Division of Allergy, Immunology and Rheumatology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi 62247, Taiwan; School of Medicine, Tzu Chi University, 701 Jhongyang Road Section 3, Hualien 97004, Taiwan.
Rehabilitation Counseling Program, Portland State University, Portland, OR 97207-0751, USA.
Complement Ther Med. 2019 Aug;45:124-129. doi: 10.1016/j.ctim.2019.05.029. Epub 2019 Jun 1.
Rheumatoid arthritis (RA) patients have increased risk of developing stroke. The use Chinese herbal medicines (CHMs) is increasing, but whether they can reduce the risk of developing stroke remains unclear. We conducted a longitudinal cohort study to compare the effect of CHMs use on the subsequent stroke risk in RA individuals.
Using claims data from the National Health Insurance of Taiwan, we identified 7925 newly-diagnosed RA patients with no history of previous stroke who were 20 years of age or older between 1998 and 2010. From this sample, we enrolled 3134 CHMs users and 3134 non-CHMs users, randomly selected using propensity scores matching from the remaining cases. They were followed until the end of 2012 to record stroke incidence. A Cox proportional hazards regression model was used to compute the hazard ratio of stroke with regard to CHMs use.
During the follow-up, 299 CHMs users and 395 non-CHMs users developed stroke, representing incidence rates of 10.94 and 16.69, respectively, per 1000 person-years. CHMs use was associated with 38% (adjusted HR: 0.62; 95% confidence interval: 0.54-0.73) lower subsequent risk of stroke. The most prominent effect was observed in those receiving CHMs for over two years. The following seven commonly-prescribed CHMs were found to lessen the stroke risk: Dan-Shen, Tian-Hua-Feng, Fu-Zi, Shao-Yao-Gan-Cao-Tang, Jia-Wei-Xiao-Yao-San, Ge-Gen-Tang, and Gui-Zhi-Shao-Yao-Zhi-Mu-Tang.
The CHMs use was associated with lower risk of stroke for RA patients, suggesting that it could be integrated into conventional therapy to prevent subsequent stroke incident.
类风湿关节炎（RA）患者发生中风的风险增加。中药（CHMs）的使用正在增加，但它们是否能降低中风的风险尚不清楚。我们进行了一项纵向队列研究，比较了 CHMs 使用对 RA 个体随后中风风险的影响。
使用来自台湾全民健康保险的理赔数据，我们确定了 1998 年至 2010 年间无既往中风史且年龄在 20 岁或以上的 7925 例新诊断的 RA 患者。从这个样本中，我们招募了 3134 名 CHMs 用户和 3134 名非 CHMs 用户，使用倾向评分匹配从剩余病例中随机选择。他们被随访至 2012 年底，以记录中风的发生率。使用 Cox 比例风险回归模型计算 CHMs 使用与中风风险的风险比。
在随访期间，299 名 CHMs 用户和 395 名非 CHMs 用户发生中风，每 1000 人年的发生率分别为 10.94 和 16.69。CHMs 使用与中风的后续风险降低 38%（调整后的 HR：0.62；95%置信区间：0.54-0.73）相关。在接受 CHMs 治疗超过两年的患者中观察到最显著的效果。发现以下七种常用的 CHMs 可以降低中风风险：丹参、天花粉、附子、芍药甘草汤、加味逍遥散、葛根汤和桂枝芍药知母汤。
CHMs 使用与 RA 患者中风风险降低相关，表明它可以与常规治疗相结合，以预防后续中风事件。
