請用此 Handle URI 來引用此文件：
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/47252完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 賴美淑 | |
| dc.contributor.author | Yun-Ju Lai | en |
| dc.contributor.author | 賴韻如 | zh_TW |
| dc.date.accessioned | 2021-06-15T05:52:24Z | - |
| dc.date.available | 2015-09-09 | |
| dc.date.copyright | 2010-09-09 | |
| dc.date.issued | 2010 | |
| dc.date.submitted | 2010-08-18 | |
| dc.identifier.citation | 1. Haentjens, P., et al., Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med, 2010. 152(6): p. 380-90.
2. Lau, E., et al., Mortality following the diagnosis of a vertebral compression fracture in the Medicare population. J Bone Joint Surg Am, 2008. 90(7): p. 1479-86. 3. Cummings, S.R. and L.J. Melton, Epidemiology and outcomes of osteoporotic fractures. Lancet, 2002. 359(9319): p. 1761-7. 4. Melton, L.J., 3rd, Who has osteoporosis? A conflict between clinical and public health perspectives. J Bone Miner Res, 2000. 15(12): p. 2309-14. 5. Chie, W.C., et al., High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database. Osteoporos Int, 2004. 15(12): p. 998-1002. 6. Ali, T., D.N. Roberts, and W.M. Tierney, Long-term safety concerns with proton pump inhibitors. Am J Med, 2009. 122(10): p. 896-903. 7. Chen, T.J., L.F. Chou, and S.J. Hwang, Prevalence of anti-ulcer drug use in a Chinese cohort. World J Gastroenterol, 2003. 9(6): p. 1365-9. 8. Chen, T.J., L.F. Chou, and S.J. Hwang, Trends in prescribing proton pump inhibitors in Taiwan: 1997 - 2000. Int J Clin Pharmacol Ther, 2003. 41(5): p. 207-12. 9. Kanis, J.A., et al., Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int, 2001. 12(12): p. 989-95. 10. Kanis, J.A., et al., A meta-analysis of previous fracture and subsequent fracture risk. Bone, 2004. 35(2): p. 375-82. 11. Van Staa, T.P., et al., Use of oral corticosteroids and risk of fractures. J Bone Miner Res, 2000. 15(6): p. 993-1000. 12. Cummings, S.R., et al., Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med, 1995. 332(12): p. 767-73. 13. Ensrud, K.E., et al., Weight change and fractures in older women. Study of Osteoporotic Fractures Research Group. Arch Intern Med, 1997. 157(8): p. 857-63. 14. Kanis, J.A., et al., Smoking and fracture risk: a meta-analysis. Osteoporos Int, 2005. 16(2): p. 155-62. 15. Berg, K.M., et al., Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med, 2008. 121(5): p. 406-18. 16. Johnell, O., et al., Predictive value of BMD for hip and other fractures. J Bone Miner Res, 2005. 20(7): p. 1185-94. 17. Mezuk, B., W.W. Eaton, and S.H. Golden, Depression and osteoporosis: epidemiology and potential mediating pathways. Osteoporos Int, 2008. 19(1): p. 1-12. 18. Lim, L.S., et al., Loop diuretic use and increased rates of hip bone loss in older men: the Osteoporotic Fractures in Men Study. Arch Intern Med, 2008. 168(7): p. 735-40. 19. Liu, B., et al., Use of selective serotonin-reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people. Lancet, 1998. 351(9112): p. 1303-7. 20. Andress, D.L., et al., Antiepileptic drug-induced bone loss in young male patients who have seizures. Arch Neurol, 2002. 59(5): p. 781-6. 21. Richards, J.B., et al., Effect of selective serotonin reuptake inhibitors on the risk of fracture. Arch Intern Med, 2007. 167(2): p. 188-94. 22. Schoofs, M.W., et al., Thiazide diuretics and the risk for hip fracture. Ann Intern Med, 2003. 139(6): p. 476-82. 23. Bauer, D.C., et al., Use of statins and fracture: results of 4 prospective studies and cumulative meta-analysis of observational studies and controlled trials. Arch Intern Med, 2004. 164(2): p. 146-52. 24. Rejnmark, L., P. Vestergaard, and L. Mosekilde, Decreased fracture risk in users of organic nitrates: a nationwide case-control study. J Bone Miner Res, 2006. 21(11): p. 1811-7. 25. Schlienger, R.G., et al., Use of beta-blockers and risk of fractures. JAMA, 2004. 292(11): p. 1326-32. 26. Wright, M.J., et al., Proton pump-inhibiting drugs, calcium homeostasis, and bone health. Nutr Rev, 2008. 66(2): p. 103-8. 27. Graziani, G., et al., Calcium and phosphate plasma levels in dialysis patients after dietary Ca-P overload. Role of gastric acid secretion. Nephron, 2002. 91(3): p. 474-9. 28. Hardy, P., et al., Inhibition of gastric secretion by omeprazole and efficiency of calcium carbonate on the control of hyperphosphatemia in patients on chronic hemodialysis. Artif Organs, 1998. 22(7): p. 569-73. 29. Graziani, G., et al., Effect of gastric acid secretion on intestinal phosphate and calcium absorption in normal subjects. Nephrol Dial Transplant, 1995. 10(8): p. 1376-80. 30. O'Connell, M.B., et al., Effects of proton pump inhibitors on calcium carbonate absorption in women: a randomized crossover trial. Am J Med, 2005. 118(7): p. 778-81. 31. Serfaty-Lacrosniere, C., et al., Hypochlorhydria from short-term omeprazole treatment does not inhibit intestinal absorption of calcium, phosphorus, magnesium or zinc from food in humans. J Am Coll Nutr, 1995. 14(4): p. 364-8. 32. Mizunashi, K., et al., Effect of omeprazole, an inhibitor of H+,K(+)-ATPase, on bone resorption in humans. Calcif Tissue Int, 1993. 53(1): p. 21-5. 33. Kocsis, I., et al., Short-term omeprazole treatment does not influence biochemical parameters of bone turnover in children. Calcif Tissue Int, 2002. 71(2): p. 129-32. 34. Vestergaard, P., L. Rejnmark, and L. Mosekilde, Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcif Tissue Int, 2006. 79(2): p. 76-83. 35. Yang, Y.X., et al., Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA, 2006. 296(24): p. 2947-53. 36. Targownik, L.E., et al., Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ, 2008. 179(4): p. 319-26. 37. Kaye, J.A. and H. Jick, Proton pump inhibitor use and risk of hip fractures in patients without major risk factors. Pharmacotherapy, 2008. 28(8): p. 951-9. 38. Yu, E.W., et al., Acid-suppressive medications and risk of bone loss and fracture in older adults. Calcif Tissue Int, 2008. 83(4): p. 251-9. 39. Gray, S.L., et al., Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women: results from the Women's Health Initiative. Arch Intern Med, 2010. 170(9): p. 765-71. 40. WHO Collaborating Centre for Drug Statics Methodology. http://www.whocc.no/. 41. 國家衛生研究院. 2005年承保抽樣歸人檔，LHID2005. http://w3nhriorgtw/nhird/date_cohorthtm#1. 42. Shi, S. and U. Klotz, Proton pump inhibitors: an update of their clinical use and pharmacokinetics. Eur J Clin Pharmacol, 2008. 64(10): p. 935-51. 43. Kirchheiner, J., et al., Relative potency of proton-pump inhibitors-comparison of effects on intragastric pH. Eur J Clin Pharmacol, 2009. 65(1): p. 19-31. 44. Karam, W.G., et al., Human CYP2C19 is a major omeprazole 5-hydroxylase, as demonstrated with recombinant cytochrome P450 enzymes. Drug Metab Dispos, 1996. 24(10): p. 1081-7. 45. Pearce, R.E., et al., Identification of the human P450 enzymes involved in lansoprazole metabolism. J Pharmacol Exp Ther, 1996. 277(2): p. 805-16. 46. Blume, H., et al., Pharmacokinetic drug interaction profiles of proton pump inhibitors. Drug Saf, 2006. 29(9): p. 769-84. 47. Schwab, M., et al., Esomeprazole-induced healing of gastroesophageal reflux disease is unrelated to the genotype of CYP2C19: evidence from clinical and pharmacokinetic data. Clin Pharmacol Ther, 2005. 78(6): p. 627-34. 48. Yang, T.S., et al., Osteoporosis: prevalence in Taiwanese women. Osteoporos Int, 2004. 15(4): p. 345-7. 49. Yang, N.P., et al., Estimated prevalence of osteoporosis from a Nationwide Health Insurance database in Taiwan. Health Policy, 2006. 75(3): p. 329-37. 50. Grisso, J.A., et al., Risk factors for hip fracture in men. Hip Fracture Study Group. Am J Epidemiol, 1997. 145(9): p. 786-93. 51. Farina, C. and S. Gagliardi, Selective inhibition of osteoclast vacuolar H(+)-ATPase. Curr Pharm Des, 2002. 8(23): p. 2033-48. 52. Targownik, L.E., et al., Proton-pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss. Gastroenterology, 2010. 138(3): p. 896-904. 53. Fisher, E.S., et al., The accuracy of Medicare's hospital claims data: progress has been made, but problems remain. Am J Public Health, 1992. 82(2): p. 243-8. 54. Raghunath, A.S., et al., Symptoms in patients on long-term proton pump inhibitors: prevalence and predictors. Aliment Pharmacol Ther, 2009. 29(4): p. 431-9. | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/47252 | - |
| dc.description.abstract | 背景
質子幫浦抑制劑(PPI)抑制胃酸的分泌，而胃內的酸性環境是造成鈣離子吸收的重要因子。PPI抑制了胃酸，使得血清中的鈣離子濃度下降，造成骨骼代謝率增加，進一步造成骨折的風險增加。過去的部分研究發現，使用PPI會輕度增加骨折的風險，但是有些又呈現無相關，呈現不一致的結論。本研究的目的在於探討PPI在台灣是否會增加骨折的風險，而不同種類的PPI對骨折的風險影響是否會有不同。 研究方法： 這是一個利用全民健保資料庫2005年百萬人抽樣歸人檔所進行的回溯性世代研究，研究期間為2002年至2007年。研究組群是針對2003年，在排除了index date前曾經有過髖骨、脊椎骨或是腕骨骨折者後，第一次使用PPI、H2RA或沒有使用以上兩種藥物者。用上述研究族群個別的人口學資料、共病、用藥及醫療利用率等變項去算出個別的propensity score，再利用propensity score 1:1配對選取PPI使用者及沒有使用者。配對後的研究對象追蹤至2007年底，而若這期間在門診、急診或住院的就醫紀錄中發生骨折，包括髖骨、脊椎骨，或是腕骨骨折則定義為事件的發生，其餘的則追蹤至最後一筆就醫紀錄或是研究結束。用Cox proportional hazard model來驗證PPI比起未使用者是否有較高的骨折風險。 結果： 配對後的研究對象共有9146人，而配對後的基本特徵在PPI使用者及非PPI或H2RA使用者兩組並無顯著差異。總共有4573人使用PPI，在平均追蹤時間4.1年間，而在PPI使用者再追蹤期間共發生274人發生骨折，其中88人發生髖骨骨折；而所有骨折發生率及髖骨骨折發生率分別為每千人年14.8及4.7人。PPI使用者較非PPI或H2RA使用者有較高的所有骨折風險(adjusted hazard ratio,1.26;95% CI, 1.06-1.51)及髖骨骨折風險(adjusted hazard ratio,1.70; 95% CI, 1.21-2.40)，但對於脊椎骨折或腕骨骨折的風險則沒有顯著相關。對於不同種類的PPI，只有omeprazole和lansoprazole會增加所有骨折和髖骨骨折的風險，其餘PPI均顯著相關性。而H2RA也會些微增加所有骨折(adjusted hazard ratio,1.09;95% CI, 1.06-1.12)和脊椎骨骨折的風險(adjusted hazard ratio,1.15;95% CI, 1.10-1.20)。 結論： 本研究顯示使用PPI會輕度增加所有骨折及髖骨骨折的風險，但不同種類的PPI影響有差異，風險在Omeprazole和Lansoprazole兩類的PPI較為明顯。 | zh_TW |
| dc.description.abstract | Background:
Proton pump inhibitors (PPIs) suppress the production of hydrochloric acid, which is an important mediator of calcium absorption. Low serum calcium will increase skeletal turnover, and further increase risk of fracture. Previous studies showed that PPI use was associated with a modestly increased risk of fracture, but with inconsistent results. Objectives: To explore the effect of PPI on fracture among general population in Taiwan and to find if different effect among individual PPIs. Methods: We conducted a retrospective cohort study analyzing data from a random sample of 1,000,000 persons obtained from Taiwan’s National Health Insurance Research Database. The study cohort consisted of new users of PPI therapy, and nonusers in 2003 after excluding those with hip, vertebral, and wrist fracture occurring before drug initiation. We calculated each patient’s propensity scores based on demographic, comorbidities, medication and resource utilization one year before drug initiation, and matched each PPI user to nonuser by similar propensity score. Patients were followed to the earliest of death, occurring of fracture (including hip, spine, wrist, and total fractures), or end of 2007. We estimated adjusted hazard ratios (HR) and 95% confidence intervals (CIs) for PPI overall and individual PPIs with a Cox proportional hazards model. Results: A total of 4573 PPI users and 4573 nonusers successfully matched on propensity score were included. The incidence rate of all fractures and hip fracture per 1,000 person-years was 14.8 and 4.7 for PPI users (274 and 88 cases) and 11.8 and 2.9 for nonusers (222 and 54 cases) during an average follow-up of 4.1 years. As compared with nonuser, PPI users were associated with a significantly higher risk of total fracture (adjusted HR, 1.26; 95% CI, 1.06-1.51) and hip fracture (adjusted HR, 1.70; 95% CI, 1.21-2.40), but not for spine or wrist fracture (adjusted HR,1.31 and 0.93 respectively). Among individual PPIs, only omeprazole and lansoprazole were associated with increased risk of total fracture and hip fracture. Conclusions: Use of PPIs was modestly associated with an increased risk of total fracture, mostly due to an excess of hip fracture. Omeprazole and lansoprazole seemed to be associated with higher risks. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-15T05:52:24Z (GMT). No. of bitstreams: 1 ntu-99-R97846004-1.pdf: 1164281 bytes, checksum: 9a119066cc556efffe74fb3df0404fea (MD5) Previous issue date: 2010 | en |
| dc.description.tableofcontents | 中文摘要 I
ABSTRACT III 目錄 V 表目錄 VII 圖目錄 VIII 第一章 緒論 1 第二章 文獻探討 3 第一節、影響骨質疏鬆性骨折的相關因素 3 第二節、PPI的藥理作用及機轉 4 第三節、PPI與骨折風險之相關性研究 5 第四節、文獻回顧小結 10 第五節、藥品的國際分類ATC/DDD系統 18 第三章 研究目的與研究架構 19 第一節、研究目的 19 第二節、研究架構 20 第四章 研究材料與方法 22 第一節、研究設計 22 第二節、資料來源 22 第三節、研究資料庫之建立 24 第四節、PROPENSITY SCORE配對樣本之建立 27 第五節、主要變項之定義 30 第六節、統計分析 32 第七節、敏感度分析 33 第五章 研究結果 35 第一節、配對前及配對後研究樣本特性描述性分析結果 35 第二節、使用PPI / H2RA與未使用者骨折的發生率差異 42 第三節、使用PPI / H2RA造成骨折危險比值之分析結果 45 第四節、使用不同種類PPI造成骨折危險比值之分析結果 51 第五節、不同性別使用PPI造成骨折危險比值之分析結果 53 第六節、不同年齡層使用PPI造成骨折危險比值之分析結果 53 第七節、敏感度分析 55 第六章 討論 56 第一節、PPI / H2RA與骨折風險的相關性 56 第二節、研究限制 60 第七章 結論與建議 62 第一節、結論 62 第二節、建議 62 參考文獻 63 表目錄 表一、PPI與骨折風險之病例對照研究 (2006-2008) 13 表二、PPI與骨折風險之世代研究 (2008-2010) 16 表三、PPI根據ATC編碼的分類 24 表四、H2RA根據ATC編碼的分類 24 表五、 PROPENSITY SCORE配對前樣本之特性 36 表六、PROPENSITY SCORE配對後樣本特性(PPI VS. NONUSER) 38 表七、PROPENSITY SCORE配對後樣本特性(H2RA VS. NONUSER) 40 表八、 配對族群之追蹤資料(所有骨折) 43 表九、PPI與NONUSER配對族群之追蹤資料(個別部位骨折) 44 表十、H2RA與NONUSER配對族群之追蹤資料(個別部位骨折) 44 表十一、配對樣本(PPI V.S NONUSER, H2RA V.S NONUSER)與所有骨折之風險比值 47 表十二、配對樣本(PPI V.S NONUSER)與個別部位骨折之風險比值 49 表十三、配對樣本(H2RA V.S NONUSER)與個別部位骨折之風險比值 50 表十四、不同種類PPI與所有骨折及個別部位骨折之風險比值 (配對前樣本) 52 表十五、不同性別或年齡對所有骨折及髖骨骨折之風險比值(配對前樣本) 54 圖目錄 圖一、研究資料庫之篩選流程 26 圖二、病患定義及追蹤模式 31 圖三、配對後樣本KAPLAN-MEIER 曲線圖 (PPI V.S NONUSER) 46 圖四、配對後樣本KAPLAN-MEIER 曲線圖 (H2RA V.S NONUSER) 46 | |
| dc.language.iso | zh-TW | |
| dc.subject | 骨折 | zh_TW |
| dc.subject | 藥物流行病學 | zh_TW |
| dc.subject | 髖骨骨折 | zh_TW |
| dc.subject | 質子幫浦抑制劑 | zh_TW |
| dc.subject | 副作用 | zh_TW |
| dc.subject | adverse effect | en |
| dc.subject | PPI | en |
| dc.subject | pharmacoepidemiology | en |
| dc.subject | hip fractures | en |
| dc.subject | fractures | en |
| dc.subject | proton pump inhibitor | en |
| dc.title | 使用質子幫浦抑制劑與骨折風險之相關性研究 | zh_TW |
| dc.title | Use of Proton Pump Inhibitors and the Risk of Fractures | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 98-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 張家勳,邵文逸,劉仁沛,林敏雄 | |
| dc.subject.keyword | 質子幫浦抑制劑,骨折,髖骨骨折,藥物流行病學,副作用, | zh_TW |
| dc.subject.keyword | PPI,proton pump inhibitor,fractures,hip fractures,pharmacoepidemiology,adverse effect, | en |
| dc.relation.page | 66 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2010-08-18 | |
| 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 | 1.14 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。