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研究生:尤鐘賢
研究生(外文):Chung-Shian, You
論文名稱:第2型糖尿病與胰臟癌相關性探討
論文名稱(外文):The Relationship between the Type 2 Diabetes and Pancreatic Cancer in Taiwan
指導教授:張偉斌張偉斌引用關係
指導教授(外文):Wei-Pin, Chang
學位類別:碩士
校院名稱:元培科技大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
畢業學年度:102
語文別:中文
論文頁數:51
中文關鍵詞:糖尿病胰臟癌存活分析
外文關鍵詞:diabetes mellituspancreatic cancersurvival analysis
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研究目的:民國 101年糖尿病在台灣十大死因排行中排名第五位,而胰臟癌在台灣也常列為十大癌症死亡疾病之一,且90%以上的胰臟癌病人,當發現得病時幾乎都無法手術治療。五年的存活率甚至低於5%,可以說是預後極差的疾病。國外有許多研究指出,糖尿病病患對胰臟癌有較高的發生風險,其機轉及因果關係尚未十分明朗。本研究將採用全民健康保險資料庫,進行台灣糖尿病病人,其胰臟癌之罹患率是否較一般民眾來的高。
研究方法:本研究使用全民健康保險學術研究資料庫2005年100萬人承保抽樣歸人檔,篩選2003~2005年50歲以上新罹患第2型糖尿病病患(擷取ICD-9-CM前3碼為250**,並排除250*1、250*3個案),並以2003~2005年非糖尿病病患為對象,依性別年齡1:5配對,採用存活分析(Cox proportional hazard regression)進行統計分析,分析2003-2005年新罹患糖尿病個案追蹤至2010年罹患胰臟癌(ICD-9-CM前3碼為157.*)之相對危險性。
研究結果:本研究共分析34,266位,每位並追蹤5年的結果,發現共有25人(0.1%)發生胰臟癌。案例組有9人(0.2%),對照組有16人(0.1%)。初步分析得知,罹患糖尿病患者追蹤5年得胰臟癌要比一般大眾高2.82倍。經校正後(因子為年齡、性別、月薪、高血壓、高血脂、酒精成癮、肥胖與抽菸成癮),糖尿病者比一般大眾罹患胰臟癌高2.63倍之風險。以性別來看,男生罹患胰臟癌粗危險率稍高(Crude HR=3.34; 95% confidence interval: 1.19-9.38, P <0.05),但校正後,性別罹患胰臟癌並無顯著差異存在。以年齡來看,本研究中年齡分為三個群組為50-64歲、65-79歲與80歲以上,比較是否不同年齡罹患胰臟癌之風險,研究結果得之,65-79歲的粗危險率為最高(Crude HR=5.01, 95% confidence interval: 1.76-14.28, P<0.01)。另外,本研究又將追蹤年度分成三個階段(1年追蹤、3年追蹤與5 年追蹤)來分析是否因為罹患糖尿病的時間較久會有較高的風險存在,研究結果得之,粗危險率是逐年降低,5年追蹤後的粗危險率為(Crude HR=2.82; 95% confidence interval: 1.24-1.6.37, P<0.05)。
討論與建議:本研究的結果與國內及國外研究成果類似,但對65-79歲之糖尿病老年族群更是需要注意三年內或五年內是否罹患胰臟癌之發生。

Aim:Diabetes is top 5 death cause in Taiwan in 2010. The latest cancer statistic published that pancreatic cancer was increased cancer. Few studies were result of the relationship between diabetes and pancreatic cancer. The mechanism and relationship is not very clear, which might relate to insulin resistance, hyperinsulinemia or pharmaceutical. This research investigates the relationship between diabetes and pancreatic cancer to evidence the diabetes increase the risk of pancreatic cancer based on the national health insurance research database. Method:This study recruited the random sample of 1,000,000 individuals covered by the National Health Insurance which provided for study. We selected newly type 2 diabetes (ICD-9-CM:250**,excluded ICD-9-CM:250*1、250*) from 2003 to 2005 and compared with the general population who were match by age and gender in the same year. Every sample was followed five years periods. This study used Chi-square test and Cox proportional hazard regression to analyze the risk of pancreatic cancer with diabetes. Result:There were 5,711 newly type 2 diabetes mellitus patient(Female:2,834、Male:2,877). The comparison group has 28,555 cases (Female:14,170, Male:14,385). After adjusting for other factors, the hazard ratio of pancreatic cancer was 2.63; 95% confidence interval [CI]=1.11-6.20; p<0.05). Pancreatic cancer was the most significant disease in the study group higher than the comparison group (AHR=2.02; 95% [CI]=1.39-2.94; p<0.001). Furthermore, we separated by gender to analysis. We found that male patients had higher risk of pancreatic cancer (Crude HR=3.34; 95% [CI]=1.19-9.38;p<0.05), but female patients were not (Crude HR=2.14; 95% [CI]=0.55-8.28; p=0.84). In our study, we also found that the age of 65-79 have higher increased risk for development of pancreatic cancer (Crude HR=5.54; 95% [CI]=1.79-17.08; p<0.01). Conclusion:This study showed that type 2 diabetes mellitus is associated with an increased risk of pancreatic cancer.
誌 謝 I
中文摘要 II
圖目錄 VI
表目錄 VII
第一章 緒論 1
1.1研究背景與動機 1
1.2研究目的 2
第二章 文獻探討 3
2.1糖尿病簡介 3
2.1.1糖尿病類型說明 4
2.1.2糖尿病診斷 4
2.1.3糖尿病併發症 5
2.2胰臟癌簡介 7
2.2.1胰臟癌症狀 7
2.2.2胰臟癌分期 7
2.2.3胰臟癌篩檢 8
2.2.4胰臟癌危險因子 9
2.3糖尿病與胰臟癌相關性 9
2.3.1探討糖尿病與癌症關聯之國際會議 9
第三章 研究方法 10
3.1研究類型 10
3.2研究資料來源 10
3.3資料處理流程 10
3.5研究變項定義 17
3.6分析方法 19
3.6.1描述性統計分析 19
3.6.2推論性統計分析 20
第四章 研究結果 21
4.1研究對象基本資料 21
4.1.1基本人口學特徵 21
4.1.2糖尿病共併症及併發症分布 22
4.2.1研究個案罹患胰臟癌風險分析 25
4.2.2研究個案性別不同罹患胰臟癌之風險 28
4.2.3研究個案年齡組別不同罹患胰臟癌之風險 32
4.2.4研究個案追蹤年度不同罹患胰臟癌之風險 37
第五章 結論與討論 42
5.1第2型糖尿病與胰臟癌之相關性 42
5.2綜合討論 43
5.3研究限制 44
5.3.1檢驗與生活習慣料無法確知 44
5.3.2死亡資料無法得知 44
5.3.3研究樣本限制 44
5.4建議 44
參考文獻 46

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