臺灣博碩士論文加值系統

中文摘要

吉里巴斯學齡兒童風濕性心臟病盛行率調查研究

風濕性心臟病RHD(Rheumatic Heart Disease)儘管是完全可預防和可治療的疾病但它仍被認為是發展中國家中兒童和青少年的公共健康問題。本研究調查吉里巴斯學齡兒童(9-19歲)RHD的盛行率，冀以瞭解該族群RHD盛行率現況及相關危險因子。此不僅可填補過去研究缺口，也有助於醫學界針對風濕性心臟病提供更多案例參考，並有助於政府架構契合RHD患者需求的預防和篩查策略。本研究對象主要為吉里巴斯10所學校地區學齡兒童，共篩檢三千多位學童。共計發放問卷3,711份，回收問卷3,711份，問卷回收率為99%，使用SPSS22.0統計套裝軟體，以次數分配分析，描述性統計，羅吉斯迴歸等分析方法進行分析，獲致以下結論：
一、盛行率現況顯示：整體學童3,711人中，確診RHD或者邊緣RHD共計68人，吉里巴斯學齡兒童風濕性心臟病粗盛行率為18.32/1000 (95%CI: 13.8~22.2)。
二、相關危險因子：多變量邏輯斯迴歸結果顯示，學齡兒童接受Benzathine青黴素注射(adjusted odds ratio, AOR=22.48,95%CI: 6.02~83.94)、家庭成員有發生過風濕熱(AOR=4.40,95%CI: 1.85-10.46)家庭成員不確定發生過風濕熱(AOR=5.79,95%CI: 2.53~13.24)與風濕性心臟病盛行率具有顯著相關性。
本研究結果顯示影響吉里巴斯學齡兒童風濕性心臟病盛行率最主要的因素為與環境因素有關。建議政府衛生部在還無法全面改善初級預防及一級預防的狀態下，需要逐步架構契合吉里巴斯學齡兒童風濕性心臟病患者需求的預防和篩檢策略，台灣可以協助建構當地的風濕性心臟病醫師持續篩檢能力，及早進行二級預防措施，且對二級預防的依從性加強，除了降低學齡兒童風濕性心臟病盛行率外，也可以預防已經得到風濕性心臟病的學童，心臟功能持續惡化。

關鍵字：風濕性心臟病、學齡兒童、吉裡巴斯

Abstracts

The Prevalence of Rheumatic Heart Disease among School-aged Children in Kiribati

Background and Objective
Rheumatic Heart Disease (RHD) is considered to be a public health issue for children and adolescents in developing countries, although it is preventable and treatable. This study investigated the prevalence of RHD among school-aged children (aged 9-19) in Kiribati, in order to know the RHD prevalence of the population and related risk factors. Pioneering in this subject, which was rarely studied in the past, this study is expected to encourage the medical field to provide more cases about RHD for reference and help the government to formulate the RHD prevention and screening strategies according to the RHD patients' needs.

Methods
The objects of study were school-aged children in 10 schools in Kiribati. more than 3,000 children received screening. A total of 3,711 questionnaires were distributed, and 3,711 were collected, so the recovery rate was 99%. The SPSS22.0 statistical software package was used and analysis methods such as frequency distribution analysis, descriptive statistics, and logistic regression analysis were adopted.

Result
The following conclusions were reached:
1. Prevalence of RHD: among the 3,711 school-aged children, 68 were confirmed to have RHD or were prone to RHD. The prevalence of RHD among school-aged children in Kiribati is 18.32/1000 (95% CI: 13.8~22.2).
2. Relevant risk factors: the following are the results of multivariate logistic regression: school-aged children receiving Benzathine penicillin injection (adjusted odds ratio, AOR = 22.48, 95% CI: 6.02 ~ 83.94), family members having rheumatic fever (AOR = 4.40, 95% CI: 1.85-10.46) and family members not sure of having rheumatic fever or not (AOR=5.79, 95% CI: 2.53~13.24). As indicated by the results, environment factor is significantly associated with the prevalence of RHD.

Conclusion and Suggest
The results of this study suggest that the most important factor affecting the prevalence of RHD among school-aged children in Kiribati is environment factor. It is recommended that the Ministry of Healthof Kiribati needs to formulate and gradually improve the prevention and screening strategies based on the needs of school-aged children with RHD when they can’t perfect the primary prevention system. Taiwan government can help improve the continuous screening ability of the local RHD physicians. take secondary preventive measures for intervention as early as possible and enhance the children compliance with the secondary preventive measures. With these countermeasures taken. not only the prevalence of RHD children can be lowered. but also the cardiac function of the children with RHD can be prevented from continuous worsening.


Key words: Rheumatic Heart Disease、School-aged Children、Kiribati

目錄
中文摘要 - 1 -
Abstract - 1 -
目錄 - 5 -
圖目錄 - 7 -
表目錄 - 8 -
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與問題 4
第三節 研究假設 4
第四節 研究之重要性 5
第二章 文獻探討 6
第一節 風濕性心臟病之概述 6
第二節 風濕性心臟病流行病學之描述 13
第三節 風濕性心臟病之相關危險因子 22
第三章研究方法 31
第一節 研究設計 31
第二節 研究對象 32
第三節 研究工具 32
第四節 變項操作型定義 34
第五節 統計與分析 36
第四章研究結果 38
第一節 學童基本資料 38
第二節 學童風濕性心臟病的盛行率 40
第三節 學童背景變項、人口與家庭環境與風濕性心臟病之相關性 42
第四節 綜合討論 46
第五章結論與建議 51
第一節 研究結論 51
第二節 研究建議與限制 52
參考文獻 53

 
圖目錄
圖2-1 預防和治療風濕熱和風濕性心臟病的級別 13
圖2-2 不同國家/地區有不同的風濕性心臟病流行病學模式 15
圖2-3 風濕性心臟病的死亡率 16
圖3-1 研究架構 31

參考文獻
一、中文文獻
陳進成(2011)。風濕熱和風濕性心臟病，2018年5月20取自http://www.babydoctor.com.tw/rheumatic%20fever.htm。
陳銘仁(2016)。風濕熱及風濕性心臟病，2018年5月20取自http://www.mmh.org.tw/taitam/ped_ca/index4_1_car%20(27).html，
健康猴(2018)。風濕熱的症狀和治療方法。2018年5月20取自 http://www.jiankanghou.com/jibing/32902.html
詹聖霖(2012)。風濕性心臟病學齡兒童時期的心臟殺手，2018年5月20取自https://www.vghtc.gov.tw/GipOpenWeb/wSite/ct?xItem=38046&ctNode=37902&mp=8190。
中亞健康網(2018)。風濕性心臟病，2018年5月20取自6https://www.ca2-health.com/cvd/2014/08/25/%E9%A2%A8%E6%BF%95%E6%80%A7%E5%BF%83%E8%87%9F%E7%97%85
二、英文文獻
Agarwal,B.L.(1981). Rheumatic heart disease unabatedin developing countries. Lancet, 318(8252):910-1.
ARF/RHD Writing Group(2012). The Australian Guideline for Prevention, Diagnosis, and Management of Acute Rheumatic Fever and Rheumatic Heart Disease. 2nd edition Darwin: Menzies School of Health Research.
Aryanpur-Kashani,I.(1980).On rheumatic fever iin children(letter).American Heart Journal, 100:942-943.
Bangladesh Bureau of Statistics. Household Income and Expenditure Survey( 2010). Dhaka:Ministry of Planning. Receive from http://www.bbs.gov.bd/PageReportLists.aspx?PARENTKEY=66.
Barik,R.(2018).Secondary prophylaxis to control rheumatic heart disease in developing countries:Put into a cage if can’nt be killed.Indian Heart Journal,8,23-45.
Carapetis, J.R., Steer, A.C., Mulholland, E.K., Weber, M.(2005). The global burden of group A streptococcal diseases. Lancet Infect Dis, 5:685–694.
Carapetis, J.R.,(2007). Rheumatic Heart Disease in Developing Countries. N. Engl. J. Med,357:439–441.
Courtney,H.S., Niedermeyer,S.E., Penfound,T.A., Hohn,C.M., Greeley,A., & Dale, J.B.(2017).Trivalent Mrelated protein as a component of next generation group Astreptococcal vaccines. Clin Exp Vaccine Res,1(1) :45–49.
Cunningham, M.W.,(2016). Post-Streptococcal Autoimmune Sequelae: Rheumatic Fever and Beyond, Streptococcus pyogenes: Basic Biology to Clinical Manifestations.
Engel, M,E,, Stander,R., Vogel ,J., Adeyemo,A.A.,& Mayosi, B.M.(2011).Genetic susceptibility to acute rheumatic fever: a systematic review and meta-analysis of twin studies. PLoS One, 6:e25326.
Faruq, Q.O., Tokeshi, S.,& Islam, A.K.M.N. et al..(1992).Nutritional and socio-economic status of rheumatic fever and rheumatic heart disease cases- an experience of rheumatic fever and rheumatic heart disease control project.Proceedings of 1st National Scientific Conference on Rheumatic fever and Rheumatic heart disease.Dhaka, Bangladesh, May 4-5:68.
Gewitz, M.H., Baltimore, R.S., Tani, L.Y., Sable, C.A., Shulman, S.T., Carapetis, J.,Remenyi, B., Taubert, K.A., Bolger, A.F., Beerman, L., Mayosi, B.M., Beaton, A.,Pandian, N.G., & Kaplan, E.L.,(2015). American Heart Association Committee on RheumaticFever, Endocarditis, and K.D. of the C. on C.D. in the Y, 2015. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association.Circulation, 131:1806–1818.
Gibson, R.S (1993).Nutritional Assessment: A Laboratory Manual.New York/Oxford: Oxford University Press.
Gopal, R., Harikrishnan, S., Sivasankaran, S., Ajithkumar, V.K., Titus, T., & Tharakan, J.M.(2012). Once weekly azithromycin in secondary prevention of rheumatic fever. Indian Heart J., 64(Feb 29 (1)) :12–15.
Gordis,L.(1985). The virtual disappearance of rheumatic fever in the United States:lessons in the rise and fall of disease. T. Duckett Jones memorial lecture.Circulation,72(6) :1155–1162.
Guilherme, L., & Kalil, J.,( 2010). Rheumatic fever and rheumatic heart disease: cellular mechanisms leading autoimmune reactivity and disease. J. Clin. Immunol,30, 17–23.
Hussain,M., Hossain,M., Molla,M.R., & Alam,M.S. (1992).Study on noncompliance of secondary prevention of rheumatic fever and rheumatic heart disease in a hospital. In: Proceedings of First National Scientific Conference on Rheumatic Fever and Rheumatic Heart Disease. 4–5.Pilot Project for Prevention and Control of Rheumatic Fever and Rheumatic Heart Disease in Bangladesh. Ministry of Health and Family Welfare, Government of Bangladesh and JICA, Government of Japan1992.
Hussain, M.A., Nahar, A., Begum ,K., & Tanira ,S.(2008). Study on life styl of the patients of rheumatic fever attending the National Centre for Control of Rheumatic Fever and Heart Diseases (NCCRF/HD) during the year 1993 to 1996. J Dhaka Med Coll, 17:56–58.
Jalil,M.Q., Haque,K.M.H., Rouf,M.A., et al..(1997). Recurrence of rheumatic fever and rheumatic heart disease after penicillin prophylaxis. Bangladesh Heart J, 12:20–24.
Kane,A.(2011).134 Prevalence of rheumatic heart disease in SENEGAL An echocardiographic screening.Archives of Cardiovascular Diseases Supplements,3(1) :43.
Kumari,N.R.,Raju,I.B.etal.(2013).Prevalence of rheumatic and congenital heart disease in school children of Andhra Pradesh,South India.Journal of Cardiovascular Disease Research,4(1) :11-14.
Lawrence,T.M.,Ahmadi,S.,Morrey,B.F.,&Sanchez-Sotelo,J.,(2013).The value of intraoperative histology in predicting infection in patients undergoing revision elbow arthroplasty.Journal of Bone & Joint Surgery American Volume,95 (21) :1976.
Lozano R, Naghavi M, Foreman K, et al.. (2012).Global and regional mortality from235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010, 380:2095–128.
Manji,R.A., Witt,J., Tappia,P.S., Jung,Y., Menkis,A.H., & Ramjiawan,B.(2013). Cost–effectiveness analysis of rheumatic heart disease prevention strategies. Expert Rev Pharmacoecon Outcomes Res,13(Dec 1 (6)):715–724.
Marijon,E., Mirabel,M., Celermajer,D.S., & Jouven,X.(2012). Rheumatic heartdisease, 379, 953–64.
Martin, W.J., Steer, A.C., Smeesters, P.R., Keeble, J., Inouye, M., Carapetis, J., & Wicks, I.P.,(2015). Post-infectious group A streptococcal autoimmune syndromes and the heart.Autoimmun. Rev,14: 710–725.
Massell,B.F., Chute,C.G., Walker,A.M., & Kurland,G.S.(1988). Penicillin and the marked decrease in morbidity and mortality from rheumatic fever in the United States.N Engl J Med,318:280–286.
Mehta,A.,etal.(2016).Characteristics and outcomes of Indian children enrolled in a rheumatic heart sisease registry.International Journal of Cardiology,222:1136-1140.
Meyers, D. (1975). Ischaemic heart disease and the water factor. A variable relationship.British Journal of Preventive and Social Medicine, 29: 98-102.
Mirabel,M.,etal.(2016).Prevalence of Rheumatic Heart Disease in the Pacific: From Subclinical to Subclinical to Symptomatic Heart Valve Disease.Journal of the American College of Cardiology,67(12) :1500-1502.
Molla,M.R., Hossain,M.,& Alam,H.S.K.(1992). Long-term penicillin therapy – a Dhaka Shishu Hospital-based study. In:Proceedings of First National Scientific Conference on Rheumatic Fever and Rheumatic Heart Disease. 4–5 .Pilot Project for Prevention and Control of Rheumatic Fever and Rheumatic Heart Disease in Bangladesh. Ministry of Health and Family Welfare, Government of Bangladesh and JICA,Government of Japan1992.
Monwarul Islam,A.K.M.,& Majumder,A.A.S,(2015). Rheumatic fever and rheumatic heart disease in Bangladesh: A review. Indian Heart Journal，Volume 68, Issue 1, January–February, 2016:88-98.
Nascimento etal.(2016).Echocardiographic prevalence of rheumatic heart disease in Brazilian schoolchildren: Data from the PROVAR study. International Journal of Cardiology,Volume 219:439-445.
Ozkan,M.,Carin,M.Sonmez,G.,Senocak,M.,Ozdemir,M.,Yakut,C.(1993).HLA antigen in Turkish race with rheumatic heart disease.Circulation, 87:1974-1978.
Paar,J.A.,etal.(2010).Prevalence of Rheumatic Heart Disease in Children and Young Adults in Nicaragua.
Phibbs,B.,Taylor,J.& Zimmerman,R.A.A.(1970). community-wide streptococcal control project: the Natrona County primary prevention program,Casper,Wyomin.Journal of the American Medical Association, 214:2018-2024.
Reeves,B.M., Kado, J.,& Brook,M. (2011).High prevalence of rheumaticheart disease in Fiji detected by echocardiography screening.J Paediatr Child Health,47:473-8.
Remenyi, B., Carapetis,J., Wyber,R., Taubert,K., & Mayosi,B.M.(2013). World HeartFederation: position statement of the World Heart Federation on theprevention and control of rheumatic heart disease. Nat Rev Cardiol, 10:284–292.
Remenyi,B., Wilson,N., Steer,A.et al..(2012). World Heart Federationcriteria for echocardiographic diagnosis of rheumatic heart disease–an evidence-based guideline. Nat Rev Cardiol, 9:297-309
Reményi,B., Wilson,N., Steer,A.et al..(2012). World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease—an evidence-based guideline. Nat Rev Cardiol,9(May 1 (5)):297–309.
Riaz,B.K., Selim,S., Karim,M.N., Chowdhury,K.N., Chowdhury,S.H.,& Rahman,M.R.(2013). Risk factors of rheumatic heart disease in Bangladesh: a case-control study. J Health Popul Nutr,31:70–77.
Rothenbühler,M., O'Sullivan,C.J., Stortecky,S.et al..(2014). Active surveillance for rheumatic heart disease in endemic regions: a systematic review and metaanalysis of prevalence among children and adolescents. Lancet Global Health, 2(Dec 31 (12)):e717–26.
Saxena,A.,Desai,A.,Narvencar,K.,Ramakrishnan,S.,Thangjam,R.S.,Kulkarni,S.,Jacques’s Costa,A.K.,Mani,K.,Dias,A.,Sukharamwala,R.,(2017).Echocardiographic prevalence of rheumatic heart disease in Indian school children using World Heart Federation criteria – A multi site extension of RHEUMATIC study (the e-RHEUMATIC study). International Journal of Cardiology,Volume,249: 438-442.
Seckeler,M.D., & Hoke,T.R.(2011). The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clin Epidemiol,3:67–84.
Stocks,P.,(1973). Mortality from cancer and cardiovascular diseases in the county boroughs of England and Wales classified according to the sources and hardness of their water supplies, 1958–1967.Epidemiology & Infection,71(2) :237-252.
Vincent,Y.F. He, John R. Condon, Anna P. Ralph, Yuejen Zhao, Kathryn Roberts, Jessica L. de Dassel, Bart J. Currie, Marea Fittock, Keith N. Edwards, Jonathan R. Carapetis(2016). Long-Term Outcomes From Acute Rheumatic Fever and Rheumatic Heart Disease:A Data-Linkage and Survival Analysis Approach. Circulation, 134 (3) :222-232.
Walker, M.J., Barnett, T.C., McArthur, J.D., Cole, J.N., Gillen, C.M., Henningham, A.,Sriprakash, K.S., Sanderson-Smith, M.L., Nizet, V.,(2014). Disease manifestations and pathogenic mechanisms of group A Streptococcus. Clin. Microbiol, Rev27: 264–301.
Watkins ,D.A., Johnson ,C.O., Colquhoun, S.M., Karthikeyan, G., Beaton ,A., Bukhman, G., Forouzanfar, M.H., Longenecker, C.T., Mayosi ,B.M., Mensah ,G.A., Nascimento ,B.R., Ribeiro, A.L.P., Sable, C.A., Steer, A.C., Naghavi ,M., Mokdad ,A.H., Murray, C.J.L., Vos, T., Carapetis ,J.R., Roth ,G.A. (2017). Global, Regional, and National Burden of Rheumatic Heart Disease, 1990-2015.N Engl J Med, 377 (8):713-722.
Watkins., Colquhoun,S., Johnson,C., Carapetis,J., Karthikeyan,G., Naghavi,M.,et al.. (2017).PM214 trends in the global burden of rheumatic heart disease during1990–2013: findings from the global burden of disease 2013 study. Global Heart,1 (2)):e106–e107.
Watkins,D.A., Johnson,C.O., Colquhoun, S.M., et al.. (2017).Global, regional, and national burden of rheumatic heart disease, 1990–2015. New Engl J Med, 377(Aug24 (8)):713–722.
WHO(2014). Global action plan for the prevention and control of NCDs 2013–2020. http://www.who.int/nmh/events/ncd_action_plan/en/.
Wyber, R., Grainger,Gasser.A., Thompson,D., Kennedy,D., Johnson,T., Taubert,K.,et al..(2015). TIPS Handbook: Tools for Implementing Rheumatic Heart Disease ControlProgrammes .Global Heart,10 (1) :79-80.
Yacoub,Wasef(2004).Gender differences in systemic lupus erythematosus.Gender Medicine,1 (1) :12.
Yadeta,Dejuma,etal.(2016).Prevalence of rheumatic heart disease among school children iin Ethiopia:A multisite echocardiography-based screening. International Journal of Cardiology,221:260-263.
Zaman,M.M., Yoshiike, N., Chowdhury,A.H., et al.. (1998).Nutritional factors associated with rheumatic fever. J Trop Pediatr,44:142–147.
Zaman, M.M., Yoshiike,N., Chowdhury,A.H., et al..(1997). Socio-economic deprivation associated with acute rheumatic fever. A hospital-based case-control study in Bangladesh.Paediatr Perinat Epidemiol, 11:322–332.
Zaman,M.M., Yoshiike,N., Rouf,M.A., et al..(1998). Association of rheumatic fever with serum albumin concentration body iron stores in Bangladeshi children: case-control study. BMJ.1998,317:1287–1288.
Zaman,M.M.,Choudhury,S.R.,Rahman,S.,& Ahmed ,J.(2015).Prevalence of rheumatic feverand rheumatic heart disease in Bangladeshi children.Indian Heart Journal,67(1) :45-49.
Zühlke,L.,Karthikeyan,G.,Engel,M.E.Rangarajan,S.,Mackie,P.,Cupido,B.,Mauff,K.,ISLAM,S.,Daniels,R.,Francis,V.,Ogendo,S.et al..(2016). Clinical Outcomes in 3343 Children and Adults With Rheumatic Heart Disease From 14 Low- and Middle-Income Countries: Two-Year Follow-Up of the Global Rheumatic Heart Disease Registry (the REMEDY Study). Circulation,134 (19) :1456-1466.
Zühlke,L.J.,Engela,M.,Watkins,D.,&Mayosi,B.M.(2015).Incidence,prevalence and outcome oof rheumatic heart disease in South Africa:A systematic review of contemporary studies.International Journal of Cardiology,199:375-383.