中医药方案防治肝郁脾虚型抑郁障碍自杀风险的临床疗效:一项基于云数据的多中心、前瞻性队列研究  

Clinical efficacy of traditional Chinese medicine regimen in prevention and treatment of suicide risk in major depressive disorder with liver depression and spleen deficiency syndrome type:A multi-centered,prospective cohort study based on cloud data

作　　者：刘云霞 王艳 张艺 唐启盛 孙文军 LIU Yunxia;WANG Yan;ZHANG Yi;TANG Qisheng;SUN Wenjun(Beijing University of Chinese Medicine,Beijing 100029,China;Traditional Chinese Medicine Hospital of Dali Bai Autonomous Prefecture,Dali 671099,China;Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京100029 [2]云南省大理白族自治州中医医院,大理671099 [3]北京中医药大学第三附属医院,北京100029

出　　处：《中华中医药杂志》2024年第3期1511-1516,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家中医药行业专项(No.201507001);首都卫生发展科研专项(No.首发2022-2-7035);国家中医药管理局岐黄学者项目(No.10400633210001);北京自然科学基金项目(No.7222274);第五批全国中医临床优秀人才项目,中华中医药学会求实项目(No.2022-QNQSDEP-14);教育部工程研究中心培育项目(No.BZYSY-2022-GCYJZXQX-09);云南省区域中医(针灸)诊疗中心建设项目。

摘　　要：目的:基于真实世界评价中医药方案防治肝郁脾虚型抑郁障碍(MDD)自杀风险的疗效。方法:招募于2017年1月至2018年4月期间在全国的13个分中心就诊的肝郁脾虚型MDD患者,将是否接受中医药方案治疗作为暴露因素,形成西医、中医、中西医3个治疗队列,评估防治自杀风险的效果差异。并根据中医药干预的时间,比较不同暴露水平下自杀观念的发生率。结果:共纳入无自杀观念的肝郁脾虚型MDD患者351例,其中,中医治疗队列97例,西医治疗队列141例,中西医治疗队列113例。中医治疗队列、西医治疗队列、中西医治疗队列的自杀观念发生率分别为37.91%、65.75%、32.08%。在自杀观念发生率的多因素比较中,中医治疗队列、中西医治疗队列分别比西医治疗队列降低了42.9%[HR=0.571,95%CI(0.413-0.789),P<0.01]、62.8%[HR=0.372,95%CI(0.265-0.522),P<0.01]。在中医治疗队列中,以低水平暴露为参照,中水平暴露、高水平暴露分别使患者的自杀观念发生风险降低61.3%[HR=0.387,95%CI(0.228-0.656),P<0.01]、91.0%[HR=0.090,95%CI(0.035-0.232),P<0.01]。在中西医治疗队列中,中水平暴露、高水平暴露则分别使自杀风险下降51.8%[HR=0.482,95%CI(0.252-0.922),P<0.05]、76.8%[HR=0.232,95%CI(0.094-0.577),P<0.01]。结论:中医药治疗方案能够降低肝郁脾虚型MDD患者的自杀风险。此外,自杀观念的发生率与中医药方案干预的时间密切相关。Objective:To evaluate the prevention and treatment effects of traditional Chinese medicine(TCM)for suicide risk in major depressive disorder(MDD)with liver depression and spleen deficiency syndrome type based on a real-world study.Methods:MDD patients with liver depression and spleen deficiency syndrome type who visited 13 sub-centers nationwide were recruited from January 2017 to April 2018.Whether or not to accept TCM treatment was taken as the exposure factor,and three queues were formed,including western medicine cohort,TCM cohort,and integrated Chinese and Western medicine cohort.The difference of the effect of prevention and treatment of suicide risk was evaluated.According to the time of TCM intervention,the incidence rate of suicidal ideation under different exposure levels was compared.Results:A total of 351 MDD patients with liver depression and spleen deficiency syndrome type without suicidal ideation were included,including 97 cases in TCM cohort,141 cases in western medicine cohort and 113 cases in integrated Chinese and Western medicine cohort.The incidence rates of suicidal ideation in the three cohorts were 37.91%,65.75%,32.08%,respectively.In the multi-factor comparison of the incidence rates of suicidal ideation,the TCM cohort and the integrated Chinese and Western medicine cohort decreased by 42.9%[HR=0.571,95%CI(0.413-0.789),P<0.01]and 62.8%[HR=0.372,95%CI(0.265-0.522),P<0.01]respectively compared with the western medicine cohort.In the TCM cohort,taking low-level exposure as a reference,the risk of suicidal ideation was reduced by 61.3%[HR=0.387,95%CI(0.228-0.656),P<0.01]with medium-level exposure,and by 91.0%[HR=0.09,95%CI(0.035-0.232),P<0.01]with high-level exposure.In the integrated Chinese and Western medicine cohort,the risk of suicidal ideation was reduced by 51.8%[HR=0.482,95%CI(0.252-0.922),P<0.05]with medium-level exposure,and by 76.8%[HR=0.232,95%CI(0.094-0.577),P<0.01]with high-level exposure.Conclusion:TCM treatment regimen can reduce the probability of suicidal ideation in MDD pa

关 键 词：自杀观念 中医药 抑郁障碍 多中心 前瞻性队列研究 云数据 

分 类 号：R277.7[医药卫生—中医学]