背景與目的：台灣屬於結核病的中度盛行地區，且有研究指出透析病患結核病的發生率較一般民眾高6.9倍，而目前國內外相關研究大多為比較一般民眾與透析病患感染結核病之情況，且過去甚少有研究探討不同透析方式感染結核之情形，因此本研究欲比較不同透析方式感染結核之相對風險及其相關因素探討。
方法：本研究採回溯性世代研究法，利用1997年至2009年之全民健康保險研究資料庫，以這13年間所有接受透析治療超過三個月之末期腎病病患為研究對象。並藉由傾向分數(PS, propensity score)配對法，腹膜透析(PD)與血液透析(HD)以1:1的方式配對產生，PD病患與HD病患各有5,093人，總計10,186位研究樣本。再以Cox對比涉險模式(Cox proportional hazard regression models)分析不同透析方式之病患罹患結核病之相關風險。
結果：有313位透析病患罹患結核病，由Cox對比涉險模式分析結果顯示，在控制其他變項後，接受血液透析者罹患結核病的相對風險為腹膜透析者的1.67倍(95%CI：1.30-2.13)。其他顯著相關因素包括女性相對風險為男性的0.70倍(95%CI：0.56-0.89)；年齡越長者相對風險越高；高血壓患者與結締組織疾病者風險較低(HR:0.25，95%CI:0.19-0.32；HR:0.56，95%CI:0.43-0.72)。
結論與建議：本研究發現血液透析患者罹患結核病的風險較腹膜透析者高；而病患的性別、年齡及患有高血壓及結締組織疾病者皆會影響透析病人結核病感染情形。因此衛生主管機關對醫療院所之血液透析單位應加強結核病感染管制措施，醫院療院所應定期幫院內員工進行結核病篩檢及教育訓練，並加強罹患結核病之高風險透析病患相關衛教，以達到事先預防及減少結核感染情形。
Objective: Taiwan belongs to the moderate prevalence of tuberculosis (TB) region, and research indicates that the incidence of dialysis patients with TB is 6.9 times higher than the general population. At present, most domestic and international research compared the TB infection rate between the general population and dialysis patients. In the past, few studies examined the TB infection rate for different dialysis modality, and thus the purpose of this study is to explore patients with the different dialysis modality suffering from tuberculosis infection and its related factors.
Method: This study used a retrospective cohort study method, and obtained the data of patients treated by dialysis for more than three months from the National Health Insurance Research Database in 1997 to 2007. We used propensity score matching (PSM) method, and matched the patients with peritoneal dialysis (PD) and those with hemodialysis (HD) by 1:1. The number of PD patients and HD patients have 5,093 people, respectively. We used Cox proportional hazard regression models to examine the relative risk of dialysis patients with different modality suffering from TB and the associated factors.
Results: There were 313 dialysis patients suffering from tuberculosis. The Cox model analysis results show that after controlling for other variables, patients with HD had 1.67 time higher risk of suffering from TB than those with PD. Other significant factors include the relative risk for men to women was 0.70 times; the relative risk is higher with the increased age; connective tissue diseases and hypertension in patients have low risk (HR:0.25 ; HR:0.56).
Conclusions and recommendations: This study found that HD patients with the risk of suffering from TB were higher than the PD patients. Therefore, health authorities on the medical institutions of the dialysis unit should strengthen TB infection control measures; the hospital staff should be regularly screened for TB and enhance education and training; We also need to reduce the high risk of suffering from TB for the dialysis patients.
