Guo Jenny Chun-Ling, Pan Heng-Chih, Yeh Bo-Yan, Lu Yen Chu, Chen Jiun-Liang, Yang Ching-Wei, Chen Yu-Chun, Lin Yi-Hsuan, Chen Hsing-Yu
Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Front Pharmacol. 2021 Feb 18;12:616522. doi: 10.3389/fphar.2021.616522. eCollection 2021.
Chronic kidney disease (CKD) has become a worldwide burden due to the high co-morbidity and mortality. Diabetic nephropathy (DN) is one of the leading causes of CKD, and pre-dialysis is one of the most critical stages before the end-stage renal disease (ESRD). Although Chinese herbal medicine (CHM) use is not uncommon, the feasibility of using CHM among pre-dialysis DN patients remains unclear. We analyzed a population-based cohort, retrieved from Taiwan's National Health Insurance Research Database, to study the long-term outcome of using CHM among incident pre-dialysis DN patients from January 1, 2004, to December 31, 2007. All patients were followed up to 5 years or the occurrence of mortality. The risks of all-cause mortality and ESRD were carried out using Kaplan-Meier and competing risk estimation, respectively. Further, we demonstrated the CHM prescriptions and core CHMs using the Chinese herbal medicine network (CMN) analysis. A total of 6,648 incident pre-dialysis DN patients were analyzed, including 877 CHM users and 5,771 CHM nonusers. With overlap weighing for balancing all accessible covariates between CHM users and nonusers, we found the use of CHM was associated with lower all-cause mortality (0.22 versus 0.56; log-rank test: -value <0.001), and the risk of mortality was 0.42 (95% CI: 0.36-0.49; -value <0.001) by adjusting all accessible covariates. Further, the use of CHM was associated with a lower risk of ESRD (cause-specific hazard ratio: 0.59, 95%CI: 0.55-0.63; -value <0.001). Also, from the 5,901 CHM prescriptions, we found Ji-Sheng-Shen-Qi-Wan, Bunge or ( (Fisch.) Bge.) L. ( Willd.), Bunge, and ( (Maxim. ex Regel) Balf. Baill.) were used as core CHMs for different CHM indications. Use of core CHMs was associated with a lower risk of mortality than CHM users without using core CHMs. The use of CHM seemed feasible among pre-dialysis DN patients; however, the beneficial effects still need to be validated by well-designed clinical trials.
由于高合并症和死亡率，慢性肾脏病（CKD）已成为全球负担。糖尿病肾病（DN）是CKD的主要病因之一，透析前是终末期肾病（ESRD）之前最关键的阶段之一。尽管使用中草药（CHM）并不罕见，但在透析前DN患者中使用CHM的可行性仍不明确。我们分析了一个基于人群的队列，该队列取自台湾国民健康保险研究数据库，以研究2004年1月1日至2007年12月31日期间初发透析前DN患者使用CHM的长期结局。所有患者随访至5年或死亡发生。分别使用Kaplan-Meier法和竞争风险估计法评估全因死亡率和ESRD的风险。此外，我们使用中草药网络（CMN）分析法展示了CHM处方和核心CHM。共分析了6648例初发透析前DN患者，包括877例CHM使用者和5771例非CHM使用者。通过重叠加权以平衡CHM使用者和非使用者之间所有可及的协变量，我们发现使用CHM与较低的全因死亡率相关（0.22对0.56；对数秩检验：P值<0.001），通过调整所有可及的协变量，死亡风险为0.42（95%CI：0.36 - 0.49；P值<0.001）。此外，使用CHM与较低的ESRD风险相关（特定病因风险比：0.59，95%CI：0.55 - 0.63；P值<0.001）。同样，从5901份CHM处方中，我们发现济生肾气丸、黄芪（Astragalus membranaceus (Fisch.) Bge.）、茯苓（Poria cocos (Schw.) Wolf）和牡丹皮（Paeonia suffruticosa Andr.）被用作不同CHM适应症的核心CHM。使用核心CHM的患者比未使用核心CHM的CHM使用者死亡风险更低。在透析前DN患者中使用CHM似乎是可行的；然而，其有益效果仍需通过精心设计的临床试验来验证。
