透過您的圖書館登入
IP:54.172.95.106
  • 學位論文

南市某醫學中心結核病之趨勢研究:2015-2016

Trend of Tuberculosis in a Medical Center in Tainan City: 2015-2016

指導教授 : 張振平 吳佩芝

摘要


背景與目的:本研究主要目的為探討台南市某醫學中心結核病的發生率趨勢及相關共生疾病分析。 研究方法:從衛生福利部疾病管制署全國結核病資料庫摘取2015年到2016年間該醫學中心通報的結核病個案加以分析結核病患者及相關共生疾病之人數並計算發生率與死亡風險,並以肺內外結核的特性來評估其流行病學。 結果與討論:研究顯示年齡越大結核病的發生率呈現增加的趨勢,其中以大於65歲族群增加最為顯著。而408位結核病病人中併有糖尿病者佔96位,發生率為23.5%、末期腎臟病佔80位,發生率為19.6%、癌症佔65位,發生率為15.9%、肝硬化佔15位,發生率為3.6%、愛滋病佔6位,發生率為1.47%,由此統計資料指出65歲以上年齡層合併有糖尿病、末期腎臟病、癌症的患者對於結核病的感受性較大。此外未完成治療即死亡的共有63位,藉此分析結核病與不同共生疾病所造成的死亡相關性,經由R統計執行邏輯迴歸分析(logistic regression analysis)並計算勝算比(odds ratio, OR)和其95%信賴區間(95% confidence interval, 95%CI),得知肝硬化OR值為1.94 (95%CI 2.11~24.60)、頭頸癌OR值為1.69 (95%CI 2.75~10.97)、末期腎病變OR值為0.85 (95%CI 1.19~4.59);年齡區間65歲以上者OR值為2.14 (95%CI 1.47~172.72),以上皆與死亡有正相關並具有顯著意義(OR值>1或95%CI無跨越1),研究中更是呈現出年齡區間65歲以上者其死亡風險為40歲以下者的8.57倍,由此可知年齡對於罹病後的死亡率具有顯著意義。 結論與建議:建議對結核病病人作例行糖尿病篩檢、癌症篩檢、相關疾病的抽血檢驗等措施。由於衛生福利部疾病管制署現有的全國結核病資料庫「中央傳染病追蹤管理系統」中缺乏共病的統計資料,使得資料不完整,希望能建立結核病與這些免疫缺乏患者的關係,期望有更多的族群背景以提供一個較佳的資料庫,指引未來防治新策略。

關鍵字

結核病 共生疾病 死亡率 年齡 發生率

並列摘要


Background and Objectives: This study evaluated the incidence trends of tuberculosis (TB) and the analysis of related comorbidities in a Tainan City’s medical center. Methods: We collected data obtained the reporting cases of the TB in the medical center from the nationwide TB database of Taiwan Center for Disease Control (CDC) on 2015 and 2016. All TB patients were analyzed with related comorbidities, incidence and mortality risk, and evaluated the epidemiology by characteristics of pulmonary TB and extra-pulmonary TB. Conclusion and suggestion: The study showed the increase of the incidence of TB on older age, significantly on more than aged 65. Out of the total of 408 TB patients, 96 (23.5%) had diabetes mellitus (DM), 80 (19.6%) had end-stage renal disease (ESRD), 65 (15.9%) had cancer, 15 (3.6%) had liver cirrhosis and 6 (1.47%) had HIV. The statistics showed patients more than age 65 with comorbid DM, ESRD and cancer were more sensitive to TB. Additionally, 63 out of 408 patients could not finish the procedure of treatment due to death. We conducted logistic regression analyses by using R statistics and evaluated the association between TB deaths and different comorbidities through the calculation of odds ratio (RR) and its 95% confidence interval (95%CI) for each comorbidity. The results revealed that the OR of liver cirrhosis was 1.94 (95%CI 2.11~24.60), head and neck cancer was 1.69 (95%CI 2.75~10.97), end-stage renal disease was 0.85 (95%CI 1.19~4.59) and age over 65 was 2.14 (95%CI 1.47~172.72). All of these results showed significantly positive correlations between TB deaths and comorbidities (OR>1 or 95%CI not containing 1). Especially, the OR of mortality for the TB patients with age over 65 was 8.57 times more than that for those who were age under 40. We demonstrated that the age of patients would influence the mortality of TB. Therefore, we suggested routine diabetes screening, cancer screening and blood tests would be required for TB patients. Due to the lack of comorbid statistical data in the existing national surveillance network of communicable diseases of CDC, the nationwide TB database still supplies incomplete information yet. We hope to build a TB database linking to immuno-deficient patients and to provide a better environment to guide the future prevention and new strategies.

並列關鍵字

tuberculosis comorbidities mortality age incidence rate

參考文獻


19. Taiwan CDC. Statistics of Communicable Diseases and Surveillance Report, Republic of China, 2015。
2. 王培東 (2005) 台北市肺外結核之趨勢:1998至2002.北市醫學雜誌,2(12),1125-1136。
9. 黃婉瑩、鄭舒倖、莊意芬、劉勝芬、索任(2007).桃園某區域醫院醫療人員結核菌素測驗五年追蹤調查.感染控制雜誌,17(2),69-79。
15. 顧淑芳、林永崇、曾修儀 (2005) 護理人員於負壓病房照顧肺結核病患之風險初探.中華職業醫學雜誌,12(3),161-167。
3. 王培東 (2005) 台北市結核病流行趨勢與防治成效之研究.內科學誌,16(1),26-32。

延伸閱讀