Lin Tsai-Hui, Chen Shu-I, Su Yuan-Chih, Lin Mei-Chen, Lin Hung-Jen, Huang Sheng-Teng
Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
Front Pharmacol. 2019 Sep 13;10:987. doi: 10.3389/fphar.2019.00987. eCollection 2019.
Lung cancer has high global incidence and mortality rates. Chronic obstructive pulmonary disease (COPD) is strongly associated with lung cancer and is an independent risk factor for lung cancer with or without smoking. Chinese herbal medicines (CHMs) are used to treat COPD. This study sought to determine whether CHM treatment effectively decreases the incidence of lung cancer in COPD patients receiving conventional Western medical treatment. Records obtained from the National Health Insurance Research Database (NHIRD) were used to identify 81,780 adults aged ≥18 years newly diagnosed with COPD in Taiwan between 2000 and 2010. Among them, 11,180 received CHMs after COPD diagnosis and 23,319 did not (non-CHM). After excluding patients with missing basic demographic information, each group consisted of 2,682 patients. Statistical methods analyzed the baseline characteristics for both groups and we performed a Cox proportional hazard regression analysis to examine the incidence of lung cancer. The cumulative incidence of lung cancer in COPD patients with or without CHM treatment was calculated by the Kaplan-Meier method. The association between herbs and formulas was examined by NodeXL to perform a network analysis of CHM. COPD patients using CHM had a lower risk for lung cancer (adjusted hazards ratio [aHR] = 0.36, 95% confidence interval [CI] = 0.24-0.53, p < 0.001). Older age was associated with a higher risk of lung cancer: patients aged 40-59 years (aHR = 5.32, 95% CI = 2.19-12.94, p < 0.001) and those aged ≥60 years (aHR = 16.75, 95% CI = 7.54-37.23, p < 0.001) were at significantly greater risk compared with patients aged 18-39 years. CHM use was associated with a trend for a lower cumulative incidence of lung cancer compared with non-CHM use (p < 0.001). Among the 10 most commonly used single herbs and formulas used to decrease the risk of lung cancer in COPD patients, was the most commonly used single herb and Xiao Qing Long Tang the most commonly used formula. The findings from this nationwide retrospective cohort study indicate that CHM as adjunctive therapy in COPD treatment regimens may reduce the risk of lung cancer in this vulnerable patient population.
肺癌在全球的发病率和死亡率都很高。慢性阻塞性肺疾病（COPD）与肺癌密切相关，是肺癌的独立危险因素，无论是否吸烟。中药用于治疗COPD。本研究旨在确定中药治疗是否能有效降低接受传统西医治疗的COPD患者患肺癌的发生率。利用从国民健康保险研究数据库（NHIRD）获得的记录，识别出2000年至2010年期间在台湾新诊断为COPD的81780名年龄≥18岁的成年人。其中，11180人在COPD诊断后接受了中药治疗，23319人未接受（非中药组）。在排除基本人口统计学信息缺失的患者后，每组各有2682名患者。统计方法分析了两组的基线特征，并进行了Cox比例风险回归分析以检查肺癌的发生率。采用Kaplan-Meier法计算接受或未接受中药治疗的COPD患者肺癌的累积发生率。通过NodeXL检查草药与方剂之间的关联，以对中药进行网络分析。使用中药的COPD患者患肺癌的风险较低（调整后风险比[aHR]=0.36，95%置信区间[CI]=0.24-0.53，p<0.001）。年龄较大与患肺癌的风险较高相关：40-59岁的患者（aHR=5.32，95%CI=2.19-12.94，p<0.001）和≥60岁的患者（aHR=16.75，95%CI=7.54-37.23，p<0.001）与18-39岁的患者相比，风险显著更高。与未使用中药相比，使用中药与肺癌累积发生率较低的趋势相关（p<0.001）。在用于降低COPD患者肺癌风险的10种最常用的单味草药和方剂中， 是最常用的单味草药，小青龙汤是最常用的方剂。这项全国性回顾性队列研究的结果表明，在COPD治疗方案中使用中药作为辅助治疗可能会降低这一脆弱患者群体患肺癌的风险。
