- 學位論文
結核病患者不良反應類別對醫師是否持續使用特定藥物之影響
Impact of adverse drug reactions on whether physicians continue to use specific drugs on tuberculosis patients
摘要
目的：透過位衛生福利部疾病管制署「二線抗結核藥物申請資料庫」之中區大規模樣本，瞭解臨床醫師對結核病患者用藥之選擇。 研究方法：收集中部地區2010年至2014年所有申請結核病(TB)二線免費藥物之資料庫，分析醫師持續使用某種特定二線抗結核藥物之大規模樣本，探討臨床醫師在結核病患使用一線藥物產生不良反應後，更換成二線藥物的相關因素。以描述性統計分析5年內申請個案年齡、性別、申請年度及醫院別，再以卡分檢定及邏輯斯迴歸進行統計分析。 研究結果：經卡方檢定二線抗結核藥物中僅有Moxifloxacin(MFX)和Levofloxacin(LFX)達統計顯著、副作用則僅有抗藥和高尿酸達統計顯著、二線抗結核藥物中Tubax與不良反應型態達統計顯著意義。本研究結果得知一線抗結核藥物不良反應與二線藥物的持續使用無關的。 結論：二線抗結核藥物持續使用與不良反應分析結果均未達統計顯著，僅有MFX在申請年度中達統計顯著意義，這與疾病管制署政策有關：MFX須為單一抗藥者才能開立，其餘結核病者優先使用LFX。 肝毒性是最常見的一線抗結藥物不良反應，這也是醫師轉換成二線抗結核藥物最主要的原因；結核病治療通常需要6個月以上的時間，在治療過程中臨床醫師須隨時注意病人臨床症狀的變化、迅速處理藥物不良反應，以增進病人服藥順從性、提高完治率， 如此才能逐步達到WHO 2035消除結核的目標。
並列摘要
Objectives: A large-scale sample from the central Taiwan of the "Second Line Anti-Tuberculosis Drug Application Database" of the Taiwan Centers for Disease Controls was used to understand the clinicians’ choice of medications for tuberculosis patients. Methods: All the database of free tuberculosis second-line medicines applications between 2010 to 2014 in central Taiwan were collected. Samples of physicians continuous using of a specific second-line anti-tuberculosis drug were analyzed to explore the adverse reactions with first-line tuberculosis drugs. Descriptive statistical analysis was used to understand the age, gender, application year and hospital category of patients. The Chi-squared test and logistic regression test were used as statistical analysis. Results: among second-line anti-tuberculosis drugs, only Moxifloxacin and Levofloxacin were statistically significant in Chi-squared test. About side effects, only drug resistance and high uric acid were statistically significant. In second-line anti-tuberculosis drugs, Tubax and type of side effects reached statistical significance. The results of this study indicate that the adverse effects of first-line anti-tuberculosis drugs are not related to the continued use of second-line drugs. Conclusions: The continuous using of second-line anti-tuberculosis drugs and the analysis of adverse reactions did not reach statistical significance. Only the annual application of Moxifloxacin had statistic significant finding. Hepatotoxicity is the most common adverse effect of first-line anti- tuberculosis drugs, which is the main reason why physicians switch to second-line anti-tuberculosis drugs. It usually takes 6 months to treat tuberculosis. During the treatment, clinicians must pay attention to the changes in clinical symptoms of patients at any time, and quickly deal with adverse drug reactions in order to improve patient medication compliance and improve the cure rate. Only then the WHO 2035 goal of eliminating tuberculosis can be achieved.
參考文獻
延伸閱讀
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