記錄
編號
5659
狀態
NC093FJU00255034
助教
查核
索書
號
學校
名稱
輔仁大學
系所
名稱
食品營養學系
舊系
所名
稱
學號
491445140
研究
譚義賽
生(中)
研究
TAN, I-SAI
生(英)
論文
名稱
(中)
攝食優酪乳對血液透析患者免疫調節之影響
論文
名稱
(英)
Immunoregulatory effects of yogurt supplement to hemodialysis patients
其他
題名
指導
教授
(中)
王果行 吳文勉
指導
教授
(英)
Hsu Wang, Guoo-Shyng Wu, Wen-Mein
校內
全文
開放
日期
不公開
校外
全文
不公開
開放
日期
全文
不開
放理
由
電子
全文 同意
送交
國圖.
國圖
全文 2007.01.01
開放
日期.
檔案
說明
電子全文
電子
全文
01
學位
類別
碩士
畢業
學年
度
93
出版
年
語文
別
中文
關鍵
血液透析 優酪乳 益生菌 免疫力
字(中)
關鍵
hemodialysis yogurt probiotic immunoregulatory effects
字(英)
摘要
(中)
血液透析病人的營養狀況及免疫力與病患的健康與存活是具有很高的相
關性。臨床上常使用抗生素以減低金黃色葡萄球菌的感染，但長期使用
抗生素的病人會產生有抗藥性的菌株。有研究報導：健康人攝食益生菌
可以增強免疫力，並且減少鼻腔內致病的病原菌。因此，本次研究是以
血液透析病人為對象，探討攝食添加益生菌奶是否可以增強免疫力且減
少金黃色葡萄球菌的感染。本次研究是以桃園榮民醫院洗腎室接受常規
血液透析達六個月以上的病患為對象，排除有急性疾病、身體虛弱、對
乳品不適應者，篩選出 28 位自願參加者，平均分為兩組，採隨機、交
叉實驗設計。參加者平均分成二組，每日規律的分別給予早、晚各 1
瓶，每瓶 200 毫升優酪乳（添加益生菌含量為 4.2 x 109 CFU/ml 的
Lactobacillus rhamnosus GG）或蘋果口味的低脂乳共計三週，再經過三週
的緩衝期後，二組互換乳品，持續再供應三週。實驗前、實驗期第三週
及第九週分別收集病人的血液，分析顆粒球吞噬能力、淋巴球次群、細
胞質內之干擾素及細胞激素的分泌量及生化檢查、鼻腔細菌數，並評估
飲食攝取量、體位變化情形之相關性，共 16 位受試者完成全程實驗
（完成率 57％）。結果顯示，不論是優酪乳或低脂乳的攝取都使得熱
量、蛋白質的攝取量較實驗前顯著的提昇（p < 0.05）。攝食二種乳品都
能顯著提昇週邊血液顆粒球吞噬能力、IFN-γ 細胞激素分泌量，且由螢
光流式細胞計數儀分析發現週邊血液單核球中總 T 細胞百分比都顯著較
實驗前有較高的表現（p < 0.05）。攝食優酪乳比低脂乳使得顆粒球吞噬
能力、CD8+T 細胞及 CD4+CD25+T 細胞的百分比都顯著較佳（p <
0.05）。因此；乳品中豐富的熱量、蛋白質、維生素及微量元素可能對
於攝食量不足、年長且免疫力差的血液透析患者，具有改善營養及增強
免疫力的功效。添加益生菌乳在增強 CD8+T 細胞、活化型 T 淋巴球
（CD4+CD25+T）的細胞百分比及顆粒球吞噬能力較低脂乳有更佳的免
疫調節功效。
摘要
(英)
Infections remain a major cause of morbidity and mortality in hemodialysis
patients. Therefore, an intervention to successfully improve immunity might exert
substantial effects on overall patient health and survival. Prophylactic antibiotic
use with mupirocin results in reduction of Staphylococcal infection in dialysis
patients, but there is cumulating evidence of its resistance with prolonged use.
Recently, ingestion of probiotics has been shown to enhance PMN phagocytosis
and decrease nasal carriage of pathogenic bacteria in healthy populations. To test
the hypothesis that probiotic intake will enhance immunity and reduce
Staphylococcus colonization in dialysis patients, twenty-eight dialysis patients of
Taoyuan Veterans Hospital were randomly assigned to probiotic LGG and
placebo in a crossover design study for the duration of three periods of 3-weeks
interval. All subjects have been on regular hemodialysis over six months without
the acute disease, weakness and lactose intolance patients. Each subject drank 200
ml of yogurt twice per day (with probiotic of 4.2 x 109 CFU/ml of Lactobacillus
rhamnosus GG) or low-fat milk with apple flavor daily for the first 3 weeks.
Following by three weeks of wash-out period, subjects were switched to the other
kind of milk drink for another 3 weeks. Blood samples were collected and nasal
cultures were taken at the time points of the baseline, 3rd, and 9th weeks of the
experiment. Dietary intake, body weight and biochemical measurements were
examined. Sixteen patients had completed the whole study. Significantly (p <
0.05) increased of total dietary energy, protein as well as phagocytic activity of
granulocytes and cytokines secretion of IFN-γ, and the percentage of T cells in
peripheral blood were found by ingestion of either yogurt or low-fat milk drink
compared to baseline. However, the percentages of CD8+T and CD4+CD25+T
cells in PBMC were enhanced only when subjects drank LGG drink. Therefore,
the rich content of essential amino acids, calories, vitamins and/or trace elements
in various types of milk drinks may improve the nutritional and immunity status
of these hemodialysis patients. On the other hand, LGG drink has better
immunoregulatory effects than low-fat milk as it can increase the percentage of
CD8+T and activated T lymphocytes (CD4+CD25+), and phagocytosis activity of
granulocytes.
論文
目次
參考
文獻
中文摘要 1 英文摘要 3 目錄 5 圖表目錄 9 簡寫表 10 第一章 緒論 11 一、
前言 11 二、研究目的 13 第二章 文獻回顧 14 一、血液透析病患常見的
併發症 14 （一）血液透析病患的營養狀況 15 （二）血液透析病患致病
的原因 15 （三）血液透析病患免疫功能 16 （四）台灣血液透析醫療現
況 17 二、優酪乳 18 （一）優酪乳的簡介 18 （二）優酪乳的營養價值
18 （三）優酪乳在動物實驗方面的研究 19 三、益生菌 20 （一）益生菌
的簡介 20 （二）益生菌的分類 21 （三）益生菌作為功能性食品 22
（四）益生菌劑量、安全性及限制 22 四、益生菌的臨床應用 23 五、益
生菌對於免疫調節機能 26 六、益生菌應用在人體之相關研究 27 （一）
應用於兒童期之實例 27 （二）應用於成年期之實例 28 （三）應用於老
年期之實例 30 （四）應用於癌症方面之實例 31 七、免疫系統之簡介 31
（一）先天性免疫力 31 （二）後天性免疫力 32 （三）先天性與後天性
免疫力間的相互關係 33 （四）免疫系統的重要性 36 （五）免疫反應的
調控因素 36 （六）鼻腔粘膜變化及呼吸道感染與免疫的關係 37 （七）
營養狀況對免疫調節之影響 38 （八）血液透析與免疫的關係 41 （九）
老年人與免疫的關係 41 第三章 材料與方法 42 一、實驗設計 42 （一）
實驗對象 42 （二）實驗設計 42 二、實驗儀器與評估方法 44 （一）儀器
簡介 44 （二）評估免疫力改變的方法 44 三、分析項目 44 （一）體位測
量 45 （二）飲食評估 45 （三）營養相關血液檢查 45 （四）鼻腔帶菌檢
查 46 （五）免疫細胞相關檢查 47 四、統計與分析 51 第四章 結果與討
論 52 一、受試者基本資料 52 （一）受試者基本資料及體位測量 52
（二）年齡、經濟能力、透析時間長短的影響 53 二、受試者營養狀況
之評估 54 （一）飲食改變及蛋白質、熱量攝取量 54 （二）磷結合劑
（降低高血磷） 54 三、攝取不同乳品對受試者營養狀況之影響 55
（一）攝取乳品對營養攝取量及體位的影響 55 （二）血液生化營養指
標之影響 55 四、攝取乳品對受試者免疫反應的影響 58 （一）攝取乳品
對週邊血液單核球中細胞之影響 58 （二）攝取乳品對於細胞吞噬能力
之影響 58 （三）攝取乳品對於 T 細胞之影響 58 （四）攝取乳品對週邊
血液細胞激素分泌量之影響 58 （五）攝取乳品對鼻腔帶菌之影響 59
（六）益生菌菌株及濃度對免疫力之影響 61 （七）攝取乳品對 CRP 的
影響 61 第五章 結論 64 第六章 未來展望 65 參考文獻 66
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