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研究生:鐘威昇
研究生(外文):Wei-Sheng Chung
論文名稱:國中氣喘學童的預後研究
論文名稱(外文):The prognosis of Bronchial Asthma from Middle School-aged Childhood to Adulthood
指導教授:郭浩然郭浩然引用關係蘇慧貞蘇慧貞引用關係
指導教授(外文):How-Ran GuoHuey-Jen Su
學位類別:碩士
校院名稱:國立成功大學
系所名稱:環境醫學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:86
中文關鍵詞:不活動性氣喘活動性氣喘過敏性鼻炎喘鳴
外文關鍵詞:inactive asthmawheezeallergic rhinitisactive asthma
相關次數:
  • 被引用被引用:5
  • 點閱點閱:493
  • 評分評分:
  • 下載下載:98
  • 收藏至我的研究室書目清單書目收藏:6
雖然治療氣喘的藥物有了改善,但是證據顯示世界各國氣喘的盛行率及罹病率仍在增加中。台灣是氣喘高盛行率的地方,國小學童氣喘的盛行率甚至比二十年前增加八倍之多。而學童氣喘的嚴重度是不相同的,輕者只有在特殊情況才發生;重者有每天出現喘鳴聲及持續性肺功能異常。歐美等國家對氣喘預後的追蹤研究陸續有多篇報導,基於研究族群不同其結果也不一樣。東方國家鮮少有這方面報告;台灣地處亞熱帶地區,氣候屬高溫潮溼,適合黴菌及塵�E生長,是否影響氣喘預後,國內對此研究仍缺乏。本研究的目地是觀察本國國中氣喘學童進入成人後的氣喘狀況,來試著了解本國氣喘學童的預後,並探討可能影響預後之相關因子。
704位國中學童在1995年嘉義縣中等學校學童氣喘盛行率的調查中,報告在過去的12個月曾經發生喘鳴聲併呼吸困難者,目前這些學童已依次進入成年期。369位個案完成電話追蹤,包括問卷調查關於最近十二個月是否仍有發生呼吸困難併喘鳴聲及理學檢查的追蹤。我們所追蹤的個案與原來的母群體在性別上(p=0.61)、平均年齡(p=0.28)及經醫師診斷氣喘比例(p=0.50)並沒有統計學上的差異。他們的平均年齡為二十歲,其中男生為211位和女生158位。在我們追蹤的這些學童裡,119(32%)位仍然有氣喘症狀稱為活動性氣喘,而250(68%)位個案至少有一年不曾有症狀發生稱為不活動性氣喘,其中大部分(60%)則是有五年以上不曾發作。
在369位電話追蹤個案中,110位﹙50位活動性氣喘和60位不活動性氣喘﹚回院接受詳細問卷調查、醫師理學檢查、肺功能檢測、及免疫球蛋白E的測量。在探討影響氣喘預後的因子中,我們的研究顯示居家牆壁發霉數大於一面者﹙OR=5.0﹚在居家環境因子中較會使國中氣喘學童持續至成人﹙p=0.04﹚。而在過敏家族史及個人體質方面以氣喘家族史﹙OR=2.9﹚及氣喘個案併有過敏性鼻炎者﹙OR=3.4﹚影響國中氣喘學童持續至成人較有顯著相關性﹙p=0.02 vs p=0.003 respectively﹚。
本研究結果顯示在這平均二十歲的氣喘個案中,大約三分之二的國中氣喘學童已經不再出現氣喘症狀。影響國中氣喘是否持續至成人的因子,環境與基因均扮演重要角色。特別是居家環境牆壁發霉數大於一面者在台灣這高潮溼的亞熱帶地區是一重要的公共衛生議題,尤其對氣喘學童。未來我們也將進一步研究牆壁發霉數與黴菌量及塵�E數的關係及其影響氣喘預後的機轉。
There is sufficient evidence that asthma prevalence and morbidity are on the rise despite of improved treatment regimen throughout the world. High prevalence rate of asthma in Taiwan, almost an 8-times increase of prevalence, was observed for primary school children compared with survey of 20 years ago. Meanwhile, childhood asthma is heterogeneous in severity. There are subjects who have daily wheezing and continuous pulmonary function abnormalities, and, yet, some subjects get symptoms infrequently. There are several reports on the prognosis of asthma in the western countries with varied results. Limited information is available for populations in the eastern half of the globe. Taiwan is located at subtropical region with high humility climate, which is suitable for growth of dust mites and fungi. There was void of report about the prognosis of childhood asthmatics in Taiwan. The aim of the study is to investigate the nature of bronchial asthma from middle school-aged childhood to adulthood and risk factors influencing the nature.
704 subjects had ever reported wheeze with difficult breathing in the past 12 months from a questionnaire survey of middle-school students at Chiayi County in 1995. Of these, 369 subjects received questionnaires and physical examination 7 years later. There was no statistical significance of our total subjects in gender (p=0.61), mean age (p=0.28), and physician-diagnosed asthma (p=0.5) compared with the original study subjects. 211 male and 158 female, with mean age of 20 have been interviewed to observe their asthma status in the past 12 months. Among them, 119 subjects (32%) were considered to have asthma persistence into adulthood, and 250 subjects (68%) had no more experienced asthma symptoms at least one year. A majority (60%) of those with inactive asthma were symptoms free for more than 5 years.
Among these 369 subjects contacted, 110 subjects (50 active asthmatics and 60 inactive asthmatics) came to a hospital visit with detail questionnaire, physical examination, pulmonary function test, and Immunoglobulin E check. Among all environmental- and hereditary- related factors evaluated, mold growth more than one wall of the residential walls was associated with an odds ratio of 5.0 and statistical significance (p=0.04) associated for presistence of asthma into adulthood. Familial history of asthma had an odds ratio of 2.9, and concomitant allergic rhinitis had an odds ratio of 3.4; both were observed to be significant risk factors (p=0.02 vs 0.003 respectively) for persistence of asthma into adulthood.
The asthma symptoms were no longer present in about two-thirds of the asthma subjects in this 20-year-old age group. Environmental and genetic factors played vital roles on the prognosis of middle-school aged asthmatics. Mold growth on the residential walls was an important pulblic health issue in Taiwan, especially for childhood asthmatics. Mold growth on the walls associated with the amounts of fungi and dust mites, and its influnce on the prognosis of asthma merit further investigation.
中文摘要…..…………………………..…………….…………………...1
英文摘要………………………………..………….….………………….3
致謝………………………………………..……….…...………………...5
目錄……………………………………………..…….……...……………6
表目錄………………………….……………..….…….………..………..9
圖目錄……………………..…..……………………….…………………10
第一章 緒論………………...…………………………….…………….11
1-1 前言……....……………………………………………………11
1-2 研究目的………………..…………………………………….13
1-3 研究的重要性………………..………………………………13
第二章 文獻回顧…………………………….………………..………..14
2-1 氣喘的定義……………………………………………………14
2-2 氣喘的分類.………..……………….……..…………………14
2-3 氣喘的盛行率及對社會造成的衝擊……..…………..……16
2-4 氣喘的危險因子……………………………………………...17
2-5 氣喘的惡化因子……………………………..……………….19
2-6 學童氣喘的預後及其可能的影響因子……………………20
2-7 氣喘與肺功能…………………………………………………22
2-8 氣喘與免疫球蛋白E…………………………………………23
第三章 材料與方法……………………………………………….……24
3-1 研究材料………………………………………………………24
3-1-1 研究個案的收集……………………………………………..24
3-1-2 研究方法及研究類型……………………………………..25
3-1-3 問卷調查……………………………………………………25
3-1-4 肺功能的檢測………………………………………………25
3-1-5 血清中免疫球蛋白E濃度的測量………………...……26
3-2 研究方法…………………………………………...………..26
3-2-1 研究團隊的訓練………………………………………….27
3-2-2 統計應用軟體………………………………………….…27
3-2-3 統計分析方法..……………………………………………27
第四章 研究結果………………………………………………………29
4-1 研究個案……….…………..………………………………29
4-2 探討影響國中氣喘學童持續至成年人的因子…..…….30
4-3 國中氣喘學童持續至成年人與肺功能的關係………….31
第五章 討論……………………………………………………………33
5-1 研究個案分析……………………………………………….33
5-2 國中氣喘學童成為成人後的狀況…………………….….33
5-3 影響國中氣喘學童持續至成人的相關因素…………….34
5-3-1 性別、發作年齡、父母親的教育程度及規律運動與國中氣喘學童是否持續至成年人的關係..………………34
5-3-2 抽煙、點蚊香、燒香拜拜、居家牆壁發霉數等環境與國中氣喘學童是否持續至成年人的關係…………….35
5-3-3 過敏性家族史與國中氣喘學童是否持續至成年人的關係………………………………………………………….35
5-3-4 過敏性體質與國中氣喘學童是否持續至成年人的關係………………………………………………………….36
5-3-5 免疫球蛋白E與國中氣喘學童是否持續至成年人的關係…………………………………………………………36
5-4 國中氣喘學童持續至成年人與肺功能的關係………….36
5-5研究限制………………………………………………………37
第六章 結論與建議……………………………………………………38
6-1 結論…………………………………………………………..38
6-2 建議…………………………………………………………..38
參考文獻…………………………………………………………………39
附表………………………………………………………………………51
附圖………………………………………………………………………63
附錄………………………………………………………………………66
附錄一 電話訪視簡短問卷……………………………………….….67
附錄二 詳細問卷調查………………………………………………..68
附錄三 Codebook………………………………………………………74
附錄四 同意書…………………………………………………………86

表目錄
表一 研究個案與母群體依性別、醫師診斷及年齡的比較
表二 臨床症狀緩解(稱不活動性或潛伏性氣喘)氣喘案的分析
表三 回醫院檢查的個案與研究個案的比較
表四 110位研究個案特質、過敏家族史、及居家環境的盛行率
表五 性別、氣喘發作年齡、父母教育程度及規律運動與國中氣喘童是否持續至成年人的關係
表六 抽煙、點蚊香、燒香拜拜與國中氣喘學童是否持至成年人的關係
表七 過敏性家族史與國中氣喘學童是否持續至成年人關係
表八 過敏性體質與國中氣喘學童是否持續至成年人的係
表九 免疫球蛋白E與國中氣喘學童是否持續至成年人的關係
表十 國中氣喘學童肺功能中第一秒用力吐氣容積預期值(FEV1% of predicted)與氣喘是否持續至成年人的關係
表十一 國中氣喘學童持續至成年人與第一秒用力吐氣容積(FEV1)及第一秒用力吐氣容積(FEV1%)預期值的關係

圖目錄
圖一 肺功能操作的程序步驟
圖二 研究個案收集結果
圖三 病例組與個案組回醫院檢查的個案分析
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