Lu Chieh-Hua, Chung Chi-Hsiang, Lee Chien-Hsing, Hsieh Chang-Hsun, Hung Yi-Jen, Lin Fu-Huang, Tsao Chang-Huei, Hsieh Po-Shiuan, Chien Wu-Chien
Department of Internal Medicine, Division of Endocrinology and Metabolism, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.
Department of Medical Research, National Defense Medical Center, Taipei, Taiwan, ROC.
PLoS One. 2018 Jan 31;13(1):e0191242. doi: 10.1371/journal.pone.0191242. eCollection 2018.
Osteoarthritis (OA) is the most common form of arthritis associated with an increased prevalence of type 2 diabetes mellitus (T2DM), however their impact on decreasing joint replacement surgery has yet to be elucidated. This study aimed to investigate if the combination of COX-2 inhibitor and metformin therapy in OA with T2DM were associated with lower the rate of joint replacement surgery than COX-2 inhibitor alone.
In total, 968 subjects with OA and T2DM under COX-2 inhibitor and metformin therapy (case group) between 1 January to 31 December 2000 were selected from the National Health Insurance Research Database of Taiwan, along with 1936 patients were the 1:2 gender-, age-, and index year-controls matched without metformin therapy (control group) in this study. Cox proportional hazards analysis was used to compare the rate of receiving joint replacement surgery during 10 years of follow-up.
At the end of follow-up, 438 of all enrolled subjects (15.08%) had received the joint replacement surgery, including 124 in the case group (12.81%) and 314 in the control group (16.22%). The case group tended to be associated with lower rate of receiving the joint replacement surgery at the end of follow-up than the control group (p = 0.003). Cox proportional hazards regression (HR) analysis revealed that study subjects under combination therapy with metformin had lower rate of joint replacement surgery (adjusted HR 0.742 (95% CI = 0.601-0.915, p = 0.005)). In the subgroups, study subjects in the combination metformin therapy who were female, good adherence (>80%), lived in the highest urbanization levels of residence, treatment in the hospital center and lower monthly insurance premiums were associated with a lower risk of joint replacement surgery than those without.
Patients who have OA and T2DM receiving combination COX-2 inhibitors and metformin therapy associated with lower joint replacement surgery rates than those without and this may be attributable to combination therapy much more decrease pro-inflammatory factors associated than those without metformin therapy.
骨关节炎（OA）是最常见的关节炎形式，与2型糖尿病（T2DM）患病率增加相关，然而它们对减少关节置换手术的影响尚未阐明。本研究旨在调查OA合并T2DM患者中，COX-2抑制剂与二甲双胍联合治疗相比单独使用COX-2抑制剂是否与更低的关节置换手术率相关。
从台湾国民健康保险研究数据库中选取2000年1月1日至12月31日期间接受COX-2抑制剂和二甲双胍治疗的968例OA合并T2DM患者（病例组），以及1936例未接受二甲双胍治疗的1:2性别、年龄和索引年份匹配的对照患者（对照组）。采用Cox比例风险分析比较10年随访期间接受关节置换手术的比率。
随访结束时，所有纳入研究的受试者中有438例（15.08%）接受了关节置换手术，其中病例组124例（12.81%），对照组314例（16.22%）。病例组在随访结束时接受关节置换手术的比率往往低于对照组（p = 0.003）。Cox比例风险回归（HR）分析显示，接受二甲双胍联合治疗的研究对象关节置换手术率较低（调整后HR 0.742（95%CI = 0.601 - 0.915，p = 0.005））。在亚组中，接受二甲双胍联合治疗的女性、依从性良好（>80%）、居住在城市化水平最高地区、在医院中心接受治疗且月保险费较低的研究对象与未接受该治疗的对象相比，关节置换手术风险较低。
患有OA和T2DM的患者接受COX-2抑制剂和二甲双胍联合治疗与未接受联合治疗的患者相比，关节置换手术率更低，这可能归因于联合治疗比未使用二甲双胍治疗更多地降低了促炎因子。
