長期動靜脈血管通路失能與其續發心血管疾病風險之關聯：健保資料庫之世代研究

研究目的：執行血液透析過程必需具備功能性良好之長期動靜脈血管通路，血液透析血管通路失能是血液透析族群罹病率和住院率的主要原因，而心血管疾病（CVD）是接受慢性血液透析患者死亡的主要原因；血液透析患者因長期尿毒素累積、缺氧、氧化壓力、體液超負荷、血栓形成等因素造成動靜脈血管通路因靜脈內膜增生發生狹窄或阻塞導致失能時，此因素可能使心血管負荷相對增加，因此研究欲分析長期動靜脈血管通路失能與患者發生CVD風險間之相關性。研究方法及資料：使用台灣全民健康保險研究資料庫百萬歸人檔進行分析之回溯性世代研究。收集2000年至2013年之相關數據。研究族群選取2000年至2007年之末期腎病患者接受長期動靜脈血管通路手術且開始規律血液透析患者進行統計分析，且其年齡需大於或等於20歲。研究結果：根據研究的納入和排除標準，參與研究族群分為197例發生長期動靜脈血管通路失能患者作為病例組及100例長期動靜脈血管通路非失能患者為控制組，與控制組比較，經校正後動靜脈血管通路失能組罹患CVD風險比為控制組的3.05倍（95％CI：1.14-8.20），且經 Kaplan-Meier分析後顯示，動靜脈血管通路失能組發生CVD的累積發生率高於控制組（p = 0.020）。結論與建議：研究結果發現長期動靜脈血管通路失能與隨後發生CVD的風險增加顯著相關，如以動靜脈血管通路失能為早期徵兆之思維，防範治療心血管疾病的產生，照護血液透析之血管通路失能患者上，除需定期監測其血管通路問題，也應追蹤心血管疾病的徵兆防範於未然。

Background: A functional permanent vascular access (VA) is required to perform a successful hemodialysis procedure. Hemodialysis vascular access dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population. Cardiovascular disease (CVD) is the leading cause of the death in patients receiving chronic hemodialysis. We analyzed the association between dialysis VA dysfunction and the risk of developing CVD in hemodialysis patients . Methods: The nationwide population-based cohort study was conducted using data from the National Health Insurance Research Database in Taiwan. One million subjects were sampled from the 23 million beneficiaries and collected the data from 2000 to 2013. Patients with end stage renal disease who receive permanent VA construction, hemodialysis and age more than or equal to 20 years old from 2000 to 2007 were included in the study population.Results: A total of 197 individuals with permanent VA dysfunction and 100 individuals with non- permanent VA dysfunction as the control gourp were selected. Compared with the control group, the adjusted hazard ratio of CVD for the VA dysfunction group was 3.05 (95% CI: 1.14-8.20). The Kaplan-Meier analysis reveald that the cumulative incidence of CVD was higher in the permanent VA dysfunction group than in the comparison group.Conclusion: Permanent VA dysfunction is significantly associated with an increased risk of subsequent CVD.