中文摘要
慢性鼻竇炎、過敏性鼻炎，為兩大主要上呼吸道疾病。目前認為慢性鼻竇炎為多重原因造成，主要包含病患體質因素、微生物因素、環境因素三大類；過敏性鼻炎則為在接觸過敏原之後，由IgE媒介的發炎反應，所引發的鼻部徵候。近年來由基礎研究已發現，由鼻黏膜所產生之過敏反應，會經由血液產生全身性發炎反應(systemic effects)，而誘發的過敏細胞再度影響鼻腔。對於氣候因子對呼吸道的影響，過去研究主要針對下呼吸道疾病，氣喘。本研究針對氣候因子：溫度和相對溼度，對慢性鼻竇炎、過敏性鼻炎就診率之影響。
研究資料來自於全民健保資料庫，和中央氣象局2003至2012年資料。統計軟體為SAS 9.3，並將台灣選取五個主要區域：台北市、宜蘭縣、花蓮縣、台中市、高雄市，即不同氣候區域之下分析。
結果發現，由2003年起始計算，總共476833人納入研究：研究族群小於18歲占26.8%，大於18歲占73.2%。男女比例為1.02:1。研究期間過敏性鼻炎隨時間就診率增加，慢性鼻竇炎則是下降。過敏性鼻炎就診率趨勢與季節性(時間變動)較為相關，慢性鼻竇炎就診率趨勢與季節性(時間變動)無關。以Coefficients Poisson regression model 計算相關性：五個城市平均而言，隨時間過敏性鼻炎就診率上升，相對溼度增加， 就診率下降，溫度上升，就診率下降；當以相對溼度和溫度做交互作用，P值小於0.05。慢性鼻竇炎則是五個城市平均而言，隨著相對溼度上升，就診率下降；隨著溫度上升，就診率下降(P值均達統計意義)，相對溼度、溫度交互作用後結果不顯著。最後將西元2003至2012年間，各月分氣喘及過敏性鼻炎就診人次，以Pearson Correlation Coefficients做相關性分析，呈現高度相關性(r=0.947, p<0.0001)；氣喘及慢性鼻竇炎就診人次，亦呈現高度相關性(r=0.906, p<0.0001)。
綜合以上結果，兩種主要鼻部疾病：過敏性鼻炎、慢性鼻竇炎就診率，與氣候因子溫度、相對濕度相關，因此雖然慢性鼻竇炎為多重原因綜合造成之疾病，在本國仍偏向過敏性，疾病的控制應與過敏性鼻炎類似，結合對於過敏原的防治。

Abstract
Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) are two of the most common upper airway diseases worldwide. Generally, CRS was regarded as a syndrome with multiple etiologies. Therefore, CRS may be a common endpoint for the interactions of different factors, including microbial factors, environmental factors, and host factors. Allergic rhinitis is defined by Allergic Rhinitis and its Impact on Asthma (ARIA) Guidelines as “a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation”. Recently, it has been noted that after exposure to allergens from snares, systemic humoral recirculation of allergic cells would nonspecifically recruit back to the diseased sinuses. In the past studies, climate factors, such as relative humidity, average daily temperature, and northeasterly winds were found to be related to worsening asthma, an allergic lower airway disease. However, the association between climate factors with CRS or AR has not been clarified. We conduct a retrospective analysis by using the National Health Insurance database during 2003 to 2012. The meteorological data will be obtained from the Central Weather Bureau of Taiwan, including relative humidity, average temperature. Five geographic zones and the related outpatient rates (Taipei city, Taichung city, Kaohsiung city, Hualien county, and I-Lan county) were analyzed.
From 2003 to 2012, 476,833 patients were included in the study, with a male: female ratio of 1.02: 1. Twenty seven percent of patients were under eighteen years old. The outpatient rate of AR is increasing by time, but in CRS, it shows a decreasing pattern. The outpatient rate of AR presents with seasonal changes but CRS dose not. In AR, significant interactions between any single city/county and time, and generally, when temperature or relative humidity elevates, the rate of outpatient drops. In CRS, the rate of outpatient drops when temperature or relative humidity elevates, and variant interactions between any single city/county with temperature or relative humidity were found. The rates of outpatient of AR and asthma shows strong correlation (r=0.947, p<0.0001), and rates of outpatient of CRS and asthma also shows strong correlation by time (r=0.906, p<0.0001).
In summary, the rates of outpatient of CRS and AR were influenced by two of the climate factors, relative humidity and temperature. In Taiwan, though the etiologies of CRS were multiple, it shows strong relation between CRS and atopy. The prevention of these two nasal diseases should be point on the prevention of allergen exposures.

目 錄
致謝……………………………………………………………………………………i
目錄……………………………………………………………………………………ii
圖表目錄…………………………………………………………………………….. iv
中文摘要…………………………………………………………………………… ..vi
英文摘要………………………………………………………………………… viii
壹、文獻回顧及研究目的……………………………………………………………1
一、 鼻及鼻竇炎(Rhinosinusitis)
二、 過敏性鼻炎(allergic rhinitis)
三、 氣喘(Asthma)
貳、研究方法與材料…………………………………………………………………6
一、病患資料
二、研究病患
三、氣象資料
四、統計分析
叁、研究結果……………………………………………………………………….. 9
一、統計資料
二、相對溼度和溫度的關係
三、分析西元2003至2012年間，以2005年承保抽樣歸人檔50萬
人抽樣檔，就診人次長期趨勢
四、西元2003至2012年間，以2005年承保抽樣歸人檔50萬人抽
樣檔，分析氣候因子，相對溼度和溫度對於過敏性鼻炎就診率
影響
五、西元2003至2012年間，以2005年承保抽樣歸人檔50萬人抽
樣檔，分析氣候因子，相對溼度和溫度對於慢性鼻竇炎就診率
影響
六、比較相對溼度、溫度、時間因子之影響力: 過敏性鼻炎
七、比較相對溼度、溫度、時間因子之影響力: 慢性鼻竇炎
八、西元2003至2012年間，以2005年承保抽樣歸人檔50萬人抽
樣檔，分析過敏性鼻炎、慢性鼻竇炎與過敏性下呼吸道疾病：
氣喘在十年就診率之相關性
肆、討論與結論…………………………………………………………………….13
一、西元2003至2012年間，過敏性鼻炎就診率逐漸增加
二、西元2003至2012年間，慢性鼻竇炎就診率逐漸降低
三、當溫度或濕度上升時，慢性鼻竇炎就診率下降
四、當溫度或濕度上升時，過敏性鼻炎就診率下降
五、依時間變動，慢性鼻竇炎和氣喘就診率高度相關
六、依時間變動，過敏性鼻炎和氣喘就診率高度相關
伍、附圖表………………………………………………………………………….19
陸、參考文獻……………………………………………………………………….40
圖表 目 錄
表一、鼻及鼻竇炎的臨床表徵………………………………………………………20
圖二、慢性鼻竇炎的致病因素……………………………………………………...21
圖三、鼻竇內視鏡下，慢性鼻竇炎併鼻息肉……………………………………..22
圖四、鼻竇內視鏡下，慢性鼻竇炎無鼻息肉……………………………………..22
圖五、國際疾病編碼九(ICD-9)…………………………………………………….23
圖六、研究流程圖…………………………………………………………………. 24
圖七、台灣相對溼度和溫度的關係………………………………………………..25
圖八、西元2003至2012年間，以2005年承保抽樣歸人檔50萬人抽樣檔，過敏
性鼻炎就診人次長期趨勢圖………………………………………………..26
圖九、西元2003至2012年間，以2005年承保抽樣歸人檔50萬人抽樣檔，慢性
鼻竇炎就診人次長期趨勢圖………………………………………………..26
表十、研究過敏性鼻炎就診率和時間的關係……………………………………..27
表十一、城市間和相對溼度做交互作用：過敏性鼻炎就診率…………………..28
表十二、若以城市間和溫度做交互作用：過敏性鼻炎就診率…………………..29
表十三、相對濕度和氣溫因子做交互作用：過敏性鼻炎就診率………………..30
表十四、因時間為影響過敏性鼻炎就診率之因子，將時間因子固定：過敏性鼻炎
就診率……………………………………………………………………..31
表十五、研究慢性鼻竇炎就診率和時間的關係…………………………………..32
表十六、城市間和相對溼度交互作用：慢性鼻竇炎就診率……………………..33
表十七、城市間和溫度交互作用：慢性鼻竇炎就診率…………………………..34
表十八、因時間為影響過敏性鼻炎就診率之因子，將時間因子固定：慢性鼻竇炎
就診率……………………………………………………………………..35
表十九、分析單項變數：時間、相對濕度、溫度：過敏性鼻炎就診率………..36
表二十、分析單項變數：時間、相對濕度、溫度：慢性鼻竇炎就診率………..37
圖二十一、西元2003至2012年間，就診人次長期趨勢圖：氣喘……………..38
圖二十二、西元2003至2012年間，氣喘及過敏性鼻炎就診人次相關性……..39
圖二十三、圖二十二、西元2003至2012年間，氣喘及慢性鼻竇炎就診人次相關
性………………………………………………………………………..39

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