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系統識別號 U0026-1907201711423900
論文名稱(中文) 慢性腎臟病進展對生活品質的影響
論文名稱(英文) Progression of Chronic Kidney Disease and Change of Quality of Life
校院名稱 成功大學
系所名稱(中) 公共衛生研究所
系所名稱(英) Graduate Institute of Public Health
學年度 105
學期 2
出版年 106
研究生(中文) 陳秉鈺
研究生(英文) Ping-Yu Chen
學號 T86031078
學位類別 碩士
語文別 英文
論文頁數 28頁
口試委員 指導教授-王榮德
口試委員-李中一
口試委員-宋俊明
口試委員-黃尚志
中文關鍵字 慢性腎臟病  生活品質 
英文關鍵字 chronic kidney disease  quality of life 
學科別分類
中文摘要 背景: 生活品質是逐漸被重視的健康測量計量單位。目前已知慢性腎臟病人的生活品質會下降。之前的研究大多為橫斷性研究,且著重於生活品質和死亡及心血管事件的關係。本研究的目的為評估慢性腎臟病進展時的生活品質改變。

方法: 本研究之受試者為南台灣兩家醫院的腎臟科門診病人,其中一家為醫學中心,一家為社區型地區醫院。每次受訪時,我們會蒐集世界衛生組織生活品質問卷-台灣簡明版,以及當次的人口學變項及實驗室數據。總共有945名病人完成調查,共1314份問卷納入最後分析。我們使用混和效果模型來分析影響生活品質的關連因子。

結果: 本研究發現年齡、白蛋白、貧血及醫院別皆會影響生活品質分數。在校正年齡、性別、婚姻、教育程度、醫院層級、身體質量函數、慢性腎臟病期別、血色素、白蛋白及追蹤時間後,我們發現當慢性腎臟病進展時,除了社會功能以外,其他的生活品質範疇皆會下降。從慢性腎臟病分期3B開始,「睡眠」及「正面感受」的分數開始下降。隨著進展到慢性腎臟病分期第4期,「活力及疲倦」、「靈性感受」、「自尊」及「休閒娛樂」的分數跟著下降。

結論: 慢性腎臟病進展會對生活品質產生負面影響。臨床上我們需對生活品質更加關注,以提早發現慢性腎臟病的進展。
英文摘要 Background: Quality of life (QOL) measures are tools of patient reported outcomes. Chronic kidney disease (CKD) is known associated with a decreased QOL. Previous studies were mostly cross-sectional survey and focused on the relationships of QOL and hard outcomes (cardiovascular event and death). Our study aimed to evaluate QOL changes when CKD stage progressed.

Method: We conducted a questionnaire survey in the nephrology clinic in two hospitals in Southern Taiwan (one tertiary center and one community hospital). The scores of WHO Quality of Life-BREF (WHOQOL-BREF) and demographic data were obtained during each visit. Total 945 patients completed survey and 1314 WHOQOL-BREF questionnaires were analyzed. We used mixed effects model to study factors associated with QOL questions.

Results: The associations between QOL scores and age, albumin level, anemia, and health care services corroborated with previous reports. After adjustments for age, sex, marital status, education level, hospital level, body mass index (BMI), CKD stage, hemoglobin, albumin, follow-up time, we found QOL deteriorated when CKD stages advanced in all aspects except social domain, beginning with item scores of “sleep” and “positive feelings” in CKD stage 3B, followed by “energy & fatigue”, “spirituality”, “self-esteemed”, and “recreation” in stage 4.

Conclusions: Progression of CKD associates with negative impacts on QOL. Future studies are warranted to explore the possible monitoring of QOL for early detection of CKD progression.
論文目次 摘要 I
Abstract II
Contents IV
Introduction 1
Methods 2
Participants. 2
Data Collections. 3
Tools of Investigations 4
Statistical Analysis. 5
Results 5
Baseline Characteristics 5
QOL Measures in patients with different stages of chronic kidney disease 6
Determinants of QOL 7
Discussion 8
Conclusion 13
Figure 15
Tables 16
Table 1 Comparison of baseline demographic and clinical characteristics of enrolled population stratified by hospital types 16
Table 2 Average scores (± standard deviation) of WHOQOL(World Health Organization Quality of Life) stratified by stages of chronic kidney disease (CKD) 17
Table 3 Mixed effects model of variables correlate with HRQOL after adjustment for age, sex, marital status, education level, hospital level, body mass index (BMI), CKD stage, hemoglobin, albumin, follow-up time 18
Reference 19
Appendix 27
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