Traditional Chinese medicine use is associated with lower end-stage renal disease and mortality rates among patients with diabetic nephropathy: a population-based cohort study
Traditional Chinese medicine use is associated with lower end-stage renal disease and mortality rates among patients with diabetic nephropathy: a population-based cohort study
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DOI：
10.1186/s12906-019-2491-y
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发表时间：
2019-04-03
影响因子：
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通讯作者：
Wu, Hau-Tieng
中科院分区：
文献类型：
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作者：
Chen, Hsing-Yu;Pan, Heng-Chih;Wu, Hau-Tieng
背景糖尿病肾病（diabetic nephropathy，DN）是糖尿病（diabetes mellitus，DM）的常见并发症，给医疗系统带来了巨大的负担。虽然一些研究表明，传统中医药（TCM）治疗对DN具有保护作用，但长期影响仍不清楚。本研究的目的是研究终末期肾病（ESRD）和死亡率与DN.MethodsA的中医药用户之间的事件DN患者从2004年至2006年共125，490例，确定从台湾的国民健康保险研究数据库，并随访至2012年。采用里程碑法避免永久时间偏差，采用倾向评分匹配选择1：1基线特征匹配队列。Kaplan-Meier法和竞争风险分析被用来评估死亡率和ESRD率分别为independent.ResultsAmong所有合格的科目，约60%的患者被归类为中医药用户（65,812中医药用户和41,482 nonusers）。在1：1匹配后，分析了68，882例患者的结局。对于终末期肾病的发生率，使用中药者的8年累积发生率为14.5%[95%置信区间（CI）：13.9-15.0]，非使用者为16.6%（95% CI：16.0-17.2）。对于死亡率，8年累积发生率为33.8%（95%CI：33.1-34.6），中药使用者和非使用者为49.2%（95%CI：48.5-49.9）。调整混杂协变量后，ESRD的病因特异性风险比为0.81（95%CI：0.78-0.84），中药使用者死亡率的风险比为0.48（95%CI：0.47-0.50）。与非ESRD的TCM使用者（30.1，95%CI：29.4-30.9）相比，ESRD的TCM使用者（56.8，95%CI：54.6-59.1）的累积死亡率迅速增加。此外，使用中医药时间较长或在诊断为DN后开始中医药治疗的中医药使用者死亡风险较低。这些结果是一致的敏感性测试与不同的定义的中医药用户和逆概率加权subjects.ConclusionsThe较低的ESRD和死亡率与事件DN患者之间使用中医药治疗。DN的具体中医证型或用药有待进一步研究。
BackgroundDiabetic nephropathy (DN) is a common complication of diabetes mellitus (DM) that imposes an enormous burden on the healthcare system. Although some studies show that traditional Chinese medicine (TCM) treatments confer a protective effect on DN, the long-term impact remains unclear. This study aims to examine end-stage renal disease (ESRD) and mortality rates among TCM users with DN.MethodsA total of 125,490 patients with incident DN patients from 2004 to 2006 were identified from the National Health Insurance Research Database in Taiwan and followed until 2012. The landmark method was applied to avoid immortal time bias, and propensity score matching was used to select 1:1 baseline characteristics-matched cohort. The Kaplan-Meier method and competing-risk analysis were used to assess mortality and ESRD rates separately.ResultsAmong all eligible subjects, about 60% of patients were classified as TCM users (65,812 TCM users and 41,482 nonusers). After 1:1 matching, the outcomes of 68,882 patients were analyzed. For the ESRD rate, the 8-year cumulative incidence was 14.5% for TCM users [95% confidence interval (CI): 13.9-15.0] and 16.6% for nonusers (95% CI: 16.0-17.2). For the mortality rate, the 8-year cumulative incidence was 33.8% for TCM users (95% CI: 33.1-34.6) and 49.2% for nonusers (95% CI: 48.5-49.9). After adjusting for confounding covariates, the cause-specific hazard ratio of ESRD was 0.81 (95% CI: 0.78-0.84), and the hazard ratio of mortality for TCM users was 0.48 (95% CI: 0.47-0.50). The cumulative incidence of mortality increased rapidly among TCM users with ESRD (56.8, 95% CI: 54.6-59.1) when compared with TCM users without ESRD (30.1, 95% CI: 29.4-30.9). In addition, TCM users who used TCM longer or initiated TCM treatments after being diagnosed with DN were associated with a lower risk of mortality. These results were consistent across sensitivity tests with different definitions of TCM users and inverse probability weighting of subjects.ConclusionsThe lower ESRD and mortality rates among patients with incident DN correlates with the use of TCM treatments. Further studies about specific TCM modalities or medications for DN are still needed.