探討使用阿斯匹靈與預防攝護腺癌的關聯性

The association between use of aspirin and the prevention of prostate cancer

黃婉婷(Wan-Ting Huang)

指導教授 ： 吳宗軒

臺北醫學大學/藥學院/藥學系(碩博士班)/碩士(2015年)

https://doi.org/10.6831/TMU.2015.00016

摘要

研究背景
攝護腺癌為美國癌症死因之一。在2012年，據統計罹癌男性中約有26%為罹患攝護腺癌患者。也因此在攝護腺癌的經濟負擔上也十分沉重，在2010年，花費在攝護腺癌的醫療支出約一百一十九百億萬美元。近幾年的研究顯示，非類固醇類消炎止痛藥與降低攝護腺癌的風險具關聯性。可能的機轉為阿斯匹靈可以抑制cyclooxygenase-2 (COX-2)的過度表現有關。然而臨床上探討兩者關聯性卻十分缺乏，此外相關研究因納入的變項差異與不足其研究結果則仍存在歧異，

研究目的
因此本研究目的是想經由美國健康訪問調查(National Health Interview Survey )來探討使用阿斯匹靈與攝護腺癌發生的關聯性。

研究方法
本研究利用2010年的美國健康訪問調查，從訪查資料中抽取年齡大於或等於20歲的成年男性做為研究族群。自變項為規律地使用阿斯匹靈，其定義為：每周至少使用三次以上阿斯匹靈的成年男性。而應變項則為是否曾被告知罹患攝護腺癌。在選擇共變項的部分，利用Andersen’s Behavioral Model選取共變項並加以分類。統計分析法則採用邏輯式迴歸模型確認應變項與自變項之間的關聯性。美國健康訪問調查利用加權的方式得到當年度全美國的人口，因此本實驗結果將呈現加權後的估算值。

研究結果
在2010年的美國男性人口中，約有兩千三百萬的美國成年男性規律服用阿斯匹靈(23.7 %)。其中，5.0 %的人被診斷罹患攝護腺癌。經校正變項後，邏輯式迴歸模型的結果
呈現出規律使用阿斯匹靈者與降低攝護腺癌的發生具有關聯性 (OR: 0.57, 95% CI: 0.36 - 0.91)。

結論
本研究發現在美國成年男性中規律使用阿斯匹靈與降低攝護腺癌風險具有關聯性。健康醫療照護者應可針對高風險的族群定期確認其使用阿斯匹靈狀況。未來則需要更多的臨床試驗來證實阿斯匹靈治療攝護腺癌的機轉，方能對攝護腺癌的預防提供更完善的醫療照護。

關鍵字

攝護腺癌 ； 阿斯匹靈 ； Andersen 健康行為模式 ； 美國國民健康訪問調查

並列摘要

Background
Prostate cancer is one of the leading causes of cancer death in the United States (U.S.). In 2012, an estimated 26% of the male cancer patients were prostate cancer patients. The financial burden of prostate cancer is high. The medical expenditure of prostate cancer in the U.S. has been estimated 11.9 billion dollars in 2010. In recent studies, aspirin was reported to be associated with a lower risk of prostate cancer. The underlying mechanism was assumed that non-steroidal anti-inflammatory drugs (NSAIDs) could lower the overexpression of cyclooxygenase-2 (COX-2). However, the association between aspirin and prostate cancer remains controversial.
Objective
The purpose of this study is to investigate the association between the use of aspirin and the risk of prostate cancer using the 2010 National Health Interview Survey (NHIS).
Methods
We conducted a cross-sectional survey study using the 2010 National Health Interview Survey (NHIS). Male respondents aged equal or greater than 20 years old were included as our study population.. The key independent variable was the aspirin regular users which were defined as male respondents who took aspirin at least three times per week. The dependent variable was defined as “Ever had prostate cancer”. The Andersen’s Behavioral Model was used to select covariates, which were categorized as predisposing, enabling, and need factors. Logistic regression models were used to evaluate the association between the regular use of aspirin and the risk of prostate cancer. NHIS is a U.S. national representative dataset and results were reported as national estimates.
Results
An estimated 23 million (23.7 %) men reported that they took aspirin regularly. Of them, 5.0 % had prostate cancer. After adjusting predisposing factors, enabling factors, and need factors, the result showed that regular use of aspirin was significantly associated with a lower risk of prostate cancer (OR: 0.57; 95% CI: 0.36 - 0.91).
Conclusion
The risk of prostate cancer was lower in male respondents who self-reported regularly took aspirin than male respondents who did not regularly took aspirin. Health care providers may regularly check patients’ aspirin use among patients with prostate cancer. Further trails and cohort studies are necessary to investigate the mechanism and confirm the association between aspirin use and the prevention of prostate cancer.

並列關鍵字

prostate cancer ； aspirin ； the Andersen’s Behavioral Model ； National Health Interview Survey (NHIS)

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