中醫藥研究論叢

211.1 退化性膝關節炎患者葡萄糖胺與獨活寄生湯合併使用情形與臨床成效
TJ TCM.21(1) : 01-14, 2018
退化性膝關節炎患者葡萄糖胺與獨活寄生湯合併使用情形與臨床成效
Prescription Pattern and Clinical Efficacy for Combined Use of Glucosamine and Du-Huo-Ji-Sheng-Tang in Patients with Degenerative Knee
陳瑩倫1 吳淑娟1 林舜穀2*
1 台北市立聯合醫院仁愛區藥劑科,台北,台灣
2 台北市立聯合醫院仁愛區中醫科,台北,台灣
【摘要】
背景:葡萄糖胺(Glucosamine) 是退化性膝關節炎患者常服用的治療藥物,有助於防止軟骨的磨耗和損壞,並能減緩退化性膝關節炎的疼痛症狀。過去的研究亦發現高比例的退化性膝關節炎患者會看中醫開立藥物如獨活寄生湯或龜鹿二仙膠等,但是並沒有詳細的統計研究中西藥併用情形,為了更加了解退化性膝關節炎患者的用藥習慣,本研究將探討獨活寄生湯與葡萄糖胺(Glucosamine) 之併用情形,了解可能影響併用習慣之因子;並分析合併使用對於全膝關節置換手術需求的影響,和是否能降低非類固醇消炎止痛藥的使用需要。
方法:本研究採回溯性方式,自健保資料庫百萬歸人檔中,蒐集1997-2003年間被診斷為退化性膝關節炎,且接受葡萄糖胺(Glucosamine) 治療的患者,再連結中醫就醫資料,分析患者服用中藥複方獨活寄生湯的情形。本研究亦將年齡、性別、居住地區都市化程度、患者健保投保費用作為分類變項,並納入慢性病如糖尿病、高血壓、慢性腎臟病、心臟病、類風濕性關節炎等。用邏輯式回歸分析探討併用獨活寄生湯與否的患者再上述變項中是否有差異。我們用Kaplan-Meier 曲線來比較患者接受全膝關節置換手術的存活曲線,並用log-rank test 檢定兩者之間的顯著性。兩者的風險比值則用Cox proportional hazardmodel 方法來計算,並校正年齡、性別、居住地、投保金額與共病症等變項。我們統計醫師在住院或門診中開立給患者的非類固醇消炎止痛藥總量,並且將不同種類換算為定義每日劑量(defined daily dose)累計起來,並且以 independent t test 檢驗評估兩組間的非類固醇消炎止痛藥總量差異。
結果:本研究共蒐集到36,016 位退化性膝關節炎患者,刪除並非在研究其間內初次診斷、基本資料不全,以及未服用葡萄糖胺(Glucosamine)的患者後,共有26,257 位患者納入分析之中。其中有4738 (18.2%)患者併用獨活寄生湯的治療,另有21,474 (81.8%) 患者則無。分析可能影響中西藥併用的因素,則發現隨著年紀越大、居住地區都市化程度越低、以及健保投保費用越高,則患者併用葡萄糖胺與獨活寄生湯的機會越大。同時若患者有骨質疏鬆症則使用的傾向也較高,相對的高血壓患者則有較低的併用可能。相比於單純使用葡萄糖胺,合併使用獨活寄生湯的患者需要接受全膝關節置換的比例較低,且logranktest p 值小於0.05,達到統計上的顯著差異。校正後的風險比值與95% 信賴區間為0.84(0.71-0.94)。合併使用獨活寄生湯的患者平均相較單純使用葡萄糖胺的患者,非類固醇消炎止痛藥的使用量更少,平均減少23.57 定義每日劑量(defined daily dose)
結論:中西藥合併使用是台灣民眾特別常見的就醫習慣,本研究發現年齡、經濟情形與居住地區,還有是否罹患慢性病都可能會影響到患者併用葡萄糖胺與獨活寄生湯的傾向,且合併使用可以降低非類固醇消炎止痛藥的使用總量,和全膝關節置換手術的需要。
【關鍵詞】退化性膝關節炎、葡萄糖胺、獨活寄生湯、中西藥併用
Ying-Luen Chen1 Shu-Chuan Wu1 Shun-Ku Lin2*
1Department of Pharmacy, Taipei City Hospital, RenAi Branch, Department of Health, Taipei
City Government, Taipei, Taiwan
2Department of Chinese Medicine, Taipei City Hospital, RenAi Branch . Department of
Health, Taipei City Government, Taipei, Taiwan
【Summary】
Backgroun Background: Glucosamine is a commonly used treatment for patients with degenerative arthritis that helps prevent cartilage wear and damage and slows down the pain symptoms of degenerative knee arthritis. Previous studies have also found that a high proportion of patients with degenerative arthritis will receive Chinese medicine treatment, but there is no detailed statistical study of Western medicine. To realize the prescription pattern of degenerative knee arthritis, this study would explore the combined use of Du-Huo-Ji-Sheng-Tang and glucosamine (Glucosamine) and calculate the factors that may affect use patterns. We analyzed the impact of combined use on total knee replacement and reducing the need for non-steroidal anti-inflammatory drugs.
Methods: In this study, the retrospective method was used to collect the patients who had been diagnosed with degenerative knee arthritis and treated with Glucosamine from 1997 to 2003, and then the TCM medical information, Analysis of patients taking traditional Chinese medicine compound solitary Du-Huo-Ji-Sheng-Tang. The study will also be age, gender, urbanization degree of living areas, patients health insurance costs as a classification of variables, and included chronic diseases such as diabetes, hypertension, chronic kidney disease, heart disease, rheumatoid arthritis. The use of logical regression analysis and the use of solitary Du-Huo-Ji-Sheng-Tang with or without the above variables are different. We used Kaplan-Meier curves to compare the survival curves of patients undergoing total knee arthroplasty and using the log-rank test to test the significance of the two measures. The risk ratio is calculated using the Cox proportional hazard model method and corrects variables such as age, gender, place of residence, insured amounts, and comorbid conditions. We counted the patient’s total amount of non-steroidal anti-inflammatory painkiller and converted to a defined daily dose. We used an independent t-test to assess differences in nonsteroidal anti-inflammatory analgesics between the two groups.
Results: Of the 36,016 patients with degenerative knee arthritis, 26,257 patients were excluded from the analysis of patients who were not initially diagnosed during the study, with incomplete data, and who did not take Glucosamine. Of these, 4738 (18.2%) were treated with independent live parasites, and 21,474 (81.8%) were absent. Analysis of factors that may affect the use of Chinese and Western medicine, it is found that with the older, the lower the degree of urbanization in the living area, and the higher the cost of health insurance, the patient with glucosamine and the only chance of Du-Huo-Ji-Sheng-Tang. At the same time if the patient tends to use coronary artery disease is also higher, relatively high blood pressure in patients with lower and possible. Patients who received combine threapy lower rates of total knee arthroplasty and a p-value of the log-rank test of less than 0.05, achieving a statistically significant difference.The adjusted odds ratio and 95% confidence interval were 0.84 (0.71-0.94). The average number of patients who used combined live alone soup was lower than that of patients on pure glucosamine alone, with an average of 23.57 defined daily doses.
Conclusions: The combination of Chinese and Western medicine is a common practice for Taiwanese people. This study found that age, economic situation and living area, and whether chronic diseases are likely to affect the tendency of patients with glucosamine and bovine parasite soup. Combined use can reduce the total amount of non-steroidal anti-inflammatory drugs, and total knee replacement surgery needs.
Keywords Degenerative knee arthritis, glucosamine, Du-Huo-Ji-Sheng-Tang, combine use of Chinese and Western medicine