接受中医药治疗眩晕的患者中风风险降低：基于人群的队列研究。
Decreased risk of stroke in patients receiving traditional Chinese medicine for vertigo: A population-based cohort study.
机构信息
Department of Medical Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi 62247, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70428, Taiwan; Department of Nursing, Tzu Chi College of Technology, 880 Chien-Kuo Road Section 2, Hualien 97004, Taiwan.
Department of Public Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70428, Taiwan; Department of Public Health, College of Public Health, China Medical University, 91 Hsueh-Shih Road, Taichung 40402, Taiwan.
出版信息
J Ethnopharmacol. 2016 May 26;184:138-43. doi: 10.1016/j.jep.2016.03.008. Epub 2016 Mar 8.
ETHNOPHARMACOLOGICAL RELEVANCE
Patients with vertigo are reported to exhibit a higher risk of subsequent stroke. However, it remains unclear if Traditional Chinese Medicine (TCM), the most common form of complementary and alternative medicine, can help lower the risk of stroke for these patients. So the aim of the study was to investigate the effects of TCM on stroke risk among patients with vertigo.
MATERIALS AND METHODS
This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 112,458 newly diagnosed vertigo patients aged ≥20 years who received treatment between 1998 and 2007. Among these patients, 53,203 (47.31%) received TCM after vertigo onset (TCM users), and the remaining 59,201 patients were designated as a control group (non-TCM users). All enrollees received follow-up until the end of 2012 to measure stroke incidence. Cox proportional hazards regression was used to compute the hazard ratio (HR) of stroke in recipients of TCM services.
RESULTS
During 15-year follow-up, 5532 TCM users and 12,295 non-TCM users developed stroke, representing an incidence rate of 13.10% and 25.71% per 1000 person-years. TCM users had a significantly reduced risk of stroke compared to non-TCM users (adjusted HR=0.64; 95% confidence interval CI=0.59-0.74). The predominant effect was observed for those receiving TCM for more than 180 days (adjusted HR=0.52; 95% CI=0.49-0.56). Commonly used TCM formulae, including Ban-Xia-Bai-Zhu-Tian-Ma-Tang, Ling-Gui-Zhu-Gan-Tang, Bai Zhi (Angelica dahurica (Hoffm.) Benth. & Hook.f. ex Franch. & Sav., root), Ge Gen (Pueraria lobata (Willd.) Ohwi, root) and Hai Piao Xiao (Endoconcha Sepiae, Cuttlefish Bone) were significantly associated with lower risk of stroke.
CONCLUSIONS
Results of this population-based study support the effects of TCM on reducing stroke risk, and may provide a reference for stroke prevention strategies. The study results may also help to integrate TCM into clinical intervention programs that provide a favorable prognosis for vertigo patients.
民族药理学相关性
据报道，眩晕患者发生中风的风险更高。然而，目前尚不清楚中医（TCM）——最常见的补充和替代医学形式——是否可以帮助降低这些患者中风的风险。因此，本研究旨在探讨 TCM 对眩晕患者中风风险的影响。
材料和方法
本纵向队列研究使用台湾全民健康保险研究数据库，确定了 1998 年至 2007 年间 112458 例年龄≥20 岁的新诊断为眩晕的患者，其中 53203 例（47.31%）在眩晕发作后接受 TCM 治疗（TCM 用户），其余 59201 例患者被指定为对照组（非 TCM 用户）。所有参与者均接受随访至 2012 年底，以测量中风发生率。采用 Cox 比例风险回归计算 TCM 服务使用者中风的风险比（HR）。
结果
在 15 年的随访中，5532 名 TCM 用户和 12295 名非 TCM 用户发生中风，每 1000 人年的发病率分别为 13.10%和 25.71%。与非 TCM 用户相比，TCM 用户中风的风险显著降低（调整后的 HR=0.64；95%置信区间 CI=0.59-0.74）。对于接受 TCM 治疗超过 180 天的患者，观察到主要效果（调整后的 HR=0.52；95%置信区间 CI=0.49-0.56）。常用的 TCM 方剂，包括半夏白术天麻汤、苓桂术甘汤、白芷（杭白芷（Hoffm.）Benth. & Hook.f. ex Franch. & Sav.，根）、葛根（野葛（Willd.）Ohwi，根）和海漂硝（乌贼骨），与中风风险降低显著相关。
结论
这项基于人群的研究结果支持 TCM 对降低中风风险的作用，并可为中风预防策略提供参考。研究结果还可能有助于将 TCM 纳入为眩晕患者提供有利预后的临床干预计划。
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