| Abstract: | 研究目的
痛風是一種炎症及代謝性疾病，它是有可能促進退化性或氧化壓力相關疾病的發展，例如白內障。然而，目前痛風與白內障的流行病學的關聯缺乏，因此，本世代研究主要是調查在臺灣的痛風與白內障之間的關係。
研究方法
本世代研究研究使用臺灣健保資料庫2000年百萬歸人檔（Longitudinal health insurance database 2000）來進行分析，有51,786位診斷為痛風的患者被選入研究組，而有853,658位沒有被診斷為痛風的患者被選入對照組。依照1：4的比例配對年齡、性別和沒有使用皮質性類固醇的使用，並且使用1：1的比例操作傾向分數配對(propensity score matching)，配對年齡、高血壓、慢性肝疾病、糖尿病、葡萄膜炎、青光眼和眼科就診。使用多變量Cox回歸分析估計白內障的風險值，並透過Kaplan-Meier analysis和log-rank test計算白內障的存活分析與累積發生率。
試驗結果
經過匹配後，有20,642位患者選入痛風組與非痛風組。從Kaplan-Meier analysis和Log-rank test顯示，在所有患者都有較高的白內障累積發生率。多變量分析顯示，罹患痛風的患者有較高的白內障風險(aHR = 1.26，95% CI=1.21-1.31, P <0.05)。並且在分層分析中，發現在所有年齡中都有較高的白內障風險。而在敏感分析中，痛風的患者也有較高的白內障風險(aHR = 1.32，95% CI=1.24-1.41, P <0.05)。
結論
痛風患者罹患白內障的風險顯著高於無痛風對照組。在臨床工作中，應該對痛風患者進行白內障的評估以及衛教。
Objective
Gout, as a metabolic and inflammatory disease, may contribute to the development of degenerative and oxidative stress related diseases, such as cataract. However, the epidemiological association between gout and cataract is lacking. This cohort study aims to investigate the association between gout and cataract in Taiwan.
Methods
A retrospective cohort study was conducted using data from the Taiwan National Health Insurance Research Database. A total of 51,786 patients diagnosed with gout were enrolled in the study cohort, and 853,658 patients without gout individuals were selected as the control group. After matching 1:4 by age, gender and excluding the usage of corticosteroids, the propensity score was matched 1:1 by age, hypertension, chronic liver disease, diabetes, uveitis, glaucoma and ophthalmology. Multivariate Cox regression analysis was performed to estimate the hazard ratio for cataract. The survival analysis and cumulative incidence of cataract were calculated by Kaplan-Meier analysis and log-rank test.
Results
After matching, 20,642 patients were enrolled in each of the gout group and non-gout group. In Kaplan-Meier analysis and Log-rank test, it was found that gout patients had a higher cumulative incidence of cataract. The multivariate analysis revealed that the risk of cataract was higher in patients with gout, compared to non-gout controls (aHR = 1.26, 95% CI=1.21-1.31, P <0.05). In subgroup analysis, it was found that gout patients had a higher risk of cataract in all ages and genders. Sensitivity analysis was done and the results were consistent (aHR = 1.32, 95% CI=1.24-1.41, P <0.05).
Conclusion
The incidental risk of cataract in gout patients was significantly higher than in the non-gout controls. Clinically, gout patients should be evaluated and educated for cataract. |
