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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 林慧玲 | |
dc.contributor.author | Cheng-Pin Chen | en |
dc.contributor.author | 陳政斌 | zh_TW |
dc.date.accessioned | 2021-06-15T03:57:15Z | - |
dc.date.available | 2015-09-13 | |
dc.date.copyright | 2010-09-13 | |
dc.date.issued | 2010 | |
dc.date.submitted | 2010-06-15 | |
dc.identifier.citation | 1. Warren JD, Blumbergs PC, Thompson PD. Rhabdomyolysis: a review. Muscle Nerve. Mar 2002;25(3):332-347.
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/44882 | - |
dc.description.abstract | 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。 | zh_TW |
dc.description.abstract | 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. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T03:57:15Z (GMT). No. of bitstreams: 1 ntu-99-R97451006-1.pdf: 2271100 bytes, checksum: 70c5c929174d65695207862f26484a57 (MD5) Previous issue date: 2010 | en |
dc.description.tableofcontents | 致謝 i
中文摘要 ii Abstract iv 目錄 vi 圖目錄 ix 表目錄 x 第一章 前言 1 第二章 文獻探討 2 2.1. 橫紋肌溶解症及其併發症之簡介 2 2.1.1. 流行病學 2 2.1.2. 病因學 3 2.1.3. 診斷 6 2.1.4. 橫紋肌溶解症與其併發症的治療與預防 7 2.2. 降血脂藥品造成橫紋肌溶解症之回顧 9 2.2.1. 降血脂類藥品引起橫紋肌溶解症之機轉 9 2.2.2. 降血脂藥品引起橫紋肌溶解症之流行病學 9 2.3. Johns Hopkins醫院住院病人橫紋肌溶解症評估研究 15 第三章 研究目的 18 第四章 研究方法 19 4.1. 研究設計 19 4.2. 研究對象 19 4.2.1. 病人族群 19 4.2.2. 病人納入條件 19 4.2.3. 病人排除條件 20 4.3. 資料收集 20 4.3.1. 病人基本資料 20 4.3.2. 本研究相關定義 20 4.4. 研究流程 26 4.5 統計方法 27 4.4.1. 作業軟體 27 4.4.2. 敘述性分析 27 4.4.3. 組間比較 27 4.4.4. 線性回歸分析(linear regression model) 27 4.5.5急性腎損傷預測因子分析 27 第五章 研究結果 28 5.1. 病人特性 28 5.1.1. 納入病人人數 28 5.1.2 橫紋肌溶解症發生率 28 5.1.3 病人基本特性 28 5.2. 橫紋肌溶解症病因分析 33 5.2.1. 橫紋肌溶解症成因 33 5.2.2. 橫紋肌溶解症各年度病因分佈情形 39 5.2.3. 橫紋肌溶解症各病因族群特性 39 5.3. 橫紋肌溶解症併發症分析結果 46 5.3.1. 當次住院死亡病人之分析 46 5.3.2. 橫紋肌溶解症併發急性腎損傷分析結果 46 5.4. 藥品引起的橫紋肌溶解症分析結果 57 5.4.1. 藥品引起的橫紋肌溶解症病人族群特性 57 5.4.2. 藥品引起橫紋肌溶解症病人不良反應評估 57 第六章 討論 60 6.1. 橫紋肌溶解症發生率 60 6.2. 病人特性 60 6.3. 橫紋肌溶解症病因分佈情形 61 6.3.1. 非法藥品或酒精引起的橫紋肌溶解症 65 6.3.2. 肌肉疾病引起的橫紋肌溶解症 65 6.3.3. 創傷引起的橫紋肌溶解症 66 6.3.4. NMS引起之橫紋肌溶解 66 6.3.5. 敗血症或休克引起的橫紋肌溶解症 67 6.3.6. 運動過度引起的橫紋肌溶解症 68 6.3.7. 長時間無法移動引起的橫紋肌溶解症 68 6.3.8. 代謝異常引起的橫紋肌溶解症 68 6.3.9. 接受心肺復甦術或電擊而造成的橫紋肌溶解症 69 6.3.10.因為肢體局部缺血症引起的橫紋肌溶解症 69 6.3.11.一氧化碳中毒引起的橫紋肌溶解症 70 6.3.12.其他原因造成的橫紋肌溶解症 70 6.3.13.不明原因造成的橫紋肌溶解症 71 6.3.14.其他文獻研究比較 71 6.4. 橫紋肌溶解症併發症之急性腎臟損傷 75 6.4.1. 發生率與腎功能估計方法 75 6.4.2. 慢性腎臟病病人發生橫紋肌溶解症併發急性腎損傷之討論 78 6.4.3. 橫紋肌溶解症中急性腎損傷的預測因子 78 6.5. 藥品引起的橫紋肌溶解症 82 6.5.1. 降血脂藥品引起的橫紋肌溶解症 82 6.6. 超過CK上限值10倍的病人族群 98 6.7. 入院後發生橫紋肌溶解症之病人 98 6.8. 研究限制 98 6.8.1. 資料收集 98 6.8.2. 病因判斷 99 6.8.3. 病人族群與研究時期 99 6.9. 未來研究展望 99 第七章 結論 105 參考文獻 107 附錄一 個案報告表 115 附錄二 藥品不良反應評分表(Naranjo score) 119 | |
dc.language.iso | zh-TW | |
dc.title | 橫紋肌溶解症–臺灣某醫學中心住院病人回溯性分析 | zh_TW |
dc.title | Rhabdomyolysis: A Retrospective Analysis of Hospitalized Patients at a Medical Center in Taiwan | en |
dc.type | Thesis | |
dc.date.schoolyear | 98-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 吳寬墩 | |
dc.contributor.oralexamcommittee | 沈麗娟,何?芳 | |
dc.subject.keyword | 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, | zh_TW |
dc.subject.keyword | rhabdomyolysis,kidney injury, acute,antilipemic agents,hydroxymethylglutaryl-CoA reductase inhibitors,etiology,retrospective study, | en |
dc.relation.page | 124 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2010-06-15 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床藥學研究所 | zh_TW |
顯示於系所單位: | 臨床藥學研究所 |
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