Department of Surgery, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan.
Institute of Biostatistics, China Medical University, Taichung, Taiwan.
Eur J Intern Med. 2014 Jun;25(5):444-8. doi: 10.1016/j.ejim.2014.03.015. Epub 2014 Apr 6.
BACKGROUND & AIMS: Patients with cholangitis may exhibit repeated and chronic inflammation of the biliary tract despite successful medical or surgical treatments. This nationwide cohort study examined the association between cholangitis and the subsequent development of acute coronary syndrome (ACS).
We identified a cohort of 37676 patients who were diagnosed with cholangitis between January 1998 and December 2010, and a comparison cohort of 150704 subjects frequency matched by age, sex, and index year after excluding comorbidities for ACS. Both cohorts were followed until the end of 2010 to measure the incidence of ACS. Both incidence rate ratios and hazard ratios of ACS were estimated by age and sex.
Sex-specific analysis showed that males were at a higher incidence of ACS than females in both groups with (16.2 vs 11.5 per 10,000 person-years) and without (18.7 vs 12.5 per 10,000 person-years) cholangitis. The incidence of ACS also increased with age no matter having or not having cholangitis. The age stratified analysis revealed that the risk of ACS was significantly higher in patients with cholangitis younger than 65 years old. The multivariable Cox proportional hazard model demonstrated that cholangitis was significantly associated with ACS (adjusted hazard ratio [HR]=1.18; 95% confidence interval [CI], 1.03-1.35) after adjusting age and sex in the model.
This study suggests that patients with cholangitis are at an elevated risk of ACS. Awareness of the potential ACS risk for patients with cholangitis is important for patients and clinicians.
尽管经过成功的医学或手术治疗，胆管炎患者仍可能出现胆道反复和慢性炎症。本项全国性队列研究旨在探讨胆管炎与急性冠状动脉综合征（ACS）发生后的相关性。
我们确定了 1998 年 1 月至 2010 年 12 月期间被诊断为胆管炎的 37676 例患者的队列，并排除 ACS 合并症后，通过年龄、性别和指数年对 150704 例受试者进行频数匹配，构建了对照组。两个队列均随访至 2010 年底，以测量 ACS 的发生率。通过年龄和性别来估计 ACS 的发生率比值比和风险比。
性别特异性分析表明，两组中男性的 ACS 发生率均高于女性（胆管炎患者中为 16.2/10000 人年，无胆管炎患者中为 18.7/10000 人年）。无论是否患有胆管炎，ACS 的发生率均随年龄增加而增加。分层年龄分析显示，年龄小于 65 岁的胆管炎患者 ACS 风险显著升高。多变量 Cox 比例风险模型显示，在调整模型中的年龄和性别后，胆管炎与 ACS 显著相关（校正后风险比[HR]=1.18；95%置信区间[CI]，1.03-1.35）。
本研究表明胆管炎患者 ACS 的风险增加。了解胆管炎患者潜在的 ACS 风险对患者和临床医生很重要。
