台灣的族群與晚發型阿茲海默氏病之關聯研究

Abstract

背景: 種族(或族群)的意涵，包括生物特性、習俗及生活習慣的差異，過去的研究發現不同的種族(或族群)發生失智症之風險不同，但並沒有針對台灣族群的相關研究。因此，本研究想探討台灣族群與阿茲海默氏病的關聯性。 方法：本研究採用病例-對照設計，收案期間為2007-2010年，地點為台大醫院；病例組來自神經科門診，共收集209位年齡60歲以上的阿茲海默氏病個案，對照組共計497位，為相同年齡層的該院老年健康檢查長者以及志工。研究方式包括以自填問卷取得收案對象之基本人口學資料、族群分類(客家、閩南以及外省人)，以及生活習慣等因子；並取得個案之血液樣本，進行ApoE e4基因分型。分析方式以邏輯斯回歸模式評估台灣族群與阿茲海默氏病之關聯性，並且分析 ApoE e4 以及生活型態等因子對於前述關聯性之影響狀況。 結果： 外省人得到阿茲海默氏病之風險顯著低於閩南人[Adjusted OR (AOR)= 0.22, 95% CI =0.12–0.40]。性別與宗教信仰會顯著的調整台灣族群與晚發型阿茲海默氏病之關聯性(交互作用之P值為0.02及 0.04)。不帶有ApoE e4 基因型的收案對象中，外省人得病的風險顯著低於本省人 (AOR=0.19, 95% CI=0.09-0.40)；而在教育程度較低的個案中也有類似的結果(教育年數≤ 6年，AOR=0.17, 95% CI=0.04-0.78；教育年數介於7-12年，AOR=0.27，95% CI=0.10-0.67)，此外，從事高頻率運動的外省人得病的風險也顯著的低於同類型之本省人(AOR=0.17, 95% CI=0.08-0.37)。 結論：外省人得到阿茲海默氏病之風險顯著的低於本省人。性別與宗教信仰均顯著的調整前述關聯性。

Background. Different races reflect different genetic and environment factors, which have known to affect the risk of Alzheimer’s disease (AD). However, no study has explored the association between Taiwanese ethnic groups and AD risk. Methods. This is a hospital-based case-control study. A total of 209 late-onset (age 60 or older) AD( patients were recruited from one teaching hospital between 2007 and 2010. Healthy controls (n =497) with the same age of cases were recruited from the health checkup and volunteers of the hospital during the same time period. A self-reported questionnaire was administered to collect information on demography, parental ethnicity (Hakka, Minnan, and Mainlander), and lifestyle factors. Logistic regression model was utilized to assess the association between Taiwanese ethnic groups and AD risk, and how ApoE e4 status, and lifestyle factors modified this association. Result. Mainlander had a significantly decreased risk of AD [adjusted odds ratio (AOR) = 0.22, 95% confidence interval (CI) =0.12–0.40] as compared with that of Minnan. Gender and religious affiliation significantly modified the association between Taiwanese ethnic groups and AD (p interaction=0.02 and 0.04 respectively). After stratification, Mainlander had a decreased risk of AD in ApoE e4 non-carriers (AOR=0.19, 95% CI=0.09-0.40) as compared with Minnan. Similar findings were observed for lower educated levels (education years≤6, AOR=0.17, 95% CI=0.04-0.78; 7≤education years≤12, AOR=0.27, 95% CI=0.10-0.67) and high frequency of physical activity (AOR=0.17, 95% CI=0.08-0.37). Conclusions. Mainlander was associated with a decreased risk of AD. Gender and religious affiliation significantly modified this association.