| 摘要: | 研究背景與動機：糖尿病與癌症是兩種不同形式的慢性病，且影響全球民眾健康，尤其是第2型糖尿病與癌症之間有許多錯綜複雜的共同危險因子。口服降血糖藥物為第2型糖尿病之主要治療方式，其中一類為Thiazolidinedione(TZDs)。該類藥物接二連三發生不良事件，最近美國FDA再發佈『使用糖尿病藥物(Actos ，愛妥糖)超過一年以上，可能會增加罹患膀胱癌的風險』，震驚全球醫界，更讓新陳代謝科醫師及病患陷入恐慌。目前關於使用TZDs類藥物與罹患癌症風險之大型具全國代表性研究仍然不多，尤其利用亞洲人口數據探討糖尿病患者使用TZDs藥物與癌症發生之相關性研究，更是付之闕如。
研究目的：以健保資料庫探討第2型糖尿病患者服用TZDs藥物與罹患膀胱癌、大腸癌及其他癌症之相關性。
研究方法：資料來源為全民健保2005年之承保抽樣歸人檔資料庫，本研究申購2002-2009年共100萬人進行分析。研究對象為使用降血糖TZDs類藥物且ICD-9-CM主診斷、次診斷及第三診斷碼為250.00~250.93之糖尿病患者，年齡大於40歲。本研究樣本八年共27,382人，其中男性患者為14,748人，女性為12,634人。以卡方檢定與二元邏輯斯及多項式邏輯斯進行分析。
研究結果：本研究發現性別、年齡、糖尿病病齡、疾病嚴重度、TZDs使用期長短及就醫層級別影響糖尿病患者服用TZDs藥物罹患大腸癌、膀胱癌或其他癌症風險。顯示男性年齡50歲以上隨著年齡增加罹患大腸癌或膀胱癌風險性成正相關，其勝算比為年齡40-49歲之2至9倍以上。糖尿病病齡1-2年者且TZDs使用期3年以上者比未滿1年有高於1倍以上之風險比。大多數罹患癌症者選擇醫學中心就醫。疾病嚴重程度重度者比輕度高達3-4倍以上風險罹患癌症。
結論：第2型糖尿病服用TZDs類藥物3年以上有高風險罹患膀胱癌、大腸癌或其他癌症，高齡者及疾病嚴重程度重度者為高危險群。建議衛生署是否考慮將TZDs類藥物下架或將高齡使用TZDs類藥物3年以上者給予免費膀胱癌篩檢及定期追蹤，以確保民眾用藥安全及降低健保醫療費用支出。
Background: Diabetes and cancer are common chronic diseases with tremendous impact on health worldwide.Type 2 diabetes and cancer have many common risk factors complicated. Oral hypoglycemic drugs for type 2 diabetes, is the primary treatment, one of drugs is the Thiazolidinedione (TZDs). Adverse events occurred one after another of these drugs. The U.S. Food and Drug Administration (FDA) is informing the public that“use of the diabetes medication Actos (pioglitazone) for more than one year may be associated with an increased risk of bladder cancer”, shocked the world medical, making panic with endocrinologist and patients. Current association between TZDs use and cancer onset among patients with diabetes, a large nationally representative study is still small. Especially in the Asian diabeties data with taking TZDs and cancer related research, it is missing.
Objectives: To explore association between TZDs use and bladder cancer, colorectal cancer or other cancers onset among patients with type 2 diabetes by National Health Insurance (NHI) database.
Methods: A random sample of 1,000,000 people insured by the NHI in 2005 was created by the National Health Research Institute for academic research.To study on National Health Insurance database from 2002-2009. Study for the use of hypoglycemic drugs TZDs and ICD-9-CM primary diagnosis, secondary diagnosis, and the third diagnosis code 250.00- 250.93 of diabetes, with greater than 40 years of age. The results of 27,382 patients, of which 14,748 were males, 12,634 were females. By Chi-square test , binary logistic and multinomial logistic analysis.
Results: The study found that gender, age, duration of diabetes, severity of diabetes, TZDs use and hospital level influence patients with diabetes taking TZDs risk of colorectal cancer , bladder cancer and other cancers. Showed that males with age over 50 years as the age increases the risk of bladder cancer or colorectal cancer is positively related and the odds ratio of 2 to 9 times for the age of 40-49 years. Duration of diabetes 1-2 years and TZDs period of 3 years than those with less than one year are more than one times higher than the risk ratio. Most patients with cancer choose Medical Center for cancer treatment. Those with severity of disease and severe up to 3-4 times more than the mild risk of cancer.
Conclusion: Type 2 diabetes taking TZDs drugs for 1-2 years have high risk of suffering from bladder cancer, colorectal cancer and other cancers, elderly and disease severity were severe for the high risk group. Recommended that the Department of Health is considering TZDs withdrawal or to be used TZDs drugs were given over 3 years free bladder cancer screening and regular follow-up to ensure public safety and reducing medication health insurance expenses. |
