中風後帕金森氏症患者接受中醫治療可減少急診與住院醫療耗用

Reduced Use of Emergency Care and Hospitalization in Patients with Post-Stroke Parkinson's Disease Treated with Traditional Chinese Medicine

10.6516/TJTCM.202303_26(1).0002

吳佩芸(Pei-Yun Wu)；陳朝宗(Chao-Tsung Chen)；孫茂峰(Mao-Feng Sun)；陳大樑(Ta-Liang Chen)；廖建彰(Chien-Chang Liao)

急診 ； 住院 ； 帕金森氏症 ； 中風 ； 中醫 ； Emergency care ； Hospitalization ； Parkinson's disease ； Stroke ； Traditional Chinese Medicine

中醫藥研究論叢

26卷1期（2023 / 03 / 30）

13 - 28

繁體中文;英文

背景：中風患者使用中醫後之療效已多次被證實，但目前尚無證據顯示中醫治療可改善中風後帕金森氏症患者之預後。本研究評估有中風病史的帕金森氏症患者接受中醫治療後是否會減少急診及住院醫療的耗用。方法：本研究利用全民健康保險資料，篩選了2000－2007年間40歲以上初次罹患帕金森氏症且有中風病史之患者（30,373位），來建立介入性的世代研究。我們利用傾向分數進行配對，選取合適的中醫治療組（2701位）及非中醫治療組（2701位）之患者進行追蹤，觀察病患在追蹤期間一年內的急診及住院醫療利用，再用Cox迴歸模型來計算中醫治療與急診及住院之醫療耗用的危害比（hazard ratio, HR）及95%信賴區間（confidence interval, CI）。結果：中風後帕金森氏症患者接受中醫治療後的追蹤期間一年內，與沒有接受中醫治療組相比，中醫治療組與減少的急診次數（β=-0.06，p=0.0063）、住院次數（β=-0.22，p<0.0001）、住院醫療花費（β=-817.43，p=0.0001）及住院天數（β=-4.92，p=0.0006）等有關。中醫治療與減少中風相關急診利用風險（HR=0.89，95% CI=0.81-0.99）、住院利用風險（HR=0.78,95% CI=0.73-0.83）及加護病房利用風險（HR=0.67，95% CI=0.57-0.78）有關。另外，無論是僅使用針灸（HR=0.76，95% CI=0.62-0.93）、僅使用中藥（HR=0.67，95% CI=0.60-0.74）或使用針灸及中藥（HR=0.67，95%CI=0.59-0.77）的組別對降低醫療耗用都有統計上的顯著差異。結論：中風後帕金森氏症患者在追蹤期間接受中醫治療可以減少急診及住院的醫療耗用。建議醫療主管機關與各醫療院所可鼓勵帕金森氏症患者接受中醫治療。本研究結果將有助於作為未來擬定醫療政策的參考。

Background: It has been proved that traditional Chinese medicine (TCM) has beneficial effects on the clinical outcomes in patients with stroke. However, little was known about the effects of TCM on patients with Parkinson's disease (PD). Our purpose is to evaluate the effect of TCM on the use of emergency care and hospitalization in patients with PD who had stroke history. Methods: Using research data of Taiwan's National Health Insurance, we conducted a retrospective cohort study included 30,373 patients with post-stroke PD who aged over 40 years in 2000-2007. After propensity-score matching, we obtained 2,701 pairs of PD patients who had previous stroke with and without TCM treatment for comparison. Using multiple Cox proportional hazard models, we calculated the adjusted hazard ratio (HRs) and 95% confidence interval (CI) of 1-year use of emergency care and hospitalization associated with TCM treatment. Results: Among PD patients with previous stroke, those who received TCM treatment had significantly lower frequency of emergency care medical visits (β= 0.06, p=0.0063), frequency of hospitalization (β=-0.22, p<-0.0001), expenditure of hospitalization (β=-817.43, p=0.0001), and length of hospitalization (β=- 4.92, p=0.0006). The HRs of emergency care, hospitalization and intensive care associated with TCM treatment were 0.89 (95% CI 0.81-0.99), 0.78 (95% CI 0.79-0.83) and 0.67 (95% CI 0.58-0.78). In addition, only acupuncture (HR=0.76, 95% CI=0.62-0.93), only Chinese herbal medicine (HR=0.67, 95% CI=0.60-0.74) and both acupuncture and Chinese medicine (HR=0.67, 95% CI=0.59-0.77) were associated with decreased risks of emergency care visit and hospitalization. Conclusion: Among patients with post-stroke PD, TCM treatment was associated with reduced risks of emergency care visit and hospitalization. Our findings implicated that the health authority and hospitals may encourage patients with post-stroke PD to receive TCM treatment.

1. Boehme, A.K.,Elkind, M.S.V.(2017).Stroke risk factors, genetics, and prevention.Circ Res,120(3),472-495.
2. Chae, Y.,Lee, H.,Kim, H.,Kim, C.H.,Chang, D.I.,Kim, K.M.,Park, H.J.(2009).Parsing brain activity associated with acupuncture treatment in Parkinson’s diseases.Mov Disord,24(12),1794-1802.
3. Chang, C.C.,Chen, T.L.,Lin, C.S.,Chung, C.L.,Yeh, C.C.,Hu, C.J.,Lane, H.L.,Liao, C.C.,Shih, C.C.(2018).Decreased risk of pneumonia in stroke patients receiving acupuncture: a nationwide matched-pair retrospective cohort study.PLoS One,13(5),e0196094.
4. Chen, C.,Leys, D.,Esquenazi, A.(2013).The interaction between neuropsychological and motor deficits in patients after stroke.Neurology,80(3 suppl 2),S27-S34.
5. Chen, F.P.,Chang, C.M.,Shiu, J.H.,Chiu, J.H.,Wu, T.P.,Yang, J.L.,Kung, Y.Y.,Chen, F.J.,Chern, C.M.,Hwang, S.J.(2015).A clinical study of integrating acupuncture and Western medicine in treating patients with Parkinson’s disease.Am J Chin Med,43(3),407-423.
6. Chen, J.,Huang, Y.,Lai, X.,Tang, C.,Yang, J.,Chen, H.,Zeng, T.,Wu, J.,Qu, S.(2013).Acupuncture at Waiguan (TE5) influences activation/deactivation of functional brain areas in ischemic stroke patients and healthy people: a functional MRI study.Neural Regen Res,8(3),226-232.
7. Chen, K.Y.,Wu, M.Y.,Yang, P.S.,Chiang, J.H.,Hsu, C.Y.,Chen, C.Y.,Yen, H.R.(2018).Utilization of Chinese herbal medicine and its association with the risk of fracture in patients with Parkinson’s disease in Taiwan.J Ethnopharmacol,226,168-175.
8. Chen, L.W.,Wang, Y.Q.,Wei, L.C.,Shi, M.,Chan, Y.S.(2007).Chinese herbs and herbal extracts for neuroprotection of dopaminergic neurons and potential therapeutic treatment of Parkinson’s disease.CNS Neurol Drug Targets,6(4),273-281.
9. Cho, S.Y.,Shim, S.R.,Rhee, H.Y.,Park, H.J.,Jung, W.S.,Moon, S.K.,Park, J.M.,Ko, C.N.,Cho, K.H.,Park, S.U.(2012).Effectiveness of acupuncture and bee venom acupuncture in idiopathic Parkinson’s disease.Parkinsonism Relat Disord,18(8),948-952.
10. Chuang, S.F.,Shih, C.C.,Yeh, C.C.,Lane, H.L.,Tsai, C.C.,Chen, T.L.,Lin, J.G.,Chen, T.,Liao, C.C.(2015).Decreased risk of acute myocardial infarction in stroke patients receiving acupuncture treatment: a nationwide matched retrospective cohort study.BMC Complement Altern Med,15,318.
11. Fukuda, S.,Kuriyama, N.,Tsuru, H.,Egawa, M.(2016).Immediate effect of acupuncture on tongue pressure including swallowing reflex latency in Parkinson’s disease.Acupunct Med,34(1),59-61.
12. Gasiorowski, K.,Lamer-Zarawska, E.,Leszek, J.,Parvathaneni, K.,Yendluri, B.B.,Blach-Olszewska, Z.,Aliev, G.(2011).Flavones from root of Scutellaria baicalensis Georgi: drugs of the future in neurodegeneration?.CNS Neurol Disord Drug Targets,10(2),184-191.
13. GBD 2016 Parkinson’s Disease Collaborators(2018).Global, regional, and national burden of Parkinson’s disease, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet Neurol,17(11),939-953.
14. GBD 2016 Stroke Collaborators(2019).Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet Neurol,18(5),439-458.
15. Gustafsson, H.,Nordström, A.,Nordström, P.(2015).Depression and subsequent risk of Parkinson disease: a nationwide cohort study.Neurology,84(24),2422-2429.
16. Guttman, M.,Slaughter, P.M.,Theriault, M.E.,DeBoer, D.P.,Naylor, C.D.(2003).Burden of Parkinsonism: a population-based study.Mov Disord,18(3),313-319.
17. Hornykiewicz, O.(2006).The discovery of dopamine deficiency in the parkinsonian brain.J Neural Transm Suppl,70,9-15.
18. Huang, Y.,Jiang, X.,Zhuo, Y.,Tang, A.,Wik, G.(2009).Complementary acupuncture treatment increases cerebral metabolism in patients with Parkinson’s disease.Int J Neurosci,119(8),1190-1197.
19. Huang, Y.F.,Yeh, C.C.,Chou, Y.C.,Hu, C.J.,Cherng, Y.G.,Shih, C.C.,Chen, T.L.,Liao, C.C.(2019).Stroke in Parkinson’s disease.QJM,112(4),269-274.
20. Johnston, K.C.,Li, J.Y.,Lyden, P.D.,Hanson, S.K.,Feasby, T.E.,Adams, R.J.,Faught, R.E., Jr,Haley, E.C., Jr(1998).Medical and neurological complications of ischemic stroke: experience from the RANTTAS trial. RANTTAS Investigator.Stroke,29(2),447-453.
21. Kalia, L.V.,Lang, A.E.(2015).Parkinson’s disease.Lancet,386(9996),896-912.
22. Kerr, G.D.,Higgins, P.,Walters, M.,Ghosh, S.K.,Wright, F.,Langhorne, P.,Stott, D.J(2011).Socioeconomic status and transient ischaemic attack/stroke: a prospective observational study.Cerebrovasc Dis,31(2),130-137.
23. Kim, S.N.,Doo, A.R.,Park, J.Y.,Bae, H.,Chae, Y.,Shim, I.,Lee, H.,Moon, W.,Lee, H.,Park, H.J.(2011).Acupuncture enhances the synaptic dopamine availability to improve motor function in a mouse model of Parkinson’s disease.PLoS One,6(11),e27566.
24. Kim, S.N.,Doo, A.R.,Park, J.Y.,Choo, H.J.,Shim, I.,Park, J.J.,Chae, Y.,Lee, B.,Lee, H.,Park, H.J.(2014).Combined treatment with acupuncture reduces effective dose and alleviates adverse effect of L-dopa by normalizing Parkinson’s disease-induced neurochemical imbalance.Brain Res,1544,33-44.
25. Kliger, B.M.,Rakowski, D.,Christian, M.,Cedar, D.,Wong, B.,Crawford, J.,Uveges, K.,Berk, J.,Abaca, E.,Corbin, L.,Garvan, C.(2016).Randomized, controlled trial of acupuncture for fatigue in Parkinson’s disease.Mov Disord,31(7),1027-1032.
26. Kowal, S.L.,Dall, T.M.,Chakrabarti, R.,Storm, M.V.,Jain, A.(2013).The current and projected economic burden of Parkinson’s disease in the United States.Mov Disord,28(3),311-318.
27. Kumar, S.,Selim, M.H.,Caplan, L.R.(2010).Medical complications after stroke.Lancet Neurol,9(1),105-118.
28. Lanfgorne, P.,Stott, D.J.,Robertson, L.,MacDonald, J.,Jones, L.,McAlpine, C.,Dick, F.,Taylor, G.S.,Murray, G.(2000).Medical complications after stroke: a multicenter study.Stroke,31(6),1223-1129.
29. Lee, S.H.,Lim, S.(2017).Clinical effectiveness of acupuncture on Parkinson disease: a PRISMA-compliant systematic review and meta-analysis.Medicine,96(3),e5836.
30. Li, Y.,Zhao, J.,Holscher, C.(2017).Therapeutic potential of baicalein in Alzheimer’s Disease and Parkinson’s Disease.CNS Drugs,31(8),639-652.
31. Liao, C.C.,Lin, J.G.,Tsai, C.C.,Lane, H.L.,Su, T.C.,Wang, H.H.,Sung, F.C.,Chen, T.L.,Shih, C.C.(2012).An investigation of the use of traditional Chinese medicine in stroke patients in Taiwan.Evid Based Complement Alternat Med,2012,387164.
32. Liu, C.C.,Li, C.Y.,Lee, P.C.,Sun, Y.(2016).Variations in incidence and prevalence of Parkinson’s disease in Taiwan: a population-based nationwide study.Parkinsons Dis,2016,8756359.
33. Liu, W.M.,Wu, R.M.,Lin, J.W.,Liu, Y.C.,Chang, C.H.,Lin, C.H.(2016).Time trends in the prevalence and incidence of Parkinson’s disease in Taiwan: A nationwide, population-based study.J Formos Med Assoc.,115(7),531-538.
34. MacPherson, H.,Richmond, S.,Bland, M.,Brealey, S.,Gabe, R.,Hopton, A.,Keding, A.,Lansdown, H.,Perren, S.,Sculpher, M.,Spackman, E.,Torgerson, D.,Watt, I.(2013).Acupuncture and counselling for depression in primary care: a randomised controlled trial.PLoS Med.,10(9),e1001518.
35. Park, H.J.,Lim, S.,Joo, W.S.,Yin, C.S.,Lee, H.S.,Lee, H.J.,Seo, J.C.,Leem, K.,Kim, Y.J.,Kim, C.J.,Chung, J.H.(2003).Acupuncture prevents 6-hydroxydopamineinduced neuronal death in the nigrostriatal dopaminergic system in the rat Parkinson’s disease model.Exp Neurol,180(1),93-98.
36. Shah, S.H.,Engelhardt, R.,Ovbiagele, B.(2008).Pattern of complementary and alternative medicine use among United States stroke survivors.J Neurol Sci.,271(1-2),180-185.
37. Shi, G.X.,Liu, C.Z.,Li, Q.Q.,Zhu, H.,Wang, L.P.(2012).Influence of acupuncture on cognitive function and markers of oxidative DNA damage in patients with vascular dementia.J Tradit Chin Med,32(2),199-202.
38. Shih, C.C.,Hsu, Y.T.,Wang, H.H.,Chen, T.L.,Tsai ,C.C.,Lane, H.L.,Yeh, C.C.,Sung, F.C.,Chiu, W.T.,Cherng, Y.G.,Liao, C.C.(2014).Decreased risk of stroke in patients with traumatic brain injury receiving acupuncture treatment: a population-based retrospective cohort study.PLoS One,9(2),e89208.
39. Shih, C.C.,Lee, H.H.,Chen, T.L.,Tsai, C.C.,Lane, H.L.,Chiu, W.T.,Liao, C.C.(2013).Reduced use of emergency care and hospitalization in patients with traumatic brain injury receiving acupuncture treatment.Evid Based Complement Alternat Med,2013,262039.
40. Shih, C.C.,Liao, C.C.,Sun, M.F.,Su, Y.C.,Wen, C.P.,Morisky, D.E.,Sung, F.C.,Hsu, C.Y.,Lin, J.G.(2015).A retrospective cohort study comparing stroke recurrence rate in ischemic stroke patients with and without acupuncture treatment.Medicine,94(39),e1572.
41. Shih, C.C.,Su, Y.C.,Liao, C.C.,Lin, J.G.(2010).Patterns of medical pluralism among adults: results from the 2001 National Health Interview Survey in Taiwan.BMC Health Serv Res,10,191.
42. Shih, C.C.,Yeh, C.C.,Hu, C.J.,Lane, H.L.,Tsai, C.C.,Chen, T.L.,Liao, C.C.(2017).Risk of dementia in patients with non-hemorrhagic stroke receiving acupuncture treatment: a nationwide matched-cohort study from Taiwan’s National Health Insurance Research Database.BMJ Open,7(6),e013638.
43. Shih, C.C.,Yeh, C.C.,Yang, J.L,Lame, H.L.,Huang, C.J.,Lin, J.G.,Chen, T.L.,Liao, C.C.(2019).Reduced use of emergency care and hospitalization in patients with post-stroke cognitive impairment treated with traditional Chinese medicine.QJM,112(6),437-442.
44. Weng, S.W.,Chen, T.L.,Yeh, C.C.,Lane, H.L.,Liao, C.C.,Shih, C.C.(2018).The effects of Bu Yang Huan Wu Tang on poststroke epilepsy: a nationwide matched study.Clin Epidemiol,10,1839-1850.
45. Weng, S.W.,Liao, C.C.,Yeh, C.C.,Chen, T.L.,Lane, H.L.,Lin, J.G.,Shih, C.C.(2016).Risk of epilepsy in stroke patients receiving acupuncture treatment: a nationwide retrospective matched-cohort study.BMJ Open,6(7),e010539.
46. Xiao, D.(2015).Acupuncture for Parkinson’s disease: a review of clinical, animal, and functional Magnetic Resonance Imaging studies.J Tradit Chin Med,35(6),709-717.
47. Zhang, Y.,Wang, Z.Z.,Sun, H.M.,Li, P.,Li, Y.F.,Chen, N.H.(2014).Systematic review of traditional Chinese medicine for depression in Parkinson’s disease.Am J Chin Med.,42(5),1035-1051.