泌尿道感染患者之罹癌風險研究

Study of the cancer risk after urinary tract infection

黃嘉宏(Chia-Hung Huang)

指導教授 ： 楊順發

中山醫學大學/醫學院/醫學研究所/博士(2019年)

https://doi.org/10.6834/CSMU201900180

摘要

泌尿道感染是全世界最常見的傳染病之一。發炎是癌症發展的主要因素，但關於泌尿道感染與得到癌症風險之關係的研究很少。先前的研究指出泌尿道感染的患者有更高的風險罹患泌尿生殖系統癌。然而，泌尿道感染已與得到泌尿相關癌症有關但對於其他種類的癌症相關性並不清楚。因此，本研究探討台灣泌尿道感染及抗生素使用的類型和時間與隨後發展癌症風險之間的相關性。本研究為以人群為基礎的回溯性世代研究，使用來自2009-2013年間縱向健康保險資料庫的數據來進行分析。本研究納入2010-2012年間被診斷為泌尿道感染的患者。進行1:2傾向分數配對以沒有泌尿道感染的人群作為對照組。應用多重Cox迴歸模型的多變量分析來分析數據。研究組共納入38,084名泌尿道感染患者，76,168名沒有泌尿道感染的患者被納入對照組。結果顯示，患有泌尿道感染的男性和女性罹患所有癌症的風險比均較高 [男性，校正風險比=1.32，95%信賴區間=1.12-1.54；女性，校正風險比=1.21，95%信賴區間=1.08-1.35]。與沒有泌尿道感染的患者相比，泌尿道感染患者發生新的泌尿生殖系統癌的可能性更高。此外，男性的生殖器官、腎臟和膀胱的影響明顯大於先前泌尿道感染的女性。再者，超過7天的抗生素治療與男性膀胱癌的發生率相關 [7-13天，校正風險比=1.23，95%信賴區間=0.50-3.02；大於14天，校正風險比=2.73，95%信賴區間=1.32-5.64]。綜合以上結論，泌尿道感染與泌尿生殖系統癌顯著相關，可作為泌尿生殖系統癌的早期徵兆，特別是在男性生殖器官、前列腺、腎臟和膀胱中。在泌尿道感染治療期間醫師應謹慎地為患者開立抗生素。

關鍵字

泌尿道感染 ； 癌症 ； 健康保險資料庫

並列摘要

Urinary tract infection (UTI) is one of the most common infectious diseases in the world. Inflammation is a main factor in cancer development, but studies on the relationship between UTI and cancer risks is scant. Previous studies have indicated that patients with UTI are at a higher risk of developing genitourinary cancers (GUC). However, whether the UTI is related to any cancer remains unclear. Therefore, this study investigated the association among urinary tract infection (UTI), the type and timing of antibiotic usage, and the subsequent risk of developing cancers in Taiwan. This retrospective population-based cohort study was conducted using 2009-2013 data from the Longitudinal Health Insurance Database. This study enrolled patients who were diagnosed with UTI between 2010 and 2012. A 1:2 propensity score-matched control population without UTI served as the control group. Multivariate analysis with a multiple Cox regression model was applied to analyze the data. A total of 38,084 patients with UTI were included in the study group, and 76,168 participants without UTI were included in the control group. The result showed a higher hazard ratio of any cancer in both sexes with UTI [for males, adjusted hazard ratio (aHR) = 1.32; 95% confidence interval (CI) = 1.12-1.54; for females, aHR = 1.21; 95% CI = 1.08-1.35]. Patients with UTI had a higher probability of developing new GUC than those without UTI. Moreover, the genital organs, kidney, and urinary bladder of men were significantly more affected than those of women with prior UTI. Furthermore, antibiotic treatment for more than 7 days associated the incidence of bladder cancer in men [7-13 days, aHR = 1.23, 95% CI = 0.50-3.02; >14 days, aHR = 2.73, CI = 1.32-5.64]. In conclusion, UTI is significantly related to GUC and can serve as an early sign of GUC, especially in the male genital organs, prostate, kidney, and urinary bladder. During UTI treatment, physicians should cautiously prescribe antibiotics to patients.

並列關鍵字

Urinary tract infection ； Cancer ； Longitudinal Health Insurance Database

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