類風濕性關節炎患者和一般人缺血性和出血性中風的發生率和嚴重程度比較

Incidence and Severity of Ischemic and Hemorrhagic Stroke in Patients with Rheumatoid Arthritis and the General Population

目的：比較有無類風濕性關節炎病人之缺血性和出血性中風的發生率與嚴重程度的關係。方法：自2000－2005年台灣國民健康保險資料庫找出23,818位確診類風濕性關節炎患者，與119,090位對照組配對。感興趣的結果是在2015年12月31日或之前住院治療缺血性或出血性中風或死亡。Stroke severity index（SSI）用於定義嚴重中風（SSI＞12）。在調整年齡，性別，Charlson Comorbidity Index和用藥後，使用Cox比例風險回歸模型估算風險比（HRs）和95%信賴區間（95%CI）。結果：我們在RA患者中發現了1166例（4.9%）缺血性中風和814例（3.42%）出血性中風，而匹配對照組分別為6409例（5.38%）和3807例（3.2%）。23,818例RA患者中每100人年缺血性和出血性中風的粗發生率（95%CI）分別為5.96（5.63－6.31）和4.14（3.86－4.43），而對照組為6.29（6.14－6.45）和3.71（3.59－3.83）。缺血性中風的多變量風險比（95%CI）為1.05（0.96－1.15），出血性中風為1.27（1.15－1.41），輕度缺血性中風為1.00（0.90－1.11），嚴重缺血性中風為1.21（1.02－1.44），輕度出血性中風1.48（1.27－1.71），嚴重出血性中風1.11（0.96－1.28）。結論：經年齡和性別調整後RA患者發生缺血性和出血性中風之風險較高。

Objectives: To compare the incidence of ischemic and hemorrhagic stroke, in relation to severity, in persons with and without rheumatoid arthritis (RA). Methods: A total of 23,818 RA patients identified in the Taiwan National Health Insurance Database during the period 2000–2005 were matched with 119,090 controls. The outcome of interest was hospitalization for ischemic or hemorrhagic stroke on or before December 31, 2015 or death. A claimsbased stroke severity index (SSI) was used to classify severe stroke (SSI >12). Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated by using Cox proportional hazard regression models after adjusting for age, sex, Charlson Comorbidity Index, and comedications. Results: We identified 1166 (4.9%) ischemic strokes and 814 (3.42%) hemorrhagic strokes in RA patients, as compared with 6409 (5.38%) and 3807 (3.2%), respectively, in the matched controls. The crude incidence rates (95% CI) for ischemic and hemorrhagic strokes per 100 person-years among the 23,818 RA patients were 5.96 (5.63–6.31) and 4.14 (3.86–4.43) respectively, as compared with 6.29 (6.14–6.45) and 3.71(3.59–3.83) for the controls. The multivariate HRs (95% CI) were 1.05 (0.96–1.15) for ischemic stroke, 1.27 (1.15–1.41) for hemorrhagic stroke, 1.00 (0.90–1.11) for mild ischemic stroke, 1.21 (1.02–1.44) for severe ischemic stroke, 1.48 (1.27–1.71) for mild hemorrhagic stroke, and 1.11 (0.96–1.28) for severe hemorrhagic stroke. Conclusions: Patients with RA have a higher age- and sex-adjusted risk for ischemic and hemorrhagic stroke.