對人類長期使用氫離子幫浦阻斷劑與中樞神經系統影響之探討

中山醫學大學機構典藏 CSMUIR > 醫學院 > 醫學研究所 > 博碩士論文 > Item 310902500/20777

Please use this identifier to cite or link to this item: https://ir.csmu.edu.tw:8080/ir/handle/310902500/20777

Title:	對人類長期使用氫離子幫浦阻斷劑與中樞神經系統影響之探討 Study of the association between long time use of proton pump inhibitor and the adverse effect to the central nerve system in human being
Authors:	洪維德 Hung, Wei-Te
Contributors:	中山醫學大學:醫學研究所;林隆堯;葉兆斌
Keywords:	氫離子幫浦阻斷劑;不良效果;中樞神經系統感染 proton pump inhibitor;adverse effect;CNS infection;retrospective cohort study
Date:	2019
Issue Date:	2020-07-03T07:59:15Z (UTC)
Abstract:	研究背景: 氫離子幫浦阻斷劑(Proton Pump inhibitor, PPI)被廣泛的使用在治療患者有胃潰瘍、相關胃酸增加疾病的患者及降低在麻醉期間容易造成吸入性肺炎的高風險患者。長期使用PPI可能產生許多合併症，甚至影響患者中樞神經系統(CNS)和心臟血管系統等，並會增加感染的風險，進而影響患者的生活品質甚至生命。在對CNS的影響中，有報告認為長期使用PPI可能會造成CNS感染，但都沒有比較好的研究統計證明。研究目的: 利用台灣全民健康保險研究資料庫研究患者長期使用PPI造成CNS感染的發生率。除調查患者CNS感染風險外並由利用文獻來探討長期使用PPI對患者CNS的影響。研究方法: 本研究為一項回溯性的世代研究。利用〔台灣全民健康保險研究資料庫〕，將三年間有使用台灣可提供患者服用的五種PPI藥物Omeprazole,Pantoprazol,Lansoprazol,Esomeprazole 及Rabeprazole的患者納入為研究對象。定義PPI使用患者為一年內使用PPI至少90天且年齡大於或等於20歲。非PPI使用者的收集與使用PPI患者採用10:1依年齡性別配對，在配對的同時亦將非PPI使用患者在參考日期前診斷為CNS感染患者排除在外。最後利用傾向評分採用1:1的配對比較兩組CNS感染的比率。論文亦收集文獻以探討PPI對CNS 的影響。研究結果: 長期使用PPI患者發生CNS感染的比率較沒有使用PPI患者的發生率高2.23倍，因此我們認為長期使用PPI是一個造成CNS感染的危險因子。經由文獻探討推論長期使用PPI可能是一個造成阿茲海默症的風險因子，同時也會造成失智症的風險增加。結論: 患者長期使用PPI對CNS的影響是造成CNS感染增加而且是CNS感染的一個風險因子，患者長期使用PPI也會造成阿茲海默症及失智症的風險增加。 Background: Proton Pump inhibitor (PPI) are widely used to treat the patient with peptic ulcer, related gastric diseases because of increasing gastric acid secretion and to prevent aspiration pneumonia in high risk patients perioperatively. Long-term use of PPI causes lots of complications including cardiovascular and central nerve system (CNS), and etc. That might influence the patient’s quality of life even death. About CNS adverse effects, some papers reported that long term use of PPI is a risk factor of CNS infection. But there has not being scientifically documented report. Objective: From “The National Health Insurance Research Database”, we wanted to investigate the risk of CNS infection following long term used of PPI. Besides CNS infection, I reviewed the studies to discuss the relation between CNS adverse effects after long term use of PPI. Method: This study was a retrospective cohort design. From “The National Health Insurance Research Database”, the PPI considered in the study were Omeprazole, Pantoprazole, Lansoprazole, Esomeprazole, and Rabeprazole , which are available to be prescribed in Taiwan. We defined PPI users as patients who used PPI for at least 90 days within 1 year and who were 20 years or older. The PPI control group comprised patients who did not use PPI selected around the period of PPI user group. A 1:10 ratio was used for age and sex matching while establishing an index date between two groups. Patients with a diagnosis of CNS infection before the index date were excluded. Propensity score matching (1:1) was then performed for two groups for comparing of CNS infection. I also reviewed the literatures to discuss CNS adverse effects of the patient after long term use of PPI. Results: The Incidence of CNS infection in the long term PPI users was a 2.23-fold higher risk of CNS infection than that of PPI nonusers. So I thought that long term use of PPI could be a risk factor of CNS infection. Long time use of PPI could also be a risk factor of Alzheimer’s disease (AD). Similar reports also reported that long term use of PPI could at risk of dementia. Conclusion: About CNS adverse effects of long term PPI user, when compared to PPI nonuser, the incidence of CNS infection was higher. It could also be a risk factor of Alzheimer’s disease and increase risk of dementia after long term use of PPI from literatures’ review.
URI:	https://ir.csmu.edu.tw:8080/ir/handle/310902500/20777
Appears in Collections:	[醫學研究所] 博碩士論文

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