年輕成年軍人頸動脈內膜厚度與相關因子:橫斷性研究

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林彥伯(Yen-Po Lin) 查詢紙本館藏

畢業系所

生醫科學與工程學系

論文名稱

年輕成年軍人頸動脈內膜厚度與相關因子:橫斷性研究
(Carotid Intima-Media Thickness and Related Factors among Military Young Adults: A Cross-Sectional Study)

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摘要(中)

目前研究顯示左心室肥厚及胰島素抗性與頸動脈內膜中層厚度相關，頸動脈
內膜中層厚度是高血壓糖尿病及及中高齡族群亞臨床動脈粥樣硬化的指標但在健康年輕族群中，這種關聯性尚不清楚。因此，本研究旨在釐清台灣陸軍年輕成年軍人其心電圖，心臟超音波檢查參數及各種非胰島素測量胰島素抗性指數與頸動脈內膜中層厚度之間的關聯性。我們紀錄自2018年至2020年，共有1822名18歲至40歲的台灣軍人接受年度健康檢查，其中包括心電圖和心臟超音波檢查。透過高解析度頸部超音波檢查測量左頸動脈球內膜中層厚度。臨床參數紀錄包括各項生理及血液生化檢查。以共變異數分析比較心電圖和心臟超音波參數特徵。另外分別測試四種非胰島素測量胰島素抗性指數(簡稱nIIR):三酸甘油酯濃度糖TyG 指數，三酸甘油酯/高密度脂蛋白比率糖胰島素抗性代謝評分(METS-IR)，以多變量線性迴歸分析來確定相關性。結果顯示心電圖定義的左心室肥厚，右心室肥厚和心率?75/min的受試者與頸動脈內膜中層厚度?0.8?mm呈正相關，而心臟超音波檢查左心室肥厚受試者與頸動脈內膜中層厚度?0.8?mm呈負相關。所有參與者的頸動脈內膜中層厚度和三酸甘油酯之間存在關聯。較好的體適能表現會造成心肌肥厚但可能會降低動脈粥狀硬化的嚴重程度，導致心臟超音波與心電圖檢查結果矛盾。這項研究表基於心心電圖顯示的三酸甘油酯可作為軍人族群中亞臨床動脈粥狀硬化的良好標誌。另外非胰島素測量下胰島素抗性指數可用心評估肥胖和無高病酸血症的年輕成年人族群頸動脈內膜中層厚度。而以三酸甘油酯為於礎的胰島素抗性指數是年輕族群的頸動脈內膜中層厚度較佳預測工具，可取代胰島素抗性代謝評分(METS-IR)。

摘要(英)

Current studies have shown that left ventricular hypertrophy (LVH) and insulin resistance are associated with carotid intima-media thickness (cIMT), which is an indicator of hypertension and subclinical atherosclerosis in middle-aged and elderly people. However, in physically fit young adults, this association is unclear. There are no studies to clarify the association between left ventricular hypertrophy and
atherosclerosis with ultrasound and electrocardiogram (ECG) in young adults. Therefore, this study aimed to examine the association between ECG, cardiac ultrasound parameters and various insulin resistance indices with subclinical
atherosclerosis assessed by carotid intima-media thickness (cIMT) in young adults of the Taiwan Army. A total of 1822 Taiwanese military adults free of diabetes, aged 18
40?years, received an annual health examination including electrocardiography (ECG) and echocardiography in 2018–2020. Left carotid bulb cIMT was measured by high resolution ultrasonography. nIIR indices were assessed by TG concentrations, the TyG index, the TG/high-density lipoprotein cholesterol (HDL-C) ratio, and the metabolic
score for IR (METS-IR). Multiple logistic regression analysis was used to determine the associations between echocardiographic and ECG parameters. Multivariable linear
regression analyses were used to determine the associations between nIIR indices. ECG-based LVH, RVH and heart rate ?75/min were associated with cIMT ?0.8?mm, while echocardiographic LVH was inversely associated with cIMT ?0.8?mm. In the overall participants, there was an association between cIMT and TG. Higher physical
fitness may cause cardiac muscle hypertrophy and reduce the atherosclerosis severity, possibly leading to the paradoxical echocardiographic finding. This study suggests that ECG-based LVH remains a good marker of subclinical atherosclerosis in our military population. This study also highlights that some nIIR indices could be used to assess
cIMT in young adults, particularly for those with obesity and those without hyperuricemia. The TG-based indices instead of the novel marker, METS-IR, are suggestive as stronger predictors of greater cIMT in young adults.

關鍵字(中)

★ 年輕成年軍人
★ 體適能
★ 粥狀動脈硬化
★ 頸動脈內膜中層厚度
★ 非胰島素測量胰島素抗性指數
★ 三酸甘油酯
★ 左心室肥厚
★ 心電圖
★ 心臟超音波

關鍵字(英)

★ young adults soliders
★ physically fittness
★ atherosclerosis
★ carotid intima-media thickness
★ non-insulin-based IR indices
★ cholesterol
★ left ventricular hypertrophy
★ electrocardiogram
★ echocardiography

論文目次

中文摘要………………………………………………………………………………i
英文摘要 ……………………………………………………………………………ii
目錄 ………………………………………………………………………………iii
圖目錄 ……………………………………………………………………………iv
表目錄 ……………………………………………………………………………v
第一章糖緒論 ………………………………………………………………………1
1-1 動脈粥狀硬化 …………………………………………………………1
1-2 胰島素抗性 ……………………………………………………………3
1-3 研究動機 ………………………………………………………………3
第二章糖研究內容與方法 …………………………………………………………5
2-1 研究族群 ………………………………………………………………5
2-2 生理特徵及血清生化檢查 ……………………………………………7
2-3 三千公尺跑步測驗 ……………………………………………………7
2-4 頸動脈內膜中層厚度評估 ……………………………………………7
2-5 十二導程心電圖 ………………………………………………………9
2-6 心臟超音波立體結構測量……………………………………………11
2-7 統計方法 ……………………………………………………………13
第三章糖研究成果 ………………………………………………………………15
3-1 族群生理特徵…………………………………………………………15
3-2 心臟超音波結果分析…………………………………………………18
3-3 十二導程心電圖特性分析……………………………………………20
3-4 體適能與左心室質量關聯性分析……………………………………22
3-5 心電圖及心臟超音波異常與頸動脈內膜中層厚度關聯性分析……23
3-6 所有受試者胰島素抗性指數與頸動脈內膜中層厚度相關性分析…26
3-7 肥胖族群胰島素抗性指數與頸動脈內膜中層厚度相關性分析……27
3-8 高病酸族群胰島素抗性指數與頸動脈內膜中層厚度相關性分析…29
第四章糖討論 ……………………………………………………………………31
第五章糖結論 ……………………………………………………………………34
參考文獻 ……………………………………………………………………………35
附錄 ………………………………………………………………………………41

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指導教授

許藝瓊(Yi-Chiung Hsu)

審核日期

2024-10-9

推文