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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 宋鴻樟 | |
dc.contributor.author | Hsiao-Ling Chang | en |
dc.contributor.author | 張筱玲 | zh_TW |
dc.date.accessioned | 2021-06-13T06:59:28Z | - |
dc.date.available | 2005-08-04 | |
dc.date.copyright | 2005-08-04 | |
dc.date.issued | 2005 | |
dc.date.submitted | 2005-07-27 | |
dc.identifier.citation | (1) 痰細胞化生之流行病學調查
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/35580 | - |
dc.description.abstract | (1) 痰細胞化生之流行病學調查
民國80~82年國人的肺癌死亡率相當於發生率,但自83年起,死亡率增加的趨勢大於發生率,顯示肺癌不易被診斷。肺部疾病(包括肺癌)與暴露於二手菸及炒菜油煙之環境等因子相關,本研究即為探討大台北地區民眾痰細胞化生盛行率及其危險因子,進而瞭解餐飲業者健康狀況及痰細胞化生盛行情形。 本研究於2000年至2001年在大台北地區包括基隆市、台北市及台北縣三縣市,以自願方式收集研究對象。利用橫斷研究法進行問卷調查、健康檢查(包括胸部X光檢查)及痰檢體收集,並進行細胞學檢驗。 共收集513位的有效檢體,包括基隆市158位、台北市130位及台北縣225位,其中185位有痰細胞化生現象,328位無痰細胞化生現象。發現有痰細胞化生現象者較年輕,健康狀況亦較好,但是目前仍有吸菸的盛行率較高,為無痰細胞化生者的1.4倍(p=0.046)。在控制年齡、性別、籍貫、教育程度及吸菸習慣情形後,發現不論是全部研究對象、或是吸菸者、或是烹調者,在家中烹調因子均與痰細胞化生間具有統計顯著性,尤其是吸菸者有烹調行為,且每週下廚至少4天及以上者發生痰細胞化生現象之危險性竟高達7.6倍(95%信賴區間為1.5~39.2),故具有油煙暴露及吸菸者會有較高的痰細胞化生情形。另目前仍吸菸者發生痰細胞化生的危險性是已戒菸者與不吸菸者的1.7~1.9倍,而已戒菸者與不吸菸者發生痰細胞化生的危險性差不多,顯示吸菸行為與痰細胞化生有關。吸菸者除了在家中烹調因子外,吸菸時未使用濾嘴及有肺氣腫疾病者,發生痰細胞化生之危險性各達3.5倍及5.8倍。 因每週在家中下廚至少會有4天及以上者與痰細胞化生現象之相關均達統計顯著意義,故自研究對象中選取工作地點在台北縣、市之餐飲業者59人及社區民眾126人,進一步探討餐飲業者與社區居民生活型態、健康狀況及痰細胞學檢驗結果之相關。餐飲業者較社區民眾年輕,大多為女性,其教育程度與目前吸菸習慣均較低,但健康狀況較好。餐飲業者除了在工作上會暴露在油煙的環境下外,在家中亦較社區民眾有較多的機會暴露在油煙的環境下。 餐飲業者及社區民眾痰細胞化生盛行率差不多。若將餐飲業者以工作性質細分為廚師、餐務處理者及外場行政者,其中廚師約13.3%有肺部鈣化現象是值得注意的。雖然痰細胞化生盛行率在三組間之差異不具統計意義,但仍以廚師痰細胞化生盛行率最高約為45.0%,是外場行政者36.4%的1.2倍,比餐務處理者23.5%的1.9倍顯著。 本研究結果顯示家中烹調情形及吸菸習慣與發生痰細胞化生現象之相關性強。建議改變烹調行為及吸菸習慣,可能降低發生痰細胞化生的危險性。 (2) 嚴重急性呼吸道症候群死亡之血液生化預測因子 嚴重急性呼吸道症候群全球致死率為10.9%。本研究探討台灣嚴重急性呼吸道症候群病例在流行病學、臨床徵候及臨床檢驗值之死亡預後因子。由於血漿C-反應蛋白質(C-reactive protein,CRP)與發炎有關,亦探討CRP值與有無呼吸困難及存活間之關係。 研究對象以台灣地區自2003年3月14日至6月15日通報至傳染病監視通報系統之資料,並經SARS之冠狀病毒相關檢驗分析方法檢出陽性結果者為主,共有346例SARS確定病例。蒐集病患之基本資料、入院時臨床徵候及臨床檢驗初始資料,整理後進行分析。 結果顯示SARS病患有高的初始CRP值及低的初始淋巴球(lymphocyte)數,SARS死亡者(n=73或21.1%)之CRP平均值為47.7 mg/L比存活者的24.6 mg/L高(p=0.0001)。而死亡者之淋巴球數平均值為814 /mL比存活者的1019 / /mL低(p=0.004)。在探討SARS死亡預測因子之多變項分析時,於控制年齡及性別因子後,病患初始中性球數在7000 /mL以上者死亡的勝算比是7000 /mL 以下者的6.4倍(95%信賴區間為1.1~36.0)。其他具有統計顯著意義之死亡預測因子有初始CRP值大於47.5 mg/L者(5.8倍)及初始乳酸脫氫酶(lactic acid dehydrogenase,LDH)大於593.5 IU/L者(4.2倍)。另SARS病患具有慢性阻塞性肺疾病、腦中風或心臟病之一者,有高的初始CRP值,約61.5 mg/L。在控制年齡及性別因子下,發現有呼吸困難死亡者、有呼吸困難存活者及沒有呼吸困難死亡者,發生CRP值大於47.5mg/L之勝算比各為沒有呼吸困難存活者的6.0倍(95%信賴區間為1.8~20.3)、3.5倍(95%信賴區間為1.3~9.0)及2.8倍(95%信賴區間為1.0~7.4),其差異均具有統計顯著意義。 高初始中性球數、高初始CRP值及高初始LDH濃度是SARS死亡的重要預測因子。其中初始CRP值不僅僅為死亡預測因子,亦是嚴重感染SARS冠狀病毒的一個很好的預測因子。 | zh_TW |
dc.description.abstract | (1) Epidemiology of sputum metaplasia
In Taiwan, the annual mortality rate from lung cancer was approximately similar to the incidence rate of the disease in 1991~1993. Pulmonary diseases, including lung cancer, have been associated with the exposure to environmental tobacco smoking (ETS) and cooking oil fumes in addition to smoking. This study evaluated the detection of metaplsia in sputum and investigated corresponding prevalence and risk factors for metaplsia in sputum among general residents in Taipei areas. These associations were also evaluated for restaurant employees as separate sample. Study subjects being recruited in 2000~2001 received a pulmonary X-ray examination, completed a self-reported questionnaire for information on socio-demographic characteristics and life-style, and provided a specimen of the first sputum in the morning. This study included a total of 513 volunteer persons, recruited from Keelung City (158), Taipei City (130), and Taipei County (225). The results indicated that the subjects with metaplasia in sputum were younger than those without metaplasia in sputum, and had the best health status. The proportion of smokers among those with metaplasia in the sputum specimen was 35.7% or 1.4 times higher than that with no metaplasia in the sputum. After adjusting for age, gender, residential town and education, it was found that cooking and smoking history were significantly associated with developing metaplsia in sputum (p<0.05). Particularly, the odd ratio(OR) of metaplasia in sputum was 7.6 (95% confidence interval (CI)=1.5-39.2)for smokers with cooking, compared with smokers with no cooking or rarely cooked. In addition, the risk of metaplsia for smokers was 1.7~1.9 times higher than ex-smokers and non-smokers. No difference was found in the risk of metaplsia between ex-smokers and non-smokers. These results implied that smoking was likely related to the development of metaplsia in sputum. Using cigarette filter and emphysema were also risk factors of metaplasia positive for smokers. This study recruited 59 restaurant employees and 126 community residents in Taipei city/county. Restaurant employees were younger, with larger portion of females and lower education level, and more prevalent in cooking oil fume exposure at home than community residents. The restaurant chefs had the highest prevalence rate (13.3%) of calcification at pulmonary X-ray and metaplasia (45.5%) in sputum examinations. The prevalence of metaplasia in sputum for restaurant chefs was 1.2 times higher than restaurant staff (36.4%) and 1.9 times higher than cook assistants (23.5%). The study results suggest that the development of metaplasia in sputum is likely associated with cooking and smoking. Improved ventilation while cooking and smoking cessation may reduce the likelihood of developing the metaplasia in sputum. (2) Hematological and Biochemical Factors in Predicting SARS Fatality in Taiwan Severe acute respiratory syndrome (SARS) has a high fatality rate (10.9%) worldwide. We examined the epidemiological and clinical patterns associated with deaths for all SARS patients. Plasma C-reactive protein (CRP) is an important indicator of inflammation. We also investigated factors associated with the CRP concentration among SARS patients in Taiwan. Using initial data in medical records reported by hospitals to the Center for Disease Control in Taiwan, we analyzed whether hematological, biochemical and arterial blood gas measures for patients predict the fatality for 346 SARS patients. Both fatalities (n=73 or 21.1%) and survivors had elevated plasma concentration of initial CRP with higher average in fatalities (47.7±43.3 mg/L) than in survivors (24.6±28.2 mg/L), and low lymphocytes counts in both fatalities(814 /mL±378 /mL)and survivals(1019 /mL±480 /mL). After controlling for age and sex, the multivariate model showed that patients with neutrophils higher than 7000 /mL were at the highest risk of fatality (odds ratio [OR] = 6.4, 95% confidence interval [CI] = 1.1-36.0). Other significant conditions independently associated with deaths included CRP (OR=5.8) and lactic acid dehydrogenase (LDH, OR=4.2). This study also found SARS patients with chronic obstructive pulmonary disease, cerebrovascular accident and/or cardiac diseases had a higher average level of CRP approximately 61.5 mg/L. Compared with survivors with no dyspnea, the age-sex-adjusted odds ratios in patients with CRP levels greater than 47.5 mg/L were 6.0 (95% CI = 1.8-20.3) for fatalities with dyspnea, 3.5 (95% CI = 1.3-9.0) for survivors with dyspnea, and 2.8 (95% CI = 1.0-7.4) for fatalities with no dyspnea. Neutrophil counts, and CRP and LDH levels are important predictors of deaths from SARS. The initial CRP not only is a marker associated with the progress of SARS, but also can be used to predict the severity of the coronavirus infection. | en |
dc.description.provenance | Made available in DSpace on 2021-06-13T06:59:28Z (GMT). No. of bitstreams: 1 ntu-94-D85821008-1.pdf: 716110 bytes, checksum: feb54d065420541484994414ced4c336 (MD5) Previous issue date: 2005 | en |
dc.description.tableofcontents | (1) 痰細胞化生之流行病學調查
目錄 中文摘要 ………………………………………………………… I 英文摘要 ………………………………………………………… III 目錄 ……………………………………………………………… V 表圖目錄 ………………………………………………………… VI 第一章 緒論 第一節 研究背景與重要性 …………………………………… 1 第二節 研究目的 ……………………………………………… 8 第二章 研究方法及步驟 第一節 研究架構 ……………………………………………… 9 第二節 流行病學研究對象 …………………………………… 10 第三節 基本資料 ……………………………………………… 10 第四節 健康檢查及痰細胞學檢驗 …………………………… 12 第五節 資料處理與統計分析 ………………………………… 14 第六節 執行步驟 ……………………………………………… 14 第三章 研究結果 第一節 研究對象人口學基本特性及生活習慣 ……………… 16 第二節 呼吸系統健康狀況及生化檢驗值 …………………… 17 第三節 吸菸者之吸菸特性、呼吸系統健康狀況及生化檢驗值 18 第四節 家中烹調者之烹調特性、呼吸系統健康狀況及生化檢驗值20 第五節 痰細胞化生相關因子 ………………………………… 22 第六節 餐飲業者及社區民眾之人口學基本特性 …………… 30 第七節 餐飲業者及社區民眾之呼吸系統健康狀況及生化檢驗值32 第四章 結論及建議 …………………………………………… 34 第五章 研究限制及困難 ……………………………………… 38 第六章 參考文獻 ……………………………………………… 39 附錄一 研究調查問卷 ………………………………………… 83 附錄二 取痰的正確方式 ……………………………………… 89 附錄三 健康檢查報告單 ……………………………………… 91 表圖目錄 表一 研究對象痰細胞化生之人口及生活型態特徵 ………… 47 表二 研究對象痰細胞化生之飲食特性 ……………………… 49 表三 研究對象痰細胞化生之自述疾病盛行及症狀特性 …… 50 表四 研究對象痰細胞化生之血液生化檢查結果 …………… 51 表五 研究對象痰細胞化生之尿液檢查不正常結果 ………… 52 表六 吸菸者痰細胞化生之人口及生活型態特徵 …………… 53 表七 吸菸者痰細胞化生之吸菸特性 ………………………… 55 表八 吸菸者痰細胞化生之自述疾病盛行及症狀特性 ……… 56 表九 吸菸者痰細胞化生之血液生化檢查結果 ……………… 57 表十 吸菸者痰細胞化生之尿液檢查不正常結果 …………… 58 表十一 在家中烹調者痰細胞化生之人口及生活型態特徵 … 59 表十二 在家中烹調者痰細胞化生之烹調特性 ……………… 61 表十三 在家中烹調者痰細胞化生之自述疾病盛行及症狀特性 62 表十四 家中烹調者痰細胞化生之血液生化檢查結果 ……… 63 表十五 家中烹調者痰細胞化生之尿液檢查不正常結果 …… 64 表十六 不同樣本間呼吸系統健康狀況及胸部X光鈣化現象比較65 表十七 全部研究對象痰細胞化生之相關因子單變項分析 … 66 表十八 吸菸者與不吸菸者痰細胞化生之相關因子單變項分析 68 表十九 在家中烹調者與不烹調者痰細胞化生之相關因子單變項分析70 表二十 痰細胞化生與相關因子間之邏輯氏複迴歸模式 …… 72 表二十一 餐飲業者與社區民眾之人口及生活型態特徵 …… 73 表二十二 餐飲業者與社區民眾之之飲食特性 ……………… 75 表二十三 餐飲業者與社區民眾吸菸者吸菸特性及二手菸暴露 76 表二十四 餐飲業者與社區民眾烹調者烹調特性 …………… 77 表二十五 餐飲業者與社區民眾之自述疾病盛行及症狀特性 78 表二十六 餐飲業者與社區民眾之血液生化檢查結果 ……… 79 表二十七 餐飲業者與社區民眾之尿液檢查不正常結果 …… 80 表二十八 餐飲業者與社區民眾各樣本間呼吸系統健康狀況分布81 (2) 嚴重急性呼吸道症候群死亡之血液生化預測因子 目錄 中文摘要 ………………………………………………………… VII 英文摘要 ………………………………………………………… VIII 目錄 ……………………………………………………………… X 表圖目錄 ………………………………………………………… XI 第一章 緒論 第一節 研究背景與重要性 …………………………………… 95 第二節 研究目的 ……………………………………………… 99 第二章 研究方法及步驟 第一節 流行病學研究對象 …………………………………… 100 第二節 統計分析 ……………………………………………… 101 第三章 研究結果 第一節 SARS病例人口學特徵 ………………………………… 103 第二節 SARS病例臨床特徵 …………………………………… 104 第三節 SARS病例之死亡預測因子 …………………………… 105 第四節 有無初始C-反應蛋白質檢驗值者間之人口學特徵 … 106 第五節 高初始CRP值之相關因子 ……………………………… 107 第四章 討論及結論 …………………………………………… 109 第五章 研究限制及困難 ……………………………………… 112 第六章 參考文獻 ……………………………………………… 113 附錄四 發表文章 ……………………………………………… 139 附錄五 論文口試委員意見 …………………………………… 141 表圖目錄 表一 台灣SARS病患死亡者與存活者之人口學特徵比較 …… 118 表二 台灣SARS病患死亡者與存活者就醫初期之臨床特徵比較 119 表三 台灣SARS病患死亡者與存活者就醫時之初始臨床檢驗值比較120 表四 台灣SARS病患臨床檢驗值之四分位及其正常範圍 …… 121 表五 台灣SARS病例死亡之影響因子-單變項邏輯氏迴歸法 122 表六 台灣影響SARS病例死亡之預測因子-多變項邏輯氏迴歸法124 表七 台灣SARS病患有無檢驗C-反應蛋白質者間之比較 …… 125 表八 不同慢性疾病之初始C-反應蛋白質之平均值及百分比分布127 表九 C-反應蛋白質值大於>47.5 mg/L之相關因子-單變項邏輯氏迴歸方式 …………………………………………………………… 128 表十 SARS病例與C-反應蛋白質值大於> 47.5 mg/L間之相關因子-多變項邏輯氏複迴歸方式 ……………………………………… 129 表十一 SARS病例控制年齡及性別後存活與有無呼吸困難間C-反應蛋白質值大於47.5 mg/L之勝算比 ………………………………… 130 圖一 台灣SARS病患不同期間發病前之接觸史比較 ………… 131 圖二 台灣2003年2月24日至7月15日SARS疫情流行曲線 …… 132 圖三 台灣SARS病例居住縣市地理分布 ……………………… 133 圖四 台灣SARS死亡病例居住縣市地理分布 ………………… 134 圖五 SARS病例有無慢性病史之致死分布 …………………… 135 圖六 不同性別間C-反應蛋白質之累積分布 ………………… 136 圖七 不同年齡層間C-反應蛋白質之累積分布 ……………… 137 | |
dc.language.iso | zh-TW | |
dc.title | (1) 痰細胞化生之流行病學調查
(2) 嚴重急性呼吸道症候群死亡之血液生化預測因子 | zh_TW |
dc.title | (1) Epidemiology of sputum metaplasia
(2) Hematological and Biochemical Factors in Predicting SARS Fatality in Taiwan | en |
dc.type | Thesis | |
dc.date.schoolyear | 93-2 | |
dc.description.degree | 博士 | |
dc.contributor.oralexamcommittee | 林瑞雄,吳聰能,張淑惠,陳國東,陳保中 | |
dc.subject.keyword | (1) 肺癌,痰檢體,細胞化生,廚師,吸菸,油煙 (2) 嚴重急性呼吸道症候群,致死,C-反應蛋白質,淋巴球減少症,乳酸脫氫酶,呼吸困難, | zh_TW |
dc.subject.keyword | (1) Lung cancer,Sputum,Metaplasia,Cooking oil fume,Smoking (2) Severe acute respiratory syndrome (SARS),Fatality,C-reactive protein,Lymphopenia,Lactic acid dehydrogenase,Dyspnea, | en |
dc.relation.page | 140 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2005-07-28 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 環境衛生研究所 | zh_TW |
顯示於系所單位: | 環境衛生研究所 |
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