Lee Ai-Lin, Chen Bor-Chyuan, Mou Chih-Hsin, Sun Mao-Feng, Yen Hung-Rong
From the Department of Chinese Medicine, China Medical University Hospital, Taichung (A-LL, M-FS, H-RY); Department of Chinese Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi (B-CC); Management Office for Health Data (C-HM); Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung (H-RY); Research Center for Chinese Medicine and Acupuncture (M-FS, H-RY); and School of Chinese Medicine, China Medical University, Taichung, Taiwan (M-FS, H-RY).
Medicine (Baltimore). 2016 Jan;95(3):e2536. doi: 10.1097/MD.0000000000002536.
With an increasing use of traditional Chinese medicine (TCM) in type 2 diabetes mellitus (T2DM), evidence of long-term benefit with adjunctive TCM treatment is limited. This study investigated whether the concurrent TCM treatment reduces the risk of vascular complications in T2DM patients by using a large population from National Health Insurance Research Database (NHIRD).We identified 33,457 adult patients with newly diagnosed T2DM using anti-diabetic agents from a random sample of one million beneficiaries in the NHIRD between January 1, 2000 and December 31, 2011. We recruited 1049 TCM users (received TCM over 30 days with a diagnosis of T2DM) and randomly selected 4092 controls as the non-TCM cohort at a ratio of 1:4 frequency-matched by age, sex, hypertension, hyperlipidemia, and index year. We investigated the prescription pattern of TCM and conducted a Cox proportional hazards regression to calculate the hazard ratios (HRs) of stroke, chronic kidney diseases (CKD), and diabetic foot between the 2 cohorts.In the TCM cohort, the prescription pattern of TCM was different between insulin and noninsulin patients. The most common herbs were Dan-Shen (Radix Salviae Miltiorrhizae) in noninsulin group and Da-Huang (Radix et Rhizoma Rhei) in insulin group. The most common formulae were Liu-Wei-Di-Huang-Wan in noninsulin group and Yu-Quan-Wan in insulin group. Although no significant reduction in the hazard ratio of CKD and diabetic foot, the incidence rate of stroke was 7.19 per 1000 person-years in the TCM cohort and 10.66 per 1000 person-years in the control cohort, respectively. After adjustment of age, sex, hypertension, hyperlipidemia, and antidiabetes agent use (including sulfonylureas, α-glucosidase, metformin, meglitinide, thiazolidinediones, and insulin), TCM cohorts were found to have a 33% decreased risk of stroke (95% CI = 0.46-0.97; P < 0.05).This population-based retrospective study showed that the complementary TCM therapy might associate with the decreased risk of stroke in T2DM, suggesting TCM as an adjunctive therapy for T2DM to prevent subsequent stroke.
随着中药在2型糖尿病（T2DM）治疗中的使用日益增加，中药辅助治疗带来长期益处的证据有限。本研究利用国民健康保险研究数据库（NHIRD）中的大量人群，调查了同时进行中药治疗是否能降低T2DM患者发生血管并发症的风险。我们从NHIRD中2000年1月1日至2011年12月31日的100万受益人的随机样本中，确定了33457名使用抗糖尿病药物新诊断为T2DM的成年患者。我们招募了1049名使用中药的患者（确诊为T2DM且使用中药超过30天），并以1:4的比例按年龄、性别、高血压、高脂血症和索引年份进行频率匹配，随机选择4092名对照作为非中药队列。我们调查了中药的处方模式，并进行Cox比例风险回归分析以计算两组之间中风、慢性肾脏病（CKD）和糖尿病足的风险比（HRs）。在中药队列中，胰岛素治疗患者和非胰岛素治疗患者的中药处方模式不同。非胰岛素组最常用的草药是丹参（丹参根），胰岛素组是大黄（大黄根茎）。非胰岛素组最常用的方剂是六味地黄丸，胰岛素组是玉泉丸。虽然CKD和糖尿病足的风险比没有显著降低，但中药队列中中风的发病率分别为每1000人年7.19例，对照组为每1000人年10.66例。在调整年龄、性别、高血压、高脂血症和抗糖尿病药物使用情况（包括磺脲类、α-葡萄糖苷酶抑制剂、二甲双胍、格列奈类、噻唑烷二酮类和胰岛素）后，发现中药队列中风风险降低了33%（95%CI = 0.46 - 0.97；P < 0.05）。这项基于人群的回顾性研究表明，辅助中药治疗可能与T2DM患者中风风险降低有关，提示中药可作为T2DM的辅助治疗手段以预防后续中风。
