台灣全身性紅斑狼瘡患者與腦膿瘍之流行病學與危險因子分析：全國性人口為基礎的回顧性研究

Risk of brain abscesses in patients with systemic lupus erythematosus: A Taiwanese cohort study

目的：全身性紅斑狼瘡（SLE）是一種可侵犯全身之自體免疫性疾病。中樞神經系統感染在全身性紅斑狼瘡患者中很罕見（0.53-2.25%），但相關的死亡率卻在26.3-52.2%之間，其中包括腦膜炎和腦膿瘍。儘管對全身性紅斑狼瘡已有更深入的了解，但導致病人發生腦膿瘍的危險因與其流行病學尚不明瞭。目前尚未有研究專門探討全身性紅斑狼瘡患者罹患腦膿瘍風險的情形。我們用台灣全民健康保險研究資料庫庫（NHIRD）進行了一項全國性基於人口的世代研究（2006-2017年），以分析全身性紅斑狼瘡患者中腦膿瘍的發生率以及潛在風險因素。
方法：利用全民健康保險研究資料庫回顧性研究全身性紅斑狼瘡患者，並比較其與非全身性紅斑狼瘡患者對照組的腦膿瘍發生率。使用Cox多變量比例風險模型評估全身性紅斑狼瘡群體中的腦膿瘍風險。
結果：此研究共納入11,457名全身性紅斑狼瘡患者和57,285名非全身性紅斑狼瘡對照組（平均年齡42.36歲，標準差16.66歲；85.46%女性，表1）。在六年的追蹤期內，全身性紅斑狼瘡患者的腦膿瘍發生率顯著較高（每10萬人年28.83 vs. 3.08，HR 9.36，p<0.001，表2），Kaplan-Meier分析顯示全身性紅斑狼瘡患者中腦膿瘍的累積發生率較高（p<0.001，圖2）。多變量Cox迴歸分析（表4）在調整變量後顯示SLE是一個重要的風險因素（調整後風險比7.33，95%信賴區間3.45-15.58，p<0.001）。心臟衰竭（adjusted HR 4.21，CI 1.23-14.44, p<0.05）和平均口服皮質類固醇劑量>7.5毫克（adjusted HR 23.92，CI 2.97-192.44, p<0.05）是全身性紅斑狼瘡患者中發生腦膿瘍的獨立風險因子。
結論：全身性紅斑狼瘡患者顯著增加罹患腦膿瘍的風險。在全身性紅斑狼瘡群體中，與腦膿瘍相關的風險因子包括心臟衰竭和平均口服皮質類固醇劑量>7.5毫克。

Objectives: Brain abscesses (BAs), are rare in patients with systemic lupus erythematosus (SLE) but are associated with high mortality. We conducted a nationwide population-based cohort study in Taiwan to analyze trends, incidence, mortality, and potential risk factors of BAs in patients with SLE over a period from 2006 to 2017.
Methods: Using data from Taiwan’s National Health Insurance Research Database, we identified patients with SLE and compared BA incidence rates with those of matched controls without SLE. A Cox multivariable proportional hazards model was employed to assess the risk of BA in the SLE and non-SLE cohorts.
Results: In total, 11,457 patients with SLE and 57,285 controls without SLE were enrolled (mean age 42.36 years, SD 16.66 years; 85.46% women). Over 6 years of follow-up, patients with SLE had a significantly higher incidence of BAs (28.83 vs. 3.08 per 100,000 person-years, incidence rate ratio 9.36, p < 0.001) than controls. Kaplan–Meier analysis results revealed higher cumulative BA incidence in patients with SLE (p < 0.001). Multivariate Cox regression analysis results revealed SLE as a significant risk factor for BAs (adjusted hazard ratio [HR] 7.33, 95% confidence interval [CI] 3.45–15.58, p < 0.001). Heart disease (adjusted HR 4.21, CI 1.23–14.44) and mean prednisolone dose >7.5 mg/day (adjusted HR 23.92, CI 2.97–192.44) were independent risk factors for BAs in patients with SLE.
Conclusions: Patients with SLE have a high risk of developing BAs. Risk factors for BAs are heart disease and a mean prednisolone dose >7.5mg/day.