透析方式與骨性關節炎病發之相關性探討

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Title:	透析方式與骨性關節炎病發之相關性探討 Association between Dialysis and Osteoarthritis
Authors:	周明賢;Ming-Hsien Chou
Contributors:	醫務管理學系碩士在職專班
Keywords:	血液透析;腹膜透析;骨性關節炎;存活分析;腎骨病變;Hemodialysis;Peritoneal dialysis;Osteoarthritis;Survival Analysis;Renal Osteodystrophy
Date:	2013-07-28
Issue Date:	2013-10-16 14:47:34 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	背景與目的：台灣民眾使用透析之人口密度為全球第一，每年仍以5千人之速度增長，促進透析族群健康成為甚為重要課題。病患接受透析治療後，可能出現腎性骨骼病變，導致骨性關節炎發生，惟國內外仍未見以存活分析探討透析方式於骨性關節炎發生之相對風險差異。本研究欲分析不同透析方式之骨性關節炎發生之風險差異，並探討骨性關節炎發生之其他相關因素。研究方法：使用國家衛生研究院2002-2010全民健保資料庫百萬承保抽樣歸人檔中接受血液透析或腹膜透析且年齡為50歲以上的1,514位患者為研究對象，進行回溯性世代研究。以SAS 9.1統計軟體進行McNemar檢定、羅吉斯迴歸、Cox比?風險模型及存活曲線分析。研究結果：透析使用者之骨性關節炎盛行率9.31%(血液：9.79%，腹膜：1.17%)。經過1:3(有無透析)年齡與性別之配對，透析有無與骨性關節炎發生與否無顯著相關(Logistic regression, p=0.2487)。透析方式與罹患骨性關節炎呈顯著相關(Cox regression, p=0.0265)；其他相關因素為年齡及用藥情形。相較於血液透析，腹膜透析患者較易罹患骨性關節炎。血液透析治療至罹患骨性關節炎平均時間間隔為25.29月。結論與建議：透析方式與骨性關節炎發生存在顯著相關。本研究亦發現藥物使用(利尿劑、骨鬆藥物及其他)可視為透析患者罹患骨性關節炎之風險因素。此因素應被重視，而藥物劑量與透析患者罹患骨性關節炎之相關性值得未來研究進一步探索。建議政府及醫療機構宜針對相對風險偏高之腹膜透析患者，進行介入性就醫規劃，並審慎評估用藥情形，加強藥物諮詢，以嘗試減少透析患者罹患骨性關節炎，及減少不必要及重複用藥，降低不必要之醫療花費。 Background: The population density of dialysis use in Taiwan has been ranked the highest in the world, with the annual growth rate of five thousand people per year. Therefore, the authorities face a significant challenge in caring dialysis patients in the implications of health promotion. After dialysis, renal osteodystrophy may occur, leading to osteoarthritis. However, there is no literature worldwide on the risk difference of osteoarthritis between hemodialysis and peritoneal dialysis by survival analysis. Therefore, this study sought to examine the relative hazards of osteoarthritis from the two different dialysis methods and the associated factors. Methods: In a retrospective cohort design, the present study utilized the medical claims data from 1,000,000 randomly sampled beneficiaries recorded in the 2002-2010 Taiwan National Health Insurance (NHI) Research Database. A total of 1,514 subjects aged over 50 years and treated with hemodialysis or peritoneal dialysis was identified and analyzed in SAS 9.1. Major analysis methods include McNemar test, logistic regression, Cox proportional hazards model, and Cox survival curve. Results: The prevalence of osteoarthritis among dialysis users was 9.31% (hemodialysis: 9.79%，peritoneal dialysis: 1.17%). Under the random sampling ratio of 1:3 (dialysis versus no dialysis) with matching for age and gender, no significant association between receipt of dialysis or not and osteoarthritis was found (Logistic regression, p=0.2487). Factors significantly associated with osteoarthritis among dialysis patients included age, medicine use, and dialysis (Cox regression, p=0.0265). Compared to the hemodialysis counterparts, the peritoneal dialysis patients were more likely to suffer from osteoarthritis. Of all the hemodialysis patients, the average time interval between the first-time dialysis and the subsequent diagnosis of osteoarthritis was 25.29 months. Conclusions: Dialysis is closely linked to osteoarthritis. Certain medicine use can be regarded as the risk factor of osteoarthritis among dialysis users. This factor should be more emphasized and, therefore, justifies the necessity of future research on the association between drug dosage and osteoarthritis among dialysis patients. The authorities and healthcare organizations should target the peritoneal dialysis patients of high risk and plan for timely medical interventions, in the attempt to prevent osteoarthritis and reducing unnecessary medical costs.
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