强直性脊柱炎后精神障碍的风险：一项基于全国人口的回顾性队列研究。
Risk of Psychiatric Disorders following Ankylosing Spondylitis: A Nationwide Population-based Retrospective Cohort Study.
作者信息
Shen Cheng-Che, Hu Li-Yu, Yang Albert C, Kuo Benjamin Ing-Tiau, Chiang Yung-Yen, Tsai Shih-Jen
机构信息
From the Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung; School of Medicine, National Yang-Ming University; Department of Psychiatry, and Department of Research and Medication, Taipei Veterans General Hospital, Taipei; Department of Information Management, National Chung-Cheng University; Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi; Department of Dental Technology and Materials, Science Central Taiwan University of Science and Technology, Taichung, Taiwan.C.C. Shen, MD, School of Medicine, National Yang-Ming University, and Department of Information Management, National Chung-Cheng University, and Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; L.Y. Hu, MD, Department of Psychiatry, Kaohsiung Veterans General Hospital, and School of Medicine, National Yang-Ming University; A.C. Yang, MD, PhD, School of Medicine, National Yang-Ming University, and Department of Psychiatry, Taipei Veterans General Hospital; B.I. Kuo, MD, PhD, School of Medicine, National Yang-Ming University, and Department of Research and Medication, Taipei Veterans General Hospital; Y.Y. Chiang, DMD, Department of Dental Technology and Materials, Science Central Taiwan University of Science and Technology; S.J. Tsai, MD, School of Medicine, National Yang-Ming University, and Department of Psychiatry, Taipei Veterans General Hospital.
出版信息
J Rheumatol. 2016 Mar;43(3):625-31. doi: 10.3899/jrheum.150388. Epub 2016 Feb 1.
OBJECTIVE
Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease. A higher prevalence of psychiatric comorbidities, including depressive disorder, has been proven in patients with AS. However, a clear temporal causal relationship between AS and psychiatric disorders has not been well established. We performed a nationwide population-based retrospective cohort study to analyze the relationship between AS and the subsequent development of psychiatric disorders, including schizophrenia, bipolar disorder, depressive disorders, anxiety disorders, and sleep disorders.
METHODS
We identified subjects who were newly diagnosed with AS between January 1, 2000, and December 31, 2008, in the Taiwan National Health Insurance (NHI) Research Database. A comparison cohort was constructed of patients without AS who were matched according to age and sex. All patients with AS and control patients were observed until diagnosed with psychiatric disorders, or until death or withdrawal from the NHI system, or until December 31, 2009.
RESULTS
The AS cohort consisted of 2331 patients and the comparison cohort consisted of 9324 matched control patients without AS. The adjusted HR for depressive disorders, anxiety disorders, and sleep disorders in subjects with AS were higher than those of the controls during followup (HR 1.718, 95% CI 1.303-2.265; HR 1.848, 95% CI 1.369-2.494; and HR 1.494, 95% CI 1.031-2.162, respectively).
CONCLUSION
AS might increase the risk of a subsequent newly diagnosed depressive disorder, anxiety disorder, or sleep disorder, but not schizophrenia or bipolar disorder. These observations highlight the need for psychiatric evaluation and intervention for patients with AS.
目的
强直性脊柱炎（AS）是一种常见的炎性风湿性疾病。已证实AS患者中包括抑郁症在内的精神疾病共病率较高。然而，AS与精神障碍之间明确的时间因果关系尚未完全确立。我们进行了一项基于全国人口的回顾性队列研究，以分析AS与后续精神障碍（包括精神分裂症、双相情感障碍、抑郁症、焦虑症和睡眠障碍）发生之间的关系。
方法
我们在台湾国民健康保险（NHI）研究数据库中确定了2000年1月1日至2008年12月31日期间新诊断为AS的受试者。构建了一个无AS患者的对照队列，根据年龄和性别进行匹配。所有AS患者和对照患者均被观察，直至被诊断为精神障碍，或直至死亡、退出NHI系统，或直至2009年12月31日。
结果
AS队列由2331例患者组成，对照队列由9324例匹配的无AS对照患者组成。在随访期间，AS患者中抑郁症、焦虑症和睡眠障碍的校正风险比高于对照组（风险比分别为1.718，95%可信区间1.303 - 2.265；风险比1.848，95%可信区间1.369 - 2.494；风险比1.494，95%可信区间1.031 - 2.162）。
结论
AS可能会增加后续新诊断为抑郁症、焦虑症或睡眠障碍的风险，但不会增加精神分裂症或双相情感障碍的风险。这些观察结果凸显了对AS患者进行精神评估和干预的必要性。
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