慢性蕁麻疹患者的全身紅斑性狼瘡風險: 一項全國回溯性世代之研究

研究目的慢性蕁麻疹(CU)是一種免疫疾病，其致病機轉與過敏反應，與免疫系統改變有關。而全身紅斑性狼瘡(SLE)是一種複雜性、致命的免疫疾病。然而，目前缺乏慢性蕁麻疹與全身紅斑性狼瘡的流行病學的關聯，因此，本世代研究主要是在調查臺灣慢性蕁麻疹與全身紅斑性狼瘡之間的關係。研究方法本世代研究使用臺灣健保資料庫 2000 年百萬歸人檔（Longitudinal health insurance database 2000）來進行分析，共13845位診斷為慢性蕁麻疹病人被選入研究組，而55380位沒有被診斷為慢性蕁麻疹的病人被選入對照組。依照1：4的比例配對年齡、性別。並且使用1：1的比例操作傾向分數配對（propensity score matching），配對年齡、高血壓、慢性肝病、糖尿病。使用多變量Cox回歸分析估計全身紅斑性狼瘡的風險值，並透過 Kaplan-Meier analysis 和log-rank test計算全身紅斑性狼瘡的存活分析與累積發生率。研究結果慢性蕁麻疹病人以女性居多，並且有慢性蕁麻疹者居住在城市相較於對照組高(62.61% vs. 60.72%)及患慢性蕁麻疹者住院天數相較於對照組高(1-6天：9.73% vs. 7.64% ；7-13天：3.25% vs. 2.69%；≧14天：3.02% vs. 2.61%)，皆有顯著的差異(p <0.0001)。慢性蕁麻疹和對照組的全身紅斑性狼瘡發病率分別為每十萬人月3.55(1.28 – 2.20 )和1.68(2.45 – 5.14 )。與非蕁麻疹對照組相比，慢性蕁麻疹病人的全身紅斑性狼瘡粗風險比為2.113。在調整住院天數與合併症後，與對照組相比，慢性蕁麻疹組的全身紅斑性狼瘡校正風險比(aHR)仍顯著較高(aHR = 2.113, 95% CI = 1.331-3.352, p = 0.0015)。另外加入使用藥物分析，粗估風險比為1.388 (aHR = 1.388, 95% CI = 0.810-2.378, p = 0.2330)，而使用非類固醇止痛藥或皮質類固醇可降低慢性蕁麻疹患者的SLE風險分別為1.376 (aHR=1.376, 95% CI = 0.763-2.481, p = 0.0216)和1.520 (aHR=1.520, 95% CI=0.380-6.060, p = 0.0120）。 結論全國回溯性世代研究中，慢性蕁麻疹與全身紅斑性狼瘡風險有正有關。因此，臨床上應仔細評估慢性蕁麻疹病人未來罹患全身紅斑性狼瘡的風險。

ObjectiveChronic urticaria (CU) may be closely pathogenically related to systemic lupus erythematosus (SLE). This study aims to investigate the association between CU and SLE patients in Taiwan. MethodA nationwide population-based cohort study from 1997 to 2013 was conducted. Investigated subjects were selected from the Taiwan National Health Insurance Research Database using the International Classification of Disease, Ninth Revision code. Participants consisted of 13 845 subjects newly diagnosed with CU from 2003 to 2013. The number of control group was 55380. The four controls were age and sex, individually matched with one CU patient, and they were still at risk at the index date. We estimated the incidence risk of SLE among patients with CU by time-to-event analysis. ResultsPatients with CU were more likely to be female, and had a significant difference in urbanization (62.61% vs. 60.72%) and length of hospital stays (1-6 days：9.73% vs. 7.64% ；7-13 days：3.25% vs. 2.69%；≧14 days：3.02% vs. 2.61%) (p< 0.0001). The incidence rates of SLE for the CU and control groups were 3.55(1.28 – 2.20) and 1.68(2.45 – 5.14) per 100,000 person months, respectively. The crude hazard ratio of SLE among subjects with CU was 2.113 compared with the non-urticarial control group. After adjusting the demographic, length of hospital stays and comorbidity, the adjusted hazard ratio (aHR) of SLE was still significantly higher in the CU group (aHR = 2.113, 95% CI = 1.331-3.352, p = 0.0015) compared with the control group. The use of non-steroidal anti-inflammatory drugs or corticosteroids may decrease the risk of SLE in patients with CU (aHR = 1.376, 95% CI = 0.763-2.481, p = 0.0216 & aHR= 1.520, 95% CI = 0.380-6.060, p = 0.0120, respectively). ConclusionsCU is associated with a higher risk of incidental SLE in this population-based nationwide cohort study. Clinically, patients with urticaria should be carefully evaluated for risk of future SLE.