayama et al., "Simultaneous noninvasive recording of electrocardiogram and skin sympathetic nerve activity (neuECG)", Nature Protocols, vol. 15, no. 5, pp. 1853-1877, 2020/05/01 2020, doi: 10.1038/s41596-020-0316-6.
[ 5 ] T. Kusayama et al., "Skin sympathetic nerve activity and the temporal clustering of cardiac arrhythmias", (in eng), JCI Insight, vol. 4, no. 4, Feb 21 2019, doi: 10.1172/jci.insight.125853.
[ 6 ] Anisiia Doytchinova et al., “Simultaneous non-Invasive Recording of Skin Sympathetic Nerve Activity and Electrocardiogram” ,Heart Rhythm, Volume 14, Isssue l January 2017, Pages 25-33. doi: https://doi.org/10.1016/j.hrthm.2016.09.019
[ 7 ] Andrew S.P. Lim et al., “Quantification of the Fragmentation of Rest-Activity Patterns in Elderly Individuals Using a State Transition Analysis”, Sleep, Volume 34, Issue 11, 1 November 2011, Pages 1569–1581. doi: https://doi.org/10.5665/sleep.1400
[ 8 ]Jien-Jiun Chen et al., “Alterations of sympathetic dynamics after atrial fibrillation ablation by analysis sympathetic nerve activity provide prognostic value for recurrence and mechanistic insights into ablation”, Volume, November, 2022 ,doi:10.3389/fcvm.2022.1024156
指導教授 羅孟宗 審核日期 2023-8-11
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