荷爾蒙替代療法對台灣地區女性肺癌風險之影響

Hormone replacement therapy and risk of female lung cancer in Taiwan

林可昕(Ke-Hsi Lin)

指導教授 ： 楊俊毓

高雄醫學大學/健康科學院/公共衛生學研究所碩士在職專班/碩士(2011年)

摘要

§研究目的:自1985年起肺癌成為全球死亡率及發生率最高之疾病，台灣肺癌更是國民健康局所公布的十大死因之首惡性腫瘤當中的第一名；有強烈的證據顯示肺癌最大危險因子為菸害，但在台灣地區的肺癌流行病學調查卻顯示，屬於低吸菸率的族群 “女性”其肺癌的發生率與死亡率與男性一樣逐年增加，是否在女性族群上存在著影響肺癌風險的危險因子？本研究目的為探討女性為緩解更年期所致之不適症狀，所使用賀爾蒙替代療法是否影響女性肺癌風險之變化。
§研究方法:本研究為病例對照研究法，使用台灣「全民健康保險研究資料庫」之承保抽樣歸人檔進行分析討論，共抓取339位2004~2008年初次罹患肺癌之50歲以上更年期女性為病例組，並以1:4的比例且依照年齡與就醫日期挑選共1596位健康對照組，並排除過去曾罹患癌症、慢性阻塞性肺疾病、肺結核、塵肺症及外物所導致之肺疾病、心血管疾病與腦血管疾病，回朔研究對象由1997年起之住院及門診資料，取得研究對象過去病史及用藥史資訊。統計分析使用邏輯斯迴歸分析，估算荷爾蒙替代療法的使用與累積使用劑量對於肺癌的風險性。
§研究結果:在校正年齡與其他危險因子後，分析結果顯示更年期女性使用荷爾蒙替代療法肺癌風險會比未使用者高1.24倍(95% C.I.=0.98~1.57)但結果未據有統計學上顯著意義，而在將荷爾蒙替代療法進一步依總使用累積劑量分析，結果顯示總使用累積劑量與肺癌風險呈顯著線性關係，特別是在使用荷爾蒙替代療法總使用累積劑量較高(>2136.23 mg)的更年期女性族群會較沒有使用者高1.50倍(95% C.I.=1.00~2.26)，而使用荷爾蒙替代療法總使用累積劑量較低(<2136.23 mg)族群期肺癌風險是未使用者的1.17倍(95% C.I.= 0.91~1.52)。

關鍵字

荷爾蒙替代療法 ； 使用劑量更年期 ； 女性 ； 肺癌 ； 台灣

並列摘要

§Objective: Since 1985, lung cancer is the highest cause of mortality and incidence in the world. In Taiwan, Bureau of Health Promotion, Department of Health, R.O.C.(Taiwan) published that lung cancer is number one of our top 10 causes of death. Smoking is a worldwide main factor of lung cancer, but we found that most female patient with lung cancer is non-smokers in Taiwan. Incidence and mortality of female’s lung cancer is increased year by year as men. Do the risk factors of lung cancer exist in female? The purpose of the research is to discuss unwell symptoms when women want to ease menopause, by using of Hormone Replacement Therapy (HRT) if affect the risk of female to get lung cancer.
§Methods: Using a case-control study way and the analyzed data which based on Longitudinal Health Insurance Database of the National Health Insurance Research Database (NHIRD). At the period of 2004 to 2008, 339 women with age over 50 and lung cancer was our study and according to 1-4 percentage to select 1596 people who matched health controls with data of HRT, but excluded the people who has case history of cancer, chronic obstructive pulmonary disease, pulmonary tuberculosis, pneumoconiosis, and lung disease caused by foreign objects, cardiovascular disease and cerebrovascular disease. All information of women in this study was retrospected since 1997, also knew their case history and medical history. Multiple logistic regression analyses were conducted to assess the association between HRT and the risk of lung cancer.
§Results: After adjusted potential confounders, the risk of lung cancer for women who used HRT was higher than nonusers (OR=1.24; 95% CI = 0.98~ 1.57). There was an increased risk of lung cancer association with high (OR=1.5; 95% CI = 1.00 ~ 2.26) and low (OR=1.17; 95% CI = 0.91 ~ 1.52) dose of HRT user, it reflected dose-response. These findings indicate that HRT may be involved in the etiology of lung cancer.

並列關鍵字

Hormone Replacement Therapy (HRT) ； Dose ； Menopause ； Women ； lung cancer ； Taiwan

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