Department of Internal Medicine, Division of Endocrinology and Metabolism, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.
School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.
PLoS One. 2024 May 2;19(5):e0289455. doi: 10.1371/journal.pone.0289455. eCollection 2024.
Studies have confirmed that osteoporosis has been considered as one of the complications of diabetes, and the health hazards to patients are more obvious. This study is mainly based on the Taiwan National Health Insurance Database (TNHID). Through the analysis of TNHID, it is shown that the combined treatment of traditional Chinese medicine (TCM) medicine in patients of diabetes with osteoporosis (T2DOP) with lower related risks.
According to the study design, 3131 patients selected from TNHID who received TCM treatment were matched by 1-fold propensity score according to gender, age, and inclusion date as the control group. Cox proportional hazards analyzes were performed to compare fracture surgery, hospitalization, and all-cause mortality during a mean follow-up from 2000 to 2015.
A total of 1055/1469/715 subjects (16.85%/23.46%/11.42%) had fracture surgery/inpatient/all-cause mortality of which 433/624/318 (13.83%/19.93%/10.16%) were in the TCM group) and 622/845/397 (19.87%/26.99%/12.68%) in the control group. Cox proportional hazards regression analysis showed that subjects in the TCM group had lower rates of fracture surgery, inpatient and all-cause mortality (adjusted HR = 0.467; 95% CI = 0.225-0.680, P<0.001; adjusted HR = 0.556; 95% CI = 0.330-0.751, P<0.001; adjusted HR = 0.704; 95% CI = 0.476-0.923, P = 0.012). Kaplan-Meier analysis showed that the cumulative risk of fracture surgery, inpatient and all-cause mortality was significantly different between the case and control groups (all log-rank p<0.001).
This study provides longitudinal evidence through a cohort study of the value of integrated TCM for T2DOP. More research is needed to fully understand the clinical significance of these results.
研究证实，骨质疏松症已被认为是糖尿病的并发症之一，对患者的健康危害更为明显。本研究主要基于台湾全民健康保险数据库（TNHID）。通过对 TNHID 的分析，表明骨质疏松症合并糖尿病（T2DOP）患者接受中药（TCM）联合治疗的相关风险较低。
根据研究设计，从 TNHID 中选择 3131 例接受 TCM 治疗的患者，按照性别、年龄和纳入日期进行 1 倍倾向评分匹配，作为对照组。采用 Cox 比例风险分析比较 2000 年至 2015 年平均随访期间的骨折手术、住院和全因死亡率。
共有 1055/1469/715 名受试者（16.85%/23.46%/11.42%）发生骨折手术/住院/全因死亡，其中 433/624/318（13.83%/19.93%/10.16%）为 TCM 组）和对照组的 622/845/397（19.87%/26.99%/12.68%）。Cox 比例风险回归分析显示，TCM 组受试者骨折手术、住院和全因死亡率较低（调整后的 HR=0.467；95%CI=0.225-0.680，P<0.001；调整后的 HR=0.556；95%CI=0.330-0.751，P<0.001；调整后的 HR=0.704；95%CI=0.476-0.923，P=0.012）。Kaplan-Meier 分析显示，病例组和对照组之间骨折手术、住院和全因死亡率的累积风险差异有统计学意义（所有对数秩检验 P<0.001）。
本研究通过对骨质疏松症合并糖尿病患者的队列研究提供了纵向证据，表明 TCM 联合治疗的价值。需要进一步研究以充分了解这些结果的临床意义。
