目的：尋找藥物導致肝傷害個案有相當的困難度，在BC型肝炎盛行的地區，許多肝功能異常個案常會被判為BC肝炎或肝硬化導致。目前臨床藥物學會與肝臟專科醫學會都建議要以RUCAM因果關係判斷評估量表（7個面向24問題）來評估個案是否是藥物導致肝傷害。本研究目的是要評估在醫院電子病歷搜尋平台建立RUCAM查詢式演算法尋找疑似藥物導致肝傷害個案的績效。
　　方法：本研究資料來源為南部一家醫療體系（含醫學中心、區域醫院、地區醫院各一）2017至2019年住院病患肝功能異常（丙胺酸轉胺超過正常值五倍或鹼性磷酯酶正常值兩倍）事件8155筆，隨機抽樣200筆，以臨床藥師人工翻閱病歷為金字標準，評估查詢式演算法的績效。遇到給分不一致者，進一步瞭解造成原因。
　　結果：在200筆雙盲分析中，查詢式演算法給分<3分（不太可能）46筆，3-5分（可能）138筆，>5分（極可能）16筆；金字標準給分<3分62筆，3-5分123筆，>5分15筆。資訊演算法有16筆給3分，但是金字標準給2分，造成偽陽性。主要原因是第五面向「是否有其他非藥物導致肝傷害原因」要檢視的細項較多，查詢式演算法只有使用到結構式數據（譬如國際疾病分類編碼與數值型檢驗結果），沒有檢視影像（超音波或電腦斷層）的文字報告，因此造成錯誤給分。
　　結論：本研究開發的查詢式演算法只使用結構式資料進行24個細項問題逐一判斷給分，沒有用到半結構式資料文字分析較高階程式語法。這個特色是優點也是缺點，優點是使用簡單語法，所以外推應用價值較高，沒有資訊工程師的醫院也可以複製此做法，也不需要再安裝一些程式軟體。缺點就是有一些遺漏判斷造成偽陽性，必須要再翻閱影像文字報告確認，稍微增加一些人力與時間。權衡優缺點，本查詢式演算法還是優點大於缺點，比原本人工找尋個案節省大量人力與時間。

We developed a query algorithm based on Roussel Uclaf Causality Assessment Method (RUCAM) and applied to hospital electronic medical record data in a health care system (a medical center, a regional hospital and a district hospital) in South Taiwan to identify people with potential drug-induced liver injury (DILI) adverse drug reactions. There were 8155 events with abnormal liver function results (ALT ≥5 ULN or ALKP≥2ULN) from 2017 to 2019 and 200 events were randomly selected to assess the performance of query algorithm. The gold standard of assessment was the score given by a clinical pharmacist. The scores the query algorithms gave were <3 (unlikely) for 46 events, 3-5 (possible) for 138 events, and >5 (probable or highly probable) for 16 events. The scores the clinical pharmacist gave were <3 for 62 events, 3-5 for 123 events, and >5 for 15 events. There were 16 possible events (score 3) according to algorithm been assessed as false positive (score 2) according to clinical pharmacist. The main reason for the discrepancies came from dimension five “whether there were other non-pharmaceutical liver injury causes” and the items include the assessment of reports of image examination (abdominal echo or CT scan). In conclusion, despite the increase of some efforts to reassess the potential false positive cases, the strengths over-weighted the weaknesses. This query algorithm can efficiently identify DILI cases than traditional manual assessment.

中文文獻
游佳玲、江俐慧、蔡慈貞、卓偉民。藥物性肝損傷評估量表-RUCAM。藥學雜誌。36(3):112-118, 2020.
趙必暉、陳文雯、翁菀菲。國內藥物不良反應通報資料分析藥品引起肝傷害。台灣醫學。17(5):457-467, 2013.
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