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Title: | 臺灣急性冠心症病人使用Statins與攝護腺癌的風險 Statins Use and the Risk of Prostate Cancer in Acute Coronary Syndrome Patients in Taiwan |
Authors: | Wei Ho 何暐 |
Advisor: | 林珍芳(ZHEN-FANG LIN) |
Keyword: | Statins,亞洲,急性冠心症,攝護腺癌, Statins,Asian,Acute coronary syndrome,Prostate cancer,NHIRD, |
Publication Year : | 2017 |
Degree: | 碩士 |
Abstract: | 背景:過去關於statins的使用與攝護腺癌風險之間關係的研究大多都是以西方族群為研究對象,且得到不一致的結果。
目的:分析台灣statins的使用與攝護腺癌風險之間的關係,以及不同特性的statins對攝護腺癌風險之影響。 方法:本研究為一個回溯性的觀察性世代研究,取材自2000年1月至2013年12月健保資料庫資料。男性保險人在2001年1月至2008年12月之間,被新診斷急性冠心症且已滿55歲以上,以及在指標日期前或後180天內沒有任何癌症的診斷且在指標日期前180天無statins的使用者,會被納入本研究分析。傾向分數會被用來配對statins的使用者與非使用者,時間相依共變相存活分析會被用來分析使用者與非使用者的攝護腺癌的風險。我們會分析病人直到最早的攝護腺癌發生、退保或直到研究結束(2013年12月31日)。 結果:經過一比一傾向分數配對後,共26,628位男性被納入研究。相較於非statins使用族群,使用者有較低的攝護腺癌風險(HR: 0.719, 95% CI: 0.570-0.908),在晚期攝護腺癌風險上亦有統計上的顯著差異(HR: 0.718, 95% CI: 0.530-0.972)。相較於沒有使用statins,累積標準化定義之每日劑量(cDDD)在84以下之使用者,其風險比為1.241 (0.931-1.654),cDDD介於84與312者,其風險比為1.203 (0.903-1.604),cDDD介於818與312者,其風險比為0.712 (0.513-0.989),cDDD大於818者,其風險比為0.426 (0.298-0.609)。在不同的statins中,simvastatin、fluvastatin、atorvastatin和rosuvastatin可以分別下降攝護腺癌風險26. 6% (HR: 0.734, 95% CI: 0.552-0.976)、30.2% (HR: 0.698, 95% CI: 0.490-0.995)、30.9% (HR: 0.691, 95% CI: 0.537-0.889)、37.8% (HR: 0.622, 95% CI: 0.453-0.853)。使用脂溶性statins的人其攝護腺癌風險並無比水溶性statins來的低(HR: 0.916, 95% CI: 0.570-1.472)。然而,高強度statins使用者比非使用者,攝護腺的風險有顯著的下降 (HR: 0.548, 95% CI: 0.367-0.820)。 結論:在台灣的急性冠心症族群中,statins的使用者有較低的攝護腺癌風險,且隨著statins暴露的增加,其風險可能越低,尤其是simvastatin、fluvastatin、atorvastatin、rosuvastatin。 Background: Literature studying statins use and the risk of prostate cancer were mainly done in western countries and yielded inconsistent results. Objective: First, to analyze the statins effects on the risk of prostate cancer in Taiwan. Second, to access whether different characteristics of statins will affect the risk of prostate cancer differently. Methods: This is a retrospective cohort study using National Health Insurance Research Database from January 1, 2000 to December 31, 2013. Patients aged more than 55 and were newly diagnosed with acute coronary syndrome between January 1, 2001 to December 31, 2008 without any cancers diagnosis before or 180 days after index date were included. The propensity score was used to match statin users and non-users. Time-dependent Cox hazards regression model was used to calculate the risk of prostate cancer between drug exposure group and non-exposure group. The analyses were also stratified to assess the statins effect in different age groups, the severity of underline diseases, comorbidities, and hospital levels. The follow-up period was the time from index date to the outcome of interests, withdraw from the registry, and the end of study (2013.12.31). Results: After 1:1 propensity score matching, a total of 26,628 men were included. Statin use was associated with significantly lower risk of both total and advanced prostate cancer (Adjusted HR: 0.719, 95% CI: 0.570-0.908; Adjusted HR: 0.718, 95% CI: 0.530-0.972 respectively). Compared with statins non-users, the adjusted HR (95% CI) were 1.328 (0.931-1.654) for the group with cumulative dose <84 cDDD, 1.203 (0.903-1.604) for the group 312>cDDD≧84, 0.712 (0.513-0.989) for the group 818>cDDD≧312, and 0.426 (0.298-0.609) for the group cDDD≧818. Simvastatin, fluvastatin, atorvastatin, and rosuvastatin users showed significant 26.6%, 30.2%, 30.9%, and 37.8% reductions in total prostate cancer risk respectively. Lipophilic statins were not different from hydrophilic statins in total and advanced prostate cancer risk (Adjusted HR: 1.014, 95% CI: 0.638-1.610; Adjusted HR: 0.806, 95% CI: 0.445-1.459). However, high-intensity statins showed a significant reduction in total and advanced prostate cancer risk compared with statins non-users (Adjusted HR: 0.548, 95% CI:0.367-0.820; Adjusted HR: 0.487, 95% CI: 0.284-0.836). Conclusions: In Taiwan ACS population, reduction in risk of prostate cancer were observed in statin users, especially patients used simvastatin, fluvastatin, atorvastatin, rosuvastatin or high-intensity statins. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/67490 |
DOI: | 10.6342/NTU201702337 |
Fulltext Rights: | 有償授權 |
Appears in Collections: | 臨床藥學研究所 |
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