簡易檢索 / 詳目顯示

回結果列表
研究生： 莊昆霖
Chuang, Kun-Lin
論文名稱： 以全國健保資料庫進行台灣壞死性筋膜炎發生率研究
The incidence of necrotizing fasciitis in Taiwan: a nationwide population-based study
指導教授： 謝式洲
Shieh, Shyh-Jou
呂宗學
Lu, Tsung-Hsueh
學位類別： 碩士
Master
系所名稱： 醫學院 - 臨床醫學研究所
Institute of Clinical Medicine
論文出版年： 2014
畢業學年度： 102
語文別： 英文
論文頁數： 56
中文關鍵詞： 壞死性筋膜炎 、發生率 、流行病學 、共病 、死亡率 、台灣
外文關鍵詞： Necrotizing fasciitis, incidence, epidemiology, comorbidity, mortality, Taiwan
相關次數： 點閱：154  下載：3 
分享至:
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報

    • 在亞洲地區缺少以國家為樣本，針對壞死性筋膜炎的流行病學研究。我們嘗試利用健保資料庫調查台灣壞死性筋膜炎的年發生率，並以性別、年齡、發生年、發生月、人職業別、人居住地進行分析。同時我們計算了台灣地區壞死性筋膜炎的死亡率，並檢驗影響發生率與死亡率的共病。
    2005年到2010年台灣住院並接受相關手術的壞死性筋膜炎整體平均年發生率為11.6/每十萬人（95%信賴區間11.4-11.8），男性為14.9/每十萬人（95%信賴區間14.9-15.5），女性為8.3（95%信賴區間7.9-8.3）。2005年的發生率為10.7（95%信賴區間10.3-11.1），2010年的發生率為12.3（95%信賴區間11.9-12.8）。年紀較大的病患有較高的年發生率；八月份、南台灣有較高的發生率，可能與月平均溫度有關。年發生率自2005年至2009年逐年升高，在2010年略為下降。
    2005年到2010年的平均死亡率為8.6%。死亡率最高的年分為2006年(9.9%)，之後逐年下降。第二型糖尿病的病人有較低的死亡率。
    在發生率部分，男性病人合併週邊血管病變、第一型糖尿病、第二型糖尿病與庫欣氏症有比較高的壞死性筋膜炎發生率，女性病人中合併腦血管病變、肝癌與第二型糖尿病有比較高的發生率。在年齡大於等於65歲的病人中，合併腦血管病變有比較高的發生率。整體來看，年紀大、有肝硬化的病人因為會增加發生率，也會增加死亡率，是預防壞死性筋膜炎的首要目標。

    In Asia, little is known about nationwide population-based incidence of necrotizing fasciitis (NF) and its related epidemiological profiles, including Taiwan. The nationwide annual incidence rate of NF was determined by using Taiwan’s National Health Insurance inpatient claims data from 2005 to 2010, based on factors such as gender, age, year, month, occupation, and region. In addition, the comorbidities as risk factors of incidence of NF were identified. Finally, annual mortality rate of NF was calculated and factors associated with the mortality were examined.
    The overall average annual incidence rate (cases per 100,000 population) of those six years of hospitalized and operated-on patients with NF was 11.6 (95% CI: 11.4-11.8, CI: confidence interval) for both genders, 14.9 (95% CI: 14.9-15.5) for males, and 8.3 (95% CI: 7.9-8.3) for females. The age-adjusted annual incidence rate was 10.7 (95% CI: 10.3-11.1) in 2005 and 12.3 (95% CI: 11.9-12.8) in 2010. The annual incidence rate increased with age, peaked in August, was the highest in southern Taiwan, and correlated with monthly temperature. The annual incidence rate of NF in Taiwan increased between 2005 and 2009, and slightly decreased in 2010.
    The mean mortality rate from 2005 to 2010 was 8.6%. By year, the highest annual mortality rate was 9.9% in 2006 and since then the rate decreased gradually by year. Type II diabetes was showed as a protective factor of mortality.
    As for incidence rate of NF, factors such as peripheral vascular disorder, type I diabetes, type II diabetes and Cushing syndrome contributed to higher incidence rate in male patients, while cerebrovascular disease, hepatocellular carcinoma and type II diabetes contributed to higher incidence rate in female patients. Among patients who were greater than or equal to 65 years old, the incidence rate of NF appeared to be higher for those with cerebrovascular disease. Generally speaking, patients with elder age and liver cirrhosis have higher incidence and mortality rate of NF, and these groups should therefore be given the first priority for prevention.

    ABSTRACT II 中文摘要 III ACKNOWLEDGEMENTS IV ABBREVIATIONS V INTRODUCTION 1 RESEARCH DESIGN AND METHODS 4 INSTITUTIONAL REVIEW BOARD APPROVAL 4 DATA SOURCES 4 CASE DEFINITION 4 ASSESSMENT OF CODING 5 STATISTICAL ANALYSIS 6 RESULTS 7 INCIDENCE OF NECROTIZING FASCIITIS 7 MORTALITY OF NECROTIZING FASCIITIS 9 COMORBIDITIES AND INCIDENCE OF NECROTIZING FASCIITIS 9 DISCUSSION 10 CONCLUSIONS 15 REFERENCE 16 TABLES AND FIGURES 20 LIST OF TABLES 20 Table 1. Incidence rate (per 100,000 population) of hospitalized and operated-on NF cases by gender and year based on National Health Insurance claims data in Taiwan, 2005-2010 22 Table 2. Incidence rate (per 100,000 population) of hospitalized and operated-on patients with NF cases by gender and age, based on National Health Insurance claims data in Taiwan, 2005-2010 23 Table 3. Results of chart reviews of 400 charts of patients with NF as a discharge diagnosis in National Cheng Kung University Hospital, 2005-2010 24 Table 4. Mortality rate of NF by year, based on National Health Insurance claims data in Taiwan, 2005-2010 (P-value=0.018) 25 Table 5. Factors associated with mortality rate of NF, based on National Health Insurance claims data in Taiwan, 2005-2010 26 Table 6. Demographic characteristics of patients with NF and comparison group patients, chosen from a representative subset database consisting of 1,000,000 systematically and randomly sampled subjects created by the Taiwan National Health Research Institute, 2005-2008 (N=1948) 30 Table 7. Prevalence of medical comorbidities in patients with NF compared with controls, chosen from a representative subset database consisting of 1,000,000 systematically and randomly sampled subjects created by the Taiwan National Health Research Institute, 2005-2008 (N=1948) 31 Table 8. Crude, adjusted odds ratios and 95% confidence interval for medical comorbidities between NF patients and the comparison group, chosen from a representative subset database consisting of 1,000,000 systematically and randomly sampled subjects created by the Taiwan National Health Research Institute, 2005-2008 33 Table 9. Crude, adjusted odds ratios and 95% confidence interval for medical comorbidities between MALE NF patients and the comparison group, chosen from a representative subset database consisting of 1,000,000 systematically and randomly sampled subjects created by the Taiwan National Health Research Institute, 2005-2008 35 Table 10. Crude, adjusted odds ratios and 95% confidence interval for medical comorbidities between FEMALE NF patients and the comparison group, chosen from a representative subset database consisting of 1,000,000 systematically and randomly sampled subjects created by the Taiwan National Health Research Institute, 2005-2008 37 Table 11. Crude, adjusted odds ratios and 95% confidence interval for medical comorbidities between necrotizing fasciitis patients and the comparison group, age < 45 years old, chosen from a representative subset database consisting of 1,000,000 systematically and randomly sampled subjects created by the Taiwan National Health Research Institute, 2005-2008 39 Table 12. Crude, adjusted odds ratios and 95% confidence interval for medical comorbidities between necrotizing fasciitis patients and the comparison group, age ≥ 45, < 65 years old, chosen from a representative subset database consisting of 1,000,000 systematically and randomly sampled subjects created by the Taiwan National Health Research Institute, 2005-2008 41 Table 13. Crude, adjusted odds ratios and 95% confidence interval for medical comorbidities between necrotizing fasciitis patients and the comparison group, Age ≥ 65 years old, chosen from a representative subset database consisting of 1,000,000 systematically and randomly sampled subjects created by the Taiwan National Health Research Institute, 2005-2008 43 Table 14. Prognostic factors affecting mortality rate of necrotizing fasciitis 45 Table 15. Risk factors increasing the incidence rate of necrotizing fasciitis 46 LIST OF FIGURES 47 Figure 1. Number of NF cases by month in Taiwan, 2005-2010. 48 Figure 2. Incidence rate (per 100,000 population) of NF cases by occupation in Taiwan, 2005-2010. 49 Figure 3. Central: Incidence rate (per 100,000 population) of NF cases in each region. Peripheral: The number of cases with NF by month, region, and regional mean monthly temperature in Taiwan, 2005-2010 50 Figure 4. The incidence rate and mortality rate of NF in Taiwan, 2005-2010. 51 APPENDIX 52 CURRICULUM VITAE 55

    Anaya DA, Dellinger EP. (2007). Necrotizing soft-tissue infection: diagnosis and management. Clinical Infectious Diseases 44, 705-710.
    Anaya DA, McMahon K, Nathens AB, Sullivan SR, Foy H, Bulger E. (2005). Predictors of mortality and limb loss in necrotizing soft tissue infections. Archives of Surgery 140, 151-157
    Chen JL, Fullerton KE, Flynn NM. (2001). Necrotizing fasciitis associated with injection drug use. Clinical Infectious Diseases 33, 6-15
    Chen YC, Yeh HY, Wu JC, Haschler I, Chen TJ, Wetter T. (2011). Taiwan National Health Insurance Research Database: administrative health care database as study object in bibliometrics. Scientometrics 86, 365-380.
    Chi C, Lee JL, Schoon R. (2012). Assessing health information technology in a national health care system--an example from Taiwan. Advances in Health Care Management 12, 75-109.
    Das DK, Baker MG, Venugopal K. (2011). Increasing incidence of necrotizing fasciitis in New Zealand: a nationwide study over the period 1990 to 2006. The Journal of Infection 63, 429-433.
    Dworkin MS, Westercamp MD, Park L, McIntyre A. (2009). The epidemiology of necrotizing fasciitis including factors associated with death and amputation. Epidemiology and Infection 137, 1609-1614
    Elixhauser A, Steiner C, Harris DR, Coffey RM. (1998). Comorbidity measures for use with administrative data. Medical Care 36, 8–27.
    Elliott DC, Kufera JA, Myers RA. (1996). Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Annals of Surgery 224, 672-683
    Ellis Simonsen SM, van Orman ER, Hatch BE, Jones SS, Gren LH, Hegmann KT, Lyon JL. (2006). Cellulitis incidence in a defined population. Epidemiology and Infection 134, 293–299
    Hippocrates. (1957). Epidemics: (translated by WHS Jones).Vol I. London: Heinemann, for Harvard University Press, 24-43.
    Hsiao CT, Weng HH, Yuan YD, Chen CT, Chen IC. (2008). Predictors of mortality in patients with necrotizing fasciitis. The American Journal of Emergency Medicine 26, 170-175
    Hsiao FY, Yang CL, Huang YT, Huang WF. (2007). Using Taiwan's national health insurance research databases for pharmacoepidemiology research. The Journal of Food and Drug Analysis 15, 99-108.
    Huang KF, Hung MH, Lin YS, Lu CL, Liu C, Chen CC, Lee YH. (2011). Independent predictors of mortality for necrotizing fasciitis: a retrospective analysis in a single institution. The Journal of Trauma 71, 467-473
    Jones J. (1871). Surgical memoirs of the war of the rebellion: investigation upon the nature, causes and treatment of hospital gangrene as prevailed in the Confederate armies 1861–1865. New York: US Sanitary Commission.
    Kuo YL, Shieh SJ, Chiu HY, Lee JW. (2007). Necrotizing fasciitis caused by Vibrio vulnificus: epidemiology, clinical findings, treatment and prevention. European Journal of Clinical Microbiology & Infectious Disease 26, 785-792
    McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. (1995). Determinants of mortality for necrotizing soft-tissue infections. Annals of Surgery 221, 558-563
    Meleney FL. (1929). Haemolytic streptococcal gangrene. Importance of early diagnosis and early operation. Journal of the American Medical Association 92, 2009-2012.
    Morgan MS. (2010). Diagnosis and management of necrotizing fasciitis: a multiparametric approach. Journal of Hospital Infection 75, 249-257
    Muldrew KL, Miller RR, Kressin M, Tang YW, Stratton C. (2007). Necrotizing fasciitis from Vibrio vulnificus in a patient with undiagnosed hepatitis and cirrhosis. Journal of Clinical Microbiology 45, 1058-1062
    Mulla ZD, Gibbs SG, Aronoff DM. (2007). Correlates of length of stay, cost of care, and mortality among patients hospitalized for necrotizing fasciitis. Epidemiology and Infection 135, 868-876
    Nisbet M, Ansell G, Lang S, Taylor S, Dzendrowskyi P, Holland D. (2011). Necrotizing fasciitis: review of 82 cases in South Auckland. Internal Medicine Journal 41, 543-548
    Park KH, Jung SI, Jung YS, Shin JH, Hwang JH. (2009). Marine bacteria as a leading cause of necrotizing fasciitis in coastal areas of South Korea. The American Journal of Tropical Medicine and Hygiene 80, 646-650
    Psoinos CM, Flahive JM, Shaw JJ, Li Y, Ng SC, Tseng JF, Santry HP. (2013). Contemporary trends in necrotizing soft-tissue infections in the United States. Surgery 153, 819-827.
    Singh G, Sinha SK, Adhikary S, Babu KS, Ray P, Khanna SK. (2002). Necrotising infections of soft tissue—a clinical profile. The European Journal of Surgery 168, 366-371
    Tsai YH, Hsu RW, Huang KC, Huang TJ. (2010). Laboratory indicators for early detection and surgical treatment of vibrio necrotizing fasciitis. Clinical Orthopaedics and Related Research 468, 2230-2237
    Tsao CH, Chen CC, Tsai SJ, Li CR, Chao WN, Chan KS, Lin DB, Sheu KL, Chen SC, Lee MC, Bell WR. (2013). Seasonality, clinical types and prognostic factors of Vibrio vulnificus infection. Journal of Infection in Developing Countries 7, 533-540
    Waldron C, Solon JG, O’Gorman J, Humphreys H, Burke JP, McNamara DA. (2014). Necrotizing fasciitis: The need for urgent surgical intervention and the impact of intravenous drug use. Surgeon Mar 30. [Epub ahead of print]
    Wilson B. (1952). Necrotizing fasciitis. American Surgeon 18, 416–431.
    Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. (2003). Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. The Journal of Bone & Joint Surgery 85, 1454-1460

    下載圖示 校內：2019-09-04公開
    校外：2019-09-04公開
    QR CODE