第二型糖尿病性腎臟病患使用ACEIs/ARBs藥物情形及其相關因素

Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin Ⅱ Receptor Blockers in Patients with Type 2 Diabetic Chronic Kidney Disease

10.6288/TJPH2007-26-06-07

戴嘉伶(Chia-Ling Dai)；朱慧凡(Hui-Fan Chu)；林宏達(Hong-Da Lin)；吳義勇(Yee-Yung Ng)；吳肖琪(Shiao-Chi Wu)

第二型糖尿病性腎臟病 ； 血管張力素轉化抑制劑 ； 血管張力素受體阻斷劑 ； 末期腎臟病 ； type 2 diabetic CKD ； angiotensin converting enzyme inhibitors ； angiotensin Ⅱ receptor blockers ； end-stage renal disease

台灣公共衛生雜誌

26卷6期（2007 / 12 / 01）

499 - 506

繁體中文

目標：糖尿病性腎臟病為末期腎臟病的主要原因之一，國外已有許多研究證實，血管張力素轉化抑制劑(ACEIs)或血管張力素受體阻斷劑(ARBs)對第二型糖尿病性腎臟病患，能減緩末期腎臟病之發生及死亡，本研究目的為暸解第二型糖尿病性腎臟病患使用ACEIs/ARBs藥物情形及其相關因素。方法：以2001年全民健康保險資料庫中尚未發展至第5期之13,673位第二型糖尿病性腎臟病新個案為對象，暸解其ACEIs/ARBs用藥情形。考慮到同一醫師看診下病患有聚集情形，因此以GEE（廣義估計模式）分析影響ACEIs/ARBs用藥之相關因素。結果：2001年第二型糖尿病性腎臟病新個案ACEIs/ARBs用藥率低，初診斷前一年有合併症者其ACEIs/ARBs用藥率較高，其中以併有充血性心衰竭（OR值為1.49，95%信賴區間為1.30-1.72）及高血壓（OR值為1.40，95%信賴區間為1.23-1.60）者ACEIs/ARBs用藥率較高。第二型糖尿病患在地區或基層醫療院所相較於在區域以上醫院就醫、由家醫科或其他科醫師相較於內科及神經專科醫師，在初診斷為慢性腎臟病時被開立ACEIs/ARBs藥物的機率顯著較低。結論：國內第二型糖尿病性腎臟病患ACEIs/ARBs用藥率較國外低。建議國內應藉由醫師繼續教育與民眾衛教宣導，以提高ACEIs/ARBs用藥率。

Objectives: Diabetic chronic kidney disease (CKD) is one of the main causes of end-stage renal disease (ESRD). Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin Ⅱ receptor blockers (ARBs) have been shown to prevent ESRD or mortality among patients with type 2 diabetic CKD. The aim of this study was to investigate the use of ACEIs and ARBs and factors associated with the use of ACEIs and ARBs. Methods: Thirteen thousand six hundred seventy-three new cases of type 2 diabetic CKD below stage 5 were identified in the Taiwan National Health Insurance (NHI) databases in 2001. The factors for ACEIs and ARBs prescription were analyzed by a generalized estimating equation (GEE) for adjusting the cluster effect. Results: ACEIs and ARBs were prescribed less than medically indicated in this cohort. The co-morbidities before CKD was diagnosed were strongly associated with the prescription of ACEIs and ARBs, with adjusted odds ratios (ORs) of 1.49 (95% CI, 1.30-1.72) and 1.40 (95% CI, 1.23-1.60) for congestive heart failure and hypertension, respectively. The prescription rate of ACEIs and ARBs was lower in physician offices and district hospitals than in regional hospitals and medical centers. The prescription of ACEIs and ARBs was more by internists and neurologists than family physicians and other subspecialists. Conclusions: The use of ACEIs and ARBs is lower in Taiwan than expected. Educational efforts to physicians and patients may increase the use of ACEIs and ARBs.

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