探討流感疫苗對於慢性阻塞性肺部疾病病人併發缺血性心臟疾病之影響

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題名:	探討流感疫苗對於慢性阻塞性肺部疾病病人併發缺血性心臟疾病之影響 Investigation of Outcomes of annual influenza vaccination on chronic obstruction pulmonary disease patients comorbid with ischemic heart disease
作者:	郭碧蓮 Kuo, Pih-Lian
關鍵詞:	流感疫苗;慢性阻塞性肺部疾病;缺血性心臟疾病;全民健保資料庫;Influenza vaccine;Chronic obstruction pulmonary disease;Ischemic heart disease;National Health Insurance research database
日期:	2012-06-27
上傳時間:	2018-10-17 09:27:56 (UTC+8)
摘要:	研究背景：慢性阻塞性肺病多年來一直位居台灣地區十大死因之中，其盛行率達6.7%；世界衛生組織統計，慢性阻塞性肺病患者快速增加，目前已名列全球第4大死因，預估2020年躍昇為世界第3大死因，可見慢性阻塞性肺部疾病的廣泛性及嚴重性。而該項疾病是可預防、可治療的健康問題，如何降低其併發症成為治療重點之一，缺血性心臟病則是最常見的併發疾病，因此找到可以減緩心臟病發生的措施，是重要的課題。研究目的：本研究目的旨在探討接種流感疫苗對於慢性阻塞性肺部疾病病人併發缺血性心臟疾病的影響。研究方法：本研究運用國家衛生研究院所提供之台灣全民健保研究資料庫，以1997年至2008年所收集之資料進行分析。研究對象為2000年時首次診斷有慢性阻塞性肺部疾病病人，資料回溯至1997年以排除有缺血性心臟病者，並逐年追蹤該群病人至2008年，期間一旦出現缺血性心臟病，即停止追蹤並回溯是否曾接種流感疫苗。結果以描述性統計呈現各變項分佈情形，利用2-way Contingency Table Analysis，以卡方檢定方式檢定流感疫苗接種與慢性阻塞性肺部疾病病人併發缺血性心臟疾病的相關性。研究結果：研究對象係西元2000年首次診斷有慢性阻塞性肺部疾病病人共計35897人，至2008年止產生缺血性心臟病病人數共1464人，其中接種流感疫苗人數為703人(佔48.02%)；沒有產生缺血性心臟病病人數共29250人，其中接種流感疫苗人數6010人(佔22.90%)。比較男女性別的差異，慢性阻塞性肺部疾病病人接種疫苗比為1.5比1，而合併有缺血性心臟疾病之病人，男性接種比例是女性的1.2倍。流感疫苗接種能降低缺血性心臟疾病由統計可見發生於 70-80歲的分層族群 (OR, 0.746; 95% CI. 0.595–0.937 )。結論：研究結果發現慢性阻塞性肺部疾病病人合併有缺血性心臟病患者，接種流感疫苗比例較未發生缺血性心臟病患者為多；至於流感疫苗的接種，只有對於年長的族群與降低發生缺血性心臟病有相關。若能進一步了解疾病嚴重度及共病情形，將可在疾病的管理上獲得更完整的資訊。 Background：Chronic obstruction pulmonary disease (COPD) is within the top 10 leading causes of death in Taiwan many years, and the prevalence rate has reached 6.7%. WHO estimate COPD is the fourth leading cause of death and is projected to be the third by 2020 although the disease is both preventable and treatable. So how to reduce its complications becomes one of the key of treatment. The ischemic heart disease (IHD) is the most common comorbidity of COPD, therefore to find an intervention which can reduce heart diseases in COPD patients is an important issue. Purpose：The purpose of this study was to investigate the effect of influenza vaccine on comorbidity of ischemic heart disease with COPD. Methods：This was a study by using “National Health Insurance research database” between 1997 and 2008. The subjects were included the first diagnosed with COPD but without ischemic heart diseases in 2000. These subjects were followed until the ischemic heart disease occurred and traced back to check if they were vaccinated. The descriptive statistics were used to analyze the distributions of variables and 2-way Contingency Table Analysis with Chi-Square test ( test) was used to explore the effect of influenza vaccine on comorbidity of ischemic heart disease with COPD. Results：Among 35,897 first diagnosed COPD subjects in 2000, there were 1,464 patients developed ischemic heart disease (IHD) between 2001 and 2008. 703 (48.02%) out of COPD patients with comorbidity of IHD were vaccinated, but only 6010 patients (22.9%) were vaccinated without develop IHD. Comparing vaccination rate of male to female with COPD was 1.5 to 1, and of COPD with IHD patients was 1.2 to 1. Under statistically control age and gender factors, vaccination was associated with reduced risk of IHD in elderly COPD patients who were in 71-80 years old group (OR, 0.746; 95% CI. 0.595–0.937 ). Conclusions：The findings of this study showed that the vaccination rate of COPD patients with ischemic heart diseases were higher than those without IHD. Influenza vaccination was associated with reduced risk of IHD in COPD patients only on the elderly group. If the severity and comorbidities of the COPD can be further understood, it will provide more comprehensive information for these patients and improve their disease management.
描述:	碩士指導教授-簡文山委員-李顯章委員-張偉斌
資料類型:	thesis
顯示於類別:	[醫務管理學系暨研究所] 博碩士論文

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