- 學位論文
子宮內膜異位症與後續發生乾燥症候群 風險關聯之研究
Association Between Endometriosis and Subsequent Risk of Sjögren’s Syndrome
摘要
研究背景: 子宮內膜異位症患者經常會發生數種慢性炎症和自體免疫性疾病，而乾燥症候群主要是內分泌或外分泌腺的發炎性疾病，雖然病理機制可能有所連結，但兩者之間是否有流行病學關聯目前仍不清楚；本研究旨在為子宮內膜異位症與後續發生乾燥症候群(Sjögren’s Syndrome)風險之間的相關性，提供流行病學證據。 研究方法：這是一項針對2000年至2012年間台灣全民健康保險資料庫，新診斷的子宮內膜異位症患者與匹配對照組的回溯性世代研究。經年齡匹配後，我們分析子宮內膜異位症與乾燥症候群(ICD-9-CM 710.2)之間的關聯；研究使用Cox比例風險模型來檢定乾燥症候群的風險比，另外對年齡、共病症和追蹤時間進行了亞組分析。 暴露(Exposure): 子宮內膜異位症定義為2000年至2012年間子宮內膜異位症的就醫記錄ICD-9-CM診斷碼(ICD-9-CM 617.0-617.9和621.3)。 結局指標(Outcomes): 定義ICD-9-CM診斷碼710.2的乾燥症候群發生率。 研究結果：本研究共納入73,665人，其中14,733例新診斷的子宮內膜異位症個案和58,932名非子宮內膜異位症對照組；與非子宮內膜異位症對照組相比，有子宮內膜異位症組乾燥症候群的調整風險比(aHR)為1.45 (95% CI = 1.27-1.65)；調整後分析顯示，調整後HR在20-39歲年齡組為1.53 (95% CI = 1.25-1.88)，在40-64歲年齡組為1.41 (95% CI = 1.18-1.68)；我們通過追蹤時間對兩個世代發生乾燥症候群的風險進行分層，結果發現，與沒有子宮內膜異位症的世代相比，追蹤時間少於五年的子宮內膜異位症患者(調整後HR=1.57, 95% CI=1.32-1.87)，罹患乾燥症候群的風險顯著升高。 結論與未來建議：根據這項以全國人口為對象之世代研究顯示，有子宮內膜異位症病史的患者，後續發生乾燥症候群的風險增加，尤其是在20-39歲年齡組和診斷出子宮內膜異位症後的前五年內。臨床醫師未來在處理子宮內膜異位症或乾燥症候群患者時，應注意到這種可能的關聯。 關鍵詞:乾燥症候群; 自體免疫性疾病; 流行病學 ; 子宮內膜異位症
並列摘要
Objective: Patients with endometriosis often suffer from several chronic inflammatory and autoimmune diseases, while Sjögren’s syndrome is mainly an inflammatory disease of endocrine or exocrine glands. Although the pathological mechanism may be linked, is there any relationship between patients with endometriosis at an increased risk of incidental Sjögren’s syndrome? The relationship between endometriosis and the subsequent risk of Sjögren’s syndrome has remained unclear. This study aims to explore epidemiological evidence for this association. Methods: This is a retrospective cohort study of endometriosis patients (ICD-9-CM 617.0-617.9 and 621.3) and matched comparison group between 2000 and 2012 in the National Taiwan Insurance Research Database. After age matching, we analyzed the association between endometriosis and incidental Sjögren’s syndrome (ICD-9-CM 710.2). We used the Cox proportional hazard model to examine the hazard ratio of incidental Sjögren’s syndrome. Subgroup analyses on age, comorbidities, and disease duration were also performed. Results: A total of 73,665 individuals were included in this study. We identified 14733 newly diagnosed endometriosis patients and 58,932 non-endometriosis comparison group. The adjusted hazard ratio (aHR) for incidental Sjögren’s syndrome was 1.45 (95% confidence interval CI=1.27-1.65) in the endometriosis group, compared to the non-endometriosis comparison group. In subgroup analysis, the adjusted HR was 1.53 (95% CI=1.25-1.88) in the age group of 20-39 and 1.41 (95% CI =1.18-1.68) in the age of 40-64. Time-vary analysis showed that patients with endometriosis who have a follow-up time of fewer than five years (adjusted HR=1.57, 95% CI=1.32-1.87) have a significantly highest risk of having subsequent Sjögren’s syndrome. Conclusion: This population-based cohort study indicated that patients with endometriosis patients were associated with at an increased risk of incidental Sjögren’s syndrome afterward, especially in the age group of 20-39 and within the first five years after the diagnosis of endometriosis. Clinicians should recognize this possible association in managing endometriosis or Sjögren’s syndrome patients. Keywords: Sjögren’s syndrome; autoimmune disease; epidemiology; endometriosis