Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan.
School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Chinese Herbal Medicine, China Medical University, Taichung 404, Taiwan; Chinese Medicine Research Center, China Medical University, Taichung 404, Taiwan; Department of Biotechnology, Asia University, Taichung 413, Taiwan.
J Affect Disord. 2019 May 1;250:298-306. doi: 10.1016/j.jad.2019.03.020. Epub 2019 Mar 5.
Depression had a significantly increased risk of stroke. Some patients with depression seek acupuncture treatment. The aim of this study is to investigate the association between acupuncture treatment and risk of developing stroke in patients with depression.
Patients with newly diagnosed depression above 18 years old between 1997 and 2010 were selected from the Taiwanese National Health Insurance Research Database, and followed up until the end of 2013. The 1:1 propensity score method was used to match an equal number of patients (N = 13,823) in the acupuncture and non-acupuncture cohorts, based on characteristics including sex, age, baseline comorbidity and drug used. The outcome measurement was the comparison of stroke incidence in the two cohorts. We used the Cox regression model and the Kaplan-Meier method to estimate the risk of developing stroke.
Compared with the non-acupuncture cohort, patients who received acupuncture treatment had a lower risk of stroke (adjusted hazard ratio (HR) = 0.49, 95% confidential interval = 0.45-0.52) after adjustment for age, sex, comorbidities and drugs used. Regarding the two types of stroke, acupuncture users also had lower risk of hemorrhagic or ischemic stroke (adjusted HR = 0.37 and 0.49, respectively). The cumulative incidence of stroke in the acupuncture cohort was significantly lower than that of the non-acupuncture cohort (log-rank test, p < 0.001). At the 5th year of follow-up, 7.22% of acupuncture users had stroke onset compared with 14% in the non-acupuncture cohort.
The database provided information of antidepressants but not the severity of depression. Details of the life style and selection of acupoints were also not provided.
The present study revealed that acupuncture reduced the risk of developing stroke in depression patients in Taiwan. Further clinical studies investigating the mechanisms and efficacy of acupuncture are warranted.
抑郁症患者发生中风的风险显著增加。一些抑郁症患者寻求针灸治疗。本研究旨在探讨针灸治疗与抑郁症患者发生中风风险之间的关系。
从台湾全民健康保险研究数据库中选择 1997 年至 2010 年间年龄在 18 岁以上的新发抑郁症患者，并随访至 2013 年底。采用 1:1 倾向评分匹配法，基于性别、年龄、基线合并症和药物使用等特征，在针灸组和非针灸组中匹配相同数量的患者（N=13823）。结局测量为两组中风发生率的比较。采用 Cox 回归模型和 Kaplan-Meier 方法估计发生中风的风险。
与非针灸组相比，接受针灸治疗的患者发生中风的风险较低（校正后的风险比（HR）=0.49，95%置信区间（CI）=0.45-0.52），校正后年龄、性别、合并症和药物使用。对于两种类型的中风，针灸患者的出血性或缺血性中风风险也较低（校正 HR=0.37 和 0.49）。针灸组的中风累积发生率明显低于非针灸组（对数秩检验，p<0.001）。在 5 年的随访中，针灸组中有 7.22%的患者发生中风，而非针灸组中有 14%的患者发生中风。
该数据库提供了抗抑郁药的信息，但未提供抑郁症的严重程度。生活方式和选穴的细节也未提供。
本研究表明，针灸可降低台湾地区抑郁症患者发生中风的风险。需要进一步的临床研究来探讨针灸的机制和疗效。
