中药贴敷疗程和腹泻痊愈的关联性及饱和阈值效应分析:一项基于全国基层医院的多中心回顾性队列研究  

An analysis of the association and threshold effect between treatment course of acupoint application and diarrheal recovery in community hospitals nationwide:a multicenter retrospective cohort study

作　　者：盛松 高洪阳 张北华[2] 栗蕊 黄烨[1] 徐凤芹[4] SHENG Song;GAO Hongyang;ZHANG Beihua;LI Rui;HUANG Ye;XU Fengqin(Department of Emergency,Xiyuan HospitaUChina Academy of Chinese Medical Science,Beijing,100091,China;Department of Gastroenterology,Xiyuan Hospital,China Academy of Chinese Medical Science;Institute of Clinical Pharmacology,Xiyuan Hospital,China Academy of Chinese Medical Science;Institute of Geriatrics of Xiyuan Hospital,China Academy of Chinese Medical Science)

机构地区：[1]中国中医科学院西苑医院急诊科,北京100091 [2]中国中医科学院西苑医院脾胃病科 [3]中国中医科学院西苑医院临床药理研究所 [4]中国中医科学院西苑医院老年病研究所

出　　处：《中国中西医结合消化杂志》2021年第11期757-761,共5页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：2019国家中医药管理局中医药循证能力建设项目(No:ZZ13-024-4)。

摘　　要：目的:基于一项全国基层医院的多中心回顾性队列研究探讨中药贴敷疗程和腹泻痊愈的关联性与饱和阈值效应的关系。方法:回顾性连续收集中国上百家社区医院自2020年8月22日—2020年11月5日在春播万象云诊所病例注册登记平台中有腹泻就诊记录的患者。每次门诊随访时采集患者划分区域、年龄、性别、中药汤药处方、西药处方、腹泻天数、腹泻频率、稀便、水样便、黏液或脓血便、大便气味酸臭和气味不明显、腹泻痊愈等数据。采用Logistic回归和趋势性检验分析贴敷疗程对腹泻痊愈的独立作用,遵照STROBE指南展示多套调整策略下的回归结果。采用分段线性模型和递归法对贴敷疗程和腹泻痊愈进行饱和阈值效应分析,得到具体的贴敷疗程范围。结果:经有向无环图和效应改变法调整混杂后的Logistic回归结果显示,贴敷疗程和腹泻痊愈呈独立正相关(OR=1.08,95%CI 1.03~1.13,P=0.0013)。趋势性检验表明,随着贴敷疗程延长,腹泻痊愈的增加趋势是显著的(趋势性检验P<0.05),而且增加趋势可能是非线性的。饱和阈值效应分析显示,中药贴敷治疗腹泻的疗程范围为4~19 d。结论:中药贴敷疗程与腹泻痊愈呈独立正相关,中药贴敷治疗腹泻的疗程范围为4~19 d。Objective:The present study aimed to explore the association and threshold effect between treatment course of acupoint application and diarrheal recovery in community hospitals nationwide based on a multicenter retrospective cohort study.Methods:We retrospectively and consecutively collected the medical records of patients with diarrhea of hundreds of community hospitals nationwide on the Chun Bo Wan Xiang cloud clinic from August 22 to November 5,2020.Medical information including region,age,sex,use of Chinese Medicine decoction,use of Western Medicine,duration of diarrhea,frequency of diarrhea,loose stool,watery stool,mucous or bloody stool,acid odor stool smell and unobvious stool smell and diarrheal recovery was collected at each outpatient follow-up.Logistic regression and trend test were used to analyze the independent effect of treatment course of acupoint application on diarrheal recovery.We adhered to the STROBE guidelines for cohort studies and displayed the multiple results of Logistic regression under different covariate adjustment strategies.Piecewise linear model and recursive method were applied to assess the threshold effect between treatment course of acupoint application and diarrheal recovery and obtain specific the range of treatment course.Results:Logistic regression adjusting for confounders by directed acyclic graph and change in effect estimate showed that treatment course was independently and positively correlated with diarrheal recovery(OR=1.08,95%CI 1.03-1.13,P=0.0013).Test trend suggested a significantly non-linear increasing trend of diarrheal recovery with the accumulation of treatment course(P<0.05).The analysis of threshold effect indicated that treatment course of acupoint application should range from 4 to 19 days.Conclusion:Treatment course of acupoint application was independently and positively correlated with diarrheal recovery.Treatment course of acupoint application should range from 4 to 19 days.

关 键 词：中药贴敷 疗程 腹泻 饱和阈值效应 分段线性模型 递归法 

分 类 号：R247.9[医药卫生—中医临床基础]