慢性乙型肝炎患者规定的中草药与肝细胞癌的风险之间的关

StephenW

BMJ Open. 2017 Jan 25;7(1):e014571. doi: 10.1136/bmjopen-2016-014571.
Associations between prescribed Chinese herbal medicine and risk of hepatocellular carcinoma in patients with chronic hepatitis B: a nationwide population-based cohort study.Tsai TY1,2,3, Livneh H4, Hung TH5,6, Lin IH7, Lu MC6,8, Yeh CC7,9.
Author information

• 1Department of Medical Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.
• 2Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
• 3Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan.
• 4Rehabilitation Counseling Program, Portland State University, Portland, Oregon, USA.
• 5Division of Gastroenterology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Chiayi, Taiwan.
• 6School of Medicine, Hualien, Taiwan.
• 7School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.
• 8Division of Allergy, Immunology and Rheumatology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.
• 9Department of Chinese Medicine, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.
  

AbstractOBJECTIVE: Patients with chronic hepatitis B (CHB) are reported to exhibit higher risk of subsequent hepatocellular carcinoma (HCC). However, it remains unclear if Chinese herbal medicine (CHM), an important category of traditional Chinese medicine (TCM), may lower HCC risk in this population. So this study aimed to investigate the effects of CHM on HCC risk among patients with CHB.
METHODS: This cohort study used the Taiwanese National Health Insurance Research Database to identify 21 020 newly diagnosed patients with CHB from 1998 to 2007. Among them, 8640 received CHM products after CHB onset (CHM users), and the remaining 12 380 patients were designated as a control group (non-CHM users). All enrolees were followed until the end of 2012 to measure the incidence rate and HR of HCC.
RESULTS: During 15 years of follow-up, 371 CHM users and 958 non-CHM users developed HCC, representing an incidence rate of 5.28% and 10.18% per 1000 person-years, respectively. CHM users had significantly lower HCC risk compared with non-CHM users (adjusted HR=0.63, 95% CI 0.56 to 0.72). The predominant effect was observed in those receiving CHM products for more than 180 days (adjusted HR=0.52). Some CHM products, such as Hedyotis diffusa, Scutellaria barbata, Rehmannia glutinosa, Isatis tinctoria, Yi Guan Jian, Xiao Chai Hu Tang, Wu Ling San and Gan Lu Yin, were significantly associated with lower risk of HCC.
CONCLUSIONS: The use of CHM was associated with a significantly reduced HCC risk in patients with CHB, which supports the integration of TCM with CHM into clinical practice to influence a favourable prognosis.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/produ ... hts-and-licensing/.

KEYWORDS: Chinese herbal medicine; chronic hepatitis B; cohort study; hepatocellular carcinoma

PMID:28122837DOI:10.1136/bmjopen-2016-014571

StephenW

BMJ开放。 2017 Jan 25; 7（1）：e014571。 doi：10.1136 / bmjopen-2016-014571。
慢性乙型肝炎患者规定的中草药与肝细胞癌的风险之间的关联：一个全国基于人群的队列研究。
Tsai TY1,2,3，Livneh H4，Hung TH5,6，Lin IH7，Lu MC6,8，Yeh CC7,9。
作者信息

    医学研究部，Dalin Tzuchi医院，佛教Tzuchi医学基金会，嘉义，台湾。
    2台湾台南国立成功大学医学院环境与职业健康学院。
    台湾花莲Tzu Chi技术学院3室。
    4波特兰州立大学康复咨询项目，波特兰，俄勒冈州，美国。
    台湾嘉义佛教慈济基金会Dalin Tzu Chi医院胃肠病学。
    6台湾花莲医学院。
    7，台湾花莲县慈济大学后学士中医学院。
    8Division of Allergy，Immunology and Rheumatology，Dalin Tzuchi Hospital，The Buddhist Tzuchi Medical Foundation，Chiayi，Taiwan。
    9，中国台湾大学医学院附属医院，中国台湾嘉义。

抽象
目的：

据报道，慢性乙型肝炎（CHB）患者表现出较高的后续肝细胞癌（HCC）的风险。然而，仍然不清楚中草药（CHM），一个重要的中药类（TCM），可能会降低这个人口的HCC风险。因此本研究旨在探讨CHM对CHB患者HCC风险的影响。
方法：

这项队列研究使用台湾国家健康保险研究数据库，从1998年到2007年确定21 020新诊断的CHB患者。其中，8640例在CHB发病后接受CHM产品（CHM使用者），其余12 380例患者被指定为控制组（非CHM用户）。随访所有enrolees直到2012年底，以测量HCC的发病率和HR。
结果：

在15年的随访中，371名CHM用户和958名非CHM用户发展HCC，发病率分别为5.28％和10.18％/ 1000人年。与非CHM使用者相比，CHM使用者具有显着较低的HCC风险（调整的HR = 0.63,95％CI 0.56至0.72）。在接受CHM产品的那些人中观察到超过180天的主要效应（调整的HR = 0.52）。一些CHM产品如Hedyotis diffusa，黄芩，地黄，枸杞，易冠健，小柴胡汤，吴凌三和甘路贤等与肝癌的低危率有显着相关性。
结论：

CHM的使用与CHB患者的显着降低的HCC风险相关，这支持了TCM与CHM的整合到临床实践中以影响有利的预后。

由BMJ出版集团有限公司出版。有关使用许可（如果尚未根据许可授予许可），请访问http://www.bmj.com/company/produ ... ghts-and-licensing/。
关键词：

中草药;慢性乙型肝炎;队列研究;肝细胞癌

PMID：
    28122837
DOI：
    10.1136 / bmjopen-2016-014571

MP4

hedyotis diffusa=白花蛇舌草
Yi Guan Jian=一贯煎，中医方剂名，北沙参、麦冬、当归各样9g，生地黄18-30g，枸杞子9-18g，川楝子4.5g
Wu Ling San=五苓散，【别名】猪苓散，茯苓180g 泽泻300g 猪苓180g 肉桂120g 白术（炒）180g
Gan Lu Yin=甘露饮，主要成分：炒甘草，熟地黄，麦冬，黄芩，生地黄，茵陈，麸炒枳壳，天冬，石斛，枇杷叶


黄芩，地黄，枸杞

MP4

加权
白花蛇舌草，麦冬，黄芩，地黄，枸杞