臺灣博碩士論文加值系統

研究目的：本研究旨在探討愛滋病毒感染者中非酒精性脂肪肝疾病的盛行率及其相關危險因子。對於接受高效能抗愛滋病毒治療的愛滋病毒感染者，本研究先評估非酒性脂肪肝的盛行率，接著將分析愛滋病毒感染者其基本人口學特徵(包括年齡、身高、體重、腰圍和身體質量指數)以及臨床危險因子(如糖尿病、代謝症候群、飲酒、抽菸、嚼檳榔及其他藥物使用情況)的分布情形。最後，研究將分析基本人口學和臨床危險因子對非酒性脂肪肝的影響。
研究方法：本研究採用前瞻性研究，以在中山醫學大學附設醫院接受高效能抗愛滋病毒治療的愛滋病毒感染者為研究對象。研究期間為2018年9月至2021年2月。研究納入條件包括患者年齡需達20歲以上且在過去六個月內持續接受高效能抗愛滋病毒治療。排除條件則包括患者拒絕參與、年齡未滿20歲、未接受或停止治療超過六個月，以及數據記錄不完整者。數據收集包括基本人口統計資料、臨床危險因子（如糖尿病、代謝症候群、飲酒、抽菸、嚼檳榔、脂肪肝及藥物使用），以及非侵入性診斷工具（如血清檢查以及超音波彈性影像數據）。
結果：本研究共有372位愛滋病毒感染者進入分析，其中有非酒精性脂肪肝之感染者有88位，盛行率約23.66%。使用獨立樣本t檢定進行檢驗，結果得知，有糖尿病感染者在ARFI之數值較沒有糖尿病感染者高(t = -2.31；p = 0.0219)；有嚼檳榔感染者在ARFI之數值較沒有嚼檳榔高(t = -2.94；p = 0.0158)；有使用TAF感染者在ARFI之數值較沒有使用TAF感染者高(t =-2.03；p = 0.0441)。
結論：本研究發現愛滋病毒感染者有非酒精性脂肪肝之盛行率為23.66%。同時，也發現臨床危險因子相較於基本人口學，與非酒精性脂肪肝有顯著影響，特別是糖尿病、嚼檳榔以及使用TAF藥物。

Purpose: This study aims to investigate the prevalence and associated risk factors of non-alcoholic fatty liver disease (NAFLD) in individuals with HIV infection. For those receiving highly active antiretroviral therapy (HAART), this study first evaluates the prevalence of NAFLD. Then it analyzes the distribution of demographic characteristics (including age, height, weight, waist circumference, and body mass index) and clinical risk factors (such as diabetes, metabolic syndrome, alcohol consumption, smoking, betel nut chewing, and other drug use). Finally, the study will analyze the impact of these demographic and clinical risk factors on NAFLD.
Method: This prospective study focuses on HIV-infected individuals receiving HAART at Chung Shan Medical University Hospital. The study period spans from September 2018 to February 2021. Inclusion criteria are patients aged 20 years and above who have continuously received HAART for the past six months. Exclusion criteria include refusal to participate, age under 20 years, discontinuation of treatment for more than six months, and incomplete data records. Data collection includes demographic information, clinical risk factors (such as diabetes, metabolic syndrome, alcohol consumption, smoking, betel nut chewing, fatty liver, and drug use), and non-invasive diagnostic tools (such as AST to Platelet Ratio Index and Acoustic Radiation Force Impulse Imaging)
Result: A total of 372 HIV-infected individuals were analyzed in this study, of whom 88 had NAFLD, resulting in a prevalence rate of approximately 23.66%. Using independent samples t-test, it was found that diabetic patients had higher ARFI values compared to nondiabetic patients (t = -2.31; p = 0.0219); betel nut chewers had higher ARFI values compared to non-chewers (t = -2.94; p = 0.0158); and patients using TAF had higher ARFI values compared to non-users (t = -2.03; p = 0.0441).
Conclusion: This study found that the prevalence of NAFLD among HIV-infected individuals is 23.66%. Additionally, clinical risk factors, rather than demographic characteristics, significantly impact NAFLD, particularly diabetes, betel nut chewing, and TAF medication use.

目次
謝誌 I
摘要 II
Abstract IV
目次 VI
圖次 VIII
表次 IX
第一章緒論 1
第一節 研究背景與動機 1
第二節 研究目的 4
第二章文獻探討 6
第一節 愛滋病毒感染者與高效能抗愛滋病毒治療 6
第二節 愛滋病毒感染者之非酒精性脂肪肝疾病 9
第三節 臨床危險因子對於非酒精性脂肪肝疾病之影響 12
第四節 研究假設與架構 15
第三章研究方法 17
第一節 研究設計與研究對象 17
第二節 研究工具 18
第三節 資料處理與分析方法 22
第四章研究結果 24
第一節 研究樣本之基本人口學 24
第二節 基本人口學以及臨床危險因子在使用ARFI檢查之肝纖維指數中之分佈情形 26
第三節 基本人口學以及臨床危險因子在使用APRI檢查之肝纖維指數中之分佈情形 27
第四節 基本人口學特徵在肝纖維嚴重程度(FIB4)之次數與百分比分佈狀況 28
第五節 基本人口學特徵在有無脂肪肝之次數與百分比分佈狀況 28
第六節 總樣本之基本人口學變項、臨床危險因子對於肝纖維指數之關係 29
第七節 總樣本之基本人口學變項對於肝纖維指數之關係 29
第五章討論 30
第一節 研究主要發現 30
第二節 愛滋病毒感染者得到非酒性脂肪肝的盛行率 31
第三節 愛滋病毒感染者同時合併著糖尿病 31
第四節 愛滋病毒感染者有非酒精性脂肪肝的臨床危險因子為嚼食檳榔 32
第五節 非酒精性脂肪肝之愛滋病毒感染者使用TAF藥物 32
第六節 研究限制 33
第六章結論與建議 34
第一節 結論 34
第二節 研究建議 34
參考文獻 36







圖次
圖1、研究架構圖 16

















表次
表1、基本人口學分佈 (N=372) 41
表2、超音波彈性影像(ARFI)在臨床危險因子之分佈狀況 43
表3、血清檢查(APRI)在臨床危險因子之分佈狀況 45
表4、纖維化指數(FIB4)在臨床危險因子之分佈狀況 47
表5、是否有脂肪肝在臨床危險因子之分佈狀況 50
表6、基本人口學與ARFI、APRI之迴歸分析結果 53
表7、基本人口學與ARFI、APRI之相關分析結果 55

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