氣喘與慢性鼻竇炎之相關: 以全國資料為基礎的研究

背景：文獻上臨床研究已探討氣喘和「有鼻息肉的慢性鼻竇炎」及「無鼻息肉的慢性鼻竇炎」之相關性，然而此議題未有全人口的分析，故本研究利用台灣全民健保資料庫，探討罹患氣喘與慢性鼻竇炎分型之相關性，以期結果能推論至一般族群。材料方法：研究資料來自1997年至2009年的全民健康保險資料庫，本研究分為世代分析和配對病例對照分析兩部分，其分述如下：在世代分析當中，建立2000年至2008年之氣喘世代，控制組則依病例組之性別、年齡、居住地、經濟與未發生氣喘族群，以人數1:1的比例進行配對，兩組追蹤至2009年，期間發生有鼻息肉的慢性鼻竇炎及無鼻息肉的慢性鼻竇炎，並利用競爭風險調整Cox回歸分析(Competing risk-adjusted Cox regression analyses)，調整類固醇藥物、共病症、查爾森指數和死亡率，檢視氣喘與慢性鼻竇炎之相關性。在配對病例對照分析當中，選取病例組為2000年至2009年間，診斷患有慢性鼻竇炎個案，控制組則依病例組之性別、年齡、居住地、經濟與未發生慢性鼻竇炎的族群以人數1:4的比例進行配對，並利用條件邏輯斯回歸(Conditional logistic regression)，調整類固醇藥物、共病症和查爾森指數，檢視氣喘與慢性鼻竇炎之相關性。結果：在世代分析當中，追蹤5.8年，共有40,731名氣喘患者，其中有585人(1.44%)在罹患氣喘以後發生無鼻息肉的慢性鼻竇炎，39人(0.10%)在罹患氣喘以後發生有鼻息肉的慢性鼻竇炎，競爭風險調整Cox回歸分析在調整類固醇、高血脂、糖尿病、高血壓、冠狀動脈疾病、查爾森指數之後，世代研究之氣喘與慢性鼻竇炎之間具有顯著正相關。世代研究氣喘與有鼻息肉的慢性鼻竇炎(Hazard-ratio=1.80 ; 95%信賴區間為1.02-3.17 ; P=0.041)；氣喘與無鼻息肉的慢性鼻竇炎(Hazard -ratio=2.62 ; 95%信賴區間為2.23-3.08 ; P<0.001)。在配對病例對照分析當中，2000-2009年研究期間共有1204名，有鼻息肉的慢性鼻竇炎患者，其中共有107人(8.89%)在發生有鼻息肉的慢性鼻竇炎以前曾罹患氣喘；11308名無鼻息肉的慢性鼻竇炎患者，其中共有1617人(14.30%)在發生無鼻息肉的慢性鼻竇炎以前曾罹患氣喘，條件邏輯斯回歸分析在調整類固醇、高血脂、糖尿病、高血壓、冠狀動脈疾病、查爾森指數之後，配對病例對照研究之氣喘與慢性鼻竇炎之間具有顯著正相關。配對病例研究氣喘與有鼻息肉的慢性鼻竇炎 (Odds-ratio=2.49 ; 95%信賴區間為1.89-3.30 ; P<0.001)；氣喘與無鼻息肉的慢性鼻竇炎 (Odds-ratio=3.10 ; 95%信賴區間為2.87-3.34 ; P<0.001)。結論：根據本研究結果顯示，氣喘與「有鼻息肉的慢性鼻竇炎」及「無鼻息肉的慢性鼻竇炎」風險增加都有顯著相關，與先前國外的研究結果相符，本研究支持氣喘會增加慢性鼻竇炎的風險。此外，本研究顯示，氣喘與無鼻息肉的慢性鼻竇炎相關強度高於有鼻息肉的慢性鼻竇炎。

關鍵字

慢性鼻竇炎；有鼻息肉的慢性鼻竇炎；沒有鼻息肉的慢性鼻竇炎；鼻息肉；氣喘；類固醇；全民健康保險研究資料庫

並列摘要

Background: Several studies have reported the association between asthma and chronic rhinosinusitis with/without nasal polyps. However, this relationship has not been investigated demographically . The aim of this study was to utilize the Taiwan National Health Insurance database to analyze the association between asthma and the risk of chronic rhinosinusitis patterns in order to provide information for clinical applications. Methods: Data were obtained from the National Health Insurance Research Database (NHIRD) of Taiwan from 1997 to 2009. The study was divided into cohort and matched case-control analysis of two parts, which were described as follows: Cohort study included cases with a new primary diagnosis of asthma (ICD-9: 493) between 2000 and 2008. These cases were compared in sex-, age-, residence-, and insurance premium-matched controls, and both groups were followed up until the end of 2009 for instances of chronic rhinosinusitis with/without nasal polyps (CRS w/s NP), defined as ICD-9 codes CRS (473, 473.0, 473.1, 473.2, 473.3, 473.8, and 473.9), with/without NP (471, 471.0, 471.1, 471.8, and 471.9). Both of CRSwNP and CRSsNP analysis were performed. Competing risk-adjusted Cox regression analyses were applied after adjusting for sex, age, residence, insurance premium, steroid use (topical or systemic), hyperlipidemia, diabetes, hypertension, coronary artery disease, Charlson comorbidity index and mortality. In matched case-control study, case group were diagnosed with chronic rhinosinusitis with/without nasal polyps (CRS w/s NP), defined as ICD-9 codes CRS (473, 473.0, 473.1, 473.2, 473.3, 473.8, and 473.9), with/without NP (471, 471.0, 471.1, 471.8, and 471.9) between 2000 and 2009. In the matched case-control study the control groups were matched according to sex, age, residence, insurance premium with the population rate of 1:4 from non-CRS population. Conditional logistic regression models analyses were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) between the asthma and CRS w/s NP risk, adjusted for other types of steroid drugs and comorbidities. Results: In cohort study, among 81,462 subjects, 58 developed CRSwNP and 799 developed CRSsNP with a mean (SD) follow-up period of 5.8 (2.4) years. Asthma was an independent predictor of CRSwNP in the fully adjusted model (HR =1.80; 95% CI = 1.02-3.17; P=0.041). Among the CRSsNP analysis, asthma was also an independent predictor of CRSsNP in the fully adjusted model (HR =2.62; 95% CI = 2.23-3.08; P<0.001). In matched case-control analysis, a total of 1204 subjects were identified as CRSwNP, including 107 with asthma before diagnosed as CRSwNP；a total of 4816 subjects were identified as Non-CRSwNP, including 155 with asthma before diagnosed as Non-CRSwNP between 2000-2009. A total of 11308 people were identified as CRSsNP, including 1617 with asthma before diagnosed as CRSsNP；a total of 45232 subjects were identified as Non-CRSsNP, including 1960 subjects with asthma before diagnosed as Non-CRSsNP between 2000-2009. Conditions logistic regression analysis for which steroid use, hyperlipidemia, diabetes, hypertension, coronary artery disease, and Charlson comorbidity index were adjusted, asthma was positively associated with CRSwNP (Odds-ratio= 2.49; 95% CI = 1.89–3.30; P < 0.001). Asthma was also positively associated with CRSsNP (Odds-ratio= 3.10; 95% CI = 2.87–3.34; P < 0.001). Conclusion: Results of this study show that asthma was associated with an increased risk of CRS w/s NP. The result is consistency with previous reports and confirms that there is an relationship between asthma and CRS w/s NP. It is evident that, in Taiwan, asthma has increased effect on the risk of developing CRSsNP than CRSwNP.

並列關鍵字

chronic rhinosinusitis ； chronic rhinosinusitis with nasal polyp (CRSwNP) ； chronic rhinosinusitis without nasal polyp (CRSsNP) ； nasal polyp ； asthma ； steroid use ； National Health Insurance Research Database