蛋白尿在醫療從業人員之盛行率及危險因子研究

背景及目的：醫療從業人員為民眾健康的守護者；其健康狀況良好時，能提供品質較佳且更具說服力的醫療服務。國際健康促進醫院網絡(The International Network of Health Promoting Hospitals & Health Services)多年前即把醫院員工的健康促進列為必備環節之一。腎臟病因人口老化及生活型態改變等因素，在許多國家的盛行率日漸上升，成為公共衛生之重要議題。而蛋白尿可有效偵測早期腎臟病、作為心血管疾病的風險指標、並透過適當介入而改善病患預後，故在近年來受到極大的強調及重視。本研究指在了解蛋白尿於醫療從業人員的盛行現況及相關危險因子。方法：此為橫斷性之流行病學研究。使用北部某醫學中心五年間員工健檢結果，擷取符合納入條件之個案後，進行尿蛋白陽性之描述性統計及危險因子分析。結果：母群體共有4,330人。平均年齡(mean ±SD)為40.18±8.43歲，身體質量指數23.78±3.86。尿蛋白陽性之總盛行率為2.33％，男略高於女，超過40歲族群高於20-40歲者，職務類別以行政及其他最高、醫師最低。校正後顯示危險因子包括：血壓過高、空腹血糖過高、三酸甘油酯過高、腎絲球過濾率降低等；而職務類別則以醫師的風險顯著較低。其他因子包含年齡、性別、腰圍、身體質量指數、總膽固醇類、麩丙酮酸轉胺脢、吸菸、喝酒等未達統計顯著。結論：考量醫療從業人員健康狀況對於自身及社會的重大影響，及蛋白尿與多種疾病的強烈相關，建議針對具危險因子的醫療從業人員積極進行相關健康評估、管理及促進。另考量醫療產業性質特殊，未來可取得專業及工作特性的變項包括健康知識、健康認知、自我效能、身體勞動、心理壓力、工時長短、值班型態等資料，並與尿蛋白及估計腎絲球過濾速率一併納入評估受檢者之腎功能，再進行分析，將有助更精確地了解醫療從業人員之腎功能，並釐清工作對其所造成的影響。

關鍵字

醫療從業人員；尿蛋白陽性盛行率；尿蛋白陽性危險因子；健康促進醫院；醫院員工健康促進

並列摘要

Background and purpose: Quality and effectiveness of health-care is better when its providers are in good health. The International Network of Health Promoting Hospitals & Health Services as well encourage medical sectors to embrace mandates of pursuing health gain of hospital staff beyond its responsibility for providing clinical and curative services. Proteinuria has been proven with robust evidence to be closely linked to chronic kidney disease and cardiovascular diseases, in which early intervention can considerably alter medical outcomes. This study aims to investigate the prevalence of proteinuria among health-care workers and determine possible risk factors. Method: This is a cross-sectional epidemiological study. Data including sex, age, profession category, body weight (BW), body height (BH), waist circumference (WC), blood pressure (BP), fasting sugar, triglyceride (TG), total cholesterol, alanine aminotransferase (ALT), creatinine (Cr), urine exam, smoking and drinking history are collected from results of routine worker health exams from a medical center in Northern Taiwan during year 2008-2012. The prevalence of proteinuria is described. Possible risk factors are analyzed using univariate and multivariate logistic regression. Result：Data of 4,330 individuals is included in the study with 1,172 (27.1%) males and 3,158 (72.9%) females. The prevalence of proteinuria is 2.33%, slightly higher in men (2.47%) than in women (2.28%) and higher in the older group (2.80%) than younger group (1.98%). The prevalence among different profession categories from highest to lowest is accordingly administrative staff and others (2.77%), technicians (2.53%), nurses (2.02%), and doctors (1.71%). Multivariate- adjusted odds ratios show risk factors with statistical significance include: higher BP (2.26; 1.21 to 4.23), higher fasting glucose (3.17; 1.73 to 5.82), higher triglyceride (2.26; 1.35 to 3.80), and lower estimated glomerular filtration rate (26.67; 8.17 to 87.06). Profession category of doctor has a significantly lower odds ratio (0.43; 0.20 to 0.90). Conclusion：The prevalence of proteinuia is higher in the older group. Possible risk factors include higher BP, higher fasting glucose, higher TG, and lower eGFR, while doctors have a significant lower risk. Health-care workers with risk factors should be closely monitored and provided life-style modification program for early intervention. Further research with more intricate design would be interests to further understand the relationship between work determinants such as health knowledge, health belief, self-efficacy, physical activities, mental stress, working hour, shift types and renal function estimated by proteinuria and eGFR.

並列關鍵字

health-care worker ； proteinuria prevalence ； proteinuria risk factor ； health promotion hospital

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蛋白尿在醫療從業人員之盛行率及危險因子研究

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