臺灣博碩士論文加值系統

背景―糖尿病是二十一世紀全世界最重要的公共衛生課題之一，而其衍申的併發症以及社會成本更是不容忽視，早期的診斷及預防皆有助於疾病的控制及改善。
方法―本研究針對血糖異常的高危險族群：家族史的遺傳以及環境的影響，兩者來加以分析比較，收集有糖尿病家族史的成員共223人，無糖尿病家族史的成員共1199人，進行問卷及生化檢驗；兩組族群經由性別、年齡?b2歲、籍貫以case:control=1:3之方式配對後，再依家族史的親疏：直系(父親、母親、父母親)、旁係、姻親以及是否與糖尿病人同住分析，並且再對45歲以上及以下者，加以分析比較其對血糖異常的影響。
結果―發現有糖尿病家族史的人比無糖尿病家族史的人更容易罹患血糖異常，有糖尿病家族史群體血糖異常的相對危險性，是無糖尿病家族史的3.5倍(95% CI=2.02-6.07, p=0.000)；而與糖尿病人同住者，又比沒有與糖尿病人同住者，罹患血糖異常的危險性更高，有家族史沒有與糖尿病人同住者，其血糖異常的比例，較沒有家族史又沒有與糖尿病人同住者要高，分別為25.3% 比13.7%，其相對危險性較無家族史無與糖尿病人同住者，高出3.17倍(95% CI=1.70-5.91, p=0.000)；而有家族史又與糖尿病人同住者，其血糖異常的比例又較有家族史沒有與糖尿病人同住者高，為38.5%；其相對危險性較無家族史無與糖尿病人同住者更高出5.59倍(95% CI=2.57-12.16, p=0.000) ，而 45歲以上的個案，有家族史沒有同住、有家族史有同住，其血糖異常的風險，更是較沒有家族史沒有與糖尿病人同住者，高出4.21倍(95% CI=2.16-8.22, p=0.001)，以及8.28倍(95% CI=3.40-20.15, p=0.000)；而在家族史當中，又以直系及姻親，血糖異常的影響最大，高於旁系血親，直系組別血糖異常的相對危險性，是無糖尿病家族史的4.58倍(95% CI=2.57-8.14, p=0.000)。
結論―由此可見，糖尿病家族史的遺傳以及生活環境習慣的相同，的確是造成血糖異常的主要原因，與糖尿病人血緣關係越密切，則血糖越容易異常，尤其年齡越大危險性越高。

Background ― Diabetes is one of the most important public health topics in the 21st century. Early diagnosis and prevention are helpful to control and improve the disease.We aimed to evaluate the risks of diabetes among subjects with or without diabetes family history and subjects who live with or without diabetes patients. We hope to develop relationships between diabetes and it’s risk fators such as genetic or environment .
Methods ―We collected 223 volunteers subjects with diabetes family history from family members of diabetes patients presented at policlinic or a medical center and a district hospital. We also selected 1199 subjects who answered no diabetes family history known from a data bank of health survey in a community near by the two hospitals.Subjects with diabetes family history was matched by the ratio of 1:3 with sex, age: +-2 years old.The OR of diabetes for risk factors of lineal relations ( father,mother,father and mother),were seel in subjects of case and control groups.
Results ― After compared and analyzed the different groups, the study found out that the person who has diabetes family history has better chance than the non- diabetes family history person to suffer from the trouble blood sugar. The risk of having blood sugar anomaly for the person who has the diabetes family history is 3.5 times higher than the person who has non- diabetes family history(95% CI=2.02-6.07, p=0.000). Also the person who lives with the diabetes family history people has better chance to suffer from the blood sugar diseases than the person who doesn’t live with the diabetes family history people.
Compare between people who live with and without diabetes patients, people who live with diabetes patients has high chance of getting diabetes. If two people both live without diabetes patient, one come from diabetes history family and the other from non-diabetes family. The ratio of getting diabetes is 25.3% to 13.7%. The risk of blood sugar anomaly is 3.17 times (95% CI=1.70-5.91, p=0.000) higher than the person who has non- diabetes family history and not living with diabetes patient. On the other hand, a person who comes from a diabetes history family and lives with a diabetes patient has 38.5% more chance of having blood sugar anomaly than a person who come form a diabetes history family and does not live with a diabetes patient. In addition, the risk of blood sugar anomaly is 5.59 times higher than a person who has non- diabetes family history and does not lives with diabetes patient. (95% CI=2.57-12.16, p=0.000). In the group age 45 and above, the risk of blood sugar anomaly is 4.21 times higher for a person who has diabetes family history but doesn’t live with diabetes patients than a person from a non-diabetes history family and no diabetes patient in the house hood. (95% CI=2.16-8.22, p=0.001). In addition it is 8.28 times higher than a person who has diabetes family history and lives with a diabetes patient (95% CI=3.40-20.15, p=0.000). On the other hand, lineal relatives affect the chance of getting diabetes the most then collateral relatives and in-law relatives. The risk of blood sugar anomaly in lineal group is 4.21 times higher than a person who has not have diabetes family history (95% CI=2.57-8.14, p=0.000).
Conclusions ―In the current study,we found family history of diabetes and the similarity of living condition or habits were important risk factors of blood sugar anomaly. By having a closer blood relationship to the diabetes patient will higher the chance to get diabetes and blood sugar exceptionally, especially in the older people. For early prevention of diabetes and control of blood sugar population with these two characteristics should be targeted as priority of prevention measures.

中文摘要------------------------------------- 5
英文摘要------------------------------------- 7
第一章 緒論
第一節 研究背景與動機------------------- 9
第二節 研究目的------------------------- 12
第二章 文獻探討
第一節 血糖異常之探討--------------------14
第二節 糖尿病防治的重要性----------------18
第三節 家族史及環境對血糖異常之影響------23
第三章 材料與方法
第一節 研究設計 -------------------------26
第二節 樣本的選取------------------------31
第三節 研究工具--------------------------33
第四節 名詞解釋--------------------------34
第五節 統計分析--------------------------36
第四章 結果
第一節 有、無糖尿病家族史之比較----------38
第二節 有糖尿病家族史之直系、旁系、姻親以及無糖尿病家族史之比較 ----------------- 40
第三節 有糖尿病家族史之直系(父親、母親、父母親)、旁系、姻親以及無糖尿病家族史之比較---------- 42
第四節 有、無糖尿病家族史與是否與糖尿病人同住血糖異常之比較 ---------- 44
第五章 討論與結論
第一節 家族史與血糖異常的關係 ---------- 45
第二節 生活環境與血糖異常的關係 ---------- 50
第三節 遺傳與環境對血糖異常的影響----------52
第六章 參考文獻---------------------------------57
附表--------------------------------------------62

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