在年輕成年人痛風長期對急性心肌梗塞的影響：以全國人口為對象之研究

Long-term effects of gout on acute myocardial infarction in young adults: a population-based study

簡介：在年輕成年人，痛風長期對急性心肌梗塞的影響並不大清楚。本研究是以全國人口為研究對象，目的在調查痛風與急性心肌梗塞發病率之間的關聯，特別對於低於40歲的年輕成年人來研究痛風對將來罹患急性心肌梗塞的風險評估。方法：本研究是利用台灣全民健康保險資料庫，收集2002年到2013年間,有痛風但無急性心肌梗塞病史，共有60,997位病人。觀察這些病人在2002年到2013年間是否有罹患急性心肌梗塞。另外，並使用統計學上的存活分析來評估病人有無痛風病史對之後發生急性心肌梗塞的危險性。結果：有痛風病史病人的急性心肌梗塞的發生率是3.80千人年，而無痛風病史病人的急性心肌梗塞的發生率是1.01千人年。有痛風病史病人比沒痛風病史病人有較高危險性罹患急性心肌梗塞（風險比率：1.21，百分之95信賴區間：1.15-1.26），而且不管男性或女性，痛風病人罹患急性心肌梗塞的風險都比沒痛風病人高（男性：風險比率：1.25，百分之95信賴區間：1.19-1.31；女性：風險比率：1.19，百分之95信賴區間：1.09-1.30）。另外針對20-39歲年輕成年人，特別是男性痛風病人將來罹患急性心肌梗塞危險性也比無痛風病人高（風險比率：1.92，百分之95信賴區間：1.54-2.39）結論：我們的研究顯示痛風是罹患急性心肌梗塞的危險因子，特別是40歲以下的年輕人。而年輕人若罹患急性心肌梗塞，對家庭和社會都是一個負擔。所以特別提醒年輕人對痛風治療的重要性。

 

Background and purpose: The long-term effect of gout on the risk of acute myocardial infarction (AMI) in young adults is unknown. This nationwide cohort study aimed to in-vestigate the independent association between gout and the incidence of AMI, especially in patients younger than 40 years. Methods: We retrospectively obtained data of 60,997 pa-tients (683,652 person-years) diagnosed with gout in 2002 from the Longitudinal Health Insurance Database, Taiwan. All participants were followed up from the date of enrollment until AMI or the end of data collection in 2013, whichever occurred first. Multivariate Cox proportional hazards models and Nelson-Aalen cumulative hazard function were used to evaluate the risk of AMI in patients with gout. Results: The incidence of AMI was 3.80 and 1.01 per 1000 person-years in patients with and individuals without gout, respectively. After adjustment for demographics and comorbidities, individuals with gout had a higher overall risk of AMI (hazard ratio, HR=1.21, 95% confidence interval, CI=1.15-1.26), and this finding was noted in men (HR=1.25, 95% CI=1.19-1.31) and women (HR=1.19, 95% CI=1.09-1.30). Gout in adults aged 20-39 years had a higher independent effect on AMI in men (HR=1.92, 95% CI=1.54-2.39) than in women (HR=1.34, 95% CI=0.48-3.70). Con-clusion: Our study reveals that gout is a risk factor for AMI, particularly in adults younger than 40 years. Given the potential long-term complications of AMI among young patients, as well as their families and society, the results of this study may contribute to the devel-opment of early pharmacological interventions to prevent AMI.