抗血栓藥物對非瓣膜型心房顫動血栓預測之影響

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姓名

楊謹安(Chin-an Yang) 查詢紙本館藏

畢業系所

系統生物與生物資訊研究所

論文名稱

抗血栓藥物對非瓣膜型心房顫動血栓預測之影響
(Impact of antithrombotic agents on prediction of thromboembolism with nonvalvular atrial fribrillation-A nationwide database analysis)

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摘要(中)

心房顫動，是一種最常見嚴重持續性心律失常的疾病，它與血栓的發生息息相關。在先前西方國家，為了預防心房顫動所造成的血栓問題，提供了幾個預測血栓的模型，給予臨床醫師瞭解病患的罹患血栓的風險，並施予適當的抗血栓藥物。其中，最常見的模型為CHADS2。近日，ACC/AHA/ESC guideline 修改CHADS2 並建立新的模型CHA2DS2-VASc。 CHA2DS2-VASc 在西方族群的準確率比 CHADS2.較佳。
然而，適用於台灣非辦模型病患的模型，目前是未知的。而且抗血栓藥物的使用，對亞洲非瓣膜型心房顫動病患影響的研究，仍然有限。所以根據以上的理由，本篇研究將著重在以下兩點: 第一點,比較抗血栓藥物的使用，在兩個(CHADS2 與CHA2DS2-VASC)模型的在台灣族群之間的差異。第二點，希望找出適合台灣非辦模型心房顫動病患的預測模型。

摘要(英)

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia disorder. It is associated with thromembolism. Several algorithms of risk stratification of thromembolism help clinicians decide the risk and the appropriate antithrombotic treatment in AF patient. One of the most commonly used is the CHADS2 score. More recently, the 2006 ACC/AHA/ESC guideline risk schema evolved into the CHA2DS2-VASc score. The predictive power of CHA2DS2-VASc is better than CHADS2 in the western countries.
However, the appropriate model to predict the TE for patients with AF in Taiwan is unknown and the knowledge of the impact of TE related to antithrombotic agents use for AF in Asian is limited.
According to the above reasons, this study will focus on these items: first, comparing whether antithrombotic agents use and outcomes differ across CHADS2 and CHA2DS2-VASC risk strata in Taiwan; second, finding an appropriate predicting model for nonvalvular AF patients in Taiwan.

關鍵字(中)

★ ROC
★ 血栓
★ 抗血栓藥物
★ 心房顫動
★ CHADS2
★ CHADS-VASC

關鍵字(英)

★ thromboembolism
★ ROC
★ CHADS-VASC
★ CHADS2
★ atrial fribrillation
★ antithrombotic agents

論文目次

摘要 I
ABSTRACT II
誌謝 IV
LIST OF FIGURES VII
LIST OF TABLES IX
Chapter 1 Introduction 1
1.1 Background 1
1.2 Motivation 2
1.3 Research Goal 2
Chapter 2 Related Works 3
2.1 Atrial fibrillation 3
2.2 Atrial fibrillation and thromembolism 6
2.3 CHADS2 7
2.4 CHA2DS2-VASC 8
Chapter 3 Materials And Methods .... 12
3.1 Database 12
3.2 Study population 12
3.3 Definition of diseases 14
3.3.1 Nonvalvular atrial fibrillation 14
3.3.2 Covariates of CHADS2 and CHA2DS2-VASC 14
3.3.3 Outcome 15
3.4 Statistical analysis 15
3.4.1 Chi-Square test 15
3.4.2 Odds ratio 16
3.4.3 Receiver-Operating Characteristic analysis 18
Chapter4 Results 20
4.1 Baseline characteristics of patients with/without antithrombotic agents. 20
4.2 OR of thromboembolism in patients with atrial fibrillation..................... 22
4.3 Odds ratios of risk factors for thromboemolism events in with/without antithrombotic agents. 24
4.4 The distribution of antithrombotic agents use and TE events based on the models scoring system at one year follow-up.. 26
4.5 ROC curves in the group with/without antithrombotic agents. 28
4.6 New models in the group with antithrombotic agents 31
Chapter 5 Discussion 36
Chapter 6 Summary 39
References 40
Supplementary figures and tables 45

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指導教授

洪炯宗(Jorng-Tzong Horng)

審核日期

2012-7-26

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