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http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/82106完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 簡國龍(Kuo-Liong Chien) | |
| dc.contributor.author | Jui Wang | en |
| dc.contributor.author | 王睿 | zh_TW |
| dc.date.accessioned | 2022-11-25T05:35:58Z | - |
| dc.date.available | 2026-10-25 | |
| dc.date.copyright | 2021-11-11 | |
| dc.date.issued | 2021 | |
| dc.date.submitted | 2021-10-26 | |
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/82106 | - |
| dc.description.abstract | "背景： DPP-4 抑制劑(二肽基肽酶-4抑制劑)可以有效的調控血糖以減緩糖尿病的病程，但其對於心血管健康的影響目前仍然沒有一致的結果。本研究利用全國性世代研究比較DPP-4 抑制劑對於心血管健康的效果。透過醫院臨床資料庫，比較DPP-4 抑制劑對於心血管相關血液生化指標的效果。 方法： 全國性世代研究以健保資料進行，使用2008到2013年間所有糖尿病病人，取追蹤期間以二甲雙胍為第一線治療且有服用至少30天第二線降血糖用藥者做為研究對象，依照使用DPP-4 抑制劑情況分組進行1比1的配對，比較兩組人重大心臟不良事件、心臟衰竭、心肌梗塞、腦血管疾病以及低血糖風險。使用台大醫院資料庫，選擇2008年到2016年40歲以上以二甲雙胍為第一線治療且至少使用半年第二線降血糖用藥之糖尿病患者做為研究對象，依照使用DPP-4 抑制劑情況分組進行1比1的配對，比較糖化血色素、空腹血糖、總膽固醇、三酸甘油脂、高/低密度脂蛋白、肌酐酸以及腎絲球過濾率的差異。 結果： 在全國性世代研究當中共有37317組配對樣本。經過平均2.1年追蹤後，DPP-4 抑制劑相對於sulfonylurea(硫醯基尿素類藥物)，有較低的重大心臟不良事件(HR, 0.79; 95% CI, 0.75 to 0.82)、心臟衰竭(HR, 0.86; 95% CI, 0.79 to 0.93)、心肌梗塞(HR, 0.76; 95% CI, 0.68 to 0.92)以及腦血管疾病(HR, 0.72; 95% CI, 0.67 to 0.77)的風險。在醫院進行的世代研究納入475組平均處方2.0年降血糖用藥之配對樣本中，DPP-4 抑制劑跟sulfonylurea都可以有效降低糖化血色素、空腹血糖、總膽固醇、三酸甘油脂以及低密度脂蛋白。DPP-4 抑制劑比起sulfonylurea更能夠有效的降低糖化血色素(effect estimate for the change of percentages = -1.96 %; 95% CI, -3.52 to -0.41%)，對於空腹血糖則有接近顯著的下降效果(effect estimate for the change of levels = -0.49 mg/dL; 95% CI, -8.54 to 0.36 mg/dL)。 結論： 本研究觀察到在以二甲雙胍做為第一線治療下，DPP-4 抑制劑比起sulfonylurea，對於重大心臟不良事件、心臟衰竭、心肌梗塞、腦血管疾病以及低血糖有較低的風險。而在血糖調控部分，亦可觀察到DPP-4 抑制劑比起sulfonylurea有較好的血糖控制。" | zh_TW |
| dc.description.provenance | Made available in DSpace on 2022-11-25T05:35:58Z (GMT). No. of bitstreams: 1 U0001-2210202114105700.pdf: 5110228 bytes, checksum: 2d653da05395ed3396f2c2c2a1942f7b (MD5) Previous issue date: 2021 | en |
| dc.description.tableofcontents | 致謝 I 中文摘要 III Abstract V Table of Contents VII List of Figures IX List of Tables X List of Appendixes XII Chapter One: Introduction 1 1.1 Cardiovascular health in diabetic patients 1 1.2 Medications of type 2 diabetes 5 1.3 Dipeptidyl peptidase 4 inhibitors 6 1.4 Biological mechanisms of DPP4i on cardiovascular system 8 1.5 Literature review of DPP-4 inhibitors on cardiovascular system 11 1.6 Meta-analysis 16 1.7 Research gaps 21 Chapter Two: Objectives 23 Chapter Three: Materials and Methods 25 3.1 Comparison between DPP4 inhibitors and Sulfonylurea for cardiovascular disease in a retrospective cohort study 25 3.1.1 Data sources 25 3.1.2 Study participants 25 3.1.3 Study design and exposure assessment 27 3.1.4 Primary and secondary outcomes 29 3.1.5 Statistical analysis 30 3.2 Comparison between DPP4 inhibitors and Sulfonylurea for cardiovascular disease in a hospital-based cohort study 33 3.2.1 Data sources 33 3.2.2 Study participants 33 3.2.3 Study design and exposure assessment 34 3.2.4 Primary and secondary outcomes 35 3.2.5 Statistical analysis 36 Chapter Four: Results 39 4.1 Comparison between DPP4 inhibitors and Sulfonylurea for cardiovascular disease in a retrospective cohort study 39 4.2 Comparison between DPP4 inhibitors and Sulfonylurea for cardiovascular disease in hospital-based cohort study 45 Chapter Five: Discussion 51 5.1 Comparison between DPP4 inhibitors and Sulfonylurea for cardiovascular disease in a retrospective cohort study 51 5.1.1 Main findings 51 5.1.2 Strengths of this study 51 5.1.3 Compared with other studies 52 5.1.4 Limitations of this study 54 5.2 Comparison between DPP4 inhibitors and Sulfonylurea for cardiovascular disease in a hospital-based cohort study 56 5.2.1 Main findings 56 5.2.2 Strengths of this study 56 5.2.3 Compared with other studies 57 5.2.4 Limitations of this study 60 5.3 Conclusions 61 References 62 Figures 72 Tables 86 Appendixes 119 | |
| dc.language.iso | en | |
| dc.subject | 腦血管疾病 | zh_TW |
| dc.subject | 二肽基肽酶-4抑制劑 | zh_TW |
| dc.subject | 糖尿病 | zh_TW |
| dc.subject | 回溯性世代研究 | zh_TW |
| dc.subject | 重大心臟不良事件 | zh_TW |
| dc.subject | 心臟衰竭 | zh_TW |
| dc.subject | 心肌梗塞 | zh_TW |
| dc.subject | diabetes | en |
| dc.subject | cerebrovascular disease | en |
| dc.subject | myocardial infarction | en |
| dc.subject | heart failure | en |
| dc.subject | major adverse cardiac event | en |
| dc.subject | retrospective cohort study | en |
| dc.subject | Dipeptidyl peptidase 4 inhibitors | en |
| dc.title | 二肽基肽酶-4抑制劑使用對於心血管健康之影響：回溯性世代研究 | zh_TW |
| dc.title | Effect of Dipeptidyl Peptidase-4 Inhibitors on Cardiovascular Health: Retrospective Cohort Study | en |
| dc.date.schoolyear | 109-2 | |
| dc.description.degree | 博士 | |
| dc.contributor.author-orcid | 0000-0003-4800-5276 | |
| dc.contributor.coadvisor | 吳泓彥(Hon-Yen Wu) | |
| dc.contributor.oralexamcommittee | 洪冠予(Hsin-Tsai Liu),李文宗(Chih-Yang Tseng),白其卉,唐德成,杜裕康 | |
| dc.subject.keyword | 二肽基肽酶-4抑制劑,糖尿病,回溯性世代研究,重大心臟不良事件,心臟衰竭,心肌梗塞,腦血管疾病, | zh_TW |
| dc.subject.keyword | Dipeptidyl peptidase 4 inhibitors,diabetes,retrospective cohort study,major adverse cardiac event,heart failure,myocardial infarction,cerebrovascular disease, | en |
| dc.relation.page | 122 | |
| dc.identifier.doi | 10.6342/NTU202104025 | |
| dc.rights.note | 同意授權(限校園內公開) | |
| dc.date.accepted | 2021-10-26 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 流行病學與預防醫學研究所 | zh_TW |
| dc.date.embargo-lift | 2026-10-25 | - |
| 顯示於系所單位： | 流行病學與預防醫學研究所 | |
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