臺灣博碩士論文加值系統

男性勃起障礙的原因很多，如心因性、血管性、神經性、荷爾蒙低下等。而以血管性居多，和心血管疾病與腦中風常合併發生，因此被視為是一種全身性血管疾病之一。而高血壓、高血脂、糖尿病、吸煙等皆為危險因子。近年來越多的研究報告指出，性勃起障礙的發生在心血管疾病和腦中風發生之前。本研究企圖以台灣地區的男性在器質性勃起障礙發生後5年內，後續發生心血管疾病和腦中風的機率，來探討器質性勃起障礙是否能做為心血管疾病和腦中風的預測指標。
我們從台灣健保資料庫2002~2007年隨機抽樣300,000筆資料中，共收集了2002年看門診有器質性勃起障礙且排除心血管疾病和腦中風的男性，年齡45~60歲，計72人。另收集2002年因表淺損傷看門診的男性，但排除勃起障礙、心血管疾病及腦中風，年齡45~60歲，共計561人。我們依據資料庫追蹤兩組病人往後5年的門診紀錄。
研究結果顯示，在器質性勃起障礙組，5年內發生心血管疾病與腦中風的有19位佔26.39％，而非勃起障礙組，則有44位佔7.84％，顯示在器質性勃起障礙組後續發生心血管疾病及腦中風的比例，比非器質性勃起障礙組高出許多。透過卡方檢定與假設性檢定，顯示兩群組間有顯著差異，所以器質性勃起障礙可做為45-60歲台灣地區的男性後續5年內發生心血管疾病和腦中風的預測指標。

Organic erectile dysfunction (ED) often associated with cardiovascular disease and stroke. Causes of ED is multifactorial, includespychogenic, vasculogenic, neurogenic, and hormone deficiency. Hypertension, hyperlipidemia, diabetes and smoking, all are risk factors. Organic ED in a substantial majority of men is due to underlying vascular causes, especially atherosclerosis . Organic ED is also considered as a generalized vascular disease. In recent studies, there have been growing evidences indicated the development of ED precedes cardiovascular disease and stroke. That suggests ED is an early manifestation of atherosclerosis and a precursor to systemic vascular disease, which underlines the importance of timely detection of early-stage vascular system lesions. Aim of this study is to evaluate the role of erectile dysfunction as a potential predictor of subsequent cardiovascular disease and stroke in 5-years period after ambulatory visit for the treatment of ED.
Based on Taiwan National Health Institute Research Database and designed a prospective case-cohort study. We collected 72 ED male patients with first ambulatory visit in 2002, excluded cardiovascular disease and stroke, age were 45-60. and also collected 561 male ambulatory patients of superficial injuries in 2002, excluded ED, cardiovascular disease and stroke, age were 45-60, as comparison cohort. We looked up the development of subsequent cardiovascular disease and stroke within following 5 years period in each group.
In ED group, 19 cases(26.39%)developed cardiovascular disease and stroke subsequently. In non ED group, 44 cases (7.84%) developed cardiovascular disease and stroke subsequently. With statistics examination, The results suggest that ED can be a predictor of subsequent cardiovascular disease and stroke in 5 years for Taiwanese 45-60 years old male.

誌謝 I
摘要 II
目錄 IV
圖目錄 V
表目錄 VI
第一章 緒論 1
1.1 研究背景與動機 1
1.2 研究問題與目的 2
1.3 研究流程 2
第二章 文獻探討 4
2.1 全民健康保險研究資料庫相關說明 4
2.1.1疾病分類之定義 4
2.1.2疾病分類之應用 5
2.1.3疾病分類發展沿革 5
2.1.4國際疾病分類 5
2.2 器質性勃起障礙定義及發生原因 6
2.3 器質性勃起障礙與心血管疾病之相關研究 8
2.4 小結 10
第三章 研究方法與結果 11
3.1 研究方法 11
3.2 研究步驟 12
3.3 敘述性統計 16
3.3.1 敘述性統計分析 16
3.3.2 結果比較 18
3.4 卡方檢定 20
3.5 小結 22
第四章 討論 23
第五章 結論與建議 25
參考文獻 27

1.王淑娟(2004)，心臟血管疾病危險因子和代謝性症候群及其組成與脈搏傳導速度之相關性研究。
2.王俊毅(2006)，適合度檢定：卡方分布之自由度。
3.林廷燦(2001)，心臟血管疾病預防之最新觀念，內科學誌 。
4.陳哲民、吳岱穎、陳建志、林光洋、郭冠良、黃惠娟,(2006)，基層醫學第二十一卷第一期。
5.康新立(2002)，年輕人勃起功能障礙的病因調查。J Medern Urol Vol.7 No.3,p170-171。
6.楊建華(2007)，《現代男性不育診療學》, P238-244。
7.翁耀臨(2006)，淺談交叉分析與卡方檢定
8.Aizenberg, D. et al. (1995), Sexual dysfunction in male schizophrenic patients. J Clin Psych.;56:137-141.
9.Araujo, A. B., Zilber, S.M., O'Donnell A. B., McKinlay, J. B. (2005), Erectile dysfunction and stroke risk in aging men: prospective results from the Massachusetts Male Aging Study. J Urol;173;291
10.Berookhim, B. M., Bar-Chama N.(2011), Medical implications of erectile dysfunction. Med Clin North Am.;95(1):213-21.
11.Böhm, M., Baumhäkel M., Teo, K., Sleight, P., Probstfield, J., Gao P., Mann, J. F., Diaz R., Dagenais, G. R., Jennings, G. L., Liu, L., Jansky, P., Yusuf, S. (2010), Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both Circulation;121(12):1439-46.
12.Corona, G., Monami, M., Boddi, V., Cameron-Smith, M., Lotti, F., de Vita, G., Melani, C., Balzi, D., Sforza. A., Forti, G., Mannucci, E., Maggi, M.(2010), Male sexuality and cardiovascular risk. A cohort study in patients with erectile dysfunction J Sex Med.;7(5):1918-27.
13.Costa ,C., Virag, R.(2009). The endothelial-erectile dysfunction connection: an essential update. J Sex Med. Sep;6(9):2390-404.
14.Guo, W., Liao, C., Zou, Y., Li, F., Li, T., Zhou, Q., Cao, Y., Mao, X.(2010).Erectile Dysfunction and Risk of Clinical Cardiovascular Events: A Meta-Analysis of Seven Cohort Studies.J Sex Med.
15.Jack Ende(2000). Chapter 187, Organic Impotence Bookshelf; ID: NBK297 PMID: 21250140
16.Jones, R. W., Rees, R. W., Minhas, S., Ralph, D., Persad, R. A., Jeremy, J. Y. (2002), Oxygen free radicals and the penis.. Expert Opin Pharmacother, 3(7):889-97. 18 ..
17.Kew-Kim Chew et al(2010). ErectileDyfunction as a Predictor for Subsequent Atherosclerotic Cardiovascular Events: Findings from a Linked-Data Study.The Journal of Sexual Medicine .Volume 7, Issue 1pt1, pages 192–202.