臺灣博碩士論文加值系統

眾所周知以往臺灣在「人類嗜T淋巴球病毒(human T-lymphotropic virus簡稱HTLV)」的流行病學探討中，被列為高感染區，這對全民大眾健康及輸血安全顯然將造成危害與威脅。自1996年起我們已經使用酵素免疫分析法(enzyme immunoassay；簡稱EIA)對志願捐血者實施常規的第一型暨第二型人類嗜T淋巴球病毒抗體(anti-HTLV I/II)篩檢。在這項研究中，我們調查全國志願捐血者血清HTLV I/II抗體盛行率(seroprevalence)，並探討HTLV陽性捐血者家族內感染危險因素。
以1996年二月到1998年十二月從分佈在臺灣六個捐血中心的志願捐血者為篩檢對象，捐血人數分別為1996年766,571人、1997年889,264人、1998年922,403人；在三年時間的捐血者先予面談，然後實施檢驗篩檢採用直接三明治酵素免疫分析法(direct sandwich enzyme immunoassay)測試anti-HTLV I/II，若為陽性則進行複檢(duplicate method)，並針對EIA檢測陽性檢體進行HTLV-I和HTLV-II西方墨點確認試驗(Western blots 簡稱W.B.)。吾人徵得20個捐血者HTLV抗體帶原者(carrier)的家族成員(共計93人)的同意，進行面談，並全面檢驗anti-HTLV I/II。依實驗篩檢結果，配合人口學資料(demographics)，如性別、年齡及生活行為如餵食母乳和醫學相關病史，對其構築族譜圖，以執行感染危險因子統計分析。
在三年探討中被檢測確定anti-HTLV-I陽性的志願捐血者共計1,952人，陽性率分別為1996年0.130%，1997年0.063%，1998年0.044%；而同時期HTLV-II血清陽性(sero-positivity)之志願捐血者只發現一位（佔1998年當年度志願捐血者0.0001%）。在同期間針對1800位志願捐血者實施anti-CMV抗體血清盛行率調查，結果為91.3%。在HTLV-I血清反應陽性的志願捐血者中，我們面談並調查20個志願捐血者HTLV抗體帶原者家屬共93位。分析得到HTLV-I家族內感染率為36.6% (34/93)；由丈夫傳予妻子者33.3% (3/9)，由妻子傳予丈夫者未曾發現(0/5)；年齡35歲(含)以上家族族群內HTLV抗體血清陽性的有55.6% (20/36)，年齡35歲以下家族內HTLV抗體血清陽性者24.6% (14/57)；在HTLV陽性捐血者家族問卷中，經感染之各項單項變異(univariate)分析統計(Odds Ratio簡稱OR)結果為曾住院治療、曾有輸血病史、曾餵食母乳、與anti-HCV陽性者感染HTLV之機率較高。OR分別為6.58、5.74、4.44、5.61，p值均< 0.05。
本研究結論證實台灣捐血者HTLV-I感染率很低，若依HTLV血清抗體陽性率與捐血人數次比較，則只佔0.075% (若以1998年捐血人次計之，首次捐血者HTLV-I/II抗體陽性盛行率為0.069%，重複捐血者HTLV-I/II抗體陽性盛行率為0.03%)，故台灣應是HTLV的非感染盛行區(nonendemic area)。此外，在本調查中我們發現HTLV抗體陽性帶原者的家族內感染危險因素以曾住院治療為最高，經由輸血感染次之，藉由餵食母乳途徑傳染比例亦高。由此看來，透過餵食母乳及經子宮分娩過程應是HTLV主要垂直感染傳染途徑。本研究建議應將anti-HTLV I/II列入產前檢查項目並加強哺乳衛教，以減除白血球之血液製品為輸血導向，以杜絕anti-HTLV I/II之傳播。

Background and Objectives: There is controversial for epidemiological status of human T-lymphotropic virus (HTLV) in Taiwan, it is important to define a more precise picture for greater insight into public health and for safe blood transfusion .In Taiwan area, six blood donor centers have started to use enzyme immunoassay (EIA) for routine screening of blood donors for antibodies to HTLV type I and II since 1996. In this study, we investigated the seroprevalence and intrafamilial transmission risk factors of HTLV infection among blood donors based on screening data. Material and methods: During the period of February 1996 to December 1998, 2,578,238 donors from six blood centers in Taiwan were recorded. An interview-based survey, which collected data on demographics, feeding pattern in neonate period as well as medical history, was conducted on seropositive donors. HTLV-I and HTLV-II determinations were performed by using a combined HTLV-I/HTLV-II direct sandwich immunoassay screening test, and confirmed by Western blots test. Statistical analysis was further performed on laboratory screening data of donors. Results: Of all donors enrolled in these three years, 1,953 (0.07%) were seropositive for HTLV-I while HTLV-II seropositivity was only found in one case. Among the HTLV-I-seropositive donors, 20 index HTLV-I carriers (10 male, 10 female, age ranged from 38 to 64 yr) were interviewed, and 93 relatives were enrolled. Of the 93 relatives, 34 (36.6%) were seropositive for HTLV-I. Spouses of 14 HTLV-I carrier were studied. Three out of nine (33.3%) wives of male carrier but none of the five husbands of female carriers were seropositive for HTLV-I. On univariate analysis, revealed HTLV-I risk factors includeing a history of hospitalization (OR = 6.58; p < 0.05), blood transfusion (OR = 5.74; p < 0.05), breast feeding (OR = 4.44; p < 0.05), and operation history (OR = 0.5; p > 0.05). Conclusions: Our findings suggest that Taiwan is a low prevalence, nonendemic area for HTLV infection. Furthermore, husband-to-wife, mother-to-child, breast feeding and blood transfusion transmission are the main forms of intrafamilial transmission of HTLV-I in Taiwan. Through the large-scale HTLV screening program the HTLV seropositivity has much decreased among blood donors. It has efficiently prevented HTLV viral transmission via transfusion in Taiwan.
Key words: Enzyme immunoassay(EIA); human T-lymphotropic virus (HTLV); blood donors; intrafamilial transmission.

英文摘要 1~~2
中文摘要 3~~5
前言及文獻回顧 6~~16
材料與方法 17~~28
結 果 29~~39
討 論 40~~52
參考文獻 53~~63
圖 表 64~~82

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