鼻咽癌為隅角開放性青光眼之危險因子: 台灣人口之世代追蹤研究

鼻咽癌（NPC, Nasopharyngeal Carcinoma）是一種發生於鼻咽腔或上咽喉部的癌症，生活環境及遺傳基因為主要的影響因素。鼻咽癌發病年齡平均為40歲，較其他癌症平均提早20年發病。男女比例為3比1。鼻咽癌的治療原則以放射治療為主，一般而言鼻咽癌細胞對放射治療的效果極佳。由於鼻咽癌常侵犯眼窩部位，導致視神經壓迫或血液循壞破壞，而這也和隅角開放型青光眼的致病機轉類似。青光眼(Glaucoma)是多種因素造成的視神經病變，為最常見的不可逆致盲原因，依隅角構造分為隅角開放性和隅角閉鎖性青光眼，其中隅角開放性青光眼目前已經證實的危險因子包括眼壓、年齡、種族、家族史、糖尿病、高血壓、低眼部灌流壓及類固醇使用等。很多研究發現鼻咽癌會有眼部併發症，其中眼窩是最常被鼻咽癌侵犯的位置。部分鼻咽癌患者被發現有視神經病變，和青光眼的表現相似，然而目前並沒有相關研究確認鼻咽癌和後續發生青光眼的關聯。本篇研究是從2000年至2016年的台灣健保資料庫中找了4184個鼻咽癌患者和16736個配對的非鼻咽癌患者，比較兩組之後發生隅角開放性青光眼的比例。在鼻咽癌病患組中有151個病人在診斷鼻咽癌之後發生青光眼；在非鼻咽癌族群中有513位之後發生青光眼。鼻咽癌病患組發生青光眼的機率明顯較非鼻咽癌族群高，風險比是1.293 (95%信賴區間:1.077-1.551, P=0.0057 )。另外，我們也發現鼻咽癌的時間越長，青光眼的累積發生率也隨之增加。本篇研究也有發現青光眼的其他相關危險因子，包括年齡、糖尿病和持續的類固醇使用，這些都和青光眼發生有關。所以這項研究看起來鼻咽癌或許也是隅角開放性青光眼發生的危險因子。

Nasopharyngeal carcinoma (NPC) is an epithelial carcinoma that grows at the nasopharyngeal region. Cigarette consumption, human papillomavirus infection and the Epstein-Barr virus infection are well-known risk factors for the occurrence of NPC. NPC in the advanced stage and the radiotherapy during the NPC treatment could damage nearby regions like the orbital and cervical area. Ophthalmic complications in the individuals with NPC have been demonstrated in the previous research. The orbit is the most common region of ophthalmic involvement in the patients with NPC which account for nearly 50% of NPC cases with ophthalmic complications. Open angle glaucoma (OAG) is mainly progressive optic neuropathy which may also appear in patients with NPC. However, there are few studies evaluating the relationship between the NPC and OAG. This study aimed to investigate the possible association between nasopharyngeal carcinoma (NPC) and following open angle glaucoma (OAG). This retrospective research applying the National Health Insurance Research Database (NHIRD) of Taiwan was conducted with a follow up period from January 1, 2000 to December 31, 2016. There were 4184 and 16736 participants that selected and categorized into the NPC and non-NPC groups after exclusion. The major outcome of our study was the development of OAG according to diagnostic codes, exam and managements. The Cox proportional hazard regression was employed to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) of OAG between the two groups. In this study, numbers of 151 and 513 OAG episodes occurred in the NPC and non-NPC groups and the NPC population showed a significantly higher incidence of OAG compared to the non-NPC population in multivariable analysis (aHR: 1.293, 95% CI: 1.077-1.551, p = 0.0057). Besides, the cumulative probability of OAG was significantly higher in the NPC group than that in the non-NPC population (p = 0.0041). About other risk factor for OAG, age older than 40 years old, diabetes mellitus and persistent steroid usage were related to OAG occurrence (all p < 0.05). In conclusion, the NPC may be an independent risk factor of following OAG development.