晚期慢性腎臟病患者的中醫使用狀況—醫院資料庫橫斷性研究

Utilization Pattern for Traditional Chinese Medicine among Late Stage Chronic Kidney Disease Patients: a Hospital-Based Cross-sectional Study

慢性腎臟病在台灣具有高盛行率並且中藥也是台灣最普遍使用的替代療法，然而，對於晚期慢性腎臟病患者使用中藥的狀況至今仍缺乏相關調查及研究，因此，我們以2006 年1 月至2011 年12 月之間長庚紀念醫院院內電子病歷資料庫做了橫斷性研究來分析此一議題。此研究中，我們根據國際疾病碼(ICD-9-CM codes) 585 及586 進行搜尋，配合實驗數據分析，找出被診斷為第3b、4 以及5 期的晚期慢性腎臟病患者納入此研究。在所有納入研究的8,459 位患者中，中醫組( 有接受過院內中醫治療) 有408 位，非中醫組( 未接受過院內中醫治療) 有8,051位。研究發現，在控制相關變異之下，發現大於55 歲以上的族群比較有尋求中醫治療的傾向(adjusted odds ratio [aOR]: 3.98, 95% confidence interval [CI]: [2.33, 6.81])，此外，我們也發現中醫組較少併見糖尿病 (aOR: 0.48)、高血壓 (aOR: 0.62) 或是痛風 (aOR: 0.62)。在所有併見疾病中，有腫瘤的晚期慢性腎臟病患者有較高尋求中醫治療的傾向 (aOR: 5.39, 95% CI: [4.64, 6.26])。進一步分析中醫組，發現尋求中藥治療的人次較針灸/ 骨傷治療的人次來得多 (3,476 vs. 320 人次)。在所有中藥處方中，加味逍遙散是這些晚期慢性腎臟病患者中最常使用的方劑 (36.2%)，其次為補陽還五湯 (33.1%)。這項研究首次分析晚期慢性腎臟病患者使用中醫的狀況，並可提供將來進一步研究分析相關中藥對這些患者的療效和安全性。

In Taiwan, chronic kidney disease (CKD) is highly prevalent and traditional Chinese medicine (TCM) is one of the most commonly used complementary medicines. To date, little information is available on the utilization patterns for TCM among CKD patients, particularly those with late stage CKD. We conducted a cross-sectional hospital-based study to investigate this issue. In this study, late stage CKD patients were identified by ICD-9-CM codes: 585 and 586, and only CKD stage 3b, 4 and 5 patients were included in the analysis. Clinical information was retrieved from the electronic medical records database from January, 1, 2006 to December, 31, 2011. Among a total of 8,459 patients, 408 TCM users and 8,051 non-TCM users were identified and their data were analyzed. We found that TCM users were almost four times more likely to be older than 55 years than non-TCM users, after controlling for the other covariates (adjusted odds ratio [aOR]: 3.98, 95% confidence interval [CI]: [2.33, 6.81]). They were also less likely to have diabetes (aOR: 0.48), hypertension (aOR: 0.62) or gout (aOR: 0.62). Among all disease conditions, late stage CKD patients with neoplasms had the highest tendency to seek TCM treatment compared to non-neoplasm CKD patients (aOR: 5.39, 95% CI: [4.64, 6.26]). Among all TCM users, internal medicine outpatient services (providing CHMs only) is more frequently used than acupuncture/massage outpatient services (3,476 vs. 320 visits). Jia-Wei-Xiao-Yao-San (JWXYS) was the most commonly prescribed Chinese herbal medicine (CHM) for late CKD patients (36.2% of 4,494 prescriptions), followed by Bu-Yang-Huan-Wu-Tang (BYHWT) (33.1%). This is the first study to identify the characteristics of TCM users among late stage CKD patients and further research targeting the safety and efficacy of the most commonly used CHMs is needed.