第二章 文獻探討
第七節 飲食型態與減縮維度回歸分析
2004 年以前飲食型態分析常用之方法有兩種，第一種方式是根據 膳食建議來計算飲食品質分數 (diet-quality score)126-127 ，這是一種以 營養素為前提，將各類食物給分加總之方式，而非根據飲食攝取之數 據分析實際之飲食型態，所以飲食品質分數無法反應一般民眾飲食之 全 面 效 應 ； 第 二 種 方 式 是 常 用 於 營 養 流 行 病 學128推 導 飲 食 型 態 之 方 式 ： 因 素 分 析 (factor analysis) 之 主 成 分 分 析 (principal component analysis, PCA) ，但是 PCA 有時無法分析出一個可預測疾病發生與否 之飲食型態，於是 Kurt Hoffmann129-130等人於 2004 年提出另一個飲 食 型 態 之 統 計 方 式-- 減 縮 維 度 回 歸 分 析 (Reduced rank regression, RRR)，此法可以選擇反應疾病之專一性變項 ，例如面皰嚴重性，並 且找出最能解釋此反應變項之各種飲食項目攝取頻率之線性組合，即 飲食型態。至今已有十八篇文獻分別運用減縮維度回歸預測冠狀動脈 疾 病131、 第 二 型 糖 尿 病132、 發 炎 作 用133、 乳 癌134、 肥 胖135、代謝症候 群136等疾病風險之飲食型態，但是尚無使用減縮維度回歸來探討面皰 與飲食型態關係之研究。
表一、各種面皰病變之特徵
Acne lesion Size Color Pus Effect Comments
Whitehead Tiny Whitish No No pain, non-inflammatory Chronic whitehead is called milia Blackhead Tiny Black or brown No No pain, non-inflammatory Not dirt but black due to excess
oil and dead cells Papule 0.5 mm in diameter Pink No Warm and painful, inflammatory Very common Pustule 0.5 mm in diameter Red at the base
with a yellowish or a whitish center
Yes Warm and painful, inflammatory Very common
Nodule 5–10 mm in
diameter Pink and red No Warm and painful, inflammatory Nodule is similar to papule but is less common
Cysts More than 5 mm Red No but has
liquid inside Warm and painful, inflammatory Least common
表二、各種面皰分級量表，1956 年至 2008 年。
No. 面皰嚴重性量表 方法 參考文獻
1 Pillsbury DM, he First grading system.
G ade Description
Grade1 Comedones and occasional small cysts confined the face.
Grade2 Comedones with occasional pustul s and small cysts confined to th face
Grade3 Many comedones and small and large inflammatory papules and pustules, more extensive but confined to the face.
Grade4 Many comedones and deep lesions tending to coalesce and canalize, and involving the face and the upper aspects of the trunk.
Lesion counting.
Pillsbury DM et al.,1956.137
2 Grading system by James and Tisserand Grade Descripion
Grade 1 Simple non-inflammatory acne comedones and a few papules.
Grade 2 Comedones, pastules and a few pustules.
Grade 3
Larger inflammatory papules, pustules and a few cysts; a more severe form involving the face, neck and upper portions of the trunk.
Grade 4 More severe, with cysts becoming confluent.
Lesion counting.
Witkowski JA et al., 2004. 138
No. 面皰嚴重性量表 方法 參考文獻 3 Classification of acne severity on lesion counting of comedonal and papulopustular
per half face by Plewig and Kligman.
Grade Comedonal Papulopustular
1 Fewer than 10 comedones Fewer than 10 inflammatory lesions 2 Between 10 and 25 comedones Between 10 and 20 inflammatory lesions 3 Between 25 and 50 comedones Between 20 and 30 inflamm tory lesions 4 More than 50 comedones More than 30 inflammatory lesions
Lesion counting.
Witkowski JA et al., 2004. 139 4 Scale of acne severity based on percentage of reduction by Christiansen et al.
Scale Percentage of reduction Level 4 100 reduction Excellent 3 75–99% reduction Good 2 50–74% reduction Moderate 1 1–49% reduction Insufficient
0 Unchanged -1 Worse
Lesion counting.
No. 面皰嚴重性量表 方法 參考文獻 5 Severity index based on types of lesions by Michaelson et al..
Severity index Types of esion 0.5 Comedones
1 Papules
2 Pustules
3 Infiltrates 4 Cysts
Lesion counting.
Adityan B et al, 2009.
140
6 Acne grading method by Cook et al. using photographic standards
Grade Description
0 Up to small scattered comedones and/or small papules are allowed.
2 Very few pustules or three dozen papules and/or comedones; lesion are hardly visible from 2.5m away.
4 There are red lesions and inflammation to a significant degree; worth treating.
6 Loaded with comedones, numerous pustules; lesions are easily recognized at 2.5m.
8 Conglobata, sinus or cystic type acne; covering most of the face.
Photographic. Cook CH, et al, 1979.
141
No. 面皰嚴重性量表 方法 參考文獻 7 The degree of change and description by Samuelson.
The degree of change Description
Excellent There was a decrease of three or more grade numbers with reduced redness and tenderness.
Good There was a decrease of two grades with reduced redness and tenderness.
Moderate There was a decrease of one grade with reduced redness and tenderness.
None There was no change.
Worse There was an increase of one grade or more or an increase in redness or tenderness with the same grade.
Photographic. Witkowski JA et al., 2004. 142
No. 面皰嚴重性量表 方法 參考文獻
8 Lesion
counting.
Lucky A et al., 1996.143
No. 面皰嚴重性量表 方法 參考文獻 9 The Global Acne Grading System (GAGS) by Doshi et al.
Location Factor
(F) Severity(S) Local score
10 The grade based on a photographic standard
Body part Mild Moderate Severe
Photographic. O’Brian SC et al., 1998. 145
No. 面皰嚴重性量表 方法 參考文獻 11 面皰樣本調查的全球評估（IGA）標準
Grade Description
0 Clear skin with no inflammatory or noninflammatory lesions.
1 Almost clear; rare noninflammatory lesions with no more than one small inflammatory lesion.
2 Mild severity; greater than Grade 1; some noninflammatory lesions with no more than a few inflammatory lesions.
(papules/pustules only, no nodular lesions)
3 Moderate severity; greater than Grade 2; up to many noninflammatory lesions and may have some inflammatory lesions, but no more
than one small nodular lesion.
4 Severe; greater than Grade 3; up to many noninflammatory and inflammatory lesions, but no more than a few nodular lesions
lesion counting. 2005 年美國之 人體食品與藥 物健康管理局
146
No. 面皰嚴重性量表 方法 參考文獻 12 The grade based on a photographic standard and lesion counting
Total number of lesions Group
0–5 Mild 6–20 Moderate 21–50 Severe
>50 Very severe
Photograph and lesion counting.
Hayashi N, et al.,2008. 147
表三、青少年面皰盛行率之大型研究回顧 國家 樣本數 面皰評估量表 面皰盛行率
(%)
中等至嚴重程度
(%) 研究型態 參考文獻
China
(Hong Kong) 522 91.3 NR CB, Q Yeung et al., 2002. 148
Singapore 1,045 87.9 48.6 CB, Q Tan et al., 2007. 149
Iran 1,002 93.2 14.0 CB, Q, CE Ghodsi et al., 2009. 150
United Kingdom 317 49.8 21.5 SS, Q, CE Smithard et al., 2001. 151
Belgium 594 94.9 36.2 CB, Q, CE Nijsten et al., 2007. 152
Portugal 1,290 82.1 23.8 CB, Q, CE Amado et al., 2006. 153
Peru 1,857 44.1 19.2 CB, Q, CE Freyre et al., 1998. 154
New Zealand
(Auckland) 847 91.0 (male) 79.0 (female)
6.9 (male)
1.1 (female) CB, Q Lello J et al., 1995. 155
Australia 666 83.1 20.9 CB, Q, CE Kilkenny et al., 1998. 156 CB, community-based; CE, clinical examination; NR, not reported; Q, questionnaire; SS=single school.
表四、面皰與飲食相關性研究之回顧