血液透析患者死亡風險評估與分析

The Evaluation & Analysis of the Risk of Mortality for Patients Receiving Long -Term Hemodialysis Proposal

黃世淵(Shih-Yuan Huang)

指導教授 ： 蔣以仁

共同指導教授 ： 賴彬卿(Ping Chin Lai)

臺北醫學大學/醫學院/醫學資訊研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00172

摘要

本研究目的主要在探討血液透析患者死亡風險評估與分析。在台灣，腎炎、腎徵候群及腎性病變名列台灣前十大死因，民國97年死亡人數高達4012人，依據2005的研究顯示台灣在慢性腎臟病發病率與患病率都是世界之冠。另外，根據溫崧峰教授從美兆健診的大型資料庫研究分析發現，國內約有11.93%,相當於200萬名慢性腎臟病患者。民國97年洗腎的健保支出為將近300億台幣，佔整個重大傷病門診費用的50.4%，而截至民國98年9月止，領有重大傷病卡有效證明之慢性腎衰竭(尿毒症)須定期透析治療者為61,231人，顯見末期腎臟病威脅台灣民眾生命甚鉅，實為醫療研究上之重大議題。
本研究與北部某醫學中心之血液透析中心合作，該血液透析中心採全天24小時三班制輪值、共計250台透析機服務近1300名病患之長期血液透析治療，不僅設立時間悠久，管理良善，更獲獎無數，是取樣的最佳選擇。
資料採自2003年到2007年，期間長達54個月，內容包含血液透析病患每年四次抽血檢驗資料，追蹤項目達30餘項,本研究總計涵蓋992位血液透析病患。本研究使用Classification and Regression Tree(決策樹)、Mann-Whittney U Test、卡方分配、Pearson Correlation(皮爾遜積差相關分析)、Nomogram等統計分析方法，以資料涵蓋範圍內之死前/存活的最後一筆資料進行死亡風險評估與分析。
研究結果顯示Albumin、Age是最重要的影響死亡因子，同時在進一步的分組中，第一組年紀輕、營養好的病患當中(Age-，Albumin+)，若同時有DM(糖尿病)為共存疾病，其死亡機率是無糖尿病患者的5.45倍；另外第二組年紀大、營養不好的病患(Age+，Albumin-)當中發現，Albumin、Creatinine是唯二死亡與存活之間有顯著差異之關鍵指數，同時兩者呈正相關關係，兩者越低死亡機率越高。
因此得到結論，經由本研究證實Albumin、Age、DM、Creatinine經過再分群後可協助用來預測死亡危險因子，期望提供醫療人員能持續就以上危險因子提前做監控，以達成降低血液透析病患死亡之目標。

關鍵字

洗腎 ； 血液透析 ； 死亡風險評估 ； 決策樹

並列摘要

The main purpose of this study is to investigate the predictive factors of mortality in those received hemodialysis treatment patients. This is a retrospective study which covered 992 patients with end-stage renal disease (ESRD) who had received hemodialysis treatment in a medial center of northern Taiwan and its two branches. The basic data of patients were collected from their medical records, and laboratory examinations from the periods of 2003/02-2008/08. Both descriptive and data mining statistical analyses such as Classification and Regression Tree、Mann-Whitney U Test、X2 Test、Pearson Correlation、Nomogram、Box plot were used to analyze the factors. The results are as follows: 1) Albumin and Age are the most important risk factors which could be used to predict the mortality of received hemodialysis treatment patients in the regular 3 month examinations. 2) In the subgroup(Albumin≧3.5 , Age<=62)，the odds ratio of comobility with Diabetes Group is 5.45 times than Non Diabetes group. 3) In the subgroup(ALB<3.5 , AGE>62), it shows Albumin and Creatinine are the major risk factors of mortality.
It is hoped that the results could provide valuable references to researchers who may interested in relevant topics, and also provide medical workers a prospects guidelines for evaluating the prognoses of patients who were continue receiving hemodialysis treatment, and to avoid the progress of death preventively.

並列關鍵字

End-stage Renal Disease (ESRD) ； Hemodialysis ； Mortality ； Predictive Factors ； Classification and Regression Tree ； Nomogram

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