乾癬患者死亡分析及疾病嚴重程度對存活的影響

Abstract

乾癬是一個慢性發炎性疾病，影響台灣0.19%的人口。乾癬患者除了生活品質不佳，可能合併憂鬱及焦慮等心理症狀。目前也知道，乾癬患者有比較高的風險會合併肥胖、糖尿病、心臟血管疾病及癌症。除此之外，乾癬患者有比較高的比例有喝酒及抽菸的習慣。這些都可能讓乾癬患者死亡的風險提高。從目前關於乾癬和死亡的研究結果來看，無論是大型全國性的世代研究，或是小型以醫院為主的世代研究都顯示出，乾癬的死亡風險升高，而心臟血管疾病、癌症、肝臟疾病、糖尿病和腎臟病都是它可能的特殊死因。 本研究是針對台灣一醫學中心的乾癬患者所作的。總共收集5490位20歲以上，65歲以下的乾癬患者，計算乾癬世代和全國人口比較的全死因和個別死因標準化死亡比，來看乾癬患者和全國人口比較後的死亡風險。另外，我們也調整了和死亡相關的風險因子包括年齡、性別和共同疾病，想探討嚴重型乾癬是否為死亡的風險因子。 由我們的研究結果發現，乾癬患者的全死因死亡率和全國人口比較起來是升高的(SMR：1.55，95%CI：1.35-1.77)；而在特殊死因的部分，因為糖尿病(SMR：2.32，95%CI：1.46-3.68)、心臟血管疾病(SMR：2.20，95%CI：1.48-3.29)、肝臟疾病(SMR：2.74，95%CI：1.85-4.05)、癌症(SMR：1.34，95%CI：1.05-1.73)及腎臟疾病(3.30，95%CI：1.77-6.13)等原因而死亡的風險，都比全國人口還高。在探討乾癬的死亡風險因子時，我們發現在追蹤小於4年的患者中，嚴重型乾癬的死亡風險沒有升高(Hazard ratio(HR)：0.82，95%CI：0.55-1.22)；但是在追蹤大於4年的患者中，嚴重型乾癬的死亡風險則是升高(HR：1.83，95%CI：1.18-2.83)。 由以上研究結果可知，乾癬患者的確有比較高的死亡風險，和全國人口比起來，腎臟疾病的死亡風險最高。這些不同的死因和乾癬的關聯性需要進一步的研究來作釐清。另外，嚴重型乾癬是乾癬的死亡風險因子主要是表現在追蹤比較長的患者身上。

Background Psoriasis is a chronic inflammatory disease which affects 0.19% of Taiwanese population. It has been known that psoriasis is associated with several co-morbidities including obesity, diabetes, cardiovascular disease, cancer and depression. In addition, patients with psoriasis have higher rates of smoking and drinking alcohol. All these co-morbidities may lead to high risks of mortality in patients. So far, several studies related to mortality and psoriasis showed that patients with psoriasis had an increased risk of death. Patients with severe psoriasis were found to have higher risk of death from cardiovascular disease, cancer, liver disease, diabetes and dementia. However, the data related to Asian population is limited. Objectives To describe all-cause and cause-specific mortality in patients with psoriasis and determine the risk for mortality in psoriasis Material and method We perform a hospital-based cohort study from 2001 to 2008 of patients aged of more than 20 years and less than 65 years. Survival status, date of death and cause of death were ascertained by linking the study cohort with the National Register of Deaths Database of Taiwan. All-cause and cause-specific standardized mortality ratios (SMRs) were estimated. Besides, age- and sex-adjusted Cox proportional hazards models were used to determine the risk of mortality. Results We observed 209 deaths in 5940 patients. The all-cause standardized mortality ratio (SMR) was 1.55 (95% confidence interval [CI], 1.35-1.77). In the analysis of causes of death, the SMRs for death due to diabetes( 2.32; 95%CI, 1.46-3.68), cardiovascular disease(2.20 ;95%CI, 1.48-3.29), liver disease (2.74; 95%CI, 1.85-4.05), malignancy (1.34; 95%CI, 1.05-1.73)and kidney disease (3.30, 95%CI: 1.77-6.13) were significantly higher. Severe psoriasis is not associated with mortality in patients who were followed less than 4 years (Hazard ratio:0.82; 95%CI, 0.55-1.22). However, the risk of severe psoriasis increased for mortality in those followed for more than 4 years (HR:1.83; 95%CI, 1.18-2.83). Conclusion The overall mortality among patients with psoriasis was 1.5 times greater than that of the general population. Patients with psoriasis have higher risk of mortality from diabetes, cardiovascular disease, liver disease, malignancy and kidney disease. Severe psoriasis is associated with an increased risk of death in patients who were followed more than 4 years.