背景: 近年來台灣 地區末期腎衰竭病患盛行率已攀升至世界第一，其中糖尿病是造成末期腎衰竭的重要原因。非創傷性下肢病變是困擾糖尿病患的常見疾病，已有許多研究發現，糖尿病且罹患末期腎衰竭病患，下肢發生病變甚至導致截肢的機率，高於一般的糖尿病人。下肢病變的預防已是末期腎衰竭患者不可忽視的一環。
目的:本研究探討台灣末期腎衰竭患者發生下肢病變的盛行率，以及末期腎衰竭患者發生下肢病變之人口學特徵、共病程度、透析治療、醫療資源利用等概況，以探討發生下肢病變之影響因素。
方法:本研究利用健保資料庫進行次級資料分析，共分析2000、2002、2004、2006共四年度資料，四年樣本數分別為57021人、75711人、76750人以及86902人。主要使用重大傷病證明明細檔、門診處方及治療明細檔，篩選出台灣末期腎衰竭族群利用資料統計方法進行分析末期腎衰竭患者發生下肢病變之罹病急就醫情形。
結果: 四年度末期腎臟衰竭病患發生下肢病變之盛行率分別為1.30%、1.44%、2.71%、2.45%。末期腎臟衰竭病患發生下肢病變，共病嚴重程度越高者罹病風險越高(四年度末期腎臟衰竭病患發生下肢病變罹病/未罹病OR: 2.06、1.98、1.86、1.83)；採血液透析者罹病風險較高(血液透析/腹膜透析OR: 17.1、16.79、15.12、9.23)；透析持續時間在第二年起至第五年間，罹病風險最高(2002年資料顯示1-5年/5年以上OR: 1.39)；末期腎衰竭患者是否發生下肢病變在醫療資源利用方面，在區域分布方面，顯示東部院所有較多病例發生，中部則較少(2000年中部/北部OR:0.67、2002年東部/北部OR:1.47、2006年中部/北部OR: 0.87)；就醫醫院層級以醫學中心為參考組時，除2000年外，皆以醫學中心發現較多病例(2000年，區域醫院OR:1.40、地區醫院OR:1.50、基層院所OR:0.36。2002年，基層院所者OR:0.18。2004年，區域醫院OR:0.76、地區醫院OR:0.78、基層院所OR:0.23。2006年，區域醫院OR:0.66、地區醫院OR:0.75、基層院所OR:0.26)；罹病患者並有較多的門診利用次數，除2000 年以外，皆呈現正向相關。
結論:本研究初步探討末期腎衰竭患者發生下肢病變的風險因子及醫療概況，末期腎衰竭發生下肢病變之危險因子為共病、透析方式以及持續透析時間。就醫區域性觀察，顯示東部地區末期腎衰竭患者發生下肢病變之機率較高，中部則相對較低。末期腎衰竭發生下肢病變治療多發現於醫學中心，並在門診次數上，有顯著的提升。建議相關研究可持續追蹤下肢病變者治療及預後情況，以更進一步評估醫療品質以利往後政策參考。

Background: The prevalence of patients with end stage renal disease (ESRD) in Taiwan has risen to the first in the world in recent years. Non-traumatic lower extremity lesion is a common disease of diabetic and ESRD patients. Many studies have found that the prevalence of non-traumatic lower extremity lesion in diabetic patients with ESRD is higher than normal diabetic patients. Prevention the incidence of lower extremity lesions in patients with ESRD may prevent patients from further amputation.
Objectives: This study explored the prevalence of ESRD with Non-traumatic lower extremity lesion. We focused on demography status, comorbidities, dialysis therapies and utilization of health care to define the risk factors of disease.
Methods: This study conducted secondary data analysis with administrative data from Bureau of National Health Insurance (HV_CD data) for four years (2000, 2002, 2004 and 2006). In total, there were 57021, 75711, 76750, and 86902 for years 2000, 2002, 2004, and 2006, respectively. To attain the research purposes, descriptive analyses and logistic regression were performed.
Result: The prevalence of ESRD with non-traumatic lower extremity lesion for the four years were 1.30%, 1.44%, 2.71% and 2.45%, respectively. ESRD patients with and without non-traumatic lower extremity lesion were significant difference between comorbidities (OR for the four years were 2.06, 1.98, 1.86 and 1.83), dialysis therapies (hemodialysis / peritoneal dialysis, OR for the four years were 17.1, 16.79, 15.12 and 9.23) and duration of dialysis (1-5 years / 5 years and more, OR was 1.39 in 2002).There were significant differences in regions of hospital organizations (compared with the north, OR were 0.67 in the center in 2000, 1.47 in the east in 2002 and 0.87 in the center in 2006), class of hospital organizations (compared with Academic Medical Centers, OR were 1.40 in Regional Hospitals, 1.50 in District Hospitals and 0.36 in Physician Clinics in 2000, 0.18 in Physician Clinics in 2002, 0.76 in Regional Hospitals, 0.78 in District Hospitals and 0.23 in Physician Clinics in 2004, 0.66 in Regional Hospitals, 0.75 in District Hospitals and 0.26 in Physician Clinics in 2006 ) and outpatient visits ( positive correlation in all years except 2000).
Conclusion: The risk factors of suffering non-traumatic lower extremity lesion in ESRD patients are comorbidities, dialysis therapies and duration of dialysis. In the part of regions of hospital organizations, the east region has higher and the center region has lower probability of suffering the disease, comparing with the north region. Academic Medical Centers has the highest probability to find ESRD patients with non-traumatic lower extremity lesion. We also found the numbers of outpatient visits were increasing with the disease. Based on the results, we highly suggest that caregivers from dialysis units have to pay great attention in taking care of the ESRD patients with non-traumatic lower extremity lesion to prevent from the further amputation.

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
第二章 、文獻探討 4
第一節、 腎臟衰竭疾病 4
第二節、 末期腎臟衰竭病患發生下肢病變 5
第三節、 末期腎臟衰竭發生下肢病變之臨床症狀 7
第四節、 末期腎臟衰竭發生下肢病變之基本人口學特質 8
第五節、 末期腎臟衰竭患者常見共病症 9
第三章 、研究方法 11
第一節、 研究架構及研究假設 11
第二節、 研究樣本與資料來源 14
第三節、 研究流程 14
第四節、 測量變項 18
第五節、 分析方法 22
第四章、研究結果 24
第一節 描述性統計分析 24
第二節 推論性統計分析 34
一、 卡方檢定 34
二、 獨立樣本t 檢定 46
三、 邏輯斯回歸分析 54
第五章、討論 62
第一節 末期腎臟衰竭者下肢病變之盛行率 62
第二節 末期腎臟衰竭者發生下肢病變之人口學特質 63
第三節 末期腎臟衰竭者發生下肢病變之共病 65
第四節 末期腎臟衰竭者發生下肢病變之透析治療與透析持續時間 66
第五節 末期腎臟衰竭者發生下肢病變之醫療資源利用 68
第六章、結論與建議 70
第一節、 研究結論 70
第二節、 研究限制 73
第三節、 研究建議 74
參考文獻 75

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