糖尿病腎病變患者服用中藥與未服用中藥之發生率比較

Renal Disease between Taking Traditional Chinese Medicine and Non-Taking Traditional Chinese Medicine in Diabetic Nephropathy Patients

目的：此項研究的主要目的即是探討台灣第二型糖尿病族群在罹患糖尿病後，尋求中西醫藥療法的使用概況與影響。方法：本研究以1997-2008年間100萬健保抽樣歸人檔中，探討糖尿病患者對其接受中醫藥療法的影響，並分析其常合併使用中西醫之藥品種類及處方開立之模式。除此之外，更進一步利用個案對照(case-control)研究設計做因果型分析，分析末期腎病變與服用中藥之因果關係。結果：本研究共收入了40,163位第二型糖尿病民眾中，有百分之77.9（31,289人）採用中醫療法。這些第二型糖尿病病人中大部分同時使用兩種西藥降血糖藥（共13,609人，占33.9%），而六味地黃丸為最常與西藥併用的中藥處方。與對照組相比較下，使用中藥的族群中，有較低的糖尿病末期腎病變的發生率：未曾使用中醫者為14.5(ESRDs/1,000person-years)；男性患者有15.6，女性患者有12.6。曾使用中醫者為3.9 (HR=0.28, p＜0.001)；男性患者有5.0 (HR=0.34, p＜0.001)，女性患者有2.8(HR=0.23, p＜0.001)。結論：臺灣糖尿病病患在尋求中醫治療糖尿病的態度上，是以輔助治療為主，而非取代性治療。服用中藥對於糖尿病腎病變的發生具有保護與預防的效果。然而，對於更多的中藥療效與安全性以及中藥與降血糖西藥之間併用的安全性及療效評估是急需要被了解的。

Objectives: The aim of the study is to explore the demographics and utilization patterns between Chinese herbal products (CHPs) users and non-users among people with diabetes. Methods: The usage, frequency of services, and CHP prescribed among diabetic patients using hypoglycemic drugs were evaluated, recruited from a randomly sampled cohort of 1,000,000 beneficiaries from the National Health Insurance Research Database. The logistic regression method was employed to estimate the co-prescription of a CHP and hypoglycemic drugs and to investigate the incidence rate of consuming traditional Chinese medicine among diabetic patients with newly diagnosed end-stage renal disease (ESRD) in Taiwan. Results: 77.9 percent of diabetic patients utilized traditional Chinese medicine (TCM) during the 11-year study period. Most type II diabetic patients also received western medicine (WM) treatment, only 8.4 percent (n=3,370) never used WM. Liu-Wei-Di-Huang-Wan were the most prescribed Chinese formula. In comparison with control group, there was a lower incidence rate of the traditional Chinese medicine users (incidence rate: TCM nonusers=14.5, male=15.6, female=12.6; TCM users=3.9 (HR=0.28, p＜0.001), male=5.0 (HR=0.34, p＜0.001), female=2.8 (HR=0.23, p＜0.001). Conclusions: Liu-Wei-Di-Huang-Wan and its derivatives are the most frequent prescribed formulas by TCM doctors in Taiwan for diabetes patients. Utilization of traditional Chinese medicine had the protective effect and lowing inducing diabetic nephropathy.