早期慢性腎臟病篩檢工具的建構與測試

背景：慢性腎臟病為高盛行率及高發生率的疾病。通常在早期並無明顯症狀，一旦腎功能持續惡化，最後進展至尿毒症，則須終生依賴透析治療。臨床上，檢驗血液肌酸酐或尿液尿蛋白是診斷腎臟病高危險群最精確的方式，然此二種方式皆非便利。因此，有必要建立一隨時可進行篩檢之工具，及早偵測出無症狀之高危險群。目的：本研究旨在發展一簡易便利的「早期慢性腎臟病篩檢工具（ECKDST）」，並測試此篩檢工具的信、效度。方法：本研究是以社區為主之早期慢性腎臟病篩檢。受試者來自一所醫學中心與一所區域教學醫院體檢部及十一個社區。收案條件為18歲以上，共招募1,1 80位受試者填寫結構式問卷與腎功能測試。結果：本研究有效樣本數達1,159位。早期慢性腎臟病篩檢工具所發展的預測因子有：年齡、教育程度、蛋白尿病史、最近三個月血壓值。此篩檢工具分數0~17分，最佳切點4分，準確性AUC為0.79，敏感性86.7％，特異性63.1％，陽性預測值12.9 %，陰性預測值98.7%。結論：本研究發展之篩檢工具有良好的效度。所建立的篩檢題項僅4題，方便填寫。於實務應用上，可有效快速地將高危險群篩檢出來，達到早期預防、早期治療的目標。

關鍵字

慢性腎臟病；危險因子；篩檢工具；預測

並列摘要

Background: Chronic kidney disease (CKD) is one of disease had high prevalence and incidence. In the CKD early stage, no significant symptom, however, the renal function decline, and finally progress to uremia, shall lifelong dependence on dialysis. To confirm the high risk of kidney disease, serum creatinine or urine protein as a screening method, that is inconvenient. Therefore, the development of a simple screening tool, the early detection of asymptomatic high-risk groups. Purpose: This study aims to develop a easy and convenient to detect "early chronic kidney disease screening tool (ECKDST)," and test this screening tool of reliability and validity. Methods: This study is a community-based screening of early CKD. Subjects were recruited from a medical center and a regional teaching hospital medical department and eleven communities. Subjects include over 18 years, 1,180 subjects were recruited to fill in a structured questionnaire and renal function tests. Results: In this study, the effective sample size of 1,159. Predictors of ECKDST included: age, educational level, history of proteinuria, blood pressure last three months. Scores for screening tool ranged between 0 and 17 points. The area under the AUC was 0.79 for the cut-off point of 4, the sensitivity was 86.7%, specificity was 63.1%, positive predictive value was 12.9% and negative predictive value was 98.7%. Conclusion: Screening tool for the development of this study has good validity. Screening questions of established only 4 questions, easy to fill out. For practical applications, quickly and effectively screening out high -risk groups, to achieve the goal of early prevention and early treatment.