台灣膿胸的危險因子及其對預後的影響

Risk Factors of Empyema and Their Impacts on the Prognosis in Taiwan

盧緹婕(Ti-Chieh Lu) ； 沈德群(Te-Chun Shen) ； 林橙莉(Cheng-Li Lin) ； 顏至慶(Chih-Ching Yen) ； 吳樺姍(Hua-Shan Wu)

《內科學誌》 31卷4期 (2020/08) Pp. 276-283

https://doi.org/10.6314/JIMT.202008_31(4).08

摘要

膿胸的發生率有持續上升的趨勢，是威脅健康的重要疾病，本研究將釐清台灣膿胸的危險因子及其與預後的關聯性。我們使用台灣全民健康保險研究資料庫之百萬歸人抽樣檔案，探查台灣膿胸病例組與無膿胸對照組各項共病症的分佈、病例組30天內與90天內的死亡情形以及導致膿胸發生與死亡的相關因子。以卡方檢定來檢驗病例組與對照組、死亡組與存活組的類別變項，以羅吉斯迴歸模型來分析膿胸發生和死亡的勝算比與95%信賴區間。膿胸病例組總計納入1851人（2000到2012年新診斷的病人，平均年齡62.4歲，男性占75.9%），對照組總計納入7404人。病例組在30天內死亡79人（4.3%），90天內死亡397人（21.4%）。與膿胸發生相關的因子包括嗆入病史、人類免疫不全病毒感染、營養失調、癌症、糖尿病、腦血管疾病、慢性腎臟病、肺阻塞、氣喘和慢性肝臟病；與30天內死亡相關的因子包括年長和癌症；與90天內死亡相關的因子包括年長和營養失調、嗆入病史、癌症、肺阻塞、糖尿病與腦血管疾病。本研究成功地確認了數個膿胸的危險因子，其中有幾個危險因子也確實與預後有顯著相關。

關鍵字

膿胸（Empyema） ； 流行病學（Epidemiology） ； 危險因子（Risk factor） ； 預後（Prognosis） ； 死亡（Mortality）

並列摘要

The incidence of empyema is increasing, indicating that it is an important disease worldwide. This study aimed to investigate the risk factors of empyema and their impacts on the prognosis in Taiwan. We conducted a retrospective study by using data from the Taiwan National Health Insurance Research Database. We established an empyema group comprising 1,851 newly diagnosed adult patients during 2000-2012 and a non-empyema group comprising 7,404 individuals who were 1:4 frequency matched by age, sex, and date of empyema diagnosis. Variables included age, sex, cerebrovascular disease (CVD), chronic obstructive pulmonary disease (COPD), asthma, chronic liver disease and cirrhosis (CLD), chronic kidney disease (CKD), diabetes mellitus (DM), rheumatic disease, immune deficiency, human immunodeficiency virus (HIV) infection, cancer, depression, malnutrition, and aspiration history, and corticosteroid use. We monitored 30-day and 90-day mortality in the empyema group. Logistic regression analysis was utilized to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The significant factors leading to empyema occurrence included aspiration history (OR = 7.28, 95% CI = 5.00-10.6), HIV infection (OR = 5.66, 95% CI = 1.38-23.2), malnutrition (OR = 2.86, 95% CI = 2.07-3.95), cancer (OR = 2.74, 95% CI = 2.28- 3.30), DM (OR = 2.25, 95% CI = 1.96-2.59), CVD (OR = 1.99, 95% CI = 1.70-2.34), CKD (OR = 1.78, 95% CI = 1.42-2.25), COPD (OR = 1.72, 95% CI = 1.47-2.01), asthma (OR = 1.34, 95% CI = 1.15-1.57), and CLD (OR = 1.20, 95% CI = 1.06-1.35). The 30-day mortality rate was 4.3% (n = 79) and the 90-day mortality rate was 21.4% (n = 397). The significant factors for 30-day mortality included old age (OR = 2.03, 95% CI = 1.25-3.31) and cancer (OR = 2.69, 95% CI = 1.61-4.47). The significant factors for 90-day mortality included old age (OR = 1.92, 95% CI = 1.48-2.49), malnutrition (OR = 2.24, 95% CI = 1.44-3.50), aspiration history (OR = 2.04, 95% CI = 1.37-3.03), cancer (OR = 1.78, 95% CI = 1.30-2.43), COPD (OR = 1.55, 95% CI = 1.17-2.04), DM (OR = 1.48, 95% CI = 1.15-1.91), and CVD (OR = 1.45, 95% CI = 1.09-1.91). We successfully identified several risk factors of empyema, and some of them were significantly associated with poor prognosis.