Center for East West Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA; Tzu Chi Medical Foundation, Alhambra, CA, USA.
Center for East West Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA.
J Ethnopharmacol. 2021 Nov 15;280:114419. doi: 10.1016/j.jep.2021.114419. Epub 2021 Jul 17.
To determine whether adjuvant Chinese herbal medicine (CHM) treatment is associated with the risk of joint replacement in osteoarthritis (OA) patients.
This retrospective study used a population-based national health insurance (NHI) database from 2000 to 2012 in Taiwan. A total of 125,023 newly diagnosed OA patients were selected from one million beneficiaries of longitudinal health insurance database. Based on applying ten selected frequently used CHM formulas for OA, patients were divided into CHM user and non-CHM user. One-CHM to four-non-CHM user were propensity score matched with age, gender, monthly income, urbanization, comorbidities, Nonsteroidal anti-inflammatory drugs (NSAIDs) and index year were adjusted to reduce selection bias and confounding. Cox regression model was used for comparing the hazard ratios (HR) for the risk of joint replacement and Kaplan-Meier curve for the proportion of joint replacement.
OA patients who were female, younger (20-60 years), higher income and lived in urbanization location were found to preferred using CHM. Younger CHM users had a lower adjusted HR (0.63) of the risk of joint replacement (95% confidence interval (CI) = 0.42-0.94). Compared to non-CHM user, HR among CHM users (≥225 days annually) is 0.48 (95% CI = 0.31-0.76). The proportion of joint replacement in younger non-CHM user began to rise notably with time (log-rank test, p = 0.026). However, this benefit by CHM did not apply to older (over 60 years) OA patients.
This study suggested that adjuvant CHM might be associated with a lower rate of joint replacement in OA patients. CHM therapy might be considered in OA patients to reduce the need of joint replacement.
确定辅助中草药（CHM）治疗是否与骨关节炎（OA）患者关节置换的风险相关。
本回顾性研究使用了台湾 2000 年至 2012 年的基于人群的国家健康保险（NHI）数据库。从纵向健康保险数据库的 100 万受益人中选择了总共 125023 例新诊断为 OA 的患者。根据应用于 10 种常用的 OA 治疗 CHM 配方，将患者分为 CHM 用户和非 CHM 用户。通过年龄、性别、月收入、城市化程度、合并症、非甾体抗炎药（NSAIDs）和指数年进行倾向评分匹配，以减少选择偏差和混杂因素。Cox 回归模型用于比较关节置换风险的风险比（HR）和关节置换比例的 Kaplan-Meier 曲线。
发现女性、年龄较小（20-60 岁）、收入较高且居住在城市化地区的 OA 患者更倾向于使用 CHM。年轻的 CHM 用户的关节置换风险调整后 HR（0.63）较低（95%置信区间（CI）=0.42-0.94）。与非 CHM 用户相比，CHM 用户（每年≥225 天）的 HR 为 0.48（95% CI=0.31-0.76）。年轻非 CHM 用户的关节置换比例随时间显著上升（对数秩检验，p=0.026）。然而，这种 CHM 的益处不适用于年龄较大（60 岁以上）的 OA 患者。
本研究表明，辅助 CHM 可能与 OA 患者关节置换率降低相关。CHM 治疗可考虑用于 OA 患者，以减少关节置换的需求。
