C型肝炎感染對僵直性脊椎炎病人死亡率的影響

Influence of hepatitis C virus infection on mortality among patients with ankylosing spondylitis

Objectives: To determine the factors affecting long-term survival and the influence of hepatitis C virus(HCV) infection on mortality among patients with ankylosing spondylitis (AS).Methods: We used data from the National Health Insurance Research Database from 2000 to 2011. A totalof 51,989 adult patients with new-onset AS were enrolled. These patients were followed from the diagnosisof AS until death or the end of 2011. We performed a Kaplan-Meier analysis of the cohort and multivariatesurvival analysis using Cox’s regression model to determine significant predictors for survival.Results: A total of 1,129 patients (2.17%) had HCV infection at the time of diagnosis of AS. Hypertensionand diabetes mellitus were the 2 most commoncomorbidities in AS patients. Multivariate analysisshowed that age ≥ 45 years, male gender, hypertension,diabetes mellitus, coronary artery disease, stroke, andrenal disease at baseline were independent predictorsof long-term mortality in AS patients (p<0.05).Patients with HCV infection had significantly highermortality than those without. The crude mortality rateof patients infected with HCV was highest in patients with dual hepatitis B virus (HBV) and HCV infections.Conclusions: HCV infection has a great influenceon mortality in patients with AS, whether those withHCV infection alone or with dual HBV and HCVinfections. 目標：為了確認僵直性脊椎炎病人長期預後的因素，以及C型肝炎對僵直性脊椎炎病人死亡率的影響。方法：我們使用了2000年至2011年的全民健康保險研究資料庫數據。總共收錄51989個新發生的僵直性脊椎炎病人。這些病人從診斷為僵直性脊椎炎開始被追蹤直到病人死亡或者至2011年底。我們執行了Kaplan-Meier世代分析及Cox’s regression模組多變異存活分析，來決定影響存活的重要因素。結果：總共1129（2.17%）個病人在診斷僵直性脊椎炎的同時已經有C型肝炎病毒感染。高血壓和糖尿病是僵直性脊椎炎病人的兩個最常見的合併症。在僵直性脊椎炎病人多變異分析顯示，收錄時年齡大於45歲、男性、高血壓、糖尿病、冠狀動脈疾病、中風、以及腎臟疾病，是預測長期死亡率的獨立因素（p＜0.05）。有C型肝炎病毒感染的病人比起沒有感染的人，有顯著更高的死亡率。而其中同時合併有B型肝炎病毒及C型肝炎病毒感染的病人的粗死亡率是最高的。結論：C型肝炎病毒感染對於僵直性脊椎炎病人有極大的影響力，不論是單獨C型肝炎病毒感染或者是合併B型肝炎病毒感染。