慢性B型肝炎（hepatitis B virus, HBV）和C型肝炎（hepatitis C virus, HCV）是造成肝硬化及肝癌的最主要原因，台灣正為肝炎高盛行地區，而高雄縣梓官鄉更是一個B、C、D型肝炎同時盛行社區，因此，對於B、C型肝炎現況和疾病自然史的了解就相形重要。所以，本研究之目的是以民國八十六年曾參加全鄉第一次篩檢的高雄縣梓官鄉45歲以上社區居民為研究對象，延續研究以探討一般社區族群中慢性B、C型肝炎標記長期變化及相關因子，以補足B、C型肝炎在一般族群的疾病自然史之全貌。
本研究族群為高雄縣梓官鄉轄內15個村的居民，曾於民國八十六年（1997年）接受梓官鄉全鄉四十五歲以上居民肝癌篩檢者共計2909人，扣除死亡321人及遷出42人後，目前仍設籍在梓官鄉的社區居民共有2546位為研究對象，透過各種方式喚回個案以進行追踪抽血檢查，探討7年之後B、C型肝炎發生率及肝炎標記變化及相關因子。
追踪結果顯示高雄縣梓官鄉成人居民接受追踪複檢者為1002人，回應率為39.4%，B型肝炎表面抗原（HBsAg）年陽轉率為0，C型肝炎抗體（anti-HCV）年陽轉率為1.35%/人年。慢性B型肝炎表面抗原年陰轉率為1.58%/人年，陰轉相關因子為男性、年長以及胺基丙酸轉胺（alanine transaminase, ALT）第一次檢查異常後來檢查變正常者較容易產生陰轉。慢性C型肝炎抗體年陰轉率為0.63%/人年，相關因子為輕微或無肝實質病變以及持續的ALT正常，並且在多重感染的情況下C型肝炎抗體陰轉率並無明顯增加或減少。
此研究結果得知在老年族群中並沒有B型肝炎新感染者；因此，沒有再施打B型肝炎疫苗的考量，另外C型肝炎的發生率也明顯下降，此外，慢性B型肝炎的B型肝炎表面抗原陰轉率以及相關因子和過去研究相似，而慢性C型肝炎抗體的陰轉率並不高，重點是多重病毒的感染對於慢性B型肝炎表面抗原陰轉以及慢性C型肝炎抗體陰轉並無影響，且根據作者所知，本研究結果更是目前國內多重病毒肝炎感染社區的唯一數據，相信具有相當的參考價值，因此，藉著了解高盛行地區肝炎發生率的變化可以做為肝炎防治政策的修正參考，而肝炎標記陰轉率則可補足B、C型肝炎自然史資料不足的部分。

Hepatitis B virus（HBV）, and hepatitis C virus（HCV） are the top-listed culprits causing liver cirrhosis（LC） and hepatocellular carcinoma (HCC). Due to the high prevalence rate of hepatitis virus infection in Taiwan, especially in Tzukuan Township Kaohsiung County, consequently, it is important to realize the current development and nature course of the disease. The study subjects were residents , aged＞45-year-old, who had participated in the first examination of hepatitis in 1997.The purpose of this study was to explore the long-term evolution and relevant factors of HBV and HCV and to understand more about the nature course of HBV and HCV in general population.
After deduction the passing away and moving out, the amount of the subjects who reside across 15 villages in Tzukuan Township and conform to conditions required is 2546. By all means recalling them to conduct second blood-testing after 7years from 1997, we try to explore the occurring rate, mark change as well as relevant factors of HBV and HCV.
The results indicate that 1002 residents of Tzukuan Township Kaohsiung County receive second blood-testing, the rate of which is 39.4%, HBsAg positive seroconversion rate is 0 %/person year, anti-HCV positive seroconversion rate is 1.35%/ person year, HBsAg negative seroconversion rate is 1.58%/ person year, relevant factors are male gender, age and ALT. Whoever having been negative to the test turning to be positive is likely to lead to negative seroconversion .The results also show that the rate of anti-HCV negative seroconversion is 0.63%/ person year, the relevant factors are light, even none, liver pathological change and remaining normal ALT, and no obvious decrease or increase of the rate of anti-HCV negative seroconversion occurs in the condition of multiple infections.
The conclusions of the study are as followings：1.There is no newly-infected case in aged people, so it’s needless for them to be vaccinated again. 2. The occurring rate of HCV decreases obviously. 3. The HBsAg negative seroconversion rate of HBV and relevant factors by our study resemble previous ones which have been discussed before. 3. Multiple-virus-infection do no influence to HBV and HCV negative seroconversion. Finally and most importantly, our study provides relevant statistic figures about multiple-HV-infectious area domestically, and by means of knowing the variation of occurring rate of HV in high-prevalence area, we extend the reference material to policy-making about preventing HV.

第一章、前言-----------------------------------------9 ~ 11
第一節、研究背景與動機--------------------------------- 9
第二節、研究目的 --------------------------------------11
第一項、總目標-------------------------------------- 11
第二項、分項目標------------------------------------ 11

第二章、文獻探討------------------------------------12 ~ 23
第一節、B型肝炎--------------------------------------- 12
第一項、B型肝炎病毒介紹 ---------------------------- 12
第二項、B型肝炎的發生率及其危險因子------------------15
第三項、慢性B型肝炎的陰轉及其相關因子----------------17
第二節、C型肝炎--------------------------------------- 19
第一項、C型肝炎病毒介紹------------------------------19
第二項、C型肝炎的發生率及其危險因子------------------21
第三項、慢性C型肝炎的陰轉及其相關因子----------------22
第三節、文獻探討總結-----------------------------------23

第三章、研究材料與方法------------------------------24 ~ 29
第一節、研究問題---------------------------------------24
第二節、研究流程---------------------------------------24
第三節、研究架構---------------------------------------24
第四節、研究地區---------------------------------------25
第五節、研究對象---------------------------------------26
第六節、方法與材料-------------------------------------26
第七節、資料收集與方法---------------------------------27
第八節、研究變項之操作定義-----------------------------28
第九節、統計方法---------------------------------------29

第四章、結果----------------------------------------30 ~ 32
第一節、研究世代基本資料-------------------------------30
第二節、HBsAg陽轉--------------------------------------30
第三節、Anti-HCV陽轉 ----------------------------------31
第四節、HBsAg陰轉及相關因子----------------------------32
第五節、Anti-HCV的陰轉及其相關因子 --------------------32

第五章、討論----------------------------------------33 ~ 37
第一節、討論-------------------------------------------33
第二節、研究限制---------------------------------------37

第六章、結論-------------------------------------------- 38

參考文獻 ---------------------------------------------39~46

附 錄 ---------------------------------------------64~66

自 述 ------------------------------------------------67

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