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系統識別號 U0026-0608201701122200
論文名稱(中文) 從乳癌化療藥之藥物動力學看併用科學中藥交互作用之可能性
論文名稱(英文) Pharmacokinetics of chemotherapeutic agents for breast cancer and potential interactions with co-prescribed Chinese herbal products
校院名稱 成功大學
系所名稱(中) 公共衛生研究所
系所名稱(英) Graduate Institute of Public Health
學年度 105
學期 2
出版年 106
研究生(中文) 呂雯慈
研究生(英文) Wen-Tzu Lu
學號 T86041049
學位類別 碩士
語文別 中文
論文頁數 46頁
口試委員 指導教授-王榮德
口試委員-賴榮年
口試委員-徐之昇
中文關鍵字 乳癌  化療  中藥  潛在藥物交互作用 
英文關鍵字 breast cancer  chemotherapy  Chinese herbal medicine  potential herb-drug interactions 
學科別分類
中文摘要 研究背景
乳癌是全世界女性最常罹患的癌症之首,隨著乳癌患者中西藥併用的情況增加,需要對其可能發生之藥物交互作用做更多了解。然而過去研究缺少以藥物代謝之角度深入探討化療藥與中藥之併用情形,故本研究欲分析台灣女性乳癌患者於接受化療藥物治療期間,西藥代謝至體內劑量消失前之中藥使用情形,以探討可能之中西藥藥物交互作用。
研究方法
研究資料來自全民健康保險研究資料庫兩百萬人承保抽樣歸人檔,於癌症登記檔篩選出於2002至2013年間之新發女性乳癌個案,並串聯門診就醫資料。分析乳癌化療患者中有使用中藥者和無使用中藥者之基本特性差異,並分析病患於化療藥使用期間、化療藥使用結束至五至十個半衰期期間的中藥處方情形。
研究結果與討論
共有2,854位乳癌化療患者進入分析,其中有2,233位(78.24%)有使用化療藥及中藥,621(21.76%)位沒有使用中藥。第二期乳癌患者在兩組當中皆占了半數,有使用中藥者平均診斷年齡51.05±10.18歲,沒有使用中藥者平均診斷年齡52.76±10.48歲。年輕族群在有使用中藥者中之比例高於在無使用中藥者中之比例,老年族群在有使用中藥者中之比例低於在無使用中藥者中之比例,趨勢達顯著差異(p<0.001)。高教育程度者在有使用中藥者中之比例高於在無使用中藥者中之比例,低教育程度者在有使用中藥者中之比例低於在無使用中藥者中之比例,達顯著差異(p<0.01)。在兩組樣本中,多數人的投保金額為20,000元/月以下,而投保地區多在北台灣。
總計571位乳癌新個案在化療藥使用期間至十個半衰期內使用中藥,占乳癌化療患者之20%,此期間內共有137,894筆中藥處方,其中約90%中藥處方在化療藥使用結束至五個半衰期期間內所開立。各項化療藥中,在cyclophosphamide之觀察期間(十個半衰期內),有最多次數的中藥處方(33,079項次,每品項各計一次),其次為epirubicin (24,637項次)、paclitaxel (22,420項次)、methotrexate (22,417項次)、docetaxel (17,252項次)、vinorelbine (10,047項次)。
在化療藥使用期間,共有7,697筆中藥處方,最常使用的中藥分別為白花蛇舌草、黃耆、加味逍遙散、厚朴、甘露飲、蒲公英、生脈飲、枳實、延胡索、白芷。在化療藥使用結束至五個半衰期期間有124,017筆中藥處方,最常使用的中藥分別為貝母、加味逍遙散、桔梗、川芎茶調散、茯苓、蒲公英、黃芩、麥門冬、延胡索、雞血藤。而在五至十個半衰期期間有6,180筆中藥處方,最常使用的中藥分別為蒲公英、半夏、白花蛇舌草、大黃、加味逍遙散、雞血藤、生脈飲、半夏瀉心湯、黃芩、茯苓。
有許多藥物經由cytochrome P450 (CYP450)酵素家族代謝,例如:doxorubicin、vinorelbine、docetaxel、paclitaxel由CYP3A4代謝。而貫葉連翹(Hypericum perforatum)、大蒜(Allium sativum)、紫錐菊(Echinacea spp.)、金印草(Hydrastls canadensis L)、鉤藤(Uncaria tomentosa DC.)、甘草(Glycyrrhiza glabra L.)等中藥會抑制CYP3A4之活性。
研究結論
台灣女性乳癌患者使用西藥和中藥的情形十分普遍,中藥的使用除了用於治療乳癌,也用於改善治療所帶來的不適症狀。當中部分患者在化療藥物尚未於體內完全排除的情況下開始使用中藥,可能會導致中西藥藥物交互作用,尤其是在當不同藥物由同一類酵素代謝或者不同藥物影響同一類酵素的情況下。針對中西藥併用之情形,應特別注意可能的藥物交互作用,未來研究可進一步探討中西藥藥物交互作用是否會影響病患之治療療效及存活情況。在臨床應用上也需更加謹慎,並投入更多相關研究,以保障民眾之用藥安全。
英文摘要 The aim of this study is to explore the utilization of Chinese herbal products (CHPs) among female breast cancer patients during the period of receiving treatment of chemotherapeutic agents, or, within ten half-lives of these agents. This study was a population-based study using random sampled data obtained from the National Health Insurance Research Database in Taiwan between 2002 and 2013. There were 2,854 female patients with newly diagnosed breast cancer receiving chemotherapeutic agents after diagnosis. Among them, 2,233(78.24%) of them used CHP at least once after diagnosis. There were higher proportions of high education and young age among CHP users compared with non-users. There were 571 patients who received 137,894 CHP prescriptions with potential herb-drug interactions. The most frequently co-prescribed chemotherapeutic agents was cyclophosphamide (24.0%), followed by epirubicin (17.9%). Among these co-prescriptions, about 90% of CHP were prescribed within five half-lives of chemotherapeutic agents. The most frequently prescribed CHP in this period was bei-mu, jia-wei-xiao-yao-san, jie-geng, chuan-xiong-cha-tiao-san, fu-ling, pu-gong-ying, huang-qin, mai-men-donɡ, yan-hu-suo and ji-xue-tenɡ. We conclude that the combined use of Chinese herbal medicine with Western medicine is common and there are potential herb-drug interactions. In addition to avoid such co-prescriptions, we recommend that future studies are warranted to determine if such instances would affect survival and/or quality of life of breast cancer patients.
論文目次 中文摘要 I
Extended Abstract III
誌謝 VI
目錄 VII
表目錄 IX
圖目錄 X
第壹章 前言 1
第一節 研究重要性 1
第二節 研究目的 2
第貳章 文獻探討 3
第一節 乳癌簡介 3
第二節 化學治療對乳癌患者之影響 5
第三節 中國傳統醫學之利用情形 7
第四節 乳癌患者中醫醫療利用情形 10
第參章 研究方法 12
第一節 資料來源 12
第二節 研究對象 13
第三節 研究變項定義 15
第四節 統計分析 18
第肆章 研究結果 19
第一節 樣本之基本特性分布 19
第二節 化療藥與中藥利用情形 21
第伍章 討論 24
第一節 研究對象之基本特性分布 24
第二節 研究對象之化療藥與中藥利用情形 25
第三節 可能之Herb-drug interaction探討 26
第四節 研究優勢與限制 28
第陸章 結論 29
參考文獻 30
附錄 35
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