以健保資料庫探討眼部表現及與系統性疾病之關聯性

Using National Health Insurance Research Database to Explore Ocular Manifestations in Systemic Diseases

顏如娟(Ju-Chuan Yen)

指導教授 ： 李友專

臺北醫學大學/醫學科技學院/醫學資訊研究所/博士(2016年)

摘要

導論:
探索系統性疾病在眼科學的臨床表現，有助於早期發現系統性疾病。本博士論文利用健保資料庫來探索系統性疾病在眼科學的臨床表現。
材料與方法:
我們首先在PubMed上搜尋眼科領域使用台灣健保資料庫之學術論文，其中34篇是眼科疾病與系統性疾病的關聯性研究。我們針對這34篇研究論文，把系統性疾病與眼科疾病的ICD-9-CM診斷碼分別找出，在疾病地圖(the disease map)上找出其同時發生的勝算比(odds ratio)。第二階段，我們使用疾病地圖，探討眼科疾病(疾病分類代碼ICD-9-CM 360-379) 與系統性疾病的關聯性。經由第一階段所得結果，我們以勝算比大於5，同時發生次數大於100為選取條件，將符合條件之disease pairs依年齡層進行討論。第三階段，我們選取其中一個disease pair以台灣健保資料庫進行世代比較研究(Cohort comparison study)。
結果:
使用「台灣」、「健保資料庫」及「眼科」三個關鍵字在PubMed上可搜尋得到68篇論文，其中34篇是眼科疾病與系統係疾病的關聯性研究。這34篇的論文探索之disease pair，若有關聯性，其在disease map之勝算比多大於5,共同發生次數大於100。依上述條件，疾病地圖中有898疾病配對。其中自體免疫疾病與血管性疾病佔顯著之比例。我們選擇乾眼症是否為乾燥症的風險因子進行研究。結果顯示乾眼症盛行率為4.87%。乾眼症研究對象的乾燥症發病率為4.8%，而對照的世代比較研究對象為1.5%。校正過的百分之95信心區間之風險比值為3.64 (3.43-3.87)。
結論:
健保資料庫有助於探討系統性疾病在眼科學的臨床表現，我們認為本論文提出的三階段模式，可以應用在其他臨床科別。

關鍵字

健保資料庫 ； 疾病地圖 ； 眼科學 ； 乾眼症 ； 修格連氏症候群

並列摘要

Introduction
Exploration of ophthalmological clinical presentations in systemic diseases could help to detect systemic disease timely. We used Taiwan’s national health insurance database to explore ophthalmological manifestations in systemic diseases in this dissertation.
Materials and Methods:
We searched PubMed using “National Health Insurance Database”, “Taiwan” and “Ophthalmology” as keywords as the first step of the research. There were 34 research articles targeting on the associations between ocular diseases and systemic diseases. Towards these 34 research articles, we found the corresponding ICD-9-CM disease codes of the ocular diseases and systemic diseases and examined their disease pair odds ratio in disease map. The second step of this research was to use disease map to investigate the associations between ophthalmological diseases (ICD-9-CM 360-379) and systemic diseases. Based on the result of the first step, we set the criteria of odds ratio and examined all the disease pairs which met the inclusion criteria. The third part of this research; we chose one disease pair to conduct a Cohort comparison study by using national health insurance database.
Results:
Using “national health insurance database”, “ Taiwan” and “ophthalmology” as keywords to search in PubMed, we have found 68 research articles. Among them, 34 articles were focusing on the association of ocular diseases and systemic diseases. And the results revealed that if the association results of these disease pairs in the 34 articles were positive, then the odds ratio were mostly greater than 5 and co-counts greater than 100. Based on these inclusion filtering criteria, we found 898 disease pairs, and among them we have found that autoimmune diseases and vascular diseases played an obvious role. We chose whether dry eye syndrome was a risk factor of Sjogren’s syndrome to conduct a cohort study. The results showed that the prevalence of dry eye syndrome was 4.87%, the incidence rates of developing SS were 4.8% for the DES group and 1.5% for comparison group, and the adjusted hazard ratio (with 95% confidence interval) was 3.64 (3.43–3.87).
Conclusion:
Using Taiwan’s National Health Insurance Database to explore ophthalmological manifestations in systemic diseases is helpful. And the three-step approach could be applied to other clinical disciplines as well.

並列關鍵字

national health insurance database ； ophthalmology ； disease map ； dry eye syndrome

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