子癇前症/子癇症與憂鬱症相關研究：利用國民健康保險研究資料庫

The association between eclampsia/ preclampsia and major depressive disorder by National Health Insurance Research Database

温櫻花(Ying-Hua Wen)

指導教授 ： 杜鴻賓

高雄醫學大學/護理學院/護理學系碩士班/碩士(2015年)

摘要

目的：子癇前症和子癇症已經發現相關於認知困難和神經認知功能障礙-兩者可能是憂鬱症的預測因子。我們研究假設子癇前症和子癇症可能有較大風險發展成為憂鬱症。
方法：利用國民健康保險研究資料庫(2010年承保抽樣歸人檔，LHID2010)，當作研究資料來源，使用Kaplan-Meier analysis and Cox regression估算，探討子癇前症(ICD-9-CM code 642.4 和 642.5)與子癇症(ICD-9-CM code 642.6和642.7)女性1:4年齡配對一般曾經生育女性，追蹤研究發生憂鬱症(ICD-9-CM code 296.2 和 296.3)的發生率與風險。
結果：本研究納入1329位子癇前症與子癇症和5316位曾經生育女性。研究結果呈現女性發生子癇前症/子癇症在第一胎佔約86%(第一胎的平均年齡是29.8歲)、曾經發生至少一次子癇前症/子癇症佔約94%和76%曾經有剖腹產經驗。結果呈現發生子癇症次數>1次患者(平均年齡27歲)，有13%發生憂鬱症(P=0.0476)。研究也發現，子癇前症/子癇症的累積發生憂鬱症大約7年(Log-rank test p= 0.0174)。一致的研究結果，子癇前症/子癇症發生率率比(IRR)是2.76(P=0.0260; 7.08每10000人年比較2.56每10000人年未曾發生子癇前症/子癇症)和控制疾病共變項後，子癇前症/子癇症危險對比值(HR)是2.63(95%信賴區間1.01-6.85；P=0.0472)。我們研究呈現子癇前症/子癇症的可歸因憂鬱症風險大約64%。
結論：研究發現女性罹患子癇前症/子癇症在比較一般曾經生育女性之後，發現患者會增加憂鬱症的風險。在衛生政策與公共衛生社區照護(護理照護與預防醫學)上，本研究的訊息能夠幫助個體們，對於可能發生憂鬱症的風險和發展為慢性憂鬱症給予適當醫療照護。

關鍵字

子癇前症 ； 子癇症 ； 憂鬱症

並列摘要

Objectives: Preeclampsia/eclampsia has been linked to cognitive difficulties and neurocognitive dysfunction- both are predictors of depression. We hypothesized that preeclampsia /eclampsia patients might have a greater risk for developing major depression.
Method: Using the longitudinal National Health Insurance Research Database (LHID2010), we conducted a retrospective population-based cohort study to evaluate the incidence of preeclampsia(International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM code 642.4 and 642.5) and eclampsia (ICD-9-CM code 642.6 and 642.7) in adult major depressive patients and controls matched (1:4) by age. Kaplan-Meier analysis and Cox regression were conducted to compare differences in the development of major depression(ICD-9-CM code 296.2 and 296.3).
Results: We identified 1329 adults preeclampsia/eclampsia patients and 5316 controls. Our results showed that women with preeclampsia/eclampsia had high frequencies of first delivery(86%), once of occurrence(94%)(mean age 29.8 years), and surgical delivery(76%). Furthermore, we also showed that the occurrence of eclampsia>1 women (mean age 27.0 years) had 13% of major depression when compared to the occurrence of eclampsia=1 women (mean age 29.6 years; P=0.0476). The cumulative incidence of preeclampsia/eclampsia in major depressive patients was significantly higher than controls (log-rank test P=0.0174), specifically 7th year follow up. The incidence rate of preeclampsia/eclampsia(7.08 per 10000 person-years) in major depressive patients was significantly higher than controls(2.56 per 10000 person-years; incidence rate ratio (IRR)=2.76, P=0.0260). After adjusting for potential confounders, preeclampsia/eclampsia was an independent predictor for major depression (adjusted hazard ratio= 2.63, 95% confidence interval 1.01-6.85; P=0.0472). The attributable risk percent(AR%) of major depression explained by preeclampsia/eclampsia was 64%.
Conclusions: Women with preeclampsia/eclampsia are at increased risk of major depression independently compared with the general once pregnant women. In health administration policy and public health community care(nursing care and preventive medicine), this information could help identify individuals at risk for major depression and development long before the onset of clinical features of the disease.

並列關鍵字

Preeclampsia ； Eclampsia ； Major depression

參考文獻

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