介入組受詴者以次分組分析組別間教育介入成效

本次研究分析比較組內不同次分組的差異，包括：受詴者納入收案 條件為高血磷或低白蛋白的分組，年齡以 65 歲為切點的年齡分組，以及 性別分組的比較分析。

(一) 知識、態度及行為（KAP）問卷

起始期介入組受詴者在收案條件、年齡及性別次分組分析比較上，

知識題、態度題、行為題及 KAP 總分皆無顯著差異，僅知識題，年齡小 於 65 歲受詴者分數顯著較高（p = 0.009），見表 17。經 3 個月教育介入 後，介入組受詴者在收案條件、年齡及性別次分組比較上亦無顯著差異，

僅行為題年齡大於 65 歲受詴者分數顯著較高（p = 0.011），見表 18。

表 17. 介入組受詴者起始期 KAP 分數在收案條件、性別和年齡次分組比較¹

Table17. Comparison of KAP scores between different subgroup, sex and age groups at baseline in intervention group.¹ Baseline

Intervention group (n = 36) Hyperphosphatemia Values are expressed as mean ±SE. ¹Comparisons were undertaken using Wilcoxon rank sum test. **means significantly different at p < 0.01.

表 18. 介入組受詴者教育介入後 KAP 分數在收案條件、性別和年齡次分組比較¹

Table18. Comparison of KAP scores between different subgroup, sex and age groups after intervention in intervention group.¹ After

intervention

Intervention group (n = 36) Hyperphosphatemia Values are expressed as mean ±SE. ¹Comparisons were undertaken using Wilcoxon rank sum test. *means significantly different at p < 0.05.

(二) 飲食內容

介入組受詴者在收案條件分組比較上，飲食內容皆無顯著差異。在 3 個月教育介入期間，兩組受詴者蛋白質（g）、磷（mg）與支鏈胺基酸（g）

攝取量顯著增加，見表 19。在追蹤期，兩組受詴者飲食攝取量則皆與起 始期並無顯著差異。

介入組受詴者在性別分組比較上，男性受詴者的熱量（kcal）、蛋白 質（g）、脂質（g）、醣類（g）與磷（mg）攝取量顯著較女性多。在 3 個月教育介入期間，特別是女性受詴者，顯著增加蛋白質（g）、蛋白質

（g/kg）、磷（mg）與支鏈胺基酸（g）攝取量，見表 20。在追蹤期，兩 組受詴者飲食攝取量則皆與起始期並無顯著差異。

介入組受詴者在年齡分組比較上，飲食內容皆無顯著差異。在 3 個 月教育介入期間，特別是年齡大於 65 歲受詴者，顯著增加熱量（kcal/kg）、

蛋白質（g）、蛋白質（g/kg）、磷（mg）與支鏈胺基酸（g）攝取量，見 表 21。在追蹤期，兩組受詴者飲食攝取量則皆與起始期並無顯著差異。

表 19. 介入組受詴者在收案條件分組比較 6 個月期間飲食內容改變情形

Table19. Comparison of daily nutrients intake between 6 months in hyperphosphatemia and hypoalbuminemia subgroup in intervention group.

Hyperphosphatemia group (n = 21) Hypoalbuminemia group (n = 15) p for

group

¹

p for time

²

p for interaction

³

Baseline Month1 Month3 Month6 Baseline Month1 Month3 Month6

Calorie, kcal 1210 ± 92 1377 ± 93 1407 ± 93 1462 ± 101 1457 ± 135 1414 ± 91 1486 ± 87 1318 ± 80 0.929 0.260 0.374 Calorie,

kcal/kg 21.7 ± 1.8 23.1 ± 1.5 23.8 ± 1.8 24.7 ± 1.8 26.1 ± 2.4 26.6 ± 1.9 27.9 ± 1.8 24.8 ± 1.8 0.360 0.385 0.307 Protein, g 44.8 ± 3.5

^b

52.6 ± 3.7

^ab

57.9 ± 4.7

^a

55.4 ± 4.8

^b

57.5 ± 5.5

^b

55.9 ± 4.2

^b

61.9 ± 3.6

^a

54.1 ± 3.2

^b

0.793 0.008 0.850 Protein, g/kg 0.80 ± 0.06 0.89 ± 0.07 0.98 ± 0.09 0.93 ± 0.08 1.05 ± 0.11

^b

1.05 ± 0.08

^b

1.17 ± 0.08

^a

1.03 ± 0.09

^b

0.260 0.043 0.589 Lipid, g 46.0 ± 5.1 52.5 ± 4.9 51.8 ± 4.4 52.9 ± 4.7 56.9 ± 6.9 66.7 ± 6.1 65.8 ± 7.3 58.7 ± 6.2 0.190 0.279 0.473 CHO, g 156.0 ± 12.4 173.6 ± 12.9 179.0 ± 13.2 189.5 ± 13.5 173.4 ± 19.3

^ab

164.8 ± 11.0

^ab

177.0 ± 13.7

^a

155.6 ± 12.8

^b

0.572 0.666 0.092 P, mg 527 ± 48

^b

609 ± 41

^ab

685 ± 58

^a

639 ± 66

^ab

598 ± 72

^b

648 ± 49

^b

756 ± 50

^a

573 ± 63

^b

0.847 0.003 0.347 P, mg/g

protein 11.7 ± 0.5 11.8 ± 0.4 11.9 ± 0.5 11.5 ± 0.6 10.3 ± 0.6 11.7 ± 0.5 12.3 ± 0.5 10.3 ± 0.9 0.950 0.180 0.258 BCAA, g 6.4 ± 0.7

^b

7.1 ± 0.6

^b

8.3 ± 0.8

^a

7.6 ± 0.8

^ab

7.3 ± 0.9

^b

7.5 ± 0.8

^b

8.5 ± 0.8

^a

6.5 ± 0.9

^b

0.842 0.014 0.482

Values are expressed as mean ± SE. ^{1, 2,3}Comparisons were undertaken using two-way repeated measures ANOVA. Values with different superscripts are significantly different at p < 0.05 by one-way repeated measures ANOVA.

表 20. 介入組受詴者在性別分組比較 6 個月期間飲食內容改變情形

Table20. Comparison of daily nutrients intake between 6 months in male and female subgroup in intervention group.

Male (n = 17) Female (n = 19) p for

group

¹

p for time

²

p for interaction

³

Baseline Month1 Month3 Month6 Baseline Month1 Month3 Month6

Calorie, kcal 1245 ± 98 1605 ± 94 1591 ± 102 1514 ± 96 1373 ± 123 1202 ± 66 1305 ± 71 1312 ± 94 0.004 0.312 0.376 Calorie,

kcal/kg 21.9 ± 2.1 26.7 ± 1.7 26.5 ± 2.0 24.8 ± 1.6 25.0 ± 2.0 22.6 ± 1.5 24.6 ± 1.7 24.7 ± 2.0 0.168 0.602 0.182 Protein, g 47.3 ± 4.1 61.1 ± 4.5 63.9 ± 4.6 61.3 ± 4.6 52.7 ± 4.8

^b

47.6 ± 2.6

^b

55.6 ± 4.0

^a

49.5 ± 3.9

^ab

0.021 0.010 0.918 Protein, g/kg 0.84 ± 0.09 1.02 ± 0.09 1.08 ± 0.10 1.01 ± 0.08 0.96 ± 0.08

^b

0.89 ± 0.06

^b

1.04 ± 0.08

^a

0.94 ± 0.09

^ab

0.359 0.078 0.737 Lipid, g 47.6 ± 5.8 70.0 ± 6.0 67.1 ± 6.1 63.6 ± 5.3 53.2 ± 6

^a

48.1 ± 3.9

^ab

49.2 ± 4.9

^b

48.2 ± 4.7

^ab

0.001 0.441 0.923 CHO, g 162.3 ± 14.5 195.0 ± 12.0 195.3 ± 16.0 181.9 ± 16.0 164.0 ± 16.1 147.5 ± 10.4 162.9 ± 9.9 170.9 ± 12.4 0.035 0.667 0.076 P, mg 517 ± 50

^b

698 ± 49

^b

782 ± 55

^a

672 ± 67

^b

591 ± 63

^b

560 ± 34

^b

654 ± 55

^a

562 ± 65

^ab

0.050 0.004 0.984 P,

mg/g protein 10.9 ± 0.6

^b

11.6 ± 0.4

^ab

12.4 ± 0.4

^a

10.8 ± 0.6

^b

11.3 ± 0.6 11.9 ± 0.4 11.8 ± 0.5 11.3 ± 0.8 0.911 0.237 0.700 BCAA, g 6.3 ± 0.8 7.7 ± 0.8 8.7 ± 0.8 7.6 ± 0.9 7.2 ± 0.8

^b

6.8 ± 0.5

^b

8.1 ± 0.7

^a

6.8 ± 0.8

^ab

0.365 0.019 0.920

Values are expressed as mean ± SE. ^{1, 2,3}Comparisons were undertaken using two-way repeated measures ANOVA. Values with different superscripts are significantly different at p < 0.05 by one-way repeated measures ANOVA.

表 21. 介入組受詴者在年齡分組比較 6 個月期間飲食內容改變情形

Table21. Comparison of daily nutrients intake between 6 months in age < 65 years and age ≧ 65 years subgroup in intervention group.

Age < 65 years group (n = 20) Age ≧ 65 years group (n = 16) p for

group

¹

p for time

²

p for interaction

³

Baseline Month1 Month3 Month6 Baseline Month1 Month3 Month6

Calorie, kcal 1254 ± 97 1438 ± 102 1487 ± 98 1476 ± 103 1386 ± 132 1335 ± 75 1381 ± 81 1308 ± 81 0.219 0.267 0.959 Calorie,

kcal/kg 22.5 ± 1.9 23.6 ± 1.5 24.6 ± 1.6 24.4 ± 1.8 24.9 ± 2.4

^b

25.7 ± 1.9

^ab

26.7 ± 2.1

^a

25.1 ± 1.9

^ab

0.803 0.397 0.282 Protein, g 47.0 ± 4.1 55.2 ± 3.6 57.0 ± 4.1 53.7 ± 4.8 54.1 ± 5.0

^c

52.4 ± 4.4

^bc

62.8 ± 4.6

^a

56.4 ± 3.6

^ab

0.957 0.004 0.220 Protein, g/kg 0.85 ± 0.08 0.91 ± 0.06 0.94 ± 0.07 0.89 ± 0.08 0.98 ± 0.09

^c

1.01 ± 0.1

^bc

1.21 ± 0.11

^a

1.09 ± 0.08

^ab

0.182 0.024 0.068 Lipid, g 50.6 ± 6.1 58.7 ± 5.5 59.5 ± 6.0 53.9 ± 5.0 50.5 ± 5.7 58.2 ± 5.7 55.4 ± 5.5 57.1 ± 5.8 0.563 0.384 0.604 CHO, g 160.5 ± 12.3 173.3 ± 12.9 182.9 ± 12.9 193.1 ± 13.5 166.6 ± 19.1 165.7 ± 11.7 172.3 ± 14.1 153 ± 12.4 0.279 0.639 0.189 P, mg 552 ± 54

^b

622 ± 37

^ab

680 ± 53

^a

582.8 ± 70

^ab

561.4 ± 65

^b

629 ± 54

^b

758 ± 61

^a

652 ± 58

^ab

0.708 0.002 0.384 P,

mg/g protein 11.8 ± 0.4 11.5 ± 0.4 12.0 ± 0.4 10.7 ± 0.8 10.3 ± 0.7 12.1 ± 0.5 12.1 ± 0.5 11.5 ± 0.6 0.465 0.302 0.843 BCAA, g 6.5 ± 0.6 7.3 ± 0.6 8.5 ± 0.7 7.1 ± 0.9 7.2 ± 1.0

^b

7.1 ± 0.8

^b

8.2 ± 0.8

^a

7.2 ± 0.8

^ab

0.581 0.015 0.693

Values are expressed as mean ± SE. ^{1, 2,3}Comparisons were undertaken using two-way repeated measures ANOVA. Values with different superscripts are significantly different at p < 0.05 by one-way repeated measures ANOVA.

(三)體位、血液生化數值和營養狀態指標

本次研究分析六個月期間體位、血液生化數值和營養狀態指標的次 分組比較，皆以兩組受詴者每個月的數據進行 two-way repeated measures ANOVA 分析，因版面篇幅太大，請詳見附錄八提供完整數據結果。在結 果部分僅摘錄起始期、第 3 和第 6 個月之數據呈現。

在收案條件分組中介入組受詴者 6 個月期間體位、血液生化數值和 營養狀態指標改變情形，分析得高血磷組 TP、GNRI、P、Ca × P 和 K 皆 顯著較低白蛋白組高。在 3 個月教育介入期間，高血磷及低白蛋白組受 詴者皆維持營養狀態（包括：albumin 和 GNRI）和蛋白質攝取量（nPCR），

而血磷控制（包括：P 和 Ca × P）僅高血磷組在教育介入期間顯著降低，

低白蛋白組維持不變，見表 22。在追蹤期間，兩組營養狀態、蛋白質攝 取量及血磷控制與起始期相較皆無顯著差異。

分析在性別中介入組受詴者 6 個月期間體位、血液生化數值和營養 狀態指標改變情形，分析得男性受詴者 albumin 顯著較女性受詴者高，而 TC 顯著較低。在 3 個月教育介入期間，男性與女性受詴者皆維持營養狀 態（包括：albumin 和 GNRI）和蛋白質攝取量（nPCR），而血磷控制（包 括：P 和 Ca × P）僅男性受詴者在教育介入期間顯著降低，女性受詴者則 維持不變，見表 23。在追蹤期間，兩組營養狀態、蛋白質攝取量及血磷 控制與起始期相較皆無顯著差異。

分析在年齡中介入組受詴者 6 個月期間體位、血液生化數值和營養 狀態指標改變情形，分析得年齡小於 65 歲受詴者 Cr、albumin、GNRI、

P、Ca × P 和脫水量皆顯著較年齡大於 65 歲受詴者高。在 3 個月教育介 入期間，年齡小於 65 歲和年齡大於 65 歲受詴者皆維持營養狀態（包括：

albumin 和 GNRI）和蛋白質攝取量（nPCR），而血磷控制（包括：P 和 Ca × P）僅年齡小於 65 歲受詴者在教育介入期間顯著降低，年齡大於 65 歲受詴者則維持不變，見表 24。在追蹤期間，兩組營養狀態、蛋白質攝 取量及血磷控制與起始期相較皆無顯著差異。

表 22. 介入組受詴者在收案條件分組 6 個月期間體位、血液生化數值和營養狀態指標改變情形

Table22. Comparison of anthropometric, laboratory measurements and indicator of nutritional status between 6 months in hyperphosphorusmia and hypoalbuminemia subgroup in intervention group.

Hyperphosphorusmia group (n = 21) Hypoalbuminemia group (n = 15)

p

¹

p

²

p

³

Baseline Month3 Month6 Baseline Month3 Month6

BUN, mg/dL 79.4 ± 3.8 84.0 ± 3.6 74.8 ± 4.4 75.1 ± 5.8^b 82.7 ± 7.5^ab 75.8 ± 6.3^ab 0.613 0.073 0.823 Values are expressed as mean ± SE. ¹

p for group by two-way repeated measures ANOVA,

²

p for time by two-way repeated measures ANOVA,

³

p for

interaction by two-way repeated measures ANOVA. BUN, blood urea nitrogen; Cr, creatinine; UA, uric acid; BMI, body mass index; TP, total protein;

GNRI, geriatric nutritional risk index; nPCR, normalized protein catabolic ratio; TG, triglyceride; TC, total cholesterol; HGB, hemoglobin; Ca, calcium; P, phosphorus; Ca×P, calcium phosphorus product; K, potassium. Values with different superscripts are significantly different at p < 0.05 by one-way repeated measures ANOVA and post hoc test with Friedman's test.

表 23. 介入組受詴者在性別分組 6 個月期間體位、血液生化數值和營養狀態指標改變情形

Table23. Comparison of anthropometric, laboratory measurements and indicator of nutritional status between 6 months in male and female subgroup in intervention group.

Male (n = 17) Female (n = 19)

p

¹

p

²

p

³

Baseline Month3 Month6 Baseline Month3 Month6

BUN, mg/dL 76.5 ± 4.5 82.8 ± 5.4 81.5 ± 4.9 78.6 ± 4.7^ab 84.1 ± 5.2^a 69.9 ± 5.0 ^ab 0.789 0.101 0.346 Values are expressed as mean ± SE. ¹

p for group by two-way repeated measures ANOVA,

²

p for time by two-way repeated measures ANOVA,

³

p for

interaction by two-way repeated measures ANOVA. BUN, blood urea nitrogen; Cr, creatinine; UA, uric acid; BMI, body mass index; TP, total protein;

GNRI, geriatric nutritional risk index; nPCR, normalized protein catabolic ratio; TG, triglyceride; TC, total cholesterol; HGB, hemoglobin; Ca, calcium; P, phosphorus; Ca×P, calcium phosphorus product; K, potassium. Values with different superscripts are significantly different at p < 0.05 by

表 24. 介入組受詴者在年齡分組 6 個月期間體位、血液生化數值和營養狀態指標改變情形

Table24. Comparison of anthropometric, laboratory measurements and indicator of nutritional status between 6 months in age < 65 years and age ≧ 65 years subgroup in intervention group.

Age < 65 years group (n = 20) Age ≧ 65 years group (n = 16)

p

¹

p

²

p

³

Baseline Month3 Month6 Baseline Month3 Month6

BUN, mg/dL 76.9 ± 3.3^b 83.2 ± 4.7^a 75.7 ± 4.9 ^ab 78.5 ± 6.1 83.8 ± 6.2 74.6 ± 5.6 0.816 0.121 0.821 Values are expressed as mean ± SE. ¹

p for group by two-way repeated measures ANOVA,

²

p for time by two-way repeated measures ANOVA,

³

p for

interaction by two-way repeated measures ANOVA. BUN, blood urea nitrogen; Cr, creatinine; UA, uric acid; BMI, body mass index; TP, total protein;

GNRI, geriatric nutritional risk index; nPCR, normalized protein catabolic ratio; TG, triglyceride; TC, total cholesterol; HGB, hemoglobin; Ca, calcium; P, phosphorus; Ca×P, calcium phosphorus product; K, potassium. Values with different superscripts are significantly different at p < 0.05 by one-way repeated measures ANOVA and post hoc test with Friedman's test.

(四) BMI、飲食攝取量、血液生化數值及營養指標相關性分析

經調整年齡及性別後多變項相關性分析得，白蛋白與血鉀、鈣磷乘 積和 GNRI 分數呈顯著正相關。GNRI 分數與 BMI、白蛋白、血磷和鈣磷 乘積呈顯著正相關。血磷與 BMI、血鉀、鈣磷乘積和 GNRI 分數呈顯著 正相關。鈣磷乘積與 BMI、白蛋白、血鉀、血鈣、血磷和 GNRI 分數呈 顯著正相關。nPCR 與血鉀和飲食攝取量呈顯著正相關。飲食磷（mg）

與血鉀、nPCR 和飲食攝取量呈顯著正相關，見表 25。

表 25. 調整年齡和性別之多變項相關性分析

Table25. Partial correlation analysis between univariate variables, adjust age and sex.

BMI Albumin K Ca Phosphorus Ca×P Kt/V nPCR GNRI Calorie

Values are correlation coefficients and p value. BMI, body mass index; K, serum potassium; Ca, serum calcium; Phosphorus, serum phosphorus; Ca×P, calcium phosphorus product; nPCR, normalized protein catabolic ratio; GNRI, geriatric nutritional risk index; Calorie, daily calorie intake, Protein, daily protein intake, Phosphorus, daily phosphorus intake. *means

第五節 介入組受詴者教育介入成效與控制組受詴者比較

在文檔中 Taipei Medical University Institutional Repository:Item 987654321/44563 (頁 73-86)