Increased Risk of Arrhythmia in Patients with Cervical Spinal Cord Injury: A Nationwide Population-based Matched Cohort Study

脊髓損傷病患心律不整風險與危險因子之探討

林佳璇(Chia-Hsuan Lin) ； 李炎諭(Yan-Yuh Lee) ； 郭純恩(Chun-En Kuo) ； 陳柏成(Po-Cheng Chen)

《台灣復健醫學雜誌》 48卷2期 (2020/12) Pp. 113-122

https://doi.org/10.6315/TJPMR.202012_48(2).0005

摘要

Objective: To investigate the risk of cardiac arrhythmias among adults with spinal cord injury (SCI). Methods: This is a retrospective population-based matched cohort study. Data were derived from the National Health Insurance Research Database. This study identified all patients diagnosed with SCI from January 1, 2000 to December 31, 2013. Patients with SCI were categorized into the cervical SCI (C-SCI) and other SCI (O-SCI) groups according to the level of injury. The cumulative incidence of cardiac arrhythmias was compared between patients with C-SCI, those with O-SCI, and those without SCI. Cox proportional hazards regression model was used to assess the differences in the incidence of cardiac arrhythmias between C-SCI and O-SCI groups. Results: The cumulative incidence of arrhythmia was higher in the C-SCI group than the O-SCI group or non-SCI group (log-rank p ＜0.0001). The C-SCI group had a higher risk of arrhythmia than the O-SCI group (adjusted hazard ratio = 1.64(95% CI 1.29-2.08, p ＜ 0.0001). Other factors associated with arrhythmia included age, hyperlipidemia, hypertension, and chronic obstructive pulmonary disease. The incidence rate ratios (IRR) of three different types of cardiac arrhythmia were significantly higher in the C-SCI group than in the O-SCI group (supraventricular arrhythmia IRR = 3.65, 95% CI 2.23-5.99; ventricular arrhythmia IRR = 5.00, 95% CI 1.10-22.82; other arrhythmia IRR = 4.15, 95% CI 3.17-5.45). Conclusions: Patients with C-SCI had a higher risk of cardiac arrhythmia than patients with O-SCI or those without SCI. We should monitor these patients more carefully to detect the occurrence of arrhythmia.

關鍵字

spinal cord injury ； cardiac arrhythmia ； risk

並列摘要

本研究從健保資料庫搜尋2000年到2013年脊髓損傷的病患，比較頸髓損傷組、其他部位損傷組和對照組心律不整發生率的差異。統計發現頸髓損傷組病人心律不整的累積發病率（cumulative incidence）比其他部位損傷組和對照組還高（p＜0.0001）。其他與心律不整相關的危險因子包括年紀、性別、高血脂、慢性腎病變、高血壓、慢性阻塞性肺病。而我們也發現頸髓損傷組病人心律不整的發生率（incidence rate ratio）也比其他部位損傷組高。本篇研究結果顯示頸髓損傷組病人心律不整的風險的確比脊髓損傷在其他部位和無脊髓損傷的人高。

並列關鍵字

脊髓損傷（spinal cord injury） ； 心律不整（cardiac arrhythmia） ； 風險（risk）

參考文獻

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