臺灣博碩士論文加值系統

背景

糖尿病在台灣的盛行率逐年成長，其中第二型糖尿病病患佔了九成以上，如何去預防新生糖尿病是一個重要的臨床議題；心血管疾病是糖尿病危險因子之一，病患發生糖尿病的前幾年可能已有心血管疾病，故兩者具有高度相關性，近年來有研究指出，急性心肌梗塞病患的血糖異常與新生糖尿病的發生相關，但進一步的詳細情況仍未知；降血壓藥的使用在台灣應用廣泛，心血管疾病病患使用降血壓藥治療的情況也十分普遍，根據文獻，不同類型的降血壓藥其機轉可能會影響血糖的增加或減少，故降血壓藥與新生糖尿病一直都有關聯性，但急性心肌梗塞病患使用降血壓藥後而導致新生糖尿病之風險，台灣目前則尚未有此研究。

目的

本研究欲了解使用不同類型降血壓藥對於急性心肌梗塞病患導致新生糖尿病的風險。
方法
本研究使用全民健康保險資料研究庫進行回溯性世代研究，分析2002至2003年有診斷急性心肌梗塞之記錄並使用降血壓藥的病患作為研究對象，追蹤至2007年，藉由多變項Logistic迴歸分析來評估急性心肌梗塞病患使用降血壓藥與新生糖尿病之相關性。

結果

符合本研究條件的研究對象共有936人，而在觀察期間有156人診斷出新生糖尿病。經校正性別、年齡、共病症和其他影響血糖用藥後，本研究結果顯示急性心肌梗塞病患使用ARBs有統計上顯著意義可降低新生糖尿病之風險。(OR=0.28，95% CI=0.08－0.93)

結論

本研究結果建議急性心肌梗塞病患可考量選擇使用ARBs治療，以降低新生糖尿病之風險。

Background

The prevalence of diabetes mellitus has increasing in Taiwan. Additionally, the type II diabetes mellitus accounts for more than 90 percent of diabetes mellitus. How to prevent new-onset diabetes became an important clinical issue. Cardiovascular diseases are one of risk factor of diabetes, and they might be diagnosed earlier than diabetes so they are highly correlative. Recently, some studies have indicated that the patients with acute myocardial infarction having abnormal blood sugar link to new-onset diabetes. However, there are no further details. Antihypertensive drugs are accessible to medicines use in Taiwan. It is, also, used on the treatment of cardiovascular disease. According to previous researches, diverse mechanisms of antihypertensive drugs could result in increasing or decreasing of blood glucose. Thus, antihypertensive drugs is associated with new-onset diabetes. However, the relationship between using antihypertensive drugs to cardiovascular diseases and the risk of new-onset diabetes remain poorly understood.

Objective

To clarify the possibility of different type of antihypertensive drugs might induce new-onset diabetes.

Methods

We utilize National Health Insurance Research Database in retrospective cohort study and analyze the records of acute myocardial infarction with antihypertensive drugs from 2002 to 2003. Then we follow up the records until 2007 and evaluate the relationship between the antihypertensive drugs use and new-onset diabetes by multivariate logistic regression analysis.

Result

In our study 936 patients were qualified after selection. During the observation period, 156 of them had new-onset diabetes. After adjusting of gender, age, comorbid diseases, and other medications, our results shows that patients with acute myocardial infarction used ARBs could decrease the risk of new-onset diabetes significantly. (OR=0.28，95% CI=0.08－0.93)

Conclusion

Our result suggests that ARBs can be considered for patients with acute myocardial infarction. It could reduce the risk of new-onset diabetes.

目錄 I
表目錄 V
圖目錄 VI
中文摘要 VII
英文摘要 IX
第一章　緒論 1
　　　　第一節　研究背景 1
　　　　第二節　研究目的 2
第二章　文獻探討 3
　　　　第一節　急性心肌梗塞 3
　　　　　　　　一、 急性心肌梗塞之定義與流行病學 3
　　　　　　　　二、 急性心肌梗塞之醫療處置 4
　　　　第二節　糖尿病 5
　　　　　　　　一、 糖尿病之定義 5
　　　　　　　　二、 糖尿病之診斷 5
　　　　　　　　三、 糖尿病之類型 6
　　　　第三節　降血壓藥 7
　　　　　　　　一、 血管張力素轉化酶抑制劑 7
　　　　　　　　二、 血管張力素接受器阻斷劑 8
　　　　　　　　三、 Thiazide類利尿劑 9
　　　　　　　　四、 環利尿劑 9
　　　　　　　　五、 乙型交感神經接受體阻斷劑 10
　　　　　　　　六、 甲型交感神經接受體阻斷劑 11
　　　　　　　　七、 鈣離子通道阻斷劑 12
　　　　第四節　新生糖尿病與急性心肌梗塞之相關研究 13
　　　　第五節　新生糖尿病與降血壓藥之相關研究 14
　　　　　　　　一、 血管張力素轉化酶抑制劑 14
　　　　　　　　二、 血管張力素接受器阻斷劑 15
　　　　　　　　三、 Thiazide類利尿劑 ＆ 環利尿劑 15
　　　　　　　　四、 乙型交感神經接受體阻斷劑 16
　　　　　　　　五、 甲型交感神經接受體阻斷劑 17
　　　　　　　　六、 鈣離子通道阻斷劑 17
　　　　　　　　第六節 小結 18
第三章　研究方法 19
　　　　第一節　研究設計 19
　　　　　　　　一、 研究設計 19
　　　　　　　　二、 研究架構 20
　　　　　　　　三、 研究流程 21
　　　　第二節　研究來源 22
　　　　　　　　一、 資料來源 22
　　　　　　　　二、 擷取資料 22
　　　　第三節　研究對象與研究期間 24
　　　　　　　　一、 納入對象 24
　　　　　　　　二、 排除對象 25
　　　　　　　　三、 觀察終點 25
　　　　第四節　研究變項與操作型定義 25
　　　　　　　　一、 自變項 26
　　　　　　　　二、 依變項 27
　　　　　　　　三、 控制變項 27
　　　　　　　　四、 操作型變項 27
　　　　第五節　資料處理流程 29
　　　　　　　　一、 資料檔建置 29
　　　　　　　　二、 資料檔串檔 29
　　　　　　　　三、 資料檔檢誤 30
　　　　　　　　四、 資料擷取與篩選 31
　　　　第六節　統計分析 33
　　　　　　　　一、 描述性統計 33
　　　　　　　　二、 推論統計 33
　　　　　　　　三、 統計軟體 34
　　　　第七節　研究倫理相關考量 34
　　　　　　　　一、 研究倫理委員會審查 34
　　　　　　　　二、 研究資料處理保護 34
第四章　研究結果 35
　　　　第一節　研究世代收案 35
　　　　第二節　基本人口學特質描述 37
　　　　　　　　一、 診斷出新生糖尿病組族群特性分析 38
　　　　　　　　二、 未診斷出新生糖尿病組族群特性分析 39
　　　　　　　　三、 診斷與未診斷出新生糖尿病之兩組比較 40
第三節　多變項分析結果 41
第五章　研究討論 46
　　　　第一節　研究族群 46
　　　　第二節　主要研究結果 47
　　　　　　　　一、 血管張力素轉化酶抑制劑 47
　　　　　　　　二、 血管張力素接受器阻斷劑 52
　　　　　　　　三、 利尿劑 55
　　　　　　　　四、 乙型交感神經接受體阻斷劑 58
　　　　　　　　五、 甲型交感神經接受體阻斷劑 62
　　　　　　　　六、 鈣離子通道阻斷劑 64
　　　　第三節　研究優勢 68
　　　　第四節　研究限制 68
第六章　結論 70
參考文獻 71
附錄 82

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