慢性白血病病患經標靶藥物治療中血栓發生率之探討

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標題:	慢性白血病病患經標靶藥物治療中血栓發生率之探討 The incidence of venous thromboembolism in chronic myeloid leukemia treatment based on the normalized million people file of National Health Insurance Research Database of Taiwan
作者:	蘇志偉
貢獻者:	藥學系唐自強
關鍵字:	慢性白血病 CML
日期:	2016
上傳時間:	2016-12-21 15:36:10 (UTC+8)
摘要:	慢性白血病在成年人的血液性惡性腫瘤當中，是一種發生於幹細胞中的疾病。現在有許多第一代或第二代的鉻胺酸脢抑制劑標靶藥物可用於第一線或第二線處方（如Imatinib, Nilotinib, Dasatinib）。而靜脈栓塞在慢性白血病病患當中是一項具有生命威脅的嚴重併發症狀。　　這項研究將分析由台灣國家衛生研究院提供從2004至2013年的國民健康保險研究數據庫（NHIRD）數據。主要目的是將確認疾病的治療和嚴重不良事件之間的關係，特別是在靜脈血栓栓塞。在本實驗當中有實驗組CML患者90位且都有接受TKI藥物治療，以及對照組經闌尾切除術9506例均符合實驗設計要求。　　經統計分析過後，在所有被診斷有慢性白血病中及對照組比較當中，所得到的發生靜脈血栓栓塞的數值各為4.69%，2.82%，P值為0.1239，兩組在統計學上並無差異；在實驗組與對照組的分析比較中所得到的發生靜脈血栓栓塞的數值各為2.22%，2.82%，P值為0.3502，兩組在統計學上並無差異。且在本實驗當中只有兩位病患在服用Imatinib治療時發生靜脈血栓栓塞症狀。　　因本實驗受限於未能涵蓋目前所有慢性白血病病患，並且無法連結到病患的遵醫囑性與臨床的療效，未能全部分析所有慢性白血病病患全部發生的血栓併發症數。從本實驗分析當中，已知在年老以及具有其他疾病的病患具有較高併發靜脈血栓栓塞的風險，但是在實驗組中發生靜脈血栓栓塞症狀發生率與對照組相比並無顯著的差異，因此在本實驗中結論，慢性白血病病患發生靜脈血栓栓塞症狀與標靶藥物並無顯著關聯性。 Chronic myeloid leukemia (CML) is a myeloproliferative disorder of blood stem cells and amongst the most common hematological malignancies encountered in adults. Nowadays, many clinical trials data show the availability of the first and second-generation Tyrosine Kinase Inhibitor (TKI) (imatinib, nilotinib, and dasatinib) in the first and second line settings. Venous thromboembolism (VTE) is a life-threatening condition that occurs as a complication of CML.This study analyzed the data of the National Health Insurance Research Database (NHIRD) deposited from 2004 to 2013, which provided by the National Health Research Institutes in Taiwan. The major outcome reveals the relationship between disease treatment and severe adverse events, especially in VTE. 9506 appendectomy patients were eligible and 90 CML patients were routed out which received TKI drugs treatment.The 10-year cumulative risk for VTE was not significant in the CML group than in the control group (4.69% vs. 2.82%, P-value 0.1239). The rate of VTE among CML patients whom received TKI drugs was not significant, too. (2.22% vs. 2.82%, P-value 0.3502) 192 CML patients were diagnosed and 90 patients had received Tyrosine Kinase Inhibitor (TKI) drug for the treatment, while 9 patients encountered vein thromboembolism event. Only two patients have VTE event during Imatinib treat.This study was limited in which the population cannot cover all of CML patients. And we cannot link to the real clinical profile to analyze the adherence and clinical effect of patients. Following the analyzed results, the patients of elder or with more complication ones maybe have higher risk than normal population in VTE, and the incidence rate of VTE is not significant vs. control group. The incidence of VTE in CML patients should not associated with TKI drugs.
關聯:	學年度：104，50頁
显示于类别:	[藥學系(所)] 博碩士論文

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