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研究生:詹啓宏
研究生(外文):Chi-Hung Chan
論文名稱:骨質疏鬆與顳顎關節障礙的關聯性—族群的世代研究
論文名稱(外文):The Association between Osteoporosis and Temporomandibular disorders - A Population-based Cohort Study
指導教授:吳慶榕
指導教授(外文):Ching-Zong Wu
口試委員:袁瑞昱張仲達
口試委員(外文):Rey-Yue YuanChung-Ta Chang
口試日期:2015-06-29
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:牙醫學系碩博士班
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:2014
畢業學年度:103
語文別:英文
論文頁數:39
中文關鍵詞:骨質疏鬆顳顎關節障礙雙磷酸鹽類世代研究
外文關鍵詞:osteoporosisTMDsbisphosphonatecohort study
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目的:

此研究為求得顳顎關節障礙患者於已得骨質疏鬆患者的發生率以及之間的關聯性。雙磷酸鹽藥物與顳顎關節障礙之間的關聯性也一併被探討。


實驗方法:

本篇文獻使用台灣健保資料庫做為資料分析之來源。此篇世代研究文獻的族群包括西元2000年至2002年間被診斷出患有骨質疏鬆的民眾。被診斷出骨質疏鬆的當日訂為基準日。在基準日之前被診斷出顳顎關節障礙的族群必須被排除。在基準日前,從未診斷出骨質疏鬆及顳顎關節障礙選定四個控制變因(包括年齡,性別,共病,以及骨質疏鬆)。他們隨著年齡(5歲區間)及性別進行分組編排。整個世代研究介於西元2000年至2011年,包括了56,250個研究對象,其中11,250個對象被編入骨質疏鬆族群;另外45,000個對象則被編入對比組別。卡方測定在研究中被用來檢定人口統計差異與基本共病。Cox比例風險回歸分析用來評估兩族群間的風險比值及95%信賴區間。


實驗結果:

比起健康的族群,患有骨質疏鬆的對象有較高的風險罹患顳顎關節障礙(調整後的風險比例為1.61,95%信賴區間落在1.51至1.68之間)。顳顎關節障礙在已罹患骨質疏鬆使用雙磷酸鹽類藥物族群之發生率比起未使用藥物族群有明顯的降低(1.59 對上4.73)。此外,在排除年齡、性別以及共病之後,已罹患骨質疏鬆且使用雙磷酸類藥物族群的顳顎關節障礙發生率是未使用藥物族群的發生率的0.61倍(調整後的風險比值為0.60)。


結論:

我們得出顳顎關節障礙較易發生在罹患骨質疏鬆的族群上的結論。隨著年紀越大(大於35歲),顳顎關節障礙發生在罹患骨質疏鬆族群的機會多於對比族群。而罹患骨質疏鬆的族群在使用雙磷酸鹽類藥物後的顳顎關節障礙發生率有降低的趨勢。因此,雙磷酸鹽類藥物用於避免顳顎關節障礙發生的藥物效應在未來是可以期待的。
Aim: This study sought to acquire the incidence rate and the association of temporomandibular joint disorders (TMDs) in osteoporotic patients. The association between bisphosphonates (BPs) treatment and TMDs was also estimated.

Methods: Data from the National Health Insurance system of Taiwan were applied for the analysis. The cohort study included patients diagnosed with osteoporosis between 2000 and 2002. The date for osteoporosis diagnosis was defined as index date. Population with TMDs before the index date was excluded. Four controls (age, gender, comorbidity, and osteoporosis) were selected from people without osteoporosis and TMDs diagnosis before the index date. They were frequency matched with age (5-year stratum), and gender. This cohort study included 56,250 patients between 2000 and 2011. 11,250 subjects were placed in an osteoporotic cohort and 45,000 subjects were arranged in a comparison cohort. The chi-square test was applied to analyze demographic differences and baseline comorbidities. Cox’s proportional hazard regression was used to estimate the hazard ratio (HR) and 95% confidence intervals (CI) for the two cohorts.

Results: Patients with osteoporosis had a significantly higher risk to develop TMDs than healthy persons (adjusted HR = 1.61; 95% CI =1.55 to 1.68).The incidence of TMDs in osteoporotic group with BPs got obvious decrease (1.59 versus 4.73). Moreover, the incidence of TMDs in osteoporotic groups with BPs treatment was 0.61 fold higher than that in comparison group, with an adjusted HR of 0.60 after controlling for age, gender, and comorbidities.

Conclusion: We concluded that higher incidence of TMDs in osteoporotic cohort than that in comparison cohort. With higher age group (>age 35), TMDs in osteoporotic cohort was found more dominant than those in comparison cohort. However, the incidence of TMDs reduced in osteoporotic group with BPs treatment. The possible therapeutic protection of BPs to prevent the occurrence of TMD would be expected according to the present results.
標題....................................................I
審定書.................................................II
同意公開申請書.........................................III
學位考試保密簽到書暨簽到表...............................IV
致謝...................................................VI
目錄..................................................VII
中文摘要(Chinese Abstract).............................IX
英文摘要(English Abstract)............................XII

Chapter 1: 緒論(Introduction)...........................1

Chapter 2: 研究材料與方法(Materials and Methods)

2.1 資料來源(Data source)...............................4

2.2 研究族群(Study subjects)............................5

2.3 統計分析(Statistical analysis)......................6

Chapter 3: 結果(Results)................................7

Chapter 4: 討論(Discussion).............................9

Chapter 5: 結論(Conclusion)............................14

Chapter 6: 參考文獻(Reference)..........................15

圖目錄
Figure 1 The distribution of study cohort ............XIV

表目錄

Table 1 Distribution for age, gender and comorbidity between osteoporosis and comparison cohort ............XV

Table 2 Incidence and hazard ratio for TMD in osteoporosis cohort compared to comparison cohort stratified age, gender and comorbidity................XVI

Table 3 Incidence and hazard ratio for TMD among osteoporosis treatment...............................XVII
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