影響中藥治療乾癬療效因子分析：橫斷性研究

Factors Influencing Response to Psoriasis Treatment with Chinese Herbal Medicine: A Cross-Sectional Study

目的：探討中藥治療乾癬效果的影響因子。方法：採橫斷性研究，病人來源為基隆、台北及林口長庚紀念醫院中醫門診乾癬病人，依其接受過中藥治療後的主觀改善程度分成3組：A組，改善九成者；B組，改善五成至九成者；C組，改善小於五成者。以單因子變異數分析、卡方檢定分析中藥治療的主觀改善程度與病人的共生疾病、生活型態和飲食習慣的關係，最後以比例勝算模型的向前選取法來獲知哪些因子與主觀改善程度有關。結果：自2016年6月至2017年3月，符合分析條件共385人。A組114人，B組177人，C組94人，三組有統計上顯著差異的因子：(1)乾癬病程(年)，A：B：C = 16.4±10.51：13.1±9.26：13.2±9.45，p = 0.0102；(2)血中HDL-C濃度(mg/dL)，A：B：C = 48.9±12.85：47.1±11.41：43.7±9.61，p = 0.0048；(3)目前吸菸百分比，A：B：C = 21.9%：21.5%：36.2%，p = 0.0439；(4)需勞力工作百分比，A：B：C = 12.3%：26%：26.6%，p = 0.0108；(5)有服用綜合維他命百分比，A：B：C = 17.5%：10.2%：3.2%，p = 0.0036。多變量分析結果顯示，病人的主觀改善程度最終影響因子為是否服用綜合維他命、HDL-C及是否從事勞力工作。結論：接受中醫治療乾癬的成效相當不錯，病人主觀改善程度達九成以上者佔30%，五成至九成者有46%。有服用綜合維他命及高HDL-C病人，其主觀改善程度越佳。而從事勞力工作的病人，其主觀改善程度越差。

"Objective: This study aimed to investigate which factors are associated with patients’response to Chinese herbal remedies of psoriasis. Methods: This is a crosssectional study. Patients with psoriasis who visited the Traditional Chinese Medicine Departments in three branches of Chang Gung Memorial Hospital (Keelung, Taipei, and Linkou) were recruited and interviewed. According to their subjective response to treatment with Chinese herbal medicine (CHM), the patients were divided into three groups: more than 90% improvement (group A); 50-90% improvement (group B); and less than 50% improvement (group C). The influence of comorbidities, lifestyle, and dietary habits on treatment response was analyzed by One-way ANOVA and Chisquare test. A proportional odds model with forward selection was made to determine which factors being associated with the patient’s subjective response to Chinese herbal remedies of psoriasis. Results: From June 2016 to March 2017, 385 patients were eligible for this study (group A, 114; group B, 177; group C, 94). In univariate analysis, the following factors are statistically significant differences among the three groups: (1) the duration of psoriasis (years) was 16.4±10.51, 13.1±9.26, 13.2±9.45 for A, B, and C respectively (p = 0.0102) ; (2) the levels of HDL-cholesterol (HDL-C, mg/ dL) were 48.9±12.85, 47.1±11.41, and 43.7±9.61 for A, B, and C respectively (p = 0.0048); (3) the percentages of current smokers were 21.9%, 21.5%, and 36.2% respectively (p = 0.0439); (4) the percentages of having a physical labor job were 12.3%, 26.0%, and 26.6%, respectively (p = 0.0108); (5) the percentages of regularly taking multiple vitamins supplements were 17.5%, 10.2%, and 3.2% respectively (p = 0.0036). Multivariate analysis reveals that whether regularly taking multiple vitamins supplements, the level of HDL-C, and whether having a physical labor job were important factors of patient’s subjective response to Chinese herbal remedies of psoriasis. Conclusion: The patient’s subjective response to Chinese herbal remedies of psoriasis in our sample was very good, in which 30% felt improvement more than 90% and 46% felt improvement between 50-90%. Taking multiple vitamins supplements regularly and a high level of HDL-C is positively associated with the patient’s subjective good improvement to Chinese herbal remedies of psoriasis. Those who had a physical labor job tend to have a poor response to Chinese herbal remedies of psoriasis."