中医药治疗降低骨关节炎高凝状态患者再入院风险:一项基于OA人群的回顾性队列研究

Reduced risk of readmission in patients with hypercoagulable state of osteoarthritis by traditional Chinese medicine treatment:a population-based retrospective cohort study

目的:探讨中医药治疗对骨关节炎(OA)高凝状态(HS)患者再入院的影响。方法:收集安徽中医药大学第一附属医院风湿科3929例OA患者资料并进行电话随访,采用倾向评分匹配法(PSM)进行回顾性队列研究,采用Kaplan-Meier曲线分析高凝状态和中医药干预对OA患者再入院的影响,采用Logistic回归模型评估OA高凝状态患者再入院的风险因素,采用数据挖掘观察中药治疗对OA高凝状态患者临床实验室指标(ESR、hs-CRP、APTT、PT、TT、PLT、FBG)及再入院的影响。结果:根据纳入和排除标准,本研究最终纳入3747例OA患者,其中高凝状态的发生率为25.54%(957/3747)。经1∶1匹配后,最终纳入928例OA高凝状态患者和928例非高凝状态OA患者,并将其分为OA-HS组和OA-non-HS组。随后根据是否使用中药将OA-HS组分为中药组(CHM组)364例和非中药组(Non-CHM组)564例。结果显示,OA-HS组患者的再入院率高于OA-non-HS组患者,差异有统计学意义(P<0.01)。CHM组患者的再入院率明显低于Non-CHM组,差异有统计学意义(P<0.01)。Kaplan-Meier生存曲线和Logistic回归模型分析发现中药是OA高凝状态患者再入院的独立保护因素,而ESR、APTT与FBG则是其危险因素。回顾性数据挖掘显示中药治疗可有效改善OA高凝状态患者的炎症(ESR、hs-CRP)和凝血指标(APTT、FBG、PLT)。关联规则分析发现红花、鸡血藤、陈皮与威灵仙与OA高凝状态患者非再入院之间具有强关联。结论:伴有高凝状态的OA患者再入院的风险高于非高凝状态的OA患者。中药治疗作为一种保护因素,可改善OA患者炎症和凝血指标,从而降低OA高凝状态患者再入院的风险。

Objective:To analyze the effect of traditional Chinese medicine treatment on readmission of patients with hypercoagulable state(HS)of osteoarthritis(OA).Methods:The data of 3929 OA patients in the rheumatology department of the First Affiliated Hospital of Anhui University of Chinese Medicine were collected and followed up by telephone.A retrospective cohort study was conducted using propensity score matching(PSM).Kaplan-Meier curve was used to analyze the effects of HS and traditional Chinese medicine intervention on the readmission of OA patients.Logistic regression model was used to evaluate the risk factors of readmission in OA patients with HS.Data mining was used to observe the effects of Chinese herbal treatment on clinical laboratory indicators(ESR,hs-CRP,APTT,PT,TT,PLT and FBG)and readmission in OA patients with HS.Results:According to inclusion and exclusion criteria,3747 patients with OA were finally included in this study,among which the incidence of HS was 25.54%(957/3747).After 1∶1 matching,928 OA patients with HS and 928 OA patients with non-HS were finally included,and they were divided into OA-HS group and OA-non-HS group.The OA-HS group was then divided into CHM group(364 cases)and Non-CHM group(564 cases)according to whether Chinese herbal medicines were used or not.The results showed that the readmission rate of OA-HS group was higher than that of OA-non-HS group,and the difference was statistically significant(P<0.01).The readmission rate of CHM group was significantly lower than that of Non-CHM group,and the difference was statistically significant(P<0.01).Kaplan-Meier survival curve and logistic regression model analysis showed that Chinese herbal medicine was an independent protective factor for readmission in OA patients with HS,while ESR,APTT and FBG were risk factors.Retrospective data mining showed that Chinese herbal medicine treatment could effectively improve inflammation(ESR and hs-CRP)and coagulation indexes(APTT,FBG and PLT)in OA patients with HS.Association rule analysis found that there was a strong correlation between Honghua,Jixueteng,Chenpi and Weilingxian and non-readmitted OA patients with HS.Conclusion:The risk of readmission for OA patients with HS is higher than that for OA patients with non-HS.As a protective factor,Chinese herbal medicine treatment can improve inflammation and coagulation indexes in OA patients,thereby reducing the risk of readmission in OA patients with HS.