| Abstract: | 臨床上發現C型肝炎病毒感染的併發症中，第二型糖尿病相當常見。研究指出C型肝炎病毒感染與第二型糖尿病主因胰島素阻抗具高度相關性，但確切的機制並不清楚。C型肝炎病毒套膜蛋白E2在感染宿主細胞的過程中扮演很重要的角色，但此E2蛋白是否參與第二型糖尿病的致病機制尚未被探討。有文獻指出，E2蛋白會活化ERK/MAPK訊息傳遞路徑，另一篇文獻也指出，ERK能抑制IRS-1的功能最終導致胰島素阻抗，故推斷E2蛋白極有可能藉由活化ERK而抑制IRS-1的功能，最終導致胰島素阻抗。此研究希望探討E2蛋白是否會導致胰島素阻抗，先前本實驗室結果證實，E2蛋白會抑制胰島素所誘導的Akt/PKB Thr308和GSK3β Ser9磷酸化表現。此實驗透過放射線標的葡萄糖與肝醣分析，觀察到E2蛋白影響肝臟細胞，造成胰島素誘導葡萄糖攝取能力和肝醣合成量降低，但並不影響肝臟中主要表現的GLUT 2表現量。另透過Real time PCR與西方墨點法證明，SOCS3 mRNA、pSTAT3 Tyr705蛋白與SOCS3蛋白表現都會受到E2蛋白影響而增加，且透過免疫沉澱法觀察到，對IRS-1蛋白ubiquitination增加，可能進而造成降解。根據本實驗結果，證實C型肝炎病毒E2蛋白，可促進SOCS3蛋白表現造成IRS-1表現降低。因此可能進而產生胰島素阻抗，並促使第二型糖尿病產生。
Since the national health insurance program was implemented on 1996, the health care of Taiwan has been dramatically changed with increasing competition among hospitals. View of the evaluation criteria have been used for many years, it’s not easy to adjust quality, therefore the HQIC (Healthcare Quality Improvement Campaign in Taiwan) making the new hospital accreditation standards in 2006, mostly improvement form the JCAHO. A great result in Hospital accreditation standards for health care and improving the quality of patient care. HQIC often emphasize evaluation of policy guidance functions and criteria should be forward-looking vision with international standards. How to cross international standards, participate in international evaluation is the most direct option. Currently, when facing competitive medical environment, patient not only requires the results of medical care, business management theory was introduced in the spirit of the medical industry, the patient is not only get medical treatment, but also treat as “customer”, the conversion of this role, making the health care satisfaction, loyalty, gradually leading importance of medical institutions.
In this study, two medical centers were chosen as sample hospital basic on the willing to cooperate with this study. Research methods: descriptive statistic, validity analysis, reliability analysis, factor analysis, t-test, anova, SEM. The results shows affect with certification of JCIA had signification contribution for patient satisfaction. |
