慢性腎臟病患罹患梅尼爾氏症的風險: 台灣健保資料庫研究

Abstract

研究目的：慢性腎臟病是目前國內十大死因之ㄧ，在許多國家發生率都有逐年增加的趨勢，在台灣腎臟病的發生率約有11.9%，死亡率高達八成，影響著國人的健康、經濟與健保資源。慢性腎臟病引發的併發症相當多，目前已知的併發症有高血壓、心血管疾病、腎性貧血、腎性骨病變、神經病變、感染等，為減低健保醫療資源的浪費與達成預防醫學中提早預防的目標，除了針對慢性腎臟病的危險因子進行預防外，隨之可能引發的高風險疾病的預防也是項重要的工作。根據先前的研究顯示，腎臟與內耳早已存在著許多關聯，但卻沒有研究正式探討慢性腎臟病與梅尼爾氏症之間的風險關係，因此梅尼爾氏症的罹患對於慢性腎臟病病友來說是否存在高風險，在釐清了兩疾病之間的關係後，在治療慢性腎臟病的同時，也助於一併預防梅尼爾氏症的罹患。 研究方法：本研究為一縱貫性研究，使用2000年到2010年全民健康保險研究資料庫的資料進行研究，首先選取2003至2007年第一次診斷出患有慢性腎臟病且年紀大於20歲以上的成人做為實驗組，接著將2000至2010年沒有慢性腎臟病且與實驗組匹配性別、年紀區間的方式抽取三倍的受試者最為本研究的對照組，每位被包含入的受試者皆往後追蹤三年觀察是否罹患梅尼爾氏症，最後使用卡方檢定、Kaplan-meier、cox比例風險模型與對數等級檢定對資料進行分析。 研究結果：本研究發現有慢性腎臟病的人與沒有慢性腎臟病的病人在經過三年後的追蹤，罹患梅尼爾氏症的比例分別為0.27%與0.16%且統計上具有顯著差異(p < 0.001)。將潛在的危險因子經過校正後，結果顯示有慢性腎臟病的病患在經過三年追蹤後得梅尼爾氏症的風險相較於對照組有1.58倍之高(95 % CI = 1.24 – 2.02 )且達統計上顯著差異(p < 0.001)。在本研究中發現性別、年紀、自體免疫疾病中的皮肌炎、類風濕性關節炎、乾燥綜合症以及糖尿病亦為梅尼爾氏症的獨立風險因子。 結論：研究結果顯示慢性腎臟病與梅尼爾氏症這兩個疾病之間具有顯著的風險關係，其中又發現對於有慢性腎臟病且年紀大於40歲以上有合併症皮肌炎、類風濕性關節炎、乾燥綜合症或糖尿病的女性罹患梅尼爾氏症的風險又更高。

Purpose：Chronic kidney disease (CKD) is the ten leading causes of death in Taiwan. In many countries, the incidence has increased year by year. The incidence of kidney disease in Taiwan has about 11.9% and the mortality rate as high as 80%, people who had CKD indirectly affecting the health, the economy and a lot of resource of health insurance. As we know, CKD have many complications such as hypertension, cardiovascular disease, renal anemia, renal bone disease, neuropathy, infection etc. In order to reduce the health insurance waste of medical resources and achieve the goal of preventing early in the field of prevention medicine, directing against the risk factor of CKD to prevent. Furthermore, how to prevent the consequential diseases of CKD is also important. According previous studies revealed, the kidneys and the inner ear have been existed many related. However, there has no formally study to investigate the relationship between CKD and Meniere’s disease. Therefore, when we clarified the CKD patients have a high risk to develop Meniere’s disease, we not only treated the CKD but also prevented the risk of Meniere’s disease at the same time. Method：This is a longitudinal study and used 2000-2010 data from the National Health Insurance Research Database. First, we collected the patients who had over 20 years old and had first diagnosed with CKD in 2003-2007 as our study cohort. Then, our control cohort was randomly selected three age- and gender-matched subjects without CKD. After that, for each individual we follow up for three years form the index date to identify those who subsequently developed Meniere’s disease. Finally, the chi-square test, Kaplan-meier, cox proportional hazard model and log-rank test were used to analyze the data. Results：In this study, we compared CKD cohort to control cohort, we found patients with CKD had a higher proportion developed into Meniere’s disease (0.27% vs. 0.16%) and both them had a statistically significant difference (p <0.001). After adjusting for potential confounders, the results showed the hazard ratio of Meniere’s disease during the 3-year follow-up period was 1.58 higher for patients with CKD (95% CI = 1.24 – 2.02, p < 0.01) compared with the control cohort. In addition, this study also found gender, age, dermatomyositis, rheumatoid arthritis and Sjo¨gren syndrome of autoimmune diseases and diabetes was also an independent risk factor of getting Meniere’s disease. Conclusion：Our analysis presents that has a significant associated between CKD and increased risk of developing Meniere’s disease. Comorbidities of dermatomyositis, rheumatoid arthritis, Sjo¨gren syndrome and diabetes in patients with CKD displayed to be associated with increased risk of suffering Meniere’s disease, especially for the patients who are female and 40 years of age and older.