臺灣博碩士論文加值系統

糖尿病目前仍居國人十大死因之第五位，目前台灣盛行率約為100萬人口[1]，且有逐年上升之趨勢。糖尿病患者後期容易罹患慢性腎臟病，糖尿病且慢性腎臟病患者常因身體代謝異常，導致下肢循環不好，嚴重時可能需要足部截肢。cilostazol經研究證實，可以增加跛行患者行走之最大距離且可以降低患者下肢截肢之風險，而cilostazol常使用在患有周邊血管疾病之患者，因此本研究想探討第二型糖尿病且罹患慢性腎臟病及周邊血管疾病之患者使用cilostazol後是否可以降低足部截肢之風險。
本研究使用台灣健保資料庫，利用患者之就診紀錄來找出第二型糖尿病且罹患慢性腎臟病及周邊血管疾病之患者，並使用用藥紀錄來判別病患是否有使用cilostazol，再使用手術紀錄來尋找有足部截肢之患者，整合病患資料後，再用統計方法Cox迴歸分析（Cox proportional hazards model）計算出第二型糖尿病且有慢性腎臟病及周邊血管疾病之患者使用cilostazol後足部截肢之風險值。
本研究以2000~2007之第二型糖尿病患為樣本，追蹤病患到2010年12月31日；本研究結果顯示有使用cilostazol患者足部截肢之風險是有增加的，且HR=4.16（95%CI 3.929~4.405）。

Diabetes is the fifth leading cause of death in Taiwan, and its prevalence is about one million. The late diabetic patients are more easily to get kidney disease. When a patient who suffers from diabetes and kidney disease, he is often getting metabolic abnormalities and leading poor lower extremity amputation. The experiments have proved cilostazol can improve the risk of lower extremity amputation in patients with peripheral artery diseases (PAD). Therefore, I want to understand if patients not only get PAD but also have type 2 diabetes (T2DM) and kidney diseases; after taking the cilostazol if the risk of lower extremity amputation can be reduced.
This study uses national health insurance database in 2000 and 2007 to find out patients with PAD, T2DM and kidney disease, and check cilostazol and amputation information of these patients until 2010. Finally calculate the Cox proportional hazards ratio (HR), the HR is 4.16 (95%CI 3.929 to 4.405).

目錄--------------------------------------------------------------------------------Ⅰ
致謝--------------------------------------------------------------------------------Ⅲ
中文摘要--------------------------------------------------------------------------Ⅳ
英文摘要--------------------------------------------------------------------------Ⅴ
第一章 序論
第一節 研究動機與背景-------------------------------------------------- 1
第二節 研究目的----------------------------------------------------------- 3
第二章 文獻探討
第一節 糖尿病介紹-------------------------------------------------------- 4
第二節 慢性腎臟病介紹-------------------------------------------------- 6
第三節 周邊血管疾病介紹----------------------------------------------- 7
第四節 定義每日劑量介紹¬----------------------------------------------- 9
第三章 研究設計與方法
第一節 研究架構---------------------------------------------------------- 10
第二節 資料來源---------------------------------------------------------- 12
第三節 疾病之定義------------------------------------------------------- 13
第四節 藥物之選取------------------------------------------------------- 15
第五節 研究方法---------------------------------------------------------- 15
第六節 統計分析---------------------------------------------------------- 21
第四章 結果
第一節 研究結果---------------------------------------------------------- 22
第五章 結論與討論
第一節 研究討論---------------------------------------------------------- 26
參考文獻------------------------------------------------------------------------- 28
附錄一---------------------------------------------------------------------------- 30
附錄二---------------------------------------------------------------------------- 31
附錄三---------------------------------------------------------------------------- 33
附錄四---------------------------------------------------------------------------- 36
附錄五---------------------------------------------------------------------------- 37
附錄六---------------------------------------------------------------------------- 38
附錄七---------------------------------------------------------------------------- 41
附錄八---------------------------------------------------------------------------- 42
附錄九---------------------------------------------------------------------------- 43
附錄十---------------------------------------------------------------------------- 45
附錄十一------------------------------------------------------------------------- 46
附錄十二------------------------------------------------------------------------- 47

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