臺灣博碩士論文加值系統

研究背景：退化性關節炎是一種好發於老年人的慢性疾病，會隨著年齡增長而病情變嚴重，進而造成活動能力受限並影響到往後日常生活作息。因此本研究欲了解退化性關節炎病程進展對於健康情形、生活品質及發炎因子濃度改變的相關性，以期望找出關節炎進展的重要預測指標。
研究目的：探討追蹤3年期間，退化性關節炎老人其膝關節嚴重度之進展與膝關節健康狀況WOMAC、健康生活品質SF-12、及發炎因子改變情形之相關性。
研究方法：本研究採回溯性世代研究，從民國100年至103年蘇遂龍老師國科會研究計畫之65歲以上台北市某醫學中心老人健檢民眾資料庫中選取追蹤3年者，共計29人。發炎因子選定以IL-6、VEGF、MCP-1、TNF-α、TNFR1、TNFR2及RANTES，利用流式細胞技術分析觀察血清中發炎因子濃度。並透過WOMAC、SF-12問卷了解受試者膝關節健康狀況，以及生活品質狀況；利用X光影像檔與K-L量表定義膝關節嚴重度情形，以及收集基本人口學資料了解人口特性。資料彙整後運用SPSS 18.0版進行分析。
研究結果：結果顯示在3年追蹤下，WOMAC在疼痛及功能方面(P=0.008, P=0.05)以及SF-12裡心理構面(P=0.03)反而變得更好，RANTES濃度並呈現顯著下降(P=0.008)。影響因子方面，影響WOMAC改變量為BMI，其可解釋WOMAC改變量總變異量35.5%；影響SF-12裡PCS改變量為BMI、下肢肌力及運動習慣，其共可解釋PCS改變量總變異量62.2%；影響MCS改變量為工作是否須搬重物或蹲跪，其可解釋MCS改變量總變異量42%；影響RANTES為運動習慣，其可解釋RANTES改變量總變異量45%。另外，比較膝關節嚴重度惡化與無惡化者其WOMAC 、SF-12及發炎因子濃度變化上均未明顯差異。

Background: Osteoarthritis is the most common disease, and it is a growing cause of social and economic burden. The symptom will become serious and cause progressive loss of function, displaying increasing dependency in walking, stair climbing and other lower extremity tasks. The goal of this study is to realize the progression of osteoarthritis which associates with the change in health status, health-related quality of life ,and the concentration of inflammatory factors and expect to find an important predictor of progression of osteoarthritis.
Methods: This study was a retrospective cohort study included 29 patients with osteoarthritis selected from Prof. Su Sui Lung’s database “elderly people participating in physical checkup from medical center in Taipei in 2011 to 2014 ”. Patients would be included when they had been followed up in three years. Inflammatory factors included IL-6, VEGF, MCP-1, TNF-α, TNFR1, TNFR2 and RANTES, and analyzed the concentration by flow cytometry. The severity of symptoms and health status were evaluated by WOMAC scale, SF-12 scale respectively. The radiographic severity of knee OA is assessed by the Kellgren–Lawrence (K/L)grading system. SPSS version 18.0 is using to analysis data.
Results: The results showed that WOMAC score and MCS score become better(P = 0.008, P = 0.05；P = 0.03), and the concentration of RANTES decreased (P = 0.008) in the selected patients. The impact factor of changes in WOMAC is “BMI”, which might explain WOMAC change amount of the total variance of 35.5%; The impact factors of changes in PCS are “BMI”, “lower extremity muscle strength” and “exercise habits”, which might explain PCS change amount of the total variance of 62.2%. The impact factor of changes in MCS is “work required to move heavy objects whether kneeling or squatting”, which can explain MCS change amount of 42% of the total variance; The impact factor of changes in RANTES is “exercise habit” , which can explain RANTES change amount of the total variance 45%. In addition, there were no significant difference between change in WOMAC ,SF-12,and the concentration of inflammatory factor in the comparison of the progression of osteoarthritis.

表目錄 ....................................................................................................................................... II
圖目錄 ...................................................................................................................................... III
附錄目錄 .................................................................................................................................. IV
中文摘要 ................................................................................................................................... V
Abstract ................................................................................................................................... VII
第一章 緒論 .............................................................................................................................. 1
第一節 研究背景 .............................................................................................................. 1
第二節 研究目的 .............................................................................................................. 3
第二章 文獻探討 ...................................................................................................................... 4
第一節 退化性關節炎之重要性 ...................................................................................... 4
第二節 膝關節嚴重度、膝關節整體健康狀況及健康相關生活品質 .......................... 8
第三節 發炎因子與退化性關節炎之相關性 ................................................................ 14
第三章 研究材料與方法 ........................................................................................................ 21
第一節 研究架構 ............................................................................................................ 21
第二節 研究對象與資料收集 ........................................................................................ 22
第三節 研究流程 ............................................................................................................ 25
第四節 實驗流程 ............................................................................................................ 26
第五節 統計分析 ............................................................................................................ 28
第四章 研究結果 .................................................................................................................... 30
第一節 研究對象之基本人口學分布及追蹤3 年期間之改變情形 ............................ 30
第二節 膝關節嚴重度改變(K-L 進展)與健康狀況(WOMAC) 、生活品質(SF12)及發
炎因子改變情形之相關性 .............................................................................................. 35
第四節 影響膝關節生活品質改變之影響因子 ............................................................ 41
第五章 討論 ............................................................................................................................ 55
第一節 膝關節嚴重度與健康狀況、生活品質及發炎因子之相關性 ........................ 55
第二節 膝關節嚴重度與健康狀況、生活品質及發炎因子之影響因子 .................... 58
第三節 研究限制 ............................................................................................................ 60
第六章 結論與建議 .............................................................................................................. 61
第一節 結論 .................................................................................................................... 61
第二節 建議 .................................................................................................................... 62
參考文獻 .................................................................................................................................. 63

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