臺灣博碩士論文加值系統

根據世界衛生組織（WHO）報告指出全球已有三分之一的人口感染結核桿菌，且肺結核為罹病人數最多與死亡人數最多的法定傳染病；而醫療保健人員因職業關係常需接觸病人而成為結核桿菌感染的高危險群。因此，瞭解醫療保健人員（Healthcare workers）結核桿菌感染的盛行情形與相關危險因子，實屬刻不容緩之事。
本研究為一橫斷性研究（cross-sectional study），研究對象為某醫院的醫療保健人員，依其暴露於結核桿菌之危險性分成高暴露組、中暴露組與低暴露組。此外，在通過該院人體試驗委員會後，亦針對願意提供血液檢體的研究對象採集血液樣本，並偵測血液中的interferon gamma（IFN-γ）濃度以得知該受測者是否遭受結核桿菌感染。最後以多變項邏輯式迴歸（Multiple Logistic Regression）來探討危險因子與結核桿菌感染之相關。
本研究結果發現該院醫療保健人員結核桿菌感染盛行率為11.7％（36/307）。在校正干擾因素後發現，工作年資、輪班情形及是否接種過卡介苗與結核桿菌感染有關。工作年資每增加一年其感染結核桿菌的危險性將增加7.9％（OR=1.079, 95％CI=1.029-1.131）；有輪班的人感染結核桿菌的危險性是沒有輪班的人的2.7倍（OR=2.696, 95％CI=1.018-7.142）；沒有施打卡介苗的人其感染結核桿菌的危險性是有打卡介苗的人的7.8倍（OR=7.822, 95％CI=1.787-34.231）。此外，在36位QFT Gold In-Tube結核桿菌感染血液檢體結果陽性者中，沒有人於問卷中自述曾經罹患過肺結核，因此該36位結核桿菌感染者是在不知不覺中感染了結核桿菌，其感染原因是否因職業而感染，需進一步探討方能得知。
據此研究結果，QFT Gold In-Tube血液檢驗結果為陽性者，建議至門診尋求醫師診斷，若為肺結核病患者則應給予治療；若不是，則建議其平時注意個人衛生清潔習慣及做好防護措施且應避免輪班工作情形，以減少其發展成肺結核病的機會。另外，建議針對新進員工實施結核桿菌感染的篩檢，並將此篩檢項目列為員工年度體檢，以降低醫療保健人員結核桿菌感染的危險性。

According to the WHO report, nearly one-third of the global population has been infected with Mycobacterium tuberculosis (TB). TB was the top one of mortality and morbidity in infectious diseases, respectively. TB is an occupational hazard to the healthcare workers; we thus conducted a cross-sectional study to assess the TB infection prevalence and risk factors among healthcare workers in Taiwan.
Study subjects were divided into three groups: high risk, middle risk, and low risk groups. Demographic data, work history, and disease history were collected by using a self-conducted structured questionnaire. Volunteer blood was also collected for diagnosis of TB infection by using QuantiFERON-TB Gold In-Tube assay (QFT-G IT). Multiple logistic regression were used to assess the association of interests, as well to adjust for potential confounders.
The prevalence of TB infection was 11.7% (36/307). After adjusting for confounders, we found that work year, shift, and BCG vaccination were associated with TB infection. With an increasing in one year of work, the risk of TB infection was increased 7.9%（OR=1.079, 95%CI=1.029-1.131）. Workers with a shift job had 2.7-times（OR=2.696, 95%CI=1.018-7.142） higher risk of having a TB infection than none. Workers who did not have a BCG vaccination had 7.8-times higher risk of having a TB infection than that of BCG workers（OR=7.822, 95%CI=1.787-34.231）. However, all of the 36 positive workers did not know themselves had a TB infection. Further study should be conducted to identify occupational or non-occupational infection.
We referred these 36 positive workers to a clinic for further diagnosis and treatment, and suggested more self protection and few shift work. In addition, a QFT-G IT test was recommended for new healthcare workers.

正文目錄
表目錄
圖目錄
附錄目錄
中文摘要
英文摘要
第一章 前言
第一節 研究背景
第二節 文獻探討
第三節 研究目的與假設
第二章 研究方法
第一節 研究對象
第二節 研究設計
第三節 研究架構
第四節 研究變項之操作型定義
第五節 研究工具與研究工具之信效度
第六節 資料收集方法與步驟
第七節 統計方法
第三章 結果
第一節 研究對象之人口學變項
第二節 研究對象之暴露情形
第三節 研究對象之問卷自我檢測分佈情形
第四節 醫療保健人員結核桿菌感染之盛行情形
第五節 肺結核疾病史與QFT Gold In-Tube結核桿菌感染血液檢體結果比較
第六節 結核桿菌感染之多變項分析
第七節 影響醫療保健人員結核桿菌感染之危險因素
第四章 討論
第一節 醫療保健人員結核桿菌感染盛行率之比較
第二節 肺結核疾病史與QFT Gold In-Tube結核桿菌感染血液檢體結果比較
第三節 探討醫療保健人員結核桿菌感染之危險因素
第五章 結論與建議
參考文獻
附錄一 結核菌素皮膚試驗陽性判斷標準
附錄二 QuantiFERON-TB Gold In-Tube test結果判斷標準
附錄三 潛在性肺結核感染預防性治療之標準

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