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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 林珍芳(Zhen-Fang Lin) | |
dc.contributor.author | Chia-Hao Liu | en |
dc.contributor.author | 劉家豪 | zh_TW |
dc.date.accessioned | 2021-06-17T04:58:32Z | - |
dc.date.available | 2020-08-01 | |
dc.date.copyright | 2018-08-01 | |
dc.date.issued | 2018 | |
dc.date.submitted | 2018-07-26 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/71205 | - |
dc.description.abstract | 背景及目的
已有眾多文獻顯示NSAIDs(non-steroidal anti-inflammatory drug)與心血管風險存在相關,本研究探討在骨關節炎OA (osteoarthritis) 合併非瓣膜性心房顫動且無中風病史的群族,長期使用非aspirin的NSAIDs與缺血性中風風險之關係,及該族群的NSAIDs使用現況,提供臨床上處方NSAIDs時相對安全的選擇。 方法 本研究為回溯性世代研究,使用2005年到2011年的台灣健保資料庫資料,分析使用NSAIDs 的OA群族,以缺血性中風為研究終點。使用cox proportional hazards regression校正潛在的干擾因素,以hazard ratio (HR) 以及95% 信賴區間 (cofidence interval, CI) 呈現風險結果。 結果 共3826位病患納入研究,其中NSAIDs non-user佔3105人;NSAIDs user佔721人。整體NSAIDs user的平均年齡為65.4±13.7歲,平均CHA2DS2-VASc Score為3.4±1.7分,除了心律不整之外,高血壓為最常見的共病症比例為72.5 %,最常見的共藥為steroid比例為 86.9%。處方量最多的傳統NSAIDs以diclofenac最多占28.5%。另外,COX-2抑制劑中celecoxib占全部使用量13.5%。研究結果顯示以non-user為參考時,naproxen有較低的缺血性中風風險 (adjHR=0.759; 95%CI=0.101-5.685),其餘藥物皆與上升的缺血性中風風險有相關,特別是celecoxib有達到統計上顯著 (adjHR=1.879; 95%CI=1.003-3.522)。其他藥物則無統計上顯著etoricoxib (adjHR=1.897; 95%CI=0.682-5.281),ibuprofen (adjHR= 1.497; 95%CI= 0.365-6.152),diclofenac (adjHR=1.462; 95%CI=0.837-2.553),meloxicam (adjHR=1.111; 95%CI=0.63-1.958)。 結論 根據本研究結果,在高風險的骨關節炎合併非瓣膜性心房顫動的族群,NSAIDs user 相比non-user時,celecoxib呈現較高的缺血性中風風險,相反的,naproxen則呈現較低的風險。然而結果與過去文獻略有不同,仍需要進一步之研究釐清NSAIDs與缺血性中風風險之相關性。 | zh_TW |
dc.description.abstract | Background: A great number of studies implied that the NSAIDs(non-steroidal anti-inflammatory drug)including COX-2 inhibitors(selective inhibitors of cyclooxygenase-2)and traditional NSAIDs are related to higher risk of vascular events such as myocardial infarction, thromboembolism, and stroke. In addition, atrial fibrillation may also increase the opportunity to cause vascular events. Stroke would lay a serious burden on the medical care system. Consequently, establishing the safety profile of NSAIDs is necessary. This study aims to clarify the association between risk of ischemic stroke and use of non-aspirin NSAIDs in osteoarthritis (OA) patients with non-valvular atrial fibrillation.
Methods: A retrospective cohort study is devoted to the analysis of the Taiwan National Health Insurance Database. A total of 3826 subjects diagnosed with OA with atrial fibrillation were eligible in the study. The endpoint was defined as ischemic stroke. The hazard ratio (HR) and 95% confidence interval of outcomes were calculated by Cox regression models. Results: In demographic analysis, diclofenac accounted for 28.5% and celecoxib accountd for 13.5% among all NSAIDs prescriptions in user group. Compared to non-user, some drugs were associated with increased risk of ischemic stroke such as etoricoxib (adjHR=1.897; 95%CI=0.682-5.281), diclofenac (adjHR=1.462; 95%CI=0.837-2.553), meloxicam (adjHR=1.111; 95%CI=0.63-1.958), ibuprofen (adjHR= 1.497; 95%CI= 0.365-6.152). Especially, celecoxib (adjHR=1.879; 95%CI=1.003-3.522) show higher and statistically significant risk of ischemic stroke. Conclusion: Our study finds that in OA patients with non-valvular atrial fibrillation, celecoxib was related to a higher risk of ischemic stroke. In contrast, naproxen was associated with decreased risk. Further research is needed to clarify the relationship between NSAIDs and ischemic stroke risk. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T04:58:32Z (GMT). No. of bitstreams: 1 ntu-107-R04423032-1.pdf: 2421841 bytes, checksum: dc118a9638deb3d907a6a745839b2e3e (MD5) Previous issue date: 2018 | en |
dc.description.tableofcontents | 目錄
誌謝 i 中文摘要 ii ABSTRACT iii 目錄 v 表目錄 viii 圖目錄 x Chapter 1 前言 1 Chapter 2 疾病簡介 2 2.1 心房顫動 2 2.1.1心房顫動病理機轉 2 2.1.2心房顫動之流行病學 2 2.1.3心房顫動風險因子 3 2.1.4心房顫動之治療 3 2.1.4.1心速控制 3 2.1.4.2心律控制 4 2.1.4.3栓塞預防 6 2.2 骨關節炎 6 2.2.1骨關節炎之機轉 7 2.2.2骨關節炎之流病學 7 2.2.3骨關節炎之治療 7 2.3 NSAIDs藥物 8 2.3.1 NSAIDs之臨床作用與選擇 8 2.3.2 NSAIDs藥物之機轉 10 2.3.3 NSAIDs藥物之選擇性 10 2.3.4 NSAIDs藥物之副作用 11 2.3.5 NSAIDs藥物之劑型 12 2.4 中風 13 2.4.1中風之臨床表現與診斷 13 2.4.2中風之分類與病理機轉 14 2.4.3中風風險因子 14 2.4.4中風之治療與預防 14 Chapter 3 文獻回顧 16 3.1 NSAIDs對心血管風險研究相關探討 16 3.2 NSAIDs對心血管風險之隨機對照臨床試驗 16 3.3 NSAIDs對心血管風險之meta-analysis 和sysmatic review 17 3.4 NSAIDs對心血管風險之觀察性研究 18 3.5 在關節炎族群中NSAIDs對心血管風險之研究 19 Chapter 4 研究方法 21 4.1 研究資料來源 21 4.2 研究對象 21 4.3 研究設計 22 4.4 藥物暴露 22 4.5 研究終點 22 4.6 統計方法 23 4.7 研究變項 23 Chapter 5 研究結果 25 5.1 骨關節炎合併非瓣膜性心房顫動族群特性 25 5.2 主要族群分析-non-user與user 26 5.3 主要族群分析-non-user與個別NSAIDs 26 5.4 次族群分析-傳統 NSAIDs與COX-2抑制劑 26 5.5 次族群分析-COX-2抑制劑 27 Chapter 6 討論 28 6.1 台灣地區心房顫動合併骨關節炎或類風溼關節炎病人特性 28 6.2 NSAIDs藥物在非瓣膜性心房顫動合併骨關節炎病人對中風風險討論 30 6.2.1 NSAIDs user相比於non-user之中風風險 30 6.2.2個別NSAIDs user 相比於non-user之中風風險 30 6.2.3 COX-2抑制劑相比於傳統NSAIDs之中風風險 32 6.2.4 COX-2抑制劑之間相比之中風風險 33 6.2.5個別NSAIDs之間相比之中風風險 33 6.3 研究限制 35 6.4 研究優點 36 Chapter 7結論 37 參考資料 110 附錄 116 | |
dc.language.iso | zh-TW | |
dc.title | 骨關節炎合併心房顫動病人使用
NSAIDs藥物與中風風險相關性之回溯性世代研究 | zh_TW |
dc.title | The Risk of Stroke Associated with Nonsteroidal Anti-Inflammatory Drugs among Osteoarthritis Patients with Atrial Fibrillation:
A Population-based Retrospective Cohort Study | en |
dc.type | Thesis | |
dc.date.schoolyear | 106-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 簡國龍(KUO-LIONG CHIEN),蕭斐元(FEI-YUAN HSIAO),張國軒(Chang, Kuo Hsuan) | |
dc.subject.keyword | 非類固醇抗發炎藥,骨關節炎,心房顫動,中風,回溯性世代研究, | zh_TW |
dc.subject.keyword | Retrospective Cohort Study,Ischemic Stroke,NSAIDs,COX-2 inhibitor,Osteoarthritis, | en |
dc.relation.page | 119 | |
dc.identifier.doi | 10.6342/NTU201801782 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2018-07-27 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 藥學研究所 | zh_TW |
顯示於系所單位: | 藥學系 |
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