精神分裂症與慢性腎臟病之關聯性

Abstract

精神分裂症的病患經歷精神和身體機能逐漸衰弱的過程，且因長期服用抗精 神病藥物，會導致高血壓、糖尿病、腦中風等代謝症候群的伴隨，這些都是國人高 盛行率之慢性疾病。另一方面，慢性腎臟病是全球性的挑戰與負擔，台灣約有 12 ％的人口患有慢性腎臟病，由於慢性腎臟病早期不易被發現，精神分裂症病患又因 長期服用藥物，增加腎臟代謝的負擔，本研究希望能探討其中之關聯性，達到早期 預防之效果。 本研究使用台灣全民健康保險研究百萬歸人檔資料庫之資料，找出 2003-2007 初次罹患精神分裂症病患，並濾除 2000-2002 年有精神分裂症和慢性腎臟病診斷之 病患，以及年齡小於 18 歲的病患。最後本研究中包含 2338 位精神分裂症病患，以 及符合相對應年紀、性別族群之三倍 7014 位無精神分裂症族群，追蹤三年記錄慢 性腎臟病診斷、抗精神病藥物使用情況、以及慢性腎臟病共病罹患情形。以多變量 Cox 迴歸以及羅吉斯迴歸分析，依變項為有無罹患慢性腎臟病，自變項調整性別、 年紀族群、所得收入、都市化程度、居住地域、糖尿病、高血壓、高血脂、肥胖症、 心臟病和有無服用抗精神病藥物等一系列存活分析方式來探究兩疾病之關聯性。 結果發現，有精神分裂症的病患有較高的風險罹患慢性腎臟病，調整風險比為 1.33，95%信賴區間為 1.10-1.61，p-value 為 0.004，達到統計上顯著相關差異，可 見精神分裂症有較高的風險罹患慢性腎臟病。進一步分析十七種典型和非典型抗 精神病藥物服用情況，發現精神分裂症病患其服用抗精神病藥物，與之後罹患慢性 腎臟病的勝算無統計上顯著相關(典型抗精神病藥物罹患慢性腎臟病調整勝算比為 1.47，95%信賴區間為 0.86-2.53，p-value 為 0.159；非典型抗精神病藥物罹患慢性 腎臟病勝算比為 1.53，95%信賴區間為 0.92-2.55，p-value 為 0.104)。而近年來有文 獻指出精神分裂症病患因服用抗精神病藥物有較高風險罹患糖尿病、高血壓、高血 脂、心臟病等代謝症候群，是否因此因素而後罹患慢性腎臟病，將有待進一步臨床 實驗驗證。 本研究發現精神分裂症病患會顯著增加罹患慢性腎臟病之風險，並進一步探 討其關連性。研究此巨量資料使用一系列流行病學統計模型方法探討精神分裂症 與慢性腎臟病之關聯性，由於健保資料庫規模龐大，資料處理分析複雜，相信本研 究的統計分析模型與流程也能夠應用於其他探討疾病因果關係的相關議題上。

Schizophrenia patients experience mental and physical function weakened in the process, and because use of antipsychotics, may cause hypertension, diabetes, stroke and other and other associated metabolic syndrome, these chronic diseases are high prevalence in Taiwan. The burden of chronic kidney disease (CKD) is a global challenge. 12% of population in Taiwan suffer from CKD, due to CKD is not easy to find, and because of schizophrenia patients use long-term medication, increasing the burden of renal metabolism, this study aim to find the association between schizophrenia and chronic kidney disease, hoping to achieve the effect of early prevention. This study uses the Taiwan National Health Insurance Research Database 1 million data. From 2003 to 2007, we identified newly diagnosed schizophrenia patients, including 2338 patients with schizophrenia and 7014 sex and age group matched three times were selected for comparison without schizophrenia, two cohorts were followed up three years, and the diagnosis of CKD, antipsychotics, and comorbidity were observed. In multivariate cox regression and logistic regression analysis, dependent variable is with or without CKD, independent variables are sex, age group, monthly income, urbanization level, geographic location, diabetes mellitus, hypertension, hyperlipidemia, obesity, heart disease, and antipsychotics use, a series of above survival analysis methods to explore the association between two diseases. The results show patients with schizophrenia were have a higher risk of suffering from chronic kidney disease than comparison significantly (HR=1.33, 95% CI=1.10-1.61, P=0.004). Further analysis of 17 kinds of typical and atypical antipsychotics, and found that schizophrenic patients taking antipsychotics and then suffering from CKD with no statistically significant difference (Adjusted odds ratio for typical antipsychotics and then suffering from CKD was 1.47, 95%CI=0.86-2.53, p-value=0.159; adjusted odds ratio for atypical antipsychotics and then suffering from CKD 1.53, 95%CI=0.92-2.55, p-value 0.104). In recent years, the literature indicates that antipsychotics may increases the odds of diabetes, hypertension, hyperlipidemia, and heart disease, whether due to patients take iii

antipsychotics lead to the comorbidity of CKD, then transform chronic kidney disease finally, further verification maybe prove by clinical trials. This study to find the patients with schizophrenia will increase the risk of chronic kidney disease significantly. This epidemiological study used a series of statistical modeling to analysis the association between schizophrenia and chronic kidney disease. Because it’s the big data in NHIRD, hoping statistical analysis models and processes in this study can also be applied to other related study issues.