臺灣博碩士論文加值系統

流行性感冒是一種由病毒引起的傳染性呼吸道疾病，會在老年人口引起嚴重的發病率和死亡率。急性心肌梗塞的發生率在冬季為高峰期，與流感的季節循環模式類似，因此急性心肌梗塞發生的部分原因可能與流感疫情有關，可能的假說為感染導致動脈粥樣硬化斑塊的進展和不穩定，進而使得斑塊破裂造成急性心肌梗塞，而這代表接種流感疫苗可能可以防止某些情況的急性心肌梗塞，因此本研究的主要目的為利用病例對照研究法探討接種流感疫苗是否可以防止急性心肌梗塞。

本研究使用全民健保資料庫2005及2010年承保資料抽樣歸人檔，第一部分研究使用1:4配對病例對照研究，研究2003-2010年65歲以上之初次被診斷為急性心肌梗塞的老年人，配對性別、年齡及診斷時間，以條件式邏輯斯迴歸進行分析是否施打流感疫苗與急性心肌梗塞的相關性。依據第一部分資料，進行第二部分研究使用病例對照研究探討疫苗吻合株與當年度流感流行情況是否相符與急性心肌梗塞的相關性，並以邏輯斯迴歸進行分析。

研究結果顯示，第一部分研究中，一年內施打流感疫苗顯著降低急性心肌梗塞發生的機率20.9%。早期施打流感疫苗，顯著降低急性心肌梗塞的發生的機率16.3%。晚期施打流感疫苗，顯著降低急性心肌梗塞的發生的機率17.3%。第二部分研究，2004-2005流感季(疫苗吻合株不相符)，施打流感疫苗顯著降低急性心肌梗塞的發生的機率28.8%。2008-2009流感季(疫苗吻合株相符)，施打流感疫苗顯著降低急性心肌梗塞的發生的機率18.6%。

本研究結果顯示不管早期或晚期施打流感疫苗皆可能有助於預防心肌梗塞的發生，且不論疫苗吻合株是否相符，施打流感疫苗皆有顯著降低急性心肌梗塞發生的機率，這可做為在65歲以上老人常規施打流感疫苗的醫療建議。

Influenza, a contagious respiratory tract infection caused by viruses, can cause severe morbidity and mortality especially in the elderly. Acute myocardial infarction (AMI) peaks in the winter months, and the pattern is quite similar to epidemic influenza. It has been speculated that influenza might be one reason that cause AMI. Although the exact mechanism is unknown, some researchers hypothesize that infection disturbs atherosclerotic plaques, and in turn crack plaque that causes AMI. This implies that influenza vaccination may prevent the occurrence of some AMI cases.

This study use Longitudinal Health Insurance Database 2005 (LHID 2005) and Longitudinal Health Insurance Database 2010 (LHID 2010) from National Health Insurance Research database (NHIRD). The first part of the study using a 1:4 matched case-control study. Cases were patients who were at least 65 years old at diagnosis of first AMI recorded from 2003 to 2010, and were matched for sex, age and index date. We use conditional logistic regression to analyze whether influenza vaccination correlated with AMI. Based on the result from the first part, the second part of the study uses a case-control study to study if matches of vaccine strain would affect the results. For matched and unmatched vaccine strains, we run logistic regression to separately calculate the correlation between vaccine strain and AMI.

Result from the first part of the study shows that the influenza vaccination within one year significantly reduced the odds of having first AMI for 20.9%. Early influenza vaccination significantly reduced the odds of having first AMI for 16.3%, while late influenza vaccination significantly reduced the odds of having first AMI for 17.3%. For the second part of the study, influenza vaccination, which occurs during 2004-2005 influenza seasons (vaccine strain does not match), significantly reduced the odds of having first AMI for 28.8%. Furthermore, influenza vaccination, which occurs in 2008-2009 influenza seasons (vaccine strains match), significantly reduced the odds of having first AMI for 18.6%.

The results of this study indicate that regardless of early or late influenza vaccinations are likely to prevent the occurrence of AMI, and whether the vaccine strains match and not match, influenza vaccinations all significantly reduce the risk of AMI. This research could be used as medical advice to convince routine influenza vaccination for those over 65 years old.

致謝 i
中文摘要 ii
Abstract iii
目次 iv
表目次 vi
圖目次 vii
第一章 文獻探討 1
第一節 流行性感冒 1
第二節 流感高危險族群、流感併發症 2
第三節 流行性感冒疫苗 3
第四節 臺灣流感流行現況 5
第五節 急性心肌梗塞 6
第六節 流感、流感疫苗與急性心肌梗塞 8
第七節 全民健康保險研究資料庫 11
第八節 研究動機與方向 12
第二章 材料與方法 14
第一節 資料來源與研究族群 14
第二節 研究時間 14
第三節 研究變項定義 14
第四節 資料整理與統計分析 18
第三章 研究結果 23
第一節 第一部分研究結果 23
第二節 第二部分 2004-2005 年流感季研究結果 28
第三節 第二部分 2008-2009 年流感季研究結果 31
第四章 討論 34
第一節 基本資料分析 34
第二節 慢性病探討 35
第三節 初次急性心肌梗塞辨識 35
第四節 施打流感疫苗時期對急性心肌梗塞的影響 36
第五節 早期及晚期施打疫苗對急性心肌梗塞的影響 36
第六節 流感疫苗吻合度對急性心肌梗塞的影響 37
第七節 研究限制 37
第八節 結論 38
第五章 參考文獻 65

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網路資源
World Health Organization:WHO http://www.who.int/en/
衛生福利部疾病管制署 http://www.cdc.gov.tw/
全民健康保險研究資料庫 http://nhird.nhri.org.tw/
內政部統計處 http://www.moi.gov.tw/stat/city02.aspx
行政院主計處 http://www.dgbas.gov.tw/mp.asp?mp=1