臺灣博碩士論文加值系統

本研究主要目的在暸解肌無力症患者接受各種治療方法與失能狀況與生活品質的關係。研究設計屬量性、橫斷性研究，採立意取樣方式選取北部某醫學中心腦神經內科專責肌無力症患者之門診為研究對象，共計有效樣本數為66人，收案時間為九十七年十一月一號至九十八年一月三十一日止，共計三個月。研究工具為自填式結構問卷與病歷查閱，主要內容包括：肌無力症人口特質、疾病特徵、接受治療方法，並在個案知情同意之下接受巴氏量表（Barthel index,B.I.）、肌無力症日常功能量表（Myasthenia Gravis activities of daily living scale, MG-ADL）、The Medical Outcome Study Short Form-36台灣版生活品質問卷量表做現況評估。研究結果如下：肌無力症患者疾病嚴重度多屬於眼肌型肌無力症（54.6％），平均接受治療的類別為1.64±0.87種，失能狀況 MG-ADL 方面，總平均分數是3.71±2.67分失能狀況列為「輕度」，失能最高為眼皮下垂，其次是複視，ADL 方面平均得分為98.33±5.5亦屬「輕度依賴失能」。生活品質方面，整體生理健康構面為64.26±19.9、整體心理健康構面61.33±19.75、總生活品質總分65.46±19.82，略高於國人最低健康生活品質常模50分。
多元回歸分析結果顯示：（1）在失能情況 MG-ADL 方面：整體回歸模式可解釋失能狀況為82％的變異量，有無其他疾病、現有症狀類別總和、有無因肌無力住院、有無接受免疫抑制劑均有顯著意義，其中以現有症狀類別總和最具解釋力。失能情況ADL 方面：整體回歸模式可解釋失能狀況為 31％ 的變異量，以發病年齡、罹病年數、治療方式類別總和具顯著。（2）生活品質方面：現有症狀類別總和可預測整體生理健康構面 32％ 的總變異量。現有症狀類別總、有無接受免疫抑制劑可預測整體心理健康構面 26％ 的總變異量，以現有症狀類別總和最具解釋力。現有症狀類別總和可預測總生活品質 29％的總變異量。現有症狀類別總和、有無接受免疫抑制劑為預測失能與生活品質重要預測因子。本研究結果，有助於了解肌無力症個案接受治療後，主要失能狀況及生活品質之相關性，能提供臨床實務對提昇肌無力症個案生活品質與減少失能的參考。

Myasthenia Gravis (MG) is a neuromuscular autoimmune disease which causes the muscle weakness and fatigue. How to improve the quality of life for patients with MG has been the primary target of medical treatment. Not many studies have focused on the subject. The purpose of this study was to investigate the disability status and the quality of life (QoL) in the patients with MG.
Materials and Methods：This is a quantitative and cross-sectional study. Data for this study were collected from patients seeking medical attention in an outpatient clinics of the internal neurological department in a medical center in northern Taiwan from November 2008 to January 2009. Medical charts were reviewed and self-administered questionnaires used. Several instruments were used, including Barthel index (B.I.), MG activities of daily living scale (MG-ADL), and Medical Outcome Study Short Form-36 (SF-36). Multiple linear regression method was used for multivariate analysis to examine the relation of disability and treatment methods to QoL.
Results：A total of 66 MG patients have enrolled in the study. Ocular MG was the predominant type (54.6%). The mean score for the treatment methods was 1.64±0.87, indicating that patients receiving more than one type of treatment. MG-ADL results showed that on average patients’disability level was mild (disability profile score: 3.71±2.67). Eyelid ptosis ranked as the top symptom, followed by diplopia. The mean disability profile score of ADL was 98.33±5.5, showing the mild dependence for most patients. For the QoL, the mean score of Physical component summary（PCS）was 64.26±19.9. The mean score of Mental component summary（MCS）was 61.33±19.75. In overall QoL, the mean profile score was 65.46±19.82.
The results of multiple linear regressions indicated ：(1) For disability, the whole model explained 82％ of the variances. Several variables turned out significant, including comorbidity, the sum of the existing symptom categories, hospitalization due to the MG, immunosuppressive agent using. The regression model for ADL could explain 31％ of the variance. Several variables reached significance, including the age of onset, duration of the illness, and sum of treatment option. (2) The model for QoL explained 32％ of PCS variances. The sum of the existing symptom categories and immunosuppressive agent use could predict 26％ of the MCS variance. The sum of the existing symptom categories had the most explanatory power. The sum of the existing symptom categories could predict 29％ of the total variance of the QoL. Conclusion：The existing symptoms and the immunosuppressive agent use were significant predictors. They bore crucial prognostic meaning in the sense that they served as indictors for health workers to target patients for medical attention.

目錄
第一章 緒論.......................................................1
第一節 研究動機與重要性.......................................1
第二節 研究目的..............................................3
第二章 文獻回顧....................................................4
第一節 肌無力症.............................................4
第二節 肌無力症的治療方法及其效果.............................11
第三節 肌無力症與失能........................................15
第四節 肌無力症與生活品質.....................................20
第三章 研究設計與方法..............................................24
第一節 研究方法..............................................24
第二節 研究架構與研究假設.....................................25
第三節 研究流程..............................................27
第四節 研究對象與樣本.........................................28
第五節 變項與測量工具.........................................29
第六節 資料分析方法...........................................37
第七節 倫理考量..............................................40
第四章 研究結果.....................................................41
第一節 樣本之描述性統計分析...................................41
第二節 生活品質與失能狀況的相關因子分析........................51
第三節 生活品質和失能狀況預測因子分析..........................59
第五章 討論.........................................................65
第一節 研究對象基本資料、疾病特性與接受治療情形.................65
第二節 肌無力症失能狀況與生活品質之現況探討.....................67
第三節 肌無力症個案失能情況與生活品質相關性的探討................69
第六章 結論與建議...................................................74
第一節 結論..................................................74
第二節 研究限制與未來研究建議..................................75
第三節 實務建議...............................................77
參考文獻...........................................................78
中文部份.....................................................78
英文部分.....................................................81
附件一 肌無力症個案病歷查核表.........................................88
附件二 肌無力症患者失能情形與生活品質現況調查表.........................90
附件三 ADL失能評估量表...............................................91
附件四 MG-ADL量表...................................................92
附件五 SF-36生活品質量表.............................................93
附件六 同意書.......................................................96
表圖索引
表2-1 Osserman Staging of myasthenia gravis.................6
表2-2 Quantitative MG Scale................................18
表2-3 MG Activities of Daily Living Scale..................19
表3-1 自變項與依變項之操作型定義.............................34
表3-2 統計分析方法..........................................39
表4-1 肌無力病患基本屬性.....................................42
表4-2 肌無力患者疾病特性.....................................44
表4-3 肌無力患者治療情形.....................................46
表4-4 日常生活活動（ADL）功能量表得分情形......................47
表4-5 日常生活活動功能量表子題目得分情形.......................48
表4-6 MG-ADL日常生活活動功能量表得分情形......................49
表4-7 肌無力症之生活品質 ....................................50
表4-8 個人基本屬性與生活品質和失能狀況相關因素分析..............52
表4-9 疾病特症與生活品質和失能狀況相關因素分析..................54
表4-10 接受治療方法與生活品質與失能狀況相關因素分析.............56
表4-11 生活品質與失能狀況相關因素分析..........................57
表4-12 自變項與依變項之雙變項關係..............................58
表4-13 生活品質整體生理健康構面之複回歸分析.....................59
表4-14 生活品質整體心理構面之複回歸分析.........................60
表4-15 生活品質總分之複回歸分析................................61
表4-16 失能狀況（MG-ADL）之複回歸分析..........................63
表4-17 失能狀況（ADL）之複回歸分析 ............................64
圖2-1 肌無力症之治療流程圖 ....................................14
圖3-1 肌無力個案治療結果及其相關因子探討之概念架構...............26
圖3-2 研究流程圖..............................................27

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