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    Please use this identifier to cite or link to this item: http://asiair.asia.edu.tw/ir/handle/310904400/117043


    Title: 巴金森氏症患者使用Benzodiazepines與Non-Benzodiazepines發生肺炎之相關性研究
    Other Titles: A study on correlation between benzodiazepines and non-Benzodiazepines uses and pneumonia among patients with Parkinson disease
    Authors: 楊書熏
    YANG, SHU-HSUN
    Contributors: 李建瑩;楊鎮嘉
    LEE, CHIEN-YING;YANG, CHENG-CHIA
    健康產業管理學系健康管理組碩士在職專班
    Keywords: 巴金森氏症;苯二氮平類;非苯二氮平類;肺炎
    Parkinson's disease;Benzodiazepines;Non-benzodiazepines;Pneumonia
    Date: 2023
    Issue Date: 2023-11-22 02:04:16 (UTC+0)
    Abstract: 研究動機與目的：巴金森氏症是一種運動系統退化疾病。在疾病的進展中常加入Benzodiazepines (BZDs)與Non-benzodiazepines (Non-BZDs)藥物來治療失眠等臨床症狀。過去已有研究證實使用BZDs和Non-BZDs藥物，與肺炎發生的風險具有相關性。較少研究巴金森氏症患者使用BZDs與Non-BZDs之後是否會對於肺炎風險的造成影響。本研究希望藉由全民健康保險資料庫，來分析探討巴金森氏症患者使用BZDs和Non-BZDs藥物與發生肺炎風險之關聯性。研究方法：本研究使用病例對照研究設計。研究資料來源為衛生福利部衛生福利資料科學中心之2001-2016年「兩百萬人抽樣檔」。研究母群體為診斷為巴金森氏症且年齡大於65歲的患者。病例組為在2002到2016年間，選取被診斷為肺炎巴金森氏症患者，共10237名。而對照組使用傾向配對分析，以1:4的方式配對出未被診斷為肺炎者，共40948名。以肺炎發生前一年作為本研究的觀察期。使用條件式邏輯回歸分析，探討BZDs藥物、Non-BZDs藥物與肺炎發生相關性。研究結果：本研究共收錄了51185位巴金森氏症患者。使用BZDs與發生肺炎風險之研究結果顯示，「過去使用」(aOR= 1.14, 95% CI =1.08-1.19)比「未使用」者，發生肺炎的相對危險性較高;「近期使用」(aOR =0.91, 95% CI =0.86-0.95)較「未使用」者，發生肺炎的相對危險性較低。針對個別BZDs藥物研究的結果顯示，以Midazolam的「現正使用」(aOR =3.84, 95% CI =3.17-4.64)產生的風險最高，Flunitrazepam的「近期使用」(aOR =0.55, 95% CI =0.43-0.69)產生的風險最低。使用Non-BZDs與發生肺炎風險之研究結果顯示，「過去使用」(aOR =1.11, 95% CI =1.05-1.17)比「未使用」者，肺炎發生相對危險性較高。「現正使用」(aOR =0.81, 95% CI =0.74-0.88)與「近期使用」(aOR =0.83, 95% CI =0.77-0.90)比「未使用」者，肺炎發生相對危險性較低。結論：使用BZDs藥物將可能導致肺炎風險的增加。由於個別BZDs藥物之間藥理特性的差異，造成肺炎的風險不同，其中以Midazolam造成肺炎發生的風險為最高，Flunitrazepam導致肺炎發生的風險為最低。臨床上巴金森氏症患者須使用BZDs治療時，Flunitrazepam是較好的選擇，應避免使用Midazolam。Non-BZDs藥物相較於BZDs藥物，肺炎發生的風險較低。臨床上治療巴金森氏症患者失眠時，選用Non-BZDs藥物是較好的選擇。
    Background:Parkinson's disease is a degenerative disease of the motor system. Benzodiazepines (BZDs) and Non-benzodiazepines (Non-BZDs) drugs are often added during the progression of the disease to treat clinical symptoms such as insomnia. Previous studies have confirmed that the use of BZDs and Non-BZDs drugs is associated with the risk of pneumonia. Less research has been done on the effect of BZDs versus Non-BZDs on the risk of pneumonia in patients with Parkinson's disease. This study hopes to use the national health insurance database to analyze and explore the association between the use of BZDs and Non-BZDs drugs and the risk of pneumonia in patients with Parkinson's disease.Methods:This study used a case-control study design. The source of the research data is the 2001-2016 "sample file of two million people" of the Health and Welfare Data Science Center of the Ministry of Health and Welfare. The study population was patients diagnosed with Parkinson's disease and older than 65 years. The case group consisted of 10,237 patients with Parkinson's disease diagnosed with pneumonia between 2002 and 2016. In the control group, using propensity matching analysis, a total of 40,948 people who were not diagnosed with pneumonia were matched in a 1:4 manner. The observation period of this study was one year before the onset of pneumonia. Conditional logistic regression analysis was used to explore the correlation between BZDs drugs, Non-BZDs drugs and pneumonia.Results:A total of 51,185 patients with Parkinson's disease were included in this study. The results of the research on the use of BZDs and the risk of pneumonia showed that the relative risk of pneumonia was higher in "Past use" (aOR= 1.14, 95% CI =1.08-1.19) than in "No use" "Recent use" (aOR =0.91, 95% CI =0.86-0.95), the relative risk of pneumonia is lower than in "No use". The results of studies on individual BZDs drugs showed that "Current use" of Midazolam (aOR =3.84, 95% CI =3.17-4.64) had the highest risk, and "Recent use" of Flunitrazepam (aOR =0.55, 95% CI = 0.43-0.69) produced the lowest risk. The results of the study on the use of Non-BZDs and the risk of pneumonia showed that the relative risk of pneumonia was higher in "Past use" (aOR =1.11, 95% CI =1.05-1.17) than in "No use". "Current use" (aOR =0.81, 95% CI =0.74-0.88) and "Recent use" (aOR =0.83, 95% CI =0.77-0.90) had a lower relative risk of pneumonia than "No use".Conclusion:The use of BZDs drugs may lead to an increased risk of pneumonia. Due to the differences in the pharmacological properties of individual BZDs, the risk of pneumonia is different, among which Midazolam has the highest risk of pneumonia, and Flunitrazepam has the lowest risk of pneumonia. Clinically, when patients with Parkinson's disease must be treated with BZDs, Flunitrazepam is a better choice, and Midazolam should be avoided. Non-BZDs drugs have a lower risk of pneumonia than BZDs drugs. In the clinical treatment of insomnia in patients with Parkinson's disease, it is a better choice to use Non-BZDs drugs.
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