- 學位論文
氣喘及痛風之雙向關係： 台灣健保資料庫研究
Bidirectional Association Between Asthma and Gout A National Health Insurance Database Study from Taiwan
摘要
研究背景與目的：日前一篇動物實驗研究發現尿酸值和氣喘有相關;而就目前所知尿酸沉積是引起痛風的因素。過去尚未有研究探討氣喘對痛風的影響與其間的雙向相關。因此我們想要知道氣喘的病患未來得到痛風的機率是否有相關。 材料方法：利用2005健保資料庫百萬歸人檔，使用ICD-9-CM從醫療紀錄得到2000到2007年間住院或門診就醫紀錄中有氣喘(ICD-9-CM:493.xx) 的病患，之後所有的病患觀察到2008年12月31日.利用Competing risk adjusted Cox regression（存活分析）分析，在控制了性別、年齡、城鄉差距、投保薪資、高血脂、糖尿病、高血壓、腎臟疾病及死亡等因素，觀察氣喘患者是否和未來有痛風機率有相關。痛風病患的定義為任何一次住院診斷有痛風記錄或者門診診斷至少兩次且就醫超過三個月以上紀錄者。氣喘病患的定義為任何一次住院診斷有氣喘記錄或者門診診斷至少兩次且就醫超過一年以上紀錄者。本研究另一方向為運用上述方法相同氣喘及痛風診斷定義，在控制了性別、年齡、城鄉差距、投保薪資、高血脂、糖尿病、高血壓、腎臟疾病及死亡等因素探討痛風對氣喘的影響。 研究結果：共有42,676名病患納入本研究，在後續的研究期間總共有2465病患發生痛風，包括氣喘組內1534名（7.19％）和非氣喘組內931名（4.36％）。平均追蹤時間為5.78±2.32（平均值±SD）年。調整競爭死亡和干擾因素後;氣喘病患罹患痛風的風險增加66%（ HR=1.66 ，95％CI=1.46-1.74，P <0.001）。本研究另一方向分析則發現痛風增加了94%罹患氣喘的危險（HR=1.94 ，95％CI= 1.77-2.12,p<0.001）。 結論： 本研究發現在控制干擾因子與死亡後，氣喘是痛風的危險因子；此外本研究亦以相同方法驗證痛風是氣喘的危險因子，兩者可能存在雙向相關。
並列摘要
Background and Objective: Both asthma and gout are associated with inflammation. Uric acid had been proved to be related to inflammation. There was no study assessing the effect of asthma on gout and bidirectional associations between these two diseases. Therefore, we sought to investigate bidirectional association between asthma on gout in Taiwan. Methods: All new subjects were identified from the National Health Insurance Research Database with a primary diagnosis of asthma (ICD-9:493) between 2000 and 2007. The subjects were verified by any inpatient diagnosis of asthma or at least twice diagnosis of asthma with duration of more than one year in outpatient service. There were a total of 21,338 asthma cases in subject over 15 years old. There were 21,338 gender-, age-, urbanization- and insurance premium- matched subjects. All subjects were followed until December 31, 2008. Competing risk adjusted Cox regression was utilized to reveal the effect of asthma on gout by controlling gender, age, urbanization, insurance premium, hyperlipidaemia, diabetes mellitus type 2, hypertension, renal diseases and death. Gout was defined in this study as those with medical service claim of ICD-9: 274, for any inpatient diagnosis or at least twice gout diagnosis with duration of more than three months in outpatient service.. In the other direction, the same method was applied to investigate the effect of gout on asthma by controlling gender, age, urbanization, insurance premium, hyperlipidaemia, diabetes mellitus type 2, hypertension, renal diseases and death. Results: In a total of 42,676 subjects, 2465 claimed gout in the follow-up study period, including 1534 (7.19%) within the asthma group and 931 (4.36%) within the non- asthma group. The average follow-up time was 5.78±2.32 (mean±SD) years. After adjusting for competing death and confounding factors, asthma increased gout risk by 66% (HR=1.66; 95% CI=1.46-1.74, p<0.001). In the other direction, gout cases increased asthma risk by 94% （HR=1.94 ，95％CI= 1.77-2.12,p<0.001）。 Conclusions: Asthma may be as a risk factor on gout in Taiwan after controlling competing death, and confounding factors. In addition, gout also has been verified as a risk factor on asthma in this retrospective cohort study. There are bidirectional associations between these two diseases.
參考文獻
延伸閱讀
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