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某醫學中心因藥物相關橫紋肌溶解症或肌肉病變並引起肌肉疼痛之危險因子分析

Analysis the Risk Factors of Drug- Associated Rhabdomyolysis or Myopathy Which Cause Muscle Pain in Medical Center

摘要


目的:本研究以回溯性研究,收集某醫學中心因藥物導致橫紋肌溶解或肌肉病變之不良反應事件,從中發現特定藥物及相關危險因子,欲藉由分析結果提供臨床用藥參考依據,避免此不良反應發生,維護病人用藥安全。方法:本研究收集2009 至2013 年某醫學中心之門、急、住診資料檔的次級資料作為研究材料。研究族群為符合橫紋肌溶解或肌肉病變診斷之病人,納入條件包括(1) 篩選符合橫紋肌溶解症或肌肉病變的ICD-9-CM 診斷碼;(2) 肌酸激酶 (creatinekinase) 大於等於500IU/L 或肌紅蛋白 (myoglobulin) 大於正常值。主要評估可疑藥物所占比率、危險因子及藥物自使用至發生不良反應之時間。結果:於2009 至2013 年因藥物引起肌肉病變或橫紋肌溶解症者,共186 人。其中以降血脂HMG-CoA 還原酶抑制劑占最大宗,其次為telbivudine,daptomycin與降血脂纖維鹽酸衍生物類藥物 (fibrates) 並列第三。根據存活分析,病人自藥物使用至發生肌酸激酶或肌紅蛋白顯著升高之25 百分位時間為49 天。結論:建議臨床使用降血脂HMG-CoA 還原酶抑制劑,telbivudine、daptomycin及降血脂纖維鹽酸衍生物類藥物,應例行監測肌酸激酶或肌紅蛋白以避免橫紋肌溶解症或肌肉病變的風險。

並列摘要


Objective: A retrospective study of adverse events of drug-associated rhabdomyolysis or myopathy cases reported to medical center was conducted. The analysis included the number of unique cases and the risk factors of adverse events which provide the foundation of clinical medicine use to avoid this adverse events and maintain medication safety. Methods: This study was conducted using administrative claims data including inpatients, outpatients and emergent patients in the medical center between 2009 and 2013. This study screened the study population on the basis of the current consensus definition of rhabdomyolysis or myopathy. The inclusion criterias were: (a) A diagnosis code ICD-9-CM was used to screen rhabdomyolysis or myopathy cases reported. (b) Creatine kinase ≥ 500 IU/L or myoglobulin over normal range. The main outcome measure of this study were the percentage of frequently reported suspected drugs, risk factors and time to onset of adverse events from beginning of the suspected drugs. Results: Drug- associated rhabdomyolysis or myopathy were a total of 186 people in 2009 ~ 2013. HMG-CoA reductase inhibitors which were accounted for the largest, followed by telbivudine , and ranked third daptomycin and fibrates. The time of 25 percentile to significant increase of creatine kinase or myoglobulin was 49 days in survival analysis. Conclusion: It is recommended that routine monitoring of creatine kinase or myoglobulin to avoid the risk of rhabdomyolys or myopathy when the clinical use of HMG-CoA reductase inhibitors, telbivudine , daptomycin and fibrates.

並列關鍵字

Rhabdomyolys Myopathy Survival Analysis

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