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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 翁德怡 | zh_TW |
| dc.contributor.advisor | Te-I Weng | en |
| dc.contributor.author | 楊文杰 | zh_TW |
| dc.contributor.author | Wen-Chieh Yang | en |
| dc.date.accessioned | 2023-05-18T17:09:30Z | - |
| dc.date.available | 2023-11-10 | - |
| dc.date.copyright | 2023-09-22 | - |
| dc.date.issued | 2023 | - |
| dc.date.submitted | 2002-01-01 | - |
| dc.identifier.citation | Obesity and overweight fact sheet No. 311. Switzerland: World Health Organization; 2016. https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight.
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European Medicines Agency. 2020;1-24 https://www.ema.europa.eu/en/documents/herbal-report/final-assessment-report-rheum-palmatum-l-rheum-officinale-baillon-radix-revision-1_en.pdf. Taiwan Herbal Pharmacopeia 3rd Edition Committee. Taiwan Herbal Pharmacopeia 3rd Edition English version. Taiwan, R.O.C: Ministry Health and Welfare; 2019. https://www.mohw.gov.tw/dl-58890-eac24140-225d-4eef-bb1f-e318d678ba81.html. Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(20):2200-2211. https://doi.org/10.1001/archinte.158.20.2200 Izzo AA, Di Carlo G, Borrelli F, Ernst E. Cardiovascular pharmacotherapy and herbal medicines: the risk of drug interaction. Int J Cardiol. 2005;98(1):1-14. https://doi.org/10.1016/j.ijcard.2003.06.039. Liao HL, Ma TC, Li YC, Chen JT, Chang YS. Concurrent use of corticosteroids with licorice-containing TCM preparations in Taiwan: a National Health Insurance Database study. 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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/87339 | - |
| dc.description.abstract | 總論：
在台灣去中醫診所看減肥一直相當普遍。但礙於減重屬於健保自費項目，這些病患的資料並未被完整上傳至健保資料庫。由於自費項目未受明顯規範，衍生出減肥中藥濫用和病歷記載不實之情事，對病人健康造成相當危害。2013年一名103公斤正值青壯年為家庭主要經濟來源的爸爸，在服用知名減重中醫診所的中藥處方一個月後，死於急性心肌梗塞之重大不良心血管事件，法院最終判決中醫師過失致人於死罪處有期徒刑陸月定讞。有鑑於此，服用中藥是否產生重大不良心血管事件須得到澄清，且中醫與重大心血管事件之間仍缺乏大規模的臨床風險評估。本研究旨在闡明台灣診斷為肥胖症的年輕及中年成人病患中，接受中醫治療發生重大不良心血管事件之風險。 研究方法與步驟： 從2008年至2018年台灣全民健康保險研究資料庫（NHIRD）中，搜尋18至50歲之間曾診斷為肥胖的患者，經過傾向分數配對後，分成67,655名的中藥使用組和67,655名的非中藥使用組。從指標日期開始對所有患者進行追蹤，直至患者發生重大不良心血管事件 (MACE)、死亡或至2018年底。以Cox比例回歸模型評估中藥使用組與非中藥使用組之間發生重大不良心血管事件的風險比。 結果： 經過平均4.2年的追蹤，與非中藥使用組對照相比，中藥組重大不良心血管事件的發生率較高。（每1000人年9.35 vs. 8.27，P < 0.001）。中藥組發生重大不良心血管事件的風險是非中藥組的1.13倍（aHR: 1.13; 95% CI: 1.07–1.19），尤其是在缺血性腦中風 (aHR: 1.18; 95% CI: 1.07–1.31）、心律不整 (aHR: 1.26; 95% CI: 1.14–1.38) 和18–29 歲的年輕人（aHR: 1.22; 95% CI: 1.05–1.43）。連續使用中藥一年仍較非中藥組高出1.18倍重大不良心血管事件的風險。 結論： 此項台灣全人口健保資料庫的研究顯示，使用中藥的青壯年肥胖患者發生重大不良心血管事件的風險高於非中藥使用者。中藥可能是造成肥胖青壯年重大不良心血管事件的危險因素。 | zh_TW |
| dc.description.abstract | Background:
In Taiwan many obese patients visit traditional Chinese medicine (TCM) clinics for Chinese herbal medicine (CHM). This study aimed to determine the risk of major adverse cardiovascular events (MACE) among adults with a diagnosis of obesity in Taiwan, with or without CHM. Methods: Obese patients aged between 18 and 50 years were identified from Taiwan’s National Health Insurance Research Database (NHIRD) from 2008 to 2018. We enrolled 67,655 CHM users and 67,655 non-CHM users, randomly selected using propensity score matching from the remaining cases. All patients were followed from the study date until MACE development, death, or the end of 2018. The Cox proportional regression model was used to evaluate hazard ratios of MACE between CHM and non-CHM cohorts. Results: During a median follow-up period of 4.2 years, the incidence rate of MACE was higher in the CHM cohort when compared with the non-CHM control cohort (9.35 vs. 8.27 per 1,000 person-years). The risk of MACE was 1.13-fold higher in the CHM group compared with the non-CHM control (adjusted hazard ratio [aHR]: 1.13; 95% confidence interval [CI]: 1.07–1.19), especially in ischemic stroke (aHR: 1.18; 95% CI: 1.07–1.31), arrhythmia (aHR: 1.26; 95% CI: 1.14–1.38), and young adults aged 18–29 (aHR: 1.22; 95% CI: 1.05–1.43). Continuous use of CHM for approximately 360 days still had a 1.18-fold higher risk of MACE. Conclusions: Young and middle-aged adults receiving CHM have a higher risk of MACE than non-CHM users. CHM may be an independent risk factor for MACE in obese patients. | en |
| dc.description.provenance | Submitted by admin ntu (admin@lib.ntu.edu.tw) on 2023-05-18T17:09:30Z No. of bitstreams: 0 | en |
| dc.description.provenance | Made available in DSpace on 2023-05-18T17:09:30Z (GMT). No. of bitstreams: 0 | en |
| dc.description.tableofcontents | 誌謝 i
中文摘要 ii ABSTRACT iv CONTENTS vi LIST OF FIGURES viii LIST OF TABLES ix Chapter 1 Introduction 1 Chapter 2 Materials and Methods 3 2.1 Data source 3 2.2 Study population 4 2.3 Comorbidities and study endpoint 4 2.4 Core patterns of Chinese herbal medicine 5 Chapter 3 Results 7 3.1 Baseline characteristics 7 3.2 Hazard ratios and cumulative risk of MACE for CHM and non-CHM cohorts 7 3.3 Stratification analysis of MACE associated with CHM use 8 3.4 Hazard ratios of MACE associated with cumulative duration and cumulative dose 9 3.5 Prescription patterns of Chinese herbs issued by TCM doctors 10 Chapter 4 Discussion 11 Chapter 5 Conclusion 18 References 19 Appendix 36 | - |
| dc.language.iso | zh_TW | - |
| dc.subject | 肥胖 | zh_TW |
| dc.subject | 重大不良心血管事件 | zh_TW |
| dc.subject | 台灣健保資料庫 | zh_TW |
| dc.subject | 全國世代研究 | zh_TW |
| dc.subject | 中醫藥 | zh_TW |
| dc.subject | Nationwide cohort study | en |
| dc.subject | Major adverse cardiovascular events | en |
| dc.subject | Obesity | en |
| dc.subject | Traditional Chinese medicine | en |
| dc.subject | Chinese herbal medicine | en |
| dc.subject | Taiwan’s National Health Insurance Research Database | en |
| dc.title | 肥胖青壯年使用中藥發生重大不良心血管事件之風險 | zh_TW |
| dc.title | Increased risk of major adverse cardiovascular events in obese young and middle-aged adults receiving Chinese herbal medicine: A nationwide cohort study in Taiwan | en |
| dc.type | Thesis | - |
| dc.date.schoolyear | 111-2 | - |
| dc.description.degree | 碩士 | - |
| dc.contributor.oralexamcommittee | 方震中;李建璋 | zh_TW |
| dc.contributor.oralexamcommittee | Cheng-Chung Fang;Chien-Chang Lee | en |
| dc.subject.keyword | 重大不良心血管事件,肥胖,中醫藥,台灣健保資料庫,全國世代研究, | zh_TW |
| dc.subject.keyword | Major adverse cardiovascular events,Obesity,Traditional Chinese medicine,Chinese herbal medicine,Taiwan’s National Health Insurance Research Database,Nationwide cohort study, | en |
| dc.relation.page | 36 | - |
| dc.identifier.doi | 10.6342/NTU202201455 | - |
| dc.rights.note | 同意授權(限校園內公開) | - |
| dc.date.accepted | 2022-08-05 | - |
| dc.contributor.author-college | 醫學院 | - |
| dc.contributor.author-dept | 法醫學研究所 | - |
| 顯示於系所單位： | 法醫學科所 | |
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