臺灣博碩士論文加值系統

目的：本研究為了比較死亡個案和完治個案，以探討老年結核病治療結果相關因子
方法：本研究以病例對照研究法（case-control study）進行研究，利用行政院衛生署疾病管制局「中央傳染病追蹤系統」2006年期間通報結核病為研究對象，死亡個案為病例組，完成治療個案為對照組。以通報個案的人口學特徵及共病疾病史等相關因子與治療結果間進行描述性統計及羅吉斯回歸分析。
結果：已設籍彰化對359位接受結核病的治療個案納入本研究，其中死亡的個案有173位，完治個案有186位。兩組間性別、年齡及抽菸史有相似的分布情形，死亡的個案有較高慢性腎疾病、癌症和其他的共病史。從多變項羅吉斯迴歸分析結果發現，顯著的相關因素如下：結核病病患之腎絲球過濾率第Ⅴ分期（勝算比(odds ratio (OR) =6.32, 95%可信限 confidence interval (CI)）: 1.13-35.28)、癌症病史(OR) = 20.34, 95%(CI):3.77-109.79)、住院次數3次以內個案(OR) = 3.81, 95%(CI): 1.10-13.26)及曾入住過加護病房(OR) = 128.06, 95% (CI): 38.25-428.77 )。
結論：在研究結果中發現，結核病病患，腎絲球過濾率第Ⅴ分期和癌症者有較大死亡勝算比，死亡的個案多數有因重症而住院或入住過加護病房。

Purpose：This study examined factors associated with the tuberculosis (TB) treatment effectiveness for patients of the elderly.
Methods：We conducted a case-control study using the 2006 surveillance data of the Central Tuberculosis Registration, Center for Disease Control, Taiwan. Cases were deceased patients with tuberculosis (TB) and controls were survival patients completed the treatment, patients of both groups were residents of Chang Haw County. The socio-demographic characteristics, history of the disease treatment and co-morbidities were compared. Both descriptive statistics and logistic regression analysis were applied for the data analyses.
Result：Among 359 patients receiving TB treatment, 173 cases were deceased and 186 cases completed the treatment. Both groups were similar in the distributions of gender, age and history of smoking. Deceased patients were more prevalent with history of renal disease, cancer and other comorbidities. The results of multivariate logistic regression analysis revealed that factors associated with mortality from TB included the glomerular filtration rate(GFR) in the stage Ⅴ(odds ratio (OR) = 6.32, 95% confidence interval (CI): 1.13-35.28), and history of cancer (OR) = 20.34, 95% (CI): 3.77-109.79), hospitalization for 3 times (OR) = 3.81, 95% (CI): 1.10-13.26) and intensive care (OR) = 128.06, 95% (CI): 38.25-428.77)。

Discussion：TB patients with co-morbidities of glomerular filtration rate(GFR) in the Ⅴstage and cancer are at higher risk of death. The deceased patients are more likely having experiences of hospitalization and/or intensive care.

目錄
中文摘要 II
Abstract IV
第一章　緒論 1
第一節 研究背景與研究動機 1
第二節 研究的重要性 6
第三節 研究的目的 7
第四節 研究問題與研究假設 7
第五節 名詞界定 8
第二章 文獻探討 9
第一節 全球結核病流行趨勢 9
第二節 台灣及彰化地區結核病流行趨勢 10
第三節 結核病的自然病史與個案之定義 13
第四節 結核病診斷與治療 17
第五節 結核病的危險因子 19
第六節 研究資料 21
第三章 研究方法 22
第一節 研究設計 22
第二節 研究對象 23
第三節 研究工具的擬定 23
第四節 資料收集過程 26
第五節 資料統計與分析 28
第四章 研究結果 30
第一節 樣本特質描述性分析 30
第二節 影響結核病有無死亡羅吉斯回歸分析 32
第三節 結核病有無死亡複羅吉斯回歸分析 35
第五章 討論 49
第六章 結論與建議 53
第一節 結論 53
第二節 研究限制 54
第三節 應用與建議 55
中文文獻 57
英文文獻 58



附表目錄

表1 臨床疾病發展成活動性結核病之危險因子。 20
表 2. 研究變項之操作型定義及屬性 25
表 3-1.結核病死亡與完治之相關人口、生活型態及檢測因素比較-單變項分析 39
表3-2.結核病死亡與完治個案之共病比較-單變項分析 40
表 3-3.結核病死亡與完治住院史比較-單變項分析 41
表 3-4.結核病死亡與完治感染檢測比較-單變項分析 42
表4-1.結核病死亡與完治個案比較人口學因子及生活型態相關勝算比-羅吉斯迴歸單變項分析 43
表 4-2.結核病死亡與完治個案比較的共病勝算比-羅吉斯迴歸單變項分析 44
表4-3.結核病死亡與完治個案比較的醫療狀況勝算比-羅吉斯迴歸單變項分析 45
表 4-4.影響結核病死亡或完治之結核病相關資料-羅吉斯迴歸分析 46
表 4-5.結核病死亡與完治之相關影響因素-複羅吉斯迴歸分析結果 47
表 4-6.結核病死亡與完治之相關影響因素-複羅吉斯迴歸分析結果 48

附圖目錄

圖1-1台灣地區結核病近十年死亡趨勢圖 12
圖1-2台灣地區與彰化地區發生率趨勢圖 12
圖1-3台灣地區與彰化地區死亡率趨勢圖 13
圖2-1結核病的自然病程 14
圖3-1 研究架構 21
圖4.研究樣本收集資料過程 27

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