臺灣博碩士論文加值系統

退化性關節炎(osteoarthritis, OA)是一個盛行率高且容易引起關節疼痛、僵硬及行動不良甚至失能的重要公共衛生問題。過去的文獻中雖已證實職業性負重是引起退化性關節炎的原因之一，但是卻一直缺乏兩者之間明顯的劑量效應關係。本研究的目的在探討職業性負重與退化性膝關節炎間的相關性，並且希望能藉由量化的職業暴露指標來找出兩者之間的劑量效應關係。
本研究選取1961年至2002年間曾經在台南縣七股及北門鹽場工作過的鹽工作為研究對象，以問卷收集研究對象的職業史及膝蓋關節的症狀。參與研究者同時被安排接受雙側膝關節的X光攝影，X光片由放射科醫師以Kellgren/Lawrence scale來分級。退化性膝關節炎的診斷是由骨科醫師依照美國風濕症醫學會的標準來做確認。退化性膝關節炎患者的疾病嚴重程度則是經由Lequesne’s Index來評估。職業暴露的量化指標：負重行走總量(TWW)，是以問卷中的工作資料來計算。
結果在所有316個登錄的鹽工中，有231個(73.1%)完成研究。男性鹽工退化性膝關節炎的盛行率為55.6%，女性鹽工則是67.9%。將鹽工職業生涯的TWW以四分位法分組，並以最低四分位組為研究對照組，結果發現較高負重四分位組的鹽工比起最低四分位組的鹽工更容易發生退化性膝關節炎。勝算比(ORs)在男性鹽工的第三、第二及最高TWW四分位組分別為：1.77, 14.09,及85.99；女性鹽工為2.48, 4.25,及50.06。使用多變項迴歸分析並調整年齡、體質指數、抽煙況狀後，顯示鹽工的TWW與退化性膝關節炎的危險性之間呈明顯劑量效應關係。除此之外，疾病嚴重度(Lequesne’s Index)與TWW之間也有明顯劑量效應關係。因此本研究認為有強烈證據支持職業性負重為退化性膝關節炎的致病危險因子之一。

Osteoarthritis(OA) is a major public health problem due to its high prevalence, costs, and levels of pain and disability. Occupational physical demand is generally considered to be a contributing risk of osteoarthritis, but clear dose-response relationship has been relatively lacking in previous studies. The purpose of this study was to assess the risk of knee OA associated with occupational workload in salt workers in Southern Taiwan.
The registered works of two Salt Society, Chigu and Beimen in Tainan Country between 1961 and 2002 were recruited. Occupational histories and symptoms of knee were collected by questionnaires. Subjects were also asked to receive knee radiographic testing, and graded by Kellgren/Lawrence scale. Symptomatic knee OA was defined as at least one knee fulfilling the American College of Rheumatology criteria. The quantified occupational exposure, total walking time with weight bearing (TWW), was computed from the questionnaire. The subjects were categorized into four groups, according to their cumulative TWW. The severity of symptomatic knee OA was obtained by scoring of Lequesne’s Index. Subjects were categorized into four groups, according to their cumulative TWW. Data were analyzed by conditional logistic regression.
Of the 316 registered salt workers, 231 completed the study (88 males, 143 females). The prevalence of symptomatic knee OA was 55.6% in men and 67.9% in women. Weight excess (BMI ≧ 25.0 kg/M2 or ABMI ≧25.0 kg/M2) was not a risk factor for developing knee OA in this study. After adjustment for average body mass index (ABMI), age, and the status of smoking, risk was elevated in subjects who reported career TWW ≧ 15.4•105 kg•hr. in men, and career TWW ≧ 8.5•105 kg•hr. in women. There was strong dose-response relationship was found between risk of the knee OA and the cumulative TWW. We also found significant positive correlation between TWW and the severity of symptomatic knee OA. In this first attempt to quantify the long term occupational exposure, we conclude that, there was strong evidence for an occupational hazard of knee OA resulting from heavy physical workload.

ABSTRACT IN CHINESE …………………………………………2
ABSTRACT IN ENGLISH …………………………………………3
ACKNOWLEDGE …………………………………………………4
INDEX OF APPENDIX ……………………………………………7
INDEX OF TABLE …………………………………………………8
INDEX OF FIGURE ……………….………………………………9

CHAPTER ONE PREFACE ………………………………10
Section One: Background …………………………………………10
Section Two: Purpose ………………………………………………10
Section Three: Significance …………………………………………11
CHAPTER TWO LITERATURE REVIEW ………………12
Section One: Epidemiology of osteoarthritis ………………………12
Section Two: Diagnosis of knee osteoarthritis ………………………12
Section Three: Functional severity of knee osteoarthritis ……………13
Section Four: Risk factors associated with knee osteoarthritis ………13
Section Five: Occupational factors and knee osteoarthritis …………14
CHAPTER THREE MATERIALS AND METHODS ……15
Section One: Subjects ……………………………………………15
Section Two: Body mass index (BMI) and averaged body mass index (ABMI)……16
Section Three: Total walking time with weight bearing (TWW) ………17
Section Four: Statistics ……………………………………………17
CHAPTER FOUR RESULTS ………………………………18
Section One: Demographic data ……………………………………18
Section TWO: Relationship between body mass index (BMI) and knee OA …18
Section Three: Relationship between averaged body mass index
(ABMI) and knee OA ………………………………19
Section Four: Association of the knee radiographic change and
the score of Lequesne’s index …………………………19
Section Five: Association of cumulative TWW and knee OA …………19
Section Sex: Association of cumulative TWW and functional
severity of knee osteoarthritis …………………………20
CHAPTER FIVE DISCUSSIONS …………………………21
CHAPTER SEX CONCLUSION ……………………………24
REFERENCES ……………………………………………………25
APPENDIX ………………………………………………………28
TABLES …………………………………………………………31
FIGURES ………………………………………………………38

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