臺灣博碩士論文加值系統

本研究旨在調查嘉義縣18鄉鎮第三至第五期慢性腎臟疾病之盛行率現況、各鄉鎮的差異性、以及慢性腎臟病的危險因子進行多變項邏輯式迴歸分析。針對嘉義縣年齡大於40歲以上，參與嘉義縣衛生局複合式篩檢活動的縣民，於2002年1月至2008年12月間共36,836筆受檢資料作分析，依照美國腎臟基金會於2002年提出之腎臟疾病預後品質導引（K/DOQI™）計算出腎功能並加以分期，以腎絲球過濾率小於60毫升/分鐘定義為慢性腎臟病（第三至第五期的腎臟疾病）。研究結果顯示，嘉義縣的慢性腎臟病盛行率為22.9﹪，慢性腎臟病的盛行率隨年齡增加而上升，女性的慢性腎臟病盛行率比男性多1.05倍，血糖每增加1 mg/dl，發生慢性腎臟病的機會就增加1.001倍，但各鄉鎮民眾對糖尿病的疾病認知度差異極大。
從研究結果可驗證區域、年齡、性別與糖尿病、疾病認知等的確為慢性腎臟病的重要影響因素。研究顯示，在慢性腎臟病早期，血糖過高將相對造成腎絲球過濾率下降，尤其以第三期慢性腎臟病最為顯著，直接證實早期診斷、早期治療的重要性，故此研究在延緩慢性腎臟病惡化及預防相關併發症上提供相當的參考價值，也可作為未來國內慢性腎臟病早期篩檢及個案管理工作之參考。從區域差異分析上，遠離市郊而位於偏遠地區之阿里山鄉、梅山鄉及布袋鎮等，分屬嘉義縣山線與海線的極端區域，其慢性腎臟病盛性率及糖尿病之風險皆相對偏高，有理由成為社區健康管理的重點目標，若能依據鄉鎮特性，開發創新之健康行銷策略，並落實執行推動，強化既有社區醫療服務之持續性及完整性，落實預防醫學、提供更有效率之疾病管理模式，深耕個案追蹤管理等共同照護網及建構完善的健康照護系統，相信對嘉義縣慢性腎臟病之防治工作將有莫大的助益。

The purpose of this study was to investigate the prevalence of CKD, the geographical and regional variations of CKD, and risk factors of CKD using multivariate logistic regression in the middle-aged and elderly population with stage III-V CKD among the 18 townships in Chiayi County. From January 2002 to December 2008, the health bureau of Chiayi County launched a large-scale healthy survey project naming the Community Complex Health Screening program. Residents of the county with age above 40 years were invited to participate the health survey. A total of 36836 participants were enrolled in this study. CKD was classified according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) guidelines. The current study focus is on stage 3, 4, and 5 CKD defined by eGFR value < 60 ml/min/1.73 m2. In this study, the overall prevalence of CKD in Chiayi County was found to be 22.9%.The prevalence of CKD showed a significant increasing trend with aging process. The prevalence of CKD in female group was significantly higher 5% when compared to those in male group. Furthermore, an increase of 1 mg/dl in blood sugar level was associated with an adjusted OR for CKD of 1.001.
As for awareness for disease, there is significantly variation of the 18 townships in Chiayi County. The important factors for CKD are as following regional variation, age, sex, diabetes and low awareness rate.; therefore, intervention in early stage of CKD esp. in CKD stage III patients should be done as early as possible.In addition , this study provides valuable information which means the importance of not only slowing down the progression of CKD, but also reduction of the complications of end-stage renal disease. From regional variation analysis, remote districts including Alishan, Meishan and Budai belong to extreme marginal area located in sea-side and mountain-side area in Chiayi County. To our interest, the proportional hazard ratios of prevalence of CKD and diabetes are relatively higher in these three townships. These areas therefore seem to become a focus of community health management goals in Chiayi County. Based on specific township characteristics in Chiayi County, we provide several important targets and items of Prevention and Treatment of Chronic Kidney Disease to Chiayi County as follows:
1.To develop innovative and healthy marketing strategies in CKD prevention
2.To promote implementation of CKD prevention
3.To strengthen the continuity and integrity of the existing community health care services
4.Implementation of preventive medicine
5.To Provide a more efficient model of disease management
6.To perform Follow-up care case management under Shared Care Network
7.To Construct a sound health care system

誌謝 i
摘要 ii
ABSTRACT iii
目錄 iv
表目錄 vi
圖目錄 vii

第一章 序論 1
1.1 問題定義 1
1.2 研究的重要性 2
1.3 文獻總覽 6
1.4 文獻缺失 9
1.5 研究目的 9
1.6 研究範圍 10
1.7 名詞解釋 10
1.8 研究的預期貢獻 12

第二章 文獻探討 15
2.1 慢性腎臟病及晚期慢性腎臟病的影響 15
2.2 慢性腎臟病、晚期慢性腎臟病流行病學現況及問題 16
2.3 腎臟病、慢性腎臟病的危險因子 20
2.4 糖尿病對健康之威脅 23
2.5 糖尿病與腎病變之關連 24

第三章 研究架構與假說 29
3.1 研究架構 29
3.2 研究假說 30

第四章 研究方法 35
4.1 研究變項操作性定義 35
4.2 研究對象 35
4.3 資料分析方法 35

第五章 研究結果 37
5.1 嘉義縣民慢性腎臟病之年齡、性別、地區分佈的概況 37
5.2 嘉義縣各鄉鎮慢性腎臟病的詳細資料 40
5.3 嘉義縣各鄉鎮糖尿病與慢性腎臟病的關係 44

第六章 討論 49

第七章 結論與建議 53
7.1 管理上之應用 53
7.2 研究限制與未來研究方向 54
7.3 研究結論 55

參考文獻 57

附錄A 嘉義縣複合式健康篩檢計畫 63

附錄B 內文研究結果圖表數值 65

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