糖尿病患者使用HMG-CoA還原酶抑制劑和胰臟癌風險之相關性研究

Statins and the Risk of Pancreatic Cancer in Diabetic Subjects – A Nationwide Population Study

陳美志(Mei-Jyh Chen)

指導教授 ： 陳保中

共同指導教授 ： 吳明賢

國立臺灣大學/公共衛生學院/職業醫學與工業衛生研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.10295

摘要

研究目的: 本研究的目的在於探討HMG-CoA還原酶抑制劑(Statins)的使用對糖尿病患者的胰臟癌是否有保護作用。

研究方法: 本病例對照研究是分析從1997年至2008年在台灣的全民健康保險研究資料庫（NHIRD）。胰臟癌病例的選擇是根據國際分類疾病第九次臨床修訂版（ICD9.0）。每個案例會隨機從健保資料庫百萬歸人檔中的糖尿病患者，依年齡、性別、糖尿病診斷時間配對作對照組，分析其可能的危險因子。此外，本研究使用累積每日標準劑量（cDDD）計算HMG-CoA還原酶抑制劑(Statins)與其他各項藥物的總量，並以條件式邏輯式迴歸來分析各種危險因子模式與胰臟癌的關聯性。

研究結果: 本研究包括3338名糖尿病患者且為新診斷胰臟癌，同樣選取3338名糖尿病患者且未患有癌症者為對照組。其中高齡，男性，有酒精相關的疾病，慢性腎功能不良，胰臟炎，缺血性心臟病，糖尿病視網膜疾病和糖尿病腎病史與胰臟癌的風險增加有關。而在校正干擾因子後，本研究發現使用中高劑量的HMG-CoA還原酶抑制劑(Statins)有較低的胰臟癌風險　(OR=0.82 in 28-180累積每日標準劑量; OR=0.76 in > 180累積每日標準劑量)。此外，本研究也發現胰臟癌風險也與HMG-CoA還原酶抑制劑(Statins)使用的劑量高低有相關性(P for trend=0.0024)。

研究結論: 糖尿病患者使用>180累積每日標準劑量的HMG-CoA還原酶抑制劑(Statins)有較低的胰臟癌風險。

關鍵字

糖尿病 ； 胰臟癌 ； HMG-CoA還原?抑制劑 ； 健保資料庫 ； 化學預防

並列摘要

Objective: The aim of this study was to investigate whether the use of statins was associated with protective effect of pancreatic cancer in diabetic subjects.

Methods: A case-control study was designed to analyze the National Health Insurance Research database (NHIRD) from 1997 to 2008 in Taiwan. The cohort selection of pancreatic cancer cases was based on International Classification of Disease 9th Revision-Clinical Modification (ICD 9.0). Each case was matched with one control based on sex, year of birth and the year of diabetic age. The index date was defined as the date of newly diagnosed pancreatic cancer. Cumulative defined daily dose (cDDD) was used to calculate the total amount of statins use till one year prior to the index date. Conditional logistic regression was conducted to estimate crude and adjusted odds ratio of pancreatic cancer associated with the cDDD of stains.

Results: The study included 3,338 diabetic subjects with newly diagnosed pancreatic cancer and 3,338 controls with free of cancer diagnosis. The age, male gender, underlying of alcohol related disease, chronic renal injury, ischemic heart disease, history of pancreatitis, diabetic complications including retinopathy and nephropathy were associated with increased risk of pancreatic cancer in diabetic subjects. The statin use with moderate and high cDDD had significantly decreased risk of pancreatic cancer (OR=0.82 in 28-180 DDD; OR=0.76 in > 180 DDD) after adjusting multiple confounders. Also, there was a significant dose-effect of statin use for risk of pancreatic cancer (P for trend=0.0024).

Conclusions: The statin use more than 180 cDDD may be associated with modest protection of pancreatic cancer in diabetic subjects.

並列關鍵字

Diabetes mellitus ； Pancreatic cancer ； Statins ； National Health Insurance Research database (NHIRD) ； Chemoprevention

參考文獻

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