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研究生:劉小瑜
研究生(外文):Liu, Hsiao-yu
論文名稱:台灣慢性病毒性肝炎患者之慢性病發生率及全死因之風險探討
論文名稱(外文):Chronic diseases incidence and total mortality in Taiwanese with chronic viral hepatitis
指導教授:林富宮林富宮引用關係
指導教授(外文):Lin, Fu-gong
口試委員:李美璇林富宮
口試委員(外文):Lee, Meei-shyuanMark L. WahlqvistLin, Fu-gong
口試日期:100.5.19
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
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:2011
畢業學年度:99
語文別:中文
論文頁數:140
中文關鍵詞:慢性病毒性肝炎代謝症候群及慢性病死亡率
外文關鍵詞:chronic hepatitis infectionmetabolic syndrome and chronic diseasestotal mortality
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B、C型肝炎病毒所造成的慢性肝炎是全球性的健康議題,據世界衛生組織評估全世界有超過3億5千萬人是B型肝炎帶原者,有超過1億7千萬C型肝炎帶原者(Custer et al., 2004, Armstrong et al., 2006)。雖施打B型肝炎疫苗政策使帶原率逐漸下降,但仍有少數民眾因未能治療或施打無效,進而造成慢性帶原者,而C型肝炎目前尚無一有效的預防方法且盛行率正逐年增加當中,因此在往後的數十年間慢性B型、C型肝炎病毒感染及其所造成健康危害仍舊是國人之健康大敵。先前研究指出慢性肝炎病毒感染與醣類、脂質的代謝異常有關,然而目前對致病機轉及因果關係並不明確。因此本研究欲探討慢性肝炎與慢性病的關係及對死亡的影響,期能針對危險因子提出有效之預防策略以早期預防,以降低疾病對健康的危害,提高患者生活品質。
本論文以世代研究探討慢性病毒性肝炎感染(慢性B、C型肝炎)在台灣地區的流行病學特性。第一部分利用世代研究基線資料描述慢性病毒性肝炎患者代謝症候群、慢性疾病盛行率及研究個案基本人口學變項、地理分布、體位、血液生化值及生活習慣之分布情形,第二部份以Cox proportional hazard model評估慢性病毒性肝炎患者發生慢性病及死亡的風險。
本研究結果顯示,慢性B型肝炎盛行率分別為15.51%及0.61%,代謝症候群盛行率分別為17.56%及22.24%。經過10年的追蹤調查,慢性B型肝炎患者糖尿病、心臟病及高血壓發生率分別為5.59‰、1.68‰、16.23‰;慢性C型肝炎患者糖尿病、心臟病及高血壓發生率分別為10.09‰、2.62‰、20.58‰;慢性B型肝炎患者全死因死亡率為每10萬人口258人,慢性C型肝炎患者全死因死亡率為每10萬人口661人,非慢性肝炎個案全死因死亡率為每10萬人口225人,上述結果顯示不管是疾病盛行率、發生率及死亡率皆以慢性C型肝炎患者為最高。經Cox proportional hazard model分析,本研究發現慢性病毒性肝炎(慢性B、C型肝炎)感染可能會影響慢性疾病的發生。在校正相關干擾因子(年齡、性別、教育程度、地區及BMI)後發現,C型肝炎病毒感染會增加罹患糖尿病的風險,而B型肝炎感染對慢性病的發生則是沒有明顯的影響。在全死因的部分發現,慢性肝炎病毒感染會增加死亡的風險(HBV, HR=1.54(1.39-1.71), HCV, HR=2.10, (1.50-2.93))。此外,慢性C型肝炎患者發生糖尿病及心臟病會增加死亡的風險,HR=3.34(1.39-8.02), 3.39(1.48-24.0)。

Hepatitis B, C virus infection are important global health issue. The WHO estimates that The number of HBV infected people worldwide is estimated at nearly 400 million, with about 50 million new infections annually; The number of HCV infected people worldwide is estimated at nearly170 million, with about 3-4 million new infections annually. In spite of extensive vaccination against HBV in many countries and considerable underreporting, acute and chronic viral hepatitis due to these viruses still rank among the most frequent reportable infectious disease throughout the world.The extrahepatic manifestations of hepatitis virus (HBV, HCV) infection may include multiple metabolic abnormalities. However, the characteristic features of lipid and glucose metabolism in CHB patients have not been fully elucidated.
The aim of present study is to evaluate the role of chronic virus infection on the incident of chronic diseases (diabetes, heart disease and hypertension) and total mortality. This study Use a cohort study design, hepatitis B and hepatitis C patients free of the chronic diseases will be followed for the development of the chronic diseases and death. Potential confounders to be taken into account include age, gender,personal behaviors and various co-morbidities (CCI) and family history.
In this study, the prevalence of chronic hepatitis B is 15.51%, chronic hepatitis C prevalence is 0.62%, the prevalence of metablic syndrome are 17.56% and 22.24% separately.After 11 years of follow-up, the incident of diabetes, heart disease and hypertension in patients with chronic hepatitis B patients with diabetes, heart disease and hypertension are 5.59 ‰, 1.68 ‰, 16.23 ‰; in patients with chronic hepatitis C are 10.09 ‰ , 2.62 ‰, 20.58 ‰, in addition, the total mortality in patients with chronic hepatitis B, C and general population are 258, 661, 225 per 100000 person-years, respectively. Cox regression analysis demonstrate that chronic hepatitis infection is associated with chronic diseases and HCV infection is a risk factors of diabetes, in addition, chronic hepatitis infection increase the risk of total mortality(HBV, HR=1.54(1.39-1.71), HCV, HR=2.10, (1.50-2.93)).Furthermore, HCV-infected patients with diabetes and heart disease will increase the risk of total mortality(HR=3.34(1.39-8.02), 3.39(1.48-24.0)).
IR in chronic hepatitis B-infected patients is a reflection of the host metabolic profile and HBV infection is not in itself correlated with IR. HCV core protein has been shown to disturbance the hemostasis of lipid and glucose. Accumulation of hepatic TG induce proinflammation cytokines production, overproduction of proinflammation cytokines contribute to systemic insulin resistance and various other metabolic anomalies.

目錄………………………………………………………………………………………I
圖目錄……………………………………………………………………………………III
表目錄……………………………………………………………………………………IV
中文摘要…………………………………………………………………………………VI
Abstract…………………………………………………………………………………..VII
本文目錄
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究動機 2
第三節 研究目的 3
第二章 文獻探討 4
第一節 慢性病毒性肝炎與及危險因子 4
第二節 慢性病毒性肝炎與醣類、脂質代謝之相關研究 - 16 -
壹、肝臟與三大營養素代謝 - 17 -
貳、慢性B型肝炎與醣類、脂質代謝 - 18 -
參、 慢性C型肝炎與醣類、脂質代謝 - 20 -
肆、肝臟酵素(ALT, AST, GGT) - 22 -
伍、慢性病毒性肝炎與發炎反應 - 26 -
第三節 慢性病毒性肝炎與代謝症候群及慢性疾病之相關研究 - 28 -
壹、慢性病毒性肝炎與代謝症候群 - 28 -
貳、慢性病毒性肝炎與慢性疾病 - 29 -
第四節 代謝症候群定義與其危險因子 - 32 -
壹、代謝症候群的定義 - 34 -
貳、 代謝症候群的危險因子 - 36 -
第五節 代謝症候群及慢性疾病 - 40 -
第三章 研究方法與研究設計 - 45 -
第一節 研究設計 - 45 -
第二節 研究架構 - 45 -
第三節 研究假說 - 46 -
第四節 研究對象與資料來源 - 46 -
第五節 研究工具 - 49 -
第六節 疾病變項定義 - 51 -
第七節 資料處理與統計分析 - 53 -
第四章 結 果 - 56 -
第一節 有無慢性肝炎感染個案之基本資料描述 - 57 -
第二節 影響慢性疾病發生的因素 - 59 -
壹、 影響糖尿病發生之因素 - 59 -
貳、 影響心臟病發生的因素 - 61 -
參、 影響高血壓發生的因素 - 63 -
第三節 模式建立─探討慢性病毒性肝炎與慢性病的關係 - 65 -
壹、 探討慢性B型肝炎患者罹患糖尿病的風險 - 65 -
貳、 探討慢性B型肝炎患者罹患心臟病的風險 - 66 -
參、 探討慢性B型肝炎患者罹患高血壓的風險 - 66 -
肆、 探討慢性C型肝炎患者罹患糖尿病的風險 - 67 -
伍、 探討慢性C型肝炎患者罹患心臟病的風險 - 67 -
陸、 探討慢性C型肝炎患者罹患高血壓的風險 - 68 -
第四節 模式建立-慢性病之發生是否會影響慢性肝炎患者死亡情形 - 69 -
第五章 討論 - 70 -
第一節 研究對象基本資料分布情形 - 70 -
壹、慢性病毒性肝炎盛行率 - 70 -
貳、慢性肝炎患者疾病的發生率 - 71 -
第二節 影響慢性病毒性肝炎患者慢性病發生的因素 - 71 -
第三節 慢性病毒性肝炎與血脂的代謝 - 74 -
壹、 慢性B型肝炎與血脂代謝 - 75 -
貳、 慢性C型肝炎與血脂代謝 - 77 -
第四節 慢性病毒性肝炎與血糖的代謝 - 79 -
壹、慢性B型肝炎與血糖代謝 - 80 -
貳、慢性C型肝炎與血糖代謝 - 82 -
第五節 慢性病毒性肝炎與代謝症候群及慢性疾病的關係 - 84 -
壹、 慢性病毒性肝炎與代謝症候群 - 84 -
貳、 慢性病毒性肝炎與糖尿病 - 86 -
參、 慢性病毒性肝炎與心臟病 - 88 -
肆、 慢性病毒性肝炎與高血壓 - 90 -
壹、 尿酸 - 91 -
貳、 肝臟酵素 - 92 -
參、 生活習慣 - 92 -
第六節 慢性肝炎感染與死亡率 - 93 -
第七節 研究限制 - 93 -
結論與建議 - 94 -
參考文獻 - 97 -

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