腎臟移植與發生痛風風險的相關研究

Kidney Transplant Associated with Incident Risk of Gout: A Retrospective Cohort Study

沈若云(Fransiska Romana Simbolon)

指導教授 ： 杜鴻賓

高雄醫學大學/醫學院/醫學研究所碩士班/碩士(2017年)

摘要

摘要
背景：
末期腎臟疾病患者，為維持生命的延續，其較好醫療處置，是患者能夠移植功能較好腎臟至患者身上。學術研究報告指出痛風發生與腎移植患者之間具有相關性，但臨床流行病學研究上，仍有部分有待需釐清它們之間的相關強度.
目的：
研究目的是探討腎移植患者和痛風發生風險之相關研究。
研究設計：
研究設計是回溯性追蹤研究；研究數據來源，是使用台灣健康保險資料庫和重大傷病資料庫並行，進行研究分析與探討它們之間的相關強度。研究樣本納入5745位腎移植患者，在1：4配對年齡、年齡組別、性別等變項條件下，配對可比較性非腎移植之對照組22980位，並探討與分析腎移植患者追蹤至痛風發生的風險比；其研究之統計方法，主要是Cox比例風險回歸分析。
結果：
我們的結果發現腎移植患者追蹤至痛風發生的發生率，是較高於配對樣本組別(18.92 vs 9.16 每1000人年， 發生率率比2.07, P值0.0006)；其結果揭露腎移植患者是顯著增加痛風發生風險(風險比1.52)。我們也發現女性腎移植患者遠大於男性，有較高痛風發生風險(風險比7.57 vs 2.15)，特別發現20-50歲女性，予3年內接受腎移植者，有較高痛風發生風險(風險比38.35，P值 <0.0001)。
結論：
這研究結果呈現腎移植患者相關於痛風事件發生之風險，特別是3年內之20到50歲女性腎移植患者，需要較大關注與醫療照顧。
關鍵字: 痛風,腎移植, 回顧性隊列研究, 人口數據庫

關鍵字

痛風 ； 腎移植 ； 回顧性隊列研究 ； 人口數據庫

並列摘要

Abstract
Background: Kidney transplantation has become the treatment of choice for most patients with end-stage renal disease (ESRD).Gout is a common problem among renal transplant patients. Study on kidney transplant and the association with gout is still few and low quality
Aims: The purpose of this study was to investigate the association between kidney transplant and the risk of gout.
Study Design: In this age, age group, and sex matched retrospective cohort study, the National Health Insurance Research Database (NHIRD) and the Catastrophic Illness Certificate (CIC) dataset were linked. A total of 5745 patients with kidney transplant and 22980 controls were included at a ratio of 1:4. Hazard ratios [HRs] for incident of gout were calculated after adjustment for comorbidities by using Cox proportional hazards regression
Results: Transplant cases had higher incidence rate of gout than those in control group (18.92 vs 9.16 per 1000 person-years, IRR 2.07, P =0.0006). Cox proportion hazard regression analysis showed that kidney transplant significantly associated with the risk of gout (HR 1.52). It suggested that the risk of gout is larger in women than in men in the duration of follow up ≤3 years (HR 7.57 vs HR 2.15). The result showed the highest risk of gout in women group in the age of 20-50 years (HR 38.35, P<0.000).
Conclusion: There is an association between kidney transplant and incident risk of gout. The magnitude of association is significantly larger in women than in men, in age 20 to 50 years old with follow up duration less than 3 years.
Keywords: Gout, kidney transplant, retrospective cohort study, and population database.

並列關鍵字

Gout ； kidney transplant ； retrospective cohort study ； population database

參考文獻

References

1. Hiesse C. [Kidney transplantation epidemiology in France]. Nephrol Ther 2013;9:441-50.

2. Garcia-Garcia G, Harden P, Chapman J. The Global Role of Kidney Transplantation for the World Kidney Day Steering Committee 2012. International Journal of Organ Transplantation Medicine 2012;3:1-8.

3. Shiozawa A, Szabo SM, Bolzani A, Cheung A, Choi HK. Serum Uric Acid and the Risk of Incident and Recurrent Gout: A Systematic Review. The Journal of Rheumatology 2017;44:388-96.

4. Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis care & research 2012;64:1431-46.