進階搜尋

 
查詢範圍:「 關鍵字=chronic kidney disease   」
顯示範圍:第1、2、3、4、5筆 論文書目資料
顯示格式:全部欄位
共 5 筆
------------------------------------------------------------------------ 第 1 筆 ---------------------------------------------------------------------
系統識別號 U0007-0208201015432500
論文名稱(中文) 台灣慢性腎臟疾病患者盛行率與醫療利用分析-以健保資料庫為例
論文名稱(英文) Prevalence and Health Service Utilization of Chronic Kidney Disease in Taiwan - A Population-based Study
校院名稱 臺北醫學大學
系所名稱(中) 醫務管理學研究所
系所名稱(英) School of Health Care Administration
學年度 99
學期 2
出版年 99
研究生(中文) 蔡秉諺
學號 M111097004
學位類別 碩士
語文別 中文
口試日期 2010-06-28
論文頁數 74頁
口試委員 指導教授-李顯章
委員-朱基銘
委員-溫信財
關鍵字(中) 慢性腎臟疾病
末期醫腎臟疾病
醫療利用
盛行率
關鍵字(英) chronic kidney disease(CKD)
End-Stage Renal Disease(ESRD)
Health Service Utilization
Prevalence
學科別分類
中文摘要 背景:末期腎臟疾(ESRD)病每年消耗健保338億台幣,對健保制度造成嚴重的衝擊,然而我國對末期腎臟疾病前期的慢性腎臟疾病(CKD)的盛行率仍然不甚清楚。
目的:推估台灣地區慢性腎臟疾病盛行率,並且推估若慢性腎臟疾病惡化成末期腎臟疾病造成的醫療利用變化。
方法:運用國家衛生研究院發行之全民健康保險資料庫,並利用可能成為末期腎臟疾病之慢性腎臟疾病診斷碼,以一年內發生兩次以上就診記錄且兩次間隔在3個月以上做為判斷條件,做為本研究之樣本,推估2001年~2005年慢性腎臟疾病在台灣地區的盛行率,並計算其醫療利用率。採用SAS 9.1.3統計軟體進行資料分析,統計方法包括獨立t檢定、變異數分析、邏輯斯迴歸、卜瓦松迴規及複迴歸等。
結果:在盛行率方面,2005年全人口標準化盛行率為每十萬人口1,717.9人,女性盛行率為每十萬人口1,889.2人、男性盛行率為每十萬人口1,550.3;男女性比為1.22;在醫療利用率上,經扣除精神科利用及意外事故門診費用後,慢性腎臟疾病患者男性每人每年平均花費56,905元、女性每人每年平均花費56,220元,,若進入長期透析則每人每年花費較未進入長期透析者增加619,760元,在平均門診就診次數上,男性32.73次、女性34.91次;再扣除透析利用費用後,男性每人每年平均花費36,985元、女性每人每年平均花費39,346元;非透析利用門診次數男性32.33次、女性34.46次,在總門診費用的複迴歸中,以經常利用醫院的層級別高者、及有共病者的花費較高;在總門診次數的複迴歸中,以性別、年齡、就醫區域、低收入者、經常利用醫院的教學別、經常利用醫院的層級別及有共病者的就診次數較高;在門診非透析利用的複迴歸中,以經常利用醫院的層級別、有共病者的費用較高;其次,在住院的比較上、性別、年齡、就醫區域、低收入者、經常利用醫院層級別、及有共病者的住院機會較高,在加護病房的入住機率中,年齡、經常利用醫院的權屬、有多重共病因子較高。
結論:國內慢性腎藏疾病的盛行率呈現升高趨勢,男性及老年人口盛行率更高,長期利用透析服務者,其總體醫療利用將大幅提高,建議主管機關應重視腎臟疾病。
英文摘要 Background:End-Stage Renal Disease (ESRD) consumes TWD33.8 billion in health insurance each year; it leads to a serious impact on the health insurance system. However, the prevalence rate of chronic kidney disease (CKD) on early ESRD is still unclear in Taiwan.
Objectives:The current study aims to analyze the CKD prevalence rate between 2001 to 2005 in Taiwan and calculate its medical utilization.
Methods:Using the National Health Insurance Database published by National Health Research Institute, ESRD candidates extracted from CKD diagnosis code were collected as the study samples; the candidates must have at least two clinical visit records within a year, and the gap between the two visits must be three months or longer. Statistical Analysis Software (SAS) Version 9.1 was used for data analysis. The statistical methods included t-test, Chi-square test, ANOVA, chronological trend through Poisson regression, and logistic regression.
Results:Regarding the prevalence rate, the standardized prevalence rate was 1,717.9 per 100 thousand total population in 2005, 1,889.2 per 100 thousand females, and 1,550.3 per 100 thousand males; the male to female ratio was 1.22. Regarding medical utilization, after eliminating psychiatric and accidental event utilization, each CKD male patient spent TWD56,905 per year on average and each CKD female patient spent TWD56,220 per year on average. If long term dialysis is required, an additional TWD619,760 would be spent on each patient per year, as compared to those who did not require long term dialysis. Regarding average outpatient visit frequency, the results show 32.73 per male patient and 34.91 per female patient. After eliminating the dialysis utilization, each male spent TWD36,985 per year on average, each female spent TWD39,346 per year on average. The frequency of outpatient visits for non-dialysis utilization was 32.33 per male patient and 34.46 per female patient on average. In regression analysis of the total outpatient cost, higher outcomes were observed on frequent use higher accredited level and patients with disease complications; in regression analysis of the total outpatient frequency, higher outcomes were observed on gender, age, clinic visit location, patients with low income, frequent use hospital teaching status, frequent use hospital accredited level and patients with combined diseases; in regression analysis of non-dialysis outpatient clinics, higher outcomes were observed on the frequent use hospital accredited level and patients with combined diseases; furthermore, regarding hospitalization opportunities, higher outcomes were observed on gender, age, clinic visit location, patients with low income, frequent use hospital accredited level and patients with combined diseases; for ICU ward hospitalization opportunities, higher outcomes were observed on age, frequent use hospital ownership and patients with combined diseases.
Conclusions:An increasing trend is observed on the prevalence rate of CKD in Taiwan; it is even higher in males and older populations, and long term dialysis users, which greatly increases the total medical utilization. Authoritative organizations are recommended to pay more attention to CKD.
論文目次 目  次 I
表  次 III
圖  次 IV
中文摘要 V
ABSTRACT VII
第一章 緒論 1
 第一節 研究背景與動機 1
 第二節 研究目的 2
 第三節 研究重要性 3
第二章 文獻探討 4
 第一節 慢性腎臟疾病的定義與分期 4
 第二節 慢性腎臟疾病的流行病學現況與危險因子 6
 第三節 治療方式及其費用 12
 第四節 全民健康保險承保抽樣歸人檔簡介 14
 第五節 實證研究 15
第三章 研究材料與方法 19
 第一節 研究設計 19
 第二節 研究架構 20
 第三節 研究假說 20
 第四節 研究樣本與操作型定義 22
第四章 研究結果 31
 第一節 盛行率 31
 第二節 醫療利用的變化 35
第五章 討論 62
參考文獻 66
 中文部分 66
 西文部分 68

參考文獻 中文部分
王冠懿、鄭守夏 (2006)•民眾就醫層級與醫療利用分析:SARS疫情前後的觀察•台灣衛誌,25 (1),75-82。
王震宇、劉玲玲、王登鶴、夏清智、秋文祥 ( 2005 ) •慢性腎疾病病人的冠狀動脈疾病的傳統危險因子的矯正•腎臟與透析雜誌,17(4),202-219。
王曦澔、陳泓源、姜至剛、吳寬墩 ( 2006 ) •透析病患常見營養不良的原因及評估方法•腎臟與透析雜誌,18(3),109-113。
台北榮民總醫院血液透析室 ( 2005 )•血液透析(HD)•瀏覽日期2009年12月30
日,取自http://homepage.vghtpe.gov.tw/~neph/hdu/edu-hd.htm
林大維、楊五常 ( 2005 )•慢性透析病人的心臟血管疾病•腎臟與透析雜誌,
  17(1),30-43。
行政院衛生署 ( 2009,11月09日 )•97年醫療統計年報•瀏覽日期2009年12
  月30日,取自
http://www.doh.gov.tw/CHT2006/DM/DM2_2_p02.aspx?class_no=440&now_fod_list_no=10903&level_no=3&doc_no=73472
行政院衛生署 國民健康局 ( 2006,5月29日 )•慢性腎臟疾病之定義•瀏覽日
  期2009年12月30日,取自http://www.bhp.doh.gov.tw/BHPnet/Portal/PFShow.aspx?No=200712250004
李柏蒼 ( 2005 ) •透析膜的特性與臨床應用•腎臟與透析雜誌,17(2),123-125。
吳肖琪、黃麟珠、雷秀麗、吳義勇 ( 2004 ) •從健保透析申報資料定義並分析國內慢性腎衰竭病患透析情形•台灣衛誌,23(5),419-427。
常逸平、錢慶文、楊耿如 ( 2007 )•全民健保腹膜透析比血液透析省錢嗎?•台
  灣衛誌,26(5),400-408。
連賢明 ( 2008 )•如何使用健保資料庫進行經濟研究•經濟論文叢刊,36(1),
  115-143。
葉俊東、唐德成、黃東波 ( 2005 ) •末期腎病變之貧血探討•腎臟與透析雜誌,
  17(1),1-10。
國家衛生研究院 ( 2009 )•全民健康保險研究資料庫•瀏覽日期2009年12月30
  日,取自http://w3.nhri.org.tw/nhird/index.php
周碧瑟(2005)•糖尿病、高血壓及心血管疾病與末期腎病變(ESRD)之相關研 
  究 : 病因比例與醫療費用分析•台北:行政院衛生署中央健康保險局。

西文部分
Bakris, G.L., & Ritz, E. (2009). The message for world kidney day 2009. American Journal of Nephrology 30 (1), 95-98.
Bolton, W.Kline, & Kliger, A. S. (2000) . Chronic renal insufficiency: Current understandings and their implications. American Journal of Kidney Diseases 36(6), S4-S12.
Chen, Y. C., Chen, M. F., Liu, S. Z., Romeis, J. C., & Lee, Y. T. (2004). SARS in teaching hospital, Taiwan. Emerging Infectious Disease, 10(10), 1886-1887.
Chien, K. L. (2009) . Chronic kidney disease and Cardiovascular risk in Taiwan: A review of current evidenece. Journal of Taiwan Society of Nephrology, 23(1), 1-3.
Cockcroft, D. W,, & Gault, M. H. (1976) . Prediction of creatinine clearance from serum creatinine. Nephron 16, 31-41.
Diez, C., Mohr, P., Koch, D., Silber, R.-E., Schmid, C., & Hofmann, H.-S. (2009) .  
  Age- and gender-specific values of estimated glomerular filtration rate among  
  6232 patients undergoing cardiac surgery. Interactive Cardiovascular and
  Thoracic Surgery, 9(4), 593-597
Felker, G.M., Adams Jr., K.F., Gattis, W.A., & O'Connor, C.M.. (2004) . Anemia as a
  risk factor and therapeutic target in heart failure. Journal of the American
  College of Cardiology, 44(5), 959-966.
Glassock, R. J., & Winearls, C. (2008) . The global burden of chronic kidney disease: How valid are the estimates? Nephron - Clinical Practice 110 (1), c39-c46.
Go, A. S., Chertow, G. M., Fan, D., McCulloch, C. E., & Hsu, C. Y. (2004) . Chronic
  kidney disease and the risks of death, cardiovascular events, and hospitalization.
  New England Journal of Medicine, 351(13), 1296-1305.
González, A.O., de Francisco, A., Gayoso, P., & García, F. (2010) . Prevalence of chronic renal disease in Spain: Results of the EPIRCE study. Nefrologia 30 (1), 78-86.
Hallan, S. I., Coresh, J., Astor, B. C., Asberg, A., Powe, N. R., Romundstad, S.,  
  Hallan, H. A., Lydersen, S., & Holmen, J. (2006) . International comparison of
  the relationship of chronic kidney disease prevalence and ESRD risk. Journal of
  the American Society of Nephrology, 17(8), 2275-2284.
Huang, C.-C., Cheng, K.-F., & Wu, H.-D.I. (2008) . Survival analysis: Comparing peritoneal dialysis and hemodialysis in Taiwan. Peritoneal Dialysis International. 8 (SUPP. 3), S15-S20.
Hsu, C. C., Hwang, S. J., Wen, C. P., Chang, H. Y., Chen, T., Shiu, R. S., Horng, S.-S., ,Chang, Y. K., & Yang, W. C. (2006) High Prevalence and Low Awareness of CKD in Taiwan: A Study on the Relationship Between Serum Creatinine and Awareness From a Nationally Representative Survey. American Journal of Kidney Diseases 48 (5), 727-738.
Hwang, S. J., Tsai, J. C., & Chen, H. C. (2010). Epidemiology, impact and preventive care of chronic kidney disease in Taiwan. Nephrology 15(2), 3-9.
Hwang, S. J., & Yang, W. C. (2004) . The Burden of CKD in Taiwan, Taipei, Taiwan.
McDonald, S.P., Marshall, M.R., Johnson, D.W., & Polkinghorne, K.R. (2009) . Relationship between dialysis modality and mortality. Journal of the American Society of Nephrology.20(1), 155-163.
National Kidney Foundation (2010). NKF Website. Retrieved Dec 30, 2009,
http://www.kidney.org/
Imai, E., Horio, M., Iseki, K., Yamagata, K., Watanabe, T., Hara, S., Ura, N., Kiyohara, Y., Hirakata, H., Moriyama, T., Ando, Y., Nitta, K., Inaguma, D., Narita, I., Iso, H., Wakai, K., Yasuda, Y., Tsukamoto, Y., Ito, S., Makino, H., Hishida, A., & Matsuo, S. (2007) Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient. Clinical and Experimental Nephrology 11 (2), 156-163.
Ingsathit, A., Thakkinstian, A., Chaiprasert, A., Sangthawan, P., Gojaseni, P., Kiattisunthorn, K., Ongaiyooth, L., Vanavanan, S., Sirivongs, D., Thirakhupt, P., Mittal, B., & Singh, A. K. (2010). Prevalence and risk factors of chronic kidney disease in the Thai adult population: Thai SEEK study. Nephrology Dialysis Transplantation 25 (5), 1567-1575.
Jager, D. J.de., Grootendorst, D. C., Jager, K. J., Dijk, P. C.van., Tomas, L. M. J.,
  Ansell, D., Collart, F., Finne, P., Heaf, J. G., Meester, J. D., Wetzels, J. F. M., Rosendaal, F. R., & Dekker, F. W. (2009) . Cardiovascular and noncardiovascular mortality among patients starting dialysis. Journal of American Medical Association, 302(16), 1782-1789.
Kuo, H. W., Tsai, S. S., Tiao, M. M., & Yang, C. Y. (2007) . Epidemiological Features of CKD in Taiwan. American Journal of Kidney Diseases 49 (1), 46-55.
Lassalle, M., Labeeuw, M., Frimat, L., Villar, E., Joyeux, V., Couchoud, C., & Stengel, B. (2010). Age and comorbidity may explain the paradoxical association of an early dialysis start with poor survival. Kidney International 77 (8), 700-707.
Levey, A. S., Andreoli, S. P., DuBose, T., Provenzano, R., & Collins, A. J. (2007). Chronic kidney disease: Common, harmful, and treatable - World kidney day 2007. Journal of the American Society of Nephrology 18 (2), 374-378.
Roderick, P. J., Atkins, R. J., Smeeth, L., Nitsch, D. M., Hubbard, R. B., Flectcher, A. E., & Bulpitt, C. J. (2008) . Detecting chronic kidney disease in older people; what are the implications? Age and Ageing 37 (2), 179-186.
Roderick, P.J., Atkins, R.J., Smeeth, L., Mylne, A., Nitsch, D.D.M., Hubbard, R.B., Bulpitt, C.J., & Fletcher, A.E. (2009). CKD and Mortality Risk in Older People: A Community-Based Population Study in the United Kingdom. American Journal of Kidney Diseases 53 (6), 950-960.
Schieppati, A., & Remuzzi, G. . (2005) . Chronic renal diseases as a public health problem: Epidemiology, social, and economic implications. Kidney International, Supplement 68 (98), S7-S10.
Smith, D.H., Gullion, C.M., Nichols, G., Keith, D.S., & Brown, J.B. (2004). Cost of Medical Care for Chronic Kidney Disease and Comorbidity among Enrollees in a Large HMO Population. Journal of the American Society of Nephrology 15 (5), 1300-1306.
Snyder, J. J., Foley, R. N., & Collins, A. J.(2009) . Prevalence of CKD in the United States: A Sensitivity Analysis Using the National Health and Nutrition Examination Survey (NHANES) 1999-2004. American Journal of Kidney Diseases 53 (2), 218-228.
St. Peter, W.L., Khan, S.S., Ebben, J.P., Pereira, B.J.G., & Collins, A.J. (2004) Chronic kidney disease: The distribution of health care dollars. Kidney International 66 (1), 313-321.
Takamatsu, N., Abe, H., Tominaga, T., Nakahara, K., Ito, Y., Okumoto, Y., Kim, J.,
  Kitakaze, M., & Doi, T. (2009) . Risk factors for chronic kidney disease in Japan:
  a community-based study. BMC Nephrology, 10(1), art. No. 34
Tonelli, M ., Wiebe, N., Culletion, B., House, A., Rabbat, C., Fok, M., McAlister, F., & Garg, A. X. (2006). Chronic kidney disease and mortality risk : A systematic review. Journal of the American Society of Nephrology, 17(7), 2034-2047.
Trivedi, H. (2010). Cost Implications of Caring for Chronic Kidney Disease: Are Interventions Cost-effective? Advances in Chronic Kidney Disease 17 (3), 265-270.
United States Renal Data System (2009). USRDS Website. Retrieved Dec 30, 2009, http://www.usrds.org/2009/pdf/V2_12_09.PDF
Wang, A. Y. -M., Wang, M., Woo, J., Lam, C. W. -K., Li, P. K. -T., Lui, S. -F.,&
  Sanderson, J. E. (2003) . Cardiac valve calcification as an important predictor for
  all-cause mortality and cardiovascular mortality in long-term peritoneal dialysis
  patitents: a prospective study. Journal of the American Society of Nephrology,
  14(1), 159-168
Wen, C. P., Cheng, T. Y. D., Tsai, M. K., Chang, Y. C., Chan H. T., Tasi, S. P.,
  Chiang, P. H., Hsu, C. C., Sung, P. K., Hsu, Y. H., & Wen, S. F. (2008) . All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462293 adults in Taiwan. Lancet, 371(9631), 2173-2182.
Yang, W. C., Hwang, S. J. & Taiwan Society of Nephrology (2008) . Incidence, prevalence and mortality trends of dialysis end-stage renal disease in Taiwan from 1990 to 2001: the impact of national health insurance. Nephrol Dial Transplant (23), 3977–3982.
Zhang, Q. L., Koenig, W., Raum, E., Stegmaier, C., Brenner, H., & Rothenbacher, D.(2009). Epidemiology of chronic kidney disease: Results from a population of older adults in Germany. Preventive Medicine 48 (2), 122-127.
Zhang, L., Zhang, P., Wang, F., Zuo, L., Zhou, Y., Shi, Y., Li, G., Jiao, S., Liu, Z., Liang, W., & Wang, H. (2008) . Prevalence and Factors Associated With CKD: A Population Study From Beijing. American Journal of Kidney Diseases 51 (3), 373-384.
Zhang, L., Zuo, L., Wang, F., Wang, M., Wang, S., Lv, J., Liu, L., & Wang, H. (2006) . Cardiovascular disease in early stages of chronic kidney disease in a Chinese population. Journal of the American Society of Nephrology 17 (9), 2617-2621.

------------------------------------------------------------------------ 第 2 筆 ---------------------------------------------------------------------
系統識別號 U0007-0907201012073900
論文名稱(中文) 慢性腎臟病之臨床營養支援系統開發與研究
論文名稱(英文) Research and Development of a Clinical Nutrition Support System for Chronic Kidney Disease
校院名稱 臺北醫學大學
系所名稱(中) 醫學資訊研究所
系所名稱(英) Graduate Institute of Biomedical Informatics
學年度 98
學期 2
出版年 99
研究生(中文) 陳立甫
學號 M110097013
學位類別 碩士
語文別 中文
口試日期 2010-06-24
論文頁數 64頁
口試委員 指導教授-徐建業
共同指導教授-楊騰芳
委員-楊淑惠
委員-趙振瑞
委員-黃衍文
關鍵字(中) 慢性腎臟病
營養資訊系統
營養評估
關鍵字(英) chronic kidney disease
nutrition information systems
nutritional assessment
學科別分類
中文摘要 根據衛生署的統計資料,自2002年至2008年止,腎炎、腎徵候群及腎變性病一直高居國人十大死亡原因的第8位、第10位。另一方面,依據2007年美國腎臟病資料登錄系統(United States Renal Data System, USRDS)統計,台灣末期腎病(end stage renal disease, ESRD)的發生率和盛行率,均為世界第一。而目前國內洗腎病患更是年年增加,造成健保龐大支出,已成為健保支出的首位。

因此慢性腎臟病早期階段的防治工作更為重要,目前國內已有全國性的慢性腎臟病共同照護網,藉由多專業的照護,慢性腎臟病患者可藉由衛教師和營養師得到更多疾病照護知識和飲食方法,期望可延緩慢性腎臟病進程,更進一步延長國人的壽命和提升生活品質。

本研究以營養的觀點,開發一輔助臨床營養師之資訊系統,藉由整合檢驗數據和病患基本資料,更有效的做臨床營養評估和治療。藉由電腦系統可更快速且精確的計算腎絲球過濾率(glomerular filtration rate, GFR)等相關腎臟功能指標,以及蛋白質和熱量等相關需要特別控制的營養成分,並提供相關參考指引做提示。期望藉由營養資訊系統的發展更有效的改善慢性腎臟病患的飲食狀況,並有助於了解長期照護的病患其病程發展和營養改善狀況,進一步改善或延緩病情發展。
英文摘要 According to the statistics from Department of Health, disease diagnosis nephritis, nephrotic syndrome and nephrosis has been ranked in the 8th or 10th among the top 10 causes of death from 2002 to 2008. On the other hand, according to the 2007 statistics of United States Renal Data System (USRDS), end stage renal disease (ESRD) incidence and prevalence in Taiwan are both 1st in the world. The number of dialysis patients is increasing every year in Taiwan. This issue causes enormous health care spending and has become the top expenditures in the record of National Health Insurance.

Therefore, the prevention and control of early stage of chronic kidney disease (CKD) is increasing more important. Now we have a common care network for CKD patient, through much professional care, CKD patients can get more knowledge of diseases care and diet methods by consultations through the health care providers and dietitians. This process is expected to prolong the CKD patients’ lives and improve their quality of life.

In this study, an information system that was developed to assists in clinical dietitians. This system integrates the laboratory data and patient’s basic information, and more effectively to do the clinical nutritional assessment and treatment. By the computer system, the glomerular filtration rate (GFR) and other related indicators of kidney function can be calculated more quickly and accurately, as well as protein and calorie control and other related nutrients, and provide relevant information and tips. Clinical Nutrition Support System designed by us is expected to effectively improve the CKD patients’ diet, and help researchers to understand the long-term care of patients whose course development and nutrition, in order to halt the progression of CKD.
論文目次 審定書 ii
博碩士論文電子檔案上網授權書 iii
誌謝 iv
目錄 v
表目錄 viii
圖目錄 ix
中文摘要 xi
Abstract xiii
第一章 緒論 1
1.1 前言 1
1.2 研究動機 2
1.3 研究目的 2
第二章 文獻探討 4
2.1 腎臟的構造 4
2.2 腎臟生理功能 5
2.3 慢性腎臟病 5
2.4慢性腎臟病之死亡率與醫療費用 7
2.5 尿毒症 8
2.6 透析治療(dialysis) 9
2.7 Kidney Disease Outcomes Quality Initiative (K/DOQI) 10
2.8 主觀性整體營養評估(subjective global assessment, SGA) 11
2.9 替代健康飲食指標(alternate healthy eating index, AHEI) 11
2.10 常見的營養不良 13
2.11 評估腎功能的方法 15
2.12 慢性腎臟病與營養治療 18
2.13 相關營養系統概況 20
第三章 研究方法 21
3.1 研究架構 21
3.2 檢驗數據之參考值建立 22
3.3 熱量及營養素攝取建議量建置 23
3.4 腎絲球過濾率(Glomerular filtration rate, GFR)計算公式 24
3.5 料理資料庫與食品營養成分資料庫建置 25
3.6 系統架構與建置工具 27
3.7 系統功能設計 28
3.8 系統評估 31
第四章 研究結果 33
4.1 系統開發工具 33
4.2 系統資料庫設計 33
4.3系統功能規劃 34
4.4 系統前台功能 36
4.5系統後台功能 45
4.6問卷調查結果 50
第五章 討論 54
5.1 營養支援系統的臨床應用 54
5.2 料理資料庫 55
第六章 結論與未來研究方向 56
6.1結論 56
6.2未來研究方向 56
參考文獻 58
附錄一 慢性腎臟病之臨床營養支援系統滿意度調查問卷 62

參考文獻 1.行政院衛生署國民健康局: 國民健康局年報 2008~2009.
2.中央健康保險局 [http://www.nhi.gov.tw/webdata/webdata.asp?menu=1&menu_id=4&webdata_id=805&WD_ID=4]
3.行政院衛生署 [http://www.doh.gov.tw]
4.United States Renal Data System 2009 Annual Data Report
5.Pedrini MT, Levey AS, Lau J, Chalmers TC, Wang PH: The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases: a meta-analysis. Annals of Internal Medicine 1996, 124(7):627-632.
6.Biesemeier C, Chima CS: Computerized Patient Record: Are we Prepared for our Future Practice? Journal of The American Dietetic Association 1997, 97(10):1099-1104.
7.黃基礎:腎臟生理學:藝軒圖書出版社;1991;1-10。
8.葉瑞圻,楊鴻儒:腎臟病診療室:書泉出版社;1993;5-20。
9.謝明哲,葉松鈴: Krause's 膳食療養學:藝軒圖書;2006;623-658。
10.Greenberg A (ed.): Primer on Kidney Diseases, 3rd edn: Academic Press; 2001.
11.張盈森:腎臟學十日速成:合記圖書出版社; 1996;1-55。
12.Judith A. Beto P, RD, FADA, Vinod K. BANSAL M: Medical Nutrition Therapy in Chronic Kidney Failure: Integrating Clinical Practice Guidelines. Journal of the American Dietetic Association 2004, 104:404-409.
13.腹膜透析專業諮詢網 [http://www.capd.com.tw]
14.National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. American Journal of Kidney Diseases 2002 39(suppl 1):S1-S266.
15.Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. The New England Journal of Medicine 2004, 351(13):1296-1305.
16.Muntner P, He J, Hamm L, Loria C, Whelton PK: Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States. Journal of the American Society of Nephrology 2002, 13(3):745-753.
17.Smith DH, Gullion CM, Nichols G, Keith DS, Brown JB: Cost of medical care for chronic kidney disease and comorbidity among enrollees in a large HMO population. Journal of the American Society of Nephrology: 2004, 15(5):1300-1306.
18.林杰樑:透析治療學:合記圖書出版社;1996;1-6。
19.National Kidney Foundation [http://www.kidney.org]
20.Susan Ash, Katrina Campbell, Helen MacLaughlin, Ellen McCoy, Maria Chan, Kathryn Anderson, Karen Corke, Ruth Dumont, Lyn Lloyd, Anthony Meade et al: Evidence based practice guidelines for the nutritional management of chronic kidney disease. Nutrition & Dietetics: The Journal of the Dietitians Association of Australia 2006, 63 (Suppl. 2):S35-S45.
21.National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure. American Journal of Kidney Diseases 2000, 35:S1-S3.
22.Steiber AL, Kalantar-Zadeh K, Secker D, McCarthy M, Sehgal A, McCann L: Subjective Global Assessment in chronic kidney disease: a review. Journal of Renal Nutrition 2004, 14(4):191-200.
23.Enia G, Sicuso C, Alati G, Zoccali C: Subjective global assessment of nutrition in dialysis patients. Nephrology Dialysis Transplantation 1993, 8(10):1094-1098.
24.Canada-USA (CANUSA) Peritoneal Dialysis Study Group. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. . Journal of the American Society of Nephrology 1996, 7(2):198-207.
25.de Mutsert R, Grootendorst DC, Boeschoten EW, Brandts H, van Manen JG, Krediet RT, Dekker FW, Netherlands Cooperative Study on the Adequacy of Dialysis-2 Study G: Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients. American Journal of Clinical Nutrition 2009, 89(3):787-793.
26.McCullough ML, Feskanich D, Stampfer MJ, Giovannucci EL, Rimm EB, Hu FB, Spiegelman D, Hunter DJ, Colditz GA, Willett WC: Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. American Journal of Clinical Nutrition 2002, 76(6):1261-1271.
27.McCullough ML, Willett WC: Evaluating adherence to recommended diets in adults: the Alternate Healthy Eating Index. Public Health Nutrition 2006, 9(1A):152-157.
28.Waijers PM, Feskens EJ, Ocke MC: A critical review of predefined diet quality scores. Br J Nutr 2007, 97(2):219-231.
29.李永成:台灣版健康飲食評量指標(Alternate Healthy Eating Index for Taiwan, AHEI-T)與第2型糖尿病之人體測量值、血糖、血壓及血清脂質相關性探討。台北市:臺北醫學大學保健營養研究所,碩士論文;2010。
30.Lee MS, Lai CJ, Yang FY, Su HH, Yu HL, Wahlqvist ML: A global overall dietary index: ODI-R revised to emphasize quality over quantity. Asia Pac J Clin Nutr 2008, 17 Suppl 1:82-86.
31.United States Department of Agriculture (2005) MyPyramid [http://www.mypyramid.gov/]
32.Cockcroft DW, Gault MH: Prediction of creatinine clearance from serum creatinine. Nephron 1976, 16(1):31-41.
33.Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Annals of Internal Medicine 1999, 130(6):461-470.
34.Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F: Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Annals of Internal Medicine 2006, 145(4):247-254.
35.Melloni C, Peterson ED, Chen AY, Szczech LA, Newby LK, Harrington RA, Gibler WB, Ohman EM, Spinler SA, Roe MT et al: Cockcroft-Gault versus modification of diet in renal disease: importance of glomerular filtration rate formula for classification of chronic kidney disease in patients with non-ST-segment elevation acute coronary syndromes. Journal of the American College of Cardiology 2008, 51(10):991-996.
36.Snyder S, Pendergraph B: Detection and evaluation of chronic kidney disease. American Family Physician 2005, 72(9):1723-1732.
37.Huang MC, Chen ME, Hung HC, Chen HC, Chang WT, Lee CH, Wu YY, Chiang HC, Hwang SJ: Inadequate energy and excess protein intakes may be associated with worsening renal function in chronic kidney disease. Journal of Renal Nutrition 2008, 18(2):187-194.
38.Mircescu G, Garneata L, Stancu SH, Capusa C: Effects of a supplemented hypoproteic diet in chronic kidney disease. Journal of Renal Nutrition 2007, 17(3):179-188.
39.Caglar K, Fedje L, Dimmitt R, Hakim RM, Shyr Y, Ikizler TA: Therapeutic effects of oral nutritional supplementation during hemodialysis. Kidney International 2002, 62(3):1054-1059.
40.Campbell KL, Ash S, Bauer JD: The impact of nutrition intervention on quality of life in pre-dialysis chronic kidney disease patients. Clinical Nutrition 2008, 27(4):537-544.
41.Laws RA, Tapsell LC, Kelly J: Nutritional status and its relationship to quality of life in a sample of chronic hemodialysis patients. Journal of Renal Nutrition 2000, 10(3):139-147.
42.Ahmad S: Manual of Clinical Dialysis, 2nd edn: Springer US; 2009;169-180.
43.Pifer TB, McCullough KP, Port FK, Goodkin DA, Maroni BJ, Held PJ, Young EW: Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS. Kidney International 2002, 62(6):2238-2245.
44.Leavey SF, Strawderman RL, Jones CA, Port FK, Held PJ: Simple nutritional indicators as independent predictors of mortality in hemodialysis patients. American Journal of Kidney Diseases 1998, 31(6):997-1006.
45.李佩珊:以病患為中心的營養照護支援系統。台北市:臺北醫學大學醫學資訊研究所,碩士論文; 2001。
46.黃立杰:應用模糊決策模式建立營養諮詢系統。台北市:臺北醫學大學醫學資訊研究所,碩士論文; 2007。
47.林賢怡:隨手可得之營養資訊系統。台北市: 臺北醫學大學醫學資訊研究所,碩士論文;2008.
48.Six BL, Schap TE, Zhu FM, Mariappan A, Bosch M, Delp EJ, Ebert DS, Kerr DA, Boushey CJ: Evidence-based development of a mobile telephone food record. J Am Diet Assoc, 110(1):74-79.
49.Mirtallo JM, Hawksworth K, Payne B: A nutrition support service web application to manage patients receiving parenteral nutrition. Nutr Clin Pract 2009, 24(4):447-458.
50.台灣營養學會臨床營養委員會主編:臨床營養工作手冊 行政院衛生署
51.National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. American Journal of Kidney Diseases 2003, 42(4 Suppl 3):S1-201.
52.胡秋明:以料理本體論為基礎之食品營養素成分分析系統。台北市:臺北醫學大學醫學資訊研究所,碩士論文; 2006。
53.行政院衛生署食品衛生處(2002)。台灣地區食品營養成分資料庫 [http://www.doh.gov.tw/FoodAnalysis/]
54.Ajax: A New Approach to Web Applications [http://www.adaptivepath.com/ideas/essays/archives/000385.php]
55.楊惠琄:發展手術全期護理資訊系統及評估其使用成效。台北市:臺北醫學大學醫學資訊研究所,碩士論文;2009。
56.何桂芳:依NANDA、NOC、NIC標準建置護理過程知識基礎決策支援系統-以國內精神衛生為例。台北市:臺北醫學大學醫學資訊研究所;2009。
57.DeLone WH, McLean ER: Information systems success: The quest for the dependent variable. Information Systems Research 1992:60-95.

------------------------------------------------------------------------ 第 3 筆 ---------------------------------------------------------------------
系統識別號 U0007-1107200817000700
論文名稱(中文) 砷代謝能力、微量營養素與慢性腎臟病及腎臟功能之相關性研究
論文名稱(英文) The Relationship among Arsenic Metabolism Capability, Micronutrients and Chronic Kidney Disease and Kidney Function
校院名稱 臺北醫學大學
系所名稱(中) 公共衛生學研究所
系所名稱(英) Graduate Institute of Public Health
學年度 96
學期 2
出版年 97
研究生(中文) 戴正偉
學號 M508095013
學位類別 碩士
語文別 中文
口試日期 2008-06-26
論文頁數 109頁
口試委員 指導教授-薛玉梅
委員-蒲永孝
委員-吳美滿
關鍵字(中) 慢性腎臟病
砷代謝能力
微量營養素
關鍵字(英) Chronic kidney disease
Arsenic Metabolism Capability
Micronutrients
學科別分類
中文摘要 慢性腎臟病(包括腎炎、腎症候群及腎變性病)在95年台灣十大死因排名第八位,國內目前約有四萬多名腎臟透析病患,盛行率在全世界的排名第一名。本研究主要探討砷代謝能力、血漿中微量營養素與慢性腎臟病及腎臟功能的相關性,另外也探討抽菸、喝酒與止痛藥的使用等危險因子對慢性腎臟病之交互作用。慢性腎臟病病例共201位來自財團法人新光吳火獅紀念醫院腎臟科門診,皆由腎臟專科醫師診斷,患有輕重程度不一的腎臟相關疾患。對照組為與病例組匹配年齡(± 3歲)及性別之萬芳醫院參與健康檢查之民眾共有408位健康民眾。向所有的研究對象說明研究目的與簽具同意書後進行問卷訪視與檢體收集。利用高效率液相層析儀進行血漿中維生素A、維生素E、蕃茄紅素與β-胡蘿蔔素分析,尿液砷物種則使用高效能液相層析儀分離三價砷、五價砷、單甲基砷酸與雙甲基砷酸,使用流動系統注入氫化物產生器與原子吸收光譜儀進行定量。分析結果顯示總砷濃度較高會增加慢性腎臟病危險性,這可能代表慢性腎臟病患體內暴露的砷較多。微量營養素中蕃茄紅素濃度較低,顯著增加慢性腎臟病的風險。若以腎絲球過濾率作為腎臟功能指標,發現血漿維生素E、蕃茄紅素和β胡蘿蔔素越高腎臟功能越好呈現正相關,尿液單甲基砷酸百分比越高腎臟功能越差呈負相關。本研究同時發現慢性腎臟病患服用止痛藥的比例較健康對照顯著偏高,顯示止痛藥也是慢性腎臟病重要危險因子。
英文摘要 Chronic renal disease (include nephritis, nephrotic syndrome, and nephropathy) is the eighth among the top ten leading causes of death in Taiwan. There are about forty thousand hemodialysis patients in our country; the prevalence is the first rank in the world. This study explored the relationship among arsenic metabolism capability, micronutrients and chronic kidney disease and kidney function. In addition, this study also examined whether cigarette smoking, alcohol drinking and analgesic usage confounded the results or not. A total of 201 chronic kidney disease (CKD) patients were recruited from the department of nephrology in Shin Kong Wu Ho-Su Memorial Hospital and diagnosed by nephrologist. All CKD patients had different stages of kidney function damage. Age (± 3 years) and gender matched controls were recruited from the Taipei Medical University-Wan Fang Hospital. Plasma samples were examined by high-performance liquid chromatography (HPLC) to analyze the concentration of plasma micronutrients (retinol, α-tocopherol, lycopene, and β-carotene). Urine samples were examined by HPLC to specify the arsenite (AsIII), arsenate (AsV), monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) and then quantitated by hydride generator combined with atomic absorption spectrometry. This study found that the higher total arsenic concentration have the higher CKD risk. It is suggested that arsenic exposure in CKD group was higher than control group. CKD patients had higher plasma retinol and lower lycopene than control group. According to the glomerular filtration rates to define kidney function, and found glomerular filtration rates were inversely correlated with MMA percentage. α-Tocopherol, lycopene and β-carotene were positively related with the glomerular filtration rates. The frequency of analgesic usage was higher in CKD group than in control group. It is also suggesed that analgesic usage is an important risk factor for CKD.
論文目次 目錄 I
表目錄 III
圖目錄 V
第一章 前言 1
第二章 文獻探討 3
第一節 慢性腎臟病、危險因子與流行病學相關研究 3
第二節 砷和慢性腎臟病之相關研究 8
第三節 砷的氧化壓力傷害 12
第四節 砷的代謝機轉 15
第五節 砷甲基化反應與氧化壓力及抗氧化物之關係 16
第六節 微量營養素與腎臟病 19
第七節 氧化壓力與腎臟功能 25
第八節 止痛藥服用與慢性腎臟病相關研究 27
第三章 材料與方法 29
第一節 研究對象 29
第二節 腎臟功能的判定 29
第三節 慢性腎臟病的定義 30
第四節 基本資料的收集 30
第五節 血漿中微量營養素分析 30
第六節 尿液中砷物種濃度分析 34
第四章 結果 - 腎臟功能分析 37
第一節 腎臟功能與基本人口學危險因子分析 37
第二節 砷代謝指標和微量營養素與腎絲球過濾率的關係 41
第五章 結果 - 慢性腎臟病危險因子分析 48
第一節 慢性腎臟病危險因子分析 48
第二節 砷物種及砷代謝指標和慢性腎臟病的相關性 52
第三節 微量營養素和慢性腎臟病的相關性 55
第四節 基本人口學特徵、飲食習慣、生活型態、生活習慣、化學藥品接觸和疾病史與砷代謝能力相關性 57
第五節 基本人口學特徵、飲食習慣、生活型態、生活習慣、化學藥品接觸和疾病史與微量營養素相關性 60
第六節 止痛藥、砷代謝指標及微量營養素與慢性腎臟病的關係 63
第七節 砷代謝指標及微量營養素與慢性腎臟病的交互作用關係 66
第六章 討論 78
參考文獻 Reference List

Agarwal,A., Shen,H., Agarwal,S., and Rao,A.V. (2001). Lycopene Content of Tomato Products: Its Stability, Bioavailability and In Vivo Antioxidant Properties. J. Med. Food 4, 9-15.
Agarwal,R. (2005). Smoking, oxidative stress and inflammation: impact on resting energy expenditure in diabetic nephropathy. BMC. Nephrol. 6, 13.
Amanvermez,R., Demir,S., Tuncel,O.K., Alvur,M., and Agar,E. (2005). Alcohol-induced oxidative stress and reduction in oxidation by ascorbate/L-cys/ L-met in the testis, ovary, kidney, and lung of rat. Adv. Ther. 22, 548-558.
Anderson,R.N. and Smith,B.L. (2005). Deaths: leading causes for 2002. Natl. Vital Stat. Rep. 53, 1-89.
Arreola-Mendoza,L., Reyes,J.L., Melendez,E., Martin,D., Namorado,M.C., Sanchez,E., and Del Razo,L.M. (2006). Alpha-tocopherol protects against the renal damage caused by potassium dichromate. Toxicology 218, 237-246.
Augusti,P.R., Conterato,G.M., Somacal,S., Einsfeld,L., Ramos,A.T., Hosomi,F.Y., Graca,D.L., and Emanuelli,T. (2007). Effect of lycopene on nephrotoxicity induced by mercuric chloride in rats. Basic Clin. Pharmacol. Toxicol. 100, 398-402.
Bates,C.J. (1995). Vitamin A. Lancet 345, 31-35.
Bates,M.N., Rey,O.A., Biggs,M.L., Hopenhayn,C., Moore,L.E., Kalman,D., Steinmaus,C., and Smith,A.H. (2004). Case-control study of bladder cancer and exposure to arsenic in Argentina. Am. J Epidemiol. 159, 381-389.
bdel-Zaher,A.O., bdel-Hady,R.H., Mahmoud,M.M., and Farrag,M.M. (2008). The potential protective role of alpha-lipoic acid against acetaminophen-induced hepatic and renal damage. Toxicology 243, 261-270.
Bentley,M.D., Rodriguez-Porcel,M., Lerman,A., Sarafov,M.H., Romero,J.C., Pelaez,L.I., Grande,J.P., Ritman,E.L., and Lerman,L.O. (2002). Enhanced renal cortical vascularization in experimental hypercholesterolemia. Kidney Int. 61, 1056-1063.
Bhuvaneswaran,C. (1979). The influence of phosphorylation state ratio on energy conservation in mitochondria treated with inorganic arsenate. Biochem. Biophys. Res. Commun. 90, 1201-1206.
Blackhall,M.L., Fassett,R.G., Sharman,J.E., Geraghty,D.P., and Coombes,J.S. (2005). Effects of antioxidant supplementation on blood cyclosporin A and glomerular filtration rate in renal transplant recipients. Nephrol. Dial. Transplant. 20, 1970-1975.
Bongiovanni,G.A., Soria,E.A., and Eynard,A.R. (2007). Effects of the plant flavonoids silymarin and quercetin on arsenite-induced oxidative stress in CHO-K1 cells. Food Chem. Toxicol. 45, 971-976.
Briganti,E.M., Branley,P., Chadban,S.J., Shaw,J.E., McNeil,J.J., Welborn,T.A., and Atkins,R.C. (2002). Smoking is associated with renal impairment and proteinuria in the normal population: the AusDiab kidney study. Australian Diabetes, Obesity and Lifestyle Study. Am. J Kidney Dis. 40, 704-712.
Buchet,J.P., Lauwerys,R., and Roels,H. (1981). Comparison of the urinary excretion of arsenic metabolites after a single oral dose of sodium arsenite, monomethylarsonate, or dimethylarsinate in man. Int Arch. Occup. Environ. Health 48, 71-79.
Cabral,P.C., Diniz,A.S., and de,A., I (2005). Vitamin A and zinc status in patients on maintenance haemodialysis. Nephrology. (Carlton. ) 10, 459-463.
Carr,A.C., Zhu,B.Z., and Frei,B. (2000). Potential antiatherogenic mechanisms of ascorbate (vitamin C) and alpha-tocopherol (vitamin E). Circ. Res. 87, 349-354.
Chade,A.R., Bentley,M.D., Zhu,X., Rodriguez-Porcel,M., Niemeyer,S., mores-Arriaga,B., Napoli,C., Ritman,E.L., Lerman,A., and Lerman,L.O. (2004c). Antioxidant intervention prevents renal neovascularization in hypercholesterolemic pigs. J. Am. Soc. Nephrol. 15, 1816-1825.
Chade,A.R., Bentley,M.D., Zhu,X., Rodriguez-Porcel,M., Niemeyer,S., mores-Arriaga,B., Napoli,C., Ritman,E.L., Lerman,A., and Lerman,L.O. (2004b). Antioxidant intervention prevents renal neovascularization in hypercholesterolemic pigs. J. Am. Soc. Nephrol. 15, 1816-1825.
Chade,A.R., Bentley,M.D., Zhu,X., Rodriguez-Porcel,M., Niemeyer,S., mores-Arriaga,B., Napoli,C., Ritman,E.L., Lerman,A., and Lerman,L.O. (2004a). Antioxidant intervention prevents renal neovascularization in hypercholesterolemic pigs. J. Am. Soc. Nephrol. 15, 1816-1825.
Chade,A.R., Lerman,A., and Lerman,L.O. (2005). Kidney in early atherosclerosis. Hypertension 45, 1042-1049.
Chen,C.Y., Liao,Y.M., Tsai,W.M., and Kuo,H.C. (2007). Upper urinary tract urothelial carcinoma in eastern Taiwan: high proportion among all urothelial carcinomas and correlation with chronic kidney disease. J Formos. Med. Assoc. 106, 992-998.
Chiou,H.Y., Huang,W.I., Su,C.L., Chang,S.F., Hsu,Y.H., and Chen,C.J. (1997). Dose-response relationship between prevalence of cerebrovascular disease and ingested inorganic arsenic. Stroke 28, 1717-1723.
Chiou,J.M., Wang,S.L., Chen,C.J., Deng,C.R., Lin,W., and Tai,T.Y. (2005). Arsenic ingestion and increased microvascular disease risk: observations from the south-western arseniasis-endemic area in Taiwan. Int. J. Epidemiol. 34, 936-943.
Collins,B. (1995). Renal failure. Symptom relief in ESRF. Nurs. Times 91, 29-31.
De Kimpe J,C.R.M.L.V.A. (1993). Arsenate-transferrin binding is a possible contributor to elevated arsenic levels in the serum of chronic haemodialysis patients. In Trace elements in man and animals, pp. 845-848.
De,K.J., Cornelis,R., Mees,L., Van,L.S., and Vanholder,R. (1993). More than tenfold increase of arsenic in serum and packed cells of chronic hemodialysis patients. Am. J. Nephrol. 13, 429-434.
De,S.E., Ronco,A.L., Boffetta,P., eo-Pellegrini,H., Acosta,G., Correa,P., and Mendilaharsu,M. (2006). Nutrient intake and risk of squamous cell carcinoma of the esophagus: a case-control study in Uruguay. Nutr. Cancer 56, 149-157.
Deng,G., Vaziri,N.D., Jabbari,B., Ni,Z., and Yan,X.X. (2001). Increased tyrosine nitration of the brain in chronic renal insufficiency: reversal by antioxidant therapy and angiotensin-converting enzyme inhibition. J Am. Soc. Nephrol. 12, 1892-1899.
Dreher,D. and Junod,A.F. (1996). Role of oxygen free radicals in cancer development. Eur. J Cancer 32A, 30-38.
Farvid,M.S., Jalali,M., Siassi,F., and Hosseini,M. (2005a). Comparison of the effects of vitamins and/or mineral supplementation on glomerular and tubular dysfunction in type 2 diabetes. Diabetes Care 28, 2458-2464.
Farvid,M.S., Jalali,M., Siassi,F., and Hosseini,M. (2005b). Comparison of the effects of vitamins and/or mineral supplementation on glomerular and tubular dysfunction in type 2 diabetes. Diabetes Care 28, 2458-2464.
Ferreccio,C., Gonzalez,C., Milosavjlevic,V., Marshall,G., Sancha,A.M., and Smith,A.H. (2000). Lung cancer and arsenic concentrations in drinking water in Chile. Epidemiology 11, 673-679.
Ford,E.S., Giles,W.H., Mokdad,A.H., and Ajani,U.A. (2005). Microalbuminuria and concentrations of antioxidants among US adults. Am. J Kidney Dis. 45, 248-255.
Gale,C.R., Hall,N.F., Phillips,D.I., and Martyn,C.N. (2001). Plasma antioxidant vitamins and carotenoids and age-related cataract. Ophthalmology 108, 1992-1998.
Gotloib,L., Sklan,D., and Mines,M. (1978). Hemodialysis. Effect on plasma levels of vitamin A and carotenoid. JAMA 239, 751.
Guo,H.R., Chiang,H.S., Hu,H., Lipsitz,S.R., and Monson,R.R. (1997). Arsenic in drinking water and incidence of urinary cancers. Epidemiology 8, 545-550.
Hartwig,A., Blessing,H., Schwerdtle,T., and Walter,I. (2003). Modulation of DNA repair processes by arsenic and selenium compounds. Toxicology 193, 161-169.
Hasdan,G., Benchetrit,S., Rashid,G., Green,J., Bernheim,J., and Rathaus,M. (2002). Endothelial dysfunction and hypertension in 5/6 nephrectomized rats are mediated by vascular superoxide. Kidney Int 61, 586-590.
Heck,J.E., Gamble,M.V., Chen,Y., Graziano,J.H., Slavkovich,V., Parvez,F., Baron,J.A., Howe,G.R., and Ahsan,H. (2007). Consumption of folate-related nutrients and metabolism of arsenic in Bangladesh. Am. J Clin. Nutr. 85, 1367-1374.
Himmelfarb,J., Stenvinkel,P., Ikizler,T.A., and Hakim,R.M. (2002). The elephant in uremia: oxidant stress as a unifying concept of cardiovascular disease in uremia. Kidney Int 62, 1524-1538.
Hsueh,Y.M., Chiou,H.Y., Huang,Y.L., Wu,W.L., Huang,C.C., Yang,M.H., Lue,L.C., Chen,G.S., and Chen,C.J. (1997). Serum beta-carotene level, arsenic methylation capability, and incidence of skin cancer. Cancer Epidemiol. Biomarkers Prev. 6, 589-596.
Hsueh,Y.M., Ko,Y.F., Huang,Y.K., Chen,H.W., Chiou,H.Y., Huang,Y.L., Yang,M.H., and Chen,C.J. (2003). Determinants of inorganic arsenic methylation capability among residents of the Lanyang Basin, Taiwan: arsenic and selenium exposure and alcohol consumption. Toxicol. Lett. 137, 49-63.
Ishizaka,N., Ishizaka,Y., Toda,E., Shimomura,H., Koike,K., Seki,G., Nagai,R., and Yamakado,M. (2008). Association between cigarette smoking and chronic kidney disease in Japanese men. Hypertens. Res. 31, 485-492.
Jian,L., Lee,A.H., and Binns,C.W. (2007). Tea and lycopene protect against prostate cancer. Asia Pac. J Clin. Nutr. 16 Suppl 1, 453-457.
Kanetsky,P.A., Gammon,M.D., Mandelblatt,J., Zhang,Z.F., Ramsey,E., Wright,T.C., Jr., Thomas,L., Matseoane,S., Lazaro,N., Felton,H.T., Sachdev,R.K., Richart,R.M., and Curtin,J.P. (1998). Cigarette smoking and cervical dysplasia among non-Hispanic black women. Cancer Detect. Prev. 22, 109-119.
Kibriya,M.G., Jasmine,F., Argos,M., Verret,W.J., Rakibuz-Zaman,M., Ahmed,A., Parvez,F., and Ahsan,H. (2007). Changes in gene expression profiles in response to selenium supplementation among individuals with arsenic-induced pre-malignant skin lesions. Toxicol. Lett. 169, 162-176.
Kitchin,K.T. (2001). Recent advances in arsenic carcinogenesis: modes of action, animal model systems, and methylated arsenic metabolites. Toxicol. Appl. Pharmacol. 172, 249-261.
Lee,H.S., Jeong,J.Y., Kim,B.C., Kim,Y.S., Zhang,Y.Z., and Chung,H.K. (1997). Dietary antioxidant inhibits lipoprotein oxidation and renal injury in experimental focal segmental glomerulosclerosis. Kidney Int. 51, 1151-1159.
Lee,T.C. and Ho,I.C. (1995). Modulation of cellular antioxidant defense activities by sodium arsenite in human fibroblasts. Arch. Toxicol. 69, 498-504.
Levey,A.S., Bosch,J.P., Lewis,J.B., Greene,T., Rogers,N., and Roth,D. (1999). A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann. Intern. Med. 130, 461-470.
Levin,A. and Stevens,L.A. (2005). Executing change in the management of chronic kidney disease: perspectives on guidelines and practice. Med. Clin. North Am. 89, 701-709.
Lewis,D.R., Southwick,J.W., Ouellet-Hellstrom,R., Rench,J., and Calderon,R.L. (1999). Drinking water arsenic in Utah: A cohort mortality study. Environ. Health Perspect. 107, 359-365.
Lynn,S., Shiung,J.N., Gurr,J.R., and Jan,K.Y. (1998). Arsenite stimulates poly(ADP-ribosylation) by generation of nitric oxide. Free Radic. Biol. Med. 24, 442-449.
Martin,A., Mellotte,G., and O'Neill,D. (2005). Chronic kidney disease in the elderly; a silent epidemic. Ir. Med. J 98, 46-47.
Mazumder,D.N. (2005). Effect of chronic intake of arsenic-contaminated water on liver. Toxicol. Appl. Pharmacol. 206, 169-175.
McLaughlin,J.K., Lipworth,L., Chow,W.H., and Blot,W.J. (1998). Analgesic use and chronic renal failure: a critical review of the epidemiologic literature. Kidney Int. 54, 679-686.
Meliker,J.R., Wahl,R.L., Cameron,L.L., and Nriagu,J.O. (2007). Arsenic in drinking water and cerebrovascular disease, diabetes mellitus, and kidney disease in Michigan: a standardized mortality ratio analysis. Environ. Health 6, 4.
Meydani,M. (1995). Vitamin E. Lancet 345, 170-175.
Miller,K.W., Lorr,N.A., and Yang,C.S. (1984). Simultaneous determination of plasma retinol, alpha-tocopherol, lycopene, alpha-carotene, and beta-carotene by high-performance liquid chromatography. Anal. Biochem. 138, 340-345.
Morlans,M., Laporte,J.R., Vidal,X., Cabeza,D., and Stolley,P.D. (1990). End-stage renal disease and non-narcotic analgesics: a case-control study. Br. J Clin. Pharmacol. 30, 717-723.
Mortensen,A., Skibsted,L.H., and Truscott,T.G. (2001). The interaction of dietary carotenoids with radical species. Arch. Biochem. Biophys. 385, 13-19.
Nesnow,S., Roop,B.C., Lambert,G., Kadiiska,M., Mason,R.P., Cullen,W.R., and Mass,M.J. (2002). DNA damage induced by methylated trivalent arsenicals is mediated by reactive oxygen species. Chem. Res. Toxicol. 15, 1627-1634.
Newsome,B.B., Warnock,D.G., McClellan,W.M., Herzog,C.A., Kiefe,C.I., Eggers,P.W., and Allison,J.J. (2008). Long-term risk of mortality and end-stage renal disease among the elderly after small increases in serum creatinine level during hospitalization for acute myocardial infarction. Arch. Intern. Med. 168, 609-616.
Nordenson,I. and Beckman,L. (1991). Is the genotoxic effect of arsenic mediated by oxygen free radicals? Hum. Hered. 41, 71-73.
Orth,S.R., Viedt,C., and Ritz,E. (2001). Adverse effects of smoking in the renal patient. Tohoku J Exp. Med. 194, 1-15.
Perneger,T.V., Whelton,P.K., and Klag,M.J. (1994). Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs. N. Engl. J Med. 331, 1675-1679.
Petrick,J.S., yala-Fierro,F., Cullen,W.R., Carter,D.E., and Vasken,A.H. (2000). Monomethylarsonous acid (MMA(III)) is more toxic than arsenite in Chang human hepatocytes. Toxicol. Appl. Pharmacol. 163, 203-207.
Rabbani,G.H., Saha,S.K., Akhtar,M., Marni,F., Mitra,A.K., Ahmed,S., Alauddin,M., Bhattacharjee,M., Sultana,S., and Chowdhury,A.K. (2003). Antioxidants in detoxification of arsenic-induced oxidative injury in rabbits: preliminary results. J Environ. Sci. Health A Tox. Hazard. Subst. Environ. Eng 38, 273-287.
Reckelhoff,J.F., Kanji,V., Racusen,L.C., Schmidt,A.M., Yan,S.D., Marrow,J., Roberts,L.J., and Salahudeen,A.K. (1998). Vitamin E ameliorates enhanced renal lipid peroxidation and accumulation of F2-isoprostanes in aging kidneys. Am. J. Physiol 274, R767-R774.
Russell-Briefel,R., Bates,M.W., and Kuller,L.H. (1985). The relationship of plasma carotenoids to health and biochemical factors in middle-aged men. Am. J Epidemiol. 122, 741-749.
Salvadeo A,M.C.S.5.V.G. (1977). Trace metal changes in dialysis fluid and blood of patients on hemodialysis. Int J Artif Organs 2, 17-21.
Sarafidis,P.A., Li,S., Chen,S.C., Collins,A.J., Brown,W.W., Klag,M.J., and Bakris,G.L. (2008). Hypertension awareness, treatment, and control in chronic kidney disease. Am. J Med. 121, 332-340.
Shainkin-Kestenbaum,R., Caruso,C., and Berlyne,G.M. (1990). Reduced superoxide dismutase activity in erythrocytes of dialysis patients: a possible factor in the etiology of uremic anemia. Nephron 55, 251-253.
Shen,Z.Y., Shen,W.Y., Chen,M.H., Shen,J., and Zeng,Y. (2003). Reactive oxygen species and antioxidants in apoptosis of esophageal cancer cells induced by As2O3. Int J Mol. Med. 11, 479-484.
Shila,S., Subathra,M., Devi,M.A., and Panneerselvam,C. (2005). Arsenic intoxication-induced reduction of glutathione level and of the activity of related enzymes in rat brain regions: reversal by DL-alpha-lipoic acid. Arch. Toxicol. 79, 140-146.
Smith,A.H., Goycolea,M., Haque,R., and Biggs,M.L. (1998). Marked increase in bladder and lung cancer mortality in a region of Northern Chile due to arsenic in drinking water. Am. J Epidemiol. 147, 660-669.
Smith,F.R. and Goodman,D.S. (1971c). The effects of diseases of the liver, thyroid, and kidneys on the transport of vitamin A in human plasma. J Clin. Invest 50, 2426-2436.
Smith,F.R. and Goodman,D.S. (1971a). The effects of diseases of the liver, thyroid, and kidneys on the transport of vitamin A in human plasma. J Clin. Invest 50, 2426-2436.
Smith,F.R. and Goodman,D.S. (1971b). The effects of diseases of the liver, thyroid, and kidneys on the transport of vitamin A in human plasma. J Clin. Invest 50, 2426-2436.
Steenland,N.K., Thun,M.J., Ferguson,C.W., and Port,F.K. (1990). Occupational and other exposures associated with male end-stage renal disease: a case/control study. Am. J Public Health 80, 153-157.
Steinmaus,C., Carrigan,K., Kalman,D., Atallah,R., Yuan,Y., and Smith,A.H. (2005). Dietary intake and arsenic methylation in a U.S. population. Environ. Health Perspect. 113, 1153-1159.
Styblo,M., Del Razo,L.M., LeCluyse,E.L., Hamilton,G.A., Wang,C., Cullen,W.R., and Thomas,D.J. (1999). Metabolism of arsenic in primary cultures of human and rat hepatocytes. Chem. Res. Toxicol. 12, 560-565.
Styblo,M., Del Razo,L.M., Vega,L., Germolec,D.R., LeCluyse,E.L., Hamilton,G.A., Reed,W., Wang,C., Cullen,W.R., and Thomas,D.J. (2000). Comparative toxicity of trivalent and pentavalent inorganic and methylated arsenicals in rat and human cells. Arch. Toxicol. 74, 289-299.
Svilaas,A., Sakhi,A.K., Andersen,L.F., Svilaas,T., Strom,E.C., Jacobs,D.R., Jr., Ose,L., and Blomhoff,R. (2004). Intakes of antioxidants in coffee, wine, and vegetables are correlated with plasma carotenoids in humans. J Nutr. 134, 562-567.
Takase,S., Ong,D.E., and Chytil,F. (1979). Cellular retinol-binding protein allows specific interaction of retinol with the nucleus in vitro. Proc. Natl. Acad. Sci. U. S. A 76, 2204-2208.
Tanner,G.A. and Tanner,J.A. (2001). Chronic caffeine consumption exacerbates hypertension in rats with polycystic kidney disease. Am. J Kidney Dis. 38, 1089-1095.
Thomas,D.J., Styblo,M., and Lin,S. (2001). The cellular metabolism and systemic toxicity of arsenic. Toxicol. Appl. Pharmacol. 176, 127-144.
Thompson,D.J. (1993). A chemical hypothesis for arsenic methylation in mammals. Chem. Biol. Interact. 88, 89-14.
Thomson,A.D. (1978). Alcohol and nutrition. Clin. Endocrinol. Metab 7, 405-428.
Tsai,S.M., Wang,T.N., and Ko,Y.C. (1999a). Mortality for certain diseases in areas with high levels of arsenic in drinking water. Arch. Environ. Health 54, 186-193.
Tsai,S.M., Wang,T.N., and Ko,Y.C. (1999b). Mortality for certain diseases in areas with high levels of arsenic in drinking water. Arch. Environ. Health 54, 186-193.
Tseng,C.H., Chong,C.K., Chen,C.J., and Tai,T.Y. (1996). Dose-response relationship between peripheral vascular disease and ingested inorganic arsenic among residents in blackfoot disease endemic villages in Taiwan. Atherosclerosis 120, 125-133.
Tseng,C.H., Chong,C.K., Tseng,C.P., Hsueh,Y.M., Chiou,H.Y., Tseng,C.C., and Chen,C.J. (2003). Long-term arsenic exposure and ischemic heart disease in arseniasis-hyperendemic villages in Taiwan. Toxicol. Lett. 137, 15-21.
Turkozkan,N., Seven,I., Erdamar,H., and Cimen,B. (2005). Effect of vitamin A pretreatment on Escherichia coli-induced lipid peroxidation and level of 3-nitrotyrosine in kidney of guinea pig. Mol. Cell Biochem. 278, 33-37.
US National Kidney Foundation (2002). K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am. J Kidney Dis. 39, S1-266.
Vahter,M. (1981). Biotransformation of trivalent and pentavalent inorganic arsenic in mice and rats. Environ. Res. 25, 286-293.
Vaslaki,L. (1998). [Current therapy of chronic renal failure]. Orv. Hetil. 139, 2995-2999.
Vassalotti,J.A., Uribarri,J., Chen,S.C., Li,S., Wang,C., Collins,A.J., Calvo,M.S., Whaley-Connell,A.T., McCullough,P.A., and Norris,K.C. (2008). Trends in mineral metabolism: Kidney Early Evaluation Program (KEEP) and the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am. J Kidney Dis. 51, S56-S68.
Vaziri,N.D. (2004). Roles of oxidative stress and antioxidant therapy in chronic kidney disease and hypertension. Curr. Opin. Nephrol. Hypertens. 13, 93-99.
Vaziri,N.D., Oveisi,F., and Ding,Y. (1998). Role of increased oxygen free radical activity in the pathogenesis of uremic hypertension. Kidney Int 53, 1748-1754.
Versieck J,C.R. (1989). Trace elements in human plasma or serum. FL: CRC Press,).
Wang,T.S. and Huang,H. (1994). Active oxygen species are involved in the induction of micronuclei by arsenite in XRS-5 cells. Mutagenesis 9, 253-257.
Widlak,P., Zheng,X., Osterdahl,B.G., Drettner,B., Christensson,B., Kumar,R., and Hemminki,K. (1995). N-nitrosodimethylamine and 7-methylguanine DNA adducts in tissues of rats fed Chinese salted fish. Cancer Lett. 94, 85-90.
Wilson,A.M., Sisk,R.M., and O'Brien,N.M. (1997). Modulation of cholestane-3 beta,5 alpha,6 beta-triol toxicity by butylated hydroxytoluene, alpha-tocopherol and beta-carotene in newborn rat kidney cells in vitro. Br. J. Nutr. 78, 479-492.
Wu,M.M., Chiou,H.Y., Wang,T.W., Hsueh,Y.M., Wang,I.H., Chen,C.J., and Lee,T.C. (2001). Association of blood arsenic levels with increased reactive oxidants and decreased antioxidant capacity in a human population of northeastern Taiwan. Environ. Health Perspect. 109, 1011-1017.
Yamanaka,K., Hasegawa,A., Sawamura,R., and Okada,S. (1991). Cellular response to oxidative damage in lung induced by the administration of dimethylarsinic acid, a major metabolite of inorganic arsenics, in mice. Toxicol. Appl. Pharmacol. 108, 205-213.
Yamanaka,K., Hoshino,M., Okamoto,M., Sawamura,R., Hasegawa,A., and Okada,S. (1990). Induction of DNA damage by dimethylarsine, a metabolite of inorganic arsenics, is for the major part likely due to its peroxyl radical. Biochem. Biophys. Res. Commun. 168, 58-64.
Yamanaka,K. and Okada,S. (1994). Induction of lung-specific DNA damage by metabolically methylated arsenics via the production of free radicals. Environ. Health Perspect. 102 Suppl 3, 37-40.
Yamanaka,K., Takabayashi,F., Mizoi,M., An,Y., Hasegawa,A., and Okada,S. (2001). Oral exposure of dimethylarsinic acid, a main metabolite of inorganic arsenics, in mice leads to an increase in 8-Oxo-2'-deoxyguanosine level, specifically in the target organs for arsenic carcinogenesis. Biochem. Biophys. Res. Commun. 287, 66-70.
Yokoyama,K., Ogura,Y., Kawabata,M., Hinoshita,F., Suzuki,Y., Hara,S., Yamada,A., Mimura,N., Nakayama,M., Kawaguchi,Y., and Sakai,O. (1996). Hyperammonemia in a patient with short bowel syndrome and chronic renal failure. Nephron 72, 693-695.
Yu,M.C., Mack,T.M., Hanisch,R., Cicioni,C., and Henderson,B.E. (1986). Cigarette smoking, obesity, diuretic use, and coffee consumption as risk factors for renal cell carcinoma. J Natl. Cancer Inst. 77, 351-356.
Yu,S. and Paetau-Robinson,I. (2006). Dietary supplements of vitamins E and C and beta-carotene reduce oxidative stress in cats with renal insufficiency. Vet. Res. Commun. 30, 403-413.
Zeng,H., Uthus,E.O., and Combs,G.F., Jr. (2005). Mechanistic aspects of the interaction between selenium and arsenic. J Inorg. Biochem. 99, 1269-1274.
Zhang,X., Cornelis,R., de,K.J., Mees,L., and Lameire,N. (1998). Study of arsenic-protein binding in serum of patients on continuous ambulatory peritoneal dialysis. Clin. Chem. 44, 141-147.
Zwolinska,D., Grzeszczak,W., Szczepanska,M., Kilis-Pstrusinska,K., and Szprynger,K. (2006). Vitamins A, E and C as non-enzymatic antioxidants and their relation to lipid peroxidation in children with chronic renal failure. Nephron Clin. Pract. 103, c12-c18.
許峻彬. 腎臟病常見的迷思. 聯合報 . 10-22-2007.
Ref Type: Newspaper
陳萬裕 (1982). 臨床腎臟學手冊.

------------------------------------------------------------------------ 第 4 筆 ---------------------------------------------------------------------
系統識別號 U0007-2107200810300900
論文名稱(中文) 慢性腎臟疾病患者選擇腹膜透析模式影響因素之探討
論文名稱(英文) Factors Influencing of Peritoneal Dialysis Modality Selection in the CKD Patients
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 96
學期 2
出版年 97
研究生(中文) 梁嘉慧
學號 M406094013
學位類別 碩士
語文別 中文
口試日期 2008-06-24
論文頁數 105頁
口試委員 指導教授-周桂如
委員-張玉坤
委員-盧國城
關鍵字(中) 慢性腎臟疾病
透析模式
選擇
關鍵字(英) Chronic Kidney Disease
Peritoneal Dialysis Modality
Selection
學科別分類
中文摘要 本研究目的主要探討影響慢性腎臟疾病患者選擇腹膜透析模式之相關因素。採橫斷式之研究設計,以立意取樣,在台北市四家醫院腎臟科門診、血液及腹膜透析中心選取慢性腎臟疾病患者為研究對象,共計收案 130名。研究工具為結構式問卷,內容包括「病患基本資料表」、「個人因素影響量表」、「透析模式知識量表」、「治療因素影響量表」、「家庭支持量表」等五部分。資料分析包括描述性統計分析及t-test、卡方檢定(Chi-square test)、邏輯斯迴歸分析法(Logistic regression)等推論性統計以檢定出影響選擇腹膜透析模式的主要影響因子。
從邏輯斯迴歸單因子分析方法,研究結果發現:「年齡」、「教育程度」、「職業狀況」、「疾病特性」、「醫護人員的決定」、「自我照顧能力」及「透析模式知識」等變項達統計學上顯著意義(P< .05)。但從邏輯斯迴歸多重因子分析,結果發現,經控制其他因素的影響效應後,「自我照顧能力」及「透析模式知識」二項為慢性腎臟疾病患者腹膜透析模式選擇之主要影響因子。藉由本研究結果,可以提供臨床醫護人員在慢性腎臟疾病患者選擇腹膜透析模式及照護措施上一重要參考依據,期望未來的研究由瞭解相關因素影響,進而採取適當介入措施,以提昇慢性腎臟疾病患者之照護品質。
英文摘要 The purpose of this study was to explore the factors influencing of peritoneal dialysis modality selection in the chronic kidney disease patients. This study was a cross-sectional design with 130 chronic kidney disease patients recruited from four hospitals in Taipei. A structured questionnaire with five components was used that included: 1) Demography;2) Scale of personal factor;3) Scale of knowledge for dialysis;4) Scale of medical factor;and 5) Scale of family support.
The data were analyzed by descriptive statistical analysis, t-tests, Chi-square test. By means of univariate and multivariate logistic regression analyzed that indicated the significant predictors for peritoneal dialysis modality selection in the CKD patients.
The results of this study indicated that the significant predictors of factors influencing for peritoneal dialysis modality selection in the CKD patients by univariate logistic regression analysis were: age, educational level, occupational status, medical status, decision by nephrologists, self-care agency, and knowledge for dialysis(P< .05). The significant predictors of factors influencing for peritoneal dialysis modality selection in the CKD patients were “self-care agency” and “knowledge for dialysis” by multivariate logistic regression analysis.
The resulted of the study highlighted the important influencing factors of
peritoneal dialysis modality selection in the CKD patients. It provides important reference for CKD patients care planning, and furthermore through interventions that enhances the quality of nursing care in CKD patients.
論文目次 致 謝..................................................І
中文摘要..................................................Ш
英文摘要..................................................V
目 錄................................................VІІ
圖表目次..................................................X
第一章 緒論
第一節 研究動機及重要性...................................1
第二節 研究目的...........................................3
第二章 文獻查證
第一節 慢性腎臟疾病.......................................4
第二節 透析模式...........................................8
第三節 影響選擇腹膜透析模式之因素........................14
第三章 研究方法
第一節 研究架構..........................................21
第二節 研究假設..........................................23
第三節 研究對象與場所....................................24
第四節 研究工具量表與信效度..............................25
第五節 倫理考量..........................................31
第六節 資料收集過程......................................32
第七節 資料分析方法......................................34
第四章 分析與結果
第一節 慢性腎臟疾病患者之個人因素........................36
第二節 慢性腎臟疾病患者透析模式知識之程度................45
第三節 慢性腎臟疾病患者治療因素之考量....................49
第四節 慢性腎臟疾病患者之家庭支持因素....................53
第五節 影響選擇腹膜透析模式因素之分析....................57
第五章 討論
第一節 個人因素與腹膜透析模式選擇......................68
第二節 透析模式知識與腹膜透析模式選擇..................74
第三節 治療因素與腹膜透析模式選擇......................76
第六章 結論與建議
第一節 結論 .............................................78
第二節 研究限制..........................................80
第三節 建議..............................................81
參考資料
中文部份.................................................83英文部份.................................................86
附錄
附錄一 專家效度..........................................93
附錄二 研究同意書........................................94
附錄三 病患基本資料表....................................95
附錄四 個人因素影響量表..................................98
附錄五 透析模式知識量表.................................100
附錄六 治療因素影響量表.................................102
附錄七 家庭支持量表.....................................104
圖表目次
圖一 研究架構圖..........................................22
表一 血液透析與腹膜透析之比較............................12
表二 量表信度測試結果....................................29
表三 專家內容效度評定結果................................30
表四 統計分析方法........................................35
表五 研究對象個人因素之基本屬性、疾病特性................41
表五 研究對象個人因素之基本屬性、疾病特性(續)............42
表六 研究對象個人因素之生活型態改變考慮情形..............43
表六 研究對象個人因素之自我照顧能力考慮情形(續)..........44
表七 選擇血液透析模式之透析模式知識得分情形..............47
表七 選擇腹膜透析模式之透析模式知識得分情形(續)..........48
表八 選擇血液透析模式之治療因素考慮情形..................51
表八 選擇腹膜透析模式之治療因素考慮情形(續)..............52
表九 選擇血液透析模式之家庭支持因素情形情形..............55
表九 選擇腹膜透析模式之家庭支持因素情形情形(續)..........56
表十 個人因素與腹膜透析模式選擇之影響....................59
表十一 透析模式知識與腹膜透析模式選擇之影響..............61
表十二 治療因素與腹膜透析模式選擇之影響..................63
表十三 家庭支持因素與腹膜透析模式選擇之影響..............65
表十四 經控制其他因素後影響因素與腹膜透析模式選擇之影響..67
參考文獻 中文部份
王梅美、林美良(2003)•讓她洗得更舒適-照護一位腹膜透析患者
之護理經驗•新臺北護理期刊,5(2),103-114。
中央健康保險局(2007,12月)•96年第1-2季門診透析總額專業醫療服務品質報告•取自2008年4月22日http://www.nhi.gov.tw/
中央健康保險局(2008,4月)•97年第1-2季門診透析總額專業醫療服務品質報告•取自2008年4月22日http://www.nhi.gov.tw/
台灣腎臟醫學會(2008)•96年1月1日至11月31日止腎臟保健推廣機構新收案之個案•取自2008年4月22日http://www.tsn.org.tw/
江奇霙(2002)•家庭支持對慢性病患遵醫囑行為的影響•未發表的碩士論文,臺北私立台北醫學大學醫學研究所,臺北。
江慧珠、劉雪娥(1995)•接受連續可活動性腹膜透析治療病人需要之探討•護理雜誌,42(2),91-101。
周麗華、劉雪娥(2003)•長期腹膜透析病患性問題及相關性因素探討•台灣腎臟護理學會雜誌,2(2),129-142。
胡潔瑩、林秋菊(1999)•末期腎臟疾病患者面對透析治療方式的抉擇衝突•腎臟與透析,11(2),106-109。
陳金順、洪永祥、林石化、朱柏齡(2006)•腹膜透析患者殘餘腎功
能之探討•腎臟與透析,18(1),19-23。
張峰紫(1991)•糖尿病患者的基廷支持與其認知態度遵從行為及糖化血色素控制之研究•護理雜誌,38(3),59-69。
黃東波(1990)•CAPD的歷史、現況及原理•於中華民國腎臟醫學會主辦,79年度年會暨學術演講會•台北:國際會議中心。
黃智英、楊郁(2004)•慢性腎臟病衛教簡介•台灣腎臟護理學會雜誌,3(2),81-87。
康志鵬、張宗興、江守山(2002)•腹膜透析在糖尿病末期腎病變之運用•腎臟與透析,14(2),70-74。
鈕淑芬(2001)•不同腎臟替代療法之生活品質及其相關因素探討•未發表的碩士論文,國立陽明大學臨床護理研究所,臺北。
廖秋萍、蔣偉姣、陳淑娟(2006)•腹膜透析病患生活品質及其相關因素探討•台灣腎臟護理學會雜誌,5(1),22-39。
譚柱光、楊五常(2002)•腹膜透析,人工腎臟(三版,141-178頁)•台北:力大。
蘭汝平(2007)•台灣地區腎臟專科醫師對於末期腎病患者選擇透析模式的影響因素之看法•未發表的碩士論文,國立陽明大學臨床護理研究所,臺北。
英文部份
Allan, J., Eric, W., Jon, J., Shu-Cheng, C., & Dave, G. (2002). Comparison and Survival of Hemodialysis and Peritoneal Dialysis in the Elderly. Seminars in Dialysis, 15(2), 98-102.
Baillod, R. A. (1995). Hemodialysis: lessons in patient education. Patient Education & Counseling, 26(1-3), 17-24.
Becker, M. H., & Green, L. W. (1975). A family approach to compliance with medical treatment. International Journal Health Education, 18 , 173-182.
Birgitta, K., Hjordis, B., Jonas, B., Christina, S., & Naomi, C. (1998). Predialysis patient education effects on functioning and well-being in uremia patients. Journal of Advanced Nurse, 28(1), 36-44.
Davies, S. J. (2007). Comparing Outcomes on Peritoneal and Hemodialysis : A Case Study in the Interpretation of Observational Studies. Saudi Journal of Kidney Disease and Transplantation, 18(1), 24-30.
Diaz-Buxo, J. A., Lowrie, E. G., Lew, N. L., Zhang, H., & Lararus, J. M. (2000). Quality of life evaluation using Short Form 36:comparison in hemodialysis and peritoneal dialysis patients. American Journal of Kidney Disease, 35(32), 293-300.
Erdfelder, E., Faul, F., & Buchner, A. (1996). G Power:A general power analysis program. Behavior Research Methods, Instruments, & Computer, 28, 1-11.
Fean, B. W., Micheline, M., Georges, H., Patrick, S., Thomas, P. S., Harold, I. F., Pierre, Y. M., & Fean, P. W. (2006). Satisfaction of Patient on chronic hemodialysis and peritoneal dialysis. Swiss MED WKLY, 136, 210-217.
Feujisawa, M., Ichikawa, Yoshiya, K., Isotani, S., Higuchi, A., Nagano, S., Arakawa, S., Hamami, G., Matsumoto, O., & Kamidono, S. (2000). Assessment of health-related quality of life in renal transplant and hemodialysis patients using the SF-36 health survey. Urology, 56(2), 201-206.
Gail, C. & Webber, B. A. (1990). Patient education: Review of the
issues. Medical Care, 28(11), 1089-1103.
Gessner, B. A. (1989). Adult education the cornerstone of patient
teaching. Nursing Clinics of North America, 24(3), 589-595.
Gihad, N., & David, C. M. (2006). Modality options for renal replacement therapy: The integrated care concept revisited. Hemodialysis International, 10, 143–151.
Gokal, R., & Mallick, N. P. (1999). Peritoneal dialysis. Lancet 353, 823-828.
Hall, G., Bogan, A., Dreis, S., Duffy, A. M., Greene, S., Kelley, K., Lizak,
H., Nabut, J., Schinker, V., & Schwartz, N. (2004). New Directions in
peritoneal dialysis patient training. Nephrology Nursing Journal,
31(2), 149-163.
Jager, K. J., Korevaar, J. C., Dekker, F. W., Krediet, R. T., & Boeschoten, E. W. (2004). The Effect of Contraindications and Patient Preference on Dialysis Modality Selection in ESRD Patients in The Netherlands. American Journal of Kidney Diseases, 43(5), 891-899.
Jassal, S.V., Krishna, G., Mallick, N. P., & Mendelssohn, D.C. (2002). Attitudes of British Isles nephrologists towards dialysis modality selection: a questionnaire study. Nephrol Dial Transplant, 17(3), 474-477.
King, K. (2000). Patients' perspective of factors affecting modality selection: a National Kidney Foundation patient survey. Advanced Renal Replace Therapy, 7(31), 261-268.
Kirchgessner, J., Perera-Chang, M., Klinkner, G., Soley, I., Maecelli, D., Arkossy, O., Stopper, A., & Kimmel, P. L. (2006). Satisfaction with care in peritoneal dialysis patients. Kidney International, 70, 1325-1331.
Klang, B., Bjorvell, H., & Clyne, N. (1999). Predialysis education helps patients choose dialysis modality and increases disease-specfic knowledge. Journal of Advanced Nursing, 29(4), 869-876.
Little, J., Irwin, A., Marshall, T., Rayner, H., & Smith, S. (2001). Predicting a Patient’s choice of dialysis modality: experience in a United Kingdom renal department. American Journal of Kidney Disease, 37, 981-986.
Manns, B. J., Taub, K., Vanderstraeten, C., Jones, H., Mills, C., Visser, M., et al. (2005). The impact of education on chronic kidney disease patients’plans to initiate dialysis with self-care dialysis: A randomized trial. Kidney International, 68, 1777-1783.
Marron, B., Martinez, O. J. C., Salgueira, M., Barril, G., Lamas, J. M., Martin, M., Sierra, T., Rodríguez-Carmona, A., Soldevilla, A., & Martínez, F.(2005). Analysis of patient flow into dialysis: role of education in choice of dialysis modality. Peritneal Dialysis International, Suppl 3:S56-59.
Mehrotra, R., Marsh, D., Vonesh, E., Peters, V., & Nissenson, A. (2005). Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis. Kidney International, 68, 378-390.
Mendelssohn, D. C., Mullaney, S. R., Jung, B., Blake, P. G., & Mehta, R. L. (2001). What do American nephrologists think about dialysis modality selection? . American Journal of Kidney Disease, 37, 22-29.
Michael, K. (1997). Dialysis Modality Selection Among Patients Attending Freestanding Dialysis Facilities. Health Care Financing Review, 18, 3-21.
National kidney Foundation. (2002). K/DQOI: Clinical practice guideline for chronic kidney disease. American Journal of Kidney Disease, 39(Suppl 1), S1-S266.
Nissenson, A. R., Prichard, S. S., Cheng, I. K. P., Gokal, R., Kubota, M., & Maiorca, R. (1993). Non-medical factors that impact on ESRD modality selection. Kidney International, 43 (Suppl.40) : S120–S127.
Niu, S. F., & Li, I. C. (2005). Quality of life of patients having renal replacement therapy. Journal of Advanced Nursing, 51(1), 15-21.
Pfister- Minogue, K. (1993). Enhancing patient compliance: A guide gor nurse. Geriatric Nursing, 14(3), 124-132.
Shahab, I., Khanna, R., & Nolph, K. D. (2006). Peritoneal dialysis or hemodialysis? A dilemma for the nephrologist. Advanced Peritoneal Diaysis, 22, 180-185.
Stack, G. A. (2002). Determinants of Modality Selection among Incident US Dialysis Patients: Results from a National Study. Journal of the American Society of Nephrology, 13, 1279–1287.
Stapleton, S. (1992). Etiologies and indicators of powerlessness in persons with end-stage renal disease e. In Miller, J. F.: Coping with chronic illness overcomeing powerless (pp.163-178). Philadephia: F. A. Davis company.
Thamer, M., Hwang, W., Fink, N. E., Sadler, J. H., Wills, S., Levin, N. W., Bass, E. B., Levey, A. S., Brookmeyer, R., & Powe, N. R. (2000). US nephrologists' recommendation of dialysis modality: results of a national survey. American Journal of Kidney Diseases, 36(6), 1155-1165.
Turkinaz, A., Magfiret, K., Gulay, I., & Behice, E. (2006). The experiences of loneliness,depression,and social support of Turkish patients with continuous ambulatory dialysis and their caregivers. Journal of Clinical Nursing, 15, 490-497.
U.S. Renal Data System (2005).USRDS 2002 Annual Report. Retrieved April 20, 2007, from http://www.usrds.org/
U.S. Renal Data System (2007).USRDS 2007 Annual Report. Retrieved April 22, 2007, from http://www.usrds.org/
Vonkataraman, V., & Nolph, K. D. (1999). Socioeconomic aspects of PD in North America:Role of non-medical factors in the choice of dialysis. Peritoneal Dialysis International, 19(Suppl.2): S419-422.
Whittaker, A. A., & Albee, B. J. (1996). Factors Influencing Patient Selection Of Dialysis Treatment Modality. American National Nursing Association Journal, 3, 369-375.
Wuerth, D. B., Finkelstein, S. H., Schwetz, O., Carey, H., Kliger, A. S., & Finkelstein, F. O. (2002). Patients' descriptions of specific factors leading to modality selection of chronic peritoneal dialysis or hemodialysis. Peritoneal Dialysis International, 22(2), 184-90.
Zhao, L. J., & Wang, T. (2003). Attitudes of Chinese chief nephrologists toward dialysis modality selection . Advanced Peritoneal Diaysis,19, 155-158.

------------------------------------------------------------------------ 第 5 筆 ---------------------------------------------------------------------
系統識別號 U0007-2207200814372800
論文名稱(中文) 慢性腎病患者健康行為之探討
論文名稱(英文) The Health Behaviors in Patient With Chronic Kidney Disease
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 96
學期 2
出版年 97
研究生(中文) 謝瓊香
學號 M406093016
學位類別 碩士
語文別 中文
口試日期 2008-07-10
論文頁數 108頁
口試委員 指導教授-陳品玲
委員-陳進陽
委員-陳振文
關鍵字(中) 慢性腎病
健康行為
關鍵字(英) Chronic Kidney Disease
Health Behavior
學科別分類
中文摘要 慢性腎病的早期症狀不明顯且不易發現,大多數的患者也缺乏對腎臟保健及疾病防治的觀念,未能採取促進健康的行為以致慢性腎病持續惡化。在台灣因末期腎病接受透析治療的患者之盛行率居全球之冠,對國家社會經濟及個人造成極大的負擔與衝擊,因此尋求防止慢性腎病持續惡化的策略,已成為當前重要課題。故本研究目的為評估慢性腎病患者日常生活中健康行為的執行現況;並探討其基本屬性、健康行為與腎功能間彼此之關聯,並與全體國民之健康行為做比較,以作為日後醫護人員對慢性腎病患者推動腎臟保健計畫時的參考。研究採橫斷式調查研究法,以方便取樣台北市某醫學中心之腎臟科門診中符合取樣標準之293位慢性腎病患者為研究對象,採結構式問卷收集資料。本研究結果顯示:
1.年齡與肌酸酐廓清率值呈顯著負相關,腎功能會隨年齡增長而下降。
2.約二成慢性腎病患者目前仍有喝酒習慣,其中二成三者每次喝酒會有半醉以上的現象。
3.四成六之慢性腎病患者曾經吸菸,但戒菸率也高達八成。
4.六成八之慢性腎病患者目前並未體重控制,但有體重控制的肌酸酐廓清率值顯著高於沒有的個案。
5.三成五之慢性腎病患者沒有運動的習慣。
6.約七成之慢性腎病患者至少曾經習慣使用中/草藥、成藥、止痛藥、健康食品等任一種、甚至多種藥物的情形。
根據本研究提出下列建議:慢性腎病患者仍有二~三成個案仍有喝酒、不運動的習慣,醫護專業人員宜衛教患者採取健康之生活模式。未來研究應以新發生病例為研究對象,以避免健康行為已產生變化,無法探討健康行為與腎功能之因果關係。
英文摘要 The early symptoms of chronic kidney disease (CKD) are unobvious and difficult to detect. Most patients with CKD are unaware of the concepts of health promotion and disease prevention, which may accelerate their disease progression. The prevalence rate of dialysis for end-stage renal disease in Taiwan is higher than that of most other countries in the world, leading to a great socio-economic impact to the individual and society, thus, a strategy to prevent the progression of CKD has become an important issue. The purpose of this study was to determine the distribution of health behaviors of CKD patients, the correlation of health behaviors with kidney function, and to compare the differences of health behaviors of CKD patients and healthy populations. The result of current study could be an important reference to the health care workers and the policy makers of health promotion program. This was a cross-sectional study, using a structured questionnaire to gather information. The 293 CKD patients were enrolled from the out-patient department of nephrology in a medical center in Taipei. The results of this study are shown as follows:
1.Creatinine clearance rate (Ccr) was negatively correlated with age, thus kidney function declines with aging.
2.About 20% of CKD patients still keep the habit of drinking, 23% of whom have experience of drunk in each drinking.
3.46% of CKD patients were smokers, but the rate of successful quitting of smoking was as high as 80%.
4.68% of CKD patients were under weight control; the patients under weight control had significant higher creatinine clearance rate than those not under weight control.
5.35% of CKD patients did not keep a habit of regular exercise.
6.About 70% of CKD patients had taken herb medicine, over-the-counter medication, pain killer, or health foods.
The following suggestions are made according to the research results. Since 20%-30% of the patients with chronic kidney disease maintain drinking habits and do not get regular physical exercise, health care professionals must educate patients and promote their healthy lifestyle. To accurately explore the relationship between health behavior and renal functions, future study should use new cases as research subjects to prevent the change of health behavior that may affect the research result.
論文目次 目 錄
頁數
致 謝 ………………………………………………………… I
中文摘要 ………………………………………………………… III
英文摘要 ………………………………………………………… V
目 錄 ………………………………………………………… VII
圖表目次 ………………………………………………………… X
第一章 緒論
第一節 研究背景與動機……………………………………
第二節 研究目的…………………………………………… 4
第二章 文獻查證
第一節 慢性腎病的定義及盛行率…………………………
第二節 影響慢性腎病進展之危險因子…………………… 7
第三節 健康行為的意義與測量…………………………… 14
第四節 概念架構…………………………………………… 17
第五節 研究假設…………………………………………… 18
第六節 名詞界定…………………………………………… 19
第三章 研究方法
第一節 研究設計…………………………………………… 22
第二節 研究對象…………………………………………… 23
第三節 研究工具…………………………………………… 24
第四節 資料收集步驟……………………………………… 28
第五節 資料處理與分析…………………………………… 31
第四章 研究結果
第一節 慢性腎病患者基本屬性、健康行為與腎功能分佈
第二節 個案不同基本屬性、健康行為之腎功能差異分析 41
第三節 個案健康行為與全體國民之差異分析…………… 45
第五章 討論
第一節 慢性腎病患者基本屬性、健康行為與腎功能分佈探討…………………………………………………
第二節 個案不同基本屬性、健康行為之腎功能差異探討 50
第三節 個案健康行為與全體國民之差異探討…………… 53
第六章 結論與建議
第一節 結論………………………………………………… 55
第二節 研究限制…………………………………………… 56
第三節 建議………………………………………………… 58
參考資料
中文部分 …………………………………………………… 77
英文部分 …………………………………………………… 81
附錄
附錄一 研究問卷使用同意書……………………………… 88
附錄二 專家效度檢測邀請函……………………………… 89
附錄三 研究問卷工具審核專家名單……………………… 91
附錄四 專家效度檢測結果………………………………… 92
附錄五 研究問卷工具……………………………………… 102
附錄六 參與同意書………………………………………… 107
附錄七 同意臨床試驗證明書……………………………… 108




















圖表目次

頁數
圖一 概念架構…………………………………………… 17
表一 慢性腎病之分期及盛行率………………………… 6
表二 研究個案資料之描述性統計……………………… 32
表三 對應研究假設之推論性統計……………………… 33
表四 慢性腎病患者基本屬性分佈……………………… 60
表五 慢性腎病患者健康行為分佈-喝酒狀況………… 61
表六 慢性腎病患者健康行為分佈-吸菸狀況………… 62
表七 慢性腎病患者健康行為分佈-嚼檳榔狀況……… 63
表八 目前有喝酒、吸菸、嚼檳榔之慢性腎病患者未來
改變危險健康行為之意圖分佈…………………… 64
表九 慢性腎病患者健康行為分佈-體重控制、運動、
日常生活行為、飲食型態與食品標示利用狀況… 65
表十 慢性腎病患者健康行為分佈-食品種類攝取狀況 66
表十一 慢性腎病患者健康行為分佈-平時用藥習慣狀況 67
表十二 慢性腎病患者肌酸酐廓清率值分佈……………… 68
表十三 慢性腎病患者不同基本屬性之肌酸酐廓清率值之差異分
析…………………………………………… 69
表十四 慢性腎病患者基本屬性與肌酸酐廓清率值之相關分
析………………………………………………… 70
表十五 慢性腎病患者採取不同健康行為之肌酸酐廓清率值差異分
析………………………………………… 71
表十六 慢性腎病患者健康行為與肌酸酐廓清率值之差異分
析………………………………………………… 72
表十七 慢性腎病患者食物種類攝取與肌酸酐廓清率值之差異分
析…………………………………………… 73
表十八 慢性腎病患者平時用藥習慣與肌酸酐廓清率值之差異分
析…………………………………………… 74
表十九 65歲以上慢性腎病患者與民國九十年台閩地區
65歲以上國民之健康行為差異分析……………… 75
表二十 65歲以上慢性腎病患者與民國九十年台閩地區
65歲以上國民之食物種類攝取差異分析………… 76
參考文獻 參考資料
中文部份
丁志音、江東亮(1996)•以健康行為型態分類台灣地區之成年人
口群-群聚分析之應用•中華公共衛生雜誌,15(3),175-
186。
于漱(1987)•台北市20-60歲居民預防性健康行為之調查研究•公
共衛生,14(4),391-406。
王智賢、黃建鐘(2002)•腎臟病的保護療法-多重風險因子介入
治療•腎臟與透析,14(3),136-140。
王舒民、楊雅斐、黃秋錦(2007)•慢性腎臟病與高血壓•腎臟與
透析,19(2),64-70。
石曜堂、洪永泰、張新儀、劉仁沛、林惠生、張明正、張鳳琴、熊
昭、吳聖良(2003)•「國民健康訪問調查」之調查設計、內
容、執行方式與樣本人口特性•台灣衛誌,22(6),419-
430。
丘周萍、江慧珣(2004)•護理人員在慢性腎功能不全照護之角色
功能•臺灣腎臟護理學會雜誌,3(2),75-80。
台灣腎臟醫學會(2006,1月25日)•台灣腎臟醫學會2003透析年
度報告•2006年8月15日,取自http://www.tsn.org.tw/
江慧珣(2003)•多媒體式護理指導對慢性腎功能不全患者知識、
態度、行為意向與行為之成效•未發表之碩士論文,國防大
學,台北。
全民健康保險局(2006,5月15日)•重大傷病門診醫療費用申報狀
況—按重大傷病類別分•2006年10月5日,取自
http://www.nhi.gov.tw/webdata/
李蘭(1991)•健康行為的概念與研究•中華公共衛生雜誌,10
(5),199-211。
李蘭、陸玓玲、李隆安、黃美維、潘怜燕、鄧肖琳(1995)•台灣
地區成人的健康行為探討:分怖情形、因素結構和相關因素•
中華公共衛生雜誌,14(4),358-368。
李世代、潘文涵(2004,9月1日)•台灣地區老人營養健康狀況調
查1999-2000老年人之睡眠品質、攝護腺肥大、尿失禁及腎功能
異常等健康概況•2008年1月13日,取自
http://food.doh.gov.tw/chinese/
Academic/PDF/academic3_1/200411_19.pdf
李玟儀、蔡敦仁(2005)•慢性腎病:一個流行病的新課題•當代
醫學,32(6),460-465。
呂學文、陳進陽(2004)•減緩慢性腎臟病病人腎功能惡化•臨床
醫學,54(3),173-177。
吳佩蓉、許淑蓮、蔡敦仁、黃秀梨(1997)•個別衛教對慢性腎衰
竭患者疾病認知、態度、自我照顧之成效•台灣醫學,1
(1),23-34。
林雁秋、顏妙芬(2005)•慢性腎病患者求醫行為之探討•實證護
理,1(4),263-272。
胡月娟、林豐裕(2005)•慢性病患之疾病衝擊、健康行為與因應
結果之模式檢定•實證護理,1(2),140-148。
陳漢湘(1999)•保護剩餘的腎功能•腎臟與透析,11(2),67-
68。
陳哲喜、林惠生、劉怡妏(2004,12月31日)•國人之健康行為初
探•2006年8月5日,取自http://rds.bhp.doh.gov.tw/
陳健文(2006)•以病例對照研究法探討成藥對腎功能影響•未發
表之碩士論文,臺灣大學,臺北。
許志成、徐祥明、徐真淳、石曜堂、戴東原(2003)•臺灣地區老
年人健康行為之影響因素分析•台灣衛誌,22(6),441-
452。
張鳳琴、張晞雁、劉夏園、吳聖良(2004,12月31日)•國民健康
訪問調查問卷設計介紹•2006年9月20日,取自
http://rds.bhp.doh.gov.tw/
國家衛生研究院(2006,3月17日)•2001年「國民健康訪問調查」
結果報告-台灣地區•2006年10月15日,取自
http://nhis.nhri.org.tw/
黃秀梨、吳佩蓉、許淑蓮、蔡敦仁(1996)•慢性腎衰竭患者的疾
病認知、態度及自我照顧行為之研究•慈濟醫學,8(4),
313-321。
黃尚志、楊五常、陳秀熙(2000)•臺灣地區八十八年至八十九年
度透析評估工作報告•台灣腎臟醫學會雜誌,14(4),139-
195。
曾月霞(2004)•中年人健康行為之探討•護理雜誌,51(1),
20-24。
蔣榮福、陸志平、蔣榮欽(1999)•中草藥與腎臟•腎臟與透析,
11(3),144-148。
魏榮男、莊立民、林瑞雄、趙嘉玲、宋鴻樟(2002)•1996~2000年
台灣地區糖尿病盛行率與住院率•臺灣公共衛生雜誌,21
(3),173-180。
英文部份
Adelman, R. D. (2002). Obesity and renal disease. Current
Opinion in Nephrology & Hypertension, 11(3), 331-335.
Biesenbach, G., Janko, O., & Zazgornik, J. (1994). Similar
rate of progression in the predialysis phase in type I
and type II diabetes mellitus. Nephrology Dialysis
Transplantion, 9, 1097-1102.
Chase, H. P., Garg, S. K., & Marshall, G. (1991).
Cigarette smoking increases the risk of albuminuria
among subjects with type I diabetes. The Journal of
the American Medical Association, 265, 614-617.
Cirillo, M., Anastasio, P., & De Santo, N. G. (2005).
Relationship of gender, age, and body mass index to
errors in predicted kidney function. Nephrology
Dialysis Transplantion, 20(9), 1791-1798.
Cleveland, D. R., Jindal, K. K., Hirsch, D. J. & Kiberd,
B. A. (2002). Quality of prereferral care in patients
with chronic renal insufficiency. American Journal of
Kidney Diseases, 40(1), 30-36.
Cockcroft, D. W., & Gault, M. H. (1976). Prediction of
creatinine clearance from serum creatinine. Nephron,
16, 31-41.
Coresh, J., Astor, B. C., Greene, T., Eknoyan G., & Levey
A. S. (2003). Prevalence of chronic kidney disease and
decreased kidney function in the adult US population:
Third National Health and Nutrition Examination
Survey. American Journal of Kidney Diseases, 41(1), 1-
12.
Corrato, G., Bagnardi, V., Zambon, A., & Arico, S. (1999).
Exploring the dose-respones relationship between
alcohol consumption and the risk of several alcohol-
related conditions: a meta-analysis. Addiction, 94,
1551-1573.
Davies, D. F., & Shock, N. W. (1950). Age changes in
glomerular filtration rate, effective renal plasma
flow and tubular excretory capacity in adult males.
The Journal of Clinical Investigation, 29(5), 496-507.
Eriksen, B. O., & Ingebretsen, O. C. (2006). The
progression of chronic kidney disease: A 10-year
population-based study of the effects of gender and
age. Kidney International, 69, 375-382.
Francisco, A. L. M., Fresnedo, G. F., Palomar, R., Pinera,
C., & Arias, M. (2005). The renal benefits of healthy
lifestyle. Kidney International, 68(Suppl 99), S2-S6.
Gelber, R. P., Kurth, T., Kausz, A. T., Manson, J. E.,
Buring, J. E., Levey, A. S., et al. (2005).
Association between body mass index and CKD in
apparently healthy men. American Journal of Kidney
Diseases, 46(5), 871-880.
Glanz, K., Rimer, B. K., & Lewis, F. M. (2002). The scope
of health behavior and health education. In K. Glanz,
B. K. Rimer, & F. M. Lewis (Ed.), Health behavior and
health education (3rd ed., pp. 3-21). San Franciso,
CA: Jossey-bass.
Gochman, D. S. (1997). Health behavior research:
Definitions and diversity. In D. S. Gochman (Ed.),
Handbook of Health behavior research I: Personal and
social determinants (1st ed., pp. 3-20). New York:
Plenum Press.
Gray, A., Raikou, M., McGuire, A., Fenn, P., Stevens, R.,
Cull, C., et al. (2000). Cost effectiveness of an
intensive blood glucose control policy in patients
with type 2 diabetes: economic analysis alongside
randomised controlled trial. British Medical Journal,
20, 1373-1378.
Harris, D. M., & Guten, S. (1979). Health protective
behavior: An exploratory study. Journal of Health and
Social Behavior, 20(3), 17-29.
Hsu, C. C., Hwang, S. J., Wen, C. P., Chang, H. Y., Chen,
T., Shiu, R. S., et al. (2006). High Prevalence and
low awareness of CKD in Taiwan: A study on the
relationship between serum creatinine and awareness
from a nationally representative survey. American
Journal of Kidney Disease, 48(5), 727-738.
Iseki, K. (2006). Body mass index and the risk of chronic
renal failure: the Asian experience. Contributions to
Nephrology, 151, 42-56.
Kannas, L. (1981). The dimensions of health health
behavior among young men in finland. International
Journal of Health Education, 24, 146-155.
Kasl, S. V., & Cobb, S. (1966). Health behavior, illness
behavior, and sick-role behavior. Archives of
Environment Health, 12, 246-266.
Kes, P., & Ratkovic-Gusic, I. (1996). The role of arterial
hypertension in progression of renal failure. Kidney
International, 49(Suppl 55), S72-S74.
Klag, M. J., Whelton, P. K., Randall, B. L., Neaton, J.
D., Brancati, F. L., & Stamler, J. (1997). End-stage
renal disease in African-American and white men. 16-
year MRFIT findings. Journal of the American Medical
Association, 277(16), 1293-1298.
Knight, E. L., Stampfer, M. J., Rimm, E. B., Hankinson, S.
E., & Curhan, G. C. (2003). Moderate alcohol intake
and renal function decline in women: a prospective
study. Nephrology Dialysis Transplantation, 18, 1549-
1554.
Laffrey, S. C. (1985). Health behavior choice as related
to self-actualization and health conception. Western
Journal of Nursing Research, 7(3), 279-300.
Lin, C. H., Yang, W. C., Tsai, S. T., Tung, T. H., & Chou,
P. (2006). A community-based study of chronic kidney
disease among type 2 diabetics in Kinmen, Taiwan.
Diabetes Researchand and Clinical Practice, 4, 12-14.
National Kidney Foundation. (2002). Definition and
classification of stages of chronic kidney disease.
American Journal of Kidney Disease, 39(2), S46-S75.
Newman, D. J., Mattock, M. B., Dawnay, A. B., Kerry, S.,
McGuire, A., Yaqoob, M., et al. (2005). Systematic
review on urine albumin testing for early detection of
diabetic complications. Health Technology Assessment, 9
(30), 158-163.
Otero, A., Gayoso, P., Garcia, F., & Francisco, A. L.
(2005). Epidemiology of chronic renal disease in the
Galician population: Results of the pilot Spanish
EPIRCE study. Kidney International, 68(Suppl 99), S16-
S19.
Perneger, T. V., Whelton, P. K., Puddey, I. B., & Klag, M.
J. (1999). Risk of End-stage renal disease associated
with alcohol consumption. American Journal of
Epidemiology, 150(12), 1275-1281.
Pinto-Sietsma, S. J., Mulder, J., Janssen, W. M., Hillege,
H. L., Zeeuw, D., & Jong, P. E. (2000). Smoking is
related to albuminuria and abnormal renal function in
nondiabetic persons. Annals of internal medicine, 133,
585-591.
Powe, N. R., & Melamed, M. L. (2005). Racial disparities
in optimal delivery of chronic kidney disease care.
The medical Clinics of North America, 89, 475-488.
Samuelsson, O., & Attman, P. O. (2000). Is smoking a risk
factor for progression of chronic renal failure.
Kidney International, 58(6), 2597.
Stengel, B., Tarver-Carr, M. E., Powe, N. R., Eberhardt,
M. S., & Barancati, F. L. (2003). Lifestyle factors,
obesity and the risk of chronic kidney disease.
Epidemiology, 14(4), 479-487.
Shankar, A., Klein, R., & Klein, B. E. K. (2006). The
association among smoking, heavy drinking and chronic
kidney disease. American Journal of Epidemiology, 164
(3), 263-271.
Vupputuri, S., & Sandler, D. P. (2003). Lifestyle risk
factors and chronic kidney disease. Annals of
Epidemiology, 13(10), 712-720.
Walker, S. N., Schrist, K. P. & Pender, N. J. (1987). The
health promoting lifestyle profile: Development and
psychometric characteristics. Nursing Research, 36(2),
77-81.
Wen, C. P., Tsai, S. P., Chen, C. J., Cheng, T. Y., Tsai,
M. C., & Levy, D. T. (2005). Smoking attributable
mortality for Taiwan and its projection to 2020 under
fifferent smoking scenarios. Tobacco Control, 4(Suppl
1), i76-i80.
Whelton, A., & Hamilton, C. W. (1991). Nonsteroidal anti-
inflammatory drugs: effects on kidney function.
Journal Clinical Pharmacology, 31(7), 588-598.
Whelton, P. K., Perneger, T. V., He, J., & Klag, M. J.
(1996). The role of blood pressure as a risk factor
for renal disease: A review of the epidemiologic
evidence. Journal Human Hypertension, 10(10), 683-689.

 


若您有任何疑問,請與我們聯絡!
臺北醫學大學 圖書館 李秀珍
E-mail:hsiujen@tmu.edu.tw
Tel:(02) 2736-1661 ext.2513
Fax:(02) 2737-5446