非酒精性肝硬化合併冠狀動脈疾病之病人其臨床風險

研究目的以台灣健保資料庫探討非酒精性肝硬化患者合併冠狀動脈疾病之盛行率、併發症及其死亡風險分析。研究方法本世代研究以全民健康保險資料庫2006年1月至2011年12月間，針對40歲以上過去未有冠狀動脈疾病病史族群，找出新診斷的非酒精性肝硬化患者，進行為期6年的世代追蹤，對照組則以年齡、性別、居住地及診斷時間進行配對，選取5倍於研究數量的正常族群人數，其平均追蹤期間為1152±633天，找出這些患者在接下來的6年內罹患冠狀動脈疾病的機會及其死亡風險，並探討肝硬化患者合併其他慢性疾病病史與併發症之相關性。研究結果本研究於健保資料庫100萬人中找出3,409位新診斷的非酒精性肝硬化患者，經配對後選取5倍於研究數量的正常族群人數 (16,180人)作為對照組，結果發現肝硬化患者族群相較於對照組較少人罹患冠狀動脈疾病(5.1% vs.17.5%)、高血脂症(20.6% vs.24.1%)，較多人罹患高血壓(50.1% vs.41.2%)、糖尿病(33.2% vs.19.4%)、心臟衰竭(7.8% vs.6.0%)、慢性腎臟疾病(19.0% vs.7.5%)及腦中風(12.8% vs.9.8%)。本研究發現，在所有共病中，非酒精性肝硬化患者合併慢性腎臟疾病其死亡風險最高(adjusted HR, AHR=1.76; 95% CI:1.55-2.00, p < 0.001)。至於肝硬化的併發症中，則屬腹水及腹膜炎會有較高的死亡風險(AHR=2.34; 95% CI, 2.06-2.65; p< 0.001)。這些非酒精性肝硬化患者，在追蹤的過程中，共有170位病人產生新診斷的冠狀動脈疾病，相較於無肝硬化的族群，有無冠狀動脈疾病的肝硬化患者其六年存活率各為52%及50% (p = 0.012)，罹患冠狀動脈疾病其死亡風險較低(AHR=0.56, 95% CI, 0.43-0.74; p < 0.001)。結論冠狀動脈疾病在非酒精性肝硬化患者有較低的盛行率，也與在此族群病人死亡風險的降低有所關聯

Aim: To elucidate the prevalence and risk of mortality in non-alcoholic liver cirrhosis (LC) patients with coronary artery disease (CAD).Method: The study cohort includes newly diagnosed non-alcoholic LC patients, age ≥40 years old, and without diagnosis of CAD, from 2006 until 2011 using longitudinal Health Insurance Database. The mean follow-up period for the study cohort was 1152±633 days. The control cohort was matched by sex, age, residence, as well as index date. The hazard ratios (HRs) were calculated using the Cox proportional hazard model and the Kaplan-Meier method.Result: After exclusion, a total of 3,409 newly diagnosed non-alcoholic cirrhotic patients were identified from one million samples of health insurance database. We found that CAD (5.1% vs. 17.4%) and hyperlipidemia (20.6% vs. 24.1%) were less prevalent in non-alcoholic LC patients compared with normal subjects (all p<0.001), while other comorbidities were higher. Among the comorbidities, chronic kidney disease had the highest risk for mortality (adjusted HR, AHR=1.76; 95% CI:1.55-2.00, p < 0.001). Ascites or peritonitis carried the highest risk of mortality among non-alcoholic cirrhotic patients (AHR=2.34; 95% CI, 2.06-2.65; p< 0.001). Finally, a total of 170 patients developed CAD after the diagnosis of non-alcoholic LC. The AHR of CAD in non-alcoholic LC patients was 0.56 (95% CI, 0.43-0.74; p < 0.001). The six-year survival rates for non-alcoholic LC patients with and without CAD were 52% and 50%, respectively (p = 0.012). Conclusion: We conclude from the study that CAD was less prevalent and was associated with a reduced risk of mortality in non-alcoholic cirrhotic patients.