全身性紅斑狼瘡患者使用奎寧發生末期腎病/惡性腫瘤/中風/骨質疏鬆之相關性研究

Does Quinine Can be a Reducing Factor on ESRD/Malignancy Neoplasm/Stroke/Osteoporosis for a Lupus Patient

背景和目的：全身性紅斑狼瘡（Systemic Lupus Erythematosus, SLE），大多好發於育齡婦女的自體免疫疾病，且發病時可能侵犯到身體其他多處器官。行政院衛生署於1999年5月核准使用抗發炎藥之一的奎寧（Quinine）治療SLE患者，因此接受奎寧治療的患者開始大量增加，然而使用奎寧治療SLE對患者本身是否可能造成其他影響？故本研究針對SLE患者使用奎寧治療是否會造成惡性腫瘤、末期腎病、中風及骨質疏鬆等疾病進行探討。方法：本研究採用回溯性追蹤研究法（Retro-prospective Study），對國家衛生研究院全民健保研究資料庫ICD-9-CM之重大傷病明細檔（HV）、門診處方及治療明細檔（CD）、門診處方醫令明細檔（OO）及住院醫療費用清單明細檔（DD）進行次級資料分析，以1998年新申請登錄之1,349位SLE新患者為研究對象，探討其於2000-2007年期間之奎寧藥物持有率（Medication Possession Ratio, MPR）與發生惡性腫瘤、末期腎病、中風及骨質疏鬆的相關性。結果：SLE患者使用奎寧治療且奎寧藥物持有率較高者，其發生惡性腫瘤、末期腎病、中風的比率顯著低於使用其他藥物治療者，而發生骨質疏鬆的比率則顯著高於使用其他藥物治療者。結論：SLE患者使用奎寧可降低發生末期腎病、惡性腫瘤及中風的風險，但會增加發生骨質疏鬆的風險，唯仍需進一步驗證。

SLE (Systemic Lupus Erythematosus) is an autoimmune disease which often affect women in childbearing age, and could infringe other organs as well. Since the approval of using Quinine as anti-inflammation drug for the treatment of SLE patients by the Department of Health, Executive Yuan, R.O.C (Taiwan) in May 1999, there has been a substantial increase in using the approved Quinine for treatment in SLE patients. However, does the use of Quinine for treatment in SLE patients incur side effects? The purpose of this study is to see whether the use of Quinine in SLE patients will affect the incidence of ESRD (End-Stage Renal Disease), Malignant neoplasm, Stroke, and Osteoporosis. Using a retrospective secondary data analysis approach to analyze data from the National Health Insurance Research Database(ICD-9-CM), including Registry for catastrophic illness patients (HV), Ambulatory care expenditures by visits (CD), Details of ambulatory care orders (OO), and Inpatient expenditures by admissions (DD). A total number of 1,349 new SLE patients in 1998 was selected to investigate the relationships between Quinine Medication Possession Ratio and incidence of Malignant neoplasm, ESRD, Stroke and Osteoporosis in the years of 2000 to 2007. The incidences of Malignant neoplasm, ESRD, and stroke in SLE patients who took Quinine for treatment were lower, and there is a positive correlation between Quinine Medication Possession Ratio and incidence of Malignant neoplasm and ESRD in SLE patients. But the incidence of Osteoporosis in SLE patients who took Quinine for treatment was higher. Whether the use of Quinine for treatment in SLE patients will reduce the incidences of Malignant neoplasm, ESRD, and stroke and increase the incidence of osteoporosis requires further studies.