針刺介入腕隧道症候群患者可降低罹患冠狀動脈疾病之風險

Acupuncture in carpal tunnel syndrome patient may reduce the risk of coronary artery disease

張益銓(Yi-Chuan Chang)

指導教授 ： 李育臣

共同指導教授 ： 賴英秀(Yin-Show Lai)

中國醫藥大學/中醫學院/針灸研究所碩士班/碩士(2017年)

摘要

目的：
本研究以《黃帝內經》十二經絡之是動病、所生病出發，以手厥陰心包經為例，探討疾病間之關聯性，與針刺介入對疾病預後之影響，盼能佐證典籍所論述的經絡現象與疾病關係。
方法：
本研究共分三階段，皆透過LHID2000健保資料庫數據：一、進行病例對照研究，篩選冠狀動脈疾病(CAD；ICD-9-CM: 410-414)樣本進行性別、年齡、index year等指標之病例組與對照組1：1配對。所有個案自2010年12月往前檢視至2000年或發生腕隧道症候群(CTS；ICD-9-CM 354.0,354.1)，以進行CAD與CTS關聯型比較；二、以世代研究針對CTS樣本其後發生CAD之預後，篩選2000年1月至2010年12月期間罹患CTS之樣本，進行世代組與控制組1：4之頻率配對，所選入樣本皆被篩選至2010年12月、死亡或發生CAD，以了解CTS對CAD之預後。三、以另一世代研究，篩選同期間世代組與控制組1：1頻率配對，依第二階段所設條件檢視，以檢驗CTS族群接受針刺介入對後續發展CAD之影響。又，所選入樣本診斷碼皆須被標記超過3次，且罹患CTS前即罹患CAD的樣本會被剃除。
結果：
第一階段：CAD樣本有較高勝算比合併罹患CTS(OR:1.63, 95% CI 1.48-1.8; p<0.0001)；第二階段：CTS樣本日後發展CAD的風險亦較高(HR:1.71, 95% CI 1.54-1.89; p<0.0001)，而罹患CTS樣本若經針灸介入，日後罹患CAD之風險下降(HR：0.50，95% CI：0.26-0.96；p<0.05)；第三階段：同第二階段結果顯示，CTS樣本日後發展出CAD的風險較高(HR：1.61，95% CI：1.39-1.87；p<0.001)，而CTS樣本若未經針刺介入，其後罹患CAD則風險亦較高(HR:1.62, 95% CI 1.39-1.87; p<0.001)。
結論：
CTS與CAD兩疾病之發生存在有關連性，而僅透過針刺介入或可影響CTS樣本往後罹患CAD之表現。

關鍵字

經絡現象 ； 腕隧道症候群 ； 冠狀動脈疾病

並列摘要

Background：
This study based on “Huangdi Neijing” and focused on the PC meridian for analyzing the correlation between diseases which were recorded in disease transmitted by meridian and disease produced by viscus, and also discussed the prognosis of acupuncture intervention that were expected to prove the meridian phenomenon and the relationship between diseases.
Methods：
This study contained in 3 parts and analyzed data from the Taiwan National Health Insurance Research Database (NHIRD) since 2000 to 2011. First, a case control study designed included that subjects aged over 18 y/o with diagnosed CAD (ICD-9-CM: 410-414). A non-CAD age, sex and index year for frequency matching control was selected for comparison, and paired with 1 subject within controls. All subjects were filtered until to 2000 or the occurrence of CTS diagnosed (ICD-9-CM: 354.0, 354.1). Second, we set up a cohort study from 2000 January to 2010 December which was focused on CTS patients whether suffering in CTS enhance the incidence of CAD with 4 subjects with in controls. A non-CTS age, sex and index year for frequency matching control was selected for comparison. All subjects were filtered to 2011 or the occurrence of CAD diagnosed; then, the last part, as the 2nd part for 1 subject with in controls, the other cohort study that transferred target to acupuncture in CTS patient which may affect the prognosis of CAD. For every subject included, all diagnosis must be tagged for 3 times in NHIRD system at least, and subjects with CAD occurring before CTS would be ruled out.
Results：
First part: CAD patient were higher incidence of suffering CTS before than controls (OR: 1.63, 95% CI 1.48-1.8; p<0.0001). Second part: People suffering in CTS were more risk to develop CAD afterward (HR: 1.71, 95% CI 1.54-1.89; p<0.0001), and CTS subjects who accepted acupuncture intervention would reduce the risk of CAD developed(HR: 0.50，95% CI 0.26-0.96; p<0.05). Last part: CTS subjects were more risk to develop CAD afterward(HR: 1.61，95% CI 1.39-1.87; p<0.001), and CTS patients who didn’t accept acupuncture intervention would also had higher risk to develop CAD (HR: 1.62, 95% CI 1.39-1.87; p<0.001).
Conclusions：
A significant correlation was found between CTS and CAD, and acupuncture may affect the prognosis of CAD in CTS patients.

並列關鍵字

meridian phenomenon ； carpal tunnel syndrome ； coronary artery disease

參考文獻

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