糖尿病對於慢性腎衰竭預後之研究

Analysis of Diabetes Mellitus on Chronic Renal Disease and Outcomes

許柏格(Po-Ke Hsu)

指導教授 ： 楊順發

中山醫學大學/醫學院/醫學研究所/碩士(2020年)

https://doi.org/10.6834/csmu202000244

摘要

研究目的：綜觀全世界，糖尿病（diabetes mellitus, DM）和慢性腎臟病（chronic kidney disease, CKD）的發病率正在上升，它們的共存可能對臨床產生很大的負面影響結果，像是洗腎甚至死亡；但是，尚不清楚糖尿病是如何影響慢性腎臟病患者以及該如何預防。
研究方法及資料：從台灣國家健康保險研究數據庫中識別出2000年至2013年的慢性腎臟病突發事件患者； 它們被分類為非糖尿（10,356人），已存在的糖尿病患者（6,982人）和偶發糖尿病患者 (1,103人）。 非糖尿病病例是在觀察期結束前未患糖尿病的患者。研究的預後指標是末期腎臟疾病（end stage renal disease, ESRD），死亡率和併發症（ESRD或死亡）。統計使用組加權(inverse probability of group-weighted, IPW)以及時間校正的多變量回歸分析(multivariate-adjusted time-dependent Cox regression models)。
研究結果：研究前有已經有糖尿病的患者，比起沒有糖尿病的患者中，末期腎病病變的危險比(Hazard ratio)為2.54，死亡率的危險比為2.23倍，併發症的危險比為2.29倍；另外偶發性的糖尿病比起沒有糖尿病的患者末期腎病病變的危險比為1.12倍，死亡率為2.48倍，綜合病症為1.77倍。其中危險因子包含高血壓、高血脂、缺血性心臟疾病都會引起偶發性糖尿病的產生，另外pentoxifylline (非選擇性磷酸二脂酶抑制劑 (non-selective phosphodiesterase (PDE) inhibitor)) 可以預防糖尿病的發生。
結論與建議：糖尿病以及腎臟病都是國人兩大慢性疾病，透過這個研究了解到糖尿病是如何影響個人從慢性腎病變以至於末期腎病變，甚至死亡，對於預防醫學來說透過國家健保資料庫來探討他們之間的關係，變得尤其重要，也可以加以預防腎功能的惡化，進而改善國人的糖尿病和腎臟病的盛行率，促進國人的健康。

關鍵字

糖尿病 ； 慢性腎臟病 ； 末期腎臟疾病

並列摘要

Objective：Looking at the whole world, the incidence of diabetes mellitus (DM) and chronic kidney disease (CKD) is rising, and their coexistence may have a large negative clinical effect, such as renal dialysis or even death; however, it is not clear how diabetes affects patients with chronic kidney disease and how to prevent it.
Methods and Materials：Identify patients with CKD emergencies from 2000 to 2013 from the National Health Insurance Research Database of Taiwan; they are classified as non-diabetic (10,356), pre-existing diabetic (6,982) and occasional diabetic (1,103). Non-diabetic cases are those who did not have diabetes before the end of the observation period. The prognostic indicators of the study were end-stage renal disease (ESRD), mortality and syndrome (ESRD or death). Statistics use inverse probability of group-weighted (IPW) and multivariate-adjusted time-dependent Cox regression models.
Results：Before the study, there were patients with DM, compared with patients without DM, the Harzard ratio of ESRD was 2.54, the mortality rate was 2.23 , and a composite outcome was 2.29. In addition, the Harzad ratio of incident DM wchich is compared with patients without DM was 1.12, the mortality rate is 2.48, and a composite outcome is 1.77. The risk factors including hypertension, hyperlipidemia, and ischemic heart disease can cause incidental DM, and pentoxifylline can even prevent diabetes.
Conclusion and Suggestion：DM and CKD are two major chronic diseases of Chinese people. Through this study, we learned how DM affects individuals from CKD to ESRD, and even death. The relationship has become particularly important, and it can also prevent the deterioration of kidney function, thereby improving the prevalence of DM and CKD in our country, and promoting the health.

並列關鍵字

diabetes mellitus ； chronic kidney disease ； end stage renal disease

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