請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/19872
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 何?芳 | |
dc.contributor.author | Yi-Ting Tsou | en |
dc.contributor.author | 鄒依庭 | zh_TW |
dc.date.accessioned | 2021-06-08T02:24:20Z | - |
dc.date.copyright | 2015-09-24 | |
dc.date.issued | 2015 | |
dc.date.submitted | 2015-08-18 | |
dc.identifier.citation | 參考文獻(References) 1. Bjornsson E, Olsson R. Suspected drug-induced liver fatalities reported to the WHO database. Dig Liver Dis 2006;38:33-8. 2. Hussain N, Bhattacharyya A, Prueksaritanond S. Amiodarone-induced cirrhosis of liver: what predicts mortality? ISRN Cardiology 2013;2013:14. 3. Goldschlager N, Epstein AE, Naccarelli GV, et al. A practical guide for clinicians who treat patients with amiodarone: 2007. Heart Rhythm 2007;4:1250-9. 4. Kaplowitz N. Rules and laws of drug hepatotoxicity. Pharmacoepidemiol Drug Saf 2006;15:231-3. 5. Spence MM, Polzin JK, Weisberger CL, Martin JP, Rho JP, Willick GH. Evaluation of a pharmacist-managed amiodarone monitoring program. J Manag Care Pharm 2011;17:513-22. 6. Sanoski CA, Schoen MD, Gonzalez RC, Avitall B, Bauman JL. Rationale, development, and clinical outcomes of a multidisciplinary amiodarone clinic. Pharmacotherapy 1998;18:146s-51s. 7. Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002;137:947-54. 8. Bonkovsky HL, Jones DP, Russo MW, Shedlofsky SI. Drug-induced liver injury. In: Sanyal TDBPMJ, ed. Zakim and Boyer's hepatology 6th ed. Saint Louis: W.B. Saunders; 2012:417-61. 9. Navarro VJ, Senior JR. Drug-related hepatotoxicity. N Engl J Med 2006;354:731-9. 10. Navarro, V. Hepatic adverse event nomenclature document [on line]. (Accessed July 1, 2015, at http://www.fda.gov/Drugs/ScienceResearch/ResearchAreas/ucm080336.htm.) 11. US Food and Drug Administration. Drug-induced livery injury: premarketing clinical evaluation. In: Guidance for industry, 2009. (Accessed March 8, 2015, at http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM174090.pdf.) 12. Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, Fontana RJ. ACG clinical guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol 2014;109:950-66. 13. Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott Williams Wilkins; 1999. 14. Björnsson E, Olsson R. Outcome and prognostic markers in severe drug-induced liver disease. Hepatology 2005;42:481-9. 15. Andrade RJ, Lucena MI, Fernández MC, et al. Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period. Gastroenterology 2005;129:512-21. 16. Kaplowitz N. Drug-induced liver injury: introduction and overview. In: DeLeve NKD, ed. Drug-induced liver disease 3rd ed. Boston: Academic Press; 2013:3-14. 17. Chalasani N, Fontana RJ, Bonkovsky HL, et al. Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology 2008;135:1924-34, 34.e1-4. 18. Sgro C, Clinard F, Ouazir K, et al. Incidence of drug-induced hepatic injuries: a French population-based study. Hepatology 2002;36:451-5. 19. Lucena MI, Andrade RJ, Kaplowitz N, et al. Phenotypic characterization of idiosyncratic drug-induced liver injury: the influence of age and sex. Hepatology 2009;49:2001-9. 20. Fontana RJ, Hayashi PH, Gu J, et al. Idiosyncratic drug-induced liver injury is associated with substantial morbidity and mortality within 6 months from onset. Gastroenterology 2014;147:96-108.e4. 21. Fountain FF, Tolley E, Chrisman CR, Self TH. Isoniazid hepatotoxicity associated with treatment of latent tuberculosis infection: a 7-year evaluation from a public health tuberculosis clinic. Chest 2005;128:116-23. 22. Chalasani N, Bjornsson E. Risk factors for idiosyncratic drug-induced liver injury. Gastroenterology 2010;138:2246-59. 23. Pande JN, Singh SP, Khilnani GC, Khilnani S, Tandon RK. Risk factors for hepatotoxicity from antituberculosis drugs: a case-control study. Thorax 1996;51:132-6. 24. Whiting-O'Keefe QE, Fye KH, Sack KD. Methotrexate and histologic hepatic abnormalities: a meta-analysis. Am J Med 1991;90:711-6. 25. Russo MW, Watkins PB. Are patients with elevated liver tests at increased risk of drug-induced liver injury? Gastroenterology 2004;126:1477-80. 26. Vuppalanchi R, Teal E, Chalasani N. Patients with elevated baseline liver enzymes do not have higher frequency of hepatotoxicity from lovastatin than those with normal baseline liver enzymes. Am J Med Sci 2005;329:62-5. 27. Chalasani N, Bonkovsky HL, Fontana R, et al. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN prospective study. Gastroenterology 2015;148:1340-52.e7. 28. Wong WM, Wu PC, Yuen MF, et al. Antituberculosis drug-related liver dysfunction in chronic hepatitis B infection. Hepatology 2000;31:201-6. 29. Wu JC, Lee SD, Yeh PF, et al. Isoniazid-rifampin-induced hepatitis in hepatitis B carriers. Gastroenterology 1990;98:502-4. 30. Rodriguez LAG, Ruigómez A, Jick H. A review of epidemiologic research on drug-induced acute liver injury using the general practice research data base in the United Kingdom. Pharmacotherapy 1997;17:721-8. 31. AHFS Drug Information. 56th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2015. 32. Sanoski CA, Bauman JL. The Arrhythmias. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy : a pathophysiologic approach. 9th ed. New York: McGraw-Hill Education; 2014:207-44. 33. Micromedex® 2.0, (electronic version). Truven Health Analytics, Greenwood Village, Colorado, USA. 34. Tatro DS. Drug interaction facts 2012: The Authority on Drug Interactions. Philadelphia: Lippincott Williams Wilkins; 2011. 35. Hilleman D, Miller MA, Parker R, Doering P, Pieper JA. Optimal management of amiodarone therapy: efficacy and side effects. Pharmacotherapy 1998;18:138s-45s. 36. Vorperian VR, Havighurst TC, Miller S, January CT. Adverse effects of low dose amiodarone: a meta-analysis. J Am Coll Cardiol 1997;30:791-8. 37. Jackevicius CA, Tom A, Essebag V, et al. Population-level incidence and risk factors for pulmonary toxicity associated with amiodarone. Am J Cardiol 2011;108:705-10. 38. Eskes SA, Wiersinga WM. Amiodarone and thyroid. Best Practice Research Clinical Endocrinology Metabolism 2009;23:735-51. 39. Huang CJ, Chen PJ, Chang JW, et al. Amiodarone-induced thyroid dysfunction in Taiwan: a retrospective cohort study. Int J Clin Pharm 2014;36:405-11. 40. Pollak PT, Shafer SL. Use of population modeling to define rational monitoring of amiodarone hepatic effects. Clin Pharmacol Ther 2004;75:342-51. 41. Stelfox HT, Ahmed SB, Fiskio J, Bates DW. Monitoring amiodarone's toxicities: recommendations, evidence, and clinical practice[ast]. Clin Pharmacol Ther 2004;75:110-22. 42. Bickford CL, Spencer AP. Adherence to the NASPE guideline for amiodarone monitoring at a medical university. J Manag Care Pharm 2006;12:254-9. 43. Johnson SG, Canty K, Billups S, Schimmer J. Adherence to amiodarone monitoring recommendations before and after implementation of a centralized pharmacy service: a cohort study. J Pharm Pract 2010;23:536-9. 44. Raebel MA, Carroll NM, Simon SR, et al. Liver and thyroid monitoring in ambulatory patients prescribed amiodarone in 10 HMOs. J Manag Care Pharm 2006;12:656-64. 45. Snider M, Kalbfleisch S, Carnes CA. Initial experience with antiarrhythmic medication monitoring by clinical pharmacists in an outpatient setting: a retrospective review. Clin Ther 2009;31:1209-18. 46. Raebel MA, Lyons EE, Chester EA, et al. Improving laboratory monitoring at initiation of drug therapy in ambulatory care: a randomized trial. Arch Intern Med 2005;165:2395-401. 47. Raebel MA, Lyons EE, Andrade SE, et al. Laboratory monitoring of drugs at initiation of therapy in ambulatory care. J Gen Intern Med 2005;20:1120-6. 48. Burgess C, Blaikie A, Ingham T, Robinson G, Narasimhan S. Monitoring the use of amiodarone: compliance with guidelines. Intern Med J 2006;36:289-93. 49. Kanel GC. Hepatotoxicity of cardiovascular and antidiabetic medications. In: Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 2nd ed. New York: Informa Healthcare; 2007:593-630. 50. Lewis JH, Ranard RC, Caruso A, et al. Amiodarone hepatotoxicity: prevalence and clinicopathologic correlations among 104 patients. Hepatology 1989;9:679-85. 51. Tisdale JE, Follin SL, Ordelova A, Webb CR. Risk factors for the development of specific noncardiovascular adverse effects associated with amiodarone. J Clin Pharmacol 1995;35:351-6. 52. 衛生福利部中央健康保險署.2001年ICD-9-CM疾病碼一覽表 (Accessed July 8, 2015, at http://www.nhi.gov.tw/webdata/webdata.aspx?menu=18 menu_id=703 webdata_id=1008.) 53. Jinjuvadia K, Kwan W, Fontana RJ. Searching for a needle in a haystack: use of ICD-9-CM codes in drug-induced liver injury. Am J Gastroenterol 2007;102:2437-43. 54. 行政院衛生福利部統計處. 民國103年死因結果摘要表. (Accessed August 10, 2015, at http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312 fod_list_no=5488.) 55. Chen CH, Huang MH, Yang JC, et al. Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults. J Clin Gastroenterol 2006;40:745-52. 56. Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol 2003;98:960-7. 57. Kum LCC, Chan WWL, Hui HHY, et al. Prevalence of amiodarone-related hepatotoxicity in 720 Chinese patients with or without baseline liver dysfunction. Clin Cardiol 2006;29:295-9. 58. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014;64:2246-80. 59. Farkas P, Sampson J, Slitzky B, Altman B. Liver and gastroenterology tests. In: Lee M, ed. Basic skills in interpreting laboratory data. 5th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013:247-82. 60. Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ 2005;172:367-79. 61. Wagner AK, Chan KA, Dashevsky I, et al. FDA drug prescribing warnings: is the black box half empty or half full? Pharmacoepidemiol Drug Saf 2006;15:369-86. 62. Chou HY. A study on amiodarone-related liver injury in intensive care units at a medical center: National Taiwan University; 2014. 63. 陳玉美, 羅美婷, 賴永融, 李建瑩.某醫學中心對使用 Amiodarone 病患執行安全監測之評估. 臺灣臨床藥學雜誌 2011;19:1-10. 64. Lok ASF, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology 2009;50:661-2. 65. Angulo P. Nonalcoholic Fatty Liver Disease. N Engl J Med 2002;346:1221-31. 66. Ruhl CE, Everhart JE. Epidemiology of nonalcoholic fatty liver. Clin Liver Dis 2004;8:501-19, vii. 67. Chatrath H, Vuppalanchi R, Chalasani N. Dyslipidemia in patients with nonalcoholic fatty liver disease. Semin Liver Dis 2012;32:22-9. 68. Yun KE, Shin CY, Yoon YS, Park HS. Elevated alanine aminotransferase levels predict mortality from cardiovascular disease and diabetes in Koreans. Atherosclerosis 2009;205:533-7. 69. Ghouri N, Preiss D, Sattar N. Liver enzymes, nonalcoholic fatty liver disease, and incident cardiovascular disease: a narrative review and clinical perspective of prospective data. Hepatology 2010;52:1156-61. 70. Treeprasertsuk S, Leverage S, Adams LA, Lindor KD, St Sauver J, Angulo P. The Framingham risk score and heart disease in nonalcoholic fatty liver disease. Liver International 2012;32:945-50. 71. 行政院衛生署疾病管制局. 結核病診治指引. 第五版. 2013. 72. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services., 2015. (Accessed July 11, 2015, at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.) 73. Khorashadi S, Hasson NK, Cheung RC. Incidence of statin hepatotoxicity in patients with hepatitis C. Clin Gastroenterol Hepatol 2006;4:902-7. 74. Calderon RM, Cubeddu LX, Goldberg RB, Schiff ER. Statins in the Treatment of Dyslipidemia in the Presence of Elevated Liver Aminotransferase Levels: A Therapeutic Dilemma. Mayo Clin Proc 2010;85:349-56. 75. Ridker PM, Danielson E, Fonseca FAH, et al. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. N Engl J Med 2008;359:2195-207. 76. de Denus S, Spinler SA, Miller K, Peterson AM. Statins and liver toxicity: a meta-analysis. Pharmacotherapy 2004;24:584-91. 77. Pastori D, Polimeni L, Baratta F, Pani A, Del Ben M, Angelico F. The efficacy and safety of statins for the treatment of non-alcoholic fatty liver disease. Dig Liver Dis 2015;47:4-11. 78. US Food and Drug Administration. FDA announces safety changes in labeling for some cholesterol-lowering drugs. (Accessed July 10, 2015, at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm293623.htm.) 79. Lipitor product label. 2009.2012. (Accessed July 10, 2015 at http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory#labelinfo.) 80. Chalasani N, Aljadhey H, Kesterson J, Murray MD, Hall SD. Patients with elevated liver enzymes are not at higher risk for statin hepatotoxicity. Gastroenterology 2004;126:1287-92. 81. Chalasani N, Teal E, Hall SD. Effect of Rosiglitazone on Serum Liver Biochemistries in Diabetic Patients with Normal and Elevated Baseline Liver Enzymes. Am J Gastroenterol 2005;100:1317-21. 82. Ho CM, Lee CH, Wang JY, Lee PH, Lai HS, Hu RH. Nationwide longitudinal analysis of acute liver failure in Taiwan. Medicine (Baltimore) 2014;93:e35. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/19872 | - |
dc.description.abstract | 研究背景 Amiodarone為效用廣且臨床常用之抗心律不整藥物,但可能引起肝、肺、眼、甲狀腺等多種器官系統不良反應,其中,amiodarone相關的肝傷害雖不乏嚴重肝毒性案例報導,卻常被輕忽。關於amiodarone藥物治療之文獻多建議監測各項可能副作用之用藥前檢驗基礎值並於後續定期追蹤,然而,國內鮮少有關於amiodarone安全監測及相關肝傷害(drug-induced liver injury; DILI)風險因子的研究。 研究目的 探討臨床對於新使用及長期使用amiodarone病人之遵照指引建議監測肝臟與甲狀腺相關副作用的比率與amiodarone相關肝傷害之發生情形。 研究材料與方法 本研究採回溯性分析,以某醫學中心2010年8月1日至2012年9月30日之醫療資訊為研究材料,研究對象年齡大於18歲且(1)新使用amiodarone(含口服與注射劑型)之病人,亦即於納入研究前至少六個月期間無amiodarone處方;(2)長期使用amiodarone之病人,即新使用者且amiodarone處方至少持續180天以上。所彙整之資料包括研究對象基本資料、疾病史、肝功能與甲狀腺功能檢驗值以及藥品處方,並以alanine aminotransferase(ALT)上升達3倍正常值上限定義為肝傷害事件。本研究以敘述性統計描述新使用者和長期用藥者的肝功能(ALT)與甲狀腺功能(thyroid-stimulating hormone; TSH)之用藥前基礎值監測以及用藥後180天內之監測情形,並以回歸分析探討遵循肝功能監測指引之影響因子。 研究結果 研究期間amiodarone處方總計70,512筆(8,984人),其中符合定義之新使用者共5,487位,符合長期用藥定義者計309人(5.6%)。新使用者之ALT、TSH用藥前基礎值監測率分別為82.1%、29.0%;長期用藥群ALT、TSH之基礎值監測率76.7%、24.3%,另兩群體同時監測ALT及TSH基礎值分別為 26.4%、21.0%;長期用藥群開始用藥六個月期間監測ALT、TSH比率分別為69.6%、31.7%,同時監測ALT及TSH者佔23.6%。 長期用藥群中遵循指引建議在用藥前及用藥後六個月期間監測ALT 共180位(58.3%),影響遵循監測建議的因子為具肝病史(odds ratio [OR], 6.08; 95%CI, 1.84-24.64)、高脂血症(OR, 2.86; 95%CI, 1.31-6.48)及共病症數目較多(OR, 95%CI; 1.06-1.19)、用藥180天期間併用可能引致肝傷害的藥物(OR, 2.14; 95%CI, 1.16-4.21)、住院次數較多(OR, 1.45; 95%CI, 1.02-2.11)、首次開方單位為加護病房者(OR, 5.78; 95%CI, 1.67-27.37)與首次開方單位為門診(OR, 0.20; 95%CI, 0.1-0.38)。 長期用藥群中有17人(6.3%)發生肝傷害事件,與先前研究之比率相近;發生肝傷害者(n=17)與未發生者(n=292)兩組之病人基本特性無明顯差異。在新使用amiodarone且具 ALT 基礎值監測之病人中(n=3721),發生肝傷害事件計564人(15.2%),而其中具肝病史者(n=397)與無肝病史者(n=3324)兩組之肝傷害發生比率無顯著差異。 結論 總體來說,amiodarone使用者肝功能監測率(含基礎值、用藥期間監測)與國外研究相似,用藥期間監測率稍低於基礎值監測率,而有關甲狀腺功能之監測比例卻不盡理想。本研究提供臨床醫療人員了解目前amiodarone使用者肝功能與甲狀腺監測情形以及amiodarone相關肝傷害之比率,應有助於評估amiodarone不良反應相關性與及早偵測藥物不良反應的發生,期增進藥物治療的安全性與有效性。 | zh_TW |
dc.description.abstract | Background Amiodarone is an effective and widely used anti-arrhythmic agent; however, it is associated with multi-organ adverse effects. Hepatic adverse effects of amiodarone are often neglected in clinical practice even though severe ones have been reported. Consensus guidelines often recommend that liver and thyroid function tests should be conducted before amiodarone therapy and semiannually thereafter. Little is known about the guideline concordance of laboratory monitoring and risk factors associated with amiodarone hepatotoxicity in Taiwan. Objective The study aimed to determine the proportion of and predictors for patients receiving liver and thyroid monitoring at baseline and within 180 days of initiation of chronic amiodarone therapy and the incidence of amiodarone-associated liver injury. Materials and Methods This is a retrospective study using hospital electronic medical records to identify new amiodarone users (age >18 years) who had a 180-day washout period before the index date at a medical center from August, 2010 to September 30, 2012. Patients with continuous amiodarone dispensing records ≥ 180 days were defined as chronic users. Data on patient demographics, comorbidity, liver and thyroid function tests, and concomitant medications were collected. The monitoring rate at baseline and within 6 months of amiodarone initiation, and the incidence of amiodarone-associated liver injury, defined as the first occurrence of alanine aminotransferase (ALT) higher than 3 times of upper limit of normal after amiodarone initiation, were determined. Logistic regressions were also used to explore factors associated with the guideline concordance of laboratory monitoring for assessing amiodarone hepatotoxicity. Results A total of 5,487 new amiodarone users were identified from 70,512 prescriptions during the study period. Eligible patients to be included for further analyses were 309 (5.6%) and 4,235 (77.2%) for chronic amiodarone users and liver injury cohorts (with baseline and follow-up ALT levels). Among the new users, baseline monitoring rates of ALT, TSH, or both were 82.1%, 29.0%, and 26.4%, respectively. As for the cohort of chronic users, the monitoring rates of ALT, TSH, or both at baseline were 76.7%, 24.3%, and 21.0%; and those for within first 6 months of amiodarone therapy were 69.6%, 31.7%, and 23.6%. There were 180 (58.3%) patients with ALT monitored at baseline and within 180 days of amiodarone initiation. Predictors associated with concordance of ALT monitoring included comorbid liver diseases (odds ratio [OR] 6.08, 95%CI 1.84-24.64), hyperlipidemia (OR 2.86, 95%CI 1.31-6.48), number of comorbidities (OR 1.12, 95%CI 1.06-1.19), concomitant drugs of liver injury potential (OR 2.14, 95%CI 1.16-4.21), number of hospitalization (OR 1.45, 95%CI 1.02-2.11), amiodarone initiated at ICU settings (OR 5.78, 95%CI 1.67-27.37); yet, amiodarone initiated at outpatient settings (OR, 0.20; 95%CI, 0.1-0.38) was negatively associated. Liver injury episodes occurred in 17 (6.3%) and 564 (15.2%) patients for cohorts of chronic users (n=309) and new users with baseline ALT (n=3721), respectively. Conclusions In general, monitoring rates for liver functions at baseline, within 180 days of amiodarone initiation, and the incidence of liver injury in the chronic users were compatible with earlier studies, but monitoring rates for thyroid functions were less than ideal. Even though predictors for monitoring potential liver toxicity were identified, risk factors for amiodarone-associated liver injury await further delineation. | en |
dc.description.provenance | Made available in DSpace on 2021-06-08T02:24:20Z (GMT). No. of bitstreams: 1 ntu-104-R02451003-1.pdf: 1785321 bytes, checksum: e35463041501ce7ef62ab63567c47958 (MD5) Previous issue date: 2015 | en |
dc.description.tableofcontents | 口試委員會審定書 i 誌謝 ii 摘要 iii Abstract v 目錄 (Table of Contents) vii 圖目錄 (List of Figures) ix 表目錄 (List of Tables) x 縮寫名詞 (Abbreviations) xii 第 1 章 前言 1 第 2 章 文獻回顧 2 2.1 藥物引致肝傷害(Drug-induced Liver Injury)相關文獻回顧 2 2.1.1 藥物引致肝傷害定義 2 2.1.2 藥物引致肝傷害之發生率、可疑藥品與風險因子 3 2.2 Amiodarone藥物綜述 5 2.2.1 適應症與建議治療劑量 6 2.2.2 藥品動態學特性 6 2.2.3 Amiodarone相關不良反應 7 2.2.4 Amiodarone相關不良反應監測之指引 11 2.2.5 Amiodarone安全性監測情形與不良反應之評估 12 2.3 Amiodarone與藥物引致肝傷害之關係 15 第 3 章 研究目的 17 第 4 章 研究材料與方法 18 4.1 研究材料 18 4.2 研究設計 19 4.2.1 研究對象 19 4.2.2 研究架構 19 4.2.3 研究名詞定義與資料處理 21 4.2.4 肝傷害事件與檢驗值定義 25 4.3 統計分析 27 4.3.1 描述性統計分析與組間比較 27 4.3.2 回歸分析 27 4.3.3 統計軟體 28 第 5 章 研究結果 30 5.1 研究對象及amiodarone首次處方情形 30 5.2 Amiodarone相關不良反應之監測情形 34 5.2.1 遵循安全監測建議之相關因子分析 42 5.3 Amiodarone相關之肝傷害 43 5.3.1 長期用藥群之肝傷害 43 5.3.2 肝傷害分析群之肝傷害分析 49 第 6 章 討論 55 6.1 長期用藥群之特性與藥品使用情況 55 6.2 Amiodarone使用者監測情形探討 56 6.2.1 基礎值監測與用藥後監測情形與過去文獻比較 56 6.2.2 遵循監測指引之相關因子探討 59 6.3 Amiodarone相關之肝傷害發生與文獻比較 61 6.4 研究特色與限制 61 6.4.1 Amiodarone相關不良反應之監測情形 61 6.4.2 Amiodarone相關肝傷害分析之研究限制 62 第 7 章 結論 64 參考文獻(References) 65 | |
dc.language.iso | zh-TW | |
dc.title | 某醫學中心Amiodarone相關肝傷害監測之探討 | zh_TW |
dc.title | Guideline Concordance of Monitoring Amiodarone-associated Liver Injury at a Medical Center | en |
dc.type | Thesis | |
dc.date.schoolyear | 103-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 陳瓊雪,于明暉,周迺寬,朱蓁蓁 | |
dc.subject.keyword | Amiodarone,肝功能監測,台灣,藥物引致肝傷害, | zh_TW |
dc.subject.keyword | amiodarone,guideline concordance,drug-induced liver injury,Taiwan., | en |
dc.relation.page | 71 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2015-08-18 | |
dc.contributor.author-college | 藥學專業學院 | zh_TW |
dc.contributor.author-dept | 臨床藥學研究所 | zh_TW |
顯示於系所單位: | 臨床藥學研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-104-1.pdf 目前未授權公開取用 | 1.74 MB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。