Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
J Ethnopharmacol. 2015 Jan 15;159:189-96. doi: 10.1016/j.jep.2014.11.018. Epub 2014 Nov 18.
Atopic dermatitis is a prevalent dermatologic disease in children. Corticosteroid is an important treatment but side effects caused by long-term and excessive use heavily concern patients. Traditional Chinese medicine (TCM) is potentially an alternative treatment and might cause less adverse effects. This nationwide retrospective cohort study aimed to examine the hypothesis that TCM use is associated with lower exposure to corticosteroid.
Children under 12 years of age with ICD-9 codes 691.8 and 692.x were identified as atopic dermatitis patients from 2007/1/1 to 2007/12/31. Corticosteroid use was compared between TCM users and non-users for one-year follow-up by using a general estimation equation model with propensity-score matching.
A total of 9012 TCM users were identified and the use of corticosteroid after treatment was compared with matched TCM non-users. Use of TCM significantly reduced exposure to corticosteroids after 1-year follow-up. Among TCM users, the exposure to any corticosteroids was lower (42.1% reduction in TCM users versus 34.5% increase in TCM non-users, relative risk: 0.36; p-Value<0.001), the duration was shorter (relative risk for using corticosteroid more than 14 days: 0.37; p-Value<0.001), and the rate of frequent visits with steroid prescription was also lower. CHM was the most commonly used TCM modality (98.5% of all visits) and Xiao-Feng-San was the most commonly used CHM (33% of all prescriptions) with extensive coverage for pathogenesis of atopic dermatitis.
Lower use rate of corticosteroid can be found after TCM treatment, which can be considered as an integrative therapy for atopic dermatitis. Further studies are warranted on the basis of this study.
特应性皮炎是儿童中一种常见的皮肤病。皮质类固醇是一种重要的治疗方法，但长期和过量使用引起的副作用让患者非常担忧。中药（TCM）可能是一种替代治疗方法，可能引起的不良反应较少。本全国回顾性队列研究旨在检验以下假设：使用 TCM 与皮质类固醇暴露减少相关。
从 2007 年 1 月 1 日至 2007 年 12 月 31 日，通过国际疾病分类第 9 版（ICD-9）代码 691.8 和 692.x 识别出 12 岁以下的特应性皮炎患者。使用倾向评分匹配的广义估计方程模型比较 TCM 使用者和非使用者在一年随访期间的皮质类固醇使用情况。
共确定了 9012 名 TCM 使用者，并比较了治疗后皮质类固醇的使用情况与匹配的 TCM 非使用者。在 1 年随访后，TCM 的使用显著降低了皮质类固醇的暴露量。在 TCM 使用者中，使用任何皮质类固醇的比例较低（TCM 使用者中降低了 42.1%，而 TCM 非使用者中增加了 34.5%，相对风险：0.36；p 值<0.001），使用时间较短（使用皮质类固醇超过 14 天的相对风险：0.37；p 值<0.001），并且开具类固醇处方的频繁就诊率也较低。中药（TCM）是最常用的 TCM 治疗方法（所有就诊的 98.5%），消风散是最常用的 TCM（所有处方的 33%），广泛涵盖了特应性皮炎的发病机制。
TCM 治疗后皮质类固醇使用率降低，可以考虑作为特应性皮炎的综合治疗方法。在此研究基础上，还需要进一步研究。
