慢性腎臟病人生活行為、藥物使用及憂鬱狀況

CMUR > College of Public Health > Graduate Institute of Environmental Medicine > Theses & dissertations > Item 310903500/635

Please use this identifier to cite or link to this item: http://ir.cmu.edu.tw/ir/handle/310903500/635

Title:	慢性腎臟病人生活行為、藥物使用及憂鬱狀況
Authors:	楊郁;Yang Yu
Contributors:	中國醫藥大學：環境醫學研究所碩士班
Keywords:	慢性腎臟病;末期腎臟疾病;止痛藥;中藥治療;chronic kidney disease;end-stage renal disease;folk medicine;traditional Chinese medicine
Date:	2009-06-12
Issue Date:	2009-08-11 16:56:27 (UTC+8)
Abstract:	本論文有兩個子題：(一)以醫院病人為對象進行末期腎臟病病例對照研究相關危險因子(二)以91年「台灣地區國民健康促進知識、態度與行為調查」之全國抽樣問卷調查資料檔，進行橫斷分析，觀察腎臟病患憂鬱狀況。台灣末期腎臟疾病之發生率與盛行率從2001年起名列世界第一，不但造成健保之重大負擔，也引起許多家庭社會的衝擊。台灣居民的生活型態，藥物服用偏好行為與腎臟病之相關性少有人著墨，慢性腎臟病進入尿毒症，由原發性生理疾病或生活壓力，容易引發憂鬱症，嚴重影響日後追蹤治療與預後。本研究的目標即(一)著重於生活行為與傳統中西藥或偏方使用與末期腎臟病之相關及門診規則追蹤之高血壓糖尿病患之狀況。本案研究設計是採個案對照研究與結構性問卷做基本資料調查，由訓練過的門診與透析護士做會談收案。本研究經過中部兩家醫學中心之人體試驗委員會批准，自兩家醫院腎臟科，收錄2005年元月至12 月開始透析並已取得健保透析重大傷病卡之末期腎臟病病患為病例組，以腎臟科門診追蹤之高血壓與糖尿病患且肌酐酸少於1.5mg/dL者為對照組。(二) 觀察國人慢性腎臟病患罹患憂鬱症的盛行狀況與探討相關因子。利用國健局之2002年「台灣地區國民健康促進知識、態度與行為調查」之資料檔，進行橫斷分析所抽樣調查臺灣人憂鬱量表分析，比較一般人口，慢性腎臟病及透析病患之差異。結果(一)共收入174位透析個案，186位非末期腎臟個案，顯示心血管疾病與腎臟病史明顯與末期腎臟病有關。高社經地位與身體質量指數反而與末期腎臟病較無關聯。與單獨使用西藥者比較，經調整年齡、性別、心血管疾病與腎臟病史後，接受中西醫藥合併治療者和末期腎臟疾病的相關最大Odd ratio (OR) = 4.06, 95% 可信限 = 1.38-12.0，次為使用偏方(OR = 2.85, 95% 可信限= 1.32-6.19, p < 0.01)，與單獨使用中藥(OR = 2.74, 95% 可信限= 1.22-6.18)。止痛劑與偏方使用者也與末期腎臟疾病顯著相關。(二)憂鬱症在慢性腎臟病之盛行率為12.7%，末期腎臟病為22.1% ，明顯高於一般民眾之4.4%。慢性腎臟病罹患憂鬱症的風險比 (OR)為2.88倍於常人，末期腎臟疾病透析罹患憂鬱症的風險比為5.23倍於常人，腎臟病與透析患者之憂鬱症傾向女性比男性高，大於70歲者低收入與抽煙之慢性腎臟病都易罹患憂鬱症。慢性腎臟病就是罹患憂鬱症之之獨立危險因子。 Background: Both the chronic kidney disease (CKD) and end-stage renal disease (ESRD) in Taiwan are among the most prevalent worldwide. Patients may shop for medications. Few studies have compared the effectiveness among types of medication. Purpose: Two studies were conducted. (A) A case-control study was conducted to compare the uses of Western medicine, traditional Chinese medicine (TCM) and folk medicine between patients with ESRD and patients with hypertension and/or diabetes. (B) Another study was to investigate whether of depression is associated with the chronic kidney disease using a secondary data. Methods：(A) This study recruited 174 ESRD patients and 186 non-ESRD patients with hypertension and/or diabetes receiving regular care as controls from the Nephrology out-patients at two medical centers in central-Taiwan, January-December 2005. Information on patient characteristics and medication uses were collected using questionnaire interview in person. (B) A comparism study was performed between patients with CKD, dialysis and general populations, based on the year 2002 data of a national random sample survey obtained from the Bureau of Health Promotion of Taiwan with 25165 persons interviewed. Results : (A) Cardiovascular diseases and/or CKD history were significantly associated with ESRD, while higher BMI and socioeconomic level appeared to decrease the association with ESRD. Compared with using Western medicine alone, the estimated risk of ESRD, after controlling for age and sex, was the highest for those preferred to using both Western medicine and TCM (OR = 3.74, 95% CI = 1.41- 9.96, p < 0.01), followed by using the folk medicine alone (OR = 2.85, 95% CI = 1.32- 6.19, p < 0.01), and Chinese medication alone. Data analyses also showed that the risk associated with ESRD increased further for lower BMI patients using both the Western medicine and TCM (OR = 4.06, 95% CI = 1.38- 12.0, p < 0.01). The uses of analgesics and multiple drugs were also more prevalent in ESRD cases. (B) The point prevalence of depression was the highest in dialysis patients (22.1% ), followed by CKD (12.7 %) and normal population (4.4%). The depression scores were significantly higher in the elderly and women ; After controlling for age, gender, education, income and smoking, alcohol and obesity, logistic regression analysis showed that CKD and uremia had significant association with depression (OR = 2.88, 95% CI = 2.35- 3.53 vs. OR = 5.23, 95% CI = 2.82-9.71), respectively, compared with normal population. The risk of depression in association with chronic kidney disease was higher for older persons( ≥ 70 years) than for younger persons (< 50 years)( OR = 1.62, 95 % CI = 1.35-1.94), and higher in females than males (OR = 2.71, 95 % = 2.31- 3.19). Conclusions: (A). Cardiovascular disease and CKD history are highly associated with ESRD. There is an urgent need to investigate the specific drug interaction between the western medicine and herbs used by the ESRD patients. (B). The prevalence of depression among patients with ESRD is very high in Taiwan. Chronic kidney disease itself is an independent risk factor of depression. It is important to detect depression status among patients with CKD and ESRD and to provide care for these patients.
Appears in Collections:	[Graduate Institute of Environmental Medicine] Theses & dissertations

Files in This Item:

File	Description	Size	Format
cmu-98-9465954-1.pdf		670Kb	Adobe PDF	638	View/Open
index.html		0Kb	HTML	120	View/Open

Loading...