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研究生:李詠甄
研究生(外文):LI, Yung-Chen
論文名稱:新發巴金森氏症與其合併失智症之存活分析:以10年追蹤資料分析為例
論文名稱(外文):An Analysis of Survial of Parkison’s Disease and Its Complicated Dementia: A 10-Year Population-Based Study
指導教授:李佩珍李佩珍引用關係
指導教授(外文):Lee, Pei-Chen
口試委員:邱尚志林寬佳
口試委員(外文):Chiou, Shang-JyhLin, Kuan-Chia
口試日期:2017-05-23
學位類別:碩士
校院名稱:國立臺北護理健康大學
系所名稱:健康事業管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:137
中文關鍵詞:巴金森氏症失智症死亡風險Cox比例風險模型
外文關鍵詞:Parkinson's diseaseDementiaMortality riskCox proportional hazard model
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背景與目的
巴金森氏症為第二主要的神經性退化性疾病,其發病原因目前仍不清楚,此外,過去研究顯示巴金森氏症患者其死亡率高於沒有罹患巴金森氏症之族群,影響巴金森氏症存活因子也逐漸被重視,然而僅有少數研究在探討併發失智症之巴金森氏症患者其死亡風險是否高於沒有併發失智症之巴金森氏症患者,為此,本研究利用我國全民健康保險研究資料,來比較巴金森氏症患者與非巴金森氏症患者其死亡風險、以及巴金森氏症患者與巴金森氏症合併失智症患者之存活情形。

研究方法
本研究以回溯性世代研究探討2002年新發巴金森氏症患者、非巴金森氏症患者與新發巴金森氏症合併失智症患者,在控制人口學變項後觀察其存活情形,本研究使用1999至2012年全民健康保險研究資料庫,找出2002年新發巴金森氏症個案共3,091人,以「性別」及「年齡」為匹配條件選出2002年非巴金森氏症個案共12,104人,並使用Cox比例風險模型(Cox proportional hazard model)來檢驗(1)巴金森氏症與非巴金森氏症之存活情形、以及(2)巴金森氏症與巴金森氏症合併失智症之存活情形。

研究結果
在控制性別、年齡、共病症指數與都市化程度後,巴金森氏症比非巴金森氏症高出1.37倍的死亡風險(adjusted HR = 1.37, 95% CI = 1.24-1.50)、女性比男性的死亡風險少38%(adjusted HR = 0.62, 95% CI = 0.53-0.74)、年齡 ≥ 65歲比 < 65歲高出3.00倍的死亡風險(adjusted HR = 3.00, 95% CI = 2.27-3.97)、共病症指數2分以上比0分高出1.45倍的死亡風險(adjusted HR = 1.45, 95% CI = 1.07-1.96)。在控制性別、年齡與共病症指數變項後,合併失智症之患者比無失智症者高出1.11倍的死亡風險(adjusted HR = 1.11, 95% CI = 0.98-1.26)。

結論與建議
本研究結果發現巴金森氏症患者以及巴金森氏症合併失智症患者有較高的死亡風險,本研究結果可協助患者依其不同病程之需求獲得早期介入服務及適當治療,減緩巴金森氏症患者失能的發生。並期望本研究結果亦可作為未來擬定評估與照護方針之參考依據,有助於臨床實務專家進一步發展巴金森氏症的死亡風險評估指引。
Background and Objective
Parkinson's disease is the secondary illness among neurodegenerative diseases, however, its causes are still unclear. Besides, the past studies have shown that those who suffer from Parkinson's disease will face higher mortality rate than others. Thus, the survival factors which affect the Parkinson disease are taken more seriously. In addition to a higher risk of death, most patients would confront the complication of dementia. While, only few studies explore the hypothesis whether the risk of death is higher in Parkinson’s disease patients with dementia than those who don’t have this complication. To supplement the insufficiency, this study, aims to compare the Parkinson's disease patients with non-Parkinson's disease patients using the National Health Insurance Research Database in terms of the risk of death and make a contrast between the survival of Parkinson’s disease patients and Parkinson’s disease patients with dementia.

Methods
We conducted a retrospective cohort study to evaluate the Parkinson’s disease patients, non-Parkinson's disease patients, and Parkinson's disease patients with dementia in 2002. Then, we observed the survival status after controlling the demographic variables. Based on the data extracted from the National Health Insurance Research Database from 1999 to 2012, we identified 3,091 Parkinson’s disease cases and matched “gender” and “age” to select 12,104 of non-Parkinson’s disease cases. Also, we used Cox proportional hazard model to analyze (1) the survival status of Parkinson’s disease patients and non-Parkinson's disease patients
(2) the survival status of Parkinson's disease patients and Parkinson’s disease patients with dementia.

Results
After controlling the variables of gender, age, Charlson Comorbidity Index (CCI) and urbanization level, we find that the mortality risk of Parkinson's disease is higher than non-Parkinson's disease, while the adjusted hazard ratio was 1.37 (adjusted HR = 1.37, 95% CI = 1.24-1.50); females have lower mortality risk than males, while the adjusted hazard ratio was 38% (adjusted HR = 0.62, 95% CI = 0.53-0.74); and the patients age ≥ 65 have higher mortality risk than < 65, while the adjusted hazard ratio was 3.00 (adjusted HR = 3.00, 95% CI = 2.27-3.97); CCI score 2 has higher mortality risk than CCI score 0, while the adjusted hazard ratio was 1.45 (adjusted HR = 1.45, 95% CI = 1.07-1.96). Under the controlled variables of gender, age and CCI, the data shows that those patients who suffer from dementia confronted higher mortality risk than non-dementia patients, while the adjusted hazard ratio was 1.11 (adjusted HR = 1.11, 95% CI = 0.98-1.26).

Conclusion and Suggestion
We observed that Parkinson's disease patients and Parkinson's disease patients with dementia show a higher mortality risk. The study results can help patients to obtain earlier intervention services and appropriate treatment according to their needs in a different phase of disease. In this way, it can slow down the occurrence of Parkinson's disease patients with disability. In addition, we expect the results can provide reference for future assessment and health care policy and also help clinical practitioners to get further assistance of guidelines for death risk assessment of Parkinson's disease.
中文摘要 I
Abstract II
目錄 IV
表目錄 V
圖目錄 VI
第一章 緒論 1
第一節 研究背景與動機 1
第二節 問題陳述 5
第三節 研究目的及研究問題與假設 7
第四節 研究之重要性 8
第二章 文獻探討 9
第一節 巴金森氏症流行病學及其危險因子之探討 9
第二節 抗巴金森氏症藥物 22
第三節 巴金森氏症與共病症之相關性 25
第四節 巴金森氏症之死亡率 39
第五節 巴金森氏症與失智症 53
第六節 文獻總結 67
第三章 研究方法 69
第一節 研究架構 69
第二節 研究設計 70
第三節 研究對象 71
第四節 研究資料來源及變項的操作型定義 73
第五節 研究資料處理過程 80
第六節 統計分析 84
第四章 研究結果 88
第一節 研究對象之特性 88
第二節 研究對象各年死亡人數與失智症發生情形 89
第三節 巴金森氏症死亡之風險 90
第五章 討論與建議 103
第一節 研究結果總結和討論 103
第二節 研究之優點、限制及建議 106
第三節 研究結果之應用 108
參考文獻 111
中文部份 111
英文部份 112
附錄 129

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