探討Statins類降血脂藥品在第二型糖尿病合併血脂異常患者之處方趨勢

Prescribing trends of statins for antihyperlipidemia agents to patients with type II diabetic dyslipidemia in Taiwan

詹璧瑋(Pi-Wei Chan)

指導教授 ： 黃耀斌

共同指導教授 ： 蔡東榮(Tong-Rong Tsai)

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2008年)

摘要

背景：第二型糖尿病合併血脂異常患者是心血管疾病的高危險群，因此使用Statins類降血脂藥品作為控制血脂有其重要性。且血脂異常的控制逐漸受到重視，所以值得進行Statins類降血脂藥品處方趨勢之分析。

目的：探討台灣地區第二型糖尿病合併血脂異常患者使用Statins類降血脂藥品之處方趨勢分析。

材料與方法：本研究是採用回溯性研究（Retrospective study），使用之資料係向國家衛生研究院申請購得全民健保學術研究資料庫的檔案。
研究期間為2001年~ 2005年，篩選年齡層分為青年期18~44歲、中壯年期45~64歲、老年期65歲以上之罹患第二型糖尿病合併血脂異常的門診患者為研究對象。探討此類患者於門診接受降血脂藥品Statins類之處方趨勢分析。

結果：在探討2001~2005年三組年齡層，三大類降血脂藥品之「處方比率」部份，發現第二型糖尿病病人在中壯年期使用三大類降血脂用藥的處方比率(50.7%)，比青年期及老年期都要高；並分析三大類降血脂藥品的處方比率，發現在中壯年期及老年期是Statins類處方比率較高，但是在青年期的處方比率卻略低於Fibrates。
分析2001年~2005年三大類降血脂藥品之「處方比率」趨勢，可看出雖然處方比率只有Statins類降血脂藥品是逐年增加；但從2001~2005年三大類降血脂藥品之「處方筆數」趨勢分析中，可看出三大類降血脂藥品的處方筆數皆有逐年增加的趨勢，且Statins和Fibrates類降血脂藥品在2002-2004年大幅增長。
雖然從2001年到2005年降血脂藥品Statins類的處方筆數皆呈現逐年增加的趨勢，但僅以Atorvastatin的處方比率呈現增加的趨勢，而其餘的四種Statins類藥品的處方比率呈現降低或持平的情形；另外，在2001年初，以Simvastatin的處方比率最高，但之後就逐年下降。
另一方面，分析探討Statins類降血脂藥品在台灣的四種醫院層級(醫學中心、區域醫院、地區醫院和基層院所)之中的處方比率，醫學中心以Atorvastatin的處方比率佔最多，而基層院所以Lovastatin的處方比率佔最多。
結論：從本篇研究中發現，三大類降血脂藥品的處方趨勢皆為逐年增加，其中以Statins類降血脂藥品增加最多；但Fibrates類降血脂藥品因為在降低三酸甘油脂有顯著效用，因此仍有無可取代的地位。
此外，探討2001年至2005年在Statins類降血脂藥品中，以Atorvastatin的處方筆數及比率增加幅度為最多；但是探討2001年至2005年在基層醫療院所中，以Lovastatin的處方比率最多，甚至超過後續改良的Simvastatin；因為在基層院所以Lovastatin所佔處方比例最多，使得此五年研究期間Lovastatin的整體處方比率僅次於Atorvastatin的處方比率。

關鍵字

Statins類降血脂藥品 ； 第二型糖尿病合併血脂異常 ； 處方趨勢

並列摘要

Background: Patients with type II diabetic dyslipidemia were the high risk group of cardiovascular disease. Thus, it is very important to use statins for antihyperlipidemia agents. However, the control of dyslipidemia toke a note gradually, therefore it is worth of carrying on analysis the prescribing trends of statins.

Objective: To analysis the prescribing trends of statins for antihyperlipidemia agents to patients with diabetic dyslipidemia in Taiwan.

Materials & Methods: A retrospective study was implemented using the National Health Insurance Research Database, including files of ambulatory care expenditures by visits and details of ambulatory care orders and the basic database of medical institution, between January 2001 and December 2005. Adult outpatients with type II diabetic dyslipidemia were the subjects. Their age levels include 18~44 years old,45~64 years old, and above 65 years old. To analysis the prescribing trends of statins for antihyperlipidemia agents to patients with diabetic dyslipidemia.

Results: From 2001 to 2005 years, three types of lipid lowerings drugs, only the prescribing rate of statins increased by years. But in the prescribing items, lipid lowerings drugs had increased by years. Of all statins, only Atorvastatin increased in the prescribing rate. On the other hand, of all hospital levels, Atorvastatin had the most prescribing rates in medical centers in Taiwan, and lovastatin had the most prescribing rates in clinics in Taiwan.

Conclusion: Although statins had the most prescribing rates during 2001-2005, fibrates had their unique function in marked lowering triglyceride levels. Besides, among statins, Atorvastatin had the most increase of prescribing rates. Note that lovastatin had the most prescribing rates in clinics during 2001-2005. Cause that the overall prescription rates of lovastatin were only inferior to Atorvastatin during the period of research.

並列關鍵字

statins antihyperlipidemia agents ； type II diabetic dyslipidemia ； prescribing trend

參考文獻

American Diabetes Association. (2004a). Dyslipidemia management in adults with diabetes (Position Statement). Diabetes Care, 27(Suppl. 1), S68-S71.

American Diabetes Association. (2004b). Standards of medical care in diabetes (Position Statement). Diabetes Care, 27(Suppl. 1), S68-S71.

American Diabetes Association. (2005). Standards of medical care in diabetes(Position Statement). Diabetes Care, 28, S4-36.

Cheng, S. F., Hsu, H. H., Lee, H. S., Lin, C. S., Chou, Y. C., & Tien, J. H. (2004). Rational pharmacotherapy in the diabetic hypertension: analysis-prescribing patterns in a general hospital in Taiwan. Journal of Clinical Pharmacy and Therapeutics 111, 29(6), 547-558.

Colhoun, H. M., Betteridge, D. J., & Durrington, P. N. (2004). Primary prevention of cardiovascular disease with atovastatin in type 2 diabetes in the Collaborative Atovastatin Diabetes Study(CARDS):multicenter randomised placebo-controlled trial. Lancet, 364, 685-696.