臺灣博碩士論文加值系統

動機與目的：腎臟移植後新發生糖尿病，為腎臟受贈者生活品質降低的主要原因，且會增加病人死亡風險及醫療費用支出。本研究探討臺灣腎臟移植後新發生糖尿病之危險因素，以及比較腎臟移植後有無新發生糖尿病之存活風險。
方法：採回溯性世代研究，以2000年至2013年全民健康保險研究資料庫重大傷病檔為資料來源，擷取ICD-9-CM處置碼V42.0之腎臟移植病人共4,768人。排除年齡小於18歲、移植前有糖尿病診斷、15天內移植失敗或死亡及資料不全者，共納入3,525人。以卡方檢定分析腎臟移植後有無新發生糖尿病之差異，Cox proportional hazard model分析腎臟移植後新發生糖尿病之危險因素，Kaplan-Meier比較有無新發生糖尿病之存活風險。
結果：腎臟移植後新發生糖尿病有625人（17.7％），平均年齡47.18歲。有無新發生糖尿病患者在年齡、性別、查爾森共病症指標（Charlson comorbidity index, CCI）、投保薪資、高血壓、高血脂及醫院層級等變項，均達統計顯著差異。而年齡較高、男性、CCI≧3分、投保級距15,841-28,800元、高血脂、服用免疫抑制劑藥物（Tacrolimus）者等變項，有顯著較高的罹病風險。且腎臟移植後新發生糖尿病患者之5年存活率，低於未發生糖尿病患者。
結論：臺灣腎臟移植族群中，男性、50歲以上、CCI越高、投保薪資越低、高血脂、服用免疫抑制劑藥物（Tacrolimus）有較高新發生糖尿病風險。本研究結果可提供降低腎臟移植發生糖尿病，以及提高腎臟移植病人存活之參考。

Motivation and purpose：New-onset diabetes mellitus after transplantation (NODAT) is the main reason for the reduced quality of life of renal transplant (RTx) recipients, and it increases the risk of death of kidney recipients and medical expenses. This study was conducted to explored the risk factors for NODAT in Taiwan, and compared the risk of survival with NODAT.
Method：This was a retrospective cohort study that utilized the National Health Insurance Research Database (NHIRD) and the Registry of Catastrophic Illness from 2000 to 2013. A total of 4768 renal transplant recipients with ICD-9-CM diagnosis code V42.0 were retrieved in this study, exclude those with age younger than 18 years old, history of diabetes before renal transplantation, Transplant failure or death within 15 days and incomplete data, there were 3,525 were included for study. The Pearson’s Chi-square test was used to determine the differences in categorical variables between the NODAT and non-NODAT groups. Cox proportional hazards regression to estimate the hazard ratios (HRs) and 95% CIs of NODAT to evaluate the independent effect of sex, age, and comorbidity. Kaplan-Meier compares the risk of survival of between NODAT and non-NODAT groups.
Result：There were 625 RTx recipients developed NODAT (17.7%), with an average age of 47.18 years. The NODAT recipients have significantly different in elder than 50 years old, male gender, Charlson comorbidity index (CCI)≧3, income between $15, 841 to 28, 800, hypertension, hyperlipidemia, caring in Metropolitan Hospitals and use of tacrolimus. Five-year patient and graft survival of NODAT recipients is lower than that of non-diabetic patients.
Conclusion：In this study, we demonstrated the nationwide evidence of NODAT recipients had poorer 5-year survival outcomes in this population. The most important identifiable predictive factors for NODAT after RTx were elder, male gender, CCI≥ 3, middle income, hyperlipidemia, follow-up at Metropolitan Hospitals, and use of tacrolimus. These results could provide transplant physicians to manage recipients’ risk to minimize their incidence of NODAT and to improve their patient and graft survival of RTx recipients.

目錄
誌謝 i
摘要 ii
Abstract iii
目錄 v
表目錄 vii
圖目錄 viii
第一章、緒論 1
第一節、研究背景與動機 1
第二節、研究目的 3
第二章、文獻探討 4
第一節、腎臟移植的介紹 4
第二節、腎臟移植後新發生糖尿病之探討 5
第三節、腎臟移植後新發生糖尿病之其他危險因素 7
第四節、文獻小結 9
第三章、研究設計與方法 10
第一節、研究架構 10
第二節、研究對象與資料來源 11
第三節、研究設計 13
第四節、研究假設 17
第五節、研究變項操作型定義 17
第六節、分析方法 25
第四章、研究結果 26
第一節、研究對象基本特質之分布 26
第二節、腎臟移植病人發生糖尿病風險之Cox比例風險迴歸分析 31
第三節、存活曲線 36
第五章、討論 39
第一節、研究對象基本特質之差異分析 39
第二節、腎臟移植病人發生糖尿病風險之Cox比例風險迴歸分析 41
第三節、腎臟移植病人使用藥物發生糖尿病風險之存活曲線 45
第四節、腎臟移植病人發生糖尿病死亡率之存活曲線 45
第六章、結論與建議 47
第一節、結論 47
第二節、建議 47
第三節、研究限制 47

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