Shen Hsuan-Shu, Hsu Chung-Yi, Yip Hei-Tung, Lin I-Hsin
Department of Chinese Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.
Front Pharmacol. 2022 Aug 11;13:883148. doi: 10.3389/fphar.2022.883148. eCollection 2022.
The incidence of ischemic stroke (IS) is much higher among patients with chronic kidney disease (CKD) compared to the general population. Few studies have evaluated the association between the risk of IS and the use of Chinese herbal medicine (CHM) in patients with CKD. We aimed to investigate the risk of IS among patients with CKD using CHM as add-on therapy. We conducted a retrospective cohort study based on Taiwan's National Health Insurance Research Database to assess 21,641 patients with newly diagnosed CKD between 2003 and 2012. Patients were classified as either the CHM (n = 3,149) or the non-CHM group ( = 3,149) based on whether they used CHM after first diagnosis of CKD. We used the proportional subdistribution hazards model of Fine and Gray to examine the hazard ratio (HR) of IS in propensity-score matched samples at a ratio of 1:1 for two groups. The risk of IS was significantly reduced in the CHM group (adjusted HR [aHR]: 0.58, 95% confidence interval [CI]: 0.48-0.70) compared with the non-CHM group. Those who used CHM for >180 days had an even lower risk of IS than those in the non-CHM group (aHR: 0.51, 95% CI: 0.41-0.63). Additionally, frequently prescribed formulae, such as Ji-Sheng-Shen-Qi-Wan, Liu-Wei-Di-Huang-Wan, and Zhen-Wu-Tang were associated with a 30%-50% reduced risk of IS. Our results suggest that patients with CKD who used CHM as add-on therapy had a lower hazard of IS than those in the non-CHM group, especially for patients taking CHM for >180 days. Further experimental studies are required to clarify the causal relationship.
与普通人群相比，慢性肾脏病（CKD）患者缺血性卒中（IS）的发病率要高得多。很少有研究评估CKD患者中IS风险与使用中药（CHM）之间的关联。我们旨在调查将CHM作为辅助治疗的CKD患者发生IS的风险。我们基于台湾国民健康保险研究数据库进行了一项回顾性队列研究，以评估2003年至2012年间21641例新诊断的CKD患者。根据患者在首次诊断为CKD后是否使用CHM，将其分为CHM组（n = 3149）或非CHM组（n = 3149）。我们使用Fine和Gray的比例子分布风险模型，以1:1的比例检查倾向得分匹配样本中两组IS的风险比（HR）。与非CHM组相比，CHM组的IS风险显著降低（校正后HR [aHR]：0.58，95％置信区间[CI]：0.48-0.70）。使用CHM超过180天的患者发生IS的风险甚至低于非CHM组（aHR：0.51，95％CI：0.41-0.63）。此外，常用方剂，如济生肾气丸、六味地黄丸和真武汤，与IS风险降低30％-50％相关。我们的结果表明，将CHM作为辅助治疗的CKD患者发生IS的风险低于非CHM组患者，尤其是服用CHM超过180天的患者。需要进一步的实验研究来阐明因果关系。
