- 學位論文
腦性麻痺患者罹患肺炎風險與牙科處置間的關聯性
The relationship between pneumonia and dental treatments in patients with cerebral palsy
摘要
由文獻回顧中發現，改善口腔健康可以降低罹患肺炎(pneumonia)的風險。 臨床上定期的口腔檢查很重要，但腦性麻痺(cerebral palsy，簡稱 CP)患者多伴 隨吞嚥困難，所以在洗牙(scaling)等牙科治療時可能面臨吸入性肺炎(aspiration pneumonia)的風險。因此，本研究的目的是探討台灣腦性麻痺患者罹患肺炎的 風險與牙科治療間的相關性。我們從 2010 年 1 月至 2019 年 12 月間，由台灣全 民健康保險研究資料庫(National Health Insurance Research Database，簡稱 NHIRD) 中收集年齡介於 2 至 70 歲，被診斷為腦性麻痺的患者共 10544 位，並配對篩選 從未被診斷為腦性麻痺的對照組共 63264 位，以 6:1 的比例進行回溯性世代研究 (retrospective cohort study)。研究結果顯示，跟沒有腦性麻痺的組別相比，腦 性麻痺患者發生肺炎的調整後的風險比值(adjusted hazard ratio，簡稱 aHR)為 2.691(95%CI = 2.574-2.813)，並且腦性麻痺組在 132 個月內的肺炎累積發生率 顯著高於對照組(P <0.001)。腦性麻痺組半年內牙科就診兩次以上的患者罹患 肺炎的風險較低，但沒有統計學上的顯著差異(aHR:0.858，95%CI = 0.726-1.015)。 另一方面，腦性麻痺患者的罹患肺炎風險會因胃食道逆流(aHR:1.384，95%CI =1.188-1.612)、慢性阻塞性肺病(aHR:1.628，95%CI =1.450-1.829)、吞嚥困 難(aHR:1.259，95%CI =1.020-1.555)、脊椎側彎(aHR:1.175，95%CI =1.020- 1.355)、癲癇(aHR:1.428，95%CI =1.347-1.514)和慢性皮膚潰瘍(aHR:1.860， 95%CI =1.438-2.407)等相關疾病而增加。此外，罹患肺炎的風險上升也與塗氟 (aHR: 1.186，95%CI =1.077-1.305)、鼻胃管放置(aHR:1.458，95%CI =1.294- 1.643)等醫療行為呈現正相關。總結來說，腦性麻痺患者罹患肺炎的風險較高， 並且有些相關疾病和醫療行為可能會進一步增加腦性麻痺患者罹患肺炎的風險。
並列摘要
In general, improving oral health can reduce the risk of pneumonia. While regular dental checkups are important, cerebral palsy (CP) patients with dysphagia may be at risk for aspiration pneumonia from treatments such as scaling. The purpose of this retrospective cohort study was to investigate the risk of pneumonia and the relationship with dental treatments among patients with CP in Taiwan. We identified 10,544 patients who were diagnosed with CP at ages 2 to 70 years between January 2010 and December 2019 from the Taiwan National Health Insurance Research Database (NHIRD). We also obtained 63,264 individuals who had never been diagnosed with CP from January 2010 to December 2019, and matched to CP patients on a 6:1 ratio by sex, age, and the index date. Multivariable Cox regression models, the Kaplan-Meier method and the log-rank test were used to estimate the risk of pneumonia. Compared with non-CP group, the adjusted hazard ratio (aHR) for developing pneumonia post-CP was 2.691 (95% CI = 2.574-2.813) estimated using Cox regression. A log-rank test confirmed a significant difference in the 132-month cumulative incidence rates of pneumonia between the CP and non-CP cohorts (P <0.001). Patients with CP with higher frequency of dental visits had a lower risk of pneumonia, but the difference was not statistically significant (aHR:0.858，95%CI = 0.726-1.015). Higher risks of pneumonia in CP patients were associated with younger age, lower urbanization level, history of pneumonia, comorbidities such as gastroesophageal reflux disease, chronic obstructive pulmonary disease, dysphagia, scoliosis, seizure disorder, chronic skin ulcers, medical utilizations including fluoride application, and nasogastric tube placements. The results of our study showed that patients with CP had a higher risk of pneumonia. Moreover, some comorbidities and medical interventions would cause higher risk of pneumonia in patients with CP.