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研究生:詹婌婷
研究生(外文):Shu-Ting Chan
論文名稱:第二型糖尿病患者使用Thiazolidinedione
論文名稱(外文):Use of thiazolidinediones and risk of hospitalization for myocardial infarction with type 2 diabetes
指導教授:黃文鴻黃文鴻引用關係蔡憶文蔡憶文引用關係
指導教授(外文):Weng-Foung HuangYi-Wen Tsai
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:衛生福利研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:90
中文關鍵詞:Thiazolidinedion第二型糖尿病心肌梗塞
外文關鍵詞:ThiazolidinedionThiazolidinediontype 2 diabetic
相關次數:
  • 被引用被引用:1
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  • 收藏至我的研究室書目清單書目收藏:0
背景及目的:
Thiazolidinedione(TZD)為新一類抗糖尿病藥,但具有體液滯留副作用,可能惡化或導致心臟衰竭,故不建議使用於心臟衰竭分級(NYHA分級)第3及第4級患者;惟近來國外研究發現,可能增加心肌梗塞等心血管疾病之安全性隱憂。因此本研究探討第二型糖尿病患者使用pioglitazone或rosiglitazone與其他口服降血糖藥物比較,發生心肌梗塞之風險評估。
研究方法:
本研究為回溯性世代研究設計,以全民健康保險資料檔進行分析。研究對象為2001-2005期間初次診斷的第二型糖尿病者,依其首次使用metformin或sulfonylurea分組,再依其首次加入第二種口服降血糖藥物種類,區分為metformin組加入使用pioglitazone(1,339人)、rosiglitazone(4,396人)及non-TZD(41,819人)3組,sulfonylurea組加入使用pioglitazone(4,361人)、rosiglitazone(4,361人)及non-TZD(126,579人)3組。運用Cox proportional hazard model分析,以使用non-TZD之個案為對照組,分別於metformin組或sulfonylurea組內,比較3組個案發生因心肌梗塞住院之風險。
研究結果:
於sulfonylurea組,加入使用pioglitazone或rosiglitazone治療者,其因心肌梗塞住院之粗發生率分別為1.23/100,000人日及1.53/100,000人日,於metformin組則分別為1.17/100,000人日及1.25/100,000人日。在控制加入第二種口服降血糖藥物之使用天數等因素後,於sulfonylurea組加入使用pioglitazone(HR=0.515, CI=0.347-0.763)或rosiglitazone(HR=0.596, CI=0.505-0.703)個案相較於加入使用non-TZD者,其因心肌梗塞住院之危險性顯著較低;於metformin組加入使用pioglitazone(HR=0.54, CI=0.253-1.152)或rosiglitazone(HR=0.528, CI=0.360-0.773)個案相較於加入使用non-TZD者之危險性也較低,另將加入使用第二種口服降血糖藥物天數小於12個月者之次族群分析,使用pioglitazone或rosiglitazone個案相較於使用non-TZD者,其因心肌梗塞住院之危險性亦較低。
結論:
於本研究發現,初次診斷之第二型糖尿病患者使用metformin或sulfonylurea後,加入使用pioglitazone或rosiglitazone之個案相較於使用non-TZD者,其因心肌梗塞住院之危險性顯著較低,可能降低發生心肌梗塞之風險,值得後續關注。
Background: Thiazolidinediones (TZDs) are new class of oral antidiabetic agents, however, recent studies have raised concerns over the increased cardiovascular (CV) risk of TZDs in type 2 diabetic patients.
Aim: To assess the risk of myocardial infarction (MI) in type 2 diabetic patients exposed to pioglitazone and rosiglitazone respectively compared to other oral antidiabetic agents.
Methods: We conducted a retrospective cohort study using claims database of Taiwan’s National Health Insurance (NHI) between 2001~2005. The study subjects were newly diagnosed type 2 diabetic patients. We first classified our study subjects based on their initial treatments (metformin or sulfonylurea). In metformin group, the study subjects were grouped into those who received add-on pioglitazone (1,339), add-on rosiglitazone users (4,396) and non-TZD users (41,819). In sulfonylurea group, the study subjects were grouped into those who received add-on pioglitazone (4,361), add-on rosiglitazone users (4,361) and non-TZD users (126,579). We used Cox’s proportional hazard model to estimate the hazard ratio (HR) of incident hospitalization for MI after add-on treatment of rosiglitzone or pioglitazone .
Results: Among sulfonylurea group, the crude rates per 100,000 person days for the outcome (hospitalization for MI) in patients who received add-on pioglitazone or rosiglitazone were 1.23 and 1.53, respectively. In metformin group, the crude rates per 100,000 person days for the outcome (hospitalization for MI) in patients who received add-on pioglitazone or rosiglitazone were 1.23 and 1.53, respectively. In sulfonylurea group, among the patients who received add-on pioglitazone or rosiglitazone versus non-TZD, the lower HR for hospitalization for MI were 0.515 (CI=0.347-0.763) and 0.596 (CI=0.505-0.703), respectively. In metformin group, the HR for hospitalization for MI were 0.54 (CI=0.253-1.152) and 0.528 (CI=0.360-0.773), respectively. The subgroup that received additional second oral antidiabetic agents for less than 12 months had lower HR of hospitalization for MI.
Conclusions: Our study suggests that those who received add-on TZDs in comparison to non-TZDs users had reduced hazard of hospitalization for MI in patients with type 2 diabetes mellitus.
中文摘要…………………………………………………………………1
第一章 緒論 ……………………………………………………………2
第一節 研究背景 ………………………………………………………2
第二節 研究動機與重要性 ……………………………………………3
第三節 研究目的 ………………………………………………………4
第四節 研究問題 ………………………………………………………4
第二章 文獻探討 ………………………………………………………5
第一節 糖尿病 …………………………………………………………5
第二節 冠狀動脈心臟病………………………………………………11
第三節 Thiazolidinedione之探討 ……………………………………13
第四節 Thiazolidinedione與心血管疾病相關實證研究 ……………17
第三章 研究方法………………………………………………………28
第一節 研究設計………………………………………………………28
第二節 研究架構………………………………………………………29
第三節 資料來源與個案選取…………………………………………30
第四節 研究變項定義及測量…………………………………………32
第五節 資料處理與統計分析…………………………………………40
第四章 研究結果………………………………………………………41
第一節 加入使用Thiazolidinedione前一年之個案特質分析………41
第二節 加入使用Thiazolidinedione之追蹤期間個案特質分析……47
第三節 加入使用Thiazolidinedione發生心肌梗塞住院存活分析…55
第五章 討論……………………………………………………………79
第一節 研究結果及影響因素之討論…………………………………79
第二節 研究方法之討論………………………………………………83
第三節 研究限制………………………………………………………84
第六章 結論與建議
第一節 結論……………………………………………………………85
第二節 建議……………………………………………………………86
參考文獻 ………………………………………………………………87
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