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系統識別號 U0026-0109201615322000
論文名稱(中文) 針對心律不整或腦中風病人接受傳統中醫療法後發生腦中風或急性心肌梗塞其不同預防性效果的評估
論文名稱(英文) Study the difference of preventive value on stroke or acute myocardial infarction in patients with arrhythmia and/or stroke after therapy with traditional Chinese medicine
校院名稱 成功大學
系所名稱(中) 生物醫學工程學系
系所名稱(英) Department of BioMedical Engineering
學年度 104
學期 2
出版年 105
研究生(中文) 莊順發
研究生(英文) Sun-Fa Chuang
學號 p88951084
學位類別 博士
語文別 英文
論文頁數 120頁
口試委員 指導教授-陳天送
口試委員-蘇芳慶
召集委員-何豐名
口試委員-蔡金川
口試委員-陳培展
口試委員-陳永福
口試委員-施純全
口試委員-鐘威昇
口試委員-張世良
中文關鍵字 心律不整  中國傳統醫藥  中風  針灸  急性心肌梗塞(AMI )  全民健康保險研究資料庫(NHIRD)) 
英文關鍵字 Cardiac arrhythmia  Traditional Chinese medicine(TCM)  Stroke, Acupuncture  Acute myocardial infarction (AMI)  National Health Insurance Research Database (NHIRD) 
學科別分類
中文摘要 摘要
患心律不整的病人比一般族群更容易罹患中風,中醫藥(TCM)療法對心律不整患者的治療降低腦中風風險效果未明,本研究的目的是調查患心律不整的人接受TCM治療是否可以降低中風的風險。中風患者接受針灸治療是否可降低心肌梗塞(AMI)的風險之前尚未研究過。這項研究的目的是探討中風患者接受針灸治療降低AMI的風險。
從台灣的百萬隊列中全民健康保險研究資料庫((NHIRD),我們確定心律不整組包括在2000 - 2004年接受TCM治療的患者有2029位。與傾向分數的匹配方法被用於選擇比較2029適當的控制列隊,新中風事件數目,研究直到2010結束,使用Cox比例風險模型最終的追蹤期間被確定用來計算95%信賴區間調整後的危險比來探討TCM治療中風的相關性。台灣的NHIRD用來進行分析,年齡在40-79歲,從2000年到2004年中風患者23475位接受針灸治療及對照未接受針灸治療46950的中風患者,作傾向得分匹配的回顧性世代研究研究追蹤直到2009年年底,這兩組,針灸治療和未接受針灸治療並調整了不朽的時間來衡量,新的發生率和調整後的危險比(HR)和95%可信區間(CI),來研究新發生AMI機率並使用多因素Cox比例風險模型。
在追蹤期間患者出現心律不整接受TCM治療(11.4每1000人年)有新發生的中風機率較無TCM治療(17.7每1000人年)發生率較低,與HR 0.62(95%CI = 0.50-0.78)。TCM治療和之間的關聯,減少新發生中風機率在男女雙方都顯著。接受TCM治療年齡在45-54歲年輕心律不整患者其中風的風險最低(HR = 0.48,95%CI = 0.27-0.87)。接受針灸治療(每1000人年9.2)中風患者表現急性心肌梗塞的發病率較低與那些沒有接受針灸治療(10.8每1000人年),以0.86的HR相比(95%CI, 0.80-0.93)後,調整了年齡,性別,低收入,共存的醫療條件和西藥治療。進行了調查針灸治療和AMI風險之間的關係,女性中風患者(HR,0.85:95%CI,0.76-0.95),男性中風患者(HR,0.87; 95%CI,0.80-0.95), 50至59歲患者(HR,0.75; 95%CI,0.63-0.90), 60至69歲患者(HR,0.85; 95%CI,0.75-0.95),缺血性中風患者(HR,0.87; 95 %CI,0.79-0.95),和出血性中風患者(HR,0.62; 95%CI,0.44-0.88)。
心律不整的人接受TCM治療可以降低中風的風險。不過,這項研究是由於缺乏治療中使用有關的信息包括病患生活方式,生化概況,中藥的劑量,和針灸穴位的限制。另外這項研究中我們提出可能的假設,針灸可有效降低AMI在50-69歲中風患者的風險,這項研究限制是由於在中風的嚴重程度和真正穴位信息的缺乏。我們的研究結果表明,建立在預防AMI針灸療效還需要前瞻性隨機試驗。
關鍵詞:心律不整,中醫藥(TCM),中風,針灸,急性心肌梗塞(AMI)
全民健康保險研究資料庫(NHIRD)
英文摘要 Abstract
Patients with cardiac arrhythmia were more inclined to suffer from stroke than the general population. The therapeutic efficacy of traditional Chinese medicine (TCM) on the risk of stroke in patients with cardiac arrhythmia remains unknown. The purpose of this research was to inspect the risk of stroke in patients with cardiac arrhythmia using TCM therapy. In previous studies, there has not been any research finding proving whether acupuncture therapy could protect stroke patients from acute myocardial infarction (AMI). The objective of this study was to investigate any risks of AMI among stroke patients receiving acupuncture therapy.
Based on the one million cohort subjects of the Taiwan’s National Health Insurance Research Database (NHIRD), we recognized cohort of cardiac arrhythmia included 2029 patients who had TCM therapy during 2000–2004. Propensity score matching was adapted to pick out 2029 suitable control cohort to be compared. The incidents of events of stroke were confirmed during the follow-up period at the end of 2010. Cox proportional hazard model was utilized to compute modified hazard ratios and 95% confidence intervals of stroke accompanied with TCM therapy. To manage a retrospective cohort study of 23475 stroke patients aged 40–79 years undergoing acupuncture intervention and 46950 propensity score-matched stroke patients not receiving acupuncture therapy who served as controls from 2000 to 2004, Taiwan’s NHIRD was utilized. Both stroke cohort studies were followed until the end of 2009 and were modified for immortal time bias to measure the incidence and adjusted hazard ratios (HRs) with 95 % confidence intervals (CIs) for new-onset AMI in multivariate generalizations of the Cox proportional hazard model.
Amid the follow-up period, patients with cardiac arrhythmia who received TCM therapy (11.4 per 1000 person-years) had a lower incidence of new-onset stroke possibility than those who did not receive TCM therapy (17.7 per 1000 person-years), with an HR of 0.62 (95% CI = 0.50–0.78). The correlation between TCM therapy and diminished new-onset stroke was obvious with both genders. The younger patients aged between 45–54 years old receiving TCM therapy had the lowest stroke tendency (HR = 0.48, 95% CI = 0.27–0.87). In comparison to stroke patients who did not undergo acupuncture therapy (10.8 per 1000 person-years), those who did receive acupuncture therapy (9.2 per 1000 person-years) displayed a lower incidence of AMI, with an HR of 0.86 (95 % CI, 0.80–0.93) after adjusting for age, gender, low income level, coexisting medical conditions and western medications. The relationship between acupuncture therapy and AMI risk was investigated in female stroke patients (HR, 0.85; 95%CI, 0.76–0.95), male stroke patients (HR, 0.87; 95%CI, 0.80–0.95), patients from 50 to 59 years of age (HR, 0.75; 95 % CI, 0.63–0.90), patients from 60 to 69 years of age (HR, 0.85; 95 % CI, 0.75–0.95), patients suffering from ischemic stroke (HR, 0.87; 95 % CI, 0.79–0.95), and patients suffering from hemorrhagic stroke (HR, 0.62; 95%CI, 0.44–0.88).
Receiving TCM therapy was related to a lower risk of stroke in patients with cardiac arrhythmia. However, this study was limited by lack of information, the fact of different habits of patients, biochemical profiles, the dose of scientific herbal medicine, and real acupuncture points used in medical care. Stroke patients aged 50–69 in this study displayed some possibility that acupuncture therapy may be effective in decreasing the risk of AMI. However, this study was limited by the lack of information in relation to stroke severity and real acupuncture points. Our results suggest that clinical prospective randomized trials are required to construct the efficacy of acupuncture therapy in preventing AMI.
Keywords: Cardiac arrhythmia. Traditional Chinese medicine(TCM), Stroke, Acupuncture, Acute myocardial infarction (AMI). National Health Insurance Research Database (NHIRD).
論文目次 Contents

摘要. I
Abstract.. III
誌謝. VI
Contents..VIII
List of Tables.. XI
List of Figures.. XII
Abbreviations.. XIII
Preface .. 1

Chapter I Introduction 3
1.1 Big Data---3
1.1.1 Big Data revolution3
1.1.2 Google Flu Trends can early detection of disease activity---3
1.1.3 The definition of Big Data4
1.1.4 Big Data was first proposed by IBM4
1.1.5 3Vs of Big Data-Volume, Velocity and Variety---5
1.1.6 Four points for understanding Big Data6
1.1.7 Big data can predict rates of coronary heart disease--7
1.2 Taiwan’s NHIRD8
1.3 Classification of cardiovascular diseases9
1.3.1 Risk factors of CVDs--9
1.3.2 The common symptoms of CVDs--10
1.3.3 CVDs epidemiology-12
1.3.4 Cardiac arrhythmias epidemiology13
1.3.5 AF symptoms-14
1.3.6 AF risk factors15
1.3.7 Stroke epidemiology-15
1.3.8 Myocardial infarction (MI) epidemiology18
1.4 Acupuncture therapy for stroke patients is to improve their symptoms in Taiwan---20
1.5 Criteria and definition of TCM--21
1.6 Motivations and Objectives--22
Chapter II Literature Reviews24
2.1 Prevalence of cardiac arrhythmia ---24
2.2 Risk factors of cardiac arrhythmia--24
2.3 Cost of cardiac arrhythmia ---24
2.4 AF and stroke---25
2.5 Stroke facts-25
2.6 Stroke risk factors-25
2.7 Common stroke warning signs and symptoms26
2.8 Stroke and AMI26
2.9 Stroke and acupuncture---26
2.10 Stroke recurrence rate---27
2.11 Traditional Chinese medicine (TCM)- 28
Chapter III Materials and Methods--29
3.1 Data source-29
3.2 Ethics approval 30
3.3 Study design and population-30
3.3.1 Risk of stroke in patients with cardiac arrhythmia receiving TCM---30
3.3.2 Risk of AMI among stroke patients receiving acupuncture therapy or intervention---31
3.4 Criteria and definitions34
3.5 Statistical analysis 36
3.5.1 Risk of stroke in patients with cardiac arrhythmia receiving TCM---36
3.5.2 Risk of AMI among stroke patients receiving acupuncture therapy38
Chapter IV Results-40
4.1 Risk of stroke in patients with cardiac arrhythmia receiving TCM-40
4.2 Risk of AMI among stroke patients receiving acupuncture therapy46
Chapter V Discussions-55
5.1 Risk of stroke in patients with cardiac arrhythmia receiving TCM-55
5.1.1 Possible explanations55
5.1.2 Study strengths56
5.1.3 Study limitations-57
5.2 Risk of AMI among stroke patients receiving acupuncture59
5.2.1 Possible explanations-59
5.2.2 Study strengths70
5.2.3 Study limitations-70
Chapter VI Conclusions and Future Works72
6.1 Risk of stroke in patients with cardiac arrhythmia receiving TCM. ---72
6.2 Risk of AMI among stroke patients receiving acupuncture--72
6.3 Future works73
References---74
Appendix: Published papers-- 91
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