CAJ | 학술논문

目的评价心血管疾病(CVD)对慢性肾脏病(CKD)相关医疗费用的影响.方法 96例CKD3～4期患者全部来自首都医科大学附属北京友谊医院CKD专科门诊,男性65例,女性31例,年龄(61.6±9.5)岁.回顾性查阅其2010年1月至10月间的就诊记录和医保费用明细.以CKD相关医疗费用的中位数为界分为2组,比较2组患者的差异.再按上述回顾期内存在急性发作的CVD事件、有CVD但无急性事件、无CVD分成3组,比较CKD相关医疗费用的组间差异.最后,采用最优尺度回归模型分析CKD相关医疗费用可能的影响因素.结果 2010年1月至10月间,患者CKD相关医疗费用的中位数为13960.5元(四分位数10226.5元,19667.2元).与医疗费用较低组比较,医疗费用较高组女性所占比例、尿白蛋白肌酐比值、因急性CVD事件急诊留观和(或)住院、糖尿病罹患率和钙磷乘积较高(均P＜0.05),eGFR和血红蛋白水平较低(均P＜0.05)；而CVD总的患病率差异则无统计学意义(P=0.386).按CVD患病情况不同分组进行的费用比较显示,只有存在急性发作的CVD事件组与其他两组的CKD相关医疗费用差异有统计学意义(均P＜0.01)；前者费用的中位数几乎是其他2组的3倍,费用的最大值也在该组.最优尺度回归分析显示,因急性CVD事件急诊留观和(或)住院、是否并发糖尿病两个变量进入了方程,标准化回归系数分别为-0.538和-0.217(P＜0.01,P＜0.05).结论由急性CVD事件所致的急诊留观和(或)住院是造成CKD3～4期患者高额医疗费用最重要的原因,因此,预防急性事件可能是减少CKD相关医疗费用的重要举措,但结果尚需要更大范围、更长期的前瞻性随访研究进一步证实.此外,糖尿病也参与影响患者CKD相关的医疗费用.
목적 평개심혈관질병(CVD)대만성신장병(CKD)상관의료비용적영향.방법 96례CKD3～4기환자전부래자수도의과대학부속북경우의의원CKD전과문진,남성65례,녀성31례,년령(61.6±9.5)세.회고성사열기2010년1월지10월간적취진기록화의보비용명세.이CKD상관의료비용적중위수위계분위2조,비교2조환자적차이.재안상술회고기내존재급성발작적CVD사건、유CVD단무급성사건、무CVD분성3조,비교CKD상관의료비용적조간차이.최후,채용최우척도회귀모형분석CKD상관의료비용가능적영향인소.결과 2010년1월지10월간,환자CKD상관의료비용적중위수위13960.5원(사분위수10226.5원,19667.2원).여의료비용교저조비교,의료비용교고조녀성소점비례、뇨백단백기항비치、인급성CVD사건급진류관화(혹)주원、당뇨병리환솔화개린승적교고(균P＜0.05),eGFR화혈홍단백수평교저(균P＜0.05)；이CVD총적환병솔차이칙무통계학의의(P=0.386).안CVD환병정황불동분조진행적비용비교현시,지유존재급성발작적CVD사건조여기타량조적CKD상관의료비용차이유통계학의의(균P＜0.01)；전자비용적중위수궤호시기타2조적3배,비용적최대치야재해조.최우척도회귀분석현시,인급성CVD사건급진류관화(혹)주원、시부병발당뇨병량개변량진입료방정,표준화회귀계수분별위-0.538화-0.217(P＜0.01,P＜0.05).결론 유급성CVD사건소치적급진류관화(혹)주원시조성CKD3～4기환자고액의료비용최중요적원인,인차,예방급성사건가능시감소CKD상관의료비용적중요거조,단결과상수요경대범위、경장기적전첨성수방연구진일보증실.차외,당뇨병야삼여영향환자CKD상관적의료비용.
Objective To evaluate the effect of cardiovascular disease (CVD) on the healthcare costs associated with chronic kidney disease (CKD).Methods A total of 96 patients with stage 3-4 CKD treated at CKD clinic of Beijing Friendship Hospital,Capital Medical University were enrolled in the study.Their mean age was (61.6±9.5) years including 65 male and 31 female patients.A retrospective analysis of clinical material and health claims between January 2010 and October 2010 was conducted.Firstly,patients were grouped according to median CKD-associated healthcare cost and clinical characteristics were compared between two groups.Secondly,patients were stratified into three categories based on CVD prevalence (with acute cardiovascular events,with CVD but no acute events,and without CVD),and CKD-associated healthcare costs were assessed among the groups.Finally,the potential factors influencing CKD-associated healthcare costs were evaluated by optimal scaling regression analysis.Results During January to October in 2010,median CKD-associated healthcare costs was 13960.5 yuan (interquartile range 10226.5,19667.2 yuan).In the group with higher healthcare costs,more females,greater urine albumin-creatinine ratio,more emergency observations and/or hospitalizations caused by acute cardiovascular events,higher diabetes mellitus prevalence and calcium-phosphorus products,and lower eGFR and hemoglobin levels were found (P＜0.05,respectively).In contrast,the total prevalence of CVD was not significantly different between the groups (P=0.386).When grouping by CVD prevalence,significant differences of CKD-associated healthcare costs were observed only between patients with acute cardiovascular events and the other two groups (P＜0.01,respectively).The median healthcare cost of the former was approximately twice as higher as that of the other two groups,and the maximal cost was also found in the acute-cardiovascular-event group.For the optimal scaling regression analysis,both emergency observations and/or hospitalizations caused by acute cardiovascular events and diabetes mellitus entered the equation,and standardized coefficients were -0.538 and -0.217 respectively (P＜0.01 and P＜0.05).Conclusions Emergency observations and/or hospitalizations caused by acute cardiovascular events are important factors inducing high CKD-associated healthcare costs in patients with stage 3-4 CKD.Therefore,the prevention of acute cardiovascular events may be favorable to reduce CKD-associated healthcare costs.Larger and longer-time perspective studies are required to confirm it.In addition,diabetes mellitus also influences CKD-associated healthcare costs.