- 學位論文
帕金森氏症患者患有失智症之風險與使用中草藥之關聯性：以全國人口為對象之巢式病例對照研究
Associations of Chinese Herbal Medicine Usage with Risk of Dementia in Patients with Parkinson’s Disease:A Population-Based, Nested Case–Control Study
摘要
研究目的：帕金森氏症患者伴隨有失智症是很常見的情形。隨著社會高齡化，失智症愈發普及且影響許多患者的生活品質。然而，先今對於治療帕金森氏症所引發之失智症很有限。先前有研究指出中草藥對於治療失智症具有潛力，而目前關於中草藥與帕金森氏症所引發之失智症風險的相關性也還未明。 研究方法：這是一篇來自健保資料庫的巢式病例對照研究，蒐集五十歲以上並於2000至2010年新診斷為帕金森氏症之病患。於這些病患中我們分為失智組與非失智組並探討帕金森氏症病患納入研究後使用中草藥的時間(≧90天與<90天)，年紀(50-64歲與≧65歲)和性別之間的相關性 研究結果： 帕金森氏症的患者中得到失智症的風險在中草藥的使用者比非中草藥的使用者低，特別是使用中草藥≧90天(校正後勝算比0.56; 95%信賴區間0.39-0.87)。帕金森氏症病患納入研究後使用中草藥與降低失智症之風險，比起未使用中草藥之帕金森氏症之病患有顯著相關性，特別是在年紀≧65歲使用中草藥<90天(校正後勝算比0.63; 95%信賴區間0.42-0.94)，女性患者使用中草藥≧90天(校正後勝算比0.43; 95%信賴區間0.22-0.84)與男性患者使用中草藥<90天(校正後勝算比0.62; 95%信賴區間0.43-0.88) 結論： 我們的研究結果顯示中草藥的使用與降低帕金森氏症患者罹患失智症之風險有顯著相關性，特別是在女性使用中草藥≧90天。但因為本研究為回溯性研究因此無法確立因果關係但可建立出藍圖以提供未來更多相關研究。
並列摘要
Background：Patients who have Parkinson’s disease (PD) comorbid with dementia is common. With the prolonged life expectancy, dementia is gradually becoming prevalent and affects most patients’ life qualities. However, the efficacy of current treatments in dementia of PD is limited. Previous studies indicated the potential roles of Chinese herbal medicine (CHM) in treating dementia, yet the correlation between CHM usage and risk of dementia in PD patients is unclear. Methods：This case–control study was nested within a National Health Insurance database of patients over 50 years with newly diagnosed PD from year 2000 to 2010. Among these PD patients, dementia and non-dementia groups were discussed, respectively, in terms of the duration of taking CHM (≧90 vs. <90 days), age (50–64 vs.≧65 years) and gender. Results：The risk of dementia in patients with PD is lower in CHM users compared with non-CHM users, especially in those taking CHM for more than 90 days (adjusted odds ratio [aOR] 0.58; 95% confidence interval [95% CI] 0.39–0.87). The use of CHM was significantly related to the lower risk of dementia compared to those PD patients without using CHM in the subgroups of patients with age ≧65 years for CHM usage <90 days (aOR 0.68; 95% CI 0.53–0.88), patients with age ≧65 years for CHM usage ≧90 days (aOR 0.63; 95% CI 0.42–0.94), female patients using CHM for 90 days (aOR 0.43; 95% CI 0.22–0.84), and male patients using CHM for <90 days (aOR 0.62; 95% CI 0.43–0.88). Conclusion：The authors demonstrated the association of CHM usage with lower risk of dementia in patients with PD, especially in women with the usage of CHM for more than 90 days. Since no arbitrary causal conclusions could be drawn from retrospective cohort studies, the finding in this study could be used to generate a hypothesis for a subsequent design of prospective longitudinal study.