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研究生:林佩儒
研究生(外文):Lin, Peiru
論文名稱:某行業員工潛隱性結核感染之探討
論文名稱(外文):Screening for Latent TB Infection among Occupational Employees
指導教授:辜志弘辜志弘引用關係
指導教授(外文):Ku, Chihhung
口試委員:陳宏一朱紀洪張峰義林永崇辜志弘
口試委員(外文):Chen, HongiChu, ChihongChang, FengyeeLin, JungchungKu, Chihhung
口試日期:2011-04-29
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:100
中文關鍵詞:篩檢潛隱性結核感染QFT-GIT
外文關鍵詞:screeninglatent TB infectionQFT-GIT
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某行業因工作特性,員工時常群聚生活。在此環境下若乙名員工結核發病即容易散播結核桿菌。目前台灣臨床結核病常見之診斷工具包括:胸部X光、痰液抹片及培養,這些方法僅能診斷病發之活動性結核病患,無法及早診斷潛隱性結核感染者。而結核菌素皮膚試驗(tuberculin skin test, TST)為各國臨床上經常用來診斷潛隱性結核感染(latent TB infection, LTBI)的工具,但因為容易受到卡介苗(Bacille Calmette-Guérin, BCG)的干擾,並不適用於我國。美國食品藥物管理局(Food and Drug Administration, FDA)於2007年核准第三代診斷方法 QuantiFERON®-TB Gold In-Tube test (QFT-GIT)的使用,不僅敏感度及精確度都較TST高,且不受卡介苗干擾。本研究旨在調查某行業員工潛隱性結核感染情形及其危險因子,研究期間自99年9月1日至100年4月30日。
本研究為橫斷性研究且經人體試驗審議委員會審查通過,研究對象為某行業現職員工,收案地點選定甲、乙兩地之體檢醫院。利用結構式問卷調查結核感染相關危險因子並採集血液檢體2ml,使用QFT-GIT試驗篩檢潛隱性結核感染者。統計方法採用multiple logistic regression 之逐步分析(Stepwise)。在校正潛在干擾因素後,探討QFT-GIT篩檢結果呈現陽性的危險因子。
研究結果顯示,甲地QFT-GIT陽性率為23.3% (71/305)、乙地QFT-GIT陽性率為8.3% (56/673)。某行業員工整體QFT-GIT陽性率為13% (127/978)。本研究QFT-GIT篩檢結果呈現陽性的危險因子分別為性別(女性 vs. 男性, OR=2.66, 95%CI=1.39-5.08)、結核病史(有 vs. 無, OR=26.8, 95%CI=2.30-311.92)、工作地區(甲地 vs. 乙地, OR=3.79, 95%CI=2.35-6.10)及抽菸(有 vs. 無, OR=1.96, 95%CI=1.16-3.30)。
根據上述結果,結核病發生率較高的地區,該行業員工QFT-GIT陽性率亦較高。鑒於24小時群聚團體之族群特性,除了加強高風險地區員工QFT-GIT篩檢,建議針對結核病史個案定期追蹤,防止後續結核菌再次感染及復發、針對有抽菸習慣之員工提供戒菸門診,減少結核菌暴露後之感染風險,並於年度體檢時提供結核病衛教,避免結核病事件爆發。

Based on the needs of the work, employees have to engage in congregate living. In this type of condition, once an employee progresses from tuberculosis infection to active tuberculosis, Mycobacterium tuberculosis is easily spread from one person to another. X-ray, Sputum smear and culture are currently the most common clinical diagnostic tools in Taiwan for the diagnosis of active TB, excluding latent TB infection. Tuberculin skin test (TST) is the usual clinical tool used to diagnose latent TB infection in every country; however, TST results are prone to being confounded by the Bacille Calmette-Guérin (BCG) vaccination, and therefore are not suitable in Taiwan. The Food and Drug Administration (FDA) in the United States has certified the usage of a third generation diagnostic method- QuantiFERON®-TB Gold In-Tube test (QFT-GIT) in 2007. It’s sensitivity and specificity is not only much higher than that of TST, but is also not affected by previous BCG vaccination. This study aimed to investigate the rate of latent TB infection and realize risk factors among occupational employees. The study duration was from September 1, 2010 to April 30, 2011.
This study was a cross-sectional study and had been approved by the Institutional Review Board. The study subjects were employees from an occupation. We choosed two physical examination hospitals designated hospitals A and B as our area of study. We used structural questionnaires to investigate the risk factors for latent TB infection and collected 3mls of blood specimen using QFT-GIT to screen a person for latent TB infection. Statistical analysis utilized stepwise multiple logistic regression. We discussed the risk factors for the positive results of QFT-GIT after adjusting the potential confounding factors.
The QFT-GIT positive rates were 23.3% (71/305) for hospital A, 8.3% (56/673) for hospital B and 13% for overall occupational employees. After adjustment for confounders, this study indicated that gender of women (OR=2.66, 95%CI=1.39-5.08), with TB history (OR=26.8, 95%CI=2.30-311.92), working at location A (high TB prevalence area) (OR=3.79, 95%CI=2.35-6.10) and smoking (OR=1.96, 95%CI=1.16-3.30) were associated with TB infection among occupational employees.
Our study indicated the QFT-GIT positive rate of occupational employees were elevated at higher TB incidence areas. Since these occupational employees were 24 hour clustering groups, the senior manager should enforce routine TB screening for occupational employees at higher risk areas through the use of QFT-GIT. Also we suggest performing routine follow-up for employees with TB disease history to prevent subsequent tubercle bacillus re-infection and re-activation, as well as give employees the opportunity to attend smoking cessation clinics to stop their smoking habit in order to lower infection risk after tubercle bacillus exposure. Promoting TB education during yearly physical examination to reduce TB outbreaks is also suggested.


目錄 I
表目錄 III
圖目錄 IV
摘要 V
Abstract VII
第一章 緒言 1
第一節 研究背景及重要性 1
第二節 研究動機 11
第三節 研究目的 12
第四節 研究假設 13
第二章 文獻探討 14
第一節 結核感染(病)篩檢之盛行率探討 14
第二節 結核感染(病)之危險因子探討 18
第三章 材料與方法 24
第一節 研究設計 24
第二節 研究族群及對象 25
第三節 研究架構 26
第四節 研究工具-問卷調查 27
第五節 研究工具-診斷方法 29
第六節 統計方法 30
第四章 結果 31
第一節 QuantiFERON檢驗結果之陽性率 31
第二節 基本人口學 32
第三節 醫藥狀況 35
第四節 自覺症狀 37
第五節 生活型態 39
第六節 居住環境 41
第七節 工作環境 43
第八節 QFT-GIT(+)的危險因子 45
第五章 討論 46
第一節 某行業員工潛隱性結核感染率之比較 46
第二節 某行業員工潛隱性結核感染之危險因子 47
第三節 其他文獻之危險因子 55
第四節 研究限制 60
第六章 結論與建議 61
第七章 參考文獻 63


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