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研究生:廖婉君
研究生(外文):Liao, Wan-Chung
論文名稱:基線陰性後續轉陽性糞便潛血反應免疫法大腸直腸癌篩檢結果之危險因子分析
論文名稱(外文):Risk Factors for a Positive Colorectal Cancer Screening with Immunochemical Fecal Occult Blood Test Following a Baseline Negative Result
指導教授:吳明賢吳明賢引用關係陳素秋陳素秋引用關係
指導教授(外文):Ming-Shiang WuSu-Chiu Chen
口試委員:吳明賢陳素秋李宜家邱瀚模
口試委員(外文):Ming-Shiang WuSu-Chiu ChenYi-Chia LeeHan-Mo Chiu
口試日期:2012-06-25
學位類別:碩士
校院名稱:國立臺北護理健康大學
系所名稱:健康事業管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:111
中文關鍵詞:糞便潛血反應免疫法Kaplan-Meier存活曲線估計log-rank testCox比例風險迴
外文關鍵詞:immunochemical fecal occult blood testKaplan-Meier survival curves estimationlog-rank testCox proportional hazards regression analysis
相關次數:
  • 被引用被引用:1
  • 點閱點閱:227
  • 評分評分:
  • 下載下載:7
  • 收藏至我的研究室書目清單書目收藏:0
研究背景:糞便潛血反應免疫法對大腸直腸癌篩檢提供方便與準確的方式。但對於目前二年一次篩檢政策與重複篩檢者糞便潛血反應陰性轉陽性風險因素議題上,目前卻鮮少有經由縱向長期追蹤的相關研究提出。

研究目的:針對重複接受糞便潛血反應免疫法篩檢的個案,探討其糞便潛血反應由陰性轉為陽性的相關風險因素。

研究方法:透過單一中心健檢資料庫,進行為期五年(2007-2011年)的回溯性世代分析。個案的選取為初次糞便潛血反應呈陰性且在這五年的觀察期中有持續接受糞便潛血追蹤者,再依據資料庫,進行糞便潛血反應由陰性轉為陽性的相關風險因素做分析。資料庫的風險因素選取包含人體測量、生活型態、疾病史、家族病史、檢驗數據、症狀評估及下消化道內視鏡檢查。運用Kaplan-Meier存活曲線估計及log-rank test與Cox-比例風險迴歸分析來探討糞便潛血反應由陰性轉為陽性的相關風險因素。

研究結果:在26624位受檢個案中有6532位符合我們設定的條件進入此研究中,包含4065位男性與2467位女性,平均年齡為52.4歲。糞便潛血反應免疫法對下消化道病灶之敏感度、特異度分別為17.2%(95%信賴區間16.8%-17.7%)、92.5%(95%信賴區間92.2%-92.8%)。在這6532位個案中有448位糞便潛血篩檢反應由陰性轉陽性,其中男性有68.3%。先以log-rank test來初步檢試造成糞便潛血反應由陰性轉為陽性的可能相關風險因素,接著在多變量Cox比例風險迴歸分析中,我們發現年長者(危險比hazard ratio=1.026, 95%信賴區間1.017-1.035)和男性(危險比hazard ratio=1.29,95%信賴區間105.7-1.576)是造成糞便潛血反應由陰性轉為陽性的顯著風險因素。

研究結論:年長者與男性為造成糞便潛血反應免疫法由陰性轉為陽性的危險因素。
Background: Immunochemical fecal occult blood test is a convenient and accurate modality for colorectal cancer screening. However, there are very few studies longitudinally following up the same subjects who received repeated fecal occult blood test so the optimal interval for repeated fecal screening that is tailored to individual risk factors remains elusive.
Aim: The purpose of this study was to assess the risk factors associating with a positive immunochemical fecal occult blood test following a baseline negative result.
Methods: A retrospective cohort of asymptomatic adults who underwent health screening program from January 2007 through December 2011 was evaluated in the present study. Subjects with initial negative fecal tests were recruited as our study population and we followed up these subjects who received subsequent fecal tests in the 5-year study period. Risk factor analyses were based on the computerized dataset with anthropometric measures, social habits, medical histories, family histories, laboratory findings, symptomatic evaluation, and endoscopic screening. The Kaplan-Meier survival curves estimation and log-rank test and Cox proportional hazards regression analysis were performed to identify risk factors associated with the occurrence of a positive fecal test result following an initial negative test result.
Results: A total 6532 of 26624 subjects were enrolled in the study with initial and following fecal tests, including 4065 men and 2467 women (mean age ± SD, 52.4 ± 10.8 years). The sensitivity, specificity of the fecal test for colonic neoplasm were 17.2% (95% CI: 16.8%-17.7%), 92.5% (95% CI: 92.2%-92.8%), respectively. Among 6532 study subjects, 448 had positive results of following fecal tests, including 68.3% male subjects. The Kaplan-Meier survival curves estimation and log-rank test and Cox proportional hazards regression analysis identified that elder age (hazard ratio= 1.026, 95% CI: 1.017-1.035) and male gender (hazard ratio= 1.29, 95% CI: 1.057-1.576) were significantly associated with the risk of positive fecal testing in the follow-up screening.
Conclusions: Elder age and male were risk factors for the future occurrence of positive immunochemical fecal occult blood test results.
目錄
致謝 II
中文摘要 III
英文英摘 V
圖目次 VIII
表目次 IX
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究重要性及研究目的 3
第二章 文獻探討 4
第一節 篩檢工具說明 5
第二節 篩檢策略及成效說明 7
第三節 相關危險因子介紹 7
第四節 保護因子介紹 12
第五節 總結 12
第三章 研究方法 13
第一節 概念性架構 13
第二節 操作性定義 14
第三節 研究期間及對象與資料來源及處理 14
第四節 資料分析方法 16
第四章 研究結果 18
第一節 描述性統計各年度iFOBT下腸道病灶的效度及成效分析 18
第二節 描述性統計觀察對象之人口學變項分析 20
第三節iFOBT與潛在相關因素之單變量分析 21
第四節Kaplan-Meier存活曲線估計及log-rank test 22
第五節Cox比例風險迴歸分析 24
第五章 討論 26
第一節 重要結果討論 26
第二節 研究限制 27
第三節 建議 28
參考文獻 94
中文部分 94
英文部分 94

圖目次
圖一 概念架構圖 30
圖二 研究對象篩選流程 31
圖三 Kaplan-Meier存活曲線分析-進入觀察期間之初始值潛在相關因子與iFOBT"不會由陰性轉陽性"的機會分析流程圖 32
圖四 性別與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 33
圖五 年齡分層與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 33
圖六 教育程度之高低與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 34
圖七 代謝症候群之有無與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 34
圖七之一 血壓高與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 35
圖七之二 腹圍與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 35
圖七之三 空腹血糖與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 36
圖七之四 三酸甘油脂與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 36
圖七之五 高密度膽固醇與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 37
圖八 大腸息肉病史與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 37
圖九 排便後糞便上有血與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 38
圖十 便祕自覺症狀者與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 38
圖十一 女性停經狀態與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 39
圖十二 服用抗凝血劑或抗血小板藥與iFOBT"不會由陰性轉陽性"事件 39
圖十三 服用降尿酸藥物與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 40
圖十四 飲酒習慣與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 40
圖十五 飲酒頻率與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 41
圖十六 抽菸習慣與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 41
圖十七 抽菸包年數與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 42
圖十八 運動習慣與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 42
圖十九 國健局運動政策333運動原則與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 43
圖二十 大腸癌家族病史者與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 43
圖二十一 C-反應蛋白與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 44
圖二十二 丙氨酸轉氨脢(ALT)與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 44
圖二十三 血紅素(Hemoglobin)與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 45
圖二十四 血小板(Platelet)與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 45
圖二十五 痔瘡有無與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 46
圖二十六 iFOBT由陰性轉陽性前有無腺瘤與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 46
圖二十七 風險分層與iFOBT"不會由陰性轉陽性"事件的發生機率趨勢 47
圖二十八iFOBT轉陽性前是否曾接受息肉切除術或EMR與iFOBT"不會由陰性轉呈陽性"事件的發生機率趨勢 47

表目次
表一 國內外CRC篩檢工具相關研究 48
表二 國內外CRC篩檢策略及成效說明相關研究 49
表三 變項之操作性定義說明 50
表六 人口學變項分析 59
表七 iFOBT與潛在相關因素之單變量分析 62
表九 男性iFOBT下腸道病灶的效度及成效 68
表十 女性iFOBT下腸道病灶的效度及成效 69
表十一 年齡小於50歲者iFOBT下腸道病灶的效度及成效 70
表十二 年齡50-69歲者iFOBT下腸道病灶的效度及成效 71
表十三 年齡大於70歲者iFOBT下腸道病灶的效度及成效 72
表十四 有高血壓病史者iFOBT下腸道病灶的效度及成效 73
表十五 無高血壓病史者iFOBT下腸道病灶的效度及成效 74
表十六 腹圍異常者iFOBT下腸道病灶的效度及成效 75
表十七 腹圍正常者iFOBT下腸道病灶的效度及成效 76
表十八 空腹血糖異常者iFOBT下腸道病灶的效度及成效 77
表十九 空腹血糖正常者iFOBT下腸道病灶的效度及成效 78
表二十 三酸甘油脂異常者iFOBT下腸道病灶的效度及成效 79
表二十一 三酸甘油脂正常者iFOBT下腸道病灶的效度及成效 80
表二十二 高密度膽固醇異常者iFOBT下腸道病灶的效度及成效 81
表二十三 高密度膽固醇正常者iFOBT下腸道病灶的效度及成效 82
表二十四 有代謝症候群者iFOBT下腸道病灶的效度及成效 83
表二十五 無代謝症候群者iFOBT下腸道病灶的效度及成效 84
表二十六 有高血壓過去病史者iFOBT下腸道病灶的效度及成效 85
表二十七 無高血壓過去病史者iFOBT下腸道病灶的效度及成效 86
表二十八 50-69歲男性無代謝症候群者iFOBT下腸道病灶的效度及成效 87
表二十九 50-69歲男性有代謝症候群者iFOBT下腸道病灶的效度及成效 88
表三十 小於50歲女性無代謝症候群者iFOBT下腸道病灶的效度及成效 89
表三十一 除50-69歲男性有代謝症候群者或小於50歲女性無代謝症候群者外iFOBT下腸道病灶的效度及成效 90
表三十二 50-69歲男性有高血壓病史者iFOBT下腸道病灶的效度及成效 91
表三十三 小於50歲女性無高血壓病史者iFOBT下腸道病灶的效度及成效 92
表三十四 除50-69歲男性有高血壓病史者或小於50歲女性無高血壓病史者外iFOBT下腸道病灶的效度及成效 93


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