- 學位論文
探討血管加壓素受體阻斷劑類抗高血壓藥與心肌梗塞相關性之研究
The Correlation of Angiotensin II Receptor Blockers with Myocardial Infarction
摘要
【研究背景】 血管加壓素受體阻斷劑（AngiotensinⅡ Receptor Blocker，簡稱ARB）類藥品為目前台灣治療高血壓最普遍降壓藥物之一，關於其有可能增加心肌梗塞心臟病發生率各方仍有不同看法。雖然該藥品有豐富的大型試驗，但全球性臨床試驗較缺乏東方人種數據；因此了解藥品對人種差異與實際處方的影響，可提供治療的參考。 【研究目的】 評估有使用ARB類降血壓藥品及不同成分之ARB藥品與心肌梗塞心臟疾病之相關性。 【研究方法】 以病例控制研究設計，採用中央健康保險局之100萬歸人檔中40萬歸人檔。病例組為2008~2009年初次被診斷罹患心肌梗塞病患。對照組之選取採個別1比4配對方式，隨機從未曾罹患過心肌梗塞之對照中選取4名。以SAS 9.13 for Windows軟體進行描述性及推論性之統計分析。推論性統計分析使用卡方檢定。危險因素與心肌梗塞相關強度及其95%信賴區間以條件式對數迴歸分析來估計。 【研究結果】 經排除條件後病例組為637名病患，對照組為2548名，研究結果多變相條件式對數迴歸分析調整本態性高血壓、續發性高血壓、糖尿病、純高膽固醇血症及是否使用ARB藥品等因素後，使用ARB者罹病危險對比值OR為1.5（95% CI:0.9∼1.9）。就不同ARB分析使用Candesartan、Valsartan、Olmesartan、Irbesartan、Telmisartan與Losartan者在各別均調整危險因素後，其罹病危險對比值OR分別為1.6（95% CI:1.1∼3.6）、1.4（95% CI:1∼2.4）、1.3（95% CI:0.9∼3.2）、1.3（95% CI:0.8∼2.9）、1.2（95% CI:0.6∼2.5）及0.9（95% CI:0.7∼1.8）。 【結論】 結果顯示整體ARB類藥品罹病危險對比值偏高，但未達統計上顯著差異。再就不同成份分析，最安全的為Losartan其罹病危險對比值低於未使用者，而Candesartan及Valsartan其罹病危險對比值高且達統計上顯著差異，臨床處方需更注意，但應考量其不同適應症有可能影響這二種成分的結果；因此、關於各不同成分ARB是否增加心血管疾病風險的疑慮有必要更進一步研究釐清。
並列摘要
Background: Angiotensin II receptor blockers (ARBs) are one of the most commonly used antihypertensive drugs in Taiwan. It is still controversial that ARBs may have the probable correlation with myocardial infarction(MI). ARBs have a lot of global trials that the correlation with MI is resulted from meta-analysis, however, the global clinical trials containing the complete data of Asian population are lacked. Therefore, understanding the correlation of ARBs with MI can provide more information and reference on the clinical practice. Objective: To evaluate the correlation of myocardial infarction(MI) with different kinds of angiotensin II receptor blockers (ARBs) of antihypertensive drugs. Method: By the case control study approach, this research adopted 400,000 samples from the 2005 main database of the insured of the Bureau of NHIRD as the screening basis. Inclusion criteria were essential hypertension, secondary hypertension, diabetes and pure hypercholesterolemia. Exclusion criteria were diabetic nephropathy, diabetic neuropathy, background diabetic retinopathy, proliferative diabetic retinopathy, rheumatic heart diseases and hypertensive renal diseases. The case group was diagnosis of MI, the control group was screened by diseases including the acute respiratory tract infections, acute glomerulonephritis, inguinal hernia, chronic pyelonephritis, kidney stone, cystitis, injury and poisoning. These two groups were screened by the codes of 6 approved ARB drugs and calculated cumulative doses. The SAS 9.13 for Windows statistical software was used to conduct the descriptive and inference statistical analyses. The correlation intensity and 95% CI between the risk factors and MI were estimated by the logistic analyses. Results: First, after the logistic analyses, the results indicated that after adjusting the hypertension, secondary hypertension, diabetes and pure hypercholesterolemia, patients with ARB medication whose adjusted-odds ratio of having MI is 1.5 times of patients without ARB (95%CI: 0.9~1.7).Secondly, while analyzing different kinds of ARBs, Candesartan, Valsartan, Olmesartan, Irbesartan, Telmisartan and Losartan, the OR of having MI are1.6 times (95% CI:1.1∼3.6）, 1.4 times （95% CI:1.0∼2.4）, 1.3 times （95% CI: 0.9∼3.2）, 1.3 times (95% CI:0.8∼2.9), 1.2 times (95% CI:0.6∼2.5) and 0.9 times (95% CI:0.7∼1.8) of those without any ARBs respectively. Conclusions: The research shows that ARBs no increased the risk of MI. The Odds Ratio of having MI from those who use Candesartan and Valsartan are relatively higher than other ARBs drugs. ARBs are still one of the most commonly used drugs to control BP and protect organs of patients at present. Therefore, it’s necessary to clarify the concerns about the ARBs effect on cardiovascular diseases.
參考文獻
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