臺灣博碩士論文加值系統

研究背景：台灣是已知全面實施新生兒B型肝炎疫苗接種，是台灣公衛史上的一大成就，因為這個政策，大幅下降了因為B型肝炎病毒而引起的肝臟疾病，但C型肝炎一直都沒有研發到很有效的疫苗，雖然最近幾年常聽到新型的抗病毒藥物，至目前為止，C型肝炎在台灣還是無法以注射疫苗來預防。當C型肝炎一直進展，部分的帶原者可能因而產生肝硬化甚至肝細胞癌，在肝功能嚴重受損的病人，臨床常見的症狀除了黃疸跟全身倦怠，最困惑病人的常是難治而反覆的腹水，其主要原因可能跟體內白蛋白濃度相關。近年文獻也提出了證據証明C型肝炎跟慢性腎臟疾病之間的關係，而其中也與尿中白蛋白的濃度相關，從而推測哪種基因型會比較容易引起體內白蛋白流失，甚至長遠的腎臟功能不全。
研究方法：本研究使用2007-2016 National Health and Nutrition Examination Survey(NHANES) 公開資料庫尋找HCV病毒不同基因亞型與尿中白蛋白數據，觀察哪種HCV基因亞型，會影響到尿中白蛋白的含量。
結果：
樣本40,856中HCV-RNA陰性237，陽性336，以廣義線性方程式調整性別、種族、教育程度、抽煙、糖尿病、B型肝炎、酗酒、BMI 在尿液肌酐酸比值中C型肝炎第二型較其他基因更容易造成濃度高（P<0.001），但在白蛋白尿、腎絲球過濾率較不易觀察出相關。
結論：
在尿液肌肝酸比值中觀察出最可能引起流失之基因型第二型，不過尿中白蛋白濃度及腎絲球過濾率不盡理想，可能是樣本數不夠，或部分基因型稀少造成檢力不足，可能需增加樣本數使呈現常態分佈，不論如何，C型肝炎仍是目前很重要的公衛議題，必須繼續努力找出一些關聯，希望Ｃ型肝炎患者得到更多的治療。

Background: Taiwan is known to fully implement neonatal hepatitis B vaccination, which is a major achievement in the history of Taiwan's public health. Because this policy has greatly reduced liver disease caused by hepatitis B virus, but hepatitis C virus has not been developed. To a very effective vaccine, although new antiviral drugs have been heard in recent years, so far, hepatitis C virus cannot be prevented by vaccination in Taiwan. In recent years, the literature also provides evidence to prove the relationship between hepatitis C and chronic kidney disease, and it is also related to the concentration of albumin in the urine, so it is speculated which genotypes will be more likely to cause albumin loss in the body.Even the long-term kidney is insufficiency.
Method: This study used the 2007-2016 National Health and Nutrition Examination Survey (NHANES) public database to look for different Hepatitis C Genotypes (HCV) and Urine Concentration of Albumin data, to observe which HCV Genotypes would affect Urine albumin levels.
Results: Sample 40,856 HCV-RNA negative 237, positive 336, adjusted for gender, race, education, smoking, diabetes, hepatitis B, alcohol abuse, BMI in urine creatinine ratio in type C, hepatitis C, type II Genes are more likely to cause high concentrations (P < 0.001), but are less likely to be observed in albuminuria and renal spheroid filtration rates.
Conclusion: The second type of genotype that is most likely to cause loss was observed in the Albumin creatinine ratio. However, the Urine Concentration of Albumin and the estimated Glomerular filtration rate were not ideal. It may be that the number of samples is not enough, or some genotypes are rare. Insufficient force, it may be necessary to increase the number of samples to make a normal distribution. Hepatitis C is still a very important public health issue, must be made to find some connections, and hope that patients with hepatitis C get more treatment.

正文目錄
圖表目錄 5
表目錄 6
附錄目錄 7
中文摘要 8
ABSTRACT 9
第一章 緒論 11
第一節 研究背景 11
第二節 研究動機與重要性 12
第三節 研究目的 15
第二章 文獻探討 16
第一節 肝炎定義與評估 16
第二節 簡介Ｃ型肝炎 29
第三節 肝臟的評估 35
第四節 肝衰竭併發症 39
第五節 C型肝炎的治療 42
第六節 慢性腎臟病的定義與評估 45
第三章 研究材料與方法 49
第一節 研究架構與研究假設 49
第二節 資料來源與研究對象 50
第三節 研究工具 56
第四節 研究變項之操作型定義 57
第五節 資料處理與統計分析 60
第四章 研究結果 62
第一節 個案基本資料 62
第二節 Ｃ型肝炎基因亞型分布狀況 79
第三節 Ｃ型肝炎基因亞型與白蛋白尿濃度、尿液肌酸酐比值、腎絲球過濾率之單因子變異數分析 80
第四節 Ｃ型肝炎基因亞型與白蛋白尿濃度、尿液肌酸酐比值、腎絲球過濾率之廣義線性方程式分析 90
第五章 討論 101
第一節 研究假設驗證 101
第三節 研究優勢與限制 103
第六章 結論與展望 105
第一節 結論 105
第二節 未來展望 106
參考文獻 110
附錄 113

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中文：
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肝病防治學術基金會https://www.liver.org.tw/knowledgeView.php?cat=4&sid=16
衛生福利部中央健康保險署/Ｃ型肝炎全口服新藥專區https://www.nhi.gov.tw/Content_List.aspx?n=A4EFF6CD1C4891CA&topn=3FC7D09599D25979
中華民國內政部戶政司全球資訊網/全國人口資料庫統計圖https://gis.ris.gov.tw/dashboard.html?key=B01