楊順發Shun-Fa Yang鍾瑞甫Jui-Fu Chung醫學研究所博士班2026-03-132024-08-2120242024-07-24https://handle.ncl.edu.tw/11296/e7yvuhhttps://scholars.csmu.edu.tw/handle/123456789/5478中文摘要 第二型糖尿病(type 2 diabetes mellitus (T2DM))是常見的內分泌系統代謝性疾病，治療上包含了口服降血糖藥物(oral hypoglycemic agent (OHA))以及胰島素注射。近年來，sodium-glucose cotransporter 2 (SGLT2)抑制劑展現出對血糖良好的控制效果，以及能夠減少心肌梗塞的發生、降低心衰竭的發病率、延緩慢性腎病變患者發生貧血和高血鉀，於是許多學者進而研究SGLT2抑制劑對於糖尿病引起的視網膜病變是否也有良好作用。本研究是利用台灣全民健保資料庫建立的研究族群，探討SGLT2 抑制劑與非感染性葡萄膜炎的發病率和嚴重程度是否存在顯著相關性。研究將SGLT2抑制劑組的每位患者與兩位未使用SGLT2抑制劑的第2型糖尿病患者進行配對，使用傾向分數匹配（Propensity Score-matching）方法調整人口統計、醫學和系統性的共變量。研究包含43300名SGLT2抑制劑組參與者和86600名對照組參與者。SGLT2組新發生的非感染性葡萄膜炎事件為147例，而對照組為371例。在調整了所有混雜因素的影響後，SGLT2組的非感染性葡萄膜炎發生率明顯低於對照組（調整風險比[aHR]：0.736，95%信心區間[CI]：0.602-0.899，P = 0.0007）。亞組分析顯示，在50歲以下的第2型糖尿病患者中，SGLT2抑制劑與較低的非感染性葡萄膜炎發生率更強烈相關，而在50歲以上的患者中相對較弱（P = 0.0012）。然而，SGLT2抑制劑對前部非感染性葡萄膜炎和後部非感染性葡萄膜炎發生率的影響相似（P = 0.7993）。使用SGLT2抑制劑與第2型糖尿病患者發生非感染性葡萄膜炎的機率，在調整多個非感染性葡萄膜炎風險因素後呈現負相關。其中，在50歲以下的患者中有更為顯著的效果。因此，在具有非感染性葡萄膜炎易感因素的第2型糖尿病患者中，應考慮使用SGLT2抑制劑。此外，也需更進一步進行大規模的前瞻性研究來探討SGLT2抑制劑對非感染性葡萄膜炎治療結果和預後的潛在影響。關鍵詞: 非感染性葡萄膜炎；SGLT2抑制劑；流行病學；前部；後部AbstractThis study is to survey the potential correlation between the application of sodium-glucose cotransporter 2 (SGLT2) inhibitors and the incidence of uveitis in individuals with type 2 diabetes mellitus (T2DM). The retrospective cohort study using the National Health Insurance Research Database (NHIRD) was conducted. The T2DM patients with the usage of SGLT2 inhibitors and other anti-diabetic medications were divided into the SGLT2 group and the control group with 1:2 ratio via the propensity score-matching (PSM) method. The major outcome in this study is the development of uveitis according to the diagnostic codes. The Cox proportional hazard regression was adopted to yield the adjusted hazard ratio (aHR) with 95% confidence interval (CI) between the groups. The results were as following. There were 147 and 371 new uveitis episodes in the SGLT2 and control groups after the follow-up period up to 5 years. The incidence of uveitis in the SGLT2 group (aHR: 0.736, 95% CI: 0.602-0.899, P = 0.0007) was significantly lower than that in the control group after adjusting the effect of all the confounders. In the subgroup analyses, the SGLT2 inhibitors showed a higher correlation to low uveitis incidence in T2DM patients aged under 50 than T2DM individuals aged over 50 years (P = 0.0012), while the effect of SGLT2 inhibitors on the incidence of anterior and posterior uveitis development was similar (P = 0.7993). In conclusion, The utilization of SGLT2 inhibitors could be an independent protective factor for uveitis development in T2DM population.Keywords: uveitis, SGLT2 inhibitors, epidemiology, anterior, posterior非感染性葡萄膜炎SGLT2抑制劑流行病學前部後部uveitisSGLT2 inhibitorsepidemiologyanteriorposteriorthesis