探討味覺異常在第五期慢性腎臟病病人初次血液透析前後的差異

研究背景與目的：味覺是日常生活中重要的感官之一，食物的選擇、營養補充或是電解質的平衡都與之息息相關，一旦發生味覺障礙，可能會導致營養不良，過去的研究顯示味覺改變是慢性腎臟病腎病人的常見症狀之一，毒素累積在口腔中的積累會引起口腔異味，加上鋅鐵的缺乏和唾液的減少會影響味覺轉移至其受體，從而導致味覺功能障礙。要了解非透析終末期腎病患者的口味，以及實施口味評估工具的過程既昂貴又費時。故本研究旨於了解尚未接受血液透析的第五期慢性腎臟病病人主客觀味覺功能研究方法：本研究採橫斷式研究設計，自2020年5月2日至2021年5月5日，以尚未接受血液的第五期慢性腎臟病(eGFR <15 ml / min / 1.73m2)病人為受試對象，排除已知患有會影響味覺功能的疾病，包含：帕金森氏症、甲狀腺功能低下、乾燥症、近半年內接受過化學或放射治療、頭頸部腫瘤、進行頭頸部外科手術者、無法配合測試者或是認知功能障礙者。我們將首先使用中文(台灣版)蒙特利爾認知評估來評估病人的認知功能，如果得分高於23.5，則進行味覺功能的評估，反之則排除。使用德國製味覺試紙（Taste strips）來評估客觀味覺，使用味覺問卷評估主觀味覺，並持續追蹤受試者是否接受血液透析，在首次接受血液透析的受試者，將於接受過三次血液透析後再使用味覺試紙進行第二次味覺評估。研究結果：本研究中尚未接受血液透析的第五期慢性腎臟病病人中使用味覺試紙測試的味覺障礙的發生率為57.1%，基本味道障礙中以酸味最高88.9%。在味覺問卷中的自覺味覺改變發生率為25.4%，對味覺最多的抱怨為口中有不良的氣味。味覺試紙與味覺問卷兩者間分數不一致，使用費雪精確性檢定也呈現不顯著。接受血液透析後使用味覺試紙測試味覺分數進步且味覺障礙發生率改善。結論：味覺障礙在第五期慢性腎臟病病人的發生率為57.1%，儘早偵測味覺障礙及早進行適當處置，將可避免額外增加醫療成本及給予病人更好的生活品質，主客觀味覺不一致，建議之後的研究可以一併探討。

關鍵字

味覺；味覺試紙；慢性腎臟病；血液透析

並列摘要

Background Objective: Taste is one of the most important sensories in daily's activity. Food choice, drinking, nutritional supplement are all related to the taste. Once taste dysfunction occurred could contribute to malnutrition. Studies showed that the change of taste was a common symptom in end-stage renal disease patients. The accumulation of uremic in the oral cavity causes oral odor, plus lack of zinc, iron, and reduction of saliva would affect the tastants transferred to its receptors leads to taste dysfunction. To understand taste in non-dialysis end-stage renal disease patients, and due to it was expensive and time-consuming to implement the taste assessment tool. Thus, the main purpose of this study is: To investigate the difference of taste dysfunction before and after first hemodialysis in chronic kidney disease stage 5 patients. Method: This was a self-controlled case series about taste dysfunction. We enrolled subjects who have to be over 20 years old and are diagnosed with chronic kidney disease stage 5 (eGFR < 15 ml/min/1.73m2) but haven’t been under hemodialysis yet from the outpatient department of nephrology at a medical center in Taiwan from May 2nd, 2020 to May 5th, 2021. Those who had diseases that affect the taste, and severe communication difficulty were excluded. We first used Montreal Cognitive Assessment to assess the patient’s cognitive function, if the score was higher than 23.5, then the assessments would be done. To assess the objective taste dysfunction by using taste strips. All subjects were asked not to eat or drink anything and not to brush their teeth one hour before. Taste strips was made of 8 cm and a tip area of 2 cm2 based on filter paper strips and being impregnated with tastant (4 concentrations each of the 4 basic taste qualities). The strips would place on the subject's left or right side of the anterior tongue, and they had a forced choice to answer what kind of taste. The number of correctly identified taste would add up to a “taste score”, range from 0 to 16, and which less than 9 would regard as taste dysfunction. To assess subjective taste change by using taste complaint questionnaire. When received first hemodialysis for 3 times, would accept 2nd taste strips test. Data will be analyzed with descriptive and inferential statistics using R studio statistic software. Results: In this study, the incidence of taste dysfunction in chronic kidney disease stage 5 who had not yet undergone hemodialysis was 57.1% with taste strips test, and the highest rate of sour taste was 88.9% among basic taste disorders. The incidence of subjective taste changes in the taste complaint questionnaire was 25.4%, and the most complaint about taste was a bad smell in the mouth. The scores between the taste strips test and the taste complaint questionnaire were inconsistent, and Fisher's exact test showed that was not significant. After receiving hemodialysis, the improvement of taste score and the incidence of taste dysfunction, with taste strips test. Conclusion: The incidence of taste dysfunction in non-dialysis chronic kidney disease stage 5 was 57.1%. Early detection and proper intervention will lower the medical cost and improve the quality of life. Given the inconsistency of subjective and objective tastes, it is suggested that further research can be discussed together.