臺灣冠狀動脈瘤之流行病學、處方型態與風險因子評估

Epidemiology, prescribing patterns and risk factors of coronary artery aneurysm in Taiwan

方建棠(Chein-Tang Fang)

指導教授 ： 方逸萍

共同指導教授 ： 黃耀斌(Yaw-Bin Huang)

高雄醫學大學/藥學院/藥學系碩士班/碩士(2016年)

摘要

研究背景: 冠狀動脈瘤(Coronary artery aneurysm, CAA)為一罕見疾病，平時無明顯症狀，但嚴重可能產生心絞痛、心肌梗塞甚至死亡的情形。根據文獻顯示，冠狀動脈瘤的盛行率在作冠狀動脈血管攝影的病人當中約為0.2-6.0%。冠狀動脈瘤主要成因為動脈粥狀硬化，常見於成年男性；小孩則多為川崎氏症(Kawasaki disease)併發症所引起；其他病因證據相對缺乏。對於冠狀動脈瘤治療模式以手術為主，由於冠狀動脈瘤會導致血管內產生紊流，增加血栓形成風險，因此部分學者建議給予抗血小板或抗凝血藥物預防血栓形成。
研究目的: 鑑於亞洲地區對於此疾病資料缺乏，本研究希望藉由向國家衛生研究院申請取得之全人口資料，調查台灣族群冠狀動脈瘤之流行病學、常見共病症與處方型態，並評估冠狀動脈瘤相關危險因子。
研究方法: 本研究分為兩部份，第一部分為流行病學調查，藉由全人口資料，估計冠狀動脈瘤於2005年至2011年在台灣的發生率與死亡率，並評估常見共病症及處方模式。冠狀動脈瘤以國際疾病分類碼(ICD-9 code: 414.11)加上相關檢查碼辨認。第二部分為病例對照研究，病例組選擇具有住院診斷之冠狀動脈瘤病人，藉由年齡、性別與納入日以1:10之比例，配對一群同時間具有住院紀錄且無冠狀動脈瘤之對照組。分析兩組人基本資料與納入日前一年之共存疾病，並以羅吉斯回歸(Logistic regression)經單變項與多變項模式評估個別風險因子對於冠狀動脈瘤之影響。 
研究結果: 本研究於2005-2011年總計納入1397位罹患有冠狀動脈瘤之病人。冠狀動脈瘤在台灣的平均年發生率為每十萬人0.87人；平均死亡率為每十萬人0.05人。平均追蹤時間為43.3 ± 25.8月，追蹤期間成年族群之死亡率約為9.9%。病人平均年齡為37.76 ± 31.45歲，未成年者與成年者分別為586人(41.9%)與811人(58.1%)。其中小孩族群高達95.7%為川崎氏症之患者；成人則多有冠狀動脈粥狀硬化(72.5%)。於冠狀動脈瘤診斷後，抗血栓藥品使用頻率明顯增加，其中以開立阿斯匹靈(aspirin)為主。於風險評估方面，以不同模型分析與相關變項校正後，除了心血管相關因子如動脈粥狀硬化(OR: 7.97; 95% CI: 6.46-9.84)、高血壓(OR: 2.09; 95% CI: 1.73-2.53)、高血脂(OR: 2.48; 95% CI: 2.06-2.99)與糖尿病(OR: 1.51; 95% CI: 1.26-1.81)之外，亦發現主動脈剝離(OR: 6.76; 95% CI: 1.89-24.14)、主動脈瘤(OR: 5.82; 95% CI: 2.02-16.83)及紅斑性狼瘡(OR: 4.09; 95% CI: 1.32-12.62)與冠狀動脈瘤有顯著相關性。
結論:本研究發現冠狀動脈瘤在台灣的發生率低。小孩族群多為川崎氏症患者，而成人族群常伴隨動脈粥狀硬化。抗血栓藥品於冠狀動脈瘤的病人中使用頻繁。除了常見心血管疾病，主動脈剝離、主動脈瘤與紅斑性狼瘡亦與冠狀動脈瘤相關。

關鍵字

冠狀動脈瘤 ； 流行病學 ； 處方型態 ； 風險因子

並列摘要

Background: Coronary artery aneurysm (CAA) was usually asymptomatic and a rare disease. The prevalence of CAA was around 0.2% to 6.0% in the literature. The most common cause of CAA was atherosclerosis, followed by Kawasaki disease and other factors. Information on management of CAA is scarce, which mainly focused on surgery. Considering that turbulent flow may occur in the aneurysm, antithrombotic agents are considered beneficial for the prevention of thrombosis.
Study aim: Due to lacking data of the rare disease in Asia, we perform a population-based study to investigate the epidemiology, coexisting disease, prescribing patterns and risk factors of CAA.
Methods: Data for analysis were retrieved from National Health Insurance Research Database in Taiwan. We identified CAA patients by using diagnostic code (ICD-9: 414.11) with CAA-related examinations. The incidence and mortality of CAA were calculated. The coexisting disease and prescribing patterns were investigated in the epidemiological study. Controls were selected with a ratio of 10:1 to cases by matching on age, sex and the index year. Risk for CAA between two groups were estimated by logistic regression with adjustment.
Results: A total of 1397 CAA patients were identified during 2005 to 2011. The average annual incidence and mortality of CAA in Taiwan were 0.87 and 0.05 per 100,000 population. No significant difference in the incidence of CAA was found during 2005-2011. During the study period, 9.9% of adult patients died with a mean follow-up of 43.3 ± 25.8 months. The mean age of all CAA population was 37.76 ± 31.45 years, of which pediatric and adult patients accounted for 41.9% and 58.1% respectively. Among coexisting disease, Kawasaki disease predominated in 95.7% of children and coronary atherosclerosis was found in 72.5% of adults. Antithrombotic agents were prescribed more frequently after diagnosis of CAA, among which aspirin accounted for most use. After adjustment, cardiovascular risk factors including coronary atherosclerosis (OR: 7.97; 95% CI: 6.46-9.84), hypertension (OR: 2.09; 95% CI: 1.73-2.53), hyperlipidemia(OR: 2.48; 95% CI: 2.06-2.99) and diabetes (OR: 1.51; 95% CI: 1.26-1.81) showed significantly associated with the presence of CAA. For other risk factors, we also found aortic dissection (OR: 6.76; 95% CI: 1.89-24.14), aortic aneurysm (OR: 5.82; 95% CI: 2.02-16.83) and systemic lupus erythematosus (OR: 4.09; 95% CI: 1.32-12.62) positively associated with CAA.
Conclusion: The epidemiology of CAA in Taiwan was low. Patients with CAA were mainly coexisted with Kawasaki disease in children and coronary atherosclerosis in adults. Antithrombotic agents were frequently used in CAA population. Aside from traditional risk factors, aortic disease and systemic lupus erythematosus were associated with CAA. Further investigation on the exact cause is warranted.

並列關鍵字

coronary artery aneurysm ； epidemiology ； prescribing pattern ； risk factor

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