Yu Han-Hua, Hsieh Chia-Jung
Division of Rheumatology, Allergy and Immunology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Department of Chinese Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Front Pharmacol. 2021 Sep 27;12:737105. doi: 10.3389/fphar.2021.737105. eCollection 2021.
Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that involves multiple systems and organs. Advanced conventional treatment does not appear to markedly reduce the risk of cardiovascular disease (CVD) among patients with SLE. Chinese medicine is a complementary and alternative medicine system, and some SLE patients in Taiwan also use Chinese herbal medicines (CHMs). Thus, we aimed to investigate whether integrative therapy combining CHMs with conventional therapy reduces the risk of CVD among patients with SLE. We performed a 12-years population-based retrospective cohort study using the "Systemic Lupus Erythematosus Health Database" of the National Health Insurance Research Database (NHIRD) in Taiwan. Patients newly diagnosed with SLE between 2004 and 2013 were divided into CHM and non-CHM groups and followed up until the end of 2015. We applied 1:1 individual matching by age, gender, and year of being newly diagnosed with SLE; accordingly, 2,751 patients were included in both CHM and non-CHM groups after matching. We applied the Cox proportional hazard regression model to determine the risk of CVD in relation to CHM use. During the follow-up period, 407 patients in the CHM group and 469 patients in the non-CHM group developed CVD, with incidence rates of 337 and 422 per 10,000 person-years, respectively. The Cox proportional hazards model demonstrated a significantly decreased risk of CVD among SLE patients using CHMs (adjusted HR: 0.83; 95% CI 0.73-0.95; = 0.008). Further analyses of different types of CVDs also showed a significantly decreased risk of ischemic stroke in the CHM group (adjusted HR: 0.74; 95% CI 0.57-0.97; = 0.032). Among the frequently used single herbs and polyherbal formulas, Shu-Jing-Huo-Xue-Tang was associated with a significantly decreased risk of CVD (adjusted HR: 0.76; 95% CI 0.58-0.99; = 0.041). In conclusion, CHM use reduced the risk of CVD among patients with SLE in Taiwan. Further randomized studies may be needed to determine the definite causal relationship between CHM use and its protective effects against CVD among patients with SLE.
系统性红斑狼疮（SLE）是一种累及多个系统和器官的慢性全身性自身免疫性疾病。传统的先进治疗方法似乎并不能显著降低SLE患者患心血管疾病（CVD）的风险。中医是一种补充和替代医学体系，台湾的一些SLE患者也使用中草药（CHM）。因此，我们旨在研究CHM与传统疗法相结合的综合疗法是否能降低SLE患者患CVD的风险。我们利用台湾国民健康保险研究数据库（NHIRD）的“系统性红斑狼疮健康数据库”进行了一项为期12年的基于人群的回顾性队列研究。将2004年至2013年间新诊断为SLE的患者分为CHM组和非CHM组，并随访至2015年底。我们按年龄、性别和新诊断为SLE的年份进行1:1个体匹配；因此，匹配后CHM组和非CHM组各纳入2751例患者。我们应用Cox比例风险回归模型来确定使用CHM与CVD风险之间的关系。在随访期间，CHM组有407例患者发生CVD，非CHM组有469例患者发生CVD，发病率分别为每10000人年337例和422例。Cox比例风险模型显示，使用CHM的SLE患者发生CVD的风险显著降低（调整后HR：0.83；95%CI 0.73 - 至0.95；P = 0.008）。对不同类型CVD的进一步分析还显示，CHM组缺血性中风的风险显著降低（调整后HR：0.74；95%CI 0.57 - 至0.97；P = 0.032）。在常用的单味草药和复方中，舒筋活血汤与CVD风险显著降低相关（调整后HR：0.76；95%CI 0.58 - 至0.99；P = 0.041）。总之，在台湾，使用CHM可降低SLE患者患CVD的风险。可能需要进一步的随机研究来确定使用CHM与SLE患者对CVD的保护作用之间的明确因果关系。
