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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 沈麗娟(Li-Jiuan Shen) | |
dc.contributor.author | Jun-Fon Wang | en |
dc.contributor.author | 王竣鋒 | zh_TW |
dc.date.accessioned | 2021-06-15T06:56:14Z | - |
dc.date.available | 2016-03-03 | |
dc.date.copyright | 2011-03-03 | |
dc.date.issued | 2011 | |
dc.date.submitted | 2011-02-09 | |
dc.identifier.citation | 1. National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis: National Osteoporosis Foundation Washington, DC, USA; 2008.
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/48423 | - |
dc.description.abstract | 背景:
雙磷酸鹽類藥物可以有效降低骨質疏鬆症病人發生骨折的風險。2007年一篇臨床研究報告顯示使用雙磷酸鹽類藥物可能與心房纖維顫動發作有關。有許多觀察性研究以資料庫為分析對象來探討此一相關性,但是研究結果不一致。alendornate為廣泛使用的一種口服雙磷酸鹽類藥物,因此有必要去調查臨床上使用alendronate與心房纖維顫動發作之間的關係。 目的: 探討骨質疏鬆症的病人使用雙磷酸鹽類物alendronate與心房纖維顫動之間的相關性。 研究方法: 本研究為一回溯性重疊式病例對照研究,地點位在國立台灣大學醫學院附設醫院-臺灣北部的一間醫學中心。研究對象來源為2002年1月1日至2005年12月31日間,診斷有骨質疏鬆症的門診病人。透過完整病歷回顧,我們一共確認出218位心房纖維顫動發作的病例。接著從剩下的病人裡隨機配對出218位無心房纖維顫動的對照病人,配對條件為年紀(一年之內)、性別、降血壓藥物使用與index date(一年之內)。詳細記錄兩組病人alendronate的用藥史,並收集臨床相關資訊例如心血管病史、併用藥物、心臟超音波檢查與血脂數值等等。 研究結果: 病例組有35人(16.1%)、對照組有29人(13.3%)曾經使用alendronate治療骨質疏鬆症。經過控制高血壓、降血壓藥物的使用、甲狀腺亢進、左心房擴大與心衰竭後,結果顯示曾經使用alendronate的病人比起從未用過的病人,心房纖維顫動發病的相對風險為1.89 (95%CI 0.98-3.65)。過去使用alendronate的病人更會顯著提高發病的風險(RR=2.37, 95%CI 1.01-5.42)。心房纖維顫動的發病風險與alendronate累積劑量呈現正相關 (<2.4 gm [中位數] vs ≥2.4gm: RR=1.69 [95%CI 0.68-4.17] 與RR=2.10 [95%CI 0.87-5.07], 趨勢分析 p=0.05)。曾經使用alendronate的病人與持續性心房纖維顫動發病的相關性高於間歇性及暫時性心房纖維顫動 (持續性心房纖維顫動:RR=2.73 [95%CI 0.43-17.44]; 間歇性心房纖維顫動:RR=2.06 [95%CI 0.28-5.95]與暫時性心房纖維顫動:RR=1.28 [95%CI 0.85-4.99])。 結論: 曾經使用alendronate與心房纖維顫動發作有相關的趨勢,但尚未達到統計顯著水準。然而過去使用alendronate會明顯提高心房纖維顫動發作的風險。這樣的關係可能跟alendronate累積劑量以及越嚴重的發病情形有關。 | zh_TW |
dc.description.abstract | Background:
Bisphosphonates are well-known for effectively reducing risk of fracture in osteoporotic patinets. The concern of the use of bisphosphonates associating with atrial fibrillation (AF) has been raised since 2007. However, the results were conflicting from the observational studies, most of them were register-based. For the widespread using of alendronate, the most popular oral bisphosphonate, there is a necessity to investigate the relationship between alendronate and AF in clinical practice setting. Objective: The purpose of this study is to assess the association between AF and use of alendronate among osteoporotic patients. Design: Retrospective, nested case-control study. Setting: National Taiwan University Hospital (NTUH)- a medical center in northern Taiwan. Participants: All patients visited the clinics at NTUH during the period from 2002/1/1 to 2005/12/31 with a diagnosis of osteoporosis. Methods: We identified 218 cases with confirmed incident AF through complete medical record review, and 218 control subjects, selected at a random from the remaining patients and matched on age (within 1 year), sex, use of anti-hypertensive medication, and index date (within 1 year). The detailed history of alendronate was documented. Other related information was also collected such as cardiovascular history, concomitant medications, echocardiogram and lipid profile etc. Results: 35 cases (16.1%) and 29 controls (13.3%) were ever use of alendronate for osteoporosis. The relative risk of ever use of alendronate compared with never-user was 1.89 (95%CI 0.98-3.65) after adjustment for hypertension, anti-hypertensive medication, hyperthyroidism, left atrial dilatation and heart failure. Past users had a higher adjusted relative risk of 2.37 (95%CI 1.01-5.42) compared with never user. There was a trend in AF according to the cumulative grams of alendronate (<2.4 gm [the median] vs ≥2.4gm: RR, 1.69 [95%CI 0.68-4.17] and 2.10 [95%CI 0.87-5.07], respectively, trend analysis p=0.05). The risk of sustained AF associated with alendronate ever use seemed to be higher than the risk of intermittent and transitory AF (sustained AF: RR, 2.73 [95%CI 0.43-17.44]; intermittent AF: 2.06 [95%CI 0.28-5.95]; and transitory AF: 1.28 [95%CI 0.85-4.99]). Conclusion: Ever use of alendronate was associated with an increased risk of incident AF in clinical practice, though it didn’t achieve statistical significance. However, past use of alendronate did significantly increase AF. The association might be dose-dependent and related to more severe events. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T06:56:14Z (GMT). No. of bitstreams: 1 ntu-100-R97451008-1.pdf: 1458319 bytes, checksum: 242ee6c869cd4bef069e2dcf08039ba1 (MD5) Previous issue date: 2011 | en |
dc.description.tableofcontents | 中文摘要 ii
Abstract iii 目錄 v 圖目錄 viii 表目錄 ix 第一章 前言 1 第二章 文獻探討 2 2.1.心房纖維顫動之介紹 2 2.1.1.定義與分類 2 2.1.2.流行病學 3 2.1.3.病理機轉 3 2.1.4.危險因子 4 2.2.骨質疏鬆症之介紹 8 2.2.1.定義 8 2.2.2.流行病學 8 2.2.3.藥物治療 9 2.3.雙磷酸鹽類藥物之介紹 12 2.3.1.化學結構,藥動特性與藥理機轉 12 2.3.2.藥物在臨床上的應用 16 2.3.3.藥物的不良反應 19 2.3.4.服藥的順從性 21 2.4.雙磷酸鹽類藥物與心房纖維顫動不良反應之回顧 22 2.4.1.研究顯示有相關性 22 2.4.2.研究顯示無相關性 25 2.4.3.可能的致病機轉 28 第三章 研究目的 36 3.1.研究目的 36 3.1.研究的重要性 36 第四章 研究方法 37 4.1.研究設計 37 4.2.研究對象 37 4.2.1.病人族群 37 4.2.2.病例組收納條件 37 4.2.3.病例組排除條件 38 4.2.4.對照組配對條件 38 4.2.5.對照組排除條件 38 4.3.資料收集 39 4.3.1.病人基本資料 39 4.3.2.心臟功能檢查 39 4.3.3.實驗室檢驗值 39 4.3.4.共病史 39 4.3.5.用藥史 39 4.3.6.本研究相關定義 40 4.4.統計方法 41 4.4.1.作業軟體 41 4.4.2.統計模式設定 41 4.4.3.描述性統計 41 4.4.4.推論性統計 41 4.5.樣本數估計 42 4.6研究流程圖 43 第五章 研究結果 44 5.1.病例組與對照組的基本特質分析 44 5.1.1.納入病人人數 44 5.1.2.病人基本特性 44 5.1.3.共病史 45 5.1.4.心臟血管功能 45 5.1.5.用藥史 45 5.2.病例組與對照組雙磷酸鹽alendronate的使用 46 5.2.1.曾經使用alendronate在病例組與對照組的情況 46 5.2.2.目前使用alendronate在病例組與對照組的情況 46 5.2.3.過去使用alendronate在病例組與對照組的情況 46 5.3.病例組第一次處方alendronate至發病的時間分布 47 5.4.雙磷酸鹽alendronate的使用與心房纖維顫動發作風險的相關性 47 5.4.1.alendronate的使用狀況與心房纖維顫動發作風險的相關性 47 5.4.2.依作用開始時間長短,探討alendronate的使用與心房纖維顫動發作風險的相關性 47 5.4.3.依累積劑量的大小,探討alendronate的使用與心房纖維顫動發作風險的相關性 48 5.5.雙磷酸鹽alendronate使用狀況與不同心房纖維顫動發病程度的關係 48 5.5.1.不同程度心房纖維顫動的分布 48 5.5.2.曾經使用alendronate與不同程度心房纖維顫動發作風險的相關性 48 5.6.分層分析雙磷酸鹽alendronate的使用與心房纖維顫動的關係 48 5.7.人群可歸因危險度 49 第六章 討論 56 6.1.病人族群特性 56 6.2.病例組與對照組的基本特質 57 6.3.使用alendronate與心房纖維顫動發病風險的相關性 57 6.4.病例組第一次處方alendronate至發病的時間分布 59 6.5.依作用開始時間長短,探討使用alendronate與心房纖維顫動發作風險的相關性 60 6.6.依累積劑量的大小,探討alendronate的使用與心房纖維顫動發作風險的相關性 61 6.7.曾經使用雙磷酸鹽alendronate與不同心房纖維顫動發病程度的關係 62 6.8.影響alendronate的使用與心房纖維顫動發作風險之相關性的可能因素 63 6.9.人群可歸因危險度 64 6.10.研究限制 64 6.11.未來研究展望 66 第七章 結論與建議 67 參考文獻 68 附件一 個案紀錄表 79 附件二 台灣健康保險給付之雙磷酸鹽類藥品種類 84 | |
dc.language.iso | zh-TW | |
dc.title | 使用雙磷酸鹽藥物Alendronate與心房纖維顫動的風險探討:重疊式病例對照研究 | zh_TW |
dc.title | Use of Alendronate and Risk of Atrial Fibrillation: Nested Case-control Study | en |
dc.type | Thesis | |
dc.date.schoolyear | 99-1 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 李永凌(Yungling Leo Lee) | |
dc.contributor.oralexamcommittee | 蕭斐元(Fei-Yuan Hsiao),李啟明(Chii-Ming Lee) | |
dc.subject.keyword | alendronate,心房纖維顫動, | zh_TW |
dc.subject.keyword | alendronate,atrial fibrillation, | en |
dc.relation.page | 87 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2011-02-09 | |
dc.contributor.author-college | 醫學院 | 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 |
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