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研究生:陳玉芬
研究生(外文):CHEN,YU-FEN
論文名稱:探討第二型糖尿病合併慢性腎臟病惡化狀態與HbA1c之關聯
論文名稱(外文):Risk Association Between HbA1c And Kidney Function Worsening Of Chronic Kidney Disease In Patients With Type 2 Diabetes At a Regional Hospital In Southern Taiwan
指導教授:陸海林陸海林引用關係洪萬吉洪萬吉引用關係
指導教授(外文):LU, HAI-LINHONG,WAN-JI
口試委員:楊美雪何宗翰
口試委員(外文):YANG, MEI-XUEHO, ZONG-HAN
口試日期:2017-06-17
學位類別:碩士
校院名稱:嘉南藥理大學
系所名稱:醫務管理系
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:2017
畢業學年度:105
語文別:中文
論文頁數:50
中文關鍵詞:第二型糖尿病慢性腎臟病糖化血色素肌酸酐估計腎絲球過濾率
外文關鍵詞:Type 2 diabetesChronic Kidney DiseaseHbA1cCreatinineeGFR
相關次數:
  • 被引用被引用:1
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  • 下載下載:34
  • 收藏至我的研究室書目清單書目收藏:1
根據衛福部統計處104年公布十大死因糖尿病及腎病症候群死亡率分別各佔第五名及第九名,本研究為探討糖尿病與慢性腎臟病病人的腎臟病變相關性,藉由HbA1c數值變化與腎臟病惡化情況進行分析,了解當糖尿病控制不佳會導致腎病變情況惡化,希望找出其中風險因子,能致力於緩解糖尿病腎病變惡化程度及延長進入惡化時間,提升糖尿病病人生活品質及降低健保支出費用之龐大財務危機。
分析對象採南部某區域教學醫院內使用Hyperion軟體進行LIS資料庫資料收集,收集對象為內分泌科101年為第二型糖尿病併有慢性腎臟病第3b期別之病人,相關檢驗追蹤時間為3年,共計261人次進行回溯性研究探討,並以SPSS20.0進行統計分析。
結果以描述性統計分析性別比例、年齡分布及每年度檢驗數值,包含女141人男120人年齡平均68.24歲,發現病人在糖尿病併慢性腎臟病病人其eGFR每年度下降數值皆有顯著差異(P<0.001),慢性腎臟病惡化病人HbA1c平均數也較非惡化病人來的較高(P<0.001),將每年度HbA1c與慢性腎臟病惡化相關性進行探討,當HbA1c大於7.5%時與慢性腎臟病惡化有顯著相關性(P<0.05),此外,當HbA1c每上升1%會使得慢性腎臟病惡化風險增為1.256倍。
積極控制血糖雖然無法使得糖尿病引發的慢性腎臟病腎臟破壞程度恢復,但藉由本研究可得知若能將血糖控制在7.5%將可延遲腎臟惡化情況且降低腎臟病惡化的風險。

According to the Ministry of Health and Welfare Department of Statistics, among the top ten causes of diabetes mellitus and nephropathy, respectively, the fifth and ninth. This study was to investigate the relationship between diabetes and kidney disease in patients with chronic kidney disease, variety of the HbA1c level and deterioration of renal disease analysis, to understand when the poor control of diabetes can lead to deterioration of kidney disease, hoping to find the risk factors, can focus on alleviating the degree of deterioration of diabetic nephropathy and prolonged into the deterioration of time, improve the quality of life of patients with diabetes and reduce the cost of health insurance spending a huge financial crisis.
Analysis of the object by the southern region of a teaching hospital using Hyperion software for LIS database data collection, the patients from endocrinology in 101 years for type 2 diabetes with chronic kidney disease G3b stage , 3 years of relevant test tracking time. A total of 261 people having retrospective study, statistical analysiing by SPSS20.0.
The sex ratio, age distribution and annual test values were analyzed by descriptive statistics, including female 141 and men 120 average age 68.24 years old. The eGFR level decrease from 101 to 104 year was significantly different (P <0.001). The mean of HbA1c in patients with chronic kidney disease was also higher than that in non-worsening patients (P <0.001). The correlation between HbA1c and chronic kidney disease progression was discussed every year. When HbA1c was highier than 7.5%, there was a significant correlation with the deterioration of chronic kidney disease (P <0.05). In addition, when the HbA1c increased by 1%, the risk of developing chronic kidney disease is 1.256 times higher (P <0.05).
A good control of blood sugar, although not able to make diabetes caused by chronic kidney disease kidney damage recovery, but by the study can be learned if the blood sugar control under 7.5% will delay the deterioration of the kidneys and reduce the risk of kidney disease deterioration.

第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 7
第三節 名詞解釋 7
第二章 文獻探討 17
第三章 研究方法 22
第一節 研究架構 22
第二節 研究方法 24
第三節 研究假設 28
第四章 結果 29
第一節 檢驗數值比較 29
第二節 分析病人慢性腎臟病惡化情況 32
第三節 慢性腎臟病惡化及非惡化之病人HbA1c數值變化 33
第四節 HbA1c數值之病患與慢性腎臟病惡化相關性 36
第五節 預測HbA1c與慢性腎病變惡化風險 39
第五章 討論與結論 40
第一節 討論 40
第二節 結論 43
第三節 研究限制與建議 43
參考文獻 44

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