請用此 Handle URI 來引用此文件：
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/22605完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 賴美淑(Mei-Shu Lai) | |
| dc.contributor.author | Chia-Lin Liu | en |
| dc.contributor.author | 劉珈麟 | zh_TW |
| dc.date.accessioned | 2021-06-08T04:22:06Z | - |
| dc.date.copyright | 2010-09-09 | |
| dc.date.issued | 2010 | |
| dc.date.submitted | 2010-07-06 | |
| dc.identifier.citation | 1. Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde-Zwirble WT. Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med 2002;165:766-72.
2. Kikuchi R, Watabe N, Konno T, Mishina N, Sekizawa K, Sasaki H. High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am J Respir Crit Care Med 1994;150:251-3. 3. Sekizawa K, Ujiie Y, Itabashi S, Sasaki H, Takishima T. Lack of cough reflex in aspiration pneumonia. Lancet 1990;335:1228-9. 4. Chan WK, Chan TY, Luk WK, Leung VK, Li TH, Critchley JA. A high incidence of cough in Chinese subjects treated with angiotensin converting enzyme inhibitors. Eur J Clin Pharmacol 1993;44:299-300. 5. Woo KS, Norris RM, Nicholls G. Racial difference in incidence of cough with angiotensin-converting enzyme inhibitors (a tale of two cities). Am J Cardiol 1995;75:967-8. 6. Arai T, Yasuda Y, Toshima S, Yoshimi N, Kashiki Y. ACE inhibitors and pneumonia in elderly people. Lancet 1998;352:1937-8. 7. Suzuki Y, Ruiz-Ortega M, Lorenzo O, Ruperez M, Esteban V, Egido J. Inflammation and angiotensin II. Int J Biochem Cell Biol 2003;35:881-900. 8. He X, Han B, Mura M, et al. Angiotensin-converting enzyme inhibitor captopril prevents oleic acid-induced severe acute lung injury in rats. Shock 2007;28:106-11. 9. Arndt PG, Young SK, Poch KR, et al. Systemic inhibition of the angiotensin-converting enzyme limits lipopolysaccharide-induced lung neutrophil recruitment through both bradykinin and angiotensin II-regulated pathways. J Immunol 2006;177:7233-41. 10. Raiden S, Nahmod K, Nahmod V, et al. Nonpeptide antagonists of AT1 receptor for angiotensin II delay the onset of acute respiratory distress syndrome. J Pharmacol Exp Ther 2002;303:45-51. 11. Sekizawa K, Matsui T, Nakagawa T, Nakayama K, Sasaki H. ACE inhibitors and pneumonia. Lancet 1998;352:1069. 12. Okaishi K, Morimoto S, Fukuo K, et al. Reduction of risk of pneumonia associated with use of angiotensin I converting enzyme inhibitors in elderly inpatients. Am J Hypertens 1999;12:778-83. 13. Arai T, Sekizawa K, Ohrui T, et al. ACE inhibitors and protection against pneumonia in elderly patients with stroke. Neurology 2005;64:573-4. 14. Harada J, Sekizawa K. Angiotensin-converting enzyme inhibitors and pneumonia in elderly patients with intracerebral hemorrhage. J Am Geriatr Soc 2006;54:175-6. 15. Teramoto S, Ouchi Y. ACE inhibitors and prevention of aspiration pneumonia in elderly hypertensives. Lancet 1999;353:843. 16. Arai T, Yasuda Y, Takaya T, et al. ACE inhibitors and reduction of the risk of pneumonia in elderly people. Am J Hypertens 2000;13:1050-1. 17. Arai T, Yasuda Y, Takaya T, et al. Angiotensin-converting enzyme inhibitors, angiotensin-II receptor antagonists, and pneumonia in elderly hypertensive patients with stroke. Chest 2001;119:660-1. 18. Ogihara T, Kikuchi K, Matsuoka H, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009). Hypertens Res 2009;32:3-107. 19. Ohkubo T, Chapman N, Neal B, Woodward M, Omae T, Chalmers J. Effects of an angiotensin-converting enzyme inhibitor-based regimen on pneumonia risk. Am J Respir Crit Care Med 2004;169:1041-5. 20. Etminan M, Zhang B, Fitzgerald M, Brophy JM. Do angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers decrease the risk of hospitalization secondary to community-acquired pneumonia? A nested case-control study. Pharmacotherapy 2006;26:479-82. 21. van de Garde EM, Souverein PC, van den Bosch JM, Deneer VH, Leufkens HG. Angiotensin-converting enzyme inhibitor use and pneumonia risk in a general population. Eur Respir J 2006;27:1217-22. 22. van de Garde EM, Souverein PC, Hak E, Deneer VH, van den Bosch JM, Leufkens HG. Angiotensin-converting enzyme inhibitor use and protection against pneumonia in patients with diabetes. J Hypertens 2007;25:235-9. 23. Myles PR, Hubbard RB, McKeever TM, Pogson Z, Smith CJ, Gibson JE. Risk of community-acquired pneumonia and the use of statins, ace inhibitors and gastric acid suppressants: a population-based case-control study. Pharmacoepidemiol Drug Saf 2009;18:269-75. 24. Sagnella GA, Rothwell MJ, Onipinla AK, Wicks PD, Cook DG, Cappuccio FP. A population study of ethnic variations in the angiotensin-converting enzyme I/D polymorphism: relationships with gender, hypertension and impaired glucose metabolism. J Hypertens 1999;17:657-64. 25. Takahashi T, Yamaguchi E, Furuya K, Kawakami Y. The ACE gene polymorphism and cough threshold for capsaicin after cilazapril usage. Respir Med 2001;95:130-5. 26. Arai T, Yasuda Y, Takaya T, et al. ACE inhibitors and symptomless dysphagia. Lancet 1998;352:115-6. 27. Arai T, Yasuda Y, Takaya T, et al. Angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and symptomless dysphagia. Chest 2000;117:1819-20. 28. Arai T, Yoshimi N, Fujiwara H, Sekizawa K. Serum substance P concentrations and silent aspiration in elderly patients with stroke. Neurology 2003;61:1625-6. 29. WHO Collaborating Centre for Drug Statics Methodology. http://wwwwhoccno/atcddd/ 2010. 30. Maclure M. The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol 1991;133:144-53. 31. Hallas J, Bjerrum L, Stovring H, Andersen M. Use of a prescribed ephedrine/caffeine combination and the risk of serious cardiovascular events: a registry-based case-crossover study. Am J Epidemiol 2008;168:966-73. 32. Hunter DJ, York M, Chaisson CE, Woods R, Niu J, Zhang Y. Recent diuretic use and the risk of recurrent gout attacks: the online case-crossover gout study. J Rheumatol 2006;33:1341-5. 33. Wang PS, Schneeweiss S, Glynn RJ, Mogun H, Avorn J. Use of the case-crossover design to study prolonged drug exposures and insidious outcomes. Ann Epidemiol 2004;14:296-303. 34. Delaney JA, Suissa S. The case-crossover study design in pharmacoepidemiology. Stat Methods Med Res 2009;18:53-65. 35. 國家衛生研究院. 2005年承保抽樣歸人檔，LHID2005. http://w3nhriorgtw/nhird/date_cohorthtm#1. 36. Aronsky D, Haug PJ, Lagor C, Dean NC. Accuracy of Administrative Data for Identifying Patients With Pneumonia. American Journal of Medical Quality 2005;20:319-28. 37. Hebert C, Delaney JA, Hemmelgarn B, Levesque LE, Suissa S. Benzodiazepines and elderly drivers: a comparison of pharmacoepidemiological study designs. Pharmacoepidemiol Drug Saf 2007;16:845-9. 38. Lachin J. Biostatistical Methods: Assessment of Realtive Risks 2000:192-3. | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/22605 | - |
| dc.description.abstract | 背景：有數篇報告顯示，ACEI類藥物能下降肺炎發生率，這樣的現象在亞洲族群，尤其是中風後病人特別明顯。此外，也有數篇不同族群的分析報告提到ACEI類藥物能下降肺炎發生率。本研究嘗試分析ACEI/ARB類藥物在台灣一般民眾是否也有預防住院肺炎發生的效果。
研究方法：以台灣健保資料庫2005年百萬人抽樣歸人檔，選取1997-2007年間第一次因肺炎住院的病人，以病例交叉研究設計方式分析。肺炎住院日前30天當作病例期，前90-120以及前180-210天當作對照期一、二。藥物暴露資料主要分析ACEI與ARB在各時期的使用情形。其他曾有文獻報告與肺炎發生相關藥物：、Statin、Proton pump inhibitors、H2 blocker以及各時期門診就醫次數當作隨時間改變的干擾因子分析。選取Thiazide作為對照藥物。統計方法使用Conditional logistic regression。我們將所有病人index date提前兩週以及使用不同長度時間窗（14天、60天、90天）作敏感性分析，測試分析結果的穩健程度。 結果：我們的研究族群共有10990位肺炎住院病人。校正隨時間改變危險因子與門診就醫次數後，ACEI/ARB使用與肺炎風險無顯著關連。 (ACEI: 0.99(0.81-1.21), ARB: 0.99(0.74-1.32), Thiazide: 0.85 (0.65-1.12))。ACEI/ARB使用劑量分成0<DDDs<=30，30<DDDs<=60，DDDs<=60三組，與沒有用藥病人相比。藥物劑量與肺炎風險也無顯著關連，勝算比與95%信賴區間依序為：ACEI: 0.94(0.76-1.17), 1.23(0.89-1.72), 0.89(0.5-1.57); ARB: 0.98 (0.73-1.31), 0.98(0.65-1.48), 1.99(0.76-5.26)。將過去一年ACEI/ARB/Thizaide累積用藥天數分成≦90天、90-180天與>180天三個次群體分析。即使校正隨時間改變干擾因子後，依然顯示ACEI/ARB/Thiazide累積用藥天數≦90天者肺炎風險較高、累積用藥90-180天者肺炎勝算比未達統計上顯著程度、而累積用藥天數＞180天者肺炎風險皆較低。勝算比與95%信賴區間依序為： ACEI: 1.95(1.5-2.53), 0.68(0.44-1.06), 0.18(0.11-0.32); ARB: 2.06(1.34-3.25), 0.94(0.54-1.64), 0.24(0.13-0.47); thiazide: 1.34(0.98-1.84), 1.56(0.73-3.35), 0.13(0.06-0.31)。在敏感性分析結果部分，結果大致穩健，沒有太大差異。 結論： ACEI/ARB的使用與否與肺炎風險無顯著關連；ACEI/ARB的使用累積劑量與肺炎風險也無顯著關連；ACEI/ARB使用天數小於90天的病人藥物使用與肺炎風險呈正相關，而ACEI/ARB/Thiazide使用天數超過180天的病人藥物使用與肺炎風險呈負相關。這些藥物使用與肺炎風險相關性仍須後續研究分析。 | zh_TW |
| dc.description.provenance | Made available in DSpace on 2021-06-08T04:22:06Z (GMT). No. of bitstreams: 1 ntu-99-R97846012-1.pdf: 451892 bytes, checksum: 728975a8b46274bb630098edb1039c57 (MD5) Previous issue date: 2010 | en |
| dc.description.tableofcontents | 口試委員審定書 I
致謝 II 中文摘要 1 英文摘要 3 第一章 緒論 5 第二章 文獻探討 6 第一節 血管收縮素轉化脢抑制劑（ACEI）與血管緊縮素II受體拮抗劑（ARB）對肺炎預防的文獻回顧 6 第二節 血管收縮素轉化脢抑制劑（ACEI）與血管緊縮素II受體拮抗劑（ARB）的藥理作用及機轉 15 第三節 藥品的國際分類-ATC-DDD系統 17 第四節 病例交叉設計在藥物流行病學研究採用的優缺點 19 第五節 研究目的 20 第三章 研究材料與方法 21 第一節 研究設計 21 第二節 資料來源 21 第三節 研究對象 26 第四節 資料處理流程 29 第五節 藥物暴露資料 30 第五節 變項定義 34 第六節 統計方法 36 第七節 敏感性分析 37 第四章 研究結果 38 第一節 研究族群描述性分析結果及醫療利用情形 38 第二節 ACEI/ARB使用與肺炎風險之勝算比結果 40 帝三節 ACEI/ARB使用劑量與肺炎風險之勝算比結果 43 第四節 ACEI/ARB使用累積天數與肺炎風險之勝算比結果 46 第六節 敏感性分析 49 第五章 討論 58 第一節 ACEI/ARB與肺炎風險相關性 58 第二節 研究限制 61 第六章 結論與建議 62 第一節 結論 62 第二節 建議 62 參考文獻 63 附表 66 | |
| dc.language.iso | zh-TW | |
| dc.subject | 健保資料庫 | zh_TW |
| dc.subject | 血管收縮素轉化脢抑制劑 | zh_TW |
| dc.subject | 血管緊縮素II受體拮抗劑 | zh_TW |
| dc.subject | 肺炎 | zh_TW |
| dc.subject | 病例交叉研究 | zh_TW |
| dc.subject | National Health Insurance Research Database (NHIRD) | en |
| dc.subject | ACEI | en |
| dc.subject | ARB | en |
| dc.subject | pneumonia | en |
| dc.subject | case crossover | en |
| dc.title | 血管收縮素轉化脢抑制劑（ACEI）/血管緊縮素II受體拮抗劑(ARB)與肺炎風險相關性研究 | zh_TW |
| dc.title | Angiotensin Converting Enzyme Inhibitor/
Angiotensin II Receptor Blockers and Pneumonia risk | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 98-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 邵文逸(Wen-Yi Shau),張家勳(Chia-Hsuin Chang),劉仁沛(Jen-pei Liu),林敏雄(Min-Shung Lin) | |
| dc.subject.keyword | 血管收縮素轉化脢抑制劑,血管緊縮素II受體拮抗劑,肺炎,病例交叉研究,健保資料庫, | zh_TW |
| dc.subject.keyword | ACEI,ARB,pneumonia,case crossover,National Health Insurance Research Database (NHIRD), | en |
| dc.relation.page | 73 | |
| dc.rights.note | 未授權 | |
| dc.date.accepted | 2010-07-06 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 預防醫學研究所 | zh_TW |
| 顯示於系所單位： | 流行病學與預防醫學研究所 | |
文件中的檔案：
| 檔案 | 大小 | 格式 | |
|---|---|---|---|
| ntu-99-1.pdf 未授權公開取用 | 441.3 kB | 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。