臺灣博碩士論文加值系統

中文摘要
背景：磷與尿酸廣泛地存在於食物中，對重視飲食攝取的血液透析病人來說，身體內的血清磷與尿酸濃度都會影響病人的健康狀況與預後情形。故本研究為探討血清磷合併尿酸濃度乘積對血液透析病人存活率之影響。
方法：本研究屬橫斷性的描述相關性研究，採次級資料分析。取自南部某地區醫院之血液透析室，共100位血液透析病人，依照血清磷合併尿酸濃度乘積區分為：第1組（濃度 < 25 mg/dl）有34位；第2組（25 ~ 40 mg/dl）有31位；第3組（濃度 ≧ 40 mg/dl）有35位。觀察期間為54個月，以卡方與單因子變異數分析（ANOVA）檢定3組個案基本屬性；並檢定血清磷與尿酸濃度之Pearson’s相關性，與使用Kaplan-Meier繪製3組病人的存活曲線圖和Log-Rank test進行血液透析病人的存活率比較；最後以Cox比例風險分析血清磷合併尿酸濃度影響死亡風險之因子。
結果：血液透析病人的血清磷與尿酸濃度呈現正向線性關係（r =0.53, P ＜.001）。血清磷與尿酸濃度乘積每增加1個單位(mg/dl)，則死亡風險下降0.97倍（HR = 0.97, P < .05）。經多變項Cox比例風險分析，發現「年齡」為影響血液透析病人存活率之重要因子。另外，ANOVA分析以第3組個案之基本屬性：平均年齡為64 ± 11歲（P ＜.05）最年輕、男性居多（71%）、高脫水量（2.61±0.87公斤）及高數值的身體質量指數[BMI（23.01±4.31）]、常態蛋白質分解率[nPCR (1.29±0.31)]、白蛋白（3.59±0.32）、血清鉀（4.79±0.87）、尿素氮（87.11±18.87）與肌酸酐（11.64±2.83）皆相較其他組偏高達顯著差異（P ＜.05）。因此，血清磷與尿酸濃度乘積高的第3組Kaplan–Meier的存活曲線為最高且Log-Rank test （第1組：第3組，P=0.01）顯示存活率為最佳。
結論：「年齡」為影響血液透析病人存活率之重要因子。當血液透析病人的血清磷與尿酸濃度乘積高時，表示病人的整體健康狀況相對的較佳，因此，存活率亦會較高。
實務應用：本研究結果可提供臨床護理人員作為每月判讀血液透析病人身體健康狀況的參考指標。當血液透析病人的血清磷與尿酸濃度低下時，即表示病人處於飲食攝取不足的狀態，此時的照護重點應衛教病人多攝取高營養價值食物，以增加血清磷與尿酸濃度，強化抵抗力並能提高存活率。

Background: Phosphorus (P) and uric acid (UA) are present in foods, widely. For patients with hemodialysis (HD) who are eating dietary intake, (P) and (UA) concentrations in the body can affect the patient's health and prognosis. Therefore, the aim of this study was to evaluate the long-term prognosis of serum Phosphorus〔S(P)〕with serum uric acid〔S(UA)〕in Hemodialysis Patients.
Methods: This study is a cross-sectional description of the correlation study, the secondary data analysis. A cohort of 100 maintenance HD patients from a single center were divided into tertiles based on the product of S(P) × S(UA) : Group 1: S(P) × S(UA) < 25 mg/dl: n=34; Group 2: S(P) × S(UA) =25 ~ 40 mg/dl: n=31; and Group 3: S(P) × S(UA) ≧ 40 mg/dl: n=35. The maximal observation period was 54 months. Appropriate χ2 and ANOVA with post hoc LSD tests were used for comparisons between categorical and continuous variables between the groups, respectively. The relationship between S(P) and S(UA) was assessed by Pearson correlation analysis. Actuarial survival rates of the three groups categorized by different S(P) × S(UA) products were determined by the Kaplan-Meier method, and log-rank test were used to compare different survival curves between groups.
Results: S(P) showed a positive linear correlation with S(UA) (r = 0.53; P < .001). By multiple Cox proportional hazard models showed the age at start of study is considered to be an important risk factor for mortality. Moreover, compared with those in the other two groups, patients in group 3 were younger at the beginning of study (64 ± 11 years old, P ＜.05), more male (71%) , hight of body weight gain before HD (2.61±0.87, Kg), and had highest levels of body mass index [BMI (23.01±4.31)], normalized protein catabolic rate [nPCR (1.29±0.31)] , albumin (3.59±0.32), potassium (4.79±0.87), Blood urea nitrogen [BUN (87.11±18.87)], Creatinine (11.64±2.83), significant differences in statistics (P＜.05). Kaplan-Meier analysis and log-rank test shows the cumulative survival rate of the hight for the Group 3.
Conclusion: Age is an important factor to influence the survival rate of hemodialysis patients. In chronic hemodialysis patients with higher S(P) and S(UA) levels were characterized by hyperalbuminemia and higher BMI, and they were associated with higher long-term survival rate.
Practical application: The results of this study can provide clinical healthcare staff to education the hemodialysis patients which physical health indicators. Suggested clinical healthcare staff, education focuses on dietary intake food of high nutritional value for lower S(P) and S(UA) levels of hemodialysis patients to improve the long-term prognosis.

誌謝...................................................................................................Ⅰ
中文摘要...........................................................................................Ⅱ
Abstract.............................................................................................Ⅲ
目次...................................................................................................Ⅳ
表目次...............................................................................................Ⅵ
圖目次...............................................................................................Ⅶ
第一章 緒論....................................................................................4
第一節 研究背景與動機..............................................................4
第二節 研究目的與研究假設......................................................6
第二章 文獻查證............................................................................7
第一節 血清磷對透析病人存活的影響......................................7
第二節 尿酸濃度對透析病人存活的影響..................................9
第三節 影響透析病人存活的其他因素....................................11
第三章 研究方法..........................................................................17
第一節 研究設計........................................................................17
第二節 研究架構........................................................................17
第三節 研究對象與資料來源....................................................18
第四節 測量................................................................................18
第五節 研究倫理........................................................................20
第六節 研究資料處理與分析....................................................20
第四章 研究結果..........................................................................21
第一節 研究個案之基本屬性描述..........................................21

第二節 血清磷與尿酸濃度之相關性分析…........................24
第三節 影響研究個案死亡因子之分析.................................28
第四節 存活率之比較.............................................................34
第五節 研究個案死亡與存活之基本資料分析....................46
第五章 討論.................................................................................48
第一節 影響研究個案存活率之因素.....................................48
第二節 3組血清磷與尿酸濃度乘積對研究個案之存活率影響................................................................................52
第六章 結論與建議.....................................................................56
第一節 結論..............................................................................56
第二節 研究限制與建議..........................................................57
第三節 臨床應用與研究貢獻..................................................58
參考文獻.........................................................................................59
中文部分.....................................................................................59
西文部分.....................................................................................61
附錄.................................................................................................67
附錄一 人體試驗通過同意書...................................................67

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