臺灣大腸疾病流行病學資料庫之建立與評估分析

Abstract

“流行病學”這一門獨立的學科早在100年前工業時代，即有學者從人們生活的環境、飲用的食物，乃至醫療照護體系之建立等開始研究，這些發展過程都是影響流行病學應用方向之因素，使得流行病學從早期的針對傳染性疾病的防制，演進到慢性疾病、重大傷病、健康與保健等課題，深入地探究疾病之好發因子以及危險因素，並將成果提供給衛生行政單位，作為制定衛生保健政策的一項參考資料。 鑒於臺灣學者在參與國際醫學討論會，在討論亞洲大腸疾病態勢時，常常發現獨缺臺灣大腸相關疾病的流行病學資料，因而喪失與各國作國際性的交流及比較的機會，非常的可惜。事實上，臺灣並不是沒有病例的發生，僅因資料大多散見在國內外的專業期刊、雜誌或研討會上，造成臺灣的資料未被國際資料庫所收錄，因為病歷統計資料不易取得，而少被引用。所以本研究論文的目的是希望，將目前臺灣衛生機構現有的相關資料，以及國內學者在臺灣雜誌上所發表的病例報告、研究成果作一統合性的收集，並且整理出臺灣近20年的大腸疾病發生態勢，建立一個“臺灣地區大腸流行病學”資料庫，可以提供國內外學者查詢“臺灣本土的資料與臨床經驗”，而完成一個推廣大腸疾病知識的教學網站。 網站的架設至今也已經完成，其中將大腸常見的疾病分類成31種，收錄有國人130篇的案例報告以及衛生署的年度統計數據資料，作為流行病統計數據的來源，並且還另外設置專門的網站討論區，提供作為線上討論及訪客交流的自由空間。由於這是一個活的資料網站，在未來論文完成之後仍然會持續地增加內容，期待可以作為代表臺灣大腸流行病資料的參考網站。 在完成相當數量的文獻收集之後，將整理出單一大腸疾病的臺灣年報Review，目前整理出有阿米巴腸炎（amebic colitis）、結腸扭結（colon volvulus）、缺血性大腸炎（ischemic colitis）、憩室症（diverticulosis and diverticulitis）、腸結核（tuberculosis of intestines）等五篇年報。其中可以從年報中得知，憩室症的病灶發生率，在西方國家中有九成是發生在左側結腸；亞洲東方國家則是左右結腸各佔五成，日本右側結腸發生病例的人數甚至還到七成。另外近年來罹患缺血性腸炎的人數也有增加的趨勢，應是與臺灣人口結構老化有關。 關鍵字：流行病學，資料庫網站，大腸直腸疾病，IBD，衛生統計

' Epidemiology' was the course of the independence as early as 100 years ago in the times of industry, the scholars started studying it with the environment that the people lived, food and drink, and the establishment of medical care system. These developments all influenced the factors of the Epidemiology application directions, evolving the Epidemiology defend system from the contagion disease to the chronic disease, health and care topics. Investigated dangerous factors of the disease, and provided the results to the health administration units as a reference of the health policy.

Owing to the Taiwanese scholars participating the international medical science colloquium, discussing the large bowel disease situation in Asia, usually found that lacking the Taiwanese Epidemiology data. As a result, losing a comparative chance with all countries, it’s very regrettable. In fact, Taiwan was not the occurrence that had no case, only because the data spread to professional periodicals, magazines or seminars, caused the data of Taiwan didn't include into international database, and because of it’s not easy to obtain the medical statistics, few were quoted from. So the purpose of this research is collecting the related data that the Taiwanese health organization has already had, the Taiwanese case reports announced on magazines, and the researches to tidy up the large bowel disease occurrence in recent 20 years in Taiwan. Then building up a database on 'The Epidemiology of large bowel disease in Taiwan', which can provide the domestic and international scholars searching 'The data of Taiwanese mainland and clinical experience', and can establish a teaching website that expands the large bowel disease knowledge. The set of the website has already completed as well up to now, we are categorizing the familiar disease of the large bowel disease into 31 kinds, registering 130 articles. And as a specialized website, we prepare a discussion area of free space that provides a chance with on-line discussion. Because of this is a website for living, it will increase the content steadily after this thesis completes. we expecting the website could be a reference website of the Taiwan large bowel disease. After completing the collections, we will tidy up the Taiwanese annual report of single large bowel disease, now we have amebic colitis, colon volvulus, ischemic colitis, the diverticulosis and diverticulitis, tuberculosis of intestines with five annual reports. We can know from the annual reports with the occurrence rate of the diverticulosis and diverticulitis, in western nation, 90% of patients occurrence in the left side colon; the east of the Asia nations, patients occurence in each colon of 50%, the Japanese even occurrence in right side to 70%. The numbers of ischemic colitis in recent years also have the augmentative trend, because of the ageing phenomenon in Taiwan. Key word：Epidemiology, the database website, large bowel disease, colorectal disease, IBD, the hygiene statistics