| Abstract: | 第一部 背景 代謝症候群患者聚集數種心血管疾病危險因子於一身，如血脂異常、血壓偏高、血糖偏高與腹部肥胖，導致糖尿病與冠狀動脈心臟病的發生率提高，也增加心血管疾病的死亡率。目前台灣65歲以上老年人口已經超過總人口數的10％以上，而這個階段的族群更是代謝症候群的高危險群。研究指出在這些族群身上出現的症狀確實與睪固酮濃度低下有所關聯，例如老年人的骨質疏鬆，代謝症候群中身體脂肪分布與胰島素抗性、心血管疾病和腦血管疾病有關。更有研究發現符合代謝症候群的老年人血液中的睪固酮濃度明顯較低，因此認為在老人族群裡睪固酮濃度與發炎反應及代謝症候群因子有明顯的相關，所以血液中睪固酮濃度較低也是老年族群中代謝症候群的預測指標。 目的 老化會導致男性賀爾蒙濃度的下降，而男性賀爾蒙除了用在生殖系統外在全身包括心血管系統以及新陳代謝功能上，皆扮演著特殊的角色。因此，本研究重點在探討年長男性代謝功能與男性賀爾蒙間的關係，藉此研究了解男性賀爾蒙對代謝症候群的影響，以提供醫療人員照顧老年人之重要參考並致力減緩因老年退化所產生之慢性疾病。 方法 以回朔性研究方法，利用IBM SPSS19.0統計系統，同時評估睪固酮(testosterone)、膽固醇(TC)、三酸甘油脂(TG)、空腹血糖(FG)、肝功能(GPT)、腎功能(Cre)檢查等相關生化指標的關係，進一步探討年長男性代謝功能與男性賀爾蒙間的相關性。 結果 結果顯示，以年齡分組之分析，數據結果可以清楚看到老、中、青不同年齡層的睪固酮與各種血液生化檢驗數值的分布情形(膽固醇、三酸甘油酯、空腹血糖會隨年齡增加而有升高的趨勢，而睪固酮濃度並未隨年齡增加而減少，但當睪固酮濃度≦300mg/dl各項血液生化值(Cholesterol 、Triglycedides 、Glucose AC、SGPT、Creatinine ) 都比睪固酮濃度≧300mg/dl的數值偏高，尤其在睪固酮濃度≦300mg/dl時，空腹血糖與麩胺醯轉胺酶(GPT)的數值明顯升高。最後，將各個生化值分別與各年齡組別(分成0-40歲、41-55歲、56-65歲、66歲以上，共四組)去分析，以了解在不同年齡層血液生化值的差異變化，結果顯示，睪固酮和膽固醇在不同年齡組別間並無顯著差異(p>0.05)，但在三酸甘油酯、麩胺醯轉胺酶(GPT)和空腹血糖的41-55歲和66歲以上的組別中達統計意義，數值有明顯差異性(p<0.05)；而肌酸酐(Cre)在 0-40歲和56-65歲及66歲以上的組別中達統計意義，數值有明顯差異性(p<0.05)。 結論 總而言之，當臨床睪固酮檢驗值低下症時，需警覺是否同時具有代謝症候群。對於已罹患有睪固酮低下症的患者，希望臨床血液生化數值能提供醫師在第一時間的篩檢與早期的診斷，並用來評估與討論是否適合接受睪固酮補充治療外，也需配合生活作息的改變，如運動、減重及飲食控制等，以降低代謝症候群的相關危險性。如此一來，必可大幅增進生活品質及延長健康人生。 第二部 洛神花（Hibiscus Sabdariffa ）為錦葵科（Malvaceae）植物，原產熱帶地區，分佈於印度，馬來西亞及東南亞，台灣東部及南部也有盛產。其花成分中含有機酸、類黃酮素、黃酮素及多酚酸等。根據國外之研究，在體外試驗顯示其水萃取物具有抗痙攣，降膽固醇，降血壓及抗菌作用。洛神花成份中類黃酮素具有抗氧化及抑制心血管疾病，原兒茶酸則可抑制化學致癌物誘導之癌化。肥胖是與各式各樣的疾病相關聯，包括非酒精性脂肪性肝病。本實驗室先前的研究報告指出，洛神花萃取物(HSE)具有代謝調節和護肝的潛能。在此研究中，我們進行了臨床試驗，以進一步確認HSE的療效。研究對象條件，BMI≧27，年齡平均18-65歲，將患者隨機分為控制組 (n=20) 和HSE治療(n=20) 的群體，為期12週的實驗。研究結果顯示，HSE會降低身體體重、體重指數、身體脂肪和腰臀比例。在服用安慰劑組別血清中的促發炎因子TNF-α的表現量與服用HSE組別相比較，給予HSE後，血清中TNF-α和IL-6的表現下降；給予HSE的實驗組中Leptin濃度明顯低於控制組（服用安慰劑）；從實驗結果可以觀察到，在給予HSE的實驗組中Insulin濃度明顯低於控制組（服用安慰劑），綜合以上結果，HSE確實可以降低促發炎因子的表現，減低肝臟發炎的情形發生，且對於脂肪代謝相關蛋白確實會有影響，能降低脂肪細胞分泌Leptin，進一步達到降低血中游離脂肪酸，也確實能降低肥胖者體內Insulin的濃度，進而改善體重及預防糖尿病和肥胖所引起的相關性疾病的發生。HSE會調控血清中的游離脂肪酸（FFA）使其降低。在解剖學的變化顯示，HSE 會改善肝脂肪變性的疾病。綜合以上結果，HSE確實具有預防非酒精性脂肪肝和改善肥胖、降低腹部的脂肪及減少血清游離脂肪酸之作用，未來將可朝這些方向努力進一步發展成保護肝臟的保健食品。
part 1 Background The patients with metabolic syndrome assemble several risk factors of the cardiovascular disease, such as dyslipidemia, slight hypertension, high blood sugar and abdominal obesity, which result in the increase of the incidence rate of diabetes mellitus and coronary atherosclerotic heart disease and raise the death rate of cardiovascular disease as well. Presently the old age population with 65 years old and above in Taiwan is over and above 10% of the total population, and the population in this phase is the at-risk group of metabolic syndrome. The research indicates that the symptoms appeared in this population are related to the low total testosterone indeed, such as the osteoporosis of the elders, the distribution of body fat and insulin resistance of the metabolic syndrome, cardiovascular disease and the cerebrovascular disease. More researches detect that the total testosterone in the blood of the elders who fit in with the metabolic syndrome is obviously lower. Hence, it is of the opinion that the total testosterone apparently correlates with the inflammatory response and the factor of metabolic syndrome in the older population. Therefore, the lower total testosterone in the blood is the predictive indicator of the metabolic syndrome in the older population as well. Purpose The aging will cause the decrease of the concentration of the androgen, which plays a special role in the whole body, including the cardiovascular system and the metabolic function besides the use in the reproductive system. Therefore, the key of this research is to probe for the relationship between the metabolic function of the male elders and the androgen. By this research to interpret the impact of the androgen on the metabolic syndrome, to provide the important reference of caring for the elders for the medical personnel, and to make efforts in retarding the chronic diseases resulted from the degeneration of the elders. Method In the method of the retrospective study and using the IBM SPSS19.0 statistic system to evaluate simultaneously the relationships among the relative biochemical indicators such as testosterone, TC, TG, FG, GPT and Cre examination, and to probe further into the correlation between the metabolic function of the male elders and the androgen. Result In the analysis of the groups divided by ages, the result of the record evidently shows that the distribution of the testosterone and each biochemical testing data in the blood (TC, TG and FG) has a rising tendency, according to the increase with age among the various age groups of the old, the middle age and the youth. Yet the total testosterone is not decreasing with aging. Even so, when the total testosterone≦300mg/dl, the values of each biochemical data in the blood (Cholesterol, Triglycedides, Glucose AC, SGPT and Creatinine) are higher the one of the total testosterone≦300mg/dl. Especially when the total testosterone≦300mg/dl, the values of the FG and GPT ascend in evidence. Lastly, separately analyzing each biochemical data with each age group (age of 0-40, 41-55, 56-65, 66 and above, totally four groups) in order to interpret the variation of the biochemical data in blood among different age groups. The result shows that there is no obvious difference (p>0.05) between the testosterone and the TC among various age groups. In the groups of 41-55 and 66 and above, the values of TG, GPT and FG reach the statistical significance and have an obvious difference (p<0.05). And in the groups of 0-40, 56-65 and 66 and above, the value of Cre reaches the statistical significance and has an obvious difference (p<0.05). Conclusion In brief, it should be alerted if the metabolic syndrome is possessed simultaneously when meeting up the clinic of the hypogonadism. For the patients already met the hypogonadism, hopefully the clinical biochemical data in the blood could provide the physicians with the first-time screen and the initial-stage diagnosis. In addition, it could be used to estimate and discuss whether accepting the androgen supplement therapy is appropriate or not. Besides, the changes of the daily routines such as exercise, losing weight and diet control are necessarily cooperated to reduce the interrelated danger of the metabolic syndrome. Thus, the quality of life is certainly to be promoted substantially and the healthy life is sure to be extended. part 2 Hibiscus Sabdariffa is the plant, which is part of Malvaceae and its origin is the tropical district. It is scattered in India, Malaysia and the Southeast Asia, and grows abundantly in the eastern and southern part of Taiwan as well. The components of this flower include organic acid, isoflavone, flavone and depside. According to the overseas research, the external testing shows that its water extract possesses the functions of being anticonvulsive, cholesterol- reducing, blood pressure- decreasing and antibacterial. Among the components of the Hibiscus Sabdariffa Linnaeus, the isoflavone possesses the antioxidant and is able to restrain the cardiovascular disease, and the protocatechuic acid is able to restrain the canceration inducted by the chemical carcinogens. Obesity connects to all sorts of diseases, including the nonalcoholic fatty liver disease. The previously research report of our laboratory indicated that the HSE possesses the potential of metabolic regulation and liver protection. In this research, we proceed the clinical trial in order to further confirm the curative effect of HSE. The conditions of the subjects include BMI≧27 and average age of 18-65. The patients are divided randomly into the control group (n=20) and the HSE therapy group (n=20). And the experiment lasts 12 weeks. The research result shows that the HSE is able to reduce the body weight, BMI, body fat and the waist-hip ratio. Comparing the expressivity of pro-inflammatory factor TNF-α in the serum of the group of taking the placebo and of the one taking HSE, the one given HSE has descending expressivity of TNF-α and IL-6 in the serum. The Leptin concentration of the experimental group given HSE is obviously lower than the control group (who taking the placebo). It is observed from the experimental result that the Insulin concentration of the experimental group given HSE is obviously lower than the control group (who taking the placebo). To sum up the above-mentioned results, HSE could certainly reduce the expressivity of the pro-inflammatory factor and the situation of liver inflammation, and it surely influences the relative protein of fat metabolism. It could reduce the Leptin secretion of the fat cell and further lower the free fatty acid in the blood. In addition, it could truly decrease the internal Insulin concentration of the obese and further better the weight and prevent the relative diseases caused by diabetes mellitus and adiposity. HSE could control the FFA in serum and reduce it. The anatomical change shows that HSE could improve the degenerative disease of the hepatic lipidoin. To synthesize the above-mentioned results, HSE indeed possesses the functions of preventing the nonalcoholic fatty liver disease, improving the adiposity, reducing the abdomen fat and the FFA in serum. In the future, efforts could be made toward these directions and be further developed into the liver-protecting health food. |
