臺灣博碩士論文加值系統

研究背景：退化性膝關節炎為老人常見的疾病，目前退化性膝關節炎的診斷主要利用影像學的資料判斷膝關節炎嚴重度。但影像學診斷無法斷定病患之疼痛情形，故許多文獻探討退化性膝關節炎影像學診斷嚴重度與其疼痛、功能及健康相關生活品質之間的相關性，其結果並不一致。
研究目的：探討影響台北市某醫學中心65歲以上健檢老人影像學診斷膝關節嚴重度(Kellgren- Lawrence scale，K-L)、膝關節整體健康狀況(Western Ontario and McMaster Universities Osteoarthritis index，WOMAC)及健康相關生活品質(12-item Short Form，SF-12)之影響因子。並建立退化性膝關節炎風險預測篩檢工具。
研究方法：本研究採用「台灣地區退化性關節炎類鐸基因受器多形性及功能性之流行病學相關性研究」計畫之次級資料進行分析，調查901名參與者。膝關節損傷情形以K-L標準進行判定；膝關節整體健康狀況、健康相關生活品質及下肢肌力功能則以WOMAC、SF-12、六公尺坐站行走及五次坐站測試進行評估；並使用ROC曲線評價預測模式的預測能力。所有資料以SPSS 20.0統計套裝軟體進行資料分析。
研究結果：分析結果顯示影像學診斷疾病越嚴重者其WOMAC、SF-12及下肢肌力功能情形越差，其中女性又較男性差。而影響WOMAC分數的相關因子為下肢肌力功能、運動習慣、疾病嚴重程度及性別，其共可解釋WOMAC分數總變異量19.9%。另外分析健康相關生活品質之影響因子，發現WOMAC總分、性別、六公尺坐站行走及運動習慣可解釋生理健康構面分數總變異量的43.6%；WOMAC總分、六公尺坐站行走、運動習慣及教育程度可解釋心理健康構面分數總變異量16.5%。最後，分析罹患退化性膝關節炎相關因子為年齡、性別、BMI及WOMAC整體分數，並以此建立退化性膝關節炎預測模式，以ROC曲線評價此模式，其曲線下面積為0.581，切點為101.46分，若超過此分數，即顯示可能罹病。
結論：膝關節嚴重度、性別、教育程度、下肢肌力功能及運動習慣為影響膝關節健康狀況及健康相關生活品質之重要危險因子。另外，年齡、性別、BMI及WOMAC分數為影響退化性膝關節炎相關因子，並以此建立退化性膝關節炎預測模式，以期提供民眾及醫院一個簡單方便的預測篩檢工具。

Background: Knee osteoarthritis (OA) is one of the most common forms of chronic joint disease worldwide. The impact of knee pain on health-related quality of life (HRQoL) may differ according to the severity of knee OA, and little research reported the influence of knee OA on the HRQoL and physical function. However, the findings of these studies remain controversial.
Purpose: The purpose of this study is to assess the HRQoL in the elderly and to determine its relationships with conventional clinical measure and self-reported disability, WOMAC and SF-12. In addition, to develop risk prediction model for knee OA.
Material and methods: This study was used secondary data and analyzed 901 participants. The participants’ information was collected by a questionnaire to assess demographics, knee symptoms, OA risk factors, and general health. To evaluate degree of knee pain and health-related quality of life, the WOMAC and the SF-12 were used. For each elderly, radiographic OA is assessed using the Kellgren/Lawrence (K/L) grading system. Knee functional ability is assessed using the 6 Meter-up-and-Go and the Five Times Sit-to-Stand Test.
Results: The radiographic serious of knee OA patients have the worse WOMAC, SF-12 and knee functional ability, especially in females. The influence factors of WOMAC are knee functional ability, exercise, the severity of knee and gender and can be explained 19.9% variance. In addition, the WOMAC, gender, 6 Meter-up-and-Go and exercise can be explained 43.6% variance of PCS. The WOMAC, 6 Meter-up-and-Go, exercise and education can be explained 16.5% variance of MCS. Finally, we found that the risk factors of knee OA are age, gender, BMI and WOMAC scores and develop the prediction model. The area under curve of ROC was 0.581 and the cut-off point was 101.46 points. If the scores more than 101.46 points, that indicates possible morbidity.
Conclusion: The HRQoL of knee OA patients would affect by the severity of knee, gender, education, knee functional ability and exercise. The risk factors of knee OA are age, gender, BMI and WOMAC scores and we use the risk factors to develop the prediction model.

目錄 I
表目錄 III
圖目錄 V
摘要 VI
Abstract VIII
第一章　緒論 1
第一節　研究背景與動機 1
第二節　研究目的 4
第二章　文獻探討 5
第一節　退化性膝關節炎 5
第二節　退化性膝關節炎的診斷 10
第三節 退化性膝關節炎患者健康狀況測量工具 16
第四節 影像學診斷膝關節嚴重度與膝關節整體健康狀況及健康相關生活品質相關性 23
第五節 ROC曲線與預測分數模式之應用 28
第三章　研究材料與方法 30
第一節　研究架構 30
第二節　研究對象與資料來源 34
第三節　研究工具 36
第四節　資料處理與分析方法 37
第五節　名詞解釋 40
第四章　研究結果 47
第一節　研究對象人口學特質之描述性分析 47
第二節　影像學診斷膝關節嚴重度與膝關節整體健康狀況、健康相關生活品質及下肌力功能之相關情形 53
第三節　影響65歲以上健檢老人膝關節整體健康狀況之影響因子 76
第四節　影響65歲以上健檢老人健康相關生活品質之影響因子 79
第五節　退化性膝關節炎之危險因子及預測模式 84
第五章　討論 97
第一節 退化性膝關節炎盛行率 97
第二節 膝關節嚴重度與膝關節整體健康狀況、健康相關生活品質及下肢肌力功能差異情形 99
第三節 不同性別膝關節嚴重度與膝關節整體健康狀況、健康相關生活品質及下肢肌力功能差異情形 104
第四節 影響WOMAC相關因子 107
第五節 影響SF-12相關因子 109
第六節 影響退化性膝關節炎相關因子 111
第七節 退化性膝關節炎之預測模式 114
第八節 研究限制 116
第六章　結論與建議 117
第一節 結論 117
第二節 建議 120
參考文獻 122

表目錄
表2-2-1、Kellgren-Lawrence scale退化性膝關節炎診斷標準 13
表2-2-2、AhlBack退化性膝關節炎嚴重度分類 15
表2-4-1、退化性膝關節炎影像學診斷嚴重度與健康狀況相關研究 26
表2-4-1、退化性膝關節炎影像學診斷嚴重度與健康狀況相關研究(續) 27
表2-5-1、ROC曲線下面積判別標準 29
表3-5-1、SF-12量表與SF-36量表各面向題數 40
表3-5-2、SF-12量表重新編碼題目分數轉換表 41
表3-5-3、SF-12各面向題數與分數範圍 41
表4-1-1、台北市某醫學中心65歲以上健檢老人之個人基本特質 49
表4-1-2、台北市某醫學中心65歲以上健檢老人影像學診斷膝關節嚴重度、WOAMC、 SF-12及下肢肌力功能之分布情形 52
表4-2-1、影像學診斷有無膝關節炎與WOMAC、SF-12及下肢肌力功能之比較 55
表4-2-2、比較不同影像學診斷膝關節嚴重度其WOMAC、SF-12及下肢肌力功能之差異 58
表4-2-3、不同影像學診斷膝關節嚴重度之WOMAC、SF-12及下肢肌力功能分布與比較 59
表4-2-4、影像學診斷男性有無膝關節炎與WOMAC、SF-12及下肢肌力功能之比較 63
表4-2-5、比較男性不同影像學診斷膝關節嚴重度其WOMAC、SF-12及下肢肌力功能之差異 64
表4-2-6、男性不同影像學診斷膝關節嚴重度之WOMAC、SF-12及下肢肌力功能分布與比較 65
表4-2-7、影像學診斷女性有無膝關節炎與WOMAC、SF-12及下肢肌力功能之比較 68
表4-2-8、比較女性不同影像學診斷膝關節嚴重度其WOMAC、SF-12及下肢肌力功能之差異 69
表4-2-9、女性不同影像學診斷膝關節嚴重度之WOMAC、SF-12及下肢肌力功能分布與比較 70
表4-2-10、比較男性與女性在不同影像學診斷有無膝關節炎與WOMAC、SF-12及下肢肌力功能之相關情形 74
表4-2-11、比較男性與女性在不同影像學診斷膝關節嚴重度與WOMAC、SF-12及下肢肌力功能之差異 75
表4-3-1、以單變項及多變項相關模型評估退性關節炎危險因子與WOMAC之相關性 78
表4-4-1、以單變項及多變項相關模型評估退性關節炎危險因子與SF-12生理健康構面(PCS)之相關性 82
表4-4-2、以單變項及多變項相關模型評估退性關節炎危險因子與SF-12心理健康構面(MCS)之相關性 83
表4-5-1、影響退化性膝關節炎相關危險因子之邏輯斯迴歸 89
表4-5-2、影像學診斷膝關節炎多變項邏輯斯迴歸模式(一) 90
表4-5-3、影像學診斷膝關節炎多變項邏輯斯迴歸模式(二) 91
表4-5-4、影像學診斷膝關節炎危險因子之逐步邏輯斯迴歸分析(一) 92
表4-5-5、影像學診斷膝關節炎危險因子之逐步邏輯斯迴歸分析(二) 93
表4-5-6、影像學診斷膝關節炎危險因子變項係數轉換分數表 95
表5-2-1、102年健檢老人影像學診斷嚴重度與藥物使用之相關性 103

圖目錄
圖2-1-1、正常及罹患退化性膝關節炎之關節構造變化 6
圖2-2-1、膝部X光攝影結果所判讀之K-L 14
圖3-1-1、研究架構圖(一) 31
圖3-1-2、研究架構圖(二) 32
圖3-1-3、研究架構圖(三) 33
圖3-2-1、研究流程圖 35
圖4-5-1、台北市65歲以上健檢老人危險因子預測退化性膝關節炎之ROC曲線 96

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