第五章 討論
第三節 研究限制
本研究中盛行率估算依賴 ICD-9 診斷碼的存在，存在下列的限制 1. 醫師對 IC 的認知的差異，形成臨床上診斷的歧見，進而造成盛行 率的差異。2.病患未尋求醫療，由於 IC 目前尚無法根治，因而造成 病患對於醫療喪失信心，不願尋求健保體制下的醫療，轉而尋求另類 療法，此類病患的流失亦造成盛行率的差異。
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表 3-1 排除性疾病的相對應 ICD-9 碼
Diagnosis ICD-9 code
Bladder, urethral or ureteral calculi within 3 months of IC diagnosis
594.1, 592.0, 592.1, 592.9
Bacterial cystitis within 3 months of IC diagnosis
595.0
Prostate biopsy within 3 months of IC diagnosis
CPT 55700-55705
Augmentation cystoplasty or cystectomy CPT 51960, 51570, 51575, 51585, 51595, 51596, 51580, 51590
Urethral cancer 189.3, 188.5
Bladder cancer 595.89, 188.0-188.9, 198.1, 233.7, 239.4, 185, 198.82, 239.5
Prostate cancer 185, 198.82, 239.5
Uterine cancer, Cervical cancer 179, 180.0, 180.1, 180.8, 180.9, 182, 182.1, 182.8, 183.2-183.5, 183.8, 183.9
Vaginal cancer 184
Tuberculous cystitis 016.1
Urethral diverticulum 599.2
Urethral stricture 598.0, 598.01, 598.1, 598.2, 598.8, 598.9
Radiation cystitis 595.82
Spinal cord injury 952.00-952.09, 952.10-952.19, 952.2, 952.3, 952.8, 952.10
Neurogenic bladder 595.54, 344.61
Parkinson’s disease 332.0, 332.1, 333.0, 094.82 Multiple sclerosis 340, 341.0, 341.1, 341.8, 341.9
Stroke 436, 435.9, 997.02, V12.59
Spina bifida 741.0-741.3, 741.9, 756.17
Dementia 259.2, 290.0, 290.10-290.13, 290.20,
290.21, 290.3, 290.4-290.43, 290.9,
291.2, 293.9, 294.10, 294.11, 294.8,
295.9, 319, 331.0
表 3-1 排除性疾病的相對應 ICD-9 碼(續)
Diagnosis ICD-9 code
Paraplegia 344.1
Paralysis 344.9
Cerebral palsy 343, 343.0-343.4, 343.8, 343.9
Quadriplegia 344.00.-344.04, 344.09
Anuria 788.5
表 3-2 早期潛在 IC 疾病的相對應 ICD-9 碼
症狀 ICD-9
小便疼痛(dysuria) 788.1
膀胱過動(overactive bladder) 596.51
其他膀胱炎(unspecified cystitis) 595.9
慢性膀胱炎(chronic cystitis) 595.2
頻尿(frequency) 788.41
膀胱疼痛(bladder pain) 788.9
女性生殖器官有關之未明示徵候(unspecified symptoms associated with female genital organ)
625.8
女性生殖器官有關之徵候(specified symptoms associated with female genital organ)
625.9
表 4-1、IC 之每十萬人盛行率(門診+住院)( 1997-2006)
表 4-1、IC 之每十萬人盛行率(門診+住院)(1997-2006) (續)
表 4-1、IC 之每十萬人盛行率(門診+住院)(1997-2006) (續)
表 4-2、IC 之每十萬人發生率(門診+住院) (1998-2006)
表 4-3、IC 病患之平均年齡(1997-2006)
表 4-4、IC 新發生人數之累計及每十萬人盛行率(1997-2006)
表 4-4、IC 新發生人數之累計及每十萬人盛行率(1997-2006) (續)
16500-22800 520 39.3 218.62
24000-28800 86 6.5 145.09
表 4-5、IC 之盛行率和農業人口比例、平均家戸所得、都市化程度之相關性
Pearson Correlation coefficient
變項
coefficient
農業人口比例2
0.018
1(P=0.788)
平均家戶所得2
-0.055
1(P=0.407)
都市化程度
0.107
1(P=0.343)
註
1:為 Pearson Correlation coefficient
2
:農業人口、平均家戶所得均屬連續變項
表 4-6、IC 之相關費用(1997-2006)
門急診費用 63,080 110,523 266,460 360,455 257,590 290,890 353,900 692,426 575,918 856,253 382,749 55.51 33.62
住院費用 87,409 73,607 174,159 99,888 168,504 140,130 118,339 459,683 1,105,019 641,114 306,785 44.49 24.78
總費用 150,489 184,130 440,619 460,343 426,094 431,020 472,239 1,152,109 1,680,937 1,497,367 689,535 100 29.08
每人平均費用 5,788 2,593 3,582 2,290 2,243 2,477 2,207 4,861 8,120 6,869 4,103 — 1.92
表 4-7、IC 之基本特性雙變項分析(2002-2006)
表 4-7、IC 之基本特性雙變項分析(2002-2006) (續)
IC 疾病 非 IC 疾病 χ2 tes
變項名稱 N=805 % N=4025 % p-value
都市化程度 0.778
1 188 23.35 917 22.78 2 213 26.46 1071 26.61 3 129 16.02 585 14.53 4 50 6.21 321 7.98 5 97 12.05 480 11.93 6 52 6.46 277 6.88 7 49 6.09 257 6.39 8 27 3.35 116 2.88
其他 0 0 1 0.02
是否為低收入戶 0.101
是 9 1.12 24 0.6
否 796 98.88 4001 99.4
平均家戶所得 1
高所得醫療區 359 44.6 1796 44.62 中所得醫療區 401 49.81 2004 49.79 低所得醫療區 45 5.59 225 5.59
農業人口比例 0.982
高農業人口比例 73 9.07 365 9.07 中農業人口比例 365 45.34 1811 44.99 低農業人口比例 367 45.59 1849 45.94
表 4-8、早期潛在 IC 之症狀雙變項分析(2002-2006)
表 4-9、IC 之合併疾病雙變項分析(2002-2006)
表 4-9、IC 之合併疾病雙變項分析(2002-2006) (續)
IC 疾病 非 IC 疾病 χ2 tes
變項名稱 N=805 % N=4025 % p-value 合併疾病
類風濕關節炎 0.005
有 42 5.22 129 3.2 無 763 94.78 3896 96.8
紅斑性狼瘡 0.09
有 8 0.99 20 0.5 無 797 99.01 4005 99.5
乾燥症候群 0.186
有 13 1.61 43 1.07 無 792 98.39 3982 98.93
睡眠障礙 <0.0001
有 224 27.83 812 20.17 無 581 72.17 3213 79.83
表 4-10、IC 之羅吉斯迴歸分析(2002-2006) 16,500-22,800 0.0160 1.016 0.787 1.312 0.9023 24,000-28,000 -0.2112 0.810 0.551 1.189 0.2817 30,300-36,300 -0.0646 0.937 0.629 1.398 0.7511 38,200-45,800 -0.2494 0.779 0.514 1.181 0.2398 48,200-57,800 -0.3582 0.699 0.388 1.260 0.2336 60,800-72,800 0.1559 1.169 0.644 2.121 0.6082 76,500-87,600 -1.0892 0.336* 0.116 0.977 0.0451
附錄一 National Institute Of Diabetes And Digestive And Kidney Diseases (NIDDK) Diagnostic Criteria For Interstitial Cystitis
To be diagnosed with interstitial cystitis. Patients must have either glomerulations on cystoscopic examination or a classic Hunner’s ulcer, and they must have either pain associated with the bladder or urinary urgency. An examination for
glomerulations should be undertaken after distention of the bladder under anesthesia to 80- 100 cm of water pressure for 1 to 2 minutes. The bladder may be distended up to two limes before evaluation. The glomerulations must be
diffuse—present in at least 3 quadrants of the bladder— and there must be at least 10 glomerulations per quadrant. The glomerulations must not be along the path of the cystoscope to eliminate artifact from contact instrumentation). The presence of any one of the following may indicate interstitial cystitis:
1. Bladder capacity of greater than 350 cc on awake cystometry using either a gas or liquid filling medium.
2. Absence of an intense urge to id with 11w bladder tilled to 100 cc of gas o 150 cc of water during cystometry, using a fill rate of 30 to 100 cc/min.
3. The demonstration of phasic involuntary bladder
contractions on cystometry using the fill rate described above.
4. Duration of symptoms less than 9 months.
5. Absence of nocturia.
6. Symptoms relieved by antimicrobials, urinary antiseptics, anticholinergics, or antispasmodics.
7. A frequency of urination, while awake, of less than 8 times per day.
8. A diagnosis of bacterial cystitis or prostatitis within a 3-month period.
9. Bladder or ureteral calculi.
10. Active genital herpes.
11. Uterine, cervical, vaginal, or urethral cancer.
12. Urethral diverticulum.
13. Cyclophosphamide or any type of chemical cystitis.
14. Tuberculous cystitis.
15. Radiation cystitis.
16. Benign or malignant bladder tumors.
17. Vaginitis.
18. Age less than 18 years.
From Wein A, Hanno PM. et al: Interstitial cystitis: An
introduction to the Problem. In Hanno PM, Siaskin DR. Krane RJ, Wern AJ (eds): Interstitial Cystitis. London,
Springer-Verlag, 1990, pp 13-15.
附錄二 都市化程度之分級及所屬地區
附錄二 都市化程度之分級及所屬地區(續)
附錄三 IC 合併疾病之 ICD-9 對應碼
*乾燥症後群 710.2（乾燥症後群）(Sjögren's syndrome)
*睡眠障礙 780.50 （睡眠障礙） 780.52（失眠）
附錄四