1997-2001年全民健保馬兜鈴酸相關方劑處方概況

Abstract

目標：本研究的目的在描述全民健保中可能含馬兜鈴科植物方劑使用概況，與連續服用三個月以上發生中藥腎病變的處方方式作比較。方法：使用國家衛生研究院20萬人健保抽樣歸人檔，對回溯的資料庫進行含細辛、防己、木通、木香、馬兜鈴及天仙藤中藥處方的全民使用率及性別、累積天數、處方年齡分層分析。結果：本研究發現在1997-2001年間，扣除資料不全後中醫門診總處方次數5098390次共103630人。六類方劑總處方次數為361333次共64216人；全民使用率為64.2*10-3年-1。女性較多。六類中最常用的為細辛類。六類方劑的平均處方年齡為37.9±19.3，35-44歲的處方次數為76964次。除細辛類為15歲以下，其餘各類均以35-44歲最多。每次處方開立天數均以一周內為多，8天以上者，六類方加起來共5999次。第一次服用這六類方劑平均年齡為34.9±18.8歲；除細辛類為十五歲以下天仙藤類為25-34歲；其餘均以35-44歲第一次使用最多。六類方劑累積服用天數為32.9±56.1，1-30天者有46335人，而各類方劑累積服用天數以1-30天為最常見，六類處方總累積天數超過三個月有5089人。結論：國內對馬兜鈴科的細辛類藥物仍可以使用，本研究發現這類藥物的使用十分廣泛而且使用年齡層較低；雖然累積天數並不像國外一樣長期；但最常使用的為15歲以下，危險劑量是否較成人為低及長期累積是否有不良影響；值得加以進一步研究。

Object：This study was conducted to determine the current prescription patterns of Chinese Herb Medicine May Containing Plant Species of the Genus Aristolochia in National Health Insurance in Taiwan between 1997-2001. and explore the different of prescription patterns between Taiwan’s regular using and Belgian’s Chinese herbs nephropathy cases. Method：The database containing 200,000 people randomly sampled from the National Health Insurance (NHI) system during 1997-2001 was used. The retrospective cohort was stratified for age, gender, cumulative prescribing days of mixtures containing Si-sin、Fang-ji、Mu-tong、Mu-siang、tian-sian-teng and Ma-dou-ling. Result：103630 people used Chinese medicine service and had 5098390 prescriptions between 1997-2001. There were 64216 people taking 361333 prescriptions containing these six kinds of drug, with a mean prescribing age of 37.9±19.3 and 76964 prescriptions between 35-44 years old. Using incidence rate of hole people is 64.2*10-3Year-1.Female gender is more than male. The mixture contain Si-Sin is the highest. All other kinds of mixtures had the most popular age range between 35-44 expecting Si-sin is under the 15 years old. 5999 prescriptions of six kinds of mixture had individual prescribing day more than eight days. The mean age of first time taking prescription of seven mixtures are 34.9±18.8 years old; all had the most popular age range between 35-44 expecting Si-sin is under the 15 and tian-sian-teng is between 25-34 years old. The cumulative prescribing day of all seven kinds of mixture is 32.9±56.1 days; 46355 people were less than 30 days. 5089 people had cumulative prescribing day more than 3 months. Conclusion：In Taiwan, the Chinese Herb Containing Plant Species of the Genus Aristolochia is no more used expect Si-sin. Our study find the using of mixture contain Si-sin is popular. Although the cumulative prescribing day is not as long as Belgian’s cases, Sin-Sin is frequently used in children under 15 years old. They may have lower danger dose than adult and has much long life time for cumulative dose. It is very crucial to further clarify the effect of Si-Sin on kidney function and urinary cancer in the future.