共病因子對原發性粘黏性肩關節囊炎的非類固醇消炎藥物治療時間的影響之全國性研究

Influence of Comorbidity on the Duration of NSAID Therapy in Patients with Idiopathic Adhesive Capsulitis: A Nationwide Population-Based Study

粘黏性肩關節囊炎，俗稱五十肩或冷凍肩，常以肩部疼痛和關節活動度受限為症狀表現。臨床上常以非類固醇消炎藥物為第一線治療。有關共病因子對粘黏性肩關節囊炎癒後的影響，過去的研究常受限於研究樣本數不足，而無法有統計意義的發現。本研究利用全民健保資料庫樣本數大的優點，選取過去文獻曾提及影響癒後的共病因子，進行共病因子對原發性粘黏性肩關節囊炎的非類固醇消炎藥物治療時間的橫斷面研究。我們以邏輯式回歸檢視共病因子在藥物治療超過28天（樣本數=439）和小於等於28天（樣本數=7569）的兩組原發性粘黏性肩關節囊炎病人的勝算，發現高血脂和超過28天的非類固醇消炎藥物治療時間有統計學上的相關（勝算比1314，95%信賴區間1015-1700，P值為0038）。由於高血脂和非類固醇消炎藥物對心血管的風險，我們建議對粘黏性肩關節囊炎併有高血脂的病人應進行審慎的心血管風險評估，並謹慎選用適當的非類固醇消炎藥物。

Background and purpose: Few studies have investigated the presence of comorbidity and the outcome of idiopathic adhesive capsulitis, and they usually (Chinese J. Pain involved a small number of patients. This study aims to investigate the influence of comorbidity on the duration of non-steroidal anti-inflammatory drug (NSAID) therapy in idiopathic adhesive capsulitis patients using a population-based database. Methods: A population-based cross-sectional study was conducted to examine if comorbidity associated with long-term (>28 days) NSAID therapy in patients with idiopathic adhesive capsulitis. Records of 439 adhesive capsulitis patients with long-term NSAID therapy and 7,569 adhesive capsulitis patients with ? 28 days NSAID therapy were collected. Conditional logistic regression analyses were applied to explore the differences between the two groups in terms of age, gender, and selected systemic comorbid diseases including diabetes mellitus (DM), hyperthyroidism, hypothyroidism, ischemic heart disease, and hyperlipidemia. Result: The OR of hyperlipidemia with long-term NSAID use in patients with adhesive capsulitis was 1.314 (95% CI, 1.015-1.700; p=0.038). The OR of age with long-term NSAID use in patients with adhesive capsulitis was 1.02 (95% CI, 1.011-1.029; p<0.001). There were no significant differences between the two groups regarding DM, hyperthyroidism, hypothyroidism, ischemic heart disease, and patient gender. Conclusion: This study shows an association between hyperlipidemia and long-term NSAID drug therapy in idiopathic adhesive capsulitis patients. Cardiovascular risk associates with hyperlipidemia and NSAID medication use. Physicians should, therefore, carefully evaluate the need for NSAID medication treatment in adhesive capulitis patients with concomitant hyperlipidemia. Further investigation is needed to confirm the relationship found in the present study.