橋本氏甲狀腺炎和乾燥症候群的相關性：以全國性人口為基礎的世代研究

Association between Hashimoto's thyroiditis and Sjögren's syndrome: a nationwide population-based cohort study

目的：本研究探討橋本氏甲狀腺炎的患者發生乾燥症候群的風險。
方法：此以全國性人口為基礎的世代研究，使用台灣全民健保資料庫，將2005-2012年新診斷橋本氏甲狀腺炎以及同時期非橋本氏甲狀腺炎的患者分為兩組，藉由PSM 1:2匹配年齡、性別、診斷年份、共病症，比較兩組患者乾燥症候群的發生率，使用Cox比例風險模型得出的風險比、95%信賴區間，評估橋本氏甲狀腺炎與乾燥症候群的關聯，並利用改變乾燥症候群的定義、排除其他自體免疫疾病的敏感度分析，評估此篇研究發現的穩定性。
結果：此研究共納入15,420位橋本氏甲狀腺炎的患者，與匹配的30,840位對照組，乾燥症候群的發生率在橋本氏甲狀腺炎族群為每十萬人年513人，在非橋本氏甲狀腺炎族群為每十萬人年178人，發生率比為2.49 (95%信賴區間2.13–2.89，p < 0.01)。使用Cox比例風險模型，發現橋本氏甲狀腺炎與乾燥症候群風險的增加有關(風險比2.46，95%信賴區間2.11–2.86)，敏感度分析亦呈現相符的結果。
結論：此以全國性人口為基礎的世代研究，顯示橋本氏甲狀腺炎的族群發生乾燥症候群的風險會顯著增加。

Objective: This study aimed to investigate the risk of Sjögren's syndrome (SS) in patients diagnosed with Hashimoto's thyroiditis (HT).
Methods: This population-based cohort study used claim data from the Taiwan National Health Insurance Research Database to identify patients who had been newly diagnosed with HT from 2005 to 2012 as the HT group, and individuals without HT as the non-HT group. We selected the HT and the non-HT groups through propensity score matching at a ratio of 1:2 for age, gender, index year and selected comorbidities in order to compare the incidences of SS in both groups. We used the Stratified Cox Proportional Hazards Regression Model to assess the association between HT and SS, which was shown as hazard ratios (HRs) and 95% confidence intervals (CIs). Several sensitivity analyses were performed by varying the definitions of SS or through the exclusion of patients possessing other autoimmune diseases at baseline so as to better assess the robustness of our findings.
Results: We finally included 15,420 HT patients and 30,840 matched non-HT individuals for our primary analyses. The incidence rates of SS in the HT and non-HT groups were 513 cases per 105 person-years and 178 cases per 105 person-years, respectively, with an incidence rate ratio of 2.49 (95% CI, 2.13–2.89; p < 0.01). Using the Stratified Cox Proportional Hazards Regression Model, we found that HT was associated with an increased risk of SS (HR, 2.46; 95% CI, 2.11–2.86). Sensitivity analyses revealed consistent results.
Conclusions: This nationwide, population-based cohort study showed a significantly increased risk of SS in patients who had been diagnosed with HT.