| 摘要: | 從民國89年信義鄉全民健保之成人健檢資料中發現，信義鄉40歲以上居民的痛風盛行率為13.9%、高尿酸血症盛行率為55.1%，這對於社區民眾及當地衛生單位而言是個健康管理上的嚴重問題。爲找出信義鄉社區痛風問題的相關原因及研擬一套疾病管理模式，本研究從健檢資料中的痛風個案著手，定期給予保健教育指導與個案訪視作為社區個案的追蹤管理工作；並藉由痛風家族資料的收集與分析，探討罹患痛風的相關因素，以更準確掌握疾病防治的要點。 在健檢資料的易追個案中發現，原住民個案與非原住民個案相比較，原住民個案的平均發作年齡較早，且有較高比例的一等親家族病史與較高的飲酒習慣。從家族資料之描述性分析上，年齡、性別、個人共病症（高血壓、高尿酸血症與酒癮）、家族痛風病史用在個案與非個案間的分佈上有顯著差異。利用多變數之GEE邏輯斯迴歸分析在控制其他干擾因素，發現與痛風有顯著關聯性的變項有：年齡（OR=1.04）、性別（OR=6.8）、高血壓（OR=3.16）、肝病（OR=6.53）、高尿酸血症（OR=2.0）與酒癮（OR=2.41）。而以痛風最初發作年齡之事件史分析來看，在Wilcoxon 檢定或log-rank 檢定中，與痛風發作年齡較有關的變項為性別、種族、父母親之痛風病史與個人共病症病史。 從以上的研究結果發現，性別、種族、家庭痛風病史與個人共病症在痛風發生上扮演重要的角色外，「飲酒行為」是一個高危險的行為。所以未來在個案管理及痛風防治的工作上，「節制酒精的消耗」是一個重要的課題。; During an annual health examination in 2000 at Hsin-yi township, the prevalence of gout and hyperuricemia of participants aged 40 or above were estimated to be 13.9% and 55.1% respectively, indicating a serious health-related problem. In this study, we investigated the risk factors of gout through familial data collected or ascertained via index cases which were suspected to be severe gout patients. In the univariate analysis, significant predictors for the difference between aborigines and other ethnics are：earlier age at onset, family history (in particular the first degree relative) and habit of alcohol intake. For familial data collected through index cases, univariate analysis revealed that sex, self-reported hypertension, hyperuricemia, or alcoholism, and family history of gout are significant variables associated with gout. After adjusting for the potential confounding variables, the GEE logistic regression analysis gave the significant related factors as: age (OR=1.04), sex (OR=6.8), hypertension (OR=3.16), liver disease(OR=6.53), hyperuricemia (OR=2.0), and alcoholism (OR=2.41). From event-time data analysis, the significant correlates of “age at onset” were：sex, race, parents’ history of gout and personal comorbidity. In conclusion, our study suggested that sex, race, family history and personal comorbidity were important risk factors of gout. Besides, “alcohol intake” as a risk taking behavior was an extraordinary important variable. Therefore, “how to reduce alcohol consumption” is a key step in reducing gout prevalence and related health problems in the future work. |
