臺灣博碩士論文加值系統

動脈粥狀硬化是必須早期發現早期治療的疾患，才能夠提早預防心血管病變的發生，尤以此疾患又特別好發於頸動脈，若能早期發現將有助於降低疾病的嚴重程度，這些併發症也是導致成年人死亡的頭號殺手之一，因此研發能早期診斷的新技術已是當前首要之事。
本研究為以非侵入式的壓力感測器測量橈動脈之振動，並分析橈動脈壓力波波形計算其彈性常數(Spring Constant)，並將此彈性常數與醫院檢測之頸動脈超音波檢查參數及易引起粥狀動脈的危險因子(年齡、血糖、血脂肪、糖尿病、抽菸)等指標作分析。
我們共蒐集60位個案，使用二元分類之ROC (Region Of Convergence) 曲線分析圖來分析彈性常數與頸動脈參數異常者之關係，對右側頸動脈而言，進行其橈動脈之彈性常數與收縮時內頸動脈與總頸動脈之峰值血流速度比(ICA/CCA; ICA: Internal Carotid Artery; CCA: Common Carotid Artery)異常者之ROC分析，其中ROC曲線下面積(AUC: Area Under Convergence = 0.605 ± 0.077) > 0.5，顯示此工具所測得之彈性係數對右側ICA/CCA異常者具有鑑別力；對左側ICA/CCA指標而言，ROC曲線下面積(AUC=0.504 ± 0.079)為0.504 > 0.5，顯示此工具所測得之彈性係數對左側 ICA/CCA指標異常者也具有初步鑑別能力。對於彈性常數與收縮時兩側總頸動脈之峰值血流速度比(CCA)之ROC曲線分析，結果AUC為0.727 ± 0.076 (> 0.5)， 顯示彈性常數對兩側總頸動脈異常者是具有鑑別能力的。
結果顯示此彈性常數具有作為檢測頸動脈異常的可行性，並可進一步作為評估動脈粥狀硬化病人其動脈硬化的指標，能達成快速、有效檢查出動脈血管硬化，此研究結果希望可提供臨床醫療人員一項新技術，進而對非侵入式診斷動脈粥狀硬化有新的突破及提升相關醫療品質。

Arteriosclerosis must be detected and treated in its early stage to prevent the occurrence of cardiovascular disease. Particularly, this disease is prone to befall the carotid and coronary arteries. Early detection will help reduce the severity of the disease as the complications have caused a high mortality, so it is the prime task to develop the new technology for early diagnosis or new technique for examination at this moment.
This study adopted the non-invasive pressure sensor to measure the radial artery of atherosclerosis patients, analyze the radial artery pressure waveform, and calculate the spring constant. Furthermore, the spring constant, the carotid ultrasound index detected in the hospital and atherothrombotic risk factors (age, blood pressure, blood lipids, diabetes, and smoking) were analyzed.
We collected sixty cases. The binary classification of ROC curve analysis was used to analyze the relationship between the spring constant and the abnormality of carotid artery index. The area under ROC curve up to 0.605 > 0.5 (AUC= 0.605 ± 0.077) indicates that the detected spring constant is a good determinant against right ICA/CCA index. The area under the ROC curve up to 0.504 > 0.5 (AUC=0.504 ± 0.079) indicates that the detected spring constant is a preliminary determinant against left ICA/CCA index. Regarding CCA index, the area under the ROC curve increases up to 0.727 > 0.5 (AUC = 0.727 ± 0.076), and that indicates the spring constant a good discernment for carotid abnormality.
The verification of such spring constant can be applied for the patients with carotid disorder. Furthermore, the spring constant can be an indicator for atherosclerosis patients. Because the spring constant is a fast as well as effective method, it is hoped that the result can be of use to medical professionals and sheds some light to non-invasive arteriosclerosis diagnosis as well as lift medical quality.

Table of Contents
Abstract in Chinese....................................I
Abstract...............................................III
Acknowledgements.......................................V
Table of Contents......................................VI
List of Tables.........................................VIII
List of Figures........................................IX
Chapter 1 Introduction.................................1
1.1 Background and Motivation......................1
1.2 Objectives of this Study.......................5
1.3 Chapter Outline................................8
Chapter 2 Literature Review............................9
2.1 Literature Review..............................9
2.2 Arteriosclerosis and Atherosclerosis Causes....12
2.3 Theoretical Background.........................19
Chapter 3 Methodology..................................34
3.1 Research steps.................................34
3.2 Neck Ultrasound Indicators.....................36
3.3 Risk Factor Indicators.........................38
3.4 Calculating the Spring Constants...............42
3.5 Data Collection................................43
3.6 Correlation Analysis...........................45
Chapter 4 Results and Discussion.......................46
4.1 Risk Factors...................................48
4.2 The Scatter Chart for PSV ratio (X) of the
Ipsilateral ICA/CCA of Neck Ultrasound and Spring
Constant (Y)...................................53
4.3 The Neck Ultrasound Ipsilateral CCA PSV Ratio (X)
and the Spring Indicator (Y) Scatter Chart.....55
4.4 Neck Ultrasound Intima-Media Thickness (IMT)
Analysis.......................................56
4.5 The sensitivity, specificity, positive predictive
value, and negative predictive value analysis..56
4.6 Receiver operative characteristic (R.O.C.)curve
analysis.......................................58
Chapter 5 Conclusions and Future Prospects.............62
References.............................................63
Published Articles.....................................66

List of Tables
Table 1 Median age comparison of top ten causes
of death [4]..................................4
Table 2 The definitions and units of a variety of
arteriosclerosis indicators[4]................7
Table 3 Comparison of major methods used in the noninvasive
assessment of arterial stiffness with regard to
their potential for wider clinical use........12
Table 4 The average concentration of the various
lipoproteins in the plasma....................31
Table 5 Ultrasound index..............................37
Table 6 Hypertension in adults over 18 defined by JNC.40
Table 7 The PSV of Ipsilateral ICA / CCA and spring
constants.....................................43
Table 8 The PSV ratio and spring constants of the CCA in
both sides s..................................46
Table 9 The frequency corresponding to ICD-9-CM code for
the 20 subjects...............................52
Table 10 Pearson’s correlation coefficients............55
Table 11 The spring constant and the CCA status of both
sides.........................................58

List of Figures
Fig.1 2011 Mortality rate [4].........................1
Fig.2 Accounted changes in standardized mortality
rate(2011)[4]...................................2
Fig.3 2011 Average life expectancy[4].................3
Fig.4 The comparison of arteries, veins and microvascular
structures[1]...................................13
Fig.5 Plaque accumulation in the lining of atherosclerotic
artery..........................................15
Fig.6 Aortic arch and four neck vessels...............17
Fig.7 X-rage angiography..............................21
Fig.8 Doppler speed measuring formula : V = (Fr-Fo)
C/2FoCosθ.......................................25
Fig.9 Carotid ultrasound measurement..................26
Fig.10 2D color duplex imag............................27
Fig.11 The radial pulse and its equilibrium position in the
spring model....................................33
Fig.12 Research procedure..............................35
Fig.13 Ulcerated plaque................................36
Fig.14 Ultrasound report...............................36
Fig.15 The correlation between age and systolic, diastolic,
and mean blood pressure.........................39
Fig.16 ATP-III-lipid marker and reading................41
Fig.17 Radial artery pressure wave measurement.........43
Fig.18 The distribution of spring constant against SBP.48
Fig.19 The distribution of spring constant against DBP.49
Fig.20 The distribution of spring constant against
cholesterel.....................................49
Fig.21 The distribution of spring constant against TG..50
Fig.22 The distribution of spring constant against HDL.50
Fig.23 The distribution of Spring Constant against LDL.51
Fig.24 The distribution of spring constant against Fasting
sugar...........................................51
Fig.25 The distribution of Spring Constant against HbA1C.52
Fig.26.1 The scatter chart of left ICA/CCA PSV ratio and
spring constant...............................54
Fig.26.2 The scatter chart of right ICA/CCA PSV ratio and
spring constant...............................54
Fig.27 Scatter chart for CCA and spring constant.......55
Fig.28 The distribution of the tool diagnosis result...57
Fig.29 ROC analysis for spring constant and CCA........59
Fig.30 Spring constant against right ICA/CCA on ROC curve analysis...............................................60
Fig.31 Spring constant against left ICA/CCA on ROC curve analysis...............................................61

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