近紅外組織動態血檢測於裘馨氏肌肉失養症之臨床應用

Abstract

裘馨氏肌肉失養症為兒童神經肌肉疾病中較常見一種遺傳性罕見疾病，現今的醫學技術尚未有治癒方法，因此臨床治療是以改善病人生活品質並長期監控患者肌肉在每個階段的萎縮程度。臨床監控中，有一項目為讓患者進行分鐘行走測試，此測試對患者，身理及心理上皆是極大的負擔！而且患者容易受到主觀意識影響，因此6分鐘行走測試尚無法客觀地評估出病患的病情。在運動過程中人體肌肉組織血氧代謝能力會提高，在耗氧的過程中能顯示出肌肉組織當下的動態血氧分佈，而患有裘馨氏肌肉失養症的病患於不同階段的血液循環會因萎縮程度而有異常變化，因此使用非侵入式生醫光學檢測儀器長期監控將有助於裘馨氏肌肉失氧症病情的鑑別。 本次研究中，設計一套近紅外組織動態血氧偵測系統以觀察並比對裘馨氏肌肉失養症患者與健康受測者血氧分佈的不同。測試過程有進行6分鐘行走測試以及手臂靜脈束縛測試，6分鐘行走測試是分別觀察病患與正常人的小腿腓腸肌的動態血氧分佈，手臂靜脈束縛測試則是觀察前臂橈側腕屈肌的動態血氧分佈。於實驗結果發現，病患與正常人的肌肉組織動態血氧分佈不論在6分鐘行走測試以及手臂靜脈束縛測試下皆有顯著差異，因此推測靜脈束縛並透過近紅外組織動態血氧檢測量測組織血氧的分佈情形將有機會可以輔助現行臨床上的6分鐘行走測試，未來也將進一步分析更多受試者資訊，期待能為裘馨氏肌肉失氧症臨床檢測提供一項客觀的輔助診斷參考指標。

Duchenne Muscular Dystrophy (DMD) is a rare form of inherited neuromuscular disorder that more commonly occurs in children. As current medical technology lacks any specific therapy for this disorder, physiotherapists try to improve the quality of life of patients via clinical treatments, and perform long-term monitoring at every stage of muscular dystrophy. One method used in clinical monitoring is to ask the patient to perform the six-minute walk test (6-MWT) , but in comparison with normal control subjects, this test brings about a much greater physiological and psychological burden to DMD patients. For younger patients, their self-consciousness may influence them a lot, and so the 6-MWT cannot objectively evaluate the condition of younger patients. The human muscle tissue increases blood oxygen metabolism during exercise; the oxygen consumption capacity shows the dynamic distribution of oxygen present in the muscle tissue. Muscle dynamic oxygen distribution is a direct indicator of the different stages of the disease, as different stages have varying blood circulation that highlights the degree of atrophy in muscle tissue. That proves that the information gained via use of non-invasive biomedical optical detection of hemodynamic muscle tissue can contribute to identify the disease. In this thesis, a dynamic near-infrared tissue oxygen detection system was designed in order to observe the gastrocnemius dynamic oxygen distribution, in both controls and DMD patients, when performing the 6-MWT. In addition, we conducted an arm venous occlusion test (VOT) to observe the dynamic oxygen distribution of muscle tissue. The results showed that no matter whether testing via the six-minute walk test or arm VOT, the dynamic oxygen distribution between patients and controls displayed significant differences. Therefore, preliminary results revealed that VOT is a feasible approach to replace the 6-MWT. Further analyzes are required to obtain more information to provide objective clinical testing to determine suitability as an auxiliary diagnostic reference.