影響台灣地區手指關節炎可能危險因子之研究

Potential Risk Factors Associated with Hand Osteoarthritis in Taiwan

楊雅婷(Ya-Ting Yang)

指導教授 ： 黃怡婷

國立臺北大學/商學院/統計學系/碩士(2013年)

摘要

全球人口有明顯老化的現象，一旦人進入中老年階段身體機能將逐漸退化或失去功能，所有慢性病或其他老化疾病將漸趨明顯，因此國人應好好正視老化世界的衝擊。在所有最常見的老年人疾病，骨性關節炎俗稱退化性關節炎是最麻煩且影響日常生活最多的一項疾病。目前國內有關於診斷關節炎研究，鮮少有針對手指關節炎疾病症狀以及病患自身狀況進行研究。若可藉由臨床觀察，及早診斷出骨性關節炎的發生，應可有效避免後續的疼痛症狀、行為功能喪失甚至於殘疾。
本論文藉由「骨關節炎基因研究計畫」的資料進行分析，收集八家醫院的病患個案，分成手指關節炎組共 182 人、疾病控制組共 115 人、正常控制組共 200 人。藉由所收集的基本資料、家人祖籍、關節病史、工作及生活型態、疾病史及藥物史、臨床身體檢查、臨床身體評估和外握力、捏力的測量來預測受試者所屬組別。利用因素分析和信度分析整併臨床檢測變數，並利用 Kruskal-Wallis 檢定來了解其與所屬組別之關聯，而以卡方檢定來探討其餘離散變數與所屬組別之關聯，最後利用多項式邏輯斯模型來篩選與所屬組別最有關聯的解釋變數。
由模型篩選出「年齡」、「體重」、「手指關節有腫大情形」、「性別」、「醫院分類」為影響較大的解釋變數，且研究顯示罹患手指關節炎的機率較高者為手指關節腫大的人，年齡也是手指關節炎的重要危險因素之一。本研究結果可提供臨床上初步判斷手指關節炎疾病，根據本研究歸納之結論可供衛生機關制定保健政策之參考，並廣為宣導手指關節炎的危險因子，使民眾有所依據並有效預防，以減低罹患手指關節炎的風險。

關鍵字

手指關節炎 ； 因素分析 ； 邏輯斯迴歸 ； 基線類別邏輯斯模型

並列摘要

The aging problem is become a global problem. Once people in middle age, the physical function will gradually degenerate, and the occurrence of all chronic diseases or other aging diseases will increase apparent. Thus, the impact of the aging world should be studied more carefully. Osteoarthritis, also known as degenerative Joint Disease, is one of the most troublesome diseases among all of the most common elderly diseases. It not only induces pain constantly, but also causes the physical movement uncomfortably. Up to now, hand osteoarthritis disease symptoms and the patients’ own situation are studied rarely by researches studied osteoarthritis in Taiwan. If osteoarthritis can be diagnosed earlier by the clinical observation, it can effectively avoid the subsequent pain symptoms, possible loss of the physical function and even disability.
This study utilized the data from Genome-Wide Study for Disease Susceptibility Genes in Patients with Hand Osteoarthritis (HOA) of the Han-Chinese Population involving a collection of eight hospitals. 497 eligible participants were classified into three groups. There were 182 participants who had hand osteoarthritis, and 115 participants who were treated as a disease control group and a normal control group of 200 participants. The demographics of participants, the family’s ancestral history and related disease history, profession and lifestyle, the medical history and drug history, the clinical physical examination, the clinical physical assessment, the grip strength, and pinch strength measurements were collected. Many clinical variables were grouped into many constructs established by the factor analysis and reliability analysis. The chi-square and Kruskall Wallis test were used to assess the association between the categorical variable and the continuous explanatory variable and the classification of the participants. The overall association between associated clinical variables and the classification of participants were assessed by the multinomial logit model.
Age at screening, weight, finger joints swollen, gender, hospital classification have the greatest influence in predicting the classification of participants. More specifically, the study shows that people with swelling on finger joints suffer higher probability of hand osteoarthritis, and older age is an important risk of hand osteoarthritis. The results of this study provide clinical preliminary judgment in hand osteoarthritis. The health agencies can use such information to develop health policy in this area. As a result, people can effectively prevent from suffering hand osteoarthritis or reduce the risk having this disease.

並列關鍵字

hand osteoarthritis ； factor analysis ； logistic regression ； baseline-category logit model

參考文獻

28. 林易申, 顏銘傭, 張耀文, 唐淑貞, 呂紹琦, 羅慶徽, 高森永 and 周稚傑 (2010). "台灣地區老年人使用玻尿酸注射液治療膝部退化性關節炎之回溯分析." 臺灣家庭醫學雜誌 20(2): 53-63.

1. Altman, R., G. Alarcon, D. Appelrouth, D. Bloch, D. Borenstein, K. Brandt, C. Brown, T. D. Cooke, W. Daniel, R. Gray and et al. (1990). "The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand." Arthritis Rheum 33(11): 1601-1610.

2. Begg, C. B. and R. Gray (1984). "Calculation of polychotomous logistic regression parameters using individualized regressions." Biometrika 71(1): 11-18.

3. Brosseau, L., L. MacLeay, V. Robinson, G. Wells and P. Tugwell (2003). "Intensity of exercise for the treatment of osteoarthritis." Cochrane Database Syst Rev 2.

4. Butler, W. J., V. M. Hawthorne, W. M. Mikkelsen, W. J. Carman, D. L. Bouthillier, D. E. Lamphiear and I. U. Kazi (1988). "Prevalence of radiologically defined osteoarthritis in the finger and wrist joints of adult residents of Tecumseh, Michigan, 1962-65." Journal of clinical epidemiology 41(5): 467-473.