以台灣全民健保資料庫分析牙科銀粉充填與原發性震顫相關性之研究

原發性震顫 (Essential Tremor) 是臨床常見的神經性紊亂運動障礙之一。汞蒸氣的暴露是增加震顫風險的關鍵因素。而牙科銀粉充填是汞合金修復物主要來源之一。由文獻回顧顯示，原發性震顫和牙科銀粉充填之間的關係仍不清楚。本研究的目的運用全民健康保險資料庫來分析探討牙科銀粉與罹患原發性震顫風險之間的關聯性，並利用該資料庫進行了病例對照研究。病例組和對照組分別採用性別、年齡、城市化水準、月收入、查爾森合併發病指數(Charlson comorbidity index)等指標，採用傾向評分法(propensity score)，比例為1:1。本研究，共納入了3008個病例和3008個對照組。研究結果顯示，罹患原發性震顫之風險與牙科銀粉充填間並無直接關係，且不具統計學上的顯著意義（OR：0.94，95％CI = 0.85-1.04）。進一步的分層分析結果，罹患原發性震顫與銀粉充填在男女性別上並無統計學上的差異。而對於牙科銀粉充填的患者，得到原發性震顫男性患者風險值為0.92（95％CI = 0.80–1.05）；女性患者風險值為0.97（95％CI = 0.83-1.13），無統計學上的意義。另外，年齡分組上，有牙科銀粉充填且年齡大於80歲的病患得到原發性震顫的風險是沒有牙科銀粉充填的1.03倍，無統計上的顯著差異（95％CI = 0.83-1.27）。再來，針對牙科銀粉充填數量分三組來做分析，罹患原發性震顫患者與牙科銀粉充填顆數一至三顆、四至七顆和多於七顆的風險值分別為0.90、0.94和1.02。儘管它們沒有達到統計學上的顯著性差異，但與牙科銀粉填補顆數增加呈正相關的趨勢。這項全國性的人口病例對照研究的結果並沒有顯示臺灣的原發性震顫和牙科銀粉有任何關聯。雖然沒有顯著相關，但研究結果仍有其價值。

Essential tremor (ET) is a common neurological disorder and the most common movement disorder. Low-level occupational exposure to mercury vapor is known to be a crucial factor that increases the risk of tremor. Dental amalgam is one of the main sources of mercury in our daily life. However, the relationship between ET and amalgam filling (AMF) is not quite clear. The purpose of this study was to investigate the association between AMF and the risk of ET using a population-based administrative databank. The data for this study were sourced from the Taiwanese National Health Insurance Research Database (NHIRD). A retrospective case–control study was conducted using this databank from 2000 to 2013. Case and control groups were matched by sex, age, urbanization level, monthly income, and Charlson comorbidity index using the propensity score method with a 1:1 ratio. In this study, 3008 cases and 3008 controls were included. Our results did not reveal any direct link between the risk of ET and AMF. However, they demonstrated a positive association with an increase in the number of fillings. Although the results were still not significantly statistical, the findings may be worthy to be valued. Taken together, this nationwide population-based case–control study did not indicate any association between ET and AMF in Taiwan.