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研究生:郭德貞
研究生(外文):De-Jhen Kuo
論文名稱:台灣婦女荷爾蒙補充療法短期及長期利用型態
論文名稱(外文):The short- and long-term health impact of hormone replacement therapy of the women in Taiwan
指導教授:李玉春李玉春引用關係
指導教授(外文):Yue-Chune Lee
學位類別:博士
校院名稱:國立陽明大學
系所名稱:衛生福利研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
畢業學年度:97
語文別:中文
論文頁數:117
中文關鍵詞:荷爾蒙補充療法利用型態處方期間骨折更年期及停經後期婦女
外文關鍵詞:hormone replacement therapyutilization patternsutilization durationfracturemenopause and post-menopause women
相關次數:
  • 被引用被引用:4
  • 點閱點閱:459
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
摘 要
荷爾蒙替代療法(HRT)在婦女更年期及停經後期的使用極為普遍,而婦女在停經後發生骨折之機率則隨著停經年數逐漸增加。在國外已有許多研究分析HRT對骨折發生率之影響,而國內目前僅有一短期研究,探討HRT對骨質密佈之影響,因此本研究藉全民健保資料庫進行HRT對各類骨折發生風險之長期追蹤研究。
研究目的:分析荷爾蒙替代療法(HRT)之處方利用型態、處方利用期間及處方停用年數,與骨折發生風險之相關性。
研究方法:以40-80歲婦女為研究對象,採動態世代分析設計,以國家衛生研究院提供之四組全民健保歸人檔為資料來源,研究期間為1997-2007年。依變項為全部骨折、髖骨、股骨及髖骨、脊椎等骨折事件的發生,自變項為HRT利用類型(分為從未使用、當年正在使用、及曾使用(過去使用,當年停用)、HRT處方期間(每月處方天數、每月處方比例及處方年數)、處方停用年數,控制變項為骨質疏鬆症。以Cox存活分析進行骨折發生的危險比估算(Hazards Ratio)。
研究結果:婦女因更年期症侯群之門診就診率在2002年前均在15%以上, 2002年美國婦女健康研究(WHI研究)結果發表後,2003年就診率快速下降,2007年只有7.74%。
存活分析結果發現荷爾蒙補充療法之月處方比例越高,骨折相對危險比越低;利用型態與全部骨折、髖骨、股骨骨折之發生有顯著相關,但脊椎骨折並不顯著。處方年數越高全部骨折風險愈低,但髖骨、股骨、脊椎等骨折則不顯著。荷爾蒙補充療法長短期利用型態之骨折發生機率有顯著的差異,長期利用者較短期利用者發生骨折之風險比為低,脊椎骨折除外。
結論:荷爾蒙補充療法可能會降低骨折發生之風險,建議未來可進一步評估其對其他疾病發生之影響。
關鍵字: 荷爾蒙補充療法、利用型態、處方期間、骨折、更年期及停經後期婦女。
Abstract
The use of hormone replacement therapy (HRT) is very popular among post-menopause and menopause women, who also have increased risk of fracture. Many research have confirm that HRT can reduce the risk of fracture, yet in Taiwan, there was only one short-term study evaluate the impact of HRT on risk of osteoporosis. Therefore, this study intent to evaluate the long-term effect of HRT in Taiwan based on the analysis of National Health Insurance database.
Objectives: To explore the association between prescribing pattern and prescribing duration of HRT and duration of the discontinue use of HRT and the risk of various fracture events.
Methods: Study populations were women between 40-80 years. We applied dynamic cohort design, based on the claim data of sampled registry information of 43952 beneficiaries of National Health Insurance from 1997 to 2007 provided by National Health Research Institutes. The dependent variables were the events of various fractures (total, hip, femur, vertebral fractures). The independent variables were HRT utilization patterns (never, discontinue and current users), prescribing duration (number of days of HRT prescriptions, monthly percentage of HRT prescription) and number of years of the use of HRT. The control variables were age and diagnosis of osteoporosis. We used Cox proportional-hazards model to analyze the data.
Results: The women’s outpatient contact rates for menopausal syndrome were about 15% before 2002. It has been declined since 2003 after the publication of the WHI study in 2002; and was only 7.74% in 2007.
Cox analyses show that the higher the percentage of HRT prescription per month the lower the risk of the fracture events. The HRT utilization patterns were significantly associated with risk of total, hip, and femur fractures; yet it was not significant in vertebral fractures. The higher the number of years of HRT prescriptions, the lower the risk of total fractures; the long-term use of HRT was associated with decreased risk of fractures, yet was not significant in vertebral fractures.
Conclusions: The use of HRT may reduce the risk of fractures. Future study may further evaluate the impact of HRT on other diseases.
Keywords: hormone replacement therapy, utilization patterns, utilization duration, fractures, menopause and post-menopause women
目 錄
論文電子檔著作權授權書 i
論文審定同意書 ii
誌謝 iv
中文摘要 vi
英文摘要 vii
目錄 x
圖目錄 xi
表目錄 xii
第一章 緒論  1
第一節 研究背景與動機  1
第二節 研究目的及重要性  4
第三節 重要名詞定義  5
第二章 文獻探討  7
第一節 更年期及停經後症侯群定義、症狀與治療  7
第二節 荷爾蒙補充療法的影響因素及利用情形  16
第三節 荷爾蒙補充療法在骨髂的研究  27
第四節 存活分析統計簡介  46
第五節 文獻綜合討論 48
第三章 研究方法  53
第一節 研究設計  53
第二節 研究架構及研究假說  54
第三節 研究對象及資料來源  56
第四節 研究變項  58
第五節 資料處理 63
第六節 統計分析方法  67
第四章 研究結果  68
第一節 更年期及停經後症侯群就診率及荷爾蒙補充療法的利用  68
第二節 骨折的發生率  78
第三節荷爾蒙補充療法(HRT)與骨折之存活分析結果  82
第五章 討論 95 
第一節 研究方法討論 95 
第二節 研究結果討論  99
第三節 研究限制  103
第六章 結論與建議 105
第一節 結論 105 
第二節 建議  107
參考文獻 109 
 
圖 目 錄
圖2-1-1:更年期相關名詞的定義 8
圖2-3-1: 女性年齡別骨折發生率 28
圖2-3-2: 2006年健保門住診骨折之性別就診率圖 29
圖2-3-3: 女性骨密度年齡改變圖 32
圖2-3-4: 停用荷爾蒙補充療法後的骨密度追蹤研究 37
圖3-2-1:研究架構 54
圖3-5-1:研究樣本篩檢原則及每年40歲以上符合之人數 64
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三、網路參考資訊:
1. 台灣更年期醫學會, 荷爾蒙補充療法與整體照護, 更年期關懷網,http://www.menopause.com.tw/index.asp
2. 蔡英美(台灣更年期醫學會理事長),追求全方位照護, 享受健康更年期, 更年期關懷網,http://www.menopause.com.tw/index.asp
3. 周輝政, 楊東川, 健康主題: 認識更年期, 中老年保健網, http://health91.bhp.doh.gov.tw/opinion.htm
4. 健康生活家, 荷爾蒙療法常見的副作用, http://health.healthonline.com.tw/elder/article/e00015.html
5. 健康生活家, 荷爾蒙療法, http://health.healthonline.com.tw/elder/article/e00014.html
6. 健康生活家, 更年期症狀http://health.healthonline.com.tw/elder/article/e0006.html,
7. http://health.healthonline.com.tw/may/oldma.html#走過更年期
8. 婦女與更年期, 台北巿女性權益促進會(紫色姐妹) http://newcongress.yam.org.tw/women/tapwer.html
9. 賴國良, 有關美國WHI賀爾蒙補充療法研究結果的詳實說明; 出處: http://www.lai-obs.com/
10. 賴國良, 停經的定義,症狀,及女性賀爾蒙的補充; 出處: http://www.lai-obs.com/
11. 衛生統計資訊網 http://www.doh.gov.tw/statistic/index.htm
12. 台灣女人連線, http://twl.ngo.org.tw/health04.htm
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