来源：风湿病与关节炎,2023,12（8）:8-13.

中医药降低类风湿关节炎患者再发入院的风险—基于人群的数据挖掘及回顾性队列研究（临床研究）

韩　琦，刘　健，方妍妍，李　旭，贺明玉，王帆帆

　　【摘　要】目的：探讨中医药治疗与类风湿关节炎患者再发入院的相关风险。方法：选取安徽中医药大学第一附属医院风湿科2013年1月1日至2022年1月31日诊断为类风湿关节炎的住院患者，均在西医治疗的基础上，根据是否使用中药将患者分为中药组和非中药组，根据年龄将患者分为老年组（≥60岁）和年轻组（< 60岁）。将中药组和非中药组患者的年龄、性别、合并疾病、使用药物按1∶1比例进行倾向评分匹配。对使用的中药和指标改善进行关联规则分析；Kaplan-Meier曲线用于比较用药时间对再发入院的影响；COX回归模型用于比较再发入院的风险因素。结果：随访成功并纳入740例类风湿关节炎患者，其中中药组333例，非中药组407例。经匹配后，每组252例。关联规则结果显示，陈皮-茯苓对补体C3、超敏C反应蛋白（hs-CRP）、免疫球蛋白A（IgA）、免疫球蛋白G，丹参-茯苓对补体C3、IgA，院内制剂新风胶囊、黄芩清热除痹胶囊对补体C4、hs-CRP、红细胞沉降率的改善有较强的相关性。Kaplan-Meier曲线和COX回归模型均表明，非中药组的再发入院风险高于中药组，老年组（≥60岁）的再发入院风险高于年轻组（< 60岁）。结论：配合中药治疗可能会降低类风湿关节炎患者再发入院的风险，提示中医药可能是类风湿关节炎再发加重的保护因素，中药的使用与低再发率存在长程关系。

　　【关键词】　类风湿关节炎；队列研究；倾向评分匹配；数据挖掘；中医药；再发入院风险

Reduction of the Risk of Readmission of rheumatoid Arthritis Patients Treated with Chinese Medicine:

A Population-based Data Mining and Retrospective Cohort Study

HAN Qi,LIU Jian,FANG Yan-yan,LI Xu,HE Ming-yu,WANG Fan-fan

　　【ABSTRACT】Objective:To explore the correlation between Chinese medicine treatment and the risk of readmission of rheumatoid arthritis patients.Methods:The inpatients diagnosed as rheumatoid arthritis by the Rheumatology Department of the First Affiliated Hospital of Anhui University of Chinese Medicine from 2013 to 2022 were selected.On the basis of western medicine treatment,the patients were divided into a Chinese medicine group and a non Chinese medicine group according to whether to use Chinese medicine,and the patients were divided into an elderly group（≥60 years old）and a young group（ < 60 years old）according to age.The propensity score matching of the patients in both groups was done by their age,gender,comorbidity,and drug use by a 1∶1 ratio.Association rule analysis was conducted on the improvement of indicators and Chinese medicine used.The Kaplan Meier curve is used to compare the impact of medication duration on readmission.The COX regression model is used to compare the risk factors of readmission.Results:There was a successful follow-up in this study and 740 patients with rheumatoid arthritis were included,333 cases in the Chinese medicine group and 407 cases in the non Chinese medicine group.After matching,there were 252 cases in each group.The results of association rules showed that Chenpi（Pericarpium Citri Reticulatae）-Fuling（Poria）had a strong correlation with the improvement of C3,hs-CRP,IgA and IgG;Danshen（Radix et Rhizoma Salviae Miltiorrhizae）-Fuling（Poria）had a strong correlation with the improvement of C3 and IgA;and hospital preparations Xinfeng Capsule（XFC）,Huangqin Qingre Chubi Capsule（HQC）had a strong correlation with the improvement of C4,hs-CRP and ESR.The KM curve and COX regression model both indicated that the risk of readmission in the non Chinese medicine group was higher than that in the Chinese medicine group,and the risk of readmission in the elderly group（≥60 years old）was higher than that in the young group（ < 60 years old）.Conclusion:Combining Chinese medicine treatment may reduce the risk of readmission of patients with rheumatoid arthritis,indicating that Chinese medicine may be a protective factor for the exacerbation of rheumatoid arthritis recurrence.The use of Chinese medicine has a long-term relationship with low recurrence rates.

　　【Keywords】 rheumatoid arthritis;cohort study;propensity score matching;data mining;Chinese medicine;risk of readmission