| 摘要: | 目的：透析病人因血管病變及動脈粥狀硬化等因素是造成腦中風之高危險群，但台灣鮮少針對不同透析方式罹患腦中風之相關研究，本研究將以回溯性方式探討不同透析方式罹患腦中風之相對風險及相關因素。
方法：本研究屬回溯性世代研究，以台灣全民健保研究資料庫為資料來源。以1997-2009年初次接受透析三個月以上之25,466位病人為研究對象，比較在病人特性、醫院特性、透析方式及共病危險因子等方面對罹患腦中風是否有所差異。並利用Cox proportional hazards model 探討影響透析病人罹患腦中風之相關因素。
結果：透析病人之平均年齡為55.66歲。1997-2009年罹患腦中風之人數為2490人，發生率為10.23%，其中缺血性腦中風為1876人(75%)，出血性腦中風為614人(25%)。而由Cox proportional hazards model分析結果顯示，血液透析發生腦中風之風險為腹膜透析之1.36倍(HR=1.36;95%CI=1.19-1.55)；其中透析病人若患有糖尿病其發生腦中風之風險為1.36倍(HR=1.36;95%CI=1.25-1.48)。經調整後發現若患者合併有高血壓、冠狀動脈疾病、風濕性關節炎、高血脂、貧血、腎臟癌、慢性肝炎、慢性阻塞肺病，其發生腦中風之相對風險比未罹病者低。
結論與建議：本研究發現台灣血液透析病患比腹膜透析病患較容易罹患腦中風，而糖尿病是可確定之高風險因子。然而研究也發現病患無論是否患有慢性疾病，其發生腦中風之共病危險因子都可藉由藥物之使用及疾病所產生之保護因子而降低。因此除針對危險因子糖尿病加強預防衛教外，其他相關之透析共病危險因子也應加強相關之衛教治療來預防腦中風之發生，進而提升透析病患之生活品質。
Objective: Dialysis patients are at high risk of stroke caused by vascular disease and atherosclerosis. There are very few studies focusing on different dialysis modalities for stroke research in Taiwan. This study will retrospectively investigate relative risks of stroke among the different dialysis modalities and associated risk factors.
Methods: This is a retrospective cohort study taking data from Taiwan National Health Insurance Research Database. From 1997 to 2009, 25,466 patients with more than three months of dialysis were selected as research subjects. Comparison of patient characteristics, hospital characteristics, dialysis and comorbidity risk factors such as risk of cerebral stroke were conducted to see if there is any difference. Cox proportional hazards model was used to investigate the impact of dialysis patients suffering from cerebral stroke related factors.
Results: The mean age of dialysis patients is 55.66 years old. From 1997 to 2009, the number of people suffering from stroke was 2490 (occurrence rate: 10.23%). Among the above patients, the number of ischemic stroke was 1876 (75%), and hemorrhagic stroke was 614 (25%). Through the Cox proportional hazards model analysis, it showed that the occurrence of cerebral stroke for the patients with hemodialysis is 1.36 times of those with peritoneal dialysis (HR=1.36;95%CI=1.19-1.55). In dialysis patients with diabetes mellitus (DM), the risk of occurrence of stroke was 1.36 times higher (HR=1.36, 95%CI=1.25-1.48) than the patients without DM. The statistical results revealed that patients with hypertension, coronary artery disease, rheumatoid arthritis, hyperlipidemia, anemia, kidney cancer, chronic hepatitis, chronic obstructive pulmonary disease, compared to the healthy people, the above mentioned patients have relative lower risk in terms of the occurrence of cerebral stroke.
Conclusions and recommendations: This study demonstrated that compared to peritoneal dialysis patients, hemodialysis patients were more susceptible stroke. The DM is of the identified high risk factors. However, we also found that for the patients suffering from chronic diseases, comorbidity risk factors in the occurrence of stroke, can be reduced by drugs and disease-induced protection factor to reduce the occurrence of cerebral stroke. Therefore, in addition to DM, dialysis was another risk factor contributing comorbidity. We should also increase the health education related to the treatment to prevent the occurrence of stroke as it can further improve the life quality of dialysis patients. |
