探讨台湾地区大肠癌患者使用中医之处方模式及存活分析

发布时间：2018-01-14 07:10

本文关键词：探讨台湾地区大肠癌患者使用中医之处方模式及存活分析　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：台湾地区自1995年3月1日开始实施全民健康保险,为强制性保险的福利政策,以全体居民为保障对象,拥有完善的病人健康保险就医数据,同时亦开放研究单位及学者利用此健保数据库,以流行病学角度进行相关分析研究。本研究利用健康保险数据库,探讨台湾地区接受中医医疗行为之大肠癌病人,其门诊常用处方用药特点与治疗成效,以作为未来中西医疗并治之参考。方法：本研究以2005年承保抽样归人文件资料6((longitudinal health insurance database [LHID]), LHID2005),为研究资料,其内容是以2005年承保数据文件中「在保者」随机取100万人,撷取其各年度就医资料建置而成。以大肠癌患者(ICD-9-CODE153、154)为研究对象进行数据筛选,撷取这些病人门诊就医数据与中药使用记录,将其分成有使用中医医疗行为与无使用中医医行为二组进行数据分析。中医医疗使用行为者定义：经大肠癌确诊后,有第一次中医就医纪录开始(含)计算,连续三个月内曾有3次以上中医就医纪录者,列为有使用中医医疗行为者。数据使用SAS for windows 13.0版软件进行统计分析,比较二组在性别、年龄、共病指数及门诊常用中医处方用药的情形,并以Cox proportional hazards model比较,使用中医医疗行为者,在存活率上是否有所差异,并计算其相对风险率。结果：研究结果显示：2000-2011年台湾地区大肠癌发生率,介于每十万人口34.2至64.6之间且有逐年往上升的趋势,其中约有45.51%的大肠癌病人有使用中医医疗行为。由人口学特性来看,男性使用中医医疗行为者比女性多,约为女性的1.2倍,年长者对中医医疗的认同度较高。两组死亡发生比为0.4,具有统计学差异(p-value0.001)。以Cox proportional hazards model进行多变量存活分析,结果显示大肠癌的病人使用中医医疗行为者与无使用中医医疗行为者,两组相对风险值比(hazard ratio;HR)为0.37(信赖区间：0.29-0.47),达到统计学差异(p0.001) 经调整性别及共病指数的影响之后,发现有中医医疗行为者比没有中医医疗行者其相对死亡风险较低。中医门诊最常使用的单方药前三位为丹参(1.93%)、延胡索(1.92%)、大黄(1.67%)；而单方前20位使用量共占总单方使用的27.01%。使用中药制剂复方前3位为香砂六君子(2.42%)、疏经活血汤(2.42%)、芍药甘草汤(2.13%)。复方前20位使用量共占总复方使用的33.66%。整体使用中药制剂功能前3位为补养剂(14.68%)、和解剂(8.77%)、清热泻火剂(8.5%)。结论：台湾地区大肠癌治疗仍是以西医为主,然而有使用中医医疗能增加机体整体抗病力,提高存活率。本研究结果可以作为中医药治疗大肠癌相关研究及临床应用之参考。
[Abstract]:Objective: since March 1st 1995, Taiwan has implemented the national health insurance, which is the welfare policy of compulsory insurance. It takes all residents as the protection object and has the perfect patient health insurance data. At the same time, we also open the research units and scholars to make use of the health insurance database to carry out the related analysis and research from the perspective of epidemiology. This study uses the health insurance database. Objective: to explore the characteristics and efficacy of prescriptions for colorectal cancer patients in Taiwan who received traditional Chinese medicine (TCM). As a reference for future Chinese and western medical treatment. Methods: in this study, a sample of insurance coverage was collected on 2005. Longitudinal health insurance database. [LHID, LHD 2005, for research data, its content is to take 1 million people randomly from the underwriting data file of 2005. The data were collected from each year and selected from patients with colorectal cancer (ICD-9-CODE1534). The data of outpatient visits and records of the use of traditional Chinese medicine (TCM) were obtained. It is divided into the use of TCM medical behavior and non-use of TCM medical behavior two groups for data analysis. TCM medical use behavior definition: after the diagnosis of colorectal cancer, there is the first time of TCM medical records start (including) calculation. For three months in a row, the patients who had more than 3 visits to TCM were listed as the users of TCM medical behavior. The data were analyzed by SAS for windows 13.0 software. The sex, age, index of syndromes and prescriptions of traditional Chinese medicine were compared between the two groups, and Cox proportional hazards model was used to compare the two groups. Results: the results showed that the incidence of colorectal cancer in Taiwan area from 2000 to 2011 was higher than that in Taiwan from 2000 to 2011. Between 34.2 and 64.6 per 100,000 population, there is a rising trend year by year, of which about 45.51% of colorectal cancer patients have the medical behavior of traditional Chinese medicine, according to demographic characteristics. Men used TCM medical behavior more than women, about 1.2 times as female, the elderly have a higher degree of recognition of TCM treatment. The death rate of the two groups is 0.4. Cox proportional hazards model was used for multivariate survival analysis. The results showed that the relative risk value of the two groups was higher than that of hazard ratio in patients with colorectal cancer who used traditional Chinese medicine (TCM) medical behavior and those who did not use traditional Chinese medicine (TCM). HRwas 0.37 (trust region: 0.29-0.47, P 0.001). After adjusting the effect of gender and co-disease index, HRwas 0.37 (trust region: 0.29-0.47). It was found that the relative risk of death was lower for those with TCM medical behaviors than for those without TCM practitioners. The first three most frequently used single prescription drugs in TCM outpatient clinic were Salvia miltiorrhiza 1.93 and Yanhusuo 1.92). Rhizoma et Rhizoma Rhei 1.67; And the first 20 usage of single prescription accounted for 27.01 of the total single prescription. The top 3 of using Chinese traditional medicine preparation compound were Xiangsha six gentlemen 2.42dick, and thinning Meridian Huoxue decoction 2.42). Paeoniao Licorice decoction was 2.130.The usage of the first 20 compounds accounted for 33.66kum of the total compound. The top 3 of the function of the whole use of traditional Chinese medicine preparation was the nourishing agent (14.68m). Conclusion: the treatment of colorectal cancer in Taiwan is still mainly western medicine, but the use of traditional Chinese medicine can increase the overall anti-disease ability of the body. The results of this study can be used as a reference for the study and clinical application of traditional Chinese medicine in the treatment of colorectal cancer.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R273

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