第六章 結論與建議
6.2 研究限制
對於本研究，臨床醫師建議對於健康檢查的樣本數若能擴大至全國健檢資料，或許可以 得到一些與國外研究目前未發現的潛在危險性因子。對於醫學領域後續研究上也可採用 世代研究方式，以長時間固定追蹤某族群腦血管動脈粥狀硬化狀況與危險因子之間變化 關係，更能符合臨床所需。
在建立預測模型的過程中，有好幾個階段的處理會影響最後模型的正確率，包含資料收 集前置處理、變數選取、選用的預測方法、預測方法參數設定、推衍組及驗證組與訓練 組及測試組的樣本比重等。本研究的資料前置處理方式是將可判斷錯寫及遺漏的資料欄 位做刪除處理，但對於屬性中資料偏差大的少數資料並未做進一步處理，或許會導致雜 訊發生。
6.3 未來發展與建議
本研究在研究過程中希望能力求嚴謹，但受限於研究限制以及在研究過程中發現某些部 份尚有考慮不足、涵蓋不周地方。因此提供幾項建議供後續研究者注意及參考：
類神經網路的參數設定在過去文獻上並沒有明確的決定方式，在研究過程中發現，訓練 組有最佳的AUC，但測試組並不一定有最好的AUC，會有過度訓練的情形發生。因此，
建議後續研究者可使用決策樹、基因演算法或其他可找最佳化組合的演算法，來彌補本 研究不足之處。
腦血管動脈粥狀硬化的發生與腦血管疾病有很多的關聯，本研究的樣本是取健康檢查裡 的資訊，研究對象大都是健康的族群，異常的數值較少。故建議後續研究者可以針對腦 血管疾病患者的資料來做進一步的探討。
對於醫療領域若能找出因子與因子間或是因子與病症間關係是重要的。除了本研究的方
法外，若能先將資料用關聯性分析或集群分析來找出因子間的相關影響程度，再投入分 析研究，相信可以得到不錯的結果。
中文文獻
相關因子。物理治療物理治療物理治療物理治療，34，1， 53-64。
Alamowitch, S. (2001). Risk, causes, and prevention of ischaemic stroke in elderly patients with symptomatic internal-carotid-artery stenosis. Lancet, 357, 1154~1160.
Andersen, K. K., Olsen, T. S., Dehlendorff, C., & Kammersgaard, L. P. (2009). Hemorrhagic and ischemic strokes compared: stroke severity,mortality, and risk factors. Stroke, 40(6), 2068-2072.
Bamford, J., Sandercock, P., Dennis, M., Burn, J., & Warlow, C. (1991). Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet, 337, 1521-1526.
Barnett, H. J., Gunton, R. W., Eliasziw, M., Fleming, L., Sharpe, B., Gates, P., et al. (2000).
Causes and severity of ischemic stroke in patients with internal carotid artery stenosis.
JAMA, 283, 1429-1436.
Bell, T. A., Brown, J. M., Graham, M. J., Lemonidis, K. M., Crooke, R. M., & Rudel, L. L.
(2006). Liver-specific Inhibition of Acyl-coenzyme a: Cholesterol Acyltransferase 2 with Antisense Oligonucleotides Limits Atherosclerosis Development in
Apolipoprotein B100-only Low-density Lipoprotein Receptor-/- mice Arterioscler Thromb Vasc Biol, 26(8), 1814-1820.
Berndt, M. C., Shen, Y., Dopheide, S. M., Gardiner, E. E., & Andrews, R. K. (2001). The vascular biology of the glycoprotein Ib-IX-V complex. Thromb Haemost 86, 178-188.
Bogousslavsky, J., Melle, G. V., & Regli, F. (1988). The Lausanne Stroke Registry: analysis of 1000 consecutive patients with first stroke. Stroke, 19(1083-1092).
Chien, K. L., Sung, F. C., Hsu, H. C., Su, T. C., Lin, R. S., & Lee, Y. T. (2002).
Apolipoprotein A-I and B and Stroke Events in a Community-Based Cohort in Taiwan:
Report of the Chin-Shan Community Cardiovascular Study. Stroke, 33(1), 39-44.
Chu, J. Y., Chu, J. K., & Chung, A. G. (2006). Epidemiology of cerebrovascular disease among. Chinese-Canadians: A ten years retrospective. case-mix study. Neurology Asia, 11, 13-18.
Cooper, G. F., Abraham, V., Aliferis, C. F., Aronis, J. M., Buchanan, B. G., Caruana, R., et al.
(2005). Predicting Dire Outcomes of Patients with Community Acquired Pneumonia.
Biomedical Informatics, 38, 347-366.
Cubrilo-Turek, M. (2004). Stroke Risk Factors ： Recent Evidence and New Aspects.
International Congress Series, 1262, 466-469.
Dammerman, M., & Breslow, J. L. (1995). Genetic Basis of Lipoprotein Disorders.
Circulation 91, 505-512.
Do, S. R., Richardson, D., Hung, E., Brorson, J. R., Cruz-Flores, S., Felton III, W. L., et al.
(2006). Predictors of Recurrent Stroke in African Americans. Neurology, 67, 567-571.
Du, X., McNamee, R., & Cruickshank, K. (2000). Stroke Risk from Multiple Risk
FactorsCombined with Hypertension： A Primary Care Based Case-Control Study in a Defined Population of Northwest England Annals of Epidemiology, 10, 380-388.
Ebrahim, S., Sung, J., Song, Y. M., Ferrer, R., Lawlor, D. A., & Smith, G. D. (2006). Serum cholesterol, haemorrhagic stroke, ischaemic stroke,and myocardial infarction: Korean national health system prospective cohort study. British Medical Journal, 333(7557), 22-26.
Fatahzadeh, M., & Glick, M. (2006). Oral Medicine. Oral surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics, 102, 180-191.
Feigin, V. L., Lawes, C. M., Bennett, D. A., & Anderson, C. A. (2003). Stroke
Epidemiology：A Review of Poptlarion-Based Studies of Incidence, Prevalence, and Case-Fatality in the Late 20th Century. Lancet Neurology, 2, 43-53.
Gorelick, P. S., Sacco, R. L., Smith, D. B., Alberts, M., Mustone-Alexander, L., Rader, D., et al. (1999). Prevention of a First Stroke ： A Review of Guidelines and a
Multidisciplinary Consensus Statement From the National Stroke Association,.
Journal of the American Medical Association, 281, 1112-1120.
Gresele, P., & Agnelli, G. (2002). Novel approaches to the treatment of thrombosis. Trends
Pharmacol Sci, 23(1), 25-32.
Gulliford, S., Webb, S., Rowbottom , C. G., Corne, D. W., & Dearnaley, D. P. (2004). Use of Artificial Neural Networks to Predict Biological Outcomes for Patient Receiving Radical Radiotherapy of the Prostate. Radiotherapy and Oncology, 71, 3-12.
Hanley, J. A., & McNeil, B. J. (1982). The meaning and use of the area under a receiver operating characteristic (ROC) curve.
Haykin, S. S. (2009). Neural networks and learning machines: Prentice Hall.
Hillen, T., Cosholl, C., Tilling, K., Rude, A. G., McGovern, R., & Wolfe, C. A. ( 2003).
Cause of Stroke Recurrence Is Multifactorial: Patterns, Risk Factors and Outcomes of Stroke Recurrence in the South London Stroke Register. Stroke, 34, 1457-1463.
Howng, S. L., Hung, T. P., Kwan, A. L., & Lin, C. L. (1995). Intracranial aneurysm in Taiwan. J Formos Med Asso, 148(94), S73-S80.
Hu, H. H., Sheng, W. Y., & Chu, F. L. (1992). Incidence of stroke in Taiwan. Stroke, 23, 1237-1241.
Inzitari, D., Eliasziw, M., Gates, P., Sharpe, B. L., Chan, R. K., Meldrum, H. E., et al. (2000).
The causes and risk of stroke in patients with asymptomatic internal carotid artery stenosis. N Engl J Med, 342, 1693-1700.
Iso, H., Baba, S., Mannami, T., Sasaki, S., Okada, K., Konishi, M., et al. (2004). Alcohol Consumption and Risk of Stroke among Middle-aged Men: the JPHC Study Cohort I.
Stroke, 35(5), 124-129.
Iso, H., Moriyama, Y., Sato, S., Kitamura, A., Tanigawa, T., Yamagishi, K., et al. (2004).
SerumTotal Homocysteine Concentrations and Risk of Stroke and Its Subtypes in Japanese. Circulation, 109(22), 2766-2772.
Jood, K., Ladenvall, C., Rosengren, A., Blomstrand, C., & Jern, C. (2005). Family history in ischemic stroke before 70 years of age: the 90 Sahlgrenska Academy Study on Ischemic Stroke. Stroke, 36(7), 1383-1387.
Kaste, M., & Koivisto, P. (1988). Risk of Brain Infarction in Familial Hypercholesterolemia.
Stroke, 19(1097 - 1100).
Kelly, T. N., Gu, D., Chen, J., Huang, J. F., Chen, J. C., & Duan, X. (2008). Cigarette smoking and risk of stroke in the chinese adult. Stroke, 39(6), 1688-1693.
Khan, S. N., & Vohra, E. A. (2007). Risk factors for stroke: A hospital based study. Pakistan Journal of Medical Science 23(1), 17-22.
Kim, H. C., Nam, C. M., Jee, S. H., & Suh, I. (2005). Comparison of Blood
Pressure-Associated Risk of Intracerebral Hemorrhage and Subarachnoid Hemorrhage Korea Medical Insurance Corporation Study. Hypertension, 46(2), 393-397.
Kirshner, H. S. (2003). Medical Prevention of Stroke. Southern Medical Journal, 96, 354-358.
Kowalska, I., Prokop, J., & Bachorzewska-Gajewska, H. (2001). Disturbances of glucose metabolism in men referred for coronary arteriography. Postload glycemia as predictor for coronary atherosclerosis. Diabetes Care, 24, 897-901.
Kuivenhoven, J. A., Jukema, J. W., Zwinderman, A. H., Knijff, P., McPherson, R., Bruschke, A. V., et al. (1998). The Role of a Common Variant of the Cholesteryl EsterTransfer Protein Gene in the Progression of Coronary Atherosclerosis.The Regression Growth Evaluation Statin Study Group. N Engl J Med, 338(2), 86-93.
Lee, R. G., Kelley, K. L., Sawyer, J. K., Farese, R. V., Parks, J. S., & Rudel, L. L. (2004).
Plasma Cholesteryl Esters Provided by Lecithin: Cholesterol Acyltransferase and Acyl-coenzyme a: Cholesterol Acyltransferase 2 Have Opposite Atherosclerotic Potential. Circ Res, 95(10), 998-1004.
Loizou, C. P., Pattichis, C. S., Istepanian, R. S. H., Pantziaris, M., & Nicolaides, A. ( 2004).
“Atherosclerotic carotid plaque segmentation”, Engineering in Medicine and Biology Society, EMBS 2004. Paper presented at the 26th Annual International Conference.
Mark, H. Z., & Gregory, C. (1993). Receiver-Operating Characteristic (ROC) Plots: A Fundamental Evaluation Tool in Clinical Medicine. CLINICAL CHEMISTRY, 39(4), 561-577.
McGill, H. C., McMahan, C. A., Herderick, E. E., Zieske, Z. D., Malcom, G. T., Richard, E., et al. (2002). Obesity Accelerates the Progression of Coronary Atherosclerosis in Young Men. Circulation, 105, 2712-2718.
McMahan, C. A., Gidding, S. S., Malcom, G. T., Tracy, R. E., & Strong, J. P. (2006). McGill HC and Pathobiological Determinants of Atherosclerosis in Youth Research Group.
Pathobiological Determinants of Atherosclerosis in Youth Risk Scores Are Associated with Early and Advanced Atherosclerosis. Pediatrics, 118(4), 1447-1455.
Meigs, J. B., Larson, M. G., & D'Agostino, R. B. (2002). Coronary artery calcification in type 2 diabetes and insulin resistance. The Framingham offspring study , Diabetes Care, 25, 1313-1319.
Milionis, H. J., Liberopoulos, E., Goudevenos, J., Bairaktari, E. T., Seferiadis, K., & Elisaf, M.
S. (2005). Risk factors for first-ever acute ischemic non-embolic stroke in elderly individuals. International journal of cardiology, 99(2), 269-275.
Minelli, C., Lee, F. F., & Minelli, D. P. (2007). Stroke Incidence,Prognosis, 30-Day, and 1-Year Case Fatality Rates in Matão, Brazil: A Population-Based Prospective Study Stroke. Stroke, 38(11), 2906-2911.
Mukamal, K. J., Ascherio, A., Mittleman, M. A., Conigrave, K. M., Camargo, C. A., Kawachi, I., et al. (2005). Alcohol and Risk for Ischemic Stroke in Men: the Role of Drinking Patterns and Usual Beverage. Ann Intern Med, 142(1), 11-19.
Naghavi, M., Libby, P., Falk, E., Casscells, S. W., Litovsky, S., Rumberger J, B. J., Stefanadis C,, et al. (2003). From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: part I. Circulation, 108, 1664-1672.
P.K., Y., J.S., J., T.K., L., Y.C., C., & Z.S., H. (1997). Subtype of Ischemic Stroke. A Hospital-Based Stroke Registry in Taiwan (SCAN-IV). Stroke, 28, 2507-2512.
Pan, W. H., Bai, C. H., Chen, J. R., & Chiu, H. C. (1997). Associations between carotid atherosclerosis and high factor VIII activity, dyslipidemia, and hypertension. Stroke, 28, 88-94.
Redgrave, J. N., Lovett, J. K., Gallagher, P. J., & Rothwell, P. M. (2006). Histological assessment of 526 symptomatic carotid plaques in relation to the nature and timing of ischemic symptoms .The Oxford Plaque Study. Circulation(113), 2320-2328.
Ridker, P. M., Cushman, M., Stampfer, M. J., Tracy, R. P., & Hennekens, C. H. (1997).
Inflammation, Aspirin, and the Risk of Cardiovascular Disease in Apparently Healthy Men. N Engl J Med, 336(14), 973-979.
Rodgers, A., MacMahon, S., Yee, T., & Clark, T. (1998). Blood Pressure, Cholesterol and Stroke in Eastern Asia. Lancet, 352, 1801-1807.
Sacco, R. L. (2001). Extracranial carotid stenosis. N Engl J Med, 345, 1113-1118.
Santos-Garcia, G., Varela, G., Novoa, N., & Jimenez, M. F. (2004). Prediction of
Postoperative Morbidity after Lung Resection using an Artificial Neural Network Ensemble. Artificial Intelligence in Medicine, 30, 61-69.
Spagnoli, L. G., Mauriello, A., Sangiorgi, G., Fratoni, S., Bonanno, E., Schwartz, R. S., et al.
(2004). Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke. JAMA, 292, 1845-1852.
Steinberg, D. (1997). Oxidative Modification of LDL and Atherogenesis. Circulation, 95, 1062-1071.
Strong, J. P. (1991). The Nature History of Atherosclerosis. Ann N Y Acad Sci, 623, 9-15.
Su, T. C., Jeng, J. S., Chien, K. L., Sung, F. C., Hsu, H. C., & Lee, Y. T. (2001). Hypertension status is the major determinant of carotid atherosclerosis: A community-based study in Taiwan. Stroke, 32, 2265-2271.
Su, T. C., Lee, Y. T., Chou, S., Hwang, W. T., Chen, C. F., & Wang, J. D. (2006).
Twenty-four-hour ambulatory blood pressure and duration of hypertension as major determinants for intima-media thickness and atherosclerosis of carotid arteries.
Atherosclerosis, 184, 151-156.
Sun, Y., Lin, C. H., Lu, C. J., Yip, P. K., & Chen, R. C. (2002). Carotid atherosclerosis, intima media thickness and risk factors -an analysis of 1781 asymptomatic subjects in Taiwan. Atherosclerosis, 164, 89-94.
Swets, J. A. (1988). Measuring the accuracy of diagnostic systems. Science, 18, 229-235.
Tan, T. F., Tseng, M. C., & Chang, K. C. (2004). Risk factors for first-ever ischemic stroke: a hospital-based case-control study in Kaohsiung, Taiwan. Chang Gung Medical Journal, 27(11), 801-807.
Tomida, S., Hanai, T., Koma, N., Y., S., Kobayashi, T., & Honda, H. (2002). Artificial Neural Network Predictive Model for Allergic Disease Using Single Nucleotide
Polymorphisms Data. Bioscience Bioengineering, 93, 470-478.
Ueshima, H., Choudhury, S. R., Okayama, A., Hayakawa, T., Kita, Y., & Kadowaki, T.
(2004). Cigarette Smoking as a Risk Factor for Stroke Death in Japan. Stroke, 35(8), 1836-1841.
電子資料
亞太心臟學會大會（民100年5月14日）。uho優 活 健 康 網 。民100年5月30日，取自：
http://www.uho.com.tw/pantology.asp?year=2011&mon=5&id=404
醫療統計年報(98年版)。【資料檔】。台北：衛生署。
Framingham. (2006). Profile of the Framingham Heart Study. from http://www.framingham.com/heart/profile.htm
附錄一腦中風風險評估
以上資料來源：
D'Agostino, R.B., Wolf, P.A., Belanger, A.J., Kannel, W.B. "Stroke Risk Profile: The Framingham Study." Stroke, Vol. 25,, No. 1, pp.40-43, January 1994.
附錄二 腦中風危險因子篩選問卷
(01)有 (02)沒有 (03)不記得/不知道
(02)沒有吸超過 5 包（請跳至第 23 題回答）
(01)很大 (02)大 (03)普通 (04)小 (05)很小
三、對預防腦中風的相關知識
以下問題陳述是關於預防腦中風的知識，請就您所知道的來回答對或錯。
30、中風發生在左側大腦時，會引起右半身癱瘓。
(01)對 (02)錯 (03)不知道
31、家族中若有人得到中風，則其他家人得到中風的機會比別人大。
(01)對 (02)錯 (03)不知道
32、抽菸與肺癌有關，並不會增加發生腦中風的機率。
(01)對 (02)錯 (03)不知道
33、腦中風的發生與高血壓有關，與糖尿病無關。
(01)對 (02)錯 (03)不知道
34、為預防中風發生，年滿六十五歲以上的老年人，應每三年接受健康檢查一次。
(01)對 (02)錯 (03)不知道
35、當高血壓的情況穩定後，即可酌減藥物用量，以避免副作用。
(01)對 (02)錯 (03)不知道
36、為預防中風發生，宜多攝取富含飽和脂肪酸(如含豬油、牛油)的食物。
(01)對 (02)錯 (03)不知道
37、運動要夠激烈才能有效預防再次中風發生。
(01)對 (02)錯 (03)不知道
38、抽菸者為預防中風發生，可自行至藥房購買尼古丁貼劑或口香膠使用來有效戒菸。
(01)對 (02)錯 (03)不知道
39、天氣冷時，可鼓勵高血壓患者泡溫泉，以促進血液循環來避免腦中風的發生。
(01)對 (02)錯 (03)不知道
40、教育程度：
(01)國小以下 (02)國小 (03)國(初)中 (04)高中、高職 (05)大專 (06)研究所及以上
41、婚姻狀況：
(01)未婚 (02)已婚/同居 (03)離婚/分居 (04)喪偶