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標題: | 以馬可夫鏈模型評估良好的血糖管控對台灣糖尿病腎病變之成效 An Application of Marcov Process to Evaluate the Effect of Intensive Glycemic Control on Diabetic Nephropathy in Taiwan |
作者: | Ming-Chia Hsieh 謝明家 |
指導教授: | 黃崇興 |
關鍵字: | 糖尿病腎病變,末期腎病,血糖管控,馬可夫鏈, diabetic nephropathy,ESRD,glycemic control,Markov chain, |
出版年 : | 2012 |
學位: | 碩士 |
摘要: | 糖尿病腎病變是造成末期腎病的主因,台灣的末期腎病(透析)的盛行率高居世界第一且發生率為世界第二。糖尿病腎病變是造成台灣末期腎病變的首要原因。之前的研究顯示,良好的血糖管控可以預防及延緩糖尿病腎病變,但良好的血糖管控對末期腎病及死亡率的成效並不清楚,我們欲研究良好血糖管控對台灣糖尿病腎病變、末期腎病及死亡率在第二型糖尿病患之成效。
本研究採用馬可夫鏈來評估良好血糖管控之成效,轉移機率由作者先前的世代研究分析取得,2107位台灣第二型糖尿病患平均追蹤4年來,病患依研究期間的平均糖化血色素(HbA1C)分成兩組─良好血糖控制組(HbA1C<7%)及不良血糖控制組(HbA1C 7%),馬可夫鏈的假設如下:1. 每年轉移機率是穩定的,但年齡是轉移機率主要因子,隨年齡做調整,2. 糖尿病腎病變的發生從正常白蛋白期進入微量白蛋白期,而後進入明顯白蛋白期,最後進入末期腎病,3. 血壓及其他因子被假設是相同。 我們的研究顯示,一位60歲無腎病變之糖尿病患,若接受良好血糖管控,20年後,末期腎病的發生率為1.02%,死亡率為21.74%,若血糖控制不良,末期腎病的發生率為1.88%,死亡率為23.69%。40歲明顯蛋白尿的第二型糖尿病患,接受良好的血糖管控,則進入末期腎病或死亡為22年,若血糖控制不良,則12年即進入末期腎病或死亡。另外經馬可夫鏈算出,若一位60歲正常白蛋白期病患接受良好血糖管控,20年的醫療費用為65058.54美元,若血糖控制不足,醫療費用則為71016.25美元。 結論,良好的血糖管控可以預防及延緩糖尿病腎病變,在台灣,良好的血糖管控可能可以減少末期腎病及死亡率的發生。 Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD) worldwide. Taiwan was found to have had the highest incidence of ESRD and the second highest prevalence in the world. DN is the main cause of the increases in prevalence and incidence of ESRD in Taiwan. Intensive glycemic control could reduce the incidence and progression of diabetic nephropathy. However, the effect of intensive glycemic control on ESRD and mortality was unclear. We evaluate the effect of glycemic control on diabetic nephropathy, ESRD and mortality in Taiwanese with type 2 diabetes. The Markov model was used to evaluate the effect of intensive glycemic control on diabetic nephropathy. The transition probabilities were calculated from the cohort which included 2107 Taiwanese with type 2 diabetes followed op for 4.5 years. All patients were divided into intensive glycemic control (mean HbA1c <7% during the study period) and poor glycemic control (mean HbA1c >= 7% during the study period). The assumption was made as following: 1. annual transition probabilities were stable and age-dependent; 2. diabetic nephropathy progressed without skipping any stages, and 3. blood pressure and other confounding factors were the same. The 20- year incidence of ESRD and mortality rate was 1.02% and 21.74% in a 60 y/o normoalbuminuric patients with intensive glycemic control. The incidence of ESRD and mortality rate was 1.88% and 23.69% in normoalbuminuric patients with poor glycemic control. The average time before ESRD or death was longer in a 40 y/o patients with overt proteinuria under intensive glycemic control as compared to patients under poor glycemic control (22 years vs. 12 years). The 20-year medical cost was estimated to be lower in a 60 y/o normoalbuminuric patients under intensive glycemic control as compared to patients with poor glycemic control (68058.54 vs. 71016.25 US dollar). The diabetic nephropathy can be prevented and delayed by intensive glycemic control in Taiwan. The intensive glycemic control seems to reduce the incidence of ESRD and mortality in Taiwanese with type 2 diabetes. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/64559 |
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