類風濕因子與肝病及B型肝炎關係之研究

The Association between Rheumatoid Factor and Liver Disease and Type B Hepatitis

曾國森(Kuo-Sen Tseng)

指導教授 ： 王維康

元智大學/管理學院/管理研究所/碩士(2008年)

摘要

台灣持續面臨醫療保健支出上漲的壓力，部分原因來向檢驗浮濫使用與對其臨床應用不夠瞭解。類風濕因子檢查，除輔助診斷風濕疾病外，在慢性感染；例如Ｂ型肝炎、肺結核、梅毒等亦會呈現陽性，判讀本已複雜且困難。在國內Ｂ型肝炎的高帶原率下，；加上類風濕因子的出現與Ｂ型肝炎病毒感染有關或無關，有不同的論述，使得類風濕因子與Ｂ型肝炎之間的關係更顯得撲朔迷離。
本研究蒐集Ｂ型肝炎、一般肝病、健康民眾各50位個案血清進行分析。目的要釐清國內Ｂ型肝炎合併肝功能異常者，其類風濕因子的陽性率，並比較Ｂ型肝炎與一般肝病陽性率有無不同？最後再探討肝功能指數，與類風濕因子濃度之間的數值大小有何相關性？
統計分析結果發現，Ｂ型肝炎合併肝功能異常個案，其類風濕因子陽性率為34％，一般肝病個案陽性率則為8％。類風濕因子的陽性與Ｂ型肝炎病毒感染是有關的（P＜0.05），但肝功能GPT數值大小與類風濕因子濃度的高低則無明顯的相關性。結論：Ｂ型肝炎肝功能異常個案其類風濕因子陽性率高於一般肝病與健康民眾，Ｂ型肝炎個案其類風濕因子陽性與Ｂ型肝炎病毒之感染有關，並非單純因為肝病或肝功能異常。
依據上述結論，本研究提出對醫院管理者或醫療從業人員一些實務面的建議。加強新加入臨床工作的實習醫師、住院醫師瞭解每一種檢驗、檢查其臨床應用與臨床意義。醫療從業人員面對類風濕因子陽性個案當仔細評估，除了風濕疾病外其他可能的原因。且Ｂ型肝炎患者若合併類風濕因子陽性，更應定期回診追蹤。期望達到保障病人安全，並珍惜有限醫療資源。

關鍵字

類風濕因子；B型肝炎；肝病

並列摘要

Rheumatoid factor (RF) is an antibody to IgG predominantly of the IgM class of immunoglobulins. It present in the serum of patient with rheumatoid arthritis. rhematoid factor (RF) is also known to occur in hepatitis B virus infection carriers, even when they do not develop overt hepatic dysfunction. It had been studied that rheumatoid factor (RF) presence correlates with severity of liver injury but not with the presence or absence of HBsAg.The purposes of this study were to estimate the positive rate of RF among the HBsAb positive group and miscellaneous liver disease, the association between rheumatoid factor and severity of liver function test.
Study was investigated in three serum collections. Group 1: Fifty patients of Chronic hepatitis B carriers with abnormal liver function. Group 2: Fifty patients with miscellaneous liver disease associated abnormal liver function. Group 3: Fifty healthy HBsAg negative adults. Rheumatoid factor (RF) was positive in 34%(17/50) of HBsAg positive group while it was present in 8%(4/50) of the miscellaneous liver disease group (p<0.05).The correlation between level of liver function test (GPT) and level of rheumatoid factor (RF) was not significant (p>0.05).
It was concluded that rheumatoid factor (RF) is a frequent serologic manifestation accompanying chronic hepatitis B carriers that its presence associates with presence of HBsAg. Howerer, the level of rheumatoid factor (RF) in the HBsAg positive group was found to be no significantly correlated with severity of liver function (GPT).

並列關鍵字

Rheumatoid factor ； Type B hepatitis ； liver disease

參考文獻

3. 盧勝男 (1998)．走過C型肝炎鄉．中華公共衛生雜誌，17(3)，175-187。

4. 江東亮 (2002)．臺灣醫療保健支出之趨勢分析．台灣醫誌，21(3)，157-163。

5. 陳世能、邱雅苓 (2003)．醫療保健支出成長因素之探討－時間序列分析與門檻模型的應用．經濟研究，39(2)，197-240。

6. A. C., Denman, A. Allison, M., & Barnes, R. D. (1971). Co-operating and controlling functions of thymus derived lymphocytes in relation to auto-immunity. Lancet, ii, 135-137.

7. Anderson, V. K., & Villarejos, V. M. (1980). Identity of antibody to hepatitis B e/l antigen as an atypical rheumatoid factor. J Infec Dis, 14, 603-608.