比較不同透析方式之病患罹患急性心肌梗塞之風險差異

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题名:	比較不同透析方式之病患罹患急性心肌梗塞之風險差異 A comparsion of the risk on acute myocardial infarction for different modalities of dialysis patients
作者:	柯藹洵;Ai-Shiun Ke
贡献者:	公共衛生學院醫務管理學研究所碩士班
关键词:	血液透析;腹膜透析;急性心肌梗塞;hemodialysis;peritoneal dialysis;acute myocardial infarction
日期:	2010
上传时间:	2010-09-29 12:05:51 (UTC+8)
摘要:	背景與目的：心血管疾病的罹患率及死亡率在各期腎臟疾病皆高，然而，目前針對不同透析方式之病患罹患急性心肌梗塞（AMI）之差異，尚未有一致的結論，且台灣鮮少探討慢性腎臟病患罹患急性心肌梗塞之文獻，因此，本研究將探討不同透析方式之病患罹患急性心肌梗塞之風險差異。方法：本研究屬回溯性緃貫性研究(Retrospective longitudinal study)，以1998-2007年健保資料庫中初次接受血液透析及腹膜透析三個月以上之民眾為研究對象，本研究以當年度血液透析、腹膜透析的病人，利用性別、年齡為配對條件，將腹膜透析與血液透析以1：5配對（matching）後，得到研究樣本共計22,656人，其中血液透析佔83.33％（18,880人），腹膜透析佔16.67％（3,776人）。以Cox比例風險模型(Cox proportional hazards model)，探討不同透析方式之病患是否罹患急性心肌梗塞之影響因素，並以風險危害比率（hazard ratio, HR）表示不同透析方式之病患罹患急性心肌梗塞之危害程度。結果：22,656位透析病患平均年齡為56.13±14.03歲，而有4.05％的血液透析病患有AMI；腹膜透析病患為1.27％罹患AMI。其透析病患每萬人口AMI之發生率，在1997-2007年間，由52人/萬人上升至179人/萬人，發生率成長244％。Cox比例風險模型分析顯示，「性別」、「病患年齡」、「投保金額」、「健保分區」、「醫療機構層級」、「醫療機構屬性」、「透析方式」、「糖尿病」、「高血壓」、「心律不整」、「腦血管疾病」及「心臟衰竭」為顯著影響透析病患罹患急性心肌梗塞之因素，其中血液透析病患罹患急性心肌梗塞的相對風險為腹膜透析的2.77倍（95%CI：2.012-3.814）。在比較血液透析及腹膜透析罹患急性心肌梗塞之情形，透析第一年，血液透析病患罹患急性心肌梗塞的機率約為0.012；腹膜透析約為0.004。透析第五年，血液透析病患罹患急性心肌梗塞的機率約為0.079；腹膜透析約為0.032。透析第十年，血液透析病患罹患急性心肌梗塞的機率約為0.212；腹膜透析約為0.107。結論：長期接受血液透析之病患較腹膜透析病患有較高的風險罹患急性心肌梗塞。且隨著透析時間的增加，血液、腹膜透析之病患罹患急性心肌梗塞之機率亦增加。 Objective：Patients in every stages of kidney disease have a higher incidence and mortality of cardiovascular disease. However, there were inconsistent incidence rates of acute myocardial infarction (AMI) between the patients treated by different dialysis modalities. In addition, there were few studies about the dialysis patients who suffered from AMI in Taiwan. Thus, the purpose of this study is to explore the different incidence risk of AMI for the end stage renal disease (ESRD) patients treated by different dialysis modalities. Method：The retrospective longitudinal study obtained data about patients treated by hemodialysis (HD) or peritoneal dialysis (PD) for more than three months from the databases of National Health Insurance in 1997 to 2007. First, we matched the PD and HD patients with 1:5 by gender and age each year to obtain 22,656 patients undergoing dialysis therapy. The number of HD patients was 18,880 (83.33%) compared with 3,776 (17.67%) PD patients. Then we used the Cox proportional hazards model to test the relative risk and associated factors with suffering from AMI in the different dialysis modality patients. Result：The average age of patients in this study is 56.13 years old, and 4.05% HD patients and 1.27% PD patients suffered from AMI. The incident rate of the dialysis patients suffered from AMI increased 244% within 10 years, and it is from 52 per10, 000 patients in 1997 to 179 per 10,000 patients in 2007. Gender, age, premium-based salary, resident area, hospital level, hospital ownership, dialysis modality, diabetes, hypertension, arrhythmia, cerebral vascular disease, and congestive heart failure are associated factors with patients suffering from AMI. Especially, the relative risk of HD patients suffering from AMI is 2.77 times than PD patients (95% CI: 2.012-3.814). This study also found that the incident rate of AMI increased by the dialysis yearly. In the first year, the incident rates in HD and PD patients were 0.012 and 0.004. In the fifth year, the incident rates in HD and PD patients were 0.079 and 0.032., and in the tenth year, the incident rates were 0.212 and 0.107. Conclusion：Patients receiving hemodialysis over a long period of time have a higher risk of AMI than patients treated by peritoneal dialysis. With the increase in dialysis time, both of HD and PD patients increased the incidence rate of AMI. Keyword：hemodialysis, peritoneal dialysis, acute myocardial infarction
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