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系統識別號 U0026-2907201309514900
論文名稱(中文) 愛滋病毒感染者合併梅毒引發神經系統疾病之相關因素-全國性世代研究
論文名稱(英文) Associate factors of neurological disorders on HIV patients co-infected with syphilis: A nationwide cohort study in Taiwan
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 101
學期 2
出版年 102
研究生(中文) 蔡宜蓁
研究生(英文) Yi-Tseng Tsai
電子信箱 yttsai13@gmail.com
學號 t26004011
學位類別 碩士
語文別 中文
論文頁數 89頁
口試委員 口試委員-柯文謙
召集委員-李中一
指導教授-柯乃熒
中文關鍵字 愛滋病  梅毒  神經系統疾病  全民健保資料庫 
英文關鍵字 human immunodeficiency virus (HIV)  syphilis  neurological diseases  National Health Insurance Database (NHID) 
學科別分類
中文摘要 研究背景:愛滋病毒與梅毒此兩種疾病隨著病程進展易引發神經系統疾病,雙重感染下會增加愛滋病毒傳播風險。多數研究探討愛滋病合併梅毒之發生率與危險性行為間之相關因素,對於兩者交互作用所引發神經系統疾病分類缺乏一致性,且無長期性全國調查數據;造成神經系統疾病的相關影響因素則有不同論點及爭議。
研究目的:本研究分析2000年至2010年愛滋病毒感染者合併梅毒造成神經系統功能疾病盛行率及發生率,探討愛滋病毒感染者有無合併梅毒感染出現神經系統疾病之差異及相關影響因素。
研究方法:採世代研究法,擷取全民健保資料庫所提供門診處方治療明細檔(CD)、門診處方醫令明細檔(OO)、住院處方及治療明細檔(DD)進行回溯性資料分析,分析2000年至2010年愛滋病毒感染者有無合併梅毒引發神經系統疾病之盛行率及發生率,以Cox proportional hazard分析造成神經系統疾病相關影響因素。
結果:愛滋病毒感染者神經系統疾病盛行率為10.07%,合併梅毒感染者盛行率高於單一愛滋病毒感染者(10.99% vs. 9.76%)。神經系統疾病發生率為12.69人/1,000人年,愛滋病毒合併梅毒之神經系統疾病發生率高於單一愛滋病毒感染者(16.14人/1,000人 v.s 11.94人/1,000人年)。影響愛滋感染者引發神經系統疾病因素為梅毒感染(Ajusted Harzard Ratios: 1.448, 95%CI: 1.211-1.731, p-value: <0.001)、老化(55-64歲AHR: 2.299, 95% CI: 1.533- 3.447, p-value: <0.001;≧65歲AHR: 3.205, 95%CI: 1.875-5.469, p-value: <0.001)、曾診斷物質濫用(AHR: 1.341, 95%CI: 1.048-1.718, p-value: 0.0199)及伺機性感染者(AHR: 1.686, 95%CI: 1.329-2.138, p-value: <0.001)、無定期回診(AHR: 1.329, 95%CI: 1.096-1.612, p-value: 0.0038)及服用HARRT藥物(AHR: 0.791, 95%CI: 0.714-0.878, p-value: <0.001)。
結論:愛滋病毒合併梅毒罹患神經系統疾病風險相較單一病毒感染者高出1.4倍,建議衛生單位提升愛滋病毒與梅毒篩檢率,醫療院所照護愛滋病毒合併梅毒感染、中老年人(≧45歲)、曾診斷物質濫用及伺機性感染、HARRT遵循率低及無定期回診者,每年定期評估神經生理症狀神經學相關檢驗,以降低神經系統疾病之發生。
英文摘要 Background: Patients infected with human immunodeficiency virus (HIV) or syphilis are prone to neurological disorders as their disease progression, and coinfection can increase the risk of transmission. Most studies have investigated the relationship between the incidence of coinfection and risk sexual behaviors; however, no long-term national cohort study has investigated the neurological diseases caused by infections of both diseases. Therefore, the factors associated with neurological diseases remain debatable.
Objective: This study analyze the prevalence and incidence of neurological
diseases in patients with HIV-syphilis coinfection from 2000 to 2010, investigating the differences in and relevant factors of the increasing risk of neurological diseases.
Methods: We collected data from outpatient, inpatient, and medical order files by using the National Health Research Institute (NHRI) to perform a retrospective data analysis. We analyzed the prevalence and incidence of HIV-associated neurological diseases in patients with and without syphilis coinfections, using a Cox proportional hazard to analyze the risk of and relevant factors for neurological diseases.
Results: The prevalence rate of neurological diseases among HIV-infected patients is 10.07%. With the added prevalence rate of syphilis among HIV-infected patients, the rate is higher than that of patients with only HIV (10.99% v.s 9.76%). The incidence rate of neurological diseases among HIV-infected patients is 12.69 people per 1000 person-year. The incidence rate neurological disease in patients with both HIV and syphilis is higher than that in mono-HIV infected patients (16.14 people per 1000 person-year v.s 11.94 people per 1000 person-year). The causes of neurological diseases among HIV-infected patients were syphilis infection (AHR: 1.448; 95% CI: 1.211-1.731, p-value: < .001), aging (55-64 AHR: 2.299; 95% CI: 1.533- 3.447, p-value: < .001; ≧65 AHR: 3.205, 95% CI: 1.875- 5.469, p-value: < .001), substance abuse (AHR: 1.341; 95% CI: 1.048-1.718, p-value: .0199), opportunistic infection (AHR: 1.686; 95% CI: 1.329-2.138, p-value: < .001), irregular re-visit patients(AHR: 1.329; 95% CI: 1.096-1.612, p-value: .0038) and HARRT medication(AHR: 0.791, 95%CI: 0.714-0.878, p-value: < .001).
Conclusions: The risk of dual HIV and syphilis neurological diseases is 1.4 times higher than that single virus infection. We suggest that health units increase their rates of HIV and syphilis screening. Hospitals should focus on patients infected with HIV and syphilis, substance abuse, those with opportunistic infections, a low following rate of HARRT, older patients (ages≧45), and those with irregular follow-ups. Hospitals should annually monitor neurology related tests to avoid incidences of neurological diseases.
論文目次 目錄
中文摘要 I
Abstract III
誌謝 V
目錄 VI
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機與重要性 2
第三節 研究目的 3
第二章 文獻查證 5
第一節 愛滋病毒合併梅毒感染之流行病學 5
(一) 全球愛滋病毒合併梅毒感染之流行病學 5
(二) 台灣愛滋病毒合併梅毒感染之流行病學 6
第二節 愛滋病相關神經系統疾病 8
(一) 愛滋病相關神經系統疾病之流行病學 8
(二) 愛滋病相關神經系統疾病 13
第三節 愛滋病合併梅毒相關神經系統疾病 16
(一) 愛滋病合併梅毒相關神經系統疾病之流行病學 16
(二) 愛滋病合併梅毒相關神經系統疾病 18
第四節 愛滋病相關神經系統疾病之影響因素 20
(一) 人口特性 20
(二) 共病因素 21
(三) 環境因素 23
(四) 就醫行為 23
第三章 研究方法與材料 27
第一節 研究設計與架構 27
(一) 研究設計 27
(二) 研究架構 27
第二節 資料來源 27
(一) 研究資料庫 27
(二) 樣本結構 28
(三) 資料篩選過程 29
第三節 名詞定義 30
第四節 倫理考量 33
第五節 統計分析 33
(一) 統計軟體 33
(二) 分析方法 33
第四章 研究結果 35
第一節 愛滋病毒感染族群人口學特質 35
第二節 愛滋病毒感染者之神經系統疾病盛行率及發生率 35
(一) 愛滋病毒感染者之神經系統疾病盛行率 35
(二) 愛滋病毒感染者之神經系統疾病發生率 36
第三節 愛滋病毒感染者有無合併梅毒出現神經系統疾病之差異 37
(一)愛滋病毒感染者有無合併梅毒之神經系統疾病盛行率 37
(二)愛滋病毒感染者有無合併梅毒之神經系統疾病發生率 37
第四節 愛滋病毒感染者造成神經系統疾病之相關影響因素 38
第伍章 討論 40
第一節 愛滋病毒感染者出現神經系統疾病之盛行率及發生率 40
(一)愛滋病毒感染者之神經系統疾病盛行率 40
(二)愛滋病毒感染者之神經系統疾病發生率 41
第二節 愛滋病毒感染者有無合併梅毒出現神經系統疾病之差異 41
(一)愛滋病毒感染者有無合併梅毒之神經系統疾病盛行率 41
(二)愛滋病毒感染者有無合併梅毒之神經系統疾病發生率 42
第三節 愛滋病毒感染者出現神經系統疾病之相關影響因素 43
(一)人口特性 43
(二)共病因素 43
(三)就醫行為 44
第四節 研究方法的限制 44
第陸章 結論 46
第柒章 建議 47
第一節 臨床實務的建議 47
第二節 未來研究的建議 48
第三節 政策面的建議 48
參考文獻 50
表目錄
表一 愛滋病相關中樞及周邊神經系統疾病之盛行率 61
表二 愛滋病神經系統疾病相關影響因素彙總 62
表三 研究樣本與疾病管制局年齡層分佈表 66
表四 藥品分類及ATC碼對照 67
表五 愛滋病毒感染者有無合併梅毒之人口學特質分布 71
表六 愛滋病毒感染者之神經系統疾病盛行率 73
表七 愛滋病毒感染者之神經系統疾病累積發生率 74
表八 愛滋病毒感染者之神經系統疾病發生率 75
表九 愛滋病毒感染者性別及年齡分層之神經系統疾病發生率 76
表十 愛滋病毒感染者性別年齡標準化之神經系統疾病發生率 77
表十一 愛滋病毒感染者引發神經系統疾病之相關影響因素 78
表十二 愛滋病毒感染者神經系統疾病平均罹病時間 80
圖目錄
圖一 研究架構 81
圖二 男性研究樣本與疾病管制局年齡層分佈之適合度檢定分析表 82
圖三 女性研究樣本與疾病管制局年齡層分佈之適合度檢定分析表 82
圖四 愛滋病毒感染者有無梅毒之樣本篩選 83
圖五 愛滋病毒感染者之神經系統疾病盛行率 84
圖六 愛滋病毒感染者之神經系統疾病發生率 85
圖七 愛滋病毒感染者依年齡分層之神經系統疾病發生率 86
圖八 愛滋病毒感染者年齡標準化之神經系統疾病發生率 87
圖九 愛滋病毒感染者性別年齡標準化之神經系統疾病發生率 88
圖十 愛滋病毒感染者有無梅毒性別年齡標準化之神經系統疾病發生率 89
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