Increased risks of chronic kidney disease associated with prescribed Chinese herbal products suspected to contain aristolochic acid
Increased risks of chronic kidney disease associated with prescribed Chinese herbal products suspected to contain aristolochic acid
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DOI：
10.1111/j.1440-1797.2008.01061.x
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发表时间：
2009-03-01
期刊：
影响因子：
2.5
通讯作者：
Wang, Jung-Der
中科院分区：
文献类型：
--
作者：
Lai, Ming-Nan;Lai, Jung-Nien;Wang, Jung-Der
目的：人类和动物研究已证实与马兜铃酸 (AA) 相关的肾病。中国古代草药学声称可以降低其混合物的毒性。本研究的目的是确定全国队列中与 AA 相关中草药产品 (CHP) 或草药混合物相关的慢性肾脏病 (CKD) 风险。方法：使用 1997-2002 年国家健康保险报销数据库中的系统随机样本（20 万人）进行回顾性随访研究。计算整个样本和那些使用疑似含有 AA 的 CHP 的样本的 CKD 和终末期肾病 (ESRD) 的发生率。构建Cox回归模型控制潜在的混杂因素，包括年龄、性别、高血压、糖尿病、非甾体类抗炎药和对乙酰氨基酚的使用等。结果：最终纳入分析者199 843人，其中男性102 464人（51.3%），女性97 379人（48.7%），平均发病率为1964/10(6)。 CKD 为 279/10(6) 人年，ESRD 为 279/10(6) 人年。控制其他危险因素后，服用木通超过30 g、防己中药超过60 g的患者，发生CKD的风险比似乎增加。结论：木通中药超过30 g、防己中药超过60 g，与CKD风险增加相关。除了禁止使用关木通和广防池外，还应继续对使用过这些CHP的患者进行随访。
Aim: Nephropathy associated with aristolochic acid (AA) has been documented by human and animal studies. Ancient Chinese herbology claimed to reduce toxicity in their mixtures. It was the objective of this study to determine the risk of chronic kidney disease (CKD) associated with AA-related Chinese herbal products (CHP) or mixtures of herbs in a national cohort.Methods: A retrospective follow-up study was conducted, using a systematic random sample (200 000 people) in the National Health Insurance reimbursement database during 1997-2002. The incidence rates of CKD and end-stage renal disease (ESRD) were calculated for the whole sample and those that had used CHP suspected to contain AA. Cox regression models were constructed to control potential confounders, including age, sex, hypertension, diabetes mellitus, and use of non-steroidal anti-inflammatory drugs and acetaminophen.Results: A total of 199 843 persons were included in the final analysis, 102 464 (51.3%) men and 97 379 (48.7%) women, with an average incidence rate of 1964/10(6) person-years for CKD and 279/10(6) person-years for ESRD. After controlling other risk factors, the hazard ratios for development of CKD seemed to increase for patients that had consumed more than 30 g Mu-Tong, and more than 60 g Fangchi.Conclusion: Prescription of more than 30 g Mu-Tong or more than 60 g Fangchi CHP was associated with an increased risk of developing CKD. In addition to prohibiting the use of Guan-Mu-Tong and Guang-Fangchi, patients who have used these CHP should continue to be followed up.