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研究生:李帶琪
研究生(外文):Tai-Chi Lee
論文名稱:台灣地區甲狀腺機能亢進治療型態之探討
論文名稱(外文):A Study on Hyperthyroidism Treatment Patterns in Taiwan
指導教授:林瑞雄林瑞雄引用關係
指導教授(外文):Ruey-Shiung Lin
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:預防醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
畢業學年度:97
語文別:中文
論文頁數:94
中文關鍵詞:全民健保甲狀腺機能亢進流行病學治療型態醫療利用臺灣
外文關鍵詞:National Health InsuranceHyperthyroidismTreatment PatternsEpidemiologyHealth Care UtilizationTaiwan
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本研究目的是以分析臺灣接受甲狀腺機能亢進症治療者的資料,了解其年齡、性別等的差異;分析醫師對甲狀腺機能亢進症的臨床處理方式及與國際臨床治療指引比較。本研究以國衛院提供之「全民健保研究資料庫」 的次級資料,分析1997年至2004年的全民健康保險資料庫承保抽樣歸人檔資料中,甲狀腺機能亢進患者在診療人數及處方檢驗上的耗用情形。以1997年至1999年為研究資料清洗期間,未在此期間內發生接受甲狀腺機能亢進治療的病患才歸屬於新發病個案研究。在2000年1月1日至2004年12月31日共有1157位新發病個案,接受口服抗甲狀腺藥物治療者共有949人(82%),是臺灣常見的第一線治療方式。第一次發病即接受手術者有202人(17.5%),第一次發病接受放射碘治療者只有6人(佔0.5%)。因甲狀腺機能亢進接受治療的年齡層高峰,女性為51~60歲,男性為31~40歲和71~80歲,甲狀腺機能亢進在高齡族群仍是重要的疾病。接受治療之甲狀腺機能亢進的年發生率在1.2‰〜1.4‰之間,女性為每年2.02‰,男性為每年0.58‰,女性比男性約為3.5:1。接受非口服藥治療的相關因子為年齡、性別。以口服抗甲狀腺藥物治療之甲狀腺機能亢進新個案,累積治療天數,女性平均治療天數為286.5天,男性平均治療天數為288.5天。具有抗甲狀腺藥物療程的729名甲狀腺機能亢進新個案,停藥後42.6%(311人)在追蹤期間內產生甲狀腺機能亢進復發,緩觧曲線數據分析可知抗甲狀腺藥物治療的平均復發時間為958天,約為2.6年,而有50%的甲狀腺機能亢進患者接受抗甲狀腺藥物治療停藥後833天(2.28年)會復發。與國際臨床診療指引相比較,有48.2%的病人 (265/549)是在開始治療後的 1〜3個月內第一次追蹤檢驗甲狀腺功能,屬於適當監測血清甲狀腺功能,適當監測血清甲狀腺功能的相關因子為年齡、地區、醫療院所層級。與國際臨床診療指引相比較,15.7%以抗甲狀腺藥物作為第一次治療甲狀腺機能亢進的病人,符合國際臨床診療指引所建議的用藥期間。適當口服抗甲狀腺藥物治療期間與年齡、地區、監測血清甲狀腺功能適當與否有關。以抗甲狀腺藥物作為第一次治療甲狀腺機能亢進的病人,有64.5%治療累積天數少於9個月,與國際臨床診療指引所建議的用藥期間短少許多;臺灣甲狀腺機能亢進患者抗甲狀腺藥物的最適治療期間,仍待進一步研究。
This study was intended to explore the treatment and follow-up patterns of hyperthyroidism in Taiwan and compared with guideline standards.Claims data of hyperthyroidism cases of the National Health Research Institute were collected as the data base for analysis during the period 1997 to 2004. The washout duration of new incident treated as hyperthyroidism was 3 years. The subjects who had received anti-thyroid drugs or radioiodine or thyroid operation with the principle diagnosis of hyperthyroidism as the initial treatment of hyperthyroidism between 2000 and 2004 were included in our research. In total, there were 1151 new incident treated hyperthyroidism.
The annual incidence was 1.2‰ to 1.4‰ from 2000 to 2004. The female incidence was 2.02‰ and male incidence was 0.58‰. Respectively sex ratio was 3.5 : 1. The peak age was 51 to 60 y/o in female and 31-40 y/o and 71-80 y/o in male. Hyperthyroidism was not a rare disease in aged population.
There were 949 subjects (82%) received antithyroid drug as the first line therapy;202 subjects (17.5%) received thyroid operation as the first line therapy; only 6 subjects (0.5%) received radioiodine as the first line therapy.
The mean treatment duration with antithyroid drug was 286.5 days in female and 288.5 days in male. Relapse occurred in 42.6% patients during the follow-up period after drug withdraw. Remission analysis revealed that the mean relapse time was 2.6 years and median relapse time was 2.28 years. Compared with the internation treatment guideline , appropriate thyroid function monitoring after medication was found in 48.2% patients and appropriate antithyroid drug treatment duration was found only in 15.7% patients.
The factors associated with appropriate thyroid function follow-up were patient’s age、geographic area and hospital types. The related variables to appropriate medication were patient’s age and proper thyroid function monitor.
口試委員會審定書 i
誌謝 ii
中文摘要 iii
英文摘要 v
第一章 緒論 1
第二章 文獻探討 3
  2-1 什麼是甲狀腺機能亢進症 3
  2-2 甲狀腺機能亢進症的分類 5
    2-2-1 常見病因 5
    2-2-2 少見病因 6
    2-2-3 癌症造成 7
  2-3 甲狀腺機能亢進症的治療 9
    2-3-1 抗甲狀腺藥物 9
    2-3-2 放射腺碘治療 17
    2-3-3 手術治療 18
  2-4 甲狀腺疾病的流行病學 20
  2-5 甲狀腺機能亢進實證醫學資料庫與國際臨床診療指引
      的發展 22
    2-5-1 美國的甲狀腺機能亢進指引 23
    2-5-2 Cochrane Collaboration 2005年發表對抗甲狀腺
         藥物治療的建議 24
    2-5-3 英國甲狀腺學會的建議 25
    2-5-4 日本 25
    2-5-5 荷蘭 28
  2-6 台灣甲狀腺機能亢進近來的相關研究 29
    2-6-1 甲狀腺機能亢進患者接受抗甲狀腺藥物治療
         後,甲狀腺機能亢進復發的研究 29
    2-6-2 小兒甲狀腺機能亢進的研究 30
    2-6-3 放射碘治療甲狀腺機能亢進的成效 31
    2-6-4 吸菸與甲狀腺機能亢進 32
2-6-5 甲狀腺機能亢進患者與生活壓力、焦慮、憂鬱
的研究 32
2-6-6 社區老人甲狀腺疾病盛行率的調查 32
第三章 研究目的 33
  3-1 研究目的 33
  3-2 研究假說 34
  3-3 預期成果 34
第四章 研究設計與方法 35
  4-1 研究設計與研究架構 35
  4-2 資料來源與處理 35
    4-2-1 資料來源 35
    4-2-2 研究對象確定 35
  4-3 研究變項操作型定義及研究工具 39
    4-3-1 名稱定義 39
    4-3-2 自變項 40
    4-3-3 依變項 42
  4-4 統計分析方法 44
第五章 研究結果 51
  5-1 甲狀腺機能亢進新個案的第一次治療方式分析 51
  5-2 接受治療的甲狀腺機能亢進新個案發生率與累積盛
      行率 51
  5-3 甲狀腺機能亢進新個案首次治療方式採用手術放射碘
      治療的相關因子 52
  5-4 甲狀腺機能亢進新個案首次治療採用口服抗甲狀腺藥
      物治療天數與疾病診斷碼的交叉分析 52
  5-5 甲狀腺機能亢進新個案首次口服抗甲狀腺藥物治療累
      積天數與性別及年齡層之交叉分析 54
  5-6 新個案抗甲狀腺藥物停藥後甲狀腺機能亢進的復發 56
  5-7 使用口服抗甲狀腺藥物,患者的檢驗追蹤情形並與臨
      床準則相比較 57
    5-7-1 檢驗追蹤情形 57
    5-7-2 適當監測血清甲狀腺功能的相關因子 59
  5-8 使用口服抗甲狀腺藥物,適當治療期間的相關情形並
      與臨床準則相比較 60
第六章 研究討論 61
  6-1 討論 61
  6-2 研究限制 66
第七章 結論與建議 67
  7-1 結論 67
  7-2 建議 68
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