肝硬化與結核病感染之相關性

The relationship between liver cirrhosis and tuberculosis infection

林憶婷(Yi-Ting Lin)

指導教授 ： 莊弘毅

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2013年)

https://doi.org/10.6832/KMU.2013.00034

摘要

結核病與肝臟疾病在全世界是盛行的疾病，結核病也是感染症死亡的重要原因。在過去，肝硬化的病人經驗上較一般人易感染結核病，但肝硬化是否是肺結核感染的獨立危險因子目前仍不清楚，因此本篇研究是利用台灣健保資料庫，嘗試去探討肝硬化與結核病之間的相關性。
本研究從健保資料庫重大傷病檔，找出41,076位肝硬化的病人做為研究對象，依年齡與性別，從2005年百萬人抽樣檔做1比5的配對，共有204,244位非肝硬化的病人做為對照組，觀察時間從1998年1月到2007年12月，共十年的世代研究。在追蹤觀察間，有957位(2.3%)的肝硬化病人感染結核病，非肝硬化的對照組有955位(0.46%)感染結核病，前者每十萬人的結核病發生率為279人，後者每十萬人的結核病發生率為55人，肝硬化感染結核病的發生率較非肝硬化病人有5.07倍的上升(95% CI = 4.64, 5.56)。研究結果發現，在校正年齡、性別、與其他共病後，肝硬化是結核病感染的獨立風險因子，較非肝硬化病人有2.05倍的風險(95% CI = 1.79, 2.36)罹患結核。在肝硬化族群中，C型肝炎感染結核病的風險，較非C型肝炎的肝硬化病人高(Hazard ratio=1.18, 95% CI = 1.02, 1.30 )，達統計學上的差異(p= 0.023)，相對於B型肝炎的肝硬化病人，較非B型肝炎的肝硬化者(hazard ratio=0.95, 95% CI = 0.83, 1.08 )，則無此觀察結果。
根據以上結果，本研究發現肝硬化是結核病感染的獨立危險因子，特別是C型肝炎的肝硬化患者。提醒臨床照顧者應注意肝硬化病人，是否有結核病感染的徵候，如慢性咳嗽，發燒等。

關鍵字

肝硬化 ； 肺結核 ； 結核病 ； 風險 ； 健保資料庫

並列摘要

Tuberculosis (TB) and liver cirrhosis are both endemic in many regions of the world, and they contribute to major disease morbidity and mortality worldwide. TB infection is prevalent in patients with immune dysfunction, which is a common feature of cirrhosis. However, the risk of TB infection in cirrhotic patients has rarely been investigated. A nationwide cohort study was aimed at elucidating and characterizing the association between cirrhosis and TB infection by analyzing a large-scale database from the Taiwan National Health Insurance.
Methods:
The study group consisted of 41,076 cirrhotic patients and 204,244 non-cirrhotic controls between January 1998 and December 2007. Cirrhotic and non-cirrhotic patients were 1:5 matched for age and sex.
Finding:
During the study period, 957 (2•32%) cirrhotic patients developed TB infection, yielding a rate that was significantly higher than that of non-cirrhotic patients (0•46%, 955/204 244; p<0•001). Cox’s regression model adjusted for age, sex, and underlying medical disorders, a significantly higher TB infection rate was maintained for cirrhotic patients compared with their counterparts (adjusted hazard ratio [HR], 2•05; 95% confidence interval [CI], 1•79 to 2•36; p<0•001).
Interpretation:
Cirrhotic patients have a greater risk of TB infection than non-cirrhotic patients. Primary health care providers should pay close attention to cirrhotic patients with chronic cough, fever, and other manifestations of TB infection.

並列關鍵字

liver cirrhosis ； tuberculosis ； risk factor ； cohort study ； population-based ； Taiwan National Health Insurance Research Database

參考文獻

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