目的：結核病在全球是一項重要的公共衛生議題，估計有三分之一的人口受結核分枝桿菌感染侵入而引起慢性結核病感染。臺灣近年來的發生率及與死亡率雖已逐年下降，但與其他已開發國家相比依然有較高的發生率與死亡率，因此還是一項重要的健康問題。結核病發病情況與居住地區的生活方式、生活習慣、人口密度、人口流動速率以及生活水平等具高度相關，但其治療成效是否也與所在地區之環境特性有關，則尚待研究。因此，本研究擬評估臺灣地區肺結核患者使用肺結核藥物治療的成效與環境的相關性。
方法：本研究使用回溯性世代追蹤設計，採用臺灣健保資料庫中2000年的百萬抽樣歸人檔中2004到2011年的肺結核病患做為追蹤世代，再依據肺結核用藥情形將族群分成一線用藥及二線用藥族群，並選取未被診斷有結核病的人作為對照組。空氣污染的數據則採用行政院環境保護署空氣品質監測網69個測站的資料。
結果與討論：從2004年到2011年的健保資料庫百萬抽樣歸人檔中，總共有6,770名結核病患者，其中一線用藥與二線用藥的病人各占了6,477人及293人，並選取33,346名樣本作為對照組。在共病症方面，三組人不管在糖尿病、氣喘、肺阻塞、愛滋病及塵肺症皆有統計上的顯著差異(P<0.001)。本研究將空氣污染指標依據四分法進行分組，使用logistic regression 評估空氣污染指標PM10，NO2，O3和CO與肺結核治療成效的相關性，在調整了年齡、性別、都市化程度、共病症等干擾因子後，發現空氣污染的濃度指標會影響肺結核患病情形。
關鍵字：肺結核、治療結果、空間分析

Objective: Tuberculosis (TB) is a major infectious disease that causes illness and death worldwide. It has been reported one third of the world’s population is infected with Mycobacterium tuberculosis. The incidence and the mortality of tuberculosis has been decreased recent year in Taiwan. However, compared to other developed countries, the incidence and mortality rates are higher. Its incidence is associated with the region's lifestyle, habits, population density, and social-economic status. However, it is unclear whether the treatment outcome is also related to environmental factors. Therefore, this study evaluated the associations between anti-TB treatment outcome and potential environmental factors.
Methods: We conducted a retrospective cohort study using data from the Longitudinal Health Insurance Database 2000 of Taiwan between 2004 and 2011 to identify pulmonary tuberculosis cases. According to anti-TB treatment, the patients were divided into two groups: first-line treatment and second-line treatment. We estimated individual exposure to air pollution using data from air quality monitoring stations established by the Environmental Protection Administration, Taiwan. We stratified air pollutant concentrations into quartiles and applied logistic regression models to evaluate their association with TB outcome while adjustments were made for age, sex, urbanization, and comorbidity.
Results: There were 6,770 patients diagnosed with tuberculosis between 2004 and 2011; 6,477 received first-line treatment only, and 293 received second-line treatment. A total of 33,346 individuals were selected as the control group. As to comorbidity, diffenences in the prevalence rates of diabetes mellitus, asthma, chronic obstructive pulmonary disease, AIDS and pneumoconiosis between the two patient groups were statistically significant (P<0.001). After adjusting for cofounders, our cohort study provided evidence supporting that fine particle pollution and traffic-related air pollution might be associated with an increased risk of TB.
Keywords: Tuberculosis; treatment outcome; Spatial Analysis

蔡文正:結核病患失落之因素分析研究。行政院衛生署疾病管制局九十二年度科 技研究發展計畫。
衛生福利部疾病管制署:臺灣結核病防治年報，2013:1-217。
衛生福利部疾病管制署:結核病診治指引(第五版)，2015:1-155。
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