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研究生:林暐昱
研究生(外文):LIN, WEI-YU
論文名稱:使用阿斯匹靈與肝癌風險及肝功能血液檢驗之相關性探討
論文名稱(外文):Associations of Aspirin Intake with Risks of Liver Cancer and Liver Function Blood Tests
指導教授:蘇家玉蘇家玉引用關係
指導教授(外文):SU, EMILY CHIA-YU
口試委員:張資昊楊軒佳蘇家玉
口試委員(外文):CHANG, TZU-HAOYANG, HSUAN-CHIASU, EMILY CHIA-YU
口試日期:2024-01-12
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫學資訊研究所碩士在職專班
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
論文出版年:2024
畢業學年度:112
語文別:中文
論文頁數:60
中文關鍵詞:阿斯匹靈肝癌臨床資料庫檢驗數值麩草酸轉胺酶麩丙酮酸轉胺酶
外文關鍵詞:aspirinliver cancerclinical databaseliver function testglutamic oxaloacetic transaminaseglutamic pyruvic transaminase
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論文名稱: 使用阿斯匹靈與肝癌風險及其肝臟檢驗數值的相關性探討
背景與目的:
阿斯匹靈又名乙醯水楊酸,通常當作止痛藥物、消炎藥物、抗血小板藥物使用。已有研究表明,長期服用阿斯匹靈與降低癌症的死亡風險有關;本文章利用臺北醫學大學臨床資料庫,收集並分析每位參與者的年齡、性別、服藥情況、肝癌發生情況、肝臟檢查數值,藉以觀察肝癌發生率及肝臟檢查數值的差異。
研究方法:
本研究為觀察型研究,採取回溯性世代研究法,使用2007至2016年臺北醫學大學臨床資料庫,取50歲至74歲服用阿斯匹靈90天以上參與者及未服藥參與者,分為服藥組及未服藥組,分析兩組罹患肝癌的發生率。比較兩組九項肝臟功能檢驗數值在資料庫中與其他變項的平均值或標準差是否有顯著的差異。
研究結果:
本研究共納入446,381人,服藥組參與者共26,405人,未服藥組參與者共419,976人,在進行傾向性分數配對後,合併雙和、萬芳醫院的數據中服藥組罹癌比率為0.26%,未服藥組為0.36%,服藥組罹患肝癌的勝算比是未服藥的0.69倍,95%信賴區間為0.51-0.95,p = 0.022,達統計上顯著差異。在肝臟檢驗數值部分,雙和醫院服藥組參與者麩丙酮酸轉氨脢(GPT/ALT)、直接膽紅素(DBIL)、總膽紅素(TBIL)、總蛋白質(TP)、白蛋白(Albumin)、鹼性磷酸酶(ALKP)數值較低且達統計上差異;萬芳醫院服藥組丙醯基轉胺酶(γ-GT/GGT)、白蛋白(Albumin)數值較低且達統計上差異。
研究討論:
研究中發現服用阿斯匹靈與降低罹患肝癌的關係,也與目前研究觀察到服用阿斯匹靈者能降低罹患肝癌風險的結果相似。在檢驗數值中也能夠觀察到服用阿斯匹靈與部分數值較未服藥者為低,因本研究僅收錄兩間醫院病歷資料,僅能代表特定區域參與者的健康情形,針對阿斯匹靈對於肝癌的影響,尚待未來後續更多大型資料庫研究加以探討。

Title of Thesis:Associations of Aspirin Intake with Risks of Liver Cancer and Liver Function Blood Tests
Background and Objective
Aspirin, also known as Acetylsalicylic acid, is commonly used as an analgesic, anti-inflammatory drug and Antiplatelet. Studies have shown that long-term use of Aspirin can reduce cancer mortality. This article collects and analyses each participant's personal health record, including age, gender, taking Aspirin, Hepatocellular Carcinoma occurrence and Liver function test values.
Material and method
This study is an observational study using a retrospective cohort study design. Data were collected from the clinical database of Taipei Medical University from 2007 to 2016 The study focuses on individuals aged 50 to 74 who have taken aspirin for 90 days or more and those who have not taken any medication. The participants are categorized into the medication group and the non-medication group, and the incidence rates of liver cancer are analyzed for both groups. A comparison is made between the two groups based on nine liver function test values, examining whether there are significant differences in the average or standard deviation compared to other variables in the database.
Results
This study included a total of 446,381 people, with 26,405 participants in the medication group and 419,976 participants in the non-medication group. After propensity score matching and combining data from the Shuang-Ho Hospital and Wan Fang Hospital the cancer incidence rate in the medication group was 0.26%, and that in the non-medication group was 0.37%. The odds ratio for developing liver cancer in the medication group compared to the non-medication group was 0.68, with a 95% confidence interval of 0.48-0.90(p = 0.013). In the liver function test results, participants in the medication group at Shuang-Ho Hospital exhibited statistically significant lower levels of glutamic-pyruvic transaminase, direct bilirubin, total bilirubin, total protein, albumin, and alkaline phosphatase. In the medication group at Wan Fang Hospital, lower levels were observed in γ-glutamyl transferase, and albumin.
Discussion
The results of this study are similar to those of previous studies in the literature, which have shown that aspirin can reduce the risk of liver cancer. Since this study only collected medical records from two hospitals, it can only represent the health status of participants in a specific region. Further studies with larger databases are needed to explore the impact of aspirin on liver cancer.

審定書i
誌謝ii
目錄iii
圖目錄vi
表目錄vii
摘要vii
Abstractix
第一章 緒論1
第一節 前言1
第二節 研究動機與目的2
第二章 文獻探討4
第一節 肝癌的危險因子4
1.B型肝炎及C型肝炎4
2.酒精引起的肝硬化5
3.其他危險因子6
第二節 阿斯匹靈使用與腫瘤的相關性6
1.阿斯匹靈使用與大腸癌的相關性6
2.阿斯匹靈使用與肝癌的相關性7
3.美國對於阿斯匹靈降低肝癌風險研究 7
4.韓國對於阿斯匹靈降低肝癌風險研究 7
5.臺灣健保資料庫對於阿斯匹靈降低肝癌風險研究8
第三節 服用阿斯匹靈降低肝癌風險的原因9
1.阿斯匹靈降低肝癌風險的機轉9
2.其他機轉研究 10
3.阿斯匹靈與肝臟纖維化的動物實驗10
第四節 計算口服藥物時間11
1.每日定義劑量(Defined Daily Dose)11
2.累積每日定義劑量(cDDD,cumulative defined daily dose)11
第五節 各項檢驗數值代表含意12
1.胺基轉移酶(Aminotransferase)12
2.鹼性磷酸酶(Alkaline phosphatase)12
3.丙醯基轉胺酶(Gamma-glutamyl transferse; γ-GT/GGT)13
4.膽紅素(Bilirubin)13
5.總蛋白(Total protein)14
6.白蛋白(Albumin)14
7.甲型胎兒蛋白(alpha-fetoprotein,AFP)14
第七節 傾向分數 propensity score 17
1.傾向性分數配對17
2.傾向分數計算17
3.傾向分數的應用18
第三章 研究方法19
第一節 研究設計19
第二節 資料來源20
第三節 變項選取21
第四節 研究步驟23
1.參與者篩選23
2.參與者分組24
3.評估罹癌機率24
4.肝臟檢驗數值的篩選與數值比較24
5.參與者傾向性分數配對26
6.數值比較26
第五節 資料處理27
1.描述性統計分析27
2.勝算比的計算27
3.傾向性分數配對28
第六節 研究變項操作型定義28
第四章 研究結果30
第一節 基本健康狀況描述30
第二節 不同服藥天數組與未服藥組罹患肝癌比率 32
第三節 服藥組與未服藥組未配對前勝算比34
第四節 參與者未配對前肝功能檢驗數值比較35
第五節 參與者配對後分析35
第六節 配對後服藥組與未服藥組勝算比37
第七節 配對後參與者肝功能檢驗數值比較39
第五章 討論40
第一節 肝癌發生率40
第二節 阿斯匹靈與肝癌風險相關性40
第三節 檢驗數值與肝癌風險相關性43
第六章 結論與建議46
第一節 結論46
第二節 研究限制47
第三節 未來發展48
參考文獻 49
附錄 53
附錄一 臺北醫學大學暨附屬醫院聯合人體研究倫理委員會研究計畫審查證明53
附錄二 雙和醫院參與者未配對前肝臟功能數值表 55
附錄三 萬芳醫院參與者未配對前肝臟數值表56
附錄四 雙和醫院參與者配對後肝臟功能數值表57
附錄五 萬芳醫院參與者配對後肝臟功能數值表58
附錄六 縮寫表59

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