台灣腎結石患者罹患慢性腎臟病的風險 -全國性的世代研究

Risk of Chronic Kidney Disease in Patients with Kidney Stones -A Nationwide Cohort Study

莊宗芳(TZUNG-FANG CHUANG)

指導教授 ： 洪錦墩

中臺科技大學/管理學院/醫療暨健康產業管理系碩士班/碩士(2017年)

摘要

背景：在台灣慢性腎臟病與腎結石都是很常見的疾病，特別是慢性腎臟病，具備高盛行率卻有極低的自覺率。慢性腎臟病之相關危險因子如糖尿病、高血壓，腎毒性藥物等都是明確無爭議的，腎結石卻是比較少被提到而容易被忽略的一個危險因子。腎結石是尿路結石的一種，尿路結石依位置的不同可分為腎結石、輸尿管結石、膀胱結石及尿道結石，其中以腎結石居多。腎結石大部分好發中年男性族群且多數非先天遺傳疾病所致，腎結石是否仍為慢性腎臟病的一個危險因子是本研究所要探討的主題。
方法：研究採配對世代研究，以國家衛生研究院2000年版抽樣歸人檔健保資料，擷取2001年間罹患腎結石並排除慢性腎臟病史者為研究組，並依年齡及性別以1:4的比例配對無腎結石者為對照組，同時追蹤10年觀察其慢性腎臟病的發生率。透過 SPSS 17版統計軟體分析，使用學生t檢定(Student’s t-test)和卡方檢定(Chi squared test)分別來比較連續和分類數據，使用羅吉斯回歸法(Logistic regression)來計算尿路結石患者相對於對照組發生慢性腎臟病的勝算比（OR），結石病患得到慢性腎臟病的風險比則使用Cox比例風險迴歸(Cox proportional hazard regression model)來分析，並以年齡，性別和合併症等變因來做控制。
結果：4,197人腎結石樣本在十年觀察期間，有470人罹患慢性腎臟病，發生率為11.2%，明顯高於對照組的6.2%。卡方檢驗有顯著差異(p<0.001)。二元羅吉斯迴歸顯示腎結石樣本有較高的風險得到慢性腎臟病(勝算比：1.94；p < 0.001)。以Cox比例風險迴歸分析腎結石個案罹患慢性腎臟病的風險比是非腎結石個案的1.82倍，p值小於0.001。
結論：腎結石是慢性腎臟病的一個明確的危險因子，所以腎結石患者應該接受定期的腎臟功能監測、並接受適當的治療以避免慢性腎臟病的形成。

關鍵字

慢性腎臟病 ； 腎結石 ； 尿路結石 ； 健保資料庫

並列摘要

Background: Chronic kidney disease and kidney stones in Taiwan are common diseases, especially chronic kidney disease, with a high prevalence but low rate of self-awareness. Chronic kidney disease-related risk factors such as diabetes, hypertension, and nephrotoxic drugs are clear and uncontested, kidney stones is relatively less mentioned and easily overlooked as a risk factor. CKD is a recognized complication of kidney stones, in some rare hereditary disorders(e.g., primary hyperoxaluria, Dent disease, cystinuria), due to their early onset, and the urine in a high concentration of calcium or high concentrations of oxalic acid state for a long time, acid-base abnormalities, or supersaturated crystal, resulting in repeated urolithiasis and further causing kidney damage. However, it is unknown whether kidney stones are an important risk factor for CKD in the general population.
Methods: We conducted a nationwide population-based matched cohort study to assess the risk of incident CKD in people with kidney stones. The data for this study was from the Taiwan’s National Health Insurance database. From the database we captured incident stones formers in the year 2001 excluding past history of CKD as stones cohort. Stone formers were matched 1:4 to control subjects according to sex, age and the index date. With the total observation period of 10 years, the primary end point was the occurrence of CKD. The Student’s t-test and Chi-squared test were used to compare continuous and categorical data, respectively. Logistic regression was used to calculate the odds ratio (OR) of patients with kidney stones with incident chronic kidney disease compared to the control group. The Cox proportional hazard regression model was proceeded to obtain the HRs for development of incident CKD among patients with kidney stones.
Results: During the ten years of observation, 4170 people were suffering from chronic kidney disease at a rate of 11.2%, significantly higher than the control group (6.2%). There was a significant difference in chi-square test (p <0.001). The binary Logistic regression showed that the stone formers had a higher risk of getting chronic kidney disease (OR: 1.94; p <0.001) after adjustment for potential confounders including age, gender, comorbidities (hypertension, diabetes, hyperlipidemia and cardiovascular disease). Cox proportional hazards regression models adjusted for age, gender, and comorbidities were used to assess the risk for incident CKD within stone formers (HR=1.815, <0.001).
Conclusions: Kidney stones are a definite risk factor for chronic kidney disease. Patients with stones are suggested to undergo regular renal function monitoring and receive appropriate treatment to avoid the formation of chronic kidney disease.

並列關鍵字

chronic kidney disease ； kidney stones ； National Health Insurance database

參考文獻

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