- 學位論文
使用台灣健保資料庫分析躁鬱症病人鋰鹽中毒特性之研究
Using National Health Insurance Research Database to Analyze Lithium Intoxication Characteristics in Patients with Bipolar Disorder in Taiwan
摘要
鋰鹽是治療濃度極為狹窄的藥品且被廣泛的用來治療躁鬱症、預防再發作和有自殺企圖的病人。長期服用鋰鹽有關的中毒危險因子，包含年長者、服用藥品劑量過多、腎衰竭、飲食中鈉鹽的攝取偏低、併服會影響腎功能的藥品(包含Non-steroidal anti-inflammatory drugs (NSAIDs)、Angiotensin-converting-enzyme inhibitor (ACEI)、Thiazide diuretics等)。本研究利用ANOVA、t檢定與卡方檢定分析台灣全民健康保險研究資料庫中的特定主題分檔「2002-2007精神疾病住院病患歸人檔(Psychiatric inpatient medical claim dataset，簡稱PIMC)」。以回溯性世代研究，從2003-2012年間被診斷為躁鬱症因使用鋰鹽而發生中毒的病人，分析其鋰鹽中毒特性包括：病人年齡、性別、共病症、就醫醫院層級、權屬別、健保分局別分布；鋰鹽處方型態(包括比較鋰鹽每日PDD/DDD ratio、服用天數、鋰鹽濃度監測)；藥品交互作用分析(包括有無併用交互作用藥品之族群特性分析、交互作用盛行率、併用天數以及開立處方醫師差異)。 研究結果顯示：經篩選後，共計137人符合要件，故以137人進行分析，病患之鋰鹽每日平均使用劑量為865.69(±274.247) mg/day，平均使用天數109.18(±73.760)天。女性病人佔多數為61%，平均年齡47.6(±15)歲，糖尿病、高血壓為其中最常見之共併症，有高達56.2%的病人超過三個月以上未曾監測過鋰鹽濃度，鋰鹽中毒病人有併用潛在交互作用藥品者約佔35.7%，前三名最常見之併用藥品為Diclofenac(20.4%)、Valsartan(10.2%)、Losartan(8.2%)，且近九成(87.8%)來自不同醫師開立。
並列摘要
Lithium is the narrow therapeutic concentrations and widely used to treat bipolar disorder, preventing further attacks and suicidal attempts. Long-term use lithium toxicity associated risk factors, including older people, taking too much dose, renal failure, low sodium diet and taking drugs that affect renal function (including Non-steroidal anti-inflammatory drugs (NSAIDs), Angiotensin- converting-enzyme inhibitor (ACEI), Thiazide diuretics,etc.). This study used ANOVA and chi-square to analyze Taiwan National Health Insurance database specific topic " 2002-2007 Psychiatric inpatient medical claim dataset, referred PIMC". In a retrospective cohort study between from 2003-2012 ,the patient was diagnosed with bipolar disorder and lithium intoxication, to analyze lithium intoxication characteristics include：patient age, sex, comorbidities, hospital hierarchy, ownership ,NHI Bureau; lithium prescribing patterns (including comparative lithium daily PDD / DDD ratio, taking several days, lithium concentration monitoring); drug interaction analysis (including the analyzed by group characteristics of drug interactions, interaction prevalence ,and prescribing physicians differences). The results showed: A total of 137 people were analyzed, the lithium average daily dose was 865.69 (± 274.247) mg / day, the average use 109.18 (± 73.760) days. The most was female accounted for 61%,average age 47.6 (± 15) years old, diabetes, hypertension is the most common comorbidities, more than three months had not been monitoring the lithium concentration accounted for 56.2%.The patients with lithium toxicity and potential drug interactions account for about 35.7 %,potential drug interactions of the top three common as Diclofenac (20.4%), Valsartan (10.2%), Losartan (8.2%), and nearly nine (87.8%) from different doctors order.