- 學位論文
發炎性腸道疾病與肝膽疾病之相關性:台灣全國性回溯性世代研究
Association between Inflammatory Bowel Disease and Hepatobiliary Disease : A National Retrospective Cohort Study in Taiwan
摘要
研究目的 本研究目的為比較暴露發炎性腸道疾病者相較未暴露發炎性腸道疾病(IBD)者得到與原發性硬化性膽管炎(PSC)、膽石症(GD)是否存在差異，以及IBD是否與PSC、GD存在統計上之相關性(p≤0.05)。 研究方法 本研究為回溯性世代研究（retrospective cohort study），以我國2010年之全民健康保險承保人作為研究母群體，擷取2002年至2012年之新發生之克隆氏症(CD)病人及潰瘍性結腸炎(UC)病人作為研究對象，並以性別、年齡、投保金額、投保地區都市化程度及共病症指數(CCI)進行傾向分數配對(PSM)出對照世代後，分析IBD是否與GD、PSC存在相關性，以及暴露於IBD下，罹患GD與PSC，相較未暴露者，是否有統計上較高風險(p≤0.05)。 研究結果 經卡方獨立性檢定，發炎性腸道疾病與膽石症具有統計上的顯著相關(p≤0.05)，但與原發性硬化性膽管炎無統計上的相關(p>0.05)。經Cox對比涉險模式分析之結果顯示，IBD患者相較無罹患IBD者，發生GD之年齡調整風險比為1.36倍(95%CI=1.21-1.53, p<0.001)；而PSC方面，相較無IBD者，發生PSC之年齡調整風險比為1.37倍(95%CI=0.95-1.99, p=0.092)，但兩者無統計上顯著差異(p>0.05)。 結論 本研究結果發現IBD的暴露與GD確實相關，且相較非暴露者有統計上之較高風險，若病患同時患有CD與UC時，發生GD之風險比更高。但在PSC方面，本研究結果顯示IBD暴露，在發生PSC上並無統計上的相關性及風險差異(p>0.05)。
並列摘要
OBJECTIVE The purpose of this study is to compare whether there is a difference between those exposed to Inflammatory Bowel Disease(IBD) and those who did not exposed to IBD after having Primary sclerosing cholangitis(PSC) and Gallstone Disease(GD), and whether there is a statistical correlation between PSC and GD or not. METHODS This study is a retrospective cohort study, taking Taiwan’s 2010 National Health Insurance subscriber as the research population, and choosing newly diagnosed Crohn's disease(CD) patients and Ulcerative colitis(UC) patients from 2002 to 2012 as research objects, and used propensity score matching(PSM) by sex, age, payroll bracket, degree of urbanization in the Group insurance applicant area and charlson comorbidity index(CCI) for the control cohort. Analyzing whether IBD is related to GD, PSC, and whether there is a higher risk of exposure to IBD, suffering from GD and PSC comparing with those who are not exposed(p≤0.05). RESULTS According to the Chi-square test of independence, there is a statistically significant correlation between IBD and GD, but no statistical correlation with PSC. The results of Cox proportional hazard regression models analysis show that the age-adjusted hazard ratio of GD in patients was 1.36 times (95%CI=1.21-1.53, p<0.001) more than patients without IBD, and for PSC, the age-adjusted hazard ratio for PSC was 1.37 times(95%CI=0.95-1.99, p=0.092) more than those without IBD, but there was not statistically significant(p>0.05). CONCLUSIONS The results of this study have proved that exposure to IBD is indeed related to GD, and there is a statistically higher risk than non-exposed persons. If having both CD and UC, the hazard ratio of GD is higher. However, for PSC, the results of this study show that if exposing to IIBD, there is no statistical correlation and risk difference in PSC(p>0.05).
參考文獻
延伸閱讀
- Chu, T. H., Chou, Y. W., Lin, S. L., Lin, S. F., Chen, H. H., Hu, W. H., Chen, Y. Y., Chien, G. P. C., Chang, J. H., Tsai, M. C., & Huang, C. C. (2021). 環境汙染物與大腸直腸癌關聯性之台灣單一醫學中心前驅性研究. 台灣公共衛生雜誌, 40(4), 382-393. https://doi.org/10.6288/TJPH.202108_40(4).110037
- 章殷超（2011）。肝細胞癌病患之醫療資源地理可近性與診斷、求醫行為之關聯性研究〔博士論文，國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU.2011.02692
- 王柏川、施壽全、劉建良、池永昌（1996）。肝管梗阻症候群併肝膿瘍：一例報告與文獻回顧。中華民國急救加護醫學會雜誌，7(4)，170-175。https://doi.org/10.30018/JECCM.199612.0005
- Kuo, P. C., Chien, W. C., Hsiao, C. W., Chen, C. Y., Chang, P. K., Jao, S. W., Cheng, Y. C., & Hu, J. M. (2020). Higher Risk for Papilledema in Inflammatory Bowel Disease: A Nationwide Population-Based Study Cohort Study in Taiwan. 中華民國大腸直腸外科醫學會雜誌, 31(3), 178-186. https://doi.org/10.6312/SCRSTW.202009_31(3).10907
- Ott, C., Liebold, A., Takses, A., Strauch, U. G., & Obermeier, F. (2012). High Prevalence but Insufficient Treatment of Iron-Deficiency Anemia in Patients with Inflammatory Bowel Disease: Results of a Population-Based Cohort. Gastroenterology Research and Practice, 2012(), 659-665-099. https://doi.org/10.1155/2012/595970