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標題: | 橫紋肌溶解症–臺灣某醫學中心住院病人回溯性分析 Rhabdomyolysis: A Retrospective Analysis of Hospitalized Patients at a Medical Center in Taiwan |
作者: | Cheng-Pin Chen 陳政斌 |
指導教授: | 林慧玲 |
共同指導教授: | 吳寬墩 |
關鍵字: | 橫紋肌溶解症,急性腎損傷,降血脂藥品,病因分佈,回溯性研究, rhabdomyolysis,kidney injury, acute,antilipemic agents,hydroxymethylglutaryl-CoA reductase inhibitors,etiology,retrospective study, |
出版年 : | 2010 |
學位: | 碩士 |
摘要: | 目的:
以臺大醫院橫紋肌溶解症住院病人為研究群體,分析其病因分佈的情形,且著重於藥品治療引起者,同時分析橫紋肌溶解症引起之急性腎損傷情形。 設計: 單中心、回溯性病歷回顧分析研究 地點: 國立臺灣大學醫學院附設醫院 – 臺灣北部的一間醫學中心 對象: 2003年1月1日至2009年12月31日間,診斷有橫紋肌溶解症及相關肌肉病變的住院病人,並同時具有神經肌肉臨床異常症狀與血中creatinine kinase (CK)為上限值5倍以上者 (男性> 900 IU/L; 女性> 835 IU/L)。 方法: 利用ICD-9 code及CK檢驗值篩選出病人名單,接著以病歷回顧方式,收集橫紋肌溶解症之臨床相關資訊,包括病人基本資料、醫療病史、實驗室檢驗值、用藥史及主要病因等,藉此分析各病因的發生率及各病因於特定族群的表現情形,並紀錄引起橫紋肌溶解症的藥品清單。同時觀察病人併發急性腎損傷情形,進行分析比較,使用的統計方法包括線性回歸分析及多變項羅吉斯回歸分析,藉此尋找可能導致急性腎損傷發生的相關危險因子。 結果: 本研究共收入572位病人,其病因分佈以肌肉疾病所佔比率最高(19.41 %),其次依序為醫療用藥(14.34 %)、痙攣(8.92 %)、長時間無法移動(8.74 %)、不明原因(7.87 %)、代謝異常(6.82 %)及運動過度(5.07 %)等。而醫療用藥引起者共有82例,以降血脂藥品最多為33例,其次依序為情緒性用藥21例(含抗精神病藥品、抗憂鬱劑及鎮靜安眠藥品等)、中草藥/藥酒5例、秋水仙素與民眾自行購買藥品各4例、麻醉藥品3例、抗痙攣藥品2例、其他藥品7例以及不明藥品3例。其中降血脂藥品以fenofibrate單獨引起者最多(12例),其次依序為atorvastatin(6例)、simvastatin(4例)、rosuvastatin(2例)及合併2種藥品使用者(5例)。 在併發症部分,急性腎損傷病人在本研究共有377例(65.91 %),相較於以往文獻報告發生率較高。而多變項羅吉斯回歸分析結果指出與其相關的危險因子為CK值高者、敗血症、脫水及有心衰竭病史的病人,而病因為肌肉疾病、過度運動、不明原因及代謝異常者則較不易併發急性腎損傷。 結論: 橫紋肌溶解症於臺灣地區某醫學中心的病因分佈依序以肌肉疾病、醫療用藥、痙攣引起者最多,與國外之研究結果不盡相同。而醫療用藥則以降血脂藥品發生病例數最多,與以往文獻指出以statin藥品為主要引起者比較,本研究以fenofibrate所佔的比率最高。併發症的表現方面,急性腎損傷的發生率也較以往文獻為高。 本研究建立了臺灣本土性第一個橫紋肌溶解症病因分佈的層相情形,並記錄了多個可能引起橫紋肌溶解症的藥品項目,及容易併發急性腎損傷的危險因子,在臨床上可供醫療人員作為建立處理橫紋肌溶解症相關準則的參考,以期改善病人預後及提升醫療品質。 Objective: The purpose of this study is to understand the etiology of rhabdomyolysis in Taiwan, especially those due to pharmacotherapy, and analyze the incidence of different etiologies, especially high-risk drugs. Acute kidney injury (AKI) caused by rhabdomyolysis was also evaluated. Design: A single-center, retrospective, chart-review study Setting: National Taiwan University Hospital (NTUH) – a medical center in northern Taiwan. Patients: All patients who were admitted to NTUH during the period from 2003/1/1 to 2009/12/31 with a discharged diagnosis of rhabdomyolysis, acute neuromuscular symptoms and a serum creatinine kinase (CK) greater than 5 times the upper normal limit (male > 900 IU/L; female > 835 IU/L). Methods: The patient list was generated from database according to ICD-9 code and CK value and laboratory data was collected throught medical record review. The etiology was recorded according to the medical record. For patients with suspected drugs-related rhabdomyolysis, the detailed drug history was examined. The presence of AKI was evaluated. Linear regression and multivaritate stepwise logistic regression analysis were used to identify the risk factors for AKI. Result: During the study period, 572 patients were included. Muscle diseases were the most common cause of rhabdomyolysis (111 cases, 19.41 %), followed by drugs (82 cases, 14.34 %). The drugs that are correlated with rhbdomyolysis included lipid-lowering agents (33 cases), emotional drugs (21 cases) (including antipsychotics, antidepressants, hypnotics, etc), herbs (5 cases), colchicine (4 cases), over-the-counter (OTC) (4 cases), anaesthetic agents (3 cases), anticonvulsants (2 cases), other drugs (7 cases) and unknown drugs (3 cases). Among the lipid-lowering agents, fenofibrate (12 cases) was the most common cause of rhabdomyolysis, followed by atorvastatin (6 cases) and simvastatin (4 cases). Six cases were due to concurrent use of two lipid-lowering agents. AKI occurred in 377 patients (65.91 %) in this study. The correlation between creatinine and CK was weak by linear regressin analysis. Multivariate stepwise logistic regression showed that sepsis, dehydration, heart failure, maximum CK value were independent factors for AKI. Patients with etiologies of muscle diseases, over-exercise, metabolic causes and idiopathic ones were less prone to AKI. Conclusion: This retrospective study depicted the etiologies of rhabdomyolysis in Taiwan. Muscle diseases were the most common cause of rhabdomyolysis. Medications were the second leading etiology for rhabdomyolysis. Different to other studies in western countries, fenofibrates were responsible for much more cases than individual statin. The incidence of AKI was also higher than other western studies. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/44882 |
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顯示於系所單位: | 臨床藥學研究所 |
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