醫療從業人員之肝功能異常盛行率及危險因子研究

The Prevalence and Risk Factors of Elevated Liver Enzyme among Health-Care Workers

莊海華(Hai-Hua Chuang) ； 葉維中(Wei-Chung Yen) ； 盧美君(Mei-Chun Lu) ； 陳雅鈴(Ya-ling Chen) ； 林士傑(Shih-Chieh Lin) ； 張詩鑫(Shy-Shin Chang)

《中華職業醫學雜誌》 22卷3期 (2015/07) Pp. 177-187

摘要

背景及目的：醫療從業人員的健康對於自身及社會皆有不可忽視的影響，而其特殊工作性質卻可能具有負面效應。麩丙酮酸轉胺脢為勞工體檢常見之肝功能指標，且近年來因與非酒精性脂肪肝疾病、代謝症候群、及胰島素抗性等密切相關而在國際間引起極大重視。本研究旨於了解醫療從業人員的肝功能異常盛行率及相關危險因子，並做出對應之解釋及建議，供未來規劃及執行健康篩檢、管理、及促進時參考。方法：此為橫斷性之流行病學研究。使用北部某醫學中心五年間員工健檢結果，擷取符合納入條件個案後，進行肝功能指數異常之盛行率描述性統計及相關危險因子分析。結果：某醫學中心員工勞動力組成有女性、年輕之傾向。麩丙酮酸轉胺脢異常之總盛行率為9.97%，男性之盛行率大幅高於女性，超過40歲族群略高於20-40歲者，職務類別以醫師最高、護理最低。校正後顯示危險因子包括：男性、腰圍過大、身體質量指數過大、血壓過高、空腹血糖過高、總膽固醇過高等；年紀較長為保護因子；職業類別則未達統計顯著。結論：針對醫師，及具有男性、腰圍過大、身體質量指數過大、代謝症候群傾向等危險因子者，應加強肝臟健康的篩檢及評估、並進行健康管理及促進。另醫療從業人員的特殊工作條件對其健康所產生之效應可能藉由複雜而多元的機制產生，建議可作為未來研究方向。

關鍵字

醫療從業人員 ； 麩丙酮酸轉胺脢 ； 盛行率 ； 危險因子 ； 醫院員工健康促進

並列摘要

Background and purpose: The health status of health-care workers is a particular issue to address concerning its impacts on patient safety and care quality. Presumably better health knowledge, awareness, and accessibility to health care may have positive effects on health outcome while the stress and long working-hours may have the other. Alanine aminotransferase (ALT), a very commonly used biochemistry marker to evaluate liver function in routine health exams for workers in Taiwan, has raised great concern internationally since its elevation has been suggested to be closely linked to nonalcoholic fatty liver disease (NAFLD), metabolic syndrome (MetS), and insulin resistance. This study aims to investigate the prevalence of ALT elevation among medical care workers and determine possible risk factors. Method: This is a cross-sectional epidemiological study. Data including sex, age, profession category, ALT, body weight (BW), body height (BH), waist circumference (WC), blood pressure (BP), fasting sugar, triglyceride (TG), total cholesterol, creatinine (Cr), smoking and drinking history is collected from routine worker health exams results of a medical center in Northern Taiwan during year 2008-2012. The prevalence of ALT elevation is described. Possible risk factors are analyzed using univariate and multivariate logistic regression. Result: Data of a total of 4,997 individuals is included in the study with 1,382 (27.7%) males and 3,615 (72.3%) females. The prevalence of ALT elevation is significantly higher in men (19.68%) than in women (6.25%). The highest prevalence is observed in the profession category of doctors (16.52%), followed by technicians (9.09%), administrative staff and others (9.07%), and nurses (7.26%). Multivariate-adjusted odds ratios are lower in older age (0.74; 0.59-0.93) and higher in male sex (3.17; 2.31 to 4.35), larger WC (2.58; 1.98 to 3.36), overweight (1.79; 1.33 to 2.39), higher BP (1.72; 1.21 to 2.45), higher fasting glucose (2.23; 1.55 to 3.21), higher total cholesterol (1.40; 1.11 to 1.76), and higher TG (1.95; 1.50 to 2.54) with statistical significance. Conclusion: Possible risk factors for ALT elevation observed in this study are consistent with literatures. Individuals who are doctors, male, older, and with a less preferable metabolic profiles are expected to be at greater risk. Health promotion program with a close monitor and life-style modification may be considered for the fore-mentioned population. Further research is warranted to understand possible factors and mechanisms through which they may effect on health outcome of workers in health-care industry.

並列關鍵字

health-care worker ； alanine aminotransferase prevalence ； risk factor ； health promotion hospital