臺灣博碩士論文加值系統

背景：
C型肝炎病毒感染和其併發症影響，是重要的公共衛生問題。台灣有高的C型肝炎病毒感染盛行率(1.6-19.6%)和最高的腎臟失能盛行率。C型肝炎病毒感染可能與腎功能下降和腎功能逐漸喪失有關。
目的：
研究目的是探討C型肝炎病毒感染者與臨床因子特性和腎絲球過濾率之間的相關研究。
研究設計：
研究設計是1:1年齡和性別配對之病例－對照研究設計；研究樣本納入3360人已診斷之C型肝炎病毒感染者和3360人社區對照組，其樣本納入研究期間是從2004年到2016年。
結果：
多變項邏輯斯迴歸分析，揭露獨立因子預測低腎絲球過濾率風險（<90ml/min/m3），予病例組－C型肝炎病毒感染者，其獨立預測因子是丙酮酸轉胺脢(GPT；勝算比[OR] 0.99，95% 信賴區間[CI] 0.99－0.99，P值0.001)、血小板(OR 0.99，95% CI 0.99－0.99， P值0.002)、高血壓(OR 1.31，95% CI 1.03－1.66，P值0.027)，予社區對照組，三酸甘油脂(OR　1.00，95% CI 1.00-1.00，P值0.005)、血小板 (OR 0.99，95% CI 0.99－0.99， P值<0.001)、肥胖指數>25(OR 1.43，95% CI 1.23－1.67，P值<0.001)、高血脂症(OR　1.32，95%　CI　1.02－1.71，P值0.035)、高血壓(OR 1.69， 95% CI 1.42－1.99，P值<0.001)、糖尿病 (OR　1.33，95% CI 1.03－1.71， P值0.032)是主要獨立因子。 研究結果也揭露C型肝炎病毒感染者和肥胖指數>25、高血壓、或糖尿病等預測因子，交互作用相關於低腎絲球過濾率風險(P值 <0.05)。
結論：
這研究證實C型肝炎病毒感染者，獨立和協同肥胖指數>25、高血壓、或糖尿病增加低腎絲球過濾率風險。

Background
The association between HCV and CKD has not been clearly demonstrated. We aimed to investigate the possible association of clinical features of HCV infection and CKD by estimated glomerular filtration rate.
Methods
The 3360 age and sex matched community based control individuals without HCV and 3360 patients with hepatitis C virus infection were enrolled (1:1, case and control ratio) in this study between 2004 and 2016. Demographic and laboratory parameters were assessed and appropriate statistical methods were performed for the analysis.
Results
Multivariate logistic regression analysis revealed that serum GPT (OR-0.998; 95% CI – 0.997-0.999; p=0.001) level, platelet (OR-0.997; 95% CI – 0.995-0.999; p=0.002) count and hypertension (OR-1.31; 95% CI – 1.03-1.66; p=0.027) were significantly associated with HCV infected patients and serum TG (OR-1.001; 95% CI –1.00-1.002; p=0.005) level, platelet (OR-0.996; 95% CI – 0.995-0.997; p<0.001) count, BMI>25 (OR-1.43; CI- 1.23-1.67; p<0.001), hyperlipidemia (OR- 1.32; CI-1.02-1.71; p=0.035), hypertension (OR-1.69; 95% CI – 1.42-1.99; p<0.001) and diabetes (OR-1.33; CI-1.03-1.71; p=0.032) were significantly associated with low eGFR (<90ml/min/m3) in control subjects. The BMI >25kg/m2, hypertension, and diabetes were associated with low eGFR interaction with the HCV infection by multivariate analysis.
Conclusion
Our study indicated that the patients with HCV infection are associated with low eGFR compared with non HCV infected patients. This association is consistent in obese, diabetic and hypertensive patients.

TABLE OF CONTENTS
I. Abstract-------------------------------------------------------------------------1
II. Acknowledgement------------------------------------------------------------4
III. Table of Content --------------------------------------------------------------5
IV. List of table and figures -----------------------------------------------------7
V. Abbreviation ------------------------------------------------------------------9
VI. Introduction ------------------------------------------------------------------10
4.1. Hypothesis ------------------------------------------------------------13
4.2. Study aim -------------------------------------------------------------14
VII. Patients and Methods --------------------------------------------------------15
7.1. Data sours and patients ----------------------------------------------15
7.2. Laboratory test -------------------------------------------------------16
7.3. Definition of CKD ---------------------------------------------------17
7.4. Definition of Hypertension and Diabetes--------------------------18
7.5. Histological evaluation ----------------------------------------------19
7.6. Statistical analysis ---------------------------------------------------19
VIII. Result -------------------------------------------------------------------------21
8.1. HCV infection is associated with low eGFR --------------------21
8.2. Factors associated with low eGFR score in all patients --------21
8.3. The characteristics associated with eGFR in HCV infected patients ----------------------------------------------------------------23
8.4. The characteristics associated with eGFR in contol subjects---23
8.5. The multiple analysis characteristics associated with eGFR in all population stratified by HCV infection and healthy subjects----------------------------------------------------------------------------24
8.6. The interaction effect of risk factors in low eGFR -------------25
8.7. The decrease of eGFR adjusted by risk factors -----------------25
8.8. Interaction of low eGFR and clinical future --------------------26
IX. Discussion -------------------------------------------------------------------27
X. Conclusion ------------------------------------------------------------------34
XI. Appendix --------------------------------------------------------------------35
XII. Reference --------------------------------------------------------------------50

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