以全球TriNetX資料庫探索乾癬患者與尿路結石之關聯性研究

背景：近年來的研究指出乾癬(Psoriasis, PSO)不僅僅是一種皮膚疾病，它與多種全身性疾病有關，包括心血管疾病、代謝症候群和自身免疫疾病等。尿路結石是泌尿系統常見的疾病之一，造成腎結石和尿管結石等，影響患者的生活品質和健康。過去研究顯示，代謝異常是尿路結石形成的主要原因之一，而PSO患者中亦常見代謝相關的異常，這提示了PSO與尿路結石可能存在一定的關聯性，但仍無臨床相關研究發表。方法：本研究中利用TriNetX全球健康數據庫進行了一項2019年1月1日至2023年12月31日期間內的回顧性世代研究，主要目標為評估PSO患者相較於非乾癬(Non-PSO)對照組在尿路結石發生率上的差異。研究設計著重於精確測定PSO患者中新發尿路結石的風險，並針對潛在的風險因子如年齡、性別、種族、體質指數(Body Mass Index, BMI)、醫療利用、高血壓、高血脂、糖尿病、尼古丁依賴等進行1:1傾向分數匹配(Propensity Score Matching, PSM)，以確保兩組人群在基線特徵上的相似性。利用傾向分數匹配後的數據集，我們計算了調整後的風險比及其95%信賴區間，從而提供了關於PSO與尿路結石風險相關性的精確估計。結果：研究發現，PSO患者相對於非PSO患者在多項尿路相關疾病的風險顯著增加。整體來看，PSO患者的尿路結石風險比為1.315[95% CI: 1.245-1.388]，腎結石和輸尿管結石的風險比為1.329[95% CI: 1.257-1.405]。性別分層分析顯示，女性PSO患者的尿路結石風險比為1.399[95% CI: 1.28-1.53]，高於男性PSO患者的1.290[95% CI: 1.19-1.40]。年齡分層分析中，18-64歲的PSO患者尿路結石風險比為1.370[95% CI: 1.28-1.47]，而65歲及以上的老年PSO患者為1.380[95% CI: 1.27-1.49]。種族分層顯示，白人PSO患者的尿路結石風險比為1.340[95% CI: 1.26-1.43]，而黑人PSO患者更高，達1.623[95% CI: 1.17-2.26]。結論： PSO患者相較於Non-PSO患者有更高的尿路結石風險，這一風險在所有性別、年齡組和種族亞組中都得到了證實。這些結果強調了對PSO患者進行更為嚴密的尿路結石風險評估和監測的重要性。需要在臨床管理中考慮到這些差異，尤其是對於高風險群體的早期介入，為了制定有效的預防和管理策略，未來的研究需要進一步探討PSO與尿路結石風險增加之間的潛在生物學機制。

Background: Recent studies have highlighted psoriasis (PSO) as more than just a skin condition; it is associated with a variety of systemic diseases including cardiovascular diseases, metabolic syndrome, and autoimmune disorders. Urolithiasis, a common disorder of the urinary system that leads to the formation of kidney and ureteral stones, significantly impacts the quality of life and health of patients. Previous research indicates that metabolic abnormalities, which are prevalent in PSO patients, are a primary cause for the formation of urolithiasis, suggesting a potential link between PSO and urolithiasis.Methods: This retrospective cohort study utilized the TriNetX global health database to assess the incidence of urolithiasis in PSO patients compared to a Non-PSO control group from January 1, 2019, to December 31, 2023. The study aimed to precisely determine the risk of newly diagnosed urolithiasis in PSO patients and adjusted for potential risk factors such as age, sex, race, body mass index (BMI), healthcare utilization, hypertension, hyperlipidemia, diabetes, and nicotine dependence, through 1:1 propensity score matching (PSM), ensuring baseline characteristic similarity between groups. The adjusted hazard ratios and their 95% confidence intervals were calculated using the matched dataset, providing precise estimates of the association between PSO and the risk of urolithiasis.Results: The study found that PSO patients had a significantly increased risk of several urinary-related diseases compared to Non-PSO patients. Overall, the hazard ratio for urolithiasis in PSO patients was 1.315 [95% CI: 1.245-1.388], with the risk for kidney and ureter stones being even higher at 1.329 [95% CI: 1.257-1.405]. Stratified analysis by sex revealed that female PSO patients had a higher risk of urolithiasis at 1.399 [95% CI: 1.28-1.53]compared to male PSO patients at 1.290 [95% CI: 1.19-1.40]. Age stratification showed that PSO patients aged 18-64 had a risk ratio of 1.370 [95% CI: 1.28-1.47], and those aged 65 and older had a risk of 1.380 [95% CI: 1.27-1.49]. Racial stratification indicated that white PSO patients had a urolithiasis risk ratio of 1.340 [95% CI: 1.26-1.43], whereas Black PSO patients had a higher risk at 1.623 [95% CI: 1.17-2.26].Conclusion: PSO patients exhibit a higher risk of urolithiasis compared to Non-PSO individuals, confirmed across all sex, age, and racial subgroups. These findings underscore the importance of rigorous assessment and monitoring of urolithiasis risk in PSO patients. Consideration of these disparities in clinical management, particularly for early intervention in high-risk groups, is crucial. Future research should further explore the underlying biological mechanisms linking increased risk of urolithiasis with PSO to develop effective prevention and management strategies.