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

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。

關鍵字

糖尿病；結核病； COX比例危險模式； Statin

並列摘要

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.

並列關鍵字

Diabetes (DM) ； Tuberculosis (TB) ； Cox Proportional Hazards Model ； Statin

參考文獻

李品慧（2012）‧糖尿病增加結核病復發之風險：以人群為基礎之嵌入型病例對照研究‧國立臺灣大學，臺北市。https://doi.org/10.6342/NTU.2012.00616

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Jeon, C. Y., & Murray, M. B. (2008). Diabetes mellitus increases the risk of active tuberculosis: a systemic review of 13 observational studies. PLoS Medicine, 5(7), e152. https://doi.org/10.1371/journal.pmed.0050152

Kang, Y. A., Choi, N. K., Seong, J. M., Heo, E. Y., Koo, B. K., Hwang, S. S., Park, B. J., Yim, J. J., & Lee, C. H. (2014). The eff ects of statin use on the development of tuberculosis among patients with diabetes mellitus. International Journal of Tuberculosis Lung Disease, 18(6), 717-724. https://doi.org/10.5588/ijtld.13.0854

國際替代計量

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

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