盲腸切除之病人罹患自體免疫疾病之風險性──全人口資料庫研究

Appendectomy and risks of autoimmune diseases-A nationwide population-based cohort study

目的：盲腸涉及到人體免疫功能，切除盲腸可能因此會改變免疫系統。許多研究指出，盲腸的切除和全身性紅斑狼瘡及類風濕性關節炎有相關性，但是缺乏與罹患其他自體免疫疾病的風險相關研究。在這篇研究中，我們以台灣全國人口為對象，探討盲腸切除之病人罹患自體免疫疾病之風險性。方法：我們從台灣全民健康保險研究資料庫中選取自2006年1月至2015年12月的病人，分成切除盲腸及未切除盲腸兩組，探討兩組病人罹患自體免疫疾病之風險性。結果：我們共收集 196,036 個切除盲腸的病人（54.38% 男性，平均年齡= 36.89歲，P < 0.001）及 23,513,690 個未切除盲腸的病人（50.21% 男性，平均年齡= 36.16 歲，P < 0.001）。在校正過年齡、性別及共病症後，切除盲腸的病人罹患自體免疫疾病之風險性是未切除盲腸的病人的1.31倍。（aHR = 1.31, 95% CI = 1.24, 1.38）。此外，在切除盲腸的病人組，病人罹患的自體免疫疾病，以愛迪生氏病（Addison’s disease）、第一型糖尿病（type 1 diabetes mellitus）、葛瑞夫茲病 （Graves’ disease）、橋本氏甲狀腺炎（Hashimoto’s thyroiditis）、類過敏性紫斑（Henoch–Schönlein purpura）、發炎性腸道疾病（inflammatory bowel disease）、僵直性脊椎炎（ankylosingspondylitis）、乾癬（psoriasis）、全身性紅斑狼瘡（systemic lupus erythematosus）明顯增加罹患風險性。結論：經由全人口資料庫研究，我們了解到切除盲腸之病人罹患自體免疫疾病之風險性明顯高於未切除盲腸之病人。

Objectives: The appendix is involved in immune function, and appendectomy may alter the immune system. Studies have evaluated the relationship between appendectomy and the risks of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), but information on the risks of other autoimmune diseases (ADs) remains lacking. In this study, we investigated the relationship between appendectomy and the subsequent risks of ADs using a population-based dataset in Taiwan. Methods: Patients who underwent appendectomy from January 1, 2006, through December 31, 2015, were identified from the National Health Insurance Research Database (NHIRD) and assigned to the appendectomy cohort. Patients without appendectomy were randomly selected from the NHIRD and assigned to the control cohort. All patients were followed up until ADs diagnosis. We used Cox regression models to estimate the adjusted hazard ratio (aHR) for comparing the risks of ADs between the two cohorts. Results: The study identified 196,036 patients who underwent appendectomy (54.38% men, mean age = 36.89 years, P < 0.001) and 23,513,690 controls (50.21% men, mean age = 36.16 years). The overall risk of ADs was 1.31 fold higher for the appendectomy cohort than for the control cohort after adjustment for age, sex, and comorbidities (aHR = 1.31, 95% CI = 1.24, 1.38). In the appendectomy cohort, the patients had increased risks of ADs in Addison’s disease, type 1 diabetes mellitus (type 1 DM), Graves’ disease, Hashimoto’s thyroiditis, Henoch–Schönlein purpura (HSP), inflammatory bowel disease (IBD), ankylosing spondylitis (AS), psoriasis, and systemic lupus erythematosus (SLE) subgroups. Conclusions: This nationwide retrospective cohort study demonstrated that patients who have undergone appendectomy have significantly higher risks of ADs compared with the general population.