臺灣博碩士論文加值系統

背景 過去總膽固醇與三酸甘油酯的長期追蹤資料大多為盛行率的探討。有關總膽固醇與三酸甘油酯的時間趨勢分析也多為測量二次或短時間重複測量的分析，或是利用不同時間點的橫斷研究看群體的時間變化趨勢。不同世代之飲食生活方式及不同年代血脂藥物使用，加上年齡效應，三種效應對於總膽固醇及三酸甘油酯之變化少被探討。
目的 以長期追蹤研究探討總膽固醇與三酸甘油酯的年齡、年代與世代效果。由建構連續反應變數模式探討總膽固醇與三酸甘油酯隨時間改變的趨勢，並考量重複測量的相關性與調整總膽固醇與三酸甘油酯相關因子後，觀察總膽固醇與三酸甘油酯的年齡、年代與世代效果。
方法 研究族群為1999年至2009年參與週期性健康檢查的民眾，針對設籍台灣某縣市年滿20歲以上民眾提供成人預防保健服務等慢性病及癌症篩檢。並利用問卷調查了解參與者的生活習慣與病史。以長期追蹤資料分析總膽固醇與三酸甘油酯的時間趨勢，比較經由固定效果模式及考量重複測量的混合效果模式分析後，是否總膽固醇與三酸甘油酯具有年齡、年代及世代的同時效果。
結果 共有109,478人參與篩檢，其中超過半數有重複兩次以上的測量。以相關性統計發現總膽固醇與三酸甘油酯會隨著時間而有相關性遞減的趨勢。另外，總膽固醇與三酸甘油酯與年齡呈現二次方之關係。三酸甘油酯隨年代有上升再慢慢下降的趨勢，而總膽固醇的趨勢則較不明顯。同時調整年齡、年代、世代及相關影響因子後，總膽固醇隨著出生世代越晚而增加，年代效果較不明顯，年齡具統計上顯著意義，而三酸甘油酯隨著出生世代越晚而降低，其年代效果先增再降，年齡仍具有顯著效應。
討論 年齡-年代-世代效果對於總膽固醇與三酸甘油酯的長期變化有影響，而長期追蹤研究更可以凸顯年代的影響。調整性別、年齡、年代及世代後，影響總膽固醇與三酸甘油酯變異的因子相似，但喝酒、吃肉與教育程度對兩者的影響則不同。需要更多研究證實這個結果。

中文摘要 ii
英文摘要 iv
目錄 vi
表目錄 ix
圖目錄 xi
第1章 前言 1
1.1 研究背景 1
1.2 研究動機與目的 1
第2章 血脂簡介 3
2.1 血脂肪分類 3
2.2 血脂與粥狀動脈硬化的關係 3
2.3 影響總膽固醇與三酸甘油酯的相關因子 4
第3章 材料與方法 7
3.1 研究設計 7
3.2 資料來源與結構 7
3.3 研究族群 8
3.4 分析變項 8
3.5 統計分析 8
3.5.1 描述性統計 8
3.5.2 重複測量相關性 9
3.5.3 反應評量(response profile)分析法 9
3.5.4 參數曲線 10
3.5.5 線性混合效果模式之應用 11
第4章 統計結果 12
4.1 描述性結果 12
4.2 重複測量相關性 12
4.3 年齡-年代-世代分析 13
4.4 以線性混合效果模式分析年齡-年代效果 15
4.5 以固定效果模式與線性混合效果模式分析總膽固醇與三酸甘油酯相關因子 16
4.6 以線性混合效果模式分析年齡-年代-世代效果 18
第5章 討論 21
5.1 主要結果 21
5.2 總膽固醇及三酸甘油酯與年齡-年代關係 21
5.3 影響總膽固醇與三酸甘油酯相關因子 23
5.4 總膽固醇及三酸甘油酯與世代關係 25
5.5 公共衛生上的應用 26
5.6 研究限制 27
5.7 結論 28
參考文獻 30
表 34
圖 52

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