West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China.
Research Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China.
J Evid Based Med. 2024 Sep;17(3):575-587. doi: 10.1111/jebm.12635. Epub 2024 Sep 19.
This study aimed to evaluate whether integrated traditional Chinese medicine (TCM) and Western medicine (WM) is more effective than WM for acute pancreatitis (AP).
Patients with AP were enrolled and divided into the TCM and WM (TCM&WM) and WM groups according to the therapeutic protocol in real clinical settings. We applied 1:3 propensity score matching, which was to adjust confounding factors. The primary outcome was mortality, whereas the secondary outcomes were organ failure, organ supportive therapies, local complications, hospitalization cost, and length of hospital stay. Sensitivity and subgroup analyses were also performed.
Of 5442 patients with AP, 4691 and 751 were included in the TCM&WM and WM groups, respectively. After PSM, patient baseline characteristics were well balanced. Compared with the WM group (n = 734), the TCM&WM group (n = 2096) had lower overall mortality rate (1.7% vs. 3.4%; risk ratio, 0.482; 95% confidence interval, 0.286-0.810; p = 0.005). The TCM&WM group was associated with lower risk of persistent renal failure, multiple organ failure, and infection, lower utilization of organ supportive therapies, shortened lengths of hospital and intensive care unit stay, and lower hospital costs. Sensitivity analyses showed similar results. Subgroup analysis favored TCM&WM treatment for patients aged < 60 years, with hypertriglyceridic etiology, and with admission interval between 24 and 48 h.
TCM&WM treatment can achieve lower risks of mortality and organ failure and better economic effectiveness in patients with AP than WM treatment. This study provides a promising alternative of TCM&WM treatment for AP in the real-world setting.
本研究旨在评估中西医结合治疗与单纯西医治疗相比，对急性胰腺炎（AP）的疗效。
根据真实临床实践中的治疗方案，将 AP 患者纳入并分为中医药（TCM）和西医药（WM）联合治疗（TCM&WM）组和 WM 组。我们采用 1:3 的倾向评分匹配（PSM）来调整混杂因素。主要结局是死亡率，次要结局是器官衰竭、器官支持治疗、局部并发症、住院费用和住院时间。还进行了敏感性和亚组分析。
在 5442 例 AP 患者中，4691 例和 751 例分别纳入 TCM&WM 组和 WM 组。PSM 后，患者的基线特征得到很好的平衡。与 WM 组（n=734）相比，TCM&WM 组（n=2096）的总体死亡率较低（1.7%比 3.4%；风险比，0.482；95%置信区间，0.286-0.810；p=0.005）。TCM&WM 组与持续性肾衰竭、多器官衰竭和感染的风险较低、器官支持治疗的利用率较低、住院和重症监护病房住院时间缩短、住院费用降低有关。敏感性分析显示出相似的结果。亚组分析表明，年龄<60 岁、高脂血症病因、入院间隔 24-48 小时的患者更适合 TCM&WM 治疗。
与 WM 治疗相比，TCM&WM 治疗可降低 AP 患者的死亡率和器官衰竭风险，并具有更好的经济效益。本研究为真实世界中 AP 的 TCM&WM 治疗提供了一种有前途的替代方案。
