第二型糖尿病的不同之糖化血色素軌跡分析與帶狀皰 疹的風險：來自大型資料庫的研究

The risk of herpes zoster infection in type II diabetes mellitus with distinct glycated hemoglobin trajectories: the evidence from large real-world database

潘柏霖(Bo-Lin Pan)

指導教授 ： 莊弘毅

高雄醫學大學/健康科學院/公共衛生學系職業安全衛生碩士班/碩士(2020年)

摘要

背景及研究目的:帶狀皰疹與許多慢性疾病都有相關性，許多慢性疾病會影響身體的免疫系 統，因此容易發生帶狀皰疹。過去的研究指出糖尿病是一個重要的風險因子， 不論是第二型或第一型糖尿病都會增加風險。但是鮮少有研究探討糖尿病控制 的情形與帶狀皰疹的相關性，這次的研究是利用糖化血色素之軌跡分析來和糖 尿病控制情形並且分組出控制良好和控制不好之組別，比較糖尿病控制情形之 不同發生帶狀皰疹的風險是否不一樣。 試驗設計:本試驗為長庚資料庫之回溯性研究，我們將收集民國 96 年至民國 106 年長 庚資料庫的病人，找出門診或住院有糖尿病診斷，根據糖化血色素來做軌跡分 析並分組，再進一步從這些分組資料中利用 Cox 多變項迴歸分析病人發生帶狀 皰疹的風險。 結果：總共 122,068 位個案，利用個案二年內的糖化血色素來進行軌跡分析，分出 四組軌跡，分別為第一組達標組(58%)，第二組從高降低組(9.0%)，第三組中等 控制組(25.4%)，第四組控制較差組(7.6%)，平均(標準差)糖化血色素分別為 6.7(0.8), 7.9(2.3), 8.4(1.2),10.7(1.8)。再進行帶狀皰疹的 Cox 多變項迴歸分析，校 正年齡和性別後，第四組控制較差的組別有較高的風險[Hazard Ratio(HR):1.40, 95%confidence interval(CI) 1.23-1.60]，再校正其共病症後仍然有顯著的差異 （HR: 1.44, 95% CI 1.26-1.64）。 結論：第二型糖尿病病人之血糖控制較差會有較高的帶狀皰疹感染風險。

關鍵字

軌跡分析 ； 第二型糖尿病 ； 帶狀皰疹

並列摘要

Aim: To investigate the risk for HZ infection and compare the risk among the patient with controlled diabetes to the patient with uncontrolled diabetes.Method: This retrospective cohort study was conducted by using the CGRD database. The subjects who had HbA1c data and diagnosed as diabetes mellitus were enrolled for the period of 1 January 2007 to 31 December 2017. The date when the DM was confirmed was the index date. We extracted the laboratory data of HbA1c in the first 2 years after index date. We applied group-based trajectory modelling (GBTM) to identify the HbA1c trajectories. Multivariable Cox proportional hazards regression was applied to estimate hazard ratio (HR) for HZ infection risk with adjustment of age, sex, and comorbidity.Result: This study enrolled 122,068 subjects to perform the analysis. We identified four HbA1c trajectories: ‘good control’ (58.0%), ‘highdecreasing’(9.0%), ‘moderate’(25.4%), and ‘poor control’(7.6%). The mean HbA1c increased in good control, high-decreasing, moderate, and poor control group [mean HbA1c(SD) 6.7(0.8), 7.9(2.3), 8.4(1.2),10.7(1.8)] The risk of HZ was significantly higher in the poor control group after adjusting for age and gender with HR 1.40 and 95% confidence interval (CI) 1.23–1.60. After additional adjustment for comorbidities, the risk of HZ infection remained higher (HR 1.44, 95% CI 1.26–1.64) in poor control group.Conclusion: The patients with the poor glycemic control have the higher risk of HZ infection.

並列關鍵字

trajectory ； type 2 diabetes mellitus ； herpes zoster

參考文獻

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