School of Chinese Medicine, China Medical University, No. 91, Hsueh-Shih Road, Taichung, Taiwan.
Genetic Center, Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
BMC Complement Med Ther. 2020 Jul 14;20(1):221. doi: 10.1186/s12906-020-03010-6.
Liver cirrhosis is one of the main causes of the morbidity and mortality in liver diseases. Chinese herbal medicine (CHM) has long been used for the clinical treatment of liver diseases. This study was designed to explore the usage frequency and prescription patterns of CHM for patients with decompensated liver cirrhosis and to evaluate the long-term effects of CHM on overall mortality.
Two thousand four hundred sixty-seven patients with decompensated liver cirrhosis (ICD-9-CM code: 571.2, 571.5, and 571.6) diagnosed between 2000 and 2009 in Taiwan were identified from the registry for catastrophic illness patients. Of these, 149 CHM users and 298 CHM non-users were matched for age, gender, and Charlson comorbidity index score. The chi-squared test, paired Student's t-test, Cox proportional hazard model, and Kaplan-Meier method were applied for various comparisons between these groups of patients.
CHM-treated patients showed a lower overall mortality risk compared with non-treated patients (Multivariable: p < 0.0001; HR: 0.54, 95% CI: 0.42-0.69). The cumulative incidence of overall mortality was lower in the CHM-treated group (stratified log-rank test, p = 0.0002). The strongest CHM co-prescription pattern- Yin-Chen-Hao-Tang (YCHT) → Long-Dan-Xie-Gan-Tang (LDXGT) had the highest support, followed by Zhi-Zi (ZZ) → Yin-Chen-Wu-Ling-San (YCWLS) and Bai-Hua-She-She-Cao (BHSSC) → Da-Huang (DaH).
CHM, as adjunct therapy, might decrease the risk of overall mortality in patients with decompensated liver cirrhosis. CHM co-prescription patterns and network analysis showed that comprehensive herbal medicines have a protective role against liver fibrosis. Further studies are required to enhance the knowledge of safety and efficacy of CHM in patients with decompensated liver cirrhosis.
肝硬化是肝脏疾病发病率和死亡率的主要原因之一。中草药（CHM）长期以来一直用于肝脏疾病的临床治疗。本研究旨在探讨 CHM 治疗失代偿期肝硬化患者的使用频率和处方模式，并评估 CHM 对总死亡率的长期影响。
从灾难性疾病患者登记处确定了 2000 年至 2009 年间诊断为失代偿性肝硬化（ICD-9-CM 代码：571.2、571.5 和 571.6）的 2467 名患者。在这些患者中，根据年龄、性别和 Charlson 合并症指数评分，将 149 名 CHM 使用者和 298 名 CHM 非使用者匹配。应用卡方检验、配对学生 t 检验、Cox 比例风险模型和 Kaplan-Meier 方法对两组患者进行各种比较。
与未治疗的患者相比，接受 CHM 治疗的患者整体死亡率风险较低（多变量：p<0.0001；HR：0.54，95%CI：0.42-0.69）。CHM 治疗组的整体死亡率累积发生率较低（分层对数秩检验，p=0.0002）。最强的 CHM 共同处方模式-茵陈蒿汤（YCHT）→龙胆泻肝汤（LDXGT）具有最高的支持度，其次是栀子（ZZ）→茵陈五苓散（YCWLS）和白花蛇舌草（BHSSC）→大黄（DaH）。
作为辅助治疗，CHM 可能降低失代偿期肝硬化患者的整体死亡率。CHM 共同处方模式和网络分析表明，综合草药对肝纤维化具有保护作用。需要进一步的研究来提高对失代偿期肝硬化患者使用 CHM 的安全性和疗效的认识。
