| 摘要註: |
痛風是一種常見的發炎性關節炎,多個研究指出近幾十年來國外的痛風發生率與盛行率逐年上升,且在女性痛風共病研究中,高血壓、高血脂症、糖尿病、肥胖、新陳代謝症候群有較高盛行率,其中女性的高血壓、糖尿病的盛行率高於男性。許多慢性病與癌症也多息息相關,卻少有研究探討痛風與癌症的關係。另外,男性痛風患者較易罹患癌症,尤其是膀胱癌、腎臟癌,以及前列腺癌等癌症。因此本研究主要目的是分析女性痛風發生率、盛行率、痛風共病與其癌症的發生率。利用台灣國家衛生研究院提供之2000年至2011年一百萬人健保資料,以回溯性世代研究法進行研究,研究對象為20歲以上的女性,計算痛風逐年發生率與盛行率。在探討癌症發生率的資料,排除納入日期以後一年內罹患糖尿病、慢性腎臟病、急性心肌梗塞、腦動脈阻塞、退化性關節炎以及癌症的患者,共取得新發生痛風患者共4612位,並以1:4比例依照年齡、看診日期配對女性非痛風患者作為對照組,共17082位非痛風者。共病比率為痛風確診一年內診斷之常見慢性疾病比率。痛風確診一年後的發生癌症者為癌症發生率的新個案,以Age-standardized incidence ratio (SIR)計算其標準化發生發生比,並以Cox回歸模式來探討痛風患者罹患癌症的危險比。結果顯示2002年女性痛風發生率為每千人年有1.76位個案,2011年每千人年有0.11位個案,且逐年遞減。2000年女性痛風的盛行率為0.77%,2011年為0.96%。痛風患有高血壓、高血脂症、肥胖等共病有較高的比率(P<0.001)。在不分年齡的女性痛風患者較易發生全癌症(SIR=1.13, 95%信賴區間[CI]: 1.01-1.27),癌症種類中有腎臟癌(SIR=2.34, 95% CI: 1.42-3.85)、腎細胞癌(SIR=3.11, 95% CI: 1.57-6.19)、肝癌(SIR=1.48, 95% CI: 1.08-2.02)、子宮癌(SIR=0.67, 95% CI: 0.46-0.99)等達統計上顯著性差異。年齡小於50歲之女性痛風罹患癌症的SIR為1.29倍(95% CI: 1.06-1.57),癌症種類中有腎臟癌(SIR=2.95, 95% CI: 1.10-7.93)、腎細胞癌(SIR=4.74, 95% CI: 1.27-17.67)、肝癌(SIR=1.88, 95% CI: 1.01-3.50)、大腸直腸癌(SIR=1.72, 95% CI: 1.02-2.92)達統計上顯著性差異。50歲以上的女性痛風患者罹患癌症的SIR為1.07倍(95% CI: 0.94-1.23),癌症種類中的腎臟癌(SIR=2.15, 95% CI: 1.20-3.84)、腎細胞癌(SIR=2.64, 95% CI: 1.17-5.95)、子宮癌(SIR=0.59, 95% CI: 0.35-0.98)達統計上顯著性差異。本研究顯示女性痛風發生率逐年下降,盛行率維持穩定。在排除痛風一年內有糖尿病、慢性腎臟病、急性心肌梗塞、腦動脈阻塞、退化性關節炎與癌症等疾病的診斷後,不分年齡的女性痛風患者較易罹患癌症,尤其是罹患腎臟癌與腎細胞癌與肝癌。另外,痛風患者罹患子宮癌有較少的風險。 Gout is a kind of inflammatory arthritis. Recent researches on gout have produced some worrying findings about its yearly increase of prevalence and incidence overseas. Female patients, especially combined with some diseases, such as hypertension, hyperlipidemia, diabetes (DM), obesity and metabolic syndromes, have been proved to have higher prevalence of gout. Many chronic diseases reveal close associations with cancer; evidence also shows that male gout patients are prone to contract bladder, kidney as well as prostate cancers. However, few studies exploring the relationship between gout and cancer have been found. Thus, we are interested to delve into the relationship between the female gout patients in Taiwan and the incidence of cancer. The National Health Research Institute (NHRI) provided one million of health beneficiaries for this study, including three diagnosis codes (ICD-9) and prescription. We designed a 12-year study (2000-2011) to examine the incidence, prevalence of gout and a retrospective cohort study to explore the associations between gout and cancers in those female participants over the age of 20. According to the data on cancer incidence, we covered 4612 female gout patients, excluding those with DM, chronic kidney diseases, acute myocardial infarction, occlusion of cerebral arteries, osteoarthritis and cancer diagnosed within one year of gout diagnosis, and matching to 17082 female non-gout patients by age and first-diagnosed month and year at a ratio of one to four. The cancer case was identified while a new cancer occurred after one year of gout onset; the cancer risk was evaluated by age-standardized incidence ratio (SIR) and proportional hazard ratio.The results showed that in 2002, there were 1.76 new female gout cases per 1000-person-years and the rate decreased to 0.11 per 1000 in 2011. The prevalence of female gout was 0.77% in 2000, and 0.96% in the year of 2011. Those female gout patients had comorbidity of hypertension, hyperlipidemia and obesity had higher prevalence of gout (p<0.001). Regardless of patients' age, female gout patients had higher all-cause cancer incidence (SIR=1.13, 95% CI: 1.01-1.27) , higher incidence of kidney cancer (SIR=2.34, 95% CI: 1.42-3.85) , renal cell cancer (SIR=3.11, 95% CI: 1.57-6.19) and hepatoma (SIR=1.48, 95% CI: 1.08-2.02), but lower risk of uterus cancer (SIR=0.67, 95% CI: 0.46-0.99). Compared to non-gout patients, for female gout patients under the age of 50, the incident risk of all-cause cancer was 1.29 (95% CI: 1.06-1.57), kidney cancer 2.95 (95% CI: 1.10-7.93), renal cell cancer 4.74(95% CI: 1.27-17.67), hepatoma 1.88 (95% CI: 1.01-3.50) and colorectal cancer 1.72 (95% CI: 1.02-2.92), all of which showed significant association (p<0.05). As to female gout patients over the age of 50, the incident risk of all-cause cancer was 1.07 (95% CI: 0.94-1.23), kidney cancer 2.15 (95% CI: 1.20-3.84), renal cell cancer 2.64(95% CI: 1.17-5.95) but lower risk of uterus cancer (SIR=0.59, 95% CI: 0.35-0.98), compared to non-gout patients. In conclusion, female gout incidence decreases year by year while the prevalence has kept stable for 12 years. After excluding those with DM, chronic kidney diseases, acute myocardial infarction, occlusion of cerebral arteries, osteoarthritis, and cancer, female gout patients of all ages are inclined to have higher incidence of all-cause cancer, kidney cancer, and hepatoma. However, they have lower risk of uterus cancer. |