Fleischer Tom, Chang Tung-Ti, Chiang Jen-Huai, Hsieh Ching-Yun, Sun Mao-Feng, Yen Hung-Rong
From the Graduate Institute of Chinese Medicine (TF), College of Chinese Medicine, China Medical University; Department of Chinese Medicine (T-TC, M-FS, H-RY), China Medical University Hospital; School of Chinese Medicine (M-FS, H-RY); School of Post-baccalaureate Chinese Medicine (T-TC), China Medical University; Management Office for Health Data (J-HC), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine (J-HC), College of Chinese Medicine, China Medical University; Division of Hematology and Oncology (C-YH), Department of Internal Medicine; Research Center for Traditional Chinese Medicine (H-RY), Department of Medical Research, China Medical University Hospital; Research Center for Chinese Medicine & Acupuncture (M-FS, H-RY), China Medical University, Taichung, Taiwan.
Medicine (Baltimore). 2016 May;95(21):e3788. doi: 10.1097/MD.0000000000003788.
Utilization of Chinese Medicine (CM) is not uncommon in patients with chronic lymphocytic leukemia (CLL). However, the current knowledge of the usage and efficacy of CM among CLL patients is limited. The aim of this study was to determine the impact of integrative Chinese Herbal Medicine (CHM) on the disease course of CLL and ascertain the herbal products most commonly prescribed to patients with CLL.A Taiwanese nationwide population-based study involving the use of Western medicine and CM services provided by the National Health Insurance (NHI) was conducted.An NHI Research Database-based cohort study was performed; the timeframe of the study was January 2000 to December 2010. The end of the follow-up period was defined as December 31, 2011.A total of 808 patients were diagnosed with CLL in Taiwan within the defined study period. After randomly matching for age and sex and excluding patients younger than 18 years of age, data from 616 patients were analyzed.The 2 study groups both received standard of care treatment. In addition, 1 group also received CHM. Patients who were registered as receiving other forms of CM, such as acupuncture, were excluded.Hazard ratios of mortality were used to determine the influence of CHM and the therapeutic potential of herbal products.In total, 616 CLL patients were included in the analyses. We found that the HR associated with the adjunctive use of CHM was less than half when compared to the non-CHM group (0.43, 95% CI 0.33-0.55, P < 0.0001) and that treatment-naive patients who used CHM had the lowest HR. We also established that this association between reduction in HR and CHM was dose-dependent, and the longer CHM users received prescriptions, the lower the HR (P < 0.001).We supplied data from a relatively large population that spanned a significant amount of time. Our data suggests that the treatment of CLL with adjunctive CHM may have a substantial positive impact on mortality, especially for treatment-naive patients. Further research is needed to confirm whether there is a direct causal relationship between CHM and the outcomes displayed.
在慢性淋巴细胞白血病（CLL）患者中使用中药并不罕见。然而，目前对于CLL患者使用中药的情况及其疗效的了解有限。本研究的目的是确定综合中药（CHM）对CLL病程的影响，并确定最常给CLL患者开具的草药产品。
我们进行了一项基于台湾全国人口的研究，该研究涉及使用由国民健康保险（NHI）提供的西医和中药服务。
我们进行了一项基于NHI研究数据库的队列研究；研究的时间范围是2000年1月至2010年12月。随访期结束定义为2011年12月31日。
在规定的研究期间内，台湾共有808例患者被诊断为CLL。在按年龄和性别进行随机匹配并排除18岁以下患者后，对616例患者的数据进行了分析。
两个研究组均接受标准治疗。此外，一组还接受CHM治疗。登记接受其他形式中药治疗（如针灸）的患者被排除在外。
使用死亡率风险比来确定CHM的影响以及草药产品的治疗潜力。
总共616例CLL患者被纳入分析。我们发现，与未使用CHM的组相比，辅助使用CHM的风险比不到一半（0.43，95%可信区间0.33 - 0.55，P < 0.0001），且初次接受治疗的使用CHM的患者风险比最低。我们还确定，风险比降低与CHM之间的这种关联是剂量依赖性的，CHM使用者接受处方的时间越长，风险比越低（P < 0.001）。
我们提供了来自相对大量人群且跨越较长时间的数据。我们的数据表明，辅助使用CHM治疗CLL可能对死亡率有重大积极影响，尤其是对于初次接受治疗的患者。需要进一步研究以确认CHM与所显示的结果之间是否存在直接因果关系。
