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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 陳保中 | |
| dc.contributor.author | Mei-Jyh Chen | en |
| dc.contributor.author | 陳美志 | zh_TW |
| dc.date.accessioned | 2021-06-08T00:05:24Z | - |
| dc.date.copyright | 2013-09-24 | |
| dc.date.issued | 2013 | |
| dc.date.submitted | 2013-08-13 | |
| dc.identifier.citation | 1. Raimondi S, Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol 2009;6:699-708.
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Statins inhibit Akt/PKB signaling via P2X7 receptor in pancreatic cancer cells. Biochem Pharmacol 2009;78:1115-26. 9. Khurana V, Sheth A, Caldito G, et al. Statins reduce the risk of pancreatic cancer in humans: a case-control study of half a million veterans. Pancreas 2007;34:260-5. 10. Bonovas S, Filioussi K, Sitaras NM. Statins are not associated with a reduced risk of pancreatic cancer at the population level, when taken at low doses for managing hypercholesterolemia: evidence from a meta-analysis of 12 studies. Am J Gastroenterol 2008;103:2646-51. 11. Cui X, Xie Y, Chen M, et al. Statin use and risk of pancreatic cancer: a meta-analysis. Cancer Causes Control 2012;23:1099-111. 12. Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24:683-9. 13. Kearney PM, Blackwell L, Collins R, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008;371:117-25. 14. Kreisberg RA. Diabetic dyslipidemia. Am J Cardiol 1998;82:67U-73U; discussion 85U-86U. 15. Shepherd J, Barter P, Carmena R, et al. Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes: the Treating to New Targets (TNT) study. Diabetes Care 2006;29:1220-6. 16. Ryden L, Standl E, Bartnik M, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 2007;28:88-136. 17. Chiang TL. Taiwan's 1995 health care reform. Health Policy 1997;39:225-39. 18. Bureau of National Health Insurance. Available from http://www.nhi.gov.tw/. 19. WHO Collaborating Centre for Drug Statistics Methodology. Definition and general considerations of DDD from http://www.whocc.no/ddd/definition_and_general_considera/. 20. Bowker SL, Majumdar SR, Veugelers P, et al. Increased cancer-related mortality for patients with type 2 diabetes who use sulfonylureas or insulin. Diabetes Care 2006;29:254-8. 21. Chiu HF, Chang CC, Ho SC, et al. Statin use and the risk of pancreatic cancer: a population-based case-control study. Pancreas 2011;40:669-72. 22. Pelaez-Luna M, Takahashi N, Fletcher JG, et al. Resectability of presymptomatic pancreatic cancer and its relationship to onset of diabetes: a retrospective review of CT scans and fasting glucose values prior to diagnosis. Am J Gastroenterol 2007;102:2157-63. 23. Vigneri P, Frasca F, Sciacca L, et al. Diabetes and cancer. Endocr Relat Cancer 2009;16:1103-23. 24. Yang X, Zhao H, Sui Y, et al. Additive interaction between the renin-angiotensin system and lipid metabolism for cancer in type 2 diabetes. Diabetes 2009;58:1518-25. 25. Yang X, So W, Ko GT, et al. Independent associations between low-density lipoprotein cholesterol and cancer among patients with type 2 diabetes mellitus. CMAJ 2008;179:427-37. 26. Yang X, So WY, Ma RC, et al. Low LDL cholesterol, albuminuria, and statins for the risk of cancer in type 2 diabetes: the Hong Kong diabetes registry. Diabetes Care 2009;32:1826-32. 27. Yang X, Ma RC, So WY, et al. Low triglyceride and nonuse of statins is associated with cancer in type 2 diabetes mellitus: the Hong Kong Diabetes Registry. Cancer 2011;117:862-71. 28. Gallagher EJ, LeRoith D. Minireview: IGF, Insulin, and Cancer. Endocrinology 2011;152:2546-51. 29. Bergmann U, Funatomi H, Yokoyama M, et al. Insulin-like growth factor I overexpression in human pancreatic cancer: evidence for autocrine and paracrine roles. Cancer Res 1995;55:2007-11. 30. Khurana V, Bejjanki HR, Caldito G, et al. Statins reduce the risk of lung cancer in humans: a large case-control study of US veterans. Chest 2007;131:1282-8. 31. El-Serag HB, Johnson ML, Hachem C, et al. Statins are associated with a reduced risk of hepatocellular carcinoma in a large cohort of patients with diabetes. Gastroenterology 2009;136:1601-8. 32. Hachem C, Morgan R, Johnson M, et al. Statins and the risk of colorectal carcinoma: a nested case-control study in veterans with diabetes. Am J Gastroenterol 2009;104:1241-8. 33. Lee J, Lee SH, Hur KY, et al. Statins and the risk of gastric cancer in diabetes patients. BMC Cancer 2012;12:596. | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/17294 | - |
| dc.description.abstract | 研究目的: 本研究的目的在於探討HMG-CoA還原酶抑制劑(Statins)的使用對糖尿病患者的胰臟癌是否有保護作用。
研究方法: 本病例對照研究是分析從1997年至2008年在台灣的全民健康保險研究資料庫（NHIRD）。胰臟癌病例的選擇是根據國際分類疾病第九次臨床修訂版（ICD9.0）。每個案例會隨機從健保資料庫百萬歸人檔中的糖尿病患者，依年齡、性別、糖尿病診斷時間配對作對照組，分析其可能的危險因子。此外，本研究使用累積每日標準劑量（cDDD）計算HMG-CoA還原酶抑制劑(Statins)與其他各項藥物的總量，並以條件式邏輯式迴歸來分析各種危險因子模式與胰臟癌的關聯性。 研究結果: 本研究包括3338名糖尿病患者且為新診斷胰臟癌，同樣選取3338名糖尿病患者且未患有癌症者為對照組。其中高齡，男性，有酒精相關的疾病，慢性腎功能不良，胰臟炎，缺血性心臟病，糖尿病視網膜疾病和糖尿病腎病史與胰臟癌的風險增加有關。而在校正干擾因子後，本研究發現使用中高劑量的HMG-CoA還原酶抑制劑(Statins)有較低的胰臟癌風險 (OR=0.82 in 28-180累積每日標準劑量; OR=0.76 in > 180累積每日標準劑量)。此外，本研究也發現胰臟癌風險也與HMG-CoA還原酶抑制劑(Statins)使用的劑量高低有相關性(P for trend=0.0024)。 研究結論: 糖尿病患者使用>180累積每日標準劑量的HMG-CoA還原酶抑制劑(Statins)有較低的胰臟癌風險。 | zh_TW |
| dc.description.abstract | Objective: The aim of this study was to investigate whether the use of statins was associated with protective effect of pancreatic cancer in diabetic subjects.
Methods: A case-control study was designed to analyze the National Health Insurance Research database (NHIRD) from 1997 to 2008 in Taiwan. The cohort selection of pancreatic cancer cases was based on International Classification of Disease 9th Revision-Clinical Modification (ICD 9.0). Each case was matched with one control based on sex, year of birth and the year of diabetic age. The index date was defined as the date of newly diagnosed pancreatic cancer. Cumulative defined daily dose (cDDD) was used to calculate the total amount of statins use till one year prior to the index date. Conditional logistic regression was conducted to estimate crude and adjusted odds ratio of pancreatic cancer associated with the cDDD of stains. Results: The study included 3,338 diabetic subjects with newly diagnosed pancreatic cancer and 3,338 controls with free of cancer diagnosis. The age, male gender, underlying of alcohol related disease, chronic renal injury, ischemic heart disease, history of pancreatitis, diabetic complications including retinopathy and nephropathy were associated with increased risk of pancreatic cancer in diabetic subjects. The statin use with moderate and high cDDD had significantly decreased risk of pancreatic cancer (OR=0.82 in 28-180 DDD; OR=0.76 in > 180 DDD) after adjusting multiple confounders. Also, there was a significant dose-effect of statin use for risk of pancreatic cancer (P for trend=0.0024). Conclusions: The statin use more than 180 cDDD may be associated with modest protection of pancreatic cancer in diabetic subjects. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-08T00:05:24Z (GMT). No. of bitstreams: 1 ntu-102-R99841023-1.pdf: 1774549 bytes, checksum: 9dc3211f73d4aa2e15c3504821ad8456 (MD5) Previous issue date: 2013 | en |
| dc.description.tableofcontents | 中文摘要 (i)
Abstract (ii) CHAPTER 1. INTRODUCTION 1.1 Pancreatic Cancer p.1 1.2 Diabetes Mellitus and Pancreatic Cancer p.1 1.3 Stains and Prevention of Cancer p.1 1.4 Stains and Prevention of Pancreatic Cancer p.2 1.5 Background of Study Design p.2 CHAPTER 2. METHODS AND MATERIALS 2.1 Study Population and Data Source p.4 2.2 Selection of Case and Control Groups p.5 2.3 Exposure of Medication p.5 2.4 Adjustment of Potential Confounders p.6 2.5 Statistical Analysis p.7 CHAPTER 3. RESULTS 3.1 The Selection of Case and Control Population p.9 3.2 Characteristics of Study Population p.9 3.3 Use of Medication and Pancreatic Cancer risk p.10 3.4 Model Selection and Advanced Analysis p.11 3.5 Statins Use and Pancreatic Cancer in Different Models p.12 CHAPTER 4. DISCUSSION 4.1 Main Findings p.13 4.2 Comparison with Previous Studies p.13 4.3 Postulated Mechanism p.15 4.4 Strengths and Limitations p.16 4.5 Conclusion p.17 REFERENCE p.18 List of Figure Figure 1. Flowchart of the study population p.23 List of Tables Table 1. Characteristics in diabetic subjects with pancreatic cancer and comparison cohorts p.24 Table 2. Use of medication in diabetic subjects with pancreatic cancer and comparison cohorts p.25 Table 3. Crude and adjusted odd ratios for pancreatic cancer associated with the use of medication in pancreatic cancer and comparison cohorts p.27 Table 4. Adjusted odd ratios for pancreatic cancer associated with the use of statins in pancreatic cancer and comparison cohorts after model selection p.28 Table 5. Adjusted odds ratios of statins use for pancreatic cancer after adding potentially confounding drugs and characteristics p.29 | |
| dc.language.iso | en | |
| dc.title | 糖尿病患者使用HMG-CoA還原酶抑制劑和胰臟癌風險之相關性研究 | zh_TW |
| dc.title | Statins and the Risk of Pancreatic Cancer in Diabetic Subjects – A Nationwide Population Study | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 101-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.coadvisor | 吳明賢 | |
| dc.contributor.oralexamcommittee | 王秀伯,李宜家 | |
| dc.subject.keyword | 糖尿病,胰臟癌,HMG-CoA還原?抑制劑,健保資料庫,化學預防, | zh_TW |
| dc.subject.keyword | Diabetes mellitus,Pancreatic cancer,Statins,National Health Insurance Research database (NHIRD),Chemoprevention, | en |
| dc.relation.page | 29 | |
| dc.rights.note | 未授權 | |
| dc.date.accepted | 2013-08-14 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 職業醫學與工業衛生研究所 | zh_TW |
| 顯示於系所單位： | 職業醫學與工業衛生研究所 | |
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