服用吸入式類固醇或長效支氣管擴張劑的氣喘病患在癌症上的風險: 以台灣全人口基礎的前瞻式世代研究

Risk of cancers among asthmatic patients with inhaled corticosteroids or long-acting beta2-agonists usage: A population-based prospective cohort study in Taiwan

黃煦凱(Hsu-Kai Huang)

指導教授 ： 洪炯宗

國立中央大學/資訊電機學院/資訊工程學系/碩士(2014年)

摘要

氣喘是一個常見的肺部疾病，具有慢性發炎、氣流阻塞和支氣管過度反應的特性，此外，慢性發炎已經被指出與致癌的關係密切。對氣喘病患而言，吸入式類固醇是最有效的抗發炎藥物而且被建議為第一線治療，當病患服用低劑量的吸入式類固醇控制不良時，則必須增加吸入式類固醇的劑量或者再加入長效支氣管擴張劑控制藥物(建議)。因此，我們從全民健康保險研究資料庫抓取20歲以上的新發氣喘病患，再來排除一些會影響我們研究的病患，然後評估常態性服用吸入式類固醇或長效支氣管擴張劑在癌症風險上的影響。最後，我們觀察到常態性服用吸入式類固醇(沒有服用長效支氣管擴張劑)的使用者，若平均每天吸入式類固醇劑量小於或等於2000微克，對整體癌症以及肺癌和肝癌有保護的效果，若超過2000微克則對前列腺癌有保護的效果。然而，常態性服用吸入式類固醇和長效支氣管擴張劑的使用者，若平均每天吸入式類固醇劑量小於或等於2000微克，會增加肺癌風險，若超過2000微克則會增加整體癌症以及口腔癌和皮膚癌的風險。另外，常態性服用長效支氣管擴張劑(沒有服用吸入式類固醇)的使用者，我們沒有發現長效支氣管擴張劑的使用與整體癌症風險之間的關聯。

關鍵字

氣喘 ； 吸入式類固醇 ； 長效支氣管擴張劑 ； 癌症 ； 台灣 ； 世代研究

並列摘要

Asthma is a common pulmonary disorder, which is characterized by chronic inflammation, airflow obstruction and bronchial hyperresponsiveness. Furthermore, the close relationship between chronic inflammation and carcinogenesis has been reported. Currently, inhaled corticosteroid (ICS) is the most effective anti-inflammatory drug for patients with asthma and recommended as first-line therapy. When patients do not control asthma well with the low-dose ICS, they have to either increase the dosage of ICS or add the long-acting ß-agonist (LABA) controller medication (recommended). Thus, we select ≥20 years newly asthmatic patients from National Health Insurance Research Database (NHIRD), exclude some patients who affect our study and evaluate the effects of regular use of ICS or LABA on the cancers risk. Finally, we observe that ICS have protective effects on overall, lung and liver cancer when taking ≦2000 mcg/day as well as on prostate cancer when taking >2000 mcg/day among ICS only regular users. However, ICS/LABA regular users significantly increase risk of lung cancer when taking ≦2000 mcg/day ICS dosage as well as of overall, oral and skin cancer when taking >2000 mcg/day ICS dosage. In addition, we do not find the association between LABA use and overall cancer risk among LABA only regular users.

並列關鍵字

asthma ； inhaled corticosteroids ； long-acting beta2-agonists ； cancer ； Taiwan ； cohort study

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