台灣主動脈瘤之流行病學及手術病人使用內科藥物之效果評估

Epidemiology of Aortic Aneurysm in Taiwan and the Effectiveness of Medical Therapy on Operated Aortic Aneurysm

王詩瑋(Shih-Wei Wang)

指導教授 ： 黃耀斌

高雄醫學大學/藥學院/藥學系臨床藥學碩士班/碩士(2015年)

https://doi.org/10.6832/KMU.2015.00043

摘要

研究背景：主動脈瘤為一高致死率疾病，在西方國家的盛行率約落在1.3-8%之間，而至今在亞洲地區仍無完整之流行病學資料顯示其疾病之盛行狀況。此外，內科藥物對主動脈瘤病人的效果仍舊具有爭議，研究結果發現HMG-CoA還原酶抑制劑(Statin)在學理機轉上能抑制主動脈瘤擴張、降低破裂風險，同時對於手術後的短期併發症或長期預後都有影響；而Aspirin對預防主動脈瘤擴張或降低死亡率並沒有顯著的效果，目前依然缺乏足夠的證據證明這些藥物在主動脈瘤手術病人的療效及安全性。
研究目的：本研究希望藉由向國家衛生研究院申請取得之全人口資料，探討主動脈瘤疾病在台灣的流行病學及處方型態評估，並針對主動脈瘤手術病人使用Aspirin/Statin與預後之相關性進行探討，以期提供臨床醫師相關藥物治療成效之參考。
研究方法：本研究分成兩大部分，第一部分為流行病學及藥物使用評估，探討主動脈瘤疾病於2005-2011在台灣的發生率、盛行率及死亡率等，探討主動脈瘤病人之常見共存疾病、治療型態及預後，並進行藥物使用評估，了解主動脈瘤疾病的處方型態及治療藥物選擇。第二部分為資料庫研究，以向國家衛生研究院申請取得之特殊需求檔為資料來源，分別納入2005-2010年符合納入條件之主動脈瘤手術病人，以手術日為納入日，評估病人之基本資料、共病症、內科藥物處方與手術預後的相關性。

研究結果及討論：
(一) 主動脈瘤在台灣的年平均發生率為7.35人/十萬人，且發生率在2005-2011年間逐漸升高，男性的發生率約為女性的三倍，且在老年族群的發生率較非老年族群來得高出許多。
(二) 在考慮immortal time及lag time對結果的影響，且校正相關變項後，Aspirin及Statin的使用皆能顯著降低主動脈瘤手術病人在術後的死亡風險(Aspirin: HR:0.422, CI:0.314-0.566; Statin: HR:0.279, CI:0.175-0.444)；但對於因主動脈瘤再住院(Aspirin: HR:0.771, CI:0.466-1.274; Statin: HR:0.485, CI:0.246-0.955)及再次手術(Aspirin: HR:0.9, CI:0.427-1.895; Statin: HR:0.605, CI:0.234-1.569)等相關研究終點，並無顯著之差異。
結論：主動脈瘤在台灣的疾病發生率逐年上升，尤以老年族群為主，對於已步入老年化社會的台灣而言，是我們應該更加重視的疾病之一。針對主動脈瘤手術病人在手術成功後，持續使用Aspirin或Statin皆能減少全死因死亡之風險，然而對於因主動脈瘤再住院或再次手術等並無顯著影響。

關鍵字

主動脈瘤 ； 手術 ； 流行病學 ； 資料庫研究 ； HMG-CoA還原酶抑制劑 ； 抗血小板藥品

並列摘要

Background: Aortic aneurysm (AA) is a leading cause of death in most countries. The prevalence of abdominal aortic aneurysm (AAA) has been reported in Western countries is around 1.3-8%. It’s still unclear about the incidence, prevalence and outcome of AA for all subtypes in general population. On the other hand, the effectiveness of medical therapy for AA remained controversial. The evidences are still weak, especially for patients who receive operation for aortic aneurysm.
Study aim: The objective of this study is to investigate the epidemiology of AA in Taiwan by both incidence and prevalence, as well as to evaluate the prescribing patterns. In addition, we evaluated the outcomes of patients who received operation for AA, and also find the association between medication use and outcome.
Methods: The study is divided into two parts. The first part is an epidemiological study to calculate the incidence, prevalence and mortality of AA in Taiwan between 2005 and 2011. The second part is a population-based cohort study. We identified patients who having the diagnosis of AA and also receiving operation between January 1, 2005 and December 31, 2010. Baseline characteristics, disease information, prescribing pattern were all assessed. The endpoints included all-cause death, AA-related re-hospitalization and re-operation. The association between medication use and outcome for patients received operation was evaluated by cox regression.

Results: The epidemiology research shows that the incidence of AA in Taiwan increased in recent years. The average annual incidence of AA in Taiwan is 7.35 per 100,000 people, and the prevalence is 29.04 per 100,000 people. The incidence is associated with both gender and age difference. It’s much higher in those who aged above 65 years, especially for male population.
In the second part of this study, we included 1936 operated AA patients during 2005-2010, 1633 of them survived more than 30 days. Among the 1633 patients, we found that both of aspirin and statin significantly decrease the all-cause mortality (Aspirin: HR:0.422, CI:0.314-0.566; Statin: HR:0.279, CI:0.175-0.444).
Conclusion: It shows an increased trend of AA for incidence, prevalence and mortality during 2005-2011. Prescribing aspirin and statin after AA surgery could decrease the all-cause mortality significantly, but was no significant benefit for re-operation and re-hospitalization.

並列關鍵字

aortic aneurysm ； operation ； epidemiology ； database ； HMG-CoA reductase inhibitor ； aspirin

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