台灣肝硬化病人之血品利用研究

背景與目的：國人十大死因中有兩項（肝癌及慢性肝病）與肝病有關，在台灣每年約有七千人死於肝癌，其中約有六至七成是B型肝炎所引起，可見肝炎對國人健康為害之大；肝癌為全國癌症死因第二位，當慢性肝病發展成為肝硬化之後，因肝臟內異常增生的結締組織易造成食道靜脈瘤或胃靜脈瘤出血、凝血功能異常、血小板低下而須輸血治療。本研究目的旨在探討肝硬化病人用血情形。方法：本研究為次級資料分析，利用2000年全民健保資料庫百萬歸人檔，採回溯性世代研究之方法，篩選出2001年肝硬化病人，並排除小於20歲及已經罹患肝硬化病人，追蹤至2011年共10年觀察其是否罹患肝癌，採傾向分數配對法（Propensity Score Matching, PSM）依年齡、性別等進行1：4之配對，擷取2001年未罹患肝硬化之一般民眾作為對照組比較；評估肝硬化病人病史中輸血的效應。結果：共有914位肝硬化之病患被納入追蹤，一般民眾與肝硬化病人在血品使用上與冷凍血漿、血小板濃厚液、紅血球濃厚液、洗滌紅血球濃厚液、分離術血小板、新鮮冷凍血漿、冷凍沉澱品在統計上具有顯著差異(p < .001) 不同屬性肝硬化病人血品使用上與紅血球濃厚液之血品具顯著差異(p < .05)，紅血球濃厚液之使用男性有25.0%之使用比率，女性有20.2%之使用比率，呈現男性高於女性；不同年齡別屬性肝硬化病人之血品使用以40歲至64歲使用血品比率最高，血品使用輸血次數差異上與新鮮冷凍血漿在統計上有顯著之差異(p < .05)。肝癌病患血品使用上與冷凍血漿、紅血球濃厚液、分離術血小板、新鮮冷凍血漿、冷凍沉澱品在統計上具明顯差異。在各血品使用之輸血次數差異分析上與紅血球濃厚液、新鮮冷凍血漿、冷凍血漿達統計上顯著差異。結論：肝硬化及肝癌病人在血品使用上與冷凍血漿、紅血球濃厚液、分離術血小板、新鮮冷凍血漿、冷凍沉澱品具顯著差異。

關鍵字

肝硬化；輸血；血品使用

並列摘要

Background:Among the top ten causes of death among Chinese people, liver cancer and chronic liver disease are related to liver disease. About 7,000 people die of liver cancer every year in Taiwan ,About six to seventy percent of them are caused by hepatitis B. Hepatitis can be a great threat to the health of Chinese people. Liver cancer is the second cause of cancer death in Taiwan.When chronic liver disease develops into liver cirrhosis,due to Connective tissue abnormal hyperplasia in the liver is easy to cause esophageal varices or gastric venous tumor hemorrhage, abnormal blood coagulation, and low platelet counts, liver cirrhosis need to blood transfusion therapy. The purpose of this study was to investigate the translation of blood products used in patients with liver cirrhosis. Methods:We conducted a nationwide population-based matched cohort study to assess the risk of incident liver cancer in people with liver cirrhosis. The data for this study was from the Taiwan’s National Health Insurance database. From the database we captured incident liver cirrhosis patients in the year 2001 excluding less than 20 years old and past history of liver cirrhosis patients. Observe whether has liver cancer in 10 years. liver cirrhosis patients were matched 1:4 to control subjects according to sex, age and the index date. Compare the general population without cirrhosis in 2001 as a control group，assessing the risk of liver cancer in patients with liver cirrhosis and the effect of blood transfusion in medical history. Results:914 patients with liver cirrhosis were included in the follow-up. The general population and patients with cirrhosis have statistically significant differences in blood products use with frozen plasma, platelet concentrate, packed red blood cell, washed packed red blood cell, Apheresis Platelets, fresh frozen plasma, and Cryoprecipitate(p < .001). Blood products from patients with different attributes of cirrhosis were significantly different from those of packed red blood cell (p < .05). The use of packed red blood cell has a 25.0% use ratio for men, women have a usage rate of 20.2%.,showing men higher than women. The highest blood products Utilization ratio of patients with cirrhosis of different ages is between 40 and 64 years old, the times of blood transfusions was a statistically significant difference with fresh frozen plasma (p < .05). Liver cancer patients in products using is a statistically significant difference between frozen plasma, packed red blood cell, apheresis Platelets, fresh frozen plasma, and Cryoprecipitate. There was a statistically significant difference between the packed red blood cell, the fresh frozen plasma, and the frozen plasma in the difference analysis of the number of blood transfusions used in each blood product. Conclusions:Patients with cirrhosis and liver cancer have significant differences in blood product use with frozen plasma, packed red blood cell, apheresis Platelets, fresh frozen plasma, and Cryoprecipitate.