臺灣博碩士論文加值系統

肝癌在台灣約佔10％總死亡率，肝癌感染原因大部分源於肝炎病毒A、B、C、D和E。其中，B型肝炎和C型肝炎被認為是導致肝癌的罪魁禍首，B型肝炎或C型肝炎的後續發展研究已引起學者們的關注，研究分析B型肝炎(HBV)和癌症之相關學術領域[1-10]，B型肝炎病毒是導致肝癌（HCC）的危險因素，B型肝炎患者佔HCC至少50％病例。近日學術研究肝炎病毒感染和胰腺癌發生之相關性，根據中國學者研究指出，B型肝炎病患感染胰腺癌風險會增加[4,5]。然而，臺灣學者發現B型肝炎病患感染胰腺癌風險並沒有顯著的關係[10]。後續有許多不同國家研究探索肝炎病毒感染和淋巴瘤之間相關性，根據意大利學者報告指出C型肝炎患者感染B細胞淋巴瘤有較高病毒感染率[6]，然而在法國、德國和美國進行的研究表明，卻不存在這樣的關係[6-9]。這表明，肝炎病毒和癌症之間的關聯性可能跟地區或物種因素有關。儘管B型肝炎和肝癌之間相關性已被證實，但是目前研究針對B型肝炎和非肝癌以外之癌症探討關係卻較少被研究。因此，這項研究的目的為評估台灣B型肝炎病毒感染對癌症之發生率和風險，通過數據分析全民健康保險資料庫從1996到2010年的一項全國性B型肝炎列隊之前瞻性研究，探討B型肝炎是否會增加癌症之風險和癌症之發病率在台灣。並且通過這項研究提供的資料，使治療和預後可以適當的被規劃和預測。

Liver cancer, mostly arising from hepatitis type A, B, C, D, and E, constitutes about 10% of total death in Taiwan. Among them, hepatitis B and C are regarded as the main culprits leading to liver cancer. The subsequent development after infecting hepatitis B or C has drawn scholars’ attention. Studies that analyze the relation between hepatitis B viral (HBV) and cancers flourish in academic field [1-10]. HBV is the risk factor for Hepatocellular Carcinoma (HCC) and accounts for at least 50% cases of HCC [1-3]. Recently the correlation between hepatitis viral infection and the occurrence of pancreatic cancer was also studied. Patients with HBV will have an increased risk of infecting pancreatic cancer according to studies conducted by China [4,5]. However, no significant relation was found in a reported by Taiwanese scholars [10]. The follow-up researches exploring the relevance of HBV infection to lymphoma were performed in many different countries. Italian scholar reported patients with B cell lymphoma have higher viral infection rate of hepatitis C [6]. On the other hand, researches performed in France, Germany and US revealed that such a relationship does not exist [6-9]. This indicates that the relation between hepatitis and cancer occurrence might be pending on factors relating to region or species. Even though the correlation between the infection of HBV and liver cancer was confirmed, yet relatively few researches targeting on the relation of HBV and the incidence of cancers other than liver cancer were reported. This study aims at evaluating the effect of HBV infection on cancers in Taiwan by analyzing data retrieved from National Health Insurance Research Database (NHIRD) from January 1996 to December 2010. A nationwide HBV cohort prospective study to investigate whether HBV increases the risks of cancers and cancers incidence in Taiwan. With the information provided by this research, the treatment and prognosis following can be properly planned and predicted.

論文審定書 i
論文審定論文公開授權書書 ii
誌謝 iv
中文摘要 v
英文摘要 vi
目 錄 vii
圖目錄 ix
表目錄 x
第一章 簡介 1
1.1背景與目的 1
1.2全民健康保險研究數據庫 2
1.3國際疾病分類 5
第二章相關研究 7
2.1 B型肝炎盛行率 7
2.1.1 國際上和臺灣肝炎病毒研究 7
2.2 B型肝炎傳染途徑和症狀 8
2.2.1 肝炎種類 8
2.2.2 B型肝炎病毒簡介 8
第三章 研究方法 9
3.1資料來源 9
3.2研究設定 10
3.3研究架構 10
3.4 資料處理及統計方法 12
3.4.1 發生比率Incidence rate 13
3.4.2 卡方檢定 13
3.4.3 95％信賴區間 15
第四章 實驗結果 17
4.1 發生率與罹癌數據統計 17
第五章 討論 21
參考文獻 23
附錄 27
附錄1-1 門診處方及治療明細檔(適用85~92年) 27
附錄1-2 門診處方及治療明細檔(適用93年以後) 31
附錄1-3 門診處方醫令明細檔(適用86~95年) 35
附錄1-4 門診處方醫令明細檔(適用86~95年) 36
附錄1-5住院醫療費用清單明細檔(適用85~92年) 38
附錄1-6 住院醫療費用清單明細檔(適用83~95年) 43
附錄1-7 住院醫療費用清單明細檔(適用96年以後) 48
附錄1-8 承保資料檔(適用98年前) 53
附錄1-9 承保資料檔(適用99年以後) 54

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