中國醫藥大學機構典藏 China Medical University Repository, Taiwan:Item 310903500/32416

全文

(1)ύ ୯ ᙴ ᛰ ε Ꮲ ᅺγᏢՏፕЎ ጓဦǺIEH-2051. Ѡ᡼Ӧ୔ᛰ‫ނ‬ᔲҔ‫ځ‬ᕉნᆶᒪ໺ӒᓀӢη ϐ௖૸ Environmental and Genetic Risk Factor of Drug Abuse in Taiwan. ‫܌‬. ձǺᕉნᙴᏢࣴ‫܌ز‬. ࡰᏤ௲௤ǺЦྷ࿰ ୋ௲௤ ᙔॕߙ շ౛௲௤. ύ. Ꮲ. ғǺഋॕ๭. Ꮲ. ဦǺ9765851. ๮. ҇. ୯. Yu-Ching Chen. ΐΜΐ ԃ. Ύ. Д.

(2) ठᖴ ਔӀࢬೳǴό‫ޕ‬ό᝺‫ٿ‬ԃ‫ޑ‬ᅺγᏢำς‫ډ‬Α‫׀‬ᖂǴӧ೭όߏόอ‫ޑ‬ ‫ٿ‬ԃӀ഍္Ǵ‫ך‬നགᖴ‫ࢂޑ‬ᙔॕߙԴৣᆶЦྷ࿰ԴৣǴԖΑ‫ٿ‬ՏԴৣ‫ޑ‬ धЈࡰᏤǴωᡣ೭ጇᅺγፕЎૈ୼ӵයֹԋǴߚதགᖴ‫ٿ‬ՏԴৣӧ‫ޑך‬ ᅺγғఱύ๏ϒ‫ך‬೚ӭ‫ࡰޑ‬ᏤᆶႴᓰǹགᖴᙔॕߙԴৣᕴࢂόჇ‫ޑྠځ‬ ௲Ꮴ‫ך‬Ǵഉ‫ך‬բჴᡍ‫ډ‬ъ‫ڹ‬Ǵᕴࢂᐟᓰ๱‫ך‬Ǵᡣ‫ך‬ёаԖ‫׳‬ε‫୏ޑ‬Κ۳ ߻ǴԖΑᙔԴৣ‫ޑ‬धЈࡰᏤᡣ‫ך‬᝺ளᅺγғఱᗨฅٌधࠅࡐॶளǹགᖴ Цྷ࿰ԴৣᕴࢂᜢЈ๱‫ך‬ǴόፕࢂᏢ཰ᗋࢂғࢲǴЦԴৣ൩Ⴝ‫ך‬ಃΒঁ ҆ᒃ΋૓Ǵᕴᡣ‫ך‬ག‫ߚډڙ‬தӭ‫ྕޑ‬ཪǴᡣ‫ך‬൩ᆉӧᏢਠΨႽӧৎ΋૓ ‫ޑ‬ԾӧǶૈள‫ٿډ‬ՏԴৣ‫ࡰޑ‬ᏤǴವόࢂ‫ך‬ΓғၸำύϺε‫ޑ‬ᅽ਻Ƕᗋ ाགᖴࢫίඁԴৣᆶ໳஖ྍԴৣǴ‫ٿ‬ՏԴৣόᜏٌമ‫ޑ‬ᏼҺ‫ޑך‬α၂‫ہ‬ ঩Ǵ٠๏ϒ೚ӭᝊ຦‫ޑ‬ཀ‫ـ‬ǴԖΑ‫ٿ‬ՏԴৣࡰ௲ᆶࡌ᝼Ǵωளаᡣ೭ጇ ፕЎૈ‫׳‬ᑪֹऍǶନԜϐѦǴᗋाགᖴֺᗶክଣߏჹ೭ጇፕЎ‫ޑ‬຤Јঅ ‫ׯ‬ǴԖΑֺଣߏ‫ޑ‬ҔЈωૈᡣ೭ጇፕЎ‫׳‬у‫ֹޑ‬᏾Ƕ ӧ‫ٿ‬ԃ‫ޑ‬ᅺγғఱύǴ۩ၮ‫ךޑ‬ၶ‫ډ‬Αғ‫ڮ‬ύ೚ӭ‫ޑ‬຦ΓǴᡣ‫ך‬ӧ ‫؃‬Ꮲၸำύό‫ൂې‬Ƕ२Ӄाགᖴ‫ޑ࠻زࣴࢂޑ‬٩⣬Ꮲ‫ۆ‬ǴགᖴᏢ‫ۆ‬ᕴࢂ ࡐԖऐЈ‫ޑ‬௲ᏤᎮ໌‫ךޑ‬Ǵջ٬Ꮲ‫ߚۆ‬தԆ࿛ǴϝࢂಒЈ‫ޑ‬ᔅշ‫ך‬ှ، ჴᡍᆶፕЎ฻εελλ‫ޑ‬ୢᚒǹགᖴᒤϦ࠻‫߷ޑ‬ᐇᏢ‫ۆ‬ᆶ޲ְǴᔅշ‫ך‬ ှ،ӧჴᡍᆶғࢲ΢‫ޑ‬ୢᚒǴ٠ਔਔ‫ޑ‬ᜢЈ‫ך‬ᆶႴᓰ‫ך‬ǹགᖴࣴ‫࠻ز‬ᖃ ܴզ߭‫ޑ‬Ꮲ‫ۑ–ॺۂ׌‬৒ǵӵ‫ٵ‬ǵΪ໋ǵࡘӼǴӧჴᡍᆶፕЎ΢๏‫ך‬೚ӭ ‫ޑ‬ᔅշǴаϷ‫϶ܻޑך‬ᆶӕᏢॺ-λྼǵߓᝊǵηసᆶѯզǴགᖴգॺ‫ޑ‬ ഉՔǴፓᏊ‫ך‬ғࢲύ‫ޑ‬ᆙ஭ᆶੲಕǴՔ‫ࡋך‬ၸ೚೚ӭӭ‫זޑ‬኷ᆶᜤၸǶ നࡕाགᖴ‫ޑך‬ৎΓ–ྭྭǵѪѪǵ༰༰ǵε‫ۆ‬ᆶΒ‫ۆ‬ǴᖴᖴѪѪᡏ ፊ‫ך‬Ӣࣁ‫ۺ‬ਜค‫ݤ‬ததӣৎྣ៝ྭྭǴགᖴ༰༰ᡏፊ‫ך‬ӢࣁቪፕЎค‫ݤ‬ ϩᏼৎύৎ୍ǴགᖴΒ‫ۆ‬ӧ‫ך‬Ԇ‫ܭ‬Ꮲ཰ਔᕴᔅԆϩᏼৎ୍Ǵགᖴε‫ۆ‬ӧ i.

(3) ‫ך‬ᅺγғఱύᜢЈ‫ޑך‬ғࢲᆶᏢ཰٠ᔅԆྣ៝ྭྭѪѪǴԖΑգॺ‫ޑ‬Ѝ ࡭Ǵ‫ך‬ωૈคࡕ៝ϐኁ‫ֹޑ‬ԋ‫ޑך‬Ꮲ཰Ƕ നࡕǴᗋࢂाӆ΋ԛ‫ޑ‬གᖴ‫ࡰޑך‬ᏤԴৣǴࣴ‫ޑ࠻ز‬უՔᆶ‫ܻޑך‬ ϶ǵৎΓǴགᖴգॺǼ. ii.

(4) ύЎᄔा Ҟ‫ޑ‬Ǻҁࣴ‫ز‬ЬाགྷाΑှቹៜᛰ‫ނ‬ᔲҔՉࣁ‫ޑ‬ᕉნᆶᒪ໺ӒᓀӢ ηǴӢԜࣴ‫ز‬ϩࣁ‫ঁٿ‬೽ҽ: (1)೸ၸୢ‫ڔ‬ፓࢗΑှቹៜѠ᡼Ӧ୔‫ڙ܄ت‬Ӊ Γ‫ځ‬ᛰ‫ނ‬ᔲҔՉࣁ‫ޑ‬ӒᓀӢηǴаࡌҥ‫ڙ܄ت‬ӉΓᛰ‫ނ‬ᔲҔ‫ޑ‬॥ᓀႣෳ ኳԄǴҔٰႣෳଯӒᓀ௼ဂᛰ‫ނ‬ᔲҔ‫ޑ‬॥ᓀǴ٠ගଯ‫ځ‬ჹᛰ‫ނ‬ᔲҔ॥ᓀ ‫ ޑ‬Ծ ᝺ Ǵ а 儁 ‫ ډ‬ٛ ‫ ޑ ݯ‬ਏ ݀ ; (2) ᅱ ෳ HIV-1 ໚ ‫ ܄‬஻ ‫ ځ ޣ‬COMT Val158Met ୷Ӣӭࠠ‫܄‬ᆶᛰ‫ނ‬ᔲҔՉࣁϐ࣬ᜢǴΑှ HIV ໚‫܄‬஻‫ځޣ‬ᛰ ‫ނ‬ᔲҔՉࣁ‫୷ڙ‬Ӣቹៜ‫ޑ‬ᐒ཮ԖӭεǴයఈ‫ډפ‬ᛰ‫ނ‬ᔲҔ‫ޑ‬ғ‫ނ‬኱૶բ ࣁᛰ‫ނ‬ᔲҔՉࣁ‫ޑ‬ᒪ໺ӒᓀӢηǶ Б‫ݤ‬Ǻҁࣴ‫ز‬ԏ໣ 2007 ԃԾѠ᡼ӚӦᅱ‫ڙ܄ت܌‬ӉΓ‫ޑ଺܌‬ᛰ‫ނ‬ᔲ Ҕ‫ޕ‬᛽ǵᄊࡋ‫ک‬ՉࣁϐӒᓀӢηԏ໣ϐፓࢗୢ‫ڔ‬ᆶύ୯ᙴᛰεᏢᔠᡍࣽ ϐ HIV-1 ໚‫܄‬஻‫ޣ‬ϐՈనኬҁǶࣴ‫( ز‬1)Ǵӧ‫ڙ܄ت‬ӉΓᛰ‫ނ‬ᔲҔ॥ᓀႣ ෳኳԄБय़Ǵࢂ٬Ҕ 2007 ԃѠ᡼ӚӦᅱ‫܌܌‬ԏ໣‫ڙ܄تޑ‬ӉΓϐୢ‫ڔ‬ၗ ਑Ǵаੰ‫ٯ‬ჹྣࣴ‫( ݤز‬case-control study) ௖૸ԋࣁᛰ‫ނ‬ᔲҔ‫ޑޣ‬Ӓᓀ ӢηǴ຾΋‫؁‬٬Ҕᡄᒠථ଑ᘜ (logistic regression) ࡌҥ॥ᓀႣෳኳԄǴ уᕴኳԄύ‫؂‬΋ঁᡂ໨‫ޑ‬ӒᓀჹКॶ (odds ratio, OR)ǴӆճҔ ROC curve (Receiver operating characteristic curve) ϩ‫݋‬຾Զள‫ډ‬ԋࣁᛰ‫ނ‬ᔲҔ ‫ ޣ‬॥ ᓀ ⸣ ॶ (Threshold) Ƕ ࣴ ‫( ز‬2) Ǵ HIV-1 ໚ ‫ ܄‬஻ ‫ ځ ޣ‬COMT Val158Met ୷Ӣӭࠠ‫܄‬ᆶᛰ‫ނ‬ᔲҔՉࣁϐ࣬ᜢ೽ϩǴࢂճҔύ୯ᙴᛰε Ꮲᔠᡍࣽϐ HIV-1 ໚‫܄‬஻‫ޣ‬ϐՈనኬҁǴ‫ ڗܜ‬DNA а PCR-RFLP ٰ բ COMTVal158Met ୷ Ӣ ӭ ࠠ ‫ ޑ ܄‬ղ ‫ ۓ‬Ǵ ٠ ϩ ‫ ݋‬ᛰ ‫ ނ‬ᔲ Ҕ Չ ࣁ ᆶ COMTVal158Met ୷Ӣӭࠠ‫࣬ޑ܄‬ᜢǴ٠຾΋‫؁‬а‫܄‬ձϩቫբϩ‫݋‬Ƕ ่݀Ǻ(1)‫ڙ܄ت‬ӉΓᛰ‫ނ‬ᔲҔ॥ᓀႣෳኳԄ: ኳԄύ‫ޑ‬ᡉ๱ӒᓀӢ ηӅԖ 8 ঁǴಃ΋ԛวғ‫܄‬Չࣁ‫ޑ‬ԃសᆶख़ᙟΕᅱࣁᛰ‫ނ‬ᔲҔ‫ޑ‬ՉࣁӒ iii.

(5) ᓀӢηǴᛰ‫ނ‬ᔲҔ‫ޣ‬Ԗၨ٫‫ޑ‬ᛰ‫ނ‬ᔲҔᇡ‫ޕ‬ǴԶߚᛰ‫ނ‬ᔲҔ‫߾ޣ‬Ԗၨ٫ ‫ޑ‬ᛰ‫ނ‬ᔲҔᄊࡋǶ຾΋‫؁‬٬Ҕ ROC curve ࡷᒧᕴӒᓀჹКॶ (Odds ratioǴ OR)ࣁ 9.665 ଺ࣁന፾྽‫ޑ‬॥ᓀ⸣ॶ(௵གࡋࣁ 83.9%Ǵ੝౦ࡋࣁ 69.3%)Ƕ (2) HIV-1 ໚‫܄‬஻‫ ځޣ‬COMT Val158Met ୷Ӣӭࠠ‫܄‬ᆶᛰ‫ނ‬ᔲҔՉࣁϐ ࣬ᜢ: COMT Val158Met ୷Ӣӭࠠ‫܄‬ჹᛰ‫ނ‬ᔲҔՉࣁӧ‫܄‬ձ΢Ԗόӕ‫ޑ‬ ቹៜำࡋǴ‫܄ت‬ᆶζ‫܄‬ᛰ‫ނ‬ᔲҔ‫ޣ‬ӧ COMT Val158Met ୷Ӣӭࠠ‫ޑ܄‬ᓎ ౗ϩѲ΢Ԗᡉ๱‫ޑ‬ৡ౦)‫!܄ت‬Val/Val % v.s ζ‫ ܄‬Val/Val %: 56.3 % v.s 28.6 %, P=0.049*Ƕ ᜢᗖӷǺᛰ‫ނ‬ᔲҔǵROC curveǵ॥ᓀႣෳኳԄǵCOMT. iv.

(6) Abstract ObjectiveǺ ǺThe main purposes of this study were to investigate the environmental and genetic risk factors associatied with drug abuse using two groups of study subjects. (1) We first conducted a questionnaire survey among male inmates to collect their practices, knowledge and attitude to predict factors association with drug abuse. Our prediction model can be used as a tool to predict now drug abuse we invoted in male inmates and to increase their self-awareness of drug abuse. (2) For the genetic risk factors of drug abuse, this study investigated the distribution of the COMT Val158Met polymorphism is associated with the drug abuse behavior among HIV positive patients. MethodsǺ We conducted survey for drug abuse risk factors using questionnaire among inmates with drug abuse and with nosuch. abuse at jails. in 2007 in Taiwan; and collected HIV-1 seropositive blood samples from HIV/AIDS outpatients in Taichung area. (1) Information on demographic factors, sexual and drug abuse practices, and knowledge and attitude of drug abuse were used to build up Drug Abuse Risk Prediction Model. We investigated risk factors of drug abuse using case-control study. The risk prediction model was established by logistic regression, and odds ratios for risk factors were measured. We then used ROC curve (receiver operating characteristic curve) to estimate drug abuse risk threshold. (2) In regarding COMT Val158Met genotype study, we collected HIV-1 seropositive blood samples in 2007-2009 from HIV-1 surveillance network .Genotypes were identified using PCR-RFLP. Chi-square was used to estimate to the v.

(7) association between COMT Val158Met genotypes and drug abuse among HIV positive patients. Ǻ (1) For the environmental risk factors of drug abuse : Result of ResultǺ the risk prediction among male inmates in Taiwan showed that “Age of first time having sex” and “Who repeatedly entry into prison” are drug abuse practices risk factors, and drug abuser had a better knowledge about drug abuse; non-drug abuser had a better attitude towards drug abuse. The overall OR of risk threshold value in male inmates was 9.665 (sensitivity: 0.839; specificity: 0.693). (2) For the genetic risk factors of drug abuse: Drug abusers and non-drug abuser were not significantly different in COMT Val158Met gene frequencies (P = 0.933) for HIV-1 patients. We found a significant gender difference in COMT Val158Met polymorphisms in HIV drug abusers. (Male in Val/ Val v.s Female in Val /Val: 56.3% v.s 28.6%, P = 0.049) KeywordsǺDrug abuseǵROC curveǵRisk prediction model.ǵCOMT. vi.

(8) Ҟᒵ ठᖴ ..............................................................................................................................................i ύЎᄔा ................................................................................................................................... iii Abstract ...................................................................................................................................... v Ҟᒵ .......................................................................................................................................... vii ߄Ҟᒵ ........................................................................................................................................ix კҞᒵ ......................................................................................................................................... x ಃ΋കǵᆣፕ ............................................................................................................................. 1 ಃ΋࿯ ࣴ‫ز‬ङඳϷ୏ᐒ ................................................................................................... 1 ಃΒ࿯ ࣴ‫ޑز‬ख़ा‫ ܄‬....................................................................................................... 4 ಃΟ࿯ ࣴ‫ز‬Ҟ‫ ޑ‬............................................................................................................... 6 ಃѤ࿯ Ӝຒࣚ‫ ۓ‬............................................................................................................... 8 ಃΒകǵЎ᝘௖૸ ................................................................................................................... 10 ಃ΋࿯ ᛰ‫ނ‬ᔲҔӄౚࢬՉ௃‫ ׎‬..................................................................................... 10 ಃΒ࿯ ᛰ‫ނ‬ᔲҔѠ᡼ࢬՉ௃‫ ׎‬..................................................................................... 12 ಃΟ࿯ ᛰ‫ނ‬ᔲҔϐቹៜ ................................................................................................. 14 ಃѤ࿯ ᛰ‫ނ‬ᔲҔᕉნӒᓀӢη௖૸ ............................................................................. 16 ಃϖ࿯ ᛰ‫ނ‬ᔲҔᆶᒪ໺Ӣη ......................................................................................... 19 ಃϤ࿯ ෧্ीฝ ............................................................................................................. 27 ಃΎ࿯ ੯ੰ॥ᓀႣෳኳԄ ............................................................................................. 30 ಃΖ࿯ ࣴ‫ࢎز‬ᄬᆶࣴ‫ࢬز‬ำ ......................................................................................... 32 ಃΟകǵࣴ‫ز‬Б‫ ݤ‬................................................................................................................... 35 ಃ΋࿯ ࣴ‫ز‬೛ी ............................................................................................................. 35 ಃΒ࿯ ࣴ‫ز‬ჹຝ ............................................................................................................. 38 ಃΟ࿯ ၗ਑ԏ໣ၸำ ..................................................................................................... 40 vii.

(9) ಃѤ࿯ ୢ‫ڔ‬ၗ਑಍ीᆶՈనኬҁϩ‫ ݋‬......................................................................... 42 ಃѤകǵࣴ‫ ่݀ز‬................................................................................................................... 48 ಃ΋࿯ ᛰ‫ނ‬ᔲҔϐ࣬ᜢᕉნӒᓀӢη ......................................................................... 48 ಃΒ࿯ ࡌҥᛰ‫ނ‬ᔲҔ‫ޣ‬ϐ॥ᓀႣෳኳԄ ..................................................................... 53 ಃΟ࿯ HIV-1 ໚‫܄‬஻‫ ޣ‬COMT Val158Met ୷Ӣӭࠠ‫܄‬ϐ᠘‫ ۓ‬.................................. 56 ಃϖകǵ૸ፕ ........................................................................................................................... 59 ಃϤകǵ่ፕᆶࡌ᝼ ............................................................................................................... 63 ಃ΋࿯ ่ፕ ..................................................................................................................... 63 ಃΒ࿯ ࣴ‫ز‬ज़‫ ڋ‬............................................................................................................. 64 ಃΟ࿯ ᔈҔᆶࡌ᝼ ......................................................................................................... 65 ୖԵЎ᝘ ................................................................................................................................... 66 ߕᒵǺୢ‫ ڔ‬............................................................................................................................... 96. viii.

(10) ߄Ҟᒵ ߄΋ǵ ‫ڙ܄ت‬ӉΓϐᛰ‫ނ‬ᔲҔ॥ᓀႣෳኳԄϐࣴ‫ز‬ჹຝٰྍϷΓኧ ............................. 81 ߄ΒǵHIV-1 ໚‫܄‬஻‫ ޣ‬COMT Val158Met ୷Ӣӭࠠ‫܄‬ᅱෳϐࣴ‫ز‬ჹຝΓኧ .................. 82 ߄Οǵࣴ‫ز‬ჹຝΓαᏢ୷ҁၗ਑ ........................................................................................... 83 ߄ѤǵԖคᛰ‫ނ‬ᔲҔ‫ޣ‬ϐՉࣁ‫ރ‬ᄊ ....................................................................................... 85 ߄ϖǵԖคᛰ‫ނ‬ᔲҔ‫ޣ‬ჹᛰ‫ނ‬ᔲҔ‫ޑ‬ᇡ‫ ޕ‬........................................................................... 87 ߄ϤǵԖคᛰ‫ނ‬ᔲҔ‫ޣ‬ჹᛰ‫ނ‬ᔲҔ‫ޑ‬ᄊࡋ ........................................................................... 88 ߄Ύǵࣴ‫ز‬ჹຝჹᛰ‫ނ‬ᔲҔ‫ޕޑ‬᛽ǵᄊࡋǵՉࣁϐᡄᒠථӣᘜϩ‫ ݋‬............................... 90 ߄Ζǵࣴ‫ز‬ჹຝ॥ᓀႣෳኳԄीϩБ‫ ݤ‬............................................................................... 91 ߄ΐǵԖคᛰ‫ނ‬ᔲҔՉࣁϐ HIV-1 ໚‫܄‬஻‫ ځޣ‬Val158Met ୷Ӣࠠᓎ౗ .......................... 92 ߄ΜǵКၨ‫ ܄ت‬HIV-1 ໚‫܄‬஻‫ځޣ‬ᛰ‫ނ‬ᔲҔՉࣁ‫ ځ‬Val158Met ୷Ӣࠠᓎ౗ৡ౦ .......... 93 ߄Μ΋ǵКၨζ‫ ܄‬HIV-1 ໚‫܄‬஻‫ځޣ‬ᛰ‫ނ‬ᔲҔՉࣁ‫ ځ‬Val158Met ୷Ӣࠠᓎ౗ৡ౦ ...... 93 ߄ΜΒǵКၨ HIV-1 ᛰ‫ނ‬ᔲҔ‫ ځޣ‬COMT Val158Met ୷Ӣࠠᓎ౗ӧ‫܄‬ձ΢ϐৡ౦..... 94 ߄ΜΟǵКၨ HIV-1 ߚᛰ‫ނ‬ᔲҔ‫ ځޣ‬COMT Val158Met ୷Ӣࠠᓎ౗ӧ‫܄‬ձ΢ϐৡ౦ ................................................................................................................................................... 94. ix.

(11) კҞᒵ ୖԵၗ਑კ 1: ᖄӝ୯ᛰࠔᆅ‫کڋ‬Ⴃٛҍ࿾࿿ 2009 ԃШࣚᛰ‫ނ‬ൔᏤ ...................... 11 ୖԵၗ਑კ 2:Ѡ᡼Ӧ୔ᔲҔᛰ‫ֿނ‬నᔠᡍ಍ीკ(88 ԃɴ99 ԃ 1 Д ....................... 13 ୖԵၗ਑კ 3:ӭЃữᆶѐҘ҅๝΢ဏનϐӝԋᆶжᖴ .............................................. 22 ୖԵၗ਑კ 4:ӭЃữ໺Ꮴᆶӆ֎ԏ .............................................................................. 23 ୖԵၗ਑კ 5:ӭЃữӧદ‫ރ‬ᡏ(Striaum)ᆶ߻ᚐယҜ፦(PFC)‫ޑ‬໺Ꮴ ....................... 24 ୖԵၗ਑კ 6:COMT ჹ‫ٽ‬ૡ⇌Ҙ୷ϯཷाკ:............................................................ 25 ୖԵၗ਑კ 7:COMT ϐ୷ӢՏ࿼ᆶᙯᒵ ..................................................................... 26 ୖԵၗ਑კ 8:‫ڙ܄ت‬ӉΓϐᛰ‫ނ‬ᔲҔ॥ᓀႣෳኳԄࡌҥ .......................................... 33 ୖԵၗ਑კ 9:HIV-1 ໚‫܄‬஻‫ ޣ‬COMT Val158Met ୷Ӣӭࠠ‫܄‬᠘‫ ۓ‬...................... 33 ୖԵၗ਑კ 10:ࣴ‫ࢬز‬ำკ ............................................................................................ 34 კ 1. ճҔ ROC curve ϩ‫݋‬ᛰ‫ނ‬ᔲҔ‫ޣ‬॥ᓀႣෳኳԄϐ॥ᓀ⸣ॶ. ......................... 95. x.

(12) ಃ΋കǵᆣፕ ಃ΋࿯ ࣴ‫ز‬ङඳϷ୏ᐒ Ѡ᡼Ӧ୔१ࠔᛰ‫ނ‬ᆅ౛ֽӧ҇୯ 99 ԃ 1 Д྽Д‫ޑ‬಍ीᡉҢǴᔲҔᛰ ‫ֿނ‬నᔠᡍᔠᡏᕴҹኧӅी 18,074 ҹǴᔠᡏ໚‫܄‬ኧࣁ 4,492(໚‫܄‬౗ 24.9 %)(1)ǶӚ୯ᛰ‫ނ‬ᔲҔ‫ޑ‬௃‫ݩ‬ᗨฅԖ‫܌‬ৡ౦Ǵՠӧ೭൳ΜԃٰǴӧԃᇸ௼ ဂύᛰ‫ނ‬ᔲҔ௃‫ݩ‬ຫٰຫᝄख़ΨຫٰຫӭኬϯǴ೭ኬ‫ޑ‬௃‫ݩ‬٬ளᛰ‫ނ‬ᔲ Ҕԋࣁӄౚᝄख़‫ޑ‬ϦӅፁғୢᚒǶӧᖄӝ୯ࢥࠔ‫ک‬ҍ࿾ୢᚒᒤ٣ೀ (United Nations Office for Drug Control, UNODC) 2009 ԃШࣚᛰ‫ނ‬ൔᏤ (World Drug Report, WDR) ࡰрӄౚҞ߻аεഞࣁന೏ቶ‫ݱ‬ᔲҔ‫ނޑ‬ ፦ǴӄౚऊԖѤϩϐΟ‫ޑ‬୯ৎԖੇࢶӢᔲҔ‫ޑ‬௃‫ݩ‬ǴӕਔΨԖΟϩϐΒ ୯ৎԖђ࢒ᡵᔲҔୢᚒ(2)Ƕᛰ‫ނ‬ᔲҔନΑ೷ԋҍ࿾౗΢ϲᆶኪΚ٣ҹቚу ѦǴ‫׳‬೷ԋӵΓᜪխࣝόӄੰࢥ (human immunodeficiency viruses, HIV) གࢉϷࡕϺխࣝલЮੱংဂ (acquired immunodeficiency syndrome, AIDS) ‫ݹط܈‬฻໺ࢉ੯ੰ‫ޑ‬౰Չ౗ቚуǴԶ೭٤੯ੰ‫ݯޑ‬ᕍΨ೷ԋᙴᕍၗྍό ‫ى‬Ǵ٠Ъቚу‫཮ޗ‬࿶ᔮԋҁǶ ᖄ ӝ ୯ ᛰ ࠔ ᆅ ‫ ک ڋ‬Ⴃ ٛ ҍ ࿾ ࿿ (United Nations Office for Drug Control and Crime Prevention, Studies on Drugs and Crime, UNODCCP) ‫ܭ‬ 2009 ԃ‫ޑ‬Шࣚᛰ‫ނ‬ൔᏤ಍ीၗ਑ᡉҢǴӄౚԃសӧ 15-64 ྃ‫ޑ‬ΓαऊԖ ‫ٿ‬ሹӧѐԃϣම࿶٬ҔၸࢥࠔǶӧ೭٤ම٬Ҕࢥࠔ‫ޑ‬ΓύǴऊԖ΋ሹϤ ί࿤Γࢂ٬ҔεഞǴΟίΖԭ࿤ࢂ٬ҔӼߚд‫ڮ‬ᜪ‫ޑ‬ᛰ‫ނ‬Ǵ΋ί‫ٿ‬ԭ࿤ ߾ࢂ٬Ҕ଎Єᛰ‫( ނ‬2)ǶӧᎻТᜪᛰ‫ނ‬٬Ҕ௃‫ݩ‬೽ҽǴ࣬ၨѐԃԖᡉ๱ቚ уǴεऊ΋ίϤԭ࿤Γ٬ҔǴԶ٥ࢪࢂЬाቚу‫୔ޑ‬ୱǶӧђ࢒ᡵ‫ޑ‬೽ ҽǴऊԖ΋ίΖԭ࿤Γ٬ҔǴΨࢂ΢ϲ‫ޑ‬ᖿ༈Ƕ2002 ԃ୯ሞഞᎈᛰࠔᆅ ౛ֽ‫ޑ‬ԃൔࡰрǴࢥࠔ‫ޑ‬Ьाᇙ೷ᎍ୧Ϸᙯၮઠӧܿࠄ٥ǴԶѠ᡼Տೀ 1.

(13) ٥ࢪኰફՏ࿼Ǵᎃ߈٥ࢪࢥࠔౢӦǴӧҬ೯ߡճ‫ޑ‬௃‫ݩ‬ΠǴࢥࠔёள‫܄‬ ၨଯǴԶ٬୯Γᎁ‫ࠔࢥڙ‬ವε࠶ુǶ Զ୯ϣᛰ‫ނ‬ᔲҔ‫ޑ‬ᅿᜪΨ΋‫ޔ‬ᒿ๱όӕ‫ޑ‬ԃжԶԖ‫ׯ܌‬ᡂǴ҇୯ϖ ΜԃжаᎻТࣁЬǴԶ҇୯ϖΜԃж‫ډ‬ΎΜԃж߾ᙯඤԋೲ፥நǵமΚ ጤǵआύǵқ݈ϷߙวࣁЬाᔲҔ‫ޑ‬ᛰ‫ނ‬Ǵ҇୯ΖΜԃж߾аҘ୷Ӽߚ д‫ڮ‬ᆶੇࢶӢ‫ޑ‬ᔲҔࣁЬǶԶ‫ډ‬Α҇୯ΐΜΟԃ୯ϣ‫ޑ‬಍ीᡉҢǴନΑ Ҙ ୷ Ӽ ߚ д ‫ ڮ‬ᆶ ੇ ࢶ Ӣ ‫ ޑ‬ᔲ Ҕ а Ѧ Ǵ འ ᓐ Τ (MDMA) ᆶ K д ‫ڮ‬ (Ketamine) ΨԖ೴ᅌ౰Չ‫ޑ‬ᖿ༈(3)Ƕ җጒᕇࢥࠔ಍ीᡉҢǴ҇୯ 92 Կ 98 ԃය໔ǴੇࢶӢࣁᐕԃጒᕇࢥ ࠔໆಃ΋ՏǴ‫ځ‬ԛࣁҘ୷Ӽߚд‫(ڮ‬1)Ƕ‫ځ‬ύੇࢶӢǵђ࢒ᡵ฻ᛰࠔǴନΑ ёճҔ֎१‫ޑ‬БԄѦǴࣣёҗᓉે‫ݙ‬৔ٰ٬ҔǴԶࢥࠔ‫ޑ‬ᓉે‫ݙ‬৔ନΑ ཮೷ԋࢥ᠅ѦǴ‫ځ‬ӅҔଞᓐ‫ޑ‬ՉࣁΨ཮٬΋٤੯ੰ‫ז‬ೲ‫ޑ‬ጭ‫ۯ‬Ǵ೷ԋϦ Ӆፁғ΢‫ુ࠶ޑ‬Ƕӧ 2003 Կ 2004 ԃ໔Ǵ‫ݙ‬৔ᛰ᠅‫( ޣ‬injecting drug users, IDUs) ໔ᛈว HIV-1 ࢬՉǴᏤठҁ୯ᝤ HIV-1 གࢉΓኧҗ 862 Γቚу Կ 1520 ΓǴӧ 2004 Կ 2005 ԃ໔ҁ୯ᝤ HIV-1 གࢉΓኧ‫׳‬΢ϲԿ 3399 ΓǴҗԜё‫ݙـ‬৔ᛰ᠅‫ ࣁޣ‬HIV Ьा‫ޑ‬Ӓᓀ௼ဂ(4)Ƕ ቹៜᛰ‫ނ‬ᔲҔ‫ޑ‬Ӣનх֖Αࡐӭቫय़(5)ǴӃ߻‫زࣴޑ‬ஒ೭٤ቫय़εठ ёᘜᜪԋঁΓǵৎ৥ᆶӕᏆ฻Бय़‫ޑ‬Ӣη(6)Ƕӧ୯ϣǴᛰ‫ނ‬ᔲҔ‫ޑ‬ԃស໘ ቫԖΠफ़‫ޑ‬ᖿ༈Ǵ୯ϣ΋ጇଞჹଯᙍᏢғ‫܌‬բ‫ࡰزࣴޑ‬рǴߙϿԃ٬Ҕ ᛰ‫ނ‬ԋ᠅‫ޑ‬ӒᓀӢηёϩࣁঁΓӒᓀӢηǵৎ৥ӒᓀӢηǵӕᏆӒᓀӢ ηǵᏢਠӒᓀӢηǵ‫୔ޗ‬ӒᓀӢη(7)Ƕ. Զ߈ԃٰ೚ӭࣴ‫ز‬ว౜୷Ӣᆶ੯ੰՉࣁϐ໔‫࣬ޑ‬ᜢ‫܄‬Ǵࣴ‫ࡰز‬р ႽࢂՎ΍Ⴅᆸᗂੱǵߓ૟ੇᓨੱϷ೽ϩᏤठ٢ᕎ‫ޑ‬চӢ೿ࢂᆶᒪ໺Ԗ࣬ 2.

(14) ᜢ‫(܄‬8)ǴԶନΑ੯ੰаѦǴԖ೽ϩ‫زࣴޑ‬Ψว౜ᒪ໺ӢηჹՉࣁ‫ޑ‬ቹៜǴ ୯Ѧ‫ޑ‬΋ঁаऍ୯‫܄ت‬ᚈझजࣁࣴ‫ز‬௼ဂǴ௖૸Ԝ௼ဂ‫ځ‬ᒪ໺Ӣηӧ‫ނ‬ ፦‫ޑ‬٬ҔǵᔲҔᆶ٩ᒘϐቹៜǴࣴ‫ز‬ว౜ᛰ‫ނ‬ᔲҔՉࣁᆶ٩ᒘᆶᒪ໺Ԗ ࣬ᜢ‫(܄‬9)Ǵӧќ΋ঁࣴ‫ز‬ᒪ໺Ӣηჹζ‫܄‬ᚈझजӧεഞ٬ҔǵᔲҔ‫܈‬٩ᒘ ‫ޑ‬ቹៜ‫ޑ‬Ў᝘Ψว౜ᜪ՟‫(่݀ޑ‬10)Ǵ‫׳‬Ԗ‫ځ‬дࣴ‫ز‬௖૸Ҙ୷शЧữ‫ޑ‬٬ Ҕ੯஻)ᔲҔǵ٩ᒘᆶᆒઓੰ*ᆶᒪ໺Ӣη‫࣬ޑ‬ᜢ‫܄‬ǴԖ‫س‬಍‫ޑ‬ѐϩ‫݋‬ё ૈᆶҘ୷शЧữ٬Ҕ੯஻Ԗᜢ‫୷ޑ‬Ӣӭࠠ‫(܄‬11)ǴҗԜё‫ـ‬ᒪ໺Ӣηӧ੯ ੰᆶՉࣁ‫ޑ‬ቹៜς࿶೏ቶ‫زࣴޑݱ‬Ƕ. Զᛰ‫ނ‬ᔲҔՉࣁԖ೽ϩࢂӢࣁᒪ໺ᆶᕉნӢηҬϕբҔ‫܌‬Ꮴठ‫ޑ‬Ǵ (12,13). ೚ӭࣴ‫ز‬೿ࡰрᒪ໺‫୷܈‬Ӣᆶᛰ‫ނ‬ᔲҔՉࣁϐ໔‫ڀ‬Ԗ࣬ᜢ‫( ܄‬14,15)ӧ. Ӄ߻‫زࣴޑ‬ύว౜ӭЃữ‫س‬಍ᆶ‫ނ‬፦ᔲҔᐒ‫ڋ‬Ԗᜢ(16)ǴӢԜӭЃữ‫س‬಍ ‫୷ޑ‬Ӣ೏ቶ‫زࣴޑݱ‬ǴΨբࣁ‫ނ‬፦ᔲҔᆶԋ᠅‫ޑ‬ংᒧ୷Ӣ(17)Ǵՠࣴ‫ޑز‬ ่݀ࠅࢂό΋ठ‫ޑ‬Ƕ‫ٽ‬ૡ⇌ữҘ୷ᙯ౽䁙 (catechol-omethyl transferaseǴ COMT) ߄౜ӧεတӭЃữઓ࿶ϡ‫୔ޑ‬ୱǴࣁफ़ှ‫ٽ‬ૡ⇌ữ‫ޑ‬΋ᅿ䁙(18)Ǵ ӕਔΨёаफ़ှӭЃữ(19)ǴΨӢԜ COMT ୷Ӣӭࠠ‫܄‬Ψӧ೚ӭԋ᠅‫ޑ‬ ࣴ‫ز‬ύ೏௖૸Ƕ. ᛰ‫ނ‬ᔲҔՉࣁࢂҗ೚ӭፄᚇ‫ޑ‬Ӣη‫܌‬೷ԋǴӢԜΑှᛰ‫ނ‬ᔲҔ‫ޑ‬ᕉ ნӒᓀӢηᆶ୷Ӣჹᛰ‫ނ‬ᔲҔՉࣁ‫ޑ‬ቹៜǴჹ‫ך‬୯ӧᛰ‫ނ‬ᔲҔ‫ޑ‬ႣٛБ य़ࢂࡐख़ा‫ޑ‬Ƕ. 3.

(15) ಃΒ࿯ ࣴ‫ޑز‬ख़ा‫܄‬ ӧѠ᡼ᛰ‫ނ‬ᔲҔՉࣁ‫ޑ‬ୢᚒВᖿᝄख़ǴӵՖԖਏ‫ޑ‬Ⴃٛᛰ‫ނ‬ᔲҔՉ ࣁࢂࡐख़ा‫ޑ‬ǴฅԶӧࣴᔕрԖਏ‫ޑ‬Ⴃٛ฼ౣ߻Ǵ໪ૈ୼ඓඝᛰ‫ނ‬ᔲҔ ‫ޑ‬ӒᓀӢηǴԶቹៜᛰ‫ނ‬ᔲҔ‫ޑ‬ӒᓀηӢηёϩࣁᕉნӒᓀӢηᆶঁΓ ӒᓀӢηǴ໪ӕਔଞჹᕉნᆶঁΓӧᛰ‫ނ‬ᔲҔӒᓀӢη‫܌‬ቹៜ‫ޑ‬ำࡋǴ ωૈଞჹᛰ‫ނ‬ᔲҔ‫ޑ‬চӢѐ๱Ћᛰ‫ނ‬ᔲҔ‫ޑ‬ႣٛǶ. ӧӃ߻‫زࣴޑ‬ύԖࣴ‫ޣز‬а‫ݙ‬৔ᛰ᠅‫ޣ‬ჹགࢉ HIV-1 ‫ޕޑ‬᛽ǵᄊ ࡋǵՉࣁϐၗ਑Ǵϩ‫݋‬р‫ݙ‬৔ᛰ᠅‫ޣ‬གࢉ HIV-1 ‫ޑ‬ӒᓀӢηǴ຾Զว৖ р‫ݙ‬৔ᛰ᠅‫ޣ‬གࢉ HIV-1 ‫ޑ‬॥ᓀႣෳኳԄǴԶԜኳԄΨԖόᒱ‫௵ޑ‬གࡋ ၟ੝౦ࡋ(20)ǶԶҞ߻ӧѠ᡼ᛰ‫ނ‬ᔲҔࢂឦ‫ܭ‬ҍ࿾ՉࣁǴ‫ॺך‬ёᙖҗᅱෳ Ѡ᡼Ӧ୔ᅱ‫܌‬ύ‫ڙ܄ت‬ӉΓჹᛰ‫ނ‬ᔲҔ‫ޑ‬ӒᓀӢηǴٰࡌҥᛰ‫ނ‬ᔲҔ॥ ᓀႣෳኳԄǴёගϲଯӒᓀ௼ဂ‫ޑ‬Ӓᐒཀ᛽Ǵ຾Զ‫ׯ‬ᡂ‫ځ‬Ծ‫ޑي‬Չࣁǹ ӆ‫ޣ‬ǴԜ॥ᓀႣෳኳԄ‫ࡌޑ‬ҥБ‫ݤ‬ёᔈҔ‫ځܭ‬д୯ৎ‫܈‬੯ੰύǴаճղ ᘐ҇౲ӧᛰ‫ނ‬ᔲҔ‫ޑ‬॥ᓀǴ٠ёග‫ٮ‬๏ࡹ۬࣬ᜢᐒᜢว৖ᛰ‫ނ‬ᔲҔ‫ޑ‬ٛ ‫ݯ‬฼ౣǴ٠ଞჹଯӒᓀ௼ဂᛰ‫ނ‬ᔲҔ‫ޑ‬ӒᓀӢηٰ຾Չፁ௲࠹ᏤǶନԜ ϐѦǴԜᛰ‫ނ‬ᔲҔ॥ᓀႣෳኳԄ‫ࡌޑ‬ҥǴ҂ٰΨёၮҔӧཥΕᅱ‫܄تޑ‬ ‫ڙ‬ӉΓӧᛰ‫ނ‬ᔲҔ‫ޑ‬ᑔᔠ΢Ǵ೸ၸԜኳԄ‫ޑ‬ᑔᔠǴନΑёаቚу‫ڙ‬ӉΓ ҁ‫ي‬ჹᛰ‫ނ‬ᔲҔ‫ޑ‬Ծ‫ך‬᝾᝺ǴΨૈ୼а‫׳‬࿶ᔮᙁܰ‫ޑ‬БԄѐբᛰ‫ނ‬ᔲҔ ॥ᓀ‫ޑ‬ᔠෳǶ. ฅԶᏃᆅᛰ‫ނ‬ᔲҔ࣬ᜢ‫ޕޑ‬᛽ǵᄊࡋǵՉࣁࣁᛰ‫ނ‬ᔲҔ‫ޑ‬ӒᓀӢηǴ ՠᛰ‫ނ‬ᔲҔՉࣁࠅค‫ֹݤ‬ӄа‫ޕ‬᛽ǵᄊࡋǵՉࣁٰբှញǶԶӧӃ߻‫ޑ‬ ࣴ‫ز‬ගрΑ୷ӢᆶՉࣁϐ໔‫࣬ޑ‬ᜢ‫܄‬Ǵё࣮рᒪ໺ӢηΨଅ᝘ჹՉࣁ‫ޑ‬ ቹៜǶӢԜࣁΑૈ୼ֹ᏾‫ޑ‬ѐϩ‫݋‬ᛰ‫ނ‬ᔲҔ‫ޑ‬ӒᓀӢηǴନΑϩ‫݋‬ᛰ‫ނ‬ 4.

(16) ᔲҔ‫ޑ‬ᕉნӒᓀӢηѦǴҁࣴ‫ز‬Ψ‫׆‬ఈёаᙖҗჹᛰ‫ނ‬ᔲҔ‫ޣ‬ᒪ໺୷Ӣ ‫ޑ‬ϩ‫݋‬ǴٰΑှ୷Ӣჹᛰ‫ނ‬ᔲҔՉࣁ‫ޑ‬ቹៜำࡋǶҁࣴ‫ز‬ᒧ‫ ڗ‬COMT ྽ բ΋ᅿ biomaker ٰΑှ HIV ໚‫܄‬஻‫ځޣ‬ᛰ‫ނ‬ᔲҔՉࣁ‫୷ڙ‬Ӣቹៜ‫ޑ‬ ᐒ཮ԖӭεǴ‫่݀زࣴځ‬҂ٰයఈૈၮҔӧᒪ໺Ӣηჹᛰ‫ނ‬ᔲҔ‫ޑ‬ቹ ៜǴ຾Զᔕ‫ۓ‬ӝ፾‫ޑ‬Ⴃٛ฼ౣǶ. 5.

(17) ಃΟ࿯ ࣴ‫ز‬Ҟ‫ޑ‬ ᠙‫ܭ‬౜Ӹࢥࠔ‫ޑ‬όᘐബཥǴаϷ୯Γࢥࠔ֎१Γαԃᇸϯǵᅿᜪӭ ኬϯǵ֎१БԄፄᚇϯ฻౜ຝǴς٬Ҟ߻୯ϣᛰ‫ނ‬ᔲҔ‫ޑ‬Ⴃٛ฼ౣय़ᖏ ᖑᜤ‫ࡷޑ‬ᏯǶ‫ډ‬Ҟ߻ࣁЗǴ‫؂‬ԃᛰ‫ނ‬ᔲҔΓኧόᘐᚹϲ(1)ǴࣁΑᕕှ୯Γ ᛰ‫ނ‬ᔲҔԋ᠅௃‫׎‬Ǵ٠‫׆‬ఈԖਏ‫ޑ‬෧጗ᛰ‫ނ‬ᔲҔԋ᠅ΓኧǴаϷफ़եࡹ ۬ӧᛰ‫ނ‬ᔲҔԋ᠅‫ݯ‬ᕍ‫࣬ޑ‬ᜢᙴᕍ࿶຤ᆶ‫ॄ཮ޗ‬ᏼǴҁࣴ‫ز‬ճҔϩηࢬ ՉੰᏢ‫ޑ‬Б‫ݤ‬ϩձଞჹᛰ‫ނ‬ᔲҔӒᓀӢηᆶ COMT Val158Met ୷Ӣӭ ࠠ‫܄‬ჹ HIV ஻‫ޣ‬ύჹᛰ‫ނ‬ᔲҔՉࣁ‫ޑ‬ቹៜ‫ঁٿ‬೽ϩ຾Չࣴ‫ز‬Ƕ. ࡺҁࣴ‫زࣴޑز‬Ҟ‫ޑ‬ԖΒǺ Ҟ‫ޑ‬΋Ǵᙖҗԏ໣Ѡ᡼ӚӦ୔ᅱ‫܌‬ϣᛰ‫ނ‬ᔲҔ‫ޑޣ‬ୢ‫ڔ‬ၗ਑Ǵٰ຾ Չੰ‫ٯ‬ჹྣࣴ‫( ز‬case-control study)Ǵа௖૸ԜଯӒᓀ௼ဂ‫ޑ‬ӒᓀӢηǴ ٠຾΋‫ࡌ؁‬ҥᛰ‫ނ‬ᔲҔԋ᠅‫ޑ‬॥ᓀႣෳኳԄǴаղᘐԜΓԖคԋࣁᛰ‫ނ‬ ᔲҔԋ᠅‫ޑޣ‬॥ᓀǶԜ॥ᓀႣෳኳԄё଺ࣁԾ‫ך‬॥ᓀຑ՗ໆ߄аቚуଯ Ӓᓀ௼ဂ‫ޑ‬Ծ‫ך‬᝾᝺‫( ܄‬self-awareness)Ǵයఈёа෧጗ᛰ‫ނ‬ᔲҔԋ᠅Γ ኧ٠फ़եᛰ‫ނ‬ᔲҔԋ᠅‫ݯ‬ᕍᆶ࣬ᜢԋҁǶ‫زࣴځ‬Б‫׆ݤ‬ఈճҔ॥ᓀᆅ౛ (risk management) ،฼ϩ‫݋‬ϐ‫؁‬ᡯǴԖ‫س‬಍‫ࡌޑ܄‬ҥឦ‫ܭ‬Ѡ᡼όӕᛰ‫ނ‬ ᔲҔ௼ဂϐᛰ‫ނ‬ᔲҔԋ᠅‫ޑ‬ႣෳኳԄǶ҂ٰ‫׆‬ఈёаճҔ‫ࡌ܌‬ҥϐᛰ‫ނ‬ ᔲҔ॥ᓀႣෳኳԄǴаጕ΢‫ޑ‬БԄว৖຾Զຑ՗ϟΕ௲‫ػ‬ჹ‫ܭ‬୯Γӧᛰ ‫ނ‬ᔲҔ‫ޕޑ‬᛽ǵᄊࡋᆶՉࣁ‫ޑ‬ԋਏǶ. Ҟ‫ޑ‬ΒǴᛰ‫ނ‬ᔲҔ‫ࣁޣ‬གࢉ HIV ‫ޑ‬ଯӒᓀဂǴԶନΑ௖૸ᕉნӢη аѦǴ‫ځ‬ᒪ໺ӢηΨࢂ‫ת‬ᄽख़ा‫فޑ‬ՅǴࣁΑᕕှ HIV ஻‫ޣ‬ѐ௖૸ COMT Val158Met ୷Ӣӭࠠ‫܄‬ჹԜ௼ဂӧᛰ‫ނ‬ᔲҔ‫ޑ‬ቹៜǴࣴ‫ز‬ύஒԏ ‫ڗ‬ύ୯ᙴᛰεᏢߕ೛ᙴଣύ HIV-1 ໚‫ੰ܄‬஻‫ޑ‬Ոనኬҁ຾ՉፓࢗǴаள 6.

(18) ‫ޕ‬Ǻ (΋) HIV-1 ໚‫ੰ܄‬஻୷ҁၗ਑ϩ‫݋‬ (Β) HIV-1 ໚‫ੰ܄‬஻ύԖคᛰ‫ނ‬ᔲҔՉࣁ‫ځ‬ᆶ COMT Val158Met ୷Ӣӭࠠ‫ޑ܄‬ᓎ౗ϩթ (Ο) HIV-1 ໚‫ੰ܄‬஻Ԗคᛰ‫ނ‬ᔲҔՉࣁ‫ځ‬ᆶ COMT Val158Met ୷ Ӣӭࠠ‫ޑ܄‬ᓎ౗ϩթӧ‫܄‬ձ΢‫ޑ‬ৡ౦. 7.

(19) ಃѤ࿯ Ӝຒࣚ‫ۓ‬ ΋ǵġ. ᛰ‫ނ‬ᔲҔ:. ਥᏵ୯ሞ੯ੰϩᜪಃΜ‫( ހ‬ICD-10) ჹ‫ܭ‬ᛰ‫ނ‬ᔲҔ‫ۓޑ‬ကӅԖϤ ᗺǴऩҁ‫ي‬ӧၸѐ൳ԃԖΠӈΟᗺȐ֖ȑа΢‫ޑ‬௃‫ݩ‬Ǵ߾ж߄ჹ‫ܭ‬Ԝ‫ނ‬ ፦Ԗ٩ᒘ‫( ܄‬dependence)(21): (΋) மਗ਼‫ޑ‬෰ఈ‫܈‬மॐ٬Ҕᛰ‫ޑނ‬ՉࣁǶ (Β) Ծ‫ך‬ค‫ݤ‬௓‫ڋ‬ኩଶǵύᘐǵಖЗᛰ‫ܺޑނ‬ҔՉࣁǶ (Ο) ྽ଶЗܺҔᛰ‫ނ‬ਔ཮ౢғ‫י‬ᘐੱ‫( ރ‬withdrawal symptoms)Ƕ‫܌‬ᒏ‫יޑ‬ ᘐੱ‫ࣁރ‬྽֎ࢥ‫ޣ‬΋ӆख़ፄ٬Ҕ΋ᅿ‫܈‬ӭᅿᛰ‫ނ‬Ǵᅌᅌ‫׎‬ԋғ౛٩ᛰ ‫܄‬Ƕ΋ѿᛰ‫׫ނ‬ᆶಖЗ‫܈‬෧ϿਔǴ‫܌‬ౢғϐߚதขចǵཱུࡋόӼϐ‫ي‬ ᡏੱ‫ރ‬ǴЪԖமਗ਼ሡाܺҔᛰ‫ނ‬ϐኅఈǶ (Ѥ) ऐ‫( ࡋڙ‬tolerance)Ǻ‫׆‬ఈቚуᛰ‫ޑނ‬٬Ҕໆа‫؃‬ளᅈ‫ى‬ǹฅԶǴᝩុ ٬Ҕӕኬ‫ޑ‬ᛰໆǴ཮ౢғᅈ‫ޑى‬ਏҔሀ෧Ƕ (ϖ) ᒿ๱ᛰ‫ޑނ‬٬Ҕਔ໔ຫߏǴ‫ځ‬ᛰ‫ނ‬ᅈ‫ى‬ਏҔ཮ሀ෧ǴӢԜԋ᠅‫཮ޣ‬ቚ уᛰ‫ނ‬٬Ҕ‫ޑ‬ԛኧϷҔໆςၲ‫࣬ډ‬ӕ‫ޑ‬ਏ݀Ƕ (Ϥ) ࡭ុ‫ޑ‬٬Ҕᛰ‫཮ނ‬೷ԋᝄख़‫ޑ‬໾্Ǵ‫ٯ‬ӵǺЈ౛Ϸᆒઓ΢‫ޑ‬ᓸ‫׭‬ǵᇡ ‫ޕ‬фૈ‫ޑ‬ཞ໾ǵঁΓ଼நǴቹៜ‫཮ޗځ‬ᆶᙍ཰፾ᔈ฻໾্Ƕ Βǵġ. ൂ΋ਡ㧿ለӭࠠ‫( ܄‬single nucleotide polymorphism, SNP):. DNA ‫ׇ‬ӈύ‫ൂޑ‬΋ᡵ୷ჹ (base pair)ᡂ౦ǴӢԶ೷ԋ DNA ‫ׇ‬ӈӭ ᄊ‫܄‬ǶࣁΓᜪёᒪ໺‫ޑ‬ᡂ౦ύനத‫ޑـ‬΋ᅿǴSNP ౢғᐒ౗ࣁ 1/1000Ǵ ӧΓᜪ୷Ӣಔύቶ‫ݱ‬ӸӧǴѳ֡‫ ؂‬300ɴ1000 ঁᡵ୷ჹύ൩Ԗ 1 ঁǴ՗ ी‫ځ‬ᕴኧёၲ 300 ࿤ঁࣗԿ‫׳‬ӭǶ. 8.

(20) Οǵġ. HIV (Γᜪխࣝόӄੰࢥǹང෷ੰࢥ)Ǻ. ࢂ΋ᅿ‫װ‬ᔐ T4 ಒझ‫ޑ‬ཥϸᙯᒵੰࢥ (retrovirus)Ǵ‫ ܭ‬1983 ԃҗ Barre-Sinoussi ฻Γӧ‫ݤ‬୯ЃᎿவᑡ஻ AIDS ‫تޑ‬ӕ‫܄‬ᠰੰ஻‫ޑ‬ՈనϷ రЃ่ᔠᡏύϩᚆрٰ(22)Ƕ HIV Ьाёϩࣁ HIV-1 Ϸ HIV-2 ‫ࠠٿ‬Ǵ ‫ٿ‬ᅿੰࢥ‫ޑ‬ठੰΚ٠ό࣬ӕǴਥᏵЎ᝘ࡰрǴ HIV-1 ‫ޑ‬ଆྍёૈࢂٰԾ ߚ ࢪ ‫ ྱ ޑ‬ญ Ƕ HIV-1 ‫ ޑ‬ଆ ྍ ё ૈ ࢂ ٰ Ծ ߚ ࢪ ฎ ฎ (African ape, chimpanzee) ǹ Զ. HIV-2 ‫ ྱ ࢪ ߚ ک‬ญ խ ࣝ લ Ю ੰ ࢥ. (simian. immunodeficiency virus, SIV)࣬՟ǴӢԜѬ‫ޑ‬ଆྍёૈΨࢂٰԾߚࢪ‫ޑ‬ญ η (African monkey, mangabey) (23,24,25,26)Ƕ. 9.

(21) ಃΒകǵЎ᝘௖૸ ಃ΋࿯ ᛰ‫ނ‬ᔲҔӄౚࢬՉ௃‫׎‬ ᖄӝ୯ᛰࠔᆅ‫کڋ‬Ⴃٛҍ࿾࿿‫ ܭ‬2009 ԃ‫ޑ‬Шࣚᛰ‫ނ‬ൔᏤ಍ीၗ਑ᡉ ҢǴ2008 ԃђ࢒ᡵᆶੇࢶӢ‫ޑ‬ౢໆ෧ϿǴᖄӝ୯ࢥࠔ‫ک‬ҍ࿾ୢᚒᒤ٣ೀ ჹόӕ୯ৎ‫࣬ࠔࢥޑ‬ᜢբ‫ނ‬હᅿբፓࢗǴว౜ᎻТӧ Afghanistan ‫ޑ‬હ բय़ᑈ෧ϿΑ 19%ǴԶђ࢒ယӧ Colombia હᅿय़ᑈϿΑ 18%Ǵՠӄౚ ჹ‫ܭ‬Ӽߚд‫ڮ‬ᜪᛰ‫ޑނ‬٬ҔࠅԖൾϯ‫ޑ‬ᖿ༈ǴচӢЬाࢂӢࣁᇙ೷‫ޑ‬୯ ৎቚуᆶ‫ޑೌמ‬຾‫؁‬Ƕӧ 2007 ԃӄౚεऊԖ 30%Ӽߚд‫ڮ‬ᜪ‫ޑ‬ᛰ‫ނ‬ᇙ೷ ࢂӧᇻܿᆶ߈ܿӦ୔Ǵӧ೭٤୯ৎӼߚд‫ڮ‬ᜪᛰ‫ޑނ‬٬ҔΨࢂߚதᓎᕷ ‫(ޑ‬2)Ƕ. ӄౚԃសӧ 15-64 ྃ‫ޑ‬ΓαऊԖ‫ٿ‬ሹӧѐԃϣම࿶٬ҔၸࢥࠔǶӧ೭ ٤ම٬Ҕࢥࠔ‫ޑ‬ΓύǴऊԖ΋ሹϤί࿤Γࢂ٬ҔεഞǴΟίΖԭ࿤ࢂ٬ ҔӼߚд‫ڮ‬ᜪ‫ޑ‬ᛰ‫ނ‬Ǵ΋ί‫ٿ‬ԭ࿤߾ࢂ٬Ҕ଎Єᛰ‫ނ‬ǶӧᎻТᜪᛰ‫ނ‬٬ Ҕ௃‫ݩ‬೽ҽǴၨѐԃԖᡉ๱ቚуǴεऊ΋ίϤԭ࿤Γ٬ҔǴԶ٥ࢪࢂЬ ाቚу‫୔ޑ‬ୱǶӧђ࢒ᡵ‫ޑ‬೽ҽǴऊԖ΋ίΖԭ࿤Γ٬ҔǴΨࢂ΢ϲ‫ޑ‬ ᖿ༈(2)Ƕ ӧόӕӦ୔ύ‫ځ‬Ьाୢᚒᛰ‫ޑނ‬ᅿᜪΨԖ‫܌‬όӕǴߚࢪᆶεࢩࢪа εഞࣁЬǴϩձэ၀Ӧ୔Ьाୢᚒᛰ‫ ޑނ‬63%ᆶ 47%ǴԶ٥ࢪᆶኻࢪ߾ аᎻТࣁЬǴϩձэ၀Ӧ୔Ьाୢᚒᛰ‫ ޑނ‬65%ᆶ 60%ǴԶӧࠄऍࢪᆶ чऍࢪࢂађ࢒ᡵࣁε‫ے‬Ǵϩձэ၀Ӧ୔Ьाୢᚒᛰ‫ ޑނ‬34%ᆶ 52%Ǵ ԶӼߚд‫ڮ‬ᜪ‫ޑ‬ᛰ‫ނ‬ӧ٥ࢪ՞ 18%ǵࠄऍࢪ՞ 18%ǵεࢩࢪ՞ 20%Ƕ1990 ԃࡕεഞӧኻࢪǵчऍᆶεࢩࢪ٬Ҕ‫ޑ‬௃‫ݩ‬ε൯ቚуǴԶӼߚд‫ڮ‬ᜪ‫ޑ‬ ᛰ‫ނ‬ӧࠄऍࢪᆶчऍࢪ٬Ҕ௃‫ݩ‬ΨКၸѐӭ(2)Ƕ)ୖԵၗ਑;კ΋*! 10.

(22) 11. ୖԵၗ਑კ 1: ᖄӝ୯ᛰࠔᆅ‫کڋ‬Ⴃٛҍ࿾࿿ 2009 ԃШࣚᛰ‫ނ‬ൔᏤ http://www.unodc.org/documents/wdr/WDR_2009/WDR2009_eng_web.pdf.

(23) ಃΒ࿯ ᛰ‫ނ‬ᔲҔѠ᡼ࢬՉ௃‫׎‬ ୯ϣᛰ‫ނ‬ᔲҔ௃‫ۚݩ‬ଯόΠǴҗፁғ࿿ᆅ‫ڋ‬ᛰࠔᆅ౛ֽᛰ‫ނ‬ᔲҔਢ ҹᄤᔠᡍ಍ीኧᏵၗ਑ᡉҢǴѠ᡼Ӧ୔ᔲҔᛰ‫ֿނ‬నᔠᡍ಍ीҗ95ԃԿ 99ԃ1ДЗǴᑔᔠ໚‫܄‬౗ϩձࣁ27.1%ǵ33.5%ǵ29.6%ǵ24.7%ǵ24.9%Ǵ ё࣮рᑔᔠ໚‫܄‬౗ӧ95ԃ‫ډ‬96ԃԖ΢ϲ‫ޑ‬ᖿ༈ǴԶ96ԃၲ೭ϖԃٰ‫ޑ‬ന ଯঢ়Ǵ‫ډ‬ന߈‫ٿ‬ԃωΞ໒‫ۈ‬Πफ़ǹ‫ځ‬ύ༏ଢ଼ᜪᛰ‫ނ‬໚‫܄‬౗߾Ԗ೴ԃΠफ़ ‫ޑ‬ᖿ༈Ǵ໚‫܄‬౗ࣁǺ 23.7%ǵ23%ǵ21.7%ǵ14.5%ǵ10.8%ǹҘ୷Ӽߚд ‫ڮ‬ᜪᛰ‫ނ‬໚‫܄‬౗ӧ95ԃ(13.1%)‫ډ‬96ԃ(18.9%)Ԗ΢ϲ‫ޑ‬ᖿ༈Ǵՠ‫ډ‬Α97ԃ (15.9%)‫ډ‬98ԃ(14.9%)Ξ໒‫ۈ‬Πफ़Ǵ‫ډ‬Α99ԃ1Д(16.9%)Ξ໒‫ۈ‬΢ϲ)ୖԵ ၗ਑;კΒ*ǶԶҗጒᕇࢥࠔ಍ीᡉҢǴ҇୯92Կ97ԃය໔ǴੇࢶӢࣁᐕ ԃጒᕇࢥࠔໆಃ΋ՏǴ‫ځ‬ԛࣁҘ୷Ӽߚд‫ڮ‬ǴԶ98ԃ‫܌‬ጒᕇҘ୷Ӽߚд ‫ޑڮ‬ኧໆ‫ࢂ׳‬К97ԃӭрΑ277.2%ǴεഞΨӭрΑ362.3%ǴёࡑӢӭр Α13853.8%Ǵё࣮рӧѠ᡼ᛰ‫ނ‬ᔲҔ‫ޑ‬ᅿᜪςԖόӕ‫ޑ‬ᖿӛ(1)Ƕ ऩаߙϿԃҔᛰᅿᜪٰ࣮Ǵவ҇୯83Կ҇୯87ԃаӼߚд‫ࣁڮ‬ᛰ‫ނ‬ ᔲҔനӭ‫ޑ‬ᛰࠔǴಃΒϷಃΟ໩Տ߾೴ԃ‫ׯ‬ᡂǶԶ93 ԃଆѠ᡼εᏢഋࣁ ୲௲௤‫ޑ଺܌‬ೱុΟԃࣴ‫ࡰ߾ز‬рಃ΋໩Տ‫ޑ‬ᔲҔᛰ‫ࣁނ‬འᓐΤǴಃΒ ໩Տࣁ K д‫ڮ‬ǴόӕᔲҔᛰ‫ނ‬ᅿᜪ‫ޑ‬К‫ٯ‬Πफ़ᡉҢҔᛰᅌᅌ‫ޑ‬ᖿӛӭϡ ϯ(27,28)Ƕ ᛰ‫ނ‬ᅿᜪύੇࢶӢǵђ࢒ᡵ฻ᛰࠔǴନΑёճҔ֎१‫ޑ‬БԄѦǴࣣ ёҗᓉે‫ݙ‬৔ٰ٬ҔǴԶࢥࠔ‫ޑ‬ᓉે‫ݙ‬৔ନΑ཮೷ԋࢥ᠅ѦǴ‫ځ‬ӅҔଞ ᓐ‫ޑ‬ՉࣁΨ཮٬໺ࢉ‫܄‬੯ੰ‫ז‬ೲ‫ޑ‬ጭ‫ۯ‬Ǵ೷ԋϦӅፁғ΢‫ુ࠶ޑ‬ǶӢԜǴ ӵՖԖਏႣٛᛰ‫ނ‬ᔲҔ‫ޑ‬௃‫ݩ‬ӧଯӒᓀ௼ဂ໔໺ኞ໒ٰǴаϷߏයᅱ௓ акϩΑှ୯Γᛰ‫ނ‬ᔲҔ‫ޑ‬௃‫׎‬Ǵჹ‫ך‬୯ӧႣٛᛰ‫ނ‬ᔲҔ‫ޑ‬௃‫ࡐࢂ׎‬ख़ ा‫ޑ‬Ƕ ӧѠ᡼٬Ҕߚ‫ނݤ‬፦‫ࢂ܈‬ό྽٬Ҕᛰ‫ࢂނ‬ឦ‫ܭ‬ҍ࿾ՉࣁǴ٬Ҕ‫ޣ‬ऩ 12.

(24) ೏ጒਂѸ໪ाॄଆ࣬྽‫ޑ‬Ӊ٣ೢҺǴӢԜ٬Ҕ‫ࣁޣ‬Αխ‫ܭ‬ӉೢǴத཮ᗦ ᑀ٬Ҕߚ‫ݤ‬ᛰ‫ޑނ‬௃‫׎‬Ǵ٬ளၸѐѠ᡼ჹ‫ܭ‬٬Ҕߚ‫ݤ‬ᛰ‫ޑނ‬౰Չ౗ፓࢗ όܰǶၸѐ‫زࣴޑ‬ӭаԃᇸ௼ဂࣁЬǴ‫ځ‬д௼ဂ߾ؒԖբుΕ‫زࣴޑ‬Ǵ ӢԜჹ‫ܭ‬ᛰ‫ނ‬ᔲҔ‫ޑ‬౰Չ౗ค‫଺ݤ‬ᆒዴ‫ޑ‬՗ीǹӧၸѐමԖፁғ࿿ᆅ‫ڋ‬ ᛰࠔֽᆶ୯଼҇நֽӝբǴፓࢗӄ୯ᛰ‫ނ‬ᔲҔ‫ޑ‬௃‫׎‬Ǵჹ఼ᇂόӕԃស ቫ‫ޑ‬ᛰ‫ނ‬ᔲҔ౰Չ౗բፓࢗǴՠ၀ࣴ‫ࢂز‬аৎЊࣁൂՏǴаᒿᐒ‫ڗܜ‬ኬ ҁ‫ޑ‬БԄ຾ՉೖፋǴ‫ڙ‬ೖ‫ޣ‬Ӣ্‫ࢻ܂‬ᅅߚ‫ݤ‬٬Ҕᛰ‫ޑނ‬٣ჴǴԶ٬ளᛰ ‫ނ‬ᔲҔ‫ޑ‬౰Չ౗ᜤа՗ीǶ. ୖԵၗ਑კ 2:Ѡ᡼Ӧ୔ᔲҔᛰ‫ֿނ‬నᔠᡍ಍ीკ(88 ԃɴ99 ԃ 1 Д Չࡹଣፁғ࿿१ࠔᛰ‫ނ‬ᆅ౛ֽ. 99 ԃᔲҔᛰ‫ֿނ‬నᔠᡍ಍ी. http://www.fda.gov.tw/gradation.aspx?site_content_sn=1659.. 13.

(25) ಃΟ࿯ ᛰ‫ނ‬ᔲҔϐቹៜ ᛰ‫ނ‬ᔲҔ཮೷ԋ೚ӭϦӅፁғ‫ޑ‬ୢᚒ٠཮ჹ‫཮ޗ‬೚ӭቫय़೷ԋॄय़ ቹៜᆶॄᏼǶаΠϩғ౛ᆶӅੰੱǵ‫཮ޗ‬ৎ৥ᆶ࿶ᔮΟঁቫय़ٰբ௖૸Ƕ. 1. ғ౛ᆶӅੰੱቫय़ ऍ୯ᛰ‫ނ‬ᔲҔࣴ‫( ܌ز‬National Institute on Drug Abuse, NIDA) ၗ਑ ᡉҢᛰ‫ނ‬ᔲҔ཮ԋࣁЬा‫ޑ‬ϦӅፁғୢᚒࢂӢࣁᆶ೚ӭᙴᛰୢᚒԖ‫ޔ‬ௗ ‫࣬ޑ‬ᜢǴӵᕎੱ(29)ǵЈ᠌ੰ(30)ᆶ HIV/AIDSǶᛰ‫ނ‬ᔲҔ‫ޣ‬Ӣߏය٬Ҕᛰ ‫ނ‬ǴܰՔᒿ‫ي‬ᡏӅੰੱ‫ޑ‬วғǴᛰ‫ނ‬ԋ᠅‫ޣ‬ԖၨଯК౗‫ࢥੰޑ‬གࢉǵ่ ਡགࢉǵB ‫( ط‬hepatitis B virus; HBV) Ϸ C ‫( ط‬hepatitis C virus; HCV) ག ࢉǵང෷ੰᆶ‫܄‬໺ࢉੰ‫ޑ‬གࢉǶ΋ጇа Texas Health Care Information Council (THCIC) ࣁኬҁ‫ࡰزࣴޑ‬рԖӼߚд‫ڮ‬ᔲҔ‫ߙޑ‬ԃᆶрՈ‫ޑ܄‬ ύ॥Ԗᡉ๱‫࣬ޑ‬ᜢ‫܄‬ǹԶԖђ࢒ᡵᔲҔ‫ߙޑ‬ԃ߾ᆶрՈ‫܄‬ᆶલՈ‫܄‬ύ॥ Ԗᡉ๱‫࣬ޑ‬ᜢ‫(܄‬31)ǶԖ٤ࣴ‫ز‬ΨࡰрǴᚶѫύ‫஁ޑ‬ζ٬Ҕђ࢒ᡵ཮Ԗ೚ ӭ‫ٳ‬วੱǴӵԐౢǵजዬগပǵη৐ઇ຋ǵЈࡓό᏾ǵ‫᠌ط‬ઇ຋ǵတ೽ લՈࣗԿԖठԝ‫ޑ‬Ӓᓀ(32,33,34,35,36,37)ǶԶᛰ‫ނ‬ᔲҔ‫ޣ‬வ֎१‫ډ‬ᓉે‫ݙ‬৔Ǵ ό໻཮Ꮴठ೚ӭࡕុ‫ޑ‬ό‫଼ؼ‬நਏᔈǴΨх֖ၸໆ٬Ҕᆶੰࢥ໺ࢉ‫ޑ‬ୢ ᚒ(38)Ƕ߮୯‫ޑ‬ဃ۶ளൕ‫ځ‬ᎻТᜪᛰ‫ނ‬ၸໆ٬Ҕ (overdose) ‫ޑ‬௃‫ߚݩ‬தᓎ ᕷǴԖ 80%‫ޑ‬Γම࣮ၸ਒ΓԖᎻТᜪᛰ‫ނ‬ၸໆ٬Ҕ‫ޑ‬࿶ᡍǴԶ೭٤ᛰ‫ނ‬ ٬Ҕၸໆ‫ޣ‬ǴԖ 15%Ӣၸໆ٬ҔԶठԝǴԶ၀୯ৎӢࣁᎻТၸໆ٬ҔԶ ठԝ‫ޑ‬К౗Ψ೴ԃቚу(39)Ƕ୯ѦᏢ‫ޣ‬ΨբΑᕍᎦଣϣᛰ᠅‫ޣ‬ᆶߚᛰ᠅‫ޣ‬ ‫ ځ‬B ‫ط‬Ϸ C ‫ط‬གࢉ౗‫ޑ‬КၨǴว౜ᛰ᠅‫ࣣޣ‬ଯ‫ߚܭ‬ᛰ᠅‫ޣ‬ǴHBV ‫ޑ‬ག ࢉК౗ࣁ 76.9%ᆶ 12.5%; HCV གࢉ‫ޑ‬К౗߾ࢂ 76.9%ᆶ 16.9%(40)Ƕ ୯ϣӧ 1999 ԃаଯ໢Ӧ୔ୌ‫܌י‬ᆶᅱᅢࣁኬҁ‫زࣴޑ‬ว౜Ǵ889 Տ ᓉે‫ݙ‬৔‫ޣ‬ύ C ‫ޑط‬གࢉ౗ଯၲ 67.2%(41)Ƕќ΋ጇჹ‫ܭ‬ѠчѱҥᕍᎦଣ 14.

(26) ‫ނ‬፦ᔲҔ‫زࣴޑޣ‬ว౜ǴੇࢶӢԋ᠅‫ޑޣ‬ԝΫ౗ၲ 1.94%Ǵߏය٬Ҕёૈ ཮Ꮴठ‫ڬ‬ᜐઓ࿶ੰᡂᆶགࢉǵ‫ܜ‬โЈࡓǵό᏾฻ੱ‫(ރ‬42)Ƕ٩ᏵѠ᡼੯ੰ ᆅ‫ޑֽڋ‬ၗ਑ᡉҢǴѠ᡼வ 1984 ԃಕᑈԿ 2009 ԃ 7 Дۭ‫ ޑ‬6186 Տ HIV/AIDS གࢉ‫ޣ‬ύǴऊԖ 35%ࣁ‫ݙ‬৔ᛰ᠅‫(ޣ‬4)Ǵ‫ݙ‬৔ᛰ᠅‫ࢥੰޣ‬໺ࢉ‫ז‬ ೲ‫ޑ‬௃‫ݩ‬зΓኁЈǴԶ೭٤‫ݙ‬৔ᛰ᠅‫ޑޣ‬Ӓᓀ‫ݙ‬৔ՉࣁǵႣٛᆶੰࢥག ࢉࡕ‫ݯޑ‬ᕍǴჹ‫ܭ‬᏾ᡏϦӅፁғᙴᕍ೷ԋࡐε‫ॄޑ‬ᏼǶ. 2. ‫཮ޗ‬ᆶৎ৥ቫय़ ନΑ੯ੰϐѦǴᛰ‫ނ‬ᔲҔ‫܌‬஥ٰ‫཮ޗޑ‬ᆶৎ৥ୢᚒΨࢂ࣬྽‫ޑ‬ᝄ ख़Ǵᛰ‫ނ‬ᔲҔନΑჹҁ‫يޑي‬ᡏᆶЈ౛೷ԋ໾্ѦǴΨ೷ԋৎ৥ୢᚒǴ ‫ࣁࢂ܈‬ΑЍбᚳε‫ޑ‬ᛰ‫ނ‬ᔲҔ຤ҔԶҍ࿾ቚу‫ॄ཮ޗ‬ᏼǶਥᏵऍ୯ NIDA ၗ਑ࡰрǴᛰ‫ނ‬ᔲҔ஥ٰ‫཮ޗޑ‬ୢᚒԖ֎ࢥᎯᎭᏤठًᅾǵኪΚǵ ᓸΚᆶ‫ࢥ֎ูٽ‬ǴԶ೭٤ୢᚒ೿ࢂԋࣁᅿᅿ‫཮ޗ‬໶ຝ‫ޑ‬ਥྍ. (43). Ƕ. 3. ࿶ᔮቫय़ а ऍ୯Զ‫ ق‬Ǵ‫؂‬ԃ ऍ୯޸ӧ ࣬ᜢ‫ ނ‬፦ᔲҔ‫ ޑ‬຤ҔԖ 4840 ሹ ϡ (44,45,46). Ǵ೭ߎᚐाКऍ୯‫؂‬ԃ޸຤ӧႽࢂᑗֿੰ‫ࢂ܈‬ᕎੱ΢ᗋाٰ‫ޑ‬ᚳε. (47,48). Ƕऍ୯ӧ 1985 ԃӢᛰ‫ނ‬ᔲҔ)όх֖ଚ‫ޑ‬ᔲҔ*ԶӧᙴᕍᆶΓΚၗྍ. ΢ཞѨΑऊ 440 ሹऍϡǴԶ‫ډ‬Α 1988 ԃ߾ቚԿ 583 ሹऍϡ(49)ǹќѦ୯ϣ Ꮲ‫ޣ‬ϩ‫ ݋‬93 ԃࡋѠ᡼࣬ᜢൂՏӢᛰ‫ނ‬ᔲҔ‫઻܌‬຤‫཮ޗޑ‬ԋҁऊཥѠჾ 208 ሹ(50)ǶҗԜё‫ـ‬όፕӧ୯ϣѦǴᛰ‫ނ‬ᔲҔ‫܌‬೷ԋ‫཮ޗޑ‬ԋҁཞѨό৒ ۹ຎǶ. 15.

(27) ಃѤ࿯ ᛰ‫ނ‬ᔲҔᕉნӒᓀӢη௖૸ ୯Ѧᛰ‫ނ‬ᔲҔς࿶ᝄख़‫ޑ‬ቹៜऍࢪӑӦӼΓ‫܎ߓک‬ථуβ๱Γ‫଼ޑ‬ நǴӢԜӄౚς࿶ӧ൨‫פ‬फ़եᛰ‫ނ‬ᔲҔ‫ޑ‬Б‫کݤ‬Ⴃٛ(5)Ƕ୯ϣᛰ‫ނ‬ᔲҔ‫ޑ‬ ԃស໘ቫԖΠफ़‫ޑ‬ᖿ༈Ǵ୯ϣ΋ጇଞჹଯᙍᏢғ‫܌‬բ‫ࡰزࣴޑ‬рǴߙϿ ԃ٬Ҕᛰ‫ނ‬ԋ᠅‫ޑ‬ӒᓀӢηёϩࣁঁΓӒᓀӢηǵৎ৥ӒᓀӢηǵӕᏆ ӒᓀӢηǵᏢਠӒᓀӢηǵ‫୔ޗ‬ӒᓀӢη(7)ǶԶቹៜᛰ‫ނ‬ᔲҔ‫ޑ‬Ӣનࡐӭ (51,52,53). Ǵ‫׵‬ඳऍ฻Γ(6)‫زࣴޑ‬ஒ೭٤ቫय़εठёᘜᜪԋঁΓǵৎ৥ᆶӕᏆ. ฻Бय़‫ޑ‬ӢηǶ. ࡐӭࣴ‫ز‬ᡉҢ΋૓Γௗ᝻ࢥࠔ߻Ǵӧന໒‫཮ۈ‬Ӄௗ᝻ଚᆒ‫ྟ܈‬૛ (51). ǶԖᏢ‫ޣ‬ᇡࣁᛰ‫ނ‬ᔲҔࢂԖ໘ࢤ‫ޑ܄‬ǴႽࢂ๨ǵଚϷᘓ཯೿ࢂᛰ‫ނ‬ᔲ. Ҕ‫ޑ‬Εߐ‫ނ‬፦(54,55)Ƕࣴ‫ࡰز‬рᏤठᛰ‫ނ‬ᔲҔ‫ޑ‬Չࣁ཮வ΋໒‫ޑۈ‬Ȩֹӄό ٬ҔҺՖ‫ނ‬፦ȩǴ Ȩ໯Ҕ୥ଚ‫܈‬఩ଚȩǴ Ȩ֎๨‫܈‬ਗ਼ଚȩനࡕ‫ډ‬Ȩߚ‫ݤ‬ᛰ‫ނ‬ ‫ޑ‬٬Ҕȩ Ƕ΋ѿ໒‫ۈ‬٬Ҕߚ‫ݤ‬ᛰ‫ނ‬Ǵ߾཮வଽԶ٬ҔǴೕ߾٬ҔԶനࡕᄽ ᡂԋᔲҔ‫܈‬٩ᒘ(56,57)Ƕଚᆒ‫ྟک‬૛٠҂೏ӈΕࢥࠔᆅ‫ڋ‬Ǵ΋ՠჹ‫ܭ‬๨ଚౢ ғ٩ᒘ‫܄‬Ǵёૈԋࣁᛰ‫ޑ᠅ࢥނ‬ӒᓀӢηǶ. ᆕӝ΢ॊЎ᝘௖૸Ǵᛰ‫ނ‬ᔲҔ‫ޑ‬ᕉნӒᓀӢηёϩࣁаΠ൳໨Ǻ 1. ঁΓӒᓀӢη ਥᏵ‫׵‬ඳऍ฻Γ(7)‫ࡰزࣴޑ‬рǴ٬Ҕԋ᠅ᛰ‫ނ‬ᆶঁΓ࿶ᔮૈΚǵଓ‫؃‬ ‫ڈ‬ᐟǵୃৡՉࣁǵ‫܄‬ՉࣁǵԖคੋϷό‫ؼ‬൑‫܌‬ᆶҔᛰᄊࡋԖ࣬ᜢ‫܄‬Ƕ୯ ϣᏢ‫زࣴޑޣ‬ว౜ǴࢂցΑှ֎१‫ݙ܈‬৔ᛰ‫ٳ཮ނ‬ว‫ځ‬Ѭੱ‫ރ‬ԶठԝǴ ᆶࢂցΑှᛰ‫ނ‬٬Ҕࡕ݀Ϸ‫ࡓݤ‬ೢҺǵჹࢥࠔલЮ᝾᝺ǵჹࢥࠔલЮᇡ ᛽Ǵ೿ࢂᏤठ֎ࢥ‫ޑ‬॥ᓀӢન(27,58,59,60,61)Ƕ. 16.

(28) 2. ৎ৥ӒᓀӢη Ў᝘ࡰрৎύԋ঩ԖҔᛰಞᄍᆶৎύԋ঩ᖄ่ե೿ࢂቹៜᛰ‫ނ‬ᔲҔ ‫ޑ‬ৎ৥Ӣન(6)Ƕ୯ϣᏢ‫زࣴޑޣ‬ว౜ৎύԋ঩ࢂց֎१‫ݙ܈‬৔ࢥࠔᆶߙϿ ԃҔᛰԖᡉ๱‫࣬ޑ‬ᜢ(27)Ƕचឮ฻Γ(62)ࣴ‫ز‬Ψว౜ǴৎΓόϸჹ٬Ҕԋ᠅ ‫ނ‬፦཮ቹៜᛰ‫ނ‬ᔲҔՉࣁǶৎΓᜢ߯Ϸৎ৥ࠠᄊΨࢂቹៜᛰ‫ނ‬ᔲҔ‫ޑ‬ख़ ाӢηǴР҆ჹηζ‫ޑ‬ᒃஏࡋ (parental closeness) ǴΨ཮ቹៜᛰ‫ޑނ‬٬ Ҕ(56) 3. ӕᏆӒᓀӢη ୯Ѧ‫ࡰزࣴޑ‬рӕᏆၨத٬Ҕԋ᠅ᛰ‫ނ‬ǵӕᏆ٬Ҕᛰ‫ނ‬К౗ၨଯǵ ӕᏆᗎҔԋ᠅ᛰ‫ނ‬К౗ၨଯᆶӕᏆୃৡՉࣁК౗ၨଯ೿ࢂቹៜ٬Ҕԋ᠅ ᛰ‫ޑނ‬ӒᓀӢη(6)Ƕ୯ϣ‫ࡰزࣴޑ‬рᇡࣁऩӕՔ೿ӧ٬Ҕᛰ‫ނ‬ǴߙϿԃᇡ ࣁѨѐܻ϶‫ޑ‬Ӓᐒ(risk)К٬Ҕᛰ‫׳ނ‬εਔǴࣁΑ߄Ңჹიᡏ‫ޑ‬ᇡӕǴ‫܌‬ а൩‫϶ܻک‬΋ଆ٬Ҕᛰ‫(ނ‬63,64)ǶԢਁՎ฻Γ(58)‫ޣࢥ֎܄ت‬Ҕᛰᐕำ॥ᓀ Ӣનࣴ‫ز‬ว౜ǴࣁΑय़ηԶ٬Ҕᛰ‫ࣁނ‬ಃ΋ԛҔᛰ‫ޑ‬চӢϐ΋Ƕच๧࣓(65) ‫زࣴޑ‬ΨࡰрǴӧიᡏᇡӕ‫ޑ‬ᓸΚΠёૈߦ٬ঁΓ჋၂֎ࢥ(60)ǶӕᏆࢂ ቹៜߙϿԃՉࣁ‫ޑ‬ख़ाӢનǴԶӕᏆᜢ߯ΨࢂቹៜԋΓࢂց٬Ҕࢥࠔ‫ޑ‬ ЬाӢનǶӕᏆᜢ߯೯த࿶җՉࣁ‫ޑ‬ኳүǴаϷიᡏ‫ঁ܈‬Γᇡӕ‫ޑ‬ᓸΚ Զߦ٬ঁΓ٬ҔࢥࠔǴ٠࿶җϩ٦ᒃஏᜢ߯‫ޑ‬௃གǴ࣬ϕЍ࡭٠࡭ុ֎ ࢥՉࣁǶ. ԶӧΑှ೭٤ᕉნ‫ޑ‬ӒᓀӢηࡕǴ‫׳‬Ԗ‫ځ‬Ѭࣴ‫ز‬а୏‫ނ‬ኳԄ‫ޑ‬БԄ ٰኳᔕ೭٤ᕉნӢηჹᛰ‫ނ‬ᔲҔՉࣁ‫ޑ‬ቹៜǶ‫ځ‬ύԖࣴ‫ز‬ว౜ፍғਔᎁ ‫҆ڙ‬ངগღ‫ޑ‬εႵᡂளჹ༏ଢ଼аϷੇࢶӢ‫ޑ‬ዛ፞ਏᔈ (rewarding effect) ၸࡋ௵གЪࡐ‫ז‬ԋ᠅(66,67)ǹΨԖࣴ‫ز‬ว౜ؒԖ҆ᒃྣ਑‫ݞࡡޑ‬ญ‫ځ‬ଚᆒឪ ‫ޑڗ‬ໆࢂКၨӭ‫(ޑ‬68,69)ǹନԜϐѦԖ٤ࣴ‫ز‬Ψว౜Ǵᐱۚ‫ޑ‬ԴႵ཮Кဂۚ 17.

(29) ‫ޑ‬ԴႵჹђ࢒ᡵԖၨமਗ਼‫௵ޑ‬ག‫(܄‬70,71)Ǵ‫ځ‬дࣴ‫߾ز‬ว౜ԴႵᐱۚ཮ߦ຾ ჹ‫ܭ‬ђ࢒ᡵ‫ޑ‬Ծ‫ڗך‬१ (self-administration) )࣬ၨ‫ۚܭ‬Րӧ൤ျ‫ޑ‬ᕉ ნ*(72)ǶќѦǴΨԖଞჹԴႵ‫཮ޗޑ‬ᓸΚϐࣴ‫ز‬Ǵ่݀྽ϦႵኪ៛ӧԖߟ ౣ‫܄‬ϐϦႵ‫҆܈‬Ⴕ‫ޑ‬ᕉნΠǴᆶ҂ኪ៛ӧԖߟౣ‫܄‬ᕉნ‫ޑ‬ϦႵКၨǴ཮ ቚуђ࢒ᡵ‫ޑ‬Ծ‫ڗך‬१(73,74)Ǵҗ୏‫ނ‬ኳࠠё‫ـ‬ᕉნӢηჹᛰ‫ނ‬ᔲҔՉࣁ‫ޑ‬ ቹៜᆶӢ݀࣬ᜢǶ. 18.

(30) ಃϖ࿯ ᛰ‫ނ‬ᔲҔᆶᒪ໺Ӣη ᛰ‫ނ‬ԋ᠅౜ӧς೏ቶ‫ޑݱ‬ຎࣁ΋ᅿတ೽ၿᖴ‫س‬಍‫ޑ‬੯஻ǴԜၿᖴ‫س‬ ಍Տ‫ܭ‬Ьाඓᆅ௃ག‫ޑ‬εတᜐጔ‫س‬಍(75,76,77)Ƕӧൔᓭ‫س‬಍ύЬा‫ޑ‬ઓ࿶໺ ᏤનࣁӭЃữǴԶ‫ځ‬дႽൂữ୷ለᆶΌㄽᖌᡵΨୖᆶ‫ځ‬ύǶ. Ԝၿᖴ‫س‬಍‫ޑ‬ਡЈࣁՏ‫ܭ‬ဎୁ೏ᇂ୔‫ޑ‬ӭЃữઓ࿶ϡǴԜઓ࿶ϡ‫ޑ‬ ँ᝻߾཮ௗ᝻ҷ႖ਡǴ‫׶‬ϘਡǴ߻ᚐယҜቫ‫ځک‬д߻တ่ᄬǶӃϺൔᓭ ‫ޑ‬բҔೀᆶΓπϯᏢ‫ڈނ‬ᐟೀ೿ࢂӧ࣬ӕ‫ޑ‬೽ՏǴՠӃϺ‫ࢲޑ‬ϯ‫཮ނ‬ᙖ җӣ㎸‫ޑ‬ᐒ‫ٰڋ‬෧Ͽ‫܄ࢲځ‬ǴՠࠅࡐϿёаज़‫ڋ‬ԋ᠅ᛰ‫ނ‬ϐᜪΓπᑫᏟ Ꮚ‫ޑ‬ϸᔈǶԶ߈ٰ‫ޑ‬ઓ࿶ቹႽ‫زࣴޑ‬Ψว౜ᚐယҜ፦ΨୖᆶԜൔᓭ‫ޑ‬຾ ำ(78,79)Ƕ ၸѐ‫زࣴޑ‬ว౜ӭЃữ‫س‬಍ᆶ‫ނ‬፦ᔲҔᐒ‫ڋ‬Ԗᜢ(16)Ƕ٣ჴ΢‫܌‬Ԗᔲ Ҕ‫ޑ‬ᛰ‫ނ‬೿཮‫ڈ‬ᐟӭЃữઓ࿶ϡǴ೭٤ᛰ‫཮ނ‬ቚமӭЃữ‫ޑ‬மࡋǴԶว ৖ࣁԋ᠅‫ޑ‬চӢ߾ᆶӭЃữញрᆶύတ‫ޑ‬ӭЃữၿᖴ‫س‬಍Ԗᜢ(75)Ƕӧ୷ Ӣ‫زࣴޑ‬ύว౜Ǵঁᡏӧ‫ނ‬፦ᔲҔ‫ޑ‬॥ᓀόӕࢂӢࣁ೚ӭ୷ӢᆶᕉნӢ η‫ޑ‬ҬϕբҔ‫܌‬Їଆ‫ޑ‬ǴԶ೭ৡ౦Ψ຾΋‫ߦ؁‬຾࣬ᜢ‫ނ‬፦ᔲҔংᒧ୷Ӣ ‫(زࣴޑ‬8)Ǵх֖੯஻ᆶ୷Ӣӭࠠ‫܄‬ϐ໔‫࣬ޑ‬ᜢ‫܄‬ᆶ୷Ӣ‫ޑ‬ቹៜǶԶ୷Ӣᆶ ੯ੰ॥ᓀ‫ޑ‬ᜢᖄёૈᆶфૈϷᡂ౦ԖᜢǶӢԜाዴϪගр୷Ӣ‫ޑ‬ӒᓀӢ ηࢂ֚ᜤ‫ޑ‬Ǵҗ‫ܭ‬ᒪ໺΢ǵᖏ‫׉‬΢Ϸ୷Ӣ΢౦፦‫ޑ܄‬ፄᚇǴ٬ள୷Ӣӧ ‫܌‬ԖӒᓀӢη‫ޑ‬ቹៜ΢ࢂࡐᇸ༾‫ޑ‬Ƕ. ฅԶϝԖ೚ӭࣴ‫ز‬ว౜ᛰ‫ނ‬ᔲҔᆶ୷Ӣϐ໔‫࣬ޑ‬ᜢ‫܄‬ǴӧѠ᡼Ԗჹ ‫ܭ‬Ӽߚд‫ڮ‬ԋ᠅࣬ᜢ‫زࣴޑ‬ว౜ǴՈమનᙯၮη (serotonin transporter, 5-HTTLPR) S, LG, LA ୷ӢࠠᆶӼߚд‫ڮ‬ᔲҔᆶԾఠՉࣁԖ࣬ᜢ‫(܄‬80) ǶԶ 19.

(31) ᆶӭЃữௗ‫ڙ‬ᏔԖᜢ‫୷ޑ‬Ӣᆶᛰ‫ނ‬ᔲҔ‫زࣴޑ‬ΨόӧϿኧǴԖࣴ‫ز‬ว౜ ӭЃữௗ‫ڙ‬Ꮤύ‫ ޑ‬DRD2 (dopamine type-2 receptor) Taq1A ୷Ӣࠠаଯу ઩Γࣁࣴ‫ز‬ჹຝᆶӭख़‫ނ‬፦ᔲҔ‫ڀ‬Ԗ࣬ᜢ‫( ܄‬81) ǹԶ DRD4 (dopamine receptor; seven transmembrane helix receptor) VNTR ୷ӢࠠΨว౜аቺ୯ Γࣁࣴ‫ز‬ჹຝύᆶଚᆒᔲҔԖ࣬ᜢ‫( ܄‬82) ǶԶѠ᡼௼ဂளࣴ‫ز‬Ψว౜ DRD4 VNTR ୷ӢࠠӧჹྣಔᆶҘ୷Ӽߚд‫ڮ‬ᔲҔ‫ޑޣ‬ᓎ౗΢Ԗ‫܌‬ৡ౦ (83). ǹќѦаଯу઩ΓᆶကεճΓࣁࣴ‫ز‬ჹຝǴࣴ‫ز‬ว౜ੇࢶӢ٩ᒘ‫ځޣ‬. Γ ᡏ Kappa Ꮋ Т ௗ ԏ Ꮤ (OPRK1, Human Kappa Opioid Receptor) 36G>T ‫ځ‬஥Ԗ T ჹଽ୷Ӣ‫ޑ‬ᓎ౗ၨଯ(84)ǶନΑ΢ॊࣴ‫ز‬ว౜୷ӢჹᔲҔ Չࣁ‫ޑ‬ቹៜѦǴ‫ځ‬ӭЃữжᖴ୷Ӣӧᛰ‫ނ‬ᔲҔ‫زࣴޑ‬΢Ψਔத೏௖૸Ǵ ЬाࢂӢࣁ εတ‫ޑ‬ӭЃữ‫س‬಍ᆶᛰ‫ޑނ‬ၿᖴԖᜢ(85)ǴԶӧԜೀ߄౜‫୷ޑ‬ Ӣ ࣁ ჹ ‫ ނ‬፦ ᔲ Ҕ ‫ ޑ‬ং ᒧ ୷ Ӣ Ƕ ‫ ٽ‬ૡ ⇌ ữ Ҙ ୷ ᙯ ౽ 䁙 (Catechol-Omethyltransferase,COMT) ߄౜ӧεတӭЃữઓ࿶ϡ‫୔ޑ‬ୱǴ ࣁफ़ှ‫ٽ‬ૡ⇌ữ‫ޑ‬΋ᅿ䁙(18)ǴӕਔΨёаफ़ှӭЃữ(19)Ƕ. ӭЃữࣁတύख़ा‫ޑ‬ઓ࿶໺Ꮴ‫ނ‬፦ǴฅԶӭЃữ‫ޑ‬ᐚࡋሡा೸ၸғ ԋᆶжᖴٰၲ‫ډ‬ѳᑽωૈᆢ࡭҅த‫ޑ‬фૈ)ୖԵၗ਑;კΟ*Ǵӧ‫ޑॺך‬ε တӭЃữ໺ሀ‫ډ‬ઓ࿶ࡕǴ཮ᙖҗઓ࿶߄य़‫ޑ‬ӭЃữௗ‫ڙ‬ᏔٰௗԏǴ྽ӭ Ѓữ‫ޑ‬ᐚࡋຬၸѳᑽࡕǴߡ཮җઓ࿶߄य़ dopamine transporter (DAT) ٰ ჹӭЃữ଺ӆ֎ԏ)ୖԵၗ਑;კѤ*ǴΓᡏεတદ‫ރ‬ᡏ (striaum) ёаճ Ҕ DAT ٰ֎ԏӭЃữǴՠࢂӧεတ‫߻ޑ‬ᚐယҜ፦લЮ DATǴӢԜӧԜ ೽Տ߾а COMT ٰჹӭЃữբжᖴٰၲ‫ډ‬ѳᑽ)ୖԵၗ਑;კϖ*(86)Ƕ. COMTࣁӧတύжᖴ‫ٽ‬ૡ⇌ữᜪ)ӭЃữǵ๝΢ဏનǵ҅๝΢ဏન* ‫ޑ‬΋ᅿख़ा‫ޑ‬䁙ǴCOMT‫ڬޑ‬ൎҗΖঁ α-helicesಔԋǴԶύЈ߾җ൳ঁ β-sheetಔԋǴЪ֖Ԗ S-adenosyl-L-methionine (AdoMet) բࣁࢲϯᆶ໽ϯ 20.

(32) ‫ޑ‬Տ࿼ǶԶ໽ϯՏ࿼‫׀ޑ‬ᆄԖϿኧ‫ޑ‬ữ୷ለǴჹ‫ܭ‬టҘ୷ϯ‫୷ޑ‬፦ǵᗔ ᚆηᆶНϩηӧҘ୷ϯ‫ޑ‬ၸำύࢂࡐख़ा‫ޑ‬Ƕၸำύᗔᚆη཮ᆶ COMT ‫׀‬ᆄ‫ ޑ‬AdoMet ่ӝǴӆೱௗ‫ٽ‬ૡ⇌΢‫ޑ‬ణ਼ਥ٬‫ٽ‬ૡ⇌‫׳‬৒ܰ೏ᚆη ϯǴԜਔ COMT ΢‫ޑ‬ᚆữለ཮ௗ‫ڙ‬Ԝణ਼ਥ΢‫ޑ‬፦ηǴௗ๱ AdoMet ‫׀‬ᆄ‫ޑ‬Ҙ୷൩཮ᙯ౽‫ٽډ‬ૡ⇌΢Ԝణ਼ਥ‫ޑ‬Տ࿼ǴԶֹԋҘ୷ϯ‫ޑ‬ၸำ )ୖԵၗ਑;კϤ* (87)Ƕ COMTՏ‫ ܭ‬chromosome 22q11.22–23‫ޑ‬Տ࿼ (88) ǴҗϤঁ exons ಔ ԋǴ߻‫ ঁٿ‬exons ࣁߚጓዸ୔Ǵ֖Ԗ‫ ঁٿ‬promoter Ǵϩձࣁ P1 Ϸ P2Ǵ ёᙯᒵрߏࡋϩձࣁ1.5 kb ᆶ1.3 kb ‫ ޑ‬mRNA(89)Ƕ೭‫ ঁٿ‬promoter Տ ‫ ܭ‬COMT exon3 ‫ ޑ‬Տ ࿼ (90,91) Ƕ Զ P2 Ь ा ࢂ ፓ ࿯ ‫ ځ‬ύ ߏ ࡋ ၨ ߏ ‫ޑ‬ mRNA Т ࢤ Ǵ ё а ᙯ ᝿ р ‫ ٿ‬ᅿ COMT ೈ қ Ǵ ϩ ձ ࣁ MB-COMT (membrane-bound COMT) ᆶ S-COMT (soluble COMT) )ୖԵၗ਑;კ Ύ*ǹԶP1߾ࢂፓ࿯ၨอТࢤ‫ ޑ‬mRNAǴҗ‫ ܭ‬P1 ‫ޑ‬Տ࿼ᆶ MB-COMT ໒‫ۈ‬ᙯ᝿‫ޑ‬Տ࿼Ԗ೽ϩख़᠄ǴӢԜၨอТࢤ‫ ޑ‬mRNA ߾ѝ཮ᙯ᝿р S-COMTೈқ(89,92,93)Ƕӧ‫ॺך‬Γᡏε೽ϩ‫ޑ‬ಔᙃύ೿ԖߏอТࢤ‫ ޑ‬COMT mRNA ‫߄ޑ‬౜ǴฅԶӧεတύኰઓ࿶‫س‬಍୔ୱࠅѝ࣮‫ډ‬ၨߏТࢤ‫ޑ‬ mRNA ߄౜Ǵ‫ځ‬ύаૉᡎઓ࿶߄౜നଯǴԶ‫׶‬Ϙਡ߾߄౜നեǴԶவࣴ ‫่࣮݀ޑز‬рߏТࢤ‫ ޑ‬COMT mRNA ‫߄ځ‬౜ჹεတύኰઓ࿶‫س‬಍ύ COMT ‫ࡐࢂ܄ࢲޑ‬ख़ा‫(ޑ‬94)Ƕ. COMT ୷Ӣ΢Ԗ೚ӭ‫୷ޑ‬Ӣӭࠠ‫܄‬Ǵ‫ځ‬ύ Val158Met Տ‫ ܭ‬exon 4 ‫ޑ‬Տ࿼ǴVal158Met Ԝфૈ‫୷ޑ܄‬Ӣӭࠠ‫཮܄‬ቹៜ䁙‫܄ࢲޑ‬ǴӃ߻‫ࣴޑ‬ ‫ز‬ว౜஥Ԗ Val ჹଽ୷ӢК஥ԖMetჹଽ୷ӢԖၨଯ‫(܄ࢲޑ‬19,95,96,97,98)Ƕ Val158Met ӧ೚ӭᛰ‫ނ‬ᔲҔ‫࣬ޑ‬ᜢࣴ‫ز‬ύ೏ቶ‫ޑݱ‬௖૸ǴЪΨӧ೭٤ࣴ ‫ ز‬ύ Ԗ ว ౜ Val158Met ୷ Ӣ ӭ ࠠ ‫ ܄‬ჹ ᛰ ‫ ނ‬ᔲ Ҕ Չ ࣁ ‫ ޑ‬ቹ ៜ Ƕ ୯ Ѧ 21.

(33) Vandenbergh ฻Γ(99)‫زࣴޑ‬ว౜Ǵ‫ځ‬фૈ‫ ޑ܄‬COMT Val158Met ୷Ӣӭ ࠠ‫ޑ܄‬ᓎ౗ϩѲǴӧӭख़‫ނ‬፦ᔲҔ‫ޣ‬ᆶჹྣಔԖᡉ๱‫ޑ‬ৡ౦ (Controls vs. abusersǹgenotypes: χ2=6.51, P =0.038 , df =2; alleles: χ2 = 5.75, P =0.02 , df =1)ǴԶ Horowitz ฻ΓΨӧੇࢶӢԋ᠅‫ޑޣ‬ৎ௼ࣴ‫ز‬ύว౜஥Ԗ Val158 ჹଽ୷Ӣࠠ‫ޣ‬Ԗᡉ๱ၨଯ‫࣬ޑ‬ჹӒᓀ‫ࢶੇࣁ܄‬Ӣԋ᠅‫( ޣ‬HRR= 4.48, P = 0.03)(100)ǹԶӧ୯ϣ‫زࣴޑ‬ΨԖว౜ Val158Met ୷Ӣӭࠠ‫܄‬ᆶҘ ୷Ч⇌ữ‫ޑ‬ᔲҔ‫ڀ‬Ԗ࣬ᜢ‫(܄‬Ҙ୷Ч⇌ữᔲҔ‫ޣ‬v.sჹྣಔ:genotype-wise: χ2 = 6.77, P=0.04; allele-wise: χ2 = 5.78, P=0.02.)(83)Ƕ. җ೭٤ࣴ‫ز‬ёаΑှᒪ໺Ӣηჹ‫ܭ‬ᛰ‫ނ‬ᔲҔՉࣁ‫ޑ‬ቹៜӧ߈ԃٰς ࿶೏ख़ຎǴΑှᒪ໺Ӣηჹᛰ‫ނ‬ᔲҔՉࣁቹៜ‫ޑ‬ำࡋǴჹ‫ܭ‬ᛰ‫ނ‬ᔲҔ‫ޑ‬ ‫ݯ‬ᕍᆶႣٛΨࢂёаග‫ٮ‬ख़ा‫ޑ‬ၗૻǶ. ӝԋၡ৩! ѐҘ҅๝΢ဏન. ӭЃữ. ӭ Ѓ ữ ж ᖴ. !. !. ж ᖴ ၡ ৩. ѐ Ҙ ҅ ๝ ΢ ဏ ન ж ᖴ. ୖԵၗ਑კ3:ӭЃữᆶѐҘ҅๝΢ဏનϐӝԋᆶжᖴ (Kopin IJ.Pharmacol Rev1985: 37:333–364) 22.

(34) ӭᎩ‫ޑ‬ӭЃữᙖҗ DAT ‫֎܌‬ԏ ୖԵၗ਑კ 4:ӭЃữ໺Ꮴᆶӆ֎ԏ Haile et al. Am J Drug Alcohol Abuse. 2009 ; 35(3): 161–177.. 23.

(35) ӧεတદ‫ރ‬ᡏ୔ୱӭЃữᙖҗ DAT ӆ֎ԏ. εတ߻ᚐယҜ፦୔ୱӭЃữᙖҗ COMT жᖴ. ୖԵၗ਑კ 5:ӭЃữӧદ‫ރ‬ᡏ(Striaum)ᆶ߻ᚐယҜ፦(PFC)‫ޑ‬໺Ꮴ Sesack SR, Hawrylak VA, Matus C, Guido MA, Levey AI . J Neurosci 1998;18:2697–2708.. 24.

(36) 1. 2. 4. 3. ୖԵၗ਑კ 6:COMT ჹ‫ٽ‬ૡ⇌Ҙ୷ϯཷाკ: STEP 1:ᗔᚆηᆶAdoMet‫ޑ‬Ҙ୷่ӝ STEP2:ᗔᚆηᆶҘ୷่ӝࡕӆᆶ‫ٽ‬ૡ⇌ữϐణ਼ਥ่ӝ STEP3:‫ٽ‬ૡ⇌ữ΢೏่ӝϐణ਼ਥ‫ޑ‬፦ηᙯ౽ϐᚆữለ(Lys 144) STEP4: AdoMet‫ޑ‬Ҙ୷ᙯ౽Կ‫ٽ‬ૡ⇌ữֹԋҘ୷ϯ (Männistö PT and Kaakkola S : Catechol-o-methyltransferase (COMT). Pharmacol Rev1999 ;51:593– 628.) 25.

(37) . P2 promoter ᙯᒵϐ mRNA Тࢤ. P1 promoter ᙯᒵ ϐ mRNA Тࢤ. ୖԵၗ਑კ 7:COMT ϐ୷ӢՏ࿼ᆶᙯᒵ Grossman MH, Emanuel BS, BudarfML. Genomics 1992;12:822– 825.. 26.

(38) ಃϤ࿯ ෧্ीฝ ᛰ‫ނ‬ᔲҔ‫ޑ‬ᓉે‫ݙ‬৔Չࣁࢂ HIV ǵC ࠠ‫ݹط‬ᆶ࣬ᜢ੯ੰ‫ޑ‬൞ϟǴ ԶࢬՉੰᏢ‫ࡰزࣴޑ‬рǴᓉે‫ݙ‬৔‫ޣ‬໺ኞ HIV ࢂҗ‫ܭ‬ख़ፄ٬Ҕ‫܈‬ӅҔ‫ڙ‬ ԡࢉ‫ޑ‬ଞ‫ڀ‬ǵ‫ݙ‬৔Ꮤ‫ݙ܈‬৔π‫ࢂ܈ڀ‬ԖόӼӄ‫܄ޑ‬Չࣁ(101,102)ǴԶᡣ೭٤ ‫ݙ‬৔ᛰ᠅‫ޣ‬Αှ‫ ډ‬HIV ॥ᓀᆶ‫ݙ‬৔Չࣁ‫࣬ޑ‬ᜢ‫ࡕ܄‬Ǵߡ཮ᡣ೭٤‫ݙ‬৔ᛰ ᠅‫ׯޣ‬ᡂдॺՉࣁԶफ़ե HIV གࢉ‫ޑ‬॥ᓀ(103,104)Ƕ. ࣁΑफ़ե‫ݙ‬৔ᛰ᠅‫ޣ‬໺ኞ੯ੰ‫ޑ‬॥ᓀǴ೚ӭ‫ޑ‬฼ౣߡӢᔈԶғǴԶ ೭٤ଞჹ‫ݙ‬৔ᛰ᠅‫ޣ‬໺ࢉ੯ੰ‫ޑ‬฼ౣ߾ᆀࣁ෧্ीฝǴԶ෧্ीฝЬा ‫ޑ‬Ҟ‫ޑ‬ӧ‫ܭ‬Ⴃٛ࣬ᜢ੯ੰ‫ޑ‬໺ኞǴᆶ෧Ͽᙴᕍॄᏼᆶ‫཮ޗ‬ୢᚒǶ. όӕ୯ৎ‫ځ‬෧্ीฝ‫ޑ‬฼ౣΨԖ‫܌‬όӕǴЬाёϩࣁаΠ൳ᅿ฼ౣ: 1. ऍ؅✉ඹжᕍ‫ݤ‬ ӧ 1950 ԃжǴу৾εࢂчऍࢪಃ΋ঁ௦‫ڗ‬ऍ؅✉ඹжᕍ‫ޑݤ‬୯ৎǴ ЬाࢂࣁΑ෧ϿӢੇࢶӢ‫܌‬஥ٰ‫ޑ‬Ӓ্(105)Ƕ ऍ؅✉ӧШࣚ΢όϿӦБςࢂᎻТԋ᠅‫ޑ‬Ԗਏᕍ‫ݤ‬Ǵ೚ӭߏය‫ੇޑ‬ ࢶӢ֎१‫ޣ‬Ǵૈ೸ၸှࢥ (detoxification) ᆶ‫י‬ନ (abstinence) ᕍ‫ݤ‬ԋф ᕇள‫ݯ‬ᕍ(106)Ƕ΋ጇຑ՗਱Ꮉӓ٥ऍ؅✉ᕍ‫زࣴޑݤ‬ว౜Ǵ٬Ҕऍ؅✉ᕍ ‫ޑݤ‬Γ཮‫ׯ‬๓٬ҔᎻТᜪᛰ‫ނ‬ᆶ‫ځ‬д‫ݯ‬ᕍᆒઓ౦த‫ޑ‬ᛰ‫ޑނ‬௃‫ݩ‬ǴԶ෧ Ͽ‫ݙ‬৔‫ޑ‬ӒᓀՉࣁ(107)ǶԶќ΋ጇӧ Denver(108) ‫زࣴޑ‬Ψࡰр٬Ҕऍ؅✉ ᕍ‫ݤ‬ϤঁДࡕᛰ‫ނ‬٬Ҕᆶ HIV ‫ޑ‬ӒᓀՉࣁԖᕇள‫ׯ‬๓ǶฅԶᗨฅς࿶᛾ ჴऍ؅✉ᕍ‫ݤ‬ёа‫ׯ‬๓ᛰ‫ނ‬٬Ҕ‫ޑ‬௃‫ݩ‬Ǵՠऍ؅✉ᕍ‫ݤ‬ϝԖ‫ځ‬॥ᓀӸ ӧǴӧ٬Ҕऍ؅✉ᕍ‫ݤ‬Ψ໪ाԵቾ೚ӭ‫ځ‬д‫ޑ‬ୢᚒ(106)Ƕ 2. ᛰ‫ނ‬ඹж ऍ؅✉ᕍ‫ݤ‬ᗨฅёаᔅշ‫י‬ᘐᎻТᜪᛰ‫ޑނ‬ᔲҔǴՠჹ‫ܭ‬Ӽߚд‫ڮ‬ 27.

(39) ᜪᛰ‫ނ‬ᆶђ࢒ᡵࠅؒԖ࣬ӕ‫ޑ‬ਏҔ(109)ǴӢԜӧᐆ૥तථᆶम਱ើ໒‫ۈ‬๏ ϒαܺ‫ޑ‬Ӽߚд‫ޑڮ‬ीฝǴԶӧ೭ঁीჄ‫ޑ‬Οԃࡕว౜ǴԖ΋ъ‫ޑ‬٬Ҕ ‫ޣ‬ଶЗ‫ݙ‬৔ᛰ‫ނ‬ǴԶԖ 85%‫ޑ‬٬Ҕ‫ޣ‬ӧ೭ঁीฝ‫ࡼޑ‬ՉύؒԖ٬Ҕ‫܈‬Ӆ Ҕ‫ݙ‬৔‫ޑ‬Ҕ‫(ڀ‬110)Ƕ 3. ଞ‫ڀ‬Ҭඤ ε೽ϩ‫ޑ‬ᓉે‫ݙ‬৔‫ޣ‬வ҂ௗ‫ڙ‬ၸҺՖ‫ݯޑ‬ᕍ(111,112,113,114)Ǵऍ؅✉ᕍ‫ݤ‬ ჹᎻТᜪᛰ‫ނ‬٩ᒘ‫ޑޣ‬ਏҔԖज़ǴЬाࢂӢࣁ‫ݙ‬৔ᎻТᜪᛰ‫ޣނ‬ε೽ϩ Ψ཮ӝ‫ݙٳ‬৔ђ࢒ᡵǴԶ٬ளऍ؅✉ᕍ‫ݤ‬ค‫ݤ‬Ԗਏ‫ޑ‬ၲ‫ډ‬෧Ͽᛰ‫ނ‬ԋ᠅ ‫ޑ‬ᕍਏᆶ෧ϿӢ‫ݙ‬৔ՉࣁᏤठ‫ ޑ‬HIV ॥ᓀǶ‫׳‬Ԗࣴ‫ز‬ว౜ǴӧԖၸ‫ݯ‬ᕍ ࿶ᡍࠅΞൺว‫ݙ‬৔ᛰ‫ޣނ‬Ǵ཮Ӣ‫ݙ‬৔ᓎ౗ǵଞ‫ڀ‬ᆶᛰ‫ނ‬ӅҔ‫׳‬ᓎᕷԶᡉ ๱ቚуགࢉ HIV ‫ޑ‬॥ᓀ(115,116,117)ǶԶଞ‫ڀ‬Ҭඤ‫ޑ‬ख़ᗺӧ‫ܭ‬ᙖҗග‫ٮ‬ଳృ ‫ޑ‬ଞ‫ٰڀ‬෧Ͽԡࢉଞ‫ޑڀ‬ᒿཀቲక(118)ǴΨ෧Ͽଞ‫ڀ‬ӅҔᆶଞ‫ڀ‬ख़ፄ٬Ҕ ‫ޑ‬ԛኧ(119)Ƕӧફࠖ޹ѱଞ‫ڀ‬Ҭඤ‫ޑ‬฼ౣჴࡼࡕǴӧ၀୯ৎफ़եΑεऊ 33% HIV ‫ޑ‬วғ౗(119)ǴԶӧફऊΨफ़եΑ߈Я 70% HIV ‫ޑ‬วғ౗(120)ǴԶ ќ΋ጇӕኬӧફऊ‫܌‬բ‫ࡰزࣴޑ‬р၀ीฝ‫؂‬ԃග‫ٮ‬ଞ‫ڀ‬ϐҬඤኧໆᆶࢥ ᠅‫ޣ‬གࢉང෷ੰࢥϐวғ౗ӧ಍ी΢Ԗܴᡉॄ࣬ᜢ(121)Ƕᐞࢪӧ 1991 Կ 2000 ԃ௢Չమዅଞ‫ڀ‬ीฝࡕǴ಍ीԋਏࡕว౜Ԗჴࡼమዅଞ‫ڀ‬ीฝ‫ࠤޑ‬ ᙼǴ‫ځ‬གࢉང෷ੰࢥϐ౰Չ౗ѳ֡Πफ़ 18.6%ǴԶؒԖჴࡼ‫ᙼࠤޑ‬ϸԶѳ ֡ቚуΑ 8.1%ǴΞӢࣁ෧Ͽང෷ঁਢ‫ޑ‬วғǴ࿯࣪Α 13 ሹԿ 35 ሹऍߎ ‫ޑ‬ᙴᕍЍр(122)Ƕ 4. ‫܄‬௲‫ػ‬฼ౣ ೚ӭ෧্ीฝЬा‫ޑ‬Ҟ‫ޑ‬ӧ‫ܭ‬෧ϿӢᛰ‫ނ‬ᔲҔԶ໺ኞ HIV ‫ޑ‬॥ ᓀǴՠࠅ۹ౣ‫ޑ‬Ӣ‫܄‬Չࣁ໺ኞ HIV ‫ޑ‬೽ҽǶԖࣴ‫ࡰز‬рᛰ᠅‫ݙ‬৔‫܄ځޣ‬ Քߧεӭࢂߚᛰ‫ݙނ‬৔‫ޣ‬Ǵ٠ӧ຾Չ‫܄‬Չࣁਔᛰ᠅‫ݙ‬৔‫ࡐޣ‬Ͽ཮٬Ҕߥ ᓀ঺(123)ǶԶ‫๊ܔ‬٬Ҕߥᓀ঺К‫ځ‬дӒᓀՉࣁ‫׳‬ᜤа‫ׯ‬ᡂǴջ٬‫܄‬πբ‫ޣ‬ 28.

(40) ೏௲‫ػ‬πբਔѸ໪٬Ҕߥᓀ঺Ǵՠᆶ‫܄‬Քߧ຾Չ‫܄‬ՉࣁਔࠅࡐϿ٬Ҕߥ ᓀ঺(123)Ƕ‫ځ‬дΨࣴ‫ࡰز‬рჹ‫ܭ‬ᛰ᠅‫ݙ‬৔‫ޣ‬Զ‫ق‬Ǵ෧Ͽ‫܄‬Քߧ‫ঁޑ‬ኧ཮К ቚуߥᓀ঺‫ޑ‬٬Ҕٰ‫ޑ‬৒ܰ(124,125)Ƕ 5. ᛰ‫ނ‬٬Ҕ௲‫ػ‬ Ьाࢂଞჹ‫୔ޗ‬ϣ‫ޑ‬ᛰ᠅‫ݙ‬৔‫ޣ‬ᆶਠ༜଺Ԗᜢᛰ‫ނ‬٬Ҕ‫ޑ‬௲‫ػ‬ǴԖ ࣴ‫ࡰز‬рቚуᛰ᠅‫ݙ‬৔‫ޣ‬Ԗᜢ HIV ‫ޕޑ‬᛽Ԗշ‫ܭ‬෧Ͽдॺ‫ޑ‬ӒᓀՉࣁ (109). Ǵ Garfein ฻Γ(126)Ψว౜‫ݙ‬৔࿶ᡍӧ΋ԃϣ‫ޑ‬ᛰ᠅‫ޣ‬Ӣό྽٬Ҕ‫ݙ‬৔. ଞ‫ڀ‬Զགࢉ੯ੰ‫ޑ‬॥ᓀࢂനε‫ޑ‬ǶԶ೭ኬ‫ޑ‬ၗૻᡉҢჹ‫ܭ‬ཥ‫ݙ‬৔‫ޑޣ‬Ԗ ᜢ‫ݙ‬৔Չࣁ‫ޑ‬௲‫ࡐࢂػ‬ख़ा‫ޑ‬ǴฅԶ౜ӧჹ‫ܭ‬ᛰ᠅‫ݙ‬৔‫ޣ‬ӧ॥ᓀ‫ޕ‬᛽‫ޑ‬ ௲‫ػ‬΢ᗋόֹӄ (127)ǶԶӧѠ᡼‫ޑ‬෧্ीฝύፁғ௲‫ػ‬Ψࢂࡐख़ा‫ޑ‬΋ ᕉǴ‫׆‬ఈёаճҔჹ‫ܭ‬ଯӒᓀဂ‫ޑ‬ፁғ௲‫ٰػ‬෧Ͽ‫ݙ‬৔Չࣁ໺ࢉ੯ੰ‫ޑ‬ ᓎ౗Ǵ٠ଞჹਠ༜բϸࢥϐ࠹ᏤǴа෧Ͽ୯ϣߙϿԃᛰ‫ނ‬ᔲҔ‫ޑ‬௃‫׎‬Ƕ ෧্ीฝࡼՉӧ୯ϣΨ࣮‫ډ‬ΑԋਏǴਥᏵፁғ࿿੯ੰᆅ‫ֽڋ‬൩2006 ԃࢥࠔੰ஻ང෷෧্၂ᒤीฝ୺Չཷ‫ݩ‬ᇥܴ(128)Ǵӧ2005 ԃीฝࡼՉࡕǴ 2006 ԃ೯ൔགࢉ HIV ΓኧύǴӢ‫ݙ‬৔ՉࣁԶགࢉ‫ޑ‬ΓኧܴᡉΠफ़Ǵ‫܌‬ аё௢ፕ၀၂ᒤीฝࢂԖշ‫ܭ‬෧Ͽང෷གࢉҞ኱ϐၲԋǶ ջ٬όӕ‫ޑ‬୯ৎ‫ځ‬෧্ीฝ‫ޑ‬ϣ৒Ԗ‫܌‬όӕǴՠЬा‫ޑ‬Ҟ‫ޑ‬೿ࢂ‫׆‬ ఈёа෧Ͽ੯ੰ‫ޑ‬໺ࢉǴԶၲ‫ߥډ‬ៈ୯Γ଼ந‫ޑ‬Ҟ‫ޑ‬ǶԶ෧্ीฝ‫ځ‬Ь ा‫ޑ‬ჹຝջࢂᛰ‫ނ‬ᔲҔ‫ޣ‬Ǵჹ‫ܭ‬ᛰ‫ނ‬ᔲҔ‫ࡼޣ‬Չ෧্ीฝ฼ౣё෧Ͽᛰ ‫ނ‬ᔲҔ‫ޑ‬௃‫ݩ‬วғǶฅԶǴ෧্ीฝ‫୺ޑ‬Չሡाߏਔ໔‫ޑ‬ոΚᆶεໆ‫ޑ‬ ΓΚ଄ΚǴऩૈჹ‫ܭ‬Ԗԋࣁᛰ᠅‫ޣ‬॥ᓀ‫ޑ‬Γॺ๱Ћ଺ႣෳᆶႣٛ‫ޑ‬π բǴߡૈ‫׳‬ᑈཱུ‫ޑ‬ႣٛӢᛰ‫ނ‬ᔲҔ‫܌‬೷ԋ‫ޑ‬Ӓ্Ƕ. 29.

(41) ಃΎ࿯ ੯ੰ॥ᓀႣෳኳԄ ௲‫ׯ܈ػ‬ᡂε౲ჹ੯ੰ‫ޑ‬Ծ‫ך‬ᇡ‫ޣ܈ޕ‬ቚу҇౲ჹ‫ܭ‬੯ੰ‫ޕޑ‬᛽Ǵ ࣁ੯ੰ‫ޑ‬॥ᓀႣෳኳԄ (risk prediction model) ‫ޑ‬ЬाҞ‫ޑ‬ǴճҔԜᅿႣ ෳኳԄё຾΋‫ׯ؁‬ᡂ‫ځ‬ӒᓀՉࣁǶԶᛰ‫ނ‬ᔲҔ‫ޑ‬ႣෳኳԄ‫߾ॺך‬ёа๱ ख़‫ܭ‬ଯӒᓀ௼ဂ‫ځ‬ԋࣁᛰ‫ނ‬ᔲҔ‫ޑޣ‬ӒᓀӢη٠௖૸‫࣬ځ‬ᜢ‫܄‬Ǵ‫פ‬рЬ ाቹៜଯӒᓀဂᛰ‫ނ‬ᔲҔ‫ޑ‬ӒᓀӢηǴ٠຾΋‫ࡌ؁‬ҥ॥ᓀႣෳኳԄǴٰ ղᘐԜΓࢂցԖԋࣁᛰ‫ނ‬ᔲҔ‫ޑޣ‬॥ᓀǴаගԐᡣଯӒᓀ௼ဂ᝾᝺Ծ‫ך‬ ࢂցԖԋࣁᛰ‫ނ‬ᔲҔ‫ޑޣ‬॥ᓀǴ຾Զ‫ׯ‬ᡂԾ‫ޕޑي‬᛽ǵᄊࡋ‫ک‬ՉࣁǴа ၲ‫ډ‬෧Ͽԋࣁᛰ‫ނ‬ᔲҔ‫ޑޣ‬௃‫׎‬Ƕ. ଞჹ΋٤ᄌ‫܄‬੯ੰ‫܈‬ᕎੱǴӧ୯ѦςԖ೚ӭࣴ‫ࡌޣز‬ҥΑ೭٤੯ੰ ‫܈‬ᕎੱ‫ޑ‬॥ᓀႣෳኳԄǴаள‫زࣴځޕ‬ჹຝࢂցԖᑡੰ‫ޑ‬॥ᓀǶ‫ځ‬ύ‫׳‬ Ԗ٤੯ੰ‫ޑ‬॥ᓀႣෳኳԄ‫ࡌޑ‬ҥࢂ࿶җ಍ीᐒ౗‫ۺཷޑ‬ѐࡼՉǴ‫ٯ‬ӵǺ 1989 ԃǴ Gail ฻ΓճҔ٢ᕎϐ࣬ᜢӒᓀӢηѐࡌᄬ΋঺ᐒ౗಍ी‫ޑ‬Б ‫ݤ‬Ǵ຾Զीᆉр 5 ԃϣள٢ᕎ‫ޑ‬ᐒ౗(129,130)ǹԶ Framingham Ј᠌ࣴ‫ࢂز‬ ճҔШжࣴ‫( ز‬cohort study) ٰࡌҥ΋ঁႣٛύ॥‫ે୏ރ߷ک‬Ј᠌ੰ‫ޑ‬ ଼நႣෳኳԄ(131,132)ǹќѦǴࠖՕ‫ޑ‬ᕎੱࣴ‫ز‬ΨࢂаШжࣴ‫ޑز‬Б‫ݤ‬ѐࡌ ᄬӚᅿᕎੱႣෳኳԄǴӵεဉ‫ޔ‬ဉᕎǵ‫ޤ‬ᕎ฻฻Ǵ٠ஒԜ੯ੰႣෳኳԄ ࡌҥ‫ܭ‬ᆛၡୢ‫ڔ‬΢Ǵග‫ٮ‬ε౲ӭၲ 12 ᅿᕎੱ‫ޑ‬Ծ‫ך‬ᔠෳǴԜѦᗋϟಏӚ ᅿᕎੱ‫࣬ޑ‬ᜢ‫ޕ‬᛽‫ک‬ӒᓀӢη(133,134)ǶԶӧ୯ϣჹ‫ܭ‬Ԝᜪ੯ੰ‫ޑ‬॥ᓀႣෳ ኳԄ‫ࡌޑ‬ҥࣴ‫ࢂ߾ز‬ၨϿ‫ޑ‬ǴҞ߻ѝԖယ‫ד‬మ฻Γ(135)ࡌҥଞჹεဉ‫ޔ‬ဉ ᕎ‫ޑ‬॥ᓀႣෳኳԄϷ॥ᓀࡰ኱Ƕ. а΢‫ޑ‬೭٤੯ੰ‫ޑ‬॥ᓀႣෳኳԄεӭࢂࣁΑᄌ‫܄‬੯ੰ‫܈‬ᕎੱ‫ࡌ܌‬ᄬ ‫ޑ‬Ǵՠࢂჹ‫ܭ‬ᛰ‫ނ‬ᔲҔࠅલЮᜪ՟‫ޑ‬॥ᓀႣෳኳԄࣴ‫ز‬Ƕࡺҁࣴ‫׆ز‬ఈ 30.

(42) ᙖҗԏ‫ڗ‬ᛰ‫ނ‬ᔲҔ‫ޑޣ‬ୢ‫ڔ‬ၗ਑Ǵаੰ‫ٯ‬ჹྣࣴ‫ޑز‬Б‫פݤ‬рଯӒᓀ௼ ဂԋࣁᛰ‫ނ‬ᔲҔ‫ޑޣ‬ӒᓀӢηࡕǴаᡄᒠථӣᘜ಍ीБ‫ࡌݤ‬ҥёૈԋࣁ ᛰ‫ނ‬ᔲҔ‫ޑޣ‬ႣෳኳԄǴԜኳԄջࣁᛰ᠅‫ޑޣ‬॥ᓀႣෳኳԄǴϐࡕӆஒ ኳԄύ‫ޑ‬ӒᓀӢηϐӒᓀॶ࣬уࡕǴа ROC curve ‫ޑ‬Б‫ࡷݤ‬ᒧр፾྽‫ޑ‬ ॥ᓀ⸣ॶаᔅշ‫୔ॺך‬ϩԜࣴ‫ز‬ჹຝԖคԋࣁᛰ‫ނ‬ᔲҔ‫ޑޣ‬॥ᓀǶඤ‫ق‬ ϐǴຬၸԜ॥ᓀ⸣ॶ‫ޣ‬ёૈԖԋࣁᛰ‫ނ‬ᔲҔ‫ޑޣ‬॥ᓀǴԶե‫ܭ‬Ԝ॥ᓀ⸣ ॶ‫ؒ߾ޣ‬Ԗԋࣁᛰ‫ނ‬ᔲҔ‫ޑޣ‬॥ᓀ‫ޑ‬ёૈǶ. 31.

(43) ಃΖ࿯ ࣴ‫ࢎز‬ᄬᆶࣴ‫ࢬز‬ำ ಃ΋໨ ࣴ‫ࢎز‬ᄬ ࿶΢ॊ‫ޑ‬Ў᝘௖૸ࡕǴࣁΑႣٛᛰ‫ނ‬ᔲҔ௃‫ޑݩ‬ጭ‫ۯ‬ǵ෧ϿӢᛰ‫ނ‬ ᔲҔ‫܌‬ቚу࣬ᜢ‫ޑ‬ᙴᕍ࿶຤ᆶ‫ॄ཮ޗ‬ᏼǴ٠Αှᛰ‫ނ‬ᔲҔ‫ޑ‬ӒᓀӢηᆶ ᒪ໺Ӣη‫ޑ‬ቹៜǴҁࣴ‫ز‬ᔈҔࢬՉੰᏢ‫ޑ‬Б‫ݤ‬Ǵ௖૸ӧᅱ‫܌‬ύ‫܄ت‬ᛰ‫ނ‬ ᔲҔ‫ޑޣ‬ӒᓀӢηǴࡌҥ΋ঁ‫ڙ܄ت‬ӉΓϐᛰ‫ނ‬ᔲҔ॥ᓀႣෳኳԄǴ٠ ᅱෳӧ HIV-1 ໚‫܄‬஻‫ޣ‬ύǴԖคᛰ‫ނ‬ᔲҔՉࣁᆶ Val158Met ୷Ӣӭࠠ ‫܄‬ϐ໔‫࣬ޑ‬ᜢ‫܄‬Ƕ. ӧӒᓀӢηፓࢗБय़ǴЬाаᅱ‫܌‬ύ‫ڙ܄ت‬ӉΓ‫ޑ଺܌‬ୢ‫ڔ‬Ǵፓࢗ ቹៜᛰ‫ނ‬ᔲҔՉࣁ‫ޑ‬ӒᓀӢηǴхࡴΓαᏢᡂ໨Ϸ࣬ᜢӒᓀՉࣁӢηǴ ٠຾΋‫ࡌ؁‬ҥᛰ‫ނ‬ᔲҔ‫ޑ‬॥ᓀႣෳኳԄǴҔаղᘐԜ௼ဂࢂցԖᛰ‫ނ‬ᔲ Ҕ‫ޑ‬॥ᓀǴаගଯ‫ځ‬Ծ‫ך‬᝾᝺‫܄‬Ƕ. ӧ Val158Met ୷Ӣӭࠠ‫܄‬᠘‫ۓ‬Бय़ǴࢂճҔ HIV-1 གࢉ‫ ځޣ‬DNA ᔠᡏٰϩ‫୷ځ݋‬Ӣᓎ౗Ǵᕕှ Val158Met ୷Ӣӭࠠ‫܄‬ᆶᛰ‫ނ‬ᔲҔՉࣁϐ ࣬ᜢ‫܄‬ǶԜѦǴΨଞჹόӕ‫܄‬ձѐϩ‫ ݋‬HIV-1 ໚‫܄‬஻‫ޣ‬Ԗคᛰ‫ނ‬ᔲҔՉ ࣁᆶ Val158Met ୷Ӣӭࠠ‫࣬ޑ܄‬ᜢ‫܄‬Ƕ. 32.

(44) аΠࣁҁࣴ‫ز‬ϐࣴ‫ࢎز‬ᄬკǺ ΓαᏢᡂ໨ǵᛰ‫ނ‬ᔲҔ࣬ᜢ‫ޕ‬᛽ǵ! ᛰ‫ނ‬ᔲҔ࣬ᜢᄊࡋǵᛰ‫ނ‬ᔲҔ࣬ᜢՉࣁୢ‫ڔ‬ፓࢗ!. ᛰ‫ނ‬ᔲҔ‫ޕ‬᛽ǵᄊࡋǵՉࣁϐ! ᕉნӒᓀӢηຑ՗!. ᛰ‫ނ‬ᔲҔ॥ᓀႣෳኳԄࡌҥ! ୖԵၗ਑კ 8ǵ‫ڙ܄ت‬ӉΓϐᛰ‫ނ‬ᔲҔ॥ᓀႣෳኳԄࡌҥ HIV-1 ໚‫܄‬஻‫ޣ‬. ᛰ‫ނ‬ᔲҔ‫!ޣ‬ !. ߚᛰ‫ނ‬ᔲҔ‫!ޣ‬ ! Val158Met ୷Ӣӭࠠ‫܄‬. Val158Met ୷Ӣӭࠠ‫܄‬. ‫܄ت‬ᛰ‫ނ‬ᔲҔ‫ޣ‬. ζ‫܄‬ᛰ‫ނ‬ᔲҔ‫ޣ‬. ‫ߚ܄ت‬ᛰ‫ނ‬ᔲҔ‫ޣ‬. ζ‫ߚ܄‬ᛰ‫ނ‬ᔲҔ‫ޣ‬. Val158Met ୷Ӣӭࠠ‫܄‬. Val158Met ୷Ӣӭࠠ‫܄‬. Val158Met ୷Ӣӭࠠ‫܄‬. Val158Met ୷Ӣӭࠠ‫܄‬. ୖԵၗ਑კ 9ǵ HIV-1 ໚‫܄‬஻‫ ޣ‬COMT Val158Met ୷Ӣӭࠠ‫܄‬᠘‫ۓ‬. 33.

(45) ಃΒ໨ ࣴ‫ࢬز‬ำ ٩ࣴ‫ز‬Ҟ‫ޑ‬Ǵҁࣴ‫ز‬ԏ໣ 2007 ԃԾѠ᡼ӚӦᅱ‫܌‬ϣ‫ڙ܄ت‬ӉΓϐᛰ ‫ނ‬ᔲҔӒᓀӢηୢ‫ڔ‬ၗ਑)хࡴΓαᏢᡂ໨Ϸᛰ‫ނ‬ᔲҔ࣬ᜢ‫ޕ‬᛽ǵᄊࡋ‫ک‬ Չࣁϐፓࢗ*Ǵٰፓࢗᛰ‫ނ‬ᔲҔ‫ޑ‬ӒᓀӢη٠ࡌҥᛰ‫ނ‬ᔲҔ‫ޑ‬॥ᓀႣෳኳ ԄǶ. Զӧ HIV-1 ໚‫܄‬஻‫ ޣ‬Val158Met ୷Ӣӭࠠ‫܄‬ᅱෳ೽ϩǴ߾ࢂӧ 2007 ԃύ୯ᙴᛰεᏢߕ೛ᙴଣǴ‫ ڗܜ‬HIV-1 ໚‫ঁ܄‬ਢ‫ޑ‬ՈనኬҁǴаϩ ‫ ݋‬Val158Met ୷Ӣӭࠠ‫܄‬ჹ‫ ܭ‬HIV-1 ໚‫܄‬஻‫ޣ‬ӧᛰ‫ނ‬ᔲҔՉࣁ‫ޑ‬ቹ ៜǶ ҁࣴ‫ز‬ϐࣴ‫ࢬز‬ำკǺ 2007 ԃѠ᡼ӚӦᅱ‫܌‬ᆶ ύ୯ᙴᛰεᏢߕ೛ᙴଣ (IRB/Inform consent). Ѡ᡼ӚӦᅱ‫܌‬. ύ୯ᙴᛰεᏢߕ೛ᙴଣ. ӒᓀӢηୢ‫ڔ‬ፓࢗ. Ոనኬҁϐ୷Ӣࠠ᠘‫ۓ‬. ࣴ‫ز‬Ҟ‫ޑ‬΋. ࣴ‫ز‬Ҟ‫ޑ‬Β. ᛰ‫ނ‬ᔲҔӒᓀӢηፓࢗ. HIV-1 ໚‫܄‬஻‫ ޣ‬COMT Val158Met. (‫ڙ܄ت‬ӉΓᛰ‫ނ‬ᔲҔ॥ᓀႣෳኳԄ). ୷Ӣӭࠠ‫܄‬᠘‫ۓ‬. ୖԵၗ਑კ 10ǵࣴ‫ࢬز‬ำკ. 34.

(46) ಃΟകǵࣴ‫ز‬Б‫ݤ‬ ಃ΋࿯ ࣴ‫ز‬೛ी җ‫ܭ‬Ѡ᡼ᛰ‫ނ‬ᔲҔឦ‫ܭ‬ҍ࿾ՉࣁǴाவ΋૓҇౲ύ‫ܜ‬ᒧᛰ‫ނ‬ᔲҔ‫ޣ‬ ྽բࣴ‫ز‬ჹຝԖჴՉ΢‫֚ޑ‬ᜤǴӢԜࣁΑёаԖਏᒧ‫ڗ‬ᛰ‫ނ‬ᔲҔϐࣴ‫ز‬ ჹຝǴҁࣴ‫ز‬ӧၨܰௗ᝻‫ډ‬ଯӒᓀ௼ဂ‫ޑ‬ᅱ‫܌‬ύ‫ڙޑ‬ӉΓբኬҁ‫ޑ‬ᒧ ‫ڗ‬Ǵҗ‫ܭ‬ᅱ‫܌‬ύϐᛰ‫ނ‬ᔲҔ‫཮ޣ‬ӧᅱ‫܌‬ϣௗ‫࣬ڙ‬ᜢ෧্ीฝϐ௲‫ػ‬Ǵ຾ ΋‫؁‬ёаΑှ෧্ीฝϐԋਏǶҁࣴ‫ز‬а 2007 ԃԾѠ᡼ӚӦᅱ‫ڙ܄ت܌‬ ӉΓ຾Չᛰ‫ނ‬ᔲҔ‫ޕ‬᛽ǵᄊࡋ‫ک‬ՉࣁϐӒᓀӢηፓࢗୢ‫ڔ‬Ǵϩ‫݋‬ୢ‫ڔ‬ၗ ਑аࡌҥᛰ‫ނ‬ᔲҔ॥ᓀႣෳኳԄǶ ᛰ‫ނ‬ᔲҔ‫ޣ‬ӭࣁགࢉ HIV-1 ‫ޑ‬ଯӒᓀဂǴ HIV-1 ໚‫܄‬஻‫ޣ‬ᆶ߻ॊ ࣴ‫ز‬ჹຝ΋ኬǴӧ΋૓҇౲ύԖᒧኬ΢‫֚ޑ‬ᜤǴ٠Ъ HIV-1 ໚‫܄‬஻‫ޣ‬Ո నኬҁ‫ޑ‬ԏ‫ڗ‬όܰǴ໪ӧӼӄፁғϐᙴᕍଣ‫܌‬຾ՉǴӢԜࣁΑૈӼӄ‫ޑ‬ ԏ‫ ڗ‬HIV-1 ໚‫܄‬஻‫ޣ‬ϐՈనኬҁǴҁࣴ‫ܭز‬ၨܰௗ᝻‫ ډ‬HIV-1 ໚‫܄‬஻ ‫ޣ‬௼ဂ‫ޑ‬ᙴଣᔠᡍࣽԏ‫ڗ‬ՈనኬҁǴଞჹ HIV-1 ໚‫܄‬஻‫ޣ‬Ԗคᛰ‫ނ‬ᔲҔ Չࣁᆶ Val158Met ୷Ӣӭࠠ‫࣬ޑ܄‬ᜢ‫܄‬բϩ‫݋‬Ǵ٠຾΋‫؁‬ଞჹ‫܄‬ձբϩ ձள௖૸Ƕ ΋ǵࡌҥ‫ڙ܄ت‬ӉΓϐᛰ‫ނ‬ᔲҔ॥ᓀႣෳኳԄǺ (΋) ࣴ‫ز‬ჹຝ ӧኳԄࡌҥ೽ϩǴࣴ‫ز‬ჹຝࢂٰԾ‫ ܭ‬2007 ԃՏ‫ܭ‬ѠύᅱᅢǵѠύ࣮ Ӻ‫܌‬ǵѠύ‫܌ݯי‬ǵ໦݅ಃΒᅱᅢǵଯ໢ᅱᅢǵ޸ጪᅱᅢϣ‫ޑ‬ཥΕᅱ‫ت‬ ‫ڙ܄‬ӉΓ‫ޑ଺܌‬ᛰ‫ނ‬ᔲҔ‫ޕ‬᛽ǵᄊࡋ‫ک‬ՉࣁϐӒᓀӢηፓࢗୢ‫ڔ‬ϣϐၗ ਑Ƕӧ HIV-1 ໚‫܄‬஻‫ ޣ‬Val158Met ୷Ӣӭࠠ‫܄‬᠘‫ۓ‬೽ϩǴࣴ‫ز‬ჹຝࢂ 2007 ԃύ୯ᙴᛰεᏢߕ೛ᙴଣᔠᡍࣽ HIV-1 ໚‫ੰ܄‬஻ϐՈనኬҁ. 35.

(47) (Β) ୢ‫ڔ‬ၗ਑৤ϣ৒ ୢ‫ڔ‬ၗ਑ϣ৒хࡴࣴ‫ୖز‬ᆶӕཀਜǵ୷ҁၗ਑ǵᛰ‫ނ‬ᔲҔ࣬ᜢ‫ޕ‬᛽ ᚒǵᛰ‫ނ‬ᔲҔᛰ‫ނ‬ᔲҔ࣬ᜢᄊࡋᚒǵᛰ‫ނ‬ᔲҔ࣬ᜢՉࣁᚒǵࢥࠔ٬Ҕ௃ ‫׎‬Ƕҁୢ‫ڔ‬ӧࡼෳ߻ς࿶࿶ၸ஑ৎਏࡋቩࢗǶࣴ‫ز‬Ԗᜢᛰ‫ނ‬ᔲҔϐӒᓀ Ӣηࢂаୢ‫ڔ‬ፓࢗ‫ޑ‬БԄ຾ՉǶхࡴࣴ‫ز‬ीฝᇥܴǵୢ‫ڔ‬ϣ৒ᖱှᆶ༤ ቪǶୢ‫ڔ‬ၗ਑৤ϣ৒၁ኧӵΠǺ 1. ୷ҁΓαᏢၗ਑ ϣ৒Ԗᅱ‫܌‬Ӝᆀǵ‫ي‬ϩ᛾ӷဦǵрғВයǵ‫܄‬ձǵᝤೣǵۚՐӦǵ ஆ࠷‫ݩރ‬ǵ௲‫ػ‬ำࡋǵᙍ཰ǵΕᅱԛኧ฻Ƕ 2. ᛰ‫ނ‬ᔲҔ࣬ᜢ‫ޕ‬᛽ᚒ ϣ৒Ԗᛰ‫ނ‬ᔲҔ‫ޣ‬ԋ᠅௃‫׎‬ǵ෧্ीฝϣ৒!)ඹжᕍ‫*ݤ‬ǵᔲҔᛰ‫ނ‬ ଎ࡘǵ੯ੰ໺ࢉ฻Ƕ 3. ᛰ‫ނ‬ᔲҔ࣬ᜢᄊࡋᚒ ϣ৒хࡴԾ᝺ԋࣁᛰ‫ނ‬ᔲҔ‫ޑޣ‬Ӓᓀ‫܄‬ǵௗ‫ڙ‬Ծρ‫܈‬дΓԋࣁᛰ‫ނ‬ ᔲҔ‫ޑޣ‬ᄊࡋ฻Ƕ 4. ᛰ‫ނ‬ᔲҔ࣬ᜢՉࣁᚒ ᜢ‫ܭ‬ӒᓀՉࣁୢᚒϣ৒хࡴಃ΋ԛ‫܄‬Չࣁԃសǵࢥࠔ٬Ҕ ௃‫׎‬ϐୢ ᚒԖ֎१‫ݙ܈‬৔ࢥࠔᅿᜪǵ֎१‫ݙ܈‬৔ࢥࠔԃኧǵಃ΋ԛ֎१‫ݙ܈‬৔ࢥ ࠔԃសǵࢥࠔ٬Ҕᓎ౗ǵӅҔଞᓐ‫܈‬ӅҔีញనϐ௃‫׎‬ǵ‫܄‬Քߧ٬Ҕࢥ ࠔ‫ޑ‬௃‫׎‬฻ǹќѦᗋԖᑡ஻‫ޑੰ܄‬௃‫ݩ‬ǵਈՈ฻ϣ৒Ƕ (Ο) ಍ीϩ‫݋‬ ୢ‫ڔ‬ၗ਑৤ύ‫ޑ‬ၗ਑а SPSS 13.0 ‫ ܈‬SAS 9.1 ঺း೬ᡏ଺಍ीϩ ‫݋‬ೀ౛Ƕ಍ीϩ‫݋‬Б‫ݤ‬х֖ඔॊ‫܄‬಍ी‫ک‬ϩ‫܄݋‬಍ीǴඔॊ‫܄‬಍ी‫ޑ‬೽ ϩࢂаѳ֡ॶ²኱ྗৡٰբೱុᡂ໨‫ޑ‬և౜Ǵᜪձᡂ໨߾ࢂаԭϩКٰբ ߄ҢǴ຾΋‫؁‬ӧа t ᔠ‫ۓ‬ᆶьБᔠ‫ٰۓ‬բ‫ٿ‬ಔ໔‫ޑ‬Кၨᆶϩ‫݋‬Ǵ٠ճҔᚈ 36.

(48) ‫׀‬ᔠ‫ۓ‬а P < 0.05 ࣁၲ಍ी΢ᡉ๱ৡ౦Ƕ (Ѥ) ኳԄࡌҥ ಍ीϩ‫݋‬ύǴᡄᒠථӣᘜ (logistic regression) ‫ࡌ܌‬ҥ‫ޑ‬ኳԄջࣁᛰ ‫ ނ‬ᔲ Ҕ ॥ ᓀ Ⴃ ෳ ኳ Ԅ Ƕ Ԝ Ѧ Ǵ ٬ Ҕ ROC curve (receiver operating characteristic curve) ‫ ݀ ่ ޑ‬، ‫ ۓ‬Ԗ ค ԋ ࣁ ᛰ ‫ ނ‬ᔲ Ҕ ‫ ޣ‬॥ ᓀ ‫ॶ ⸣ ޑ‬ (threshold)Ƕ Βǵ HIV-1 ໚‫܄‬஻‫ ޣ‬Val158Met ୷Ӣӭࠠ‫܄‬᠘‫ۓ‬Ǻ (΋) ࣴ‫ز‬ჹຝ ӧ HIV-1 ໚‫܄‬஻‫ ޣ‬Val158Met ୷Ӣӭࠠ‫܄‬᠘‫ޑۓ‬೽ϩǴࣴ‫ز‬ჹຝ ࢂ 2007 ԃύ୯ᙴᛰεᏢߕ೛ᙴଣᔠᡍࣽ HIV-1 ໚‫ੰ܄‬஻ϐՈనኬҁ (Β) ୷ҁၗ਑ϣ৒ Ԝࣴ‫ز‬ፓࢗԏਢϐࣴ‫ز‬ჹຝ‫ޑ‬ΓαᏢ୷ҁᡂ໨)‫܄‬ձ* ᆶࢂցࣁᛰ ‫ނ‬ᔲҔ‫ޣ‬Ƕ (Ο) Ոనኬҁϩ‫݋‬ ௦໣‫ڬ‬ᜐՈనኬҁǴ๧‫ڗ‬қՈౚరЃಒझ (Lymphocyte) ϐ DNA а ᆫӝ䁙᜘ᙹϸᔈ-ज़‫ڋ‬䁙Тࢤߏࡋӭࠠ‫( ܄‬PCR-RFLP) բ Val158Met ୷ Ӣӭࠠ‫ޑ܄‬᠘‫ۓ‬Ƕ (Ѥ) ಍ीϩ‫݋‬ Ոనኬҁ࿶୷Ӣࠠ᠘‫ޑࡕۓ‬ၗ਑а SPSS 13.0 ‫ ܈‬SAS 9.1 ঺း೬ᡏ ຾Չ಍ीϩ‫݋‬ೀ౛Ƕ಍ीϩ‫݋‬Б‫ݤ‬х֖ඔॊ‫܄‬಍ी‫ک‬ϩ‫܄݋‬಍ीǴඔॊ ‫܄‬ϩ‫݋‬аԭϩКբᜪձᡂ໨‫ޑ‬և౜Ǵ٠аьБᔠ‫ۓ‬ϩ‫ ݋‬HIV-1 ໚‫܄‬஻‫ޣ‬ Val158Met ୷Ӣᆶᛰ‫ނ‬ᔲҔՉࣁϐ࣬ᜢ‫܄‬Ǵ٠຾΋‫؁‬ჹ‫܄‬ձբϩቫϩ ‫݋‬ǴନԜϐѦǴΨ຾΋‫؁‬ѐКၨᛰ‫ނ‬ᔲҔ‫ޣ‬ᆶߚᛰ‫ނ‬ᔲҔ‫܄ځޣ‬ձӧ Val158Met ୷Ӣᓎ౗΢‫ޑ‬ৡ౦Ƕ. 37.

(49) ಃΒ࿯ ࣴ‫ز‬ჹຝ ΋ǵġ ‫ڙ܄ت‬ӉΓϐᛰ‫ނ‬ᔲҔ॥ᓀႣෳኳԄࡌҥ ӧኳԄࡌҥ೽ϩǴࣴ‫ز‬ჹຝࢂٰԾ‫ ܭ‬2007 ԃՏ‫ܭ‬Ѡ᡼Ӧ୔‫ޑ‬ᅱᅢǵ ࣮Ӻ‫܌‬Ϸ‫܌ݯי‬ϣ‫ޑ‬ཥΕᅱ‫ڙ܄ت‬ӉΓ‫ޑ଺܌‬ᛰ‫ނ‬ᔲҔ‫ޕ‬᛽ǵᄊࡋ‫ک‬Չ ࣁϐӒᓀӢηፓࢗୢ‫ڔ‬ϣϐၗ਑Ƕҁࣴ‫ز‬௦ੰ‫ٯ‬ჹྣࣴ‫( ݤز‬case-control study) ٰ௖૸‫ځ‬ӒᓀӢηǶ‫ځ‬ύᅱ‫܌‬х֖ѠύᅱᅢǵѠύ࣮Ӻ‫܌‬ǵѠύ ‫܌ݯי‬ǵ໦݅ಃΒᅱᅢǵଯ໢ᅱᅢǵ޸ጪᅱᅢǶԏ‫ڗ‬ϐୢ‫ڔ‬Ӆी 1089 ҽǴ ᛰ᠅‫ޣ‬Ӆ 753 ΓǴߚᛰ᠅‫ޣ‬Ӆ 336 Γ)߄΋*Ƕ ‫ڙ܄ت‬ӉΓϐᛰ‫ނ‬ᔲҔ॥ᓀႣෳኳԄϐࣴ‫ز‬ჹຝٰྍϷΓኧ ࣴ‫ز‬ჹຝٰྍ. ᛰ‫ނ‬ᔲҔ‫(ޣ‬Γኧ). ߚᛰ‫ނ‬ᔲҔ‫(ޣޣ‬Γኧ) Total(Γኧ). Ѡύᅱᅢ. 295. 190. 485. Ѡύ࣮Ӻ‫܌‬. 138. 2. 140. Ѡύ‫܌ݯי‬. 63. 0. 63. ໦݅ಃΒᅱᅢ. 132. 72. 204. ଯ໢ᅱᅢ. 89. 50. 139. ޸ጪᅱᅢ. 36. 22. 58. Total (Γኧ). 753. 336. 1089. Βǵġ HIV-1 ໚‫܄‬஻‫ ޣ‬COMT Val158Met ୷Ӣӭࠠ‫܄‬ᅱෳ ӧ HIV-1 ໚‫܄‬஻‫ ޣ‬COMT Val158Met ୷Ӣӭࠠ‫܄‬ᅱෳ‫ޑ‬೽ϩǴࣴ‫ز‬ ჹຝࢂ 2007 ԃٰԾ‫ܭ‬ύ୯ᙴᛰεᏢߕ೛ᙴଣᔠᡍࣽ HIV-1 ໚‫ੰ܄‬஻ϐ ՈనኬҁǴԖ 142 Տᛰ‫ނ‬ᔲҔ‫ ܄ت)ޣ‬128 ՏǴζ‫ ܄‬14 Տ*Ǵ256 Տᛰ‫ނ‬ ᔲҔ‫ ܄ت)ޣ‬203 ՏǴζ‫ ܄‬36 Տ*ǴӅԏ‫ ڗ‬381 Տ HIV-1 ໚‫܄‬஻‫ޣ‬ϐՈ నኬҁǶ)߄Β* 38.

(50) HIV-1 ໚‫܄‬஻‫ ޣ‬COMT Val158Met ୷Ӣӭࠠ‫܄‬ᅱෳϐࣴ‫ز‬ჹຝΓኧ ࣴ‫ز‬ჹຝ‫܄‬ձ ᛰ‫ނ‬ᔲҔ‫(ޣ‬Γኧ) ߚᛰ‫ނ‬ᔲҔ‫(ޣ‬Γኧ) Total(Γኧ) ‫܄ت‬. 128. 203. 331. ζ‫܄‬. 14. 36. 50. Total (Γኧ). 142. 239. 381. 39.

(51) ಃΟ࿯ ၗ਑ԏ໣ၸำ Ѡ᡼ӚӦᅱ‫ڙ܌‬ӉΓၗ਑ԏ໣ Ѡ᡼ӚӦᅱ‫ڙ܌‬ӉΓ‫ޑ‬ၗ਑хࡴѠύᅱᅢǵѠύ࣮Ӻ‫܌‬ǵѠύ‫ݯי‬ ‫܌‬ǵ໦݅ಃΒᅱᅢǵଯ໢ᅱᅢǵ޸ጪᅱᅢϐ‫ڙ܄ت‬ӉΓ‫܌‬༤เϐᛰ‫ނ‬ᔲ Ҕ࣬ᜢፓࢗୢ‫ڔ‬Ƕ࿶җࣴ‫ز‬Γ঩ᖱှࣴ‫ز‬Ҟ‫ޑ‬Ϸࣴ‫ز‬ჹຝ‫៾ޑ‬ճᆶက୍ ࡕǴ๏ϒ‫ڙ‬ӉΓᛝ࿿ୢ‫ڔ‬ӕཀਜǴ࿶җ‫ڙ‬ӉΓӕཀࡕǴϒа຾Չୢ‫ڔ‬ፓ ࢗǶୢ‫ڔ‬ϣ৒ӧ຾Չ߻ς࿶ၸ஑ৎਏࡋ‫ޑ‬ቩࢗǴୢ‫ڔ‬ϣ৒хࡴǺ 1. ୷ҁΓαᏢၗ਑ ϣ৒хࡴᅱ‫܌‬Ӝᆀǵ‫ي‬ϩ᛾ӷဦǵрғВයǵ‫܄‬ձǵᝤೣǵۚՐӦǵ ஆ࠷‫ݩރ‬ǵ௲‫ػ‬ำࡋǵᙍ཰ǵΕᅱԛኧ฻Ƕ 2. ᛰ‫ނ‬ᔲҔ࣬ᜢ‫ޕ‬᛽ᚒ ϣ৒хࡴᛰ‫ނ‬ᔲҔ‫ޣ‬ԋ᠅௃‫׎‬ǵ෧্ीฝϣ৒ (ඹжᕍ‫)ݤ‬ǵ੯ੰ໺ ࢉ฻Ƕ 3. ᛰ‫ނ‬ᔲҔ࣬ᜢᄊࡋᚒ ϣ৒хࡴԾ᝺ԋࣁᛰ‫ނ‬ᔲҔ‫ޑޣ‬Ӓᓀ‫܄‬ǵௗ‫ڙ‬Ծρ‫܈‬дΓԋࣁᛰ‫ނ‬ ᔲҔ‫ޑޣ‬ᄊࡋ฻Ƕ 4. ᛰ‫ނ‬ᔲҔ࣬ᜢՉࣁᚒ ᜢ‫ܭ‬ӒᓀՉࣁୢᚒϣ৒хࡴಃ΋ԛ‫܄‬Չࣁԃសǵࢥࠔ٬Ҕ௃‫׎‬ǵ֎ १‫ݙ܈‬৔ࢥࠔᅿᜪǵ֎१‫ݙ܈‬৔ࢥࠔԃኧǵಃ΋ԛ֎१‫ݙ܈‬৔ࢥࠔԃសǵ ࢥࠔ٬Ҕᓎ౗ǵ‫܄‬Քߧ٬Ҕࢥࠔ‫ޑ‬௃‫׎‬฻ǹќѦᗋԖᑡ஻‫ޑੰ܄‬௃‫ݩ‬฻ ϣ৒Ƕ. 40.

(52) ύ୯ᙴᛰεᏢߕ೛ᙴଣᔠᡍࣽՈనኬҁԏ໣ ҁࣴ‫ز‬࿶ύ୯ᙴᛰεᏢߕ೛ᙴଣΓᡏ၂ᡍ‫ہ‬঩཮ቩࢗࡕӕཀǴᔠᡍ ࣽග‫ ٮ‬HIV-1 ໚‫ੰ܄‬஻ՈనኬҁǶќѦǴҁࣴ‫ز‬ύሡፓࢗԏਢϐࣴ‫ز‬ჹ ຝ‫ޑ‬ΓαᏢ୷ҁᡂ໨)‫܄‬ձ*ᆶࢂցࣁᛰ‫ނ‬ᔲҔ‫ޣ‬Ǵՠҗ‫ܭ‬ᔠᡍࣽύ‫ࣴޑ‬ ‫ز‬ჹຝࣣؒԖ຾Չୢ‫ڔ‬ፓࢗǴ‫܌‬а‫ځ‬ΓαᏢ࣬ᜢၗ਑߾җᙴଣύ‫ੰޑ‬ᐕ ၗ਑‫ڗ‬ளǶ. 41.