運用資料探勘技術評估使用Clopidogrel併用氫離子幫浦抑制劑之急性冠心病患再入院因子

Estimation of Readmission Factors for ACS Patients Who Received Clopidogrel with Clopidogrel PPIs by Data Mining Techniques

陳冠臻(Kuan-Chen Chen)

指導教授 ： 張怡秋博士 ； 胡雅涵博士

國立中正大學/管理學院/資訊管理系醫療資訊管理研究所/碩士(2015年)

摘要

急性冠心症候群是指任何急性心肌缺血的臨床症狀，此疾病最常由冠狀動脈內形成的急性血栓所導致。
為防止冠狀動脈內血栓的形成，臨床醫師常會給予抗血小板用藥(clopidogrel)來保持血液的流暢。抗血小板藥物雖可有效降低心血管疾病之風險，但也增加了腸胃道出血的機會，臨床常合併氫離子幫浦抑制劑(PPIs)來降低出血之發生率。近來有許多的研究顯示併用氫離子幫浦抑制劑會影響clopidogrel的臨床療效，但其臨床實證仍不一致。
為探討clopidogrel與氫離子幫浦抑制劑併用對急性冠心病患預後之影響，本研究擷取國家衛生研究院發行之「全民健康保險研究資料庫」2005年至2010年間的急性冠心病患住院資料，應用WEKA3.7.3為資料探勘工具，建構不同分類器來評估影響clopidolgrel併用PPIs對急性冠心病患預後之影響因子。
本研究收案2603人，其中施行冠狀動脈繞道手術計342人，皆無30天再入院情形；施行經皮冠狀動脈血管成形術個案為2261，有121人於30天再入院 。以CART樹分析再入院風險後發現：：男性再入院風險大於女性、男性服用Diltiazem若同時服用Esomeprazole及Nifedipine藥物者再入院風險更高、大於65歲男性若同時服用Diltiazem 、Esomeprazole及Nifedipine再入院風險較高、女性服若用Esomeprazole, Pantoprazole再入院風險較高。

關鍵字

氫離子幫浦抑制劑 ； Clopidogrel ； 資料探勘技術 ； 急性冠心症

並列摘要

Acute coronary syndrome (ACS) refers to any clinical manifestations of myocardial ischemia, which often caused by coronary thrombosis.
For secondary prevention, clinic physicians use antiplatelet agents, such as clopidogrel, to decrease platelet aggregation therefore inhibit thrombus formation. While these drugs are effective in reducing the risk of ACS, they can increase the change of GI bleeding. Proton pump inhibitors (PPIs) are widely used to decrease the opportunity of this side effect. However multiple researches have reported use clopidogrel combination with PPIs may affect the effective of clopidogrel. The evident of the effect is inconsistent.
To discuss the effects on prognosis of ACS patients who use clopidogrel with PPIs, we retrieved data of ACS inpatients through 2005 to 2010 from National Health Insurance Research Database. We Apply WEKA3.7.3 as our data mining tool and build up various of classifiers to estimate the prognosis factors of ACS patients taking clopidogrel with PPIs.
With collect total 2,603 cases, 342 of them received coronary artery bypass graft (CABG), and 2261 received percutaneous coronary intervention (PCI). None of CABG patients experienced readmission after discharged, while 121 PCI patients experienced. Using CART Tree Analysis the readmission risk, we find the risk of male is greater than female. For male who take diltiazem with esomeprazole and nifedipine, the risk is much greater. The risk of readmission of males who are older than 65 is increased. Finally females receiving esomeprazole or pantoprazole have higher chance of readmission.

並列關鍵字

Clopidogrel ； Clopidogrel ； Data Mining ； ACS

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