中医药研究论丛

211.1 退化性膝关节炎患者葡萄糖胺与独活寄生汤合并使用情形与临床成效
TJ TCM.21(1) : 01-14, 2018
退化性膝关节炎患者葡萄糖胺与独活寄生汤合并使用情形与临床成效
Prescription Pattern and Clinical Efficacy for Combined Use of Glucosamine and Du-Huo-Ji-Sheng-Tang in Patients with Degenerative Knee
陈莹伦1 吴淑娟1 林舜谷2*
1 台北市立联合医院仁爱区药剂科,台北,台湾
2 台北市立联合医院仁爱区中医科,台北,台湾
【摘要】
背景:葡萄糖胺(Glucosamine) 是退化性膝关节炎患者常服用的治疗药物,有助於防止软骨的磨耗和损坏,并能减缓退化性膝关节炎的疼痛症状。过去的研究亦发现高比例的退化性膝关节炎患者会看中医开立药物如独活寄生汤或龟鹿二仙胶等,但是并没有详细的统计研究中西药并用情形,为了更加了解退化性膝关节炎患者的用药习惯,本研究将探讨独活寄生汤与葡萄糖胺(Glucosamine) 之并用情形,了解可能影响并用习惯之因子;并分析合并使用对於全膝关节置换手术需求的影响,和是否能降低非类固醇消炎止痛药的使用需要。
方法:本研究采回溯性方式,自健保资料库百万归人档中,蒐集1997-2003年间被诊断为退化性膝关节炎,且接受葡萄糖胺(Glucosamine) 治疗的患者,再连结中医就医资料,分析患者服用中药复方独活寄生汤的情形。本研究亦将年龄、性别、居住地区都市化程度、患者健保投保费用作为分类变项,并纳入慢性病如糖尿病、高血压、慢性肾脏病、心脏病、类风湿性关节炎等。用逻辑式回归分析探讨并用独活寄生汤与否的患者再上述变项中是否有差异。我们用Kaplan-Meier 曲线来比较患者接受全膝关节置换手术的存活曲线,并用log-rank test 检定两者之间的显着性。两者的风险比值则用Cox proportional hazardmodel 方法来计算,并校正年龄、性别、居住地、投保金额与共病症等变项。我们统计医师在住院或门诊中开立给患者的非类固醇消炎止痛药总量,并且将不同种类换算为定义每日剂量(defined daily dose)累计起来,并且以 independent t test 检验评估两组间的非类固醇消炎止痛药总量差异。
结果:本研究共蒐集到36,016 位退化性膝关节炎患者,删除并非在研究其间内初次诊断、基本资料不全,以及未服用葡萄糖胺(Glucosamine)的患者後,共有26,257 位患者纳入分析之中。其中有4738 (18.2%)患者并用独活寄生汤的治疗,另有21,474 (81.8%) 患者则无。分析可能影响中西药并用的因素,则发现随着年纪越大、居住地区都市化程度越低、以及健保投保费用越高,则患者并用葡萄糖胺与独活寄生汤的机会越大。同时若患者有骨质疏松症则使用的倾向也较高,相对的高血压患者则有较低的并用可能。相比於单纯使用葡萄糖胺,合并使用独活寄生汤的患者需要接受全膝关节置换的比例较低,且logranktest p 值小於0.05,达到统计上的显着差异。校正後的风险比值与95% 信赖区间为0.84(0.71-0.94)。合并使用独活寄生汤的患者平均相较单纯使用葡萄糖胺的患者,非类固醇消炎止痛药的使用量更少,平均减少23.57 定义每日剂量(defined daily dose)
结论:中西药合并使用是台湾民众特别常见的就医习惯,本研究发现年龄、经济情形与居住地区,还有是否罹患慢性病都可能会影响到患者并用葡萄糖胺与独活寄生汤的倾向,且合并使用可以降低非类固醇消炎止痛药的使用总量,和全膝关节置换手术的需要。
【关键词】退化性膝关节炎、葡萄糖胺、独活寄生汤、中西药并用
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