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研究生:周昌樺
研究生(外文):Chang-Hua Chou
論文名稱:台灣南部養豬場員工Q熱的血清流行病學研究
論文名稱(外文):Sero-prevalence of Q fever among pig farmers in southern Taiwan
指導教授:郭浩然郭浩然引用關係
指導教授(外文):How-Ran Guo
學位類別:碩士
校院名稱:國立成功大學
系所名稱:環境醫學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:42
中文關鍵詞:養豬場Coxiella burnetiiQ熱
外文關鍵詞:Coxiella burnetiipig farmQ fever
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目的:Q熱是由Coxiella bunnetii感染所造成的人畜共通疾病,其分佈遍及全世界。以前的研究顯示,雖然豬會被C. burnetii感染而血清抗體轉陽性,但是很少會感染到人,本研究進行台灣南部的養豬場中員工被C. bunnetii感染的流行病學調查,比較台灣南部養豬場從業人員與一般族群的C. bunnetii血清抗體盛行率,及分析感染的可能相關因數。方法:我們收集台灣南部某養豬公司員工96人的血液樣本為研究對象,另取台灣南部某藥廠性別相同且年齡相近之員工96人的血液樣本做為參考對象,以間接螢光抗體法分析血清中C. bunnetii的phase I 及 phase II抗原之抗體。當phase I或phase II抗體濃度(titer)皆大於1:16,或phase II抗體濃度大於1:256 即診斷為C. bunnetii感染,比較養豬場與藥廠員工的C. bunnetii感染之血清盛行率是否有明顯差異。我們也對養豬場員工做肝功能試驗、血液檢查及問卷調查,由養豬場員工C. burnetii血清陽性的病例組與血清陰性的對照組進行病例對照研究,以分析C. bunnetii感染的相關因素。結果:養豬廠員工的C. burnetii的血清陽性率為20%,遠高於藥廠員工的2%血清陽性率,OR (95% CI) = 11.6(2.6-51.3)。由養豬場員工C. burnetii血清陽性的病例組與血清陰性的對照組進行病例對照研究,並未發現C. burnetii感染的顯著相關因數。結論:養豬場員工的C. burnetii血清抗體陽性率遠高於藥廠員工,因而C. bunnetii感染可能是養豬場員工的潛在職業傷病之一,而感染的危險因數需要更多的研究做進一步的分析。
  Objective: Q fever is a worldwide zoonosis caused by Coxiella burnetii. Previous studies showed although pigs would be infected with C. burnetii and became seroconvert, they rarely infected humans. We conducted an epidemiological study of C. burnetii infections in workers of pig farms in southern Taiwan to compare the seroprevalence rate of antibodies to C. burnetii infections of pig farm workers to general population and to assess the associated factors. Methods: We collect blood samples from 96 pig farm workers as study populations and 96 drug company workers as reference populations; both were in southern Taiwan. We measured the antibodies against phase I and phase II antigens of C. burnetii using indirect immunofluorescence assay (IFA). C. burnetii infections are diagnosed when both phase I and phase II antibody titers were higher than 1:16, or phase II antibody titer was higher than 1:256. The seroprevalence rates of C. burnetii antibodies between the pig farmers and drug company workers were compared with statistical analysis. A questionnaire survey was conducted as well as liver function test and complete blood count (CBC) checked on pig farm workers . A case-control study between seropositive and seronegative pig farm workers was compared to assess the associated factors for C. burnetii infections. Results: The C. burnetii seropositive rate was 20% in pig farm workers, much higher than the 2% positive rate in drug company workers (OR(95% CI)= 11.6(2.6-51.3)). The case-control study between seropositive and seronegative pig farm workers did not disclose the significant associated factors for C. burnetii infections. Conclusion: The seroprevalence rate of antibodies to C. burnetii infections in pig farm workers was much higher than that in drug company workers. C. burnetii infections poses a potential occupational hazard to workers in pig farms. More studies are needed to explore the risk factors.
目錄
中文摘要..................................................................................................Ⅰ
英文摘要..................................................................................................Ⅲ
目錄..........................................................................................................Ⅴ
表目錄......................................................................................................Ⅷ
附錄目錄..................................................................................................Ⅸ
第一章 緒綸..............................................................................................1
1-1 研究背景.............................................................................................1
1-2 研究的重要性.....................................................................................3
1-3 研究目的.............................................................................................4
第二章 文獻回顧......................................................................................5
2-1 Q熱簡介...............................................................................................5
2-2 流行病學.............................................................................................5
2-3 Q熱的病原致病因數...........................................................................6
2-4 傳染方式.............................................................................................7
2-5 Q熱的臨床症狀...................................................................................8
2-5-1 急性Q熱....................................................................................9
2-5-2 慢性Q熱....................................................................................9
2-6 Q熱的診斷.........................................................................................10
2-6-1 血清學診斷C. burnetii抗體濃度...........................................10
2-6-2聚合酶鏈鎖反應(PCR)檢測DNA..........................................11
2-6-3 分離病原體.............................................................................11
2-7 Q熱的治療.........................................................................................11
2-8 Q熱的預防.........................................................................................12
第三章 材料與方法................................................................................14
3-1 研究架構...........................................................................................14
3-2 研究對象...........................................................................................14
3-2-1 研究組.....................................................................................14
3-2-2 對照組.....................................................................................14
3-3 研究工具...........................................................................................15
3-3-1 間接免疫螢光.........................................................................15
3-3-2 對養豬場員工做問卷調查.....................................................16
3-3-3 養豬場員工血液檢查.............................................................16
3-4 研究變項...........................................................................................17
3-5 統計分析方法...................................................................................17
第四章 研究結果....................................................................................18
4-1 養豬場與藥廠基本資料及血清中C. bunnetii抗體檢查結果.........18
4-2 血清陽性員工的C. bunnetii抗體濃度.............................................19
4-3 養豬場員工的描述性分析...............................................................20
4-4 養豬廠員工的C. bunnetii血清抗體陽性的病例組與血清陰性對照
組的病例對照分析..........................................................................20
第五章 討論............................................................................................23
第六章 結論與建議................................................................................28
第七章 參考文獻....................................................................................29
表..............................................................................................................34
附錄..........................................................................................................40

表目錄

表一、研究組與參考組基本資料及血清中C. bunnetii抗體檢查結果
..................................................................................................... 25
表二、血清陽性員工的C. bunnetii抗體濃度....................................... 24
表三、養豬場96位員工的描述性分析................................................. 25
表四、96位養豬廠員工的C. bunnetii血清陽性的病例組與血清陰性對照組的病例對照分析................................................................. 26
表五、成大醫學院環醫所Q熱問卷調查............................................ 27

附錄目錄
附錄一、人體試驗委員會核證............................................................... 38
附錄二、受試者同意書........................................................................... 39
第七章 參考文獻

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