臺灣博碩士論文加值系統

背景介紹：
此研究將探討糖尿病、不同的糖化血色素程度、和使用statin類藥物與否，和日後發生之腦中風的關聯。
方法：
此研究為一回溯性世代研究，我們由2002年度台灣地區三高調查挑選出5434名符合納入條件的參與者 (380 [7%] 名糖尿病患者)，並定義過去糖尿病及其糖化血色素程度。此外，我們整合台灣全民健康保險研究資料庫及全國死因分析檔，聯結過去病史、用藥、及結果。此研究使用傾向分數1：2配對後的資料做分析，以探討statin藥物在中風的關聯。
結果：
在中位數為9.7年的長期追蹤下，糖尿病患者在中風的平均發生率為每1000人年12例，而非糖尿病患者則為每1000人年2.6例 (P<0.001)。在調整所有因子後，糖尿病患者比沒有糖尿病者仍有較高的中風風險 (調整後 HR：1.56, 95% CI：1.01-2.40)。我們發現每增加1%的糖化血色素，在腦中風之風險有顯著的正向關聯 (調整後 HR: 1.21, 95% CI：1.09-1.34)。當糖化血色素大於5.5%為中風風險的切點。此研究顯示使用statin類藥物治療和中風無顯著的相關。
結論：
研究顯示在台灣地區，經長期的觀察，糖尿病會增加中風的風險，而糖化血色素的程度越高，則發生中風的風險也越大。

Introduction：
This study aimed to explore the relationships between the level of glycated hemoglobin (HbA1c) in diabetes mellitus (DM) patients and statin therapy on future risk of stroke.
Methods：
Based on a retrospective cohort, a total of 5434 participants (380 [7%] with Diabetes mellitus [DM]) was selected from Taiwan''s Triple High Survey, 2002, DM and HbA1c were confirmed by the survey. Underlying diseases, medication uses, and outcomes of stroke were traced and followed by Taiwan’s National Health Insurance Research Database and National Death Registry. This study employed the propensity-score 1:2 matching to investigate the relationship between statin therapy and stroke risk.
Results：
After a median follow-up of 9.7 years, DM participants had a higher incidence of new stroke compared with non-DM participants (12 versus 2.6 cases per 1000 person-years, P<0.001). After adjustment for multivariables, DM participants were at a higher risk of all-type stroke (adjusted hazard ratio [HR]：1.56, 95% confidence interval [CI]：1.01-2.40). A positive association of stroke risk was demonstrated with an 1% increment of HbA1c (HR: 1.21, 95% CI：1.09-1.34). The cut-off value for HbA1c on stroke risks was 5.5%. The risk of stroke was not correlated with the statin therapy.
Conclusions：
In diabetic patients, inadequate glycemic control with higher HbA1c level was associated with higher risk of stroke during a long-term follow-up in Taiwan.

Contents
Acknowledgements......P1
中文摘要......P2
English abstract......P3
Abbreviations......P4
Contents......P6
實習單位簡介......P10
(一) 實習單位......P10
1. 台北榮民總醫院 - 心臟內科 - 心律不整小組......P10
2. 衛生署福利部健康加值應用協作中心 (實際資料分析地點......P10
(二) 單位介紹......P10
專科簡介......P10
主要研究策略與成果......P10
健康資料加值應用協作中心建置目標......P11
(三) 機構與實習目標的相關性......P12
(四) 實習單位提供資源與限制......P12
(五) 實習工作與內容......P13
Chapter 1、Background......P15
1.1 Importance of stroke in public health......P15
1.2 Risk of stroke with diabetes mellitus (DM)......P15
1.3 Risk of stroke with glycemic control in terms of HbA1c......P16
1.4 Effects of statin therapy on stroke risk in diabetic patients......P18
1.5 Research gap......P19
Chapter 2、Study hypotheses and aims......P20
Chapter 3、Methods......P21
3.1 Study design and participants......P21
3.2 Databases......P21
3.2.1 National Health Interview Survey, 2001......P21
3.2.2 Taiwan’s Hypertensive, Hyperglycemia, Hyperlipidemia Survey, 2002......P22
3.2.3 Taiwan’s National Health Insurance Research Database ......P23
3.3 The methodology of examination for biochemical measures......P23
3.4 Ascertainment of underlying diseases and medications ......P24
3.5 End points......P26
3.6 Statistical methods......P26
3.6.1 Descriptive analyses......P26
3.6.2 Technique of propensity-score matching......P27
3.6.3 Analytic analyses......P27
3.7 Sample size and statistical power......P28
Chapter 4、Results......P29
4.1 Baseline characteristics of this study......P29
4.2 DM as a risk on stroke and all-cause death......P30
4.3 Effects of HbA1c on the risk of stroke and all-cause death......P31
4.4 The effectiveness of statins for prevention of stroke and all-cause death......P33
4.5 Other important factors on the risk of outcomes beyond DM and HbA1c......P34
Chapter 5、Discussions......P35
5.1 Main findings......P35
5.2 Comparisons with previous studies......P35
5.3 Possible mechanisms and clinical implications......P38
5.4 Strengths and limitations......P38
5.5 Conclusions......P40
Chapter 6、References......P41
Chapter 7、Tables......P46
Chapter 8、Figures......P70
Chapter 9、Appendixes......P79

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