Statin在末期腎病合併心肌梗塞患者的效果

根據世界衛生組織(WHO, World health Organization)的統計資料，人類死亡的因素第一位為心血管疾病，其中以急性心肌梗塞最為嚴重。近幾十年來，由於醫學技術與藥物的進步，心肌梗塞的死亡率已經逐漸下降，其中降膽固醇藥物佔有舉足輕重的地步。降膽固藥物可以明顯降低急性心肌梗塞病人的心肌再梗塞機率及死亡率。而這個數字在臺灣人與西方人皆然。在西方的APPLO STUDY 中，心肌梗塞病人的再復發機率及死亡率三年約20%左右，而根據臺灣健保資料庫的資料，心肌梗塞病人三年的復發機率約在14%左右。降膽固醇藥物在末期腎衰竭接受透析合併心肌梗塞病人是否能降低心肌梗塞再發率並無明顯之研究證實。此研究主要是針對末期腎病接受透析的心肌梗塞病人，使用降膽固醇藥物是否有降低死亡率的效果。　　我們蒐集臺灣健保資料庫從2000年到2012年的所有心肌梗塞病人，因末期腎病有接受血液透析的患者，排除復發的心肌梗塞，小於18歲的病人，及資料不全者，共蒐集到8056位病人，其中有2134位有接受降膽固醇藥物治療，5922位病人未接受降膽固醇藥物治療，追蹤其十二年的死亡率。結果發現有使用降膽固醇藥物者，其十二年的死亡率較未使用者低。有使用降膽固醇藥物者中風、腦出血與再心肌梗塞發生機率也較低。在調整過變數(After Propensity match 1:2)後，Cox Proportional Hazard Regression analysis分析發現，降膽固醇藥物可以降低心肌梗塞患者之長期(十二年)死亡率。

關鍵字

死亡率；全民健保資料庫；降膽固醇藥物；心肌梗塞；末期腎衰竭

並列摘要

According to WHO (World health organization) data, the leading cause of mortality of human being is cardiovascular disease. Acute myocardial infarction (AMI) is the most severe form. In the past decades, owing to improvement of medical technique and medicine, the mortality rate and myocardial infarction rate decreased gradually, in which, lipid lowering agent (Statin) played important role. Use of statin has been associated with reduced risk of myocardial re-infarction rate and overall mortality in patients after AMI. However, in patients with end-stage renal disease (ESRD), receiving hemodialysis, the protective effects of statin seem to be controversial. This study aimed to evaluate the impact of statin use on clinical outcome of AMI in ESRD patients. Total 8056 subjects with ESRD admitted for first AMI was enrolled from Taiwan National Health Insurance Research Database (NHIRD). In these patients, 2,134 patients underwent therapy with statin and other 5,922 patients did not receive stain therapy. Statin use resulted in a significantly better 12-year survival rate in overall AMI patients with ESRD than non-statin users, including stroke, intracranial bleeding and myocardial re-infarction rate. In sub-group analysis, benefits of statin in AMI patient with ESRD also existed in patients irrespective of age, diabetes or not, and in male patient, patient not undergoing cardiac revascularization. After propensity matching (1:2 match), Cox Proportional Hazard Regression analysis showed use of statin made a better contribution to AMI long-term survival rate (adjusted Hazard Ratios 0.89, 95% CI: 0.82-0.97; p =0.007). Statin therapy was shown to have better long term (12-year) outcome among ESRD patients suffered from first episode of AMI, irrespective of age, diabetes mellitus. In subgroup analysis, the benefit also existed in patients not undergoing cardiac revascularization, male patient. Among ESRD patients with acute MI, statin therapy was associated with reduced all-cause mortality.

並列關鍵字

Mortality ； National health insurance database ； Acute myocardial infarction ； Statin ； End-stage renal disease

參考文獻

Reference

Google Scholar

Athyros, V. G., Hatzitolios, A. I., Karagiannis, A., Savopoulos, C., Katsiki, N., Tziomalos, K., Papagianni, A., Kakafika, A., Gossios, T. D., Mikhailidis, D. P., & Group, I. C. 2011. Improving the implementation of current guidelines for the management of major coronary heart disease risk factors by multifactorial intervention. The IMPERATIVE renal analysis. Archives of Medical Science, 7(6), 984-992.

Google Scholar

Barylski, M., Nikfar, S., Mikhailidis, D. P., Toth, P. P., Salari, P., Ray, K. K., Pencina, M. J., Rizzo, M., Rysz, J., Abdollahi, M., Nicholls, S. J., Banach, M., Lipid, & Blood Pressure Meta-Analysis Collaboration, G. 2013. Statins decrease all-cause mortality only in CKD patients not requiring dialysis therapy--a meta-analysis of 11 randomized controlled trials involving 21,295 participants. Pharmacological research, 72, 35-44.

Google Scholar

Cannon, C. P., Blazing, M. A., Giugliano, R. P., McCagg, A., White, J. A., Theroux, P., Darius, H., Lewis, B. S., Ophuis, T. O., & Jukema, J. W. 2015. Ezetimibe added to statin therapy after acute coronary syndromes. The New England Journal of Medicine, 372(25), 2387-2397.

Google Scholar

Castelli, W. P. 1984. Epidemiology of coronary heart disease: the Framingham study. American Journal of Medicine, 76(2), 4-12.

Google Scholar

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