類風溼性關節炎與慢性肝病之關聯性

Abstract

類風溼性關節炎為一多系統自身免疫性疾病，病患本身的免疫系統會侵犯全身各個組織器官，雖然類風濕性關節炎患者對於肝臟的損壞相較其他臨床表現不突出，類風濕性關節炎患者後來引起肝臟損傷的案例並不少見，有臨床表現出肝臟嚴重的損害甚至危及病患生命的例子。全身性的類風濕關節炎可能與自體免疫性肝病如原發性膽汁性肝硬化或自體免疫性肝炎而導致肝損傷有關。但之前類風濕性關節炎患者肝功能異常多認為主要為類風濕性關患者感染其他併發症，如病毒性肝炎、脂肪肝或類風濕性關節炎藥物治療所引起，臨床上肝臟受損的原因仍不知是類風濕性關節炎本身還是藥物所導致。因此利用健保資料庫進行病例對照研究探討類風濕性關節炎、藥物與慢性肝病風險相關性，提供臨床用藥一個參考。 2001-2005年18歲以上第一次診斷出類風濕性關節炎患者（N=7864）；對照組以實驗組1:3匹配性別、年齡之抽樣無罹患類風濕性關節炎的個案（N=23592）。往後追蹤5年是否有慢性肝病的診斷、與慢性肝病相關共病與類風溼性關節炎藥物使用記錄。以多變量Cox回歸調整性別、年齡、所得收入、高血壓、糖尿病、高血脂、心臟病、慢性腎臟病、惡性腫瘤探究兩疾病間的相關性。結果顯示，類風濕性關節炎病患有較高的風險罹患慢性肝病，調正後的風險比為1.38（95% CI=1.29-1.46，p<0.001）；進一步分析類風濕性關炎患者服用各種類風溼性關節炎藥物與之後罹患慢性肝病的相關性，在多種藥物中，類風濕性關節炎患者服用Hydroxychloroquine與NSAID 和之後罹患慢性肝病的風險相關。

Rheumatoid arthritis is an autoimmune disease, which cause patient's own immune system violating various body tissues and organs. Although the damage to the liver of patients with rheumatoid arthritis are not prominent compared to other clinical manifestations, rheumatoid arthritis causing inflammation in patients with liver damage cases are common. It is known that chronic liver disease cause by other infectious complications, such as viral hepatitis, fatty liver, or the rheumatoid arthritis drug therapy, but whether rheumatoid arthritis itself is one of the risk factor of chronic liver disease and other liver damage still do not understand. Therefore the study use the Taiwan Health Insurance Research Database study to conduct epidemiologic analysis for following research purpose: First, find the association between rheumatoid arthritis and chronic liver disease. Second, understand the association between treatment of rheumatoid arthritis with chronic liver disease relevance. From 2001 to 2005, we identified the first time diagnosed with rheumatoid arthritis (N = 7864) and the control group 1: 3 matching gender, age of the sample not suffering from rheumatoid arthritis (N = 23592). After collecting and verifying the experimental group and the control group, we track five years to find whether there is the diagnosis of chronic liver disease, comorbidity and rheumatoid arthritis drug use records. In multivariate Cox regression analysis, independent variables was adjusting for sex, age, income, high blood pressure, diabetes, high cholesterol, heart disease, chronic kidney disease, rheumatoid arthritis, and cancer and to explore the correlation between the two diseases. The results showed that rheumatoid arthritis patients have a higher risk of developing chronic liver disease, the adjusted hazard ratio is 1.38 (95% CI = 1.29-1.46, p <0.001). Further analysis the association between rheumatoid arthritis and various drugs, finding that rheumatoid arthritis patients who take Hydroxychloroquine and NSAID have a higher risk of suffering from chronic liver disease.