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作者:陳世真
作者(外文):Shih-Jen Chen
論文名稱:台灣石牌地區老年性黃斑部退化之社區流行病學研究
論文名稱(外文):Community-based Epidemiologic Study of Age-related Macular Degeneration in Shihpai, Taiwan
指導教授:周碧瑟
指導教授(外文):Pesus Chou
學位類別:博士
系所名稱:公共衛生研究所
學號:39307006
出版年:97
畢業學年度:96
語文別:英文中文
論文頁數:84
中文關鍵詞:老年性黃斑部退化盛行率發生率危險因子華人台灣流行病學
外文關鍵詞:Age-related macular degenerationPrevalenceIncidencerisk factorsChineseTaiwanEpidemiology
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老年性黃斑部退化,是發生在已開發國家很常見的視網膜眼疾。它會造成不可逆的中心視力減退。目前在台灣以及華人世界,尚未見根據社區人口為基礎,以眼底照相,國際分類為標準,而進行老年性黃斑部退化的盛行率以及發生率的調查報告。在1999年,石牌地區眼研究共有1361位年齡在65歲以上的居民參加篩檢。在1058(77.7%)位眼底相片可以符合判讀者中,早期和晚期老年性黃斑部退化各佔9.2%和1.9%。年齡是最重要的危險因子。當年齡由65-69升至80以上,早期黃斑部退化的盛行率由5%升高到24.4%,而晚期黃斑部退化則由1.0%升至9.0%。目前仍持續喝酒者比起從未喝酒者罹患早期黃斑部退化的比率較低(校正後勝算比 0.32, 95%信賴區間: 0.11-0.93, p=0.037)。抽煙則和黃斑部退化的盛行率沒有關聯。在2006年,石牌地區眼研究再度邀請七年前曾參加眼篩檢的老年人回來參加第二次眼篩檢。在這個七年後的世代研究,480位參加者中,402位(83.8%)眼底相片可以符合判讀。研究發現,七年的累積發生率在早期和晚期黃斑部退化各為7.9%和1.7%。年齡仍然是發生黃斑部退化最重要的危險因子。第一次篩檢年齡在80歲以上者,七年後得到黃斑部退化的勝算比為年齡65-69歲的11.9倍 (95%信賴區間:3.06-46.24, p<0.0001)。抽煙和喝酒與黃斑部退化的發生無關。在第一次篩檢檢查,眼底如果出現10顆以上的小硬隱結或中型隱結,則以後較易發生早期黃斑部退化。若是出現大型的隱結,或是大型隱結範圍達500um以上,或是有色素異常者,則以後較易發生晚期黃斑部退化。石牌地區的老年性黃斑部退化的盛行率和發生率和其他已開發國家相近,顯示黃斑部退化在台灣的老年人,是一常見的眼疾。因為黃斑部退化而造成的失明,以及其對未來台灣老年化社會的衝擊,和其早期偵測,與預防之道,將值得進一步研究。
Age-related macular degeneration is a common eye disease with irreversible central visual loss in the elderly people in the developed countries. The population-based study with photographic grading, international classification and incidence rate of this blinding eye disease in the Chinese people had not been reported in Taiwan or in the literatures before. In 1999, the Shihpai eye study was conducted with 1361 elder people attended the ocular examination. Among the 1058 (77.7%) participants with gradable photographs, the prevalence rate of early and late AMD was 9.2% and 1.9%, respectively. Age was the most significant risk factor associated with both early and late AMD. The prevalence of early AMD rose from 5.0% in the 65-69 year age group to 24.4% in those aged 80 years and over; and for late AMD, from 1.0% to 9.0%. Those who currently drank alcohol had lower rate of early AMD than the non-drinker (adjusted odd ratio 0.32, 95% CI: 0.11-0.93, p=0.037). Smoking habit had no association with prevalent AMD. In 2006, the cohort was invited to participate the second ocular examination. Among the 480 participants, 402 (83.8%) had gradable photographs and were analyzed for the incidence study. The 7-year cumulative incidence of early and late AMD was 7.9% and 1.7%, respectively. Age was still the most significant factor for any AMD progression. Age of 80 and older at baseline had 11.9 fold (95% CI:3.06-46.24, p<0.0001) of acquiring any AMD than age 65-69 at baseline. Smoking and alcohol drinking were not risk factors for the incident AMD. Specific fundus lesions of >10 small hard drusen, intermediate drusen at baseline were associated with progression of early AMD while large distinct or indistinct drusen, drusen area>500um and pigment abnormalities were associated with late AMD comparing to those without the lesions. The comparable rate of AMD to other developed countries and ethnos in the world confirmed that AMD is a common eye disease among the elderly people in Taiwan. The impact of this blinding eye disease on the aging society of Taiwan as well as their early detection and preventive intervention deserve further researches.
Abstract………………………………………………………………
中文摘要………………………………………………………………
Introduction…………………………………………………………
Objectives……………………………………………………………
Literatures review………..……………………………………….
Definition and classification of AMD………………………..
Regional and racial differences in prevalence…………
Regional and racial differences in incidence……………
Prevention of AMD…………………………………
Chapter 1 Prevalence
Methods…………………………………………………………...
Study population……………………………………………….
Procedures………………………………………………………
Fundus grading…………………………………………………
Definition…………………………………………………...
Statistical analysis…………………………………….
Results…………………………………………………
Participants……………………………………………..
Prevalence………………………………………………………
Risk factors for early and late AMD………………………
Discussion…………………………………………………………
Chapter 2 Incidence
Methods………………………………………………………
Study population………………………………………………
Procedures…………………………………………………………
Fundus grading………………………………………………………
Definition of progression………………………………………
Statistical analysis…………………………………………….
Results…………………………………………………………….
Participants……………………………………………………..
Incidence……………………………………………...
Risk factors for incident AMD……………………………….
Discussion………………………………………………………..
Conclusion…………………………………………………………..
Abbreviation…………………………………………………………
References……………………………………………………………
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