慢性C型肝炎病毒感染與代謝症候群、心血管疾病危險之研究

論文名稱(英文), Serum hepatitis B virus antibody or hepatitis C virus ... 慢性C型肝炎病毒感染其發生代謝症候群、高血脂危險及血脂異常的危險性都較未感染者顯著 ... 進階搜尋 學院別 >臺北醫學大學 >公共衛生學院 >公共衛生學系暨研究所   查詢北醫館藏 系統識別號 U0007-2007201121052800 論文名稱(中文) 慢性B型肝炎病毒感染、慢性C型肝炎病毒感染與代謝症候群、心血管疾病危險之研究 論文名稱(英文) SerumhepatitisBvirusantibodyorhepatitisCvirusantibodyassociatedwiththerisksofmetabolicsyndromeand cardiovasculardiseases. 校院名稱 臺北醫學大學 系所名稱(中) 公共衛生學研究所 系所名稱(英) GraduateInstituteofPublicHealth 學年度 99 學期 2 出版年 100 研究生(中文) 李芳宇 研究生(英文) Fang-YuLi 學號 M508098006 學位類別 碩士 語文別 中文 口試日期 2011-06-24 論文頁數 102頁 口試委員 指導教授-白其卉委員-廖朝聖委員-謝芳宜 中文關鍵字 慢性B型肝炎病毒感染  慢性C型肝炎病毒感染  代謝症候群  心血管疾病  英文關鍵字 SerumhepatitisBvirusantibody  SerumhepatitisCvirusantibody  Metabolicsyndrome  Cardiovasculardiseases  學科別分類 中文摘要 研究背景：慢性B型、C型肝炎病毒感染與脂質代謝異常及胰島素阻抗有關，慢性病毒感染所造成之反覆且持續的發炎反應也與動脈粥狀硬化及心血管疾病有關。

本研究欲探討慢性B型、C型肝炎病毒感染與代謝症候群、血脂異常、血糖異常的關連性，並進一步分析其全死因、心血管疾病及肝癌的死亡風險。

材料方法：本研究分為橫斷研究及縱貫研究兩部分。

橫斷研究是利用美兆集團30,000人健檢資料。

當HBsAg檢測結果呈陽性者即定義為慢性B型肝炎病毒感染(n=8,157)、anti-HCV檢測結果呈陽性者即定義為慢性C型肝炎病毒感染(n=789)。

以線性迴歸及邏輯式迴歸分別探討慢性B型、C型肝炎病毒感染與代謝症候群、血脂異常、血糖異常的關連性。

縱貫研究則是將美兆集團所提供之30,000人健檢資料與行政院衛生署2000-2008年死亡檔作勾稽，依ICD-9疾病碼將死亡原因分為全死因、心血管疾病及肝癌三大類，使用存活分析分別探討慢性B型、C型肝炎病毒感染其全死因、心血管疾病及肝癌的死亡風險。

結果：慢性B型肝炎病毒感染者其空腹血糖、三酸甘油酯及總膽固醇濃度較未感染者低，高密度脂蛋白膽固醇濃度較未感染者高，發生代謝症候群、高血脂危險、血脂異常、高血糖危險、血糖異常的危險性都較未感染者顯著地低(OR皆<1,p<0.05)，發生全死因及肝癌的死亡風險分別為未感染者的1.38及5.92倍(p<0.05)，心血管疾病的死亡風險為0.93倍(p>0.05)。

慢性C型肝炎病毒感染者其空腹血糖較未感染者高，三酸甘油酯、總膽固醇及高密度脂蛋白膽固醇濃度較未感染者顯著地低，發生代謝症候群、高血脂危險、血脂異常的危險性都較未感染者低(OR皆<1,p<0.05)，發生全死因及肝癌的死亡風險分別為未感染者的2.26及9.40倍(p<0.05)，心血管疾病的死亡風險為1.22倍(p>0.05)。

結論：本研究結果顯示，雖然慢性B型肝炎病毒感染者與心血管疾病、動脈粥狀硬化相關疾病的死亡風險無關，但是其發生代謝症候群、高血脂危險、血脂異常、高血糖危險、血糖異常的危險性都較未感染者顯著地低。

慢性C型肝炎病毒感染其發生代謝症候群、高血脂危險及血脂異常的危險性都較未感染者顯著地低，但其他如：發生高血糖危險、血糖異常的危險性及心血管疾病、動脈粥狀硬化相關疾病的死亡風險上皆未達顯著相關。

英文摘要 Background：ChronichepatitisBvirus(HBV)andhepatitisCvirus(HCV)infectionareassociatedwithabnormallipidmetabolismandinsulinresistance(IR).Inaddition,chronicviralinfectionmaycausepersistentinflammationthathavebeenassociatedwithanincreasedriskofatherosclerosisandcardiovasculardisease.Thegoalofourstudyistoinvestigatetherelationshipsbetweenmetabolicsyndrome,hyperlipidemia,hyperglycemiaandHBV,HCVinfectioninTaiwanese.Additionally,wealsoaimtoassessthemortalitiesofallcause,cardiac,andhepatomaamonghepatitisBandCviruscarriersinthispopulation. MaterialsandMethods：Thisdata-basestudycontainstwoparts:across-sectionalpartandalongitudinalpart.Cross-sectionaldesignwasusedthedatasetsfrom2000to2001oftheMJHealthScreeningCenter.Longitudinaldesignstudywasinitiatedsince2000,andthesubjectswerecensoredatthedateofdeathattributabletoall-causeorbyDecember31,2008ifnocensoringeventoccurred.ChronicHBVinfectionwasdefinedasapositiveresultofHBVsurfaceantigen(HBsAg).ChronicHCVinfectionwasapositiveresultofanti-HCVantibody.Usinglinearregressionandlogisticregressiontoinvestigatetherelationshipsbetweenmetabolicsyndrome,hyperlipidemia,hyperglycemiaandhepatitisBvirus,hepatitisCvirusinfection.Coxproportionalhazardsmodelwasusedtoassessthehazardratiosofmortalityfromallcause,cardiac,andhepatomaforHBsAgoranti-HCVseropositivescomparedwiththoseseronegatives,respectively,afteradjustmentforageandgender. Results：HBsAgseropositivesubjectshadalowerfastingglucose,triglyceride,totalcholesterollevelsandhigherhigh-densitylipoproteincholesterollevelcomparedwiththoseneverinfected.SubjectswithHBsAgseropositiveswerelesslikelytohavemetabolicsyndrome,highlipidcomponents,highglucosecomponent,hyperlipidemiaandhyperglycemia(allOR<1,p<0.05).Afteradjustmentforage,genderandthecompetingriskofhepaticdisease,thefullyadjustedhazardratiosofmortalityfromcardiovasculardiseasewere0.93(p>0.05).Anti-HCVseropositivessubjectshadalowertriglyceride,totalcholesterolandhigh-densitylipoproteincholesterollevelsandhigherfastingglucoselevelcomparedwiththoseneverinfected.Alsotheywerelesslikelytohavemetabolicsyndrome,highlipidcomponentsandhyperlipidemia(allOR<1,p<0.05).Thefullyadjustedhazardratiosofmortalityfromcardiovasculardiseasewere1.22(p>0.05). Conclusion：AlthoughHBsAgseropositivitywasnotassociatedwithincreaseddeathrisksofcardiovascular/atherosclerosis-relateddiseasesbuttheywerelesslikelytohavemetabolicsyndrome,highlipidcomponents,highglucosecomponent,hyperlipidemiaandhyperglycemia.Eventhoughanti-HCVseropositivitywerelesslikelytohavemetabolicsyndrome,highlipidcomponentsandhyperlipidemia,italsocan’tnotbeasignificantpredictorforcardiovascular/atherosclerosis-relateddiseases. 論文目次 第一章、緒論 -1- 第一節、研究背景與動機 -1- 第二節、研究目的 -3- 第二章、文獻探討 -4- 第一節、B型肝炎及B型肝炎病毒(HepatitisBvirus,HBV) -4- 第二節、C型肝炎及C型肝炎病毒(HepatitisCvirus,HCV) -7- 第三節、病毒感染、發炎反應及動脈粥狀硬化 -10- 第四節、代謝症候群與發炎反應 -14- 第五節、心血管疾病 -20- 第三章、研究方法與材料 -23- 第一節、資料來源 -23- 第二節、研究設計與研究對象 -25- 第三節、研究變項與操作型定義 -29- 第四節、資料分析 -33- 第四章、結果 -36- 第一節、B型肝炎檢測陽性者與心血管風險之分析 -36- 第二節、C型肝炎檢測陽性者與心血管風險之分析 -59- 第五章、討論 -78- 第一節、慢性B型、C型肝炎病毒感染者與血糖 -78- 第二節、慢性B型、C型肝炎病毒感染者與血脂 -81- 第三節、慢性B型、C型肝炎病毒感染者與代謝症候群 -83- 第四節、慢性B型、C型肝炎病毒感染者與動脈粥狀硬化相關疾病 -85- 第五節、研究限制 -88- 第六章、結論 -89- 附錄 -90- 參考文獻 -93- 參考文獻 Adam,E.,J.L.Melnick,J.L.Probtsfield,B.L.Petrie,J.Burek,K.R.Bailey,C.H.McCollumandM.E.DeBakey(1987)."Highlevelsofcytomegalovirusantibodyinpatientsrequiringvascularsurgeryforatherosclerosis."Lancet2(8554):291-293. 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