臺灣博碩士論文加值系統

研究背景：支氣管擴張症的特徵為因重複的氣管感染和發炎所導致的不可逆氣管擴張。動脈硬化及發炎之相關性已經被普遍證實； 然而，探討支氣管擴張症及缺血性中風相關性之研究仍然很少見。因此，本論文進行人口世代研究，調查具有支氣管擴張症之病患，後續罹患缺氧性中風之風險。
方法：首先，從台灣健保資料庫中擷取在2000至2008期間，被診斷為支氣管擴張症之1,295位病人(實驗組)之資料； 然後，根據每一位實驗組病患之年齡及性別進行匹配，以1比5之取樣方式，從健保資料庫中擷取6,475人沒有罹患支氣管擴張症之一般民眾做為對照組。所有的參與者被追蹤至以下其中一個事件發生之日期為止：缺氧性中風被確診、設限狀況發生、達2010年底期限。電腦斷層掃描被用於缺氧性中風之確診。Cox比例風險模式被用於區別及比較支氣管擴張症病患和非支氣管擴張症病患間罹患缺氧性中風之風險。
結果：分析結果顯示，支氣管擴張症病患發生缺氧性中風之風險顯著地比非支氣管擴張症病高(發生率： 9.18 vs 4.66/1000PY)；其中，調整後之風險率(adjusted HR)為 1.74倍 (95% CI= 1.28-2.35)。支氣管擴張症病患伴隨有其它共病者發生 缺氧性中風之風險比沒有支氣管擴張症也沒有共病之病患高2.66倍(95% CI= 1.85-3.84)。分析參與者之急診及住院次數之結果顯示，支氣管擴張症病患發生缺氧性中風之風險呈現明顯的劑量效應。
結論： 此全國性縱貫性之世代研究結果顯示，罹患支氣管擴張症之病患發生缺氧性中風之風險顯著地比沒有支氣管擴張症之參與者高，特別是那些伴隨有其它共病之支氣管擴張症病患。然而，詳細分析共病之影響程度後發現，支氣管擴張症並不是導致缺氧性中風之獨立風險 。另外，根據急診及住院次數之資料分析結果顯示，支氣管擴張症病患發生缺氧性中風之風險呈現明顯的劑量效應。

Background: Bronchiectasis is characterized by an irreversible dilatation of the bronchial tree caused by recurrent airway infection and inflammation. The association of atherosclerosis and inflammation is well established. However, studies on the relationship between bronchiectasis and ischemic stroke are scant. Therefore, we conducted a population-based cohort study to investigate the incidence and risk of ischemic stroke in patients with bronchiectasis.
Methods: Data of 1,295 patients newly diagnosed as bronchiectasis between 2000 and 2008 were retrieved from the Taiwan National Health Insurance Research Database. And then, a total of 6,475 controls without bronchiectasis were randomly selected from general population based on frequency-matched (1:5) age and sex. All participants were followed up to the date of occurred ischemic stroke, censoring, or the end of 2010. The patients with ischemic stroke were confirmed by computerized tomography (CT) examination. The Cox proportional hazard model was obtained to identify the risk of ischemic stroke in patients with bronchiectasis compared with those without bronchiectasis.
Results: The patients with bronchiectasis indicated a higher incidence rate of ischemic stroke (9.18 vs 4.66 per 1000 person years) than the patients without bronchiectasis, with an adjusted HR of 1.74 (95% CI= 1.28-2.35). The patients with bronchiectasis and comorbidities exhibited a 2.66-fold increased risk of ischemic stroke compared with those without either bronchiectasis or comorbidity (95% CI= 1.85-3.84). The patients with bronchiectasis exhibited a dose response risk of ischemic stroke according to the number of emergency visits and hospital admissions per year.
Conclusion: This longitudinal nationwide cohort study showed that the risk of ischemic stroke is significantly higher in patients with bronchiectasis, especially comorbid with other diseases, than those without bronchiectasis. However, by considering the effect of comorbidity, bronchiectasis is not shown to be an independent risk factors associated with the ischemic stroke. Furthermore, the risk of ischemic stroke showed dose response according to number of emergency visits and hospital admissions per year. Furthermore, the risk of ischemic stroke showed a dose response according to the annual number of emergency visits and hospital admissions.

ACKNOWLEDGEMENTS...............................................I
摘要...........................................................II
ABSTRACT.....................................................III
TABLE OF CONTENT...............................................V
TABLE CONTENT................................................VII
FIGURE CONTENT...............................................VII
ABBREVIATION................................................VIII
CHAPTER I INTRODUCTION.........................................1
1.1 The general purpose of the study............... .......2
1.2 The specific objectives of the study...................3
1.3 The research questions of the study....................4
CHAPTER II METHODS.............................................5
2.1 Data sources...........................................5
2.2 Subjects...............................................5
2.3 Outcome measures.......................................6
2.4 Covariates and comorbid diseases.......................6
2.5 Statistical analysis...................................7
CHAPTER III RESULT.............................................8
3.1 Demographic characteristics and comorbidities of patients with and without bronchiectasis.......................8
3.2 Comparison of incidence and hazard ratio of ischemic stroke between patients with and without bronchiectasis.......10
3.3 Interaction on risk of ischemic stroke between bronchiectasis and comorbidities..............................14
3.4 Association between risk of ischemic stroke and number of emergency visits and hospitalizations......................17
3.5 Comparison of probability of induced ischemic stroke between bronchiectasis and non- bronchiectasis cohorts during follow up.....................................................18
CHAPTER IV DISCUSSIONS AND CONCLUSIONS........................19
4.1 Discussions...........................................19
4.2 Conclusions...........................................23
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