慢性腎絲球腎炎病人使用中藥之分析：基於醫院的橫斷面研究

The Chinese Herbal Products Analysis of Chronic Glomerulonephritis Patients: A Hospital-Based Cross-Sectional Study

隨著人口高齡化，慢性疾病增加，全球慢性腎臟病的發生率及盛行率甚高。慢性腎病最常見原因為慢性腎絲球腎炎、糖尿病腎病變及高血壓腎硬化。本研究目的為分析慢性腎絲球腎炎常用之中藥、方劑及組合，並藉由客觀血液檢驗數據評估中藥對於慢性腎絲球腎炎患者腎功能之變化。 本研究收集2000-2015 年台北、林口、桃園長庚院區，疾病診斷碼為582 之患者，共55,165 人次，4,865 位患者，最常使用方劑為加味逍遙散，單味藥為芡實，使用關聯規則分析最常使用組合為加味逍遙散加補陽還五湯。使用加味逍遙散加補陽還五湯的族群，依照腎功能分Stage ，觀察Creatinine、eGFR 的變化，對於Stage 3b 以下族群經治療後3 個月、6 個月、9 個月內在統計上較有顯著差異，Creatinine 有下降趨勢，eGFR 有上升趨勢，並且在數據上沒有使腎功能惡化的表現。另以累積開立天數及累積使用劑量各別分組比較分析後，對於累積開立天數越多及累積劑量越高的族群Creatinine 有較顯著下降的趨勢，eGFR 有較顯著上升的趨勢。此研究為目前我們已知第一個關於慢性腎絲球腎炎使用中醫藥物治療， 且提出客觀之檢驗數據的研究，但其可能療效及機轉仍需更多相關臨床研究去進一步證實。

 

Chronic kidney disease (CKD) has a high incidence and prevalence rate in whole world, and the most common causes of CKD include chronic glomerulonephritis (CGN), diabetic nephropathy and hypertensive renal sclerosis. Therefore, it is important to diagnose early, treat, and prevent CGN and CKD. The purpose of this study is to analyze the prescription patterns and frequencies of chinese herbal products (CHPs) for CGN by using a hospital-based database from the Chang Gung Memorial Hospital (CGMH), a large, tertiary hospital system in Taiwan and to evaluate the safety and possibly be efficacy of CHPs by blood test. The International Classification of Disease Ninth Revision (ICD-9) code 582 was used to identify patients with CGN. From 2000-2015, a total of 55,165 CHPs used by 4,865 CHP users for CGN were provided. Association rule mining was used to analyze the prevalent of CHP combination patterns in treating CGN. Jia-Wei-Xiao-Yao-San (JWXYS) and Gorgon (Euryale feroxSalisb.) were the most frequently prescribed herbal formula and single herb, respectively. The most frequently prescribed combination of CHPs was that of JWXYS with Bu-Yang-Huan-Wu-Tang (BYHWT) in CGMH. In statistical, there are significant changes of Creatinine、eGFR after treatment in 3-6-9 months in Stage 3b group.The more cumulative time and dosage of CHPs exposure were found to have more significant change of Creatinine and eGFR. To the best of our knowledge, this is the first pharmaco-epidemiological study to review CHP treatments for CGN. However, additional studies and clinical trials are needed to provide data on the safety and efficacy of these CHPs.