背景：
腕隧道症候群，是正中神經在手腕處穿過「腕隧道」遭受到壓迫時所造成的臨床症狀，常發生在需重複手腕動作的人身上。過去的研究發現，除了職業性因素外，尚有其他非職業性因素。研究指出，停經後女性之腕隧道症候群發生率上升，此時期為體內雌性激素最低的時期。懷孕時期也有較高的腕隧道症候群發生率。由此推測，腕隧道症候群的發生亦可能與雌性激素變化有關。本研究的目的為探討婦女使用荷爾蒙補充療法與否，和腕隧道症候群的相關性。

研究方法：
本研究使用台灣健保資料庫百萬歸人檔，自1996年至2010年共15年期間，對象為45歲以上女性，在使用荷爾蒙補充療法之前已被診斷腕隧道症候群之個案予以排除。有腕隧道症候群診斷者為研究組，其他為對照組。此外，也分析幾個腕隧道症候群的相關危險因子，並計算其危險性對比值及95％信賴區間。

研究結果：
研究對象共有118930位45歲以上女性，排除使用荷爾蒙補充療法之前已被診斷腕隧道症候群之個案後，有4535位研究組，113774位為對照組。45歲以上女性使用荷爾蒙補充療法者有6.81%被診斷腕隧道症候群，沒有使用荷爾蒙補充療法者有2.62%被診斷腕隧道症候群，其勝算比(OR)為2.72，95%信賴區間為2.56-2.88，p〈0.001，顯示有顯著差異；經校正後之勝算比(OR)為2.04，95%信賴區間為1.91-2.17，p〈0.001，顯示有顯著差異。使用荷爾蒙補充療法為腕隧道症候群顯著的危險因子。

結論：
45歲以上女性使用荷爾蒙補充療法者比起沒有使用荷爾蒙補充療法者，有較高的腕隧道症候群盛行率，這有可能與雌性激素的補充有關。

Background: Carpal tunnel syndrome (CTS) refers to the complex of symptoms and signs caused by compression of the median nerve as it passes through the carpal tunnel. It often occurs in people who need repetitive wrist movements. In addition to occupational factors, there are some non-occupational factors that may also contribute to occurrence of CTS. The incidence of CTS in postmenopausal women has been reported to be increased, when the decrease in serum estrogen concentrations are at the greatest. Also, higher CTS rate was noted in pregnancy women. Therefore, the occurrence of CTS may be related to the fluctuation of estrogen. We conducted a study to evaluate the relationship between hormone replacement therapy (HRT) and the occurrence of CTS.

Methods: Data from the Taiwan National Health Insurance Research Database of one million enrollees during a period of 15 years starting 1 January 1996 was used. All female older than 45 years-old was selected, and those with the diagnosis of CTS before HRT use were excluded. We selected people with diagnosis of CTS as cases, and people who without diagnosis of CTS as controls. Statistical association with CTS was determined for several medical risk factors. The odds ratio and its 95% confidence interval (CI) were calculated for each potential risk factor.

Results: A total of 118930 female older than 45 years-old was selected. After excluded people with the diagnosis of CTS before HRT use, 4535 patients with a diagnosis of CTS older than 45 years-old were included, together with 113774 patients as a comparison group. The prevalence of CTS in HRT users in women older than 45 years-old was 6.81% while it was 2.62% in those who had not received HRT, yielding an odds ratio is of 2.72 (p〈0.001, 95% CI 2.56-2.88). The adjusted odds ratio is 2.04 (p〈0.001, 95% CI 1.91-2.17). HRT use was found to be the significant comorbidity associated with CTS.

Conclusion: A higher prevalence of CTS in HRT users in women older than 45 years-old was observed in comparison with those who had not received HRT. It is possible that the occurrence of CTS may be related to the supplement of estrogen.

目錄

Abstract I
摘要 III
誌謝 IV
目錄 V
表目錄 VI
圖目錄 VII
主文 - 1 -
(I).Background - 1 -
(A).Introduction of carpal tunnel syndrome - 1 -
(B). Introduction of menopause and hormone replacement therapy - 2 -
(II). Literature review - 3 -
(III). Significance - 4 -
(IV).Materials and Methods - 5 -
(A).Data sources - 5 -
(B).Study design - 5 -
(C).Statistical analysis - 6 -
(V).Result - 7 -
(VI).Discussion - 10 -
(A).Prevalence of CTS - 10 -
(B).Pathogenesis of CTS - 10 -
(C).CTS and HRT - 11 -
(D).CTS and other comorbidities - 12 -
(E).Strength and limitations - 14 -
(F).Conclusion - 15 -
(VII).Conflict of interest - 16 -
Reference - 35 -

表目錄

Table 1 Gender distribution of one million randomly selected enrollees from NHIRD - 17 -
Table 2 ICD-9-CM Codes and A-codes used in the study - 18 -
Table 3 Prevalence of CTS in one million randomly selected enrollees from NHIRD - 19 -
Table 4 Prevalence of estrogen users in one million randomly selected enrollees from NHIRD - 20 -
Table 5 Prevalence of CTS in female older than 45-years-old - 21 -
Table 6 Prevalence of CTS in female older than 45-years-old after exclusion those with CTS diagnosis before HRT use - 22 -
Table 7 The relationship of CTS and HRT in female older than 45-years-old - 23 -
Table 8 The relationship of CTS and HRT in female at different age group - 24 -
Table 9 Univariate logistic regression analysis of comorbidities of CTS in female older than 45-years-old - 25 -
Table 10 Multivariate logistic regression analysis of comorbidities of CTS in female older than 45-years-old - 26 -
Table 11 Multivariate logistic regression analysis of comorbidities of CTS in female at the age of 45 to 49-years-old - 27 -
Table 12 Multivariate logistic regression analysis of comorbidities of CTS in female at the age of 50 to 54-years-old - 28 -
Table 13 Multivariate logistic regression analysis of comorbidities of CTS in female at the age of 55 to 59-years-old - 29 -
Table 14 Multivariate logistic regression analysis of comorbidities of CTS in female at the age of 60 to 64-years-old - 30 -
Table 15 Multivariate logistic regression analysis of comorbidities of CTS in female older than 65-years-old - 31 -
Table 16 The Breslow-Day statistics test for the homogeneity of the odds ratio across categories of the layer variable - 32 -


圖目錄

Figure 1 Flow chart of the study - 33 -
Figure 2 Possible mechanisms of estrogen causing CTS - 34 -

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