臺灣博碩士論文加值系統

高血脂是指體內血液中脂肪量過高，雖然於症狀輕微時，只會稍微不適，但當患者沒有好好控制放任其發展，症狀嚴重時甚至會引發腦血管疾病或心臟疾病而導致死亡，高血脂患者根據行政院衛生署之研究[2-3]，在2013年時高血脂患者已高達432萬人，是一種很常見之疾病。
高血脂能引起動脈粥樣硬化[4-6]，動脈粥樣硬化為一種血管阻塞之疾病，當導致阻塞心臟血管或腦部動脈可能導致缺血性腦中風或心臟衰竭造成患者死亡，因此如何治療高血脂以避免得到動脈粥樣硬化為有意義之研究，目前治療高血脂方式為服藥，大部分患者服用西藥，然而卻有研究指出降血脂藥物有不少副作用對肝，肌肉，胃有不良影響 [7-10]，有研究[21-25]指出部分中藥確實有療效，因此有部分患者改為使用中藥治療，雖然高血脂和動脈粥樣硬化有關，然而卻無針對高血脂患者服用中藥預防動脈粥樣硬化之研究。
本研究目的為評估服用中藥治療高血脂是否有助於避免得到動脈粥樣硬化，由全民健保資料庫共1,000,000人中，搜尋1996年到2005年間被診斷出高血脂患者共120768人，進一步搜尋一年內有三次以上看診紀錄或一次住院紀錄之患者69218人，再排除有糖尿病或高血壓患者共46256人，更進一步排除得到高血脂前已經有動脈粥樣硬化患者共1178人，最終獲得高血脂患者共21984人，將其區分為，僅服用中藥治療、服用中藥和西藥治療及僅服用西藥治療，並追蹤至2010年，結果顯示僅服用中藥高血脂患者僅有3.52%機率得到動脈粥樣硬化，和另外兩組18.38%及16.62%相比，其結果明顯低。本研究又更進一步針對性別、年齡、居住區域等進行分析和統計，亦就僅服用中藥患者所服用之中藥種類進行根據使用次數排名進行分析和統計，其能協助高血脂患者降低得到動脈粥樣硬化之機率。

Hyperlipidemia corresponds to abnormally elevated levels of lipids or lipoproteins in the blood. Hyperlipidemia is the most important risk factor for atherosclerosis [4-6]. Atherosclerosis is a disease in which plaque builds up inside your arteries. . If the disease is not properly controlled, atherosclerosis can further cause other death-causing cardiovascular diseases such as ischemic stroke or heart failure. In light of the association between hyperlipidemia and Atherosclerosis, the study regarding the risk of getting atherosclerosis under different treatment methods of hyperlipidemia is meaningful. This paper aims at evaluating the effectiveness of TCM drugs in treating hyperlipidemia to prevent the risk of getting atherosclerosis. The result shows that till 2010, a surprisingly low 3.52% hyperlipidemia patients in the TCM-only group later developed into atherosclerosis, in contrast with 14.52% and 14.48% in the mixed-usage and western medicine-only ones, respectively. If further stratified according to gender, age, and area. The specific drugs prescribed are also ranked according to the number of usage, average prescription period, and dosage in the hope that the risking of developing into atherosclerosis for patients with hyperlipidemia can be effectively lowered through this study.

目 錄
論文審定書 i
誌謝 iii
中文摘要 iv
英文摘要 v
目 錄 vii
圖目錄 ix
表目錄 x
第一章 簡介 1
1-1 背景與目的 1
1-2 全民健康保險研究數據庫 4
1-3 國際疾病分類 8
第二章 相關研究 10
2-1外動脈粥樣硬化之分級 10
2-2 高血脂之判斷標準 11
第三章 研究方法 12
3-1 資料來源 12
3-2 研究設定 12
3-3 研究架構 13
3-4 資料處理及統計方法 16
3-4-1搜尋步驟 13

第四章 實驗結果 17
4-1高血脂患者年紀與性別和居住區域統計 17
4-2 高血脂患者得到動脈粥樣硬化之數據與統計 18
4-3 中西藥患者治療天數分析 20
4-4 僅服用中藥患者服用中藥種類分析 21
第五章 討論 23
5-1研究限制 23
5-2詳細討論 23
參考文獻 27
附錄 32
附錄1-1 門診處方及治療明細檔(適用85~92年) 32
附錄1-2 門診處方及治療明細檔(適用93年以後) 36
附錄1-3 門診處方醫令明細檔(適用86~95年) 40
附錄1-4 門診處方醫令明細檔(適用96年以後) 42
附錄1-5 承保資料檔(適用98年前) 43
附錄1-6 承保資料檔(適用99年以後) 44

圖目錄
圖1 全民健康保險研究資料庫抽樣年齡層分布 3
圖2-1 全民健康保險研究資料庫抽樣年齡層分布 7
圖2-2 全民健康保險研究資料庫抽樣性別分布 7
圖3-1 病患自我感覺之狀況 10
圖3-2 ABI阻塞程度之不同狀況 10
圖4-1 1996年CD檔部分資訊 12
圖4-2 健保局公佈檔案欄位部分資訊 12
圖5-1 分組流程圖一-找出所有高血脂患者 14
圖5-2 分組流程圖二-高血脂患者依據服用之藥物分組 15
圖5-3 分組流程圖三-服用中藥統計 15
圖6 服用中藥與得到動脈粥樣硬化之關聯 18
圖7-1 服用中藥治療之時間圖 20
圖7-2 服用西藥治療之時間圖 20


表目錄
表1 健保資料庫分類檔 5
表2 健保資料庫分類檔 5
表3 動脈粥樣硬化及高血脂之國際疾病分類碼 9
表4高血脂之判斷標準 11
表5 1996-2010年高血脂患者之比例 17
表6 高血脂患者後來得到動脈粥樣硬化之分析 19
表7-1 中藥單方之排名和服用平均天數及克數 21
表7-2 中藥複方之排名和使用平均天數及克數 22

[1]衛生福利部-統計處-104年國人十大死因統計: http://www.mohw.gov.tw/news/572256044
[2]行政院衛生署國民健康局-2007年台灣高血壓，高血脂，高血脂之追蹤調查研究: http://www.hpa.gov.tw/BHPNet/Web/HealthTopic/TopicArticle.aspx?id=201102140001&parentid=200712250011
[3]行政院衛生署國民健康局-青壯年救心活動: http://www.mohw.gov.tw/news/531652300
[4]Wouters K, Shiri-Sverdlov R, van Gorp PJ, van Bilsen M, Hofker MH, “Understanding hyperlipidemia and atherosclerosis: lessons from genetically modified apoe and ldlr mice, ”Mini Rev Med Chem, 2010 Mar, pp 204 -217
[5]Julie Freischlag, MD, “Hyperlipidemia in Childhood and the Development of Atherosclerosis. May 2 to May 4, 1990, Bethesda, Maryland.,”J VASC SURG, February 1993, Volume 17, Issue 2, pp 455
[6]S. Garrido-Urbani., M. Meguenani., F. Motecuuco., B.A.Imof, “Immunological aspects of atherosclerosis,” Elsevier B V, October 1990, Volume 2, Issue 4, pp 192-203
[7]Chung WF1, Liu SW, Chang PY, Lin FS, Chen LF, Wu JC6, Chen YC, Liu L, Huang WC, Cheng H, Lo SS, “Hyperlipidemia and statins affect neurological outcome in lumbar spine injury,” Int J Environ Res Public Health, 2015 Jan, pp 402-413
[8]Chang CC, Ho SC, Chiu HF, Yang CY, “Statins increase the risk of prostate cancer : a population-based case-control study.,” Prostate, 2011 Dec, pp 1818-1824, Doi: 10.1002/pros.21401
[9]Jiunn-Horng Kang, Li-Ting Kao, Herng-Ching Lin, Ming-Chieh Tsai, Shiu-Dong Chung, “Statin use increases the risk of depressive disorder in stroke patients: A population-based study,” J NEUROL SCI, 2015 Jan, Volume 348, Issue 2, pp 89-93
[10]CLARK GILLETT, and ANGELICA NORRELL, “Considerations for Safe Use of Statins: Liver Enzyme Abnormalities and Muscle Toxicity,” Am Fam Physician, 2011 Mar, Volume 83, Number 6, pp 711-716
[11]Chu SM, Shih WT, Yang YH, Chen PC, Chu YH, "Use of traditional Chinese medicine in patients with hyperlipidemia: A population-based study in Taiwan.,” J Ethopharmacol, 2015 Jun, Volume 168, Page 129-135
[12]Zhao Lan Liu, Jian Ping Liu, Anthony Lin Zhang, Qiong Wu, Yao Ruan, George Lewith, and Denise Visconte, “Chinese herbal medicines for hypercholesterolemia,” Cochrane Database Syst Rev, 2011 Jul, Volume 7, Doi: 10.1002/14651858.CD008305.pub2
[13]Xie W, Zhao Y, Du L., “Emerging approaches of traditional Chinese medicine formulas for the treatment of hyperlipidemia,” J Ethnopharmacol, Volume 140, Issue 2, 27 March 2012, Pages 345–367
[14]全民健康保險研究資料庫：http://nhird.nhri.org.tw/index.php
[15]呂宗學，“國際疾病分類簡史與第十版簡介”，公共衛生，第二十一卷，第四期，頁數221-230，1995。
[16]World Health Organization, “Instruction manual of international statistical classification of disease and related health problems,” Geneva : World Health Organization, Vol. 3, pp. 11–pp. 13, 1993.
[17]Lu, Tsung-Hsueh, Chiang, Tong-Liang, “External Cause of Injury Coding: A Comparison of the Ninth and Tenth Revisions of International Classification of Diseases,” Taiwan Journal of Public Health, pp. 242–pp. 251, 2006.
[18]Marie D. Gerhard-Herman, Heather L. Gornik, Coletta Barrett, Neal R. Barshes, Matthew A. Corriere, Douglas E. Drachman, Lee A. Fleisher, Francis Gerry R. Fowkes, Naomi M. Hamburg, Scott Kinlay, Robert Lookstein, Sanjay Misra, Leila Mureebe, Jeffrey W. Olin, Rajan A.G. Patel, Judith G. Regensteiner, Andres Schanzer, Mehdi H. Shishehbor, Kerry J. Stewart, Diane Treat-Jacobson and M. Eileen Walsh, “2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary” Circulation, 2016 Nov, Doi: 10.1161/CIR.0000000000000471
[19]Chien-Jung Chang, Ching-Hsiu Feng, Kuo-Hua Hung, “Therapy for Lower Extremity Peripheral Arterial Disease,” Journal of Taiwan Pharmacy, Sep 2014, Vol 30, No 3, pp 92-97
[20]衛生福利部國民健康署-健康九九網站:高血脂紅色通緝令https://health99.hpa.gov.tw/educZone/edu_detail.aspx?CatId=20060

[21]Kang-ting Ji, Jun-de Chai, Cheng Xing, Jin-liang Nan, Peng-lin Yang, and Ji-fei Tang, “Danshen protects endothelial progenitor cells from oxidized low-density lipoprotein induced impairment,” J Zhejiang Univ Sci B, 2010 Aug, Volume 8, pp 618-626
[22]Niu C, Chen C, Chen L, Cheng K, Yeh C, Cheng J, “Decrease of blood lipids induced by Shan-Zha (fruit of Crataegus pinnatifida) is mainly related to an increase of PPARα in liver of mice fed high-fat diet,” Horm Metab Res, 2011 Aug, Volume 9, Page 625-630, DOI: 10.1055/s-0031-1283147
[23]Du L, Yuan B, Zhang BX, Zhang YL, Gao XY, Wang Y, “Study on mechanism for anti-hyperlipidemia efficacy of rhubarb through assistant analysis systems for acting mechanisms of traditional Chinese medicine,” Zhongguo Zhong Yao Za Zhi, 2015 Oct, Volume 19, pp 3703-3708
[24]Lin YJ, Ho TJ1, Yeh YC, Cheng CF, Shiao YT, Wang CB, Chien WK, Chen JH, Liu X, Tsang H, Lin TH, Liao CC, Huang SM, Li JP, Lin CW, Pang HY, Lin JG, Lan YC, Liu YH, Chen SY, Tsai FJ, Liang WM, “Chinese Herbal Medicine Treatment Improves the Overall Survival Rate of Individuals with Hypertension among Type 2 Diabetes Patients and Modulates In Vitro Smooth Muscle Cell Contractility,” PLos One, 2015 Dec, Doi: 10.1371/journal.pone.0145109
[25]Geng ZH, Shou BD, Liu H, Yang YB, Ren JJ, “Effect of Xuefu Zhuyu decoction on the expression of blood-lipid and vasoactive substances in the rats with atherosclerosis,” J Hebei Univ, Nat Sci Ed, 2011 May, Page 304–308
[26]Haihua Shu, Hideko Arita, Masakazu Hayashida, Liang Zhang, Ke An, Wenqi Huang, Kazuo Hanaoka, “Anti-hypersensitivity effects of Shu-jing-huo-xue-tang, a Chinese herbal medicine, in CCI-neuropathic rats,” J Ethnopharmacol, Volume 131, Issue 2, 15 September 2010, Pages 464–470
[27]衛生福利部中央健康保險署-中藥用藥品項 http://www.nhi.gov.tw/webdata/webdata.aspx?menu=21&menu_id=713&webdata_id=932