慢性腎臟病高危險群及病人之病程變化與相關因素研究

The Disease Progression and Related Factors in Subjects with or at Risks of Chronic Kidney Disease

本研究旨在探討慢性腎臟病高危險群及病人的疾病發生率、盛行率及病程嚴重度進退階變化，並探究影響慢性腎臟病分期之相關因素，以作為在慢性腎臟病防治擬訂策略與計畫之參考。以立意取樣選取民國98至100年間在南投縣某地區醫院有尿液及血液肌酸酐檢驗2次以上之高危險群及病人為研究對象共366人，女性佔53.0%，男性佔47.0%，平均年齡為64.2±12.0歲。以結構式問卷調查研究樣本個人屬性、過去治療病史及自我照顧的健康行為。結果發現：慢性腎臟病發生率為在98~99年為50.0%、99~100年為42.9%、98~100年間為46.9%。慢性腎臟病盛行率在98年為66.8%、99年為68.1%、100年為51.5%；區分各年各期時：慢性腎臟病第1、2期由98年的43.8%下降到100年為28.2%，第3-5期由98年的22.9%上升到100年為23.3%。病程變化顯示轉好的期數增加，轉壞的期數減少，與發生率、盛行率下降的結果吻合。單變項分析顯示年齡愈大愈易罹患第3期以上慢性腎臟病；男性罹患慢性腎臟病較女性為多，且嚴重度也較高；糖尿病人罹病率較無病史者為4.01倍；高血脂、使用降血糖或降血脂藥、按時使用降血糖或降血脂藥，影響慢性腎臟病發生與分期有顯著差異。以多項式邏輯斯複迴歸分析發現：年齡、性別及糖尿病史是影響罹患慢性腎臟病的最主要原因。經由地區性流行病學調查及探究其相關影響因子，研擬適切預防保健及健康促進措施，及早施以個案健康管理，既可降低民眾罹患慢性腎臟病，亦可延緩演變成末期腎衰竭。

The purpose of this study was to investigate the disease incidence, prevalence and course changes of the disease severity of high-risk groups and patients with chronic kidney disease (CKD), and explore the related factors that affected the staging of CKD, as references for medical professionals to formulate strategies and plans for prevention of CKD. Using purposive sampling, we selected the high-risk group and patients with CKD, who had taken urine and blood creatinine examination at least twice between 2009 and 2011, and were willing to participate in the survey in a Nantou district hospital. The total number of subjects was 366 persons including 47.0% males and 53.0% females. The average age of subjects was 64.2±12.0. A structured questionnaire survey included sample personal attributes, past history of treatment and self-care behavior of health. The results showed that: The incidence of CKD was 50.0% in 2009-2010, 42.9% in 2010- 2011, and 46.9% in 2009-2011 respectively. The prevalence of CKD was 66.8% in 2009, 68.1% in 2010 and 51.5% in 2011. Based on stages of disease, the prevalence rate for stage 1 and 2 of CKD decreased from 43.8% in 2009 to 28.2% in 2011, and for stage 3, 4 and 5 of CKD increased from 22.9% in 2009 to 23.3% in 2011. The disease progression indicated that stages of CKD for which the patient got better were going upward, and those for which the patient got worse were going downward. This result matched with the downtrend of incidence and prevalence rate for CKD. Based on the univariate analysis, the older the individual, the more vulnerable to be affected with the stage 3-5 of CKD. Males were more vulnerable and severe to be affected with CKD than females. The patient with diabetes mellitus was 4.01 times more likely to be affected with CKD than those without it. The impact of hyperlipidemia, taking hypoglycemic drugs, taking hypoglycemic drugs regularly, taking hypolipidemic drugs, and taking hypolipidemic drugs regularly on the occurrence and stage of CKD showed significantly different. Applying the multinomial logistic multiple regression analysis, we found that sex, age and the history of having diabetes mellitus are major factors in the causes of CKD. Through applying the regional epidemiological investigation and exploring related factors of CKD, we propose appropriate preventive care and health promotion measures, and early impose cases health management. We can not only reduce people suffering from CKD, but also delay the evolution of CKD to end-stage renal failure.