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| 題 名 | Statin類藥物對於糖尿病患者罹患結核病影響之探討:全國性世代回顧分析研究=The Influence of Statins Medication on Tuberculosis in Diabetes Patients: A Nationally Representative Cohort Study |
|---|---|
| 作 者 | 蕭惠元; 陳隆輝; 薛水上; 余廣亮; | 書刊名 | 醫務管理期刊 |
| 卷 期 | 23:2 2022.06[民111.06] |
| 頁 次 | 頁167-182 |
| 分類號 | 415.668 |
| 關鍵詞 | 糖尿病; 結核病; COX比例危險模式; Diabetes; DM; Tuberculosis; TB; Cox proportional hazards model; Statin; |
| 語 文 | 中文(Chinese) |
| DOI | 10.6174/JHM.202206_23(2).167 |
| 中文摘要 | 目的:糖尿病會造成結核病感染風險上升且治療失敗,近年發現降血脂 Statin 類藥 物具有預防結核病等傳染病之效果。本研究探討使用 Statin 類藥物能否預防糖尿病 患罹患結核病,以提供糖尿病和結核病整合防治策略的參考。 方法:使用全民健保險資料庫,採傾向評分法將糖尿病患者有使用 Statin 類藥物患 者設為觀察組,與另一無使用 Statin 類藥物但混雜因素相似的對照組進行配對,以 邏輯性迴歸計算兩組結核病發病機率。以觀察糖尿病患者到結核病發病之間的存 活月數為時間變項,依據 Statin 類藥物累積劑量(Cumulative Daily Defined Doses, cDDDs),運用 Cox 比例危險模式(Cox proportional hazards model)建構存活迴歸 模式分析結核病風險,同時探討 Statin 類藥物對於糖尿合併結核病患的成本效益。 結果:配對後共有 11,565 位糖尿病患者,有跟沒有使用 Statin 類藥物的人數分別為 5,782 及 5,783,研究期間罹患結核病的案數為 340 位,占率為 2.93%,觀察組的罹 病風險顯著低於對照組(0.7% vs. 2.2%)。高劑量 Statin( > 721 cDDDs)比起中劑 量(28-720 cDDDs)有顯著較低罹病風險,低劑量( < 28 cDDDs)的風險則顯著高 於中劑量(28-720 cDDDs)。使用 Statin 類藥物對於糖尿合併結核病患者有較少的 平均住院天數(10.8 vs. 13.6 天)及較高的平均住院費高(新臺幣 75,286 vs. 73,620 元)。 結論:使用 Statin 類藥物可降低糖尿病患罹患結核病的風險及醫療負擔,其預防效 果呈現劑量效應關係。 |
| 英文摘要 | Objectives: Diabetes (DM) triples the risk of tuberculosis (TB) infection. Recent epidemiological data suggest antihyperlipidemic statins reduce active TB incidence. We sought to examine whether statin therapy decreases the DM-TB burden. Methods: Based on data from Taiwan National Health Insurance Research Database between 2004 and 2013, we used pairwise (1:1) propensity score method to match statin and non-statin drug samples for each TB patient in a DM population. Logistic regression was used to calculate the incidence of TB. Regarding the survival of DM patients to the incidence of TB between the number of months as a time variable, combined with statin cumulative definite daily doses (cDDDs). Cox’s proportional hazards model was used to construct a survival regression model. Cost-effectiveness analysis was also performed. Results: Matching 11,565 DM patients yielded two cohorts of 5,782 and 5,783 patients, statin users and non-users, 340 individuals were diagnosed with active TB. Statin users were less frequent among TB patients (0.7% vs. 2.2%). Cox model analysis indicated non-statin users had a higher risk of TB incidence (HR = 1.258). In comparison to medium dose (cDDDs 28-720) users, high dose (cDDDs > 721) had a lower and low dose (cDDDs < 28) had a higher risk of TB. Statin users were associated with fewer hospital stay (10.8 vs. 13.6 days) but more hospitalization expenses (NT$ 75,286 vs. 73,620) among DM-TB patients. Conclusions: Statin therapy among DM patients reduced TB incidence and related medical burden, the protective effect is dose-responsive. |
本系統中英文摘要資訊取自各篇刊載內容。