基于云数据的中医药方案防治抑郁障碍自杀风险临床疗效的多中心、前瞻性队列研究  

Clinical efficacy evaluation of cloud data-based TCM regimen in prevention and treatment of suicide risk in major depressive disorder:a multicentered,prospective cohort study

作　　者：曲淼 孙文军 黄世敬[3] 王娣[4] 郑军然 李小黎 尹洪娜 刘向哲 李乐军 王志强[9] 徐向青[10] 杨文明 林安基 马良[13] 唐启盛 QU Miao;SUN Wenjun;HUANG Shijing;WANG Di;ZHENG Junran;LI Xiaoli;YIN Hongna;LIU Xiangzhe;LI Lejun;WANG Zhiqiang;XU Xiangqing;YANG Wenming;LIN Anji;MA Liang;TANG Qisheng(Xuanwu Hospital Capital Medical University,Beijing100053,China;Third Affiliated Hospital,Bejing University of Chinese Medicine,Beijing 100029,China;Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing100053,China;Beijing Anding Hospital,Capital Medical University,Beijing100088,China;Bejing Huilongguan Hospital,Bejing100096,China;Second Affiliated Hospital,Heilongjiang University of Chinese Medicine,Haerbin150001,China;The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou450099,China;Suzhou Hospital Afiliated to Nanjing University of Chinese Medicine,Suzhou 215008,China;Chui Yang Liu Hospital Afiliated to Tsinghua University,Bejing 100022,China;The Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan250014,China;The First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei230031,China;Xiamen Hospital,Beijing University of Chinese Medicine,Xiamen 361001,China;The Third Hospital of Chaoyang District,Bejing 100025,China)

机构地区：[1]首都医科大学宣武医院,北京100053 [2]北京中医药大学第三附属医院 [3]中国中医科学院广安门医院 [4]首都医科大学附属北京安定医院 [5]北京回龙观医院 [6]黑龙江中医药大学附属第二医院 [7]河南中医药大学第一附属医院 [8]南京中医药大学苏州附属医院 [9]清华大学附属垂杨柳医院 [10]山东中医药大学附属医院 [11]安徽中医药大学第一附属医院 [12]北京中医药大学厦门医院 [13]北京市朝阳区第三医院

出　　处：《北京中医药大学学报》2022年第9期882-889,共8页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家重点研发计划项目(No.2020YFC2003100,No.2020YFC2003103);国家中医药行业专项(No.201507001-12)。

摘　　要：目的基于云数据技术建立中医药防治抑郁障碍(MDD)的信息资源库,评价中医药方案防治MDD患者自杀风险的临床疗效。方法2017年1月—2018年4月,招募全国7个城市的13家中医医院、中西医结合医院及精神专科医院住院及门诊MDD患者4440例,纳入其中无自杀观念的患者2513例,按照接受的治疗方案自然形成中医治疗、西医治疗与中西医结合治疗3个队列,并根据中医治疗暴露时间水平分为高、中、低水平。随访间隔时间3个月,以蒙哥马利-艾森贝格抑郁评定量表(MARDS)评估患者抑郁症状变化情况及出现自杀观念终点事件的发生。结果MDD无自杀观念患者的中医治疗队列(896例)、西医治疗队列(744例)、中西医结合治疗队列(873例)的2年自杀观念发生率分别为34.5%(309/896)、46.9%(349/744)、23.0%(201/873)。以西医治疗队列为参照,中医治疗队列自杀观念发生风险降低32.9%[HR=0.671,95%CI(0.575~0.784),P<0.001],中西医结合治疗队列自杀观念发生风险降低59.4%[HR=0.406,95%CI(0.341~0.483),P<0.001]。在中医治疗队列中,以低水平中药暴露时间(TCM-ET)为参照,中水平TCM-ET自杀观念发生风险降低47.2%[HR=0.528,95%CI(0.414~0.674),P<0.001],高水平TCM-ET自杀观念发生风险降低81.6%[HR=0.184,95%CI(0.127~0.267),P<0.001]。在中西医结合治疗队列中,以低水平TCM-ET为参照,中水平TCM-ET自杀观念发生风险降低39.9%[HR=0.601,95%CI(0.438~0.826),P<0.001],高水平TCM-ET自杀观念发生风险降低65.9%[HR=0.341,95%CI(0.235~0.495),P<0.001]。结论中医治疗、西医治疗及中西医结合治疗均可改善MDD患者抑郁症状,运用中医药治疗方案较单纯西药治疗可更好降低MDD患者自杀观念的出现率,且治疗时间达半年以上(中高水平TCM-ET)对防治MDD自杀风险的疗效更为显著。Objective To establish a TCM information database for the prevention and treatment of major depressive disorder(MDD)based on cloud data technology,and to evaluate the clinical efficacy of traditional Chinese medicine(TCM)regimen in the prevention and treatment of suicide risk in MDD.Methods A total of 4440 patients with MDD who were inpatients or outpatients in 13 hospitals including TCM hospitals,integrated Chinese and Western medicine hospitals and psychiatric hospitals in 7 cities across the country were recruited,among which 2513 patients without suicidal ideation were included in this cohort study.The data was collected from January 2017 to April 2018.Three groups of cohorts(TCM,Western medicine,and integrated Chinese&Western medicine)were naturally formed.The follow-up interval was 3 months.Taking the appearance of suicidal ideation as the end event and the Montgomery-Asberg Depression Rating Scale(MARDS)as the evaluation tool in the follow-up,we assessed the patients′dynamic status of depression and the occurrence of the end event.Results A TCM cohort(896 patients),a Western medicine cohort(744 patients),and an integrated Chinese and Western medicine cohort(873 patients)were established with MDD patients without suicidal ideation at baseline,and the overall two-year incidence rates of suicidal ideation in the three groups were 34.5%(309/896),46.9%(349/744),and 23.0%(201/873)respectively.Compared with the Western medicine cohort,the risk of suicidal ideation was reduced in the TCM cohort by 33.9%(HR=0.671,95%CI(0.575-0.784),P<0.001),and by 59.4%(HR=0.406,95%CI(0.341-0.483),P<0.001)in the integrated Chinese and Western medicine cohort.In the TCM cohort,compared with low-level TCM exposure time(TCM-ET),the risk of suicidal ideation was reduced by 47.2%(HR=0.528,95%CI(0.414-0.674),P<0.001),with medium-level TCM-ET,and by 81.6%(HR=0.184,95%CI(0.127-0.267),P<0.001),with high-level TCM-ET.In the integrated Chinese and Western medicine cohort,compared with the low-level TCM-ET time,the risk of suicidal ideation

关 键 词：云数据 中医药治疗 抑郁 自杀观念 多中心 前瞻性队列研究 

分 类 号：R277.7[医药卫生—中医学]