骨盆腔炎症女性發生周邊動脈疾病之風險

Risk of Peripheral Artery Disease in Women with Pelvic Inflammatory Disease

骨盆腔炎症為女性上生殖道發生感染和發炎，其發炎反應可為全身性且持續性的。過去曾有研究指出骨盆腔炎症與心血管疾病有所相關，但至今尚無研究調查骨盆腔炎症與周邊動脈疾病的關聯性。我們利用台灣全民健康保險研究資料庫設計一個回溯性世代研究。骨盆腔炎症組包含66,846名於2000至2010年間新診斷的13－50歲的病人，無骨盆腔炎症組為相同人數經過傾向分數配對的對照組，配對的項目包括年齡、疾病診斷日期及相關共病症。研究追蹤至2011年底並計算所有發生周邊動脈疾病的人數。我們使用Cox比例風險迴歸模型來評估發生周邊動脈疾病的風險。研究結果發現骨盆腔炎症組較無骨盆腔炎症組發生周邊動脈疾病整體高出1.18倍（每萬人年為7.76比6.55），經校正後的風險比值為1.54，95%信賴區間為1.35到1.76。此外，骨盆腔炎症的病人若為此頻繁就醫（每年7次以上），發生周邊動脈疾病的風險更將大幅上升（校正風險比值為22.7，95%信賴區間為17.7到29.0）。本研究顯示骨盆腔炎症的女性比一般女性具有較高的風險罹患周邊動脈疾病，此風險亦隨著骨盆腔炎症的就醫頻率明顯增加。因此，我們應對患有骨盆腔炎症的女性審慎評估其伴有心血管疾病的可能性。 Pelvic inflammatory disease (PID) is an inflammatory infection of the upper urogenital tract in women, and the inflammatory responses can be systemic and persistent. Some studies have demonstrated the association between PID and cardiovascular diseases; however, the association between PID and peripheral artery disease (PAD) remains unknown.We used the data of the National Health Insurance Research Database of Taiwan to conduct this retrospective cohort study. We established a PID group comprising 66,846 newly diagnosed patients aged between 13 and 50 years during 2000-2010 and a non-PID group comprising the same number of individuals who were matched by the propensity score with age, date of diagnosis, and comorbidities. Incident PAD was monitored toward the end of 2011. Relative risks of PAD were estimated using the Cox proportional hazard model.The results revealed that the overall PAD incidence was 1.18-fold greater in the PID group than in the non-PID group (7.76 vs. 6.55 per 10,000 person-years), with an adjusted hazard ratio of 1.54 (95% confidence interval, 1.35–1.76). In addition, individuals with more annual medical visits for their PID (≥7 times) were associated with an extremely elevated risk for developing PAD (adjusted hazard ratio, 22.7; 95% confidence interval, 17.7–29.0).In conclusion, patients with PID are at an elevated risk for developing PAD, and the risk increases for those with more medical demands. We suggest that cardiovascular risk in women with PID should be evaluated.

Pelvic inflammatory disease (PID) is an inflammatory infection of the upper urogenital tract in women, and the inflammatory responses can be systemic and persistent. Some studies have demonstrated the association between PID and cardiovascular diseases; however, the association between PID and peripheral artery disease (PAD) remains unknown.We used the data of the National Health Insurance Research Database of Taiwan to conduct this retrospective cohort study. We established a PID group comprising 66,846 newly diagnosed patients aged between 13 and 50 years during 2000-2010 and a non-PID group comprising the same number of individuals who were matched by the propensity score with age, date of diagnosis, and comorbidities. Incident PAD was monitored toward the end of 2011. Relative risks of PAD were estimated using the Cox proportional hazard model.The results revealed that the overall PAD incidence was 1.18-fold greater in the PID group than in the non-PID group (7.76 vs. 6.55 per 10,000 person-years), with an adjusted hazard ratio of 1.54 (95% confidence interval, 1.35–1.76). In addition, individuals with more annual medical visits for their PID (≥7 times) were associated with an extremely elevated risk for developing PAD (adjusted hazard ratio, 22.7; 95% confidence interval, 17.7–29.0).In conclusion, patients with PID are at an elevated risk for developing PAD, and the risk increases for those with more medical demands. We suggest that cardiovascular risk in women with PID should be evaluated.