周邊動脈阻塞性疾病及深部靜脈栓塞與敗血症之風險研究

The association of Peripheral Arterial Occlusive Disease and Deep Venous Thrombosis With Risk of Consequent Sepsis Event

鍾錡粢(Chung-Tzu Chung)

指導教授 ： 曾淑玲

中山醫學大學/醫學院/醫學研究所/碩士(2022年)

https://doi.org/10.6834/csmu202200225

摘要

研究目的：周邊動脈阻塞性疾病（ peripheral artery occlusive disease, PAOD）和深部靜脈栓塞（ deep vein thrombosis, DVT） 可引起多種急性和慢性血管併發症，使患者面臨後續敗血症的風險，然而，目前少有研究探討PAOD和 DVT與敗血症的關係。在本文中，我們使用台灣國家健康保險研究資料庫（ National Health Insurance Research Database, NHIRD） 的數據來進行回溯性世代研究，調查敗血症與PAOD和DVT之間的是否相關，並試圖探討 PAOD和 DVT何者發展至敗血症的風險較高。
研究方法及資料：這項研究從縱向健康保險數據庫的200萬患者中納入了 43,535 名新診斷為 PAOD 的患者和6,932名新診斷為患有DVT的患者。對經傾向評分匹配 ( Propensity Score Matching , PSM) 後的PAOD和DVT組共4383人之間進行了敗血症風險分析。
研究結果：對4,383名PAOD 患者和4,383名DVT 患者進行了敗血症風險分析。 PAOD患者每 1,000 人年敗血症的發病率為 25.75（ 95% CI = 23.90 至 27.74），DVT 患者為 35.61（ 95% CI = 33.29 至 38.09）。在對年齡、性別、相關合併症和抗生素給藥進行調整後，DVT 組的敗血症風險比 PAOD 組高1.46倍（95% CI = 1.32-1.62）
結論與建議：總之，PAOD 或DVT 患者的敗血症風險較無患病族群增加。此外，與PAOD患者相比，DVT患者隨後發生敗血症的風險更高，臨床醫師在遇到DVT患者時考量其較高的敗血症風險是應該特別留意的。

關鍵字

周邊動脈阻塞性疾病 ； 深部靜脈栓塞 ； 敗血症 ； 風險

並列摘要

Objective : Peripheral artery occlusive disease (PAOD) and deep vein thrombosis (DVT) can cause a variety of acute and chronic vascular complications and put patients at risk of subsequent sepsis. This study aimed to determine whether the risk of sepsis is associated with PAOD and DVT. Methods and Materials:
This study recruited 43,535 patients newly diagnosed as having PAOD and 6,932 patients who were newly diagnosed as having DVT from a population of 2 million patients from the Longitudinal Health Insurance Database. Propensity score matching (PSM) between the PAOD and DVT groups was performed for age, sex, comorbidities, and prior antibiotic administration.
Results:
A total of 4,383 patients with PAOD and 4,383 patients with DVT were analyzed for risk of sepsis. The incidence density of sepsis per 1000 person years for patients with PAOD was 25.75 (95% CI = 23.90 to 27.74) and 35.61 (95% CI = 33.29 to 38.09) for patients with DVT. After age, sex, associated comorbidities, and antibiotic administration were adjusted for, the risk of sepsis for the DVT group was 1.46-fold (95% CI = 1.32-1.62) higher than that for the PAOD group.
Conclusion and Suggestion:
In conclusion, patients with either PAOD or DVT exhibited an increased risk of sepsis. Moreover, patients with DVT exhibited a higher risk of subsequent sepsis than did patients with PAOD. Aging was another risk factor. Patients who had a history of antibiotic administration history had a minor reduction in their risk of sepsis.

並列關鍵字

Peripheral arterial occlusive disease ； deep vein thrombosis ； Sepsis ； Risk

參考文獻

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