Department of Chinese Medicine, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.
Rehabilitation Counseling Program, Portland State University, Portland, Oregon.
Int J Rheum Dis. 2019 Jun;22(6):986-994. doi: 10.1111/1756-185X.13571. Epub 2019 Apr 10.
Depression is a common mental disorder in rheumatoid arthritis (RA) patients and may provoke the onset of poor clinical prognoses. In view of this, whether or not the use of Chinese herbal medicines (CHMs) can alleviate the risk of depression still remains unclear. We conducted a longitudinal cohort study to evaluate the association between CHMs us and depression risk among RA patients.
Using claims data from the National Health Insurance of Taiwan, we identified 6609 newly diagnosed RA patients aged 20 years or older between 1998 and 2010. From this sample, we recruited 3386 CHM users and randomly selected 3223 controls using propensity scores matching from the remaining cases as the non-CHMs users. They were followed until the end of 2012 to record depression incidence. A Cox proportional hazards regression model was used to compute the hazard ratio (HR) of depression with regard to the use of CHMs.
During the 15-year follow-up, 249 CHM users and 314 non-CHM users developed depression, representing an incidence rate of 9.33 and 14.98, respectively, per 1000 person-years. We found that use of CHMs was associated with lower risk of depression by 38% (95% confidence interval 0.54-0.76). The most predominant effect was observed in those receiving CHMs for over 2 years (adjusted HR 0.34). Seven commonly prescribed CHMs could lessen the risk of depression: Chuan-niu-xi, Jie-geng, San-qi, Jia-wei-xia-yao-san, Dang-gui-nian-tong-tang, Zhi-gan-cao-tang, and Suan-zao-ren-tang.
This study supports that adding CHMs into conventional therapy may prevent subsequent depression risk for RA patients.
抑郁症是类风湿关节炎（RA）患者常见的精神障碍，可能引发不良临床预后。鉴于此，中药（CHM）的使用是否能降低抑郁风险尚不清楚。我们进行了一项纵向队列研究，以评估 RA 患者使用 CHM 与抑郁风险之间的关系。
我们利用来自台湾全民健康保险的理赔数据，确定了 1998 年至 2010 年间年龄在 20 岁及以上的 6609 例新诊断的 RA 患者。从该样本中，我们招募了 3386 例 CHM 用户，并使用倾向评分匹配从其余病例中随机选择了 3223 例作为非 CHM 用户。随访至 2012 年底，以记录抑郁发生率。使用 Cox 比例风险回归模型计算 CHM 使用与抑郁发生的风险比（HR）。
在 15 年的随访期间，249 例 CHM 用户和 314 例非 CHM 用户发生了抑郁，相应的发生率分别为每 1000 人年 9.33 和 14.98。我们发现 CHM 的使用与抑郁风险降低 38%（95%置信区间 0.54-0.76）相关。在接受 CHM 治疗超过 2 年的患者中观察到最显著的效果（调整后的 HR 0.34）。七种常用的 CHM 可以降低抑郁风险：川芎、羌活、三七、加味逍遥散、当归拈痛汤、炙甘草汤和酸枣仁汤。
本研究支持将 CHM 添加到常规治疗中可能预防 RA 患者随后的抑郁风险。
