中藥治療中風後失智症的療效評估：一項回溯性世代研究

The Therapeutic Assessment of Chinese Herbal Medicine on Post-Stroke Dementia:A Retrospective Cohort study

背景：中醫已在亞洲盛行，也是中風患者的主要治療方式之一。本研究目的在評估中風病患使用中藥治療是否能減少中風後失智症發生之風險。方法：我們使用全民健康保險申報資料做為研究資料來源，本研究篩選2000-2004年間年齡大於50歲的初中風患者，追蹤接受中藥治療組及沒有接受中藥治療組兩個世代至2009年底並觀察罹患中風後失智症的情形。本研究使用多變量Cox迴歸模型，計算中藥治療與中風後失智症的相關危害比與95%信賴區間。結果：在追蹤過程中，我們發現接受中藥治療的中風患者與沒有接受中藥治療的中風患者相比，罹患中風後失智症的風險有顯著減少（危害比=0.70，95%信賴區間=0.67-0.73）。接受中藥治療減少罹患中風後失智症風險的相關性，在不同性別、年齡、各種中風類型（出血性中風、缺血性中風、其他中風）的次族群上，都呈現統計上的顯著意義。另外，我們也分析中風病患最常使用中藥治療單味藥及複方的情形。結論：本研究提出接受中藥治療可以減少中風患者罹患中風後失智症風險的可能性。建議醫療主管機關及各醫院可鼓勵中風患者接受中醫會診及中藥治療。本研究結果可作為醫療主管機關未來推動中風患者防治及中醫藥衛生政策之參考。

Background: Traditional Chinese medicine was prevalent in Asian countries and it was as one of major therapies for stroke patients. Our purpose is to evaluate the risk of dementia for stroke patients with and without use of Chinese herbal medicine (CHM). Method: We used claim data of Taiwan's National Health Insurance and conducted a stroke cohort study including hospitalized stroke patients aged 50 years and old in 2000-2004. Use a matching procedure by propensity score, we selected 55074 stroke patients who received CHM and 55074 stroke patients without Chinese medicine for comparison. Both cohorts were followed until the end of 2009. Multivariate Cox proportional hazard regressions were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of incidence of dementia after stroke associated with CHM. We also analyzed the most common use of formula and herbs in stroke patients. Results: During the follow-up period, use of CHM was associated with a decreased risk of dementia in stroke patients (HR, 0.70; 95% CI 0.67 to 0.73). The association between CHM and reduced risk of post-stroke dementia was significant in both sexes, all age group and all type of stroke. The most common used herb and formula for stroke patients were Dan Shen and Shu Jing Huo Xie Tang, respectively. Conclusions: Our study raised the possibility that CHM is beneficial in reducing dementia risk in stroke patients. We suggested that the health authority and hospitals to encourage stroke patients receiving CHM and adjuvant therapy of traditional Chinese medicine during the stroke admission. The findings of this study is the important references for the health authority to making health policy for stroke patients and traditional Chinese medicine.