血液透析病患周邊動脈疾病盛行率及相關因素

Prevalence and Risk Factors of Peripheral Arterial Disease Among Hemodialysis Patients

背景：周邊動脈疾病容易被一般人與血液透析病人所忽略，若不妥善治療，常演變為心臟病、腦中風或截肢。長期透析患者是周邊動脈疾病的高危險群，過去的研究只針對單一醫院的病患研究，本研究希望透過跨醫院的合作，增加研究的樣本數做更深入的探討。目的：本研究之目的在於評估血液透析病患併有周邊動脈疾病之盛行率及分析其相關因素。方法：以三家醫院之275位常規血液透析病患為研究對象，以結構式問卷收集資料，內容包含人口學特質、過去病史與生活習慣，並參閱病歷收集受訪者之臨床生化檢驗值資料；周邊動脈疾病之診斷標準為其中有一側足踝及手臂收縮壓比值<0.9。結果：長期透析患者周邊動脈疾病之盛行率為16.9%，有周邊動脈疾病平均年齡（69.2歲）顯著大於非周邊動脈疾病者(59.8歲)，罹患任何一種慢性病、糖尿病與冠狀動脈硬化（分別為95.6％、66.7％、37.8％）亦均顯著高於非周邊動脈疾病者(73.4％、26.6％、8.6％)，但透析前尿素氮與透析前肌酸酐顯著低於非周邊動脈疾病者；複邏輯斯迴歸分析顯示，年齡越大、糖尿病、冠狀動脈硬化罹患周邊動脈疾病勝算比顯著較高，而透析前尿素氮濃度的增加與較低的周邊動脈疾病勝算比有顯著相關。結論：相較於國外研究，本研究顯示長期透析患者的周邊動脈疾病盛行率較低；本研究也發現周邊動脈疾病比率與年齡、糖尿病、冠狀動脈硬化病史與透析前尿素氮濃度有顯著相關。

Background: Peripheral arterial disease (PAD) is often neglected in usually person and undergoing hemodialysis patients. If PAD patients do not receive proper care, they run greater risks of heart disease, stroke, and amputation. Hemodialysis patients are high-risk population of PAD. The similar studies in Taiwan before which just only conducted in one hospital. Researchers invited three hospitals to join this study and enlarge sample size for deeply explore this issue. Objects: The purposes of this study are to evaluate the prevalence of PAD among dialysis patients and to analyze the correlations between PAD and risk factors (such as demographic characteristics, clinical biochemical values and life habits). Methods: Total of 275 regular hemodialysis patients which selected from three hospitals participated in this study. Data were collected by a constructed questionnaire which included information on demography, past history and life habits. Researchers also collected clinical biochemical data by patient record. The diagnosis criteria of PAD is ankle-brachial index (ABI) <0.9. Results: The prevalence rate of PAD among dialysis patients was 16.9%. The mean age of PAD patients are older than non-PAD patients (69.2 vs 59.8). These PAD patients suffer for any one chronic disease, diabetes mellitus, and coronary heart disease were 95.6%, 66.7%, and 37.8%, respectively. Above three prevalence rates of PAD patients were higher than non-PAD patients (73.4%, 26.6% and 8.6%, respectively). Multiple logistic regressions analysis showed that age, diabetes mellitus, and coronary heart disease are risk factors of PAD. Additionally, the more urea nitrogen concentration on pre-dialysis stage revealed less odd on PAD. Conclusions: The prevalence rate of PAD among dialysis patients in this study was less than most of foreign study. This study also finds that age, diabetes mellitus, cardiovascular diseases, and urea nitrogen concentration on pre-dialysis stage are significantly related to PAD.