患有慢性阻塞肺病會增加得到敗血症的風險: 以台灣全人口基礎的前瞻式世代研究

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邱鼎文(Ding-Wen Chiu) 查詢紙本館藏

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資訊工程學系在職專班

論文名稱

患有慢性阻塞肺病會增加得到敗血症的風險: 以台灣全人口基礎的前瞻式世代研究
(Increased risk of sepsis among patients with chronic obstructive pulmonary disease patients: A population-based prospective cohort study in Taiwan)

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摘要(中)

慢性阻塞性肺疾病（COPD）是一種常見的健康問題，有很高的發病率及死亡率，其特
徵在於氣流受限和不完全可逆的。敗血症是一種全身性的炎症反應，而主要發生原因是受
到細菌的感染。患有敗血症患者死亡率在全球高達30%到60%，而在最近的一項研究中顯
示，慢性阻塞性肺疾病的患者容易感染肺炎，肺炎和敗血症是有密切關聯的，嚴重感染肺
炎的患者最終都會導致敗血症的發生，因而肺炎可能是慢性阻塞性肺疾病造成敗血症之間
的中介，而肺炎可能是其中一個非常重要關鍵因素之一，因此我們從全民健康保險研究資
料庫抓取100 歲以下的新發慢性阻塞性肺疾病病患，再來排除一些會影響我們研究的病患，
然後評估慢肺炎及共病是否會影響得到敗血症的風險，最後我們分析出慢性阻塞性肺疾病
的患者得到敗血症的風險是比較高的（HR=1.50，95％ CI=1.42-1.59），而在我們控制了肺
炎之後，得到敗血症的風險會降低（HR=1.21，95％ CI =1.15-1.28），所以肺炎是導致敗血
症的一個非常重要的關鍵因素。然而，較年長的慢性阻塞性肺疾病患者會比年輕的患者有
更高的風險得到敗血症，尤其是年齡在60 歲以上的患者。

摘要(英)

Chronic obstructive pulmonary disease (COPD) is a major health problem and a leading
cause of morbidity and mortality, which is characterized by airflow limitation that is progressive
and not fully reversible. Sepsis is a systemic inflammatory response to infection. The fatality rate
of patients with sepsis has continues as high as 30%-60% worldwide. In a recent study, COPD
are at increased risk of contracting pneumonia, pneumonia and sepsis are interrelated because
severe cases of pneumonia can eventually lead to sepsis. Thus pneumonia is acts as an
intermediary between COPD and the sepsis, it is an important key factor. Thus, we select ≦100
years newly COPD patients from National Health Insurance Research Database (NHIRD),
exclude some patients who affect our study and evaluate the effects of comorbidities or
pneumonia with COPD on the sepsis risk. Finally, we analyzed the patients with COPD had an
increased risk for sepsis in this cohort (HR=1.50, 95% CI=1.42-1.59), after controlling for
pneumonia, the risk was attenuated (HR=1.21, 95% CI =1.15-1.28). Pneumonia was a very
strong factor of sepsis. However, the elderly COPD patients were at a higher hazard for sepsis
than the younger, especially in the group aged >60 years.

關鍵字(中)

★ 敗血症
★ 慢性阻塞肺病

關鍵字(英)

★ sepsis
★ chronic obstructive pulmonary disease

論文目次

摘要 ...................................................................................................................................................i
ABSTRACT .................................................................................................................................... ii
Table of Contents ........................................................................................................................... iii
List of Figures ................................................................................................................................... v
List of Tables ...................................................................................................................................vi
Chapter 1 Introduction ...................................................................................................................... 1
Chapter 2 Related Works .................................................................................................................. 3
2.1 Chronic Obstructive Pulmonary Disease ......................................................................... 3
2.2 COPD and Sepsis ............................................................................................................ 4
Chapter 3 Materials and Methods ..................................................................................................... 6
3.1 Data Source ..................................................................................................................... 6
3.2 Study Design ................................................................................................................... 6
3.3 Sepsis Exposure ............................................................................................................... 9
3.4 Confounding Factors ....................................................................................................... 9
3.5 Statistical Analysis .......................................................................................................... 9
Chapter 4 Results ............................................................................................................................ 11
4.1 Demographic Characteristics ......................................................................................... 11
4.2 Incidence Rate and Risk of Sepsis between Two Cohorts ............................................ 14
4.3 Incidence Rate and Risk of Pneumonia between Two Cohorts .................................... 17
4.4 Incidence Rate and Risk of Bacteremia between Two Cohorts .................................... 19
4.5 Relative Risk of Sepsis among COPD Cohorts ............................................................. 21
4.6 Incidence Rate and Risk for Age Groups of Sepsis between Two Cohorts .................. 22
4.7 Theophylline Effects ..................................................................................................... 28
4.8 Kaplan-Meier Sepsis-Free Curves ................................................................................. 31
4.9 Kaplan-Meier Pneumonia-Free Curves ......................................................................... 32
4.10 Kaplan-Meier Bacteremia-Free Curves ......................................................................... 33
Chapter 5 Discussion ...................................................................................................................... 34
iv
References ...................................................................................................................................... 37

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指導教授

洪炯宗(Jorng-Tzong Horng)

審核日期

2016-1-29

推文