痛風病患使用Allopurinol在心血管疾病的影響:以台灣人口為基礎的世代研究

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姓名

張菀珊(Wan-shan Chang) 查詢紙本館藏

畢業系所

資訊工程學系在職專班

論文名稱

痛風病患使用Allopurinol在心血管疾病的影響:以台灣人口為基礎的世代研究
(Effect of Gout and Allopurinol Use on Cardiovascular Disease Outcomes:A Population-Based Cohort Study in Taiwan)

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摘要(中)

痛風為代謝疾病之一，此病常合併高尿酸血症、急性及慢性關節炎、腎臟炎等疾病。近年研究顯示痛風患者，也是心血管疾病發生及死亡的高危險群。Allopurinol為臨床上經常使用於降低血液中尿酸濃度的藥物，其作用機制為抑制黃嘌呤氧化酶(Xanthine oxidase)而減少尿酸之形成。本研究擬利用台灣全民健保研究資料庫之資料，針對大於40歲的痛風病患使用Allopurinol治療是否有效降低心血管疾病之發生率。研究結果顯示，Allopurinol使用者與非使用Allopurinol使用者相比，Allopurinol使用者有顯著增加心血管事件風險 (HR =1.33, 95% CI 1.26-1.41).。在使用Allopurinol組中，比起服用低劑量（<100毫克和100毫克）的用戶，服用高劑量（≥300毫克）的用戶有顯著減少心血管事件的風險（HR =0.67, 95％ CI 0.48-0.92）。結論：整體上痛風患者使用Allopurinol治療在引發心血管疾病而住院的患者比起非使用Allopurinol治療組並沒有減少的表現。而在所有使用Allopurinol治療的患者中，服用高劑量患者的心血管事件風險均低於低劑量的患者。

摘要(英)

Gout is a type of metabolic diseases, the disease is often associated with hyperuricemia, acute and chronic arthritis, kidney disease go far. In recent years, studies have shown that patients with gout also cardiovascular disease and death in high risk groups. Allopurinol is frequently used in clinical practice to lower blood uric acid concentrations of the drug, and its mechanism of inhibition of xanthine oxidase and reduce the formation of uric acid. This study intends to use the Taiwan National Health Insurance Research Database information which more than 40-year-old patient with gout use allopurinol whether treatment reducing the incidence of cardiovascular disease. The results show that, if allopurinol compared with non-allopurinol users, the allopurinol users were significant increased risk of cardiovascular events (HR =1.33, 95% CI 1.26–1.41). Compared with low-dose (<100 mg & 100 mg) users, high-dose (≥300 mg) users had significant reductions in the risk of cardiovascular events (HR =0.67, 95% CI 0.48–0.92), which all patients on allopurinol treatment. The results did not show an effect of use allopurinol as a class on reductions cardiovascular disease hospitalization rate in patients with gout. Higher doses of allopurinol risks of cardiovascular events were lower than lower doses in all patients on allopurinol treatment.

關鍵字(中)

★ 痛風
★ 心血管疾病
★ Allopurinol
★ 世代研究

關鍵字(英)

★ gout
★ cardiovascular
★ Allopurinol
★ Population-Based Cohort Study

論文目次

Chinese Abstract I
English Abstract II
Table of Contents III
List of Tables V
List of Figures VI
Chapter 1 Introduction 1
1-1 Background 1
1-2 Motivation 1
1-3 Research Goal 2
Chapter 2 Related Works 3
2-1 Gout 3
2-2 Mechanism of Allopurinol 4
2-3 Cardiovascular Disease Associated with Allopurinol 5
Chapter 3 Materials And Methods 7
3-1 Data Source 7
3-2 Study Population and Design 8
3-3 Definition of diseases 10
3-4 Statistical Analyses 11
Chapter 4 Results 12
4-1 Basic Demographics and Clinical Characteristics 12
4-2 Relation to Different Treatment-Groups and Associated CVD Outcome Hazard Rates 18
4-3 Relation to Different Treatment-Groups and Associated different CVD Outcome Hazard Rates 21
4-4 Relation to Different Treatment-Groups and Associated different CVD Outcome Hazard Rates and Stratified by Presence of Diabetes Mellitus and Chronic Kidney Disease 21
4-5 Relation to Different Treatment-Groups and Associated Survival curve 24
Chapter 5 Discussion 25
Chapter 6 Conclusion 28
References 29
Appendix 31

參考文獻

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指導教授

洪炯宗(Jorng-tzong Horng)

審核日期

2013-8-19

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