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研究生:楊清評
研究生(外文):Ching-ping Yang
論文名稱:慢性腎臟病人的周邊動脈疾病盛行率和臨床相關因子
論文名稱(外文):The Prevalence and Clinical Correlative Factors of Peripheral Arterial Disease in Patients with Chronic Kidney Disease
指導教授:葉淑娟葉淑娟引用關係
指導教授(外文):Shu-chuan Jennifer Yeh
學位類別:碩士
校院名稱:國立中山大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:英文
論文頁數:54
中文關鍵詞:慢性腎臟病鈣離子阻斷劑高血壓周邊動脈疾病脈壓腳踝和腕上臂血壓比例
外文關鍵詞:Ankle brachial indexChronic kidney diseaseCalcium channel blockerPulse pressurehypertensionPeripheral artery disease
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研究目的
慢性腎臟病的病人有動脈粥樣硬化和周邊動脈疾病增加的風險。然而周邊動脈疾病在慢性腎臟病患者比冠狀動脈病受到了較少的注意。所以只有少數研究在審查周邊動脈疾病在慢性腎臟病患者的相關風險因素。在這個研究,我們研究了慢性腎臟病患者和周邊動脈疾病的相關風險因素,並發現了高血壓治療在慢性腎臟病患者的周邊動脈疾病可能的好處。
研究方法
我們包括129 名慢性腎臟病第3 到5 期,兩性的患者,慢性腎臟病第3 到5分期是依據結果質量主動性( K/DOQI)分類,患者都尚未接受透析療法,且先前未被診斷有周邊動脈疾病。研究在六個月期間之內收集了,包括人口統計的特徵如下:高血壓的病史,高血壓藥物的使用,糖尿病,抽煙和先前已存在的心血管疾病,身體質量指標,空腹的血糖,糖化血色素,總膽固醇,三酸甘油酯,高密度脂蛋白膽固醇,低密度脂蛋白膽固醇,鈣離子,磷離子,白蛋白,尿酸值,尿蛋白質。腳踝和腕上臂血壓比例是一個非侵入性的診斷工具,且在數值小於 0.9 可以有效率的診斷出無症狀周邊動脈疾病。
研究結果
總共有22 個(17.7%) 參與研究者有周邊動脈疾病。較高的心臟收縮血壓,較高的心臟舒張血壓,較高的脈壓在慢性腎臟病患者,顯示和周邊動脈疾病之間較強的相關。在進一步分析,發現用鈣離子阻斷劑治療的高血壓慢性腎臟病患者,較少合併有周邊動脈疾病 (χ2 =7.055, p =0.008)。多維分佈的邏輯式的回歸分析後,發現在高血壓的慢性腎臟病患者顯示了風險因素為脈壓,而鈣離子阻斷劑治療在高血壓的慢性腎臟病患者身上,也許和減少周邊動脈疾病的發生有相關( odds ratio = 0.232, CI = 0.07-0.73, p =0.013)。
結論
研究發現周邊動脈疾病在慢性腎臟病患者有較高的盛行率,特別是那些合併有高血壓的患者。腳踝和腕上臂血壓比例 (ABI)的檢查應常規的使用在慢性腎臟病患者,使慢性腎臟病患者能獲得及早治療周邊動脈疾病的益處。
Research Objective
Patients with chronic kidney disease (CKD) are at increased risk for atherosclerosis and peripheral artery disease (PAD). PAD has received far less
attention than coronary artery disease (CAD) in CKD patients. Few studies have examined risk factors for PAD in CKD. We studied the possible related risk factors and benefit of hypertension treatment in CKD patients with PAD.
Data Sources
We included 129 patients of both sexes with stages 3 to 5 of CKD, as described by the Kidney Outcome Quality Initiatives (K/DOQI ) classification, without
receiving dialysis therapy, not previously diagnosed with PAD.
Study Design
The following information were collected within six month period, including demographic characteristics, history of hypertension, anti-hypertension drug, diabetes, smoking, and pre-existing cardiovascular disease, body mass index (BMI), fasting blood glucose, HbA1c, total cholesterol, triglyceride(TG), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol(LDL), calcium (Ca),
phosphate(P), Albumin, uric acid, urine protein. Ankle-brachial index (ABI) is a noninvasive diagnostic test that is efficient in detecting asymptomatic PAD with ABI
<0.9.
Findings
There were 22 (17.7 %) participants with PAD. Higher systolic blood pressure (SBP), higher diastolic blood pressure (DBP), higher pulse pressure showed strong association with PAD in CKD patients. On further analysis, significant fewer patients treated with calcium channel blocker (CCB) in hypertensive CKD patients with PAD (χ2 =7.055, p =0.008). The multivariate logistic regression analysis in hypertensive patients demonstrated the risk factors for PAD was pulse pressure, and Calcium channel blocker treatment may correlate with decreasing PAD formation (odds ratio= 0.232, 95% CI=0.07-0.73, p =0.013) in CKD patients.
Conclusion
There is a high prevalence rate of PAD in population of CKD, especially those with hypertension. ABI should be routinely examined in these patients who can benefit earlier from therapeutic measures.
Acknowledgement ..………………………………………………………………..i
Abstract ..…………………………………………………………………………..ii
Chinese Abstract ..…………………………………………………………………iv
Table of Contents ..………………………………………………………………...vi
List of Tables ..…………………………………………………………………….vii
List of Figures ..…………………………………………………………………...vii
Chapter 1 Introduction ……………………………………………………………..1
Introduction …………………………………………………………………...1
Purpose of the study …………………………………………………………..2
Chapter 2 Literature Review ……………………………………………………….3
The Definition of Chronic kidney disease (CKD) ……………………………3
The Definition of Peripheral artery disease (PAD) .....……………………….4
The Prevalence of PAD in general population ……………………………….5
Risk factors of PAD in general population …………………………………...5
Risk factors of PAD in dialysis patients ……………………………………...6
Clinical manifestations of PAD ………………………………………………8
Non-invasive Diagnosis of PAD ……………………………………………..9
Ankle-brachial index examination …………………………………………...9
Management of PAD ………………………………………………………...12
Chapter 3 Theoretical Framework ………………………………………………...13
Peripheral arterial disease and chronic kidney disease ………………………13
Conceptual Framework ………………………………………………………16
Hypotheses …………………………………………………………………...19
Chapter 4 Methodology ……………………………………………………………20
Study Design ………………………………………………………………….20
Unit of Analysis and Samples ………………………………………………...20
Measurement ………………………………………………………………….20
Statistical Analysis …………………………………………………………….22
Chapter 5 Results …………………………………………………………………...23
Chapter 6 Discussion & Conclusion ………………………………………………..28
Conclusion …………………………………………………………………….34
References ………………………………………………………………………….35
List of Tables
Table 5-1 Characteristics of study population ……………………………………..24
Table 5-2 Comparison of risk factors in patients with PAD and non-PAD ………..25
Table 5-3 Comparison of drug used in hypertensive CKD patients with PAD and
non-PAD ………………………………………………………………...26
Table 5-4 Multivariate logistic regression analysis of hypertensive CKD patients with
PAD ……………………………………………………………………..27
List of Figures
Figure 2-1 Measurement of the Ankle–Brachial Index …………………………….11
Figure 3-1 Conceptual Framework of this Study …………………………………...18
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