| 摘要: | 研究背景：隨著生活水準的上升，速食產業的興起，使得國民飲食習慣有極大轉變，導致國民攝取過量動物性脂肪以及低纖維食物。由於飲食習慣的轉變，不僅使得國民心血管疾病的增加，甚至大腸癌發生率也逐漸升高。
研究方法：本研究樣本來源為嘉義大林慈濟醫院癌症登記資料庫與中醫門診記錄資料庫，自西元2007年至2014年期間就診的大腸癌患者。統計方法使用卡方檢定分析中西醫組與純西醫組之大腸癌病患的基本特性分佈上有無差異性，接著透過存活分析中的Kaplan-Meier存活曲線繪製兩組存活曲線，並進一步採用對數等級檢定各存活曲線間是否有達顯著差異。同時透過Cox比例風險模式探討相關因子在就診方式及中醫用藥對大腸癌病患其存活情形之影響。
研究結果：共有535位大腸癌病患被納入研究中，147位病患使用中西醫和388位病患使用純西醫，平均年齡為65.85(SD=13.16)歲及平均追蹤時間為3.00(SD=1.90)年，研究期間197人死亡。卡分檢定中就診方式在共病症1分達顯著差異，其餘變項分布上並無顯著差異。
Cox多變項分析在控制其他因素後，與純西醫比較，中西醫死亡風險顯著下降；與純西醫比較，用藥天數180天以上死亡風險顯著下降。
中醫用藥部分，加味逍遙散高、低劑量相較於無劑量其死亡風險顯著下降，高劑量每天用藥須達4.59克且連續用藥63天、低劑量每天用藥須達4.09克且連續用藥25天；知柏地黃丸高劑量相較於無劑量其死亡風險顯著下降，每天用藥須達4.50克且連續用藥57天；平胃散高劑量相較於無劑量其死亡風險顯著下降，每天用藥須達2.92克且連續用藥58天；歸脾湯高劑量相較於無劑量其死亡風險顯著下降，每天用藥須達4.68克且連續用藥33天；行氣組高劑量相較於無劑量其死亡風險顯著下降，每天用藥須達3.71克且連續用藥113天；解毒組高劑量相較於無劑量其死亡風險顯著下降，每天用藥須達3.01克且連續用藥63天；補氣組高、低劑量相較於無劑量其死亡風險顯著下降，高劑量每天用藥須達4.48克且連續用藥84天、低劑量每天用藥須達4.2克且連續用藥39天；地黃組高劑量相較於無劑量其死亡風險顯著下降，每天用藥須達4.48克且連續用藥95天。
結論：加入中醫輔助療法之病患死亡風險較純西醫治療低，顯示使用中醫輔助治療確實可提升存活率。
Background: With the living standards have risen and the growth of fast food industry, people’s eating habits have changed dramatically such as diet with excessive intake of animal fat and low on fiber. The change of eating habits has led to increase in the risk of cardiovascular disease gradually, or even the colorectal cancer.
Materials and Methods: Data of patients diagnosed colorectal cancer from 2007 to 2014 from the Cancer Registry Databases and outpatient records of Traditional Chinese Medicine Department of Dalin Tzu Chi Hospital in Chiayi. We analyzed the differences of basic characteristics distribution of colorectal cancer patients between using both Chinese and Western Medicine and using only Western Medicine by chi-square test. We then performed survival analysis and generated two Kaplan-Meier survival curves, then further verified whether there are any significant differences between these two curves by log-rank test. At the same time, we used Cox proportional hazards model to investigate the related factors of influencing the treatment mode and of the survival rate of colorectal cancer patients prescribed with Chinese Medicine.
Result: 535 colorectal cancer patients were included in this research, in which 147 patients treated by both Chinese and Western Medicine, and 388 patients treated by only Western medicine. The average age of them is 65.85 years old (SD=13.16) and the average follow-up time is 3.00 years (SD=1.90).197 patients died within the study observed time. Chi-square test shows that there is a significant difference in treatment mode and no significant difference between other variables. When controlling other factors, COX multi-factor analysis shows that the death risk drops significantly with patients treated by both Chinese and Western Medicine compared with patients treated by only Western Medicine. When prescribed with both Chinese and Western medicine more than 180 days, the death risk drops significantly compared with patents treated by only Western medicine. As for the Chinese herbal medicine, with either high or low dosage of Jia Wei Xia Yao San Extract Powder, the death risk drops significantly compared with zero dose of the Jia Wei Xia Yao San Extract Powder. The high dosage of Jia Wei Xia Yao San Extract Powder means prescribed 4.59 g for 63 days constantly. Low dosage means prescribed 4.09 g for 25 days constantly. Significant decrease of the death risk with prescribing high dosage, 57-day constant prescription with 4.50 g, of Anemarrhena, Phellodendron, and Rehmannia Pill compared with zero dosage of it. Significant decrease of the death risk with prescribing high dosage, 58-day prescription with 2.92 g, of Pingwei San compared with zero dosage of it. Significant decrease of the death risk with prescribing high dosage, 33-day prescription with 4.68 g, of Guipi Decoction compared with zero dosage of it. Significant decrease of the death risk of the Qi improving group with high dosage prescription, 113-day prescription with 3.71 g, compared with zero dosage of it. Significant decrease of the death risk of the Detoxification group with high dosage prescription, 63-day prescription with 3.01 g constantly, compared with zero dosage of it. Significant decrease of the death risk of the Qi tonifying group with both high and low dosage prescriptions compared with zero dosage of it. The high dosage of the Detoxification group prescribed the amount of 4.48 g for 84 days constantly. The low dosage of the Detoxification group prescribed the amount of 4.2 g for 39 days constantly. Significant decrease of the death risk of the Rehmannia Glutinosa with high dosage prescription, 95-day prescription with 4.48 g constantly, compared with zero dosage of it.
Conclusion: The death risk of patients took adjuvant therapy of Chinese Medicine is lower than patients that took purely western medicine treatment. This shows adjuvant therapy of Chinese Medicine can truly enhance survival rate. |
