2019年11月5日星期二

[榮譽獲獎] 2019年中華民國中醫師公會全聯會「中醫藥特殊傑出論文獎」- 多發性肌炎及皮肌炎(PM/DM，Polymyositis and Dermatomyositis)

[榮譽獲獎]

108年度中華民國中醫師公會全國聯合會

中醫藥特殊傑出論文獎

感謝 楊鈞百醫師、何文照教授、陳曾基主任、施柏瑄醫師

研究團隊的幫忙！⋯⋯

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2019 Feb 25. pii: S0378-8741(18)34634-8. doi: 10.1016/j.jep.2019.02.042. [Epub ahead of print]

Integrated Therapy Decreases the Mortality of Patients with Polymyositis and Dermatomyositis: A Taiwan-wide Population-Based Retrospective Study.

整合中西醫醫療可減少多發性肌炎與皮肌炎患者之死亡率：臺灣族群回顧性研究

Chang CM1, Shih PH2, Chen TJ3, Ho WC4, Yang CP5.

Author information

Abstract

ETHNOPHARMACOLOGICAL RELEVANCE:

The issue of whether integrated treatment with conventional medicine (CM) and herbal medicine (HM) can reduce mortality in patients with polymyositis/dermatomyositis (PM/DM) had not been addressed.

AIM OF THE STUDY:

In this study, we investigated the effect of integrated therapy on mortality in a retrospective PM/DM cohort in the Taiwan National Health Insurance Research Database (NHIRD).

MATERIALS AND METHODS:

Patients with PM/DM were retrospectively enrolled from the PM/DM Registry of Catastrophic Illnesses cohort in the Taiwan NHIRD between 1997 and 2011. The patients were divided into an integrated medicine (IM) group that received CM and HM and a non-IM group that received CM alone. The Cox proportional hazards regression model and Kaplan-Meier method were used to evaluate the hazard ratio (HR) for mortality.

RESULTS:

Three hundred and eighty-five of 2595 patients with newly diagnosed PM/DM had received IM and 99 had received non-IM. The adjusted HR for mortality was lower in the IM group than in the non-IM group (0.42, 95% confidence interval 0.26-0.68, p<0.001). The adjusted HR for mortality was also lower in the IM group that had received CM plus HM than in the group that received CM alone (0.48, 95% confidence interval 0.28-0.84, p<0.05). The core pattern of HM prescriptions integrated with methylprednisolone, methotrexate, azathioprine, or cyclophosphamide to decrease mortality included "San-Qi" (Panax notoginseng), "Bai-Ji" (Bletilla striata), "Chen-Pi" (Citrus reticulata), "Hou-Po" (Magnolia officinalis), and "Dan-Shan" (Salvia miltiorrhiza).

CONCLUSION:

Integrated therapy has reduced mortality in patients with PM/DM in Taiwan. Further investigation of the clinical effects and pharmaceutical mechanism involved is needed.

KEYWORDS:

Complementary and alternative medicine; Dermatomyositis; Herbal medicine; Integrated therapy; Polymyositis

本研究利用臺灣健保資料庫探討1997至2011年間，臺灣多發性肌炎及皮肌炎(PM/DM，Polymyositis and Dermatomyositis)之中西醫整合照護情形，研究顯示在總數2595位PM/DM患者中，有385位接受中西醫整合治療，僅99位接受純西醫治療。而接受中西醫整合之患者，可顯著降低死亡風險達0.42 (p<0.001)，且細部分析中西整合照護與純西醫照護相比，也可顯著降低死亡風險達0.48 (p<0.05)。前五大常使用中醫複方為銀翹散、加味逍遙散、血府逐瘀湯、參苓白朮散及龜鹿二仙膠，前五大常見使用中醫單方為三七、丹參、木瓜、炙甘草及蟬蛻，治療中醫核心處方為三七、白芨、陳皮、厚朴及丹參。本文也整理中醫藥治療PM/DM核心處方之機轉，並整理成相關表格及機轉圖，也提出中醫藥核心處方可以降低死亡率，可作為提供中西醫師治療PM/DM之實證醫學之證據。