2013-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/657657摘要：雖然許多流行病學研究均指出巴金森氏症患者有較高的全死因死亡率，但是對於巴金森氏症與心血管疾病的關係的看法卻仍然分歧。先前對於巴金森氏症及心血管疾病之間的關係研究結果並不一致，有些研究發現巴金森氏症病人有較高的中風相關的死亡率以及心臟病猝死的風險。但另一方面，亦有研究顯示巴金森氏症並不會增加罹患心血管疾病的風險；其它甚至有研究指出巴金森氏症患者具有較少的心血管危險因子及較低的罹患心血管疾病的風險。因此，巴金森氏症與心血管疾病風險之間的關係仍有待進一步釐清。此外，巴金森氏症的 levodopa 藥物治療曾被認為可降低心血管危險因子例如高血壓、糖尿病及高血脂。levodopa 藥物治療降低心血管危險因子的機轉被認為在於其可能對交感神經系統有抑制效果。相反的，卻也有研究指出 levodopa 藥物治療有可能使病人發生高胱胺酸血症(hyperhomocysteinemia)的機率增加，而高胱胺酸血症已知為動脈硬化的獨立危險因子。因此，levodopa 治療對於巴金森氏症病患的心血管風險的效應為何，仍需要進一步研究。 先前有關巴金森氏症與心血管疾病的研究大多數是採用橫斷調查或病例對照研究設計，而較少以縱向世代追蹤研究偵測新發生心血管事件，因此不易呈現巴金森氏症與後續發生心血管疾病的時序相關。此外，病例對照研究法較容易納入較嚴重或者是較難診斷之巴金森氏症患者，相較於以人口為基礎的研究可能造成風險比的高估。而許多研究沒有適當處理巴金森氏症病人的重要共併症所可能造成之干擾，也可能導致無法有效評估巴金森氏症對心血管風險之效應。本研究計畫將藉由傾向分數配對（propensity score matching）把干擾因子的效應降到最低，有助於釐清巴金森氏症對心血管疾病以及其存活的真正影響。 本計畫將使用行政院衛生署健康資料加值應用協作中心之全民健保資料庫及死亡登錄檔，採用世代研究設計探討巴金森氏症與 levodopa 對於後續發生心血管事件機率的影響。為了控制來自臨床特徵，包括年齡、性別、醫學共併症及社經地位之潛在干擾，本研究將使用傾向分數配對建立可比較的巴金森氏症與其對照世代研究分組。有鑑於全民健保資料庫資料量龐大，本研究將分兩階段的傾向分數配對，使用八比一的 greedy matching 演算法，根據 propensity score 挑選與巴金森氏症病患配對的唯一對照個案。使用 Stratified Cox proportional hazard regression 評估巴金森氏症對心血管風險的影響。<br> Abstract: Although many epidemiological studies have reported higher all-cause mortality in patients with Parkinson’s disease, the association between Parkinson’s disease and cardiovascular disease remains controversial. Some studies have shown Parkinson’s disease is linked to higher stroke-related mortality and higher risk of cardiac death. However, some other studies have reported reduced frequency of cardiovascular risk factors and lower risk of developing cardiovascular disease in patients with Parkinson’s disease. Hence, further studies are required to clarify the association between Parkinson’s disease and cardiovascular disease. In addition, levodopa treatment in Parkinson's disease has been associated with reduced frequency of vascular risk factors such as hypertension, diabetes mellitus and hyperlipidemia. The inhibitory effect on sympathetic nerve system by levodopa has been suggested to be responsible for the reduced vascular risk factors. In contrast, some studies have shown levodopa treatment may promote hyperhomocysteinemia, which is an independent risk factor of atherosclerosis. Accordingly, further studies are needed to investigate the effect of levodopa treatment on cardiovascular risk in patients with Parkinson’s disease. Most prior studies on the association between Parkinson’s disease and cardiovascular disease were cross-sectional or case study in design. These studies investigated prevalent cases rather than new incident cases identified in longitudinal follow up, which may result in difficulty in establishing the temporal relationship between Parkinson’s disease and subsequently developed cardiovascular disease. Moreover, the potential confounding effects from various clinical characteristics may not be effectively eliminated by multiple regression analysis. We therefore propose this population based, propensity score matched, longitudinal follow-up study to assess the effect of Parkinson's disease on cardiovascular risk. This study will use the National Health Insurance database and mortality registry from the Collaboration Center of Health Information Application (CCHIA), Department of Health in Taiwan. Cohort study design is used to investigate the effect of Parkinson’s disease and levodopa treatment on the risk of cardiovascular events. In order to control for potential confounding from clinical characteristics (e.g. age, sex, medical comorbidity and social economic status), we will use propensity score matching to establish comparable Parkinson’s disease group and reference group. A two-stage sampling method with 8-to-1 greedy matching algorithm will be used to identify the unique propensity score-matched reference subject. Stratified Cox proportional hazard regression matched on propensity score is used to estimate the effect of Parkinson’s disease on the risk of cardiovascular events.巴金森氏症心血管疾病危險因子傾向分數中風急性心肌梗塞Parkinson’s diseasecardiovascular diseaserisk factorspropensity scoreacute myocardial infarctionstroke