臺灣博碩士論文加值系統

人類的生活與環境息息相關，快速且不穩定的氣候變遷，讓人們也產生許多與氣候、天氣相關的疾病，氣喘就是其中之一。近年來全球罹患氣喘的人口持續上昇，其死亡率也持續攀升中，如何防範未然，實為不容輕忽的問題。本研究目的在使用醫院之資料，結合易取得之環境因子，以資料採礦（Data Mining）的方式，發展一氣喘預測模式，期望該模型能達到降低病徵發作之可能。
為達到以上之目的，本研究使用北部某醫學中心自2007年1月至2009年12月為期三年之急診資料及門診就醫資料，將該次就醫主要診斷碼為493.*之病患資料抽出，分別整理出其以該年度經整理並計算出該天氣喘發作機率，將其與環境中的空氣因子及氣象因子結合，使用WEKA工具訓練類神經網路的模型，以建立起環境因子與氣喘發作之關連性。
結果顯示，雖此模型於急診之中未能顯現有效之預測（準確率66.57%，敏感性0.666，特異性0.601，AUC: 0.682），但施行於門診之中能得到不錯之預測成效（準確率75.18%，敏感性0.752，特異性0.757，AUC: 0.846）。本研究僅以方便取得之環境因子即可瞭解其對於病人之影響高達七成以上，未來更應近一步研究分析，以達到氣喘發作預警、降低病徵發作之目的。

Our life is closely related to the environment. Climate change getting fast and unstable, so people are getting climate-related diseases such as asthma. According to World Health Organization (WHO) estimates, 235 million people suffer from asthma globally, and the prevalence of asthma is increasing. Asthma, become a world-wild health problem. We use existing data in hospital and combine with the environment parameters to find an appropriate model for assist asthma patients in asthma attack control.
To reach this propose, patients who were diagnosed as asthma (ICD-9 code: 493.*) by physicians from emergency department (ED) and outpatient department (OPD) during January 2007 to December 2009 were selected. According to the patient data, we can classify all the date to high-risk attack date or low-risk attack date, and we use Atmospheric parameters and Air pollution parameters as variables to predict asthma attack. Through the data preprocessing, feature selection and neural network adjust, we can decide the final predict variables and perform the best prediction of the model.
Although the performance of the ED model is not good enough (Accuracy: 66.57%, Sensitivity: 0.666, Specificity: 0.601, AUC: 0.682), but the result from the OPD is much better (Accuracy: 75.18%, Sensitivity: 0.752, Specificity: 0.757, AUC: 0.846).
In this study, asthma attack could be predicted by the easy-get environment parameters, the accuracy performance is higher than 70%. In future studies, we could apply this model in clinical practice to help asthma patients.

論文電子檔著作權授權書 i
論文審定同意書 ii
誌謝 iii
中文摘要 iv
英文摘要 v
目錄 vi
表目錄 viii
圖目錄 ix
第一章 緒論 1
1.1 研究背景與動機 1
1.2 研究目的 3
第二章 文獻探討 4
2.1 氣喘相關概念 4
2.2 氣候因素的影響 7
2.3 空氣汙染的影響 9
2.4 類神經網路介紹 11
第三章 材料與方法 15
3.1 資料來源 15
3.2 資料前處理方式 17
3.3 預測變項 19
3.4 研究方法 22
3.5 預測模型的評估 26
第四章 研究結果 28
4.1 研究資料描述 28
4.2 變數選擇結果 35
4.3 參數調整 40
第五章 結果討論及建議 44
5.1 討論 44
5.2 結論與建議 47
參考文獻 49

[1] Global Initiative for Asthma. (2010). Global strategy for asthma management and prevention. http://www.ginasthma.org/.
[2] 呂克桓、謝貴雄。（1988）。臺北市學童過敏病：11年間之變化。Acta Paediatrica Sinica 29, 104-109。
[3] 吳家興、林瑞雄、謝貴雄、邱文達、陳麗美、邱淑媞、黃國晉、劉文良、邱宏毅、蕭慧娟、方淑慧、陳雄文、林嘉明、宋鴻樟。（1998）。台灣北部國中學生氣喘盛行率調查。中華衛誌 17, 214-125。
[4] Newman-Taylor, A. (1995). Environmental determinants of asthma. Lancet 345, 296-299.
[5] 行政院衛生署。98_死因統計統計表。（2010）。http://www.doh.gov.tw/CHT2006/DisplayStatisticFile.aspx?d=76512&s=1。
[6] Cross, S. (1991). Asthma education and prophylaxis. Nurs Stand 5, 26-28.
[7] 曾麗琦。（2000）。屏東地區學齡期氣喘學童疾病知識、態度與自我處理行為。已發表的碩士論文，高雄醫學大學護理研究所。
[8] 翁德昌、周炳克、孫斌、陳家勉、馮煥光、陳宏一。（2005）。氣喘藥物治療的趨勢。台灣醫界 48, 19-22。
[9] 彭萬誠。（2000）。氣喘之診斷及臨床表徵。國防醫學 31, 272-277。
[10] Platts-Mills TA. (1991). Role of allergens in asthma and airway hyperresponsiveness: relevance to immunotherapy and allergen avoidance. In: Kaliner MA, Persson CG, eds. Asthma: its pathology and treatment. New York: Marcel Dekker.
[11] Nelson, H.S. (2000). The importance of allergens in the development of asthma and the persistence of symptoms. The Journal of allergy and clinical immunology 105, S628-632.
[12] Peat, J.K., Tovey, E., Mellis, C.M., Leeder, S.R., and Woolcock, A.J. (1993). Importance of house dust mite and Alternaria allergens in childhood asthma: an epidemiological study in two climatic regions of Australia. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology 23, 812-820.
[13] Gold, D.R. (2000). Environmental tobacco smoke, indoor allergens, and childhood asthma. Environ Health Perspect 108 Suppl 4, 643-651.
[14] Suphioglu, C., Singh, M.B., Taylor, P., Bellomo, R., Holmes, P., Puy, R., and Knox, R.B. (1992). Mechanism of grass-pollen-induced asthma. Lancet 339, 569-572.
[15] D'Amato, G., Spieksma, F.T., Liccardi, G., Jager, S., Russo, M., Kontou-Fili, K., Nikkels, H., Wuthrich, B., and Bonini, S. (1998). Pollen-related allergy in Europe. Allergy 53, 567-578.
[16] 朱瑞兆主編，戚啟勳校閱。（1993）。應用氣候手冊，台北：明文書局，335~378。
[17] Weitzman, M., Gortmaker, S., Walker, D.K., and Sobol, A. (1990). Maternal smoking and childhood asthma. Pediatrics 85, 505-511.
[18] Ehrlich, R.I., Du Toit, D., Jordaan, E., Zwarenstein, M., Potter, P., Volmink, J.A., and Weinberg, E. (1996). Risk factors for childhood asthma and wheezing. Importance of maternal and household smoking. American journal of respiratory and critical care medicine 154, 681-688.
[19] Siroux, V., Pin, I., Oryszczyn, M.P., Le Moual, N., and Kauffmann, F. (2000). Relationships of active smoking to asthma and asthma severity in the EGEA study. Epidemiological study on the Genetics and Environment of Asthma. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology 15, 470-477.
[20] Pedersen, B., Dahl, R., Karlstrom, R., Peterson, C.G., and Venge, P. (1996). Eosinophil and neutrophil activity in asthma in a one-year trial with inhaled budesonide. The impact of smoking. American journal of respiratory and critical care medicine 153, 1519-1529.
[21] von Mutius, E. (2000). The environmental predictors of allergic disease. The Journal of allergy and clinical immunology 105, 9-19.
[22] Samet, J.M., Marbury, M.C., and Spengler, J.D. (1987). Health effects and sources of indoor air pollution. Part I. The American review of respiratory disease 136, 1486-1508.
[23] Hackney J, Linn W. (1993). Environmental factors: air pollution, weather and noxious gases. In: Weiss EB, Stein M, eds. Bronchial asthma: mechanisms and therapeutics. Boston: Little Brown.
[24] Gissler M, Jarvelin MR, Louhiala P, Hemminki E. (1999). Boys have more health problems in childhood than girls: follow-up of the 1987 Finnish birth cohort. Acta Paediatr, 88: 310-4.
[25] Smith, J.M., Harding, L.K., and Cumming, G. (1971). The changing prevalence of asthma in school children. Clinical allergy 1, 57-61.
[26] Sears, M.R., Burrows, B., Flannery, E.M., Herbison, G.P., and Holdaway, M.D. (1993). Atopy in childhood. I. Gender and allergen related risks for development of hay fever and asthma. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology 23, 941-948.
[27] Martin, A.J., McLennan, L.A., Landau, L.I., and Phelan, P.D. (1980). The natural history of childhood asthma to adult life. British medical journal 280, 1397-1400.
[28] 吳兌，鄧雪嬌。(2001)。環境氣象學與特種氣象預報，北京：氣象出版社。
[29] Garty, B.Z., Kosman, E., Ganor, E., Berger, V., Garty, L., Wietzen, T., Waisman, Y., Mimouni, M., and Waisel, Y. (1998). Emergency room visits of asthmatic children, relation to air pollution, weather, and airborne allergens. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 81, 563-570.
[30] 夏廉博。（1986）。人類生物氣象學，北京：氣象出版社。
[31] Rossi, O.V., Kinnula, V.L., Tienari, J., and Huhti, E. (1993). Association of severe asthma attacks with weather, pollen, and air pollutants. Thorax 48, 244-248.
[32] Castellsague, J., Sunyer, J., Saez, M., and Anto, J.M. (1995). Short-term association between air pollution and emergency room visits for asthma in Barcelona. Thorax 50, 1051-1056.
[33] Tenias, J.M., Ballester, F., and Rivera, M.L. (1998). Association between hospital emergency visits for asthma and air pollution in Valencia, Spain. Occupational and environmental medicine 55, 541-547.
[34] 張斐章、張麗秋、黃浩倫。（2003）。類神經網路-理論與實務，台北：東華書局。
[35] 葉怡成。（2001）。應用類神經網路，台北：儒林圖書公司。
[36] 交通部中央氣象局網站。http://www.cwb.gov.tw/V7/index.htm
[37] 行政院環保署空氣品質監測網。歷年監測資料下載，http://taqm.epa.gov.tw/taqm/zh-tw/YearlyDataDownload.aspx
[38] WEKA網站。http://www.cs.waikato.ac.nz/ml/weka/
[39] Hanley, J.A., and McNeil, B.J. (1982). The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143, 29-36.
[40] Asthma Information Guide. (2006). http://http://www.asthmainformationguide.com/
[41] Andersen, Z.J., Loft, S., Ketzel, M., Stage, M., Scheike, T., Hermansen, M.N., and Bisgaard, H. (2008). Ambient air pollution triggers wheezing symptoms in infants. Thorax 63, 710-716.
[42] Gent, J.F., Triche, E.W., Holford, T.R., Belanger, K., Bracken, M.B., Beckett, W.S., and Leaderer, B.P. (2003). Association of low-level ozone and fine particles with respiratory symptoms in children with asthma. JAMA : the journal of the American Medical Association 290, 1859-1867.
[43] O'Connor, G.T., Neas, L., Vaughn, B., Kattan, M., Mitchell, H., Crain, E.F., Evans, R., 3rd, Gruchalla, R., Morgan, W., Stout, J., et al. (2008). Acute respiratory health effects of air pollution on children with asthma in US inner cities. The Journal of allergy and clinical immunology 121, 1133-1139 e1131.
[44] Leikauf, G.D., Kline, S., Albert, R.E., Baxter, C.S., Bernstein, D.I., and Buncher, C.R. (1995). Evaluation of a possible association of urban air toxics and asthma. Environ Health Perspect 103 Suppl 6, 253-271.
[45] Freeman, J. A. and Skapura, D. M.(1992), Neural Networks Algorithms, Applications, and Programming Techniques, Addison-Wesley , N.Y..