輕度頭部外傷接受腦部電腦斷層使甲狀腺疾病風險提高分析

Risk of Thyroid disease in minor head injury Patients with computer tomography scan: A Population-Based Retrospective Cohort Study

劉鎬瑜(Haw-Yu Liu)

指導教授 ： 葉兆斌

共同指導教授 ： 周明智(Ming-Chih Chou)

中山醫學大學/醫學院/醫學研究所/碩士(2021年)

https://doi.org/10.6834/csmu202100274

摘要

研究目的：對於輕度頭部外傷的病患，腦部電腦斷層檢查（Computerized tomography of the brain，是臨床上常用快速可以排除腦部出血的檢查，在急診初步處理中,可以有效排除腦部出血此一疾病可能,但此類病患常常伴有持續性的症狀,如持續性頭暈,嘔吐,步態不穩等症狀,因此臨床醫師常常會重複進行檢查以追蹤腦部後續狀況,但病人是否在反覆高輻射量檢查的過程中增加了某些疾病的風險,例如對輻射易感的甲狀腺疾病。在本文中，我們使用台灣國家健康保險研究資料庫（NHIRD）的數據來進行回溯性世代研究，調查輕度頭部外傷接受腦部電腦斷層使甲狀腺疾病風險提高分析。
研究方法及資料：本研究我們使用回溯性世代研究分析，總共收集55734位遭遇輕度頭部外傷在急診接受初步處理的病人,並且後續有接受腦部電腦斷層檢查的病患。根據國際疾病分類，使用第九版臨床診斷代碼（ICD-9）。本研究收錄西元2009年到2013年中，第一次輕度頭部外傷到急診就診的病患，排除在收錄日期前就已經有接受過腦部電腦斷層檢查,及本來就有甲狀腺疾病的病患之後,觀察單純因輕度頭部外傷後反覆接受腦部電腦斷層，甲狀腺疾病的累積發生率。
研究結果：在此研究中，我們追蹤頭部外傷病患接受腦部電腦斷層後甲狀腺疾病的發生率。追蹤期中分組年齡層及其他共病。長期追蹤下，合併年齡、性別、高血壓、糖尿病、慢性阻塞性肺疾、癌症等與甲狀腺事件無相關。在本研究中，整個追蹤期間，甲狀腺罹病率皆與較多的暴露次數相關。
結論與建議：本研究發現輕度頭部外傷病患接受腦部電腦斷層，追蹤期中重複接受腦部電腦斷層掃描會增加甲狀腺罹病率；與年齡或其他共病無明顯相關；臨床醫師於持續有症狀之輕度頭部外傷病人排定腦部電腦斷層時，須注意相關風險。

關鍵字

腦部電腦斷層 ； 甲狀腺疾病 ； 世代研究

並列摘要

Objective:
Computerized tomography of the brain is a standard image survey for patients with head injury, the image survey included high dose of radiation which may cause disease for radiation sensitive organ, such like thyroid. It has been a concern that would Iatrogenic radiation induced the disease. Therefore, we conducted a population-based cohort study to investigate the Cumulative incidence rate of thyroid disease in minor head injury patient with or without receiving head Computerized tomography the by using the data from National Health Insurance Research Database (NHIRD) of Taiwan.

Methods and Materials:
Retrospective cohort study using data from NHIRD and including 55734 patients with first time visited ED received first aid. And with the diagnosis of minor head injury from March, 2009, through October, 2013. Patients was included by diagnostic code according to International Classification of Diseases, Ninth Edition, Clinical Modification (ICD 9 CM). All age patients were included. Exposures was included according to National Health Insurance Research Database (NHIRD) of Taiwan. Main outcomes were thyroid disease diagnosis.

Adjusted incidence rate of patient with or without concurrent disease and were estimated using Poisson regression. The cumulative incidence of outcomes was evaluated using Kaplan–Meier analysis.

Results:
Among 55734 patients with minor head injury visited emergency department,
We excluded index date was before March 2009 or after October 2013, n=4,606, also excluded received any CT scan within 3 months before index date, n=1,360 Some patient withdraw within 3 months after index date, n= 1,457. And most of all patient who had preexisting thyroid diseases or diagnosed with thyroid diseases within 3 months after index date was also excluded.
We found it no significant difference of risk in different groups. Which including age, sex, Diabetes mellitus, Hypertension, Chronic obstructive pulmonary disease, Coronary artery disease, Cancer. What only matters is that the patients who had received more than one times radiation exposure had a higher risk of subsequent thyroid disease, Comparisons group with incidence rate of 0.46(0.42-0.51). (95% C.I.), and total CT group with incidence rate of 0.59(0.52-0.67). (95% C.I.)
CT group with 1 times exposure with incidence rate of 0.54(0.46-0.62). (95% C.I.)
2 times with incidence rate of 0.74(0.53-1.01). ≧3 times with incidence rate of 1.12(0.76-1.65).

Conclusion and Suggestion:
Among patients with minor head injury, repeated use of Computerized tomography of the brain was associated with increased risk of thyroid disease. We found it no significant difference of risk in different groups. Which including age, sex, Diabetes mellitus, Hypertension, Chronic obstructive pulmonary disease, Coronary artery disease, Cancer. What only matters is that the patients who had received more than one times radiation exposure had a higher risk of subsequent thyroid disease

並列關鍵字

Computerized tomography of the brain ； population-based cohort study

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