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標題: | 乾癬治療藥品對心血管疾病風險與結果評估 Risk and Outcome Evaluation of Systemic Psoriasis Therapy on Cardiovascular Disease |
作者: | Meng-Sui Lee 李孟穗 |
指導教授: | 賴美淑 |
關鍵字: | 糖尿病,高血壓,心血管疾病,系統性的乾癬治療藥物,慢性發炎反應, diabetes mellitus,hypertension,cardiovascular disease,systemic anti-psoriatic therapy,chronic inflammation, |
出版年 : | 2016 |
學位: | 博士 |
摘要: | 乾癬是一種慢性發炎疾病,有越來越多的證據顯示慢性發炎反應在腹部肥胖、代謝症候群、糖尿病、高血壓及心血管疾病扮演重要角色。目前的研究顯示乾癬病人有較高糖尿病及高血壓的發生率及盛行率,尤其是嚴重型乾癬的病人,但之前的研究並未考量乾癬常用藥物及共病症對乾癬病人發生糖尿病及高血壓的影響。系統性的乾癬治療藥物: 環孢靈素、非類固醇抗發炎藥物及類固醇可能會誘發高血壓; 環孢靈素、類固醇及methotrexate可能會誘發糖尿病。然而methotrexate抗發炎的特性被認為可能可以減少乾癬病人發生心血管疾病的風險,但因為methotrexate會造成hyperhomocysteinemia而引起缺血性心血管疾病,心血管疾病造成乾癬病人重大的疾病負擔及也是乾癬病人主要的死亡原因。因此系統性的乾癬治療藥物對於發生心血管疾病危險因子及結果的影響是很重要的議題。
本研究的目的為利用臺灣健保資料庫估算乾癬病人的糖尿病及高血壓的發生率及發生風險,及系統性的乾癬治療藥物對於病人發生糖尿病、高血壓及心血管疾病的影響。 考量乾癬病人的常見藥物及共病症的影響,乾癬病人有較高發生糖尿病及高血壓的風險。乾癬病人現在使用環孢靈素、非類固醇抗發炎藥物及類固醇相對於未使用有較高的風險發生高血壓; 現在使用類固醇及methotrexate相對於未使用有較高的風險發生糖尿病;使用methotrexate相對於使用retinoid發生心血管疾病的風險較低。 總結來看,乾癬病人有較高的風險發生糖尿病及高血壓的風險,雖然系統性的乾癬治療藥物有抗發炎的效果,但是各個藥物對心血管疾病的危險因子及結果影響不同,因此臨床醫師使用這些藥物時需審慎評估早期發現心血管疾病危險因子之發生。 Psoriasis is a common chronic inflammatory skin disease. There is a growing body of evidence to suggest that chronic silent inflammation is a key feature in abdominal obesity, metabolic syndrome, diabetes mellitus (DM), hypertension, and cardiovascular disease (CVD). Psoriasis is associated with an increased prevalence and incidence of DM and hypertension. The association of psoriasis with DM or hypertension may be strongest among patients with severe psoriasis. However, most of these studies did not completely adjust for other covariates that may predispose to DM and hypertension. Systemic anti-inflammatory treatments for psoriasis, such as cyclosporine, non-steroidal anti-inflammatory drugs, and systemic corticosteroids, may induce hypertension. Cyclosporine, systemic corticosteroids, and methotrexate can potentially increase DM progression. The anti-inflammatory properties of methotrexate have been hypothesized to be beneficial in reducing CVD risk in patients with psoriasis and/or psoriatic arthritis (PsA). However, methotrexate therapy may promote hyperhomocysteinemia and thereby increase the risk of ischemic CVD. The high prevalence and serious health impacts of cardiovascular morbidity and mortality has been recognized in patients with psoriasis and/or PsA; therefore, the risk or benefit of anti-psoriatic systemic therapy on cardiovascular morbidity and mortality is an important issue. This study sought to estimate the incidence and risk of newly diagnosed DM, and hypertension, and the risk or effectiveness of anti-psoriatic systemic therapy on newly diagnosed DM, hypertension, and cardiovascular outcomes in patients with psoriasis and/or PsA using the databases of the National Health Insurance and National Death Registry to create a nationwide cohort with a large population base. After adjusting for comorbidities and concomitant medications, psoriasis was found to be independently associated with an increased risk of DM and hypertension. After adjustment for potential confounders, patients with current use of cyclosporine, nonsteroidal anti-inflammatory drugs, or systemic glucocorticoids showed an increased risk of hypertension as compared to those not exposed to these drugs. The current use of methotrexate, and glucocorticoids were associated with newly diagnosed DM. Furthermore, we found that patients with psoriasis who were receiving methotrexate therapy were less likely to develop cardiovascular events than those receiving retinoid treatments. In summary, the patients with psoriasis and/or PsA had a higher risk of DM and hypertension. Although systemic therapy has been focused on the anti-inflammatory pathogenesis of psoriasis, the effects on CVD risk factors and outcomes depend on the drug itself, and the treatment strategy in patients with psoriasis may have an effect on cardiovascular outcomes. Therefore, CVD risk should be evaluated before starting treatment with any drug. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/19631 |
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顯示於系所單位: | 流行病學與預防醫學研究所 |
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