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    題名: 台灣地區藥物濫用其環境與遺傳危險因子之探討
    Environmental and Genetic Risk Factor of Drug Abuse in Taiwan
    作者: 陳郁菁;Yu-Ching Chen
    貢獻者: 公共衛生學院環境醫學研究所碩士班
    關鍵詞: 藥物濫用;ROC curve;風險預測模式;COMT;Drug abuse;ROC curve;Risk prediction model;COMT
    日期: 2010
    上傳時間: 2010-09-29 12:03:23 (UTC+8)
    摘要: 目的:本研究主要想要了解影響藥物濫用行為的環境與遺傳危險因子,因此研究分為兩個部份: (1)透過問卷調查了解影響台灣地區男性受刑人其藥物濫用行為的危險因子,以建立男性受刑人藥物濫用的風險預測模式,用來預測高危險族群藥物濫用的風險,並提高其對藥物濫用風險的自覺,以逹到防治的效果; (2)監測 HIV-1 陽性患者其COMT Val158Met 基因多型性與藥物濫用行為之相關,了解 HIV 陽性患者其藥物濫用行為受基因影響的機會有多大,期望找到藥物濫用的生物標記作為藥物濫用行為的遺傳危險因子。
    方法:本研究收集2007年自台灣各地監所男性受刑人所做的藥物濫用知識、態度和行為之危險因子收集之調查問卷與中國醫藥大學檢驗科之HIV-1陽性患者之血液樣本。研究 (1),在男性受刑人藥物濫用風險預測模式方面,是使用2007年台灣各地監所所收集的男性受刑人之問卷資料,以病例對照研究法 (case-control study) 探討成為藥物濫用者的危險因子,進一步使用邏輯斯迴歸 (logistic regression) 建立風險預測模式,加總模式中每一個變項的危險對比值 (odds ratio, OR),再利用 ROC curve (Receiver operating characteristic curve) 分析進而得到成為藥物濫用者風險閾值 (Threshold)。研究 (2), HIV-1 陽性患者其 COMT Val158Met 基因多型性與藥物濫用行為之相關部分,是利用中國醫藥大學檢驗科之HIV-1 陽性患者之血液樣本,抽取 DNA 以 PCR-RFLP 來作 COMTVal158Met 基因多型性的判定,並分析藥物濫用行為與 COMTVal158Met 基因多型性的相關,並進一步以性別分層作分析。
    結果:(1)男性受刑人藥物濫用風險預測模式: 模式中的顯著危險因子共有8個,第一次發生性行為的年齡與重覆入監為藥物濫用的行為危險因子,藥物濫用者有較佳的藥物濫用認知,而非藥物濫用者則有較佳的藥物濫用態度。進一步使用ROC curve挑選總危險對比值 (Odds ratio,OR)為9.665做為最適當的風險閾值(敏感度為83.9%,特異度為69.3%)。(2) HIV-1 陽性患者其 COMT Val158Met基因多型性與藥物濫用行為之相關: COMT Val158Met 基因多型性對藥物濫用行為在性別上有不同的影響程度,男性與女性藥物濫用者在 COMT Val158Met 基因多型性的頻率分布上有顯著的差異(男性 Val/Val % v.s 女性 Val/Val %: 56.3 % v.s 28.6 %, P=0.049)。

    Objective:The main purposes of this study were to investigate the environmental and genetic risk factors associatied with drug abuse using two groups of study subjects. (1) We first conducted a questionnaire survey among male inmates to collect their practices, knowledge and attitude to predict factors association with drug abuse. Our prediction model can be used as a tool to predict now drug abuse we invoted in male inmates and to increase their self-awareness of drug abuse. (2) For the genetic risk factors of drug abuse, this study investigated the distribution of the COMT Val158Met polymorphism is associated with the drug abuse behavior among HIV positive patients.

    Methods:We conducted survey for drug abuse risk factors using questionnaire among inmates with drug abuse and with nosuch abuse at jails in 2007 in Taiwan; and collected HIV-1 seropositive blood samples from HIV/AIDS outpatients in Taichung area. (1) Information on demographic factors, sexual and drug abuse practices, and knowledge and attitude of drug abuse were used to build up Drug Abuse Risk Prediction Model. We investigated risk factors of drug abuse using case-control study. The risk prediction model was established by logistic regression, and odds ratios for risk factors were measured. We then used ROC curve (receiver operating characteristic curve) to estimate drug abuse risk threshold. (2) In regarding COMT Val158Met genotype study, we collected HIV-1 seropositive blood samples in 2007-2009 from HIV-1 surveillance network .Genotypes were identified using PCR-RFLP. Chi-square was used to estimate to the association between COMT Val158Met genotypes and drug abuse among HIV positive patients.

    Result: (1) For the environmental risk factors of drug abuse : Result of the risk prediction among male inmates in Taiwan showed that “Age of first time having sex” and “Who repeatedly entry into prison” are drug abuse practices risk factors, and drug abuser had a better knowledge about drug abuse; non-drug abuser had a better attitude towards drug abuse. The overall OR of risk threshold value in male inmates was 9.665 (sensitivity: 0.839; specificity: 0.693). (2) For the genetic risk factors of drug abuse: Drug abusers and non-drug abuser were not significantly different in COMT Val158Met gene frequencies (P = 0.933) for HIV-1 patients. We found a significant gender difference in COMT Val158Met polymorphisms in HIV drug abusers. (Male in Val/ Val v.s Female in Val /Val: 56.3% v.s 28.6%,
    P = 0.049)
    顯示於類別:[環境醫學研究所(已停用)] 博碩士論文

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