中醫門診高脂血症患者用藥頻率與形態分析

Frequency and Patterns of Chinese Medicine Prescriptions for Hyperlipidemia

目的：本研究目的為探討中醫門診申報高脂血症患者就醫年齡層分布、處方用藥排行、單味藥及複方方劑用前20名排名、處方品項數、開藥天數及就醫天數為主。以探討逐年之醫療費用及提供中醫臨床治療高脂血症的一些信息為目的。材料方法：本研究資料來源以2009－2010年中央健康保險局台北業務組特約中醫院所申報全資料為資料庫，以門診申報高脂血症病患資料為擷取條件，依中醫院所申報ICD-9-CM主、次診斷為272.0、272.1、272.2、272.4之所有患者。結果：2009年至2010年中醫門診所申報高脂血症人數與件數均有成長，2009年申報人數為8,174人，申報件數為31,944件，平均每人就醫次數為3.9次；而2010年申報人數為8,365人，申報件數為34,667件，平均每人就醫次數為3.9次。2009－2010年總人數為14,435人，總申報件數共計66,611件，平均平均每人就醫件數為4.6次。年齡層分佈，以36歲至65歲年齡層占最多，而其高峰層為46歲至65歲之間之中老年人居多。其男女患病之比率為44.7：55.30，呈現女多於男的現象。前5名複方品項依序分別為血府逐瘀湯（14.35%）、加味逍遙散（9.22%）、防風通聖散（7.11%）、大柴胡湯（5.38%）、麻子仁丸（4.79%）；單方藥材前5名藥品當中依序為丹參（20.51%）、山楂（20.27）、決明子（9.92%）、何首烏（9.04%）、紅麴（7.11%）。所用單方品項數以一至五個品項占最多，複方品項數以一至三方占最多，而在不分單、複方時，其處方之總藥味品項數以四至七個品項數最為普遍。在治療方式件數上，以純內科的治療方法件數占96.12%為最多。2009－2010年中醫門診主次診斷申報高脂血症同病患歸戶歷年持續就醫追蹤，連續二年追蹤占率為25.15%。結論：本研究發現，臨床門診中醫治療高脂血症常用的單味中藥及複方中藥方劑主要的作用機轉不外乎活血化瘀、舒肝理氣解鬱、消食、化痰、瀉下清腑、滲濕利水、及清熱藥為主，較符合高脂血症用藥原則及效用。本研究結果可以提供臨床中醫師在治療高脂血症的一個選擇。對於提昇中醫醫療品質應是正面的，並且讓高脂血症患者除西藥治療外，中醫臨床方藥對於高脂血症患者也能提供一項有效的選擇。

Purpose: To conduct a large-scale pharmacoepidemiological study and evaluate the frequency and pattern of TCM prescriptions in treating hyperlipidemia disease. Methods: we obtained the database of Traditional Chinese medicine outpatient (including ICD-9-272.0.1, ICD-9-272.1, ICD-9-272.2, ICD-9-272.4) claims from the National Health Insurance in Taipei for the whole 2009-2010. Patients with hyperlipidemia diseases were identified by the corresponding diagnosis of International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed and association rule were applied to evaluate the co-prescription of TCM in treating hyperlipidemia diseases. We analysed the age distribution, prescription frequency and patterns of hyperlipidemia diseases. Results: Among the 14,435 subjects treated by TCM for hyperlipidemia diseases, the peak age was in the range of 36 -60yrs. Male/female ratio was 44.7:55.3 (0.8:1). The first five ranks of TCM prescriptions for treating hyperlipidemia disease were Xue-Fu-Zhu-Yu-Tang Jia-Wei-Xia-Yao-San (JWXYS), Fang Feng Tong Sheng San (FFTSS), Da Chai Hu Tang (TCHT), Ma-Zi-Ren-Wan (MZRW); The first five ranks of singleTraditional Chinese Medicine for treating hyperlipidemia disease were Salviae muliorrhizae radix, crataegi fructus, Cassia obusifolia L., Poligoni multifolia radix and Monascus. The number of TCMs and formule in a prescription that Traditional physicians wrote out almost contained 4-7 items TCMs and 1-3 iterms formule, and 1-5 items of single herbs, respectively. Conclusions: This study showed the utilization pattern of Chinese herbal drugs or prescription in treating hyperlipidemia disease. The treating principle of hyperlipidemia disease in TCM clinic is blood- activating and transforming stasis, dispersing food, transforming phlegm, coursing depression and rectifying qi, disinhibiting water and percolating dampness, draining precipitation and clearing visceral heat and heat-cleaning medicals so on. The present results are worthy of being considered as the reference by the Traditional physicans. Further researches and clinical trials are needed to evaluate the efficacy of these Chinese herbs or its ingredients in treating hyperlipidemia disease.