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研究生:徐碧秀
研究生(外文):HSU, PI-HSIU
論文名稱:吸菸、喝酒、嚼檳榔與慢性腎臟病 惡化之關聯
論文名稱(外文):Smoking, alcohol drinking, chewing betel nut and the progression of chronic kidney disease
指導教授:邱于容邱于容引用關係
指導教授(外文):CHIU, YU-LUNG
口試委員:林富宮盧國城邱于容
口試委員(外文):LIN, FU-GONGLU, KUO-CHENGCHIU, YU-LUNG
口試日期:2019-05-13
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2019
畢業學年度:107
語文別:中文
論文頁數:132
中文關鍵詞:慢性腎臟病吸菸喝酒嚼檳榔慢性腎臟病病程進展(惡化)
外文關鍵詞:Chronic kidney disease (CKD)smokingdrinkingchewing betel nutchronic kidney disease (CKD) progression
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台灣末期腎臟病(end-stage renal disease, ESRD)的盛行率、發生率不斷攀升,透析治療花費為健保單一給付金額最高的疾病,對台灣社會與經濟各層面莫不造成沉重負擔。不良健康行為中吸菸、喝酒及嚼檳榔是可以改變的不良習慣,如可透過簡單的行為改變達到降低慢性腎臟病(Chronic kidney disease, CKD)惡化,延緩ESRD的發生,進而減少醫療費用的支出。因此,本研究想探討吸菸、喝酒及嚼檳榔,此不良健康行為與CKD惡化之關聯性。
本研究為前瞻性世代追蹤研究(prospective cohort study),資料來源為2008 -2011年執行國民健康局委託計畫「慢性腎臟病流行病學研究」及2012 - 2015年「慢性腎臟病世代追蹤研究」。研究對象來自北、中、南14家醫學中心及區域醫院,本研究納入條件為年齡為≥18歲慢性腎臟病者,共計4,937位。慢性腎臟病惡化定義為腎絲球過濾率(eGFR)平均每年下降超過5 ml/min/1.73 m2或進入透析治療階段。
利用羅吉斯迴歸分析發現,控制相關影響因素後,吸菸、喝酒及嚼檳榔行為與慢性腎臟病惡化整體上沒有顯著關係,而糖尿病為惡化因子。再依據吸菸、喝酒、嚼檳榔行為分層分析,利用羅吉斯迴歸分析控制相關影響因素後,吸菸及嚼檳榔不良健康行為仍與慢性腎臟病患惡化也未達統計上的顯著關係,然而不喝酒者,吸菸、嚼檳榔、糖尿病與貧血為惡化因子。
建議慢性腎臟病患者若同時伴隨糖尿病者,應定期追蹤腎功能,以及早發現慢性腎臟病惡化之情形。提供不喝酒之慢性腎臟病患者戒菸及戒檳榔之衛教,改變其不健康之行為。

The prevalence and incidence of end-stage renal disease (ESRD) continue to rise in Taiwan. The cost of dialysis is the highest among all healthcare treatments, and it imposes a heavy burden on the social and economic levels of Taiwan. Smoking, drinking, and chewing betel nut are unhealthy habits that can be quit to improve the situation. For example, simple behavioral changes can reduce the deterioration of chronic kidney disease (CKD), delay the occurrence of ESRD, and reduce medical expenses. Therefore, we investigated the association of smoking, drinking, and chewing betel nut with CKD progression.
This study is a prospective cohort study. The data were obtained from the “Chronic Kidney Disease Epidemiology Study” commissioned by the National Health Service from 2008 to 2011 and “Second Chronic Nephrology Generation Tracking Study” from 2012 through 2015. The sample comprised 4,937 patients with CKD (age: ≥18 years) from 14 medical centers and regional hospitals in North, Central, and South Taiwan. CKD was defined as estimated Glomerular Filtration Rate (eGFR) falling declining by more than 5 mL/min/1.73 m2 per year or entering the dialysis treatment phase.
After adjustment for relevant influencing factors, we found that smoking, drinking, and chewing betel nut were not significantly related to the deterioration of CKD. However, diabetes was related to CKD progression. Furthermore, according to the stratification analysis of the aforementioned three habits, smoking and chewing betel nut did not exhibit a statistically significant relationship with the deterioration of CKD after controlling relevant influencing factors. However, smoking, chewing betel nut, diabetes, and anemia were risk factors for CKD progression in non-drinkers.
Regular tracking of renal function to detect CKD progression is recommended for patients with CKD and diabetes. Creating an awareness in the non-drinker population to quit their unhealthy behaviors, such as smoking and chewing betel nut, is needed.

目錄 頁碼
目錄 i
表目錄 ii
圖目錄 iv
中文摘要 v
英文摘要 vi
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 3
第三節 研究必要性及重要性 5
第四節 研究目的 6
第五節 名詞解釋 7
第二章 文獻探討 9
第一節 慢性腎臟病流行病學 9
第二節 慢性腎臟病危險因子 12
第三節 慢性腎臟病惡化之影響因素 19
第三章 研究方法 25
第一節 研究設計及對象 25
第二節 研究架構 30
第三節 研究假設 31
第四節 研究工具 2
第五節 研究變項操作型定義 36
第六節 資料收集方法與步驟 39
第七節 資料處理與統計分析 42
第四章 研究結果 44
第一節 研究對象基本特質、不良健康行為、疾病史之分布 44
第二節 研究對象基本特質、不良健康行為、疾病史分布與慢性腎臟病惡化之單變項檢 52
第三節 研究對象慢性腎臟病惡化之影響因素 69
第五章 討論 78
第一節 研究對象基本特質 78
第二節 吸菸行為、喝酒行為、嚼檳榔行為與慢性腎臟病惡化 79
第三節 其他因素與慢性腎臟病惡化 83
第四節 研究限制 85
第六章 結論與建議 86
第一節 結論 86
第二節 建議 88
表目錄
表一:慢性腎臟病的分期 8
表二:97-100年執行「慢性腎臟病流行病學研究」收案數 28
表三:101-104年研究計畫總個案數預估 29
表四:研究對象之慢性腎臟病期別定義 38
表五:研究對象資料追蹤收案頻率 40
表六:慢性腎臟病惡化影響因素 87
表1:慢性腎臟病患者基本特質、生化檢驗值 89
表2:慢性腎臟病患者不良健康行為之分布 90
表3:慢性腎臟病患者疾病史之分布 91
表4:慢性腎臟病患者基本特質、生化檢驗值與吸菸行為之分布 92
表5:慢性腎臟病患者不良健康行為與吸菸行為之分布 93
表6:慢性腎臟病患者疾病史與吸菸行為之分布 94
表7:慢性腎臟病患者基本特質、生化檢驗值與喝酒行為之分布 95
表8:慢性腎臟病患者不良健康行為與喝酒行為之分布 96
表9:慢性腎臟病患者疾病史與喝酒行為之分布 97
表10:慢性腎臟病患者基本特質、生化檢驗值與嚼檳榔行為之分 98
表11:慢性腎臟病患者不良健康行為與嚼檳榔行為之分布 99
表12:慢性腎臟病患者疾病史與嚼檳榔行為之分布 100
表13:慢性腎臟病患者基本特質、生化檢驗值與惡化之單變項檢定 101
表14:慢性腎臟病患者不良健康行為與惡化之單變項檢定 102
表15:慢性腎臟病患者疾病史與惡化之單變項檢定 103
表16:慢性腎臟病患者基本特質、生化檢驗值與惡化之單變項檢定-依吸菸行為分層分析 104
表17:慢性腎臟病患者不良健康行為與惡化之單變項檢定-依吸菸行為分層分析 106
表18:慢性腎臟病患者疾病史與惡化之單變項檢定-依吸菸行為分層分析 107
表19:慢性腎臟病患者基本特質、生化檢驗值與惡化之單變項檢定-依喝酒行為分層分析 109
表20:慢性腎臟病患者不良健康行為與惡化之單變項檢定-依喝酒行為分層分析 111
表21:慢性腎臟病患者疾病史與惡化之單變項檢定-依喝酒行為分層分析 112
表22:慢性腎臟病患者基本特質、生化檢驗值與惡化之單變項檢定-依嚼檳榔行為分層分析 114
表23:慢性腎臟病患者不良健康行為與惡化之單變項檢定-依嚼檳榔行為分層分析 116
表24:慢性腎臟病患者疾病史與惡化之單變項檢定-依嚼檳榔行為分層分析 117
表25:慢性腎臟病患者惡化影響因素之羅吉斯迴歸分析 119
表26:慢性腎臟病患者惡化影響因素之羅吉斯迴歸分析-有吸菸行為者 120
表27:慢性腎臟病患者惡化影響因素之羅吉斯迴歸分析-沒有吸菸行為者 121
表28:慢性腎臟病患者惡化影響因素之羅吉斯迴歸分析-有喝酒行為者 122
表29:慢性腎臟病患者惡化影響因素之羅吉斯迴歸分析-沒有喝酒行為者 123
表30:慢性腎臟病患者惡化影響因素之羅吉斯迴歸分析-有嚼檳榔行為者 124
表31:慢性腎臟病患者惡化影響因素之羅吉斯迴歸分析-沒有嚼檳榔行為者 125
參考文獻 127
圖目錄
圖1 慢性腎臟病世代研究之收案流程圖 27
圖2 研究對架構 30
圖3 慢性腎臟病世代研究之追蹤流程圖 41





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