Higher Risk for Papilledema in Inflammatory Bowel Disease: A Nationwide Population-Based Study Cohort Study in Taiwan

發炎性腸道疾病增加視乳頭水腫的風險性：台灣全國人口之世代研究

郭柏辰(Po-Chen Kuo) ； 簡戊鑑(Wu-Chien Chien) ； 蕭正文(Cheng-Wen Hsiao) ； 陳昭仰(Chao-Yang Chen) ； 張筆凱(Pi-Kai Chang) ； 饒樹文(Shu-Wen Jao) ； 鄭屹喬(Yi-Chiao Cheng) ； 胡哲銘(Je-Ming Hu)

《中華民國大腸直腸外科醫學會雜誌》 31卷3期 (2020/09) Pp. 178-186

https://doi.org/10.6312/SCRSTW.202009_31(3).10907

摘要

Purpose. Inflammatory bowel disease (IBD) is a multifactorial disease with many ocular complications, including papilledema. Using the National Health Insurance Research Database (NHIRD), this study aimed to evaluate whether patients with IBD are exposed to the potential risk of papilledema. Methods. Data were collected from the NHIRD over a 14-year period. Variables were analyzed with the Pearson chi-square test and Fisher's exact test. The risk factors for disease development were examined by the adjusted hazard ratio (aHR). Kaplan-Meier analysis was performed to compare the survival of papilledema. Results. A total of 4498 patients with IBD were enrolled in the study cohort, and there were 17992 patients without IBD in the control cohort. The papilledema incidence rate was higher in the study cohort than in the control cohort (aHR = 4.330, p = 0.012). Papilledema occurred equally in both genders. The overall incidence of papilledema was 12.67 per 100,000 person-years in the study cohort and 3.44 per 100,000 person-years in the control cohort. For IBD patients, male, young age onset, sleep apnea, hypertension, medicine use (tetracycline, minocycline, doxycycline), spring are the predisposing factors of developing papilledema. Conclusions. Patients with IBD were associated with an increased risk of papilledema. Patients with IBD should stay alert for any potential visual impairment disorder. Further prospective studies examining the relation-ship between IBD and papilledema may provide more information.

關鍵字

Inflammatory bowel disease (IBD) ； National Health Insurance Research Database (NHIRD) ； Papilledema ； Retrospective cohort study

並列摘要

目的：發炎性腸炎是一個多發性疾病，並且可能對身上各部位器官造成影響，本計畫使用世代研究法（cohort study），以台灣健保資料庫針對發炎性腸炎患者進行全面且長期的追蹤研究，比較是否會增加罹患視乳頭水腫的風險性。方法：利用台灣全民健康保險資料庫之承保抽樣百萬歸人檔，研究期間為2000年到2013年，總共14年的數據，並利用SPSS進行資料處理及統計分析，分析方法包括卡方檢定法及費雪精確檢定。使用校正風險比值（aHR），用Kaplan-Meier曲線分析比較發炎性腸炎患者的視乳頭水腫的發生率。結果：自資料庫中截取2000－2013年共989,753人，依照相關因子進行1:4配對，抽出發炎性腸炎有4,498位個案，及對照組為17,992位個案。在病例組裡罹患視乳頭水腫的比例（12.67%），比再對照組的比例（3.44%）高，且校正控制變相後aHR為4.330（95% CI= 1.130-16.590, p = 0.012）。結果分析顯示，在發炎性腸炎患者中，男性、年輕人發作、睡眠中止症、高血壓，合併有相關藥物使用者（四環黴素，美諾四環素，去氧羥四環素），以及春季是發生乳頭水腫的風險因子。結論：在本研究中主要為罹患發炎性腸炎患者，會有顯著的高風險罹患視乳頭水腫病變。由本研究結果，站在預防醫學的觀點，應該針對有發炎性腸炎診斷之個案，針對同時具有相關風險因子病患，應該加強衛教及視神經檢查以降低視乳頭水腫的發生風險。

並列關鍵字

發炎性腸道疾病 ； 視乳頭水腫 ； 台灣全民健康保險資料庫 ； 世代研究法

參考文獻

L. Prideaux, M.A. Kamm, P.P. De Cruz, et al.Inflammatory bowel disease in Asia: a systematic review J Gastroenterol Hepatol, 27 (2012), pp. 1266-1280

Ng WK, Wong SH, Ng SC. Changing epidemiological trends of inflammatory bowel disease in Asia. Intest Res 2016;14:111–119.

3. Hsu Y-C, Wu T-C, Lo Y-C, Wang L-S. Gastrointestinal complications and extraintestinal manifestations of inflammatory bowel disease in Taiwan: a population-based study. J Chin Med Assoc 2017;80(2):56e62.

4. Mintz R, Feller ER, Bahr RL, Shah SA. Ocular manifestations of inflammatory bowel disease. Inflamm Bowel Dis 2004;10: 135–9.

7. Ghanchi FD, Rembacken BJ. Infl ammatory bowel disease and the eye. Surv Ophthalmol. 2003;48:663–76.