| 摘要: | 研究背景及目的
近期研究指出高血脂患者有較高的傾向得到牙周炎，而statins與fibrates為血脂患者最常使用的兩類口服藥品。Statins除了本身降血脂效果外，還有抗發炎、調節免疫、促骨細胞生成與抗菌效果。有其他研究團隊將statins製成凝膠輔助治療慢性牙周炎，發覺statins能有效改善患者牙周狀態。Fibrates也被發現有抗發炎的效果，但目前少有研究探討其對牙周炎之影響。因此本研究欲探討降血脂藥品statins或fibrates的服用是否能降低高血脂患者得到慢性牙周炎的風險。
研究方法
本研究為回溯性的世代研究，以衛生福利部資料科學中心提供的兩百萬人抽樣檔分析2001至2012年新診斷為高血脂的患者五年內的血脂藥品服用情形與發生慢性牙周炎的關聯性。研究族群依據有無使用statins、fibrates分成三個實驗組與一個對照組，分別為五年內僅使用過statins、僅使用過fibrates、兩類藥品都使用過以及兩類藥品都沒用過，共四個組別。三個實驗組分別與對照組依據年齡、性別與干擾因子進行1:1的傾向分數配對形成三個研究臂。以Cox比例風險回歸模型計算三個研究臂中得到慢性牙周炎的風險比。同時依據累積用藥日數、累積用藥劑量與statins化學特性進行牙周炎風險的次族群分析。
研究結果
僅使用statins與僅使用fibrates的組別跟對照組的慢性牙周炎風險相比並無顯著差異(aHR, 1.039；95% CI, 0.964-1.119、aHR, 0.84；95% CI, 0.86-1.097)；statins/fibrates都用過的組別比對照組少了25.7%的慢性牙周炎風險(aHR, 0.743；95% CI, 0.678-0.815)。單獨使用statins超過三年或累積使用超過720 DDD時可見其對牙周炎的保護效果；單獨使用fibrates超過三年或累積使用超過1080 DDD時也可見其降低牙周炎風險之效用。口服疏水性statins比親水性statins有較低的慢性牙周炎風險。
結論
Statins、fibrates同時或交錯使用可以降低高血脂患者的慢性牙周炎風險，而任一類藥品的單獨使用則需要長期使用後才能看見其對慢性牙周炎的保護效果。口服疏水性statins較親水性statins有更低的慢性牙周炎風險。
Background and objective
Recent studies show patients with hyperlipidemia have higher risk of chronic periodontitis (CP) than normolipidemic people. Statins and fibrates are the most use medication for managing serum lipid. Statins are found to be a beneficial adjunctive therapy in CP due to the pleiotropic effect, such as anti-inflammatory, immunomodulatory, decreased bone resorption and anti-infectious. Fibrates can reduce proinflammatory cytokines but few studies have investigated the association between fibrates and CP. Thus, current study wants to figure out the impact of antihyperlipidemic agents on the risk of CP in patients with hyperlipidemia.
Method
This is a retrospective cohort study, using the 2000 longitudinal generation tracking database from the health and welfare data science center to analyze the association between 5-year antihyperlipidemic agents use and the risk of CP among newly diagnosed hyperlipidemia patients from 2001 to 2012. Study population is divided into 4 groups: statins monotherapy, fibrates monotherapy, using both statins and fibrates and statins/fibrates non-users (control). Each treatment group is matched with the control group at a ratio of 1:1 by age, gender and propensity score, forming 3 study arms. The risk of CP is compared between 3 study arms by Cox proportional hazard model. Study population is classified into different subgroups based on cumulative dose, cumulative day of drug use and the hydrophilicity of statins to do further analysis.
Result
There is no significance difference of CP risk between statins monotherapy and control group or between fibrates monotherapy and control group (aHR, 1.039；95% CI, 0.964-1.119、aHR, 0.84；95% CI, 0.86-1.097). Hyperlipidemia patients receiving both statins and fibrates during follow up can reduce 25.7% risk of CP compared to the control group(aHR, 0.743；95% CI, 0.678-0.815). When the cumulative dose of statin monotherapy and fibrate monotherapy beyond 720 DDD and 1080 DDD respectively, the risk of CP start to reduce. When the cumulative day of statin or fibrate monotherapy beyond 3 years, the risk of CP start to decline as well. Hydrophobic statins users have lower risk of CP than hydrophilic statin users.
Conclusion
Hyperlipidemia patients receiving both statins and fibrates can reduce their risk of CP. The long term of either statin or fibrate monotherapy can reduce CP risk among hyperlipidemia patients as well. Hydrophobic statins decrease more CP risk than hydrophilic statins when taken orally. |
