| 摘要: | 研究目的：研究調查分析失智症 Dementia患者使用Statin降血脂藥物與罹患Sepsis敗血症風險的關係。
研究方法及資料：本研究採回顧性世代追蹤病例分析，擷取在台灣使用全民健保資料庫百萬歸人檔，記載失智症病患以及使用降血脂藥物與敗血症之發生率。納入1999到2013年間，登記資料庫中的失智症病患進行分析。我們確定並收納了308例確立新診斷的失智症患者，確診後使用Statin藥物。這些患者各別傾向分數Propensity score匹配（1：1）根據年齡，性別，高血壓，高脂血症，糖尿病，腦血管疾病，腎臟疾病，肝臟病，哮喘，惡性腫瘤，帕金森氏病和失智症藥物（donepezil, rivastigmine, galantamine, and memantine）與251位對照患者 (非Statin藥物使用者）作比較。Cox proportional hazard Model估算Statin藥物使用者與敗血症的調整風險比和非Statin藥物使用者。再進行其他干擾因素Cofounding factor調整後，統計分析Statin藥物使用者與敗血症的發生率，較非Statin使用者高1.42倍（95 ％信賴區間= 0.81-2.5）。
研究結果：我們的分析顯示失智症患者，Statin物的使用與敗血症無正相關。
結論與建議：雖然本回顧性研究，失智症患者使用Statin與敗血症無正相關，但是於臨床上針對健康的族群Statin用藥，需要再作長時間前瞻性的追蹤分析。
This study was investigated the association of statin use with sepsis risk in patients with
dementia. This retrospective cohort study was conducted in Taiwan by using data from the National Health Insurance Research Database. We identified and enrolled 308 patients with newly diagnosed dementia who used statin after dementia diagnosis. These patients were individually propensity score matched (1:1) according to age, sex, hypertension, hyperlipidemia, diabetes, cerebrovascular disease, renal disease, liver disease, asthma, malignancy, parkinsonism, and dementia drugs used
(donepezil, rivastigmine, galantamine, and memantine) with 251 controls (statin non-users). A Cox proportional hazard model was used to estimate the adjusted hazard ratio for sepsis events in statin users and non-users. After adjustment for other confounding factors, the incidence of sepsis in statin users was 1.42-fold higher than that in non-users (95% confidence interval = 0.81–2.5).
In conclusion, our analysis showed no positive association of sepsis with statin use in patients with dementia. Difference types of statin prescription should be cautious by physician according to individual patients, especially in healthy patient population. |
