中医药治疗可降低类风湿关节炎合并血小板升高患者再入院的风险:一项匹配队列研究

Traditional Chinese medicine may reduce the risk of readmission in patients with rheumatoid arthritis complicated with elevated platelet count:a matched cohort study

目的确定中医药治疗是否与类风湿关节炎合并血小板升高患者(RA-PLT)再入院的风险相关。方法回顾性收集了安徽中医药大学第一附属医院2013年~2021年诊断为类风湿关节炎(RA)的住院患者资料,并进一步筛选出伴有血小板升高的患者。采用倾向评分匹配法,将RA-PLT患者分为中医药(TCM)组和非中医药(Non-TCM)组,按1-TCM:1-Non-TCM的比例进行匹配,对性别、年龄、中成药、外敷药等因素进行调整,以减少选择偏倚和混淆。采用Cox比例风险模型评估RA-PLT患者再入院风险的危险比(HR);采用Kaplan-Meier曲线评估RA-PLT患者再入院的发生率。结果本研究最终纳入1176例RA-PLT患者,其中TCM组842例,Non-TCM组334例。经过1∶1倾向评分匹配,每组纳入334人。COX比例风险模型结果示:TCM组的再入院率明显低于Non-TCM组[风险比(HR)=0.59,95%CI=0.48,0.73,P<0.001]。TCM是RA-PLT患者低再入院风险的保护因素。Kaplan-Meier曲线结果显示:长期服用中药有助于降低再入院风险(Log-rank P<0.001)。关联规则显示,部分中草药与临床指标的改善具有较强的相关性,如类风湿因子、血沉、C反应蛋白等。结论本研究提示TCM的使用可能与RA-PLT患者较低的再入院有强关联,并存在长程关联。中医药是这些患者低再入院风险的保护因素。

Objective To evaluate the association of traditional Chinese medicine(TCM)treatment with the risk of readmission in patients with rheumatoid arthritis(RA)complicated with elevated platelet count.Methods We retrospectively collected the data of inpatients diagnosed with RA in our hospital from 2013 to 2021.The patients with elevated platelet count receiving TCM treatment were matched to those without TCM treatment using propensity score matching at the 1∶1 ratio,and the confounding factors were adjusted including gender,age,Chinese patent medicine,and external application.A Cox proportional hazard model was used to evaluate the hazard ratio(HR)of the risk of readmission,and a Kaplan-Meier curve was generated to assess the incidence of readmission in these patients.Results A total of 1176 RA patients with elevated platelet count were included in this study,including 842 patients in the TCM group and 334 patients in the non-TCM group,and after 1∶1 propensity score matching,334 patients were included in each group.The Cox proportional hazards model showed that the readmission rate was significantly lower in TCM group than in non-TCM group(HR=0.59,95%CI:0.48-0.73,P<0.001),and TCM was a protective factor against readmission in RA patients with elevated platelet count.Kaplan-Meier curves demonstrated that long-term use of TCM helped to decrease the risk of readmission(Log-rank P<0.001).Association rules showed that the use of several Chinese herbal medicines and the Chinese patent medicine Xinfeng Capsule had a strong correlation with improvement of such clinical indicators as rheumatoid factor,erythrocyte sedimentation rate,and C-reactive protein.Conclusion In RA patients with elevated platelet count,the use of TCM,as a protective factor against readmission,is strongly associated with a lowered risk of readmission with a long-term association.