臺灣博碩士論文加值系統

研究目的: 以「生物心理社會模式」，探討發病原因不明的慢性蕁麻疹(chronic idiopathic urticaria)與壓力間的潛在因果關係。
研究方法: 以民國88年10月到89年2月，台大醫院皮膚部門診所有發病原因不明的慢性蕁麻疹患者 (N=75) 為病例組，同時以該段時間所有門診的皮膚黴菌感染病患 (dermatological fungus infection，N=133) 為對照組。訪員以結構式問卷測量患者此次皮膚病發作或突然惡化之前半年內之「生活事件數」、 「事件主觀認知影響大小」、 「(生理)症狀總頻度」、 「心理症狀」、 「失眠嚴重度」、 「生活不規律度」、 「家庭支持」、 「自我功能」、 「正向因應程度」、 「負向因應程度」。 以因素分析、 Mann-Whitney 檢定、T 檢定、Spearman Rank相關分析、多變項迴歸分析、群集分析、徑路分析等方法進行統計分析。
研究結果: 病例組在「發病前便年內重大生活事件件數」、「事件造成主觀認知影響大小」、「生理症狀總頻度」、「失眠嚴重度」、「心理症狀」、「負向因應」上都顯著高於對照組； 在「家庭支持度」、「正向因應」則顯著低於對照組。 由相關分析發現，發生生活事件越多、事件主觀認知影響愈大、負向因應程度愈高、失眠愈嚴重、生活愈不規律，則個人的生理、心理症狀的發生頻率增加，也愈容易導致蕁麻疹的發生或惡化。 而家庭支持、正向因應、自我功能、男性性別、年齡愈大則是對壓力作用的修緩因子，可減低壓力所造成的負面生理心理反應與蕁麻疹的發生。 多變項迴歸分析發現，影響「症狀總頻度」的主要變項為失眠、生活事件數、及負向因應；影響「心理症狀數」的主要變項是失眠、家庭支持、負向因應、及生活事件數； 由此項迴歸分析發現，「失眠」是非常重要的影響因子，大約可解釋模式總變異量的80%。
以集群分析將所有個體分成高、中、低三種風險組態的集群，發現高風險集群，其組成特徵為: 1.半年內生活事件數最多 2.症狀總頻度最高 3.失眠最嚴重 4.家庭支持度最低 5.負向因應傾向最大 6.平均年齡最輕； 而高風險組得蕁麻疹的勝算比是低風險組的8.9倍 (95% 信賴區間 3.1 to 25.9)。
結論: 以生物心理社會模式分析發現，慢性蕁麻疹發病或惡化可能與生活壓力有潛在因果關係存在；而失眠是相當重要的中介影響變項。以集群分析找出得病的高風險暴露組態，再配合徑路分析或結構方程模式的方法檢驗組態各變項間的影響模式，可能是未來流行病學方法研究壓力健康效應的新模式。

Objectives─ To assess possible causal association between chronic idiopathic urticaria and stress in biopsychosocial model.
Methods─ 75 patients cases with chronic idiopathic urticaria and 133 patients controls with dermatological fungal infection were enrolled in this study. Both groups were assessed with structured questionnaire recalling life events, subjective impact of such events, somatic symptoms, psychological complaints, insomnia, irregularity of daily life, family support, ego-function, positive coping, and negative coping. The scoring of each questionnaire were based on factor analysis and item analysis.
Mann-Whitney U test and T-test were applied for comparing the differnce in each dimension between cases and controls. Spearmnan rank correlation was applied to determine the association between each test. Multiple regression analysis, factor analysis and cluster analysis were also employed in this study. Path analysis was used to figure out the causal relationships between each major determinants in the high risk pattern.
Results─ Cases reported significantly more life events and perceived a higher subjective impact of events than controls in the past half year (p=0.00). The cases also experienced more somatic symptoms (p=0.02), psychological symptoms (p=0.03), insomnia (p=0.01), irregularity of daily life (p=0.26),and negative coping (p=0.01), whereas perceived a lower family support (p=0.00) and a lower positive coping (p=0.04) than controls. Cluster analysis was used to find out a risk pattern and showed that the high risk group of being cases tended to have more life events, higher subjective impact of events, more somatic symptoms, more severe insomnia, lower family support, more obviously negative coping tendency, and younger age. The odds ratio of high risk group comparing low risk group was 8.9 (95% CI 3.1 to 25.9). The result of path analysis suggests a causal association between stress of life events and development of somatic symptons and insomnia which predispose the onset of chronic idiopathic urticaria, while ego-function, coping strategy and family support seemed to counteract such a tendency.
Conclusion─ Occurrence of chronic idiopathic urticaria seems consistent with the biopsychosocial model of stress, and the combination of cluster analysis and path analysis could be a new way in future epidemiological research to tackle the issue.

第一章 緒論
第一節「壓力」(stress)的基本概念 ………………………………1
第二節 蕁麻疹簡介……………………………………………………7
第二章 文獻回顧……………………………………………….13
第三章 研究方法
第一節 研究架構………………………………………………………16
第二節 研究假設………………………………………………………18
第三節 研究設計………………………………………………………20
第四節 研究步驟………………………………………………………21
第五節 問卷測量……………………………………………………..22
第六節 血清學檢查…………………………………………………..28
第七節 統計分析……………………………………………………..29
第四章 研究結果………………………………………………..30
第五章 討論與結論………………………………………………49
參考文獻……………………………………………………..……55
附錄

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