2015-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/645527摘要：結核病仍然是全球重要之傳染性疾病之一，在2013 年全球統計有九百萬名新增個案，並造成一百五十萬人死亡。但即使在全球持續推行都治計畫(DOTS)的治療計劃之下，全球發生率近年維持2% 左右的速度在下降中，仍然遠低於WHO 希望於2050 年免除結合為傳染性疾病的遠程目標。因此除了現行積極診斷及治療分針外，急需進一併根除結核病的方法。本研究的假說為門診醫療環境可為結核病傳播的場所，根據的原因有二：基於結核病的初期表現方式不一，全球研究均顯示自有臨床症狀至結核病被診斷平均需44-51 天，而此期間病人因不適就診，共同使用的門診環境即可能造成結核病的傳染。其二，在國科會贊助的本研究團隊前期研究(NSC101-2314-002-124)以台灣健保資料庫的研究發現：在校正既有疾病等危險因子後，使用門診頻率越高者，則有較高風險得到結核病。因此本研究案計畫以回溯性世代研究(cohort)，由已知台大醫院診斷之肺結核患者為指標個案，追蹤其於診斷前到訪之門診紀錄，以與指標個案同門診之其他暴露病人為cohort ，若於後續兩年內被診斷為結核病，則取其菌株與指標個案之菌株進行分子分型鑑定，若相同分子分型顯示有相同菌株，進一步分析cohort 中發病及未發病之危險因子分析。<br> Abstract: Tuberculosis (TB) remains a major global health challenge, with 9.0 million incident cases and 1.5million deaths in the world in 2013. However, the current trend of TB incidence revealed a slow decline of2% per year despite the implementation of directly observed treatment, short-course (DOTS) strategy. Thusbeyond active case detection and treatment, methods to interrupt disease transmission is also important.We hypothesis that healthcare environment a possible site for TB transmission. First, delay in TBdiagnosis is commonly observed worldwide, range from 44-51 days among studies in Taiwan, NorthAmerica and Australia. Our prior project (NSC 101-2314-002-124) revealed increased risk of active TBwith increased frequency of out-patient department (OPD) visiting, even after adjusting underlying diseases.Thus we aim to conduct a molecular epidemiology study via a retrospective cohort of TB exposedpatients in OPD. The index cases were the patients who diagnosed as pulmonary TB at a tertiary teachinghospital with culture available. The exposed cohort were patients who attend the same clinic with the indexcase, 3 month before TB diagnosis. The molecular typing from the index cases and subsequent TB casesamong the exposed cohort would be analyzed by mycobacterial interspersed repetitive unit -variablenumber tandem repeats (MIRU-VNTR) and spacer oligonucleotide genotyping. If cluster in the OPD settingis identified, we will further analysis the risk factors for acquiring active TB, including the host factors (e.g.age, underlying diseases, concurrent medication, et al) and environmental factors (e.g. out-patientdepartment categories and ventilation system)neuroblastomaNGFVEGFneuronal differentiation