肺炎病患與罹患心房顫動風險之世代研究

研究目的：感染可透過人體內一系列的反應影響心血管系統，研究發現肺炎病患若伴隨心血管併發症發生與短期內死亡率顯著相關。許多文獻顯示，肺炎患者的心電圖變化與疾病的嚴重程度有關，因此肺炎與心律不整的關係密不可分。由於心房顫動是心律不整種類中最常見的類型，本研究探討肺炎與心房顫動之關係。在本文中我們進行了肺炎病患的回溯性世代研究，我們使用台灣國家健康保險研究資料庫（NHIRD）的數據來調查台灣成年人患有肺炎的心房顫動發生率。研究方法及資料：本研究我們使用回溯性世代研究設計方法，將病人分為患有肺炎病患的肺炎組及非肺炎病患的非肺炎組。根據國際疾病分類，我們使用第九版的臨床診斷代碼（ICD-9）。本研究收錄的所有患者年齡皆大於等於20歲，且先前從未診斷肺炎與心房顫動。在排除之前已診斷心房顫動的病人後，肺炎組和非肺炎組依照年紀、性別及病人之共病一比一分配病人，最後兩個組別分別有35,016位病人，並觀察1年內心房顫動之發生率。此篇研究使用Kaplan–Meier分析評估病人之心房顫動累積發生率，並使用Cox比例風險模型估計兩組別的心房顫動風險比。研究結果：在本研究中，我們觀察到病患被診斷肺炎後的追蹤1年內，和未診斷肺炎的病患相比更容易罹患心房顫動，統計學上具有顯著意義（P<0.001）。研究發現肺炎病患每1000人年的心房顫動發生率為1.1（395 / 348,479）。與未患有肺炎的患者相比，肺炎患者罹患心房顫動的風險在追蹤1年內增加了3.54倍（95％信賴區間為2.92–4.29）。此外，本研究發現除了病患之年齡外，以下的共病皆會增加心房顫動的風險，包括：高血壓、心血管疾病、心臟衰竭、中風、慢性阻塞性肺疾病和慢性腎臟疾病。結論與建議：本研究顯示，罹患肺炎之病患會增加心房顫動發生之風險。此外，會增加心房顫動發生的其他風險因子包括：衰老、高血壓、心血管疾病、心臟衰竭、中風、慢性阻塞性肺疾病和慢性腎臟疾病。因此，臨床醫師在評估肺炎病患的心血管併發症（如心律不整）時需格外小心，尤其是病患診斷為肺炎的頭幾天內。

關鍵字

肺炎；心房顫動；世代研究

並列摘要

Objective： Cardiac arrhythmias have a strong association with pneumonia due to the cardiovascular response to the infection. Electrocardiogram changes in patients with pneumonia are associated with greater disease severity. Besides, atrial fibrillation (AF) is the most common type of cardiac arrhythmia. Herein, we conducted a population-based cohort study to investigate the incidence of AF in Taiwanese adults with pneumonia by using data from the National Health Insurance Research Database (NHIRD) in Taiwan. Methods and Materials： We used a retrospective cohort study design. Diagnostic codes were recorded according to the International Classification of Diseases, Ninth Edition, Clinical Modification. All patients were aged≥20 years and were not diagnosed with pneumonia and AF previously. A total of 35,016 patients with pneumonia and the same number of individuals without pneumonia were recruited after excluding individuals with the diagnosis of AF before and matching 1:1 by age and gender, and comorbidities. The cumulative incidence of AF was evaluated using Kaplan–Meier analysis. The Cox proportional-hazards model was used to estimate the hazard ratios of AF in both groups. Results： We observed that patients were more likely to develop AF throughout the one year follow-up period after the diagnosis of pneumonia. The incidence of AF was 1.1 (395/348,479) per 1000 person-years. Patients with pneumonia had a 3.54-fold (95% CI 2.92–4.29) increased AF risk than patients without pneumonia. An increased AF risk was noted in aging and the following comorbidities: hypertension, cardiovascular disease, heart failure, stroke, chronic obstructive pulmonary disease, and chronic kidney disease. Conclusion and Suggestion： In conclusion, patients with pneumonia have an increased AF risk. Aging, hypertension, cardiovascular disease, heart failure, stroke, chronic obstructive pulmonary disease, and chronic kidney disease are other risk factors for AF development. Therefore, physicians should exercise caution while evaluating cardiovascular complications, such as cardiac arrhythmia, heart failure, or acute coronary syndromes in patients with pneumonia after the diagnosis of pneumonia.