慢性腎臟病與糖尿病在急性心肌梗塞病人之預後影響

Impact of chronic kidney disease and diabetes mellitus on the prognosis in patients with acute myocardial infarction

陳永崢(Yung-Cheng Chen)

指導教授 ： 簡國龍

共同指導教授 ： 吳彥雯(Yen-Wen Wu)

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2015年)

https://doi.org/10.6342/NTU.2015.00352

摘要

背景：本研究將探討有無合併糖尿病與慢性腎臟疾病，對急性心肌梗塞病人短期及長期預後之影響。
方法：此為前瞻性世代研究，在亞東紀念醫院心臟內科進行，由心臟科專責研究助理與專科護理師依據病歷記錄建立資料庫，每月定期由專責心臟專科主治醫師進行品質管控。本研究針對糖尿病與慢性腎臟疾病進行分層分析，比較兩種疾病對短期（三十天）及長期（兩年）預後的影響。分析方法採單變量分析後再以Cox比例風險模式（Cox proportional hazards model）對共變因子做迴歸分析。
結果：2005年至2013年本資料庫共收納2259位急性心肌梗塞確診病患，平均追蹤1.69 ± 0.23年。單變數分析顯示，慢性腎臟疾病對於三十天預後的風險比值（adjusted hazard ratio）為2.11（95%信賴區間為1.66-2.69），兩年預後為6.07（95%信賴區間為4.67-7.92）；糖尿病的三十天預後之風險比值為1.81（95%信賴區間為1.33-2.46），兩年預後為2.11（95%信賴區間為1.66-2.69），均達統計顯著意義。其他包括吸菸、高血壓、心房纖維顫動、冠狀動脈疾病或中風病史等亦達到統計顯著意義。利用Cox比例風險模式分析則顯示，慢性腎臟疾病之無糖尿病組及慢性腎臟疾病合併糖尿病組的調整後風險比值，較兩者皆無或單純糖尿病之患者高，分別為2.22（95%信賴區間為1.43-3.44）及3.34（95%信賴區間為2.17-5.13）。進一步分析顯示，相對於糖尿病，慢性腎臟疾病為全死因死亡率之主要預後因子。
結論：本研究證實慢性腎臟疾病為急性心肌梗塞短期及長期預後之主要預測因子。

關鍵字

急性心肌梗塞 ； 糖尿病 ； 慢性腎臟疾病 ； 全死因死亡率

並列摘要

Introduction：This study aimed to explore the combined impact of diabetes mellitus (DM) and chronic kidney disease (CKD) on short-term and long-term all-cause mortality in patients with acute myocardial infarction (AMI).
Methods：This is a prospective cohort AMI registry conduced in Cardiology Division of Cardiovascular Medical Center in Far Eastern Memorial Hospital which is located in New Taipei City, Taiwan. Database are constructed by the study coordinators and nurse practitioners according to medical records, and quality control by a cardiologist is performed every month. The primary endpoint is follow-up all-cause mortality. The data stratified by CKD and DM, univariate analysis and Cox proportional hazards model were used to evaluate the impacts in 30-day, 1- and 2-year all-cause mortality.
Result：Between 2005 and 2013, a total of 2259 AMI patients were recruited. Mean follow-up duration was 1.69 ± 0.23 years. In the univariable analysis, the hazard ratio（HR）for CKD was 2.11 (95% confidence interval (CI) 1.66-2.69) in 30-day, and 6.07 (95% CI 4.67-7.92) in 2-year all-cause mortality. As for DM, HR was 1.81（95% CI 1.33-2.46）in 30-day, and 6.07（95% CI 4.67-7.92）in 2-year all-cause mortality (all P<0.05). Other prognostic factors including smoking, hypertension, atrial fibirllaiton, history of coronary artery disease or stroke, all reached statistical significance. Subjects with either CKD or DM had significantly higher risk of all-cause mortality than who without. Cox proportional hazards model showed significantly higher adjusted HRs of CKD only, or with DM and CKD were 2.22 (95% confidence interval (CI) 1.43-3.44) and 3.34 (95% CI 2.17-5.13), respectively, compared to subjects with neither DM and CKD, or DM only. Our findings support a positive association with CKD in short-term and long-term prognosis in patients with AMI.
Conclusion：This study confirmed that CKD, rather than DM, is a strong prognostic factor in short-term and long-term all-cause mortality in AMI.

並列關鍵字

Acute myocardial infarction (AMI) ； Diabetes mellitus (DM) ； Chronic kidney disease (CKD) ； All-cause mortality

參考文獻

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