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  • 學位論文

比較有無新陳代謝症候群之第三期慢性腎臟疾病病人預後及其相關因素

A Comparison of Prognosis Factors between patient of Chronic kidney Disease stage 3 with and without Metabolic syndrome

指導教授 : 楊麗玉

摘要


美國腎臟疾病資料顯示2011年台灣末期腎衰竭的發生率是全世界第二,同時,慢性腎臟病合併新陳代謝症候群有逐年上升的趨勢,然而,國內目前尚未有研究慢性腎臟疾病合併新陳代謝症候群病人在自我照顧行為、人口學特性以及危險因子之預後相關研究,期盼研究發展出預防慢性腎臟疾病惡化的措施,延緩進入末期腎衰竭的階段。 本研究屬於回朔性病歷研究,以南部某醫學中心慢性腎臟疾病照護網中第三期個案之慢性腎臟疾病共484位病人資料進行分析,透過病歷回朔檢視有無合併新陳代謝症候群個案進入末期腎衰竭或死亡的時間以及在人口學特性、自我照顧行為以及危險因子等變項是否有差異,並找出影響預後主要的因素。資料採用獨立t檢定、卡方檢定與存活分析方法進行統計分析。 研究結果顯示:有合併新陳代謝症候群組別、年齡較輕者、無血壓監測者等因子與較早進入末期腎臟衰竭呈現顯著,其中有合併新陳代謝症候群者進入末期腎衰竭的相對危險比是無合併新陳代謝症候群者的7.31倍(p<0.01),因此醫護理人員要提高新陳代謝症候群危險因子的警覺度,並且教育個案居家血壓監測的重要性,以提升對於慢性腎臟疾病病人合併新陳代謝症候群的了解、診斷與治療。

並列摘要


The 2011 United States Renal Disease Database (USRDS) showed the prevalence of end stage renal disease (ESRD) in Taiwan was second highest in the world. There is a trend of increasing rate in chronic kidney disease (CKD) combined with metabolic syndrome (MS) year by year. Previous studies revealed that MS would worsen the decline of renal function. However, so far there is no study focusing on the association between self-care, population characteristics and risk factors with prognosis among patients of CKD combined with MS. The goal of our study is to predict the important factors associated with the prognosis of CKD, to develop the prevention strategy which may slow the decline of renal function and to delay the entrance of ESRD. This was a retrospective cohort study. We enrolled total 465 patients in CKD stage 3 under the nationwide CKD Preventive Project with multidisciplinary care program at a tertiary medical center in Southern Taiwan. From chart review we investigated the association between self-care, population characteristics and risk factors with prognosis among patients of CKD combined with or without MS. Furthermore, we found the main determining factors effecting outcome by statistics analysis including t-test, Chia-Square and Kaplan-Meier survival estimate. The results showed CKD with MS, young aged, irregular blood pressure monitor were significantly associated with outcome of ESRD. The hazard ratio for ESRD among CKD with MS was 7.31 compared with CKD without MS. In conclusion, we should pay more attention to identify the risk factors of MS among CKD patients and educate for the importance of home blood pressure check to improve the understanding, detection and management of CKD with MS.

並列關鍵字

CKD Metabolic syndrome Prognosis Factors

參考文獻


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