臺灣博碩士論文加值系統

盡管醫藥科技不斷進步，仍有許多癌症病人面臨死亡，許多的預後因子如臨床症狀、身體功能狀況、生活品質、癌症種類及部位的轉移等，均是用來預測癌症病人的存活期。過量的細胞激素製造會造成免疫-發炎疾病和死亡，有些可能會促進腫瘤生長而影響存活期（Caruso et al., 2004）。復發性乳癌病人血清中IL-8/CXCL8升高其復發後的存活期顯著短於IL-8/CXCL8正常的人（Benoy et al., 2004）。白血病和淋巴瘤血清中TNF-a濃度升高已經被建議為不利的預後因子（Torben, Lotta, & Jonas, 2005）。因此本研究主要探討癌症病人血清細胞激素濃度與存活期之相關性。研究設計採前瞻性研究設計，研究工具為KPS功能狀況量表、台灣版安德森症狀量表及測量細胞激素，以立意取樣於台北地區兩家區域醫院進行收案，追蹤其存活時間，共收案226名癌症病人，失聯74位，最後進入分析共152人。以描述性統計、Kaplan-Merier survival analysis、Cox regression、Mann-Whitney test 統計、皮爾森相關及迴歸分析進行資料分析。
研究結果顯示：疾病轉移與否、KPS、IL-8/CXL8、可以用來預測存活期。本研究結果顯示除了臨床症狀、身體功能、癌症種類、癌症轉移等預測因子外，也藉由血清細胞激素之濃度來預測癌症病人的存活期，於臨床上可幫助醫謢人員作為照護依據，於家屬層面可提供家屬及病人利用剩下時間完成心願及準備。

Although medical science and technology is progressing constantly, a lot of cancer patients face the death. A lot of prognosis factor was used for predicting survival time in cancer patients, such as clinical symptoms, Karnofsky Performance Status, quality of the life, cancer type and, stage of disease etc. Excessive produce of cytokines can promote the tumor to grow and may influence survival time (Caruso, et al., 2004). The purpose of this study is to describe the relationship between levels of serum cytokines and survival in cancer patients. This study is a perspective design. This study tools is include demographic form, Karnofsky Performance Status, M. D. Anderson Symptom Inventory-Taiwan Form, ELISA. 152 subjects with cancer were recruited by convenience sampling at two regional of teaching hospitals in Taipei. Data were analyzed using descriptive statistics, Kaplan-Merier survival analysis, Cox regression, Mann-Whitney test statistics, Pearson correlation, and regression statistics.
The results of study showed stage of disease, KPS, and IL-8/CXL8 could be used for predicting survival time. The result not only showed except clinical symptom, performance status, cancer type, stage of disease prognosis factor, but also serum cytokines levels could predicted survival time in cancer patient. Results from this study can provide decision making of clinical value to patient, family, and health care provider in assisting with the relative and patient preparing for planning a quality end of life.

目 錄
頁數
致 謝……………………………………………………………… Ⅰ
中文摘要……………………………………………………………… Ⅲ
英文摘要……………………………………………………………… Ⅴ
目 錄……………………………………………………………… Ⅵ
圖表目次……………………………………………………………… Ⅸ
第一章　緒論………………………………………………………… 1
第一節　研究動機……………………………………………… 1
第二節　研究重要性…………………………………………… 3
第三節　研究目的……………………………………………… 5
第二章　文獻查証…………………………………………………… 6
第一節　細胞激素……………………………………………… 6
第二節　影響存活期之因素…………………………………… 10
第三節　細胞激素與存活期相關之研究………………… 13
第三章　研究方法…………………………………………………… 15
第一節　名詞解釋……………………………………………… 15
第二節　研究設計……………………………………………… 16
第三節　研究對象及場所……………………………………… 17
第四節　研究工具……………………………………………… 18
第五節　研究過程……………………………………………… 24
第六節　資料分析……………………………………………… 25
第四章　研究結果…………………………………………………… 27
第一節　整體個案之存活分析………………………………… 28
第二節　死亡個案之症狀分佈 …………………………… 48
第三節　死亡個案基本屬性與存活期之分析………………… 50
第四節　年齡、細胞激素、症狀、身體功能狀態與存活期之
相關…………………………………………………… 53
第五節 以細胞激素預測存活期之迴歸分析………………… 57
第五章　討論………………………………………………………… 65
第一節　基本屬性與存活期之關係…………………………… 66
第二節　症狀與存活期關係…………………………………… 68
第三節　KPS身體功能狀態與存活期之關係………………… 70
第四節　細胞激素與存活期之關係…………………………… 72
第六章　結論與建議………………………………………………… 75
第一節　結論…………………………………………………… 75
第二節　研究限制……………………………………………… 77
第三節　建議…………………………………………………… 79
參考資料……………………………………………………………… 82
中文部分………………………………………………………… 82
英文部分………………………………………………………… 83
附錄…………………………………………………………………… 91
附錄一　個案基本資料………………………………………… 92
附錄二　Karnofsky 功能狀況量表…………………………… 93
附錄三　台灣版安德森症狀量表……………………………… 94

圖 表 目 次
圖一　生命累積函數曲線圖………………………………………… 38
圖二　疾病狀態之Kaplan-Meier存活曲線圖……………………… 42
圖三　化學治療之Kaplan-Meier存活曲線圖……………………… 43
圖四　放射線治療之Kaplan-Meier存活曲線圖…………………… 44
表一　資料統計分析方法…………………………………………… 26
表二　人口學特性…………………………………………………… 30
表三　疾病特性分佈………………………………………………… 33
表四　死亡組與存活組細胞激素及KPS功能狀態之比較………… 36
表四之ㄧ　死亡組與存活組細胞激素（正常人血清比對值）之比
較………………………………………………………… 36
表五　基本屬性與存活期之關係…………………………………… 41
表六　基本屬性及細胞激素單一變項對生存時間之分析………… 47
表六之ㄧ　基本屬性及細胞激素（正常人血清比對值）單一變項
對生存時間之分析……………………………………… 47
表七　疾病分佈……………………………………………………… 49
表八　以基本屬性分析存活期……………………………………… 52
表九　年齡、細胞激素、症狀、身體功能狀態與存活期之相關… 55
表九之ㄧ　年齡、細胞激素（正常人血清比對值）、症狀、身體
功能狀態與存活期之相關…………………………… 56
表十　以症狀、KPS預測存活期之迴歸分析……………………… 58
表十一　KPS、症狀總分、細胞激素與存活期之單一迴歸分析… 60
表十一之ㄧ　KPS、症狀總分、細胞激素（正常人血清比對值）
與存活期之單一迴歸分析…………………………… 60
表十二 以細胞激素預測存活期之迴歸分析……………………… 62
表十二之ㄧ　以細胞激素（正常人血清比對值）預測存活期之
迴歸分析……………………………………………… 62
表十三 以症狀總分、KPS身體功能狀態、細胞激素預測存活期之
迴歸分析…………………………………………………… 64
表十三之ㄧ 　以症狀總分、KPS身體功能狀況及細胞激素（正
常人血清比對值）預測存活期之迴歸分析……… 64

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