2011-01-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646012摘要： 台灣過去四十年來的經濟起飛，工業的急速發展扮演了重要的角色，然而相伴而來的各種環境與職業病，卻一直被低估而忽略。引起心臟血管疾病的因子中，除了傳統的心血管危險因子(年齡、高血壓、糖尿病、高膽固醇等)外，而會增加心臟血管疾病的工作因素，則有心理社會因子，及工作相關因子等。爾來，過勞死的問題越來越被重視，然而由於心臟血管疾病之致病機轉相當複雜，環境職業因素與心臟血管疾病之致病關係不易確定。許多流行病學研究已證實工作相關因子與心臟血管疾病相關。然其各種不同之工作相關因子對心血管疾病的效應，目前仍不清楚。 本人希望能建立一已罹患冠狀動脈心臟病的職業研究世代，對目前尚不清楚的過勞死相關議題進行前瞻性的研究。我們將從台大醫院心臟內科邀請60歲以下，被診斷為急性心肌梗塞或經心導管檢查證實的嚴重冠狀動脈心臟病（左主要冠狀動脈，三條血管，或兩條以上血管且有包含左前降枝前段阻塞者），這些病人如果本來有固定工作者，參與本研究。我們將在第一年建立200 位病患，接著後續2年則每年有200位的病人納入本研究。同時從每年台大健康管理中心邀請年齡性別對照組200位(本來有固定工作者)，在第3年則完成總共1200位病人之收案。之後，全部追蹤到第4年。 這些病人將接受一系列的檢查及研究，包括了生物相關因子（血脂質，血糖，胰島素，口服葡萄糖耐量試驗，以及一些傳統及新興的心血管危險因子及遺傳因子），工作相關因子的評估（超時工作，輪班工作，工作特質：需求－控制－社會支持及付出－回饋不平衡的工作壓力問卷）。而非侵入性動脈硬化檢查，包括用顱外頸動脈及下肢動脈超音波評估動脈硬化。而主動脈硬度則用VP-1000來評估脈波傳導速率(Pulse wave velocity)，24小時心電圖監測檢查，及心電圖的T波型態 (T wave morphology)。上述檢查將被當作得病後之基礎值，與發病前之各種生物及工作相關因子做分析。後續則用來當做心臟血管疾病再發之危險因子。我們亦將邀請這些病患填寫生活品質問卷，包括一般問卷是採用世界衛生組織的生活品質問卷(WHOQOL-BREF)及疾病特殊問卷是採用心肌梗塞生活品質問卷第二版(QLMI-2)。住院當中之心導管結果，介入性治療及用藥，病人之心臟功能、心電圖及重要的臨床資料，亦將被記錄以為後續追蹤之預測指標。 這些病人將被安排在環境職業醫學部職業心臟病特別門診追蹤。短期將研究分析工作及生物相關因子，與其發生此次冠狀動脈心臟病的相關性。此外，工作及生物相關因子及住院的各項治療，與其復工是否有關，接著將繼續追蹤到第4年，希望評估工作因素是否與心臟血管疾病（冠心病，腦中風，及猝死等）事件發生相關。 <br> Abstract: Working factors have been associated with cardiovascular (CV) disease in epidemiological studies. However, the CV effects of work-related factors are still controversial. In this study, we will recruit patients below 60 years-old, having a formal work before this event and with newly onset AMI or angiography-documented severe coronary heart disease (CHD) from NTUH. Severe CHD was defined as left main disease, triple-vessel disease, or two-vessel disease with involvement of the proximal LAD. We will recruit 200 patients in the first year and 200 new patients every year in the following 2 years. Meanwhile, we will recruit 200 age- and gender-matched control subjects (have a formal work, and without CHD, stroke, CHF, or major diseases) every year from Health Management Center, NTUH. Thus, there will be 600 patients and 600 control subjects that mean 1200 subjects in total recruited for this cohort study at the end of third years. Then, each participant will be followed up to evaluate the possible roles of work-related factors and biological factors in CV events and the determinants of returning to work until the end of fourth year. This study is aimed to create a case-control designed cohort study and to study the possible role of work-related factors (including work and psychosocial stress) in CV events risk after controlling detailed biological factors. The rational use of this design is that these patients are at higher risk to develop CV disease and sudden death during the follow-up at the end of fourth year. The primary endpoint in this study has two aspects. One is the ability of return to work (short-term) and another is major cardiovascular events that are occurrence of myocardial infarction, stroke and cardiovascular mortality. The secondary outcomes are occurrence of cardiovascular events, defined as repeated percutaneous coronary artery intervention, receiving CABG, new onset of PAD, or admission for CHF in this study. The factors of biological, work-related, and psychosocial factors will be combined in the statistical analyses to determine whether these factors are the predictors of return to work and CV events in patients with AMI or severe CHD at the end of 4th year. We hope to demonstrate the association between work-related factors and CV disease, and then to develop a prevention strategy for working population.工作相關因子急性心肌梗塞冠狀動脈心臟病心臟血管疾病過勞死Work-related factorsacute myocardial infarctioncoronary diseasecardiovascular diseaseKaroshi