臨廠健康服務在醫療人員之血清麩丙酮酸轉胺酶偏高之介入與追蹤的角色:一個台灣南部醫院為基礎的研究

The role of basic occupational health service among healthcare workers with elevated serum alanin aminotransferase level: a hospital-base study in Southern Taiwan

賴韋安(Wei-An Lai)

指導教授 ： 戴嘉言

高雄醫學大學/健康科學院/公共衛生學系職業安全衛生碩士班/碩士(2016年)

摘要

背景 : 肝功能檢查為常規健康檢查中的ㄧ個部份，血液中的血清麩丙酮酸轉胺酶(ALT)是在急慢性肝炎中最常被當作肝細胞損傷的因子;且ALT也是疾病嚴重度的標記或是肝活動的指標。根據勞工健康保護規則第七條，雇主應使醫護人員臨廠服務辦理事項包括勞工體格、健康檢查紀錄之分析、評估、管理與保存及健康管理。
目的：1. 探討醫療人員其ALT偏高的盛行率和原因。2. 呈現臨廠服務對血清ALT偏高的健康管理成果。
方法：檢視南部某醫學中心2014年度以及2015年度員工健康資料及後續追蹤結果。基本資料包括:性別，年齡，身高，體重，身體質量指數，血液檢查資料包括血清ALT，血脂（總膽固醇，三酸甘油酯）等資料。病歷資料收集時間為2014年2月1日至2016年3月1日。ALT大於兩倍正常上限值 (80 U / L) 者被列入需要追蹤名單，此追蹤名單內的對象經由臨廠服務，安排了特殊諮詢門診或電話諮詢進行評估，找出符合健保治療的個案並積極安排進一步治療和追蹤。
結果：肝指數ALT異常者在2014年度為184人，占接受檢驗總人數1756人的10.5%。在2015年度為ALT指數異常率則為10.9% (236/2173)。兩個年度中ALT>80IU/L而被列入需要追蹤名單的69名人員當中，有40名男性和29名女性。初始ALT異常的平均值為128.6±66.1U / L(範圍：81〜388 U / L）。 扣除15位拒絕追蹤之個案，其餘54人之病因分析如下:有10位個案的異常是暫時的，並且在無治療之狀況下短時間內恢復正常;其餘44人結果如下:病毒性肝炎帶原者共有12人，含:僅B型肝炎帶原者 (HBsAg (+)) 有9人，僅C型肝炎(anti-HCV(+))有2人，同時有B型及C型肝炎帶原者有1人。同意接受檢查且符合病毒性肝炎健保給付治療者有3例B型肝炎及1例C型肝炎。均經由臨廠服務積極轉介安排進一步治療和追蹤，以上4例個案均接受適當的病毒性肝炎治療。餘32例個案當中，有26位個案歸類於疑似非酒精性脂肪肝造成肝功能異常，含:有5位僅為肥胖(BMI>27)、有7位僅有高血脂、有14位同時合併高血脂與肥胖，以上則另有規劃健康促進及介入治療措施。還有6人不能以病毒性肝炎或非酒精性脂肪肝解釋。
結論：ALT升高(>40U/L) 在醫學中心的醫療人員的盛行率約為10.5~10.9％，與一般族群相似。員工健康檢查結果發現成ALT兩倍上限值的原因，以非酒精性脂肪肝約占半數，病毒性肝炎約占四分之一。經過醫學中心的職業安全健康服務的積極介入後，4位患有病毒性肝炎且符合健保給付的治療標準者都接受適當的治療，並達預期效果。此種對於健康檢查後的臨廠服務介入模式將可推廣至其他工作場所或其他疾病的照護。

關鍵字

肝功能異常 ； 醫療人員 ； 病毒性肝炎 ； 非酒精性脂肪肝疾病 ； 臨廠健康服務

並列摘要

BACKGROUND: Liver function tests (LFTs) are part of routine health checks. Serum alanine aminotransferase (ALT) has, for some time, been viewed as a sensitive indicator of liver-cell injury. Serum ALT is also the liver enzyme most commonly used as an indicator of hepatocellular damage in acute and chronic hepatitis. According to Article 7 of the Regulations of Labor Health Protection, employers should arrange occupational health service to handle matters include labor health exam, analysis of records of medical examinations, assessment, management and preservation and health management.
AIMS: 1. To explore the prevalence and evaluate the causes of an elevated serum alanine aminotransferase (ALT) level among healthcare workers in a medical center. 2. To present a result of health management about elevated serum ALT operated by occupational health service.
METHODS: Basic characteristic such as gender, age, height, weight, and body mass index (BMI), and serum blood data including serum ALT, lipid profile (total cholesterol, triglyceride) were recorded from annual health examination in 2014 and 2015. Record collection was from February 1, 2014 to March 1, 2016. Those who have elevated ALT greater than twice the upper limit of normal (80 U/L) were included in the intervention list. By occupational health service, the subjects in the intervention list were arranged to special counseling clinic or telephone counseling for evaluation and further treatment for those needed.
RESULT: The prevalence of abnormal serum ALT in 2014 was 10.5% (184/1756), and 10.9% (236/2173) in 2015. There were 69 cases that meet the criteria of ALT>80IU/L and they were recruited in the intervention list. Among them, 40 were man and 29 were women. The average of initial ALT was 128.6±66.1 U/L (with a range of 81~388 U/L). Excluding the 15 subjects that refused follow-up by the occupational health service, the etiologies of abnormal serum ALT of the 54 subjects were as follow: there were 10 subjects that were negative for HBsAg and anti-HCV experienced only transient elevation of ALT without significant risk factor. The ALT levels were normalized at the follow-up check. The remaining 44 subjects were as follows: there were 12 subjects that were viral hepatitis carrier, including 9 with only hepatitis B, 2 with only hepatitis C and 1 with both hepatitis B and hepatitis C. Among the 12 subjects, 3 patients with chronic hepatitis B and 1 with hepatitis C met criteria of anti-viral therapy and underwent proper treatment arrange by occupational health service. Among the other 32 cases, there were 5 cases with only obesity (BMI>27), 7 cases with only hyperlipidemia, and 14 cases with both obesity and hyperlipidemia. These suspected cases of non-alcoholic fatty liver diseases were enrolled into another health promotion and disease control protocol for obesity and/or hyperlipidemia. The other 6 subjects could not be explained by viral hepatitis or non-alcoholic fatty liver diseases.
CONCLUSION: The prevalence of elevated ALT among healthcare workers in a medical center is about 10.5~10.9%, which was similar to the general population. Half of the etiologies of ALT>80IU/L were non-alcoholic fatty liver disease and one quarter were viral hepatitis in this group. After active interventions by an occupational health service, there were four employees with viral hepatitis flared up got adequate counseling and appropriate treatments. This post-screening control model under the occupational health service may be promoted to other working place as well as other diseases.

並列關鍵字

alanine aminotransferase ； healthcare workers ； viral hepatitis ； non-alcoholic fatty liver disease ； occupational health service

參考文獻

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