骨質疏鬆症是否接受中醫治療療效分析-長庚醫院病例對照研究

Abstract

目的 世界衛生組織認定骨質疏鬆症是現代人第二大慢性疾病，骨質疏鬆症常造成脊椎壓迫性骨折、股骨頸骨折與腕部骨折，進而增加患者死亡率與急性照護的費用，尤其髖部骨折後患者容易長期臥床，增加照護的費用與人力，進而造成勞動力減退，形成經濟上的損失，如何預防與治療骨質疏鬆症在人口老化的國家是急需面對的問題，而中醫治療對骨質疏鬆症有何臨床助益或協助降低醫療費用，來提供另一種治療方法是本研究所要探討的目的。 方法 使用長庚醫學資料庫做為資料來源，選取在2004年至2018年期間，患者有兩次以上骨質密度檢查(DXA)，兩次時間在半年至四年間納入收案條件，分為開立中藥超過14天以上共有83人做為實驗組，以及利用傾向分數配對出未使用中藥組332人，蒐集基本資料、骨質密度T值(T-score)、各項醫療費用、住院發生率、骨折發生率等作兩組間的比較，並利用Cox proportional hazard model 做相關風險因子分析。 結果 結果發現有使用中藥組可以降低住院的機率(P=0.03)，在整體醫療費用兩組沒有顯著差異，但在急門診費用上有使用中藥組費用較高且有顯著差異，在骨質密度第一次T值(T-score)與第二次T值(T-score)兩組間沒有差異，在未使用中藥組內之前未骨折的在追蹤期間發生率高於曾經骨折過的患者(P<0.001)，住院風險有使用中藥住院的風險較未使用中藥HR: 0.23(95% CI: 0.07-0.74)，70歲以上住院的風險較未滿70歲HR: 4.43 (95% CI: 2.22-8.55)。骨折的風險因子具有顯著差異有年齡70歲以上HR: 1.93 (95% CI: 1.26-2.97)、之前有骨折HR:0.27 (95% CI: 0.15-0.51)，最常使用的中藥單味藥為杜仲，方劑為龜鹿二仙膠。 結論 合併中藥治療骨質疏鬆症可以降低患者住院的機率，且不會增加整體的醫療費用，但骨質疏鬆症中醫治療在門急診費用上與非中醫治療有替代的效果，有使用中藥組的骨質密度T值(T-score)與未使用中藥組結果沒有差異；減少住院風險的因子為使用中藥，增加住院風險的因子為年齡大於70歲，增加骨折的風險因子為年齡大於70歲，減少骨折的風險因子為之前有過骨折經驗。

Background The World Health Organization recognizes osteoporosis as the second most chronic disease of people. Osteoporosis often causes spine compression fractures, femoral neck fractures and wrist fractures, which increases patient mortality and the cost of acute care, especially after hip fractures. It is easy for patients become bedridden for a long time, which increases the cost of care and manpower, which leads to labor decline and economic losses. How to prevent and treat osteoporosis is an urgent problem in an aging population. Traditional Chinese medicine (TCM) has potentiality to treat osteoporosis. It is the purpose of this study to provide clinical treatment of clinical benefits or to reduce medical expenses to provide another treatment method. Methods Using Chang Gung Research Database as the data source, selected from 2004 to 2018, the patient had more than two bone density examinations (DXA), two times and between half a year and four years were included, and were divided into prescribing TCM group and non-TCM group. A total of 83 people were used in TCM group for prescribing herbs more than 14 days, and 332 people in the non-TCM group were matched using the propensity scores. Basic data, T value, various medical expenses, and fracture incidence were collected for comparison between the two groups, and Cox proportional hazard model to do relevant risk factor analysis. Results It was found that the use of TCM group can reduce the probability of hospitalization (P = 0.03). There is no significant difference in the overall medical cost between the two groups, but the cost of emergency medicine in the TCM group is higher and there is a significant difference. The first T-score and the second T-score value have no difference between two group. The incidence without previous fractures in the non-TCM group during the follow-up period was higher than that of patients who had fractured before (P <0.001). Admission rate TCM group has low HR: 0.23(95% CI: 0.07-0.74) and age older 70 years has high HR: 4.43 (95% CI: 2.22-8.55). There are significant differences in risk factors for follow-up fractures: age older 70 years HR: 1.93 (95% CI: 1.26-2.97), previous fracture HR:0.27 (95% CI: 0.15-0.51). Conclusion Combined treatment of osteoporosis with traditional Chinese medicine can reduce the patient ’s chance of being hospitalized without increasing the overall medical cost, but osteoporosis traditional Chinese medicine treatment has an alternative effect on outpatient and emergency costs compared with non-Chinese traditional medicine treatment. There was no difference in the results about T-score between the non-Chinese medicine group and Chinese medicine group. The factors that reduced the risk of hospitalization were TCM group and the increased the risk of hospitalization were age, the factors that increased the risk of fractures were age, and the factors that reduced the risk of fractures were previous fractures.