研究目的:幽門螺旋桿菌感染目前在國內的感染率約為五成，是國人很普遍之症狀之一。幽門螺旋桿菌會導致胃潰瘍、胃炎、十二指腸潰瘍、胃癌以及胃部淋巴瘤。
本研究目的主要為國內目前對於早晚期進行除菌治療之醫療資源耗用之研究仍偏少，本研究希冀透過早期除菌的時機，探討後續醫療資源的使用情形。另外，癌症多年蟬聯國人死因第一位，欲透過幽門螺旋桿菌與大腸直腸癌之關聯，探討早期接受幽門螺旋桿菌除菌治療與罹患大腸直腸癌之風險關係。
研究方法:本研究採回溯性世代研究方式，利用國家衛生研究院之全民健康保險研究資料庫，2000年百萬人承保抽樣歸人檔次級資料分析之門診住院紀錄。選定於2000年至2005年間有被診斷為胃潰瘍且接受幽門螺旋桿菌(Helicobacter pylori ,H.p)治療之新個案。病患經診斷一年內接受治療為為早期殺菌；晚於一年治療則為晚期殺菌。進行短期、長期(一年、二年及四年)之平均門診次數及門住診醫療費用之分析。
利用Kaplan Meire survival curve繪出早殺菌與晚殺菌兩組十年累積風險圖。且利用Cox proportional Hazard Regression校正年齡、性別、共病、疾病嚴重度後，探討早殺菌及晚殺菌對於罹患結直腸癌之風險差異。而在醫療耗用及回診次數之分析，則利用多變量線性回歸(Multiple linear regression)校正共病(其他干擾因子:年齡、性別、共病)後，比較早殺菌及晚殺菌對於醫療耗用及就診次數有否統計上顯著差異。
結果:早期接受幽門螺旋桿菌除菌治療之病患，一年內及二年內平均回診次數有明顯降低。在平均醫療花費，早期接受幽門螺旋桿菌除菌治療之病患，一年內及二年內回診之平均醫療費用較晚期接受除菌有明顯降低；而住院之平均醫療費用則於二年內及四年內具顯著差異。平均回診次數在四年內無顯著差異；於平均醫療耗用上，門診在四年內之平均醫療費用以及住院一年內平均醫療費用均無顯著差異。且早晚期接受幽門螺旋桿菌除菌治療與罹患大腸直腸癌之風險無顯著相關性。
結論:本研究中早期進行幽門螺旋桿菌除菌治療與醫療資源間之耗用情形，早期接受除菌治療之平均回診次數較晚期接受除菌治療少，可證明有效降低醫療資源耗用的情形，可有效減少全民健保的掛號費、部分負擔費用。另，早期進行幽門螺旋桿菌除菌治療與罹患大腸直腸癌間之關聯性，於本研究中無顯著關係。可能與其他研究因診斷幽門螺旋桿菌之工具不同、研究設計上之差異性、偏頗、以及考量的干擾因子，以致於結果不一致。
根據本研究結果，基於預防保健、以及達到全民健保永續經營之理念，鼓勵患者即早接受幽門螺旋桿菌除菌治療，即可降低醫療資源耗用且降低健保費用支出，對於全民之健康利益，可謂一大福祉。
關鍵詞：幽門螺旋桿菌、大腸直腸癌、幽門螺旋桿菌除菌治療、醫療資源耗用

Objectives: Helicobacter pylori (H.p) infection is common in Taiwan, with approximately 50% of Taiwanese nationals infected. H.p causes gastric ulcer, gastritis, duodenal ulcer, gastric cancer, and gastric lymphoma.
The main objective of this study was to address the research gap in Taiwan on medical resource utilization for early and late antibacterial treatments. In addition, cancer has consistently been the leading cause of death in Taiwan for numerous years. Therefore, this study also aimed to determine the correlation between the early antibacterial treatment for H.p and the risk of developing colorectal cancer based on the relationship between this bacterium and cancer.
Methodology: This study employed a retrospective cohort design and secondary data analysis of outpatient and admission records from the 2000 Longitudinal Health Insurance Database obtained from the National Health Insurance (NHI) Research Database of the National Health Research Institutes, Taiwan. Patients that were newly diagnosed with gastric ulcer between 2000 and 2005 and were receiving treatment for H.p were selected. Patients receiving treatments within a year of diagnosis was defined as receiving early antibacterial treatment whereas those receiving treatment later than 1 year after diagnosis were considered as receiving late antibacterial treatment. An analysis was conducted on the mean number of clinical visits and medical expenses of patients in short and long term (1, 2, and 4 years) periods.
A 10-year cumulative risk chart of both early and late antibacterial treatment groups was generated using a Kaplan–Meier survival curve, and then the variables of age, sex, comorbidity, and severity of illness were controlled for by applying Cox proportional hazard regression to determine the differences in risk between early and late antibacterial treatment on developing colorectal cancer. In terms of medical resource utilization and the number of return visits, multiple linear regression was applied to control for comorbidities (other confounders such as age, sex, and comorbidities) in order to determine if early and late antibacterial treatments caused statistically significant differences.
Results: For patients that received early antibacterial treatment for H.p, the number of return visits within the first and second year was significantly lower than for those who received late treatment. In terms of mean medical expenses, the patients that received early antibacterial treatment spent considerably less on return visits within the first and second year than those who received late antibacterial treatment. Regarding the mean admission expenses, significant differences were observed within the period of 2–4 years. No significant differences were noted regarding the mean number of return visits within 4 years and the mean outpatient and admission expenses within 4 years and 1 year, respectively. Moreover, early or late antibacterial treatment for H.p was not significantly correlated with a risk of developing colorectal cancer.
Conclusion: This study revealed that early antibacterial treatment for H.p resulted in fewer return visits compared with late antibacterial treatment, which proved to be effective in lowering medical resource utilization, thus decreasing registration fees and copayments for the NHI. Additionally, in contrast to other studies, the results of this study did not indicate any significant correlation between early antibacterial treatment for H.p and the development of colorectal cancer. This inconsistency in results might have been caused by the use of different diagnostic tools for H.p, research design differences, research bias, and different confounders.
According to this study, on the basis of applying preventive health care to reduce NHI expenses and ensuring its sustainability, encouraging patients to receive early antibacterial treatment for H.p is recommended. This measure can lower medical resource utilization and reduce NHI expenses, which will bring substantial health benefits to the Taiwanese population.
Key Word: Helicobacter pylori、Colorectal Cancer、Helicobacter pylori eradication、Resources utilization

論文審定書 i
誌謝 ii
摘要 iii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 預期貢獻 3
第二章 文獻探討 4
第一節 幽門螺旋桿菌特性 4
第二節 幽門螺旋桿菌感染之診斷與治療 7
第三節 幽門螺旋桿菌與大腸直腸癌之關係 17
第四節 醫療資源之探討 21
第三章 研究方法 26
第一節 研究架構 26
第二節 研究假設 27
第四節 研究資料蒐集程序與變項操作型定義 30
第五節 統計分析方法 34
第四章 研究結果 36
第一節 研究個案描述性統計 36
第二節 推論性統計分析 39
第五章 結論與建議 46
第一節 研究討論 46
第二節 研究限制 51
第三節 結論與建議 52
參考文獻 53
附錄一 60

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衛生福利部中央健康保險署(2017 )。2015年 11月23日消化性潰瘍病人接受除菌
藥物治療比率(疾病別指標)。2018年 3月，取自
https://data.gov.tw/dataset/39218