發炎性腸道疾病與肝膽疾病之相關性:台灣全國性回溯性世代研究

研究目的本研究目的為比較暴露發炎性腸道疾病者相較未暴露發炎性腸道疾病(IBD)者得到與原發性硬化性膽管炎(PSC)、膽石症(GD)是否存在差異，以及IBD是否與PSC、GD存在統計上之相關性(p≤0.05)。研究方法本研究為回溯性世代研究（retrospective cohort study），以我國2010年之全民健康保險承保人作為研究母群體，擷取2002年至2012年之新發生之克隆氏症(CD)病人及潰瘍性結腸炎(UC)病人作為研究對象，並以性別、年齡、投保金額、投保地區都市化程度及共病症指數(CCI)進行傾向分數配對(PSM)出對照世代後，分析IBD是否與GD、PSC存在相關性，以及暴露於IBD下，罹患GD與PSC，相較未暴露者，是否有統計上較高風險(p≤0.05)。研究結果經卡方獨立性檢定，發炎性腸道疾病與膽石症具有統計上的顯著相關(p≤0.05)，但與原發性硬化性膽管炎無統計上的相關(p>0.05)。經Cox對比涉險模式分析之結果顯示，IBD患者相較無罹患IBD者，發生GD之年齡調整風險比為1.36倍(95%CI=1.21-1.53, p<0.001)；而PSC方面，相較無IBD者，發生PSC之年齡調整風險比為1.37倍(95%CI=0.95-1.99, p=0.092)，但兩者無統計上顯著差異(p>0.05)。結論本研究結果發現IBD的暴露與GD確實相關，且相較非暴露者有統計上之較高風險，若病患同時患有CD與UC時，發生GD之風險比更高。但在PSC方面，本研究結果顯示IBD暴露，在發生PSC上並無統計上的相關性及風險差異(p>0.05)。

OBJECTIVEThe purpose of this study is to compare whether there is a difference between those exposed to Inflammatory Bowel Disease(IBD) and those who did not exposed to IBD after having Primary sclerosing cholangitis(PSC) and Gallstone Disease(GD), and whether there is a statistical correlation between PSC and GD or not.METHODSThis study is a retrospective cohort study, taking Taiwan’s 2010 National Health Insurance subscriber as the research population, and choosing newly diagnosed Crohn's disease(CD) patients and Ulcerative colitis(UC) patients from 2002 to 2012 as research objects, and used propensity score matching(PSM) by sex, age, payroll bracket, degree of urbanization in the Group insurance applicant area and charlson comorbidity index(CCI) for the control cohort. Analyzing whether IBD is related to GD, PSC, and whether there is a higher risk of exposure to IBD, suffering from GD and PSC comparing with those who are not exposed(p≤0.05).RESULTSAccording to the Chi-square test of independence, there is a statistically significant correlation between IBD and GD, but no statistical correlation with PSC. The results of Cox proportional hazard regression models analysis show that the age-adjusted hazard ratio of GD in patients was 1.36 times (95%CI=1.21-1.53, p<0.001) more than patients without IBD, and for PSC, the age-adjusted hazard ratio for PSC was 1.37 times(95%CI=0.95-1.99, p=0.092) more than those without IBD, but there was not statistically significant(p>0.05).CONCLUSIONSThe results of this study have proved that exposure to IBD is indeed related to GD, and there is a statistically higher risk than non-exposed persons. If having both CD and UC, the hazard ratio of GD is higher. However, for PSC, the results of this study show that if exposing to IIBD, there is no statistical correlation and risk difference in PSC(p>0.05).