臺灣博碩士論文加值系統

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 -

Abdi F, Mobedi H, Mosaffa N, Dolatian M, Ramezani Tehrani F. 2016. Hormone therapy for relieving postmenopausal vasomotor symptoms: A systematic review. Archives of Iranian medicine 19:141-146.
Aboonq MS. 2015. Pathophysiology of carpal tunnel syndrome. Neurosciences (Riyadh, Saudi Arabia) 20:4-9.
Aroori S, Spence RA. 2008. Carpal tunnel syndrome. The Ulster medical journal 77:6-17.
Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. 1999. Prevalence of carpal tunnel syndrome in a general population. Jama 282:153-158.
Baker VL. 1994. Alternatives to oral estrogen replacement. Transdermal patches, percutaneous gels, vaginal creams and rings, implants, other methods of delivery. Obstetrics and gynecology clinics of North America 21:271-297.
Barcenilla A, March LM, Chen JS, Sambrook PN. 2012. Carpal tunnel syndrome and its relationship to occupation: A meta-analysis. Rheumatology (Oxford, England) 51:250-261.
Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, et al. 2002. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology 113:1429-1434.
Blok RD, Becker SJ, Ring DC. 2014. Diagnosis of carpal tunnel syndrome: Interobserver reliability of the blinded scratch-collapse test. Journal of hand and microsurgery 6:5-7.
Boz C, Ozmenoglu M, Altunayoglu V, Velioglu S, Alioglu Z. 2004. Individual risk factors for carpal tunnel syndrome: An evaluation of body mass index, wrist index and hand anthropometric measurements. Clinical neurology and neurosurgery 106:294-299.
Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Neto FC, Silva JB. 2014. Carpal tunnel syndrome - part i (anatomy, physiology, etiology and diagnosis). Revista brasileira de ortopedia 49:429-436.
Clisham PR, Cedars MI, Greendale G, Fu YS, Gambone J, Judd HL. 1992. Long-term transdermal estradiol therapy: Effects on endometrial histology and bleeding patterns. Obstetrics and gynecology 79:196-201.
de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. 1992. Carpal tunnel syndrome: Prevalence in the general population. Journal of clinical epidemiology 45:373-376.
Deger AN, Deger H, Taser F. 2016. The role of neoangiogenesis and vascular endothelial growth factor in the development of carpal tunnel syndrome in patients with diabetes. Nigerian journal of clinical practice 19:189-195.
Ettema AM, Amadio PC, Zhao C, Wold LE, An KN. 2004. A histological and immunohistochemical study of the subsynovial connective tissue in idiopathic carpal tunnel syndrome. The Journal of bone and joint surgery American volume 86-a:1458-1466.
Freeland AE, Tucci MA, Barbieri RA, Angel MF, Nick TG. 2002. Biochemical evaluation of serum and flexor tenosynovium in carpal tunnel syndrome. Microsurgery 22:378-385.
Geoghegan JM, Clark DI, Bainbridge LC, Smith C, Hubbard R. 2004. Risk factors in carpal tunnel syndrome. Journal of hand surgery (Edinburgh, Scotland) 29:315-320.
Gingery A, Yang TH, Passe SM, An KN, Zhao C, Amadio PC. 2014. Tgf-beta signaling regulates fibrotic expression and activity in carpal tunnel syndrome. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 32:1444-1450.
Hall GM, Spector TD, Studd JW. 1992. Carpal tunnel syndrome and hormone replacement therapy. BMJ (Clinical research ed) 304:382.
Jillapalli D, Shefner JM. 2005. Electrodiagnosis in common mononeuropathies and plexopathies. Seminars in neurology 25:196-203.
Jurgens RW, Jr., Downey LJ, Abernethy WD, Cutler NR, Conrad J. 1992. A comparison of circulating hormone levels in postmenopausal women receiving hormone replacement therapy. American journal of obstetrics and gynecology 167:459-460.
Karne SS, Bhalerao NS. 2016. Carpal tunnel syndrome in hypothyroidism. Journal of clinical and diagnostic research : JCDR 10:Oc36-38.
Kim HS. 2014. Carpal tunnel syndrome caused by tophaceous gout. The Korean journal of internal medicine 29:544-545.
Kim JK, Hann HJ, Kim MJ, Kim JS. 2010. The expression of estrogen receptors in the tenosynovium of postmenopausal women with idiopathic carpal tunnel syndrome. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 28:1469-1474.
Lee KH, Lee CH, Lee BG, Park JS, Choi WS. 2015. The incidence of carpal tunnel syndrome in patients with rheumatoid arthritis. International journal of rheumatic diseases 18:52-57.
Muller M, Tsui D, Schnurr R, Biddulph-Deisroth L, Hard J, MacDermid JC. 2004. Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: A systematic review. Journal of hand therapy : official journal of the American Society of Hand Therapists 17:210-228.
Pfeilschifter J, Koditz R, Pfohl M, Schatz H. 2002. Changes in proinflammatory cytokine activity after menopause. Endocrine reviews 23:90-119.
Shum C, Parisien M, Strauch RJ, Rosenwasser MP. 2002. The role of flexor tenosynovectomy in the operative treatment of carpal tunnel syndrome. The Journal of bone and joint surgery American volume 84-a:221-225.
Sikkandar MF, Sapuan J, Singh R, Abdullah S. 2012. Gouty wrist arthritis causing carpal tunnel syndrome--a case report. The Medical journal of Malaysia 67:333-334.
Solomon DH, Katz JN, Bohn R, Mogun H, Avorn J. 1999. Nonoccupational risk factors for carpal tunnel syndrome. Journal of general internal medicine 14:310-314.
Toesca A, Pagnotta A, Zumbo A, Sadun R. 2008. Estrogen and progesterone receptors in carpal tunnel syndrome. Cell biology international 32:75-79.
van Dijk MA, Reitsma JB, Fischer JC, Sanders GT. 2003. Indications for requesting laboratory tests for concurrent diseases in patients with carpal tunnel syndrome: A systematic review. Clinical chemistry 49:1437-1444.
Zyluk A. 2013. Carpal tunnel syndrome in pregnancy: A review. Polish orthopedics and traumatology 78:223-227.