論文使用權限 Thesis access permission:校內立即公開,校外一年後公開 off campus withheld
開放時間 Available:
校內 Campus: 已公開 available
校外 Off-campus: 已公開 available
論文名稱 Title |
慢性腎臟病人的周邊動脈疾病盛行率和臨床相關因子 The Prevalence and Clinical Correlative Factors of Peripheral Arterial Disease in Patients with Chronic Kidney Disease |
||
系所名稱 Department |
|||
畢業學年期 Year, semester |
語文別 Language |
||
學位類別 Degree |
頁數 Number of pages |
54 |
|
研究生 Author |
|||
指導教授 Advisor |
|||
召集委員 Convenor |
|||
口試委員 Advisory Committee |
|||
口試日期 Date of Exam |
2009-06-10 |
繳交日期 Date of Submission |
2009-06-17 |
關鍵字 Keywords |
慢性腎臟病、鈣離子阻斷劑、高血壓、周邊動脈疾病、脈壓、腳踝和腕上臂血壓比例 Ankle brachial index, Chronic kidney disease, Calcium channel blocker, Pulse pressure, hypertension, Peripheral artery disease |
||
統計 Statistics |
本論文已被瀏覽 5690 次,被下載 1934 次 The thesis/dissertation has been browsed 5690 times, has been downloaded 1934 times. |
中文摘要 |
研究目的 慢性腎臟病的病人有動脈粥樣硬化和周邊動脈疾病增加的風險。然而周邊動脈疾病在慢性腎臟病患者比冠狀動脈病受到了較少的注意。所以只有少數研究在審查周邊動脈疾病在慢性腎臟病患者的相關風險因素。在這個研究,我們研究了慢性腎臟病患者和周邊動脈疾病的相關風險因素,並發現了高血壓治療在慢性腎臟病患者的周邊動脈疾病可能的好處。 研究方法 我們包括129 名慢性腎臟病第3 到5 期,兩性的患者,慢性腎臟病第3 到5分期是依據結果質量主動性( K/DOQI)分類,患者都尚未接受透析療法,且先前未被診斷有周邊動脈疾病。研究在六個月期間之內收集了,包括人口統計的特徵如下:高血壓的病史,高血壓藥物的使用,糖尿病,抽煙和先前已存在的心血管疾病,身體質量指標,空腹的血糖,糖化血色素,總膽固醇,三酸甘油酯,高密度脂蛋白膽固醇,低密度脂蛋白膽固醇,鈣離子,磷離子,白蛋白,尿酸值,尿蛋白質。腳踝和腕上臂血壓比例是一個非侵入性的診斷工具,且在數值小於 0.9 可以有效率的診斷出無症狀周邊動脈疾病。 研究結果 總共有22 個(17.7%) 參與研究者有周邊動脈疾病。較高的心臟收縮血壓,較高的心臟舒張血壓,較高的脈壓在慢性腎臟病患者,顯示和周邊動脈疾病之間較強的相關。在進一步分析,發現用鈣離子阻斷劑治療的高血壓慢性腎臟病患者,較少合併有周邊動脈疾病 (χ2 =7.055, p =0.008)。多維分佈的邏輯式的回歸分析後,發現在高血壓的慢性腎臟病患者顯示了風險因素為脈壓,而鈣離子阻斷劑治療在高血壓的慢性腎臟病患者身上,也許和減少周邊動脈疾病的發生有相關( odds ratio = 0.232, CI = 0.07-0.73, p =0.013)。 結論 研究發現周邊動脈疾病在慢性腎臟病患者有較高的盛行率,特別是那些合併有高血壓的患者。腳踝和腕上臂血壓比例 (ABI)的檢查應常規的使用在慢性腎臟病患者,使慢性腎臟病患者能獲得及早治療周邊動脈疾病的益處。 |
Abstract |
Research Objective Patients with chronic kidney disease (CKD) are at increased risk for atherosclerosis and peripheral artery disease (PAD). PAD has received far less attention than coronary artery disease (CAD) in CKD patients. Few studies have examined risk factors for PAD in CKD. We studied the possible related risk factors and benefit of hypertension treatment in CKD patients with PAD. Data Sources We included 129 patients of both sexes with stages 3 to 5 of CKD, as described by the Kidney Outcome Quality Initiatives (K/DOQI ) classification, without receiving dialysis therapy, not previously diagnosed with PAD. Study Design The following information were collected within six month period, including demographic characteristics, history of hypertension, anti-hypertension drug, diabetes, smoking, and pre-existing cardiovascular disease, body mass index (BMI), fasting blood glucose, HbA1c, total cholesterol, triglyceride(TG), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol(LDL), calcium (Ca), phosphate(P), Albumin, uric acid, urine protein. Ankle-brachial index (ABI) is a noninvasive diagnostic test that is efficient in detecting asymptomatic PAD with ABI <0.9. Findings There were 22 (17.7 %) participants with PAD. Higher systolic blood pressure (SBP), higher diastolic blood pressure (DBP), higher pulse pressure showed strong association with PAD in CKD patients. On further analysis, significant fewer patients treated with calcium channel blocker (CCB) in hypertensive CKD patients with PAD (χ2 =7.055, p =0.008). The multivariate logistic regression analysis in hypertensive patients demonstrated the risk factors for PAD was pulse pressure, and Calcium channel blocker treatment may correlate with decreasing PAD formation (odds ratio= 0.232, 95% CI=0.07-0.73, p =0.013) in CKD patients. Conclusion There is a high prevalence rate of PAD in population of CKD, especially those with hypertension. ABI should be routinely examined in these patients who can benefit earlier from therapeutic measures. |
目次 Table of Contents |
Acknowledgement ..………………………………………………………………..i Abstract ..…………………………………………………………………………..ii Chinese Abstract ..…………………………………………………………………iv Table of Contents ..………………………………………………………………...vi List of Tables ..…………………………………………………………………….vii List of Figures ..…………………………………………………………………...vii Chapter 1 Introduction ……………………………………………………………..1 Introduction …………………………………………………………………...1 Purpose of the study …………………………………………………………..2 Chapter 2 Literature Review ……………………………………………………….3 The Definition of Chronic kidney disease (CKD) ……………………………3 The Definition of Peripheral artery disease (PAD) .....……………………….4 The Prevalence of PAD in general population ……………………………….5 Risk factors of PAD in general population …………………………………...5 Risk factors of PAD in dialysis patients ……………………………………...6 Clinical manifestations of PAD ………………………………………………8 Non-invasive Diagnosis of PAD ……………………………………………..9 Ankle-brachial index examination …………………………………………...9 Management of PAD ………………………………………………………...12 Chapter 3 Theoretical Framework ………………………………………………...13 Peripheral arterial disease and chronic kidney disease ………………………13 Conceptual Framework ………………………………………………………16 Hypotheses …………………………………………………………………...19 Chapter 4 Methodology ……………………………………………………………20 Study Design ………………………………………………………………….20 Unit of Analysis and Samples ………………………………………………...20 Measurement ………………………………………………………………….20 Statistical Analysis …………………………………………………………….22 Chapter 5 Results …………………………………………………………………...23 Chapter 6 Discussion & Conclusion ………………………………………………..28 Conclusion …………………………………………………………………….34 References ………………………………………………………………………….35 List of Tables Table 5-1 Characteristics of study population ……………………………………..24 Table 5-2 Comparison of risk factors in patients with PAD and non-PAD ………..25 Table 5-3 Comparison of drug used in hypertensive CKD patients with PAD and non-PAD ………………………………………………………………...26 Table 5-4 Multivariate logistic regression analysis of hypertensive CKD patients with PAD ……………………………………………………………………..27 List of Figures Figure 2-1 Measurement of the Ankle–Brachial Index …………………………….11 Figure 3-1 Conceptual Framework of this Study …………………………………...18 |
參考文獻 References |
Al-Delaimy, WK, Merchant, AT, Rimm, EB, et al. (2004) Effect of type 2 diabetes and its duration on the risk of peripheral arterial disease among men. Am J Med; 116:236. Baigent C, Landry M (2003) Study of Heart and Renal Protection (SHARP). Kidney Int Suppl 63: S207–S210. doi: 10.1046/j.1523-1755.63.s84.4.x Belch JJ, Topol EJ, Agnelli G, et al. (2003) for the prevention of atherothrombotic disease network : critical issues in peripheral arterial disease detection and management. Arch Intern Med 163:884–892 Boaz, M, Weinstein, T, Matas, Z, et al. (2005) Peripheral vascular disease and serum phosphorus in hemodialysis: A nested case-control study. Clin Nephrol ; 63:98. Buchwald H, Bourdages HR, Campos CT, Nguyen P, Williams SE, Boen JR. (1996) Impact of cholesterol reduction on peripheral arterial disease in the Program on the Surgical Control of the Hyperlipidemias (POSCH).Surgery; 120:672-9. CAPRIE Steering Committee (1996) A randomised blinded trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). Lancet 348: 1329–1339 Centers for Disease Control and Prevention (CDC) (2005) Lower extremity disease among persons aged _40 years with and without diabetes—United States, 1999–2002. MMWR Morb Mortal Wkly Rep 54: 1158–1160 Clagett GP, Sobel M, Jackson MR (2004) Antithrombotic therapy in peripheral arterial occlusive disease. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126: 609S–626S Coresh, J, Astor, BC, Greene, T, et al. (2003) Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination survey. Am J Kidney Dis; 41:1. Coresh, J, Selvin, E, Stevens, LA, et al. (2007) Prevalence of chronic kidney disease in the United States. JAMA; 298:2038. Couch, NP. On the arterial consequences of smoking. J Vasc Surg 1986; 3:807. Criqui, MH, Fronek, A, Barrett-Connor, E, et al. (1985) The prevalence of peripheral arterial disease in a defined population. Circulation; 71:510. D.R.J. Singer, A. Kite. (2008) Management of hypertension in peripheral artery disease: Dose the choice of drug matter? Eur J Vasc Endovasc Surg 35:701-708. doi:10.1016/j.eivs.2008.01.007 DeLoach, SS, Mohler ER, 3rd. (2007) Peripheral arterial disease: a guide for nephrologists. Clin J Am Soc Nephrol; 2:839. Dormandy JA, Heeck L, Vig S. (1999) The fate of patients with critical leg ischemia. Semin Vasc Surg;12:142-7 Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). (2001) JAMA 285:2486–2497. Feringa HH, Karagiannis SE, Chonchol M, et al.(2007) Lower progression rate of end-stage renal disease in patients with peripheral arterial disease using statins or Angiotensin-converting enzyme inhibitors. J Am Soc Nephrol; 18:1872. Foley RN, Herzog CA, Collins AJ (2003) Smoking and cardiovascular outcomes in dialysis patients: The United States Renal Data System Wave 2 Study. Kidney Int 63: 1462–1467, 2003. doi:10.1046/j.1523-1755.2003.00860.x Greenlandams J, Aurigemma GP,Bond MG, et al (2000) Prevention conference V. Beyond secondary prevention: Identifying the high-risk patients for primary prevention. Noninvasive tests of atherosclerosis burden. Circulation 101:e16-e22 Hiatt W.R. (2001) Medical treatment of peripheral arterial disease and claudication, N. Engl. J. Med. 344 :1608–1621. Hirsch A.T., Criqui M.H , D. Treat-Jacobson, J.G. Regensteiner, M.A. Creager, J.W. Olin, et al. (2001) Peripheral arterial disease detection, awareness, and treatment in primary care, JAMA 286:1317–1324. doi:10.1001/jama.286.11.1317 Imparato AM, Kim GE, Davidson T, Crowley JG. (1975) Intermittent claudication: its natural course. Surgery;78:795-9 Jaar BG, Plantinga LC, Astor BC, et al. (2007) Novel and traditional cardiovascular risk factors for peripheral arterial disease in incident-dialysis patients. Adv Chronic Kidney Dis; 14:304. Jonason T, Bergstrom R (1987) Cessation of smoking in patients with intermittent claudication. Effects on the risk of pe-ripheral vascular complications, myocardial infarction and mortality. Acta Med Scand 221: 253–260 Jude EB, Oyibo SO, Chalmers N, Boulton AJ. (2001) Peripheral Arterial Disease in Diabetic and Nondiabetic Patients: A comparison of severity and outcome. Diabetes Care; 24:1433. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39:S1. Kuller LH, Shemanski L, Psaty BM, et al. (1995) Subclinical disease as an independent risk factor for cardiovascular disease. Circulation; 92:720. Leng G.C., Lee A.J., Fowkes F.G., Whiteman M., Dunbar J., Housley E., et al.(1996) Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population, Int. J. Epidemiol. 25: 1172–1181. Leskinen Y, Salenius JP, Lehtimaki T, et al. (2002) The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: requirements for diagnostics. Am J Kidney Dis 40:472–9. doi.10.1053/ajkd.2002.34885 Levey, AS, Coresh, J, Balk, E, Kausz, AT. (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med; 139:137. Lip, GY, Makin, AJ. (2003) Treatment of hypertension in peripheral arterial disease. Cochrane Database Syst Rev (4):CD003075 Mann, JF, Gerstein, HC, Pogue, J, et al (2001) Renal insufficiency as a predictor of ardiovascular outcomes and the impact of ramipril: The HOPE randomized trial. Ann Intern Med 134:629–636 McDaniel, MD, Cronenwett, JL. (1989) Basic data related to the natural history of intermittent claudication. Ann Vasc Surg; 3:273. McDermott, MM, Greenland, P, Liu, K, et al. (2001) Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. JAMA; 286:1599. McDermott, MM, Mehta, S, Liu, K, et al. (1999) Leg symptoms, the anklebrachial index, and walking ability in patients with peripheral arterial disease. J Gen Intern Med;14:173-81. McDermott,,M.M., Kerwin, D.R. , K. Liu, G.J. Martin, E. O’Brien, H. Kaplan, et al. (2001) Prevalence and significance of unrecognized lower extremity peripheral arterial disease in general medicine practice, J. Gen. Intern. Med. 16 :384–390. doi: 10.1046/j.1525-1497.2001.016006384.x. McKenna, M, Wolfson, S, Kuller, L. (1991) The ratio of ankle and arm arterial pressure as an independent predictor of mortality. Atherosclerosis;87: 119-28. Mehler PS, Coll JR, Estacio R, Esler A, Schrier RW, Hiatt WR. (2003) Intensive blood pressure control reduces the risk of cardiovascular events in patients with peripheral arterial disease and type 2 diabetes. Circulation 107:753-756. doi:10.1161/01.cir.0000049640.46039.52 Meijer WT, Grobbee DE, Hunink MG, Hofmana A, Hoes AW. (2000) Determinants of peripheral arterial disease in the elderly: the Rotterdam study. Arch Intern Med 160:2934-2938. Mohler ER (2003) Peripheral arterial disease: Identification and implications. Arch Intern Med 163: 2306–2314 Mohler ER, III, MD (2009) Clinical features, diagnosis, and natural history of lower extremity peripheral arterial disease. UpTodate review version 17.1 Mohler ER, III, MD (2009) Noninvasive diagnosis of peripheral arterial disease. UpTodate review version 17.1 MRC/BHF (2002) Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: A randomized placebo-controlled trial. Lancet 360: 7–22. doi:10.1016/S0140-6736(02)09327-3 Murabito JM, D’Agostino RB, Silbershatz H, Wilson WF (1997) Intermittent claudication : A risk profile from the Framingham Heart Study. Circulation 96: 44-9 Murabito JM, Evans JC, Nieto K, Larson MG, Levy D, Wilson PW (2002) Prevalence and clinical correlates of peripheral arterial disease in the Framingham off spring study. Am Heart J 143:961-5. doi.org/10.1067/mhj.2002.122871 Newman A.B., Siscovick D.S., Manolio, T.A. Polak J., Fried, L.P. Borhani N.O., et al.(1993) Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group, Circulation 88:837–845. Newman AB, Shemanski L, Manolio TA, et al. (1999) Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. Arterioscler Thromb Vasc Biol;19:538-45 Norgren L, Hiatt WR, Dormandy JA, et al. (2007) Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg; 45 Suppl S:S5. O’Hare AM (2004) High prevalence of peripheral arterial disease in persons with renal insufficiency: Results from the National Health and Nutrition Examination Survey. Circulation 109: 320–323. doi: 10.1161/01.CIR.0000114519.75433.DD O’Hare AM, Hsu CY, Bacchetti P, et al. (2002) Peripheral vascular disease risk factors among patients undergoing hemodialysis. J Am Soc Nephrol 13: 497–503. O'Hare AM, MD (2008) Peripheral arterial disease in chronic kidney disease. UpTodate review version 17.1 O'Hare AM, MD, Kirsten Johansen, MD (2008) Lower extremity peripheral arterial disease in end-stage renal disease. UpTodate review version 17.1 O'Hare AM, Rodriguez RA, Bacchetti P. (2005) Low ankle-brachial index associated with rise in creatinine level over time: results from the atherosclerosis risk in communities study. Arch Intern Med; 165:1481. Olin JW, Kaufman JA, Bluemke DA, et al. (2004) Atherosclerotic vascular disease conference: Writing Group IV: imaging. Circulation; 109:2626. Ostchega Y, Pauloseram R, Dillon CF, Gu Q, Hughes JP (2007) Prevalence of peripheral arterial disease and risk factors in persons aged 60 and older: data from the National Health and Nutrition Examination Survey 1999-2004. J Am Geriatr Soc 55:583-589. doi: 10.1111/j.1532-5415.2007.01123.x Ostergren J, Sleight P, Dagenais G, Danisa K, Bosch J, Qilong Y, Yusuf S (2004) HOPE Study Investigators: Impact of ramipril in patients with evidence of clinical or subclinical peripheral arterial disease. Eur Heart J 25: 17–24. doi: 10.1016/j.ehj.2003.10.033 Pasternak RC, Criqui MH, Benjamin EJ, et al. (2004) Atherosclerotic vascular disease conference: Writing Group I: epidemiology. Circulation; 109:2605. Pedersen TR, Kjekshus J, Pyorala K, et al. (1998) Effect of simvastatin on ischemic signs and symptoms in the Scandinavian Simvastatin Survival Study (4S). Am J Cardiol; 81:333-5. Pepone CJ, Kowey PR, Kupfer S, Kolloch RE, Benetos A, Mancia G et al. (2006) INVEST investigators. Predictors of adverse outcome among patients with hypertension and coronary artery disease. J Am Coll Cardiol 47:547-551. Pinkau T, Hilgers KF, Veelken R, Mann JFE (2004) How does minor renal dysfunction influence cardiovascular risk and the management of cardiovascular disease? J AmSoc Nephrol 15:517–523. doi: 10.1097/01.ASN.0000107565.17553.71 Prevalence of chronic kidney disease and associated risk factors--United States, 1999-2004. MMWR Morb Mortal Wkly Rep 2007; 56:161. Radack K, Deck C. (1991) Beta-adrenergic blocker therapy does not worsen intermittent claudication in subjects with peripheral arterial disease. A meta-analysis of randomized controlled trials. Arch Intern Med 151:1769-1776. Rajagopalan, S, Dellegrottaglie, S, Furniss, AL, et al. (2006 ) Peripheral arterial disease in patients with end-stage renal disease: observations from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Circulation; 114:1914. Reddan DN, Marcus RJ, Owen WF Jr, et al. (2001) Long term outcomes of revascularization for peripheral vascular disease in end-stage renal disease patients. Am J Kidney Dis 38:57–63. doi:10.1053/ajkd.2001.25194 Reeder BA, Liu L, Horlick L. (1996) Sociodemographic variation in the prevalence of cardiovascular disease. Can J Cardiol; 12:271. Resnick HE, Lindsay RS, McDermott MM, et al. (2004) Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation; 109:733. Ridker PM, Stampfer MJ, Rifai N (2001) Novel risk factors for systemic atherosclerosis: A comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein, and standard cholesterol screening as predictors of peripheral arterial disease. JAMA 285:2481-5. doi:10.1001/jama.285.19.2481 Ritz E, Mcclellan WM (2004) Increased cardiovascular risk in patients with minor renal dysfunction: An emerging issue with far-reaching consequences. J Am Soc Nephrol 15:523–516. doi: 10.1097/01.ASN.0000115398.92270.30 Rofsky NM, Adelman MA. (2000) MR angiography in the evaluation of atherosclerotic peripheral vascular disease. Radiology; 214:325. Roldan C, Campo C, Segura J, et al. (2004) Inpacto del ′ındice tobillobrazo sobre la estratificaci ′on del riesgo cardiovascular de pacientes hipertensos. Hipertensi ′on 21:66–70 Rose GA, Blackburn H. Cardiovascular survey methods. World Health Organization monograph series. No. 56. Geneva: World Health Organization,1968. Selvin E, Erlinger, TP. (2004) Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation; 110:738. Shilpak MG, Heidenreich PA, Noguchi H, Chertow GM, Browner WS, Mcclellan MB (2002) Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients. Ann Intern Med 137: 555–562 Tonelli M, Moye L, Sacks FM, Kiberd B, Curhan G (2003) Cholesterol and Recurrent Events (CARE) Trial Investigators: Pravastatin for secondary prevention of cardiovascular events in persons with mild chronic renal insufficiency. Ann Intern Med 138: 98–104 Townsend RR (2002) Cardiac mortality in chronic kidney disease: A clearer perspective. Ann Intern Med 137: 615–616 Tseng CH (2000) Prevalence and risk factors of peripheral arterial obstructive disease in Taiwanese type 2 diabetic patients. Angiology 54: 331-8. doi: 10.1177/000331970305400309 Vogt MT, Cauley JA, Kuller LH, Nevitt MC. (1994) Functional status and mobility among elderly women with lower extremity arterial disease: the Study of Osteoporotic Fractures. J Am Geriatr Soc;42:923-9 Vogt MT, McKenna M, Anderson SJ, Wolfson SK, Kuller LH. (1993) The relationship between ankle-arm index and mortality in older men and women. J Am Geriatr Soc;41:523-30 Wang JC, Criqui MH, Denenberg JO, et al. (2005) Exertional leg pain in patients with and without peripheral arterial disease. Circulation; 112:3501. Zanchetti A, Julius S, Kjekdsen S, Mcinnes GT, Hua T, Weber M et al. (2006) Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: an analysis of findings from the VALUE trial. J Hypertens 24(11): 2163-2168. doi: 10.1097/01.hjh.0000249692.96488.46 Zelis R, Mason DT, Braunwald E, Levy RI. (1970) Effects of hyperlipoproteinemias and their treatment on the peripheral circulation. J Clin Invest; 49:1007. |
電子全文 Fulltext |
本電子全文僅授權使用者為學術研究之目的,進行個人非營利性質之檢索、閱讀、列印。請遵守中華民國著作權法之相關規定,切勿任意重製、散佈、改作、轉貼、播送,以免觸法。 論文使用權限 Thesis access permission:校內立即公開,校外一年後公開 off campus withheld 開放時間 Available: 校內 Campus: 已公開 available 校外 Off-campus: 已公開 available |
紙本論文 Printed copies |
紙本論文的公開資訊在102學年度以後相對較為完整。如果需要查詢101學年度以前的紙本論文公開資訊,請聯繫圖資處紙本論文服務櫃台。如有不便之處敬請見諒。 開放時間 available 已公開 available |
QR Code |