臺灣博碩士論文加值系統

研究目的：本研究探討老年人，在使用率較高之降血壓及降血脂藥物後,對於慢性腎臟疾病所造成的影響。
研究方法：採回溯性(retrospective)的世代追蹤研究法，資料來源是利用全民健保資料庫(National Health Insurance Research Database，NHIRD)三十二萬筆資料，分析研究對象為老年人(年齡>60)於2000~2009年間，比較慢性腎臟疾病患者及無慢性腎臟疾病者，共病及藥物使用情況。本研究利用邏輯斯回歸分析方法，預測使用降血壓或降血脂藥物後造成慢性腎臟疾病的風險大小。
研究結果：患有高血壓的男性罹患慢性腎臟疾病的OR=2.11、女性OR=2.36；患有糖尿病的男性OR=1.22、女性OR=1.41；患有痛風的男性OR=1.41、女性OR=1.28；患有胃潰瘍的男性OR=1.24、女性OR=1.32；患有酸鹼平衡異常的男性OR=2.35、女性OR=2.29，而心房纖維性顫動只有在男性看到顯著性差異，其OR=1.47。依使用率高之降血壓藥，血管收縮素受體阻斷劑(Angiotensin II receptor antagonist，ARB)類中，使用Valsartan的男性OR=0.44、女性OR=0.29；使用Losartan potassium的男性OR=1.40、女性OR=0.55；使用Irbesartan的男性OR=1.29、女性OR=1.26，而甲型交感神經阻斷劑(α-adrenergic antagonists)類中，使用Terazosin的男性OR=0.63、女性OR=3.81；使用Doxazosin (METHANESULFONATE)的男性OR=0.75、女性OR=2.35；使用Doxazosin (MESYLATE)的男性OR=0.86、女性OR=6.79，另外血管收縮素轉換酶抑制(Angiotensin-I converting enzyme inhibitors，ACEI)類中，使用Enalapril的男性OR=3.54、女性OR=2.49。依使用率較高之降血脂藥物，HMG-CoA還原酶抑制劑(3-hydroxy-3-methyl- glutaryl-coenzyme A reductase inhibitor，statin)類中，使用Atorvastatin男性OR=0.40、女性OR=0.36，使用Simvastatin男性OR=0.79、女性OR=0.84，使用Lovastatin男性OR=1.53、女性OR=0.75，使用Fluvastatin sodium男性OR=4.19、女性OR=2.29，使用Pravastatin sodium男性OR=2.59、女性OR=2.42，而Fibrate類，使用Gemfibrozil男性OR=0.92、女性OR=0.68，使用Fenofibrate男性OR=2.20、女性OR=2.07。
結論：在老年人中對於腎臟功能具保護效益上，降血壓藥和降血脂藥分別以Valsartan和Atorvastatin為優先選擇的治療藥物。降血壓藥，以Valsartan對腎臟最具保護性；以Enalapril及Hyderalazine hcl對慢性腎臟疾病罹患的風險性最高。降血脂藥，以Atorvastatin對腎臟最具保護性；以Fluvastatin、Pravastatin及Fenofibrate對慢性腎臟疾病罹患的風險性最高。

Purpose：The purpose of this study was to explore the association between utilization of Anti-hypertensive drugs or Anti-hyperlipidemic drugs and chronic kidney disease (CKD) in elderly.
Method：A retrospective cohort study method was used in this study,the database is composed of 320,000 subjects whom were randomly selected from National Health Insurance (NHI) Research Database,the study participations were 60 years old and more in Taiwan from 2000 to 2009.To compare the comorbidity and drug use between CKD and non-CKD,we conducted the logistic models to predict the odds ratio of Anti-hypertensive drugs or Anti-hyperlipidemic drugs cause CKD.
Results：After adjusted for the other comorbidity covariables,multivariate logistic model showed the odds ratio for hypertension 【OR=2.11 for male and OR=2.36 for female】and diabetes mellitus【OR=1.22 for male and OR=1.41 for female】and gout【OR=1.41 for male and OR=1.28 for female】and Gastric ulcer【OR=1.24 for male and OR=1.32 for female】and abnormal acid-base balance【OR=1.32 for male and OR=2.29 for female,but there was only significant for male Atrial fibrillation 【OR=1.47】not female. After adjusted other drugs covariables,multivariate logistic model showed CKD was associated with hypotensive drugs utilization of Valsartan【OR=0.44 for male and OR=0.29 for female】,Losartan potassium【OR=1.40 for male and OR=0.55 for female】,Irbesartan【OR=1.29 for male and OR=1.26 for female】,Terazosin【OR=0.63 for male and OR=3.81 for female】,Doxazosin (METHANESULFONATE) 【OR=0.75 for male and OR=2.35 for female】, Doxazosin (MESYLATE)【OR=0.86 for male and OR=6.79 for female】,and Enalapril【OR=3.54 for male and OR=2.49 for female】;and Anti- hyperlipidemic drugs utilization of Atorvastatin【OR=0.40 for male and OR=0.36 for female】,Simvastatin【OR=0.79 for male and OR=0.84 for female】,Lovastatin【OR=1.53 for male and OR=0.75 for female】,Fluvastatin sodium【OR=4.19 for male and OR=2.29 for female】,Pravastatin sodium 【OR=2.59 for male and OR=2.42 for female】,Gemfibrozil【OR=2.59 for male and OR=2.42 for female】,and Fenofibrate【OR=2.20 for male and OR=2.07 for female】.
Conclusion：Our findings suggested that Valsartan and Atorvastatin could be a better choice of the medical treatment for the elderly and to protection efficiency of kidney function.
The results of this study also found that Enalapril and Hyderalazine hcl are higher risk for their kidney function in the Anti-hypertensive drugs. Additionally，Fluvastatin、Pravastatin、Fenofibrate are higher risk for their kidney function in the Anti-hyperlipidemic drugs.
Keywords：Chronic kidney disease、Anti-hypertensive drugs、 Anti-hyperlipidemic drugs

第一章、前言...... 1
第一節 研究動機... 1
第二節 研究目的... 2
第二章、文獻探討.. 3
第一節 台灣慢性腎臟疾病之流行病學... 3
第二節 慢性腎臟疾病定義及危險因素... 4
第三節 藥物與腎臟疾病間的探討...... 5
第三章、材料與方法 7
第一節 研究方法... 7
第二節 研究變項及操作定義說明....... 10
第三節 研究流程.. 16
第四節 統計分析... 19
第四章、研究結果.. 20
第一節 研究對象之基本人口變項....... 20
第二節 藥理分類變項與慢性腎臟疾病之相關性.... 20
第三節 降血脂或降血壓藥對慢性腎臟疾病之影響.. 21
第四章、討論...... 22
第一節 共病與慢性腎臟疾病間的關係... 22
第二節 降血壓藥與慢性腎臟疾病間的關係........ 22
第三節 降血脂藥與慢性腎臟疾病間的關係........ 25
第四節 限制....... 29
第六章、結論...... 30
第七章、參考文獻 31

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