痛風病患使用Allopurinol在心血管疾病的影響:以台灣人口為基礎的世代研究

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研究生：	張菀珊 Wan-shan Chang
論文名稱：	痛風病患使用Allopurinol在心血管疾病的影響:以台灣人口為基礎的世代研究 Effect of Gout and Allopurinol Use on Cardiovascular Disease Outcomes:A Population-Based Cohort Study in Taiwan
指導教授：	洪炯宗 Jorng-tzong Horng
口試委員:
學位類別：	碩士 Master
系所名稱：	資訊電機學院 - 資訊工程學系在職專班 Executive Master of Computer Science & Information Engineering
論文出版年：	2013
畢業學年度：	101
語文別：	中文
論文頁數：	45
中文關鍵詞：	痛風、心血管疾病、Allopurinol 、世代研究
外文關鍵詞：	gout, cardiovascular, Allopurinol, Population-Based Cohort Study
相關次數：	點閱：15 下載：0
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痛風為代謝疾病之一，此病常合併高尿酸血症、急性及慢性關節炎、腎臟炎等疾病。近年研究顯示痛風患者，也是心血管疾病發生及死亡的高危險群。Allopurinol為臨床上經常使用於降低血液中尿酸濃度的藥物，其作用機制為抑制黃嘌呤氧化酶(Xanthine oxidase)而減少尿酸之形成。本研究擬利用台灣全民健保研究資料庫之資料，針對大於40歲的痛風病患使用Allopurinol治療是否有效降低心血管疾病之發生率。研究結果顯示，Allopurinol使用者與非使用Allopurinol使用者相比，Allopurinol使用者有顯著增加心血管事件風險 (HR =1.33, 95% CI 1.26-1.41).。在使用Allopurinol組中，比起服用低劑量（<100毫克和100毫克）的用戶，服用高劑量（≥300毫克）的用戶有顯著減少心血管事件的風險（HR =0.67, 95％ CI 0.48-0.92）。結論：整體上痛風患者使用Allopurinol治療在引發心血管疾病而住院的患者比起非使用Allopurinol治療組並沒有減少的表現。而在所有使用Allopurinol治療的患者中，服用高劑量患者的心血管事件風險均低於低劑量的患者。

Gout is a type of metabolic diseases, the disease is often associated with hyperuricemia, acute and chronic arthritis, kidney disease go far. In recent years, studies have shown that patients with gout also cardiovascular disease and death in high risk groups. Allopurinol is frequently used in clinical practice to lower blood uric acid concentrations of the drug, and its mechanism of inhibition of xanthine oxidase and reduce the formation of uric acid. This study intends to use the Taiwan National Health Insurance Research Database information which more than 40-year-old patient with gout use allopurinol whether treatment reducing the incidence of cardiovascular disease. The results show that, if allopurinol compared with non-allopurinol users, the allopurinol users were significant increased risk of cardiovascular events (HR =1.33, 95% CI 1.26–1.41). Compared with low-dose (<100 mg & 100 mg) users, high-dose (≥300 mg) users had significant reductions in the risk of cardiovascular events (HR =0.67, 95% CI 0.48–0.92), which all patients on allopurinol treatment. The results did not show an effect of use allopurinol as a class on reductions cardiovascular disease hospitalization rate in patients with gout. Higher doses of allopurinol risks of cardiovascular events were lower than lower doses in all patients on allopurinol treatment.

Chinese Abstract    I
English Abstract     II
Table of Contents     III
List of Tables      V   
List of Figures     VI
Chapter 1 Introduction     1
    1-1 Background     1
    1-2 Motivation     1
    1-3 Research Goal     2
Chapter 2 Related Works     3
    2-1 Gout     3
    2-2 Mechanism of Allopurinol    4
    2-3 Cardiovascular Disease Associated with Allopurinol    5
Chapter 3 Materials And Methods     7
    3-1 Data Source     7
    3-2 Study Population and Design     8
    3-3 Definition of diseases     10
    3-4 Statistical Analyses     11
Chapter 4 Results     12
    4-1 Basic Demographics and Clinical Characteristics     12
    4-2 Relation to Different Treatment-Groups and Associated CVD Outcome Hazard Rates     18
    4-3 Relation to Different Treatment-Groups and Associated different CVD Outcome Hazard Rates    21
    4-4 Relation to Different Treatment-Groups and Associated different CVD Outcome Hazard Rates and Stratified by Presence of Diabetes Mellitus and Chronic Kidney Disease     21
    4-5 Relation to Different Treatment-Groups and Associated Survival curve     24
Chapter 5 Discussion     25
Chapter 6 Conclusion     28
References     29
Appendix     31
                                

1. Neogi, T., Clinical practice. Gout. N Engl J Med, 2011. 364(5): p. 443-52.
2. Okamoto, K., et al., Mechanism of inhibition of xanthine oxidoreductase by allopurinol: crystal structure of reduced bovine milk xanthine oxidoreductase bound with oxipurinol. Nucleosides Nucleotides Nucleic Acids, 2008. 27(6): p. 888-93.
3. Day, R.O., et al., Clinical pharmacokinetics and pharmacodynamics of allopurinol and oxypurinol. Clin Pharmacokinet, 2007. 46(8): p. 623-44.
4. Struthers, A. and F. Shearer, Allopurinol: novel indications in cardiovascular disease. Heart, 2012. 98(21): p. 1543-5.
5. Primatesta, P., E. Plana, and D. Rothenbacher, Gout treatment and comorbidities: a retrospective cohort study in a large US managed care population. BMC Musculoskelet Disord, 2011. 12: p. 103.
6. Kao, M.P., et al., Allopurinol benefits left ventricular mass and endothelial dysfunction in chronic kidney disease. J Am Soc Nephrol, 2011. 22(7): p. 1382-9.
7. George, J., et al., High-dose allopurinol improves endothelial function by profoundly reducing vascular oxidative stress and not by lowering uric acid. Circulation, 2006. 114(23): p. 2508-16.
8. El Solh, A.A., et al., Allopurinol improves endothelial function in sleep apnoea: a randomised controlled study. Eur Respir J, 2006. 27(5): p. 997-1002.
9. Guthikonda, S., et al., Xanthine oxidase inhibition reverses endothelial dysfunction in heavy smokers. Circulation, 2003. 107(3): p. 416-21.
10. Farquharson, C.A., et al., Allopurinol improves endothelial dysfunction in chronic heart failure. Circulation, 2002. 106(2): p. 221-6.
11. Struthers, A.D., et al., Effect of allopurinol on mortality and hospitalisations in chronic heart failure: a retrospective cohort study. Heart, 2002. 87(3): p. 229-34.
12. Doehner, W., et al., Effects of xanthine oxidase inhibition with allopurinol on endothelial function and peripheral blood flow in hyperuricemic patients with chronic heart failure: results from 2 placebo-controlled studies. Circulation, 2002. 105(22): p. 2619-24.
13. Butler, R., et al., Allopurinol normalizes endothelial dysfunction in type 2 diabetics with mild hypertension. Hypertension, 2000. 35(3): p. 746-51.
14. Cardillo, C., et al., Xanthine oxidase inhibition with oxypurinol improves endothelial vasodilator function in hypercholesterolemic but not in hypertensive patients. Hypertension, 1997. 30(1 Pt 1): p. 57-63.
15. Schlesinger, N., Management of acute and chronic gouty arthritis: present state-of-the-art. Drugs, 2004. 64(21): p. 2399-416.
16. Schlesinger, N., Difficult-to-treat gouty arthritis: a disease warranting better management. Drugs, 2011. 71(11): p. 1413-39.
17. Curiel, R.V. and N.J. Guzman, Challenges associated with the management of gouty arthritis in patients with chronic kidney disease: a systematic review. Semin Arthritis Rheum, 2012. 42(2): p. 166-78.
18. Wei, L., et al., Impact of allopurinol use on urate concentration and cardiovascular outcome. Br J Clin Pharmacol, 2011. 71(4): p. 600-7.
19. Becker, M.A., et al., The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther, 2010. 12(2): p. R63.
20. Kok, V.C., et al., Gout and subsequent increased risk of cardiovascular mortality in non-diabetics aged 50 and above: a population-based cohort study in Taiwan. BMC Cardiovasc Disord, 2012. 12: p. 108.
21. Kanbay, M., et al., The role of uric acid in the pathogenesis of human cardiovascular disease. Heart, 2013. 99(11): p. 759-66.
22. Alderman, M. and K.J. Aiyer, Uric acid: role in cardiovascular disease and effects of losartan. Curr Med Res Opin, 2004. 20(3): p. 369-79.
23. Cappola, T.P., et al., Allopurinol improves myocardial efficiency in patients with idiopathic dilated cardiomyopathy. Circulation, 2001. 104(20): p. 2407-11.
24. Alderman, M.H., Podagra, uric acid, and cardiovascular disease. Circulation, 2007. 116(8): p. 880-3.
25. Teng, G.G., et al., Mortality due to coronary heart disease and kidney disease among middle-aged and elderly men and women with gout in the Singapore Chinese Health Study. Ann Rheum Dis, 2012. 71(6): p. 924-8.
26. Kuo, C.F., et al., Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology (Oxford), 2010. 49(1): p. 141-6.
27. Goicoechea, M., et al., Effect of allopurinol in chronic kidney disease progression and cardiovascular risk. Clin J Am Soc Nephrol, 2010. 5(8): p. 1388-93.
28. Thanassoulis, G., et al., Gout, allopurinol use, and heart failure outcomes. Arch Intern Med, 2010. 170(15): p. 1358-64.
29. Wei, L., et al., Association between allopurinol and mortality in heart failure patients: a long-term follow-up study. Int J Clin Pract, 2009. 63(9): p. 1327-33.

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