臺灣博碩士論文加值系統

目的：高血壓、高血脂、糖尿病是心血管疾病的主要危險因子，不僅影響國人健康，對慢性病在醫療成本上也是沉重的負擔。因此，若能在高血壓、高血脂、糖尿病的發病前期就對其進行相關預防以減少疾病發生率。藉由分析代表台灣成年人的血液樣本檢查結果及生理測量數據，於高血壓、高血脂、高血糖前期對於生活型態是否影響高血壓、高血脂、高血糖的發生之相關因素之探討。
方法：資料來源為中央研究院學術調查研究資料庫長期追蹤調查中台灣2004-2008國民營養健康狀況變遷調查的資料庫。根據人口學特質、生活型態和生理測量數據，以描述性分析及邏輯式迴歸分析與高血壓前期、高血脂前期、高血糖前期有關的相關因素。
結果：本研究樣本數高血壓前期692人、高血脂前期1012人、糖尿病前期共1027人；高血壓前期、高血脂前期、糖尿病前期盛行率分別為34.5％、41.3％、42.2％，平均年齡為54.8±16.3歲、56.3±15.7歲、56.6±15.9歲。在邏輯式迴歸分析中，發現以男性、教育程度在國中以下、喪偶者、有抽菸、喝酒及BMI值過重及肥胖者位在三高前期者勝算較大，若伴隨已確診是高血壓、高血脂、高血糖者罹病勝算也較高。
結論：在台灣高血壓、高血脂、糖尿病前期者盛行率偏高，這些人都不知道已處於高危險群且罹患高血壓、高血脂及糖尿病的機率可能高出正常者，多數三高前期者認為自己健康狀況是跟一般人同年齡者好的，對於這些尚未達到疾病的診斷標準而容易忽略三高對健康所帶來威脅性的三高前期者，若能及早給予預防性衛教，將可以減少疾病發生率及健保醫療費用的支出。

Objective:High blood pressure, Hyperlipidemia, and High blood sugar are major risk factors for the leading causes of death in Taiwan, such as diabetes and cardiovascular diseases. The increasing burden of these diseases will impose substantial cost on Taiwan’s health care systems in the years to come. Studies point out that efforts should be directed to those who have not yet had the disease in order to be more cost-effective in terms of disease prevention. In this study, we investigate the prevalence of pre-stage Hypertension, hyperlipidemia, and diabetes among a representative sample of adults in Taiwan.
Methods: Data were taken from the 2005-2008 Nutrition and Health Survey in Taiwan (NAHSIT). Both the questionnaire information and biochemistry data from the 8-hour fasting blood samples were used to determine the participant’s pre-stage status for Hypertension (120-139/80-89mmHg), Hyperlipidemia (cholesterol 200-239mg/dl, triglyceride 150-199mg/dl, low density lipoprotein 130-159mg/dl), and Diabetes (impaired fasting glucose 100-125mg/dl) and their related factors.
Results:After excluding participants who reported that they had Hypertension, Hyperlipidemia, or Diabetes, there were 692 cases with a Pre-stage hypertension,1012 cases with a Pre-stage Hyperlipidemia and 1027 cases with a Pre-diabetic status. The prevalence rates for the 3 pre-stage conditions were 34.5％, 41.3％, and 42.2％, respectively.
Conclusions:Our results suggested that significant proportions of the adults in Taiwan did not know that they were already in pre-stage conditions for Hypertension, Hyperlipidemia and Diabetes. Future primary prevention programs should pay more attention to people who are unaware of their high-risk status for these chronic diseases.

中文摘要
英文摘要
目錄 I
表目錄 III
圖目錄 IV
第一章 緒論
第一節 研究背景與動機 1
第二節 研究目的 4
第二章 文獻查證
第一節 高血壓的定義及分類標準 5
第二節 高血脂定義及分類標準 7
第三節 糖尿病的定義及分類標準 10
第四節 高血壓前期、高血脂前期、糖尿病前期盛行率及其相關因素 12
第三章 研究方法
第一節 研究材料及研究樣本 21
第二節 研究架構 24
第三節 變項定義 25
第四節 統計分析 28
第四章 研究結果
第一節 高血壓、高血脂、高血糖前期者盛行率 29
第二節 敘述性分析 30
第三節 邏輯式迴歸分析 41
第五章 討論與限制
第一節 針對高血壓前期、高血脂前期、高血糖前期個別做討論 51
第二節 研究限制 54
第六章 結論與建議 55
中文參考文獻 57
英文參考文獻 59
表 目 錄
表 1 高血壓前期基本人口學資料之描述性分析（n=692） 32
表 2 高血脂前期基本人口學特質之描述性分析（n=1012） 33
表 3 高血糖前期基本人口學資料之描述性分析（n=1027） 34
表 4 高血壓前期相關因素之描述性分析(n=692) 35
表 5 高血脂前期相關因素之描述性分析（n=1012） 37
表 6 高血糖前期相關因素之描述性分析（n=1027） 39
表 7 有無高血壓前期相關因素之二元邏輯式迴歸分析（n=2005） 45
表 8 有無高血脂前期相關因素之二元邏輯式迴歸分析（n=2452） 47
表 9 有無糖尿病前期相關因素之二元邏輯式迴歸分析（n=2432） 49
圖 目 錄
圖 1 樣本篩選流程 23
圖 2 高血壓高血糖高血脂前期盛行率 29

中文參考文獻
1.沈德昌 顏兆熊（2009）．糖尿病前期．台灣醫界，52（4），186-189。
2.林志遠，王建楠，蘇世斌（2008）．台灣南部某直場工作者低密度脂蛋白膽固醇過高之盛行率及相關因子探討．台灣家醫誌，18（4），221-230。
3.姚建安，李龍騰，陳慶餘，黃國晉（2005）．健檢老年人代謝症候群之相關研究．台灣老年醫學雜誌，1（1），18-25。
4.陳暉明、王聖棻、黃志芳、周騰達、辜美安(2010)‧健康生活型態介入對於女性高膽固醇血症及其他代謝症候群風險因子之影響‧台灣家醫誌，20 ，192-202。
5.陳筱筠，鍾嫈嫈（2004）．糖尿病前期．基層醫學，21（7），172-176。
6.莊宗憲（2012）．續發性高血脂症之原因簡介．台灣醫界，55（9），479-480。
7.錢凱平（2010）．現代人潛在的健康問題三高危機．長庚醫訊，32（10），26-28。
8.中華民國糖尿病學會（2012）．糖尿病臨床照護指引．台北：中華民國糖尿病學會。
9.行政院衛生署國民健康局（2003）．糖尿病防治手冊．取自http://health99.doh.gov.tw/media/public/pdf/21702.pdf
10.行政院衛生署國民健康局（2005）．高血壓防治手冊．取自http://health99.doh.gov.tw/educZone/edu_detail.aspx?Catid=21446
11.行政院衛生署國民健康局（2003）．高血脂防治手冊．取自http://health99.doh.gov.tw/media/public/pdf/21447.pdf
12.行政院衛生署（2012）．100年國人主要死因統計．取自http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=25&level_no=1&doc_no=84788
13.行政院衛生署（2010）．98年藥費前十名藥品．取自http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=25&level_no=1&doc_no=74802
14.行政院衛生署國民健康局（2009）．2007年台灣地區高血壓高血脂高血糖之追蹤調查研究．取自http://www.bhp.doh.gov.tw/BHPNet/Portal/File/ThemeDocFile/201102111207511077/
15.行政院衛生署國民健康局．遠離糖尿病完全學習手冊。取自http://www.bhp.doh.gov.tw/BHPNet/Portal/file/ThemeULFile/200802210227063612/ 95糖尿病學習手冊（民眾版）.pdf
16.基隆市衛生局（2009）．高血壓．取自http://chmuseum.klchb.gov.tw/web/menu/menuLink.aspx?c0=452
17.吳思賢（2009）．屏東地區40 歲以上中老年人肥胖相關指標與高血壓、高血糖、高血脂之相關性探討（碩士論文）．屏東：美和技術學院健康照護研究所。
英文參考文獻
1.American Diabetes Association(2009). Standards of medical care in diabetes--2009. Diabetes Care.32 Suppl 1: S13-61.
2.Andrejs Ērglis., Vilnis Dzērve., Jeļena Pahomova-Strautiņa., Inga Narbute, Sanda Jēgere., Iveta Mintāle., Renāte Ligere., Pēteris Apinis., Aivars Lejnieks.,Dana Misiņa., Aldis Rozenbergs.(2012). A Population-Based Cross-Sectional Study of Cardiovascular Risk Factor in Latvia. Medicina (Kaunas) ,48(6),310-316.
3.Banegas JR., Rodriguez-Artalejo F., de la Cruz Troca JJ., Guallar-Castillon P., del Rey Calero J.(1998) .Blood pressure in spain: Distribution, awareness, control,and benefits of a reduction in average pressure. Hypertension. 32:998-1002
4.Chen CK., Chen CJ., Gregg ED.（2003）. Impaired fasting glucose and risk of diabetes in Taiwan: follow-up over 3 years. Diabetes Res Clin Pract 60:177-182.
5.Cherie James., MSPH.,Kai Mckeever Bullard., PHD.,Deborah B. Rolka., MS.,Linda S. Geiss,MA.,Desmond E. Williams, MD, PHD., Catherine C. Cowie, PHD.,Ann Albright, PHD, RD.,Edward W. Gregg, PHD.(2011). Implications of Alternative Definitions of Prediabetes for Prevalence in U.S. Adults. DIABETES CARE,34,387-391.
6.Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med ,346,393-403.
7.Greenlund KJ.,Croft JB.,Mensah GA. (2004). Prevalence of heart disease and stroke risk factors in persons with prehypertension in the United States, 1999-2000 .Arch Intern Med, 164,2113-2118.
8.Karamatollah Rahmanian., Mohammad Shojaie y.(2012). The prevalence of pre-hypertension and its association to established cardiovascular risk factors in south of Iran. BMC Research Notes,5,386.
9.Kitai E., Vinker S., Halperin L., Meidan A., Grossman E.(2007). Pre-hypertension is a common phenomenon: national database study. Isr Med Assoc J, 9,8-11.
10.Li-Kuo Liu., Li-Ning Peng., Liang-Kung Chen., Shinn-Jang Hwang., Shu-Ti Chiou.(2010). Prehypertension Among Middle-Aged and Elderly People in Taiwan:A Five-Year Follow-Up. J Atheroscler Thromb,17(2),189-194.
11.Liang DP., Yao XG., Li NF., Zhang DL., Guo YY., Lin L., Zhou L., Li WC., Yan ZT., Wang HM., Luo WL., Chang JH.(2011). Epidemiological survey of lipid levels and factors in Kazakan people over 30-year old in Fukang of Xinjiang. Zhonghua Yu Fang Yi Xue Za Zhi,45(5),440-3.
12.M. Lee, MD., J.L. Saver, MD., B. Chang, BS, K.-H. Chang, MD, PhD., Q. Hao, MD, PhD ＆ B. Ovbiagele, MD, MSc.(2011). Presence of baseline prehypertension and risk of incident stroke A meta-analysis. Neurology,77(14),1330-1337.
13.Marcos Aparecido Sarria Cabrera,Selma Maffei de Andrade, Arthur Eumann Mesas.(2012). A prospective study of risk factors for cardiovascular events among the elderly. Clinical Interventions in Aging,7,463-468.
14.Meng Lee instructor., Jeffrey L Saver professor., Keun-Sik Hong professor., Sarah Song instructor.,Kuo-Hsuan Chang assistant professor.,Bruce Ovbiagele professor.(2012).Effect of pre-diabetes on future risk of stroke: meta-analysis. Bmj, 344:e3564 doi: 10.1136.
15.Mostafa Hosseini , Shervin Taslimi.,Mahmoud Yousefifard.,Fereshteh Asgari. , Koorosh Etemad.,Hamid Heidarian Miri.,Ali Rafei., Jalil Koohpayehzadeh., Iman Navid.,Mohammad Mehdi Gouya.(2013). Serum Cholesterol Level Nomograms for Iranian Population; Suggestion for National Cut-Offs. Iranian J Publ Health,42(2),164-171.
16.Nathan DM., Davidson MB., DeFronzo RA .（2007）.: Impaired fasting glucose and impaired glucose tolerance:implications of care. Diabetes Care 30:753-759.
17.National Institutes of Health National Heart, Lung, and Blood Institute (2003).The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation,and Treatment of High Blood Pressure: the JNC 7report. Retrieved from http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
18.QureshiA I , Suri MF, Kirmani JF. (2005). Prevalence and trends of prehypertension and hypertension in United States: National Health and Nutrition Examination Surveys 1976 to 2000. Med SciMonit, 11,CR403-409.
19.Ryuichi Kawamoto.,Katsuhiko Kohara.,Yasuharu Tabara.,Tetsuro Miki.(2008).High prevalence of prehypertension isassociated with the increased body mass index in community-dwelling Japanese. Tohokuj.Exp.Med,261,253-361.
20.Su-Hao Tu ., Cheng Chen ., Yao-Te Hsieh. , Hsing-Yi Chang.,Chih-Jung Yeh ., Yi-Chin Lin.,Wen-Harn Pan.(2011). Design and sample characteristics of the 2005-2008Nutrition and Health Survey in Taiwan. Asia Pac J Clin Nutr 2011,20 (2),225-237.
21.Sun Z., Zheng L.,Wei Y. (2007). Prevalence and risk factors of the rural adult people prehypertension status in Liaoning Province of China . Circ J , 71,550-553.
22.Susan P., Fisher-Hoch, Kristina P., Vatcheva, Susan T., Laing, M. Monir Hossain M., Hossein Rahbar.,Craig L. Hanis, H., Shelton Brown III, Anne R. Rentfro, RN.,Bel inda M., Reininger, Joseph B. McCormick.(2012). Missed Opportunities for Diagnosis and Treatment of Diabetes, Hypertension, and Hypercholesterolemia in aMexican American Population, Cameron County Hispanic Cohort, 2003–2008. Centers for Disease Control and Prevention,9(11),1-11
23.Trevor S Ferguson., Novie OM Younger., Marshall K Tulloch-Reid., Marilyn B Lawrence Wright., Elizabeth M Ward., Deanna E Ashley., Rainford J Wilks. (2008). Prevalence of prehypertension and its relationship to risk factors for cardiovascular disease in Jamaica: Analysis from a cross-sectional survey. BMC Cardiovascular Disorders , 8(20),1-9.
24.Wenying Yang, MD., Jianzhong Xiao, MD. PhD., Zhaojun Yang, MD., Linong Ji, MD.,Weiping Jia, MD., Jianping Weng, MD., Juming Lu, MD.,Zhongyan Shan, MD.,Jie Liu, MD;Haoming Tian, MD., Qiuhe Ji, MD., Dalong Zhu, MD; Jiapu Ge, MD; Lixiang Lin, MD; Li Chen, MD;Xiaohui Guo, MD., Zhigang Zhao, MD., Qiang Li, MD., Zhiguang Zhou, MD.,Guangliang Shan, MD, PhD., Jiang He, MD, PhD.(2012) Serum Lipids and Lipoproteins in Chinese Men and Women.American Heart Association, 125:2212-2221.
25.YanFeng Li, MD., Linda S. Geiss, MA., Nilka R. Burrows, MPH., Deborah B. Rolka, MS., Ann Albright, PhD.(2013). Awareness of Prediabetes — United States, 2005–2010.CDC MMWR,62(11).209—212.
26.Yong Hui Zhang., Wen Jun Ma1., G. Neil Thomas, Yan Jun Xu1, Xiang Qian Lao, Xiao Jun Xu1, Xiu Ling Song, Hao Feng Xu, Qiu Mao Cai, Liang 15.Xia, Shao Ping Nie, Hui Hong Deng, Ignatius Tak Sun Yu.(2012). Diabetes and Pre-Diabetes as Determined by Glycated Haemoglobin A1c and Glucose Levels in a Developing Southern Chinese Population. PLoS ONE :e37260,7(5),1-8.