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  • 學位論文

胰臟癌病患發生腦中風的風險:台灣人口的世代研究

Higher Incidence of Stroke in the Patients with Pancreatic Cancer: A Nation-based Cohort Study in Taiwan

指導教授 : 丁化

摘要


研究目的:腦血管疾病常會發生在罹患癌症的病人族群。然而,對於胰臟癌患者與腦血管疾病之風險的相關研究卻極為稀少。本研究旨在利用以台灣人口為基礎的健保資料庫來探討胰臟癌患者未來罹患腦血管疾病之風險。 研究方法及資料:本研究為一個回溯性病例對照的世代研究,以台灣健保資料庫為資料來源,找出2000年至2007年間新診斷胰臟癌的病人,以首次出現胰臟癌診斷之日期為index date,並排除在診斷胰臟癌前曾有腦中風或其他癌症相關診斷者,為本研究之病例組。再依性別及年齡,與健保資料庫承保資料檔中未曾發生腦中風及任何癌症者,以1:4比例進行隨機配對,為本研究之對照組。於2000年至2009年追蹤期間,記錄新發生腦中風診斷者;其中以國際疾病分類碼臨床修訂第九版 ICD-9-CM codes 430-438為腦中風之診斷依據。針對病例組及對照組的基本性質分析,連續變項採用t-test,類別變項則採用Chi-squared test;針對胰臟癌與腦中風風險的相關性,則採用Cox proportional hazards regression model進行統計分析。另外,採用Kaplan-Meier analysis及log-rank test進行存活分析。 研究結果:在2000年至2007年間,新診斷胰臟癌的病例組有7102人,對照組有28408人。病例組的平均年齡為66.2歲(標準差13.0歲) ;其中57.4% 為男性。相較於對照組而言,病例組的病人中大多合併有高血壓、糖尿病、高血脂、冠心病及心房顫動等疾病。在追蹤期間,病例組的腦中風累積發生率高於對照組的腦中風累積發生率,分別是32.77及16.86每一千人年累積發生率。經過Cox proportional hazards regression model分析及校正相關共病後,病例組相較於對照組罹患缺血性及出血性腦中風的風險分別為2.07倍(95% CI: 1.77-2.42)及1.88倍(95% CI: 1.22-2.90)。 結論:研究顯示胰臟癌患者有較高的風險罹患缺血性及出血性腦中風。在追蹤期間內,胰臟癌族群相較於非胰臟癌族群罹患缺血性及出血性腦中風的風險分別為2.07倍及1.88倍。其中又以胰臟癌診斷後的前6個月內發生缺血性及出血性腦中風的風險最高,其風險分別為3.56倍及2.47倍。

並列摘要


Objective Cerebrovascular disease is quite common in cancer patients. However, literature on risk of stroke in patients with pancreatic cancer is sparse. This study aims to investigate the risk of stroke in pancreatic cancer patients using a nationwide, population-based database in Taiwan. Methods and Materials A retrospective case-control cohort study was conducted. For the study cohort, we identified patients newly diagnosed with pancreatic cancer in 2000-2007 from the Taiwan National Health Insurance Research Database. For the comparison cohort, subjects without pancreatic cancer matched in terms of sex, age, and the index year were randomly extracted from the same dataset. Events of stroke from 2000-2009 were ascertained from medical claims (International Classification of Disease, Ninth Revision, Clinical Modification, ICD-9-CM, codes 430-438). Stratified Cox proportional hazard regression was used to compare the risk of stroke over follow-up period. Results From 2000 to 2007, 7102 pancreatic cancer patients (66.2±13.0 years; 57.4% male) and 28408 subjects as control group (66.2±13.0 years; 57.4% male) were enrolled into the study. The majority of the patients with pancreatic cancer had hypertension, diabetes, hyperlipidemia, coronary artery disease and atrial fibrillation, which was significantly higher in ratio than control. The incidence of stroke was also found higher in patients with pancreatic cancer than control (32.8 vs. 16.9 per 1,000 person-years) over the follow-up period. Where the hazard ratio of ischemic and hemorrhagic stroke were 2.07 (95% CI: 1.77-2.42) and 1.88 (95% CI: 1.22-2.90), respectively. Conclusion The patients with pancreatic cancer have higher risks of ischemic and hemorrhagic stroke, particularly by first 6 months since pancreatic cancer diagnosed.

參考文獻


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